A comparison of idiopathic scoliosis surgery between teenage years and adulthood.

PURPOSE: Idiopathic scoliosis is an evolutive deformity during patient's life. In case of moderate deformity in a well aligned adolescent, it's a big concern to decide when to do the surgery. Objective of this work was to evaluate and compare clinical, radiological and surgical data of patients with adolescent idiopathic scoliosis operated in childhood (before 20 years) and those operated adults (after 35 years). METHODS: In this retrospective multicenter study, inclusion period extended from 2008 to 2018. Two groups were defined, those operated on before the age of 20 (YAIS), and those operated on after 35 years (OAIS). Demographic, radiographic and surgical data were collected. At follow-up, radiographic data and functional outcomes (VAS, SRS, SF12, Oswestry) were analyzed. Minimum FU was 5 years for young and 2 years for old patients. RESULTS: YAIS group included 364 patients, and OAIS group, 131 patients. In both groups, deformity was important (mean Cobb 63°). Vertebral osteotomies were significantly more frequent, fusions and length of stays were longer for old than young patients. Main Cobb correction was better in young than old (37 ± 10° vs 2 ± 13°, p = 0.03). Functional outcomes were better for young, operated patients than for operated groups after 35 years (SF12 PCS 50 ± 7 vs 39 ± 6, p = 0.02). The same trends were observed at longer follow-up. CONCLUSION: Surgery for idiopathic scoliosis seems to offer a better quality of life and deformity correction when it is performed at adolescence. After 35 years, surgery remains an acceptable therapeutic option, despite higher complication rate.

Needs Assessment for Pharmacy Program Creation Designed to Serve Minority Francophone Populations in Canada.

OBJECTIVES: Current literature provides little insight into the need for French-language pharmaceutical services in Francophone minority settings in Canada. This study aims to understand the pharmaceutical care and services offered in French in Canada. It also aims to conduct a needs assessment in the context of curriculum development, by validating whether pharmaceutical needs are being met in Francophone minority settings in Canada. METHODS: An online survey was sent to community members and health care professionals. Respondents were asked to identify the perceived importance of pharmaceutical needs and the degree to which they perceive these to be fulfilled in French and English in their communities. RESULTS: A total of 113 community members and 109 health care professionals completed the survey. Most respondents were from Ontario (64.84%), Quebec (10.50%), or Atlantic Provinces (10.05%). In total, > 95% of survey respondents identified that pharmaceutical needs assessed were of very high importance. The rate of pharmaceutical need fulfillment was lower in French than English across all pharmaceutical needs assessed. The greatest difference in rate of pharmaceutical need fulfillment was seen with "Having safe access to required medication". The perception of pharmaceutical needs being met was congruent between community members and health care professionals. CONCLUSION: These results confirm a lack of pharmaceutical needs being met in French in Canadian Francophone minority communities. There is a lack of French-language services that limit the ability to receive care in one's own language. Pharmacy education in French may be an effective approach to improve pharmaceutical care services received in French in Francophone minority communities.

Minimally invasive femoral head fracture fixation using three-dimensional navigation: a technical note.

Femoral head fractures are rare traumatic injuries that are usually associated with hip dislocations. Open reduction and internal fixation are performed when indicated, but can be associated with a higher risk of avascular necrosis. We report the case of a 24-year-old patient with a Pipkin type II fracture dislocation of the femoral head fixed via a minimally invasive three-dimensional navigated internal fixation technique. This technique minimizes deep soft tissue dissection to the hip capsule and associated vascularity and allows for accurate implant positioning.Level of evidence: Therapeutic case report Level IV.

Update on post-traumatic periprosthetic acetabular fractures.

Aims: Post-traumatic periprosthetic acetabular fractures are rare but serious. Few studies carried out on small cohorts have reported them in the literature. The aim of this work is to describe the specific characteristics of post-traumatic periprosthetic acetabular fractures, and the outcome of their surgical treatment in terms of function and complications. Methods: Patients with this type of fracture were identified retrospectively over a period of six years (January 2016 to December 2021). The following data were collected: demographic characteristics, date of insertion of the prosthesis, details of the intervention, date of the trauma, characteristics of the fracture, and type of treatment. Functional results were assessed with the Harris Hip Score (HHS). Data concerning complications of treatment were collected. Results: Our series included 20 patients, with a mean age of 77 years (46 to 90). All the patients had at least one comorbid condition. Radiographs showed that 75% of the fractures were pure transverse fractures, and a transverse component was present in 90% of patients. All our patients underwent surgical treatment: open reduction and internal fixation, revision of the acetabular component, or both. Mean follow-up was 24 months, and HHS at last follow-up was 75.5 (42 to 95). The principal complications observed were dislocations of the prosthesis (30%) and infections (20%). A need for revision surgery was noted in 30% of patients. No dislocation occurred in patients undergoing osteosynthesis with acetabular reconstruction. We did not note either mechanical loosening of the acetabular component nor thromboembolic complications. In all, 30% of patients presented acute anemia requiring transfusion, and one death was reported. Conclusion: Post-traumatic periprosthetic acetabular fractures frequently have a transverse component that can destabilize the acetabular implant. The frequency of complications, principally dislocations, led to a high rate of revision surgery. Improvements in preoperative planning should make it possible to codify management to reduce this high rate of complications. The best results were obtained when the surgical strategy combined osteosynthesis with acetabular reconstruction.

Development and Refinement of a Matrix Competency Framework, with Associated Entrustable Professional Activities, to Support Initial Pharmacy Education in Kuwait.

The development of competency frameworks serves as the foundation for the development of competency-based education. It is vital to develop a country-specific framework to address the specific needs of the local population for pharmacy services. This study aimed to describe the development process of a competency framework for undergraduate pharmacy education in Kuwait with a unique matrix structure. The process started with the development of guiding principles for curriculum revision and implementation, as well as the identification of global educational outcomes. This process was followed by: (A) a needs assessment with key stakeholders; (B) development of the initial competency framework; and (C) refinement of the framework. Qualitative data were thematically analyzed to identify the main competency domains that students need to perform the identified entrustable professional activities (EPAs). Five population needs were identified by the needs assessment, with 17 EPAs suggested to fulfill those needs. In addition, 11 competency domains were identified. The initial competency framework was created as a 3 × 8 matrix, with 3 professional and 8 transversal competency domains. Refinement of the framework resulted in the removal of redundancies and the development of a global behavior competency profile. The development of a matrix competency framework and associated EPAs for Kuwait serves as a foundation for preparing pharmacists to fulfill local population needs and expanding the scope of practice in the country.

Computer Navigation-Assisted Resection of Heterotopic Ossification Around the Hip: A Technical Note.

Heterotopic ossification is a rare but debilitating situation. It occurs in patients who have undergone paralysis and/or immobilization. Hip osteoma is one of the most frequent locations and is associated with a significant functional handicap. Its treatment is based on surgical resection, which is a risky surgery that is not devoid of complications such as infections, hematoma, and recurrence. We describe in this paper a new surgical technique that adds to the classic hip osteoma resection: guidance with a navigation system coupled to a 3D imaging tool. We performed this technique on two patients (three hips, one bilateral case). We think that this technique makes the surgery safer with fewer complications.

New Insights into Alpine Cortinariaceae (Basidiomycota): Three New Species, Two Type Revisions, and a New Record for the Alpine Zone.

Thirty-one alpine species of Cortinarius (Agaricales, Cortinariaceae) were described from the alpine zone of the Alps during the second half of the XX century, by the Swiss mycologist Jules Favre, and by the French mycologists Denise Lamoure and Marcel Bon. Notoriously difficult to identify by macro- and microscopical characters, most of these species, which belong to subgen. Telamonia, have been thoroughly revised in global publications based on type sequencing. Recent surveys in the alpine areas of France (Savoie) and Italy (Lombardy), as well as the sequencing of D. Lamoure's collections, identified three new species that are here described and illustrated: C. dryadophilus in sect. Castanei, C. infidus in sect. Verni, and C. saniosopygmaeus in sect. Saniosi. The holotypes of C. caesionigrellus Lamoure and C. paleifer var. brachyspermus Lamoure could be sequenced. A recent collection of the former is described and illustrated here for the first time, and based on available data, the latter name is recombined as Cortinarius flexipes var. brachyspermus comb. nov. Lastly, C. argenteolilacinus var. dovrensis is reported from the alpine zone for the first time and a new combination, Thaxterogaster dovrensis comb. & stat. nov. is introduced in the present work.

The Saint-Joseph Acetabular score: a reproducible and accurate prediction of the outcome of open reduction and internal fixation of acetabular fractures.

PURPOSE: Acetabular fractures are associated to an increased risk of subsequent hip osteoarthritis. The only available score for post-operative reduction assessment in acetabular fractures (Matta's score) is x-ray based. CT-scan was shown superior to X-rays in post-operative reduction assessment. We aim to describe a CT-scan-based post-operative reduction score in acetabular fractures and evaluate its accuracy and reproducibility. METHODS: This is a retrospective study that includes 138 patients who underwent surgery for an acetabular fracture in our tertiary referral centre with a mean follow-up of 104.39±42.2 months. The post-operative CT-scan was reviewed and residual displacement (maximum gap and step) measured by three independent observers. The association between the occurrence of THA and the CT-scan measurements was evaluated. This led to a new prognostic score. The interobserver reliability and accuracy of this score were calculated. RESULTS: Interobserver reproducibility for the residual maximal gap was 0.82 (95% CI [0.70-0.89]) and 0.61 (95% CI [0.52-0.70]) for the residual maximal step displacement measurements. We created a score from a logistic regression model, attributing 1 point for every 1 mm of residual maximal step displacement and 1 point for every 2 mm of residual maximal gap displacement. The interobserver reproducibility of this score was 0.78 (95% CI [0.71-0.84]), and its AUC was 0.79 (95% CI [0.69-0.88]). CONCLUSION: This is the first CT-scan-based score for the assessment of residual displacement of a surgically treated acetabular fracture. It shows good interobserver reproducibility and accuracy in predicting the risk for secondary THA. It should be regularly used per-operatively (if per-operative 3D imaging is available) and post-operatively to predict the prognosis.

Transforming pharmacy practice in Kuwait.

In the last few decades, pharmacy services have expanded to fulfil the need for more complex health needs from population worldwide. Moving from 'product-centred' to a 'patient-centred' profession, pharmacists are required to master more professional competencies to deliver high quality pharmaceutical services to their patients and community. In Kuwait pharmacy practice has long been identified as a sector yet to be developed. With the announcement of the 'new Kuwait vision 2035' planning for pharmacy practice and workforce development and improvement has become imperative. Academic, professional, and regulatory bodies have collaborated to shape the future of pharmacy profession in the country. The approach described here reflects the initial steps for transforming and advancing the pharmacy profession in Kuwait.

Dissecting the polygenic basis of atherosclerosis via disease-associated cell state signatures.

Coronary artery disease (CAD) is a pandemic disease where up to half of the risk is explained by genetic factors. Advanced insights into the genetic basis of CAD require deeper understanding of the contributions of different cell types, molecular pathways, and genes to disease heritability. Here, we investigate the biological diversity of atherosclerosis-associated cell states and interrogate their contribution to the genetic risk of CAD by using single-cell and bulk RNA sequencing (RNA-seq) of mouse and human lesions. We identified 12 disease-associated cell states that we characterized further by gene set functional profiling, ligand-receptor prediction, and transcription factor inference. Importantly, Vcam1+ smooth muscle cell state genes contributed most to SNP-based heritability of CAD. In line with this, genetic variants near smooth muscle cell state genes and regulatory elements explained the largest fraction of CAD-risk variance between individuals. Using this information for variant prioritization, we derived a hybrid polygenic risk score (PRS) that demonstrated improved performance over a classical PRS. Our results provide insights into the biological mechanisms associated with CAD risk, which could make a promising contribution to precision medicine and tailored therapeutic interventions in the future.

Transforming pharmaceutical education: A needs-based global analysis for policy development.

Background: A needs-based approach is desirable for the transformation of pharmaceutical education, and to link pharmaceutical education with the health needs of populations and national priorities. There are varying levels of data in the literature on the status of pharmaceutical education in all six World Health Organization (WHO) regions, especially in the context of needs identification and evidence-based policy interventions. The framework for this study was the FIP Development Goals. Objectives: The aim of the study was to develop evidence-based policies through a needs-based approach for pharmaceutical education transformation nationally, regionally and globally by addressing the following objectives: 1. Identify global and regional needs in pharmaceutical education, through a regional SWOT analysis and prioritization of FIP development goals; 2. Develop valid and credible regional roadmaps for pharmaceutical education advancement according to the identified prioritized goals and 3. Develop a global call to action as a policy intervention for advancing pharmaceutical education. Methods: This study was conducted between 2020 and 2021 using a mixed methods approach. Surveys of higher education institutions and a series of qualitative interviews were conducted with national professional leadership organizations, with further regional workshops having 284 participants recruited from the International Pharmaceutical Federation (FIP) membership base, spanning all six WHO regions. Results: Eleven out of 21 FIP DGs were identified as priorities for regional roadmaps and FIP DG 1 (Academic capacity) was identified as a priority in four regions. All regions had distinctive results with an area of commonality between them. There were common weaknesses in the adoption of competency-based education and inter-professional education. Conclusions: It is critical for every country and region to develop needs- and evidence-based policies for the transformation of pharmaceutical education, for which FIP DGs provide a systematic framework.

Is Minimally Invasive Bipolar Technique a Better Alternative to Long Fusion for Adult Neuromuscular Scoliosis?

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To report the results for an alternative technique based on minimally invasive fusion-less surgery. This approach is original in that it corrects deformities by proximal and distal fixation, with reliable pelvic fixation through the use of iliosacral screws on osteoporotic bones. METHODS: Adult cerebral palsy patients requiring spinal correction surgery were included prospectively between 2015 and 2019. The technique involved the use of a double-rod construct anchored proximally by four clawed hooks and distally by iliosacral screws, in a minimally invasive approach. Cobb angle and pelvic obliquity were measured before and after initial surgery and at final follow-up. Complications and functional results were reviewed. This group (P) was compared with a second group (R) of patients who underwent surgery between 2005 and 2015, for whom data were collected retrospectively. RESULTS: Thirty-one patients were included in group P, and 15 in group R. The two groups were comparable for demographic data and deformity. At most recent follow-up (3 years for group P [2-6] and 5 years for group R [2-16]), neither correction nor surgical complications differed between the two groups. However, group P had 50% less blood loss and a lower medical complication rate than group R. CONCLUSIONS: Our results confirm the effectiveness of this minimally invasive technique for neuromuscular scoliosis in adults. The results were similar to those obtained with the usual techniques, but with fewer medical complications. Confirmation of these results is now required for a longer follow-up period.

A MOPEVAC multivalent vaccine induces sterile protection against New World arenaviruses in non-human primates.

Pathogenic New World arenaviruses (NWAs) cause haemorrhagic fevers and can have high mortality rates, as shown in outbreaks in South America. Neutralizing antibodies (Abs) are critical for protection from NWAs. Having shown that the MOPEVAC vaccine, based on a hyperattenuated arenavirus, induces neutralizing Abs against Lassa fever, we hypothesized that expression of NWA glycoproteins in this platform might protect against NWAs. Cynomolgus monkeys immunized with MOPEVACMAC, targeting Machupo virus, prevented the lethality of this virus and induced partially NWA cross-reactive neutralizing Abs. We then developed the pentavalent MOPEVACNEW vaccine, expressing glycoproteins from all pathogenic South American NWAs. Immunization of cynomolgus monkeys with MOPEVACNEW induced neutralizing Abs against five NWAs, strong innate followed by adaptive immune responses as detected by transcriptomics and provided sterile protection against Machupo virus and the genetically distant Guanarito virus. MOPEVACNEW may thus be efficient to protect against existing and potentially emerging NWAs.

Unravelling the French National Fungal Database: Geography, Temporality, Taxonomy and Ecology of the Recorded Diversity.

Large datasets are highly valuable resources to investigate multi-scale patterns of organisms, and lay foundations for citizen science-based conservation strategies. Here, we used 1,043,262 records from 1708 to 2021 to explore the geography, taxonomy, ecology and distribution patterns of 11,556 fungal taxa in metropolitan France. Our analysis reveals a four-phase pattern of temporal recording, with a main contribution of post-1977 observations in relation with the structuration of associative mycology. The dataset shows an uneven geography of fungal recording. Four clusters of high-intensity sampling scattered across France contrast with poorly documented areas, including the Mediterranean. Basidiomycota and Agaricales highly dominate the dataset, accounting for 88.8 and 50.4% of records, respectively. The dataset is composed of many rare taxa, with 61.2% of them showing fewer than 100 records, and 20.5% recorded only once. The analysis of metadata brings to light a preponderance of the mycorrhizal guild (44.6%), followed by litter saprotrophs (31.6%) and wood saprotrophs (18.1%). Highly documented forests (76.3% of records) contrast with poorly investigated artificial (6.43%) and open habitats (10.1%). This work provides the first comprehensive overview of fungal diversity in France and identifies the Mediterranean area and open habitats as priorities to integrate into a global strategy for fungal conservation in France.

Biogeographic history of a large clade of ectomycorrhizal fungi, the Russulaceae, in the Neotropics and adjacent regions.

The biogeography of neotropical fungi remains poorly understood. Here, we reconstruct the origins and diversification of neotropical lineages in one of the largest clades of ectomycorrhizal fungi in the globally widespread family Russulaceae. We inferred a supertree of 3285 operational taxonomic units, representing worldwide internal transcribed spacer sequences. We reconstructed biogeographic history and diversification and identified lineages in the Neotropics and adjacent Patagonia. The ectomycorrhizal Russulaceae have a tropical African origin. The oldest lineages in tropical South America, most with African sister groups, date to the mid-Eocene, possibly coinciding with a boreotropical migration corridor. There were several transatlantic dispersal events from Africa more recently. Andean and Central American lineages mostly have north-temperate origins and are associated with North Andean uplift and the general north-south biotic interchange across the Panama isthmus, respectively. Patagonian lineages have Australasian affinities. Diversification rates in tropical South America and other tropical areas are lower than in temperate areas. Neotropical Russulaceae have multiple biogeographic origins since the mid-Eocene involving dispersal and co-migration. Discontinuous distributions of host plants may explain low diversification rates of tropical lowland ectomycorrhizal fungi. Deeply diverging neotropical fungal lineages need to be better documented.

Pluteus insidiosus Complex, Four New Species Described and Pluteus reisneri Resurrected.

We studied the taxonomy of Pluteus insidiosus and similar species using morphological and molecular (nrITS, TEF1-α) data, including a detailed study of the type collection of P. insidiosus. Based on our results, we recognize five species in this group: P. insidiosus sensu stricto and four other taxa: P. assimilatus; P. farensis; P. flavostipitatus; and P. pseudoinsidiosus; described here as new. All these taxa are distinct from each other based on molecular data, but some of them are semi-cryptic based on morphology and co-occur in the Palaearctic region. An additional molecular lineage, phylogenetically separates from the P. insidiosus complex, but with many morphological similarities, was recognized in the molecular phylogenies. Based on the revision of available type collections, the name Pluteus reisneri Velen., was adopted for this Clade. Pluteus reisneri was validly published in 1921, but it has barely been used since its original description. A modern epitype, with molecular data, was selected for P. reisneri.

Amanita Section Phalloideae Species in the Mediterranean Basin: Destroying Angels Reviewed.

In Europe, amatoxin-containing mushrooms are responsible for most of the deadly poisonings caused by macrofungi. The present work presents a multidisciplinary revision of the European species of Amanita sect. Phalloideae based on morphology, phylogeny, epidemiology, and biochemistry of amatoxins and phallotoxins. Five distinct species of this section have been identified in Europe to date: A. phalloides, A. virosa, A. verna, the recently introduced North American species A. amerivirosa, and A. vidua sp. nov., which is a new name proposed for the KOH-negative Mediterranean species previously described as A. verna or A. decipiens by various authors. Epitypes or neotypes are selected for species lacking suitable reference collections, namely A. verna and A. virosa. Three additional taxa, Amanita decipiens, A. porrinensis, and A. virosa var. levipes are here considered later heterotypic synonyms of A. verna, A. phalloides, and A. amerivirosa, respectively.

Development and validation of a new method for visual acuity assesment on tablet in pediatric population: eMOVA test.

BACKGROUND: Amblyopia is a major public health concern. Its screening and management require reliable methods of visual acuity assessment. New technologies offer nowadays many tests available on different app stores for smartphone or tablet but most of them often lack of scientific validation for a medical use. The aim of our study was to attempt validating a tablet-based near visual acuity test adapted to the pediatric population: the eMOVA test (electronic Measurement Of Visual Acuity) by comparing visual acuity measured with more conventional test. METHODS: A cohort of 100 children aged 3 to 8 attending the ophthalmic-pediatric for eye examination between September 2016 and June 2017 were included in the study. Near visual acuity was assessed on participants using both the eMOVA test and a Standard test (Rossano-Weiss test). Duration of each test, its comprehension, its acceptability and the attention of the child during the test was also investigated. RESULTS: The eMOVA test overestimated near visual acuity by 0.06 logMAR. This difference, statistically significant, was not clinically relevant. The duration of the eMOVA test was longer than the reference test, but less discomfort and preferred by children and their parents compared to standard tests. CONCLUSION: The eMOVA test appears as a reliable test to assess near visual acuity in children. By its portability and efficiency, this application proved to be a relevant tool to be used for children eye examination in daily routine at the hospital.

Role of 68Ga-DOTATOC PET/CT in Insulinoma According to 3 Different Contexts: A Retrospective Study.

OBJECTIVE: The aim of this study was to assess the performance of 68Ga-DOTATOC PET/CT in the detection and extension of insulinomas according to 3 different contexts: sporadic benign, sporadic metastatic, and multiple endocrine neoplasia type 1 (MEN1). PATIENTS AND METHODS: The data of 71 adult patients who underwent 68Ga-DOTATOC PET/CT for suspected or confirmed sporadic insulinoma, suspicion of insulinoma in the context of MEN1, follow-up of metastatic insulinoma, or suspicion of recurrence of insulinoma were retrospectively analyzed. Pathological examination or strong clinical and biological findings were used as standards of truth. RESULTS: For the assessment of a confirmed sporadic insulinoma in 17 patients, the sensitivity of SR-PET was 75%, including 2 patients for whom metastatic lesions had been revealed by SR-PET. For 35 patients with a suspicion of insulinoma, the sensitivity was 39%. In 10 patients followed up for metastatic insulinoma, the sensitivity was 100%. For 5 patients with a history of MEN1, interpretation of SR-PET was difficult, as 3 of them presented with multiple pancreatic uptake foci. The global sensitivity of SR-PET in all insulinomas excluding those with a MEN1 story was 64% (100% for metastatic insulinomas, 62% for benign insulinomas), with a specificity of 89%. CONCLUSIONS: 68Ga-DOTATOC PET/CT is a useful examination tool for the assessment of insulinomas in selected contexts, with very high performance for the detection and extension workup of metastatic insulinomas and high specificity for the detection of sporadic benign insulinomas. The examination should be completed with GLP-1 receptor PET when it is negative or in a MEN1 context.