St. Hedwig-Krankenhaus

Background. The gut microbiota plays a key role in metabolic regulation and is increasingly recognized as a mediator of lifestyle-related health outcomes. Physical activity has emerged as a potential modulator of microbial composition and function. Aim. This narrative review aims to summarize current evidence on the relationship between physical activity and the gut microbiota and to evaluate its implications for metabolic health. Materials and Methods. A PubMed search of English-language studies published over the last 10 years was conducted to assess the effects of physical activity on the gut microbiota and metabolic health. Additional studies were identified through reference screening. Results. Regular moderate physical activity is associated with increased microbial diversity and a higher abundance of beneficial bacteria, including short-chain fatty acid producers. These changes are linked to improved glucose metabolism, reduced inflammation, and enhanced intestinal barrier function. However, excessive or prolonged high-intensity exercise may induce adverse effects, such as increased gut permeability and dysbiosis. The observed effects are strongly influenced by diet and individual factors. Conclusions. The gut microbiota represents an important mediator of exercise-induced metabolic adaptations. Combined lifestyle interventions, particularly physical activity and a fiber-rich diet, may provide synergistic benefits. Further research is needed to develop personalized strategies targeting the gut microbiota in metabolic disease prevention.

Zusammenfassung Was früher Science-Fiction war, ist heute klinische Realität: Patient*innen begegnen in einer virtuellen Welt ihren Ängsten, werden mit traumatischen Erinnerungen konfrontiert, widerstehen ihrem Suchtdruck und interagieren mit Avataren. Die Effektivität von innovativen Virtuelle Realität– basierten Ansätzen im Vergleich zu traditionellen Therapien sowie deren Grenzen und Nebenwirkungen stehen im Fokus vieler aktueller Studien.

Background/Objectives: The goal of reconstructive hand surgery is to achieve both functional and aesthetic restoration. The primary aim of this study is to perform a detailed, practice-oriented evaluation of perforator-based and local flaps for soft-tissue reconstruction of the hand and digits, focusing specifically on their functional reliability, anatomical consistency, complication profile, and aesthetic integration in a real-world, high-complexity referral population. Methods: This retrospective single-center study included 37 patients with soft tissue defects of the hand that required flap coverage between September 2021 and September 2024. The study assessed patient demographics, defect characteristics, flap selection, surgical techniques, and outcomes including satisfactory soft tissue coverage, functional results and occurrence of complications. Various perforator flaps were analyzed, including the dorsal metacarpal artery flap, reverse radial forearm flap, reverse posterior interosseous artery flap, reverse homodigital and heterodigital island flaps, and the thenar flap. Results: Satisfactory soft tissue coverage was achieved in 35 out of 37 patients. One case involved partial distal flap necrosis, and another presented with Foucher flap failure. The remaining flaps demonstrated stable integration, preserved perfusion, and durable soft-tissue coverage with satisfactory contour and pliability. Functional outcomes were favorable, with restoration of joint mobility and absence of secondary deformities. Conclusions: This study supports the continued use of perforator and local flaps in upper extremity reconstruction, emphasizing the need for individualized planning to optimize the outcomes.

IntroductionSex workers are exposed to high levels of mental health risk. Yet, the psychological effects of self-stigmatization in legalized sex work contexts remain underexplored. This study examines how different dimensions of self-stigma influence mental health outcomes among female sex workers (FSWs) in Germany, where sex work is legalized and regulated.MethodsA cross-sectional study was conducted with 397 FSWs recruited across diverse work settings in Germany between August 2022 and October 2024. Mental health conditions were assessed using the Mini-DIPS Open Access structured interview. Self-stigmatization was measured via the Paradox of Self-Stigmatization Scale (PaSS-24), which captures three dimensions: stereotype endorsement, non-disclosure, and righteous anger. Logistic regression analyses were used to examine associations between self-stigma and four psychiatric outcomes: affective disorders, anxiety disorders, trauma-related disorders, and substance use disorders, adjusting for demographic and occupational covariates.ResultsA high prevalence of mental health disorders was observed among participants, reflecting the categories assessed in this study (affective, anxiety, trauma-related, and substance use disorders). Emotional and behavioral dimensions of self-stigmatization, particularly concealment and emotional reactivity, showed associations with certain psychiatric outcomes. In contrast, cognitive endorsement of stereotypes showed no consistent links to mental health status in this sample.DiscussionFindings support the “Paradox of Self-Stigma” model: FSWs cognitively reject negative stereotypes yet exhibit strong emotional and behavioral responses that heighten psychological distress. Righteous anger and concealment may reflect unresolved trauma rather than resilience. Interventions should address emotional stigma responses, promote safer work environments, and support disclosure in trusted relationships. This study highlights the need for context-sensitive, multidimensional strategies to reduce stigma-related mental health burdens among sex workers in legalized systems.

Since 2016, >21000 patients with prostate cancer (PC) used our personalized online decision aid in routine care in Germany. We analyzed the effects of this online decision aid for men with nonmetastatic PC in a randomized controlled trial. In the randomized controlled EvEnt-PCA trial, 116 centers performed 1:1 allocation of 1115 patients with nonmetastatic PC to use an online decision aid (intervention=I) or a printed brochure (control=C). The primary outcome was treatment decision after 14 mo. The secondary endpoints were knowledge, acceptance, decisional conflict, physician-patient communication, anxiety and depression, decision regret, and quality of life. With complete data from 1000 patients, there was no difference between the two groups in terms of primary or secondary endpoints. In the intervention group, consultation time was shorter (I: 61 min vs C: 70 min, p=0.02), and more patients provided a summary of their preparation (I: 76% vs C: 56%, p<0.001). Life expectancy (I: 53% vs C: 47%, p=0.03), radiotherapy (I: 90% vs C: 84%, p=0.005), rehabilitation (I: 69% vs C: 62%, p=0.02), and psycho-oncology (I: 21% vs C: 16%, p=0.07) were discussed more frequently in the intervention group. Additionally, more counseling sessions with general practitioners (I: 43% vs C: 35%, p=0.01) and radiotherapists (I: 24% vs C: 18%, p=0.03) were held in the intervention group. The use of the online decision aid was associated with structural improvements, for example, significantly shorter doctor-patient consultation time. Our findings suggest stronger guideline adherence in the counseling process and promotion of health literacy. Successful implementation of our online decision aid in routine care can provide an example for solving this key obstacle for shared decision-making.

Zusammenfassung Gegenstand und Ziel Patient:innen mit gleichzeitig schwerwiegenden psychischen und somatischen Erkrankungen befinden sich in einer äußerst belastenden Situation, die eine klinische Herausforderung darstellt. Oft führen psychiatrische Symptome zu eingeschränkter Versorgung. 2023 wurde das AGIPE-Konzept für psychisch kranke Patient:innen am Lebensende des Gerontopsychiatrischen Zentrums der Charité im St. Hedwig-Krankenhaus in Berlin vorgestellt. Bestandteile sind unter anderem die Etablierung einer strukturierten ethischen Visite sowie eine Nachbesprechung Sterbefall, die im Folgenden evaluiert werden. Material und Methoden Es werden 21 Fälle analysiert, die im Rahmen von 23 AGIPE-Visiten und/oder 5 Nachbesprechungen bei Sterbefall besprochen und dokumentiert wurden. Ergebnisse Das Patient:innenkollektiv zeigt komplexe psychiatrische sowie somatische Mehrfacherkrankungen. Die AGIPE-Visite integriert die Bedürfnisse der Betroffenen sowie die Herausforderungen an das multiprofessionelle Team, erweist sich als umsetzbar und liefert inhaltlichen Mehrwert. Schlussfolgerungen Die kontinuierliche Evaluation und Weiterentwicklung des AGIPE-Konzepts ist zur weiteren Versorgungsoptimierung geplant.

Background: A dilated main pancreatic duct (MPD) ≥ 5 mm can be observed in main-duct IPMNs (MD-IPMN) and chronic pancreatitis (CP); however, distinguishing between the two differently treated diseases can be difficult. Cell-free (cf) DNA in MPD fluid obtained by EUS-guided FNA might help to distinguish MD-IPMN from CP. Methods: All patients with a dilated MPD ≥ 5 mm on EUS during the period of 1 June 2017 to 30 April 2024 were prospectively analysed in this single-centre study, with EUS-guided MPD fluid aspiration performed for suspected MD-IPMN or CP in patients who were suitable for surgery. Twenty-two known gastrointestinal cancer genes, including GNAS and KRAS, were analysed by deep targeted (dt) NGS. The results were correlated with resected tissue, biopsy, and long-term follow-up. Results: A total of 164 patients with a dilated MPD were identified, of which 30 (18.3%) underwent EUS-guided FNA, with 1 patient having a minor complication (3.3%). Twenty-two patients (mean MPD diameter of 12.4 (7-31) mm) with a definitive, mostly surgically confirmed diagnosis were included in the analysis. Only a fish-mouth papilla, which was present in 3 of 12 (25%) MD-IPMNs, could reliably differentiate between the two diseases, with history, symptoms, diffuse or segmental MPD dilation, presence of calcifications on imaging, cytology, and CEA in the ductal fluid failing to achieve differentiation. However, GNAS mutations were found exclusively in 11 of the 12 (91.6%) patients with MD-IPMN (p < 0.01), whereas KRAS mutations were identified in both diseases. Conclusions: GNAS testing by dtNGS in aspirated fluid from dilated MPD obtained by EUS-guided FNA may help differentiate MD-IPMN from CP for surgical resection.

Aprolonged overall treatment time (OTT) has been demonstrated to adversely affect the primary radiation therapy (RT) outcome in various solid tumors, including non-small cell lung cancer (NSCLC). Retrospective data from our group suggested an advantage of shorter OTT also for postoperative RT (PORT) in patients with NSCLC. The PORTAF trial (ClinicalTrials.gov: NCT02189967) was initiated to prospectively test this hypothesis. The multicenter prospective randomized phaseII trial in patients with NSCLC investigated whether an accelerated schedule of PORT (7fractions per week, 2 Gy per fraction, OTT 3.5-4weeks) improved outcome compared to conventional fractionation (5fractions per week, 2 Gy per fraction, OTT 5-6weeks). Target volumes and total radiation doses were stratified in both treatment arms based on individual risk factors. Primary endpoint of the study was locoregional tumor control (LRTC) 36months after PORT, with 154 patients to be included in each arm. Due to slow accrual and changed indications for PORT, we prematurely closed the trial in 2019. Between 2014 and 2019, eight recruiting centers included 27evaluable patients. An interim safety analysis performed for the first 21patients showed nonsignificant differences regarding grade3 toxicities between the treatment arms, thus not meeting the termination criteria. LRTC was not significantly different between accelerated (73%) and conventionally fractionated RT (92%; p = 0.535). Noteworthily, in 21FDG-PET/CT restagings before RT, an unexpectedly high number of locoregional recurrences (n = 4) and distant metastases (n = 2) were seen, resulting in changed treatment intentions for these patients. The prematurely closed PORTAF trial did not find significant differences in 3‑year LRTC when comparing accelerated versus conventionally fractionated irradiation. The observed additional benefit of FDG-PET/CT restaging prior to PORT should be further investigated in alarger cohort to optimize patient selection and avoid unnecessary side-effects.

Abstract Background There is sufficient evidence to suggest that ileocecal resection (ICR) is an alternative to medical therapy for isolated ileocecal CD. However, the optimal timing for surgical intervention remains a topic of debate. Aims To gain insight into the patient experience, we surveyed individuals who had undergone ileocecal resection. We inquired as to whether, in retrospect, they would have chosen a different time for resection. Methods A survey was administered to patients who had undergone ICR for isolated CD between February 2015 and April 2024 in tertiary referral centers for Crohn's Disease. The survey included questions regarding their retrospective time preference for surgery, as well as information and influences on timing at the time. Results A total of 125 patients have responded to the questionnaire thus far. The median duration of Crohn's disease was found to be 6.6 years, while the median duration of drug treatment prior to surgery was 5 years (range, resp. 0–20yrs). 45.6% of all patients (n = 57) would have preferred an earlier operation. 47.2% (n = 60) expressed satisfaction with the timing. In comparison, 3.1% (n=4) would have preferred a later surgery. Another 4% of the patients (n=5) received no medical treatment but elected to commence treatment with surgery. 86% of patients who would have liked an earlier surgical intervention in retrospect felt that this would have led to earlier symptom relief. 45.6% (n = 26) reported that they had not been offered counselling about the possibility of surgery. Another 31.6% (n=18) indicated that their gastroenterologists recommended postponement of surgery until the last feasible opportunity. Conclusion It is imperative that physicians consider the patients' rationale for advocating for earlier surgical intervention as a means of alleviating pain. According to the patients, there is a striking lack of information regarding the potential for primary resection.