Swiss School of Archaeology in Greece
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Current Trends and Future Challenges in Transcatheter Aortic Valve Replacement: Utility of Cardiac Computed Tomography Angiography.
No full textTranscatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. As TAVR continues to evolve, precise pre-procedural planning and imaging have become increasingly critical. While transthoracic echocardiography remains indispensable for assessing the severity of aortic stenosis, cardiac computed tomography angiography (CCTA) has emerged as the benchmark imaging modality for pre-procedural planning for TAVR. CCTA provides detailed anatomical information essential for patient selection, procedural success, and the mitigation of complications. This review aims to equip practitioners with the knowledge to effectively integrate CCTA into the TAVR workflow, ensuring a systematic approach to patient evaluation and procedural planning while addressing future challenges in the field
Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition.
No full textPatients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.
The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness using a modified Delphi approach with a requirement of ≥75% agreement.
(1) To identify pre-existing malnutrition, we suggest evaluation within 48 h of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). (2) To identify the development and progression of malnutrition, we suggest re-evaluation of all patients every 7-10 days (97% agreement). (3) To identify progressive loss of muscle mass, we suggest evaluation of muscle mass as soon as feasible (92% agreement) and again after 7-10 days (89% agreement). (4) To identify the development and progression of malnutrition before and after ICU discharge, we suggest re-evaluating nutrition status before ICU discharge and during clinical visits that follow (100% agreement).
Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients
Changes in tissues and organs through PMCTA carrier substances.
No full textTo date, lipophilic contrast agents mixed with oil, usually paraffin oil, are the most commonly used contrast agents in post-mortem computed tomography angiography (PMCTA). Iodine-based hydrophilic contrast media in combination with a water-soluble carrier, e.g. polyethylene glycol (PEG), are also common. However, their influence on different tissues and organs is poorly understood. In order to analyse the changes in the cadavers caused by the different carrier substances, we evaluated the effects of PEG 200 and oil on the different tissues and organs. Therefore, during a forensic autopsy, liquid femoral vein blood and samples of different organs and vessels were taken and preserved at room temperature in the two liquids mentioned. The condition of the samples was documented during the autopsy and 24, 48 and 72 h after preservation. Microscopic examination took place after 72 h. After 24 h, the samples placed in PEG 200 already showed a clear solidification of almost all structures. Crumbly blood agglomerates had formed in the previously liquid blood. In contrast, the samples stored in oil showed signs of classic cadaveric decomposition after 24 h, which increased with time. The microscopic and immunohistochemical evaluation of the samples stored in PEG showed a good diagnostic quality. The analysis of tissues stored in oil was much more difficult due to putrefaction. PEG and oil show significantly different effects on human tissues, mainly conservation and dehydration are affected. It is crucial to be aware of these differences in order to choose the most appropriate PMCTA method for each forensic case
Diffusion MRI of white matter microstructure and biological correlates in early psychosis and schizophrenia
No full textSchizophrenia and related psychotic disorders are severe psychiatric conditions characterised by persistent cognitive, functional, and structural brain abnormalities. However, the biological mechanisms underlying white matter disruption remain incompletely understood, particularly in relation to oxidative stress and glial dysfunction. This thesis examines white matter microstructural changes in early psychosis and schizophrenia using advanced diffusion MRI (dMRI) models, including Diffusion Kurtosis Imaging and White Matter Tract Integrity-Watson, which offer enhanced sensitivity and specificity compared to conventional Diffusion Tensor Imaging.
Building upon the Lausanne Psychosis Cohort, comprising over 300 individuals across early psychosis, chronic schizophrenia, and healthy controls, four main projects are presented. First, group-level analyses compared white matter microstructure across diagnostic categories, comparing group-level alteration patterns to the large-scale ENIGMA consortium findings and quantifying the trade-off between sensitivity and specificity across diffusion models. Second, a hypothesis-driven investigation examined the oxidative stress hypothesis in schizophrenia, studying the associations between white matter alterations and peripheral blood biomarkers of the glutathione redox cycle. The study tested the premise that redox imbalance disrupts oligodendrocyte differentiation and contributes to white matter pathology. Third, the multimodal integration of magnetic resonance spectroscopy with dMRI assessed the links between glial metabolites (e.g., myo-inositol, choline) and white matter alterations, providing cell-type-specific insights. Finally, a last ongoing normative modelling project is presented, studying the individual differences in early psychosis.
Results confirmed widespread microstructural abnormalities in early psychosis and schizophrenia, with advanced diffusion models revealing patterns not detectable with classical diffusion tensor scalars. Associations between myo-inositol and white matter measures support a role for glial processes in disease mechanisms, while oxidative stress markers showed limited evidence of direct white matter damage in vivo. These findings suggest that integrating biologically informed imaging models with peripheral and metabolic biomarkers can refine mechanistic understanding and guide patient stratification strategies. Finally, the need to shift toward individualised, longitudinal approaches, by moving beyond traditional group-based comparisons, is discussed.
Overall, this work advances the characterisation of white matter pathology in psychosis, demonstrating the utility of advanced dMRI for enhancing biological specificity and highlighting potential translational biomarkers for early detection and intervention
D’"Autobiographie d’une Courgette" à "Ma vie de Courgette". Le public cible comme moteur du processus adaptationnel
No full textLe roman "Autobiographie d’une Courgette" (Gilles Paris, 2002) a été adapté pour le cinéma par Claude Barras en 2016 dans un film d’animation en volume intitulé "Ma vie de Courgette". À travers l’analyse croisées de documents d’archives relatifs au développement du film, cet article s’intéresse à la genèse de Ma vie de Courgette. Il propose de saisir les motivations sous-jacentes aux transformations narratives et formelles qui ont été opérées tout au long du processus adaptationnel à travers la question de la catégorie du film familial. La transposition médiatique du roman vers le film s’est vue doublée d’un changement progressif d’identité catégorielle – le passage de la catégorie d’objet culturel pour (jeunes) adultes à celle d’objet culturel pour les familles – qui a participé à configurer le contenu visuel et narratif du film de Barras. Il s’agit de montrer dans cet article que le mode d’adresse du film découle d’une connaissance construite – qui repose notamment sur d’autres productions de la catégorie du long métrage d’animation – et subjective – déterminée par le parcours et les références des personnes participant à l’élaboration du film – des attentes et des goûts du public visé
ESPEN guideline on clinical nutrition in surgery - Update 2025
No full textEarly oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, nutritional therapy is mandatory for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: a) Integration of nutrition into the overall management of the patient, b) avoidance of long periods of preoperative fasting c) re-establishment of oral feeding as early as possible after surgery d) start of nutritional therapy early, as soon as a nutritional risk becomes apparent e) metabolic control e.g. of blood glucose, f) reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function, g) minimized time on paralytic agents in the postoperative period, and h) early mobilization to facilitate protein synthesis and muscle function. The guideline presents 44 recommendations for clinical practice in patients undergoing elective and non-elective surgery, including new recommendations for frailty assessment, sarcopenia diagnosis, and prehabilitation. As in the former ESPEN practical guideline, the recommendations were additonally presented in decision-making flowcharts.
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