Osteoarthritis is a common disease worldwide, most commonly affecting the knee. With the rise of obesity, paired with higher life expectancy, prevalence of osteoarthritis of the knee will rise as well. Therefore, Total Knee Arthroplasty (TKA) rates are expected to increase 85 %, estimating 1.26 million procedures worldwide in 2030. Patients will become older with demographic changes and more elderly people will be eligible for procedure, a patient group is often considered vulnerable, with a higher risk of mortality and complications. This systematic review aimed to compare perioperative outcomes after TKA in Octogenarians with those in a younger cohort. After screening 33,336 publications on total joint arthroplasty in the elderly in the PubMed and Web of Science databases, four studies investigating TKA and matching criteria were included. No notable variations in outcomes were detected among elderly compared to younger patients. Eligibility for a procedure should be based on comorbidities and overall health status rather than age alone.

Severe trauma continues to pose a substantial burden on survivors, particularly in terms of long-term physical, psychological, and social functioning. While survival rates have improved, data on long-term outcomes remain limited. This study evaluates ten-year post-injury outcomes in patients with major trauma, focusing on return to work and social participation. In this single-center, retrospective cohort study, adult patients (≥ 18 years) with an Injury Severity Score (ISS) ≥ 9 treated between 2010 and 2013 were surveyed and distributed minimally 10 years later. Patients completed standardized questionnaires assessing sociodemographic and occupational data, functional status, and psychological well-being using the Trauma Outcome Profile (TOP). Ninety-one patients completed the follow-up. The mean age at injury was 43.0 years, with a mean ISS of 20.8. Ten years post-trauma, 82.4

Background: Texture analysis has the potential to deliver quantitative imaging markers. Patients receiving computed tomography (CT)-guided percutaneous bone biopsies could be characterized using texture analysis derived from CT. Especially for breast cancer (BC) patients, it could be crucial to better predict the outcome of the biopsy to better reflect the immunohistochemistry status of the tumor.Objectives: The present study examined the relationship between texture features and outcomes in patients with BC receiving CT-guided bone biopsies.Design: This study is based on a retrospective analysis.Methods: The present study included a total of 66 patients. All patients proceeded to undergo a CT-guided percutaneous bone biopsy, using an 11-gauge coaxial needle. Clinical and imaging characteristics as well as CT texture analysis were included in the analysis. Logistic regression analysis was performed to predict negative biopsy results.Results: Overall, 33 patients had osteolytic metastases (50%) and 33 had osteoblastic metastases (50%). The overall positivity rate for the biopsy was 75%. The clinical model exhibited a predictive accuracy for a positive biopsy result, as indicated by an area under the curve (AUC) of 0.73 [95% confidence interval (CI) = 0.63-0.83]. Several CT texture features were different between Luminal A and Luminal B cancers; the best discrimination was reached for "WavEnHH_s-3" with a P-value of .002. When comparing triple-negative to non-triple-negative cancers, several CT texture features were different, the best discrimination achieved "S(5,5)SumVarnc" with a P-value of .01. For the Her 2 discrimination, only 3 parameters reached statistical significance, "S(4,-4)SumOfSqs" with a P-value of .01.Conclusions: The utilization of CT texture features may facilitate a more accurate characterization of bone metastases in patients with BC. There is the potential to predict the immunohistochemical subtype with a high degree of accuracy. The identified parameters may prove useful in clinical decision-making and could help to identify patients at risk of a negative biopsy result.

Background: Osteoarthritis (OA) is a prevalent degenerative joint disease that causes disability and diminishes quality of life. The pathogenesis of OA remains poorly understood, creating an urgent need for biomarkers to aid research, diagnosis, and treatment. Methods: This study integrated transcriptome data from the GEO database with bioinformatics analyses to identify biomarkers associated with OA. The bioinformatics methods utilized include the Limma package, WGCNA, PPI network analysis, and machine learning algorithms. Genetic variants were used as instrumental variables to evaluate the potential causal impact of circulating white blood cell (WBC) counts on OA. Data sources encompassed the largest genome-wide analysis for OA and a comprehensive GWAS summary for circulating WBC counts. Four mendelian randomization (MR) methods were employed to investigate the genetic association, with a primary focus on findings from the inverse variance-weighted (IVW) method. Results: Total of 233 OA-related genes were identified, showing significant enrichment in pathways associated with WBC function. Key biomarkers, including CD4, CSF1R, and TYROBP, were upregulated in OA samples and exhibited strong diagnostic potential. MR analysis findings provided evidence of a genetic association between elevated neutrophil counts and a reduced risk of OA across sites (IVW: OR = 0.97, 95% CI 0.93–1.00, p = 0.047). Additionally, higher circulating WBC counts, particularly neutrophil counts, were associated with a suggestive decrease in hip OA (WBC IVW: OR = 0.94, 95% CI 0.89–0.99, p = 0.015; neutrophil IVW: OR = 0.93, 95% CI 0.88–0.99, p = 0.017). Conversely, reverse MR analysis found no evidence to support a genetic effect of OA on circulating WBC counts. Conclusion: Our findings suggest that elevated neutrophil counts may offer protective effects against OA, underscoring the interplay between the immune functions and OA pathogenesis. CD4, CSF1R, and TYROBP emerge as promising OA biomarkers, meriting further validation in prospective studies.

Osteoarthritis (OA), a degenerative disease, frequently necessitates the replacement of the affected joint, commonly involving the hip. With increasing life expectancy and the anticipated rise in OA incidence, the demand for Total Hip Arthroplasty (THA) is expected to surge, particularly among Octogenarians. The elderly are often perceived as a vulnerable patient group, with concerns about their eligibility for THA primarily based on age alone. Aims There is a prevailing presumption that Octogenarians face an elevated risk of perioperative mortality, increased complication rates, and prolonged hospital stays.This systematic review aimed to compare perioperative outcomes after THA in Octogenarians, with primary outcomes being mortality and length of stay in hospital. Methods A systematic screening of 33,336 titles from the PubMed and Web of Science databases following Cochrane Handbook for Systematic Reviews and PRISMA guidelines was performed. Eight publications about THA met inclusion criteria for final analysis, Studies underwent evaluation for certainty of evidence according to GRADE criteria. Results Eight studies were included in this systematic review, covering data from 494,144 patients.Perioperative mortality rates varied between 0.33 % and 1.96 % in the older cohort. The duration of hospital stay was longer among Octogenarians compared to their younger counterparts across all publications. Surgical complications were similar in elderly and younger patients. Although elderly patients generally experienced higher rates of medical complications, differences were subtle. Conclusion Age alone should not hinder performance of THA in Octogenarians. This systematic review underlines that eligibility for a procedure should be based on comorbidities and overall health status. Important findings from international guidelines for improving safety in elderly undergoing THA were included, but further research is needed to ensure optimal perioperative management of risk factors and potential complications.

Texture analysis can provide new imaging-based biomarkers. Texture analysis derived from computed tomography (CT) might be able to better characterize patients undergoing CT-guided percutaneous bone biopsy. The present study evaluated this and correlated texture features with bioptic outcome in patients undergoing CT-guided bone biopsy. Overall, 123 patients (89 female patients, 72.4 %) were included into the present study. All patients underwent CT-guided percutaneous bone biopsy with an 11 Gauge coaxial needle. Clinical parameters and quantitative imaging features were investigated. Random forest classifier was used to predict a positive biopsy result. Overall, 69 patients had osteolytic metastasis (56.1 %) and 54 had osteoblastic metastasis (43.9 %). The overall positive biopsy rate was 72 %. The developed radiomics model demonstrated a prediction accuracy of a positive biopsy result with an AUC of 0.75 [95 %CI 0.65 - 0.85]. In a subgroup of breast cancer patients, the model achieved an AUC of 0.85 [95 %CI 0.73 - 0.96]. In the subgroup of non-breast cancer patients, the signature achieved an AUC of 0.80 [95 %CI 0.60 - 0.99]. Quantitative CT imaging findings comprised of conventional and texture features can aid to predict the bioptic result of CT-guided bone biopsies. The developed radiomics signature aids in clinical decision-making, and could identify patients at risk for a negative biopsy.

Background: Visits to an outpatient cancer clinic represent a challenging situation for patients, which can trigger anxiety and helplessness in those affected. It is important to identify patients with high psychological distress as early as possible in order to provide them with supportive psychological interventions. The aim of this study was to validate the Distress Thermometer (DT), a widely used screening for distress, in a cohort of patients with musculoskeletal tumors and to explore associations between distress, treatment satisfaction and health literacy.Methods: All patients presenting to a University outpatient clinic for musculoskeletal cancers were asked to complete a set of questionnaires including the DT), the Hospital Anxiety and Depression Scale (HADS) as a comparison scale, the Patient Satisfaction with Comprehensive Cancer Care (SCCC) and European Health Literacy Survey Questionnaire (HLS-EU-Q16).To assess the sensitivity and specificity of the DT in a cohort of patients with musculoskeletal tumors, we compare the performance of the DT in relation to an established screener for anxiety and depression using receiver operating characteristics (ROC) analyses.Results: A total of 120 patients (age 58 +/- 18, 51% female) were analyzed. Patients reported a mean DT of 5.0 (SD 2.3, range, 0 to 10). Eighty-six patients (71.7 %) had a DT score >= 5 indicating moderate or severe psychological distress.The mean total HADS score (scale 0 to42 points) was 11.7 (SD 7.6, range, 0 to 32) with a HADS score of >= 15 in 29.2% of patients. The DT correlated moderately with anxiety and depression (HADS total r = 0.48, p < 0.001), while the correlation with depression (HADS-D, r = 0.47, p < 0.001) was stronger than with anxiety (HADS-A, r = 0.38, p < 0.001).For a DT score >= 5, ROC analysis yielded a sensitivity of 71.4% and a specificity of 75.3% for detecting moderate or severe psychological distress (HADS >= 15, AUC 0.782).The REPERES-G, collected from a subgroup (n = 49), showed high treatment satisfaction with a median score of 132 (min 90, max 163). Especially the "satisfaction with medical aspects of treatment" (REPERES-G medical aspects) showed a moderate correlation with the DT (r = 0.51, p < 0.001) a strong correlation with anxiety and depression (HADS total, r = 0.69, p < 0.001).Conclusion: About three in four patients with musculoskeletal tumors have relevant psychological distress. A visual analogue scale can only be a rough guide for identifying patients in need of psychological support, with a sensitivity of 71.4 % and a specificity of 75.3 %. A strong relationship between patient and care team was associated with lower patient psychological distress.Consequently, screening tools cannot replace detailed discussion and personal contact, especially in the treat-ment of malignant diseases.

Background Metabolic remodeling and changes in tumor immune microenvironment (TIME) in osteosarcoma are important factors affecting prognosis and treatment. However, the relationship between metabolism and TIME needs to be further explored. Methods RNA-Seq data and clinical information of 84 patients with osteosarcoma from the TARGET database and an independent cohort from the GEO database were included in this study. The activity of seven metabolic super-pathways and immune infiltration levels were inferred in osteosarcoma patients. Metabolism-related genes (MRGs) were identified and different metabolic clusters and MRG-related gene clusters were identified using unsupervised clustering. Then the TIME differences between the different clusters were compared. In addition, an MRGs-based risk model was constructed and the role of a key risk gene, ST3GAL4, in osteosarcoma cells was explored using molecular biological experiments. Results This study revealed four key metabolic pathways in osteosarcoma, with vitamin and cofactor metabolism being the most relevant to prognosis and to TIME. Two metabolic pathway-related clusters (C1 and C2) were identified, with some differences in immune activating cell infiltration between the two clusters, and C2 was more likely to respond to two chemotherapeutic agents than C1. Three MRG-related gene clusters (GC1-3) were also identified, with significant differences in prognosis among the three clusters. GC2 and GC3 had higher immune cell infiltration than GC1. GC3 is most likely to respond to immune checkpoint blockade and to three commonly used clinical drugs. A metabolism-related risk model was developed and validated. The risk model has strong prognostic predictive power and the low-risk group has a higher level of immune infiltration than the high-risk group. Knockdown of ST3GAL4 significantly inhibited proliferation, migration, invasion and glycolysis of osteosarcoma cells and inhibited the M2 polarization of macrophages. Conclusion The metabolism of vitamins and cofactors is an important prognostic regulator of TIME in osteosarcoma, MRG-related gene clusters can well reflect changes in osteosarcoma TIME and predict chemotherapy and immunotherapy response. The metabolism-related risk model may serve as a useful prognostic predictor. ST3GAL4 plays a critical role in the progression, glycolysis, and TIME of osteosarcoma cells.

Weichgewebesarkome sind seltene, heterogene Tumore, welche häufig an den Extremitäten lokalisiert sind. Die Therapie beinhaltet die chirurgische Resektion, Kombinationschemotherapie und/oder Strahlentherapie sowie ergänzende Verfahren wie isolierte Extremitätenperfusion und regionale Tiefenhyperthermie. Die Prognose ist abhängig vom Tumorstadium und den etwa 70 histologischen Subtypen, wobei nur für einige Subtypen spezifische Therapieansätze existieren. Diese Übersichtsarbeit fasst die Empfehlungen der deutschen S3-Leitlinie „Adulte Weichgewebesarkome“ und der Leitlinie der European Society for Medical Oncology (ESMO) „Soft tissue and visceral sarcomas“ zur Diagnostik und Therapie lokalisierter Weichgewebesarkome der Extremitäten zusammen.

Additional file 2: Table S2. DEGs between high- and low-ImmuneScore groups. Table S3. DEGs between high- and low-StromalScore groups. Table S4. Genes of green, blue and yellow modules in WGCNA. Table S6. DEGs between high- and low-TMEindex groups. Table S7. Correlations between TMEindex and IC50 value in different drugs. Table S8. Target pathway of 29 TMEindex-related drugs.

BACKGROUND:The tumor microenvironment (TME) has a central role in the oncogenesis of osteosarcomas. The composition of the TME is essential for the interaction between tumor and immune cells. The aim of this study was to establish a prognostic index (TMEindex) for osteosarcoma based on the TME, from which estimates about patient survival and individual response to immune checkpoint inhibitor (ICI) therapy can be deduced. METHODS:Based on osteosarcoma samples from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database, the ESTIMATE algorithm was used to estimate ImmuneScore and StromalScore. Combined differentially expressed gene analysis, weighted gene co-expression network analyses, the Least Absolute Shrinkage and Selection Operator regression and stepwise regression to construct the TMEindex. The prognostic role of TMEindex was validated in three independent datasets. The molecular and immune characteristics of TMEindex and the impact on immunotherapy were then comprehensively investigated. The expression of TMEindex genes in different cell types and its effects on osteosarcoma cells were explored by scRNA-Seq analysis and molecular biology experiments. RESULTS:Fundamental is the expression of MYC, P4HA1, RAMP1 and TAC4. Patients with high TMEindex had worse overall survival, recurrence-free survival, and metastasis-free survival. TMEindex is an independent prognostic factor in osteosarcoma. TMEindex genes were mainly expressed in malignant cells. The knockdown of MYC and P4HA1 significantly inhibited the proliferation, invasion and migration of osteosarcoma cells. A high TME index is related to the MYC, mTOR, and DNA replication-related pathways. In contrast, a low TME index is related to immune-related signaling pathways such as the inflammatory response. The TMEindex was negatively correlated with ImmuneScore, StromalScore, immune cell infiltration, and various immune-related signature scores. Patients with a higher TMEindex had an immune-cold TME and higher invasiveness. Patients with a low TME index were more likely to respond to ICI therapy and achieve clinical benefit. In addition, the TME index correlated with response to 29 oncologic drugs. CONCLUSIONS:The TMEindex is a promising biomarker to predict the prognosis of patients with osteosarcoma and their response to ICI therapy, and to distinguish the molecular and immune characteristics.

BackgroundThis research integrates a comparative analysis of the performance of human researchers and OpenAI's ChatGPT in systematic review tasks and describes an assessment of the application of natural language processing (NLP) models in clinical practice through a review of 5 studies. ObjectiveThis study aimed to evaluate the reliability between ChatGPT and human researchers in extracting key information from clinical articles, and to investigate the practical use of NLP in clinical settings as evidenced by selected studies. MethodsThe study design comprised a systematic review of clinical articles executed independently by human researchers and ChatGPT. The level of agreement between and within raters for parameter extraction was assessed using the Fleiss and Cohen κ statistics. ResultsThe comparative analysis revealed a high degree of concordance between ChatGPT and human researchers for most parameters, with less agreement for study design, clinical task, and clinical implementation. The review identified 5 significant studies that demonstrated the diverse applications of NLP in clinical settings. These studies’ findings highlight the potential of NLP to improve clinical efficiency and patient outcomes in various contexts, from enhancing allergy detection and classification to improving quality metrics in psychotherapy treatments for veterans with posttraumatic stress disorder. ConclusionsOur findings underscore the potential of NLP models, including ChatGPT, in performing systematic reviews and other clinical tasks. Despite certain limitations, NLP models present a promising avenue for enhancing health care efficiency and accuracy. Future studies must focus on broadening the range of clinical applications and exploring the ethical considerations of implementing NLP applications in health care settings.

Soft tissue sarcomas are rare, heterogeneous tumors that are frequently in the extremities. Treatment includes surgical resection, combination chemotherapy and/or radiotherapy, as well as supplementary procedures such as isolated limb perfusion and regional deep hyperthermia. The prognosis depends on the tumor stage and the approximately 70 histological subtypes, with specific treatment approaches existing only for some subtypes. This review summarizes the recommendations of the German S3 guideline "Adult Soft Tissue Sarcomas" and the European Society for Medical Oncology (ESMO) guideline "Soft tissue and visceral sarcomas" regarding the diagnostic workup and therapy of soft tissue sarcomas of the extremities.

Introduction Multidisciplinary tumor conferences are a fundamental component in the treatment of oncological patients. The COVID-19 pandemic and its resulting social distancing restrictions offered the opportunity to compare in-person to virtual multidisciplinary tumor conferences. Methods Retrospective analysis of first-time presentations in tumor conferences at a university musculoskeletal tumor center in the time periods from September 2019 to February 2020 (in-person) and May 2020 to October 2020 (virtual). Results A total of 209 patients were first-time discussed in one of 52 analyzed musculoskeletal multidisciplinary tumor conferences (105 patients in 25 in-person, and 104 patients 27 virtual meetings). The total number of participants was slightly lower with virtual meetings ( p < .001) and more disciplines were represented in virtual tumor conferences ( p < .001). With median six consultants present in either, the level of available expertise did not differ between the conference formats ( p = .606). Compared to in-person tumor meetings, the patients were discussed earlier in the virtual conferences ( p = .028). The interval between first presentation to biopsy was significantly shorter after virtual tumor conferences (median 4 vs. 7 days, p < .001). There was no significant difference in the interval between initial presentation and resection ( p = .544) among the two conference formats. Conclusions The implementation of virtual tumor conferences appears to have had a positive effect on timely diagnosis and multidisciplinarity during tumor conferences. This may result in better decision-making and treatment of patients with musculoskeletal tumors and could be routinely implemented into cancer care.

Despite various treatment attempts, the heterogenous group of soft tissue sarcomata (STS) with more than 100 subtypes still shows poor outcomes. Therefore, effective biomarkers for prognosis prediction and personalized treatment are of high importance. The Procollagen-Lysine, 2-Oxoglutarate 5-Dioxygenase (PLOD) gene family, which is related to multiple cancer entities, consists of three members which encode important enzymes for the formation of connective tissue. The relation to STS, however, has not yet been explored. In this study, data from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases were used to analyze the role of PLOD1–3 in STS. It was found that an overexpression of PLOD family members correlates with poor prognosis, which might be due to an increased infiltration of immune-related cells in the tumor microenvironment. In STS, the expression of PLOD genes could be a novel biomarker for prognosis and a personalized, more aggressive treatment in these patients.

Soft tissue sarcomas (STS) are a rare disease with high recurrence rates and poor prognosis. Missing therapy options together with the high heterogeneity of this tumor type gives impetus to the development of individualized treatment approaches. This study identifies potential tumor antigens for the development of mRNA tumor vaccines for STS and explores potential immune subtypes, stratifying patients for immunotherapy. RNA-sequencing data and clinical information were extracted from 189 STS samples from The Cancer Genome Atlas (TCGA) and microarray data were extracted from 103 STS samples from the Gene Expression Omnibus (GEO). Potential tumor antigens were identified using cBioportal, the Oncomine database, and prognostic analyses. Consensus clustering was used to define immune subtypes and immune gene modules, and graph learning-based dimensionality reduction analysis was used to depict the immune landscape. Finally, four potential tumor antigens were identified, each related to prognosis and antigen-presenting cell infiltration in STS: HLTF, ITGA10, PLCG1, and TTC3. Six immune subtypes and six gene modules were defined and validated in an independent cohort. The different immune subtypes have different molecular, cellular, and clinical characteristics. The immune landscape of STS reveals the immunity-related distribution of patients and intra-cluster heterogeneity of immune subtypes. This study provides a theoretical framework for STS mRNA vaccine development and the selection of patients for vaccination, and provides a reference for promoting individualized immunotherapy.

Lower-grade glioma (LGG) is a group of tumors arising from the cells of the central nervous system. Although various therapy interventions are used, the prognosis remains different. Novel biomarkers are needed for the prognosis of disease and novel therapeutic strategies in LGG. The procollagen-lysine, 2-oxoglutarate 5-dioxygenase (PLOD) family contains three members and is related to multiple cancers, yet it was not investigated in LGG. Data from the Chinese Glioma Genome Atlas (CGGA) and The Cancer Genome Atlas (TCGA) cohorts were used to analyze the role of PLOD in LGG. As the PLOD family is involved in processes, such as tumor formation and cancer metastasis, we focused on its relationship to the tumor microenvironment (TME) in LGG. A high expression of the PLOD family relates to poor prognosis and high infiltration of immune cells within the TME. The expression level of the PLOD family might become a novel biomarker for prognosis and is a potential target for individual treatment decisions in LGG.

BACKGROUND:During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations.OBJECTIVE:This study describes the establishment and management of a CCCC at a German university hospital.METHODS:We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered.RESULTS:During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% (291/1068) of patients were admitted to normal wards, and 12.9% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 (US $60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found.CONCLUSIONS:Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient's life against another's.

Soft tissue sarcomas (STS), a group of rare malignant tumours with high tissue heterogeneity, still lack effective clinical stratification and prognostic models. Therefore, we conducted this study to establish a reliable prognostic gene signature. Using 189 STS patients’ data from The Cancer Genome Atlas database, a four-gene signature including DHRS3, JRK, TARDBP and TTC3 was established. A risk score based on this gene signature was able to divide STS patients into a low-risk and a high-risk group. The latter had significantly worse overall survival (OS) and relapse free survival (RFS), and Cox regression analyses showed that the risk score is an independent prognostic factor. Nomograms containing the four-gene signature have also been established and have been verified through calibration curves. In addition, the predictive ability of this four-gene signature for STS metastasis free survival was verified in an independent cohort (309 STS patients from the Gene Expression Omnibus database). Finally, Gene Set Enrichment Analysis indicated that the four-gene signature may be related to some pathways associated with tumorigenesis, growth, and metastasis. In conclusion, our study establishes a novel four-gene signature and clinically feasible nomograms to predict the OS and RFS. This can help personalized treatment decisions, long-term patient management, and possible future development of targeted therapy.

Zusammenfassung Hintergrund Die interdisziplinäre Versorgung von polytraumatisierten PatientInnen ist personal- und ressourcenaufwendig. Seit der Einführung des G‑DRG-Systems 2003 in Deutschland wurde in den meisten Untersuchungen ein finanzielles Defizit in der Schwerstverletztenversorgung festgestellt. Ziel dieser Studie war es, Auswirkungen des 2020 neu eingeführten aG-DRG-Systems auf die Kostendeckung in der Schwerverletztenbehandlung zu analysieren. Erstmals wurden auch die Kosten für Organisation, Zertifizierung und Dokumentation sowie die Kosten für nicht schwer verletzte SchockraumpatientInnen betrachtet. Methodik Eingeschlossen wurden alle PatientInnen, die im Jahr 2017 im chirurgischen Schockraum der Zentralen Notaufnahme des Universitätsklinikums Leipzig behandelt wurden. Für die Analyse wurden das Kostenmodell nach Pape et al. um die Module Organisation, Dokumentation und Zertifizierung ergänzt sowie die Kosten für „übertriagierte“ PatientInnen betrachtet. Es erfolgte die Berechnung der Kosten in den Jahren 2017–2020 im Vergleich der jeweiligen Erlöse. Ergebnisse Es wurden 834 PatientInnen im Schockraum behandelt. Die 258 schwer verletzten PatientInnen wurden in 3 Gruppen untergliedert: „ISS 9–15 + ITS“ (n 72; ∅ ISS 11,9; Kosten/PatientIn 14.715 €), „ISS ≥ 16“ (n 186; ∅ ISS 27,7; Kosten/PatientIn 30.718 €) und „DRG-Polytrauma“ (n 59; ∅ ISS 32,4; Kosten/PatientIn 26.102 €). Schlussfolgerung Die Polytraumaversorgung im aG-DRG 2020 ist defizitär. Insgesamt entstand im Jahr 2020 ein Defizit von 5858 € pro schwer verletztem/verletzter PatientIn.