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Long-term outcomes of arthroscopic management of femoroacetabular impingement syndrome: a systematic review
Full text linkIntroduction Femoroacetabular impingement (FAI) syndrome is a condition characterised by irregularities in the femur or acetabular rim, leading to hip pain, increased risk of osteoarthritis (OA), and potential need for total hip arthroplasty (THA). Non-surgical treatments are the first-line approach. However, arthroscopic surgery has become more prevalent due to its promising short- and medium-term outcomes. Recent meta-analyses suggest that hip arthroscopy may offer superior results compared to non-operative treatments, though follow-up periods in these studies have been limited to 12 months. This systematic review aims to evaluate the long-term effectiveness of arthroscopic management for FAI syndrome, hypothesising that it will significantly improve patient-reported outcomes (PROMs) over a follow-up period exceeding ten years. Methods The review focused on studies published in peer-reviewed journals with a minimum follow-up of 120 months and assessed outcomes such as PROMs and complication rates. It adhered to PRISMA guidelines and used the PICOT algorithm to evaluate the literature. Data extraction covered study characteristics, PROMs, and complications. Statistical analyses were conducted using IBM SPSS software to summarise continuous and dichotomous data. Results Of 1,245 identified articles, 7 were included after rigorous screening. Risk of bias assessment with the ROBINS-I tool revealed a serious or moderate risk of bias due to confounding, although overall methodological quality was acceptable. Data from 478 patients showed significant improvements in PROMs from baseline to follow-up. Conclusion This systematic review indicates that arthroscopic management for FAI syndrome significantly improves PROMs with a mean follow-up of approximately 130 months. Nevertheless, 32% of patients required THA within ten years, underscoring the importance of careful patient selection and consideration of factors like OA and age. While conservative treatments such as physical therapy may yield comparable short-term outcomes, recent evidence suggests that arthroscopy provides superior results, particularly for younger patients and those without preoperative OA. Level of evidence Level II, systematic review and meta-analysis.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Halle (Saale) (8960
Correction: Gender-affirming hormonal therapy induces a gender-concordant fecal metagenome transition in transgender individuals
Full text linkMachine learning based assessment of hoarseness severity: a multi-sensor approach centered on high-speed videoendoscopy
Full text linkIntroduction Functional voice disorders are characterized by impaired voice production without primary organic changes, posing challenges for standardized assessment. Current diagnostic methods rely heavily on subjective evaluation, suffering from inter-rater variability. High-speed videoendoscopy (HSV) offers an objective alternative by capturing true intra-cycle vocal fold behavior. Integrating time-synchronized acoustic and HSV recordings could allow for an objective visual and acoustic assessment of vocal function based on a single HSV examination. This study investigates a machine learning-based approach for hoarseness severity assessment using synchronous HSV and acoustic recordings, alongside conventional voice examinations. Methods Three databases comprising 457 HSV recordings of the sustained vowel /i/, 634 HSV-synchronized acoustic recordings, and clinical parameters from 923 visits were analyzed. Subjects were classified into two hoarseness groups based on auditory-perceptual ratings, with predicted scores serving as continuous hoarseness severity ratings. A videoendoscopic model was developed by selecting a suitable classification algorithm and a minimal-optimal subset of glottal parameters. This model was compared against an acoustic model based on HSV-synchronized recordings and a clinical model based on parameters from other examinations. Two ensemble models were constructed by combining the HSV-based models and all models, respectively. Model performance was evaluated on a shared test set based on classification accuracy, correlation with subjective ratings, and correlation between predicted and observed changes in hoarseness severity. Results The videoendoscopic, acoustic, and clinical model achieved correlations of 0.464, 0.512, and 0.638 with subjective hoarseness ratings. Integrating glottal and acoustic parameters into the HSV-based ensemble model improved correlation to 0.603, confirming the complementary nature of time-synchronized HSV and acoustic recordings. The ensemble model incorporating all modalities achieved the highest correlation of 0.752, underscoring the diagnostic value of multimodal objective assessments. Discussion This study highlights the potential of synchronous HSV and acoustic recordings for objective hoarseness severity assessment, offering a more comprehensive evaluation of vocal function. While practical challenges remain, the integration of these modalities led to notable improvements, supporting their complementary value in enhancing diagnostic accuracy. Future advancements could include flexible nasal endoscopy to enable more natural phonation and refinement of glottal parameter extraction to improve model robustness under variable recording conditions
Measurement of disease-related knowledge of patients with axial spondyloarthritis—Development and application of the G-ASKQ7 questionnaire
No full textZusammenfassung Hintergrund/Ziel Patientenedukation ist integraler Bestandteil der Behandlung von Patient*innen mit axialer Spondyloarthritis (axSpA). Allerdings sind die verfügbaren validen Messinstrumente zur Erhebung des krankheitsbezogenen Wissens veraltet und im Falle der axSpA nur in englischer Sprache verfügbar. Die Ziele dieser Studie waren daher (1) die Entwicklung eines geeigneten deutschsprachigen Instruments zur Messung krankheitsspezifischen Wissens bei axSpA-Patient*innen und (2) die Pilotierung dieses Instruments. Methoden Verfügbare Messinstrumente speziell für die axSpA wurden von einem Expertengremium geprüft, und ein Entwurf des aktuellen G‑ASKQ7 wurde abgestimmt. Nach Evaluation der Augenscheinvalidität und entsprechenden Anpassungen wurden erwachsene konsekutive axSpA-Patient*innen der rheumatologischen Hochschulambulanz des Universitätsklinikums Erlangen gebeten, den Fragebogen auszufüllen. Es wurden Korrelationen zwischen dem erreichten Summenscore und weiteren erhobenen Parametern (Alter, Geschlecht und Krankheitsdauer) untersucht. Ergebnisse Der entwickelte G‑ASKQ7-Fragebogen umfasst 7 Fragen, wurde als leicht verständlich bewertet und innerhalb von durchschnittlich 6,3 ±2,0 min ausgefüllt; 65 axSpA-Patient*innen (36 Frauen; mittleres Alter: 45,3 ± 12,4 Jahre; mittlere Erkrankungsdauer: 8,6 ±7,3 Jahre) beantworteten den finalen Fragebogen. Der G‑AKSQ7-Mittelwert lag bei 17,8/25 und war bei Frauen (19,0/25) signifikant höher als bei Männern (16,3/25) ( p = < 0,05). Am häufigsten wurde Frage 7 (79,3 %) mit Hinblick auf das Selbstmanagement der Erkrankung korrekt beantwortet. Frage 4 mit Blick auf die Messung der Krankheitsaktivität wurde am schlechtesten beantwortet (55,8 %). Es konnte keine signifikante Korrelation zwischen der Krankheitsdauer ( p = 0,57; r = 0,07; Pearson-Korrelationstest) oder dem Alter ( p = 0,67; r = −0,05; Pearson-Korrelationstest) und dem krankheitsbezogenen Wissen festgestellt werden. Diskussion Der G‑ASKQ7 bietet erstmals ein deutschsprachiges Instrument zur Ermittlung des krankheitsspezifischen Wissens von axSpA-Patient*innen. Durch eine routinemäßige Erhebung mittels G‑ASKQ7 kann der individuelle Wissensbedarf von Patient*innen niedrigschwellig ermittelt werden, und Edukationsinhalte können gezielt auf Patient*innen abgestimmt werden. Eine kontinuierliche Aktualisierung und weitere Evaluationsstudien sind erforderlich.Background and objective Patient education is an integral component of the treatment of axial spondyloarthritis (axSpA). However, the validated tools currently available for assessing disease-related knowledge are outdated and, in the case of axSpA, only available in English. The aims of this work were therefore (1) to develop a German-language tool for assessing disease-specific knowledge among axSpA patients and (2) to assess this tool in a pilot study. Methods Available axSpA-specific tools were assessed by a panel of experts and a draft of the current G‑ASKQ7 questionnaire was agreed upon. After evaluation of face validity and subsequent adaptation, consecutive adult axSpA patients of a university hospital (Universitätsklinikum Erlangen) outpatient rheumatology department were asked to complete the questionnaire. Correlation between the patients′ overall scores and other collected parameters (age, sex, and disease duration) were investigated. Results Patients rated the developed G‑ASKQ7 questionnaire comprising seven questions as easy to understand and completed it within an average of 6.3 ± 2.0 min. The final questionnaire was completed by 65 axSpA patients (36 women; mean age 45.3 ± 12.4 years; mean disease duration 8.6 ± 7.3 years). The average G‑AKSQ7 score was 17.8/25, with significantly higher scores among women (19.0/25) than men (16.3/25; p ≤ 0.05). The question most often answered correctly (79.3 %) was question 7 concerning disease self-management, whereas question 4 on measurement of disease activity received the most incorrect answers (55.8 %). No significant correlation between disease duration ( p = 0.57; Pearson′s correlation coefficient, r = 0.07) or age ( p = 0.67; r = −0.05) and disease-specific knowledge was found. Conclusion The G‑ASKQ7 represents the first German-language instrument for measuring disease-specific knowledge among axSpA patients. Routine application of this questionnaire would enable low-threshold assessment of an individual patient′s knowledge requirements and thus provision of appropriate educational information. Continuous updates and further evaluation studies are required.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Erlangen (8546
Winkelabhängigkeit von 3D-Bewegungsparametern eines Silikon-Stimmlippenmodells
Full text linkHintergrund und Ziele:
Die vorliegende Arbeit befasste sich mit dem Vergleich der Algorithmen von Luegmair et al. und Semmler et al., welche beide das Ziel hatten, die 3D Bewegungsinformationen eines Silikon-Stimmlippenmodells zu berechnen. Dies bezog sich sowohl auf die Ermittlung der Amplituden als auch der Bewegungsgeschwindigkeiten, wobei eine Abhängigkeit der Resultate von unterschiedlichen Laryngoskop-Positionen untersucht wurde. Die Untersuchungen
bildeten die Grundlage für eine Etablierung von Berechnungen der Stimmlippenbewegung im dreidimensionalen Raum in der klinischen Routine, um Pathologien der Stimmlippen bereits in frühen Stadien erkennen und therapieren zu können.
Material und Methoden:
Oszillationen eines einschichtigen Silikon-Stimmlippenmodells wurden mittels einer an einem Laryngoskop befestigten Highspeed-Kamera aufgezeichnet. Am Laryngoskop wurde eine Laserlichtquelle angebracht, welche ein 2D Gitter aus Laserpunkten auf die Oberfläche
des Modells projizierte. Der Messwinkel zwischen Laryngoskop und Stimmlippenoberfläche konnte variabel in 5°-Schritten (Bereich α = -15° bis 15°) und der Messabstand zu d = 50mm, 65mm und 80mm verändert werden. Die Rekonstruktion der 3D-Bewegungsinformationen (laterale und vertikale Amplituden, mittlere und maximale Öffnungsgeschwindigkeiten und Schlussgeschwindigkeiten) aus den 2D-Laserprojektionen erfolgte in mehreren Schritten: Detektion der Laserpunkte, Bestimmung der 3D-Positionen, Interpolation der Stimmlippenoberfläche und anschließende Berechnung der Bewegungen gemäß vorher etablierter Algorithmen von Luegmair et al. und Semmler et al.
Ergebnisse:
Algorithmus von Luegmair et al.: Für die lateralen und vertikalen Amplituden, sowie die mittlere laterale und vertikale Öffnungsgeschwindigkeit zeigten sich je nach Messpunkt partiell Korrelationen mit den eingestellten Messwinkeln. Bei den maximalen lateralen Öffnungsgeschwindigkeiten ergab sich eine stark ausgeprägte positive Korrelation. Für die maximalen lateralen Schlussgeschwindigkeiten zeigte sich keine Korrelation zwischen Geschwindigkeit und Messwinkel, für die übrigen Schlussgeschwindigkeiten zeigten sich je nach Messpunkt oder Messabstand partiell Korrelationen mit den Messwinkeln.
Algorithmus von Semmler et al.: Für die lateralen Amplituden zeigte sich eine stark ausgeprägte, signifikante negative Korrelation mit den eingestellten Messwinkeln. Bei den vertikalen Amplituden, den maximalen lateralen und vertikalen Öffnungsgeschwindigkeiten war die negative Korrelation weniger stark ausgeprägt. Die mittleren vertikalen Öffnungsgeschwindigkeiten zeigten mit Ausnahme zweier Werte eine starke negative Korrelation mit den Messwinkeln.
Für alle Schlussgeschwindigkeiten zeigten sich je nach Messpunkt oder Messabstand partiell Korrelationen mit den Messwinkeln.
Schlussfolgerung:
Die Algorithmen von Luegmair et al. und Semmler et al. wiesen unterschiedlich ausgeprägte Abhängigkeiten der untersuchten Parameter von den Messeinstellungen auf. Weitere Untersuchungen ex vivo und in vivo zu beiden Berechnungsverfahren sind notwendig, um diese weiterführend zu validieren
The Influence of Indisulam on Human Immune Effector Cells: Is a Combination with Immunotherapy Feasible?
Full text linkBackground: As a modulator of pre-mRNA splicing, the anti-cancer agent indisulam can induce aberrantly spliced neoantigens, enabling immunologic anti-tumor activity. Consequently, combining indisulam with immunotherapy is expected to be a promising novel approach in cancer therapy. However, a prerequisite for such a combination is that immune effector cells remain functional and unharmed by the chemical. Methods: To ensure the immunocompetence of human immune effector cells is maintained, we investigated the influence of indisulam on ex vivo-isolated T cells and monocyte-derived dendritic cells (moDCs) from healthy donors. We used indisulam concentrations from 0.625 µM to 160 µM and examined the impact on the following: (i) the activation of CD4 + and CD8 + T cells by CD3-crosslinking and via a high-affinity TCR, (ii) the cytotoxicity of CD8 + T cells, (iii) the maturation process of moDCs, and (iv) antigen-specific CD8 + T cell priming. Results: We observed dose-dependent inhibitory effects of indisulam, and substantial inhibition occurred at concentrations around 10 µM, but the various functions of the immune system exhibited different sensitivities. The weaker activation of T cells via CD3-crosslinking was more sensitive than the stronger activation via the high-affinity TCR. T cells remained capable of killing tumor cells after treatment with indisulam up to 40 µM, but T cell cytotoxicity was impaired at 160 µM indisulam. While moDC maturation was also rather resistant, T cell priming was almost completely abolished at a concentration of 10 µM. Conclusions: These effects should be considered in possible future combinations of immunotherapy with the mRNA splicing inhibitor indisulam.This work was supported by funding from the European Unions’ Horizon Europe research and innovation program under grant agreement number 101057250 (CANCERNA) to N.S., J.D. and M.C.-F. on behalf of the CANCERNA Consortium. Furthermore, we thank the Interdisciplinary Center for Clinical Research (IZKF) at the University Hospital of the University of Erlangen-Nuremberg (MD-Thesis Scholarship Program) for their support of L.A.European Unions’ Horizon Europe research and innovation programInterdisciplinary Center for Clinical Research (IZKF) at the University Hospital of the University of Erlangen-Nurember
Long-term cultivation of retinal pigment epithelium cells on nanofiber scaffolds
Full text linkPurpose The retinal pigment epithelium (RPE) plays an important role in the pathogenesis of age-related macular degeneration (AMD) and other retinal degenerative diseases. The introduction of healthy RPE cell cultures into the subretinal space offers a potential treatment strategy. The aim of this study was the long-term culture and characterisation of RPE cells on nanofiber scaffolds. Methods Nanofiber scaffolds consisting of polycaprolactone (PCL) and collagen were prepared by electrospinning. Porcine RPE cell cultures were maintained on PCL scaffolds, PCL-collagen scaffolds, and controls at the bottom of 24-well plates. Cell culture analysis was performed by immunohistochemistry, while the release of inflammatory cytokines IL-6, IL-8, TNF-α, and PDGF-β was measured by ELISA and multiplex assays. Ultrastructural features were examined by transmission electron microscopy. Results The observation period averaged 42.7 weeks for controls, 38.7 weeks for PCL scaffold cultures, and 36.1 weeks for PCL-collagen scaffold cultures, with cell number and morphology remaining stable. TNF-α levels in the supernatants were minimal, IL-6 levels were consistently low, and IL-8 levels decreased from initially high to lower levels over time. Conclusion RPE cells were stably cultured on nanofiber scaffolds for extended periods of time. The long-term physiological properties of RPE cells, including phagocytic ability and visual cycle enzyme activity, need to be further investigated before clinical application. In addition, controlling the expression of inflammatory mediators is a major challenge. Despite these hurdles, overcoming them is critical given the increasing prevalence of retinal degenerative diseases.Key Messages What is known Retinal pigment epithelium (RPE) cells play an important role in the pathogenesis of degenerative retinal diseases. One therapeutic approach is to transplant healthy RPE cells into the subretinal space. Various nanofiber scaffolds have been used in the past to replace Bruch's membrane. What is new RPE cells can be stably cultured on polycaprolactone (PCL) and collagen nanofiber scaffolds for up to one year. RPE cells show characteristic properties in terms of cell number, morphology and secretion behaviour on PCL/collagen nanofiber scaffolds.Open Access funding enabled and organized by Projekt DEAL.Universität Münster (1056
Graph neural networks in multi-stained pathological imaging: extended comparative analysis of Radiomic features
Full text linkPurpose This study investigates the application of Radiomic features within graph neural networks (GNNs) for the classification of multiple-epitope-ligand cartography (MELC) pathology samples. It aims to enhance the diagnosis of often misdiagnosed skin diseases such as eczema, lymphoma, and melanoma. The novel contribution lies in integrating Radiomic features with GNNs and comparing their efficacy against traditional multi-stain profiles. Methods We utilized GNNs to process multiple pathological slides as cell-level graphs, comparing their performance with XGBoost and Random Forest classifiers. The analysis included two feature types: multi-stain profiles and Radiomic features. Dimensionality reduction techniques such as UMAP and t-SNE were applied to optimize the feature space, and graph connectivity was based on spatial and feature closeness. Results Integrating Radiomic features into spatially connected graphs significantly improved classification accuracy over traditional models. The application of UMAP further enhanced the performance of GNNs, particularly in classifying diseases with similar pathological features. The GNN model outperformed baseline methods, demonstrating its robustness in handling complex histopathological data. Conclusion Radiomic features processed through GNNs show significant promise for multi-disease classification, improving diagnostic accuracy. This study’s findings suggest that integrating advanced imaging analysis with graph-based modeling can lead to better diagnostic tools. Future research should expand these methods to a wider range of diseases to validate their generalizability and effectiveness.Open Access funding enabled and organized by Projekt DEAL.Friedrich-Alexander-Universität Erlangen-Nürnberg (1041
Making mistakes is welcome! Interdependencies between perceived error culture, resilience and achievement emotions of students
Full text linkZusammenfassung Lern- und Leistungsemotionen gelten als bedeutsame Einflussgrößen auf Lernprozesse und -ergebnisse im schulischen Kontext. Gemäß der Kontroll-Wert-Theorie (CVT) entstehen Emotionen situativ und im Zusammenspiel von kontextuellen Gegebenheiten und deren individueller Interpretation. Bisherige Studien zeigen, dass eine konstruktive Fehlerkultur im Unterricht in positivem Zusammenhang mit den Emotionen von Schüler:innen steht. Darüber hinaus kann angenommen werden, dass dieser Zusammenhang durch die Resilienz der Schüler:innen, als Fähigkeit der Anpassung an widrige Gegebenheiten, moderiert wird. Bislang wurde dies allerdings empirisch nicht untersucht. Die vorliegende Studie setzt hier an. Im Rahmen von Mehrebenenmodellen wurden die individuell und kollektiv wahrgenommene Fehlerkultur, die Resilienz der Schüler:innen sowie die Interaktion zwischen diesen Variablen als unabhängige Variablen betrachtet, um zu analysieren, in welchem Zusammenhang diese mit den Lern- und Leistungsemotionen Freude, Angst und Langeweile stehen. Die Ergebnisse basieren auf einer Stichprobe von N = 1749 Sekundarschüler:innen (Durchschnittsalter: M = 13,11, SD = 3,65; 47,50 % weiblich) und zeigen, dass eine hohe Resilienz sowie sowohl eine individuell als auch eine kollektiv positiv wahrgenommene Fehlerkultur im Unterricht mit einer höheren Ausprägung von Freude und einer geringeren Ausprägung von Angst und Langeweile einhergehen. Weiterhin zeigt sich, dass die Resilienz den Zusammenhang zwischen der individuell wahrgenommenen Fehlerkultur und den negativen Lern- und Leistungsemotionen moderiert. Der negative Zusammenhang zwischen einer positiven Fehlerkultur und den negativen Lern- und Leistungsemotionen ist bei höherer Resilienz der Schüler:innen stärker. Die Studie verbindet somit die Forschung zu Lern- und Leistungsemotionen mit derjenigen zu Resilienz im Unterrichtskontext und unterstreicht die Bedeutung von Resilienz und einer positiven Fehlerkultur sowie deren Zusammenspiel im Unterricht für das emotionale Erleben von Schüler:innen.Learning and achievement emotions are considered significant factors influencing the learning process and performance in the school context. According to the control-value theory (CVT), emotions arise situationally and through the interplay between contextual circumstances and their individual interpretation. Empirical findings suggest that a constructive error culture in the classroom (a contextual factor) is positively associated with students’ learning and achievement emotions. In addition, it can be assumed that students’ resilience as an ability to adapt to adverse conditions moderates this relationship. However, this has not yet been empirically investigated. This study addresses this research gap. Using multi-level models, the individually and collectively perceived error culture, students’ resilience, and the interaction between these variables were analyzed as independent variables to examine their relationship with students’ learning and achievement emotions, specifically enjoyment, fear, and boredom. The results, based on data from N = 1749 secondary school students (average age: M = 13,11, SD = 3,65; 47,50% female), show that both the individual and the collective positive perception of classroom-related error culture as well as students’ resilience are positively related to their enjoyment and negatively related to their anxiety and boredom. Furthermore, the level of resilience moderates the relationship between the individually perceived error culture and students’ negative achievement emotions. Thus, resilient students benefit more from a positive error culture. This study connects research on achievement emotions with research on resilience in the classroom context and emphasizes the importance of resilience and a positive error culture in the classroom for students’ achievement emotions.Open Access funding enabled and organized by Projekt DEAL.Thüringer Ministerium für Bildung, Jugend uns SportEuropäischer Sozialfondshttp://dx.doi.org/10.13039/501100023651Friedrich-Alexander-Universität Erlangen-Nürnberg (1041
Photon counting CT versus energy‐integrating CT: A comparative evaluation of advances in image resolution, noise, and dose efficiency
Full text linkBackground Photon counting computed tomography (PCCT) employs direct and spectrally resolved counting of individual x‐ray quanta, enhancing image quality compared to the standard energy‐integrating CT (EICT). Purpose To evaluate the quantitative improvements in CT image quality metrics by comparing the first medical PCCT with a state‐of‐the‐art EICT. Methods The PCCT versus EICT noise improvement ratio R was derived from the quantum statistics of the measurement process and measured across the clinical x‐ray flux range for both systems. Detector and system modulation transfer functions (MTFs) were obtained using tilted‐slit and wire phantom measurements. Image root mean square (RMS) noise, noise power spectrum (NPS), and x‐ray patient dose were compared using a CatPhan phantom at two identical clinical target resolutions. Results The measurement of the PCCT noise improvement ratio R showed an elimination of electronic noise and a 10% noise transfer advantage. The PCCT detector MTF exhibited 3x higher angular resolution limits in comparison to EICT and close to ideal sinc behavior due to the electromagnetic formation of pixels in the PCCT semiconductor detector. This translated to 3.5x enhancements in CT system MTF ratios at 10 LP/cm, reflecting a significant improvement in millimeter range CT imaging. Both the improved quantum detection and the system MTF ratio improvement contribute to the measured 3x enhancements in image NPS at 10 LP/cm for identical image target resolution. An improvement of up to 1.7x in RMS image noise was observed accordingly. For low and ultra‐low dose imaging with image filtering, dose efficiency increased between 2x and 10x, demonstrating the PCCT's capability to advance CT ultra‐low dose imaging. Conclusion The direct counting detection in PCCT has been shown to significantly improve sinogram noise and detector MTF ratios compared to energy integrating EICT. The observed translations into CT system MTF, image NPS, image noise, and dose ratios reflect a paradigm shift for CT image quality and dose efficiency