Caroline Giroudon

Summary: In this systematic review, we aimed to characterize the semiology of 'pure' opercular seizures by identifying cases in which the epileptogenic zone was restricted to the operculum. Seventy patients from 24 articles were included and categorized into four anatomic groups: 11 frontal, 27 central, 14 parietal, and 18 temporal operculum cases. Across these four anatomic regions, we identified the following semiological patterns: Frontal opercular seizures were characterized by a lower frequency of auras, most commonly nonpainful somatosensory sensations affecting the limbs or trunk and never exclusively the face, along with frequent elementary motor signs. Central opercular seizures exhibited the highest frequency of auras, predominantly nonpainful somatosensory sensations often involving the face; the central operculum was the only region associated with negative motor seizures. Parietal opercular seizures showed the greatest diversity of auras, notably painful sensations, and were associated with a higher prevalence of hypermotor behavior. Temporal opercular seizures were characterized by auditory hallucinations and a higher incidence of generalized tonic-clonic seizures.

Aim: To estimate the prevalence of breastfeeding—overall, exclusive, partial and depending on infants' age—in infants with Down syndrome, and to investigate associated factors. Methods: A systematic literature search was conducted in Medline, Cochrane Library, Web of Science, Embase, CINAHL and SciELO up to 1 August 2024. Original articles that estimated the prevalence of breastfeeding in infants with Down syndrome, written in French, English or Spanish, were included. Study quality was assessed using the Joanna Briggs Institute (JBI) scale. Meta‐analyses were performed for breastfeeding outcomes and meta‐regression explored heterogeneity. The review was registered in PROSPERO (CRD42021278019). Results: Twenty‐six studies (3463 infants) were included. The estimated prevalence of overall breastfeeding regardless of duration was 71.6% (95% CI [60.3; 80.7]; 25 studies, 3351 infants) with high heterogeneity, I ² = 94%. The estimated prevalence of exclusive breastfeeding was 38.4% (95% CI [22.4; 57.3]; 10 studies, 1099 infants). No factor assessed in meta‐regression was significantly associated with overall breastfeeding. Conclusion: The estimated breastfeeding prevalence in infants with Down syndrome is similar to that reported in the general population, despite high heterogeneity. Further studies using standardised methodology to assess breastfeeding barriers and facilitators in the context of Down syndrome would allow us to improve support for breastfeeding.

Importance: Septoplasty, turbinoplasty, and septorhinoplasty are common and generally-safe procedures. However, their effects on the olfactory system, despite its anatomical proximity, are not well documented. Given the importance of olfaction for quality of life, evaluating the olfactory impact of these surgeries is warranted. Objective: This study aimed to assess the olfactory sequelae of nasal surgeries. Design: Systematic review with meta-analysis Setting and Participants: A search equation used in PubMed/Medline, Cochrane Library, Web of Science, and Embase identified 7780 articles published since 1990, evaluating the adverse events of nasal surgeries. Exposure: The studies included evaluated adult patients exposed to one of the following nasal surgeries: septoplasty, septorhinoplasty, and/or inferior turbinoplasty. Main outcome measures: Olfactory assessment results and number of patients presenting with preoperative or postoperative hyposmia were extracted, as well as the number of patients presenting with surgery-induced hyposmia. A meta-analysis was conducted to compare different surgical subgroups. Results: One hundred and two studies were ultimately included in the analysis, centralizing data from 16,072 patients. Surgery-induced hyposmia was identified in 2.7% of cases, regardless of the surgical intervention performed. Overall, nasal surgeries led to a postoperative improvement in hyposmia scores [3.73 (±1.58) vs 2.39 (±1.45), P < .001] and a reduction in the number of patients with hyposmia [22.2% (945/4254) vs 14.5% (380/2620), P < .001]. The meta-analysis revealed no significant difference between the surgical subgroups. Conclusion and Relevance: The present systematic review and meta-analysis suggest that nasal surgery may impair olfaction in a non-negligible number of cases and highlight the need for objective and systematic olfactory assessment in nasal surgery studies.

Background: Frontal sinus inverted papilloma (IP) is a particularly rare form of IP and its management is challenging, with a high rate of recurrence. Objectives: Our aim was to evaluate the recurrence rate of frontal sinus IP after surgery and compare this rate according to the surgical modality (purely endoscopic sinus surgery vs. a combined/open approach). Design: A systematic review without meta-analysis conducted by a working group of the Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (yo-IFOS). Data Sources and Methods: A systematic analysis of the literature was performed and reported following the criteria laid down in the SWiM guidelines. The review was registered on Prospero, a dedicated software was used for screening (Covidence), and R (v.4.2.2) was used for statistical analysis. Eligible articles were studies reporting at least five cases of frontal sinus IP surgically treated. Results: A total of 2925 studies were identified based on the MeSH equation, and 39 studies were included (n = 642 patients). Among the studies included, the recurrence rate was 18.4% (118/642) with a mean time to recurrence of 25.6 (±11.7) months. The difference between surgical modalities was not statistically significant in terms of recurrence rate (14.7% vs. 16.5%; p = 0.675). Conclusions: The recurrence rate of frontal sinus IP is not different between surgical modalities. However, it does not reduce the need for a tailored therapeutic strategy, as other factors also need to be considered (time to recurrence, complications, quality of life) when choosing the most appropriate approach.

Background: The intersection of Autism and Gender Diversity (GD) is an emerging field of research. While prior studies have primarily focused on autistic traits within gender-diverse populations, limited evidence exists on the prevalence and characteristics of GD among individuals with a confirmed Autism Spectrum Disorder (ASD) diagnosis. This study aims to fill this gap through a systematic review and meta-analysis, offering comprehensive insights into the prevalence of GD in autistic individuals and the factors influencing this intersection. Methods: We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines. We searched for studies published between 2013 and 2023 in four databases. Inclusion criteria focused on studies assessing GD in children and adult participants with a formal ASD diagnosis based on Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition, criteria. We used random-effects models to estimate prevalence rates, and subgroup analyses explored potential influencing factors, including age, gender assigned at birth, type of GD assessment, ASD diagnosis methodology, and primary objective of the study. Results: From 7133 identified reports, we deemed 24 studies suitable for the systematic review, with 14 meeting all eligibility criteria for meta-analysis, representing 3894 autistic participants. We estimated the pooled prevalence of GD at 7.37% (95% confidence interval [CI]: 4.45–11.98). Subgroup analyses revealed no significant impact of age, type of GD assessment, or diagnostic methodology of ASD on GD prevalence. Although we found a higher prevalence of GD among individuals assigned female at birth (14.54%) compared with those assigned male at birth (8.15%), the difference was not statistically significant. However, studies explicitly addressing GD reported statistically higher GD rates (13.71%) compared with those with other primary objectives (4.71%). Non-binary identities appeared particularly prevalent, but we did not underexplore it due to variability in GD definitions across studies. Conclusion: This study highlights a notable prevalence of GD among autistic individuals, emphasizing the need for inclusive definitions and diagnostic process. Understanding this intersection is crucial for enhancing support services and ensuring equitable access to gender-affirming care for neurodiverse populations.

Objective The efficacy of balneotherapy in rheumatology remains unclear. We aimed to estimate its benefits and risks in rheumatology. Methods We conducted a systematic review of randomised trials assessing any European balneotherapy for a rheumatological indication in adults versus any control, on clinical outcomes. We searched PubMed, Cochrane Library, Embase and https://clinicaltrials.gov/ (up to 28 November 2023). We used the Cochrane risk of bias tool version 2, funnel plot and asymmetry tests. We used a random effects model with an inverse-variance weighting method for standardised mean difference (SMD) and risk ratio (RR). We used the Grading of Recommendations Assessment, Development and Evaluation approach for two primary outcomes, pain and quality of life (QoL) at 3 months, and two safety outcomes, withdrawal and any adverse event (AE). Results We included 29 trials in mechanical disorders, 9 in inflammatory diseases and 4 in fibromyalgia. The synthesis suggested a decrease in pain of a very low level of certainty (SMD: −0.72 (95% CI (−1.00; −0.44)), very serious risk of bias and of inconsistency, publication bias strongly suspected); an increase in QoL of a very low level of certainty (SMD: 0.56 (95% CI (0.37; 0.75)), very serious risk of bias and serious risk of inconsistency); inconclusive results regarding the risk of withdrawal (RR: 0.75 (95% CI (0.46; 1.20)), very serious risk of bias and serious risk of imprecision) and of AE (RR: 0.80 (95% CI (0.43; 1.50)), serious risk of bias and of inconsistency and very serious risk of imprecision). Conclusion The certainty of the effect of balneotherapy in rheumatology was very low. PROSPERO registration number CRD42023448206.

FcRn plays a major role in regulating immune homeostasis, but it is also able to transport biologics across cellular barriers. The question of whether FcRn could be an efficient transporter of biologics across the nasal epithelial barrier is of particular interest, as it would allow a less invasive strategy for the administration of biologics in comparison to subcutaneous, intramuscular or intravenous administrations, which are often used in clinical practice. A focused systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It was registered on the international prospective register of systematic reviews PROSPERO, which helped in identifying articles that met the inclusion criteria. Clinical and preclinical studies involving FcRn and the nasal delivery of biologics were screened, and the risk of bias was assessed across studies using the Oral Health Assessment Tool (OHAT). Among the 12 studies finally included in this systematic review (out of the 758 studies screened), 11 demonstrated efficient transcytosis of biologics through the nasal epithelium. Only three studies evaluated the potential toxicity of biologics’ intranasal delivery, and they all showed that it was safe. This systematic review confirmed that FcRn is expressed in the nasal airway and the olfactory epithelium, and that FcRn may play a role in IgG and/or IgG-derived molecule-transcytosis across the airway epithelium. However, additional research is needed to better characterize the pharmacokinetic and pharmacodynamic properties of biologics after their intranasal delivery.

Several low‐impact laparoscopic strategies have been developed to improve the safety of pneumoperitoneum. We conducted a systematic review to establish the current evidence base for the use of the AIRSEAL^® insufflation device for low‐pressure pneumoperitoneum in laparoscopic surgery. We searched the literature using several electronic databases, for studies with comparative design published in the English language from January 2010 to April 2020. The population of interest included patients with any type of health condition who underwent laparoscopic surgery using the AIRSEAL^® insufflation system or a standard CO₂ insufflator. Ten studies (four randomized clinical trials/six non‐randomized clinical trials), that enrolled 1394 participants in total who underwent urology, gynaecology or abdominal surgeries, were included. Total complication rates were similar between groups. Only three studies evaluated the impact of the insufflation system on post‐operative pain, and showed inconsistent benefit of AIRSEAL^® (significant decrease in pain in two studies, no difference in one). The same was observed in the two sole studies in which pain killers consumption was measured (significant decrease in morphine consumption 24 h after surgery in one study, no difference in the other). Operative duration was significantly shorter with AIRSEAL^® in three studies. For both post‐operative room and total length of stay, there was no difference between groups. No studies reported economic outcomes. Current literature supports the feasibility of the AIRSEAL^® system during laparoscopic surgery but more studies are required to establish the added clinical benefit and to explore the preferences of physicians and patients.