Rapid response system for critically ill patients with haematological malignancies: A pre- and post-intervention study.

BACKGROUND: This study aimed to determine whether implementing a rapid response system (RRS) is associated with improved short-term outcomes in critically ill patients with haematological malignancies. METHODS: Our monocentric pre- versus post-intervention study was conducted between January 2012 and April 2020. RRS was activated at early signs of haemodynamic or respiratory failure. The primary outcome was the reduction in Sequential Organ Failure Assessment (SOFA) score on Day 3 after intensive care unit (ICU) admission. Secondary outcomes included time to ICU admission and mortality. RESULTS: A total of 209 patients with a median age of 59 years were enrolled (108 in the pre-intervention period and 101 in the post-intervention period). 22% of them had received an allogeneic transplant. The post-intervention period was associated with a shorter time to ICU admission (195 vs. 390 min, p < .001), a more frequent favourable trend in SOFA score (57% vs. 42%, adjusted odds ratio, 2.02, 95% confidence interval, 1.09 to 3.76), no significant changes in ICU (22% vs. 26%, p = .48) and 1-year (62% vs. 58%, p = .62) mortality rates. CONCLUSION: Detection of early organ failure and activation of an RRS was associated with faster ICU admission and lower SOFA scores on Day 3 of admission in critically ill patients with haematological malignancies.

Gender-Affirming Mastectomy: Psychosocial and Surgical Outcomes in Transgender Adults.

BACKGROUND: Limited literature exists examining the effects of gender-affirming mastectomy on transmasculine and nonbinary patients that is prospective and uses validated survey instruments. STUDY DESIGN: The psychosocial functioning of transmasculine and nonbinary patients was compared between patients who underwent gender-affirming mastectomy and those who had not yet undergone surgery. Participants were enrolled in a single-site, combined study of surgical and psychosocial outcomes, including a cross-sectional cohort of preoperative and postoperative patients, as well as separate prospective cohort. Participants completed the BREAST-Q psychosocial and sexual well-being modules, the BODY-Q satisfaction with chest and nipples modules, the Body Image Quality of Life Inventory, the Transgender Congruence Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 scale before and after surgery. We also examined how patient demographic factors correlated with postoperative surgical and psychosocial outcomes. RESULTS: A total of 111 transmasculine and nonbinary patients 18 to 63 years of age (mean ± SD 26.5 ± 8) underwent mastectomy and were included in the study. All were included in the cross-sectional cohort, and 20 were enrolled in the prospective cohort. More than one-third (34.2%) of patients were nonbinary. After surgery, psychosocial and sexual well-being, satisfaction, body image-related quality of life, and gender congruence were increased (p < 0.001) in both cohorts, and depression (p < 0.009 cross-sectional), and anxiety (p < 0.001 cross-sectional) were decreased. The most common adverse event was hypertrophic scarring, which occurred in 41 (36.9%) participants. CONCLUSIONS: In this study of transmasculine and nonbinary adults, gender-affirming mastectomy was followed by substantial improvements in psychosocial functioning.

Rapid synthesis process and characterization for high purity sodium thioantimoniate nonahydrate.

For the first time, Na3SbS4·9H2O, also known as Schlippe's salt, has been synthesized through high-energy ball milling. This innovative synthesis way allows for obtaining high purity thioantimonate nonahydrate with around 90% yield in only approximately four hours. To validate the synthesis route described herein, the crystal structure has been refined, at room temperature, through high-resolution X-ray diffraction, pair distribution function analysis and energy dispersive spectrometry. Dehydration and rehydration of the compound have also been studied by thermogravimetric analysis and differential scanning calorimetry.

How arts engagement supported social connectedness during the first year of the COVID-19 pandemic in the United Kingdom: findings from the HEartS Survey.

OBJECTIVES: This study investigated how adults in the United Kingdom perceived their arts and cultural engagement to facilitate social connectedness over two phases in the first year of the COVID-19 pandemic. STUDY DESIGN: The study used the HEartS Survey, a newly designed online survey tool to capture arts engagement in the United Kingdom and its associations with social and mental well-being, over two phases in 2020: March to May (Phase 1) and October (Phase 2). METHODS: Qualitative data were provided at both phases by 581 respondents, who identified which arts and cultural activity they felt most connected them to others and how during the last month. RESULTS: Thematic analysis revealed that, at both phases, arts and cultural engagement was perceived to facilitate social connectedness through four pathways that were also identified prepandemic: social opportunities, sharing, feelings of commonality and belonging and collective understanding. The subthemes shed light on specific ways that respondents used the arts during the pandemic to connect with others, including using the arts: as a catalyst for conversations, to maintain, reinstate or strengthen relationships during social distancing and to facilitate social interactions (Theme 1); to bring people together through shared experiences and sharing of art (Theme 2); to elicit feelings of direct and indirect proximity to others, to connect people with common interests, to feel a sense of belonging to something and to feel part of a collective 'COVID-19 experience' or to feel collectively distracted from the pandemic (Theme 3); and to learn from and about other people and to relate to others (Theme 4). The activity most frequently cited as connecting was watching a film or drama, followed by listening to recorded music. CONCLUSIONS: Engagement in arts and cultural activities supported feelings of social connection among adults in the United Kingdom over two phases in the first year of the COVID-19 pandemic, highlighting the importance of access to the arts and culture to support social connectedness.

Monthly anomaly database of atmospheric and oceanic parameters in the tropical Atlantic ocean.

The Tropical Atlantic Ocean Database and Monthly Anomalies of River Discharge on Atlantic Ocean datasets encompass the monthly anomalies of a variety of physical, biogeochemical parameters from the tropical Atlantic Ocean and the monthly anomalies of river runoff in the Atlantic Ocean and its adjacent seas. The parameters used as the base for the computation of anomalies come from the TROPFLUX, GPCP, ASCAT, SODA, GODAS, DASK, SeaWiFS, OAFLUX, WAVEWATCH III, NOAA/ESRL 20th Century Reanalysis, GLOBAL_REANALYSIS_BIO_001_029, GLOBAL_REANALYSIS_BIO_001_033, OCEANCOLOUR_GLO_OPTICS_L4_REP_OBSERVATIONS_009_081, OSCAR, SMOS, MODIS-Aqua, CO2_Flux, and GRDC datasets. Several of the anomaly data are redundant, but come from different data sources making comparative studies possible. For ease of use, both datasets are provided in NetCDF format, CF convention. These datasets include 18 files in NetCDF format, which facilitates its handling due to the diversity of freeware tools that exist and are structured in two-, three- and four-dimensional grids. All these anomalies can be useful to oceanographers, meteorologists, ecologists and other researchers for studies of climate variation in the tropical Atlantic Ocean. These datasets are hosted at https://www.seanoe.org/data/00718/82962/ and https://data.mendeley.com/datasets/pn5b35vn6s/1.

Omasal flow of nonstructural carbohydrates and nitrogenous compounds in lactating dairy cows fed diets containing timothy cut in the afternoon or morning.

Shifting the cutting of grass from morning to afternoon has been shown to increase the concentration of nonstructural carbohydrates (NSC) in forages. We compared the effects of diets (66:34, forage:concentrate ratio) containing a mix (% of the diet dry matter) of baleages (46.5%) and silages (19.3%) harvested from timothy cut in the afternoon (p.m.-cut TIM diet) or morning (a.m.-cut TIM diet) on omasal flows of NSC and nitrogenous fractions, ruminal and total-tract digestibilities of nutrients, plasma concentration of AA, and milk yield and composition. Eight ruminally cannulated Holstein cows averaging (mean ± standard deviation) 31.4 ± 6.13 kg/d of milk, 136 ± 17.0 d in milk, and 611 ± 66.4 kg of body weight in the beginning of the experiment were used in a crossover design with 21-d periods (14 d for diet adaptation and 7 d for data and sample collection). Intake of total ethanol-soluble carbohydrates (TESC; +150 g/d), starch (+129 g/d), and total NSC (TESC plus starch = +278 g/d) was greater with feeding the p.m.- than the a.m.-cut TIM diet. Likewise, the apparent ruminal digestibilities of TESC (+149 g/d), starch (+167 g/d), and total NSC (+316 g/d) increased in the p.m.-cut TIM diet. Diets, however, had no effect on the omasal flows and apparent ruminal and total-tract digestibilities of dry matter and organic matter. Intake of N increased in cows fed the p.m.- versus the a.m.-cut TIM diet (562 and 528 g/d, respectively) despite no effect of diets on dry matter intake. Diets did not affect the omasal flows of total nonammonia N, total bacterial nonammonia N, nonammonia and nonbacterial N, and individual AA, and the efficiency of microbial protein synthesis in the rumen. Contrarily, supply of rumen-degradable protein increased (+9.2%) in cows fed the p.m.-cut TIM diet, with this response driven by the 6.4% increase in N intake. Plasma concentrations of essential and nonessential AA followed the omasal flow of AA and were not changed by diets. Feeding the p.m.- versus the a.m.-cut diet significantly increased yields of 4% fat-corrected milk and milk fat, and tended to increase energy-corrected milk, milk true protein, and milk lactose yields. Overall, feeding the p.m.-cut TIM diet to mid-lactation dairy cows did not improve microbial protein synthesis and omasal flow of AA, and these responses were in line with the lack of a treatment effect on dry matter intake.

A data-driven spike sorting feature map for resolving spike overlap in the feature space.

Objective.Spike sorting is the process of extracting neuronal action potentials, or spikes, from an extracellular brain recording, and assigning each spike to its putative source neuron. Spike sorting is usually treated as a clustering problem. However, this clustering process is known to be affected by overlapping spikes. Existing methods for resolving spike overlap typically require an expensive post-processing of the clustering results. In this paper, we propose the design of a domain-specific feature map, which enables the resolution of spike overlap directly in the feature space.Approach.The proposed domain-specific feature map is based on a neural network architecture that is trained to simultaneously perform spike sorting and spike overlap resolution. Overlapping spikes clusters can be identified in the feature space through a linear relation with the single-neuron clusters for which the neurons contribute to the overlapping spikes. To aid the feature map training, a data augmentation procedure is presented that is based on biophysical simulations.Main results.We demonstrate the potential of our method on independent and realistic test data. We show that our novel approach for resolving spike overlap generalizes to unseen and realistic test data. Furthermore, the sorting performance of our method is shown to be similar to the state-of-the-art, but our method does not assume the availability of spike templates for resolving spike overlap.Significance.Resolving spike overlap directly in the feature space, results in an overall simplified spike sorting pipeline compared to the state-of-the-art. For the state-of-the-art, the overlapping spike snippets exhibit a large spread in the feature space and do not appear as concentrated clusters. This can lead to biased spike template estimates which affect the sorting performance of the state-of-the-art. In our proposed approach, overlapping spikes form concentrated clusters and spike overlap resolution does not depend on the availability of spike templates.

Factors contributing to ice nucleation and sequential freezing of leaves in wheat.

MAIN CONCLUSION: Anatomical, metabolic and microbial factors were identified that contribute to sequential freezing in wheat leaves and likely contribute to supercooling in the youngest leaves and potentially meristematic regions. Infrared thermography (IR) has been used to observe wheat leaves freezing independently and in an age-related sequence with older leaves freezing first. To determine mechanisms that might explain this sequence of freezing several analytical approaches were used: (1) The size of xylem vessels, in proximity to where freezing initiated, was measured to see if capillary freezing point depression explained sequential freezing. The sequence of freezing in the four youngest leaves was correlated, with the largest vessels freezing first. (2) Carbohydrate and amino acids were analyzed to determine if solute concentrations as well as interactions with membranes explained the freezing sequence. Sucrose was highly correlated to the freezing sequence for all leaves suggesting a prominent role for this sugar as compared to other simple sugars and fructans. Among individual free amino acids proline and serine were correlated to the freezing sequence, with younger leaves having the highest concentrations. (3) Microflora within and on leaf surfaces were determined to measure potential freezing initiation. Levels of bacteria and fungi were correlated to the freezing sequence for all leaves, and species or genera associated with high ice nucleation activity were absent in younger leaves. Moisture content and transcript expression of ice binding proteins were also measured. As expected, our results show that no single mechanism explains the freezing sequence observed via infrared analyses. While these multiple mechanisms are operative at different levels according to the leaf age, they seem to converge when it comes to the protection of vital meristematic tissues. This provides potential phenotypic characters that could be used by breeders to develop more winter-hardy genotypes.

Etiology of Early-Onset Neonatal Sepsis and Antibiotic Resistance in Bukavu, Democratic Republic of the Congo.

BACKGROUND: The Democratic Republic of the Congo (DRC) has one of the highest neonatal death rates (between 14% and 28%) in the world. In the DRC, neonatal sepsis causes 15.6% of this mortality, but data on the bacterial etiology and associated drug susceptibility are lacking. METHODS: Hemocultures of 150 neonates with possible early-onset neonatal sepsis (pEOS) were obtained at the Hôpital Provincial Général de Référence de Bukavu (Bukavu, DRC). The newborns with pEOS received an empirical first-line antimicrobial treatment (ampicillin, cefotaxime, and gentamicin) based on the synopsis of international guidelines for the management of EOS that are in line with World Health Organization (WHO) recommendations. Isolates were identified using matrix-assisted laser desorption/ ionization time-of-flight mass spectrophotometry. Antibiotic resistance was assessed using the disk diffusion method. RESULTS: Fifty strains were obtained from 48 patients and identified. The 3 most prevalent species were Enterobacter cloacae complex (42%), Klebsiella pneumoniae (18%), and Serratia marcescens (12%). Enterobacter cloacae isolates were resistant to all first-line antibiotics. All K. pneumoniae and S. marcescens isolates were resistant to ampicillin, and the majority of the K. pneumoniae and half of the S. marcescens isolates were resistant to both cefotaxime and gentamicin. All E. cloacae complex strains, 89% of K. pneumoniae, and half of S. marcescens had an extended-spectrum ß-lactamase phenotype. CONCLUSIONS: The most prevalent pathogens causing EOS in Bukavu were E. cloacae complex, K. pneumoniae, and S. marcescens. Most of these isolates were resistant to the WHO-recommended antibiotics.

A new thermo-desorption laser-heating setup for studying noble gas diffusion and release from materials at high temperatures.

A new heating and gas treatment line for Thermo-Desorption Spectrometry (TDS) of noble gases (He, Ne, Ar, Kr, and Xe) is presented. It was built with the primary objective to offer advanced temperature controls and capabilities while working in a cold environment. By choosing a high-power continuous wave laser as the heating source and using a proportional-integral-derivative controller system, TDS of noble gases can now be performed with fast and highly steady heating ramps (e.g., less than 1 °C deviation from the set point for ≤1 °C s-1 ramps). Sample temperature over 2000 °C can also routinely be reached, with limited heating of the sample support and the sample chamber, offering the possibility to have several samples awaiting in the ultra-high vacuum chamber. We also present the development efforts made to increase temperature homogeneity of the heated sample while limiting the contact with the sample holder. Recent results acquired with this TDS setup on krypton thermal diffusion in uranium dioxide (UO2) as a function of O2 additions are also presented as an application example.

COMPLETE REMISSION OF MEDICALLY TREATED LUTEINIZED THECOMAS WITH SCLEROSING PERITONITIS.

We describe the first French patient treated for sclerosing peritonitis syndrome associated with lutheinized thecomas. At 42 years old, she had respiratory distress with increased abdominal volume. Physical examination revealed ascites, pleural effusions, and two mobile latero-uterine masses. Radiological examinations revealed bilateral ovarian masses of 10 cm. Bilateral adnexectomy was performed by laparotomy. Histological analysis concluded that there were benign luteinized thecomas. Until the 36th postoperative day, the general condition of the patient deteriorated to become critical. A second surgical procedure was attempted revealing sclerosing fibrosis preventing access to the peritoneal cavity. Subsequently, a medical treatment combining parenteral nutrition, high intravenous doses of corticosteroids, antiestrogens, colchicine and sandostatin was administered and effective allowing continuity recovery 15 months later. The clinical outcomes has been favorable at 24 month later.

Epothilones Improve Axonal Growth and Motor Outcomes after Stroke in the Adult Mammalian CNS.

Stroke leads to the degeneration of short-range and long-range axonal connections emanating from peri-infarct tissue, but it also induces novel axonal projections. However, this regeneration is hampered by growth-inhibitory properties of peri-infarct tissue and fibrotic scarring. Here, we tested the effects of epothilone B and epothilone D, FDA-approved microtubule-stabilizing drugs that are powerful modulators of axonal growth and scar formation, on neuroplasticity and motor outcomes in a photothrombotic mouse model of cortical stroke. We find that both drugs, when administered systemically 1 and 15 days after stroke, augment novel peri-infarct projections connecting the peri-infarct motor cortex with neighboring areas. Both drugs also increase the magnitude of long-range motor projections into the brainstem and reduce peri-infarct fibrotic scarring. Finally, epothilone treatment induces an improvement in skilled forelimb motor function. Thus, pharmacological microtubule stabilization represents a promising target for therapeutic intervention with a wide time window to ameliorate structural and functional sequelae after stroke.

Online monitoring of volatile organic compounds emitted from human bronchial epithelial cells as markers for oxidative stress.

Particulate air pollution is associated with adverse respiratory effects and is a major factor for premature deaths.In-vitroassays are commonly used for investigating the direct cytotoxicity and inflammatory impacts due to particulate matter (PM) exposure. However, biological tests are often labor-intensive, destructive and limited to endpoints measured offline at single time points, making it impossible to observe the progression of cell response upon exposure. Here we explored the potential of a high-resolution proton transfer reaction mass spectrometer (PTR-MS) to detect the volatile organic compounds (VOCs) emitted by human bronchial epithelial cells (BEAS-2B) upon exposure to PM. Cells were exposed to single components (1,4-naphthoquinone and Cu(II)) known to induce oxidative stress. We also tested filter extracts of aerosols generated in a smog chamber, including fresh and aged wood burning emissions, as well asα-pinene secondary organic aerosol (SOA). We found that 1,4-naphthoquinone was rapidly internalized by the cells. Exposing cells to each of these samples induced the emission of VOCs, which we tentatively assigned to acetonitrile, benzaldehyde and dimethylbenzaldehyde, respectively. Emission rates upon exposure to fresh and aged OA fromα-pinene oxidation and from biomass burning significantly exceeded those observed after exposure to similar doses of Cu(II), a proxy for transition metals with high oxidative potential. Emission rates of biomarkers from cell exposure toα-pinene SOA exhibited a statistically significant, but weak dose dependence. The emission rates of benzaldehyde scaled with cell death, estimated by measuring the apical release of cytosolic lactate dehydrogenase. Particle mass doses delivered to the BEAS-2B cells match those deposited in the human tracheobronchial tract after several hours of inhalation at elevated ambient air pollution. The results presented here show that our method has the potential to determine biomarkers of PM induced pulmonary damage in toxicological and epidemiological research on air pollution.

[Association of hypertension and antihypertensive agents and the severity of COVID-19 pneumonia. A monocentric French prospective study]. / Association entre l'hypertension artérielle, les traitements inhibiteurs du système rénine angiotensine et les formes graves de COVID-19. Étude prospective monocentrique française.

BACKGROUND AND AIM: Angiotensin converting enzyme (ACE) type 2 is the receptor of SARSCoV-2 for cell entry into lung cells. Because ACE-2 may be modulated by ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there are concern that patients treated with ACEIs and ARBs are at higher risk for COVID-19 infection or severity. This study sought to analyse the association of severe forms of COVID-19 and mortality with hypertension and a previous treatment with ACEI and ARB. METHODS: Prospective follow-up of 433 consecutive patients hospitalised for COVID-19 pneumonia confirmed by PCR or highly probable on clinical, biological, and radiological findings, and included in the COVHYP study. Mortality and severe COVID-19 (criteria: death, intensive care unit, or hospitalisation >30 days) were compared in patients receiving or not ACEIs and ARBs. Follow-up was 100% at hospital discharge, and 96.5% at >1month. RESULTS: Age was 63.6±18.7 years, and 40%) were female. At follow-up (mean 78±50 days), 136 (31%) patients had severity criteria (death, 64 ; intensive care unit, 73; hospital stay >30 days, 49). Hypertension (55.1% vs 36.7%, P<0.001) and antihypertensive treatment were associated with severe COVID-19 and mortality. The association between ACEI/ARB treatment and COVID-19 severity criteria found in univariate analysis (Odds Ratio 1.74, 95%CI [1.14-2.64], P=0.01) was not confirmed when adjusted on age, gender, and hypertension (adjusted OR1.13 [0.59-2.15], P=0.72). Diabetes and hypothyroidism were associated with severe COVID-19, whereas history of asthma was not. CONCLUSION: This study suggests that previous treatment with ACEI and ARB is not associated with hospital mortality, 1- and 2-month mortality, and severity criteria in patients hospitalised for COVID-19. No protective effect of ACEIs and ARBs on severe pneumonia related to COVID-19 was demonstrated.

[Use of rituximab in maintenance treatment of pemphigus: A retrospective series]. / Utilisation en pratique du rituximab en 2nde ligne et au-delà dans le traitement du pemphigus: série rétrospective.

INTRODUCTION: Rituximab (RTX), currently recommended as first-line treatment in moderate to severe pemphigus vulgaris (PV) and superficial pemphigus (PS) along with initial systemic steroids, may also be used as second-line or subsequent treatment, and this therapeutic strategy was investigated in a real-life monocentre retrospective survey. MATERIAL AND METHODS: All patients treated between January 2010 and March 2018 with RTX as second-line or subsequent treatment for moderate to severe PV or PS and followed for at least one year were included. The main objective was to evaluate rates and times of complete clinical remission (CCR) after a first course of RTX. The secondary objectives consisted mainly of treatment safety, and frequency and time to relapse after the initial CCR. RESULTS: The 24 patients selected received on average 2 cycles of RTX (i.e. 24 initial cycles and 24 additional cycles in all) over a mean follow-up period of 45 months. 18/24 (75%) patients achieved initial CCR within a mean 7.7 months. Despite at least one relapse in 13/18 initially responding patients regardless of relapse time, 59% (14/24) and 33% (8/24) were either in CCR and off treatment, or in partial remission, whether treated or untreated, according to the latest patient news, with an overall response rate of 92%. Safety was fair in these fragile patients. DISCUSSION AND CONCLUSION: This survey of the practical use of RTX confirms its interest in moderate to severe pemphigus as a second-line or subsequent treatment, a situation that probably remains relevant even if this molecule is increasingly used as first-line therapy.

Water-soluble carbohydrates in Patzkea paniculata (L.): a plant strategy to tolerate snowpack reduction and spring drought in subalpine grasslands.

In subalpine grasslands of the central French Alps, cessation of traditional mowing promotes dominance of Patzkea paniculata (L.) G.H.Loos (Poaceae) tussocks, with high biomass but low fodder quality. Mowing limits P. paniculata abundance through the depletion of its water-soluble carbohydrate (WSC) reserves, which sustain early spring growth initiation. However, the effectiveness of mowing effects is modulated by grassland functional composition, fertilization and climate change, as WSC compounds, and notably fructans, support plant physiological responses to climate stresses such as drought or frost. To characterize the mechanisms underpinning the control of P. paniculata under global change, we tested the effects of climate manipulation (combined snow removal and drought) and management (cutting and fertilization) alone or in combination on P. paniculata WSC storage in assembled grassland communities of varying functional composition. Management and climate treatments individually decreased seasonal fructan storage, with neither additive nor synergic effects between them, primarily due to the dominance of management over climate effects. Fructan amounts were higher in individuals growing in unmanaged exploitative communities compared to unmanaged conservative communities, regardless of climate treatments, but management overrode these differences. Our findings suggest that reduction by combined snow removal and drought of P. paniculata carbon allocation to WSC storage may similarly limit its dominance to that in current mowing practices.

One-bloc percutaneous large biopsy of soft-tissue tumours: feasibility study and possible indications.

AIM: To report the early results of the Intact lesion excision system (LES) regarding feasibility, tolerance and efficiency in obtaining soft-tissue tumour samples under ultrasound guidance. MATERIALS AND METHODS: The feasibility and tolerance of Intact LES procedures under ultrasound guidance were studied prospectively in 15 patients. The procedure was performed on an outpatient basis under local anaesthesia by a single interventional radiologist with 6 years of experience and lasted around 30 min. RESULTS: The feasibility of the Intact LES for soft-tissue masses was good except when lesions were hard and calcified. Tolerance was good, with median pain experienced during the procedure evaluated at 4.5/10 (SD 2.2) and median post-procedural pain at day 1 evaluated at 1.8/10 (SD 2.5). No major complications were observed; however, for vascularised lesions, one case of acute wound bleeding and two post-procedural haematomas led to delayed pain. CONCLUSION: Percutaneous biopsy of suspected soft-tissue sarcoma using the LES device under ultrasound guidance is well tolerated and feasible. After a first non-contributing core biopsy, and especially, in the case of lipomatous lesions, it is a valuable option to consider, as is surgical incision biopsy.