University Medicine of Greifswald

Word-finding difficulty is a common challenge in older age and is linked to various neuropathological conditions associated with ageing. Transcranial direct current stimulation (tDCS) has shown promise as a cognitive enhancement tool for both healthy aging and age- related cognitive disorders. However, its effectiveness in enhancing word-finding ability remains inconsistent, especially among healthy adults. Variability across studies is likely due to factors such as task selection, stimulation parameters, and small and variable sample sizes. Additionally, many studies have overlooked within-study variability of potentially relevant participant characteristics, including the role of baseline performance in evaluating tDCS efficacy. In this preregistered study, we examined 72 older and 72 younger adults using a double-blind, sham-controlled design, delivering anodal focal tDCS to either the left inferior frontal gyrus or the left temporoparietal junction. Baseline naming performance and fluid intelligence were measured before stimulation. Anodal stimulation of the left inferior frontal gyrus significantly increased response speed for object and action naming in older adults, but crucially only in older adults who performed poorly during the baseline naming session, p = .02, η ² ₚ = 0.17. Findings demonstrate regionally specific effects of focal tDCS in healthy older individuals in greater need for naming facilitation. Notably, performance on a broad measure of fluid intelligence was unrelated to stimulation response, suggesting task specificity of this effect.

Pflegeforschung wirft ethische Fragen auf. Forschungsethik betrifft nicht nur Forschende, sondern auch Pflegefachpersonen, die (indirekt) in die Forschung involviert sind. Sie fordert ihrerseits entsprechendes Wissen und eine forschungsethische Haltung. Die Integrität der Handelnden im Forschungsprozess nimmt für gute Forschung eine Schlüsselrolle ein. Forschungsethik ist eine angewandte Ethik, die sowohl prospektiv (vorausschauend) als auch prozessual während des gesamten Forschungsprozesses präsent ist. Sie umfasst ethische, rechtliche und methodische Fragen und Anforderungen, die einer individuellen und durch Ethikkommissionen gestützten Reflexion bedürfen. Forschungsethik ist das Resultat historischer Prozesse und muss sich stetig weiterentwickeln. Nicht zuletzt angesichts der aktuellen Entwicklungen im Bereich der künstlichen Intelligenz entstehen in Forschungsprozessen neuartige ethisch reflexionswürdige Momente, in denen normativ-ethische Orientierung nötig ist.

Diminished prepontine interval is a challenging intraoperative finding that creates an additional risk while doing an endoscopic third ventriculostomy (ETV) due to the proximity of the basilar artery to the ventriculostomy site. It is not a contraindication for the procedure especially in patients with thinned floors through which the vascular structures can be easily visualized and it was not proven to be a risk factor for failure of the procedure. Old children with hydrocephalus secondary to tectal glioma have a high chance of successful ETV, thus avoiding shunt dependency. A 12-year-old male patient presented with headache and grade III papilledema, magnetic resonance imaging brain revealed tectal glioma and triventricular hydrocephalus. He underwent a successful ETV despite a challenging intraoperative, extremely diminished prepontine interval. At 1-year follow-up, brain imaging showed a complete resolution of hydrocephalus and stationary course for the tectal glioma. The present case highlights that diminished prepontine interval is not a contraindication for doing ETV unless safety cannot be guaranteed, and it was not proven to be a risk factor for ETV failure. Creating a stoma on the dorsum sellae after palpating the bone or just behind it using blunt fenestration is a safe way especially in the presence of a thinned third ventricle floor with clearly visualized vascular structures.

In the sustainable development goals (SDG) context of seeking universal health coverage, the expanding gap between the supply of specialized and primary health-care providers of headache-related health care and the care needs of the very large number of people affected by headache is a formidable but not insoluble public-health challenge. Structured headache services provide a cost-effective framework wherein controlled patient flows enable the care needs of people with headache to be met at appropriate levels, but these services may still be overwhelmed by inappropriate demand. Community pharmacists are an underutilized resource, potentially well able to provide the solution. To do so, they must, as a profession, be integrated into structured headache services. What remains to be determined is how to achieve this integration in an encouraging climate for change, which recognises the potential for relieving strained health-care systems and meeting a range of health-care needs by expanding pharmacists’ scope of practice. This position statement on behalf of the European Headache Federation (EHF) and Lifting The Burden (LTB) is formally endorsed by the International Pharmaceutical Federation (FIP).

Aim To estimate alcohol consumption's effect on edentulism using state alcohol taxes as an instrumental variable (IV). Material and Methods Analysis of 514,357 U.S. Behavioural Risk Factor Surveillance System participants (2003–2006, 2008, 2010, 2012) linked to state alcohol taxes. We used IV regression modelling to assess the relationship between alcohol consumption and edentulism, plus potential mediators (body mass index, dental visits) and a positive control (coronary heart disease). Robustness to imperfect exogeneity was evaluated through sensitivity analyses and falsification testing using IV analysis on individuals under the age of 16 years. Results A 1.1‐drink increment per day was associated with a 12% higher risk of edentulism (95% confidence interval: 9%–16%). Alcohol consumption was positively associated with body mass index, dental visits and coronary heart disease. No significant effect on edentulism was observed in the negative control population (individuals aged < 16 years). Conclusion The findings of this quasi‐experimental study suggest that alcohol consumption increases the risk of edentulism.

Background and Aims Associations of hyperlipidaemia and inflammation with the risk for incident major adverse cardiovascular events (MACEs) were analysed in individuals with and without cholesterol-lowering medication therapy. Methods Data from 322,922 participants (55.9% women) aged 38 to 73 years from the UK Biobank were included. Longitudinal associations of low-density lipoprotein cholesterol (LDL-C), lipoprotein(a) [Lp(a)], and high-sensitivity C-reactive protein (Hs-CRP), both individually and in combination, were analysed with the risk for incident MACEs using Cox regression models, stratified by cholesterol-lowering medication use. Results During a median follow-up of 13.7 years, 31,295 (9.69%) participants had incident MACEs. The incidence was 8.32% in non-users and 18.6% in users of cholesterol-lowering medication. Higher LDL-C levels were associated with the highest risk for MACEs, followed by Lp(a) and Hs-CRP. One higher standard deviation in LDL-C, Lp(a), and Hs-CRP was associated with a 13%, 8%, and 6% greater risk for MACEs in non-users and 11%, 7%, and 6% in cholesterol-lowering medication users, respectively. When combined, LDL-C, Lp(a), and Hs-CRP demonstrated a synergistic effect. Compared with individuals with all three biomarkers at or below the 75th percentile, those with all three biomarkers above the 75th percentile had a 77% higher risk for incident MACEs among non-users and a 58% higher risk among those on cholesterol-lowering medications. Conclusions Hyperlipidaemia and inflammation independently and synergistically contribute to an increased risk for incident cardiovascular events. The magnitude of risk is more closely related to serum biomarker concentrations than to the use or not of cholesterol-lowering medications.

In multi-analyst studies, several analysts use the same data to independently investigate identical research questions. Multi-analyst studies have been conducted mainly in psychology, social sciences, and neuroscience, but rarely in epidemiology. Sixteen analyst groups (24 researchers) with backgrounds mainly in statistics, mathematics, and epidemiology were asked to independently perform an analysis on the influence of marital status (never married versus cohabiting married) on cardiovascular outcomes. They were asked to use data from the Survey of Health, Ageing and Retirement in Europe (SHARE), a panel study of 140,000 persons aged 50 years and above from 28 European countries and Israel, and to provide an effect estimate, a comment on their results, and the full syntax of their analyses. In additional analyses beyond the multi-analyst approach, one group selected an exemplary regression model and varied definitions of exposure and outcome and the confounder adjustment set. Each analysis was unique. The size of the 16 datasets used for the analyses ranged from 15,592 to 336,914 observations. The effect estimates (odds ratios, hazard ratios, or relative risks) ranged from 0.72 to 1.02 (reference: cohabiting married) in strictly or partly cross-sectional analyses and from 0.95 to 1.31 in strictly longitudinal analyses. The choice of regression models, adjustment sets for confounding, and variations in the precise definition of exposure and outcome, all had only small effects on the effect estimates. The range of results was mainly due to differences from cross-sectional versus longitudinal analyses rather than to single analytical decisions each of which had less influence.

Clinicians, scientists and regulators do not use a common set of definitions and terminology to classify and code periprosthetic tissue reactions to wear debris of arthroplasty implants and a limited granularity is present to allow early identification of associated adverse events. Adverse local tissue reactions (ALTRs) is an umbrella term, which has been used in particular for periprosthetic tissue reactions to metal wear debris. In this review, it has been extended to all implant materials and adverse reaction to metallic debris as a subset of ALTR caused by or associated with metallic particulate debris. The high variability in the terminology of ALTRs used by national arthroplasty registries, various coding systems and clinicians impedes their accurate reporting and interpretation, crucial for evaluating the reasons for implant failure and revision arthroplasty. Histopathological examination of periprosthetic soft tissue and bone uses standardized criteria for the diagnoses of reactions to wear particles, significantly contributing to their understanding and refining their interdisciplinary terminology. This review critically analyzes the current gap in coding ALTRs due to arthroplasty implants’ wear in national registries and classification systems of adverse events and the use of key terms. A comprehensive unified lexicon and classification system grounded on evidence-based histopathological analyses is proposed, implementing the following findings. (a) Pseudotumor is a descriptive term for ALTR, which cannot be used for codification. (b) Metallosis is a term lacking quantitative and qualitative determination and thus not a codifiable term for ALTR. (c) Aseptic lymphocyte dominant vasculitis-associated lesion (ALVAL) should not be used due to absence of histological findings diagnostic of vasculitis. (d) Metal delayed hypersensitivity and metal allergy should be codified as separate categories of adverse events. (e) ALTR is to be classified in due consideration of definition of predominant lymphocytic or predominant macrophage infiltrate. (f) Granulomatous reaction should be reserved to sarcoid-like, immune granulomas separated from the macrophage infiltrate with/without foreign body giant cell reaction. (g) Macrophage infiltrate containing particulate wear debris with or without lymphocytic component associated with macrophage induced osteolysis/aseptic loosening should be considered as a type of ALTR.

Background Inflammatory bowel diseases (IBD) have been associated with an increased long‐term risk of coronary artery disease due to chronic systemic inflammation. Aim To evaluate the risk of major adverse cardiovascular events (MACE) after coronary interventions. Methods In this nationwide cohort study of adults undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) (2012–2022), patients with IBD were propensity score‐matched 1:10 to comparators without IBD. The primary outcome was MACE, a composite of acute myocardial infarction, stroke, hospitalisation for heart failure, or mortality. Secondary outcomes included each MACE component, 30‐day all‐cause readmission, revascularisation and in‐hospital outcomes including intensive care unit admission and length of hospital stay. We calculated hazard ratios (HRs) and incidence rates (IRs) using Cox proportional hazards modelling. Results We included 987 patients with IBD and 9571 matched comparators. After a median follow‐up of 3.5 years, MACE occurred in 488 patients with IBD (49.4%, IR: 96.5/10,000 person‐years [PY]) and in 3857 matched comparators (40.3%, IR: 68.9/10,000 PY); HR 1.37 (95% CI, 1.24–1.52). This equates to one additional MACE for every 36 patients with IBD over 10 years. The risk of each MACE component was increased, except for stroke. There were no differences between IBD subtypes or coronary intervention (PCI vs. CABG). Risks were highest in older individuals and elective interventions. Conclusions Patients with IBD were at 37% higher risk of MACE after coronary intervention, indicating a need for intensified cardiovascular risk reduction in these high‐risk individuals.

Aims Various factors can impair wound healing by disrupting key stages of the process. This study evaluates the impact of concomitant anticoagulant medication on wound healing in a cohort of 212 patients. Methods Data from 2 open‐label, blindly evaluated, prospective, randomized, multicentre phase III trials (n = 212) were analysed. Healing durations of patients taking anticoagulants were compared to a control group (split‐thickness skin graft donor site halves treated with standard moist wound dressing). Kaplan–Meier estimators and multivariable Cox regression were applied. Results Kaplan–Meier analysis demonstrated significantly accelerated wound healing in patients treated with enoxaparin or nadroparin. Among monotherapies, 75% of patients on enoxaparin achieved wound closure within 16.5 days (95% confidence interval [CI]: 14–21), and those on nadroparin within 15 days (95% CI: 11.5–19), compared to 24 days (95% CI: 20–28) in patients receiving other anticoagulants (log‐rank test: P < .001). Cox regression confirmed a significantly faster healing rate with enoxaparin or nadroparin (hazard ratio = 1.50, 95% CI: 1.02–2.19, P = .039). Conclusion Enoxaparin and nadroparin may enhance wound healing, whereas phenprocoumon, acetylsalicylic acid, and certain low‐molecular‐weight heparins (certoparin, tinzaparin, dalteparin, bemiparin) appear to delay wound healing. Anticoagulant monotherapy with enoxaparin or nadroparin should be considered postoperatively when feasible.

Purpose The objective of this paper is to report on the origin of the EQ VAS and current understanding of the EQ VAS conceptual framework via a literature search based on the snowball approach. Methods A review was conducted in two steps: (1) a citation search and (2) a search of the EuroQol group’s grey literature. Results The findings indicate that the EQ VAS was originally designed as a warm-up task for valuing hypothetical health states. The characters of the EQ VAS reflect its valuation origin, such as drawing a line (the previous version), vertical orientation, and choice of end labels. None of these design elements of the EQ VAS were chosen for the purpose of measuring self-reported overall health. Despite this, the EQ VAS proves to be a valid self-reported health status measure with its psychometric properties demonstrated in various general and clinical populations. We found a dearth of literature addressing the conceptual framework of EQ VAS as a measure of self-rated overall health. Conclusion With its potential as a powerful measure of overall health, further research into EQ VAS design, conceptual framework and empirical function is warranted.

BACKGROUND Postoperative neurocognitive disorders (PNDs) are frequent and serious complications that cause an enormous social and economic burden. A previous study demonstrated that certain electroencephalographic (EEG) patterns during emergence from general anesthesia are associated with a higher risk for PND. Compared to patients demonstrating the most favorable trajectory ( Traj Ref : delta-dominant slow-wave anesthesia (ddSWA)→spindle-dominant SWA (sdSWA)→non-SWA (nSWA)→wake), patients presenting Traj Abrupt (ddSWA→wake) had 4-fold increased odds to develop PND and patients with Traj High (nSWA→wake) had 8-fold increased odds of developing PND. We hypothesized that commonly used neuromonitoring devices (state entropy [SE], quantium consciousness index [qCON], bispectral index [BIS], and Patient State Index [PSI]) can differentiate between the various trajectories. METHODS From the original database of the study by Hesse et al, we analyzed 59 EEGs from patients emerging from general anesthesia. They were selected according to their trajectory. We included 19 patients who had shown the most favorable trajectory ( Traj Ref ), 20 who had demonstrated Traj Abrupt , and 20 who had followed Traj High . To evaluate the performance of the neuromonitoring devices, we replayed the patients’ EEGs to the monitors using an EEG player. We compared the index values for the 3 different trajectories ( Traj Ref , Traj Abrupt , and Traj High ) generated by the different monitoring devices, respectively. Additionally, we evaluated the correlation between the monitoring devices. RESULTS SE and PSI were able to resolve significant differences between Traj Ref and Traj Abrupt during a major part of emergence. Traj Ref showed an almost linear increase of index values, whereas Traj Abrupt led to an episode of low index values followed by a sudden increase. However, when comparing Traj Ref vs Traj High , qCON, PSI, and BIS were the indices showing significant differences, especially at the beginning of emergence. Patients representing Traj Ref patterns had significantly lower index values than those depicting Traj High . Due to the Traj High cases starting in nSWA, their indices were already high at the start of emergence. CONCLUSIONS Our analysis revealed that the course of the different indices reflects spectral EEG patterns during the emergence from general anesthesia. Considering certain emergence trajectories associated with a higher risk of developing PND, our approach might enable the anesthetist to identify patients particularly susceptible to PND by observing the course of index values before admission to the postanesthesia care unit.