Depression is a common difficulty among adolescents with epilepsy (AWE). Compassion-focused therapy (CFT) has demonstrated potential benefits for adults with epilepsy. This study was a preliminary investigation evaluating whether an eight-session online group intervention based on CFT could reduce symptoms of depression and enhance self-compassion in AWE. Sixteen AWE aged 13-17 took part, completing measures for depression and self-compassion before the intervention (pre-CFT), immediately afterwards (post-CFT), and again six months later (follow-up). Results showed significant reductions in depression and increases in self-compassion from pre- to post-CFT, with these improvements sustained at follow-up. By both post-CFT and six-month follow-up, three-quarters of AWE were below clinical threshold for depression. Overall, these findings offer preliminary, tentative evidence that CFT may be a beneficial approach for supporting AWE who are experiencing depression, though further robust research is required to propose such recommendations.
Understanding the organization of afferent and efferent spinal cord pathways can be challenging for students due to their complex spatial relationships. This study aimed to develop a three-dimensional (3D) educational model demonstrating these pathways and to compare student learning outcomes between model-based instruction and conventional slide-based teaching. A pre-test/post-test educational study was conducted with second-year dental students (n = 60). Transverse sections of the C4 and T7 vertebrae were designed and 3D-printed at four times their anatomical size. A spinal cord model made of modeling clay was placed within the vertebral canal, and afferent and efferent pathways were represented using color-coded cables. Students completed a 15-item multiple-choice pre-test assessing baseline knowledge of spinal cord pathways and were allocated into two groups. Group 1 (n = 30) received conventional slide-based instruction, while Group 2 (n = 30) was taught using the 3D model. After the instructional sessions, students completed the same test as a post-test. Within-group and between-group comparisons were analyzed using paired-sample and independent-sample t-tests. Both instructional approaches resulted in significant improvements in post-test scores. In the slide-based instruction group, mean scores increased from 5.00 ± 1.98 to 8.47 ± 2.54 (p < 0.001). In the 3D model group, mean scores increased from 4.77 ± 2.39 to 10.27 ± 2.29 (p < 0.001). The mean improvement was significantly greater in the 3D model group (5.50 ± 3.07) compared with the slide-based group (3.47 ± 2.70) (p = 0.007). The effect size for the difference between groups was moderate to large (Cohen's d ≈ 0.70). Both instructional methods improved short-term knowledge of spinal cord pathways; however, model-based instruction was associated with greater learning gains. These findings suggest that three-dimensional models may serve as a useful supplementary tool in neuroanatomy education. Further studies using validated assessment tools and evaluating long-term knowledge retention are needed to confirm these findings.
Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease caused by JC polyomavirus (JCV) that affects immunosuppressed individuals and has no approved therapy. Here we evaluate the safety and efficacy of third-party, off-the-shelf, partially HLA-matched BK virus-specific T cells (BK-VST) in patients with PML. We conducted a single-center phase 2 study where 37 patients received most closely HLA-matched BK-VST at 2.0 x 105 T cells/kg, with additional infusions permitted for subjects who did not achieve a complete response. Twenty-three patients had an underlying diagnosis of hematologic malignancy. Each patient received a median of 2 doses (range, 1-12; IQR 2). Overall response (OR) was defined as virologic clearance with neurologic stabilization or improvement. During 12 months of follow-up, 21 patients (56.8%) achieved an OR, including 16 (43.2%) with a complete response. Responses were rapid (median 23 days) and durable, with no loss of response observed despite limited HLA matching. The 1-year overall survival was 61.1% (95% CI, 41.9-77.4). Patients achieving an OR after the first infusion had markedly improved 1-year survival compared with non-responders (93.3% vs 0%; p<0.001). Higher donor IL-2 and IFN-γ-producing T-cell frequencies and greater HLA matching correlated with clinical benefit. These data demonstrate that third-party BK-VST infusions are safe and potentially effective, supporting a scalable immunotherapeutic approach for this otherwise fatal disease. (ClinicalTrials.gov NCT02479698).
The phosphoinositide 3-kinase alpha inhibitor alpelisib has been increasingly used in the treatment of venous malformations. In this systematic review of 47 patients with a molecular diagnosis for their venous malformations treated with alpelisib, a partial or complete radiological response was achieved by 77% of evaluable patients and symptomatic improvement in 98%. Adverse effects were predominantly mild, with hyperglycaemia the most frequent, occurring in 58% of patients with available safety data. TRIAL REGISTRATION: PROSPERO Registration: CRD420261339549.
Assessing fall risk is essential for older adults as well as for specific patient populations, including those with neurological or musculoskeletal disorders. The Activities-specific Balance Confidence Scale is a widely used instrument for evaluating perceived balance confidence, and its Hungarian version has already been validated. However, administering the original 16-item scale can be time-consuming. The aim of this study was to develop and validate the 6-item short version of the Hungarian Activities-specific Balance Confidence Scale among individuals with neurological and musculoskeletal conditions. Our investigation was conducted in two phases. In the first phase, 167 participants completed the full 16-item version of the Hungarian Activities-specific Balance Confidence Scale, data for the 6 selected items were extracted and analyzed. Convergent validity was tested against the Berg Balance Scale here. In the second phase, 63 participants completed the 6-item Hungarian short version of the scale along with other patient-reported surveys. Data on falls in the previous year and perceived pain levels were also collected. Internal consistency was evaluated using Cronbach's alpha and McDonald's omega, while test-retest reliability was assessed via the intraclass correlation coefficient. We also calculated floor and ceiling effects and minimal detectable change. Convergent validity was evaluated using the Hungarian version of the Falls Efficacy Scale - International. Discriminative validity was examined comparing the scores of patients with or without falls. The effect of perceived pain on scale results was also evaluated. The 6-item Hungarian short version of the Activities-specific Balance Confidence Scale demonstrated high reliability with no floor or ceiling effect. Strong to moderate correlations were found with the physical test and the Falls Efficacy Scale - International. The scale effectively discriminated between individuals with and without a history of falls. Perceived pain did not significantly influence the scores. The average completion time was under 4 minutes. The 6-item Hungarian version of the Activities-specific Balance Confidence Scale is a brief, reliable, and valid instrument for assessing balance confidence in patients with neurological and musculoskeletal conditions. Due to its sensitivity and short completion time, it is highly suitable for both clinical practice and research. Orv Hetil. 2026; 167(27): 1068-1078. Bevezetés: Az eleséskockázat felmérése alapvető jelentőségű mind idősek, mind speciális betegcsoportok, így a neurológiai és mozgásszervi betegek körében. A Tevékenységfüggő Egyensúlybiztonsági Skála (Activities-specific Balance Confidence Scale) a szubjektív egyensúlybiztonság értékelésére szolgál, magyarul is elérhető, azonban a teljes, 16 kérdéses változat kitöltése időigényes lehet. Célkitűzés: Tanulmányunk célja a Tevékenységfüggő Egyensúlybiztonsági Skála rövidített, 6 kérdéses magyar változatának létrehozása és pszichometriai jellemzőinek vizsgálata volt, neurológiai és mozgásszervi betegek körében. Módszer: Vizsgálatunk két fázisban zajlott. Az első fázisban 167 beteg töltötte ki a teljes, 16 kérdéses skálát, jelen tanulmányunkban a kiválasztott 6 kérdés értékeit vettük figyelembe. Ebben a fázisban a konvergens validitást fizikális teszttel, a Berg Egyensúlybiztonsági Skálával összehasonlítva vizsgáltuk. A második fázisban 63 beteg a skála rövid, 6 kérdéses változatát és más önkitöltős skálákat kapott. Itt rákérdeztünk az előző évben elszenvedett esésekre, illetve a megélt fájdalomra. A megbízhatósági vizsgálatok során a belső konzisztenciát Cronbach-alfa és McDonald-ómega, a teszt-reteszt megbízhatóságot osztályon belüli korrelációs együttható segítségével vizsgáltuk. Emellett plafon- és padlóhatást, illetve minimálisan kimutatható változást is számoltunk. A konvergens validitás vizsgálatához a Falls Efficacy Scale – International magyar változatát használtuk. A diszkriminatív validitás vizsgálata céljából összehasonlítottuk az esést szenvedett és nem szenvedett betegek eredményeit, és elemeztük a megélt fájdalom hatását a skála eredményére. Eredmények: A rövidített Tevékenységfüggő Egyensúlybiztonsági Skála megbízhatóságát jónak találtuk. Plafon- és padlóhatás nem jelentkezett. Erős vagy mérsékelt korrelációt találtunk a fizikális teszttel és más egyensúlybiztonsági skálákkal való összehasonlítás során. Ez a skála megfelelően különbséget tett az eleső és nem eleső betegek között, míg a fájdalom nem befolyásolta az eredményeket. A kitöltés átlagos ideje 4 percnél kevesebb volt. Következtetés: A 6 kérdéses Tevékenységfüggő Egyensúlybiztonsági Skála rövid, jól értelmezhető és megbízható eszköz a szubjektív egyensúlybiztonság mérésére neurológiai és mozgásszervi betegek körében. Rövid kitöltési ideje és érzékenysége alapján alkalmas a mindennapi klinikai gyakorlatban és kutatásokban való alkalmazásra. Orv Hetil. 2026; 167(27): 1068–1078.
Children with cleft lip and palate (CLP) frequently experience middle-ear dysfunction and conductive hearing loss, which may affect functional listening in noise. This study examined speech-in-noise recognition and visual-task latency cost during concurrent auditory-visual task performance in children with unilateral CLP and minimal conductive hearing loss. Twenty-five children with unilateral CLP and minimal conductive hearing loss and 28 age-matched typically developing controls, aged 7-15 years, completed audiological assessment, a single-task speech-in-noise condition (SIN), a concurrent auditory-visual condition combining speech recognition in noise with a randomized visual saccade task (SIN-WS), and a saccade-only condition. Word recognition accuracy and mean saccadic latency were recorded. Articulation was assessed in the CLP group using a standardized cleft speech assessment. Children with CLP showed poorer word recognition accuracy than controls in both SIN and SIN-WS conditions. Model-based analysis showed significant main effects of group and condition, whereas the Group × Condition interaction for word recognition was not significant. Mean saccadic latency increased during the concurrent-task condition in both groups, with a significantly greater increase in the CLP group. Within the CLP group, higher articulation error counts were associated with poorer word recognition accuracy and greater saccadic-latency cost. Children with unilateral CLP and minimal conductive hearing loss showed reduced speech-in-noise recognition and greater visual-task latency cost during concurrent auditory-visual task performance. These findings support the clinical value of assessing functional listening beyond isolated auditory thresholds in children with CLP.
Prognosis in metastatic renal cell carcinoma (mRCC) treated with PD-1 blockade remains difficult to estimate early during therapy. Routine laboratory markers of systemic inflammation and metabolic stress are widely available, yet single-marker approaches may not reflect coordinated early inflammatory-metabolic dynamics. In a multicenter real-world cohort of previously treated mRCC patients receiving nivolumab monotherapy, we applied a prespecified day-28 (1-month) landmark framework. Using baseline (BL) and month-1 (Mo1) LDH and complete blood count (CBC)-derived indices (NLR, PLR, SII) as systemic inflammatory and metabolic markers, we engineered BL, Mo1, and early relative change features (log2[Mo1/BL]), standardized them within the phenotype-eligible cohort, and derived early inflammatory-metabolic trajectory phenotypes via unsupervised k-means clustering (k = 3). Phenotypes were labeled post hoc as IM-Quiescent (P1), IM-Quiescent-to-Inflamed (P2), and IM-Inflamed-Persistent (P3). OS and PFS were analyzed from the landmark using Kaplan-Meier and multivariable Cox models. Durable benefit was assessed as 24-month OS (OS24) using multivariable logistic regression. The overall cohort included 498 patients; 329 were phenotype-eligible (P1 n = 142; P2 n = 69; P3 n = 118). Survival differed across phenotypes (log-rank OS p = 0.002; PFS p = 0.001). In multivariable Cox models (reference P1), P3 was associated with worse outcomes (OS HR 1.63, 95% CI 1.09-2.45; p = 0.019; PFS HR 1.92, 95% CI 1.36-2.73; p < 0.001), whereas P2 was not statistically supported versus P1 (OS HR 1.30, 95% CI 0.82-2.07; p = 0.262; PFS HR 1.21, 95% CI 0.82-1.79; p = 0.336). OS24 rates differed across phenotypes and phenotype remained associated with OS24 after covariate adjustment. Early inflammatory-metabolic trajectory phenotypes derived from routine systemic inflammatory and metabolic markers within a day-28 landmark framework were clinically interpretable and associated with OS, PFS, and durable benefit in nivolumab-treated mRCC. External validation and prospective evaluation in contemporary ICI-based regimens are warranted.
Perseverative coping refers to the continued use of an ineffective strategy or reimplementation of a strategy that had been abandoned. Self-compassion refers to being supportive of oneself when experiencing suffering. However, little is known about the mechanisms underlying the association between self-compassion and depressive symptoms. In stress research, self-compassion can be regarded as a coping resource that influences coping strategy selection, while coping affects depressive symptoms (i.e., stress response). This study aimed to examine the hypothesis that perseverative coping mediates the relationship between self-compassion and depressive symptoms. The participants were 303 Japanese college students who completed questionnaires on self-compassion, perseverative coping and depressive symptoms. Eight months later, they completed a questionnaire exclusively on depressive symptoms. Structural equation modelling analyses revealed that higher levels of perseverative coping mediated the association between lower levels of self-compassion and greater depressive symptoms. This result was consistent with the predictions of a typical psychological stress model (i.e., transactional stress model). Our findings suggest that the stress model contributes to our understanding of the role of higher levels of self-compassion in decreasing depressive symptoms.
Understanding how 24-h movement behaviors (i.e., physical activity, sedentary behavior, sleep) differ among children with developmental disabilities (e.g., delays, disorders, disabilities) is crucial, with evidence indicating that variations seen in older children may begin to emerge in early childhood. However, reviews have not acknowledged such developmental considerations in young participants. Therefore, a scoping review of the growing body of research focused on preschool-aged children is essential for gaining deeper insights into how these behaviors evolve and differ during this critical period. This scoping review aimed to (1) identify 24-h movement behavior levels in preschool-aged children with developmental disabilities, (2) determine whether 24-h movement behaviors differed between children with and without developmental disabilities, and (3) determine if 24-h movement behaviors varied by the domain of developmental difference. We conducted a systematic search in nine databases. Inclusion criteria were: (1) children between 33 and 72 months, (2) inclusion of children with developmental disabilities in the sample, (3) measures of at least two movement behaviors, (4) written in English, and (5) empirical, original research designs. The date of publication was unrestrained. Title/abstract and full text screening were completed by two independent reviewers. The date of publication was unrestrained. Twenty predominantly cross-sectional articles published between 2004 and 2024 were included. Studies examined movement behaviors across various developmental domains such as autism spectrum disorder, cerebral palsy, and developmental coordination disorder. Findings on sleep, sedentary behavior, and physical activity were mixed, with some studies reporting significant group differences while others found no or inconsistent group differences. This review highlights the variability and gaps in current research on movement behaviors among children with developmental disabilities, underscoring the need for more comprehensive and consistent measurements that consider all 24-h movement behaviors to better inform targeted interventions.
Family environments play a critical role in shaping children's lifestyle behaviours that influence obesity risk. However, culturally validated instruments to assess these behaviours are lacking in Portuguese primary care. This study aims to translate and culturally adapt the Family Nutrition and Physical Activity (FNPA) screening tool for use in Portugal (FNPA-PT) and to evaluate its face and content validity through cognitive interviews with parents attending well-child visits. An exploratory, descriptive study followed internationally endorsed guidelines (Beaton; MAPI) for translation and cross-cultural adaptation. The process comprised seven stages: forward translations, synthesis, back translations, comparisons of back translations, expert committee review, cognitive debriefing and final proofreading. Ten parents of five-year-old children attending a public primary care centre in Lisbon completed the FNPA-PT while participating in individual cognitive interviews. Data were analysed using Content Analysis, guided by Tourangeau's four-stage response model. Semantic equivalence between forward and back translations was high (85% of items with satisfactory or perfect equivalence). Minor linguistic and cultural adaptations were introduced to improve clarity and contextual relevance. Cognitive interviews indicated that the FNPA-PT was well understood, acceptable to parents, and feasible to complete during well-child visits. Parents valued the questionnaire's comprehensiveness and its potential to enhance awareness and stimulate discussion about family health behaviours. Minor revisions addressed comprehension issues in three items related to milk consumption, screen time and sleep. The FNPA-PT demonstrated strong face and content validity and high acceptability among Portuguese parents. It provides a culturally appropriate, family-centred tool for health professionals to support early identification of obesogenic environments and to guide preventive counselling in primary care. The study also offers a transparent methodological pathway for translating and adapting behavioural measures across languages and settings.
Magnesium oxide nanoparticles (MgONPs) demonstrate size-influenced antibacterial activity against Ralstonia solanacearum, with physical disruption mechanisms appearing to play a more prominent role than reactive oxygen species (ROS) effects under the tested conditions. While 30 nm particles generated maximum ROS levels, 20 nm MgONPs exhibited superior bactericidal efficacy, reducing survival to 36% at 300 mg/L versus 46% for 30 nm particles-a superiority consistently supported by motility, membrane, and transcriptomic assessments even at the complete-killing concentration (500 mg/L). This size-dependent efficacy was further validated in vivo. ROS scavenging tests and transcriptomics suggested that oxidative stress may not be the primary driver of antimicrobial action, though a potential synergistic role cannot be entirely excluded. The primary mechanisms involved size-specific physical membrane damage, DNA integrity changes, and metabolic interference. Smaller particles (20 nm) caused significant membrane destabilization and uniquely disrupted acetyl-CoA metabolism and oxidoreductase activity through downregulation of ribosome biogenesis, oxidative phosphorylation, and amino acid degradation pathways. Transcriptomic profiling revealed that particle size modulates catabolic gene expression and redox-related processes, with 20 nm particles inducing distinct metabolic suppression patterns. This study provides insights into the ongoing debate regarding ROS versus physical mechanisms, suggesting that nanoscale precision combined with surface properties governs antibacterial efficiency. The findings position MgONPs as a tunable antimicrobial platform where optimized particle dimensions and formulation strategies enhance pathogen control through targeted physical disruption and metabolic interference. These mechanistic insights offer a basis for engineering nanomaterials with improved bactericidal performance via optimization of multiple physicochemical properties.
Primary mediastinal large B-cell lymphoma (PMBCL) during pregnancy is rare and presents therapeutic challenges due to fetal safety concerns. We report the case of a 29-year-old woman diagnosed with PMBCL at 19 weeks of gestation who wished to continue her pregnancy despite her diagnosis. She received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy with multidisciplinary management and delivered a healthy infant at term. Although the tumor partially responded, residual disease persisted after eight cycles of treatment. She subsequently underwent chimeric antigen receptor T-cell therapy and achieved a complete response. This case highlights the importance of individualized treatment decisions and multidisciplinary collaboration in managing PMBCL during pregnancy.
Rituximab can cause immediate and delayed immune reactions, including rituximab-induced serum sickness (RISS). However, the temporal and mechanistic relationship between these reactions is unclear. We report a case in which RISS developed several days after rituximab-induced anaphylaxis. A 70-year-old woman with stage I mucosa-associated lymphoid tissue lymphoma was initially treated with weekly rituximab monotherapy. Four days after the third infusion, she developed fever, nonpruritic erythema, and arthralgia, which resolved spontaneously. When rituximab was re-administered, she immediately developed symptoms consistent with anaphylaxis, prompting treatment discontinuation. One year later, rituximab was re-started due to slight disease progression. The infusion induced nasal congestion and hoarseness but was completed under hydrocortisone. Eight days later, she presented with fever, widespread pruritic plaques, vomiting, diarrhea, and hypotension. Laboratory testing revealed elevated inflammatory markers without evidence of bacterial infection. Human anti-chimeric antibody levels were markedly elevated (> 5000 ng/mL). Intradermal testing with rituximab induced both an immediate wheal and a delayed erythematous flare lasting several days, indicating coexisting immediate-type hypersensitivity and RISS. This case demonstrates that RISS may occur several days after the resolution of rituximab-induced anaphylaxis. When immediate reactions occur after rituximab administration, patient education to ensure prompt reporting of delayed reactions is essential. Skin testing supported the identification of sequential immediate and delayed rituximab hypersensitivity in this case.
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides are systemic autoimmune disorders affecting small- and medium-sized vessels. Cutaneous involvement is common, but diagnosis can be challenging when inflammatory lesions mimic infectious processes, particularly fungal infections such as cryptococcosis. We describe two female patients with ANCA-associated vasculitis who developed widespread cutaneous lesions with histopathological features resembling Cryptococcus. The first patient, a 57-year-old woman with p-ANCA MPO-positive vasculitis, presented with bullous and purpuric lesions along with pulmonary hemorrhage. Despite corticosteroids and cyclophosphamide, her disease course was complicated by multiorgan involvement and fatal outcome. The second patient, a 73-year-old woman with multiple comorbidities, developed vesicular and necrotic skin lesions initially misdiagnosed as disseminated herpes zoster. Histology demonstrated vasculitis with Cryptococcus-like changes, and after exclusion of fungal infection, immunosuppressive therapy led to complete resolution. Cryptococcus-like histopathological changes have been reported in neutrophilic dermatoses, described as cryptococcoid Sweet syndrome. These yeast-like structures are thought to represent degenerating neutrophils rather than fungal organisms. Awareness of this rare finding is essential to avoid unnecessary antifungal therapy and ensure prompt initiation of immunosuppression. Cutaneous Cryptococcus-like changes in ANCA vasculitis are rare but clinically significant. Accurate diagnosis requires integration of clinical context, microbiological testing, and histopathology. Early recognition is critical to guide appropriate management and improve patient outcomes.
Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms composed of epithelioid cells that co-express melanocytic and smooth muscle markers. They can arise in various anatomic sites, most commonly the uterus, retroperitoneum, gastrointestinal tract, and liver. While most PEComas are sporadic and associated with TSC1/TSC2 mutations leading to mTOR pathway activation, a distinct molecular subset harbors TFE3 gene rearrangements, often exhibiting more aggressive clinical behavior. Given their rarity, the diagnosis and management of PEComas remain challenging and largely unstandardized. We report the case of a 37-year-old woman with no significant medical history who presented with fatigue, unintentional weight loss, and vomiting. Imaging revealed a large hepatic mass and pulmonary nodules. Histopathological and immunohistochemical evaluation confirmed a diagnosis of TFE3-rearranged PEComa involving the liver and left upper lung lobe. The patient underwent right partial hepatectomy with complete resection of the hepatic lesion. Subsequent disease progression was noted in the lung, lymph nodes, and bone despite treatment with an mTOR inhibitor. TFE3-rearranged PEComas represent a rare and aggressive molecular subset with limited therapeutic options. This case demonstrates resistance to mTOR inhibition, highlighting the critical importance of molecular subtyping to distinguish TFE3-rearranged from TSC1/TSC2-mutant disease and guide individualized management. Expanded molecular profiling is essential to refine treatment strategies for this uncommon entity.
Medication-related osteonecrosis of the jaw (MRONJ) represents a significant complication for patients receiving antiresorptive therapy. Dentists play a pivotal role in prevention, early detection, and management, yet global studies suggest variable practitioner preparedness. This study aimed to assess the current knowledge, attitudes, and clinical practices (KAP) of Tunisian dentists concerning MRONJ and identify factors influencing competency. A nationwide, cross-sectional online survey was distributed in September 2024. The validated 26-item questionnaire covered demographics, MRONJ knowledge, risk perception, and reported clinical behaviors. Data were analyzed descriptively and analytically. Among 106 respondents (mean age: 30 years; 79.2% female; 83% general practitioners), key findings revealed a profound knowledge-practice gap. While 77.4% identified intravenous bisphosphonates and extractions as primary risks, only 11.3% felt confident managing affected patients. Clinical caution was pronounced: 87.7% were reluctant to perform surgery, 63.2% would routinely refer, and 39.6% had refused treatment. Analytical results identified younger age (< 35 years), specialist status, and urban practice as significant positive correlates with accurate knowledge (p < 0.05). A defensive cycle emerged, linking low patient exposure to higher anxiety and avoidance behaviors. This first national study in Tunisia highlights critical deficits in dentist preparedness for MRONJ, driven by knowledge gaps and risk overestimation. The findings underscore an urgent need for structured, continuous education programs, clear national guidelines, and interdisciplinary collaboration to transform defensive practice into evidence-based, proactive patient management.
Robotic surgery has been increasingly used in colorectal surgery, where the improved visualization and dexterity are of benefit. The aim of this study was to confirm the perioperative and early postoperative safety and evaluate the clinical performance of the DEXTER® Robotic Surgery System in right colectomy. A prospective, multicenter, post-market study was conducted across three sites in France, Germany, and Switzerland. Four surgeons performed the surgeries with DEXTER. The primary endpoints were major complications defined as Clavien-Dindo grades III-V, and procedural success rate. Secondary endpoints included perioperative safety and performance assessment up to 30 days post procedure. A total of 33 patients with a median age of 71 years (IQR 63-78) and BMI 25.4 kg/m2 (IQR 23.4-27.9) were enrolled. Robotic intracorporeal anastomosis was performed in 49% of the procedures. All procedures were completed without device-related conversion to open surgery. Two patients experienced Clavien-Dindo III-V complications, none of which were device-related. Median estimated blood loss was 100 mL (IQR 20-120) with no blood transfusions. Operative time was 168 min (IQR 152-197) and length of stay was 5 days (IQR 4-6). Right colectomy with DEXTER is feasible and the results of this study support the short-term safety and clinical performance of the device, even early in the learning curve. Studies with long-term follow-up and functional outcomes are needed to assess long-term safety and performance. ClinicalTrials.gov NCT05537727 (registered on 8 September 2022).
Cerebral amyloid angiopathy (CAA) is associated with transient focal neurological episodes (TFNEs), which are brief, stereotyped symptoms. As these may occur regularly, pharmacological treatment of TFNEs is needed but remains poorly investigated. To systematically evaluate the available evidence on the use of pharmacological treatment to reduce the frequency, severity, or duration of TFNEs in patients with CAA. A systematic literature search of PubMed and Embase was conducted. Eligible studies included observational studies, interventional trials, and case reports or series that assessed pharmacological interventions for TFNEs in patients with confirmed CAA. Nine case reports/series involving 13 patients met the inclusion criteria. The mean age was 75.15 years, with a predominance of sensory and motor TFNE symptoms. One EEG recording out of nine reported paroxysmal activity whereas the rest showed no epileptiform activity. Antiseizure medications (levetiracetam) were the most common treatment. Eleven patients experienced complete remission, and two had partial improvement. Most patients exhibited convexity subarachnoid hemorrhage or cortical superficial siderosis on imaging. Although symptomatic improvement following pharmacological treatment was commonly reported, the current evidence is limited to descriptive case reports without control groups. The unpredictable course of TFNEs and absence of long-term follow-up complicate treatment evaluation. Larger, controlled studies or observational studies are needed to establish effective and evidence-based treatment strategies for TFNEs in CAA.
Cognitive decline is common after cancer, but little is known regarding the etiology of this adverse effect, especially in terms of molecular mechanisms. This prospective study obtained brain imaging and cognitive testing from 50 newly diagnosed women with primary breast cancer prior to any cancer treatment and 53 female controls. Participants completed up to seven assessments for a total time span of 9.7 ± 0.92 years. Imaging transcriptomics was used to measure the expression of genes in the brain involved in N-methyl-D-aspartate (NMDA) and calcium-mediated neurotransmission. GRIN2A, GRIN2B, and CACNA1C were significantly expressed in gray matter in both groups (R2 ≥ 0.092, p ≤ 0.015). GRIN2A (t = -2.72, p = 0.018) was significantly lower in the cancer group compared to controls across timepoints. GRIN2A declined over time in patients, and this was significantly different compared to controls (χ2 = 9.73, p = 0.005). Cognitive scores were significantly lower in patients compared to controls (p ≤ 0.004). In patients, GRIN2A was significantly associated with cognitive performance over time (p ≤ 0.009). These findings suggest that gene expression involved in neurotransmission is disrupted in the brain among patients with breast cancer and may contribute to cognitive changes. Our results provide novel molecular insights regarding the roles of non-CNS cancer pathology and treatments in the brain related to NMDA signaling and pro-survival/plasticity-related pathways. Our findings also point to potential treatments for cognitive effects of cancer.
The Intuitive Eating Scale-3 (IES-3) is a new 12-item instrument that provides an updated assessment of intuitive eating, a recognized protective factor of disordered eating. However, the IES-3's psychometric properties have not been assessed outside the parent study. Here, we assessed the psychometric properties of a novel French translation of the IES-3 in 772 French-speaking Canadian adults. Respondents completed the French IES-3 alongside additional measures selected to provide assessments of validity. Exploratory factor analysis with a first split-half subsample showed that a 4-factor model fit the data well. In a second split-half subsample, a bifactor-exploratory structural equation model (B-ESEM) with a G-factor and four S-factors best fit the data. Across subsamples, the 4-factor and B-ESEM models demonstrated gender invariance, and did not show measurement bias in terms of age and body mass index (BMI). Additional analyses showed some variation in intuitive eating as a function of age, BMI, and gender identity. Finally, results supported the composite reliability and convergent and concurrent validity. In sum, the French IES-3 demonstrates strong psychometric properties.