Montpellier, France
Montpellier, France

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Roca L.,ICM | Dieras V.,University Pierre and Marie Curie | Roche H.,Institute Claudius Regaud | Lappartient E.,University Pierre and Marie Curie | And 10 more authors.
Breast Cancer Research and Treatment | Year: 2013

The purpose of this study was to investigate, in the context of a prospective node-positive-breast cancer trial HER2 containing-regimen (UNICANCER-PACS 04 trial), the predictive value of HER2, FCGRIIA, and FCGRIIIA gene polymorphisms for cardiac toxicity and efficacy of trastuzumab. We analyzed HER2-I655V, FCGR2A-H131R, and FCGR3A-V158F single nucleotide polymorphisms in patients in adjuvant setting treated by six courses of either fluorouracil 500 mg/m2, epirubicin 100 mg/m2 and cyclophosphamide 500 mg/m2, or epirubicin 75 mg/m2 and docetaxel 75 mg/m 2 every 3 weeks then randomly assigned, in case of HER2 overexpressing tumor, to either trastuzumab for 1 year or nothing. Left ventricular ejection fraction and clinical examination were monitored in each patient, seven times throughout the study to detect congestive heart failure or asymptomatic subclinical cardiac toxicity. All genotypes were analyzed in relation to cardiac toxicity, EFS, and OS. One hundred and thirty-two HER2-positive breast cancer patients were analyzed. The HER2-I655V genotype was significantly associated with cardiac toxicity (p = 0.025). The FCGR2A-131 H/H genotype was significantly correlated with a shorter EFS (p = 0.027). The FCGR3A-158 V/V genotype was not correlated with EFS nor OS. These results might be useful in making a treatment choice of HER2 blockers in adjuvant setting by with an increase in efficacy and decrease in toxicity. © 2013 Springer Science+Business Media New York.

Bauchet L.,French Institute of Health and Medical Research | Zouaoui S.,French Institute of Health and Medical Research | Darlix A.,French Brain Tumor DataBase | De Champfleur N.M.,Montpellier University Hospital Center | And 4 more authors.
Neuro-Oncology | Year: 2014

Glioblastoma (GBM) is the most common malignant primary brain tumor. Its incidence continues to increase in the elderly because the older segment of the population is growing faster than any other age group. Most clinical studies exclude elderly patients, and "standards of care" do not exist for GBM patients aged.70 years. We review epidemiology, tumor biology/molecular factors, prognostic factors (clinical, imaging data, therapeutics), and their assessments as well as classic and specific endpoints plus recent and ongoing clinical trials for elderly GBM patients. This work includes perspectives and personal opinions on this topic. Although there are no standards of care for elderly GBM patients, we can hypothesize that (i) Karnofsky performance status (KPS), probably after steroid treatment, is one of the most important clinical factors for determining our oncological strategy; (ii) resection is superior to biopsy, at least in selected patients (depending on location of the tumor and associated comorbidities); (iii) specific schedules of radiotherapy yield a modest but significant improvement; (iv) temozolomide has an acceptable tolerance, even when KPS <70, and could be proposed for methylated elderly GBM patients; and (v) the addition of concomitant temozolomide to radiotherapy has not yet been validated but shows promising results in some studies, yet the optimal schedule of radiotherapy remains to be determined. In the future, specific assessments (geriatric, imaging, biology) and use of new endpoints (quality of life and toxicity measures) will aid clinicians in determining the balance of potential benefits and risks of each oncological strategy. © The Author(s) 2014.

PubMed | University of Technology, Sydney, Womens Health and Development, ICM, UNFPA and 2 more.
Type: | Journal: Midwifery | Year: 2015

The 2014 State of the Worlds Midwifery report included a new framework for the provision of woman-centred sexual, reproductive, maternal, newborn and adolescent health care, known as the Midwifery2030 Pathway. The Pathway was designed to apply in all settings (high-, middle- and low-income countries, and in any type of health system). In this paper, we describe the process of developing the Midwifery2030 Pathway and explain the meaning of its different components, with a view to assisting countries with its implementation. The Pathway was developed by a process of consultation with an international group of midwifery experts. It considers four stages of a womans reproductive life: (1) pre-pregnancy, (2) pregnancy, (3) labour and birth, and (4) postnatal, and describes the care that women and adolescents need at each stage. Underpinning these four stages are ten foundations, which describe the systems, services, workforce and information that need to be in place in order to turn the Pathway from a vision into a reality. These foundations include: the policy and working environment in which the midwifery workforce operates, the effective coverage of sexual, reproductive, maternal, newborn and adolescent services (i.e. going beyond availability and ensuring accessibility, acceptability and high quality), financing mechanisms, collaboration between different sectors and different levels of the health system, a focus on primary care nested within a functional referral system when needed, pre- and in-service education for the workforce, effective regulation of midwifery and strengthened leadership from professional associations. Strengthening of all of these foundations will enable countries to turn the Pathway from a vision into reality.

PubMed | ICS Integrare, University of Technology, Sydney, Womens Health and Development, ICM and UNFPA
Type: Journal Article | Journal: Human resources for health | Year: 2016

Education, regulation and association (ERA) are the supporting pillars of an enabling environment for midwives to provide quality care. This study explores these three pillars in the 73 low- and middle-income countries who participated in the State of the Worlds Midwifery (SoWMy) 2014 report. It also examines the progress made since the previous report in 2011.A self-completion questionnaire collected quantitative and qualitative data on ERA characteristics and organisation in the 73 countries. The countries were grouped according to World Health Organization (WHO) regions. A descriptive analysis was conducted.In 82% of the participating countries, the minimum education level requirement to start midwifery training was grade 12 or above. The average length of training was higher for direct-entry programmes at 3.1years than for post-nursing/healthcare provider programmes at 1.9years. The median number of supervised births that must be conducted before graduation was 33 (range 0 to 240). Fewer than half of the countries had legislation recognising midwifery as an independent profession. This legislation was particularly lacking in the Western Pacific and South-East Asia regions. In most (90%) of the participating countries, governments were reported to have a regulatory role, but some reported challenges to the role being performed effectively. Professional associations were widely available to midwives in all regions although not all were exclusive to midwives.Compared with the 2011 SoWMy report, there is evidence of increasing effort in low- and middle-income countries to improve midwifery education, to strengthen the profession and to follow international ERA standards and guidelines. However, not all elements are being implemented equally; some variability persists between and within regions. The education pillar showed more systematic improvement in the type of programme and length of training. The reinforcement of regulation through the development of legislation for midwifery, a recognised definition and the strengthening of midwives associations would benefit the development of other ERA elements and the profession generally.

Hasson A.,Toulouse 1 University Capitole | Hasson A.,Jet Propulsion Laboratory | Delcroix T.,Toulouse 1 University Capitole | Boutin J.,LOCEAN | And 2 more authors.
Journal of Geophysical Research: Oceans | Year: 2014

The tropical Pacific Ocean remained in a La Niña phase from mid-2010 to mid-2012. In this study, the 2010-2011 near-surface salinity signature of ENSO (El Niño-Southern Oscillation) is described and analyzed using a combination of numerical model output, in situ data, and SMOS satellite salinity products. Comparisons of all salinity products show a good agreement between them, with a RMS error of 0.2-0.3 between the thermosalinograph (TSG) and SMOS data and between the TSG and model data. The last 6 months of 2010 are characterized by an unusually strong tripolar anomaly captured by the three salinity products in the western half of the tropical Pacific. A positive SSS anomaly sits north of 10°S (>0.5), a negative tilted anomaly lies between 10°S and 20°S and a positive one south of 20°S. In 2011, anomalies shift south and amplify up to 0.8, except for the one south of 20°S. Equatorial SSS changes are mainly the result of anomalous zonal advection, resulting in negative anomalies during El Niño (early 2010), and positive ones thereafter during La Niña. The mean seasonal and interannual poleward drift exports those anomalies toward the south in the southern hemisphere, resulting in the aforementioned tripolar anomaly. The vertical salinity flux at the bottom of the mixed layer tends to resist the surface salinity changes. The observed basin-scale La Niña SSS signal is then compared with the historical 1998-1999 La Niña event using both observations and modeling. Key Points The well-marked signature of the 2010-2011 La Nina is described and analyzed In situ, modeled and SMOS surface salinity products show good overall agreement The processes for the western Pacific strong tripolar anomaly shift are studied © 2014. American Geophysical Union. All Rights Reserved.

Lana A.,ICM | Simo R.,ICM | Vallina S.M.,Massachusetts Institute of Technology | Dachs J.,IDAEA
Biogeochemistry | Year: 2012

During the last decade the number of seawater dimethylsulfide (DMS) concentration measurements has increased substantially. The importance this gas, emitted from the ocean to the atmosphere, may have in the cloud microphysics and hence in the Earth albedo and radiation budget, makes it necessary to accurately reproduce the global distribution. Recently, the monthly global DMS climatology has been updated taking advantage of the threefold increased size and better resolved distribution of the observations available in the DMS database. Here, the emerging patterns found with the previous versions of the database and climatology are explored with the updated versions. The statistical relationships between the seasonalities of DMS concentrations and other variables are re-examined. The positive correlation previously found between surface seawater DMS and the daily-averaged climatological solar radiation dose in the upper mixed layer of the open ocean is confirmed with both the updated DMS database and climatology. Re-examination of the latitudinal match-mismatch between the seasonalities of DMS and phytoplankton, represented by the chlorophyll a concentration, reveals that they are highly positively correlated in latitudes higher than 40°, but anti-correlated in the 20°-40° latitudinal bands of both hemispheres. Overall, these global emerging patterns provide key information to further understanding the factors that control the emission of volatile sulfur from the ocean. The large uncertainties associated with the methodologies used in global computations, however, call for caution in using these emerging patterns as predictive tools, and prompt to the design of time series and process-oriented studies aimed at testing the validity of the observed relationships. © 2011 Springer Science+Business Media B.V.

PubMed | McGill University, Montpellier University Hospital Center, Tottori University and ICM
Type: Comparative Study | Journal: Journal of magnetic resonance imaging : JMRI | Year: 2015

To evaluate the relationship between MR measurements and the pathological tumor regression grade (pTRG).Two radiologists independently reviewed the pre- and postchemoradiation therapy (CRT) rectal MR images of 73 consecutive patients with locally advanced low rectal cancer who underwent neoadjuvant CRT and subsequent surgery and measured tumor diameter, area, signal intensity (SI). The percentage reduction rate for each parameter was calculated. The absolute SI ratio reduction rate was defined as the absolute value of the SI ratio reduction rate. The Kruskal-Wallis test and multivariate analysis were performed to assess the correlation between each parameter and the pTRG. Receiver operating characteristic (ROC) curves were plotted for predicting favorable regression outcomes (pTRG 3-4).In multivariate analysis, the absolute SI ratio reduction rate was a significant predictor of pTRG for both radiologists. Area under the ROC curve (Az) values were 0.77-0.709 for diameter reduction rate, 0.757-0.694 for area, 0.652-0.648 for the SI ratio, 0.736-0.837 for the absolute SI ratio.The absolute SI ratio reduction rate was significantly associated with pTRG and predicted favorable responses to CRT. Measurement of the diameter reduction rate is convenient and reliable in predicting favorable responses.

Bonhomme V.,University of Liège | Boveroux P.,ICM | Boveroux P.,University of Liège | Hans P.,University of Liège | And 5 more authors.
Current Opinion in Anaesthesiology | Year: 2011

PURPOSE OF REVIEW: To describe recent studies exploring brain function under the influence of hypnotic anesthetic agents, and their implications on the understanding of consciousness physiology and anesthesia-induced alteration of consciousness. RECENT FINDINGS: Cerebral cortex is the primary target of the hypnotic effect of anesthetic agents, and higher-order association areas are more sensitive to this effect than lower-order processing regions. Increasing concentration of anesthetic agents progressively attenuates connectivity in the consciousness networks, while connectivity in lower-order sensory and motor networks is preserved. Alteration of thalamic sub-cortical regulation could compromise the cortical integration of information despite preserved thalamic activation by external stimuli. At concentrations producing unresponsiveness, the activity of consciousness networks becomes anticorrelated with thalamic activity, while connectivity in lower-order sensory networks persists, although with cross-modal interaction alterations. SUMMARY: Accumulating evidence suggests that hypnotic anesthetic agents disrupt large-scale cerebral connectivity. This would result in an inability of the brain to generate and integrate information, while external sensory information is still processed at a lower order of complexity. © 2011 Wolters Kluwer Health | Lippincott Williams &Wilkins.

Gastric and esophageal adenocarcinomas (GEA) are among the leading causes of cancer-related death worldwide. Despite a decline in the incidence of gastric adenocarcinomas, incidence of oesophagogastric junction adenocarcinoma is rising rapidly in occidental countries. Surgical resection being the only curative treatment and the 5-year survival rate depending on pTNM stage, treatment approach remains challenging for oncologists. Several treatment modalities including systemic chemotherapy have been evaluated to prevent recurrences and improve overall survival. The UK-MAGIC and FNCLCCFFCD trials showed survival benefit with preoperative chemotherapy in operable gastric and lower oesophageal cancers, and those results had impact on clinical practice in Europe. Novel strategies such as the induction chemotherapy followed by preop-CRT, targeted therapies added to perioperative chemotherapy or the use of new cytotoxic regimens are being assessed to improve current standards and facilitate the delivery of more tailored therapeutic interventions. © 2013 Springer-Verlag France.

Simarro G.,ICM | Orfila A.,CSIC - Mediterranean Institute for Advanced Studies | Galan A.,ETSICCP
Coastal Engineering | Year: 2013

This work focuses on linear shoaling performance of low order Boussinesq-type equations. It is shown that the linear shoaling errors can be important in well known equations in the literature. New sets of coefficients are presented for three well known sets of equations. The sets are found so as to minimize a global linear error that includes celerity and shoaling errors. Finally, a new set of enhanced bilayer low order equations is presented, with much improved linear behavior (errors in wave celerity and wave amplitude below 1% up to kh=. 20). For completeness, the equations are written in their fully nonlinear version, and the nonlinear coefficients are also given. © 2013.

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