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La estimación del puntaje Gleason (PG) en pacientes con cáncer de próstata (PCa) mediante modelos radiómicos es de especial interés por ser una alternativa no invasiva a la biopsia, para estratificar el nivel de riesgo y ayudar en la elección del tratamiento. Nuestro objetivo es estimar el PG mediante un modelo radiómico con imágenes [68Ga]-antígeno de membrana específico de la próstata (PSMA, Prostate Specific Membrane Antigen) de tomografía por emisión de positrones (PET, Positron Emission Tomography). Para la cohorte de entrenamiento (20 pacientes), además de la segmentación manual, se disponía de corregistro histopatológico, que se estableció como segmentación ideal para la confirmación de los resultados. Los modelos radiómicos fueron adicionalmente validados para la segmentación manual en una segunda cohorte (40 pacientes). Se calcularon 133 características radiómicas y primero se evaluó en maniquíes experimentales la dependencia intrínseca con el volumen y con los equipos híbridos de PET y tomografía computarizada (TC) y posteriormente en pacientes, se comparó sus valores dentro y fuera del tumor y la caracterización del PG. Se utilizó la prueba de los rangos con signo de Wilcoxon, la correlación de Spearman y la regresión logística como métodos de análisis. Los resultados mostraron 50 características radiómicas intrínsecamente independientes del volumen y con capacidad para discriminar el tumor independientemente de la segmentación utilizada. El PG se estratificó (PG < 8 vs PG ≥ 8) mediante una característica radiómica con área-bajo-la-curva (AUC, area-under-the-curve) de 0.91/0.84 (cohorte entrenamiento/validación) y con una firma radiómica (AUC de 0.93/0.78). Nuestros resultados avalan la capacidad del modelo radiómico con 68Ga- PSMA-PET para estratificar el PG en PCa.

Zusammenfassung Ziel Die Gesundheitsgefährdung durch langes Sitzen auch am Arbeitsplatz ist ein wichtiges Problem unserer Zeit. Seine Lösung verlangt interdisziplinäre Zusammenarbeit von Expertinnen und Experten aus Wissenschaft und betrieblicher Praxis. Methodik Hierzu wurde im Februar 2019 in Berlin ein Workshop mit Fachleuten aus unterschiedlichen Bereichen durchgeführt, der die derzeitigen wissenschaftlichen Erkenntnisse der Gesundheitsgefährdung durch lange, wenig unterbrochene Sitzzeiten am Arbeitsplatz in verschiedenen Beiträgen thematisiert und betriebliche Lösungsansätze aufzeigt. Dieser Workshop wird hier in 2 Teilen dokumentiert. Genderrelevante Aspekte werden, wenn möglich, hervorgehoben. Ergebnisse Im vorliegenden Teil II werden Lösungsansätze aus der Praxis vorgestellt. Es werden neue Evaluationsergebnisse zu dynamischen Arbeitsstationen gezeigt. Zwei Beispiele geben einen Einblick in die betriebliche Praxis, die in Deutschland aktuell weniger von Maßnahmen zur Unterbrechung der Sitzzeiten als von Bewegungsförderung geprägt ist. In der abschließenden Plenumsdiskussion wird zusammengefasst, wie Interventionen am Arbeitsplatz gelingen können. Schlussfolgerung Entscheidungsträger erkennen zunehmend, dass im 21. Jahrhundert ein Trend hin zu körperlicher Unterforderung durch sedentäres Verhalten am Arbeitsplatz besteht, der die Gesundheit der Beschäftigten und der Bevölkerung generell gefährdet. Trotz Evidenzlücken können und sollten wissenschaftsbasierte Entscheidungen für Politik und Praxis getroffen werden. In Deutschland können wir dabei von den guten Beispielen anderer Länder lernen.

ObjectivesSedentary behaviour is a modifiable risk factor for cardiovascular health. Although long periods of sedentary behaviour take place at work, evidence of the relationship between such occupational sitting and cardiometabolic health risks remains limited. This systematic review aimed to update the evidence on the associations of occupational sitting with cardiovascular outcomes and cardiometabolic risk factors based on longitudinal studies.DesignSystematic review.SettingWorkplace.PopulationEmployees aged 18–65 years.Primary and secondary outcomesPrimary outcomes were cardiovascular diseases and cardiometabolic risk markers. The secondary outcome was all-cause mortality.Data sourcesTen databases, including PubMed, Web of Science and CINAHL (search January 2018, updated February 2019).Data extraction and synthesisData were screened, extracted and appraised by three independent reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsStudies were markedly heterogeneous in terms of measurement of occupational sitting, cardiometabolic risk factors and cardiovascular morbidity and mortality, so that standards were hardly identifiable and limiting the value of the evidence. The review included 27 high or acceptable quality publications. Of the eight high-quality publications from seven cohorts, three cohort studies found significant associations of occupational sitting with primary outcomes. Additionally, one study described an association with the secondary outcome. Another high-quality publication found an association between occupational sitting and ischaemic heart disease in a subgroup already at risk due to hypertension. For sex/gender analysis, 11 of the 27 high and acceptable quality publications reported sex-stratified results. Five of these found sex differences.ConclusionsEvidence regarding the association of occupational sitting with cardiometabolic health risks was limited because of the lack of standardised measurements for occupational sitting. Occupational sitting combined with an overall sedentary lifestyle was associated with an elevated relative risk for several cardiometabolic outcomes. There is an urgent need for standardised measurements of occupational sitting to facilitate meta-analysis. Sex/gender aspects of this relationship require further investigation.

Purpose Accurate definition of the intraprostatic gross tumor volume (GTV) is crucial for diagnostic and therapeutic approaches in patients with primary prostate cancer (PCa). The optimal methodology for contouring of GTV using Prostate specific membrane antigen positron emission tomography (PSMA-PET) information has not yet been defined. Methods and Materials PCa patients who underwent a [68Ga]PSMA-11-PET/CT followed by radical prostatectomy were prospectively enrolled (n = 20). Six observer teams with different levels of experience and using different PET image scaling techniques performed manual contouring of GTV. Additionally, semi-automatic segmentation of GTVs was performed using SUVmax thresholds of 20–50%. Coregistered histopathological gross tumor volume (GTV-Histo) served as reference. Inter-observer agreement was assessed by calculating the Dice similarity coefficient (DSC). Results Most contouring methods provided high sensitivity and specificity. For manual delineation, scaling the PET images from SUVmin-max: 0–5 resulted in high sensitivity (>86%). The highest specificity (100%) was obtained by scaling the PET images from SUVmin-max: 0-SUVmax. High interobserver agreement (median DSC 0.8) was observed when using the same PET image scaling technique (PET images SUVmin-max: 0–5). For semi-automatic segmentation, a low SUVmax threshold of 20% optimized sensitivity (SUVmax threshold 20%, 100% sensitivity, 32% of prostatic volume), whereas a higher threshold optimized specificity (SUVmax threshold 40%–50%, 100% specificity). Conclusions Contouring of regions with high tracer-uptake resulted in very high specificities and should be used for biopsy guidance. Both manual and semi-automatic approaches using validated SUV scaling (SUVmin-max: 0–5) or thresholding (20%) may provide high sensitivity, and should be considered for PSMA-PET-based focal therapy approaches.

Purpose: To evaluate the performance of radiomic features (RF) derived from PSMA PET for intraprostatic tumor discrimination and non-invasive characterization of Gleason score (GS) and pelvic lymph node status. Patients and methods: Patients with prostate cancer (PCa) who underwent [68Ga]-PSMA-11 PET/CT followed by radical prostatectomy and pelvic lymph node dissection were prospectively enrolled (n=20). Coregistered histopathological gross tumor volume (GTV-Histo) in the prostate served as reference. 133 RF were derived from GTV-Histo and from manually created segmentations of the intraprostatic tumor volume (GTV-Exp). Spearman´s correlation coefficients (ρ) were assessed between RF derived from the different GTVs. We additionally analyzed the differences in RF values for PCa and non-PCa tissues. Furthermore, areas under receiver-operating characteristics curves (AUC) were calculated and uni- and multivariate analyses were performed to evaluate the RF based discrimination of GS 7 and ≥8 disease and of patients with nodal spread (pN1) and non-nodal spread (pN0) in surgical specimen. The results found in the latter analyses were validated by a retrospective cohort of 40 patients. Results: Most RF from GTV-Exp showed strong correlations with RF from GTV-Histo (86% with ρ>0.7). 81% and 76% of RF from GTV-Exp and GTV-Histo significantly discriminated between PCa and non-PCa tissue. The texture feature QSZHGE discriminated between GS 7 and ≥8 considering GTV-Histo (AUC=0.93) and GTV-Exp (prospective cohort: AUC=0.91 / validation cohort: AUC=0.84). QSZHGE also discriminated between pN1 and pN0 disease considering GTV-Histo (AUC=0.85) and GTV-Exp (prospective cohort: AUC=0.87 / validation cohort: AUC=0.85). In uni- and multivariate analyses including patients of both cohorts QSZHGE was a statistically significant (p

Health risks of prolonged periods of sitting at work are a matter of concern. Solutions are needed based on interdisciplinary collaborations of research experts and practitioners in occupational safety and health areas.In February 2019, at a workshop in Berlin of experts from different fields, issues of scientific evidence on the health risks of sedentary behaviour at work were presented in 6 lectures and solutions for the workplace were discussed. The workshop is documented here in 2 parts. Gender relevant aspects are distinguished where possible.Part II describes solution approaches for practice in the workplace. The results of a recent evaluation of dynamic workplaces are presented. Two examples provide insight into ongoing workplace health promotion measures addressing sedentary behavior in Germany which currently mainly target measures to increase physical activity rather than measures to interrupt long sedentary bouts. The documentation of the plenary discussion summarizes how interventions addressing sedentary behaviour at the workplace can be successful.Decision makers increasingly realize that there is a trend in the 21st century towards low physical demands due to increasingly sedentary tasks in the workplace. Despite research gaps, there is a need for evidence-based decisions in policy and workplace practices. Germany can learn from the experiences of other countries.ZIEL: Die Gesundheitsgefährdung durch langes Sitzen auch am Arbeitsplatz ist ein wichtiges Problem unserer Zeit. Seine Lösung verlangt interdisziplinäre Zusammenarbeit von Expertinnen und Experten aus Wissenschaft und betrieblicher Praxis.Hierzu wurde im Februar 2019 in Berlin ein Workshop mit Fachleuten aus unterschiedlichen Bereichen durchgeführt, der die derzeitigen wissenschaftlichen Erkenntnisse der Gesundheitsgefährdung durch lange, wenig unterbrochene Sitzzeiten am Arbeitsplatz in verschiedenen Beiträgen thematisiert und betriebliche Lösungsansätze aufzeigt. Dieser Workshop wird hier in 2 Teilen dokumentiert. Genderrelevante Aspekte werden, wenn möglich, hervorgehoben.Im vorliegenden Teil II werden Lösungsansätze aus der Praxis vorgestellt. Es werden neue Evaluationsergebnisse zu dynamischen Arbeitsstationen gezeigt. Zwei Beispiele geben einen Einblick in die betriebliche Praxis, die in Deutschland aktuell weniger von Maßnahmen zur Unterbrechung der Sitzzeiten als von Bewegungsförderung geprägt ist. In der abschließenden Plenumsdiskussion wird zusammengefasst, wie Interventionen am Arbeitsplatz gelingen können.Entscheidungsträger erkennen zunehmend, dass im 21. Jahrhundert ein Trend hin zu körperlicher Unterforderung durch sedentäres Verhalten am Arbeitsplatz besteht, der die Gesundheit der Beschäftigten und der Bevölkerung generell gefährdet. Trotz Evidenzlücken können und sollten wissenschaftsbasierte Entscheidungen für Politik und Praxis getroffen werden. In Deutschland können wir dabei von den guten Beispielen anderer Länder lernen.

The introduction of tracers targeting the prostate-specific membrane antigen (PSMA) has revolutionized PET imaging of acinar prostate adenocarcinoma. In general, an increasing PSMA expression is assumed with increasing dedifferentiation. Whereas loss of PSMA expression has been reported in case of neuroendocrine dedifferentiation, we present a patient with acinar prostate adenocarcinoma with a loss of PSMA expression after chemotherapy on PET/CT and in histological and immunohistochemical analyses. All tissue samples indicated the retention of acinar features but no expression of neuroendocrine markers (NSE, synaptophysin, chromogranin, and CD56), corresponding to nonelevated serum NSE.

Accurate detection of prostate cancer lymph node metastases (LNM) through PET/CT before lymphadenectomy is crucial for successful therapy. PET/CT with choline derivatives used to be the standard tool for imaging metastases, whereas (68)Ga-PSMA (prostate-specific membrane antigen) PET/CT was introduced recently. Both PET techniques were investigated with respect to what extent the detection rate of LNM depends on the size of tumor deposits (TDs) within LNM. Methods: Documenting the switch from the use of (18)F-choline to (68)Ga-PSMA in 2014, we used 2 patient cohorts undergoing a template lymphadenectomy because of a PET/CT indicating LNM. Forty-four and 40 patients underwent PET/CT with (18)F-choline or (68)Ga-PSMA ligand, respectively. In total, 226 LNM (125 (18)F-choline, 101 (68)Ga-PSMA) originated from 73 salvage lymphadenectomies at biochemical recurrence and from 11 primary lymphadenectomies at radical prostatectomy. LNM eligible for direct correlation of PET/CT to histopathology were identified from lymphadenectomies conducted in small anatomic subregions, with 1 LNM (condition 1) or 1–2 LNM (condition 2). Longitudinal and short diameters of TD within LNM were determined by histopathology, allowing linking of the size of TD in LNM to the detection threshold of PET/CT. Diameters associated with a detection rate of 50% and 90% (d(50%), d(90%)) were calculated on the basis of logistic growth curve models fitted. Results: Gleason score, number of removed LNs, and subregions for lymphadenectomy per patient did not differ significantly between the (18)F-choline and (68)Ga-PSMA groups. The median prostate-specific antigen level at imaging and number of LNM per patient were significantly higher in the (18)F-choline group (3.4 ng/mL, n = 34) than in the (68)Ga-PSMA group (2.2 ng/mL, n = 28; both P < 0.05). Longitudinal and short diameters of TD in LNM to reach d(90%) were 11.2 and 7.4 mm, respectively, for (18)F-choline PET/CT and 6.3 and 4.9 mm, respectively, for (68)Ga-PSMA PET/CT. Corresponding diameters to reach d(50%) were 5.5 and 3.3 mm, respectively, for (18)F-choline PET/CT and 3.7 and 2.3 mm, respectively, for (68)Ga-PSMA PET/CT. Detection rates were significantly higher under (68)Ga-PSMA (P = 0.005 and 0.04 for longitudinal and short diameter). Conclusion: (68)Ga-PSMA PET/CT is superior to (18)F-choline PET/CT in the detection of LNM. Whether those results will lead to an improved patient outcome after (68)Ga-PSMA PET–guided therapy needs to be investigated by further studies.

Intraoperative identification of lymph node (LN) metastases (LNM) detected on preoperative PSMA PET/CT may be facilitated by PSMA radioguided surgery with the use of a gamma probe. We evaluated the uptake ofSix patients with prostate cancer (PCa) with suspicion of LNM on preoperative PSMA PET/CT underwentOverall 310 LN (mean 52 ± 19.7) were removed from 74 subregions (mean 12 ± 3.7). Of the 310 LN, 35 turned out to be LNM on histopathology. Separation of the samples from all subregions resulted in 318 single specimens: 182 PCa-negative LN samples with 275 LN, 35 single LNM samples, 3 non-nodal PCa tissue samples and 98 fibrofatty tissue samples. The median SULs of nonaffected LN (0.16) and affected LN (13.2) were significantly different (p 0.0001). Based on 38 tumour-containing and 182 tumour-free specimens, ROC analysis revealed an area under the curve of 0.976 (95% CI 0.95-1.00, p 0.0001). Using a SUL cut-off value of 1.136, sensitivity, specificity, positive predictive value, negative predictive value and accuracy in discriminating affected from nonaffected LN were 92.1% (35/38), 98.9% (180/182), 94.6% (35/37), 98.4% (180/183) and 97.7% (215/220), respectively.Ex situ analysis at the level of single LN showed that

PURPOSE: Intraoperative identification of lymph node (LN) metastases (LNM) detected on preoperative PSMA PET/CT may be facilitated by PSMA radioguided surgery with the use of a gamma probe. We evaluated the uptake of 111In-labelled PSMA ligand DKFZ-617 (referred to as 111In-PSMA-617) in unaffected LN and LNM at the level of single LN. METHODS: Six patients with prostate cancer (PCa) with suspicion of LNM on preoperative PSMA PET/CT underwent 111In-PSMA-617-guided lymphadenectomy (LA; four salvage LA and two primary LA). 111In-PSMA-617 (109 ± 5 MBq). was injected Intravenously 48 h prior to surgery Template LAs were performed in small subregions: common, external, obturator and internal iliac vessels, and presacral and retroperitoneal subregions (n = 4). Samples from each subregion were isolated aiming at the level of single LN. Uptake was measured ex situ using a germanium detector. Receiver operating characteristic (ROC) analysis was performed based on 111In-PSMA-617 uptake expressed as standardized uptake values normalized to lean body mass (SUL). RESULTS: Overall 310 LN (mean 52 ± 19.7) were removed from 74 subregions (mean 12 ± 3.7). Of the 310 LN, 35 turned out to be LNM on histopathology. Separation of the samples from all subregions resulted in 318 single specimens: 182 PCa-negative LN samples with 275 LN, 35 single LNM samples, 3 non-nodal PCa tissue samples and 98 fibrofatty tissue samples. The median SULs of nonaffected LN (0.16) and affected LN (13.2) were significantly different (p

Aktuelle Befunde deuten darauf hin, dass Kompetenzen zur interprofessionellen Zusammenarbeit sowohl das Outcome von Gesundheitsleistungen verbessern, als auch die Patientensicherheit und die Arbeitszufriedenheit der Beteiligten erhöhen können. Dem wird in der Ausbildung von Mediziner/innen sowie der von Therapie- und Pflegeberufen in Deutschland noch zu wenig Rechnung getragen, v.a. auch im internationalen Vergleich mit Ländern im skandinavischen und englischsprachigen Raum. Das Vorhaben, Angehörige der Gesundheitsprofessionen bereits in frühen Phasen ihrer Ausbildung miteinander in Kontakt zu bringen und ihnen gemeinsame Lernräume für interprofessionelle Zusammenarbeit zu eröffnen, stellt an bundesdeutschen (Hoch-)Schulen und in Versorgungseinrichtungen immer noch eine große strukturelle und inhaltliche Herausforderung dar. Um dem zu begegnen, werden im Projekt INTERTUT die an der Charité in den letzten Jahren gesammelten Erfahrungen mit extracurricularen studentischen Tutorien genutzt, um interprofessionelle Basiskompetenzen für die spätere Zusammenarbeit verschiedener Gesundheitsprofessionen gezielt einzuüben. Konkret wurden in dem von Oktober 2013 bis Dezember 2015 durchgeführten Projekt interprofessionelle Lerneinheiten – kurz interTUTs – partizipativ entwickelt, erprobt, evaluiert und nachhaltig implementiert. Teilgenommen haben Studierende der Medizin, der Ergo- und Physiotherapie sowie Auszubildende und Studierende der Gesundheits- und Krankenpflege. Die Lerneinheiten haben die bereits am Lernzentrum der Charité erprobte Form extracurricularer studentischer Tutorien. In einem ersten Schritt wurden zwei Basistutorien entwickelt und angeboten, die im Verlauf als Vorbereitung für weitere, darauf aufbauende Tutorien zu interprofessionellen Kernkompetenzen dienten.

Am 15. Juni 2017 fand in Berlin die Netzwerktagung der Berliner Projekte interTUT — Interprofessionelle Tutorien und INTER-M-E-P-P — Interprofessionelles Lernen und Lehren in Medizin, Ergotherapie, Physiotherapie und Pflege statt. Die Tagung prasentierte Herausforderungen, Ergebnisse und Ausblicke auf das weite und weitgehend brachliegende Feld der interprofessionellen Zusammenarbeit in der Gesundheitslandschaft in Deutschland.