Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial

Background Third-generation aromatase inhibitors are more effective than tamoxifen for preventing recurrence in postmenopausal women with hormone-receptor-positive invasive breast cancer. However, it is not known whether anastrozole is more effective than tamoxifen for women with hormone-receptor-positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole with that of tamoxifen in postmenopausal women with hormone-receptor-positive DCIS. Methods In a double-blind, multicentre, randomised placebo-controlled trial, we recruited women who had been diagnosed with locally excised, hormone-receptor-positive DCIS. Eligible women were randomly assigned in a 1:1 ratio by central computer allocation to receive 1 mg oral anastrozole or 20 mg oral tamoxifen every day for 5 years. Randomisation was stratified by major centre or hub and was done in blocks (six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation and only the trial statistician had access to treatment allocation. The primary endpoint was all recurrence, including recurrent DCIS and new contralateral tumours. All analyses were done on a modified intention-to-treat basis (in all women who were randomised and did not revoke consent for their data to be included) and proportional hazard models were used to compute hazard ratios and corresponding confidence intervals. This trial is registered at the ISRCTN registry, number ISRCTN37546358. Results Between March 3, 2003, and Feb 8, 2012, we enrolled 2980 postmenopausal women from 236 centres in 14 countries and randomly assigned them to receive anastrozole (1449 analysed) or tamoxifen (1489 analysed). Median follow-up was 7·2 years (IQR 5·6–8·9), and 144 breast cancer recurrences were recorded. We noted no statistically significant difference in overall recurrence (67 recurrences for anastrozole vs 77 for tamoxifen; HR 0·89 [95% CI 0·64–1·23]). The non-inferiority of anastrozole was established (upper 95% CI <1·25), but its superiority to tamoxifen was not (p=0·49). A total of 69 deaths were recorded (33 for anastrozole vs 36 for tamoxifen; HR 0·93 [95% CI 0·58–1·50], p=0·78), and no specific cause was more common in one group than the other. The number of women reporting any adverse event was similar between anastrozole (1323 women, 91%) and tamoxifen (1379 women, 93%); the side-effect profiles of the two drugs differed, with more fractures, musculoskeletal events, hypercholesterolaemia, and strokes with anastrozole and more muscle spasm, gynaecological cancers and symptoms, vasomotor symptoms, and deep vein thromboses with tamoxifen. Conclusions No clear efficacy differences were seen between the two treatments. Anastrozole offers another treatment option for postmenopausal women with hormone-receptor-positive DCIS, which may be be more appropriate for some women with contraindications for tamoxifen. Longer follow-up will be necessary to fully evaluate treatment differences

Spurious hypokalemia in horses : the role of serum insulin levels and sample storage conditions

Spurious hypokalemia is a laboratory result that is "analytically correct but does not reflect the in vivo plasma potassium concentration" (GAMA et al., 2011.). Not correlated to the clinical presentation, it can lead to misdiagnosis and unnecessary and dangerous choices of treatment. From 2009 to 2014, 11,5% of horses' laboratory results from PraxisLab veterinary laboratories presented unexplained hypokalemia. These results lead us to study the effects of high ambient temperature, delayed serum separation and postprandial insulin levels in equine blood samples

Dynamiques croisées des milieux et des sociétés dans les basses terres tropicales mayas : hydrosystème et agrosystème à Naachtun (Guatemala)

International audience"Managing resources in inter-tropical environment has always been a critical issue for the rise and prosperity of complex societies. The socio-ecological system of Naachtun, a large Classic Period Maya city (AD 250-950), lies at the heart of this issue. It will be studied here in the perspective of understanding water and soil variability, which is under climate, environmental and anthropogenic controls. Both the hydrosystem and the agrosystem will be characterized through a systemic and multi-scalar approach, allowing for the study of the evolution, the uses and the management of these resources under the influence of climate and population dynamics. Occupied for nearly one millennia (AD 150-950/1000), the city of Naachtun expanded next to a large humid area (bajo), which clearly played a central role in its creation and development, both for water uses and for its agricultural potential." (source éditeur)"La gestion des ressources en milieu intertropical a de tout temps constitué un enjeu crucial pour l’essor et la prospérité des sociétés complexes. L’éco-socio-système de Naachtun, grande cité maya de la période Classique (250-950 apr. J.-C.), est au cœur de cette problématique. Il est étudié sous l’angle de la variabilité des ressources en eau et en sol, laquelle dépend du climat de l’environnement et des sociétés. L’hydrosystème et l’agrosystème sont caractérisés au moyen d’une approche systémique et multi-scalaire permettant l’étude des variabilités, des usages et de la gestion de ces deux ressources sous l’influence du climat et des populations. Occupée durant près d’un millénaire (150 – 950/1000 apr. J.-C.), la cité de Naachtun se distingue par son implantation au bord d’une vaste zone humide (bajo) qui a manifestement joué un rôle central dans son implantation et son développement, tant pour les usages de l’eau que pour son potentiel agricole." (source éditeur

Lymphome digestif à lymphocytes granuleux de haut grade au stade leucémique chez une jument frison

International audienc

Intérêt du dosage de la sérum amyloïde A chez les poulains à l’aide d’un appareil portable.

National audienc

Comparaison du lavage trachéal et du lavage broncho-alvéolaire pour le diagnostic cytologique de l’hémorragie pulmonaire induite par l’exercice

National audienceIntroduction:Various methods are reported for diagnosis of exercise-induced pulmonary haemorrhage (EIPH). Cytological evaluation of airway samples is a sensitive method, but the correlation between tracheal wash (TW) and bronchoalveolar lavage fluid (BALF) findings for diagnosis of EIPH is unknown.The objective was to determine whether diagnosis of EIPH, using haemosiderophages/macrophages (H/M) ratio, differs when based on samples from TW and BALF collected concomitantly from the same racehorse.Methods:Prospective cross-sectional study on 102 Standardbred horses in active training. TW and BALF from each lung separately were collected from all horses at rest. Smears were stained with May-Grünwald-Giemsa (MGG) and H/M ratio calculated. Diagnostic cut-off values were set at 17% for individual (left and right) BALF and 9% for pooled BALF. H/M ratio in TW samples were scored as none (0%), occasional (50%).Results:In BALF, 21 horses met the cytological inclusion criteria for EIPH diagnosis from individual and/or pooled samples. In TW, 20 horses had occasional proportions of haemosiderophages, and respectively 9, 1 and 3 horses had small, moderate and large proportions. Poor correlations between TW and respectively pooled, left and right BALF were found for H/M ratio. Among the 13 horses with at least small proportions of haemosiderophages in TW, 8 (61.5%) had no cytological evidence of EIPH in any BALF.Conclusion and clinical relevance:No association between TW and BALF was found for the cytological diagnosis of EIPH. A large number of horses has cytological evidence of pulmonary bleeding in BALF with none or occasional proportions of haemosiderophages in TW. In addition, finding small to large proportions of haemosiderophages in TW is mostly not associated with evidence of pulmonary haemorrhage in BALF. Based on H/M ratio, BALF remains the sample of choice for cytological diagnosis of EIPH

Comparison of tracheal wash and bronchoalveolar lavage for cytological diagnosis of exercise-induced pulmonary haemorrhage in horses

International audienceIntroduction:Various methods are reported for diagnosis of exercise-induced pulmonary haemorrhage (EIPH). Cytological evaluation of airway samples is a sensitive method, but the correlation between tracheal wash (TW) and bronchoalveolar lavage fluid (BALF) findings for diagnosis of EIPH is unknown.The objective was to determine whether diagnosis of EIPH, using haemosiderophages/macrophages (H/M) ratio, differs when based on samples from TW and BALF collected concomitantly from the same racehorse.Methods:Prospective cross-sectional study on 102 Standardbred horses in active training. TW and BALF from each lung separately were collected from all horses at rest. Smears were stained with May-Grünwald-Giemsa (MGG) and H/M ratio calculated. Diagnostic cut-off values were set at 17% for individual (left and right) BALF and 9% for pooled BALF. H/M ratio in TW samples were scored as none (0%), occasional (50%).Results:In BALF, 21 horses met the cytological inclusion criteria for EIPH diagnosis from individual and/or pooled samples. In TW, 20 horses had occasional proportions of haemosiderophages, and respectively 9, 1 and 3 horses had small, moderate and large proportions. Poor correlations between TW and respectively pooled, left and right BALF were found for H/M ratio. Among the 13 horses with at least small proportions of haemosiderophages in TW, 8 (61.5%) had no cytological evidence of EIPH in any BALF.Conclusion and clinical relevance:No association between TW and BALF was found for the cytological diagnosis of EIPH. A large number of horses has cytological evidence of pulmonary bleeding in BALF with none or occasional proportions of haemosiderophages in TW. In addition, finding small to large proportions of haemosiderophages in TW is mostly not associated with evidence of pulmonary haemorrhage in BALF. Based on H/M ratio, BALF remains the sample of choice for cytological diagnosis of EIPH

Correlation between cytologic and microbial respiratory profiles and performance in french trotters

International audienceThe impact of clinical and respiratory findings on performance is poorly understood. The aim of this study was to investigate the possible association between cytological, mycological, and bacteriological profiles of the respiratory tract of racehorses and the level of performance. Clinical examination, airway samples (bilateral bronchoalveolar lavage (BAL), tracheal wash (TW) and bilateral guttural pouch lavage (GPL)) and performance results of 32 Standardbred racehorses were analysed. Horses were classified as good performers (GP, n=12) or poor performers (PP, n=20) based on a modified performance-score (out of 4 based on the podiums ratio, earnings and national index and ranking). Data were compared between groups and correlation to performance was statistically analysed by Chi-square, Fisher or Mann-Whitney test depending on variables. Significance was set at P=0.05. The most common respiratory conditions included tracheal inflammation (n=28/32), mild-moderate equine asthma (mEA, n=9/32) and exercise-induced pulmonary haemorrhage (EIPH, n=7/32). While none of the variables or conditions were statistically associated with performance, the following were seen more often in poor performers: tracheal inflammation (GP: 9/12 (75%) vs PP: 19/20 (95%)), positive TW bacterial culture (GP: 2/12 (17%) vs PP 6/20 (30%)) and Mycoplasma (GP: 3/12 (25%) vs PP: 7/20 (35%)). The presence of mEA, EIPH or fungal colonisation of the airways was not associated either with poor performance. The small number of horses limited interpretation. No significant correlation was found between respiratory profiles and performance. However, the higher prevalence of tracheal inflammation, equine asthma and Mycoplasma in poor performers warrants further investigatio