University Hospital of Geneva

Cardiac MRI (CMRI) is crucial for assessing cardiovascular structure and function, yet manual analysis is time-consuming and subjective. This paper introduces CMRI Insight, an open-source, Python-based GUI tool designed for automated cardiac segmentation and motion tracking like CardioTrackNet in CMRI. Leveraging deep learning models like CardSegNet and MECardNet, it enables accurate delineation of the left ventricle, right ventricle, and myocardium with mean Dice scores of 95.8% for the left ventricle, 94.2% for the right ventricle, and 95.0% for the myocardium. The tool offers 3D mesh reconstruction, strain analysis, bull’s-eye visualization, and support for custom models. CMRI Insight enhances efficiency and reproducibility in cardiac imaging research and clinical evaluation, providing a user-friendly platform for comprehensive CMRI analysis.

While wastewater-based surveillance (WBS) has informed our understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza and respiratory syncytial virus (RSV) circulation in the community, its use in hospital settings remains limited. We aimed to use WBS to understand the dynamics between SARS-CoV-2, influenza (A/B) and RSV loads in the hospital wastewater and infections among patients in a geriatric hospital in Switzerland. We conducted a prospective WBS study which involved the collection of 24-h composite samples 7 days/week from the centralised hospital wastewater of the geriatric hospital. We measured SARS-CoV-2, influenza A/B and RSV RNA concentrations using digital reverse transcription polymerase chain reaction. Kendall's rank correlation (τ) and cross-correlation function were used to assess the correlation and lag time between the viral RNA loads and SARS-CoV-2, influenza A/B and RSV infections among hospitalised patients. Between 14th October 2024 and 19th April 2025, we collected 166 wastewater samples. The associations between wastewater loads and infections were significant and positive for SARS-CoV-2 (τ = 0.29, 95% confidence interval [CI]: 0.19-0.39, P < 0.01), influenza A (τ = 0.36, 95% CI: 0.25-0.44, P < 0.01) and RSV (τ = 0.48, 95% CI: 0.38-0.57, P < 0.01). In sensitivity analyses restricted to healthcare-associated infections, the associations between wastewater loads and infections among patients remained significant and positive for SARS-CoV-2 (τ = 0.32, 95% CI: 0.23-0.41, P < 0.01), influenza A (τ = 0.24, 95% CI: 0.12-0.34, P < 0.01) and RSV (τ = 0.37, 95% CI: 0.27-0.47, P < 0.01). Increases in wastewater viral load preceded increases in reported SARS-CoV-2 and influenza A healthcare-associated infections by approximately three and five days, respectively. WBS could be used as a complementary early warning system for the circulation of respiratory viruses in hospital settings.

Perioperative antibiotic prophylaxis is crucial in improving outcomes after colorectal surgery. Although guidelines in elective procedures are well established, evidence in emergency settings remains limited. This study evaluated the association between antibiotic timing before incision and 30-day mortality as well as surgical site infections (SSIs) in emergency colorectal surgery. This nationwide retrospective cohort study analyzed colorectal operations recorded in the Swiss National Infection Surveillance Program. Demographics, antibiotic regimens, and surgical characteristics of consecutive cases were compared between elective and emergency procedures. Independent predictors of 30-day mortality and SSIs were identified using multivariable logistic regression adjusted for patient and surgical factors. Timing of antibiotic administration was modeled using natural cubic splines to assess nonlinear effects. Among 63,945 patients, 16,939 (26.5%) underwent emergency procedures. In the fully adjusted model, antibiotic timing was significantly associated with 30-day mortality (p < 0.001) in both elective and emergency operations. A U-shaped pattern was observed, with the lowest predicted 30-day mortality when antibiotics were administered 48 minutes before incision in elective operations (mean 1.28%, 95% CI 1.15 to 1.40) and 51 minutes before incision in emergency procedures (mean 10.50%, 95% CI 9.71 to 11.20). In contrast, antibiotic timing was not significantly associated with SSIs (p = 0.229). In both elective and emergency colorectal operations, early or late administration of antibiotics relative to the incision was associated with increased 30-day mortality. The lowest risk occurred when antibiotics were administered approximately 50 minutes before incision. These findings support optimizing perioperative antibiotic timing to improve postoperative outcomes in emergency colorectal surgery.

Avoidant/restrictive food intake disorder (ARFID) involves restrictive eating driven by sensory sensitivity, low interest in food, or fear of negative consequences of eating. ARFID affects males and females equally and presents across the weight spectrum. Leptin, an anorexigenic hormone linked to adiposity, may contribute to low hunger and early satiety in ARFID. Prior findings indicate low leptin levels in low-weight females with ARFID; however, the role of leptin in ARFID across weight status and sex remains unknown. We hypothesized that youth with full/subthreshold ARFID, including a subgroup of low-weight males, would exhibit lower fasting leptin levels than healthy controls (HCs). We explored cross-sectional and longitudinal associations between leptin and clinical characteristics. Participants were youth aged 10-23 years (BMI percentile M [SD] = 41.4 (33.6)) with full/subthreshold ARFID (n = 95; 49.5% female) and HCs (n = 28; 50.0% female). At baseline, participants completed questionnaires, a fasted blood draw, and a diagnostic interview for ARFID, readministered at 1- and 2year follow-ups. Leptin levels did not differ between ARFID and HC groups. Low-weight ARFID males had significantly lower leptin than HC males (η 2 = 0.258); however, this difference was nonsignificant after adjusting for BMI percentile. Leptin showed medium-to-large positive associations with age, BMI, and anxiety but not appetite or ARFID severity. Baseline leptin did not predict symptom or weight changes longitudinally. Hypoleptinemia was only evident in low-weight ARIFD and strongly correlated with BMI percentile. However, relationships with anxiety may suggest additional roles of leptin in underlying ARFID psychopathology. Findings should be replicated in larger, more representative samples.

Neurological prognostication after cardiac arrest remains challenging despite multimodal approaches recommended by the European Resuscitation Council and the European Society of Intensive Care Medicine (ERC/ESICM). Prognostic certainty is achieved in only a subset of comatose patients, leaving a substantial proportion with an indeterminate prognosis. In this population, the incremental prognostic value of electroencephalography beyond established predictors remains insufficiently characterized. We conducted a prospective 5-year (2021–2025) single-center observational study of adult comatose patients after cardiac arrest admitted to the Intensive Care Unit (ICU) of the University Hospitals of Geneva. Patients presenting with fewer than two ERC/ESICM poor outcome factors were included. Continuous electroencephalogram (EEG) recordings obtained within 72 h after cardiac arrest were analyzed. Quantitative EEG features reflecting spectral power, functional connectivity, signal complexity, and background continuity were extracted and combined with automated estimates of rhythmic and periodic patterns derived from a previously validated neural network. These features were integrated into a random forest classifier to predict neurological outcome at 3–6 months, dichotomized as good (Cerebral Performance Category 1–2) or poor (3–5). Model performance was evaluated using repeated stratified cross-validation, and feature contributions were assessed using Shapley value analysis. Of a total of 313 patients, 77 met the inclusion criteria (mean age 61, 21 female), of whom 35 (45%) achieved a good neurological outcome. The model demonstrated good discriminative performance, with a mean Receiver Operating Characteristic – Area Under the Curve (ROC-AUC) of 0.80 and a Precision–Recall Area Under the Curve (PR-AUC of 0.83). Delta-band electroencephalography features accounted for most of the predictive contribution. Higher delta functional connectivity, higher delta relative power, and higher probability of periodic discharges were associated with poor outcome, whereas preserved relative alpha power and higher probability of rhythmic delta activity were associated with good outcome. In comatose patients after cardiac arrest with ERC/ESICM guideline-defined indeterminate prognosis, an interpretable EEG-based prognostic model provides clinically relevant information. This approach may complement current multimodal prognostication strategies by refining early risk stratification in a population characterized by substantial prognostic uncertainty.

Health-related quality of life (HRQoL) has emerged as a central outcome in pediatric type 1 diabetes (T1D), reflecting not only metabolic control but also the lived experience of children, adolescents, and their families.As diabetes care increasingly incorporates continuous glucose monitoring and automated insulin delivery (AID) systems, it is often assumed that improved glycemic metrics will naturally translate into better quality of life.However, accumulating evidence suggests that this relationship is neither linear nor universal and is strongly shaped by age, gender, family dynamics, cultural context, and psychosocial burden. GENDER, AGE, AND PERSISTENT PSYCHOSOCIAL VULNERABILITYe gender differences observed align closely with European and global evidence documenting higher diabetes-related distress among females.Lithuanian registry data show greater emotional burden and lower confidence in self-care among adolescent and emerging adult females, independent of insulin delivery method. [2]Norwegian national data, in the age group 10-17 years, https://ispae-jped.com/

Background.FLASH-RT defines a promising treatment modality against medulloblastoma, as it minimizes treatment-related complications. To support its clinical translation, we dissected the cellular and molecular determinants of the FLASH response in the tumor-microenvironment (TME) and healthy hippocampus using an orthotopic human medulloblastoma mouse model treated with a hypo-fractionated FLASH regimen.Methods.Five cohorts of 4 weeks-old UW228-MB-bearing female nude mice (n=57) were irradiated, or sham-irradiated using 3×10 Gy (BED=60), delivered 48h apart at 0.1 Gy/s (CONV) or 5.5×106 Gy/s (FLASH) using an electron beam (eRT6). Digital spatial profiling (DSP) was performed 24h after radiotherapy in one cohort, while the four other cohorts were followed for long-term tumor response, cognition, and neuroinflammation.Results.Both CONV and FLASH-RT induced a complete and long-lasting anti-tumor response in 100% of animals associated with cognitive decline. However, more mice maintained a very good discrimination score after FLASH exposure (38%) than CONV (7%). DSP revealed a sustained microglial activation in the cerebellar tumor micro-environment, where FLASH enhanced expression of genes with phagocytic and proteolytic activity. In the tumor free hippocampus, FLASH exposure induced a preferential neuron/astrocyte transcriptional crosstalk, which manifested over protracted times to minimize neuroinflammation and cognitive complications.Conclusion:The study shows the tumor-ablative efficacy of hypo-fractionated FLASH-RT in a human medulloblastoma mouse model. It is associated with qualitatively distinct transcriptional signatures prone to tumor and debris clearance mediated by microglial cells of the TME. Moreover, in the hippocampus, FLASH mitigates radiation-induced neurotoxicity by enhancing genes involved in synaptic plasticity, attenuating neuroinflammation, and preserving metabolic function.