Université de Rouen Normandie

Toxoplasmosis, a parasitic infection caused by Toxoplasma gondii, is widely distributed worldwide. Although it generally remains asymptomatic in immunocompetent individuals, it can lead to severe complications in immunocompromised patients, particularly those infected with HIV. These individuals are at increased risk of developing encephalitis, primarily due to the reactivation of a latent infection. Genotyping of T. gondii in humans is an essential tool for studying the epidemiology of this parasitosis. Previous studies have identified three main archetypal (classical) lineages or genotypes: type I, II, and III, as well as strains that show distinct and broader genetic variations. In this study, we report for the first time in Algeria the isolation and genetic characterization of the Africa 4 lineage of Toxoplasma gondii using microsatellites genotyping in an HIV-positive patient. This recently described clonal lineage in animal and human highlights the genetic diversity of T. gondii. This work underscores the need for studies to explore the prevalence and distribution of genotypes in the Maghreb region.

Neonatal laparoscopic surgery offers numerous advantages but remains challenging due to limited anatomical workspace and scarce training opportunities. Existing simulators often lack neonatal-specific anatomical realism. We developed and evaluated the Space Child Neonatal Trainer (SCNT), a low-cost (€10), fully 3D-printed neonatal laparoscopic simulator derived directly from patient-specific imaging data, designed to improve anatomical accuracy and training realism.

The SCNT was developed using anonymized CT scans of a one-month-old neonate. Anatomical segmentation was performed using 3D Slicer, with refinements in Blender and Fusion 360®, integrating realistic trocar entry points. Models were 3D-printed using thermoplastic polyurethane (TPU 87A) with infill density optimized by mechanical testing. Evaluation involved two phases: (1) a laparoscopic skills workshop with 21 pediatric surgery residents and three expert surgeons assessing realism and usability; (2) a comparative evaluation against the validated Pediatric Laparoscopic Simulator (PLS) with 22 first-year medical students, measuring task time, errors, and Objective Structured Assessment of Technical Skills (OSATS) scores.

Participants rated the SCNT highly for anatomical fidelity and usability (trocar placement: 4.0 ± 0.6; workspace adequacy: 4.2 ± 0.7). A comparative assessment revealed similar performance between SCNT and PLS across most metrics. Only tissue handling scores differed significantly, favoring PLS (p = 0.014). Mechanical analysis identified 15 % infill density as optimal for balancing flexibility and structural integrity, confirmed by expert surgeons for superior haptic realism.

The SCNT provides a realistic, cost-effective, anatomically precise neonatal laparoscopic trainer. Initial evaluations support its value in pediatric surgical education, though further validation in broader educational contexts is necessary.

To evaluate the efficacy and safety of adalimumab, anakinra, and tocilizumab in patients with active and refractory non-infectious uveitis (NIU).

Multicenter, Bayesian, randomized controlled trial.

A total of 112 patients with active, noninfectious, nonanterior uveitis across 27 French centers were enrolled.

Participants were randomly assigned (1:1:1) to receive either subcutaneous adalimumab (n=44; initial dose 80 mg, followed by 40 mg every other week), anakinra (n=18; 100 mg daily), or tocilizumab (n=50; 162 mg weekly) for a 16-week treatment period.

The primary endpoint was a reduction of at least two steps on the Miami 9-step scale for vitreous haze with a corticosteroid dose of 0.1 mg/kg/day or less at week 16.

During interim analyses, anakinra was shown to be ineffective, and this arm was stopped prematurely. By week 16, the primary outcome was achieved in 7/44 (16%) and 7/50 (14%) patients in the adalimumab and tocilizumab groups, respectively (mean difference -2.0%; 95% Credible interval, CrI -16.8% to +12.3%). Absence of macular edema and retinal vasculitis was seen in 54% and 56%, and 59% and 57%, respectively (mean differences -2.0% [95% CrI, -14% to +26%] and 2.0% [95% CrI, -31% to +15%]). A prednisone taper to ≤0.1 mg/kg/day at week 16 was reached by 59% and 74% of patients, respectively (mean difference -15%; 95% CrI, -4% to +32%). Mild-to-moderate adverse events occurred in 43% (adalimumab) and 54% (tocilizumab).

Adalimumab and tocilizumab show comparable efficacy in active, refractory NIU, whereas anakinra was ineffective.

ClinicalTrials.gov Identifier: NCT02929251.