[Organ-preserving treatment as the most important option in the treatment of primary penile cancer]. / Organerhaltende Therapie als wichtigste Option in der Behandlung des Primärtumors des Peniskarzinoms.

The treatment of patients with penile cancer presents a significant challenge for therapists and patients alike. In this context, the focus must not only be on surgical techniques but rather on patient education and collaborative treatment planning. Consistent information about potential organ preservation and its consequences is essential. Following clinical examination and histological confirmation of the diagnosis, an organ-preserving and stage-adapted surgical procedure should be used in almost all cases. Intraoperatively, the aim should be to achieve tumour-free surgical margins through rapid pathological examination. Psycho-oncological support should be offered to all patients. Centralisation of treatment appears highly desirable for Germany, considering the excellent outcomes observed in English and Dutch centres. Until this has been achieved, following the valuable experience of the "Second Opinion Network for Testicular Tumours", the Second Opinion platform "eKonsil Urologie" (https://www.ekonsil.org) can be used as a reference.

Distinct phenotypes of stimulation-induced dysarthria represent different cortical networks in STN-DBS.

BACKGROUND: Deep brain stimulation of the subthalamic nucleus is an effective treatment of Parkinson's disease, yet it is often associated with a general deterioration of speech intelligibility. Clustering the phenotypes of dysarthria has been proposed as a strategy to tackle these stimulation-induced speech problems. METHODS: In this study, we examine a cohort of 24 patients to test the real-life application of the proposed clustering and attempt to attribute the clusters to specific brain networks with two different approaches of connectivity analysis. RESULTS: Both our data-driven and hypothesis-driven approaches revealed strong connections of variants of stimulation-induced dysarthria to brain regions that are known actors of motor speech control. We showed a strong connection between the spastic dysarthria type and the precentral gyrus and supplementary motor area, prompting a possible disruption of corticobulbar fibers. The connection between the strained voice dysarthria and more frontal areas hints toward a deeper disruption of the motor programming of speech production. CONCLUSIONS: These results provide insights into the mechanism of stimulation-induced dysarthria in deep brain stimulation of the subthalamic nucleus and may guide reprogramming attempts for individual Parkinson's patients based on pathophysiological understanding of the affected networks.

Comparing Direct and Indirect Methods of Audio Quality Evaluation in Virtual Reality Scenes of Varying Complexity.

Many quality evaluation methods are used to assess uni-modal audio or video content without considering perceptual, cognitive, and interactive aspects present in virtual reality (VR) settings. Consequently, little is known regarding the repercussions of the employed evaluation method, content, and subject behavior on the quality ratings in VR. This mixed between- and within-subjects study uses four subjective audio quality evaluation methods (viz. multiple-stimulus with and without reference for direct scaling, and rank-order elimination and pairwise comparison for indirect scaling) to investigate the contributing factors present in multi-modal 6-DoF VR on quality ratings of real-time audio rendering. For each between-subjects employed method, two sets of conditions in five VR scenes were evaluated within-subjects. The conditions targeted relevant attributes for binaural audio reproduction using scenes with various amounts of user interactivity. Our results show all referenceless methods produce similar results using both condition sets. However, rank-order elimination proved to be the fastest method, required the least amount of repetitive motion, and yielded the highest discrimination between spatial conditions. Scene complexity was found to be a main effect within results, with behavioral and task load index results implying more complex scenes and interactive aspects of 6-DoF VR can impede quality judgments.