Optimization of manual ventilation quality using respiratory function monitoring in neonates: A two-phase intervention trial.

OBJECTIVE: The aim of this study was the evaluation of the impact of a respiratory function monitor (RFM, Neo100, Monivent AB, Gothenburg, Sweden) on the quality of ventilation in neonates. METHODS: This single-center two-phase intervention study was conducted at the Neonatal Intensive Care Unit and the delivery room of the Medical University of Vienna. Patients with clinical need for positive pressure ventilation were included in either of two consecutive study phases: (i) patients were ventilated with a hidden RFM (control) or (ii) visible RFM (intervention) during manual positive pressure ventilations. The duration of each phase was approximately six months. The primary outcome was the percentage of ventilations within a tidal volume range of 4-8 ml/kg (pVTe). RESULTS: A total of 90 patients (GA 22-66 weeks) were included. The primary outcome was significantly higher in the intervention group with a visible RFM (53.7%, SD 22.6) than in the control group without the monitor (37.3%, SD 20.5); (p < 0.001, mean difference [i.e., change in percentage points]: 16.95% CI: 7.4-35). In terms of secondary outcomes, excessive tidal volumes (>8ml/kg), potentially associated with an increased risk of brain injury, could be significantly reduced when a RFM was visible during ventilation (10.9% [IQR 26.4] vs. 29.5% [IQR 38.1]; p = 0.004). Furthermore, mask leakage could be significantly decreased (37.3% [SD 22.7] vs. 52.7% [SD 23.0]; p = 0.002). CONCLUSION: Our results suggest that the clinical application of a RFM for manual ventilation of preterm and term infants leads to a significant improvement in ventilation parameters.

Innovative therapeutic strategies in the treatment of gastroesophageal reflux disease (GERD): A review of progress and perspectives.

Gastroesophageal Reflux Disease (GERD) is a commonly occurring condition that can significantly impact quality of life. Often considered a lifestyle disease. Traditional treatment methods focus on pharmacotherapy, lifestyle modifications, and in extreme cases, surgical interventions. This article discusses current and novel approaches to managing gastroesophageal reflux disease. The foundation of this work was medical articles and research gathered from the PubMed database. Keywords such as "esophageal reflux treatment", "new technologies in GERD treatment", "innovative reflux treatment methods", were used to facilitate the literature search. In managing gastroesophageal reflux disease, the application of appropriate pharmacological therapy and lifestyle changes for the patient remains key. However, new technologies and treatment methods, such as advanced endoscopic repair procedures, innovative medications, and personalized approaches, are gaining importance. These new strategies can significantly improve patients' quality of life, reduce symptoms, and minimize the need for surgical interventions.

Extraction of Bioactive Compounds from the Fruits of Jambolan (Syzygium cumini (L.)) Using Alternative Solvents.

This work demonstrates the effectiveness of using alternative solvents to obtain jambolan extracts with a high content of bioactive compounds compared to conventional organic solvents, being the first study to evaluate the best ecological solvent alternative for Syzygium cumini (L.) Skeels. Five alternative solvents were used for extraction: water at 25 °C (W25), water at 50 °C (W50), water at 75 °C (W75), water with citric acid at 2.4% (CA2), and water with citric acid at 9.6% (CA9) in comparison with three conventional solvents: ethanol (EtOH), water with ethanol at 50% (WE), and water with methanol at 50% (WM). A protocol was then established for the extraction and concentration of samples obtained with these solvents. The highest content of total phenolic compounds (TPCs) in the extracts was obtained with the solvent W75 (1347.27 mg GAE/100 g), while in the concentrates it was the solvents EtOH (3823.03 mg GAE/100 g) and WM (4019.39 mg GAE/100 g). Total monomeric anthocyanins (TMAs) increased by 209.31% and 179.95% in extractions with CA2 and CA9, respectively, compared to pulp (35.57 mg eq c-3-g/100 g), demonstrating that they are the most efficient alternative solvents in this extraction. The levels of bioactive compounds and antioxidant activity varied according to the solvents used. Delphinidin 3,5-diglucoside, cyanidin 3,5-diglucoside, delphinidin 3-glucoside, petunidin 3,5-diglucoside, cyanidin 3-glucoside, peonidin 3,5-diglucoside, malvidin 3,5-diglucoside, petunidin 3-glucoside, and malvidin 3-glucoside were identified in most of the samples by UPLC-MS/MS. This study suggests that a simple procedure using alternative solvents can be used as an environmentally friendly strategy to achieve efficient extraction of bioactive compounds in jambolan.

Recommendations for articles and reviews in colorectal cancer-related research at the year-end of 2023.

As peer reviewers of the World Journal of Gastroenterology, our weekly routine involves immersing ourselves in the newly published issue, particularly focusing on the realm of colorectal cancer (CRC) research. We diligently sift through various contributions, ranging from comprehensive reviews to original articles and other scholarly works. Through meticulous examination, we discern the most notable papers, delving into each with careful scrutiny to distill their merits and shortcomings. Undoubtedly, this undertaking demands considerable time and effort. Yet, it stands as an indispensable pursuit, affording us a profound comprehension of the latest breakthroughs in CRC research. Moreover, these meticulously curated selections furnish readers with invaluable resources, serving as enduring references for the nuanced exploration of this dynamic field.

Imaging of Carotid Stenosis: Where Are We Standing? Comparison of Multiparametric Ultrasound, CT Angiography, and MRI Angiography, with Recent Developments.

Atherosclerotic disease of the carotid arteries is a crucial risk factor in predicting the likelihood of future stroke events. In addition, emerging studies suggest that carotid stenosis may also be an indicator of plaque load on coronary arteries and thus have a correlation with the risk of acute cardiovascular events. Furthermore, although in symptomatic patients the degree of stenosis is the main morphological parameter studied, recent evidence suggests, especially in asymptomatic patients, that plaque vulnerability should also be evaluated as an emerging and significant imaging parameter. The reference diagnostic methods for the evaluation of carotid stenosis are currently ultrasonography, magnetic resonance imaging (MRI), and computed tomography angiography (CTA). In addition, other more invasive methods such as 123I-metaiodobenzylguanidine (MIBG) scintigraphy and PET-CT, as well as digital subtraction angiography, can be used. Each method has advantages and disadvantages, and there is often some confusion in their use. For example, the usefulness of MRI is often underestimated. In addition, implementations for each method have been developed over the years and are already enabling a significant increase in diagnostic accuracy. The purpose of our study is to make an in-depth analysis of all the methods in use and in particular their role in the diagnostic procedure of carotid stenosis, also discussing new technologies.

Physical Activity, Body Composition, and Fitness Variables in Adolescents After Periods of Mandatory, Promoted or Nonmandatory, Nonpromoted Use of Step Tracker Mobile Apps: Randomized Controlled Trial.

BACKGROUND: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed. OBJECTIVE: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence. METHODS: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants' PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours. RESULTS: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD -0.170; P<.001), maximal oxygen uptake (MD -1.006; P<.001), countermovement jump test (MD -1.337; P=.04), curl-up test (MD -3.791; P<.001), and push-up test (MD -1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed. CONCLUSIONS: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared. TRIAL REGISTRATION: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041.

A Novel Two-Step Method for Converting Lumbar Cortical Screw to Pedicle Screw: A Case Report.

The cortical bone trajectory (CBT) technique has emerged as a minimally invasive approach for lumbar fusion but may result in pseudoarthrosis and hardware failure. This report presents a case of successful pedicle screw revision in a patient with previous failed L2 and L3 fusion using a novel "two-step" technique, including (1) drilling a new trajectory with Medtronic EM800N Stealth MIDAS Navigated MR8 drill system (Medtronic, Dublin, Ireland) and (2) placement of Solera 4.75 ATS (awl-tapped screws) with navigated POWEREASE™ (Medtronic), described here for the first time. This method involves utilizing neuronavigation and specialized instruments to safely place pedicle screws through the path of the old cortical screw trajectory, addressing the challenges associated with CBT hardware failure.

Emergency services response to eCall System alerts: Observations from 2016-2022 in the National Fire and Rescue System.

OBJECTIVE: Analysis of interventions by fire protection units in road traffic incidents alerted by the eCall system between 2016 and 2022. MATERIALS AND METHODS: Data from the State Fire Service Decision Support System (SFS DSS), provided by the Operational Planning Office, were used. Events from January 1, 2016, 00:00 to December 31, 2022, 23:59 were analyzed. Quantitative data were described using mean (Mean) and standard deviation (SD). Correlations and differences at a significance level of p < 0.05 were considered statistically significant. The analysis is anonymous for both victims and officers involved in the interventions. RESULTS: Between 2016 and 2022, firefighters were alerted by the e-call system 896 times. The shortest average intervention time was 47 ± 37 min and was recorded in 2021. In the comparative analysis of intervention time and factors conditioning the use of the eCall system, it was shown that this time was significantly statistically dependent on the number of cars involved in the incident (p < 0.001), the number of injured persons (p < 0.001), the type of intervention (p < 0.001),), and the occurrence of fuel leakage (p < 0.001). CONCLUSIONS: ECall is a relevant system for reporting accidents and collisions on the road. While it proves reliable in road incidents, a significantly high number of false alarms initiated from eCall requires system refinement to avoid accidental alarms and user education about the possibility of unintentionally sending an alarm signal. The authors predict that as the number of vehicles with the eCall system introduced to the roads increases, so will the number of notifications from this system. Data from the analysis of false reports suggest that mechanics and electricians in facilities performing repairs and maintenance of vehicles with the eCall system may lack the necessary knowledge of the need to deactivate the system before starting work. The number of injured people had no impact on the intervention time, which may prove that the rescue services were properly prepared.

Application and progress of new technologies and new materials in the treatment of pathological scar.

Pathological scars (PS), including hypertrophic scars (HTS) and keloids, are a common complication of poor wound healing that significantly affects patients' quality of life. Currently, there are several treatment options for PS, including surgery, drug therapy, radiation therapy, and biological therapy. However, these treatments still face major challenges such as low efficacy, high side effects, and a high risk of recurrence. Therefore, the search for safer and more effective treatments is particularly urgent. New materials often have less immune rejection, good histocompatibility, and can reduce secondary damage during treatment. New technology can also reduce the side effects of traditional treatments and the recurrence rate after treatment. Furthermore, derivative products of new materials and biomaterials can improve the therapeutic effect of new technologies on PS. Therefore, new technologies and innovative materials are considered better options for enhancing PS. This review concentrates on the use of two emerging technologies, microneedle (MN) and photodynamic therapy (PDT), and two novel materials, photosensitizers and exosomes (Exos), in the treatment of PS.

Technological Perception with Rural and Urban Differentiation and Its Influence on the Quality of Life of Older People with Age-Related Macular Degeneration.

The past decade has seen a global increase in population age, especially in developed countries, where aging involves visual diseases such as age-related macular degeneration (AMD), which severely affect quality of life (QoL) and mental health, as well as increase isolation and care costs. This study investigated how persons with AMD perceive the impact of technology use on their QoL, focusing on potential disparities between urban and rural contexts in Spain. Using a cross-sectional observational design, data from the 2020 National Statistics Institute's Disability, Personal Autonomy, and Dependency Situations Survey were analyzed, focusing on QoL aspects based on the WHO items of the WHOQOL-100 scale. The results revealed a generally positive perception of technology among participants, with urban residents perceiving technology's positive impact more favorably. Sex discrepancies in technology perception were also observed, as women exhibited a more positive outlook on technology's influence on QoL. The analysis of QoL aspects, such as 'Visibility', 'Learning', 'Mobility', and 'Domestic life', highlighted distinct challenges faced by rural and urban populations, underscoring the importance of context-specific approaches in technology interventions. However, these perceptions were intertwined with comorbidities, which can exacerbate AMD-related issues. Furthermore, this study explored the role of technology in enhancing QoL among older adults with AMD, examining how it influences daily activities and independence, particularly in the context of AMD management. This study concluded that developing more-inclusive policies tailored to the specific needs of persons with AMD, with special attention to environmental and sex differences, is imperative to enhance the positive impact of technology on their QoL.

A comprehensive investigation of the use of freeze concentration appro aches for the concentration of fish protein hydrolysates.

Fish protein hydrolysates (FPH) are inherently unstable in their liquid form, necessitating either freezing or dewatering for stabilization. Gentle methods such as freeze concentration can be used to remove water, this can be achieved by freezing water in solution by decreasing the bulk temperature below freezing point and separating pure ice crystals from concentrated solution. This approach serves as an alternative to techniques like evaporation and reverse osmosis for concentrating solutions that have high water content, significant nutritional value, and thermolabile compounds. This is crucial as many bioactive compounds degrade when exposed to elevated temperatures. Another notable advantage of this technology is its potential to reduce energy consumption by up to 40% when integrated into the FPH drying process. Although this technology is currently industrialized primarily for juices, it can achieve concentrations of up to 60°Brix and manage viscosities up to 400 mPa.s. Numerous studies have been dedicated to enhancing design and processes, leading to a 35% reduction in the system's capital cost and a 20% reduction in energy consumption. Moreover, freeze concentration can synergize with other concentration techniques, creating more efficient hybrid processes. This review aims to introduce freeze concentration as a superior option for preserving fish protein hydrolysates, enhancing their stability, and maintaining their nutritional and bioactive qualities.

Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications.

Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed field ablation (PFA), a revolutionary technique gaining prominence in interventional electrophysiology because of its efficacy and safety. PFA employs non-thermal electric fields to create irreversible electroporation, disrupting cell membranes selectively within myocardial tissue, thus preventing the non-selective damage associated with traditional thermal ablation methods like radiofrequency or cryoablation. Clinical studies have consistently shown PFA's ability to achieve pulmonary vein isolation-a cornerstone of AF treatment-rapidly and with minimal complications. Notably, PFA reduces procedure times and has shown a lower incidence of esophageal and phrenic nerve damage, two common concerns with thermal techniques. Emerging from oncological applications, the principles of electroporation provide a unique tissue-selective ablation method that minimizes collateral damage. This review synthesizes findings from foundational animal studies through to recent clinical trials, such as the MANIFEST-PF and ADVENT trials, demonstrating PFA's effectiveness and safety. Future perspectives point towards expanding indications and refinement of techniques that promise to improve AF management outcomes further. PFA represents a paradigm shift in AF ablation, offering a safer, faster, and equally effective alternative to conventional methods. This synthesis of its development and clinical application outlines its potential to become the new standard in AF treatment protocols.

Transforming the Management of Articular Fractures in the Foot: A Critical Examination of Current Methods and Future Directions: A Review.

This study provides a comprehensive examination of the current methodologies and potential strategies for the treatment of articular fractures of the foot. In the field of orthopedic healthcare, these fractures present a significant challenge due to their complex nature and the fact that they affect the routines of patients. The motivation behind this study is based on two main concepts. The first one is represented by the use of emerging medical technologies and personalized medicine to bring a significant transformation in the management of foot fractures and give a better quality of treatment that is accepted by the patient. However, because there are inequities in the availability of the necessary medical care and equipment, as well as uneven incorporation in clinical settings, new technologies cannot be used to treat these types of fractures. Regarding the second concept behind this study, it is indicated that although current treatment methods are essential, they have a number of shortcomings when it comes to properly addressing these types of injuries. An approach is needed that takes into account the biomechanical points of view and the particularities of each patient. This approach could be applied in all hospital settings. Through this study, we want to highlight the progress made in recent years in surgical techniques such as 3D printing, minimally invasive surgery (MIS), and biological products. However, in the application of this new discovery, new obstacles have been discovered that prevent the efficient treatment of these types of injuries. This study examines the effectiveness and limitations of current treatments, as well as how differences in healthcare, such as available equipment, training of medical staff, and technological advances, affect patient outcomes in everyday life. This research wishes to emphasize that continuous innovation, interdisciplinary collaboration, and the use of an optimal approach that is appropriate for each patient, are essential. This study aims to provide new insights and useful recommendations for future research and clinical practice. The main role of this research is to improve the quality of life of patients and increase the standards of care in this complex field, which is in permanent evolution.

Novel Post-Harvest Preservation Techniques for Edible Fungi: A Review.

Edible fungi are well known for their rich nutrition and unique flavor. However, their post-harvest shelf-life is relatively short, and effective post-harvest preservation techniques are crucial for maintaining their quality. In recent years, many new technologies have been used for the preservation of edible fungi. These technologies include cold plasma treatment, electrostatic field treatment, active packaging, edible coatings, antimicrobial photodynamic therapy, and genetic editing, among others. This paper reviews the new methods for post-harvest preservation of mainstream edible fungi. By comprehensively evaluating the relative advantages and limitations of these new technologies, their potential and challenges in practical applications are inferred. The paper also proposes directions and suggestions for the future development of edible fungi preservation, aiming to provide reference and guidance for improving the quality of edible fungi products and extending their shelf-life.

Enhancing visualization and guidance in general surgery: a comprehensive and narrative review of the current cutting-edge technologies and future perspectives.

BACKGROUND: In the last decade, there has been a great effort in developing new technologies to enhance surgical visualization and guidance. This comprehensive and narrative review aimed to provide a wide and extensive overview of the current state of the art on this topic and their near-future perspectives linked to the development of artificial intelligence (AI), by focusing on the most recent and relevant literature. METHODS: A comprehensive and narrative review of the literature was performed by searching specific terms on PubMed/MEDLINE, Scopus, and Embase databases, assessing the current state of the art on this topic. RESULTS: Fluorescence-guided surgery, contrast-enhanced ultrasound (CEUS), ultra-high frequency ultrasound (UHFUS), photoacoustic imaging (PAI), and augmented reality (AR) are boosting the field of image-guided techniques as the rapid development of AI in surgery is promising a more automated decision-making and surgical movements in the operating room. CONCLUSION: Fluorescence-guided surgery, CEUS, UHFUS, PAI, and AR are becoming crucial to give surgeons a new level of information during the intervention, with the right timing and sequence, and represent the future of surgery. As many more controlled studies are needed to validate the employment of these technologies, the next generation of surgeons must become more familiar with the basics of AI to better incorporate new tools into the daily surgical practice of the future.

A survey of perceptions of exposure to new technology in residents and practicing ophthalmologists.

BACKGROUND: Incorporation of the rapid advances in ophthalmologic surgical and diagnostic techniques inherent in the field poses a challenge to residency training programs. This study investigates exposure to new technologies during residency and perception of its impact on practice patterns. METHODS: Ophthalmology residents at various training levels and practicing ophthalmologists who had completed their training were invited to participate in a survey study assessing exposure to various technologies in residency and in practice. Data collection occurred from December 2022 to June 2023. Descriptive statistics were performed. RESULTS: The study received 132 unique responses, including 63 ophthalmology residents and 69 practicing ophthalmologists. 65.2% (n = 45) of practicing ophthalmologists and 47.6% (n = 30) of current residents reported discussion/training on newly developed products on the market (e.g. premium IOLS, MIGS), was "minimally discussed but not emphasized" or "not discussed at all" in residency. 55.1% (n = 38) of practicing ophthalmologists reported that exposure to new technologies during residency did influence types of technologies employed during practice. The majority resident physicians reported enjoying being trained on newer technology and feeling more prepared for future changes in the field (95.2%, n = 60) and felt that having industry partnerships in residency enhances education and training (90.5%, n = 57). CONCLUSIONS: Considering how to maximize exposure to newer technologies/devices during residency training is important, and may contribute to training more confident, adaptable surgeons, who are more likely to critically consider new technologies and adopt promising ones into their future clinical practice.

Ultrasound-guided robotic surgical procedures: a systematic review.

INTRODUCTION: Ultrasound has been nicknamed "the surgeon's stethoscope". The advantages of laparoscopic ultrasound beyond a substitute for the sense of touch are considerable, especially for robotic surgery. Being able to see through parenchyma and into vascular structures enables to avoid unnecessary dissection by providing a thorough assessment at every stage without the need for contrast media or ionising radiation. The limitations of restricted angulation and access within the abdominal cavity during laparoscopy can be overcome by robotic handling of miniaturised ultrasound probes and the use of various and specific frequencies will meet tissue- and organ-specific characteristics. The aim of this systematic review was to assess the reported applications of intraoperative ultrasound-guided robotic surgery and to outline future perspectives. METHODS: The study adhered to the PRISMA guidelines. PubMed, Google Scholar, ScienceDirect and ClinicalTrials.gov were searched up to October 2023. Manuscripts reporting data on ultrasound-guided robotic procedures were included in the qualitative analysis. RESULTS: 20 studies met the inclusion criteria. The majority (53%) were related to the field of general surgery during liver, pancreas, spleen, gallbladder/bile duct, vascular and rectal surgery. This was followed by other fields of oncological surgery (42%) including urology, lung surgery, and retroperitoneal lymphadenectomy for metastases. Among the studies, ten (53%) focused on locating tumoral lesions and defining resection margins, four (15%) were designed to test the feasibility of robotic ultrasound-guided surgery, while two (10.5%) aimed to compare robotic and laparoscopic ultrasound probes. Additionally two studies (10.5%) evaluated the robotic drop-in probe one (5%) assessed the hepatic tissue consistency and another one (5%) aimed to visualize the blood flow in the splenic artery. CONCLUSION: The advantages of robotic instrumentation, including ergonomics, dexterity, and precision of movements, are of relevance for robotic intraoperative ultrasound (RIOUS). The present systematic review demonstrates the virtue of RIOUS to support surgeons and potentially reduce minimally invasive procedure times.

Giant Cell Tumor of the Frontal Bone: A Rare Case Report and Review of Literature.

Giant cell tumors (GCTs), typically benign, predominantly manifest in individuals aged 20-40, with the most common locations being the metaphysis or epiphysis of the femur or tibia. Infrequently, they may occur in the skull. Despite their benign nature, these tumors can exhibit aggressive behavior and have the potential to metastasize. In the case at hand, a 20-year-old female presented to the hospital with a progressively enlarging right frontal swelling over the preceding months. The patient reported intermittent headaches, alleviated by analgesics, and exhibited a normal neurological examination along with a Glasgow Coma Scale (GCS) score of 15 out of 15. Imaging revealed an expansive soft tissue mass in the right frontal bone involving both inner and outer tables. Surgical intervention was pursued through a right frontal incision followed by tumor excision. Histopathological examination of the specimen confirmed the presence of a GCT. The limited existing literature on this topic highlights the need for further research and insights into effective strategies. This case contributes to addressing this gap in knowledge, offering valuable information to enhance our understanding of the challenges associated with similar rare cases and improve patient outcomes.

"Masked dissociation": the many faces of technology.

After briefly explaining the concepts of dissociation and repression and discussing the new interest that the concept of dissociation has acquired within the actual psychoanalytic panorama, the author explains the concept of a dissociative continuum and presents Peter Goldberg's theory on somatic dissociation. Starting from this model, she proposes an interpretation of the use of technology, and especially of the internet, as a dissociative modality that helps separate the mind from the body, one that allows the maintenance of personal security-a concept dear to Sullivan-through physical distance. The implications of this point of view are discussed.

Physical activity advice given by French general practitioners for low back pain and the role of digital e-health applications: a qualitative study.

BACKGROUND: Low back pain is the fourth most common reason for consulting a general practitioner (GP) among people aged 40-50 years. Beyond the overall benefits of physical activity (PA) on health (psychological, cardiovascular, etc.), PA for low back pain seems to improve the prognosis in terms of pain, disability, and quality of life. The French National Health Insurance developed media campaigns to promote physical activity with low back pain and a smartphone application (app). Despite the known benefits and campaigns, GPs do not routinely provide advice about physical activity during low back pain consultations. To promote giving physical activity advice for low back pain, there is a need to understand how GPs currently provide this advice and whether technology could help. This study aims to explore the content of physical activity advice for low back pain that GPs provide in France, and their opinion about healthcare smartphone app provided electronically via the internet (e-health apps) as a support for this advice. METHODS: This qualitative study was conducted with semi-structured individual interviews among French GPs. The verbatim was double coded using a coding tree. Thematic analysis was performed using an inductive approach. RESULTS: Sixteen GPs from Maine et Loire, Sarthe, and Mayenne were included. The thematic analysis identified the following themes: GPs use a global patient-centred approach to physical activity advice for low back pain. The main goal is to enable patients to participate in their care. Advice was almost always general with little information about duration and frequency. The importance of patient-appropriate and easily achievable activities was emphasised. GPs referred patients to physiotherapists to reinforce regular physical activity, maintain motivation and improve patient adherence through supervision and follow-up. GPs knew little about e-health apps but felt they could be useful with young patients. The main barriers to their use included poor internet connection, lack of technical knowledge and no supervision meaning patients could injure themselves. CONCLUSIONS: This is one of the first studies to assess the contents of physical activity advice GPs provide for low back pain. Further research is needed into the implementation of e-health apps for low back pain management. TRIAL REGISTRATION: Not applicable.