Hôpital Pasteur

Postoperative pain management typically relies on numerical (NRS) or analogue rating scales. However, exclusive focus on nociception may overlook broader aspects of patient experience, especially under regional anaesthesia (RA). This post hoc analysis of the COMFORT trial (NCT05234216) examined whether replacing the NRS with a comfort-focused scale affects patient-reported experience, opioid use, and related outcomes. We analysed data from a cluster-randomised trial in 29 French centres. Adults undergoing elective non-cardiac surgery managed in the post-anaesthesia care unit (PACU) were included. The intervention (comfort scale) and comparator (pain NRS) were applied in the PACU. Patient-reported experience was measured with the EVAN-G/LR scales, self-completed on the ward/day-care unit ≥4 h postoperatively. Participants were divided into RA and general anaesthesia subgroups. Of 885 randomised patients, 786 had evaluable EVAN data. After regional anaesthesia (RA; n = 305), comfort‑focused assessment was associated with higher EVAN Pain (median 88 [IQR 75-94] vs. 75 [69-88]; p = 0.034), Waiting (100 [75-100] vs. 75 [50-100]; p = 0.012), and Global Index (81 [72-91] vs. 77 [68-90]; p = 0.044). After general anaesthesia (GA; n = 481), EVAN scores were similar between groups. Nefopam use was lower with the comfort approach in RA (7% vs. 18%; p = 0.005). Antiemetic use was lower with the comfort approach in GA. Replacing the NRS with a comfort-focused approach did not improve global patient experience after surgery. In patients receiving regional anaesthesia, however, using a comfort scale was associated with better patient-reported experience in the EVAN "Pain" dimension, while no benefit was observed after general anaesthesia.

Radiologically isolated syndrome (RIS) is a neurological condition in people with demyelinating lesions on brain and/or spinal cord magnetic resonance imaging (MRI) studies, but without clinical symptoms of disease. Elucidating the immune profile of people with RIS (pwRIS) who will display MRI or clinical features of advancing disease is critical to our understanding of disease pathogenesis. Our lab previously identified features of B cell dysregulation in people with clinically isolated syndrome (pwCIS), who have both demyelinating lesions and a first clinical event of disease. The goal of this study was to compare features of B cell dysregulation in pwRIS, pwCIS, and healthy controls (HC). The second goal was to determine if these features of B cell dysregulation would be evident in people who meet the new MS diagnostic criteria, particularly in the context of their disease course for 5 years post-sampling. Features of plasmablast responses that distinguish pwRIS from pwCIS include PB expansion, antigen-driven selection, VH4 and JH6 antibody gene over-usage, neuron reactivity by purified IgG and individually cloned antibodies. Furthermore, VH4:JH6 pairing in plasmablasts was higher in people with stable MS who do not show changes in MRI or clinical events from those with advancing disease activity.

Acute Respiratory Distress Syndrome (ARDS) is a heterogeneous, life-threatening condition with persistent diagnostic uncertainty, limited causal treatments, and high mortality in intensive care. ARDS management remains largely supportive, and conventional scores and trial designs have struggled to account for its biological and clinical heterogeneity. This narrative review summarizes current and emerging applications of Artificial Intelligence (AI) in ARDS and mechanical ventilation. It focuses on how Machine Learning (ML) can refine early risk prediction, diagnosis, phenotyping, management and outcome prediction, while outlining the strengths, weaknesses and nuances of these applications. ML models using electronic health records, imaging, physiological waveforms and omics data show strong performance for predicting ARDS onset, enabling early diagnosis, optimising management and forecasting outcomes. These models show performance equivalent to and often outperform traditional guidelines and scores. However, most of these models remain limited to the research setting and show limited clinical adoption. Most studies are retrospective, single-center and lack rigorous external validation, limiting generalizability and real-world impact. Additional challenges include data quality and bias, poor calibration and scarce decision-curve analyses, limited interpretability, and the absence of prospective trials demonstrating that AI-guided strategies improve patient-centered outcomes. ML has substantial potential to advance precision medicine in ARDS by enabling predictive and prognostic enrichment and supporting personalized ventilatory care. Its safe and equitable deployment, however, requires standardized methodology, transparent reporting, multicenter prospective validation, and clinician-led governance to ensure that AI augments rather than replaces expert clinical judgment.

Spinal muscular atrophy (SMA) types III and IV are the most common late-onset forms, and they progress slowly, making the identification of sensitive biomarkers critical. The Motor Unit Number Index (MUNIX) estimates motor unit loss and may complement traditional electrophysiological measurements such as Compound Muscle Action Potential amplitudes (CMAP). However, their respective performances have never been directly compared in adult SMA. In a French multicenter study (NCT04690998), 71 adult patients with SMA and 24 healthy controls underwent clinical and electrophysiological evaluation. MUNIX, CMAP, and Motor Unit Size Index (MUSIX) were recorded in four muscles, and sum scores (SumMUNIX, SumCMAP, SumMUSIX) were calculated. Reliability was assessed using intraclass correlation coefficients (ICCs), and associations with functional outcomes were explored. MUNIX and CMAP effectively distinguished SMA patients from controls, showing strong test - retest reliability. MUNIX showed the highest discriminative performance (AUC = 0.92), while CMAP demonstrated the strongest and most consistent associations with clinical severity. In multivariate analyses, only CMAP remained independently associated with all functional and strength measures, whereas MUNIX and MUSIX lost significance. MUNIX demonstrated the highest discriminative performance among biomarkers for differentiating SMA from controls, indicating early motor unit loss even when CMAP values were within normal limits. However, disease burden and functional impairment were better reflected by CMAP, probably due to it integrating both motor unit loss and reinnervation. The complementary nature of these profiles supports their combined use (concurrent application), and longitudinal studies are warranted to assess their responsiveness in adult SMA as well as their appropriateness for clinical trial settings.

To establish French recommendations for the management of people living with hand osteoarthritis (OA) on behalf of the French Society of Rheumatology (SFR) and of the French Society of Physical and Rehabilitation Medicine (SOFMER). A systematic review of the literature, including systematic reviews, meta-analyses, and randomized controlled trials on pharmacological and non-pharmacological treatments, was conducted from inception until November 24, 2023. Based on this review and expert consensus, a multidisciplinary group of 25 healthcare professionals-including rheumatologists, physical and rehabilitation medicine physicians, hand surgeons, general practitioner, geriatrician, occupational therapists, physiotherapists, and patients-formulated the recommendations. Each statement was assigned a level of evidence, a grade of recommendation, and a level of agreement based on EULAR standardized procedures for recommendations. The group established four general principles and 11 specific recommendations. The general principles emphasize treatment objectives, individualized management, patient education, and a multimodal approach combining non-pharmacological and pharmacological therapies. Four specific recommendations address non-pharmacological strategies, including exercise, ergonomic advice, assistive devices, orthoses and heat applications. The group advises against the use of electromagnetic waves, laser therapy, acupuncture, or kinesiotaping. Seven specific recommendations cover pharmacological treatments, advocating for topical and oral NSAIDs, acetaminophen, chondroitin sulfate for symptom relief, low-dose oral corticosteroids for inflammatory flares, and intra-articular steroid injections for inflammatory painful interphalangeal OA. Given the current data, the group advises against the use of conventional synthetic or biological disease-modifying anti-rheumatic drugs (DMARDs). These recommendations provide a structured approach for the management of people living with hand OA in France, aligning with national healthcare practices and patient needs.