Ewing sarcoma, the second most common primary bone cancer in children, requires intensive treatment that may lead to significant long-term sequelae, particularly in infants. We retrospectively analyzed data from 1621 French patients treated between 1988 and 2015 within the EW88/93/97 or EE99 trials, focusing on 17 infants diagnosed before 24 months of age (1% of the cohort). Their outcomes were compared to the 1245 older pediatric patients (aged 2-18 years). Infant Ewing sarcomas were more frequently extraosseous (29% vs. 8%, p = 0.0037). Acute chemotherapy tolerance was comparable between infants and children under 2 years of age and older children. With a median follow-up of 13.2 years (range: 7.8-15), adapted chemotherapy doses and reduced use of radiotherapy for local treatment, outcomes in infants were favorable, with the same rate of 88% for 5-year disease-free survival (DFS) and overall survival (OS). Two infants experienced localized recurrences, one of whom had undergone incomplete tumor resection without additional local treatment. At the last follow-up, long-term side effects were predominantly associated with local treatments, particularly surgery, rather than chemotherapy. However, given the young age of the patients, certain late toxicities (e.g., fertility impairment) remain unevaluated or could manifest in later years. Adapting chemotherapy doses to age and weight, combined with optimal local treatment, enables high survival rates in infants with Ewing sarcoma. Further monitoring is essential to assess long-term sequelae as this population ages.

Aim: Growth hormone deficiency (GHD) in pediatric patients is characterized by impaired growth and reduced quality of life. Recombinant human growth hormone therapy requires consistent daily administration, yet adherence remains challenging. Electronic injection devices with adherence monitoring, like Easypod®, may support more consistent administration and enable more accurate assessment of treatment response. This study evaluated the cost-effectiveness of somatropin administered via a connected injection device (EasyPod) compared with nonconnected devices in pediatric patients with GHD in Spain. Materials & methods: A microsimulation model simulated 10,000 pediatric patients aged 2-13 years and incorporated adherence-dependent growth response, treatment discontinuation, costs and utilities. Outcomes included final height, height gain, cost per cm gained and incremental cost per quality-adjusted life year gained. Scenario and sensitivity analyses assessed the impact of parameter and structural uncertainty. Results: Easypod was associated with greater height gains than nonconnected devices. Projected final height at bone maturation was 163.04 cm with Easypod versus 159.21 cm with nonconnected devices, an incremental gain of 3.83 cm. Cost per cm gained was €2625 with Easypod and €3158 with nonconnected devices, a saving of €534 per cm. The incremental cost per quality-adjusted life year gained was €27,200 within Spain's willingness-to-pay threshold. Scenario and sensitivity analyses showed consistent results. Conclusion: In this model-based analysis, Easypod was associated with improved growth outcomes and was cost-effective compared with nonconnected devices in pediatric GHD patients in Spain. Continuous adherence monitoring may support treatment optimization and more efficient healthcare resource utilization.

Extracting quantitative data from the growing body of scientific literature is a challenge central to modern research across disciplines. While recent advances in large language models have significantly facilitated automation of this traditionally time-consuming task, their computational demands limit scalability and accessibility. Smaller specialized systems offer reduced computational requirements but sacrifice accuracy, domain generalization, or the extraction of contextual details. To address these gaps, we present Quinex, a domain-agnostic framework for quantitative information extraction based on comparably small language models. Quinex identifies quantities and their associated entities, properties, and qualifiers using a multi-turn question-answering approach. By addressing the data bottleneck, considering implicit properties, and optimizing extraction order and question templates, Quinex achieves state-of-the-art F1 scores of over 98% for quantities, 82% for entities, and 87% for properties across diverse scientific genres. It goes beyond identification by normalizing units, aligning them with a unit ontology, and detailing critical qualifiers such as references, spatiotemporal scopes, and determination methods. By reducing the effort required to extract structured quantitative data from texts, Quinex enables transformative applications, including automated literature reviews, quantitative search, and trend monitoring, and sets a new benchmark for scalable, accurate, and domain-agnostic quantitative information extraction.

Visual awareness includes the ability to distinguish internally generated sensory experience from veridical percepts derived from the external world. Visual hallucinations (VHs) are an example of internally generated experience with important clinical implications and are common in Lewy body disease (LBD), with some patients aware of their hallucinations and others not. The awareness difference between LBD patients provides an opportunity to study the neural and neuropsychological mechanisms of hallucination awareness (VH-awareness). We hypothesized that VH-awareness would be associated with functional brain alterations in terms of resting-state functional connectivity (rs-FC) within and between cerebral systems involved in VH (intra-/inter-network rs-FC). In this cross-sectional study, we focused on visual association areas and networks (VIS) engaged in prediction errors (PEs) and reality monitoring, comparing LBD patients with preserved awareness of VH (VH-aware) to those with impaired awareness of VH (VH-unaware). Compared to the VH-aware group, the VH-unaware group showed reduced rs-FC between the VIS and PE in the right hemisphere, with no differences in rs-FC within each individual system. This suggests that VH-unawareness in LBD might reflect disruptions in implicit, online awareness processes and, specifically, may depend on impaired functional coupling between the brain regions providing perceptual contents to the hallucinatory experience and those evaluating its congruency with internal predictions. Furthermore, VH-unaware patients exhibited deficits in executive functioning, aligning with altered PE mechanisms and visuoperceptual abilities, which may represent the primary dysfunction defining VH content. Although preliminary, our findings provide a foundation for further investigations into VH-awareness in LBD and a model of visual awareness set within a general framework of perception, hallucination and consciousness. Future research will need to explore the proposed awareness model in diverse clinical populations to further unveil the mechanisms and wider clinical implications of one of the most distinctive aspects of brain function.

Disseminated cryptococcosis is a rare but serious opportunistic infection following solid organ transplantation and rarely occurs within the first month of transplantation. We report a case of disseminated Cryptococcus neoformans infection occurring 14 days after orthotopic heart transplantation which required mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Management was complicated by alterations in antifungal pharmacokinetics and the inability to perform serial lumbar punctures while anticoagulated. Antifungal therapy with nonliposomal amphotericin B, flucytosine, and fluconazole was administered. A combination of optic nerve sheath diameter measurements, CT scans, and evaluation for papilledema was used as temporizing, noninvasive surrogates for intracranial pressure monitoring until lumbar punctures could be safely performed. The patient was successfully decannulated, weaned from mechanical support, and discharged from the intensive care unit.