Background: Port-a-catheter (PAC) placement is a common procedure in oncology that, despite local anaesthesia, can induce patient discomfort, procedural pain, and anxiety. Virtual reality hypnosis (VRH), combining immersive virtual reality with clinical hypnosis, has been proposed as a non-pharmacological adjunct to reduce peri-procedural distress. Objectives: This pilot study aimed to explore the suitability of VRH during PAC placement and its potential effects on pain, anxiety, and VRH-related experiences, while investigating psychological variables associated with VRH engagement. Methods: In this single-arm interventional monocentric prospective pilot study, twenty oncology patients undergoing first-time elective PAC placement received a VRH intervention delivered via a medical-grade head-mounted display throughout the procedure. Pain, anxiety, and VRH-related dimensions-including absorption, dissociation, automaticity, arousal, and sense of presence-were assessed pre- and post-procedure using self-reported numerical rating scales and questionnaires. Non-parametric Wilcoxon tests evaluated pre-post changes, and correlational analyses (Pearson's and Spearman's when necessary) explored associations between variables. Results: VRH was well tolerated by most participants, although three patients required additional pharmacological support, and four could not complete the session due to intolerance or technical issues. Anxiety scores decreased significantly following VRH, whereas pain showed a non-significant trend toward reduction. Post-procedural absorption and dissociation were positively associated with presence, and higher absorption traits were linked to greater immersive engagement and prior VR/hypnosis experience. Cybersickness was negatively associated with absorption. Older age was correlated with lower post-procedural pain, and females reported higher state anxiety. Conclusions: In this pilot, VRH was feasible, well tolerated, and associated with a significant exploratory reduction in procedural state anxiety. Given the single-arm design, these findings constitute directional evidence warranting controlled trial evaluation rather than proof of efficacy. These preliminary results support the rationale for randomised controlled trials to evaluate VRH efficacy, underlying mechanisms, and potential role as a non-pharmacological adjunct in oncology perioperative care.
Introduction: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the two most commonly performed metabolic and bariatric surgery (MBS) procedures worldwide, yet routine clinical practice long-term comparative data remain limited, particularly regarding gastroesophageal reflux disease (GERD), postoperative morbidity, and nutritional deficiencies. Methods We performed a retrospective observational cohort study including 860 consecutive adults undergoing primary laparoscopic SG (n = 502) or RYGB (n = 358) between 2014 and 2020 at a certified bariatric center. Outcomes were assessed at baseline and 3, 6, 12, 24, 36, 48, and 60 months. Longitudinal BMI, %EWL, and %TWL were analyzed using generalized linear mixed models; repeated binary outcomes were analyzed using generalized estimating equations. Results RYGB achieved greater long-term weight loss and lower BMI throughout follow-up (60 months: %EWL 84.0 ± 30.0 vs. 70.2 ± 26.9; %TWL 30.1 ± 10.3 vs. 26.8 ± 9.4). Clinical GERD was more prevalent after SG (60 months: 49.3% vs 29.9%); among individuals with baseline GERD, RYGB achieved higher GERD remission rates at 12 months (70.0% vs 21.9%). Major complications (Clavien–Dindo ≥ III) and readmissions were more frequent after RYGB (7.3% vs 1.8%; and 14.5% vs 6.7% within 12 months). SG was associated with higher rates of folate and vitamin D deficiency during the first two years. Conclusion At five years, RYGB provides superior weight-loss durability and more effective GERD control compared with SG, with an associated increase in major morbidity and readmission rates. SG remains an effective procedure but requires close long-term monitoring for reflux progression and specific micronutrient deficiencies.
Background:Data on fertility after breast cancer (BC) relative to the general population are lacking. This study aimed to compare the time-to-pregnancy between women with and without prior BC seeking to become pregnant. Methods:We conducted a prospective exposed-unexposed cohort study between March 13, 2018 and June 27, 2019, recruiting participants via the collaborative network Seintinelles. Women aged 18-43 years with a history of localized BC without relapse (exposed) were compared to women without BC (unexposed). Follow-up data were collected every six months over three years. The primary endpoint, time-to-pregnancy, was analyzed using Kaplan-Meier survival analysis with inverse probability weighting. Censoring was performed if women stopped trying to conceive for personal reasons, were lost to follow-up before conception, or completed the study without achieving pregnancy or using assisted reproductive technologies (ART). Findings:Among 4351 women enrolled, 642 sought pregnancy during the study period (76 exposed, 566 unexposed). Among them, 50 exposed (65.8%) and 402 weighted unexposed women (weighted percentage 71.0%) became pregnant at least once. Median time-to-pregnancy was 5.0 months, 95% CI [3.0-7.0] for exposed and 3.0 months, 95% CI [2.0-5.0] for unexposed women (difference in median time-to-pregnancy: 2.0 months, 95% CI [-2.5; 5]). Two years after starting to seek pregnancy, 74.9% of weighted unexposed women and 74.1% of exposed women obtained a pregnancy. Overall, 15 exposed women (19.8%) used either ART methods (n = 7, 9.2%) or cryopreserved material (n = 8, 10.5%) and 25 unexposed women (4.4%) used ART.The median time-to-pregnancy was 3.0 months for both exposed and unexposed women (95% CI [2.0; 5.0] and [2.0; 4.0] respectively) (difference in median time-to-pregnancy: -0.0 months [-2.0; 3.0]) in women who sought pregnancy spontaneously, and 14.0 months for exposed (95% CI [6.0-27.0]) and 17.6 months for unexposed women (95% CI [17.6-30.0]) in women seeking pregnancy with ART. Interpretation:In this study from a French collaborative research network, we found no strong evidence of a largely reduced time-to-pregnancy in exposed women seeking to become pregnant compared with unexposed women. Further research on fertility outcomes in the broader population of BC survivors is warranted. Funding:The FEERIC study was funded by Institut National du Cancer (InCA), InCA-SHS, grant no. 2016-124, and is part of the Young Breast Cancer Project, funded by Monoprix.
Hematology patients require central venous catheters for cancer treatment and nutrition, which increases their risk of intravascular device-associated bacteremia. In the absence of recent data, we investigated intravascular device-associated bacteremia in this specific context. A three-month surveillance was conducted annually in 27 hematology wards, using a protocol derived from the HAI-Net ICU ECDC protocol (2020–2024). We analyzed the characteristics of infected patients, the sources and microorganisms of healthcare-associated bacteremias, and intravascular device-associated bacteremias (including catheter type: central venous catheter (CVC), implantable venous access device (IVAD), peripherally inserted central catheter (PICC), midline catheter (MID), and peripheral venous catheter (PVC)), the time between catheter insertion and infection onset, and bacteremia incidence rates per 1,000 patient-days. Over the five-year period, 1,835 patients experienced healthcare-associated bacteremia. No significant changes were observed in patient characteristics over the five-year period. The two primary sources of bacteremias were intravascular devices (n = 682; 37.2
HIV/AIDS infection is a significant public health issue, particularly among vulnerable populations like pregnant women. Despite progress in prevention, diagnosis, early management and treatment, there is still a need to strengthen efforts toward eliminating mother-to-child transmission (eMTCT). This study aimed to update the seroprevalence of HIV in pregnant women attending antenatal consultations in Senegal. Blood samples from 1,227 participants were collected from March to July 2021. The plasma samples were processed within 2 h after collection and were frozen at − 80 °C or stored at − 20 °C on site until processing. Serological tests were carried out using national diagnostic algorithms. Rapid diagnostic tests (RDTs) were used at all screening stages, starting with the DetermineTM HIV-1/2 Abott test. Positive samples were confirmed with the SD bioline HIV-1/2 3.0 test and Multisure® MP diagnostics typing test, following the manufacturer’s instructions. Statistical tests were conducted using JMP® Pro Version 15.0.0 software. The HIV prevalence found was 1.05
