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Introduction: Hip fracture surgery is associated with high in-hospital and 30-day mortality rates and serious adverse patient outcomes. Evidence from randomised controlled trials regarding effectiveness of spinal versus general anaesthesia on patient-centred outcomes after hip fracture surgery is sparse.
Methods and analysis: The iHOPE study is a pragmatic national, multicentre, randomised controlled, open-label clinical trial with a two-arm parallel group design. In total, 1032 patients with hip fracture (>65 years) will be randomised in an intended 1:1 allocation ratio to receive spinal anaesthesia (n=516) or general anaesthesia (n=516). Outcome assessment will occur in a blinded manner after hospital discharge and inhospital. The primary endpoint will be assessed by telephone interview and comprises the time to the first occurring event of the binary composite outcome of all-cause mortality or new-onset serious cardiac and pulmonary complications within 30 postoperative days. In-hospital secondary endpoints, assessed via in-person interviews and medical record review, include mortality, perioperative adverse events, delirium, satisfaction, walking independently, length of hospital stay and discharge destination. Telephone interviews will be performed for long-term endpoints (all-cause mortality, independence in walking, chronic pain, ability to return home cognitive function and overall health and disability) at postoperative day 30±3, 180±45 and 365±60.
Ethics and dissemination: iHOPE has been approved by the leading Ethics Committee of the Medical Faculty of the RWTH Aachen University on 14 March 2018 (EK 022/18). Approval from all other involved local Ethical Committees was subsequently requested and obtained. Study started in April 2018 with a total recruitment period of 24 months. iHOPE will be disseminated via presentations at national and international scientific meetings or conferences and publication in peer-reviewed international scientific journals.
Trial registration number: DRKS00013644; Pre-results
Objective: Many cancer patients complain about cognitive dysfunction. While cognitive deficits have been attributed to the side effects of chemotherapy, there is evidence for impairment at disease onset, prior to cancer-directed therapy. Further debated issues concern the relationship between self-reported complaints and objective test performance and the role of psychological distress.
Method: We assessed performance on neuropsychological tests of attention and memory and obtained estimates of subjective distress and quality of life in 27 breast cancer patients and 20 healthy controls. Testing in patients took place shortly after the initial diagnosis, but prior to subsequent therapy.
Results: While patients showed elevated distress, cognitive performance differed on a few subtests only. Patients showed slower processing speed and poorer verbal memory than controls. Objective and self-reported cognitive function were unrelated, and psychological distress correlated more strongly with subjective complaints than with neuropsychological test performance.
Conclusion: This study provides further evidence of limited cognitive deficits in cancer patients prior to the onset of adjuvant therapy. Self-reported cognitive deficits seem more closely related to psychological distress than to objective test performance.
Objective: To evaluate prognostic factors in pediatric patients with gonadal germ cell tumors (GCT). Methods: Patients <18 years with ovarian and testicular GCT (respectively OGCT and TGCT) were prospectively registered according to the guidelines of MAKEI 96. After resection of the primary tumor, patients staged ≥II received risk-stratified cisplatin-based combination chemotherapy. Patients were analyzed in respect to age (six age groups divided into 3-year intervals), histology, stage, and therapy. The primary end point was overall survival. Results: Between January 1996 and March 2016, the following patients were registered: 1047 OGCT, of those, 630 had ovarian teratoma (OTER) and 417 had malignant OGCT (MOGCT); and 418 TGCT, of those, 106 had testicular teratoma (TTER) and 312 had malignant TGCT (MTGCT). Only in MTGCT, older age correlated with a higher proportion of advanced tumors. All 736 teratomas and 240/415 stage I malignant gonadal GCT underwent surgery and close observation alone. In case of watchful waiting, the progression rate of OGCT was higher than that of TGCT. However, death from disease was reported in 8/417 (1.9%) MOGCT and 8/312 (2.6%) MTGCT irrespective of adjuvant chemotherapy and repeated surgery. Conclusions: The different pathogenesis and histogenesis of gonadal GCT reflects sex- and age-specific patterns that define clinically relevant risk groups. Therefore, gender and age should be considered in further research on the biology and clinical practice of pediatric gonadal GCT.
A medium modified gluon propagator is used to evaluate the scattering cross section for the process gg - gg in the QCD medium by performing an ex- plicit sum over the polarizations of the gluons. We incorporate a magnetic sreening mass from a non - perturbative study. It is shown that the medium modified cross section is finite, divergence free, and is independent of any ad-hoc momentum transfer cut-off parameters. The medium modified finite cross sections are necessary for a realistic investigation of the production and equilibration of the minijet plasma expected at RHIC and LHC PACS: 12.38.Mh; 14.70.Dj; 12.38.Bx; 11.10.Wx
Tens of thousands of man-made chemicals are in regular use and discharged into the environment. Many of them are known to interfere with the hormonal systems in humans and wildlife. Given the complexity of endocrine systems, there are many ways in which endocrine-disrupting chemicals (EDCs) can affect the body’s signaling system, and this makes unraveling the mechanisms of action of these chemicals difficult. A major concern is that some of these EDCs appear to be biologically active at extremely low concentrations. There is growing evidence to indicate that the guiding principle of traditional toxicology that “the dose makes the poison” may not always be the case because some EDCs do not induce the classical dose–response relationships. The European Union project COMPRENDO (Comparative Research on Endocrine Disrupters—Phylogenetic Approach and Common Principles focussing on Androgenic/Antiandrogenic Compounds) therefore aims to develop an understanding of potential health problems posed by androgenic and antiandrogenic compounds (AACs) to wildlife and humans by focusing on the commonalities and differences in responses to AACs across the animal kingdom (from invertebrates to vertebrates).
Mobilität ist eine Grundvoraussetzung, um am gesellschaftlichen Leben teilhaben zu können. Ist der Möglichkeitsraum potenzieller Ortsveränderungen eingeschränkt – beispielsweise durch räumliche, finanzielle oder körperliche Barrieren oder Ängste –, wird von Mobilitätsarmut gesprochen. Wie Mobilitätsarmut auf der Verwaltungsebene verhindert werden kann, zeigt dieser Policy Brief des Projektes Social2Mobility. Diese Handlungsempfehlungen basieren auf Erkenntnissen des Projektes Social2Mobility und adressieren insbesondere Verwaltungsmitarbeitende der Fachplanungen Verkehrs-, Raum- und Sozialplanung von der Kommunal- bis zur Landes- und Bundesebene. Ziel des Projektes Social2Mobility war es, die soziale Teilhabe armutsgefährdeter Personen durch eine Steigerung ihrer Mobilitätsoptionen zu stärken. Der Policy Brief erläutert die Problematik von Mobilitätsarmut, thematisiert deren Relevanz und zeigt verschiedene Facetten von Mobilitätsarmut auf. Er beinhaltet fünf verschiedene Handlungsfelder zur Verhinderung von Mobilitätsarmut. Der Policy Brief soll zu einer dezernats- und abteilungsübergreifenden Zusammenarbeit der Fachplanungen Sozial-, Raum- und Verkehrsplanung zur Lösung von Mobilitätsarmut anregen. Synergieeffekte und gegenseitige Potentiale bei einer Zusammenarbeit werden dabei herausgestellt. Hierzu gehören beispielsweise die Anwendung von Verkehrsnachfragemodellen in der Sozialplanung oder die Berücksichtigung vielfältiger unterschiedlicher Lebenslagen und der daraus hervorgehenden Mobilitätsbedarfe in der Verkehrsplanung.