Assistance Publique–Hôpitaux de Paris (AP-HP) (French pronunciation: [asistɑ̃s pyblik opito də paʁi]) is the university hospital trust operating in Paris and its surroundings. It is the largest hospital system in Europe and one of the largest in the world. It provides the highest quality[citation needed] of health care, teaching, research, prevention, education and emergency medical service by very specialized doctors and experts in 52 branches of medicine. It is also the home to one of the highest-regarded[citation needed] residency and fellowship education programs in the world. It receives an average of more than 10 million patients per year.It employs more than 90,000 people in 44 hospitals and receives more than 10 million annual patient visits.It is linked with the University of Paris and its seven colleges of medicine, two of odontology and two of pharmacy as AP-HP is the university hospital for the capital and its surroundings.AP-HP is organized in several hospital local trusts, each associated to a faculty to offer integrative care to its population.As a teaching hospital, AP-HP Trust is in charge of training healthcare professionals and doctors, and plays a prominent role in French healthcare research alongside Inserm..
Stroke survivors with spasticity, an involuntary increase in muscle tone, often struggle to access specialized equipment and medical support for their rehabilitation. Rehabilitation exercises are daily routines requiring patients to perform repetitive movements of their spastic joints. To reduce patient mobilization within hospitals, offering orthoses suitable for use in home settings, outside of clinical environments, is required to limit the involvement of healthcare personnel in the treatment of hemiparesis for patients. Such orthoses must be designed to be portable and be able to tolerate the erratic motions of spasms without breaking or injuring patients. This paper presents the use of magnetorheological actuators to design an elbow orthosis, improving weight, reactivity, and transparence necessary for effective rehabilitation of spastic patients. A prototype is designed, built, and characterized experimentally. Results suggest that the technology is lightweight and highly transparent to erratic motion, and thus well-suited for spastic patients.
This study evaluates the clinical utility of an artificial intelligence (AI)-driven volumetric approach for assessing treatment response in colorectal liver metastases (CRLM) compared to conventional RECIST 1.1 measurements. We developed and validated an AI segmentation pipeline using the nnU-Net framework trained on 476 CT scans from three datasets (LiTS, MetaRec, and MetaBrest). Performance was evaluated on 112 held-out CT scans from MetaBrest. For clinical validation, 157 patients with CRLM from the PRODIGE 9–FFCD clinical trial with baseline and 3-month follow-up CT scans were assessed using both RECIST 1.1 and AI-volumetric methods. Overall survival analysis was performed to compare the prognostic value of both approaches. The nnU-Net model achieved a Dice similarity coefficient of 0.775 ± 0.211, with performance varying by lesion size (large: 0.899 ± 0.046; medium: 0.821 ± 0.135; small: 0.566 ± 0.330). In the overall validation cohort, both RECIST 1.1 and volumetric assessment demonstrated significant prognostic value for overall survival (p < 0.0001). In patients with liver-only metastases (n = 43), volumetric assessment showed significant prognostic stratification (p = 0.0150 at −30
BACKGROUND AND AIMS:Immune checkpoint inhibitors (ICI) are associated with life-threatening myocarditis but milder presentations are increasingly recognized. The same autoimmune process that causes ICI myocarditis can manifest concurrent generalized myositis, myasthenia-like syndrome, and respiratory muscle failure. Prognostic factors for this 'cardiomyotoxicity' are lacking. The main aim of this study was to determine predictors and construct a risk score associated with negative outcomes in patients admitted for ICI myocarditis. METHODS:A multicentre registry collected data retrospectively from 17 countries between 2014 and 2023. A multivariable Cox regression model was used to determine risk factors for the primary composite outcome: time to severe arrhythmia, heart failure, respiratory muscle failure, and/or cardiomyotoxicity-related death. Covariates included demographics, comorbidities, cardiomuscular symptoms, diagnostics, and treatments. Time-dependent covariates were used, and missing data were imputed. A point-based prognostic risk score was derived and externally validated. RESULTS:In 748 patients (67% male, age 23-94 years), 30-day incidence of the primary composite outcome, cardiomyotoxic death, and overall death were 33%, 13%, and 17%, respectively. By multivariable analysis, the primary composite outcome was associated with active thymoma (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7-7.7), presence of cardiomuscular symptoms (HR 2.6 [1.5-4.2]), low QRS voltage on presenting electrocardiogram (HR for ≤0.5 mV vs >1 mV 1.9 [1.1-3.1]), left ventricular ejection fraction (LVEF) < 50% (HR 1.7 [1.1-2.6]), and incremental troponin elevation (HR 1.8 [1.4-2.4], 2.9 [1.8-4.7], and 4.6 [2.3-9.3], for 20, 200, and 2000-fold above upper reference limit, respectively). A prognostic risk score developed using these parameters showed good performance; 30-day primary outcome incidence increased gradually from 4% (risk score = 0) to 81% (risk score ≥ 4). This risk score was externally validated in two independent French and US cohorts. This risk score was used prospectively in the external French cohort to identify low-risk patients who were managed with no immunosuppression resulting in no cardiomyotoxic events. CONCLUSIONS:ICI-associated myocarditis can manifest with high morbidity and mortality. Myocarditis severity is associated with magnitude of troponin, thymoma, low QRS voltage, depressed LVEF, and cardiomuscular symptoms. A risk score incorporating these features performed well. CLINICAL TRIAL REGISTRATION:NCT04294771 and NCT05454527.
ObjectivesTo alert on the risk of interhuman transmission of beta-amyloid (A beta) pathology leading to cerebral amyloid angiopathy (CAA) after non-neurosurgical procedures, here cardiovascular procedures, using cadaveric dura mater (DM) patches.MethodsWe describe 2 patients with a similar medical history of cardiac surgery for transposition of the great vessels and presenting with symptomatic hematomas revealing imaging features of probable CAA according to Boston 2.0 but with early onset.ResultsBoth patients lacked hereditary causes of CAA. PET amyloid imaging with 18F-flutemetamol evidenced diffuse brain amyloidosis, with abnormal A beta levels in CSF analysis. We propose a diagnosis of iatrogenic CAA after cardiac surgery using cadaveric DM.DiscussionThese 2 cases add to the growing evidence regarding A beta transmissibility in humans and remove the confounding factor of neurosurgery. Iatrogenic CAA diagnosis should be considered after exclusion of genetic causes in patients with early-onset clinical and neuroimaging features of CAA. Patient should have evidence of A beta accumulation in the CNS and a suggestive medical history. Treatments at risk should not be limited to neurosurgery and should namely include cardiovascular procedures with CNS tissues such as cadaveric DM or exposure to cadaveric human growth hormone.
OBJECTIVES:This study aims to provide an update of the European Alliance of Associations for Rheumatology (EULAR) rheumatoid arthritis (RA) management recommendations addressing the most recent insights. METHODS:An International Task Force was formed with a wide expertise and solicited 2 systemic literature research activities on the safety and efficacy of disease-modifying antirheumatic drugs (DMARDs). New evidence was discussed, considering the update from 2022. A voting process was applied to each item. Levels of evidence and strengths of recommendation were assigned, and participants voted on the levels of agreement. RESULTS:The task force agreed on 5 overarching principles and reduced the number of recommendations to 9 concerning use of conventional synthetic DMARDs (methotrexate [MTX], leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b)DMARDs (tumour necrosis factor inhibitors [adalimumab, certolizumab pegol, etanercept, golimumab, infliximab], abatacept, rituximab, tocilizumab, sarilumab, including biosimilars) and targeted synthetic [ts]DMARDs (namely the Janus kinase inhibitors [JAKi] tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target), and tapering following clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were considered. Initially, MTX ideally in combination with short-term GCs is recommended; upon insufficient response after 3 to 6 months, a bDMARD should be added; after careful consideration of risks, including MACEs, malignancies and/or thrombo-embolic events, JAKi may also be considered. If the first bDMARD (or JAKi) fails, any other bDMARD (from another or the same class) or JAKi (considering risks) is recommended. With sustained remission, DMARDs may be tapered, but caution is required as stopping often leads to a flare. Levels of evidence and levels of agreement were high for most recommendations. CONCLUSIONS:These updated EULAR recommendations provide consensus on RA management based on currently available evidence regarding efficacy, safety, and cost.
