The PEARL Approach for CT-guided Lung Biopsy: Assessment of Complication Rate.

Background Percutaneous CT-guided biopsy of lung nodules is an established method with high diagnostic accuracy but a high rate of pneumothorax and chest tube insertion compared with endobronchial methods. Purpose To investigate the effect of a protocol combining patient positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching (PEARL) on complication rate after percutaneous CT-guided lung biopsy, especially chest tube insertion. Materials and Methods In a secondary analysis of both prospectively and retrospectively acquired data from December 2019 to November 2020, consecutive participants underwent biopsy with use of the PEARL protocol (prospective data) and were compared with patients who underwent biopsy at the same tertiary cancer center according to the standard method without any additional techniques (controls, retrospective data). Patient demographics, lesion characteristics, intraprocedural data, complications, and histologic results were recorded and compared. Results One hundred patients in the control group (mean age ± standard deviation, 63 years ± 12; 61 men) and 100 participants in the PEARL group (mean age, 64 years ± 12; 48 men) were evaluated. No differences were found in patient and lesion characteristics. The emphysema rate was 47 of 100 patients (47%) in both groups. The rate of pneumothorax was 37 of 100 patients (37%) in the control group versus 16 of 100 (16%) in the PEARL group (P = .001). Of the pneumothoraxes that occurred, fewer were during the intervention in the PEARL group, with 21 of 37 onsets (57%) in the control group versus three of 16 onsets (19%) in the PEARL group (P < .001). A chest tube was inserted in 13 of 100 patients (13%) in the control group and only in one of 100 (1%) in the PEARL group (P = .002). Histologic findings were diagnostic in 94 of 100 patients (94%) in the control group and 95 of 100 (95%) in the PEARL group (P > .99). Conclusion During CT-guided percutaneous lung biopsy, a protocol of positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching, or PEARL, reduced rates of pneumothorax and chest tube insertion. © RSNA, 2021.

Long Term Efficacy and Assessment of Tumor Response of Transarterial Chemoembolization in Neuroendocrine Liver Metastases: A 15-Year Monocentric Experience.

BACKGROUND: transarterial chemoembolization (TACE) is an established treatment for neuroendocrine tumor (NET) liver metastases. The aim was to evaluate the long-term treatment efficacy of TACE for NET liver metastases, and correlate imaging response with survival. METHODS: this IRB-approved, single-center, retrospective study evaluated all TACE procedures performed for NET liver metastases from 2003-2017 for imaging tumor response (RECIST and mRECIST), time to liver progression (TTLP), time to untreatable progression with TACE (TTUP), and overall survival (OS). Patient, tumor, and treatment characteristics were analyzed as prognostic factors. Survival curves according to the Kaplan-Meier method were compared by Log-rank test. Tumor responses according to RECIST and mRECIST were correlated with OS. RESULTS: 555 TACE procedures were performed in 202 NET patients (38% grade 1, 60% grade 2) with primary tumors originating from pancreas, small bowel, and lung (39, 26, and 22% respectively). Median follow-up was 8.2 years (90-139 months). Median TTLP and TTUP were 19.3 months (95%CI 16.3-22.3) and 26.2 months (95%CI 22.3-33.1), respectively. Median OS was 5.3 years (95%CI 4.2-6.7), and was higher among mRECIST responders (80.5 months; 95%CI 64.6-89.8) than in non-responders (39.6 months; 95%CI = 32.8-60.2; p < 0.001). In multivariable analysis, age, tumor grade and liver involvement predicted worse OS, whereas administration of somatostatin analogs correlated with improved OS. CONCLUSION: TACE for NET liver metastases provides objective response and sustained local disease control rates. RECIST and mRECIST responses correlate with OS.

Occupational risk perception, stressors and stress of fishermen.

BACKGROUND: The aim of this survey was to assess the stress in fishermen by analysing its relationship with sociodemographic and professional characteristics, by evaluating work stressors, and by estimating psychosomatic symptoms. MATERIALS AND METHODS: This cross-sectional survey involved representative sample of 828 artisanal and coastal fishermen. All participants were men and had a regular activity for at least 2 years. We used an individual questionnaire inspired by those of the National Institute for Research and Security of France and of the Karasek's Job Content Questionnaire. RESULTS: The prevalence of self-reported stress was 53.9%. The average age was 36.7 ± 8.7 years, it was higher among stressed than non-stressed. The prevalence of stress was higher in subjects with dependents (69.1%) versus 30.9% without dependents, and among those living alone (61%) versus 47.5% among those living in couple. The prevalence of harmful habits was 68.5% for tobacco smoking or snuff, 36.8% for cannabis smoking, 35.4% for alcohol consumption, 8.6% for other psychotropic substances and medications, and 21.4% for antalgic drugs. These toxic habits were significantly higher in stressed individuals. Thirty-three point seven per cent had self-reported chronic pathologies (40.5% among stressed vs. 25.7% non-stressed). Thirty-four per cent were overweight (38.3% among stressed vs. 28.8% non-stressed), and 14% obese (19.3% among stressed vs. 7.6% non-stressed). The average daily working hours were 11.2 h (12.8 h among stressed subjects vs. 10.5 h non-stressed). Psychological demand was higher in stressed subjects, while decisional latitude and social support were lower. Psychosomatic symptoms were higher among stressed than non-stressed. The main suggestions of the fishermen were to improve income, social welfare, health insurance, safety on board, quality of lifestyle, sport and leisure activities, information and awareness campaigns of occupational stress, and fight against addictive behaviours. CONCLUSIONS: Fishermen were at a high risk of chronic stress with its health consequences. Health promotion and education initiatives should be conducted to raise fishermen's awareness of the dangers of occupational stressors.

The assessment of seafarers' knowledge, attitudes and practices related to STI/HIV/AIDS in northern Morocco.

BACKGROUND: The purpose of this study was to assess the knowledge, attitudes and practices of seafarers in relation to sexually transmitted infections (STI) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). MATERIALS AND METHODS: This transversal, descriptive and behavioural study was conducted in 2014 on a representative sample of 1447 seafarers. RESULTS: The rate of participation was 95%. The mean age was 36.1 ± 8.2 years. Knowledge about transmission and prevention mode was satisfactory on HIV/AIDS; however, some misconceptions still persist. The level of stigmatisation and discrimination towards people living with the virus was considered high. The prevalence of sexual high-risk behaviour was significant: 32% had at least two sexual partners and 26.3% have had sex with sex workers, 60% of them were not protected; 42.8% have never used the condom and only 15.1% used it systematically. The sailors who had sexual intercourse under the influence of alcohol or drugs are less protected. As too HIV testing, only 10.2% did it. CONCLUSIONS: This study showed a gap in knowledge about transmission and prevention of HIV infection/AIDS and sexual risk behaviour. Increasing awareness and information among seafarers is of prime importance.

Health assessment of self-employed in the food service industry.

Objectives This study's objective was to assess the morbidity of self-employed workers in the food service industry, an industry with a large amount of occupational health risks. Methods A cross-sectional study, consisting of 437 participants, was conducted between 2011 and 2013 in Champagne-Ardenne, France. The health questionnaire included an interview, a clinical examination, and medical investigations. Results The study population consisted of 146 self-employed workers (not working for an employer) and 291 employees (working with employment contracts for an employer). Logistic regression analysis revealed that self-employed workers had a higher morbidity than employees, after adjusting for age (OR: 3.45; 95% CI: 1.28 to 9.25). Main adverse health conditions were joint pain (71.2% self-employed vs. 38.1% employees, p < 0.001), ear disorders (54.1% self-employed vs. 33.7%, employees, p < 0.001), and cardiovascular diseases (47.3% self-employed vs. 21% employees, p < 0.001). Conclusions The study highlights the need for occupational health services for self-employed workers in France so that they may benefit from prevention of occupational risks and health surveillance. Results were presented to the self-employed healthcare insurance fund in order to establish an occupational health risks prevention system.

Health assessment of self-employed hairdressers in France.

OBJECTIVE: Hairdressers have a high incidence of occupational diseases, owing to excessive wet work and exposure to chemical substances. The objective of this study was to assess the prevalence of occupational diseases in a population of self-employed hairdressers, matched for age and sex with a control group of wage-earning hairdressers. METHOD: A health questionnaire was administered to both groups by an occupational health practitioner. RESULTS: Irritative skin diseases were reported by 1.5% of the self-employed hairdressers versus 9.1% of the wage earners. Conversely, the rates of respiratory diseases and cumulative musculoskeletal injuries were much higher among self-employed hairdressers. CONCLUSIONS: This study shows that the overall health of self-employed hairdressers is lower than that of their wage-earning counterparts. This can be attributed to several aspects of work exposure, organization, including longer working hours, fewer protective measures and the absence of preventive medicine in the workplace.

Irinotecan loaded in eluting beads: preclinical assessment in a rabbit VX2 liver tumor model.

PURPOSE: The purpose of this study was to study the pharmacokinetics of irinotecan injected intravenously, intra-arterially, or loaded onto a delivery platform. MATERIAL AND METHODS: Fifty-four New Zealand White rabbits with VX2 liver tumor, divided in 3 groups of 17 rabbits, each received irinotecan either by intravenous (IV) route, intra-arterial hepatic (IA) route, or loaded on drug-eluting beads (DEBIRI). Animals were killed at 1, 6, and 24 h. Irinotecan and SN-38 concentrations were measured at different time points in serum, tumor, and normal liver. RESULTS: Twelve milligrams of irinotecan were injected IV and IA, whereas 6-16.5 mg were injected loaded onto DEBIRI. Normalized serum irinotecan reached a peak of 333 ng/ml (range 198.8-502.5) for IV, 327.1 ng/ml (range 277.1-495.6) for IA, and 189.7 ng/ml (range 111.1-261.9) for DEBIRI (P < 0.001) delivery. The area-under-the-curve value from 10 to 60 min of serum irinotecan concentration was significantly lower for DEBIRI (P = 0.0009). Tumor irinotecan levels for IV, IA, and DEBIRI (in ng/200 mg of tissue followed by ranges in parentheses) were, respectively, 23.6 (0.3-24.9), 36.5 (7.7-1914.1), and 20.2 (2.9-319) at 1 h; 4.2 (1-27.9), 99.3 (46.6-159.5), and 42.1 (11.3-189) at 6 h; and 2.7 (2.5-6.9), 18.3 (1.5-369.1), and 174.4 (3.4-5147.3) at 24 h (P = 0.02). At 24 h, tumor necrosis was 25% (10-30), 60% (40-91.25), and 95% (76.25-95) for IV, IA, and DEBIRI, respectively (P = 0.03). CONCLUSION: Compared with IV or IA, DEBIRI induces lower early serum levels of irinotecan, a high and prolonged intratumoral level of irinotecan, and a greater rate of tumor necrosis at 24 h. Further evaluation of the clinical benefit of DEBIRI is warranted.

Exposure risk assessment in an aluminium salvage plant.

INTRODUCTION: A cross-sectional study was conducted to evaluate possible nervous or respiratory system effects from occupational aluminium exposure. METHODOLOGY: Exposed workers in Al salvage plant were compared with controls. The investigation involved a standardized occupational and medical history and assessments of Al levels in ambiance, serum, and urine. This was combined with an evaluation of respiratory complaints, lung, and cognitive functions. RESULTS: Thirty workers exposed to Al were matched to 60 individuals without exposure to Al. Significantly higher internal doses of Al in urine were found in exposed workers (11.59 microg/L), when compared with the controls (4.37 microg/L). Few high Al atmospheric levels were obtained (0.12-10.86 mg/m3). No significant differences concerning respiratory or neurological symptoms prevalence between the two groups were reported. DISCUSSION: Chronic exposure to Al dust, at the levels documented in this study over the German limit values, does not induce measurable cognitive decline.

Sources and assessment of occupational stress in the police.

The role of the police in Western society is undergoing a transformation that reflects the economic social and technological changes in the community and the assertion of individual rights within a democracy. The aim of this study is to evaluate level of stress among a group of French policemen and to examine the association between policing, potential stressors and stress levels. The sample is drawn from a large metropolitan police force (n=617). The population extends from the first line policeman to top senior management. Each policeman is matched for age (more or less five years) and sex, to a control. Policemen and controls complete a self administered questionnaire including demographic, occupational and health characteristics, and a stress level assessment with the help of a visual analogue scale. The average age of the two groups is 40 yr. Eighty-four percent are men. The total score for average sources is not statistically significantly different for policemen and controls. Comparison of a police group with a high stress level to a police population with a low and moderate stress level is made. The comparison is done first only with men, and second with the whole population. Policemen with a high stress level (same results only for men and the whole population) belong to the following groups: more than 15 yr service, sergeant, officer and administrative employee rank, divorced experience, age over 30, no leisure-time activities and no hobbies. Multivariate analysis shows that the two last parameters are bound to the stress level. For the whole population, age over 30 has to be added, and for the group of men, length of service over five years should be noted. Stress at work is an ill-health provoking factor. Police from minority groups such as ageing subjects or police officers have been reported to experience greater stress. This population is adversely affected by lack of available manpower and long working hours. In fact sources of stress in the police population are found both in the weariness of the job and private life planning.