Das Person-in-the-barrel-Syndrom (PIBS) beschreibt eine isolierte, meist symmetrische Schwäche der proximalen Armmuskulatur bei erhaltener Funktion der unteren Extremitäten und der Gesichtsmuskulatur. Das Syndrom stellt keinen eigenständigen Erkrankungskomplex dar, sondern einen topographisch definierten klinischen Phänotyp, der auf eine Schädigung entlang der motorischen Bahnen auf zerebraler, spinaler oder peripherer Ebene beruht. Eine Manifestation im Rahmen einer Riesenzellarteriitis (RZA) ist außerordentlich selten. Wir berichten über eine 77-jährige Patientin mit neu aufgetretener, beidseitiger proximaler Armparese vor dem Hintergrund systemischer Entzündungszeichen. Klinisch und elektromyographisch waren die Befunde mit einer bilateralen Plexopathie des Truncus superior (C5–C6) vereinbar, während die Sensibilität weitgehend erhalten war. Duplexsonographisch fanden sich typische Halo-Zeichen der Arteria temporalis, wodurch die Diagnose einer RZA bestätigt wurde. Die Literatur zeigt, dass PIBS in der RZA überwiegend durch eine Vaskulitis der großen supraaortalen Gefäße mit konsekutiver ischämischer Plexopathie entsteht. Die Sensibilität kann, abhängig vom Ausmaß der Plexusbeteiligung, erhalten oder vermindert sein. Bei Patienten mit RZA sollte eine neurologische Manifestation im Sinne eines PIBS als Ursache einer bilateralen Armparese in Betracht gezogen werden.
Background and objectives: Pruritus is a frequent cutaneous immune-related adverse event (irAE) associated with immune checkpoint inhibitors (ICI), impacting patients' quality of life. This study investigates the incidence, severity and management of pruritus in melanoma patients treated with ICI. Patients and methods: Clinical data from 461 melanoma patients at the University Hospital of Zurich were analyzed in a retrospective, monocentric study. Patients received ICI either as combination therapy (ipilimumab and nivolumab) or monotherapy (nivolumab or pembrolizumab). Results: Immune-related pruritus (irPruritus) was associated with increased overall survival. It affected 23.0 % of patients (106/461), with a significantly higher frequency and earlier onset observed in combination therapy compared to monotherapy (p < 0.001). A significant, pronounced increase in eosinophil counts was noted from baseline to onset of irPruritus. Topical steroids proved effective in 90.9 % of cases. Additionally, irPruritus was significantly correlated with both irFatigue (p < 0.01) and irRash (p < 0.001). Conclusions: Pruritus is a common side effect of ICI therapy. Its correlation with irFatigue and irRash highlights the broader systemic impact impairing patients' quality of life. Further prospective studies are needed to elucidate the underlying mechanisms such as involvement of eosinophils and identify optimal treatment strategies while maintaining ICI effectiveness.
Malnutrition is a multifactorial and complex condition with significant consequences for recovery, functional outcomes, and healthcare systems. Research in malnutrition is often limited by single-component interventions, heterogeneous study designs, and variable outcome measures. This perspective paper introduces a practical guiding framework for clinical nutrition research, emphasizing interdisciplinary, multifactorial approaches, co-designed interventions, and pragmatic, adaptive study designs. Evidence from several trials demonstrates that individualized nutritional support delivered by multidisciplinary teams improves clinical outcomes, yet challenges remain in recruitment, adherence, and balancing intervention intensity with patient burden. The framework provides a structured approach to intervention development, outcome selection, and implementation, while remaining flexible to accommodate innovation, context-specific adaptation, and emerging outcome measures. By integrating lessons from prior trials, globally, and promoting systematic reporting and feasibility assessment, this framework aims to enhance the design, comparability, and translational impact of future research in clinical nutrition in older and other clinically vulnerable populations. Adoption of such a framework can guide research prioritization, optimize intervention delivery, and ultimately improve patient recovery and quality of life.
Over the past two decades, significant advances have been made in the characterisation of autoimmune encephalitis, its pathophysiology, and the associated autoantibodies. Given the lack of robust clinical trials, the choice of therapy is principally based on observational studies and expert consensus. Current management strategies include immunotherapy, removal of immunological triggers such as tumours when present, and symptomatic treatment of seizures and psychiatric manifestations. With an improved understanding of the underlying pathogenic mechanisms in this rapidly evolving field, the pharmacological treatment of autoimmune encephalitis has evolved over the years, now encompassing various novel therapeutic targets, particularly in the context of third-line immunotherapies. These modalities include B cell depletion, cytokine-targeted therapies, plasma cell-depleting agents, interventions aimed at intrathecal immune cells or their trafficking across the blood–brain barrier, and blockade of the neonatal Fc receptor. This article reviews both established and novel therapeutic approaches for autoimmune encephalitis, with a focus on disease associated with neural surface antibodies, covering immunotherapy and symptomatic management. Additionally, we discuss the unmet needs of patients and the burden of care within this population.
BACKGROUND:Aneurysmal subarachnoid haemorrhage (SAH) is a life-threatening condition with high morbidity. Delayed cerebral ischaemia (DCI) significantly contributes to secondary injury and poor outcomes. While perfusion CT (CTP) aids DCI detection, multimodal neuromonitoring-including brain tissue oxygenation (PtiO2) and cerebral microdialysis-offers superior temporal resolution. Its value in guiding treatment remains underexplored. METHODS:This prospective cohort study included SAH patients monitored with multimodal neuromonitoring at RWTH Aachen University Hospital (2014-2020). DCI was diagnosed with neuromonitoring abnormalities and confirmed by CTP. First-line treatment involved induced hypertension, with endovascular rescue treatment for refractory cases. Physiological data were time-aligned to treatment onset and aggregated into hourly summaries. Binomial logistic regression identified predictors of favourable 1-year outcome (modified Rankin Scale 0-3). RESULTS:Of 56 patients with confirmed DCI, correctly placed probes and available outcome data, 22 (39.3%) achieved favourable outcome. These patients showed greater post-treatment reductions in pressure reactivity index (PRx) and lactate-to-pyruvate ratio (LPR). In multivariable analysis, greater PRx reduction was significantly associated with favourable outcome (OR 0.023, 95% CI 0.001 to 0.394, p=0.009), translating to a 46.5% increase in odds per 0.1-unit decrease. Greater LPR reductions were also predictive (OR 0.950, 95% CI 0.904 to 0.998, p=0.042), with a 5-unit drop linked to a 29.3% increase in odds. Although PtiO2₂ improved post-treatment, it was not associated with outcome. CONCLUSION:PRx and LPR reflect meaningful physiological responses to DCI treatment and are associated with 1-year outcomes. Multimodal neuromonitoring may support not only diagnosis but also treatment monitoring and decision-making in unconscious SAH patients. TRIAL REGISTRATION NUMBER:German Clinical Trial Registry (DRKS00030505).
