University Hospital of Bern

To assess the discriminatory ability of vertebra-specific volumetric bone mineral density (vBMD), finite element analysis-derived fracture load (FEA-derived FL), and texture analysis (TA) features for incidental vertebral fractures, and to compare performance between thoracic and lumbar levels. We retrospectively reviewed baseline and follow-up thoracolumbar CT scans from 420 patients and identified 11 patients with incidental vertebral fractures contributing to 20 fractured vertebrae (7 females; mean age 65.5years). For each fractured vertebra, three level-matched control vertebrae from patients without fractures were selected, yielding 58 controls across 29 control patients (total 78 vertebrae). Parameters evaluated include vBMD, FEA-derived FL, and TA features (24 total). Discriminatory ability was assessed using area under the curve (AUC) values. vBMD, FEA-derived FL, and 4 of 24 TA features showed group-wise differences between fractured and control vertebrae groups. AUCs were 0.76 [95% CI 0.55-0.90] (vBMD) and 0.73 [95% CI 0.52-0.90] (FEA-derived FL); selected texture features ranged 0.70-0.72. Region-stratified AUC point estimates were higher in the lumbar than in the thoracic vertebrae, but the 95% CIs were wide/overlapping; comparisons are descriptive. vBMD had the numerically largest AUC point estimate for discriminating fractured from control vertebrae; FEA-derived FL was similar, and selected texture features showed modest discrimination with comparable point estimates across lumbar and thoracic levels, generating the hypothesis of less region dependence. Regional comparisons are descriptive. Findings are exploratory and intended to prioritize candidate measures for validation and future multivariable modeling before any clinical application.

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive biliary destruction and cholestasis. Current therapies, including ursodeoxycholic acid (UDCA), exhibit limited efficacy in advanced disease. In this study, we investigate the therapeutic potential of microbial intervention using Lactobacillus rhamnosus (Lbr) in the Mcpip1fl/flAlbCre knockout mouse model of PBC, which we described previously. Knockout mice develop human PBC-like features such as bile acid dysregulation, autoantibodies, cholangiocyte hyperplasia and fibrosis. Six-week-old Mcpip1fl/fl (wild-type) and Mcpip1fl/flAlbCre (knockout) mice were treated with Lactobacillus rhamnosus supplementation, UDCA (15mg/kg/day), UDCA + Lbr, and UDCA + OCA (obeticholic acid, 10mg/kg/day) for six weeks. Treatment response was characterized by liver and gut pathology, serum biomarkers, transcriptomic profiles, and microbiome composition. Treatment of Mcpip1fl/flAlbCre animals with Lbr decreased serum bile acids and reduced pathological cholangiocyte dysplasia in the liver, decreased leukocyte infiltration and fibrosis. RNAseq of liver tissue revealed enrichment of humoral immune responses and T cell activation pathways in knockouts, all of which were significantly attenuated by Lbr monotherapy. Gut pathology marked by increased intraepithelial lymphocyte infiltration and mucosal hypertrophy, was also normalized upon Lbr administration. Finally, probiotic treatment modulated the microbiome by increasing the Firmicutes/Bacteroidetes ratio and enriching butyrate-producing Lachnospiraceae. Administration of UDCA and UDCA+OCA had less pronounced effects: only decreased serum bile acids was detected in both groups. Probiotic intervention with Lbr represents a feasible strategy to attenuate fibrotic progression in a mouse model of autoimmune cholestatic disease by modulation of the gut-microbiome-immune crosstalk.

Depression and anxiety are common during pregnancy, but the prevalence of antidepressant use during pregnancy in Switzerland is not well documented. We explored antidepressant use before, during, and after pregnancy in Switzerland. We conducted a descriptive study using a Swiss health care insurance claims database (Helsana) between 2015 and 2021. We included pregnancies resulting in birth of women who were continuously insured during three 270-day periods: preconceptional, pregnancy, and postpartum. In these periods, we quantified the exposure prevalence to antidepressants overall and stratified by region and use of co-medication. Antidepressants of interest included selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors, Hyperici herba and others. Additionally, we assessed prevalence of antidepressant discontinuation during pregnancy. We included 34,584 pregnancies of whom 1386 (4.0%) were exposed (≥1 claim) to antidepressants preconceptionally, 788 (2.3%) during pregnancy, and 1273 (3.7%) postpartum. Of 1386 women with preconceptional use, 60% had no antidepressant claim during pregnancy. Antidepressant use decreased from 1.6% in trimester one to 1.1% in trimester three. The most frequently dispensed antidepressants during pregnancy were SSRIs (75.0%). Exposure to antidepressants was two-fold higher in the French-speaking region (2.6%) than in Central Switzerland (1.3%). About one-third of women continuing antidepressant treatment during pregnancy also used benzodiazepines (co-medication) at least once during this time. 4 of 100 women in Switzerland took antidepressants before pregnancy, but 60% discontinued treatment when they became pregnant. Since untreated depression in pregnancy may lead to severe long-term consequences for mother and child, this might be of concern.

Perioperative antibiotic prophylaxis is crucial in improving outcomes after colorectal surgery. Although guidelines in elective procedures are well established, evidence in emergency settings remains limited. This study evaluated the association between antibiotic timing before incision and 30-day mortality as well as surgical site infections (SSIs) in emergency colorectal surgery. This nationwide retrospective cohort study analyzed colorectal operations recorded in the Swiss National Infection Surveillance Program. Demographics, antibiotic regimens, and surgical characteristics of consecutive cases were compared between elective and emergency procedures. Independent predictors of 30-day mortality and SSIs were identified using multivariable logistic regression adjusted for patient and surgical factors. Timing of antibiotic administration was modeled using natural cubic splines to assess nonlinear effects. Among 63,945 patients, 16,939 (26.5%) underwent emergency procedures. In the fully adjusted model, antibiotic timing was significantly associated with 30-day mortality (p < 0.001) in both elective and emergency operations. A U-shaped pattern was observed, with the lowest predicted 30-day mortality when antibiotics were administered 48 minutes before incision in elective operations (mean 1.28%, 95% CI 1.15 to 1.40) and 51 minutes before incision in emergency procedures (mean 10.50%, 95% CI 9.71 to 11.20). In contrast, antibiotic timing was not significantly associated with SSIs (p = 0.229). In both elective and emergency colorectal operations, early or late administration of antibiotics relative to the incision was associated with increased 30-day mortality. The lowest risk occurred when antibiotics were administered approximately 50 minutes before incision. These findings support optimizing perioperative antibiotic timing to improve postoperative outcomes in emergency colorectal surgery.

Patient-reported pain during intravitreal injection (IVI) may vary by injection quadrant and influence adherence to repeated treatments. Hence, this study aimed to quantify whether patient-reported pain differs by IVI quadrant and identify the least-painful approach. We searched 13 literature databases on 15 October 2025 for clinical studies reporting patient-reported IVI pain stratified by injection quadrant (superotemporal [ST], superonasal [SN], inferotemporal [IT], inferonasal [IN]). Random-effects meta-analyses synthesized mean differences (MD) in 0-10 visual analogue scale (VAS) pain across all six pairwise quadrant contrasts. All eligible studies were included for a qualitative review and a meta-analysis. The review was prospectively registered (PROSPERO CRD420251164189). Seven studies comprising 2048 IVI were included (ST 611, SN 469, IT 556, IN 412). Most injections involved anti-VEGF agents. All injections were performed under topical anesthesia (100%; drops or gel), with no subconjunctival anesthesia reported (0%), and pain was recorded immediately post-procedure using VAS-derived scales. Across all six pairwise contrasts, pooled mean differences between quadrants were small (typically < 1 VAS unit on a 0-10 scale), and all 95% confidence intervals crossed zero. Across quadrant comparisons, pooled pain differences were small and inconsistent; none of the pairwise pooled estimates demonstrated a statistically consistent difference, and between-study heterogeneity was substantial to considerable (I2 generally > 80%). Current evidence does not demonstrate a clearly less painful quadrant for intravitreal injections. Estimates varied across studies and heterogeneity was substantial, limiting confidence in any single average quadrant effect. Efforts to minimize IVI-related pain should prioritize optimized anesthesia protocols, communication, and injection technique, while future studies should standardize pain measurement and quadrant allocation to clarify whether subtle quadrant effects exist. PROSPERO registration:CRD420251164189.