Zug Cantonal Hospital

BackgroundWith chronic liver disease (CLD) rising globally, noninvasive methods are needed to stratify early, intermediate, and advanced CLD with and without clinically significant portal hypertension (CSPH).PurposeTo analyze the combined diagnostic value of intravoxel incoherent motion (IVIM) and liver stiffness (LS) from magnetic resonance elastography (MRE) for CLD stage discrimination vs secondary single-parameter analyses.Materials and methodsThis retrospective cross-sectional study included 185 patients who underwent 3T liver MRI, including MRE and IVIM, between March 2016 and November 2023. Patients with CLD were grouped based on their liver fibrosis degree into early CLD (F0-F1; n = 21), intermediate CLD (F2; n = 19), advanced CLD (F3-F4, n = 20), and advanced CLD with CSPH (n = 22). CSPH was defined as splenomegaly (>120 mm) with thrombocytopenia (<100 × 109/L), ascites, or portosystemic collaterals. Patients without CLD (n = 103) served as negative controls. IVIM parameters (tissue diffusivity D, perfusion fraction f, and pseudo-diffusion coefficient D*) and MRE LS were analyzed. Statistical analysis included the Kruskal-Wallis test and both univariate and multivariate regression.ResultsIn total, 185 patients (median age: 55 years, interquartile range 25%-75%: 45-63 years; 94 men) were evaluated. All parameters differed significantly between all groups (P < .001). f and D* decreased with disease progression, while LS increased. D initially decreased in patients with CLD but increased in those with CSPH. Consequently, higher D-values indicated the presence of CSPH in advanced stages (odds ratio [OR] 1.09, 95% CI 1.03-1.17, P = .009). Elevated LS values showed strong associations with the presence of CLD (OR 5.01, CI 2.25-12.65, P < .001). Combining D and LS further improved diagnostic differentiation between disease stages, especially for differentiation between advanced CLD and advanced CLD with CSPH (OR 2.41, CI 1.33-5.44, P = .01).ConclusionIVIM and MRE are useful for characterizing CLD and CSPH. Combining D from IVIM with LS from MRE improves diagnostic accuracy compared to MRE alone.

The application of patient-derived organoids (PDOs) in prostate cancer (PCa) research has been hampered by poor take rates and benign overgrowth. We highlight the limitations of existing culture conditions and identify extracellular matrix composition as a determinant of organoid outcome. Single-cell RNA sequencing reveals that Matrigel-free PDOs exhibit cellular heterogeneity, preserve patient-specific PCa cells with active androgen receptor signaling, and enrich in intermediate cells. In contrast, Matrigel fails to maintain primary PCa cells and produces in vitro basal-like features divergent from patient samples. Furthermore, we redefine cell-type signatures, identify biomarkers discriminating tumor versus other cell types, and show that expression of laminin-binding integrins is a hallmark of Matrigel-derived organoids. Finally, integrating previously published datasets with our data, we generate a prostate PDO single-cell atlas (PPScA), which captures a spectrum of cellular identities while revealing pathways altered in vitro. Our study provides methodological improvements for short-term culture and cellular biology insights.

Vitiligo is an autoimmune disorder marked by the progressive loss of skin melanocytes, increasingly linked to immune dysregulation as a key driver of disease onset and progression. Regulatory T (Treg) cells are essential for maintaining immune homeostasis by suppressing autoreactive immune responses. Mounting evidence implicates functional and numerical alterations in Treg cells in the pathogenesis of vitiligo. This study reviews findings on lesional and circulating Treg cells in vitiligo patients compared to healthy controls (HCs), examining Treg cell frequency, their ability to suppress CD4+ and CD8+ T cell activity, levels of the immunoregulatory cytokines interleukin-10 (IL-10) and transforming growth factor-β (TGF-β), expression of the key suppressive marker FOXP3, as well as levels of the pro-inflammatory cytokines interleukin-17 (IL-17) and interleukin-22 (IL-22). A comprehensive systematic search was performed across Embase, MEDLINE/PubMed, and Scopus databases to identify eligible studies. A total of 21 studies comprising 1016 vitiligo patients and 846 HCs were included in the review. The analysis revealed a significant reduction in peripheral Treg cell counts (p = 0.01), impaired overall suppressive capacity of CD4+ and CD8+ T cells (p = 0.01), reduced levels of IL-10 (p = 0.02), increased levels of IL-17 (p ≤ 0.01) and IL-22 (p ≤ 0.01) in the blood of vitiligo patients compared to HCs. No statistically significant difference was observed in circulating TGF-β levels (p = 0.1). Most studies reported reduced FOXP3 expression in both skin and blood of vitiligo patients. Current evidence suggests vitiligo involves both reduced numbers and impaired function of Treg cells, supporting further study of Treg pathways as targets for immunomodulatory therapy.

Minimally invasive laser enucleation of the prostate has emerged as a promising treatment for benign prostatic hyperplasia. This study investigates the efficacy and safety of miniaturized holmium laser enucleation of the prostate (MiLEP) using Slim (22 Fr) and Ultra-Slim HoLEP (18.5 Fr). We retrospectively analyzed 84 patients who underwent MiLEP between February 2022 and October 2023, performed by a single experienced surgeon. Thirteen patients were treated with Ultra-Slim HoLEP, and 71 with Slim HoLEP. Perioperative parameters, functional outcomes, and complications were assessed intraoperatively and at 2, 6, and 12 weeks postoperatively. Median patient age was 62 [IQR 60-72] and 72 [IQR 65-77] years in the Ultra-Slim and Slim groups, respectively. The median prostate volume was 45ml [IQR 35-65] and 65ml [IQR 50-90], with similar median enucleation weights (36g vs. 35g). No urethral strictures were observed at three months. Continence rates at 12 weeks reached 100% in the Ultra-Slim group and 95.6% in the Slim group. Perioperative efficiency, including total operation time and laser energy use, was comparable between the groups despite differences in prostate volume. MiLEP using Slim and Ultra-Slim instruments provides a safe and effective alternative to standard HoLEP (≥ 26 Fr), demonstrating favorable postoperative continence and a low complication profile. The findings suggest potential benefits of miniaturized instruments in reducing urethral trauma while maintaining enucleation efficiency. Further prospective studies are warranted to validate these results and explore long-term outcomes.

To determine whether the nonfunctional liver volume (NFLV) is an indicator of chronic liver disease (CLD).Multiparametric 3T abdominal MRI examinations enhanced with gadobenate dimeglumine of 51 patients were included in the study and divided into two groups: patients with (n=20) and without (n=31) CLD. Pre- and postcontrast T1 relaxation times of the liver and aorta were measured in the T1 mapping sequences. Total and segmental liver volumes (Lvol) were determined using a convolutional neuronal network. The functional liver fraction (FLF) defined as [(1/T1liver postcontrast - 1/T1liver precontrast) ÷ (1/T1blood pool postcontrast - 1/T1blood pool precontrast)] × (1 - hematocrit) and the nonfunctional liver volume (NFLV) defined as (1 - FLF) × Lvol were calculated for the whole liver, segments I-III, and IV-VIII. Volumes, FLF, and NFLV were compared between the groups using the Mann-Whitney U test and receiver operation characteristics (ROC) analysis.Volumes were significantly higher in patients with CLD than without CLD for the whole liver (p<.01), segments I-III (p<.001), and segments IV-VIII (p<.01). No significant difference was found regarding FLF (p=.20-31). NFLV of the whole liver (p<.01), segments I-III (p<.001), and IV-VIII (p<.01) were significantly increased in patients with CLD. The highest AUCs were observed for Lvol (AUC=.80; p<.001) and NFLV (AUC=.78; p<.001), both in segments I-III. The optimal NFLV cutoff values for CLD were 745 ml for the whole liver (77 % sensitivity; 75% specificity), 174 ml for segments I-III (85% sensitivity; 70% specificity), and 573 ml for segments IV-VIII (77% sensitivity; 75% specificity).MRI-derived nonfunctional liver volume (NFLV) is helpful for early detection of imaging changes in CLD. NFLV is highly associated with CLD, notably when measured in the liver segments I-III. · MRI-derived NFLV may be useful for early detection of CLD.. · NFLV is significantly higher in patients with CLD than those without.. · The best AUC was obtained when NFLV was calculated for segments I-III.. · Ardoino M, Zbinden L, Klaus JB et al. Association of MRI-derived Segmental Nonfunctional Liver Volume and Chronic Liver Disease. Rofo 2025; 197: 1300-1310.

BackgroundThere is a lack of valid instruments for assessing spiritual resources and distress in the context of psychiatry and psychotherapy. To fill this gap, the newly developed Spiritual Distress and Resources Questionnaire (SDRQ) was studied in patients with affective disorders. The purpose of this study was to examine the psychometric properties of the SDRQ.MethodsThe SDRQ was administered to 177 patients with affective disorders. Measurement properties including reliability, structural validity and construct validity were analysed. In addition, a sub-sample of 41 participants completed the SDRQ a second time to assess test-retest reliability.ResultsExploratory factor analysis confirmed that the 22 items of the SDRQ could be grouped into four subscales: spiritual distress, spiritual coping, immanence and transcendence. The spiritual distress, transcendence, immanence and spiritual coping subscales showed high internal consistency as indicated by Cronbach’s alpha coefficients (0.83–0.88). The construct validity of the SDRQ was supported by meaningful and significant correlations with established measures in the field. In particular, higher levels of spiritual distress were strongly associated with higher scores on the Hospital Anxiety and Depression Scale.ConclusionThe results of this study suggest that the SDRQ is a reliable, valid and user-friendly screening tool for assessing spiritual distress, spiritual resources and spiritual coping in patients with affective disorders. The use of the SDRQ may be useful to adequately address and integrate spiritual aspects in a multimodal care approach.

Persistence to B cell depleting therapies (BCDT) like ocrelizumab and rituximab may be higher compared with other disease-modifying therapies (DMT) in multiple sclerosis (MS). Clinical trials directly comparing these treatments are lacking. To compare the risk of treatment discontinuation, relapse, and confirmed disability worsening in patients starting BCDT vs other DMT within real-world settings. In a longitudinal cohort study, patients with relapsing MS starting BCDT (ocrelizumab/rituximab, n = 269) after enrolment into the Swiss MS Cohort (SMSC) were evaluated for treatment discontinuation, occurrence of relapses, and disability worsening in comparison with platform (n = 57) and oral (n = 454) DMT, or natalizumab (n = 73) using Cox regression with double robust adjustment for baseline covariates. Patients starting BCDT were less likely to discontinue treatment than all other DMT combined (HR = 0.26, 95% CI = 0.18-0.36, p < .01), oral DMT (HR = 0.28, 95% CI = 0.20-0.39, p < .01) and natalizumab (HR = 0.35, 95% CI = 0.21-0.58, p < .01). BCDT were associated with lower risk of relapses as compared to oral DMT HR = 0.59, 95% CI = 0.39-0.88, p < .01), but not to natalizumab (HR = 0.90, 95% CI = 0.45-1.82, p = .778). Disability worsening was not significantly different between treatment groups. We provide real-world evidence for patients being more persistent to BCDT than to other treatments, and better clinical outcomes may partly explain this.

PurposeInternal carotid artery dissection (ICA-D) frequently leads to ischemic stroke in individuals under 50 years. There is mounting evidence on the role of the styloid process (SP) in ICA-D, particularly SP length and the SP–ICA distance. Despite having clear guidelines on the treatment of SP-related Eagle syndrome and ICA-D, the concept of SP-related ICA-D is relatively new and no therapeutic guidelines exist.MethodsA narrative literature search was performed to identify all articles pertaining to the diagnosis and treatment of ICA-D linked to an ipsilateral elongated SP or short SP-ICA distance. The treatments were evaluated in terms of symptom recurrence after the treatment. As illustrative examples of clinical management, we present an in-house case series of patients with suspected ICA-D related to SP.ResultsTreatment efficacy was assessed, with an in-house case series provided. Seventy-five reports and case studies involving 84 patients were analyzed. Conservative treatments were common (52%) but had a high symptom recurrence rate (33%). It is noteworthy that no patients treated initially with styloidectomy exhibited symptom recurrence.ConclusionIn case of a correctly diagnosed SP-related ICA-D, a styloidectomy may offer a curative option, but more research is needed for clear indications and standardized guidelines to prevent recurrent symptoms or strokes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00234-025-03616-y.