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Volume 149, No. 1314

Published March 25, 2019

Review article: Biomedical intelligence

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    Panagiotis Samaras, Mario Bargetzi, Daniel C. Betticher, Christoph Driessen, Michel A. Duchosal, Dominik Heim, Nicolas Ketterer, Erika Lerch, Thomas Matthes, Ulrich Mey, Thomas Pabst, Adrian Schmidt, Christian Taverna, Thilo Zander, Christoph Renner (Author)

    Updated recommendations for diagnosis and treatment of plasma cell myeloma in Switzerland

    This update on plasma cell myeloma has been elaborated by a Swiss expert panel as a result of the plethora of new data on the treatment of plasma cell myeloma reported recently. It adds new insights to the more extensive review that was published 3 years ago and may help clinicians on decision making for their patients. The new recommendations for distinguishing plasma cell myeloma from smouldering myeloma are briefly presented, including a section on contemporary imaging studies with this respect. Former panel recommendations that remain unchanged by new results will not be discussed in detail as the major focus of this review is on treatment-relevant new developments.

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    Evanthia Tatsidou, Costas Tsiamis, Evika Karamagioli, Georgios Boudouris, Andreas Pikoulis, Eleni Kakalou, Emmanuel Pikoulis (Author)

    Reflecting upon the humanitarian use of unmanned aerial vehicles (drones)

    Nine years after the earthquake in Haiti and the appearance of the concept of “humanitarian drones”, it remains a poorly discussed yet highly controversial issue. Emergency mapping and light cargo deliveries to inaccessible areas are only some of the most popular ways in which drones are currently used for post-disaster relief and health crisis management by first responders around the world. On the other hand, every single successful use for drones is always followed by controversy about the problems caused by that very same, initially successful, use. However, examples of good practices will contribute to the investigation, study and analysis of the ways in which new, cutting-edge technologies such as drones can be implemented and adapted to meet the needs and requirements of humanitarian organisations and local communities affected by disasters. The issue is how and under what circumstances drone use can potentially fulfil humanitarian functions, particularly in the aftermath of a disaster, and how this type of technology could be deployed in non-violent, ethically desirable ways as part of the humanitarian response. In conclusion, it is questionable whether the benefits of using drones outnumber the moral obstacles they raise, and whether they will eventually be considered an inseparable part of humanitarian aid as well as a cutting-edge technological toy.

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    Sophie S. Wang, Yang Yang, Julia Velz, Emanuela Keller, Andreas R. Luft, Luca Regli, Marian C. Neidert, Oliver Bozinov (Author)

    Management of brainstem haemorrhages

    Among spontaneous intracranial haemorrhages, primary non-traumatic brainstem haemorrhages are associated with the highest mortality rate. Patients classically present with rapid neurological deterioration. Previous studies have found that the severity of initial neurological symptoms and hydrocephalus are predictors of poor outcomes. In addition, radiological parameters aim to classify brainstem haematomas according to volume, extension and impact on prognosis. However, previous studies have failed to agree on a differentiated radiological classification for outcome and functional recovery. Electrophysiology, including motor, auditory and somatosensory evoked potentials, is used to estimate the extent of the initial injury and predict functional recovery. The current management of brainstem haematomas remains conservative, focusing on initial close neurocritical care monitoring. Surgical treatment concepts exist, but similarly to general intracranial haemorrhage management, they continue to be controversial and have not been sufficiently investigated. This is especially the case for haematomas in the posterior fossa, as these are excluded from most current clinical trials. Existing studies were mostly carried out before the present millennium began, and limitations are evident in the adaptation of those results and recommendations to current management, with today’s technological and diagnostic possibilities. We therefore recommend the re-evaluation of brainstem haemorrhages in the modern neurosurgical and intensive care environment.

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    Benoîte Mery, Alexis Vallard, Elise Rowinski, Nicolas Magne (Author)

    High-throughput sequencing in clinical oncology: from past to present

    The war on cancer remains a major challenge. One of the obstacles to additional progress is the complexity of the mechanisms underlying the disease. Cutting-edge technologies and computing tools have led to whole genome sequencing and an integrated and inclusive omic approach to cancers, from accurate molecular signatures of tumours to impressive progress in the field of next-generation sequencing (NGS). Genomic data may foster strategies for new drug development in addition to a better understanding of cancer genesis, opening a new era in oncological clinical practice. This review discusses the development of genomics approaches in cancer research and the potential of genomics for precision medicine, as well as clinical implications and remaining challenges.

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    Marcus Mumme, Anke Wixmerten, Sylvie Miot, Andrea Barbero, Alexandre Kaempfen, Franziska Saxer, Sebastian Gehmert, Andreas Krieg, Dirk J. Schaefer, Marcel Jakob, Ivan Martin (Author)

    Tissue engineering for paediatric patients

    The effects of oncological treatment, congenital anomalies, traumatic injuries and post-infection damage critically require sufficient amounts of tissue for structural and functional surgical reconstructions. The patient’s own body is typically the gold standard source of transplant material, but in children autologous tissue is available only in small quantities and with severe morbidity at donor sites. Engineering of tissue grafts starting from a small amount of autologous material, combined with suitable surgical manipulation of the recipient site, is expected to enhance child and adolescent health, and to offer functional restoration for long-term wellbeing. Moreover, engineered tissues based on patient-derived cells represent invaluable models to investigate mechanisms of disease and to develop/test novel therapeutic approaches. In view of these great opportunities, here we introduce the currently limited successful implementation of tissue engineering in paediatric settings and discuss the open challenges in the field. A particular focus is on the specific needs and envisioned strategies in the areas of bone and osteochondral regeneration in children.

Original article

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    Claire Da Costa-Demaurex, Maria T. Cárdenas, Hernando Aparicio, Patrick Bodenmann, Blaise Genton, Valérie D’Acremont (Author)

    Screening strategy for Chagas disease in a non-endemic country (Switzerland): a prospective evaluation

    The WHO recommends screening of Latin American migrants for Chagas disease to reduce morbidity and mortality and increase the likelihood of eradicating the disease. The objective was to assess the feasibility and acceptability of a screening strategy in one Swiss canton. From February 2011 to September 2012, people attending six healthcare centres of different types were offered a rapid diagnostic test if they or their mother were of Latin American origin (or, at the blood donation centre, if they had travelled for ≥1 year in Latin America). In addition, testing was offered during events where Latin Americans gathered. In total, 1,010 people were tested, mainly originating from Brazil (24%), Ecuador (13%) and Chile (10%). 54% were born in Latin America, 15% had a Latin American mother, and 29% were travellers. The prevalence of Chagas disease was 2.3% among migrants (15.5% in the community testing) and 0% among travellers. The prevalence was 18.0%, 0.8%, 0.5% and 0% among Bolivians, Ecuadorians, Brazilians and other countries respectively. Predictors for Chagas disease were: born in Latin America (OR = infinite, p <0.001), Bolivian origin (OR = 95, 95% CI: 19–482, p <0.001), being tested in the community (OR = 56, 95% CI: 14–218, p <0.001), and age >35 years OR = 3.4, 95% CI: 1.1–10.5, p = 0.03). The prevalence of Chagas disease was much higher in people attending social events than healthcare centres, suggesting that observations based only on health facility data underestimate the real prevalence of Chagas disease. Screening in the community was well accepted and should be promoted to reach the population at highest risk.

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    Francesca Compagno, Klaudia Naegele, Christian R. Kahlert, Irene Hösli, Karoline Aebi-Popp, Begona Martinez de Tejada, Paolo Paioni, Sabine Yerly, Jürg Böni, Manuel Battegay, Christoph Rudin, Hans H. Hirsch, the Swiss HIV Cohort Study (Author)

    The rate of mother-to-child transmission of antiretroviral drug-resistant HIV strains is low in the Swiss Mother and Child HIV Cohort Study

    AIMS OF THE STUDY

    Combination antiretroviral therapy (cART) has reduced mother-to-child transmissions (MTCT) and improved the prognosis of HIV-infected newborns. However, drug resistance mutations (DRM) in HIV-infected children, either transmitted by MTCT (HIV-tDRM) or selected by suboptimal adherence and drug levels (HIV-sDRM), remain a concern. We sought to determine the rate of HIV-tDRM and HIV-sDRM in MTCT pairs in Switzerland.

    METHODS

    We performed a retrospective analysis of prospectively collected clinical data and available stored samples from MTCT pairs participating in the Swiss Mother-Child HIV (MoCHIV) cohort.

    RESULTS

    We identified 22 HIV-infected mother-child pairs with delivery between 1989 and 2009 who had 15 years of follow-up (33% white ethnicity). Twenty-one women (96%) were treatment-naïve before pregnancy, 8 (36%) had an unknown HIV status and delivered vaginally, 2 were diagnosed but not treated, and 11 (50%) received antiretrovirals during pregnancy or at delivery, of whom only 6 cases (27%) had cART. HIV subtypes were concordant in all mother-child pairs (subtype B 13/22 [59%]). Using stored plasma (n = 66) and mononuclear cell (n = 43) samples from the children, HIV-tDRM (M184V) was identified in 1 of 22 (4.5%) mothers (1/11 treated, 9%) and was followed by HIV-sDRM at 10 months of age. HIV-sDRM (M184V 23%; K103N 4.5%; D67N 13.6%) occurred in 16/22 (73%) after 4 years, half of whom were treatment naïve. HIV-sDRM were associated with a lower CD4 T-cell nadir (p <0.05) and tended to have higher viral loads and more frequent cART changes.

    CONCLUSIONS

    HIV-tDRM were low in this Swiss MoCHIV cohort, making them a minor yet preventable complication of prenatal HIV care, whereas HIV-sDRM are a significant challenge in paediatric HIV care.

Errata