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Darstellung des Themas : Low Back Pain (LBP) ist eines der häufigsten muskuloskelettalen Probleme heutzutage. In 85 Prozent der Fälle ist er unspezifisch. Cognitive Functional Therapy (CFT) ist eine individualisierte Therapieeinheit, die aus drei Phasen besteht. Sie berücksichtigt die multidimensionale Natur des Schmerzes, wodurch den Betroffenen geholfen werden soll, mit ihrem Leiden umzugehen. Zielsetzung : Ziel dieser Bachelorarbeit ist es, herauszufinden, inwiefern sich CFT bei Patienten/-innen mit chronischem, unspezifischem LBP auf die Outcomes Disability und Fear of Physical Activity auswirkt. Methodik : Mithilfe einer Literaturrecherche in verschiedenen Datenbanken und der Definition von Ein- und Ausschlusskriterien wurden vier Hauptstudien herausgefiltert. Als Analyseinstrumente zur Studienbewertung dienten PEDro und Law und Letts. Zur Zusammenfassung der Studien wurde AICA verwendet. Resultate : Die Ergebnisse zeigen, dass CFT die Disability betroffener Personen signifikant vermindert. In drei der vier ausgewählten Studien führt CFT ebenfalls zu einer signifikanten Reduktion der Fear of Physical Activity. Schlussfolgerung : Während CFT die Disability der Betroffenen vermindert, ist ihre effektive Auswirkung auf die Fear of Physical Activity unklar. Es bleibt offen, inwiefern CFT in den Praxis-alltag integriert werden soll., Background : Low Back Pain (LBP) is one of the most common health-related problems nowadays. In 85 percent of all cases, it is non-specific. Cognitive Functional Therapy (CFT) is an individualised method of treatment consisting of three different stages. It considers the multidimensional nature of pain and, hence, should help the affected to cope with their disabling condition. Objective : This bachelor thesis aims at investigating how CFT impacts the outcomes disability and fear of physical activity in patients with chronic, non-specific LBP. Methods : By means of literature research in various databases and by defining inclusion and exclusion criteria, four main studies were selected. PEDro and Law and Letts were used as instruments of critical appraisal. In order to summarize the studies, AICA was applied. Results : All four studies find that CFT significantly eases the patients’ disability. Furthermore, three out of the four also reveal a considerable alleviation of the fear of physical activity. Conclusion : Whilst CFT improves the patients’ disability, its effective impact on fear of physical activity is indistinct. Therefore, it remains unclear to what extent CFT should be integrated into everyday physiotherapeutic practice.

Darstellung des Themas: Ältere Menschen sind aufgrund degenerativer körperlicher Veränderungen oft sturzgefährdet. Dies hat sowohl individuelle als auch gesellschaftliche Auswirkungen. Die Wassertherapie ist eine Interventionsmöglichkeit, welche Potenzial aufweist, das Sturzrisiko zu verringern. Ziel: In der vorliegenden Bachelorarbeit wird aufgezeigt, welchen Einfluss die Wassertherapie auf das Sturzrisiko von Menschen ab 60 Jahren hat. Das Sturzrisiko wird anhand des Timed-Up-and-Go-Tests, des 8-Foot-Up-and-Go-Tests und der Berg Balance Scale gemessen. Methode: Mit definierten Keywords wurde in den Datenbanken CINAHL, MEDLINE, PEDro und swisscovery eine systematisierte Literaturrecherche durchgeführt und mittels Ein- und Ausschlusskriterien fünf Studien für dieses Literaturreview berücksichtigt. Diese wurden zusammengefasst und anhand der PEDro-Skala kritisch gewürdigt. Relevante Ergebnisse: Alle fünf Studien zeigen einen signifikanten Rückgang des Sturzrisikos nach der Wassertherapie, gemessen an den ausgewählten Assessments. Ausserdem wurde gezeigt, dass die Wassertherapie im Vergleich zur Therapie an Land das Sturzrisiko gleich stark oder sogar stärker verringert. Schlussfolgerung: Es ist Evidenz vorhanden, dass Wassertherapie das Sturzrisiko reduzieren kann. Diese ist jedoch limitiert und vorwiegend von mangelhafter Qualität. Deshalb ist weiterführende Forschung notwendig, um Empfehlungen für effektive und evidenzbasierte Wassertherapie abzugeben, welche das Sturzrisiko klinisch relevant vermindert., Background: Older people are often at risk of falling due to degenerative physical changes. This has both individual, and societal implications. Water therapy is an intervention option that has the potential to reduce the risk of falls. Aim: In this bachelor thesis, the influence of water therapy is shown on the risk of falls in people 60 years and older. The risk of falls is measured using the Timed-Up-and-Go-Test, the 8-Foot-Up-and-Go-Test and the Berg Balance Scale. Methods: A systematized literature search was conducted in the CINAHL, MEDLINE, PEDro and swisscovery databases with defined keywords. Five studies were considered for the literature review using inclusion and exclusion criteria. They were summarized and critically appraised using the PEDro Scale. Results: All five studies showed a significant decrease in the risk of falls after water therapy, as measured by the selected assessments. Conclusion: The use of water therapy to reduce the risk of falls shows limited and low-quality evidence. Therefore, further research is needed to make recommendations for effective and evidence-based water therapy that reduces the risk of falls in a clinically relevant way.

Einleitung und Fragestellung: Emodin wird für Wirkungen von Pflanzenheilmitteln der traditionellen chinesischen Medizin verantwortlich gemacht. Anti-diabetische Effekte in Nagern wurden den unterschiedlichsten molekularen Wirkmechanismen zugeschrieben. Wir haben untersucht, wie weit die Verbesserung der Glukosehomöostase durch Emodin eine simple Folge von reduziertem Appetit und Körpergewicht sein könnte. Methodik: Emodin wurde der High Fat Diet adipöser Mäuse beigemischt (3 und 5 g/kg; Daten im Abstrakt beziehen sich auf die hohe Dosis). Als Kontrollen wurden nicht nur Mäuse mit freiem Zugang zu Futter verwendet, sondern auch solche, die durch eingeschränkte Fütterung die gleichen Gewichtskurven zeigten wie die Emodin-behandelten Tiere. Ergebnisse: Während 3 Wochen Emodinbehandlung (tägliche Aufnahme 229 mg/kg) war die Nahrungsaufnahme um 28% reduziert, was freilich eine entsprechende Wirkung auf die Gewichtszunahme hatte (−5% gegenüber +13% in Kontrollmäusen mit freiem Zugang zu Futter). Der Unterschied im Körpergewicht war, wie schon von anderen beschrieben, mit einer signifikanten Verbesserung der Glukosetoleranz verbunden (Reduktion der inkrementalen Fläche unter der Glukosekurve um 24%). Der Vergleich mit Kontrollmäusen mit gleicher Nahrungsaufnahme und gleichem Körpergewicht zeigte jedoch eine Emodin-induzierte signifikante Verschlechterung der Glukosetoleranz (inkrementale Glukosefläche um 54% größer). Ein Insulintoleranztest wies auf eine Emodin-bedingte Beeinträchtigung der Insulinsensitivität als mögliche Ursache hin. Schlussfolgerungen: Die Ergebnisse zeigen, dass die beschriebenen anti-diabetischen Effekte von Emodin in Nagern wohl nur die banale Folge von reduziertem Appetit sind, wie er durch sehr unspezifische Beeinträchtigungen, wie z. B. Übelkeit, hervorgerufen werden kann.

In ihrer erfolgreichen Zusammenarbeit konnten die beiden Fachgruppen das Grundgerüst eines pharmazeutischen Wirkstoffes identifizieren, das von einem therapeutisch relevanten Protein aus sich selbst heraus hergestellt wurde. Dieses Grundgerüst wurde anschliessend durch strukturbasiertes de novo Design zu einem sehr wirksamen Inhibitor von Kollagenasen entwickelt, die unter anderem bei der Krebsentstehung eine Rolle spielen. Diese Arbeit wurde vom weltweit renommierten chemischen Fachjournal Angewandte Chemie als Titel-Story präsentiert und als «hot paper» ausgezeichnet.

Background: Previous ecological studies reported that increasing antidepressant prescriptions were associated with decreasing suicide rates. Aim: To determine whether antidepressant prescription prevalence is negatively associated with suicide rates (i.e., as antidepressant prescribing increases, suicide rates decrease) between 1999 and 2020. Method: The study protocol was pre-registered on the Open Science Framework (https://osf.io/978sk/). Publicly available data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) and Medical Expenditure Panel Survey (MEPS) were used. Results: Overall, both the antidepressant prescription prevalence and the suicide rate were increasing from 1990 to 2020 in the United States. Positive trends for both outcomes were also evident when analyses were stratified according to sex and/or race/ethnicity. Pearson's correlation analyses consistently found positive associations between antidepressant prescription prevalence and suicide rates. Limitations: Trends and their associations were examined at the population level. The results cannot clarify the causal nature of the association observed. Conclusion: The results of our analysis consistently demonstrated positive trends for both antidepressant prescription prevalence and suicide rates over time as well as positive associations between them. These findings update those from previous studies and are at odds with the notion that, at a population level, more antidepressant prescriptions would lead to lower suicide rates. However, it needs to be acknowledged that ecological studies provide insufficient evidence to infer causality.

In search for more effective prophylactic and curative therapeutics against SARS-CoV-2, an ethnopharmcological approach was used to select 20 plants described in the “Arzneibuch von Hallwyl” (ABvH), an influential recipe text from 16th century Switzerland. Plants were selected based on specific historical uses possibly linked with the treatment of microbial or viral infections as well as inflammatory conditions. For each plant candidate, aqueous and hydroethanolic extracts have been produced, respectively. The prophylactic activity of extracts against SARS-CoV-2 was assessed using the CellTiter-Glo​ Luminescent Cell Viability Assay upon viral infection in vitro. Four plants showed promising activity; among them Sambucus nigra L. (leaves) and Artemisia vulgaris L. (aerial parts) showed an anti-SARS-CoV-2 potential both with an activity of≤33.3 µg/mL for their hydroethanolic extract. The findings confirm the historical traditional use in the area of infectious diseases. Accordingly, this study shows supportive evidence that an ethnopharmacological approach combined with robust in vitro methods effectively enables to screen for promising antiviral plant extracts against SARS-CoV-2.

Study design: Single-centre, two-parallel group, methodological randomised controlled trial to assess blinding feasibility. Background: Trials of manual therapy interventions of the back face methodological challenges regarding blinding feasibility and success. We assessed the feasibility of blinding an active manual soft tissue mobilisation and control intervention of the back. We also assessed whether blinding is feasible among outcome assessors and explored factors influencing perceptions about intervention assignment. Methods: On 7–8 November 2022, 24 participants were randomly allocated (1:1 ratio) to active or control manual interventions of the back. The active group (n = 11) received soft tissue mobilisation of the lumbar spine. The control group (n = 13) received light touch over the thoracic region with deep breathing exercises. The primary outcome was blinding of participants immediately after a one-time intervention session, as measured by the Bang blinding index (Bang BI). Bang BI ranges from –1 (complete opposite perceptions of intervention received) to 1 (complete correct perceptions), with 0 indicating ‘random guessing’—balanced ‘active’ and ‘control’ perceptions within an intervention arm. Secondary outcomes included blinding of outcome assessors and factors influencing perceptions about intervention assignment among both participants and outcome assessors, explored via thematic analysis. Results: 24 participants were analysed following an intention-to-treat approach. 55% of participants in the active manual soft tissue mobilisation group correctly perceived their group assignment beyond chance immediately after intervention (Bang BI: 0.55 [95% confidence interval (CI), 0.25 to 0.84]), and 8% did so in the control group (0.08 [95% CI, −0.37 to 0.53]). Bang BIs in outcome assessors were 0.09 (−0.12 to 0.30) and −0.10 (−0.29 to 0.08) for active and control participants, respectively. Participants and outcome assessors reported varying factors related

Glioblastoma is the most frequent primary malignant brain tumor without effective treatment, which makes this work extremely relevant. The study of the bioactive compounds from medicinal plants plays an important role in the discovery of new drugs.This research investigated the constituents of Tapirira guianensis and its antitumor potential (in vitro and in vivo) in glioblastoma. The T. guianensis extracts were characterized by mass spectrometry. The ethyl acetate partition (01ID) and its fractions 01ID-F2 and 01ID-F4 from T. guianensis showed potential antitumor treatment evidenced by selective cytotoxicity for GAMG with IC50 14.1 µg/mL, 83.07 µg/mL, 59.27 µg/mL and U251 with IC50 25.92 µg/mL, 37.3 µg/mL and 18.84 µg/mL. Fractions 01ID-F2 and 01ID-F4 were 10 times more selective when compared to TMZ and 01ID for the two evaluated cell lines. T. guianensis also reduced matrix metalloproteinases 2 - 01ID-F2 (21.84%), 01ID-F4 (29.6%) and 9 - 01ID-F4 (73.42%), ID-F4 (53.84%) activities, and induced apoptosis mainly through the extrinsic pathway. Furthermore, all treatments significantly reduced tumor size (01ID p < 0,01, 01ID-F2 p < 0,01 and 01ID-F4 p < 0,0001) and caused blood vessels to shrink in vivo. The present findings highlight that T. guianensis exhibits considerable antitumor potential in preclinical studies of glioblastoma. This ability may be related to the phenolic compounds and sesquiterpene derivatives identified in the extracts. This study deserves further in vivo research, followed by clinical investigation.

There is ongoing controversy about suicide risk associated with antidepressant use, but much less is known about suicide risk related to discontinuation of antidepressants. Antidepressant withdrawal syndrome (AWS) can be a burdensome syndrome, with well-known symptoms. One possible explanation for this condition is the oppositional model of tolerance. Some study results are suggestive that suicidality can be part of AWS, although the data are still inconclusive. We are aware of only 3 case reports of suicidal behavior with antidepressant discontinuation, which occurred after discontinuation of paroxetine, venlafaxine, and escitalopram. In this case report, we present a patient without a history of suicidal crisis who, in the span of 6 months, experienced 2 suicidal crises, each occurring directly following rapid discontinuation of venlafaxine. Both crises subsided with reintroduction of the drug.

Background: Growing evidence raises doubts about the need for routine hip precautions after primary total hip replacements to reduce the risk of postoperative dislocation. However, hip precautions are still routinely and widely prescribed in postoperative care in Switzerland. We aimed to investigate experts’ clinical reasoning for hip precaution recommendations after total hip arthroplasty. Methods: Using a convenience sampling strategy, 14 semi-structured expert interviews were conducted with surgeons, physiotherapists, and occupational therapists in the vicinity of an inpatient rehabilitation clinic in Switzerland. Data analysis followed Mayring’s principle of inductive and deductive structuring content analysis. Results: Expert statements from the interviews were summarised into four main categories and 10 subcategories. Categories included statements on the incidences of dislocation and underlying risk factors; current preferences and use of hip precautions; their effect on physical function, anxiety, or costs; and patient’s adherence to the movement restrictions. Hip surgeons routinely prescribed hip precautions, although in different variations. Fear of dislocation and caution are barriers to changing current practice. Some surgeons are considering individualised prescribing based on patients’ risk of dislocation, which therapists would welcome. Conclusion: A lack of clear instructions from the surgeon leads to ambiguity among therapists outside the acute hospital. A shared understanding of the need for and nature of hip precautions, guidelines from societies, or at least specific instructions from surgeons to therapists are warranted.

Ethnopharmacological relevance: In recent decades, the study of historical texts has attracted research interest, particularly in ethnopharmacology. All studies of the materia medica cited in ancient and medieval texts share a concern, however, as to the reliability of modern identifications of these substances. Previous studies of European or Mediterranean texts relied mostly on authoritative dictionaries or glossaries providing botanical identities for the historical plant names in question. Several identities they suggest, however, are questionable and real possibility of error exists. Aim of the study: This study aims to develop and document a novel and interdisciplinary methodology providing more objective assessment of the identity of the plants (and minerals) described in these resources. Materials and methods: We developed an iterative experimental approach, using the 13th century Byzantine recipe text John the Physician's Therapeutics in its Commentary version (JC) as a case study. The methodology has six stages and relies on comparative analyses including statistical evaluation of botanical descriptions and information about medicinal uses drawn from both historical and modern sources. Stages 1-4 create the dataset, stage 5 derives the primary outcomes to be reviewed by experts in stage 6. Results: Using Disocorides' De Materia Medica (DMM) (1st century CE) as the culturally related reference text for the botanical descriptions of the plants cited in JC, allowed us to link the 194 plants used medicinally in JC with 252 plants cited in DMM. Our test sample for subsequent analyses consisted of the 50 JC plant names (corresponding to 61 DMM plants) for which DMM holds rich morphological information, and the 130 candidate species which have been suggested in the literature as potential botanical identities of those 50 JC plant names. Statistical evaluation of the comparative analyses revealed that in the majority of the cases, our method detected the candidate

Electroconvulsive therapy (ECT) is a highly efficient treatment for depression. Previous studies repeatedly reported an ECT-induced volume increase in the hippocampi. We assume that this also affects extended hippocampal networks. This study aims to investigate the structural and functional interplay between hippocampi, hippocampal pathways and core regions of the default mode network (DMN). Twenty patients with a current depressive episode receiving ECT-treatment and twenty age and sex matched healthy controls (HC) were included in the study. ECT-patients underwent multimodal magnetic resonance imaging (MRI)-scans (diffusion weighted imaging, resting state functional MRI) before and after an ECT-index series. HC were also scanned twice in a similar between-scan time-interval. Parahippocampal cingulum (PHC) and uncinate fasciculus (UF) were reconstructed for each participant using manual tractography. Fractional anisotropy (FA) was averaged across tracts. Furthermore, we investigated seed-based functional connectivity (FC) from bilateral hippocampi and from the PCC, a core region of the DMN. At baseline, FA in PHC and UF did not differ between groups. There was no baseline group difference of hippocampal-FC. PCC-FC was decreased in ECT-patients. ECT induced a decrease in FA in the left PHC in the ECT group. No longitudinal changes of FA were found in the UF. Furthermore, there was a decrease in hippocampal-PCC-FC, an increase in hippocampal-supplementary motor area-FC, and an increase in PCC-FC in the ECT-group, reversing group differences at baseline. Our findings suggest that ECT induces structural and functional remodeling of a hippocampal-DMN. Those changes may contribute to ECT-induced clinical response in patients with depression.

Question: Tricyclic antidepressants are used to treat depression worldwide, but the adverse effects have not been systematically assessed. Our objective was to assess the beneficial and harmful effects of all tricyclic antidepressants for adults with major depressive disorder. Study selection and analysis: We conducted a systematic review with meta-analysis and trial sequential analysis. We searched CENTRAL, MEDLINE, Embase, LILACS and other sources from inception to January 2023 for randomised clinical trials comparing tricyclic antidepressants versus placebo or ‘active placebo’ for adults with major depressive disorder. The primary outcomes were depressive symptoms measured on the 17-item Hamilton Depression Rating Scale (HDRS-17), serious adverse events and quality of life. The minimal important difference was defined as three points on the HDRS-17. Findings: We included 103 trials randomising 10 590 participants. All results were at high risk of bias, and the certainty of the evidence was very low or low. All trials only assessed outcomes at the end of the treatment period at a maximum of 12 weeks after randomisation. Meta-analysis and trial sequential analysis showed evidence of a beneficial effect of tricyclic antidepressants compared with placebo (mean difference −3.77 HDRS-17 points; 95% CI −5.91 to −1.63; 17 trials). Meta-analysis showed evidence of a harmful effect of tricyclic antidepressants compared with placebo on serious adverse events (OR 2.78; 95% CI 2.18 to 3.55; 35 trials), but the required information size was not reached. Only 2 out of 103 trials reported on quality of life and t-tests showed no evidence of a difference. Conclusions: The long-term effects of tricyclic antidepressants and the effects on quality of life are unknown. Short-term results suggest that tricyclic antidepressants may reduce depressive symptoms while also increasing the risks of serious adverse events, but these results were based on low and very low certainty evidence.

Botanical raw materials for phytopharmaceutical applications must comply with the current regulations for medicines in the EU or guidelines for herbal medicinal products in terms of quality, safety and effectiveness when placed on the market in Europe. In the EU, the legal requirements for active ingredients (API) and medicines (Herbal Medicinal Products for human use) as well as the guidelines and monographs of the Herbal Medicinal Product Committee (HMPC) as an expert committee for medicinal plant products within the EMA apply here. If extracts are used in the food sector, the safety regulations of the European Food Safety Agency (EFSA) must be considered. In both cases, genotoxicity testing is an important aspect of the safety assessment of plant extracts and their preparations. So far, the Ames test has been mandatory. In recent years it has been shown that this established test has some disadvantages. In the field of ecotoxicology, which also deals with multi-component mixtures, the suitability of the more sensitive umuC test in addition to or even instead of the Ames test is already being discussed. This poster demonstrates the application of the umuC test coupled to HPTLC (planar umuC) for assessing plant extracts and their leachables from their containers. The results of a validation study as well as S9 activation of metabolites prior to chromatography show the applicability of the novel effect directed analysis method for routine safety screening in R&D, quality control and regulatory compliance of plant derived natural health products.

This study aims to investigate the impact of electrode shape and positioning on skin impedance measurements, with a focus on a specific radiofrequency therapy device developed in-house for treating cutaneous Leishmaniasis. The study involved 22 volunteers of mixed genders, whose skin impedance was measured in the frequency range of 1~MHz to 10~MHz using the device's uniquely shaped, dry-applied electrodes. Additional measurements were conducted to record skin moisture, surface temperature, and personal parameters of the subjects, which were later used in correlation analysis. While the resistivity values from this study were found to be in alignment with those reported in the existing literature, it is positioning of the electrodes that significantly impacted the skin impedance measurements. Correlations were identified between the skin moisture and average phase shift in facial and forearm measurements and between the average magnitude and phase shift depending on the measurement site. Furthermore, a correlation was observed between the Cole series resistances of the facial and forearm skin. The study does not find a significant influence of gender, age, skin color, ethnicity, or Body Mass Index on the impedance measurements within the tested frequency range. This research enhances our understanding of skin impedance measurements using unique electrode designs and contributes to refining the design of radiofrequency therapy systems.

Combination of conventional antibiotics with natural products represents a promising strategy in overcoming antibiotic resistance. The aim of this work was to assess the interactions between plant-derived products and several antibiotics in order to identify potential synergistic antibacterial combinations. Both extracts and pure phytochemicals were included in this study. The effects of the combinations were evaluated against Gram-positive including methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacteria. Our studies on essential oils showed that coriander essential oil and its major constituent, linalool, acted synergistically with several antibiotics (oxacillin, gentamicin, tetracycline, ciprofloxacin) against both Gram-positive and Gram-negative bacteria with coriander essential oil reversing tetracycline resistance of Staphylococcus epidermitis [2]. Despite its moderate antibacterial activity, white mulberry leaf ethanolic extract was found to reverse oxacillin resistance of MRSA and to act synergistically with gentamicin against MRSA. Additionally, the extract showed synergy with gentamicin and tetracycline against Staphylococcus epidermitis [3]. Two of its constituents, namely morusin and kuwanon G, also reversed oxacillin resistance of MRSA and acted synergistically with gentamicin, tetracycline and ciprofloxacin against MRSA. Morusin also reversed tetracycline resistance of Staphylococcus epidermitis. Both morusin and kuwanon G increased the permeability of the bacterial membrane as shown by fluorescence and differential interference contrast microscopy. Conclusion: Plant-derived products are promising candidates for the development of novel treatment strategies in bacterial infections.

The present study aimed to (1) provide an update on trends in AD consumption both at the national and regional unit of analysis for the period 2000-2020 in Italy and (2) analyze sociodemographic and healthcare system-related factors associated with AD prescribing at the regional-population level between 2000 and 2019. Data were extracted from reports of the Italian Medicines Agency and databases of the Italian National Institute of Statistics. Linear regression and mixed models were applied to analyze trends in AD use (DDD/1000/day) and ecological factors associated with AD prescribing. Between 2000 and 2010 AD prescription rates constantly increased. Thereafter they stabilized until 2017 when a positive trend began again. There was a positive ecological association between AD prescribing and rates of hospital discharge due to affective disorders, antibiotics prescribing, public non-drug healthcare spending per capita, and Northern regions compared to Southern regions. AD consumption increased massively during the 2000s, flattened during the 2010s but thereafter increased again until 2020. The ecological correlation between healthcare provision/spending and AD consumption suggests that health-economic factors may play an important role.

Übermedikation entsteht häufig aufgrund eines Teufelskreises. Medikament A verursacht Nebenwirkung und fordert Medikament B. Wie vorbeugen? Ein Pflegeentwicklungsprojekt, das im Rahmen einer Masterarbeit entwickelt wurde, liefert Antworten.

A systematic review and meta-analysis of observational studies on the suicide risk with new-generation antidepressants for depression and any treatment indication.

Relapse prevention trials build the scientific foundation for recommendation of antidepressant continuation and maintenance therapy. However, the validity of the evidence is disputed and may be biased due to withdrawal confounding. We digitised and analysed the survival curves (time-to-event data) from all antidepressant relapse prevention trials submitted to the US Food and Drug Administration between 1987 and 2012. The main outcome was the percentage of the drug effect (antidepressant-placebo difference in relapse events) at any week of the maintenance phase in relation to the total drug effect at the end of the randomised maintenance phase.

Sie sind gleichwertig und kostengünstiger. Dennoch werden Biosimilars – die Nachahmerprodukte von Biologika – in der Schweiz bisher selten verordnet. Was sind die Gründe dafür? Ein im Auftrag des BAG durchgeführtes Health Technology Assessment (HTA) liefert Antworten anhand des Biologikums Infliximab und dessen Biosimilars bei der Behandlung von rheumatoider Arthritis.

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), Purpose: Antidepressant use has increased in many European countries, mostly driven by longer treatment duration. The aim of this study was to provide prevalence rates of long-term users of antidepressants for the Swiss population over the last decade and to investigate associated factors for longer use. Methods: We examined the prevalence rates of individuals with at least one prescription for antidepressants using longitudinal health claims data for 2013 to 2021. We defined short- (< one year), medium- (one–two years), and long-term users (> two years) for 2015 to 2019. We applied a binary logistic regression model to investigate the effects of population (gender, age, area of living, language, health insurance plan, and nursing home) and treatment characteristics (psychiatric or psychotherapeutic care) on long-term compared to short- and medium-term users in 2019. Results: In 2021, 9% of the Swiss population (n = 770,698) received at least one antidepressant prescription, which remained stable since 2013. In 2019, the proportion of long-term users was 57.4%, with steady increase since 2015. The proportion of medium- and short-term users has decreased. Older age, being a woman, living in an urban area, living in a nursing home, being enrolled in a standard care plan, and receiving psychiatric or psychotherapeutic care were factors positively associated with being a long-term user. Conclusion: The proportion of long-term users in Switzerland is high and steadily increasing. Given the ongoing debate about the confounding effects of relapse and withdrawal, more research is needed to investigate longer use of antidepressants that could indicate overprescribing.

Background: Most individuals affected by cancer who are treated with certain chemotherapies suffer of CIPN. Therefore, there is a high patient and provider interest in complementary non-pharmacological therapies, but its evidence base has not yet been clearly pointed out in the context of CIPN. Methods: The results of a scoping review overviewing the published clinical evidence on the application of complementary therapies for improving the complex CIPN symptomatology are synthesized with the recommendations of an expert consensus process aiming to draw attention to supportive strategies for CIPN. The scoping review, registered at PROSPERO 2020 (CRD 42020165851), followed the PRISMA-ScR and JBI guidelines. Relevant studies published in Pubmed/MEDLINE, PsycINFO, PEDro, Cochrane CENTRAL, and CINAHL between 2000 and 2021 were included. CASP was used to evaluate the methodologic quality of the studies. Results: Seventy-five studies with mixed study quality met the inclusion criteria. Manipulative therapies (including massage, reflexology, therapeutic touch), rhythmical embrocations, movement and mind-body therapies, acupuncture/acupressure, and TENS/Scrambler therapy were the most frequently analyzed in research and may be effective treatment options for CIPN. The expert panel approved 17 supportive interventions, most of them were phytotherapeutic interventions including external applications and cryotherapy, hydrotherapy, and tactile stimulation. More than two-thirds of the consented interventions were rated with moderate to high perceived clinical effectiveness in therapeutic use. Conclusions: The evidence of both the review and the expert panel supports a variety of complementary procedures regarding the supportive treatment of CIPN; however, the application on patients should be individually weighed in each case. Based on this meta-synthesis, interprofessional healthcare teams may open up a dialogue with patients interested in non-pharmacological treatment options

Chronic low back pain (CLBP) is a leading cause of disability globally. Exercise therapies are one of the commonly prescribed treatment options for CLBP. The specific exercise therapies for CLBP most commonly target movement dysfunction, but seldom brain-based pain modulation. Exercise therapies with specific breathing techniques (SBTs) have been shown to influence and enhance brain-based structural and functional pain modulation.

Extracellular vesicles (EVs), nanovesicles released by cells to effectively exchange biological information, are gaining interest as drug delivery system. Yet, analogously to liposomes, they show short blood circulation times and accumulation in the liver and the spleen. For tissue specific delivery, EV surfaces will thus have to be functionalized. We present a novel platform for flexible modification of EVs with target-specific ligands based on the avidin-biotin system. Genetic engineering of donor cells with a glycosylphosphatidylinositol-anchored avidin (GPI-Av) construct allows the isolation of EVs displaying avidin on their surface, functionalized with any biotinylated ligand. For proof of concept, GPI-Av EVs were modified with i) a biotinylated antibody or ii) de novo designed and synthesized biotinylated ligands binding carbonic anhydrase IX (CAIX), a membrane associated enzyme overexpressed in cancer. Functionalized EVs showed specific binding and uptake by CAIX-expressing cells, demonstrating the power of the system to prepare EVs for cell-specific drug delivery.

Given the vast number of venomous and poisonous animals, it is surprising that only relatively few animal-derived toxins have been explored and made their way into marketed drugs or are being investigated in ongoing clinical trials. In this review, we highlight marketed drugs deriving from animal toxins as well as ongoing clinical trials and preclinical investigations in the field. We emphasize that more attention should be paid to the rich supply of candidates that nature provides as valuable starting points for addressing serious unmet medical needs.

Background: Major depressive disorder causes a great burden on patients and societies. Venlafaxine and mirtazapine are commonly prescribed as second-line treatment for patients with major depressive disorder worldwide. Previous systematic reviews have concluded that venlafaxine and mirtazapine reduce depressive symptoms, but the effects seem small and may not be important to the average patient. Moreover, previous reviews have not systematically assessed the occurrence of adverse events. Therefore, we aim to investigate the risks of adverse events with venlafaxine or mirtazapine versus ‘active placebo’, placebo, or no intervention for adults with major depressive disorder in two separate systematic reviews. Methods: This is a protocol for two systematic reviews with meta-analysis and Trial Sequential Analysis. The assessments of the effects of venlafaxine or mirtazapine will be reported in two separate reviews. The protocol is reported as recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, risk of bias will be assessed with the Cochrane risk-of-bias tool version 2, clinical significance will be assessed using our eight-step procedure, and the certainty of the evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. We will search for published and unpublished trials in major medical databases and trial registers. Two review authors will independently screen the results from the literature searches, extract data, and assess risk of bias. We will include published or unpublished randomised clinical trial comparing venlafaxine or mirtazapine with ‘active placebo’, placebo, or no intervention for adults with major depressive disorder. The primary outcomes will be suicides or suicide attempts, serious adverse events, and non-serious adverse events. Exploratory outcomes will include depressive symptoms, quality of life, and individual adverse events. If feasible, we will assess

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