Does Obesity Modify the Relationship between Exposure to Occupational Factors and Musculoskeletal Pain in Men? Results from the GAZEL Cohort Study

Objective: To analyze relationships between physical occupational exposures, post-retirement shoulder/knee pain, and obesity. Methods: 9 415 male participants (aged 63–73 in 2012) from the French GAZEL cohort answered self-administered questionnaires in 2006 and 2012. Occupational exposures retrospectively assessed in 2006 included arm elevation and squatting (never, <10 years, ≥10 years). “Severe” shoulder and knee pain were defined as ≥5 on an 8-point scale. BMI was self-reported. Results: Mean BMI was 26.59 kg/m2 +/−3.5 in 2012. Long-term occupational exposure to arm elevation and squatting predicted severe shoulder and knee pain after retirement. Obesity (BMI≥30 kg/m2) was a risk factor for severe shoulder pain (adjusted OR 1.28; 95% CI 1.03, 1.90). Overweight (adjusted OR 1.71; 1.28,2.29) and obesity (adjusted OR 3.21; 1.90,5.41) were risk factors for severe knee pain. In stratified models, associations between long-term squatting and severe knee pain varied by BMI. Conclusion: Obesity plays a role in relationships between occupational exposures and musculoskeletal pain. Further prospective studies should use BMI in analyses of musculoskeletal pain and occupational factors, and continue to clarify this relationship

RESECT-SEG: Open access annotations of intra-operative brain tumor ultrasound images

Purpose: Registration and segmentation of magnetic resonance (MR) and ultrasound (US) images play an essential role in surgical planning and resection of brain tumors. However, validating these techniques is challenging due to the scarcity of publicly accessible sources with high-quality ground truth information. To this end, we propose a unique annotation dataset of tumor tissues and resection cavities from the previously published RESECT dataset (Xiao et al. 2017) to encourage a more rigorous assessments of image processing techniques. Acquisition and validation methods: The RESECT database consists of MR and intraoperative US (iUS) images of 23 patients who underwent resection surgeries. The proposed dataset contains tumor tissues and resection cavity annotations of the iUS images. The quality of annotations were validated by two highly experienced neurosurgeons through several assessment criteria. Data format and availability: Annotations of tumor tissues and resection cavities are provided in 3D NIFTI formats. Both sets of annotations are accessible online in the \url{https://osf.io/6y4db}. Discussion and potential applications: The proposed database includes tumor tissue and resection cavity annotations from real-world clinical ultrasound brain images to evaluate segmentation and registration methods. These labels could also be used to train deep learning approaches. Eventually, this dataset should further improve the quality of image guidance in neurosurgery.Comment: Bahareh Behboodi and Francois-Xavier Carton share the first authorshi

An assessment of ten ocean reanalyses in the polar regions

Global and regional ocean and sea ice reanalysis products (ORAs) are increasingly used in polar research, but their quality remains to be systematically assessed. To address this, the Polar ORA Intercomparison Project (Polar ORA-IP) has been established following on from the ORA-IP project. Several aspects of ten selected ORAs in the Arctic and Antarctic were addressed by concentrating on comparing their mean states in terms of snow, sea ice, ocean transports and hydrography. Most polar diagnostics were carried out for the first time in such an extensive set of ORAs. For the multi-ORA mean state, we found that deviations from observations were typically smaller than individual ORA anomalies, often attributed to offsetting biases of individual ORAs. The ORA ensemble mean therefore appears to be a useful product and while knowing its main deficiencies and recognising its restrictions, it can be used to gain useful information on the physical state of the polar marine environment.Peer reviewe

Observational needs for improving ocean and coupled reanalysis, S2S prediction, and decadal prediction

Developments in observing system technologies and ocean data assimilation (DA) are symbiotic. New observation types lead to new DA methods and new DA methods, such as coupled DA, can change the value of existing observations or indicate where new observations can have greater utility for monitoring and prediction. Practitioners of DA are encouraged to make better use of observations that are already available, for example, taking advantage of strongly coupled DA so that ocean observations can be used to improve atmospheric analyses and vice versa. Ocean reanalyses are useful for the analysis of climate as well as the initialization of operational long-range prediction models. There are many remaining challenges for ocean reanalyses due to biases and abrupt changes in the ocean-observing system throughout its history, the presence of biases and drifts in models, and the simplifying assumptions made in DA solution methods. From a governance point of view, more support is needed to bring the ocean-observing and DA communities together. For prediction applications, there is wide agreement that protocols are needed for rapid communication of ocean-observing data on numerical weather prediction (NWP) timescales. There is potential for new observation types to enhance the observing system by supporting prediction on multiple timescales, ranging from the typical timescale of NWP, covering hours to weeks, out to multiple decades. Better communication between DA and observation communities is encouraged in order to allow operational prediction centers the ability to provide guidance for the design of a sustained and adaptive observing network

BMC Med

BACKGROUND: Overall survival (OS) is the gold standard endpoint to assess treatment efficacy in cancer clinical trials. In metastatic breast cancer (mBC), progression-free survival (PFS) is commonly used as an intermediate endpoint. Evidence remains scarce regarding the degree of association between PFS and OS. Our study aimed to describe the individual-level association between real-world PFS (rwPFS) and OS according to first-line treatment in female patients with mBC managed in real-world setting for each BC subtype (defined by status for both hormone-receptor [HR] expression and HER2 protein expression/gene amplification). METHODS: We extracted data from the ESME mBC database (NCT03275311) which gathers deidentified data from consecutive patients managed in 18 French Comprehensive Cancer Centers. Adult women diagnosed with mBC between 2008 and 2017 were included. Endpoints (PFS, OS) were described using the Kaplan-Meier method. Individual-level associations between rwPFS and OS were estimated using the Spearman's correlation coefficient. Analyses were conducted by tumor subtype. RESULTS: 20,033 women were eligible. Median age was 60.0 years. Median follow-up duration was 62.3 months. Median rwPFS ranged from 6.0 months (95% CI 5.8-6.2) for HR-/HER2 - subtype to 13.3 months (36% CI 12.7-14.3) for HR + /HER2 + subtype. Correlation coefficients were highly variable across subtypes and first-line (L1) treatments. Among patients with HR - /HER2 - mBC, correlation coefficients ranged from 0.73 to 0.81, suggesting a strong rwPFS/OS association. For HR + /HER2 + mBC patients, the individual-level associations were weak to strong with coefficients ranging from 0.33 to 0.43 for monotherapy and from 0.67 to 0.78 for combined therapies. CONCLUSIONS: Our study provides comprehensive information on individual-level association between rwPFS and OS for L1 treatments in mBC women managed in real-life practice. Our results could be used as a basis for future research dedicated to surrogate endpoint candidates

The CONSTANCES cohort: an open epidemiological laboratory

<p>Abstract</p> <p>Background</p> <p>Prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an "open epidemiologic laboratory" accessible to the epidemiologic research community. Although designed as a "general-purpose" cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on aging.</p> <p>Methods/Design</p> <p>The CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200,000 subjects will be included over a five-year period. At inclusion, the selected subjects will be invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities will be performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data will be collected from the French national retirement, health and death databases. The data that will be collected include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data will cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death.</p> <p>To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants will be set up and followed through the same national databases as participants.</p> <p>A field-pilot was performed in 2010 in seven HSCs, which included about 3,500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data.</p> <p>Discussion</p> <p>The constitution of the full eligible sample is planned during the last trimester of 2010, and the cohort will be launched at the beginning of 2011.</p

Ovarian Real-World International Consortium (ORWIC): A multicentre, real-world analysis of epithelial ovarian cancer treatment and outcomes

IntroductionMuch drug development and published analysis for epithelial ovarian cancer (EOC) focuses on early-line treatment. Full sequences of treatment from diagnosis to death and the impact of later lines of therapy are rarely studied. We describe the establishment of an international network of cancer centers configured to compare real-world treatment pathways in UK, Portugal, Germany, South Korea, France and Romania (the Ovarian Real-World International Consortium; ORWIC).Methods3344 patients diagnosed with EOC (2012-2018) were analysed using a common data model and hub and spoke programming approach applied to existing electronic medical records. Consistent definition of line of therapy between sites and an efficient approach to analysis within the limitations of local information governance was achieved.ResultsMedian age of participants was 53-67 years old and 5-29% were ECOG &gt;1. Between 62% and 84% of patients were diagnosed with late-stage disease (FIGO III-IV). Sites treating younger and fitter patients had higher rates of debulking surgery for those diagnosed at late stage than sites with older, more frail patients. At least 21% of patients treated with systemic anti-cancer therapy (SACT) had recurrent disease following second-line therapy (2L); up to 11 lines of SACT treatment were recorded for some patients. Platinum-based SACT was consistently used across sites at 1L, but choices at 2L varied, with hormone therapies commonly used in the UK and Portugal. The use (and type) of maintenance therapy following 1L also varied. Beyond 2L, there was little consensus between sites on treatment choice: trial compounds and unspecified combinations of other agents were common.DiscussionSpecific treatment sequences are reported up to 4L and the establishment of this network facilitates future analysis of comparative outcomes per line of treatment with the aim of optimizing available options for patients with recurrent EOC. In particular, this real-world network can be used to assess the growing use of PARP inhibitors. The real-world optimization of advanced line treatment will be especially important for patients not usually eligible for involvement with clinical trials. The resources to enable this analysis to be implemented elsewhere are supplied and the network will seek to grow in coverage of further sites

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Facteurs de risque professionnels des cancers des voies aérodigestives supérieures chez les femmes : analyse des données de l’étude Icare.

Background : Few occupational studies have addressed head and neck cancer, and these studies have been predominantly conducted in men. Objective : Our objective was to investigate the associations between head and neck cancer and occupational exposures in women Population and methods : ICARE, a French population-based case–control study, included 296 squamous cell carcinomas of the head and neck (HNSCC) in women and 775 female controls. Lifelong occupational history was collected. Job-exposure matrices were used to assess exposure to five chlorinated solvents (carbon tetrachloride; chloroform; methylene chloride; perchloroethylene; trichloroethylene), 5 petroleum solvents (benzene; special petroleum product; gasoline; white-spirits and other light aromatic mixtures; diesel, fuels and kerosene), 5 oxygenated solvents (alcohols; ketones and esters; ethylene glycol; diethyl ether; tetrahydrofuran) and 7 fibers and dusts (asbestos, flour dust, leather dust, refractory ceramic fibers, cement dust, mineral wools and silica) . An analysis by job title was conducted, and then associations with specific occupational exposures were investigated.Odds ratio (ORs) and 95% confidence intervals (CI), adjusted for smoking, alcohol drinking, age and residence area, were estimated with logistic models. Results : Significantly increased HNSCC risks were found for several jobs and industries. Some of these occupations (food and beverage processors, electrical and electronic equipment assemblers, welders and flame cutters) may entail exposure to agents such as solvents, metals, welding fumes and various dusts. Analyses for specific occupational exposures showed a significantly elevated risk of HNSCC associated with exposure to trichloroethylene and perchloroethylene. There is no clear evidence that petroleum or oxygenated solvents, some of them commonly used by women, are risk factors for HNSCC. Exposure to flour dust increased significantly HNSCC risk. Probable exposure to asbestos was associated with a moderate, non-significant elevation in risk. Analyses by cancer site (oral cavity, pharynx, larynx) were hampered by small numbers and did to reveal any specific association.Conclusion : These findings suggest that occupational exposure to perchloroethylene, trichloroethylene and flour dust may increase the risk of HNSCC in women.Contexte : Peu d’études ont recherché le rôle des facteurs de risque professionnels dans la survenue des cancers des voies aérodigestives supérieures (VADS). Ces études ont été conduites principalement chez des hommes.Objectif : L’objectif de cette thèse était d’étudier les associations entre les cancers des VADS et les expositions professionnelles chez les femmes.Méthodes : Icare est une étude cas-témoins en population générale incluant 296 cas féminins de cancers épidermoïdes des VADS et 775 femmes témoins. Les historiques de carrières recueillis ont été codés et croisés avec les matrices emplois-expositions du programme Matgéné. Outre les intitulés d’emplois, les expositions à 5 solvants chlorés (chloroforme, chlorure de méthylène, perchloréthylène, trichloréthylène, tétrachlorure de carbone), 5 solvants oxygénés (éthylène glycol, tétrahydrofurane, éther éthylique, cétones, alcools), 5 solvants pétroliers (essences carburants, essences spéciales, gazole, benzène, white-spirit) et à 7 poussières et fibres (amiante, farine, cuir, fibres céramiques réfractaires, ciment, laines minérales, silice) ont été étudiées. Les odds-ratios et leurs intervalles de confiance à 95% ajustés sur l’âge, le département, les consommations de tabac et d’alcool ont été estimés par régressions logistiques non conditionnelles.Résultats :Plusieurs professions et secteurs d’activité associés à un risque élevé de cancer des VADS ont été identifiés. Certaines professions (ouvrières de l’alimentation et des boissons, monteuses en appareillage électrique ou électronique, soudeuses) peuvent être à l’origine d’expositions professionnelles aux solvants, aux métaux, aux fumées de soudage et à diverses poussières. Les analyses par nuisance ont mis en évidence des associations significatives entre le risque de cancer des VADS et l’exposition au perchloréthylène et au au trichloréthylène. Aucune association claire n’est observée avec les solvants pétroliers et oxygénés, certains largement utilisés par les femmes L’exposition aux poussières de farine augmente significativement le risque de cancer des VADS. Une exposition probable à l’amiante est associée à une augmentation modérée et non significative du risque. Les analyses par localisation de cancer (cavité orale, pharynx, larynx), limitées par des effectifs faibles, ne mettent pas en évidence d’association spécifique.Conclusion : Nos résultats suggèrent un rôle des expositions professionnelles au trichloréthylène, au perchloréthylène et aux poussières de farine dans la survenue des cancers des VADS chez les femmes