Radiotherapy in the management of lung oligometastases

In recent years, the development of both medical imaging and new systemic agents (targeted therapy and immunotherapy) have revolutionized the field of oncology, leading to a new entity: oligometastatic disease. Adding local treatment of oligometastases to systemic treatment could lead to prolonged survival with no significant impact on quality of life. Given the high prevalence of lung oligometastases and the new systemic agents coming with increased pulmonary toxicity, this article provides a comprehensive review of the current state-of-art for radiotherapy of lung oligometastases. After reviewing pretreatment workup, the authors define several radiotherapy regimen based on the localization and size of the oligometastases. A comment on the synergistic combination of medical treatment and radiotherapy is also made, projecting on future steps in this specific clinical setting.

Radiotherapy in the management of synchronous metastatic lung cancer

Metastatic lung cancer classically portends a poor prognosis. The management of metastatic lung cancer has dramatically changed with the emergence of immune checkpoint inhibitors, targeted therapy and due to a better understanding of the oligometastatic process. In metastatic lung cancers, radiation therapy which was only used with palliative intent for decades, represents today a promising way to treat primary and oligometastatic sites with a curative intent. Herein we present through a literature review the role of radiotherapy in the management of synchronous metastatic lung cancers.

Lung metastases radiation therapy

We present an update of the French society of oncological radiotherapy recommendation regarding indication, doses, and technique of radiotherapy for intrathoracic metastases. The recommendations for delineation of the target volumes and critical organs are detailed.

Surface Chemistry of Gold Nanoparticles Produced by Laser Ablation in Pure and Saline Water

Pulsed laser ablation in liquid (PLAL) is a powerful method for producing nanoparticle colloids with a long-term stability despite the absence of stabilizing organic agents. The colloid stability involves different reactivities and chemical equilibria with complex ionic-specific effects at the nanoparticle/solvent interface which must be strongly influenced by their chemical composition. In this work, the surface composition of PLAL-produced gold nanoparticles in alkaline and saline (NaBr) water is investigated by X-ray photoelectron spectroscopy on free-flying nanoparticles, exempt from any substrate or radiation damage artifact. The Au 4f photoelectron spectra with a depth profiling investigation are used to evaluate the degree of nanoparticle surface oxidation. In alkaline water, the results preclude any surface oxidation contrary to the case of nanoparticles produced in NaBr solution. In addition, the analysis of Br 3d core-level photoelectron spectra agrees with a clear signature of Br on the nanoparticle surface, which is confirmed by a specific valence band feature. This experimental study is supported by DFT calculations, evaluating the energy balance of halide adsorption on different configurations of gold surfaces including oxidation or adsorbed salts.

Aurore: A platform for ultrafast sciences

We present the Aurore platform for ultrafast sciences. This platform is based on a unique 20 W, 1 kHz, 26 fs Ti:sapphire laser system designed for reliable operation and high intensity temporal contrast. The specific design ensures the high stability in terms of pulse duration, energy, and beam pointing necessary for extended experimental campaigns. The laser supplies 5 different beamlines, all dedicated to a specific field: attosecond science (Aurore 1), ultrafast phase transitions in solids (Aurore 2 and 3), ultrafast luminescence in solids (Aurore 4), and femtochemistry (Aurore 5). The technical specifications of these five beamlines are described in detail, and examples of the recent results are given.

Laser Generation of Sub-Micrometer Wrinkles in a Chalcogenide Glass Film as Physical Unclonable Functions

Laser interaction with solids is routinely used for functionalizing materials' surfaces. In most cases, the generation of patterns/structures is the key feature to endow materials with specific properties like hardening, superhydrophobicity, plasmonic color-enhancement, or dedicated functions like anti-counterfeiting tags. A way to generate random patterns, by means of generation of wrinkles on surfaces resulting from laser melting of amorphous Ge-based chalcogenide thin films, is presented. These patterns, similar to fingerprints, are modulations of the surface height by a few tens of nanometers with a sub-micrometer periodicity. It is shown that the patterns' spatial frequency depends on the melted layer thickness, which can be tuned by varying the impinging laser fluence. The randomness of these patterns makes them an excellent candidate for the generation of physical unclonable function tags (PUF-tags) for anti-counterfeiting applications. Two specific ways are tested to identify the obtained PUF-tag: cross-correlation procedure or using a neural network. In both cases, it is demonstrated that the PUF-tag can be compared to a reference image (PUF-key) and identified with a high recognition ratio on most real application conditions. This paves the way to straightforward non-deterministic PUF-tag generation dedicated to small sensitive parts such as, for example, electronic devices/components, jewelry, or watchmak.

Assessing the Surface Oxidation State of Free-Standing Gold Nanoparticles Produced by Laser Ablation

The surface chemistry of gold nanoparticles produced by the pulsed laser ablation in liquids method is investigated by X-ray photoelectron spectroscopy (XPS). The presence of surface oxide expected on these systems is investigated using synchrotron radiation in conditions close to their original state in solvent but free from substrate or solvent effects which could affect the interpretation of spectroscopic observations. For that purpose we performed the experiment on a controlled free-standing nanoparticle beam produced by combination of an atomizer and an aerodynamic lens system. These results are compared with those obtained by the standard situation of deposited nanoparticles on silicon substrate. An accurate analysis based on Bayesian statistics concludes that the existence of oxide in the free-standing conditions cannot be solely confirmed by the recorded core-level 4f spectra. If present, our data indicate an upper limit of 2.15 ± 0.68% of oxide. However, a higher credence to the hypothesis of its existence is brought by the structureless valence profile of the free-standing beam. Moreover, the cross-comparison with the deposited nanoparticles case clearly evidences an important misleading substrate effect. Experiment with free-standing nanoparticles is then demonstrated to be the right way to further investigate oxidation states on Au nanoparticles.

An electrostatic in-line charge-state purification system for multicharged ions in the kiloelectronvolt energy range

The performance of a newly built omega type electrostatic analyzer designed to act as an in-line charge-state purification system for ions in the kiloelectronvolt energy range is reported. The analyzer consists of a set of four consecutive electrostatic 140° concentric cylindrical electrodes enclosed by Matsuda electrodes. This setup was recently tested and validated using O⁵⁺, Ar⁹⁺, and Xe²⁰⁺ ion beams at an energy of 14 qkeV at the ARIBE facility. A resolving power of 10.5 and a transmission of 100% of the desired charge state are measured allowing a good purification of incoming ion beams with charge states up to 10+ and a fairly good purification for charge states at least up to 20+. In comparison with other in-line solutions such as the Wien filter, our system has the advantage of being purely electrostatic and therefore lacking common drawbacks as, for example, hysteresis.

Pharmacological modulation of radiation-induced oral mucosal complications

Radiation-induced mucositis is a common toxicity, especially in patients with head and neck cancers. Despite recent technological advances in radiation therapy, such as intensity-modulated radiotherapy, radiation-induced mucositis is still causing treatment disruptions, negatively affecting patients' long and short term quality of life, and impacting medical resources use with economic consequences. The objective of this article was to review the latest updates in the management of radiation-induced mucositis, with a focus on pharmaceutical strategies for the prevention or treatment of mucositis. Although numerous studies analysing the prevention and management of oral radiation-induced mucositis have been conducted, there are still few reliable data to guide daily clinical practice. Furthermore, most of the tested drugs have shown no (anti-inflammatory cytokine, growth factors) or limited (palifermin) effect. Therapies for acute oral mucositis are predominantly focused on improving oral hygiene and providing symptoms control. Although low-level laser therapy proved efficient in preventing radiation-induced oral mucositis in patients with head and neck cancer, this intervention requires equipment and trained medical staff, and is therefore insufficiently developed in clinical routine. New effective pharmacological agents able to prevent or reverse radio-induced mucositis are required.

[Therapeutic strategies in patients undergoing surgery for non-small cell lung cancer. Results of the ESCAP-2011-CPHG study, promoted by the French College of General Hospital Respiratory Physicians (CPHG)]

BACKGROUND

The aim of ESCAP-2011-CPHG, promoted by the French College of General Hospital Respiratory Physicians, was to describe therapeutic strategies in lung cancer in the first 2 years after diagnosis, in a real-life setting. This article focuses on patients undergoing surgical management of a non-small cell lung cancer (NSCLC).

METHODS

A prospective multicentre study was conducted in 53 French general hospitals. For each patient with lung cancer diagnosed in 2010, a standardised form was completed following each change in treatment strategy up to 2 years after diagnosis.

RESULTS

Overall, 3418 of the 3943 included patients had NSCLC. 741 patients (21.7%) underwent curative surgery (stage 0-II, IIIA, IIIB, and IV: 65%, 27%, 3% and 5%, respectively). The therapeutic strategy changed less often in surgical than non-surgical patients and average follow-up time was longer: 23.3 months (SD: 9.3) versus 10.4 months (SD: 9.5) for non-surgical patients. Among patients with a surgical first strategy (92.6% of surgical patients as a whole), 56.9% did not receive any other treatment, 34.7% received chemotherapy, 5.9% radio-chemotherapy, 2.6% radiotherapy. At the end of follow-up, 55.8% were still alive without any other strategy, 13.1% had died, and 31.1% had received at least one more strategy. Among patients with a surgical second strategy, 63% had received chemotherapy alone during the first strategy.

CONCLUSIONS

ESCAP -2011- CPHG assessed everyday professional practice in the surgical management of NSCLC in general hospitals. It pointed out the discrepancies between current guidelines and the therapeutic strategies applied in real life conditions.

Low energy Ne ion beam induced-modifications of magnetic properties in MnAs thin films

Investigations of the complex behavior of the magnetization of manganese arsenide thin films due to defects induced by irradiation of slow heavy ions are presented. In addition to the thermal hysteresis suppression already highlighted in Trassinelli et al (2014 Appl. Phys. Lett. 104 081906), we report here on new local magnetic features recorded by a magnetic force microscope at different temperatures close to the characteristic sample phase transition. Complementary measurements of the global magnetization in different conditions (applied magnetic field and temperatures) enable the film characterization to be completed. The obtained results suggest that the ion bombardment produces regions where the local mechanical constraints are significantly different from the average, promoting the local presence of magneto-structural phases far from the equilibrium. These regions could be responsible for the thermal hysteresis suppression previously reported, irradiation-induced defects acting as seeds in the phase transition.

Adsorption studies of p-aminobenzoic acid on the anatase TiO₂(101) surface

The adsorption of p-aminobenzoic acid (pABA) on the anatase TiO2(101) surface has been investigated using synchrotron radiation photoelectron spectroscopy, near edge X-ray absorption fine structure (NEXAFS) spectroscopy, and density functional theory (DFT). Photoelectron spectroscopy indicates that the molecule is adsorbed in a bidentate mode through the carboxyl group following deprotonation. NEXAFS spectroscopy and DFT calculations of the adsorption structures indicate the ordering of a monolayer of the amino acid on the surface with the plane of the ring in an almost upright orientation. The adsorption of pABA on nanoparticulate TiO2 leads to a red shift of the optical absorption relative to bare TiO2 nanoparticles. DFT and valence band photoelectron spectroscopy suggest that the shift is attributed to the presence of the highest occupied molecular orbitals in the TiO2 band gap region and the presence of new molecularly derived states near the foot of the TiO2 conduction band.

Ultrafast short-range disordering of femtosecond-laser-heated warm dense aluminum

We have probed, with time-resolved x-ray absorption near-edge spectroscopy (XANES), a femtosecond-laser-heated aluminum foil with fluences up to 1  J/cm2. The spectra reveal a loss of the short-range order in a few picoseconds. This time scale is compared with the electron-ion equilibration time, calculated with a two-temperature model. Hydrodynamic simulations shed light on complex features that affect the foil dynamics, including progressive density change from solid to liquid (∼10  ps). In this density range, quantum molecular dynamics simulations indicate that XANES is a relevant probe of the ionic temperature.

[Results of definitive radiotherapy for squamous cell carcinomas of the larynx patients with subglottic extension]

BACKGROUND

Squamous cell carcinoma of larynx with subglottic extension is a rare location described to carry a poor prognosis. The aim of this study was to analyze outcomes and feasibility of definitive radiotherapy in patients with squamous cell carcinoma.

PATIENTS AND METHODS

Between 1998 and 2012, 56 patients with squamous cell carcinoma were treated at our institution and included in the analysis. Patients received definitive radiotherapy/chemoradiotherapy alone (63%) or after induction chemotherapy (37%) at our institute.

RESULTS

The 5-year actuarial overall survival, progression-free survival and specific survival were 64% (CI 95%: 48-90), 45% (CI 95%: 28-61), 88% (CI 95%: 78-98), respectively, with median follow-up of 74 months. The 5-year locoregional control was 69% (CI 95%: 56-83) and the 5-year distant control was 95% (CI 95%: 89-100). There was no difference in overall survival and locoregional control according to front-line treatments or between primary subglottic cancer and glotto-supraglottic cancers with subglottic extension. In the multivariate analysis, performance status of at least 1 and positive N stage were the only predictors for overall survival (hazard ratio [HR] [CI 95%]: 6.5 [1.3-34; P=0.03] and 11 [1.6-75; P=0.02], respectively). No difference of locoregional control was observed according to the first received therapy. The univariate analysis retrieved that T3-T4 patients had a lower locoregional control (HR: 3.1; CI 95%: 1.1-9.2, P=0.04), but no prognostic factor was retrieved in the multivariate analysis. In patients receiving a larynx preservation protocol, 5-year larynx preservation rate was 88% (CI 95%: 78-98), and 58% in T3 patients. The 5-year larynx preservation rate was 91% (CI 95%: 79-100) and 83% (CI 95%: 66-100) for patients who received radiotherapy/chemoradiotherapy or induction chemotherapy as a front-line treatment, respectively.

CONCLUSION

This analysis suggests that the results for squamous cell carcinoma patients treated with radiotherapy/chemoradiotherapy are comparable to those obtained for other laryngeal tumors. This thus suggests the feasibility of laryngeal preservation protocols for infringement subglottic for selected cases. Further studies are needed to clarify these preliminary data.

X-ray diagnosis of the pressure induced Mott nonmetal-metal transition

The evolution of the K-edge x-ray absorption near-edge spectroscopy (XANES) spectrum is investigated for an aluminum plasma expanding from the solid density down to 0.5  g/cm{3}, with temperatures lying from 5 down to 2 eV. The dense plasma is generated by nanosecond laser-induced shock compression. These conditions correspond to the density-temperature region where a metal-nonmetal transition occurs as the density decreases. This transition is directly observed in XANES spectra measurements through the progressive formation of a preedge structure for densities around 1.6  g/cm{3}. Ab initio calculations based on density functional theory and a jellium model have been efficiently tested through direct comparison with the experimental measurements and show that this preedge corresponds to the relocalization of the 3p atomic orbital as the system evolves from a dense plasma toward a partially ionized atomic fluid.

Unraveling the solid-liquid-vapor phase transition dynamics at the atomic level with ultrafast x-ray absorption near-edge spectroscopy

X-ray absorption near-edge spectroscopy (XANES) is a powerful probe of electronic and atomic structures in various media, ranging from molecules to condensed matter. We show how ultrafast time resolution opens new possibilities to investigate highly nonequilibrium states of matter including phase transitions. Based on a tabletop laser-plasma ultrafast x-ray source, we have performed a time-resolved (∼3  ps) XANES experiment that reveals the evolution of an aluminum foil at the atomic level, when undergoing ultrafast laser heating and ablation. X-ray absorption spectra highlight an ultrafast transition from the crystalline solid to the disordered liquid followed by a progressive transition of the delocalized valence electronic structure (metal) down to localized atomic orbitals (nonmetal-vapor), as the average distance between atoms increases.

Picosecond short-range disordering in isochorically heated aluminum at solid density

Using ultrafast x-ray probing, we experimentally observed a progressive loss of ordering within solid-density aluminum as the temperature raises from 300 K to >10{4} K. The Al sample was isochorically heated by a short ( approximately ps), laser-accelerated proton beam and probed by a short broadband x-ray source around the Al K edge. The loss of short-range ordering is detected through the progressive smoothing of the time-resolved x-ray absorption near-edge spectroscopy (XANES) structure. The results are compared with two different theoretical models of warm dense matter and allow us to put an upper bound on the onset of ion lattice disorder within the heated solid-density medium of approximately 10 ps.

Fast-ion energy-flux enhancement from ultrathin foils irradiated by intense and high-contrast short laser pulses

Recent significant improvements of the contrast ratio of chirped pulse amplified pulses allows us to extend the applicability domain of laser accelerated protons to very thin targets. In this framework, we propose an analytical model particularly suitable to reproducing ion laser acceleration experiments using high intensity and ultrahigh contrast pulses. The model is based on a self-consistent solution of the Poisson equation using an adiabatic approximation for laser generated fast electrons which allows one to find the target thickness maximizing the maximum proton (and ion) energies and population as a function of the laser parameters. Model furnished values show a good agreement with experimental data and 2D particle-in-cell simulation results.

Proton acceleration with high-intensity ultrahigh-contrast laser pulses

We report on simultaneous measurements of backward- and forward-accelerated protons spectra when an ultrahigh intensity (approximately 5 x 10(18) W/cm(20), ultrahigh contrast (>10(10)) laser pulse interacts with foils of thickness ranging from 0.08 to 105 microm. Under such conditions, free of preplasma originating from ionization of the laser-irradiated surface, we show that the maximum proton energies are proportional to the p component of the laser electric field only and not to the ponderomotive force and that the characteristics of the proton beams originating from both target sides are almost identical. All these points have been corroborated by extensive 1D and 2D particle-in-cell simulations showing a very good agreement with the experimental data.

Double plasma mirror for ultrahigh temporal contrast ultraintense laser pulses

We present and characterize a very efficient optical device that employs the plasma mirror technique to increase the contrast of high-power laser systems. Contrast improvements higher than 10(4) with 50% transmission are shown to be routinely achieved on a typical 10 TW laser system when the pulse is reflected on two consecutive plasma mirrors. Used at the end of the laser system, this double plasma mirror preserves the spatial profile of the initial beam, is unaffected by shot-to-shot fluctuations, and is suitable for most high peak power laser systems. We use the generation of high-order harmonics as an effective test for the contrast improvement produced by the double plasma mirrors.

[Buschke-Löwenstein tumour: diagnosis and treatment]

Buschke-Löwenstein tumour is classified as a verrucous carcinoma. It presents like an exophytic tumour of the genital or peri-anal area, with ulceration and sometimes fistulae and sinuses. It is preferentially seen in men and immunocompromised patients. Histological appearance is not far from condyloma acuminata, but with a tendency to compress and displace deeper tissues, without basement membrane disruption. HPV types 6 or 11 are regularly found in association with this tumour. Other STI have to be searched. Physical examination and precise imagery are useful to chose the right treatment regimen. Radical excision is recommended to avoid malignant transformation, but has to be large because of the high number of recurrences. Other treatment modalities such as chemotherapy or imiquimod could be of interest to avoid mutilating surgical interventions. A regular follow-up is necessary because of frequent recurrences and possible malignant transformation.

Up-regulation of rat myometrial phospholipases C{beta}1 and C{beta}3 correlates with increased term sensitivity to carbachol and oxytocin

In the present study, we compared rat uterine contractility and myometrial inositol phosphate (InsP) production in response to activation of muscarinic and oxytocin receptors during pregnancy and at term. The level of myometrial phospholipase (PL) Cbeta was also determined by Western blotting at different stages of pregnancy and following administration of oestradiol, progesterone or vehicle. The results showed an increased potency of carbachol (CCh), a cholinergic muscarinic agonist, and oxytocin (OT) to enhance myometrial InsP production at term. This correlated with an increased potency of both agonists to induce contraction of the circular but not the longitudinal muscle. For both InsP production and contractile activity, the maximal response of CCh was unaltered, while that of OT was significantly increased. Interestingly, the increased responsiveness to CCh and OT was associated with an up-regulation of PLCbeta1 and PLCbeta3 enzymes. Such regulation is under the control of oestradiol since administration of this steroid to pregnant rats increased the amount of both enzymes by 200-260%. In contrast, progesterone administration was without effect. The present study presents the first evidence that the expression of rat myometrial PLCbeta1 and PLCbeta3 is under the positive control of oestradiol. This could participate in the enhancement of myometrial InsP accumulation and uterine contraction at term in response to CCh and OT. Based on contraction studies, we also propose that the longitudinal and circular uterine muscles differ in the regulation of the PLC pathway during pregnancy.

Early biliary pseudolithiasis during ceftriaxone therapy for acute pyelonephritis in children: a prospective study in 34 children

The prolonged biological half-life of Ceftriaxone, allowing once-daily dosing, has contributed to the large diffusion of this third-generation cephalosporin in children. Ceftriaxone is known to induce reversible precipitates in the gallbladder of adults and children. A prospective study was conducted during 1997 in 34 children admitted for the treatment of acute pyelonephritis. Ceftriaxone (intravenous daily single-dose of 50 mg/kg under 2g/day) was initially used. A first gallbladder sonogram, performed before the first or second injection, was normal in all cases. A second evaluation was performed before the fifth and last injection. On this second evaluation the presence of one (n = 3) or two gallstones was recorded in 5 children (15%) on a sonogram made after 3 (n = 4) or 5 (n = 1) injections. Their median age was 7 years (range 4 months to 11 years). All five children remained symptom-free and the normalization of the sonographic patterns was constant on the last sonogram performed 2 (n = 1), 3 (n = 2) and 5 months (n = 2) after discontinuation of Ceftriaxone. This study confirms the possibility of precocious biliary lithiasis under Ceftriaxone therapy in childhood and their spontaneous dissolution after discontinuation of the drug. They seem unpredictable and independent of the age, sex in a cohort homogeneous for the nature of the infection, modality of a short- and low-dose therapy. Clinicians and radiologists should be aware of this complication as an etiology of a so-called primary cholelithiasis and to prevent anxiety or unnecessary cholecystectomy. The antibacterial and pharmacokinetic benefits of Ceftriaxone outweigh the problem of reversible biliary pseudolithiasis with this drug.

[Severe obstetric complications nescessitating hospitalization and intensive care: a ten year retrospective study]

OBJECTIVES

To assess the serious maternal morbidity during pregnancy, delivery and post partum, which led to an hospitalization in a medical or surgical intensive care unit.

STUDY DESIGN

A Retrospective study was carried out on a period of ten years, from July 1986 to July 1996, in the University Teaching Hospital of Besançon.

PATIENTS

The criterions of inclusion come from the definition of the serious maternal morbidity decided by the Inserm: any admission of a pregnant woman in a medical or surgical intensive care unit in the 42 days of the post-partum, whatever the term of the pregnancy and the type of the post-partum, extra uterine pregnancy, spontaneous miscarriage and medical or voluntary abortion.

METHODS

Forty-six patient's medical file hospitalized in a medical or surgical intensive care unit between July, 1st 1986 and July, 31st 1996, have been studied.

RESULTS

The analysis of the cause underline the gravity of the pathologies handled with young patients and initially healthy, the short length of controlled ventilation and hospitalization, the avoidability of great number of transfer in an intensive care unit, and the lack of hospitalization due to anaesthesia. The frequency of hospitalisation in an intensive care unit during and after the pregnancy was estimated at 0.17% of lives births.

CONCLUSION

The serious maternal morbidity could be an indicator of the quality of the obstetrics cares which would complete the study of the maternal mortality. The potential gravity of the complication of the pregnancy and the delivery require better care of this patients.

Disclosure of HIV seropositivity

Deciding whether or not to disclose one's HIV-positive status to another person is an important decision: the way each person experiences and copes with the illness is reflected in this choice. We conducted a study of 174 patients (29.3% of women) to examine how the decision to disclose or conceal was made, as well as its subjective and social consequences. We discovered that only 3.5% of the individuals remained silent about their illness. Most spoke about it, regardless of how they had been infected or of the advice they had received to be discrete. The confession often did not bring them the relief they sought. Revealing one's HIV-positive status is not a sign of social responsibility, or of a special trust in someone, but rather a compulsive act to release suppressed tension. Individuals who do not confess need attention; their silence is a sign of their inability to adapt to their illness, as well as of their self-imposed exclusion from society.