Swiss School of Archaeology in Greece
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Palliative Care for Patients with Severe Chronic Lung Diseases: A Swiss Position Paper
No full textBackground: Severe chronic lung diseases are frequently associated with a high symptom burden, dependence on caregivers, poor quality of life, and a high risk of early mortality. Medical, psychological, and social situations can become increasingly complex despite established disease-modifying treatment. In patients with lung cancer, palliative care (PC) is well established; however, PC is typically underused in chronic lung diseases including chronic obstructive pulmonary disease, interstitial lung disease, and pulmonary hypertension. With this position paper, the multidisciplinary and interprofessional expert group aims to guide healthcare professionals on how to assess and address PC needs and when to refer patients for specialized PC. Furthermore, the objectives include to increase awareness and to encourage interprofessional education and research on PC in patients with chronic lung diseases. Summary: PC is a holistic, multidisciplinary, person-centered approach to control symptoms, improve quality of life in patients with severe chronic respiratory diseases, and support their caregivers. PC and symptom-oriented treatment should be delivered early alongside with disease-modifying treatment and adapted to individual values and needs of patients and caregivers. General PC can be provided by nonspecialists whereas a specialized PC team is needed when symptoms become challenging to treat and care situations become increasingly complex. Key Messages: Patients with severe chronic lung diseases and their caregivers benefit tremendously from PC, which ranges from simple symptom control to complex interventions delivered by multidisciplinary and interprofessional teams. There is still a clear need to improve availability, awareness, education, and research on PC for patients with severe chronic lung diseases. .
© 2025 The Author(s). Published by S. Karger AG, Basel
Coronary CT angiography-derived pericoronary fat attenuation index: Post-mortem histopathological correlation in fatal plaques.
No full textThe fat attenuation index (FAI) is a biomarker that has recently gained attention for reflecting perivascular inflammation in coronary arteries. We investigated the utility of the FAI in identifying high-risk coronary plaques responsible for sudden cardiac death (SCD).
Using multiphase post-mortem CT angiography (MPMCTA), we analyzed culprit plaques from 35 individuals who died from acute coronary syndrome, comparing these to control vessels from within-subject unaffected coronary arteries, with FAI measurement. Histopathological examination of culprit plaques assessed intraplaque inflammation, adventitial inflammation, and vasa vasorum density.
Perivascular FAI values were significantly higher in culprit lesions than control lesions, -62.5 ± 10.4 vs. -68.5 ± 7.2 HU, respectively (p = 0.003). However, no significant differences in FAI were found between culprit lesions with and without local histopathological inflammation (p = 0.378). Additionally, FAI values ≥ -70.1 HU were more common in culprit than control lesions, though this threshold did not reach statistical significance (p = 0.081). Other imaging biomarkers, including the napkin-ring sign (p = 0.049) and plaque enhancement (p = 0.024), were more closely associated with histopathological inflammation.
Our findings support FAI as a surrogate marker of high-risk coronary artery disease, although more extensive studies are needed to confirm its predictive accuracy for SCD. Integrating FAI with routine coronary CT angiography features could improve risk stratification in clinical settings
Towards personalized mapping through lumbosacral spinal cord task fMRI
No full textThe lumbosacral spinal cord contains neural circuits crucial for locomotion, organized into rostrocaudal levels with distinct somatosensory and motor neuron pools that project to and from the muscles of the lower limbs. However, the specific spinal levels that innervate each muscle and the locations of neuron pools vary significantly between individuals, presenting challenges for targeted therapies and neurosurgical interventions aimed at restoring locomotion. Non-invasive approaches to functionally map the segmental distribution of muscle innervation-orprojectome-are therefore essential. Here, we developed a pipeline dedicated to record blood oxygenation level dependent (BOLD) signals in the lumbosacral spinal cord using functional magnetic resonance imaging (fMRI). We assessed spinal activity across different conditions targeting the extensor/flexor muscles of the right leg (ankle, knee, and hip) in 12 healthy participants. To enhance clinical relevance, we included not only active movements but also two conditions that did not rely on participants' performance: passive stretches and muscle-specific tendon vibration, which activates proprioceptive afferents of the vibrated muscle. BOLD activity patterns were primarily located on the side ipsilateral to the movement, stretch, or vibration, both at the group and participant levels, indicating the BOLD activity being associated with the projectome. The fMRI-derived rostrocaudal BOLD activity patterns exhibited mixed alignment with expected innervation maps from invasive studies, varying by muscle and condition. While some muscles and conditions matched well across studies, others did not. Significant variability among individual participants underscores the need for personalized mapping of projections for targeted therapies and neurosurgical interventions. To support the interpretation of BOLD activity patterns, we developed a decision tree-based framework that combines reconstruction of neural structures from high-resolution anatomical MRI datasets and muscle-specific fMRI activity to produce personalized projectomes. Our findings provide a valuable proof-of-concept for the potential of fMRI to map the lumbosacral spinal cord's functional organization, while shedding light on challenges associated with this endeavor.
© 2025 The Authors. Published under a Creative Commons Attribution 4.0 International (CC BY 4.0) license
Treatment-resistant late-life depression prevalence and clinical/sociodemographic correlates: An electronic health records study.
No full textTreatment-resistant late-life depression (TRLLD) remains a clinical challenge. Our aim was to identify demographic and clinical factors associated with TRLLD.
A large naturalistic retrospective cohort study was conducted using mental health records from south London. Patients were selected at first recorded depression diagnosis after the age of 60. We defined TRLLD when ≥3 antidepressants were prescribed across their mental health record or a natural language processing algorithm indicated depression was described as treatment-resistant. We collected demographic and clinical characteristics around the first depressive episode diagnosis at age ≥ 60 and used multivariate logistic regression models to investigate factors associated with TRLLD.
Of 8171 patients with late-life depression, 1443 (17.7 %) had TRLLD. Amongst those with severe, psychotic or recurrent depression the prevalence of TRLLD was 30.7 %, 31.4 % and 27.0 % respectively. Female sex, recurrent, severe, or psychotic depression and higher self-harm risk were associated with higher odds of TRLLD after adjustment for demographics (Adjusted Odds ratio (aOR): 1.36, 2.05, 2.34, 2.21 and 1.30 respectively). Older age, Black ethnicity, cognitive impairment and difficulties in activities of daily living were associated with a lower likelihood of TRLLD (aOR: 0.97, 0.65, 0.71 and 0.76 respectively). Several physical conditions examined were associated with increased odds for TRLLD, the strongest association was with hypertension (aOR: 2.20).
This is the first large-scale study examining the socio-demographic data as well as psychiatric and physical comorbidities in TRLLD without known dementia. Prevention and management of multi-morbidity should be considered in primary or secondary prevention of treatment-resistant depression
Allocation of Treatment Slots in Elective Mental Health Care-Are Waiting Lists the Ethically Most Appropriate Option?
No full textWaiting lists are a standard approach to managing excess demand in elective health care. While waiting times are an important policy issue, the ethical validity of the first come, first served (FCFS) principle as such is rarely questioned. Presenting a psychiatric day hospital where all eligible patients have roughly equal claims as a case study, we criticize the reflex use of FCFS for allocation of elective psychiatric care, consider conditions under which this may not be the optimal strategy, and discuss alternatives. We conclude that in our example prioritizing more recent referrals (last come, first served [LCFS]) makes more sense, clinically and ethically. Where several referrals arrive (near-)simultaneously under LCFS, we propose that a higher level of scrutiny be applied to detect possible good reasons for prioritizing one of them. We believe that our observations can be applied to other health care settings that share relevant characteristics with our case
Visit-to-visit changes in heart rate in heart failure: A pooled participant-level analysis of the PARADIGM-HF and PARAGON-HF trials.
No full textResting heart rate (HR) is a strong risk marker in patients with heart failure (HF), but the clinical implications of visit-to-visit changes in HR (ΔHR) are less well established. We aimed to explore the association between ΔHR and subsequent outcomes in a pooled dataset of two well-characterized cohorts of patients with HF across the full range of left ventricular ejection fraction (LVEF).
PARADIGM-HF and PARAGON-HF were randomized trials testing sacubitril/valsartan versus enalapril or valsartan, respectively, in patients with HF and LVEF ≤40% (PARADIGM-HF) or LVEF ≥45% (PARAGON-HF). We analysed the association between ΔHR from the preceding visit with the primary endpoint of HF hospitalization (HFH) or cardiovascular death using covariate-adjusted Cox proportional hazards models. A total of 13 194 patients (mean age 67 ± 11 years, 67% men, mean LVEF 40 ± 15%) were included. Over a median follow-up of 2.5 years, 3114 patients experienced a first HFH or cardiovascular death event (10.4 events per 100 patient-years). An increase in HR from the preceding visit, compared with no change, was associated with a higher risk (hazard ratio 1.12; 95% confidence interval [CI] 1.10-1.15; p interaction = 0.006).
Across a broad spectrum of patients with chronic HF, increases in HR from a preceding visit independently predicted clinical outcomes. The detection of notable increases in HR between outpatient visits may help identify patients at heightened risk of adverse events.
ClinicalTrials.gov NCT01035255 (PARADIGM-HF), NCT01920711 (PARAGON-HF)
Formes de l’extra-ordinaire et réflexivité sociologique
No full textCe travail interroge la situation de fête comme forme singulière d’expérience sociale, révélatrice de la capacité des acteurs à suspendre et à reconfigurer les cadres ordinaires de la vie collective. La visée festive est envisagée comme une aspiration de rupture avec l’ordre de la vie quotidienne, produisant temporairement une normativité alternative où s’expérimentent d’autres modes d’agencement du social. Par la mise à distance qu’elle suscite, elle manifeste une compétence métasociale : les participants s’engagent dans une analyse implicite de leur inscription dans le monde et des formes de coordination qui en soutiennent la cohérence. En articulant les héritages de la sociologie durkheimienne, de la phénoménologie et du pragmatisme, l’analyse met en lumière le processus de subjectivation qui se déploie à travers l’expérience festive. Loin d’un simple exutoire cathartique ou d’une reproduction symbolique de l’ordre social, la visée festive apparaît comme un opérateur de réinvention du commun : une métaphore critique et créatrice où s’élabore, dans le silence de l’extra-ordinaire, une compréhension renouvelée du lien social
Contrasting contribution of resident and repopulated brain macrophages in sustaining sleep-wake circuitry
No full textSleep is a complex behavior regulated by various brain cell types. However, the roles of brain-resident macrophages, including microglia and CNS-associated macrophages (CAMs), particularly those derived postnatally, in sleep regulation remain poorly understood. Here, we investigated the effects of resident (embryo-derived) and repopulated (postnatally derived) brain-resident macrophages on the regulation of vigilance states in mice. We found that depletion in resident brain macrophages caused increased sleep in the active period, but reduced its quality, reflected in reduced power of brain sleep oscillations. This was observed both for the Non-REM and REM sleep stages. Subsequent repopulation by postnatal brain macrophages resulted in altered, but not fully restored, sleep-wake patterns and additionally induced sleep fragmentation. Furthermore, brain macrophage depletion caused excitatory-inhibitory synaptic imbalance, which was resistant to repopulation, and led to increased inhibitory synapses. At the metabolite level, the distinct metabolite profile induced by brain macrophage depletion largely returned to normal after repopulation. Our findings suggest a so far largely unknown interaction between brain-resident macrophages and sleep and highlight functional differences between resident and postnatally-derived repopulated brain macrophages, paving the way to future exploration of the role of brain macrophages of different origin in sleep disorders and synaptic connectivity.
© 2025. The Author(s)