KRASFormer: a fully vision transformer-based framework for predicting KRAS gene mutations in histopathological images of colorectal cancer.

Detecting the Kirsten Rat Sarcoma Virus (KRAS) gene mutation is significant for colorectal cancer (CRC) patients. The KRAS gene encodes a protein involved in the epidermal growth factor receptor (EGFR) signaling pathway, and mutations in this gene can negatively impact the use of monoclonal antibodies in antiEGFR therapy and affect treatment decisions. Currently, commonly used methods like next-generation sequencing (NGS) identify KRAS mutations but are expensive, time-consuming, and may not be suitable for every cancer patient sample. To address these challenges, we have developed KRASFormer, a novel framework that predicts KRAS gene mutations from Haematoxylin and Eosin (H&E) stained WSIs that are widely available for most CRC patients. KRASFormer consists of two stages: the first stage filters out non-tumor regions and selects only tumour cells using a quality screening mechanism, and the second stage predicts the KRAS gene either 'wildtype' or 'mutant' using a Vision Transformer-based XCiT method. The XCiT employs cross-covariance attention to capture clinically meaningful long-range representations of textural patterns in tumour tissue and KRAS mutant cells. We evaluated the performance of the first stage using an independent CRC-5000 dataset, and the second stage included both The Cancer Genome Atlas colon and rectal cancer (TCGA-CRCDX) and in-house cohorts. The results of our experiments showed that the XCiT outperformed existing state-of-the-art methods, achieving AUCs for ROC curves of 0.691 and 0.653 on TCGA-CRC-DX and in-house datasets, respectively. Our findings emphasize three key consequences: the potential of using H&E-stained tissue slide images for predicting KRAS gene mutations as a cost-effective and time-efficient means for guiding treatment choice with CRC patients; the increase in performance metrics of a Transformer-based model; and the value of the collaboration between pathologists and data scientists in deriving a morphologically meaningful model.

True-T - Improving T-cell response quantification with holistic artificial intelligence based prediction in immunohistochemistry images.

The immune response associated with oncogenesis and potential oncological ther- apeutic interventions has dominated the field of cancer research over the last decade. T-cell lymphocytes in the tumor microenvironment are a crucial aspect of cancer's adaptive immunity, and the quantification of T-cells in specific can- cer types has been suggested as a potential diagnostic aid. However, this is cur- rently not part of routine diagnostics. To address this challenge, we present a new method called True-T, which employs artificial intelligence-based techniques to quantify T-cells in colorectal cancer (CRC) using immunohistochemistry (IHC) images. True-T analyses the chromogenic tissue hybridization signal of three widely recognized T-cell markers (CD3, CD4, and CD8). Our method employs a pipeline consisting of three stages: T-cell segmentation, density estimation from the segmented mask, and prediction of individual five-year survival rates. In the first stage, we utilize the U-Net method, where a pre-trained ResNet-34 is em- ployed as an encoder to extract clinically relevant T-cell features. The segmenta- tion model is trained and evaluated individually, demonstrating its generalization in detecting the CD3, CD4, and CD8 biomarkers in IHC images. In the second stage, the density of T-cells is estimated using the predicted mask, which serves as a crucial indicator for patient survival statistics in the third stage. This ap- proach was developed and tested in 1041 patients from four reference diagnostic institutions, ensuring broad applicability. The clinical effectiveness of True-T is demonstrated in stages II-IV CRC by offering valuable prognostic information that surpasses previous quantitative gold standards, opening possibilities for po- tential clinical applications. Finally, to evaluate the robustness and broader ap- plicability of our approach without additional training, we assessed the universal accuracy of the CD3 component of the True-T algorithm across 13 distinct solid tumors.

Effect of bariatric and metabolic surgery on rheumatoid arthritis outcomes: A systematic review.

INTRODUCTION: Obesity is a growing and debilitating epidemic worldwide that is associated with an increased inflammation. It is often linked to rheumatic diseases and may impact negatively their natural history. The use of bariatric and metabolic surgery (BMS) has increased thanks to its positive effect on major comorbidities like diabetes type 2. This systematic review provides the most up-to-date published literature regarding the effect of BMS on outcomes in rheumatoid arthritis. METHODS: This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed, Embase and Cochrane, published until June 16th 2023, and tackling the effect of BMS on disease outcomes in patients with RA were included. RESULTS: Three studies met the inclusion criteria. They were published between 2015 and 2022. The total number of RA patients was 33193 and 6700 of them underwent BMS. Compared to non-surgical patients, weight loss after BMS was associated with lower disease activity outcomes at 12 months (p<0.05). Similarly, prior BMS in RA patients was significantly associated with reduced odds ratios for all the morbidities and in-hospital mortality compared with no prior BMS (36.5% vs 54.6%, OR = 0.45, 95% CI (0.42, 0.48), p< 0.001) and (0.4% vs 0.9%, OR = 0.41, 95% CI (0.27-0.61), p < 0.001) respectively. CONCLUSION: To conclude, published data indicate that BMS seems a promising alternative in reducing RA disease activity as well as morbidity and mortality in patients with obesity.

The first case of SARS-CoV-2-induced eosinophilic fasciitis.

Eosinophilic fasciitis (EF), also known as Shulman syndrome, is a rare auto-immune fibrosing disorder of the fascia. Etiopathogeny of EF is still unclear. Nowadays, it is widely known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce hyper-stimulation of the immune system. Several cases with fasciitis and rhabdomyolysis induced by coronavirus disease 2019 vaccines have been reported in the literature. Herein, we report the first case of EF possibly triggered by SARS-CoV-2 infection. A 45-year-old Tunisian woman, with no medical history, presented to our department with severe widespread muscle pain noticed one month after a SARS-CoV-2 infection. Physical examination showed an induration of the skin and subcutaneous tissue of the arms, forearms and legs with a restricted joint mobility. The level of eosinophils was 430 E/mm3 (6.1%) [1-4%]. Electromyography and creatine kinase levels were normal. Myositis-related antibodies were negative. Magnetic resonance imaging of the left arm showed high-intensity signal and thickness of the fascia without evidence of muscle or bone involvement. A muscular biopsy from the right deltoid showed thickening and inflammation of the fascia. The patient received intraveinous injections of 1000 mg of methylprednisolone for 3 days with an oral relay of 1 mg/kg per day of prednisone equivalent during 4 weeks. At one-month follow-up, a significant improvement of the skin induration and myalgia was observed, with a disappearance of the biological inflammatory syndrome. This brief report suggests a potential link between SARS-CoV-2 infection and new-onset of auto-immune fasciitis.

Effect of music therapy on patients with rheumatic diseases.

BACKGROUND: Music therapy seems to have a multitude of positive effects not only on mental health but also on organic pain. Some studies have showed its effectiveness on reducing pain for patients undergoing surgical procedures. However, data on its efficiency on patients' anxiety during rheumatology medical consultation for patients with chronic rheumatic diseases is lacking. OBJECTIVES: The purpose of the present study was to describe the impact of music therapy on the mood of patients followed for chronic rheumatic diseases. METHODS: We conducted a cross-sectional study including patients followed for chronic rheumatic diseases seen in the outpatient rheumatology department during a period of three weeks. Patients selected were randomly assigned into two groups. Patients seen while listening to music "The Mozart Sonata" formed theG1 (n = 40). Patients seen without listening to music formed the group G2 (n = 30). Participants' anxiety levels were assessedbefore and immediately after medical consultations by collecting vital signs (heart rate and respiratory rate) and by the Spielberger State Trait Anxiety inventory questionnaire (STAI). RESULTS: The mean age of 70 patients included was 54.36 ± 14.62 years. Females outnumbered males (62.9 %).The STAI scores were 38.44 (range, 25-60) and 34.51 (range, 22-52)respectively pre- and post-consultation. The medical consultation lasted for a mean of 24 ± 1.1 min in G1 and 20.63 ± 1.3 in G2. Sharp after the consultation, the mean Heart Ratewas significantly lower in the group with music therapy (64±1.5 in G1 versus 66.3 ± 1.3 in G2, p = 0.02) and the mean STAI decreased also significantly in tne G1 (34.72±1 in G1 versus 40.7 ± 5.2 in G2, p = 0.018). However, the decline of the mean Respiratory Ratewas not significant between both groups(16.1 ± 1 in G1 versus 16.96 ± 1.7 in G2, p = 0.42). CONCLUSION: Our study showed a significant lowering in anxiety level and heart rate in patients consulted while listening to music.This costless and available tool should be more used in our daily practice specially when treating patients with chronic painful diseases.

Baseline predictors of fatigue and persistent fatigue in rheumatoid arthritis: A longitudinal observational study.

OBJECTIVES: To determine factors associated with fatigue in patients with rheumatoid arthritis (RA), and to identify baseline predictors of persistent fatigue at 12 months of follow-up. METHODS: We enroled patients with RA fulfiling the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Fatigue was assessed using the Arabic version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Using univariate and multivariate analyses, we examined baseline variables associated with fatigue and persistent fatigue (if the FACIT-F score was less than 40 at baseline and 12 months of follow-up). RESULTS: We included 100 RA patients of whom 83% reported fatigue. At baseline, the FACIT-F score was significantly associated with older age (p = 0.007), pain (p < 0.001), global patient assessment (GPA) (p < 0.001), tender joint count (TJC) (p < 0.001), swollen joint count (p = 0.003), erythrocyte sedimentation rate (ESR) (p < 0.001), disease activity score (DAS28 ESR) (p < 0.001), and health assessment questionnaire (HAQ) (p < 0.001). At 12 months of follow-up, the percentage of patients who reported persistent fatigue was 60%. The FACIT-F score was significantly associated with age (p = 0.015), symptom duration (p = 0.002), pain (p < 0.001), GPA (p < 0.001), TJC (p < 0.001), C-Reactive Protein (p = 0.007), ESR (p = 0.009), DAS28 ESR (p < 0.001), and HAQ (p < 0.001). Pain was an independent baseline predictor of persistent fatigue (OR = 0.969 (95% CI [0.951-0.988]), p = 0.002). CONCLUSIONS: Fatigue is a frequent symptom in RA. Pain, GPA, disease activity and disability were associated with fatigue and persistent fatigue. Baseline pain was the only independent predictor of persistent fatigue.

Rheumatoid arthritis with concomitant fibromyalgia: The role of ultrasound in assessing disease activity.

INTRODUCTION: Fibromyalgia (FM) is a chronic painful condition frequently associated with rheumatoid arthritis (RA), which may falsely increase RA activity. The aim of our study was to compare clinical scoring and ultrasound (US) assessment in RA patients with concomitant FM with those without FM. METHODS: A cross-sectional study including patients with RA according to the ACR/EULAR 2010 criteria was conducted. Patients were divided into two groups: RA patients meeting ACR 2016 FM criteria (cases) and RA patients not meeting FM criteria (controls). Clinico-biological and US assessments of RA activity were performed on the same day for each patient. RESULTS: Eighty patients distributed into 40 patients in each group were recruited. Biologic DMARD prescription was more frequent in RA with FM patients than the control group (p = 0.04). DAS28 was significantly greater than DAS28 V3 in RA with FM group (p = 0.002). FM group had significantly less US synovitis (p = 0.035) and less Power Doppler (PD) activity (p = 0.035). Grey scale US score (p = 0.87) and DP US score (p = 0.162) were similar in the two groups. The correlation between the clinical and the ultrasonographic scores was strong to very strong in both groups with the strongest correlation found between DAS28 V3 and US DAS28 V3 (r = 0.95) in RA + FM group. CONCLUSION: Our study confirms the overestimation of disease activity by the clinical scores in RA with concomitant FM. DAS28 V3 score and US assessment would represent a better alternative.

Is there an association between plantar fasciitis and knee osteoarthritis?

BACKGROUND: Knee osteoarthritis (OA) and plantar fasciitis share similar risk factors including ageing, occupation, obesity, and inappropriate shoe wear. However, the association between knee OA and heel pain caused by plantar fasciitis has received limited attention to date. AIM: We aimed to assess the prevalence of plantar fasciitis using ultrasound in patients with knee OA and to identify factors associated with plantar fasciitis in these patients. PATIENTS AND METHODS: We conducted a cross-sectional study including patients with Knee OA, fulfiling the European League Against Rheumatism criteria. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and the Lequesne indexes were used to evaluate pain and function of the knees. The Manchester Foot Pain and Disability Index (MFPDI) was used to estimate foot pain and disability. Each patient underwent a physical examination, plain radiographs of the knees and the heels, and an ultrasound examination of both heels to find signs of plantar fasciitis. Statistical analysis was performed using SPSS. RESULTS: We included 40 knee OA patients, with a mean age of 59.85 ± 9.65 years [32-74] and a male-to-female ratio of 0.17. The mean WOMAC was 34.03 ± 19.9 [4-75]. The mean Lequesne for knees was 9.62 ± 4.57 [3-16.5]. Among our patients, 52% (n = 21) experienced heel pain. The heel pain was severe in 19% (n = 4). The mean MFPDI was 4.67 ± 4.16 [0-8]. Limited ankle dorsiflexion and plantar flexion were noted in 47% of patients (n = 17) each. High and low arch deformities were seen in 23% (n = 9) and 40% (n = 16) of patients. Ultrasound revealed a thickened plantar fascia in 62% (n = 25). An abnormal hypoechoic plantar fascia was noted in 47% (n = 19), with the loss of normal fibrillar architecture in 12 cases (30%). No Doppler signal was exhibited. Patients with plantar fasciitis had significantly limited dorsiflexion (n = 2 (13%) versus n = 15 (60%), p = 0.004) and plantar flexion (n = 3 (20%) versus n = 14 (56%), p = 0.026). The range of supination was also less important in the plantar fasciitis group (17.73 ± 4.1 vs. 12.8 ± 6.46, p = 0.027). The low arch was statistically more present in patients with plantar fasciitis (G1: 36% [n = 9] vs. G0: 0% [n = 0], p = 0.015). However, the high arch deformity was statistically more present in patients without plantar fasciitis (G1: 28% [n = 7] vs. G0: 60% [n = 9], p = 0.046). Multivariate analysis showed that the risk factor for plantar fasciitis in knee OA patients was limited dorsiflexion (OR = 3.889, 95% CI [0.017-0.987], p = 0.049). CONCLUSION: In conclusion, our work showed that plantar fasciitis is frequent in knee OA patients, with reduced ankle dorsiflexion being the main risk factor for plantar fasciitis in these patients.

The concept of telemedicine in pediatric rheumatology in Tunisia: Parents' perceptions.

INTRODUCTION: With the COVID-19 pandemic, health care systems are facing challenges in delivering proper patient care. Children and adolescents with juvenile idiopathic arthritis require specialized and comprehensive attention. In this context, telemedicine is an alternative that has the potential to improve access to healthcare in addition to cost savings. The objective of our study was to evaluate parents' willingness for telemedicine and factors helping to adopt this alternative in the era of COVID-19. METHODS: We undertook a cross-sectional study via structured phone interviews of parents' JIA patients as well as those with no established diagnoses. We evaluated their point of view and willingness to adhere to TM. RESULTS: The study included 40 parents. The main reasons for favoring TM were avoiding hospitals during the pandemic (32.5%), time saving (27.5%) as well as avoiding school absenteeism (27.5%). The main reasons for preferring a live consultation were the fear of a possible discrepancy between physical and distant evaluation (47.5%) and the fear of the trivialization of the disease (38.5%). There was no association between preference for TM and a family history of COVID-19 (p = 0.704) as well as electronic devices afforded (p = 0.263). However, patients who lived away from hospital, not familiar with the concept of TM and with higher income adhered less to TM. CONCLUSION: Unlike the literature data, our study showed the low prevalence of parents willing to accept TM as a model of care. This imply an urgent need for parent and patient education to promote TM especially in pediatric rheumatology.

Assessment tools in juvenile idiopathic arthritis: A narrative review.

Juvenile idiopathic arthritis (JIA), as a chronic condition, is associated with significant disease- and treatment-related morbidity, thus impacting children's quality of life. In order to optimize JIA management and to ensure the best possible care and outcome for children with rheumatic diseases, dedicated disease activity and damage assessment tools are essential. In recent years, there has been a concerted and important international effort to develop and validate disease activity and outcome instruments specific to JIA. This update aims to describe the main outcome measures currently used in JIA patients. These outcome measures include composite disease activity score, measures of physical function, measures of health related quality of life, clinical measures of damage and the assessment of Parent and child reported outcomes (PCROs).

Patient education: improving health outcomes in rheumatoid arthritis.

INTRODUCTION: Rheumatoid arthritis is a disabling disease leading to an impaired quality of life. To avoid joint damage, innovative strategies such "educational" medical procedures are developing, involving the patient in the management of his illness. AIM: The objective of our study was to assess the effectiveness of patient education (PE) program on quality of life and adherence in the short and medium term. METHODS: A prospective study including RA patients. The intervention consisted of sessions that lasted half a day including four workshops. The parameters studied included the quality of life evaluated by the HAQ, adherence to treatment according to Girerd's questionnaire, fatigue evaluated by the MAF psychological state evaluated according to the HAD. We compared these results at baseline, then after 3 and 6 months of follow-up. RESULTS: Fifty-one patients participated in the PE program. At the end of the intervention, HAQ remained stable through the different controls with a slight improvement at 6 months. The percentage of patients with poor therapeutic compliance decreased to 33.3% at baseline to 13.7% at 3 months and to 9% at 6 months. The MAF decreased significantly from 33.1% at inclusion to 25.6% at 6 months post-intervention (p=0,001, p=0,000 respectively). HADA and HADD also decreased significantly at 3 months and 6 months. CONCLUSIONS: Our PE program demonstrated in Tunisian RA patients an improvement in the quality of life at 6 months and a significant improvement in adherence in the short and medium term.

Prevalence and associated factors for persistent low back pain in the postpartum period.

INTRODUCTION: Low back pain (LBP) is common during pregnancy and tends to increase in the third trimester. This pregnancy-related condition may even persist through the postpartum period, and become a lifelong problem. AIM: To determine the prevalence of persistent LBP in the postpartum and to identify factors associated with this condition. METHODS: In this cross-sectional study, we assessed a survey of women under the age of 40 for back pain symptoms during the postpartum period. Questions included sociodemographic data, data related to low back pain during pregnancy and the postpartum period as well as characteristics of the delivery. We identified factors associated with persistent LBP in postpartum. The level of significance was fixed at 0.05. RESULTS: We interviewed 100 women during their postpartum period. A history of LBP before and during pregnancy was found in 44.6% and 75% of cases respectively. In addition to pregnancy-related LBP, 53% experienced persistent postpartum LBP. A history of previous back pain episodes when not pregnant (p<0,001), as well as during previous pregnancies (p<0,001) were associated with persistent LBP. In contrast, no association was found between LBP in the postpartum and the number of children (p=0.681), body mass index (p=0.37), and physical activity (p=0.726). In multivariate analysis, we did not identify any associated factors for persistent LBP. CONCLUSIONS: Our study showed that the prevalence of persistent LBP in the postpartum is high. The main factors associated with this condition were previous episodes of back pain while non-pregnant or pregnant. Identification of these risk factors may help in the determination of appropriate prevention strategies and treatment options.

Zoledronate-Associated Seizure in Chronic Recurrent Multifocal Osteomyelitis.

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease characterised by sterile bone lesions. We report a case of a seven-year-old female patient who presented at a university hospital in 2010 and 2018 with CRMO. While the most promising results have been observed in patients under treatment with bisphosphonates (BPs), the initial decision to treat the current patient with a dose of zoledronic acid every six months was recalled as the patient developed tonic-clonic seizures immediately following the second dose BP administration. Following recall, the patient maintained a prompt response at follow-up and her disease remained controlled with non-steroidal anti-inflammatory drugs. The current case report speculates a possible relationship between BP use and a possible seizure threshold reduction, thereby emphasising the need for closer monitoring when BPs are used.

Validity of Remission Criteria in Rheumatoid Arthritis Compared to Ultrasound-Defined Remission.

Objectives: Remission is the ultimate purpose of treatment in rheumatoid arthritis (RA). However, even when the most stringent composite scores are used, structural damages can occur; hence, ultrasonography (US) appears to be the best way to assess real remission. This study aimed to investigate the validity of different RA remission scores using US as a reference. Methods: An analytic diagnostic study, of 30 RA patients in remission (according to the Disease Activity Score in 28 Joints [DAS28]) and a control group with active RA, was conducted between January and October 2018 at Mongi Slim Hospital in Tunis, Tunisia. Among them, patients in remission were identified according to their Simple Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and the Boolean American College of Rheumatology/European League against Rheumatism activity index (ACR/EULAR) remission scores. The validity of each activity score for remission was calculated by considering the absence of power Doppler (PD) signals as a gold standard. Results: All patients were in remission according to the DAS28, with an average score of 2.03 (1.1-2.6). US examination showed PD signals in 57% of patients. A total of 26 patients were in remission according to the CDAI; a Doppler signal was detected in 58% of those cases. SDAI remission was accomplished in 19 patients, with PD activity in 53% of cases. Of the 14 patients in remission according to the Boolean ACR/EULAR criteria, synovial hyper-vascularisation was found in 64%. Considering true remission as the absence of PD signals, the most sensitive and specific score was the DAS28 (93% and 68%, respectively). Conclusion: Considering remission in RA as the absence of vascularised synovitis, the DAS28 is the most sensitive and most specific score.

ICOSeg: Real-Time ICOS Protein Expression Segmentation from Immunohistochemistry Slides Using a Lightweight Conv-Transformer Network.

In this article, we propose ICOSeg, a lightweight deep learning model that accurately segments the immune-checkpoint biomarker, Inducible T-cell COStimulator (ICOS) protein in colon cancer from immunohistochemistry (IHC) slide patches. The proposed model relies on the MobileViT network that includes two main components: convolutional neural network (CNN) layers for extracting spatial features; and a transformer block for capturing a global feature representation from IHC patch images. The ICOSeg uses an encoder and decoder sub-network. The encoder extracts the positive cell's salient features (i.e., shape, texture, intensity, and margin), and the decoder reconstructs important features into segmentation maps. To improve the model generalization capabilities, we adopted a channel attention mechanism that added to the bottleneck of the encoder layer. This approach highlighted the most relevant cell structures by discriminating between the targeted cell and background tissues. We performed extensive experiments on our in-house dataset. The experimental results confirm that the proposed model achieves more significant results against state-of-the-art methods, together with an 8× reduction in parameters.

Factors associated with the inflammatory process in pain in ankylosing spondylitis.

Introduction: sleep disorders, closely related to any chronic pain process, are frequent among patients with rheumatic diseases, mainly ankylosing spondylitis (AS). Our study aimed to determine the association between sleep disturbances and the inflammatory process in pain in AS patients compared with lower back pain (LBP) patients. We have additionally examined factors associated with sleep disorders among AS patients. Methods: we conducted a cross-sectional study among AS patients. Sociodemographic data, patient reported outcomes and disease characteristics were recorded. Sleep was assessed using the medical outcomes study sleep scale measure (MOS-SS). For psychological assessment, Beck anxiety (BAI) and depression index (BDI) was used. A multivariate logistic regression was performed to identify factors associated with sleep disorders. Results: the study included 50 patients with AS and 40 patients with low back pain. The most common affected domains among AS patients were inadequacy, sleep disturbance, and daily somnolence. The MOS-SS index was significantly higher in the AS group than in the control group (p<0.001). Sleep disorder was associated with age, female gender, analphabetism, patient-reported outcomes (all p<0.05), but was not associated with profession, comorbidities and smoking habits. In multivariate analysis, factors associated with sleep disruption were the duration of morning stiffness (MS), disease activity, bath ankylosing spondylitis metrology index (BASMI), ASQol, as well as anxiety and depression (odds ratio: 5.4(CI 95% 1.6-18.3), 9.9 (CI95%1.1-86); 6 (CI95%1.1-32); 13 (CI 95% 1.4-143.8); 15.7 (CI 95% 2.6-94.3); 14 (CI 95% 2-105.7) respectively, p<0.05 for each). Conclusion: our study highlighted the importance of sleep disorders among patients with AS with a predilection for inadequacy, sleep disturbance, and daily somnolence. Factors associated with sleep disruption were high disease activity, a longer duration of MS, an altered function and quality of life as well as anxiety and depression.

General Roadmap and Core Steps for the Development of AI Tools in Digital Pathology.

Integrating artificial intelligence (AI) tools in the tissue diagnostic workflow will benefit the pathologist and, ultimately, the patient. The generation of such AI tools has two parallel and yet interconnected processes, namely the definition of the pathologist's task to be delivered in silico, and the software development requirements. In this review paper, we demystify this process, from a viewpoint that joins experienced pathologists and data scientists, by proposing a general pathway and describing the core steps to build an AI digital pathology tool. In doing so, we highlight the importance of the collaboration between AI scientists and pathologists, from the initial formulation of the hypothesis to the final, ready-to-use product.

[Vaccinations for patients with chronic inflammatory rheumatism during a pandemic]. / Vaccinations des patients atteints de rhumatisme inflammatoire chronique en période pandémique.

Vaccinations for patients with chronic inflammatory rheumatism during a pandemic.

Vaccinations des patients atteints de rhumatisme inflammatoire chronique en période pandémique La pandémie du sars-cov-2 est une source de préoccupations pour la prise en charge des patients atteints de rhumatisme inflammatoire.

Management of chronic recurrent multifocal osteomyelitis: review and update on the treatment protocol.

INTRODUCTION: Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder primarily affecting children. It is characterized by a peripheral involvement of the metaphysis of long bones rather than axial involvement. Due to the scarcity of the disease, there are no guidelines regarding its management. AREAS COVERED: This review aims to provide an overview of the different therapeutic alternatives and recent protocols. For this reason, first-line and second-line treatment, as well as the impact of new therapies, are discussed in depth. We conducted a search through PubMed on the different aspects of CRMO. Outcomes were categorized as first and second-line treatments. EXPERT OPINION: Non-steroidal anti-inflammatory drugs remain the keystone of CRMO management and are proposed as the first-line treatment. In the case of vertebral involvement, bisphosphonate should be considered, even as a first-line treatment. Several case series and retrospective studies highlight the efficacy of anti-TNF agents. Their use could be an optimal treatment choice for CRMO with comorbid immune-mediated diseases. The potentially favorable effect of interleukin-1 antagonists remains to be determined.