Heart transplantation following donation after controlled circulatory death (DCD) is not authorized in France, hence a feasibility study was mandatory. To conduct a preclinical study to validate the feasibility of DCD heart procurement. We further sought to investigate the metabolic signature of DCD hearts during normothermic ex-situ perfusion (NESP). The study design was approved by the Agence de la biomedecine (PFS20-004, La Plaine Saint-Denis, France). Five patients were considered for DCD heart procurement. Femoral vessels were canulated to ensure abdominal normothermic regional perfusion (A-NRP). Direct procurement followed by 4hours of NESP was performed. Donors' demographics and duration of functional warm ischaemic time (fWIT) were collected. Lactate levels were assessed every 30minutes during NESP. Plasma and left ventricular biopsies were collected every 30 and 60minutes, respectively, for untargeted metabolomic analyses using liquid chromatography coupled to high-resolution mass spectrometry. Mean±standard deviation donor age was 40±11 years and fWIT for the hearts was 26±10min. DCD lungs and kidneys were transplanted except in one case each (impaired ex vivo lung perfusion and premature arrest of A-NRP, respectively). DCD livers were all transplanted when allocated. All hearts were successfully perfused for 4hours. Lactate decreased during NESP for all hearts with a mean±standard deviation initial lactate at 5.42±0.98mmol/L and a final concentration at 3.02±0.86mmol/L (P=0.003). In plasma samples, there were notable changes for 166 metabolites. Most of them either initially increased and stabilized (64/166; 38.6%, e.g. carnitines) or continuously increased (67/166; 40.4%, e.g. purines, medium-chain fatty acids and amino acids). In biopsy samples, there were notable changes for 103 metabolites. Most of them initially decreased and stabilized, such as carnitines and nucleotides. DCD heart procurement is feasible in France. Lactate trends were consistent with suitability of these hearts for transplantation. The metabolomic signature was characterized by nucleotide catabolism along with consumption of carnitines.
Diamond-Blackfan anemia (DBA) is a rare inherited bone marrow failure syndrome characterized by macrocytic anemia and physical malformations. The only available curative treatment for patients with DBA is hematopoietic cell transplantation (HCT). Previous studies have included umbilical cord blood transplantation (UCBT) alongside other graft sources. We conducted a retrospective analysis of 41 pediatric patients with DBA who underwent related or unrelated UCBT between 1994 and 2023, using data from the Eurocord/EBMT registry. Twenty patients received related and 21 received unrelated single UCBT. Most patients received myeloablative conditioning and were transplanted after 1999. In related UCBT, median follow-up was 144.8 months, neutrophil engraftment at day +42 was 100% and 5-year overall survival (OS) was also 100%. In unrelated UCBT, median follow-up was 34 months, neutrophil engraftment at day +42 was 90%, and 5-year OS was 66%. The incidence of acute graft-versus-host disease (GvHD) was considerably higher among unrelated UCBT recipients. The incidence of chronic GvHD was similar between the two cohorts; however, extensive disease was more common after unrelated UCBT. UCBT from an HLA-identical sibling should be considered for DBA patients given the favorable short- and long-term outcomes. For the remaining patients, unrelated UCBT could be considered after individualized risk-benefit assessement.
Patients with obesity have a reduced access to kidney transplantation due to the higher risk of surgical and medical complications. Our aim was to provide clinical guidelines in this population focused on: (i) the main anthropometric parameter that contraindicates open kidney transplantation; (ii) other clinical factors to consider before transplantation; (iii) contraindications to robot-assisted transplantation; (iv) efficient and safe weight loss methods for kidney transplantation candidates with obesity. After a systematic review of studies published between January 2010 and June 2025 performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, these guidelines were developed by a multidisciplinary task force and reviewed by independent experts. In total, 153/962 publications met the inclusion criteria. The decision to allow kidney transplantation should not be based solely on Body Mass Index (BMI), but also on skin-to-vessel distance and pelvis angle. Robot-assisted kidney transplantation may be considered in highly selected patients with obesity and limited vascular disease, even those with grade 3 obesity. Patients with frailty should receive appropriate care before weight loss therapies. After appropriate nutritional preparation, bariatric surgery should be considered fairly quickly in patients with kidney failure and grade ≥ 2 obesity (grade B), or grade 1 obesity and poorly controlled type 2 diabetes. While Roux-en-Y gastric bypass achieves superior long-term weight loss than sleeve gastrectomy, it is associated with an increased mortality and morbidity. Pharmacological treatment (mainly GLP-1 agonists) is currently evaluated for weight loss in this population. These guidelines allow personalizing the management in kidney transplantation candidates with obesity.
Some pediatric tracheal pathologies remain therapeutic dead ends for which current palliative strategies are fraught with serious complications. With the aim of a tracheal replacement, our team has previously developed and patented a clinical grade partially decellularized trachea (PDT) from porcine tracheas. The aim of this work was to study and compare the biointegration mechanisms of this PDT in vivo, in a pig cervical muscle, with or without immunosuppressant. The secondary objective was to evaluate the optimal maturation time of the PDT in this heterotopic position. In total, 11 female Large White/Landrace pigs, weighing between 50 and 70 kg were included in this study. The mean age of the animals at the implantation was 4.8 months. The PDTs were implanted in a cervical muscle of pigs for either 28 days, with or without cyclosporin A treatment, or for 56 days without immunosuppression. Histological evaluation showed very good PDT biointegration, characterized by neovascularization and fibroblast colonization, and no detectabale infection. Additionally, tissue and blood analyses showed no signs of graft rejection or surrounding tissue necrosis. Immunosuppression did not show any superiority in terms of biointegration after 28 days of treatment. After 56 days of implantation, a more significant degradation of the cartilage. Therefore, the optimal condition for PDT maturation proved to be 28 days, without immunosuppression. The online version contains supplementary material available at 10.1038/s41598-026-37823-1.
Pineal lesions are rare and surgically challenging due to their deep location, histological diversity, and potential malignancy. The complexity of the pineal region anatomy and the diverse pathological spectrum contribute to the lack of standardized treatment strategies, making appropriate management controversial. This study aimed to evaluate the surgical outcomes of patients with pineal tumors or cysts and to assess the impact of different surgical approaches, particularly the extent of resection, on progression-free survival. We conducted a retrospective analysis of 27 patients treated for pineal tumors or cysts at our institution between 2010 and 2020. Data regarding clinical presentation, surgical technique, extent of resection, pathological diagnosis, and follow-up outcomes were collected and analyzed. Surgical outcomes were compared between patients undergoing biopsy and those receiving varying degrees of tumor resection. Our analyses suggest that total resection could be the most effective approach for reducing the risk of tumor recurrence. Furthermore, our findings indicate that histological subtype is a statistically significant predictor of progression-free survival in patients. Our findings suggest that achieving a greater extent of resection, when safely feasible, may contribute to improved long-term outcomes. These results emphasize the need for larger, multicenter studies to further optimize treatment strategies for these complex lesions.
Advances in sequencing technologies have enabled researchers to sequence whole genomes rapidly and cheaply. However, despite improvements in genome assembly, structural genome annotation (i.e. the identification of protein-coding genes) remains challenging, particularly for eukaryotic genomes. It requires using several approaches (typically ab initio, transcriptomics, and homology search), which may give substantially different results. Deciding which gene models to retain in a consensus is far from trivial, and automated approaches tend to lag behind laborious manual curation efforts in accuracy. We present OMAnnotator, a novel approach to building a consensus annotation. OMAnnotator repurposes the OMA algorithm, originally designed to elucidate evolutionary relationships among genes across species, to integrate predictions from different annotation sources into a consensus annotation, using evolutionary information as a tie-breaker. During benchmarking on the Drosophila melanogaster reference, OMAnnotator's consensus improved upon its source annotations and two state-of-the-art pipelines used as annotation combiners with the same inputs. When applied to three recently published genomes, OMAnnotator gave substantial improvements in two cases, and mixed results in the third, which had already benefitted from extensive expert curation. This underlines the method's effectiveness and robustness for combining the results of disagreeing annotation softwares, strengthening the toolkit for eukaryotic genome annotation. OMAnnotator is available on GitHub (https://github.com/DessimozLab/OMAnnotator).
Repetitive elements, particularly satellite DNA (satDNA), play a significant role in genome evolution and organisation. However, their diversity and evolutionary dynamics remain poorly understood in non-model organisms. Freshwater crayfish (Decapoda, Astacidea) have large genomes with a high chromosome number and are rich in satDNAs. This makes them attractive for studying the impact of satDNA on genome evolution. In this study, we investigated the repetitive genomic landscape of 19 species representing four freshwater crayfish families. Our analysis revealed a high proportion of repetitive DNA in all studied species, with the total repeat content ranging from 30% to 66%. The number of satDNA families was remarkably high (54–622 families per species), with minisatellites (< 100 bp) forming the largest component of the satellitome. Family-specific patterns emerged: Astacidae and Cambaroididae showed the highest satDNA proportions, while Cambaridae and Parastacidae were dominated by Class I transposable elements. Species of the family Parastacidae showed the largest number of unique satDNA clusters and were clearly separated from other families, reflecting their phylogenetic divergence and distinct biogeographic history. We identified specific satDNAs conserved across all species, among them the PlSAT3-411, pointing to their important functional roles as pericentromeric satDNA. This study provides the first comprehensive comparative analysis of satDNA in freshwater crayfish. Our results highlight the dynamic nature of repetitive DNA and underscore its importance in genome organisation and evolutionary history. The online version contains supplementary material available at 10.1186/s13100-026-00399-8.
In patients with stage 4 and 5 chronic kidney disease (CKD), the reduction of kidney function prompts decisions regarding kidney replacement therapy (KRT): dialysis, transplantation or an alternative to KRT, ie conservative kidney management. The international literature reports that a majority of patients living with CKD (regardless of stage) are female, whilst more males undergo KRT. The objective of this study was to compare sex differences in terms of clinical trajectories and treatment decision making, taking into account clinico-biological characteristics. A registry-based observational cohort study that included adult patients in Brittany, France enrolling CKD stages 4 and 5 between 2019 and 2021. Descriptive statistics were reported using frequencies and percentages, means and standard deviations. Variables included in the multivariate regression models (linear or logistic) were selected based on clinical relevance and statistical significance (P value <0.2 in univariate regression). We included 1623 patients. At inclusion, 1048 patients (64%) had stage 4 CKD, including 627 males. Estimated GFR and age did not differ significantly between males and females. In terms of comorbidities, males had more cardiovascular disease (55% (n = 338)) than females (37% (n = 154), P < 0.001) and were more likely to have KRT planned than females (24% (n = 149) vs 16% (n = 65), P < 0.001). In multivariate logistic regression analysis, female sex was associated with a significantly lower probability of having a KRT plan, as well as a shorter duration of nephrology follow-up (less than one year), older age (>75 years), heart failure, living in a residential care facility or an institution, and having an underlying kidney disease defined as "other", compared with chronic glomerulonephritis. The presence of a stable eGFR explained the majority of the "not discussed" or "undecided" treatment plans for males and females (88% (n = 222) vs 90% (n = 306)). This study does not support the hypothesis that females with CKD are more likely to choose conservative kidney management than males, but it does suggest females are less likely to have a plan for KRT, which was in turn linked to stable kidney function in both sexes. The data showed no statistical difference in kidney function decline between females and males, however a larger study is needed to confirm this finding. Future research including other markers of kidney function decline could also help test this hypothesis.
E-cigarettes are often presented as a smoking cessation tool, less harmful than tobacco and are now a regular feature of everyday life. However, the fruity and sweet flavours are attractive to teenagers who can use them recreationnaly. The main risk of this phenomenon is becoming trapped in nicotine addiction. Although e-liquids, which combine nicotine, humectants and flavouring agents, seem to affect the pulmonary system and in particular the alveolar-capillary barrier (ACB), data on nicotine-free e-liquids remain scarce. The aim of this work is to study the toxicity of nicotine-free e-liquids/aerosols flavoured with berries (Strawberry, Raspberry, Blackberry, Blueberry) using two exposure methods. First, we validated an in vitro model of the ACB using epithelial NCI-H441 and endothelial EA.hy926 cells. Secondly, barrier integrity, production of oxidative species and cytotoxicity were assessed by transepithelial resistance (TER) measurement, MitoSOX® and LDH test, respectively, after exposure to two different methods: dilution of the e-liquid and aerosol trapping in the culture medium. Finally, a non-exhaustive analysis of the chemical compounds found in berry e-liquids was performed to identify potentially toxic compounds specific to certain flavours. The model mimicked phenotypically and functionally the ACB. The two exposure methods tested revealed significant differences in terms of e-liquid/aerosol toxicity on the ACB, probably due to variations in aromatic and degradation products. Flavours are not all equal in terms of cell toxicities, making it essential to chemically identify the compounds responsible for these different degrees of toxicity.
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Liver transplantation (LT) remains the definitive treatment for patients with end-stage chronic liver disease (CLD). However, those transplanted while in the intensive care unit (ICU) represent a high-risk population. Large-scale data on long-term prognosis in this group are limited. We aimed to assess long-term outcomes in patients with CLD undergoing LT from the ICU and to compare outcomes over time. This retrospective cohort study used the French national transplant registry (CRISTAL). Adults with CLD who underwent LT from the ICU between 2008 and 2018 were included. Organ failures were defined according to EASL CLIF-OF criteria. Five-year survival and associated risk factors were analyzed and compared across four time periods (2008-2010, 2011-2013, 2014-2016, 2017-2018). Among 13,372 LTs performed in France during the study period, 9,686 were for CLD, of which 1,287 (13.2%) patients were in the ICU at the time of LT. Alcohol-related liver disease (50%) and viral hepatitis (16.1%) were the leading etiologies. Five-year survival was significantly lower in ICU patients compared with non-ICU patients (69.2% vs. 79.1%, p <0.0001). Among patients who survived the first post-transplant year, 5-year survival exceeded 83% and was comparable to that of patients with CLD transplanted outside the ICU. Survival by era showed no significant improvement (p = 0.28). Age (hazard ratio [HR] 1.03, p <0.0001), mechanical ventilation (HR 1.57, p = 0.0001) and French donor risk score (HR 1.05, 95% CI [1.02-1.09], p <0.001) were independent predictors of mortality. Patients transplanted from the ICU have significantly lower long-term survival, primarily due to elevated early post-transplant mortality, with no observed improvement over time. Careful candidate evaluation and donor selection remain critical to improving outcomes in this high-risk population.ClinicalTrials.gov number NCT06636409. This large national cohort study provides a comprehensive evaluation of long-term outcomes in critically ill patients with cirrhosis undergoing liver transplantation while in the intensive care unit. Despite advances in transplant care over the past decade, we observed a persistent survival gap in this high-risk population, primarily driven by increased mortality within the first year after transplantation. Age, the need for mechanical ventilation, and donor-related factors were independently associated with this excess risk. We also found no significant improvement in outcomes over time. These results underscore the continued need for refined candidate selection and donor allocation strategies, taking into account age, pre-transplant clinical stability, and graft quality to optimize post-transplant survival.
Over recent decades, considerable attention has been directed toward the discovery of novel compounds capable of targeting survival-related signaling networks as therapeutic candidates for triple-negative breast cancer (TNBC). Central to TNBC pathobiology are the Akt/mTOR and MAPK/ERK signaling axes, both contribute to tumor progression and therapeutic resistance. Caffeic acid (CA), a naturally derived phenolic compound with anti-inflammatory activity, has previously been investigated for its anti-cancer potential. In the present study, we explored the therapeutic value of newly synthesized CA derivatives in TNBC models using both cellular and animal based systems. The anti-tumor efficacy of these CA derivatives was examined through a series of functional assays, including cell proliferation, clonogenicity, cell cycle profiling, apoptosis quantification, ELISA, western blotting, and histopathological analysis. Among the tested derivatives, decyl caffeate (DC) demonstrated the most pronounced inhibitory effects on TNBC cell growth, significantly decreasing viability, colony formation, and enhancing cisplatin responsiveness (P < 0.05). DC induced G2/M phase arrest in MDA-MB-468 cells, accompanied by suppression of cyclin B1 and CDK1 expression. In addition, DC downregulated both total and phosphorylated c-Myc and reduced secretion of TGF-α, a key ligand for EGFR. Apoptotic responses were evident through upregulation of Bax, cleaved caspase3, and cleaved-PARP. Mechanistic analysis revealed that these effects were mediated via concurrent inactivation of the Akt/mTOR and MAPK/ERK signaling pathways. Oral administration of DC in a murine TNBC xenograft model significantly suppressed tumor growth in vivo. Altogether, these results highlight DC as a promising bioactive compound that targets essential oncogenic pathways in TNBC and support its potential for further preclinical development.
Neuropsychiatric systemic lupus erythematosus (NPSLE) is a major clinical challenge, characterized by heterogeneous manifestations and the absence of reliable biomarkers. The mechanisms linking systemic autoimmunity to neuronal injury and neuropsychiatric symptoms remain poorly understood. Using the lupus-prone MRL/Lpr mouse model, we integrated systemic cytokine profiling, plasma neurofilament light chain (NfL), region-specific CNS cytokine mRNA mapping, cortical metabolomics, and behavioral analyses to dissect immune-metabolic-neuronal interactions. Inflammation was dominated by a Th1 cytokine program, with interferon-gamma emerging as a prominent component of the inflammatory profile. Composite cytokine scores correlated strongly with plasma NfL, establishing an immune-neuronal injury axis. Region-resolved analyses revealed distinct CNS cytokine signatures, including selective hippocampal loss of interleukin-10 and IFNγ-dominated responses in the frontal cortex. Cortical metabolomics demonstrated diversion of tryptophan metabolism away from serotonin toward the kynurenine pathway, with increased quinolinic acid/kynurenic acid (QA/KA) ratio and upregulation of indoleamine 2,3-dioxygenase-1 (Ido1) and kynurenine 3-monooxygenase (Kmo). NfL levels were negatively associated with serotonin and positively with 3-hydroxykynurenine and QA/KA, linking axonal damage to an excitotoxic metabolic environment. Importantly, cortical serotonin levels correlated with exploratory behavior, linking serotonergic depletion to anxiety-like phenotypes. Together, these results support an associative framework in which systemic IFNγ levels are linked to cortical metabolic reprogramming and neuronal vulnerability, bridging peripheral immune activation with serotonergic depletion, melatonin loss, axonal injury, and behavioral dysfunction. Translationally, combined blood-based monitoring of IFNγ, NfL, and kynurenine metabolites may represent a candidate biomarker framework for NPSLE. However, validation in independent patient cohorts will be essential, and therapeutic modulation of IDO1/KMO or serotonergic pathways remains an avenue for future investigation.
Paediatric data of children born to mothers receiving chronic dialysis are scarce, although this information is essential to study the possible risk of morbidity related to intrauterine exposure to uremic toxins and maternal therapies. Our aim was to examine the impact of this exposure on the short and mid-term outcomes of children. This national observational study was based on data from the French National Health Data System. In France, over the period 2013-2021, 70 live births were born to mothers receiving chronic dialysis. The median gestational age was 37 (33-39) weeks, including 40 (57.1%) full-term and 30 (42.9%) preterm births. The median birth weight was 2615 (1941-3448) g, and 32 (45.7%) new-borns had a birthweight < 2500 g. Other neonatal complications were: 5 respiratory distress syndrome (7.1%), 2 small for gestational age (2.8%) and 5 admissions to the NICU (7.1%). From birth up to eight years of age, the main diseases were those of the respiratory system 31 (44.2%), including acute bronchiolitis 22 (31.4%); diseases and infections of the digestive system 22 (31.4%), including enteritis and gastroenteritis 14 (20%); diseases of the urinary system 7 (10%), including tubulo-interstitial nephritis 5 (7.1%); and congenital malformations 17 (24.2%) including 9 cardiac (12.8%). This study highlights the risk of morbidity in children born to mothers on chronic dialysis. Further larger studies are required to confirm the relatively high frequency of congenital malformations.
Arteriovenous fistula (AVF) is the preferred access for hemodialysis. Achieving one-year patency is crucial to avoid dependence on central venous catheters, which carry significant risks of infection and thrombosis. In French Guiana, a territory marked by precariousness, isolation, and a tropical climate, local determinants of patency are poorly documented. This study aims to evaluate AVF patency at 6 weeks and one year and to identify associated factors. This is a single-center retrospective study including all AVFs created at the Cayenne Hospital Center between 2018 and 2022. Demographic data, comorbidities, vascular parameters, technical characteristics, and season were analyzed. Associations were studied using univariate and multivariate logistic regressions with a multilevel model. The primary endpoint was AVF patency at 6 weeks and 1 year. Among 176 patients, 226 AVFs were created, 92.5% of which were autologous. Patency at one year was 73.7%. Obesity (Body Mass Index ≥ 30) was associated with reduced patency at one year (OR = 0.46; 95% CI [0.24–0.85], p = 0.014) but not at 6 weeks while active smoking reduced patency at one year (OR = 0.34; [0.13–0.89], p = 0.029) but not at 6 weeks. Each previous AVF also reduced the probability of patency (OR = 0.45; [0.27–0.75], p = 0.002 at 6 weeks; OR = 0.54; [0.35–0.84], p = 0.006 at one year). Conversely, a higher mean initial arterial flow significantly improved patency (OR = 3.31; [1.22–8.92], p = 0.018); high flow had an even more pronounced effect (OR = 6.32; [1.63–24.6], p = 0.008); a larger radial diameter was also associated with better outcomes (OR = 2.42; [1.45–4.05], p = 0.001). A season × flow interaction suggested increased vulnerability of AVFs at low flow during the wet season (OR = 0.15; [0.02–1.04], p = 0.05). In French Guiana, AVF patency at one year is primarily determined by vascular parameters (arterial flow and diameter). Modifiable risk factors including obesity and active smoking significantly reduce patency, while multiple previous AVF attempts predict worse outcomes. Exploratory analysis suggests possible seasonal vulnerability in low-flow fistulas, requiring prospective vascular assessment, risk factor optimization, and targeted protocols. Not applicable. This is a retrospective observational cohort study. Trial registration is not required for observational studies according to ICMJE and BMC guidelines. The study was not registered prospectively.
This qualitative study explored veterinarians' and producers' perspectives on the role veterinarians play in knowledge transfer and translation (KTT) for dairy producers, and the barriers to success of current KTT strategies. Five focus groups were conducted with 20 dairy producers in Ontario, and 5 focus groups were conducted with 20 bovine veterinarians across Canada. Using applied thematic analysis, 4 main themes were identified: 1) educational role of the veterinarian, 2) progress is a collaborative approach toward success, 3) veterinary strategies for knowledge transfer and translation, and 4) veterinary barriers to knowledge transfer and translation. Participants felt that the veterinary role is shifting from clinical practitioner to farm advisor, with veterinarians valued for the novel information they can provide. Additionally, it was emphasized that veterinarians serve as an unbiased information filter to ensure their clients are able to make practical and informed management decisions. However, the disconnection of communication between producers and veterinarians was reported by both groups to be a barrier to KTT. Earning client respect was vital to the success of the producer-veterinarian relationship, resulting in trust and ultimately leading to effective and engaged knowledge extension. Both sets of participants discussed that producer success was a collaborative effort that required the adoption of progressive best management practices, for which effective KTT is crucial. Both small group and large annual meetings hosted by veterinarians or in collaboration with other on-farm advisors were considered valuable, but identifying ways to individualize KTT will further engage producers and may alleviate advisor fatigue, which was a barrier reported by veterinarians. Additional KTT barriers include a need to strengthen veterinary emotional intelligence and inconsistencies of advice and practices between veterinarians, both of which result in reduced producer trust and reduced uptake of recommendations. Therefore, identifying and implementing solutions to KTT barriers for both producers and veterinarians will optimize the successful and timely adoption of best management practices.
Integrating artificial intelligence-based large language models (AI-LLMs) into medical and other scientific domains is increasingly recognized as a tool to support complex tasks, such as interpreting histopathology slides and scientific figures. AI-LLMs can simplify these processes by providing clearer explanations. By improving accessibility and comprehension, AI-LLMs can significantly assist healthcare professionals in diagnosing and therapy determination. Students and the public also find it easier to understand complex scientific concepts and images. This study explores the capability of AI-LLMs in interpreting histopathological slides and scientific images. This study aims to evaluate the performance of AI-LLMs in supporting diagnostics and improving comprehension in biomolecular sciences. The study was divided into two parts: interpreting histopathology slides and scientific figures. Twelve histopathology images and twelve scientific figures were tested on each of the three most frequently used chatbots (ChatGPT-4, Gemini Advanced, and Copilot). Responses from the chatbots were coded and blindly examined by expert raters using five parameters-relevance, clarity, depth, focus, and coherence-on a 5-point Likert scale. Statistical analysis included one-way ANOVA and multiple linear regression. ChatGPT-4 outperformed Gemini Advanced and Copilot in histopathology and scientific image interpretation (P < 0.001) with significantly higher scores across all parameters (relevance, clarity, depth, focus, and coherence). ChatGPT-4's superior performance may be due to its advanced algorithms, extensive training data, specialized modules, and user feedback. ChatGPT-4 excels in interpreting histopathology and scientific images, which may lead to improving diagnostic accuracy, clinical decision-making, and reducing pathologists' workload. It also benefits education by enhancing students' understanding of complex images and promoting interactive learning. ChatGPT-4 shows a significant potential to improve patient care and enrich student learning.
Cardiovascular disease (CVD) represents the leading cause of mortality among individuals with chronic kidney disease (CKD). While Chinese herbal medicine (CHM) is commonly used by CKD patients in Taiwan, the impact of CHM use on cardiovascular outcomes in this population remains insufficiently understood. This study aimed to evaluate the association between CHM use and the long-term risk of major adverse cardiac events (MACEs) in patients with CKD. Data were obtained from the Taiwan National Health Insurance Research Database to identify patients aged over 20 years with newly diagnosed CKD. A 1:1 propensity score matching was performed based on age, sex, comorbidities, medication use, and CHM exposure, resulting in 6351 matched pairs. Participants were followed from 2000 to 2017 to assess the incidence of MACEs, including heart failure (HF), myocardial infarction (MI), ischemic stroke (IS), cardiovascular death, and all-cause mortality. The CHM group comprised 56.4 % females with a mean age of 49.4 ± 15.3 years. After matching, CHM use was associated with a statistically significant reduction of 23 %-31 % in the adjusted hazard ratios for various cardiovascular outcomes and all-cause mortality (P < 0.001). The most commonly prescribed CHM formula and single herb were Ji-Sheng-Shen-Qi-Wan (JSSQW) and Danshen (Salviae Miltiorrhizae), respectively. The use of CHM as an adjunct therapy in CKD patients was associated with a significantly lower risk of MACEs and all-cause mortality. These findings support the potential of CHM in cardiovascular risk mitigation among CKD patients and highlight the need for future clinical and ethnopharmacological investigations.
Chronic kidney disease (CKD) represents a heavy global health burden associated with increased mortality and morbidity and high economic impact. Chronic kidney disease, which is largely asymptomatic and is diagnosed based on laboratory tests, is particularly difficult to identify in medical-administrative databases in the absence of laboratory results and no specific medications or procedures. The aim of this paper is to describe the progressive stages of constructing and validating an algorithm for targeting chronic kidney disease in the French medical administrative databases SNDS . A consortium of experts in nephrology, kidney epidemiology and healthcare claims databases, referred to as group "REDSIAM Kidney Disease", collaborated to design a practical algorithm for assessing the probability of chronic kidney disease cases likelihood through a combination of items associated with the CKD care pathway. The performance of the RENALGO-EXPERT algorithm differs significantly depending on the population and the databases used. Sensitivity tends to improve in more at-risk populations. However, at this stage, the results are not very satisfactory. To improve case detection performance and in the hope of capturing weak signals overlooked by experts, a project using machine learning methods was devised, RENALGO-IA.
Addictive and eating disorders are the two deadliest psychiatric disorders. Emotional dysregulation and impulsivity are central processes in both disorders. Maladaptive emotion regulation strategies play a key role in the development and maintenance of these disorders. The standard treatment for emotion regulation is Dialectical Behavioral Therapy (DBT); its implementation is often a challenge, but transdiagnostic groups can facilitate it. Due to the lack of data available on these groups in addictology, our study aimed to determine whether emotional dysregulation and impulsivity are improved with the implementation of transdiagnostic DBT groups. Eight two-month cycles of transdiagnostic DBT groups occurred between 2021 and 2023. The 35 participants had substance use disorder (89%), addictive behavior disorder (14%), or eating disorder (20%). Other psychiatric comorbidities, especially borderline personality disorder (42.9%), were also present. The evolution of questionnaires completed by the participants and the attrition rate were analyzed. The dropout rate was 21%. During DBT, the improvement reached high effect sizes for emotional dysregulation (d = 0.9), positive cognitive emotional regulation (d = 0.978) and negative cognitive emotional regulation (d = 1.04), and medium effect sizes for impulsivity (d = 0.586) and mindfulness (d = 0.766). Depending on the cycle, improvement in emotional dysregulation ranged from 0% to 31%, and retention ranged from 12% to 100%. An association was found between attrition rate and therapists’ level of experience (effect size = 0.320, p = 0.001). While DBT is known to be effective on emotional dysregulation and impulsiveness, two particularly important functions in addictology, we found that their improvement can occur as soon as this therapy is implemented despite challenges present. These results suggest that the transdiagnostic format, which facilitates DBT implementation, preserves DBT’s effects. The online version contains supplementary material available at 10.1186/s13011-025-00698-y.