BACKGROUND:The combination of radiofrequency microneedling (RFMN) with fractional 1927 nm thulium (Tm) laser has gained popularity in clinical practice. However, comparative studies remain limited. OBJECTIVES:To evaluate the efficacy and safety of combined RFMN/Tm laser treatment versus RFMN alone for rejuvenation of photoaged skin of the lower face and neck area. MATERIAL AND METHODS:A prospective, evaluator-blinded, clinical study. Patients were assigned to a combined protocol consisting of 1-3 RFMN treatment sessions immediately followed by Tm laser, supplemented by three additional Tm laser sessions at 6-8-week intervals. Study endpoints were compared with data from our previously published RFMN monotherapy cohort. Outcomes were assessed using validated clinical grading scales, computer-assisted analysis of submental volume, and a standardized color space system to quantify skin tone evening. Pain was assessed using a numeric rating scale. Adverse events (AEs) were monitored throughout the study period. RESULTS:26 received the combined treatment, and 27 patients were treated with RFMN alone. Mean ages were 50.7 ± 7.4 and 55.6 ± 8.9 years, respectively. Both groups showed significant reductions in submental volume without significant differences between them. However, only the combination group demonstrated a distinct improvement in hyperpigmented lesions, as quantified by the color analysis. Blinded evaluations noted improvements in the melomental area, jawline, and neck in both groups, while greater improvements in skin tone evening and therefore overall appearance were seen only in the combination group. No serious AEs were reported. CONCLUSION:Both treatment modalities effectively addressed lower facial and neck laxity. The addition of Tm laser to RFMN provided additional benefits in treating pigmentary irregularities and improving overall clinical outcome without notably compromising downtime. Larger studies are warranted to validate these findings and assess long-term outcomes. TRIAL REGISTRATION:This study was preregistered in clinicaltrials.gov (NCT06029725) on 23 August 2023.

In sarcomas, surgery is an essential component of therapy. Depending on their location, sarcomas can reach a considerable size, which increases the risk of wound complications (WC) after resections. This often results in longer hospital stays and thus delays further oncological treatment. Therefore, reducing WCs is indispensable for improving treatment. The VAC (Vacuum-Assisted Closure) therapy has been shown to have a positive effect on wound healing, but there are limited studies for its use after sarcoma resections. The aim of this study was to analyze the outcomes of various wound closure techniques. This was intended to identify optimal wound care to prevent WCs and to determine risk factors for complications. This study is a single-center study that included all patients who underwent surgery for sarcomas of the body surface and extremities. A retrospective data analysis was conducted for the years 2021–2023. The primary endpoint was the development of wound complications. Here, primary wound closure was compared with secondary closure after negative wound pressure therapy (NWPT). Secondary endpoints included the impact of drains, subtype, location, and comorbidities. A total of 211 patients were examined. The most common histological subtype was liposarcoma (32,88

Aim:Transgender people face many unique challenges. Thus, some of them report excessive use of social media. Our aim was to identify the frequency of social media addiction and to investigate the factors associated with problematic social networking sites use exclusively amongst transgender adults in times of the Covid-19 pandemic. Subjects:We used data from the "Transgender Survey" HH-TPCHIVG (n = 104 in the analytical sample). Transgender people from self-help groups were involved in gathering information about gender-affirming surgery at a German hospital were included. Specific exclusion criteria did not exist. The validated Bergen Social Media Addiction Scale served as a tool to quantify probable social media addiction. Results:In sum, 20.5 % of the transgender people are probably addicted to social media. Regressions showed that problematic social networking sites use was significantly positively associated with the presence of a migration background (β = 2.41, p < 0.05), and a higher frequency of sports activities. Conclusion:In conclusion, our study stressed the challenge of probable social media addiction among transgender people. Knowledge about the correlates of problematic social networking sites use may assist in addressing individuals at risk. The associations identified in this study could be explained, by, among other things, body dissatisfaction (especially with regard to sporting activities) or increased internet contacts (for people with a migration background). Efforts to reduce social media addiction (e.g., awareness-raising, promotion of offline activities, using role models) could prove effective in this group, pending longitudinal research.

BackgroundProlyl hydroxylase 1 (PHD1) is a prognostic marker in several cancers.Aims and scopesThis study was undertaken to elucidate the clinical relevance of PHD1 in colorectal cancer (CRC) prognosis.Materials and methodsWe compared PHD1 expression on a tissue microarray (TMA) containing samples from 1800 CRCs with corresponding clinicopathological tumor variables and patient survival.ResultsWhile PHD1 staining was always high in benign colorectal epithelium, high PHD1 staining was detectable in only 71.8% of CRCs. Low PHD1 staining was associated with advanced tumor stage (p = 0.0101) and shortened overall survival in CRC patients (p = 0.0011). In a multivariable analysis including tumor stage, histological type and PHD1 staining revealed tumor stage and histological type (p < 0.0001 each), but also PHD1 staining (p = 0.0202) to be independent prognostic markers for CRC.ConclusionsIn our cohort, loss of PHD1 expression independently identified a subset of CRC patients with poor overall survival and might, thus, be a promising prognostic marker. PHD1 targeting may even allow for specific therapeutic approaches for these patients.

Here, we report the prevalence of loneliness and social isolation and investigate the levels of loneliness and social isolation among transgender and gender diverse people using cross-sectional data from the HH-TPCHIGV study. Using the De Jong Gierveld tool, we assess loneliness, using the Bude and Lantermann tool, we assess perceived social isolation and using the Lubben Social Network Scale, we assess objective social isolation. The prevalence rate of loneliness was 83.3% (perceived social isolation: 77.7%; objective social isolation: 34.4%). Regressions revealed that favorable outcomes (i.e., lower loneliness levels, lower perceived social isolation, and lower objective social isolation) were consistently associated with higher school education. Beyond that, we identify an association between particularly poor health-related factors and higher loneliness and objective social isolation levels. We also report that unemployment was significantly associated with higher levels of perceived social isolation. In conclusion, we show high prevalence rates of loneliness and social isolation among transgender and gender diverse people. Additionally, important correlates (e.g., education, health-related factors, or unemployment) were identified. Such knowledge may provide help to address transgender and gender diverse people at risk for loneliness and social isolation.

PDF file 404K, Supplementary Table 1: Detailed information for each CTC-positive patient regarding tumor size (T-stage), lymph node involvement (N-stage) and distant metastasis (M-stage) at diagnosis and number of CTCs/7.5 mL blood. Supplementary Table 2: Detailed information for each DTC-positive patient regarding tumor size (T-stage), lymph node involvement (N-stage) and distant metastasis (M-stage) at diagnosis and number of DTCs/2x106 mononuclear cells. Supplementary Figure 1: Gallery of CTC images generated with the CellSearch system from cases #1-10 equivalent to Patient ID in Supplementary Table 1. Supplementary Figure 2: Time to relapse for CTC-positive patients by adjuvant therapy (none, radiotherapy, radiochemotherapie, A left), A right: Time to relapse for CTC-negative patients by adjuvant therapy (none, radiotherapy, radiochemotherapie); B left: Time to relapse for DTC-positive patients by adjuvant therapy (none, radiotherapy, radiochemotherapie), right: Time to relapse for DTC-negative patients by adjuvant therapy (none, radiotherapy, radiochemotherapie) Supplementary Figure 3: Time to locoregional relapse for CTC-positive patients without metastatic disease at diagnosis (A); Time to locoregional relapse for DTC-positive patients without metastatic disease at diagnosis (B) Supplementary Figure 4: Gallery of detected DTCs from cases #1-18 equivalent to Patient ID in Supplementary Table 2

Objectives: The aim was to investigate the prevalence of probable depression and probable anxiety and to investigate the determinants of depressive symptoms and anxiety symptoms among transgender people. Methods: In this “Transgender Survey” (n = 104) we included transgender people who had joined self-help groups to obtain and share information about the gender-affirming surgeries performed at the Division of Plastic, Reconstructive and Aesthetic Surgery at the University Medical Center Hamburg-Eppendorf. Data collection took place between April and October 2022. To measure probable depression, the patient health questionnaire-9 was used. The generalized anxiety disorder-7 was used to quantify probable anxiety. Results: The prevalence of probable depression was 33.3% and it was 29.6% for probable anxiety. Multiple linear regressions showed that both more depressive symptoms and anxiety symptoms were significantly associated with younger age (β = −0.16, p < 0.01; β = −0.14, p < 0.01), being unemployed (e.g., full-time employed compared to unemployment: β = −3.05, p < 0.05; β = −2.69, p < 0.05), worse self-rated health (β = −3.31, p < 0.001; β = −1.88, p < 0.05), and having at least one chronic disease (β = 3.71, p < 0.01; β = 2.61, p < 0.05). Conclusions: Remarkably high prevalence rates were identified among transgender people. Furthermore, risk factors of poor mental health (e.g., unemployment or younger age) were identified—which can help to address transgender people at risk for poor mental health.

Background Our goal was to examine the proportion of transgender people satisfied with their lives (i.e., cognitive evaluation of life as a whole) and the determinants of life satisfaction level among transgender individuals. Methods Data were taken from the HH-TPCHIGV study. Included were 104 transgender people who had joined self-help groups to get and share information about the gender-affirming surgeries performed at the Division of Plastic, Reconstructive and Aesthetic Surgery at the University Medical Center Hamburg-Eppendorf. The established Satisfaction with Life Scale was used to quantify life satisfaction. Sociodemographic-, lifestyle-related and health-related determinants were included in multiple linear regressions. In regression analysis, life satisfaction served as outcome measure and in a robustness check ordered probit regressions were used. Results Among transgender people, 12.9% can be classified as “extremely dissatisfied”, 18.3% can be classified as “dissatisfied”, 12.9% can be classified as “slightly dissatisfied”, 7.5% as “neutral”, 30.1% as “slightly satisfied”, 17.2% as “satisfied” and 1.1% as “extremely satisfied”. Higher levels of life satisfaction were associated with higher age (β = .15, p < .05), higher school education (β = 5.54, p < .001), and favorable self-rated health (β = 2.20, p < .001). Conclusions Nearly half of the transgender people were at least “satisfied” with their lives. Knowledge about the correlates of life satisfaction may assist in addressing unsatisfied individuals.

BACKGROUND Radiofrequency microneedling (RFMN) treatment is the latest generation of fractional skin rejuvenation methods. OBJECTIVE To evaluate the efficacy, safety, tolerability and patient satisfaction of RFMN treatment for skin rejuvenation of the lower face and neck area. MATERIALS AND METHODS A prospective, intraindividual, controlled study. Subjects were treated with a fractional insulated RFMN system with 1 to 3 sessions at intervals of 4 to 12 weeks. Follow-up visits were scheduled on Day 90 and 180 posttreatment. Outcome was assessed by volume analysis of standardized 3-dimensional imaging, and validated clinical scales were rated by the physician, a blinded investigator, and patients. RESULTS Thirty patients (mean age 55.5 years, Fitzpatrick skin type I–IV) were included. Mean submental volume difference was −4.72 cm3 (±10.07 cm3; range −26.65 cm3 to +16.01 cm3). Physician, blinded investigator, and subjects rated the clinical outcome as highly improved. Mean pain intensity was 5.61/10 on Numeric Rating Scale. Beside slight swelling and redness, no relevant downtime has been observed. CONCLUSION Fractional RFMN treatment is a safe and effective technique for rejuvenation of the lower face, jawline, and neck region. Sufficient pain management should be provided. Data indicated low to no downtime and high patient satisfaction.

BACKGROUND:Abdominoplasty is one of the most commonly performed surgical procedures to reshape the body contour in patients who have undergone massive weight loss.OBJECTIVES:This study was undertaken to assess the clinical outcome, complication rates, and risk factors for complications of patients undergoing abdominoplasty after massive weight loss.SETTING:University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.METHOD:Clinical outcome was retrospectively analyzed in 121 patients, who underwent abdominoplasty. The retrospective analysis included demographic data of patients, such as sex, age, body mass index (BMI), and pre-existing illnesses. Moreover, postoperative complications including seroma, hematoma, wound infection, and tissue necrosis were analyzed.RESULTS:In our study cohort, the median age was 43.7 years, the median weight was 94.7 kg, and the median BMI was 32.3 kg/m2. The majority of included patients were women (70.3%). Death occurred in none of the patients. Among individuals, wound infection occurred in 3.3%, tissue necrosis in 1.7%, seroma in 7.4%, and hematoma in 3.3% of patients during the postoperative course. Reoperations were necessary in 2 patients (1.7%) due to postoperative bleeding and tissue necrosis of the navel. Tissue necrosis was significantly more often seen in a subset individual with type 2 diabetes (P = .006). Moreover, the rate of reoperations was significantly higher in patients with pre-existing cardiovascular illnesses compared with cardiovascular healthy patients (P = .036). Multivariate analysis analyzing risk factors for postoperative complications, including sex, age, BMI, diabetes, pulmonary disease, and cardiovascular disease, revealed strong independent relevance for type 2 diabetes (P = .024).CONCLUSIONS:We found that abdominoplasty is a safe operative procedure. In addition, the risk for complications is significantly increased in the subgroup of diabetic patients and patients with cardiovascular diseases.

BACKGROUND/AIM:Conventional in vitro assays measure the effect of drugs on total cells, while separating the effect to those on tumor and non-tumor cells is important for assessing drug specificity. Our aim was to evaluate the feasibility of separating the efficacy of vemurafenib on tumor and non-tumor cells in a mixed culture.MATERIALS AND METHODS:Melanoma A2058 cells and CCD18Co non-tumor cells were mixed and treated with vemurafenib. DNA was subjected to digital PCR to determine the ratio of the mutant 1799A to the wild-type 1799T alleles and viabilities of total cells were subsequently calculated as percentages of tumor and non-tumor cells.RESULTS:The set-up proportion of tumor cells correlated well with the calculated one. The calculated viability of tumor cells decreased with increasing doses of vemurafenib while that of the non-tumor cells remained rather constant. Variability of digital PCR data was high.CONCLUSION:Using the BRAF mutation 1799T>A to separate the response of tumor and non-tumor cells to a drug, such as vemurafenib, is feasible, supporting a foundation for a genetic in vitro tool for testing drug efficacy and specificity.

Introduction The heterotrimeric Sec61α translocon complex is topological located in the membrane of the endoplasmic reticulum (ER) and allows protein transport and calcium across the membrane. Recently, aberrant expression of Sec proteins was linked to carcinogenesis and prognosis of patients. Materials and methods Here, we analysed the role of Sec61α in esophageal cancer, and we analysed Sec61α staining on a tissue microarray containing more than 600 esophageal cancer specimens by immunohistochemistry. Results Sec61α staining was always strong in benign esophagus, but was only found in 5% of interpretable esophageal adenocarcinomas (EACs) and 14.5% of squamous cell carcinomas (ESCCs). Reduced Sec61α staining was not strongly linked to tumor phenotype in both subgroups of esophageal cancers and was unrelated to clinical outcome of patients (EACs: p = 0.8051 and ESCCs: p = 0.2751). Conclusions Thus, Sec61α measurement has not an additional prognostic benefit for the patients.

IntroductionAberrant expression of RNA-binding motif protein 3 (RBM3) has been suggested as a prognostic biomarker in several malignancies.Materials and methodsThis study was performed to analyse the prevalence and clinical significance of RBM3 immunostaining in non-small cell lung cancers (NSCLCs). Therefore, we took advantage of our tissue microarray (TMA) containing more than 600 NSCLC specimens.ResultsWhile nuclear RBM3 staining was always high in normal lung tissue, high RBM3 staining was only seen in 77.1% of 467 interpretable non-metastatic NSCLCs. Reduced RBM3 staining was significantly associated with advanced pathological tumor stage (pT) in NSCLCs (p=0.0031). Subset analysis revealed that the association between reduced RBM3 staining and advanced pT stage was largely driven by the histological subgroup of lung adenocarcinoma (LUACs) (p=0.0036). In addition, reduced RBM3 expression predicted shortened survival in LUAC patients (p=0.0225).ConclusionsIn summary, our study shows that loss of RBM3 expression predicts worse clinical outcome in LUAC patients.

ObjectivesStrong expression of survivin is associated with worse survival in many different tumours, and in cell culture, a correlation between radiation resistance and survivin expression can be seen. The potential of survivin expression as a prognostic/predictive marker or therapeutic target has not been examined in head and neck squamous cell carcinomas (HNSCC) yet.Material and methodsRetrospective study of 452 tissue samples and clinical data from patients with squamous cell carcinomas of the larynx/hypopharynx (LSCC), oral cavity (OSCC) and oropharynx (OPSCC) treated in the University Medical Centre Hamburg-Eppendorf between 2002 and 2006. The expression patterns were detected by tissue microarray technique and correlated with clinical parameters (sex, age, tumour location, TNM 7th edition, grading, recurrence-free and overall survival).Results222 OSCC, 126 OPSCC and 105 LSCC tumours of 118 females and 335 males with a mean follow-up of 41.3months were examined. Survivin expression correlates with pN, cM, pT and overall survival.Conclusion and clinical relevanceThe potential of survivin as a prognostic/predictive marker is very high. The findings have to be confirmed in a larger cohort of HNSCC esp. in those tumours treated primarily with radio/radiochemotherapy.

BackgroundEnhancer of zeste homolog 2 (EZH2), the catalytic subunit of the polycomb repressive complex 2, plays an important role in tumor development and progression by interacting with histone and non-histone proteins. EZH2 represents a putative therapeutic target and has been suggested as a prognostic marker in several cancer types. Material and MethodsThis study investigates the prognostic relevance of immunohistochemical EZH2 expression in head and neck squamous cell carcinoma. Tissue microarray sections with 667 cancers of oral cavity, oro- and hypopharynx and larynx were analyzed for EZH2 expression. ResultsNuclear EZH2 staining was recorded in 322 (81.8%) of 394 cases. Staining was weak in 33 (10.2%), moderate in 128 (39.6%), and strong in 103 (32.0%) cancers. The prevalence of EZH2 expression in tumors of the oral cavity and the orohypopharynx was higher as compared to cancers of the larynx (P = .0023). EZH2 expression was correlated to presence of lymph node metastasis (P = .0089) but was unrelated to histological grade, tumor stage, surgical margin, or distant metastasis. EZH2 expression had no impact on patient survival. ConclusionThe high prevalence of EZH2 expression in head and neck squamous cell carcinoma stresses its capability as a therapeutic target.

Split‐thickness skin grafting is a common procedure to treat different kinds of wounds. This systematic, multicentre, observational, cross‐sectional study of adult patients with split‐thickness skin graft (STSG) donor site wounds was conducted to evaluate quality of life (QoL) impairments caused by donor site wounds following split‐thickness skin grafting. Therefore, 112 patients from 12 wound centres in Germany were examined based on patient and physician questionnaires as well as a physical examination of the donor site wound. Most indications for skin grafting were postsurgical treatment (n = 51; 42.5%) and chronic wounds (n = 47; 39.2%). European QoL visual analoque scale (EQ VAS) averaged 64.7 ± 23.3, European QoL 5 dimensions (EQ‐5D) averaged 77.4 ± 30.0. Wound‐QoL (range: 0‐4) was rated 0.8 ± 0.8 post‐surgery and 0.4 ± 0.6 at the time of survey (on average 21 weeks between the time points). Compared to averaged Wound‐QoL scores of chronic wounds donor site‐related QoL impairments in split‐thickness skin‐graft patients were less pronounced. There were significant differences in patient burden immediately after surgery compared to the time of the survey, with medium effect sizes. This supports the hypothesis that faster healing of the donor site wound leads to more favourable patient‐reported outcomes.