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

Photodynamic Therapy with Protoporphyrin IX Precursors Using Artificial Daylight Improves Skin Antisepsis for Orthopedic Surgeries

Classical preoperative skin antisepsis is insufficient in completely eliminating bacterial skin colonization for arthroplasty. In contrast, photodynamic therapy (PDT) with red light and methyl-aminolevulinate (MAL), combined with skin antisepsis, led to the absence of bacterial growth in healthy participants, though with local skin erythema, posing an obstacle for orthopedic surgery. Therefore, we explored whether artificial daylight PDT (PDT-DL) was superior to red light. Twenty healthy participants were allocated to either 5-aminolevulinic acid-(5-ALA) PDT-DL (n = 10) or MAL-PDT-DL (n = 10) before antisepsis with povidone-iodine/alcohol. Skin swabs from the groin were taken to cultivate bacteria at baseline, after PDT-DL, and after the subsequent antisepsis. Additional swabs were taken on day 4 before and after antisepsis without PDT. The contralateral groin of each participant and of ten additional healthy volunteers served as the control (n = 30). In selected participants, 16S rRNA-based amplicon deep sequencing was performed. All participants showed a baseline bacterial colonization. After a PDT-DL with skin antisepsis, bacterial growth occurred in three (30%) and in one (10%) participants with 5-ALA and MAL, respectively, compared to the sixteen (55%) participants in the control group. On day 4, three (30%) participants per group showed positive cultures post antisepsis. Adverse effects were reported in six (60%) and zero (0%) participants for 5-ALA- and MAL-PDT-DL, respectively. The skin bacteriome changes correlated with the bacterial culture results. The MAL-PDT-DL with skin antisepsis significantly increased bacterial reduction on the skin without adverse effects. This offers an opportunity to prevent infections in arthroplasty patients and reduce antibiotic use, thus contributing to antibiotic stewardship goals emphasized in the One Health approach

Long-term safety and efficacy of fitusiran prophylaxis, and perioperative management in people with hemophilia A or B

Fitusiran is an investigational small interfering RNA therapeutic that targets antithrombin (AT) to rebalance hemostasis in people with hemophilia. Here we present the results of the completed Phase 2 open-label extension study, which evaluated the long-term safety and efficacy of fitusiran in participants with moderate or severe hemophilia A or B, with or without inhibitors. Male participants who had completed the Phase 1 study (NCT02035605) were enrolled. Participants received monthly subcutaneous fitusiran (50 mg or 80 mg) under the original dose regimen until a voluntary dosing pause in 2020, following which the AT-based dose regimen was introduced, targeting the recommended AT activity levels of 15-35%. Thirty-four participants (hemophilia A [n=27]; hemophilia B [n=7]) were enrolled in the Phase 2 study and treated with fitusiran for a median exposure of 4.1 years. Adverse events reported on the original and the AT-based dose regimen were consistent with the identified risks of fitusiran. Following implementation of the AT-based dose regimen, no thrombotic events, and a reduction in the incidence of elevated transaminases and biliary events were reported. The observed median annualized bleeding rate (ABR) on the AT-based dose regimen (0.87) was comparable to the ABR under the original dose regimen (0.70). Furthermore, fitusiran prophylaxis was associated with improved health-related quality of life compared to baseline and provided successful hemostatic control during surgical procedures and invasive interventions. Overall, fitusiran was well tolerated and effective bleeding control was maintained on an AT-based dose regimen. This trial was registered at www.clinicaltrials.gov as #NCT02554773

Profiling the cellular immune response after aneurysmal sub-arachnoid hemorrhage using single-cell ribonucleic acid (RNA) sequencing

Aneurysmal Subarachnoid hemorrhage is a serious condition caused by bleeding into the subarachnoid space, with significant public health impact due to high mortality and long-term disability rates. Beyond the immediate consequences of the hemorrhage, secondary brain injury further contributes to morbidity and mortality. Recent research has identified cell-free hemoglobin as a key factor in the development of those secondary injuries, particularly in the 4 to 14 days following the initial hemor-rhage. While previous studies have focused on soluble markers in cerebrospinal fluid there is a need to better understand the cellular immune response in the context of the development of secondary injuries as this might offer a potentially modifiable course. This study aims to identify differences in the immune cell population between patients after subarachnoid hemorrhage and healthy subjects