[The lying and rumination behavior of healthy dairy cows housed in tie stalls is associated with bedding depth]. / Das Liege- und Wiederkauverhalten klinisch gesunder Milchkühe in Anbindehaltung ist assoziiert mit der Einstreutiefe.

INTRODUCTION: The lying and rumination behavior of dairy cows is internationally used as an animal welfare indicator. Dairy cow housing in Switzerland is subordinated to detailed legal requirements. It is particularly described that the lying area for cows must be covered with a sufficient amount of bedding. In the current study, we investigated whether bedding depth influences the lying and rumination behavior and thus, the animal welfare of healthy dairy cows housed in tie stalls. Bedding depth was categorized as ≤ 2 cm and > 2 cm. The lying and rumination behavior of 145 cows from 33 farms was recorded and analyzed considering farm effects; 105 cows were housed on ≤ 2 cm bedding, and 40 cows on > 2 cm bedding. Cows on > 2 cm bedding had on average a one hour longer daily lying time compared with cows on ≤ 2 cm bedding (mixed-effects linear regression: mean difference [cows on > 2 cm bedding - cows on ≤ 2 cm bedding] = 60,7 min/d; standard error = 28,6 min/d; p-value = 0,037). The odds of a cow to lie while ruminating were significantly higher in cows on > 2 cm bedding against cows on ≤ 2 cm bedding (mixed-effects logistic regression: Odds ratio = 1,27; CI95% [1,17-1,38]; p-value 2 cm can make a significant difference in the lying and rumination behavior of healthy dairy cows housed in tie stalls. Consequently, the animal welfare of dairy cows in tie stalls is improved by providing at least 2 cm of bedding.

INTRODUCTION: Le comportement de couchage et de rumination des vaches laitières est internationalement utilisé comme indicateur du bien-être animal. En Suisse, la détention des vaches laitières est soumise à des règles légales précises. Il est entre autre prescrit que l'aire de couchage doit être pourvue d'une litière appropriée en quantité suffisante. Dans la présente étude nous avons examiné si l'épaisseur de la litière avait une influence sur le comportement de couchage et de rumination, et ainsi aussi sur le bien-être animal, de vaches laitières saines détenues en stabulation entravée. L'épaisseur de la litière a été répartie en catégories de ≤ 2 cm respectivement de > 2 cm. Le comportement de couchage et de rumination de 145 vaches en provenance de 33 exploitations a été documenté et analysé en tenant compte de l'impact de l'exploitation: 105 vaches ont été détenues sur ≤ 2 cm de litière et 40 vaches sur > 2 cm de litière. Les vaches détenues sur > 2 cm de litière avaient en moyenne une durée de couchage journalière prolongée d'une heure (régression linéaire mixte: différence moyenne [vaches sur > 2 cm de litière ­ vaches sur ≤ 2 cm de litière] = 60,7 min/d; écart type = 28,6 min/d; Valeur p = 0,037). La probabilité que les vaches soient couchées lors de la rumination était significativement plus grande chez les vaches détenues sur > 2 cm de litière par rapport aux vaches détenues sur ≤ 2 cm de litière (régression logistique mixte: odds ratio = 1,27; CI95% [1,17­1,38]; Valeur p 2 cm est associée à des différences significatives de comportement de couchage et de rumination de vaches saines détenues en stabulation entravée. En conséquence, la mise à disposition d'un minimum de 2 cm de litière sur les zones de couchage des vaches détenues en stabulation entravée permet une amélioration quantifiable du bien-être animal.

BK Polyomavirus-Specific 9mer CD8 T Cell Responses Correlate With Clearance of BK Viremia in Kidney Transplant Recipients: First Report From the Swiss Transplant Cohort Study.

BK polyomavirus (BKPyV) causes premature kidney transplant (KT) failure in 1-15% of patients. Because antivirals are lacking, most programs screen for BKPyV-viremia and, if positive, reduce immunosuppression. To evaluate the relationship of viremia and BKPyV-specific immunity, we examined prospectively cryopreserved plasma and peripheral blood mononuclear cells at the time of transplantation (T0) and at 6 mo (T6) and 12 mo (T12) after transplant from 28 viremic KT patients and 68 nonviremic controls matched for the transplantation period. BKPyV IgG seroprevalence was comparable between cases (89.3%) and controls (91.2%; p = 0.8635), but cases had lower antibody levels (p = 0.022) at T0. Antibody levels increased at T6 and T12 but were not correlated with viremia clearance. BKPyV-specific T cell responses to pools of overlapping 15mers (15mer peptide pool [15mP]) or immunodominant CD8 9mers (9mer peptide pool [9mP]) from the early viral gene region were not different between cases and controls at T0; however, clearance of viremia was associated with stronger 9mP responses at T6 (p = 0.042) and T12 (p = 0.048), whereas 15mP responses were not informative (T6 p = 0.359; T12 p = 0.856). BKPyV-specific T cells could be expanded in vitro from all patients after transplant, permitting identification of 78 immunodominant 9mer epitopes including 50 new ones across different HLA class I. Thus, 9mP-responses may be a novel marker of reconstituting CD8 T cell function that warrants further study as a complement of plasma BKPyV loads for guiding immunosuppression reduction.

Days spent in acute care hospitals at the end of life of cancer patients in four Swiss cantons: a retrospective database study (SAKK 89/09).

Number of days spent in acute hospitals (DAH) at the end of life is regarded as an important care quality indicator for cancer patients. We analysed DAH during 90 days prior to death in patients from four Swiss cantons. Claims data from an insurance provider with about 20% market share and patient record review identified 2086 patients as dying of cancer. We calculated total DAH per patient. Multivariable generalised linear modelling served to evaluate potential explanatory variables. Mean DAH was 26 days. In the multivariable model, using complementary and alternative medicine (DAH = 33.9; +8.8 days compared to non-users) and canton of residence (for patient receiving anti-cancer therapy, Zürich DAH = 22.8 versus Basel DAH = 31.4; for other patients, Valais DAH = 22.7 versus Ticino DAH = 33.7) had the strongest influence. Age at death and days spent in other institutions were additional significant predictors. DAH during the last 90 days of life of cancer patients from four Swiss cantons is high compared to most other countries. Several factors influence DAH. Resulting differences are likely to have financial impact, as DAH is a major cost driver for end-of-life care. Whether they are supply- or demand-driven and whether patients would prefer fewer days in hospital remains to be established.

Association of daptomycin use with resistance development in Enterococcus faecium bacteraemia-a 7-year individual and population-based analysis.

OBJECTIVE: In this study we aimed to analyse the association between use of daptomycin and MICs of daptomycin in Enterococcus faecium bacteraemia. METHODS: We prospectively enrolled patients aged ≥18 years with E. faecium bacteraemia hospitalized at the University Hospital Basel from 2008 to 2014. We determined daptomycin MICs by Etests and used pulsed field gel electrophoresis to determine clonal relatedness. We recorded the defined daily dosages of daptomycin (DDDs) per 100 patient-days and clinical data from charts. We correlated daptomycin MIC with use of daptomycin in patients with recurrence/persistence. RESULTS: In 195 E. faecium bacteraemias originating from 162 patients the median MIC for daptomycin was 2 mg/L (IQR 2-3); 30% (15.4%) isolates had a MIC ≥4 mg/L and 6 (3.1%) were resistant (MIC >4 mg/L) according to CLSI criteria. The usage of daptomycin increased more than four-fold from 0.36 DDDs/100 patient-days in 2008 to 1.6 in 2014. In 13 of 28 (42.9%) patients with a relapsing or persisting bacteraemia, the daptomycin MIC of the second isolate increased from a median of 2.0 to 2.5 mg/L (p 0.010); 3/13 (23.1%) developed resistance. All patients with the same clone in the first and second episode and an increase of daptomycin MIC had been treated with daptomycin (6/6 versus 1/7 p 0.005). CONCLUSIONS: Daptomycin MICs and Daptomycin usage increased over time. On an individual patient level daptomycin exposure was associated with an increased MIC in subsequent bacteraemia episodes. Diversity did not indicate a clonal origin and argues for a de novo development of resistance.

Altered processing of self-related emotional stimuli in mindfulness meditators.

Mental health benefits of mindfulness techniques are thought to involve changes in self-processing, such as decreased attachment to the self, higher self-compassion and lower emotional reactivity to inner experience. However, self-related emotion processing in regular mindfulness practitioners is not extensively studied. In the current work we investigate differential neural and behavioral correlates of self-criticism and self-praise in 22 mid-to-long-term mindfulness meditators (LTM) compared to 22 matched meditation-naïve participants (MNP). In an fMRI experiment, participants were presented with blocks of individually selected positive (self-praise, SP), negative (self-critical, SC), negative but not-self-critical (NNSC), and general, neutral (NT) adjectives, and reported their affective state after the blocks. On the neural level, both SP and SC yielded more activation in the dorso-medial prefrontal cortex (DMPFC) in LTM compared to MNP. Activation in this region correlated positively with non-react scores of the Five Facets Mindfulness Questionnaire (FFMQ) and showed decreased functional connectivity to posterior midline and parietal regions in LTM compared to MNP during both self-related appraisals. Further, we found evidence for emotional reactivity in LTM on the neural level, particularly during SP. On the behavioral level, a mixed effects analysis revealed significantly higher differences in affective ratings after blocks of SC compared to SP in MNP compared to LTM. Differences in DMPFC activation and affective ratings point towards increased awareness, potentially mindful regulation of SC and SP in LTM, while decreased connectivity to other regions of the default mode network could reflect a decreased self-focus in this group. As such, our results illustrate differences in self-related emotional processes in meditators and offer clinically relevant insights into mechanisms of mindful emotion regulation when facing self-criticism and self-praise.

Antibiotic use in adult outpatients in Switzerland in relation to regions, seasonality and point of care tests.

The use of antibiotics is highest in primary care and directly associated with antibiotic resistance in the community. We assessed regional variations in antibiotic use in primary care in Switzerland and explored prescription patterns in relation to the use of point of care tests. Defined daily doses of antibiotics per 1000 inhabitants (DDD(1000pd) ) were calculated for the year 2007 from reimbursement data of the largest Swiss health insurer, based on the anatomic therapeutic chemical classification and the DDD methodology recommended by WHO. We present ecological associations by use of descriptive and regression analysis. We analysed data from 1 067 934 adults, representing 17.1% of the Swiss population. The rate of outpatient antibiotic prescriptions in the entire population was 8.5 DDD(1000pd) , and varied between 7.28 and 11.33 DDD(1000pd) for northwest Switzerland and the Lake Geneva region. DDD(1000pd) for the three most prescribed antibiotics were 2.90 for amoxicillin and amoxicillin-clavulanate, 1.77 for fluoroquinolones, and 1.34 for macrolides. Regions with higher DDD(1000pd) showed higher seasonal variability in antibiotic use and lower use of all point of care tests. In regression analysis for each class of antibiotics, the use of any point of care test was consistently associated with fewer antibiotic prescriptions. Prescription rates of primary care physicians showed variations between Swiss regions and were lower in northwest Switzerland and in physicians using point of care tests. Ecological studies are prone to bias and whether point of care tests reduce antibiotic use has to be investigated in pragmatic primary care trials.

[Importance of PCR for the diagnostics of canine babesiosis]. / Bedeutung der PCR in der Diagnostik der caninen Babesiose.

Clinical standards to confirm babesiosis in dogs include the direct identification of the infectious agent in blood smears and serological assays for Babesia canis-specific antibodies. Here, we demonstrate in seven cases (with data on anamnesis, clinics, laboratory diagnostics, and therapeutic outcomes) that a new diagnostic procedure is required. This is the molecular-genetic identification of babesia by real time PCR allowing an unequivocal identification of the infectious agents. Indeed, all seven patients presenting severe clinical symptoms were PCR-positive, but only two of them had specific antibodies and showed babesia in their bloodstream. Six of the dogs appeared to have acquired babesiosis while travelling abroad, and one in the Swiss canton of Schaffhausen.

[Successful treatment of tuberculosis in a patient with poor compliance. Intermittent controlled treatment in general practice]. / Erfolgreiche Tuberkulosebehandlung bei einem Patienten mit schlechter Compliance. Die intermittierende kontrollierte Behandlung in der Arztpraxis.

Treatment of tuberculosis requires strict discipline in order to eradicate mycobacteria and to cure the disease. Standard therapy still requires daily intake of medication for 6 months. Poorly compliant patients may be switched to weekly controlled administration of medication. Controlled medication intake then takes place in the office of the physician, in an outpatient clinic or at sociomedical services. The current report concerns a patient who showed good therapeutic compliance during hospitalisation but poor control during outpatient follow up because of a known alcohol problem. The patient was cured by intermittent controlled treatment in the office of his pneumologist.

Incomplete aspirin desensitization in an aspirin-sensitive asthmatic.

Aspirin desensitization is a valuable treatment for aspirin-sensitive sinusitis. We present a case where long-term desensitization failed. While undergoing desensitization, our patient had prolonged severe asthmatic reactions and therefore received high intravenous doses of prednisone. We hypothesize that high steroid doses administered at the time of desensitization may have raised the threshold of intolerance to a point where the administered aspirin doses were tolerated. Consequently, symptoms of intolerance subsided during the procedure. Subsequent tapering down of the daily prednisone dose caused a re-emergence of the symptoms of intolerance, apparently due to a decrease in the intolerance threshold.

No demonstrable effect of sobrerol as an expectorant in patients with stable chronic bronchial diseases.

A randomized double-blind cross-over study compared the clinical effectiveness of a 14-day treatment with 400 mg X day-1 of sobrerol and placebo in 23 patients with stable chronic bronchial disease. During the seven week trial, subjective symptoms and findings (cough frequency and severity, difficulty in raising sputum, dyspnoea) were recorded, pulmonary function tests performed and sputum physical characteristics (24-h sputum volume, purulence, cell concentration, protein, sputum dry weight and "apparent" viscosity) determined on a regular basis. Side-effects were closely monitored. Both subjective assessment of overall clinical efficacy as well as statistical analysis of the above mentioned factors failed to show any significant advantage of sobrerol to placebo--except for a transient decrease of the 24-h sputum volume. Sobrerol appears to be another example of an expectorant lacking evidence of clinical effectiveness in the management of chronic bronchial secretions.

[Does self-measurement of blood pressure improve compliance in hypertensive patients?]. / Verbessert die Blutdruckselbstmessung die Compliance des Hypertonikers?

To increase compliance in antihypertensive therapy, adherence was measured before and after distribution of non-automatic blood pressure devices. After 2 weeks of taking placebo, 37 essential hypertensive patients, both male and female, were treated over a period of 8 months with an antihypertensive combination drug containing triamterene. At each follow-up, compliance was checked by triamterene urine fluorescence. In the third month of therapy all patients were given a non-automatic blood pressure device. The results showed that self-recording of blood pressure increased the compliance rate of the group from 65% at the beginning of the trial to 81% at the end. Patients who showed poor adherence and consistently insufficient blood pressure values increased their compliance rate from 0% before to 70% after self-measuring of blood pressure. In the light of these findings, self-recording of blood pressure can be recommended in cases where compliance is suspected to be poor and blood pressure is inadequately controlled.

[Diuretics and antihypertensive agents in chronic kidney insufficiency: comparison of the effects of metolazone and furosemide]. / Diuretika und Antihypertensiva bei chronischer Niereninsuffizienz: Wirkungsvergleich von Metolazon und Furosemid.

Increasing dosages of two potent diuretic agents (5, 10, 20 mg metolazone or 40, 80, 160 mg furosemide) were compared in 35 patients with hypertension and chronic renal failure. In cases with insufficient blood pressure control, 10 mg pindolol was given as a second drug. Finally, patients not responding to a betablocker-diuretic combination received 100 mg hydralazine as a third drug. Both diuretics had comparable antihypertensive potency during a treatment period of up to 12 weeks. Maximal antihypertensive response was observed under 10 mg metolazone or 160 mg furosemide. However, only in 25% of our patients blood pressure was normalized with diuretic monotherapy (metolazone or furosemide). The remaining cases needed either an additional betablocker or a combination of three different antihypertensive agents. Under these conditions a substantial proportion of our patients (20%) did not reach the therapeutic goal (diastolic blood pressure less than 95 mm Hg). These results document the difficulties of hypertension management in chronic renal failure. An early change to the stepped-care approach should be made in all cases with insufficient blood pressure response to potent diuretics.