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Volume 155, No. 7

Published July 1, 2025

Review article: Biomedical intelligence

  1. Marine Monney, Jiri Hodecek, Jean-Marc Schwob, Niccolò Buetti, Jacques Schrenzel, Viviane Donner (Author)

    Myiasis in the intensive care unit: report from Switzerland and review of worldwide cases

    Nosocomial myiasis is seldom reported in Europe, and intensive care unit (ICU)-acquired myiasis is even rarer. Here, we describe the first report of hospital-acquired oral myiasis caused by Lucilia sericata occurring in a Swiss ICU. We provide a review of all European cases of oral ICU-acquired myiasis published since 1997 and discuss entomological aspects as well as treatment and prevention of this entity.

  2. Heinz Läubli, Andreas Holbro (Author)

    Genetically engineered T cell and tumour-infiltrating lymphocyte therapies

    Haemato-oncology has made significant progress in recent years, particularly through the development of innovative immunotherapeutic approaches such as CAR T cell (chimeric antigen receptor T cell) and tumour-infiltrating lymphocyte therapies. Both methods use the patient’s own immune system to treat cancer, but in different ways. CAR T cell therapy is a form of immunotherapy in which the patient’s own T cells are genetically modified. CAR T cell therapies have proven to be particularly effective in haematological B-cell neoplasms, such as B-cell acute lymphoblastic leukaemia (B-ALL) and B-cell lymphomas, as well as in multiple myeloma. Tumour-infiltrating lymphocyte therapy, on the other hand, exploits the natural ability of T cells to recognise tumour-associated antigens of tumour cells with the T cell receptor. Tumour tissue is taken from the patient then tumour-infiltrating lymphocytes are isolated from it. These tumour-infiltrating lymphocytes are expanded ex vivo to increase their number and activity. This review discusses the principles of these innovative therapies. Both therapies represent significant advances in personalised cancer treatment and offer new hope for our cancer patients.

  3. Sami Hosari, Michaela Ramser, Matthias Turina (Author)

    Faecal incontinence in the era of sacral neuromodulation

    Faecal incontinence is a debilitating condition that significantly affects an individualʼs quality of life. Accurate assessment and a thorough understanding of the underlying aetiology are crucial in determining the appropriate management approach. Conservative management strategies, including dietary modifications, pelvic floor exercises and biofeedback therapy are the first therapeutic steps. If these measures are not effective, patients should be referred to a specialised pelvic floor centre for further treatment evaluations. With the latest updates on national and international guidelines, this review aims to provide a comprehensive overview of current best practices in the management of faecal incontinence, with a particular focus on the role of sacral neuromodulation.

  4. Samuel E. Christen, Elias Bekka, Yasmin Schmid, Neal L. Benowitz, Evangelia Liakoni (Author)

    Caffeine, nicotine, cannabis, and psilocybin: Pharmacology, toxicology, and potential therapeutic uses of four naturally occurring psychoactive substances

    Psychoactive substances are compounds that can influence perception, consciousness, cognition, and emotions. The psychoactive substances caffeine, nicotine, cannabis, and psilocybin all originate from natural sources and can be used without complex processing or synthesis. Their natural availability has contributed to a long-standing history of human use and cultural significance. Caffeine and nicotine are freely available and commonly used as everyday stimulants, whereas psilocybin is more strictly regulated and cannabis has been legalised in some countries and regions. Some of these substances have been intensively studied, and their pharmacological and toxicological properties are well known, but ongoing research continues to investigate their therapeutic use for specific diseases and disorders. This narrative review aims to provide an overview of the pharmacology and toxicology of these four naturally occurring psychoactive substances, including a summary of the currently available evidence on their therapeutic potential, health benefits, and associated risks.

  5. Laura Rings, Petar Risteski, Igor Tudorache, Achim Häussler, Nestoras Papadopoulos, Hector Rodriguez Cetina Biefer, Omer Dzemali (Author)

    Advancements in less-invasive aortic root, ascending aorta and arch surgery: current evidence and future directions

    Aortic surgery is one of the most challenging areas in cardiovascular medicine because of the complexity of the procedure and the potential for life-threatening complications. Historically, median sternotomy has been the gold-standard approach for thoracic aortic interventions, providing excellent exposure to the entire ascending aorta and the distal aortic arch. This approach has yielded satisfactory postoperative results over the years. However, the invasiveness of median sternotomy is associated with significant surgical trauma, increased postoperative pain and prolonged recovery. Minimally invasive aortic surgery has emerged as a potential alternative to conventional approaches with the aim of combining the benefits of minimally invasive cardiac surgery with the demands of complex aortic interventions. In this review, we aimed to critically analyse the current experiences with minimally invasive aortic surgery via partial upper sternotomy for the treatment of aortic root, ascending aorta and aortic arch pathologies. The partial upper sternotomy (PUS), as a less invasive approach in minimally invasive aortic surgery, represents a substantial advancement in the field of aortic surgery. The current literature on minimally invasive aortic surgery via PUS is predominantly based on retrospective, single-centre studies with small sample sizes, which limits the strength of the conclusions and generalisability. Ventilation time, intensive care unit (ICU) stay, length of hospital stay and bleeding complications can be reduced using this approach. Survival was not negatively affected and cosmetic results were improved by minimally invasive aortic surgery.

Review article: Medical guidelines

  1. Johanna Mangana, Berna C. Özdemir, Daniela Mihic-Probst, Marco Siano, Yannis Metaxas, Lara Valeska Maul, Robert E. Hunger, Nicole Lindenblatt, Radu Olariu, Roger von Moos, Panagiotis Balermpas, Luis Schiappacase, Cristina Mangas, Olivier Michielin, Reinhard Dummer (Author)

    The updated Swiss guidelines for the treatment and follow-up of cutaneous melanoma

    Despite the globally rising incidence of melanoma, mortality rates have decreased by approximately 18% in Caucasian populations following the introduction of effective systemic treatments.

    Thanks to new molecular insights, the management of cutaneous melanoma has undergone several transformations over the past decade. The existing guidelines were last updated in 2016 to provide evidence-based practical recommendations for melanoma specialists across Switzerland. Recent data on surgical, radiotherapeutic and mainly systemic treatment with the implementation of adjuvant and neoadjuvant treatments in the current melanoma management have made modifications of the treatment and follow-up recommendations necessary.

  2. Max J. Rieger, Andreas J. Flammer, Sabine Gerull, Thomas Pabst, Holger W. Auner, Kaveh Samii, Felicitas Hitz, Ulrich Mey, Veronika Ballova, Raphael Battegay, Giorgia Melli, Dominik Benz, Yakup Yakupoglu, Christoph Gräni, Regina Schläger, Sarah Hugelshofer, Annina Studer, Luca Oechslin, Adam Bakula, Thomas M. Suter, Julia Leo-Stickelberger, Manuela Averiamo, Thomas Fehr, Hans H. Jung, Natallia Laptseva, Robert Manka, Axel Rüfer, Adrian Schmidt, Harald Seeger, Beat Müllhaupt, Simon F. Stämpfli, Carmen de Ramon Ortiz, Marie Théaudin, Bernhard Gerber, Rahel Schwotzer (Author)

    Updated recommendations for the treatment of light-chain amyloidosis from the Swiss Amyloidosis Network

    Since the publication of the first Swiss recommendations on systemic light-chain amyloidosis in 2020, treatment strategies have evolved. As a result of the third joint meeting of the Swiss Amyloidosis Network, a multidisciplinary and multicentre Swiss clinical consortium, in 2024, recommendations for the treatment of light-chain amyloidosis were updated. They discuss the role of the new standard first-line protocol Daratumumab, Cyclophosphamide, Bortezomib, Dexamethasone (Dara-CyBorD), the timing and indication of high-dose treatment and potential second-line strategies as well as emerging treatment options, with a special focus on multidisciplinary supportive care measures. The update represents a synopsis of current evidence and expert consensus and intends to provide general treatment guidance tailored to the Swiss healthcare system. Nonetheless, treatment decisions should always be personalised and involve a multidisciplinary approach. This update replaces the previous “therapeutic recommendations” while the previous “diagnostic recommendations” remain valid.

Original article

  1. Lydia Canham, Carolin Steinack, René Hage, Maurice Roeder, Silvia Ulrich, Gernot Ortmanns, Silvan Vesenbeckh, Thomas Gaisl, Macé M. Schuurmans (Author)

    Coronavirus infection and chronic lung allograft dysfunction: a retrospective cohort study

    INTRODUCTION: Long-term survival in lung transplant recipients is limited by chronic lung allograft dysfunction, which can be triggered by respiratory tract infections.

    STUDY AIMS: We investigated the incidence of chronic lung allograft dysfunction in a cohort of lung transplant recipients over 10 years, focusing on its association with human coronavirus (HCoV) respiratory tract infections and all-cause mortality.

    METHODS: This 10-year retrospective cohort included 259 lung transplant recipients between 2010 and 2020. Nasopharyngeal swab samples were analysed during regular outpatient visits and when symptoms indicated respiratory tract infections using a multiplex polymerase chain reaction panel to test for HCoV subtypes 229E, HKU1, NL63, and OC43. Data regarding chronic lung allograft dysfunction, clinical characteristics, infectious parameters, and lung function tests were recorded. An adjusted Cox proportional hazards regression model was applied.

    RESULTS: 166 lung transplant recipients survived the early postoperative period. Over a cumulative observation period of 711.4 patient-years, 57.8% (96/166) of patients were confirmed to have had at least one HCoV infection. On average, the incidence of HCoV respiratory tract infections (n = 380) was 0.53±0.33 per patient-year, and 32.9% (125/380) of respiratory tract infections were in asymptomatic patients. In routine follow-up visits, patients were tested for HCoV infections based on unclear inflammatory responses. Chronic lung allograft dysfunction developed in 45.8% (76/166) of lung transplant recipients. HCoV infections were associated with a higher subsequent likelihood of chronic lung allograft dysfunction (hazard ratio [HR] adjusted = 2.52, 95% CI 1.32–4.80, p = 0.005). After contracting HCoV infections, lung transplant recipients experienced higher C-reactive protein levels on days 4 and 5 after the infection, but there were no immediate changes in lung function parameters.

    CONCLUSION: While HCoV infections may not always show symptoms, they may increase the likelihood of subsequent chronic lung allograft dysfunction in lung transplant recipients.

  2. Marlon Petrus, Silke Graul, Rafael Loucas, Julius M. Mayer, Sebastian Leitsch, Thomas Holzbach (Author)

    Comparing coverage of medically indicated reduction mammoplasty among Swiss health insurers: a retrospective study

    BACKGROUND: Reduction mammoplasty is commonly used to treat macromastia, highlighting the need to address the physical and psychosocial issues associated with breast hypertrophy. However, clear inconsistencies in insurance coverage and varying criteria for medically necessary surgery are evident. The compliance of Swiss insurance companies with the 2019 recommendations of the Swiss Society of Medical Officers and Insurance Physicians has not been fully assessed.

    AIM: This study aimed to investigate the proportion and variability in cost approvals for reduction mammoplasty among Swiss insurers, focusing on differences in their approval and denial rates.

    METHODS: A retrospective study was conducted on patients presenting with breast disease at Spital Thurgau AG between January 2016 and December 2022. It analysed the proportion and variability in cost approval rates for reduction mammoplasty among different insurance providers. Demographic patient data were collected and statistically analysed using chi-squared and Fisher’s exact tests to evaluate if a statistically significant relationship exists between insurance providers and cost approval. Only Swiss insurance providers servicing at least five patients in the final cohort were included.

    RESULTS: Between January 2016 and December 2022, 1105 patients with breast disease were evaluated at Spital Thurgau AG, of whom 210 were eligible for this study on reduction mammoplasty cost approvals. Of the 210 cost approval requests made to nine different insurance companies, 54% were approved. Approval rates differed significantly among insurers (p = 0.003).

    CONCLUSION: This study uncovered an elevated rate of cost approval denials, which depended significantly on the insurance provider. To ensure that the costs of a medically indicated breast reduction are covered consistently and fairly, a review of existing guidelines and their implementation is necessary to improve the system.

  3. Sara Cottler-Casanova, Véra Lourenço, Cécile Guillot, Antoine Poncet, Fartuun Musse, Romane Imbaud, Patrice Mathevet, Patrick Petignat, Michal Yaron, Tony Fracasso, Jasmine Abdulcadir (Author)

    Sexual assault reporting: a retrospective study on care provided in gynaecology emergency care settings after sexual assault

    OBJECTIVE: To assess the characteristics of all people reporting sexual assault at the obstetrics and gynaecology emergency departments of Geneva University Hospitals (HUG) and Lausanne University Hospitals (CHUV) between 2018 and 2021.

    METHODS: Retrospective analysis of medicolegal reports for all people reporting sexual assault at the obstetrics and gynaecology emergency departments of HUG and CHUV between 2018 and 2021. Included: cisgender women, non-binary, queer persons, transgender men with a vulva and vagina and transgender women, regardless of sexual orientation, aged at least 14 years old. Excluded: Children and adolescents <14, cisgender men and trans men with a penis (who usually do not consult obstetrics and gynaecology emergency departments after a sexual assault) and recurrent patients with more than three sexual assaults reported at a participating centre within the study period (the first three assaults were included). During the study period, the two regional university hospitals used the same forensic sexual assault reporting forms, which allows a uniform description of the sociodemographic and clinical characteristics of patients reporting sexual assault as well as the characteristics of the sexual assault itself.

    KEY FINDINGS: Of the 962 sexual assault records during the 48-month study, 740 were retained for the analysis. Median age of victims: 24 years (interquartile range: 19 to 33 years; range: 14 to 93 years). On weekend days, the number of assaults was twice as high as on weekdays (45% of all sexual assaults took place during the weekend, on either a Saturday or Sunday). During the summer, the monthly number of assaults was increased by half. The summer months had the highest number of consultations (34%). 58% of victims reported knowing their assaulter, 28% did not, and due to amnesia, 14% did not know whether they knew their attacker or not. 24% of the patients were unable to recall or specify which types of penetration they were subjected to (if any), because of amnesia. 67% of patients reported vaginal penetration, 17% anal and 21% oral. 63% of victims reported some type of substance use (alcohol, drugs) prior to the assault. The police or public prosecutor ordered 40% of the sexual assault medicolegal examinations, while 60% of the victims came to the emergency department seeking care on their own. 56% of assaults take place at someone’s home (victim’s home, assailant’s home, friend/family member’s home, couple’s home). 83% of patients were examined within 72 hours of the sexual assault. Ano-genital injuries were found in 28% of patients who underwent a gynaecological exam (n = 705). 21% of patients who underwent a gynaecological exam and reported anal penetration presented with anal injury. 28% of patients who underwent a gynaecological exam and reported vaginal penetration presented with genital injury.

    CONCLUSIONS AND RECOMMENDATIONS: Such data can inform the general population as well as actors working in this field, including legislators, about the use of services after sexual assault, prevention and health education strategies and how to improve services for people who are sexually assaulted. There is no countrywide observatory of persons consulting for sexual assault in Swiss hospitals. We aim to create a national observatory that can inform prevention, care and education campaigns against sexual assault and its consequences for both men and women.

  4. Eleni Theano Samara, Lorraine Sazgary , Anja Stüssi , Natalia Saltybaeva , Matthias Guckenberger , Frank Ruschitzka , Thomas Wolber , Nadine Molitor , Daniel Hofer, Fu Guan, Gonca Suna , Julia Hermes-Laufer , Corinna B. Brunckhorst , Firat Duru , Alexander Breitenstein, Ardan M. Saguner (Author)

    Local diagnostic reference levels for cardiac implantable electronic device procedures: data from a tertiary care centre

    AIM: To establish local diagnostic reference levels for cardiac implantable electronic device procedures and to compare local practice with national guidelines.

    METHODS: A retrospective cohort study including all consecutive patients from October 2018 to October 2020 who underwent implantation of a cardiac implantable electronic device including pacemaker, implantable cardioverter defibrillator (ICD), cardiac resynchronisation therapy (CRT) or lead extraction / device explantation. Data was collected from a dose management system and cross-checked for accuracy with the patient information system. The pre-specified outcome was patient radiation exposure, evaluated with the kerma area product (KAP), cumulative dose, fluoroscopy time and number of cine acquisitions. The median values were set as local diagnostic reference levels.

    RESULTS: A total of 541 patients were included. 28.3% had a conventional pacemaker, 22.0% a leadless pacemaker, 21.1% an ICD and 17.2% a CRT implanted, while lead extraction / device explantation was performed in 11.5% of patients. The local diagnostic reference levels for the kerma area product were lower than the national Swiss diagnostic reference levels (0.4 Gray [Gy]∙cm2 vs 30 Gy∙cm2 for conventional pacemakers; 0.4 Gy∙cm2 vs 20 Gy∙cm2 for ICDs; 10.2 Gy∙cm2 vs 57 Gy cm2 for CRTs). Similarly, the local diagnostic reference levels for cumulative dose and fluoroscopy time were below national diagnostic reference levels.

    CONCLUSIONS: Local diagnostic reference levels values were far below national diagnostic reference levels. A multicentre approach to assess patient radiation exposure in current practice is strongly desired to establish revised national diagnostic reference levels.

  5. Michael Doulberis, Daniele Riva, Ioannis Linas, Patrick Mosler, Tom Völler, Imen Jallouli, Jürg Knuchel, Claudia Gregoriano, Pablo Gressot, Thrasyvoulos Gkretzios, Christos Kiosses, Thomas Balanis, Radu Tutuian, Hasan Kulaksiz, Anna Cano-Català, Pablo Parra, Leticia Moreira, Olga P. Nyssen, Francis Megraud, Colm O' Morain, Thomas Kuntzen, Javier P. Gisbert (Author)

    Effectiveness and safety of first-line empirical Helicobacter pylori eradication regimens in Switzerland: an interim analysis from a prospective multicentre registry (Hp-EuReg)

    BACKGROUND: Helicobacter pylori infection remains prevalent globally. Despite the relatively low reported prevalence in Switzerland, the actual burden is thought to be higher, primarily due to migration. To date, limited evidence is available regarding the effectiveness of Helicobacter pylori eradication therapy in Switzerland.

    METHODS: This is a sub-study of the European Registry on Helicobacter pylori Management (Hp-EuReg), an international, multicentre, prospective, non-interventional registry of the routine clinical practice of gastroenterologists. All adult patients with Helicobacter pylori infections were systematically registered in the AEG-REDCap electronic case report form from 2013 to December 2023. Swiss data were analysed for effectiveness on a modified intention-to-treat (mITT) basis, assessing both the therapy duration and the acid inhibition administered with treatment.

    RESULTS: A total of 486 adult patients diagnosed with Helicobacter pylori infection were evaluated. Of these, 428 (88%) were treatment-naïve patients. A total of 283 patients with available follow-up were evaluated for effectiveness, adverse events, and compliance. Two first-line regimens accounted for over 90% of cases: amoxicillin-clarithromycin triple therapy in 49% and 10-day single-capsule bismuth quadruple therapy (containing metronidazole-tetracycline-bismuth) in 42%. The overall modified intention-to-treat effectiveness was 92%, achieving 91% in the low-dose proton pump inhibitor (PPI) group (20 mg omeprazole equivalent twice daily) and 96% in the group receiving high-dose (80 mg omeprazole equivalent twice daily) proton pump inhibitors. The lowest effectiveness (82%, 28/34 cases) was reported with 7-day amoxicillin-clarithromycin triple therapy, while the highest effectiveness (97%, 100/103 cases) was achieved with single-capsule bismuth quadruple therapy. Regarding safety, the overall incidence of at least one adverse event was 8.5%, and no serious adverse events were reported.

    CONCLUSIONS: In Switzerland, 10-day single-capsule bismuth quadruple therapy with metronidazole, tetracycline, and bismuth demonstrated high eradication success (>90%) and represents a promising empirical first-line treatment option in routine clinical practice.

  6. Bettina Marturet Fendt, Celina Geiss, Muriel Elhai, Joachim Diebold, Alexander Vogetseder (Author)

    From gaps to compliance: a 12-year retrospective cohort study of trends in mismatch repair protein testing and Lynch syndrome identification in colorectal cancer in Central Switzerland

    STUDY AIM: Alongside an analysis of incidence trends in colorectal cancer and Lynch syndrome over time, the study sought to evaluate the implementation and trends of reflex testing for mismatch repair proteins and key mutations in relevant genes (BRAF, KRAS, NRAS) in colorectal cancer in Central Switzerland from 2011 to 2022, specifically assessing adherence to the Swiss Academy for Quality in Medicine (SAQM) guidelines, in order to identify any gaps or inconsistencies in testing practices that may hinder the diagnosis of Lynch syndrome or microsatellite instability, highlighting areas requiring improvements for optimal patient care.

    METHODS: This retrospective study enrolled 2602 patients with 2673 histologically confirmed colorectal cancers. Data collection from the Central Switzerland Cancer Registry included demographic, molecular and immunohistochemical profiles of all histologically confirmed colorectal cancers over the analysed 12-year period. Statistical analyses were performed using R (v4.3.1) with the tidyverse package. Normality was assessed with the Shapiro-Wilk test and non-parametric comparisons were made using the Wilcoxon rank-sum test. Chi-square and Fisher’s exact tests were used for categorical variables, while Poisson and binomial regression models were used to evaluate temporal trends.

    RESULTS: Of 2673 tumours analysed, 76% were tested for mismatch repair proteins, with testing rates improving significantly from 58% in 2011 to >99% in 2022. Among these, 14% showed a mismatch repair protein deficiency, with 77% being MLH1-related and 23% non-MLH1-related, categorising them as Lynch-suspected. 73% (n = 257) of the MLH1-deficient tumours underwent further molecular testing for BRAF mutations. Among these, 33% showed no mutation, also categorising them as Lynch-suspected, while the remaining 67% were categorised as sporadic. In total, 6% of the tested tumours were categorised as Lynch-suspected and required further testing and/or genetic counselling. Statistical estimates suggest that among the non-tested tumours, 88 cases could potentially harbour a microsatellite instability, including approximately 5 Lynch-suspected cases. Additionally, in 44 cases, incorrect mismatch repair proteins were tested, potentially leading to missed microsatellite instability. Among the 59 tumours that did not undergo BRAF testing, approximately 20 may have been Lynch-suspected and missed due to insufficient testing. Tumour incidence and the proportion of Lynch-suspected tumours among all tumours remained stable over time, without cantonal hotspots.

    CONCLUSIONS: Remarkable progress in colorectal cancer diagnostics across Central Switzerland could be demonstrated, leading to a near-complete compliance with guidelines for mismatch repair proteins and molecular testing by 2022. This high adherence to guidelines provides a solid foundation for better personalised surveillance and treatment, ultimately improving the quality of care for colorectal cancer patients in the region. However, during the early years of the study some gaps existed, particularly in testing practices for rectal cancers and incomplete molecular follow-up, potentially missing some patients with a microsatellite instability, who could have benefited from different therapies, and Lynch syndrome patients, who together with their families could have benefited from tighter surveillance.