Clinique Saint Jean

The aim of this study is to evaluate the second medical opinions (SMOs) clinical value for endometriosis diagnostic strategy and patient profiles, using nationwide data from a specialized French physician network dedicated to SMOs and endometriosis management. We conducted an observational cohort study including patients from France who submitted a request for an SMO through a dedicated platform ( https://www.deuxiemeavis.fr/ ) between January 1st, 2020, and March 31st, 2024. Patients completed predefined questionnaires and subsequently received a written report following the expert SMO. A total of 3,061 patients requested a SMO for endometriosis. Most patients (61.1%) declared experiencing chronic painful symptoms a negative impact on daily life, corresponding to an Eastern Cooperative Oncology Group (ECOG) score ≥ 1. Dysmenorrhea was reported by 50.7% of patients, and 69.4% reported interruption of intercourse due to pain. Among the 2,987 patients with a complete medical record, the SMO modified the diagnosis in 51.1% of cases. After SMO, experts were unable to establish a conclusion in only 5.0% of cases, compared to 24.7% after the first medical opinion. For patients finally diagnosed with endometriosis, the SMO provided a diagnosis at a mean of 3.8 ± 1.5 years after symptom onset. Seeking a SMO with access to medical experts can be essential for patients dealing with painful symptoms unsuccessfully treated, or other problems such as endometriosis diagnosis.

Abstract Objectives The impact of preoperative glycometabolic profile of diabetic patients on the risk of penile prosthesis (PP) infection remains uncertain. Current data are conflicting but the studies to date have been limited by retrospective design and by including heterogenous cohorts of patients (both diabetic and non-diabetic). Hence, the available evidence on the impact of diabetes mellitus (DM) and glycemic control on infection rate after PP implantation was systematically reviewed. Methods A comprehensive Medline, Embase, and Cochrane search was performed including the keywords penile prosthesis and diabetes mellitus. English-language articles between January 1st, 1969, up to May 31st, 2024 were included. Primary outcome was the PP infection rate in patients with DM. Secondary endpoints included the contribution of glycometabolic control on PP infection rate. Random-effect model was uniformly applied. Robust meta-analytical techniques were employed to control for heterogeneity and undetected bias including sensitivity analyses and regression linear adjusted models where appropriate. The protocol of this study (CRD42024557982) was published on PROSPERO. Results Out of 182 retrieved articles, 9 were included in the study (3 prospective and 6 retrospective) accounting for 5493 subjects with a mean age of 59.7 years, and a mean follow-up of 29.4 months. Overall, a PP infection rate of up to 7% was observed. The PP infection rate increased according to baseline HbA1c levels and was confirmed in multivariate analysis adjusting for age and trial duration (B = 7.8 ± 0.2%; p < 0.0001). PP infection rate was almost 3-times higher when trials with a mean HbA1c greater than 8% were compared to the rest of the sample (9.1 (7.5;11.0) vs. 3.8(3.2;13.5)%; Q = 43.18; p < 0.0001). Conclusions The present study suggests a significantly increased risk of PP infection for patients with DM and pre-operative HbA1c greater than 8%. A multidisciplinary approach to optimise preoperative glycometabolic control in patients with DM may be the key element for successful PP implant outcomes. However, better quality studies are needed to better guide clinical practice and preoperative optimisation. Conflicts of Interest nil.

Même si plusieurs jeux vidéo sont accompagnés d’une trame sonore officielle, celle-ci ne réplique pas exactement la bande sonore du jeu : des sections peuvent être sautées, les pistes sont souvent réarrangées, et certaines chansons n’y figurent pas. La version en jeu est-elle alors plus authentique que celle de la trame sonore officielle ? Comment cela affecte-t-il la compréhension et le rapport des joueurs et des joueuses à cette chanson ? Cet article examine trois façons dont la musique s’adapte aux contextes en jeu et se distingue des trames sonores officielles : 1) en tant que réarrangements des œuvres originales ; 2) par la variation dans le déploiement des pistes dans le système de gestion audio du jeu ; 3) comme montages ou autres modifications d’œuvres préexistantes. Cette contextualisation permet d'aborder les raisons pour lesquelles de tels changements ont lieu et comment ils influent sur la compréhension des joueurs et des joueuses.