Verlaufskontrolle und Ermittlung der Prognose mittels audiologischer Funktionsdiagnostik bei Patienten mit akutem sensorineuralen Hörverlust

Magdeburg, Univ., Med. Fak., Diss., 2012von Ioannis Charalampaki

Deep Reinforcement Learning with semi-expert distillation for autonomous UAV cinematography

Unmanned Aerial Vehicles (UAVs, or drones) have revolutionized modern media production. Being rapidly deployable “flying cameras”, they can easily capture aesthetically pleasing aerial footage of static or moving filming targets/subjects. Current approaches rely either on manual UAV/gimbal control by human experts or on a combination of complex computer vision algorithms and hardware configurations for automating the flight+flying process. This paper explores an efficient Deep Reinforcement Learning (DRL) alternative, which implicitly merges the target detection and path planning steps into a single algorithm. To achieve this, a baseline DRL approach is augmented with a novel policy distillation component, which transfers knowledge from a suitable, semi-expert Model Predictive Control (MPC) controller into the DRL agent. Thus, the latter is able to autonomously execute a specific UAV cinematography task with purely visual input. Unlike the MPC controller, the proposed DRL agent does not need to know the 3D world position of the filming target during inference. Experiments conducted in a photorealistic simulator showcase superior performance and training speed compared to the baseline agent while surpassing the MPC controller in terms of visual occlusion avoidance

Τοπική εφαρμογή συμπυκνωμένων αιμοπεταλίων στη θεραπεία των χρόνιων ελκών

Εισαγωγή: Η επουλωτική διεργασία είναι κοινή για όλους τους ιστούς. Ιδιαίτερο ενδιαφέρον παρουσιάζει η επούλωση του δέρματος στα χρόνια έλκη. Ως χρόνια ορίζονται τα έλκη που παραμένουν χωρίς επούλωση για χρονικό διάστημα μεγαλύτερο των 3 μηνών. Στη θεραπεία των χρόνιων ελκών χρησιμοποιούνται διάφορες τοπικές θεραπείες με σκοπό να διεγείρουν και να επιταχύνουν την επούλωση. Στις θεραπείες αυτές συγκαταλέγεται και το πλάσμα πλούσιο σε αιμοπετάλια (Platelet Rich Plasma PRP). Σκοπός: Ο σκοπός της μελέτης ήταν η διερεύνηση της υπάρχουσας βιβλιογραφίας και η διεξαγωγή συμπερασμάτων γύρω από το πεδίο της τοπικής εφαρμογής συμπυκνωμένων αιμοπεταλίων στην θεραπεία των χρόνιων ελκών. Υλικό και Μέθοδος: Πραγματοποιήθηκε βιβλιογραφική ανασκόπηση, χρησιμοποιώντας τη βάση δεδομένων Google Scholar, και PubMed, για το διάστημα 2015 – 2019. Χρησιμοποιήθηκαν <<λέξεις κλειδιά>>: πλάσμα συμπυκνωμένων αιμοπεταλίων, (Platelet Rich Plasma), έλκη κατάκλισης (Pressures ulcers). Και τέθηκαν κριτήρια εισόδου στη μελέτη. Αποτελέσματα: Τα χρόνια έλκει είναι τα τραύματα εκείνα που εκδηλώνουν αδυναμία να ακολουθήσουν, τη φυσιολογική πορεία της επουλωτικής διαδικασίας. Στα συγκεκριμένα έλκη, για πολυποίκιλες κάθε φορά αιτίες, παρατηρείται αναστολή της διαδικασίας της επούλωσης, και μη θεραπεύσιμη πρόοδος της κατάστασης του πυθμένα του τραύματος, για αρκετό χρονικό διάστημα. Σύμφωνα με την διεθνή βιβλιογραφία, χρόνιο έλκος καλείται το τραύμα που αποτυγχάνει να επουλωθεί εντός τριών μηνών. Με κύριο γνώμονα ότι τα χρόνια έλκη αποτελούν πολύπλευρο πρόβλημα υγείας αφενός για τους ίδιους τους ασθενείς και αφετέρου για το σύστημα υγείας, πραγματοποιήθηκε βιβλιογραφική ανασκόπηση μελετών από το 2015 – 2019 με σκοπό την διερεύνησης της αποτελεσματικότητας τις θεραπείας με πλάσμα πλούσιο σε αιμοπετάλια σε σχέση με συμβατικές θεραπείας. Βρέθηκαν και εξετάστηκαν δέκα τυχαιοποιημένες κλινικές δοκιμές, τέσσερις κλινικές δοκιμές χωρίς ομάδα ελέγχου, τρεις συστηματικές ανασκοπήσεις με μετα-ανάλυση, μία αναφορά περίπτωσης και μία συγκριτική μελέτη. Όπως παρουσιάζεται από τις περισσότερες έρευνες υπάρχει μια στατιστικά σημαντική εγγύτητα κατά την εφαρμογή της μεθόδου με συμπύκνωμα αιμοπεταλίων, σε σχέση με άλλες παραδοσιακές θεραπείες. Συμπεράσματα: Η χρήση του PRP στην επούλωση των χρόνιων ελκών έχει δείξει κάποιο κλινικό όφελος στις διαθέσιμες μελέτες. Ωστόσο, δεδομένης της αφθονίας αντικρουόμενων και μέτριας ποιότητας στοιχείων, δεν υπάρχουν προς το παρόν σαφείς ενδείξεις για τη χρήση του PRP. Περαιτέρω έρευνα, θα πρέπει να πραγματοποιηθεί για την διεξαγωγή εγγύτερων συμπερασμάτων.Introduction: The healing process is common to all tissues. Of particular interest is the healing of the skin in chronic ulcers. Chronic ulcers are defined as ulcers that remain without healing for more than 3 months. In the treatment of chronic, various local treatments are used to stimulate and accelerate healing. These treatments include platelet-rich plasma PRP. Aim: The aim of the study was to explore in depth the existing literature and to draw conclusions around the scope of local application of concentrated platelets in the treatment of chronic ulcers. Methodology: A bibliographical review was carried out on the subject using the Google Scholar database, and PubMed, for the period 2015 - 2020. Key << were used>>: Platelet Rich Plasma, pressure ulcers. Results: Chronic ulcers are those traumas that manifest inability to follow the normal course of the healing process. In these ulcers, for a maniac of causes at a time, there is inhibition of the healing process, and non-treatable progression of the condition of the wound bottom, for quite a period of time. According to international literature, a chronic ulcer is called the wound that fails to heal within three months. Based on the fact that chronic ulcers are a multifaceted health problem for both the patients themselves and the health system, a literature review of studies was conducted from 2015 to 2019 in order to investigate the effectiveness of treatment with platelet-rich plasma in relation to conventional treatment. Ten randomized clinical trials, four clinical trials without a control group, three systematic reviews with meta-analysis, one case report and one comparative study were found and examined. As shown by most research there is a statistically significant proximity when applying the method with platelet concentrate, compared to other traditional treatments. Conclusions: The use of PRP in the healing of chronic ulcers has shown some significant clinical benefit in the available studies. However, given the abundance of conflicting and moderate data quality, there is currently no clear indication of the use of PRP. Further research should be carried out to draw closer conclusions

Inmate cancer patients – highlighting the importance of a holistic approach to oncological care

Purpose: Inmate oncologic patients' rates increased drastically worldwide. Elderly, limited exercise, unhealthy diet, hepatitis, HIV+ status, tobacco and alcohol use, constitute the main cancer risk factors. We present an outline of practical oncological management and ethical thinking, in the specific environment of a detention facility. Methods: PubMed, Cochrane Database of Controlled Trials, SCOPUS and grey literature were extensively searched upto October 2021. Ιncarcerated oncologic patients experiencevarious everyday challenges:their confinement in high securityfacilities, the lack of access to critical care and related ethicaldilemmas inherent to the context of a correctional facility. Results: The detention facilities may be inadequate in providing early cancer diagnosis and appropriate care mainlydue to a lack of specialized personnel, b) in-house or in external specialized cancer hospitals, care variability (e.g. admissions in small local or regional hospitals), c) delays inproviding access and d) gatekeeper systems. There is a paucity of administration of a) systemic therapy(chemotherapy, targeted drug therapy etc), b) radiotherapy, c)palliative care, and d) enrollment in clinical trials.  Conclusions: Correctional facilities must encourage teamwork between healthcare and correctional professionals inorder to improve the provided anticancer care

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study : a WSES observational study

BackgroundTiming and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted.MethodsThis worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018.ResultsA total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate >= 22 breaths/min, systolic blood pressure 4mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8.ConclusionsThe simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.Peer reviewe

Fault models for the Bodrum–Kos tsunamigenic earthquake (Mw6.6) of 20 July 2017 in the east Aegean Sea

We investigate a fault model for the shallow, strong (Mw6.6) tsunamigenic earthquake of 20 July 2017 with source area in the east Aegean Sea between Bodrum peninsula (Turkey) and Kos Isl. (Greece). Fault plane solutions are consistent with the regional active tectonics indicating normal faulting striking about E–W. A relocated hypocenter of the main shock was obtained and the rupture time-space history for two alternative fault solutions dipping either to the south or to north was approached by inverting P-waves recorded at teleseismic (30°–90°) distances. In both fault solutions the seismic moment calculated corresponds to magnitude Mw=6.6 while the earthquake had total rupture duration of less than 10 s. The maximum co-seismic slip was close to the hypocenter ∼1.6m and ∼2.2m for the south and north dipping faults, respectively. Close to the surface coseismic slip of ∼0.3m was calculated. Our analysis of Sentinel satellite InSAR images showed ground deformation fringes indicating ∼13 cm vertical displacement change between the North and South coasts of the Karaada islet. This result is in line with our preference of the south dipping fault, supported primarily by GPS displacements, regional tectonics, aftershock activity and tsunami observations, although results of InSAR inversion fit equally well both solutions.Published1016463T. Sorgente sismicaJCR Journa

Hereditary Diffuse Gastric Cancer: A 2022 Update

Gastric cancer is ranked fifth among the most commonly diagnosed cancers, and is the fourth leading cause of cancer-related deaths worldwide. The majority of gastric cancers are sporadic, while only a small percentage, less than 1%, are hereditary. Hereditary diffuse gastric cancer (HDGC) is a rare malignancy, characterized by early-onset, highly-penetrant autosomal dominant inheritance mainly of the germline alterations in the E-cadherin gene (CDH1) and β-catenin (CTNNA1). In the present study, we provide an overview on the molecular basis of HDGC and outline the essential elements of genetic counseling and surveillance. We further provide a practical summary of current guidelines on clinical management and treatment of individuals at risk and patients with early disease

The role of surgical treatment in isolated organ recurrence of esophageal cancer—a systematic review of the literature

Abstract Background Despite the improvements in the early detection and treatment of non-metastatic esophageal cancer, more than half of patients undergoing a curative treatment for esophageal cancer will develop recurrence within three years. The prognosis of these patients is poor. However, a wide range in overall survival has been reported, depending on the pattern of recurrence, and no optimal treatment strategy following recurrence has yet been uniformly accepted. Aim In this article, we aimed to systematically review the literature for the role of surgical resection of metachronous distant metastasis following primary treatment of esophageal cancer. Furthermore, we discuss possible factors that could possibly predict which patients may benefit from a surgical approach. A comprehensive literature search was conducted in PubMed using combinations of keywords. Results Patients with recurrence may benefit of a multimodality treatment. Regarding the isolated recurrence of esophageal cancer in solid visceral organs, operative intervention has been proposed as a treatment that may offer a survival benefit in an individual basis. No definitive conclusions regarding the potential survival advantage offered by the surgical treatment of solitary recurrent lesions can be drawn. However, recent improvements in surgical treatment and optimization of perioperative management guarantee an acceptable operative risk, making surgical resection of solitary recurrence lesions a considerable therapeutic option. Conclusions It can be conferred from the available studies that the surgical treatment of isolated recurrence from esophageal cancer may offer a survival benefit for properly selected patients. Prospective, multicenter studies might be useful to gain a better insight into those factors that affect selection of patients to take benefit from an operative intervention

Olfactory training is helpful in postinfectious olfactory loss: A randomized, controlled, multicenter study

Objectives/Hypothesis The aim of this study was to evaluate the effects of olfactory training (OT) on olfactory function in patients with persistent postinfectious olfactory dysfunction (PIOD). Study Design Randomized, single-blind, controlled, multicenter crossover study. Methods Twelve tertiary university medical centers participated. Investigations were performed at three visits (baseline, after 18 weeks, and after 36 weeks), including only subjects with PIOD of <24-months duration. At each visit, participants received detailed assessment of olfactory function. Seventy subjects trained with high concentrations of four odors for 18 weeks; the other half (n = 74) trained with low concentrations of odors. For the following 18 weeks this regimen was switched. Results After 18 weeks, olfactory function improved in the high-training group in 18 of 70 participants (26%), whereas only 11/74 improved in the low-training group (15%). In subjects with a duration of olfactory dysfunction of <12 months, olfactory function improved in 15/24 participants (63%) of the high-training group and in 6/31 participants (19%) of the low-training group (P = .03). Conclusions OT improves PIOD, and the use of odors at higher concentrations is beneficial to improvement. OT is a safe procedure and appears to be particularly useful in patients who start OT within 12 months after the onset of the disorder. OT is the first successful therapy regime in patients with PIOD. Level of Evidence 1b. Laryngoscope, 124:826-831, 201

Impact of Radiation Therapy on Pain Relief of Cancer Patients Affected by on Malignant Psoas Syndrome: 26 Years of Experience

Aim: The malignant psoas syndrome (MPS) is a rare and complex cancer-related clinical entity, with a significant impact on cancer patients&apos; quality of life. The literature describing malignant infiltration of the psoas muscle as well as its management is limited. The primary endpoint of the study was the assessment of pain relief in symptomatic terminal-stage MPS patients. Materials and Methods: Patients underwent hypofractionated (two- or three-dimensional conformal) radiotherapy as palliative treatment. A dose of 42.5 Gy in 17 daily fractions (2.5 Gy/fraction) was prescribed. Pain response was measured before 3 and 6 months after radiation delivery. Results: Between May 1992 and April 2019, eight patients were treated. The median age was 75 years (range: 59-87 years). All patients had distant metastatic disease at the time of treatment. We found a significant pain relief (median duration of response of 105 days) and an improvement in health-related quality of life. Conclusions: Radiotherapy had a favorable outcome and can be considered an effective analgesic treatment in case of painful MPS