Universitätsklinikum Knappschaftskrankenhaus Bochum

Functional movement disorder (FMD), characterized by abnormal movements and motor weakness, represents a common manifestation within the spectrum of functional neurological disorders (FND). Integrative therapy, comprising specialised physiotherapy, psychotherapy, and patient education, has demonstrated efficacy in improving motor function and quality of life. To assess symptom severity and treatment response, both patient-reported outcome measures (PROMs) and clinician-rated outcome measures (CROMs) can be employed. In a preliminary analysis of an ongoing transdisciplinary treatment study, we examined the association between the 'Simplified FMD Rating Scale' (S-FMDRS, CROM) and the 'FMD Questionnaire' (FMDQ, PROM) during integrative therapy and explored their suitability for monitoring treatment-related changes over time. Twenty-six patients contributed 60 paired longitudinal assessments. Linear mixed-effects modelling demonstrated significant associations between clinician-rated motor severity (S-FMDRS) and patient-reported total FMDQ scores as well as all functional domains. In the subgroup with complete pre-post data (n=15), both S-FMDRS and FMDQ scores improved significantly during treatment (S-FMDRS: p=.003, r=0.76; FMDQ: p=.012, r=0.65). Concordance in MCID-based responder classification was partial, with 53% agreement between instruments. Clinician- and patient-reported measures in FMD are significantly associated but not interchangeable at the individual level, supporting their complementary use in treatment evaluation.

BackgroundPatients undergoing extended multivisceral, non-cardiac surgery require a high demand for intravenous fluid administration, leading to substantial positive fluid balances. This study aimed to perioperatively characterize extravasation as a correlate of capillary leakage and micro-arterial regulation, as well as venous return characteristics, as possible causes for the positive fluid balances.MethodsIn this single center, observational trial we included patients undergoing abdominal debulking surgery due to ovarian cancer. The measurements were performed by a venous congestion plethysmography (VCP) protocol to determine extravasation, micro-arterial reagibility, and after deflation of congestion venous outflow characteristics at timepoints before and during surgery, and repeatedly during the postoperative course.ResultsThirty patients with primary ovarian cancer undergoing cytoreductive surgery treated within a goal-directed hemodynamic algorithm (GDA) based on the esophageal Doppler were included in the analysis. Stroke volume index did not change throughout the procedure with an increase in heart rate and consequently an increase in cardiac index. The norepinephrine requirements to maintain mean arterial pressure increased during surgery. Patients received a median 1750[25-quartile 1075;75-quartile 2100]ml crystalloids and 1000[1000;1500]ml starches, transfusions of 0[0;1040]ml red-packed cells, and 360[0;2880]ml fresh-frozen plasma. The intraoperative fluid and blood loss of 1020[508;1695]ml resulted in a positive fluid balance (2820[1338;6075]ml). Extravasation did not increase during surgery, even in the presence of substantially positive fluid balances. On the third and fifth postoperative days, extravasation increased relative to the preoperative baseline value. The micro-arterial function deteriorated throughout the course of the surgery, recovering to baseline values within 4 h after surgery. The venous outflow characteristics of the limb after releasing the venous congestion deteriorated over the course of surgery.ConclusionsThere was no increase in extravasation measured by VCP during surgery despite a substantial intraoperative positive fluid balance, showing that they were not associated with each other. The micro-arterial function and venous backflow characteristics deteriorated during surgery, indicating that vascular dilation rather than capillary leakage may contribute to the high fluid demands.Trial registration: ClinicalTrials.gov identifier: NCT01311297.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40635-025-00839-4.

Injectable platelet-rich fibrin (i-PRF) is often used in maxillofacial surgery in combination with commercially available materials, but until now no study has compared biological and mechanical interactions between i-PRF and different composition biomaterial scaffolds. This study investigated how biomaterials - Collacone® (Biotiss), Bio-Oss® Collagen (90% Geistlich Bio-Oss®/10% porcine collagen, Geistlich), and CeraForm® (65% hydroxyapatite/35% β-tricalcium phosphate, Teknimed) - interact with i-PRF and influence material degradation, growth factor release, osteoblastogenesis, and osteoclastogenesis. Blood from three healthy donors was centrifuged at 700rpm for 5min to prepare i-PRF. Materials were impregnated with i-PRF and allowed to coagulate for 30min. Surface properties were examined by scanning electron microscopy, and material degradation was monitored for 50days. Growth factor release (IL-6, IL-8, EGF, PDGF, TGF-β1) was quantified by ELISA over 14days. Osteoblastogenesis was evaluated using CellTiter-Blue®, and osteoclastogenesis was assessed through resorption assays on simulated body fluid/collagen type I-coated plates via image analysis and qPCR for differentiation markers. Data was analysed using ANOVA. i-PRF delays the degradation of collagen-containing biomaterials. Impregnation of studied biomaterials with i-PRF only reduced growth factor release during the first 6h. TGF-β1 release increased significantly after platelet activation by foreign surfaces, while collagen-based biomaterials triggered rapid IL-6 and IL-8 release. Composites with i-PRF promoted earlier activation of both osteoclasts and osteoblasts. i-PRF showed different synergetic responses based on collagen and calcium phosphate composition in materials it was combined with. Meaning that these findings provide guidance for optimizing biomaterial and i-PRF combinations in surgical applications and inform the design of next-generation PRF-material composites.

Background and ObjectivesThe number of critically ill patients with haematological conditions is increasing, yet transfusion practices in this population remain poorly defined. This study aimed to compare transfusion strategies in critically ill patients with versus without haematological conditions.Study Design and MethodsThis international, prospective observational substudy of the International Point Prevalence Study of Intensive Care Unit [ICU] Transfusion Practices (InPUT) evaluated transfusion use in ICU patients with and without haematological conditions, including benign or malignant diseases or a history of stem cell transplantation. Outcomes included use of red blood cells (RBCs), platelets, plasma, haemostatic interventions, transfusion indications and thresholds.ResultsOf 3643 ICU patients, 131 (3.6%) had a haematological condition. These patients were more likely to receive RBC (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.09–2.29) and platelet transfusions (OR 8.32, 95% CI 5.09–13.6), primarily due to low haemoglobin rather than physiological triggers. Platelet thresholds were lower (median 23 × 109/L vs. 64 × 109/L) compared to non‐haematology patients. Both platelet and plasma transfusions were more frequently administered prophylactically rather than for active bleeding. Haemostatic interventions were more often used in haematology patients, at higher doses and typically without viscoelastic testing. Transfused haematology patients had higher 28‐day mortality and longer ICU stays.ConclusionICU patients with haematological conditions receive transfusions differently, particularly regarding platelet and plasma use. These findings underscore the need for prospective studies to define optimal transfusion thresholds in this growing and vulnerable patient population, although the study's limited sample size and lack of diagnostic granularity may affect interpretation.

Abstract INTRODUCTION Given the changing treatment landscape in IDH-mutant gliomas, prognostic stratification is pivotal to guide postoperative treatment decisions. METHODS Overall, 457 patients with IDH-mutant glioma and [18F]fluoroethyltyrosine or [11C]methionine positron emission tomography (PET) prior to radiotherapy or systemic treatment were included in this retrospective, bicentric study. Maximum and mean tumor-to-background ratios (TBRmax/TBRmean) and PET-positive volume (PET volume) were measured according to PET RANO 1.0 criteria, and their associations with time to next intervention (TTNI) and overall survival (OS) were evaluated. RESULTS In total, 251 (54.9%) patients with astrocytoma and 206 (45.1%) with oligodendroglioma were included. In patients with astrocytoma undergoing PET before resection, measurable disease was associated with shorter TTNI compared to no/non-measurable disease (median 46.0 vs. 67.9 months; p=0.004). Univariable analysis showed an association of TTNI with TBRmax (Hazard ratio [HR]: 1.44 [95%CI: 1.23-1.68]), TBRmean (HR: 1.91 [95%CI: 1.34-2.71]) and PET volume (HR: 1.16 [95%CI: 1.07-1.26] per 10 mL increase). Multivariable analysis in astrocytoma adjusting for clinical factors such as age, WHO grade, extent in magnetic resonance imaging (MRI), extent of resection, and postoperative treatment confirmed the findings for TBRmax (HR 1.48 [95%CI: 1.09-2.01]) alongside T2/FLAIR extent (HR 1.03 [95%CI: 1.02-1.05] per 1 cm2 increase of product of maximum perpendicular diameters). In univariable OS analysis in astrocytoma, an association with TBRmax (HR: 1.40 [95%CI: 1.13-1.74]), TBRmean (HR: 1.97 [95%CI: 1.21-3.22]), and PET volume (HR: 1.23 [95%CI: 1.10-1.37]) was observed. Univariable TTNI analysis in oligodendroglioma showed an association with PET volume (HR: 1.11 [95%CI: 1.05-1.19]) which remained in multivariable analysis (HR 1.18 [95%CI: 1.03-1.36]). Further analyses considering timepoint of PET showed consistent results. CONCLUSION In this retrospective analysis, associations of quantitative PET parameters with outcome were observed after adjusting for known prognostic factors. Prospective validation in clinical trials including PET imaging is needed to establish PET-based prognostic signatures.

Neurovascular networks (NVNs) in Germany are supra-regional care structures for patients with neurovascular diseases. Each NVN consists of a tertiary care center serving as the coordinating center-in some cases, two or three coordinating centers-and at least three partner hospitals. Since 2018, 19 neurovascular networks (NVNs) have been audited and certified. NVNs play a crucial role in stroke care in Germany, as first described and quantified in 2020. The present article provides an update on interdisciplinary NVNs in Germany and outlines recent developments in neurovascular patient care. Audit reports from 19 NVNs, certified between 2021 and 2024, were analyzed, and compared to previously reported data from 2017 to 2019. Additionally, structural and quality-related parameters for coordinating centers and partner hospitals were compared. The number of NVNs increased from 15 to 19, with approximately 120,000 from an estimated 262,000 neurovascular patients in Germany now treated annually in certified NVN hospitals. In particular, annual thrombectomy rates at coordinating centers have increased over-proportionally (> 4400, as compared to previously < 2500), and surgical treatments for intracerebral hemorrhages have also increased. Process times-door-to-needle and door-to-groin times-remained stable or exhibited slight increases. Substantial variability was observed among NVN partner hospitals regarding procedural volumes. The treatment of patients with neurovascular diseases in Germany has expanded considerably within certified NVN hospitals in recent years. The NVNs ensure comprehensive, high-quality stroke care nationwide.