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Background: While the management of nonmetastatic and oligometastatic rectal cancer has rapidly evolved over the last few decades, many grey areas and highly debated topics remain that foster significant variation in clinical practice. We aimed to identify controversial points and evidence gaps in this disease setting by systematically comparing recommendations from national and international clinical guidelines.Methods: Twenty-six clinical questions reflecting practical challenges in the routine management of nonmetastatic and oligometastatic rectal cancer patients were selected. Recommendations from the ESMO, NCCN, JSCCR, Australian and Ontario guidelines were extrapolated and compared using a 4-tier classification system (i.e., identical/very similar, similar, slightly different, different). Overall agreement between guidelines (i.e., substantial/complete disagreement, partial disagreement, partial agreement, substantial/complete agreement) was assessed for each clinical question and compared against the highest level of available evidence by using the χ2 statistic test.Results: Guidelines were in substantial/complete agreement, partial agreement, partial disagreement, and substantial/complete disagreement for 8 (30.8%), 2 (7.7%), 7 (26.9%), and 9 (34.6%) clinical questions, respectively. High level of evidence supported clinical recommendations in 3/10 cases (30%) where guidelines were in agreement and in 10/16 cases (62.5%) where guidelines were in disagreement (χ2 = 2.6, p = 0.106). Agreement was frequently reached for questions regarding diagnosis, staging, and radiology/pathology pro-forma reporting, while disagreement characterised most of the treatment-related topics.Conclusions: Substantial variation exists across clinical guidelines in the recommendations for the management of nonmetastatic and oligometastatic rectal cancer. This variation is only partly explained by the lack of supporting, high-level evidence. [ABSTRACT FROM AUTHOR]

Background: Extramammary Paget disease of the vulva (EMPV) is a rare skin disorder commonly seen in postmenopausal Caucasian females that appears clinically as red, eczematous, pruriginous, and sometimes painful lesions. Although most cases are noninvasive, EMPV may be associated with an underlying or distant adenocarcinoma. EMPV has a chronic and relapsing course. The reference treatment is based on local surgical excision with negative margins. However, disease frequently extends far from the visible lesion, and surgical margins are frequently positive. Topical photodynamic therapy (PDT) is an established treatment modality for various dermatooncologic conditions. For example, red light irradiation with the Aktilite CL 128 and Metvixia (Galderma SA) as a photosensitizing molecule is a conventional protocol approved and widely used in Europe for PDT treatment of actinic keratosis, but this treatment is not yet widely used for EMPV because it has never clearly been demonstrated and is very painful. Objective: The aim of the study is to investigate the efficacy and safety relating to the medical device PAGETEX as a new painless PDT device using Metvixia in the treatment of vulvar Paget disease. The primary end point is the disease control rate at 3 months in 30% of the patients included, defined as stability, partial response, or total response, considering the extent of the lesion. Secondary end points are the disease control rate at 6 months, patient quality of life, level of pain experienced by the patient at each PDT session, severity of erythema, presence of protoporphyrin IX in Paget cells after each PDT session, and overall satisfaction level of the patient. Methods: The trial is an interventional, exploratory, simple group, nonrandomized, and single center (Lille University Hospital) study. Twenty-four patients will be included according to Simon's optimal plan. Therapeutic procedure is based on a cycle of two PDT sessions with the PAGETEX medical device at 15-day intervals (Metvixia incubation during 30 minutes and 635 nm red light illumination with a low irradiance for 2 hours and 30 minutes for a total fluence of 12 J/cm²). At the assessment session, 3 months after inclusion, if the control of the disease is partial or null, the patient will complete another cycle of two PDT sessions. A final evaluation will be performed in all patients at 6 months. Analyses will be performed using SAS version 9.4 software (SAS Institute Inc). The characteristics of the patients at baseline will be described; qualitative variables will be described by numbers and percentages, and quantitative variables will be described either by the mean and standard deviation for Gaussian distribution or by the median and interquartile range (ie, 25th and 75th percentiles). The normality of the distributions will be tested by a Shapiro-Wilk test and checked graphically by histograms. Results: First patient was included in September 2019 and clinical investigations are planned until August 2022. The final results of this study are expected to be available in January 2023. Conclusions: This clinical trial aims to evaluate the efficacy and safety of a new PDT protocol for the treatment of EMPV. The PAGETEX device could become the treatment of choice if it is effective, painless, and easy to implement and use in hospitals. Trial Registration: ClinicalTrials.gov NCT03713203; https://clinicaltrials.gov/ct2/show/NCT03713203 International Registered Report Identifier (IRRID): PRR1-10.2196/15026 We help JMIR researchers to raise funds to pursue their research and development aimed at tackling important health and technology challenges. If you would like to show your support for this author, please donate using the button below. The funds raised will directly benefit the corresponding author of this article (minus 8% admin fees). Your donations will help this author to continue publishing open access papers in JMIR journals. Donations of over $100 may also be acknowledged in future publications. Suggested contribution levels: $20/$50/$100 [ABSTRACT FROM AUTHOR]

Background: Actinic keratosis (AK) is characterized by preinvasive, cancerous lesions on sun-exposed skin that negatively affect patient quality of life and may progress to invasive squamous cell carcinoma (SCC). If untreated, AK may either regress or progress to SCC, with significant morbidity and possible lethal outcomes. The most commonly used treatments for AK are cryotherapy, topical chemotherapy and, more recently, photodynamic therapy (PDT). This clinical study is part of a project that aims to create specific light-emitting fabrics (LEFs) that strongly improve the efficiency and reliability of PDT as a treatment for AK. Objective: This study aims to compare the efficacy and tolerability of a new PDT protocol involving the Flexitheralight device (N-PDT) with the classical protocol involving the Aktilite CL 128 device (C-PDT; Galderma Laboratories) for the treatment of AK. All participants receive both protocols. The primary objective of this study is to compare the lesion response rate after 3 months of N-PDT with C-PDT. Secondary objectives are evaluations of pain and local tolerance during treatment, clinical evolution of the subject's skin, and evaluations of patient quality of life and satisfaction. Methods: The study is a split-face, intraindividual comparison of two PDT protocols. The total number of patients recruited was 42. Patients were exposed to a continuous red light with the Aktilite CL 128 device on one side of the face and to fractionated red illumination with the new device, Flexitheralight, on the other side of the face. Males or females over the age of 18 years with a clinical diagnosis of at least 10 previously untreated, nonpigmented, nonhyperkeratotic grade I and II AK lesions of the forehead and/or scalp were included and were recruited from the Department of Dermatology of the Centre Hospitalier Universitaire de Lille. The patients came to the investigational center for one treatment session (day 1), and they were followed up after 7 days, 3 months and 6 months. A second treatment session was performed on day 111 in cases in which an incomplete response was observed at the 3-month follow-up. Data will be analyzed using SAS software version 9.4 (SAS Institute Inc). Continuous variables will be reported as means and standard deviations, and categorical variables will be reported as frequencies and percentages. The Shapiro-Wilk test will be used to assess the normality of the distribution. Results: The clinical investigation was performed by July 2018. Data analysis was performed at the end of 2018, and results are expected to be published in early 2019. Conclusions: This phase II clinical trial aims to evaluate the noninferior efficacy and superior tolerability of N-PDT compared to that of C-PDT. If N-PDT is both efficacious and tolerable, N-PDT could become the treatment of choice for AK due to its ease of implementation in hospitals. Trial Registration: ClinicalTrials.gov NCT03076918; https://clinicaltrials.gov/ct2/show/NCT03076918 (archived by WebCite at http://www.webcitation.org/771KA0SSK) International Registered Report Identifier (IRRID): DERR1-10.2196/11530 We help JMIR researchers to raise funds to pursue their research and development aimed at tackling important health and technology challenges. If you would like to show your support for this author, please donate using the button below. The funds raised will directly benefit the corresponding author of this article (minus 8% admin fees). Your donations will help this author to continue publishing open access papers in JMIR journals. Donations of over $100 may also be acknowledged in future publications. Suggested contribution levels: $20/$50/$100 [ABSTRACT FROM AUTHOR]

Background: Actinic keratosis (AK) is a common early in situ skin carcinoma caused by long-term sun exposure and usually develops on sun-exposed skin areas. Left untreated, AK may progress to squamous cell carcinoma. To prevent such risk, most clinicians routinely treat AK. Therapy options for AK include cryotherapy, topical treatments, curettage, excision surgery, and photodynamic therapy (PDT). Objective: The aim of this study is to assess the noninferiority, in terms of efficacy at 3 months, of a PDT protocol involving a new light-emitting device (PDT using the Phosistos protocol [P-PDT]) compared with the conventional protocol (PDT using the conventional protocol [C-PDT]) in the treatment of AK. Methods: In this randomized, controlled, multicenter, intra-individual, phase II noninferiority clinical study, subjects with AK of the forehead and scalp are treated with P-PDT on one area and with C-PDT on the contralateral area. In both areas, lesions are prepared and methyl aminolevulinate (MAL) is applied. Thirty minutes after MAL application, the P-PDT area is exposed to red light at low irradiance (1.3 mW/cm2) for 2.5 hours so that a light dose of 12 J/cm2 is achieved. In the control area (C-PDT area), a 37 J/cm2 red light irradiation is performed 3 hours after MAL application. Recurrent AK at 3 months is retreated. The primary end point is the lesion complete response rate at 3 months. Secondary end points include pain scores at 1 day, local tolerance at 7 days, lesion complete response rate at 6 months, cosmetic outcome at 3 and 6 months, and patient-reported quality of life and satisfaction throughout the study. A total of 45 patients needs to be recruited. Results: Clinical investigations are complete: 46 patients were treated with P-PDT on one area (n=285 AK) and with C-PDT on the contralateral area (n=285 AK). Data analysis is ongoing, and statistical results will be available in the first half of 2019. Conclusions: In case of noninferiority in efficacy and superiority in tolerability of P-PDT compared with C-PDT, P-PDT could become the treatment of choice for AK. Trial Registration: ClinicalTrials.gov NCT03076892; https://clinicaltrials.gov/ct2/show/NCT03076892 (Archived by WebCite at http://www.webcitation.org/779qqVKek) International Registered Report Identifier (IRRID): DERR1-10.2196/12990 We help JMIR researchers to raise funds to pursue their research and development aimed at tackling important health and technology challenges. If you would like to show your support for this author, please donate using the button below. The funds raised will directly benefit the corresponding author of this article (minus 8% admin fees). Your donations will help this author to continue publishing open access papers in JMIR journals. Donations of over $100 may also be acknowledged in future publications. Suggested contribution levels: $20/$50/$100 [ABSTRACT FROM AUTHOR]

Mineral amendments (lime as CaCO3, N as ammonitrate and NPKCa) were applied in 1973 to the floor of some plots located in an acidic beech forest (Fougeres state forest, eastern Brittany, France).Resulting modifications to humus structure and soil fauna composition were observed 22 years after amendment by comparison with control plots without amendment. Abundance and diversity of pedofauna (micro-,meso- and macrofauna) were estimated by Berlese funnel and formaldehyde methods. Micromorphological description of humus profiles and comparative quantification of their structure were achieved by digital image analysis. Humus structure in limed and NPKCa-treated plots had evolved from moder to mull-moder, whereas in N-treated plots it was unchanged and similar to the moder-type humus of control plots. Modifications in soil fauna were also observed, especially an increase in the lumbricid population. The observed changes in abundance and diversity differed between edaphic groups. Some effects of liming, like increase in numbers, were still present in NPKCa or limed plots, for example in pseudoscorpions (long-term effects). Lumbricid numbers (epigeic species) increased and remained higher in limed and NPKCa-treated plots than in N and control plots. Conversely, nitrogenous amendment did not induce similar changes, probably because of its soil acidifying effect. Nitrogenous amendment decreased numbers of oribatid mites and Collembola. These numbers are not different for limed and NPKCa plots in comparison with control ones." [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Despite new treatments, the HCC rate remains important, making it necessary to develop novel therapeutic strategies. Photodynamic therapy (PDT) using a Rose-Bengal (RB) photosensitizer (RB-PDT) could be a promising approach for liver tumor treatment. However, the lack of standardization in preclinical research and the diversity of illumination parameters used make comparison difficult across studies. This work presents and characterizes a novel illumination device based on one green light-emitting diode (CELL-LED-550/3) dedicated to an in vitro RB-PDT. The device was demonstrated to deliver a low average irradiance of 0.62 mW/cm 2 over the 96 wells of a multi-well plate. Thermal characterization showed that illumination does not cause cell heating and can be performed inside an incubator, allowing a more rigorous assessment of cell viability after PDT. An in vitro cytotoxic study of the RB-PDT on an HCC cell line (HepG2) demonstrated that RB-PDT induces a significant decrease in cell viability: almost all the cells died after a light dose irradiation of 0.3 J/cm 2 using 75 µM of RB (<10% of viability). In conclusion, the RB-PDT could be a therapeutic option to treat unresectable liver lesions and subclinical disease remaining in the post-resection tumor surgical margin.

In coffee, fruit production on a given shoot drops after some years of high yield, triggering pruning to induce resprouting. The timing of pruning is a crucial farmer's decision affecting yield and labour. One reason for fruit production drop could be the exhaustion of resources, particularly the non-structural carbohydrates (NSC). To test this hypothesis in a Coffea L. arabica agroforestry system, we measured the concentrations of NSC, carbon (C) and nitrogen (N) in leaves, stems and stumps of the coffee plants, 2 and 5 years after pruning. We also compared shaded vs full sun plants. For that purpose, both analytical reference and visible and near infrared reflectance spectroscopy (VNIRS) methods were used. As expected, concentrations of biochemical variables linked to photosynthesis activity (N, glucose, fructose, sucrose) decreased from leaves to stems, and then to stumps. In contrast, variables linked more closely to plant structure and reserves (total C, C:N ratio, starch concentration) were higher in long lifespan organs like stumps. Shading had little effect on most measured parameters, contrary to expectations. Concentrations of N, glucose and fructose were higher in 2-year-old organs. Conversely, starch concentration in perennial stumps was three times higher 5 years after pruning than 2 years after pruning, despite high fruit production. Therefore, the drop in fruit production occurring after 5-6 years was not due to a lack of NSC on plant scale. Starch accumulation in perennial organs concurrently to other sinks, such as fruit growth, could be considered as a 'survival' strategy, which may be a relic of the behaviour of wild coffee (a tropical shade-tolerant plant). This study confirmed that VNIRS is a promisingly rapid and cost-effective option for starch monitoring (coefficient of determination for validation, R2val = 0.91), whereas predictions were less accurate for soluble sugars, probably due to their too similar spectral signature., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Biomass production in ecosystems is a complex process regulated by several facets of biodiversity and species identity, but also species interactions such as competition or complementarity between species. For studying these different facets separately, ecosystem biomass is generally partitioned in two biodiversity effects. The composition effect is a simple, linear effect, and the interaction effect is a more subtle, nonlinear effect. Here we used a clustering approach (1) to separately and comprehensively capture all linear and nonlinear effects induced by both biodiversity effects on ecosystem functioning, and (2) to determine the functional composition at the origin of each biodiversity effect. We used data from the long-term Cedar Creek BioDIV experiment carried out over 22 yr, and we partitioned multiplicatively the biomass in composition and interaction effects. Both biodiversity effects were weakly correlated. Our clustering approach accurately explains and predicts each diversity effect over time: each one is modeled by a different functional composition. Even if environmental conditions and the strength of interaction effect strongly varied over time, the functional clusters of species that govern the interaction effect do not change over the 22 yr of the experiment. The functional composition governing the interaction effect is therefore very robust. In contrast, the functional clusters of species that govern the composition effect are less robust and change with environmental conditions. Understanding ecosystem functioning therefore requires that ecological properties are first partitioned by type, then each type of property is analyzed and modeled separately. Approaches without a priori groupings of species, such as functional clustering, appear particularly efficient and robust to unravel the web of species interactions, and identify the role played by species on biodiversity effects., (© 2021 by the Ecological Society of America.)

Photodynamic therapy (PDT) appears to be a promising strategy in biomedical applications. However, the complexity of its parameters prevents wide acceptance. This work presents and characterizes a novel optical device based on knitted light-emitting fabrics and dedicated to in vitro PDT involving low irradiance over a long illumination period. Technical characterization of this device, called CELL-LEF, is performed. A cytotoxic study of 5-ALA-mediated PDT on human cancer cell lines is provided as a proof of concept. The target of delivering an irradiance of 1 mW/cm 2 over 750 cm 2 is achieved (mean: 0.99 mW/cm 2 ; standard deviation: 0.13 mW/cm 2 ). The device can maintain a stable temperature with the mean thermal distribution of 35.1 °C (min: 30.7 °C; max: 38.4 °C). In vitro outcomes show that 5-ALA PDT using CELL-LEF consistently and effectively induced a decrease in tumor cell viability: Almost all the HepG2 cells died after 80 min of illumination, while less than 60% of U87 cell viability remained. CELL-LEF is suitable for in vitro PDT involving low irradiance over a long illumination period.

Background: Neonatal jaundice is a common condition occurring in 60%-80% of all healthy-term and late-preterm neonates. In the majority of cases, neonatal jaundice resolves spontaneously and causes no harm; however, in some neonates, significant hyperbilirubinemia can develop and lead to kernicterus jaundice, a serious neurological disease. Phototherapy (PT) is the preferred treatment for jaundice; however, to be effective, PT devices need to have a broad light emission surface to generate no or little heat and to provide an optimal wavelength and light intensity (420-490 nm and ≥30 µW/cm²/nm, respectively)., Objective: This study aimed to investigate the feasibility, safety, and level of satisfaction of parents and health care teams with the BUBOlight device, an innovative alternative to conventional hospital PT, in which luminous textiles have been incorporated in a sleeping bag., Methods: This interventional, exploratory, simple group, nonrandomized, single-center trial will be conducted at Lille Hospital. In total, 10-15 neonates and their parents will be included to obtain evaluable data from 10 parent-neonate pairs. Neonates weighing more than 2500 g at birth and born with ≥37 weeks of amenorrhea that required PT in accordance with the guidelines of the National Institute For Health and Clinical Excellence will receive one 4-hour session of illumination. Total serum bilirubin and transcutaneous bilirubin levels were obtained at the start and 2 hours after the end of PT. Cutaneous and rectal temperatures, heart rate, and oxygen saturation will be measured at the beginning and during PT. The number of subjects is therefore not calculated on the basis of statistical assumptions. We aim to obtain a minimum proportion of 90% (ie, 9 of 10) of the neonates included, who have been able to undergo 4-hour PT without unacceptable and unexpected toxicities. We will calculate the mean, median, quartiles, minimum and maximum values of the quantitative parameters, and the frequency of the qualitative parameters. The rate of patients with no unacceptable and unexpected toxicities (ie, the primary endpoint) will be calculated., Results: The first patient is expected to be enrolled at the end of 2020, and clinical investigations are intended for up to June 2021. The final results of this study are expected to be available at the end of 2021., Conclusions: Our findings will provide insights into the safety and feasibility of a new PT device based on light-emitting fabrics for the treatment of newborn jaundice. This new system, if proven effective, will improve the humanization of neonatal care and help avoid mother-child separation., Trial Registration: ClinicalTrials.gov NCT04365998; https://clinicaltrials.gov/ct2/show/NCT04365998., International Registered Report Identifier (irrid): PRR1-10.2196/24808., (©Fabienne Lecomte, Elise Thecua, Laurine Ziane, Pascal Deleporte, Alain Duhamel, Clémence Vamour, Serge Mordon, Thameur Rakza. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 25.05.2021.)

Many studies have shown that introducing N 2 -fixing trees (e.g. Acacia mangium) in eucalypt plantations can increase soil N availability as a result of biological N 2 fixation and faster N cycling. Some studies have also shown improved eucalypt P nutrition. However, the effects of N 2 -fixing trees on P cycling in tropical soils remain poorly understood and site-dependent. Our study aimed to assess the effects of planting A. mangium trees in areas managed over several decades with eucalypt plantations on soil organic P (Po) forms and low molecular weight organic acids (LMWOAs). Soil samples were collected from two tropical sites, one in Brazil and one in the Congo. Five different treatments were sampled at each site: monospecific acacia, monospecific eucalypt, below acacias in mixed-species, below eucalypts in mixed-species as well as native vegetation. Po forms and LMWOAs were identified in sodium hydroxide soil extracts using ion chromatography and relationships between these data and available P were determined. At both sites, the concentrations of most Po forms and LMWOAs were different between native ecosystems and monospecific eucalypt and acacia plots. Also, patterns of Po and LMWOAs were clearly separated, with glucose-6-P found mainly under acacia and phytate and oxalate mainly under eucalypt. Despite the strongest changes occurred at site with a higher N 2 fixation and root development, acacia introduction was able to change the profile of organic P and LMWOAs in <10 years. The variations between available Pi, Po and LMWOA forms showed that P cycling was dominated by different processes at each site, that are rather physicochemical (via Pi desorption after LMWOAs release) at Itatinga and biological (via organic P mineralization) at Kissoko. Specific patterns of Po and LMWOAs forms found in soil sampled under acacia or eucalypt would therefore explain the effect of acacia introduction in both sites., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Extramammary Paget disease of the vulva (EMPV) is a rare skin disorder commonly seen in postmenopausal Caucasian females that appears clinically as red, eczematous, pruriginous, and sometimes painful lesions. Although most cases are noninvasive, EMPV may be associated with an underlying or distant adenocarcinoma. EMPV has a chronic and relapsing course. The reference treatment is based on local surgical excision with negative margins. However, disease frequently extends far from the visible lesion, and surgical margins are frequently positive. Topical photodynamic therapy (PDT) is an established treatment modality for various dermatooncologic conditions. For example, red light irradiation with the Aktilite CL 128 and Metvixia (Galderma SA) as a photosensitizing molecule is a conventional protocol approved and widely used in Europe for PDT treatment of actinic keratosis, but this treatment is not yet widely used for EMPV because it has never clearly been demonstrated and is very painful., Objective: The aim of the study is to investigate the efficacy and safety relating to the medical device PAGETEX as a new painless PDT device using Metvixia in the treatment of vulvar Paget disease. The primary end point is the disease control rate at 3 months in 30% of the patients included, defined as stability, partial response, or total response, considering the extent of the lesion. Secondary end points are the disease control rate at 6 months, patient quality of life, level of pain experienced by the patient at each PDT session, severity of erythema, presence of protoporphyrin IX in Paget cells after each PDT session, and overall satisfaction level of the patient., Methods: The trial is an interventional, exploratory, simple group, nonrandomized, and single center (Lille University Hospital) study. Twenty-four patients will be included according to Simon's optimal plan. Therapeutic procedure is based on a cycle of two PDT sessions with the PAGETEX medical device at 15-day intervals (Metvixia incubation during 30 minutes and 635 nm red light illumination with a low irradiance for 2 hours and 30 minutes for a total fluence of 12 J/cm²). At the assessment session, 3 months after inclusion, if the control of the disease is partial or null, the patient will complete another cycle of two PDT sessions. A final evaluation will be performed in all patients at 6 months. Analyses will be performed using SAS version 9.4 software (SAS Institute Inc). The characteristics of the patients at baseline will be described; qualitative variables will be described by numbers and percentages, and quantitative variables will be described either by the mean and standard deviation for Gaussian distribution or by the median and interquartile range (ie, 25th and 75th percentiles). The normality of the distributions will be tested by a Shapiro-Wilk test and checked graphically by histograms., Results: First patient was included in September 2019 and clinical investigations are planned until August 2022. The final results of this study are expected to be available in January 2023., Conclusions: This clinical trial aims to evaluate the efficacy and safety of a new PDT protocol for the treatment of EMPV. The PAGETEX device could become the treatment of choice if it is effective, painless, and easy to implement and use in hospitals., Trial Registration: ClinicalTrials.gov NCT03713203; https://clinicaltrials.gov/ct2/show/NCT03713203., International Registered Report Identifier (irrid): PRR1-10.2196/15026., (©Fabienne Lecomte, Elise Thecua, Laurine Ziane, Pascal Deleporte, Alain Duhamel, Cyril Maire, Delphine Staumont-Salle, Serge Mordon, Laurent Mortier. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.12.2019.)

Background: Actinic keratosis (AK) is a common early in situ skin carcinoma caused by long-term sun exposure and usually develops on sun-exposed skin areas. Left untreated, AK may progress to squamous cell carcinoma. To prevent such risk, most clinicians routinely treat AK. Therapy options for AK include cryotherapy, topical treatments, curettage, excision surgery, and photodynamic therapy (PDT)., Objective: The aim of this study is to assess the noninferiority, in terms of efficacy at 3 months, of a PDT protocol involving a new light-emitting device (PDT using the Phosistos protocol [P-PDT]) compared with the conventional protocol (PDT using the conventional protocol [C-PDT]) in the treatment of AK., Methods: In this randomized, controlled, multicenter, intra-individual, phase II noninferiority clinical study, subjects with AK of the forehead and scalp are treated with P-PDT on one area and with C-PDT on the contralateral area. In both areas, lesions are prepared and methyl aminolevulinate (MAL) is applied. Thirty minutes after MAL application, the P-PDT area is exposed to red light at low irradiance (1.3 mW/cm 2 ) for 2.5 hours so that a light dose of 12 J/cm 2 is achieved. In the control area (C-PDT area), a 37 J/cm 2 red light irradiation is performed 3 hours after MAL application. Recurrent AK at 3 months is retreated. The primary end point is the lesion complete response rate at 3 months. Secondary end points include pain scores at 1 day, local tolerance at 7 days, lesion complete response rate at 6 months, cosmetic outcome at 3 and 6 months, and patient-reported quality of life and satisfaction throughout the study. A total of 45 patients needs to be recruited., Results: Clinical investigations are complete: 46 patients were treated with P-PDT on one area (n=285 AK) and with C-PDT on the contralateral area (n=285 AK). Data analysis is ongoing, and statistical results will be available in the first half of 2019., Conclusions: In case of noninferiority in efficacy and superiority in tolerability of P-PDT compared with C-PDT, P-PDT could become the treatment of choice for AK., Trial Registration: ClinicalTrials.gov NCT03076892; https://clinicaltrials.gov/ct2/show/NCT03076892 (Archived by WebCite at http://www.webcitation.org/779qqVKek)., International Registered Report Identifier (irrid): DERR1-10.2196/12990., (©Anne-Sophie Vignion-Dewalle, Henry Abi Rached, Elise Thecua, Fabienne Lecomte, Pascal Deleporte, Hélène Béhal, Theresa Hommel, Alain Duhamel, Rolf-Markus Szeimies, Laurent Mortier, Serge Mordon. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.04.2019.)

Background: Actinic keratosis (AK) is characterized by preinvasive, cancerous lesions on sun-exposed skin that negatively affect patient quality of life and may progress to invasive squamous cell carcinoma (SCC). If untreated, AK may either regress or progress to SCC, with significant morbidity and possible lethal outcomes. The most commonly used treatments for AK are cryotherapy, topical chemotherapy and, more recently, photodynamic therapy (PDT). This clinical study is part of a project that aims to create specific light-emitting fabrics (LEFs) that strongly improve the efficiency and reliability of PDT as a treatment for AK., Objective: This study aims to compare the efficacy and tolerability of a new PDT protocol involving the Flexitheralight device (N-PDT) with the classical protocol involving the Aktilite CL 128 device (C-PDT; Galderma Laboratories) for the treatment of AK. All participants receive both protocols. The primary objective of this study is to compare the lesion response rate after 3 months of N-PDT with C-PDT. Secondary objectives are evaluations of pain and local tolerance during treatment, clinical evolution of the subject's skin, and evaluations of patient quality of life and satisfaction., Methods: The study is a split-face, intraindividual comparison of two PDT protocols. The total number of patients recruited was 42. Patients were exposed to a continuous red light with the Aktilite CL 128 device on one side of the face and to fractionated red illumination with the new device, Flexitheralight, on the other side of the face. Males or females over the age of 18 years with a clinical diagnosis of at least 10 previously untreated, nonpigmented, nonhyperkeratotic grade I and II AK lesions of the forehead and/or scalp were included and were recruited from the Department of Dermatology of the Centre Hospitalier Universitaire de Lille. The patients came to the investigational center for one treatment session (day 1), and they were followed up after 7 days, 3 months and 6 months. A second treatment session was performed on day 111 in cases in which an incomplete response was observed at the 3-month follow-up. Data will be analyzed using SAS software version 9.4 (SAS Institute Inc). Continuous variables will be reported as means and standard deviations, and categorical variables will be reported as frequencies and percentages. The Shapiro-Wilk test will be used to assess the normality of the distribution., Results: The clinical investigation was performed by July 2018. Data analysis was performed at the end of 2018, and results are expected to be published in early 2019., Conclusions: This phase II clinical trial aims to evaluate the noninferior efficacy and superior tolerability of N-PDT compared to that of C-PDT. If N-PDT is both efficacious and tolerable, N-PDT could become the treatment of choice for AK due to its ease of implementation in hospitals., Trial Registration: ClinicalTrials.gov NCT03076918; https://clinicaltrials.gov/ct2/show/NCT03076918 (archived by WebCite at http://www.webcitation.org/771KA0SSK)., International Registered Report Identifier (irrid): DERR1-10.2196/11530., (©Fabienne Lecomte, Anne Sophie Vignion-Dewalle, Claire Vicentini, Elise Thecua, Pascal Deleporte, Alain Duhamel, Serge Mordon, Laurent Mortier. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.04.2019.)

Natural DayLight-mediated PhotoDynamic Therapy (NDL-PDT) is an efficacious treatment option for thin actinic keratosis that offers advantages over conventional PDT in terms of tolerability and cost. It is now accepted that the minimum criteria required for effective NDL-PDT is a dose of 4 J/cm² with a treatment time of 2 hours and a minimum temperature of 10 °C, corresponding to a minimum illuminance of 11,000 lux. This value is easily achievable: 20,000 lux can be obtained during a typical overcast day at midday. It can reach 110,000 lux with a bright sunlight. However, it is limited to certain times of the year at our latitude. However rain and cold temperatures appear the main limitations of NDL-PDT. Greenhouses make possible to perform the illumination even in harsh weather conditions. Furthermore, it is difficult to install a greenhouse everywhere. Several solutions are now proposed to carry out indoor illumination so-called artificial white light or simulated daylight (SDL-PDT). Illumination sources installed at the ceiling of the treatment room is one option. Several lamp pairs can be combined to illuminate groups of patients simultaneously. A surgical theatre light can be used or dedicated systems using white LEDs can be used to deliver the required illumination dose. In conclusion, Indoor lightning (or simulated daylight: SDL-PDT or Artificial White Light: AWL) could offer an interesting alternative to NDL-PDT.

[This corrects the article DOI: 10.1371/journal.pone.0201135.].

Understanding the relationship between biodiversity and ecosystem functioning has so far resulted from two main approaches: the analysis of species' functional traits, and the analysis of species interaction networks. Here we propose a third approach, based on the association between combinations of species or of functional groups, which we term assembly motifs, and observed ecosystem functioning. Each assembly motif describes a biotic environment in which species interactions have particular effects on a given ecosystem function. Clustering species in functional groups generates a classification of ecosystems based on their assembly motif. We evaluate the quality of each species clustering, that is its ability to predict an ecosystem function, by the coefficient of determination of the ecosystem classification. An iterative process then enables identifying the species clustering in functional groups that best accounts for the functioning of the observed ecosystems. We test this approach using experimental and simulated datasets. We show that our combinatorial analysis makes it possible to identify the combinations of functional groups of species whose interactions govern ecosystem functioning without any a priori knowledge of the species themselves or their interactions. Our combinatorial approach reproduces the associative learning of empirical ecologists, and proves to be powerful and parsimonious., Competing Interests: The authors have declared that no competing interests exist.

Aim: Photodynamic therapy (PDT) appears to be a valuable new treatment modality for cancer therapy. Studies have reported successful application of PDT for glioblastoma. Here, we introduce a new device dedicated to intraoperative PDT delivered early after fluoro-guided resection combined with a transfer function that determines the treatment time based on the size of the surgical resection cavity., Materials & Methods: First, we describe the device, which is composed of a trocar, a balloon filled with a diffusing solution, and a fiber guide in which a cylindrical light diffuser is inserted. Ex vivo experiments were performed to measure the fluence rate inside biological tissues. A calibration factor was defined to convert power measurements into fluence rate values. Calf brains were used to simulate light propagation in human brain tissue, and the photosensitizer administration effect on optical properties was discussed. The temperature elevation during illumination was evaluated., Results: Light power was measured in tissues surrounding the device during ex vivo experiments. Using the previously characterized calibration factor, power measurements were converted to fluence rate values to obtain the transfer function. No thermal elevation was observed during a 2-h temperature test, and the impact of protoporphyrin IX on brain optical properties was considered negligible., Conclusion: A discussion of experimental precision is presented. The light duration determined by the abacus had a standard deviation of <1 min. This value is weak compared with the total illumination time necessary to treat one patient. The main advantage of our device lies in its straightforward implementation of intraoperative PDT for neurosurgery with acceptable dosimetry and easy treatment time.

Background and Aims: Despite their importance for plant production, estimations of below-ground biomass and its distribution in the soil are still difficult and time consuming, and no single reliable methodology is available for different root types. To identify the best method for root biomass estimations, four different methods, with labour requirements, were tested at the same location., Methods: The four methods, applied in a 6-year-old Eucalyptus plantation in Congo, were based on different soil sampling volumes: auger (8 cm in diameter), monolith (25 × 25 cm quadrate), half Voronoi trench (1·5 m(3)) and a full Voronoi trench (3 m(3)), chosen as the reference method., Key Results: With the reference method (0-1m deep), fine-root biomass (FRB, diameter <2 mm) was estimated at 1·8 t ha(-1), medium-root biomass (MRB diameter 2-10 mm) at 2·0 t ha(-1), coarse-root biomass (CRB, diameter >10 mm) at 5·6 t ha(-1) and stump biomass at 6·8 t ha(-1). Total below-ground biomass was estimated at 16·2 t ha(-1) (root : shoot ratio equal to 0·23) for this 800 tree ha(-1) eucalypt plantation density. The density of FRB was very high (0·56 t ha(-1)) in the top soil horizon (0-3 cm layer) and decreased greatly (0·3 t ha(-1)) with depth (50-100 cm). Without labour requirement considerations, no significant differences were found between the four methods for FRB and MRB; however, CRB was better estimated by the half and full Voronoi trenches. When labour requirements were considered, the most effective method was auger coring for FRB, whereas the half and full Voronoi trenches were the most appropriate methods for MRB and CRB, respectively., Conclusions: As CRB combined with stumps amounted to 78 % of total below-ground biomass, a full Voronoi trench is strongly recommended when estimating total standing root biomass. Conversely, for FRB estimation, auger coring is recommended with a design pattern accounting for the spatial variability of fine-root distribution.

The phylogenetic relationships among 11 species of the Cervidae family were inferred from an analysis of male vocalizations. Eighteen characters, including call types (e.g. antipredator barks, mating loudcalls) and acoustic characteristics (call composition, fundamental frequency and formant frequencies), were used for phylogeny inference. The resulting topology and the phylogenetic consistency of behavioral characters were compared with those of current molecular phylogenies of Cervidae and with separate and simultaneous parsimony analyses of molecular and behavioral data. Our results indicate that male vocalizations constitute plausible phylogenetic characters in this taxon. Evolutionary scenarios for the vocal characters are discussed in relation with associated behaviors., (© The Willi Hennig Society 2008.)

This paper describes aggressive behaviour in the cockroach Schultesia nitor, a tropical forest species living in bird nests. Young S. nitor nymphs are known to show active dispersal while old nymphs and adults are contrastingly strongly gregarious, a combination of features never observed in other cockroach species. Our laboratory experiments using video recording of confrontations between pairs show that aggressive behaviour towards conspecific nymphs is not exhibited towards nymphs of the species Phoetalia pallida, and thus can be considered species specific in S. nitor. But, it is not kin oriented: the mother and all adults of both sexes in different physiological states exhibit this behaviour as well. Six types of aggressive interactions were discriminated, occurring in age-symmetric pairs of nymphs and adults. Even more frequent aggression was exhibited by adults and last instar nymphs towards younger nymphs of all instars. The frequency of aggressive acts and types of aggressive interactions varied according to sex and size of the two interacting individuals. The possible function and evolution of this behaviour is discussed, with emphasis on the difficulty of interpreting obvious but weak and not kin-biased aggression., (2007 Wiley-Liss, Inc.)

The dynamics of the main nutrient fluxes of the biological cycle were quantified in a clonal Eucalyptus plantation throughout the whole planted crop rotation: current annual requirements of nutrients, uptake from the soil, internal translocations within trees, return to soil (litterfall and crown leaching) and decomposition in the forest floor. As reported for other species, two growth periods were identified in these short-rotation plantations: (1) a juvenile phase up to canopy closure, during which the uptake of nutrients from the soil reserves supplied most of the current requirements; and (2) a second phase up to harvest, characterized by intense nutrient recycling processes. Internal translocation within trees supplied about 30 % of the annual requirements of N and P from 2 years of age onwards, and about 50 % of the K requirement. The mineralization of large amounts of organic matter returned to the soil with litterfall during stand development represented a key process providing nutrients to the stand at the end of the rotation. The importance of the recycling processes was clearly shown by the small amounts of nutrients permanently immobilized in the ligneous components of trees, compared with the total requirements accumulated over the stand rotation which were two to four times higher. Small pools of nutrients circulating quickly in the ecosystem made it possible to produce high amounts of biomass in poor soils. The sustainability of these plantations will require fertilizer inputs that match the changes in soil fertility over successive rotations, mainly linked to the dynamics of organic matter in this tropical soil.

Nutrient concentrations (N, P, K) were determined within stemwood in an age series of eucalyptus stands. Four trees per stand were selected according to their size to represent the whole range of basal areas in 1-, 2-, 3-, 4-, 5-, 6- and 7-year-old stands. Cross-sections were sampled every 4 m from the ground to the top of the tree, and chemical analyses were performed for each annual ring in the cross-sections. We constructed a new and generic model to describe the dynamics of nutrient concentrations within the stemwood. Three main parameters were used: (1) the initial concentration of the ring, Ic; (2) the final concentration of the ring at harvest, Fc; and (3) the rate of change in concentration, k. The model is very flexible and was adapted to describe N, P and K concentrations within the stems, and their dynamics over time. An analysis of the parameters showed that k was constant for a given nutrient. Ic varied with height within the tree for P, whereas for N and K it was a function of: (1) the age of the tree when the ring was initiated: and (2) height within the tree. Fc was constant for N, and dependent on the age of the tree when the ring was initiated for K and P. The final models showed a low Root Mean Square Error for a limited number of parameters (less than seven). When validated on an independent sample, the models were shown to have high predictive quality.