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Depression is the leading cause of disability in many countries, contributing to an enormous burden on individuals, families, and healthcare systems.

While many individuals find relief through therapy and medication, a significant number of people do not respond to standard therapies, leaving them trapped in cycles of despair. These individuals often suffer from a form of depression known as melancholia, characterized by deep sadness, lack of motivation, an inability to experience pleasure, and physical symptoms such as significant weight loss and sleep disturbances.

For decades, psychiatrists have struggled to find effective treatments for melancholic depression that cannot be alleviated by traditional therapies. Some patients with this severe form of depression also exhibit symptoms that resemble catatonia – a condition that affects movement and responsiveness. People experiencing catatonia may become physically rigid, unable to speak, or stuck in repetitive motions.

Historically, catatonia was considered a separate disorder from depression, and was mainly associated with schizophrenia. However, recent research suggests that catatonia can also occur in people with mood disorders, particularly in those suffering from melancholic depression. This raises an important question: are melancholia and catatonia distinct conditions, or are they different expressions of the same underlying disorder?

Recent research by psychiatrist Dr. Yassir Mahgoub and his colleagues explores this question. Their study examines the relationship between melancholia and catatonia, shedding new light on how these conditions overlap and how they might be treated more effectively.

Traditionally, melancholic depression has been treated with antidepressants. Catatonia, on the other hand, is often managed with benzodiazepines – a class of drugs that includes lorazepam. Dr. Mahgoub and his colleagues proposed that some patients with melancholic depression may actually be experiencing an overlooked form of catatonia, and that benzodiazepines such as lorazepam could provide significant relief for these individuals.

In their study, Dr. Mahgoub and his team analyzed six patients who were hospitalized due to severe depressive episodes. These patients exhibited classic melancholic symptoms, including profound sadness, lack of motivation, loss of pleasure, anxiety, difficulty making decisions, and significant physical symptoms such as weight loss and sleep disturbances.

Additionally, they displayed psychomotor abnormalities – either moving very slowly or becoming unusually agitated. Such symptoms are commonly associated with catatonia rather than typical depression, leading Dr. Mahgoub’s team to investigate whether these patients might benefit from catatonia-specific treatment.

The patients were given lorazepam and were closely monitored. Remarkably, all six patients experienced a rapid and dramatic improvement soon after they were given lorazepam. Within hours, they became more alert, engaged, and able to make decisions. Some even regained their ability to interact socially, showing noticeable reductions in anxiety and physical symptoms.

One particularly striking case was a 54-year-old man with bipolar disorder who was admitted due to extreme irritability, paranoia, and suicidal thoughts. He refused to eat, and had persistent auditory hallucinations telling him to end his life. Despite many previous trials of antidepressants and antipsychotics, his condition had worsened. However, within hours of receiving lorazepam, his paranoid delusions faded, his appetite returned, and his mood drastically improved.

However, when the medication was discontinued, symptoms returned for all six patients.

This discovery is important because it challenges the way melancholic depression is currently treated. Many patients with this form of depression do not respond well to standard antidepressants. In some cases, standard antidepressants such as SSRIs can even exacerbate symptoms.

Dr. Mahgoub’s research suggests that GABA-related treatments like lorazepam may offer a better alternative for certain patients, particularly those with psychomotor symptoms. If further studies confirm these findings, they could lead to significant changes in how psychiatrists diagnose and treat severe depression.

Mahgoub’s research builds upon historical psychiatric observations. In the 19th century, the German psychiatrist Karl Kahlbaum described catatonia as a condition that could emerge in patients with severe depression.

Later, researchers such as Emil Kraepelin and Eugen Bleuler classified catatonia as a symptom of schizophrenia, effectively separating it from mood disorders. This separation has influenced psychiatric diagnoses for the past century, causing catatonia to be overlooked in cases of severe depression.

The study by Dr. Mahgoub and his colleagues revives Kahlbaum’s earlier perspective, arguing that catatonia is not limited to schizophrenia but can also be a crucial aspect of melancholic depression.

Another significant contribution from Dr. Mahgoub’s team is their proposal for refining how melancholia is diagnosed. Their work shows that in addition to symptoms like deep sadness and loss of pleasure, doctors should pay close attention to physical symptoms such as slowed movement or restlessness. Recognizing these symptoms could help identify patients who might benefit from treatments like lorazepam rather than standard antidepressants.

While the team’s findings are promising, their study has some limitations. The sample size was small, and more research is needed to determine whether these results apply to a larger group of patients. Additionally, benzodiazepines such as lorazepam can be habit-forming, so their long-term use must be carefully managed.

Future research should explore alternative treatments and develop better diagnostic tools for identifying patients who may have catatonic features within their depressive episodes.

Ultimately, the study by Dr. Mahgoub and his colleagues challenges long-held assumptions about depression and catatonia, suggesting that these conditions may not be as distinct as previously believed. By highlighting the effectiveness of lorazepam for certain types of severe depression, the team’s research opens the door to new treatment possibilities for patients who have struggled to find relief.

If larger studies confirm these findings, they could lead to a major shift in how psychiatrists approach treatment, offering new hope to those suffering from the most debilitating and persistent forms of depression.

To conduct reliable scientific research, laboratory animals need to be as healthy as possible. If a research colony is plagued by disease or environmental stress, experimental results become inconsistent and unreliable, making it difficult to draw meaningful conclusions or accurately identify subtle physiological phenomena. For killifish, this challenge is particularly complex.

Older killifish are more susceptible to disease, and it is not always clear if they are displaying signs of aging or illness. It can be difficult to identify and separate sick animals from the rest of the fish, meaning that disease can spread unchecked. Standardized guidelines for best practice in housing and caring for killifish have not been established by the research community, making the results from different labs potentially difficult to compare. Moreover, a full understanding of the pathogens that can take hold in laboratory killifish colonies, and what this means for the experimental results deriving from these colonies, has not been established.

Unlike mice or other commonly used lab animals, standardized health monitoring systems for these fish have been lacking, until now. Dr. Hoppe and her colleagues spent over four years meticulously tracking the health of killifish in their facility to create such a monitoring system. They developed a scoring system that helps identify whether a fish is thriving, showing mild signs of distress, or suffering from severe health issues. This system works much like a traffic light: green for healthy, yellow for mild concerns requiring monitoring, and red for serious conditions that may require humane euthanasia.

To ensure the accuracy of their system, the researchers implemented a rigorous daily inspection routine. Trained animal technicians used a standardized checklist to assess key indicators of health, including swimming behavior, feeding patterns, body condition, and the appearance of skin, fins, and eyes. This approach allowed the team to differentiate between different natural aging traits, such as reduced activity and mild spinal curvature, and symptoms of disease that required intervention.

One of the most significant findings was the identification of common pathogens affecting the fish. Using a combination of molecular diagnostics, examination of tissues, and routine environmental sampling, the team discovered that Mycobacterium species were frequently present in their colony, sometimes without causing visible illness. These bacteria, related to the ones that cause tuberculosis in humans, can persist in aquatic environments and pose a long-term risk to fish health.

Additionally, they identified a new pathogen for killifish, Loma acerinae, a parasite that infects the swim bladder, a gas-filled organ that helps fish maintain buoyancy. Affected fish developed a condition known as a buoyancy disorder, which prevented them from swimming normally. By carefully monitoring their colony and using genetic testing to sensitively detect the pathogens, the team was able to track and contain the outbreak, preventing widespread infection.

Beyond infections, the study also revealed important insights into aging-related health issues in killifish. Older fish were more likely to suffer from kidney disease, inflammation, and spinal deformities, conditions that mirror some human age-related diseases. Kidney pathology was particularly prevalent, with aged fish often developing nephrocalcinosis, a condition where calcium deposits build up in the kidneys, leading to organ dysfunction.

The researchers used a variety of diagnostic tools to assess fish health. One key method was histopathology, where tissue samples from fish were examined under a microscope to detect signs of infection, inflammation, or abnormal growths. This technique helped identify infections in the swim bladder and granulomas, clusters of immune cells responding to bacterial infections, in the kidneys and other organs.

Another essential tool was real-time polymerase chain reaction, a highly sensitive laboratory technique used to detect the presence of specific pathogens by amplifying their DNA. By analyzing both individual fish and environmental water samples, the team was able to identify bacterial and parasitic infections before they caused major outbreaks. In addition to laboratory testing, survival curve analysis, a statistical method used to study lifespan trends, provided insights into mortality patterns across different age groups.

Dr. Hoppe’s research doesn’t just improve the well-being of lab fish; it also benefits the broader scientific community. By reducing disease and improving health monitoring, researchers can obtain more accurate and reproducible results. The team’s work aligns with the “3Rs” principle of animal research, Replacement, Reduction, and Refinement, which aim to ensure that animals are used responsibly and humanely in scientific studies.

Furthermore, their approach demonstrates the importance of proactive health management in research facilities. Routine monitoring and early detection of disease not only protect fish from unnecessary suffering but also help maintain the integrity of scientific experiments. The introduction of a killifish-specific health score sheet provides a standardized method that can be adopted by other research institutions worldwide.

As more scientists turn to killifish for aging research, the findings from Dr. Hoppe and her colleagues will help shape better practices worldwide. Their work proves that good science starts with good animal care, and that even tiny fish can have a big impact on our understanding of life and longevity.

Dr. Omelu and his team focused on a critical question: Can health systems continue to offer evidence-based interventions (or EBIs for short) for colorectal cancer screening without ongoing financial support from programs like C4P? Their study explored how seven health systems and their 38 satellite clinics, which served underserved communities across California, navigated the challenge of sustaining these vital programs once funding from the CDC ended.

Colorectal cancer often develops from precancerous polyps in the colon or rectum. Screening tests such as the Fecal Immunochemical Test (or FIT for short) can detect these polyps early, sometimes even before they turn into cancer. FIT is a simple, noninvasive test that checks for hidden blood in the stool, an early warning sign of colorectal cancer. Compared to colonoscopy, which requires a more intensive preparation and procedure, FIT is more accessible, affordable, and easier to encourage among large populations. Part of the attractiveness of FIT lies in its convenience, requiring participants to provide a simple stool sample, rather than undergo an invasive colonoscopy, which would deter many participants in a routine screening program.

At the time C4P intervention was implemented, the U.S. Preventive Services Task Force recommended regular colorectal cancer screening for adults aged 50-75 (it has since been changed to 45-75), yet screening rates remain stubbornly low in many communities. The C4P program, funded by the Centers for Disease Control and Prevention, aimed to boost colorectal cancer screening rates in California by supporting health systems in implementing proven strategies.

These strategies, known as evidence-based interventions (EBIs), included patient reminders. These involved personalized message via letters, emails, text messages, or phone calls that aimed to alert patients when they were due for a screening. The system also included electronic alerts within patient health records that prompted doctors and nurses to recommend screening during visits. The EBIs also included supporting activities such as small media campaigns involving informational materials, brochures, posters, and videos designed to educate and motivate patients about colorectal cancer screening. Another key aspect was patient navigation services, where trained health workers guided patients through the often confusing healthcare process, helping them schedule tests, overcome language barriers, and address transportation issues. Community health workers were another key EBI resource and provided supporting activity. These local health advocates, often from the same communities they serve, provided culturally relevant education and support for colorectal cancer screening.

Dr. Omelu’s research revealed both promising successes and significant challenges. The study found that 100% of clinics sustained provider reminder systems (that remind healthcare staff a patient is due for screenings) and professional development initiatives. This suggests that once integrated into routine clinical workflows, these strategies became part of the daily practice, requiring minimal additional funding. 84% of clinics maintained patient reminder systems. Automated systems for patient outreach, like text message reminders, were relatively easy to keep running even without external funding. 71% of clinics continued small media campaigns. Many clinics had developed materials that could be reused without ongoing costs.

However, the situation was far more precarious for more personalized and resource-heavy interventions. Only 26% of clinics sustained patient navigation services. These services rely heavily on dedicated staff to work one-on-one with patients, a role that often disappears when funding vanishes. Just 21% retained Community Health Workers. Despite their crucial role in reaching marginalized populations, many clinics could not afford to keep such staff. 61% of clinics reported they lacked the funding stability to maintain colorectal cancer screening efforts long-term. Without secure financial resources, core supporting activity strategies like patient navigation and community outreach were at risk.

Funding stability emerged as the linchpin of sustainability. Programs such as patient navigation and Community Health Worker support require staffing, training, and community engagement, all of which depend on reliable funding. Clinics with strong financial support were far more likely to maintain these high-impact services. For example, the clinics that could sustain patient navigation were often those serving insured populations, allowing them to bill for some services. In contrast, clinics primarily serving uninsured patients found themselves unable to continue offering these personalized services.

The study also highlighted structural barriers beyond funding. Transportation issues, limited clinic hours, and language barriers were all cited as ongoing challenges to colorectal cancer screening access. Without patient navigators and Community Health Workers, these obstacles become even harder to overcome.

Dr. Omelu and his colleagues stress that sustainability doesn’t happen by accident, it requires deliberate planning and collaboration. They recommend that health systems integrate colorectal cancer screening into core operations. By embedding patient reminders, provider prompts, and data tracking into everyday workflows, clinics can reduce their reliance on temporary funding.

Clinics can also strengthen partnerships. Collaboration with organizations such as the American Cancer Society and local health departments can provide additional resources and support. Seeking additional funding sources could also help. Exploring multi-agency grants, state health programs such as Medi-Cal, community fundraising, and other stakeholder-based funding can help fill financial gaps. Investing in data and technology may also help to bridge the gap. Optimizing electronic health records ensures that clinics can track patient progress, identify screening gaps, and sustain key interventions with minimal cost.

Ultimately, Dr. Ndukaku Omelu and his team’s work highlights a critical truth: fighting colorectal cancer is about more than just medical tests, it’s about building systems that last. Their research offers a blueprint for sustaining colorectal cancer screening programs and many other public health programs, even in the face of funding challenges. As we move forward, their insights remind us that a healthier future requires not only innovation but also commitment, collaboration, and strategic planning.

Colorectal cancer is preventable, but only if the tools and support systems needed to catch it early are kept alive. With the right strategies, we can ensure that every community, regardless of funding cycles, has access to life-saving screening programs.

When we think of cartilage, we often imagine a single, uniform layer of translucent tissue. However, cartilage is studded with cells called chondrocytes that create and maintain a network of fibers in the wider space around them that give cartilage its structure, flexibility and strength. As cartilage undergoes significant abrasion during normal movement, it is a highly dynamic tissue, remodelling itself in response to mechanical and biochemical cues to maintain its structure. Chondrocytes play a key role in this process, creating and secreting the constituent components of the tissue. However, chondrocytes are also enclosed in a vital, lesser-known “cocoon” called the pericellular matrix (or PCM for short).

This microscopic cocoon surrounds individual chondrocytes and serves as both a shock absorber and a communication hub, helping cells to respond to mechanical forces and biochemical signals. In healthy cartilage, this matrix keeps chondrocytes well-organized and functioning efficiently, and it also protects them from the mechanical demands of this dynamic tissue, enhancing their survival. However, Dr. Danalache and her team have uncovered a disturbing truth: osteoarthritis attacks this protective chondrocyte cocoon at the very early stages of the disease, long before the visible destruction of cartilage begins.

As osteoarthritis progresses, the normally well-arranged chondrocytes shift from isolated strands to larger cell clusters, indicating ongoing degeneration. This change is not random; it directly correlates with the breakdown of the PCM. Chondrocytes lose their protective environment, making them more susceptible to mechanical stress and inflammation. This disruption compromises their ability to maintain cartilage integrity, which accelerates the disease process.

At the core of cartilage remodelling are MMPs, a group of enzymes that meticulously shape and maintain the extracellular environment. But in osteoarthritis, this balance is lost, and these enzymes accelerate the breakdown of the protective PCM. By analyzing cartilage from 148 osteoarthritis patients, Dr. Danalache’s team identified MMP-2, MMP-3, and MMP-7 as the primary drivers of this destructive shift.

To pinpoint the involvement of specific MMPs in PCM degradation, Dr. Danalache’s team employed a combination of advanced laboratory techniques. Cartilage samples were collected from osteoarthritis patients undergoing knee replacement surgery, ensuring a wide range of osteoarthritis severity. These samples were then analyzed using immunohistochemistry, a technique where specific proteins (such as enzymes) are labelled with fluorescent markers or dye and then viewed using a microscope. This allowed researchers to visually track the presence and distribution of specific MMPs within the tissue.

To further validate their findings, the team performed multiplexed immunoassays, a sophisticated technique that can detect multiple proteins simultaneously. This method revealed that MMP-2, MMP-3, and MMP-7 were consistently elevated in OA-affected cartilage. Dr. Danalache’s research group then assessed the activation states of these enzymes, confirming that they were not just present but actively degrading the PCM.

Perhaps most revealing was an experiment in which healthy cartilage was exposed to purified MMPs in a controlled environment. This approach allowed the researchers to observe, in real time, how collagen type VI and perlecan, both important components of the PCM, were broken down by these enzymes. The results confirmed that MMP-2 primarily degraded collagen type VI, while MMP-3 and MMP-7 targeted perlecan. This was a crucial discovery, as it pinpointed exactly how the PCM is dismantled during the early stages of OA.

What makes these findings so significant is that they highlight the earliest stages of osteoarthritis, before irreversible damage occurs. If MMP activity can be controlled early enough, it might be possible to preserve the PCM and slow down the entire disease process. Current treatments for osteoarthritis primarily focus on managing pain and symptoms, but this research suggests a more proactive approach: targeting the enzymes responsible for the initial cartilage breakdown and actively disrupting disease processes.

Potential therapies could involve developing drugs that specifically inhibit MMP-2, MMP-3, and MMP-7, preventing them from degrading the PCM. Such treatments could help maintain joint health for much longer, offering relief to millions who suffer from osteoarthritis. Scientists are exploring tissue inhibitors of metalloproteinases (or TIMPs for short), which are proteins that naturally regulate MMP activity. By enhancing TIMP function or developing synthetic MMP inhibitor drugs, researchers hope to create new treatments that protect the PCM from early degradation.

Moreover, advancements in biomaterials and regenerative medicine may provide additional ways to reinforce the PCM. Biomaterial-based scaffolds infused with TIMPs or growth factors could offer a dual approach, shielding chondrocytes while actively promoting tissue repair. Such innovations are still in their early stages, but they hold great promise for future osteoarthritis therapies.

While there is no cure for osteoarthritis yet, research like that of Dr. Marina Danalache and her team provides crucial insights into how the disease begins. By understanding the role of MMPs in PCM degradation, scientists can develop targeted interventions that may one day stop osteoarthritis in its tracks. For now, these findings serve as a reminder that the fight against joint degradation could start long before pain sets in. As science continues to unravel the complexities of OA, one thing remains clear: the key to healthier joints may lie in protecting chondrocyte cocoons.

CIED infections are not just minor inconveniences; they can be serious, sometimes leading to extended hospital stays, additional surgeries, and, in the worst cases, increased risk of death. These infections occur when bacteria enter the body during the implantation procedure or afterwards, causing complications that can spread beyond the device itself to surrounding tissues or even the bloodstream.

The study highlighted in Heddle’s Editorial analyzed data from over 37,000 patients who had undergone CIED procedures between 2016 and 2021. It found that about 1.1% of these patients developed infections within the first year, and the risk was highest in the first month after implantation. Among high-risk patients, those receiving device replacements or upgrades, the infection rate was even higher at 2.5%. The study also revealed that most infections required hospitalization, and in severe cases, complete removal of the device was necessary to treat the infection effectively.

While this percentage might seem small, it is significant given the growing number of people receiving these devices as our populations age. The consequences of infection can be severe, making it essential to identify who is most at risk and take preventive measures. A 1% infection rate represents hundreds of individuals facing serious health complications, additional medical interventions, and increased healthcare costs

The study identified several factors that increased the likelihood of infection. Surprisingly, people under 65 were more likely to develop infections than older patients. This may be because younger individuals are more likely to require additional procedures over time, increasing their exposure to infection risk. Moreover, certain procedures, such as cardiac resynchronization therapy with defibrillators, had a higher infection rate compared with procedures using standard pacemakers. Cardiac resynchronization devices are more complex and often require multiple leads, which increases the risk of bacterial contamination.

In addition, patients who had a prior CIED-related infection faced a significantly higher risk. Patients with a history of CIED infections had an 11.4 times higher risk of developing another infection, underscoring the need for careful monitoring and preventive measures. In addition, patients who had undergone multiple CIED procedures also faced increased risk. Each additional procedure introduces new opportunities for bacteria to enter the body, and the presence of scar tissue or device erosion could also play a role in infection risk. Patients with underlying health conditions were also at increased risk. Chronic illnesses such as kidney disease, chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy increased infection risk.

Conditions that weaken the immune system or require frequent hospital visits make patients more susceptible to infections. Those who had additional heart surgery at the time of their device implantation had a greater chance of developing infections. More extensive procedures increase the exposure time and complexity of the operation, raising infection risks.

Knowing the risk factors, doctors and patients can take several steps to reduce infections. These include judicious antibiotic use. The American Heart Association already recommends giving prophylactic antibiotic therapy before cardiac implantation to prevent infections. These antibiotics help kill bacteria that might be introduced during surgery.

Ensuring proper surgical hygiene, using antibiotic-coated device covers, and following strict aseptic surgical technique can also help to minimize risk. It is also important to monitor patients carefully after the procedure. Close follow-up, especially in the first month after implantation, can lead to early detection and treatment of infections. Symptoms such as redness, swelling, fever, or drainage near the implant site should be reported immediately.

Selecting which device to implant is also an important consideration in the context of infection risk. For high-risk patients, doctors might consider alternative treatment options or extra precautions during surgery. Newer technologies, such as absorbable, antibiotic-eluting envelopes that surround the device, have shown promise in reducing infection rates. Another option could be leadless pacemakers. Unlike traditional pacemakers, which require leads (thin wires) inserted into the heart, leadless pacemakers are small, self-contained devices placed directly inside the heart, reducing potential entry points for bacteria.

Moreover, patient lifestyle and self-care may also help to reduce infections. Patients can reduce their risk by maintaining good hygiene, avoiding unnecessary touching of the surgical site, and following post-surgical care instructions carefully.

CIEDs are essential medical advancements that have saved countless lives, but they come with risks that must be understood and managed. The study highlighted by Prof. William Heddle provides valuable insights into infection risks and reveals the need for improved prevention strategies.

For anyone considering a heart device or already living with one, open conversations with healthcare providers about infection prevention can make all the difference in staying healthy and complication-free. Patients should have open discussions with their doctors about the benefits and potential risks of device implantation before making a decision. Understanding the likelihood of complications allows individuals to make informed choices about their health. Physicians must ensure patients are aware of not only the immediate benefits of CIED implantation but also the long-term risks and possible complications.

By understanding these risks and taking proactive measures, both doctors and patients can work together to ensure safer, more effective heart treatments. With advances in medical technology and continued research into infection prevention, the future of CIED procedures looks promising.

Urinary tract infections (or UTIs for short) are among the most common ailments that bring pets to the vet. These infections, caused by bacteria, are typically treated with antibiotics. However, bacteria can adapt to these drugs over time, rendering treatments less effective or even useless. When this happens, infections persist longer, spread more easily, and become harder, and more expensive, to cure. Resistant bacteria can also sometimes jump between animals and humans, becoming a One Health issue and threatening public health.

The collaborative research driven by representatives of various animal health companies including Dr. Temmerman and conducted through the CEESA ComPath programme, seeks to understand and mitigate this risk. The programme monitors antibiotic resistance in companion animals across Europe, gathering valuable data to guide veterinarians in selecting effective treatments. By using rigorous, standardized methods across multiple countries, this initiative represents the gold standard for antimicrobial surveillance in pets.

Between 2013 and 2018, Dr. Temmerman and colleagues, through local partners, collected over 2,000 bacterial samples from dogs and cats with clinical signs of UTIs. Their analysis focused on two periods: ComPath II (running from 2013–2014) and ComPath III (running from 2017–2018). The results offered a mixed but largely encouraging picture.

The most frequently identified bacteria in UTIs were Escherichia coli (E. coli), responsible for nearly half of the cases in dogs and even more in cats. Encouragingly, E. coli exhibited low resistance rates to many antibiotics commonly used in veterinary medicine. For example, resistance to amoxicillin-clavulanic acid, a standard treatment, was less than 10%. This means that in most cases, veterinarians can rely on these drugs to treat infections effectively.

Not all findings were as positive. Resistance to doxycycline, an older antibiotic, was alarmingly high, nearly 99% in some cases. Similarly, resistance to fluoroquinolones (a class of powerful antibiotics) such as enrofloxacin and marbofloxacin was moderate, hovering around 10–12%. These results highlight the need for judicious use of antibiotics, reserving certain drugs for cases where other options have failed.

One of the most reassuring aspects of the study was the relatively low level of multidrug-resistant (or MDR) bacteria. MDR bacteria are capable of evading multiple antibiotics, making them particularly dangerous. In this study, MDR levels ranged from 0% in some pathogens to a manageable 11.7% in others. Compared to some reports of MDR bacteria in human medicine, these figures are heartening.

The scale and depth of the CEESA ComPath surveillance programme make it unique. By harmonizing collection and testing methods, Dr. Temmerman and his team ensured that results were consistent and comparable across countries. This is crucial because different testing methodologies across laboratories might lead to different results. Resistance patterns also can vary significantly by region due to differences in antibiotic use and local bacterial strains.

The programme’s findings don’t just inform veterinarians; they also have broader implications for public health. The bacterial species causing UTIs in pets are often similar to those affecting humans, and resistance traits can sometimes transfer between species. By monitoring these trends in animals, we gain early warnings that can guide human medicine as well.

Dr. Temmerman’s work exemplifies how collaboration between contract research organisations, the pharmaceutical industry, and academia can produce meaningful results. The veterinary pharmaceutical industry played a pivotal role by funding this research and ensuring that its findings were publicly available. This transparency is vital for fostering trust and advancing science.

By sharing these results openly, the industry empowers veterinarians to make evidence-based decisions, reducing the unnecessary use of antibiotics and helping to slow the march of resistance. For pet owners, these findings carry an important message: they can play a role in combating antibiotic resistance.

This involves following their vet’s advice, such as always completing the prescribed course of antibiotics, even if a pet seems to recover quickly. Stopping treatment early can allow resistant bacteria to flourish.

Pet owners should also avoid unnecessary antibiotic use. If a pet is unwell, consult a veterinarian rather than self-diagnosing. Not all infections require antibiotics, and a vet can determine the best course of action. Finally, by supporting vets who follow evidence-based practices, pet owners can further aid in the fight against antibiotic resistance. For instance, they can avail of clinics that emphasize diagnostic testing and responsible prescribing habits.

Dr. Temmerman and his colleagues’ work underscores the power of science to address complex challenges. While antibiotic resistance remains a global One Health concern, the low to moderate resistance levels observed in companion animals in this study offer hope. By continuing surveillance efforts and promoting responsible antibiotic use, we can protect the health of our pets, and ourselves.

This research is a testament to what can be achieved when science, industry, and the community work together. With vigilance and proactive measures, we can ensure that antibiotics remain effective tools for both human and animal health in the years to come.

Chest wall deformities have been known to humanity for millennia, even depicted in Egyptian tombs and Renaissance art. However, the medical understanding of and ability to effectively and safely treat such phenomena was absent until relatively recently. Pectus excavatum, in particular, occurs when the cartilage connecting the ribs to the sternum grows abnormally, causing the chest to sink inward. This can compress the heart and lungs, leading to unpleasant symptoms such as shortness of breath, chest pain, and fatigue.

By the 20th century, surgical techniques aimed at correcting these deformities became more ambitious. Early surgeons such as Sauerbruch in the 1930s and Ravitch in the 1940s developed invasive methods involving extensive removal of rib cartilage and cutting the sternum free from its natural attachments. These procedures, while groundbreaking for their time, often resulted in severe complications such as restricted chest flexibility, prolonged recovery times, and unsatisfactory cosmetic outcomes.

By the late 1990s, dissatisfaction with invasive techniques spurred new thinking. Prof. Donald Nuss introduced a groundbreaking minimally invasive procedure in 1997. Known as the Nuss procedure, it involves placing a curved stainless steel or titanium bar beneath the sternum through small incisions on either side of the chest. Once in place, the bar is rotated to push the chest outward, helping to reshape the rib cage by effectively ‘popping’ the sunken area back out. This simple yet ingenious technique capitalized on the natural flexibility of young patients’ chest walls, avoiding the trauma of cartilage removal.

The results of the Nuss procedure were transformative, offering not only cosmetic improvements but also enhanced breathing and cardiac function. The recovery process, too, was much shorter and less painful compared to older invasive treatment methods. Dr. Ivan Schewitz has further contributed to this treatment evolution by documenting and refining these modern techniques, ensuring their safety and efficacy. Together, Schewitz and Nuss have been at the forefront of an ongoing revolution in treating pectus excavatum.

The innovation in this space didn’t stop with surgical techniques. For younger patients, or those with milder deformities, non-invasive methods such as the vacuum bell suction device offer promising results. This device uses gentle suction from outside the chest to gradually correct its shape without any surgery, making treatment accessible to a wider range of patients. The vacuum bell is particularly effective in children with flexible chest walls, as it allows gradual reshaping over time with consistent use, but does require a suitably motivated patient who is willing to use the suction device for a couple of hours a day for at least one year.

Prof. Nuss’ procedure has also undergone significant refinement over the years. Improvements include stronger and more anatomically shaped bars, advanced imaging technologies to guide placement, and enhanced pain management strategies. For instance, techniques such as cryo-analgesia, which temporarily freezes nerves to reduce pain, have been introduced, allowing patients to recover more comfortably and leave the hospital within a few days. Postoperative care has also improved significantly, with innovations in nerve block techniques and patient-controlled pain relief contributing to quicker recoveries and minimal discomfort.

These advancements have not only made the procedure safer but also extended its applicability to older patients and those with more severe deformities. Adult patients, who previously faced limited options due to the rigidity of their chest walls, are now experiencing life-changing results thanks to these refinements.

The impact of these innovations goes beyond physical health. For many, a sunken chest is not just a medical issue but a source of deep psychological distress. Adolescents and young adults with pectus excavatum often report feelings of embarrassment, low self-esteem, and social withdrawal due to their appearance. The minimally invasive procedures developed by Nuss and championed by Schewitz have empowered patients to reclaim their confidence and live fuller lives.

The benefits may extend to physical performance as well. Many patients, particularly young athletes, experience significant improvements in stamina and exercise capacity after undergoing treatment. These changes stem from the relief of pressure on the heart and lungs, which allows for better oxygenation and circulation. Correcting severe cases of pectus excavatum may dramatically improve cardiac output and lung function, enabling patients to participate in activities they once avoided.

Families of young patients have also noted a profound difference in their children’s social interactions and emotional well-being post-surgery. Children who were once shy or withdrawn may become more outgoing, eager to engage in sports and other group activities. This shift highlights the far-reaching impact of these medical advancements on patients’ overall quality of life.

The shift from invasive to minimally invasive and non-invasive techniques in chest wall treatment exemplifies how medical progress can transform lives. The work of innovators such as Prof. Donald Nuss has opened doors to safer, more effective, and less traumatic solutions for patients worldwide. Today, individuals with pectus excavatum have access to treatments that not only restore their physical health but also their sense of dignity and confidence.

Their legacy reminds us that innovation isn’t just about advancing technology or increasing efficiency and profit margins, it’s about restoring hope and possibility to those who need it most. With ongoing research and refinement, the future of chest wall treatment looks brighter than ever. As techniques continue to evolve, the dream of a painless, quick, and universally accessible solution to chest wall deformities is closer than ever to becoming a reality.