Dementia is a progressive disease that puts substantial strain on caregivers. Many persons with dementia (PwDs) receive care from a relative. Since male and female caregivers experience different issues related to stress, it is important to meet their different needs to prevent the early nursing home placement of PwDs. This study investigated the multifactorial aspects of caregiver burden and explored gender differences in caregiver burden in a rural setting. This was a cross sectional study that administered anonymous questionnaires to family caregivers of PwDs. Caregiver burden was assessed using the Burden Scale for Family Caregivers—short version. A path model was used to determine the multivariate associations between the variables. To reflect the multifaceted aspects of caregiver burden, we used Pearlin’s model with its four dimensions. A total of 113 family caregivers responded to our survey. The overall burden of caregivers was moderate. According to the path model, gender differences were predictors of caregiver burden. The behaviour of the person with dementia and cohabitation had direct effects on caregiver burden. Our results suggest that the experiences of men and women caring for a PwD are different and highlight the need for tailored support in dementia care.

Purpose The objective of this study was to determine the incidence of needle track seeding after ultrasound-guided percutaneous biopsy of indeterminate liver lesions with a coaxial biopsy system without any other additional intervention or ablation therapy. Methods We identified 172 patients in a retrospective cohort study who underwent ultrasound-guided biopsy due to a liver mass in our institution between 2007 and 2016. The same coaxial biopsy system was used in all patients, no consecutive ablation was performed. Results None of the finally included 131 patients developed neoplastic seeding. There was one major complication (0.76%), the rest of the complications were minor (3.8%) and did not require further intervention. Conclusion Needle track seeding is a rare delayed complication after percutaneous liver biopsy. Coaxial liver biopsy is a safe method to obtain multiple samples with a single punch in patients with primary or metastatic liver lesions.

Purpose: Progressive loss (sarcopenia) and fatty infiltration of muscle mass (myosteatosis) are well-established risk factors for an adverse clinical outcome in obese patients. Data concerning non-obese sarcopenic patients in oncologic surgery are scarce and heterogeneous. The aim of this study was to determine the impact of sarcopenia and myosteatosis in non-obese patients with cancer of the right colon on clinical outcome. Methods: This study comprised 85 patients with a BMI < 30 kg/m², who underwent surgery for right colon cancer in a single center. Skeletal muscle area (SMA), visceral fat area (VFA), and myosteatosis were retrospectively assessed using preoperative abdominal CT images. Univariate und multivariate analysis was performed to evaluate the association between body composition, complications, and oncologic follow-up. Results: Traditional risk factors such as visceral fat (p = 0.8653), BMI (p = 0.8033), myosteatosis (p = 0.7705), and sarcopenia (p = 0.3359) failed to show any impact on postoperative complications or early recurrence. In our cohort, the skeletal muscle index (SMI) was the only significant predictor for early cancer recurrence (p = 0.0467). Conclusion: SMI is a significant prognostic factor for early cancer recurrence in non-obese colon cancer patients. Our study shows that conventional thresholds for sarcopenia and BMI do not seem to be reliable across various cohorts. Target prehabilitation programs could be useful to improve outcome after colorectal surgery. Trial Registration: DRKS00014655, www.apps.who.int/trialsearch

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a worldwide concern in patients receiving neurotoxic agents for cancer therapy. High tone external muscle stimulation is a promising therapeutic approach to alleviate symptoms of CIPN. Methods: This pilot study aims to investigate whether the application of home-based high-tone external muscle stimulation therapy (HTEMS) improves symptoms of CIPN. The trial is planned as a therapist- and assessor-blinded, 1:1 randomized controlled study. A total of 50 patients with chemotherapy-induced peripheral polyneuropathy will be included. All patients will perform therapy at home. Study participants will be allocated randomly to the HTEMS therapy (intervention group) or to the transcutaneous electrical nerve stimulation (TENS, control group), respectively, following a standardized therapy schedule. Compliance of participants can be verified by reading out the tool box. Outcomes will be evaluated at baseline and after 8 weeks of home-based therapy. The primary outcome includes improvement of CIPN according to the patient-reported EORTC QLQ-CIPN 20 questionnaire. Secondary outcomes are the patient-reported change in health-related quality of life and clinician-reported changes of vibration sensibility, tendon reflexes, temperature sensibility, perception of touch, and strength of the lower leg muscles. Further a safety- and process evaluation will be performed. Discussion: This pilot RCT aims to evaluate the impact of home-based HTEMS as compared to TENS in CIPN. There is a need for an effective treatment for CIPN and the results of this study are expected to possibly identify a novel and effective treatment strategy in the future.

Current definitions of low muscle mass rely on ratios in combination with gender-specific cut-offs. While these approaches aim to adjust for differences in body metrics, their mathematical validity has not been systematically examined and may introduce bias-not only in relation to muscle mass itself, but also in relation to adiposity. In the National Health and Nutrition Examination Survey (NHANES) cohort 1999-2006 (n = 8325) DXA-based definitions for low muscle mass of the European Working Group on Sarcopenia in Older People (ALST/height²), of the Foundation for the National Institutes of Health sarcopenia project (ALST/BMI) and of the ESPEN and EASO consensus for sarcopenic obesity (ALST/weight) were analyzed for proportional (isometric) scaling by regression analysis, calculation of scaling exponents of the denominators and graphical illustrations. The complex relationship between muscle mass, fat mass and BMI was analyzed and the adiposity related bias, cut-offs entail, explored. To illustrate the clinical relevance, we examined the relationship between low muscle mass and fatty liver disease in a second NHANES cohort (2017-2018, n = 673). While ALST/height² approximated isometric scaling, ALST/BMI and ALST/weight showed a major mathematical bias. Instead of the assumed β = 1, BMI scaled to ALST with β = 0.6 and weight with β = 0.7. In addition to the increase with BMI, variation of muscle mass at a given BMI was tightly linked to adiposity: age and BMI adjusted standard deviation scores for muscle and fat mass correlated with r = 0.833 and r = 0.799 in men and women, respectively (p < 0.001). As none of the ratio-based definitions correctly adjusted for these associations, cut-offs unmasked a major, adiposity-related bias. Using ALST/height² the group with low muscle mass had a ∼7 kg/m² lower BMI, opposed by ALST/BMI and ALST/weight with a ∼6 kg/m² and ∼7 kg/m² higher BMI. In line, fatty liver disease was less prevalent in subjects with low muscle mass following the ALSTI/height² definition (PR = 0.30; CI 0.09-0.97), but more prevalent following the ALST/BMI and ALST/weight definitions (PR = 1.92; CI 1.38-2.67 and PR = 2.20; CI 1.58-3.06). Latter associations were no longer statistically significant when BMI and weight were corrected for β values (BMI^0.6 and weight^0.7). In contrast to ALST/height², ALST/BMI and ALST/weight were not mathematically valid. Normalization of muscle mass by these ratios cannot correctly account for the complex association of muscle mass with fat mass, BMI and age and therefore potentially confounds results when cut-offs are applied. Reference equations that adjust for age and BMI and yield standard deviation scores may offer a more valid and clinically meaningful alternative.