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Management of nontuberculous mycobacterial Pulmonary disease refractory to guideline-based therapy: A systematic review.
No full textInternational audienceIntroduction: Managing patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) unresponsive to guideline-based therapy remains challenging due to limited treatment options and complex disease progression. This study systematically reviewed existing literature on management strategies and emerging therapeutic approaches for refractory NTM-PD.Methods: We systematically reviewed studies on NTM-PD treatment failure published from inception until 31 January 2024, examining associated factors, intensification strategies, and supportive measures. Twenty-five studies met the inclusion criteria, mostly retrospective and observational, focusing on pulmonary disease by Mycobacterium avium complex and Mycobacterium abscessus species. Findings were synthesised qualitatively because of substancial heterogeneity in study design and outcomes.Results: Before treatment intensification or de-escalation, the impact of antibiotics on health-related quality of life and microbiological factors, including acquired resistance and pathogen shifts, should be assessed. Severe baseline radiological findings and multiple prior regimen modifications were associated with lower treatment success. Evidence for supportive interventions-such as nutritional counselling, respiratory rehabilitation, and psychosocial support-remains limited. Intermittent intravenous antibiotics may aid symptom control. Depending on NTM species, additional antibiotics have been explored to intensify treatment, though evidence is largely observational. Surgical resection may be considered for localised disease, but recurrence risk remains substantial, particularly with preoperative positive cultures. Novel therapeutic approaches remain under investigation as potential alternatives.Discussion: This systematic review underscores the complexity of managing refractory NTM-PD, highlighting the role of treatment intensification, symptom control, supportive measures, and knowledge gaps. While no standardised approach exists, individualised strategies incorporating clinical, microbiological, and radiological factors remain essential for optimising patient outcomes
Early Clinical and Molecular Biomarkers in Patients With Advanced Ovarian Cancer Undergoing Neoadjuvant Chemotherapy: CHIVA Phase II GINECO Trial
No full textInternational audiencePURPOSE Platinum-based chemotherapy and surgery are pivotal in managing ovarian cancer (OC), yet prognosis remains poor, and early biomarkers for platinum resistance are needed. The neoadjuvant setting provides an opportunity to evaluate tumor responsiveness to platinum chemotherapy in vivo. This study evaluated whether early measures of platinum response combined with molecular alterations could predict surgical outcomes and survival in patients with OC treated with neoadjuvant chemotherapy (NACT). METHODS The CHIVA study enrolled stage III/IV OC patients eligible for three cycles NACT with or without nintedanib, followed by interval debulking surgery. Archival samples underwent extensive sequencing to detect clinically relevant variants and copy number alterations and calculate genomic instability (GIS). Early chemotherapy response measures—cancer antigen 125 kinetics by KELIM, major pathologic response, GIS status, tumor infiltrating lymphocytes (TILs) abundance, and genomic alterations—were correlated with surgery completeness and survival. RESULTS Among 127 patients, the overall response rate was 44%, and the complete cytoreduction (CC0) rate was 54.8%. Homologous recombination deficiency (HRD) was identified in 56% of patients and was associated with better survival. The median progression-free survival was 21.4, 20.5, and 14.4 months in the BRCAmut , BRCAwt /GIS-high, and BRCAwt /GIS-low subgroups, respectively ( P = .001). Unfavorable KELIM predicted lower objective response rate, CC0, and shorter survival, while low intraepithelial TILs (ieTILs) correlated with poor outcomes. Multivariate analysis confirmed KELIM, HRD status, and ieTILs as independent biomarkers. CCNE1 amplifications, observed in 20% of patients, were associated with moderate chemotherapy sensitivity. CONCLUSION HRD status, KELIM, and TILs are key independent biomarkers in advanced OC. CCNE1 amplifications, although typically associated with platinum resistance, were linked to moderate chemotherapy sensitivity, defining an intermediate prognostic subgroup
Management of radiation-induced gynecological toxicities: AFSOS-SFCE-GFRCP clinical practice guidelines
No full textInternational audienceRadiation-induced gynecological toxicities are frequently under-recognized, under-diagnosed, and insufficiently managed. These adverse effects negatively impact patients' quality of life and may compromise oncological outcomes by delaying or interrupting cancer treatment. This guideline aims to define best clinical practices for the prevention, identification, and management of both acute and late radiation-induced gynecological toxicities. The French Association for Supportive Care in Cancer (AFSOS) convened a multidisciplinary task force to perform a literature review and apply a consensus methodology to establish these guidelines. External validation was conducted by an independent panel of experts. Optimal management involves a 3-phase approach: before, during, and after radiotherapy. Patients should receive pre-treatment counseling on potential gynecological and sexual side effects, along with preventive hygienic and dietary guidance. During treatment, acute toxicities such as vulvitis, vaginitis, urethritis, and proctitis should be actively managed. Post-radiotherapy care must address vaginal dryness, stenosis, synechiae, premature menopause, lymphedema, and sexual dysfunction, with integration of onco-sexological support as needed. Awareness and proactive management of radiation-induced gynecological toxicities are critical for maintaining quality of life and ensuring treatment continuity. This guideline provides structured recommendations to support clinicians in delivering comprehensive, patient-centered supportive care
Interictal epileptiform discharges are involved in momentary lapses of attention in children with epilepsy
No full textInternational audienceAbstract Objective Attention impairments are common in children with epilepsy and widely impact their quality of life. Interictal epileptiform discharges (IEDs) may induce subtle dysfunctions of various cognitive processes, but data regarding the impact of IEDs on sustained attention remain limited. The objective of the present study was to evaluate the impact of IEDs on continuous undivided attention in children with epilepsy, controlling for the number of treatments, type of epilepsy, frequency of seizures in the past year, age at onset, and comorbid attention disorder. Methods Using a computerized sustained attention test synchronized with the electroencephalogram in 61 children with diverse epilepsy syndromes, reaction time (RT), errors, attention stability over time, and the event‐related potential (ERP) in Pz (related to attentional engagement) were collected. The cumulative impact of IEDs was evaluated using multivariate models controlling for epilepsy‐related factors. The transient impact of IEDs was assessed by comparing responses in trials with and without IEDs. Results IEDs were associated with attention fluctuations independently from other epilepsy‐related factors. In terms of cumulative impact, a higher IED rate was associated with a poorer sustained attention performance over the entire task. In terms of transient impact, trials disrupted by IEDs were characterized by longer RT and a lower amplitude of the ERP extending over a long time window that included attentional processing (P300). Significance These results suggest that IEDs may negatively impact sustained attention, independently of other epilepsy‐related features. These findings support the hypothesis that IEDs could contribute to subtle attentional deficits and serve as potential biomarkers of abnormal brain function
ALGORITHME PLUG-AND-PLAY AVANT-ARRIÈRE POUR RESTAURER LES IMAGES LANDSAT : UNE ÉTAPE PRÉLIMINAIRE POUR DÉCOUVRIR L'HISTOIRE DES EAUX DE SURFACE
No full textInternational audienceThe temporal and spatial analysis of river dynamics is a key factor for studying and understanding human impacts on floodplains.To assess the changes taking place, it is necessary to have high-resolution images with a large spatial coverage and a high temporal revisit frequency over the long term. Satellite imagery meets several of these criteria. For instance, Sentinel data provide high-resolution images but only after 2015. Therefore, to study water surface evolution prior to this date, it is necessary to rely on other satellite images such as Landsat, which offers longer historical coverage, albeit with lower spatial resolution. In this study, we aim to increase the spatial resolution of Landsat data from 30 to 10 meters (resolution of Sentinel images). To achieve this goal, we develop an innovative single image super-resolution method based on a plug-and-play approach.L'analyse temporelle et spatiale de la dynamique fluviale est un facteur clé pour étudier et comprendre les impacts humains sur les plaines inondables.Pour évaluer les changements qui se produisent, il est nécessaire de disposer d'images haute résolution avec une large couverture spatiale et une fréquence de revisite temporelle élevée sur le long terme. L'imagerie satellite répond à plusieurs de ces critères.Par exemple, les données Sentinel fournissent des images haute résolution, mais uniquement après 2015. Par conséquent, pour étudier l'évolution de la surface de l'eau avant cette date, il est nécessaire de s'appuyer sur d'autres images satellites telles que Landsat, qui offre une couverture historique plus longue, mais avec une résolution spatiale inférieure. Dans cette étude, nous visons à augmenter la résolution spatiale des données Landsat de 30 à 10 mètres (résolution des images Sentinel). Pour atteindre cet objectif, nous développons une méthode innovante de super-résolution d'une seule image basée sur une approche plug-and-play
Spiral phyllotaxis in the moss Physcomitrium patens emerges from simple division rules of the apical cell
No full textInternational audienceIn many plants, leaves are arranged around the stem in a pattern called Fibonacci spiral phyllotaxis. These patterns have been well studied in flowering plants and are thought to arise from a spacing mechanism based on the cell-to-cell transport of the plant hormone auxin. This causes new primordia to emerge as far as possible from previous ones in the available space on multicellular meristems. However, it is not clear how a spacing mechanism can create spirals in a plant with a unicellular meristem. Through time-lapse imaging, quantification and computer modeling, we study the single tetrahedral apical stem cell of the moss Physcomitrium patens and the emergence of a spiral pattern of leaf-like structures. We find that the apical cell divides asymmetrically in a spiral pattern giving rise to a leaf progenitor daughter cell and another apical cell. Phyllotaxis, and ultimately the whole architecture of the shoot, is thus defined by the orientation of this cell division. The default division plane selection in plants (the 'shortest wall rule') is to choose a wall of minimal area through the cell centroid. Modeling shows that dividing the cell with a wall of minimal area through a displaced centroid is sufficient to explain the division asymmetry, as well as the division plane patterns leading to spiral phyllotaxis. Some cell types in flowering plants undergo a similar spiraling division plane pattern, suggesting this may be a common mechanism
Spatio‐temporal patterns and risk factors of wild boar–pig farm contact across Europe
No full textInternational audienceAbstract Diseases circulating at the wild–domestic animal interface are increasingly difficult to control due to human encroachment into wildlife habitats. Understanding the factors driving wild animals to visit livestock farms is crucial for reducing the risk of disease outbreaks with severe economic and social consequences. In this study, we quantified the contact rate at the wild boar–domestic pig interface across Europe using a large‐scale dataset of wild boar GPS tracking and domestic pig farm geolocations. We estimated wild boar contact rate with pig farms at hourly and monthly scales and analysed the influence of environmental, wild boar‐ and farm‐related variables. Across 187 tracked wild boars and 457 pig farms, we detected 3322 contact events, with a highly skewed contact distribution: only 5% of wild boars and 1% of farms accounted for 50% of all events. On average, each wild boar had 1.59 contacts per month with a given farm (95% CI: 1.33–1.85) and 2.58 contacts per month when considering all farms located within its monthly home range (95% CI: 1.62–3.53). Seasonal variation differed between sexes, with a bimodal distribution for males with contact rates peaking in March and August–September, and a slight increase in contact rate throughout winter for females. Monthly contact rate increased with forest cover, human footprint, wild boar population density and individual proximity to pig farms. Farms with more built infrastructure faced fewer contacts, and larger farms had higher contact rates. Contacts occurred mostly after sunset and around sunrise. Synthesis and applications . Our results highlight the need to incorporate wild boar spatio‐temporal behaviour and farm context into strategies aimed at reducing contact at the wild–domestic pig interface. While physical barriers and avoiding unintentional feeding remain essential, targeted measures during high‐risk periods, such as night‐time surveillance in summer and autumn, especially around large farms in wooded landscapes or areas with high wild boar density, could help reduce contact occurrence
La confirmation de la légalité de la directive (UE) 2022/2041
No full textInternational audienceConditions de travail, rémunération et négociation collective : des clarifications bienvenues - CJUE 11 novembre 2025, aff. C-19/23, Royaume de Danemark c/ Parlement européen et Consei
The Crucial Link: How Institutional Support Shapes the Professional Quality of Life of Foster Parents in France
No full textInternational audienceFoster parenting is a highly demanding caregiving profession that involves sustained emotional engagement with vulnerable children and significant institutional constraints. These demands may adversely affect foster parents’ professional well-being and professional quality of life. Within this context, institutional support provided by child welfare services represents a critical resource that may help buffer professional strain. The present study examined the role of perceived institutional support as a protective factor for foster parents’ professional well-being, with a specific focus on the mediating role of the three dimensions of Professional Quality of Life (ProQOL): burnout, secondary traumatic stress, and compassion satisfaction. The study was conducted among 1,181 foster parents working within the French child welfare system. Using mediation analyses, we examined both direct and indirect associations between perceived institutional support and professional well-being. Results showed that higher perceived institutional support was associated with better professional well-being and that this association was partially mediated by burnout, secondary traumatic stress, and compassion satisfaction. Perceived institutional support accounted for a substantial proportion of the variance in burnout (R² = 0.26) and professional well-being (R² = 0.33). These findings highlight the central role of institutional support in shaping foster parents’ professional experiences and underscore the importance of organizational resources aimed at preventing professional exhaustion and promoting sustainable foster care engagement
Spatial controls of homology search
No full textInternational audienceHomologous recombination is a conserved DNA double-strand break (DSB) repair pathway that uses an intact dsDNA molecule as a template. A filament of the RecA/Rad51 protein family catalyzes the search for this homologous template, in a process that minimally requires the collision of these two partners in the nuclear space. Orthogonal methodological developments recently revealed that this search for homology is a choreographed process under control by both 3D chromatin organizers of the structural maintenance of chromosomes (SMC) family and the structure and dynamics of the RecA/Rad51 filament. Here we review these advances that establish a novel framework for homology search, highlight the commonalities and distinctions between search facilitation strategies in eukaryotes and bacteria, and discuss outstanding open questions