[Characteristics of radiotherapy for adolescents and young adults]

Radiotherapy for adolescents and young adults is complex in several aspects. The population is very heterogeneous and has characteristics derived from both paediatric and adult populations both in terms of pathology (anatomical pathology, response to treatment) and the patient's physical, biological and psychological characteristics. This article reviews the characteristics to be taken into account in adolescent and young adult patients radiotherapy and more particularly in some of the most common diseases.

Incidence, characteristics, management and outcome of patients with follicular lymphoma with tumor epidural compression, a study on 22 cases

PURPOSE

Follicular lymphoma (FL) is one of the most common lymphoma. Occasionally, FL is associated with tumoral epidural compression and management of these patients remain poorly codified. This study aims to report incidence, clinical characteristics, management and outcomes of patients with FL and tumoral epidural compression.

MATERIAL AND METHODS

Observational, retrospective cohort study of adult patients with FL and epidural tumor compression, treated in a French Institute over the last 20 years (2000-2021).

RESULTS

Between 2000 and 2021, 1382 patients with FL were followed by the haematological department. Of them, 22 (1.6%) patients (16 men and 6 women) had follicular lymphoma with epidural tumor compression. At epidural tumor compression occurrence, 8/22 (36%) patients had a neurological clinical deficit (motor, sensory or sphincter function) and 14/22 (64%) had tumor pain. All patients were treated with immuno-chemotherapy; the main regimen being used was R-CHOP plus high dose IV methotrexate in 16/22 (73%) patients. Radiotherapy for tumor epidural compression was performed in 19/22 (86%) patients. With a median follow-up of 60 months (range=[1-216]), 5 year local tumor relapse free survival was achieved in 65% (95% CI 47-90%) of patients. The median PFS was of 36 months (95% CI 24-NA) and 5 years OS estimate was 79% (95% CI 62-100%). Two patients developed a relapse at a second epidural site.

CONCLUSION

FL with tumoral epidural compression reached 1.6% of all FL patients. Management based on immuno-chemotherapy with radiotherapy appeared to produce comparable outcomes with the general FL population.

Guide for paediatric radiotherapy procedures

A third of children with cancer receive radiotherapy as part of their initial treatment, which represents 800 paediatric irradiations per year in France carried out in 15 specialized centres approved on the recommendations of the French national cancer institute in decreasing order of frequency, the types of cancer that require irradiation are: brain tumours, neuroblastomas, Ewing's sarcomas, Hodgkin's lymphomas, soft tissue sarcomas including rhabdomyosarcomas, and nephroblastomas. The treatment guidelines follow the recommendations of the French society for childhood cancers (SFCE) or the French and European prospective protocols. The therapeutic indications, the technical and/and ballistic choices of complex cases are frequently discussed during bimonthly paediatric radiotherapy technical web-conferences. All cancers combined, overall survival being 80%, long-term toxicity logically becomes an important concern, making the preparation of treatments complex. The irradiation methods include all the techniques currently available: 3D conformational irradiation, intensity modulation radiation therapy, irradiation under normal or hypofractionated stereotaxic conditions, brachytherapy and proton therapy. We present the update of the recommendations of the French society for radiation oncology on the indications, the technical methods of realization and the organisation and the specificities of paediatric radiation oncology.

P–670 Urine estrone–3-glucuronide (E3G) assay: is there any place during ovarian stimulation for IVF cycles?

Study question

Could the urine estrone–3-glucuronide (E3G) assay be used efficiently to monitor a controlled ovarian hyperstimulation (COH) cycle, in comparison to a serum estradiol (E2) assay?

Summary answer

E3G testing provides an alternative to serum E2 assessment and a new “patient friendly” approach for COH monitoring.

What is known already

In many IVF clinics basic monitoring tools for controlled ovarian stimulation during IVF procedure are ultrasound measurements of follicle growth and hormone assessment of serum E2 levels. The monitoring can occur 4–6 times during stimulation, but repeated blood sampling causes patient stress. In contrast, E3G sampling, one of principal metabolites of estradiol in urine, is non-invasive and can be performed by the patients themselves and measured by fluorescent immunoassay. A correlation has been shown between concentrations of E2 present in plasma and concentrations of E3G in different phases of menstruation cycle.

Study design, size, duration

This is a pilot, prospective study, in a single IVF clinic. Twenty female participants were recruited November 2020 -January 2021, aged 25–43 years and BMI: 18–28kg/m2. Dynamic change of serum E2 and urine E3G at ovarian stimulation monitoring are being analyzed.

Participants/materials, setting, methods

Concurrent urine E3G and serum E2 values were collected from patients who provided between 2 and 4 samples on different days of their COH IVF cycle. Serum E2 values were assessed routinely, while E3G values were measured and validated using a fluorescent immunoassay Mira Fertility Plus® analyzer.Main results and the role of chance: The urine E3G of assay was validated for intra- and inter-assay variability with a coefficient of variation of < 20%. It was also validated for analytical and functional sensitivity and sample stability. Linear regression of serum E2 and E3G values of 56 early morning urine samples who had evaluated between Days 4 and 13 of menstruation cycle provided an R = 0,81. Urine E3G values also correlated to follicle growth. Patient survey results showed that urine sampling was the preferred method of analysis.

Limitations, reasons for caution

We have provided proof of principle that urine E3G measurement can be accurately carried out using fluorescent immunoassay technology during routine COH for IVF cycles. The patients’ study group has to be expanded in order to enable us to find the appropriate place of urine E3G assay in COH protocol.

Wider implications of the findings: Urine E3G testing correlates well to serum E2 assessment in COH. Urine E3G assay provides an alternative to serum-based assessment. The ease of urine sampling allows a reduction in patient discomfort during venopuncture, costs, time, and infection risks in epidemics/pandemics, like COViD–19, and offers a patient-friendly approach to ovarian stimulation.

Trial registration number

NA

Liver resection and ablation for squamous cell carcinoma liver metastases

Background

Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS).

Method

Members of the European–African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS.

Results

Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30).

Conclusion

Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome.

Interlaboratory Study of a Multiresidue Gas Chromatographic Method for Determination of Organochlorine and Pyrethroid Pesticides and Polychlorobiphenyls in Milk, Fish, Eggs, and Beef Fat

An interlaboratory study was conducted to validate a gas chromatographic (GC) method for determination of 21 organochlorine pesticides, 6 pyrethroid pesticides, and 7 polychlorobiphenyl (PCB) congeners in milk, beef fat, fish, and eggs. The method was performed at low contamination levels, which represent relevant contents in food, and is an extension of the European standard (method NF-EN-1528, Parts 1–4). It enlarges the applicable scope of the reference EN method to pyrethroid pesticides and proposes the use of solid-phase extraction (SPE) as a cleanup procedure. Cryogenic extraction was made, and SPE cleanup was performed with 2 successive SPE cartridges: C18 and Florisil®. After injection of the purified extract onto a GC column, residues were measured by electron capture detection. Food samples (liquid milk, beef fat, mixed fish, and mixed eggs) were prepared, tested for homogeneity, and sent to 17 laboratories in France. Test portions were spiked with 27 pesticides and 7 PCBs at levels from 26 to 45, 4 to 27, 31 to 67, and 19 to 127 ng/g into milk, eggs, fish, and fat, respectively. Based on results for spiked samples, the relative standard deviation for repeatability ranged from 1.5 to 6.8% in milk, 3 to 39% in eggs, 4.5 to 12.2% in fish, and 7 to 13% in fat. The relative standard deviation for reproducibility ranged from 33 to 50% in milk, 29 to 59% in eggs, 31 to 57% in fish, and 30 to 62% in fat. This method showed acceptable intra- and interlaboratory precision data, as corroborated by HORRAT values at low levels of pesticide and PCB contamination. The statistical evaluation of the results was performed according to the International Organization for Standardization (ISO; ISO 3534 standard) and 5725-2 Guideline.

Oenological attributes of the yeast Hanseniaspora vineaeand its application for white and red winemaking

Flavour and some compounds associated with wine colour are known to be yeast strain-dependent. These metabolites are important for the sensory quality of wines, studies searching for increase aroma and color are a key area today in winemaking. The aim of this work was to study the oenological potential of the two main strains of Hanseniaspora vineae,native to Uruguay to better understand their successful application at winery level. It is known that these strains contribute with extracellular proteases and β-glucosidase enzyme activities that might increase cell lysis and flavor depending in grape varieties. Application and nutrient management of the process of these strains in production of white wines (Chardonnay, Macabeo and Petit Manseng) and red wine Tannat are discussed. Wines were evaluated to determine the volatile compounds composition and their effect compared to conventional processes. Low production of short and medium chain fatty acids and ethyl esters, and high production of acetate esters and isoprenoids are found compared to S. cerevisiaestrains. The most outstanding characteristic of the species H. vineaewas the production of benzenoids, phenylpropanoids and acetate esters. This behavior was reflected in the sensory evaluation, where all the fermentations performed with H. vineaewere considered superior compared to Saccharomyces cerevisiaewine strains.

Anti-PD-1 immunotherapy in combination with sequential involved-site radiotherapy in heavily pretreated refractory Hodgkin lymphoma

The purpose of this study was to assess efficacy and tolerance of anti-programmed death (PD)-1 immunotherapy in combination with sequential involved-site radiotherapy in heavily pretreated refractory Hodgkin lymphoma. In this case series, we reported the outcome of four heavily pretreated patients with refractory Hodgkin lymphoma treated by anti-PD-1 immunotherapy and involved site radiation therapy. After a median follow-up of 13-month, all patients were alive with complete metabolic response. After radiotherapy, all four patients experienced lung toxicity, which was resolved after antibiotherapy with or without corticosteroid treatment. Anti-PD-1 immunotherapy followed by involved-site radiotherapy is feasible and showed very encouraging results in heavily pretreated patients.

[Siriade 2.0: An e-learning platform for radiation oncology contouring]

PURPOSE

In 2008, the French national society of radiation oncology (SFRO) and the association for radiation oncology continued education (AFCOR) created Siriade, an e-learning website dedicated to contouring.

MATERIAL AND METHODS

Between 2015 and 2017, this platform was updated using the latest digital online tools available. Two main sections were needed: a theoretical part and another section of online workshops.

RESULTS

Teaching courses are available as online commented videos, available on demand. The practical section of the website is an online contouring workshop that automatically generates a report quantifying the quality of the user's delineation compared with the experts'.

CONCLUSION

Siriade 2.0 is an innovating digital tool for radiation oncology initial and continuous education.

Choosing a career in oncology: results of a nationwide cross-sectional study

BACKGROUND

Little information is currently available concerning young medical students desire to pursue a career in oncology, or their career expectations.

METHODS

This project is a cross-sectional epidemiological study. A voluntary and anonymous questionnaire was distributed to all young oncologists studying in France between the 2nd of October 2013 and the 23rd of February 2014.

RESULTS

The overall response rate was 75.6%. A total of 505 young oncologists completed the questionnaire. The main determining factors in the decision to practice oncology were the cross-sectional nature of the field (70.8%), the depth and variety of human relations (56.3%) and the multi-disciplinary field of work (50.2%). Most residents would like to complete a rotation outside of their assigned region (59.2%) or abroad (70.2%) in order to acquire additional expertise (67.7%). In addition, most interns would like to undertake a fellowship involving care, teaching and research in order to hone their skills (85.7%) and forge a career in public hospitals (46.4%). Career prospects mainly involve salaried positions in public hospitals. Many young oncologists are concerned about their professional future, due to the shortage of openings (40.8%), the workload (52.8%) and the lack of work-life balance (33.4%).

CONCLUSIONS

This investigation provides a comprehensive profile of the reasons young oncologists chose to pursue a career in oncology, and their career prospects.

Comparative efficacy of the Leucofeligen™ FeLV/RCP and Purevax™ RCP FeLV vaccines against infection with circulating feline Calicivirus

Background

Feline calicivirus (FCV) is a common virus, found worldwide, mainly responsible for chronic ulceroproliferative faucitis and periodontitis. This virus has a high mutation rate, leading to the presence of numerous FCV strains in the field. The objectives of this study was to evaluate and compare the efficacy of two vaccines (Leucofeligen™ FeLV/RCP and Purevax™ RCP FeLV), which differ by their nature (live vs. inactivated) and the vaccinal strains, against circulating FCV strains. Thirty 9-week-old specific pathogen free (SPF) kittens were thus randomised into 3 groups and were either not vaccinated (control) or vaccinated (2 injections, 3 weeks apart) with one of the vaccines. Four weeks after the second injection of primary vaccination, the cats were inoculated with a pathogenic strain representative of the ones circulating in Europe (FCV-FR4_01) and followed for 2 weeks.

Results

After challenge, significant differences (p < 0.05) between control cats and cats vaccinated with Leucofeligen™ FeLV/RCP or Purevax™ RCP FeLV were observed for body weight variation, rectal temperature rise and maximum clinical scores, reflecting the intensity of the signs (83% and 67% lower in the respective vaccinated groups than in the control group). Significant differences were observed between the vaccinated groups, as cats vaccinated with Leucofeligen™ FeLV/RCP had a lower temperature rise (p < 0.05 at days post-challenge 3 to 5) and lower virus shedding titres (p < 0.05 at days post-challenge 8, 9 and 11) than cats vaccinated with Purevax™ RCP FeLV. Finally, only cats vaccinated with Leucofeligen™ FeLV/RCP had a significantly lower cumulative score, reflecting the intensity and duration of calicivirosis clinical signs, than the control cats (77% lower vs. 62% lower for cats vaccinated with Purevax™ RCP FeLV).

Conclusions

Both vaccines, Leucofeligen™ FeLV/RCP and Purevax™ RCP FeLV, were found to be efficacious in reducing clinical signs induced by FCV-FR4_01, a FCV strain representative of the circulating ones. However, cats vaccinated with Leucofeligen™ FeLV/RCP were able to control the infection more efficiently than those vaccinated with Purevax™ RCP FeLV, as evidenced by the shorter duration of clinical signs and lower viral titre in excretions.

[Combination of radiotherapy and androgen deprivation therapy for localized prostate cancer]

Combination of radiotherapy and androgen deprivation is now considered as the standard of care for patients with a localized prostate cancer but poor prognosis factors. Two groups of randomized trials have led to this recommendation: some have compared radiotherapy alone versus hormonal treatment and radiotherapy: these trials demonstrated, now with a long follow-up, an improvement in 10-year survival for the combined treatment. Three recent trials compared androgen deprivation alone or combined with radiotherapy; a benefit in survival was also demonstrated in favour of the combination. Some questions remained concerning the optimal duration of hormonal treatment, in view of its potential side effects. Patients in the intermediate prognostic groups could receive a short-term androgen deprivation, but those with a high Gleason score must be treated with a long-term hormonal treatment. Modalities of radiotherapy, regarding volumes and dose must also be précised in the next years.

Inhibition of WNT signaling attenuates self-renewal of SHH-subgroup medulloblastoma

The SMOOTHENED inhibitor vismodegib is FDA approved for advanced basal cell carcinoma (BCC), and shows promise in clinical trials for SONIC HEDGEHOG (SHH)-subgroup medulloblastoma (MB) patients. Clinical experience with BCC patients shows that continuous exposure to vismodegib is necessary to prevent tumor recurrence, suggesting the existence of a vismodegib-resistant reservoir of tumor-propagating cells. We isolated such tumor-propagating cells from a mouse model of SHH-subgroup MB and grew them as sphere cultures. These cultures were enriched for the MB progenitor marker SOX2 and formed tumors in vivo. Moreover, while their ability to self-renew was resistant to SHH inhibitors, as has been previously suggested, this self-renewal was instead WNT-dependent. We show here that loss of Trp53 activates canonical WNT signaling in these SOX2-enriched cultures. Importantly, a small molecule WNT inhibitor was able to reduce the propagation and growth of SHH-subgroup MB in vivo, in an on-target manner, leading to increased survival. Our results imply that the tumor-propagating cells driving the growth of bulk SHH-dependent MB are themselves WNT dependent. Further, our data suggest combination therapy with WNT and SHH inhibitors as a therapeutic strategy in patients with SHH-subgroup MB, in order to decrease the tumor recurrence commonly observed in patients treated with vismodegib.

[Estimation of the population attributable fraction due to obesity in hospital admissions for flu valued according to Body Mass Index (BMI) and CUN-BAE]

INTRODUCTION

The obesity pandemic together with the influenza pandemic could lead to a significant burden of disease. The body mass index (BMI) does not discriminate obesity appropriately. The CUN-BAE has recently been used as an estimate of body fatness for Caucasians, including BMI, gender, and age. The aim of this study is to assess the population attributable fraction of hospital admissions due to influenza, due to the body fatness measured with the BMI, and the CUN-BAE.

METHODS

A multicentre study was conducted using matched case-controls. Cases were hospital admissions with the influenza confirmed by the RT-PCR method between 2009 and 2011. The risk of hospital admission and the population attribuible fraction were calculated using the BMI or the CUN-BAE for each adiposity category in a conditional logical regression analysis adjusted for confounding variables. The analyzes were estimated in the total sample, in unvaccinated people, and those less than 65 years-old.

RESULTS

A total of 472 hospitalised cases and 493 controls were included in the study. Compared to normal weight, the aOR of influenza hospital admissions increases with each level of BMI (aOR=1.26; 2.06 and 11.64) and CUN-BAE (aOR=2.78; 4.29; 5.43 and 15.18). The population attributable fraction of influenza admissions using CUN-BAE is 3 times higher than that estimated with BMI (0,72 vs. 0,27), with the differences found being similar the non-vaccinated and under 65 year-olds.

CONCLUSION

The BMI could be underestimating the burden of disease attributable to obesity in individuals hospitalised with influenza. There needs to be an appropriate assessment of the impact of obesity and vaccine recommendation criteria.

Soluble Milk Proteins Improve Muscle Mass Recovery after Immobilization-Induced Muscle Atrophy in Old Rats but Do not Improve Muscle Functional Property Restoration

OBJECTIVES

Effect of 3 different dairy protein sources on the recovery of muscle function after limb immobilization in old rats.

DESIGN

Longitudinal animal study.

SETTING

Institut National de la Recherche Agronomique (INRA). The study took part in a laboratory setting.

INTERVENTION

Old rats were subjected to unilateral hindlimb immobilization for 8 days and then allowed to recover with 3 different dietary proteins: casein, soluble milk proteins or whey proteins for 49 days.

MEASUREMENTS

Body weight, muscle mass, muscle fibre size, isometric, isokinetic torque, muscle fatigability and muscle oxidative status were measured before and at the end of the immobilization period and during the recovery period i.e 7, 21, 35 and 49 days post immobilization.

RESULTS

In contrast to the casein diet, soluble milk proteins and whey proteins were efficient to favor muscle mass recovery after cast immobilization during aging. By contrast, none of the 3 diary proteins was able to improve muscle strength, power and fatigability showing a discrepancy between the recovery of muscle mass and function. However, the soluble milk proteins allowed a better oxidative capacity in skeletal muscle during the rehabilitation period.

CONCLUSION

Whey proteins and soluble milk proteins improve muscle mass recovery after immobilization-induced muscle atrophy in old rats but do not allow muscle functional property restoration.

Brain plasticity and cognitive functions after ethanol consumption in C57BL/6J mice

Acute or chronic administrations of high doses of ethanol in mice are known to produce severe cognitive deficits linked to hippocampal damage. However, we recently reported that chronic and moderate ethanol intake in C57BL/6J mice induced chromatin remodeling within the Bdnf promoters, leading to both enhanced brain-derived neurotrophic factor (BDNF) expression and hippocampal neurogenesis under free-choice protocol. We performed here a series of cellular and behavioral studies to analyze the consequences of these modifications. We showed that a 3-week chronic free-choice ethanol consumption in C57BL/6J mice led to a decrease in DNA methylation of the Bdnf gene within the CA1 and CA3 subfields of the hippocampus, and upregulated hippocampal BDNF signaling pathways mediated by ERK, AKT and CREB. However, this activation did not affect long-term potentiation in the CA1. Conversely, ethanol intake impaired learning and memory capacities analyzed in the contextual fear conditioning test and the novel object recognition task. In addition, ethanol increased behavioral perseveration in the Barnes maze test but did not alter the mouse overall spatial capacities. These data suggested that in conditions of chronic and moderate ethanol intake, the chromatin remodeling leading to BDNF signaling upregulation is probably an adaptive process, engaged via epigenetic regulations, to counteract the cognitive deficits induced by ethanol.

Improved tolerance of peripheral fatigue by the central nervous system after endurance training

PURPOSE

The purposes of this study were to evaluate the effect of endurance training on central fatigue development and recovery.

METHODS

A control group was compared to a training group, which followed an 8-week endurance-training program, consisting in low-force concentric and isometric contractions. Before (PRE) and after (POST) the training period, neuromuscular function of the knee extensor (KE) muscles was evaluated before, immediately after and during 33 min after an exhausting submaximal isometric task at 15 % of the maximal voluntary contraction (MVC) force. After training, the trained group performed another test at iso-time, i.e., with the task maintained until the duration completed before training was matched (POST2). The evaluation of neuromuscular function consisted in the determination of the voluntary activation level during MVCs, from peripheral nerve electrical (VAPNS) and transcranial magnetic stimulations (VATMS). The amplitude of the potentiated twitch (Pt), the evoked [motor evoked potentials, cortical silent period (CSP)] and voluntary EMG activities were also recorded on the KE muscles.

RESULTS

Before training, the isometric task induced significant reductions of VAPNS, VATMS and Pt, and an increased CSP. The training period induced a threefold increase of exercise duration, delayed central fatigue appearance, as illustrated by the absence of modification of VAPNS, VATMS and CSP after POST2. At POST, central fatigue magnitude and recovery were not modified but Pt reduction was greater.

CONCLUSION

These results suggest that central fatigue partially adapts to endurance training. This adaptation principally translates into improved tolerance of peripheral fatigue by the central nervous system.

Laccase wiring on free-standing electrospun carbon nanofibres using a mediator plug

The enzyme laccase was wired on a free-standing electrospun carbon fiber mat using a cross-linker plug based on the pyrene modified electron shuttle ABTS.

[Pulsed-dose rate brachytherapy in cervical cancers: why, how?]

The end of the production of 192 iridium wires terminates low dose rate brachytherapy and requires to move towards pulsed-dose rate or high-dose rate brachytherapy. In the case of gynecological cancers, technical alternatives exist, and many teams have already taken the step of pulsed-dose rate for scientific reasons. Using a projector source is indeed a prerequisite for 3D brachytherapy, which gradually installs as a standard treatment in the treatment of cervical cancers. For other centers, this change implies beyond investments in equipment and training, organizational consequences to ensure quality.

Stereotactic radiotherapy for large solitary brain metastases

PURPOSE

To assess effectiveness and toxicity levels of stereotactic radiation therapy without whole brain radiation therapy in patients with solitary brain metastases larger than 3cm.

PATIENTS AND METHODS

Between June 2007 and March 2009, 12 patients received fractionated stereotactic radiation therapy and 24 patients underwent stereotactic radiosurgery. For the fractionated stereotactic radiation therapy group, 3×7.7Gy were delivered to the planning target volume (PTV); median volume and diameter were 29.4 cm(3) and 4.4cm, respectively. For the stereotactic radiosurgery group, 14Gy were delivered to the PTV; median volume and diameter were 15.6 cm(3) and 3.7cm, respectively.

RESULTS

Median follow-up was 218 days. For the fractionated stereotactic radiation therapy group, local control rates were 100% at 360 days and 64% at 720 days; for the stereotactic radiosurgery group, rates were 58% at 360 days and 48% at 720 days (P=0.06). Median survival time was 504 days for the fractionated stereotactic radiation therapy group and 164 days for the stereotactic radiosurgery group (P=0.049). Two cases of grade 2 toxicity were observed in the fractionated stereotactic radiation therapy group, and 6 cases of grade 1-2 toxicity, in the stereotactic radiosurgery group.

CONCLUSIONS

This study provides data to support that fractionated stereotactic radiation therapy without whole brain radiation therapy with a margin dose of 3 fractions of 7.7Gy for treatment of solitary large brain metastases is efficient and well-tolerated. Because of the significant improvement in overall survival, this schedule should be assessed in a randomized trial.

Effects of endurance training on the maximal voluntary activation level of the knee extensor muscles

PURPOSE

The aim of this study was to investigate the neural adaptations to endurance training, and more specifically the adaptation of the cortical voluntary activation of the knee extensor (KE) muscles.

METHODS

Sixteen sedentary men were randomly allocated into an endurance training (n = 8) or a control group (n = 8). All subjects performed a maximal aerobic speed test (MAS) before and immediately after the training period. Training lasted 8 weeks and was based on endurance running. During Pre- and Post-training testing sessions, maximal voluntary contraction (MVC) was measured and voluntary activation (VA) was calculated via peripheral nerve (PNS) and transcranial magnetic stimulations (TMS) superimposed to MVC. Electromyographic activity (EMG) of the KE muscles was also measured during MVC, PNS (M-wave) and TMS (motor evoked potentials-MEP). The cortical silent period following TMS was also assessed.

RESULTS

Despite a significant improvement in endurance running performance, as suggested by the increase of MAS in the training group (Pre 15.4 ± 1.6 vs. Post 16.4 ± 1.6 km·h(-1)), endurance training did not affect MVC or VA as measured with PNS and TMS. Similarly, the EMG of KE muscles during MVC did not show any significant changes. Furthermore, the MEP amplitude and the duration of the silent period also remained unchanged after endurance training.

CONCLUSIONS

The present study suggests an 8-week endurance-training program does not generate adaptations of neural factors in sedentary subjects.

Synthesis of medicinally useful lipidicα-amino acids, 2-amino alcohols and diamines

The lipidicα-amino acids (LAAs) are non-naturalα-amino acids with saturated or unsaturated long aliphatic side chains. LAAs and their derivatives (lipid mimetics) together with the lipidic peptides represent a class of compounds which combine structural features of lipids with those of amino acids and peptides. Racemic LAAs may be prepared by classical methods and resolved by chemical or enzymatic methods. LAA amides and esters with saturated or unsaturated long chain amines and alcohols respectively, as well as lipidic dipeptide derivatives inhibit both pancreatic and human platelet phospholipase A2. Lipophilic peptide derivatives are inhibitors of human neutrophil elastase. LAAs and their oligomers have been used as drug delivery system. A Lipid-Core-Peptide system has been designed and used as a combined adjuvant-carrier-vaccine system. A variety of lipid mimetics such as lipidic 2-amino alcohols, lipidic 1,2- and 1,3-diamines have been prepared based upon LAAs. Some of them are potent inhibitors of phospholipase A2. A general approach to enantioselective synthesis of LAAs and lipid mimetics is based on the oxidative cleavage of 3-amino-1,2-diols obtained by the regioselective opening of enantiomerically enriched long chain 2,3-epoxy alcohols.

Dynamic Stark spectroscopic measurements of microwave electric fields inside the plasma near a high-power antenna

Fully dynamic Stark effect visible spectroscopy was used for the first time to directly measure the local rf electric field in the boundary plasma near a high-power antenna in high-performance, magnetically confined, fusion energy experiment. The measurement was performed in the superconducting tokamak Tore Supra, in the near field of a 1–3 MW, lower-hybrid, 3.7 GHz wave-launch antenna, and combined with modeling of neutral atom transport to estimate the local rf electric field amplitude (as low as 1–2 kV/cm) and direction in this region. The measurement was then shown to be consistent with the predicted values from a 2D full-wave propagation model. Notably the measurement confirmed that the electric field direction deviates substantially from the direction in which it is launched by the waveguides as it penetrates only a few cm radially inward into the plasma from the waveguides, consistent with the model.

UV filters for hair protection

Synopsis Hair damage, caused by sunlight, and the possibility to protect hair against sunlight by means of cosmetic formulations was studied. For this, five UV-filters were tested: benzophenone-3 (UV-A/UV-B); benzophenone-4 (UV-A/UV-B); phenylbenzimidazole sulfonic acid (UV-B); butylmethoxydibenzoylmethane (UV-A); octyl dimethyl PABA (UV-B). The stability of the UV-filters was tested as pure substances as well as in two cosmetic formulations: a setting lotion and a shine spray. The degree of decolouration and stress strain behaviour were determined. The benzophenones had the best protection ability both on colour and on morphology. Stability data and UV-spectra are discussed.

A protection system for the JET ITER-like wall based on imaging diagnostics

The new JET ITER-like wall (made of beryllium and tungsten) is more fragile than the former carbon fiber composite wall and requires active protection to prevent excessive heat loads on the plasma facing components (PFC). Analog CCD cameras operating in the near infrared wavelength are used to measure surface temperature of the PFCs. Region of interest (ROI) analysis is performed in real time and the maximum temperature measured in each ROI is sent to the vessel thermal map. The protection of the ITER-like wall system started in October 2011 and has already successfully led to a safe landing of the plasma when hot spots were observed on the Be main chamber PFCs. Divertor protection is more of a challenge due to dust deposits that often generate false hot spots. In this contribution we describe the camera, data capture and real time processing systems. We discuss the calibration strategy for the temperature measurements with cross validation with thermal IR cameras and bi-color pyrometers. Most importantly, we demonstrate that a protection system based on CCD cameras can work and show examples of hot spot detections that stop the plasma pulse. The limits of such a design and the associated constraints on the operations are also presented.

Modeling of the ITER-like wide-angle infrared thermography view of JET

Infrared (IR) thermography systems are mandatory to ensure safe plasma operation in fusion devices. However, IR measurements are made much more complicated in metallic environment because of the spurious contributions of the reflected fluxes. This paper presents a full predictive photonic simulation able to assess accurately the surface temperature measurement with classical IR thermography from a given plasma scenario and by taking into account the optical properties of PFCs materials. This simulation has been carried out the ITER-like wide angle infrared camera view of JET in comparing with experimental data. The consequences and the effects of the low emissivity and the bidirectional reflectivity distribution function used in the model for the metallic PFCs on the contribution of the reflected flux in the analysis are discussed.

Molecular characterization of EGFR and EGFR-downstream pathways in triple negative breast carcinomas with basal like features

AIMS

Triple negative breast cancer with basal like features (TN-BCBL) do not benefit from hormonal and anti-HER2 therapies. As a considerable fraction of TN-BCBLs shows EGFR deregulation, EGFR-targeted therapies have been proposed as an option. The characterization of EGFR and EGFR-downstream members may therefore provide important predictive information.

METHODS AND RESULTS

Based on morphological and immunophenotypic features, we identified 38 TN-BCBLs that were subsequently investigated for alterations in EGFR signaling pathways. EGFR and PTEN protein levels were studied by immunohistochemistry, EGFR gene status by FISH, EGFR, H-Ras, K-Ras, N-Ras, BRAF and PIK3CA gene mutations by direct sequencing. EGFR overexpression and loss of PTEN expression characterized the majority of TN-BCBLs (76% and 74% of patients, respectively). EGFR gene copy number gain (FISH+) was identified in 51% of analyzable patients. PIK3CA gene mutations were detected in three cases (8%), whereas EGFR, H-Ras, K-Ras, N-Ras and BRAF genes showed no mutations. Overall, out of 17 patients classified as FISH+, 12 cases (70%) showed a concomitant alteration in PI3K/PTEN pathway.

CONCLUSIONS

These results provide evidence that the efficacy of anti-EGFR drugs in TN-BCBL patients could be impaired by frequent alterations in the PI3K/PTEN axis, and suggest that TN-BCBLs could benefit from tailored treatments against this axis.