Active tuberculosis screening among the displaced population fleeing Ukraine, France, February to October 2022.

Persons fleeing Ukraine since February 2022 have potentially higher risk of tuberculosis (TB) vs all European Union countries. Interest of active TB screening among this population is debated and not widely adopted. In this screening intervention by a network of TB centres in France, the number needed to screen (NNS) was 862 to find one case. This experience shows that this strategy may be relevant for TB control in situations of massive displacement, similar to that following the Russian invasion.

First-line carboplatin plus pemetrexed with pemetrexed maintenance in HIV-positive patients with advanced non-squamous non-small cell lung cancer: the phase II IFCT-1001 CHIVA trial.

HIV infection is an exclusion criterion in lung cancer trials. This multicentre phase II trial aimed to assess feasibility, efficacy and safety of first-line carboplatin plus pemetrexed (CaP) followed by pemetrexed (P) maintenance in people living with HIV (PLHIV) with advanced non-squamous non-small cell lung cancer (NS-NSCLC).Four cycles of CaP were followed by P-maintenance therapy in patients with Eastern Cooperative Oncology Group performance status ≤2. The primary objective was a disease control rate (DCR) ≥30% after 12 weeks.Of the 61 PLHIV enrolled, 49 (80%) had a performance status of 0-1, and 19 (31%) had brain metastases. Median CD4 lymphocyte count was 418 cells·µL-1 (range 18-1230), median CD4 lymphocyte nadir was 169.5 cells·µL-1 (1-822); 48 (80%) patients were virologically controlled. Four-cycle inductions were achieved by 38 (62%) patients, and 31 (51%) started P-maintenance (median of 4.1 cycles (range 1-19)). The 12-week DCR was 50.8% (95% CI 38.3-63.4) and partial response rate 21.3%. Median progression-free survival and overall survival were 3.5 (95% CI 2.7-4.4) and 7.6 months (5.7-12.8), respectively. Patients with a performance status of 0-1 had the longest median progression-free survival (4.3 months, 95% CI 3.1-5.2) and overall survival (11.9 months, 95% CI 6.4-14.3). During induction, CaP doublet was well tolerated apart from grade 3-4 haematological toxicities (neutropenia 53.8%; thrombocytopenia 35.0%; anaemia 30.0%). Two fatal treatment-related sepses were reported. No opportunistic infections were experienced.In PLHIV with advanced NS-NSCLC, first-line four-cycle CaP induction followed by P-maintenance was effective and reasonably well-tolerated. Further studies should evaluate combination strategies of CaP with immunotherapy in PLHIV.

Coordinating Upper and Lower Body During FES-Assisted Transfers in Persons With Spinal Cord Injury in Order to Reduce Arm Support.

OBJECTIVE: The goal of this study is to minimize arm forces applied during sit-to-stand (STS) transfers in persons with spinal cord injury (SCI) by using functional electrical stimulation (FES) applied to lower limbs muscles. MATERIALS AND METHODS: A new FES system has been used to automatically trigger muscle stimulation of the lower limbs, at the desired moment in regards to trunk motion. The objective was to decrease arm participation during STS motion of a person with complete paraplegia and low-level tetraplegia. Six participants with chronic SCI participated in the study. Participants with SCI were recruited to complete STS movement using a new system for FES-assisted STS transfer. All participants attended one muscle mapping session to test their muscles condition, two training sessions to become familiarized with the experimental setup, and two measurement sessions using the proposed system for FES-assisted STS movement. The applied arm forces during STS movement were recorded and analyzed for different stimulation onset values with respect to the maximal trunk acceleration signal using one-way ANOVA statistical test. Post-hoc analysis was performed using Tukey's method. RESULTS: The results of this study showed that the moment of the stimulation onset has an influence on the arm forces applied during the STS motion. The lowest values of arm forces were obtained for STS movements where the electrical stimulation was triggered before and around the time corresponding to the maximal value of the trunk acceleration signal. CONCLUSION: Lowest arm forces values were obtained for STS motions that were similar to those of healthy persons in terms of trunk movements and beginning of lower limb movements in regards to maximal trunk acceleration signal. The FES system was able to mimic the rising motion of a healthy individual by triggering the FES at the appropriate moment. This method could prove useful for pivot transfer, therapeutic or functional verticalization.

Whole body center of mass estimation with portable sensors: using the statically equivalent serial chain and a Kinect.

The trajectory of the whole body center of mass (CoM) is useful as a reliable metric of postural stability. If the evaluation of a subject-specific CoM were available outside of the laboratory environment, it would improve the assessment of the effects of physical rehabilitation. This paper develops a method that enables tracking CoM position using low-cost sensors that can be moved around by a therapist or easily installed inside a patient's home. Here, we compare the accuracy of a personalized CoM estimation using the statically equivalent serial chain (SESC) method and measurements obtained with the Kinect to the case of a SESC obtained with high-end equipment (Vicon). We also compare these estimates to literature-based ones for both sensors. The method was validated with seven able-bodied volunteers for whom the SESC was identified using 40 static postures. The literature-based estimation with Vicon measurements had a average error 24.9 ± 3.7 mm; this error was reduced to 12.8 ± 9.1 mm with the SESC identification. When using Kinect measurements, the literature-based estimate had an error of 118.4 ± 50.0 mm, while the SESC error was 26.6 ± 6.0 mm. The subject-specific SESC estimate using low-cost sensors has an equivalent performance as the literature-based one with high-end sensors. The SESC method can improve CoM estimation of elderly and neurologically impaired subjects by considering variations in their mass distribution.

Integration of human walking gyroscopic data using empirical mode decomposition.

The present study was aimed at evaluating the Empirical Mode Decomposition (EMD) method to estimate the 3D orientation of the lower trunk during walking using the angular velocity signals generated by a wearable inertial measurement unit (IMU) and notably flawed by drift. The IMU was mounted on the lower trunk (L4-L5) with its active axes aligned with the relevant anatomical axes. The proposed method performs an offline analysis, but has the advantage of not requiring any parameter tuning. The method was validated in two groups of 15 subjects, one during overground walking, with 180° turns, and the other during treadmill walking, both for steady-state and transient speeds, using stereophotogrammetric data. Comparative analysis of the results showed that the IMU/EMD method is able to successfully detrend the integrated angular velocities and estimate lateral bending, flexion-extension as well as axial rotations of the lower trunk during walking with RMS errors of 1 deg for straight walking and lower than 2.5 deg for walking with turns.

[Tuberculosis, a contagious disease]. / La tuberculose, une maladie contagieuse.

Despite the marked fall in the number of cases of tuberculosis in France, the disease remains a public health issue due to its contagiousness and the current emergence of forms resistant to classic antituberculotics. Prevention and the systematic screening of the people close to the patient help to control the spread of the disease.

Circulating tumor DNA in advanced non-small-cell lung cancer patients with HIV is associated with shorter overall survival: Results from a Phase II trial (IFCT-1001 CHIVA).

INTRODUCTION: HIV is an exclusion criterion for most lung cancer (LC) trials, however LC is the most common non-AIDS-defined malignancy in people living with HIV (PLHIV), poorer prognosis than the general population. Circulating tumor DNA (ctDNA) was a prognostic marker in LC patients from the general population. This study assessed ctDNA's prognostic value in PLHIV from a dedicated phase II trial. METHODS: Overall, 61 PLHIV with advanced non-squamous non-small-cell lung cancer (NSCLC) participated in the IFCT Phase II trial evaluating first-line four-cycle carboplatin (Ca) AUC5 pemetrexed (P) 500 mg/m2 induction therapy every 3 weeks, followed by P maintenance therapy. Blood samples collected before treatment were analyzed to detect ctDNA using ultra-deep targeted next-generation-sequencing (NGS). RESULTS: Appropriate samples were available from 55 PLVIH and analyzed for ctDNA detection. Including 42 males (76.4 %), 52.9 years median age, 51 smokers (92.7 %), five with non-squamous NSCLC Stage III (9%), 50 Stage IV (91 %), and performance status (PS) 0-2. ctDNA was detected in 35 patients (64 %), 22 with high and 13 with low ctDNA levels. Overall, 77 % were positive for TP53, 29 % for KRAS, and 11 % for STK11 mutations, more than one alteration was detected in 43 % of samples. Multivariate analysis showed that positive ctDNA was significantly associated with shorter PFS (HR, 4.31, 95 %CI: 2.06-8.99, p < 0.0001), and shorter OS (HR, 3.52, 95 %CI: 1.72-7.19, p < 0.001). Moreover, OS was significantly longer for patients with low ctDNA levels at diagnosis as compared to high (p = 0.01). CONCLUSION: We show that ctDNA detection using ultra-deep NGS is an independent prognostic factor in PLHIV with advanced NSCLC.

SARS-CoV-2 Pneumonia in Hospitalized Asthmatic Patients Did Not Induce Severe Exacerbation.

BACKGROUND: Viral infections are known to exacerbate asthma in adults. Previous studies have found few patients with asthma among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia cases. However, the relationship between SARS-CoV-2 infection and severe asthma exacerbation is not known. OBJECTIVE: To assess the frequency of asthma exacerbation in patients with asthma hospitalized for SARS-CoV-2 pneumonia and compare symptoms and laboratory and radiological findings in patients with and without asthma with SARS-CoV-2 pneumonia. METHODS: We included 106 patients between March 4 and April 6, 2020, who were hospitalized in the Chest Diseases Department of Strasbourg University Hospital; 23 had asthma. To assess the patients' asthma status, 3 periods were defined: the last month before the onset of COVID-19 symptoms (p1), prehospitalization (p2), and during hospitalization (p3). Severe asthma exacerbations were defined according to Global INitiative for Asthma guidelines during p1 and p2. During p3, we defined severe asthma deterioration as the onset of breathlessness and wheezing requiring systemic corticosteroids and inhaled ß2 agonist. RESULTS: We found no significant difference between patients with and without asthma in terms of severity (length of stay, maximal oxygen flow needed, noninvasive ventilation requirement, and intensive care unit transfer); 52.2% of the patients with asthma had Global INitiative for Asthma step 1 asthma. One patient had a severe exacerbation during p1, 2 patients during p2, and 5 patients were treated with systemic corticosteroids and inhaled ß2 agonist during p3. CONCLUSIONS: Our results demonstrate that patients with asthma appeared not to be at risk for severe SARS-CoV-2 pneumonia. Moreover, SARS-CoV-2 pneumonia did not induce severe asthma exacerbation.

Grasping a Chestnut Burr.

This work aimed to assess the role of manual laterality in action coding strategies and, subsequently, in environmental features relevant for each hand's action. Relying on Eder and Hommel's (2013) proposal, we distinguished stimulus-related and end state-related consequences in a Simon paradigm where right-handed participants were divided into two groups, one responding with gloves and one without. Two objects were presented pictorially: one for which sensory consequences of grasping were negatively valenced (a chestnut burr), and one for which they were positively valenced (an apricot). By these means, stimulus and end-state effects could be assessed separately, along with the relevance of each feature of the experimental settings. Results showed that the use of one's dominant or non dominant hand gives rise to different repercussions of stimulus-related and end state-related effects on response: Responses made with the right (dominant) hand were based on an elaborated coding (representing features of stimulus-related and end state-related consequences of action). In contrast, responses made with the left (non dominant) hand seemed to be based on a less elaborated coding (not taking into account end-state consequences of an action).

Optimal External Wrench Distribution During a Multi-Contact Sit-to-Stand Task.

This paper aims at developing and evaluating a new practical method for the real-time estimate of joint torques and external wrenches during multi-contact sit-to-stand (STS) task using kinematics data only. The proposed method allows also identifying subject specific body inertial segment parameters that are required to perform inverse dynamics. The identification phase is performed using simple and repeatable motions. Thanks to an accurately identified model the estimate of the total external wrench can be used as an input to solve an under-determined multi-contact problem. It is solved using a constrained quadratic optimization process minimizing a hybrid human-like energetic criterion. The weights of this hybrid cost function are adjusted and a sensitivity analysis is performed in order to reproduce robustly human external wrench distribution. The results showed that the proposed method could successfully estimate the external wrenches under buttocks, feet, and hands during STS tasks (RMS error lower than 20 N and 6 N.m). The simplicity and generalization abilities of the proposed method allow paving the way of future diagnosis solutions and rehabilitation applications, including in-home use.

Virtual Reality-Based Center of Mass-Assisted Personalized Balance Training System.

Poststroke hemiplegic patients often show altered weight distribution with balance disorders, increasing their risk of fall. Conventional balance training, though powerful, suffers from scarcity of trained therapists, frequent visits to clinics to get therapy, one-on-one therapy sessions, and monotony of repetitive exercise tasks. Thus, technology-assisted balance rehabilitation can be an alternative solution. Here, we chose virtual reality as a technology-based platform to develop motivating balance tasks. This platform was augmented with off-the-shelf available sensors such as Nintendo Wii balance board and Kinect to estimate one's center of mass (CoM). The virtual reality-based CoM-assisted balance tasks (Virtual CoMBaT) was designed to be adaptive to one's individualized weight-shifting capability quantified through CoM displacement. Participants were asked to interact with Virtual CoMBaT that offered tasks of varying challenge levels while adhering to ankle strategy for weight shifting. To facilitate the patients to use ankle strategy during weight-shifting, we designed a heel lift detection module. A usability study was carried out with 12 hemiplegic patients. Results indicate the potential of our system to contribute to improving one's overall performance in balance-related tasks belonging to different difficulty levels.

Determination of subject specific whole-body centre of mass using the 3D Statically Equivalent Serial Chain.

This study investigates the possibility of using the so-called Statically Equivalent Serial Chain approach to estimate the subject-specific 3D whole-body centre of mass (CoM) location. This approach is based on a compact formulation of the 3D whole-body CoM position associated with a least squares identification process. This process requires a calibration phase that uses stereophotogrammetric and dynamometric data collected in selected static postures. After this calibration phase, the instantaneous position of the identified subject-specific 3D whole-body CoM can be estimated for any motor task using kinematic data only. This approach was experimentally validated on twelve healthy young subjects. The Statically Equivalent Serial Chain solution was validated during static trials with the centre of pressure, with the double integrated ground reaction forces during dynamic tasks, and also compared with a segmental method using a stereophotogrammetric system and anthropometric tables. Considerations relative to the choice of algorithm parameters, such as the number of necessary static postures and their time duration, are discussed. The proposed method shows much smaller differences between the projection of the centre of mass and the centre of pressure (root mean square value under 3.5%) than the method using anthropometric tables (root mean square value over 9%). Same conclusion can be made during dynamic tasks with a smaller difference obtained for SESC (root mean square value under 4% at contrary the 20% obtained with anthropometric table).

Real-time estimate of body kinematics during a planar squat task using a single inertial measurement unit.

This study aimed at the real-time estimation of the lower-limb joint and torso kinematics during a squat exercise, performed in the sagittal plane, using a single inertial measurement unit placed on the lower back. The human body was modeled with a 3-DOF planar chain. The planar IMU orientation and vertical displacement were estimated using one angular velocity and two acceleration components and a weighted Fourier linear combiner. The ankle, knee, and hip joint angles were thereafter obtained through a novel inverse kinematic module based on the use of a Jacobian pseudoinverse matrix and null-space decoupling. The aforementioned algorithms were validated on a humanoid robot for which the mechanical model used and the measured joint angles virtually exhibited no inaccuracies. Joint angles were estimated with a maximal error of 1.5°. The performance of the proposed analytical and experimental methodology was also assessed by conducting an experiment on human volunteers and by comparing the relevant results with those obtained through the more conventional photogrammetric approach. The joint angles provided by the two methods displayed differences equal to 3±1°. These results, associated with the real-time capability of the method, open the door to future field applications in both rehabilitation and sport.

Three dimensional visualization of the statically equivalent serial chain from kinect recording.

We develop and present a portable tool intended for real time estimation of the center of mass (CoM) in human subjects. Using the statically equivalent serial chain (SESC) method we can account for subject specificity after identification of the model's parameters. CoM position estimates are then available from measurements of the subject's limbs orientations. For portability, we make use of widely accessible sensors such as the Kinect and Wii balance board for identification. Use of the Kinect as a measurement device allows us to establish the SESC outside of the laboratory, without many special considerations on the environment. Only Kinect is used for CoM tracking after identification was performed. We present here an overview of the SESC concept and the identification procedure. The aspects involved in the visualization tool are discussed and results are shown in order to verify the performance.

A least-squares identification algorithm for estimating squat exercise mechanics using a single inertial measurement unit.

This study investigated the possibility of estimating lower-limb joint kinematics during a squat exercise performed in the sagittal plane based on data collected from a single inertial measurement unit located on the lower trunk. The human body was modeled as a three-degrees-of-freedom planar chain and the relevant joint angles (ankle, knee, and hip) are represented by Fourier series. A least-squares approach based on the minimization of the difference between the measured and estimated linear accelerations and the angular velocity of the lower trunk was used to solve the related analytical problem. The approach was validated on ten healthy young volunteers (ten trials each) using a force plate and a stereophotogrammetric system to collect reference data. The root mean square differences between the estimated joint angles and those reconstructed with the stereophotogrammetric system were lower than 4° with correlation coefficients higher than 0.99. The ankle joint resultant vertical force component was estimated with an accuracy of about 3% and a high correlation coefficient of r=0.95, whereas much lower percentage accuracies were found for the horizontal force and couple components. The latter accuracies were similar to those affecting these force and couple components as estimated through inverse dynamics and the stereophotogrammetric data in conjunction with the same mechanical model, which suggests that only minor errors were introduced by the proposed algorithm and measurement tools.

[Metastatic non-small cell lung cancer: Systemic treatment of patients aged 70 and over]. / Cancer bronchique non à petites cellules métastatique : les traitements systémiques des sujets de plus de 70 ans.

Patients aged 70 and over represent the third of the population of patients with lung cancer. There has been for a long time a certain nihilism regarding the treatment of elderly patients with advanced lung cancer as well from medical doctors but also from families and patients themselves with the false belief of an indolent course of the disease in elderly patients. As a result, clinical trials devoted to elderly patients were quite scarce until the end of the last decade. Nevertheless, an important trial was published in 1999 with the comparison of vinorelbine as a single agent versus best supportive care only in patients aged 70 and over with an advanced non-small cell lung cancer. The survival benefit with vinorelbine was important. Then two trials were published comparing monotherapy with either vinorelbine or gemcitabine to the doublet vinorelbine and gemcitabine without convincing results. As a consequence, the ASCO 2004 recommendations were to treat elderly patients with a monotherapy (gemcitabine or vinorelbine). Recently an IFCT trial was presented at the plenary session of the ASCO 2010. A carboplatin (every 4weeks)+weekly paclitaxel doublet was compared to a vinorelbine or gemcitabine (choice of the center). The survival benefit was of such magnitude that the paradigm of treatment of elderly patients PS 0-2 with advanced NSCLC should be modified in favor of the tested doublet. There should be a reappraisal of the geriatric indexes recommended by the oncogeriatricians regarding their exact prognostic or predictive role.

An optimization algorithm for joint mechanics estimate using inertial measurement unit data during a squat task.

The use of dynamic optimization as a tool to estimate joint kinematics and kinetics, and ground reaction forces using data from a single inertial measurement unit (IMU) positioned on the lower trunk was investigated. The feasibility of this approach and its accuracy was explored for the analysis of a squat task, focusing on the ankle, knee and hip joints. An optimal motor control strategy aimed at minimizing the sum of the intersegmental couples and of their time derivatives was imposed to estimate the mechanics of a three-segment sagittal model. Moreover, in the optimization process constraints to the measured vertical acceleration, to the maximal vertical IMU excursion, and with regard to the maintenance of dynamic balance were imposed. Experiments were performed using 10 volunteers. Data were collected from the IMU, from a stereophotogrammetric system (SS) and from a force platform for validation purposes. Results showed a very good consistency of the model output with the lower limb joint trajectories, as obtained using the SS, and with the measured vertical component of the ground reaction (low root mean square differences (<10%) and high correlation coefficients (0.98)).