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The prognostic value of BRAF V600 mutation level on clinical outcomes in patients with BRAF V600-mutated metastatic melanoma treated with BRAF and MEK inhibitors remains uncertain. The association was retrospectively analysed between BRAF V600 mutation level (defined as the ratio of the quantification of the BRAF V600 allele to the percentage of tumoral cells in the sample analysed) and progression-free and overall survival (PFS and OS, respectively) and 3-month response rate in a cohort of 58 patients with metastatic melanoma who harboured BRAF V600E/K mutations and received dual targeted-therapy BRAF/MEK inhibitors. The BRAF mutation level cut-off determined by the area under the receiver operating characteristic curve after internal validation by bootstrap methods was 0.44. Risk of poor PFS and OS was associated with BRAF V600 mutation level > 0.44 on multivariate analysis (p = 0.02 and p = 0.02, respectively) after adjusting for major confounding factors (age, sex, lactate dehydrogenase level, brain metastasis, and treatment line). No association was found between BRAF mutation level and 3-month response rate. Our study shows that high BRAF V600 mutation level in melanoma tissue was associated with poor prognosis in patients with metastatic melanoma treated with BRAF and MEK inhibitors.

Objective: People with intellectual disabilities (ID) have difficulty in accessing oral or written health information presented in a conventional manner what compromises prevention. This study aims to develop accessible information on breast, cervical and colorectal cancer screening for people with ID., Method: The instructional material has been developed collaboratively by a team involving representatives from different scientific disciplines (medical and psychoeducational) and people with ID. Five principles guided its elaboration, i.e. coconstruction, multimodality, phasing, socio-cognitivism and accessibility., Results: The material created is a 5-component module including a 20-minute easy-toread and understand oral presentation with a slideshow, a workshop that encourages manipulation and discussion, a booklet to take away, a film to consolidate information and a questionnaire., Conclusion: Providing accessible information is considered a key action in reestablishing equality in access to cancer health care and preventing a cascade of consequences. The co-construction of the module ensures its social and ecological validity. An interventional study is underway to verify its efficacy., Practical Implication: The best practices for cancer prevention endorse spending enough time to discuss screening. This accessible module can be used to provide people with ID basic information about screening, increase their adherence, and facilitate the discussion on this issue., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: The purpose of this study was to compare the diagnostic performance of an artificial intelligence (AI) solution for the detection of fractures of pelvic, proximal femur or extremity fractures in adults with radiologist interpretation of radiographs, using standard dose CT examination as the standard of reference., Materials and Methods: This retrospective study included 94 adult patients with suspected bone fractures who underwent a standard dose CT examination and radiographs of the pelvis and/or hip and extremities at our institution between January 2022 and August 2023. For all patients, an AI solution was used retrospectively on the radiographs to detect and localize bone fractures of the pelvis and/or hip and extremities. Results of the AI solution were compared to the reading of each radiograph by a radiologist using McNemar test. The results of standard dose CT examination as interpreted by a senior radiologist were used as the standard of reference., Result: A total of 94 patients (63 women; mean age, 56.4 ± 22.5 [standard deviation] years) were included. Forty-seven patients had at least one fracture, and a total of 71 fractures were deemed present using the standard of reference (25 hand/wrist, 16 pelvis, 30 foot/ankle). Using the standard of reference, the analysis of radiographs by the AI solution resulted in 58 true positive, 13 false negative, 33 true negative and 15 false positive findings, yielding 82 % sensitivity (58/71; 95 % confidence interval [CI]: 71-89 %), 69 % specificity (33/48; 95 % CI: 55-80 %), and 76 % accuracy (91/119; 95 % CI: 69-84 %). Using the standard of reference, the reading of the radiologist resulted in 65 true positive, 6 false negative, 42 true negative and 6 false positive findings, yielding 92 % sensitivity (65/71; 95 % CI: 82-96 %), 88 % specificity (42/48; 95 % CI: 75-94 %), and 90 % accuracy (107/119; 95 % CI: 85-95 %). The radiologist outperformed the AI solution in terms of sensitivity (P = 0.045), specificity (P = 0.016), and accuracy (P < 0.001)., Conclusion: In this study, the radiologist outperformed the AI solution for the diagnosis of pelvic, hip and extremity fractures of the using radiographs. This raises the question of whether a strong standard of reference for evaluating AI solutions should be used in future studies comparing AI and human reading in fracture detection using radiographs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Background: Image-guided percutaneous lung biopsy (PLB) may lead to major complications requiring hospitalization. This study aims to evaluate the rate of major PLB complications and determine a predictive computed tomography (CT) score to define patients requiring hospitalization due to these complications., Methods: This single-center retrospective study included all PLBs performed from July 2019 to December 2020 in Nimes University Hospital, France. Patients who were undergoing thermo-ablation during the same procedure or for whom PLB procedure data were not available were excluded. All major complications leading to hospitalization were recorded. A Percutaneous Image-guided Lung biopsy In/out Patient score (PILIP) based on variables significantly associated with major complications was calculated by multivariate analysis., Results: A total of 240 consecutive patients (160 men, 80 women; mean age: 67.3±10.5 years) were included. The major complication rate was 10.4%. Length of lung parenchyma traversed <20 vs . 20-40 mm [P=0.017, odds ratio (OR) =5.02; 95% confidence interval (CI): 1.33-18.92] and vs . >40 mm (P=0.010, OR =6.15; 95% CI: 1.54-24.53), middle vs . superior lobar location (P=0.011, OR =6.34; 95% CI: 1.53-26.31), emphysema along the needle pathway (P<0.0001, OR =10.96; 95% CI: 3.61-33.28), and pleural/scissural attraction (P=0.023, OR =3.50; 95% CI: 1.19-10.32) were independently associated with major complications. Based on these parameters, the PILIP made it possible to differentiate low-risk patients (PILIP <4) from those at high risk (PILIP ≥4) of major complications with 0.40 sensitivity (95% CI: 0.21-0.59), 0.95 specificity (95% CI: 0.93-0.98), a positive predictive value of 0.50 (95% CI: 0.28-0.72) and a negative predictive value of 0.93 (95% CI: 0.90-0.97)., Conclusions: PLB showed a major complication rate of 10.4%. The PILIP is an easy-to-use CT score for differentiating patients at a low or high risk of complications requiring hospitalization., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-500/coif). The authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: Inception cohorts aim to describe chronic diseases from diagnosis and over years of follow-up. Axial spondyloarthritis (axSpA) diagnosis might be challenging during the first years of the disease. Thus, identifying the features that will be associated with a confirmed diagnosis over time is key., Objectives: To assess the frequency and the predisposing factors for a change of an initial diagnosis in an inception axSpA cohort., Methods: DESIR is an ongoing national multicentre inception axSpA cohort with currently 12.5 years of follow-up. At the entry visit and confirmed at each visit, the diagnosis of axSpA was based on the opinion of the treating rheumatologist. Follow-up was interrupted in case of a change in this initial diagnosis. Multiple imputation was used to estimate the probability of a change in the initial diagnosis of axSpA for each patient lost to follow-up. Factors predisposing to an unchanged diagnosis of axSpA were then assessed using a multivariate logistic regression model on the imputed data sets., Results: Of the 708 patients included, over 10 years of follow-up, 45 (6.4%) were excluded due to a diagnosis change and 300 (42.4%) patients were lost to follow-up. Based on the imputation of these 300 patients, a change in their initial axSpA diagnosis was estimated in 42 (14.0%). Factors predisposing to an unchanged initial axSpA diagnosis during follow-up were (ORs (95% CIs)): radiographic sacroiliitis: 17.0 (4.1 to 71.0); psoriasis: 5.3 (2.0 to 14.3); CRP≥6 mg/L: 2.7 (1.3 to 5.3); good NSAID response: 2.5 (1.5 to 4.2); HLA B27+: 2.0 (1.3 to 3.3); anterior chest wall pain: 2.0 (1.2 to 3.3) and female sex: 1.9 (1.2 to 3.0)., Conclusion: These data suggest that a change in diagnosis in recent onset axSpA exists, but is not frequent, and is less likely to occur in the presence of objective features at baseline., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: The treatment of acute type B aortic dissection (ATBAD) is currently a challenge for vascular surgeons, because of the early morbidity and mortality rates and the high risk of late aortic events up to 50% at 5 years. This study presents the initial outcomes of ATBAD treatment using optimal medical therapy alone or combined with proximal entry tear stent-graft coverage. Additionally, it provides an analysis of the evolution of the aortic diameter and its clinical consequences during the chronic phase in each group., Materials and Methods: Conducted as a retrospective, single-center study, we enrolled all consecutive ATBAD patients (n=130) treated between 2008 and 2020. The primary analysis studies the entire patient cohort based on their initial management approach, namely, medical treatment alone for uncomplicated ATBAD (n=67) or combined with stent-graft entry tear coverage (n=63). We also conducted a subgroup analysis to investigate factors associated with disease progression in the medical management group., Results: Median follow-up was 29.5 months. During this time aneurysmal evolution was observed in: 42.4% of cases in the medical group compared with 21.8% in the stent-graft group, primarily affecting the thoracic aorta. The stent-graft group exhibited significant aortic remodeling, with a decrease in false lumen (FL) and thoracic aortic diameters. Initial aortic diameter ≥40 mm and FL ≥22 mm were independent risk factors for aneurysmal degeneration. Five-year survival was consistent at 76.1% in both groups., Conclusion: This study confirms the safety and efficacy of stent-graft entry tear coverage for ATBAD. Initial thoracic endovascular aortic repair (TEVAR) appears to reduce late aortic events by promoting aortic remodeling. Considering TEVAR's safety and potential to prevent late aortic complications, it may be considered for uncomplicated ATBAD patients with an initial aortic diameter ≥40 mm or an FL ≥22 mm., Clinical Impact: This study validates the efficacy and safety of using endovascular stent grafts to seal the proximal entry tear in cases of acute type B aortic dissections, compared to optimal medical therapy. Aortic remodelling significantly benefits from endovascular stent graft coverage of the proximal entry tear. Given the heightened risk of late aortic events observed in the medical therapy cohort, there appears to be a necessity for including endovascular interventions in the management of uncomplicated acute type B aortic dissections, particularly when aortic diameter is ≥40 mm and false lumen diameter is ≥22 mm., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: This study aimed to evaluate the 10-year clinical outcome of patients with recent-onset axial spondyloarthritis (axSpA)., Methods Study Design: The DESIR cohort is an inception cohort of axSpA patients., Methods Diagnosis and Management: The diagnosis and management of patients were based on the decision of the treating rheumatologist., Methods Statistical Analysis: Both complete cases and imputed data analyses were conducted., Results: Of the 708 enrolled patients, 45 were excluded due to a change in the baseline diagnosis, 3 patients died, and 300 were lost to follow-up over the 10years. In the completer population, one patient required bilateral total hip replacement, and 56 patients received a pension due to invalidity. The prevalence of main extra-musculoskeletal features increased from baseline to year 10: psoriasis from 18% to 30%, acute anterior uveitis from 10% to 18%, and inflammatory bowel disease from 5% to 10%. The most frequent comorbidity was hypertension, with an increase from 5% to 15% from baseline to year 10. In the imputed data analysis the estimated proportions of patients with an acceptable status at year 10 were 70% [95% CI: 63; 77] for acceptable PASS, 43% [95% CI: 37; 49] for BASDAI<3, and 48% [95% CI: 41; 56] for ASDAS<2.1., Conclusion: These findings suggest that despite a quite favorable 10-year outcome exists for severe outcomes, a large proportion of patients present with an important disease burden reflected by patient-reported outcomes. This information can be valuable for providing patients with information at the time of diagnosis., (Copyright © 2024 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

The impact of chronic urticaria on work has been scarcely reported, whereas its peak incidence is between the ages of 20 and 40. The aim of this study was to assess the occupational impact of chronic urticaria and its treatment, by combining objective and patient-reported data. A monocentric observational study was performed using questionnaires over a 1-year period from 2021 to 2022 in chronic urticaria patients who were in a period of professional activity and agreed to participate. Of the 88 patients included, 55.7% assessed the occupational impact of their chronic urticaria as significant, and even more severe when chronic urticaria was poorly controlled. Some 86% of patients had symptoms at work, in a third of cases aggravated by work. However, occupational physical factors were not associated with an aggravation of inducible chronic urticaria. A total of 20% reported treatment-related adverse effects affecting their work. Despite low absenteeism, presenteeism and reduced productivity were important (> 20%). Six patients (6.8%) had difficulties keeping their work. For 72.7% of the patients, the occupational physician was not informed. The occupational impact of chronic urticaria should be discussed during consultations, particularly when it is insufficiently controlled. The occupational physician should be informed in order to support patients' professional project.

Study Objective: During the COVID crisis, pre-anesthesia teleconsultations were widely used leading to savings in time and money. However, the non-inferiority of this system has not yet been evaluated., Design: Prospective, randomized, controlled, single-blind non-inferiority study., Setting: University hospital., Patients: Patients scheduled for surgery requiring a single pre-anesthesia consultation (PAC)., Intervention: Pre-anesthesia teleconsultation (PATC) from patient's home., Measurements: Primary outcome: concordance between the pre-anesthesia visit (PAV), performed on the day of surgery, and PAC or PATC on: Secondary outcomes: cancellation rate, immediate perioperative complications, patient satisfaction, organization, and economic and ecological costs., Main Results: Out of 172 patients included, 149 were analyzed. PATC was no less effective than PAC in terms of the primary outcome or each of its components: the difference between groups was: - 0.044[90% CI: -0.135; 0.047] (p = 0.0002). There was no difference in cancellation rates (PAC 1.99% vs. PATC 1.27%, p = 0.6) or in immediate perioperative complications (none). Satisfaction was 9.48 (±1.45) in the PAC group and 8.96 (±1.68) in the PATC group (p = 0.0006). In the PATC group, the mean savings per patient were 30 km (± 29), 36 min (± 27), and 18 (± 18) euros, respectively., Conclusions: According to our criteria, PATC was not inferior to PAC for preoperative patient evaluation and may be an interesting economical, ecological alternative., Competing Interests: Declaration of Competing Interest EM received fees as a consultant from Medin+ Company, a telehealth company that does not operate teleconsultation. The other authors have no disclosures to make related to that field., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Context: Spinal-cord injury (SCI) induces bone loss and dramatically increases the risk of fracture., Objectives: Determine the effects of whole-body vibration (WBV) on areal bone mineral density (aBMD), whole body composition and bone biological parameters in individuals with chronic-state SCI., Design: Randomized study., Setting: Centre Neurologique PROPARA., Participants: Fourteen subjects were randomly assigned to a WBV or a control group., Interventions: WBV (20-45 min, 30-45 Hz, 0.5 g) was performed in verticalized persons twice weekly for 6 months., Outcome Measures: aBMD was measured by DXA at baseline and 6 months and bone biological parameters at baseline, 1, 3 and 6 months., Results: No significant aBMD change was found in either the WBV or control group after 6 months of follow-up. Similarly, periostin, sclerostin and bone turnover markers remained relatively stable throughout follow-up and no difference in variation was observed within-group and between groups. Except for whole-body fat mass, which showed a significant decrease in the WBV group compared to controls, no difference in changes was observed, whatever the localization for fat and lean body mass., Conclusions: During the chronic phase, aBMD and bone remodeling reach a new steady state. However, the DXA technique and the bone markers, including sclerostin and periostin, both of which reflect bone cell activity influenced by mechanical strain, showed that the bone tissue of individuals with SCI was insensitive to 6 months of WBV training at the study dose. Nevertheless, results of this preliminary study that was underpowered need to be confirmed and other modalities of WBV may be more effective in improving aBMD of this population., Trials Registration: N°IDRCB:2011-A00224-37.

It is well documented that lean tissue mass (LTM) decreases with aging in patients with obesity, but there is no information available regarding muscle strength changes, a parameter that may be better associated with sarcopenic obesity (SO). The objectives of this study were to analyze the changes in LTM and fat mass (FM), muscle strength and muscle function with aging in women with obesity and to determine the prevalence of SO. LTM and FM were determined by DXA, muscle strength with the hand-grip test and muscle function with the 6 min walk test (6MWT) in 383 women with obesity. A redistribution of the LTM and FM occurred with age, characterized by a gain at the trunk to the detriment of the lower limbs, thus reducting in appendicular LTM indices. The physical performances evaluated by the muscle strength and muscle function decreased concomitantly, and the prevalence of low values for both these parameters was 22.8% and 13.4%, respectively, in the older patients. In summary, although a reduction in appendicular LTM and muscle performances occurred with age and resulted in an increase in the prevalence of SO, the number of women with obesity affected by SO remained low ( n ≤ 15), even in those older than 60 years.

Background: The study aimed to determine the level of agreement between patients with epilepsy and their proxies when assessing psychiatric comorbidities, sleep disorders, and medication adherence using standardized questionnaires., Methods: This agreement study is an ancillary analysis of the PRERIES study, a matched case-control study exploring SUDEP risk factors. Controls aged 15 years and older, with active epilepsy or in remission for less than 5 years were recruited between 01/01/2011 and 03/31/2019. An interview was carried out by a trained psychologist on both the patient and a proxy-respondent. During these independent interviews, the following comorbidities were explored: psychiatric comorbidities using the MINI, the STAI- Y 2 and NDDI-E scales, sleep disorders with the SDQ-SA and Epworth scales and medication adherence. Level of agreement between patient and their proxy was estimated using Gwet's AC1&2., Results: Among the 107 patient-proxy dyads recruited, proxy respondents were mainly family members (65.4%) or spouses (30.8%). Exploration of present major depression showed excellent agreement at 0.81 [0.65;0.97], as well as exploration of dysthymia at 0.96 [0.61;1]. Suicidal risk evaluation had a lesser agreement at 0.77 [0.60;0.94]. Agreement on anxiety was moderate 0.5 [0.38;0.62]. For sleep disorder, SDQ-SA presented a better agreement than the Epworth questionnaire with respectively 0.73 [0.51;0.95] and 0.45 [0.26;0.63]. For medication adherence, the overall agreement rate was excellent (0.90 [0.78;1])., Conclusion: Exploration of potential risk factors through families can give valuable and relatively robust information, especially if the respondent lives with the patient, and should be retrieved, when possible, in usual clinical setting., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Aim: To evaluate the real-life diagnosis and therapeutic means of Charcot Neuroosteoarthropathy (CN) in French-Belgian diabetic foot expert centers., Methods: We collected clinical characteristics, results of exams and therapeutic pathways of consecutive adult patients with diabetic osteoarthropathy seen in consultation or hospitalization from January 1 to December 31, 2019 in 31 diabetic foot expert centers. The primary outcome was to describe the diagnostic and management methods for CN according to patient clinical characteristics, the clinical-radiological characteristics of acute and chronic CN and discharge means., Results: 467 patients were included: 364 with chronic CN and 103 in the acute phase. 101 patients had bilateral chronic CN. Most patients were male (73.4%), treated with insulin (73.3%), and with multicomplicated diabetes. In the acute phase, edema and increased foot temperature were present in 75% and 58.3% of cases, respectively. Diagnosis confirmation was usually by MRI and the mode of discharge was variable. In the chronic phase, orthopedic shoes were prescribed in 81.5% of cases., Conclusions: This observational study highlights the diagnostic and therapeutic practices in 31 diabetic foot centers. Our results highlight that the use of MRI and the modalities of offloading, an essential treatment in the acute phase, need to be better standardized. Centers were highly encouraging about creating a patient registry., (© 2023. Springer-Verlag Italia S.r.l., part of Springer Nature.)

Spinal cord injury (SCI) induces severe losses of trabecular and cortical volumetric bone mineral density (vBMD), which cannot be discriminated with conventional dual-energy X-ray absorptiometry (DXA) analysis. The objectives were to: (i) determine the effects of SCI on areal BMD (aBMD) and vBMD determined by advanced 3D-DXA-based methods at various femoral regions and (ii) model the profiles of 3D-DXA-derived parameters with the time since injury. Eighty adult males with SCI and 25 age-matched able-bodied (AB) controls were enrolled in this study. Trabecular and cortical vBMD, cortical thickness and derived strength parameters were assessed by 3D-SHAPER® software at various femoral subregions. Individuals with SCI had significantly lower integral vBMD, trabecular vBMD, cortical vBMD, cortical thickness and derived bone strength parameters (p < 0.001 for all) in total proximal femur compared with AB controls. These alterations were approximately to the same degree for all three femoral subregions, and the difference between the two groups tended to be greater for cortical vBMD than trabecular vBMD. There were minor differences according to the lesion level (paraplegics vs tetraplegics) for all 3D-DXA-derived parameters. For total proximal femur, the decreasing bone parameters tended to reach a new steady state after 5.1 years for integral vBMD, 7.4 years for trabecular vBMD and 9.2 years for cortical vBMD following SCI. At proximal femur, lower vBMD (integral, cortical and trabecular) and cortical thickness resulted in low estimated bone strength in individuals with SCI. It remains to be demonstrated whether these new parameters are more closely associated with fragility fracture than aBMD., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Obstetric anal sphincter injuries (OASIs) at the time of childbirth can lead to serious consequences including anal incontinence, dyspareunia, pain and rectovaginal fistula. These types of lesions and their incidence have been well studied after cephalic presentation deliveries, but no publications have specifically addressed this issue in the context of vaginal breech delivery. The goal of our study was to evaluate the incidence of OASIs following breech deliveries and compare it with cephalic presentation births., Methods: This was a retrospective cohort study involving 670 women. Of these, 224 and 446 had a vaginal birth of a fetus in the breech (breech group) and cephalic (cephalic group) presentations respectively. Both groups were matched for birthweight (± 200 g), date of delivery (± 2 years) and vaginal parity. Main outcome of interest was to evaluate the incidence of OASIs following breech vaginal birth compared to cephalic vaginal births. Secondary endpoints were the incidence of intact perineum or first-degree tear, second-degree perineal tear and rates of episiotomies in each group., Results: There was no statistically significant difference in OASIs incidence between the breech and cephalic groups (0.9% vs. 1.1%; RR 0.802 (0.157; 4.101); p = 0.31). There were more episiotomies in the breech group (12.5% vs. 5.4%, p = 0.0012) and the rate of intact or first-degree perineum was similar in both groups (74.1% vs. 75.3%, p = 0.7291). A sub-analysis excluding patients with episiotomy and history of OASIs did not show any statistically significant difference either., Conclusion: We did not demonstrate a significant difference in the incidence of obstetric anal sphincter injuries between women who had a breech vaginal birth compared to cephalic., (© 2023. The Author(s).)

The study's aim was to assess the impact of a deep learning image reconstruction algorithm (Precise Image; DLR) on image quality and liver metastasis conspicuity compared with an iterative reconstruction algorithm (IR). This retrospective study included all consecutive patients with at least one liver metastasis having been diagnosed between December 2021 and February 2022. Images were reconstructed using level 4 of the IR algorithm (i4) and the Standard/Smooth/Smoother levels of the DLR algorithm. Mean attenuation and standard deviation were measured by placing the ROIs in the fat, muscle, healthy liver, and liver tumor. Two radiologists assessed the image noise and image smoothing, overall image quality, and lesion conspicuity using Likert scales. The study included 30 patients (mean age 70.4 ± 9.8 years, 17 men). The mean CTDI vol was 6.3 ± 2.1 mGy, and the mean dose-length product 314.7 ± 105.7 mGy.cm. Compared with i4, the HU values were similar in the DLR algorithm at all levels for all tissues studied. For each tissue, the image noise significantly decreased with DLR compared with i4 ( p < 0.01) and significantly decreased from Standard to Smooth (-26 ± 10%; p < 0.01) and from Smooth to Smoother (-37 ± 8%; p < 0.01). The subjective image assessment confirmed that the image noise significantly decreased between i4 and DLR ( p < 0.01) and from the Standard to Smoother levels ( p < 0.01), but the opposite occurred for the image smoothing. The highest scores for overall image quality and conspicuity were found for the Smooth and Smoother levels.

Background: A nation-wide study recently published the dose reference levels for the main CT-guided interventional procedures in 5001 patients. We assessed the impact of patient's age, sex and targeted organ on the patient dose during thoracic and abdominopelvic biopsies and punctures/drainages., Patients and Methods: Data were extracted from the previous nationwide study. All biopsies, punctures and drainages for thoracic or abdominopelvic locations performed between January 2017 and June 2019 in all participating centers were included in the study. Multivariable analyses were carried out using a linear regression of the dose-length product (DLP) log, adjusted to age, sex, anatomical location, number of helical acquisitions and inclusion center., Results: Of the 5001 patients of the initial study, 2383 benefited from thoracic or abdominopelvic procedures, including 674 percutaneous destructions excluded. 1709 patients (44 centers), 1045 men, 664 women, median age 64.4 ± 14.0 years were included. The mean DLP was 751.2 ± 642.7mGy.cm. It was significantly higher in men than women ( p  = 0.0005) and higher for abdominopelvic procedures than for thoracic locations ( p <0.0001)., Conclusion: Doses delivered to patients for abdominal and thoracic biopsies and punctures/drainages performed under CT guidance depend on gender and location. Furthers studies taking into account the patient's morphology and anatomical location of the procedure would allow proposing finer dose reference levels., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Objective: To evaluate the rates of serious complications and reoperation for recurrence following sacrospinous ligament fixation (SSLF) for apical pelvic organ prolapse. Methods: This was a national registry ancillary cohort comparative study. The VIGI-MESH registry includes data from 24 French health centers prospectively collected between May 2017 and September 2021. Time to occurrence of a serious complication or reoperation for genital prolapse recurrence was explored using the Kaplan-Meier curve and Log-rank test. The inverse probability of treatment weighting, based on propensity scores, was used to adjust for between-group differences. Results: A total of 1359 women were included and four surgical groups were analyzed: Anterior SSLF with mesh (n = 566), Anterior SSLF with native tissue (n = 331), Posterior SSLF with mesh (n = 57), and Posterior SSLF with native tissue (n = 405). Clavien-Dindo Grade III complications or higher were reported in 34 (2.5%) cases, with no statistically significant differences between the groups. Pelvic organ prolapse recurrence requiring re-operation was reported in 44 (3.2%) women, this was higher following posterior compared with anterior SSLF ( p = 0.0034). Conclusions: According to this large database ancillary study, sacrospinous ligament fixation is an effective and safe surgical treatment for apical prolapse. The different surgical approaches (anterior/posterior and with/without mesh) have comparable safety profiles. However, the anterior approach and the use of mesh were associated with a lower risk of reoperation for recurrence compared with the posterior approach and the use of native tissue, respectively.

Background and Purpose: A clinical risk score for sudden unexpected death in epilepsy (SUDEP) in patients with drug-resistant focal epilepsy could help improve prevention., Methods: A case-control study was conducted including (i) definite or probable SUDEP cases collected by the French National Sentinel Mortality Epilepsy Network and (ii) control patients from the French national research database of epilepsy monitoring units. Patients with drug-resistant focal epilepsy were eligible. Multiple logistic regressions were performed. After sensitivity analysis and internal validation, a simplified risk score was developed from the selected variables., Results: Sixty-two SUDEP cases and 620 controls were included. Of 21 potential predictors explored, seven were ultimately selected, including generalized seizure frequency (>1/month vs. <1/year: adjusted odds ratio [AOR] 2.6, 95% confidence interval [CI] 1.25-5.41), nocturnal or sleep-related seizures (AOR 4.49, 95% CI 2.68-7.53), current or past depression (AOR 2.0, 95% CI 1.19-3.34) or the ability to alert someone of an oncoming seizure (AOR 0.57, 95% CI 0.33-0.98). After internal validation, a clinically usable score ranging from -1 to 8 was developed, with high discrimination capabilities (area under the receiver operating curve 0.85, 95% CI 0.80-0.90). The threshold of 3 has good sensitivity (82.3%, 95% CI 72.7-91.8), whilst keeping a good specificity (82.7%, 95% CI 79.8-85.7)., Conclusions: These results outline the importance of generalized and nocturnal seizures on the occurrence of SUDEP, and show a protective role in the ability to alert someone of an oncoming seizure. The SUDEP-CARE score is promising and will need external validation. Further work, including paraclinical explorations, could improve this risk score., (© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Purpose: The purpose of this multicenter study was to evaluate the clinical success at three months of prostate artery embolization (PAE), assess PAE safety in centers with various experiences and identify factors associated with PAE success., Patients and Methods: This multicenter, retrospective study included patients who underwent PAE for lower urinary tract symptoms (LUTS) including those with indwelling urinary catheter. PAE clinical success was defined as either 25% improvement of the International Prostate Symptom Score (IPSS) or 1-point improvement of quality of life (QoL) score, or catheter removal at three months. Multivariable analyses were performed using a logistic regression adjusted on patient variables, technical parameters and center experience in PAE., Results: A total of 383 men (mean age, 68.4 ± 9.7 [standard deviation] years; range: 46-94) with LUTS, including 99 (25.8%) patients with indwelling urinary catheter, were included in seven centers from January 2017 to March 2019. Five patients reported major complications (1.3%), three (0.8%) penile ulceration, three (0.8%) acute urinary retention, one (0.3%) prostatic abscess, and 56 (14.6%) minor complications. Follow up data were available for 271 patients (center 1: n = 159; other centers: n = 112). Clinical success was reported in 232 patients (85.6%). In multivariable analyses, presence of cardiovascular comorbidities (diabetes, stroke history, myocardial infarction and lower limb artery disease) was the single independent variable inversely associated with PAE clinical success (odds ratio = 0.396; 95% confidence interval: 0.17-0.91; P = 0.029). There was no center effect., Conclusion: Our results show that PAE is safe and effective in centers with various PAE experiences. Cardiovascular comorbidity is the single independent variable associated with PAE failure., Competing Interests: Conflict of interest The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article., (Copyright © 2022 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Several studies have suggested a strong relationship between the number of peripherally inserted central catheter (PICC) lumens and the risk of complications. The purpose of this study is to evaluate the impact of the intervention of a clinical pharmacist (CP) on the number of lumens of PICC inserted and assess PICC-related complications., Method: This prospective monocentric study included all consecutive patients from 5 different units who underwent PICC insertions from September 2017 to March 2018. In the intervention group, the CP validated the pertinence of each PICC request according to the patients' records, choice of device (single or double lumen), and incompatibilities between treatments. The control group consisted of patients who underwent PICC insertions without a CP intervention. Complications were prospectively recorded up to PICC removal. Multivariate analyses adjusted for sex, age, and PICC line duration were performed., Results: In the intervention group, 207 PICCs were inserted, 81.2% (n = 168) were single-lumen devices and 18.8% (n = 39) were double-lumen devices. In the control group (n = 77), the use of single-lumen PICCs was significantly lower (n = 48, 62.3%; P = 0.002). After intervention, the overall complication incidence rate decreased from 4.42 to 3.23 per 1000 catheter days ( P = 0.082). Considering the overall population, 216 single-lumen PICCs were inserted with significantly fewer complications than double-lumens (respectively n = 16, 16/216 = 7.4%, versus n = 15, 15/68 = 22.1%, P = 0.002). The adjusted odds ratio of double-lumen PICC was 3.83 (95% confidence interval, 1.46-10.07; P = 0.007)., Conclusions: Our study showed the intervention of a CP in the PICC insertion process could increase the use of single-lumen PICCs and tended to reduce associated complications., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Percutaneous cryoablation with liquid nitrogen is a new technique being used in the treatment of some malignant tumors. Our objective was to assess its feasibility in the ablation of tumor lesions of various sizes and locations., Methods: This retrospective, monocentric study included all consecutive patients who underwent percutaneous cryoablation with liquid nitrogen between December 2019 and March 2021. Cryoablation was performed using 10G or 13G cryoprobes. The ablation volume was measured on post-treatment CT or MRI., Results: 22 patients (24 lesions) were included, 16 of whom were men (73%), while median age was 66 years. The lesions were located in the bone (42%), kidney (29%), soft tissue (17%), lung (8%), or liver (4%). It was feasible in all tumor locations and produced median ablation zones 25 mm in width and 35 mm in length, with a 23 min median freezing time. Freezing duration was correlated with the ice volume ( p Spearman = 0.02), but not with the ablation volume ( p = 0.11). The average difference between the ablation zone and ice ball sizes were -6.4 mm in width and -7.7 mm in length. Both ice and ablation volumes were larger when using the 10G probe as compared to when the 13G was used. No complications were reported., Discussion: We showed that this technique was safe and feasible in all organs tested. The freezing duration was correlated with the ice ball size, but not with the ablation zone.

The prevalence of sarcopenia in patients with obesity varies according to the definition used. The purpose of our study was to: (i) determine the prevalence of sarcopenia in terms of lean tissue mass in older women with obesity using the current cut-offs, (ii) redefine a specific cut-off for low lean tissue mass (LLTM), and (iii) re-determine the prevalence of LLTM using this new cut-off. Appendicular lean mass (ALM) and the ALM index [ALM/height 2 : ALMI(h 2 )] and ALMI/body mass index [ALMI(BMI)] were determined in 791 women with or without obesity. LLMM prevalence was calculated using the current cut-offs: EWGSOP2: ALM < 15 kg and ALMI(h 2 ) < 5.5 kg/m 2 ; FNIH: ALM < 15.02 kg and ALMI(BMI) < 0.51; and IWGS: ALMI(h 2 ) < 5.67 kg/m 2 and cut-offs newly determined from data provided from young women with obesity. ALM, ALMI(h 2 ) and ALMI(BMI) were lower in older compared to young obese women. Using the current cut-offs, a wide distribution of LLTM prevalence (0 to 29.2%) was observed. When the newly determined cut-offs were applied - i.e., ALM < 18.51 kg; ALMI(h 2 ) < 7.15 kg/m 2 , ALMI(BMI) < 0.483, and T-score: [(ALMI(h 2 ) measured)-(2.08 + 0.183*BMI)]/0.72] - the LLTM mass prevalence was 17.37%; 8.47, 14.8 and 12.71%. respectively. This study showed that the current cut-offs for LLTM as criteria for sarcopenia diagnosis are not adapted to the obese population. Although the new "static" cut-offs appeared to be more adapted, a "dynamic" cut-off for ALMI(h 2 ) that took into account the BMI and thus the obesity severity appeared even more relevant., (© 2022. The Author(s).)

Purpose: We analyzed the relationship between use of anticholinergic drugs to treat overactive bladder (OAB) and risk of incident dementia in older patients, overall and for each drug separately., Materials and Methods: We conducted a nested case-control study using the French National Medical-Administrative Database. We identified incident dementia cases and controls from January 1, 2013 to December 31, 2018 in individuals aged ≥60 years. Controls were matched 5:1 to cases by date of case diagnosis (index date), age, sex, and income. We set a 5-year exposure period ending 2 years before the index date (lag-time period to avoid protopathic bias). We quantified cumulative exposure to flavoxate, oxybutynin, solifenacin, trospium, and fesoterodine using defined daily doses (DDDs). We performed conditional logistic regression analyses adjusted for factors known to be associated with OAB and/or dementia including obesity, diabetes, stroke, coronary heart disease, and psychotic disorders., Results: We analyzed 4,810 cases and 24,050 matched controls with a median age of 82 years. OAB anticholinergic use was associated with an increased risk of dementia (adjusted OR [aOR]=1.23, 95% CI 1.10-1.37) with a cumulative dose-response: aOR=1.07 (95% CI 0.91-1.25) for 1-90 DDDs, aOR=1.29 (1.05-1.58) for 91-365 DDDs and aOR=1.48 (1.22-1.80) for >365 DDDs. Considering each OAB anticholinergic separately showed a particularly marked increased risk of dementia for oxybutynin and solifenacin, but no increased risk for trospium., Conclusions: When treating OAB in older patients, OAB anticholinergics should be used with caution, taking into account the patient's cognitive status, the anticholinergic load, and the different therapeutic options.

Background: Postoperative pancreatic fistula (POPF) is a common and serious complication after distal pancreatectomy (DP). An effective and accepted score to predict the occurrence of clinically relevant (CR-) postoperative pancreatic fistula (POPF) does not exist., Methods: Data regarding 103 consecutive patients undergoing DP from 2015 to 2019 were collected. A multivariate logistic regression was performed, in order to build a simplified score. The accuracy in predicting a categorical outcome was evaluated using the receiver operating characteristic (ROC) curves. Youden's J test was performed to evaluate the performance of a positive score on the POPF occurrence., Results: Thirty-three patients developed a CR-POPF. Based on multivariate analysis results, a 4 points score was created by assigning 1 point if operation time was >4 hours, amylase levels on drains' fluid >500 UI on POD 3, pancreatic thickness >10 mm and if the BMI was >30. The discriminating ability was tested on the ROC curve, showing an area under the curve of 0.83 (95% CI: 0.75-0.92). The score threshold was determined at 2 points/4, the highest value according to the Youden Index (0.53). The sensitivity is calculated at 82% (95% CI: 69-95) and the specificity at 71 (95% CI: 61-82). A threshold of 3 points/4 allows to reach a specificity of 99% (95% CI: 99-100)., Conclusions: An easy-to-use postoperative score based on operation time, obesity, amylase level on drains on POD3 and pancreatic thickness on preoperative CT seems to predict the risk of developing CR-POPF.

Objectives: Sjögren's syndrome (SS) and ANCA-associated vasculitis (AAV) have distinct clinical presentation and evolution, with paucity of reports on overlap syndrome. We aimed to better characterize this entity., Methods: We report four additional cases from the Montpellier university hospital. We also performed a systematic literature review, according to PRISMA guidelines, in Medline, Embase, Web of science, Cochrane Library, and grey literature. Demographic, clinical, and paraclinical data on SS and AAV were analysed., Results: A total of 3133 articles was identified in databases, with 2695 articles screened for eligibility. After exclusion, we had 30 articles on 40 patients to analyse, in addition to 4 patients from our local recruitment (44 patients overall). Patients were female in 81.8%, with median age at AAV onset of 63.5 years. All patients but one presented with SS before, or concomitantly to the diagnosis of AAV, with a median delay of 12 months between both diagnoses. AAV predominantly had renal involvement (35/44 patients, 79.5%), anti-MPO antibodies being the most frequent (35 patients), even in patients presenting with granulomatosis with polyangiitis. We observed significantly more Raynaud phenomenon and associated auto-immune diseases in the group of non-granulomatous AAV (10 patients versus 1, p = 0.015 and 8 patients versus 0, p = 0.013, respectively)., Conclusions: This is the largest descriptive study on the association between SS and AAV, providing information on this challenging diagnosis and interplay between these two diseases. Particular attention should be paid in the first months after diagnosis, given the specific complications and outcomes of each disease., (Copyright © 2022 Elsevier B.V. All rights reserved.)