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A jointly prepared, interagency (US Environmental Protection Agency [USEPA] and the US Nuclear Regulatory Commission [USNRC]), §316(a) Technical Guidance Manual has been the primary guide to ecological studies of thermal discharges at power plants since 1977. It reflected contemporary ecological theory, which assumed that undisturbed populations and ecosystems possessed a balanced and relatively unchanging structure and function that could be disrupted by addition of heat from a thermal discharge. It was intended primarily to facilitate the licensing of proposed nuclear power plants and thus focused on predictive assessments. Since 1977, however, scientific and regulatory contexts of §316(a) assessments have changed. Ecologists abandoned the notion of "balance" in populations and ecosystems and now recognize that natural systems are always changing spatially and temporally. Regulatory emphasis has shifted from predictive assessments at new plants, largely based on thermal-tolerance laboratory data, to retrospective assessments based on field data at operating plants. We suggest updates to thermal-assessment studies based on modern ecological theory and recent thermal-assessment practice. The concepts we outline are fully consistent with statutory language and may assist in design and implementation of study plans by applicants and their consultants, development of discharge permits by USEPA or state agencies, and reviews of assessment documents by interested public and environmental organizations. Integr Environ Assess Manag 2022;18:459-468. © 2021 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental ToxicologyChemistry (SETAC).

Cooling-water intakes often entrain large numbers of larval and juvenile fish, leading to questions why a water intake on the Columbia River, USA, with axial flow, cylindrical screens on a T-screen...

Manipulation of water velocities and turbulence using pumps, propellers, or jets is a promising alternative to physical water control structures to guide fish towards traps or fishways. Sea lamprey (Petromyzon marinus) are a species of concern in much of their native and invasive ranges, and their improved guidance could benefit management actions for both conservation and control. The flow velocity enhancement system (FVES), an emergent technology that uses a Venturi pump to generate a plume of turbulence, has shown promise guiding downstream migrating fish in slow-moving or static water conditions formed by large reservoirs, but is untested for guidance of upstream swimming fish in low current environments. The FVES had minimal impact on depth averaged velocity profiles, but produced elevated levels of turbulence. Changes in spatial distribution and number of turns suggest sea lamprey detect and are mildly attracted to turbulence induced by the FVES. These results demonstrate the potential of induced turbulence as a guidance mechanism for upstream migrating sea lamprey, but more extensive testing is needed to show the full utility of this approach.

Breast reconstruction is becoming increasingly important in the management of breast cancer. Among breast reconstruction with flap, latissimus dorsi flap is the most frequent technique used in France. Lipofilling's emergence led to changes for using latissimus dorsi flap in breast reconstruction. The aim of this study was to compare postoperative complications following conventional latissimus dorsi (CLD) flap versus muscle-sparing latissimus dorsi (MSLD) flap breast reconstruction.Data from 96 patients, who underwent CLD flap or MSLD flap breast reconstruction, were retrospectively collected from January 2018 to December 2019 in Georges-Francois Leclerc Cancer Center in France. Uni- and multivariate analyses, using a logistic regression, were performed to define operative factors and postoperative morbidity associated with surgical technique and evaluate whether MSLD flap could be associated with less postoperative outcome.After univariate analysis, factors significantly associated with MSLD flap were reduced surgical time (p0.001), reducing seroma and punctures (p0.001), postoperative complications of donor site (p=0.09), and a shorter length hospital stay (p0.001). After multivariate analysis, a shorter length hospital stay was significantly associated with the muscle-sparing group (OR=0.47, 95% CI (0.30-0.73), p0.001).This is the first French study comparing postoperative complications following the two techniques of latissimus dorsi flap breast reconstruction. In this study, the hospital stay was significantly decreased with MSLD flap compared with the CLD flap breast reconstruction. Both seem to be reliable methods with few complications.

Introduction/Background* The management of ovarian cancer is based on a combination of surgery and chemotherapy. The aim of surgery is to achieve zero residual tumour at the end of the procedure. In advanced stage ovarian cancer, two therapeutic approaches are possible: primary debulking surgery, or primary chemotherapy followed by interval debulking surgery. The primary objective of this study was to describe overall survival (OS) in FIGO stage III and IV ovarian cancers according to the therapeutic sequence (i.e. primary surgery or interval surgery). Methodology We performed a retrospective, observational study using data from the gynecological cancer registry of the Cote d’Or, for patients diagnosed with FIGO stage III or IV ovarian cancer between 1998 and 2015. We recorded FIGO stage, histological type, treatment and completeness of cytoreduction. Result(s)* In total, 460 patients were included. OS at 5 years was 47% in patients with primary surgery, versus 38% in patients with interval surgery (p=0.06). Five-year OS was 45% in patients with complete cytoreduction, versus 30% in those with incomplete cytoreduction (p Conclusion* OS appears to be slightly better in patients receiving primary surgery, and when cytoreduction is complete. Every effort should be made during surgery to achieve complete cytoreduction, by an experienced team. Primary surgery should be preferred in these patients.

Background The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. Patients and methods The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. Results A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. Conclusions In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years., Highlights • A reduction of the number of cancer patients attending cancer centers was observed in France from January to July 2020. • This reduction was observed only for newly diagnosed patients. • The reduction of new diagnosis was more pronounced in women, for breast cancer, and prostate cancer, and nonmetastatic cancer. • No compensation was observed for the last months of 2020. The magnitude of delays may be larger in centers within the same country. • An estimation of the excess cancer death resulting from these delays is presented.

Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process.Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care.One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%).Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.

Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period.Recommendations based on the consensus conference model.In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies.During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.

Introduction/Background Standard of care worldwide of locally advanced cancer tend to be non surgical (chemoradiation therapy) with no certainty if this attitude improves survival or not. Therefore, it is important to assess the value of hysterectomy in addition to chemoradiation therapy in this context. The sole randomized controlled trial (Morice 2012) designed to answer a similar question was closed early due to poor accrual and included 61 women, reported no difference in overall and recurrence-free survival between chemoradiation therapy and hysterectomy versus chemoradiotherapy alone. Methodology Data from 1,963 patients with cervical cancer were collected retrospectively from1 January 2000 to 31 December 2016, from the FRANCOGYN database, pooling data from 12 centres. Survival was determined using the Kaplan-Meier method. Univariate and multivariate analyses were performed to define prognostic factors of survival. Patients included had IB2 to IIB FIGO stage. Results 739 were included with a mean age of 53.5 years (±13.5). 634 women had available data of imaging after chemoradiotherapy. Management according to the presence of residue on imaging is presented on figure 1. 376 women had hysterectomy. There were significant differences for the 5-year Overall Survival (OS) rates between women who underwent hysterectomy and women who did not (p There were also significant differences for the 5-year Disease-Free Survival (DFS) rates between the two groups (p Conclusion A potential positive effect of hysterectomy after chemoradiation therapy for stage IB2 to IIB cervical cancer should be considered. Disclosure Nothing to disclose.

The aim of this study was to compare the value ofFifty-one women with HER2-positive breast cancer treated with trastuzumab plus taxane-based NAC were retrospectively included from January 2005 to December 2015. ForFor CGFL/Curie nomogram's performances, Se, Sp, PPV and NPV were respectively: 76% (95%CI: 58-90%), 57% (95%CI: 43-66%), 55% (95%CI: 42-65), 77% (95%CI: 59-90%). For PETCGFL/Curie nomogram and PET

Afin de diminuer lamorbidite du curage axillaire (CA) et le taux de reintervention apres procedure du ganglion sentinelle (GS), l’utilisation de modeles predictifs d’envahissement des ganglions non sentinelles (GNS) en cas de GS metastatique peut etre utile dans la prise en charge des patientes. Avant de pouvoir etre utilises en pratique courante, ces modeles doivent etre valides sur des cohortes independantes de patientes avec une methodologie rigoureuse. Les criteres de validation sont la discrimination, la calibration et l’interet clinique qui reposent, d’une part, sur l’analyse du taux de faux-negatifs et, d’autre part, sur l’efficacite du modele, c’est-a-dire sa capacite a selectionner un nombre suffisant de patientes. Cet article a pour but de rappeler les differents types de modeles predictifs utilises et leur definition et de presenter et comparer les differents modeles publies permettant d’estimer le risque d’envahissement du GNS en cas de GS positif.

Les agriculteurs en zone irriguee sont confrontes a une pression croissante pour preserver la ressource en eau. Cette situation les amene d'une part, a economiser l'eau en mettant l'accent sur des productions moins consommatrices, d'autre part, a mieux valoriser les quantites utilisees. Plusieurs strategies sont envisageables comme modifier les choix d'assolement ou adapter les modes de conduite des cultures. Ces strategies peuvent avoir des consequences importantes sur l'organisation des filieres aval, notamment a l'echelle de bassins d'approvisionnement de l'industrie agro-alimentaire. Cet article propose une analyse des impacts et des consequences economiques de fortes restrictions d'eau, a l'echelle des filieres. Cette analyse a ete mise en oeuvre en France sur le cas de la nappe de Beauce, avec la participation des acteurs des filieres locales. Elle permet d'analyser les adaptations et les strategies de chacun face a des baisses de volumes d'eau disponibles. Elle met en evidence les interactions entre les operateurs d'une meme filiere et les interactions entre differentes filieres. (Resume d'auteur)

Introduction La gigantomastie est une mastite inflammatoire benigne rare caracterisee par une hypertrophie mammaire diffuse, rapide et excessive. Elle survient le plus souvent a la puberte ou pendant la grossesse, mais est parfois d’origine iatrogene, auto-immune ou idiopathique. Observation Le cas rapporte est celui d’une jeune femme caucasienne de 34 ans qui etait suivie depuis 2010 pour un syndrome auto-immun biologique avec anticorps anti-nucleaires positifs (1/1280), anti-ADN natifs (35U/mL), anti-cardiolipides (IgG > 160, IgM = 32), diminution des fractions C3 (0,59) et C4 (0,08), decouverts sur un syndrome de Raynaud isole a capillaroscopie normale. Pour sa premiere grossesse (2015), la patiente etait mise sous antiagregants plaquettaires et hydroxychloroquine en prophylaxie. Le poids etait de 55 kg. A 15 semaines d’amenorrhees (SA), elle se plaignait d’une inflammation et augmentation genante de la taille de sa poitrine (tour de poitrine a 115 cm, fleche droite a 36 cm et gauche a 33 cm). L’echographie mammaire etait normale. La biopsie mammaire confirmait le diagnostic de gigantomastie gravidique. Il n’y avait ni dysthyroidie ni anticorps anti-TPO mais des anticorps anti-recepteurs a l’acetylcholine tres positifs (a 245, a electroneuromyogramme normal) et une hyperprolactinemie (difficile d’interpretation en per-partum) a IRM hypophysaire negative. Une corticotherapie a 15 mg/jour et du quinagolide etaient debutes (gigantomastie gravidique et dysimmunite). A 30 SA, le tour de poitrine etait de 173 cm (fleche gauche a 50 cm et droite a 52 cm). La patiente beneficiait d’une cesarienne prophylactique a 33SA (poids = 90 kg) pour une dyspnee aigue sur hyper-debit cardiaque (15 litres/minutes en echographie) multifactoriel (dont un « vol mammaire » sur sa gigantomastie). A trois mois de l’accouchement, les corticoides etaient arretes ; le bilan auto-immun etait toujours positif. La chirurgie mammaire etait initiee (mammectomie bilaterale avec preservation du mamelon, insertion d’une prothese mammaire, lipomatose avec changement de prothese, re-implantation du mammelon) ; aucune manifestation myasthenique n’etait note. Cependant, dix-huit mois apres l’accouchement et trois mois apres l’arret de l’hydroxychloroquine, la patiente decrivait l’apparition d’un ptosis a bascule (confirmation de myasthenie a l’electroneuromyogramme, sans thymome au TDM). Discussion La survenue d’une gigantomastie au cours de la grossesse est une maladie rare (une centaine de cas rapportes dans la litterature) qui survient habituellement chez les femmes caucasiennes et multipares. Cette maladie pourrait etre secondaire a une hypersensibilite des recepteurs hormonaux ou une maladie auto-immune sous-jacente declenchee par la grossesse. Quelques cas de gigantomastie ont ete decrits en association au lupus erythemateux dissemine, la myasthenie, la thyroidite d’Hashimoto, et la polyarthrite rhumatoide. Dans la revue de la litterature de Anne Jancey, 115 cas de gigantomastie ont ete rapportes (41 cas de gigantomastie gravidique dont seulement deux associees a une myasthenie, 57 cas de gigantomastie juvenile, 13 cas de formes idiopathiques et 4 induites par des medicaments) ; pour les formes idiopathiques, 3 etaient associees a une maladie auto-immune et 1 aura ete revelatrice d’un LES, suggerant la presence d’un terrain auto-immun sous-jacent. Touraine et son equipe ont decrit 8 cas de gigantomastie survenue chez des patientes presentant une maladie auto-immune. Les dosages hormonaux sont le plus souvent negatifs, l’echographie mammaire rassurante et la biopsie mammaire elimine d’eventuels diagnostics differentiels (tumeur phyllode, fibroadenome, lymphome non-hodgkinnien et lymphome lymphoblastique). La gigantomastie peut se compliquer de douleurs, d’ulcerations, de necrose, d’infections et d’hemorragie. S’il existe plusieurs alternatives therapeutiques, le traitement de choix reste la mastectomie bilaterale complete, en post partum, en diminuant significativement le risque de recidives. Les alternatives medicamenteuses (bromocriptine, tamoxifene, danazol et medroxyprogesterone/corticoides) apportent des reponses inconstantes et souvent temporaires. La bromocriptine semble cependant apporter les meilleurs resultats sur les symptomes de la gigantomastie. Conclusion Cette observation est donc originale a deux points de vue : par la survenue d’une gigantomastie gravidique sur terrain dysimmunitaire (re-insistant sur le lien possible entre maladies auto-immunes et gigantomastie) et par la survenue d’une myasthenie clinique au cours du suivi (plusieurs mois apres mise en evidence d’anticorps anti-recepteurs de l’acetylcholine positifs).

Introduction In breast cancer, early changes in tumor glucose metabolism and blood flow (BF) have been evaluated separately and are proposed to monitor tumor response to neoadjuvant chemotherapy (NAC). This study used a single 18FDG dual-acquisitions PET exam to simultaneously assess these imaging features and to answer two questions: (i) Do tumor blood flow (BF) and tumor metabolism correlated with the same pre-therapy tumor phenotypic features? (ii) Are early changes in tumor BF and metabolism in response to NAC comparable or complementary in the ability to predict the final pathological response (pCR)? Methods 150 women with breast cancer and an indication for NAC were prospectively included. Women had a baseline PET exam with a 2-min chest-centered dynamic acquisition, started at the time of 18F-FDG injection, followed by a delayed static PET acquisition performed at 90 min. Tumor BF was calculated from the dynamic image using a validated first-pass model, and tumor glucose metabolism (SUVmax) was calculated on the delayed acquisition. This dual-PET acquisition was repeated after the first cycle of NAC to measure early changes in tumor BF (?BF) and SUVmax (?SUVmax). Results A weak correlation was found between baseline tumor SUVmax and BF ( r = 0.22; P = 0.006). A higher baseline SUVmax was associated with all biological markers of tumor aggressiveness, including the Triple Negative Breast Cancer (TNBC) subtype ( P P = 0.002). Mean?SUVmax was −44.6 ± 26.9% and varied significantly depending on the SBR grade, the overexpression of HER2+ and the lack of hormonal receptor expression ( P = 0.04, P P = 0.01, respectively). Mean?BF was −26.9 ± 54.3% and a drastic reduction was only observed in HER2-positive subtypes (−58.7 ± 30.0%), supporting the anti-angiogenic effect of Trastuzumab. Changes in tumor glucose metabolism outperformed changes in BF to predict pCR in all tumor subtypes: the AUC of?SUVmax (ROC curves analyses) were 0.82, 0.65 and 0.90 in the TNBC, HER2-positive and Luminal subtypes, respectively. Conclusion Of the two biological hallmarks of cancer evaluated in this study, the reduction in tumor metabolism was more accurate than the reduction in BF to predict pCR in the different subtypes of breast cancer.

Triple-negative breast cancer (TN), as defined by the triple negativity in immunohistochemistry: the absence of estrogen receptor, progesterone receptor and the absence of overexpression or amplification of HER2, corresponds to 15 % of invasive breast cancers. This is a very heterogeneous group of tumors both at the genomic and transcriptomic level and at morphological, clinical and prognostic level. Although there are some good prognosis forms, the majority of TN tumors is characterized by a poor prognosis with a greater frequency of visceral metastases and a maximum risk of relapse in the first two years after diagnosis. Systemic adjuvant treatment with chemotherapy is almost always indicated. The surgical treatment and radiotherapy treatment should be comparable to the other subtypes and obey the same rules of oncologic surgery. TN tumors are not associated with a higher risk of locoregional relapse after conservative treatment and adjuvant radiotherapy. Optimization of systemic therapies is currently and for the last decade a challenge. A number of targeted therapies and efficiency biomarkers identification of these targeted therapies is essential to allow significant progress in optimizing systemic therapy for these tumors.

The main goal of preoperative chemotherapy is to reduce the size of the tumor and allow conservative treatment. Neoadjuvant treatment can affect axillary status with a downstaging in one third of the cases. For these patients, the benefit of axillary node dissection is questioned and the sentinel node biopsy (SLNB) seems to be a relevant option. However, the timing of performing SLNB is still debated especially for clinical negative patients with negative axillary ultrasound before preoperative chemotherapy. For axillary positive nodes proved by biopsy/cytology before preoperative chemotherapy, SLNB can be an option if there is a good clinical and radiological response.

The year 2006 marked two milestones in the Columbia River Basin and the Pacific Northwest region's efforts to rebuild its once great salmon and steelhead runs—the 25th anniversary of the creation of the Northwest Power and Conservation Council and the 10th anniversary of an amendment to the Northwest Power Act that formalized scientific peer review of the council's Fish and Wildlife Program and its varied individual projects. The authors of this article served as peer reviewers in the last decade. Restoration efforts in the Columbia River constitute a massive long-term attempt at fisheries and ecosystem restoration. In this article we examine some of the lessons we learned in reviewing the research, monitoring, and evaluation efforts of projects and their effects on advancing knowledge (i.e., adaptive management) in the Columbia River Basin Fish and Wildlife Program, one of the most ambitious and expensive long-term ecological restoration programs in the United States.

Axillary lymph node dissection (ALND) is recommended for patients with breast cancer metastasis to a sentinel lymph node (SLN). However in 40-70% of cases, the SLN may be the only area of metastasis in the dissected axillary contents. In patients with a positive SLN, independently predictive factors for non-SLN metastasis include size of the primary tumor, the size of the SLN metastases, extracapsular extension, and the proportion of positive SLN's among all identified SLNs. Some authors have developed scores and nomograms to estimate a patient's risk for non-SLN metastases. These scores and nomograms should be applied prospectively to a large numper of SLN positive patients who thereafter undergo completion ALND. It is necessary to verify the predictive validity of these scores before we recommend the abandonment of ALND in patients with a very low likelihood of non-SLN metastasis. In this article we review the various predictive factors of non-SLN involvement and the scores or nomograms which have been developed to predict the likelihood of a positive ALND after a positive SLN biopsy.

In the last few years, diagnostics of high-risk breast lesions (atypical ductal hyperplasia [ADH], flat epithelial atypia [FEA], lobular neoplasia: atypical lobular hyperplasia [ALH], lobular carcinoma in situ [LCIS], radial scar [RS], usual ductal hyperplasia [UDH], adenosis, sclerosing adenosis [SA], papillary breast lesions, mucocele-like lesion [MLL]) have increased with the growing number of breast percutaneous biopsies. The management of these lesions is highly conditioned by the enlarged risk of breast cancer combined with either an increased probability of finding cancer after surgery, either a possible malignant transformation (in situ or invasive cancer), or an increased probability of developing cancer on the long range. An overview of the literature reports grade C recommendations concerning the management and follow-up of these lesions: in case of ADH, FEA, ALH, LCIS, RS, MLL with atypia, diagnosed on percutaneous biopsies: surgical excision is recommended; in case of a diagnostic based on vacuum-assisted core biopsy with complete disappearance of radiological signal for FEA or RS without atypia: surgical abstention is a valid alternative approved by multidisciplinary meeting. In case of ALH (incidental finding) associated with benign lesion responsible of radiological signal: abstention may be proposed; in case of UDH, adenosis, MLL without atypia, diagnosed on percutaneous biopsies: the concordance of radiology and histopathology findings must be ensured. No data is available to recommend surgery; in case of non-in sano resection for ADH, FEA, ALH, LCIS (except pleomorphic type), RS, MLL: surgery does not seem to be necessary; in case of previous ADH, ALH, LCIS: a specific follow-up is recommended in accordance with HAS's recommendations. In case of FEA and RS or MLL combined with atypia, little data are yet available to differ the management from others lesions with atypia; in case of UDH, usual sclerosing adenosis, RS without atypia, fibro cystic disease: no specific follow-up is recommended in agreement with HAS's recommendations.

Conversely to breast cancer, few data and guidelines are available to explore and manage benign breast disorders. Therefore, the Collège national des gynécologues et obstétriciens français (CNGOF - French College of Gynaecologists and Obstetricians) decided to establish clinical practice guidelines for benign breast tumour (BBT). CNGOF appointed a committee with responsibility for selecting experts, compiling questions and summarizing the recommendations. The summary of valid scientific data for each question analyzed by the experts included a level of evidence, based on the quality of the data available and defined accordingly rating scheme developed by the Haute Autorité de santé (French National Authority for Health).

Breast sonography is required with mammogram to explore clinical breast mass (grade B), colored unipore breast nipple discharge (grade C), or mastitis (grade C). Bi-RADS system is recommended to describe and classify breast-imaging abnormalities. For breast abscess, a percutaneous biopsy is recommended in case of mass or persistent symptoms (grade C). For mastodynia, when breast imaging is normal, no MRI neither breast biopsy is recommended (grade C). Percutaneous biopsy is recommended for BI-RADS 4-5 mass (grade B). For persistent erythematous breast nipple or atypical eczema lesion, a nipple biopsy is recommended (grade C). For distortion and asymmetry, a vacuum core needle biopsy is recommended because of the risk of underestimation by simple core needle biopsy (grade C). For BI-RADS 4-5 microcalcifications without ultrasound signal, a vacuum core needle biopsy of at least 11 gauges is recommended (grade B); in the absence of microcalcifications on radiograph carrots, additional samples are recommended (grade B). For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial with atypia, radial scar, mucocele with atypia, surgical excision is commonly recommended (grade C). Expectant management is feasible after multidisciplinary concertation. For these lesions, when excision is not in sano, no new excision is recommended except for pleomorphic or with necrosis CLIS (grade C). For grade 1 phyllode tumour, in sano surgical resection is recommended; for grade 2 phyllode, 10-mm margins are recommended (grade C). For breast papillary without atypia, complete disappearance of the radiologic signal is recommended (grade C). For breast papillary with atypia, complete surgical excision is recommended (grade C).

White sturgeon (Acipenser transmontanus) has recruitment failure or severe interannual variability in much of its range. Exceptions are Columbia River below Bonneville Dam, Snake River below Hells Canyon Dam, lower Fraser River, and Sacramento River. Since rivers were impounded or flows regulated, once-continuous populations now isolated by natural barriers or dams often have not reproduced successfully, despite successful spawning events. Research has not adequately explained recruitment failures or why certain populations are successful. This paper proposes that submerged riparian habitat during seasonal high water is needed for early development. Where recruitment is successful, channels are complex and floodable riparian vegetation or rocky substrate is abundant. There, spawning occurs in turbulent zones upstream (1–5 km) of seasonally submerged riparian habitat, eggs can disperse into inundated habitat and adhere to newly wetted surfaces for incubation, yolk-sac larvae can move to riparian crevices f...

We report the effects of short daily exposures to sublethal increases in water temperature during the egg and larval stages on the development of the schooling behavior of the little sand smelt Atherina mochon. The experiments were conducted to simulate the periodic exposure of different developmental stages to a transient thermal plume caused by the discharge of heated effluents into the spawning environment. Exposures were administered for eggs only, larvae only, and both eggs and larvae and consisted of nonlethal increases in water temperature from a 20°C acclimation temperature to 28.5°C over a period of 30 min, maintenance at 28.5°C for 15 min, and a gradual reduction to 20°C over 35 min. Heat treatments were administered to the egg-only and larvae-only groups for 10 consecutive days each; those administered at both the egg and larval stages were for 20 consecutive days. Behavioral testing of larval fish at 10, 15, 20, 25, 30, and 35 d posthatch showed significant modification or retardation...

To assess the prognostic factors of T1 and T2 infiltrating lobular breast cancers, and to investigate predictive factors of axillary lymph node involvement.This is a retrospective multicentric study, conducted from 1999 to 2008, among 13 french centers. All data concerning patients with breast cancer who underwent a primary surgical treatment including a sentinel lymph node procedure have been collected (tumors was stage T1 or T2). Patients underwent partial or radical mastectomy. Axillary lymph node dissection was done systematically (at the time of sentinel procedure evaluation), or in case of sentinel lymph node involvement. Among all the 8100 patients, 940 cases of lobular infiltrating tumors were extracted. Univariate analysis was done to identify significant prognosis factors, and then a Cox regression was applied. Analysis interested factors that improved disease free survival, overall survival and factors that influenced the chemotherapy indication. Different factors that may be related with lymph node involvement have been tested with univariate than multivariate analysis, to highlight predictive factors of axillary involvement.Median age was 60 years (27-89). Most of patients had tumours with a size superior to 10mm (n=676, 72%), with a minority of high SBR grade (n=38, 4%), and a majority of positive hormonal status (n = 880, 93, 6%). The median duration of follow-up was 59 months (1-131). Factors significantly associated with decreased disease free survival was histological grade 3 (hazard ratio [HR]: 3,85, IC 1,21-12,21), tumour size superior to 2cm (HR: 2,85, IC: 1,43-5,68) and macrometastatic lymph node status (HR: 3,11, IC: 1,47-6,58). Concerning overall survival, multivariate analysis demonstrated a significant impact of age less than 50 years (HR: 5,2, IC: 1,39-19,49), histological grade 3 (HR: 5,03, IC: 1,19-21,25), tumour size superior to 2cm (HR: 2,53, IC: 1,13-5,69). Analysis concerning macrometastatic lymph node status nearly reached significance (HR: 2,43, IC: 0,99-5,93). There was no detectable effect of chemotherapy regarding disease free survival (odds ratio [OR] 0,8, IC: 0,35-1,80) and overall survival (OR: 0,72, IC: 0,28-1,82). Disease free survival was similar between no axillary invasion (pN0) and isolated tumor cells (pNi+), or micrometastatic lymph nodes (pNmic). There were no difference neither between one or more than one macromatastatic lymph node. But disease free survival was statistically worse for pN1 compared to other lymph node status (pN0, pNi+ or pNmic). Factors associated with lymph node involvement after logistic regression was: age from 51 to 65 years (OR: 2,1, IC 1,45-3,04), age inferior to 50 years (OR 3,2, IC: 2,05-5,03), Tumour size superior to 2cm (OR 4,4, IC: 3,2-6,14), SBR grading 2 (OR 1,9, IC: 1,30-2,90) and SBR grade 3 (OR 3,5, IC: 1,61-7,75).The analysis of this series of 940 T1 and T2 lobular invasive breast carcinomas offers several information: factors associated with axillary lymph node involvement are age under 65 years, tumor size greater than 20mm, and a SBR grade 2 or 3. The same factors were significantly associated with the OS and DFS. The macrometastatic lymph node involvement has a significant impact on DFS and OS, which is not true for isolated cells and micrometastases, which seem to have the same prognosis as pN0.

Chinook salmon (Oncorhynchus tshawytscha), hatchery-reared as juveniles, returned to the upper Columbia River Basin in numbers exceeding broodstock and fishery needs during the spring of 2000. Plans to euthanize these adults were opposed by some regional stakeholders, who preferred letting them spawn naturally in streams also used by endangered spring-run chinook salmon. The National Marine Fisheries Service requested that the Independent Scientific Advisory Board review the scientific literature and conclude whether it was biologically sound to permit hatchery-origin adult salmon to spawn in the wild in large numbers. Substantial experimental evidence demonstrates that domestication selection can genetically alter hatchery populations in a few generations and that hatchery-origin adults returning from the ocean and spawning in the wild produce fewer progeny than adults of wild origin spawning in the wild. More limited evidence suggests that interbreeding between hatchery-origin adults and wild f...

Judgments of adverse environmental impact from cooling water intake structures need to be preceded by an appreciation of what is normal. In its report, Return to the River, the Independent Scientific Group (now called the Independent Scientific Advisory Board) — the scientific peer review arm of the Northwest Power Planning Council — advanced the notion of a ‘normative river ecosystem’ as a new conceptual foundation for salmonid recovery in the Columbia River basin. With this perspective, the sum of the best scientific understanding of how organisms and aquatic ecosystems function should be the norm or standard of measure for how we judge the effects of human activities on aquatic systems. For the best likelihood of recovery, key aspects of altered systems should be brought back toward normative (although not necessarily fully back to the historical or pristine state); new alterations should be judged for adversity by how much they move key attributes away from normative or what might be considered normal. In this paper, I ask what ‘normative’ is for the setting of cooling water intake structures and how this concept could help resolve long-standing disputes between groups interested in avoiding damage to all organisms that might be entrained or impinged and those who take a more population or community perspective for judging adverse environmental impact. In essence, I suggest that if a water intake does not move the aquatic ecosystem outside the ‘normative’ range, based on expressions of normalcy such as those discussed, then no adverse impact has occurred. Having an explicit baseline in normal or normative would place 316(b) analyses on the same conceptual foundation as 316(a) analyses, which strive to demonstrate the continuation of a balanced, indigenous community of aquatic organisms at the power station location.

We evaluated the literature on fish behavior as it relates to passage of fish near or through hydropower turbines. Our goal was to foster compatibility of engineered systems with the normal behavior patterns of fish species and life stages such that passage into turbines and injury in passage are minimized. In particular, we focused on aspects of fish behavior that could be used for computational fluid dynamics (CFD) modeling of fish trajectories through turbine systems. Salmon smolts approaching dams are generally surface oriented and follow flow. They can be diverted from turbines by spills or bypasses, with varying degrees of effectiveness. Smolts typically become disoriented in dam forebays. Those smolts drawn into turbine intakes orient vertically to the ceilings but are horizontally distributed more evenly, except as they are affected by intake-specific turbulence and vortices. Smolts often enter intakes while oriented with their heads upstream, but they may change orientation in the flow f...

The Columbia River once was one of the most productive river basins for anadromous salmonids on the West Coast of North America; however, its current runs total less than 10% of historic levels. The Independent Scientific Group (ISG) of the Northwest Power Planning Council reviewed regional salmon management actions described in the Columbia River Basin Fish and Wildlife Program and concluded that the current program is unlikely to recover declining salmon and steelhead stocks. Adoption of a salmon life history ecosystem concept as a guiding foundation is needed to recover depressed stocks. Increasing natural ecosystem processes and functions should rebuild salmon populations to more abundant, productive, and stable levels. Elements of a salmon recovery program that increase these normative conditions include restoration of habitat for all life history stages (including migrations), reduction of mortality sources (including harvesters), planning of hydropower mitigation measures in the context of...

Objectifs Le traitement des cancers du col uterin localement evolues repose sur une chimioradiotherapie concomitante suivie d’une curietherapie uterovaginale. Le benefice d’une hysterectomie de cloture reste debattu. Notre objectif principal etait de determiner l’impact d’une chirurgie de cloture sur la qualite de vie des patientes recevant une chimioradiotherapie concomitante suivie d’une curietherapie uterovaginale pour un cancer du col uterin localement evolue. Les objectifs secondaires etaient d’evaluer la survie sans recidive, la survie globale et la toxicite tardive des traitements. Patientes et methodes Le questionnaire de qualite de vie de l’European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 a ete adresse a toutes les patientes prises en charge pour un cancer du col uterin de stade IB2 a IIIB par chimioradiotherapie concomitante et curietherapie uterovaginale, suivie ou non d’une chirurgie de cloture, entre 2000 et 2012 dans le centre Georges-Francois-Leclerc a Dijon. Resultats Sur les 69 patientes sollicitees, 45 ont renvoye l’autoquestionnaire (65 %). Parmi elles, 58 % avaient eu une hysterectomie de cloture. En moyenne 6,5 annees (±3,1) apres le traitement, les patientes operees et non operees avaient des scores de qualite de vie globale moyens comparables : respectivement 65 ± 21 et 69 ± 18, (p = 0,60). A 4 ans, les patientes operees et non operees avaient un taux de survie globale respectivement de 93 % et 80 %, (p = 0,08) et un taux de survie sans recidive de 85 % et 77 % (p = 0,43). Les patientes operees n’ont pas significativement souffert de plus de complications tardives. Conclusions Dans notre population, nous n’avons pas mis en evidence de difference concernant la qualite de vie globale, la survie globale, la survie sans recidive, ni sur le taux de complications tardives selon que les patientes aient eu ou non une hysterectomie de cloture. Une evaluation de la qualite de vie sexuelle et de l’image de soi de ces patientes est en cours, grâce au questionnaire de l’EORTC CX24.

In its report, Return to the River, the Independent Scientific Group (now called the Independent Scientific Advisory Board—the scientific peer review arm of the Northwest Power Planning Council) advanced the notion of a “normative river ecosystem” as a new conceptual foundation for salmonid recovery in the Columbia River basin. With this perspective, the sum of the best scientific understanding of how organisms and aquatic ecosystems naturally function should be the norm or standard of measure for how we judge the effects of human activities on aquatic systems. For the best likelihood of recovery, key aspects of altered systems should be brought back toward normative (although not necessarily fully back to the historical or pristine state); new alterations should be judged by how much they move key functions away from normative or what might be considered as normal. In this paper, I ask what “normative” is for fish pathogens and how this concept could help resolve the long-standing disputes betwe...

4 pages; International audience; We report on the broadband resonant energy transfer processes observed in dye doped gold nanoshells, consisting of spherical particles with a dielectric core (SiO2) covered by a thin gold shell. The silica core has been doped with rhodamine B molecules in order to harness a coherent plasmon-exciton coupling between chromophores and plasmonic shell. This plasmon-exciton interplay depends on the relative spectral position of their bands. Here, we present a simultaneous double strong coupling plasmon-exciton and exciton-plasmon. Indeed, experimental observations reveal of a transmittance enhancement as function of the gain in a wide range of optical wavelengths (about 100 nm), while scattering cross sections remains almost unmodified. These results are accompanied by an overall reduction of chromophore fluorescence lifetimes that are a clear evidence of nonradiative energy transfer processes. The increasing of transmission in the range of 630-750 nm is associated with a striking enhancement of the extinction cross-section in the 510-630 nm spectral region. In this range, the system assumes super-absorbing features. This double behavior, as well as the broadband response of the presented system, represents a promising step to enable a wide range of electromagnetic properties and fascinating applications of plasmonic nanoshells as building blocks for advanced optical materials.

We developed a simulation model to predict instream flow effects on smolt production for fall chinook salmon ( Oncorhynchus tshawytscha ) in regulated rivers. The principal purpose of this model is to serve as a management tool to evaluate effects on salmon of instream releases from upstream reservoirs. The dramatic decline in chinook salmon in California rivers suggests a need for such a tool. We developed an individual-based and spatially explicit model to simulate the influences of riverine habitat on each lifestage leading to successful outmigration of chinook salmon. Model predictions of development, growth and survival showed good agreement with four years of field data collected on the Tuolumne River, California. Our analysis of parameter sensitivities identified flow-related redd mortality and temperature-related juvenile mortality as limitations on smolt production.

The south-eastern United States and Gulf Coast of Mexico is physiographically diverse, although dominated by a broad coastal plain. Much of the region has a humid, warm temperate climate with little seasonality in precipitation but strong seasonality in runoff owing to high rates of summer evapotranspiration. The climate of southern Florida and eastern Mexico is subtropical with a distinct summer wet season and winter dry season. Regional climate models suggest that climate change resulting from a doubling of the pre-industrial levels of atmospheric CO 2 may increase annual air temperatures by 3-4°C. Changes in precipitation are highly uncertain, but the most probable scenario shows higher levels over all but the northern, interior portions of the region, with increases primarily occurring in summer and occurring as more intense or clustered storms. Despite the increases in precipitation, runoff is likely to decline over much of the region owing to increases in evapotranspiration exceeding increases in precipitation. Only in Florida and the Gulf Coast areas of the US and Mexico are precipitation increases likely to exceed evapotranspiration increases, producing an increase in runoff (...)

Large catchment basins may be viewed as ecosystems in which natural and cultural attributes interact. Contemporary river ecology emphasizes the four-dimensional nature of the river continuum and the propensity for riverine biodiversity and bioproduction to be largely controlled by habitat maintenance processes, such as cut and fill alluviation mediated by catchment water yield. Stream regulation reduces annual flow amplitude, increases baseflow variation and changes temperature, mass transport and other important biophysical patterns and attributes. As a result, ecological connectivity between upstream and downstream reaches and between channels, ground waters and floodplains may be severed. Native biodiversity and bioproduction usually are reduced or changed and non-native biota proliferate. Regulated rivers regain normative attributes as distance from the dam increases and in relation to the mode of dam operation. Therefore, dam operations can be used to restructure altered temperature and flow regimes which, coupled with pollution abatement and management of non-native biota, enables natural processes to restore damaged habitats along the river’s course. The expectation is recovery of depressed populations of native species. The protocol requires: restoring peak flows needed to reconnect and periodically reconfigure channel and floodplain habitats; stabilizing baseflows to revitalize food-webs in shallow water habitats; reconstituting seasonal temperature patterns (e.g. by construction of depth selective withdrawal systems on storage dams); maximizing dam passage to allow recovery of fish metapopulation structure; instituting a management belief system that relies upon natural habitat restoration and maintenance, as opposed to artificial propagation, installation of artificial instream structures (river engineering) and predator control; and, practising adaptive ecosystem management. Our restoration protocol should be viewed as an hypothesis derived from the principles of river ecology. Although restoration to aboriginal state is not expected, nor necessarily desired, recovering some large portion of the lost capacity to sustain native biodiversity and bioproduction is possible by management for processes that maintain normative habitat conditions. The cost may be less than expected because the river can do most of the work.

Clays are of paramount importance for soil stability, but also in applications ranging from oil recovery to composites and hydrogels. Generically, clays are divided into two subclasses: macroscopically swelling, ‘active’ clays that have the capacity for taking up large amounts of water to form stable gels, and ‘passive’ or non-swelling clays; the former stabilize soils whereas the latter are known to lead to landslides. However, it has been unclear so far what mechanisms underlie clay swelling. Here, we report the first observation of a temperature-induced transition from a passive to an active, swelling clay. We propose a simple description of the swelling transition; while net attractive interactions are dominant at low temperatures so that the clay particles remain attached to each other in stacks, at higher temperatures it is energetically favourable for the clay to swell due to the entropy that is gained by counterions which are liberated during swelling. Open access article. Creative Commons Attribution License 4.0.

Les fils enduits de Triclosan® (antimicrobien) ont ete developpes afin de prevenir la colonisation microbienne des fils de suture.