Gymnase de Nyon

Virtual reality (VR) distraction techniques are promising adjuncts to reduce pain and anxiety. This study assessed the impact of VR distraction during bedside change of vacuum assisted closure (VAC) dressings. In this non-blinded randomized superiority trial, patients scheduled for bedside change of a subcutaneous VAC dressing were allocated to receive distraction through VR masks in addition to a standardized pain protocol (intervention) or pain protocol alone (control). Primary endpoints were pain scores assessed by a visual analogue scale (VAS: 0-10), secondary outcomes were anxiety (State Trait Anxiety Inventory (STAI), VAS: 0-10), hemodynamic parameters, and satisfaction (VAS: 0-10). Pre- and postoperative pain levels were 2.2 ± 2.2 versus 2.0 ± 2.1 (p = 0.38) for the intervention group (21 patients) compared with 2.6 ± 2.1 versus 2.2 ± 1.6 (p = 0.26) for the control group (19 patients), with no significant difference between the groups (p = 0.38). No differences between the two groups were observed for blood pressure and heart rate (HR), besides lower post-procedural HR in the intervention group. Anxiety was reduced in both groups post VAC change in the intervention and control group: STAI 40 ± 12 pre-VAC versus 30 ± 8 post VAC and 45 ± 14 pre-VAC versus 32 ± 9 post VAC (both p < 0.01), ∆VAS -2 (interquartile range IQR 0, -3) versus -2 (IQR 0, -5), both p < 0.01. Postinterventional satisfaction was 8.3 ± 1.9 (intervention) versus 7.5 ± 2.4 (p = 0.11). Pain and anxiety were well managed within a standardized pain protocol, with or without adjunct VR distraction. While this may be due to limited statistical power in this exploratory pilot study, further studies should focus on patients with insufficient control of pain and anxiety with a standard protocol to assess the additional value of VR distraction. Trial Registration: study registered in the FOPH portal SNCTP (Swiss National Clinical Trial): NCT04472416.

This study aimed to assess if there are sex differences in the functional outcome of intravenous thrombolysis (IVT) among patients with lacunar stroke (LS). Consecutive patients admitted from 1 January 2014 to 31 January 2020 to hospitals participating in the Swiss Stroke Registry presenting with LS and treated with IVT were included. The study population was then divided into two groups based on patient sex, and a multivariable ordinal logistic regression analysis was performed to uncover sex differences in the modified Rankin Scale (mRS) score at 90 days after stroke. A total of 413 patients with LS were treated with IVT: 177 (42.9%) women and 236 (57.1%) men. Women were older than men (median age 74 years, 25th-75th percentiles 67-84 years versus 70 years, 25th-75th percentiles 60-80 years, value of p 0.001) and, after adjustment for meaningful variables, showed more frequently increased odds of a higher mRS score at 90 days after stroke (adjusted odds ratio 1.49, 95% confidence interval 1.01-2.19, value of p 0.044). This study showed that female sex increased the odds of a worse functional response to IVT in patients with LS. Future studies should further elucidate the mechanisms underlying such sex differences.

BackgroundThe real-world experience of Swiss chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs) is largely unknown, in particular with regard to achievement of response per European Leukemia Net (ELN) criteria and adherence to ELN recommendations.MethodsThis was a retrospective, non-interventional, multicenter chart review of patients with newly diagnosed CML who had received first-line TKI and were solely treated with TKIs between 2010 and 2015, with a minimum follow-up of 18 months, at six Swiss hospitals. Effectiveness was evaluated according to ELN 2013 milestone achievements at 3, 6, 12 and 18 months, and at last follow-up.ResultsData from 63 patients (56% men; median age at diagnosis 55 years) were collected (first-line imatinib [n = 27], nilotinib [n = 27], dasatinib [n = 8], or ponatinib [n = 1]). TKI switches (49 times) and dosing changes (165 times) due to intolerance or insufficient response were frequent. Compared with patients receiving first-line imatinib, a higher proportion of patients receiving first-line nilotinib or dasatinib achieved optimal response at all timepoints, irrespective of subsequent TKI therapy, and a higher proportion of patients treated with first-line nilotinib and dasatinib reached deep molecular response (BCR-ABL1IS ≤ 0.01%) at 18 months (42 and 38%, respectively, versus 27%). Patients who received nilotinib or dasatinib switched therapies less frequently than patients treated with imatinib, irrespective of subsequent TKI therapy.ConclusionsAlthough patient numbers were small, this real-world evidence study with patients with CML confirms that ELN guidelines are generally implemented in Swiss clinical practice, with a large proportion of patients achieving ELN 2013 milestones. While TKI use involved all inhibitors approved at the time of the study, an unexpectedly high number of TKI therapy switches suggests a clear difference in TKI use between registration trials and clinical practice.

Hemojuvelin (HJV) enhances signaling to the iron hormone hepcidin and its deficiency causes iron overload, a risk factor for hepatocellular carcinoma (HCC). We utilized Hjv−/− mice to dissect mechanisms for hepatocarcinogenesis. We show that suboptimal treatment with diethylnitrosamine (DEN) triggers HCC only in Hjv−/− but not wt mice. Liver proteomics data were obtained by mass spectrometry. Hierarchical clustering analysis revealed that Hjv deficiency and DEN elicit similar liver proteomic responses, including induction of mitochondrial proteins. Dietary iron overload of wt mice does not recapitulate the liver proteomic phenotype of Hjv−/− animals, which is only partially corrected by iron depletion. Consistent with these data, primary Hjv−/− hepatocytes exhibit mitochondrial hyperactivity, while aged Hjv−/− mice develop spontaneous HCC. Moreover, low expression of HJV or hepcidin (HAMP) mRNAs predicts poor prognosis in HCC patients. We conclude that Hjv has a hepatoprotective function and its deficiency in mice promotes mitochondrial dysfunction and hepatocarcinogenesis.

In Switzerland, the COVID-19 epidemic is progressively slowing down owing to &ldquo;social distancing&rdquo; measures introduced by the Federal Council on 16 March 2020. However, the gradual ease of these measures may initiate a second epidemic wave, the length and intensity of which are difficult to anticipate. In this context, hospitals must prepare for a potential increase in intensive care unit (ICU) admissions of patients with acute respiratory distress syndrome. Here, we introduce icumonitoring.ch, a platform providing hospital-level projections for ICU occupancy. We combined current data on the number of beds and ventilators with canton-level projections of COVID-19 cases from two S-E-I-R models. We disaggregated epidemic projection in each hospital in Switzerland for the number of COVID-19 cases, hospitalisations, hospitalisations in ICU, and ventilators in use. The platform is updated every 3-4 days and can incorporate projections from other modelling teams to inform decision makers with a range of epidemic scenarios for future hospital occupancy.

The military government that the Shah half-heartedly installed in early November under General Gholam-Reza Azhari initially scored gains, an indication that the crisis was responding to a show of strength. But Azhari soon began acting as a normal prime minister and quickly lost the initial advantage. The month of Muharram loomed as a daunting challenge. Navigating through that turbulence with minimal damage came to be seen by the regime moguls as a victory in itself. The ban on political processions was lifted. The mammoth twin processions on the days of Tasua and Ashura were seen by all, foreign capitals included, as a plebiscite for Khomeini’s movement and marked a watershed. In the heightened street unrest in late December, a forlorn Shah was forced to play his final cards.

Abstract This paper seeks to estimate how the impact of nontariff measures (NTMs) on trade can vary across exporter–importer pairs. Covering data for the early 2000s, regressions are run at a disaggregate tariff line level and the estimated results are converted into ad valorem equivalents (AVEs). The results underline the importance of conditioning conclusions on trading partners and products and demonstrate that the same NTM can have different—even opposite—effects across exporting countries. One general pattern that emerges is that low‐income importers impose more restrictive NTMs, but that the capacity for exporting countries to address NTMs increases with GDP per capita.