As obesity has reached pandemic proportions worldwide, improving technical solutions for its treatment requires robust planning and numerical modelling. Yet existing material models obtained from biaxial tensile test are scarce and based only on frozen human or porcine samples, without histological quantitative consideration. Our objective was to generate fresh-human biaxial data including microstructure orientation/dispersion and provide patient-specific material models suitable for biofidelic FE modelling. Fundus and corpus samples of human stomach (10 sleeve-gastrectomy patients) underwent planar biaxial testing at two rates (0.1 and 1 mm·s⁻1) and three displacement ratios (1:1, 1:2, 2:1). Full-field strain was measured by digital image correlation. Collagen orientation/dispersion were extracted from histology using machine learning techniques. An incompressible anisotropic hyperelastic law (neo-Hookean matrix + two fibre families) was fitted per specimen across all ratios/directions. A consistent hierarchy emerged despite inter-patient variability with corpus stiffer than fundus, and longitudinal orientation stiffer than circumferential. Higher speed resulted in higher stress. In terms of safe characterisation limit (measured at 0.1 mm·s⁻1), median true-strain at safe characterisation limit was 0.33 (corpus) vs 0.38 (fundus). Isotropic matrix-only model failed to fit ratios/directions simultaneously while anisotropic model reproduced multi-ratio responses with R2 > 0.7 both in circumferential and longitudinal in respectively 85 and 81
BACKGROUND:Endoscopic sleeve gastroplasty (ESG) is an established endoscopic bariatric therapy. Two main platforms are currently used in clinical practice: the OverStitch Endoscopic Suturing System (OESS) and the triangulation Endomina System (ES). Comparative data regarding their technical performance and suture durability remain limited. This experimental study aimed to compare both systems in terms of usability, safety, and durability of full-thickness sutures. METHODS:In this prospective comparative animal study, six adult minipigs were randomized to ESG using either OESS or ES (three animals per group; five sutures per animal). Primary outcomes included ease of use, tissue apposition (TA) tightness assessed at index procedure, day 15 endoscopy, and day 30 necropsy, as well as histological evaluation of serosal fusion and bite size. RESULTS:All procedures were successfully completed without intra-procedural adverse events. Overall ease-of-use scores were higher with ES compared to OESS (median 6 vs 5; p=0.047). Immediate post-procedural TA scores were similar between groups (both tight; p=1). However, at day 15, ES demonstrated significantly higher TA scores than OESS (OR=29.1; 95% CI 4.3-200.3; p=0.026). At day 30 necropsy, TA remained significantly tighter with ES (OR=199.9; 95% CI 2.5-16245; p=0.029). No leaks or abscesses were observed. Histologically, serosal fusion was observed only in the ES group, although differences did not reach statistical significance. CONCLUSION:Both ESG platforms were safe and feasible in this animal model. While immediate suture performance was comparable, the Endomina System demonstrated superior mid-term durability and tighter tissue apposition compared with OverStitch. The clinical relevance of these findings warrants further investigation.
BACKGROUND AND AIMS:The impact of Physical activity (PA) on the activity of inflammatory bowel disease (IBD) remains unclear. PATIENTS AND METHODS:A descriptive cross-sectional study included consecutive patients with Crohn's disease (CD), ulcerative colitis (UC). PA was assessed using the short International Physical Activity Questionnaire. PA was classified as low, medium or high PA. PA was also assessed according to WHO recommendations. IBD activity was evaluated using PRO-2, while IBD-related disability was assessed with the IBD-disk questionnaire. RESULTS:Among a total of 2514 patients (1715 CD), only 28.8% met the WHO recommendations on PA (49.8% had low PA, 35.2% had medium PA, and 15.0% had high PA). Medium and high PA levels were associated with a higher rate of patient-reported clinical remission in patients with CD (OR 1.30 [1.08-1.57] for medium PA, and 1.33 [1.03-1.72] for high PA vs. low PA; p-trend=0.02) but not in those with UC. Higher PA levels were associated with less IBD-related disability in both CD, and UC. CONCLUSION:In a large cohort of IBD patients, moderate and high PA was associated with higher rates of clinical remission in patients with CD and lower IBD-related disability in both CD and UC patients.
BACKGROUND:Oral and ocular medications are frequently used in the treatment of allergic rhinitis (AR). As part of the update of the Allergic Rhinitis and its Impact on Asthma (ARIA)-EAACI guidelines, this manuscript presents the ARIA-EAACI 2024-2025 recommendations for oral and ocular treatments. METHODS:The ARIA-EAACI 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgements and recommendations, including systematic reviews, mHealth and pharmacovigilance data as well as a survey on costs. RESULTS:Eight guideline questions concerning oral treatments for AR and three questions concerning ocular treatments were addressed. These questions led to the recommendations. Overall, these questions concern the choice between different classes of medication. They also discuss the role of oral antihistamines (OAH), leukotriene receptor antagonists (LTRA), ocular antihistamines (OcAH) and ocular mast cell stabilisers. Four questions had not been previously evaluated in ARIA guidelines, while, for the other four, there was a change in the strength or directionality of the recommendations. Overall, these guidelines recommend using intranasal corticosteroids over OAH and using OAH over LTRA. Moreover, they suggest using OAH over OcAH and suggest being against adding LTRA to OAH. Finally, considerations for choosing between different individual OAHs are presented. CONCLUSION:This ARIA-EAACI 2024-2025 article supports patients, their caregivers and healthcare professionals in choosing oral and ocular treatments for AR. Decisions on treatment should consider the clinical variability of the disease, patients' values and the affordability of medications.
The impact of high-efficacy therapies (HET) on progression independent of relapse and MRI activity (PIRMA) remains poorly defined. In this context, using the French MS registry, we aimed to assess the real-life effectiveness of HET compared with moderate-efficacy therapies (MET) on PIRMA in patients with relapsing-onset multiple sclerosis. Data were collected from patients with relapsing-onset multiple sclerosis of the French MS registry, between January 2010 and June 2023, with a mean follow-up of 3.7 years. Patients with relapsing-onset multiple sclerosis were included in the analysis if they were treated first with HET (2666 included) or MET (7833 included) and had expanded disability status scale and MRI follow-up every 2 years. Each outcome was studied using a propensity score framework. The primary outcome was time to first PIRMA. Secondary outcomes were PIRMA incidence, time to first confirmed disability progression, relapse-associated worsening (RAW), MRI-associated worsening (MAW) and identification of risk factors associated with PIRMA. A total of 10 499 patients fulfilled the inclusion criteria. The mean and standard deviation (SD) age at treatment initiation was 36.4 (10.3) years, with a mean (SD) disease duration of 3.1 (5.1) years. The restricted mean (SD) survival time to first PIRMA was slightly, but significantly shorter in the HET group compared with the MET group [8.7 (0.08) versus 8.9 (0.05) years, P = 0.017]. However, when looking at time to first confirmed disability progression, it tend to be longer in the HET group compared with the MET group [7.6 (0.10) versus 7.3 (0.06) years, P = 0.071], and it was probably linked to the shorter time to first RAW and MAW in the MET group [9.2 (0.06) versus 8.7 (0.05) years, P < 0.001 for RAW; and 9.0 (0.05) versus 8.5 (0.07) years, P < 0.001 for MAW]. Baseline risk factors associated with increased PIRMA incidence in the whole population were high expanded disability status scale, higher age at baseline and the presence of spinal cord lesions. Even if HET gives better control on disability accumulation related to disease activity than MET, our real-life study suggests that PIRMA-related mechanisms are not differentially affected by HET versus MET.
