Background: Postoperative complications following major abdominal surgery are frequent despite progress in surgical technique and perioperative care. Early and enhanced postoperative mobilisation has been advocated to reduce postoperative complications, but it is still unknown whether it can independently improve outcomes after major surgery. Fitness trackers (FTs) are a promising tool to improve postoperative mobilisation, but their effect on postoperative complications and recovery has not been investigated in clinical trials. Methods: This is a multicentre randomised controlled trial with two parallel study groups evaluating the efficacy of an enhanced and early mobilisation protocol in combination with FT-based feedback in patients undergoing elective major abdominal surgery. Participants are randomly assigned (1:1) to either the experimental group, which receives daily step goals and a FT giving feedback about daily steps, or the control group, which is mobilised according to hospital standards. The control group also receives a FT, however with a blackened screen; thus no FT-based feedback is possible. Randomisation will be stratified by type of surgery (laparoscopic vs. open). The primary endpoint of the study is postoperative morbidity within 30 days measured via the Comprehensive Complication Index. Secondary endpoints include number of steps as well as a set of functional, morbidity and safety parameters. A total of 348 patients will be recruited in 15 German centres. The study will be conducted and organised by the student-led German Clinical Trial Network SIGMA. Discussion: Our study aims at investigating whether the implementation of a simple mobilisation protocol in combination with FT-based feedback can reduce postoperative morbidity in patients undergoing major abdominal surgery. If so, FTs would offer a cost-effective intervention to enhance postoperative mobilisation and improve patient outcomes. Trial registration: Deutsches Register Klinischer Studien (DRKS, German Clinical Trials Register): DRKS00016755, UTN U1111-1228-3320. Registered on 06.03.2019.

Background: Most data on COVID-19 was collected in hospitalized cases. Much less is known about the spectrum of disease in entire populations. In this study, we examine a representative cohort of primarily symptomatic cases in an administrative district in Southern Germany. Methods: We contacted all confirmed SARS-CoV-2 cases in the administrative district. Consenting participants answered a retrospective survey either via a telephone, electronically or via mail. Clinical and sociodemographic features were compared between hospitalized and non-hospitalized patients. Additionally, we assessed potential risk factors for hospitalization and time to hospitalization in a series of regression models. Results: We included 897 participants in our study, 69% out of 1,305 total cases in the district with a mean age of 47 years (range 2–97), 51% of which were female and 47% had a pre-existing illness. The percentage of asymptomatic, mild, moderate (leading to hospital admission) and critical illness (requiring mechanical ventilation) was 54 patients (6%), 713 (79%), 97 (11%) and 16 (2%), respectively. Seventeen patients (2%) died. The most prevalent symptoms were fatigue (65%), cough (62%) and dysgeusia (60%). The risk factors for hospitalization included older age (OR 1.05 per year increase; 95% CI 1.04–1.07) preexisting lung conditions (OR 3.09; 95% CI 1.62–5.88). Female sex was a protective factor (OR 0.51; 95% CI 0.33–0.77). Conclusion: This representative analysis of primarily symptomatic COVID-19 cases confirms age, male sex and preexisting lung conditions but not cardiovascular disease as risk factors for severe illness. Almost 80% of infection take a mild course, whereas 13% of patients suffer moderate to severe illness. Trial registration: German Clinical Trials Register, DRKS00022926. URL: https://www.drks.de/drks_web/setLocale_EN.do

(1) Background: A reliable non-invasive distinction between low- and high-risk pancreatic intraductal papillary mucinous neoplasms (IPMN) is needed to effectively detect IPMN with malignant potential. This would improve preventative care and reduce the risk of developing pancreatic cancer and overtreatment. The present study aimed at exploring the presence of autoreactive antibodies in the blood of patients with IPMN of various grades of dysplasia. (2) Methods: A single-center cohort was studied composed of 378 serum samples from patients with low-grade IPMN (n = 91), high-grade IPMN (n = 66), IPMN with associated invasive cancer (n = 30), pancreatic ductal adenocarcinoma (PDAC) stages T1 (n = 24) and T2 (n = 113), and healthy controls (n = 54). A 249 full-length recombinant human protein microarray was used for profiling the serum samples. (3) Results: 14 proteins were identified as potential biomarkers for grade distinction in IPMN, yielding high specificity but mediocre sensitivity. (4) Conclusions: The identified autoantibodies are potential biomarkers that may assist in the detection of malignancy in IPMN patients.

The management of gastric cancer (GC) with peritoneal metastasis (PM) remains a significant clinical challenge. Despite advances in molecular profiling, the underreporting of key molecular markers in patients undergoing surgical treatment for GC with PM is concerning. Signet ring cell (SRC) histology is associated with poor prognosis and chemoresistance, while Laurén diffuse subtype is linked to a higher risk for PM. Despite the established role of HER2 in GC progression, its impact on the efficacy of surgical treatment is not clearly defined. The lack of comprehensive reporting on these and recent molecular markers underscores the need for further research. Incorporating molecular diagnostic into clinical practice could improve the personalisation of treatment for GC with PM and overcoming important drug resistance issues, enhancing the effectiveness of current therapy approaches.

Thromboembolic events (TEE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), are important causes of morbidity after major surgery. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) may carry particularly high risks. We evaluated TEE incidence following CRS-HIPEC for pseudomyxoma peritonei (PMP) of appendiceal origin. A retrospective analysis of prospectively collected data (2020-2024) was performed in a high-volume peritoneal malignancy centre. Routine duplex ultrasound on postoperative day 10 screened for DVT. CT pulmonary angiography (CTPA) was performed in symptomatic patients to assess for PE. Demographics, prior surgery, peritoneal cancer index (PCI), operative duration, cryoprecipitate transfusion, postoperative complications, and tumour histopathology were recorded. Univariate analyses used the Mann-Whitney U test and Pearson's chi-square test. In total, 1.180 patients underwent CRS and HIPEC, including 710 with an appendiceal primary, of whom 554 had PMP. TEE occurred in 63/554 (11.4%), including 41 PE (7.4%) and 22 DVT (4.0%). Median time to diagnosis was 8 days for PE and 11 days for DVT. DVT was associated with greater cryoprecipitate use (p = 0.002, OR 1.4) and high-grade appendiceal mucinous neoplasm (HAMN) (p = 0.027, OR 2.5). Most PEs were peripheral (37/41; 90.2%). PE was more common in males (11.1% vs. 5.2%; p = 0.010, OR 2.3) and associated with higher PCI (p = 0.017, OR 2.3). TEE is frequent and under-reported after CRS and HIPEC for PMP. PE often develops early, is predominantly peripheral, and may occur independently of DVT. Male sex, high PCI, cryoprecipitate transfusion, and HAMN histology were significant risk factors.