Intraoperative magnetic resonance imaging-guided transsphenoidal surgery for giant pituitary adenomas

Giant pituitary adenomas (GPAs), defined as  ≥40mm in one extension, present a challenging subgroup of pituitary adenomas in terms of radical tumor removal and complication rates. The potential impact of intraoperative magnetic resonance imaging (iMRI) is investigated in a consecutive series and the results compared to the literature. From November 2004 until February 2005, six (five male) patients were operated for GPAs via an iMRI-guided transsphenoidal approach in the PoleStar™ N20. Clinical, endocrinological, and neuroradiological outcomes (at 3months and yearly postoperative over 4years) were assessed. Mean age was 46years (range, 34-60). All patients presented with preoperative visual field defects, five with pituitary failure. Five adenomas were clinically nonfunctioning, one was producing GH and TSH. Preoperative imaging showed invasion of the cavernous sinus in all and extension to the interventricular foramen in two patients (one with occlusive hydrocephalus). Resection was total in four and subtotal (small cavernous sinus remnants) in two patients, leading to transsphenoidal reoperation in one patient. Visual acuity and fields improved in all six patients. The patient with occlusive hydrocephalus developed a postoperative cerebrospinal fluid leak (subsequently revised), two patients developed temporary, one permanent central diabetes insipidus, and one of them transient hyponatremia. Compared to the preoperative situation, endocrine status in the long-term follow-up (mean, 25months) remained unchanged in four and worsened in two. Two patients were considered not to require hormone replacement therapy. IMRI supports transsphenoidal resections of GPAs because residual adenoma and related risk structures are easily detected and localized intraoperatively, extending the restricted visual access of the microscope beyond mere surface anatomy to a three-dimensional view. More radical removal of adenomas in a single surgical session combined with low complication rates are accomplished. This may add to a favorable clinical and endocrinological outcome in GPA

Adaptive behavior in optimal sequential search

Sequential decision making-making a decision where available options are encountered successively-is a hallmark of everyday life. Such decisions require deciding to accept or reject an alternative without knowing potential future options. Prior work focused on understanding choice behavior by developing decision models that capture human choices in such tasks. We investigated people's adaptive behavior in changing environments in light of their cognitive strategies. We present two studies in which we modified (a) outcome variance and (b) the time horizon and provide empirical evidence that people adapt to both context manipulations. Furthermore, we apply a recently developed threshold model of optimal stopping to our data to disentangle different cognitive processes involved in optimal stopping behavior. The results from Study 1 show that participants adaptively scaled the values of the sampling distribution to its variance, suggesting that the value of an option is perceived in relative rather than absolute terms. The results from Study 2 suggest that increasing the time horizon decreases the initial acceptance level, but less strongly than would be optimal. Furthermore, for longer sequences, participants more weakly adjusted this acceptance threshold over time than for shorter sequences. Further correlations between individual estimates in each condition indicate that individual differences between the participants' thresholds remain fairly stable between the conditions, pointing toward an additive effect of our manipulations

The new mobility paradigm: transformation of value chain and business models

We would like to thank Philipp Schwarz and Julia Gückel for their dedicated support in preparing this paper and our colleagues and students of the School of Engineering and the Business School for our fruitful discussions.Four categories of innovations have been identified by Freeman and Perez: incremental innovations, radical innovations, new technological systems (systemic innovations), and technological revolutions or new techno-economic paradigms. New techno-economic paradigms represent changes in technological systems that are so far-reaching in their effects that they have a major influence on the behaviour of the entire economy. Scarcity of oil and external costs like global warming are the key arguments and the main drivers of the change of the current paradigm. They will affect especially the mobility of individuals and the interlinked business models. Novel business models within newly created markets will raise e.g. extended mobility services, activities aiming at the infrastructure, new opportunities in the field of energy transmission and supply and even new strategies of recycling, reusing or reducing the use of resources in order to address global scarcity issues. Especially for the established players of the automotive industry like original equipment manufacturers (OEMs) or 1st and 2nd tier suppliers this implicates opportunities and risks at the same time. But also new players will get the chance to create and enter new markets with new or extended products or services and lead the new value chain. This paper compiles and evaluates current approaches and business models of selected OEMs together with upcoming players. Additionally their positions within the existing value chain are being analyzed and classified. Bringing together the identified drivers of changes with current trends within the automotive industry the authors also show new concepts of extended business models, e.g. the idea of an ecosystem, that have the potential to cause an additional shift of power within the global mobility value chain

Oligometastasis in breast cancer-current status and treatment options from a radiation oncology perspective

Evidence from a few small randomized trials and retrospective cohorts mostly including various tumor entities indicates a prolongation of disease free survival (DFS) and overall survival (OS) from local ablative therapies in oligometastatic disease (OMD). However, it is still unclear which patients benefit most from this approach. We give an overview of the several aspects of stereotactic body radiotherapy (SBRT) in extracranial OMD in breast cancer from a radiation oncology perspective. A PubMed search referring to this was conducted. An attempt was made to relate the therapeutic efficacy of SBRT to various prognostic factors. Data from approximately 500 breast cancer patients treated with SBRT for OMD in mostly in small cohort studies have been published, consistently indicating high local tumor control rates and favorable progression-free (PFS) and overall survival (OS). Predictors for a good prognosis after SBRT are favorable biological subtype (hormone receptor positive, HER2 negative), solitary metastasis, bone-only metastasis, and long metastasis-free interval. However, definitive proof that SBRT in OMD breast cancer prolongs DFS or OS is lacking, since, with the exception of one small randomized trial (n = 22 in the SBRT arm), none of the cohort studies had an adequate control group. Further studies are needed to prove the benefit of SBRT in OMD breast cancer and to define adequate selection criteria. Currently, the use of local ablative SBRT should always be discussed in a multidisciplinary tumor board

Effect of suture technique on the occurrence of incisional hernia after elective midline abdominal wall closure: study protocol for a randomized controlled trial

Background: Based on a recent meta-analysis, a continuous suture technique with a suture to wound length ratio of at least 4: 1, using a slowly absorbable monofilament suture material, is recommended for primary median laparotomy closure. Incisional hernia, which develops in 9 to 20% of patients, remains the major complication of abdominal wall closure. Current clinical data indicate that the incidence of incisional hernias increases by 60% between the first and the third year after median laparotomy, implicating that a follow-up period of 1 year postoperatively is too short with regard to this common complication. Trauma to the abdominal wall can be reduced by improvements in suture technique as well as suture material. Several factors, such as stitch length, suture tension, elasticity, and tensile strength of the suture material are discussed and currently under investigation. A Swedish randomized controlled trial showed a significant reduction in the incisional hernia rate by shortening the stitch length. However, a non-elastic thread was used and follow-up ended after 12 months. Therefore, we designed a multicenter, international, double-blinded, randomized trial to analyze the influence of stitch length, using an elastic, extra-long term absorbable monofilament suture, on the long term clinical outcome of abdominal wall closure. Methods: In total, 468 patients undergoing an elective, median laparotomy will be randomly allocated to either the short stitch or the long stitch suture technique for abdominal wall closure in a 1: 1 ratio. Centers located in Germany and Austria will participate. The primary endpoint measure is the incisional hernia rate 1 year postoperatively, as verified by ultrasound. The frequency of short term and long term complications as well as costs, length of hospital stay and patients' quality of life (EQ-5D-5 L) will be considered as secondary parameters. Following hospital discharge, patients will be examined after 30 days and 1, 3, and 5 years after surgery. Discussion: This study will provide further evidence on whether a short stitch suture technique in combination with an elastic, extra-long term absorbable monofilament suture can prevent incisional hernias in the long term, compared with the long stitch suture technique

Current controversies in radiotherapy for breast cancer

Multimodal treatment approaches have substantially improved the outcome of breast cancer patients in the last decades. Radiotherapy is an integral component of multimodal treatment concepts used in curative and palliative intention in numerous clinical situations from precursor lesions such as ductal carcinoma in situ (DCIS) to advanced breast cancer. This review addresses current controversial topics in radiotherapy with special consideration of DCIS, accelerated partial breast irradiation (APBI) and regional nodal irradiation (RNI) and provides an update on the clinical practice guidelines of the Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)

Towards a cancer mission in Horizon Europe: recommendations.

A comprehensive translational cancer research approach focused on personalized and precision medicine, and covering the entire cancer research-care-prevention continuum has the potential to achieve in 2030 a 10-year cancer-specific survival for 75% of patients diagnosed in European Union (EU) member states with a well-developed healthcare system. Concerted actions across this continuum that spans from basic and preclinical research through clinical and prevention research to outcomes research, along with the establishment of interconnected high-quality infrastructures for translational research, clinical and prevention trials and outcomes research, will ensure that science-driven and social innovations benefit patients and individuals at risk across the EU. European infrastructures involving comprehensive cancer centres (CCCs) and CCC-like entities will provide researchers with access to the required critical mass of patients, biological materials and technological resources and can bridge research with healthcare systems. Here, we prioritize research areas to ensure a balanced research portfolio and provide recommendations for achieving key targets. Meeting these targets will require harmonization of EU and national priorities and policies, improved research coordination at the national, regional and EU level and increasingly efficient and flexible funding mechanisms. Long-term support by the EU and commitment of Member States to specialized schemes are also needed for the establishment and sustainability of trans-border infrastructures and networks. In addition to effectively engaging policymakers, all relevant stakeholders within the entire continuum should consensually inform policy through evidence-based advice

Effects of Hormone Agonists on Sf9 Cells, Proliferation and Cell Cycle Arrest

Methoxyfenozide and methoprene are two insecticides that mimic the action of the main hormones involved in the control of insect growth and development, 20-hydroxyecdysone and juvenile hormone. We investigated their effect on the Spodoptera frugiperda Sf9 cell line. Methoxyfenozide was more toxic than methoprene in cell viability tests and more potent in the inhibition of cellular proliferation. Cell growth arrest occurred in the G2/M phase after a methoprene treatment and more modestly in G1 after methoxyfenozide treatment. Microarray experiments and real-time quantitative PCR to follow the expression of nuclear receptors ultraspiracle and ecdysone receptor were performed to understand the molecular action of these hormone agonists. Twenty-six genes were differentially expressed after methoxyfenozide treatment and 55 genes after methoprene treatment with no gene in common between the two treatments. Our results suggest two different signalling pathways in Sf9 cells