Risks of second primary cancer among patients with major histological types of lung cancers in both men and women

10.1038/sj.bjc.6605616British Journal of Cancer10271190-1195BJCA

Health status in the ambulance services: a systematic review

BACKGROUND: Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the literature on health problems and work-related and individual health predictors in the ambulance services. METHODS: We identified the relevant empirical literature by searching several electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and ISI Web of Science. Other relevant sources were identified through reference lists and other relevant studies known by the research group. RESULTS: Forty-nine studies are included in this review. Our analysis shows that ambulance workers have a higher standardized mortality rate, higher level of fatal accidents, higher level of accident injuries and a higher standardized early retirement on medical grounds than the general working population and workers in other health occupations. Ambulance workers also seem to have more musculoskeletal problems than the general population. These conclusions are preliminary at present because each is based on a single study. More studies have addressed mental health problems. The prevalence of post-traumatic stress symptom caseness was > 20% in five of seven studies, and similarly high prevalence rates were reported for anxiety and general psychopathology in four of five studies. However, it is unclear whether ambulance personnel suffer from more mental health problems than the general working population. CONCLUSION: Several indicators suggest that workers in the ambulance services experience more health problems than the general working population and workers in other health occupations. Several methodological challenges, such as small sample sizes, non-representative samples, and lack of comparisons with normative data limit the interpretation of many studies. More coordinated research and replication are needed to compare data across studies. We discuss some strategies for future research

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Postactivation potentiation of short tetanic contractions is differently influenced by stimulation frequency in young and elderly adults.

The purpose of this study was to examine the effects of postactivation potentiation (PAP) on the torque and rate of torque development for contractions evoked by short trains of stimuli at different frequencies, in young and elderly adults. Individual mechanical contributions to each electrical stimulus within trains were also analysed. Single pulse, and two- (PT2) and three-pulse trains (PT3) delivered at 20, 50, 80 and 100 Hz were evoked before and during a 10 min period after a 6-s conditioning MVC. The results show that PAP of the torque for PT2 decreased with the increase of the stimulation frequency for young (from 184.5 to 140.4% of control values) and elderly (from 140.5 to 109.6%). Regardless of the stimulation frequency, the peak of PAP was greater in young than in elderly and occurred immediately after the conditioning MVC but was delayed for the 100 Hz condition in elderly adults. For PT3, the results were similar although the extent of PAP was less. The PAP of the mechanical contributions within the trains also decreased with the augmentation of the stimulation frequency. For most of the frequencies above 20 Hz, the peak of PAP for each mechanical contribution was delayed by 1 min after the conditioning MVC. These results indicate an age- and frequency-related PAP saturation of the successive mechanical contributions within a train of stimuli that decrease with time. The functional implication of the findings is that PAP effect is lower and delayed at high compared with low activation rate.Comparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Learning interactions between cardiac shape and deformation: application to pulmonary hypertension

International audienceCardiac shape and deformation are two relevant descriptors for the characterization of cardiovascular diseases. It is also known that strong interactions exist between them depending on the disease. In clinical routine, these high dimensional descriptors are reduced to scalar values (ventricular ejection fraction, volumes, global strains...), leading to a substantial loss of information. Methods exist to better integrate these high-dimensional data by reducing the dimension and mixing heterogeneous descriptors. Nevertheless, they usually do not consider the interactions between the descriptors. In this paper, we propose to apply dimensionality reduction on high dimensional cardiac shape and deformation descriptors and take into account their interactions. We investigated two unsupervised linear approaches, an individual analysis of each feature (Principal Component Analysis), and a joint analysis of both features (Partial Least Squares) and related their output to the main characteristics of the studied pathology. We experimented both methods on right ventricular meshes from a population of 254 cases tracked along the cycle (154 with pulmonary hypertension, 100 controls). Despite similarities in the output space obtained by the two methods, substantial differences are observed in the reconstructed shape and deformation patterns along the principal modes of variation, in particular in regions of interest for the studied disease

Neural and muscular mechanisms of electrically induced fatigue in patients with spinal cord injury

International audienceStudy design: Intervention study. Objectives: The present study aimed at examining whether spinal and/or peripheral alterations are in the origin of neuromuscular fatigue development induced by intermittent neuromuscular electrical stimulation (NMES) in subjects with complete spinal cord injury (SCI). Setting: Neurological Rehabilitation Center CMN Propara, Montpellier, France. Methods: Thirteen volunteers with complete SCI participated in the study. The right triceps surae muscle was fatigued using a 30-Hz NMES protocol (2 s ON-2 s OFF) composed of three series of five trains. Spinal excitability (assessed by the H-reflex), muscle excitability (assessed by the M-wave), muscle contractile properties (assessed by mechanical response parameters) and torque evoked by NMES were tested before and after each five-train series. Results: NMES-evoked torque significantly decreased throughout the protocol (P<0.001). This decrease was accompanied by a significant increase in M-wave amplitude (P<0.001), whereas H-reflex and the Hmax/Mmax ratio were not significantly modified. The amplitude of the mechanical response was significantly decreased at the end of the protocol (P<0.05). Conclusion: The results indicate significant fatigue development, which was attributed to impaired cross-bridge force-generating capacity, without modification of spinal excitability nor muscle excitability