155155 research outputs found
Sort by
Effect of Direct Acting Antiviral Drugs on the Occurrence and Recurrence of Intra- and Extra-Hepatic Malignancies in Patients with Chronic Hepatitis C Virus Infection.
Get PDFIntroduction: The use of direct-acting antivirals (DAAs) has drastically changed the management of HCV-infected patients by achieving a 95-98% sustained virologic response (SVR) and reducing morbidity and mortality in this population. However, despite their effectiveness, controversy exists concerning the occurrence of oncologic events following DAA therapy. Aims and Methods: A retrospective analysis was conducted on data from the Swiss Hepatitis C Cohort Study, a prospective cohort involving patients with positive HCV viremia upon inclusion, enrolled in various Swiss centers from September 2000 to November 2021. To examine potential differences in the risk of intrahepatic tumor (IHT) occurrence and death among patients treated with direct-acting antivirals (DAAs), untreated patients, and those receiving interferon (IFN)-based therapy, a semiparametric competing risk proportional hazards regression model was used. Results: Among 4082 patients (63.1% male, median age 45 years; genotype 1: 54.1%; cirrhosis: 16.1%), 1026 received exclusive treatment with IFN-based regimens, and 1180 were treated solely with DAAs. Over a median follow-up of 7.8 years (range: 3.8-11.9), 179 patients (4.4%) developed intrahepatic tumors (IHT), and 168 (4.1%) experienced extrahepatic tumors (EHT). The 5-year cumulative incidence of IHT was 1.55% (95% CI 0.96-2.48) for IFN-based therapy, 4.27% (95% CI 2.93-6.2) for DAA and 0.89% (95% CI 0.4-1.99) for untreated patients. There was no statistically significant difference in the risk of developing IHT (HR = 1.34; 95% CI = [0.70; 2.58]; p = 0.380) or death (HR = 0.66; 95% CI = [0.43; 1.03]; p = 0.066) between patients treated with DAAs and those treated with IFN. Conclusions: The DAAs reduced the risk of death and were not associated with an increased risk of extrahepatic tumors (EHT). In the adjusted model, accounting for cirrhosis and high liver stiffness, the DAA treatment was associated with a higher risk of IHT occurrence compared with untreated patients, emphasizing the relevance of implementing standardized hepatocellular carcinoma (HCC) screening post-DAA treatment
Prognostic impact of selection criteria of current adjuvant endocrine therapy trials NATALEE and monarchE in postmenopausal HRpos/HER2neg breast cancer patients treated with upfront letrozole.
Get PDFBACKGROUND
The monarchE and NATALEE trials demonstrated the benefit of CDK4/6 inhibitor (CDK4/6i) therapy in adjuvant breast cancer (BC) treatment. Patient selection, based on clinical characteristics, delineated those at high (monarchE) and high/intermediate recurrence risk (NATALEE). This study employed a historical patient cohort to describe the proportion and prognosis of patients eligible for adjuvant CDK4/6i trials.
METHODS
Between 2009 and 2011, 3529 patients were enrolled in the adjuvant PreFace clinical trial (NCT01908556). Eligibility criteria included postmenopausal patients with hormone receptor-positive (HRpos) BC for whom a five-year upfront therapy with letrozole was indicated. Patients were categorized into prognostic groups according to monarchE and NATALEE inclusion criteria, and their invasive disease-free survival (iDFS) and overall survival (OS) were assessed.
RESULTS
Among 2891 HRpos patients, 384 (13.3 %) met the primary monarchE inclusion criteria. The majority (n = 261) qualified due to having ≥ 4 positive lymph nodes. For NATALEE, 915 out of 2886 patients (31.7 %) met the eligibility criteria, with 126 patients (13.7 %) being node-negative. Patients from monarchE with ≥ 4 positive lymph nodes and NATALEE with stage III BC exhibited the poorest prognosis (3-year iDFS rate 0.87). Patients ineligible for the trials demonstrated prognoses similar to the most favorable patient groups within the eligibility criteria.
CONCLUSION
Patient populations eligible for monarchE and NATALEE trials differed. Nearly a third of the postmenopausal HRpos population, previously under upfront letrozole treatment, met the NATALEE prognostic eligibility criteria. As certain eligible groups had a prognosis similar to non-eligible patients, it might be interesting to explore additional patient groups for CDK4/6i therapy
Mandibular overdenture retained by four one-piece titanium-zirconium mini implants: a 2-year follow-up on prosthodontic outcomes.
No full textOBJECTIVE
This 2-year prospective study reports the incidence of prosthetic complications and maintenance events after treatment with mandibular overdenture retained by four mini implants opposed to a maxillary denture.
METHODS
Implant intervention included flapless or flapped surgery combined with immediate or delayed loading, as part of a randomized clinical trial. Four one-piece titanium-zirconium mini-implants (Straumann Mini Implant System) were inserted, and the retentive PEEK elements (Optiloc) were incorporated into the overdenture using chairside procedures. Prosthodontic complications and maintenance events were recorded over a 2-year follow-up, and the final outcome was defined according to standardized criteria. Data analysis included descriptive statistics, incidence and incidence density rates, and Kaplan-Meier survival.
RESULTS
73 out of 74 patients (64.9% female), mean age of 64 (SD=8.2) years, completed the study follow-up (one withdrew after 9 months). Implant survival was 100%. A total of 163 prosthodontic events occurred in 53 patients (72.6%), and 20 patients had no clinical complaints or maintenance needs. The most common procedures were adjustment/repair of the overdenture base (47.0%), replacement of retentive inserts (19.8%), and laboratory relining (12.9%). A high prosthodontic success rate was achieved (93.2%), and all patients presented serviceable overdentures and continuous use after the resolution of prosthodontic complications. The incidences of matrix replacement and laboratory relines were low in the first year, while denture base adjustments were common within the first year, especially in the first 6 months.
CONCLUSION
The mini implant system showed high prosthodontic success rates. Minor adjustments/repairs during the initial follow-up were common. Relines and matrix replacements tend to occur after one year of overdenture use, and matrix replacements may occur as a consequence of the need for relining
Anomaly detection in the veterinary antibiotic prescription surveillance system (IS ABV).
Get PDFAntibiotic resistance is one of the major concerns in veterinary and human medicine and poses a considerable threat to both human and animal health. It has been shown that over- or misuse of antibiotics is one of the primary drivers of antibiotic resistance. To develop the surveillance of antibiotic use, Switzerland introduced the "Informationssystem Antibiotika in der Veterinärmedizin" (IS ABV) in 2019, mandating electronic registration of antibiotic prescriptions by all veterinarians in Switzerland. However, initial data analysis revealed a considerable amount of implausible data entries, potentially compromising data quality and reliability. These anomalies may be caused by input errors, inaccuracies, incorrect or aberrant master data or data transmission and make analysis impossible. To address this issue efficiently, we propose a two-stage anomaly detection framework utilizing machine learning algorithms. In this study, our primary focus was on cattle treatments with either single or group therapy, as they were the species with the highest prescription volume. However, not all outliers are necessarily incorrect; some may be legitimate but unusual antibiotic treatments. Thus, expert review plays a crucial role in distinguishing outliers, that are correct from actual errors. Initially, relevant prescription variables were extracted and pre-processed with a custom-built scaler. A set of unsupervised algorithms calculated the probability of each data point and identified the most likely outliers. In collaboration with experts, we annotated anomalies and established anomaly thresholds for each production type and active substance. These expert-annotated labels were then used to fine-tune the final supervised classification algorithms. With this methodology, we identified 22,816 anomalies from a total of 1,994,170 prescriptions in cattle (1.1 %). Cattle with no further specified production type had the most (2 %) anomalies with 7758 out of 379,995. The anomalies were consistently identified and comprised prescriptions with too high and too low dosages. Random Forest achieved a ROC-AUC score of 0.994, (95 % CI: 0.992, 0.995) and a F1-Score of 0.962 (95 % CI: 0.958, 0.966) for single treatments. The versatility of this framework allows its adaptation to other species within IS ABV and potentially to other prescription-based surveillance systems. If applied regularly to uploaded prescriptions, it should reduce input errors over time, improving the validity of the data in the long term
Towards a gapless 1 km fractional snow cover via a data fusion framework
Get PDFAccurate quantification of snow cover facilitates the prediction of snowmelt runoff, the assessment of freshwater availability, and the analysis of Earth’s energy balance. Existing fractional snow cover (FSC) data, however, often suffer from limitations such as spatial and temporal gaps, compromised accuracy, and coarse spatial resolution. These limitations significantly hinder the ability to monitor snow cover dynamics effectively. To address these formidable challenges, this study introduces a novel data fusion framework specifically designed to generate high-resolution (1 km) daily FSC estimation across vast regions like North America, regardless of weather conditions. It achieved this by effectively integrating the complementary spatiotemporal characteristics of both coarse- and fine-resolution FSC data through a multi-stage processing pipeline. This pipeline incorporates innovative strategies for bias correction, gap filling, and consideration of dynamic characteristics of snow cover, ultimately leading to high accuracy and high spatiotemporal completeness in the fused FSC data. The accuracy of the fused FSC data was thoroughly evaluated over the study period (September 2015 to May 2016), demonstrating excellent consistency with independent datasets, including Landsat-derived FSC (total 24 scenes; RMSE=6.8–18.9 %) and ground-based snow observations (14,350 stations). Notably, the fused data outperforms the widely used Interactive Multi-sensor Snow and Ice Mapping System (IMS) daily snow cover extent data in overall accuracy (0.92 vs. 0.91), F1_score (0.86 vs. 0.83), and Kappa coefficient (0.80 vs. 0.77). Furthermore, the fused FSC data exhibits superior performance in accurately capturing the intricate daily snow cover dynamics compared to IMS data, as confirmed by superior agreement with ground-based observations in four snow-cover phenology metrics. In conclusion, the proposed data fusion framework offers a significant advancement in snow cover monitoring by generating high-accuracy, spatiotemporally complete daily FSC maps that effectively capture the spatial and temporal variability of snow cover. These FSC datasets hold substantial value for climate projections, hydrological studies, and water management at both global and regional scales
Characteristics and outcomes of men with erectile dysfunction as the presenting symptom due to a lactotroph adenoma.
Get PDFPURPOSE
Erectile dysfunction (ED) is frequently underreported in men suffering from prolactinomas and can be challenging to manage. Both dopamine agonists (DAs) and transsphenoidal surgery (TSS) correct hyperprolactinemia and restore gonadal function. However, there is scarce data regarding their effectiveness in correcting ED over the long term.
METHODS
This study is a retrospective single-center comparative cohort study analyzing men diagnosed with prolactinomas, both with and without confirmed erectile dysfunction (ED) at diagnosis. Independent risk factors for persistent ED over the long term were examined using multivariate logistic regression.
RESULTS
Among the 39 men with lactotroph adenomas, ED was one of the presenting symptoms in 22 (56%). The mean age at diagnosis was 45 ± 12 years. Surgery was the primary treatment in 6 (27%) ED patients and 8 (47%) non-ED patients. After a mean follow-up of 74 ± 48 months, remission from hyperprolactinemia was achieved in the majority (76%) of men: 71% in the non-ED cohort and 81% in the ED group (p = 0.70), regardless of the primary treatment strategy (surgical 84% versus medical 72%, p = 0.46). Long-term remission of ED was noted in 16 (73%) patients. Interestingly, high baseline BMI levels emerged as potential risk factors for persistent ED over the long term (OR 1.4, 95%CI 1.0-1.9; p = 0.04), while neither the initial adenoma size nor the primary treatment strategy (i.e., TSS vs. DAs) reached statistical significance.
CONCLUSIONS
Correcting hyperprolactinemia and its associated hypogonadism significantly improves ED in the majority of men with prolactinomas over the long term, regardless of the primary treatment strategy employed. In addition to addressing endocrine deficiencies, the early initiation of weight control programs may be considered for men with lactotroph adenomas and ED. Although our study suggests an association between BMI and the risk of persistent ED, further research is needed to establish any causal relationships
The effect of occlusal loading on secondary tooth eruption: An experimental study using a rat model.
Get PDFThis study aimed to assess the impact of occlusal loading on secondary tooth eruption and to determine the extent to which altering the occlusal loading influences the magnitude of secondary eruption through an experimental rat model. The present sample consisted of 48 male Wistar rats. At the onset of the experiment, 24 rats were 4 weeks old (young rats) and 24 rats were 26 weeks old (adult). Within each age group, the rats were further divided into two equal subgroups (12 rats each), receiving either a soft- or hard-food diet for the 3-month duration of the experiment. The primary outcome was the tooth position changes relative to stable references in the coronal plane by evaluating the distance between the mandibular first molars and the inferior alveolar canal. Microcomputed tomography scans were taken from all rats at three standardized intervals over the 3-month study period. Descriptive statistics were calculated by age and diet over time, and the evolution of the outcomes were plotted by age and diet over time. Longitudinal data analysis via generalized estimating equations was performed to examine the effect of age, diet and time on the primary outcomes. Secondary tooth eruption was observed in all age groups (young and adult) regardless of diet consistency (soft or hard food). In young rats, the secondary eruption was greater in the animals fed a soft diet than those fed a hard diet. In adult rats, minimal difference in secondary tooth eruption were found between different diet consistencies. Occlusal loading influences secondary tooth eruption in teeth with an established occlusal contact. The quantity of eruption in growing rats is higher when occlusal loading is less, providing a certain amount of secondary tooth eruption occurs. This difference, however, is not evident in adult rats, at least during the given 3-month time frame
Characteristics and completeness of reporting of systematic reviews of prevalence studies in adult populations: a meta-research study.
Get PDFOBJECTIVE
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, first published in 2009, has been widely endorsed and compliance is high in systematic reviews of intervention studies. Systematic reviews of prevalence studies are increasing in frequency, but their characteristics and reporting quality have not been examined in large studies. Our objectives were to describe the characteristics of systematic reviews of prevalence studies in adults, evaluate the completeness of reporting and explore study-level characteristics associated with the completeness of reporting.
STUDY DESIGN AND SETTING
We did a meta-research study. We searched 5 databases from January 2010 to December 2020 to identify systematic reviews of prevalence studies in adult populations. We used the PRISMA 2009 checklist to assess completeness of reporting and recorded additional characteristics. We conducted a descriptive analysis of review characteristics and linear regression to assess the relationship between compliance with PRISMA and publication characteristics.
RESULTS
We included 1172 systematic reviews of prevalence studies. The number of reviews increased from 25 in 2010 to 273 in 2020. The median PRISMA score for systematic reviews without meta-analysis was 17.5 out of a maximum of 23 and, for systematic reviews with meta-analysis, 22 out of a maximum of 25. Completeness of reporting, particularly for key items in the methods section was suboptimal. Systematic reviews that included a meta-analysis or reported using a reporting or conduct guideline were the factors most strongly associated with increased compliance with PRISMA 2009.
CONCLUSION
Reporting of systematic reviews of prevalence was adequate for many PRISMA items. Nonetheless, this study highlights aspects for which special attention is needed. Development of a specific tool to assess the risk of bias in prevalence studies and an extension to the PRISMA statement could improve the conduct and reporting of systematic reviews of prevalence studies
Minimally invasive extracorporeal circulation versus conventional cardiopulmonary bypass in patients undergoing cardiac surgery (MiECS): Rationale and design of a multicentre randomised trial.
No full textINTRODUCTION
The ultimate answer to the question whether minimal invasive extracorporeal circulation (MiECC) represents the optimal perfusion technique in contemporary clinical practice remains elusive. The present study is a real-world study that focuses on specific perfusion-related clinical outcomes after cardiac surgery that could potentially be favourably affected by MiECC and thereby influence the future clinical practice.
METHODS
The MiECS study is an international, multi-centre, two-arm randomized controlled trial. Patients undergoing elective or urgent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or combined procedure (CABG + AVR) using extracorporeal circulation will be randomized to MiECC or contemporary conventional cardiopulmonary bypass (cCPB). Use of optimized conventional circuits as controls is acceptable. The study design includes a range of features to prevent bias and is registered at clinicaltrials.gov (NCT05487612).
RESULTS
The primary outcome is a composite of postoperative serious adverse events that could be related to perfusion technique occurring up to 30 days postoperatively. Secondary outcomes include use of blood products, ICU and hospital length of stay (30 days) as well as health-related quality of life (30 and 90 days).
CONCLUSIONS
The MiECS trial has been designed to overcome perceived limitation of previous trials of MiECC. Results of the proposed study could affect current perfusion practice towards advancement of patient care
Navigating the evolving landscape of atopic dermatitis: Challenges and future opportunities: The 4th Davos declaration.
Get PDFThe 4th Davos Declaration was developed during the Global Allergy Forum in Davos which aimed to elevate the care of patients with atopic dermatitis (AD) by uniting experts and stakeholders. The forum addressed the high prevalence of AD, with a strategic focus on advancing research, treatment, and management to meet the evolving challenges in the field. This multidisciplinary forum brought together top leaders from research, clinical practice, policy, and patient advocacy to discuss the critical aspects of AD, including neuroimmunology, environmental factors, comorbidities, and breakthroughs in prevention, diagnosis, and treatment. The discussions were geared towards fostering a collaborative approach to integrate these advancements into practical, patient-centric care. The forum underlined the mounting burden of AD, attributing it to significant environmental and lifestyle changes. It acknowledged the progress in understanding AD and in developing targeted therapies but recognized a gap in translating these innovations into clinical practice. Emphasis was placed on the need for enhanced awareness, education, and stakeholder engagement to address this gap effectively and to consider environmental and lifestyle factors in a comprehensive disease management strategy. The 4th Davos Declaration marks a significant milestone in the journey to improve care for people with AD. By promoting a holistic approach that combines research, education, and clinical application, the Forum sets a roadmap for stakeholders to collaborate to improve patient outcomes in AD, reflecting a commitment to adapt and respond to the dynamic challenges of AD in a changing world
Data sources:
BORIS Portal Bern Open Repository and I...BAF-Online: Proceedings of the Berner Al...HASBonline – Hefte zur Archäologie des M...Informationswissenschaft: Theorie, Metho...Jahrbuch Diakonie SchweizJournal of Eye Movement ResearchJournal of Radiation Oncology Informatic...BOP SerialsVersants. Revista suiza de literaturas r...BORIS ThesesAccess Repository Dashboard
Do you manage Bern Open Repository and Information System (BORIS)? Access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard!