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Topology optimization of broadband acoustic transition section: a comparison between deterministic and stochastic approaches
Full text linkThis paper focuses on the topology optimization of a broadband acoustic transition section that connects two cylindrical waveguides with different radii. The primary objective is to design a transition section that maximizes the transmission of a planar acoustic wave while ensuring that the transmitted wave exhibits a planar shape. Helmholtz equation is used to model linear wave propagation in the device. We utilize the finite element method to solve the state equation on a structured mesh of square elements. Subsequently, a material distribution topology optimization problem is formulated to optimize the distribution of sound-hard material in the transition section. We employ two different gradient-based approaches to solve the optimization problem: namely, a deterministic approach using the method of moving asymptotes (MMA), and a stochastic approach utilizing both stochastic gradient (SG) and continuous stochastic gradient (CSG) methods. A comparative analysis is provided among these methodologies concerning the design feasibility and the transmission performance of the optimized designs, and the computational efficiency. The outcomes highlight the effectiveness of stochastic techniques in achieving enhanced broadband acoustic performance with reduced computational demands and improved design practicality. The insights from this investigation demonstrate the potential of stochastic approaches in acoustic applications, especially when broadband acoustic performance is desired.Open access funding provided by Umea University.Deutsche Forschungsgemeinschafthttp://dx.doi.org/10.13039/501100001659Swedish e-Science Research Centrehttp://dx.doi.org/10.13039/100017156Vetenskapsrådethttp://dx.doi.org/10.13039/501100004359Umea Universit
Proteus effect or bodily affordance? The influence of virtual high-heels on gait behavior
Full text linkShoes are an important part of the fashion industry, stereotypically affect our self-awareness as well as external perception, and can even biomechanically modify our gait pattern. Immersive Virtual Reality (VR) enables users not only to explore virtual environments, but also to control an avatar as a proxy for themselves. These avatars can wear any kind of shoe which might similarly affect self-awareness due to the Proteus Effect and even cause a bodily affordance to change the gait pattern. Bodily affordance describes a behavioral change in accordance with the expected constraints of the avatar a user is embodied with. In this article, we present the results of three user studies investigating potential changes in the gait pattern evoked by wearing virtual high-heels. Two user studies targeted female participants and one user study focused male participants. The participants wore either virtual sneakers or virtual high-heels while constantly wearing sneakers or socks in reality. To measure the gait pattern, the participants walked on a treadmill that also was added to the virtual environment. We measured significant differences in stride length and in the flexion of the hips and knees at heel strike and partly at toe off. Also, participants reported to walk more comfortably in the virtual sneakers in contrast to the virtual high-heels. This indicates a strong acceptance of the virtual shoes as their real shoes and hence suggests the existence of a bodily affordance. While sparking a discussion about the boundaries as well as aspects of the Proteus Effect and providing another insight into the effects of embodiment in VR, our results might also be important for researchers and developers.Open Access funding enabled and organized by Projekt DEAL.Julius-Maximilians-Universität Würzburg (3088
Use of coronary physiology to guide revascularization in clinical practice: results of the F(FR)2 registry
Full text linkBackground Despite the recommendation of coronary physiology to guide revascularization in angiographically intermediate stenoses without established correlation to ischemia, its uptake in clinical practice is slow. Aims This study aimed to analyze the use of coronary physiology in clinical practice. Methods Based on a multicenter registry (Fractional Flow Reserve Fax Registry, F(FR) 2 , ClinicalTrials.gov identifier NCT03055910), clinical use, consequences, and complications of coronary physiology were systematically analyzed. Results F(FR) 2 enrolled 2,000 patients with 3,378 intracoronary pressure measurements. Most measurements (96.8%) were performed in angiographically intermediate stenoses. Out of 3,238 lesions in which coronary physiology was used to guide revascularization, revascularization was deferred in 2,643 (78.2%) cases. Fractional flow reserve (FFR) was the most common pressure index used (87.6%), with hyperemia induced by an intracoronary bolus of adenosine in 2,556 lesions (86.4%) and intravenous adenosine used for 384 measurements (13.0%). The route of adenosine administration did not influence FFR results (change-in-estimate -3.1% for regression model predicting FFR from diameter stenosis). Agreement with the subsequent revascularization decision was 93.4% for intravenous and 95.0% for intracoronary adenosine (p = 0.261). Coronary artery occlusion caused by the pressure wire was reported in two cases (0.1%) and dissection in three cases (0.2%), which was fatal once (0.1%). Conclusions In clinical practice, intracoronary pressure measurements are mostly used to guide revascularization decisions in angiographically intermediate stenoses. Intracoronary and intravenous administration of adenosine seem equally suited. While the rate of serious complications of wire-based intracoronary pressure measurements in clinical practice seems to be low, it is not negligible. Graphical abstractOpen Access funding enabled and organized by Projekt DEAL.Abbott Laboratorieshttp://dx.doi.org/10.13039/100001316Universitätsklinikum Erlangen (8546
Deep learning-based identification of eyes at risk for glaucoma surgery
Full text linkTo develop and evaluate the performance of a deep learning model (DLM) that predicts eyes at high risk of surgical intervention for uncontrolled glaucoma based on multimodal data from an initial ophthalmology visit. Longitudinal, observational, retrospective study. 4898 unique eyes from 4038 adult glaucoma or glaucoma-suspect patients who underwent surgery for uncontrolled glaucoma (trabeculectomy, tube shunt, xen, or diode surgery) between 2013 and 2021, or did not undergo glaucoma surgery but had 3 or more ophthalmology visits. We constructed a DLM to predict the occurrence of glaucoma surgery within various time horizons from a baseline visit. Model inputs included spatially oriented visual field (VF) and optical coherence tomography (OCT) data as well as clinical and demographic features. Separate DLMs with the same architecture were trained to predict the occurrence of surgery within 3 months, within 3–6 months, within 6 months–1 year, within 1–2 years, within 2–3 years, within 3–4 years, and within 4–5 years from the baseline visit. Included eyes were randomly split into 60%, 20%, and 20% for training, validation, and testing. DLM performance was measured using area under the receiver operating characteristic curve (AUC) and precision-recall curve (PRC). Shapley additive explanations (SHAP) were utilized to assess the importance of different features. Model prediction of surgery for uncontrolled glaucoma within 3 months had the best AUC of 0.92 (95% CI 0.88, 0.96). DLMs achieved clinically useful AUC values (> 0.8) for all models that predicted the occurrence of surgery within 3 years. According to SHAP analysis, all 7 models placed intraocular pressure (IOP) within the five most important features in predicting the occurrence of glaucoma surgery. Mean deviation (MD) and average retinal nerve fiber layer (RNFL) thickness were listed among the top 5 most important features by 6 of the 7 models. DLMs can successfully identify eyes requiring surgery for uncontrolled glaucoma within specific time horizons. Predictive performance decreases as the time horizon for forecasting surgery increases. Implementing prediction models in a clinical setting may help identify patients that should be referred to a glaucoma specialist for surgical evaluation.Foundation for the National Institutes of Healthhttp://dx.doi.org/10.13039/10000000
Bildgebende Nahbereichs-Radarsensorik zur hochauflösenden Erfassung menschlicher Bewegung
No full textDerzeit bilden kontaktbasierte Sensoren, beispielsweise optische markerbasierte Systeme oder Inertialsensorik, den Stand der Technik zur Erfassung makroskopischer Bewegung am Menschen. Die zuvor genannten Sensortechniken bringen jedoch verschiedene sensorspezifische Nachteile mit sich. Dazu gehört unter anderem die Beeinflussung der Bewegungen durch das Anbringen von Sensorikbestandteilen am Körper. Kontaktlose kamerabasierte Systeme bieten hierbei eine Alternative. Diese erfassen Bewegungen jedoch nur indirekt durch das Verfolgen von Korrespondenzen oder Posenschätzungen zwischen aufeinanderfolgenden Bildern. Dadurch sind die dafür benötigten Verfahren fehleranfällig und benötigen entweder umfangreiche Trainingsdaten oder extrem rechenintensive Prozesse. Da die präzise, kontaktlose und effiziente Erfassung makroskopischer menschlicher Bewegung für Anwendungen in Medizin, Biomechanik, Robotik und Mensch-Computer-Interaktion von zentraler Bedeutung ist, wurde in dieser Arbeit eine neuartige radargestützte Methode zur hochauflösenden Erfassung und Analyse von Bewegungen entwickelt. Die erarbeitete Methode ermöglicht eine direkte Bewegungserfassung durch die Auswertung des Dopplereffekts, ohne dabei die Bewegung selbst zu beeinflussen. Das Konzept nutzt ein bildgebendes Millimeterwellenradar mit einer stufenweise frequenzmodulierten Dauerstrichsignalform und einer sehr hohen lateralen Auflösung. Die entwickelten Ansätze wurden mithilfe eines Radarversuchssystems mit 94 Sende- und 94 Empfangsantennen simulativ und experimentell verifiziert. Der Fokus innerhalb dieser Dissertation liegt dabei auf der Verifikation des erarbeiteten Konzepts speziell für die Verfolgung von Handbewegungen.
Die dreidimensionale Nahbereichs-Radarbildgebung von Menschen wird bereits seit vielen Jahren in der Sicherheitstechnik eingesetzt. Die Bildraten der verwendeten Systeme sind jedoch so gering, dass sie eine Dopplereffekt-basierte Bewegungsanalyse in aller Regel nicht erlauben. Zudem basiert die 3D-Rekonstruktion auf der Abtastung des gesamten Volumens, das die Messszene umschließt. Die Abbildung und Detektion der Körperoberfläche erfolgt zumeist durch die Projektion der maximalen Amplitude entlang der Tiefenachse sowie die Bestimmung der Tiefe, an der diese maximale Amplitude auftritt. Dieses Vorgehen ist extrem rechenintensiv und damit für eine effiziente Bewegungserfassung wenig geeignet. Gleichzeitig ist die Genauigkeit der Oberflächenschätzung abhängig von der Signalbandbreite, was jedoch unter der Bedingung eines möglichst großen Eindeutigkeitsbereichs für die Entfernungsmessung die Anzahl der gesendeten Frequenzstützstellen und somit auch die Messdauer beeinträchtigt.
Zur Überwindung der zuvor genannten Einschränkungen wurde zunächst eine innovative Methode entwickelt, die eine effiziente und hochauflösende 3D-Rekonstruktion der Körperhülle bei gleichzeitig hoher Messrate erlaubt. Die erarbeitete Methode überträgt das bekannte Prinzip der 1D-Entfernungsmessung mittels Frequenzumtastung (Frequency Shift Keying, FSK) auf die 3D-Nahbereichs-Radarbildgebung, weshalb dieses Vorgehen im Rahmen dieser Dissertation als N-FSK-Bildgebung bezeichnet wird. Bei der erarbeiteten Methode werden zur Erhöhung der Messrate lediglich zwei eng benachbarte Trägerfrequenzen ausgesendet (2-FSK), wodurch sowohl die Messdauer als auch die zu übertragende Datenmenge im Vergleich zum Stand der Technik deutlich reduziert werden. Um die Effizienz der Rekonstruktionsmethode zu steigern, wird anstelle der Abtastung eines vollständigen 3D-Volumens bei jeder Frequenz nur ein Radarbild an einem geschätzten Entfernungstor berechnet. Die Tiefeninformation der Körperoberfläche wird dabei iterativ aus den Phasendifferenzen korrespondierender Pixel gewonnen. Durch dieses Verfahren sinkt der Rechenaufwand für die Bestimmung der Körperhülle erheblich; eine Beispielrechnung zeigt dabei eine Reduktion um den Faktor 1000. Mithilfe von Raytracing-Simulationen wurde für den 2-FSK-Ansatz eine hohe Genauigkeit bei der Detektion der Handoberfläche für verschiedene Handposen erzielt, wobei sich ein mittlerer absoluter Fehler (MAE) von 1,7 mm ergab. Experimentelle Messungen ergaben abweichende Ergebnisse mit einem MAE von 6,6 mm und einer Präzision von 3,6 mm. Die gegenüber der Simulation etwas reduzierte Performanz ist unter anderem auf störende Messeinflüsse wie Rauschen und Clutter zurückzuführen.
Zur Verbesserung der Leistungsfähigkeit wurde die Methodik auf eine 3-FSK-Bildgebung erweitert, die eine zusätzliche Sendefrequenz mit größerem Abstand integriert. Die 3-FSK-Methode kombiniert in Bezug auf die Entfernungsmessung den Vorteil eines hohen Eindeutigkeitsbereichs bei kleiner Differenzfrequenz mit der erhöhten Phasensensitivität einer großen Differenzfrequenz. Dadurch erhöht sich die erreichte Genauigkeit und Präzision der Körperhüllendetektion, ohne die Recheneffizienz und Messdauer des N-FSK-Ansatzes signifikant zu beeinträchtigen. Der MAE und die Präzision wurden so auf die Werte 1,7 mm beziehungsweise 0,3 mm verbessert.
Da herkömmliche Dopplereffekt-basierte Verfahren für Fernfeldbedingungen ausgelegt sind, wird im darauffolgenden Teil dieser Dissertation eine Methode zur pixelgenauen Geschwindigkeitsanalyse im Nahbereich erarbeitet. Durch den Ansatz werden geometrische Verzerrungen, die durch Nahfeldeffekte entstehen, positionsspezifisch für jedes einzelne Pixel korrigiert. Die vorgestellte Methodik ermöglicht eine präzise Erfassung von Tiefenbewegungen mit hoher lateraler Auflösung, unabhängig von der Größe der eingesetzten Apertur, wie mit Punktzielsimulationen belegt werden konnte. Zur messtechnischen Validierung dieser Methode wurden Fingertapping-Bewegungen aufgezeichnet und die radarbasierten Ergebnisse mit einem optischen Referenzsystem verglichen. Die durch das Radar gemessene Fingerspitzengeschwindigkeit weist eine hohe Übereinstimmung mit den Markerdaten des Referenzsystems auf, wobei ein ausgezeichneter MAE von 8 mm/s ermittelt wurde.
Als ein weiterer Beitrag der Dissertation wurde ein Verfahren zur Verfolgung der menschlichen Körperhülle entwickelt, das eine Kombination von Geschwindigkeits- und Positionsdaten nutzt. Auf Basis der 2-FSK-Bildgebung werden zunächst Tiefenkarten der Hautoberfläche generiert. Anschließend wird die pixelspezifische Geschwindigkeit entlang der Tiefenachse erfasst, was die fortlaufende Anpassung der Tiefenschätzungen erlaubt und die Basis für die Lokalisierung in der nächsten Radarsequenz bildet. Durch Fusion der Geschwindigkeitsdaten mit Positionsinformationen und den Einsatz eines α-Filters werden Rausch- und Störeinflüsse reduziert und die Genauigkeit der Bewegungsverfolgung signifikant verbessert. Die Evaluierung des Verfahrens anhand der Verfolgung der Fingerspitzenposition der Fingertapping-Messungen ergab eine extrem hohe Genauigkeit mit einem mittleren absoluten Fehler (MAE) von 1,4 mm und einer Standardabweichung von 0,3 mm.
Die zuvor erläuterte innovative Methode schafft völlig neue Möglichkeiten zur kontaktlosen Verfolgung der bewegten Körperoberfläche entlang der Tiefenachse mittels Nahbereichs-Radarbildgebung. Im Rahmen dieser Arbeit wurde das Verfahren zur Erfassung der Handoberfläche demonstriert. Der vorgestellte Ansatz eröffnet jedoch auch die Möglichkeit, die gesamte vom Radar erfasste Körperhülle zu tracken. Damit stellt die Methode eine bedeutende Weiterentwicklung gegenüber bisherigen Arbeiten dar und schafft somit die Basis für einen entscheidenden Fortschritt in der radarbasierten Erfassung menschlicher Bewegungen.Currently, contact-based sensors, such as optical marker-based systems or inertial sensors, represent the state of the art for capturing macroscopic human movements. However, the aforementioned sensing techniques have various sensor-specific disadvantages, including their influence on motions caused by attaching sensor components to the body. Contactless, camera-based systems offer an alternative, but these capture movements only indirectly by tracking correspondences or pose estimations between consecutive images. As a result, the required methods are prone to errors and demand either extensive training data or highly computationally intensive processes. Given that the precise, contactless, and efficient capture of macroscopic human motions is of central importance for applications in medicine, biomechanics, robotics, and human-computer interaction, this work has developed a novel radar-based method for high-resolution movement capture and analysis. The proposed method enables direct motion detection by evaluating the Doppler effect without influencing the movement itself. The concept uses an imaging millimeter-wave radar with a stepped-frequency continuous-wave signal form and very high lateral resolution. The approaches developed were verified through simulations and experiments using a radar prototype system featuring 94 transmit and 94 receive antennas. This dissertation specifically focuses on verifying the concept developed for tracking hand movements.
Radar-based 3D near-field imaging of humans has been used in security applications for many years. However, the frame rates of these systems are generally too low to enable Doppler effect-based motion analysis. Additionally, 3D reconstruction typically involves sampling the entire volume encompassing the scene. The mapping and detection of the body surface is typically carried out by projecting the maximum amplitude along the depth axis and determining the depth at which this maximum amplitude occurs. This approach is extremely computationally intensive and thus unsuitable for efficient motion capture. Furthermore, the accuracy of surface estimation depends on the signal bandwidth, which, under the constraint of a large unambiguous range for distance measurement, affects the number of transmitted frequency points and consequently the measurement duration.
To overcome these limitations, an innovative method was developed that enables efficient and high-resolution 3D reconstruction of the body surface while maintaining a high measurement rate. The developed method transfers the well-known principle of 1D distance measurement using frequency shift keying (FSK) to 3D near-field radar imaging. Therefore, this approach is referred to as N-FSK imaging in the context of this dissertation. In this approach, only two closely spaced carrier frequencies (2-FSK) are transmitted to increase the measurement rate, significantly reducing both measurement duration and data transmission requirements compared to the state of the art. To improve the efficiency of the reconstruction method, a radar image is computed at an estimated depth gate for each frequency instead of sampling the entire 3D volume. The depth information of the body surface is iteratively derived from phase differences of corresponding pixels. This approach drastically reduces the computational effort for determining the body surface; an example calculation demonstrates a reduction by a factor of 1 000. Using ray-tracing simulations, the 2-FSK approach achieved high accuracy in detecting the hand surface for various hand poses, with a mean absolute error (MAE) of 1.7 mm. Experimental measurements yielded different results with an MAE of 6.6 mm and a precision of 3.6 mm. The slightly reduced performance compared to simulations is partly attributed to disruptive influences such as noise and clutter.
To improve performance further, the methodology was extended to a 3-FSK imaging approach, incorporating an additional transmission frequency with a larger spacing. The 3-FSK method combines the advantage of a large unambiguous range at small difference frequencies with the increased phase sensitivity of a large difference frequency for distance measurements. This enhanced the accuracy and precision of the body surface detection without significantly compromising the computational efficiency and measurement duration of the N-FSK approach. The MAE and precision improved to 1.7 mm and 0.3 mm, respectively.
Since conventional Doppler effect-based methods are designed for far-field conditions, this dissertation introduces a method for pixel-wise velocity analysis in the near field. This approach compensates for geometric distortions caused by near-field effects on a position-specific basis for each pixel. The proposed methodology allows precise depth motion capture with high lateral resolution, independent of the size of the radar aperture, as validated through point target simulations. To experimentally validate this method, finger-tapping movements were recorded, and the radar-based results were compared to an optical reference system. The fingertip velocity measured by the radar showed strong agreement with the marker data from the reference system, achieving an excellent MAE of 8 mm/s.
Another contribution of this dissertation is the development of a method for tracking the human body surface, which combines velocity and positional data. Based on the 2-FSK imaging approach, depth maps of the skin surface are initially generated. Subsequently, the pixel-specific velocity along the depth axis is captured, enabling continuous adjustment of the depth estimations and forming the basis for localization in the next radar sequence. By fusing velocity data with positional information and employing an α-filter, noise and interference are reduced, significantly improving tracking accuracy. The evaluation of the method for tracking the fingertip position during finger-tapping measurements exhibited extremely high accuracy, with an MAE of 1.4 mm and a standard deviation of 0.3 mm.
The innovative method presented here enables entirely new possibilities for contactless tracking of moving body surfaces along the depth axis using near-field radar imaging. This work has demonstrated the method for capturing the hand surface. However, the proposed approach also opens up the possibility of tracking the entire body surface detected by the radar. Thus, this method represents a significant advancement over previous works and lays the foundation for a major leap forward in radar-based human motion capture
PTEN hamartoma tumor syndrome in childhood and adolescence—a comprehensive review and presentation of the German pediatric guideline
Full text linkBackground The PTEN hamartoma tumor syndrome (PHTS) encompasses several different syndromes, which are linked to an autosomal-dominant mutation of the tumor suppressor PTEN gene on chromosome 10. Loss of PTEN activity leads to an increased phosphorylation of different cell proteins, which may have an influence on growth, migration, and apoptosis. Excessive activity of the PI3K/AKT/mTOR pathway due to PTEN deficiency may lead to the development of benign and malignant tumors and overgrowth. Diagnosis of PHTS in childhood can be even more challenging than in adulthood because of a lack of well-defined diagnostic criteria. So far, there are no official recommendations for cancer surveillance in affected children and adolescents. Main body All individuals with PHTS are at high risk for tumor development and thus might benefit from cancer surveillance strategies. In childhood, macrocephaly may be the only evident symptom, but developmental delay, behavioral problems, dermatological features (e.g., penile freckling), vascular anomalies, lipoma, or enlarged perivascular spaces in cerebral magnetic resonance imaging (cMRI) may help to establish the diagnosis. Regular psychomotor assessment and assistance in subjects with neurological impairment play an important role in the management of affected children. Already in early childhood, affected patients bear a high risk to develop thyroid pathologies. For that reason, monitoring of thyroid morphology and function should be established right after diagnosis. We present a detailed description of affected organ systems, tools for initiation of molecular diagnostic and screening recommendations for patients < 18 years of age. Conclusion Affected families frequently experience a long way until the correct diagnosis for their child’s peculiarity is made. Even after diagnosis, it is not easy to find a physician who is familiar with this rare group of diseases. Because of a still-limited database, it is not easy to establish evidence-based (cancer) surveillance recommendations. The presented screening recommendation should thus be revised regularly according to the current state of knowledge.Open Access funding enabled and organized by Projekt DEAL.Rheinische Friedrich-Wilhelms-Universität Bonn (1040
Safety and Efficacy of Brachytherapy in Inoperable Endometrial Cancer
Full text linkBackground/Objectives: Radiotherapy represents the only treatment option for patients with inoperable endometrial cancer (EC). The aim of our study was to evaluate the efficacy and safety of brachytherapy (BT) in this selected patient population. Methods: Between 1990 and 2019, 18 patients with inoperable EC in stage FIGO I–IV were treated with intracavitary brachytherapy using the “Heyman Packing technique”. BT was performed either as sole PDR- or HDR-brachytherapy with a median cumulative dose up to 60.0 Gy (67.9 Gy EQD2 α/β = 3Gy) and 34.0 Gy (75.6 Gy EQD2 α/β = 3Gy), respectively. Results: The median follow-up was 46 months (6–219). The mean age was 71 years. The 5-year cumulative local recurrence rate (CLRR) for the whole cohort was 27.3%. The 5-year overall survival (OS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were 51%, 79%, and 69%. The 5-year DFS for low-, intermediate-, and high-risk EC was 89%, 50%, and 44% (p = 0.51). No significant difference in DFS was observed in patients over 70 (p = 0.526). No late side effects of grade > 1 were documented. Conclusions: Brachytherapy for inoperable EC is a safe and effective treatment option, offering good local control and OS with minimal toxicity. Moreover, brachytherapy effectively controls hemoglobin-relevant bleeding. Therefore, BT should be considered a viable alternative to non-curative treatment strategies in gynecological multidisciplinary conferences.This research received no external funding
Extra-abdominal and intra-abdominal FET::CREM fusion mesenchymal neoplasms: comparative clinicopathological study of 9 new cases further supporting a distinct potentially aggressive sarcoma and report of novel sites
Full text linkWith the wide use of RNA sequencing technologies, the family of FET::CREB fusion mesenchymal neoplasms has expanded rapidly to include potentially aggressive neoplasms, not fitting any well established WHO entity. Recently, a group of intra-abdominal FET ( EWSR1/FUS ) ::CREB ( CREM/ATF1 ) fused unclassified neoplasms has been reported followed by recent recognition of an analogous extra-abdominal category of unclassified neoplasms carrying EWSR1::ATF1 fusions. We describe 9 additional tumors (5 extra-abdominal and 4 abdominal) carrying an EWSR1::CREM ( n = 8) and FUS::CREM ( n = 1) fusion. Patients were 7 females and 2 males aged 10 to 75 years (median, 34). Extra-abdominal tumors originated in the head and neck (2 sinonasal, 1 orbital) and soft tissues (1 gluteal, 1 inguinal). Abdominal tumors involved stomach (2), mesentery (1), and kidney (1). Tumor size ranged from 3.5 to 11 cm (median, 6). Treatment was radical surgery with (5) or without (2) neo/adjuvant radio/chemotherapy. Extended follow-up of 5 patients (21–52 months; median, 24) showed an aggressive course in two (40%); one died of disseminated metastases 52 months after several intensified chemotherapy regimens, and one was alive with progressive abdominal disease at 21 months. The immunophenotype of the two subcohorts was significantly overlapping with variable expression of EMA (7 of 8), keratin AE1/AE3 (5 of 9), CD99 (4 of 7), MUC4 (2 of 8), ALK (3 of 8), synaptophysin (3 of 9), chromogranin (1 of 8), CD34 (3 of 6), CD30 (1 of 6), PAX8 (1 of 7), and inhibin (1 of 7), but no reactivity with desmin (0 of 8), S100 (0 of 8), and SOX10 (0 of 8). This series further solidifies the notion that FET::CREB fusions are not limited to the triad of angiomatoid fibrous histiocytoma, clear cell sarcoma, and malignant gastrointestinal neuroectodermal tumor, but characterize an emerging family of potentially aggressive neoplasms occurring at both intra- and extra-abdominal sites. These tumors underscore the promiscuity of the FET::CREB fusions and highlight the pivotal role of phenotype-oriented classification of these neoplasms that share the same genotype, still featuring significant biological and behavioral distinctness.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Erlangen (8546
Minimally invasive surgeries for spontaneous hypertensive intracerebral hemorrhage (MISICH): a multicenter randomized controlled trial
Full text linkBackground Intracerebral hemorrhage (ICH) is a common stroke type with high morbidity and mortality. There are mainly three surgical methods for treating ICH. Unfortunately, thus far, no specific surgical method has been proven to be the most effective. We carried out this study to investigate whether minimally invasive surgeries with endoscopic surgery or stereotactic aspiration (frameless navigated aspiration) will improve functional outcomes in patients with supratentorial ICH compared with small-bone flap craniotomy. Methods In this parallel-group multicenter randomized controlled trial conducted at 16 centers, patients with supratentorial hypertensive ICH were randomized to receive endoscopic surgery, stereotactic aspiration, or craniotomy at a 1:1:1 ratio from July 2016 to June 2022. The follow-up duration was 6 months. Patients were randomized to receive endoscopic evacuation, stereotactic aspiration, or small-bone flap craniotomy. The primary outcome was favorable functional outcome, defined as the proportion of patients who achieved a modified Rankin scale (mRS) score of 0–2 at the 6-month follow-up. Results A total of 733 patients were randomly allocated to three groups: 243 to the endoscopy group, 247 to the aspiration group, and 243 to the craniotomy group. Finally, 721 patients (239 in the endoscopy group, 246 in the aspiration group, and 236 in the craniotomy group) received treatment and were included in the intention-to-treat analysis. Primary efficacy analysis revealed that 73 of 219 (33.3%) in the endoscopy group, 72 of 220 (32.7%) in the aspiration group, and 47 of 212 (22.2%) in the craniotomy group achieved favorable functional outcome at the 6-month follow-up ( P = .017). We got similar results in subgroup analysis of deep hemorrhages, while in lobar hemorrhages the prognostic outcome was similar among three groups. Old age, deep hematoma location, large hematoma volume, low preoperative GCS score, craniotomy, and intracranial infection were associated with greater odds of unfavorable outcomes. The mean hospitalization expenses were ¥92,420 in the endoscopy group, ¥77,351 in the aspiration group, and ¥100,947 in the craniotomy group ( P = .000). Conclusions Compared with small bone flap craniotomy, endoscopic surgery and stereotactic aspiration improved the long-term outcome of hypertensive ICH, especially deep hemorrhages. Trial Registration ClinicalTrials.gov Identifier: NCT02811614
Klinische Phänotypen bei adipösen Patient*innen mit Binge-Eating Störung, Individuen mit Adipositas und gesunden Kontrollen im Vergleich
Full text linkHintergrund: Adipositas (OB von englisch „obese“) ist eine häufige Komorbidität der Binge-Eating Störung (BED von englisch „binge-eating disorder“). Dies legt nahe, dass beide Erkrankungen phänotypische Eigenschaften im Hinblick auf Essverhalten gemein haben. Jedoch zeigen bisherige Untersuchungen zu diesem Thema inkonsistente Ergebnisse. Das Ziel der Studie „Two of a Kind? Mapping the Psychopathological Space between Obesity with and without Binge Eating Disorder” zu Deutsch „Klinische Phänotypen bei adipösen Patient*innen mit Binge-Eating Störung, Individuen mit Adipositas und gesunden Kontrollen im Vergleich“ war, einen umfangreichen Vergleich von adipösen Patient*innen mit BED mit adipösen Personen ohne BED und gesunden, normalgewichtigen Kontrollpersonen im Hinblick auf Psychopathologien, essensbezogenen Eigenschaften und frühen Lebenserfahrungen aufzustellen.
Methoden: OB-BED Patienten (n=37), OB Personen (n=50) und gesunde Kontrollen (CO) (n=44) bearbeiteten eine Serie standardisierter Fragebögen. Die OB-BED Patienten waren hierbei alles Personen, bei denen die Diagnose BED bereits gestellt wurde. Die Rekrutierung fand unter stationären und ambulanten Patient*innen der psychosomatischen Abteilung des Universitätklinikums Erlangen statt. OB und CO wurden unter Universitätsklinik-mitarbeitenden und Studierenden, sowie Patient*innen der Abteilung für Psychosomatik rekrutiert. Die Antworten der Fragebögen wurden durch univariate Vergleiche und Analysen zur Dimensionalitätsreduktion (lineare Diskriminanzanalyse „LDA“) analysiert.
Ergebnis: Die OB-BED zeigten in mehreren Antwortkategorien die höchsten Werte, zum Beispiel bei Depression, Stress-Essen und Emotionales Essen, „food addiction“ und „food craving“. In Bezug auf kindliche Traumatisierung oder Bindungsstilen konnte kein Unterschied zwischen OB-BED und OB festgestellt werden. Mittels LDA konnte eine zweidimensionale Unterscheidung zwischen gesunden Kontrollen gegenüber OB und OB-BED im Hinblick auf problematisches Essverhalten, Depression, negativer Kindheitserfahrungen aufgestellt werden. Ebenso unterschieden sich OB-BED von den anderen beiden Gruppen bezüglich Tendenzen des emotionalen Essens und Schwierigkeiten der Selbstregulierung.
Conclusio: Die Ergebnisse unterstützen die Vorstellung eines gemeinsamen Spektrums von essensbezogenen Störungen auf dem sich OB-BED und OB bewegen. Gleichzeitig scheint es wichtig, bestimmte Unterscheidungen zu treffen, um BED bei adipösen Patienten zu erkennen und zu behandeln