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Although the metastasic breast cancer is still an incurable disease, recent advances have increased significantly the time to progression and the overall survival. However, too much information has been produced in the last 2 years, so a well-based guideline is a valuable document in treatment decision making. The SEOM guidelines are intended to make evidence-based recommendations on how to manage patients with advanced and recurrent breast cancer to achieve the best patient outcomes based on a rational use of the currently available therapies. To assign a level of certainty and a grade of recommendation the United States Preventive Services Task Force guidelines methodology was selected as reference.

International audience; Two 3$^{rd}$ generation steels were studied an austenitic-ferritic MnAl steel and an austenitic-martensitic quenched and partitioned (QetP) steel. Hydrogen absorption during elaboration was simulated by exposing the steels to deuterium atmosphere during their final thermal treatment. Nitrogen-exposed specimens were also deuterium cathodically charged in order to simulate hydrogen entry in the steels during an optional electrogalvanization process. Thermal desorption mass spectrometry (TDS), combined with aging at room temperature and cold rolling, was used to study diffusion and trapping. The evolution of different TDS spectral contributions with aging and cold rolling allowed educated guesses on their origin. Peaks specific to martensitic transformation were identified.

International audience; Third generation steels are multiphase steels that contain high amounts of residual austenite that can transform into martensite during deformation and provides the steel a better ductility/formability. During their final elaboration steps, they are generally heat-treated in reducing atmospheres and potentially submitted to zinc electroplating, processes during which they may absorb a significant amount of hydrogen. Hydrogen embrittlement susceptibility of these steels is therefore to be quantified. Two 3rd generation steels have been studied an austenitic-ferritic MnAl steel and an austenitic-martensitic quenched and partionned (QetP) steel. Both were elaborated and finally heat treated under controlled reducing atmosphere (high temperature HT), using deuterium as isotopic tracer for hydrogen. Hydrogen introduction in the material during zinc plating was simulated by cathodic charging (low temperature LT). Thermal desorption mass spectrometry (TDMS) was used to study diffusion and trapping evolution in such complex materials; the localization of deuterium in the different phases was studied by nanoSIMS. The effect of hydrogen/deuterium on mechanical properties was investigated by crossed tensile tests and TDMS. Aging after deuterium charging followed by TDMS evidenced for MnAl and QetP alloys two contributions (570 K and 630 K) assigned to low energy trap sites. Besides, the QetP alloy exhibits an extra contribution around 730 K, whose assignment will be discussed with respect to nanoSIMS analysis. Modelling of the TDMS spectra, taking into account the microstructure of the materials and their history in terms of hydrogen exposure and aging, will give elements for the discussion.Finally, based on tensile tests and fractography analysis, the effect of deuterium or hydrogen on the mechanical behavior of these materials will be discussed in terms of hydrogen origin (HT or LT), concentration and localization.

International audience; Third generation steels have been designed in order to have a good compromise between strength and ductility. These multiphase steels contain high amounts of residual austenite that can transform into martensite during deformation and provides the steel a better ductility/formability. After cold rolling, these materials are heat treated in reducing atmosphere, during which they may absorb a significant amount of hydrogen. Hydrogen embrittlement susceptibility of these steels is therefore to be quantified. This study is centered on the distribution of hydrogen entered at high temperature in the material and its effect on mechanical properties.An austenitic-ferritic steel with high amounts of manganese and aluminum (MnAl steel) has been heat treated under controlled reducing atmosphere, containing deuterium as isotopic tracer for hydrogen. In order to extract information on diffusion and trapping of hydrogen, thermal desorption mass spectroscopy (TDMS) analyses were performed. Moreover, during the annealing cycle, a manganese-rich 500nm-thick oxide layer is formed at the steel surface. The impact of the presence of this oxide layer on deuterium desorption kinetics from the alloy has been investigated it has been shown that it acts both as a barrier layer to the diffusion of hydrogen and as a sink for hydrogen. A model on diffusion and trapping/detrapping of hydrogen is currently being developed to simulate the TDMS spectra. Tensile tests were performed in order to study the effect of this high temperature-charged hydrogen on mechanical properties of the MnAl steel.

National audience; Les aciers de 3eme generation a haute limite d'elasticite contiennent une fraction importante d'austenite residuelle, qui peut se transformer en martensite sous l'effet d'une deformation (effet TRIP), leur conferant ainsi une bonne ductilite. Au cours du procede d'elaboration, le traitement thermique apres laminage a froid est realise sous atmosphere reductrice, hydrogenee, etape au cours de laquelle une quantite non negligeable d'hydrogene peut etre absorbee par le materiau. Il s'agit donc d'etudier la sensibilite de ces aciers a la fragilisation par l'hydrogene (FPH) et de determiner le role de la microstructure et celui de la transformation de phase sous deformation dans les mecanismes de fragilisation. Un acier de 3eme generation, riche en manganese et en aluminium (acier MnAl), de structure duplexe austeno-ferritique fine a ainsi ete elabore sous atmosphere reductrice controlee ; le deuterium a ete utilise comme traceur isotopique de l'hydrogene. Les interactions deuterium-materiau, dans cet alliage ainsi elabore, ont ete etudiees par spectrometrie de desorption thermique (TDS), afin de determiner les differents sites de piegeage. Au cours du traitement thermique final, une couche d'oxyde riche en manganese, d'une epaisseur de l'ordre de 500 nm, croit a la surface de l'acier. L'effet de cet oxyde sur la desorption a temperature ambiante de l'hydrogene incorpore a hautes temperatures a ete etudie. Il a ete montre que cette couche d'oxyde joue a la fois le role de barriere a la diffusion de l'hydrogene et de reservoir pour l'hydrogene, limitant ainsi la desorption depuis l'acier. Un travail de modelisation sur la diffusion et le piegeage/depiegeage de l'hydrogene est en cours afin de simuler les thermogrammes obtenus par TDS et ameliorer la comprehension des phenomenes observes. Aussi, des essais de traction ont ete realises afin d'evaluer l'effet de cet hydrogene incorpore a haute temperature sur les proprietes mecaniques de l'acier MnAl.

International audience

Introducción: Entre los diferentes factores descritos, el soporte nutricional se ha asociado a la prevención y el tratamiento de las fístulas enterocutáneas (FEC). Objetivos: Evaluar la influencia que los parámetros relacionados con variables nutricionales, estado clínico y quirúrgicas tienen sobre la aparición de FEC. Métodos: Se realizó un estudio retrospectivo observacional de casos/controles en pacientes ingresados en Cirugía General y Digestiva. Se analizaron: diagnóstico, índice de masa corporal (IMC), antecedentes patológicos, número de intervenciones quirúrgicas (IQ) y complicaciones (infección previa, sangrado e isquemia). En los pacientes con IQ se analizaron: número y tipo de IQ, tiempo hasta el inicio del soporte nutricional y tipo de soporte nutricional. El análisis estadístico uni/multivariante de regresión logística múltiple se realizó mediante el software SPSSv.19.0. Resultados: Los diagnósticos primarios que se relacionaron con la aparición de FEC fueron la patología pancreática (OR = 5,346) y la enfermedad inflamatoria intestinal (EII) (OR = 9,329). Las variables quirúrgicas que se asociaron con mayor prevalencia de FEC fueron IQ de urgencia (OR = 5,79) e IQ múltiples (OR = 4,52). En cuanto a las variables nutricionales, el inicio tardío de la nutrición (más de tres días después de IQ) se relacionó con la aparición de FEC (OR = 3,82). Conclusiones: En los pacientes quirúrgicos, el soporte nutricional precoz, independientemente de la vía de administración, disminuye la aparición de fístulas. La patología pancreática, la EII, las IQ urgentes y las IQ múltiples se asociaron con mayor prevalencia de FEC. La variable desnutrición se apunta como un factor de riesgo que debería corroborarse en estudios posteriores. Introduction: Among the different factors described, nutritional support has been associated to prevention and management of enterocutaneous fistulae (ECF). Objectives: To assess the influence that the parameters related to nutritional, clinical status, and surgical variables have on the occurrence of ECF. Methods: An observational case/control retrospective study was performed on patients admitted to the General and Digestive Surgery Department. The parameters analyzed were: diagnosis, body mass index (BMI), pathologic personal history, number of surgical interventions (SI) and complications (previous infection, bleeding, and ischemia). In patients with SI, we analyzed: number and type of SI, time until onset of nutritional support, and type of nutritional support. We performed a multiple logistic uni- and multivariate regression analysis by using the SPSSv.19.0 software. Results: The primary diagnoses related to the occurrence of ECF were pancreatic pathology (OR = 5.346) and inflammatory bowel disease (IBD) (OR = 9.329). The surgical variables associated to higher prevalence of ECF emergency SI (OR = 5.79) and multiple SI (OR = 4.52). Regarding the nutritional variables, the late onset of nutrition (more than three days after SI) was associated to the occurrence of ECF (OR = 3.82). Conclusions: In surgical patients, early nutritional support , independently of the route of administration, decreases the occurrence of fistulae. Pancreatic pathology, IBD, emergency SI, and multiple SI were associated to higher prevalence of ECF. The variable hyponutrition appears as a risk factor that should be confirmed in further studies.

Introducción: Entre los diferentes factores descritos, el soporte nutricional se ha asociado a la prevención y el tratamiento de las fístulas enterocutáneas (FEC). Objetivos: Evaluar la influencia que los parámetros relacionados con variables nutricionales, estado clínico y quirúrgicas tienen sobre la aparición de FEC. Métodos: Se realizó un estudio retrospectivo observacional de casos/controles en pacientes ingresados en Cirugía General y Digestiva. Se analizaron: diagnóstico, índice de masa corporal (IMC), antecedentes patológicos, número de intervenciones quirúrgicas (IQ) y complicaciones (infección previa, sangrado e isquemia). En los pacientes con IQ se analizaron: número y tipo de IQ, tiempo hasta el inicio del soporte nutricional y tipo de soporte nutricional. El análisis estadístico uni/multivariante de regresión logística múltiple se realizó mediante el software SPSSv.19.0. Resultados: Los diagnósticos primarios que se relacionaron con la aparición de FEC fueron la patología pancreática (OR = 5,346) y la enfermedad inflamatoria intestinal (EII) (OR = 9,329). Las variables quirúrgicas que se asociaron con mayor prevalencia de FEC fueron IQ de urgencia (OR = 5,79) e IQ múltiples (OR = 4,52). En cuanto a las variables nutricionales, el inicio tardío de la nutrición (más de tres días después de IQ) se relacionó con la aparición de FEC (OR = 3,82). Conclusiones: En los pacientes quirúrgicos, el soporte nutricional precoz, independientemente de la vía de administración, disminuye la aparición de fístulas. La patología pancreática, la EII, las IQ urgentes y las IQ múltiples se asociaron con mayor prevalencia de FEC. La variable desnutrición se apunta como un factor de riesgo que debería corroborarse en estudios posteriores.