Comparison of self-perceived cardiovascular disease risk among smokers with Framingham and PROCAM scores: a cross-sectional analysis of baseline data from a randomised controlled trial.

Previous studies suggest that smokers have a misperception of their 10-year cardiovascular risk. We aimed to compare 10-year cardiovascular risk self-perception and calculated risk among smokers willing to quit and assess the determinants of a possible misperception. Cross-sectional secondary analysis of baseline data from a randomised controlled trial of smoking cessation. 514 participants, mean age 51.1 years, 46% women, 98% Caucasian. Eligible participants were regular smokers, aged between 40 and 70 years, with a consumption of at least 10 cigarettes per day for at least a year. None of them had experienced cardiovascular disease before. Exclusion criteria comprised a history of myocardial infarction, coronary heart disease, stroke, heart failure, peripheral vascular disease, carotid atherosclerosis or cardiac arrhythmia. Participants with renal or liver failure, psychiatric disorders, substance and alcohol abuse and with smoking cessation therapies were excluded. Participants were asked to estimate their 10-year cardiovascular risk using a 3-item scale corresponding to high-risk, moderate-risk and low-risk categories. We compared their risk perception with Framingham and Prospective Cardiovascular Munster Study (PROCAM) scores. We used multivariable-adjusted logistic regression models to determine characteristics of participants who underestimate their risk versus those who correctly estimate or overestimate it. Between 38% and 42% of smokers correctly perceived their 10-year cardiovascular risk, and 39-50% overestimated their 10-year cardiovascular risk while 12-19% underestimated it compared with their calculated 10-year cardiovascular risk depending on the score used. Underestimation of 10-year cardiovascular risk was associated with male gender (OR 8.16; CI 3.83 to 17.36), older age (OR 1.06; CI 1.02 to 1.09), and the presence of hyperlipidaemia (OR 2.71; CI 1.47 to 5.01) and diabetes mellitus (OR 13.93; CI 3.83 to 50.66). Among smokers, misperception of their 10-year cardiovascular risk is common, with one-fifth underestimating it. These findings may help physicians target patients with such characteristics to help them change their health behaviour and adherence to risk-reduction therapy. NCT00548665; Post-results

Short-duration aerobic high-intensity intervals versus moderate exercise training intensity in patients with peripheral artery disease: study protocol for a randomised controlled trial (the Angiof-HIIT Study).

Supervised exercise training is among the first-line therapies for patients with peripheral artery disease (PAD). Current recommendations for exercise include guidance focusing on claudication pain, programme and session duration, and frequency. However, no guidance is offered regarding exercise training intensity. This study aims to compare the effects of 12-week-long supervised walking exercise training (high-intensity interval training (HIIT) vs moderate-intensity exercise (MOD)) in patients with chronic symptomatic PAD. This study is a monocentric, interventional, non-blinded randomised controlled trial. 60 patients (30 in each group) will be randomly allocated (by using the random permuted blocks) to 12 weeks (three times a week) of HIIT or MOD. For HIIT, exercise sessions will consist of alternating brief high-intensity (≥85% of the peak heart rate (HR <sub>peak</sub> )) periods (≤60 s) of work with periods of passive rest. Patients will be asked to complete 1 and then 2 sets of 5-7 (progressing to 10-15×60 s) walking intervals. For the MOD group, exercise training sessions will consist of an alternation of periods of work performed at moderate intensity (≤76% HR <sub>peak</sub> ) and periods of passive rest. Interventions will be matched by training load. The primary outcome will be the maximal walking distance. Secondary outcomes will include functional performance, functional capacity, heath-related quality of life, self-perceived walking abilities, physical activity and haemodynamic parameters. The Angiof-HIIT Study was approved by the Human Research Ethics Committee of the Canton de Vaud (study number: 2022-01752). Written consent is mandatory prior to enrolment and randomisation. The results will be disseminated via national and international scientific meetings, scientific peer-reviewed journals and social media. NCT05612945

Chambres de cryothérapie et immersion en eau froide : utilisation thérapeutique et risques [Cryotherapy chambers and cold-water immersion : therapeutic use and risks]

Whole body cryotherapy is mainly performed either by immersion in cold water or in a cryotherapy chamber. Practiced since Antiquity and considered as a « natural » method, cryotherapy is attracting more and more followers. Beneficial health effects have been described in the literature. However, interpretation of its effects is difficult due to low quality of current studies. Cryotherapy could however be useful in addition to conventional therapies in various pathologies and situations, provided that the risks, contraindications and rules of good practice are known

Multicentric case series of scuba diving fatalities: The role of intracardiac gaseous carbon dioxide in the forensic diagnosis.

Scuba diving fatalities post-mortem diagnosis presents a higher level of forensic complexity because of their occurrence in a non-natural human life environment. Scuba divers are equipped with diving gas to breathe underwater. It is essential for them to be fully trained in order to be able to manage their dive safely despite the varying increase of ambient pressure and temperature decrease. Throughout the dive, the inhaled diving gas is dissolved in the diver's tissues during the descent and if the decompression steps are not respected during the ascent, the balance between the dissolved gas and the tissues (including blood) is disrupted, leading to a gaseous release in the organism. Depending on the magnitude of this gaseous release, free gas can occur in blood and tissue. Venous or arterial gas embolism can also occur as a consequence of decompression sickness or barotraumatism. It can also induce drowsiness that consequently leads to drowning. As a result, the occurrence of gas in dead scuba divers is very complex to interpret, as is the difficulty to distinguish it from resuscitation maneuver artifacts or body decomposition. Although the literature is scarce in this domain, significant work has been done to provide a precise intracadaveric gas sampling method to enlighten the cause and circumstances of death during the dive. The aim of this study is to obtain higher statistical significance by collecting a number of cases to confirm the gas sampling protocol and analysis and gain more information about the cause of death and the events surrounding the fatality through the establishment of clear management guidelines

Efficacy and safety profile of deep responders to carfilzomib-based therapy: a subgroup analysis from ASPIRE and ENDEAVOR

To understand the profile of best responders (complete response or better [≥CR]) to carfilzomib, we described the characteristics, progression-free survival (PFS), overall survival (OS) data, and the safety of patients who achieved ≥CR to carfilzomib-based treatment in ASPIRE and ENDEAVOR. In post hoc analyses from ASPIRE and ENDEAVOR, median PFS and OS were longer for ≥CR patients versus those who achieved a very good partial response or partial response (VGPR/PR). In the carfilzomib arm of ASPIRE, median PFS was 50.4 months for ≥CR versus 22.1 months for VGPR/PR; median OS was 67.0 versus 44.2 months, respectively. In the carfilzomib arm of ENDEAVOR, median PFS was 34.0 for ≥CR versus 20.4 months for VGPR/PR; median OS was non-estimable. Despite the longer treatment duration, fewer patients with ≥CR versus VGPR/PR experienced treatment-emergent adverse events that led to discontinuation of carfilzomib-based treatment in ASPIRE or ENDEAVOR. Low serum lactate dehydrogenase was the only factor associated with achieving ≥CR vs patients not achieving CR in ASPIRE in multivariate regression analyses. No association was found between cytogenetic risk status and reaching ≥CR. Carfilzomib treatment may lead to rapid and deep responses, irrespective of most patient characteristics

" The less, the better?The Political Economy of the Swiss Debt Brake "

In the present Master’s Thesis, we examine the causes and consequences of the Swiss debt brake, a mechanism designed to balance the Confederation's income and expenditure over a business cycle. The paper inserts the constitutional object into Swiss economic history, to understand how the country's economic, social, and political characteristics explain the birth of the brake. We use the neo-realist approach to institutional change to study the causes of the balanced budget rule. It highlights the influence of various economic, academic, and political actors during the 1990s to stimulate economic competitiveness by liberalizing the economy and restricting the power of the state. Certain political players with close ties to the industrial and financial world proposed motions to reform Swiss fiscal policy, to reduce public indebtedness, by constraining the state's share in the economy. To study the consequences of the debt brake on the Swiss economy, we use an approach based on fiscal space and functional finance. While Switzerland benefits from a large fiscal space, it does not use it to achieve full resource utilization but rather uses the generated fiscal surpluses to reduce public indebtedness. Based on sectoral accounts, this surplus has the effect of withdrawing savings from other sectors, particularly Non-Financial Corporations (NFC). If Switzerland's fiscal position is sustainable, it is largely thanks to the current account balance, which accounts for a significant proportion of national income.</p

Analysis of the differentiation potential of murine pancreatic islet precursor cells: an In Vivo clonal analysis

Le pancréas est une glande mixte du système digestif. La partie exocrine (~99%) est responsable de la production et sécrétion d'enzymes digestives. La partie endocrine (~1%) se compose de quatre types cellulaires : α, β, δ et PP, assemblés en "îlots de Langerhans", qui synthétisent et sécrètent des hormones régulant l'appétit, la motilité gastrique et la glycémie. Des études de traçage cellulaire ont montré que ces quatre types cellulaires endocrines dérivent de cellules exprimant le gène Neurogenin3. Afin de déterminer le potentiel de différentiation (unipotent ou multipotent) des cellules exprimant la Neurogenin3, nous avons procédé à une analyse clonale in vivo de celles-ci. Nous avons établis que ces cellules à Neurogenin3 représentent une population hétérogène de précurseurs unipotents. Plus particulièrement, ces résultats impliquent que les cellules β, productrices d'insuline, se différencient à partir de cellules Neurogenin3+ spécifiques, et ne prolifèrent que très peu au cours de la vie

Comparison of self-perceived cardiovascular disease risk among smokers with Framingham and PROCAM scores: a cross-sectional analysis of baseline data from a randomised controlled trial

Objectif: Plusieurs études suggèrent que les fumeurs actifs ont une perception erronée de leurs risques cardiovasculaires à 10 ans. L'objectif de notre étude consiste, dans une population de fumeurs actifs souhaitant s'affranchir du tabac, à comparer la perception du risque avec le risque calculé de survenue d'événements cardiovasculaires à 10 ans ainsi que de mettre en évidence les déterminants de cette possible perception erronée. Design : Analyse secondaire transversale de données à partir d'une étude randomisée sur l'arrêt du tabac. Participants: 514 participants, âge moyen 51.1 ans, 46% de femmes, 98% d'origine caucasienne. Les participants éligibles étaient des fumeurs réguliers, âgés entre 40 et 70 ans, avec une consommation d'au moins 10 cigarettes par jour durant les 10 dernières années. Aucun d'entre eux n'a présenté une maladie cardiovasculaire auparavant. Les critères d'exclusion comprenaient des antécédents d'infarctus du myocarde, de maladie coronarienne, d'accident vasculaire cérébral, d'insuffisance cardiaque, de maladie vasculaire périphérique, d'athérosclérose carotidienne ou d'arythmie cardiaque. Les participants ayant une insuffisance hépatique ou rénale, des troubles psychiatriques, une dépendance à l'alcool, aux drogues, aux médicaments ou étant au bénéfice d'une substitution nicotinique ont été exclus. Interventions : Nous avons demandé aux participants d'estimer leurs risques cardiovasculaires à 10 ans selon une échelle à 3 niveaux, correspondant aux catégories à haut, moyen et bas risque. Nous avons comparé leur perception du risque avec le risque calculé selon les scores Framingham et Procam. Nous avons utilisé des modèles de régression logistiques uni- et multi- variés afin de déterminer les caractéristiques des participants qui sous-estiment leurs risques par rapport à ceux qui l'estiment correctement ou le surestiment. Résultats : Entre 38-42% des fumeurs estiment correctement leurs risques cardiovasculaires à 10 ans, 39-50% le surestiment alors que 12-19% le sous-estiment par rapport au risque calculé selon les différents scores. La sous-estimation du risque cardiovasculaire à 10 ans était associée au sexe masculin (OR 8.16; CI 3.83-17.36), à l'âge avancé (OR 1.06; CI 1.02-1.09) ainsi qu'à la présence d'une dyslipidémie (OR 2.71; CI 1.47-5.01) et d'un diabète mielleux (OR 13.93; CI 3.83-50.66). Conclusions : Chez les fumeurs actifs, une perception erronée du risque cardiovasculaire à 10 ans est commune, et un cinquième des participants sous-estime son risque cardiovasculaire à 10 ans. Ces résultats pourraient aider les médecins à identifier les patients présentant ces caractéristiques afin de les encourager à changer leurs habitudes de consommation et leur adhérence à une thérapie de réduction du risque cardiovasculaire

Pancreatic neurogenin 3-expressing cells are unipotent islet precursors

Pancreatic islet endocrine cells arise during development from precursors expressing neurogenin 3 (Ngn3). As a population, Ngn3+ cells produce all islet cell types, but the potential of individual Ngn3+ cells, an issue central to organogenesis in general and to in vitro differentiation towards cell-based therapies, has not been addressed. We performed in vivo clonal analyses in mice to study the proliferation and differentiation of very large numbers of single Ngn3+ cells using MADM, a genetic system in which a Cre-dependent chromosomal translocation labels, at extremely low mosaic efficiency, a small number of Ngn3+ cells. We scored large numbers of progeny arising from single Ngn3+ cells. In newborns, labeled islets frequently contained just a single tagged endocrine cell, indicating for the first time that each Ngn3+ cell is the precursor of a single endocrine cell. In adults, small clusters of two to three Ngn3+ progeny were detected, but all expressed the same hormone, indicating a low rate of replication from birth to adult stages. We propose a model whereby Ngn3+ cells are monotypic (i.e. unipotent) precursors, and use this paradigm to refocus ideas on how cell number and type must be regulated in building complete islets of Langerhans