Swiss School of Archaeology in Greece
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French nationwide monthly online consultation meeting on complex abdominal wall repairs: 4-year assessment of an innovative collaborative decision-making tool
No full textTreatment of complex cases of abdominal wall reconstruction (AWR) has become more frequent, and management options are diverse. Treatment decision could be improved using a multicentric consultation meeting. The aim of this study was to assess quantitatively and qualitatively the outcomes of the French national online consultation meeting (OCM).
The OCM was implemented in January 2021. This is an OCM where all surgeons working in France can present their cases of complex AWR for opinion. Descriptive statistics on this OCM were collected from implementation to March 2025. Moreover, a survey on how participating surgeons perceived this OCM was performed.
During the study period, a total of 436 cases were presented at the OCM (384 ventral hernias, 88% and 52 groin hernias, 12%). Overall, 127 surgeons participated in the OCM. The majority of presented patients originated from university hospitals (n = 294, 68%). Thirty-one surgeons (31/127 = 24%) who participated in the OCM answered the survey. Most surgeons found that the OCM had a very high pedagogical interest (median 9/10, IQR 8-10). In total, 30/31 surgeons (97%) would recommend to a colleague to take part in this OCM. Among surgeons who presented a case and answered the survey (n = 24), 1 (4%), 10 (42%), and 13 (54%) surgeons found the OCM useful, very useful, and indispensable, respectively. All surgeons who responded were satisfied with the OCM (21 were very satisfied, 87%).
Implementation of a nationwide OCM for complex AWR is feasible and sustainable. Feedbacks from participants emphasized the usefulness of this meeting designed to help surgeons to better tailor treatment to patients with complex hernias. However, as patient outcomes were not available, precluding any analyses on the impact of the OCM on patient postoperative evolution, further follow-up results will be needed.
© 2025. The Author(s)
Europeanisation and domestic policy concertation: How actors use Europe to modify domestic patterns of policy-making
No full textClinical predictors of immediate response to a multimodal inpatient programme for chronic refractory musculoskeletal pain syndromes - a cross-sectional study
No full textObjectives
Chronic pain (CP) affects approximately 20% of the global population, leading to significant disability and economic burden. Multimodal programmes (MMPs) are the most effective short-term interventions for managing musculoskeletal chronic pain syndromes (MCPS). However, patient characteristics influence treatment response, requiring personalized approaches. This study aims to identify clinical, social and psycho-behavioural predictors of immediate response to a 2-week inpatient MMP for refractory MCPS.
Methods
A cross-sectional study analysed 207 MCPS patients who completed an MMP at CHUV Lausanne, Switzerland, from March 2018 to November 2022. Validated questionnaires assessed pain severity, impact, kinesiophobia, catastrophizing and other factors before and after the programme. Univariate and multivariate analyses identified predictors of treatment response.
Results
Significant improvements were observed in 9 out of 12 outcomes, including pain severity (P = 0.01), pain impact (P < 0.01), disability (P = 0.14), kinesiophobia (P<0.001) and catastrophizing (P < 0.001). Non-specific low-back pain, catastrophizing at entry, biomechanical disorders and psychiatric conditions were identified as key predictors of treatment response, respectively influencing 4, 3, 3 and 2 over 9 outcome measures in multivariable analysis. Non-specific low-back pain was linked to worse outcomes, whereas reductions in catastrophizing correlated with improved pain severity and kinesiophobia. Socioeconomic factors, such as disputes over disability financial aid, also influenced outcomes.
Conclusion
This study confirms a modest yet significant immediate benefit of MMP for patients with refractory MCPS and provided a deeper insight into the predictors of treatment outcomes and their influence on various outcome measures. Further longitudinal studies are needed to confirm these findings and explore underlying mechanisms
“Should I continue with this profession or not?”: moral distress during the COVID-19 pandemic among Swiss healthcare workers
No full textA neuronal architecture underlying autonomic dysreflexia
No full textAutonomic dysreflexia is a life-threatening medical condition characterized by episodes of uncontrolled hypertension that occur in response to sensory stimuli after spinal cord injury (SCI)1. The fragmented understanding of the mechanisms underlying autonomic dysreflexia hampers the development of therapeutic strategies to manage this condition, leaving people with SCI at daily risk of heart attack and stroke2-5. Here we expose the neuronal architecture that develops after SCI and causes autonomic dysreflexia. In parallel, we uncover a competing, yet overlapping neuronal architecture activated by epidural electrical stimulation of the spinal cord that safely regulates blood pressure after SCI. The discovery that these adversarial neuronal architectures converge onto a single neuronal subpopulation provided a blueprint for the design of a mechanism-based intervention that reversed autonomic dysreflexia in mice, rats and humans with SCI. These results establish a path towards essential pivotal device clinical trials that will establish the safety and efficacy of epidural electrical stimulation for the effective treatment of autonomic dysreflexia in people with SCI.
© 2025. The Author(s)
Trading off Iodine and Radiation Dose in Coronary Computed Tomography.
No full textCoronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction, wide-area detectors, and dual-source systems, have helped mitigate early limitations, such as high radiation doses, motion artifacts, high iodine load, and non-diagnostic image quality. However, the adjustments between ionizing radiation and iodinated contrast material (CM) volumes remain a critical concern, especially due to the increasing use of CCTA in various indications. This review explores the balance between radiation and CM volumes, emphasizing patient-specific protocol optimization to improve diagnostic accuracy while minimizing risks. Radiation dose reduction strategies, such as low tube voltage protocols, prospective ECG-gating, and modern reconstruction algorithms, have significantly decreased radiation exposure, with some studies achieving sub-millisievert doses. Similarly, CM volume optimization, including adjustments in strategies for calculating CM volume, iodine concentration, and flow protocols, plays a role in managing risks such as contrast-associated acute kidney injury, particularly in patients with renal impairment. Emerging technologies, such as photon-counting CT and deep-learning reconstruction, promise further improvements in dose efficiency and image quality. This review summarizes current evidence, highlights the benefits and limitations of dose control approaches, and provides practical recommendations for practitioners. By tailoring protocols to patient characteristics, such as age, renal function, and body habitus, clinicians can achieve an optimal trade-off between diagnostic accuracy and patient safety, ensuring optimal operation of CT systems in clinical practice
Endovascular treatment in patients with acute ischemic stroke presenting beyond 6 h after symptom onset: An international multicenter cohort study of the EVA-TRISP collaboration.
No full textAfter positive findings in clinical trials the time window for endovascular thrombectomy (EVT) for patients with an acute ischemic stroke has been expanded up to 24 h from symptom onset or last seen well (LSW). We aimed to compare EVT patients' characteristics and outcomes in the early versus extended time window and to compare outcomes with the DAWN and DEFUSE 3 trial results.
Consecutive EVT patients from 16 mostly European comprehensive stroke centers from the EVA-TRISP cohort were included. We compared rates of 90-day good functional outcomes (Modified Rankin Scale 0-2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality between patients treated in the early (<6 h after onset or LSW) versus extended (6-24 h after onset or LSW) time windows.
We included 9313 patients, of which 6876 were treated in the early and 2437 in the extended time window. National Institutes of Health Stroke Scale (NIHSS) score at presentation was lower in patients treated in the extended time window (median 13 [IQR 7-18] vs 15 [IQR 9-19], p < 0.001). The percentage of patients with good functional outcome was slightly lower in the extended time window (37.4% vs 42.2%, p < 0.001). However, rates of successful recanalization, sICH, and mortality were similar. Good functional outcome rates after EVT were slightly lower for patients in the extended window in the EVA-TRISP cohort as compared to DAWN and DEFUSE 3.
According to this large multicenter cohort study reflecting daily clinical practice, EVT use in the extended time window appears safe and effective
Uniting Machine Intelligence, Brain and Behavioural Sciences to Assist Criminal Justice.
No full textI discuss here three important roles where machine intelligence, brain and behaviour studies together may facilitate criminal law. First, predictive modelling using brain and behaviour data may support legal investigations by predicting categorical, continuous, and longitudinal legal outcomes of interests related to brain injury and mental illnesses. Second, psychological, psychiatric, and behavioural studies supported by machine learning algorithms may help predict human behaviour and actions, such as lies, biases, and visits to crime scenes. Third, machine learning models have been used to predict recidivism using clinical and criminal data whereas brain decoding is beginning to uncover one's thoughts and intentions based on brain imaging data. Having dispensed with achievements and promises, I examine concerns regarding the accuracy, reliability, and reproducibility of the brain- and behaviour-based assessments in criminal law, as well as questions regarding data possession, ethics, free will (and automatism), privacy, and security. Further, I will discuss issues related to predictability vs. explainability, population-level prediction vs. personalised prediction, and predicting future actions, and outline three potential scenarios where brain and behaviour data may be used as court evidence. Taken together, brain and behaviour decoding in legal exploration and decision-making at present is promising but primitive. The derived evidence is limited and should not be used to generate definitive conclusions, although it can be potentially used in addition, or parallel, to existing evidence. Finally, I suggest that there needs to be (more precise) definitions and regulations regarding when and when not brain and behaviour data can be used in a predictive manner in legal cases
PD-1<sup>+</sup> NK cell subsets in high grade serous ovarian cancer: an indicator of disease severity and a target for combined immune-checkpoint blockade
No full textOvarian cancer (OC) is the fifth leading cause of cancer-related death among women, with High-Grade Serous Ovarian Carcinoma (HGSC) representing the most aggressive and prevalent subtype. Despite promising results in other malignancies, immune checkpoint blockade has shown limited efficacy in HGSC, highlighting the need for alternative immunotherapeutic targets.
We conducted an integrated analysis combining multiparametric flow cytometry, RNA sequencing, multiplex immunohistochemistry, and functional assays to characterize NK cells isolated from peripheral blood, peritoneal fluid, primary tumor tissue, and metastases in 60 HGSC patients.
We identified a distinct population of PD-1⁺ NK cells enriched in HGSC tumors and metastatic sites but absent in healthy donors. These cells, characterized by a CD56dimNKG2A⁺KIR⁺/⁻NKp46⁺CD57low phenotype, displayed impaired cytotoxicity against autologous HGSC targets, correlating with poorer prognosis. Crucially, this dysfunction was reversible upon combined blockade of PD-1/PD-L1, NKG2A, and KIRs. Spatial and molecular profiling revealed that these cells localize within PD-L1⁺/HLA-E⁺ tumor niches, suggesting that immune suppression is spatially and molecularly coordinated. Transcriptomic analysis confirmed their altered functional state and highlighted actionable checkpoint targets.
Our findings uncover a previously underappreciated population of dysfunctional PD-1⁺ NK cells in HGSC and demonstrate that their suppression is reversible through combinatorial checkpoint inhibition. These insights support the development of spatially-informed, NK-targeted immunotherapies for HGSC patients, particularly those resistant to T cell-based strategies.
The online version contains supplementary material available at 10.1186/s13046-025-03508-2
Jones & Jones
No full textCompte rendu de Pascal Nordmann, Samuel Jones, Monologue, Prilly, Presses inverses, 2024, 72 pages. Samuel Jones (2024) de Pascal Nordmann consiste dans le discours d’un homme qui s’exprime sur « la fêlure » (passim) qui divise le monde. Cet expert en « mathématiques des destructions involontaires » (p. 26), lauréat du fameux « prix de Stockholm » (p. 63), est pris en charge dans une institution médicale depuis un accident fâcheux. Celui-ci aurait pu ressembler à un vaudeville, s’il n’avait pas été causé par un trouble psychiatrique : l’homme aurait voulu tuer d’une balle l’amant de sa femme, mais cet amant n’était personne d’autre que lui-même. À sa façon, Pascal Nordmann nous rappelle que le théâtre a son mot à dire, dès lors qu’il s’agit d’associer « [q]uatre mains, une clarinette, un seul corps, deux esprits » (p. 17) dans un même monologue