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"text": "\n95613\nOpen reduction and augmentation of internal fixation with an injectable skeletal cement for the treatment of complex calcaneal fractures.\n\nSchildhauer, TA\n\nBauer, TW\n\nJosten, C\n\nMuhr, G\n\nBeiträge in Fachzeitschriften\nISI:000088171300001\n10926236.0\n10.1097/00005131-200006000-00001\nNone\nOBJECTIVES: To describe the surgical handling, potential complications, and remodeling of an injectable, osteoconductive calcium phosphate cement (Norian SRS) for joint depression-type calcaneal fractures in humans, and to illustrate the clinical efficacy of this cement with special reference to early postoperative full weight bearing. DESIGN: Prospective cohort study. SETTING: Level I trauma centers in Bochum and Leipzig, Germany. INTERVENTION: Thirty-six joint depression type calcaneal fractures in thirty-two patients were augmented with the calcium phosphate cement after standard open reduction with internal fixation. Postoperative full weight bearing was allowed progressively earlier, and as the study progressed, the last patients were bearing full weight as early as three weeks postoperatively. Biopsies for histologic analysis were performed at time of hardware removal after one year (seven biopsies) or in case of infection at time of debridement (five biopsies). MAIN OUTCOME MEASURES: Clinical outcome was evaluated according to a calcaneal scoring system. Data were compared and statistically analyzed between patients with postoperative full weight bearing after eight to twelve weeks and three to six weeks, respectively. Histologic findings are described. RESULTS: Cement injection averaged ten cubic centimeters and could easily be performed under fluoroscopic control. Progressively earlier full weight-bearing was achieved without loss of reduction. There was no statistical difference in clinical outcome scores in patients with full weight bearing before or after six weeks postoperatively. The infection rate was 11 percent, possibly related to the skin incisions. The biopsies from clinically satisfactory cases showed nearly complete bone apposition, areas of vascular penetration, and reversal lines illustrating progressive cycles of resorption and new bone formation. Biopsy specimens from infected cases showed bone and cement surrounded by either fibrous tissue or acute inflammation without extensive bone apposition. CONCLUSIONS: Calcium phosphate cement augmentation of standard open reduction with internal fixation in joint-depression type calcaneal fractures allows postoperative full weight bearing as early as three weeks postoperatively. The injectable bone cement can easily be handled surgically under fluoroscopic control and has proved to be remodelable.\n\n\n"
},
{
"text": "\n114364\nClinical nodal staging scores for bladder cancer: a proposal for preoperative risk assessment.\n\nShariat, SF\n\nEhdaie, B\n\nRink, M\n\nCha, EK\n\nSvatek, RS\n\nChromecki, TF\n\nFajkovic, H\n\nNovara, G\n\nDavid, SG\n\nDaneshmand, S\n\nFradet, Y\n\nLotan, Y\n\nSagalowsky, AI\n\nClozel, T\n\nBastian, PJ\n\nKassouf, W\n\nFritsche, HM\n\nBurger, M\n\nIzawa, JI\n\nTilki, D\n\nAbdollah, F\n\nChun, FK\n\nSonpavde, G\n\nKarakiewicz, PI\n\nScherr, DS\n\nGonen, M\n\nBeiträge in Fachzeitschriften\nISI:000298248700009\n22033174.0\n10.1016/j.eururo.2011.10.011\nNone\nBACKGROUND: Radical cystectomy (RC) with pelvic lymph node dissection (LND) is the standard of care for refractory non-muscle-invasive and muscle-invasive bladder cancer. Although consensus exists on the need for LND, its extent is still debated. OBJECTIVE: To develop a model that allows preoperative determination of the minimum number of lymph nodes (LNs) needed to be removed at RC to ensure true nodal status. DESIGN, SETTING, AND PARTICIPANTS: We analyzed data from 4335 patients treated with RC and pelvic LND without neoadjuvant chemotherapy at 12 academic centers located in the United States, Canada, and Europe. MEASUREMENTS: We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed clinical (preoperative) nodal staging scores (cNSS), which represent the probability that a patient has LN metastasis as a function of the number of examined nodes. RESULTS AND LIMITATIONS: The probability of missing a positive LN decreased with an increasing number of nodes examined (52% if 3 nodes were examined, 40% if 5 were examined, and 26% if 10 were examined). A cNSS of 90% was achieved by examining 6 nodes for clinical Ta-Tis tumors, 9 nodes for cT1 tumors, and 25 nodes for cT2 tumors. In contrast, examination of 25 nodes provided only 77% cNSS for cT3-T4 tumors. The study is limited due to its retrospective design, its multicenter nature, and a lack of preoperative staging parameters. CONCLUSIONS: Every patient treated with RC for bladder cancer needs an LND to ensure accurate nodal staging. The minimum number of examined LNs for adequate staging depends preoperatively on the clinical T stage. Predictive tools can give a preoperative estimation of the likelihood of nodal metastasis and thereby allow tailored decision-making regarding the extent of LND at RC. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.\n\n\n"
},
{
"text": "\n116573\nOral biofilm analysis of palatal expanders by fluorescence in-situ hybridization and confocal laser scanning microscopy.\n\nKlug, B\n\nRodler, C\n\nKoller, M\n\nWimmer, G\n\nKessler, HH\n\nGrube, M\n\nSantigli, E\n\nBeiträge in Fachzeitschriften\nNone\n22041974.0\n10.3791/2967\nPMC3227208\nConfocal laser scanning microscopy (CLSM) of natural heterogeneous biofilm is today facilitated by a comprehensive range of staining techniques, one of them being fluorescence in situ hybridization (FISH). We performed a pilot study in which oral biofilm samples collected from fixed orthodontic appliances (palatal expanders) were stained by FISH, the objective being to assess the three-dimensional organization of natural biofilm and plaque accumulation. FISH creates an opportunity to stain cells in their native biofilm environment by the use of fluorescently labeled 16S rRNA-targeting probes. Compared to alternative techniques like immunofluorescent labeling, this is an inexpensive, precise and straightforward labeling technique to investigate different bacterial groups in mixed biofilm consortia. General probes were used that bind to Eubacteria (EUB338 + EUB338II + EUB338III; hereafter EUBmix), Firmicutes (LGC354 A-C; hereafter LGCmix), and Bacteroidetes (Bac303). In addition, specific probes binding to Streptococcus mutans (MUT590) and Porphyromonas gingivalis (POGI) were used. The extreme hardness of the surface materials involved (stainless steel and acrylic resin) compelled us to find new ways of preparing the biofilm. As these surface materials could not be readily cut with a cryotome, various sampling methods were explored to obtain intact oral biofilm. The most workable of these approaches is presented in this communication. Small flakes of the biofilm-carrying acrylic resin were scraped off with a sterile scalpel, taking care not to damage the biofilm structure. Forceps were used to collect biofilm from the steel surfaces. Once collected, the samples were fixed and placed directly on polysine coated glass slides. FISH was performed directly on these slides with the probes mentioned above. Various FISH protocols were combined and modified to create a new protocol that was easy to handle. Subsequently the samples were analyzed by confocal laser scanning microscopy. Well-known configurations could be visualized, including mushroom-style formations and clusters of coccoid bacteria pervaded by channels. In addition, the bacterial composition of these typical biofilm structures were analyzed and 2D and 3D images created.\n\nKessler, Harald\n\nKlug, Barbara\n\nKoller, Martin\n\nSantigli, Elisabeth\n\nWimmer, Gernot\n\n\n"
},
{
"text": "\n128590\nOral rivaroxaban for symptomatic venous thromboembolism.\n\nEINSTEIN Investigators\n\nBauersachs, R\n\nBerkowitz, SD\n\nBrenner, B\n\nBuller, HR\n\nDecousus, H\n\nGallus, AS\n\nLensing, AW\n\nMisselwitz, F\n\nPrins, MH\n\nRaskob, GE\n\nSegers, A\n\nVerhamme, P\n\nWells, P\n\nAgnelli, G\n\nBounameaux, H\n\nCohen, A\n\nDavidson, BL\n\nPiovella, F\n\nSchellong, S\n\nBeiträge in Fachzeitschriften\nISI:000285555600005\n21128814.0\n10.1056/NEJMoa1007903\nNone\nBackground: Rivaroxaban, an oral factor Xa inhibitor, may provide a simple, fixed-dose regimen for treating acute deep-vein thrombosis (DVT) and for continued treatment, without the need for laboratory monitoring. Methods: We conducted an open-label, randomized, event-driven, noninferiority study that compared oral rivaroxaban alone (15 mg twice daily for 3 weeks, followed by 20 mg once daily) with subcutaneous enoxaparin followed by a vitamin K antagonist (either warfarin or acenocoumarol) for 3, 6, or 12 months in patients with acute, symptomatic DVT. In parallel, we carried out a double-blind, randomized, event-driven superiority study that compared rivaroxaban alone (20 mg once daily) with placebo for an additional 6 or 12 months in patients who had completed 6 to 12 months of treatment for venous thromboembolism. The primary efficacy outcome for both studies was recurrent venous thromboembolism. The principal safety outcome was major bleeding or clinically relevant nonmajor bleeding in the initial-treatment study and major bleeding in the continued-treatment study. Results: The study of rivaroxaban for acute DVT included 3449 patients: 1731 given rivaroxaban and 1718 given enoxaparin plus a vitamin K antagonist. Rivaroxaban had noninferior efficacy with respect to the primary outcome (36 events [2.1%], vs. 51 events with enoxaparin-vitamin K antagonist [3.0%]; hazard ratio, 0.68; 95% confidence interval [CI], 0.44 to 1.04; P<0.001). The principal safety outcome occurred in 8.1% of the patients in each group. In the continued-treatment study, which included 602 patients in the rivaroxaban group and 594 in the placebo group, rivaroxaban had superior efficacy (8 events [1.3%], vs. 42 with placebo [7.1%]; hazard ratio, 0.18; 95% CI, 0.09 to 0.39; P<0.001). Four patients in the rivaroxaban group had nonfatal major bleeding (0.7%), versus none in the placebo group (P=0.11). Conclusions: Rivaroxaban offers a simple, single-drug approach to the short-term and continued treatment of venous thrombosis that may improve the benefit-to-risk profile of anticoagulation. (Funded by Bayer Schering Pharma and Ortho-McNeil; ClinicalTrials.gov numbers, NCT00440193 and NCT00439725.) N Engl J Med 2010;363:2499-510.\n\nPilger, Ernst\n\n\n"
},
{
"text": "\n133423\nDenosumab compared with risedronate in postmenopausal women suboptimally adherent to alendronate therapy: efficacy and safety results from a randomized open-label study.\n\nRoux, C\n\nHofbauer, LC\n\nHo, PR\n\nWark, JD\n\nZillikens, MC\n\nFahrleitner-Pammer, A\n\nHawkins, F\n\nMicaelo, M\n\nMinisola, S\n\nPapaioannou, N\n\nStone, M\n\nFerreira, I\n\nSiddhanti, S\n\nWagman, RB\n\nBrown, JP\n\nBeiträge in Fachzeitschriften\nISI:000328304000007\n24141036.0\n10.1016/j.bone.2013.10.006\nNone\nDenosumab has been shown to reduce new vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis. In subjects who were treatment-naïve or previously treated with alendronate, denosumab was associated with greater gains in bone mineral density (BMD) and decreases in bone turnover markers when compared with alendronate-treated subjects. This trial was designed to compare the efficacy and safety of denosumab with risedronate over 12 months in postmenopausal women who transitioned from daily or weekly alendronate treatment and were considered to be suboptimally adherent to therapy. In this randomized, open-label study, postmenopausal women aged ≥55 years received denosumab 60 mg subcutaneously every 6 months or risedronate 150 mg orally every month for 12 months. Endpoints included percentage change from baseline in total hip BMD (primary endpoint), femoral neck, and lumbar spine BMD at month 12, and percentage change from baseline in sCTX-1 at months 1 and 6. Safety was also assessed. A total of 870 subjects were randomized (435, risedronate; 435, denosumab) who had a mean (SD) age of 67.7 (6.9) years, mean (SD) BMD T-scores of -1.6 (0.9), -1.9 (0.7), and -2.2 (1.2) at the total hip, femoral neck, and lumbar spine, respectively, and median sCTX-1 of 0.3 ng/mL at baseline. At month 12, denosumab significantly increased BMD compared with risedronate at the total hip (2.0% vs 0.5%), femoral neck (1.4% vs 0%), and lumbar spine (3.4% vs 1.1%; p<0.0001 at all sites). Denosumab significantly decreased sCTX-1 compared with risedronate at month 1 (median change from baseline of -78% vs -17%; p<0.0001) and month 6 (-61% vs -23%; p<0.0001). Overall and serious adverse events were similar between groups. In postmenopausal women who were suboptimally adherent to alendronate therapy, transitioning to denosumab was well tolerated and more effective than risedronate in increasing BMD and reducing bone turnover.\n © 2013. Published by Elsevier Inc. All rights reserved.\n\nFahrleitner-Pammer, Astrid\n\n\n"
},
{
"text": "\n134544\nL1CAM in early-stage type I endometrial cancer: results of a large multicenter evaluation.\n\nZeimet, AG\n\nReimer, D\n\nHuszar, M\n\nWinterhoff, B\n\nPuistola, U\n\nAzim, SA\n\nMüller-Holzner, E\n\nBen-Arie, A\n\nvan Kempen, LC\n\nPetru, E\n\nJahn, S\n\nGeels, YP\n\nMassuger, LF\n\nAmant, F\n\nPolterauer, S\n\nLappi-Blanco, E\n\nBulten, J\n\nMeuter, A\n\nTanouye, S\n\nOppelt, P\n\nStroh-Weigert, M\n\nReinthaller, A\n\nMariani, A\n\nHackl, W\n\nNetzer, M\n\nSchirmer, U\n\nVergote, I\n\nAltevogt, P\n\nMarth, C\n\nFogel, M\n\nBeiträge in Fachzeitschriften\nISI:000322976000012\n23781004.0\n10.1093/jnci/djt144\nNone\nDespite the excellent prognosis of Fdration Internationale de Gyncologie et dObsttrique (FIGO) stage I, type I endometrial cancers, a substantial number of patients experience recurrence and die from this disease. We analyzed the value of immunohistochemical L1CAM determination to predict clinical outcome. We conducted a retrospective multicenter cohort study to determine expression of L1CAM by immunohistochemistry in 1021 endometrial cancer specimens. The KaplanMeier method and Cox proportional hazard model were applied for survival and multivariable analyses. A machine-learning approach was used to validate variables for predicting recurrence and death. Of 1021 included cancers, 17.7% were rated L1CAM-positive. Of these L1CAM-positive cancers, 51.4% recurred during follow-up compared with 2.9% L1CAM-negative cancers. Patients bearing L1CAM-positive cancers had poorer disease-free and overall survival (two-sided Log-rank P < .001). Multivariable analyses revealed an increase in the likelihood of recurrence (hazard ratio [HR] 16.33; 95% confidence interval [CI] 10.55 to 25.28) and death (HR 15.01; 95% CI 9.28 to 24.26). In the L1CAM-negative cancers FIGO stage I subdivision, grading and risk assessment were irrelevant for predicting disease-free and overall survival. The prognostic relevance of these parameters was related strictly to L1CAM positivity. A classification and regression decision tree (CRT)identified L1CAM as the best variable for predicting recurrence (sensitivity 0.74; specificity 0.91) and death (sensitivity 0.77; specificity 0.89). To our knowledge, L1CAM has been shown to be the best-ever published prognostic factor in FIGO stage I, type I endometrial cancers and shows clear superiority over the standardly used multifactor risk score. L1CAM expression in type I cancers indicates the need for adjuvant treatment. This adhesion molecule might serve as a treatment target for the fully humanized anti-L1CAM antibody currently under development for clinical use.\n\nJahn, Stephan\n\nPetru, Edgar\n\n\n"
},
{
"text": "\n146083\nThe green tea catechin epigallocatechin gallate induces cell cycle arrest and shows potential synergism with cisplatin in biliary tract cancer cells.\n\nMayr, C\n\nWagner, A\n\nNeureiter, D\n\nPichler, M\n\nJakab, M\n\nIllig, R\n\nBerr, F\n\nKiesslich, T\n\nBeiträge in Fachzeitschriften\nISI:000356571000003\n26100134.0\n10.1186/s12906-015-0721-5\nPMC4477611\nThe green tea catechin epigallocatechin gallate (EGCG) was shown to effectively inhibit tumor growth in various types of cancer including biliary tract cancer (BTC). For most BTC patients only palliative therapy is possible, leading to a median survival of about one year. Chemoresistance is a major problem that contributes to the high mortality rates of BTC. The aim of this study was to investigate the cytotoxic effect of EGCG alone or in combination with cisplatin on eight BTC cell lines and to investigate the cellular anti-cancer mechanisms of EGCG.\n The effect of EGCG treatment alone or in combination with the standard chemotherapeutic cisplatin on cell viability was analyzed in eight BTC cell lines. Additionally, we analyzed the effects of EGCG on caspase activity, cell cycle distribution and gene expression in the BTC cell line TFK-1.\n EGCG significantly reduced cell viability in all eight BTC cell lines (p < 0.05 or p < 0.01, respectively, for most cell lines and EGCG concentrations > 5 μM). Combined EGCG and cisplatin treatment showed a synergistic cytotoxic effect in five cell lines and an antagonistic effect in two cell lines. Furthermore, EGCG reduced the mRNA levels of various cell cycle-related genes, while increasing the expression of the cell cycle inhibitor p21 and the apoptosis-related death receptor 5 (p < 0.05). This observation was accompanied by an increase in caspase activity and cells in the sub-G1 phase of the cell cycle, indicating induction of apoptosis. EGCG also induced a down-regulation of expression of stem cell-related genes and genes that are associated with an aggressive clinical character of the tumor, such as cd133 and abcg2.\n EGCG shows various anti-cancer effects in BTC cell lines and might therefore be a potential anticancer drug for future studies in BTC. Additionally, EGCG displays a synergistic cytotoxic effect with cisplatin in most tested BTC cell lines. Graphical abstract Summary illustration.\n\nPichler, Martin\n\n\n"
},
{
"text": "\n153106\nOocyte competence in in vitro fertilization and intracytoplasmic sperm injection patients suffering from endometriosis and its possible association with subsequent treatment outcome: a matched case-control study.\n\nShebl, O\n\nSifferlinger, I\n\nHabelsberger, A\n\nOppelt, P\n\nMayer, RB\n\nPetek, E\n\nEbner, T\n\nBeiträge in Fachzeitschriften\nISI:000402273300013\n27317364.0\n10.1111/aogs.12941\nNone\nEndometriosis affects up to 15% of women of reproductive age. There is an obvious lack of studies dealing with morphological parameters of oocyte morphology in endometriosis patients in assisted reproduction. One aim of the study is to describe oocyte morphology in patients undergoing intracytoplasmic sperm injection suffering from endometriosis. In addition, the impact of endometriosis on in vitro fertilization results is analyzed. Both in vitro fertilization and intracytoplasmic sperm injection patients are then matched with an endometriosis-free control group for highlighting the possible association of endometriosis with pregnancy outcome.\n Oocyte morphology of endometriosis patients was assessed in two groups. Both study group and control group consisted of 129 in vitro fertilization/intracytoplasmic sperm injection cycles each. Patients were matched according to anti-Müllerian hormone, female age, previous treatment cycles, and method of fertilization. Endometriosis was graded according to the revised American Society for Reproductive Medicine guidelines of 1997.\n Patients with endometriosis had a significantly lower rate of mature oocytes (p < 0.03) and morphologically normal oocytes (p < 0.001). In particular, brownish oocytes (p < 0.009; stage I-IV) and the presence of refractile bodies (p < 0.001; stage IV) were found to be increased. Endometriosis stage IV was associated with significantly worse-quality oocytes than stages I-III (p < 0.01). Fertilization was significantly reduced in conventional in vitro fertilization but not in intracytoplasmic sperm injection (p < 0.03). This was due to lower fertilization rates in stage III-IV endometriosis compared with stage I-II (p < 0.04). No difference was observed with respect to rates of implantation, clinical pregnancy, miscarriage, live birth, and malformation.\n Endometriosis patients, in particular those with severe endometriosis, present lower-quality oocytes. Once fertilized, no impairment of further preimplantation embryo development and pregnancy outcome right up to healthy live birth rate has to be expected.\n © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.\n\nEbner, Thomas\n\nPetek, Erwin\n\n\n"
},
{
"text": "\n154619\nInteractions of Factors and Profiles of Incontinent Nursing Home Residents and Hospital Patients: A Classification Tree Analysis.\n\nMandl, M\n\nHalfens, RJ\n\nLohrmann, C\n\nBeiträge in Fachzeitschriften\nISI:000380113600012\n27196685.0\n10.1097/WON.0000000000000232\nNone\nTo investigate the interactions among well-known influencing factors for urinary incontinence (UI), fecal incontinence (FI), and double urinary and fecal incontinence (DI) in the nursing home and hospital setting and to identify profiles of UI, FI, and DI residents and patients.\n Data from more than 4200 residents and patients from 16 nursing homes and 36 hospitals were collected.\n This was a cross-sectional study.\n A cross-sectional study was used for data collection. The Austrian version of the International Prevalence Measurement of Care Problems survey was used to collect data about different nursing care problems (eg, pressure ulcer and incontinence). To improve objectivity, 2 nurses assessed each resident/patient. The Care Dependency Scale (CDS) was used to measure the degree of care dependency regarding different needs such as mobility, with lower scores indicating a higher level of care dependency. A classification and regression tree analysis was used to determine the interactions among factors and develop profiles of incontinent residents and patients.\n Interactions between the CDS-items of states of Dress/Undress, Hygiene, Mobility, and Eat/Drink and age based on incontinence were found in nursing home residents. In contrast, interactions between the CDS-items Hygiene and Eat/Drink, as well as age and gender based on incontinence, were identified in hospitalized patients. Residents with UI were care dependent with reference to the CDS-item Dress/Undress. Patients with UI were older than 77.5 years and completely, or to a great extent, care dependent with reference to the CDS-item Hygiene. Nursing home residents with DI were completely, or to a great extent, care dependent with regard to the CDS-item Hygiene and completely care dependent with reference to the CDS-item Dress/Undress. In comparison, hospitalized DI patients were completely, or to a great extent, care dependent with regard to the CDS-item Hygiene.\n The results of this study show that independently associated factors for incontinence also influence each other. Furthermore, these interactions increase the prevalence for incontinence and differ with regard to the type of incontinence and setting.\n\nHödl, Manuela\n\nLohrmann, Christa\n\n\n"
},
{
"text": "\n161063\nREGOSARC: Regorafenib versus placebo in doxorubicin-refractory soft-tissue sarcoma-A quality-adjusted time without symptoms of progression or toxicity analysis.\n\nBerry, V\n\nBasson, L\n\nBogart, E\n\nMir, O\n\nBlay, JY\n\nItaliano, A\n\nBertucci, F\n\nChevreau, C\n\nClisant-Delaine, S\n\nLiegl-Antzager, B\n\nTresch-Bruneel, E\n\nWallet, J\n\nTaieb, S\n\nDecoupigny, E\n\nLe Cesne, A\n\nBrodowicz, T\n\nPenel, N\n\nBeiträge in Fachzeitschriften\nISI:000402846300017\n28295221.0\n10.1002/cncr.30661\nPMC5485075\nIn a placebo-controlled, randomized phase 2 trial (ClinicalTrials.gov identifier NCT01900743), regorafenib improved progression-free survival (PFS) for patients with doxorubicin-pretreated advanced nonadipocytic sarcoma. A quality-adjusted time without symptoms of progression or toxicity (Q-TWiST) post hoc exploratory analysis was applied to provide an integrated measure of its clinical benefit.\n In the base-case analysis, each patient's overall survival (OS) was partitioned into 3 mutually exclusive health states: the time with a grade 3 or 4 adverse event (TOX), the time without symptoms of disease or grade 3 or 4 toxicity from treatment, and the time after tumor progression or relapse. The time spent in each state was weighted with a health-state utility associated with that state and was summed to calculate the Q-TWiST. The stability of the base-case analysis was explored with several sensitivity analyses.\n In nonadipocytic sarcoma, the PFS was (4.0 months [2.6-5.5 months] with regorafenib vs 1.0 month [0.9-1.8 months] with a placebo; hazard ratio, 0.36 [0.25-0.53]; P < .0001); the OS was 13.4 months (8.6-17.3 months) with regorafenib and 9.0 months (6.8-12.5 months) with a placebo (hazard ratio, 0.67 [0.44-1.02]). With the classic definition of TOX (including all grade 3 and 4 clinical adverse events), the Q-TWiSTs were 8.0 months (7.0-9.0 months) with regorafenib and 5.7 months (4.9-6.4 months) with a placebo (P < .001).\n For patients with doxorubicin-pretreated soft-tissue sarcoma, regorafenib significantly improved quality-adjusted survival in comparison with a placebo. Cancer 2017;123:2294-2302. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.\n © 2017 American Cancer Society.\n\nLiegl-Atzwanger, Bernadette\n\n\n"
},
{
"text": "\n166449\nMonopolar Radiofrequency Ablation of Thyroid Nodules: A Prospective Austrian Single-Center Study.\n\nDobnig, H\n\nAmrein, K\n\nBeiträge in Fachzeitschriften\nISI:000430069900007\n29490593.0\n10.1089/thy.2017.0547\nPMC5905420\nMonopolar radiofrequency ablation is currently deemed an exotic treatment option for benign thyroid nodules in many central European countries. The aim of this study was to evaluate prospectively the safety and efficacy of this method in a large patient cohort following its introduction in Austria.\n Peri- and post-interventional complications were analyzed for 277 patients. Efficacy was determined for 300 and 154 nodules at 3 and 12 months post treatment, respectively. All treatments were performed with an internally cooled 18G radiofrequency electrode using a free-hand, "moving-shot" technique following subcutaneous and local perithyroidal anesthesia.\n Mean patient age (SD) was 52 ± 12.9 years (75% female), and overall mean baseline nodule volume (SD) was 13.8 ± 15.9 mL. Nodules were visible in 62.8% of patients, 40% had a symptom score ≥4 on a 10-point visual analogue scale, and 14.4% had hyperthyroidism. Mean overall nodule volume reduction rates (VRR) at 3 and 12 months were 68 ± 16% and 82 ± 13%, respectively (p < 0.001). At 12 months, 81% of nodules exhibited a VRR of ≥70%, with 10%, 6%, and 2% of nodules showing VRRs of 60-70%, 50-60%, and ≤50%, respectively. Subgroup analysis according to baseline nodule size (≤10 mL to >30 mL) or baseline nodule composition (solid, mixed, cystic) revealed significantly higher VRRs for smaller and cystic nodules. Moreover, nodule shrinkage was accompanied by significantly improved symptom and cosmetic scores after 3 and 12 months (p < 0.001). Of 32 hyperthyroid patients, 27 (84%) were euthyroid, four had subclinical hyperthyroidism, and one had subclinical hypothyroidism at last follow-up. Post-procedural complications were absent in 83% of patients, minimal in 12.9%, moderate and reversible in 3.2% (1.8% voice change, 0.7% hyperthyroidism, 0.3% wound infection treated with antibiotics, 0.3% epifascial hematoma), and irreversible in 0.7% (one case with hypothyroidism and one with a wound infection treated by surgery).\n It is concluded that a single treatment course with monopolar radiofrequency ablation is both safe and highly effective in terms of nodule volume reduction, relief of local symptoms, and (in patients with hyperthyroidism) restoration of euthyroid function. In no case was a prescription of thyroid medication required among those patients who were euthyroid at baseline.\n\nAmrein, Karin\n\n\n"
},
{
"text": "\n168569\nA step ahead: Exploring the gut microbiota in inpatients with bipolar disorder during a depressive episode.\n\nPainold, A\n\nMörkl, S\n\nKashofer, K\n\nHalwachs, B\n\nDalkner, N\n\nBengesser, S\n\nBirner, A\n\nFellendorf, F\n\nPlatzer, M\n\nQueissner, R\n\nSchütze, G\n\nSchwarz, MJ\n\nMoll, N\n\nHolzer, P\n\nHoll, AK\n\nKapfhammer, HP\n\nGorkiewicz, G\n\nReininghaus, EZ\n\nBeiträge in Fachzeitschriften\nISI:000459791000006\n30051546.0\n10.1111/bdi.12682\nPMC6585963\nThere is evidence that the gut microbiota plays a major role in the pathogenesis of diseases of the central nervous system through the gut-brain axis. The aim of the present study was to analyze gut microbiota composition in bipolar disorder (BD) and its relation to inflammation, serum lipids, oxidative stress, tryptophan (TRP)/kynurenine (KYN) levels, anthropometric measurements and parameters of metabolic syndrome. Further, microbial community differences of individuals with BD compared with healthy controls (HC) were explored.\n In this cross-sectional study, we performed 16S rRNA gene sequencing of stool samples from 32 BD individuals and 10 HC. Laboratory parameters included inflammatory markers, serum lipids, KYN, oxidative stress and anthropometric measures. Microbial community analysis and correlation to clinical parameters was performed with QIIME, differential abundance analysis of taxa encompassed linear discriminant analysis effect size (LEfSe).\n We found a negative correlation between microbial alpha-diversity and illness duration in BD (R = -0.408, P = 0.021). Furthermore, we identified bacterial clades associated with inflammatory status, serum lipids, TRP, depressive symptoms, oxidative stress, anthropometrics and metabolic syndrome in individuals with BD. LEfSe identified the phylum Actinobacteria (LDA= 4.82, P = 0.007) and the class Coriobacteria (LDA= 4.75, P = 0.010) as significantly more abundant in BD when compared with HC, and Ruminococcaceae (LDA= 4.59, P = 0.018) and Faecalibacterium (LDA= 4.09, P = 0.039) as more abundant in HC when compared with BD.\n The present findings suggest that causes and/or consequences of BD may also lie outside the brain. Exploratory research of the gut microbiota in affective disorders like BD may identify previously unknown underlying causes, and offer new research and therapeutic approaches to mood disorders.\n © 2018 The Authors. Bipolar Disorders Published by John Wiley & Sons Ltd.\n\nBengesser, Susanne\n\nBirner, Armin\n\nDalkner, Nina\n\nFellendorf, Frederike\n\nGorkiewicz, Gregor\n\nHoll, Anna\n\nHolzer, Peter\n\nKapfhammer, Hans-Peter\n\nKashofer, Karl\n\nMörkl, Sabrina\n\nPainold, Annamaria\n\nPlatzer, Martina\n\nQueissner, Robert\n\nReininghaus, Eva\n\n\n"
},
{
"text": "\n176438\nSearching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design.\n\nPutaala, J\n\nMartinez-Majander, N\n\nSaeed, S\n\nYesilot, N\n\nJäkälä, P\n\nNerg, O\n\nTsivgoulis, G\n\nNumminen, H\n\nGordin, D\n\nvon Sarnowski, B\n\nWaje-Andreassen, U\n\nYlikotila, P\n\nRoine, RO\n\nZedde, M\n\nHuhtakangas, J\n\nFonseca, C\n\nRedfors, P\n\nde Leeuw, FE\n\nPezzini, A\n\nKõrv, J\n\nSchneider, S\n\nTanislav, C\n\nEnzinger, C\n\nJatuzis, D\n\nSiegerink, B\n\nMartínez-Sánchez, P\n\nGrau, AJ\n\nPalm, F\n\nGroop, PH\n\nLanthier, S\n\nTen Cate, H\n\nPussinen, P\n\nPaju, S\n\nSinisalo, J\n\nLehto, M\n\nLindgren, A\n\nFerro, J\n\nKittner, S\n\nFazekas, F\n\nGerdts, E\n\nTatlisumak, T\n\nBeiträge in Fachzeitschriften\nNone\n31008307.0\n10.1177/2396987317703210\nPMC6453214\nWorldwide, about 1.3 million annual ischaemic strokes (IS) occur in adults aged <50 years. Of these early-onset strokes, up to 50% can be regarded as cryptogenic or associated with conditions with poorly documented causality like patent foramen ovale and coagulopathies.\n (1) Investigate transient triggers and clinical/sub-clinical chronic risk factors associated with cryptogenic IS in the young; (2) use cardiac imaging methods exceeding state-of-the-art to reveal novel sources for embolism; (3) search for covert thrombosis and haemostasis abnormalities; (4) discover new disease pathways using next-generation sequencing and RNA gene expression studies; (5) determine patient prognosis by use of phenotypic and genetic data; and (6) adapt systems medicine approach to investigate complex risk-factor interactions.\n Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is a prospective multi-centre case-control study enrolling patients aged 18-49 years hospitalised due to first-ever imaging-proven IS of undetermined etiology. Patients are examined according to a standardised protocol and followed up for 10 years. Patients are 1:1 age- and sex-matched to stroke-free controls. Key study elements include centralised reading of echocardiography, electrocardiography, and neurovascular imaging, as well as blood samples for genetic, gene-expression, thrombosis and haemostasis and biomarker analysis. We aim to have 600 patient-control pairs enrolled by the end of 2018.\n SECRETO is aiming to establish novel mechanisms and prognosis of cryptogenic IS in the young and will provide new directions for therapy development for these patients. First results are anticipated in 2019.\n\nEnzinger, Christian\n\nFazekas, Franz\n\n\n"
},
{
"text": "\n182932\nLevosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use.\n\nPapp, Z\n\nAgostoni, P\n\nAlvarez, J\n\nBettex, D\n\nBouchez, S\n\nBrito, D\n\nČerný, V\n\nComin-Colet, J\n\nCrespo-Leiro, MG\n\nDelgado, JF\n\nÉdes, I\n\nEremenko, AA\n\nFarmakis, D\n\nFedele, F\n\nFonseca, C\n\nFruhwald, S\n\nGirardis, M\n\nGuarracino, F\n\nHarjola, VP\n\nHeringlake, M\n\nHerpain, A\n\nHeunks, LM\n\nHusebye, T\n\nIvancan, V\n\nKarason, K\n\nKaul, S\n\nKivikko, M\n\nKubica, J\n\nMasip, J\n\nMatskeplishvili, S\n\nMebazaa, A\n\nNieminen, MS\n\nOliva, F\n\nPapp, JG\n\nParissis, J\n\nParkhomenko, A\n\nPõder, P\n\nPölzl, G\n\nReinecke, A\n\nRicksten, SE\n\nRiha, H\n\nRudiger, A\n\nSarapohja, T\n\nSchwinger, RH\n\nToller, W\n\nTritapepe, L\n\nTschöpe, C\n\nWikström, G\n\nvon Lewinski, D\n\nVrtovec, B\n\nPollesello, P\n\nBeiträge in Fachzeitschriften\nNone\n32714567.0\n10.15420/cfr.2020.03\nPMC7374352\nLevosimendan was first approved for clinic use in 2000, when authorisation was granted by Swedish regulatory authorities for the haemodynamic stabilisation of patients with acutely decompensated chronic heart failure. In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitisation and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced heart failure, right ventricular failure and pulmonary hypertension, cardiac surgery, critical care and emergency medicine. Levosimendan is currently in active clinical evaluation in the US. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and non-cardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, UK and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute heart failure arena in recent times and charts a possible development trajectory for the next 20 years.\n Copyright © 2020, Radcliffe Cardiology.\n\nFruhwald, Sonja\n\nToller, Wolfgang\n\nvon Lewinski, Dirk\n\n\n"
},
{
"text": "\n183265\nMicrovascular density assessed by CD31 predicts clinical benefit upon bevacizumab treatment in metastatic colorectal cancer: results of the PassionATE study, a translational prospective Phase II study of capecitabine and irinotecan plus bevacizumab followed by capecitabine and oxaliplatin plus bevacizumab or the reverse sequence in patients in mCRC.\n\nBianconi, D\n\nHerac, M\n\nPosch, F\n\nSchmeidl, M\n\nUnseld, M\n\nKieler, M\n\nBrettner, R\n\nMullauer, L\n\nRiedl, J\n\nGerger, A\n\nScheithauer, W\n\nPrager, G\n\nBeiträge in Fachzeitschriften\nISI:000563370700001\nNone\n10.1177/1758835920928635\nNone\nBackground: Targeted therapies offer novel opportunities to explore biomarkers based on their mode of action. Taking this into consideration, we evaluated six angiogenesis-related proteins as potential predictive biomarkers, which expression might predict the benefit of bevacizumab treatment in patients with metastatic colorectal cancer (mCRC). Methods: This was a phase II multicenter, two-armed, randomized study, in which patients with mCRC were treated with XELIRI (capecitabine and irinotecan) plus bevacizumab followed by XELOX (capecitabine and oxaliplatin) plus bevacizumab (Arm A) or the reverse sequence (Arm B). Tissue expression level of six prespecified candidates [microvessel density assessed by CD31, PTEN, alpha V integrin, CD98hc, uPAR and NRP-1] was analyzedviaimmunohistochemistry. The prognostic impact on survival was quantified using the Cox regression model. The predictive potential for benefit from Arm AversusArm B treatment was investigated by fitting an interaction between the biomarkers and treatment assignment within a multivariable Cox model. Results: In total, 74 out of 126 patients were included in the analysis. The expression of PTEN, alpha V integrin, uPAR and NRP-1 was not associated with progression-free survival (PFS) or overall survival (OS). For the first time, we identified that patients with tumors expressing CD98hc had a longer PFS than patients without CD98hc-expression (p = 0.032). More importantly, and in accordance with previous studies, low microvessel density was found to be associated with a reduced PFS [adjusted HR per doubling of CD31-expression (p = 0.53, 95% confidence interval: 0.30-0.95, = 0.034)]. Conclusions: These results can contribute to the development of a personalized strategy for the treatment of mCRC with bevacizumab.\n\nGerger, Armin\n\nPosch, Florian\n\nRiedl, Jakob\n\n\n"
},
{
"text": "\n184368\nStructural rationale for the cross-resistance of tumor cells bearing the A399V variant of elongation factor eEF1A1 to the structurally unrelated didemnin B, ternatin, nannocystin A and ansatrienin B.\n\nSánchez-Murcia, PA\n\nCortés-Cabrera, Á\n\nGago, F\n\nBeiträge in Fachzeitschriften\nISI:000413448900005\n28900796.0\n10.1007/s10822-017-0066-x\nNone\nAt least four classes of structurally distinct natural products with potent antiproliferative activities target the translation elongation factor eEF1A1, which is best known as the G-protein that delivers amino acyl transfer RNAs (aa-tRNAs) to ribosomes during mRNA translation. We present molecular models in atomic detail that provide a common structural basis for the high-affinity binding of didemnin B, ternatin, ansatrienin B and nannocystin A to eEF1A1, as well as a rationale based on molecular dynamics results that accounts for the deleterious effect of replacing alanine 399 with valine. The proposed binding site, at the interface between domains I and III, is eminently hydrophobic and exists only in the GTP-bound conformation. Drug binding at this site is expected to disrupt neither loading of aa-tRNAs nor GTP hydrolysis but would give rise to stabilization of this particular conformational state, in consonance with reported experimental findings. The experimental solution of the three-dimensional structure of mammalian eEF1A1 has proved elusive so far and the highly homologous eEF1A2 from rabbit muscle has been crystallized and solved only as a homodimer in a GDP-bound conformation. Interestingly, in this dimeric structure the large interdomain cavity where the drugs studied are proposed to bind is occupied by a mostly hydrophobic α-helix from domain I of the same monomer. Since binding of this α-helix and any of these drugs to domain III of eEF1A(1/2) is, therefore, mutually exclusive and involves two distinct protein conformations, one intriguing possibility that emerges from our study is that the potent antiproliferative effect of these natural products may arise not only from inhibition of protein synthesis, which is the current dogma, but also from interference with some other non-canonical functions. From this standpoint, this type of drugs could be considered antagonists of eEF1A1/2 oligomerization, a hypothesis that opens up novel areas of research.\n\nSánchez Murcia, Pedro Alejandro\n\n\n"
},
{
"text": "\n21982\nCellular pathophysiology and therapy of pulmonary hypertension.\n\nOlschewski, H\n\nRose, F\n\nGrünig, E\n\nGhofrani, HA\n\nWalmrath, D\n\nSchulz, R\n\nSchermuly, R\n\nGrimminger, F\n\nSeeger, W\n\nBeiträge in Fachzeitschriften\nISI:000172909000003\n11753283.0\n10.1067/mlc.2001.119285\nNone\nThe identification of several mutations of the bone morphogenetic protein receptor 2 (BMPR2) gene, a member of the transforming growth factor beta receptor family, gives hope for new insights into the pathophysiology of pulmonary hypertension. Genetic predisposition might dictate the responses of pulmonary artery fibroblasts, smooth muscle cells, and endothelial cells, as well as platelets and leukocytes, or their specific interactions with different extrinsic factors. These cells possess distinct subtypes and interact with each other. Pulmonary hypertension is associated with vasoconstriction, remodeling, and in situ thrombosis of the pulmonary arteries, but the initial events and their relationship to the genetic background are presently unknown. Current therapeutic approaches are based on our knowledge of the physiologic regulation of pulmonary artery tone, pathophysiologic changes, and our clinical experience with different treatment strategies. Beyond diuretics and anticoagulants, prostaglandins are generally accepted therapeutic agents for primary pulmonary hypertension and related diseases, whereas high-dose calcium-channel blockers are reserved for a small subset of patients, those who respond favorably to vasodilators in an acute test. Long-term intravenous prostacyclin infusion has become the most important specific therapy for primary pulmonary hypertension and associated diseases. However, this therapy is hampered by catheter complications and systemic side effects. Alternative application routes of prostacyclin or its stable analogs may avoid these problems. Inhaled application of the prostacyclin analog iloprost results in predominant pulmonary vasodilation with few systemic side effects and may possess clinical efficacy similar to that of intravenous prostacyclin. Inhaled nitric oxide is widely accepted as a screening agent for active responders to vasodilators and has a similar hemodynamic profile as inhaled iloprost, although the percentage of responders is considerably lower. However, there are unsolved toxicologic questions and practical difficulties concerning the safe long-term application of nitric oxide. Combining inhaled vasodilators with phosphodiesterase inhibitors may prolong the duration of the effects and improve the convenience of inhaled therapy for pulmonary hypertension. Therapeutic approaches in the future may aim at the transforming growth factor beta pathway and at the identification of early stages of the disease to prevent further disease progression.\n\nOlschewski, Horst\n\n\n"
},
{
"text": "\n99636\nDynamic changes of specific T cell responses to melanoma correlate with IL-2 administration.\n\nAndersen, MH\n\nGehl, J\n\nReker, S\n\nPedersen, LO\n\nBecker, JC\n\nGeertsen, P\n\nStraten, PT\n\nBeiträge in Fachzeitschriften\nISI:000187388300009\n15001164.0\n10.1016/j.semcancer.2003.09.009\nNone\nInterleukin 2 (IL-2) is a promising immunotherapeutic agent for the treatment of metastatic melanoma and renal cell carcinoma. Systemic administration of high dose IL-2 produces objective responses in up to 25% of melanoma patients, and a low but significant proportion of these patients experience durable responses. Nevertheless, the cells and molecules responsible for induction of tumor regression over the course of IL-2 treatment remain unknown. New strategies in tumor immunotherapy have evolved over the past decade as a consequence of significant progress in the field, in particular with respect to the characterization of peptide epitopes derived from tumor associated antigens, and the role of antigen presenting cells in the initiation of cellular immune responses. Alongside with these factual as well as conceptual advances, new methods have been developed to monitor and characterize anti-tumor T cell responses in cancer patients. Application of these tools to dissect anti-tumor responses has demonstrated that various immune therapeutic approaches can induce powerful systemic anti-tumor cytotoxic T lymphocyte (CTL) responses. However, only limited efforts have been made to use present days tool to analyze anti-tumor immune responses in patients treated with IL-2 based immunotherapy. We have examined CTL responses against known tumor antigens in melanoma patients over the course of IL-2 based immunotherapy (electrochemotherapy). Surprisingly, anti-tumor CTL responses significantly declined upon initiation of therapy, but reappeared when IL-2 administration was paused. Molecular analyses of the clonotypic composition of responding T cells demonstrated that new clones emerged over the course of treatment, and that tumor-specific T cells that had left the peripheral blood could subsequently be detected at the tumor site. These data provide new insight into the biological actions of IL-2 and highlight the difficulties associated with the monitoring of anti-tumor immune responses. This underlines the importance of frequent sampling of blood and tumor biopsies to be analyzed with a combination of state of the art technologies in order to gain detailed information on the interactions between cancer cells and cells of the immune system.\n\n\n"
},
{
"text": "\n121622\nComparison of variable-thread tapered implant designs to a standard tapered implant design after immediate loading. A 3-year multicentre randomised controlled trial.\n\nArnhart, C\n\nKielbassa, AM\n\nMartinez-de Fuentes, R\n\nGoldstein, M\n\nJackowski, J\n\nLorenzoni, M\n\nMaiorana, C\n\nMericske-Stern, R\n\nPozzi, A\n\nRompen, E\n\nSanz, M\n\nStrub, JR\n\n\n\nBeiträge in Fachzeitschriften\nISI:000307600800005\n22866289.0\nNone\nNone\nOBJECTIVES: This randomised, controlled multicentre trial aimed at comparing two versions of a variable-thread dental implant design to a standard tapered dental implant design in cases of immediate functional loading for 36 months after loading.\r\n\r\nMATERIALS AND METHODS: 177 patients (325 implants) were included at 12 study centres and randomly allocated into one of three treatment groups: NAI (variable-thread design, NobelActive internal connection), NAE (variable-thread design, NobelActive external connection) and, as control, NR (standard tapered design, NobelReplace tapered groovy). Inclusion criteria concerned healed bony implant sites and feasibility for immediate loading. Clinical and radiographic examinations were performed at implant placement and after 3, 6, 12, 24 and 36 months. The outcome measures were marginal bone remodelling (primary outcome), implant survival and success, papilla score, plaque accumulation, and bleeding on probing.\r\n\r\nRESULTS: 127 patients (NAI: 45, NAE: 41, NR: 41) were followed-up and evaluated after 36 months. No significant differences in cumulative survival rates were seen for the groups (NAI: 95.7%; NAE: 96.3%; NR: 96.6%). In all groups, bone remodelling occurred during the first 3 months, with stable or even increasing bone levels after the initial remodelling period. The bone remodelling from insertion to 36 months for the NAI group (-0.89 ± 1.65 mm) was comparable (P = 0.98) to that of the NR group (-0.85 ± 1.32 mm). The NAE group showed comparable bone remodelling during the first year, with an increase in following years resulting in significantly less overall bone loss (-0.16 ± 1.06 mm) (P = 0.041). Overall improvement in papilla size was observed in all treatment groups.\r\n\r\nCONCLUSIONS: Over 36 months, the results show stable or improving bone levels for all treatment groups after the initial bone remodelling seen during the first 3 months after placement. The variable- thread implants showed results comparable to those of standard tapered implants in cases of immediate function, and therefore can be considered as a treatment option for immediate loading.\n\nLorenzoni, Martin\n\n\n"
},
{
"text": "\n123852\nLaparoscopic sleeve gastrectomy achieves substantial weight loss in an adolescent girl with morbid obesity\n\nTill, HKH\n\nMuensterer, O\n\nKeller, A\n\nKorner, A\n\nBlueher, S\n\nMerlde, R\n\nKies, W\n\nBeiträge in Fachzeitschriften\nISI:000254192300010\n18302070.0\n10.1055/s-2008-1038356\nNone\nBackground: The European guidelines for bariatric surgery clearly define criteria for operating children with morbid obesity. However the appropriate technique for this age-group has not been identified yet. So far gastric banding and Roux-Y bypass represent the standards, but they demand life-long tolerance of either an artificial device or significant malabsorption. Although laparoscopic sleeve gastrectomy (LSG) demands neither, it has not been advocated for this age group as a stand-alone technique. We report the outcome and the rationale for this approach in a 16-year-old girl with morbid obesity. Material and Method: The patient had been in an intensive weight loss programme for several years, but within the last 12 months her body weight had increased again dramatically. At referral she presented with a body mass index (BMI) of 43.1 kg/m(2) (height 169 cm, preoperative weight 121 kg) and suffered from co-morbidities as features of a developing metabolic-vascular syndrome such as dyslipidemia and arterial hypertension. Our obesity team and her parents opted for surgery at that time. The patient underwent LSG with a 5-trocar technique. With a gastroscope protecting the lesser curvature, the stomach was resected from the antrum to the fundus using an EndoGIA stapler. The operative time was 95 minutes, there were no perioperative complications and the patient was extubated immediately. An upper GI contrast study on postoperative day 4 showed a tubular gastric remnant with a volume of about 200 ml. The patient's diet was advanced as tolerated to full oral intake, and she was followed-up regularly in our special obesity outpatient clinic. After 12 months she had lost 36 kg (BMI 29 kg/m(2)) and enjoyed sports and activities with friends again. Laboratory studies ruled out malnutrition or vitamin deficiency. Conclusion:LSG is a safe and effective option for bariatric surgery in obese adolescents. It can be offered as a stand-alone restrictive operation and could be extended to a malabsorptive procedure at any time. However longer follow-up is required before universally recommending this procedure.\n\nTill, Holger\n\n\n"
}
]
}