Mathieu Di Bisceglie

Background/Objectives: Interstitial lung disease (ILD) is a heterogenous group of disorders characterised by an association of inflammatory and fibrotic abnormalities of the lung. Acute respiratory failure (ARF) may represent the initial picture of the disease. This study aims to highlight the diagnosis of ILD in the intensive care unit (ICU) and to describe the epidemiological, prognostic, and imaging features of patients diagnosed for the first time with ILD in the ICU. Methods: We conducted a single-centre retrospective study. We screened all 2459 patients admitted to our ICU from October 2017 to February 2020. The inclusion criteria consisted of the ILD diagnosis criteria. For each patient, clinical data and lung computed tomography scan patterns were analysed. The selected cases were then reviewed by an expert team at the tertiary care teaching hospital of Marseille (Hôpital Nord, Marseille, France). Results: During the study period, 26 ICU patients were diagnosed with ILD and 20 cases were confirmed by the expert team. The most frequent diagnoses were idiopathic ILD (n = 7, 35%), auto-immune disease-related ILD (n = 7, 35%), exposure-related ILD (n = 3, 15%), and carcinomatous lymphangitis (n = 3, 15%). Fifteen patients were men (75%), with a mean age of 70 (62–72) years. The median SOFA score was 4 (3–7), and 16 (80%) patients received invasive mechanical ventilation. The mean ratio of the oxygen pressure to the fraction of inspired oxygen was 174 (148–198) mmHg. The ICU mortality rate of our cohort was significantly higher than the average ICU mortality (65% vs. 26%, p < 0.003). The mortality rate was lower among the subgroup of auto-immune disease-related ILD (57%). Conclusions: We conducted a single-centre cohort study of patients diagnosed with ILD in the ICU. This rare cause of ARF was associated with poor outcome in the ICU, but auto-immune disease-related ILD seemed to have a better prognosis. High-resolution lung CT and identification of lesion patterns are the cornerstones of the diagnosis. Improved knowledge of ILD and multidisciplinary discussion (MDD) involving radiologists, pneumologists, and intensivists may result in an earlier diagnosis and eventually improved treatments.

Background. Interstitial lung disease (ILD) is a heterogenous group of disorders char-acterized by an association of inflammatory and fibrotic abnormalities of the lung. An acute respiratory failure (ARF) may represent the initial picture of the disease. This study aims to highlight the diagnosis of ILD in intensive care unit (ICU) and describe the epidemiologic, prognosis, and imaging features of patients with ILD diagnosed in our ICU department. We conducted a single-center retrospective study. We screened all the 2,459 patients admitted to our ICU from October 2017 to February 2020. The inclusion criteria consisted of the ILD diagnosis criteria. For each patient, clinical data and lung computed tomog-raphy scan patterns were analyzed. The selected cases were then reviewed by an expert team in the tertiary care teaching hospital of Marseille (Hôpital Nord, Marseille, France). Results During the study period, 26 ICU patients were diagnosed with ILD and 20 cases were confirmed by the expert team. The most frequent diagnoses were idiopathic ILD (n = 7, 35%), auto-immune disease related ILD (n = 7, 35%), exposure-related ILD (n = 3, 15%) and carcinomatous lymphangitis (n = 3, 15%). Fifteen patients were men (75%), with a mean age of 70 [62 – 72] years. Median SOFA score was 4 [3-7]and 16 (80%) received invasive mechanical ventilation. The mean ratio of the partial ratio of oxygen to the fraction of inspired oxygen was 174 [148 – 198] mmHg. The ICU mortality rate of our cohort was significantly higher than in the average ICU mortality (65% vs 26%, p< 0.003). The mortality rate was lower among the subgroup of auto-immune disease related ILD (57%). Conclusions We conducted a single-center cohort of patients diagnosed with ILD in the ICU. This rare cause of ARF was associated with poor outcome in ICU, but auto-immune disease related ILD seemed to have a better prognosis. Lung high-resolution CT and identifi-cation of lesion patterns are the cornerstone of the diagnosis. Improved knowledge of ILD and multidisciplinary discussion involving radiologists, pneumologists and intensivists may result in an earlier diagnosis and eventually im-proved treatments.

Purpose: The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature. We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics. Methods: Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients' CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured. Results: The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4$\pm$1.9 cm and a larger width above the umbilicus than below. Its length was 37.5$\pm$3.6 cm, which increased with body mass index (BMI) (p$\leq$0.001), and was shorter in women (p$\leq$0.001). The sagitta was 2.6$\pm$2.2 cm, three times higher in the obese group (p$\leq$0.001), majorated with age (p=0.009), but was independent of gender (p=0.212). Linea alba width increased with both age and BMI (p$\leq$0.001, p=0.002), being notably wider in women halfway between the umbilicus and pubis (p=0.007). Conclusion: This study provides an exhaustive 3D description of Linea alba's anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.

Purpose The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature. We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics. Methods Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients’ CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured. Results The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p < 0.001), and was shorter in women (p < 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p < 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p < 0.001–p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007). Conclusion This study provides an exhaustive 3D description of Linea alba’s anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.

Background: Postpartum hemorrhage is the leading cause of maternal mortality in emerging countries. This study aims to evaluate the effectiveness and safety of uterine artery embolization (UAE) using suture fragment (FairEmbo concept) in a swine model. Methods: Seven female swine uteri were embolized. The left uterine artery was embolized with 1 cm fragments of absorbable suture (Optime^® 0), and with gelatin sponge torpedoes for the contralateral side for comparison. The embolization effectiveness and the time for arterial recanalization with digital subtraction angiography (DSA) controls at D0, D7, and M1, were evaluated. Follow-up protocol also included clinical monitoring and macroscopical analyses at M1. A Mann–Whitney test (significance at P 0.05) was used for statistics. Results: A technical success was obtained for the seven arteries on each side, with no off-target embolization. The procedure time (10 min versus 3.7 min) and number of fragments (13.8 versus 5.7) required for complete occlusion were significantly greater in the FairEmbo group. All arteries were repermeabilized at M1. No necrosis was macroscopically visible at harvest at M1. Conclusion: This experimental study suggests that UAE with SBM FairEmbo method is feasible, safe, and effective in comparison with gelatin sponge procedure.

(1) Background: Segmentation of the bladder inner’s wall and outer boundaries on Magnetic Resonance Images (MRI) is a crucial step for the diagnosis and the characterization of the bladder state and function. This paper proposes an optimized system for the segmentation and the classification of the bladder wall. (2) Methods: For each image of our data set, the region of interest corresponding to the bladder wall was extracted using LevelSet contour-based segmentation. Several features were computed from the extracted wall on T2 MRI images. After an automatic selection of the sub-vector containing most discriminant features, two supervised learning algorithms were tested using a bio-inspired optimization algorithm. (3) Results: The proposed system based on the improved LevelSet algorithm proved its efficiency in bladder wall segmentation. Experiments also showed that Support Vector Machine (SVM) classifier, optimized by Gray Wolf Optimizer (GWO) and using Radial Basis Function (RBF) kernel outperforms the Random Forest classification algorithm with a set of selected features. (4) Conclusions: A computer-aided optimized system based on segmentation and characterization, of bladder wall on MRI images for classification purposes is proposed. It can significantly be helpful for radiologists as a part of spina bifida study.

Background: Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes. Methods: A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group). Results: We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group (p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 [10–25] min vs. 34 [15–40] min, p < 0.001). In-hospital mortality rates were 17% in the POCUS group and 35% in the control group (p = 0.007), but this difference was not confirmed in the propensity score sample (29% vs. 34%, p = 0.53). Conclusion: Our study suggests that protocolized use of a handheld POCUS device at the bedside in the ward may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory or circulatory failure. Clinical Trial Registration NCT02967809. Registered 18 November 2016, https://clinicaltrials.gov/ct2/show/NCT02967809.