Swiss School of Archaeology in Greece
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Management and outcome of patients with cardiac arrest after avalanche accidents in the Swiss Alps: A retrospective analysis.
No full textOur aim is to evaluate the management and outcome of avalanche victims in cardiac arrest (CA), focusing on the adherence to international management guidelines and to identify ways to improve the future care of avalanche victims through retrospective evaluation of the missions.
We analysed a retrospective cohort of all avalanche victims in CA treated by Swiss Air-Rescue Rega between 2010 and 2024. Data regarding the avalanche burial (type of burial, burial duration, presence of a patent airway) were evaluated, as were helicopter operational data, data on prehospital medical care [cardiopulmonary resuscitation (CPR) efforts, airway management, core temperature], transport destination, data from further in-hospital treatment if applicable [core temperature, type of rewarming, serum potassium levels, extracorporeal life support (ECLS)] as well as patient outcome.
147 patients could be evaluated. 50 (34%) were declared dead without CPR efforts. CPR was started in 97 patients (66%), of whom 19 achieved ROSC (13%). Only 4 of these patients survived to hospital discharge (3%), 3 of whom had a good neurological outcome (2%). 34 patients (23%) were transported to hospital while CPR was ongoing, of whom in 11 (7%) ECLS was tried to initiate. None of these patients survived to hospital discharge. 27 patients (18%) were not treated in accordance with the guidelines. 22 of these (15%) were (potentially) undertreated (mainly in the sense of transport to a non-ECLS centre, although an ECLS centre would have been correct), 5 (3%) were overtreated (mainly in the sense of transport under ongoing CPR, although not indicated). 61% were tracheally intubated. On admission, core temperature was 1.9 °C (95% confidence interval 1.1-2.7) lower than the temperature measured on scene.
Patients who suffer a CA in avalanche accidents have a very poor outcome. A high proportion of patients were not tracheally intubated during transport, cooled down further during resuscitation and transport or were not transported to ECLS centres although indicated. On the other hand, the outcome of ECLS patients is extremely poor
The bacterial microbiome modulates the initiation of brain metastasis by impacting the gut-to-brain axis.
No full textBrain metastases (BrMs) are the most common brain tumors in patients and are associated with poor prognosis. Investigating the systemic and environmental factors regulating BrM biology represents an important strategy to develop effective treatments. Toward this goal, we explored the contribution of the gut microbiome to BrM development by using in vivo breast-BrM models under germ-free conditions or antibiotic treatment. This revealed a detrimental role of gut microbiota in fostering BrM initiation. We thus evaluated the impact of antibiotics and BrM outgrowth on the gut-brain axis. We found the bacterial genus Alistipes was differentially present under antibiotic treatment and BrM progression. In parallel, we quantified circulating metabolites, revealing kynurenic acid as a differentially abundant molecule that impaired the interaction between cancer cells and the brain vasculature in ex vivo functional assays. Together, these results illuminate the potential role of gut microbiota in modulating breast-BrM via the gut-to-brain axis
Relaxed Purifying Selection is Associated with an Accumulation of Transposable Elements in Flies.
No full textAlthough the mechanisms driving genome size evolution are not yet fully understood, one potentially important factor is the dynamics of the accumulation of transposable elements (TEs). Since most TEs are neutral or slightly deleterious, a negative correlation between the genome size and the efficacy of selection is expected. However, previous empirical studies on closely related species with distinct life history traits (thought to undergo different selective regimes) have yielded inconsistent results. Here, we perform the first large-scale analysis of the effect of genetic drift on the genome size evolution, without any prior assumption on the amount of genetic drift. We reconstructed a phylogeny based on the whole-genome data (2,242 genes) for 77 Drosophilid species to examine correlations between the genome size, TE content, and the efficacy of selection (using dN/dS ratios of non-synonymous to synonymous divergence). Using an integrative approach that controls for shared evolutionary history, we reveal that the genome-wide dN/dS are strongly positively correlated with the genome size and TE content, particularly in GC-poor genes. This study suggests the critical importance of controlling for heterogeneity in the base composition when estimating dN/dS. Furthermore, we emphasize that the lack of evidence for the TE accumulation due to increased genetic drift in several previous studies may be due to a secondary effect of changes in life history traits (i.e. asexuality) on TE dynamics. In conclusion, this work provides evidence for TE proliferation in fly genomes when purifying selection is reduced, shedding new light on the role of TEs and genetic drift in the evolution of genome architecture
L'intellect agent dans la Paraphrase au De Anima d'Aristote de Thémistius. Innovations et reconfigurations de la noétique aristotélicienne
No full textExploring apathy components and their relationship in cognitive decline: insights from a network cross-sectional study.
No full textApathy worsens with age and cognitive decline, particularly in Alzheimer's, leading to functional and cognitive deterioration. Comprehending its broad impact is vital for customized, preventive treatments.
The study examined 214 adults divided in three groups-Mild Cognitive Impairment, mild Alzheimer's, and controls-using neuropsychological tests and questionnaires, with statistical and network analysis to explore apathy's links with other group variables related to demographics and treatment.
Notable differences were observed among the groups' performance of administered tests. While inferential statistics failed to return a predictive model of apathy in mild Alzheimer's, networks and cluster analyses indicate that the demographic variables analysed have different importance at different times of disease progression and that cognitive apathy is particularly prominent in AD-related decline.
Network analysis revealed insights into dementia risk differentiation, notably the impact of sex and demographic factors, beyond the scope of traditional statistics. It highlighted cognitive apathy as a key area for personalized intervention strategies more than behavioural and emotional, emphasizing the importance of short-term goals and not taking away the person's autonomy when not strictly necessary
Severe Heart Failure and Treatment With Dapagliflozin Across the Ejection Fraction Spectrum: DAPA-HF and DELIVER.
No full textPatients with severe heart failure (HF) experience debilitating clinical symptoms and worse cardiovascular (CV) outcomes with an excess mortality risk.
The authors aimed to assess the prevalence, CV outcome risk, and treatment response to the sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin among patients with severe HF across the spectrum of left ventricular ejection fraction (LVEF) in DAPA-HF and DELIVER.
Severe HF was adapted from the ESC (European Society of Cardiology) HFA (Heart Failure Association) definition: NYHA functional class III/IV, evidence of HF with reduced, mildly reduced, or preserved LVEF, HF hospitalization within the previous 12 months, and adverse patient-reported symptom burden (Kansas City Cardiomyopathy Questionnaire-Total Symptoms Score <75). Outcomes and the treatment effect of dapagliflozin were assessed for the primary endpoint of CV death or first worsening HF event by severe HF status.
Among 10,948 patients with available data to define severe HF, 730 (6.7%) fulfilled the severe HF definition (296/4,722 [6.2%] with LVEF ≤40%, 192/2,101 [9.1%] with LVEF 41%-49%, and 232/4,125 [5.6%] with LVEF ≥50%). Over a median follow-up of 22 months, the primary endpoint occurred in 231 patients, at a rate of 20 per 100 patient-years (Q1-Q3: 17-23 per 100 patient-years). Patients with severe HF experienced a higher rate of events than patients without severe HF (adjusted HR: 1.85; 95% CI: 1.60-2.12), regardless of LVEF (P interaction = 0.98). Treatment with dapagliflozin was consistently beneficial in reducing the risk of the primary endpoint regardless of severe HF status (P interaction = 0.48) across the LVEF spectrum (3-way P interaction = 0.52). The safety profile of dapagliflozin was also consistent regardless of the severe HF status.
Severe HF was associated with an excess risk of CV events across the spectrum of LVEF. Treatment with the SGLT2i dapagliflozin appeared to be safe and effective in reducing the risk of CV death or worsening HF in this population. (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure [DAPA-HF]; NCT03036124; Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213)
Myocardial Entropy and Risk Predictors in Hypertrophic Cardiomyopathy: An Analysis From the NHLBI HCM Registry
No full textEntropy, a novel measure of myocardial tissue heterogeneity by cardiovascular magnetic resonance imaging, may have clinical value in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate the associations of entropy with risk predictors in HCM, using the National Heart, Lung, and Blood Institute HCM Registry.
Entropy values were calculated using the probability distribution of pixel signal intensities of the left ventricular (LV) myocardium on the late gadolinium enhancement (LGE) short-axis stack images. Entropy values were correlated with demographic, genetic, imaging, and serum biomarkers as well as ambulatory Holter recordings and the European Society of Cardiology risk score of sudden cardiac death at 5 years.
Among 1736 patients with HCM, LV entropy demonstrated significant associations with sarcomere mutations, history of ventricular tachycardia, atrial fibrillation, and elevation of cTnT (cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels (P<0.001). Furthermore, LV entropy demonstrated an association with increased maximal LV wall thickness, LGE presence and extent, higher extracellular volume, left atrial area and function, myocardial strain (P<0.001), and was positively correlated with higher values of the European Society of Cardiology risk score (P<0.001). In the subgroup of patients without LGE (n=858), entropy values remained significantly associated with a history of ventricular tachycardia, increased maximal wall thickness, decreased myocardial strain, and the European Society of Cardiology risk score (P<0.05 for all). In both the whole cohort and in patients without LGE, LV entropy was the strongest predictor of ventricular tachycardia on Holter (odds ratio [95% CI] 1.59 [1.33-1.90]; 1.87 [1.28-2.74] respectively, P<0.001 for both).
In patients with HCM, LV entropy demonstrated associations with clinical, imaging, and biological predictors of adverse outcomes independent of LGE presence and was the strongest predictor of ventricular tachycardia on Holter.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01915615