Predictive factors associated with involved margins in breast cancer treated with neoadjuvant chemotherapy followed by breast-conserving therapy.

INTRODUCTION: This study sought to identify predictive factors of involved surgical margins in breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) to help guide the surgical procedure. MATERIALS AND METHODS: Retrospective study of patients who had BCS after NAC between January 2008 and December 2013. OUTCOME MEASURE: tumor-involved margin, defined by tumor cells on ink for invasive cancer and tumor-free margin < 2 mm for DCIS. RESULTS: Ninety-seven patients were included. The median age of patients was 46 years old [28-71]. The initial average tumor size was 47.8 mm [+/- 18.6]. Twelve patients (12.4%) had involved tumor margins on final histology after BCS and NAC. According to the multivariate model including only preoperative variables of positive margins, initial ultrasound tumor size ≤ 27 mm (p = 0.045) and low SBR grade (p = 0.009) were independently associated with tumor-involved margins. According to the multivariate model including pre- and postoperative variables of positive margins, ductal carcinomain situ was also independently associated with tumor-involved margins (p = 0.021). CONCLUSION: Initial ultrasound tumor size ≤ 27 mm and low SBR grade were independently associated with tumor-involved margins. These preoperative data were very helpful to guide the surgical procedure in breast cancer.

[Migraine: from generic recommendations to practical taking in charge]. / Migraine: des recommandations générales a la prise en charge pratique.

Although with an 11% prevalence migraine is a major public health problem, many patients are not satisfied with its handling by medical professionals. Migraine is a clinical diagnosis based on typically lateralized throbbing headache with nausea and/or photo- and phonophobia. It can in some be preceded by an aura with transient focal neurological symptoms. There are several "red flags" of clinical presentation, however, that should induce further examination with brain imaging studies. Treatment is based on identifying and avoiding provoking factors, on treating attacks with rescue medication (simple pain killers or triptans), on identifying conditions for a prophylactic treatment by one of several possible substance classes, and most importantly, on establishing a solid therapeutic relationship with the patient.

[Shining light on translational research in deep brain stimulation]. / Optogénétique: ouvrir de nouveaux horizons thérapeutiques dans la stimulation cérébrale profonde.

For the last decade, optogenetics has revolutionised the neurosciences by enabling an unprecedented characterisation of the circuits involved in brain diseases, in particular addiction, depression, and obsessive compulsive disorders (OCD) and other anxiety disorders. Recently, the technique has also been used to propose blueprints for novel treatments of these diseases. For many reasons, optogenetics cannot be applied to humans applications anytime soon; we therefore argue that an intermediate step would be novel deep brain stimulation (DBS) protocols that emulate successful optogenetic "treatments" in animal models. Here we provide a roadmap of a translational path to rational, optogenetically inspired DBS protocols to refine existing approaches and expand it to novel indications.