Synovitis maps for the assessment of inflammatory diseases of the hand

Objectives: To compare accuracy and review times of FLASH-MRI-derived synovitis maps (SM) with conventional MR images (cMRI) in the assessment of articular synovitis and tenosynovitis of the hand. Methods: 80 hands in 40 patients (mean age, 48years; range, 15-72years) were assessed for synovitis on cMRI and SM by two readers independently. Reporting times and diagnostic confidence (scale: 1 = least, 5 = most confident) were measured. Results from an assessment of a panel of senior musculoskeletal radiologists served as the standard of reference. Results: Sensitivity and specificity for the detection of articular synovitis were 0.91/1.00 (R1) and 1.00/0.67 (R2) on cMRI and 0.87/0.75 (R1) and 0.91/0.45 (R2) on SM and for the detection of tenosynovitis 0.95/0.63 (R1) and 0.67/0.79 (R2) on cMRI and 0.67/0.89 (R1) and 0.38/1.00 (R2) on SM. Mean review times (cMRI/SM, sec) were 142/37 (R1) and 167/25 (R2). Mean diagnostic confidence (cMRI/SM) was 3.7/3.4 (R1) and 3.2/3.5 (R2) for articular synovitis and 4.0/4.0 (R1), 3.3/3.7 (R2) for tenosynovitis. Conclusion: Synovitis maps provide a comparable diagnostic accuracy to conventional MR images in the assessment of articular synovitis and tenosynovitis of the hand. Because of short review times, synovitis maps provide a fast overview of locations with synovial enhancemen

Supporting Behavior Change After AECOPD – Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel

After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study’s aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients’ key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence – including but not limited to patients’ perspective – and health professionals’ perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated. Keywords: AECOPD, complex intervention, behavior, behavior change, intervention developmen

Bloodstream infection following 217 consecutive systemic-enteric drained pancreas transplants

BACKGROUND: Combined kidney pancreas transplantation (PTx) evolved as excellent treatment for diabetic nephropathy. Infections remain common and serious complications. METHODS: 217 consecutive enteric drained PTxs performed from 1997 to 2004 were retrospectively analyzed with regard to bloodstream infection. Immunosuppression consisted of antithymocyteglobuline induction, tacrolimus, mycophenolic acid and steroids for the majority of cases. Standard perioperative antimicrobial prophylaxis consisted of pipercillin/tazobactam in combination with ciprofloxacin and fluconazole. RESULTS: One year patient, pancreas and kidney graft survival were 96.4%, 88.5% and 94.8%, surgical complication rate was 35%, rejection rate 30% and rate of infection 59%. In total 46 sepsis episodes were diagnosed in 35 patients (16%) with a median onset on day 12 (range 1–45) post transplant. Sepsis source was intraabdominal infection (IAI) (n = 21), a contaminated central venous line (n = 10), wound infection (n = 5), urinary tract infection (n = 2) and graft transmitted (n = 2). Nine patients (4%) experienced multiple episodes of sepsis. Overall 65 pathogens (IAI sepsis 39, line sepsis 15, others 11) were isolated from blood. Gram positive cocci accounted for 50 isolates (77%): Coagulase negative staphylococci (n = 28, i.e. 43%) (nine multi-resistant), Staphylococcus aureus (n = 11, i.e. 17%) (four multi-resistant), enterococci (n = 9, i.e. 14%) (one E. faecium). Gram negative rods were cultured in twelve cases (18%). Patients with blood borne infection had a two year pancreas graft survival of 76.5% versus 89.4% for those without sepsis (p = 0.036), patient survival was not affected. CONCLUSION: Sepsis remains a serious complication after PTx with significantly reduced pancreas graft, but not patient survival. The most common source is IAI

Molecular Typing of Trypanosoma cruzi Isolates, United States

Studies have characterized Trypanosoma cruzi from parasite-endemic regions. With new human cases, increasing numbers of veterinary cases, and influx of potentially infected immigrants, understanding the ecology of this organism in the United States is imperative. We used a classic typing scheme to determine the lineage of 107 isolates from various hosts

Characteristics of Severe Asthma Patients and Predictors of Asthma Control in the Swiss Severe Asthma Registry

Background: Asthma is a chronic airway disease, affecting over 300 million people worldwide. 5–10% of patients suffer from severe asthma and account for 50% of asthma-related financial burden. Availability of real-life data about the clinical course of severe asthma is insufficient. Objectives: The aims of this study were to characterize patients with severe asthma in Switzerland, enrolled in the Swiss Severe Asthma Registry (SSAR), and evaluate predictors for asthma control. Method: A descriptive characterisation of 278 patients was performed, who were prospectively enrolled in the registry until January 2022. Socio-demographic variables, comorbidities, diagnostic values, asthma treatment, and healthcare utilisation were evaluated. Groups of controlled and uncontrolled asthma according to the asthma control test were compared. Results: Forty-eight percent of patients were female and the mean age was 55.8 years (range 13–87). The mean body mass index (BMI) was 27.4 kg/m2 (±6). 10.8% of patients were current smokers. Allergic comorbidities occurred in 54.3% of patients, followed by chronic rhinosinusitis (46.4%) and nasal polyps (34.1%). According to the ACT score, 54.7% had well controlled, 16.2% partly controlled and 25.9% uncontrolled asthma. The most common inhalation therapy was combined inhaled corticosteroids/long-acting β2-agonists (78.8%). Biologics were administered to 81.7% of patients and 19.1% received oral steroids. The multivariable analysis indicated that treatment with biologics was positively associated with asthma control whereas higher BMI, oral steroids, exacerbations, and COPD were negative predictors for asthma control. Conclusion: Biologics are associated with improved control in severe asthma. Further studies are required to complete the picture of severe asthma in order to provide improved care for those patients

The clinical features of asthma exacerbations in early-onset and eosinophilic late-onset asthma may differ significantly

Over 20 years ago, the concept of asthma control was created and appropriate measurement tools were developed and validated. Loss of asthma control can lead to an exacerbation. Years ago, the term "clinically significant asthma exacerbation" was introduced to define when a loss of control is severe enough to declare it an asthma exacerbation. This term is also used by health insurances to determine when an exacerbation is eligible for reimbursement of biologics in clinical practice, however, it sometimes becomes apparent that a clear separation between loss of "asthma control" and an exacerbation is not always possible. In this review, we attempt to justify why exacerbations in early allergic asthma and adult eosinophilic asthma can differ significantly and why this is important in clinical practice as well as when dealing with health insurers

Highly Selective PTK2 Proteolysis Targeting Chimeras to Probe Focal Adhesion Kinase Scaffolding Functions

Focal adhesion tyrosine kinase (PTK2) is often overexpressed in human hepatocellular carcinoma (HCC), and several reports have linked PTK2 depletion and/or pharmacological inhibition to reduced tumorigenicity. However, the clinical relevance of targeting PTK2 still remains to be proven. Here, we present two highly selective and functional PTK2 proteolysis-targeting chimeras utilizing von Hippel–Lindau and cereblon ligands to hijack E3 ligases for PTK2 degradation. BI-3663 (cereblon-based) degrades PTK2 with a median DC₅₀ of 30 nM to >80% across a panel of 11 HCC cell lines. Despite effective PTK2 degradation, these compounds did not phenocopy the reported antiproliferative effects of PTK2 depletion in any of the cell lines tested. By disclosing these compounds, we hope to provide valuable tools for the study of PTK2 degradation across different biological systems

Uniqueness in Discrete Tomography of Delone Sets with Long-Range Order

We address the problem of determining finite subsets of Delone sets $\varLambda\subset\R^d$ with long-range order by $X$-rays in prescribed $\varLambda$-directions, i.e., directions parallel to non-zero interpoint vectors of $\varLambda$. Here, an $X$-ray in direction $u$ of a finite set gives the number of points in the set on each line parallel to $u$. For our main result, we introduce the notion of algebraic Delone sets $\varLambda\subset\R^2$ and derive a sufficient condition for the determination of the convex subsets of these sets by $X$-rays in four prescribed $\varLambda$-directions.Comment: 15 pages, 2 figures; condensed and revised versio

COPD – eine unterschätzte Erkrankung

COPD - An Underestimated Disease Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition with a complex clinical picture. The diagnosis is not easy to make because COPD can develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in the early detection of the disease. Suspected COPD can be confirmed by special examinations in collaboration with pulmonologists. The new GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. A short- or long-acting bronchodilator (SAMA/SABA or LAMA/LABA) is recommended for group A, and a dual long-acting bronchodilator therapy (LABA+LAMA) is recommended for group B and E. In case of blood eosinophilia (≥300 cells/µl) and/or recent hospitalization for COPD exacerbation, triple therapy (LABA+LAMA+ICS) is recommended. General practitioners are important in implementing non-pharmacological measures (smoking cessation, regular exercise, vaccinations, patient selfmanagement education). However, this also underlines the high demands of the implementation of the GOLD guideline in daily practice.COPD ist eine heterogene Erkrankung mit komplexem Krankheitsbild. Die Diagnose ist nicht einfach zu stellen, denn COPD kann sich schleichend entwickeln und lange unbemerkt bleiben. Hausärztinnen und -ärzten kommt daher für die Früherkennung eine zentrale Rolle zu. Der COPD-Verdacht kann in Zusammenarbeit mit Pneumologen durch spezielle Untersuchungen abgesichert werden als Voraussetzung für das medikamentöse Therapiekonzept. Die neue GOLD-Guideline definiert drei COPD-Risikogruppen (A-B-E). Für Gruppe A wird ein kurz- oder langwirksamer Bronchodilatator (SAMA/SABA bzw. LAMA/LABA) empfohlen. Für Gruppe B und E wird eine Kombinationstherapie LABA+LAMA empfohlen. Bei Bluteosinophilie (≥ 300 Zellen/μl) und/oder kürzlicher Hospitalisierung aufgrund einer COPD-Exazerbation wird eine Dreifachtherapie (LABA+LAMA+ICS) empfohlen. Hausärztinnen und -ärzte sind wichtig bei der Umsetzung therapiebegleitender Massnahmen (Coaching von Patientinnen und Patienten, Impfungen, Rauchstopp, regelmässige Bewegung). Dies unterstreicht aber auch die hohen Anforderungen der Umsetzung der GOLD-Guideline in den Praxisalltag