Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort

OBJECTIVES Gastroesophageal reflux disease (GERD) is frequent in systemic sclerosis (SSc) and could predict progression of interstitial lung disease (ILD). We aimed to analyse (1) the prevalence of GERD among SSc-ILD patients, (2) its association with disease characteristics and (3) predictive factors for ILD progression in SSc-ILD patients with GERD. METHODS SSc patients from the EUSTAR database with ILD were included. GERD was labeled as present if reflux/dysphagia was reported at the baseline visit or before. Disease characteristics of patients with and without GERD were compared at baseline. ILD progression was defined as relative FVC decline ≥10% or relative FVC decline between 5-9% in association with relative DLCO decline of ≥ 15% over 12±3 months of follow-up. Prognostic factors for ILD progression, overall survival and progression-free survival in SSc-ILD patients with GERD were tested by multivariable Cox regression. RESULTS 5462 SSc-ILD patients were included, 4400 (80.6%) had GERD. Patients with GERD presented more frequently with diffuse cutaneous SSc (OR: 1.44 [1.22-1.69], p < 0.001) and more severe lung involvement with lower FVC (85.8±22.1 vs 90.2±20.1, p < 0.001), lower DLCO (60.8±19.7 vs 65.3±20.6, p < 0.001) and worse performance at the 6-minute walking test. Female sex (HR: 1.39 [1.07-1.80], p = 0.012) and older age (HR: 1.02 [1.01-1.03], p < 0.001) independently predicted ILD progression in SSc-ILD patients with GERD. CONCLUSION SSc-ILD patients with GERD appear to suffer from a more severe SSc disease. In this population, female sex may be considered as risk factor for ILD progression

Sex Differences in Patient-rated Outcomes After Lumbar Spinal Fusion for Degenerative Disease

Study design Heterogeneous data collection via a mix of prospective, retrospective, and ambispective methods. Objective To evaluate the effect of biological sex on patient-reported outcomes after spinal fusion surgery for lumbar degenerative disease. Summary of background data Current literature suggests sex differences regarding clinical outcome after spine surgery may exist. Substantial methodological heterogeneity and limited comparability of studies warrants further investigation of sex-related differences in treatment outcomes. Methods We analyzed patients who underwent spinal fusion with or without pedicle screw insertion for lumbar degenerative disease included within a multinational study, comprising patients from 11 centers in 7 countries. Absolute values and change scores (change from pe-operative baseline to post-operative follow-up) for 12-month functional impairment (Oswestry disability index [ODI]) and back and leg pain severity (numeric rating scale [NRS]) were compared between male and female patients. Minimum clinically important difference (MCID) was defined as > 30% improvement. Results Six-hundred-sixty (59%) of 1115 included patients were female. Female patients presented with significantly baseline ODI (51.5 ± 17.2 vs. 47.8 ± 17.9, P<0.001) and back pain (6.96 ± 2.32 vs. 6.60 ± 2.30, P=0.010) and leg pain (6.49 ± 2.76 vs. 6.01 ± 2.76, P=0.005). At 12-months, female patients still reported significantly higher ODI (22.76 ± 16.97 vs. 20.50 ± 16.10, P=0.025), but not higher back (3.13 ± 2.38 vs. 3.00 ± 2.40, P=0.355) or leg pain (2.62 ± 2.55 vs. .34 ± 2.43, P=0.060). Change scores at 12 months did not differ significantly among male and female patients in ODI (∆ 1.31, 95% CI -3.88-1.25, P=0.315), back (∆ 0.22, 95% CI -0.57-0.12, P=0.197) and leg pain (∆ 0.16, 95% CI -0.56-0.24, P=0.439). MCID at 12-months was achieved in 330 (77.5%) male patients and 481 (76.3%) female patients (P=0.729) for ODI. Conclusion Both sexes experienced a similar benefit from surgery in terms of relative improvement in scores for functional impairment and pain. Although female patients reported a higher degree of functional impairment and pain preoperatively, at 12 months only their average scores for functional impairment remained higher than those for their male counterparts, while absolute pain scores were similar for female and male patients

Undetectable pre-radical cystectomy circulating tumour DNA status predicts improved oncological outcomes

OBJECTIVE To assess recurrence-free survival (RFS) in patients with undetectable tumour-informed circulating tumour DNA (ctDNA) before radical cystectomy (RC) and evaluate if those who converted from detectable to undetectable ctDNA status after RC have similar RFS outcomes as those with persistently undetectable ctDNA status. PATIENTS AND METHODS Patients who underwent RC had prospectively and longitudinally collected tumour-informed ctDNA analyses during 2021-2023. ctDNA status was informed from the pre-RC specimen. The minimal residual disease (MRD) window was defined as the initial 90 days after RC. RFS was evaluated using the Kaplan-Meier method. Cox regression analysis was performed to find predictors of disease recurrence. RESULTS The cohort included 135 patients with 647 ctDNA analyses. The median (interquartile range [IQR]) age was 71 (63-77) years. Over a median (IQR) follow-up of 11 (7-18) months, 41 patients (30%) had a recurrence. Pre-RC undetectable ctDNA status was found in 54 patients (40%). The RFS rates at 6, 12, and 21 months were 98%, 93%, and 82%, respectively. Of 77 patients with undetectable ctDNA status at the MRD window available for conversion dynamics analysis, 43 had persistently undetectable ctDNA status (both at pre-RC and MRD window) and 31 converted from pre-RC detectable to MRD undetectable status (conversion group). The persistently undetectable group had significantly better RFS than the conversion group (log-rank, P < 0.001), with 12-month RFS rates of 97% vs 51%, and 18-month RFS rates of 88% vs 51%, respectively. On Cox multivariate analysis, only the conversion group status predicted disease recurrence. CONCLUSIONS Patients with undetectable pre-RC ctDNA status have a favourable prognosis and may be candidates for treatment de-escalation. Those with persistently undetectable ctDNA had superior RFS compared to the conversion group. Pre-RC ctDNA status should be incorporated into trials examining ctDNA use in clinical decision-making

Cystic echinococcosis due to EchinococcusEchinococcus equinusequinus in a Swiss donkey

A 22‐year‐old donkey (Equus asinus) mare was presented for investigation of a 3‐day history of lethargy and anorexia. Serum biochemistry profile revealed severe increased liver‐derived enzymes. Abdominal ultrasound demonstrated several large round cysts in the liver. Broad‐spectrum antimicrobials and anti‐inflammatory therapy were started. However, exacerbation of the clinical signs occurred, and the donkey was euthanised. Necropsy and histopathological evaluation showed multiple hydatid cysts with protoscoleces from Echinocococcus spp. in the liver with replacement of parenchyma by fibrosis accompanied by liver atrophy, severe ascites and thorax effusion. The present report describes the first case of a molecularly confirmed Echinococcus equinus infection in a donkey in northern Switzerland

Indikation der Opioidagonistentherapie (OAT) im Justizvollzug

Die Opioidagonistentherapie (OAT) ist für die Behandlung der Opioidabhängigkeit von zentraler Bedeutung. Es gibt Hinweise darauf, dass dieses Instrument im Justizvollzug z.T. auf Implementierungshürden trifft. Die Autor*innen gelangen auf Basis der medizinischen Evidenz zum Schluss, dass die OAT während der Haft und nach der Entlassung positive Effekte entfaltet und den Behandlungsansatz erster Wahl bei Opioidabhängigkeiten darstellt. Sofern eine inhaftierte Person sich für diesen Behandlungsansatz entscheidet, hat sie das Recht, dass ihr die Vollzugsmedizin eine OAT anbietet

Venous thromboembolism in patients aged ≥90 years: Trends in clinical features, treatment, and outcomes-RIETE registry

BACKGROUND Data on patients aged 90 or older are rare. This study aims to describe clinical characteristics, treatment strategies, and clinical outcomes (rates of VTE recurrence, major bleeding, and mortality), during the first 3 months of anticoagulant treatment for VTE, depending on the treatment period. METHODS We analyzed data from RIETE, an ongoing global observational registry of patients with objectively confirmed acute VTE, grouped in 5-year intervals (2004-2008, 2009-2013, 2014-2018, and 2019-2023). RESULTS Among 3477 patients aged 90 or older, clinical characteristics have changed over time (less heart failure, more dementia), with an increase in PE diagnoses from 57% in 2004-2008 to 69% in 2019-2023 (p-trends <0.001), but of lower severity. For long-term therapy, there was an increase in patients receiving DOACs (p-trends <0.001), with a decrease in patients on VKAs (p-trends <0.001). Mortality and fatal PE respectively showed a temporal trend: 19% and 4% in 2004-2008 to 15% (p-trends 0.026) and 2% (p-trends 0.002) in 2019-2023. In multivariable analyses, fatal PE declined from 2004 to 2023 (HR: 0.91; 95% CI: 0.87-0.96). Compared with VKAs, receiving LMWH during the first 3 months of anticoagulation was associated with a higher risk of major bleeding (HR: 1.91; 95% CI: 1.16-3.14) and death (HR: 2.20; 95% CI: 1.71-2.82). The effect seems to be the opposite for DOACs (HR: 0.50; 95% CI: 0.20-1.30 for major bleeding; HR: 0.86; 95% CI: 0.57-1.28 for all-cause death). CONCLUSIONS Fatal PE declined from 2004 to 2023, despite an increase in the diagnosis of PE. Since the arrival of DOACs, there seems to be better management of the therapeutic and diagnostic aspects of VTE in this population, underlining the need for further research on patients aged 90 or older

The combined effect of a goal-oriented leadership app and leaders’ mindset in optimising training transfer

Despite extensive investments in workplace learning, the failure to transfer the skills and knowledge acquired during training is common. To improve the transfer of training content to the workplace, scholars and practitioners have shown increased interest in setting up transfer interventions. However, there is limited understanding of how transfer interventions, as a form of self-regulated learning, affect training transfer. Using an experimental study design with leaders (N = 253) and their subordinates (N = 717), the present research examines the effectiveness of a transfer intervention, administered via a web-based app, which employs a goal-oriented microlearning approach to prompt leaders’ self-regulation in the context of leadership training. The use of this app-based transfer intervention by an experimental group is then compared to a waiting control group. Furthermore, this study examines the effects of leaders’ mindset (i.e. leadership self-efficacy and motivation to lead) on training transfer. Results from leader self-reports and subordinate ratings largely support the proposed impact of our app-based transfer intervention and leaders’ mindset on strengthening training transfer

Psilocybin increases emotional empathy in patients with major depression

Empathy plays a crucial role in interpersonal relationships and mental health. It is decreased in a variety of psychiatric disorders including major depression. Psilocybin, a promising candidate for treating depression, has been shown to acutely increase emotional empathy in healthy volunteers. However, no study has investigated this effect and its relevance for symptom improvement in a clinical population. This study examines the enduring effects of psilocybin-assisted therapy on empathy in depressed patients using a randomized, placebo-controlled design. Fifty-one depressed patients were randomly assigned to receive a single dose of psilocybin (0215 mg/kg body weight) or a placebo embedded in a 4-week psychological support intervention. Empathy was measured using the Multifaceted Empathy Test at baseline and 2 days, 1 week, and 2 weeks after substance administration. Changes in empathy were compared between treatment conditions. Patients who received psilocybin showed significant improvements in explicit emotional empathy driven by an increase in empathy towards positive stimuli compared to the placebo group for at least two weeks. This study highlights the potential of psychedelics to enhance social cognition in individuals living with depression and contributes to a better understanding of the psychological mechanisms of action of psychedelics. Further studies are necessary to investigate the interaction between social cognition and clinical efficacy.The trial is registered on clinicaltrials.gov (Identifier: NCT03715127) and KOFAM (Identifier: SNCTP000003139)

Assessment of Isokinetic Trunk Muscle Parameters, Postural Control and Quality of Life in Sedentary and Active Older Adults

OBJECTIVE The study intended to evaluate the differences between active and sedentary postural control and isokinetic trunk strength. The secondary aim was to evaluate the participants' total physical activity (PA) score regarding the specific quality of life domains assessed. METHODS An analytical cross-sectional study involving 64 participants of both sexes aged ≥60 years (60-86 years) was conducted. Habitual PA was assessed using the Baecke Modified Questionnaire for older adults, and participants were classified as active or sedentary. Quality of life was assessed using the SF-36 questionnaire, postural control was evaluated using a bipedal force plate, and trunk muscle strength was measured using an isokinetic dynamometer. The independent t-test, Spearman correlation, and Generalized Linear Model were employed, with a significance level of 5%. RESULTS No significant differences were observed in postural control between active and sedentary participants. However, significant differences were observed in the peak touch and mean power of trunk extensors and flexors at speeds of 60 and 180°/s (p < 0.005), except for the ratio between flexor and extensor muscle peak torque assessed at both speeds. Quality of life showed significant correlations with PA level regarding the domains of functional capacity, vitality, and health conditions. The logistic model revealed an association with the domains of functional capacity and pain in relation to PA. CONCLUSION Our results underscore the importance of regular PA practice for the older adult population, indicating the enhancement of health-related quality of life and the strength of trunk extensors and flexors

Auto-Contouring of Cardiac Substructures for Stereotactic Arrhythmia Radioablation (STAR) : A STOPSTORM.eu Consortium Study

BACKGROUND/PURPOSE High doses to healthy cardiac substructures (CS) in stereotactic arrhythmia radioablation (STAR) raise concerns regarding potential treatment-induced cardio-toxicity. However, CS contours are not routinely created, hindering the understanding of the CS dose-effect relationships. To address this issue, the alignment of CS contouring was initiated within the STOPSTORM consortium. In this study, we developed and evaluated auto-contouring models trained to delineate CS and major vessels in ventricular tachycardia (VT) patients. METHODS Eight centres provided standard treatment planning computed tomography (CT) and/or contrast-enhanced CT datasets of 55 VT patients, each including 16 CS. Auto-contouring models were trained to contour either large structures or small structures. Dice Similarity Coefficient (DSC), 95 % Hausdorff distance (HD95) and volume ratio (VR) were used to evaluate model performance versus inter-observer variation (IOV) on seven VT patient test cases. Significant differences were tested using the Mann-Whitney U test. RESULTS The performance on the four chambers and the major vessels (median DSC: 0.88; HD95: 5.8-19.4 mm; VR: 1.09) was similar to the IOV (median DSC: 0.89; HD95: 4.8-14.0 mm; VR: 1.20). For the valves, model performance (median DSC: 0.37; HD95: 11.6 mm; VR: 1.63) was similar to the IOV (median DSC: 0.41; HD95: 12.4 mm; VR: 3.42), but slightly worse for the coronary arteries (median DSC: 0.33 vs 0.42; HD95: 24.4 mm vs 16.9 mm; VR: 1.93 vs 3.30). The IOV for these small structures remains large despite using contouring guidelines. CONCLUSION CS auto-contouring models trained on VT patient data perform similarly to IOV. This allows for time-efficient evaluation of CS as possible organs-at-risk