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Menin inhibition enhances graft-versus-leukemia effects by T-cell activation and endogenous retrovirus induction in AML
No full textIndicators of different outcomes after prolonged weaning
No full textThe outcomes of prolonged weaning in a specialist weaning centre range from successful weaning to death. We aimed to identify indicators of the different outcomes. We analysed 915 patients who underwent prolonged weaning at Thoraxklinik Heidelberg from Dec. 2008 to Dec. 2023. 73.2% were successfully weaned, 36.1% without (3a) and 37.1% with subsequent non-invasive ventilation (3b). 20.2% were discharged with IMV (3cI) and 6.6% died (3cII). The length of stay was significantly longer in the group discharged with IMV. Patients in weaning category 3a had fewer comorbidities, also as cause of IMV and were less obese (each at least OR ≤ 0.6, p ≤ 0.02). IMV before admission in days was significantly shorter, FiO2 higher and pCO2 lower, although with a weak effect (OR between 1.014 and 0.971). Indicators of category 3b were younger age (weak effect, OR 0.977), BMI ≥ 30 kg/m2 (OR 2.470, p < 0,001), higher pCO2 (OR 1.044), cause of IMV AECOPD (OR 2.803), pre-diagnosis of COPD (OR 2.073) and nosocomial pneumonia (OR 1.857), whereas patients with malignancy (OR 0.438) and CIP (critical illness polyneuropathy, OR 0.523) were less likely to fall into this category. Indicators of category 3cI were duration of previous IMV with a weak effect (OR 1.006), neuromuscular disease as the cause of IMV (OR 6.023), restrictive thoracic disease (OR 2.330), renal insufficiency (OR 1.977) and CIP (OR 1.744), absence of nosocomial pneumonia (OR 0.366). Only BMI ≤ 20 kg/m2 (OR 3.611), renal insufficiency (OR 1.253) and pre-diagnosed malignancy (OR 1.785) were indicators of category 3cII. The relevant indicators from multivariate analyses were transferred into ROC (receiver operating characteristic) curves and show an acceptable AUC (area under curve) between 0.72 and 0.79 for each of the four outcomes. There are specific indicators for each weaning outcome and an early assessment of each patient’s individual risk profile can help plan further outpatient care, shorten length of stay in the ventilator weaning unit and generate capacities for other patients in need of prolonged weaning
Reducing the Time-to-Antibiotic by Adapting a Standard of Procedure for the Treatment of Pediatric Cancer Patients Presenting with Febrile Neutropenia—A Comparative Analysis of Two Patient Cohorts
No full textBackground: Febrile neutropenia (FN) is a common and potentially life-threatening complication in pediatric oncology. Rapid initiation of empiric antibiotics is critical to improving prognosis. This study evaluated the impact of simple changes to a standard operating procedure (SOP) for FN treatment on the time-to-antibiotic (TTA) in pediatric cancer patients, as well as potential clinical effects.Methods: In this retrospective, single-center, cohort study, children with cancer presenting with FN at the emergency room (pedER) or oncology outpatient department (OD) were included over two one-year periods—before and after SOP adaption. The revised SOP defined a target TTA of ≤30 min. The primary endpoint was to compare median TTA and the proportion of FN episodes meeting target TTA. Secondary endpoints comprised adverse events (AEs) (e.g., ICU admission, need for respiratory or circulatory support, sepsis criteria).Results: After SOP adaption, 32.9% of episodes met target TTA, up from 5.9% before. Median TTA was significantly reduced (44 min vs. 93 min). The improvement persisted during the study period. AE rates showed no significant change.Conclusions: Simple procedural adjustments may significantly improve quality indicators of care, e.g., reducing TTA in pediatric FN patients. These adjustments may be transferable to other pediatric oncology settings
Pulmonary metastasectomy : a multicenter comparison of wedge resection versus anatomic resection for single metastases of colorectal cancer
No full textBackground/Objectives: Patients with single metastases from colorectal cancer constitute a subgroup with an excellent 5-year OS of 55–70% and with a real chance for cure. In this situation, local margin recurrence in the lung may impair the prognosis and thus is the main outcome target of surgery.Methods: A retrospective multicenter analysis of patients with single metastases from colorectal cancers was performed. Four German Thoracic Surgery units contributed data from their prospective metastasectomy databases. Statistical analysis was focused on tumor recurrence and risk factors for local margin recurrence.Results: 166 patients from four centers could be further analyzed. For later comparison, 93 (56%) anatomic resections and 73 (44%) non-anatomic resections were pooled. Tumor recurrence was detected: at any site 87/161 (54%), within the lung 62/161 (38.5%) at intrapulmonary margins 25/145 (17.2%) and in intrathoracic lymph nodes 14/138 (10.1%). Intrapulmonary local margin recurrence was more often found in non-anatomic (25.4%) versus anatomic (11.6%) resections (p = 0.052). After propensity score matching (PSM), local margin recurrence was significantly more frequent after non-anatomic resection of intermediate and peripherally located metastases (p = 0.042). Furthermore, local margin recurrence was associated with small safety margins (p Conclusions: This study demonstrates that anatomical resection of single CRC lung metastases is superior to non-anatomic resection with respect to local radicality and local intrapulmonary margin recurrence, but there was no difference in OS and RFS
Damage control surgery in obstetrics and gynecology : abdomino-pelvic packing in multimodal hemorrhage management
No full textDamage control surgery (DCS) is a staged surgical strategy for rapid control of life-threatening bleeding, followed by physiological stabilization and delayed definitive repair. Abdomino-pelvic packing (APP)—placing compressive material within the pelvis and/or abdomen to tamponade bleeding—is a cornerstone of DCS as a temporizing measure to achieve hemostasis and stabilization in critically unstable patients. This narrative review synthesizes current evidence on DCS with a focus on APP—a technique historically developed in trauma and orthopedic surgery for exsanguinating pelvic bleeding but adaptable to gynecologic and obstetric emergencies. We outline the historical evolution, physiological basis, and stepwise protocol of DCS, adapted to specialty-specific conditions such as postpartum hemorrhage, placenta accreta spectrum, uterine rupture, and hepatic rupture in HELLP syndrome, as well as oncologic surgeries (debulking, exenteration, lymphadenectomy) and benign procedures (trocar-entry injuries in laparoscopy, presacral bleeding in sacrocolpopexy, and retroperitoneal hemorrhage in deep-infiltrating endometriosis). Modern adjuncts—including early tranexamic acid, topical hemostatic agents, and multidisciplinary coordination—have transformed packing from a last-resort maneuver into an integrated component of staged hemorrhage control. In OB/GYN, APP allows for successful hemostasis in 75–90% of cases, with significantly lower mortality rates than trauma surgery. In conclusion, APP as a potentially life-saving maneuver within DCS requires integration into standardized, institution-wide hemorrhage protocols in OB/GYN. Training, simulation, and guideline adoption are critical, particularly in resource-limited settings where advanced interventions for catastrophic bleeding are inaccessible
Statistical shape modelling as a novel reconstruction tool in palaeoanthropology : a case study on fossil pelves
No full text1. Reconstructing incomplete anatomical regions of extinct taxa is critical for understanding their ecological and evolutionary context, including their migration patterns, reproductive strategies and environmental adaptations. In hominins, the pelvis can be particularly challenging to reconstruct because crushing and fragmentation during fossilization affects the delicate pubis and the sacrum. Yet the pelvis provides key information about how adaptations to different ecological niches affected functional morphology and reproduction. Here, we introduce a novel method using statistical shape modelling (SSM) to predict missing skeletal morphology from partially preserved hominin pelvic remains.2. We developed three statistical shape models from different phylogenetic groupings of a dataset of 290 right hipbones comprising 100 Homo sapiens and 190 extant great apes (90 Pan troglodytes, 10 P. paniscus, 57 Gorilla gorilla, 33 G. beringei) and cross-validated each in extinct and extant hominins (Australopithecus afarensis, A. africanus, A. sediba, Neanderthals and Pleistocene humans).3. We found that models based on more diverse reference samples sometimes produced more accurate predictions. Pooling extant humans, chimpanzees and gorillas (SSM3) improved predictions for two of the fossil specimens compared to models with more restricted taxonomic composition. The human–chimpanzee model (SSM2) best predicted Ohalo 2, MH2 and Sts 14. All three models yielded high prediction error for Kebara 2, failing to predict the length and anterior orientation of its pubis.4. Our findings establish SSM as a robust tool for reconstructing missing morphologies in extinct hominin pelves, while highlighting the limitations of this method when the quality of the predictor landmarks is insufficient. We provide a methodological framework for addressing incomplete skeletal morphology in evolutionary anthropology and related disciplines, contributing to the broader understanding of pelvic adaptation in hominin evolution and of the interplay between morphology and ecological adaptation
Vielfalt und Komplexität spätantiker und frühmittelalterlicher Bestattungspraktiken zwischen Bodensee, Hochrhein und Genfersee. Mit einem Beitrag zur ethnischen Deutung von Bestattungspraktiken
No full textDetection of malignant lung tumors using stimulated Raman histology and convolutional neural networks
No full textBackground: Patients with lung tumors often receive their histopathological diagnosis intraoperatively, based on hematoxylin and eosin-stained frozen sections. However, this approach is time and labour-intensive. Intraoperative stimulated Raman histology (SRH) may bypass traditional histopathologic processing as it leverages stimulated Raman scattering (SRS) of photons at molecules in fresh tissue samples to generate histologic images. Automated image analysis using convolutional neural networks (CNNs) could further accelerate intraoperative histopathological diagnosis. This study aimed to investigate CNN-based detection of lung cancer and the ability to distinguish between histologic subtypes, primary lung tumors, and pulmonary metastasis.Methods: A total of 459 fresh frozen tissue samples were obtained from 133 patients undergoing lung resection for intrapulmonary malignancies. SRS and SRH images were acquired, images were annotated, and three CNNs were trained and evaluated on both SRS and SRH images.Results: When distinguishing between intrapulmonary malignancy and normal lung tissue, the three different CNNs VGG19 achieved a balanced accuracy of 0.89 (0.95 on SRH images), ResNet50 achieved a balanced accuracy of 0.87 (0.89 on SRH images), and Inception-ResNet-v2 achieved a balanced accuracy of 0.91 (0.94 on SRH images). On SRS images, Inception-ResNet-v2 (0.91) showed the best results, followed by VGG19 (0.89). Compared to SRS images, the SRH images show higher balanced accuracy. Neither a distinction between primary lung cancer and metastases nor between squamous cell carcinoma and adenocarcinoma was achieved.Conclusions: The results of this study demonstrate the ability of CNNs to identify malignant tumors of the lung on SRS and SRH images. A distinction between different World Health Organization (WHO) subtypes of primary lung cancer and between primary lung cancer and metastases was inaccurate in our dataset
