Hopitaux Universitaires Of Geneva Hug

Genève, Switzerland

Hopitaux Universitaires Of Geneva Hug

Genève, Switzerland
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Leonardi N.,Ecole Polytechnique Federale de Lausanne | Leonardi N.,University of Geneva | Richiardi J.,Stanford University | Richiardi J.,University of Geneva | And 12 more authors.
NeuroImage | Year: 2013

Functional connectivity (FC) as measured by correlation between fMRI BOLD time courses of distinct brain regions has revealed meaningful organization of spontaneous fluctuations in the resting brain. However, an increasing amount of evidence points to non-stationarity of FC; i.e., FC dynamically changes over time reflecting additional and rich information about brain organization, but representing new challenges for analysis and interpretation. Here, we propose a data-driven approach based on principal component analysis (PCA) to reveal hidden patterns of coherent FC dynamics across multiple subjects. We demonstrate the feasibility and relevance of this new approach by examining the differences in dynamic FC between 13 healthy control subjects and 15 minimally disabled relapse-remitting multiple sclerosis patients. We estimated whole-brain dynamic FC of regionally-averaged BOLD activity using sliding time windows. We then used PCA to identify FC patterns, termed "eigenconnectivities", that reflect meaningful patterns in FC fluctuations. We then assessed the contributions of these patterns to the dynamic FC at any given time point and identified a network of connections centered on the default-mode network with altered contribution in patients. Our results complement traditional stationary analyses, and reveal novel insights into brain connectivity dynamics and their modulation in a neurodegenerative disease. © 2013 Elsevier Inc.

Simioni S.,University of Lausanne | Cavassini M.,Center Hospitalier University Vaudois | Annoni J.-M.,University of Lausanne | Bourquin I.,University of Lausanne | And 3 more authors.
AIDS | Year: 2010

OBJECTIVE: To determine the prevalence of cognitive complaints and HIV-associated neurocognitive disorders (HANDs) in a cohort of aviremic HIV-positive patients. To evaluate the relevance of the HIV dementia scale to detect HANDs. DESIGN: Assessment of HANDs with neuropsychological tests. METHODS: Two hundred HIV-infected patients with undetectable HIV-1 RNA concentrations in the plasma, no history of major opportunistic infection of the central nervous system in the past 3 years, no current use of intravenous drugs, and no major depression answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of 50 complaining and 50 noncomplaining HIV-positive patients were assessed. RESULTS: Patients had undetectable HIV-1 RNA concentrations for a median time of 48 months (range 3.2-136.6). The prevalence of cognitive complaints was 27%. The prevalence of HANDs was 84% among patients with cognitive complaints (asymptomatic neurocognitive impairment 24%, mild neurocognitive disorders 52%, and HIV-associated dementia 8%) and 64% among noncomplainers (asymptomatic neurocognitive impairment 60%, mild neurocognitive disorders 4%, and HIV-associated dementia 0%; P < 0.001). A score of 14 points or less on the HIV dementia scale yielded a positive predictive value of HANDs of 92% in complainers and 82% in noncomplainers. CONCLUSION: The prevalence of HANDs is high even in long-standing aviremic HIV-positive patients. However, HANDs without functional repercussion in daily life (asymptomatic neurocognitive impairment) is the most frequent subtype observed. In this population, the HIV dementia scale with a cutoff of 14 points or less seems to provide a useful tool to screen for the presence of HANDs. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Perrin J.,Nancy University Hospital Center | Perrin J.,French Institute of Health and Medical Research | Depasse F.,Diagnostica Stago | Lecompte T.,Hopitaux Universitaires Of Geneva Hug
Thrombosis Research | Year: 2015

Background Calibrated Automated Thrombography (CAT) has been widely used to assess in vitro thrombin generation as an informative intermediary phenotype of coagulation. Interlaboratory exercises have documented a worrisome poor reproducibility. There are some data on the normalisation with an appropriate external reference plasma (RP). This multicentre study of the French-speaking CAT Club aimed at providing further evidence for the usefulness of such a normalisation. Materials and Methods Lyophilised aliquots of a RP along with 3 plasmas (P1 = normal; P2 = hypo-; P3 = hypercoagulable) were sent to 34 laboratories (corresponding to 38 instruments). CAT was studied using 1 and 5 pM tissue factor and other dedicated reagents. Normalisation with the local RP in use in the laboratory could also be performed. Interlaboratory CVs were calculated for each plasma before and after normalisation. Results Regarding endogenous thrombin potential, a good discrimination between the 3 plasmas was achieved in all laboratories but there was no overlap after normalisation only. CVs were generally not reduced with the use of local RP but were generally improved with normalisation using the external RP, often becoming lower than 10%. Regarding P2 however, the benefit of normalisation was poor, and there were analytical difficulties as well, some laboratories being unable to get a useable signal. Conclusions We confirm that normalisation of CAT results with a suitable external RP is useful in "real life" practice as it often permits an acceptable level of interlaboratory variability. In case of frank hypocoagulability, further improvements are required to get reliable, potentially clinically relevant results. © 2015 Elsevier Ltd.

De Bari B.,University of Lausanne | Alongi F.,Sacro Cuore Hospital | Lestrade L.,Hopitaux Universitaires Of Geneva Hug | Giammarile F.,University Claude Bernard Lyon 1
Critical Reviews in Oncology/Hematology | Year: 2014

Among PET radiotracers, FDG seems to be quite accepted as an accurate oncology diagnostic tool, frequently helpful also in the evaluation of treatment response and in radiation therapy treatment planning for several cancer sites. To the contrary, the reliability of Choline as a tracer for prostate cancer (PC) still remains an object of debate for clinicians, including radiation oncologists. This review focuses on the available data about the potential impact of Choline-PET in the daily clinical practice of radiation oncologists managing PC patients. In summary, routine Choline-PET is not indicated for initial local T staging, but it seems better than conventional imaging for nodal staging and for all patients with suspected metastases. In these settings, Choline-PET showed the potential to change patient management. A critical limit remains spatial resolution, limiting the accuracy and reliability for small lesions. After a PSA rise, the problem of the trigger PSA value remains crucial. Indeed, the overall detection rate of Choline-PET is significantly increased when the trigger PSA, or the doubling time, increases, but higher PSA levels are often a sign of metastatic spread, a contraindication for potentially curable local treatments such as radiation therapy. Even if several published data seem to be promising, the current role of PET in treatment planning in PC patients to be irradiated still remains under investigation. Based on available literature data, all these issues are addressed and discussed in this review. © 2014 Elsevier Ireland Ltd.

Azria D.,CRLC Val dAurelle Paul Lamarque | Betz M.,Hopitaux Universitaires Of Geneva Hug | Bourgier C.,Institute Gustave Roussy | Sozzi W.J.,Center Hospitalier Univesitaire Vaudois | Ozsahin M.,Center Hospitalier Univesitaire Vaudois
Critical Reviews in Oncology/Hematology | Year: 2012

The impact of curative radiotherapy depends mainly on the total dose delivered in the targeted volume. Nevertheless, the dose delivered to the surrounding healthy tissues may reduce the therapeutic ratio of many treatments. Two different side effects (acute and late) can occur during and after radiotherapy. Of particular interest are the radiation-induced late complications (LC) due to their irreversibility and the potential impact on quality of life. In one population treated with the same technique, it appears that individual radiosensitivity clearly exists. In the hypothesis that genetic is involved in this area of research, low CD4 and CD8 lymphocyte apoptosis were shown to be correlated with high grade of LC. In addition, recent data suggest that patients with severe radiation-induced LC possess 4 or more single nucleotide polymorphisms (SNPs) in candidate genes and low radiation-induced CD8 lymphocyte apoptosis in vitro. On-going studies are being analyzing the entire genome using a genome-wide association study (GWAS). © 2010 Elsevier Ireland Ltd.

Steimer T.,Hopitaux Universitaires Of Geneva Hug | Steimer T.,University of Geneva
Dialogues in Clinical Neuroscience | Year: 2011

Animal models can certainly be useful to find out more about the biological bases of anxiety disorders and develop new, more efficient pharmacological and/or behavioral treatments. However, many of the current "models of anxiety" in animals do not deal with pathology itself, but only with extreme forms of anxiety which are still in the normal, adaptive range. These models have certainly provided a lot of information on brain and behavioral mechanisms which could be involved in the etiology and physiopathology of anxiety disorders, but are usually not satisfactory when confronted directly with clinical syndromes. Further progress in this field will probably depend on the finding of endophenotypes which can be studied in both humans and animals with common methodological approaches. The emphasis should be on individual differences in vulnerability, which have to be included in animal models. Finally, progress will also depend on refining theoretical constructs from an interdisciplinary perspective, including psychiatry, psychology, behavioral sciences, genetics, and other neurosciences. © 2011, LLS SAS.

Berchtold C.,ETH Zurich | Bosilkovska M.,Hopitaux Universitaires Of Geneva Hug | Daali Y.,Hopitaux Universitaires Of Geneva Hug | Walder B.,Hopitaux Universitaires Of Geneva Hug | Zenobi R.,ETH Zurich
Mass Spectrometry Reviews | Year: 2014

Future individualized patient treatment will need tools to monitor the dose and effects of administrated drugs. Mass spectrometry may become the method of choice to monitor drugs in real time by analyzing exhaled breath. This review describes the monitoring of exhaled drugs in real time by mass spectrometry. The biological background as well as the relevant physical properties of exhaled drugs are delineated. The feasibility of detecting and monitoring exhaled drugs is discussed in several examples. The mass spectrometric tools that are currently available to analyze breath in real time are reviewed. The technical needs and state of the art for on-site measurements by mass spectrometry are also discussed in detail. Off-line methods, which give support and are an important source of information for real-time measurements, are also discussed. Finally, some examples of drugs that have already been successfully detected in exhaled breath, including propofol, fentanyl, methadone, nicotine, and valproic acid are presented. Real-time monitoring of exhaled drugs by mass spectrometry is a relatively new field, which is still in the early stages of development. New technologies promise substantial benefit for future patient monitoring and treatment. © 2013 Wiley Periodicals, Inc. Mass Spec Rev 33: 394-413, 2014 © 2013 Wiley Periodicals, Inc.

Caflisch M.,Hopitaux Universitaires Of Geneva Hug
Therapeutische Umschau | Year: 2013

Adolescent medicine is situated "in between" and "on the borders of" different areas of medical specialisations: psychiatry, gynaecology, preventive medicine, paediatrics and internal medicine (and their respective subspecialties). The specificity of adolescent medicine is the evaluation of clinical situations with a particular consideration of the successive stages of the adolescent bio-psycho social development (puberty, identity construction, modifications of the relations to the peergroups and the family). A special interest goes also to preventive aspects, especially concerning experimental and risk behaviours. The medical approach to adolescents requires a particular attention to psychosocial aspects when confronted with somatic complaints and inversely a good somatic evaluation in front of adolescents suffering from complexes psychosocial situations. © 2013 Verlag Hans Huber, Hogrefe AG, Bern.

Detterbeck F.C.,Yale University | Grodzki T.,Pomeranian Medical University | Gleeson F.,Churchill Hospital | Robert J.H.,Hopitaux Universitaires Of Geneva Hug
Journal of Thoracic Oncology | Year: 2010

The primary imaging modality for the detection of pulmonary metastases is computed tomography (CT). Ideally, a helical CT scan with 3- to 5-mm reconstruction thickness or a volumetric thin section scanning should be performed within 4 weeks of pulmonary metastasectomy. A period of observation to see whether further metastases develop does not seem to allow better patient selection. If positron emission tomography is available, it may identify the extrathoracic metastatic sites in 10 to 15% of patients. Despite helical CT scan, palpation identifies the metastases not detected by imaging in 20 to 25% of patients and remains the standard. No data define the optimal interval for follow-up surveillance imaging. Copyright © 2010 by the International Association for the Study of Lung Cancer.

This article presents the results of a survey led by senior nurses at Geneva's University Hospital in 2007, in acute and long-term care. The aim was to identify obstacles and nursing resources available for patients with urinary incontinence (UI) in order to improve their care. METHOD; A questionnaire was sent to 3300 health care professionals: doctors, nurses, midwives and auxiliary nurses, with a response rate of 55%. Health care professionals have incomplete knowledge about UI however their mental representations of UI are not an obstacle to care. In their practice they use few assessment tools and specialized health care professional are rarely consulted. Current measures for improvement aim to make resources in UI more visible, develop practice guidelines and offer specific training.

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