Refine
Year of publication
- 2018 (5) (remove)
Has Fulltext
- yes (5)
Is part of the Bibliography
- no (5)
Keywords
- Diagnostik (2)
- Früherkennung (2)
- Mammakarzinom (2)
- Nachsorge (2)
- Richtlinie (2)
- breast cancer (2)
- diagnosis (2)
- follow‑up (2)
- guideline (2)
- screening (2)
Institute
Ziele: Das Ziel dieser offiziellen Leitlinie, die von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) und der Deutschen Krebsgesellschaft (DKG) publiziert und koordiniert wurde, ist es, die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms zu optimieren.
Methoden: Der Aktualisierungsprozess der S3-Leitlinie aus 2012 basierte zum einen auf der Adaptation identifizierter Quellleitlinien und zum anderen auf Evidenzübersichten, die nach Entwicklung von PICO-(Patients/Interventions/Control/Outcome-)Fragen, systematischer Recherche in Literaturdatenbanken sowie Selektion und Bewertung der gefundenen Literatur angefertigt wurden. In den interdisziplinären Arbeitsgruppen wurden auf dieser Grundlage Vorschläge für Empfehlungen und Statements erarbeitet, die im Rahmen von strukturierten Konsensusverfahren modifiziert und graduiert wurden.
Empfehlungen: Der Teil 1 dieser Kurzversion der Leitlinie zeigt Empfehlungen zur Früherkennung, Diagnostik und Nachsorge des Mammakarzinoms: Der Stellenwert des Mammografie-Screenings wird in der aktualisierten Leitlinienversion bestätigt und bildet damit die Grundlage der Früherkennung. Neben den konventionellen Methoden der Karzinomdiagnostik wird die Computertomografie (CT) zum Staging bei höherem Rückfallrisiko empfohlen. Die Nachsorgekonzepte beinhalten Untersuchungsintervalle für die körperliche Untersuchung, Ultraschall und Mammografie, während weiterführende Gerätediagnostik und Tumormarkerbestimmungen bei der metastasierten Erkrankung Anwendung finden.
Purpose: The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer.
Methods: The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure.
Recommendations: Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.
Purpose: There are little or no published data comparing the outcomes of ILUVIEN® (0.19 mg fluocinolone acetonide [FAc]) and OZURDEX® (0.7 mg dexamethasone [DEX]) implants in patients with diabetic macular edema (DME), and this case sought to compare their outcomes.
Methods: This case was extracted from a monocentric audit involving a pool of 25 patients (33 eyes) with DME and treated with a single FAc implant between October 2013 and December 2016. This case, a 61-year-old male with a pseudophakic lens, is from a patient that had received 4 intravitreal injections of a DEX implant prior to FAc implant and then was monitored for 3 years until re-treatment with a second FAc implant. Parameters measured included visual acuity (VA), central retinal thickness (CRT), and intraocular pressure (IOP).
Results: After the DEX implants, CRT transiently improved. In March 2014, the decision was taken to administer an FAc implant, and this led to a reduction in CRT below 300 µm (from a baseline of 748 µm), and this was sustained for 30 months. VA remained above 65 Early Treatment Diabetic Retinopathy Study letters to month 36, after which time a second FAc implant (in April 2017) was administered due to recurrence of edema and CRT decreased to below 300 µm and VA improved to 70 letters. Side effects included elevated IOP, which was effectively managed with IOP-lowering drops.
Conclusion: A single injection of FAc implant led to sustained improvements in CRT and VA that lasted for between 30 and 36 months, which is in contrast to the DEX implant where re-treatment was generally required within 6–7 months. After 36 months, re-treatment with the FAc implant again led to improved VA and CRT, and responses that were similar to those achieved with the first FAc implant.
The accurate knowledge of the groundwater storage variation (ΔGWS) is essential for reliable water resource assessment, particularly in arid and semi-arid environments (e.g., Australia, the North China Plain (NCP)) where water storage is significantly affected by human activities and spatiotemporal climate variations. The large-scale ΔGWS can be simulated from a land surface model (LSM), but the high model uncertainty is a major drawback that reduces the reliability of the estimates. The evaluation of the model estimate is then very important to assess its accuracy. To improve the model performance, the terrestrial water storage variation derived from the Gravity Recovery And Climate Experiment (GRACE) satellite mission is commonly assimilated into LSMs to enhance the accuracy of the ΔGWS estimate. This study assimilates GRACE data into the PCRaster Global Water Balance (PCR-GLOBWB) model. The GRACE data assimilation (DA) is developed based on the three-dimensional ensemble Kalman smoother (EnKS 3D), which considers the statistical correlation of all extents (spatial, temporal, vertical) in the DA process. The ΔGWS estimates from GRACE DA and four LSM simulations (PCR-GLOBWB, the Community Atmosphere Biosphere Land Exchange (CABLE), the Water Global Assessment and Prognosis Global Hydrology Model (WGHM), and World-Wide Water (W3)) are validated against the in situ groundwater data. The evaluation is conducted in terms of temporal correlation, seasonality, long-term trend, and detection of groundwater depletion. The GRACE DA estimate shows a significant improvement in all measures, notably the correlation coefficients (respect to the in situ data) are always higher than the values obtained from model simulations alone (e.g., ~0.15 greater in Australia, and ~0.1 greater in the NCP). GRACE DA also improves the estimation of groundwater depletion that the models cannot accurately capture due to the incorrect information of the groundwater demand (in, e.g., PCR-GLOBWB, WGHM) or the unavailability of a groundwater consumption routine (in, e.g., CABLE, W3). In addition, this study conducts the inter-comparison between four model simulations and reveals that PCR-GLOBWB and CABLE provide a more accurate ΔGWS estimate in Australia (subject to the calibrated parameter) while PCR-GLOBWB and WGHM are more accurate in the NCP (subject to the inclusion of anthropogenic factors). The analysis can be used to declare the status of the ΔGWS estimate, as well as itemize the possible improvements of the future model development.
Multiplex families with a high prevalence of a psychiatric disorder are often examined to identify rare genetic variants with large effect sizes. In the present study, we analysed whether the risk for bipolar disorder (BD) in BD multiplex families is influenced by common genetic variants. Furthermore, we investigated whether this risk is conferred mainly by BD-specific risk variants or by variants also associated with the susceptibility to schizophrenia or major depression. In total, 395 individuals from 33 Andalusian BD multiplex families as well as 438 subjects from an independent, sporadic BD case-control cohort were analysed. Polygenic risk scores (PRS) for BD, schizophrenia, and major depression were calculated and compared between the cohorts. Both the familial BD cases and unaffected family members had significantly higher PRS for all three psychiatric disorders than the independent controls, suggesting a high baseline risk for several psychiatric disorders in the families. Moreover, familial BD cases showed significantly higher BD PRS than unaffected family members and sporadic BD cases. A plausible hypothesis is that, in multiplex families with a general increase in risk for psychiatric disease, BD development is attributable to a high burden of common variants that confer a specific risk for BD. The present analyses, therefore, demonstrated that common genetic risk variants for psychiatric disorders are likely to contribute to the high incidence of affective psychiatric disorders in the multiplex families. The PRS explained only part of the observed phenotypic variance and rare variants might have also contributed to disease development.