Intracranial sinogenic and otogenic complications and high-grade orbital complications of sinusitis in children are rare, but case numbers appeared to increase after COVID-19 health measures were lifted. As similar trends were reported internationally, we conducted a multicenter retrospective case series to evaluate this "perceived accumulation". The study population included otherwise healthy children treated at eight participating centers from seven countries including a period from 2012 to 2023 for above-mentioned complications. Recorded parameters included age, diagnosis, timing, duration and type of inpatient therapy, as well as microbiological and virological findings, and differential blood count. A total of 289 data sets were received from the eight centers. Cases per semiannual increased significantly from 6 to 28 in the sinogenic and 3 to 12 in the otogenic cohort comparing pre- to post-pandemic period. Main patient characteristics were preserved. However, the number of surgical interventions per patient rose slightly in the post-pandemic sinogenic cohort. No association with acute COVID-19 infection was identified. In summary, intracranial sinogenic and otogenic complications in children rose significantly after the lifting of COVID-19-related restrictions. As immunity to respiratory viruses is not permanent, COVID-19 protective measures may have resulted in a lack of stimulation of the immune system, favoring the occurrence of superinfections. This highlights the importance of global respiratory infection research and surveillance programs, as well as open data sharing and maintaining vaccine development and use.

STUDY OBJECTIVES:In patients with acute myocardial infarction (AMI), early use of minute-ventilation triggered adaptive servo-ventilation (ASVmv) for sleep-disordered breathing has been proposed as a therapeutic intervention to reduce infarct expansion. This study aims to assess the efficacy of ASVmv in modulating nocturnal hypoxemic burden and evaluate its association with infarct size. METHODS:This ancillary analysis of the multicenter, randomized, open-label TEAM-ASV I trial included patients with first-time AMI and sleep-disordered breathing, defined by an apnea-hypopnea index ≥ 15 events h-1 assessed with polygraphy. Infarct size was quantified via cardiac magnetic resonance imaging. Nocturnal hypoxemic burden was quantified by the time in bed spent with oxygen saturation below 90% (T90) and further decomposed into desaturation-related components (T90desaturation) and non-specific drifts (T90non-specific). RESULTS:Thirty-five patients with infarct size 15.5 ± 6.9% of left ventricular mass were randomized to early ASVmv treatment in addition to standard care of AMI (n = 16) and standard care alone (control, n = 19). Compared with baseline, all components of hypoxemic burden, T90 (9.25% [1.34-16.32] vs. 0.03% [0.00-1.72; p = .003]), T90desaturation (0.72% [0.49-7.97] vs. 0.00% [0.00-0.06]; p < .001), and T90non-specific (4.75% [0.38-10.30] vs. 0.00% [0.00-1.73]; p < .001) were significantly reduced during the ASVmv treatment initiation night. After 12 weeks, ASVmv treatment showed lower median T90desaturation compared to the control group (ASVmv: 0.10% [0.00-0.40] vs. control: 0.40% [0.22-1.80]; p = .020) but not T90non-specific. T90 (rs = 0.437, p = .023) and its component, T90non-specific, were both associated with infarct size (rs = 0.424; p = .028). CONCLUSIONS:ASVmv treatment suppresses the sleep apnea-related nocturnal hypoxemic burden following AMI. Higher T90, particularly non-specific drifts in SpO₂, were associated with larger infarct size. These findings are exploratory and should be regarded as hypothesis generating. CLINICAL TRIAL REGISTRATION:NCT02093377.

(1) Background: Early treatment of sleep-disordered breathing (SDB) with adaptive servo-ventilation (ASV) after acute myocardial infarction (AMI) has been shown to improve myocardial salvage. This analysis evaluates nocturnal electrocardiogram (ECG) Holter data, derived from polygraphy in a randomised clinical trial (NCT02093377), to assess the occurrence of nocturnal cardiac arrhythmias in patients with SDB and to explore the effect of ASV therapy. (2) Methods: In the TEAM-ASV I trial, patients were stratified by the presence/absence of SDB, defined by an apnoea–hypopnoea index (AHI) ≥15 events/h assessed with polygraphy. Those with SDB were subsequently randomised to receive ASV in addition to standard AMI care. Guideline-conforming semi-automated ECG analysis of nocturnal cardiac arrhythmias was conducted via Holter–ECG software (custo diagnostic, version 5.4). (3) Results: Patients with SDB had an increased incidence of non-sustained ventricular tachycardia (NSVT) (SDB: n = 8 (16%) vs. no SDB: n = 1 (2%); p = 0.024) and premature atrial contractions (PAC) (SDB: 1.2/h [0.3, 3.4] vs. no SDB: 0.3/h [0.1, 1.2]; p = 0.017). In patients with SDB who were randomised to ASV treatment early after AMI, we found no reduction in cardiac arrhythmias when ASV was added to standard care. (4) Conclusions: After AMI, SDB was linked to increased NSVT and PAC. ASV treatment demonstrated neither a harmful nor a beneficial effect on the occurrence of nocturnal cardiac arrhythmias. Further trials are warranted to confirm these findings.

Hereditary hemorrhagic telangiectasia (HHT) is a genetically inherited vascular disorder transmitted in an autosomal dominant manner. It is defined by the presence of arteriovenous malformations in the nasal mucosa, resulting in severe recurrent epistaxis. This study investigates the long-term efficacy and safety of blue light laser therapy for managing epistaxis in patients with HHT. A retrospective analysis was conducted on 71 patients treated between 09/2017 and 02/2023 at the Department of Otorhinolaryngology, University Hospital Regensburg. All patients underwent endonasal treatment using a pulsed diode laser at 445 nm as part of a structured stepwise protocol including nasal care. Of the 86 patients initially treated, 17.4

BACKGROUND:Patients with BRAF wildtype metastatic melanoma who exhibit primary resistance to immune checkpoint inhibitors (ICIs) have a poor prognosis. Chemotherapy has been shown to induce genetic mutations, modify the tumour microenvironment and microbiome, and influence immune system activity. OBJECTIVES:To investigate in a prospective multicentre phase II trial whether two applications of an alkylating agent (dacarbazine) can sensitize patients with metastatic melanoma who are nonresponsive to ICIs to the same checkpoint inhibitor regime. METHODS:The PROMIT trial (NCT04225390) enrolled patients with histologically confirmed BRAF wildtype metastatic melanoma who exhibited primary resistance to ICI therapy. Following radiological evidence of primary resistance to ICI (ipilimumab + nivolumab or pembrolizumab) upon the first staging after initiation, patients received two doses of dacarbazine at 850 mg m-2 intravenously on days 1 and 21. Subsequently, 1 week after application of the second dose of dacarbazine, patients were rechallenged with the same ICI therapy to which they had previously shown progressive disease. RESULTS:In total, 53 patients were enrolled across four German skin cancer centres. Of these patients, 38 were evaluable for efficacy, having received at least one dose of ICI re-exposure. The overall objective response rate was 18% (95% confidence interval 0.08-0.34), with 7 of 38 patients achieving a partial response. The disease control rate was 37%. Therapy was well tolerated, with treatment-related ≥ grade 3 CTCAE adverse events occurring in 10% of patients. No new safety signals were observed. CONCLUSIONS:The study indicates that short-term chemotherapy followed by ICI rechallenge can overcome primary ICI resistance in patients with melanoma, supporting its potential as a new therapeutic option in clinical practice.

Introduction: Septic arthritis (SA) is an orthopaedic emergency; delayed treatment endangers joint function and survival. Unlike periprosthetic infections, diagnostic criteria for native joints are poorly standardized. This study aimed to (1) evaluate diagnostic parameters including synovial white blood cell (sWBC) count, neutrophil percentage, serum C-reactive protein (CRP), and leukocyte count and (2) assess a new evaluation score combining these parameters. Methods: In a retrospective cohort study, cases of knee and shoulder SA treated at a German university hospital (2013-2022) were analysed. Parameters included synovial fluid analysis (sWBC, neutrophils), blood samples (CRP, leukocytes), and intraoperative cultures. Cut-offs for sWBC and neutrophils were determined using receiver-operating characteristic (ROC) analysis and the Youden index, comparing SA patients with non-infected controls. A new evaluation score for SA (Septic Arthritis Evaluation Score, SAES) was created: 2 points each for sWBC and neutrophils and 1 point each for CRP and leukocytes. Results: Complete data were available for 45 patients (71.4 % male, mean age 64.3 years). Knees were affected in 73.7 %, and shoulders were affected in 26.3 %. Median values were as follows: leukocytes - 11/nl, CRP - 158 mg L-1, sWBC - 42 910/ µ L, and neutrophils - 93.6 %. ROC analysis identified an optimal sWBC cut-off of 35 650/ µ L (sensitivity of 64.4 %, specificity of 87.8 %). The SAES showed higher discriminatory performance; with a threshold ≥ 3 points, sensitivity was 95.6 %, and specificity was 70.7 %. Conclusions: In this retrospective cohort, commonly used laboratory parameters for native joint SA showed limited discriminatory ability when applied individually. A newly developed composite score combining synovial and serum markers demonstrated higher sensitivity within this dataset. Prospective validation in larger cohorts is required before clinical application.

Abstract Background Rotator cuff disease (RCD) constitutes the most common cause of shoulder pain, with partial-thickness rotator cuff tears (PT-RCTs) representing a substantial subset that may progress over time. Although both surgical and non-surgical interventions are employed in clinical practice, a consensus regarding the optimal management of symptomatic PT-RCTs is lacking, and a comprehensive synthesis of available evidence has not yet been conducted. Methods A systematic review was conducted according to PRISMA guidelines using MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and WHO ICTRP. Studies on arthroscopic surgical and/or non-surgical treatments for PT-RCTs in patients ≥ 18 years were included. Clinical outcomes (Constant Score (CS), ASES Score, VAS for pain) were extracted. Random-effects meta-analysis and descriptive statistics were used to analyze outcomes and study characteristics. Results Of the 9,894 trials screened, 33 trials with a total of 1,818 patients met the inclusion criteria. Comparing pooled weighted mean outcomes across studies, surgical cohorts demonstrated higher scores than non-surgical cohorts in both the CS (p = 0.0095) and the ASES (p = 0.0060). However, no specific surgical technique proved superior, with neither Reconstruction versus Debridement (CS, p = 0.19; ASES, p = 0.06) nor Tear Completion versus Transtendon Repair (CS, p = 0.13; ASES, p = 0.65) reaching statistical significance. Although surgical treatment was statistically superior to non-surgical approaches, the observed differences remained below the minimal clinically important differences (MCID), indicating limited clinical relevance. Conclusion Pooled analyses showed higher Constant and ASES scores in surgical cohorts. However, the magnitude of this difference does not exceed MCID, indicating limited clinical relevance. No surgical technique demonstrated significant superiority. These findings highlight the need for individualized treatment decisions, considering the limited clinical benefit of surgery over non-surgical approaches. Protocol Registration The protocol was registered in PROSPERO with ID: CRD42023487714

Background: To identify the potential role of humeral retrotorsion (HRT) and range of motion (ROM) as a risk factor for shoulder overuse injury in elite youth handball players. The hypothesis was that increased HRT is associated with an increased risk of shoulder overuse injury. Methods: Over 2 seasons, 258 elite youth handball players (52% boys; age:14 +/- 0.8 years) were included. Preseason assessment included HRT and glenohumeral internal and external (ER) rotational ROM using ultrasound and a manual goniometer. Sportsspecific adaptations between male and female athletes and the dominant and nondominant shoulder were calculated. In addition, players completed standardized questionnaires over the 2018-2019 or 2019-20 season and reported any shoulder overuse symptoms using the Western Ontario Shoulder Index questionnaire. Results: Comparing male and female players showed significantly decreased HRT and decreased internal ROM in the dominant side of male athletes (P < .027). No other difference was found. Significant side-to-side differences between the dominant and nondominant shoulder were found for HRT, internal rotation, and ER, regardless of sex (P < .001). For total range of motion, only female athletes showed a significant increase in the dominant arm (P = .032). The dominant side showed a significantly higher glenohumeral internal rotation deficit in male athletes than in female athletes (10 degrees +/- 17 degrees vs 5 degrees +/- 10 degrees, P = .011). Adaptations in HRT, ER gain, and total range of motion gain were not significant. Over the course of the 2 seasons, 20 athletes reported shoulder overuse injuries. Although glenohumeral internal rotation deficit was borderline nonsignificant (P = .056), none of the parameters tested were significantly associated with shoulder overuse injuries. Conclusion: Despite significant side-to-side differences and sport-specific adaptations, individual preseason screening of humeral retrotorsion and soft tissue adaptations does not identify elite youth handball athletes at increased risk of shoulder overuse injury.

BACKGROUND:The Treatment of sleep apnoea Early After Myocardial infarction with Adaptive Servo-Ventilation (TEAM-ASV I) trial showed that adding adaptive servo-ventilation (ASV) to treat sleep-disordered breathing (SDB) early after acute myocardial infarction (AMI) improved myocardial salvage and decreased infarct size. It is purported that ASV may mitigate the inflammatory response, cardiac congestion, or fibrosis, but evidence supporting this assertion is sparse. METHODS:This ancillary analysis of the multicentre, randomised, open-label TEAM-ASV I trial assessed patients with analysable blood samples at baseline and 12-week follow-up. Patients were randomised to early ASV treatment in addition to standard care for AMI and standard care alone (control). Changes in the levels of circulating biomarkers of inflammation (high-sensitivity C-reactive protein [hs-CRP], fibrinogen, interleukin [IL]-6, and interleukin-33 receptor [IL-33R]), fluid overload (N-terminal pro-B-type natriuretic peptide [NT-proBNP] and antigen carbohydrate [CA]-125), and fibrosis (procollagen III type aminoterminal propeptide [PIIINP] and matrix metalloproteinase [MMP]-9) were compared between the ASV and control groups. RESULTS:Forty SDB patients were analysed. The reduction in IL-33R was greater in the control group than in the ASV group (-1.94 [-3.88, 1.56] versus -4.30 [-6.46, -2.02] ng·ml-1). However, changes in other biomarkers of inflammation (hs-CRP, fibrinogen, and IL-6), fluid overload (NT-proBNP and CA-125), and fibrosis (PIIINP and MMP-9) were similar in both groups. CONCLUSIONS:This ancillary analysis of TEAM-ASV I does not support that treatment of SDB in the early phase after AMI with ASV has a clinically relevant short-term effect on biomarkers of inflammation, fluid overload, or fibrosis. Further studies are warranted to explain how early treatment with ASV results in increased myocardial salvage after AMI beyond the effects of SDB treatment on hemodynamics and oxygen demand‒supply mismatch. CLINICAL TRIAL REGISTRATION:NCT02093377.

OBJECTIVES:To assess the feasibility of trial recruitment and confirm that retroperitoneal robotic partial nephrectomy (RRPN) has the same oncological efficacy as transperitoneal robotic partial nephrectomy (TRPN), with time advantages and less peri-operative morbidity, in a randomised controlled trial (RCT). PATIENTS AND METHODS:The study was designed as a single-centre, open-label, feasibility RCT. Patients with suspected localised renal cell carcinoma referred for robotic partial nephrectomy were randomised in a 1:1 ratio to receive either TRPN or RRPN. The primary outcomes were trial feasibility, postoperative mobility and pain perception. Secondary outcomes were intra-operative times, assessment of complications, and comparison of positive surgical margin (PSM) rates. The data on all randomised patients who underwent surgery were analysed descriptively. RESULTS:Sixty-one patients underwent TRPN or RRPN (31 vs 30). Postoperative mobility within 24 h after surgery (RRPN: 77 vs TRPN: 71%; P = 0.613), median postoperative pain, assessed using a numeric rating scale (RRPN: 1.5 vs TRPN: 1.8; P = 0.509), and full bowel canalisation within 3 days (RRPN: 100% vs TRPN: 90%; P = 0.315) were more favourable in the RRPN group, but the difference was not statistically significant. In comparison to TRPN, RRPN was associated with shorter operating time (81 vs 105 min; P = 0.005), shorter time on the console (49 vs 73 min; P < 0.001) and shorter time from console to renal artery preparation (7.5 vs 18 min; P < 0.001). TRPN required a shorter time from skin incision to console (16 vs 12 min; P = 0.001). There was no statistically significant difference in tumour complexity, ischaemia time, PSM rate, blood loss or complications between the two groups. CONCLUSION:We present the first data from an RCT comparing RRPN with TRPN. RRPN showed significant time benefits while being a safe alternative to TRPN, with a similar PSM rate. There was less postoperative morbidity in the RRPN group, although this was not statistically significant. These results underline that dorsolateral renal tumours should be preferably resected by RRPN. Further multicentre RCTs are necessary to confirm these results.

This study investigated isokinetic muscle strength deficits in patients with advanced knee osteoarthritis (KOA) scheduled for total knee arthroplasty (TKA) to explore the relationship between objective strength measures and subjective symptoms such as pain and functional limitations. By analyzing muscle function using isokinetic dynamometry, the study aimed to provide insights into how strength deficits relate to patient-reported outcomes and whether these assessments could inform surgical decision-making. A total of 52 patients (mean age: 66.96 years, 53.85% female) with advanced KOA awaiting TKA were included. Isokinetic muscle strength of the knee, measured in peak torque (Newton-meters), work (Joules), and power (Watts), was assessed bilaterally before surgery using a Biodex dynamometer at angular velocities of 180 degrees/s and 60 degrees/s. Subjective symptoms were evaluated using standardized assessments, including the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short Form-12 (SF-12), Hospital Anxiety and Depression Scale (HADS-D), and EuroQol 5-Dimension 3-Level questionnaire. Findings revealed a significant strength deficit on the affected side scheduled for surgery (p < 0.050). However, correlations between isokinetic knee parameters and symptom scores were weak (|r| ≤0.5), suggesting that subjective complaints do not necessarily align with objective strength measurements. Notably, isokinetic parameters were significantly intercorrelated (p < 0.050). These results indicate that isokinetic dynamometry effectively quantifies muscle strength differences in KOA patients, yet its findings should be considered alongside clinical assessments and patient-reported symptoms to form a comprehensive evaluation of disease severity and surgical necessity.

BACKGROUND AND OBJECTIVE:Multidisciplinary tumor boards (MTBs) are the gold standard for oncological treatment planning, but their implementation is resource intensive. Large language models (LLMs) such as ChatGPT-4 and Claude 3.5 Sonnet have emerged as scalable tools for clinical decision support. As their comparative performance in urological oncology remains largely untested in prospective trials, this study aimed to prospectively evaluate them against real MTBs. METHODS:In this prospective, multicenter, noninferiority study (DRKS00034797), we evaluated whether therapeutic recommendations by ChatGPT-4 and Claude 3.5 Sonnet were noninferior to those of MTBs across 110 representative case scenarios involving locally advanced or metastatic genitourinary cancer. Standardized prompts elicited recommendations from both LLMs, which were rated independently by two blinded uro-oncologists using the validated modified System Causability Scale (mSCS). The predefined noninferiority margin was 0.15 mSCS points. KEY FINDINGS AND LIMITATIONS:The mean mSCS score of the MTBs was 0.849 (standard deviation [SD] = 0.157), setting the noninferiority margin at 0.699. Claude 3.5 Sonnet scored 0.731 (SD = 0.178; 95% confidence interval [CI]: 0.697-0.765), narrowly missing noninferiority. ChatGPT-4 scored 0.660 (SD = 0.193; 95% CI: 0.623-0.696), clearly below the margin. A subgroup analysis revealed better LLM performance in locally advanced versus metastatic cases (p < 0.05). Limitations include the use of synthetic cases and inherent LLM output variability. CONCLUSIONS AND CLINICAL IMPLICATIONS:Neither LLM matched the MTB standards. These findings highlight the current limitations of public LLMs, or of their use in our study, in supporting complex oncological decisions. This underscores the need for further validation and contextual refinement before integration into multidisciplinary care.

Background: Portal vein thrombosis (PVT) leads to portal hypertension (PH) with its sequelae. Computed tomography spleno-mesenterico-portography (CT-SMPG) combines sequential CT spleno-portography and CT mesenterico-portography. CT-SMPG comprehensively illustrates the venous hemodynamic changes due to PH. Objective: To assess the effects of PV confluence thrombosis (PVCT) and liver cirrhosis on venous blood flow characteristics of patients with PVT. Method: CT-SMPG was performed in 21 patients with chronic PVT. CT-SMPG was compared to standard contrast-enhanced CT (CECT) and gastroscopy concerning the patency of splanchnic veins, varices and venous congestion. Results: PVCT had a significant effect on perfusion patterns: in patients without PVCT, esophageal varices (EV) and gastric varices were supplied by either the splenic vein (SV), the superior mesenteric vein (SMV), or both. In patients with PVCT, EV and gastric varices were mostly supplied by the SV (p = 0.021, p = 0.016). In patients without PVCT, small bowel varices were fed by both systems or the SMV, while in patients with PVCT they were fed by the SMV (p = 0.031). No statistically significant changes were detected regarding gastropathy, colorectal varices and small bowel congestion. Liver cirrhosis had no statistically relevant effect on hemodynamics. Conclusions: In CT-SMPG, patients with PVCT showed different venous hemodynamics to patients without PVCT, and this can serve as a basis for selecting therapy options.

PURPOSE:Handball is associated with a high risk of knee injury. This study investigated whether an injury prevention program is effective in reducing acute, severe and overuse knee injuries in handball athletes. METHODS:Sixty-nine men's and women's handball teams (U-15, U-17, U-19 and senior athletes) were cluster-randomised into an intervention and control group for one season. Players in the intervention group regularly completed the Knee-ABC 2 injury prevention program. Acute, severe and overuse knee injuries and handball exposure were documented every 8 weeks for both groups using an online questionnaire. The primary outcome parameter was the incidence of acute, severe knee injury. Secondary outcome parameters were prevalence and intensity of overuse knee injuries measured by the Oslo Trauma Research Centre (OSTRC) questionnaire and the Victorian Institute of Sport Assessment - Patellar Tendinopathy (VISA-P) score. RESULTS:The study included 32 teams (260 players) in the intervention group and 33 teams (215 players) as controls. Acute, severe knee injuries occurred significantly less often in the intervention group (0.059/1000 h) than in the control group (0.348/1000 h). The incidence rate ratio was 0.170 (95% confidence interval [CI] 0.031-0.619), p = 0.002). Players in the intervention group (51.5%) reported less often an OSTRC score >0 than controls (63.8%, p = 0.028) and had lower intensity scores (med 3, interquartile range [IQR] 0-15 vs. med 6 IQR: 0-19, p = 0.046). There were no differences in the VISA-P score between the two groups. CONCLUSION:Frequent use of the Knee-ABC 2 program prevents acute, severe and overuse knee injuries in adolescent and senior handball players and should therefore be included in the practical routine and in the education of team managers. LEVEL OF EVIDENCE:Level Ib.

BACKGROUND:Breast surgery, ranging from aesthetic adjustments to oncologic reconstructions, has seen a significant rise in recent years, with over 4.3 million procedures globally in 2022. However, they pose risks such as postoperative bleeding and hematoma, impacting patient recovery and morbidity. Identifying and mitigating risk factors is crucial for better postoperative outcomes. The effect of blood pressure at the wound closure start on postoperative bleeding complications is a key research area, with current studies showing inconsistent findings. This research gap necessitates further investigation to optimize outcomes in breast surgery. METHODS:For this retrospective case-control study, data from 2007 to 2021 were collected from the Caritas Hospital St. Josef database, in Regensburg, Germany. Patients undergoing subcutaneous mastectomy, breast reduction, or breast reconstruction were identified. Perioperative variables, including demographics, health status, blood pressure, and postoperative complications, were analyzed. Statistical analysis was performed using SPSS, matching cases and controls at a 1:4 ratio. RESULTS:A total of 41 patients with postoperative hemorrhage were matched to 164 controls. The primary finding was a significant link between lower systolic blood pressure at wound closure and increased hemorrhage risk, with no other demographic or medical factors (age, body mass index, hypertension, or bleeding disorders) showing a significant association. CONCLUSIONS:The authors' study suggests that low intraoperative blood pressure at wound closure start is a key risk factor for postoperative hemorrhage in breast surgery. Strict blood pressure control during surgery could reduce bleeding risk after breast surgery procedures. Further research is needed to optimize the perioperative workflow regarding blood pressure settings.

Lower estimated glomerular filtration rate (eGFR) and more severe albuminuria categories are associated with increased risk for adverse outcomes such as mortality, cardiovascular and kidney outcomes. The aim of the analysis was to evaluate whether nocturnal hypoxemic burden (NHB) is associated with worsening prognosis of CKD in a population with T2D. Overnight oximetry data from patients enrolled in the DIACORE (DIAbetes COhoRtE) sleep-disordered breathing sub-study, a prospective cohort study of patients with T2D, was analyzed and NHB as cumulative time spent below 90

Background: The increasing incidence of proximal humeral fractures poses complex challenges in determining the optimal therapeutic strategies due to the diverse fracture patterns and individual patient characteristics. Traumatologists and orthopedic surgeons face significant decisions, as potential consequences such as pain, functional limitations, and complications may significantly affect patients' quality of life. Given the varying viewpoints on appropriate treatment modalities, a thorough examination of current care practices is crucial. Methods: An adaptive online survey was conducted to present realistic case scenarios, aimed at elucidating decision-making processes in the management of proximal humeral fractures. This survey encompassed relevant patient and fracture-related variables, employing a dynamic querying algorithm that featured up to 48 conceivable case scenarios. Results: Analysis of 7012 case scenarios unveiled significant differences in treatment preferences across distinct patient age groups. Plate osteosynthesis emerged as the preferred modality for individuals below 50 years of age with complex fracture patterns. On the other hand, a balanced consideration between plate osteosynthesis and reverse shoulder arthroplasty was observed in the 50-70 age cohort. Notably, respondents favored reverse shoulder arthroplasty as the treatment modality of choice for individuals older than 70 years of age. A treatment algorithm was developed to outline decision pathways concisely, considering these patient age groups and the option of reverse shoulder Discussion and conclusion: This study provides clinically relevant insights into therapeutic decision-making processes in the management of proximal humeral fractures. The illustration of treatment preferences through a visualized algorithm serves as a crucial tool for evidencebased clinical decision-making, offering potential in enhancing the individualized care spectrum for patients with proximal humeral (c) 2024 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background: Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) have several risk factors to suffer from abdominal compartment syndrome (ACS). Little is known about this subgroup. The aim of this study was to investigate the prevalence and associated factors for ACS in patients requiring ECMO to assess the effect of decompressive laparotomy (DL) and the impact on mortality. Methods: This retrospective observational study analyzed adult patients requiring ECMO in four intensive care units at the University Medical Center Regensburg between 01/2010 and 06/2020. Patients with clinically suspected ACS were screened by measuring intra-abdominal pressure (IAP) with the trans-bladder technique. ACS was defined as IAP > 20 mmHg and survival was defined as successful discharge from hospital. Results: The prevalence of ACS in non-ECMO ICU patients was 0.8% (291/36,795) and 2.9% (47/1643) in ECMO patients. In the subgroup of resuscitated ECMO patients, ACS was present in 4.2% (32/766). Procalcitonin was associated with ACS. ECMO patients with ACS receiving DL were significantly more ill compared to those without DL (SOFA score at ICU admission 18 [15; 20], vs. 16 [13; 17], p = 0.048). DL decreased IAP and significantly improved ventilation; vasopressor and lactate stabilized within 24 hours. Survival was comparable between the DL and the non-DL groups (11% [1/9] vs. 14% [1/7], p = 1.000). Conclusions: ECMO patients are at high risk of developing ACS, even more so for resuscitated patients. This and high procalcitonin may be taken into consideration when screening for ACS. Decompressive laparotomy did improve respiratory compliance and stabilized hemodynamic parameters with low rates of complication. Even though patients that received DL were significantly more ill, the mortality rates were not higher.

PURPOSE:In heart failure (HF) and chronic obstructive pulmonary disease (COPD) populations, sleep-disordered breathing (SDB) is associated with impaired health outcomes. We evaluated whether in patients with HF, concomitant HF and COPD or COPD, the number of hospitalizations would be reduced in the year after testing for SDB with and without treatment initiation compared to the year before. METHODS:We performed a multicentre retrospective study of 390 consecutive sleep-clinic patients who had a primary diagnosis of chronic HF, HF and COPD or COPD and a secondary diagnosis of SDB. The date of SDB-testing was defined as the index date. Data on healthcare utilization was extracted for the 12-month period prior to and after this date. RESULTS:The initiation of adaptive servoventilation (ASV) and non-invasive ventilation (NIV) treatment resulted in a statistically significant reduction in the number of hospitalisations. While continuous positive airway pressure (CPAP) treatment also demonstrated a reduction in hospitalisations, the observed effect did not reach the level of statistical significance. After accounting for demographics and comorbidities in multivariable regression analyses, only NIV was significantly associated with a reduction in hospitalizations, while CPAP or ASV were not. NIV appears to be underutilized in COPD. CONCLUSIONS:Our data indicate, that patients with HF or COPD and concomitant SDB may benefit from the initiation of appropriate PAP-therapy. Whether treating SDB in HF- and COPD-patients influences healthcare utilization merits further investigation.