Raphaelsklinik Münster

For monogenic diseases, patient-derived cells are the gold standard of experimental studies. However, materials derived from biopsies are limited and the proliferation of primary cells is frequently restricted. Epithelial cells found in the urine (UCs) represent a noninvasive source for establishment of continuously growing cell lines. The aim of this study was to recapitulate pathomechanisms of various liver diseases using immortalized UCs via gene transfer of human papillomavirus 16-derived oncogenes E6 and E7 (HPVE6E7).

Abstract Purpose. In a post hoc analysis of the MAGIC trial, patients with curatively resected gastric cancer (GC) and mismatch repair (MMR) deficiency (MMRd) had better median overall survival (OS) when treated with surgery alone but worse median OS when treated with additional chemotherapy. Further data are required to corroborate these findings.Methods. Between April 2013 and December 2018, 458 patients with curatively resected GC, including cancers of the esophagogastric junction Siewert type II and III, were identified in the German centers of the staR consortium. Tumor sections were assessed for expression of MLH1, MSH2, MSH6 and PMS2 by immunohistochemistry. The association between MMR status and survival was assessed. Similar studies published up to January 2021 were then identified in a MEDLINE search for a meta-analysis. Results. MMR-status and survival data were available for 223 patients (median age 66 years, 62.8% male), 23 patients were MMRd (10.3%). After matching for baseline clinical characteristics, median OS was not reached in any subgroup. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd and MMRp had a HR of 0.67 (95% CI: 0.13-3.37, P=0.63) and 1.44 (95% CI: 0.66-3.13, P=0.36), respectively. The meta-analysis included pooled data from 385 patients. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd had an improved OS with a HR of 0.36 (95% CI: 0.14-0.91, P=0.03), whereas those with MMRp had a HR of 1.18 (95% CI: 0.89-1.58, P=0.26).Conclusion. Our data support a positive prognostic effect for MMRd in GC patients treated with surgery only and a differentially negative prognostic effect in patients treated with perioperative chemotherapy. MMR status determined by preoperative biopsies may be used as a predictive biomarker to select patients for perioperative chemotherapy in curatively resectable GC.

The rise in energy drink (ED) intake in the general population and athletes has been achieved with smart and effective marketing strategies. There is a robust base of evidence showing that adolescents are the main consumers of EDs. The prevalence of ED usage in this group ranges from 52% to 68%, whilst in adults is estimated at 32%. The compositions of EDs vary widely. Caffeine content can range from 75 to 240 mg, whereas the average taurine quantity is 342.28 mg/100 mL. Unfortunately, exact amounts of the other ED elements are often not disclosed by manufacturers. Caffeine and taurine in doses 3–6 mg/kg and 1–6 g, respectively, appear to be the main ergogenic elements. However, additive or synergic properties between them seem to be implausible. Because of non-unified protocol design, presented studies show inconsistency between ED ingestion and improved physical performance. Potential side effects caused by abusive consumption or missed contraindications are the aspects that are the most often overlooked by consumers and not fully elucidated by ED producers. In this review, the authors aimed to present the latest scientific information on ED components and their possible impact on improving physical performance as well as to bring emphasis to the danger of inordinate consumption.

Introduction:Postoperative pancreatic fistula (POPF) is the most dreaded complication after distal pancreatectomy (DP). This multicenter randomized trial evaluated the efficacy, safety, and tolerance of Hemopatch in preventing clinically relevant (grades B/C according to the ISGPS classification) POPF after DP.Material and methods:After stump closure, patients were randomized to affix Hemopatch to the stump or not. Statistical significance was set at 0.025. Clinical significance was defined as the number of patients needed to treat (NNT) to avoid 1 B/C POPF.Results:Of 631 eligible patients, 360 were randomized and 315 analyzed per protocol (155 in the standard closure group; 160 in the Hemopatch group). The rates of B/C POPF (the primary endpoint) were 23.2% and 16.3% (P = 0.120), while the number of patients with 1 or more complications (including patients with B/C POPF) was 34.8% and 24.4% (P = 0.049) in the standard and Hemopatch groups, respectively. In patients with hand-sewn stump and main duct closure, the rates were 26.2% versus 10.0% (P = 0.014) and 23.3% versus 7.7% (P = 0.015) in the standard and Hemopatch groups, respectively. The NNT in these 2 subgroups was 6 and 6.4, respectively.Conclusion:The results of the first randomized trial evaluating Hemopatch-reinforced pancreatic stump after DP to prevent type B/C POPF do not allow us to conclude that the risk of B/C POPF was lower. Based on the NNT, however, routine use of Hemopatch after DP may result in fewer complications (including POPF) overall, especially in cases with hand-sewn closure of the pancreatic stump or main pancreatic duct.

Fragestellung Die inverse Schulterprothese (RSA) hat sich als effektive Behandlungsmethode der Rotatorenmanschettendefektarthropathie erwiesen. Als weiterhin kontrovers diskutiertes Thema verbleibt die Refixation der Subscapularissehne (SSC). Zur Beurteilung des Einflusses der Subscapularissehnenrefixation im Rahmen der inversen Schulterprothetik wurde die folgende prospektiv randomisierte Studie durchgeführt.

Injuries of the acromioclavicular joint (ACJ) are frequent and often occur during sports. While arthroscopically-assisted stabilization of acute injuries of the ACJ is awell-established procedure, there is not much data available for arthroscopically-assisted stabilization of chronic injuries of the ACJ. This study assesses clinical and radiological results of arthroscopically-assisted stabilization of acute and chronic injuries of the ACJ. Thirty-six patients with acute and chronic injuries of the ACJ were assessed in aprospective clinical trial. Twenty-five patients with acute injuries (groupA) and eleven patients with chronic injuries (groupB) were included in this study. Patients of groupA were operated using two suture-button systems, while patients of groupB received one suture-button system and an autologous gracilis tendon graft. In groupA, the mean preoperative Constant score rated 38, and the ASES score rated 34. At follow-up the Constant score(92) and the ASES score(89) had improved. Panorama views revealed an increased coracoclavicular distance of the affected shoulder (15.8 mm) in comparison to the contralateral shoulder (10.9 mm). In groupB, the preoperative Constant score measured 57. It improved to 72points at follow-up. The ASES score improved from 39 to 72points in the same period. Panorama views revealed an increased coracoclavicular distance of the affected shoulder (18.9 mm) in comparison to the contralateral shoulder (12.4 mm). Stabilization of acute injuries of the ACJ with two suture-button systems is related to very good shoulder function after one year. The native coracoclavicular distance cannot be restored with this procedure. Stabilization of chronic injuries of the ACJ with asuture-button system and an autologous gracilis tendon graft is related to improved shoulder function after one year. However, shoulder function cannot be fully restored with the stabilization technique presented.

General complications in arthroscopic shoulder surgery involve the risk of cerebral hypoperfusion, which is encountered more frequently in the beach chair position when compared to the lateral decubitus position. Optimal patient selection, patient positioning, monitoring and anesthesia minimize the risk for severe complications caused by cerebral oxygen desaturation.

Postoperative hypoparathyreoidism can cause severe symptoms, relevant sequelae and far reaching impairments of quality of life. Socio-economic effects are considerable. Individual follow-up of patients at risk could improve quality of care. We analysed quality of care for patients with hypoparathyreoidism after thyreoidectomy at our centre of endocrine surgery (Kompetenzzentrum DGAV) and tried to identify potentials for improvement. 420 consecutive patients underwent thyreoidectomy (patients with hyperparathyreoidism excluded) between 08/2012 and 08/2014, follow-up 8-32 months. Group I (study group): 197 patients with calcium (Ca) in blood serum on postoperative day 1 < 2,1 mmol/l and/or parathyroide hormone (PTH) < 15 pg/ml. Group II (control group): 223 patients with Ca ≥ 2 mmol/l and PTH ≥ 15 pg/ml on postoperative day 1. Outcome parameters at follow-up: Ca-, PTH-level, symptoms, quality of life and quality of care by general practitionor in long-term outpatient care (questionnaire). Participation rate at follow-up was 30,6 % (117/382). Rate of postopertive hypoparathyreoidism: 47 % temporary, 6 % permanent. Number of symptoms and perceived burden was identical in patients with hypoparathyreoidism compared to patients in the control group. Long-term outpatient postoperative care was performed in 96 % by general practitionors. No patient with a calcium level in blood serum ≤ 2,1 mmol/l was not on calcium and/or vitamin D medication at the time of follow-up. 33 % of patients with hypoparathyreoidism received insufficient calcium and/or vitamin D medication. 24 % of all 117 patients screened received calcium/or vitamin D medication despite normal blood levels and regular blood tests by general practitionors (rate 76 %) at the time of follow-up. We found features of under-, as well as of over-treatment by general practitionors in patients with postoperative hypoparathyreoidism. From this we deduct target parameters for improvement of outpatient long-term care after thyreoidectomy: 1. Close follow-up, 2. Sufficient calcium and/or vitamin D medication in all patients with postoperative hypoparathyreoidism, 3. On-time termination of medication in patients with normal postoperative parathyroid hormone levels.