Background
This study evaluated breast imaging procedures for predicting pathologic complete response (pCR = ypT0) after neoadjuvant chemotherapy (NACT) for breast cancer to challenge surgery as a ...diagnostic procedure after NACT.
Methods
This retrospective, exploratory, monocenter study included 150 invasive breast cancers treated by NACT. The patients received magnetic resonance imaging (MRI), mammography (MGR), and ultrasound (US). The results were classified in three response subgroups according to response evaluation criteria in solid tumors. To incorporate specific features of MRI and MGR, an additional category clinical near complete response (near-cCR) was defined. Residual cancer in imaging and pathology was defined as a positive result. Negative predictive values (NPVs), false-negative rates (FNRs), and false-positive rates (FPRs) of all imaging procedures were analyzed for the whole cohort and for triple-negative (TN), HER2-positive (HER2+), and HER2-negative/hormone-receptor-positive (HER2−/HR+) cancers, respectively.
Results
In 46 cases (31 %), pCR (ypT0) was achieved. Clinical complete response (cCR) and near-cCR showed nearly the same NPVs and FNRs. The NPV was highest with 61 % for near-cCR in MRI and lowest with 44 % for near-cCR in MGR for the whole cohort. The FNRs ranged from 4 to 25 % according to different imaging methods. The MRI performance seemed to be superior, especially in TN cancers (NPV 94 %; FNR 5 %). The lowest FPR was 10 % in MRI, and the highest FPR was 44 % in US.
Conclusion
Neither MRI nor MGR or US can diagnose a pCR (ypT0) with sufficient accuracy to replace pathologic diagnosis of the surgical excision specimen.
The broad clinical spectrum of myotonic dystrophy type 1 (DM1) creates particular challenges for both medical care and design of clinical trials. Clinical onset spans a continuum from birth to late ...adulthood, with symptoms that are highly variable in both severity and nature of the affected organ systems. In the literature, this complex phenotype is divided into three grades (mild, classic, and severe) and four or five main clinical categories (congenital, infantile/juvenile, adult-onset and late-onset forms), according to symptom severity and age of onset, respectively. However, these classifications are still under discussion with no consensus thus far. While some specific clinical features have been primarily reported in some forms of the disease, there are no clear distinctions. As a consequence, no modifications in the management of healthcare or the design of clinical studies have been proposed based on the clinical form of DM1. The present study has used the DM-Scope registry to assess, in a large cohort of DM1 patients, the robustness of a classification divided into five clinical forms. Our main aim was to describe the disease spectrum and investigate features of each clinical form. The five subtypes were compared by distribution of CTG expansion size, and the occurrence and onset of the main symptoms of DM1. Analyses validated the relevance of a five-grade model for DM1 classification. Patients were classified as: congenital (n=93, 4.5%); infantile (n=303, 14.8%); juvenile (n=628, 30.7%); adult (n=694, 34.0%); and late-onset (n=326, 15.9%). Our data show that the assumption of a continuum from congenital to the late-onset form is valid, and also highlights disease features specific to individual clinical forms of DM1 in terms of symptom occurrence and chronology throughout the disease course. These results support the use of the five-grade model for disease classification, and the distinct clinical profiles suggest that age of onset and clinical form may be key criteria in the design of clinical trials when considering DM1 health management and research.
La maladie de Lyme ou (Borreliose de Lyme) est une zoonose causée par un spirochète de la famille des Borrelia, transmise par une morsure de tique infectée. Elle est caractérisée par un grand ...polymorphisme clinique.
Nous rapportons le cas d’une patiente âgée de 26ans sans antécédents pathologiques particuliers, issue de milieu rural, qui consulte pour des céphalées en casque, avec baisse de l’acuité visuelle depuis 1 semaine environ évoluant progressivement vers l’aggravation. L’examen neurologique note une baisse de l’acuité visuelle plus marquée a droite avec oedème papillaire bilatérale. L’examen ophtalmologique et l’angiographie rétinienne révèlent une acuité visuelle à 6/10 à gauche et à 4/10 à droite avec un oedème papillaire bilatérale stade 2. Biologie : absence d’hyperleucocytose. IRM Cérébrale : aspect d’une névrite optique droite avec discret élargissement des espaces sous arachnoïdiens des gaines des nerfs optiques bilatérale. IRM médullaire : sans anomalies. La sérologie de la maladie de Lyme était positive dans le sang et le liquide céphalo-rachidien (LCR). Une antibiothérapie à base de céftriaxone associée à une corticothérapie était suivie d’une évolution rapidement favorable marquée par une récupération quasi complète de l’acuité visuelle (9/10) après seulement dix mois de suivi.
La particularité de notre observation est l’atteinte isolée du nerf optique au cours de la maladie de Lyme. Le diagnostic positif est basé sur plusieurs éléments : l’anamnèse, la clinique, la positivité de la sérologie par la détection d’anticorps (Ac) dans le sang ou le LCR. Le traitement repose sur une antibiothérapie par voie parentérale associé à une corticothérapie dans les formes sévères.
La maladie de Lyme doit être évoquée et recherchée devant toute neuropathie optique pour une prise en charge précoce et adaptée.
La Neuropathie avec hypersensibilité héréditaire à la PrEssion (HNPP) est une neuropathie sensitivomotrice à transmission autosomique dominante. Elle est assez souvent sous-diagnostiquée.
Nous ...rapportons le cas d’une HNPP dont le tableau clinique été très atypique, avec une symptomatologie sensitive diffuse et douloureuse apparue au décours d’une décompression du nerf médian au canal carpien. Chez ce patient âgé de 31 ans, les critères EFNS/PNS d’une PIDC été réunis y compris la bonne réponse aux corticoïdes. L’ENMG retrouvait des critères de démyélinisation pour une PIDC avec un allongement des latences distales (LD) motrices, une perte axonale sensitive mais ce qui a fait douter du diagnostic d’une PIDC « classique » été la présence de ralentissement franc des vitesses de conduction aux zones d’étroitesse anatomique. Une enquête familiale a mis en évidence de signes cliniques chez la maman et la délétion PMP22 confirme le diagnostic de la HNPP chez notre patient.
La coexistence d’une HNPP avec un tableau clinico-électrique et biologique d’une polyradiculonévrite chronique inflammatoire (PIDC) est rare mais rend compte de la complexité et la difficulté diagnostique. L’ENMG reste l’examen clé pour poser le diagnostic d’une HNPP en extrayant des anomalies propres à cette pathologie même si les signes sont noyés dans un tableau d’une PIDC.
Cette présentation illustre qu’au-delà de savoir pratiquer et interpréter un ENMG d’une PIDC « classique », il faut savoir aussi « en extraire » les anomalies orientant vers une HNPP afin de ne pas méconnaître les autres associations pathologiques.
•We compare system of rice intensification and farmer practice methods of rice cultivation.•We analyze the economic benefits of system of rice intensification.•Application of SRI principles increase ...yields, benefit–cost ratio and save irrigation water.•SRI an opportunity to increase food security in Kenya.•Adoption rate of SRI depend on approach used to introduce it to the farmers.
A detailed farm survey was conducted in Mwea Irrigation Scheme, Kenya during the 2010/2011 and 2011/2012 main growing seasons to assess the adoption and to quantify the net income advantages of using system of rice intensification (SRI) management over farmer practices (FP) for rice cultivation.
Data were collected through questionnaires and structured interviews with farmers who were practicing both SRI and FP methods of rice production on their farms. Under FP, three seedlings aged 28 days are transplanted in respective hills at random spacing. The fields are then flooded with water throughout the growing period. For SRI practice, factors considered as essential were transplanting only one seedling per hill aged 8–15 days with spacing of at least 20cm by 20cm; weeding the crop at least three times at intervals of ten days; and intermittently irrigating the fields. The contributions of using organic manure for fertilization and soil-aeration weed control methods were not considerations in this study since the availability of organic materials and mechanical push-weeders were challenges at the time of study. A total of 40 farmers in 10 units out of the 50 SRI farmers from 18 units of the irrigation scheme were sampled. Benefit–cost relationships were estimated using tabular analysis of all the variable costs and income from production using the survey data.
On average, yield under SRI management increased by 1.6t/ha (33%), with seed requirements reduced by 87% and, water savings of 28%. SRI required 9% more labor than FP on average, but this factor of production showed great variability; in three Mwea units, labor costs were reduced by an average of 13%. SRI required 30% more labor for weeding than FP in the first season, but this was reduced to 15% in the second season when push-weeders became available. The results showed SRI giving a higher benefit–cost ratio of 1.76 and 1.88 in the first and second seasons, respectively, compared to 1.3 and 1.35 for FP.
The results indicated that SRI practices of planting younger seedlings, with wider spacing and intermittent irrigation, lead to increased paddy rice yields with concomitant rise in the income accruing to farmers. Possibly further increases in net benefit could come with enhanced availability of mechanical weeders and using organic material for fertilization. Up-scaling of SRI in Mwea can be expected to help achieve greater national and household food security
The Mara River is the lifeline of the transboundary Mara basin across Kenya and Tanzania. The basin is considered one of the more serene subcatchments of the Lake Victoria Basin and ultimately the ...Nile Basin, and traverses the famous Maasai Mara and Serengeti National Parks. The basin also contains forests, large‐scale farms, smallholder farms, pastoral grazing lands, as well as hunter gatherers and fishers. There is growing concern, however, regarding land degradation in the basin, particularly deforestation in the headwaters, that is affecting the natural resource base and the river flows. Accurate scientific data are required to advise policy, and to plan appropriate mitigation measures. This study utilizes remote sensing and geographical information system (GIS) tools, and hydrological and ground‐truth studies to determine the magnitude of the land‐use/cover changes in the Mara River Basin, and the effects of these changes on the river flows over the last 30 years. The study results indicate that land‐use/cover changes have occurred. In 1973, for example, rangelands (savannah, grasslands and shrublands) covered 10 989 km2 (79%) of the total basin area. The rangelands had been reduced to 7245 km2 (52%) by 2000, however, while the forest areas were reduced by 32% over the same period. These changes have been attributed to the encroachment of agriculture, which has more than doubled (203%) its land area over the same period. The hydrology of the Mara River also has changed, with sharp increases in flood peak flows by 7%, and an earlier occurrence of these peaks by 4 days between 1973 and 2000. There is evidence of increased soil erosion in the upper catchments, with silt build‐up in the downstream floodplains. This has caused the Mara wetland to expand by 387%, adversely affecting riparian agriculture. There is need for urgent action to stem the land degradation of the Mara River Basin, including planning and implementing appropriate mitigation measures.
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