Research continues to inadequately integrate gender and diversity, reflecting the longstanding model in which the male body has been considered the universal standard. To address these gaps, initiatives like the SAGER (Sex And Gender Equity in Research) and SAGER-swissethics guidelines have emerged, to encourage the integration of sex and gender into research, from the design to the dissemination of results. Clinical guidelines rarely include sex- or gender-specific recommendations. It is unclear whether this lack reflects the absence of differences or, conversely, a lack of data to establish specific differences. While awaiting an update in the data, clinicians are invited to critically read the literature, adjust dosages to body compositions, and value patients' experiences to ensure equitable care. La recherche continue à manquer de données intégrant le genre et la diversité, du fait d’un modèle masculin érigé en norme universelle. Pour combler ces lacunes, plusieurs initiatives existent. Les recommandations SAGER (Sex And Gender Equity in Research) et SAGER-swissethics sont un guide pour l’intégration du sexe et du genre dans la recherche, de la conception à la diffusion des résultats. Les recommandations cliniques incluent rarement des indications selon le sexe ou genre. On ignore donc si ces lacunes reflètent une réelle absence de différences ou un manque de données pour le prouver. En attendant de nouvelles données, les clinicien-ne-s sont invité-es à adopter une lecture critique de la littérature, adapter les posologies selon la composition corporelle et valoriser l’expérience des patient-e-s pour garantir des soins équitables.
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Systemic mastocytosis (SM) is a spectrum of hematologic disorders characterized by accumulation of atypical mast cells (MCs) in extracutaneous organs. SM with an associated hematologic neoplasm (SM-AHN), the most frequent subtype of advanced SM, is predominantly associated with myeloid neoplasms, consistent with shared clonal architecture. Because of its rarity and heterogeneity, robust outcome data aligned with contemporary classifications are needed to inform risk stratification. We analyzed the 10th data wave of the European Competence Network on Mastocytosis registry (34 European centers and 1 US center). SM and AHN diagnoses followed the 2022 World Health Organization classification. Baseline characteristics and overall survival (OS) were compared between patients with myeloid SM-AHN and SM without AHN (SM-no-AHN). Within SM-AHN, outcomes were analyzed by SM component (advanced: aggressive SM [ASM] or MC leukemia [MCL] vs. non-advanced: bone marrow mastocytosis, indolent SM, or smoldering SM) and AHN subtype. Among 3,925 patients with SM, 467 (11.9%) had myeloid SM-AHN. Myelodysplastic/myeloproliferative neoplasms (MDS/MPN) were the most frequent AHN category (41.1%), with chronic myelomonocytic leukemia as the most common subtype (29.6%). Compared with SM-no-AHN, SM-AHN patients were older, more often male, and less frequently had skin involvement. The SM component was advanced in 55.0% of SM-AHN versus 5.8% of SM-no-AHN (p < 0.001). OS was shorter in SM-AHN than SM-no-AHN (median 36.1 vs. 340.9 months; p < 0.001) and was reduced across SM subtypes, including ASM (31.0 vs. 81.1 months) and MCL (7.1 vs. 23.2 months). Within SM-AHN, advanced SM-AHN had shorter OS than non-advanced SM-AHN (28.3 vs. 70.9 months; p < 0.001). Median OS differed by AHN subtype (57.0 months in SM-MPN, 35.7 in SM-MDS, 34.2 in SM-MDS/MPN, and 14.7 in SM associated with acute myeloid leukemia; p < 0.001). In multivariable analysis, non-advanced SM (vs. advanced) remained independently associated with improved OS (hazard ratio = 0.44; p < 0.001). SM-AHN is associated with reduced survival compared with SM without AHN across SM subtypes. Outcomes in SM-AHN are driven primarily by the aggressiveness of the mastocytosis component, supporting recognition and classification of SM in patients with concomitant myeloid neoplasms, given approved KIT-targeted tyrosine kinase inhibitors for advanced SM.
To retrospectively evaluate pediatric robotic thyroid surgery and assess postoperative satisfaction using the SCAR-Q scale. Patients undergoing robotic thyroid surgery between January 2017 and December 2023 were included. Eu-TIRADS and Bethesda classification were assessed. Surgeries were performed either a transaxillary or retroauricular approach. Clinical variables and complications were recorded. Postoperative scar-related satisfaction was assessed using the validated SCAR-Q questionnaire. Forty patients were included, with a median age of 15 years (range: 7 - 18). Histology revealed 23 benign nodules, 6 multinodular goiters, 4 cases of Graves' disease and 7 differentiated carcinomas. A transaxillary approach was performed in 25 cases and a retroauricular approach in 15. Median operative time was 217 minutes (range: 119 - 347 minutes). Postoperative complications included seven temporary recurrent laryngeal nerve palsies, two temporary hypocalcemias, one wound dehiscence, and one temporary impairment of upper limb extension; all resolved at the last follow-up (median follow-up 31 months, range : 3 - 77). Thirty-one patients completed the SCAR-Q questionnaire from July 1, 2023 to September 1, 2023. Median scores were 80 for appearance (range: 17 - 100), 82 for symptoms (range: 47 - 100), and 87 for psychosocial impact (range: 0 - 100). Satisfaction was high overall, with a trend toward better outcomes after the transaxillary approach. Remote-access robotic thyroidectomy appears to be a feasible option in selected pediatric patients, with high cosmetic satisfaction. The transaxillary approach was associated with a trend toward higher SCAR-Q scores, although selection bias and limited sample size preclude firm conclusions regarding superiority.
This review summarizes recent advancements in gastrointestinal surgery in pet ferrets, rodents, and African pygmy hedgehogs, emphasizing species-specific perioperative considerations and evolving surgical approaches. Key innovations include adapted minimally invasive techniques, systematic full-thickness biopsies for unexplained gastrointestinal disease, and updated management of uncommon conditions such as gastric dilatation-volvulus, colonic obstruction, and congenital fistulas. The article highlights the particular susceptibility of hindgut-fermenting herbivores to postoperative ileus and dysbiosis, underscoring the need for gentle tissue handling, multimodal analgesia, early enteral nutrition, and prudent antimicrobial use. Standardized postoperative monitoring protocols are recommended to optimize outcomes across species.
Hepatobiliary disease in exotic mammals is a relatively underexplored field compared with that of dogs and cats. However, recent advances in diagnostic imaging, anesthesia, and microsurgical techniques have expanded the range of feasible interventions for species such as rabbits, ferrets, guinea pigs, and other small mammals. Among exotic mammals, rabbits appear to be the most commonly affected by hepatobiliary pathology, with hepatic lobe torsion representing the predominant surgical indication. This review article will mainly focus those 2 conditions and integrates the existing exotic animal literature with well-established principles from canine and feline hepatobiliary surgery.
Painful knee conditions impose a substantial socioeconomic burden and remain a diagnostic and therapeutic challenge. The distribution of nociceptors within the knee joint is poorly characterized, with no established consensus. This narrative review aimed to (1) describe the distribution of sensory receptors across intra-articular and periarticular knee structures and (2) characterize the articular branches contributing to the innervation of knee structures in order to inform targeted pain management strategies. We conducted a structured narrative review based on a systematic literature search performed in PubMed, Embase, Scopus, Cochrane Library, and Google Scholar (1945-2025). Studies investigating sensory receptor distribution and articular innervation of healthy human knees using dissection, histology, immunohistochemistry, or nerve tracing were included. Two reviewers independently screened, extracted data, and synthesized findings. Outcomes included mapping of parent nerves and articular branches, and semi-quantitative assessment of nociceptor distribution. Among 2222 records, 32 studies were included. Nociceptor distribution showed marked spatial heterogeneity, with the anterior capsule exhibiting the highest density. The posterior cruciate ligament demonstrated greater nociceptor density than the anterior cruciate ligament, whereas menisci and periarticular tissues showed lower densities. Knee innervation consistently arose from the femoral, sciatic, and obturator nerves, with significant overlap and anatomical variability. Major sensory contributors included the saphenous nerve, nerves to the vasti, tibial articular branches forming the popliteal plexus, the common fibular nerve, and obturator branches. Knee sensory innervation arises from a complex and overlapping network involving femoral, sciatic, and obturator articular branches. The anterior capsule represents the principal nociceptive region of the knee, whereas mechanoreceptors are predominantly concentrated within cruciate ligaments and peripheral meniscal structures. These findings provide an anatomical basis for refining targeted analgesic and interventional strategies. 1107530.
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Hip joint position sense (JPS), a key component of neuromuscular function arising from muscle spindle and periarticular mechanoreceptor input, remains underexplored, with no standardized and reliable clinical protocol available to assess hip proprioception. This study evaluated the intra- and inter-rater reliability of a laser- and inclinometer-based active hip JPS protocol and established preliminary references in healthy adults. A two-phase reliability study was conducted in accordance with GRRAS and COSMIN guidelines: 17 participants for reliability analyses and 57 for preliminary references. Six movement directions were assessed (flexion, extension, abduction, adduction, medial and lateral rotations). Reliability was quantified using intraclass correlation coefficients with their 95% confidence intervals, using two-way random-effects models with absolute agreement (ICC(3,1) for intra-rater and ICC(2,1) for inter-rater analyses), interpreted as poor (<0.50), moderate (0.50-0.70), or good (≥0.70). Absolute measurement error was reported as standard error of measurement (SEM%) and 95% minimal detectable change (MDC95%), normalized to target amplitudes to allow direct cross-direction comparison. Intra-rater reliability ranged from poor to moderate, with experienced raters reaching ICC = 0.64 (95% CI [0.39; 0.80]) for medial rotation. Inter-rater reliability improved across sessions, peaking for medial rotation (ICC = 0.78; 95% CI [0.50; 0.91]). Rotational movements yielded the lowest SEM% (3-6%), indicating high measurement precision despite trial-to-trial variability (MDC% 9-31%). Normative errors were largest in flexion (21.4 cm) and smallest in rotations (≈2.2-2.3°). Despite overall low-to-moderate reliability, the protocol achieved clinically acceptable measurement precision (SEM% < 10%) for rotational tasks, whereas the laser-based sagittal and frontal-plane components remained exploratory. The protocol provides preliminary reference values for hip JPS in healthy adults and requires further validation before clinical use.
The advent of streaming platforms and multiplicity of watching devices has transformed audiovisual consumption, popularizing the practice of binge-watching. Problematic binge-watching can be associated to negative consequences. Previous studies have highlighted heterogeneity among individuals who engage in binge-watching, with some exhibiting psychological vulnerabilities and others exhibiting different watching motivations. This study aimed to (i) identify different typologies of TV series watchers based on their viewing behaviors and related motives and (ii) explore the psychopathological features specifically associated with each profile. Data were collected via an international online survey. This study is based on answers of 1421 French students, assessing TV series watching related motives, engagement in binge-watching and characteristics of problematic binge-watching, and psychological variables. A latent class analysis was used to classify participants into clusters based on their viewing patterns and motivations. Clusters were then compared using sociodemographic and psychological measures. Three distinct clusters were identified: Single-device TV series watchers (probability of belonging: 59%), who engage in moderate viewing with minimal psychopathological impact; Multiple-device TV series watchers (26%), who are younger participants using diverse devices, with moderate emotional-oriented motivations and limited negative outcomes; and Escapist binge-watchers (15%), characterized by high emotional enhancement and escapism motivations, and marked psychological distress. The latter group also reported greater loss of control and dependency. This study underscores the importance of differentiating viewing patterns to identify at-risk individuals. A subset demonstrates clinically relevant issues linked to psychological vulnerabilities and maladaptive coping strategies. Escapism motivations may serve as preliminary markers of problematic binge-watching.
Clinical outcomes after acute ischemic stroke remain highly heterogeneous, even among patients with comparable lesion characteristics and successful reperfusion, challenging traditional lesion-based models. Increasing evidence suggests that stroke should be conceptualized as a disorder of distributed brain networks, yet the mechanisms linking focal ischemia to large-scale dysfunction remain incompletely understood. In this review, we propose that diaschisis constitutes a central physiological mechanism underlying this transition from focal injury to network-level impairment. Building on advances in functional imaging, connectomics, and cerebellar physiology, we propose that diaschisis may be conceptualized, at least in part, as a disruption of cerebello-cortical loop dynamics rather than solely a nonspecific remote effect. These closed, polysynaptic circuits linking cortex, cerebellum, and thalamus support the integration of motor and cognitive processes and are particularly vulnerable to perturbation. Focal ischemia may therefore induce a cascade of dysfunction that propagates across these loops, leading to widespread impairment despite limited structural damage. Within this framework, outcome variability emerges from the interaction of three key factors: lesion characteristics, brain reserve and network vulnerability, and the extent of diaschisis. We further highlight that functional suppression of cerebellar output, even in the absence of structural degeneration, may play a critical role in mediating network dysfunction. This circuit-based perspective provides a mechanistic explanation for inter-individual variability in stroke outcomes and shifts the focus from lesion localization to network dynamics. Understanding diaschisis as a potential manifestation of cerebello-cortical loop dysfunction opens new avenues for prognosis and therapeutic intervention, emphasizing the potential of targeting network-level restoration to improve recovery after stroke.
This study reports the results of a survey of bovine clinical cases of 'piroplasmosis-like' syndrome (PLS) on Réunion Island, encompassing haemoparasitoses such as anaplasmosis (Anaplasma marginale) and babesiosis (Babesia bovis, B. bigemina), as well as orbiviroses, notably epizootic haemorrhagic disease (EHD) and bluetongue (BT). A total of 170 cattle displaying PLS symptoms were sampled between February 2024 and August 2025 and were tested for multiple pathogens using RT-qPCR. Co-infections were common, affecting 67% of cattle. In particular, co-infection with A. marginale and B. bovis was associated with increased clinical severity compared to A. marginale infection alone, with a mortality rate of 50% versus 33% for all sampled cattle. Spatial distribution revealed that PLS clinical cases were sampled only in the western and southern parts of the island. Significant disparities in infection rates were detected across the covered climatic zones, with the Central high-altitude plain exhibiting the highest incidence (12.8 cases per 1000 cattle). Temporal variations showed a clear seasonal pattern, with most cases occurring during the southern hemisphere summer (November to April). Sporadic cases of orbiviroses were detected during the studied period.
Antimicrobial management in pediatric transplantation lacks standardized international guidelines, and current practices across European transplant centers remain poorly described. This study aimed to evaluate microbiological screening and peri-transplant antimicrobial strategies among centers participating in the European Reference Network on Transplantation in Children (ERN TransplantChild), including both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) programs. Between December 2022 and February 2023, healthcare professionals within the network completed a structured survey addressing microbiological screening practices and peri-transplant antimicrobial strategies in pediatric transplant recipients. Of 127 transplant programs invited, 76 (59.8%) responded, including 62 SOT and 14 HSCT programs from 36 centers across 16 European countries. Pre-transplant screening strategies, microbiological methods, and decolonization practices varied substantially between centers. Reported prevalence of methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing organisms was below 10% in most programs. In SOT, perioperative prophylaxis varied according to transplanted organ type. Cephalosporins were most commonly used in kidney and heart transplantation, whereas broader-spectrum regimens, including piperacillin-tazobactam and vancomycin, were more frequently adopted in liver, intestinal, and lung transplantation. Postoperative prophylaxis was continued beyond 24 h in most SOT programs. Antifungal prophylaxis was more commonly adopted in liver, intestinal, and lung transplant recipients. In HSCT, antibacterial peri-transplant use was not routinely prescribed in a substantial proportion of programs, particularly in autologous transplantation, whereas antifungals were widely used in allogeneic HSCT. Marked heterogeneity in microbiological screening and peri-transplant antimicrobial strategies across European pediatric transplant centers underscores the need for transplant-specific, evidence-based guidelines distinguishing between SOT and HSCT settings. These findings provide a foundation for the development of shared clinical pathways and harmonized recommendations.
DNA barcoding for timber species identification requires comprehensive reference datasets, informative DNA barcodes, and cost-effective protocols. We developed a workflow leveraging Hyb-Seq (target capture sequencing and genome skimming) to address these challenges, and we tested it on four genera from the mahogany family (Meliaceae). We sequenced up to 350 nuclear and 177 plastid loci from 132 herbarium specimens representing leaf samples of 22 species. We determined the DNA barcoding potential of each locus by looking at species recovery and monophyly in gene trees. We then selected 13 short regions (candidate barcodes) within high-potential loci and tested their PCR amplification and Sanger sequencing on wood DNA. Three candidate barcodes emerged as the most reliably sequenced from wood DNA and as providing the most accurate species-level identifications, with species monophyly rates above 80%. Failure to obtain sequences from some wood DNA extracts was more often associated with potential DNA impurity (as inferred from DNA color) than with DNA degradation. Our reference data and candidate barcodes provide a foundation to support the DNA barcoding of mahogany and its relatives. Our workflow illustrates how the wealth of Hyb-Seq data currently generated from global herbaria may be leveraged to monitor plant diversity.
Intravesical instillations of mitomycin C, epirubicin, and BCG are considered as the standard of care for most patients with non-muscle invasive bladder cancer (NMIBC). These guidelines aim to optimize intravesical instillations in order to improve their efficacy and decrease morbidity. An analysis of good practice, available regulations, and published guidelines was conducted through an online literature search in French and English using Medline® and Embase®, up to December 2025. The following keywords were used: "BCG"; "Mitomycin C"; "Epirubicin"; "Bladder"; "Complication"; "Toxicity"; "Adverse reaction"; "Prevention"; "Treatment". Information should be given to the patient by the attending physician before the first intravesical instillation. A medical examination to detect specific contraindications is also mandatory to select appropriate therapy. Intravesical instillations should be delivered in health-care centers where urological endoscopic procedures are performed routinely. Screening for or treating asymptomatic bacteriuria prior to intravesical chemotherapy or BCG instillation is not recommended. In the presence of a clinically apparent urinary tract infection, instillations should be postponed. Intravesical instillation can only be delivered after a bladder catheter has been inserted without any injury to the lower urinary tract. The pharmaceutical agent should be retained in the bladder for 2 h. Finally, voiding within 6 h after intravesical instillation should be done in the seated position and the patient should drink at least 2 L of water per day for 2 days. The delivery of intravesical instillations of mitomycin C, epirubicin and BCG should follow a standardized procedure for better efficacy and lower morbidity.
Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality globally, with serious implications in Lebanon. Both international and local guidelines advocate for empirical antibiotic treatments by illness severity, yet the extent to which these are followed in Lebanese hospitals is unclear. This research examined the adherence to CAP treatment guidelines and its association with clinical outcomes. Methods: We retrospectively studied adults admitted to two Lebanese referral hospitals (Mount Lebanon University Medical Center and Ain Wazein Medical Village) from April 2011 to March 2025 with CAP. Adherence to empirical antibiotic regimens was determined based on the guidelines from the Lebanese Society of Infectious Diseases and Clinical Microbiology, American Thoracic Society/Infectious Diseases Society of America, and British Thoracic Society/National Institute for Health and Care Excellence. The outcomes assessed were in-hospital mortality, Intensive Care Unit (ICU) admission, and length of hospital stay (LOS). We used logistic and linear regression analyses, adjusting for demographic and clinical variables. Results: A total of 337 patients were included with an average age of 61 years; 53.7% were male, 51.6% were admitted to the ICU, and the in-hospital mortality rate was 27%. In general, 65.6% of the treatment regimens adhered to at least one guideline. The combination of β-lactam and macrolide was the most common, used in 87.8% of cases, while monotherapy was administered in 31.8% of cases and included β-lactam, macrolide, fluoroquinolone, and other antibiotics; most monotherapies were non-adherent to guidelines, except for selected fluoroquinolone monotherapy cases that may be considered guideline-concordant under ATS/IDSA recommendations depending on clinical context. Adherence to guidelines did not significantly affect mortality rates (25.8% vs. 29.3%), ICU admissions (52.5% vs. 50.0%), or length of stay (11.4 vs. 9.3 days). Multivariate analysis revealed that older age (OR 1.025, 95% CI 1.008-1.042) and ICU admission (OR 1.024, 95% CI 1.012-1.039) were independent predictors of adverse outcomes, whereas guideline adherence, comorbidities, and inflammatory markers were not independently linked. Surprisingly, mortality was higher among younger patients (average age 58 vs. 67 years, p < 0.001). Conclusions: Although guideline-concordant empirical therapy was prevalent in this two-center Lebanese retrospective population, it did not independently correlate with length of stay following adjustment, ICU admission, or in-hospital mortality. Patient-related and clinical factors, such as the severity of the illness, may have an impact on observed differences in outcomes, which should be taken as relationships.
Background/Objectives: Class II malocclusion treatment in patients at the end of skeletal growth represents a significant clinical challenge. Traditional sequential distalization with clear aligners often requires prolonged treatment duration, carrying the risk of patient compliance burnout. This article describes a clinical technique combining a "Distalizing Bar Appliance" (DBA) with active lower clear aligners and Class II elastics for the management of dentoalveolar Class II malocclusion, and illustrates its application through a case series of three end-of-growth adolescent patients. Methods: Proposed inclusion criteria and a standardized three-phase workflow are presented: (1) distalization using a DBA supported by Class II elastics, with active lower clear aligners providing anchorage and concurrent crowding resolution; (2) alignment and arch coordination with clear aligners; and (3) finishing for occlusal settling. Results: In all three cases, a Class I molar and canine relationship was achieved, with cephalometric changes consistent with the dentoalveolar mechanisms previously reported for similar appliances and no clinically apparent mandibular skeletal changes. The concurrent use of active lower aligners allowed early crowding resolution, although careful monitoring of lower incisor and molar inclination was required to limit unwanted mesial tipping induced by Class II elastics. Conclusions: Within the limits of a case series, the technique appears clinically feasible and reproducible in carefully selected patients; comparative, controlled studies are needed before any claim of superior efficiency or effectiveness over established Class II treatment modalities can be made.
Transcatheter mitral valve replacement (TMVR) with the Tendyne Mitral Valve System is a treatment option for patients with severe symptomatic mitral regurgitation (MR) unsuitable for conventional mitral valve surgery or transcatheter edge-to-edge repair (TEER). This study sought to evaluate the safety and effectiveness of TMVR through 5-year follow-up. The Tendyne Expanded Clinical Study is a prospective, single-arm, multicentre study that enrolled patients between November 2014 and June 2020. The study enrolled 191 patients (mean age 74.1±8.0 years, 62.8% male, 70.2% NYHA class III/IV, 88.5% secondary MR), of whom 186 (97.4%) underwent TMVR with Tendyne. MR grade decreased from ≥ 3+ in 99.5% patients at baseline to grade ≤ 1+ in 95.3% at 5 years. In those patients surviving to 5 years (n=49), durable symptomatic improvement was evidenced by 73.5% patients being in NYHA class I/II at 5 years. The Kansas City Cardiomyopathy Questionnaire overall summary score increased from 48.5±22.5 points at baseline to 67.6±21.5 points at 5 years. Serious adverse events that occurred through 5 years included life-threatening bleeding (11.5%), fatal bleeding (2.6%), renal insufficiency/failure (28.8%), endocarditis (7.3%), device thrombosis (5.8%) and new onset atrial fibrillation (13.1%). No structural device degeneration or device embolism occurred through 5 years. The Tendyne TMVR was effective at achieving immediate and sustainable elimination of MR, which was associated with symptomatic improvement and absence of structural valve degeneration in a high-risk cohort over 5 years. These findings support TMVR with the Tendyne System as an alternative for patients with appropriate mitral valve anatomy and symptomatic secondary MR unsuitable for mitral surgery or TEER.
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