The Université Hospital of Lyon (French: Hospices Civils de Lyon, HCL) was created on January 18, 1802. It is the second Teaching hospital in France. It has 13 hospitals in the Lyon area and one in the south of France.
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
OBJECTIVES:To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. DESIGN:A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads as well as within subgroups, served as an integral part of the guideline development process. METHODS:New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS:The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but, for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. CONCLUSIONS:Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.
Patients with neuroendocrine tumors (NETs) often face substantial informational gaps and rely on the Internet for medical information despite variable quality and frequent misinformation. These challenges are particularly critical in complex care pathways such as radioligand therapy (RLT), where radiation safety constraints may increase anxiety and impact adherence. Large language models (LLMs) have emerged as promising tools for patient education, offering accessible and empathetic explanations tailored to patients’ level of understanding. However, their performance in specialized settings and across languages remains insufficiently evaluated. In a proof-of-concept study, five commercially available LLMs were evaluated by seven medical experts on 14 common patient questions about RLT for NETs in English and French, across three domains: accuracy, conciseness, and readability. LLMs demonstrated good performance, although significant differences were observed across models and languages. Performance was generally higher in English, highlighting cross-lingual disparities that may affect equitable access to reliable health information. While critical errors were uncommon, some responses illustrated how oversimplified information lacking clinical nuance may be misleading in institution-dependent contexts, particularly regarding hospitalization requirements. Readability analysis using the Flesch–Kincaid Grade Level indicated that responses often exceeded recommended levels for patient education. These findings suggest that LLMs could support patient education in specialized oncology settings but require careful integration into clinically supervised workflows, with potential advantages of domain-specific over general-purpose models. Improving readability, reducing cross-lingual disparities, and ensuring alignment with clinical practice will be essential to ensure safe, reliable, and equitable use of LLMs in patient education.
BACKGROUND:Vertebral metastases compromise bone integrity and may lead to fractures with substantial clinical and economic consequences. Finite element (FE) modeling based on computed tomography (CT) scans enables individualized biomechanical assessment but remains underused clinically due to workflow limitations. OBJECTIVE:To evaluate the sensitivity and accuracy of a patient-specific finite element (FE) simulation pipeline that incorporates automated vertebral segmentation for predicting vertebral strength in metastatic cases. METHODS:Thirty vertebrae (18 metastatic, 12 healthy) from 12 patients were analyzed using two finite element (FE) models (perfectly elasto-plastic vs. linear elastic) within an automated segmentation pipeline. Intra- and inter-operator reproducibility, sensitivity to boundary condition definition, and model-type comparisons were performed. Failure loads were normalized to derive equivalent stresses. RESULTS:Automated segmentation demonstrated excellent agreement with manual reference (R2 = 0.996 p < 0.001; no systematic bias). Sensitivity to operator-defined boundary conditions was minimal (<1%). The elasto-plastic model provided significantly lower failure loads than the linear elastic model (-25% on average). CONCLUSION:This study supports the feasibility of a fully-automated CT-based finite-element (FE) pipeline for vertebral fracture risk assessment in both healthy and metastatic vertebrae.
BACKGROUND:Patients with extensive ischaemic change are often excluded from endovascular thrombectomy. We aimed to synthesise the evidence from recent trials in these patients by performing a systematic review and individual patient data meta-analysis to estimate treatment benefit, including within clinical and imaging subgroups. METHODS:In this systematic review and meta-analysis, we searched PubMed and Embase for randomised trials published between March 1, 2018, and March 1, 2025, that evaluated efficacy and safety of endovascular thrombectomy compared with medical management in patients with large-core ischaemic stroke (based on an Alberta Stroke Program Early CT Score [ASPECTS] of ≤5 or estimated ischaemic core ≥50 mL) presenting within 24 h of onset. Individual patient-level data from all eligible trials were obtained. A central imaging core laboratory readjudicated ASPECTS and reanalysed ischaemic core volume. A two-stage meta-analysis with random-effects model was used to evaluate the distribution of 90-day modified Rankin Scale (mRS) scores (the primary outcome) using adjusted pooled generalised odds ratios (aGenORs). Missing data were handled by multiple imputation. Safety outcomes were all-cause mortality within 90-day follow-up and neurological worsening within 24-48 h of randomisation, reported as adjusted pooled relative risk (aRR); and symptomatic intracerebral haemorrhage within 36 h of randomisation (reported as risk difference). Subgroup analyses based on clinical and imaging characteristics were done, including subgroups defined by ischaemic core volume, ASPECTS, and time window from onset to randomisation. The meta-analysis was registered with PROSPERO (CRD420251058584). FINDINGS:We included 1886 patients (944 assigned to endovascular thrombectomy and 942 assigned to medical management) from six trials. Baseline characteristics were similar between treatment groups. At day 90, the distribution of mRS scores was improved in patients in the endovascular thrombectomy group (median score 4 [IQR 3-6]; n=940) versus those in the medical management group (5 [4-6]; n=931; aGenOR 1·63 [95% CI 1·42-1·88], p<0·0001). The endovascular thrombectomy group also had reduced mortality (292 [31·1%]) compared with the medical management group (347 [37·3%]; aRR 0·82 [95% CI 0·70-0·97], p=0·022). No significant differences were observed in symptomatic intracranial haemorrhage (ten [1·1%] of 944 vs nine [1·0%] of 942 patients; pooled unadjusted risk difference -0·17 percentage points [95% CI -1·01 to 0·67], p=0·69) or neurological worsening (197 [22·0%] of 896 patients vs 161 [17·9%] of 899; aRR 1·19 [0·87-1·62], p=0·27). Improved functional outcomes with endovascular thrombectomy were consistent across clinical and imaging subgroups, except for those with an estimated ischaemic core volume of 150 mL or greater, in whom point estimates favoured endovascular thrombectomy, particularly in the early time window (0-6 h), but wide 95% CIs limited interpretation. INTERPRETATION:Endovascular thrombectomy was associated with improved functional outcomes and reduced mortality versus medical management in patients with large-core ischaemic stroke presenting within 24 h of onset. With the exception of very extensive ischaemic changes (core volume ≥150 mL) presenting beyond 6 h, where evidence remains limited, benefit was sustained across ASPECTS and ischaemic core strata for patients presenting up to 24 h after onset. FUNDING:None.
