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Background Numerous but inconclusive findings have sparked an ongoing debate about whether the arteries of migraine patients undergo vascular alterations. The outlet angle of the superior cerebellar artery (SUCA) and the lateral displacement of basilar arteries are good surrogate parameters for determining elongation of the vertebrobasilar arteries. Methods We retrospectively determined the SUCA outlet angle and the lateral displacement of the basilar artery in 63 patients with migraine (30.6 ± 8.9 years, 84% women, 16% chronic migraine, 60% migraine with aura) and compared these with 126 age- and sex-matched control subjects. Results In patients with migraine, the SUCA outlet angle was lower (159 ± 26° vs. 169 ± 29°, p = 0.020) and the lateral displacement of the basilar artery was greater (3.7 ± 2.7 mm vs. 2.8 ± 2.4 mm, p = 0.020) than in the control subjects. Age, gender, migraine characteristics and presence of any cardiovascular risk factors did not affect the SUCA outlet angle or lateral displacement of the basilar artery. Conclusion Migraine patients exhibited a lower SUCA outlet angle and greater lateral displacement of the basilar arteries. Both may be attributable to the elongation of the vertebrobasilar arteries, which is an indication of arterial wall pathology in migraine.

ZusammenfassungIn der COVID-19-Pandemie konnte der Dritte Abschnitt der Ärztlichen Prüfung an Simulationspersonen und Simulatoren durchgeführt werden. Auch im Fach Rechtsmedizin ist deren Einsatz sinnvoll, da eine höhere Standardisierung und Vergleichbarkeit von Prüfungsleistungen erreicht wird und die Verwendung von echten Leichnamen aus medikolegalen Gründen oft nicht vertretbar ist. Der vorliegende Fall berichtet über die Vor- und Nachteile einer Simulation im Staatsexamen, in der anhand einer Leichenschau am Simulator und einer Fremdanamnese eine Todesbescheinigung vollständig ausgefüllt werden sollte.

(18)F-FDG PET/MRI might be the diagnostic method of choice for Hodgkin lymphoma patients, as it combines significant metabolic information from PET with excellent soft-tissue contrast from MRI and avoids radiation exposure from CT. However, a major issue is longer examination times than for PET/CT, especially for younger children needing anesthesia. Thus, a targeted selection of suitable whole-body MRI sequences is important to optimize the PET/MRI workflow. Methods: The initial PET/MRI scans of 84 EuroNet-PHL-C2 study patients from 13 international PET centers were evaluated. In each available MRI sequence, 5 PET-positive lymph nodes were assessed. If extranodal involvement occurred, 2 splenic lesions, 2 skeletal lesions, and 2 lung lesions were also assessed. A detection rate was calculated dividing the number of visible, anatomically assignable, and measurable lesions in the respective MRI sequence by the total number of lesions. Results: Relaxation time–weighted (T2w) transverse sequences with fat saturation (fs) yielded the best result, with detection rates of 95% for nodal lesions, 62% for splenic lesions, 94% for skeletal lesions, and 83% for lung lesions, followed by T2w transverse sequences without fs (86%, 49%, 16%, and 59%, respectively) and longitudinal relaxation time–weighted contrast-enhanced transverse sequences with fs (74%, 35%, 57%, and 55%, respectively). Conclusion: T2w transverse sequences with fs yielded the highest detection rates and are well suited for accurate whole-body PET/MRI in lymphoma patients. There is no evidence to recommend the use of contrast agents.

Background: Rebound thymic hyperplasia (RTH) is a common phenomenon caused by stress factors such as chemotherapy (CTX) or radiotherapy, with an incidence between 44% and 67.7% in pediatric lymphoma. Misinterpretation of RTH and thymic lymphoma relapse (LR) may lead to unnecessary diagnostic procedures including invasive biopsies or treatment intensification. The aim of this study was to identify parameters that differentiate between RTH and thymic LR in the anterior mediastinum. Methods: After completion of CTX, we analyzed computed tomographies (CTs) and magnetic resonance images (MRIs) of 291 patients with classical Hodgkin lymphoma (CHL) and adequate imaging available from the European Network for Pediatric Hodgkin lymphoma C1 trial. In all patients with biopsy-proven LR, an additional fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT was assessed. Structure and morphologic configuration in addition to calcifications and presence of multiple masses in the thymic region and signs of extrathymic LR were evaluated. Results: After CTX, a significant volume increase of new or growing masses in the thymic space occurred in 133 of 291 patients. Without biopsy, only 98 patients could be identified as RTH or LR. No single finding related to thymic regrowth allowed differentiation between RTH and LR. However, the vast majority of cases with thymic LR presented with additional increasing tumor masses (33/34). All RTH patients (64/64) presented with isolated thymic growth. Conclusion: Isolated thymic LR is very uncommon. CHL relapse should be suspected when increasing tumor masses are present in distant sites outside of the thymic area. Conversely, if regrowth of lymphoma in other sites can be excluded, isolated thymic mass after CTX likely represents RTH.

ZusammenfassungDie bildgebende Diagnostik hat sich zu einem integralen Element der Betreuung von PatientInnen mit neuromuskulären Erkrankungen entwickelt. Als wesentliches Diagnostikum ist hierbei die Magnetresonanztomografie als breit verfügbares und vergleichsweise standardisiertes Untersuchungsverfahren etabliert, wobei die Sonografie der Muskulatur bei hinreichend erfahrenem Untersucher ebenfalls geeignet ist, wertvolle diagnostische Informationen zu liefern. Das CT hingegen spielt eine untergeordnete Rolle und sollte nur bei Kontraindikationen für eine MRT in Erwägung gezogen werden. Zunächst wurde die Bildgebung bei Muskelerkrankungen primär in der Initialdiagnostik unter vielfältigen Fragestellungen eingesetzt. Das Aufkommen innovativer Therapiekonzepte bei verschiedenen neuromuskulären Erkrankungen machen neben einer möglichst frühzeitigen Diagnosestellung insbesondere auch eine multimodale Verlaufsbeurteilung zur Evaluation des Therapieansprechens notwendig. Auch hier wird die Bildgebung der Muskulatur als objektiver Parameter des Therapieerfolges intensiv diskutiert und in Forschung wie Praxis zunehmend verwendet.

During the COVID-19 pandemic, the third section of the medical examination could be performed with simulation patients. Simulations enable standardized examinations of medical competency according to the educational objectives of the national learning objectives catalogue. The evaluation of student's medical response to child abuse and neglect seems to be an appropriate opportunity to increase attention of prospective physicians for potential child abuse. The presented case reports the simulation of a pediatric nonaccidental trauma.

(1) Background: Practicing physicians have not been in the focus of structured qualifications in basic digital competences so far. However, they are the current gatekeepers to implement digital technologies and need empowerment to proactively take part in the ongoing digital transformation process. The present study investigates if a structured blended-learning training for practicing physicians in Germany enhances both physicians’ knowledge about central aspects of the digital transformation (including awareness of personal possibilities to act) and their attitudes towards a more digitally empowered mindset. (2) Methods: Participants (n = 32) self-assessed their knowledge (19 items, 10-point Likert-scale) and attitudes (6 items, 5-point Likert-scale) towards the digital transformation at the beginning and at the end of the training. MANCOVAs were conducted. (3) Results: Participants reported an increase in every knowledge domain, representing large effects (Hedges’ g 1.06 to 2.82). Attitudes were partly shifted towards a more empowered mindset with decreased insecurity towards technological, legal, and ethical aspects of the digital transformation (Hedges’ g −0.82 to −1.40). However, preparedness for the digital transformation remained low. (4) Conclusions: Generally, the hypotheses were confirmed. The presented on-the-job training had the desired effects on practicing physicians’ knowledge and attitudes. Nevertheless, additional empowerment and support are essential.

BACKGROUND Anaesthesiology is one of the safest fields in medicine today in relation to mortality. Deaths directly because of anaesthesia have fortunately now become rare exceptions. Nevertheless, important findings can still be drawn from the rare deaths that still occur. OBJECTIVE The aim of this study was to identify and analyse the causes of deaths related to anaesthesia alone over a 10-year period. DESIGN Retrospective structured analysis of a database of medical liability claims. SETTING Hospitals at all levels of care in Germany. PATIENTS The database of a large insurance broker included data for 81 413 completed liability claims over the 10-year period from 2006 to 2015. Among 1914 cases associated with anaesthetic procedures, 56 deaths were identified. Of these, 30 clearly involved anaesthesia (Edwards category 1) and were included in the evaluation. INTERVENTIONS None (retrospective database analysis). MAIN OUTCOME MEASURES Causes of anaesthesia-related death identified from medical records, court records, expert opinions and autopsy reports. RESULTS The 30 deaths were analysed in detail at the case and document level. They included high proportions of 'potentially avoidable' deaths, at 86.6%, and what are termed 'never events', at 66.7%. Problems with the airway were the cause in 40% and problems with correct monitoring in 20%. In addition, communication problems were identified as a 'human factor' in 50% of the cases. CONCLUSION The majority of the anaesthesia-related deaths investigated could very probably have been avoided with simple anaesthesiological measures if routine guidelines had been followed and current standards observed. Actions to be taken are inferred from these results, and recommendations are made. In future, greater care must be taken to ensure that the level of safety already achieved in anaesthesiology can be maintained despite demographic developments and increasing economic pressures.

To investigate whether a humanoid robot in a clinical radiological setting is accepted as a source of information in conversations before MRI examinations of patients. In addition, the usability and the information transfer were compared with a tablet. Patients were randomly assigned to a robot or tablet group with their consent prior to MRI. The usability of both devices was compared with the extended System Usability Scale (SUS) and the information transfer with a knowledge query. Reasons for refusal were collected by a non-responder questionnaire. At the University Hospital Halle 117 patients were included for participation. There was no statistically significant difference in gender and age. Of 18 non-responders, 4 refused to participate partly because of the robot; for another 3 the reason could not be clarified. The usability according to SUS score was different with statistical significance between the groups in the mean comparison and was one step higher for the tablet on the adjective scale. There was no statistically significant difference in knowledge transfer. On average, 8.41 of 9 questions were answered correctly. This study is the first application, in a clinical radiological setting, of a humanoid robot interacting with patients. Tablet and robot are suitable for information transfer in the context of MRI. In comparison to studies in which the willingness to interact with a robot in the health care sector was investigated, the willingness is significantly higher in the present study. This could be explained by the fact that it was a concrete use case that was understandable to the participants and not a hypothetical scenario. Thus, potentially high acceptance for further specific areas of application of robots in radiology can be assumed. The higher level of usability perceived in the tablet group can be explained by the fact that here the interface represents a form of operation that has been established for years in all population groups. More frequent exposure to robots could also improve the response in the future.· patients accept humanoid robots in clinical radiologic situations. · at present they can only convey information as well as an inexpensive tablet. · future systems can relieve the burden on personnel..· Stoevesandt D, Jahn P, Watzke S et al. Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. Fortschr Röntgenstr 2021; 193: 947 - 954.ZIEL: Untersucht wurde, ob ein humanoider Roboter im klinisch-radiologischen Setting als Informationsgeber im Gespräch vor MRT-Untersuchungen von Patienten akzeptiert wird. Ergänzend wurden die Benutzerfreundlichkeit und die Informationsvermittlung mit einem Tablet verglichen. Patienten wurden bei Einwilligung vor einem MRT randomisiert einer Roboter- oder Tablet-Gruppe zugeteilt. Die Handhabbarkeit beider Geräte wurde mit der erweiterten System Usability Scale (SUS) und die Informationsvermittlung mit einer Wissensabfrage verglichen. Ablehnungsgründe wurden per Non-Responder-Fragebogen erhoben. Im Universitätsklinikum Halle wurden 117 Patienten zur Teilnahme eingeschlossen. Bei Geschlecht und Alter gab es keinen statistisch signifikanten Unterschied. Von 18 Non-Respondern lehnten 4 die Teilnahme teilweise wegen des Roboters ab; bei weiteren 3 konnte der Grund nicht geklärt werden. Die Handhabbarkeit nach SUS-Score war zwischen den Gruppen im Mittelwertvergleich statistisch signifikant unterschiedlich und war für das Tablet um eine Stufe auf der Adjektiv-Skala höher. Bei der Wissensvermittlung gab es keinen statistisch signifikanten Unterschied; im Mittel wurden 8,41 von 9 Fragen korrekt beantwortet. Diese Studie ist der erster Anwendungsfall im klinisch-radiologischen Setting eines humanoiden Roboters, der mit Patienten interagierte. Tablet und Roboter sind zur Informationsvermittlung im Kontext eines MRT geeignet. Im Vergleich zu Studien, in denen nach der Bereitschaft zur Interaktion mit einem Roboter im Gesundheitswesen gefragt wurde, ist diese Bereitschaft in der hier vorliegenden Studie deutlich höher. Dies könnte dadurch erklärt werden, dass es sich um einen konkreten, für die Teilnehmer begreiflichen Anwendungsfall handelte und nicht um ein hypothetisches Szenario. Damit ist von einer potenziell hohen Akzeptanz für weitere spezifische Einsatzgebiete von Robotern in der Radiologie auszugehen. Der in der Tablet-Gruppe wahrgenommene höhere Bedienkomfort lässt sich dadurch erklären, dass hier das Interface eine seit Jahren in allen Bevölkerungsgruppen etablierte Bedienform darstellt. Eine häufigere Exposition mit einem Roboter könnte auch hier die Response zukünftig verbessern.· humanoide Roboter werden von Patienten in klinisch radiologischen Situationen akzeptiert. · aktuell können sie Informationen dabei jedoch nur so gut wie ein preisgünstiges Tablet vermitteln. · zukünftige Systeme können das Personal entlasten..· Stoevesandt D, Jahn P, Watzke S et al. Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. Fortschr Röntgenstr 2021; 193: 947 – 954.

During the COVID-19 pandemic the third section of the medical examination could be performed on simulation patients and simulators. Their use is also beneficial in forensic medicine, as a higher level of standardization and comparability of examination performance is achieved, and the use of real corpses is often not justifiable for medicolegal reasons. This case reports on the advantages and disadvantages of a simulation in the state examination in which a death certificate was to be completely filled out on the basis of an external postmortem examination on the simulator and an external anamnesis.

Aim Medical school is demanding, and research aimed at improving the mental health of medical students is scarce. No quantitative study about which specific measures students actually prefer to reinforce their health has been performed yet. The aim of this survey is to find out which types of support should be given to medical students according to students’ own perspectives. Subject and methods A classroom survey of medical students (N = 1108, years 1–5) was carried out regarding various support options and depressive symptoms. The statistical analysis was finalized using chi-square tests, t-tests, and the Kolmogorov–Smirnov test. Results The support options with the highest average scores were accessible sports classes, desire for free water/fruit during lectures, and a clear study structure. Groups to exchange experiences with, including social media groups, were favored less. Depressive symptoms in students correlated with a higher level of applicability of support options. Conclusion Medical students require supportive study conditions. Specific subgroups of medical students could not be correlated to a particular support program. Thus, we need a support program that addresses students’ wishes, not a program based on feasibility, staff interests or passions.

During the SARS-CoV-2 pandemic, higher education worldwide had to switch to digital formats. The purpose of this study was to evaluate CoRad-19, a digital teaching tool created by the German Radiological Society for medical students during the COVID-19 pandemic.A total of 13 German-speaking universities implemented CoRad-19 in their curriculum and partially or completely replaced their classes with the online courses. Previous experience and contact with radiology and the participants' opinions regarding the medium of e-learning were surveyed using a custom questionnaire. The subjective level of knowledge regarding the individual modules was also surveyed before and after participation to measure learning effects. The data of 994 medical students from the participating sites were analyzed and compared intraindividually using the Friedman test.From 4/1/2020-10/1/2020, 451 complete data sets from a total of 994 surveys were included. E-learning was rated "very useful" both before and after course participation (4 [IQR 3-4], p = 0.527, r = 0.16). E-learning as a method was also rated as a "very good" medium both before and after participation (4 [IQR 3-4], p = 0.414, r = 0.17). After participation, participants rated radiology as particularly suitable for digital teaching (before: 3 [IQR 3-4] vs. after 4 [IQR 3-4], p = 0.005, r = 0.6). Significant learning gains were measurable in all course modules (p ≤ 0.009). Post-hoc analysis showed interest in radiology to increase significantly after course participation (p = 0.02).In the representative survey, significant learning effects were observed in all course modules. In addition, it should be particularly emphasized that the students' interest in radiology was increased by course participation. Thus, the German Radiological Society provided significant support to German-speaking medical faculties with respect to maintaining excellent education using CoRad-19.· Co-Rad-19 course participation results in measurable subjective learning effects and increases student interest in radiology..· Brendlin AS, Molwitz I, Oechtering TH et al. CoRad-19 - Modular Digital Teaching during the SARS-CoV-2 Pandemic. Fortschr Röntgenstr 2022; 194: 644 - 651.ZIEL: Während der SARS-CoV-2-Pandemie musste die Hochschullehre weltweit auf digitale Formate umstellen. In dieser Studie sollte CoRad-19, ein im Rahmen der COVID-19-Pandemie erstelltes digitales Lehrangebot der Deutschen Röntgengesellschaft (DRG) für Medizinstudierende, evaluiert werden.Insgesamt 13 deutschsprachige Hochschulstandorte haben CoRad-19 in ihr Curriculum implementiert sowie ihre Lehrangebote teilweise oder sogar vollständig durch die Online-Kurse ersetzt. Mithilfe eines eigens entworfenen Fragebogens wurden Vorerfahrungen in und bisherige Kontakte zur Radiologie erfragt sowie die Meinung der Teilnehmenden gegenüber dem Medium E-Learning erhoben. Als Maßstab für den Lernerfolg wurde der subjektive Kenntnisstand bezüglich der einzelnen Module jeweils vor und nach der Teilnahme erhoben. Die Angaben 994 Medizinstudierender aus den beteiligten Standorten wurden analysiert und mittels Friedman-Test intraindividuell verglichen.Vom 01.04.2020–01.10.2020 wurden aus insgesamt 994 Erhebungen 451 vollständige Datensätze inkludiert. E-Learning wurde sowohl vor als auch nach der Teilnahme an den Kursen als „sehr sinnvoll“ eingeschätzt (4 [IQR 3–4], p = 0,527, r = 0,16). Auch E-Learning als Methode wurde sowohl vor als auch nach der Teilnahme als „sehr gutes“ Medium bewertet (4 [IQR 3–4], p = 0,414, r = 0,17). Nach Teilnahme an den Kursen schätzten die Teilnehmenden die Radiologie als besonders geeignet für digitale Lehre ein (vorher: 3 [IQR 3–4] vs. nachher 4 [IQR 3–4], p = 0,005, r = 0,6). In allen Kursmodulen waren signifikante Lernerfolge messbar (p ≤ 0,009). Eine Post-hoc-Analyse zeigte, dass das Interesse an der Radiologie nach Teilnahme an den Kursen signifikant zunahm (p = 0,02).In der repräsentativen Umfrage wurden signifikante Lerneffekte in allen Kursmodulen beobachtet. Zudem ist besonders hervorzuheben, dass das Interesse der Studierenden an der Radiologie durch die Kursteilnahme gesteigert werden konnte. Die DRG konnte den deutschsprachigen medizinischen Fakultäten durch CoRad-19 also wichtige Unterstützung bei der Aufrechterhaltung exzellenter Lehre bieten.· Die Kursteilnahme an CoRad-19 führt zu messbaren subjektiven Lerneffekten und steigert das Interesse Studierender an der Radiologie..· Brendlin AS, Molwitz I, Oechtering TH et al. CoRad-19 – Modular Digital Teaching during the SARS-CoV-2 Pandemic. Fortschr Röntgenstr 2022; 194: 644 – 651.

A practical education in surgery is difficult to conduct in a student-centered manner and is thus often inadequate. New teaching concepts are required to provide students with insights into surgery and make the field more appealing.As part of a two-week facultative event, medical students followed eight live surgical procedures from different disciplines from an auditorium. In the auditorium, the procedures were simultaneously moderated by an experienced surgeon. Before and after every procedure, questionnaires were used to analyze whether the teaching event was suited to improve an understanding and interest for the field of surgery.A total of 709 completed questionnaires (pre and post) from 381 students were collected. The self-reported learning effect was evaluated as good or very good by students. In many of the presented disciplines, experiencing a live surgical procedure was associated with significant positive changes in attitude regarding each discipline in general, a potential clinical traineeship in the discipline and choosing the discipline as a later specialization.The high attendance as well as the evaluation results suggest a high acceptance for the teaching event. The teaching format is suited to improve the understanding of surgical procedures and had a positive effect on medical students' attitude towards surgical disciplines.HINTERGRUND: Eine studierendenorientierte Ausbildung ist in der praktischen Chirurgie schwierig und nur unzureichend umsetzbar. Neue Lehrkonzepte sind notwendig, um Studierenden die Chirurgie näherzubringen und sie für das Fach zu begeistern.In einer zweiwöchigen fakultativen Veranstaltung konnten Studierende der Humanmedizin insgesamt acht chirurgische Eingriffe aus verschiedenen Fachrichtungen live im Hörsaal mitverfolgen. Zeitgleich erfolgte im Hörsaal eine Moderation durch eine/n erfahrene/n Chirurgen/in. Anhand von Fragebögen (prä/post) wurde begleitend zu jeder Operation untersucht, inwieweit sich die Lehrveranstaltung eignet, das Verständnis und das Interesse für die chirurgische Tätigkeit zu verbessern.Insgesamt lagen 709 vollständige Tagesevaluationen (prä und post) von 381 Studierenden vor. Der selbstberichtete Lerneffekt wurde von den Studierenden als gut bis sehr gut bewertet. In vielen dargestellten Fachgebieten zeigten sich durch die Teilnahme an den Liveoperationen signifikant positive Einstellungsänderungen in Bezug auf das jeweils operierende Fach allgemein, in Bezug auf eine geplante Famulatur und für die Wahl als späteres Fachgebiet.Die hohen Teilnehmendenzahlen und die Evaluationsergebnisse lassen auf eine hohe Akzeptanz der Lehrveranstaltung schließen. Das Lehrformat ist geeignet, das Verständnis für chirurgische Abläufe zu verbessern sowie die Einstellung von Medizinstudierenden gegenüber chirurgischen Fachgebieten positiv zu beeinflussen.

Background: Elevated levels of depressive symptoms among medical students have been the subject of international and national research before, yet associated risk factors and protective factors are to be determined. This study aims to show the burdens of depression at different stages of academic medical education with a special emphasis on correlated risk factors and protective factors. Methods: A total number of n=1103 medical students of a middle-sized German university were sampled and surveyed regarding depressive symptoms and correlating factors. The assessment of potential depressive symptoms was based on the BDI-II. Correlating factors were surveyed through a self-designed questionnaire consisting of possible cofactors for depressive symptoms based on established scientific literature. Results: Survey response rate was 90.2% (1103/1223). The prevalence of depressive symptoms was 11% for mild, 5.6% for moderate and 2.4% for severe symptoms. The sample���s most prevalent risk factors were feeling unable to confide one���s own worries to someone else (88%); and experiencing a lack of time for partner, friends and family (77%) or hobbies (76%). Significant predictors for depressive symptoms were neuroticism above all, insufficient emotional support, eating irregular meals, use of medication or drugs to calm down, and mental overload. Factors associated with less depressive symptoms could be identified as: spending time with partner, friends, family, hobbies and exercise; and confiding worries to classmates. Conclusions: Every fifth medical student surveyed reported at least mild depressive symptoms. The majority of the surveyed medical students felt unable to confide their worries to someone else and lamented not having enough time for social interaction with peers, family and hobbies. Certain personality traits ��� such as neuroticism ��� and insufficient emotional support showed to play important roles in making medical students more prone to developing depressive symptoms. Based on this research, control of the surveyed cofactors associated with depressive symptoms and possible intervention programs targeted to these are proposed to be a key subject of further research., Hintergrund: Erh��hte depressive Symptome bei Medizinstudierenden waren bereits weitgehender Gegenstand internationaler und nationaler Forschung, jedoch sind assoziierte Risikofaktoren und Schutzfaktoren bis dato ungen��gend ermittelt worden. Ziel dieser Studie ist es, die Belastungen durch depressive Symptome in verschiedenen Stadien der akademischen medizinischen Ausbildung mit besonderem Schwerpunkt auf korrelierte Risikofaktoren und Schutzfaktoren aufzuzeigen. Methoden: Insgesamt wurden n=1103 Medizinstudierende einer mittelgro��en deutschen Universit��t in die Stichprobe aufgenommen und zu depressiven Symptomen und korrelierenden Faktoren befragt. Die Beurteilung m��glicher depressiver Symptome erfolgte nach dem BDI-II. Korrelierende Faktoren wurden durch einen selbst entworfenen Fragebogen erhoben, welcher auf der Grundlage etablierter wissenschaftlicher Literatur m��gliche Kofaktoren f��r depressive Symptome enthielt. Ergebnisse: Die R��cklaufquote der Umfrage betrug 90,2% (1103/1223). Die Pr��valenz depressiver Symptome betrug 11% f��r leichte, 5,6% f��r mittelschwere und 2,4% f��r schwere Symptome. Die h��ufigsten Risikofaktoren der Stichprobe waren der Umstand, die eigenen Sorgen niemand anderem anvertrauen zu k��nnen (88%); und Mangel an Zeit f��r Partner, Freunde und Familie (77%) oder Hobbies (76%). Signifikante Pr��diktoren f��r depressive Symptome waren vor allem Neurotizismus, als unzureichend erlebte emotionale Unterst��tzung, die Einnahme unregelm����ige Mahlzeiten, Einnahme von Medikamenten oder Drogen zur Selbstberuhigung und subjektives ��berforderungserleben. Faktoren, die mit weniger depressiven Symptomen verbunden waren, konnten identifiziert werden als: Zeit mit (Ehe-)Partner, Freunden, Familie, Hobbys und Sport verbringen; und Kommilitonen eigene Sorgen anvertrauen. Schlussfolgerungen: Jeder f��nfte befragte Medizinstudierende berichtete von mindestens leichten depressiven Symptomen. Die Mehrheit der befragten Medizinstudierenden f��hlte sich nicht in der Lage, ihre Sorgen einer anderen Person anzuvertrauen und gaben an, dass sie nicht gen��gend Zeit f��r soziale Interaktionen mit Gleichaltrigen, Familie und Hobbys h��tten. Neurotizismus und als unzureichend erlebte emotionale Unterst��tzung erwiesen sich als eng mit depressiven Symptomen korreliert. Basierend auf dieser Arbeit werden wissenschaftliche Forschungsans��tze im Bereich der Kontrolle der untersuchten, mit depressiven Symptomen assoziierten Kofaktoren, sowie die Erforschung m��glicher an diesen Stellen ansetzender Interventionsprogramme f��r einen Schwerpunkt weiterer Untersuchung vorgeschlagen.

Anaesthesiology is one of the safest fields in medicine today in relation to mortality. Deaths directly because of anaesthesia have fortunately now become rare exceptions. Nevertheless, important findings can still be drawn from the rare deaths that still occur.The aim of this study was to identify and analyse the causes of deaths related to anaesthesia alone over a 10-year period.Retrospective structured analysis of a database of medical liability claims.Hospitals at all levels of care in Germany.The database of a large insurance broker included data for 81 413 completed liability claims over the 10-year period from 2006 to 2015. Among 1914 cases associated with anaesthetic procedures, 56 deaths were identified. Of these, 30 clearly involved anaesthesia (Edwards category 1) and were included in the evaluation.None (retrospective database analysis).Causes of anaesthesia-related death identified from medical records, court records, expert opinions and autopsy reports.The 30 deaths were analysed in detail at the case and document level. They included high proportions of 'potentially avoidable' deaths, at 86.6%, and what are termed 'never events', at 66.7%. Problems with the airway were the cause in 40% and problems with correct monitoring in 20%. In addition, communication problems were identified as a 'human factor' in 50% of the cases.The majority of the anaesthesia-related deaths investigated could very probably have been avoided with simple anaesthesiological measures if routine guidelines had been followed and current standards observed. Actions to be taken are inferred from these results, and recommendations are made. In future, greater care must be taken to ensure that the level of safety already achieved in anaesthesiology can be maintained despite demographic developments and increasing economic pressures.

Placement of central venous catheters (CVC) into the internal jugular vein represents a routine clinical intervention. The periprocedural complication rate ranges from 5 to 20% and can be reduced by ultrasound guidance, training of residents and other measures. We aimed to proof that the average Seldinger needle is too long, increasing the risk of periprocedural injury, best epitomized in the stellate ganglion injury/irritation. The first part of the study was an online market analysis to investigate the standard needle length currently offered as part of the CVC placement sets. The second part of the study involved 35 hospitalized patients (14 female; median age 74.5 years). In those the distance between the skin and the internal jugular vein as well as the diameter of the internal jugular vein was measured by ultrasound in both, supine position as well as 45° semi-sitting position. In the third part of the study 80 body donors (45 female; median age 83.0 years) preserved by the ethanol/formaldehyde method were studied. In those the distance and angle between the typical landmark for insertion of the Seldinger needle for internal jugular vein catheter placement to the stellate ganglion was measured. The median [interquartile range] Seldinger needle length was 7 [4.0–10.0] cm. In the examined patients the maximum distance between the skin and the internal jugular vein was 1.87 cm. The minimum distance was 0.46 cm and the median distance averaging supine and 45° position was 1.14 [0.94–1.31] cm. Regarding the body donors the median distance from the insertion point of the internal jugular vein to the stellate ganglion was longer in men 5.5 [4.95–6.35] cm than in women 5.2 [4.7–5.9] (p = 0.031 unpaired t-test). With 7 cm average length the Seldinger needle currently sold as part of CVC sets is long enough to physically reach the stellate ganglion, not to mention more proximal structures. A shorter needle length would be sufficient to reach the internal jugular vein even in obese patients and with a small insertion angle while minimizing the possibility to cause severe injury as structures like the pleura and the stellate ganglion could not be reached by shorter needles.

Zusammenfassung. Die Angehörigen übernehmen den größten Teil der häuslichen Pflege von Menschen mit Demenz. In Anbetracht der wachsenden Zahl der pflegebedürftigen Menschen mit Demenz werden auch assistive Technologien als Unterstützung zunehmend diskutiert. Der Erwerb von Wissen über bestehende technische Systeme sowie von Kompetenzen für die pflegenden Angehörigen bilden dafür die Vorrausetzung.

Erst im 20. Jahrhundert wurde die Kardiomyopathie als primare Herzmuskelerkrankung erkannt. Heute differenziert man zwischen morphologischen und funktionellen Phanotypen, wobei jeder Phanotyp in eine familiare und eine nicht-familiare Form unterteilt wird. Je nachdem, welche Form vorliegt, differiert auch die Therapie.

Objective To examine clinical severity, cognitive impairment, and MRI changes in patients with MELAS syndrome. Methods Cognitive-mnestic functions, brain MRI (lesion load, cella media index) and clinical severity of ten patients with MELAS syndrome were examined. All patients carried the m.3243A > G mutation. Results The detailed neuropsychological assessment revealed cognitive deficits in attention, executive function, visuoperception, and -construction. There were significant correlations between these cognitive changes, lesion load in MRI, disturbances in everyday life (clinical scale), and high scores in NMDAS. Conclusion Patients with MELAS syndrome showed no global neuropsychological deficit, but rather distinct cognitive deficits.

BACKGROUND: In the EuroNet Pediatric Hodgkin Lymphoma (EuroNet-PHL) trials, decision on Waldeyer's ring (WR) involvement is usually based on clinical assessment, that is, physical examination and/or nasopharyngoscopy. However, clinical assessment only evaluates mucosal surface and is prone to interobserver variability. Modern cross-sectional imaging technology may provide valuable information beyond mucosal surface, which may lead to a more accurate WR staging. PATIENTS, MATERIALS, AND METHODS: The EuroNet-PHL-C1 trial recruited 2102 patients, of which 1752 underwent central review including reference reading of their cross-sectional imaging data. In 14 of 1752 patients, WR was considered involved according to clinical assessment. In these 14 patients, the WR was re-assessed by applying an imaging-based algorithm considering information from 18 F-fluorodeoxyglucose positron emission tomography, contrast-enhanced computed tomography, and/or magnetic resonance imaging. For verification purposes, the imaging-based algorithm was applied to 100 consecutive patients whose WR was inconspicuous on clinical assessment. RESULTS: The imaging-based algorithm confirmed WR involvement only in four of the 14 patients. Of the remaining 10 patients, four had retropharyngeal lymph node involvement and six an inconspicuous WR. Applying the imaging-based algorithm to 100 consecutive patients with physiological appearance of their WR on clinical assessment, absence of WR involvement could be confirmed in 99. However, suspicion of WR involvement was raised in one patient. CONCLUSIONS: The imaging-based algorithm was feasible and easily applicable at initial staging of young patients with Hodgkin lymphoma. It increased the accuracy of WR staging, which may contribute to a more individualized treatment in the future. ispartof: PEDIATRIC BLOOD & CANCER vol:68 issue:4 ispartof: location:United States status: published

Background: Children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma achieve an event-free survival at 5 years of about 90% after treatment with vincristine, etoposide, prednisone, and doxorubicin (OEPA) followed by cyclophosphamide, vincristine, prednisone, and procarbazine (COPP) and radiotherapy, but long-term treatment effects affect survival and quality of life. We aimed to investigate whether radiotherapy can be omitted in patients with morphological and metabolic adequate response to OEPA and whether modified consolidation chemotherapy reduces gonadotoxicity. Methods: Our study was designed as a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial, and was carried out at 186 hospital sites across 16 European countries. Children and adolescents with newly diagnosed intermediate-stage (treatment group 2) and advanced-stage (treatment group 3) classical Hodgkin lymphoma who were younger than 18 years and stratified according to risk using Ann Arbor disease stages IIAE, IIB, IIBE, IIIA, IIIAE, IIIB, IIIBE, and all stages IV (A, B, AE, and BE) were included in the study. Patients with early disease (treatment group 1) were excluded from this analysis. All patients were treated with two cycles of OEPA (1·5 mg/m2 vincristine taken intravenously capped at 2 mg, on days 1, 8, and 15; 125 mg/m2 etoposide taken intravenously on days 1–5; 60 mg/m2 prednisone taken orally on days 1–15; and 40 mg/m2 doxorubicin taken intravenously on days 1 and 15). Patients were randomly assigned to two (treatment group 2) or four (treatment group 3) cycles of COPP (500 mg/m2 cyclophosphamide taken intravenously on days 1 and 8; 1·5 mg/m2 vincristine taken intravenously capped at 2 mg, on days 1 and 8; 40 mg/m2 prednisone taken orally on days 1 to 15; and 100 mg/m2 procarbazine taken orally on days 1 to 15) or COPDAC, which was identical to COPP except that 250 mg/m2 dacarbazine administered intravenously on days 1 to 3 replaced procarbazine. The method of randomisation (1:1) was minimisation with stochastic component and was centrally stratified by treatment group, country, trial sites, and sex. The primary endpoint was event-free survival, defined as time from treatment start until the first of the following events: death from any cause, progression or relapse of classical Hodgkin lymphoma, or occurrence of secondary malignancy. The primary objectives were maintaining 90% event-free survival at 5 years in patients with adequate response to OEPA treated without radiotherapy and to exclude a decrease of 8% in event-free survival at 5 years in the embedded COPDAC versus COPP randomisation to show non-inferiority of COPDAC. Efficacy analyses are reported per protocol and safety in the intention-to-treat population. The trial is registered with ClinicalTrials.gov (trial number NCT00433459) and EUDRACT (trial number 2006-000995-33), and is closed to recruitment. Findings: Between Jan 31, 2007, and Jan 30, 2013, 2102 patients were recruited. 737 (35%) of the 2102 recruited patients were in treatment group 1 (early-stage disease) and were not included in our analysis. 1365 (65%) of the 2102 patients were in treatment group 2 (intermediate-stage disease; n=455) and treatment group 3 (advanced-stage disease; n=910). Of these 1365, 1287 (94%) patients (435 [34%] of 1287 in treatment group 2 and 852 [66%] of 1287 in treatment group 3) were included in the titration trial per-protocol analysis. 937 (69%) of 1365 patients were randomly assigned to COPP (n=471) or COPDAC (n=466) in the embedded trial. Median follow-up was 66·5 months (IQR 62·7–71·7). Of 1287 patients in the per-protocol group, 514 (40%) had an adequate response to treatment and were not treated with radiotherapy (215 [49%] of 435 in treatment group 2 and 299 [35%] of 852 in treatment group 3). 773 (60%) of 1287 patients with inadequate response were scheduled for radiotherapy (220 [51%] of 435 in the treatment group 2 and 553 [65%] of 852 in treatment group 3. In patients who responded adequately, event-free survival rates at 5 years were 90·1% (95% CI 87·5–92·7). event-free survival rates at 5 years in 892 patients who were randomly assigned to treatment and analysed per protocol were 89·9% (95% CI 87·1–92·8) for COPP (n=444) versus 86·1% (82·9–89·4) for COPDAC (n=448). The COPDAC minus COPP difference in event-free survival at 5 years was −3·7% (−8·0 to 0·6). The most common grade 3–4 adverse events (intention-to-treat population) were decreased haemoglobin (205 [15%] of 1365 patients during OEPA vs 37 [7%] of 528 treated with COPP vs 20 [2%] of 819 treated with COPDAC), decreased white blood cells (815 [60%] vs 231 [44%] vs 84 [10%]), and decreased neutrophils (1160 [85%] vs 223 [42%] vs 174 [21%]). One patient in treatment group 2 died of sepsis after the first cycle of OEPA; no other treatment-related deaths occurred. Interpretation: Our results show that radiotherapy can be omitted in patients who adequately respond to treatment, when consolidated with COPP or COPDAC. COPDAC might be less effective, but is substantially less gonadotoxic than COPP. A high proportion of patients could therefore be spared radiotherapy, eventually reducing the late effects of treatment. With more refined criteria for response assessment, the number of patients who receive radiotherapy will be further decreased. Funding: Deutsche Krebshilfe, Elternverein für Krebs-und leukämiekranke Kinder Gießen, Kinderkrebsstiftung Mainz, Tour der Hoffnung, Menschen für Kinder, Programme Hospitalier de Recherche Clinique, and Cancer Research UK.

Objectives: Patient education and compliance play an important role in the success of rehabilitation in cardiovascular diseases. The aim of this study is to analyze whether interactive learning methods, in this study, the audience response system with a “clicker,” can improve the learning success of patients during and after their rehabilitation process. Methods: In a randomized, prospective cohort study, a total of 260 patients were randomized to either an interactive training group using Athens audience response system or to a control group without the use of audience response system during the educational sessions. Patients were taught and tested on four different topics concerning their primary disease: heart failure, arterial hypertension, prevention of cardiovascular diseases, and coronary heart disease. After each session, the patients had to answer questions on the previously taught topics via questionnaires. These questions were asked again at the day of discharge, as well as 3 and 12 months after discharge. Additional information on the patients’ health, plus their mental status, was gathered with the help of further questionnaires (HADS and SF-12). Results: A total of 260 patients (201 men and 59 women) were recruited. The patients were on average 61.1 ± 11 years old. A significant short-term effect on the patients’ knowledge about their disease was found immediately after the educational sessions in the intervention group. However, there was no long-term effect in either the intervention or control group. Although there was no statistical significance found in any of the observations, a positive short-term effect on learning capacity as well as positive trends in mental and physical health after discharge could be found in patients after the use of audience response system during their rehabilitation. Conclusion: This study provides interesting and new data on the use of an interactive learning method for patients to gain knowledge about their primary disease and eventually improve their physical and mental health status in a long-term perspective. By implementing different and new ways of teaching and interaction during the hospitalization, not only patients, but also medical staff and caregivers could benefit.

Zusammenfassung Hintergrund Moderne Technologien konnten in Zukunft bei Pflegebedurftigkeit einen entscheidenden Beitrag zu einem selbstbestimmten Leben in der eigenen Umgebung erbringen. Roboter konnten den Alltag in der Hauslichkeit erleichtern und Teilhabe fordern. Im pflegewissenschaftlichen Diskurs werden eine Entfremdung durch Technologie und ein Verlust des unmittelbaren sozialen und emotionalen Kontakts befurchtet. Roboter sind auch in Pflegebezugen bereits in der Erprobung, zum Beispiel als soziale Roboter im Setting Pflegeheim. Welche Kenntnislage zum Einsatz robotischer Systeme im hauslichen Bereich besteht, ist bisher nicht in Ubersichtsarbeiten untersucht. Ziel Sichtung der Moglichkeiten des Einsatzes und der Anwendung robotischer Systeme fur die pflegerische Versorgung im hauslichen Bereich. Neben den Funktionen der Systeme werden methodische Aspekte und der weitere Stand der Forschung in diesem Themengebiet betrachtet. Methoden In diesem Scoping-Review wird eine Ubersicht zum Themenfeld und der darin stattfindenden Forschungsaktivitaten erarbeitet. Funf Datenbanken und die Literaturverzeichnisse der identifizierten Publikationen wurden nach Studien ohne Eingrenzung des Designs seit dem Jahr 2005 durchsucht. Eingeschlossen wurden Studien, in denen robotische Interventionen in der hauslichen Umgebung und ihre Auswirkungen auf patienten- oder angehorigenrelevante Outcomes untersucht wurden. Die sechs Dimensionen des neuen Pflegebedurftigkeitsbegriffs im SGB XI dienten zur Einordnung der pflegerischen Relevanz der robotischen Systeme. Ergebnisse Die Suche ergab 7.755 Treffer, von denen 19 Studien eingeschlossen wurden. Zwei Studien wiesen eine Kontrollgruppe auf. Weitere Studien waren Machbarkeitsstudien und Akzeptanzbefragungen. Die Studien wurden uberwiegend in EU-Landern durchgefuhrt. Von 13 robotischen Systemen waren drei kommerziell verfugbar. In neun Studien wurde kein Votum einer Ethikkommission erwahnt, und in sieben Studien wurde nicht erwahnt, ob eine informierte Einwilligung eingeholt wurde. Diskussion Robotische Systeme in der hauslichen Versorgung sind mehrheitlich in explorativen oder pilotierenden Studien untersucht worden. Diese konzentrieren sich, neben technischen Aspekten, auf die Bedienbarkeit und verwenden dafur uberwiegend Roboter im Prototypstadium. Ein Bezug zur Lebenswelt der Nutzenden sowie ein Nachweis von Wirksamkeit fehlen. Die Gerate sind bislang weit davon entfernt, in die breite praktische Anwendung uberfuhrt zu werden.

Background The International Working Group on Staging Evaluation and Response Criteria Harmonization (SEARCH) seeks to provide a universally acceptable definition of cortical bone involvement in the staging of newly diagnosed pediatric Hodgkin lymphoma. Procedure A comprehensive literature search was performed using PubMed and Google Scholar with the search terms "Hodgkin lymphoma," "osseous lesions," "bony involvement," and "pediatric." Publications reviewed included case reports, retrospective analyses, and literature reviews. Each was evaluated for study design, number of participants, median age and age range at diagnosis, percentage of pediatric patients, criteria of interest definition, diagnostic tools, study objectives, and level of evidence. The final definition was based on the available data and consensus of the SEARCH working group. Results Twenty-five papers specifically addressing cortical bone involvement in Hodgkin lymphoma met the inclusion criteria. Eighteen papers were case reports with literature reviews; the remainder were observational cohort studies. Of these, 14 included pediatric patients (aged 0-21 years). The criteria for cortical bone involvement were not clearly defined in any paper, often varied within a study, and were inconsistent between publications. Conclusions The SEARCH group for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (CAYAHL) proposes the following criteria as defining cortical bone involvement: any cortical bone biopsy-proven lesion; a positive bony window lesion on computer tomography (CT), with an FDG-PET positive correlate in a patient with biopsy-proven Hodgkin lymphoma, if there is no other typical skeletal pathology; auspicious skeletal lesions on FDG-PET or magnetic resonance imaging should be confirmed by CT or Tc-99m scan to distinguish cortical lesions from bone marrow involvement. Nodal masses that extend into bone with bony destruction are considered extranodal extension or "E" lesions and do not represent metastatic or stage IV disease.

Abdominal lymphatic malformations (LM) are relatively rare findings in the differential diagnosis of focal abdominal lesions; however, they represent a challenge especially in younger patients. The aim of this review article is to provide up-to-date information about the different kinds of LM manifestations. In addition, related syndromes and typical imaging features to facilitate the diagnosis are discussed. The clinical presentation of abdominal LM is unspecific, whereby most are asymptomatic and comprise incidental findings of thin-walled cystic masses anywhere in the abdomen. The fluid in the cystic masses may be proteinaceous, contain blood, or be infected. Radiological imaging features overlap with other cystic diseases; hallmark in LM is a lack of a solid component and exclusive enhancement of the walls and septa. In cystic abdominal masses in early childhood or young adults, abdominal LM must be taken into account by the radiologist. Newly defined entities in this spectrum of diseases are central conducting lymphatic anomaly (CCLA) and generalized lymphatic anomaly (GLA).

At the Institute of Anatomy and Cell Biology in Halle (Saale) 74 children's bodies of unknown historical provenance are being held in storage. The aim of this study was the evaluation of their identities, the circumstances of their acquisition, as well as the documentation of their individual characteristics. For these purposes, all bodies were comprehensively examined and photo-documented. Furthermore, CT-scans of 29 bodies were performed and information was collected from various local and national archives. Although most of the bodies were found to be those of stillborn children and infants, five children were between two and twelve years old, according to an age estimate by body-length and carpal bone analysis. The CT-scans revealed the cause of death for some of the children. The embalming method indicates that the bodies date from the first decades of the 20th century, and archival sources containing documents from 1920 to 1960 strongly suggest that these children's bodies were acquired by Institute of Anatomy between 1920 and 1942. During that period, a total of 2602 children's bodies were delivered to the Institute of Anatomy and registered in the communal burial records. At this point, there is no evidence that these children might have been victims of National Socialist crimes. It is planned to give them a dignified burial.

Abdominelle lymphatische Malformationen (LM) stellen relativ seltene Befunde in der Differenzialdiagnose fokaler abdomineller Lasionen dar. Dennoch sind sie gerade bei Patienten in einer jungen Altersgruppe diagnostisch eine Herausforderung. Das Ziel dieses Ubersichtsartikels ist es, aktuellste Informationen uber die unterschiedlichen Arten der Manifestation von LM zu geben. Daruber hinaus werden die in diesem Zusammenhang auftretenden Syndrome sowie typischen Merkmale der Bildgebung behandelt. Klinisch treten abdominelle LM meist asymptomatisch auf. In der Bildgebung werden haufig Zufallsbefunde von dunnwandig begrenzten zystischen Raumforderungen im gesamten Abdomen auffallig. Die Flussigkeit in den zystischen Raumforderungen kann proteinreich sein, Blut enthalten oder Zeichen der Infektion aufweisen. Die radiologische Prasentation uberschneidet sich dabei haufig mit anderen zystischen Erkrankungen. Das typische Zeichen der LM ist das Fehlen von soliden Anteilen und die ausschliesliche Kontrastmittelaufnahme der zystischen Wande und Septen. Differenzialdiagnostisch mussen Radiologen bei zystischen abdominellen Raumforderungen v. a. bei Kindern und jungen Erwachsenen eine LM in Betracht ziehen. Die kurzlich neu definierten Entitaten dieses Krankheitsspektrums sind die sog. „central conducting lymphatic anomaly“ (CCLA) und die generalisierte lymphatische Anomalie (GLA).

ZusammenfassungDas Überbringen schlechter Nachrichten zählt zu den häufigsten und herausforderndsten Gesprächssituationen für Arzt und Patient. Erfolgt die Mitteilung schlechter Nachrichten im Rahmen eines Behandlungsverhältnisses, sollten die Erwartungen und Befürchtungen des Patienten berücksichtigt, notwendige Informationen einfach und kurz mitgeteilt werden und die emotionalen Reaktionen der Patienten empathisch beantwortet werden. Orientierung für diese unterschiedlichen kommunikativen Fertigkeiten bietet das SPIKES-Modell. Besteht kein primäres Behandlungsverhältnis, sondern werden Befunde zu rein diagnostischen Zwecken im Auftrag eines zuweisenden Arztes erhoben, gilt es, mit dem Patienten zu Beginn zu besprechen, wie mit der Befundmitteilung umzugehen ist. Grundsätzlich sollte der Patient die Möglichkeit zu einem Befundgespräch mit dem diagnostisch tätigen Arzt haben. Allerdings ist es oft zum Wohle des Patienten am sinnvollsten, wenn die Befundmitteilung durch den primär behandelnden Arzt erfolgt. Hierfür sollten klare Absprachen bestehen.

Objectives Disorders of glycogen metabolism include rare hereditary muscle glycogen storage diseases with polyglucosan, which are characterized by storage of abnormally structured glycogen in muscle in addition to exercise intolerance or muscle weakness. In this study, we investigated the etiology and pathogenesis of a late-onset myopathy associated with glycogenin-1 deficiency. Materials and methods A family with two affected siblings, 64- and 66-year-olds, was studied. Clinical examination and whole-body MRI revealed weakness and wasting in the hip girdle and proximal leg muscles affecting ambulation in the brother. The sister had weakness and atrophy of hands and slight foot dorsiflexion difficulties. Muscle biopsy and whole-exome sequencing were performed in both cases to identify and characterize the pathogenesis including the functional effects of identified mutations. Results Both siblings demonstrated storage of glycogen that was partly resistant to alpha-amylase digestion. Both were heterozygous for two mutations in GYG1, one truncating 1-base deletion (c.484delG; p.Asp163Thrfs*5) and one novel missense mutation (c.403G>A; p.Gly135Arg). The mutations caused reduced expression of glycogenin-1 protein, and the missense mutation abolished the enzymatic function as analyzed by an in vitro autoglucosylation assay. Conclusion We present functional evidence for the pathogenicity of a novel GYG1 missense mutation located in the substrate binding domain. Our results also demonstrate that glycogenin-1 deficiency may present with highly variable distribution of weakness and wasting also in the same family.

Christian Buhtz,1 Denny Paulicke,1,2 Karsten Schwarz,1 Patrick Jahn,3 Dietrich Stoevesandt,1 Thomas Frese4 1Dorothea Erxleben Learning Center, Medical Faculty, of Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany; 2International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; 3Institute for Health Science, Department Nursing Science, Medical Faculty Tuebingen, Tuebingen, Germany; 4Institute for General Practice and Family Medicine, Medical Faculty of Martin-Luther-University Halle-Wittenberg, Halle (Saale), GermanyCorrespondence: Christian BuhtzDorothea Erxleben Learning Center, Medical Faculty of Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 12, Halle (Saale) 06112, GermanyTel +49 345 557 4099Email christian.buhtz@medizin.uni-halle.deBackground: Challenges to general practitioners (GPs) as family doctors in Germany are growing because of the demographic situation. Technical assistance systems can improve the care for patients provided by GPs and care personnel to preserve autonomy. GPs are key persons in the health care team to recommend and facilitate access to technical solutions to influence their implementation into their patients’ homes.Aim: Explore the general receptiveness of GPs in Germany regarding state-of-the-art and modern assistive technology, as well as their experiences, attitudes and expectations and their training demands.Methods: A cross-sectional survey was conducted among GPs in Germany with a self-developed questionnaire sent by mail.Results: Response rate was 34% (n=194). As expected computers and smartphones are widely used. Data glasses, digital pens and virtual reality and others are often “unknown”. Experience with assistive technology was gained with emergency call systems, smart calendars and tablet dispensers. Self-reported receptiveness to use innovative technology is high but knowledge is low. The majority reported lack of access to training and support. The receptiveness for advanced education about technical solutions is high. In free-text response, some communicated their worries about the replacement of human interaction with technology.Conclusion: The survey showed an overall high receptiveness about assistance technology to GPs and strong demands for education and support. Education for GPs need greater efforts to master the process transforming the digital health care provision.Keywords: general practitioners, physicians, family physicians, self-help devices, technology, outpatients

In the future, modern technologies could make a significant contribution to a self-determined life in one's own environment when in need of care. Robots might alleviate everyday domestic life and promote participation. In the nursing science debate concerns have been raised over alienation through technology and loss of direct social and emotional contact. Robots are also being tested in nursing care, for example as social robots in the nursing home setting. The current state of knowledge regarding the domestic application of robotic systems has so far not been examined in systematic reviews.To examine the possibilities of the usage and application of robotic systems in the home healthcare setting. In addition to the functions of the systems, methodological issues and further research in this subject area are considered.In this scoping review, an overview of the subject area and current research activities is produced. Five databases and the reference lists of the publications identified were searched. All study designs and publications since 2005 were eligible. We included studies investigating robotic interventions in the home care setting and their impact on outcomes relevant to patients or family members. The relevance of the robotic systems for nursing care was assessed according to the six dimensions of the new definition of care dependency in the Eleventh Book of the German Social Code (SGB XI).The search revealed 7,755 hits; 19 studies were included. Two studies used a control group. Further studies were feasibility studies and acceptance surveys. The majority of studies were conducted in EU countries. Three out of 13 robotic systems were commercially available. Nine studies did not report ethical approval, and seven studies did not mention whether informed consent was obtained.Robotic systems in home care have mainly been investigated in exploratory or pilot studies. Apart from technical aspects, the studies focussed on ease of use and, to this purpose, predominantly employed prototype robots. No reference was made to users' living environment, and there was no proof of effectiveness. The devices are far from being in the stage of broad practical application.

To determine whether the current 18F-FDG PET response criterion for skeletal involvement in Hodgkin lymphoma (HL) is suitable, we performed a systematic evaluation of the different types of skeletal involvement and their response on PET after 2 cycles of chemotherapy (PET-2). A secondary objective was to observe the influence of the initial uptake intensity (measured as qPET) and initial metabolic tumor volume (MTV) of skeletal lesions on the PET-2 response. Methods: The initial PET scans of 1,068 pediatric HL patients from the EuroNet- PHL-C1 trial were evaluated for skeletal involvement by central review. Three types of skeletal lesions were distinguished: PET-only lesions (those detected on PET only), bone marrow (BM) lesions (as confirmed by MRI or BM biopsy), and bone lesions. qPET and MTV were calculated for each skeletal lesion. All PET-2 scans were assessed for residual tumor activity. The rates of complete metabolic response for skeletal and nodal involvement on PET-2 were compared. Results: Of the 1,068 patients, 139 (13%) showed skeletal involvement (44 PET-only, 32 BM, and 63 bone). Of the 139 patients with skeletal involvement, 101 (73%) became PET-2–negative in the skeleton and 94 (68%) became PET-2–negative in the lymph nodes. The highest number of PET-2–negative scans in the skeleton was 42 (95%) in the 44 PET-only patients, followed by 22 skeletal lesions (69%) in the 32 BM patients and 37 (59%) in the 63 bone patients. Lesions that became PET-2–negative showed a lower initial median qPET (2.74) and MTV (2 cm3) than lesions that remained PET-2– positive (3.84 and 7 cm3, respectively). Conclusion: In this study with pediatric HL patients, the complete response rate for skeletal involvement on PET-2 was similar to that for nodal involvement. Bone flare seemed to be irrelevant. Overall, the current skeletal PET response criterion—comparison with the local skeletal background—is well suited. The initial qPET and MTV of skeletal lesions were predictive of the PET-2 result. Higher values for both parameters were associated with a worse PET-2 response.

Background & Aims: Spontaneous portosystemic shunts (SPSS) have been associated with hepatic encephalopathy (HE). Little is known about their prevalence among patients with cirrhosis or clinical effects. We investigated the prevalence and characteristics of SPSS in patients with cirrhosis and their outcomes. Methods: We performed a retrospective study of 1729 patients with cirrhosis who underwent abdominal computed tomography or magnetic resonance imaging analysis from 2010 through 2015 at 14 centers in Canada and Europe. We collected data on demographic features, etiology of liver disease, comorbidities, complications, treatments, laboratory and clinical parameters, Model for End-Stage Liver Disease (MELD) score, and endoscopy findings. Abdominal images were reviewed by a radiologist (or a hepatologist trained by a radiologist) and searched for the presence of SPSS, defined as spontaneous communications between the portal venous system or splanchnic veins and the systemic venous system, excluding gastroesophageal varices. Patients were assigned to groups with large SPSS (L-SPSS, ≥8 mm), small SPSS (S-SPSS

Frank Noack,1,2 Bernd Schmidt,1 Mroawan Amoury,2 Dietrich Stoevesandt,3 Stephan Gielen,4 Birgit Pflaumbaum,5 Christiane Girschick,5 Heinz Völler,6 Axel Schlitt5,7 1Department of Medicine I, 2Department of Emergency Medicine, 3Department of Diagnostic Radiology, 4Department of Medicine III, University Clinic Halle (Saale), Halle, Germany; 5Department of Cardiology and Pulmology, Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany; 6Klinik am See, Rüdersdorf, Germany; 7Medical Faculty, Martin Luther University Halle, Wittenberg, Germany Background: Venous thromboembolism is a life-threatening disease. In survivors, different degrees of functional complaints need to be restored or prevented (eg, post-thrombotic syndrome, pulmonary hypertension). Therefore, rehabilitation after venous thromboembolism is recommended in Germany. However, a structured rehabilitation program has not been defined for this indication. Here, we present the experience of a single rehabilitation center. Methods: Data from consecutive pulmonary embolism (PE) patients who were referred for a 3-week inpatient rehabilitation program from 2006 to 2014 were retrospectively evaluated. Results: In all, 422 patients were identified. The mean age was 63.9±13.5 years, the mean body mass index (BMI) was 30.6±6.2 kg/m2, and 51.9% were female. Deep vein thrombosis according to PE was known for 55.5% of all patients. We applied a wide range of therapeutic interventions such as bicycle training with monitored heart rate in 86.7%, respiratory training in 82.5%, aquatic therapy/swimming in 40.1%, and medical training therapy in 14.9% of all patients. Adverse events (AEs) occurred in 57 patients during the 3-week rehabilitation period. The most common AEs were cold (n=6), diarrhea (n=5), and infection of the upper or lower respiratory tract that was treated with antibiotics (n=5). However, three patients under anticoagulation therapy suffered from bleeding, which was clinically relevant in one. Four patients (0.9%) had to be transferred to a primary care hospital for non-PE-associated reasons (acute coronary syndrome, pharyngeal abscess, and acute abdominal problems). No influence of any of the physical activity interventions on the incidence of any AE was found. Conclusion: Since PE is a life-threatening disease, it seems reasonable to recommend rehabilitation at least in PE patients with an intermediate or high risk. It is shown for the first time in this study that a standard rehabilitation program after PE is safe. However, efficacy and safety in the long term need to be studied prospectively. Keywords: venous thromboembolism, pulmonary embolism, rehabilitation

International harmonization of staging evaluation and response criteria is needed for childhood, adolescence, and young adulthood Hodgkin lymphoma. Two Hodgkin lymphoma protocols from cooperative trials in Europe and North America were compared for areas in need of harmonization, and an evidence-based approach is currently underway to harmonize staging and response evaluations with a goal to enhance comparisons, expedite identification of effective therapies, and aid in the approval process for new agents by regulatory agencies.