Universität Bern
  • Bern, Switzerland
Recent publications
Antibody-mediated cancer immunotherapy targets inhibitory surface molecules, such as PD1, PD-L1, and CTLA-4, aiming to re-invigorate dysfunctional T cells. We purified and characterized tumor-infiltrating lymphocytes (TILs) and their patient-matched non-tumor counterparts from treatment-naïve NSCLC patient biopsies to evaluate the effect of PD1 expression on the functional and molecular profiles of tumor-resident T cells. We show that PD1+ CD8+ TILs have elevated expression of the transcriptional regulator ID3 and that the cytotoxic potential of CD8 T cells can be improved by knocking down ID3, defining it as a potential regulator of T cell effector function. PD1+ CD4+ memory TILs display transcriptional patterns consistent with both helper and regulator function, but can robustly facilitate B cell activation and expansion. Furthermore, we show that expanding ex vivo-prepared TILs in vitro broadly preserves their functionality with respect to tumor cell killing, B cell help, and TCR repertoire. Although purified PD1+ CD8+ TILs generally maintain an exhausted phenotype upon expansion in vitro, transcriptional analysis reveals a downregulation of markers of T-cell dysfunction, including the co-inhibitory molecules PD1 and CTLA-4 and transcription factors ID3, TOX and TOX2, while genes involved in cell cycle and DNA repair are upregulated. We find reduced expression of WNT signaling components to be a hallmark of PD1+ CD8+ exhausted T cells in vivo and in vitro and demonstrate that restoring WNT signaling, by pharmacological blockade of GSK3β, can improve effector function. These data unveil novel targets for tumor immunotherapy and have promising implications for the development of a personalized TIL-based cell therapy for lung cancer.
Background The underlying etiologies of erectile dysfunction may be manifold. Among them, vasculogenic etiologies are of increasing relevance and are not strictly limited to the elderly population. According to recent study, venogenic erectile dysfunction appears to be even more relevant than arteriogenic erectile dysfunction. Venogenic erectile dysfunction due to venous leakage causes insufficient penile blood retention. Proper diagnosis of venous leakage should include both color Doppler flow analysis and computed tomography cavernosography for adequate patient selection and treatment planning. Besides surgical ligation of penile draining veins, endovascular treatment methods may demonstrate more promising results. Especially endovascular embolization of venous leakage using an anterograde access via deep dorsal penile veins appears to be more beneficial for patients’ clinical outcome and awareness of this technique should be raised among endovascular interventionalists. Case presentation A 47-year-old man was diagnosed with venogenic erectile dysfunction due to venous leakage on color Doppler flow analysis and computed tomography cavernosography. He did not respond to PDE-5-inhibitors. This patient demonstrated major venous leakage of paired deep dorsal penile veins via periprostatic veins and internal pudendal veins draining into both iliohypogastric veins. This patient’s venous leak was treated with endovascular embolization using an anterograde access via deep dorsal penile veins. Conclusion This patient’s erectile dysfunction due to venous leakage, based on findings in color Doppler flow analysis and computed tomography cavernosography, was embolized using an anterograde access via deep dorsal penile veins as a minimally-invasive endovascular treatment option.
Nutrient acquisition strategies of plants regulate water flow and mass transport within ecosystems, shaping earth surface processes. Understanding plant strategies under current conditions is important to assess and predict responses of natural ecosystems to future climate and environmental changes. Nitrogen (N) and potassium (K) (re-)utilization from topsoil and their acquisition from subsoil and saprolite were evaluated in a continental transect, encompassing three study sites – an arid shrubland, a mediterranean woodland, and a temperate rainforest – on similar granitoid parent material in the Chilean Coastal Cordillera. The short-term (<1 year) plant N and K acquisition was traced with ¹⁵N and the K analogs rubidium and cesium. To do so, the tracers were either injected into topsoil, subsoil, or saprolite, in the immediate vicinity of eight individual plants per study site and injection depth. The long-term (>decades) K uplift by plants was investigated by the vertical distribution of exchangeable K⁺ and Na⁺. Recoveries of ¹⁵N and K analogs by arid shrubland plants were similar from topsoil, subsoil, and saprolite. Mediterranean woodland shrubs recovered the tracers primarily from topsoil (i.e., 89 % of recovered ¹⁵N and 84 % of recovered K analogs). Forest plants recovered the tracers from topsoil (¹⁵N = 49 %, K analogs = 57 %) and partially from greater depth: 38 % of recovered ¹⁵N and 43 % of recovered K analogs were acquired from subsoil and saprolite, respectively. Low nutrient accessibility in the topsoil (e.g., because of frequent droughts) drives shrubland plants to expand their N and K uptake to deeper and moister soil and saprolite. Woodland and forest plants dominantly recycled nutrients from topsoil. In the forest, this strategy was complemented by short-term uplift of N and K from depth. The vertical distribution of exchangeable K indicated long-term uplift of K by roots in all three sites. This highlighted that long-term K uplift from depth complements the nutrient budget across the continental transect.
Purpose The resource use of cardiac surgery and neurosurgery patients likely differ from other ICU patients. We evaluated the relevance of these patient groups on overall ICU resource use. Methods Secondary analysis of 69,862 patients in 17 ICUs in Finland, Estonia, and Switzerland in 2015–2017. Direct costs of care were allocated to patients using daily Therapeutic Intervention Scoring System (TISS) scores and ICU length of stay (LOS). The ratios of observed to severity-adjusted expected resource use (standardized resource use ratios; SRURs), direct costs and outcomes were assessed before and after excluding cardiac surgery or cardiac and neurosurgery. Results Cardiac surgery and neurosurgery, performed only in university hospitals, represented 22% of all ICU admissions and 15–19% of direct costs. Cardiac surgery and neurosurgery were excluded with no consistent effect on SRURs in the whole cohort, regardless of cost separation method. Excluding cardiac surgery or cardiac surgery plus neurosurgery had highly variable effects on SRURs of individual university ICUs, whereas the non-university ICU SRURs decreased. Conclusions Cardiac and neurosurgery have major effects on the cost structure of multidisciplinary ICUs. Extending SRUR analysis to patient subpopulations facilitates comparison of resource use between ICUs and may help to optimize resource allocation.
Human joint action is inherently cooperative, manifested in the collaborative efforts of participants to minimize communicative trouble through interactive repair. Although interactive repair requires sophisticated cognitive abilities, it can be dissected into basic building blocks shared with non-human animal species. A review of the primate literature shows that interactionally contingent signal sequences are at least common among species of non-human great apes, suggesting a gradual evolution of repair. To pioneer a cross-species assessment of repair this paper aims at (i) identifying necessary precursors of human interactive repair; (ii) proposing a coding framework for its comparative study in humans and non-human species; and (iii) using this framework to analyse examples of interactions of humans (adults/children) and non-human great apes. We hope this paper will serve as a primer for cross-species comparisons of communicative breakdowns and how they are repaired. This article is part of the theme issue ‘Revisiting the human ‘interaction engine’: comparative approaches to social action coordination’.
With the increasing demand for customized systems and rapidly evolving technology, software engineering faces many challenges. A particular challenge is the development and maintenance of systems that are highly variable both in space (concurrent variations of the system at one point in time) and time (sequential variations of the system, due to its evolution). Recent research aims to address this challenge by managing variability in space and time simultaneously. However, this research originates from two different areas, software product line engineering and software configuration management, resulting in non-uniform terminologies and a varying understanding of concepts. These problems hamper the communication and understanding of involved concepts, as well as the development of techniques that unify variability in space and time. To tackle these problems, we performed an iterative, expert-driven analysis of existing tools from both research areas to derive a conceptual model that integrates and unifies concepts of both dimensions of variability. In this article, we first explain the construction process and present the resulting conceptual model. We validate the model and discuss its coverage and granularity with respect to established concepts of variability in space and time. Furthermore, we perform a formal concept analysis to discuss the commonalities and differences among the tools we considered. Finally, we show illustrative applications to explain how the conceptual model can be used in practice to derive conforming tools. The conceptual model unifies concepts and relations used in software product line engineering and software configuration management, provides a unified terminology and common ground for researchers and developers for comparing their works, clarifies communication, and prevents redundant developments.
Interleukin-33 (IL-33) is a member of the IL-1 family of cytokines that is constitutively expressed in the nucleus of epithelial, endothelial and fibroblast-like cells. Upon cell stress, damage or necrosis, IL-33 is released into the cytoplasm to exert its prime role as an alarmin by binding to its specific receptor moiety, ST2. IL-33 exhibits pleiotropic function in inflammatory diseases and particularly in cancer. IL-33 may play a dual role as both a pro-tumorigenic and anti-tumorigenic cytokine, dependent on tumor and cellular context, expression levels, bioactivity and the nature of the inflammatory environment. In this review, we discuss the differential contribution of IL-33 to malignant or inflammatory conditions, its multifaceted effects on the tumor microenvironment, while providing possible explanations for the discrepant findings described in the literature. Additionally, we examine the emerging and divergent functions of IL-33 in the nucleus, and aspects of IL-33 biology that are currently under-addressed.
To investigate the applicability and performance of automated machine learning (AutoML) for potential applications in diagnostic neuroradiology. In the medical sector, there is a rapidly growing demand for machine learning methods, but only a limited number of corresponding experts. The comparatively simple handling of AutoML should enable even non-experts to develop adequate machine learning models with manageable effort. We aim to investigate the feasibility as well as the advantages and disadvantages of developing AutoML models compared to developing conventional machine learning models. We discuss the results in relation to a concrete example of a medical prediction application. In this retrospective IRB-approved study, a cohort of 107 patients who underwent gross total meningioma resection and a second cohort of 31 patients who underwent subtotal resection were included. Image segmentation of the contrast enhancing parts of the tumor was performed semi-automatically using the open-source software platform 3D Slicer. A total of 107 radiomic features were extracted by hand-delineated regions of interest from the pre-treatment MRI images of each patient. Within the AutoML approach, 20 different machine learning algorithms were trained and tested simultaneously. For comparison, a neural network and different conventional machine learning algorithms were trained and tested. With respect to the exemplary medical prediction application used in this study to evaluate the performance of Auto ML, namely the pre-treatment prediction of the achievable resection status of meningioma, AutoML achieved remarkable performance nearly equivalent to that of a feed-forward neural network with a single hidden layer. However, in the clinical case study considered here, logistic regression outperformed the AutoML algorithm. Using independent test data, we observed the following classification results (AutoML/neural network/logistic regression): mean area under the curve = 0.849/0.879/0.900, mean accuracy = 0.821/0.839/0.881, mean kappa = 0.465/0.491/0.644, mean sensitivity = 0.578/0.577/0.692 and mean specificity = 0.891/0.914/0.936. The results obtained with AutoML are therefore very promising. However, the AutoML models in our study did not yet show the corresponding performance of the best models obtained with conventional machine learning methods. While AutoML may facilitate and simplify the task of training and testing machine learning algorithms as applied in the field of neuroradiology and medical imaging, a considerable amount of expert knowledge may still be needed to develop models with the highest possible discriminatory power for diagnostic neuroradiology.
Marine Heatwaves (MHW) are SST extremes that can have devastating impacts on marine ecosystems and can influence circulation patterns in the ocean and the atmosphere. Here, we present a first attempt to study the decadal predictability of MHW in an ensemble of decadal hindcasts based on the Max Planck Institute Earth System Model. For the global mean we find significant skill for the multiyear MHW trends but we cannot predict the interannual to decadal variability of MHW. In the Subpolar North Atlantic, we can predict the interannual to decadal variability of MHW days and frequency up to lead year 8. We demonstrate that in the Subpolar North Atlantic, any increase in SST is accompanied by more MHW and vice versa. Thereby we gain additional information about the decadal evolution of SST that go beyond predicting the yearly mean SST.
In this work, the presence of species of the slug family Milacidae in Switzerland was investigated by using the barcoding marker cytochrome c oxidase subunit I ( COI ) as well as traits of the body and the genital organs. Currently, three species of Tandonia living in Switzerland in established populations could be reported, i.e., T. rustica , T. budapestensis , and T. nigra . The three records of Milax gagates were re-investigated, but only for one of these records could the identification be reconfirmed. This species has currently no established and thriving population in Switzerland. For all species recorded, detailed descriptions of body morphology, genital anatomy, and distribution data are provided based on the investigated Swiss animals. An unknown pale colour morph of a Tandonia sp. from Canton Ticino could be identified as T. nigra , and the barcodes of T. nigra specimens were submitted to GenBank for the first time. The identity of the Italian and Austrian populations of T. nigra from the Bergamasque Alps and north Tirol is evaluated. Observations on details of the morphology of the genital organs in T. rustica vs. T. kusceri are discussed.
A new method for regioselective zincations of challenging N‐heterocyclic substrates such as pyrimidines and pyridazine was reported using bimetallic bases TMPZnX·LiX (TMP = 2,2,6,6‐tetramethylpiperidyl; X = Cl, Br). X = Cl, Br). Reactions occurred under mild conditions (25–70 °C, using 1.75 equivalents of base without additives), furnishing 2‐zincated pyrimidines and 3‐zincated pyridazine, which were then trapped with a variety of electrophiles. Contrasting with other s‐block metalating systems, which lack selectivity in their reactions even when operating at low temperatures, these mixed Li/Zn bases enabled unprecedented regioselectivities that cannot be replicated by either LiTMP nor Zn(TMP)2 on their own. Spectroscopic and structural interrogations of organometallic intermediates involved in these reactions have shed light on the complex constitution of reaction mixtures and the origins of their special reactivities.
A new method for regioselective zincations of challenging N‐heterocyclic substrates such as pyrimidines and pyridazine was reported using bimetallic bases TMPZnX·LiX (TMP = 2,2,6,6‐tetramethylpiperidyl; X = Cl, Br). X = Cl, Br). Reactions occurred under mild conditions (25–70 °C, using 1.75 equivalents of base without additives), furnishing 2‐zincated pyrimidines and 3‐zincated pyridazine, which were then trapped with a variety of electrophiles. Contrasting with other s‐block metalating systems, which lack selectivity in their reactions even when operating at low temperatures, these mixed Li/Zn bases enabled unprecedented regioselectivities that cannot be replicated by either LiTMP nor Zn(TMP)2 on their own. Spectroscopic and structural interrogations of organometallic intermediates involved in these reactions have shed light on the complex constitution of reaction mixtures and the origins of their special reactivities.
Charge‐transfer phenomena at heterointerfaces are a promising pathway to engineer functionalities absent in the bulk material but can also lead to degraded properties in the ultrathin films. Mitigating such undesired effects with an interlayer reshapes the interface architecture, restricting its operability. Therefore, developing less‐invasive methods to control the charge transfer would be beneficial. Here, an appropriate top‐interface design allows for remotely manipulating the charge configuration of the buried interface and concurrently restoring the ferromagnetic trait of the whole film. Double‐perovskite insulating ferromagnetic La2NiMnO6 (LNMO) thin films grown on perovskite oxide substrates are investigated as a model system. An oxygen‐vacancy‐assisted electronic reconstruction takes place initially at the LNMO polar interfaces. As a result, the magnetic properties of 2–5 unit cells LNMO films are affected beyond dimensionality effects. The introduction of a top electron‐acceptor layer redistributes the electron excess and restores the ferromagnetic properties of the ultrathin LNMO films. Such a strategy can be extended to other interfaces and provides an advanced approach to fine tune the electronic features of complex multi‐layered heterostructures. This article is protected by copyright. All rights reserved
Statement of problem: Area calculation is the primary method for quantitatively analyzing accumulated plaque on the intaglio surfaces of implant-supported fixed complete dental prostheses (IFCDPs). However, the classic calculation method for stained dental plaque is based on two-dimensional (2D) photographs, which could mislead the three-dimensional (3D) representation of an object’s actual morphology, especially when a surface is not flat. Purpose: This pilot in vitro study, used for methodological purposes, evaluated the repeatability and precision of a 3D area calculation method to analyze simulated accumulated biofilm on the intaglio surfaces of an IFCDP. Material and methods: The titanium framework of an IFCDP with a smooth intaglio surface was prepared with 8 milled sites and scanned by microcomputed tomography. Out of these, 4 sites were cubic (set sides lengths=1, 2, 3, and 4 mm), and 4 sites were hemispherical (set diameters=1, 2, 3, and 4 mm). A green-colored aerosol was sprayed onto the carved-out intaglio sites. The framework intaglio surface was 3D-scanned (n=10) and 2D-photographed (n=10) at 10 different photo angles. Two raters twice measured the 3D and 2D data from the carved-out sites’ green-colored area one week apart. Intraobserver repeatability and interobserver reliability were evaluated with an independent t test. The deviation between the measurements and the microtomography values was calculated. Pearson’s correlation coefficient (r) evaluated the repeatability of multiple measurements. A standard level of significance was set at α<0.05. Results: The differences between the 2D photographs and the microtomography values were statistically significant (P<.001), whereas the differences between the 3D scans and the microtomography values were not significant (P=.063). The overall differences between the microtomography values and the 3D measurements were smaller (2.15 ±2.30 mm2 vs. 18.91 ±22.78 mm2, P=.055) than the differences between the microtomography values and the 2D measurements. The percentage differences between the microtomography values and the 3D measurements were significantly smaller (10.41 ±8.33% vs. 65.66 ±19.22%, P<.001) than the microtomography differences values with the 2D measurements. The measurement differences between the microtomography value and the 3D measured hemispherical site data were significantly smaller than the measurement differences between the microtomography values and the 3D measured cubical site data (P=.026). The 2D method had “poor” repeatability among the 10 different shot angles (r=0.391, P<.001), whereas the 3D method had “good” repeatability among the 10 scans (r=0.999, P<.001). Conclusions: An irregular intaglio surface of an IFCDP could accurately and repeatedly be recorded and analyzed by a 3D area calculation method. This color-matching assessment of the topological environment is expected to be adopted in future studies. Clinical Implications: The morphology of pontics of implant-supported fixed complete dental prostheses (IFCDPs) is closely related to dental plaque accumulation. The proposed 3D method could be reliable for macroscopically quantifying biofilm buildup on the intaglio surfaces of IFCDPs.
Currently, cholecystectomy is performed laparoscopically. While the conventional approach (CA) with four access ports persists, other methods seek to reduce trauma or to optimize cosmetic results. In this study, the safety and cosmetic outcome of a suprapubic approach (SA) were evaluated. Between 2015 and 2016, patients undergoing elective cholecystectomy either by CA or by a suprapubic approach (SA) at our institution were included. The cosmetic outcome, postoperative morbidity, operative time and length of stay were evaluated. Pictures of the site of intervention were taken 6–12 months postoperatively and rated on a scale from 1 (unsatisfying aesthetic result) to 5 (excellent aesthetic result). Five “non-medical” and five “medical” raters as well as one board-certified plastic surgeon performed the ratings. A total of 70 patients were included (n = 28 SA, n = 42 CA). The two groups did not differ in baseline characteristics (age, gender, BMI). The SA group showed a significantly better aesthetic outcome compared to the CA group 4.8 (4.8–4.9) vs. 4.2 (3.8–4.4), (p > 0.001). Medical raters: 4.0 (3.8–4.2) vs. 4.8 (4.6–5.0), (p < 0.001); non-medical raters: 4.2 (3.8–4.6) vs. 5.0 (4.8–5.0), (p < 0.001); plastic surgeon: 4.0 (4.0–4.0) vs. 5.0 (5.0–5.0), (p < 0.001). Fair interrater consistency was demonstrated with an ICC of 0.47 (95% CI = 0.38–0.57). No significant difference in the complication rate (1 (3.5%) in SA vs. 6 (14%) in CA, (p = 0.3)), or the operating time 66 (50–86) vs. 70 (65–82) min, (p = 0.3), were observed. Patients stayed for a median of three (3–3) days in the SA group and 3 (3–4) days in the CA group (p = 0.08). This study demonstrated that the suprapubic approach is an appropriate alternative to conventional laparoscopic cholecystectomy, presenting a better cosmetic outcome with a similar complication rate.
Rationale: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome with fatal outcomes. Evidence suggests that dysregulated immune responses, including autoimmunity, are key pathogenic factors. Objectives: To assess whether IgA autoantibodies target lung-specific proteins and contribute to disease severity. Methods: We collected 147 blood, 9 lung tissue, and 36 bronchoalveolar lavage fluid samples from three tertiary hospitals in Switzerland and one in Germany. Severe COVID-19 was defined by the need to administer oxygen. We investigated the presence of IgA autoantibodies and their effects on pulmonary surfactant in COVID-19 using the following methods: immunofluorescence on tissue samples, immunoprecipitations followed by mass spectrometry on bronchoalveolar lavage fluid samples, enzyme-linked immunosorbent assays on blood samples, and surface tension measurements with medical surfactant. Measurements and main results: IgA autoantibodies targeting pulmonary surfactant proteins B and C were elevated in patients with severe COVID-19, but not in patients with influenza or bacterial pneumonia. Notably, pulmonary surfactant failed to reduce surface tension after incubation with either plasma or purified IgA from patients with severe COVID-19. Conclusions: Our data suggest that patients with severe COVID-19 harbor IgA against pulmonary surfactant proteins B and C and that these antibodies block the function of lung surfactant, potentially contributing to alveolar collapse and poor oxygenation. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Background Prevention of recurrent venous thromboembolism (VTE) is considered a main goal of VTE management. However, the extent to which physicians adhere to the recommendations from evidence-based guidelines is unknown. Aim From a large, prospective clinical cohort, we aimed to (1) quantify the adherence of treatment recommendations to evidence-based guidelines and establish its predictors, and (2) estimate its impact on clinical outcomes and costs in patients with VTE. Methods We included 6'243 consecutive patients with VTE treated at the university outpatient unit. Detailed clinical characteristics and treatment recommendations were recorded. Adherence of treatment recommendations to evidence-based guidelines at risk assessment was assessed in terms of duration of anticoagulant treatment. Data on death were obtained from the Swiss Central Compensation Office. Health care claims data recorded between 2014 and 2019 were retrieved from Helsana, one of the largest Swiss health insurance companies. Results The adherence to evidence-based guidelines was 36.1%. Among patients with non-adherence, overtreatment was present in 70.1%. Significant patient-related predictors of guideline adherence were (a) age above 50 years, (b) male sex, (c) pulmonary embolism, (d) unprovoked VTE, (e) multiple VTE, (f) laboratory tests not ordered, and (g) various cardiovascular comorbidities. Non-adherence was not significantly associated with mortality, hospitalization, admission to nursing home, and costs. Conclusions The adherence to evidence-based guidelines was low, and several unrelated predictors appeared. Although these results need to be confirmed in other settings, they highlight the need for implementation of evidence-based guidelines in clinical practice.
Sub-surface clay samples are difficult to characterize using conventional methods so non-invasive Nuclear Magnetic Resonance (NMR) techniques were used to evaluate in a preserved state the pore structure, porosity, water mobility, and affinity of various clay systems. Within the CLAYWAT project launched by the NEA Clay Club, some of the most advanced NMR techniques were applied to samples from 11 clay-rich sedimentary formations (Boom Clay, Yper Clay (both Belgium); Callovo-Oxfordian shale, Upper Toarcian (both France); Opalinus Clay from two sites (Switzerland); Queenston Fm., Georgian Bay Fm., Blue Mountain Fm. (all Canada); Boda Clay (Hungary); and Wakkanai Fm. and Koetoi Fm. (Japan)). The degree of induration within this suite of samples varies substantially, resulting in a wide porosity range of 0.02–0.6. The key finding is the determination of pore-size distribution by NMR cryoporometry in the range of 2 nm–1 μm with the native fluid present in the pore space for most samples. The water volume in pore sizes of <2 nm could also be measured, thus providing a full description of the porosity system. A specific preparation by sample milling was applied to the preserved original cores minimizing disturbances to the samples in terms of water loss. The water content measured by NMR relaxation was comparable to values obtained by drying at 105°C. In general, the narrow T2 distributions indicate that water was diffusing throughout the pore network during the magnetization lifetime, implying that T2 distributions cannot be considered as proxies for the pore-size distributions. For the set of samples considered, the T1/T2 varied between 1.7 and 4.6, implying variable surface affinity. Finally, for most samples, a pore-shape factor of ~2.4, intermediate between a sheet (1) and a cylinder (4), was deduced.
An increasing number of elderly people retain their natural teeth into old age and further, the prevalence of endosseous implants for supporting oral prosthesis is ever increasing. These teeth and implants now present a considerable challenge in terms of maintenance, especially when patients become dependent on care. Periodontal and peri‐implant diseases are more prevalent in elderly than in younger age cohorts. There are distinct differences related to the inflammatory response between periodontal and peri‐implant tissues, both in young and old age. The age‐related reasons for the increase in periodontal infections may be related to poor oral hygiene because of a loss of dexterity or vision, but also to immunosenescence. This term describes the aging of the immune system and the decline of its effectiveness with age. Low‐grade infections, like chronic periodontitis, may cause low‐grade inflammation and subsequently increase the likelihood of developing chronic diseases. In return, treatment of periodontitis may improve general health, as demonstrated for diabetes. A second mechanism illustrating how poor oral health translates into systemic disease is the risk of developing aspiration pneumonia. The treatment options in old age should be evaluated with regard to the issues of general health and maintenance. Systematic periodontal maintenance therapy, as performed in younger age cohorts, may be difficult to implement in elderly people experiencing institutional or hospital confinement because of logistics, barriers related to patients and caregivers, or cost. The scale of periodontal disease in old age represents a public health issue.
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Stephan Christen
  • Department of BioMedical Research
Christian Pfister
  • Oeschger Centre for Climate Change Research
University of Bern Hochschulstrasse 4, 3012, Bern, Switzerland