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Background and aims
Nuclear protein of the testis (NUT) carcinoma (NC) is a rare and highly aggressive tumor defined by the presence of a somatic NUTM1 rearrangement, occurring mainly in adolescents and young adults. We analyzed the clinical and biological features of German pediatric patients (≤18 years) with NC.
Methods
This study describes the characteristics and outcome of 11 children with NC registered in the German Registry for Rare Pediatric Tumors (STEP).
Results
Eleven patients with a median age of 13.2 years (range 6.6–17.8) were analyzed. Malignant misdiagnoses were made in three patients. Thoracic/mediastinal tumors were found to be the primary in six patients, head/neck in four cases; one patient had multifocal tumor with an unknown primary. All patients presented with regional lymph node involvement, eight patients (72.7%) with distant metastases. Seven patients underwent surgery, eight radiotherapy with curative intent; polychemotherapy was administered in all patients. Novel treatment strategies including immunotherapy, targeted therapies, and virotherapy were applied in three patients. Median event-free survival and overall survival were 1.5 and 6.5 months, respectively.
Conclusions
Every undifferentiated or poorly differentiated carcinoma should undergo testing for the specific rearrangement of NUTM1, in order to initiate an intense therapeutic regimen as early as possible. As in adults, only few pediatric patients with NC achieve prolonged survival. Thus, novel therapeutic strategies should be included and tested in clinical trials.
The COVID-19 pandemic has given rise to a broad range of research from fields alongside and beyond the core concerns of infectiology, epidemiology, and immunology. One significant subset of this work centers on machine learning-based approaches to supporting medical decision-making around COVID-19 diagnosis. To date, various challenges, including IT issues, have meant that, notwithstanding this strand of research on digital diagnosis of COVID-19, the actual use of these methods in medical facilities remains incipient at best, despite their potential to relieve pressure on scarce medical resources, prevent instances of infection, and help manage the difficulties and unpredictabilities surrounding the emergence of new mutations. The reasons behind this research-application gap are manifold and may imply an interdisciplinary dimension. We argue that the discipline of AI ethics can provide a framework for interdisciplinary discussion and create a roadmap for the application of digital COVID-19 diagnosis, taking into account all disciplinary stakeholders involved. This article proposes such an ethical framework for the practical use of digital COVID-19 diagnosis, considering legal, medical, operational managerial, and technological aspects of the issue in accordance with our diverse research backgrounds and noting the potential of the approach we set out here to guide future research.
Thinking like a lawyer — human rights and their association with the plastic surgeon of today
(2023)
Plastic surgeons are trained to perform a wide repertoire of surgeries—ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR).
Background
Regulation (EU) 2017/746 on in vitro diagnostic medical devices (IVDR) was passed by the European Parliament and the Council of the European Union on 5 April 2017 and came into force on 26 May 2017. A new amending regulation, which introduces a phased implementation of the IVDR with new transitional provisions for certain in vitro diagnostic medical devices (IVDs) and a later date of application of some requirements for in-house devices for healthcare facilities, was adopted on 15 December 2021.
The combined use of CE-certified IVDs (CE-IVDs), in-house IVDs (IH-IVDs), and research use only (RUO) devices are a cornerstone of diagnostics in pathology departments and crucial for optimal patient care. The IVDR not only regulates the manufacture and placement on the market of industrially manufactured IVDs, but also imposes conditions on the manufacture and use of IH-IVDs for internal use by healthcare facilities.
Objectives
Our work provides an overview of the background and structure of the IVDR and identifies core areas that need to be interpreted and fleshed out in the context of the legal framework as well as expert knowledge.
Conclusions
The gaps and ambiguities in the IVDR crucially require the expertise of professional societies, alliances, and individual stakeholders to successfully facilitate the implementation and use of the IVDR in pathology departments and to avoid aberrant developments.
Hintergrund
Die Verordnung (EU) 2017/746 über In-vitro-Diagnostika (IVDR) stellt mehrere Bedingungen an Pathologische Institute, die hausinterne In-vitro-Diagnostika (IH-IVD) entwickeln und anwenden. Diese Bedingungen müssen jedoch nicht alle unmittelbar mit dem Geltungsbeginn der IVDR zum 26.05.2022 umgesetzt worden sein. Auf der Grundlage einer Änderungsverordnung des Europäischen Parlaments und des Rates der Europäischen Union werden die Anforderungen an IH-IVD stufenweise eingeführt. Die Konformität mit den grundlegenden Sicherheits- und Leistungsanforderungen gemäß Anhang I muss seit Mai 2022 gewährleistet sein
Ziel der Arbeit
Mit diesem Artikel möchten wir die praktische Umsetzung der aktuell gültigen Bedingungen für IH-IVD im Pathologischen Institut des Universitätsklinikums Heidelberg vorstellen und damit mögliche Hilfestellung für andere Einrichtungen geben
Schlussfolgerungen
Neben der intensiven Auseinandersetzung mit den Anforderungen an IH-IVD geben mehrere Handreichungen und Hilfestellungen eine Orientierungshilfe zur Umsetzung und Harmonisierung der in Artikel 5 (5) genannten Anforderungen an Gesundheitseinrichtungen. Auch der Austausch in akademischen Netzwerkstrukturen ist für die Interpretation und die praktische Umsetzung der IVDR von großer Bedeutung. Für universitäre und nicht-universitäre Einrichtungen stellt die Sicherstellung der IVDR-Konformität – neben den wesentlichen Aufgaben in der Krankenversorgung, in der Lehre und der Forschung und Weiterentwicklung von Methoden zur optimalen und zielgerichteten Diagnostik sowie der Aufrechterhaltung des sich stetig weiterentwickelnden Qualitätsmanagementsystems – eine weitere personelle und zeitliche Herausforderung dar.
Background
Regulation (EU) 2017/746 on in vitro diagnostic medical devices (IVDR) imposes several conditions on pathology departments that develop and use in-house in vitro diagnostic medical devices (IH-IVDs). However, not all of these conditions need to be implemented immediately after the IVDR entered into force on 26 May 2022. Based on an amending regulation of the European Parliament and the Council of the European Union, the requirements for IH-IVDs will be phased in. Conformity with the essential safety and performance requirements of annex I must be ensured from May 2022.
Objectives
With this article, we would like to present the practical implementation of the currently valid conditions for IH-IVDs at the Institute of Pathology at the University Hospital of Heidelberg, in order to provide possible assistance to other institutions.
Conclusions
In addition to the intensive work on the requirements for IH-IVDs, several guidance documents and handouts provide orientation for the implementation and harmonisation of the requirements for healthcare institutions mentioned in Article 5 (5). Exchange in academic network structures is also of great importance for the interpretation and practical implementation of the IVDR. For university and nonuniversity institutions, ensuring conformity with the IVDR represents a further challenge in terms of personnel and time, in addition to the essential tasks of patient care, teaching and research and the further development of methods for optimal and targeted diagnostics, as well as the maintenance of the constantly evolving quality management system.
Three-dimensional medical printing and associated legal issues in plastic surgery: a scoping review
(2023)
Three-dimensional printing (3DP) represents an emerging field of surgery. 3DP can facilitate the plastic surgeon’s workflow, including preoperative planning, intraoperative assistance, and postoperative follow-up. The broad clinical application spectrum stands in contrast to the paucity of research on the legal framework of 3DP. This imbalance poses a potential risk for medical malpractice lawsuits. To address this knowledge gap, we aimed to summarize the current body of legal literature on medical 3DP in the US legal system. By combining the promising clinical use of 3DP with its current legal regulations, plastic surgeons can enhance patient safety and outcomes.
Laboratory-developed tests in the new European Union 2017/746 regulation: opportunities and risks
(2022)
In the context of motor-manual timber harvesting with a chainsaw, systems for sensor-based data acquisition are increasingly being used, with which personal data are processed. The manufacturers of these systems are data controllers under data protection law in relation to the owners of the chainsaws. The owners of the machines are data subjects under data protection law. If the chainsaws are additionally managed by third party additional users as data subjects, then in this relationship both the manufacturers and the owners are data controllers under data protection law. Commissioned processing by the manufacturers is not to be assumed. There is also no joint responsibility of manufacturers and owners towards the additional users. The data processing is subject to permission. Data processing by manufacturers can be legitimized by consent. Something else only applies if the data subject is an employee and the data processing is carried out at the instigation of the employer. The performance of a contract can legitimize data processing by manufacturers only in the event that the data subject has purchased the system for data collection directly from the manufacturer. Legitimate interests, however, can always justify data processing by manufacturers because they have product monitoring obligations to fulfill and must ensure product safety. Similar principles apply mutatis mutandis to data processing by service agencies. Consent is therefore in principle not a mandatory requirement for the processing of chainsaw data by manufacturers and service agencies. Data processing will regularly be legitimized by a legitimate interest of the manufacturers and service agencies. In the private sector, data processing by owners may be legitimized by the consent of the data subject. In the area of commercial chainsaw use, data processing by owners can only be legitimized by the consent of the data subject if the data subject works for the owner on a selfemployed basis. On the other hand, if the data subject is an employee of the owner, their consent cannot legitimize data processing by the owner. The performance of a contract cannot justify data processing by the owners, because, taking a close look at life, no constellation is conceivable in which data processing is necessary for the performance of a contract with the owner. For purposes of the employment relationship, only data on the equipment number as well as information on the operating time and machine operations as well as the location data can be processed by the owner. However, legitimate interests can always justify the processing of data by the owner, because the owner has a legitimate interest in optimizing the operation of the chainsaws in economic terms. Thus, consent is also not a mandatory requirement for the processing of chainsaw data by the owner. Here, too, data processing will regularly have to be legitimized by a legitimate interest of the owner. However, the collection of employee data requires the co-determination of an elected works council or staff council in any case, because the data is objectively suitable for monitoring employees in any case.
