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Delayed care in self-presenting stroke patients : real-world data on process delays : comparing process times between emergency medical services and self-presentation
(2026) Claudi, Christian; Schramm, Patrick; Juenemann, Martin; Diel, Norma J.; Fruehwald, Tobias; Loesche, Hendrik; Mueller-Nolte, Patrick; Huttner, Hagen B.; Worm, André
Background: Stroke is a time-critical emergency in which rapid diagnosis and treatment are essential to improve outcomes. While Emergency Medical Services (EMS) facilitate structured prehospital stroke care, a proportion of patients bypass EMS and self-present to emergency departments (EDs), potentially causing treatment delays. This study compares process times and outcomes between EMS-transported and self-presenting stroke patients. Methods: We conducted a retrospective analysis of prospectively collected data from 1805 patients with suspected stroke admitted between May 2019 and June 2021 to two hospitals in Germany. Patients were classified as EMS-transported or self-presenting. Process times included door-to-needle time (DNT), symptom onset to first medical contact (FMC), and intravenous thrombolysis (IVT) rates. Data are presented as mean ± standard deviation or median [interquartile range] for continuous variables and as number (%) for categorical variables. Results: A total of 1940 patients with suspected stroke were included. For the main analysis comparing EMS transport and self-presentation, 1805 patients (1525 EMS, 280 self-presenting) were evaluated. EMS patients were significantly older than self-presenting patients (73.1 ± 15.1 vs. 65.3 ± 14.9 years, p < 0.001). The median time from symptom onset to first medical contact was 114 [95–132] minutes in EMS patients and 727 [420–1440] minutes in self-presenting patients (p < 0.001). IVT was administered in 119/1197 (9.9%) EMS patients and 18/254 (7.1%) self-presenting patients (p = 0.158) among those with documented information on thrombolysis. Door-to-needle time was slightly but significantly longer in self-presenting patients (median 35 [32–54] vs. 30 [28–34] minutes, p < 0.001), while both groups remained well within certification targets. Conclusions: Self-presenting stroke patients experienced markedly longer prehospital delays and lower intravenous thrombolysis rates compared to EMS-transported patients, although the difference in IVT rates was not statistically significant. In-hospital door-to-needle times were comparable between groups. These findings highlight the need for targeted public education to improve stroke symptom recognition and timely EMS activation.
Upcycling agri-food side-streams via Tenebrio molitor rearing : growth performance, nutritional composition, and frass quality of larvae
(2026) Kryeziu, Labinot; Neitzel, Fabiola; Düring, Rolf-Alexander; Waldhardt, Rainer; Rühl, Martin
Insect bioconversion can transform agri-food side-streams into insect biomass while returning nutrients in the form of frass. This study evaluated Tenebrio molitor reared on wheat bran and on substrates in which bran was partially replaced with agri-food side-streams produced in Kosovo, including brewer’s spent grain, brewer’s spent yeast, apple and grape pomace, and surplus vegetables. Growth performance, larval composition, and frass nutrient composition were assessed across seven treatments. Larvae reared on wheat bran combined with brewer’s spent grain and melon as wet feed achieved the highest larval weight. Substrates containing wheat bran, apple pomace, and brewer spent yeast also supported high larval weights, but with a higher feed conversion ratio. In contrast, larvae reared on wheat bran, grape pomace, and brewer’s spent yeast showed the lowest larval weights. The use of potatoes as wet feed was associated with a longer development period. Larval proximate composition remained similar across treatments, with crude protein contents of 52–56% DM and only limited variation in fat and ash content. Overall, several tested side-streams supported larval growth comparable to wheat bran while generating nutrient-containing frass.
Enhanced recovery after radical cystectomy for bladder cancer : a prospective observational case -control study
(2026) Habicher, Marit; Swoboda, Christina; Hauptmann, Arne; Koch, Christian; Diemer, Thorsten; Paul, Ann-Catrin; Markmann, Melanie; Schneck, Emmanuel; Wagenlehner, Florian; Wolff, Matthias; Sander, Michael
Introduction: The perioperative management of patients undergoing major surgical interventions is a dynamic field, continually striving for advancements in quality, reduction of complications, and cost-effectiveness. The implementation of Enhanced Recovery After Surgery (ERAS) pathways has demonstrated remarkable success in various surgical disciplines, particularly in colorectal procedures. This study investigates whether the implementation of an ERAS protocol for radical cystectomy for bladder cancer at our institution results in a reduced complication rate compared to traditional standards.DRKS00035673 (retrospective) on 13th December 2024. Methods: This prospective observational case-control pilot study was conducted at the University Hospital Giessen, Germany. Following ethics committee approval, 30 patients were enrolled: 15 patients received perioperative management based on prevailing standard operating procedures, and the subsequent 15 patients were managed according to the newly developed ERAS protocol. The multidisciplinary team included urologists, anaesthesiologists, nursing staff, ICU staff, pharmacists, physiotherapists, dietitians, and administrative staff. Key components of the ERAS protocol included optimized pain management, early nutrition, thrombosis prophylaxis, intraoperative goal directed therapy and early mobilization. The primary outcome was the complication rate until the 30th postoperative day, while secondary outcomes included ICU and hospital mortality, length of stay, and quality of life assessed by the EQ-5D-5L questionnaire. Results: Thirty patients were included in the final analysis. Patients in the control group underwent radical cystectomy between September 2018 and December 2019, and those in the ERAS group between July 2020 and March 2021. There were no significant differences in basic characteristics between the groups. The primary outcome showed numeric but no statistically significant difference in complication rates (86.7% in the control group vs. 60% in the ERAS group, p=0.21). However, the cumulative POMS score was significantly higher in the control group (7.87 vs. 2.87, p<0.01), and the Clavien-Dindo score was significantly lower in the ERAS group (p=0.02). Quality of life was significantly improved in the ERAS group on the 7th and 30th postoperative day. Conclusion: Our pilot study suggests feasibility of ERAS implementation in radical cystectomy. The primary endpoint (overall complication rate) did not differ significantly between groups; however, ERAS was associated with lower complication severity and improved early postoperative quality of life, which should be interpreted as exploratory given the small, non-randomised sequential design. Larger multicentre prospective implementation studies are warranted to confirm these findings and to evaluate the influence of protocol adherence and individual ERAS elements.
Mmp2 regulates basement membrane remodeling and dedifferentiation of the visceral musculature during Drosophila metamorphosis
(2026) Töpfer, Uwe; Dahlitz, Ina; Holz, Anne
The basement membrane (BM) is a specialized extracellular matrix that surrounds most tissues and organs. Remodeling of the BM is critical for morphogenesis and to control tissue homeostasis. During Drosophila metamorphosis, most tissues undergo apoptosis and become histolyzed to be replaced by progenitor cells to generate adult structures, but the visceral musculature trans-differentiates to give rise to new adult muscles. The molecular mechanisms of the BM remodeling during this extensive tissue reorganization are poorly understood. Here, we identified Matrix metalloprotease 2 (Mmp2) as a key regulator of BM remodeling in visceral musculature. We find that Mmp2 is localized when the BM is degraded and that Mmp2 is required for degradation of the major BM components. In addition, Mmp2 is important for survival and tissue metamorphosis. Our results suggests that Mmp2-mediated BM remodeling is a prerequisite for metamorphosis and visceral muscle dedifferentiation.
Constant traffic noise affects the behavior and physiology of naïve horses at pasture
(2026) Henke-von der Malsburg, Johanna; König von Borstel, Uta
Introduction: Horses are frequently kept on pastures near major roads, exposing them to high levels of traffic noise. In humans, prolonged traffic noise exposure is associated with physiological stress, sleep disruption, and adverse health effects. Despite horses’ high auditory sensitivity, comparable data on the behavioral and welfare implications of continuous traffic noise are scarce. This study investigated short-term behavioral and physiological responses of horses naïve to constant motorway noise in their home environment. Methods: Twenty horses housed in four stable groups across three facilities were exposed to recorded motorway noise for 1–2 weeks. Emitted noise levels ranged from 54 to 71 dB, corresponding to distances of approximately 500 to 10 m from a four-lane motorway, and were played during daytime for up to 11 h/day using portable outdoor loudspeakers. Control periods without motorway noise (average ambient noise level: 38 dB) before and between exposure days served as baseline, intermediate washout, and final control phases. Behavioral parameters were recorded throughout the day using focal and scan samplings. Heart rate was continuously monitored as a physiological indicator of stress. Results: During noise exposure, horses reduced foraging behavior from a median of 81% at baseline to 41% during the first exposure phase (p<0.001), while vigilance increased from nine to 54 instances per day (p<0.001). Horses also avoided the vicinity of the noise source (p<0.001). Behavioral effects were pronounced at higher noise levels, with clear avoidance responses suggesting aversion as an active coping strategy. Heart rate increased within the first exposure phase, rising from an average of 57.60 bpm to 66.76 bpm (p<0.001), suggesting an acute stress response. Discussion: Although some behavioral habituation was observed over time, spatial avoidance of the noise source persisted, and elevated heart rates indicated continued physiological arousal. Even noise levels of a 500 m distant motorway (≥54 dB) altered behavior and physiology. These findings demonstrate that traffic noise represents a relevant environmental stressor for horses and may compromise welfare when exposure is frequent or prolonged. The study highlights the need to consider noise in equine management and supports mitigation strategies such as providing large pastures with quiet retreat zones or installing noise barriers.