Spital Thurgau (Switzerland)

Micropterix aureofasciella Heath, 1986 is a North African micropterigid endemic to the Maghreb region, initially described from specimens collected along the coastal strip between Algiers and Philippeville (now Skikda). This species, characterized by an extremely restricted distribution and considered potentially threatened, had not been observed for 116 years in Algeria. Recent surveys conducted in the Theniet El Had National Park, in northwestern Algeria, have documented new specimens, thereby representing a notable inland extension of species’ known range and marking its rediscovery. This study provides a comprehensive update of the species’ distribution and a detailed morphological description based on Heath (1986) and new genital preparations. M. aureofasciella was first recorded from Algeria. We also publish records from Tunisia, which were made in the 1986, for the first time. To date, no information is available on the biology of M. aureofasciella, and its early developmental stages remain unknown, highlighting the need for further studies and targeted conservation actions to ensure its survivor.

Myocardial injury after non-cardiac surgery (MINS) is a significant postoperative complication. In 2022, the European Society of Cardiology (ESC) updated its guidelines, recommending perioperative troponin monitoring for a broader surgical population. This study aimed to assess the implications of implementing these guidelines in a secondary Swiss hospital. Patients meeting ESC guideline criteria for troponin testing were identified, along with those undergoing surgeries deemed similar in risk and complexity. We retrospectively analyzed all in-patient non-cardiac surgeries performed in 2023 (n = 6413). Demographic data, cardiac risk factors, new cardiac diagnoses, and mortality within 3 months post-surgery were assessed. The primary outcome was the demand for postoperative troponin testing when applying the 2022 ESC guidelines. The secondary outcome was to detect new cardiac diagnoses among patients meeting these criteria. Of the 6413 in-patient surgeries, 1306 (20%) met the guideline's or study-defined criteria for intermediate-risk, high-risk, or procedures similar regarding risk and complexity. After excluding ineligible patients, we analyzed data from 1231 patients, and found 1089 patients (88% of included patients; 17% of all patients) who would have required testing. Within 3 months postoperatively, we identified 72 patients (6%) who developed new cardiac conditions and 54 patients (4%) died. Surgeries outside regular hours comprised 17% of cases. Substantial postoperative troponin testing would be required to comply with the 2022 ESC guidelines, necessitating expanded organizational capacity and resources. While the value of early detection and prevention of MINS is clear, implementation in routine clinical practice may be challenging.

Abstract Many European lakes have suffered oxygen declines from recent eutrophication raising the question as to which conditions are representative of their pre-impact state. Here we present a palaeoecological record revealing that deepwater oxygen in small lakes can be variable over long timescales and subject to human influence for millennia. Remains of chironomids and other invertebrates indicate that Bichelsee (Switzerland) shifted from a stable, oxygen-rich to a dynamic, oxygen-poor state before major human activity. Initially, increased human activity and clearcutting coincided with improved oxygen conditions for deepwater midge larvae. However, from the Roman Age onwards, similar disturbances were associated with low oxygen and reduced deepwater invertebrate populations. These results demonstrate that small European lakes can have multiple, contrasting pre-impact reference states, and that ecological effects of human activity, even their directionality, may shift over time. Furthermore, repeated cycles of impact and recovery can occur over millennia, complicating assumptions about their baseline conditions.

To evaluate the effect of intraoperative administration of 1g of tranexamic acid (TXA) on perioperative and postoperative outcomes in patients receiving antithrombotic therapy undergoing endoscopic enucleation of the prostate (EEP). This multicenter, prospective, observational study included 932 patients across 30 centers (December 2024-June 2025). Patients were divided into four groups based on TXA use and continuation or discontinuation of blood thinners during EEP. The primary endpoint was bleeding complications within 30 days, defined as a composite of transfusion, clot retention, bleeding requiring restart of continuous bladder washout (CBWO), or surgical reintervention to control hemostasis. Multivariable Logistic regression analysis identified independent predictors of bleeding complications. There were 534 patients in Group 1 (stopped blood thinners, no TXA given), 316 in Group 2 (on blood thinners, no TXA given), 69 in Group 3 (stopped blood thinners, TXA given), and 13 in Group 4 (on blood thinners, TXA given). Median total operative time was longest in Group 2 (88min [IQR 70-127]) and shortest in Group 3 (55min [IQR 39-69]). Hemostasis time was shortest in TXA groups (p < 0.001). Transfusions occurred in 0.6-7.7% and surgical reinterventions in 0.6-7.7% across groups (p < 0.001). At 3 months, urinary symptoms and continence were comparable. On multivariable analysis, TXA reduced the odds of bleeding complications (OR 0.17, p < 0.001), while ongoing anticoagulant therapy (OR 2.93, p = 0.01), dual therapy (OR 4.31, p < 0.001), and longer operative time (OR 1.01, p < 0.001) increased the odds. Intraoperative TXA might mitigate perioperative bleeding and potentially protect patients at higher hemorrhagic risk.

Teaching in the operating room represents the cornerstone of surgical education. While residents need to perform enough basic procedures to gain independence, their impact on outcomes remains debated. We conducted a retrospective study using a Swiss national registry between 2009 and 2019. Patients who underwent laparoscopic cholecystectomy were identified. Baseline characteristics were analyzed, and a propensity score was constructed using age, gender, American Society of Anesthesiologists (ASA) classification, workday status, operation setting, and surgical indication. Patients were then matched in a 2:1 ratio (non-teaching vs. teaching), and surgical outcomes were assessed. The primary outcome was safety, defined by the incidence and severity of postoperative complications. We included 34,080 cholecystectomies in our analysis. After propensity-score matching, 7038 interventions used for surgical teaching were compared to 14,076 performed by board-certified surgeons. Mean cohort age was 53 years, and 7.7% of patients had an ASA>II. Our analysis found comparable safety outcomes in regard to frequency (1.5 vs. 1.6%, p = 0.5) and severity (Clavien-Dindo ≥IIIa: 42.0 vs. 42.7%, p = 0.8) of postoperative complications. The teaching group had a longer mean operating time (85 ± 38 vs. 73 ± 44 minutes, p < 0.001), while the mean postoperative LOS was comparable between groups (3.70 ± 5.64 days). Multivariate regression analysis identified older age, ASA ≥III, weekend days, and urgent setting as independent negative predictors of teaching. Teaching residents a common surgical procedure, such as cholecystectomy appears safe, with equally low complication rates and severity, despite longer operative times.

Switzerland's decentralised healthcare system delegates responsibility for paediatric hospital infrastructure to individual cantons. To date, official statistics on the number and types of paediatric hospital beds are lacking. This study sought to fill this gap by collecting and analysing data from all paediatric hospitals in Switzerland. A nationwide cross-sectional e-mail survey was conducted in January 2023. Data on both structurally available and operated beds were collected and descriptively analysed. The survey identified a total of 1751 beds in 29 paediatric hospitals or departments, of which 85% were operated. Of the total beds, 112 were paediatric intensive care unit beds (80% operated) and 339 were neonatology beds (86% operated). Significant regional disparities in bed availability were identified: the Lake Geneva region has the highest bed-to-child ratios, while Central Switzerland, Eastern Switzerland and Ticino show notably lower ratios. These findings highlight the current distribution of paediatric beds, the considerable proportion of non-operated beds, and the importance of continued, comprehensive data collection to inform healthcare planning.

Erectile dysfunction (ED) is a concern for men undergoing prostate biopsy. With the increasing adoption of transperineal (TP) biopsy over transrectal (TR) biopsy, it remains unclear which approach carries a lower risk of erectile dysfunction. This study aims to be the first meta-analysis to evaluate erectile dysfunction following TR versus TP prostate biopsy at 1, 3 and 6months intervals, thereby providing clinicians with evidence-based guidance for patient counseling and shared decision-making. This review was prospectively registered on PROSPERO (CRD42024541557) and followed PRISMA guidelines, with searches conducted in PubMed, Scopus, and the Cochrane Library databases up to July 2024. A total of 22 studies reporting erectile function outcomes (IIEF scores) at baseline and 1, 3 and 6months post-biopsy were identified. After applying inclusion and exclusion criteria, 12 studies were included in the final meta-analysis. TR and TP biopsy methods were compared using a random-effects model to assess standardized mean differences (SMD) in erectile function at each follow-up point. The risk of bias for each study was evaluated to ensure result reliability. At 1month follow-up, a significant decline in erectile function was observed overall (SMD: - 0.3785, p = 0.038). The TP approach showed a slightly more significant decline than the TR approach; however, this difference was not statistically significant (p = 0.074). At 3months follow-up, no significant differences were observed between methods overall (SMD: - 0.1663, p = 0.132), although TP biopsy alone showed a modest yet considerable decline (SMD: - 0.1868, p = 0.03). At 6months, erectile function had generally returned to baseline, with no significant differences observed between biopsy techniques (p = 0.41). Both TR and TP prostate biopsies are associated with a transient decline in erectile function. These effects typically resolve by 6months in most patients, with no significant long-term impact observed. While the initial functional impact may be slightly greater with the TP technique, this difference attenuates over time. These findings are crucial for managing patient expectations post-biopsy.

ABSTRACT The use of low ammonia emission equipment for slurry distribution has become mandatory in a number of countries. However, the effects of different application methods on dry matter (DM) yield, nitrogen (N) utilisation, botanical composition and forage quality are still debated. This study offers a comprehensive assessment of the effect of various slurry application methods on forage production. Slurry distribution equipment (broadcast; band‐spread; trailing‐shoe), as well as slurry consistency (unaltered or extra dilution), timing (immediately or delayed after preceding cut) and sward types (with or without legumes) were tested at two sites. Low‐emission equipment significantly increased DM yield and N utilisation at one of the two sites. Slurry dilution proved positive for N utilisation and DM yield, while early application timing had marginal effects. Low‐emission equipment had no effect on the proportion of legume species, and at one site, it had only irrelevant effects on the proportion of undesired species. Silage quality was not negatively affected by low‐emission equipment but was indicated to be positively influenced by extra diluted slurry and early application. We conclude that the use of low‐emission slurry distribution equipment can be advantageous in intensively managed grasslands in terms of N utilisation and yield. However, these positive effects are not guaranteed. Negative effects on forage quality are very unlikely with such equipment, provided that the general recommendations for silage production are followed. Slurry dilution is also advantageous, particularly when broadcast or band‐spread equipment is used.