Five to 7% of breast cancers affect women under 40 years old. The survival of these patients has been improved thanks to therapeutic advances, often to the detriment of their fertility. The objective of this study is to evaluate the activity of oncofertility and the future of young women with breast cancer managed at the Montpellier University Hospital.
This is a retrospective study including women aged from 18 to 43 years-old diagnosed with breast cancer and referred in oncofertility consultation at the Montpellier University Hospital between July 2011 and December 2018.
190 patients were eligible, three refused to participate to the study, hence 187 patients were included. We estimate that only 33% of young breast cancer patients potentially eligible for fertility preservation (FP) benefited from an oncofertility consultation in our region. Of these 187 patients, 58 (31%) underwent ovarian stimulation for oocyte or embryo vitrification. They were significantly younger: 32.9 vs 34.6 years old (P=0.01) and had fewer invaded lymph nodes. A total of 66 cycles were achieved and 11.4 oocytes or 3 embryos were vitrified per patient. The reuse rate was 3.6% with 91% of post cancer pregnancies being spontaneous.
The oncofertility care network seems effective at the regional level. Enhancing health professionals\' awareness and creating a regional register could improve our long-term follow-up.

Hormone deprivation therapies play a key role in the treatment of prostate cancer. These treatments require standardized care and regular monitoring. The objective of this work was to review the different hormonal therapies available, their side effects and the role of a coordinating nurse in the management of these therapies. First generation hormone therapy is the standard treatment for metastatic prostate cancer. In the past years, second generation hormone therapies have been indicated in combination with first-generation hormone therapies at different stages of the disease. These molecules are responsible for several side effects that should be monitored and prevented. Thus, after an initial assessment, clinical and paraclinical follow-up are essential. Our center has set up monitoring by a coordinating nurse (IDEC) to optimize the education and follow-up of the patient, but also to provide psychosocial support adapted throughout the patient\'s care path under hormone therapy. This monitoring and information function by IDEC can be facilitated by new digital solutions.

BACKGROUND: The main objective of this study was to investigate the rate of ophthalmological screening for diabetic retinopathy in diabetic individuals in the Centre-Val de Loire (CVDL) region. This study secondarily aimed to identify factors associated with regular ophthalmological screening.
METHODS: Data were extracted from the French national healthcare database (SNDS). Individuals were identified on the basis of reimbursements for antidiabetic medications. Patients who were identified as having at least one reimbursed eye examination between 2015 and 2016 were considered as having regular follow-up.
RESULTS: In total, 118,181 diabetic individuals residing in CVDL were identified in the SNDS, and 74,048 had undergone ophthalmological screening. The rate of eye examination was 62.7% between 2015 and 2016 and was highly variable within the region (from 65.6% in Loiret to 54.0% in Cher). The main factors associated with regular eye screening were: follow-up with an established primary care physician (OR=2.88), regular follow-up with a diabetologist (OR=2.14), and regular follow-up with an internist (OR=1.57).
CONCLUSIONS: This study suggests that ophthalmological screening for diabetic retinopathy in individuals with diabetes in the CVDL region could be significantly improved, particularly in rural areas. Factors influencing compliance with follow-up are multiple but appear mainly related to the patients\' quality of overall medical management. These findings highlight the need for public health policies to improve detection and prevention of diabetic retinopathy by promoting comprehensive medical care for diabetic individuals.

OBJECTIVE: The spontaneous, sporadic and sometimes unpredictable nature of children\'s physical activity causes fluctuations in blood glucose level and challenges for children with type 1 diabetes. Physical activity monitoring has potential utility. In this study, we explored the perceptions of physical activity monitoring among health-care professionals and assessed the feasibility and acceptability of using it in the management of pediatric type 1 diabetes.
METHODS: Seven health-care professionals from 1 pediatric diabetes centre in the United Kingdom were involved in a focus group. Data were analyzed thematically. Physical activity monitoring using a wrist-worn monitor was tested for feasibility with 13 children aged 7 to 11 years with type 1 diabetes. The primary outcome was feasibility (i.e. recruitment, adherence, data completion, adverse events and acceptability). Secondary measures were glycemic control, parental self-efficacy for diabetes management and parental fear of hypoglycemia.
RESULTS: Health-care professionals valued having an awareness of the level, type and intensity of children\'s physical activity. They identified unmet training and resource needs that would facilitate them in being able to give physical activity advice to children and families. Recruitment rate was 20%, adherence to the activity monitoring was good and the study completion rate was 62%. No adverse events were reported. Physical activity monitoring was considered acceptable by parents.
CONCLUSIONS: Physical activity monitoring could be a feasible part of routine clinical practice, but further research is needed to understand whether health-care professionals are best placed to implement it and what impact it has on health outcomes.

The assessment of tumour response during and after radiotherapy determines the subsequent management of patients (adaptation of treatment plan, monitoring, adjuvant treatment, rescue treatment or palliative care). In addition to its role in extension assessment and therapeutic planning, positron emission tomography combined with computed tomography provides useful functional information for the evaluation of tumour response. The objective of this article is to review published data on positron emission tomography combined with computed tomography as a tool for evaluating external radiotherapy for cancers. Data on positron emission tomography combined with computed tomography scans acquired at different times (during, after initial and after definitive [chemo-]radiotherapy, during post-treatment follow-up) in solid tumours (lung, head and neck, cervix, oesophagus, prostate and rectum) were collected and analysed. Recent recommendations of the National Comprehensive Cancer Network are also reported. Positron emission tomography combined with computed tomography with (18F)-labelled fluorodeoxyglucose has a well-established role in clinical routine after chemoradiotherapy for locally advanced head and neck cancers, particularly to limit the number of neck lymph node dissection. This imaging modality also has a place for the evaluation of initial chemoradiotherapy of oesophageal cancer, including the detection of distant metastases, and for the post-therapeutic evaluation of cervical cancer. Several radiotracers for positron emission tomography combined with computed tomography, such as choline, are also recommended for patients with prostate cancer with biochemical failure. (18F)-fluorodeoxyglucose positron emission tomography combined with computed tomography is optional in many other circumstances and its clinical benefits, possibly in combination with MRI, to assess response to radiotherapy remain a very active area of research.

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.

BACKGROUND: Our work aimed to investigate the illnesses unrelated to systemic sclerosis (IUSS), diagnosed among patients with systemic sclerosis (SSc) throughout their follow-up in a referral tertiary care center.
METHODS: All the patients with SSc followed in the Internal Medicine Department of the University Hospital between October, 2014 and December, 2015, were included. We specifically reviewed the medical records of the patients who exhibited IUSS, defined as an illness that could not be considered as a typical clinical manifestation or as a usual complication of the disease.
RESULTS: Two hundred patients were included, and 38 IUSS were diagnosed among 31 SSc patients, over a 4 years median follow-up period. These diagnoses included vascular diseases (26%), heart diseases (21%), neoplasia (8%), infectious diseases (6%), autoimmune diseases (5%), endocrinopathies (5%), and others (24%). The median follow-up time before IUSS diagnosis was two years. Seventeen (45%) of these diagnoses were considered in patients showing suggestive clinical signs. A specific therapy was delivered in 25 cases (66%). Group comparisons revealed that dyslipidemia was more frequent in patients with IUSS (OR = 2.6 [1.1-1.5]; p = 0.014), while no differences were found for the other characteristics. Especially, no association between auto-antibodies specificity and the occurrence of IUSS was found.
CONCLUSIONS: This study focused on IUSS in SSc patients and highlights the need for a polyvalent clinical approach all along the follow up of SSc patients.

To date, physical activity (PA) programs for overweight and obese people are built around recommendations established for the general population. However, these people have special characteristics that require adapted coaching. In order to begin this work of recommendations, the objective of this article was to list the criteria usually used to describe and study PA programs for overweight and obese people and its associated postprogram follow-up. A systematic review of both meta-analyses and systematic reviews related to PA programs in the management of overweight and obesity has highlighted that few descriptive elements of programs are systematically reported, and that PA programs are rarely sufficiently detailed to be able to calculate a PA dose or to compare the different programs. These convergences, disparities or gaps in the description of PA programs, led us to initiate a reflection on the interest of these criteria as well as on the interest of their systematization in weight management program design, including PA. We hope that will be a first step towards facilitating the development of recommendations for PA management of overweight and obesity. Novelty Objective: to identify criteria used to describe PA programs in the management of overweight and obesity. Criteria to systematize: data to calculate PA dose; description of program individualization strategy. Criteria to develop: drop-out rate as an indicator of program adaptation; description of fatigue management strategy.
À ce jour, les programmes d’activité physique (AP) visant les personnes atteintes de surpoids et d’obésité s’organisent autour des recommandations érigées pour la population générale. Toutefois, ces personnes présentent des caractéristiques particulières qui nécessitent un accompagnement adapté. Afin de pouvoir amorcer un travail de recommandation, l’objectif de cet article était de répertorier les critères utilisés pour décrire et étudier les programmes d’AP à destination des personnes atteintes de surpoids et d’obésité et les suivis post-programmes. Une revue systématique des méta-analyses et revues systématiques portant sur la prise en charge du surpoids et de l’obésité adulte a permis, notamment, de mettre en évidence que peu d’éléments descriptifs des programmes sont rapportés de manière systématique, et que les programmes sont rarement suffisamment détaillés pour pouvoir calculer une dose d’AP ou permettre leur comparaison. Ces convergences, disparités ou manques dans la description des programmes d’AP, ont permis d’engager une réflexion sur l’intérêt des différents critères ainsi que sur l’intérêt de leur systématisation dans les dispositifs de prise en charge de la gestion du poids incluant l’AP, pour ce que nous espérons être une première étape vers l’élaboration de recommandations en matière de prise en charge du surpoids et de l’obésité par l’AP. Les nouveautés Objectif : répertorier les critères de description des programmes d’AP dans la prise en charge du surpoids et de l’obésité. Critères à systématiser : calcul dose d’AP, individualisation programme. Critères à développer : taux d’abandon comme indicateur d’adaptation du programme, stratégie de gestion de la fatigue.

Metastatic testicular germ cell tumors are rare entities with a high cure rate owing to their major chemosensitivity. Current guidelines should be strictly followed to ensure maximal cure rate. Germ cell tumor treatment requires multidisciplinary skills and is based on cisplatin-based chemotherapy. The current challenge for these patients with favorable prognosis is to limit over- or under-treatment. Centralization of care for patients with these rare cancers is a key point to achieve the best chance of cure.

OBJECTIVE: The proportion of successfully treated tuberculosis (TB) patients remains below the WHO target in France, because of a high proportion of loss to follow-up. We aimed to identify factors associated with loss to follow-up in northern France, a low-incidence area.
METHODS: Between 1997 and 2017, all consecutive patients diagnosed with TB at the Tourcoing Hospital, except those infected with multidrug-resistant or extensively drug-resistant strains, were included in a retrospective cohort study. A logistic regression analysis was performed to determine factors associated with loss to follow-up.
RESULTS: One hundred and ninety patients were included. Previous TB treatment was reported in 32 patients (17%), extrapulmonary TB in 107 (56%), and HIV infection in 44 (23%). The proportion of loss to follow-up was 15%. In multivariate analysis, the risk of loss to follow-up decreased in case of first TB treatment (OR 0.36; 95% CI: 0.14-0.92, P=0.03) and increased in non-HIV-infected patients (OR 7.67; 95% CI: 1.00-59.0, p=0.05). Support for compliance was more frequent in HIV-infected patients (23% vs. 7%, p=0.005).
CONCLUSIONS: The proportion of loss to follow-up was high. HIV infection was associated with a lower risk of loss to follow-up, likely to be due to more frequent support for compliance.