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Background: Mobile health (mhealth) is gaining interest, with mobile devices and apps being ever more available among medical facilities and patients. However, in the field of radiation oncology, the medical benefits of mhealth apps are still underexplored. As an additional approach to patient care during radiotherapy, we designed a mobile treatment surveillance app based on patient-reported outcomes., Objective: We aimed to examine the feasibility of app-based treatment surveillance in patients undergoing radiotherapy (RT). Alongside technical practicability and acceptance, we assessed patient satisfaction and quality of life during treatment., Methods: This prospective single-center study was performed at Heidelberg University Hospital between August 2018 and January 2020. During RT we measured patients' quality of life, symptoms, and treatment satisfaction. Respective questionnaires (EORTC QLQ-C30 with diagnosis-specific modules, RAND PSQ-18) were presented to patients via a mobile app running on a designated tablet device. The primary endpoint was determined by the fraction of patients who completed at least 80% of the items. Secondary endpoints were disease-related quality of life and patient satisfaction., Results: A total of 49 cancer patients (14 breast, 13 pelvic, 12 lung, 10 prostate) were eligible for analysis. 79.6% (95% confidence interval: 66.4-88.5%; n = 39) of all patients completed at least 80% of the items received by the mobile app. A mean of 227.5 ± 48.25 questions were answered per patient. Breast cancer patients showed the highest rate of answered questions, with 92.9% (n = 13) completing at least 80% of the items., Conclusion: Patients showed high acceptance, with 79.6% (n = 39) completing at least 80% of the given items. The use of a mobile app for reporting symptoms and quality of life during RT is feasible and well accepted by patients. It may allow for resource-efficient, detailed feedback to the medical staff and assist in the assessment of side effects over time., (© 2023. The Author(s).)

As a complication of subarachnoid hemorrhage (SAH), vasospasm substantially contributes to its morbidity and mortality. We aimed at analyzing predictors of outcome for these patients including the role of endovascular treatment (ET). Our database was screened for patients with SAH treated in our Neuro-ICU from 2009 to 2019. Clinical parameters including functional outcome (modified Rankin Scale, mRS of 0-2 or 3-6 at discharge and after a median follow-up of 18 months) and details about ET were gathered on 465 patients, 241 (52%) of whom experienced vasospasm. Descriptive analyses were performed to identify explanatory variables for the dichotomized mRS score. A logistic regression model was fitted on 241 patients with vasospasm including age, Hunt and Hess Score, extraventricular drainage (EVD), forced hypertension, ET and delayed cerebral ischemia (DCI). The model found a Hunt and Hess Score of 5 (OR = 0.043, p = 0.008), requirement of EVD (OR = 0.161, p < 0.001), forced hypertension (OR = 0.242, p = 0.001), ET (OR = 0.431, p = 0.043) and DCI (OR = 0.229, p < 0.001) to be negative predictors of outcome while age was not. Use of intraarterial nimodipine alone (OR = 0.778, p = 0.705) or including balloon angioplasty (OR = 0.894, p = 0.902) and number of ETs per patient (OR = 0.757, p = 0.416) were not significant in a separate model with otherwise identical variables. While DCI is clearly associated with poor outcome, the influence of ET on outcome remains inconclusive. Limited by their retrospective nature and an indication bias, these data encourage a randomized assessment of ET., (© 2023. Deutsche Gesellschaft für Neurologie e.V.)

Little is known about the metabolic differences between endurance and strength athletes in comparison with sedentary subjects under controlled conditions and about variation of the metabolome throughout one year. We hypothesized that (1) the resting metabolic profile differs between sedentary subjects and athletes and between perennially endurance- and strength-trained athletes and (2) varies throughout one year of training. We performed quantitative, targeted metabolomics (Biocrates MxP ® Quant 500, Biocrates Life Sciences AG, Innsbruck, Austria) in plasma samples at rest in three groups of male adults, 12 strength-trained (weightlifters, 20 ± 3 years), 10 endurance-trained athletes (runners, 24 ± 3 years), and 12 sedentary subjects (25 ± 4 years) at the end of three training phases (regeneration, preparation, and competition) within one training year. Performance and anthropometric data showed significant ( p < 0.05) differences between the groups. Metabolomic analysis revealed different resting metabolic profiles between the groups with acetylcarnitines, di- and triacylglycerols, and glycerophospho- and sphingolipids, as well as several amino acids as the most robust metabolites. Furthermore, we observed changes in free carnitine and 3-methylhistidine in strength-trained athletes throughout the training year. Regular endurance or strength training induces changes in the concentration of several metabolites associated with adaptations of the mitochondrial energy and glycolytic metabolism with concomitant changes in amino acid metabolism and cell signaling.

Within primary care, acute respiratory tract infections (ARTIs) are the most common reason for prescribing antibiotics. The aim of the CHANGE-3 study was to investigate how antibiotic prescribing for non-complicated ARTIs can be reduced to a reasonable level. The trial was conducted as a prospective study consisting of a regional public awareness intervention in two regions of Germany and a nested cluster randomised controlled trial (cRCT) of a complex implementation strategy. The study involved 114 primary care practices and comprised an intervention period of six winter months for the nested cRCT and two times six winter months for the regional intervention. The primary outcome was the percentage of antibiotic prescribing for ARTIs between baseline and the two following winter seasons. The regression analysis confirmed a general trend toward the restrained use of antibiotics in German primary care. This trend was found in both groups of the cRCT without significant differences between groups. At the same time, antibiotic prescribing was higher in routine care (with the public campaign only) than in both groups of the cRCT. With regard to secondary outcomes, in the nested cRCT, the prescribing of quinolones was reduced, and the proportion of guideline-recommended antibiotics increased.

Introduction: Approximately 40% of non-small-cell lung cancer (NSCLC) patients develop brain metastases (BM). Stereotactic radiosurgery (SRS) instead of whole-brain radiotherapy (WBRT) is increasingly administered as an upfront treatment to patients with a limited number of BM. We present outcomes and validation of prognostic scores for these patients treated with upfront SRS., Methods: We retrospectively analyzed 199 patients with a total of 268 SRS courses for 539 brain metastases. Median patient age was 63 years. For larger BM, dose reduction to 18 Gy or hypofractionated SRS in 6 fractions was applied. We analyzed the BMV-, the RPA-, the GPA- and the lung-mol GPA score. Cox proportional hazards models with univariate and multivariate analyses were fitted for overall survival (OS) and intracranial progression-free survival (icPFS)., Results: Sixty-four patients died, 7 of them of neurological causes. Thirty eight patients (19,3%) required a salvage WBRT. Median OS was 38, 8 months (IQR: 6-NA). In univariate analysis as well as multivariate analysis, the Karnofsky performance scale index (KPI) ≥90% (P = 0, 012 and P = 0, 041) remained as independent prognostic factor for longer OS. All 4 prognostic scoring indices could be validated for OS assessment (BMV P = 0, 007; RPA P = 0, 026; GPA P = 0, 003; lung-mol GPA P = 0, 05)., Conclusion: In this large cohort of NSCLC patients with BM treated with upfront and repeated SRS, OS was markedly favourable, in comparison to literature. Upfront SRS is an effective treatment approach in those patients and can decidedly reduce the impact of BM on overall prognosis. Furthermore, the analysed scores are useful prognostic tools for OS prediction., Competing Interests: Disclosure Dr. Adeberg reports Grants from Novocure GmbH, Accuray International Sàrl, Merck Serono GmbH and outside the submitted work. Consulting fees from Accuray International Sàrl, Sanofi Genzyme, AstraZeneca and honoraria for lectures / presentations from Accuray International Sàrl and MSD outside the submitted work. Travel reimbursements from AstraZeneca outside the submitted work. Advisory boards for Sanofi Genzyme and Novartis outside the submitted work. Dr. König reports personal fees from speaker fees from the company Optune, outside the submitted work. Prof. Dr. Christopoulos reports grants and personal fees from Roche, grants and personal fees from Takeda, grants from Amgen, grants from Merck, grants and personal fees from AstraZeneca, grants and personal fees from Novartis, personal fees from Gilead, personal fees from Janssen, personal fees from Daiichi Sankyo, personal fees from Eli Lilly, personal fees from Pfizer, personal fees from Chugai, personal fees from Boehringer Ingelheim, outside the submitted work. Dr. Eichkorn reports and Travel reimbursement from Bristol-Myers Squibb outside the submitted work. Prof. Dr. Rieken reports personal fees from Accuray Inc., personal fees from AstraZeneca GmbH, personal fees from Bristol Myers Squibb GmbH & Co., personal fees from Novocure GmbH, personal fees from Merck KGaA, grants from Accuray Inc., outside the submitted work. Prof. Dr. Debus reports grants from Viewray Inc, grants from Accuray International Sari, grants from RaySearch Laboratories AB, grants from Vision RT Limited, grants from Merck Serono GmbH, grants from Astellas Pharma GmbH, grants from Astra Zeneca GmbH, grants from Siemens Healthcare GmbH, grants from Solution Akademie GmbH, grants from Egomed PLC Surrey Reserach Park, grants from Quintiles GmbH, grants from Pharmaceutical Research Associates GmbH, grants from Boehringer Ingelheim Pharma GmbH&CoKG, grants from PTW-Freiburg Dr. Pychlau GmbH, grants from Nanobiotix S.A., grants from Accuray Incorporated, outside the submitted work. PD Dr. El Shafie reports grants from Ruprecht-Karls Universität Heidelberg, during the conduct of the study; personal fees from Accuray Inc., personal fees from AstraZeneca GmbH, personal fees from Bristol Myers Squibb GmbH & Co., personal fees from Novocure GmbH, personal fees from Merck KGaA, personal fees from Takeda GmbH, grants from Accuray Inc., outside the submitted work. The remaining authors declare no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Integrated mental health care models that provide rapid access to video consultations with mental health specialists for primary care patients are a promising short-term, low-threshold treatment option and may reduce waiting times for specialist care. This qualitative study, nested within a randomized feasibility trial, aimed to explore participants' views on this type of care model, its influence on the lived experience of patients, and barriers and facilitators for its delivery., Methods: In five primary care practices, 50 adults with depression and/or anxiety were randomly assigned to either an integrated care model (maximum of five video consultations with a mental health specialist) or usual care (primary care or another treatment option). Prior to obtaining the trial results, interviews were held with participants who had received video consultations. Interviews were transcribed and analysed thematically., Results: Twenty of the 23 patients who received video consultations participated in the interviews. Patients engaged well with the care model and reported positive effects on their most pressing needs, while denying safety concerns. Generally, they perceived the usability of video consultations as high, and temporary connectivity failures were not considered a substantial barrier. We identified two key mechanisms of impacts on the patients' lived experience: fast access to specialist mental healthcare and the emerging rapport with the specialist. In particular, patients with no prior mental healthcare experience indicated that familiarity with the primary practice and their physician as a gatekeeper were important facilitators of proactive treatment., Conclusions: From the patients' perspective, mental health care models integrating video consultations with mental health specialists into primary care are linked to positive lived experiences. Our findings imply that primary care physicians should promote their role as gatekeepers to (1) actively engage patients, (2) apply integrated care models to provide a familiar and safe environment for conducting mental health care video consultations, and (3) be able to regularly assess whether certain patients need in-person services. Scaling up such models may be worthwhile in real-world service settings, where primary care physicians are faced with high workloads and limited specialist services., Trial Registration: DRKS00015812., (© 2023. The Author(s).)

In this study, we assessed the dynamic segmental anatomy of the entire ascending aorta (AA), enabling the determination of a favorable proximal landing zone and appropriate aortic sizing for the most proximal thoracic endovascular aortic repair (TEVAR). Methods: Patients with a non-operated AA (diameter < 40 mm) underwent electrocardiogram-gated computed tomography angiography (ECG-CTA) of the entire AA in the systolic and diastolic phases. For each plane of each segment, the maximum and minimum diameters in the systole and diastole phases were recorded. The Wilcoxon signed-rank test was used to compare aortic size values. Results: A total of 100 patients were enrolled (53% male; median age 82.1 years; age range 76.8−85.1). Analysis of the dynamic plane dimensions of the AA during the cardiac cycle showed significantly higher systolic values than diastolic values (p < 0.001). Analysis of the proximal AA segment showed greater distal plane values than proximal plane values (p < 0.001), showing a reversed funnel form. At the mid-ascending segment, the dynamic values did not notably differ between the distal plane and the proximal segmental plane, demonstrating a cylindrical form. At the distal segment of the AA, the proximal plane values were larger than the distal segmental plane values (p < 0.001), thus generating a funnel form. Conclusions: The entire AA showed greater systolic than diastolic aortic dimensions throughout the cardiac cycle. The mid-ascending and distal-ascending segments showed favorable forms for TEVAR using a regular cylindrical endograft design. The most proximal segment of the AA showed a pronounced conical form; therefore, a specific endograft design should be considered.

Background: Current evidence about long-term survival of all-ceramic implant-supported cantilever fixed dental prostheses (cFDP) is limited., Purpose: To evaluate the survival and complication rates of all-ceramic and metal-ceramic implant-supported cFDPs located in anterior and posterior sites, under consideration of risk factors., Methods of Study: The retrospective analysis compared an experimental group (75 implant-supported cFDPs among 48 patients [mean age 60.47 ± 9.25 years; 21 men]; mean observation period 3.56 years) with a control group (300 implant-supported non-cantilever FDPs [ncFDP] among 241 patients [mean age 62.85 ± 10.72 years; 109 men]; mean observation period 7.25 years). Kaplan-Meier estimates were used to describe the long-term survival and success of both groups. Log-rank tests were used for group comparisons. Mixed-effects Cox proportional hazards regression models were used to examine the effects of restoration- and site-specific risk factors. A random intercept was included in the models to take multiple FDPs per patient into account., Results: Five-year cumulative survival until loss of restoration was 97.1% (95% confidence interval [CI] 0.93-1.00) for cFDPs and 97.0% (95% CI 0.95-0.99) for ncFDPs. Ten-year survival was 93.7% (95% CI 0.86-1.00) for cFDPs and 92.8% (95% CI 0.87-0.98) for ncFDPs, no difference between the survival curves of these groups was observed. Success differed between cFDPs and ncFDPs (p Log  = 0.002), zirconia and metal frameworks (p Log  < 0.001), and provisional and definitive cements (p Log  = 0.025). The effects of the variables "framework material" and "attachment method" were confirmed in a mixed-effects Cox regression model. Loss of retention was the predominant complication for both cFDPs and ncFDPs and usually affected provisionally cemented FDPs., Conclusions: cFDPs do not differ from ncFDPs with regard to long-term failure, whereas additional complications were higher for cFDPs. Fewer complications were observed for zirconia frameworks without occlusal veneers and definitive cemented FDPs., Clinical Trial Registration: the trial has no registration number because it commenced before January 31, 2017., (© 2022 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Objective: New onset aspirin resistance during surgery, known as peri-operative aspirin resistance, is observed in up to 30% of vascular surgery patients and is associated with post-operative myocardial damage; questioning aspirin effectiveness towards peri-operative cardiovascular events. The objective of this study was to prospectively evaluate whether peri-operative aspirin resistance in vascular surgery is associated with an adverse cardiovascular outcome., Methods: Based on a sample size calculation, 194 adult elective vascular or endovascular surgery patients receiving aspirin were analysed in this prospective, single centred, non-interventional cohort study. Platelet function was measured before surgery, one hour after incision, four hours post-operatively, and on the morning of the first and second post-operative days using the Multiplate analyser. The primary outcome was myocardial injury after non-cardiac surgery (MINS). Secondary outcomes included major bleeding, admission to intensive care unit, length of hospital stay, and major adverse cardiac and cerebrovascular events. Subgroup analyses were performed for patients with different cardiovascular risk and for patients who underwent endovascular surgery., Results: Peri-operative aspirin resistance was observed in 27.8% of patients but was not associated with MINS (27.8% vs. 32.1%, aspirin resistance vs. no aspirin resistance, OR 0.812, 95% CI 0.406 - 1.624, p = .56) or with any of the secondary endpoints (all p > .050). In nine of the 10 subgroup analyses, aspirin resistance was not associated with a difference in MINS rate. However, in patients with a low cardiovascular risk profile (RCRI 0-2), MINS occurred more frequently in patients without aspirin resistance (p = .049)., Conclusion: This study confirmed previous reports demonstrating that peri-operative aspirin resistance is common in patients undergoing vascular or endovascular surgery. However, in patients who continue aspirin throughout the peri-operative period, aspirin resistance is a phenomenon, which does not appear to be related to MINS. Measuring peri-operative platelet function using the Multiplate analyser with the intention to identify and potentially prevent or treat peri-operative aspirin resistance seems to be dispensable., (Copyright © 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Background: The ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program., Methods: This observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants' views on five domains of the implementation were also measured. Binary logistic and multiple linear regression analyses were used to explore which views on the implementation were associated with participants' adherence to quality circles and use of additional bonus compensation., Results: The analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n = 158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants' views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants' views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance., Conclusion: This study showed an overall high fidelity to the implementation program. Participants' views on the implementation were associated with degree of intervention fidelity., Trial Registration: ISRCTN, ISRCTN58150046., (© 2022. The Author(s).)

Background: Coexistence of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) is common, affecting morbidity and prognosis. This study evaluates outcome after cryoballoon ablation for AF in HFpEF compared with patients without heart failure., Methods: A total of 102 AF patients with left ventricular ejection fraction ≥50% undergoing cryoballoon ablation were prospectively enrolled. Baseline evaluation included echocardiography, stress echocardiography, 6-minute walk test, biomarkers, and quality of life assessment (Short-Form-36). Procedural parameters and clinical, functional and echocardiographic end points at follow-up ≥12 months after AF ablation were compared between patients with and without HFpEF., Results: Patients with HFpEF (n=24) were older (median, 74 years versus 65 years; P =0.001) more often female (83% versus 28%; P <0.001) and characterized by more pronounced AF-related symptoms (median European Heart Rhythm Association score 3 versus 2; P <0.001), higher left atrial pressures (median, 14 mm Hg versus 10 mm Hg; P =0.008), reduced left atrial-appendage velocity (median, 36 cm/s versus 59 cm/s; P <0.001), and reduced distance in the 6-minute walk test (median, 488 m versus 539 m; P <0.001). Patients with HFpEF more often experienced AF recurrence (57% versus 23%; P =0.003), repeat AF ablation (39% versus 14%; P =0.01) and AF-related rehospitalization (26% versus 7%; P =0.016). Heart failure symptoms and elevated cardiac biomarkers persisted, even in patients with HFpEF with successful rhythm control at follow-up. Echocardiographic follow-up showed progression of adverse left atrial remodeling and no relevant improvement in diastolic function in HFpEF. Quality of life improved in patients without HFpEF, whereas patients with HFpEF still exhibited a lower physical component summary score (median, 41.5 versus 53.4; P <0.004)., Conclusions: Patients with HFpEF constitute a distinct subgroup with elevated risk for AF recurrence after cryoballon ablation. Functional hallmarks of HFpEF persist, irrespective of rhythm status at follow-up. Future research is needed to optimize treatment strategies in patients with HFpEF., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT04317911.

Objectives: Accurate description of buccal bone adjacent to mandibular anterior teeth is helpful for planning and monitoring periodontal and orthodontic treatment. Low-dose cone beam computed tomography (LD-CBCT) imaging has shown promising results for very small dental structures in animals. This study asserts that LD-CBCT is sufficiently accurate to measure buccal alveolar bone adjacent to human mandibular anterior teeth., Materials and Methods: Buccal bone level adjacent to 16 mandibular anterior teeth from four human cadavers was measured radiographically using one high-dose (HD) CBCT protocol and two LD-CBCT protocols. The resulting radiographic measurements of buccal bone height (bl) and thickness (bt) were compared with reference probe and reflected-light microscopy measurements. Measurement medians and Bland-Altman plots were calculated, and a linear mixed model was used to compare raters and imaging modalities., Results: All regression coefficients were approximately 0, indicating high interrater, intrarater, and intermodality agreement. No significant differences were found between reference measurements and CBCT protocols. The mean differences for bl measurements were 0.07 mm (rater 1 [r1]) and 0.12 mm (rater 2 [r2]) for HD-CBCT; 0.07 mm (r1) and 0.13 mm (r2) for LD-CBCT-1; and 0.02 mm (r1) and 0.01 mm (r2) for LD-CBCT-2. For bt measurements, mean differences were 0.02 mm (r1) and 0.02 mm (r2) for HD-CBCT; 0.01 mm (r1) and 0.01 mm (r2) for LD-CBCT-1; and 0.00 mm (r1) and 0.01 mm (r2) for LD-CBCT-2., Conclusions: Within the limitations of the present study, LD-CBCT seems to be a precise method for describing buccal bone and its thickness adjacent to mandibular anterior teeth in this experimental setting., Clinical Relevance: For the first time, this study showed LD-CBCT produces excellent results and is a reliable modality for imaging buccal bone in vitro. If clinical studies confirm these results, LD-CBCT could enable better treatment planning and monitoring at a radiation dose that is far lower than that of conventional HD-CBCT but similar to that of panoramic views., (© 2022. The Author(s).)

Purpose: High-definition cone-beam computed tomography (HD-CBCT) offers superior image quality at the cost of higher radiation dose compared to low-dose CBCT (LD-CBCT). The aim of this study was to investigate whether peri-implant bone lesions can be accurately quantified using LD-CBCT, even when including the influence of surrounding tissues., Methods: Twelve titanium implants restored with all-ceramic crowns were placed in bovine bone, and peri-implant lesions were prepared. Radiographic imaging was performed using IR (intraoral radiography), HD-CBCT and LD-CBCT. To simulate the in-vivo situation, the samples were placed inside a dry human mandible, and a second LD-CBCT imaging was performed (LD-CBCT*). The datasets were presented to four observers in random order. Maximum lesion depth and width were measured in a standardized mesiodistal slice in IR, HD-CBCT, LD-CBCT, and LD-CBCT*. Mean lesion depth and width measurements for each sample in HD-CBCT served as reference., Results: Interrater agreement was slight for depth and excellent for width in HD-CBCT and both LD modes. For all observers, measurement deviations from HD-CBCT were below 0.3 mm in the LD protocols (LD-CBCT depth: 0.22 ± 0.17 mm, width: 0.22 ± 0.13 mm; LD-CBCT* depth: 0.24 ± 0.23 mm, width: 0.25 ± 0.21 mm) and at 0.4 mm in IR., Conclusion: Absolute differences between LD-CBCT and HD-CBCT are small, although surrounding tissues decrease LD-CBCT image quality. Within the limitations of an in-vitro trial, LD-CBCT may become an adequate imaging modality for monitoring peri-implant lesions at a substantially decreased radiation dose.

Aim: This prospective in vivo study aimed to optimize the assessment of pulpal contrast-enhancement (PCE) on dental magnetic resonance imaging (dMRI) and investigate physiological PCE patterns., Methodology: In 70 study participants, 1585 healthy teeth were examined using 3-Tesla dMRI before and after contrast agent administration. For all teeth, the quotient of post- and pre-contrast pulp signal intensity (Q-PSI) was calculated to quantify PCE. First, pulp chambers were analysed in 10 participants to compare the coefficient of variation of mean versus maximum Q-PSI values (Q-PSI mean versus Q-PSI max ). Second, dynamic PCE was evaluated in 10 subjects to optimize the time interval between contrast agent application and image acquisition. Finally, 50 participants (age groups: 20-29, 30-39, 40-49, 50-59 and 60-69 years) were examined to analyse age, gender, tooth types and maxilla versus mandible as independent factors of PCE. Statistical analysis was performed using Wilcoxon signed rank test and linear mixed models., Results: PCE assessment based on Q-PSI max was associated with a significantly smaller coefficient of variation compared with Q-PSI mean , with median values of 0.17 versus 0.21 (p = .002). Analysis of dynamic PCE revealed an optimal timing interval for image acquisition 4 min after contrast media application. No significant differences in PCE were observed by comparing age groups, female versus male participants and maxillary versus mandibular teeth (p > .05). Differences between tooth types were small (median Q-PSI max values of 2.52/2.32/2.30/2.20 for molars/premolars/canines/incisors) but significant (p < .05), except for the comparison of canines versus premolars (p = .80)., Conclusions: PCE in dMRI was a stable intra-individual marker with only minor differences between different tooth types, thus forming an important basis for intra-individual controls when assessing teeth with suspected endodontic pathosis. Furthermore, it was demonstrated that PCE is independent of age, gender and jaw type. These findings indicate that dMRI-based PCE analysis could be a valuable diagnostic tool for the identification of various pulp diseases in future patient studies., (© 2021 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

Objectives: Teeth with combined endodontic-periodontal lesions (EPLs) have favorable to hopeless prognoses. The new classification system was developed by the World Workshop on the Classification of Periodontal and Peri-Implant Disease in 2017 and suitable epidemiologic data related to this new system are currently lacking. This study aims to contribute data about the prevalence of EPLs according to the new system., Method and Materials: A total of 1,008 panoramic views taken in 2019 were analyzed, recording the presence of an EPL and other periodontic parameters. Radiographs of bad quality and of the same person were excluded. Additionally, the EPLs' radiographic patterns were rated by two raters according to their shape (j-shaped vs cone-shaped). Descriptive statistical methods as well as t tests for continuous and chi-squared tests for categorical variables were used., Results: Overall, 866 patients (with 18,963 teeth) were included. Prevalence of EPLs was 4.9% (n = 43) (patient-related)/0.4% (n = 71) (tooth-related). Mean age (62.3 years vs 51.5 years), mean maximal percentage of bone loss (60% vs 30%), and mean age-adjusted bone-loss index (1.0 vs 0.6) were considerably higher compared to patients without EPL. A total of 67 EPLs were found in patients with stage III/IV periodontitis and 4 in patients with stage II periodontitis., Conclusions: This is the first study showing prevalence of EPLs (4.9%/0.4%) according to the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Disease. Patients with EPLs have a substantially higher maximal percentage of bone loss and a higher age-adjusted bone-loss index at residual teeth, excluding teeth with EPLs. All patients have at least stage II periodontitis.

Objectives: New CBCT devices have been developed which can provide "low-dose CBCTs (LD-CBCT)". Aim of this study is to investigate the suitability of LD-CBCT for measurement of alveolar buccal/oral bone., Methods and Materials: Vestibular and oral bone loss of the teeth of seven porcine mandibles free of soft tissues were investigated by Micro-CT and three CBCT-modes: high-dose (HD), standard-dose (SD) and low-dose (LD). Radiographic measurements of bone loss (bl) and vestibular and oral bone thickness (bt) were made by two raters at 69 sites. Measurement means and differences, Intraclass correlation (ICC) and Bland-Altman plots were calculated., Results: ICCs between raters(r) concerning bl were 0.954 for HD, 0.949 for SD and 0.945 for LD; concerning bt they were 0.872 for HD, 0.845 for SD and 0.783 for LD. Means of differences of bt measurements were -0.01 mm(r1)/0.00 mm(r2) for HD, 0.04 mm(r1)/0.02 mm(r2) for SD and 0.02 mm(r1)/0.04 mm(r2) for LD; for bl measurements they were 0.06 mm(r1)/0.05 mm(r2) for HD, -0.01 mm(r1)/0.13 mm(r2) for SD and 0.07 mm(r1)/0.16 mm(r2) for LD.Linear regression indicates no noticeable differences between methods and the raters with respect to bl and bt., Conclusions: Relating to the CBCT-device used in this study, LD-CBCT is a promising method to detect and describe buccal and oral periodontal bl and bt. Further studies with human anatomic structures must confirm these results.

Objectives: The aim of this study was to develop a prognostic tool to estimate long-term tooth retention in periodontitis patients at the beginning of active periodontal therapy (APT)., Material and Methods: Tooth-related factors (type, location, bone loss (BL), infrabony defects, furcation involvement (FI), abutment status), and patient-related factors (age, gender, smoking, diabetes, plaque control record) were investigated in patients who had completed APT 10 years before. Descriptive analysis was performed, and a generalized linear-mixed model-tree was used to identify predictors for the main outcome variable tooth loss. To evaluate goodness-of-fit, the area under the curve (AUC) was calculated using cross-validation. A bootstrap approach was used to robustly identify risk factors while avoiding overfitting., Results: Only a small percentage of teeth was lost during 10 years of supportive periodontal therapy (SPT; 0.15/year/patient). The risk factors abutment function, diabetes, and the risk indicator BL, FI, and age (≤ 61 vs. > 61) were identified to predict tooth loss. The prediction model reached an AUC of 0.77., Conclusion: This quantitative prognostic model supports data-driven decision-making while establishing a treatment plan in periodontitis patients. In light of this, the presented prognostic tool may be of supporting value., Clinical Relevance: In daily clinical practice, a quantitative prognostic tool may support dentists with data-based decision-making. However, it should be stressed that treatment planning is strongly associated with the patient's wishes and adherence. The tool described here may support establishment of an individual treatment plan for periodontally compromised patients., (© 2021. The Author(s).)

Objective: Evaluation of survival of teeth with class III furcation involvement (FI) ≥5 years after active periodontal treatment (APT) and identification of prognostic factors., Methods: All charts of patients who completed APT at the Department of Periodontology of Goethe-University Frankfurt, Germany, beginning October 2004 were screened for teeth with class III FI. APT had to be accomplished for ≥5 years. Charts were analysed for data of class III FI teeth at baseline (T0), at accomplishment of APT (T1), and at the last supportive periodontal care (T2). Baseline radiographic bone loss (RBL) and treatment were assessed., Results: One-hundred and sixty patients (age: 54.4 ± 9.8 years; 82 females; 39 active smokers; 9 diabetics, 85 stage III, 75 stage IV, 59 grade B, 101 grade C) presented 265 teeth with class III FI. Ninety-eight teeth (37%) were lost during 110, 78/137 (median, lower/upper quartile) months. Logistic mixed-model regression and mixed Cox proportional hazard model associated adjunctive systemic antibiotics with fewer tooth loss (26% vs. 42%; p = .019/.004) and RBL (p = .014/.024) and mean probing pocket depth (PPD) at T1 (p < .001) with more tooth loss., Conclusions: Subgingival instrumentation with adjunctive systemic antibiotics favours retention of class III furcation-involved teeth. Baseline RBL and PPD at T1 deteriorate long-term prognosis., (© 2021 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Background: Optimal blood pressure (BP) management during endovascular stroke treatment in patients with large-vessel occlusion is not well established. We aimed to investigate associations of BP during different phases of endovascular therapy with reperfusion and functional outcome., Methods: We performed a post hoc analysis of a single-center prospective study that evaluated a new simplified procedural sedation standard during endovascular therapy (Keep Evaluating Protocol Simplification in Managing Periinterventional Light Sedation for Endovascular Stroke Treatment). BP during endovascular therapy in patients was managed according to protocol. Data from four different phases (baseline, pre-recanalization, post recanalization, and post intervention) were obtained, and mean BP values, as well as changes in BP between different phases and reductions in systolic BP (SBP) and mean arterial pressure (MAP) from baseline to pre-recanalization, were used as exposure variables. The main outcome was a modified Rankin Scale score of 0-2 three months after admission. Secondary outcomes were successful reperfusion and change in the National Institutes of Health Stroke Scale score after 24 h. Multivariable linear and logistic regression models were used for statistical analysis., Results: Functional outcomes were analyzed in 139 patients with successful reperfusion (defined as thrombolysis in cerebral infarction grade 2b-3). The mean (standard deviation) age was 76 (10.9) years, the mean (standard deviation) National Institutes of Health Stroke Scale score was 14.3 (7.5), and 70 (43.5%) patients had a left-sided vessel occlusion. Favorable functional outcome (modified Rankin Scale score 0-2) was less likely with every 10-mm Hg increase in baseline (odds ratio [OR] 0.76, P = 0.04) and pre-recanalization (OR 0.65, P = 0.011) SBP. This was also found for baseline (OR 0.76, P = 0.05) and pre-recanalization MAP (OR 0.66, P = 0.03). The maximum Youden index in a receiver operating characteristics analysis revealed an SBP of 163 mm Hg and MAP of 117 mm Hg as discriminatory thresholds during the pre-recanalization phase to predict functional outcome., Conclusions: In our protocol-based setting, intraprocedural pre-recanalization BP reductions during endovascular therapy were not associated with functional outcome. However, higher intraprocedural pre-recanalization SBP and MAP were associated with worse functional outcome. Prospective randomized controlled studies are needed to determine whether BP is a feasible treatment target for the modification of outcomes., (© 2021. The Author(s).)

Objectives: The aim of this study was to evaluate technical/clinical outcomes of the Gore TAG Conformable Thoracic Stent Graft with Active Control System (CTAG with ACS) in thoracic aortic disease since its introduction in Europe in 2017., Methods: Patients undergoing thoracic endovascular aortic repair (TEVAR) with the device between 2017 and 2020 were identified from a prospectively maintained single-centre database and retrospectively analysed. Predominant indications were aortic dissection (n = 46), thoracic/thoraco-abdominal aneurysm (n = 20/n = 7), penetrating ulcer (n = 14) and intramural haematoma (n = 12). Emergency procedures were performed in 47% (54/115). The primary outcome was technical success. Secondary outcomes were clinical success, serious adverse events and procedure-related reintervention. ACS was assessed regarding angulation, accuracy and apposition. The median follow-up was 8.46 months (interquartile range: 3.18-16.89 months)., Results: A total of 115 consecutive patients (82 males, median age 63; interquartile range: 53-74 years) have been included. Technical success was achieved in 95.7% (110/115). Clinical success rate was 80.9% (93/115); mostly due to procedure-related death (n = 14). Overall mortality was 19.1% (22/115), with significant differences between elective/emergency procedures (log-rank: P < 0.001). Procedure-related serious adverse event rate was 44.3% (51/115). Procedure-related reintervention was performed in 20.9% (24/115). The cumulative incidence for reintervention differed significantly between elective/emergency cases (Gray's test: P = 0.0033). Angulation was used in 40.9% of patients (47/115), mostly in type II arches (52.7%). Deployment accuracy was 87.8% (101/115). Sufficient apposition was present in 93.0% (107/115)., Conclusions: This single-centre study shows encouraging performance of the CTAG with ACS in an array of aortic pathologies. Although longer-term data must be awaited, ACS leads to overall favourable device placement. Despite ongoing advances in device technology, TEVAR remains challenging and is associated with significant burden inherent to the underlying disease., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

This study aimed to investigate the geometric reproducibility of three-dimensional (3D) implant planning based on magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT). Four raters used a backward-planning approach based on CBCT imaging and standard software to position 41 implants in 27 patients. Implant planning was repeated, and the first and second plans were analyzed for geometric differences regarding implant tip, entry-level, and axis. The procedure was then repeated for MRI data of the same patients. Thus, 656 implant plans were available for analysis of intra-rater reproducibility. For both imaging modalities, the second-round 3D implant plans were re-evaluated regarding inter-rater reproducibility. Differences between the modalities were analyzed using paired t-tests. Intra- and inter-rater reproducibility were higher for CBCT than for MRI. Regarding intra-rater deviations, mean values for MRI were 1.7 ± 1.1 mm/1.5 ± 1.1 mm/5.5 ± 4.2° at implant tip/entry-level/axis. For CBCT, corresponding values were 1.3 ± 0.8 mm/1 ± 0.6 mm/4.5 ± 3.1°. Inter-rater comparisons revealed mean values of 2.2 ± 1.3 mm/1.7 ± 1 mm/7.5 ± 4.9° for MRI, and 1.7 ± 1 mm/1.2 ± 0.7 mm/6 ± 3.7° for CBCT. CBCT-based implant planning was more reproducible than MRI. Nevertheless, more research is needed to increase planning reproducibility-for both modalities-thereby standardizing 3D implant planning.

Purpose: In this benign tumor entity, preservation of cranial nerve function is of special importance. Due to its advantageous physical properties, proton beam radiotherapy (PRT) is a promising approach that spares healthy tissue. Could PRT go along with satisfactory preservation rates for cranial nerve function without compromising tumor control in patients with cranial nerve schwannoma unsuitable for stereotactic radiosurgery?, Methods: We analyzed 45 patients with cranial nerve schwannomas who underwent PRT between 2012 and 2020 at our institution. Response assessment was performed by MRI according to RECIST 1.1, and toxicity was graded following CTCAE 5.0., Results: The most common schwannoma origin was the vestibulocochlear nerve with 82.2%, followed by the trigeminal nerve with 8.9% and the glossopharyngeal nerve as well as the vagal nerve, both with each 4.4%. At radiotherapy start, 58% of cranial nerve schwannomas were progressive and 95.6% were symptomatic. Patients were treated with a median total dose of 54 Gy RBE in 1.8 Gy RBE per fraction. MRI during the median follow-up period of 42 months (IQR 26-61) revealed stable disease in 93.3% of the patients and partial regression in 6.7%. There was no case of progressive disease. New or worsening cranial nerve dysfunction was found in 20.0% of all patients, but always graded as CTCAE °I-II. In seven cases (16%), radiation-induced contrast enhancements (RICE) were detected after a median time of 14 months (range 2-26 months). RICE were asymptomatic (71%) or transient symptomatic (CTCAE °II; 29%). No CTCAE °III/IV toxicities were observed. Lesions regressed during the follow-up period in three of the seven cases, and no lesion progressed during the follow-up period., Conclusion: These data demonstrate excellent effectiveness with 100% local control in a median follow-up period of 3.6 years with a promising cranial nerve functional protection rate of 80%. RICE occurred in 16% of the patients after PRT and were not or only mildly symptomatic., Competing Interests: TE reports grants from Ruprecht-Karls Universität Heidelberg, Herbert Kienzle Foundation, and Else Kröner-Fresenius Foundation and received travel reimbursement from Bristol-Myers Squibb outside the submitted work. JH-R received speaker fees and travel reimbursement from ViewRay Inc, as well as travel reimbursement and grants from IntraOP Medical and Elekta Instrument AB outside the submitted work. RS reports grants from Ruprecht-Karls Universität Heidelberg, during the conduct of the study; personal fees from Accuray Inc., personal fees from AstraZeneca GmbH, personal fees from Bristol Myers Squibb GmbH & Co., personal fees from Novocure GmbH, personal fees from Merck KGaA, personal fees from Takeda GmbH, and grants from Accuray Inc., outside the submitted work. JD reports grants from the Clinical Research Institute (CRI), grants from View Ray Incl., grants from Accuray International, grants from Accuray Incorporated, grants from RaySearch Laboratories AB, grants from Vision RT limited, grants from Merck Serono GmbH, grants from Astellas Pharma GmbH, grants from Astra Zeneca GmbH, grants from Siemens Healthcare GmbH, grants from Solution Akademie GmbH, grants from Eromed PLC Surrey Research Park, grants from Quintiles GmbH, grants from Pharmaceutical Research Associates GmbH, grants from Boehringer Ingelheim Pharma GmbH Co, grants from PTW-Frieburg Dr. Pychlau GmbH, grants from Nanobiotix A.a., grants from IntraOP Medical, outside the submitted work. LK reports grants from Ruprecht-Karls Universität Heidelberg, personal fees from Accuray Inc., and Novocure GmbH outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Eichkorn, Regnery, Held, Kronsteiner, Hörner-Rieber, El Shafie, Herfarth, Debus and König.)

Objective: Despite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers' experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care., Methods: A qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data., Results: Considering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients' improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention's context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier., Conclusions: MHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes)., Trial Registration Number: DRKS00015812; Results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To measure in vivo 3D accuracy of backward-planned partially guided implant surgery (PGIS) based on dental magnetic resonance imaging (dMRI)., Material and Methods: Thirty-four patients underwent dMRI examinations. Tooth-supported templates were backward planned using standard dental software, 3D-printed, and placed intraorally during a cone beam computed tomography (CBCT) scan. Treatment plans were verified for surgical viability in CBCT, and implants were placed with guiding of the pilot drill. High-precision impressions were taken after healing. The 3D accuracy of 41 implants was evaluated by comparing the virtually planned and definitive implant positions with respect to implant entry point, apex, and axis. Deviations from the dMRI-based implant plans were compared with the maximum deviations calculated for a typical single implant., Results: Twenty-eight implants were placed as planned in dMRI. Evaluation of 3D accuracy revealed mean deviations (99% confidence intervals) of 1.7 ± 0.9mm (1.2-2.1mm) / 2.3 ± 1.1mm (1.8-2.9 mm) / 7.1 ± 4.8° (4.6-9.6°) for entry point / apex / axis. The maximum deviations calculated for the typical single implant surpassed the upper bounds of the 99% CIs for the apex and axis, but not for the entry point. In the 13 other implants, dMRI-based implant plans were optimized after CBCT. Here, deviations between the initial dMRI plan and definitive implant position were only in part higher than in the unaltered group (1.9 ± 1.7 mm [0.5-3.4 mm] / 2.5 ± 1.5 mm [1.2-3.8 mm] / 6.8 ± 3.8° [3.6-10.1°] for entry point / apex / axis)., Conclusions: The 3D accuracy of dMRI-based PGIS was lower than that previously reported for CBCT-based PGIS. Nonetheless, the values seem promising to facilitate backward planning without ionizing radiation., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

The three-armed cluster-randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined the effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to the prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care.

Objectives: To investigate the predictability and image quality of low-dose cone-beam computed tomography (LD-CBCT) in computer-guided implantology., Methods: Pig cadaver mandibles were imaged using high-definition CBCT (HD-CBCT) and LD-CBCT (HD-CBCT: 85 kV, 6 mA, 14.2 s, 767 frames, 1184 mGycm 2 , voxel size 80 µm, effective dose 231 µSv; LD-CBCT: 85 kV, 10 mA, 2.1 s, 384 frames, 84 mGycm 2 , voxel size 160 µm, effective dose 16 µSv; Orthophos SL, Dentsply Sirona, Bensheim, Germany). Digital impressions were taken using intraoral scanning (IOS; Omnicam, Dentsply Sirona). Data of CBCT modalities and IOS were aligned. Forty-eight implants were planned virtually (24 implants per modality; Bone Level 4.1 × 10 mm; Straumann AG, Basel, Switzerland). Implants were inserted using templates by initial pilot drilling ("partially-guided implantation"). Implant positions were recorded using IOS. Geometric deviations between planned and definitive positions were assessed regarding implant apex, entry-point and angle. CBCT image quality was evaluated by raters twice on a four point scale. The results were exploratively compared (linear models, Mann-Whitney-U tests)., Results: Regarding implant apex, deviations were greater for LD-CBCT (mean 3.0±1.2 mm), as compared to HD-CBCT (mean 2.3±1.1 mm). For entry-point, no distinct difference was detected with a mean deviation of 1.4±0.9 mm in LD-CBCT, and 1.7±0.6 mm in HD-CBCT. Regarding angle, deviations were greater for LD-CBCT (mean 13.2±6.3°), as compared to HD-CBCT (mean 9.2±5.3°). The image quality of HD-CBCT provided to be better (mean 2.7±0.6) than that of LD-CBCT (mean 2.5±0.6)., Conclusions: Within the partially-guided approach, the results underline the potential of LD-CBCT alternatively to HD-CBCT for computer-guided implantology. Advantages of HD-CBCT need to be balanced against the higher radiation dose., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Optimal blood pressure is not well established during endovascular therapy of acute ischemic stroke. Applying standardized blood pressure target values for every stroke patient might be a suboptimal approach., Aim: To assess whether an individualized intraprocedural blood pressure management with individualized blood pressure target ranges might pose a better strategy for the outcome of the patients than standardized blood pressure targets. Sample size: Randomization of 250 patients 1:1 to receive either standard or individualized blood pressure management approach., Methods and Design: We conduct an explorative single-center randomized controlled trial with a PROBE (parallel-group, open-label randomized controlled trial with blinded endpoint evaluation) design. In the control group, intraprocedural systolic blood pressure target range is 140-180 mmHg. The intervention group is the individualized approach, which is maintaining the intraprocedural systolic blood pressure at the level on presentation (±10 mmHg). Study outcomes: The primary endpoint is the modified Rankin scale assessed 90 days +/- 2 weeks after stroke onset, dichotomized by 0-2 (favorable outcome) to 3-6 (unfavorable outcome). Secondary endpoints include early neurological improvement, infarction size, and systemic physiology monitor parameters., Discussion: An individualized approach for blood pressure management during thrombectomy could lead to a better outcome for stroke patients. The trial is registered at clinicaltrials.gov as 'Individualized Blood Pressure Management During Endovascular Stroke Treatment (INDIVIDUATE)' under NCT04578288., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Peter Ringleb received honoraria for advisory boards and lecture fees from Boehringer Ingelheim, Bayer, Pfizer and Daichii Sankyo, not related to the topic of the manuscript. Markus A Möhlenbruch received honoraria for lectures including service on speakers bureaus from Medtronic, MicroVention, Stryker (money paid to the institution) and has grants/grants pending from Balt, Medtronic and MicroVention, not related to the topic of the manuscript. Simon Nagel consults Brainomix, has a grant from Cerenovus and received payment for lectures including service on Speakers Bureaus from Pfizer and Boehringer Ingelheim, not related to the topic of the manuscript., (© European Stroke Organisation 2021.)

Background: Antimicrobial resistance is fueled by inappropriate use of antibiotics. Global and national strategies support rational use of antibiotics to retain treatment options and reduce resistance. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) intended to promote rational use of antibiotics for acute non-complicated infections by addressing network-affiliated physicians, primary care teams and patients through multiple interacting interventions. The present study documented patterns of antibiotic prescribing for patients with acute non-complicated infections who consulted a physician in these networks at the start of the ARena project. It explored variation across subgroups of patients and draws comparisons to prescribing patterns of non-targeted physicians., Methods: This retrospective cross-sectional analysis used mixed logistic regression models to explore factors associated with the primary outcome, which was the percentage of patient cases with acute non-complicated respiratory tract infections consulting primary care practices who were treated with antibiotics. Secondary outcomes concerned the prescribing of different types of antibiotics. Descriptive methods were used to summarize the data referring to targeted physicians in primary care networks, non-targeted physicians (reference group), and patient subgroups., Results: Overall, antibiotic prescribing rates were 32.0% in primary care networks and 31.7% in the reference group. General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR = 0.465 CI = [0.302; 0.719], p < 0.001, pediatricians vs. General practitioners: OR = 0.369 CI = [0.135; 1.011], p = 0.053). Quinolone prescribing rates were 9.9% in primary care networks and 8.1% in reference group. Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a guideline-recommended substance. Younger patients were less likely to receive antibiotics (OR = 0.771 CI = [0.636; 0.933], p = 0.008). Female gender was more likely to receive an antibiotic prescription (OR = 1.293 CI = [1.201, 1.392], p < 0.001)., Conclusion: This study provided an overview of observed antibiotic prescribing for acute non-complicated respiratory tract infections in German primary care at the start of the ARena project. Findings indicate potential for improvement and will serve as comparator for the post-interventional outcome evaluation to facilitate describing of potential changes., (© 2021. The Author(s).)

Objectives: To compare the long-term survival of dental implants placed in patients with and without a history of implant failure., Material and Methods: Within a retrospective analysis, an experimental group was selected consisting of 59 patients with 137 implants placed after previous failure. The control group included 1,072 patients with 2,664 implants without previous failure. Kaplan-Meier curves were used to describe the group-specific long-term implant survival. Mixed-effects Cox regression models were applied to examine the effects of patient- and site-specific risk factors. To take multiple implants into account, a random intercept model was applied., Results: During the observation period of up to 15 years, 11 implants (8%) failed in the experimental group and 74 implants (2.5%) in the control group (p < .001). Five-year cumulative survival was 96.8% (95% CI 0.96-0.98) in the control group and 91.5% (95% CI 0.86-0.97) in the experimental group. The variables group assignment and simultaneous augmentation had a significant effect on survival, but this effect was lost in the random intercept model. The effect of implant location remained, whereby the risk of failure was five times lower for mandible implants, irrespective of group (p = .013; 95% CI 0.103-0.767; HR: 0.281)., Conclusions: Long-term implant survival was lower in the experimental group than in the control group. The effect of previous failure was negligible. However, a patient-specific "clustering effect" was observed. Irrespective of previous implant failure, the risk of long-term failure is two times higher for maxillary implants than for mandibular implants., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Background: Emergency intubation is an inherent risk of procedural sedation regimens for endovascular treatment (EVT) of acute ischemic stroke. We aimed to characterize the subgroup of patients, who had to be emergently intubated, to identify predictors of the need for intubation and assess their outcomes., Methods: This is a retrospective analysis of the single-center study KEEP SIMPLEST, which evaluated a new in-house SOP for EVT under primary procedural sedation. We used descriptive statistics and regression models to examine predictors and functional outcome of emergently intubated patients., Results: Twenty of 160 (12.5%) patients were emergently intubated. National Institutes of Health Stroke Scale (NIHSS) on admission, premorbid modified Rankin scale (mRS), Alberta Stroke Program Early CT Score, age and side of occlusion were not associated with need for emergency intubation. Emergency intubation was associated with a lower rate of successful reperfusion (OR, 0.174; 95%-CI, 0.045 to 0.663; p = 0.01). Emergently intubated patients had higher in-house mortality (30% vs 6.4%; p = 0.001) and a lower rate of mRS 0-2 at 3 months was observed in those patients (10.5% vs 37%, p = 0.024)., Conclusions: Emergency intubation during a primary procedural sedation regimen for EVT was associated with lower rate of successful reperfusion. Less favorable outcome was observed in the subgroup of emergently intubated patients. More research is required to find practical predictors of intubation need and to determine, whether emergency intubation is safe under strict primary procedural sedation regimens for EVT.

Background: Most people with mental disorders, including those with severe and chronic disorders, are treated solely by their general practitioner (GP). Nevertheless, specialised mental health care may be required for specific patients. Notably, the accessibility of mental health specialist care is mainly complicated by (a) long waiting times for an appointment with specialists, (b) long travel distances to specialists, particularly in rural and remote areas, and (c) patients' reservations about mental health specialist care (including fear of being stigmatised by seeking such care). To mitigate those barriers, technology-based integrated care models have been proposed. The purpose of this study is to examine the effectiveness and cost-effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care., Methods: In an individually randomised, prospective, two-arm superiority trial with parallel group design, N = 320 patients with anxiety and/or depressive disorder will be recruited in general practices in Germany. The intervention includes a newly developed treatment model based on video consultations with focus on diagnostics, treatment planning, and short-term intervention by mental health specialists. We will systematically compare the effectiveness, cost-effectiveness, and adverse effects of this new model with usual care by the GP: the primary outcome is the absolute change in the mean depressive and anxiety symptom severity measured on the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) from baseline to 6 months after baseline assessment. Follow-up in both groups will be conducted by blinded outcome assessors at 6 months and 12 months after baseline. The main analysis will be based on the intention-to-treat principle. We will optimise the likelihood of treatment effectiveness by strict inclusion criteria for patients, enhanced intervention integrity, and conducting a process evaluation., Discussion: To the best of our knowledge, this is the first confirmatory study on a video-based, integrated care model for the treatment of anxiety and depressive disorders in GP patients in Germany., Trial Registration: ClinicalTrials.gov, United States National Institutes of Health NCT04316572 . Prospectively registered on 20 March 2020.

Purpose: Patients with glioblastoma (GBM) or brain metastases (MET) and atrial fibrillation (AF) might be at an increased risk of intracranial hemorrhage (ICH) due to anticoagulation (AC). Our aim was to assess this risk., Methods: Our institution's database (from 2005 to 2017) was screened for patients with GBM or MET and AF with an indication for AC according to their CHA 2 DS 2 VASc stroke risk score (≥ 2). Required follow-up was at least 3 months. AC was either performed with heparins, phenprocoumon or non-Vitamin K antagonist oral anticoagulants. Applying the propensity score approach, patient cohorts (matched according to primary tumor, age, sex) were generated (GBM [or MET] with AF ± AC, GBM [or MET] without AF/AC, no GBM [or MET] but AF on AC). ICH was defined as clinical deterioration caused by new blood on imaging. A log rank test was performed to compare the risk for ICH between the three groups., Results: In total, 104 patients were identified of which 49 with GBM (37% on AC) and 37 with MET (46% on AC) were successfully matched. Median follow up was 8.6 and 7.2 months, respectively. ICH occurred in 10.2% of GBM + AF and 12.2% GBM-AF, whereas 8% of patients with AF on AC suffered ICH (p = 0.076). 13.5% of patients with MET + AF had ICHs, in the controls it was 16% for MET-AF and 8% for AF on AC (p = 0.11)., Conclusion: AC did not seem to influence the incidence of ICH in patients with glioblastoma or brain metastases within follow up of just under 9 months.