associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. However, we also stress risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest impact on recommendations.

We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. However, we also stress risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest impact on recommendations.

Biliary tract cancer (BTC) has a poor prognosis despite treatment with first-line gemcitabine and cisplatin. In BTC, PI3K/AKT pathway activation has been shown to increase resistance to chemotherapy, which may be overcome with PI3K inhibition. This phase 2 study evaluated the safety and efficacy of copanlisib, a PI3K inhibitor, with gemcitabine and cisplatin in advanced BTCs. The role of PTEN expression in outcomes was also explored.

Patients with advanced/unresectable BTC received gemcitabine, cisplatin, and copanlisib as their first-line treatment. The primary endpoint was progression-free survival (PFS) at 6 months. Secondary endpoints were the response rate (RR), median overall survival (OS)/PFS, and safety profile. An assessment of PTEN expression by immunohistochemistry was also performed along with molecular profiling.

Twenty-four patients received at least 1 dose of the study drug. The PFS rate at 6 months was 51%; the median OS was 13.7 months (95% CI, 6.8-18.0 months), and the median PFS was 6th the addition of copanlisib in comparison with standard chemotherapy. Copanlisib may be more effective and increase survival in patients with low PTEN expression levels. Further studies are needed to confirm this. No unexpected adverse events occurred.

The addition of copanlisib, a PI3K inhibitor, to standard chemotherapy for advanced biliary tract cancers was assessed for efficacy and safety. Twenty-four patients with advanced biliary tract cancer received treatment in this study. There was no difference in survival with the addition of copanlisib in comparison with standard chemotherapy. Copanlisib may be more effective and increase survival in patients with low PTEN expression levels. Further studies are needed to confirm this. No unexpected adverse events occurred.THE EXPERIENCE OF PALLIATIVE WORK IN A PALLIATIVE CONSULTANCY SERVICE IN WESTFALEN-LIPPE Background In Westfalen-Lippe there has been a care concept for 8 years which does not insitutionalize general and specialized outpatient palliative care (AAPV and SAPV), which integrates the family doctor in a prominent position and orientates the service density to the changing needs of patients and their relatives (palliative medical consultancy service Iserlohn-Letmathe network, PKD NIL). The new Federal Framework Agreement (SAPV) emphasizes a nationwide, basically uniform structure in Germany. Existing regional structures are being put to the test.

Exploratory qualitative research was carried out. Using semi-structured, guided expert interviews, PKD NIL employees were asked how they experience their everyday work. Data from 17 people were evaluated.

Teamwork and cooperation in the network are experienced positively by everyone working in the PKD NIL. The concept is based on the family doctor, holistic care is carried out. Cooperation with individual professional groups who are critical of the cooperation with the PKD NIL, cooperation with other PKDs, communication with relatives and those affected, the shortage of skilled workers, as well as the concern of upheaval due to the framework agreement on the SAPV in Germany are challenging.

The research gives an insight into the experience of working in the PKD NIL. However, further studies are necessary in order to be able to make comparisons and to be able to assess whether improved palliative care can really be achieved in Germany.

The research gives an insight into the experience of working in the PKD NIL. However, further studies are necessary in order to be able to make comparisons and to be able to assess whether improved palliative care can really be achieved in Germany.

A 58-year-old woman presented with a symptomatic, hypertensive crisis, acute kidney failure AKIN2 and a severe hypercalcemia. The parathyroid hormone levels were in the lower normal range with highly elevated Vitamin D levels. For more than half a year she was taking 100’000 IU Vitamin D daily. Under volume loading, calcium-low-diet, Denosumab for blocking calcium resorption from bone and Ketoconazol to inhibit activation of Vitamin D a normalization of the calcium levels as well as an improvement of renal function could be observed. Loss-of-function mutations in the genes CYP24A1 and SLC34A1, involved in vitamin D metabolism leading to hypercalcemia could not be found in this patient.

A 58-year-old woman presented with a symptomatic, hypertensive crisis, acute kidney failure AKIN2 and a severe hypercalcemia. The parathyroid hormone levels were in the lower normal range with highly elevated Vitamin D levels. For more than half a year she was taking 100’000 IU Vitamin D daily. Under volume loading, calcium-low-diet, Denosumab for blocking calcium resorption from bone and Ketoconazol to inhibit activation of Vitamin D a normalization of the calcium levels as well as an improvement of renal function could be observed. Loss-of-function mutations in the genes CYP24A1 and SLC34A1, involved in vitamin D metabolism leading to hypercalcemia could not be found in this patient.

This paper deals with biomechanics of the cervical spine when using a smartphone. The forces acting on the vertebral bodies, vertebral joints, intervertebral discs, muscles and ligaments increase as the angle of flexion of the cervical spine increases. The disorders caused by smartphone neck, on the other hand, are mostly acute and can be treated well with regular exercise and strengthening the neck muscles. Therapy is therefore also suitable for prevention. However, the long-term effects should not be disregarded, because the increasing possibilities for using smartphones also mean that the average daily use increases more. PRI-724 concentration Especially the daily screen time for young people is getting longer and longer. The currently still acute clinical picture of the smartphone neck, which rarely takes a chronic course and causes long-term damage, could develop into a larger chronic clinical picture due to missing or too late measures.

This paper deals with biomechanics of the cervical spine when using a smartphone. The forces acting on the vertebral bodies, vertebral joints, intervertebral discs, muscles and ligaments increase as the angle of flexion of the cervical spine increases.