Marienhospital Bottrop

With the increasing adoption of robotic systems in hepatic surgery, standardized assessment of procedural difficulty has become crucial, particularly for case selection in training and education. The Tampa Difficulty Score (TDS) was developed to classify robotic liver resections into four levels of complexity. This study aimed to externally validate the TDS. Seventy-nine consecutive patientsundergoing robotic liver resection between 2018 and 2024 were included in this retrospective single-center study. Group comparisons between TDS categories were performed using descriptive and inferential statistics including analysis of variance via the Kruskal-Wallis test, Chi-square test, Mann-Whitney-U test, or Fisher's exact test, as appropriate. Effect sizes were calculated accordingly. Post hoc analyses for intergrupal differences were conducted using the Kruskal-Wallis test. Spearman's rank correlation assessed linear associations between TDS and perioperative variables. Significant intergroup differences between TDS categories were found for major resections (p < 0.001), operative time (p < 0.001), blood loss (p < 0.001), intensive care stay (p = 0.002), hospital stay (p = 0.005), specimen weight (p< 0.001) and tumor size (p = 0.012). Post hoc analyses with Bonferroni-Holm correction confirmed significant differences mainly between TDS groups 2 and 3 for key parameters, but also showed homogenous distribution throughout the other TDS groups. Strong positive correlations were observed between TDS and major resections (|ρ| = 0.651), operative time (|ρ| = 0.715), blood loss (|ρ| = 0.507), and specimen weight (|ρ| = 0.578; all p < 0.001). The Tampa Difficulty Score was validated for RLR, showing consistent results in both intergroup comparisons and correlation analyses. TDS proved to be a reliable instrument for assessing procedural difficulty, demonstrating its value for risk assessment, training standardization, as well as future evaluations despite the limited sample size.

Mild cognitive impairment and dementia are common symptoms in people with Parkinson's disease (PwPD) that impair the quality of life of those affected. However, PD-specific concepts for the prevention of cognitive decline are rarely incorporated into routine care. Here, we provide key data on cognitive impairment in PwPD and a framework for primary, secondary, and tertiary prevention in this context. The importance of cognitive reserve as a protective buffer for cognitive decline in PwPD is highlighted. Relevant lifestyle and health-related factors, including cognitive aspects, physical and social activity, diet, hearing loss, and cardiovascular factors, are discussed. Evidence on the efficacy of possible cognition-enhancing interventions in PwPD-pharmacological, cognitive, physical, nutritional, and multidomain interventions-is summarized. On this basis, and the recommendations of the European Task Force for Brain Health Services, a proposal is developed outlining options for preventing cognitive impairment in PwPD that could be implemented in routine care, as well as further developments needed to achieve a best-case scenario. The main pillars of a strategic agenda for this purpose include: (i) regular assessment of cognitive state, overall risk, and risk factors for cognitive decline; (ii) risk communication and education concerning modifiable risk factors with standardized procedures; (iii) risk reduction with multi-domain interventions for secondary prevention; and (iv) cognitive enhancement with cognitive and physical training for tertiary prevention. As the proposal makes clear, the prevention of cognitive impairment in PwPD requires interdisciplinary collaboration organized throughout PD care networks.

In recent years, new targeted therapies have been developed to treat patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer. Some of these therapies have not just become the new therapy standard but also led to significantly longer overall survival rates. The cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) have become the therapeutic standard for first-line therapy. Around 70 - 80% of patients are treated with a CDK4/6i. In recent years, a number of biomarkers associated with progression, clonal selection or evolution have been reported for CDK4/6i and their endocrine combination partners. Understanding the mechanisms behind treatment efficacy and resistance is important. A better understanding could contribute to planning the most effective therapeutic sequences and utilizing basic molecular information to overcome endocrine resistance. One study with large numbers of patients which aims to elucidate these mechanisms is the Comprehensive Analysis of sPatial, TempORal and molecular patterns of ribociclib efficacy and resistance in advanced Breast Cancer patients (CAPTOR BC) trial. This overview summarizes the latest clinical research on resistance to endocrine therapies, focusing on CDK4/6 inhibitors and discussing current study concepts.

Strukturbaum der quantitativ bedeutsamen teilschematischen und idiomatischen Phrasen mit Allah 146 Abb. 19 Zusammenfassung der Ergebnisse aus der Key-Subkind-Analyse, die einen hypotaktischen Satzbau als zentrales Merkmal des Fokuskorpus belegen 156 Abb. 20 Ergebnisse verschiedener Key-Analysen, die die hochfrequente Markierung von Zitaten und Quellenangaben belegen

ZusammenfassungDie adjuvante endokrine Behandlung von prämenopausalen Patientinnen mit einem hormonrezeptorpositiven, HER2-negativen (HR-pos./HER2-neg.) Mammakarzinom unterliegt bei bestehender Ovarialfunktion einigen Besonderheiten. Als therapeutische Optionen stehen Tamoxifen mit oder ohne GnRH-Analogon und Aromatasehemmer mit GnRH-Analogon zur Verfügung. Des Weiteren wird die Ovarialfunktion durch eine vorherige Chemotherapie beeinflusst. Sowohl die Indikation für GnRH-Analoga in Kombination mit Tamoxifen als auch die Indikation für Aromatasehemmer (+GnRH-Analoga) sind für Patientinnen mit einem erhöhten Rückfallrisiko vorgesehen.In nationalen und internationalen Leitlinien und Therapieempfehlungen ist jedoch keine klare Grenze für ein mittleres oder hohes Risiko definiert, sodass viele Therapieentscheidungen für jede Patientin individuell getroffen werden. Dies spiegelt sich auch in einer großen nationalen und internationalen Variabilität z. B. beim Einsatz von Aromatasehemmern + GnRH-Analoga wider.Diese Übersichtsarbeit fasst die Datenlage zu den abgeschlossenen Studien (z. B. SOFT, TEXT, EBCTCG-Metaanalysen), den aktuellen Multigentest-Studien (TailorX, RxPonder, ADAPT) zusammen, diskutiert die Rationale für aktuell durchgeführte Studien (z. B. CLEAR-B) und gibt einen Ausblick auf künftige Fragestellungen.