St. Marien Hospital

Background. Attention-deficit/hyperactivity disorder (ADHD) is a condition that affects how a person focuses, regulates behavior, and manages impulses. As a result, individuals with ADHD often experience difficulties in everyday life, including at school, at work, and in social relationships. It is characterized by persistent attention deficit, hyperactivity, and impulsivity. Aim. This literature review evaluates current treatments for ADHD, including both medication and non-medication options, and discusses their effectiveness. Materials and Methods. This review summarizes current evidence on medication and psychosocial treatments for attention-deficit/hyperactivity disorder (ADHD). The review included original studies and reviews from the Cochrane, PubMed, and Google Scholar databases. The article selection process ended in February 2026. Results. Medicines that stimulate the brain are the best treatment for ADHD for people of all ages. Non-stimulant medications show moderate effectiveness and may be particularly useful in patients with contraindications to stimulants or comorbid conditions. Pharmacotherapy tends to produce larger effect sizes in children than in adults, although it is effective in both populations. Conclusions. The current evidence shows that a multimodal approach is the best way to treat ADHD. Stimulants are still the best type of drug for this, but doctors need to plan treatments for each patient that take into account their mental and social well-being, any other health problems, their age, and how well they can handle the medication to ensure the best possible care.

Background A growing body of research indicates that autoimmune processes may play a significant role in the etiopathogenesis of mental disorders common worldwide, including schizophrenia, affective disorders, and depression. Abnormal immune system activation, including elevated levels of proinflammatory cytokines and the presence of autoantibodies, is associated with exacerbated psychopathological symptoms and cognitive decline in some patients. At the same time, research results remain inconclusive due to factors such as the heterogeneity of clinical populations, differences in disease progression, the impact of pharmacological treatment, and varying methods for measuring immune markers. Despite these limitations, autoimmune phenomena represent a promising direction for the search for biomarkers and new therapeutic approaches. Aim This study aims to review the current state of knowledge on the impact of autoimmune processes on the development of psychiatric conditions. Materials and Methods The review includes 27 studies published primarily between 2015 and 2025, selected for their number and relevance to current medical knowledge. Results Research indicates that disturbances in the proper functioning of the immune system, including elevated levels of proinflammatory cytokines, microglial activation, and the presence of autoantibodies, can affect neuronal function, synaptic plasticity, and the integrity of the blood-brain barrier. Although the results of some studies remain uncertain due to methodological differences and clinical heterogeneity, a growing body of evidence suggests that immunological mechanisms may play a significant role in the pathogenesis of mental illness. Conclusions A growing body of research shows that autoimmune processes may influence the development of certain mental illnesses through immune system dysfunction and the resulting inflammation in the central nervous system.

Background Type 2 Diabetes is, without a doubt, a global health crisis. Detailed guidelines have been made to create a universal standard for prevention, screening, and therapy, but far too often, a single model proves inefficient in treating patients from all walks of life, displaying a wide variance in both clinical and lifestyle factors. Aim This review of the existing literature attempts to showcase the main differences in the prevalence, risk factors, and therapy effectiveness of Type 2 Diabetes between a number of demographics. Materials and Methods The article thoroughly reviews the existing literature on Type 2 Diabetes and the demographic factors thereof. Original studies, reviews, meta-analyses, as well as epidemiological surveys available in the PubMed and Google Scholar databases were included. The literature review and article selection process concluded in November 2025. Results The available data backs up the hypothesis that demographic factors heavily influence the prevalence and outcomes of Type 2 Diabetes. The illness is both more prevalent and on average, more poorly controlled in women, as compared to men, resulting in a higher all-cause mortality. In terms of age, each additional year at the time of diagnosis correlates with a 4% decrease in all-cause mortality, as well as a 3% decrease in macrovascular and 5% decrease in microvascular complications. Additionally, socioeconomic factors have been found to play a significant role in therapy adherence, even in countries with a well-developed social safety net. Conclusions The findings showcase a desperate need for a more personalized approach to Type 2 Diabetes, focusing on the elimination of negative lifestyle habits, a thorough patient education, and a choice of medication that is within an acceptable financial range, rather than simply prescribing that, which displays the highest effectiveness on paper.

We aimed to assess the results of neoadjuvant radiochemotherapy (N-RCT) in a cohort of 54 patients with middle and lower third locally advanced rectal cancer (LARC) treated in real-world practice at a German certified oncologic rectal center for the treatment of rectal cancer. From September 2016 to December 2023, 54 patients (median age of 66.5 years, range=33-82 years) with middle and lower third rectal cancer received N-RCT. Mean tumor distance from anal verge was 5.34 cm (±2.93). The distribution into UICC stages was as follows: stage II, n=6; stage III, n=45; stage IV, n=3. All patients received conventionally fractionated radiotherapy (50.4 Gy in 1.8 Gy fractions) using the volumetric intensity modulated arc therapy (VMAT) technique and simultaneous chemotherapy with capecitabine 825 mg/m2 bid (d1-42). Total mesorectal excision (TME) was performed six to eight weeks after the N-RCT. Adjuvant chemotherapy was performed in 34/54 patients after surgery in accordance with the German S3 guideline. With a median follow-up of 38 months (range=4-79), local recurrence occurred in 4 out of 54 patients (7%), and distant metastasis in 11 out of 54 patients (20%). During the follow-up period, 8 out of 54 patients (15%) died. The 3-year overall survival and disease-free survival rates were 91% and 76%, respectively. Pathological downstaging (ypT < cT) was achieved in 28 of 54 patients (52%) (p=0.001), and ypN ≤ cN in 35 out of 54 patients (65%) (p=0.001). Among the 54 patients who underwent surgery, 53 had an R0 resection, while 1 patient had an R1 resection. Sphincter-preserving surgery was performed in 26 patients (48%). A pathological complete response (pCR) was observed in 7 patients (13%). No grade 3 or 4 radiogenic side effects were observed. This study demonstrates that N-RCT followed by TME yields favorable oncological outcomes with manageable toxicity in patients with locally advanced rectal cancer. Our results align with previously published findings. Further research is required to optimize patient selection and to assess the long-term benefits of evolving neoadjuvant strategies in routine clinical practice.

ABSTRACTBackgroundNitroxoline is an old antibiotic currently approved for the treatment of uncomplicated urinary tract infections. Its mode of action is based on the chelation of bivalent cations, such as zinc.ObjectivesAs zinc plays a central role in the metabolism of Aspergillus spp., we performed antifungal susceptibility testing against Nitroxoline using broth microdilution.MethodsOverall, 13 Aspergillus isolates were tested according to the EUCAST guidance document (Guinea et al. EUCAST, def. doc. 9.4, 2022) including two genetically proven Azole‐resistant strains.ResultsThe overall Minimal Inhibitory Concentration (MIC)50/90 was 0.5 mg/L.ConclusionsThese results correspond to excellent in vitro activity against Aspergillus spp.

Abstract Background and Purpose Atrial fibrillation (AF) episodes ≥30 seconds are currently considered clinically relevant in stroke diagnostics. However, shorter AF episodes may signal a significant embolic risk, especially in patients with embolic stroke of undetermined source (ESUS). This study investigates the prevalence, risk profile, and stroke severity associated with short-duration AF (SDAF &lt;30 seconds) across ischemic stroke subtypes. Methods We prospectively enrolled 714 consecutive patients with ischemic stroke or Transient ischemic attacks who underwent ≥48-hour ECG monitoring. AF episodes were classified as 0–14 s, 15–29 s, or ≥30 s. Stroke subtypes were defined using TOAST and ESUS criteria. Risk profiles, NIH Stroke Scale scores, and CHA₂DS₂-VASc scores were analyzed by AF duration. Results AF of any duration was detected in 53.8% of patients; 22.8% had episodes ≥30 seconds and 29.9% had SDAF. Among ESUS patients, 35.7% exhibited SDAF, and 80.2% of these had CHA₂DS₂-VASc scores ≥2. Stroke severity and risk scores were significantly higher in patients with SDAF than those without AF. SDAF was more prevalent in women (37.0%) and in individuals aged &gt;65 years (89.4%). Conclusions SDAF is common across stroke subtypes—particularly ESUS—and is associated with elevated thromboembolic risk despite falling below current diagnostic thresholds. These findings highlight a diagnostic blind spot in stroke workup and support reevaluation of duration-based criteria for post-stroke AF detection and risk profiling.

IntroductionRobot-assisted surgery represents a significant advancement in modern surgical techniques, offering the potential of unparalleled precision, flexibility, and control. Effective training of console surgeons is critical to harness these benefits. Simulation-based training, especially with virtual simulators like the Da Vinci Skills Trainer, plays a pivotal role in developing these essential skills. This study investigates the impact of intensive, short-term hands-on training courses on the simulation skills of robotic surgery trainees in Germany.MethodsWe conducted a retrospective analysis of 52 participants from urological clinics with established robotic programs, who attended intensive training courses organized by the German Society of Robot-assisted Surgery (DGRU) and the Working Group (AK) Laparoscopy and Robot-Assisted Surgery of the German Society of Urology between 2018 and 2022 in a single training centre (IRCAD, Strasbourg, France), guided by experienced teachers. The training program included pre- and post-course evaluations using four specific exercises on the Virtual Reality Simulator (Da Vinci Skills Trainer): Ring Walk, Peg Board, Energy Dissection and Suture Sponge. Performance improvements were analyzed using paired t-tests. Statistically significant difference was considered as p < 0.05.ResultsThe results demonstrated significant improvements in participants’ skills across all evaluated exercises. The mean scores for the Ring Walk increased from 68.9 to 86.68 (p < 0.0001); Peg Board from 75.01 to 92.89 (p < 0.0001); Energy Dissection from 62.29 to 79.42 (p = 0.0377); and Suture Sponge from 61.41 to 79.21 (p < 0.0001). Notably, 78.84% of participants showed improvements in at least three of the four exercises, with an average score increase of 17%.ConclusionIntensive simulation-based training was associated with improvements in robotic surgery simulation scores. These findings suggest that such training programs may help shorten the learning curve for novice surgeons and could contribute to improved readiness for clinical practice.