L’exploration axillaire en pratique quotidienne dans le parcours diagnostique d’un cancer du sein<br/>Axillary staging in daily practice in the diagnosis of breast cancer

When a breast cancer is diagnosed, the quality of the evaluation before treatment is essential to guide the therapeutic decision. The staging axillary is necessary because it estimates the regional extension of the disease, which makes it a paramount prognosis factor. Some different preoperative medical imaging can reveal metastasis axillary nodes. However, the axillary ultrasound remains the reference imaging and it also leads the biopsies too. Since theACOSOG-Z0011 trial, we are facing a therapeutic deescalation in the axillary surgery. According to recent results, we can note that the position of the axillary imaging is more and more important. The purpose of the ultrasound is to avoid a two-stage dissection after a positive sentinel lymph node when the ACOSOG-Z0011 criteria are not met.

Résumé
Lors de la découverte d’un cancer du sein, la qualité du bilan préthérapeutique est essentielle afin d’orienter la décision thérapeutique. L’exploration axillaire est primordiale, car elle évalue l’extension régionale de la maladie, ce qui en fait un des facteurs pronostiques majeurs. Différents examens d’imagerie préopératoires peuvent révéler une atteinte de ces ganglions axillaires. Cependant, l’imagerie de référence reste l’échographie axillaire, qui permet également de guider des prélèvements. Depuis l’étude ACOSOGZ0011, nous sommes face à une désescalade thérapeutique de la chirurgie axillaire. Selon des résultats récents, on constate que la place de l’imagerie axillaire est encore plus importante. Le but de l’échographie est d’éviter un curage en deux temps après un ganglion sentinelle positif lorsque les critères de l’ACOSOG-Z0011 ne sont pas remplis.     

Protocole d’IRM abrégée pour le diagnostic et le dépistage du cancer du sein<br/>Abbreviated Breast MRI for Diagnostic and Screening of Breast Carcinoma

Breast cancer is the first female cancer in France and its early detection is essential. Breast MRI is an element of choice in its diagnosis but it has high direct and indirect costs because of its duration which slows down its wider use. Given its elements, the use of an abbreviated protocol develops to overcome these disadvantages. Early literature data suggests that this faster examination also allows for a shorter interpretation time. In addition, the sensitivity and specificity of the examination are not inferior to that of the complete protocol. This article explains the new concept and its interest, compares it to the complete protocol and evokes the future prospects and in particular the addition of sequences with high temporal resolution.

Résumé
Le cancer du sein est le premier cancer féminin en France, et sa détection précoce est indispensable. L’IRM mammaire est un élément de choix dans son diagnostic mais présente des coûts directs et indirects élevés, notamment du fait de sa durée qui ralentit son utilisation plus large. Compte tenu de ses éléments, l’utilisation d’un protocole abrégé se développe pour pallier ces inconvénients. Les premières données de la littérature tendent à penser que cet examen plus rapide permet également une durée d’interprétation plus courte. De plus, la sensibilité et la spécificité de l’examen ne sont pas inférieures à celles du protocole complet. Cet article explique ce nouveau concept et son intérêt, le compare au protocole complet et évoque les perspectives futures et notamment à l’adjonction de séquences à haute résolution temporelle.     

Place des CTC et de l’ADN circulant dans la prise en charge du cancer du sein<br/>CTC and cDNA in Breast Cancer Management

It has been known for a long time that circulating tumor cells (CTC) as well as circulating tumor DNA (ctDNA) can be detected. However, only recent technical advances allowed evaluating the interest of CTC and ctDNA in breast cancer. In both early and metastatic breast cancers, CTC detection is a recognized factor for poor outcome. Nevertheless, CTC detection does not impact cancer management yet. The use of ctDNA in daily practice will require validation by prospective data. But ctDNA seems particularly promising both for residual disease evaluation and identification of tumor clones harbouring mutations (PI3KC, ESR1) and may predict efficacy or resistance to treatments.

Résumé
Si la présence de cellules tumorales circulantes (CTC) et d’ADN tumoral circulant (ADNtc) est connue de longue date, seuls les progrès technologiques récents ont permis d’évaluer l’intérêt de cette approche dans le cancer du sein. La détection de CTC, tant pour les cancers du sein localisés que métastatiques, est un facteur de mauvais pronostic établi, mais qui ne permet pas de proposer de prise en charge spécifique. L’usage de l’ADNtc nécessite des validations prospectives, mais semble particulièrement prometteur pour la recherche de maladie résiduelle ou l’identification de clones tumoraux porteurs de mutations (PI3KCA, ESR1) permettant de prédire l’efficacité ou la résistance thérapeutique.     

桑黄液体发酵生产多糖工艺研究

目的 考察不同培养条件对桑黄菌液体发酵生产多糖的影响.方法 通过正交试验设计,对不同培养基种类、起始pH值、发酵温度和摇床转速进行优化,在此工艺基础上,采用5L发酵罐进行发酵放大试验.结果 采用添加0.3 9/L维生素B1和0.3 g/L维生素B2的PD培养基,起始pH值5,发酵温度28℃,摇床转速180 r/min条件下,桑黄菌摇瓶发酵液中胞内多糖和胞外多糖分别为5.80、2.37 g/L;5 L发酵罐发酵液中桑黄胞内多糖和胞外多糖分别为5.85、2.30 g/L.结论 桑黄液体发酵可获得桑黄多糖,本实验结果为桑黄液体发酵工业化生产提供参考.     

早期梅尼埃病患者前庭诱发肌源性电位的特征

目的 建立听力室前庭诱发肌源性电位（VEMPs）潜伏期、耳间潜伏期差值、振幅比及耳间不对称率等参数的正常值,分析早期梅尼埃病患者的VEMPs特征。方法 随机选取听力正常的健康成人39例,用于建立VEMPs正常值范围并用作健康对照;对单侧发病的早期梅尼埃病患者37例,行双侧VEMPs检测,分析其VEMPs特征。结果 37例单侧发病的早期梅尼埃病患者中,患侧未能引出者11例,双侧未能引出者4例,另外15例患侧VEMPs的异常表现可为p13或n23潜伏期延长、耳间潜伏期差值延长、振幅增强或减弱等,总异常率为81.08%。结论 当VEMPs的耳间潜伏期差值表现为延长、振幅表现为增强或减弱时,对早期梅尼埃病的诊断有显著意义。     

‘Mate’ Intake,Hormone-Based Risk Factors and Breast Cancer: a Case-Control Study

Previous reports on the inverse association between ‘mate’ intake (infusion of Ilex Paraguariensis herb) and breastcancer (BC) risk led us to consider two main roles for the infusion: as a substantial antioxidant contributor and asa hormone regulator, particularly through anti-aromatase capacities. Since menstrual-reproductive risk factors forBC reflect women’s estrogenic exposure during the reproductive lifespan, and considering that ‘mate’ intake exertsputative stronger protection among high antioxidant contributors, we attempted to analyze interactions among theinfusion, hormon-linked reproductive factors and BC risk, which have hitherto remained unexplored. We analyzed adatabase of 572 BC incident cases and 889 controls. Women were interviewed with a specific questionnaire featuringsocio-demographic, lifestyle and reproductive variables (age at menarche, 1st live birth and menopause; number of livebirths; breastfeeding months), and a food frequency questionnaire, focusing on ‘mate’ intake (consumer status, dailyintake, age at start, age at quit, duration of habit). Odds ratios (OR) and their 95% confidence Intervals were calculatedthrough unconditional logistic regression, adjusting for relevant potential confounders. ‘Mate’ intake showed stronginverse associations with some high-risk hormone-related factors: early menarche, nulliparity, low breastfeeding, longreproductive years and high number of ovulatory cycles. Moreover, all subsets of high dietary energy demonstratedeven stronger associations. In conclusion, regarding exposure to known hormone risk factors, we found strong inverseassociations between high ‘mate’ intake and BC, which were greater among those consuming higher calorific diets.Our analyses support possible combined antioxidant and antiestrogenic effects for ‘mate’ infusions.     

Reduced dose of Bacillus Calmette-Guérin versus full dose of Bacillus Calmette-Guérin for non-muscle-invasive bladder cancer after transurethral resection bladder tumor: a meta-analysis of randomized controlled trials

Background Bladder cancer is widely known as the most common malignant tumor in the urinary tract,with 75％-85％ of patients suffering from nonmuscle invasive bladder cancer (NMIBC).However,the optimal d...     

Spatial Distribution of Head and Neck Cancer in Chiang Mai,Thailand

Background: The incidence of Head and neck (HN) cancers in Thailand is rising and survival rates not improving. Variations of its incidence among geographical areas may due to various contributing factors. Methods: We focused on data from 25 districts within Chiang Mai province, Thailand. The temporal change was described separately into two periods, 2007-2012 and 2013-2018. The OpenBUGS and the Quantum Geographic Information System were utilized to determine the geographical patterns in the incidence of HN cancer and focus on oropharynx. Results: The number of new cases of HN cancer was 1,186, of which 835 cases (70%) were male. Among those patients 548 diagnosed in 2007-2012 and 638 diagnose in 2013-2018. High risk patterns of both overall HN and oropharyngeal cancer incidences were found in the central and southern areas of the province in 2007-2013. However, the geographical patterns of the incidence of oropharyngeal cancer showed the changed pattern, with high RR in central and northern areas in more recent period. Over two periods, the RR of the cancers incidence decrease. The RR of oropharyngeal increased in Fang district and it remained high in Mueang district. Conclusion: This study have highlighted specific areas with a high risk of head and neck cancer and oropharyngeal cancer incidences in Chiang Mai province, along with the spatial inequalities in their distributions, with cluster formation. These results may be helpful in guiding any strategy put in place to respond to the high risk incidence of the cancers in specific areas.     

Manual Lymphatic Drainage for Upper Limb Lymphedema: A Clinician’s Perspective for its Adaptation<br/>Adapter le Drainage Lymphatique Manuel pour le Lymphœdème du Membre Supérieur: Point de vue de Cliniciens

Upper limb lympedema is a frequent consequence of breast cancer treatment. The International Society of Lymphology recommends physical therapy for lymphedema management. This treatment includes a combination of manual lymphatic drainage and high-compression bandaging. Actually, the effectiveness of manual lymphatic drainage remains an area of controversy, especially because of the many different techniques called “manual lymphatic drainage” since 1930. The purpose of this review was to emphasise the efficacy of these different techniques according to physiological data and evidence-based practice. To improve the manual lymphatic drainage efficiency, the pressure, sometimes important, should be tailored to each edema and the techniques had to consider altered lymphatic drainage patterns. The methods used by physical therapist in the studies should be specified for higher lightness.

Résumé
Le lymphœdème du membre supérieur est une séquelle du traitement des cancers du sein. Le traitement physique des lymphœdèmes est recommandé par la Société internationale de lymphologie. Il associe drainage lymphatique manuel et bandages de décongestion. Le drainage lymphatique manuel a fait l’objet de critiques quant à son effi- cacité. Or depuis son invention dans les années 1930, de très nombreuses techniques s’intitulent « drainage lymphatique manuel ». Les auteurs distinguent l’efficacité de ces différentes techniques en fonction des données de la physiologie lymphatique et de la démonstration de ses effets basée sur les faits. Pour améliorer son efficacité, le drainage lymphatique manuel doit être appliqué sur l’œdème avec une pression adaptée à la consistance de l’œdème, parfois élevée. Les manœuvres doivent prendre en considération les trajets remaniés des collecteurs lymphatiques. Les études qui l’utilisent doivent décrire la technique utilisée.     

恶性黑棘皮病并发Leser-Trélat征1例

患者男,72岁。全身褶皱部、乳晕肥厚、色素沉着3个月,周身泛发性丘疹伴剧痒2个月。皮肤科情况:颈部、腋窝、腹股沟、肛周皮肤肥厚、色素沉着,呈绒毛状或乳头瘤样增生,双侧乳头和乳晕角化、色素沉着,颈部、躯干及四肢散在米粒至黄豆大肤色至淡褐色角化性丘疹及斑丘疹。皮损组织病理示(上胸部):表皮角化过度,棘层肥厚,乳头瘤样增生,基底层色素增加;(右侧腹股沟):表皮中度角化过度,乳头瘤样增生,乳头似指样向上凸出,棘层中度肥厚,基底层色素增加,真皮浅层少许淋巴细胞浸润。诊断:恶性黑棘皮病并发Leser-Trélat征。