advanced maternal age, rupture of membranes before viability and termination of pregnancy in case of maternal-fetal complications

Einführung Die Perinatalmedizin befindet sich im Wandel, mit immer besserer Schwangerenvorsorge und Diagnostik und rasch voranschreitender Optimierung der neonatologischen Versorgung. Dennoch konnte die Frühgeborenenrate nicht substanziell gesenkt werden. Darüber hinaus hat sich mit dem steigenden Alter der Schwangeren und den Entwicklungen in der Reproduktionsmedizin (z. B. durch eine höhere Mehrlingsrate) das Komplikationsspektrum ebenfalls verändert. Material und Methoden Seit Januar 2000 wurden Daten von Patientinnen der Charité Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow Klinikum erhoben. Es wurde eine retrospektive Analyse der geburtsmedizinischen und neonatologischen Patientenakten, Laborbefunden und Bildgebungen durchgeführt. Die Datenbank des Bundesamtes für Statistik und eine ausführliche Literaturrecherche wurden verwendet. Aus den erhobenen Daten wurden drei individuelle Veröffentlichungen erstellt. Ergebnisse “Pregnancies in Women Aged 45 Years and Older – a 10-Year Retrospective Analysis in Berlin“: Ein maternales Alter >45 Jahre birgt ein signifikant erhöhtes Risiko für Schwangerschaftskomplikationen: Gestationsdiabetes, Präeklampsie, Frühgeburt und Sectio-Raten. “Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation”: Feten aus einer Schwangerschaft mit einem Blasensprung vor der 24 Schwangerschaftswoche haben insgesamt 51% Überlebenschance, und eine 80% Überlebenschance nach Lebendgeburt. Das neonatale Outcome hängt vom Schwangerschaftsalter bei Geburt und nicht vom Schwangerschaftsalter bei Blasensprung ab. “A 17-years analysis of terminations of pregnancy ≥14 weeks of gestation in a German level 1 perinatal center”: Die Gründe für einen medizinisch indizierten Schwangerschaftsabbruch nach der 14. Schwangerschaftswoche sind vielfältig und kommen in jedem maternalen Alter und in jeder Schwangerschaftswoche vor. Diskussion Das erhöhte Risiko für Schwangere >45 Jahren ist nicht nur Teil der Beratung in der Reproduktionsmedizin, sondern auch ein Leitfaden für den behandelnden Arzt, auf welche potentiellen Komplikationen vermehrt geachtet werden muss. Blasensprünge vor Erreichen der Lebensfähigkeit bleiben eine medizinische und ethische Herausforderung. Eine Arbeit, die sich mit dem Outcome betroffener Schwangerschaften beschäftigt hat kann als Beratungsgrundlage für betroffene paar dienen. Es ist denkbar, dass die Anzahl der Schwangerschaftsbeendigungen nach Erreichen der Lebensfähigkeit durch ein differenziertes und allgemein zugängliches Ultraschallscreening verringert werden könnten. Die Beratung der betroffenen Patientinnen kann durch eine Übersichtsarbeit erleichtert werden. Um die Beratungssituation zu verbessern, werden repräsentative Daten benötigt. Da die Entscheidungen, die in der Geburtsmedizin von Arzt und Patient getroffen werden müssen, oft sehr individuell sind und auch über das Leben des ungeborenen Kindes entscheiden können die hier präsentierten Daten nicht randomisiert und prospektiv erhoben werden.Background Perinatal medicine is changing rapidly. On one hand neonatal care is advancing, as well as prenatal care diagnostics. On the other hand, reproductive medicine increases the rate of high-risk pregnancies and the accompanying complications. As a result, preterm birth rates are not decreasing, even in the western world. Materials and methods The patient files from the Department of Obstetrics, Charité Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum since January 2000 were collected. A retrospective analysis was performed from perinatal, obstetric and neonatal files, including laboratory and imaging results. Data was also pulled from the German Federal Statistical Office and a thorough research of the literature was performed. Three individual papers were created from the results. Results “Pregnancies in Women Aged 45 Years and Older – a 10-Year Retrospective Analysis in Berlin”: Maternal age >45 years poses a significantly increased risk of pregnancy complications e.g. gestational diabetes, preeclampsia and preterm delivery; and an increased rate of cesarean sections. “Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation”: The fetal survival rate is approx. 51% overall. In case of a live birth, the neonatal survival rate is approx. 80%. The neonatal outcome depends on the gestational age at delivery, not on the gestational age at rupture of membranes. “A 17-years analysis of terminations of pregnancy ≥14 weeks of gestation in a German level 1 perinatal center”: The medical reasons for a termination of pregnancy after the 14th week of gestation are multifarious and not depending on gestational or maternal age. Discussion The patient has to be informed of the increased risk for pregnant women >45 years of age, already when considering reproductive medicine. The knowledge of the most important risk factors during pregnancy can be a guideline for the treating physicians during the pregnancy and around birth. Rupture of membranes before viability will continue to be a medical and ethical challenge. A retrospective outline of the outcomes can help couples and physicians in the decision-making process

Web-based patient-reported outcomes using the International Consortium for Health Outcome Measurement dataset in a major German university hospital: observational study

Background: Collecting patient-reported outcome (PRO) data systematically enables objective evaluation of treatment and its related outcomes. Using disease-specific questionnaires developed by the International Consortium for Health Outcome Measurement (ICHOM) allows for comparison between physicians, hospitals, and even different countries. Objective: This pilot project aimed to establish a digital system to measure PROs for new patients with breast cancer who attended the Charité Breast Center. This approach should serve as a blueprint to further expand the PRO measurement to other disease entities and departments. Methods: In November 2016, we implemented a Web-based system to collect PRO data at Charité Breast Center using the ICHOM dataset. All new patients at the Breast Center were enrolled and answered a predefined set of questions using a tablet computer. Once they started their treatment at Charité, automated emails were sent to the patients at predefined treatment points. Those emails contained a Web-based link through which they could access and answer questionnaires. Results: By now, 541 patients have been enrolled and 2470 questionnaires initiated. Overall, 9.4% (51/541) of the patients were under the age of 40 years, 49.7% (269/541) between 40 and 60 years, 39.6% (214/541) between 60 and 80 years, and 1.3% (7/541) over the age of 80 years. The average return rate of questionnaires was 67.0%. When asked about the preference regarding paper versus Web-based questionnaires, 6.0% (8/134) of the patients between 50 and 60 years, 6.0% (9/150) between 60 and 70 years, and 12.7% (9/71) over the age of 70 years preferred paper versions. Conclusions: Measuring PRO in patients with breast cancer in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate

CDK4/6 Inhibitors in Advanced HR+/HER2 - Breast Cancer: A Multicenter Real-World Data Analysis

CDK4/6 inhibitors (CDK4/6i) combined with endocrine therapy are considered standard-of-care for first-line therapy of patients with hormone receptor positive, HER2 negative, advanced breast cancer (HR+/HER2- ABC). Superiority of combination therapy over endocrine monotherapy has been demonstrated in a multitude of randomized controlled trials (RCTs) in phase III and IV. However, RCTs reflect clinical reality only to a limited extent, as narrow inclusion criteria lead to a selected patient collective. Here, we present real-world data (RWD) on CDK4/6i treatment in patients with HR+/HER2- ABC at four certified German university breast cancer centers.This study was supported by Novartis Pharma GmbH as part of the “ERIC” (“Excellent Researchers in Breast Cancer”) project

Jet energy measurement with the ATLAS detector in proton-proton collisions at root s=7 TeV

The jet energy scale and its systematic uncertainty are determined for jets measured with the ATLAS detector at the LHC in proton-proton collision data at a centre-of-mass energy of √s = 7TeV corresponding to an integrated luminosity of 38 pb-1. Jets are reconstructed with the anti-kt algorithm with distance parameters R=0. 4 or R=0. 6. Jet energy and angle corrections are determined from Monte Carlo simulations to calibrate jets with transverse momenta pT≥20 GeV and pseudorapidities {pipe}η{pipe}<4. 5. The jet energy systematic uncertainty is estimated using the single isolated hadron response measured in situ and in test-beams, exploiting the transverse momentum balance between central and forward jets in events with dijet topologies and studying systematic variations in Monte Carlo simulations. The jet energy uncertainty is less than 2. 5 % in the central calorimeter region ({pipe}η{pipe}<0. 8) for jets with 60≤pT<800 GeV, and is maximally 14 % for pT<30 GeV in the most forward region 3. 2≤{pipe}η{pipe}<4. 5. The jet energy is validated for jet transverse momenta up to 1 TeV to the level of a few percent using several in situ techniques by comparing a well-known reference such as the recoiling photon pT, the sum of the transverse momenta of tracks associated to the jet, or a system of low-pT jets recoiling against a high-pT jet. More sophisticated jet calibration schemes are presented based on calorimeter cell energy density weighting or hadronic properties of jets, aiming for an improved jet energy resolution and a reduced flavour dependence of the jet response. The systematic uncertainty of the jet energy determined from a combination of in situ techniques is consistent with the one derived from single hadron response measurements over a wide kinematic range. The nominal corrections and uncertainties are derived for isolated jets in an inclusive sample of high-pT jets. Special cases such as event topologies with close-by jets, or selections of samples with an enhanced content of jets originating from light quarks, heavy quarks or gluons are also discussed and the corresponding uncertainties are determined. © 2013 CERN for the benefit of the ATLAS collaboration

Measurement of the inclusive and dijet cross-sections of b-jets in pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

The inclusive and dijet production cross-sections have been measured for jets containing b-hadrons (b-jets) in proton-proton collisions at a centre-of-mass energy of sqrt(s) = 7 TeV, using the ATLAS detector at the LHC. The measurements use data corresponding to an integrated luminosity of 34 pb^-1. The b-jets are identified using either a lifetime-based method, where secondary decay vertices of b-hadrons in jets are reconstructed using information from the tracking detectors, or a muon-based method where the presence of a muon is used to identify semileptonic decays of b-hadrons inside jets. The inclusive b-jet cross-section is measured as a function of transverse momentum in the range 20 < pT < 400 GeV and rapidity in the range |y| < 2.1. The bbbar-dijet cross-section is measured as a function of the dijet invariant mass in the range 110 < m_jj < 760 GeV, the azimuthal angle difference between the two jets and the angular variable chi in two dijet mass regions. The results are compared with next-to-leading-order QCD predictions. Good agreement is observed between the measured cross-sections and the predictions obtained using POWHEG + Pythia. MC@NLO + Herwig shows good agreement with the measured bbbar-dijet cross-section. However, it does not reproduce the measured inclusive cross-section well, particularly for central b-jets with large transverse momenta.Comment: 10 pages plus author list (21 pages total), 8 figures, 1 table, final version published in European Physical Journal

Search for displaced vertices arising from decays of new heavy particles in 7 TeV pp collisions at ATLAS

We present the results of a search for new, heavy particles that decay at a significant distance from their production point into a final state containing charged hadrons in association with a high-momentum muon. The search is conducted in a pp-collision data sample with a center-of-mass energy of 7 TeV and an integrated luminosity of 33 pb^-1 collected in 2010 by the ATLAS detector operating at the Large Hadron Collider. Production of such particles is expected in various scenarios of physics beyond the standard model. We observe no signal and place limits on the production cross-section of supersymmetric particles in an R-parity-violating scenario as a function of the neutralino lifetime. Limits are presented for different squark and neutralino masses, enabling extension of the limits to a variety of other models.Comment: 8 pages plus author list (20 pages total), 8 figures, 1 table, final version to appear in Physics Letters

Single hadron response measurement and calorimeter jet energy scale uncertainty with the ATLAS detector at the LHC

The uncertainty on the calorimeter energy response to jets of particles is derived for the ATLAS experiment at the Large Hadron Collider (LHC). First, the calorimeter response to single isolated charged hadrons is measured and compared to the Monte Carlo simulation using proton-proton collisions at centre-of-mass energies of sqrt(s) = 900 GeV and 7 TeV collected during 2009 and 2010. Then, using the decay of K_s and Lambda particles, the calorimeter response to specific types of particles (positively and negatively charged pions, protons, and anti-protons) is measured and compared to the Monte Carlo predictions. Finally, the jet energy scale uncertainty is determined by propagating the response uncertainty for single charged and neutral particles to jets. The response uncertainty is 2-5% for central isolated hadrons and 1-3% for the final calorimeter jet energy scale.Comment: 24 pages plus author list (36 pages total), 23 figures, 1 table, submitted to European Physical Journal

Standalone vertex finding in the ATLAS muon spectrometer

A dedicated reconstruction algorithm to find decay vertices in the ATLAS muon spectrometer is presented. The algorithm searches the region just upstream of or inside the muon spectrometer volume for multi-particle vertices that originate from the decay of particles with long decay paths. The performance of the algorithm is evaluated using both a sample of simulated Higgs boson events, in which the Higgs boson decays to long-lived neutral particles that in turn decay to bbar b final states, and pp collision data at √s = 7 TeV collected with the ATLAS detector at the LHC during 2011

Measurements of Higgs boson production and couplings in diboson final states with the ATLAS detector at the LHC

Measurements are presented of production properties and couplings of the recently discovered Higgs boson using the decays into boson pairs, H →γ γ, H → Z Z∗ →4l and H →W W∗ →lνlν. The results are based on the complete pp collision data sample recorded by the ATLAS experiment at the CERN Large Hadron Collider at centre-of-mass energies of √s = 7 TeV and √s = 8 TeV, corresponding to an integrated luminosity of about 25 fb−1. Evidence for Higgs boson production through vector-boson fusion is reported. Results of combined fits probing Higgs boson couplings to fermions and bosons, as well as anomalous contributions to loop-induced production and decay modes, are presented. All measurements are consistent with expectations for the Standard Model Higgs boson