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SummaryThis study investigates the relationship between cognitive dysfunction or delirium detected in the early post-surgical phase and the 1-year mortality among 514 hip fracture hospitalized older persons. Patients with early cognitive dysfunction or delirium experienced a 2-fold increased mortality risk. Early post-operative cognitive dysfunction and delirium are negative prognostic factors for mortality.Background and purposePremorbid cognitive impairment and dementia in older individuals negatively affect functional recovery after hip fracture. Additionally, post-operative delirium is an established risk factor for negative outcomes among hip fracture patients. While the majority of hip fracture patients experience minor post-surgical cognitive dysfunction, the prognostic value of this phenomenon is unknown. Therefore, we investigated the relationship between minor cognitive dysfunction or delirium detected in the early post-surgical phase and the 1-year mortality after index hip fracture.Subjects and methodsWe enrolled 514 patients with hip fracture (77.4 % women), aged 65 years or older (mean age 83.1 ± 7.3 years), who underwent surgical hip fracture repair. Patients were assessed daily from the second to the fourth post-operative day and at 3, 6, and 12 months thereafter. All participants underwent comprehensive assessment, including detection of delirium by using the confusion assessment method and evaluation of cognitive function by using mini-mental state examination (MMSE; score range 0 to 30, with lower scores indicating poorer performance). In the absence of delirium, post-surgical cognitive dysfunction was defined as having low performance on MMSE. Vital status of 1 year after the index fracture and date of death were gathered from local registries.ResultsThe observed 1-year mortality rate was 14.8 %. Men were more likely to die than women within 1 year of the index fracture (p < 0.01). Compared to participants with better cognitive performance, those with MMSE < 24, as well as those with delirium in the post-operative phase, showed a significantly higher 1-year mortality rate (23.3 versus 17.9 and 8.1 %, respectively). Independent of age and sex, post-operative cognitive dysfunction as well as delirium was both associated with a 2-fold increased mortality risk.ConclusionsThe presence of minor cognitive dysfunction in the early post-surgical phase is a negative prognostic factor for mortality among elderly hip fracture patients. The burden of minor cognitive dysfunction is likely superimposed on that of delirium in subgroups of frail patients.

Purpose To assess d -dimer levels during pregnancy and postpartum period and evaluate the appropriateness of commonly used cut-offs for ruling out pulmonary embolism (PE) in this population. Methods Secondary analysis of the prospective PPH 1300 study conducted at the University Hospital Zurich, including 1309 women between 25 + 0 and 42 + 3 weeks of gestation without acute thromboembolic events. d -Dimer levels were measured at admission for delivery and 24–48 h postpartum, stratified into four gestational age groups. Results Median d -dimer values were 1.56 mg/L (IQR 1.20–2.12) antepartum and 1.78 mg/L (IQR 1.25–2.84) postpartum. Antepartum, 99.3% of women had levels ≥ 0.5 mg/L and 88.8% ≥ 1.0 mg/L; postpartum, 98.8% and 88.1% exceeded these cut-offs, respectively. Antepartum values showed an increasing trend with gestational age, whereas postpartum values remained uniformly elevated. No clinically relevant thromboembolic events occurred during the index hospitalization. Conclusions Nearly all pregnant and postpartum women exceed conventional d -dimer thresholds also in the absence of thromboembolism. Standard cut-offs of 0.5 and 1.0 mg/L are therefore unsuitable in obstetric practice, limiting the applicability of general diagnostic algorithms, such as YEARS and Geneva, unless specifically adapted. Trimester- and postpartum-adjusted thresholds or alternative biomarkers are needed to reduce unnecessary imaging and improve clinical management.

The K.118 building on Winterthur’s Lagerplatz, completed in March 2021, has been widely recognised and awarded as an outstanding example for applying the principles of the circular economy to architecture. Commissioned by the Swiss pension fund Stiftung Abendrot, the architects Baubüro in situ planned and constructed a building using reclaimed components wherever possible. The planning and construction process was analysed by the Institute of Constructive Design (IKE) at the Zurich University of Applied Sciences (ZHAW) in cooperation with the architects. The study shows that the reuse of building components has great potential for saving resources and reducing greenhouse gas emissions during the construction phase of buildings. In order to use this potential, economic and procedural obstacles created by the framework conditions of today’s construction industry must be tackled.

Background: The role of second-line chemotherapy (CT) is not established in advanced biliary tract cancer (aBTC). We investigated the outcome of aBTC patients treated with second-line CT and devised a prognostic model. Methods: Baseline clinical and laboratory data of 300 consecutive aBTC patients were collected and association with overall survival (OS) was investigated by multivariable Cox models. Results: The following parameters resulted independently associated with longer OS: Eastern Cooperative Oncology Group performance status of 0 ( P <0.001; hazard ratio (HR), 0.348; 95% confidence interval (CI) 0.215–0.562), CA19.9 lower than median ( P =0.013; HR, 0.574; 95% CI 0.370–0.891), progression-free survival after first-line CT ⩾6 months ( P =0.027; HR, 0.633; 95% CI 0.422–0.949) and previous surgery on primary tumour ( P =0.027; HR, 0.609; 95% CI 0.392–0.945). We grouped the 249 patients with complete data available into three categories according to the number of fulfilled risk factors: median OS times for good-risk (zero to one factors), intermediate-risk (two factors) and poor-risk (three to four factors) groups were 13.1, 6.6 and 3.7 months, respectively ( P <0.001). Conclusions: Easily available clinical and laboratory factors predict prognosis of aBTC patients undergoing second-line CT. This model allows individual patient-risk stratification and may help in treatment decision and trial design.

Abstract BackgroundSex-related differences in patients with aneurysmal subarachnoid hemorrhage (aSAH) exist. More females than males are affected. Aneurysm location is associated to sex. The relationship between sex and outcome, however, is unclear. Possible differences in management might influence the occurrence of primary and secondary brain injury and thus outcome. The study compares demographics, intensity of treatment, complications, and outcome among females and males with aSAH.MethodsAll consecutive patients with aSAH admitted to the neurocritical care unit, University Hospital Zurich over a 5-year period were eligible in this retrospective study. Patients’ characteristics, comorbidities, aSAH severity, frequency of vasospasm/delayed cerebral ischemia, frequency of invasive interventions, and 3-month outcome were compared by sex. Univariate analysis was performed with the data dichotomized by sex, and outcome. Multivariate analysis for prediction of outcomes was performed.ResultsThree hundred forty-eight patients were enrolled (64% females). Women were older than men. Comorbidities, scores at admission, and treatment modality were comparable among males and females. Vasospasm and DCI occurred similarly among females and males. Interventions and frequency of intraarterial spasmolysis were comparable between sexes. In the multivariate analysis, increasing age, female sex, increasing comorbidities, WFNS and Fisher grade, and presence of delayed cerebral ischemia were predictors of unfavorable outcome when considering all patients. However, after excluding death as a possible outcome, sex did not remain a predictor of unfavorable outcome.ConclusionsIn the study population, women with aSAH might have present a worse outcome at 3 months. However, no differences by sex that might explain this difference were found in intensity of treatment and management.

Background Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases. Case presentation We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis. Conclusions Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.

Background—The Dionysos Study is a cohort study of the prevalence of chronic liver disease in the general population of two northern Italian communities. It included 6917 subjects, aged 12–65 (69% of the total population). Aims—The aim of this part of the study was to examine the relationship of daily alcohol intake, type of alcoholic beverage consumed, and drinking patterns to the presence of alcohol induced liver damage in an open population. Patients and methods—6534 subjects, free of virus related chronic liver disease and participating in the first cross-sectional part of the study, were fully examined. Each subject underwent: (a) medical history and physical examination, (b) evaluation of alcohol intake using an illustrated dietary questionnaire, and (c) routine blood tests. More invasive diagnostic procedures were performed when indicated. Results—Multivariate analysis showed that the risk threshold for developing either cirrhosis or non-cirrhotic liver damage (NCLD) was ingestion of more than 30 g alcohol per day in both sexes. Using this definition, 1349 individuals (21% of the population studied) were at risk. Of these, only 74 (5.5% of the individuals at risk) showed signs of liver damage. The prevalence of “pure” alcoholic cirrhosis was 0.43% (30 of 6917), representing 2.2% of the individuals at risk, with a ratio of men to women of 9:1, while 44 (3.3% of the individuals at risk) showed persistent signs of NCLD. After 50 years of age, the cumulative risk of developing both NCLD and cirrhosis was significantly higher (p<0.0001) for those individuals who regularly drank alcohol both with and without food than for those who drank only at mealtimes. Conclusions—Our data show that in an open population the risk threshold for developing cirrhosis and NCLD is 30 g ethanol/day, and this risk increases with increasing daily intake. Drinking alcohol outside mealtimes and drinking multiple different alcoholic beverages both increase the risk of developing alcohol induced liver damage.

Covid-19 or SARS-CoV-2, a new RNA virus with high infectivity, and seemingly low mutability, which appeared in 2019 in the Wuhan province of China, has created a pandemic with dire consequences. At the end of May 2020, it became the first cause of mortality. As no treatment or vaccine may become available before many months, and because occurrence of similar pandemics is only a matter of time, arguments are presented here for testing the effect of transfer factor (TF), an immunomodulator devoid of toxicity, which has been extensively studied in the past for the treatment and prevention of viral infections.

There is limited evidence indicating the contribution of trunk kinematics to patellofemoral pain (PFP). A better understanding of the interaction between trunk and lower extremity kinematics in this population may provide new avenues for interventions to treat PFP. To compare trunk and lower extremity kinematics between participants with PFP and healthy controls during a stair-descent task. Cross-sectional study. Research laboratory. Twenty women with PFP (age = 22.2 ± 3.1 years, height = 164.5 ± 9.2 cm, mass = 63.5 ± 13.6 kg) and 20 healthy women (age = 21.0 ± 2.6 years, height = 164.5 ± 7.1 cm, mass = 63.8 ± 12.7 kg). Kinematics were recorded as participants performed stair descent at a controlled velocity. Three-dimensional joint displacement of the trunk, hip, and knee during the stance phase of stair descent for the affected leg was measured using a 7-camera infrared optical motion-capture system. Pretest and posttest pain were assessed using a visual analogue scale. Kinematic differences between groups were determined using independent-samples t tests. A 2 × 2 mixed-model analysis of variance (group = PFP, control; time = pretest, posttest) was used to compare knee pain. We observed greater knee internal-rotation displacement for the PFP group (12.8° ± 7.2°) as compared with the control group (8.9° ± 4.4°). No other between-groups differences were observed for the trunk, hip, or other knee variables. We observed no difference in trunk kinematics between groups but did note differences in knee internal-rotation displacement. These findings contribute to the current knowledge of altered movement in those with PFP and provide direction for exercise interventions.

At present no reports on gene expression profiling of liver metastases from colorectal cancer are available. We identified two different signatures using Affymetrix platform: epidermal growth factor receptor pathway was upregulated in metachronous lesions, whereas the pathway mainly related to angiogenesis was in synchronous lesions. Synchronous or metachronous liver metastases could be treated differently on the basis of different molecular pathways.