[Informed consent in radiotherapy care]. / Consentement aux soins en radiothérapie.

Obtaining consent to care requires the radiation oncologist to provide loyal information and to ensure that the patient understands it. Proof of such an approach rests with the practitioner. The French Society for Radiation Oncology (SFRO) does not recommend the signature of a consent form by the patient but recommends that the radiation oncologist be able to provide all the elements demonstrating the reality of a complete information circuit.

Choosing a career in oncology: results of a nationwide cross-sectional study.

BACKGROUND: Little information is currently available concerning young medical students desire to pursue a career in oncology, or their career expectations. METHODS: This project is a cross-sectional epidemiological study. A voluntary and anonymous questionnaire was distributed to all young oncologists studying in France between the 2nd of October 2013 and the 23rd of February 2014. RESULTS: The overall response rate was 75.6%. A total of 505 young oncologists completed the questionnaire. The main determining factors in the decision to practice oncology were the cross-sectional nature of the field (70.8%), the depth and variety of human relations (56.3%) and the multi-disciplinary field of work (50.2%). Most residents would like to complete a rotation outside of their assigned region (59.2%) or abroad (70.2%) in order to acquire additional expertise (67.7%). In addition, most interns would like to undertake a fellowship involving care, teaching and research in order to hone their skills (85.7%) and forge a career in public hospitals (46.4%). Career prospects mainly involve salaried positions in public hospitals. Many young oncologists are concerned about their professional future, due to the shortage of openings (40.8%), the workload (52.8%) and the lack of work-life balance (33.4%). CONCLUSIONS: This investigation provides a comprehensive profile of the reasons young oncologists chose to pursue a career in oncology, and their career prospects.

Emotional intelligence and coping strategies as determinants of quality of life in depressed patient-caregiver dyads: An actor-partner interdependence analysis.

OBJECTIVE: Patients with major depressive disorder (MDD) and their natural caregivers experience major lifestyle difficulties. Little is known concerning dyadic (i.e., patient and natural caregiver) characteristics' impact on quality of life. In a sample of depressed patient-caregiver dyads, we examined quality of life (QoL) levels compared with the general population and whether QoL is influenced by emotional intelligence (EI) and coping strategies using the actor-partner interdependence model (APIM). METHODS: This cross-sectional study involved 79 patient-caregiver dyads. The self-reported data, completed by patients and their primary caregivers, included QoL (SF-36), EI (TEIQue-SF) and coping strategies (BriefCope). The QoL of patients and caregivers was compared with 158 French age-sex-matched healthy controls. The dyadic interactions were analyzed using structural equation modeling. RESULTS: Patients and their caregivers experienced lower QoL levels than French age-sex-matched controls. The EI findings showed actor (degree to which the person's EI was associated with his/her own QoL) and partner (degree to which the person's EI was associated with QoL of the other member of the dyad) effects for patients and caregivers. The coping strategies (i.e., problem solving, positive thinking, avoidance and social support) revealed only actor effects. CONCLUSION: QoL is seriously impaired in depressed patients and their primary caregivers and is associated with EI and coping strategies. Targeted interventions focusing on EI and coping strategies could be offered to improve QoL in dyads.

[The irradiation process]. / Processus du traitement par irradiation.

The purpose of this article is to describe the regulatory framework of the radiotherapy practice in France, the external irradiation and brachytherapy process and the guidelines for patient follow-up.

Coping with a newly diagnosed high-grade glioma: patient-caregiver dyad effects on quality of life.

Patients with high-grade gliomas (HGG) and their caregivers have to confront a very aggressive disease that produces major lifestyle disruptions. There is an interest in studying the ability of patients and their caregivers to cope with the difficulties that affect quality of life (QoL). We examine, in a sample of patient-caregiver dyads in the specific context of newly diagnosed cases of HGG, whether the QoL of patients and caregivers is influenced by the coping processes they and their relatives use from a specific actor-partner interdependence model (APIM). This cross-sectional study involved 42 dyads with patients having recent diagnoses of HGG and assessed in the time-frame between diagnosis and treatment initiation. The self-reported data included QoL (Patient-Generated Index, EORTC QLQ-C30, and CareGiver Oncology QoL), emotional status, and coping strategies (BriefCope). The APIM was used to test the dyadic effects of coping strategies on QoL. Coping strategies, such as social support, avoidance, and problem solving, exhibited evidence of either an actor effect (degree to which the individual's coping strategies are associated with their own QoL) or partner effect (degree to which the individual's coping strategies are associated with the QoL of the other member of the dyad) for patients or caregivers. For positive-thinking coping strategies, actor and partner effect were not observed. This study emphasizes that the QoL for patients and their caregivers was directly related to the coping strategies they used. This finding suggests that targeted interventions should be offered to help patients and their relatives to implement more effective coping strategies.

[Brachytherapy training: a survey of French radiation oncology residents]. / État des lieux de la formation des internes français d'oncologie radiothérapie en curiethérapie.

PURPOSE: The goal of this study was to evaluate the interest of the members of the French society of young radiation oncologists (SFjRO) for brachytherapy as well as their theoretical and practical level in this radiation technique. MATERIALS AND METHODS: An anonymous survey was conducted regarding practical and theoretical teaching of brachytherapy before the French national courses on brachytherapy. RESULTS: Among the 106 residents attending this teaching course, 99 (93%) answered the survey. Most of them were interested in brachytherapy but 82% considered they had not received sufficient teaching. Relevant indications of brachytherapy were known by 76% of the residents for gynaecological malignancies and 70% for prostate. Seventy-one percent of the residents have seen at least one gynecological brachytherapy but only 12% knew how to deal with this technique. Fifty-six percent have seen vaginal high dose rate brachytherapy and 21% had acquired the technique. For prostate brachytherapy, 65% had seen and done an implant and only 4% had acquired the technique. Fifty percent have performed at least one brachytherapy treatment during their residency. Residents expressed a strong wish for more courses about dosimetry (82%), technique (75%) and treatment planning (90%). CONCLUSION: Our study shows the interest of French residents for brachytherapy but suggests that practical teaching courses and an evaluation of the existing theoretical courses are warranted.

Delegation of medical tasks in French radiation oncology departments: current situation and impact on residents' training.

OBJECTIVES: A national survey was conducted among the radiation oncology residents about their clinical activities and responsibilities. The aim was to evaluate the clinical workload and to assess how medical tasks are delegated and supervised. MATERIALS AND METHODS: A first questionnaire was administered to radiation oncology residents during a national course. A second questionnaire was mailed to 59 heads of departments. RESULTS: The response rate was 62% for radiation oncology residents (99 questionnaires) and 51% for heads of department (30). Eighteen heads of department (64%) declared having written specifications describing the residents' clinical tasks and roles, while only 31 radiation oncology residents (34%) knew about such a document (P=0.009). A majority of residents were satisfied with the amount of medical tasks that were delegated to them. Older residents complained about insufficient exposure to new patient's consultation, treatment planning and portal images validation. The variations observed between departments may induce heterogeneous trainings and should be addressed specifically. CONCLUSION: National specifications are necessary to reduce heterogeneities in training, and to insure that the residents' training covers all the professional skills required to practice radiation oncology. A frame endorsed by academic and professional societies would also clarify the responsibilities of both residents and seniors.

[Anti-Hu antibody syndrome: diagnostic and therapeutic difficulties]. / Syndrome des anticorps anti-Hu: difficultés diagnostiques et thérapeutiques.

INTRODUCTION: Anti-Hu antibody syndrome is a paraneoplastic syndrome usually associated with small cell lung carcinoma which induces various symptoms, particularly neurological ones. CASE REPORT: We describe the case of a 49-year old woman with a small cell lung carcinoma who initially experiences a spontaneous regression but then developed neurological symptoms associated with severe autonomic dysfunction manifesting as chronic intestinal pseudo-obstruction and leading finally to hemodynamic failure. CONCLUSION: Anti-Hu antibody syndrome remains a rare entity. Its diagnosis must be considered in the face of neurologic symptoms associated with small cell lung cancer.

[The impact of radiation therapy on sexual function]. / Impact de la radiothérapie sur la vie sexuelle.

The aim of this study was to evaluate the impact of radiation therapy on sexual life. The analysis was based on a Pubmed literature review. The keywords used for this research were "sexual, radiation, oncology, and cancer". After a brief reminder on the anatomy and physiology, we explained the main complications of radiation oncology and their impact on sexual life. Preventive measures and therapeutic possibilities were discussed. Radiation therapy entails local, systematic and psychological after-effects. For women, vaginal stenosis and dyspareunia represent the most frequent side effects. For men, radiation therapy leads to erectile disorders for 25 to 75% of the patients. These complications have an echo often mattering on the patient quality of life of and on their sexual life post-treatment reconstruction. The knowledge of the indications and the various techniques of irradiation allow reducing its potential sexual morbidity. The information and the education of patients are essential, although often neglected. In conclusion, radiation therapy impacts in variable degrees on the sexual life of the patients. Currently, there are not enough preventive and therapeutic means. Patient information and the early screening of the sexual complications are at stake in the support of patients in the reconstruction of their sexual life.

Genetic differentiation of wild and cultivated populations: diversity of Coffea canephora Pierre in Uganda.

Coffea canephora Pierre ex Frohener is a perennial plant originated from Africa. Two main groups, Guinean and Congolese, have already been identified within this species. They correspond to main refugia in western and central Africa. In this paper we present the analysis of a region that has not yet been studied, Uganda. Two wild, one feral (once cultivated but abandoned for many years), and two cultivated populations of C. canephora from Uganda were evaluated using 24 microsatellite markers. Basic diversity, dissimilarity and genetic distances between individuals, genetic differentiation between populations, and structure within populations were analysed. Expected heterozygosity was high for wild compartments (0.48 to 0.54) and for cultivated and feral ones (0.57 to 0.59), with the number of private alleles ranging from 12 for cultivated genotypes to 37 for a wild compartment. The Ugandan samples show significant population structuring. We compared the Ugandan populations with a representative sample of known genetic diversity groups within the species using 18 markers. Coffea canephora of Ugandan origin was found to be genetically different from previously identified diversity groups, implying that it forms another diversity group within the species. Given its large distribution and extremely recent domestication, C. canephora can be used to understand the effect of refugia colonization on genetic diversity.

Perching behaviour and perch height preference of laying hens in furnished cages varying in height.

1. The objective was to investigate the effect of cage height on perch height preference and perching behaviour in laying hens. Twelve groups of two hens and 12 groups of 14 hens were tested in furnished cages equipped with two wooden perches. These stepwise perches were designed such that hens could choose between 7 different heights (6, 11, 16, 21, 26, 31 and 36 cm). Day- and night-time perching behaviour was observed on 4 consecutive days with a different cage height each day: 150, 55, 50 and 45 cm. 2. Given that a minimum perch-roof distance of 19 to 24 cm was available, hens preferred to roost on the highest perches at night. 3. Lowering cage height not only forced hens to use lower perches, but also reduced time spent on the perches during the day (two-hen and 14-hen test) and night (14-hen test). Moreover, it affected daytime behavioural activities (more standing and less preening) on the perches in the two-hen tests (but not in the 14-hen tests). 4. During the day lower perches were used more for standing and walking, higher perches more for sitting and sleeping. This behavioural differentiation was most pronounced in the highest cages. 5. Perch preference and perching behaviour depend on both the floor-perch distance and the perch-roof distance. Higher cages provide more opportunity for higher perches (which hens prefer), for better three-dimensional spacing (and consequently reduced density at floor level) and for behavioural differentiation according to perch height.

Validation of scalp coverage scoring methods for scalp hair loss in male pattern hair loss (androgenetic alopecia).

BACKGROUND: Global evaluation of hair loss in male subjects affected by androgenetic alopecia has been proposed as a means for monitoring changes over time, including placebo-controlled drug efficacy studies. Because of the potential impact of subjectivity (e.g. placebo effect) of clinical investigators, global photographs (GPs) have been introduced as a more objective record. Examination of paired before and after pictures and rating on a seven-point scale (from greatly decreased -3 to greatly increased +3) have been historically introduced by United States of America (US) experts. METHODS: Based on published GPs and original GPs obtained at our clinical research facility, we developed a training set in order to allow European Union (EU) observers to practice and compare with ratings by the US experts. RESULTS: After training with the seven-point scale, there was a positive correlation between three US and three EU ratings (n=52 paired images from 35 different subjects, r=0.795). The results of a test-retest evaluation was performed on 18 paired images from the initial image collection by the three EU experts. Correlation r=0.806 and identical scores in 78% of cases documents a reproducibility similar to the single one US expert published data (119 subjects, retest correlation 0.76 with 75% identical duplicate ratings). Seventeen subjects taken from a placebo-controlled trial had GPs at 6 and 12 months. The average difference between an efficacious drug treatment and the placebo were almost similar in the US (0.833) as in the EU (0.689) expert panels. We also trained the EU experts in performing the scalp coverage scoring (SCS), a novel system for the global evaluation of scalp hair in vivo and on GP. SCS was performed on single images (randomised as to time and treatment) taken from the same set of 17 paired GPs. This showed a between-group difference of 0.055 at 6 months and 0.201 at 12 months, i.e. 5% improved coverage in favour of the active group. CONCLUSION: After completion of our study, US and trained - calibrated EU experts seem equally valuable in comparing before-after GPs. SCS can also be used on GPs and may support the clinical investigator during inclusion of test subjects and for real-time efficacy evaluation during the trial.

Construction and characterization of a Coffea canephora BAC library to study the organization of sucrose biosynthesis genes.

The first bacterial artificial chromosome (BAC) library of Robusta coffee (Coffea canephora) was constructed, with the aim of developing molecular resources to study the genome structure and evolution of this perennial crop. Clone 126, which is highly productive and confers good technological and organoleptic qualities of beverage, was chosen for development of this library. The BAC library contains 55,296 clones, with an average insert size of 135 Kb per plasmid, therefore representing theoretically nine haploid genome equivalents of C. canephora. Its validation was achieved with a set of 13 genetically anchored single-copy and 4 duplicated RFLP probes and yielded on average 9 BAC clones per probe. Screening of this BAC library was also carried out with partial cDNA probes coding for enzymes of sugar metabolism like invertases and sucrose synthase, with the aim of characterizing the organization and promoter structure of this important class of genes. It was shown that genes for both cell wall and vacuolar forms of invertases were probably unique in the Robusta genome whereas sucrose synthase was encoded by at least two genes. One of them (CcSUS1) was cloned and sequenced, showing that our BAC library is a valuable tool to rapidly identify genes of agronomic interest or linked to cup quality in C. canephora.

Design of laying nests in furnished cages: influence of nesting material, nest box position and seclusion.

(1) Preferences for three nesting materials and nest box positions were investigated simultaneously in two trials using a furnished cage: one with 18 individual laying hens and one with 18 groups of 5 hens. Following a habituation period in pre-test cages, every hen or group of hens was tested for 2 d: once without and once with plastic flaps at the entrance of the nest boxes. (2) Hens preferred peat and artificial turf to coated wire mesh for egg laying. (3) One nest box position was clearly preferred to both other nest boxes. The hens' choice of nest box position was influenced by the pre-test cage in which they had been habituated. (4) The presence of plastic flaps at the entrance of the nest boxes had no influence on the proportion of eggs laid on the different nesting materials or on the proportion of floor eggs. (5) Individual and group testing resulted in the same overall results despite the presence of a distinct group effect.

Dermal objective pharmacodynamic profile of cetirizine and epinastine: two controlled, randomised, double-blind, crossover studies.

Two double-blind clinical pharmacology studies were performed in healthy volunteers to compare the dermal pharmacodynamic profile of epinastine with cetirizine, a well-documented anti-H1 antagonist, after oral administration at the usual recommended dosage, i.e. 10 mg cetirizine and 20 mg epinastine (versus placebo). Histamine skin challenges (prick test) were evaluated before and at 1, 2, 4, 8 and 24 hr after drug intake by measuring the wheal and flare area (studies 1 and 2) along with laser Doppler monitoring of the microvascular responses (study 2). A decrease in wheal and flare areas was observed following intake of both drugs compared with placebo controls. With the notable exception of 1 hr post dose wheal values, which were consistently smaller after epinastine, cetirizine was superior to epinastine for both wheal and flare at all other times. At the prick test site, treatment with epinastine and cetirizine accentuated the increase in blood flow induced by histamine. This reflects the decrease of the whealing but there was no significant difference between the two active test compounds. At 1 cm from the prick test site, the administration of both active treatments inhibited the increase of blood flow, and cetirizine showed a more potent inhibitory effect from 8 hr post dose. This reflects the reduction of the flare induced after histamine-receptor activation of the axon reflex. In conclusion, epinastine shows a rapidly greater (within 1 hr post dose on the wheal only) but vanishing effect than cetirizine. At all other time points, cetirizine was generally more effective than epinastine.

Gustatory sensilla sensitive to protein kairomones trigger host acceptance by an endoparasitoid.

Proteins isolated from the host cocoon of Acrolepiopsis assectella (Lepidoptera: Yponomeutoidea) act as kairomones for host acceptance by the endoparasitoid wasp Diadromus pulchellus Wesmael (Hymenoptera: Ichneumonidae). In this study, morphological, ultrastructural and electrophysiological studies were carried out in order to identify the contact chemoreceptive sensilla on the parasitoid antennae that perceive the protein kairomones. Three types of sensillum on the antennae of the females were found to have a chemosensory function. The receptor cell(s) of one sensillar type were shown to give a positive electrophysiological response to protein kairomones. This sensillar type is apically multiporous and female specific. Consequently, this sensillum could be the one implicated in the perception of the protein kairomone that triggers the host-acceptance behaviour of D. pulchellus females.

Genetically modified coffee plants expressing the Bacillus thuringiensis cry1Ac gene for resistance to leaf miner.

A synthetic version of the cry1Ac gene of Bacillus thuringiensis has been used for the transformation of coffee species (Coffea canephora and C. arabica) to confer resistance to an important pest, the coffee leaf miner (Perileucoptera coffeella and other Leucoptera spp). Somatic embryos were co-cultivated with the LBA4404 strain of Agrobacterium tumefaciens containing the cry1Ac gene. More than 100 transformed plants from independent transformation events were obtained for each coffee genotype. The integration and expression of the cry1Ac gene was studied, and effective resistance of transgenic plants against leaf miner was verified in bioassays with the insects. These plants could represent a good opportunity to analyse the impact of genetic engineering of perennial crops for sustainable resistance to an obligate endocarpic pest using a B. thuringiensis insecticidal protein.

Comparison of the effects of cetirizine and ebastine on the skin response to histamine iontophoresis monitored with laser Doppler flowmetry.

BACKGROUND: The administration of histamine with iontophoresis is an alternative method to skin prick tests or intradermal injections. Skin reactions obtained with this method can be recorded with laser Doppler flowmetry (LDF) and previous studies with this method have shown histamine-induced laser Doppler changes in the wheal area. OBJECTIVE: In order to compare the influence of two H1 receptor antagonists (cetirizine 10 mg vs. ebastine 10 mg) on the skin vascular responses to histamine introduced by iontophoresis, we designed a double-blind, randomized, two-period crossover trial in which 18 volunteers were randomized. METHODS: Before and 2, 5 and 7 h after drug administration, iontophoresis (30 s, 1.4 mA/cm2) of histamine 10% was performed and followed by (1) monitoring of skin vascular responses with LDF at the administration site and at 1 cm from it, and (2) wheal and flare area measurements. RESULTS: 2, 5 and 7 h after intake of the antihistaminic drug, there were significant differences between both drugs. Concerning LDF recordings, we noted at the histamine administration site an increase in perfusion unit (PU) values which is an effect known to be in proportion to the degree of inhibition of wheal reaction, and at 1 cm distal to the histamine administration site, there was a decrease in PU values. These changes were more marked under cetirizine. A greater suppressive effect of cetirizine on the wheal and flare reaction was consistently observed at all time points during the study, demonstrating its superior efficacy. CONCLUSION: We conclude that (1) cetirizine demonstrated a stronger antihistaminic effect compared to ebastine at all time points; (2) iontophoresis appears to be an appropriate method to study specific microvascular changes at the delivery site of histamine and hence to detect the earliest changes occurring at the site of agonist-antagonist competition in the skin.