The impact of online yoga on sleep and quality of life in women with breast cancer: a randomized trial.

INTRODUCTION: There is growing evidence of the benefit of physical activity and mindfulness in breast cancer patients (HC et al. in BMC Complement Altern Med, 2017). Yoga offers a combination of both. The aim of this study was to establish an online yoga program for breast cancer patients and survivors. As the project was launched during the (COVID) pandemic restrictions, we intended to prove effective online yoga as a way to access supportive therapy independently of sanitary issues and geographic locations in rural regions. METHODS: The two main outcomes were quality of life and sleep quality, and both were evaluated by standardized questionnaires (EORTC-QLQ 30 BR 23 and PSQI). Participants (n = 173) had breast cancer or a history of breast cancer and were randomized to either 6 weeks online yoga, twice a week for 45 min or a waiting control group. RESULTS: Our results show improved sleep quality in the PSQI score and improved subitems (dyspnea and physical activity) in the EORTC quality of life score. DISCUSSION: Online yoga seems to be a valid option in supportive therapy for breast cancer patients, as it improves physical fitness, dyspnea and overall sleep quality. It is also safe and cost effective as a remote intervention. TRIAL REGISTRATION: Trial registration number and date of registration for prospectively registered trials: DRKS00029548, 07.07.2022.WHO International clinical trials registry platform number: DRKS00029548. The registration number of the ethical committee CAU in Kiel: D 589/20.

Observation of Light Thermalization to Negative-Temperature Rayleigh-Jeans Equilibrium States in Multimode Optical Fibers.

Although the temperature of a thermodynamic system is usually believed to be a positive quantity, under particular conditions, negative-temperature equilibrium states are also possible. Negative-temperature equilibriums have been observed with spin systems, cold atoms in optical lattices, and two-dimensional quantum superfluids. Here we report the observation of Rayleigh-Jeans thermalization of light waves to negative-temperature equilibrium states. The optical wave relaxes to the equilibrium state through its propagation in a multimode optical fiber-i.e., in a conservative Hamiltonian system. The bounded energy spectrum of the optical fiber enables negative-temperature equilibriums with high energy levels (high-order fiber modes) more populated than low energy levels (low-order modes). Our experiments show that negative-temperature speckle beams are featured, in average, by a nonmonotonic radial intensity profile. The experimental results are in quantitative agreement with the Rayleigh-Jeans theory without free parameters. Bringing negative temperatures to the field of optics opens the door to the investigation of fundamental issues of negative-temperature states in a flexible experimental environment.

Adaptation of a quantitative trait to a changing environment: New analytical insights on the asexual and infinitesimal sexual models.

Predicting the adaptation of populations to a changing environment is crucial to assess the impact of human activities on biodiversity. Many theoretical studies have tackled this issue by modeling the evolution of quantitative traits subject to stabilizing selection around an optimal phenotype, whose value is shifted continuously through time. In this context, the population fate results from the equilibrium distribution of the trait, relative to the moving optimum. Such a distribution may vary with the shape of selection, the system of reproduction, the number of loci, the mutation kernel or their interactions. Here, we develop a methodology that provides quantitative measures of population maladaptation and potential of survival directly from the entire profile of the phenotypic distribution, without any a priori on its shape. We investigate two different systems of reproduction (asexual and infinitesimal sexual models of inheritance), with various forms of selection. In particular, we recover that fitness functions such that selection weakens away from the optimum lead to evolutionary tipping points, with an abrupt collapse of the population when the speed of environmental change is too high. Our unified framework allows deciphering the mechanisms that lead to this phenomenon. More generally, it allows discussing similarities and discrepancies between the two systems of reproduction, which are ultimately explained by different constraints on the evolution of the phenotypic variance. We demonstrate that the mean fitness in the population crucially depends on the shape of the selection function in the infinitesimal sexual model, in contrast with the asexual model. In the asexual model, we also investigate the effect of the mutation kernel and we show that kernels with higher kurtosis tend to reduce maladaptation and improve fitness, especially in fast changing environments.

Classical Rayleigh-Jeans Condensation of Light Waves: Observation and Thermodynamic Characterization.

Theoretical studies on wave turbulence predict that a purely classical system of random waves can exhibit a process of condensation, which originates in the singularity of the Rayleigh-Jeans equilibrium distribution. We report the experimental observation of the transition to condensation of classical optical waves propagating in a multimode fiber, i.e., in a conservative Hamiltonian system without thermal heat bath. In contrast to conventional self-organization processes featured by the nonequilibrium formation of nonlinear coherent structures (solitons, vortices,…), here the self-organization originates in the equilibrium Rayleigh-Jeans statistics of classical waves. The experimental results show that the chemical potential reaches the lowest energy level at the transition to condensation, which leads to the macroscopic population of the fundamental mode of the optical fiber. The near-field and far-field measurements of the condensate fraction across the transition to condensation are in quantitative agreement with the Rayleigh-Jeans theory. The thermodynamics of classical wave condensation reveals that the heat capacity takes a constant value in the condensed state and tends to vanish above the transition in the normal state. Our experiments provide the first demonstration of a coherent phenomenon of self-organization that is exclusively driven by optical thermalization toward the Rayleigh-Jeans equilibrium.

Patient outcome according to the 2017 international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma.

BACKGROUND/OBJECTIVE: We evaluated the usefulness of the 2017 definition of borderline pancreatic ductal adenocarcinoma (BR-PDAC) in fit patients (performance status 0-1) based on anatomical (A) and biological dimensions (B). METHODS: From 2011 to 2018, 139 resected patients with BR-PDAC according to the 2017 definition were included: 18 patients underwent upfront pancreatectomy (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; BR-B group), and 121 received FOLFIRINOX (FX) induction chemotherapy and were divided into BR-A (CA 19-9 < 500 U/mL, no regional lymph node metastasis; n = 68) and BR-AB (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; n = 53) groups. RESULTS: The 3 groups were comparable according to patient characteristics (except for back pain (P < .01) and CA 19-9 (P < .01)), intraoperative data, and postoperative courses. BR-AB patients required more venous resections (P < .01). The 3 groups were comparable on pathologic findings, except that BR-B patients had more lymph node invasions (P = .02). Median overall survival (OS) of the 121 patients was 45 months. In multivariate analysis, venous resection (P = .039) and R1 resection (P = .012) were poorly linked with OS, whereas BR-A classification (P < .01) independently favored OS. Median survival times of BR-A, BR-AB, and BR-B groups were undetermined, 27 months, and 20 months (P < .001), respectively. CONCLUSIONS: The 2017 definition was relevant for sub-classifying patients with BR-PDAC. The anatomical dimension (BR-A) was a favorable prognostic factor, whereas the biological dimension (BR-AB and BR-B) poorly impacted survival.

Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?

PURPOSE: To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000-March 2011) and period #2 (April 2011-August 2019). RESULTS: All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P < .01), and liver DW-MRI was significantly most prescribed during period #2 (14% vs 75%, P < .01). According to the intraoperative findings, the overall NRR was 24.5%, and remained stable over the two periods (25% vs 24%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, para-aortic lymph nodes invasion rate (0.4% vs 4.6%; P < 0.001) significantly increased over the 2 periods. The mean size of the bigger extra pancreatic tumor significantly decrease (7.9 mm vs 6.4 mm (P < .01), respectively) when the resection was not done. In multivariate analysis, CA 19-9 < 500 U/mL (P < .01), and liver DW-MRI prescription (P < .01) favoured the resection. CONCLUSIONS: Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement.

SORL1 rare variants: a major risk factor for familial early-onset Alzheimer's disease.

The SORL1 protein plays a protective role against the secretion of the amyloid ß peptide, a key event in the pathogeny of Alzheimer's disease. We assessed the impact of SORL1 rare variants in early-onset Alzheimer's disease (EOAD) in a case-control setting. We conducted a whole exome analysis among 484 French EOAD patients and 498 ethnically matched controls. After collapsing rare variants (minor allele frequency ≤1%), we detected an enrichment of disruptive and predicted damaging missense SORL1 variants in cases (odds radio (OR)=5.03, 95% confidence interval (CI)=(2.02-14.99), P=7.49.10(-5)). This enrichment was even stronger when restricting the analysis to the 205 cases with a positive family history (OR=8.86, 95% CI=(3.35-27.31), P=3.82.10(-7)). We conclude that predicted damaging rare SORL1 variants are a strong risk factor for EOAD and that the association signal is mainly driven by cases with positive family history.

Decoupled polarization dynamics of incoherent waves and bimodal spectral incoherent solitons.

We consider the propagation of strongly incoherent waves in optical fibers in the framework of the vector nonlinear Schrödinger equation (VNLSE) accounting for the Raman effect. On the basis of the wave turbulence theory, we derive a kinetic equation that greatly simplifies the VNLSE and provides deep physical insight into incoherent wave dynamics. When applied to the study of polarization effects, the theory unexpectedly reveals that the linear polarization components of the incoherent wave evolve independently from each other, even in the presence of weak fiber birefringence. When applied to light propagation in bimodal fibers, the theory reveals that the incoherent modal components can be strongly coupled. After a complex transient, the modal components self-organize into a vector spectral incoherent soliton: The two solitons self-trap and propagate with a common velocity in frequency space.

Effect of nanosecond pulsed electric field on Escherichia coli in water: inactivation and impact on protein changes.

AIMS: This article shows the effect of nanosecond pulsed electric field (nsPEF) on Escherichia coli, which could imply a durable change in protein expressions and then impacted the phenotype of surviving bacteria that might lead to increase pathogenicity. METHODS AND RESULTS: The effects of nsPEF on E. coli viability and membrane permeabilization were investigated. One log10 reduction in bacterial counts was achieved at field strength of 10(7) V m(-1) with a train of 500 successive pulses of 60 × 10(-9) s. Incubation of germs after treatment with propidium iodide showed that membrane permeabilization was reversible. Possible protein changes of surviving bacteria were checked to assess potential phenotypical changes using two-dimensional electrophoresis. In our study, after 40 generations, only UniProt #P39187 was up-regulated with P ≤ 0·05 compared with the control and corresponded to the uncharacterized protein YtfJ. Antibiograms were used to check whether or not the pattern of cultivable bacteria after nsPEF deliveries changed. CONCLUSIONS: The results tend to show that nsPEFs are able to inactivate bacteria and have probably no serious impact in E. coli protein patterns. SIGNIFICANCE AND IMPACT OF THE STUDY: The use of nsPEF is a safe promising new nonthermal method for bacterial inactivation in the food processing and environmental industry.

Curative vs. preventive management of nitrogen transfers in rural areas: lessons from the case of the Orgeval watershed (Seine River basin, France).

The Orgeval watershed (104 km(2)) is a long-term experimental observatory and research site, representative of rural areas with intensive cereal farming of the temperate world. Since the past few years, we have been carrying out several studies on nitrate source, transformation and transfer of both surface and groundwaters in relation with land use and agriculture practices in order to assess nitrate (NO3(-)) leaching, contamination of aquifers, denitrification processes and associated nitrous oxide (N2O) emissions. A synthesis of these studies is presented to establish a quantitative diagnosis of nitrate contamination and N2O emissions at the watershed scale. Taking this watershed as a practical example, we compare curative management measures, such as pond introduction, and preventive measures, namely conversion to organic farming practices, using model simulations. It is concluded that only preventive measures are able to reduce the NO3(-) contamination level without further increasing N2O emissions, a result providing new insights for future management bringing together water-agro-ecosystems.

Assessing nitrate groundwater hotspots in Europe reveals an inadequate designation of Nitrate Vulnerable Zones.

Monitoring networks show that the European Union Nitrates Directive (ND) has had mixed success in reducing nitrate concentrations in groundwater. By combining machine learning and monitored nitrate concentrations (1992-2019), we estimate the total area of nitrate hotspots in Europe to be 401,000 km2, with 47% occurring outside of Nitrate Vulnerable Zones (NVZs). We also found contrasting increasing or decreasing trends, varying per country and time periods. We estimate that only 5% of the 122,000 km2 of hotspots in 2019 will meet nitrate quality standards by 2040 and that these may be offset by the appearance of new hotspots. Our results reveal that the effectiveness of the ND is limited by both time-lags between the implementation of good practices and pollution reduction and an inadequate designation of NVZs. Substantial improvements in the designation and regulation of NVZs are necessary, as well as in the quality of monitoring stations in terms of spatial density and information available concerning sampling depth, if the objectives of EU legislation to protect groundwater are to be achieved.

Cloning of the gene for spinocerebellar ataxia 2 reveals a locus with high sensitivity to expanded CAG/glutamine repeats.

Two forms of the neurodegenerative disorder spinocerebellar ataxia are known to be caused by the expansion of a CAG (polyglutamine) trinucleotide repeat. By screening cDNA expression libraries, using an antibody specific for polyglutamine repeats, we identified six novel genes containing CAG stretches. One of them is mutated in patients with spinocerebellar ataxia linked to chromosome 12q (SCA2). This gene shows ubiquitous expression and encodes a protein of unknown function. Normal SCA2 alleles (17 to 29 CAG repeats) contain one to three CAAs in the repeat. Mutated alleles (37 to 50 repeats) appear particularly unstable, upon both paternal and maternal transmissions. The sequence of three of them revealed pure CAG stretches. The steep inverse correlation between age of onset and CAG number suggests a higher sensitivity to polyglutamine length than in the other polyglutamine expansion diseases.

Agriculture specialization influence on nutrient use efficiency and fluxes in the St. Lawrence Basin over the 20th century.

Increasing the overall use efficiency of nitrogen (N) and phosphorus (P) resources in food production while minimizing losses to the environment are required to meet the dual challenge of food security and sustainability. Yet studies quantifying the overall performance of different agro-system types and how these have changed over time remain rare, although they are essential to propose solution pathways. Here, we reconstructed fluxes of N and P within 78 watersheds of the St. Lawrence Basin (SLB) of eastern Canada between 1901 and 2011, using the Generalized Representation of Agro-Food System model (GRAFS). This analysis allowed us to classify different agro-food system types and to evaluate how agricultural specialization influenced nutrient efficiencies and potential losses to the environment over time. Using a cluster analysis, we identified four agro-food system types with different overall outcomes in efficiencies and losses. We show that agricultural practices in the SLB were similar until the 1950's and deemed unsustainable in several watersheds by depleting agricultural soils of their nutrients (particularly N). With the advent of manufactured fertilizers and the intensification of livestock farming, the SLB then rapidly shifted through the 1970s and 1980s to more intensified and highly unsustainable agro-food system types, where, in 2011, ~77 % of N and ~ 94 % of P inputs were lost to the environment. We also show that nutrient pollution continued to increase despite gains in the nutrient use efficiency of animal farming due to higher nutrient throughput from intensive production. The increased proportion of confined animals, disconnected from croplands, indeed resulted in inefficient nutrient recycling. While nutrient use efficiency may mitigate nutrient pollution, reducing the absolute nutrient flux through agro-food systems should be a priority, likely through a reconnection of crop and animal farming and an overall reduction of meat production, specifically from concentrated, intensive livestock systems.

Temporal dynamics of incoherent waves in noninstantaneous response nonlinear Kerr media.

We consider the temporal evolution of an incoherent optical wave that propagates in a noninstantaneous response nonlinear medium, such as single mode optical fibers. In contrast with the expected Raman-like spectral redshift due to a delayed nonlinear response, we show that a highly noninstantaneous response leads to a genuine modulational instability of the incoherent optical wave. We derive a Vlasov-like kinetic equation that provides a detailed description of this process of incoherent modulational instability in the temporal domain.

Probabilistic multicompartmental model for interpreting DGT kinetics in sediments.

Extensive research has been performed on the use of the DIFS (DGT-Induced Fluxes in Soils and Sediments) model to interpret diffusive gradients in thin-film, or DGT, measurements in soils and sediments. The current report identifies some areas where the DIFS model has been shown to yield poor results and proposes a model to address weaknesses. In particular, two major flaws in the current approaches are considered: (i) many studies of accumulation kinetics in DGT exhibit multiple kinetic stages and (ii) several combinations of the two fitted DIFS parameters can yield identical results, leaving the question of how to select the 'best' combination. Previously, problem (i) has been addressed by separating the experimental data sets into distinct time segments. To overcome these problems, a model considering two types of particulate binding sites is proposed, instead of the DIFS model which assumed one single particulate pool. A probabilistic approach is proposed to fit experimental data and to determine the range of possible physical parameters using Probability Distribution Functions (PDFs), as opposed to single values without any indication of their uncertainty. The new probabilistic model, called DGT-PROFS, was tested on three different formulated sediments which mainly differ in the presence or absence of iron oxides. It was shown that a good fit can be obtained for the complete set of data (instead of DIFS-2D) and that a range of uncertainty values for each modeling parameter can be obtained. The interpretation of parameter PDFs allows one to distinguish between a variety of geochemical behaviors, providing useful information on metal dynamics in sediments.

Reconstructing historical trends of Berre lagoon contamination from surface sediment datasets: influences of industrial regulations and anthropogenic silt inputs.

These last decades, the Berre lagoon (in southeastern France) has been deeply affected since the 1930s by strong inputs of contaminants associated with industrial development and since 1966 by huge inputs of freshwater and silts due to the installation of a hydroelectric power plant. Surveys of the surface sediment contamination have been sparsely performed since 1964 for management and research purposes. These surveys were performed by various laboratories that investigated different chemicals and sampling areas using different analysis protocols. Therefore, the available data are disconnected in time and space and differ in quality. In order to reconstruct coherent time series of sediment contamination from this heterogeneous datasets and to discuss the influences of industrial and hydroelectric discharges we used a statistical approach. This approach is based on Principal Component Analysis (PCA) and Fuzzy clustering analysis on data from one extensive survey realized on surface sediments in 1976. The PCA allowed identifying two geochemical indexes describing the main surface sediment geochemical characteristics. The fuzzy clustering analysis on these indexes allowed identifying sub-areas under the specific influence of industrial or hydroelectric discharges. This allowed us to reconstruct, for each sub-area, a coherent and interpretable long-term time series of sediment contamination from the available database. Reconstructed temporal trends allowed us to estimate: (i) the overall decrease of sediment contamination since the mid-1970 attributed to industrial discharge regulations enacted at this period and (ii) the dilution of the concentrations of sediment bound contaminants induced by the hydroelectric power plant and its associated particulate matter inputs.

Biogeochemical functioning of an urbanized tropical estuary: Implementing the generic C-GEM (reactive transport) model.

Estuaries are amongst the most productive ecosystems of the land ocean continuum, but they are also under high anthropic pressures due to coastal urbanization. Too sparse observations have hindered the understanding of complex interactions between water quality and estuarine hydrodynamics and biogeochemical transformations. Until now, estuarine modelling studies have mainly focused on temperate estuarine systems in industrialized countries. This study investigates the responses of a tropical estuary to pollution load from a megacity (Ho Chi Minh City, Southern Vietnam) by applying a one-dimensional, biogeochemical estuarine model (C-GEM). The Saigon River Estuary flows through the megacity of Ho Chi Minh (HCMC) and is subject to episodic hypoxia events due to wastewater inputs from urban discharges. Good agreements are found between simulation outputs and observations for tidal propagation, salinity, total suspended sediment, and water quality variables in dry season in Saigon River Estuary. C-GEM reproduces the increases in ammonium, total organic carbon, phytoplankton and dissolved oxygen depletion in the urban section of the Saigon River as an impact of untreated wastewaters from HCMC. The steady-state version of C-GEM also reveals the formation of a pollutant cloud (30-km stretch) resulting from the combined effects of tidal fluctuation and low flushing capacity during the dry season. Furthermore, the quantification of the reaction fluxes simulated by the model demonstrates that nitrification is the main process removing NH4+ from the Saigon River. For the first time in such a type of environment, our study demonstrates the effectiveness of C-GEM at unraveling the complex interplay between biogeochemical reactions and transport in a tropical estuary with a minimized data requirement. This is significant for tropical estuaries in developing countries, where intensive monitoring programs are rare and have thus been rarely the object of modelling investigations.

Emerging strains of watermelon mosaic virus in Southeastern France: model-based estimation of the dates and places of introduction.

Where and when alien organisms are successfully introduced are central questions to elucidate biotic and abiotic conditions favorable to the introduction, establishment and spread of invasive species. We propose a modelling framework to analyze multiple introductions by several invasive genotypes or genetic variants, in competition with a resident population, when observations provide knowledge on the relative proportions of each variant at some dates and places. This framework is based on a mechanistic-statistical model coupling a reaction-diffusion model with a probabilistic observation model. We apply it to a spatio-temporal dataset reporting the relative proportions of five genetic variants of watermelon mosaic virus (WMV, genus Potyvirus, family Potyviridae) in infections of commercial cucurbit fields. Despite the parsimonious nature of the model, it succeeds in fitting the data well and provides an estimation of the dates and places of successful introduction of each emerging variant as well as a reconstruction of the dynamics of each variant since its introduction.

[Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) -- Text of the Guidelines (short text)]. / Accouchement normal : accompagnement de la physiologie et interventions médicales. Recommandations de la Haute Autorité de Santé (HAS) avec la collaboration du Collège National des Gynécologues Obstétriciens Français (CNGOF) et du Collège National des Sages-Femmes de France (CNSF) ­ Texte des recommandations (texte court).

OBJECTIVE: The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. METHODS: These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS: It is recommended to conduct a complete initial examination of the woman in labor at admission (consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30minutes but not more than 60minutes after delivery (consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2mg) of vitamin K (consensus agreement) be given systematically within two hours of birth. CONCLUSION: These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.

Gene expression profile and response to trastuzumab-docetaxel-based treatment in breast carcinoma.

BACKGROUND: Resistance to trastuzumab is often observed in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and has been shown to involve multiple potential mechanisms. We examined the ability of microarray analyses to determine the potential markers of pathological complete response (pCR). METHODS: We conducted an analysis of tumours from 38 patients with locally advanced HER2-positive breast cancer who had received trastuzumab combined with docetaxel. Quantitative reverse transcriptase (RT)-PCR was used to assess the expression of 30 key genes; microarray analyses were carried out on 25 tumours to identify a prognostic gene expression profile, with 13 blinded samples used to validate the identified profile. RESULTS: No gene was found to correlate with response by RT-PCR. The microarray analysis identified a gene expression profile of 28 genes, with 12 upregulated in the pCR group and 16 upregulated in non-pCR. The leave-one-out cross-validation test exhibited 72% accuracy, 86% specificity, and 55% sensitivity. The 28-gene expression profile classified the 13 validation samples with 92% accuracy, 89% specificity, and 100% sensitivity. CONCLUSION: Our results suggest that genes not involved in classical cancer pathways such as apoptosis or DNA repair could be involved in responses to a trastuzumab-docetaxel-based regimen. They also describe for the first time a gene expression signature that predicts trastuzumab response.