Les indications à une retransplantation pulmonaire : une approche selon la méthode DELPHI

1) Etat des connaissances : Actuellement, les indications à la transplantation pulmonaire sont bien décrites et validées. Par contre, lors d'une retransplantation, les résultats restent encore discutés : la retransplantation pulmonaire reste la seule option thérapeutique dans certains cas de rejet du greffon, de syndrome de bronchiolite oblitérante avancée et aussi lors de graves affections respiratoires, principalement de sténose cicatricielle. Malgré cela, son utilité a été mise en doute en raison de la pénurie de donneurs d'organes et des rapports indiquant des résultats insatisfaisants. 2) But de l'étude : Ce travail est une étude d'évaluation méthodologique dans lequel on utilisera un questionnaire DELPHI auprès de 10 soignants engagés dans le programme Vaud-Genève de transplantation pulmonaire afin de déterminer les critères de sélection qui mèneraient à la pratique d'une retransplantation. 3) Objectifs : Ce projet a pour but d'élaborer un consensus local sur les critères et les contre-indications à une retransplantation pulmonaire, dans le cadre du programme Vaud-Genève et du système d'allocation d'organes en vigueur en Suisse. D'où la question : ''Quelles sont les indications potentielles à une retransplantation pulmonaire ?'' 4) Justification : Dans une situation de pénurie explicite de ressources (manque de donneurs), l'utilisation des greffons doit être basée à la fois sur des critères d'équité et d'efficacité médicale. En l'absence de données claires dans la littérature sur les indications à la retransplantation pulmonaire, la recherche d'une attitude pragmatique au sein du programme local est justifiée. 5) Méthode : Cette étude monocentrique multisite est une étude clinique ouverte où les personnes interrogées restent en insu: un questionnaire DELPHI sera envoyé à 10 soignants spécialisés dans le domaine de la transplantation pulmonaire issus du programme Vaud-Genève. La méthode Delphi a pour but de mettre en évidence des convergences d'opinions afin de trouver des consensus grâce à l'interrogation de différents experts par le biais de questionnaires successifs. L'objectif des études Delphi est d'apporter l'éclairage des experts sur des zones d'incertitude en vue d'une aide à la décision. 6) Sélection des sujets : Les ''sujets'' éligibles sont un groupe de 10 experts anonymes spécialisés dans le domaine de la retransplantation pulmonaire du canton de Vaud et de Genève. 6.1 Critères d'inclusion : Personnel médical et paramédical directement impliqué dans le cadre du programme de transplantation Vaud-Genève. 6.2 Critère d'exclusion : Toute personne qui est elle-même directement impliquée dans l'analyse de l'étude. 7) Déroulement de l'étude et investigations prévues: L'étude aura lieu au CHUV et au HUG pour une durée de 2 ans. Les investigations seront effectuées par le biais de questionnaires envoyés par courrier électronique et seront analysées au CHUV.

Cognitive stimulation through task-oriented telerobotics

The project presented, iCognos, consists of a flexible platform to assist end-users in performing a series of mental tasks with a sensitized mobile telerobotic platform aimed at mitigating the problems associated to cognitive disorders with an ecological cognition approach.

Long-term outcome after cognitive and behavioral regression in non-lesional epilepsy with CSWS

Purpose: To present the long-term outcome (LTO) of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to non-lesional focal, mainly frontal epilepsy with continuous spike-waves during slow wave sleep (CSWS). Method: Past medical and EEG data of all patients were reviewed and neuropsychological tests exploring main cognitive functions were administered. Result: After a mean duration of follow-up of 15.6 years (range 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders that were so disturbing during the active period (AP) resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the AP disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. LTO correlated best with duration of CSWS. Conclusion: Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence as reported in adults with destructive lesions of the frontal lobes during childhood. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.

A non-randomized direct comparison of cognitive-behavioral short- and long-term treatment for binge eating disorder

Background: To compare treatment outcomes of a cognitive-behavioral long-term (CBT-L) and short-term (CBT-S) treatment for binge eating disorder (BED) in a non-randomized comparison and to identify moderators of treatment outcome. Methods: 76 female patients with BED participated in the study: 40 in CBT-L and 36 in CBT-S. Outcome values were compared at the end of the active treatment phase (16 sessions for CBT-L, 8 sessions for CBT-S) and at 12-month follow-up. Results: Both treatments produced significant reductions in binge eating. At the end of active treatment, but not at the end of follow-up, effects of primary outcomes (e.g. remission from binge eating, EDE shape concern) were better for CBT-L than for CBT-S. Dropout rates were significantly higher in CBT-L (35%) than in CBT-S (14%). Moderator analyses revealed that treatment efficacy for rapid responders and individuals exhibiting high scores on the mixed dietary negative affect subtype differed between the CBT-L and CBT-S with respect to objective binges, restraint eating and eating concern. Conclusion: Findings suggest that CBT in general represents an effective treatment for BED, but that subgroups of patients might profit more from a prolonged treatment. Short, lessintensive CBT treatments could nevertheless be a viable option in the treatment of BED.

Subjective cognitive decline in patients with mild cognitive impairment and healthy older adults: Association with personality traits.

AIM: In normal aging, subjective cognitive decline (SCD) might reflect personality traits or affective states rather than objective cognitive decline. However, little is known on the correlates of SCD in mild cognitive impairment (MCI). The present study investigates SCD in MCI patients and healthy older adults, and explores the association of SCD with personality traits, affective states, behavioral and psychological symptoms (BPS), and episodic memory in patients with MCI as compared with healthy older adults. METHODS: A total of 55 patients with MCI and 84 healthy older adults were recruited. Standard instruments were used to evaluate SCD, episodic memory, BPS and affective states. Premorbid and current personality traits were assessed by proxies using the NEO Personality Inventory Revised. RESULTS: Patients with MCI generally reported SCD more often than healthy older adults. SCD was positively associated with depressive symptoms in both groups. With regard to personality, no significant relationship was found in the healthy older group, whereas agreeableness was significantly negatively related to SCD in the MCI group. No significant association was found between SCD and episodic memory. CONCLUSIONS: SCD is more prevalent in patients with MCI than in the healthy elderly, but it does not reflect an objective cognitive impairment. SCD rather echoes depressive symptoms in both patients with MCI and healthy subjects. The negative association of SCD with agreeableness observed in patients with MCI could indicate that MCI patients scoring high on the agreeableness trait would not report SCD in order to prevent their relatives worrying about their increasing cognitive difficulties. Geriatr Gerontol Int 2014; 14: 589-595.

Pertinence d'un programme de remédiation cognitive pour patients schizophrènes : l'hypothèse de la plasticité cérébrale

L'importance des déficits neurocognitifs des patients schizophrènes a conduit la section «E. Minkowski» du Département universitaire de psychiatrie adulte de Lausanne à développer un programme de remédiation cognitive pour jeunes patients schizophrènes. Les résultats préliminaires de ce programme indiquent une très nette amélioration des performances cognitives chez la plupart des patients. Les mécanismes cérébraux responsables de ces progrès ne sont cependant pas élucidés. De nouveaux éléments concernant les mécanismes de plasticité synaptique sont évoqués pour expliquer les modifications cérébrales associées aux fonctions cognitives exercées.

The evolution of personality in patients with mild cognitive impairment.

Aims: To describe personality traits and their changes in mild cognitive impairment (MCI) and control subjects. Methods: Sixty-three MCI and 90 control subjects were asked to describe their current personality traits by the Structured Interview for the Five-Factor Model (SIFFM). For each subject, a close relative retrospectively assessed these descriptions both as to the previous and current personality traits, using the Revised NEO Personality Inventory, Form R (NEO-PI-R). Results: Self-assessed MCI subjects reported significantly lower scores in the openness dimension than control subjects [F(1, 150) = 9.84, p = 0.002, ηp(2) = 0.06]. In current observer ratings, MCI subjects had higher scores on neuroticism [F(1, 137) = 7.55, p = 0.007, ηp(2) = 0.05] and lower ones on extraversion [F(1, 137) = 6.40, p = 0.013, ηp(2) = 0.04], openness [F(1, 137) = 9.93, p = 0.002, ηp(2) = 0.07], agreeableness [F(1, 137) = 10.18, p = 0.002, ηp(2) = 0.07] and conscientiousness [F(1, 137) = 25.96, p < 0.001, ηp(2) = 0.16]. Previous personality traits discriminated the groups as previous openness [odds ratio (OR) = 0.97, 95% confidence interval (CI) = 0.95-0.99, p = 0.014] and conscientiousness (OR = 0.96, 95% CI 0.94-0.98, p = 0.001) were negatively related to MCI group membership. In MCI subjects, conscientiousness [F(1, 137) = 19.20, p < 0.001, ηp(2) = 0.12] and extraversion [F(1, 137) = 22.27, p < 0.001, ηp(2) = 0.14] decreased between previous and current evaluations and neuroticism increased [F(1, 137) = 22.23, p < 0.001, ηp(2) = 0.14], whereas no significant change was found in control subjects. Conclusions: MCI subjects undergo significant personality changes. Thus, personality assessment may aid the early detection of dementia. © 2013 S. Karger AG, Basel.

Analyse en actographe et dans sa cage, de la réponse comportementale du mulot sylvestre (Apodemus sylvaticus L.) à un jeûne de 24

1. The "general activity" of Apodemus Sylvaticus L. has been recorded and analysed using two techniques: a) in an actograph, several components of the "general activity" have been recorded and quantified over 24 hours, including wheel running, locomotion in various areas of the enclosure, nest occupancy, drinking, eating and hoarding; b) in a breeding cage, ten times smaller than the actograph and where the possibilities of locomotion are considerably reduced, the wheel running only has been recorded. In these two situations, we have compared the effects of a food deprivation for 24 hours. 2. In the actograph, starvation increases the general locomotion in the enclosure without detectable changes in wheel running. On the other hand, in the breeding cage, wheel running is somewhat increased. 3. Refeeding results in decreased wheel running under both experimental conditions, and restores general locomotion in the actograph to the predeprivation level. 4. These results are discussed in view of the current literature. The apparent disagreement between our results and those of other workers is attributed to the fact that the latter used experimental conditions where the measured response was predetermined by the lack of choice in expressed responses which were offered to the animal. Consequently, we suggest that the interpretation of such experiments can be improved by allowing a choice of possible behavioural response and that each of them should be recorded separately.

Individual Classification of Mild Cognitive Impairment Subtypes by Support Vector Machine Analysis of White Matter DTI.

BACKGROUND AND PURPOSE: MCI was recently subdivided into sd-aMCI, sd-fMCI, and md-aMCI. The current investigation aimed to discriminate between MCI subtypes by using DTI. MATERIALS AND METHODS: Sixty-six prospective participants were included: 18 with sd-aMCI, 13 with sd-fMCI, and 35 with md-aMCI. Statistics included group comparisons using TBSS and individual classification using SVMs. RESULTS: The group-level analysis revealed a decrease in FA in md-aMCI versus sd-aMCI in an extensive bilateral, right-dominant network, and a more pronounced reduction of FA in md-aMCI compared with sd-fMCI in right inferior fronto-occipital fasciculus and inferior longitudinal fasciculus. The comparison between sd-fMCI and sd-aMCI, as well as the analysis of the other diffusion parameters, yielded no significant group differences. The individual-level SVM analysis provided discrimination between the MCI subtypes with accuracies around 97%. The major limitation is the relatively small number of cases of MCI. CONCLUSIONS: Our data show that, at the group level, the md-aMCI subgroup has the most pronounced damage in white matter integrity. Individually, SVM analysis of white matter FA provided highly accurate classification of MCI subtypes.