L’implant pénien constitue une option thérapeutique définitive et efficace pour la dysfonction érectile réfractaire aux traitements médicaux (inhibiteurs de la PDE5, injections intracaverneuses ou intra-urétrales, dispositifs à vide). Depuis le 1er juillet 2025, la mise en place de ce dispositif est désormais remboursée en Suisse chez les patients présentant un échec ou une intolérance aux traitements médicaux, une maladie de Lapeyronie combinée à une dysfonction érectile ou encore dans le cadre d’une fibrose corporelle post-priapisme. La sélection des patients repose sur une évaluation préopératoire rigoureuse, comprenant le dépistage d’infections actives, l’optimisation des comorbidités et l’évaluation de la dextérité manuelle. Trois types d’implants sont disponibles : semi rigides, et gonflables à deux ou trois pièces. Les techniques chirurgicales comprennent 3 approches principales, l’incision pénoscrotale étant la plus fréquemment utilisée. Malgré des risques de complications (infection, érosion, défaillance mécanique), les résultats fonctionnels sont très bons, avec des taux de satisfaction élevés tant pour les patients que leurs partenaires.
Natural habitats of bacteria are often highly structured in space, but how this affects their interactions and community composition outcomes is poorly understood. To address this gap, we studied the development of a synthetic soil community of 21 bacterial strains under a gradient of habitat fragmentation on single or mixed-substrate conditions. Fragmentation was produced by random microfluidic seeding of the mixed inoculum into culture medium droplets of variable volume (30-150 pL), targeting mean starting densities between 1 and 27 founder cells comprising 1-2, 7 or 14 taxa per droplet. Across all droplets for each of the fragmented states, globally different community compositions arose, suggesting variable individual taxa strategies and adaptation to differences in habitat fragmentation. In comparison to the same mixed inoculum growing under the same nutrient conditions in bulk culture, the more fragmented conditions allowed higher cell density and diversity, with less overgrowth by a few strains. Community evenness was highest when inocula were dispersed into individual taxon (1-2 taxa) or low-order combinations (7 taxa per droplet), but individual dispersion reduced the productivity of the meta-community across droplets. Monod-type simulations suggested that most community composition could be explained by the inherent individual kinetic properties and dispersal constraint effects of the fragmented habitat, with smaller effects from emerging interspecific interactions. Overall, our results show the strong effect of habitat structure on community outcomes, with higher fragmentation states favoring more even species coexistence. ### Competing Interest Statement The authors have declared no competing interest.
BACKGROUND:The Medtronic Freestyle is widely used for full-root aortic valve replacement, offering excellent hemodynamics. However, structural valve deterioration, including pseudoaneurysm formation, raises concerns. METHODS:Our single-center retrospective and prospective cohort study of adult patients who underwent modified Bentall procedures with the Medtronic Freestyle between September 2015 and November 2023 analyzed early and late complications, echocardiographic results, and survival. A cross-sectional computed tomographic angiography (CTA) evaluation assessed postoperative structural abnormalities. RESULTS:Included were 153 patients (median European System for Cardiac Operative Risk Evaluation 2011 revision, 3.4%). The 1- and 5-year actuarial survival rates were 96.7% and 87.2%, respectively. Postoperative mean and maximal transvalvular gradients were 5.8 mm Hg (interquartile range, 4.3-7.6 mm Hg) and 11.1 mm Hg (interquartile range, 8.2-14.9 mm Hg). Of the 98 patients (77.8% of eligible patients) who underwent CTA imaging, 23.5% had structural abnormalities. Pseudoaneurysms were the most common (15.3%) and warranted reintervention in 3 cases. Routine echocardiography failed to detect the pseudoaneurysms. Multivariate analysis identified previous cardiac surgery as an independent predictor of pseudoaneurysm development (odds ratio, 4.32; P = .046). The cumulative risk of CTA-detectable structural abnormalities may reach 22.7% at 5 years. CONCLUSIONS:The Medtronic Freestyle displays excellent hemodynamic performance. However, silent structural deterioration is not rare. Routine echocardiography may miss these lesions, supporting the role of systematic postoperative CTA imaging, especially for redo patients. Further studies are needed to guide optimal imaging surveillance protocols.
Tanycytes are specialized glial cells lining the third ventricle that sense metabolic cues and contribute to hypothalamic regulation of energy balance. Although their role in nutrient sensing is well established, their contribution to hypothalamic immune regulation remains unclear. Here, we identify tanycytes as key immunomodulatory cells that control thermoregulation by modulating microglial state in the hypothalamus. We show that tanycytes release the pro-resolving immune mediator Annexin A1 (ANXA1) via extracellular vesicles in a nutrient-dependent manner. Tanycyte-derived ANXA1 then modulates microglial morphology, phagocytic activity, and cytokine profiles, thereby influencing thermoregulatory responses. Notably, disruption of tanycytic ANXA1 signaling induces microglial activation and hyperthermia, whereas microglial depletion rescues temperature homeostasis, establishing microglia as essential mediators of this pathway. Together, our findings uncover an immune function for tanycytes and define a tanycyte-microglia axis that links metabolic sensing to hypothalamic thermoregulation.
Abstract The hypothalamic-pituitary-gonadal axis (HPG) controls pubertal development, sexual maturation, and fertility. We hereby demonstrate a new role of hypothalamic microglia in controlling the HPG axis through Rank signaling, a pathway known for its role in bone and mammary gland biology. Whole-body and microglia Rank depletion leads to hypogonadotropic hypogonadism (HH) resulting from an alteration in gonadotropin-releasing hormone (GnRH) neuron function. In addition, we identify rare gene variants of RANK in patients with HH. Transcriptional profiling upon Rank loss reveals defective microglia activation and morphological alterations in the median eminence, decreasing the contacts and engulfment of GnRH terminal projections and impairing GnRH neuronal responses to kisspeptin. Overall, our data uncover the role of microglia in regulating GnRH neuronal function through Rank signaling, with implications for reproductive maturation and fertility.
