Pasricha, Pankaj J.

Background Gastro-oesophageal reflux disease (GORD) occurs in most (∼75%) patients with systemic sclerosis (SSc) and significantly impacts quality of life. Current recommendations lack depth and therefore our aim was to produce practical, consensus-based recommendations for refractory SSc-related GORD. Methods An international, multidisciplinary steering board (SB) was assembled (n=19) consisting of clinicians (rheumatologists, gastroenterologists, gastrointestinal surgeons), an expert methodologist and patient representation. After reviewing the latest definitions of GORD and refractory GORD in the published literature, the SB collectively devised a practical definition of SSc refractory-GORD. Initial recommendations were drafted/agreed on by the SB based on review of the existing guidelines, published literature and expert opinion. Two online voting rounds were conducted to determine whether items should be accepted, with >75% and >60% SB agreement required for first and second rounds, respectively. Results There was a good response/completion rate for the initial (74%) and final (84%) voting rounds. The SB agreed on all 36 draft recommendations. The majority (n=34) were approved in the first round. Recommendations were organised according to the following categories: general approach to management (n=5), assessment (n=6), non-pharmacological (n=2) and pharmacological (n=10) management, endoscopic and surgical treatment (n=3), and special circumstances including refractory GORD and SSc-interstitial lung disease (n=3), myositis and SSc connective tissue disease-overlap (n=3) and perilung transplant (n=4). Conclusion The group of experts has drafted extended and practical recommendations for the management of SSc refractory-GORD. The necessity of a structured approach and a patient assessment is highlighted in order to provide a multidisciplinary approach to the tailored choice of the treatment. Our work also has also identified significant unmet needs and has provided a research agenda to advance the field.

Abstract Untethered mobile milli/microrobots hold transformative potential for interventional medicine by enabling more precise and entirely non‐invasive diagnosis and therapy. Realizing this promise requires bridging the gap between groundbreaking laboratory demonstrations and successful clinical integration. Despite remarkable technical progress over the past two decades, most millirobots and microrobots remain confined to laboratory proof‐of‐concept demonstrations, with limited real‐world feasibility. Here, we identify key factors that slow translation from bench to bedside, focusing on the disconnect between technical innovation and meaningful patient outcomes. We argue that the long‐term impact and sustainability of the field depend on aligning development with unmet clinical needs, demonstrating feasibility, value and integration potential into existing clinical workflows. To foster translational research of milli/microrobots, we introduce a strategic milli/microrobot Technology Readiness Level framework (mTRL), which maps system development from initial conceptualization to clinical adoption through clearly defined milestones and their associated stepwise activities. The mTRL model provides a structured gauge of technological maturity, a common language for multi‐disciplinary collaboration and actionable guidance to accelerate translational development toward new, safer and more efficient interventions.