Southern ocean carbon and heat impact on climate.

The Southern Ocean greatly contributes to the regulation of the global climate by controlling important heat and carbon exchanges between the atmosphere and the ocean. Rates of climate change on decadal timescales are therefore impacted by oceanic processes taking place in the Southern Ocean, yet too little is known about these processes. Limitations come both from the lack of observations in this extreme environment and its inherent sensitivity to intermittent processes at scales that are not well captured in current Earth system models. The Southern Ocean Carbon and Heat Impact on Climate programme was launched to address this knowledge gap, with the overall objective to understand and quantify variability of heat and carbon budgets in the Southern Ocean through an investigation of the key physical processes controlling exchanges between the atmosphere, ocean and sea ice using a combination of observational and modelling approaches. Here, we provide a brief overview of the programme, as well as a summary of some of the scientific progress achieved during its first half. Advances range from new evidence of the importance of specific processes in Southern Ocean ventilation rate (e.g. storm-induced turbulence, sea-ice meltwater fronts, wind-induced gyre circulation, dense shelf water formation and abyssal mixing) to refined descriptions of the physical changes currently ongoing in the Southern Ocean and of their link with global climate. This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.

[Stereotactic radiotherapy of non-tumoral brain pathologies: Arteriovenous malformations and trigeminal neuralgias]. / Radiothérapie stéréotaxique des affections cérébrales non tumorales : malformations artérioveineuses et névralgies trigéminales.

Stereotactic radiotherapy and radiosurgery allow delivery of high irradiation doses in a limited volume. These techniques are specially adapted to brain and nervous pathologies. Indication are not only cancers and tumors but also non tumor tissues such as arteriovenous malformations. In some case purpose of stereotactic radiotherapy is solely functional, for example for trigeminal neuralgia. We detail the questions that raise treatment of these non-tumor pathologies. These pathologies imply a multidisciplinary approach that associate radiation oncologists, neuro-radiologist and neurosurgeons.

[Organ preservation in oropharyngeal cancers treatment: What arguments for radiotherapy?] / Préservation d'organe dans la prise en charge des cancers de l'oropharynx : quels arguments en faveur de la radiothérapie ?

Management of oropharyngeal cancer depends on several factors. Immediate surgery or radiotherapy may be considered. If the patient is operable, the choice depends on the extent of the disease, the contributing factors, and the expected functional results. For HPV-positive cancers, studies show comparable efficacy between surgery and radiotherapy. For early-stage cancers, unimodal treatment should be preferred. For HPV-negative cancers, the results of retrospective and observational studies are in favor of surgery. These studies have some limitations. In observational and/or retrospective studies, reclassification biases and the applicability of propensity scores weaken the validity of studies showing differences in management. Tumor and patient comparability are others majors interpretation biases. It is precipitate to conclude that surgery is superior for HPV-negative oropharyngeal cancers. Toxicity, therefore, becomes a criterion of choice for treatment. Unimodal management by surgery allows limited toxicity for the early stages. Surgery has less impact on salivation. Radiotherapy is rather less deleterious for swallowing in the early stages. For the advanced stages of HPV-induced tumors, the non-superiority of surgery should lead to the choice of radiochemotherapy. For oropharyngeal cancers, the possible benefit of surgery in HPV-negative oropharyngeal cancers must be confirmed in randomized studies. For the early stages of oropharyngeal cancer with unimodal treatment, management could be decided by shared decision making.

[Telomeres and lung]. / Télomères et poumon.

Genetic studies of familial forms of interstitial lung disease (ILD) have led to the discovery of telomere-related gene (TRG) mutations (TERT, TERC, RTEL1, PARN, DKC1, TINF2, NAF1, NOP10, NHP2, ACD, ZCCH8) in approximately 30% of familial ILD forms. ILD patients with TRG mutation are also subject to extra-pulmonary (immune-hematological, hepatic and/or mucosal-cutaneous) manifestations. TRG mutations may be associated not only with idiopathic pulmonary fibrosis (IPF), but also with non-IPF ILDs, including idiopathic and secondary ILDs, such as hypersensitivity pneumonitis (HP). The presence of TRG mutation may also be associated with an accelerated decline of forced vital capacity (FVC) or poorer prognosis after lung transplantation, notwithstanding which, usual ILD treatments may be proposed. Lastly, patients and their relatives are called upon to reduce their exposure to environmental lung toxicity, and are likely to derive benefit from specific genetic counseling and pre-symptomatic genetic testing.

Histosurgical mapping of endoscopic endonasal surgery of sinonasal tumours to improve radiotherapy guidance.

PURPOSE: Endoscopic endonasal surgery (EES) is becoming a standard for most malignant sinonasal tumours. Margin analysis after piecemeal resection is complex and optimally relies on accurate histosurgical mapping. Postoperative radiotherapy may be adapted based on margin assessment mapping to reduce the dose to some sinonasal subvolumes. We assessed the use of histosurgical mapping by radiation oncologists (RO). MATERIAL AND METHODS: A French practice survey was performed across 29 ENT expert RO (2 did not answer) regarding integration of information on EES, as well as quality of operative and pathology reportsto refine radiotherapy planning after EES. This was assessed through an electronic questionnaire. RESULTS: EES was ubiquitously performed in France. Operative and pathology reports yielded accurate description of EES samples according to 66.7% of interviewed RO. Accuracy of margin assessment was however insufficient according to more than 40.0% of RO. Additional margins/biopsies of the operative bed were available in 55.2% (16/29) of the centres. In the absence of additional margins, quality of resection after EES was considered as microscopically incomplete in 48.3% or dubious in 48.3% of RO. As performed, histosurgical mapping allowed radiotherapy dose and volumes adaptation according to 26.3% of RO only. CONCLUSIONS: Standardized histosurgical mapping with margin and additional margin analysis could be more systematic. Advantages of accurate EES reporting could be dose painting radiotherapy to further decrease morbidity in sinonasal tumours.

[Research ethics: French regulations and applications in radiation oncology]. / Éthique de la recherche : réglementations françaises et applications en oncologie radiothérapie.

French regulations about research ethics are based on the so-called Jardé law, which defines researches involving human beings. Researches involving human beings require the submission of research protocols to a committee for protection of persons with a precise list of documents to submit for a favourable opinion. This law describes different categories of researches and determines the ethical procedures to apply before setting up a research protocol. This issue of categorisation is central and must be taken into account by researchers from the beginning of the research process. Researches considered as not involving human beings also require a set of ethical precautions focused on patients' information and the collection of their non-opposition (due to the application of the General Data Protection Regulation adopted by the European Parliament). Thus, many regulations exist and they require a real work for researchers to meet these requirements in research ethics. This article aims to summarise French regulations. Selected examples are specifically taken into the field of radiation oncology research.

Usability and application of a data integration technique (following the thread) for multi- and mixed methods research: A systematic review.

BACKGROUND: The scope of methodological development and innovation in multi- and mixed methods design is endless and, at times, challenging. The latter is especially true with regards to the integration of data generated through different methods. About a decade ago, Professor Jo Moran-Ellis and her colleagues at the University of Sussex suggested a framework for analytical integration known as "following a thread." Despite an increased focus within health services research on different perspectives and approaches to successful data integration, the framework's usability and application have not yet been well described. OBJECTIVES: This systematic review aims to integrate and synthesise published accounts of the framework and its applications. DESIGN AND DATA SOURCES: Seven electronic databases were utilised. Included were peer-reviewed scientific papers published in English from 2006 - 2018. The authors independently screened eligible publications by title and abstract. RESULTS: Thirteen studies were included in our systematic review. One notable finding is that in almost half of the cases (n = 6), the framework had been applied as an analytical integration framework in single studies using multiple qualitative methods. Overall, the descriptions and accounts of the framework were sparse and lacked transparency. Accounts of the analytical integration framework could be said to fall within three overarching areas: (1) applications of the framework, (2) justifications for analytical integration, and (3) benefits and shortfalls of the framework. CONCLUSION: Data integration is often one of the major method steps in multi- and mixed methods designs. To further the future development of methodologically sound frameworks for analytical integration, it is essential that they are sufficiently described so as to ensure validation of the framework's usability and replicability. "Following a thread" appears to be an promising analytical integration framework, particularly in that it can be applied with the same datatypes as well as between different types of data.

[Anatomoclinical and dermatoscopic study of trichoadenoma]. / Trichoadénome : description anatomoclinique et dermatoscopique.

INTRODUCTION: Trichoadenoma is a very rare follicular tumour with a remarkable histopathological appearance. In this article we present a series of 12 cases of trichoadenoma, as well as the anatomoclinical and dermatoscopic findings in a typical case. We discuss these findings in the light of an extensive literature research. PATIENTS AND METHODS: We collated 12 cases of trichoadenoma of indisputable diagnosis made at the dermatopathology laboratory of the Dermatological Clinic of the University Hospitals of Strasbourg over a 30-year period (1989-2018). RESULTS: The 12 cases comprised 7 women and 5 men, of average age 58.9 years, the majority having lesions on the cephalic extremity followed by the buttocks and thighs. Histopathological examination, which was similar in all 12 cases, showed multiple epidermal cysts containing an eosinophil lamellar keratin with a stratified wall without any visible hair, located in the superficial and mid dermis and appearing to be stacked on top of one another. In immunohistochemistry, broad spectrum keratin markers were still positive, the follicular marker Ber-EP4 weakly expressed and PHLDA1 was negative. For the case examined using polarized-light dermatoscopy, small rounded white-yellow areas were observed corresponding to cystic structures surrounded by irregular linear vessels. DISCUSSION: Trichoadenoma is a rare tumour seen in middle-aged adults of mean age 45 years, and has no sexual predominance. It is asymptomatic, slow-growing, variable in colour, measures less than one centimeter and is most often located on the face or buttocks. In terms of histology, the juxtaposition of multiple small cystic structures suggests a follicular origin. Differential diagnosis is made with trichoblastomas, which always intensely express PHLDA1 and/or Ber-EP4, desmoplastic trichoepithelioma, which consists of multiple much thinner spans in a highly fibrous stroma with clearly visible arborescent vessels over a white-yellow ivory background at dermatoscopy, microcystic carcinoma, which has a deeper extension, and plaque milium, in which the cysts are larger.

[Chemoradiation for oesophageal cancer: A critical review of the literature]. / Chimioradiothérapie des cancers de l'œsophage : revue critique de la littérature.

Locally advanced oesophageal cancer treatment requires a multidisciplinary approach with the combination of chemotherapy and radiotherapy for preoperative and definitive strategy. Preoperative chemoradiation improves the locoregional control and overall survival after surgery for locally advanced oesophageal cancer. Definitive chemoradiation can also be proposed for non-resectable tumours or medically inoperable patients. Besides, definitive chemoradiation is considered as an alternative option to surgery for locally advanced squamous cell carcinomas. Chemotherapy regimen associated to radiotherapy consists of a combination of platinum derived drugs (cisplatinum or oxaliplatin) and 5-fluorouracil or a weekly scheme combination of carboplatin and paclitaxel according to CROSS protocol in a neoadjuvant strategy. Radiation doses vary from 41.4Gy to 45Gy for a preoperative strategy or 50 to 50.4Gy for a definitive treatment. The high risk of lymphatic spread due to anatomical features could justify the use of an elective nodal irradiation when the estimated risk of microscopic involvement is higher than 15% to 20%. An appropriate delineation of the gross tumour volume requires an exhaustive and up-to-date evaluation of the disease. Intensity-modulated radiation therapy represents a promising approach to spare organs-at-risk. This critical review of the literature underlines the roles of radiotherapy for locally advanced oesophageal cancers and describes doses, volumes of treatment, technical aspects and dose constraints to organs-at-risk.

[Prevalence and expectations of "alternative and complementary medicine" use during radiotherapy in 2016: A prospective study]. / Prévalence et attentes de l'utilisation des « médecines alternatives et complémentaires ¼ pendant la radiothérapie en 2016 : étude prospective.

PURPOSE: Alternative and complementary medicine is defined as any substance or technique of non-allopathic medicine used to improve health and quality of life. The purpose of this prospective observational study was to evaluate the use of alternative and complementary medicine during radiotherapy. MATERIAL AND METHODS: A questionnaire was given the last week of treatment to all patients treated for breast cancer, prostate cancer or head and neck cancer in our centre in 2016. RESULTS: In 2016, 132 patients were included. Fifty-seven patients (43%) used alternative and complementary medicine during radiotherapy, more women (61%) than men (35%) (P=0.005). The use of alternative and complementary medicine varied according to locations: 44% of head and neck cancers, 57% of breast cancers and 24% of prostate cancers, but sex was the confounding factor. If alternative and complementary medicine was used before radiotherapy, 82% of patients used it during treatment, compared to 30% if they were naive (P<10-7). Healing touch (68%), homeopathy (26%) and magnetisers (21%) were the most used alternative and complementary medicines. Sixty-one percent of patients used alternative and complementary medicine to reduce skin and mucosal side effects of treatments, 28% to improve well-being, and 9% to treat cancer. Seventy-two percent of all patients would advise their loved one to use an alternative and complementary medicine and 87% would like information about them in the hospital. CONCLUSION: Alternative and complementary medicines are used more by women, and by patients who used them before radiotherapy. The desired effects are mainly to reduce the side effects of the treatments. More than 80% of patients, whether or not they use alternative and complementary medicine, demand medical information.

[Radiotherapy of benign intracranial tumors]. / Radiothérapie des tumeurs intracrâniennes bénignes.

Most of the benign intracranial tumors are meningiomas, vestibular schwannomas, pituitary adenomas, craniopharyngiomas, and glomus tumors. Some of them grow very slowly, and can be observed without specific treatment, especially if they are asymptomatic. Symptomatic or growing tumors are treated by surgery, which is the reference treatment. When surgery is not possible, due to the location of the lesion, or general conditions, radiotherapy can be applied, as it is if there is a postoperative growing residual tumor, or a local relapse. Indications have to be discussed in polydisciplinary meetings, with precise evaluation of the benefit and risks of the treatments. The techniques to be used are the most modern ones, as multimodal imaging and image-guided radiation therapy. Stereotactic treatments, using fractionated or single doses depending on the size or the location of the tumors, are commonly realized, to avoid as much a possible the occurrence of late side effects.

[Practice evolution of hypofractionation in breast radiation therapy and medical impact]. / Évolution des pratiques médicales d'hypofractionnement en radiothérapie pour cancer du sein et impact économique.

PURPOSE: Whole breast irradiation after conservative surgery is the standard treatment for invasive breast cancer. Randomized studies indicate that hypofractionation can be equivalent for selected patients. This study focuses on fractionation practice evolution in a single centre, and analyses the economic impact of practice modification. MATERIAL AND METHODS: All prescriptions for invasive breast cancer between January 2010 and June 2014 were analyzed. Female patients 60 years or older, pN0 were considered for the economic study. Patients included in clinical trials or patient with high-grade tumours were excluded from the hypofractionation practice study, because physician could not choose fractionation. We used data from the Medical public health system to calculate cost per fraction and transportation cost. RESULTS: Two thousand thirty one patients were treated; 399 were eligible for the economic study (20%) and 282 for the practice study (14%). Treatment with 25 fractions decreased from 90% to 16% in the first half of 2014. Meanwhile, treatment with 15 or 16 fractions increased from 6% in 2010 to 68% in the first half of 2014. Hypofractionated treatment proportion was 100% with 42.5Gy in 16 fractions in 2010 and 100% 40Gy in 15 fractions in 2014, according to long-term follow-up publication of START trials. Treatment with five fractions remained stable around 7% (4 to 16%), reserved for patients over 80 years (P<0.0001). Based on data from 3451 fractions in 2013, transport cost was calculated at 62 € per fraction, in addition to a 170.77 € reimbursement per fraction, giving a cost per fraction of 232.77 €. CONCLUSION: Practice change led to an increase of hypofractionation in recent years. Hypofractionation may be currently prescribed and may concern 20% of patients. This practice evolution is beneficial for patients and the public health system.

What are the characteristics of asthma patients with elevated serum IgG4 levels?

INTRODUCTION: IgG4 has recently been a subject of great interest in human pathology. No data are available about the characteristics of asthma patients with elevated IgG4 levels. POPULATION AND METHODS: An observational study was conducted from January 2006 to March 2015 in a difficult-to-treat population of asthma patients. Twenty-six difficult-to-treat asthma patients with elevated serum IgG4 levels (IgG4/IgG ratio up to 10%) were compared with a control population of 98 difficult-to-treat asthma patients with normal serum IgG4. Blood eosinophilia, total IgE and FeNO were compared between groups to better characterize asthma patients with elevated serum IgG4 levels. RESULTS: Median IgG4 concentrations were 1.72 g/l [1.19-2.36] and 0.22 g/l [0.10-0.49] in the elevated IgG4 group and normal Ig4 group, respectively. Median blood eosinophilia was more than three times higher in patients with elevated serum IgG4 levels than in controls (0.75 10(9)/L [IQR 0.54-1.78] vs 0.22 10(9)/L [IQR 0.09-0.54] respectively, p < 0.0001). Total IgE was twice as high (264.5 kUI/l [IQR 166.3-779] vs 126 kUI/l [IQR 26-350] respectively; p < 0.05) and FeNO was nearly twice as high (61 [IQR 41-111] ppb vs 35 [IQR 23-51] ppb, p < 0.001). Allergic broncho-pulmonary aspergillosis (ABPA) and eosinophilic granulomatosis with polyangiitis (EGPA) were observed in the asthma patients with elevated serum IgG4. Ten patients had unexplained increased blood eosinophilia. CONCLUSION: Asthma patients with elevated IgG4 levels have significantly higher blood eosinophilia, total IgE and FeNO. ABPA and EGPA are observed in patients with elevated serum IgG4.

[Thermoplastic mask in radiotherapy: a source of anxiety for the patient?]. / Le masque de contention en radiothérapie : une source d'anxiété pour le patient ?

PURPOSE: The thermoplastic mask often used to immobilize patients in radiotherapy can cause varying levels of stress and anxiety. This study aimed at evaluating the anxiety related to the use of radiotherapy masks and the coping strategies adopted by patients. PATIENTS AND METHODS: Nineteen patients treated with radiotherapy mask for head and neck cancer, a brain tumour or a lymphoma, were met twice by a psychologist, either after the making of the mask and the first course of radiotherapy, or in the middle and at the end of treatment. Thirty-four semi-structured interviews were treated using a thematic content analysis and 13 patients answered to anxiety (STAI-YB) and coping (WCC) scales. RESULTS: The STAI-YB anxiety scores related to wearing the masks were low during the radiotherapy treatment period, and were confirmed by the remarks of patients recorded during the semi-structured interviews. Most patients had a positive perception of the mask, and considered it as a friend or protection. Twelve out of the 13 patients admitting to anxiety benefited from problem focused coping strategies. CONCLUSIONS: Thermoplastic mask-related anxiety is low and possibly lies in the positive representation patients have about the mask. The explanations provided by health professionals on the radiotherapy mask possibly have a very positive effect on this perception.

Trends in nursing research in France: a cross-sectional analysis.

AIM: To examine the engagement of French registered nurses with the Ministry of Health's initiative to spur scientific inquiry in the community. BACKGROUND: French nursing research has suffered from a lack of dedicated funding. Positive signs of change have recently appeared, with the launch of the first national public funding programme dedicated to nursing research. This initiative, begun in 2010, was launched by the French Ministry of Health. Through this initiative, 149 registered nurses, serving as principal investigators, and their teams submitted research proposals between 2010 and 2011. The administrative guidelines of the funding programme are clearly oriented towards producing quantitative and exogenous nursing research. METHOD: A cross-sectional analysis of 149 nursing research projects submitted during the first and second years of a French national funding programme for hospital-based nursing research was conducted. Research proposals were included in the analysis whether they received funding or not. Data collection took place in 2011. The categories used in the analysis were the following: (1) the socio-demographic data on the registered nurse principal investigators, (2) the research teams and (3) the research proposals (methodologies, bibliography, focus of the research, output, the status of the research proposals). RESULTS: This study highlights the presence of methodological homogeneity among the research proposals submitted for funding. Clear tendencies were towards interventional and quantitative studies and those with an exogenous factor research objective. Between 2010 and 2011, 25 projects were funded out of 149 submitted. They were mostly quantitative and/or focused on the exogenous factors in patient care. CONCLUSION: The socio-political context of a funding programme designed to encourage nursing research has had an implicit influence on the type of research to which French nurses have committed themselves to and the scientific positions with which these nurse researchers align themselves.

Recurrent malignant acrospiroma. Treatment by chest wall excision.

Malignant acrospiroma is an uncommon tumor of the eccrine sweat gland. In contrast to its relatively more common benign counterpart, malignant acrospiroma is highly invasive, often with significant lymphatic and distant metastasis. The establishment of this diagnosis is difficult on both clinical and histopathologic grounds. After diagnosis, wide surgical excision is warranted to completely extirpate these lesions. We report the case of a 66-year-old female with a recurrent malignant acrospiroma. This patient's tumor was removed by wide radical resection, including chest wall excision, followed by reconstructive surgery and radiotherapy. After 16 months there is no evidence of local recurrence or distant metastasis.

Free flap breast reconstruction: the LSU experience (1984-1996).

From 1984 through 1996 the section of Plastic and Reconstructive Surgery at Louisiana State Medical Center has performed over 330 breast reconstructive procedures with free flaps. Seven types of reconstructive procedures have been used during this time span, each with its specific salient positive and negative points. The breast reconstruction techniques included the use of (1) Superior Gluteal Myocutaneous Free Flap, (2) Superficial Inferior Epigastric Artery Flap, (3) Transverse Rectus Abdominis Myocutaneous Free Flap, (4) Deep Inferior Epigastric Perforator Flap, (5) Superior Gluteal Artery Perforator Flap, (6) Inferior Gluteal Artery Perforator Flap, and (7) Lateral Thigh Perforator Flap. The experience with these different methods of breast reconstruction has led us to believe that the ideal material for breast reconstruction is skin and fat, rather than muscle or prosthetic devices. At our institution we have evolved from the myocutaneous flap to the use of perforator flaps for breast reconstruction: the donor site morbidity is less, the 99% success rate is superior, and it allows more options with the perforator free flaps than ever realized with the myocutaneous free flap technique. We feel that, in the future, these perforator techniques will become the standard for autogenous breast reconstruction.

The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases.

The most common recipient site for free-flap breast reconstruction is the subscapular system. Because of a number of problems we encountered using this recipient site, we became interested in revisiting the internal mammary vessels. This paper reports the use of the internal mammary artery and vein as a recipient site in 110 consecutive cases of breast reconstruction in 87 patients. We also report the technical details of recipient-vessel dissection and vessel size in our series. Complications encountered in the series are discussed, and the advantages of using the internal mammary vessels are enumerated. Our experience of a 99 percent successful flap transfer rate supports the reliability of these recipient vessels in breast reconstructions.