Background The acetylcholinesterase inhibitors (AChEIs) donepezil, galantamine, and rivastigmine are commonly used in the management of various forms of dementia.

Objectives While these drugs are known to induce classic cholinergic adverse events such as diarrhea, their potential to cause psychiatric adverse events has yet to be thoroughly examined.

Methods We sought to determine the risk of psychiatric adverse events associated with the use of AChEIs through a systematic review and meta-analysis of double-blind randomized controlled trials involving patients with Alzheimer’s dementia and Parkinson’s dementia.

Results A total of 48 trials encompassing 22,845 patients were included in our analysis. Anorexia was the most commonly reported psychiatric adverse event, followed by agitation, insomnia, and depression. Individuals exposed to AChEIs had a greater risk of experiencing appetite disorders, insomnia, or depression compared with those who received placebo (anorexia: odds ratio [OR] 2.93, 95% confidence interval [CI] 2.29–3.75; p < 0.00001; decreased appetite: OR 1.93, 95% CI 1.33–2.82; p = 0.0006; insomnia: OR 1.55, 95% CI 1.25–1.93; p < 0.0001; and depression: OR 1.59, 95% CI 1.23–2.06, p = 0.0004). Appetite disorders were also more frequent with high-dose versus low-dose therapy. A subgroup analysis revealed that the risk of insomnia was higher for donepezil than for galantamine.

Conclusions Our findings suggest that AChEI therapy may negatively impact psychological health, and careful monitoring of new psychiatric symptoms is warranted. Lowering the dose may resolve some psychiatric adverse events, as may switching to galantamine in the case of insomnia.

Clinical Trial Registration The study was pre-registered on PROSPERO (CRD42021258376).

Hintergrund Patient:innen mit einseitiger Taubheit („single-sided deafness“, SSD) und asymmetrischem Hörverlust („asymmetric hearing loss“, AHL) werden zunehmend mit Cochleaimplantaten (CI) versorgt, da eine Verbesserung der auditiven Fähigkeiten und der Lebensqualität nachgewiesen wurde. Bisher gibt es nur wenige Veröffentlichungen, in denen die beiden Gruppen vergleichend untersucht werden. Ziel der vorliegenden Studie war es zu prüfen, worin sich diese beiden Gruppen, insbesondere präoperativ, unterscheiden.

Methodik Es handelt sich um eine statistische Sekundäranalyse bereits veröffentlichter Rohdaten von 66 CI-Patient:innen (21 SSD/45 AHL), die prospektiv in die Studie eingeschlossen wurden. Neben dem Sprachverstehen wurden Tinnitusbelastung (Tinnitusfragebogen), krankheitsspezifische Lebensqualität (Nijmegen Cochlear Implant Questionnaire, NCIQ), Stressbelastung (Perceived Stress Questionnaire, PSQ) und psychische Komorbiditäten (Allgemeine Depressionsskala, ADS‑L, und Generalized-Anxiety-Disorder-Fragebogen, GAD-7) bei SSD- und AHL-Patient:innen prä- und postoperativ verglichen.

Ergebnisse Präoperativ zeigte die SSD-Gruppe im NCIQ in den Subdomänen elementare und erweiterte Schallwahrnehmung signifikant höhere Werte als die AHL-Gruppe. Die Stressbelastung (PSQ) und die Angstsymptomatik (GAD-7) waren bei SSD-Patienten signifikant höher als bei AHL-Patient:innen. Diese Unterschiede waren 6 Monate postoperativ stark verringert und teils sogar nicht mehr signifikant.

Schlussfolgerung Präoperativ unterscheiden sich SSD- und AHL-Patient:innen signifikant im Hinblick auf die subjektive Höreinschätzung und psychosoziale Parameter. Bei SSD-Patient:innen können psychische Belastungsfaktoren einen stärkeren Einfluss auf die gesundheitsbezogene Lebensqualität haben als bei AHL-Patient:innen. Diese Aspekte sollten in der präoperativen Beratung sowie in der postoperativen CI-Rehabilitation berücksichtigt werden.

Purpose The assessment of health-related quality of life (HRQOL) measured via patient-reported outcomes (PROs) is a key component in clinical trials and increasingly used in clinical routine worldwide. Two PRO measures (PROMs) that share the same definition of health and report outcomes on a comparable T-metric anchored to general population samples are the PROMIS-29 and the EORTC QLQ-C30. In this study, we investigate the empirical agreement of these underlying concepts.

Methods We collected PROMIS-29 and EORTC QLQ-C30 data from 1,478 female patients at a breast cancer outpatient centre. We calculated descriptive statistics and correlations between the subscales of both instruments. We performed exploratory (EFA) and confirmatory factor analysis (CFA) in randomly split subsamples in order to assess the underlying psychometric structure of both instruments.

Results The cohort (mean age = 47.4, ± 14.49) reported comparable mean HRQOL scores between the corresponding subscales of both instruments similar to general population reference values. Correlation between the corresponding subscales of both instruments ranged between 0.59 (Social Role) and 0.78 (Physical Functioning). Both an exploratory and a theoretically driven confirmatory factor analysis provided further support for conceptual agreement of the scales.

Conclusion EORTC QLQ-C30 and PROMIS-29 showed similar scores and satisfactory agreement in conceptional and statistical analysis. This suggests that the underlying conceptualization of health is reasonably close. Hence, the development of score transformation algorithms or calibration of both instruments on common scales could prospectively increase the comparability of clinical and research PRO data collected with either instrument.

Purpose Neuroendocrine tumors of the small intestine (si-NET) describe a heterogenous group of neoplasms. Based on the Ki67 proliferation index si-NET are divided into G1 (Ki67 < 2%), G2 (Ki67 3–20%) and rarely G3 (Ki67 > 20%) tumors. However, few studies evaluate the impact of tumor grading on prognosis in si-NET. Moreover, si-NET can form distinct lymphatic spread patterns to the mesenteric root, aortocaval lymph nodes, and distant organs. This study aims to identify prognostic factors within the lymphatic spread patterns and grading.

Methods Demographic, pathological, and surgical data of 208 (90 male, 118 female) individuals with si-NETs treated at Charité University Medicine Berlin between 2010 and 2020 were analyzed retrospectively.

Results A total of 113 (54.5%) specimens were defined as G1 and 93 (44.7%) as G2 tumors. Interestingly, splitting the G2 group in two subgroups: G2 low (Ki67 3–9%) and G2 high (Ki67 10–20%), displayed significant differences in overall survival (OS) (p = 0.008) and progression free survival (PFS) (p = 0.004) between these subgroups. Remission after surgery was less often achieved in patients with higher Ki67 index (> 10%). Lymph node metastases (N +) were present in 174 (83.6%) patients. Patients with isolated locoregional disease showed better PFS and OS in comparison to patients with additional aortocaval and distant lymph node metastases.

Conclusion Lymphatic spread pattern influences patient outcome. In G2 tumors, low and high grading shows heterogenous outcome in OS and PFS. Differentiation within this group might impact follow-up, adjuvant treatment, and surgical strategy.

We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53-10.26), women with positive or unknown partner HIV-status (2.86; 1.18-6.91), and women whose partners abused alcohol (2.68; 1.15-6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting.

Purpose Anxiety is an accompanying symptom in cancer patients that can have a negative impact on patients. The aim of the present analyses is to determine the prevalence of anxiety, taking into account sociodemographic and medical variables, and to determine the odds ratio for the occurrence of anxiety in cancer patients compared to general population.

Methods In this secondary analyses, we included 4,020 adult cancer patients during and after treatment from a multi-center epidemiological study from 5 regions in Germany in different treatment settings and a comparison group consisting of 10,000 people from the general population in Germany. Anxiety was measured with the Generalized Anxiety Disorder (GAD-7) questionnaire. In multivariate analyses adjusted for age and sex, we calculated the odds of being anxious.

Results The prevalence of anxiety was observed to be 13.8% (GAD-7 ≥ 10). The level of anxiety was significant higher for patients in rehabilitation, compared to patients during inpatient and outpatient treatment (p = .013). Comparison with the general population yielded a 2.7-fold increased risk for anxiety among cancer patients (95% CI 2.4–3.1; p < .001). Patients with bladder cancer (OR, 5.3; 95% CI 3.0–9.4) and testicular cancer (OR, 5.0; 95% CI 2.1–12.1) showed the highest risk of having high levels of anxiety.

Conclusion The results highlight the importance of identifying anxiety in cancer patients.

Purpose Patients with cancer suffer from a wide range of psychological distress. Nevertheless, in the literature low utilization rates of psychooncological services are reported. Various factors may influence the utilization of professional support during inpatient care. Up to now it is unclear to what extent patients’ attitude towards psychooncological support and physicians’ recommendation for psychooncological care may influence the utilization.

Methods In a multicenter longitudinal observational study in Comprehensive Cancer Centers Germany, 1398 patients with mixed cancer diagnoses were assessed at baseline during their hospital stay with respect to psychooncological distress and the need for and use of psychooncological services.

Results Psychooncological support was used by almost 28.4% of patients up to this time. A positive attitude towards psychooncological support was reported by 41.6%. A recommendation of psychooncological support by a physician was received by 16.2%. These patients reported a significant higher level of distress compared to patients who did not received a recommendation. Multivariable logistic regression detected that the utilization rate was 3.79 times higher among patients with positive attitude towards psychooncological support (OR, 3.79; 95% CI 2.51–5.73, p < 0.001). Utilization was 4.21 times more likely among patients who received a physician´s recommendation (OR, 4.21; 95% CI 2.98–5.95, p < 0.001).

Conclusion The results of the study provide evidence of the relevance of giving more attention to psychooncological distress and attitudes towards psychooncological care. To reduce reservations, patients need low-threshold information about the psychooncological services offered.

Objectives Lymph node metastases (LNM) are frequent in patients with intrahepatic cholangiocarcinoma (iCC) and worsen their prognosis even after surgery. Our aim was to investigate the predictive value of lymph node (LN) short axis, the most common discriminator for identifying LNM in tumor-imaging and to develop a predictive model for regional LNM in iCC taking computed tomography (CT) features of extranodal disease into account.

Materials and methods We enrolled 102 patients with pathologically proven iCC who underwent CT prior to hepatic resection and hilar lymph node dissection (LND) from 2005 to 2021. Two blinded radiologists assessed various imaging characteristics and LN diameters, which were analyzed by bivariate and multivariate logistic regression to develop a prediction model for LNM.

Results Prevalence of LNM was high (42.4 %) and estimated survival was shorter in LN-positive patients (p = 0.07). An LN short axis diameter of ≥ 9 mm demonstrated the highest predictive power for LNM. Three additional, statistically significant imaging features, presence of intrahepatic metastasis (p = 0.003), hilar tumor infiltration (p = 0.003), and tumor growth along the liver capsule (p = 0.004), were integrated into a prediction model, which substantially outperformed use of LN axis alone in ROC analysis (AUC 0.856 vs 0.701).

Conclusions LN diameter alone proved to be a relevant but unreliable imaging-marker for LNM prediction in iCC. Our proposed prognostic model, which additionally considers intrahepatic metastases and hilar and capsular infiltration, significantly improves discriminatory power. Hilar and capsular involvement might indicate direct tumor extension to lymphatic liver structures.

Hintergrund Die Bedeutung der Prävention von Pflegebedürftigkeit wächst mit der Zunahme von pflegebedürftigen Menschen. Für Deutschland gibt es bislang nur unzureichende Daten darüber, welche Faktoren mit der Entstehung einer Pflegebedürftigkeit assoziiert sind. Die vorliegende Studie untersucht die Wechselwirkungen zwischen soziodemografischen und gesundheitsbezogenen Determinanten von Pflegebedürftigkeit, um daraus präventive Anknüpfungspunkte abzuleiten.

Methoden Analysiert wurden die Begutachtungsdaten des Medizinischen Dienstes (MD) Berlin-Brandenburg zur Feststellung einer Pflegebedürftigkeit nach SGB XI für die Zeiträume 2017 und 2018/2019 mit Fokus auf die Antragstellenden, die über den betrachteten Zeitraum hinweg ohne Pflegegradeinstufung blieben (6037 von insg. 72.680 Antragstellenden des Jahres 2017). Soziale Faktoren wie Haushaltszusammensetzungen, Unterstützungspotenziale und Partnerschaftsstatus wurden über Text-Mining-Verfahren extrahiert und die Daten mittels deskriptiver und multivariabler statistischer Verfahren ausgewertet.

Ergebnisse Eine erhöhte Chance, ohne Pflegegradeinstufung zu bleiben, hatten jüngere Antragstellende sowie Personen ohne Partnerschaft. Im Zeitraum 2018/2019 ebenfalls assoziiert mit einer erhöhten Chance, ohne Pflegegrad zu bleiben, waren eine Verbesserung der Gesundheit, seit 2017 ohne soziale Unterstützung zu sein, muskuloskelettale Erkrankungen sowie chronisch ischämische Herzkrankheiten. Geringere Chancen, ohne Pflegegradeinstufung zu bleiben, hatten hingegen Antragstellende mit demenziellen und sonstigen psychischen Erkrankungen.

Diskussion Die erstmalige Untersuchung der MD-Begutachtungsdaten unter einer präventiven Perspektive zeigt, dass soziodemografische und gesundheitsbezogene Determinanten in Wechselwirkung betrachtet werden müssen, um zusätzliche Präventionspotenziale auszumachen.

Hintergrund Prävention von Erkrankungen und Gesundheitsförderung im und für das Alter haben an Bedeutung gewonnen. Dennoch bedarf es mehr (nationaler) Forschung und Umsetzung in der Praxis, wie der internationale Vergleich zeigt.

Ziel der Arbeit Leitgedanken für Forschung und Praxis zu Prävention und Gesundheitsförderung im und für das Alter entwickeln.

Material und Methoden Im Rahmen eines iterativen Prozesses kamen Mitglieder der Deutschen Gesellschaft für Gerontologie und Geriatrie in Workshops und Symposien zusammen, um wesentliche Leitgedanken und Handlungsfelder zu Prävention und Gesundheitsförderung zu formulieren.

Ergebnisse Herausgearbeitet wurden: 1. Prävention und Gesundheitsförderung sind bis ins hohe Alter sinnvoll und möglich, 2. Prävention und Gesundheitsförderung für das Alter sollten früh beginnen, 3. Prävention und Gesundheitsförderung müssen die Diversität und Heterogenität der Lebenslagen alter Menschen aufgreifen, 4. Prävention und Gesundheitsförderung fördern und fordern Selbstbestimmung und Partizipation, 5. Prävention von Mehrfacherkrankungen gilt es, stärker in den Blick zu nehmen, 6. Prävention von Pflegebedürftigkeit und Prävention in der Pflege sind gleichrangig zu behandeln, 7. Prävention und Gesundheitsförderung müssen lebensweltlich und sektorenübergreifend gedacht werden, dabei sind v. a. Aspekte der sozialen Ungleichheit und eine Ressourcenorientierung mitzubeachten, 8. Prävention und Gesundheitsförderung und die Forschung dazu sind inter- und transdisziplinär und auf unterschiedlichen Ebenen anzulegen, von molekular bis gesellschaftlich.

Diskussion Die Leitgedanken spannen Schwerpunkte einer zukunftsgerichteten Alterns‑, Gesundheits- und Versorgungsforschung auf und öffnen Handlungsfelder, aber auch Grenzen dieses Zugangs für politische Entscheidungstragende, Forschende und Praktiker:innen.

Obsessive-compulsive symptoms (OCS) are frequently observed in individuals with schizophrenia (SCZ) treated with clozapine (CLZ). This study aimed to analyze prevalence of OCS and obsessive-compulsive disorder (OCD) in this subgroup and find possible correlations with different phenotypes. Additionally, this is the first study to examine polygenetic risk scores (PRS) in individuals with SCZ and OCS. A multicenter cohort of 91 individuals with SCZ who were treated with CLZ was recruited and clinically and genetically assessed. Symptom severity was examined using the Positive and Negative Symptom Scale (PANSS), Clinical Global Impression Scale (CGI), the Calgary Depression Scale for Schizophrenia (CDSS), Global Assessment of Functioning Scale (GAF) and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Participants were divided into subgroups based on phenotypic OCS or OCD using Y-BOCS scores. Genomic-wide data were generated, and PRS analyses were performed to evaluate the association between either phenotypic OCD or OCS severity and genotype-predicted predisposition for OCD, SCZ, cross-disorder, and CLZ/norclozapine (NorCLZ) ratio, CLZ metabolism and NorCLZ metabolism. OCS and OCD were frequent comorbidities in our sample of CLZ-treated SCZ individuals, with a prevalence of 39.6% and 27.5%, respectively. Furthermore, the Y-BOCS total score correlated positively with the duration of CLZ treatment in years (r = 0.28; p = 0.008) and the PANSS general psychopathology subscale score (r = 0.23; p = 0.028). A significant correlation was found between OCD occurrence and PRS for CLZ metabolism. We found no correlation between OCS severity and PRS for CLZ metabolism. We found no correlation for either OCD or OCS and PRS for OCD, cross-disorder, SCZ, CLZ/NorCLZ ratio or NorCLZ metabolism. Our study was able to replicate previous findings on clinical characteristics of CLZ-treated SCZ individuals. OCS is a frequent comorbidity in this cohort and is correlated with CLZ treatment duration in years and PANSS general psychopathology subscale score. We found a correlation between OCD and PRS for CLZ metabolism, which should be interpreted as incidental for now. Future research is necessary to replicate significant findings and to assess possible genetic predisposition of CLZ-treated individuals with SCZ to OCS/OCD. Limitations attributed to the small sample size or the inclusion of subjects on co-medication must be considered. If the association between OCD and PRS for CLZ metabolism can be replicated, it should be further evaluated if CYP1A2 alteration, respectively lower CLZ plasma level, is relevant for OCD development.

Finding effective alternatives to antibiotics and zinc oxide in livestock feed remains challenging, but phytogenic compounds show promising potential. In the first part of the present study, the in vitro antimicrobial activities of carvacrol, eugenol, garlic oil, star anise oil, and tea tree oil as well as their effects on the biofilm formation of two Escherichia coli field isolates, quorum sensing of Chromobacterium violaceum, and the adhesion of an E. coli field isolate to piglets’ small intestinal mucus were determined. Based on these results, two prototypes were formulated. Phytogenic feed additive (PFA) Core 2, containing carvacrol, eugenol, and star anise oil, showed stronger in vitro antimicrobial activity, inhibition of biofilm formation, and quorum sensing than PFA Core 1, which was mainly composed of garlic oil and tea tree oil. In the second part of the present study, 1000 post-weaning piglets were divided into four groups receiving a control or diets with either PFA Core 1, PFA Core 2, or zinc oxide. Only PFA Core 2 and zinc oxide significantly improved body weight, daily gain, feed efficiency, and fecal scores compared with the control, while PFA Core 1 increased the feed efficiency and fecal scores. The results show that feed additives based on carvacrol and eugenol can improve the growth performance of post-weaning piglets and reduce the incidence of diarrhea, possibly by influencing detrimental bacteria. Furthermore, the present study demonstrates the potential of combinations of in vitro assays to support the development of effective feed additives.

Angehörige sind die tragende Säule der pflegerischen Versorgung in Deutschland. Knapp ein Viertel der Erwachsenen kennt eine hilfe- oder pflegebedürftige Person. Für immer mehr Menschen, unter ihnen mehrheitlich Frauen, wird die pflegerische Versorgung einer hilfebedürftigen Person zur alltäglichen Aufgabe. Diese Anforderung muss oft mit beruflichen Verpflichtungen und/oder der Erziehung minderjähriger Kinder vereinbart werden. Nicht nur in dieser „Sandwichposition“ vernachlässigen häuslich Pflegende eigene Lebensbereiche und gefährden ihre Gesundheit. Der narrative Übersichtsbeitrag fokussiert die Herausforderungen bei der Vereinbarkeit von häuslicher Pflege und Berufstätigkeit. Zudem wird die Bedeutung der Pflege durch Angehörige als relevantes Public-Health-Thema herausgearbeitet. Ein Spotlight wird auf die Versorgung pflegebedürftiger Kinder und die besonderen Ansprüche ihrer pflegenden Eltern gerichtet. Aktuelle Empfehlungen zur besseren Vereinbarkeit von Pflege und Beruf und zur Anerkennung der Sorgearbeit pflegender Angehöriger geben einen Ausblick auf Lösungsstrategien, die aus der Wissenschaft kommen und von der Politik aufgegriffen werden sollten.

Background Informed consent of the patient prior to surgical procedures is obligatory. A good and informative communication improves patients’ understanding and confidence, thus may strengthen the patient-doctor relationship. The aim of our study was to investigate the usefulness of additional stereoscopic visualization of patient-specific imaging during informed consent conversation.

Methods Patients scheduled for a brain tumor surgery were screened for this study prospectively. The primary exclusion criteria were cognitive or visual impairments. The participants were randomized into two groups. The first group underwent a conventional surgical informed consent performed by a neurosurgeon including a demonstration of the individual MRI on a 2D computer screen. The second group received an additional stereoscopic visualization of the same imaging to explain the pathology more in-depth. The patients were then asked to fill in a questionnaire after each part. This questionnaire was designed to assess the potential information gained from the patients with details on the anatomical location of the tumor as well as the surgical procedure and possible complications. Patients’ subjective impression about the informed consent was assessed using a 5-point Likert scale.

Results A total of 27 patients were included in this study. After additional stereoscopic visualization, no significant increase in patient understanding was found for either objective criteria or subjective assessment. Participants’ anxiety was not increased by stereoscopic visualization. Overall, patients perceived stereoscopic imaging as helpful from a subjective perspective. Confidence in the department was high in both groups.

Conclusion Stereoscopic visualization of MRI images within informed consent conversation did not improve the objective understanding of the patients in our series. Although no objective anatomical knowledge gain was noted in this series, patients felt that the addition of stereoscopic visualization improved their overall understanding. It therefore potentially increases patient confidence in treatment decisions.

Purpose Periprosthetic joint infections (PJI) of total knee arthroplasties (TKAs) in the elderly is among the clinically most challenging scenarios given multimorbidity combined with poor bone and soft tissue quality. Despite increasing prevalence, limited is known on PJI among this unique group of patients. As such, this study analyzed PJI characteristics, implant survivorship and non-surgical complications of octogenarians revised PJI for the knee.

Methods We identified 31 patients that were revised for PJIs of the knee between 2010 and 2019 using a single university-based registry. Mean age was 83 years (range 80–87), 48% were females, and mean BMI was 29 kg/m2. Mean age adjusted Charlson Comorbidity Index was 7, and mean ASA score was 3. Major causative pathogens included Coagulase-negative Staphylococci (26%), Staphylococcus aureus (13%), and Streptococci (13%). Two-stage exchange was performed in 30 patients, permanent resection arthroplasty in one joint. Kaplan–Meier survivorship analyses were performed. Mean follow-up was 4 years.

Results The 2-year survivorship free of any recurrent PJI was 96%, and there was one PJI relapse noted at 6 months. Moreover, there were three additional revisions for aseptic loosening, and one further revision for fracture. As such, the 2-year survivorship free of any revision was 87%. In addition to the aforementioned revisions, there was one additional plate osteosynthesis for a Vancouver C fracture, resulting in a 79% survivorship free of any reoperation at 2 years. Mean perioperative complication score according to the Clavien–Dindo classification was 2 out of 5. A total of three patients died: one patient 40 days after resection arthroplasty, two others 4 months and 8 months after reimplantation.

Conclusions Octogenarians revised for PJI of the knee are at low risk of recurrent infection and overall revision at 2 years. However, moderate rates of perioperative complications and mortality at short term must acknowledge before deciding upon procedure.

Level of evidence Therapeutic level IV.

Background Conflicting evidence exists regarding outcomes in middle-aged patients undergoing periacetabular osteotomy (PAO) for symptomatic developmental dysplasia of the hip (DDH).

Aims To compare patient reported outcomes (PROMs) of middle-aged PAO patients with younger patient groups.

Methods Retrospective analysis of prospectively collected data of PAO patients between 01/2015 and 06/2017 at a single orthopedic university center with a primary diagnosis of symptomatic DDH. The cohort was divided into four age groups and compared: < 20, 20–30, 30–40 and > 40 years. Joint function was assessed using iHOT-12, mHHS and SHV. Activity level was assessed using UCLA Activity score. Patient satisfaction and pain were assessed on the numerical rating scale 0–10. Conversion rates to THA were assessed.

Results Out of 202 PAOs, 120 cases with complete data were included. Mean follow-up was 63 months (range 47–81 months). Eighteen patients were < 20 years old, 54 were 20–30 years, 37 were 30–40 years, 11 patients were older than 40. No significant differences were observed for preoperative or postoperative iHOT-12 (p = 0.898; p = 0.087), mHHS (p = 0.878; p = 0.103), SHV (p = 0.602; p = 0.352) or UCLA (p = 0.539; p = 0.978) between groups. Improvement deltas were also not significantly different for all PROMs. Postoperative patient satisfaction was similar between groups (p = 0.783).

Conclusion Patients with symptomatic DDH may benefit from PAO even at middle age with similar outcomes and pre- to postoperative improvements as younger age groups. Indication should be based on biological age and preoperative joint condition rather than age.

Purpose Chronic pelvic pain (CPP) is one of the main problems of endometriosis, leading to a significant impairment of quality of life. Understanding the pain mechanisms and the pelvic floor muscles (PFM) changes in these patients is essential to integrate additional therapeutic strategies. We hypothesize that endometriosis patients have changes in PFM and that targeted vaginal electrostimulation can be a treatment option for CPP in this disease.

Methods Fifteen patients with endometriosis and chronic acyclical pelvic pain were included. PFM electromyography with the Multiple Array Probe Leiden (MAPLe) was performed. Mapping of PFM was utilized and targeted electrostimulation of the hypertensive muscles was conducted. Control electromyography was performed afterward to evaluate the electrostimulation therapeutic effect.

Results In 12/15 (80%) patients, the myofascial trigger point could be localized by digital examination. The most frequently affected muscle was the puborectalis (10/15—66.7%). Most of the patients showed serious changes in the average resting tone (aRT) of PFM. aRT was significantly increased in all patients and decreased after stimulation, whereby the difference prior to and after stimulation was not significant (p = 0.064). The detailed separated analysis of the hypertensive muscles showed a significant (p = 0.026) reduction in their resting tone (hRT), after targeted stimulation.

Conclusion Vaginal electrostimulation is a promising and feasible complementary treatment option for CPP in endometriosis patients. Targeted treatment of pelvic floor dysfunction should be included in clinical trials.

Objective In the fourth year of the COVID-19 pandemic, mortality rates decreased, but the risk of neuropsychiatric disorders remained the same, with a prevalence of 3.8% of pediatric cases, including movement disorders (MD) and ataxia.

Methods In this study, we report on a 10-year-old girl with hemichorea after SARS-CoV-2 infection and immunostained murine brain with patient CSF to identify intrathecal antibodies. Additionally, we conducted a scoping review of children with MD and ataxia after SARS-CoV-2 infection.

Results We detected antibodies in the patient's CSF binding unknown antigens in murine basal ganglia. The child received immunosuppression and recovered completely. In a scoping review, we identified further 32 children with de novo MD or ataxia after COVID-19. While in a minority of cases, MD or ataxia were a symptom of known clinical entities (e.g. ADEM, Sydenham's chorea), in most children, the etiology was suspected to be of autoimmune origin without further assigned diagnosis. (i) Children either presented with ataxia (79%), but different from the well-known postinfectious acute cerebellar ataxia (older age, less favorable outcome, or (ii) had hypo-/hyperkinetic MD (21%), which were choreatic in most cases. Besides 14% of spontaneous recovery, immunosuppression was necessary in 79%. Approximately one third of children only partially recovered.

Conclusions Infection with SARS-CoV-2 can trigger de novo MD in children. Most patients showed COVID-19-associated-ataxia and fewer-chorea. Our data suggest that patients benefit from immunosuppression, especially steroids. Despite treatment, one third of patients recovered only partially, which makes up an increasing cohort with neurological sequelae.

Purpose Pazopanib has promising antiangiogenetic activity in solid cancers. The investigator-initiated phase I/II trial evaluated the combination of Topotecan with Pazopanib in platinum-resistant or intermediate-sensitive recurrent ovarian cancer (ROC).

Methods Patients (≥ 18 years) with first or second recurrence were enrolled in this multicentre open-label trial. Phase I analysed Topotecan 4 mg/m2 (day 1, 8, 15, ever 28 days) for six cycles to identify the maximum tolerated dose (MTD) of Pazopanib added in a dose-escalating scheme with 400 mg starting dose. The phase II analysed safety and efficacy aspects. For all patients with clinical remission a maintenance with Pazopanib until progression was allowed. This trial is registered with ClinicalTrials.gov, number NCT 01600573.

Results Between June 2012 and February 2017, 11 patients were enrolled in the phase I, and 50 patients in the phase II study. The MTD of Pazopanib was determined by 400 mg/daily. Haematological and liver toxicities determined the dose limiting toxicities (DLT) and the most common grade 3–4 adverse events: leucopenia (25%), neutropenia (22%), thrombocytopenia (19%), accumulation of cholestatic (20%) and hepatocellular damage (15%), which often caused dose modifications, but no new life-threatening events. Overall response was 16% and clinical benefit rate 68%. Median progression-free survival (PFS) was 3.5 months (95% CI 2.0—5.0). Due to early progression only 20% of the patients were able to start with maintenance treatment.

Conclusion The combination of pazopanib and weekly topotecan is feasible, resulting in a manageable haematological and liver toxicity, but despite its encouraging response rate, was not associated with a significant survival benefit.