Search

The use of HAART for the treatment of HIV/AIDS infection, despite its success, has been reported to be accompanied by increased number of adverse drug reactions (ADRs) for which some risk factors such as age, gender, co-morbidities have been implicated. The association between alcohol consumption, herbal drug intake and use of co-trimoxazole and ADRs to HAART has not been documented much. The main objective of this study is to determine the association between alcohol consumption, herbal drug intake, use of co-trimoxazole and presentation of ADRs to HAART in HIV/AIDS patients in Makurdi where there’s high HIV infection, alcohol consumption and herbal use. It was a combination of prospective and retrospective study at FMC, Makurdi. We used clinical records of the patients and questionnaires for patients enrolled from January to October, 2019 and followed up for six months. The biodata, drug history including herbal medications and social life (use of alcohol) history were retrieved. A total number of three hundred and three (303) patients were recruited during the study period out of which two hundred and ten (210) patients were used. From a total of 210 patients, 144 (68. 6%) were females while sixty-six, 66 (31.4 %) were males. Of these, only 68(32.4%) patients took alcohol while 89 (42.4%) patients used herbal medications together with HAART regimen and 185(88.1) were on cotrimoxazole prophylaxis. 22 patients presented with ADR with peripheral neuropathy and insomnia being the commonest ADRs. 54.5% (majority) of the patients with ADRs took alcohol while 81.8% (majority) of the patients who developed ADRs were actually on herbal medications or co-trimoxazole. The p-value>0.05. Alcohol consumption, herbal medication use and co-trimoxazole prophylaxis in HIV/AIDS positive patients while on ARVs may increase ADRs to ARVs. Thus, HIV/AIDS patients should be discouraged from use of alcohol and herbal medication while on HAART.

International audience; We report the case of an 18-year-old immunocompetent man who presented to the hospital with fever, headaches, and arthromyalgia, which progressed to include an erythematous rash. He had a history of a tick bite 72 h earlier. The diagnosis of rickettsial infection was suspected and a course of doxycycline was initiated for a total of 5 days. His evolution was rapidly favorable under treatment, with resolution of the symptoms within 24 h. Blood cultures came back positive for Neisseria meningitidis serotype B, indicating an authentic purpura fulminans. Purpura fulminans is a medical emergency, a syndrome of intravascular thrombosis characterized by a very rapid evolution that requires early recognition and specific treatment. It is commonly described in the young and healthy patient and has high mortality and morbidity. Common bacteria mainly associated with purpura fulminans are Meningococcus spp., Pneumococcus spp., and Staphylococcus spp.

Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10−72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10−4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10−5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids.

Aim: The configuration of the earth’s landmasses influences global weather systems and spatiotemporal resource availability, thereby shaping biogeographical patterns and migratory routes of animals. Here, we aim to identify potential migratory barriers and corridors, as well as general migration strategies within the understudied Indo-European flyway. Location: Europe, Central Asia. Major taxon studied: Common rosefinches. Methods: We used a combination of theoretical optimization modelling and empirical tracking of Common Rosefinches (Carpodacus erythrinus) breeding across a large latitudinal gradient in Europe. First, we identified optimal migration routes driven by wind and resource availability along the Indo-European flyway. Second, we tracked rosefinches from five breeding populations using light-level geolocators. Finally, we compared to what extent empirical tracks overlapped with the modelled optimal routes. Results: In autumn, theoretical wind driven migration routes formed a broad-front corridor connecting Europe and the Indian Subcontinent while the theoretical resource driven routes formed a distinct north-south divide. The latter pattern also reflected the rosefinch tracks with all but the most southerly breeding birds making a northern detour towards non-breeding sites in Pakistan and India. In spring, the resource availability model predicted a similar migratory divide, however, the southern route seemed relatively more favourable and closely matched with the optimal wind driven migration routes. Spring tracking data showed larger overlap with the modelled wind driven migration routes compared to the resource driven routes. Main conclusions: Optimal wind and resource driven migration routes along the Indo-European flyway are seasonally specific and to a large extend do not overlap with one another. Under these conditions, migratory birds adopt seasonally distinct migration strategies following energy minimization strategy in autumn, driven by resource availability, and time minimizing strategy in spring, driven by wind conditions. Our optimal migration models can be applied worldwide and used to validate against empirical data to explain large-scale biogeographic pattern of migratory animals.

Resume Introduction Les adenopathies sont une cause frequente de recours en medecine interne. Quand l'analyse histologique revele la presence de granulomes, de multiples etiologies infectieuses ou non infectieuses sont envisagees. Si les diagnostics de lymphome, sarcoidose ou tuberculose sont facilement evoques, la tularemie doit aussi etre envisagee dans le diagnostic differentiel. Observation Une patiente de 54 ans presentait une fievre vesperale avec sueurs nocturnes et une toux resistante a deux lignes d'antibiotiques. Une tomodensitometrie thoraco-abdomino-pelvienne mettait en evidence des adenopathies hilaires et mediastinales apparaissant hypermetaboliques au PET-TDM, ainsi que des nodules pulmonaires. Une PCR realisee sur biopsie ganglionnaire ainsi qu'une serologie ont permis le diagnostic de tularemie. L'evolution etait favorable apres traitement antibiotique. Conclusion L'association fievre, sueurs nocturnes, alteration de l'etat general et adenopathies mediastinales doit faire evoquer le diagnostic de tularemie. La biopsie ganglionnaire couplee aux techniques de biologie moleculaire et aux serologies, permet de confirmer le diagnostic.

Introduction et but de l’etude Depuis octobre 2019, l’Institut du cancer de Montpellier (ICM) traite certains cancers comme ceux du pancreas, du foie et les recidives de cancer de la prostate avec un accelerateur lineaire couple a un IRM de 0,35 T, le MRIdian® (ViewRay® Technologies, Inc.). Cet appareil permet une bonne visualisation des tissus mous, le suivi en temps reel d’un volume cible, et la possibilite de traitement adaptatif quotidien. La qualite des images joue donc un role primordial. Nous detaillons ici l’acceptance et la mise en place des controles de la partie IRM de l’appareil MRIdian®. Materiel et methodes L’homogeneite du champ magnetique en fonction de l’angle du bras, ainsi que le rapport signal sur bruit et l’uniformite des antennes ont ete mesures avec un fantome homogene dans les trois plans. Tous les controles ont ete effectues avec l’angle de bras produisant l’homogeneite la moins bonne. Les recommandations de l’American College of Radiology (ACR) et leur fantome ont ete utilises pour controler les performances globales de l’IRM. L’integrite spatiale a ete mesuree dans les trois plans a plusieurs positions autour de l’isocentre. Le bruit sur les images avec et sans la presence de la radiofrequence externe du faisceau a ete evalue en fonction de l’angle du bras, tout comme la presence d’eventuels artefacts en mode cine sur les coupes sagittales a l’isocentre (field of view [FOV] minimum de 30 cm) et a ± 12,5 cm (FOV minimum de 16,6 cm). Resultats et analyse statistique L’homogeneite du champ magnetique en fonction de l’angle du bras etait dans la tolerance de 5 ppm avec une valeur maximale de 3,8 ppm a 90°. Les resultats de rapport signal sur bruit etaient de 13,2 en moyenne pour l’antenne interne, 42 en moyenne pour les antennes corps et tete, et etaient superieurs aux tolerances du constructeur (12 et 30 respectivement). Il en etait de meme pour l’uniformite (moyenne de 66,9 % pour 60 % demande pour l’antenne interne, 66,7 % pour 50 % demande pour les autres antennes). Les resultats des tests de l’ACR etaient dans les specifications ( Tableau 1 ). Pour l’integrite spatiale, tous les points des images situes dans le FOV de 20 cm se situaient a moins de 1 mm de leur position attendue, et ceux situes entre 20 et 35 cm etaient a moins de 2 mm. Le rapport entre les deviations standard du bruit de l’image avec et sans la radiofrequence de l’accelerateur lineaire a atteint un maximum de 3,5 % a 240°, pour une tolerance de 20 %. Enfin, dans les images cine en coupe sagittale, aucun artefact ne se situait dans le FOV minimum associe. Un programme d’assurance qualite d’imagerie a ete mis en place afin de suivre l’evolution de ces valeurs. Conclusion L’acceptance du systeme MRIdian® a ete realisee par le constructeur en presence des physiciens referents. Les controles de qualite periodiques sont bases sur les recommandations du constructeur. A chaque intervention sur un element de l’IRM, l’homogeneite de champ magnetique en fonction de l’angle de bras doit etre effectuee. Le controle de l’ACR n’est pas adapte pour un IRM a bas champ car il est chronophage et n’utilise pas la sequence unique true fast imaging with steady state precession (TrueFISP) utilisee cliniquement pour la prise en charge des patients.

BACKGROUND: The management of breath-induced tumor motion is a major challenge for lung stereotactic body radiation therapy (SBRT). Three techniques are currently available for these treatments: tracking (T), gating (G) and free-breathing (FB). AIM: To evaluate the dosimetric differences between these three treatment techniques for lung SBRT. MATERIALS AND METHODS: Pretreatment 4DCT data were acquired for 10 patients and sorted into 10 phases of a breathing cycle, such as 0% and 50% phases defined respectively as the inhalation and exhalation maximum. GTV(ph), PTV(ph) (=GTV(ph) + 3 mm) and the ipsilateral lung were contoured on each phase. For the tracking technique, 9 fixed fields were adjusted to each PTV(ph) for the 10 phases. The gating technique was studied with 3 exhalation phases (40%, 50% and 60%). For the free-breathing technique, ITV(FB) was created from a sum of all GTV(ph) and a 3 mm margin was added to define a PTV(FB). Fields were adjusted to PTV(FB) and dose distributions were calculated on the average intensity projection (AIP) CT. Then, the beam arrangement with the same monitor units was planned on each CT phase. The 3 modalities were evaluated using DVHs of each GTV(ph), the homogeneity index and the volume of the ipsilateral lung receiving 20 Gy (V(20Gy)). RESULTS: The FB system improved the target coverage by increasing D(mean) (75.87((T))–76.08((G))–77.49((FB))Gy). Target coverage was slightly more homogeneous, too (HI: 0.17((T and G))–0.15((FB))). But the lung was better protected with the tracking system (V(20Gy): 3.82((T))–4.96((G))–6.34((FB))%). CONCLUSIONS: Every technique provides plans with a good target coverage and lung protection. While irradiation with free-breathing increases doses to GTV, irradiation with the tracking technique spares better the lung but can dramatically increase the treatment complexity.

Introduction Les adenopathies sont une cause frequente de recours en medecine interne. Leurs etiologies sont tres nombreuses. Si les diagnostics de lymphome, sarcoidose ou tuberculose sont facilement evoques, la tularemie doit aussi etre envisagee dans le diagnostic differentiel. Observation Une patiente de 54 ans, amatrice de promenades en foret, presentait depuis 2 mois une fievre vesperale, avec frissons et sueurs, ainsi qu’une toux seche. Deux traitements antibiotiques restaient sans efficacite (amoxicilline/acide clavulanique puis amoxicilline/acide clavulanique et roxithromycine). Elle presentait une polynucleose neutrophile a 16 000/mm3, ainsi qu’une elevation de la CRP a 77 mg/mL. La radiographie thoracique ne trouvait pas de foyer parenchymateux. Les examens suivants etaient normaux ou negatifs : PCR syndromique respiratoire, serologies virales, recherche de BAAR sur expectorations, hemocultures, radiographie thoracique, echographie cardiaque transthoracique. Une tomodensitometrie (TDM) thoraco-abdomino-pelvienne mettait en evidence de multiples adenopathies hilaires et mediastinales d’allure necrotique, apparaissant intensement hypermetaboliques au PET TDM, ainsi que des nodules peri-scissuraux et sous-pleuraux dont un au niveau du segment ventral du lobe superieur droit de 7 mm, non fixants. Le diagnostic de lymphome etait evoque. Une biopsie a l’aiguille d’une adenopathie sus-claviculaire droite revelait des granulomes epithelioide et gigantocellulaires, sans agent pathogene identifie. La serologie de tularemie etait positive en IgG a un titre significatif et la PCR realisee sur le prelevement ganglionnaire confirmait le diagnostic de tularemie. Bien qu’une amelioration spontanee etait observee, un traitement par ciprofloxacine 500 mg, 2 fois par jour pendant 3 semaines a ete instaure a la reception de ces resultats. La guerison etait complete. Discussion La tularemie est une infection bacterienne due a Francisella tularensis, bacille Gram negatif intracellulaire facultatif. Les lagomorphes (lapins, lievres) constituent le reservoir principal. La contamination se fait par contact direct avec les animaux infectes, par un vecteur (piqure d’arthropodes), par inhalation de poussieres provenant de sites infectes ou par ingestion de nourriture ou d’eau contaminees. La voie d’infestation determinera la forme clinique de la maladie : ulceroglandulaire, glandulaire pure, pulmonaire, oropharyngee, oculoglandulaire et/ou systemique. Le traitement de la tularemie repose, chez l’adulte, sur les fluoroquinolones, la doxycycline ou la gentamicine. Conclusion Chez un patient potentiellement expose, l’association fievre, sueurs nocturnes, alteration de l’etat general et adenopathies mediastinales doit faire evoquer le diagnostic de tularemie. La biopsie ganglionnaire, retrouvant des lesions granulomateuses, couplee aux techniques de biologie moleculaire, mais aussi aux serologies, permet de confirmer le diagnostic.

International audience; The aim was to analyze arc therapy techniques according to the number and position of the brain lesions reported by comparing dynamic noncoplanar conformal arcs (DCA), two coplanar full arcs (RAC) with volumetric-modulated arc therapy (VMAT), multiple noncoplanar partial arcs with VMAT (RANC), and two full arcs with VMAT and 10° table rotation (RAT). Patients with a single lesion (n= 10), multiple lesions (n = 10) or a single lesion close to organs at risk (n = 5) and previously treated with DCA were selected. For each patient, the DCA treatment was replanned with all VMAT techniques. All DCA plans were compared with VMAT plans and evaluated in regard to the different quality indices and dosimetric parameters. For single lesion, homogeneity index (HI) better results were found for the RANC technique (0.17 ± 0.05) compared with DCA procedure (0.27± 0.05). Concerning conformity index (CI), the RAT technique gave higher and better values (0.85 ± 0.04) compared with those obtained with the DCA technique (0.77 ± 0.05). DCA improved healthy brain protection (8.35 ± 5.61 cc vs. 10.52 ± 6.40 cc for RANC) and reduced monitor unit numbers (3046 ± 374 MU vs. 4651 ± 736 for RANC), even if global room occupation was higher. For multiple lesions, VMAT techniques provided better HI (0.16) than DCA (0.24 ± 0.07). The CI was improved with RAT (0.8 ± 0.08 for RAT vs. 0.71 ± 0.08 for DCA). The V10Gy healthy brain was better protected with DCA (9.27 ± 4.57 cc). Regarding the MU numbers: RANC < RAT< RAC < DCA. For a single lesion close to OAR, RAT achieved high degrees of homogeneity (0.27 ± 0.03 vs. 0.53 ± 0.2 for DCA) and conformity (0.72± 0.06vs. 0.56 ± 0.13 for DCA) while sparing organs at risk (Dmax = 12.36 ± 1.05Gyvs. 14.12 ± 0.59 Gy for DCA, and Dmean = 3.96 ± 3.57Gyvs. 4.72 ± 3.28Gy for DCA). On the other hand, MU numbers were lower with DCA (2254 ± 190 MUvs. 3438 ± 457 MU for RANC) even if overall time was inferior with RAC. For a single lesion, DCA provide better plan considering low doses to healthy brain even if quality indexes are better for the others techniques. For multiple lesions, RANC seems to be the best compromise, due to the ability to deliver a good conformity and homogeneity plan while sparing healthy brain tissue. For a single lesion close to organs at risk, RAT is the most appropriate technique.

Introduction Intravenous contrast agent injection during the patient CT simulation facilitates radiotherapy contouring in the case of head and neck cancers. However, the image contrast enhancement may introduce discrepancy between the planned and delivered dose. The aim of this retrospective study is to quantify the variations of Hounsfield unites (HU) and to investigate their effect on Volumetric Modulated Arc Therapy (VMAT) dose distributions. Material and methods Ten patients previously treated by VMAT techniques with identical dose levels (70/60/50 Gy) were selected. For each patient, two CT scans were performed, 2 min. (CT inj ) and 12 min. (CT delay ) after Iomeron® 350 biphasic intravenous injection (60 mL, 1 mL/s followed by 90 mL, 2 mL/s after 30 s). The treatment planning (optimization and calculation) was performed with CT inj using the Eclipse TPS and Acuros XB® algorithm. Two other treatment plans were recalculated with the same parameters and CT delay . The mean HU and the iodine distribution were compared between the two scan images in the PTV50, the parotids and the thyroid. A dosimetric comparison using dose-volume histograms in target volumes and OAR (thyroid, parotids) was performed. The maximum (D 2% ), minimum (D 98% ) and median (D 50% ) doses were registered. Results The maximum HU average difference over all the patients was observed in the thyroid (81.37 ± 36.01 HU) followed by the PTV50 (10.76 pm 15.70 HU) and the parotids (9.39 ± 16.01 HU). The differences observed with Acuros® algorithm were below 0.2% for D 2% , D 98% et D 50% in target volumes and 0.31% in OAR. Conclusion This study shows that the use of intravenous contrast during CT simulation does not significantly affect dose calculation in head and neck VMAT plans using Acuros® algorithm.

0

0

This project aimed to the development of the research and the technology necessary to promote higher added value to fishing activity. This is to be achieved by obtaining profit from a finfish species (“Rockcod”, Patagonotothen spp.) not known to consumers and currently discarded by the EU fishing fleet operating in the South West Atlantic, in order to supply the EU seafood industry with a good quality raw material for human food manufacturing. Use of this species, caught as a by-catch in the existing fisheries targeting hakes and cephalopods, should also increase the profitability of the fleet, contribute to maintaining employment and help to counterbalance the negative effects of fishing activity and discards in the ecosystem. The main scientific-technological objectives and expected achievements were the following: - Description of the fisheries - Improved knowledge of the biology of the species - Biomass assessment - Estimation of catches and discards - Analysis of the spatial and temporal distribution of the resource. Fishery forecasting and testing - Sensorial, Microbiological, Nutritional and Biochemical Evaluation of Rock cod - Development of the technical modifications on board commercial vessels - Development of new processed products from frozen Rock cod, European Commission Cooperative Research (CRAFT)

0

Objectives: This study was carried out to determine the effect of NaF, TiF4 and CPP-ACP (Tooth Mousse, Recaldent®, GC) applications on artificial white spot lesions in vitro. In order to assess remineralization potential of those agents, a fluoride-uptake, CSMH, SEM and EDX measures were performed. Methods: 75 samples of intact human premolars were expose to pH-cycling during 3 hours in demineralizing solution (pH=4, 3) and 21 hours in artificial saliva (pH=7, 2) during 8 days to create a white spot lesion. The remaining sound enamel was covered with an acid resistant nail-varnish in color (positive control window). After creation of the artificial lesion one demineralized area of each sample was covered with an nail-varnish in another color (negative control window). Specimens were randomly assigned into 5 experimental groups to obtain 15 samples per group. The groups received the treatments with different agents: 1. NaF solution (1%), 2. TiF4 solution (1%), 3. NaF solution (1%) + CPP-ACP, 4. TiF4 (1%) + CPP-ACP and 5. solely CPP-ACP. Fluoride-uptake was measured in first 4 groups. All samples were bisected in order to obtain two halves througout experimental window and positive and negative control window. Samples were examined with micro-hardness tester by making three indentations on each experimental window. The indentations were 250μm (A), 400 μm (B) and 550 μm (C) of depth. Three selected samples per group were additionally examined with SEM and EDX. Results: Fluoride uptake was the highest in the 2nd and the lowest in the 3rd group. There were no significant differences neither between 5 groups nor between experimental and control groups according to CSMH. EDX shoved significant incorporation of titanium in surface layer of enamel (4, 8 %Wt in 2nd and 7, 4 %Wt in 4th group) (p ≤ 0, 05). Conclusions: Presence of CPP-ACP does not influence physical properties of enamel. 0442

Objectif Comparer les parametres dosimetriques de trois methodes de radiotherapie stereotaxique pulmonaire par accelerateur lineaire : tracking (1), gating (2) et respiration libre (3). Patients et methodes Une etude retrospective a ete menee chez dix patients. Le volume tumoral macroscopique, le volume cible previsionnel (volume tumoral macroscopique + 3 mm) et le poumon homolateral sain ont ete definis sur chaque phase du cycle respiratoire sur une scanographie quadridimensionnelle. La dose prescrite etait de 60 Gy en quatre seances. Pour le tracking (1), dix plans de traitement, correspondant aux dix phases, ont ete crees a partir de neuf champs statiques puis additionnes. Tous les plans ont ete normalises tels que 99 % de la dose couvre 99 % du volume cible previsionnel pulmonaire homolateral et ont respecte les contraintes de l’etude ROSEL. Le gating (2) a ete analyse lors de trois phases expiratoires (40, 50 et 60 %). Pour la respiration libre (3), un volume cible interne (somme des volumes tumoraux macroscopiques) et un volume cible previsionnel (volume cible interne + 3 mm) ont ete generes. Le volume cible previsionnel a ete reporte sur chaque scanographie et la distribution de dose a ete calculee. La normalisation et les contraintes de doses sont identiques a celles utilisees pour le tracking. Enfin, les dix plans ont ete additionnes. Les trois modalites ont ete evaluees a partir des histogrammes dose-volume des volumes tumoraux macroscopiques, de l’indice d’homogeneite ( 1 H = dose maximale − dose minimale dose moyenne ) et des doses recues par le poumon sain (dose moyenne et volume recevant 20 Gy : V20 Gy). Resultats En depit de dose maximale et d’indices d’homogeneite similaires (dose maximale : tracking 80,44 Gy ; gating 80,47 Gy ; respiration libre 81,29 Gy ; IH : tracking et gating 0,17 ; respiration libre 0,15), l’irradiation en respiration libre ameliorait la couverture du volume tumoral macroscopique en augmentant les dose minimales et moyennes (dose minimale : tracking 67,5 Gy ; gating 67,35 Gy ; respiration libre 69,95 Gy ; dose moyenne : tracking 75,87 Gy ; gating 75,91 Gy ; respiration libre 77,49 Gy). En revanche, le poumon sain etait mieux protege avec le tracking (V20 Gy : tracking 3,69 % ; gating 3,89 % ; respiration libre 6,17 % et dose moyenne : tracking 3,41 Gy ; gating 3,63 Gy ; respiration libre 4,9 Gy), meme si les contraintes de doses ont ete respectees dans tous les cas (V20 Gy de moins de 10 %). Conclusion Une irradiation en respiration libre delivre plus de dose au volume tumoral macroscopique tandis que le tracking et gating epargnent d’avantage le poumon sain mais complexifient aussi le traitement.

Objectifs L’irradiation de la sphere ORL avec une technique d’arctherapie volumetrique genere plusieurs questions des lors que le calcul dosimetrique est realise sur une scanographie de simulation apres injection. Ainsi, il n’est pas possible de choisir des portes d’entrees de faisceaux evitant le rehaussement de contraste du a l’injection. L’objectif de ce travail etait d’analyser cet impact et de determiner s’il est necessaire de realiser deux acquisitions de preparation, l’une apres injection pour la definition des volumes, et une autre pour le calcul dosimetrique. Patients et methodes L’etude a porte sur les dossiers de neuf patients traites, pris en charge pour des cancers de la sphere ORL avec la technique d’arctherapie volumetrique (Varian Medical Systems). Deux acquisitions scanographiques ont ete realisees, une avec et une sans injection. L’optimisation et le calcul de dose ont ete realises sur la scanographie apres injection, au moyen du systeme de planification des traitements TPS Eclipse ® (VMS) et des algorithmes AAA et PRO (v.10). Le meme plan de traitement a ete recalcule dans un second temps sur la scanographie sans injection. Les differences entre les histogrammes doses–volumes obtenus des doses moyennes, des doses maximales et minimales ainsi que les volumes recevant 20, 30 et 45 Gy pour les organes a risque ont ete relevees et comparees. Resultats L’etude montre que la dose moyenne delivree dans le volume cible previsionnel de haute dose etait en moyenne superieure de 0,028 ± 0,038 %, la dose minimale superieure de 0,975 ± 2,06 % et la dose maximale de 0,389 ± 0,562 %. Des resultats similaires ont ete retrouves pour les volumes cibles previsionnels de dose intermediaire et de basse dose. Les ecarts sur les organes a risque etaient legerement plus importants mais inferieurs a 1,5 %. Conclusion L’effet du produit de contraste sur des traitements des cancers de la sphere ORL avec une technique d’arctherapie volumetrique s’est traduit par des ecarts inferieurs a 1 % sur les volumes cibles previsionnels et inferieurs a 1,5 % sur les organes a risque. Ces resultats ne permettent pas la remise en cause du protocole de dosimetrie sur scanographie apres injection.

Objectifs L’objectif etait l’evaluation de la tolerance et de l’efficacite des radiotherapies pulmonaires en condition stereotaxique. Patients et methodes Etude retrospective portant sur l’ensemble des patients atteints de lesions primitives ou secondaires traitees dans notre institution. De septembre 2009 jusqu’a ce jour, 152 tumeurs ont ainsi ete irradiees chez 137 patients. La majorite etait des adenocarcinomes (50 %), 30 % des carcinomes epidermoides et 21 % des tumeurs d’histologie non connue. La planification a ete realisee sur une premiere scanographie quadridimensionnelle d’une serie de quatre, avec une technique de gating respiratoire. La reproductibilite du positionnement et du volume cible interne a ete verifiee sur les trois autres scanographies quadridimensionnelles. La dose planifiee a ete adaptee aux contraintes de localisation et de volume, et generalement de 60 Gy en quatre fractions sur quatre semaines (deux tiers des cas). Les 36 premieres lesions ont ete traitees avec une technique stereotaxique avec faisceaux statiques, essentiellement neuf (95 %). Puis, les 116 suivantes ont ete traitees par une technique d’arctherapie volumetrique modulee. L’irradiation a ete delivree en respiration libre apres verification du positionnement par tomographie conique. Le gating respiratoire durant le traitement interdisait l’irradiation si la lesion se deplacait en dehors de la zone predefinie. Resultats La tolerance du traitement a ete excellente puisque aucun arret n’a eu lieu chez les patients. Il n’a pas ete note de majoration de dyspnee, d’apparition d’œsophagite ni de douleurs apres le traitement. Sur les 152 traitements, seules huit progressions locales (5,2 %) ont ete notees. La dose semblait un facteur important, puisque six de ces huit patients avaient eu une prescription de dose diminuee (sept fractions de 5 Gy pour une lesion, quatre de 12 Gy pour cinq lesions). Conclusion L’irradiation stereotaxique pulmonaire est une technique efficace occasionnant peu d’effets secondaires. La dose delivree semble etre un facteur determinant du controle local.

Introduction In order to select the best one according to the number and the position of the lesions we compare in this study dynamic conformal arc (DCA), coplanar VMAT (RAC), noncoplanar VMAT (RANC) and entire arc VMAT with table rotations of 10° and 350° (RAT). Material and methods 5 single lesions (case 1), 5 multiple lesions (case 2) and 5 single lesions close to organs at risk (case 3) were analyzed. Each technique was evaluated in regard to conformity and homogeneity indexes for PTV (CI = [[(PTV covered by prescription isodose)tˆ2/(V*PTV*V_(prescription isodose)) and HI=(D_max- D_min)/D_mean), the healthy brain tissue dose (V10Gy), Dmax (OAR) and the number of monitor units (MU). Results For case 1, HI and CI are better for RANC (HI: 0.17 RANC – 0.22 RAT – 0.23 RAC _0.27 DCA and CI: 0.86 RAT – 0.85 RANC _0.83 RAC – 0.76 DCA) but DCA reduces brain tissue V10Gy (11.97 cc DCA – 14.51 cc RANC – 15.9 cc RAT – 18.34 cc RAC) and MU (3092 DCA – 4573 RAC – 4639 RANC – 5250 RAT). In case 2, HI is similar for VMAT (0.17 RANC and RAT – 0.18 RAC – 0.22 DCA) and CI is top with RAT (0.72 RAT – 0.68 RAC – 0.67 RANC – 0.65 DCA). The healthy brain is as well protected with DCA as with RANC (10.5 DCA and RANC – 15.08 RAT – 18.12 RAC) but MU decrease with RANC (4250 RANC – 4802 RAT – 4841 RAC – 7908 DCA). For case 3, RAT improves HI and CI (HI: 0.27 RAT – 0.3 RANC – 0.31 RAC – 0.57DCA and CI: 0.74 RAT – 0.65 RAC – 0.59 RANC _0.5 DCA) and spares brain tissue and OAR (V10Gy: 1.31 RAT – 1.56 RAC – 2 RANC – 2.31 DCA and Dmax (OAR): 12.17 RAT – 12.59 RAC – 12.77 RANC – 14.15 Gy DCA). The MU numbers decrease with DCA (2184 DCA – 3533 RANC – 3714 RAT – 3840 RAC). Conclusion For simple case 1, DCA provide better plan considering low doses to healthy brain. For case 2, RANC is the best compromise ‘‘PTV cover- brain protection”. For case 3, results are significantly better with RAT.

Introduction Two Lung Stereotactic techniques with tumor control position during irradiation are compared. Material and methods The Rapidarc technology allows to homogenize the dose in the PTV while reducing the dose delivered in the OAR. For Lung stereotactic treatment, it creates a decrease of the average dose in the ITV not in compliance with the recommendations and the practices based on an important heterogeneity of dose in the target volume. Besides, the leafs movement does not allow any more the ‘‘on-line” follow-up by the portal imager made during the previous treatments realized by means of static fields. An kV intrafraction imaging technique (IMR) available on Truebeam allows to deliver these treatments while following in a continuous way the tumor position in every respiratory cycle. We analyse the dosimetrics results obtained whith an approach who consist of modulate the homogeneity of dose in the PTV so that the prescription is similar to the previous treatments realized by means of static fields. Results The concerned populations are similar with average volumes (±standard deviation) of PTV of ±9 (15) cc in Rapidarc (20 patients) and 17 (11) cc in static fields (35 patients). The dose heterogeneity imposed inside the PTV generates an increase of 5 % of the conformity index (Viso100 %/VPTV100 %) who remains however slightly better in RA, 1.15 (±0.1) vs 1.17 (±0.1). The average dose in the ITV, 117 (±3)% and in the PTV, 113 (±3)% are identical. The maximal doses in organs at risks are globally reduced by 20% with the possibility to reach more than 40% on the most critical volume. Conclusion A prescription on the average dose in the ITV associated with a coverage of the PTV by an isodose superior to 99% allows in Rapidarc to manage the heterogeneity of dose wished in the target volumes. The intra fraction follow-up by imaging kV without implanted markers allows to control the target position during the duration of the session.

Continuous insulin infusion is sometimes used in very low birth weight infants with glucose intolerance. We studied the availability of insulin to the neonate by means of a laboratory-simulated clinical infusion under both flushed and non-flushed conditions. Although loss of insulin was noted with both solutions (0.5 U/ml), under the nonflushed condition only 55.9% of the prescribed dose for the first 2 hours was delivered before the delivery rate of the flushed system, 71.4%, was approached. These findings have implications for neonatal insulin administration.