Florian S. Halbeisen’s research while affiliated with University Children's Hospital Basel and other places

Background Breast reduction surgery has been recognized for its potential to improve quality of life in patients with macromastia or after unilateral oncological treatment. However, comparative analysis of different surgical techniques remains sparse. Patient-reported outcome measures have emerged as indispensable tools in assessing patient satisfaction and postoperative outcomes. Driven by the hypothesis of substantial differences between self-reported patient outcomes and professional assessments, this study aimed to compare different technical approaches, integrating both the patients’ and plastic surgeons’ perspectives. Methods A 10-year retrospective single-center cohort study was conducted to compare patient- and surgeon-reported outcomes using pre- and postoperative BREAST-Q questionnaires and aesthetic self-assessments. Outcomes and postoperative complication rates of different technical approaches were analyzed using photographic documentation. Results A total of 170 patients met the inclusion criteria, of which 92 agreed to further photographic documentation for aesthetic evaluation. The median follow-up duration was 4.9 years. BREAST-Q scores significantly improved across all surgical techniques, with comparable scores in both oncoplastic and nononcoplastic patients. Notably, patients reported greater satisfaction with the postoperative aesthetic outcomes than surgeons. Multivariable analysis confirmed body mass index as a significant risk factor for postoperative complications. Conclusions Breast reduction surgery improves both aesthetic outcomes and long-term quality of life, regardless of surgical technique or the use of oncoplastic methods. The discrepancy between patient and surgeon satisfaction highlights the need for a patient-centered approach, such as incorporating patient-reported outcome measures to evaluate postoperative results.

Background and objective Conventional osteotomy tools, including drills and saws, have been associated with several limitations, such as restricted cutting geometry and the risk of heat-induced necrosis, which affects bone healing. Laser-based osteotomy systems have emerged as a promising solution for these constraints. This study aims to evaluate the accuracy of robot-guided laser osteotomy compared to conventional cutting-guided osteotomy based on surface scanning. Materials and methods Ten 3D printed mandibular models were used to perform segmentectomy. Five models were treated with conventional osteotomies employing a cutting-guided saw technique, while the remaining five were subjected to laser osteotomy. Initially conducted using root mean square (RMS) values, the analysis has been expanded to reevaluate the angulation and distance deviation outcomes. Results Precision analysis of the upper cutting plane revealed a statistically significant difference in distance deviation between the laser osteotomy group (0.48 mm) and the conventional osteotomy group (0.78 mm). In terms of angulation deviation, the laser osteotomy group exhibited, both in the upper and lower cutting planes, statistically significant results (2.19° and 2.86°) compared to the osteotomy group (5.15° and 8.12°). Conclusion Based on the observed angulation and distance deviations, it can be concluded that robot-guided laser systems achieve significantly higher accuracy in osteotomies than conventional cutting-guided systems currently available. Consistent with the findings of a prior study, these results confirm that robot-guided laser osteotomy provides substantial advantages, facilitating the seamless integration of precise virtual preoperative planning with exact execution in the human body.

Background Proteomics of glioma have not yet provided biomarkers and pathways that would clearly discriminate glioma subgroups. Methods 82 glioma biopsies were prospectively collected and classified into six subgroups defined by methylomic classification: two Isocitrate dehydrogenase (IDH)-mutated low-grade (LGG) and four high-grade glioma (HGG) subgroups: IDH-mutated HGG (IDH HGG), proneural (GB PN), classical (GB CL), and mesenchymal glioblastoma (GB MES). Proteins were extracted and processed for liquid chromatography mass spectrometry (LC-MS). Differentially expressed proteins (DEPs) between subgroups were annotated using Gene Ontology (GO) function analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway analysis, and Protein-protein interaction (PPI). Functional validation was performed using inhibitor response assays in subtyped, non-cultured patient derived GB single cell suspensions. Results 5057 proteins were quantified for each sample. Tumor grading and IDH mutation status were the strongest discriminators for differential expression patterns. The IDH-wildtype GB subgroups showed diverse patterns of pathways and functions enriched with overexpressed DEP (compared to LGG): Translation and cell cycle/telomere regulation in GB PN (linked to cell proliferation), actin cytoskeleton, cell adhesion and apoptosis regulation in GB CL (linked to migration and invasion), and mitochondrial ATP synthesis in GB MES (linked to metabolism). The most overexpressed and underexpressed proteins were correlated with survival and mRNA expression data. In vitro, inhibition of those proteins led to reduced cell viability that differed among subgroups, albeit in a small patient-derived exploratory cohort. Conclusion This mainly descriptive study on proteomics in glioma provides insights into subgroup metabolism, and potential biomarkers for further experimental testing.

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of microsurgery versus complex physical decongestive therapy in people with chronic breast cancer‐related lymphoedema.

Introduction Isolated patellar tendon (PT) or anterior cruciate ligament (ACL) ruptures are common injuries, yet the co-occurrence of both presents a rare challenge for clinicians. The objectives of the study are to document diagnostic and therapeutic approaches, outcomes, and complications of combined PT and ACL injuries and to develop an algorithm to guide clinicians in decision-making. Methods The systematic review und metanalysis was conducted according to the PRISMA guidelines. Studies reporting on simultaneous PT and ACL ruptures were included. Meta-analysis was performed to compare different diagnostic modalities and treatment strategies. Results Thirty-six studies reporting on 56 Patients were included. 88% of patients had a concomitant injury (apart from PT and ACL) to the ipsilateral knee. Part of the diagnosis was missed in 23% of the cases. Performance of MRI significantly reduced the risk of missing a part of the injury (5% with MRI vs 69% without MRI, p < 0.001). Surgical treatment was used only for the PT in 21% of the cases and for the PT and ACL in 77% of the cases (48% one-stage, 52% two-stage surgical treatment). Conclusion Combined ACL and PT rupture is rare, and recognizing its full extent is crucial for successful management. Performing an MRI in PT rupture from high-energy trauma and diagnostic arthroscopy/arthrotomy when MRI is not done is essential. PT ruptures should be treated surgically. For ACL rupture, conservative and operative treatment, one- or two-stage surgery are possible based on the patient's profile and concomitant injuries. Based on the limited available literature, this systematic review provides a diagnostic and therapeutic algorithm to assist in clinical decision-making.

Purpose Microsurgical reconstruction, including vascularized lymph node transfer (VLNT) and lymphaticovenous anastomosis (LVA), have emerged as promising treatment options for chronic breast cancer-related lymphedema (BCRL). Despite their clinical relevance, the precise timelines for patient improvement following these interventions remain rather unexplored. Therefore, the goal of this study was to compare the long-term outcomes and improvement patterns over time of VLNT versus LVA to lay open potential differences and aid in personalized counseling of future patients. Methods A prospectively maintained, encrypted database was analyzed for patients with chronic BCRL treated with either VLNT or LVA with a minimum follow-up of one year. Patient-specific variables, such as body weight and circumferential arm measurements at distinct locations on both arms were documented preoperatively and on regular postoperative outpatient follow-ups. Results This study comprised 112 patients, of which 107 patients fully completed the one-year follow-up period. Both VLNT and LVA achieved significant arm size reductions. LVA showed an early peak in effectiveness within the first three months, followed by a subsequent decrease and eventual stabilization. Contrarily, VLNT exhibited a distinct pattern with two significant peaks at three and eighteen months. Conclusions VLNT and LVA are both effective in long-term lymphedema management, yet they demonstrate marked differences in the timing of improvement. VLNT shows a delayed but more durable response, in contrast to the greater but shorter-lasting surge in effectiveness achieved by LVA. Interestingly, VLNT demonstrates an earlier onset of therapeutic impact than previously understood.

AIM: To assess and compare the real-world management of catheters and catheter-associated urinary tract infections (CAUTI) among Swiss general practitioners and urologists, encompassing diagnosis, treatment and prophylaxis. METHODS: An anonymised online questionnaire was distributed among Swiss general practitioners and urologists between January and October 2023 via the networks of Sentinella and the Swiss Association of Urology. The questionnaire consisted of questions on catheter management, including diagnosis, treatment and prophylaxis of CAUTI. Analysis was performed by discipline. Fisher’s exact test was applied for comparisons (statistical significance with p <0.05). RESULTS: Out of 175 participating physicians, the majority were involved in catheter management. Urologists exhibited significantly higher levels of competence as compared to general practitioners (67.1% vs 20.9%). Although no significant differences were observed regarding diagnostic approaches between disciplines, unrecommended diagnostic methods were frequently applied. general practitioners reported that they treated non-febrile CAUTI for longer durations, while urologists indicated that they treated febrile CAUTI longer. Additionally, the use of fluoroquinolones was more prevalent among general practitioners compared to urologists, while prophylactic measures were more frequently applied by urologists. CONCLUSIONS: Catheter and CAUTI management entail significant uncertainty for general practitioners. CAUTI management varied notably between general practitioners and urologists in terms of treatment and prophylaxis. The use of non-recommended diagnostic approaches and drugs was common. This trend, along with inappropriate diagnostic methods and prophylaxis, may increase antimicrobial resistance and CAUTI morbidity. The study emphasises the necessity for diagnostic and antimicrobial stewardship interventions, and proper training in CAUTI management for general practitioners and urologists.

Background: With the rise of new 3D printers, assessing accuracy is crucial for obtaining the best results in patient care. Previous studies have shown that the highest accuracy is achieved with SLS printing technology; however, SLA printing technology has made significant improvements in recent years. Methods: In this study, a realistic anatomical model of a mandible and skull, a cutting guide for mandibular osteotomy, and a splint for orthognathic surgery were replicated five times each using two different 3D printing technologies: SLA and SLS. Results: The SLA group had a median trueness RMS value of 0.148 mm and a precision RMS value of 0.117 mm. The SLS group had a median trueness RMS value of 0.144 mm and a precision RMS value of 0.096 mm. There was no statistically significant difference in RMS values between SLS and SLA technologies regarding trueness. Regarding precision, however, the RMS values for SLS technology were significantly lower in the splint and cutting guide applications than those printed with SLA technology. Conclusions: Both 3D printing technologies produce modern models and applications with equally high dimensional accuracy. Considering current cost pressures experienced by hospitals, the lower-cost SLA 3D printer is a reliable choice for point-of-care 3D printing.

Background and objective Catheter-associated urinary tract infections (CAUTIs) represent a significant burden in health care and its management is challenging. This study aims to assess and compare central European CAUTIs regarding diagnostics, treatment, and prophylaxis. Methods An anonymized online questionnaire was distributed among urologists in Austria, France, Germany, and Switzerland between January and October 2023, consisting of demographic questions on catheter management and diagnostics, treatment, and prophylaxis of CAUTIs. An analysis was performed per country. Comparisons were done with the Fisher’s exact test (statistical significance with p < 0.05). Key findings and limitations Out of 423 participating urologists, most regularly performed catheter changes and managed catheter-related issues, except for French urologists. Swiss urologists tended to change the catheter after a longer interval. In France, a higher estimated number of CAUTIs were observed. Diagnostic symptoms and measures varied significantly between countries. French urologists prescribed more antimicrobials per patient and administered longer treatment regimens. The choice of antimicrobial agents differed notably for nonfebrile and febrile CAUTIs, with cotrimoxazole/nitrofurantoin being common for nonfebrile cases and cephalosporin/amoxicillin for febrile ones. Follow-up protocols were similar among urologists, while prophylactic measures showed variations. Conclusions and clinical implications CAUTI management varied notably across countries in terms of diagnostics, treatment, and prophylaxis. Discrepancies in antimicrobial therapy could be influenced by local resistance rates; yet, nonrecommended drugs and prolonged regimens, as compared with guideline recommendations, were common. This trend, along with inappropriate diagnostics and prophylaxis, may increase antimicrobial resistance and CAUTI morbidity. This study emphasizes the necessity for diagnostic and antimicrobial stewardship interventions, and proper training in CAUTI management. Patient summary In this questionnaire-based study examining the clinical practices for managing urinary tract infections in patients with bladder catheters (CAUTIs), significant disparities were observed among European urologists regarding diagnosis, treatment, and prophylaxis. These findings underscore the critical need for clear guidelines and comprehensive training in CAUTI management.