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ImportanceBefore surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.ObjectiveTo evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery.Design, setting, and participantsRandomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France.InterventionPatients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115).Main outcomes and measuresThe primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery.ResultsOf the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes.Conclusions and relevanceAmong patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy.Trial registrationClinicalTrials.gov Identifier: NCT03374449.

Abstract Regional citrate anticoagulation use in intermittent hemodialysis is limited by the increased risk of metabolic complications due to faster solute exchanges than with continuous renal replacement therapies. Several simplifications have been proposed. The objective of this study was to validate a mathematical model of hemodialysis anticoagulated with citrate that was then used to evaluate different prescription scenarios on anticoagulant effectiveness (free calcium concentration in dialysis filter) and calcium balance. A study was conducted in hemodialyzed patients with a citrate infusion into the arterial line and a 1.25 mmol/L calcium dialysate. Calcium and citrate concentrations were measured upstream and downstream of the citrate infusion site and in the venous line. The values measured in the venous lines were compared with those predicted by the model using Bland and Altman diagrams. The model was then used with 22 patients to make simulations. The model can predict the concentration of free calcium, bound to citrate or albumin, accurately. Irrespective of the prescription scenario a decrease in free calcium below 0.4 mmol/L was obtained only in a fraction of the dialysis filter. A zero or slightly negative calcium balance was observed, and should be taken into account in case of prolonged use.

The diversity of the plant biomass available on earth makes plants an exceptional resource for replacing fossil resources in green chemistry, bioenergy and biobased materials. For numerous applications, and especially the high-tech ones (building block molecules, high-power bioenergy, additive manufacturing of biobased materials), the macrostructure assemblies of the plant biomass often need to be first broken down into a fine powder. This can be achieved by dry fractionation process combining comminution and sorting steps. The chemical and physical properties of the ground plant powder results both from the process conditions, the histological structure and chemical composition of the raw plant materials. In a forward engineering approach, the quality of the final products can be highly improved by the selection of the right powder (raw materials and production process) for the right application.This article provides production routes together with physical and chemical characterization of 10 biomass powders from 6 different biomass feedstocks (SP - spirulina, HI - hibiscus, PB - pine bark, HC - hemp Core, RH - rice husk and RHA - rice husk ash). These feedstocks represent a broad range of raw materials properties. For pine bark, hemp core, rice husk and rice husk ash, two grades of powders related to two different particle sizes were produced by two different routes to highlight the impact of the comminution process on the powder properties. The devices used and the process parameters are described. The morphological properties of the powder were quantified using laser diffraction (particle size) and image analysis (shape factor) and qualitatively analyzed with SEM. The specific surface area was determined using gas sorption with BET theory, and the hygroscopic properties were measured using direct vapor sorption. The chemical characterizations were determined with a set of biochemical assays and, complementary, FTIR and fluorescence spectra were recorded to provide fingerprints of samples. The dataset includes tables that summarize the main characteristic descriptors of each analysis as well as the raw data.The data are registered in the French Research Data Gouv public repository and also stored in the PO2 BaGaTel database using the PO2/TransformON ontology [1]. SPO2Q web tool allows on line querying of the database, which can also be consulted using PO2 manager desktop application [1–3]

Abstract A radiological accident, whether from industrial, medical, or malicious origin, may result in localized exposure to high doses of ionizing radiations, leading to the development of local radiation injury (LRI), that may evolve toward deep ulceration and necrosis of the skin and underlying tissues. Early diagnosis is therefore crucial to facilitate identification and management of LRI victims. Circulating microRNAs (miRNA) have been studied as potential diagnostic biomarkers of several diseases including hematological defects following whole-body irradiation (WBI). This study aims to identify a blood miRNA signature associated with LRI in a preclinical C57BL/6J mouse model of hindlimb irradiation using different 10-MV X-ray doses that lead to injuries of different severities. To this end, we first performed broad-spectrum plasma miRNA profiling, followed by a targeted validation step, on two independent animal cohorts. Using a multivariate sparse partial least square discriminant analysis, we identified a panel of eight circulating miRNAs able to segregate mice according to LRI severity. Interestingly, these miRNAs were previously associated with WBI (miR-150-5p, miR-342-3p, miR-146a-5p), inflammation (miR-18a-5p, miR-148b-3p, miR-532-5p) and skin diseases (miR-139-5p, miR-195-5p). Our results suggest the use of circulating miRNAs as suitable molecular biomarkers for LRI prognosis and diagnosis.

Abstract Triggering receptor expressed on myeloid cells 2 (TREM2) plays a critical role in microglial activation, survival, and apoptosis, as well as in Alzheimer’s disease (AD) pathogenesis. We previously reported the MS4A locus as a key modulator for soluble TREM2 (sTREM2) in cerebrospinal fluid (CSF). To identify additional novel genetic modifiers of sTREM2, we performed the largest genome-wide association study (GWAS) and identified four loci for CSF sTREM2 in 3,350 individuals of European ancestry. Through multi-ethnic fine mapping, we identified two independent missense variants (p.M178V in MS4A4A and p.A112T in MS4A6A) that drive the association in MS4A locus and showed an epistatic effect for sTREM2 levels and AD risk. The novel TREM2 locus on chr 6 contains two rare missense variants (rs75932628 p.R47H, P=7.16×10-19; rs142232675 p.D87N, P=2.71×10-10) associated with sTREM2 and AD risk. The third novel locus in the TGFBR2 and RBMS3 gene region (rs73823326, P=3.86×10-9) included a regulatory variant with a microglia-specific chromatin loop for the promoter of TGFBR2. Using cell-based assays we demonstrate that overexpression and knock-down of TGFBR2, but not RBMS3, leads to significant changes of sTREM2. The last novel locus is located on the APOE region (rs11666329, P=2.52×10-8), but we demonstrated that this signal was independent of APOE genotype. This signal colocalized with cis-eQTL of NECTIN2 in the brain cortex and cis-pQTL of NECTIN2 in CSF. Overexpression of NECTIN2 led to an increase of sTREM2 supporting the genetic findings. To our knowledge, this is the largest study to date aimed at identifying genetic modifiers of CSF sTREM2. This study provided novel insights into the MS4A and TREM2 loci, two well-known AD risk genes, and identified TGFBR2 and NECTIN2 as additional modulators involved in TREM2 biology.

Introduction In light of the burden of traumatic brain injury (TBI) in children and the excessive number of unnecessary CT scans still being performed, new strategies are needed to limit their use while minimising the risk of delayed diagnosis of intracranial lesions (ICLs). Identifying children at higher risk of poor outcomes would enable them to be better monitored. The use of the blood-based brain biomarkers glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1) could help clinicians in this decision. The overall aim of this study is to provide new knowledge regarding GFAP and UCH-L1 in order to improve TBI management in the paediatric population.Methods and analysis We will conduct a European, prospective, multicentre study, the BRAINI-2 paediatric study, in 20 centres in France, Spain and Switzerland with an inclusion period of 30 months for a total of 2880 children and adolescents included. To assess the performance of GFAP and UCH-L1 used separately and in combination to predict ICLs on CT scans (primary objective), 630 children less than 18 years of age with mild TBI, defined by a Glasgow Coma Scale score of 13–15 and with a CT scan will be recruited. To evaluate the potential of GFAP and UCH-L1 in predicting the prognosis after TBI (secondary objective), a further 1720 children with mild TBI but no CT scan as well as 130 children with moderate or severe TBI will be recruited. Finally, to establish age-specific reference values for GFAP and UCH-L1 (secondary objective), we will include 400 children and adolescents with no history of TBI.Ethics and dissemination This study has received ethics approval in all participating countries. Results from our study will be disseminated in international peer-reviewed journals. All procedures were developed in order to assure data protection and confidentiality.Trial registration number NCT05413499.

Abstract Objective Since 2015, Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) has been used in general anesthesia for preoxygenation or difficult exposure airway management. Its use offers new opportunities in laryngology. THRIVE increases apnea time and frees the access to the upper airway. However, its use may be less stable than orotracheal intubation. The main objective of this work was to evaluate the feasibility of laryngeal microsurgery under THRIVE including using Laser. Study Design Retrospective. Setting A total of N = 99 patients with laryngeal microsurgery (with or without CO2 laser) under THRIVE were included successively from January 1, 2020 to January 30, 2022. Method Medical history, comorbidities, clinical and surgical data were extracted and analyzed. Two groups were constituted regarding the “success” (use of THRIVE along all the procedure) or the “failure” (need for an endotracheal tube) of the use of THRIVE during the procedure. Results A failure occurred in N = 15/99 patients (15.2%) mainly due to refractory hypoxia. The odd ratios (OR) for THRIVE failure were: OR = 6.6 [2.9‐35] for overweight (BMI >25 kg/m2); OR = 3.8 [1.7‐18.7] for ASA score >2; OR = 4.7 [2.3‐24.7] for the use of CO2 laser. Elderly patients and patients with pulmonary pathology were not statistically at greater risk of THRIVE failure. No adverse event was described. Conclusion This work confirms the feasibility of laryngeal microsurgery under THRIVE, including with CO2 laser. Overweight, ASA >2 and lower fraction of inspired oxygen during CO2 laser use increased the risk for orotracheal intubation.

This paper analyzes spatial gestures and cognition in a new, or so-called “emerging”, visual language, the Yucatec Maya Sign Language (YSML). This sign language was created by deaf and hearing signers in various Yucatec Maya villages on the Yucatec Peninsula (Mexico). Although the sign language is not a signed version of spoken Yucatec Maya, both languages evolve in a similar cultural setting. Studies have shown that cultures around the world seem to rely on one preferred spatial Frame of Reference (FoR), shaping in many ways how people orient themselves and think about the world around them. Prior research indicated that Yucatec Maya speakers rely on the use of the geocentric FoR. However, contrary to other cultures, it is mainly observable through the production of gestures and not speech only. In the case of space, gestures in spoken Yucatec Maya exhibit linguistic features, having the status of a lexicon. Our research question is the following: if the preferred spatial FoR among the Yucatec Mayas is based on co-expressivity and spatial linguistic content visually transmitted via multimodal interactions, will deaf signers of an emerging language created in the same cultural setting share the same cognitive preference? In order to answer this question, we conducted three experimental tasks in three different villages where YMSL is in use: a non-verbal rotation task, a Director-Matcher task and a localization task. Results indicate that YMSL signers share the same preference for the geocentric FoR.

Radiolabeled peptides are valuable tools for diagnosis or therapies; they are often radiofluorinated using an indirect approach based on an F-18 prosthetic group. Herein, we are reporting our results on the F-18 radiolabeling of three peptides using two different methods based on click reactions. The first one used the well-known CuAAC reaction, and the second one is based on our recently reported hetero-Diels–Alder (HDA) using a dithioesters (thia-Diels–Alder) reaction. Both methods have been automated, and the 18F-peptides were obtained in similar yields and synthesis time (37–39% decay corrected yields by both methods in 120–140 min). However, to obtain similar yields, the CuAAC needs a large amount of copper along with many additives, while the HDA is a catalyst and metal-free reaction necessitating only an appropriate ratio of water/ethanol. The HDA can therefore be considered as a minimalist method offering easy access to fluorine-18 labeled peptides and making it a valuable additional tool for the indirect and site-specific labeling of peptides or biomolecules.

Ex-vivo lung perfusion (EVLP) has extended the number of transplantable lungs by reconditioning marginal organs. However, EVLP is performed at 37°C without homeostatic regulation leading to metabolic wastes’ accumulation in the perfusate and, as a corrective measure, the costly perfusate is repeatedly replaced during the standard of care procedure. As an interesting alternative, a hemodialyzer could be placed on the EVLP circuit, which was previously shown to rebalance the perfusate composition and to maintain lung function and viability without appearing to impact the global gene expression in the lung. Here, we assessed the biological effects of a hemodialyzer during EVLP by performing biochemical and refined functional genomic analyses over a 12h procedure in a pig model. We found that dialysis stabilized electrolytic and metabolic parameters of the perfusate but enhanced the gene expression and protein accumulation of several inflammatory cytokines and promoted a genomic profile predicting higher endothelial activation already at 6h and higher immune cytokine signaling at 12h. Therefore, epuration of EVLP with a dialyzer, while correcting features of the perfusate composition and maintaining the respiratory function, promotes inflammatory responses in the tissue. This finding suggests that modifying the metabolite composition of the perfusate by dialysis during EVLP can have detrimental effects on the tissue response and that this strategy should not be transferred as such to the clinic.

Introduction Lung transplantation (LTx) aims at improving survival and quality of life for patients with end-stage lung diseases. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used as intraoperative support for LTx, despite no precise guidelines for its initiation. We aim to evaluate two strategies of VA-ECMO initiation in the perioperative period in patients with obstructive or restrictive lung disease requiring bilateral LTx. In the control ‘on-demand’ arm, high haemodynamic and respiratory needs will dictate VA-ECMO initiation; in the experimental ‘systematic’ arm, VA-ECMO will be pre-emptively initiated. We hypothesise a ‘systematic’ strategy will increase the number of ventilatory-free days at day 28.Methods and analysis We designed a multicentre randomised controlled trial in parallel groups. Adult patients with obstructive or restrictive lung disease requiring bilateral LTx, without a formal indication for pre-emptive VA-ECMO before LTx, will be included. Patients with preoperative pulmonary hypertension with haemodynamic collapse, ECMO as a bridge to transplantation, severe hypoxaemia or hypercarbia will be secondarily excluded. In the systematic group, VA-ECMO will be systematically implanted before the first pulmonary artery cross-clamp. In the on-demand group, VA-ECMO will be implanted intraoperatively if haemodynamic or respiratory indices meet preplanned criteria. Non-inclusion, secondary exclusion and VA-ECMO initiation criteria were validated by a Delphi process among investigators. Postoperative weaning of ECMO and mechanical ventilation will be managed according to best practice guidelines. The number of ventilator-free days at 28 days (primary endpoint) will be compared between the two groups in the intention-to-treat population. Secondary endpoints encompass organ failure occurrence, day 28, day 90 and year 1 vital status, and adverse events.Ethics and dissemination The sponsor is the Assistance Publique–Hôpitaux de Paris. The ECMOToP protocol version 2.1 was approved by Comité de Protection des Personnes Ile de France VIII. Results will be published in international peer-reviewed medical journals.Trial registration number NCT05664204.

Summary: Background: Although immunomodulators have established benefit against the new coronavirus disease (COVID-19) in general, it is uncertain whether such agents improve outcomes without increasing the risk of secondary infections in the specific subgroup of previously immunocompromised patients. We assessed the effect of immunomodulators on outcomes of immunocompromised patients hospitalized for COVID-19. Methods: The protocol was prospectively registered with PROSPERO (CRD42022335397). MEDLINE, Cochrane Central Register of Controlled Trials and references of relevant articles were searched up to 01-06-2022. Authors of potentially eligible randomized controlled trials were contacted to provide data on immunocompromised patients randomized to immunomodulators vs control (i.e., placebo or standard-of-care). Findings: Eleven randomized controlled trials involving 397 immunocompromised patients hospitalized for COVID-19 were included. Ten trials had low risk of bias. There was no difference between immunocompromised patients randomized to immunomodulators vs control regarding mortality [30/182 (16.5%) vs 41/215 (19.1%); RR 0.93, 95% CI 0.61–1.41; p = 0.74], secondary infections (RR 1.00, 95% CI 0.64–1.58; p = 0.99) and change in World Health Organization ordinal scale from baseline to day 15 (weighed mean difference 0.27, 95% CI -0.09–0.63; p = 0.15). In subgroup analyses including only patients with hematologic malignancy, only trials with low risk of bias, only trials administering IL-6 inhibitors, or only trials administering immunosuppressants, there was no difference between comparators regarding mortality. Interpretation: Immunomodulators, compared to control, were not associated with harmful or beneficial outcomes, including mortality, secondary infections, and change in ordinal scale, when administered to immunocompromised patients hospitalized for COVID-19. Funding: Hellenic Foundation for Research and Innovation.

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• A shortage of investment may compromise society's ability to manage radiation risks. • ICRP announced a call for action to strengthen expertise in radiological protection. • In this paper, the authors expressed their support to the ICRP's call for action. The International Commission on Radiological Protection (ICRP), recently expressed concern that "a shortage of investment in training, education, research, and infrastructure seen in many sectors and countries may compromise society's ability to properly manage radiation risks" and in 2022 announced the "Vancouver call for action to strengthen expertise in radiological protection worldwide". As representatives of organisations in formal relations with ICRP, we decided to promote this position paper to declare and emphasise that strengthening the expertise in radiological protection is a collective priority for all of us. [ABSTRACT FROM AUTHOR]

La pneumopathie interstitielle diffuse (PID) compliquant la polyarthrite rhumatoïde (PR) est une manifestation extra-articulaire sévère. La mortalité dans la PR a été estimée entre 2 à 10 fois plus importante en cas de PID associée. Toutefois, les causes spécifiques de mortalité au cours de la PR-PID sont méconnues. Les patients atteints de PR-PID sont plus souvent fumeurs et ont une activité de la PR plus importante pouvant favoriser des causes de décès non-respiratoires telles que les maladies cardio-vasculaires. Notre objectif était de décrire les causes de décès au cours de la PR-PID. À l'aide d'une requête électronique, nous avons identifié l'ensemble des patients atteints de PR-PID suivis dans les services de rhumatologie et de pneumologie d'un CHU et décédés entre avril 2009 et février 2024. Le diagnostic de PR était validé par relecture des dossiers (critères ACR/EULAR 2010) et celui de PID par discussion multidisciplinaire avec scanner thoracique. Nous avons ensuite recueilli les causes directes et indirectes du décès selon les recommandations de l'organisation mondiale de la santé ainsi que des données cliniques et biologiques. Au total, 61 patients ont été inclus, 28 femmes (46 %), âge moyen au décès 72 ± 10 ans, 34 (56 %) fumeurs ou anciens fumeurs et 3 (7 %) ayant reçu une transplantation pulmonaire. Les circonstances du décès étaient disponibles pour 43 patients (70 %). Le décès était directement lié à une cause respiratoire non-infectieuse chez 15 patients (35 %) dont 7 à une exacerbation de PID et 6 à une insuffisance respiratoire chronique, Tableau 1. Une infection pulmonaire entraînait directement le décès chez 17 patients (40 %) dont 6 COVID-19, 1 aspergillose pulmonaire invasive et 3 pneumocystoses. Pour les autres patients, le décès était directement lié à des causes cardiovasculaires (n = 6, 14 %), à un cancer (n = 2, 5 %) et à une cause iatrogène (n = 1, 2 %). La PID favorisait indirectement le décès chez 16 patients (37 %). Parmi les autres causes indirectes, on retrouvait 5 infections (12 %) dont 3 infections pulmonaires hors COVID-19, 12 pathologies cardiovasculaires (28 %), 1 cancer (2 %), 2 causes iatrogéniques (5 %) et 1 pathologie gastro-intestinale (2 %), Tableau 1. La transplantation pulmonaire était indirectement liée au décès chez l'ensemble des patients transplantés (1 hémoptysie, 1 choc septique et 1 perte d'autonomie après des complications post-transplantation). Au total, le décès était considéré comme directement ou indirectement lié à la PID chez 29 patients (67 %). Les causes cardio-vasculaires étaient directement ou indirectement liées au décès chez 18 patients (42 %). Chez les patients sans transplantation pulmonaire ayant une capacité vitale fonctionnelle (CVF) < 80 % au diagnostic de PID, la principale cause directe de décès était l'insuffisance respiratoire chronique (6/15, 40 %) et chez ceux ayant une CVF > 80 %, il s'agissait de l'infection pulmonaire (10/24, 42 %). Dans notre étude, les décès chez les patients atteints de PR-PID étaient majoritairement liés à la PID. En plus des exacerbations de PID et de l'insuffisance respiratoire chronique, les infections pulmonaires et les causes cardio-vasculaires étaient fréquemment observées. Nos résultats soulignent l'importance de la prévention des maladies infectieuses et des évènements cardiovasculaires chez ces patients. [ABSTRACT FROM AUTHOR]

Les pneumopathies interstitielles diffuses (PID) associées aux maladies auto-immunes systémiques (MAIS) entraînent une importante morbi-mortalité. Dans la sclérodermie systémique (ScS), l'essai randomisé contrôlé contre placébo focuSSced montrait un ralentissement du déclin de la capacité vitale forcée (CVF) chez les patients traités par tocilizumab ayant une PID. Des Résultats similaires ont été observés dans une étude rétrospective incluant un nombre restreint de patients avec une PID associée à la polyarthrite rhumatoïde (PR). Notre objectif était d'évaluer l'efficacité et la tolérance en vie réelle des anti-interleukine 6 (IL6) dans les PID associées aux MAIS (MAIS-PID). Dans cette étude de cohorte rétrospective, nous avons identifié par requête électronique au sein d'un centre hospitalier tertiaire l'ensemble des patients atteints de MAIS-PID (au moins un code pour la PID et un code pour la PR, la ScS, le syndrome de Sjögren [SS], le lupus érythémateux systémique [LES], les myosites inflammatoires [MI], les connectivites mixtes [MCTD] ou les connectivites indifférenciées [UCTD]) initiant un traitement par anti-IL6. Le diagnostic de MAIS a été vérifié par relecture des dossiers et confirmé selon les critères de classification EULAR/ACR. Le diagnostic et l'aspect scanographique de la PID ont été validés en discussion multidisciplinaire à partir des données cliniques, biologiques et scanographiques. Nous avons collecté les données des explorations fonctionnelles respiratoires, l'évolution scanographique et les effets secondaires. Les trajectoires de la capacité vitale forcée (CVF) et de la diffusion du monoxyde de carbone (DLCO) au cours des 18 mois avant Introduction de l'anti-IL6 ont été comparées à celles au cours des 18 mois après Introduction de l'anti-IL6 par un modèle mixte linéaire à effets aléatoires. Nous avons inclus 38 patients initiant un traitement par anti-IL6 ayant une MAIS-PID (âge moyen 58,4 ans, 27 femmes, 12 MCTD, 8 ScS, 6 PR, 6 UCTD, 4 MI et 2 SS primitif, Tableau 1). À l'initiation de l'anti-IL6, les moyennes de la CVF et de la DLCO en pourcentage de la valeur théorique étaient respectivement de 74,7 % ± 19,4, et 45,8 % ± 16,7. Nous avons observé un changement significatif de la trajectoire de la CVF (+2,9 % par an après initiation de l'anti-IL6 contre −7,3 % par an avant, p = 0,002) et de la DLCO (+4,7 % par an après contre −0,17 % avant initiation du traitement vs, p = 0,02), Figure 1A. Sur les scanners thoraciques, après initiation de l'anti-IL6 (durée moyenne de 57,4 ± 26,1 semaines), l'extension de la PID était stable chez 19/38 patients, régressait chez 5/38 patients et se majorait chez 10/38 patients. La durée médiane de maintien du traitement était de 124 semaines (IC 95 % 73–330), Figure 2. Pendant le traitement par anti-IL6, 8 événements indésirables sont survenus : 3 infections sévères (2 COVID, 1 infection pulmonaire à mycobactérie atypique), 2 infections non sévères, 2 cancers, 2 décès et 1 cytolyse hépatique. Dans cette étude en vie réelle sur les MAIS-PID, une amélioration significative de la fonction pulmonaire était observée après Introduction d'un traitement par anti-IL6. Environ deux tiers des patients présentaient une amélioration ou une stabilité de l'extension scanographique de la PID sous anti-IL6. [ABSTRACT FROM AUTHOR]

Given the high mortality rate observed in our data, tocilizumab is not recommended as a salvage therapy for patients affected by acute exacerbation of pulmonary fibrosis who did not show clinical improvement after three steroids bolus https://bit.ly/3ClggYb., Competing Interests: Conflict of interest: M. Le Brun reports grants or contracts from GSK and AstraZeneca; payment or honoraria for lectures, presentations, manuscript writing or educational events from GSK, La revue du praticien and AstraZeneca; and support for attending meetings and/or travel from Asten Santé, Novartis and Sanofi; all outside the submitted work. Q. Philippot reports grants or contracts from Fondation Bettencourt Schuller and royalties or licenses form Elsevier, all outside the submitted work. C. Dupin reports consulting fees from AstraZeneca, Sanofi and GSK; lecture honoraria from AstraZeneca, GSK, Sanofi, Novartis, Chiesi, OPA Pratique, Pneumoscoop and La Lettre du Pneumologue; and travel support from AstraZeneca, Sanofi, Novartis, Chiesi and GSK; all outside the submitted work. M-P. Debray reports consulting fees from Boehringer Ingelheim and Sanofi, and support for attending meetings and/or travel form Boehringer Ingelheim, all outside the submitted work. R. Borie reports consulting fees from Boehringer Ingelheim, Ferrer and Sanofi; payment or honoraria for lectures, presentations, manuscript writing or educational events from Boehringer Ingelheim; and support for attending meetings and/or travel form Boehringer Ingelheim, all outside the submitted work. B. Crestani reports grants or contracts from Boehringer Ingelheim; consulting fees from BMS, Boehringer Ingelheim, Chiesi, GSK and Sanofi; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, BMS, Boehringer Ingelheim, GSK, Novartis, Roche and Sanofi; support for attending meetings and/or travel from AstraZeneca, BMS, Boehringer Ingelheim, Roche and Sanofi; participation on a data safety monitoring board or advisory board for BMS, Boehringer Ingelheim, Horizon and Sanofi; and he is president of the board of the Fondation du Souffle, a French charity, all outside the submitted work. G. Franco, P. Le Guen, C. Bancal and C. Taillé have no conflict of interest to declare., (Copyright ©The authors 2024.)

Background and Objective: Sarcoidosis can manifest with atypical findings on chest computed tomography (CT). Cysts are a rare manifestation of lung sarcoidosis. The aim of the study was to describe a series of patients with cystic sarcoidosis and their clinical-radiological characteristics and progression., Methods: In this retrospective, bicentric study we recruited all patients affected by sarcoidosis with lung cystic lesions at chest CT. We collected clinical characteristics, pulmonary tests and tracked number, distribution and size of the cysts at diagnosis and at the last evaluation., Results: Twelve patients (6 males, median age 53 years) were identified (prevalence: 1.9%; 95% Confidence Interval: 0.8%-2.9%). All patients presented multiple cystic lesions (median number: 14 [range: 2-216]) with a bilateral distribution in 10/12, micronodules and nodules in 11/12 and fibrotic lesions in 4/12. Seven patients had normal lung function test, three had an obstructive syndrome, one had a restrictive syndrome and one had coexistence of both. During follow-up (median: 10 years [range 1-16 years]), an increase of the number of cysts was observed in four patients. At last evaluation, 3/12 patients experienced a decline of forced vital capacity >10% and 3/12 patients a decline of diffusing capacity for carbon monoxide (DLCO) >10%. A lower DLCO at diagnosis, and the presence of nodules or fibrotic lesions on CT were associated with an increase in the number of cysts., Conclusion: Cystic lung lesions are rare in patients with sarcoidosis and do not influence long term prognosis., (© 2024 The Author(s). Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

Introduction: Methotrexate (MTX) is a folate antagonist used as an immunosuppressant in a number of conditions, including rheumatoid arthritis (RA). Low-dose MTX (MTX-LD) is associated with a risk of haematological, hepatic, gastrointestinal and pulmonary toxicity, which may up until now have limited its use., State of the Art: In RA, data from retrospective cohorts have reported a possible excess risk of methotrexate toxicity in cases of underlying interstitial lung disease (ILD). However, recent prospective and retrospective multicentre studies have found no such increased risk, and have reassuringly concluded that MTX-LD can be prescribed in cases of RA-associated ILD (RA-ILD)., Perspectives and Conclusions: Current recommendations are not to delay the introduction of MTX in patients with RA at risk of developing ILD or in the presence of RA-ILD with mild to moderate respiratory impairment., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Intro: An increased prevalence of serum anti-MCV antibody is observed in the serum of patients with idiopathic pulmonary fibrosis (IPF) but the clinical relevance of these antibodies is unknown., Methods: Patients from our center with a diagnosis of IPF according to the 2018 ATS/ERS/JRS/ALAT guidelines and at least one anti-MCV assay available were selected. All patients were part of the prospective cohort European IPF registry and selected between 03/2010 and 03/2018. We constituted two groups of patients according to the anti-MCV status at baseline to compare their characteristics at baseline and the evolution of lung function, survival and/or transplantation status., Results: Anti-MCV data were available for 101 patients, of whom 86 had complete clinical data available. Twenty-nine (34 %) patients had a positive anti-MCV assay (MCV+), at a low level in most patients (29 UI/mL [IQR 25-40]), and 57 (66 %) patients a negative assay (MCV-). MCV+ patients were 20 men and 9 women, with a median age of 73 years [IQR 67-78]. MCV- patients were 49 men and 8 women with a median age of 72 years [IQR 64-77]. Sixty-two (75 %) patients were ex-smokers and 5 (6 %) were active smokers. Median cumulative tobacco smoke exposure was 22.5 (15.0-38.6) and was similar in both groups. Lung function test results and HRCT pattern distribution was similar in both groups at baseline. The median duration of follow-up was 3.5 years [IQR 2.1-5.0]. Lung function decline was similar in both groups. During the study period, 31 (36 %) patients died or have been transplanted with no difference in transplant-free survival status between the two groups., Conclusion: Low level anti-MCV autoimmunity was prevalent in IPF patients., Competing Interests: Declaration of Competing Interest BC declares Grants or contracts from any entity for Boerhinger Ingelheim, Roche, BMS, Translate Bio; Consulting fees for Apellis, Boehringer Ingelheim, Roche, BMS, Translate Bio, Sanofi, Novartis; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events for Astra Zeneca, Boehringer Ingelheim, Roche, BMS, Sanofi; Support for attending meetings and/or travel for Astra Zeneca, BMS, Boehringer Ingelheim, Roche, Novartis; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid for President of the Fondation du Souffle (a French charity). RB declares Grants or contracts from any entity for Roche, Boehringer Ingelheim; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events for Roche, Boehtinger Ingelheim, Sanofi. A.G., S.O., P.D., P.L.G., P.N.R., C.T.N., C.L., M.P.D., C.T. : None, (Copyright © 2023. Published by Elsevier Masson SAS.)