Background The intimal flap at the distal aortic anastomosis after standard aortic dissection repair creates distal anastomotic new entry, leading to false lumen (FL) pressurization and true lumen (TL) collapse and resulting in increased mortality, malperfusion, aortic growth, and reinterventions. The Ascyrus Medical Dissection Stent (AMDS; Ascyrus Medical, Boca Raton, FL) is a hybrid prosthesis that seals and depressurizes the FL at the distal anastomosis while expanding and pressurizing the TL. Methods The Dissected Aorta Repair Through Stent Implantation trial is a prospective, nonrandomized, international type A dissection trial where patients with acute DeBakey I dissections were enrolled between March 2017 and January 2019. Forty-seven patients were enrolled (median age, 62.5; 67.4% men) with a median follow-up of 631 days. Results All patients underwent emergent surgical repair with successful AMDS implantation. One patient was excluded because of use in iatrogenic dissection. Overall mortality at 30 days and 1 year was 13.0% (6/46) and 19.6% (9/46), whereas new strokes occurred in 6.5% (3/46). Over 95% of vessel malperfusions resolved because of AMDS-induced TL expansion, including 3 patients with preoperative paralysis. Positive remodeling of the aortic arch occurred in 100% of cases with complete obliteration or thrombosis of the FL in 74%. In the proximal descending thoracic aorta positive remodeling occurred in 77% and complete obliteration or FL thrombosis in 53% of cases. Conclusions AMDS facilitates single-stage management of malperfusion and induces positive remodeling of the aortic arch through effective sealing of the distal anastomotic FL, depressurization of the FL with expansion, and pressurization of the TL. Importantly the use of AMDS is safe and reproducible.
The French West Indies, particularly Martinique and Guadeloupe, are grappling with high rates of violence, particularly among youth, which might be deeply rooted in historical trauma from slavery. A significant portion of the population has experienced abuse and violence in early life, prompting researchers to explore the connection with attachment theory. The transatlantic slave trade tore families apart and disrupted the secure attachments that are essential for healthy emotional development. Children raised without stable caregivers often develop insecure attachment styles, which may have been passed down through generations. These unresolved attachment wounds often manifest as violence or self-destructive behavior. Without nurturing figures, both parental and societal, individuals may feel unworthy and angry. France, seen as the “abusive stepmother,” failed to provide meaningful support after emancipation to replace lost parental figures. Consequently, the population oscillates between a desire for recognition and a fear of further rejection. This emotional paradox mirrors the turbulence of adolescence, where independence is both craved and feared.
Viable but non-culturable (VBNC) cells represent a reversible, metabolically active state that promotes the survival of bacteria under stressful conditions and their persistence in healthcare facilities and food industry. We conducted a systematic review following PRISMA 2020 guidelines to identify in vitro methodologies for inducing and resuscitating VBNC Enterobacteriaceae and Pseudomonas aeruginosa, and to determine key influencing factors. Eligible studies reported in vitro resuscitation of these species. Searches were performed in MEDLINE (PubMed), Scopus, and Google Scholar up to July 2025. Two independent reviewers screened and extracted data. Exclusion criteria included absence of original experimental data, focus on other species, or lack of clear VBNC definition. Risk of bias was qualitatively assessed. Analyses were descriptive without meta-analysis. Of the 1041 records, 24 articles (27 studies) were included. Resuscitation protocols typically employed standard culture media with additives and moderate incubation temperatures, with most successful recoveries occurring after 24–48 h. P. aeruginosa generally required less supplementation than Enterobacteriaceae. Reported mechanisms involved metabolic reactivation, oxidative stress modulation, nutrient sensing, and ribosome reactivation. The limitations of our study include protocol heterogeneity, lack of standardization, and selective reporting. While simple resuscitation methods were often effective, tailoring conditions to species-specific ecological preferences appears critical. Standardized approaches of VBNC cells will improve detection, risk assessment, and infection control.
Introduction La neuromyélite optique avec anticorps anti-aquaporine-4 (NMO-AQP4) et la maladie associée aux anticorps anti-MOG (MOGAD) peuvent présenter des troubles cognitifs encore sous-estimés et mal caractérisés. Objectifs Caractériser le profil cognitif des patients NMO-AQP4 et MOGAD de la cohorte lyonnaise et déterminer l’influence du phénotype clinique et des comorbidités sur leurs performances. Méthodes Vingt-trois patients NMO-AQP4 et vingt patients MOGAD ont bénéficié d’un bilan neuropsychologique comprenant treize tests. Les résultats ont été ajustés selon les comorbidités (dépression, anxiété, fatigue, troubles du sommeil), évaluées par auto-questionnaires et actimétrie, ainsi que selon le handicap neurologique (acuité visuelle, score Expanded Disability Status Scale). Résultats Plus de 30 % des patients NMO-AQP4 présentaient des performances inférieures à la norme au 10/36BCcogSEP, au test des commissions révisées, au PASAT et au CODE (WAIS-IV). Chez les MOGAD, 15 % étaient déficitaires au 10/36BCcogSEP. Les moins bonnes performances étaient associées à la dépression et à la fatigue chez les NMO-AQP4, et à une intensité douloureuse plus élevée chez les MOGAD (Figure 1)(Figure 2). Discussion Les patients NMO-AQP4 présentent un profil cognitif spécifique, dominé par des atteintes visuo-spatiales, attentionnelles et exécutives, aggravées en cas d’atteinte cérébrale. Les comorbidités, notamment dépression et fatigue, semblent moduler les performances. Chez les patients MOGAD, l’atteinte cognitive est plus limitée, suggérant une vulnérabilité sélective influencée par la douleur. Conclusion Les patients NMO-AQP4 présentent un profil cognitif altéré influencé par l’atteinte cérébrale et les comorbidités, tandis que les MOGAD montrent une atteinte plus modérée et principalement visuo-spatiale.
