bluuebunny/crossref_metadata_2025_split huggingface dataset:
Update Morbus Basedow
Authors: Allelein Stephanie , Schott Matthias 
Published: January 2019

Was ist neu?
Diagnostik Die europäischen Leitlinien von 2018 beurteilen die Messung der TRAK durch die – meistens in der Routine verwendeten – Kompetitionsassays als hochsensitiv und spezifisch. Hierdurch ist es in der Regel möglich, einen Morbus Basedow sicher zu diagnostizieren und von einer Freisetzungshyperthyreose im Rahmen einer Autoimmunthyreoiditis zu unterscheiden. Zur Unterscheidung von blockierenden und stimulierenden Antikörpern kommen unter wissenschaftlichen Aspekten Bioassays zur Anwendung.
Therapie Entsprechend der aktuellen Empfehlungen sollte wegen des etwas günstigeren Nebenwirkungsprofils – mit Ausnahme von Schwangeren – der Einsatz von Thiamazol/ Carbimazol gegenüber Propylthiouracil (PTU) vorgezogen werden. Bei einem Rezidiv oder bei fehlender Remission innerhalb von 12 bis 18 Monaten mit adäquater thyreostatischer Therapie ist eine ablative Therapie indiziert.
Prognose Zur Einschätzung des Krankheitsverlaufs ist die Bestimmung der TRAK hilfreich.
Schwangerschaft Die kürzlich erschienene Leitlinie zur Behandlung von Schwangeren mit Schilddrüsenerkrankungen gibt neue internationale Empfehlungen zur Therapie der manifesten Hyperthyreose bei Morbus Basedow. In den ersten 16 Schwangerschaftswochen (Phase der Organogenese) wird die Therapie mit PTU und im Falle einer vorbestehenden Behandlung mit Thiamazol eine zügige Umstellung auf PTU empfohlen. In der Schwangerschaft nach der 16. Woche wird nun keine klare Empfehlung bzgl. des einzusetzenden Thyreostatikums ausgesprochen. Es wird ein supprimierter TSH-Wert bei gleichzeitig (hoch-) normalem bzw. leichtgradig erhöhtem fT4-Wert angestrebt.
Endokrine Orbitopathie Eine aktuelle Studie zeigt eine signifikante Besserung der endokrinen Orbitopathie mit Behandlung durch den in Deutschland noch nicht zugelassenen monoklonalen IGF-1-Rezeptor-Antikörper Teprotumumab.
Management of colorectal laterally spreading tumors: a systematic review and meta-analysis
Authors: Russo Pedro , Barbeiro Sandra , Awadie Halim , Libânio Diogo , Dinis-Ribeiro Mario , Bourke Michael 
Published: January 2019

Abstract
Objective and study aims To evaluate the efficacy and safety of different endoscopic resection techniques for laterally spreading colorectal tumors (LST).
Methods Relevant studies were identified in three electronic databases (PubMed, ISI and Cochrane Central Register). We considered all clinical studies in which colorectal LST were treated with endoscopic resection (endoscopic mucosal resection [EMR] and/or endoscopic submucosal dissection [ESD]) and/or transanal minimally invasive surgery (TEMS). Rates of en-bloc/piecemeal resection, complete endoscopic resection, R0 resection, curative resection, adverse events (AEs) or recurrence, were extracted. Study quality was assessed with the Newcastle-Ottawa Scale and a meta-analysis was performed using a random-effects model.
Results Forty-nine studies were included. Complete resection was similar between techniques (EMR 99.5 % [95 % CI 98.6 %-100 %] vs. ESD 97.9 % [95 % CI 96.1 – 99.2 %]), being curative in 1685/1895 (13 studies, pooled curative resection 90 %, 95 % CI 86.6 – 92.9 %, I2 = 79 %) with non-significantly higher curative resection rates with ESD (93.6 %, 95 % CI 91.3 – 95.5 %, vs. 84 % 95 % CI 78.1 – 89.3 % with EMR). ESD was also associated with a significantly higher perforation risk (pooled incidence 5.9 %, 95 % CI 4.3 – 7.9 %, vs. EMR 1.2 %, 95 % CI 0.5 – 2.3 %) while bleeding was significantly more frequent with EMR (9.6 %, 95 % CI 6.5 – 13.2 %; vs. ESD 2.8 %, 95 % CI 1.9 – 4.0 %). Procedure-related mortality was 0.1 %. Recurrence occurred in 5.5 %, more often with EMR (12.6 %, 95 % CI 9.1 – 16.6 % vs. ESD 1.1 %, 95 % CI 0.3 – 2.5 %), with most amenable to successful endoscopic treatment (87.7 %, 95 % CI 81.1 – 93.1 %). Surgery was limited to 2.7 % of the lesions, 0.5 % due to AEs. No data of TEMS were available for LST.
Conclusions EMR and ESD are both effective and safe and are associated with a very low risk of procedure related mortality.
Preoperative computed tomography angiography (CTA) of the body in vascular patients: prevalence and significance of unsuspected extravascular findings
Authors: Turowski Larissa Sarah , Dollinger Marco , Wohlgemuth Walter A. , Wildgruber Moritz , Beyer Lukas Philipp , Pfister Karin , Stroszczynski Christian , Müller-Wille René 
Published: January 2019

Purpose Evaluation of the prevalence and significance of unsuspected extravascular findings on computed tomography angiography (CTA) of the body before endovascular or surgical treatment in vascular patients.
Materials and Methods This study was approved by the local institutional review board. Radiology reports of 806 patients who underwent CTA of the body during January 2004 until December 2014 before endovascular or surgical treatment of vascular diseases were retrospectively reviewed. All unexpected extravascular abnormalities were classified as clinically non-significant (requiring no follow-up) or clinically significant (requiring further follow-up/immediate treatment). The course of patients with significant extravascular findings was retrospectively evaluated.
Results Overall 806 patients were included in this study (592 men; mean age: 67 years). In 778 (96.5 %) of 806 patients 3293 incidental extravascular findings were diagnosed. There were 259 suspicious findings in 205 patients (25.4 %) that required further follow-up or immediate treatment. A previously unknown malignant tumor was diagnosed in 23 (2.9 %) patients. 10 patients (1.2 %) were diagnosed with lung cancer. Malignant tumors were detected more often in men than in women (3.5 % versus 0.9 %). Patients with an incidental tumor were significantly older than patients without a tumor (mean age: 72.3 vs. 67.5 years).
Conclusion Clinically significant unexpected extravascular findings are common in vascular patients. Especially noteworthy are malignant tumors of the lung.
Key points
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Referring Physicians Assess the Quality of Outpatient Diagnostic Imaging Services: Development and Psychometric Evaluation of a Questionnaire
Authors: Jossen Marianne , Valeri Fabio , Heilmaier Christina , Schwappach David 
Published: January 2019

Goal In order to ensure high-quality cooperation between referring physicians and imaging services, it is important to assess the quality of imaging services as perceived by referring physicians. The present study aimed to develop and validate a questionnaire for referring physicians to assess the quality of outpatient diagnostic imaging services.
Materials & Methods The questionnaire was developed by discussing and modifying an existing instrument by the German Association of Surgeons. After qualitative pretesting, the instrument was tested with physicians referring to four outpatient diagnostic imaging services in Switzerland. The results were first assessed using descriptive statistics. The final instrument was tested for validity using the concept of known-groups validity. The hypothesis underlying this procedure was that physicians referring frequently to services estimated the quality of these services to be higher than physicians who referred less often to services. The differences in ratings were assessed using a one-sided two-sample Wilcoxon test. The final questionnaire was tested for internal consistency and reliability using Cronbach’s Alpha.
Results Results show a high level of satisfaction of referring physicians with the relevant services but also potential for quality improvement initiatives. The psychometric evaluation of the final questionnaire shows that it is a valid instrument, showing significant differences between the ratings of physicians referring with high and low frequency. Furthermore, the instrument proves to be consistent and reliable.
Conclusion The final instrument presents a valid, consistent and reliable option for assess the quality of outpatient diagnostic imaging services as perceived by referring physicians. Results can be used as a basis for quality improvement.
Key Points:
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Advanced Pancreatic Cancer: High-Intensity Focused Ultrasound (HIFU) and Other Local Ablative Therapies
Authors: Marinova Milka , Wilhelm-Buchstab Timo , Strunk Holger 
Published: January 2019

Background Locally advanced pancreatic cancer is a life-limiting tumor with a wide range of incapacitating symptoms such as cancer-associated pain. Several local ablative therapies with both thermal and non-thermal sources have recently received significant attention as modern treatment options for local tumor control and symptomatic improvement. The following review article provides an overview of currently available techniques and their outcomes including our own experience with high-intensity focused ultrasound (HIFU) being one of the most exciting and innovative modalities.
Method Our experiences with HIFU treatment are based on 89 pancreatic cancer patients (UICC III-IV). Outcomes such as treatment-related changes in symptoms particularly in cancer pain and quality of life as well as local tumor response, safety and survival were compared to reported studies concerning HIFU, radiofrequency and microwave ablation, cryoablation, irreversible electroporation and stereotactic body radiation therapy.
Results Even though all strategies appeared to be feasible, the unique feature of noninvasiveness represents a substantial advantage of the HIFU procedure. In 85 % of HIFU-treated patients, long-lasting pain relief was achieved. 50 % of patients did not require any analgesic treatment 6 weeks post-ablation. Unfortunately, pain palliation and quality-of-life outcomes are only rarely reported for other local treatment modalities. Tumor mass reduction could be achieved with all ablative therapies, with a mean tumor volume reduction of 60 % after 6 months in HIFU-treated pancreatic tumors. Differences in treatment-associated morbidity were reported. However, they are only partially comparable due to unbalanced study populations.
Conclusion Various local ablative treatment modalities are available and feasible for tumor mass reduction of advanced pancreatic cancer but with different symptomatic benefit for patients. An effective and long-lasting reduction of cancer-related pain was observed following HIFU without insertion of needles or electrodes. Randomized controlled studies for head-to-head comparison of these modalities are warranted in the near future.
Key points:
Citation Format
Ein neues Konzept für die deutschsprachige Weiterbildung in
der Mikrochirurgie: Die Weiterbildungsakademie der Deutschsprachigen
Arbeitsgemeinschaft für Mikrochirurgie (DAM): Ergebnisse der
4-Jahres-Evaluierung
Authors: Bergmeister Konstantin D. , Kneser Ulrich , Kremer Thomas , Harhaus Leila , Daeschler Simeon C. , Pierer Gerhard , Schaefer Dirk J. , Hirche Christoph 
Published: January 2019

Zusammenfassung
Einleitung Eine aktuelle Umfrage unter Ärzten in Weiterbildung zum
Facharzt für Plastische und Ästhetische Chirurgie und Klinikleitern zeigt ein
großes Interesse an einer hochwertigen mikrochirurgischen Weiterbildung. Leider
gefährden ökonomischer Druck sowie forensische Bedenken diese Bemühungen
zunehmend und machen eine Verlagerung des Trainings außerhalb des OPs nötig. Zur
Förderung der mikrochirurgischen Weiterbildung bietet die Deutschsprachige
Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM)
eine Akademie an, um Kollegen ein breites mikrochirurgisches Spektrum zu bieten
und den fachlichen Austausch zu stärken. In dieser Arbeit stellen wir das
Kurskonzept und eine erste Evaluation vor.
Methodik Seit 2015 wurde jährlich durch die DAM eine praxisorientierte
Weiterbildungsakademie mit Gastoperateuren zu allen Schwerpunktbereichen der
Mikrochirurgie an der BG-Klinik Ludwigshafen veranstaltet. Pro Tag wurden
jeweils mindestens 3 mikrochirurgische Eingriffe in den Fachgebieten Brust-,
Nerven-, Knochen/Hand-Extremitäten- und Lymphgefäßrekonstruktion parallel
durchgeführt und begleitet von Fachvorträgen. Die Teilnehmer wurden gebeten,
anonym ihre Erwartungen zu dem Kurskonzept zu definieren sowie den Kurs und
seine Inhalte zu evaluieren.
Ergebnisse Das Format und die Ziele der Akademie werden dargestellt. Im
zweiten Schritt erfolgte die Evaluation, an der sich 79 % der Teilnehmer
beteiligten. 90 % der Teilnehmer waren aus einem Haus der Maximalversorgung oder
Universitätsklinik, wobei 57 % der Abteilungen weniger als 5 mikrochirurgische
Eingriffe pro Woche durchführten. Alle Teilnehmer sahen die Mikrochirurgie als
Teil ihres Arbeitsspektrums und das größte Interesse bestand für die
Extremitäten- (90 %) und die mikrochirurgische Rekonstruktion der Hand (80 %).
Alle Teilnehmer würden den Kurs weiterempfehlen, empfohlen wurde eine
Verbesserung der intraoperativen Video-Übertragung.
Diskussion Diese Arbeit zeigt, dass praxisorientierte Akademien am
Beispiel der Mikrochirurgie ein hochaktuelles Lernformat sind, um den
Limitationen der chirurgischen Aus- und Weiterbildung erfolgreich
entgegenzutreten. Insbesondere der enge Austausch mit den Experten wurde als
wertvoll erachtet, um ein Netzwerk innerhalb der deutschsprachigen
Mikrochirurgie aufzubauen. Die Akademie verfolgt das Ziel, eine junge Generation
von Mikrochirurgen dauerhaft und nachhaltig zu begeistern und ein
professionelles Netzwerk aufzubauen und weiterzuentwickeln.
Angehörigenbefragung zum Sterben im Krankenhaus: Ein Vergleich zwischen Abteilungen für innere Medizin und Palliativstationen in der Steiermark (Österreich)
Authors: Stolz Erwin , Mayerl Hannes , Baumgartner Johann , Steinkellner Karin , Freidl Wolfgang 
Published: January 2019

Zusammenfassung
Hintergrund 49% der Verstorbenen in Österreich sterben gegenwärtig im Krankenhaus, wodurch der Versorgungsqualität am Ende des Lebens sowie der Sterbensqualität im stationären Bereich eine zentrale Bedeutung zukommt. Ziel dieses Kurzbeitrages ist ein Vergleich der Wahrnehmung der Betreuung und des Sterbens im Krankenhaus zwischen Abteilungen für innere Medizin und Palliativstationen aus dem Blickwinkel Angehöriger.
Methode Im Rahmen einer Pilotstudie wurden 2015–2017 210 Angehörige von Patienten die auf 4 Abteilungen für innere Medizin und 2 Palliativstationen im Bundesland Steiermark verstorben waren hinsichtlich ihrer Wahrnehmung der Kommunikation durch die Betreuer, der Betreuungssituation sowie der Zeit des Sterbens des Patienten mittels Fragebogen befragt.
Ergebnisse Es zeigte sich, dass hinsichtlich der Betreuung der Patienten und bezüglich der Zeit des Sterbens (d. h. rechtzeitige Verständigung bei Zustandsverschlechterung des Patienten, beim unmittelbaren Sterben anwesend sein, Vorbereitung auf das Sterben sowie Qualität des Sterbens) die beiden Palliativstationen von den Angehörigen jeweils deutlich besser bewertet wurden als die Abteilungen für innere Medizin.
Schlussfolgerungen Vor dem Hintergrund der großen Anzahl an Menschen die in Österreich im Krankenhaus versterben, wurde im Rahmen dieser explorativen Studie gezeigt, dass die Betreuungs- und Sterbensqualität auf palliativmedizinischen Stationen im Vergleich zu Stationen für innere Medizin von Angehörigen Verstorbener als besser eingeschätzt wurde. Daher wird eine umfassendere und systematischere Evaluation des möglichen Mehrwerts palliativmedizinischer Einrichtungen in Krankenhäusern in Österreich empfohlen.
Kinetic Gait Analysis of Agility Dogs Entering the A-Frame
Authors: Glyde Mark , Hosgood Giselle , Dempsey Alasdair , Wickham Sarah , Appelgrein Carla 
Published: January 2019

Objective The main purpose of this study was to investigate the effect of a decrease in the A-frame angle of incline on the vertical and cranio-caudal ground reaction forces observed in a homogeneous cohort of agility dogs during entrance and contact with the A-frame.
Materials and Methods A crossover study design was applied to eight large breed dogs to compare the vertical and cranio-caudal ground reaction forces entering the A-frame at three angles of incline: 40° (standard), 35° and 30°. The peak vertical force, passive impact peak, peak propulsive force, peak braking force, the time point (percentile) in the stance phase at which these events occurred and the proportion of time for limb contact spent in braking (% braking) and propulsion (% propulsion) were examined.The variables measured from three trials at each incline were evaluated for a significant effect of A-frame angle with height and velocity included as covariates.
Results The peak propulsive force and the % propulsion were significantly higher at the 40° angle of incline compared with 30° (p = 0.013, p = 0.0165 respectively) and the % braking was significantly lower at the 40° angle of incline compared with 30° (p = 0.0165). There was no significant effect of A-frame angle on the vertical ground reaction forces measured.
Clinical Significance Compared with 30° incline, ascent up the A-frame at a 40° incline requires a higher propulsive force and extended time in propulsion to maintain forward movement and convert potential energy into forward kinetic energy.
Anatomical Study of a Chimeric Fascio-Osteomyocutaneous Fibula Flap for Free Microvascular Tissue Transfer
Authors: Hamscha Ulrike Maria , Weninger Wolfgang Josef , Freystätter Christian , Tzou Chieh-Han , Radtke Christine 
Published: January 2019

Background Functional restoration in reconstructive surgery can require complex and adaptable approaches. In this anatomical study, the combined angiosome of the septofasciomyocutaneous vessels originating from the fibular artery was defined as basis for a chimeric flap of the lateral lower leg.
Methods Methylene blue injection into the fibular artery was performed in 10 legs of fresh cadavers for visualization of the angiosome on the skin, fibula, and adjacent muscles as the lateral hemisoleus (HS) muscle. With regards to clinical specifications a maximum-size flap containing cutaneous, osseous, and muscular elements was raised. During dissection, the distribution pattern, number and size of stained septofasciomyocutaneous vessels at the lateral border of the proximal, middle, and distal thirds of the fibula length, as well as the flap dimensions were evaluated.
Results In all specimens, vessels originating from the fibular artery and supplying the resected fibular bone, the fasciocutaneous flap and dorsally located muscles were found. The mean number of vessels to the skin was 4.2 per leg with a mean diameter of 1.1 ± 0.5 mm (range: 0.4–2.5 mm) and to the HS muscle 3.4 vessels with a mean diameter of 1.2 ± 0.7 mm (range: 0.3–3.0 mm). A total of 88.4% vessels occurred in the proximal and middle thirds of the legs. The resected fibula graft had a mean length of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) and the skin paddle had a mean size of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) × 7.0 cm. The flexor hallucis longus (FHL) muscle had a mean volume of 37.2 ± 15.8 cm3 (range: 18–58 cm3) and the lateral HS muscle 77.1 ± 23.3 cm3 (range: 48–105 cm3).
Conclusion Our results and anatomical descriptions indicate that chimeric fibula flaps can meet the specific reconstructional requirements of complex and large sized defects representing a promising basis for further studies.
Low-Molecular-Weight Heparin in Cancer Patients: Overview and Indications
Authors: Voigtlaender Minna , Langer Florian 
Published: January 2019

AbstractAlthough venous thromboembolism (VTE) is a well-known cause of death in patients with cancer, both its treatment and prevention remain a challenge in daily practice. Direct oral anticoagulants have emerged as safe and efficacious alternatives to vitamin K antagonists in the general population, and recent clinical trials also support their use in select patients with cancer-associated VTE. Despite this, low-molecular-weight heparins (LMWHs), a comparatively ancient class of antithrombotic drugs, remain the anticoagulants of choice in many indications relevant to modern haematology and oncology. In addition to the treatment of established VTE, these indications include VTE prophylaxis in surgical or acutely ill, hospitalized medical cancer patients as well as the prevention of VTE in high-risk patients undergoing ambulatory chemotherapy. In a constantly changing landscape of approved anticancer agents, this review article summarizes pivotal clinical trial data and guideline recommendations regarding the use of LMWH in haematological and oncological patients, who constitute a highly vulnerable patient population due to their increased risk for both bleeding and VTE recurrence.
Trauma-Induced Coagulopathy
Authors: Petros Sirak 
Published: January 2019

AbstractTrauma-induced coagulopathy (TIC) is a heterogeneous entity that contributes to a significant morbidity and mortality following trauma. The activated protein C system, endotheliopathy and platelet dysfunction have been implicated in the pathogenesis of TIC, although there are still controversies on the exact pathogenesis. TIC can be modified by hypoperfusion, acidosis, hypothermia, haemodilution, underlying disease conditions, pre-injury medications as well as genetic predispositions. Current definition of this syndrome is based on laboratory abnormalities that do not easily allow a distinction between adaptive and maladaptive changes of the haemostatic system. The management of the coagulopathy in the early phase of trauma focuses on the treatment of bleeding. The improving quality in the early damage control following trauma has led to a marked reduction in morbidity and mortality. In the later phase, hypercoagulopathy and inflammation contribute to organ dysfunction, venous thromboembolism and poor outcome. Despite considerable advances in trauma management, TIC remains a diagnostic and therapeutic challenge both in the early and late phases of trauma. This review mainly focuses on the pathogenesis of TIC, with a very short discussion on diagnostic and therapeutic principles.
Flow interactions between uncoordinated flapping swimmers give rise to group cohesion
Authors: Newbolt Joel W. , Zhang Jun , Ristroph Leif 
Published: January 2019

Significance
Fish and birds moving in groups are thought to benefit from hydrodynamic or aerodynamic interactions between individuals. To better understand these effects, we devise a robotic “school” of flapping swimmers whose formations and motions come about from flow interactions. Surprisingly, we find that the flows naturally generated during swimming can also prevent collisions and separations, allowing even uncoordinated individuals with different flapping motions to travel together. Other benefits include freeloading by a “lazy” follower who keeps up with a faster-flapping leader by surfing on its wake. More generally, our study provides complete maps linking flapping motions to group locomotion, which is needed to test whether flow interactions are also exploited by animals.