OBJECTIVES:The systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) was specifically developed for paediatric Still's disease (SD) and has high construct validity and sensitivity to change, with validated operable thresholds. This study aims to validate the sJADAS10 and its thresholds in adults with SD. METHODS:The study involved adult patients with SD, followed in one unique reference centre. We extracted data necessary to assess disease activity according to the sJADAS10 and 4 other measures developed for adults with SD. As a reference, disease activity was classified as inactive disease (ID) or low disease activity (LDA), moderate disease activity (MDA), and high disease activity (HDA) according to the Rosina definitions. Weighted Cohen's kappa coefficients (wKappa) were used to evaluate the agreement between disease states according to the sJADAS10, the 4 other tools, and the reference. We compared the discriminative power (ID vs LDA/MDA/HDA or ID/LDA vs MDA/HDA) of the different tools by receiver operating characteristic (ROC) curves. RESULTS:Data were available for 129 different visits: according to the reference, 38 corresponded to ID, 19 to LDA, 33 to MDA, and 39 to HDA. The highest agreement with the reference was observed with the sJADAS10: wKappa (0.70) and accuracy (0.77). The sJADAS10 discriminative power was also high, with an area under the ROC curve for ID or a combination of ID and LDA at 0.94 and 0.97. CONCLUSIONS:The present study supports the external validity of the sJADAS10 in adults with SD. The sJADAS10 appears to be a relevant candidate for harmonised disease activity assessment across paediatric and adult SD populations.

BACKGROUND:Shorter leukocyte telomere length (LTL) has been reported in patients with rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) and linked to increased disease severity and mortality in idiopathic pulmonary fibrosis, which shares similarities with RA-ILD. We aimed to evaluate the impact of short LTL on baseline respiratory disease severity, disease progression and survival in patients with RA-ILD. METHODS:Patients diagnosed with RA-ILD following multidisciplinary assessment were enrolled in a prospective French observational study. LTL was measured at enrolment using qPCR. Short LTL was defined as age-adjusted LTL <10th percentile. Lung disease progression was defined as death, lung transplantation or functional respiratory decline (absolute decrease in forced vital capacity (FVC) ≥5% predicted or diffusing capacity of the lung for carbon monoxide (D LCO) ≥10% predicted). RESULTS:Among 101 patients with RA-ILD, 46% were male, mean±sd age at enrolment was 66±10 years and 43 (43%) had short LTL. Patients with short LTL had lower FVC % predicted (82% versus 93%) and D LCO % predicted (49% versus 63%) at enrolment, and greater 12-month decline in FVC % predicted and D LCO % predicted in mixed effects models (-7.7% (95% CI -11.6- -3.8%); p<0.001 and -4.5 (95% CI -7.2- -1.8%); p=0.001, respectively), although transplant-free survival was similar over a median (interquartile range) follow-up of 3.6 (1.8-7.0) years. Lung disease progression was observed within 12 months of enrolment in 33 (33%) patients, more frequently in patients with short LTL (47% versus 22%; univariate p=0.011) and lower FVC at enrolment. Multivariate logistic regression identified lower FVC and short LTL as predictors of 12-month progression (OR 0.97 (95% CI 0.94-1.00); p=0.031 and OR 2.80 (95% CI 0.99-8.29); p=0.056, respectively). CONCLUSION:Short LTL is associated with baseline severity and 12-month progression in RA-ILD.

Background: Cyclops syndrome is loss of terminal knee extension caused by a fibrous nodule developed in the anterior intercondylar notch. The many known risk factors include preoperative motion-range limitation, tibial tunnel malposition, and tight hamstrings. The primary objective of this study was to assess whether intercondylar notch size was associated with the risk of cyclops syndrome or graft tear after anterior cruciate ligament (ACL) reconstruction using a quadruple semi-tendinosis autograft. The secondary objective was to determine whether intercondylar notch size was associated with functional outcomes. Hypothesis: A narrow intercondylar notch is associated with higher risks of cyclops syndrome and poor functional outcomes. Methods: Consecutive patients who underwent ACL reconstruction by quadruple semi-tendinosus autograft were included retrospectively. Preoperative magnetic resonance imaging scans were assessed by a single senior surgeon, who determined the conventional notch width index (NWI) and the anterior NWI (aNWI) for each patient. Results: The 120 included patients had a mean follow-up of 2.4 +/- 0.8 years. Among them, 20 (16.7%) experienced cyclops syndrome and 7 (5.8%) graft rupture. At last follow-up, 26 (21.7%) had not returned to sports and only 47 (39.2%) had returned to sports at the pre-injury level. The mean Lysholm score was 87.9 +/- 13.5 and the main subjective IKDC score was 84 +/- 13. A narrow notch was significantly associated with lower likelihoods of returning to sports (p = 0.001), returning to the same sport (p < 0.0001), and returning to the pre-injury sport level (p = 0.004). By multivariate analysis, only the aNWI index was significantly associated with the risk of cyclops syndrome (p < 0.0001). An aNWI index lower than 0.18 had 85% sensitivity and 78% specificity for predicting cyclops syndrome. Conclusion: A narrow anterosuperior intercondylar notch may increase the risk of cyclops syndrome after ACL reconstruction using a quadruple semi-tendinosus graft but is not associated with the risk of graft rupture. Level of evidence: IV, retrospective observational cohort study. (c) 2024 Published by Elsevier Masson SAS.

OBJECTIVE:Musculoskeletal pain (MP) is a leading cause of disability worldwide, affecting individual well-being and public health. However, in the literature, the prevalence of MP varies considerably because of methodological inconsistencies, selection biases, and differences in case definitions. This study aimed to estimate the population-based prevalence of MP in France and identify key demographic, socioeconomic, and occupational factors associated with MP. METHODS:This cross-sectional study used baseline data for the CONSTANCES cohort study, a large, population-based epidemiological study with participants representative of the French adult population (18-69years old). Inverse probability weighting was used to correct for selection bias and to improve the generalizability of prevalence estimates. MP was assessed with the Nordic Musculoskeletal Questionnaire, with significant pain defined as lasting>30days in the past 12months. Multivariate logistic regression models were used to identify factors associated with low back pain, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS:Among 193,436 participants, 46.2% reported pain in at least one anatomical site. The most affected areas were the low back (26.6% adjusted prevalence), shoulder (21.4%), neck (19.0%), and knee (19.1%). Odds of low back pain was associated with female sex (OR: 1.39 [95% CI: 1.32-1.47]), older age, obesity, depression (1.71 [1.62-1.80]), and comorbidity burden (1.20 [1.15-1.25]). Odds of low back pain was associated with moderate or high occupational physical activity (OR: 1.33 [1.20-1.50] and 1.69 [1.48-1.93]) but was inversely associated with very active leisure-time physical activity (0.82 [0.70-0.96]). Education level but not household income was a significant socioeconomic factor associated with MP. CONCLUSION:MP imposes a substantial burden on the French population, particularly among individuals with physically demanding jobs and low education levels. These findings highlight the paradox of physical activity associated with MP.

OBJECTIVE:Subarachnoid hemorrhage (SAH) is a critical condition with high morbidity and mortality. Despite medical advances, predicting functional outcomes 1 year after the hemorrhage remains challenging. The aim of this study was to develop, compare, and validate a predictive score for 1-year functional outcomes after SAH. METHODS:This monocentric, retrospective observational study included all adults admitted to a neurosurgical ICU for aneurysmal SAH from 2002 to 2020, excluding moribund patients. The primary endpoint was a poor 1-year functional outcome, defined as a modified Rankin Scale score of 4 to 6. Independent risk factors for poor outcomes were identified using multivariate logistic regression in a derivation cohort. The predicting SAH long-term outcome (PSL) score was compared with the World Federation of Neurosurgical Societies (WFNS), Fisher, and admission bioclinical scores and validated in an independent cohort. RESULTS:In the overall population (n = 1564), 21% experienced poor functional outcomes at 1 year. In the derivation cohort (n = 1095), independent predictors of poor outcomes included age (p < 0.001), WFNS score (p < 0.001), troponin level (p = 0.007), S100β level (p = 0.01), surgical or coiling complications (p < 0.001), incomplete aneurysm exclusion (p = 0.03), and hydrocephalus requiring CSF drainage (p = 0.002). The PSL score achieved an area under the receiver operating characteristic curve (ROC-AUC) of 0.85 (95% CI 0.82-0.88), outperforming other scores. These findings were consistent across various subgroups. In the validation cohort (n = 469), the PSL score achieved an ROC-AUC of 0.80 (95% CI 0.74-0.85), surpassing the WFNS and Fisher scores, with a negative predictive value of 95% (95% CI 94%-97%). CONCLUSIONS:The authors developed a simple and effective score to identify predictors of poor 1-year functional outcomes at admission and early after aneurysmal SAH in a large cohort.

Background and objective Magnetic resonance imaging (MRI) plays a critical role in prostate cancer diagnosis, but is limited by variability in interpretation and diagnostic accuracy. This systematic review evaluates the current state of deep learning (DL) models in enhancing the automatic detection, localization, and characterization of clinically significant prostate cancer (csPCa) on MRI. Methods A systematic search was conducted across Medline/PubMed, Embase, Web of Science, and ScienceDirect for studies published between January 2020 and September 2023. Studies were included if these presented and validated fully automated DL models for csPCa detection on MRI, with pathology confirmation. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and the Checklist for Artificial Intelligence in Medical Imaging. Key findings and limitations Twenty-five studies met the inclusion criteria, showing promising results in detecting and characterizing csPCa. However, significant heterogeneity in study designs, validation strategies, and datasets complicates direct comparisons. Only one-third of studies performed external validation, highlighting a critical gap in generalizability. The reliance on internal validation limits a broader application of these findings, and the lack of standardized methodologies hinders the integration of DL models into clinical practice. Conclusions and clinical implications DL models demonstrate significant potential in improving prostate cancer diagnostics on MRI. However, challenges in validation, generalizability, and clinical implementation must be addressed. Future research should focus on standardizing methodologies, ensuring external validation and conducting prospective clinical trials to facilitate the adoption of artificial intelligence (AI) in routine clinical settings. These findings support the cautious integration of AI into clinical practice, with further studies needed to confirm their efficacy in diverse clinical environments. Patient summary In this study, we reviewed how artificial intelligence (AI) models can help doctors better detect and understand aggressive prostate cancer using magnetic resonance imaging scans. We found that while these AI tools show promise, these tools need more testing and validation in different hospitals before these can be used widely in patient care.

Global health (GH) and health-related quality of life are patient priorities in axial spondyloarthritis (axSpA). Our objective was to assess the relative importance of disease-related factors including disease activity, and patient-related factors including comorbidities, to explain GH in axSpA. Post hoc cross-sectional analyses of 4 sets (COMOSPA, PERSPA, COMEDSPA, and DESIR) of patients fulfilling ASAS criteria for axSpA. GH was assessed through the ASAS Health Index (ASAS-HI) or the EuroQoL-5D-3L (EQ-5D). Disease-related factors included disease activity (ASDAS, psoriasis, arthritis, enthesitis, and CRP), disease duration, diagnostic delay, bamboo spine, and treatment. Non-disease-related factors included sociodemographic characteristics, comorbidities and chronic widespread pain. Multivariable logistic and linear regressions and partial variances (R2) were applied to identify independent determinants of GH. In 6064 patients (range 284–2756 across datasets), mean age ranged 38.9–45.8 years, 51–68

ObjectivesIn axial spondyloarthritis (axSpA), patient-perceived quality of life/global functioning and health (GH) can be assessed using disease-specific [Assessment of SpondyloArthrit is international Society Health Index (ASAS-HI)] or generic [(3-level EuroQol 5 Dimensions (EQ-5D-3L)] scores. Our objectives were to explore the link between these scores and to define thresholds for good and poor GH.MethodWe conducted a post-hoc analysis of the cross-sectional ASAS-PerSpA study for patients fulfilling ASAS criteria for axSpA. The ASAS-HI and EQ-5D scores were analysed visually (distribution, scatterplot) and through Spearman correlation and agreement (deciles). To determine cut-offs for good and poor GH on EQ-5D based on the validated <= 5 and >= 12 cut-offs for ASAS-HI, respectively, receiver operating characteristics (ROC) curves and distribution-based methods were applied. Validity was assessed using crude concordance and prevalence-adjusted bias-adjusted kappa; discordance between groups was explored.ResultsIn 2651 patients (median age 41.0 years, 66.5% men), the correlation between ASAS-HI and EQ-5D was high (r = -0.73) and agreement (between deciles) was moderate (weighted kappa = 0.51). Both ROC areas under the curve were 0.86; thresholds of 0.69 and 0.54 for EQ-5D were chosen for good and poor GH, respectively. Crude concordances and agreement were satisfactory (0.80-0.81 and 0.60-0.61, respectively). The EQ-5D cut-off for good GH performed better than that for poor GH.ConclusionASAS-HI and EQ-5D were highly correlated but did not fully overlap. We propose EQ-5D thresholds corresponding to the ASAS-HI thresholds for good and poor GH; however, caution is needed when assessing poor GH with EQ-5D. These findings will be useful to compare GH when only one of the outcome measures is available.

Introduction L’atteinte cardiaque dans la maladie de Still de l’adulte (MSA) constitue une complication potentiellement sévère et relativement fréquente. Cependant, les facteurs prédictifs et les modalités de prise en charge sont encore mal définis. Nous avons réalisé une étude rétrospective multicentrique pour décrire les manifestations, les traitements et l’évolution de l’atteinte cardiaque dans la MSA. Matériels et méthodes Les patients ont été inclus à partir de trois bases de données différentes provenant d’hôpitaux français. Tous répondaient aux critères de Yamaguchi et/ou de Fautrel. Les données démographiques, cliniques, biologiques, ainsi que les modalités thérapeutiques de 66 patients avec atteinte cardiaque (groupe MSA+C) ont été recueillies, analysées et comparées à celles de 126 témoins sans atteinte cardiaque (groupe MSA–C) Résultats L’atteinte cardiaque est survenue au début de la MSA, avant ou pendant la phase de diagnostic dans 62/66 (93,9 %) des cas, avant tout traitement spécifique (Tableau 1). Le groupe MSA+C présentait au diagnostic une maladie plus active sur le plan clinique (avec plus fréquemment une odynophagie, une hépatosplénomaglie, des myalgies, un syndrome d’activation macrophagique (SAM), une pleurésie), biologique (avec des valeurs plus élevées de globules blancs, de polynucléaires neutrophiles, de ferritine et de CRP) et sur le plan du score modifié de Pouchot qui était en moyenne (±écart-type) plus élevé (7±1,6 contre 3,8±1,3 ; p=0,001). Les complications cardiaques incluaient dans 36/66 (54,5 %) des cas une péricardite (dont une tamponnade chez 6 patients), 29 (44 %) des cas une myocardite et 1 (1,5 %) cas d’endocardite non infectieuse (Tableau 2). Les symptômes cardiaques étaient non spécifiques et incluaient le plus souvent une douleur thoracique (73,7 % des cas), ou une dyspnée (52,6 %). Des signes d’insuffisance cardiaque droite étaient présents chez un peu plus de 15 % des patients, et 9 % n’avaient pas de symptômes cardiaques (découverte sur bilan systématique). Les facteurs prédicteurs d’atteinte cardiaque étaient la présence d’un score modifié de Pouchot élevé, d’une hépatomégalie, d’un épanchement pleural, de myalgies et d’une CRP élevée. Moins de 50 % des patients sous glucocorticoïdes (GC) seuls en première ligne de traitement ont atteint une rémission complète, tandis que 90–100 % des patients ayant combiné les GC avec de l’anakinra ou du tocilizumab y sont parvenus (Fig. 1). Bien que 50 % des patients aient été initialement pris en charge dans des unités de soins intensifs, il n’y a pas eu de décès. Conclusion Ce travail représente la plus grande série rapportée de patients atteints de MSA présentant une atteinte cardiaque. Celle-ci est le plus souvent inaugurale, et semble être associé à une MSA plus active. Le fait que près de 10 % de patients n’avaient pas de symptômes cardiaques (découverte fortuite sur bilan systématique) pose la question d’un dépistage systématique, a fortiori si la MSA est très active. Nos résultats soutiennent l’utilisation précoce de la biothérapie anti-IL1 ou anti-IL6 en combinaison avec les GC, et d’une prise en charge multidisciplinaire.

Background: RA-associated interstitial lung disease (ILD) and idiopathic pulmonary fibrosis (IPF) share the MUC5B rs35705950 genetic risk factor and a predilection for the usual interstitial pneumonia (UIP) pattern. The role of telomere-related genes (TRGs) in the RA-ILD genetic background is unclear. Previous work found an excess of TRG rare exonic variants in RA-ILD compared to healthy controls. However, lack of RA controls without ILD precluded an investigation of whether the enrichment for rare variants in TRGs was associated with the RA or ILD pattern. Objectives: To investigate the contribution of TRG rare variants to ILD vs. no ILD in patients with RA, and to IPF vs. healthy controls. Methods: For the RA analyses, this genetic case-control association study consisted of a derivation (France) and a replication (US) sample that included cases with RA-ILD and controls with RA without ILD (RA-noILD). For the IPF analyses, cases with IPF were compared to healthy controls without IPF. Whole exome or genome sequencing was performed in all participants. ILD status and pattern (UIP or non-UIP) was determined by review of clinically-indicated high-resolution computed tomography (HRCT) chest imaging. Exonic variants from 14 candidate TRGs previously associated with IPF or linked to familial pulmonary fibrosis (TERT, TERC, PARN, RTEL1, CTC1, TINF2, ACD, POT1, NAF1, ZCCHC8, NHP2, NOP10, WRAP53, and DKC1) were identified and annotated for their frequency by gnomAD database and their functional impact using predictive tools (SIFT, POLYPHEN-2, and CADD score). Telomere length (TL) was measured in RA cases and controls from the derivation sample, in IPF cases and in non-IPF healthy controls. TRG rare variants enrichment in cases and controls was compared using the classical burden test adjusted for sex, age at RA, RA duration, MUC5B rs35705950 genotype and principal component of ancestry. Derivation and replication results were combined and meta-analyzed. We performed sub-group analyses restricted to cases with TL < 10th percentile. Results: In the RA analyses, the derivation sample included 157 RA-ILD cases and 231 RA-noILD controls, and the replication sample included 85 RA-ILD cases and 305 RA-noILD controls; Table 1. In the derivation sample, we identified 19 distinct rare TRG variants carried by 13/157 RA-ILD cases and 8/231 RA-noILD controls (8.3% vs. 3.5%, OR 2.83, 95% CI 0.96-8.58; p=0.06); Table 2. In the replication sample, an enrichment of TRG rare variants was also observed in RA-ILD cases (9/85 [10.6%] compared to 18/305 [5.9%] in RA-noILD controls, Burden test p=0.20), reaching statistical significance in the meta-analysis analysis (OR 2.12, 95% CI 1.07-4.21, p=0.03). When restricting the analyses to RA-UIP cases, we found a greater enrichment of TRG rare variants in both derivation and replication samples (10.5% and 13.8%, respectively) leading to a significant association with RA-UIP (OR 3.17, 95% CI 1.37-7.32, p=0.007), whereas no association was detected with non-UIP RA-ILD (p=0.33). Similar to RA-ILD and RA-UIP, the analysis of 1277 IPF cases and 1874 non-IPF healthy controls, found a significant excess of rare variants in TRG comparing patients with IPF to healthy controls: 2.0% vs. 1.5%, OR 2.31, 95% CI 1.24-4.37, p=0.013. No interaction between TRG rare variants and smoking status nor MUC5B rs35705950 was detected. When restricting to patients with RA-ILD having a TL<10th percentile, we observed a significant enrichment of TRG rare variants with an increased risk: 10.0% vs. 3.5%, OR 5.93, 95% CI 1.28-26.30, p=0.04. Similar to that observed in RA-ILD, when restricting the analysis to the IPF cases having a TL<10th percentile, a significant excess of TRG rare variants was detected (5.5% vs. 1.5%, OR 6.09 95% CI 2.58-13.50, p=0.0002). Conclusion: In aggregate, our findings provide proof of a contribution of TRGs to ILD risk in RA. Like MUC5B rs35705950, the excess of TRG rare variants support the paradigm of a shared genetic background between RA-ILD and IPF. Similar to IPF, our results indicates that the short TL observed in RA-ILD can be partially attributed to TRG rare variants. REFERENCES: NIL. REFERENCES: NIL. Acknowledgements: Société Française de Rhumatologie. Disclosure of Interests: None declared.

Objective: Due to the similarities between rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and idiopathic pulmonary fibrosis (IPF), we aimed to investigate the contribution of rare variants in telomere related genes (TRGs) to the risk of RA-ILD and IPF.Methods: For RA-ILD, this genetic case-control association study consisted of a derivation and a replication sample that included cases with RA-ILD and controls with RA without ILD (RA-noILD). For IPF, cases with IPF were compared to healthy controls. Whole-exome sequencing was performed in all participants. We used a classical burden test to compare the enrichment of rare variants in 14 candidate TRGs. We performed subgroup analyses restricted to cases with extreme phenotype defined by a telomere length (TL) <10th percentile.Results: For RA-ILD, the derivation sample included 157 cases (72 males, mean age 63.2 ± 11.0 years) and 231 controls (43 males, mean age 58.3±13.1 years), and the replication sample included 85 cases (24 males, mean age 65.7±17.6 years) and 305 controls (76 males, mean age 60.2±19.2 years). The burden test found an enrichment for TRG rare variants in both derivation and replication samples leading to a significant association for RA-ILD in the meta-analysis (OR=2.12, 95%CI 1.07-4.21; p=0.03). For IPF, similar findings were observed in 1227 patients with IPF (942 males, mean age 67.0±7.8 years) compared to 1874 healthy controls (507 males, mean age 56.4±9.3 years), OR=2.32, 95%CI 1.24-4.37, P=0.013. Rare variants in TRGs were enriched in cases with a TL<10th percentile in both RA-ILD (OR 5.93, 95%CI 1.28-26.30, p=0.04) and IPF (OR=6.09, 95%CI 2.58-13.50, p=0.0002).Conclusion: Our findings provide evidence that TRGs contribute to the risk of RA-ILD, supporting the paradigm of a shared genetic background between RA-ILD and IPF. Similar to IPF, our results indicates that the short TL observed in RA-ILD can be partially attributed to TRG rare variants.Funding: Dr. Juge was funded by the Société Française de Rhumatologie for the present study. Dr. Sparks is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers R01 AR080659, R01 AR077607, P30 AR070253, and P30 AR072577), the R. Bruce and Joan M. Mickey Research Scholar Fund, and the Llura Gund Award funded by the Gordon and Llura Gund Foundation.Declaration of Interest: PAJ has received grants from la Société Française de Rhumatologie and Novartis, and consulting fees from Galapagos and honoraria from Boehringer Ingelheim and Novartis. LKD has received grants from Boehringer Ingelheim and Bristol Myers Squibb and personal fees from Boehringer Ingelheim and Roche. ADS, and BLY are full time employees of Roche-Genentech with stock or stock options in Roche, or were at the time of study execution. JSL reports grants and other support from the NIH, Galapagos, Boehringer Ingelheim, United Therapeutics, Eleven P15, Bonac, Avalyn and the Pulmonary Fibrosis Foundation, outside the submitted work. RB has received grants and personal fees from Roche and Boehringer Ingelheim, and personal fees from Savara, outside the submitted work. PJW reports grants from Genentech, grants and personal fees for advisory board work from Boehringer Ingelheim, Sanofi, and Blade Pharmaceuticals, grants and personal fees for lectures from Pliant, outside the submitted work. SMA reports having received consultancy for board membership, consultancy or speaker fees from AstraZeneca, Boehringer Ingelheim, Novartis and Roche, GSK, BMS, Chiesi and Pfizer; and travel support from Boehringer Ingelheim. CR has received consultancy and speaking fees from Amgen, AstraZeneca, Roche, BMS, Galapagos, GSK, Lilly, Hospira, Biogen, Sandoz, Mylan, Novartis and Pfizer. RMF reports honoraria from Abbvie, Pfizer, MSD and Celltrion. VC reports unrestricted grants paid to his institution from Boehringer Ingelheim; consulting fees from AstraZeneca, Boehringer Ingelheim, Celgene/BMS, CSL Behring, F. Hoffmann-La Roche, Ltd., Ferrer/United Therapeutics, GlaxoSmithKline, Pliant, Pure Tech, RedX, Sanofi and Shionogi; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Boehringer Ingelheim, F. Hoffmann-La Roche, Ltd. and Ferrer/United Therapeutics; support for attending meetings and/or travel from Boehringer Ingelheim and F. Hoffmann-La Roche, Ltd.; participation on a Data Safety Monitoring Board or Advisory Board for Galapagos and Galecto; and leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with FibroGen. TS reports grants for clinical research from AbbVie, Abivax, Biogen, Pfizer, Lilly, MSD, Novartis, Sandoz; participation on an advisory board from AbbVie, BMS, Lilly, Novartis, Pfizer, Sanofi; and payments for lectures from AbbVie, Biogen, BMS, Galapagos, Lilly, Janssen, Novartis, Nordic Pharma, Pfizer, Viatris. BC reports grant funding from Boehringer Ingelheim, Bristol Myers Squibb and Roche and personal fees from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, GSK, Novartis, Roche and Sanofi, unrelated to this study. TJD reports grant funding and other support from Bristol Myers Squibb, Genentech, and Bayer and personal fees from Boehringer Ingelheim, unrelated to this study. SR reports consulting fees from Pfizer, Janssen, Sonoma Biotherapeutics, AbbVie, Sanofi, Biogen and Nimbus Therapeutics, and a leadership role for Mestag Therapeutics. JAS has received research support from Bristol Myers Squibb and Boehringer Ingelheim unrelated to this work; he has performed consultancy for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, Pfizer, ReCor, Sobi, and UCB unrelated to this work. PD reports grant funding and other support from Boehringer Ingelheim, Bristol Myers Squibb and Pfizer and personal fees from Bristol Myers Squibb, Sanofi, Lilly, Abbvie, Pfizer, Medac, Novartis, UCB Pharma and Boehringer Ingelheim, unrelated to this study. The remaining authors have declared no conflicts of interest. Ethical Approval: For RA analyses, the institutional review boards at each institution approved all protocols, and all patients provided written informed consent (Northern and Western French Ethic Committee III no. 2019-31, and MGB IRB, Protocol #: 2019P000264). For IPF analyses, ethical approval was provided as per the four original clinical trials, the UCSF Committee on Human Research approved the sample and data collection for the USCF cohort, and the Institutional Review Boards from Vanderbilt University approved the study for the Vanderbilt cohort.

Background: RA-associated interstitial lung disease (ILD) is not a single entity as illustrated by different HRCT patterns, different risk factors and prognoses suggesting heterogenous phenotypes. Objectives: Our objective was to identify definite sub-phenotypes among a large RA-ILD dataset performing unsupervised clustering analysis. Methods: In this international collaborative study (22 centers from 13 countries), we included patients with RA (ACR/EULAR 2010 classification criteria) having ILD defined by high-resolution computed tomography (HRCT) chest scan. Clinical, biological, imaging, and functional data were retrospectively collected from extensive chart review. Missing data were handled using multiple imputation with chained equations. A multiple correspondence analysis was performed on each sample to reduce dimensions and a non-parametric Bayesian algorithm was used to attribute a cluster to each patient. The clusters were aggregated over the multiple imputations using weighted Non-negative Matrix Factorization. MUC5B rs35705950 T risk allele distribution in the identified clusters was investigate for patients with available genotype. A surrogate decision tree was conducted using the non-imputed dataset to predict a cluster for each patient. The prediction error rate of the tree was estimated using cross-validation. Results: A total of 1696 patients with RA-ILD were included in the cluster analysis; Table 1. Among the 37 collected variables, 20 active variables were used to construct clusters. The non-parametric Bayesian clustering algorithm detected 2 definite clusters: cluster 1 (n=1015) and cluster 2 (n=681); Table1. Compared to cluster 2, patients from cluster 1 were more frequently male (45.5% vs 38.3%, p=0.003), older at RA onset (56.9 ± 13.3 vs 53.8 ± 14.5, p<0.001) and at ILD onset (65.5 ± 10.1 vs 61.9 ± 12.3, p<0.001), more frequently with European ethnicity (85.9% vs 68.3%, p<0.001), more frequently ever smokers at ILD onset (64.2% vs 55.7%, p<0.001) and had less Sjogren syndrome (10.8% vs 20.6%, p<0.001). They were more frequently positive for anti-citrullinated peptides antibodies (90.7% vs 70.0%, p<0.001) and for rheumatoid factor (95.8% vs 67.4%, p<0.001). UIP HRCT pattern was predominant in cluster 1 (72.5%) whereas various patterns were observed in cluster 2 (UIP = 30.8%, NSIP = 17.2%), p<0.001. There was no difference in lung function at ILD onset between the 2 clusters. MUC5B rs35705950 genotype was available for 444 patient (26.2%) with a higher minor allele frequency (MAF) in cluster 1 (33% compared to 18%, p<0.001). Figure 2 shows the decision tree that can be used to predict the cluster for a new patient with a prediction error rate of 9.8%. Conclusion: Our results provide evidence that RA-ILD is a heterogeneous disease and allow the identification of at least two distinct subsets. This heterogeneity is illustrated by a contribution of the MUC5B promoter variant restricted to cluster 1, promoting the identification of specific risk scores for each RA-ILD subset. This heterogeneity underlies distinct physio pathological mechanisms which could influence not only the prognosis of patients with RA-ILD but also their therapeutic management. REFERENCES: NIL.Data are numbers (percentages) for categorical variables or means (Standard Deviation) for continuous variables. 95% confidence interval for clustering analysis are indicated in the brackets for each variable. Normalized ACPA and RF represents fold above upper limit normal. Active variable: variable used to construct the clusters. ACPA anti-citrullinated peptides antibodies; DLCO: diffusion capacity of the lung for carbon monoxide; HRCT: high-resolution computed tomography; ILD: interstitial lung disease; LIP: lymphocytic interstitial pneumonia; NSIP: non-specific interstitial pneumonia; OP: organizing pneumonia; RF: rheumatoid factor; UIP: usual interstitial pneumonia Acknowledgements: NIL. Disclosure of Interests: None declared.

BackgroundMechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke from large vessel occlusion (LVO). While embolization to a new territory (ENT) after MT is well-documented, data on embolization in the same distal territory (EDT) are limited. Achieving modified Treatment In Cerebral Infarction (mTICI) 3 reperfusion presents significant clinical benefits over mTICI 2b/2c, necessitating strategies to reduce both ENT and EDT. Previous studies suggest higher rates of EDTs with contact aspiration compared with stentrievers. However, comprehensive comparison studies in clinical practice are scarce. This study compares the rates of overall clot emboli (OCE) between these MT strategies.MethodsA retrospective, multicenter observational study was conducted at four university hospitals in France from January 2015 to November 2019. Adult patients (≥18 years) with acute ischemic stroke due to LVO, treated with either contact aspiration (ADAPT, A Direct Aspiration First Pass Technique) or stentrievers, specifically using the Embotrap device to maintain sample homogeneity, were included. Digital subtraction angiography was used for imaging, with two independent, blinded reviewers assessing OCE post-first MT pass. Propensity score full matching and independent sample testing were employed to evaluate OCE after the first MT pass.ResultsA significant difference in OCE rates was observed between contact aspiration and stentriever techniques, with the stentriever technique resulting in fewer embolic events compared with ADAPT, based on a propensity score analysis that accounts for key confounding factors.ConclusionA statistically significant reduction in embolic events was observed with the stentriever technique compared with contact aspiration. These results suggest that the stentriever method may offer a safer profile in terms of embolic risk for LVO interventions, and should be considered over contact aspiration when embolic risk is a primary concern, while also considering individual patient factors.

Introduction Une utilisation croissante des antalgiques opioïdes, non opioïdes et gabapentinoïdes a été rapporté dans certains pays, comme les États-Unis, entraînant une augmentation de la morbi-mortalité. L’objectif de cette étude est de décrire l’utilisation des antalgiques par les personnes ayant des douleurs subaiguës ou chroniques musculosquelettiques en France. Patients et méthodes Cette étude est une étude transversale nichée dans la cohorte Constances, qui est la plus grande cohorte en population générale française, constituée de volontaires, âgés de 18 à 69ans à l’inclusion et qui est chaînée au SNDS. Les données des questionnaires à l’inclusion ont été utilisées. Participants : Les douleurs lombaires, cervicales, d’épaule ou de genou durant plus de 30jours dans les 12 derniers mois ont été considérées significatives. Le syndrome douloureux chronique a été défini comme étant des douleurs en permanence dans les 12 derniers mois sur au moins 4 des 6 régions du corps. Les participants ayant un cancer dans les 12 derniers mois ont été exclus de l’analyse. Les données manquantes ont été gérées par imputation multiple. L’exposition d’intérêt a été définie sur la base des délivrances d’antalgiques (données SNDS) dans les 12 mois précédant l’inclusion. Pour les opioïdes (faibles ou forts), un équivalent morphinique oral (EMO) a été calculé, Une utilisation à dose élevée ou très élevée d’opioïdes a été définie comme un EMO>50 ou>90/jour. Une consommation chronique d’opioïde a été définie par au moins 4 délivrances distinctes sur 12 mois ou 3 délivrances et au moins 10 boites d’opioïdes sur 12 mois. Afin d’évaluer la tendance selon l’année d’inclusion, un test de tendance de Cochran-Armitage des délivrances chroniques d’opioïdes et de délivrances des gabapentinoïdes a été calculé. Résultats Au total, 155 312 personnes ont été incluses dans la cohorte CONSTANCES avec des données chaînées avec le SNDS de 2012 à 2020. Les délivrances de paracétamol, nefopam, AINS, gabapentinoïdes, opioïdes faibles et forts étaient très proches quel que soit la localisation douloureuse (Tableau 1). La délivrance chronique d’opioïde était entre 6,3 et 6,8 % pour les différentes localisations et de 13 % pour le syndrome douloureux chronique. Moins de 2 % des patients ayant des douleurs lombaires, cervicales, des genoux ou des épaules avaient des doses élevées d’opioïdes, et 5,2 % pour ceux ayant un syndrome douloureux chronique (tableau). Pour les différentes localisations douloureuses, il y avait une décroissance de délivrance chronique des opioïdes (p<0,001) entre 2012 et 2020. Il n’y avait pas de tendance à l’augmentation ou à la décroissance pour les gabapentinoïdes. Conclusion L’utilisation des antalgiques opioïdes et gabapentinoïdes pour les douleurs musculosquelettiques reste modérée en prévalence et en dosage, en accord avec les recommandations françaises et internationales. Il ne semble pas y avoir de « crise des opioïdes et des gabapentinoïdes » en France.

BACKGROUND:Spinal arteriovenous fistulas can be treated either by surgery or by endovascular means, using different strategies. The main drawback of embolization is the risk of recurrence. Our objective is to evaluate the angiographic occlusion rate and the predictive factors of angiographic cure of spinal arteriovenous fistulas at 3 months or more after embolization. METHODS:This is a retrospective single-center study including 38 consecutive patients with spinal arteriovenous fistulas treated by embolization as first-line treatment. We reviewed clinical and imaging data, complications, and the immediate angiographic occlusion rate of the fistulas, and at 3 months or more after the embolization. RESULTS:A total of 45 embolization procedures were performed: 30 procedures using glue, 15 using Onyx by 'pressure cooker' or 'balloon pressure' techniques. We observed no statistically significant difference between the two groups concerning the immediate angiographic occlusion rate (87% in both groups; P>0.9), as well as for periprocedural complication rates. The angiographic occlusion rate at 3 months or more was higher in the Onyx 'combined' techniques treated group (87% vs 40%, P=0.007). The use of Onyx 'combined' techniques was independently associated with angiographic cure at 3 months after embolization (P=0.029). No other factors were identified as predictive of angiographic cure and clinical recovery after embolization procedures, nor were any predictive factors identified for the occurrence of periprocedural complications. CONCLUSION:Embolization of spinal arteriovenous fistulas with Onyx using 'combined' techniques appears to be safe and associated with a higher rate of angiographic occlusion at 3 months than regular embolization with glue.

Purpose: The purpose of this study was to investigate the relationship between inter -reader variability in manual prostate contour segmentation on magnetic resonance imaging (MRI) examinations and determine the optimal number of readers required to establish a reliable reference standard. Materials and methods: Seven radiologists with various experiences independently performed manual segmentation of the prostate contour (whole -gland [WG] and transition zone [TZ]) on 40 prostate MRI examinations obtained in 40 patients. Inter -reader variability in prostate contour delineations was estimated using standard metrics (Dice similarity coefficient [DSC], Hausdorff distance and volume -based metrics). The impact of the number of readers (from two to seven) on segmentation variability was assessed using pairwise metrics (consistency) and metrics with respect to a reference segmentation (conformity), obtained either with majority voting or simultaneous truth and performance level estimation (STAPLE) algorithm. Results: The average segmentation DSC for two readers in pairwise comparison was 0.919 for WG and 0.876 for TZ. Variability decreased with the number of readers: the interquartile ranges of the DSC were 0.076 (WG) / 0.021 (TZ) for configurations with two readers, 0.005 (WG) / 0.012 (TZ) for configurations with three readers, and 0.002 (WG) / 0.0037 (TZ) for configurations with six readers. The interquartile range decreased slightly faster between two and three readers than between three and six readers. When using consensus methods, variability often reached its minimum with three readers (with STAPLE, DSC = 0.96 [range: 0.945 -0.971] for WG and DSC = 0.94 [range: 0.912-0.957] for TZ, and interquartile range was minimal for configurations with three readers. Conclusion: The number of readers affects the inter -reader variability, in terms of inter -reader consistency and conformity to a reference. Variability is minimal for three readers, or three readers represent a tipping point in the variability evolution, with both pairwise-based metrics or metrics with respect to a reference. Accordingly, three readers may represent an optimal number to determine references for artificial intelligence applications. (c) 2023 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Objectif Le syndrome du cyclope est défini par un flessum irréductible du genou dû à la formation d’un nodule fibreux à la partie antérieure de l’échancrure intercondylienne. Les facteurs de risque identifiés sont nombreux (raideur préopératoire, malposition du tunnel tibial, contracture des ischio-jambiers…). L’objectif principal était de déterminer si la taille de l’échancrure intercondylienne avait un impact sur le risque de survenue d’une rupture de greffe ou d’un syndrome du cyclope après reconstruction du ligament croisé antérieur (LCA) par une technique DT4. L’objectif secondaire était de déterminer si la taille de l’échancrure avait un impact sur le résultat fonctionnel. Hypothèse L’hypothèse était qu’une échancrure étroite constituait un facteur de risque de syndrome de cyclope et de mauvais résultats. Méthodes Tous les patients opérés consécutivement d’une reconstruction du LCA par DT4 ont été inclus rétrospectivement. Cent vingt patients ont été analysés après un suivi moyen de 2,4±0,8 ans. Toutes les mesures IRM préopératoires ont été effectuées par un seul opérateur sénior, en utilisant l’indice de largeur de l’encoche (notch width index, NWI) et l’indice FK. Résultats Sept patients (120 ; 5,8 %) avaient présenté une rupture de leur greffe et 20/120 (16,7 %) un syndrome de cyclope. Au dernier suivi, 26/120 patients (21,7 %) n’avaient pas repris d’activité sportive et seulement 47/120 (39,2 %) avaient repris le même sport au même niveau qu’avant l’accident initial. Le score de Lysholm était de 87,9±13,5 et l’IKDC subjectif de 84±13. Une échancrure étroite était associée à un moins bon taux de retour au sport (p=0,001), de retour au même sport (p<0,0001) et du niveau sportif par rapport à avant l’accident initial (p=0,004). En analyse multivariée, seule une diminution de l’indice FK était associée au risque de syndrome du cyclope (p<0,0001). Un indice FK inférieur à 0,18 avait une sensibilité de 85 % et une spécificité de 78 % pour prédire la survenue d’un cyclope. Conclusion Une échancrure intercondylienne antéro-supérieure étroite pourrait augmenter le risque de syndrome du cyclope après une reconstruction du LCA utilisant une technique d’autogreffe DT4, mais n’influençait pas le risque de rupture du greffon. Niveau de preuve IV ; étude de cohorte observationnelle rétrospective.

Les résultats oncologiques de la cystectomie totale robot assistée (CTRA) sont similaires à ceux de la cystectomie ouverte (CTO) pour le traitement du cancer de la vessie (CaV) avec cependant une augmentation du nombre de jours vivants et en dehors de l'hôpital après CTRA en Angleterre. Notre objectif était donc d'évaluer la durée et le coût d'hospitalisation des patients traités par CTRA vs CTO pour un CaV en France. Nous avons réalisé une étude rétrospective comparative ayant inclus l'ensemble des patients traités par CTRA ou CTO pour un CaV en France entre le 01/01/21 et le 31/12/21. Les données agrégées à l'échelle du centre ont été extraites du Système national des données de santé (SNDS). Les durées moyennes et les coûts moyens d'hospitalisation ont été calculés pour chaque groupe de traitement en séparant les dérivations urinaires de type Bricker et néo-vessie. En ce qui concerne l'analyse des coûts, la perspective adoptée était celle de la sécurité sociale. Les comparaisons ont été réalisées avec le test Wilcoxon en raison de la distribution non normale des données. Au total, 2630 patients traités par CTRA (n = 506 ; 19,2 %) ou CTO (n = 2124 ; 80,8 %) pour un CaV dans 346 centres ont été inclus dans cette étude. La déviation urinaire la plus utilisée était le Bricker (n = 1875 ; 71,3 %) que ce soit dans le groupe CTRA (n = 295 ; 58,3 %) ou CTO (n = 1580 ; 74,4 %). La durée moyenne d'hospitalisation était plus courte dans le groupe CTRA vs CTO (16,7 vs 18,6 jours, p < 0,001) que ce soit pour les Bricker (15,8 vs 17,6 jours, p < 0,001) ou les néo-vessies (17,9 vs 20 jours, p 0,03). Le coût moyen d'hospitalisation était plus bas dans le groupe CTRA vs CTO (11 846 vs 13 429 euros, p < 0,001), que ce soit pour les Bricker (11 412 vs 13 066 euros, p < 0,001) ou dans une moindre mesure pour les néo-vessies (12 354 vs 13 978 euros, p = 0,08). En comparaison à la CTO, l'utilisation de la CTRA permet de diminuer la durée et le coût d'hospitalisation des patients traités pour un CaV. Les économies de santé réalisées à ce niveau pourraient permettre d'atténuer le surcoût lié à l'achat, l'utilisation et l'entretient du robot chirurgical.