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Navigating complex choices through legitimation: Narrative strategies in risk-reduction mastectomy decision-making among unaffected women with genetic risk for breast cancer in Switzerland
No full textFor unaffected women at high risk for developing breast cancer due to pathogenic variants in BRCA1 or BRCA2 (BRCA) genes, bilateral risk-reducing mastectomy (RRM) is an alternative to intensive surveillance. RRM reduces breast cancer risk but may generate additional health and psychosocial issues, making the choice between surveillance and RRM complex and personal. This grounded theory study explores how unaffected women carrying BRCA pathogenic variants engage in a decision-making process leading to the choice of undergoing RRM. Narrative data were collected in Switzerland through biographical interviews with 38 unaffected women carrying BRCA pathogenic variants. Participants had either undergone RRM or were planning the surgery in the future. Findings indicate that the decision to undergo RRM was influenced by femininity and body image, current life engagements, anticipation of surgery risks and outcomes, perception and acceptance of cancer risk, surveillance experiences, attitudes of healthcare providers and family, and financial considerations. These factors interacted, creating contradictions that made decision-making challenging. To navigate this uncertainty, women progressively built their decision through a triple process of making sense: framing RRM as an obligated, empowering and mundane choice. This sense-making process is described as a process of legitimation, through which women decide to undergo RRM and integrate it into their life trajectory, ensuring its acceptability for themselves and their social circles. The discussion provides insights into the legitimation process as a heuristic tool for exploring crucial choices in uncertainty and offers implications for healthcare providers assisting individuals in complex decision-making processes
Behaviour-Based Predictive Scores of Hepatocellular Carcinoma in People With Chronic Hepatitis B (ANRS CO22 HEPATHER).
No full textEarly assessment of hepatocellular carcinoma (HCC) risk could improve long-term outcomes in people with chronic hepatitis B virus (HBV) infection. Some existing HCC predictive scores are not easily implementable. We developed easy-to-use HCC predictive scores based on behavioural and routine bio-clinical data in people with chronic HBV infection.Eight-year follow-up data was analysed from people with chronic HBV infection enrolled in the French ANRS CO22 HEPATHER cohort. Patients were randomly split into two samples (training/testing). A multivariable Cox model for time to HCC was estimated on the training sample. The HCC predictive score was computed by summing the points assigned to model predictors, normalising their coefficients over a 10-year age increment, and rounding to the nearest integer. The Youden index identified the score's optimal risk threshold. Comparisons with existing predictive scores were performed on the testing sample.In the study population (N = 4370; 63% of men; 65% of < 50 years old), 56 HCC cases occurred during 25,900 follow-up person-years. Two HCC predictive scores were defined: SADAPTT (daily soft drink consumption, age, hepatitis Delta infection, unhealthy alcohol use, platelet count, heavy tobacco smoking, and HBV treatment) and ADAPTT (the same predictors except for daily soft drink consumption), with ranges 0-13 and 0-14, respectively, and values ≥ 3 indicating a high HCC risk. Their performances were similar to existing scores.We developed two effective behaviour-based HCC predictive scores, implementable in many settings, including primary care and decentralised areas. Further studies are needed to validate these scores in other datasets.journal article2025 Aprimporte
7-T MRI-based surrogate for histopathology examination of liver fibrosis.
No full textTo demonstrate that 7-T magnetic resonance imaging (MRI) provides a surrogate for histopathology of fresh ex vivo liver tissue, using the case study of liver fibrosis.We prospectively enrolled 20 patients undergoing surgical liver resection between November 2021 and April 2023. Each ex vivo fresh liver tissue specimen (~ 1 cmFive patients were excluded from the final analysis (one patient due to poor specimen quality, two due to surgery cancellation, and two previously published used for reader training). Of the remaining 15 patients, 10 (67%) presented with chronic liver diseases and 8/15 (53%) with advanced (F3 or F4) fibrosis. Radiologists achieved 88% sensitivity, 100% specificity, 93% accuracy (95% confidence interval 68-100%) and 0.94 Harrell's c-index (0.86-1.00). Pathologists achieved 88% sensitivity, 86% specificity, 87% accuracy (60-98%) and 0.87 Harrell's c-index (0.74-0.99). There were no statistically significant differences between MRI-based and pathologic reference standard stage (p ≥ 0.655).With an in-plane spatial resolution of ~ 75 × 75 µm7-T MRI provides a surrogate for histopathology visualisation of fresh ex vivo liver tissue, opening new research perspectives for clinical high-field MRI of the liver.Using the newly developed MRI-METAVIR score, 7-T MRI data strongly correlated with histopathology, achieving excellent agreement and accuracy. 7-T MRI accurately differentiated advanced from minimal liver fibrosis. 7-T MRI visualises liver micro-architecture, enabling pathology-like, noninvasive three-dimensional imaging.journal article2025 May 232025 05 23importe
Recension de Olivier Peterschmitt, Affaire Vincent Lambert, un parcours éthique, L’Harmattan 2024
No full textApplication of Biomaterials for the Prevention of Pharyngeal Fistulae: A Systematic Review
No full textBackground: PharyngoCutaneous Fistulae (PCF) represent a significant clinical challenge in otorhinolaryngology practice. The use of biomaterials could improve outcomes or even replace the use of a flap in pharyngolaryngeal surgery.
Methods: This systematic review included all studies evaluating the application of biomaterials for the prevention of PCF after pharyngeal surgery.
Results: A total of 19 articles (12 clinical and 7 animal studies) were included. They assessed the use of a biomaterial to cover mucosal sutures (n = 15) or to replace a mucosal defect and guide secondary healing (n = 4). Most studies evaluated commercialized biomaterials (n = 11) rather than experimental devices (n = 5) or platelet-derived autologous medical devices (n = 4).
Conclusion: There are already strong arguments to support the use of several biomaterials to cover pharyngeal sutures in order to decrease the rate of PCF after TL or TPL. Replacing a pharyngeal mucosal defect by a biomaterial is currently a more elusive goal.
Keywords: biomaterial; fistula; pharyngeal leak; sealant; total laryngectomy
Ours Is a Speciesist World, Really
No full textTo date, much of the speciesism debate has centered on an ethical question: Can speciesism be justified, or is it immoral, as the analogy with racism suggests? Another question has received less attention: How prevalent is speciesism? Animal ethicists have largely assumed that speciesism is pervasive in our societies. After all, almost everyone routinely treats animals in ways they would never treat fellow humans. This widespread assumption is now being challenged. Some philosophers are beginning to question whether speciesism is an accurate diagnosis for our conduct. This paper defends the orthodox view against such critiques. It refutes three challenges to the existence of speciesism—one posed by Travis Timmerman, another by Shelly Kagan, and a third inspired by Stijn Bruers. Some of these arguments rely on a flawed understanding of speciesism; all generate implausible empirical predictions
