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Background: Necrotizing enterocolitis (NEC) is a major health burden in peterm neonates with mortality rates between 21% and 50%. Prophylaxis is of primary importance as early diagnosis is hindered by the lack of specific signs and laboratory markers. Although probiotics have been routinely used for NEC prophylaxis in neonatal intensive care units around the world, clinical trials provide contradictory data, which fuels an ongoing debate about their efficacy and safety.Aims: To perform a review and bibliometric analysis on available clinical trials and case reports data on the safety and efficacy of probiotics in preterm neonates and identify relevant publication trends and patterns.Methods: A bibliometric search for publications on the topic was performed in the Web of Science Core Collection database and the resulting records analyzed in bibliometrix package in R.Results: Trends in publication activity, historical direct citation network relationships and keyword co-ocurrences were discussed in the context of the most recent therapeutic recommendations.Conclusion: We took a round view of the potential drawbacks to probiotic use in preterm infants and their possible solutions.

NOABSTRACTBlepharoplasty is among the most demanded plastic surgery procedures worldwide. The popularity of the eyelid surgical rejuvenation is closely related to the remarkable improvement in facial aesthetics that these procedures bring to the patients with relatively short recovery period. However, these surgical interventions are among the most challenging since form, function and aesthetics have to be equally considered, preserved and improved. This is particularly true when dealing with age-related changes of the lower eyelids.To demonstrate the author’s personal approach for obtaining safe and reliable results in aesthetic lower eyelid surgical rejuvenation combining transconjunctival approach for fat bags resection and pinch technique for excess skin excision.A retrospective chart review was conducted encompassing patients who underwent aesthetic lower blepharoplasty performed by the author between January 2020 and January 2024 by using the above mentioned combined surgical technique (transconjunctival approach + pinch skin resection). A minimum follow-up of 9 months was set. Exclusion criteria included previous surgeries and non-surgical procedures on the lower eyelids and underlying eyelid pathologies and comorbidities that aff ect the eyelids.A total of 72 consecutive patients (mean age = 53.78 years; range: 34-70 years) underwent bilateral lower eyelid blepharoplasty for creation of youthful look and improving the quality of life. Out of them, 56 were female (n = 56; 77.78%) and 16 were male (n = 16; 22.22%). In fi ve of the cases simultaneous upper blepharoplasty was performed too. One of the cases presented a rare and distressing intraoperative side eff ect of the local anaesthetics – transient anisocoria. Analysis of the outcomes demonstrated signifi cant aesthetic improvement and high satisfaction rate among the patients presenting from mild to severe age-related deformities of the lower eyelids with no major complications in the series.The described combined surgical approach for lower eyelid surgical rejuvenation has shown to be safe and eff ective technique with high patient satisfaction rate. Since patient’s safety and diminishing surgical risks is fi rst priority in plastic surgery, this approach is recommended when fast and uneventful recovery with optimal outcome is aimed.

NOABSTRACTUpper blepharoplasty has significantly evolved over the past two decades from the unified routine excision of skin, muscle, and fat to a sophisticated and individualized to the patients’ needs surgical intervention. The contemporary techniques aim to correct age-related changes while preserving or even improving anatomy and function.To demonstrate the author’s personal approach for obtaining safe and reliable results in aesthetic upper eyelid surgical rejuvenation.A retrospective chart review was conducted encompassing patients who underwent aesthetic upper blepharoplasty performed by a single surgeon in an ambulatory setting under local anesthesia between September 2020 and August 2023. A minimum follow-up of 9-month was established. Cases with concurrent periorbital or facial surgery, any previous surgical and non-surgical procedures on the eyelids and any underlying eyelid pathologies and comorbidities that could affect the eyelids were excluded from the study.A total of 137 consecutive patients (mean age, 51.09 years; range, 32-77 years) were found and studied. Out of them, 119 were female (n = 119; 86.86%) and 18 were male (n = 18; 13.14%). Analysis of the obtained results demonstrated significant aesthetic improvement and high satisfaction rate among the patients with no major complications in the series.The described technique has shown to be safe and effective approach for upper eyelid surgical rejuvenation with reproducible and reliable results. It gives a natural outcome and also an improved quality of life which is of particular importance for elderly patients and those with excessive dermatochalasis.

Neutron stars are natural laboratories for testing gravity in the strong field regime. That is why the full spectrum of neutron star solutions in different modified theories should be thoroughly studied. Among the most natural modifications of general relativity are the theories in which additional scalar degrees of freedom are present. That is why scalar-tensor theories like Brans–Dicke and Damour–Esposito–Farese theories, as well as their extensions such as scalar-Gauss–Bonnet gravity, attracted attention throughout the years. In the present work, we combine those theory families and explore extensively the neutron star solution space in their realm. We identify qualitative new behavior of the solutions, including the existence of new types of phase transitions and new branches of solutions present only for high neutron star masses. Due to the peculiarities of the solutions, they can not be easily mimicked by a simple change of the equation of state.

Objectif : La douleur abdominale aiguë est un motif fréquent de consultation aux urgences. L’identification des urgences chirurgicales est parfois difficile devant la faible spécificité des signes cliniques. L’objectif de cette étude était de déterminer si la présence d’une douleur intense était associée à un diagnostic d’urgence chirurgicale. Méthodes : Il s’agit d’une étude observationnelle, rétrospective, monocentrique. Les patients adultes admis aux urgences pour une douleur abdominale aiguë entre le 1er janvier et le 31 décembre 2018 ont été inclus. L’intensité de la douleur était mesurée par l’infirmier d’orientation et d’accueil via une échelle numérique (EN). Les patients ont été classés en deux groupes selon l’intensité de leur douleur (EN ≥ 6 et EN < 6). Le diagnostic posé aux urgences était réparti en deux catégories : urgences chirurgicales et pathologies médicales. Les comparaisons ont été réalisées à l’aide des tests univariés de Wilcoxon et du Chi2 puis d’un modèle logistique multivarié. Résultats : Au total, 4 493 patients ont été inclus, dont 2 491 femmes (55 %). L’âge médian était de 39 ans [EIQ : 27–56]. Un diagnostic d’urgence chirurgicale a été posé chez 677 patients (15 %), l’appendicite et l’occlusion digestive étant les diagnostics les plus fréquents. Une douleur intense était significativement associée à une urgence chirurgicale (OR : 1,28 ; [IC 95 % : 1,04–1,57]), tout comme le sexe masculin et un âge, une fréquence cardiaque et une température plus élevés. Conclusion : La présence d’une douleur intense (EN ≥ 6) est associée à un diagnostic d’urgence chirurgicale chez les patients consultant aux urgences pour une douleur abdominale aiguë. Aim : Acute abdominal pain is a common reason for emergency department (ED) visits. The identification of surgical emergencies is sometimes difficult due to the low specificity of clinical signs. The aim of our study was to assess whether the presence of severe pain was associated with a surgical emergency diagnosis. Procedure : This was a single-center, retrospective, observational study. All adult patients admitted to the ED with acute abdominal pain between January 1st and December 31st, 2018, were included. Pain intensity was measured by the triage nurse on a numerical scale (NS). Patients were classified into two groups according to their pain intensity (NS ≥ 6 and NS < 6). The diagnosis made in the ED was divided into two categories: surgical or medical cases. Comparisons between groups were made using Wilcoxon and Chi2 tests and then a multivariate logistic model. Results : A total of 4,493 patients were included, out of which 2,491 were women (55%). The median age was 39 years (IQR: 27–56). A surgical diagnosis was made in 677 patients (15%), appendicitis and bowel obstruction being the most common diagnoses. Severe pain was significantly associated with surgical emergency (OR: 1.28; [CI 95%: 1.04–1.57]), as were male gender and higher age, heart rate, and temperature. Conclusion : The presence of severe pain (NS ≥ 6) is associated with a surgical emergency diagnosis in patients visiting the ED for acute abdominal pain.

Introduction : Depuis novembre 2017, la médecine d’urgence est filiarisée en France. Le profil des internes ayant choisi cette spécialité à l’issue de l’examen classant national, inconnu actuellement, différerait de celui de leurs aînés du diplôme d’études spécialisées complémentaire. Nous avons voulu connaître les caractéristiques des étudiants inscrits en phase socle du nouveau diplôme d’études spécialisées de médecine d’urgence, les motivations de leur choix et leur vision de leur futur exercice. Méthode : Nous avons mené une étude épidémiologique transversale déclarative à partir d’un questionnaire anonyme envoyé par courriel à tous les internes de phase socle du diplôme de médecine d’urgence affectés en 2017 dans les 28 subdivisions françaises. Résultats : Trois cent soixante-dix-sept internes ont répondu, dont 51 % de femmes, et l’âge moyen était de 26 ans. Quatrevingt- six pour cent avaient réalisé un stage aux urgences et 44 % un stage ou des gardes en service d’aide médicale urgente. La médecine d’urgence était un premier choix chez 81 % des étudiants et un choix par défaut chez 18 %. Leurs principales motivations étaient la transversalité de la spécialité, les gestes techniques, le contexte aigu, le travail en équipe et les lieux d’exercice variés. La majorité souhaitait exercer à l’hôpital public. Quatre-vingt-douze pour cent envisageaient un exercice partagé entre urgences et service d’aide médicale urgente. Leurs principales craintes concernaient l’absence de réorientation possible et l’épuisement. Discussion : La très grande majorité des internes du diplôme d’études spécialisées de médecine d’urgence sont venus vers la spécialité par choix. Malgré leur jeune expérience, ils ont des idées bien précises du type de pratique qu’ils souhaiteraient. L’exercice exclusif, qu’il soit aux urgences ou en service mobile d’urgence et de réanimation, ne semble plus être le modèle idéal pour ces jeunes professionnels qui plébiscitent l’exercice partagé. Background : In November 2017 emergency medicine became a full speciality in France. The profile of the residents who choose this specialty for the first time could differ from the profile of their predecessor who chose the sub-speciality. We therefore wanted to know the characteristics of the students enrolled in the first phase of this new diploma, their motivations and vision of their future exercise. Method : We conducted a cross-sectional epidemiological study based on an anonymous survey sent by email to all residents of the emergency medicine diploma. Results : Three hundred (and) seventy-seven students answered our questionnaire, 51% were women and the average age was 26 years. Eighty-six per cent declared a rotation in anemergency department and 44% a rotation or shifts in an emergency mobile unit during their studies. For 81% of the resident, emergency medicine was their first choice. Their main motivations were the fact that emergency medicine is a transversal specialty, with technical acts, in an acute setting, with important teamwork and large variety of working place. The majority wanted to practice in a public hospital. And for 92% the practice should be shared between emergency room and pre-hospital mobile unit. Their main concerns were the lack of possible reconversion and exhaustion. Discussion : The vast majority of emergency medicine residents voluntarily chose the specialty. Most declared that they would prefer to have a mixed practice (pre and in hospital emergency medicine).

Objectif : Le taux de vacance de poste des médecins est estimé à 23 % dans les services d’urgence (SU). L’objectif de l’étude était d’identifier des facteurs d’attractivité potentiels des SU en France. Méthodes : Cette étude est composée de deux enquêtes observationnelles transversales nationales. La première, adressée aux responsables de service, comparait les facteurs d’attractivité entre les SU à faible et forte vacance de poste. La seconde, réalisée auprès des médecins urgentistes, hiérarchisait par évaluation numérique (échelle de 1 à 10) l’attractivité des différents facteurs. Résultats : Concernant l’enquête auprès des responsables de service, 76 SU ont été inclus : 47 à forte vacance de poste et 29 à faible vacance de poste. Le taux de vacance globale était de 23 %. En analyse univariée, les facteurs associés significativement à une faible vacance de poste étaient un nombre annuel de passages élevé (OR = 1,03 [1,01–1,06] pour 1 000 passages supplémentaires ; p = 0,03), un faible taux d’hospitalisation (OR = 0,93 [0,85–0,99] par pourcentage supplémentaire ; p = 0,04), la possibilité d’enseignement facultaire (OR = 3,07 [1,05–9,33] ; p = 0,02), le respect du temps de travail hebdomadaire (OR = 0,10 [0,01–0,54] si temps de travail ≥ 48 heures par rapport à 39 heures ; p = 0,02) et une bonne ambiance au sein du service (OR = 10,0 [2,12–74,5] si ambiance excellente par rapport à moyenne ; p = 0,02). Concernant l’enquête auprès des médecins urgentistes, 971 ont répondu. Les trois facteurs considérés comme les plus attractifs étaient l’ambiance au sein du service, la facilité d’aval et la présence d’un service de réanimation. La qualité de vie au travail était la thématique d’attractivité la plus importante pour les médecins urgentistes. Conclusion : Les facteurs liés à la qualité de vie au travail et certaines caractéristiques hospitalières sont associés à une plus faible vacance de poste et qualifiés d’attractifs par les médecins urgentistes. Aim : The vacancy rate for physicians is estimated at 23% in emergency departments (EDs). The aim of the study was to identify potential attractiveness factors in French EDs. Procedure : This study consisted of two national cross-sectional observational surveys. The first, addressed to ED’s heads, compared the attractiveness factors between EDs with low and high vacancies. The second, addressed to emergency physicians, ranked the attractiveness of the different factors by numerical evaluation (scale of 1–10). Results : For the department heads survey, 76 EDs were included: 47 with high vacancy and 29 with low vacancy. The overall vacancy rate was 23%. In univariate analysis, factors significantly associated with low vacancy were higher number of annual visits (odds ratio [OR] = 1.03 [1.01–1.06] per 1,000 additional visits; P = 0.03), lower hospitalisation rate (OR = 0.93 [0.85–0.99] per additional percentage; P = 0.04), opportunity for faculty teaching (OR = 3.07 [1.05–9.33]; P = 0.02), respect for weekly working hours (OR = 0.10 [0.01–0.54] if working time ≥ 48 vs. 39 h; P = 0.02) and a good working atmosphere within the department (OR = 10.0 [2.12–74.5] if excellent vs. moderate; P = 0.02). Regarding the survey of emergency physicians, 971 responded. The three factors considered most attractive were the working atmosphere within the department, the ease of movement out of the ED and the presence of an intensive care unit. Quality of work life was the most important attractiveness factor for emergency physicians. Conclusion : Factors related to quality of work life and few hospital characteristics are associated with lower vacancy rates and considered as attractive by emergency physicians.

Background Compared with conventional hospitalization, admission to an acute geriatric care unit (AGU) is associated with better outcomes in elderly patients. In 2012, 50% of the hospitalizations of elderly patients were preceded by an emergency department (ED) visit. Hospital occupancy, access blocks and overcrowding experienced by patients during ED visits are associated with increased morbidity. Objective Our aim was to evaluate the effect of direct admission (DA) to an AGU on both the hospital length of stay and morbidity of elderly patients. Design This study was a retrospective cohort study conducted using electronic medical records and administrative claims data from the Greater Paris University Hospitals (APHP) health data warehouse involving 19 different AGUs. Participants We included all patients ≥ 75 years old who were admitted to an AGU for more than 24 h between January 1, 2013, and December 31, 2018. Intervention Direct admission to the AGU compared to admission after an ED visit. Main measures The main outcome was hospital length of stay. Two outcomes were used to analyse morbidity: postacute care and rehabilitation ward transfer at the end of the index hospitalization and ED return visit within 30 days after the index hospitalization (for those who survived to hospitalization). We used an inverse probability of treatment weighting (IPTW) approach to balance the differences in patient baseline variables between the two groups. Univariate linear and logistic regression models were built to estimate the effect of DA on hospital length of stay and the likelihood of postacute care transfer and ED return visit. Key results Among the 6583 patients included in the study, DA was associated with a lower hospital length of stay (estimate = -1.28; 95% CI = -1.76–0.80), and a lower likelihood of postacute care transfer (OR = 0.87; 95% CI = 0.77–0.97). It was not significantly associated with a lower risk of ED return visits (OR = 0.81; 95% CI = 0.60–1.08) in the following month. Conclusion DA should be prioritized, and reorganization of the geriatric pathway around DA should be encouraged due to the frailty of elderly individuals.

The femoro-acetabular impingement (FAI) syndrome is a motion-related disorder of the hip joint with premature contact between the acetabulum and the proximal femur. It is a relatively new clinical entity and no strict treatment protocols and guidelines have been established yet. Furthermore, patients are often misdiagnosed and not properly treated. We report a clinical case of a young adult female patient presenting with a bilateral FAI-CAM type deformity during the last 2 years. An individual progressive global elastic resistant training program was established which involved stimulation to all affected muscle groups using Pilates concept. Hip-specific and functional lower limb strengthening targeted the deep hip external rotators, abductors and flexors in the transverse, frontal, and sagittal planes. Improving the dynamic stability and Core stability was the main aim of the challenging physiotherapy treatment in this case. A good functional result was registered at 6 months follow up. All therapeutic activities were performed in a pain free range of motion which was of paramount importance for achieving excellent patient compliance and successful outcome respectively. The applied treatment strategy demonstrated to be reliable and could be a helpful tool in the armamentarium of contemporary physiotherapy when dealing with the FAI group of patients.