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We examine the validity of the slump test for predicting the yield stress of polymeric suspensions and mineral suspensions. First we propose a modification of this test: in order to make measurements on fluids with high yield stress (of the order of several hundreds of Pascal) we add a mass at the sample top. From detailed observations of the slump in time we show that, for polymeric suspensions (hair gel and sewage sludges), two critical stresses can be distinguished which almost exactly correspond to the two critical stresses (respectively corresponding to a regime change and to the asymptotic slump) observed in rheometry during creep tests. Thus the slump test appears as a practiceful and relevant means to determine the intrinsic properties of these fluids. For mineral suspensions it is shown that the flow abruptly stops after a short time, a behaviour in agreement with the results of rheometrical tests carried out by progressively decreasing the applied stress. In that case the slump also appears to significantly depend on the procedure and cannot be related to a single property of the material.

Background The place of MRI in the assessment of pulmonary hypertension remains controversial. Several studies proposed to use MRI to assess pulmonary pressure but the level of proof is low. Purpose To evaluate the diagnostic power of cardiac MRI within a non-selected population of patients suspected of pulmonary hypertension after an echocardiography. Material and methods Fifty-six consecutive patients, suspected of pulmonary hypertension after an echocardiography, were assessed with right heart catheterization and cardiac MRI (including a high temporal resolution pulmonary flow curve). We extracted from the MR data the main parameters proposed by all precedent studies available in the literature. We looked for multivariate linear relations between those parameters and the mean pulmonary arterial pressure (mPAP), and eventually assessed with a logic regression the ability of those parameters to diagnose pulmonary hypertension in our population. Results The multivariate model retained only two parameters: the right ventricle ejection fraction and the pulmonary trunk minimum area. The prediction of mPAP ( r 2 = 0.5) yielded limits of agreement of 15 mmHg. However, the prediction of pulmonary hypertension within the population was feasible and the method yielded a specificity of 80% for a sensitivity of 100% ( Fig. 1 ). Conclusion The performance of MRI to assess mPAP is too low to be used as a replacement for right heart catheterization but MRI could be used as second line examination after echocardiography to avoid right heart catheterization for normal patients. [ABSTRACT FROM AUTHOR]

Abstract: Echocardiography plays an important role in the management of patients with pulmonary arterial hypertension (PAH). First of all, it has a key role in the early detection of the disease. Furthermore, as a non-invasive examination, it is easily repeated during the follow-up, thereby allowing close monitoring of the therapeutics and prognostic evaluation. Echocardiographic examination can be separated into three phases. First, morphologic analysis appreciates the impact of PAH on right heart chambers, mainly by quantifying their dilation. Second, hemodynamic analysis allows the estimation of most of the parameters usually measured during right heart catheterization, such as pulmonary artery pressures, right atrial pressure, pulmonary vascular resistance and cardiac index. Finally, functional assessment of right ventricle can be done by classical parameters such as right ventricular area fractional shortening, tricuspid annular plane systolic excursion, and myocardial performance index. Furthermore, new techniques, such as Tissue Doppler imaging, 2D speckle imaging and 3D echocardiography, are potentially very useful in the examination of RV function. [Copyright &y& Elsevier]

COPD EXACERBATIONS. COPD exacerbations, characterized by an acute worsening of dyspnea and/or cough and sputum volume beyond daily variations, are a public health issue because of their frequency, the number of hospitalizations and the high rate of recurrence. Because of non-specific symptoms, differential diagnoses must be ruled out. Additional tests are rarely necessary, and treatment is outpatient, except in severe cases (respiratory distress, severity of COPD, socio-economic conditions). Increased bronchodilator treatment, and sometimes antibiotic and/or systemic corticosteroid therapy, are the main measures to be introduced and should be systematically reassessed. After an exacerbation, the aim is to optimize follow-up and treatment, to prevent recurrences., Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts pour cet article.

Natural History of Copd: EVOLUTION OF CONCEPTS. Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease responsible for significant morbidity and mortality. The natural history of this disease is complex. The first cause is tobacco smoke exposure, followed by exposure to biomass smoke and occupational exposure to inhaled toxic substances. Genetic predisposing factors are known as the alpha-1-antitrypsin deficiency. The involvement of respiratory events in childhood in the genesis of the disease is also increasingly described. The decline of the different respiratory trajectories can be accelerated in COPD. The phenotypes of this disease also have a role in the evolution of respiratory function over time and their descriptions can modulate the therapeutic management in this disease., Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts pour cet article.

Objectives: COVID-19 pandemic seems to be under control. However, despite the vaccines, 5 to 10% of the patients with mild disease develop moderate to critical forms with potential lethal evolution. In addition to assess lung infection spread, chest CT helps to detect complications. Developing a prediction model to identify at-risk patients of worsening from mild COVID-19 combining simple clinical and biological parameters with qualitative or quantitative data using CT would be relevant to organizing optimal patient management., Methods: Four French hospitals were used for model training and internal validation. External validation was conducted in two independent hospitals. We used easy-to-obtain clinical (age, gender, smoking, symptoms' onset, cardiovascular comorbidities, diabetes, chronic respiratory diseases, immunosuppression) and biological parameters (lymphocytes, CRP) with qualitative or quantitative data (including radiomics) from the initial CT in mild COVID-19 patients., Results: Qualitative CT scan with clinical and biological parameters can predict which patients with an initial mild presentation would develop a moderate to critical form of COVID-19, with a c-index of 0.70 (95% CI 0.63; 0.77). CT scan quantification improved the performance of the prediction up to 0.73 (95% CI 0.67; 0.79) and radiomics up to 0.77 (95% CI 0.71; 0.83). Results were similar in both validation cohorts, considering CT scans with or without injection., Conclusion: Adding CT scan quantification or radiomics to simple clinical and biological parameters can better predict which patients with an initial mild COVID-19 would worsen than qualitative analyses alone. This tool could help to the fair use of healthcare resources and to screen patients for potential new drugs to prevent a pejorative evolution of COVID-19., Clinical Trial Registration: NCT04481620., Clinical Relevance Statement: CT scan quantification or radiomics analysis is superior to qualitative analysis, when used with simple clinical and biological parameters, to determine which patients with an initial mild presentation of COVID-19 would worsen to a moderate to critical form., Key Points: • Qualitative CT scan analyses with simple clinical and biological parameters can predict which patients with an initial mild COVID-19 and respiratory symptoms would worsen with a c-index of 0.70. • Adding CT scan quantification improves the performance of the clinical prediction model to an AUC of 0.73. • Radiomics analyses slightly improve the performance of the model to a c-index of 0.77., (© 2023. The Author(s).)

Background: Pulmonary hypertension (PH) is a hemodynamic condition characterized by an abnormal elevation in pulmonary arterial pressures. Several pathophysiological pre-capillary and post-capillary mechanisms have been described. PH is a common complication of chronic obstructive pulmonary disease (COPD), however, the prevalence of each mechanism in the development of PH in patients with COPD has been hardly studied., Methods: We reported the clinical, functional, hemodynamic characteristics and outcomes of patients diagnosed with COPD and PH among the expert PH center of Nancy between January 1 st , 2015 and March 31 st , 2021., Results: 123 patients with COPD and PH were included. Most patients (n=122, 99%) had a pre-capillary mechanism, 9% (n=11) a post-capillary mechanism, and 1% (n=1) an unclassified mechanism. 111 (90%) patients had pure pre-capillary PH and 11 (9%) patients had combined pre- and post-capillary PH. Combined pre- and post-capillary PH group was characterized by higher prevalence of cardiovascular comorbidities and of sleep apnea-hypopnea syndrome, a higher body mass index, lower lung volumes, higher mean pulmonary arterial pressure, pulmonary arterial wedge pressure and right atrial pressure. At follow-up (median 30 months), 52 patients had died, and 11 had undergone lung transplantation. One-year, three-year and five-year transplant-free survival rates were 71%, 29% and 11% respectively. There was no difference on outcomes between groups., Conclusion: PH in COPD patients is mostly due to pre-capillary mechanism. However, the existence of various and numerous comorbidities in COPD, especially cardiovascular, can lead to the participation of post-capillary mechanisms in the development of PH. Further studies are needed to confirm these findings and to assess the impact on outcomes and management strategies in these different patients., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 SPLF and Elsevier Masson SAS. All rights reserved.)

Background: Survivors of severe-to-critical coronavirus disease 2019 (COVID-19) may have functional impairment, radiological sequelae and persistent symptoms requiring prolonged follow-up. This pragmatic study aimed to describe their clinical follow-up and determine their respiratory recovery trajectories, and the factors that could influence them and their health-related quality of life., Methods: Adults hospitalised for severe-to-critical COVID-19 were evaluated at 3 months and up to 12 months post-hospital discharge in this prospective, multicentre, cohort study., Results: Among 485 enrolled participants, 293 (60%) were reassessed at 6 months and 163 (35%) at 12 months; 89 (51%) and 47 (27%) of the 173 participants initially managed with standard oxygen were reassessed at 6 and 12 months, respectively. At 3 months, 34%, 70% and 56% of the participants had a restrictive lung defect, impaired diffusing capacity of the lung for carbon monoxide ( D LCO ) and significant radiological sequelae, respectively. During extended follow-up, both D LCO and forced vital capacity percentage predicted increased by means of +4 points at 6 months and +6 points at 12 months. Sex, body mass index, chronic respiratory disease, immunosuppression, pneumonia extent or corticosteroid use during acute COVID-19 and prolonged invasive mechanical ventilation (IMV) were associated with D LCO at 3 months, but not its trajectory thereafter. Among 475 (98%) patients with at least one chest computed tomography scan during follow-up, 196 (41%) had significant sequelae on their last images., Conclusions: Although pulmonary function and radiological abnormalities improved up to 1 year post-acute COVID-19, high percentages of severe-to-critical disease survivors, including a notable proportion of those managed with standard oxygen, had significant lung sequelae and residual symptoms justifying prolonged follow-up., Competing Interests: Conflict of interest: F. Schlemmer reports support for the present manuscript from Fondation du Souffle, consulting fees from Pfizer, lecture honoraria from Gilead, and travel support from Chiesi, GSK, Elivie, Boerhinger Ingelheim, Gilead and Roche, outside the submitted work. P. Le Guen reports support for attending ATS 2022 from Unimed, outside the submitted work. M. Roumila reports grants from Vivisol and AstraZeneca, outside the submitted work. T. Gille reports lecture honoraria from Boehringer Ingelheim and Roche/Genetech, and travel support from Oxyvie, LVL Medical and Vitalaire, outside the submitted work. L. Sésé reports consulting fees from AstraZeneca, lecture honoraria from Boehringer Ingelheim and Roche-Genentech, and travel support from Novartis and Sanofi Aventis, outside the submitted work. Y. Uzunhan reports personal fees from Boehringer Ingelheim, grants and non-financial support from Oxyvie, and personal fees from Roche, outside the submitted work. M. Patout reports grants from Fisher & Paykel, ResMed and Asten Santé, consulting fees from Philips Respironics, ResMed, Asten Santé and GSK, lecture honoraria from Philips Respironics, Asten Santé, ResMed, Air Liquide Medical, SOS Oxygène, Antadir, Chiesi and Jazz Pharmaceutical, travel support from Asten Santé, advisory board participation from ResMed, Philips Respironics and Asten Santé, stock/stock options from Kernel Biomedical, and receipt of equipment/materials from Philips Respironics, ResMed and Fisher & Paykel, outside the submitted work. M. Zysman reports grants from AVAD and INSERM U1045, lecture honoraria from CSL Behring, GSK, Boehringer Ingelheim and AstraZeneca, and travel support Chiesi and AstraZeneca, outside the submitted work. S. Habib reports lecture honoraria from GSK and AstraZeneca, travel support from GSK and Novartis, and advisory board participation with Pfizer, Novartis and Sanofi. C. Jung reports grants from Danone and Menarini, lecture honoraria from Adare and Nestle, and a leadership role and stock/stock options from Biofoodie, outside the submitted work. All other authors have nothing to disclose., (Copyright ©The authors 2023.)

Background: No large, prospective study has investigated respiratory symptoms in patients with inflammatory bowel diseases. We aimed to describe the prevalence of and factors associated with respiratory symptoms in patients with inflammatory bowel disease., Methods: In an observational, prospective, cross-sectional study, we evaluated the frequency of respiratory symptoms using a validated self-reporting questionnaire from February 2019 to February 2021 during routine follow-up outpatient visits of patients with inflammatory bowel disease followed in the Gastroenterology Department of the Nancy University Hospital. In case of a positive questionnaire, patients were systematically offered a consultation with a pulmonologist in order to investigate a potential underlying respiratory disease., Results: There were 325 patients included, and 180 patients had a positive questionnaire (144 with Crohn's disease). Of the included patients, 165 (50.8%) presented with respiratory symptoms, with dyspnea being the most frequent symptom (102 patients). There were 102 patients (56.7%) who benefited from a consultation in the pulmonology department: 43 (42.2%) were diagnosed with a respiratory disease, mainly asthma (n = 13) or chronic obstructive pulmonary disease (n = 10). Fourteen patients (13.7%) had obstructive sleep apnea. A body mass index increase, being a smoker or ex-smoker, and having articular extra-intestinal manifestations were independently associated with a higher prevalence of respiratory symptoms., Conclusions: Half of patients with inflammatory bowel disease reported respiratory symptoms in our study. Patients with inflammatory bowel disease should be systematically screened, as pulmonary disease is frequently present in this population, with specific attention being given to smokers or ex-smokers and patients with extra-articular intestinal manifestations., (© The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: While pulmonary rehabilitation is registered in the COPD management guidelines with a high level of evidence, it is not adequately performed in accordance with patients' needs. Advanced nurse practitioners (IPA, in French) provide expertise enabling improved access and enhanced implementation of rehabilitation programs. Based on foreign experience, the present study has been designed to propose avenues for the development of more effective practices in France., Methods: Using Google Scholar and Pubmed databases, a search algorithm was used to identify international publications from 2003 to 2022 dealing with the role of nurse practitioners (IP, in French) in respiratory rehabilitation for COPD patients., Results: Fourteen articles, mainly from English-speaking countries, were analysed. The involvement of nurse practitioners in pulmonary rehabilitation is very broad-based, their main missions being initial disease assessment, therapeutic education, improved professional sensitivity and patient follow-up at all stages of a rehabilitation program., Conclusion: Nurse practitioners have a major role in the implementation of pulmonary rehabilitation programs for COPD patients. Their involvement at different levels can improve access and success of programs over time., (Copyright © 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Home respiratory equipment (HRE) designed for the management of chronic respiratory failure includes oxygen therapy (O 2 ), noninvasive ventilation (NIV) and mechanical insufflation-exsufflation (MI-E). The growth of the number of patients treated by HRE, the prevalence and the associated costs in France have not been determined., Methods: The French open access national health insurance aggregated data was used to estimate the evolution of theses parameters from 2006 to 2019., Results: The number of patients treated by HRE increased by 117% between 2006 and 2019, reaching a total of 245,896 patients (367/100,000). Prescriptions for O 2 , NIV, and MI-E increased by 88%, 189% and 162%, respectively. In 2019, 139,323 patients received long-term home O 2 alone (208/100,000) with a 13% decrease for liquid O 2 compared to a 44% increase for O 2 concentrator. The number of patients treated by portable oxygen concentrator increased by 509% over the last 5 years. In 2019, 96,126 patients received NIV (144/100,000) and 97% of these patients were treated by NIV for less than 12 h/day. A total of 9,158 patients were treated by MI-E in 2019 (13.6/100,000). Despite the global increase in the number of patients, health costs decreased from 9% to 8% of total medical device spending in 2019 due to adjustment of health policies, such as a reduction of reimbursement rates., Conclusion: Our results highlighted the high rate of HRE prescription, but with cost control as a result of adapted health policies., Competing Interests: Declaration of Competing Interest BRB, AB, BG, AV, RO, CR, FC have no competing interests to declare that are relevant to the content of this article. JG reports receiving grants Breas, Air Liquide, L3 medical and lecture fees from Breas and Resmed. No funding was received for conducting this study., (Copyright © 2022 SPLF and Elsevier Masson SAS. All rights reserved.)

Background: A higher risk of osteoporotic fracture was described in systemic sclerosis patients than in healthy patients., Objective: To evaluate the relation between osteoporotic fracture risk measured by the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) on computed tomography (CT) scan and the presence of ectopic calcifications: vascular, valvular and spinal., Methods: This monocentric retrospective study was performed on patients followed between 2000 and 2014 at Nancy University Hospital. Systemic sclerosis patients, according to ACR/EULAR 2013 criteria, followed from 2000 to 2014 and who underwent, during their follow-up, a CT including the first lumbar vertebra were included. The SBAC-L1 was measured with a threshold set at 145 Hounsfield units (HU). Vascular and spinal calcifications were studied on CT. For vascular calcifications, the Agatston score was used. Valvular calcifications were studied on echocardiography., Results: A total of 70 patients were included (mean age: 62.3 (±15.6) years, women 88.5%). The mean SBAC-L1 was 157.26 (±52.1) HU, and 35 patients (50%) presented an SBAC-L1 ⩽ 145 HU. The reproducibility of the calcification evaluation was good, with kappa coefficients varying between 0.63 and 1. In univariate analysis, spinal and vascular calcifications were associated with an SBAC-L1 ⩽ 145 HU, with ORs of 13.6 (1.6-113.3) and 8 (95%CI: 2.5-25.5), respectively. In multivariate analysis, the SBAC-L1 was not associated with the presence of any ectopic calcifications. The SBAC-L1 decreased with age (p = 0.0001)., Conclusion: Patients with systemic sclerosis with an SBAC-L1 ⩽ 145 HU were older, but they did not have more ectopic calcification., Trial Registration: The ethics committee of Nancy Hospital agreed with this study (referral file number 166). This study was designed in accordance with the general ethical principles outlined in the Declaration of Helsinki., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2022.)

Rationale: Viral respiratory infections, including SARS-CoV-2 infection, can trigger respiratory symptoms among patients suffering from chronic respiratory diseases, leading to exacerbations and hospitalizations. Despite the tropism of SARS-CoV-2 into the respiratory tract, chronic respiratory diseases do not seem to be risk factors for severe forms of COVID-19., Objectives: To assess whether hospitalized patients for COVID-19 with chronic respiratory diseases were at lower risk of developing a severe form than other patients., Methods: This French study included patients admitted to hospital in COVID-19 ward, suffering from a SARS-CoV-2 infection, diagnosed on RT-PCR or chest computed tomography associated with clinical symptoms, from March 15 to June 30, 2020. Ambulatory patients who were tested in the emergency department and patients with severe hypoxaemia requiring intensive care were not included. All data were collected from electronic medical records up to discharge of the patient., Main Results: 617 patients were included: 125 with a chronic respiratory disease, mainly chronic obstructive pulmonary disease (45%) and asthma (30%). The percentage of patients scoring 6 or higher on the WHO Clinical Progression Scale during hospital stay was lower in patients with chronic respiratory disease compared to those without chronic respiratory disease (21.6% versus 31.3%, respectively, p = 0.03). Among patients with chronic respiratory disease, temperature above 38 °C on admission (OR 16.88 (95% CI 4.01-71.00)), lymphopenia (OR 5.08 (1.25-20.72)), CPAP therapy (OR 4.46 (1.04-19.17)) and age (OR 1.09 (1.02-1.16)) were associated with an increased risk to reach a score of 6 or above., Conclusions: Hospital admissions in COVID-19 ward of patients suffering from chronic respiratory diseases are at lower risk of developing a severe form of COVID- 19, especially in patients with chronic obstructive pulmonary disease or asthma. Prospective studies would confirm our results and allow to better organize the follow-up of these patients in a pandemic period., Competing Interests: Declaration of Competing interest None., (Copyright © 2021 SPLF and Elsevier Masson SAS. All rights reserved.)

Competing Interests: Conflicts of Interest None.

Introduction: Cardiac MRI is increasingly used to assess and monitor pulmonary vascular disease., State of the Art: In pulmonary arterial hypertension, the role of cardiac MRI has become more clearly defined due to its proven capacity to assess the morphology and function not only of the heart, but also of pulmonary circulation. Complementarily to echocardiography, technological advances have rendered it possible for MRI to search and assess shunts. More generally, MRI provides prognostic information on the follow-up of patients undergoing treatment. In cases of chronic thromboembolic pulmonary hypertension, chest MRI locates lesions and assesses pulmonary microcirculation, thereby guiding therapeutic choice. It is also an important prognostic marker in diagnosis and follow-up of patients undergoing treatment. To ensure high-quality examination, it is essential that the patient having to carry out repeated apneas cooperate., Prospects: Studies are ongoing in view of clarifying the role of cardiac MRI as compared to right cardiac catheterization in the follow-up of patients with pulmonary arterial hypertension., Conclusions: Cardiac MRI is the examination of choice in assessment of right ventricular morphology and function. It is a minimally invasive technique with good inter- and intra-operator reproducibility in the evaluation of patients with pulmonary arterial hypertension and chronic pulmonary thromboembolic hypertension., (Copyright © 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Among interstitial pneumonia with autoimmune features (IPAF) patients, identifying those at risk to develop a connective tissue disease (CTD) during the disease course is a key issue. The aim of this study was to evaluate the incidence of definite CTD diagnosis in IPAF patients during follow-up., Methods: We performed a multicentric cohort study of interstitial lung disease (ILD) from 2010 to 2017 in pneumology and immunology departments of tertiary care centers. Patients with a known cause of ILD (including established CTD) at diagnosis were excluded. Among patients with idiopathic ILD and at least three years of follow-up, two groups (IPAF and non-IPAF) were retrospectively analyzed at time of diagnosis., Results: A total of 249 patients with ILD were enrolled, including 70 IPAF and 179 non-IPAF patients. After a mean follow-up time of 77 ± 44 months, 18/70 IPAF patients (26%) had a CTD diagnosis - 9 antisynthetase syndrome, 8 systemic sclerosis and 1 overlap myositis - compared with 4/179 non-IPAF patients (2%). IPAF patients were at higher risk of CTD occurrence at 3 years of follow-up compared to non-IPAF patients (HR 10.1, 95% CI 3.1-33.1, p < 0. 01). IPAF patients progressing to CTD tended to be younger, more often female and have more frequently puffy fingers, capillaroscopy abnormalities and antisynthetase antibodies at diagnosis., Conclusions: We found that a significant proportion of IPAF patients had associated CTD diagnosis during follow-up. Prospective studies are needed to confirm baseline predictive factors of CTD occurrence in IPAF patients., (Copyright © 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Background: Drugs approved for the treatment of pulmonary arterial hypertension (PAH) improve long-term outcomes. These drugs have pulmonary vasodilator properties which may potentially cause a decrease in arterial oxyhaemoglobin saturation ( S aO 2 ) in some patients. The present retrospective study of the French Pulmonary Hypertension Registry aimed to describe the clinical characteristics and outcomes of patients showing a ≥3% decrease in S aO 2 while treated with PAH drugs., Methods: We reviewed 719 PAH patients. The exclusion criteria were PAH associated with congenital heart disease and PAH with overt features of venous/capillaries involvement., Results: 173 (24%) patients had a ≥3% decrease in S aO 2 . At diagnosis, they were older with a lower diffusing capacity of the lung for carbon monoxide and a shorter 6-min walk distance compared with those who did not display a ≥3% decrease in S aO 2 . The percentage of patients meeting the European Society of Cardiology/European Respiratory Society (ESC/ERS) low-risk criteria at re-evaluation was significantly lower in those with a ≥3% decrease in S aO 2 and more patients started long-term oxygen therapy in this group (16% versus 5%; p<0.001). A ≥3% decrease in S aO 2 was associated with a poorer survival (hazard ratio 1.81, 95% CI 1.43-2.34; p<0.0001). In a multivariate Cox analysis, a ≥3% decrease in S aO 2 was a prognostic factor independent of age at diagnosis and ESC/ERS risk stratification at follow-up., Conclusions: When treated with PAH drugs, a large subset of patients experience a ≥3% decrease in S aO 2 , which is associated with worse long-term outcomes and reduced survival., Competing Interests: Conflict of interest: S. Valentin has nothing to disclose. Conflict of interest: A. Maurac has nothing to disclose. Conflict of interest: O. Sitbon reports grants, personal fees and non-financial support from Actelion, grants and personal fees from Bayer and MSD, personal fees from Acceleron, Ferrer and Gossamer Bio, grants from GlaxoSmithKline, outside the submitted work. Conflict of interest: A. Beurnier reports personal fees from Sanofi and AstraZeneca, outside the submitted work. Conflict of interest: E. Gomez has nothing to disclose. Conflict of interest: A. Guillaumot reports non-financial support from Actelion, AstraZeneca, Boehringer Ingelheim, MSD and Roche, outside the submitted work. Conflict of interest: L. Textoris has nothing to disclose. Conflict of interest: R. Fay has nothing to disclose. Conflict of interest: L. Savale reports personal fees and non-financial support from Actelion and MSD, grants from Bayer, outside the submitted work. Conflict of interest: X. Jaïs reports grants from Bayer, grants, personal fees and non-financial support from Actelion/Janssen, personal fees from MSD, outside the submitted work. Conflict of interest: D. Montani reports grants and personal fees from Actelion and Bayer, personal fees from GlaxoSmithKline, Pfizer, MSD and Chiesi, outside the submitted work. Conflict of interest: F. Picard reports personal fees from Novartis, outside the submitted work. Conflict of interest: J-F. Mornex reports personal fees and non-financial support from Actelion, grants, personal fees and non-financial support from GlaxoSmithKline, during the conduct of the study; grants, personal fees and non-financial support from LFB and CSL Behring, personal fees from Roche and Chiesi, outside the submitted work. Conflict of interest: G. Prevot has nothing to disclose. Conflict of interest: F. Chabot reports non-financial support from Actelion, AstraZeneca, Boehringer Ingelheim and MSD, outside the submitted work. Conflict of interest: M. Humbert reports grants, personal fees and non-financial support from GlaxoSmithKline, grants and personal fees from Acceleron, Actelion and Bayer, personal fees from AstraZeneca, Novartis, Roche, Sanofi, Teva and Merck, outside the submitted work. Conflict of interest: A. Chaouat has received personal fees for lecturing and/or consulting from Actelion, Boehringer Ingelheim, Novartis, MSD and Chiesi, and research grants from Actelion and GlaxoSmithKline., (Copyright ©The authors 2021. For reproduction rights and permissions contact permissions@ersnet.org.)

Introduction: Depression is a common comorbidity in COPD patients, worsening their quality of life and their current level of physical activity. Respiratory rehabilitation is therefore highly recommended for COPD patients but only few of them have access to that kind of program. In real life, exercise training is often the only therapeutic activity provided to patients., Methods: The aim of this study was to evaluate the specific effect of exercise training on the level of depression (using Beck Depression inventory short form (BDI-SF)) and quality of life in COPD patients [using the Saint George's Respiratory Questionnaire (SGRQ)]. Five hundred and fifteen COPD patients were enrolled in home-based exercise training programs. 421 programs were completed and the data was available for 182 patients (SGRQ, BDI-SF et TE) at T0 and T12., Results: Dyspnoea (mMRC), SGRQ, BDI-SF scores and TE were significantly improved by the exercise training: mMRC 2,7±0,9 vs. 2,3±1,2; SGRQ 45±15 vs 34±18; BDI-SF 4,2±5,1 vs. 2,7±4,3; TE 6,4±5,4 vs. 17,2±12,8 respectively at T0 and T12. The improvement of TE was significantly correlated to that of the SGRQ scores (r=0,4; P<0,001) and of the BDI-SF scores (r=-0,24; P=0,001)., Conclusion: This home-based exercise training program improved dyspnoea, quality of life, depression and exercise capacity. The improvement of the TE and BDI-SF scores were correlated., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: The intrathoracic manifestations of IgG4-related disease include a range of conditions and severity, and can on occasion cause acute respiratory failure as reported in the case described here., Observation: A 69-year-old male former smoker, was admitted to our hospital with dyspnea, fever, cough, fatigue, and a 3-month history of weight loss. He received high flow oxygen therapy and non-invasive ventilation for severe respiratory failure. Chest computed tomography revealed multifocal condensations and ground glass opacities, accompanied by thickening of the perilymphatic interstitium, mediastinal lymphadenopathy and bilateral pleural effusion. Elevated serum concentrations of IgG4 suggested an IgG4-Related Disease. He developed renal failure and underwent a renal biopsy. Histopathological analysis of which supported the diagnosis by showing dense lymphocytic infiltrate with a count of IgG4+ cells/hpf higher than 60, and storiform fibrosis - a swirling, "cartwheel" pattern of fibrosis which may have a patchy distribution. The patient responded well to steroid therapy., Conclusion: Although respiratory symptoms are usually mild in IgG4-relatd disease, thoracic features can evolve into acute respiratory failure with few extra thoracic manifestations., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The objectives of this study were to describe the prevalence and characteristics of radiographic lesions of the hands, and calcifications of the spine on computer tomography scans (CT-scans), and to investigate the relationships between radiographic and CT-scan abnormalities and clinical features in a population of patients with systemic sclerosis (SSc).Subjects underwent X-ray examination of the hands, and thoracic or thoraco-abdominal and pelvic CT scan or lumbar CT scan in the year. Structural lesions on hand X ray was scored and spinal calcifications were evaluated in the anterior, intracanal and posterior segments. Intra and inter-reliability was tested for radiography and CT- scan. Prognostic factors considered were interstitial pulmonary lesions on the CT scan, pulmonary arterial hypertension (PAH) and death.This study involved 77 SSc patients, 58 (75%) with limited cutaneous SSc (lcSSc) and 19 (25%) with diffuse SSc (dSSc). The prevalences of radiographic lesions of the hand were 28.6% for periarticular calcifications and 26% for calcinosis. On CT scan, 64 (83%) patients exhibited at least 1 calcification. Spine calcifications were depicted in 80.5%, 27.3%, and 35.1% at the anterior, intracanal and posterior segments respectively. Calcifications were mainly localized on thoracic spine. Inter reader reliabilities were good for hands and moderate for spine respectively. Spine calcifications and periarticular calcifications in the hands were associated (P = .012). Calcinosis in the hands was related to PAH (P = .02). Posterior calcification segment and foraminal calcifications were associated with interstitial lung disease (ILD) (P = .029) and death (P = .001).More than 80% of systemic sclerosis patients presented spine calcifications. A significant association between hands and spinal calcifications were confirmed and some localization in the posterior segment considered as a bad prognostic factor.

Rationale: Promoting endogenous pulmonary regeneration is crucial after damage to restore normal lungs and prevent the onset of chronic adult lung diseases. Objectives: To investigate whether the cell-cycle inhibitor p16 INK4a limits lung regeneration after newborn bronchopulmonary dysplasia (BPD), a condition characterized by the arrest of alveolar development, leading to adult sequelae. Methods: We exposed p16 INK4a-/- and p16 INK4a ATTAC (apoptosis through targeted activation of caspase 8) transgenic mice to postnatal hyperoxia, followed by pneumonectomy of the p16 INK4a-/- mice. We measured p16 INK4a in blood mononuclear cells of preterm newborns, 7- to 15-year-old survivors of BPD, and the lungs of patients with BPD. Measurements and Main Results: p16 INK4a concentrations increased in lung fibroblasts after hyperoxia-induced BPD in mice and persisted into adulthood. p16 INK4a deficiency did not protect against hyperoxic lesions in newborn pups but promoted restoration of the lung architecture by adulthood. Curative clearance of p16 INK4a -positive cells once hyperoxic lung lesions were established restored normal lungs by adulthood. p16 INK4a deficiency increased neutral lipid synthesis and promoted lipofibroblast and alveolar type 2 (AT2) cell development within the stem-cell niche. Besides, lipofibroblasts support self-renewal of AT2 cells into alveolospheres. Induction with a PPARγ (peroxisome proliferator-activated receptor γ) agonist after hyperoxia also increased lipofibroblast and AT2 cell numbers and restored alveolar architecture in hyperoxia-exposed mice. After pneumonectomy, p16 INK4a deficiency again led to an increase in lipofibroblast and AT2 cell numbers in the contralateral lung. Finally, we observed p16 INK4a mRNA overexpression in the blood and lungs of preterm newborns, which persisted in the blood of older survivors of BPD. Conclusions: These data demonstrate the potential of targeting p16 INK4a and promoting lipofibroblast development to stimulate alveolar regeneration from childhood to adulthood.

Introduction: Eosinophilic pneumonias are characterized by an increase in lung eosinophils. These disorders can be induced by drug reactions., Case Report: A 57-year-old woman suffering from bipolar disorder and treated by sodium divalproate for more than 2 years was hospitalised in the department of respiratory medicine for dyspnoea and cough. The investigations showed severe hypoxaemia, airflow limitation, multiple ground-glass opacities and crazy paving on the chest CT-scan and a blood eosinophilia. A significant alveolar eosinophilia was found in the broncho-alveolar lavage. A complete assessment of possible causes was made. Finally, we made the diagnosis of eosinophilic pneumonia secondary to sodium divalproate. The treatment was stopped and systemic corticosteroid therapy was not introduced. The patient showed an improvement of her dyspnoea in a few days. Lung function and the CT-scan were normal within a few months., Conclusions: Sodium divalproate, frequently used in the treatment of bipolar disorder, is a rare cause of eosinophilic lung disease, even years after its introduction. Rapid diagnosis and withdrawal of treatment led to complete resolution in the reported case., (Copyright © 2020. Published by Elsevier Masson SAS.)