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Active cancer causes approximately 25% of all acute events of venous thromboembolism (VTE). link= learn more While most of the cancer diagnoses are known or clinically apparent at the time of VTE, care providers and patients may be worried about the 3 to 8% risk of occult cancer occurring in the year after VTE. Several studies have compared limited to extensive cancer screening after acute VTE, especially with the addition of abdominal computed tomography (CT) or whole-body PET-CT, with the hope to shorten the time to cancer diagnosis and lead to less advanced cancer stages. These studies have not shown improved clinical outcomes with an extensive screening, and have led to current recommendations of limited screening for cancer in patients with acute VTE, including unprovoked cases. Several risk assessment models have been developed to identify patients at greatest risk of occult cancer, however, with low discriminative performances and no current clinical usefulness. Some clinical situations may empirically deserve a more thorough cancer screening, such as unprovoked upper extremity deep vein thrombosis (DVT), bilateral leg DVT, descending leg DVT, or recurrent VTE during anticoagulation.Preventing thromboembolic events, while minimizing bleeding risks, remains challenging when managing patients with atrial fibrillation. Despite large and successful trial programs, several clinical concerns remain which commonly relate to fears of over- or underexposure to drugs and unfavorable outcomes. After a short summary of the main phase III trial findings, this short review discusses the evidence and clinical relevance of common clinical concerns (correct direct oral anticoagulant [DOAC] dosing; DOAC in moderate-to-severe renal impairment; and the relevance of fasting, nasogastric tube feeding, or high body mass index) on DOAC plasma levels. Finally, the need for specific DOAC antidotes will be addressed.Direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and ischemic stroke. The main advantage of DOAC over VKA is the lower rate of bleeding and mortality. This review covers challenges clinicians can encounter when treating patients with AF and ischemic stroke, including timing of DOAC start and ongoing randomized clinical trials, appropriate dosing, and available comparative evidence across DOACs. For patients without AF but with an ischemic stroke, the review outlines the role of DOACs. Finally, the risk of thrombotic events associated with specific DOAC reversal agents and DOAC pausing is reviewed.Thrombosis of the cerebral veins and sinuses (CVT) is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects children and young adults, especially women. In this review, we will summarize recent advances on the knowledge of patients with CVT.Ischemic stroke is a leading cause of disability, with its treatment not yet optimal. It is thus mandatory to make preclinical research on this topic more efficient. This review summarizes current development of research aimed to improve diagnosis and prognosis of ischemic stroke. For more details, see our recent review published in Lancet Neurology.Platelet activation and aggregation are essential to limit blood loss at sites of vascular injury but may also lead to occlusion of diseased vessels. link2 The platelet cytoskeleton is a critical component for proper hemostatic function. learn more Platelets change their shape after activation and their contractile machinery mediates thrombus stabilization and clot retraction. In vitro studies have shown that platelets, which come into contact with proteins such as fibrinogen, spread and first form filopodia and then lamellipodia, the latter being plate-like protrusions with branched actin filaments. However, the role of platelet lamellipodia in hemostasis and thrombus formation has been unclear until recently. This short review will briefly summarize the recent findings on the contribution of the actin cytoskeleton and lamellipodial structures to platelet function."Bienvenue!", "Benvenuti!", "Willkommen!", "Welcome!" to the GTH 2021 congress, simply online … worth experiencing. During the Opening Ceremony, which will take place on Monday, February 22, you will enjoy, among other inspiring presentations (check on www.gth2021.org), the Alexander Schmidt Lecture held by the Awardee Markus Bender. The corresponding manuscript by BENDER AND PALANKAR ,1 masterfully summarizing recent findings on the contribution of the actin cytoskeleton and lamellipodia structures to platelet function, opens this year's congress issue of Hämostaseologie - Progress in Haemostasis.

Current research suggests that individuals with preexisting psychiatric conditions experienced particularly high levels of psychological distress during the various 'shutdown' measures to contain Covid-19. In order to gain a better insight into the demands for psychiatric care in times of crisis, this study compared levels of psychological distress in individuals with preexisting psychiatric conditions with healthy controls and further examined associations of daily routines with psychological distress.

Out of 99 participants of an online survey, 44 individuals reported prior mental health-related inpatient treatment. Patients were asked about their levels of psychological distress and adaptation of lifestyle and activities of daily living.

Individuals with a psychiatric history were significantly more psychologically distressed (p < 0.001; d = 1.68) and displayed significantly less behavioral adaptation than healthy controls (p = 0.012; d = -0.52) in response to the changed circumstances. link2 The difference in behavioral adaptation accounted for 21 % of the difference in psychological distress.

In times of crisis, individuals with a psychiatric history require ongoing support from mental health services, in particular those supporting every-day lifestyle in order to better cope with the consequences of a drastically changed environment.

In times of crisis, individuals with a psychiatric history require ongoing support from mental health services, in particular those supporting every-day lifestyle in order to better cope with the consequences of a drastically changed environment.Denosumab discontinuation is associated with rapid reversal of bone turnover suppression and with a considerable increase in fracture risk, including a risk for multiple vertebral fractures (MVF). Long-term follow-up of patients who sustained MVF after denosumab discontinuation has not been reported. This case-series was aimed to provide a long-term follow-up on the management and outcome of denosumab discontinuers who initially presented with multiple vertebral fractures. Denosumab discontinuers were identified from a computerized database of a large healthcare provider. Baseline and follow-up clinical, laboratory, and imaging data were obtained from the computerized database and electronic medical records. The post-denosumab discontinuers MVF patients consisted of 12 women aged 71±12. Osteoporotic fractures were prevalent before denosumab discontinuation in 6 of the patients. link3 The majority received bisphosphonates before denosumab. MVF occurred 134±76 days after denosumab discontinuation. The patients were followed for a median of 36.5 (IQR 28.2, 42.5) months after MVF. Two patients passed-away. Two patients suffered recurrent vertebral fractures. Following MVF, patients were treated inconsistently with denosumab, teriparatide, oral, and intravenous bisphosphonates, in various sequences. Two patients underwent vertebroplasty/kyphoplasty. This long-term follow-up of real-world patients with MVF following denosumab discontinuation reveals that management is inconsistent, and recurrent fractures are not uncommon. It calls for clear management guidelines for patients with MVF after denosumab discontinuation and for special attention to this high-risk group.

Clostridioides difficile (C. difficile) is the most frequently identified causative agent of antibiotic-associated diarrhea in industrialized countries. As early as 2007, severe C. difficile infections (CDI) were to be notified in Germany as a "threatening disease with an indication of grave danger to the general public". In 2016, the Notification Adjustment Ordinance put in force a duty to notify CDI with a clinically severe course. Here, the necessity and suitability of mandatory notification of severe CDI in Frankfurt am Main, Germany, 2014-2018 is examined.

Cases of CDI reported to the health department Frankfurt am Main were compared with the C. difficile-associated deaths in Frankfurt for 2014-2018. link3 The results were compared with data from the literature, the national reporting data according to the Infection Protection Act (IfSG), the mortality statistics, the hospital treatment data as well as the hospital surveillance data of the German hospital infection surveillance system for C difficile-assoc (4) Infection prevention act (IfSG), and regarding European recommendations and available data on CDI surveillance, the obligation to notify CDI should be lifted.

The notification data from Frankfurt am Main show an approx. 2-fold lower score compared to the CDI-associated deaths. From the data of the Hospital Surveillance System (CDAD-KISS), it can be estimated that the majority of the cases are not notified. While an increase in CDI notifications is reported nationwide, there is a decrease in data from nationwide death statistics, hospital treatment data and CDI prevalence, and an increase in incidence of severe CDI. Therefore, and taking into account legal requirements of the IfSG and the options for action of the health authorities according to § 23 (4) Infection prevention act (IfSG), and regarding European recommendations and available data on CDI surveillance, the obligation to notify CDI should be lifted.Neoplasms of the peripheral nervous system represent a heterogenous group with a wide spectrum of morphological features and biological potential. They range from benign and curable by complete excision (schwannoma and soft tissue perineurioma) to benign but potentially aggressive at the local level (plexiform neurofibroma) to the highly malignant (malignant peripheral nerve sheath tumors [MPNST]). In this review, we discuss the diagnostic and pathologic features of common peripheral nerve sheath tumors, particularly those that may be encountered in the intracranial compartment or in the spine and paraspinal region. The discussion will cover schwannoma, neurofibroma, atypical neurofibromatous neoplasms of uncertain biological potential, intraneural and soft tissue perineurioma, hybrid nerve sheath tumors, MPNST, and the recently renamed enigmatic tumor, malignant melanotic nerve sheath tumor, formerly referred to as melanotic schwannoma. learn more We also discuss the diagnostic relevance of these neoplasms to specific genetic and familial syndromes of nerve, including neurofibromatosis 1, neurofibromatosis 2, and schwannomatosis. In addition, we discuss updates in our understanding of the molecular alterations that represent key drivers of these neoplasms, including neurofibromatosis type 1 and type 2, SMARCB1, LZTR1, and PRKAR1A loss, as well as the acquisition of CDKN2A/B mutations and alterations in the polycomb repressor complex members (SUZ12 and EED) in the malignant progression to MPNST. In summary, this review covers practical aspects of pathologic diagnosis with updates relevant to neurosurgical practice.