Group Dynamics in Extreme Earth Environments: Analogs for Space Missions (Past and Present Expeditions Analysis)

Introduction: Crew performance in space has become an increasing focus of many space faring nations due to the recent shift in focus of colonizing the Moon and then preparing to travel to Mars and beyond. This recent shift in focus to more long- duration missions has moved researchers in the direction of analyzing crew performance aspects associated win, crew dynamic development on such long missions. More recently researchers have been analyzing past expeditions carried out on Earth, as these expeditions kept records of crew performance, which have been compared and analyzed to those reported on space missions. Purpose: This study investigates a comparison of the recorded errors across time from a well-known past expedition (the Lewis and Clark Expedition) to those recorded by space mission simulation studies, as they provide insight into critical human elements that may be associated with exploration into isolated and confined (or semi-confined) extreme (ICE) environments here on Earth and their extrapolation for future space crews. The study further investigates various aspects of crew psychosocial group functioning through an analysis of group environment, stress, and coping data. Such investigation includes a detailed analysis of pre-mission communication and awareness strategies for positive group functioning and development (Study 1); management of competition and besting among crew members (Study 2); overall crew performance (Study 3); and a comparison of mission mistakes made to habitat problems that arose intra-mission (Study 4). Methods: A six person heterogeneous American crew conducted a Mars simulation mission at the Mars Society’s Mars Desert Research Station in Utah, USA in 2006. Participants were administered pre-mission assessments of personality, stress and coping, and personal motivation and orientation. Personal mission mistakes and Habitat problems were reported daily by each crewmember to the crew psychologist. Mid- and end-mission assessments were administered to measure cognitive functioning; group fiinctioning/identity; perceived stress and coping; and personal motivation and orientation. Results and Conclusions: Data collected and obtained by both assessment and journaling methods were both consistent and indicative of positive personalities desirable of expedition crews. Journals kept by the crew psychologist indicated that crewmembers all felt that the pre-mission awareness of group dynamic development tendencies of past expedition crews was integral in maintaining crew cohesiveness throughout the mission. Crewmembers felt that raising the level of awareness, both pre- and intra-mission, served as a positive factor in the overall positive group dynamic development of the crew. Crewmembers all displayed low levels of competition while still reporting high motivation and satisfaction for group dynamic development and the mission objectives that were completed. The overall analysis indicated effective performance and positive coping with regards to the heavy workload and environmental stressors the crew experienced. A relationship also existed between the psychology assessment data obtained, overall crew performance, and habitat problems that arose

Long-term exposure to environmental concentrations of the pharmaceutical ethynylestradiol causes reproductive failure in fish

International audienceHeightened concern over endocrine-disrupting chemicals is driven by the hypothesis that they could reduce reproductive success and affect wildlife populations, but there is little evidence for this expectation. The pharmaceutical ethynylestradiol (EE(2)) is a potent endocrine modulator and is present in the aquatic environment at biologically active concentrations. To investigate impacts on reproductive success and mechanisms of disruption, we exposed breeding populations (n = 12) of zebrafish (Danio rerio) over multiple generations to environmentally relevant concentrations of EE(2). Life-long exposure to 5 ng/L EE(2) in the F, generation caused a 56% reduction in fecundity and complete population failure with no fertilization. Conversely, the same level of exposure for up to 40 days in mature adults in the parental F(0) generation had no impact on reproductive success. Infertility in the F, generation after life-long exposure to 5 ng/L EE(2) was due to disturbed sexual differentiation, with males having no functional testes and either undifferentiated or intersex gonads. These F, males also showed a reduced vitellogenic response when compared with F(0) males, indicating an acclimation to EE(2) exposure. Deputation studies found only a partial recovery in reproductive capacity after 5 months. Significantly, even though the F(0) males lacked functional testes, they showed male-pattern reproductive behavior, inducing the spawning act and competing with healthy males to disrupt fertilization. Endocrine disruption is therefore likely to affect breeding dynamics and reproductive success in group-spawning fish. Our findings raise major concerns about the population-level impacts for wildlife of long-term exposure to low concentrations of estrogenic endocrine disruptors

Die direkte Strahlungswirkung von Aerosolteilchen auf ein Klimamodell

Ziel cler vorliegenden Arbeit uncl cler heutigen Aerosolforschung ist es, die geographische und zeitliche Var-iation der Strahlungseigenschaften atmosphärischer Aerosole in l{lima- rnoclellen zu berücksichtigen, also clen Strahlungsantrieb cler Aerosole zu bestimmen uncl clar-aus clie l{limawirkung abzuschätzen. Da eine interaktive Berüclisichtigung von Aerosolen in ihlel Gesamtheit einschließlich Entstehung, Tra,nsport uncl Räckkopplungen aufgruncl del Komplexität in Klimamodellen nicht rnögiich ist, wirci cler Globale Aerosolclatensatz (GADS) (I(öpke et al. (1997)) fär cliese Untersuchungen benutzt. Dieser', auf Messungen uncl realistischen Modellannahmen ba,sierende Datensatz, beinhaltet natürliches und anthropogenes Aerosol und läßt sich ohne großen Rechenzeitaufivancl in I{limarnodellen berücksichtigen. Das wird in dieser Arbeit ausfiïhllich beschrieben, die sich wie folgt glieclert: Mit einem ó-Eclclingion-Strahlungstranspoltmoclell wird cler Strahlungsantrieb durch Ae- losol in Abhängigkeit von der Oberflächenalbedo uncl dem Zenitwinkel abgeschåtzt. Für ein mittleles Aerosol erhalten r,vir irn globalen Mittel einen negativen kurzwelligen Strah- lungsantrieb, cler regional inhomogen ist. In Abhängigkeit vom Sonnenwinkel, der Bo- clenalbedo und clen optischen Eigenschaften des Aerosols kann der Antrieb sowohl negativ als auch positiv sein. Die Abhängigkeiten sind nicht linear. Der clirelite Aelosolstrahlungsantrieb wirkt sich auf die Temperatur aus. Anhand einer vertikalen Säule cles Klimamodells (ECHAMID) werden die Auswirkungen des Aerosoi- strahlungsantriebs auf clie cliabatischen Prozesse und die Temperatur berechnet. Eine veränclerte Aerosolzusammensetzung a1s Folge cler Inclustrialisierung ist eine mögliche IJrsache für' clie Reclulition cler Globalstrahlung. Die in clieser Arbeit vorgestellte Sensiti- vitätsstuclie mit dem ECHAMID für mittlere nördliche Breiten ergibt, claß die Änclelung cler Aelosolzusarnrnensetzung zu einer Recluktion der Globalstrahlung um 16 Wf nf in Jahresmittel ftihrt. Del Vergleich mit clel Literatur zeigt, daß die clirekte Strahlungswir- kttng von Aerosol hier einen Anteil von bis m 20% an der Recluktion clel Globalstlahlung ausrnach.t. Die veränclelte Aerosolzusammensetzung fährt zul Elwärmung der bodenna- iren Schichten um 0.3 K, verursacht clurch clen erhöhten R.ußanteil. Es folgt, daß Ruß zur Bestimmnng cler Iilimawirkung anthlopogener Aerosole zu berücksichtigen ist. Del Globale Aerosolclatensatz wircl in clas globale Zirkulationsmoclell (ECHAM4) in- tegriert. Aus clen Teilchenzahlen der GADS Aerosolkomponenten werclen Massenmi- schungsvelhältnisse bestimmt uncl die optischen Eigenschaften der Aelosole an clie Spek- tralbeleiche cles ECHAM4 angepasst. Der direkte Aerosolstra,hlungsantrieb wircl für clie wolkenfreien Gebiete bestimmt, Riïck- kopplungsmechanismen werclen ausgeschlossen. Im globalen Mittel beträgt der gesamte kulzwellige Strahlungsantrieb clurch GADS am Oberrand der Atmosphär'e im Januar -1.4 IMf nf , -2.I lVf nz2 im Juli. Die Sonnenstrahlung wircl am Boden im globalen Mittei im Ja,nual um -4.3 Wf nz2, im Juli um -6.5 Wf m,2 reduziert.IJm die mittlere Klimawirkung des direkten Aerosolstrahlungsantriebs zu untersuchen, werden die Ergebnisse aus perrnanenten Januar uncl Juli Simulationen des ECHAM4 über 20 Jahre gemittelt und ausgewertet. Es werden die Änderungen der Strahlungs- flüsse, Temperatur, Wärmefliïsse, Bewölkung uncl Niederschlags sowie des Geopotentials, verursacht durch clie Wechselwirkung und R,ückkopplungen des direkten Aerosolstrah- lungsantriebs mit dem I{limasystem, betrachtet. Die wichtigsten Ergebnisse sind: Der global mittlere kurzwellige Strahlungsantrieb am Oberland cler Atmosphär.e clurch GADS beträgt im Januar -r.4 Wlm,', -0.1 wl*' im Juli, cler langwellige Antrieb im Janua'r 2.02 lVlm2 uncl 0.86 Wln't2 im Juli. Der clirekte langwellige Strahlungsantrieb clulch Aerosole, bei clem mineralische Teilchen eine entscheidende Rolle spielen, kann nicht vernachlässigt werclen. Im globalen Mittel kählt das Aelosol clie bodennahen Schichten um -0.2 K im Winter, erwä'rmt sie im Sommer um 0.17 I(. Dies zeigt, claß clie Gesamtheit der Aerosole clen globalen Treibhauseffei<t je nach Jahreszeit uncl Region verstärken ocler reduzieren kann. In polaren Breiten fählt Aerosol zu verstärktem Schneefall. Der konvektive Nieclerschlag wircl irn zonalen Mittel sowohl im Sommer als a,nch im Winter reduziert. Ein Vergleich cler lilimawirkung, der bis heute im Klimamodell beinhalteten Aerosole, mit cler cles GADS zeigt, wie unzureichend Aerosolen bisher im Moclell Rechnung getragen wurcle. Der Versuch einer Valiclielung des Stahlungshaushalts des ECHAM4 inklusive GADS mit ERBE-Messungen weist auf qualitative Verbesserungen cles Stahlungshaushalts durch GADS hin. Es gibt komplexe Untelsuchungen zurn globalen Stlahlungsantrieb von rnineralischen Teil- chen uncl wasserlöslichen Teilchen rnit Ruß. Daher werclen cliese l(omponenten des GADS für Experirlente gewälilt, um einen clirekten Vergleich zu ermöglichen. Die Ergebnisse cler Moclellsimulationen zeigen gute Übereinstimmung mit cler Literatur uncl bestärken clas R.esuitat cliesel Arbeit: Del Glolta,len Aerosolclatensatz liefert in den hier benutzten Moclellen gute Ergebnisse. Eine Vielzahl von Abschätzungen uncl Untersuchungen zur l(limawirkung cles direkten Aelosolstrahlungsantriebs sincl auf einfache uncl fl.exible Weise möglich. Es wurcle nachge- wiesen, daß clie Beräcksichtigung von Aerosolen in clen Modellen notwenclig und zwingencl ist. Für I(limarechnungen ist die Beräcksichtigung von Aerosolen in Form cles Globalen Aerosolclatensatzes zeitgemäß und ausleichend

Analysen zur Prädiktion des Therapieerfolgs von Vedolizumab bei chronisch entzündlichen Darmerkrankungen

Background and objectives Almost half a million people in Germany suffer from Crohn's disease (CD) or ulcerative colitis (UC). These inflammatory bowel diseases (IBD) often affect patients over long periods of time, as they manifest in flares, are associated with pain, diarrhoea and a number of complication risks and often occur at young age. [1,2] The therapeutic management of these complex and multifaceted diseases is associated with several challenges. More and more therapeutic compounds are available, but there is no reliable and evidence-based algorithm to prioritize the order of their use in the treatment of UC and CD or to predict the response in the individual patient case. [1] Biologicals (therapeutics produced by genetic engineering) are new treatment options targeting specific cytokines and inflammatory mediators and have opened new opportunities for IBD treatment. However, in many patients there is still a primary non-response. or a secondary loss of response during therapy and various, sometimes severe side effects. [1–3] The anti-α4β7 antibody vedolizumab (VDZ), which has been approved in 2014, is one of these biologicals. Studies have shown that VDZ blocks the adhesion of α4β7-expressing T lymphocytes to the endothelial mucosal vascular addressin cell adhesion molecule-1 (MAdCAM-1). This prevents the migration of pro-inflammatory lymphocytes into the intestine and thereby reduces the inflammatory response in the tissue. Since MAdCAM-1 is almost exclusively expressed in the intestine, the drug specifically suppresses lymphocyte migration (homing) into the gut without any relevant influence on other organs. [4–6] However, as only the recruitment of pro-inflammatory lymphocytes but not the inflammatory processes in the intestine itself are affected, the effect of VDZ has a rather slow onset in many cases. [3] Thus, from a clinical perspective, a strategy to predict the success of therapy with the anti α4β7-integrin-antibody VDZ by means of a biomarker would be highly desirable but is missing so far. The aim of this doctoral thesis was therefore to identify potential biomarkers based on integrin expression and function and to investigate their potential suitability for predicting the therapeutic success of VDZ in IBD. Methods We conducted a retrospective cohort study in 21 patients with UC who received therapy with VDZ for the first time. CD4+ T cells were isolated from peripheral blood and dynamic adhesion to MAdCAM-1 was determined in vitro, as well as the effect of VDZ on this adhesion in vitro. In addition, the expression of α4β1-integrin on CD4+ T cells from the peripheral blood was 4 quantified by flow cytometry. Based on electronic patient records, the clinical response to VDZ was retrospectively assessed using the Mayo Clinical Subscore (MCS). Clinical and experimental data were correlated. Results and observations In patients with a response to VDZ (responder), we observed a higher number of CD4+ peripheral blood T cells adhering to MAdCAM-1 in dynamic adhesion assays compared to patients without a response (non-responder). In addition, we confirmed and extended previous observations showing that the dynamic change of α4β1-expression on CD4+ T cells between week 0 and week 6 of VDZ treatment correlates with the later clinical response. [7] Upregulation of α4β1-expression on CD4+ T cells was observed in patients with stable or increasing clinical activity, while downregulation was mainly observed in patients with a clinical response at week 15 of therapy. Responders could be identified with high specificity and high positive predictive value. Conclusion Determining the dynamic adhesion of CD4+ T cells to MAdCAM-1 and the in vitro effect of VDZ on the dynamic T cell adhesion before the initiation of treatment, as well as analyzing dynamic integrin regulation in the early course of treatment appear to be promising approaches to predict the clinical response of UC patients to VDZ therapy. For the first time, our study presents a concept for predicting the success of VDZ treatment with the help of peripheral blood samples and provides the rationale for carrying out larger prospective studies.Hintergrund und Ziele Knapp eine halbe Millionen Menschen in Deutschland leiden an Morbus Crohn (MC) oder Colitis Ulcerosa (CU). Diese chronisch entzündlichen Darmerkrankungen (CED) beeinträchtigen Patienten oft über lange Zeiträume hinweg, da sie in Schüben verlaufen, mit Schmerzen, Diarrhöen und einer Reihe von Komplikationsrisiken einhergehen und häufig bereits im jungen Alter auftreten. [1,2] Das therapeutische Management dieser komplexen und vielschichtigen Erkrankungen ist mit einer Reihe von Herausforderungen verbunden. Immer mehr Wirkstoffe stehen zur Verfügung, aber es gibt keinen verlässlichen und evidenzbasierten Algorithmus, um die Reihenfolge ihres Einsatzes bei der Behandlung von CU und MC priorisieren zu können bzw. im individuellen Patientenfall das Ansprechen vorhersagen zu können. [1] Zu den neueren Medikamenten zählen Biologicals (gentechnisch hergestellte Therapeutika). Biologicals richten sich zielgerichtet gegen bestimmte Zytokine und Entzündungsmediatoren und haben der CED-Behandlung neue Möglichkeiten eröffnet. Jedoch kommt es weiterhin bei vielen Patienten zu einem primären Nichtansprechen oder einem sekundären Wirkverlust während der Therapie und es kommen verschiedene, zum Teil schwere Nebenwirkungen vor. [1–3] Auch der seit 2014 zugelassene anti-α4β7-Antikörper Vedolizumab (VDZ) zählt zu den Biologicals. In Studien konnte für VDZ gezeigt werden, dass es die Adhäsion von α4β7-exprimierenden-T-Lymphozyten an das endotheliale Mucosal vascular Addressin Cell Adhesion Molecule-1 (MAdCAM-1) blockiert. Dadurch wird das Auswandern von entzündungsfördernden Lymphozyten in den Darm verhindert und so die Entzündungsreaktion reduziert. Da MAdCAM-1 beinahe ausschließlich im Darm exprimiert ist, führt das Medikament höchst spezifisch zu einer Unterdrückung der Einwanderung von Lymphozyten (Homing) in den Darm ohne relevanten Einfluss auf andere Organe. [4–6] Da jedoch nur der Nachschub an pro-inflammatorischen Lymphozyten, nicht aber der Entzündungsprozess im Darm an sich beeinflusst werden, tritt die Wirkung von VDZ in vielen Fällen erst nach mehreren Wochen ein. Zudem spricht, wie auch bei allen anderen bei CED eingesetzten Biologika, nur ein Teil der Patienten auf das Medikament an. [3] Eine Möglichkeit, den Erfolg einer Therapie mit dem anti-α4β7-Integrin-Antikörper VDZ mittels eines Biomarkers vorhersagen zu können, wäre daher aus klinischer Sicht äußerst wünschenswert, fehlt allerdings bislang. Ziel dieses Promotionsvorhabens war es daher, mögliche Biomarker, insbesondere der Integrin-Expression und -Funktion, zur Unterstützung von 2 Behandlungsentscheidungen zu identifizieren und auf ihre mögliche Eignung zur Prädiktion des Therapieerfolgs von VDZ bei CED zu untersuchen. Methoden Wir führten eine retrospektive Kohortenstudie bei 21 Patienten mit CU durch, die erstmalig eine Therapie mit VDZ erhielten. CD4+ T-Zellen wurden aus dem peripheren Blut isoliert und die dynamische Adhäsion an MAdCAM-1 in vitro bestimmt sowie die Wirkung von VDZ auf diese Adhäsion in vitro. Zusätzlich wurde die Expression von α4β1-Integrin auf CD4+ T-Zellen des peripheren Blutes mittels Durchflusszytometrie quantifiziert. Anhand der elektronischen Patientenakten wurde mittels des Mayo Clinical Subscore (MCS) retrospektiv das klinische Ansprechen auf VDZ erhoben. Klinische und experimentelle Daten wurden korreliert. Ergebnisse und Beobachtungen Bei Patienten mit einem Ansprechen auf die VDZ-Therapie (Responder) beobachteten wir im Vergleich zu Patienten ohne Ansprechen (Non-Responder) in dynamischen Adhäsionassays eine höhere Anzahl von CD4+ T-Zellen aus dem peripheren Blut, die an MAdCAM-1 adhärierten. Zudem bestätigten und erweiterten wir frühere Beobachtungen, dass die dynamische Änderung der α4β1-Expression auf CD4+ T-Zellen zwischen Woche 0 und Woche 6 der VDZ-Behandlung mit dem späteren klinischen Ansprechen korreliert. [7] Eine Heraufregulation der α4β1-Expression auf CD4+ T-Zellen wurde bei Patienten mit stabiler oder zunehmender klinischer Aktivität erfasst, während eine Herunterregulation überwiegend bei Patienten mit einem klinischen Ansprechen in der 15. Therapiewoche beobachtet werden konnte. Diese Responder konnten mit hoher Spezifität und hohem positivem Vorhersagewert identifiziert werden. Schlussfolgerungen Die Bestimmung der dynamischen Adhäsion von CD4+ T-Zellen an MAdCAM-1 und der in vitro-Wirkung von VDZ auf die dynamische T-Zell-Adhäsion vor Behandlungsbeginn sowie die Erfassung der dynamischen Integrin-Regulation im frühen Verlauf der Behandlung scheinen vielversprechende Ansätze zu sein, um das klinische Ansprechen von CU-Patienten auf die VDZ-Therapie vorherzusagen. Unsere Studie legt somit erstmals ein Konzept zur Vorhersage des Erfolgs einer VDZ-Behandlung mit Hilfe von peripheren Blutproben vor und liefert die Rationale für die Durchführung größerer prospektiver Studien

Study of the Blending Efficiency of Pitched Blade Impellers

This paper presents an analysis of the blending efficiency of pitched blade impellers under a turbulent regime of flow of an agitated low viscous liquid. The conductivity method is used to determine of the blending (homogenization) time of miscible liquids in pilot plant mixing equipment with standard radial baffles. For the given homogeneity degree (98 %) a three-blade pitched blade impeller is tested with various off-bottom clearances, vessel/ impeller diameter ratios and various impeller pitch angles. The experimental results show in accordance with theoretical data from the literature, that the greatest effect on the dimensionless blending time is exhibited by the vessel/ impeller diameter ratio and the impeller pitch angle. The number of total circulations necessary for reaching the chosen homogeneity degree depends on the impeller pitch angle and amounts more than three. Finally, the energetic efficiency of the blending process is calculated. The results of this study show, that the highest energetic efficiency of the three-blade pitched blade impeller appears for the pitch angle a = 24°, the impeller/vessel diameter ratio T/D = 2 and the impeller off-bottom clearance h/D = 1

Two-dimensional wetting layer structures of reduced ternary oxides on Ru(0001) and Pt(111)

Long-range ordered structures of reduced oxide films with monolayer thickness derived from BaTiO3 and SrTiO3 on Ru(0001) and Pt(111) are investigated by scanning tunneling microscopy (STM) and low-energy electron diffraction (LEED). Upon ultrahigh vacuum annealing at 1100 K, a hexagonal phase is observed for BaTiO3 on Ru(0001), which forms similarly from SrTiO3 on Pt(111). At higher temperatures, a triangle–square tiling called σ-phase develops in the BaTiO3/Ru(0001) system, with a unit cell rotation of 15° against the Ru(0001) substrate. Furthermore, it is shown that this 15° rotated σ-phase also forms in the BaTiO3/Pt(111) system in addition to the already known 8° rotated σ-phase. The results emphasize a strong flexibility in the structural parameters of the reduced oxide wetting layers in response to the substrate interaction strength

X-ray imaging of a water bear offers a new look at tardigrade internal anatomy

Gefördert durch den Publikationsfonds der Universität Kasse

Advance directives in patients with head and neck cancer - status quo and factors influencing their creation

Background Advance Care Planning including living wills and durable powers of attorney for healthcare is a highly relevant topic aiming to increase patient autonomy and reduce medical overtreatment. Data from patients with head and neck cancer (HNC) are not currently available. The main objective of this study was to survey the frequency of advance directives (AD) in patients with head and neck cancer. Methods In this single center cross-sectional study, we evaluated patients during their regular follow-up consultations at Germany’s largest tertiary referral center for head and neck cancer, regarding the frequency, characteristics, and influencing factors for the creation of advance directives using a questionnaire tailored to our cohort. The advance directives included living wills, durable powers of attorney for healthcare, and combined directives. Results Four hundred and forty-six patients were surveyed from 07/01/2019 to 12/31/2019 (response rate = 68.9%). The mean age was 62.4 years (SD 11.9), 26.9% were women (n = 120). 46.4% of patients (n = 207) reported having authored at least one advance directive. These documents included 16 durable powers of attorney for healthcare (3.6%), 75 living wills (16.8%), and 116 combined directives (26.0%). In multivariate regression analysis, older age (OR ≤ 0.396, 95% CI 0.181–0.868; p = 0.021), regular medication (OR = 1.896, 95% CI 1.029–3.494; p = 0.040), and the marital status (“married”: OR = 2.574, 95% CI 1.142–5.802; p = 0.023; and “permanent partnership”: OR = 6.900, 95% CI 1.312–36.295; p = 0.023) emerged as significant factors increasing the likelihood of having an advance directive. In contrast, the stage of disease, the therapeutic regimen, the ECOG status, and the time from initial diagnosis did not correlate with the presence of any type of advance directive. Ninety-one patients (44%) with advance directives created their documents before the initial diagnoses of head and neck cancer. Most patients who decide to draw up an advance directive make the decision themselves or are motivated to do so by their immediate environment. Only 7% of patients (n = 16) actively made a conscious decision not create an advance directive. Conclusion Less than half of head and neck cancer patients had created an advance directive, and very few patients have made a conscious decision not to do so. Older and comorbid patients who were married or in a permanent partnership had a higher likelihood of having an appropriate document. Advance directives are an essential component in enhancing patient autonomy and allow patients to be treated according to their wishes even when they are unable to consent. Therefore, maximum efforts are advocated to increase the prevalence of advance directives, especially in head and neck cancer patients, whose disease often takes a crisis-like course

Endoscopic surgery versus various open approaches in esthesioneuroblastoma: a systematic review of the literature

Objective Esthesioneuroblastoma (ENB) is treated using several open surgery (OpS) methods, with or without endoscopic assistance ( ± E-ass) or endoscopic surgery (ES). This systematic review compared the results with various approaches using OpS ± E-ass and ES. Data sources A systematic PubMed/Medline search was conducted for the period 1990–2023. Review methods Keywords were “esthesioneuroblastoma” or “olfactory neuroblastoma” and “surgery,” “surgical,” “resection,” “approach,” “open,” and “endoscopic.” Studies/case series and case reports were included. Results with OpS ± E-ass (stratified into various approaches) were compared with ES results. Parameters assessed were follow-up period, frequencies of advanced tumor stages, Hyams grade III–IV tumors, negative margins/gross total resection, postoperative complication rates, preoperative/postoperative radiation therapy/chemotherapy, primary tumor progression, and frequency of/time to first recurrence. Results A total of 88 studies/case series or single cases/case reports (SC/CR) with results after OpS ± E-ass (850 cases) and 84 with results after ES (584 cases) were included. Compared with OpS ± E-ass, after ES, the average follow-up was significantly shorter ( p =0.048) and mean crude disease-free survival (DFS) significantly better (studies/case series, p =0.0001; SC/CR, p =0.001). Compared with OPS ± E-ass, after ES, significantly fewer advanced tumors were treated (studies/case series, p =0.0001; SC/CR, p =0.001); negative margins were significantly less frequent (studies/case series, p =0.009); surgical complications were less frequent (studies/case series, p =0.022); less radiation therapy (studies/case series, p =0.043) and/or chemotherapy (SC/CR, p =0.022) was performed; and recurrences were noted significantly less often (studies/case series, p =0.0001; SC/CR, p =0.034). Among OpS ± E-ass, craniofacial resection ± E-ass showed most significant differences from ES. Conclusions These data support that ES can be regarded as the surgical method of first choice in less advanced ENB but may also be a good choice in carefully selected advanced ENB

The Effects of a ‘New Generation’ of Heat and Moisture Exchangers in Laryngectomized Patients with Previous Heat and Moisture Exchanger Experience

Objectives: To evaluate the effects of a new generation of heat and moisture exchangers (NG-HMEs) on pulmonary rehabilitation, quality of life, patient satisfaction, and usage patterns. Methods: A prospective observational study on 23 laryngectomized patients with prior HME experience from June 1, 2021 to November 30, 2021. Patients were interviewed at inclusion, after 6 weeks and after 12 weeks after the introduction of NG-HMEs. Two validated questionnaires were used to report pulmonary complaints and quality of life: the Cough and Sputum Assessment Questionnaire (CASA-Q), the European Quality of Life 5 Dimensions Index Score (EQ-5D Index Score), and the European Quality of Life 5 Dimensions Visual Analog Scale (EQ-5D-VAS). Usage patterns and patient satisfaction were reported using study-specific questionnaires. Results: The patients had an average age of 65.7 ± 6.8 years, with 87% being male, on average 33.7 ± 35.3 months after total laryngectomy (TLE). NG-HMEs were used for a mean of 21.87 ± 4.63 hours/day ( P = .034). After 12 weeks of use, patients reported the following changes in the CASA-Q domains: cough symptoms (+5; P = .663), cough impact (0; P = .958), sputum symptoms (+8; P = .13), and sputum impact (+3; P = .489). The EQ-5D index score increased (+0.024; P = .917) as well as the EQ-5D VAS (+0.8; P = .27). All patients rated their experience with NG-HMEs with ≥3 out of 5. The patients who used NG-HMEs as instructed (n = 13) reported more profound changes in the CASA-Q domains: cough symptom (+11; P = .129), cough impact (+7; P = .209), sputum symptom (+11; P = .123), and sputum impact (+10; P = .102). Conclusions: Our results show that NG-HMEs could have a positive clinical impact on pulmonary rehabilitation after TLE, even in HME-experienced patients. The use of NG-HMEs does not affect the quality of life. The possible effects of NG-HMEs require further evaluation in long-term studies to fully assess their efficacy. </jats:p