Time to revise classification of phyllodes tumors of breast? Results of a French multicentric study

OBJECTIVE: To assess prognostic factors of recurrence of phyllodes tumors (PT) of the breast. METHODS: We performed a retrospective, multicentric cohort study, including all patients who underwent breast surgery for grade 1 (benign), 2 (borderline) or 3 (malignant) PT between 2000 and 2016 in five tertiary University hospitals, diagnosed according to World Health Organisation classification. RESULTS: 230 patients were included: 144 (63%), 60 (26%) and 26 (11%) with grade 1, 2 and 3 PT, respectively. Recurrence occurred in 10 (7%), 7 (12%) and 5 (19%) patients with grade 1, 2 and 3 PT, respectively. In univariate analysis, moderate to severe nuclear stromal pleomorphism (HR 8.00 [95% CI: 1.65-38.73], p < 0.009) was correlated with recurrence in all groups including grade 1 (HR 14.3 [95% CI: 1.29-160], p = 0.031). In multivariate analysis, surgical margin >5 mm, (HR 0.20 [95% CI: 0.06-0.63], p = 0.013) were significantly correlated with less recurrence in all PT grades. For grade 1 PT, there was also significantly less recurrence with surgical margin >5 mm, (HR 0.09 [95% CI: 0.01-0.85], p = 0.047) in multivariate analysis. CONCLUSION: The surgical margin should be at least 5 mm whatever the grade of PT. Moderate to severe nuclear stromal pleomorphism identified a subgroup of grade 1 PT with a higher rate of recurrence. This suggests that the WHO classification could be revised with the introduction of nuclear stromal pleomorphism to tailor PT management

Impact of fortified versus unfortified lipid-based supplements on morbidity and nutritional status: A randomised double-blind placebo-controlled trial in ill Gambian children

Multiple micronutrients (MMN) are commonly prescribed in pediatric primary healthcare in sub-Saharan Africa to improve nutritional status and appetite without evidence for their effectiveness or international clinical guidelines. Community-wide MMN supplementation has shown limited and heterogeneous impact on growth and morbidity. Short-term ready-to-use therapeutic foods in acutely sick children in a hospital setting also had limited efficacy regarding subsequent growth. The effectiveness of MMN in improving morbidity or growth in sick children presenting for primary care has not been assessed.We undertook a double-blind randomised controlled trial of small-quantity lipid-based nutrient supplements (SQ-LNS) fortified with 23 micronutrients in children aged 6 months (mo) to 5 years (y) presenting with an illness at a rural primary healthcare centre in The Gambia. Primary outcomes were repeat clinic presentations and growth over 24 wk. Participants were randomly assigned to receive 1 of 3 interventions: (1) supplementation with micronutrient-fortified SQ-LNS for 12 wk (MMN-12), (2) supplementation with micronutrient-fortified SQ-LNS for 6 wk followed by unfortified SQ-LNS for 6 wk (MMN-6), or (3) supplementation with unfortified SQ-LNS for 12 wk (MMN-0) to be consumed in daily portions. Treatment masking used 16 letters per 6-wk block in the randomisation process. Blinded intention-to-treat analysis based on a prespecified statistical analysis plan included all participants eligible and correctly enrolled. Between December 2009 and June 2011, 1,101 children (age 6-60 mo, mean 25.5 mo) were enrolled, and 1,085 were assessed (MMN-0 = 361, MMN-6 = 362, MMN-12 = 362). MMN supplementation was associated with a small increase in height-for-age z-scores 24 wk after recruitment (effect size for MMN groups combined: 0.084 SD/24 wk, 95% CI: 0.005, 0.168; p = 0.037; equivalent to 2-5 mm depending on age). No significant difference in frequency of morbidity measured by the number of visits to the clinic within 24 wk follow-up was detected with 0.09 presentations per wk for all groups (MMN-0 versus MMN-6: adjusted incidence rate ratio [IRR] 1.03, 95% CI: 0.92, 1.16; MMN-0 versus MMN-12: 1.05, 95% CI: 0.93, 1.18). In post hoc analysis, clinic visits significantly increased by 43% over the first 3 wk of fortified versus unfortified SQ-LNS (adjusted IRR 1.43; 95% CI: 1.07, 1.92; p = 0.016), with respiratory presentations increasing by 52% with fortified SQ-LNS (adjusted IRR 1.52; 95% CI: 1.01, 2.30; p = 0.046). The number of severe adverse events during supplementation were similar between groups (MMN-0 = 20 [1 death]; MMN-6 = 21 [1 death]; MMN-12 = 20 [0 death]). No participant withdrew due to adverse effects. Study limitations included the lack of supervision of daily supplementation.Prescribing micronutrient-fortified SQ-LNS to ill children presenting for primary care in rural Gambia had a very small effect on linear growth and did not reduce morbidity compared to unfortified SQ-LNS. An early increase in repeat visits indicates a need for the establishment of evidence-based guidelines and caution with systematic prescribing of MMN. Future research should be directed at understanding the mechanisms behind the lack of effect of MMN supplementation on morbidity measures and limited effect on growth.ISRCTN 73571031

IPCC, 2023: Climate Change 2023: Synthesis Report, Summary for Policymakers. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, H. Lee and J. Romero (eds.)]. IPCC, Geneva, Switzerland.

This Synthesis Report (SYR) of the IPCC Sixth Assessment Report (AR6) summarises the state of knowledge of climate change, its widespread impacts and risks, and climate change mitigation and adaptation. It integrates the main findings of the Sixth Assessment Report (AR6) based on contributions from the three Working Groups1 , and the three Special Reports. The summary for Policymakers (SPM) is structured in three parts: SPM.A Current Status and Trends, SPM.B Future Climate Change, Risks, and Long-Term Responses, and SPM.C Responses in the Near Term.This report recognizes the interdependence of climate, ecosystems and biodiversity, and human societies; the value of diverse forms of knowledge; and the close linkages between climate change adaptation, mitigation, ecosystem health, human well-being and sustainable development, and reflects the increasing diversity of actors involved in climate action. Based on scientific understanding, key findings can be formulated as statements of fact or associated with an assessed level of confidence using the IPCC calibrated language

Audit Des Cesariennes En Milieu Africain

Objective: Perform a criteria based audit of each case of caesarean section during the study period. Patients and Methods: It was a prospective study conducted from march the 1st to may the 22nd 2005 at the maternity ward of Bobo Dioulasso University Teaching Hospital. The audit used criteria derived from those of the royal college of obstetrics and gynaecology and those of the French agency for evaluating health services (ANAES) for the medical record. Results: The proportion of C section during the study period was 19.96%. The main indications for caesarean section were: foetal distress (15.38%), obstructed pelvis (14.33%), scar uterus (9.44%) and severe eclampsia/preeclampsia (8.40%). 38.5% of the patients were aware of the decision to perform the caesarean and 6.5% knew the diagnosis. In extreme emergency cases the mean duration between the indication and the caesarean section was 55 minutes. The reasons for these delays were mainly the non availability of consumables and the operating theatre. Antibioprophylaxis was administered to all patients. The operations were performed under general anaesthesia in 69%, the Misgav Ladach technique was used most of the time. Consultants obstetricians were present in 9.5% of the cases and 58% of the patients were allowed to drink 6 hours post operative. In the record keeping analysis, the identity of the patient was completely recorded in 6%. However the date and the unit of admission were recorded in all files. Reason for admission and the diagnosis were noticed respectively in 93% and 56% of the files. Each patient had a operative note and an anaesthesia form. The majority (86.5%) of operative notes were incomplete with the missing data being the antithrombolytic prophylaxis (98.5%), the per operative diagnosis (70.5%), the duration of the operation (10%) and the amount of blood loss (9.5%). Conclusion: This study has shown some flaws in the management of caesarean section patients : communication with patients, type of anaesthesia, preoperative diagnosis, use of antibiotics and records keeping. Improving these areas will lead to a better care for C section patients.Objectif: Faire l’audit de chaque cas de césarienne en utilisant des critères prédéfinis. Patientes et méthodes: Il s’agissait d’une étude prospective menée du 1er mars au 22 mai 2005 à la maternité du CHU de Bobo-Dioulasso au Burkina Faso. Chaque cas de césarienne a fait l’objet d’un audit en utilisant des critères dérivés de ceux du collège anglais de gynécologie et d’obstétrique (indication de la césarienne, le délai d’opération, les types d’anesthésie et d’incision, l’antibioprophylaxie, le délai pour l’ablation de la sonde urinaire et pour l’autorisation de boire) et de ceux de l’ANAES pour le dossier médical (complétude des données du dossier médical). Résultats: La proportion de césariennes a été de 19,96%. Les principales indications furent la souffrance foetale aiguë (15,38%), les anomalies du bassin (14,33%), les utérus cicatriciels (9,44%) et les éclampsies/préclampsies sévères (8,40%) 38,5% des parturientes ont été informées qu’elles allaient être césarisées et 6,5% informées du diagnostic. Le délai moyen entre l’indication et la césarienne était 55 minutes en cas d’extrême urgence. Les raisons de ces retards ont été essentiellement la non acquisition rapide des produits pour l’intervention et l’occupation du bloc opératoire. L’antibioprophylaxie a été administrée à toutes les opérées. Les interventions ont le plus souvent été faites sous anesthésie générale, 69% ; la technique opératoire la plus pratiquée fut celle de Misgav Ladach. Les médecins titulaires ont été présents lors de 9,5% des césariennes. 58% des opérées ont été autorisées à boire dès la 6ème heure. L’identité de la parturiente a été complètement remplie dans 6% des dossiers. En revanche, la date et l’unité d’admission ont été précisées dans tous les dossiers ; le motif d’hospitalisation et le diagnostic d’entrée existaient respectivement dans 93% et 56% des dossiers. Chaque opérée a eu une fiche d’anesthésie et un compte rendu opératoire. Mais 86,5% des comptes rendus opératoires étaient incomplets. Il manquait surtout la prophylaxie antithrombolytique (98,5%), le diagnostic per opératoire (70,5%), la durée de l’intervention (10%), la quantité de sang perdue (9,5%). Conclusion: La pratique de l’audit a permis de mettre en évidence des insuffisances au niveau de la communication entre soignants et soignées, du type d’anesthésie, du diagnostic per opératoire, de l’antibiothérapie ainsi qu’au niveau du remplissage du dossier médical. La prise en compte de ces insuffisances doit permettre d’améliorer la qualité des soins aux patientes bénéficiant d’une césarienne

Cancers du sein et de l’ovaire liés aux mutations constitutionnelles délétères BRCA1&2 et reproduction : revue de la littérature

National audienc