Risk-Stratification using the 40-Gene Expression Profile (40-GEP) Test Identifies Patients with Node Negative Cutaneous Squamous Cell Carcinoma (cSCC) at Higher Risk of Metastasis Who May Benefit from Adjuvant Radiation Therapy (ART)

PURPOSE/OBJECTIVE(S)

ART is a standard treatment used to reduce the risk of metastasis and recurrence in moderate‒to‒high-risk cSCC patients. Indications for ART have been largely based on pathologic risk factors and informed by staging systems, and while radiation oncologists generally designate a >10% risk threshold for usage of ART, there is no consensus on which groups of tumors may benefit from ART. The 40-GEP test has been independently validated to predict a cSCC patient's risk for regional/distant metastasis in patients with one or more high-risk clinicopathologic factors and reports three biologic risk groups: Class 1 (low, ∼7%), Class 2A (moderate, 20-25%), and Class 2B (high risk, >50%) for metastasis. This study aims to evaluate whether a biomarker informed risk stratification approach using a 40-GEP result could refine the ability to select patients with node negative cSCC at higher risk of metastasis who are most likely to benefit from ART.

MATERIALS/METHODS

In this retrospective study, all patients had primary cSCC tissue with verified clinicopathologic information of tumors with one or more high-risk factors, met clinical testing criteria, were comprehensively staged, and had outcomes data (n = 954). Patients with node positive disease, or those with nodal failure within 3 months of diagnosis were excluded (n = 19). From the n = 935, an intermediate risk population wherein ART is often considered was defined as Brigham and Women's Hospital (BWH) ≥T2a (n = 489). Kaplan-Meier survival analysis and log-rank test were used to assess metastasis free survival (MFS). Univariate Cox regression compared metastasis rates between 40-GEP results.

RESULTS

The 3-year MFS rate for this eligible for ART cohort was 82.4% The 40-GEP demonstrated statistically significant risk stratification with MFS rates of 92.4%, 76.1% and 59.4% for Class 1, Class 2A and Class 2B, respectively (p<0.0001). Cox regression was significant for Class 2A and 2B compared to Class 1, with a 3.2-fold and 6.4-fold increase in metastasis, respectively (p<0.0001). 64% (59/92) of all metastases received a Class 2A result, and 44% (14/32) of Class 2B patients metastasized. 46% (223/489) of the cohort received a Class 1 result. Of patients staged BWH T1 (n = 446), those with a Class 2A and 2B had an 88.7% and 66.7% MFS rate, respectively.

CONCLUSION

Within this eligible for ART population, patients with Class 2A or 2B 40-GEP results have inferior rates of MFS, while Class 1 patients have <10% risk of metastasis. Nearly half of this population received a 40-GEP Class 1 result and could be considered for treatment de-intensification trials. Conversely, patients with low-risk BWH T1 stage, who are traditionally not considered for ART, that received a Class 2A or 2B (>10% risk of metastasis) could be considered for adjuvant therapy.

Obesity increased the risk for SARS-CoV-2 positivity in children

AIM

To determine the effects of obesity in childhood on SARS-CoV-2 infection.

METHODS

A population-based, cross-sectional study combining the Israeli Growth Survey and COVID-19 data for children with at least one SARS-CoV-2 test from 16 February 2020 - 20 December 2021. Overweight and obesity status were based on body mass index and Center for Disease Control criteria. Multivariate logistics regression was performed to validate reliability for weight categories at age of approximately six years compared to weights at approximately 12 years.

RESULTS

A total of 444,868 records for children with an overall positivity rate of 22% were studied. The mean age was 9.5 years. The odds ratios of children with obesity or overweight after controlling for sex at six years to test positive were 1.07-1.12 and 1.06-1.08 (depending on model) respectively, compared to those with healthy range body mass index.

CONCLUSION

Excess weight appears to increase risk for SARS-CoV-2 infection. This finding should be considered for public health planning. For example, children with overweight and obesity should be prioritized for vaccination. Excess weight in childhood can be harmful at a young age and not only for long term health.

Atypical working hours are associated with tobacco, cannabis and alcohol use

Background

We examined prospective associations between atypical working hours, substance use and sugar and fat consumption.

Methods

In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use; among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use if appropriate.

Results

Working at night was associated with increased tobacco use in women [odds ratios ranging from 1.45 to 1.48], with increased cannabis use in men [from 1.40 to 1.54] and with increased alcohol use in both men and women [from 1.12 to 1.14]. Weekend work and non-fixed working hours were associated with increased tobacco and alcohol use in both men and women [from 1.15 to 1.54 and 1.12 to 1.14, respectively]. Dose-dependent relationships were found regarding the association between working at night and tobacco use in women as well as regarding non-fixed working hours and tobacco use in both men and women (P for trends &lt;0.001).

Conclusions

The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.

Key messages

• Night shifts were associated with increased smoking in women with dose-dependent relationships, cannabis use in men and alcohol use in both.

• Weekend work and non-fixed working hours were associated with increased alcohol and tobacco use with dose-dependent relationships in men and women.

Atypical working hours are associated with substance use, especially in women: longitudinal analyses from the CONSTANCES cohort

Introduction

Difficult working conditions could be associated with addictive behaviors.

Objectives

To examine the prospective associations between atypical working hours and substance use, including sugar and fat consumption.

Methods

In the CONSTANCES cohort, a total of 47,288 men and 53,324 women currently employed were included from 2012-2017 for tobacco and cannabis outcomes, and 35,647 and 39,767, respectively from 2012-2016 for alcohol and sugar and fat outcomes, and they were then followed up annually. Atypical working hours were self-reported at baseline and considered three different indicators: night shifts, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to baseline atypical working hours while adjusting for sociodemographic factors, baseline depression and baseline level of consumption.

Results

Night shifts increased significantly the odds of using tobacco in women (Odds ratios, ORs varying from 1.55 to 1.62) and cannabis in men (ORs varying from 1.80 to 1.95). Weekend work increased the odds of using tobacco (ORs varying from 1.51 to 1.67) and alcohol (OR of 1.16) in women. Non-fixed working hours increased the odds of using tobacco and alcohol in men and women (ORs varying from 1.15 to 1.19 and 1.12 to 1.14, respectively). Dose-dependent relationships were found for tobacco use in women (P for trends<0.0001). No significant associations were found for sugar and fat consumption.

Conclusions

The role of atypical working hours on substance use should be taken into account by public health policy makers and clinicians for information and prevention strategies, especially among women.

Disclosure

Nadine Hamieh was supported by a grant from “Direction de la recherche, des études, de l’évaluation et des statistiques”, DREES, Ministry of Labour, France.

Physical exertion at work and addictive behaviors: tobacco, cannabis, alcohol, sugar and fat intake

Background

This study examined the prospective association of physical exertion at work with risk of tobacco, cannabis, alcohol use and sugar and fat consumption.

Methods

Volunteers of the French population-based CONSTANCES cohort currently employed were included from 2012 to 2017 for tobacco and cannabis outcomes (n = 100,612), and from 2012 to 2016 for alcohol and sugar and fat outcomes (n = 75,414). High level of physical exertion was defined as a score ≥12 at the Rating Perceived Exertion Borg scale. Substance use was self-reported and patterns of sugar and fat intakes were obtained from principal component analysis and used in quartiles. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to baseline physical exertion at work, while adjusting for sociodemographic factors, depressive symptoms and baseline level of consumption.

Results

High physical exertion was associated with tobacco use, i.e.: increased odd of relapse in former smokers (OR = 1.13, 95% confidence interval (CI):1.02-1.24), and increased number of cigarettes per day in current smokers (OR = 1.54, 95%CI:1.33-1.78) with dose-dependent relationships (P for trend&lt;0.001). It was also associated with increased odd of cannabis use at least once per month compared to no use in the past year (OR = 1.31, 95%CI:1.03-1.66) and with increased odds of sugar and fat consumption (OR = 1.06, 95%CI:1.01-1.11 and OR = 1.13, 95%CI:1.07-1.18, for third and fourth quartiles compared to the first, respectively).

Conclusions

The associations between physical exertion at work and subsequent tobacco and cannabis use and sugar and fat consumption should be taken into account for information and prevention strategies.

Key messages

The associations between physical exertion at work and subsequent tobacco and cannabis use and sugar and fat consumption should be taken into account for information and prevention strategies. High physical exertion at work was positively associated with subsequent tobacco and cannabis use and sugar and fat consumption.

Early-life Exposures and Age at Breast Development in the Sister Study Cohort

Purpose: Early age at breast development (thelarche) has been associated with increased breast cancer risk. Average age at thelarche has declined over time, but there are few established risk factors for early thelarche. We examined associations between pre- and postnatal exposures and age at thelarche in a U.S. cohort of women born between 1928 and 1974. Methods: Breast cancer-free women ages 35–74 years who had a sister diagnosed with breast cancer were enrolled in the Sister Study from 2003–2009 (N = 50,884). At enrollment, participants reported their age at thelarche, which we categorized as early (≤10 years), average (11–13 years), and late (≥14 years), as well as information on early-life exposures. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for early and late thelarche relative to average age at thelarche using polytomous logistic regression for each early-life exposure, adjusted for birth cohort, race/ethnicity and family income level in childhood. We examined modification by birth cohort, race/ethnicity, family income, relative weight at age 10, and extent of breast cancer family history through stratification. Results: Early thelarche was more common in recent birth cohorts and among non-Hispanic Black and Hispanic women. Early thelarche (≤10 years) was associated with multiple prenatal exposures: gestational hypertensive disorder (OR = 1.25, 95% CI, 1.09–1.43), maternal diethylstilbestrol (DES) use (OR = 1.23, 95% CI, 1.04–1.45), maternal smoking during pregnancy (OR = 1.20, 95% CI, 1.13–1.27), and young maternal age (OR 1.30, 95% CI, 1.16–1.47 for &lt;20 vs 25–29 years). Being firstborn was also associated with early thelarche (OR = 1.25, 95% CI, 1.17–1.33). Low birthweight (&lt;2500 vs 2500–3999g) was suggestively associated with both early (OR = 1.06, 95% CI, 0.96–1.17) and late (OR = 1.15, 95% CI, 1.05–1.25) thelarche, as was use of soy formula in infancy (Early: OR = 1.10, 95% CI, 0.93–1.30; Late: OR = 1.07, 95% CI, 0.92–1.25). Patterns were generally similar across strata of modifiers of interest. Conclusion: Associations between pre- and postnatal exposures and age at thelarche suggest that the early-life environment may influence breast development and therefore may also affect breast cancer risk by altering the timing of pubertal breast development.

The CONSTANCES Cohort Biobank: An Open Tool for Research in Epidemiology and Prevention of Diseases

“General-purpose cohorts” in epidemiology and public health are designed to cover a broad scope of determinants and outcomes, in order to answer several research questions, including those not defined at study inception. In this context, the general objective of the CONSTANCES project is to set up a large population-based cohort that will contribute to the development of epidemiological research by hosting ancillary projects on a wide range of scientific domains, and to provide public health information. CONSTANCES was designed as a randomly selected sample of French adults aged 18–69 years at study inception; 202,045 subjects were included over an 8-year period. At inclusion, the selected participants are invited to attend one of the 24 participating Health Prevention Centers (HPCs) for a comprehensive health examination. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HPC. Procedures have been developed to use the national healthcare databases to allow identification and validation of diseases over the follow-up. The biological collection (serum, lithium heparinized plasma, EDTA plasma, urine and buffy coat) began gradually in June 2018. At the end of the inclusions, specimens from 83,000 donors will have been collected. Specimens are collected according to a standardized protocol, identical in all recruitment centers. All operations relating to bio-banking have been entrusted by Inserm to the Integrated Biobank of Luxembourg (IBBL). A quality management system has been put in place. Particular attention has been paid to the traceability of all operations. The nature of the biological samples stored has been deliberately limited due to the economic and organizational constraints of the inclusion centers. Some research works may require specific collection conditions, and can be developed on request for a limited number of subjects and in specially trained centers. The biological specimens that are collected will allow for a large spectrum of biomarkers studies and genetic and epigenetic markers through candidate or agnostic approaches. By linking the extensive data on personal, lifestyle, environmental, occupational and social factors with the biomarker data, the CONSTANCES cohort offers the opportunity to study the interplays between these factors using an integrative approach and state-of-the-art methods.

Sleep disordered breathing: prevalence and association with cardiovascular disease in the French general population

Background

Sleep Disordered Breathing (SDB) is highly prevalent and associated with cardiovascular disease (CVD) but many studies have a limited sample size or uncertain generalizability.

Purpose

The aim of this study was to obtain contemporary data on SDB prevalence and to assess its impact on CVD occurrence in a large French population-based sample.

Methods

Data came from participants of the French population-based CONSTANCES cohort, included between 2012 and 2016, with clinical interview, examination and standard biology at inclusion and who were screened for SDB in 2017 using the Berlin Questionnaire (BQ). Follow-up was performed through yearly CONSTANCES questionnaires. CVD occurrence was defined by self-declared myocardial infarction or stroke between 2013 and 2017. Exposure variables were SDB diagnosis on the basis on BQ and its related sleeping symptoms (snoring, apnea and sleepiness). Odds Ratios (OR) were computed with their 95% Confidence Interval (95% CI) and adjusted for age, sex, smoking, dyslipidemia, diabetes, hypertension and body mass index (except for SDB since BQ considers these variables).

Results

Among 54 228 participants, SDB prevalence was 16.1%. Over four years of follow-up, CVD occurred in 2.23% of SDB participants vs 0.72% in non SDB (OR=1.72, 95% CI [1.41–2.09]). CVD occurrence did not increase significantly with snoring (OR=0.95, 95% CI [0.78; 1.17]), but with apnea (OR=1.34, 95% CI [1.05; 1.71]) and with sleepiness (OR=1.42, 95% CI [1.18–1.72] when fatigue occurred after-sleep and OR=1.62, 95% CI [1.33–1.97] during waking time). These associations remained non-significant for snoring regardless of its frequency or noise, were significant for sleepiness as soon as it happened at least once a week and tended to increase with its frequency whenever fatigue occurred (p for trend&lt;0.001). Subgroups analysis in hypertensive and non-hypertensive participants found similar results concerning snoring and sleepiness.

Conclusions

These results confirm that SDB is highly prevalent in the general French population and is associated with a higher occurrence of CVD particularly in sleepy and apneic subjects. Screen for SDB and its symptoms should be relevant to identify high cardiovascular risk people who would benefit from preventive measures.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Plan d'Investissement d'Avenir-3 (PIA3-RHU, Ministry of Health)

Periodontal Inflammation Primes the Systemic Innate Immune Response

The presence of periodontal diseases (PDs) often strongly correlates with other severe chronic inflammatory conditions, including cardiovascular disease, diabetes, and arthritis. However, the mechanisms through which these diseases interact are unclear. In PD, tissue and bone destruction in the mouth is driven by elevated recruitment of polymorphonuclear neutrophils (PMNs), which are primed and recruited from the circulation to sites of inflammation. We predicted that systemic effects on PMN mobilization or priming could account for the interaction between PD and other inflammatory conditions. We tested this using a mouse model of ligature-induced PD and found elevated PMN counts specifically in bone marrow, supporting a systemic effect of periodontal tissue inflammation on PMN production. In contrast, mice with induced peritonitis had elevated PMN counts in the blood, peritoneum, and colon. These elevated counts were further significantly increased when acute peritonitis was induced after ligature-induced PD in mice, revealing a synergistic effect of multiple inflammatory events on PMN levels. Flow cytometric analysis of CD marker expression revealed enhanced priming of PMNs from mice with both PD and peritonitis compared to mice with peritonitis alone. Thus, systemic factors associated with PD produce hyperinflammatory PMN responses during a secondary infection. To analyze this systemic effect in humans, we induced gingival inflammation in volunteers and also found significantly increased activation of blood PMNs in response to ex vivo stimulation, which reverted to normal following resolution of gingivitis. Together, these results demonstrate that periodontal tissue inflammation has systemic effects that predispose toward an exacerbated innate immune response. This indicates that peripheral PMNs can respond synergistically to simultaneous and remote inflammatory triggers and therefore contribute to the interaction between PD and other inflammatory conditions. This suggests larger implications of PD beyond oral health and reveals potential new approaches for treating systemic inflammatory diseases that interact with PD.

Does substance use explain social differences in terms of depression? Findings from the Constances cohort

BACKGROUND

The role of alcohol, tobacco and cannabis use in social differences in terms of depression is poorly understood.

METHOD

We have applied mediation and moderated-mediation models stratified by gender to a population-based sample (N = 37,192) of French men and women from the Constances cohort with baseline and follow-up measures of depressive states. We have examined whether socioeconomic status (SES, measured by education and income) differences in the prevalence of depressive states may be explained by both differences in prevalence of substance use according to SES (mediating effects) and differential effects of substance use on depressive state according to SES (moderating effects).

RESULTS

In the mediation models, substance use only explained 5.3% and 2.4% of the association between low education and depressive state in men and women respectively, and was not a significant mediator for income. Moderated mediation models showed robust moderation effects of education and income in both men and women. The association of tobacco use with depressive symptoms, which was the only substance for which a mediation effect remained and for which the moderation effect of SES was the strongest, was significantly higher in participants with low SES.

LIMITATIONS

The partially cross-sectional nature of the data restricts the possibility of drawing causality with regards to associations between SES and substance use.

CONCLUSION

Targeting substance use, particularly tobacco, can especially reduce depression risk in individuals of low SES.

Socioeconomic inequalities in cognitive performance among early ageing people: The Constances cohort

Background

In spite of the recent awareness of environmental characteristic’s impact on brain aging, links between contextual socioeconomic status and cognitive performance (CP) remains unclear. The objective was to investigate the influence of individual and contextual deprivation on cognitive performance in order to better characterize vulnerable population.

Methods

We performed cross-sectional analyses on 44,762 participants (45-70 y) of the French Constances cohort. Cognitive performance was assessed using a global cognitive score calculated with 6 cognitive tests evaluating global cognitive function, episodic verbal memory, language abilities, and executive functions. Poor performance was defined as a score below or equal to the 25th percentile of the distribution. We approached the deprivation by two validated multidimensional index: at individual level with the EPICES score (deprived if &lt; 30.17) and contextual level with the FDep09 score divided in quintile (Q5 being the most deprived). Associations were estimated with multilevel logistic regressions.

Results

At the individual level, participants more deprived had poorer CP independently to sex, age, education and health status (OR 1.58 [1.48; 1.69]). At the contextual level, the more people lived in deprived environment, the poorer their CP (p&lt;.0001), even after adjustment on individual deprivation and other individual characteristics (Q5 vs Q1: OR 1.28 [1.15; 1.41]).

Conclusions

In this large cohort of early-ageing people, area-based disparities in cognitive impairment were highlighted. A better understanding of the influence of living environment deprivation level on cognitive aging could help to define new strategies in prevention by targeting at-risk populations in interventions studies in order to reduce social health inequalities.

Key messages

Our study evidenced a strong socio-economic gradient of cognitive performance identifiable on both individual and contextual level, in a large sample of middle-aged volunteers. Independently to individual deprivation and other individual characteristics, living in a deprived environment may be detrimental to the brain health.

Electronic cigarette use and smoking reduction – longitudinal data from CONSTANCES cohort study

Aims

Electronic cigarettes are often used by smokers to stop smoking and former smokers to prevent relapse. We examined whether electronic cigarette use lead to smoking reduction and cessation among smokers, and relapse among former smokers.

Design and Settings

The CONSTANCES cohort, France (2012 - ongoing).

Measurements

Among smokers (N = 5,400, average follow-up of 23.4 months), mixed regression models were used to examine whether electronic cigarette use was linked to a decrease in the number of cigarettes smoked per day and Poisson regression models with sandwich variance estimators were used to test smoking cessation. In parallel, Cox proportional hazards regression models were used to examine the relationship between electronic cigarettes use and smoking relapse among former smokers who stopped smoking since 2010 (N = 2,025, average follow-up of 22.1 months), year in which electronic cigarettes were introduced in France. All statistical analyses were adjusted for socio-demographic characteristics, duration of follow-up, and smoking characteristics.

Findings

There was a significantly higher decrease in the number of cigarettes smoked/day among smokers who used electronic cigarettes (decrease of 4.4 cigarettes/day) compared to those who did not (decrease of 2.7 cigarettes/day), as well as a higher relative risk of smoking cessation (adjusted RR: 1.67 [95% CI: 1.51-1.84]). At the same time, among former smokers, EC use was associated with an increase in the rate of smoking relapse (adjusted HR = 1.70 [95% CI: 1.25-2.30]).

Conclusions

After a follow-up of approximately 2 years, electronic cigarettes use among smokers was associated to a decrease in smoking level and an increase in smoking cessation attempts but among former smokers it was associated to a higher risk of smoking relapse.

Key messages

Among smokers, electronic cigarette use was associated to smoking reduction and smoking cessation. Among former smokers who quit smoking since 2010, electronic cigarette use was associated to a higher likelihood of relapse.

P2484SGLT2 inhibitors in diabetes with CKD

Background

DM mellitus (DM) and chronic kidney disease (CKD) significantly increase the risk of cardiovascular morbidity and mortality. Current guideline recommendations do not support the use of SGLT2 inhibitors in patients with CKD stage III or higher. We performed a comprehensive meta-analysis to evaluate their cardiovascular effects in patients with type 2 DM and CKD stage III or higher.

Methods

A comprehensive search was performed in PubMed, Cochrane central and Embase for randomized controlled trials (RCTs) evaluating the cardiovascular outcomes of SGLT-2 inhibitors in patients with type 2 DM and CKD defined as glomerular filtration rate of <60ml/min. There were no data available on patients with end-stage renal disease. We calculated treatment effects and associated standard errors from the corresponding odds ratio and confidence interval. These values were imputed in software R to perform meta-analysis via generic inverse variance method. Additionally, we conducted a network meta-analysis to compare the relative efficacy and safety of each agent.

Results

Data from 7 RCTs and 6,527 participants was available. In patients with type 2 DM and CKD, SGLT-2 inhibitor use resulted in a significant reduction of myocardial infarction (22%), heart failure hospitalization (39%), and major adverse cardiac events (20%) (all p-value<0.05). There was also a trend towards a reduction in stroke and cardiovascular mortality. In a network meta-analysis, canagliflozin was the most effective in reduction of MI, stroke and heart failure hospitalization. Empagliflozin performed better for the outcome of cardiovascular mortality, but the results failed to reach significance.

Conclusion

SGLT-2 inhibitors significantly improve cardiovascular outcomes in patients with type 2 DM and CKD stage III or higher. This meta-analysis confirms that renal dysfunction should not be a deterrent to the widespread utilization of SGLT-2 inhibitors. Further studies are needed to identify the mechanisms behind these improved cardiovascular outcomes

Acknowledgement/Funding

None

Barriers and facilitators to students with physical disabilities' participation in academic laboratory spaces

Purpose: To provide empirical evidence on learning barriers and facilitators in instructional science and engineering laboratory settings from a national survey on students with physical disabilities (SwD-P).Methods: A nationwide self-report survey, the Full Participation Science and Engineering Accessibility (FPSEA), was disseminated online via Qualtrics. Approximately 1200 organizations and universities across the United States were contacted through purposive sampling. Descriptive statistics were primarily used for the analysis of the results.Results: Survey findings reveal that students experience a wide range of limitations to full participation in the laboratory, from entering the laboratory (25%) to being given passive roles (50%). Additionally, while 66% of respondents indicated that instructors were willing to help SwD-P participate in science and engineering (S&E) laboratories, 16.8% were not willing to do so, and 47% SwD-P felt that practices were not in place to provide accommodations. The survey also reveals a range of facilitators such as elevators, ramps, accessible course materials and peer assistance. Most respondents (74%) also indicated that peers were helpful in completing laboratory tasks.Conclusion: This survey provides empirical evidence that was previously voiced through non-empirical information in the literature. Participants cited barriers such as inappropriate accommodations and instructors' negative viewpoints, as well as gaining access to facilities even after the enactment of the Americans with Disabilities Act (ADA). These findings suggest that while ADA has lessened some barriers to SwD-P, barriers remain in using the laboratory space. The FPSEA survey fills the gap in finding barriers and facilitators to using S&E laboratories from the SwD-P's perspective.Implications for RehabiliationBarriers students with disabilities encounter in science and engineering (S&E) laboratory environments remain unclear.The FPSEA survey fills the gap in finding barriers and facilitators to using S&E laboratories from the SwD-P's perspective.The FPSEA survey allows former and current SwD-P to share their experiences using a postsecondary S&E instructional laboratory.

Association between Hospitalization and Change of Frailty Status in the GAZEL Cohort

OBJECTIVES

To assess the relationship between changes of frailty status and intervening hospitalizations, using information of the GAZEL cohort, matched with the data of the French National Health Data System.

DESIGN

Observational cohort study.

PARTICIPANTS

Community-dwelling adults of the GAZEL cohort (n = 12145; aged between 58 and 73 years in 2012).

MEASUREMENTS

Frailty was determined with the Strawbridge questionnaire in 2012, 2013 and 2014. Data regarding hospitalizations (notably their number, length of stay, emergency department use, and main diagnosis) were collected from the French National Health Data System. The relationship between intervening hospitalizations and changes of frailty status over time was assessed with multivariate Markov models.

RESULTS

The prevalence of frailty was 14% in 2012 and 2013 and 17% in 2014. A total of 2715 changes in frailty status were observed from 2012 to 2014. At least one hospitalization was recorded for 1453 people (12%) between the 2012 and 2013 questionnaires, and 1472 (13%) between the 2013 and 2014 questionnaires. No association was found between intervening hospitalizations and changes of frailty status (aHR 1.14 [0.97-1.35] for robust to frail transition and aHR 0.89 [0.73-1.08] for frail to robust transition). However, repeated hospitalizations, hospitalizations after emergency department use, surgery and several diagnosis groups were significantly associated with transitions towards frailty or its recovery.

CONCLUSION

Hospitalizations encompass a wide range of clinical situations, some of them being associated with incident frailty. An early recognition of these situations could help to better prevent and manage frailty in the early old age.

Participation in science and engineering laboratories for students with physical disabilities: survey development and psychometrics

Purpose: The purpose of this study is to address the development of the Full Participation Science and Engineering Accessibility (FPSEA) self-report survey that gathers experiences from students with physical disabilities (SwD-P) using a postsecondary laboratory and to evaluate the survey's stability. Methods: Survey items were generated from an extensive literature review and recommendations articulated by experts. Think-aloud sessions and content validity index (CVI) were used to determine survey content validity and help finalize survey items. Individuals with physical disabilities (n = 20) who have taken a postsecondary science or engineering laboratory course completed the survey and took it again 10-14 days apart. The test-retest reliability was assessed using Spearman Rho coefficients for Likert-scale items, Chi-square and Fisher's exact test for the dichotomous items. Missing data completely at random (MCAR) test was computed before reliability data analysis. Results: Each sub-item passed the MCAR test, indicating that the data are missing completely at random and can be imputed to perform the analysis. Reliability analysis was completed on 20 individuals. The FPSEA had good content reliability: the item-level CVI of items kept ranged from 0.86 to 1. The scale-level CVI was 0.94. Stability was demonstrated with adequate Spearman correlation ranged from 0.56 to 0.86. Conclusions: No previous survey had been developed linking SwD-P and the postsecondary science and engineering (S&E) laboratory setting prior to this work. Overall, FPSEA is reliable and stable for reporting the barriers and facilitators to use S&E laboratories from the SwD-P's perspective. Implications for rehabilitation The barriers students with disabilities encounter in S&E laboratory environments are largely unknown. The FPSEA survey may help identify barriers and facilitators to using S&E laboratories for SwD-P. The FPSEA Survey allows former and current SwD-P to share their experiences using a postsecondary S&E instructional laboratory.

SARI : A User-Oriented Data Bank System for Medical Applications

This paper describes a general data base management package, devoted to medical applications. SARI is a user-oriented system, able to take into account applications very different by their nature, structure, size, operating procedures and general objectives, without any specific programming. It can be used in conversational mode by users with no previous knowledge of computers, such as physicians or medical clerks.

As medical data are often personal data, the privacy problem is emphasized and a satisfactory solution implemented in SARI.

The basic principles of the data base and program organization are described ; specific efforts have been made in order to increase compactness and to make maintenance easy.

Several medical applications are now operational with SARI. The next steps will mainly consist in the implementation of highly sophisticated functions.

Oral and Blood Neutrophil Activation States during Experimental Gingivitis

Polymorphonuclear neutrophils (PMNs) are the primary leukocytes present in the healthy and inflamed oral cavity. While unique PMN activation states have been shown to differentiate health and periodontitis, little is known about the changes in PMN activation states that occur during the transition from periodontal health to gingivitis. The objective of this study was to characterize oral and circulatory PMNs during induction and resolution of experimental gingivitis. Healthy volunteers were recruited to undergo experimental gingivitis. Clinical assessment of pocket depths, bleeding on probing, gingival index, and plaque index, as well as flow cytometric analysis of CD (cluster of differentiation) activation markers on blood and oral PMNs, was performed weekly. All clinical parameters increased significantly during the induction period and returned to baseline levels during the resolution phase. During the induction phase, while oral PMN counts increased, oral PMN activation state based on surface expression of CD63, CD11b, CD16, and CD14 was diminished compared to those seen in health and during the resolution phase. PMNs in circulation during onset showed increased activation based on CD55, CD63, CD11b, and CD66a. Using clinical parameters and oral PMN counts assessed at day 21, we noted 2 unique disease patterns where one-third of subjects displayed an exaggerated influx of oral PMNs with severe inflammation compared to the majority of the population who experienced a moderate level of inflammation and PMN influx. This supports the notion that PMN influx and severe inflammatory changes during gingivitis could identify subjects at risk for the development of severe gingival inflammation and progression toward destructive periodontitis. This study demonstrates that oral PMN activation states are reduced in gingivitis and suggest that only in periodontitis do PMNs become hyperactivated and tissue damaging.

Knowledge Transfer Statement: Our article creates a paradigm for future studies of the evolution of essential oral and circulatory biomarkers to identify individuals at risk to develop periodontitis at an early stage of periodontal disease, which is reversible upon proper oral hygiene practices and dental treatments.

Hybrid capture-based genomic profiling of circulating tumor DNA from patients with estrogen receptor-positive metastatic breast cancer

BACKGROUND

Genomic changes that occur in breast cancer during the course of disease have been informed by sequencing of primary and metastatic tumor tissue. For patients with relapsed and metastatic disease, evolution of the breast cancer genome highlights the importance of using a recent sample for genomic profiling to guide clinical decision-making. Obtaining a metastatic tissue biopsy can be challenging, and analysis of circulating tumor DNA (ctDNA) from blood may provide a minimally invasive alternative.

PATIENTS AND METHODS

Hybrid capture-based genomic profiling was carried out on ctDNA from 254 female patients with estrogen receptor-positive breast cancer. Peripheral blood samples were submitted by clinicians in the course of routine clinical care between May 2016 and March 2017. Sequencing of 62 genes was carried out to a median unique coverage depth of 7503×. Genomic alterations (GAs) in ctDNA were evaluated and compared with matched tissue samples and genomic datasets of tissue from breast cancer.

RESULTS

At least 1 GA was reported in 78% of samples. Frequently altered genes were TP53 (38%), ESR1 (31%) and PIK3CA (31%). Temporally matched ctDNA and tissue samples were available for 14 patients; 89% of mutations detected in tissue were also detected in ctDNA. Diverse ESR1 GAs including mutation, rearrangement and amplification, were observed. Multiple concurrent ESR1 GAs were observed in 40% of ESR1-altered cases, suggesting polyclonal origin; ESR1 compound mutations were also observed in two cases. ESR1-altered cases harbored co-occurring GAs in PIK3CA (35%), FGFR1 (16%), ERBB2 (8%), BRCA1/2 (5%), and AKT1 (4%).

CONCLUSIONS

GAs relevant to relapsed/metastatic breast cancer management were identified, including diverse ESR1 GAs. Genomic profiling of ctDNA demonstrated sensitive detection of mutations found in tissue. Detection of amplifications was associated with ctDNA fraction. Genomic profiling of ctDNA may provide a complementary and possibly alternative approach to tissue-based genomic testing for patients with estrogen receptor-positive metastatic breast cancer.

[The REDSIAM network]

The French national health database (SNIIRAM) proved to be very useful for epidemiology, health economics, evaluation, surveillance or public health. However, it is a complex database requiring important resources and expertise for being used. The REDSIAM network has been set up for promoting the collaboration of teams working on the Sniiram. The main aim of REDSIAM is to develop and validate methods for analyzing the Sniiram database for research, surveillance, evaluation and public health purposes by sharing the knowledge and experience of specialized teams in the fields of diseases identification from the Sniiram data. The work conducted within the network is devoted to the development and the validation of algorithms using Sniiram data for identifying specific diseases. The REDSIAM governance includes the Steering Committee composed of the main organizations in charge of producing and using the Sniiram data, the Bureau and the Technical Committee. The network is organized in thematic working groups focused on specific pathological domains, and a charter defines the rules for participation in the network, the functioning of the thematic working groups, the rules for publishing and making available algorithms. The articles in this special issue of the journal present the first results of some of the thematic working groups.

Informal caregiving as a risk factor for type 2 diabetes in individuals with favourable and unfavourable psychosocial work environments: A longitudinal multi-cohort study

AIM

To examine whether informal caregiving is associated with increased risk of type 2 diabetes (T2D), and whether job strain and social support at work modify the association.

METHODS

Individual participant's data were pooled from three cohort studies-the French GAZEL study, the Swedish Longitudinal Occupational Survey of Health (SLOSH) and the British Whitehall II study-a total of 21,243 study subjects. Informal caregiving was defined as unpaid care for a closely related person. Job strain was assessed using the demand-control model, and questions on co-worker and supervisor support were combined in a measure of social support at work. Incident T2D was ascertained using registry-based, clinically assessed and self-reported data.

RESULTS

A total of 1058 participants developed T2D during the up to 10 years of follow-up. Neither informal caregiving (OR: 1.09, 95% CI: 0.92-1.30) nor high job strain (OR: 1.04, 95% CI: 0.86-1.26) were associated with T2D risk, whereas low social support at work was a risk factor for T2D (OR: 1.18, 95% CI: 1.02-1.37). Also, informal caregivers who were also exposed to low social support at work were at higher risk of T2D (OR: 1.40, 95% CI: 1.08-1.82) compared with those who were not informal caregivers and had high social support at work (multiplicative test for interaction, P=0.04; additive test for interaction, synergy index=10).

CONCLUSION

Informal caregiving was not independently associated with T2D risk. However, low social support at work was a risk factor, and informal caregivers with low social support at work had even higher risks of T2D.

The Role of Matrix Metalloproteinases (MMPs) in Human Caries

The objective of this review is to summarize our understanding of the role of host matrix metalloproteinases (MMPs) in the caries process and to discuss new therapeutic avenues. MMPs hydrolyze components of the extracellular matrix and play a central role in many biological and pathological processes. MMPs have been suggested to play an important role in the destruction of dentin organic matrix following demineralization by bacterial acids and, therefore, in the control or progression of carious decay. Host-derived MMPs can originate both from saliva and from dentin. They may be activated by an acidic pH brought about by lactate release from cariogenic bacteria. Once activated, they are able to digest demineralized dentin matrix after pH neutralization by salivary buffers. Furthermore, the degradation of SIBLINGs (Small Integrin-binding Ligand N-linked Glycoproteins) by the caries process may potentially enhance the release of MMPs and their activation. This review also explores the different available MMP inhibitors, natural or synthetic, and suggests that MMP inhibition by several inhibitors, particularly by natural substances, could provide a potential therapeutic pathway to limit caries progression in dentin.