Total hip arthroplasty (THA) for hip developmental dysplasia (DDH) carries a high perioperative complication rate, with dislocation representing the most frequent adverse event. Monoblock dual-mobility (DMM) cups have demonstrated promising results in reducing prosthetic instability while ensuring long-term implant survival. However, data specifically addressing DMM THA in low-grade DDH remain scarce. The aim of this study was to evaluate clinical outcomes and complication rates at a minimum ten-year follow-up in patients undergoing DMM THA for low-grade DDH. A single-centre retrospective study was conducted, including all patients who underwent DMM THA for Crowe grade I or II DDH between 2008 and 2018. Clinical outcomes including the Harris Hip Score (HHS), Postel–Merle d'Aubigné (PMA) score, Devane score, visual analog scale (VAS), and range of motion (ROM) were assessed preoperatively, at one year, and at final follow-up. Implant survival was estimated using Kaplan–Meier analysis. Thirty-one THAs were performed in 25 patients (mean age 55.1 ± 13.4 years; mean follow-up 10.06 ± 1,98 years). All functional scores improved significantly at final follow-up (HHS 48 to 98, PMA 11 to 17, Devane 3 to 4, all p < 0.001). No dislocation, loosening, periprosthetic fracture, or septic complication was recorded. Implant survival was 100
The long-term management of patients after pulmonary embolism (PE) remains a major challenge, owing to the risk of persistent symptoms, complications, and recurrence. Residual pulmonary vascular obstruction (RPVO) is common, affecting up to 50% of patients after six months of anticoagulation. Ventilation-perfusion (V/Q) scintigraphy is the imaging modality of choice for detecting RPVO, which typically presents as mismatched perfusion defects, as it offers a sensitivity superior to that of computed tomography pulmonary angiography (CTPA), together with lower radiation exposure and the absence of iodinated contrast agents. V/Q scintigraphy plays a pivotal role in the screening of chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD). Furthermore, follow-up V/Q scintigraphy may aid in the diagnosis of recurrent PE and in predicting recurrence risk.
Stepped-wedge cluster randomised trials (SW-CRTs) increasingly evaluate complex interventions, yet methodological guidance for analysing composite endpoints using generalized pairwise comparisons (GPC)remains limited. This work investigates the performance of several GPC-based estimators in the presence of clustering, temporal trends, and varying correlation structures typical of SW-CRTs. We conducted an extensive simulation study covering a range of intraclass correlations (ICC), cluster autocorrelation coefficients (CAC), time effects, and treatment effect sizes. Eight analytical approaches were compared, including unadjusted estimators, cluster-stratified win odds, mixed-effects models applied to cluster-period win odds, and probabilistic index models (PIMs). Type I error control was strongly compromised for methods ignoring time or clustering, whereas only two approaches consistently maintained nominal error rates: a hierarchical mixed-effects model with sequence and cluster-level random slopes (b4) and a cluster-restricted PIM (c2). These two methods were further evaluated in terms of statistical power, where c2 generally showed higher efficiency, particularly under strong clustering, low CAC, or the presence of temporal trends, while both converged to similar performance for large treatment effects. Overall, our findings identify b4 and c2 as the most reliable GPC-based strategies for SW-CRT analysis and provide practical guidance for their application, including for ongoing trials such as ETHER.
Background: Cutaneous melanoma metastases (CMM) represent a clinically relevant manifestation of advanced melanoma and may constitute the first sign of disseminated disease. Their diagnosis is challenging because CMM shows highly variable clinical and dermoscopic presentations and frequently mimic other benign or malignant skin lesions. Although dermoscopy is routinely used to improve skin lesion assessment, dermoscopic criteria specific to CMM remain poorly defined and still non-standardized. Methods: We performed a narrative review of the literature to summarize dermoscopic features reported in CMM. MedLine (via PubMed) and Web of Science were searched up to 3 December 2025 using the keywords “dermoscopy” and “melanoma metastasis,” complemented by manual reference screening. Eligible studies were English-language full-text articles in peer-reviewed journals providing a complete dermoscopic description. Extracted data included patient demographics and major dermoscopic criteria, categorized as global patterns and focal dermoscopic and vascular structures. Due to heterogeneity, results were synthesized descriptively. Results: Twenty studies were included, comprising 774 patients. Dermoscopic findings were markedly heterogeneous. Globally, lesions frequently showed homogeneous pigmentation with variable colors and included amelanotic presentations. Commonly evaluated focal features included irregular dots and globules, crystalline structures, peripheral gray dots, and lacuna-like areas. Vascular patterns were prominent, particularly serpentine and corkscrew-like vessels. Conclusions: CMM dermoscopy is characterized by substantial heterogeneity and a lack of standardized criteria. Systematic classification of recurring dermoscopic features may improve diagnostic consistency and provide an interpretable framework for future artificial intelligence-based approaches supporting non-invasive recognition of melanoma metastases.
Objectif Dans cette scoping revue, le but a été d’établir une synthèse globale de notre savoir sur l’architecture du sommeil en réanimation tout en soulignant les limites de notre connaissance sur le sujet et en formulant des axes d’amélioration. Méthodes Une recherche systématique a été effectuée dans plusieurs bases de données (Pubmed, Cochrane) avec une série de mots clés, afin d’extraire les publications relatant du sommeil en réanimation adulte incluant ou mentionnant des données électroencéphalographiques (EEG) enregistrées dans ce contexte. Les articles pédiatriques et les articles mentionnant l’apnée du sommeil dans leur titre ont été exclus. La recherche systématique a été complétée par l’ajout de textes identifiés dans les bibliographies des articles déjà inclus et une recherche Google Scholar complémentaire. Des variables ont ensuite été recueillies dans les textes intégraux. Résultats Sur les 961 études analysées des bases de données et les 709 études provenant d’autres sources, 152 publications ont été inclus dans cette revue. La répartition des différents types de papiers et les caractéristiques des études et des patients (type unité de soins intensifs (USI), ventilation, centre(s), méthode EEG, sommeil atypique) ont été recensée dans un tableau. Les méthodologies de mesure utilisées sont très hétérogènes ce qui rend difficile la généralisation des résultats, d’autant que les connaissances longitudinales sur le sommeil de réanimation sont très pauvres. Conclusion Notre connaissance actuelle du sommeil en terme quantitatif est basée sur des données relevées à un instant t du séjour et nous avons retrouvé très peu de données longitudinales dans le temps. La question en suspens est donc de connaître la dynamique d’évolution du sommeil en réanimation. Sur le plan des techniques d’étude du sommeil en réanimation, nous sommes limités par la polysomnographie qui reste lourde pour des patients sévèrement malades. Dans cette optique, de nombreuses recherches sont en cours sur un matériel plus léger mais restant performant pour interpréter l’EEG de réanimation et pourvoir étudier le sommeil sur une plus longue période.
