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The first COPD biennial organized by the French Society of Respiratory Diseases (SPLF) took place on 17 December 2021.The objective of the biennial was to discuss current knowledge regarding COPD pathophysiology, current treatments, research development, and future therapeutic approaches.The different lecturers laid emphasis on the complexity of pathophysiologic mechanisms including bronchial, bronchiolar and parenchymal alterations, and also dwelt on the role of microbiota composition in COPD pathenogenesis. They pointed out that addition to inhaled treatments, ventilatory support and endoscopic approaches have been increasingly optimized. The development of new therapeutic pathways such as biotherapy and cell therapy (stem cells…) call for further exploration.The dynamism of COPD research was repeatedly underlined, and needs to be further reinforced, the objective being to "understand so as to better innovate" so as to develop effective new strategies for treatment and management of COPD.

Additional file 1: Table S1. Comparison of SA patients on biologics (anti-IL5 or anti-IgE) with or without chronic OCS treatment (n = 270).

Objectif Rapporter notre experience de l’endoscopie en dehors des heures ouvrables dans un centre hospitalier general ou elle est faite par un praticien d’astreinte de securite sans assistance specialisee.

Resume L’allergie a l’albumine serique d’origine animale est une affection frequente, nettement sous-diagnostiquee actuellement. Les voies de sensibilisation a cette proteine sont multiples etant donnee sa presence ubiquitaire dans les fluides biologiques. L’allergie a l’albumine contenue dans la viande de bœuf est la plus souvent rapportee et est frequemment croisee avec les autres viandes. Les manifestations cliniques sont variees : diarrhee recurrente, dermatite atopique, syndrome oral, voire angio-œdeme ou choc anaphylactique. L’albumine contenue dans les phaneres des chats ou des chiens peut etre responsable d’une rhinite ou d’un asthme. Les allergies croisees sont frequentes, comme le classique syndrome porc-chat, mais aussi entre les œufs et le lait ou les volailles. Le diagnostic est confirme par tests epicutanes avec l’albumine pure et/ou par la recherche d’anticorps IgE specifiques. Selon la symptomatologie, le traitement pourra consister en la cuisson attentive des aliments, l’eviction des contacts avec les chats ou les chiens ou en un traitement symptomatique.

A duplication cyst of the gastric antrum was diagnosed in a 35-year man after recurring attacks of acute pancreatitis. The patient was operated on with the preoperative diagnosis of cystic dystrophy on aberrant pancreatic tissue of the antrum wall. Diagnosis of duplication was established on pathologic examination of antrectomy specimen. A review of the literature about gastric duplication is performed.

Dos terceras partes de los casos de cirrosis se descubren en el estadio de las complicaciones; un diagnostico precoz permite la instauracion de un tratamiento etiologico y una prevencion eficaz de las complicaciones hemorragicas. En presencia de un higado duro y de una tasa de protrombina (TP) inferior al 85 %, el diagnostico de cirrosis puede confirmarse por la existencia de varices o por la biopsia hepatica.

Lipopolysaccharide is a component of the outer membrane of gram-negative bacteria. It plays an important role in asthma as an adjuvant to allergens in activating the airway epithelium.Following treatment of a cutaneous mycosis by injection of endotoxin from Salmonella (Pyrogenalum), a 49-year-old non-smoking man developed an acute bronchitis followed by persistent cough, sometimes productive of sputum. Clinical examination was unremarkable. Lung function tests showed airway obstruction, FEV1 54% predicted, partly reversible with salbutamol, and exhaled NO was increased to 73.5 ppb. There was a moderate blood eosinophilia ranging from 540 to 890 per mm(3) (7.4 to 9.6%). Lung CT scan showed no parenchymal or bronchial abnormalities, and ENT examination showed nasal polyposis.Besides its critical adjuvant role in the development of asthma when inhaled, this case suggests that endotoxin can also provoke asthma when administered systemically.

Mucosal defence mechanisms are critical in preventing colonization of the respiratory tract by pathogens and penetration of antigens through the epithelial barrier. Recent research has now illustrated the active contribution of the respiratory epithelium to the exclusion of microbes and particles, but also to the control of the inflammatory and immune responses in the airways and in the alveoli. Epithelial cells also mediate the active transport of polymeric immunoglobulin-A from the lamina propria to the airway lumen through the polymeric immunoglobulin receptor. The role of IgA in the defence of mucosal surfaces has now expanded from a limited role of scavenger of exogenous material to a broader protective function with potential applications in immunotherapy. In addition, the recent identification of receptors for IgA on the surface of blood leukocytes and alveolar macrophages provides an additional mechanism of interaction between the cellular and humoral immune systems at the level of the respiratory tract.

Recently, we developed a new method to measure collateral blood flow in rats: splenorenal shunt (SRS) blood flow (BF). The aims were to evaluate the reproducibility of SRSBF measurement in different models of portal hypertension, and to investigate the ability of SRSBF to disclose pharmacological changes.Hemodynamics were determined in anesthetized rats with secondary biliary, CCl4 or DMNA cirrhosis and portal vein ligation (PVL) under baseline and pharmacological (octreotide, vapreotide) conditions. The main measurements performed were: SRSBF by the transit time ultrasound (TTU) method and % portosystemic shunts (PSS) by the microsphere method.SRSBF was 6 to 10 times higher in portal hypertensive rats and was similar in the different models of cirrhosis but was higher in portal vein ligated rats than in cirrhotic rats (1.1+/-0.7 vs 0.6+/-0.7 ml x min(-1) x 100 g(-1), p=0.01). SRSBF was correlated with mesenteric %PSS (r=0.61, p0.01), splenic %PSS (r=0.54, p0.05), portal pressure (r= 0.32, p0.05) and the area of liver fibrosis (r=0.33, p0.05). Octreotide significantly decreased SRSBF (-23+/-20%, p0.01 vs placebo: -6+/-8%, NS). Vapreotide significantly decreased SRSBF but not mesenteric or splenic %PSS compared to placebo. The variations in SRSBF (-26+/-32%) and in splenic %PSS (0+/-15%) with vapreotide were significantly different (p0.05) and not correlated (r=-0.1, NS).Determination of SRSBF by TTU is an accurate way to measure collateral blood flow in different models of intra- and extra-hepatic portal hypertension in rats. Its sensitivity provides accurate measurement of pharmacological changes, unlike the traditional estimation of %PSS by the microsphere method.

We report the case of a cirrhotic patient with a hepatocellular carcinoma and a synchronous hepatic metastasis of a colorectal cancer, both visualized on a positron emission tomography (PET) and a CT scanner. We repeat the need for the arterial phase on CT scanner when a possibility of cirrhosis exists, even in the follow-up of a colorectal cancer. We detail the usual pattern of HCC and the present efficacy of the PET in the diagnosis of HCC.

Our aim was to study the antifibrotic and hemodynamic effects of simvastatin (SMV), pentoxifylline (PTX) and spironolactone (SPN), three drugs which may have antifibrotic and/or portal hypotensive properties, in a model of hepatic fibrosis and portal hypertension induced in rats by bile duct ligation. A blind study was performed in five groups of 53 Sprague-Dawley rats: sham, placebo (PL), SMV (2.5 mg x kg(-1) x J(-1)), PTX (50 mg x kg(-1) x J(-1)) and SPN (100 mg x kg(-1) x J(-1)). Drugs were administered by daily gavage over a 4-week period as soon as bile duct ligation was performed. At day 28, the following parameters were evaluated: area of hepatic fibrosis by image analysis after staining collagen with picrosirius and plasma concentrations of hyaluronate, splanchnic and systemic hemodynamics (radiolabeled microspheres).Portal venous pressure (PL: 15.5+/-1.5, SMV: 15.8+/-2.5, PTX: 15.9+/-1.8, SPN: 13.5+/-2.1 mmHg, p0.05) and porto-systemic shunts (PL: 30+/-31, SMV: 18+/-27, PTX: 25+/-24, SPN: 5+/-4%, p0.05) were significantly reduced in the SPN group; other hemodynamic parameters were not significantly altered. There was a significant correlation between portosystemic shunts and portal pressure (r(s)=0.47, p0.01). The area of fibrosis was not significantly different among the four groups of bile duct ligated rats (PL: 8.7+/-3.9, SMV: 7.1+/-3.6, PTX: 7.8+/-2.7, SPN: 6.6+/-3.3%) but was higher than in sham rats (1.5+/-0.5%, p0.001). Hyaluronate was significantly higher in bile duct ligated rats (from 374+/-162 to 420+/-131 microg/l, among the four groups) than in sham rats (52+/-16 microg/l, p0.0001).In this model, none of the drugs prevented hepatic fibrosis. On the other hand, spironolactone decreased portal pressure and prevented porto-systemic shunts. Therefore, this drug may have beneficial effects in patients with early portal hypertension.

Chronic obstructive pulmonary disease (COPD) is characterized by poorly reversible airflow limitation associated with airway remodelling and inflammation of both large and small airways. The site of airflow obstruction in COPD is located in the small airways, justifying a focus on this compartment. The structural abnormalities that are found in bronchioles with a diameter less than 2mm are characterized by increased airway wall thickness with peribronchial fibrosis, and by luminal obstruction by mucous exudates. Destruction of alveolar walls, the hallmark of emphysema, may be related to protease-antiprotease imbalance, and to mechanisms involving apoptosis, senescence, and autoimmunity. Cigarette smoke inhalation triggers the recruitment of innate immune cells (neutrophils and macrophages) and putatively adaptive immunity mediated via T and B lymphocytes and lymphoid follicles in the small airways. These data suggest a potential role for therapies that can target remodelling and inflammation in the small airways of patients with COPD.

We report the case of a patient working in a factory producing inulin from chicory who developed rhinoconjunctivitis and asthma to the dust of dry chicory roots and oral allergy syndrome to raw fruits and vegetables. Nonspecific bronchial hyperresponsiveness was diagnosed. A provocation test with dry chicory induced acute rhinoconjunctivitis and an immediate asthmatic response with no further clinical symptoms. Skin prick test results were positive to birch pollen and fresh/dry chicory, and negative for inulin. Specific immunoglobulin (Ig) E was100 kU(A)/L for rBet v 1. Specific IgE were detected by immunoblotting chicory extract with the patient's serum, but not with a control serum. The main immunoreactive band corresponded to a protein with a molecular weight of approximately 17 kDa, like Bet v 1, and this immunoreactivity was effectively inhibited by preincubating serum with purified Bet v 1. This case documents occupational rhinoconjunctivitis and asthma due to IgE sensitization to inhaled chicory allergens, including one identified for the first time as a 17-kD Bet v 1 homologous protein, with secondary oral allergy syndrome to related foods.

Epidemiological data concerning hepatitis B are scarce in France.To describe epidemiological, clinical, virological and histological features of HBsAg-positive patients followed at non-academic hospitals in France.Clinical, biological, virological and histological data of all HBsAg-positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed.Nearly 1166 HBsAg-positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 +/- 15 years. Twenty-nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg-positive and 57% HBeAg-negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age40 years (P0.05), HBeAg-negative status (P0.02) and histological activity (P0.0001). Factors associated with cirrhosis: age (P0.0001), platelet count150 000/mm(3) (P0.0001) and viral co-infection (P0.03).HBV infection represents a significant workload for hepatogastroenterologists at non-academic hospitals in France.

Introduction L’HCV chez les patients HD est associee a une morbi-mortalite importante. Les anciens traitements sont souvent mal toleres. Le sofosbuvir, nouveau antiviral a action directe n’a jamais ete teste chez les pts HD [1] . Nous rapportons ici le cas d’un patient HCV et qui a beneficie d’un traitement combinant sofosbuvir et ribavirine. Patients et methodes Un patient âge, diabetique, 86 ans, 90 kg, en HD depuis 7 ans avait presente une seroconversion HCV de genotype 2 au stade de cirrhose a son retour en octobre 2014 d’un sejour de 2 mois au Maroc. Il a ete traite par sofosbuvir 400 mg 1 j/2 apres la seance de dialyse et ribavirine 200 mg/j pendant 12 semaines. Un suivi de l’ARN viral par PCR couple a des dosages de sofosbuvir et du metabolite 007 avant et apres dialyse ont ete mis en place pour evaluer la biodisponibilite du sofosbuvir avec les concentrations du sofosbuvir, du metabolite 007 et de ribavirine. Une surveillance des parametres hematologiques et hepatologiques a ete faite. Resultats La negativation de la serologie a ete rapide apres 3 semaines de traitement antiviral avec, apres 2 mois depuis la fin du traitement de 12 semaines, une charge virale HCV negative. Une baisse de l’hemoglobine a 8,9 g/100 mL a ete notee. Les concentrations plasmatiques residuelles de sofosbuvir mesurees avant la seance de dialyse sont Discussion Les concentrations plasmatiques residuelles de sofosbuvir mesurees avant la seance de dialyse sont Conclusion Le sofosbuvir a la dose de 400 mg apres la dialyse en combinaison avec la ribavirine a permis d’eradiquer l’HCV avec a prori aucune toxicite due a la retention du metabolite 007 du fait de l’IR aux doses donnees.

Resume Introduction Nous decrivons un cas de lymphome malin non hodgkinien a cellules B apparu chez un malade atteint d'une hepatite chronique virale C traitee par interferon α. Exegese Certains virus pourraient etre a l'origine des lymphomes, tels le virus d'Epstein-Barr et le virus du lymphome malin a cellules T de type I et II. La survenue d'un lymphome a cellules B au cours de l'hepatite chronique virale C a ete rapportee et pourrait etre une consequence du tropisme lymphocytaire du virus de l'hepatite C. Conclusion Cette nouvelle association entre une infection par le virus de l'hepatite C et un lymphome malin non hodgkinien doit inciter a rechercher des signes en faveur d'un lymphome chez les malades atteints d'hepatite chronique virale C.

We report the case of a cirrhotic patient with a hepatocellular carcinoma and a synchronous hepatic metastasis of a colorectal cancer, both visualized on a positron emission tomography (PET) and a CT scanner. We repeat the need for the arterial phase on CT scanner when a possibility of cirrhosis exists, even in the follow-up of a colorectal cancer. We detail the usual pattern of HCC and the present efficacy of the PET in the diagnosis of HCC.

Over the last decade, economists have identified that presenteeism, the first cousin of absenteeism, occurs when employees show up for work but, because of mental or medical illness, do not function productively or perform at 100%. Research has begun to identify nursing as an occupational group with high presenteeism. The author discusses the etiology and potential solutions for managing this new component in the productivity equation and in addressing depression, the major contributor to presenteeism.

Continuous exposure of the respiratory tract to inhaled particles and microbes implies the presence of effective defence mechanisms at a bronchial and alveolar level.Among the mechanisms involved secretory mucosal immunity contributes considerably to the defence of the bronchial tree. This immunity depends essentially on the active trans-epithelial transport of IgA involved in both innate non-specific and acquired specific immunity. Recently an IgA receptor has been identified on the surface of phagocytes including alveolar macrophages, establishing a link between alveolar and bronchial defences.The respiratory mucosa represents a crucial interface between the host and its environment, and should provide in the future a new target for the development of diagnostic and therapeutic tools.Beyond its function as an anatomical barrier the bronchial epithelium possesses a secretory activity that is essential for the protection of the lung. Despite a better understanding of mucosal immunity this secretory activity and in particular the part played by IgA remains to be elucidated.

A duplication cyst of the gastric antrum was diagnosed in a 35-year man after recurring attacks of acute pancreatitis. The patient was operated on with the preoperative diagnosis of cystic dystrophy on aberrant pancreatic tissue of the antrum wall. Diagnosis of duplication was established on pathologic examination of antrectomy specimen. A review of the literature about gastric duplication is performed.

An asymptomatic patient presented a pulmonary metastatis of a synovial sarcoma 15 years after resection of the primary tumor localized in the right groin area. The pathology findings demonstrated the non-specific variable nature of the biphasic epithelial and mesenchymatous feature of such tumors. No treatment was initiated and the patient has remained asymptomatic after five years follow-up. Lack of change in the radiological images led us to re-examine the prognosis and treatment in light of data in the literature.

We report the case of a 32-year-old man with portal hypertension without cirrhosis due to chronic vitamin A intoxication. Portal hypertension revealed by oesophageal varice rupture progressively worsened and ascites occurred 5 years after the patient stopped vitamin A intake. Initially, serum retinyl palmitate concentration was increased whereas serum retinol concentration was normal. There was no hepatic fibrosis on light microscopic examination of liver biopsy specimens. Five years after the patient stopped excessive vitamin A intake, serum retinol and retinol-binding protein concentrations were below the normal range even though there was an increased hepatic retinyl ester content. This was attributed to the late development of peri-sinusoidal fibrosis. This case mainly shows the importance of retinyl ester level determination: serum retinyl palmitate should be measured immediately after intoxication and hepatic retinyl esters should be measured initially and particularly later. Indeed, later serum and hepatic retinol levels in chronic hyper-vitaminosis A may be normal and lead to under-estimation of liver vitamin A overload.