Charité Universitätsmedizin Berlin

Objectives The seasonality of conception and birth has intrigued scientists for over 200 years. Since the 1970s, peak birth months in the northern hemisphere have shifted from early spring to late summer, influenced by oral contraceptives and socio-economic factors. The division of Germany from the end of World War II until reunification in 1990 offers a unique opportunity to analyze these influences while both regions had equal access to contraception. This study aims to identify differences in fertility trends and peak birth months between West and East Germany before and after reunification, considering political, socio-economic factors, and contraceptive availability. Methods A population-based study analyzed overall fertility rates, monthly birth data, peak birth months, and average maternal ages from 1950 to 2022. Results Fertility patterns were similar in both regions until 1970, showing a sharp increase post-1955 followed by a decline around 1965, likely due to contraception. From 1970 to 1990, East German fertility increased while West Germany’s remained lower. After reunification, East German fertility fell sharply but later rose to West German levels. The peak birth month shifted from March to August in West Germany by the mid-1980s, while East Germany experienced this change 20 years later, post-reunification. Conclusions The 20-year delay in East Germany’s shift suggests that oral contraception’s impact was influenced by other factors, particularly the age of women at childbirth. Increased control over fertility in the West allowed for more choice in conception timing, a trend adopted in the East after gaining similar autonomy.

Aim: Percutaneous transluminal angioplasty (PTA) for peripheral artery disease (PAD) commonly leads to dissections which are associated with higher target lesion revascularization (TLR) rates. Clinical and economic consequences of dissection management in the femoropopliteal artery following PTA, and specifically the potential economic benefit of focal dissection repair using the novel Tack Endovascular System, remain unknown. Methods: A decision-analytic model was used to estimate 24-month clinical events, costs and quality-adjusted life year (QALY) gain for a Tack-supported versus status-quo PTA strategy. Patient and lesion characteristics and TLR rates were derived from the PTA cohort of the TOBA II clinical trial, an observational cohort, and literature. Cost–effectiveness was determined from a US payer and provider perspective separately for the non-severe (grade A or B), severe (grade C and higher) and the entire dissection cohort. Results: TLR rates were lower for the Tack-supported strategy compared with PTA (7.7 vs 27.4% in the non-severe, 13.9 vs 25.8% in the severe and 12.0 vs 26.3% in the entire dissection cohort). Cost and QALY differences were +$297/ + 0.0110 in the non-severe dissection cohort and -$1602/ + 0.0067 in the severe dissection cohort, resulting in an incremental cost–effectiveness ratio (ICER) of $25,622 in the non-severe cohort and dominance in the severe cohort and the entire cohort. Conclusion: Compared with a ‘status-quo’ approach, proactive focal stenting may lead to fewer reinterventions and improved quality of life. There appears to be a graded economic benefit of focal dissection treatment, being cost-effective in non-severe dissections and even cost saving in severe dissections.

OBJECTIVE Robotics in neurosurgery is becoming increasingly prevalent. The integration of intraoperative imaging for patient registration into workflows of newer robotic systems enhances precision and has further driven their widespread adoption. In this study, the authors report on a lightweight, table-mounted robotic system integrating robotic cone-beam CT (CB-CT) for automated patient registration in cranial biopsies and stereotactic electroencephalography (sEEG). METHODS This prospective cohort study included patients who underwent stereotactic biopsy or sEEG with the Cirq system from January 2023 to August 2024. For patient-to-image registration, an external registration matrix was secured near the patient’s head before conducting CB-CT with robotic Artis Pheno. CT was then fused with preoperative planning MRI and used as the navigation dataset. Demographic and clinical data were evaluated, and entry and target errors, as well as vector deviation of sEEG electrodes, were assessed and compared with those of patients who underwent biopsies and sEEG with the frameless VarioGuide system. RESULTS In 26 Cirq-assisted surgical procedures, robotic CB-CT was used for image registration in 20 cases. Of these, 15 were biopsies (mean ± SD 7 ± 1 specimens) and 5 were sEEG with 31 depth electrodes, compared to 29 VarioGuide biopsies and 3 VarioGuide sEEG cases with 25 electrodes. The mean age was 56 ± 19 years, with a male/female ratio of 1.9:1. Lesion size averaged 19 ± 17 cm ³ on T1-weighted imaging and 61 ± 53 cm ³ on T2-weighted imaging for Cirq and 14 ± 14 cm ³ and 68 ± 47 cm ³ for VarioGuide. The mean surgical times were 117 ± 34 minutes for biopsy and 269 ± 54 minutes for sEEG in the Cirq group, with skin-to-skin times of 40 ± 23 minutes for biopsy and 208 ± 74 minutes for sEEG; in comparison, surgical times of 78 ± 21 minutes for biopsy and 218 ± 33 minutes for sEEG were reported with VarioGuide, with skin-to-skin times of 34 ± 13 and 158 ± 27 minutes. No complications occurred. The mean dosage area product was 983 ± 351 µGym ² for biopsies and 1772 ± 968 µGym ² for sEEG. Cirq-assisted sEEG electrodes had mean entry and target errors of 1.4 ± 1.2 mm and 2.6 ± 1.6 mm, compared to 5.3 ± 3.3 mm and 6.5 ± 2.8 mm with VarioGuide. Mean vector deviation was 1.6 ± 0.9 mm with Cirq versus 4.9 ± 2.9 mm with VarioGuide. CONCLUSIONS The integration of a lightweight, table-mounted robotic alignment tool with intraoperative CB-CT for automated patient-to-image registration enables high precision and a seamless workflow. This combination is safe, has a manageable learning curve, and holds potential to replace traditional frame-based and frameless procedures. Its efficiency and accuracy are likely to contribute to the increasing adoption of robotics in neurosurgery.

Purpose The purpose of the present study was to analyze associations between different skeletal muscle quality parameters and survival in patients with hepatocellular carcinoma (HCC) undergoing treatment with transarterial chemoembolization (TACE). Methods We retrospectively enrolled 784 treatment-naïve patients with HCC undergoing TACE at six tertiary care centers between 2010 and 2020. Intramuscular adipose tissue (IMAT) and skeletal muscle density (SMD) were estimated. Myosteatosis was defined as SMD < 28.0 HU for men and < 23.8 HU for women. Furthermore, albumin-SMD score (ADS) was calculated as follows: serum albumin (g/dL) × SMD (HU). To assess the impact of muscle quality on survival, Cox regression model was used. Kaplan-Meier curves were used for survival analysis. Parameters of skeletal muscle quality were compared in univariate and multivariate regression analyses, adjusted for established risk factors. Results In the overall sample, survivors had higher SMD and ADS in comparison to non-survivors. Patients with low ADS had a lower OS than patients with high ADS (8.4 vs. 14.3 months, p < 0.001). In alcohol-induced HCC, none of the analyzed parameters of muscle quality influenced survival. In viral induced HCC, patients with low ADS had lower OS than patients with high ADS (8.8 vs. 15.7 months, p < 0.001). In patients with non-alcoholic steatohepatitis (NASH), none of the analyzed parameters of muscle quality influenced survival. Conclusions Low ADS is an independent predictor of worse OS in patients with viral-induced HCC undergoing treatment with TACE. In alcohol-induced and NASH-induced HCCs, parameters of muscle quality do not influence OS.

Non-healing bone defects are a pressing public health concern accounting for one main cause for decreased life expectancy and quality. An aging population accompanied with increasing incidence of comorbidities, foreshadows a worsening of this socio-economic problem. Conventional treatments for non-healing bone defects prove ineffective for 5%–10% of fractures. Those challenges not only increase the patient’s burden but also complicate medical intervention, underscoring the need for more effective treatment strategies and identification of patients at risk before treatment selection. To address this, our proteomic meta-analysis aims to identify universally affected proteins and functions in the context of bone regeneration that can be utilized as novel bioactive biomaterial functionalizations, drug targets or therapeutics as well as analytical endpoints, or biomarkers in implant design and testing, respectively. We compiled 29 proteomic studies covering cellular models, extracellular vesicles, extracellular matrix, bone tissue, and liquid-biopsies to address different tissue hierarchies and species. An innovative, integrated framework consisting of data harmonization, candidate protein selection, network construction, and functional enrichment as well as drug repurposing and protein scoring metrics was developed. To make this framework widely applicable to other research questions, we have published a detailed tutorial of our meta-analysis process. We identified 51 proteins that are potentially important for bone healing. This includes well-known ECM components such as collagens, fibronectin and periostin, and proteins less explored in bone biology like YWHAE, HSPG2, CCN1, HTRA1, IGFBP7, LGALS1, TGFBI, C3, SERPINA1, and ANXA1 that might be utilized in future bone biomaterial development. Furthermore, we discovered the compounds trifluoperazine, phenethyl isothiocyanate, quercetin, and artenimol, which target key proteins such as S100A4, YWHAZ, MMP2, and TPM4 providing the option to manipulate undesired processes in bone regeneration. This may open new ways for treatment options to face the increasing socio-economic pressure of non-healing bone defects.

Background Disparities in the development of Type 2 Diabetes (T2D) are associated with various social determinants, including sex/gender, migration background, living arrangement, education, and household income. This study applied an intersectional perspective to map social disparities and investigate intersectional effects regarding the onset of T2D among older adults across Europe. Methods We used data from the Survey of Health and Retirement in Europe (SHARE) to conduct an Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA) of T2D onset. Individuals aged 50 years or older without known T2D at Wave 4 (2011, baseline) were included and followed through Waves 5 (2013), 6 (2015), 7 (2016), and 8 (2019–2020). Intersectional models were used to estimate additive main effects of sex/gender, migration background, living arrangement, education level, and household income and intersectional interactions. Results A total of 39,108 individuals were included (age at baseline M = 65.18 years (SD = 9.62), 57.4% women). T2D onset was reported for 9.2% of the sample over the 9-year observation period. In the fully adjusted model, all social determinants showed significant additive associations with T2D onset, while the discriminatory accuracy of the social strata was found to be low (Variance Partition Coefficient = 0.3%). Conclusions This study provides a comprehensive mapping of intersectional disparities in onset of T2D among older adults in Europe. The results highlight the risk heterogeneity within the population and show social disadvantages faced by certain groups. However, while the T2D risks were higher in some strata than in others, the intersectional effects were small overall and mostly attributable to the additive main effects. The results suggest that public health strategies to prevent T2D should be universal but tailored to meet the specific situation of the different intersectional strata.

We aimed to explore the association between peripapillary retinal nerve fiber layer thickness (pRNFL), macular ganglion cell-inner plexiform layer (mGCIPL), and cognitive impairment (CI) in patients with neuromyelitis optica spectrum disorder (NMOSD). In this cross-sectional study, 38 (28 aquaporin-4 (AQP4) IgG-seropositive) NMOSD patients and 20 healthy controls (HC) underwent cognitive assessment using Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery. Spectral-domain optical coherence tomography (OCT) was performed for both eyes of all NMOSD patients. First, we examined the association of pRNFL and mGCIPL with cognitive function in all patients, regardless of the history of previous optic neuritis (ON). We then included only eyes without a prior history of ON, incorporating non-ON eyes in patients with unilateral ON and the average of OCT measures for both non-ON eyes in patients without a history of ON. Sixteen (42.1%) NMOSD patients exhibited global CI. There was a significant decrease in pRNFL (Δ: 24.33 μm, p = 0.002) and mGCIPL (Δ: 9.20 μm, p = 0.009) in NMOSD patients with CI compared to those without. The atrophy of pRNFL showed an inverse association with CI before (OR = 1.059, 95% CI: 1.015, 1.105) and after adjustment for age, sex, and disease duration (OR = 1.072, 95%CI: 1.009, 1.139). An inverse significant association was observed between mGCIPL atrophy and CI before adjustment (OR = 1.102, 95% CI: 1.017, 1.194), but not after adjustment (OR = 1.106, 95%CI: 0.999, 1.224). After narrowing our analysis to non-ON eyes, the same results for pRNFL and CI were observed (unadjusted: OR = 1.054, 95% CI: 1.004, 1.106; adjusted: OR = 1.081, 95%CI: 1.000, 1.168). There was no significant association found between mGCIPL thickness and CI in both unadjusted and adjusted models. In sensitivity analyses, we observed no significant association between pRNFL and mGCIPL with CI in AQP-IgG-seropositive NMOSD patients. This study, for the first time, provide a preliminary evidence for a possible relation between pRNFL atrophy and occurrence of cognitive impairment in NMOSD patients. Further studies are required to explore the possible association of OCT parameters with cognition function in NMOSD patients.

Background A lack of serotonin (also known as 5-hydroxytryptamine, 5-HT) in the brain due to deficiency of the rate-limiting enzyme in 5-HT synthesis, tryptophan hydroxylase 2 (TPH2), was recently reported to result in impaired maternal affiliation across species, including mice, rats, and monkeys. In rodents, this was reflected in a lack of preference for maternal odors and reduced levels of isolation-induced ultrasonic vocalizations (USV), possibly contributing to a severe growth retardation phenotype. Methods Here, we tested whether growth retardation, maternal affiliation deficits, and/or impairments in socio-affective communication caused by Tph2 deficiency can be rescued through early social enrichment in rats. To this aim, we compared male and female Tph2−/− knockout and Tph2+/− heterozygous rat pups to Tph2+/+ wildtype littermate controls, with litters being randomly assigned to standard nesting (SN; one mother with her litter) or communal nesting (CN; two mothers with their two litters). Results Our results show that Tph2 deficiency causes severe growth retardation, together with moderate impairments in somatosensory reflexes and thermoregulatory capabilities, partially aggravated by CN. Tph2 deficiency further led to deficits in socio-affective communication, as evidenced by reduced emission of isolation-induced USV, associated with changes in acoustic features, clustering of subtypes, and temporal organization. Although CN did not rescue the impairments in socio-affective communication, CN ameliorated the maternal affiliation deficit caused by Tph2 deficiency in the homing test. To close the communicative loop between mother and pup, we assessed maternal preference and showed that mothers display a preference for Tph2+/+ controls over Tph2−/− pups, particularly under CN conditions. This is consistent with the aggravated growth phenotype in Tph2−/− pups exposed to the more competitive CN environment. Conclusion Together, this indicates that CN aggravates growth retardation despite ameliorating maternal affiliation deficits in Tph2-deficient rat pups, possibly due to reduced and acoustically altered isolation-induced USV, hindering efficient socio-affective communication between mother and pup.

The long-term consequences of cancer and its therapy on the patients’ immune system years after cancer-free survival remain poorly understood. Here, we present an in-depth characterization of the bone marrow immune ecosystem of multiple myeloma long-term survivors, from initial diagnosis up to 17 years following a single therapy line and cancer-free survival. Using comparative single-cell analyses combined with molecular, genomic, and functional approaches, we demonstrate that multiple myeloma long-term survivors exhibit pronounced alterations in their bone marrow microenvironment associated with impaired immunity. These immunological alterations were frequently linked to an inflammatory immune circuit fueled by the long-term persistence or resurgence of residual myeloma cells. Notably, even in the complete absence of any detectable residual disease for decades, sustained changes in the immune system were observed, suggesting an irreversible ‘immunological scarring’ caused by the initial exposure to the cancer and therapy. Collectively, our study provides key insights into the molecular and cellular bone marrow ecosystem of long-term survivors of multiple myeloma, revealing both reversible and irreversible alterations in the immune compartment.

Introduction Blood-brain barrier disruption in acute ischemic stroke is a well described phenomenon associated with hemorrhagic complications. The hyperintense acute reperfusion marker (HARM) represents gadolinium leakage in the cerebrospinal fluid. Gadolinium leakage into ocular structures (GLOS) might represent a dysfunction of the blood-ocular barrier. We aimed to investigate the presence of GLOS in the WAKE-UP trial and its association with HARM, hemorrhagic transformation (HT) and functional outcome. Patients and methods Randomized patients from the WAKE-UP trial who underwent dynamic susceptibility contrast perfusion weighted imaging at baseline and fluid attenuated inversion recovery (FLAIR) imaging at both baseline and follow-up, were included. We studied the association between GLOS with baseline and outcome variables. Results We were able to analyze the data of 192/503 (38%) randomized WAKE-UP patients. GLOS was detected in 56 (29%) cases, four times more frequently than HARM (7%). GLOS positive patients were older (73 vs 65 years; p < 0.01), had a lower glomerular infiltration rate (GFR 79.5 vs 87.2 mL/min; p = 0.01), higher white matter hyperintensity volume (15.0 vs 9.9 mL; p < 0.01), less often presented with a large vessel occlusion (27% vs 44%; p = 0.02) and HARM was more often observed (9/56 vs 4/136; p = 0.01). In multivariable analysis the presence of GLOS was not associated with HT nor poor functional outcome (modified Rankin scale 3–6). Discussion and conclusion GLOS is a relatively common finding in acute ischemic stroke patients and is associated with older age, worse renal function, increased white matter hyperintensity burden and HARM but not with HT or functional outcome.

This Anaphylaxis Manifesto calls on communities to prioritise 10 practical actions to improve the lives of people at risk of serious allergic reactions. The Global Allergy and Asthma European Network and the European Federation of Allergy and Airways Diseases Patients' Associations (EFA) compiled patient‐centric priorities. We used qualitative consensus methods, research evidence and feedback from over 200 patient groups, stakeholder organisations and healthcare professionals. We encourage healthcare, education and food organisations to collaborate with people at risk of serious allergic reactions to tackle safety, anxiety and financial burdens for individuals and societies. Key priorities for prevention include awareness‐raising campaigns for the public and professionals, school and workplace initiatives and mandatory precautionary allergen labels on food. Priorities for improving immediate and long‐term management include educating healthcare professionals, patients and schools about when and how to use adrenaline, funding two approved adrenaline devices for everyone at risk, and facilitating access to allergy specialists. Integrated care pathways should include clinical and non‐clinical management options such as individualised risk assessment and quality of life assessment, self‐management plans, dietetic and psychosocial support and peer support. Organisations around the world are committing to work together towards these priorities.

Proton beam therapy is a unique modality of radiation that provides several physical advantages compared to traditional photon radiation. Protons have superior dose conformality and, therefore, significantly reduce normal tissue exposure to low-dose radiation in the central nervous system (CNS). This increased conformality may provide improved clinical outcomes for some indications. Examples of this benefit are explored and discussed in this chapter. However, there are certain limitations to proton therapy, including the high capital costs and the lack of robust prospective data on clinical outcomes. The benefits of proton therapy remain an active area of investigation, and ongoing studies to measure the potential reduction of treatment-related adverse effects will help to elucidate these controversies. In this chapter, the evolution, potential applications, and limitations of proton therapy are described, with a particular focus on CNS tumors. Important treatment considerations, treatment planning, and quality assurance guidelines are also highlighted.

Angiosarcomas (AS) are an aggressive subtype of head and neck tumors. Current outcome research is limited to single-surgeon and/or single-institution data. This study analyzes the Surveillance, Epidemiology, and End Results program (SEER) database data to improve outcomes of head and neck AS. In this study, the authors accessed the SEER database from 2000 to 2020 to identify patients who underwent surgical and/or nonsurgical treatment of head and neck AS. Data included demographics, diagnostic workup, tumor characteristics, treatment pathways, and therapy outcomes. The study included 691 patients (210 females, 481 males) with AS of the head and neck. The median tumor size was 40 mm. Most patients (63%) underwent surgery, with surgery followed by radiation being the most common treatment combination (50%). Median survival was 16 months. Patients treated with surgery showed significantly longer survival (18 mo) compared with nonsurgery cases (12 mo, P<0.001). Neoadjuvant treatment significantly improved survival (28 mo) compared with non-neoadjuvant cases (15 mo, P=0.023). Adjuvant treatment also improved overall survival (19 mo) versus nonadjuvant treatment (14 mo, P<0.001). There was no significant difference between neoadjuvant and adjuvant treatment outcomes (P=0.270). Bottom of Form This study compares the outcomes of multimodal treatments, especially surgery and radiotherapy, for head and neck AS, emphasizing tailored approaches to optimize patient outcomes and extend survival. Future research should refine these strategies.

Prophylaxis strategies for Graft versus host disease (GVHD) in allogeneic hematopoietic cell transplantation (allo‐HCT) frequently encompass a combination of a calcineurin inhibitor (CNI) with either methotrexate (MTX) or mycophenolate mofetil (MMF). The aim of this retrospective, EBMT registry‐based study was to determine outcome differences for chronic myeloid malignancies and secondary acute myeloid leukemia (sAML) between MTX‐ and MMF‐based prophylaxis regimens while taking potential heterogeneity between subgroups into consideration. Eligible were patients transplanted between 2007 and 2017 who received either MTX‐ or MMF prophylaxis in combination with a CNI. Endpoints after allo‐HCT were overall survival, relapse‐free survival (RFS), relapse incidence, non‐relapse mortality (NRM), and Grades 2–4 acute GVHD (aGvHD). Overall, 13 699 patients from 321 centers were included. Median follow‐up was 42.8 months (IQR 19.8–74.5 months). MTX prophylaxis was associated with reduced overall mortality (HR 0.87, 95% CI 0.81–0.95, p = 0.001) and NRM (HR 0.86, 95% CI 0.78–0.96, p = 0.006) compared with MMF in multivariable Cox regression models in the whole cohort without significant interaction between prophylaxis and subgroups. In contrast, there was no significant association of prophylaxis with risk of relapse (HR 1.03 MTX vs. MMF, 95% CI 0.94–1.14, p = 0.53) or RFS (HR 0.95, 95% CI 0.88–1.01, p = 0.12). There was a reduced risk of Grades 2–4 acute GVHD and reduced mortality after acute GVHD with MTX prophylaxis but no association with outcome in a landmark analysis in patients without aGvHD at 3 months after allo‐HCT. In conclusion, MTX‐complemented CNI prophylaxis was associated with favorable survival, and with favorable survival after aGVHD compared with MMF.

Background First-episode psychosis (FEP) imposes a substantial burden not only on the individual affected but also on their families. Given that FEP usually occurs during adolescence, families overtake a big part of informal care. Early family interventions, especially psychoeducation, are crucial for informal family caregivers to best support the recovery of their loved one with FEP and to reduce the risk of a psychotic relapse as much as possible, but also to avoid chronic stress within the family due to the burden of care. Digital health interventions offer the possibility to access help quicker, use less resources, and improve informal family caregiver outcomes, for example, by reducing stress and improving caregiver quality of life. Objective This study aimed to systematically identify studies on digital health interventions for informal family caregivers of people with FEP and to describe and synthesize the available literature on user experience, as well as the effectiveness of such digital applications on the clinical outcomes, consisting of (1) perceived caregiver stress, (2) expressed emotion, and (3) parental self-efficacy. Methods A systematic search was carried out across 4 electronic databases. In addition, reference lists of relevant studies were hand-searched. This review aimed to include only primary studies on informal family caregivers, who had to care for a person with FEP between 15 years and 40 years of age and a diagnosis of FEP with onset of observed symptoms within the past 5 years. All types of digital interventions were included. This systematic review is aligned with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines. Results The search identified 7 studies that reported on user experience or effectiveness of digital health interventions on perceived caregiver stress, expressed emotion, and parental self-efficacy, including 377 informal family FEP caregivers across trials. Digital health interventions–web-based, videoconferences, and mHealth–were well accepted and perceived as relevant, easy to use, and helpful by informal family FEP caregivers. Psychoeducational content was rated as the most important across studies. Perceived caregiver stress, expressed emotion, and parental self-efficacy improved in all studies that reported on these clinical outcomes. Conclusions The results of this review suggest that digital health interventions aimed at informal family caregivers of individuals with FEP can improve relevant clinical outcomes, with participants reporting a positive user experience. However, for some interventions reviewed, specialized in-person family care outperformed the digital intervention and partially led to better results in perceived caregiver stress and parental self-efficacy. Therefore, while digital interventions present a promising approach to alleviate the burden of care and improve informal family FEP caregiver outcomes, more studies with well-powered experimental designs are needed to further investigate the effectiveness of such applications in this population. Trial Registration PROSPERO CRD42024536715; https://tinyurl.com/bdd3u7v9

Background Scar endometriosis (EM) is defined by the presence of endometrial-like tissue outside the uterine cavity within the scar region after abdominal or pelvic surgery. It is a form of abdominal wall EM. This systematic review addresses the question of whether women after cesarean delivery (CD) are more frequently affected by scar EM than women after other pelvic surgical procedures. The primary aim is to analyze the distribution of previous operations in patients with scar EM. Secondarily, symptoms, diagnosis, and treatment are described. Methods A systematic literature search in MEDLINE (Pubmed) was performed. Twelve studies were included. Results The terminology of scar EM is unspecific and the descriptions are, therefore, of limited comparability among authors. In 64–96%, patients with scar EM had a history of CD, followed by laparoscopy, laparotomy, and episiotomy. The main symptoms were pain, often cyclical, and the presence of local swelling. For diagnosis ultrasound, CT scan and MR imaging were used. All patients had undergone surgical resection and the diagnosis was confirmed. Conclusion Most often scar EM develops after CD. Diagnosis and treatment are often delayed. As an objective classifications system is missing, we propose a simple objective descriptive tool for abdominal wall EM.

Man-made climate change is one of the greatest challenges of the future. The course is being set in the current generation. As the healthcare sector contributes a considerable proportion of greenhouse gas emissions, measures to counteract this must be introduced as a matter of urgency. A guideline is therefore necessary as an initial recommendation for action in the intensive care and emergency medicine sector. As part of the guideline program of the Association of the Scientific Medical Societies in Germany (AWMF e. V.), an S1 guideline was developed with the participation of 12 professional societies and initiatives, and published in October 2024. The guideline group defined relevant key topics and carried out a systematic search of the literature; due to the S1 classification, no separate evidence review was carried out. The classification of the recommendations took place in a formal consensus-building process. The guideline contains 73 recommendations for the implementation of sustainable approaches in intensive care and emergency medicine. These are recommendations that concern both the interprofessional team in the departments and the organizational structure of the hospital. The guideline shows that there are already relevant and concrete possibilities for more sustainable work in intensive care and emergency medicine. However, there is a need for further research (e.g., detailed analyses, such as life cycle assessment) on how exactly to reduce the environmental impact of medical facilities, while maintaining high-quality patient care.