Traffic-related air pollution and the onset of myocardial infarction: disclosing benzene as a trigger? A small-area case-crossover study.

Exposure to traffic is an established risk factor for the triggering of myocardial infarction (MI). Particulate matter, mainly emitted by diesel vehicles, appears to be the most important stressor. However, the possible influence of benzene from gasoline-fueled cars has not been explored so far.We conducted a case-crossover study from 2,134 MI cases recorded by the local Coronary Heart Disease Registry (2000-2007) in the Strasbourg Metropolitan Area (France). Available individual data were age, gender, previous history of ischemic heart disease and address of residence at the time of the event. Nitrogen dioxide, particles of median aerodynamic diameter <10 µm (PM10), ozone, carbon monoxide and benzene air concentrations were modeled on an hourly basis at the census block level over the study period using the deterministic ADMS-Urban air dispersion model. Model input data were emissions inventories, background pollution measurements, and meteorological data. We have found a positive, statistically significant association between concentrations of benzene and the onset of MI: per cent increase in risk for a 1 µg/m3 increase in benzene concentration in the previous 0, 0-1 and 1 day was 10.4 (95% confidence interval 3-18.2), 10.7 (2.7-19.2) and 7.2 (0.3-14.5), respectively. The associations between the other pollutants and outcome were much lower and in accordance with the literature.We have observed that benzene in ambient air is strongly associated with the triggering of MI. This novel finding needs confirmation. If so, this would mean that not only diesel vehicles, the main particulate matter emitters, but also gasoline-fueled cars--main benzene emitters-, should be taken into account for public health action

Ambient air pollution daily mean value correlation coefficients, Strasbourg (France) Metropolitan Area, 2000–2007.

<p>Ambient air pollution daily mean value correlation coefficients, Strasbourg (France) Metropolitan Area, 2000–2007.</p

Exposure to air pollution and the onset of a myocardial infarction (MI) in the Strasbourg (France) Metropolitan Area, 2000–2007, base model^a.

a<p>Associations observed for different lag times; excess odds ratios (eOR) are expressed as per cent (95% confidence interval) increase for <i>i</i>) a 1 µg/m³ increase in benzene concentrations; <i>ii</i>) a 10 µg/m³ in NO₂, O₃ and PM₁₀ concentrations and <i>iii</i>) a 100 µg/m3 increase in CO concentrations. Adjusted for the previous day maximum atmospheric pressure, same day minimum temperature and influenza epidemics.</p

Air pollutants daily concentrations (µg/m³) and meteorological parameters in the Strasbourg (France) Metropolitan Area, 2000–2007.

<p>Air pollutants daily concentrations (µg/m³) and meteorological parameters in the Strasbourg (France) Metropolitan Area, 2000–2007.</p

Exposure to air pollution and the onset of a myocardial infarction in the Strasbourg (France) Metropolitan Area, 2000–2007, by subgroups^a.

a<p>Associations observed for different lag times; excess odds ratios (eOR) are expressed as per cent (95% confidence interval) increase for <i>i</i>) a 1 µg/m³ increase in benzene concentrations; <i>ii</i>) a 10 µg/m³ in NO₂, O₃ and PM₁₀ concentrations and <i>iii</i>) a 100 µg/m³ increase in CO concentrations. Adjusted for the previous day maximum atmospheric pressure, same day minimum temperature and influenza epidemics.</p><p>*p<0.05.</p><p>**p<0.001.</p

Myocardial infarction events (ICD-9: 410) collected by the Bas-Rhin Coronary Heart Disease Register, Strasbourg Metropolitan Area, France, 2000–2007.

<p>Myocardial infarction events (ICD-9: 410) collected by the Bas-Rhin Coronary Heart Disease Register, Strasbourg Metropolitan Area, France, 2000–2007.</p

[Localised rhabdomyosarcoma of the extremities in children and adolescents: results of the French experience]

PATIENTS AND METHODS: Forty-six patients with localised RMS of the limbs entered the MMT 89 and 95 study in France. We studied potential risk factors that were predictive of relapse and survival to propose a therapeutic approach of surgery and radiotherapy appropriate to the risk of relapse. RESULTS: Median age at diagnosis was 6.5 years [9 months to 15.5 years]. At time of diagnosis, 43% had marginal surgery and only 13% radical intervention. Primary re-excision was performed in 12% of the patients. All patients received chemotherapy, 43% had second look surgery and 37% received radiotherapy. Fifty-four percent of all tumors relapsed: local relapse 36%, nodes l8%, metastatic 40%, local and metastatic 16%. Estimated overall 5-year event-free survival (EFS) and overall survival (OS) were 40 and 57%, respectively. CONCLUSIONS: Prognosis of RMS of the limbs is bad but only 37% of the patients had radiotherapy. We could define patients with very high risk among those with limbs RMS as nodal involvement (5 years overall survival OS 22%), alveolar histology (OS 38%) and site of hand and foot (4 survivors out of 10 patients). In further studies, these patients should be treated even more aggressive with early surgery followed by re-excision if necessary, chemotherapy including alkylating agents and systematic radiotherapy

Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study

Erratum inCorrection to Lancet Respir Med 2021; published online April 19. https://doi.org/10.1016/S2213-2600(21)00096-5.International audienceBackground: In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic.Methods: In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO.Findings: The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45-58) and Simplified Acute Physiology Score-II of 40 (31-56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H2O (14-21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54-70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84-0·99] per day decrease), younger age (2·89 [1·41-5·93] for ≤48 years and 2·01 [1·01-3·99] for 49-56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55-0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46-6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation.Interpretation: Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources