Hôtel-Dieu de France

The authors declare no conflicts of interest. Data sharing is not applicable to this article as no data sets were generated or analysed during the current study.

The WIL-31 study demonstrated efficacy and safety of prophylaxis with the plasma-derived von Willebrand factor/factor VIII concentrate wilate in von Willebrand disease (VWD) of all types and was the only prospective study with an on-demand run-in study as an intra-individual comparator. This subgroup analysis examines the efficacy of wilate prophylaxis in patients with type 3 VWD in WIL-31. Patients received 20-40 IU/kg wilate prophylaxis 2-3 times weekly for 12 months. Twenty-two patients in WIL-31 had type 3 VWD. Mean total annualized bleeding rate (ABRs) during on-demand versus prophylaxis was 37.1 versus 5.2 (86% reduction). During prophylaxis, 115 bleeds occurred, most (95%) of which were minor; the most common bleeding site was the nose (40% of bleeds). Mean overall spontaneous ABRs during on-demand versus prophylaxis were 26.5 versus 2.8 (89% reduction); mean treated spontaneous ABRs were 20.3 versus 1.4, respectively (93% reduction). ABRs were reduced further during the second 6 months of prophylaxis versus the first 6 months. Results were consistent in subgroups by age. No serious adverse events related to study treatment and no thrombotic events were observed. Prophylaxis with wilate was effective and well tolerated in patients with type 3 VWD, in all age groups. NCT04052698; https://clinicaltrials.gov/study/NCT04052698.

ABSTRACT Background Glucagon‐like peptide‐1 receptor agonists (GLP‑1 RAs) play a pivotal role in treating type 2 diabetes. Despite their widespread use, their dermatological manifestations remain under‐recognized, hence the interest of this systematic review. Objectives This systematic review aims to assess dermatological manifestations associated with GLP‐1 RA therapy, highlighting both adverse effects and potential therapeutic benefits. Methods Following the PRISMA guidelines, articles that evaluated dermatological outcomes in patients receiving GLP‑1 RAs were systematically searched using PubMed and ScienceDirect databases. Only randomized controlled trials (RCTs) and observational studies involving human subjects were included. Results Hair loss was the most significant side effect, unlike the usually reported injection‐site reactions or lipodystrophy. Interestingly, several studies found that liraglutide and semaglutide therapy improved psoriasis lesions. Conclusions The most frequent side effect associated with GLP1‐RA use in this review appeared to be hair loss. Importantly, some GLP1‐RAs have been shown to improve psoriatic lesions.

Osteosarcoma is the most common malignant bone tumor in children and adolescents, characterized by high heterogeneity and a complex tumor microenvironment (TME). Despite multimodal treatments, survival rates have stagnated, highlighting the need for new therapeutic options. Single-cell RNA sequencing (scRNA-seq) offers a powerful tool to dissect heterogeneity and uncover mechanisms of progression and immune evasion. A narrative literature review, guided by PRISMA principles, was conducted through October 2024 via PubMed and Scopus databases to assess scRNA-seq contributions to osteosarcomagenesis. A total of 107 studies were analyzed to highlight the identification of tumor subpopulations, signaling pathways, diagnostic and prognostic biomarkers, and therapeutic assessments. Our analysis highlights the critical role of scRNA-seq in revealing the complexity of the osteosarcoma TME. Studies identified distinct immune and non-immune cell subpopulations, with TXNIP+ and IFIT1+ macrophages, KAZALD1, EGFL7, TNFSF11, and TRAIL receptors emerging as potential therapeutic targets. scRNA-seq has elucidated mechanisms of tumor progression and metastasis, including CD24 expression, and enabled the discovery of immune and stromal biomarkers within the TME. It also revealed novel therapeutic strategies, such as targeting Tregs via CXCR4 inhibition, CAFs through LOX and SERPINE1 modulation, and MCL1 in metastatic niches. Additionally, it uncovered promising drug candidates-etoposide, mevastatin, oxfendazole, HDAC inhibitors, and TIGIT blockade-as well as immunotherapies like PD-1 inhibition and adoptive CD8+ T cell therapy. scRNA-seq has transformed insights into osteosarcoma by exposing key cellular dynamics and potential therapeutic targets. While technical challenges remain, it paves the way for more personalized and effective treatment strategies. However, the current findings are subject to limitations, including technical biases in single-cell protocols and the exclusion of non-English literature, which may affect generalizability.

The Lifetech KONAR-MF ventricular septal defect occluder (MFO) is increasingly used for transcatheter perimembranous ventricular septal defect (pmVSD) closure. We aim to collect real-world data on patient outcomes and MFO performance in pmVSD cases. This was a nonrandomized, retrospective, multicenter, postmarketing clinical follow-up study of pmVSD patients implanted with the MFO device between 2018 and 2023. The primary endpoint was 6-month composite clinical success, defined as technical success (successful implantation and device retention at the end of the procedure), closure success (trivial or no residual shunt), absence of serious adverse events at 30 days, and no device removal or reintervention. Secondary endpoints consisted of technical success, procedural success (technical success and less than moderate residual shunt), closure success (clinically insignificant or absent residual shunt), and safety. Our cohort comprised 333 patients (51.4% male, 10.2% adults), with a median age of 4.6 [IQR, 2-10] years and a median weight of 17 [IQR, 11-32] kg. Baseline defect characteristics consisted of a left ventricular defect diameter of 8 [IQR, 7-10] mm, with 13.8% of patients having aortic valve regurgitation, 9.9% having an indirect Gerbode shunt, 10.5% having mild aortic valve prolapse, and 32.2% having subaortic rim deficiency. Closure via a retrograde approach was performed in 183 patients (55%). Technical success at procedure completion was 97.6%, and procedural success was 94.6%. Closure success at 6 months was 97.1%, while composite clinical success was 90.1%. Freedom from serious adverse events was 95.2% at 30 days. Freedom from device-related events was 96.8% at 6 months and 93.8% at 24 months. Risk factors for 6-month composite clinical failure were aortic valve prolapse (OR, 4.85; 95%CI, 2.07-11.39) and right ventricular defect diameter (OR, 1.41; 95%CI, 1.01-1.98). Transcatheter closure of pmVSD with the MFO device demonstrated feasibility, effectiveness, and safety in real-world settings.

The study examines the preparedness of emergency department (ED) nurses in Lebanon to manage psychiatric emergencies, providing important insights into a domain that remains underexplored in developing countries. The findings of this study are consistent across several dimensions. In fact, nearly half of the ED nurses reported fear when caring for patients with mental illness; only a minority acknowledged that such patients rarely pose a risk to the public, and many described infrastructural and training deficits that left them unable to act independently. Together, these results point not only to individual unease but also to a systemic failure to adequately address psychiatric emergencies within the ED. Fear is not a minor issue in acute care; it shapes how emergency nurses interact with patients, often determining whether de-escalation or coercion predominates. When people with mental illness are assumed to be dangerous by default, despite evidence that they are more often victims than aggressors, the result is premature sedation, unnecessary restraint, and stigma.[1] This fear, fueled by concerns about workplace violence, uncertainty, and lack of training, also affects nurses’ well-being, leading to distress, reduced engagement, and even burnout.[2] Rather than viewing it only as an individual emotional response, fear should be understood as a signal of systemic unpreparedness, such as the absence of clear protocols, adequate support, and structured mental health training that leaves nurses feeling unsafe and unable to act independently. Addressing this requires proper training and education, supportive environments, and institutional commitment to integrating psychiatric care into the ED. Moreover, a large proportion of nurses reported difficulty recognizing early signs of agitation and felt unable to act independently, a deficit that reflects how psychiatric preparedness remains low in emergency medicine. While resuscitation and trauma protocols are standardized worldwide, the management of psychiatric crises is too often left to improvisation, particularly in resource-limited environments. This gap fosters both hesitation and reliance on medication, with discomfort around psychotropics reinforcing the sense of uncertainty. In the absence of structured protocols and training, nurses fluctuate between avoidance and overmedication, leading to responses that undermine patient safety and lead to the marginalization of mental health patients in the ED. Equally important is the environment in which care is delivered. Nurses in this study highlighted the absence of dedicated spaces and the lack of adequate support for patients with behavioral symptoms. Such deficits are not minor but causal. For instance, a patient in acute distress placed in a crowded corridor under bright lights and constant noise is far more likely to escalate.[3] Even well-trained staff will be limited if the physical setting itself fuels agitation. Just as intensive care units and negative pressure rooms are considered essential in EDs, so too should safe, calming spaces for psychiatric emergencies be available. Therefore, infrastructure is not an optional complement to training; it is a core component of effective care. The risk in interpreting the results of this study is to place the problem solely on the individual nurse, by attributing it to insufficient knowledge, low confidence, or limited autonomy. This overlooks the systemic deficiencies, since no degree of individual competence can compensate for the absence of structured support. What is required are standardized protocols, comparable to those that revolutionized the management of cardiac arrest and trauma. Psychiatry deserves an equivalent framework to ensure care that is organized, reliable, and safe. Such protocols might include the use of validated assessment tools for psychiatric emergencies, comprehensive training in both pharmacologic and nonpharmacologic interventions, environmental adaptations, and rapid access to psychiatric consultation.[4] Moreover, the ethical dimension cannot be ignored. For many individuals, the ED encounter is the first or only contact with the mental health system.[5] If this encounter is dominated by fear, coercion, and improvisation, it deepens stigma and deters future help-seeking. However, if ED nurses are equipped to approach psychiatric emergencies with competence and calm, the encounter can foster trust and promote continuity of care. This study should thus be read as a description of current conditions. It exposes a gap that still persists internationally and is even more pronounced in countries such as Lebanon. This is despite the fact that psychiatric emergencies account for up to 25% of consultations in the ED.[6] Yet policies regarding education, ED infrastructure, and care organization remain very underdeveloped in Lebanon. This highlights the urgent need for national measures, including standardized training, mandatory infrastructural requirements, and validated protocols. Only then can the burden shift from individual clinicians improvising under stress to systems designed for predictable, ethical, and effective care. Until that transformation occurs, fear will remain the default companion of emergency nurses, and patients with mental illness will continue to face a system unprepared to receive them with the dignity they deserve. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.