Krankenhaus Sachsenhausen

BackgroundThe diagnosis of rare uterine leiomyosarcoma (uLMS) remains a challenge given the high incidence rates of benign uterine tumors such as leiomyoma (LM). In the last decade, several clinical scores and blood serum markers have been proposed. The aim of this study is to validate and update the pLMS clinical scoring system, evaluating the accuracy of the scoring system by Zhang et al. and examining the discriminatory ability of blood markers such as serum lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).MethodsIn a case-control study, 90 new uLMS from the DKSM consultation registry and 659 prospectively recruited LM cases from the Saarland University Hospital were used for validation. Welch’s t-test and Hedges’ g were used to evaluate blood markers and optimal thresholds and diagnostic odds ratios were calculated. Scoring systems were compared using receiver operating characteristics and proposed diagnostic cut-offs were reviewed. Missing values were imputed by random forest imputation to create the updated scoring system ‘pLMS2’ using penalized logistic regression based on the pooled data sets of 384 uLMS and 1485 LM.ResultspLMS achieved an AUC of 0.97 on the validation data, but sensitivity and specificity varied at the proposed thresholds due to a shift in the score distributions. 43 uLMS and 578 LM were included in the comparison of pLMS with Zhang’s scoring system, with pLMS being superior (AUC 0.960 vs 0.845). LDH, NLR, and PLR achieved a diagnostic odds ratios of 18.03, 8.64 and 4.81, respectively. pLMS2 is based on subscores for menopausal status interacting with age, tumor diameter, intermenstrual bleeding, hypermenorrhea, dysmenorrhea, postmenstrual bleeding, rapid tumor growth, and suspicious sonography.ConclusionsValidation of the pLMS shows stable discriminatory ability as expressed by AUC, although caution should be taken with cut-off values, as sensitivity and specificity may vary. Data collection of the updated clinical score pLMS2 remains simple and convenient, with no additional cost. The proposed thresholds of 1.5 and 5.5 can be used as a guide to avoid unnecessary or inappropriate surgery and to make the use of further diagnostic measures cost-effective. LDH, NLR and PLR provide further evidence to differentiate uLMS from LM in conjunction with clinical data.

Introduction and hypothesisThe use of synthetic mesh for prolapse and incontinence surgery is discussed controversially and in several countries is either no longer used or permissible. Previous approaches with autologous tissue did not show from a patient´s perspective convincing long-term results. As there have been repeatedly significant complications with synthetic mesh, a new approach is urgently needed.During orthopedics and trauma surgeries, tendons from the thigh have been used for decades to replace cruciate ligament. The procedure of tendon removal from the thigh is fast, easy to learn and morbidity is low. In addition, a long-term durability of the transplant ought to be expected. The objective of this investigation was to show our experience with a semitendinosus tendon instead of a mesh for genital prolapse repair.MethodAfter the first successful attempts using such tendons in cervicosacropexy and pectopexy in patients with genital prolapse, we initiated a national multicenter study in 2020. Five German hospitals participated in order to determine the feasibility of cervicosacropexy with tendon tissue instead of mesh.ResultUp until now, we have operated and observed 113 patients for at least 6 months and have seen stable results in terms of fixation of the apical compartment. The expected low morbidity at the donor site was also confirmed through subjective assessment of the patients (Knee and Osteoarthritis Outcome Score). Improvement of quality of life was confirmed after the procedure with the Short Form Health Survey 12, Version 2.0. The results of this multicenter study showed that the desired elevation of the apical compartment with tendon tissue can be achieved with low morbidity and without a synthetic mesh.ConclusionWomen with uterine prolapse can be treated minimally invasively and with very low morbidity by using the semitendinosus tendon. The involvement of multiple (five) medical centers confirms that the technique is easy to learn and be transferred to other clinical centers.

Abstract Background Iron deficiency and anaemia are among the most common complications of IBD. While the distinction between functional and absolute iron deficiency (AID) is vital for therapeutic decision-making, inflammation is a frequent confounder in their diagnosis: An indirect indicator of body iron stores, serum ferritin is the most specific biomarker of AID. However, it is also an acute-phase reactant and can thus be obscured by IBD-related inflammation. Patients with active IBD often have anaemia of inflammation (AOI), i.e., reduced availability of iron for erythropoiesis (iron-restricted erythropoiesis, IRE) despite adequate stores. ECCO guidelines suggest adding biomarkers to distinguish functional from absolute ID in AOI. Here, we compared the utility of red cell indices and biochemical markers to detect IRE in IBD and define a decision threshold for the selection of biomarkers to discriminate AID and iron sequestration. Methods In an observational cross-sectional study, routine blood samples of patients with IBD were collected. CBC, iron status (serum ferritin, SF; transferrin saturation, TSAT; serum iron % of hypochromic red cells, %HYPO; reticulocyte haemoglobin content, CHr; soluble transferrin receptor, sTfR) and high sensitivity CRP (hsCRP) as inflammatory marker were determined by standard methods. sTfR-F index was calculated (sTfR (mg/L)/log10 SF(μg/L)). Patients with SF<30μg/L were assigned as AID-consistent controls to define decision thresholds for iron markers in patients with SF≥30μg/L which were then used to evaluate IRE in patients with SF≥30μg/L. The accuracy of the markers in the presence/absence of inflammation were assessed and contextual diagnostic thresholds determined. Results Samples were collected from 312 patients with IBD (159f/153m;163CD/149UC;42.7±14.5y), of whom 122(39.1%) had inflammation. 43 patients with SF<30μg/L were selected as AID-control group. Results in this group were: TSAT (cut-off 20%; AUCROC 0.730; sens.65%, spe.34%), %HYPO (3.5%; 0.733; 42%, 93%), CHr (32pg; 0.713; 51%, 86%), sTfR (2.70mg/L; 0.775; 81%, 63%), sTfR-F (2.01; 0.914; 88%, 88%). sTfR-F was used as reference for IRE in patients with SF ≥30μg/L. Accuracy of the markers as detectors of IRE is shown in Table 1. Conclusion sTfR was the most accurate sole marker of IRE in patients both with and without inflammation, its cut-off being higher in the presence of inflammation. In patients without inflammation, SF was a valuable additional parameter. Relative cost-effectiveness of the markers alone or in combination is under investigation.

Introduction: Obesity is a major global health problem associated with comorbidities such as diabetes, cardiovascular disease, and cancer. Bariatric surgery is recognized to be the most effective weight loss intervention, but it is highly invasive and costly and can have serious side effects. Intragastric balloon (IGB) placement by endoscopy and hypocaloric diets are among a number of techniques that have been used in patients unsuitable for, or unwilling to undergo, obesity surgery. In this study, we compared the efficacy, safety, and cost-effectiveness of the hypocaloric OPTIFAST program (OPT) with endoscopic IGB placement for weight loss. Methods: In this retrospective observational cohort propensity score-weighted comparison (performed May 2014 to December 2020), participants with a BMI of 30–55 kg/m2, aged 18–70 years, were randomized to OPT or IGB for 26 weeks, followed by a weight maintenance phase. Patients were matched according to age, gender, and BMI. The study outcomes were percentage excess body weight lost, total body weight lost (TBWL), and percentage TBWL (%TBWL). Results: A total of 148 participants (75% of those randomized; 74 OPT, 74 IGB) made up the ITT population. Mean age was 44.1 ± 10.4 years, and the patients were predominantly female (77%). Baseline BMI was 44.1 ± 10.4 kg/m2. At 26 weeks, %TBWL in the OPT group was 19.6 ± 6.8% versus 11.9 ± 6.7% for IGB (p < 0.001). At 52 weeks, %TBWL for OPT was 18.2 ± 9.0% versus 12.0 ± 6.6% for IGB (p < 0.001). The OPT cohort also experienced significantly fewer adverse events compared with the IGB group. Conclusion: IGB placement and OPT induce clinically meaningful weight loss. However, OPT appears to induce clinically superior weight loss and has economic advantages through lower rates of complications and adverse events.

Background: Biotin, a water-soluble B vitamin, has demonstrable anti-inflammatory properties. A biotin-deficient diet induced a colitis-like phenotype in mice, alleviable by biotin substitution. Mice with dextran sulfate sodium (DSS)-induced colitis showed biotin deficiency and diminished levels of sodium-dependent multivitamin transporter, a protein involved in biotin absorption. Biotin substitution induced remission by reducing activation of NF-κB, a transcription factor involved in intestinal permeability and inflammatory bowel disease (IBD). We investigated for the first time a possible clinical role of biotin status in IBD. Methods: In a comparative, retrospective, cross-sectional study, serum samples of 138 patients with IBD (67 female; 72 Crohn’s disease (CD), 66 ulcerative colitis (UC)) aged 18–65 years and with a mean age (±SD) of 42.5 ± 14.3 years as well as 80 healthy blood donors (40 female; 40.0 ± 10.0 years; range 20–60 years) were analyzed. Inflammation was defined as hsCRP ≥5 mg/L, and to determine biotin status, serum 3-hydroxyisovaleryl carnitine (3HIVc) levels were measured by LC-MS/MS. Results: A total of 138 patients with IBD (67f; 72CD/66 UC; 42.5 ± 14.3 years) were enrolled: 83/138 had inflammation. Mean serum 3HIVc levels were significantly higher in IBD patients but unaffected by inflammation. Biotin deficiency (95th percentile of controls: >30 nmol/L 3HIVc) was significantly more common in IBD patients versus controls. Conclusion: High serum 3HIVc levels and biotin deficiency were associated with IBD but not inflammatory activity or disease type. Our findings suggest biotin may play a role as cause or effect in IBD pathogenesis. Routine assessment and supplementation of biotin may ameliorate IBD and support intestinal integrity.

Einleitung Sowohl in den Schwellen- und Industrieländern, als auch in Deutschland, hat die Prävalenz von Adipositas in den letzten 40Jahren deutlich zugenommen. Derzeit sind in Deutschland ein Viertel der Erwachsenen (23 % der Männer, 24 % der Frauen) adipös (BMI> 30). Intragastrische Magenballons (IGB) stellen eine seit Jahren angebotene etablierte endoskopische Alternative zur Adipositasbehandlung dar. Zwar ist die Effektivität der des IGB i.d.R. höher als die von konservativen Maßnahmen, Vergleiche zu multimodalen Gewichtsreduktionsprogrammen fehlen bisher.