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The molecular pathways underlying the pathogenesis after subarachnoid haemorrhage (SAH) are poorly understood and continue to be a matter of debate. A valid murine SAH injection model is not yet available but would be the prerequisite for further transgenic studies assessing the mechanisms following SAH. Using the murine single injection model, we examined the effects of SAH on regional cerebral blood flow (rCBF) in the somatosensory (S1) and cerebellar cortex, neuro-behavioural and morphological integrity and changes in quantitative electrocorticographic and electrocardiographic parameters. Micro CT imaging verified successful blood delivery into the cisterna magna. An acute impairment of rCBF was observed immediately after injection in the SAH and after 6, 12 and 24 hours in the S1 and 6 and 12 hours after SAH in the cerebellum. Injection of blood into the foramen magnum reduced telemetric recorded total ECoG power by an average of 65%. Spectral analysis of ECoGs revealed significantly increased absolute delta power, i.e., slowing, cortical depolarisations and changes in ripples and fast ripple oscillations 12 hours and 24 hours after SAH. Therefore, murine single-blood-injection SAH model is suitable for pathophysiological and further molecular analysis following SAH.

Background Despite ongoing efforts to integrate palliative care into the German healthcare system, challenges persist, particularly in areas where infrastructure does not fully support digital technologies (DT). The increasing importance of digital technology (DT) in palliative care delivery presents both opportunities and challenges. Objective This study aimed to explore the perspectives and preferences of palliative care patients and their family caregivers regarding the use of DT in care delivery. Methods An exploratory qualitative study was conducted using semi-structured interviews with palliative care patients and their family caregivers across various settings. Participants were selected through gatekeeper-supported purposive sampling. Interviews were analysed using structured qualitative content analysis. Results Nineteen interviews were conducted.Three themes emerged: (1) Application of DTs in palliative care; (2) Potential of DTs; (3) Barriers to the use of DTs. Key findings highlighted the preference for real-time communication using DTs that participants are familiar with. Participants reported limited perceived value for digital transformation in the presence of in-person care. The study identified requirements for DT development and use in palliative care, including the need for direct and immediate functionality, efficiency in healthcare professional (HCP) work, and continuous access to services. Conclusion The findings highlight a demonstrate the importance of familiarity with DTs and real-time access for patients and their families. While DT can enhance palliative care efficiency and accessibility, its integration must complement, not replace, in-person interaction in palliative care. As DTs continue to grow in scope and use in palliative care, maintaining continued user engagement is essential to optimise their adoption and ensure they benefit patients and their caregivers.

PurposeThe new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) require the development of competence-oriented teaching formats. In addition, there is a great need for high-quality teaching in the field of radiation oncology, which manifests itself already during medical school. For this reason, we developed a simulation-based, hands-on medical education format to teach competency in performing accelerated partial breast irradiation (APBI) with interstitial multicatheter brachytherapy for early breast cancer. In addition, we designed realistic breast models suitable for teaching both palpation of the female breast and implantation of brachytherapy catheters.MethodsFrom June 2021 to July 2022, 70 medical students took part in the hands-on brachytherapy workshop. After a propaedeutic introduction, the participants simulated the implantation of single-lead catheters under supervision using the silicone-based breast models. Correct catheter placement was subsequently assessed by CT scans. Participants rated their skills before and after the workshop on a six-point Likert scale in a standardized questionnaire.ResultsParticipants significantly improved their knowledge-based and practical skills on APBI in all items as assessed by a standardized questionnaire (mean sum score 42.4 before and 16.0 after the course, p < 0.001). The majority of respondents fully agreed that the workshop increased their interest in brachytherapy (mean 1.15, standard deviation [SD] 0.40 on the six-point Likert scale). The silicone-based breast model was found to be suitable for achieving the previously defined learning objectives (1.19, SD 0.47). The learning atmosphere and didactic quality were rated particularly well (mean 1.07, SD 0.26 and 1.13, SD 0.3 on the six-point Likert scale).ConclusionThe simulation-based medical education course for multicatheter brachytherapy can improve self-assessed technical competence. Residency programs should provide resources for this essential component of radiation oncology. This course is exemplary for the development of innovative practical and competence-based teaching formats to meet the current reforms in medical education.

Background Digital health technologies (DHTs) can help address challenges in palliative care, particularly in rural and underserved areas. However, evidence on their routine use and acceptance among healthcare professionals (HCPs) remains limited. Aim To assess HCPs reported use of DHTs, digital health literacy, attitudes, and perceived benefits and barriers regarding DHT implementation in routine palliative care. Design Cross-sectional survey using a self-administered questionnaire informed by prior qualitative research. Data were collected online and on paper (Sept–Nov 2023). Setting/participants 152 HCPs in palliative care across Brandenburg, Germany: 68 physicians, 36 nurses, and 48 others (e.g. psycho-oncologists, social workers). Results Physicians showed the highest digital health literacy (mean eHEALS: 33/40). Nurses expressed the highest general agreement with DHTs, though acceptance in palliative care was lower—especially among physicians. Email (72–78%) and documentation tools (60–67%) were widely used. Innovative tools such as video consultations (6%), mobile apps (10–22%), and wearables (10–22%) were used infrequently. Perceived benefits included location flexibility (up to 81%) and time independence (up to 78%). Barriers included inadequate infrastructure (up to 78%) and limited digital skills among patients and families (up to 80%). DHT use was more frequent in inpatient settings (ρ = 0.183, p  = 0.014), urban areas ( p  = 0.04), and among physicians and nurses ( p  = 0.049). Non-users had a higher median age than users ( p  = 0.023). Those using conventional tools were more likely to adopt innovative ones ( p  < 0.001). Conclusions DHT use in palliative care remains centered on conventional tools. While professionals recognize potential benefits, structural deficits and limited perceived relevance hinder adoption. Strengthening infrastructure and digital literacy is key to sustainable digital transformation.

Introduction Demographic aging poses a significant challenge for specialized inpatient palliative care (SIPC). In the German healthcare system, SIPC is defined as hospital-based multi-professional care delivered through dedicated palliative units, consultation services, or complex care on general wards. To inform future resource allocation, this study predicts the demand for SIPC in Germany up to 2035, specifically examining the impact of shifting population structures on hospital-based palliative service utilization. Methods We analyzed baseline utilization data from the 2021 Trinovis Database, which aggregates mandatory structural and performance reports from German hospitals submitted to the Federal Joint Committee (G-BA). Specialized inpatient palliative care (SIPC) was defined using specific Operation and Procedure (OPS) codes. By applying these age-, gender-, and region-specific utilization rates to population projections provided by the German Federal Statistical Office, we forecasted the annual demand for SIPC from the 2021 baseline through the target year of 2035. Results Germany’s adult population is expected to decline slightly by 2035, but the proportion of individuals aged 65 years and older will increase. SIPC cases are projected to rise from 108,645 in 2021 to 119,923 by 2035, reflecting a growth rate of 0.7% annually. The proportion of SIPC cases involving patients aged 65 years and older will increase. Regional disparities will persist, with varying growth rates in different federal states. Conclusion The “FuturePall” study forecasts a rising demand for SIPC in Germany due to demographic shifts, particularly among older adults. Policymakers must plan for these changes by allocating resources, enhancing infrastructure, and adapting healthcare strategies to meet the evolving needs of an aging population. Future research should explore the impact of non-demographic factors on SIPC demand.

Neuro-oncology, with its various conservative, surgical, and interventional disciplines, is ideally suited to teach basic knowledge, skills, and attitudes important to medical practice in general. However, training is less about teaching specific treatment protocols and more about fostering skills for interdisciplinary collaboration, development of treatment recommendations, communication skills, and an ethical stance. To adequately teach this content, new and innovative formats are needed to test and learn high levels of student interaction, communication, and collaboration. New teaching concepts such as inverted teaching formats as well as the use of modern media technology can be helpful to improve networking between disciplines and to improve the quality of medical education.

Intracranial metastases are the most frequent brain tumor with recurrence rates after treatment of around 40–60%. Age is still considered a determinant of treatment and prognosis in this pathology. Recent studies analyzing the impact of metastasectomy in elderly patients focused on reporting perioperative mortality and morbidity rates but not on the evaluation of oncological outcome parameters. Aim of this study is to determine risk factors for in-brain local recurrence after brain surgery in this sub-population. From October 2009 until September 2016 all patients aged 65 years and above with histopathologically confirmed metastasis after surgical resection were retrospectively studied. Clinical, radiological and perioperative information was collected and statistically analysed. Follow-up consisted of clinical and radiological assessment every 3-months following surgery. 78 patients were included, of these 50% were female (39 patients). Median age was 71 years (66–83). Early postoperative-MRI verified a complete surgical resection in 41 patients (52.6%) and showed a tumor-remnant in 15 patients (19.2%). In 22 patients the MRI result was inconclusive (28.2%). None of the patients experienced severe complications due to surgery. The median postoperative NIHSS was adequate 1 ± 1.4 (0–6), nonetheless, insignificantly improved in comparison to the preoperative NIHSS (p = 0.16). A total of 20 patients (25.6%) presented local recurrence. The only statistically significant factor for development of local in-brain recurrence after resection of cerebral metastases in patients above 65 years of age was a tumor-remnant in the early postoperative MRI (p = 0.00005). Median overall survival was 13 months. Local in-brain recurrence after surgical resection of a cerebral metastasis in patients above 65 years of age was 25.6%. In our analysis, tumor-remnant in early postoperative MRI is the only risk factor for local in-brain recurrence. Oncological parameters in the present cohort do not seem to differ from recent phase III studies with non-geriatric patients. Nevertheless, controlled studies on the impact of metastasectomy in elderly patients delivering high quality reliable data are required.

Introduction Literature on outcomes of patients with Lennox–Gastaut syndrome (LGS) receiving adjunctive vagus nerve stimulation (VNS) lacks information on seizure types and the time course of therapeutic effects. We have therefore performed what is to our knowledge the largest and most in‐depth analysis of the effectiveness of VNS in LGS patients paying special attention to the impact of VNS Therapy on individual seizure types. Methods The VNS Therapy Outcomes Registry includes over 7000 patients. A propensity score matching method was employed to match patients with LGS to non‐LGS patients with drug‐resistant epilepsy (DRE). Overall seizure frequencies were assessed prior to implantation and at 3‐, 6‐, 12‐, 18‐, and 24‐month follow‐ups to derive the main study outcomes: response rates and time to first response. Results A total of 564 LGS patients with sufficient data were identified in the registry and matched 2:1 to 1128 non‐LGS patients. Responder rates at 24 months were 57.5% in the LGS group and 61.5% in the non‐LGS group. Median seizure frequency reduction at 24 months was 64.3% versus 66.7% in the LGS versus non‐LGS group, respectively. In both groups, VNS was most effective at reducing focal aware seizures, “other” seizures, generalized‐onset non‐motor seizures, and drop attacks with relative reduction rates for these seizure types at 24 months exceeding 90% in both groups. Time‐to‐first response did not differ between the groups; however, there was a significantly higher proportion of patients who regressed from bilateral tonic–clonic (BTC) seizure response in the LGS group versus the non‐LGS group at 24 months: 22.4% versus 6.7%; p = .015. Conclusions Although limited by its retrospective design, the study shows that the effectiveness of VNS is comparable in DRE patients with and without LGS; however, LGS patients may be more prone to fluctuating control of BTCs. At 24 months of VNS, responder rates were 57.5% vs 61.5% in the LGS vs non‐LGS group, respectively. VNS was most effective at reducing the same seizure types in both groups. LGS patients displayed more fluctuating control of bilateral tonic‐clonic seizures

Background Despite rising importance of integration of palliative medicine in treating life-threatening illnesses in intensive care units (ICU), the extent remains unknown. Using billing data, we analysed the frequency of specialized palliative care use in ICU patients in Germany. Methods Billing data (2019 -2022) from the InEK was used in this cross-sectional study on all billed adult ICU cases. Data included case numbers, demographics, diagnoses, treatment procedures, ventilation (≥ 95 h), palliative care frequency. Results 61,591,299 adult cases were treated, 11.2% (6,912,316) requiring ICU and 499,262 (7.2%) needing long-term ventilation. 44.2% of all ICU cases and 36.2% of long-term ventilated patients were female ( p  < 0.0001). ICU mortality was 11.1%, long-term ventilation mortality was 38.8%; higher in men and patients aged ≥ 65 ( p  < 0.001). Leading diagnoses for ICU deaths: heart failure (6.9%), stroke (6.3%), sepsis (6.2%). 0.8% of ICU cases and 1.4% of long-term ventilated cases received specialized palliative care, with a higher proportion of females ( p  < 0.0001). Most palliative care patients were aged ≥ 65. Conclusion From 2019 to 2022, 11.2% of hospital cases required ICU-treatment. Despite suffering from life-threatening conditions and high mortality rates, less than 1% of all ICU cases and 1.4% of long-term ventilated cases received palliative care (differing sexes and ages). This highlights deficiencies in palliative care integration into ICUs to alleviate patients and their families suffering from complex needs. Implementing benchmarking could be beneficial in this process.

Cancer cells upregulate anabolic processes to maintain high rates of cellular turnover. Limiting the supply of macromolecular precursors by targeting enzymes involved in biosynthesis is a promising strategy in cancer therapy. Several tumors excessively metabolize glutamine to generate precursors for nonessential amino acids, nucleotides, and lipids, in a process called glutaminolysis. Here we show that pharmacological inhibition of glutaminase (GLS) eradicates glioblastoma stem-like cells (GSCs), a small cell subpopulation in glioblastoma (GBM) responsible for therapy resistance and tumor recurrence. Treatment with small molecule inhibitors compound 968 and CB839 effectively diminished cell growth and in vitro clonogenicity of GSC neurosphere cultures. However, our pharmaco-metabolic studies revealed that only CB839 inhibited GLS enzymatic activity thereby limiting the influx of glutamine derivates into the TCA cycle. Nevertheless, the effects of both inhibitors were highly GLS specific, since treatment sensitivity markedly correlated with GLS protein expression. Strikingly, we found GLS overexpressed in in vitro GSC models as compared with neural stem cells (NSC). Moreover, our study demonstrates the usefulness of in vitro pharmaco-metabolomics to score target specificity of compounds thereby refining drug development and risk assessment.