Swiss School of Archaeology in Greece
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Challenges in diagnosing gestational diabetes after Roux-en-Y gastric bypass: a comparative analysis of OGTT, SMBG, and CGM
No full textGestational diabetes mellitus (GDM) is a common complication of pregnancy, and the oral glucose tolerance test (OGTT) is the standard diagnostic tool. However, in women after Roux-en-Y gastric bypass (RYGB), OGTT is less reliable and potentially unsafe due to the risk of hypoglycemia.
This study compares 3 methods of GDM diagnosis-OGTT, self-monitoring of blood glucose (SMBG), and continuous glucose monitoring (CGM)-in post-RYGB pregnant women to assess and compare their diagnostic performance.
University Hospital, Switzerland.
A cohort of 15 pregnant women with a history of RYGB was evaluated between 24 and 28 weeks of gestation. Each participant underwent OGTT, SMBG, and CGM. We assessed the sensitivity, specificity, and concordance of OGTT and SMBG against CGM, which served as the reference test. The incidence of hypoglycemia during OGTT was examined.
Using OGTT, 7 of the 15 participants were diagnosed with GDM, and 8 participants experienced hypoglycemia (glucose levels below 3.0 mmol/L). SMBG diagnosed GDM in 7 participants and CGM identified GDM in 11 participants. There was no significant concordance among OGTT, SMBG, and CGM (φ .26 (-.26 to .67) between OGTT and CGM (P = .57); φ -.07 (-.58 to .44) between OGTT and SMBG (P = 1), φ .26 (-.21 to .67), and between CGM and SMBG (P = .57). OGTT and SMBG demonstrated similar sensitivity and specificity, when compared to CGM (sensitivity of 54.40% and specificity of 75%) even though the patients diagnosed differed between the methods.
In this exploratory study, CGM appears to be a possible approach for diagnosing GDM in post-RYGB patients. SMBG is a commonly available method. OGTT poses risks of severe hypoglycemia. These findings support the need for tailored GDM screening approaches in postbariatric surgery pregnancies and highlight the importance of further research to establish specific guidelines for this population.
Copyright © 2025 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved
Lymphoscintigraphy for the Evaluation of Primary Lymphedema: A Scoring System Aimed at Harmonizing the Procedure and Interpretation and Increasing Reproducibility.
No full textThe diagnostic workup of primary lymphedema includes lymphoscintigraphy, a diagnostic test that provides objective data derived from the characteristics of the lymphatic flow and the lymphatic nodes. Several empirical scoring systems have been proposed with the aim of harmonizing the procedure. Here we comment the latest one, reflecting on the relevance of these tools to make possible multicenter research, based on intraobserver and interobserver reliability with the aim to, in the long run, improve patient outcomes
Impact of workflow times on successful reperfusion after endovascular treatment in the late time window
No full textBackground and PurposeSuccessful and complete reperfusion should be the aim of every endovascular thrombectomy (EVT) procedure. However, the effect of time delays on successful reperfusion in late window stroke patients presenting 6-to-24 h from onset has not been investigated.Materials and MethodsWe pooled individual patient-level data from seven trials and registries for anterior circulation stroke patients treated with EVT between 6 and 24 h from onset. We explored the impact of delays across multiple interval times, including onset to hospital arrival; hospital arrival to arterial puncture; imaging to arterial puncture; and onset to arterial puncture. Our primary outcome was successful reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2b-3. Logistic regression analyses were performed to assess the association between each of the interval times and successful reperfusion.ResultsWe included 608 patients. The median age was 70 years (IQR 58-79), and 307 (50.5%) were females. Successful reperfusion was achieved in 494 (81.2%) patients. Patients with successful reperfusion had lower NIHSS scores (median 15 [IQR11-19] vs 17 [11-21], p = .02) and significantly shorter hospital arrival to arterial puncture time (90 min [60-150] vs 110 min [84.5-150], p = .01) than unsuccessful reperfusion. The odds of successful reperfusion decreased by 15% for every one-hour delay in arrival-to-puncture time (adjusted odds ratio 0.85, 95% CI: 0.75-0.95). Other workflow times did not impact the rate of successful reperfusion.ConclusionFaster hospital arrival to arterial puncture time is associated with higher odds of successful reperfusion in late window stroke patients
Patent Foramen Ovale in Pregnancy: A Call for Action.
No full textPatent foramen ovale (PFO) is a common anatomical variant that can promote paradoxical embolic events. As pregnancy and the postpartum period are responsible for a hypercoagulable state, the risk for paradoxical embolism might be increased in the presence of a PFO. An updated systematic review was performed to evaluate the available data regarding the risk of adverse pregnancy outcomes in women with reported PFO-related complications during pregnancy or postpartum. A comprehensive literature search was performed using MEDLINE, Scopus, and Web of Science electronic databases from their inception to April 2024. A total of 28 pregnant women diagnosed with PFO were included (mean age, 29.43 ± 5.48 years). The majority of the paradoxical embolic events occurred during pregnancy (60%) while 3 (11%) occurred during delivery and 8 (29%) postpartum. A significant proportion of paradoxical embolism comprised ischemic events (89%) including ischemic stroke (57%), transient ischemic attack (14%), acute myocardial infarction (7%), and branch retinal artery occlusion (11%). Three women (11%) suffered cardiopulmonary arrest due to an amniotic fluid embolism. Moreover, thrombus in transit appeared in 4 women (14%). Twelve women (42%) underwent transcatheter PFO closure procedure during the pregnancy, 4 (14%) in the postpartum, and 7 (25%) received only medical treatment. Limited data exist regarding optimal management of PFO in pregnant women. Further research is needed to develop refined guidelines and improve outcomes for this unique patient population, ensuring both maternal and fetal safety
A 2035 Clinical Research Vision and Roadmap for High-Risk Neuroblastoma.
No full textDespite the introduction of anti-GD2 antibody therapy, outcomes for children with high-risk neuroblastoma remain poor, with low cure rates and a high proportion of survivors facing long-term sequelae. In this report, leaders from international cooperative groups and patient advocacy organizations review lessons learnt, identify current challenges, and provide a vision to bring new agents into frontline therapy to increase cure rates and reduce long-term toxicities over the next decade. The implementation of this vision requires improved global collaboration, incorporation of novel biomarkers, and a strengthened interaction with the regulatory landscape
Influence de l’auto-stigmatisation, de l’état de santé perçu et de l’estime de soi sur l’espoir chez les patients psychiatriques
No full textIntroduction : L’auto-stigmatisation, processus par lequel les patients psychiatriques internalisent les préjugés sociaux à leur égard, a des conséquences importantes sur leur bien-être psychologique.
Objectifs : L’objectif principal est de déterminer dans quelle mesure l’estime de soi et la perception de l’état de santé agissent comme médiateurs dans la relation entre l’auto-stigmatisation (cognitive, affective et comportementale) et l’espoir dans l’avenir.
Méthode : Une étude par modèles de médiation a été réalisée auprès d’un échantillon de patients psychiatriques. L’auto-stigmatisation a été évaluée à travers ses dimensions cognitives, affectives et comportementales. L’estime de soi, la perception de l’état de santé, l’espoir et le pessimisme ont été mesurés à l’aide d’échelles standardisées. Des analyses statistiques de médiation univariée et multivariée ont été effectuées pour examiner les effets directs et indirects.
Résultats : Les analyses montrent que toutes les dimensions de l’auto-stigmatisation ont un effet direct significatif sur le pessimisme, et exercent une influence négative sur l’estime de soi et la perception de l’état de santé. Parmi les médiateurs étudiés, l’estime de soi joue un rôle central en expliquant plus de 50% de la relation entre l’auto- stigmatisation et le pessimisme, tandis que la perception de l’état de santé contribue de manière plus modeste (environ 10%) et ne présente pas d’effet significatif lorsqu’elle est analysée conjointement avec l’estime de soi.
Conclusion : Ces résultats soulignent l’importance de cibler l’estime de soi dans les interventions cliniques pour réduire l’impact de l’auto-stigmatisation chez les patients psychiatriques. Des stratégies thérapeutiques visant à renforcer l’image de soi et à améliorer la perception de l’état de santé pourraient favoriser une diminution du pessimisme et encourager une vision plus positive de l’avenir
PD-1 cis-targeted IL-2v in combination with radiotherapy inhibits lung cancer growth and remodels the immune microenvironment.
No full textMore efficient therapeutic options for non-small cell lung cancer (NSCLC) are needed as the survival at 5 years of metastatic disease is near zero. In this regard, we used a preclinical model of metastatic lung adenocarcinoma (SV2-OVA) to assess the safety and efficacy of novel radio-immunotherapy combining hypofractionated radiotherapy (HRT) with muPD1-IL2v immunocytokine and muFAP-CD40 bispecific antibody.
We evaluated the changes in the lung immune microenvironment at multiple timepoints following combination therapies and investigated their underlying antitumor mechanisms. Additionally, we analyzed the tumor clonal heterogeneity upon the combination treatments to explore potential mechanisms associated with the lack of complete response.
The combination of HRT with muPD1-IL2v had a potent antitumor effect and increased survival in the SV2-OVA lung cancer model. Importantly, this combination therapy was devoid of measurable toxicity. It induced remodeling of the immune contexture through the increase of CD8 + T and natural killer (NK) cells. The addition of muFAP-CD40 to the combination treatment further increased infiltrating CD8 + T cells, expressing high levels of effector molecules, both in the periphery and core tumor regions. An accumulation of CD8 + PD-1 + TOX + (exhausted) T cells, already at the 'early' timepoint, is consistent with the limited clinical benefits provided by the various combination treatments in this model. The study of the clonal dynamics of tumor cells during disease progression and therapy highlighted a clonal selection upon HRT+muPD1-IL2v therapy.
We demonstrated that HRT+muPD1-IL2v combination is a potent therapeutic strategy to delay tumor growth and increase survival in a metastatic lung cancer model, but additional studies are required to completely understand the resistance mechanisms associated with the lack of complete response in this model
Effect of surfactants on inactivation of Bacillus subtilis spores by chlorine.
No full textBacterial spores pose significant risks to human health, yet the inactivation of spores is challenging due to their unique structures and chemical compositions. This study investigated the synergistic effect between surfactants and chlorine on the inactivation kinetics of Bacillus subtilis spores. Two surfactants, cocamidopropyl betaine (CAPB) and cetyltrimethylammonium chloride (CTMA) were selected to investigate chlorine disinfection in absence and presence of surfactants. The concurrent presence of both chlorine and surfactant resulted in a moderate reduction in the lag-phases for spore inactivation and negligible increase in the second-order inactivation rate constants. In contrast, when the spores were pre-exposed to surfactants, the lag-phases decreased by about 50 % for both CAPB and CTMA, and the second-order inactivation rate constants during post-chlorination remained constant for CAPB but increased by a factor of 2.3 for CTMA, compared to the control group with phosphate buffer. This synergistic effect became more pronounced with longer surfactant pre-exposure times, reaching its maximum at 3-6 h. The observed synergistic effect suggests that surfactants can potentially enhance the permeability of the coat which is the outmost layer of B. subtilis spores and a primary barrier for chemical disinfectants. Tracing a group of B. subtilis spores sequentially treated with surfactant and chlorine by atomic force microscopy, a significant decrease in compressive stiffness of the spores was observed due to exposure to surfactants, indicating alterations in the coat by surfactants. The trend in reducing compressive stiffness aligned well with the decrease of lag-phases in inactivation kinetics. Furthermore, CTMA was found to inactivate B. subtilis spores through mechanisms different from chlorine. Chlorine primarily inactivated B. subtilis spores before damaging the inner membrane of the spores which plays a crucial role in protecting the genetic material stored in the core of the spores. In comparison, CTMA damaged 22 % of the inner membrane for an inactivation efficiency of 99 %. A synergistic effect in damaging the inner membrane was observed when applying CTMA and chlorine simultaneously instead of sequentially
Planning Sufficiency in Switzerland : from a metabolic perspective to multi-policy transition scenarios
No full textEarly vascular aging ambulatory score in acute ischemic stroke.
No full textUnderstanding the impact of early vascular aging (EVA) on acute ischemic stroke (AIS) outcomes may provide new insights for improving prognostic assessments and developing targeted therapeutic strategies. This study aimed to validate the EVA ambulatory score (EVAAs) in AIS patients, assessing its association with stroke type, severity, and prognosis. Among the 2,730 AIS patients with a mean age of 72.0 ± 14.4 years, 83.4% exhibited EVA. EVA was identified as an independent predictor of poor outcome at both discharges (aOR:1.72, 95%CI:1.25-2.36, p < 0.001) and at 90 days (aOR:2.22, 95%CI:1.49-3.31, p < 0.001). In subgroup analyses, EVAAs showed improved predictive value in AIS patients with a lower cardiovascular disease burden and a non-atherogenic lipid profile. The EVAAs, as an indicator of EVA that could be easily integrated into daily clinical practice, are a significant predictor of adverse outcomes in AIS patients