Aston Medical (France)

Abstract Introduction Minimally invasive techniques have transformed early rectal cancer treatment; yet the optimal approach is unclear. ESD, EMR, and TAMIS are increasingly being used, however, most studies only compare two of these techniques. This meta-analysis directly compares all three in efficacy, safety, and oncological performance. Methods PubMed, Scopus, and Medline were searched to identify relevant studies as of September 2024. Criteria included studies in adults with early rectal cancer treated by ESD, EMR, or TAMIS, reporting at least one outcome and specifying treatment type and cancer stage. Comprehensive Meta-Analysis v4 was used for analysis with heterogeneity assessed via I². Results A total of 127 studies encompassing 8915 patients were included (EMR = 3979, ESD = 4470, and TAMIS = 466). Mean procedural times were: overall 8.3 min (7.7–8.8), I² = 99%; EMR 7.5 (6.9–8.1), I² = 98%; ESD 32.6 (29.3–36), I² = 99%; TAMIS 101.6 (83.9–119.9), I² = 95%. En bloc resection: overall 87.1% (85.6–88.5), I² = 81%; EMR 86.5% (84.4–88.4), I² = 82%; ESD 87.2% (84.4–89.5), I² = 80%; TAMIS 94.1% (88.9–97), I² = 0%. R0 resection: overall 79.7% (78.6–80.8), I² = 80%—EMR 79.9% (78.3–81.5), I² = 85%; ESD 78.7% (77.1–80.3), I² = 76%; TAMIS 87.1% (82.8–90.4), I² = 42%. Conclusions Although EMR appears efficient, it demonstrated less favourable outcomes regarding en bloc resection. ESD showed favourable oncological outcomes while maintaining moderate procedural time. TAMIS is most time-intensive but yields the highest resection quality.

Nanotechnology has revolutionised pharmaceutical sciences, with mesoporous silica nanoparticles (MSNs) extensively studied as drug carriers. However, their clinical translation is hindered by challenges such as toxicity, tumour accumulation, and uncontrolled endocytosis. Mesoporous silica microparticles (MSMs) have emerged as a safer alternative, offering enhanced drug loading, controlled release, and improved formulation properties. MSMs facilitate protein delivery, solubility enhancement, and bioavailability improvement through pore size modulation, amorphous drug loading, and surface functionalisation. Additionally, they aid in overcoming multi-drug resistance and enable organ-specific targeting using aptamers or magnetic nanoparticles. Beyond drug delivery, MSMs enhance pharmaceutical formulations, with commercial products such as SYLOID®, Aeroperl®, and Neusilin® improving tablet performance and drug stability. Their role in controlled release systems further underscores their pharmaceutical potential. As research advances, MSMs offer promising strategies for precision medicine and optimised drug delivery, reinforcing their potential for future clinical applications.

Sulfation pathways are an essential part of overall sulfur metabolism. Sulfation pathways are mainly about sulfate activation, and the making and breaking of biological sulfate esters. This special issue features some extended reflection on what was presented at the SUPA 2023 meeting on Sulfation Pathways. Novel insights into the synthesis and analytics of sulfate, of sulfated conjugates, and of protein persulfides are presented. Oxysterol sulfates are presented as emerging sulfo-metabolites. Sulfation pathways enzymes are discussed in various disease settings. This special issue also presents insights into polysaccharide sulfotransferases and their functional characterization. Finally, cytoplasmic sulfotransferases are highlighted with regards to their impact on DNA-modification, and in the context of endocrine disruptors. All in all, thought-provoking findings, with the potential to guide and stimulate future research in the field of sulfation pathways and beyond.

IntroductionThe issue of underrepresentation of women in medical leadership roles, particularly in their retention and long-term engagement, is a pressing challenge in healthcare. Despite advancements in women’s initial entry into these roles, their sustained presence and advancement in leadership roles have been relatively underexplored. This narrative literature review aims to addresses this significant gap, focusing on the retention of women in medical leadership. The review aims to uncover the factors that influence their long-term commitment and progression in these roles. Understanding these challenges is essential for fostering a diverse and inclusive leadership culture in healthcare, which is vital for meeting the varied needs of patients and enhancing organisational effectiveness. This review endeavours to provide insights into the retention strategies that can support the continuous growth and presence of female leaders in healthcare.Aims and objectives of the research project or activityThis narrative review primarily aims to investigate the factors affecting the retention of women in medical leadership positions, an area that has received less attention in research compared to their initial recruitment into such roles. Specific objectives include: 1) To assess the extent of female underrepresentation in medical leadership across various healthcare systems; 2) To identify and analyse the key factors contributing to this gender disparity, encompassing policy, organisational culture, and individual-level challenges; 3) Evaluating the effectiveness of strategies and interventions designed to enhance this retention and ongoing engagement of women in these positions. Through addressing these objectives, this review seeks to fill a critical gap in the literature and contribute to a more comprehensive understanding of gender inclusivity in medical leadership.Method or approachThis narrative review employs an exploratory and interpretative methodology, focusing on the theme of women’s retention in medical leadership roles. The search encompasses key academic databases including PubMed, MEDLINE(Ovid) and Scopus, alongside grey literature and reports from healthcare organisations, ensuring a broad spectrum of viewpoints. A narrative review approach allows for the inclusion of a diverse range of studies. The selection criteria were designed to prioritise studies and articles that directly address the unique challenges and solutions associated with retaining women in medical leadership positions. The search was narrowed to articles published between 2003 and 2023 in order to capture current workforce trends, whilst maintaining a comprehensive review. A total of 193 materials were initially identified to be potentially relevant for the review. A total of 19 articles were found to match the inclusion criteria and were subsequently reviewed.FindingsThe findings from this narrative review underscore that the retention of women in medical leadership roles is influenced by a complex range of factors. Structural barriers, such as limited progression opportunities beyond initial leadership roles and insufficient retention-focused policies are significant. Culturally, deeply ingrained gender stereotypes and biases within professional environments create formidable challenges. On a personal level, balancing professional growth with personal life commitments emerges as a pivotal issue. This review highlights various promising strategies for mitigating these challenges, including leadership development programs tailored for retention, ongoing mentorship and sponsorship initiatives, as well as organisational policy reforms aimed at supporting the long-term engagement of female leaders. However, there is a notable gap in rigorous, long-term evaluations of these strategies, pointing to the need for more comprehensive research into their effectiveness. These findings suggest that a multifaceted approach, distinct from strategies that solely focus on entry-level barriers, is essential for retaining women in leadership positions within the medical field.Key messagesThe central message of this review is the vital need for a strategic emphasis on the retention of women in medical leadership roles, a crucial yet underemphasised aspect of fostering inclusive healthcare leadership. This review advocates for the development and implementation of targeted strategies and policies specifically geared towards supporting the long-term engagement and career progression of women in such roles. Recommendations include specialised leadership training programs, continuous mentorship and sponsorship opportunities, along with organisational policies that foster work-life balance and career sustainability. By highlighting the advantages of a diverse and inclusive leadership, this review urges healthcare institutions and policy- makers to actively confront the unique challenges associated with retaining women in medical leadership positions. Such focused efforts are essential not only for achieving gender equity in leadership but also for enhancing healthcare delivery through a leadership structure that truly reflects the diversity of our medical workforce and patient population.

BackgroundParkinson's disease (PD) is a progressive neurodegenerative condition characterised by the loss of dopaminergic neurons and the presence of Lewy bodies. PD medications, notably Levodopa, are critical in controlling patients' symptoms and improving their quality of life. These medications are time-critical, and a delay in administration can have a negative impact on a patient's mobility, quality of life and symptoms.ObjectiveThe objective of this quality improvement project (QIP) was to (1) determine the occurrence and underlying factors contributing to delays in PD medication administration at Huddersfield Royal Infirmary and (2) evaluate the impact of subsequent interventions in improving the administration of time-critical PD medications.MethodsA total of 20 patients were recruited from Ward 5, a care of the elderly ward, at Huddersfield Royal Infirmary for the entire duration of this QIP; 10 in the pre-intervention phase and 10 for the post-intervention phase one month following the implementation of three interventions: 'Parkinson's Drug Box', ward-based teaching and a hospital-wide screensaver reminder.Data was collected from the electronic patient record (EPR) to determine and compare the following measures before and after the interventions: the percentage of PD medications administered within the 30-minute recommended window, the admission-to-medication reconciliation time, scheduled-to-actual dose administration time, and factors causing delays.ResultsFollowing the implementation of three interventions, the percentage of patients receiving PD medications within the recommended 30-minute window doubled, increasing from 10% to 20%. Moreover, the average delay in patients receiving their initial PD medication dose decreased from 7.8 hours to 3.7 hours. The percentage of patients experiencing medication delays due to stock shortages also dropped from 50% to 10%.ConclusionsEarlier medicines reconciliation and the availability of time-critical drugs out of hours are both key factors in helping to ensure PD medication is administered on time in hospitals. Staff education and a 'Parkinson's Drug Box' are two relatively simple measures that have resulted in improved outcomes for Parkinson's inpatients.

The development of medical science requires a constant increase in the effectiveness and safety of treatment. Collection of real-world data (RWD) is one way of solving these problems. Clinical registries are one of the most important parts of this process. Clinical registries allow collecting data on the use of medical technologies and monitoring the results of therapy in real clinical practice. The introduction of patient registers and the collection of RWD data into widespread medical practice can help to optimize costs in the treatment of high-cost diseases and to better plan the budget.

IntroductionThe association between chronic inflammatory demyelinating polyneuropathy (CIDP) and diabetes is uncertain despite important diagnostic and management implications.MethodsWe retrospectively analysed two European cohorts, totaling 257 patients with ‘definite’ or ‘probable’ CIDP, from Serbia and Birmingham, UK.ResultsDiabetes was present at CIDP diagnosis in 25/139 (18%) subjects in the Serbian cohort and in 23/118 (19.5%) in the UK cohort. In both cohorts, diabetes prevalence was higher than local general population prevalence rates (RR: 2.09; 95% CI 1.39 to 2.95 and RR: 2.22; 95% CI 1.46 to 3.17, respectively). Considering typical CIDP only, diabetes prevalence was greater than expected in both cohorts (RR: 2.58; 95% CI 1.60 to 3.82 and RR: 2.68; 95% CI 1.71 to 3.87, respectively). CIDP with diabetes occurred later in life than CIDP without diabetes (58.96 years, SD: 11.09 vs 51.71 years, SD: 16.02; p=0.003) and presented more frequently in the typical form than in patients without diabetes (79.2% vs 61.2%; p=0.02). Baseline Inflammatory Neuropathy Cause and Treatment disability scores were similar in patients with and without diabetes (p=0.90). Proportions of treatment responders were similar in both groups (70% vs 74.9%; p=0.65), as were response amplitudes (p=0.87).DiscussionOur results, both for all CIDP and typical CIDP presentations, support a twofold increased relative risk of diabetes compared with the general population. CIDP with diabetes appears to present older and more frequently in the typical form, as compared with CIDP without diabetes. CIDP with diabetes appears similar to CIDP without diabetes in disability levels at diagnosis and probability, as well as amplitude of treatment response.