Dtsch Arztebl Int
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The effectiveness of intraoral appliances (IOA), maxillary expansion (ME), and maxillomandibular advancement (MMA) in the treatment of children and adults with obstructive sleep apnea (OSA) has not yet been adequately assessed. ⋯ Intraoral appliances are effective in reducing AHI and their use is substantiated by robust evidence. There is no evidence from high-quality research to support treatment with ME (conventional or surgically assisted) or MMA in patients with OSA.
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Persistent fever of unknown cause is only rarely of cardiac origin, but heart disease must be considered in the differential diagnosis. Aside from endocarditis, pericarditis and various other conditions may be responsible. ⋯ Fever can have both infectious and non-infectious cardiac causes. Its interpretation depends on the clinical context. The evidence base for treatment is sparse, and controlled trials are needed.
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Cluster-randomized trials (CRT) are needed to compare interventions that are allocated to entire groups of subjects, rather than to individuals. Publications about CRT have become steadily more common over the past decade. Readers of such publications should be able to categorize and interpret the findings of CRT correctly while considering the methodological requirements applicable to this type of study. ⋯ Readers of publications on CRT should be aware of the special requirements mentioned above with respect to the design, performance, and analysis of this type of study as opposed to individually randomized studies. If no special techniques are applied in the design, performance, and analysis of a CRT, or if the assumptions underlying each of these steps have not been properly checked, then the findings of the study may well be misleading.
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2-4% of newly diagnosed cases of malignant disease involve cancer of unknown primary (CUP). This mixed entity is one of the 6 most common types of malignant disease in Germany. Highly refined treatment strategies can now be offered to patients with CUP. ⋯ A combination of conventional and innovative diagnostic methods enables the provision of highly refined therapeutic strategies to patients with CUP who are undergoing treatment in interdisciplinary cancer centers.