The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Plantes envahissantes pour les milieux naturels de Nouvelle-Calédonie

Menaces pour la biodiversité, contraintes pour les agriculteurs et les activités humaines, les plantes envahissantes constituent un problème de plus en plus évoqué à travers le monde. Partant de ce constat, l'APICAN (Agence pour la Prévention et l'Indemnisation des Calamités Agricoles ou Naturelles) et ses partenaires ont soutenu l'élaboration de ce guide dans le but de faire connaitre, du plus grand nombre, les problématiques liées aux plantes envahissantes, les moyens de les identifier et les techniques à mettre en oeuvre pour les contrôler. Il s'adresse aux services techniques des communes et des réserves naturelles terrestres, aux exploitants agricoles, aux professionnels des espaces verts mais aussi aux citoyens sensibilisés à la protection de l'environnement. Ce guide décrit 81 espèces végétales envahissantes principales des milieux naturels de Nouvelle-Calédonie (Grande Terre et îles Loyauté). Le texte donne la description, la biologie, la répartition et les moyens de contrôler chaque espèce. Des photographies accompagnent chaque fiche pour faciliter l'identification des plantes