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This article presents a radiation-hardened Cortex-R4F system-on-chip prototype with integrated total ionizing dose (TID) dynamic compensation capabilities, designed and fabricated in 28-nm fully depleted silicon-on-insulator (FD-SOI) technology. The processor was made robust to single-event effects, thanks to several design techniques: error correcting code (ECC) protected and bit-interleaved memories, optimized radiation-hardened sequential cells, and sensitive logic cells filtering. To counter the TID effects on the processor functionality and performances, the system embeds an integrated digital dosimeter. The dosimeter is capable of computing the TID in real time and providing the information to the system. Using a software lookup table (LUT), coupled with 28-nm FD-SOI technology support of asymmetric and wide-body-biasing, the reported TID can be converted to a request made to an external body-bias generator and be fully compensated. The system, operating at 0.9 V and 500 MHz, was tested under space grade radiations and has shown no failure in the 0 krad(Si) to 50 krad(Si) TID range.

With the rise of the use of CPU-based Systems on a Chip (SoCs) in critical applications, the need to comply with harsh environments such as radiations or environmental fluctuation of parameters where they will evolve is essential. Devices must be qualified using Accelerated Soft-Error Rate (ASER). They are irradiated with neutrons, heavy ions, protons, or alpha particles depending on the mission profile. In addition, high frequency and complex computing tasks make SoCs difficult to observe and origin of errors difficult to identify. Radiation-induced Single-Event Effects (SEEs) are then hard to interpret. In this paper we present the Fail-Reason Capture (FIRECAP) Intellectual Property (IP). This IP is embedded in a SoC and allows probing and recording processor resources. Recording is controlled by hardware watchpoints that are triggering actions when hit. In addition, illegal jump traps have been added in the memory, such as deadcode traps around program loops and Error Capturing Instructions (ECI) spread in unused memory. The FIRECAP IP is interfaced to a RISC-V based SoC. Probes are implemented on the PC, IR, SP and RA registers of the processor. Two SoCs are integrated in a 28-nm FDSOI test chip. The failure mode coverage and observation points have been evaluated through a fault injection campaign done in simulation, then experiments using Electromagnetic Fault Injection (EMFI) on the device are presented.

International audience; In the field of automatic quality or safety assurance level evaluation, this paper proposes the first approach towards the automation of the extraction processes of both the valid and faulty state machines within a System-on-a-Chip. The data automatically extracted by this method is a relevant input for behavioural modelization and FMEA analysis. The method is based on a semi-automated approach for the systematic extraction of failure modes of a digital design in the hypothesis of a single-event upset (SEU) or stuck-at in flip-flops. This procedure aims to enhance human driven failure analysis and provide inputs for RAMS frameworks in the process of quality assurance of complex devices. The main objective is to transport and apply RAMS methods and tools in the area of SoCs design. Experimental results have been conducted on an I2C - AHB system, laying the base for a complete and more complex analysis on an entire SoC.

Numerous techniques for closure of the anterior skull base in cancer patients have a high success rate but management of failure is poorly documented. To standardize the post-operative follow-up after reconstruction surgery of the anterior skull base after removal for sinonasal carcinoma. Retrospective review of failure of anterior skull base reconstruction between 2005 and 2018 in a multicenter setting. Twenty four patients were included. Reconstruction failure was detected by a cerebrospinal (CSF) leak in 79.2%, by an infectious complication without CSF leak (i.e. meningitis) in 12.5%, and in 8.3% by extensive pneumocephalus. Failure was observed during the first week after surgery in 75% of patients, in the second week in 21%, and in 4% after day 15. The delay in discovery of the failure was associated with multilayer reconstruction (p=.03). Failure was treated surgically in 54% of the patients and medically in 46%, with a similar success rate (85 vs. 100%). After carcinologic resection of the anterior skull base, monitoring should be systematic during the first postoperative week. Surgical management of failure is not always necessary.

The use of adjuvant radiation in the treatment of soft-tissue sarcoma (STS) is equivocal in selected cases. Our objective was to compare the short-term outcomes in patients operated on for a local recurrence who had radiation for the primary tumour to those who were spared radiation. This was a retrospective study of 103 patients treated for a local recurrence: 48 (47%) with previous radiation and 55 (53%) without. Our primary outcome criterion was to identify the differences in the local treatment provided. Secondary outcomes were the cumulative incidence of a surgical site infection/wound complication (SSI/WC), variables associated with SSI/WC, and local recurrence. Amputation and the incidence of re-operation were significantly more frequent in patients who received previous radiation compared to patients without previous radiation (27% vs 9%, p = 0.02, for amputation; 26% vs 36% at 2 years for SSI/WC, p = 0.049). Multivariable regression models found previous radiation (p = 0.049), arteriopathy (p = 0.012), location at lower limb (p = 0.09), and use of a flap (0.0048) associated with the risk of SSI/WC. Previous radiation is associated with an increased risk of amputation and reoperation for SSI/WC when treating a local recurrence. This information should be accounted for when deciding for the use of radiation.

The design of ultra-low-voltage microcontroller (MCU) systems with high energy-efficiency operations is a key concept to achieve fully autonomous energy-harvesting powered Internet-of-Things applications. In this paper, a system-on-chip (SoC) is presented, embedding an ARM® Cortex®-M0+ MCU, $2 \times 4$ KB SRAM, an ultra-low power frequency synthesizer, a custom power switch, and a power management unit enabling the active and sleep modes. The 28 nm fully depleted silicon-on-insulator (FD-SOI) technology has been used to fabricate the device. The whole system operates at a fixed voltage of 0.5 V, and can switch from active and sleep/deep sleep modes, adjusting its frequency from 16 to 8 MHz or 32 kHz in one cycle upon energy availability. Silicon measurements report an SoC’s power consumption of 2.7 pJ/cycle at 16 MHz during active mode, and a total power consumption of 0.7 $\mu \text{W}$ during deep sleep mode. By combining frequency and power modes switching with extra reverse body-biasing, the system power consumption is drastically reduced by $2\times $ and $61\times $ in, respectively, sleep and deep sleep modes.

Background Free fibular flap (FFF) mandible reconstruction is at high risk of complications due to patient comorbidities, microvascular surgery after neck irradiation and intrabuccal exposure. We aimed to describe clinical and microbiological features, management and outcome of osteomyelitis following mandibular reconstruction with FFF. Methods Patients referred to our reference center for an osteomyelitis following FFF reconstruction of the mandible were included in a retrospective cohort. Microbiology was described based on gold-standard samples. Risk factors for treatment failure (infection persistence or relapse, need for additional surgery for septic reason, infection-related death) were assessed by logistic regression and Kaplan-Meier survival curve analysis. Results 48 patients (age, 60.5 [IQR, 52.4–66.6]; 30 males; 62.5%; modified Charlson comorbidity index, 4 [3–5]) were included. Indications for FFF mandible reconstruction were mostly carcinoma (n=27; 56.3%) and osteoradionecrosis (n=12; 25.0%), with 44 (82.9%) previous neck irradiation. FFF osteomyelitis were mostly early (≤ 3 months post-surgery; n=43; 89.6%). Main symptoms were local inflammation (n=28; 59.6%), ununion or sinus tract (n=28; 59.6%), bone or device exposure (n=21; 44.7%), and were associated with radiological signs for infection in 33 (75.0%) cases. Microbiological documentation highlighted Enterobacteriaceae (n=25; 61.0%), Streptococcus spp. (n=22; 53.7%), S. aureus (n=10; 24.4%), anaerobes (n=10, 24.4%), Enterococcus spp. (n=9; 22.0%) and non-fermenting Gram negative bacilli (GNB; n=8; 19.5%). Thirty-nine (81.3%) required surgery, consisting in debridement with implant retention in 25 (64.1%) cases, associated with a 93 (64–128) day course of antibiotherapy. After a follow-up of 18 (11–31) months, 24 (50.0%) treatment failure were observed. An early ID-specialist referral was the only significant predictor of favorable outcome (OR, 0.167; p=0.005). Non-fermenting GNB infections tended to be associated with a higher risk of failure (OR, 8.4; p=0.058). Probability of treatment failure of osteomyelitis following FFF mandible reconstruction according to ID-referral (A), CRP level 2 weeks after surgery (B) and presence of non-fermenting GNB Conclusion Osteomyelitis following mandibular reconstruction with FFF represent difficult-to-treat infections. Our results advocate for a multidisciplinary management, including an early ID-specialist referral. Disclosures All Authors: No reported disclosures

Diamond-based microelectromechanical systems (MEMS) enable direct coupling between the quantum states of nitrogen-vacancy (NV) centers and the phonon modes of a mechanical resonator. One example, diamond high-overtone bulk acoustic resonators (HBARs), feature an integrated piezoelectric transducer and support high-quality factor resonance modes into the GHz frequency range. The acoustic modes allow mechanical manipulation of deeply embedded NV centers with long spin and orbital coherence times. Unfortunately, the spin-phonon coupling rate is limited by the large resonator size, $>100~��$m, and thus strongly-coupled NV electron-phonon interactions remain out of reach in current diamond BAR devices. Here, we report the design and fabrication of a semi-confocal HBAR (SCHBAR) device on diamond (silicon carbide) with $f\cdot Q>10^{12}$($>10^{13}$). The semi-confocal geometry confines the phonon mode laterally below 10~$��$m. This drastic reduction in modal volume enhances defect center electron-phonon coupling. For the native NV centers inside the diamond device, we demonstrate mechanically driven spin transitions and show a high strain-driving efficiency with a Rabi frequency of $(2��)2.19(14)$~MHz/V$_{p}$, which is comparable to a typical microwave antenna at the same microwave power., 29 pages, 12 figures including supporting information

Real industrial examples have been used to evaluate the viability of several cavitation erosion risk indicators (ERIs). Industry standard endurance tests resulted in non-critical cavitation erosion of a shoe and shoe-guide assembly in a high-pressure fuel pump. A design modification was made which eliminated the erosion. Transient CFD simulations of the two designs were run. The distribution and intensity of the resulting ERIs were evaluated against photographic evidence of erosion taken after endurance testing. Details of the component dynamics and the resulting cavitation formation and collapse are presented, along with an analysis of the ERIs for their potential usefulness. Of the 10 ERIs studied, two were found to be particularly good indicators, one of which is newly derived for this research. It is now anticipated that using these ERIs to guide product design and development will save considerable time and cost.

TPF (docetaxel, cisplatin, fluorouracil) is the standard chemotherapy used for induction in locally advanced head and neck squamous cell carcinoma (LAHNSCC). Its toxicity limits it to younger patients with good functional status and without significant comorbidity. Since modified TPF (mTPF) demonstrated higher tolerability with similar efficacy in gastric cancer, we tested this scheme on frail patients. From July 2010 to July 2014, the files of the 48 patients treated for LAHNSCC with mTPF in three French institutions were retrospectively collected. mTPF was chosen because of age>70 years, or severe denutrition, or PS>1, or severe comorbidities or after severe toxicity of standard TPF. During the first 4 cycles, 2 patients died, 14 secondary hospitalizations were required and 10 patients stopped treatment due to no lethal toxicity. Two patients died during radiotherapy. The response rate was 83% (19% complete response). With a median follow-up of 15.2 months, 4 patients died during treatment, 8 died of non-head and neck cancer related disorders, 18 progressed (17 deaths) and 18 were free of disease. The median overall survival was 18.5 months (95% IC: 16.9-30.0). mTPF is effective in terms of response rate compared with the standard TPF and could become a new option in induction for frail patients with LAHNSCC.

Monolayer WSe2 hosts bright single-photon emitters. Because of its compliance, monolayer WSe2 conforms to patterned substrates without breaking, thus creating the potential for large local strain, which is one activation mechanism of its intrinsic quantum emitters. Here, we report an approach to creating spatially isolated quantum emitters from WSe2 monolayers that display clean spectra with little detrimental background signal. We show that a bilayer of hexagonal boron nitride and WSe2 placed on a nanostructured substrate can be used to create and shape wrinkles that communicate local strain to WSe2, thus creating quantum emitters that are isolated from substrate features. We compare quantum emitters created directly on top of substrate features with quantum emitters formed along wrinkles and find that the spectra of the latter consist of mainly a single peak and a low background fluorescence. We also discuss possible approaches to controlling the emitter position along hexagonal boron nitride wrinkles.

Purpose The main goal of palliative radiotherapy is to reduce patient's discomfort. But sometimes patients do not receive any benefits from this treatment because of rapid worsening of their general condition. This prospective monocentric study assessed the effective delivery of palliative radiotherapy. Materials and methods From 1st December 2015 to 29th February 2016, all consecutive patients receiving palliative radiotherapy in our hospital were included. The primary endpoint was the effective delivery of palliative radiotherapy according to the initial prescription (total dose, overall treatment time and fractionation). The secondary endpoints were the number of treatment breaks, the clinical benefit, the number of deaths and the delays for admission in the palliative care unit. Results Fifty-nine patients were included and 64 treatments were analysed. The treatment sites were: bone (70.3%) and brain (21.9%). The treatment goals were: pain control only (43.8%), decompression only (21.9%), pain control and decompression (32.8%), haemostatic aim (1.6%). Palliative treatment was achieved in 57 cases (89%). Temporary interruption of the radiotherapy treatment was necessary in six cases (9.4%; three for medical reason, three for logistic reason). The main reason of permanent interruption was worsening of performance status (seven cases). Palliation of symptoms (complete or partial responses) was obtained in 44 cases (68.8%). Seven patients (11.9%) died during the month after the end of the treatment. No delay or cancellation for admission in the palliative care unit were observed. Conclusion Palliative radiotherapy was completed as originally planned in 51 cases (79.9%) with a clinical benefit for 44 cases (68.8%). Radiation therapy must not be neglected as a palliative treatment at the end-of-life.

To assess the contribution of multidisciplinary team meetings (MTM) on vestibular schwannoma management as well as to (1) compare professional compliance to national guidelines and (2) study the percentage of loss to follow-up in cases of conservative management by radiologic observation. A retrospective descriptive study of MTMs held between January 2011 and May 2013 in a tertiary referral center. Patients were classified in three groups according to the MTM decision (observation, surgery or radiotherapy). A total of 363 cases were discussed during the study period (29 months). One hundred and ninety-four decisions (53.4 %) were for conservative management with radiologic observation, 130 (35.8 %) for surgery, and 39 (10.7 %) for radiation therapy. The sex ratio was 0.94, and the patients had a median age of 59 years (range 18–86 years). Most of the vestibular schwannomas (74.2 %) were small (stages I and II). Global concordance between the MTM decision and International Radiosurgery Association guidelines was 88.7 %. Twenty-three percent of the 104 files that were discussed in MTMs between January 2011 and July 2012, for which conservative management was decided, were lost to follow-up by 18 months. Management of vestibular schwannoma remains controversial, but it usually depends on the evolutive status. MTMs improve practice and facilitate the creation and maintenance of local registries. Future studies in MTMs are warranted to evaluate the benefit and evaluated if MTM could optimize long-term follow-up, limiting loss to follow-up in the observation of vestibular schwannomas that may be evolutive.

Resume Objectif Etude prospective monocentrique de la toxicite liee a l’administration concomitante du trastuzumab a la radiotherapie mammaire. Patientes et methodes Cent soixante-treize patientes ont ete traitees entre juin 2003 et mars 2009 par trastuzumab concomitant a une radiotherapie normofractionnee. Le trastuzumab etait delivre toutes les trois semaines (8 mg/kg a la premiere injection puis 6 mg/kg) pendant une duree mediane de 12 mois (2–62). La fraction d’ejection ventriculaire gauche a ete mesuree par echocardiographie ou scintigraphie cardiaque au moment du diagnostic, avant et apres la radiotherapie, tous les trois mois pendant un an puis annuellement. Une fraction d’ejection ventriculaire gauche strictement inferieure a 55 % etait consideree comme alteree. La toxicite a ete evaluee selon la Common Terminology Criteria for Adverse Effects version 3.0. Resultats Le suivi median etait de 52 mois (17–88). L’âge median etait de 52 ans (25–83). Cent trente-quatre patientes (77,5 %) ont recu une radiotherapie de la chaine mammaire interne. Une epitheliite aigue de grades 1, 2 et 3 a ete decrite chez respectivement 132 (76,3 %), 32 (18,5 %) et six patientes (3,4 %). Avec un recul median de 23 mois, une fibrose de grades 1 et 2 a ete observee chez respectivement 31 et huit patientes (18,8 et 4,6 %). La fraction d’ejection ventriculaire gauche etait normale pour 159 patientes (91,9 %) avant la radiotherapie. Elle etait alteree chez ces patientes 18 fois (11,3 %), dont huit (5,0 %) au terme de la radiotherapie. Une insuffisance cardiaque congestive symptomatique est survenue chez une patiente (0,6 %). Conclusion La toxicite en rapport avec l’association du trastuzumab a la radiotherapie mammaire s’est averee moderee. Un suivi prolonge est necessaire.

We demonstrate a high-purity source of indistinguishable single photons using a quantum dot embedded in a nanophotonic waveguide. The source features a near-unity internal coupling efficiency and the collected photons are efficiently coupled off-chip by implementing a taper that adiabatically couples the photons to an optical fiber. By quasi-resonant excitation of the quantum dot, we measure a single-photon purity larger than 99.4% and a photon indistinguishability of up to 94+-1% by using p-shell excitation combined with spectral filtering to reduce photon jitter. A temperature-dependent study allows pinpointing the residual decoherence processes notably the effect of phonon broadening. Strict resonant excitation is implemented as well as another mean of suppressing photon jitter, and the additional complexity of suppressing the excitation laser source is addressed. The study opens a clear pathway towards the long-standing goal of a fully deterministic source of indistinguishable photons, which is integrated on a planar photonic chip., 12 pages (10 figures)

Diesel engines continue to offer best-in-class fuel economy. Continuous development on all types of engines and an unprecedented thrust towards lower CO2 fleet average will ensure that they continue to be in high demand in European and other markets. This requires that fuel injection equipment provides improved injection rate and a highly flexible multi-injection capability. In addition, Diesel injection systems need very precise control of each individual injection event as this accuracy is necessary to promote the best combustion and exhaust after treatment results. In order to make sure that this control is accurate over the complete engine lifetime and for all injections, Delphi is developing a closed-loop control based on a unique technology.

International audience; —This work presents a System-on-Chip designed for Energy-Harvested applications. It embeds an ARM Cortex-M0+ microcontroller, 4 KB RAM, 4 KB ROM, an ultra-low power frequency synthesizer, a custom power switch, and a Power Management Unit enabling Active and Sleep modes. The system fabricated in 28 nm FD-SOI technology achieves 2.7 pJ/cycle at 16 MHz during active mode, and the core consumes 4.3 nW during deep sleep mode. The system operates at a fixed voltage of 0.5 V, and can switch from Active and Sleep/Deep Sleep modes, adjusting the frequency from 16 MHz to 8 MHz or 32 kHz in one cycle upon energy availability. By combining frequency/power switching with extra Reverse Body-Biasing the system power consumption is reduced by 53% and 98% in respectively sleep and deep sleep modes.

Many photonic quantum information processing applications would benefit from a high brightness, fiber-coupled source of triggered single photons. Here, we present a fiber-coupled photonic-crystal waveguide single-photon source relying on evanescent coupling of the light field from a tapered out-coupler to an optical fiber. A two-step approach is taken where the performance of the tapered out-coupler is recorded first on an independent device containing an on-chip reflector. Reflection measurements establish that the chip-to-fiber coupling efficiency exceeds 80 %. The detailed characterization of a high-efficiency photonic-crystal waveguide extended with a tapered out-coupling section is then performed. The corresponding overall single-photon source efficiency is 10.9 % $\pm$ 2.3 %, which quantifies the success probability to prepare an exciton in the quantum dot, couple it out as a photon in the waveguide, and subsequently transfer it to the fiber. The applied out-coupling method is robust, stable over time, and broadband over several tens of nanometers, which makes it a highly promising pathway to increase the efficiency and reliability of planar chip-based single-photon sources., 9 pages, 3 figures

This paper presents an energy efficiency improvement methodology based on the use of additional static biasing instead of margins during design stage. While the impact of margins used to prevent unsystematic process limitations cannot be recovered after fabrication, using biasing anticipation offers the possibility to enable the degradation recovery only when it is required. A CAD study on ARM Cortex®-M4 Microcontrollers (MCU) showed up to 50% of static current reduction at typical corner, nominal voltage, compared to the margin-based methodology. An implementation of a 1GHz ARM Cortex®-A53 core in 28nm fully-depleted silicon-on-insulator (FD-SOI) was performed using this methodology, and silicon measurements on 60 dies confirmed up to 30% median static power improvements.

Objective: To test the a priori hypothesis that longer duration of ruptured membranes is associated with increased risk of vertical transmission of HIV. Design: The relationship between duration of ruptured membranes and vertical transmission of HIV was evaluated in an individual patient data meta-analysis. Methods: Eligible studies were prospective cohort studies including at least 100 mother-child pairs, from regions where HIV-infected women are counselled not to breastfeed. Analyses were restricted to vaginal deliveries and non-elective Cesarean sections; elective Cesarean section deliveries (those performed before onset of labour and before rupture of membranes) were excluded. Results: The primary analysis included 4721 deliveries with duration of ruptured membranes ≤ 24 h. After adjusting for other factors known to be associated with vertical transmission using logistic regression analysis to assess the strength of the relationship, the risk of vertical HIV transmission increased approximately 2% with an increase of 1 h in the duration of ruptured membranes [adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.04; for each 1 h increment]. There were no significant interactions of duration of ruptured membranes with study cohort or with any of the covariates, except maternal AIDS. Among women diagnosed with AIDS, the estimated probability of transmission increased from 8% to 31% with duration of ruptured membranes of 2 h and 24 h respectively (P < 0.01). Conclusions: These results support the importance of duration of ruptured membranes as a risk factor for vertical transmission of HIV and suggest that a diagnosis of AIDS in the mother at the time of delivery may potentiate the effect of duration of ruptured membranes. © 2001 Lippincott Williams & Wilkins.

Summary Objective The present study describes the clinical, radiological and histological features of pharyngeal synovial sarcoma, on the basis of one clinical case, and discusses management. Case study A male patient, aged 27 years, presented with synovial sarcoma of the lateral pharyngeal wall, revealed by pharyngeal discomfort and bloody sputum. CT and MRI showed a partially necrotic tumoral process centered on the upper half of the piriform sinus. Pathologic analysis found a malignant biphasic tumor, suggestive of synovial sarcoma. Partial pharyngolaryngectomy was performed on a lateral approach, with associated radiotherapy. Discussion Synovial sarcoma raises diagnostic and therapeutic issues. Prognostic factors are not clearly established. Conclusion Pharyngeal synovial sarcoma is a rare tumor. Treatment is essentially surgical, requiring wide margins; radiotherapy is usually associated. The value of chemotherapy has yet to be assessed.

Resume Objectif Comparer la radiotherapie conformationnelle asservie a la respiration et la radiotherapie conformationnelle classique pour l’irradiation des cancers du poumon non a petites cellules et des cancers du sein. Patients et methodes Le projet du programme de Soutien aux techniques innovantes couteuses (Stic) de 2003 etait une etude comparative, non randomisee, multicentrique et prospective qui a inclus entre avril 2004 et juin 2008 dans 20 centres francais, un total de 634 patients, 401 atteints de cancer du poumon non a petites cellules et 233 de cancer du sein. Resultats L’analyse des resultats definitifs a confirme la faisabilite et la bonne reproductibilite des differents systemes de radiotherapie asservie a la respiration. Il a ete observe dans le groupe traite par irradiation asservie a la respiration une diminution des parametres dosimetriques predictifs d’une toxicite pulmonaire, cardiaque et œsophagienne, notamment pour les cancers du poumon non a petites cellules. Ces benefices dosimetriques ont ete surtout rapportes avec les techniques de blocage proche de l’inspiration maximum actif Active Breath Control (ABC, Eleckta™) ou volontaire SDX (Dyn’R™) par rapport au systeme de synchronisation respiratoire (RPM). Pour les cancers du poumon non a petites cellules, ces benefices dosimetriques theoriques etaient correles avec une diminution significative de la toxicite clinique aigue et tardive, notamment pulmonaire. Pour les cancers du sein, bien que moins evident compte tenu de la plus faible dose totale, il a ete retrouve une reduction de la dose au cœur diminuant potentiellement le risque de toxicite cardiaque a long terme, particulierement lors de l’irradiation du sein gauche, et une reduction de la dose delivree au sein controlateral. Conclusion La radiotherapie asservie a la respiration apparait essentielle pour reduire le risque de toxicite aigue et tardive, notamment pulmonaire et cardiaque, lors des irradiations des cancers du poumon non a petites cellules et des cancers mammaires.

A comparative, nonrandomized, multicenter, and prospective analysis were performed between April 2004 and June 2008 in 20 French centers in order to compare clinical aspects of respiratory-gated conformal radiotherapy (RGRT) during breast cancer irradiation versus conventional conformal radiotherapy. The final results based on 233 evaluable patients at 48 months confirm the feasibility and good reproducibility of the RGRT systems. The main results demonstrated a marked reduction of dosimetric parameters predictive of lungs and cardiac toxicities in the RGRT group; especially the dose delivered to the heart during irradiation of the left breast; mostly observed with deep inspiration breath-hold techniques.

Purpose To evaluate the effect of postmastectomy radiotherapy (PMRT) in Stage II-III breast cancer patients with negative lymph nodes (pN0) after neoadjuvant chemotherapy (NAC). Patients and Materials Of 1,054 breast cancer patients treated with NAC at our institution between 1990 and 2004, 134 had pN0 status after NAC and mastectomy. The demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The effect of PMRT on locoregional recurrence-free survival and overall survival (OS) was evaluated by multivariate analysis, including known prognostic factors. Results Of the 134 eligible patients, 78 (58.2%) received PMRT and 56 (41.8%) did not. At a median follow-up time of 91.4 months, the 5-year locoregional recurrence-free survival and OS rate was 96.2% and 88.3% with PMRT and 92.5% and 94.3% without PMRT, respectively ( p = NS). The corresponding values at 10 years were 96.2% and 77.2% with PMRT and 86.8% and 87.7% without PMRT ( p = NS). On multivariate analysis, PMRT had no effect on either locoregional recurrence-free survival (hazard ratio, 0.37; 95% confidence interval, 0.09–1.61; p = .18) or OS (hazard ratio, 2.06; 95% confidence interval, 0.71–6; p = .18). This remained true in the subgroups of patients with clinical Stage II or Stage III disease at diagnosis. A trend was seen toward poorer OS among patients who had not had a pathologic complete in-breast tumor response after NAC (hazard ratio, 6.65; 95% confidence interval, 0.82–54.12; p = .076). Conclusions The results from the present retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence, or death when PMRT was omitted in breast cancer patients with pN0 status after NAC and mastectomy. Whether the omission of PMRT is acceptable for these patients should be addressed prospectively.

Resume Objectif de l’etude Evaluer le benefice de la chirurgie mammaire chez les patientes traitees pour un cancer du sein inflammatoire. Patientes et methodes Cette etude retrospective a ete basee sur 232 patientes traitees pour des cancers du sein inflammatoire. Toutes les patientes ont recu une chimiotherapie premiere suivie soit de radiotherapie exclusive (118 patientes, 51 %) soit de chirurgie avec ou sans radiotherapie (114 patientes, 49 %). La duree mediane de surveillance etait de 11 ans. Resultats Les deux groupes etaient comparables en dehors de l’existence d’un plus petit nombre de tumeurs de moins de 70 mm (43 % contre 33 %, p = 0,003), un plus grand taux de tumeurs classees N2 cliniquement (15 % contre 5 %, p = 0,04) et un plus petit nombre de tumeurs de grade 3 (46 % contre 61 %, p Conclusion L’analyse des resultats indique que la chirurgie associee a la chimiotherapie et a la radiotherapie augmente le taux de controle local chez les patientes traitees pour un cancer du sein inflammatoire.

Resume Objectifs La chimiotherapie neoadjuvante peut entrainer un down-staging tumoral et remettre en question les indications d’irradiation adjuvante. Cette etude retrospective a evalue l’interet de l’irradiation apres une mastectomie chez les patientes atteintes d’un cancer du sein sans envahissement ganglionnaire (pN0) apres chimiotherapie neoadjuvante. Patientes et methodes Chez les 1054 patientes ayant recu une chimiotherapie neoadjuvante pour un cancer du sein entre 1990 et 2004, 134 de ces cancers (23,6 %) ont ete classes pN0 apres chimiotherapie neoadjuvante, mastectomie et lymphadenectomie axillaire. L’ensemble des caracteristiques demographiques, anatomocliniques et therapeutiques ont ete recueillies prospectivement. L’impact de la radiotherapie sur les survies sans rechute locoregionale et globale a ete evalue en analyse multifactorielle tenant compte des principaux facteurs pronostiques. Resultats Parmi les 134 patientes, 78 (58,2 %) ont ete irradiees apres la mastectomie. Apres un suivi median de 91,4 mois, les probabilites de survie sans recidive locoregionale et de survie globale a dix ans etaient respectivement de 96,2 % et 77,2 % apres irradiation et 86,8 % et 87,7 % sans irradiation ( p = NS). En analyse multifactorielle, seule l’absence de reponse histologique complete de la tumeur primitive etait associee a une tendance a une probabilite de survie globale moindre ( hazard ratio [HR] de deces = 6,65 ; intervalle de confiance a 95 % [IC95 %], 0,82–54,12 ; p = 0,076). La radiotherapie delivree apres la mastectomie n’a pas eu d’impact significatif sur la probabilite de survie sans recidive locale (HR : 0,37 ; IC95 % : 0,09–1,61 ; p = 0,18) ni sur celle de survie globale (HR : 2,06 ; IC95 % : 0,71–6 ; p = 0,18). Conclusion Sous reserve de la nature retrospective des donnees, la radiotherapie delivree apres la mastectomie ne semble pas avoir eu d’impact sur la survie de patientes atteintes d’un cancer du sein sans envahissement ganglionnaire apres chimiotherapie neoadjuvante. Une confirmation prospective de ces donnees est necessaire.

Resume Objectif de l’etude Evaluer la radiotherapie exclusive comme option therapeutique apres reponse clinique complete a une chimiotherapie neoadjuvante pour des cancers du sein de stade II-IIIA. Patientes et methodes Entre 1985 et 1999, 1477 patients ont recu une chimiotherapie neoadjuvante pour un cancer du sein de stade II-IIIA considere trop volumineux pour etre opere de facon conservatrice. Parmi les 165 patientes en situation d’une reponse clinique complete apres la chimiotherapie neoadjuvante, 65 ont ete traitees par chirurgie mammaire et irradiation et 100 par irradiation exclusive. Resultats Les deux groupes etaient comparables en termes de caracteristiques initiales, excepte pour le diametre tumoral au diagnostic (plus grand dans le groupe exclusivement irradie). Aucune difference statistiquement significative n’a ete observee en termes de survie globale, de survie sans maladie ni de survie sans metastase. Les taux de survie globale a cinq et dix ans etaient respectivement de 91 et 77 % dans le groupe exclusivement irradie et de 82 et 79 % dans le groupe opere et irradie ( p = 0,9). Cependant, une tendance en faveur d’un taux plus eleve de recidive locoregionale a ete observee dans le groupe exclusivement irradie (31 contre 17 % a dix ans ; p = 0,06). Chez les patientes en situation de remission complete d’apres la mammographie et/ou l’echographie, il n’y avait pas de difference statistiquement significative de taux de recidive locoregionale (a dix ans : 21 dans le groupe opere et irradie contre 26 % dans le groupe exclusivement irradie, p = 0,45). Aucune difference n’a ete observee en termes de toxicite cutanee, cardiaque et pulmonaire. Conclusion La chirurgie est une etape incontournable du traitement locoregional des cancers du sein ayant repondu completement a une chimiotherapie neoadjuvante.

Purpose Neoadjuvant chemotherapy (NAC) generally induces significant changes in the pathologic extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation (LNI) in breast cancer (BC) patients with pathologic N0 status (pN0) after NAC and breast-conserving surgery (BCS). Methods and Materials Among 1,054 BC patients treated with NAC in our institution between 1990 and 2004, 248 patients with clinical N0 or N1 to N2 lymph node status at diagnosis had pN0 status after NAC and BCS. Cox regression analysis was used to identify factors influencing locoregional recurrence–free survival (LRR-FS), disease-free survival (DFS), and overall survival (OS). Results All 248 patients underwent breast irradiation, and 158 patients (63.7%) also received LNI. With a median follow-up of 88 months, the 5-year LRR-FS and OS rates were respectively 89.4% and 88.7% with LNI and 86.2% and 92% without LNI (no significant difference). Survival was poorer among patients who did not have a pathologic complete primary tumor response (hazard ratio, 3.05; 95% confidence interval, 1.17–7.99) and in patients with N1 to N2 clinical status at diagnosis (hazard ratio = 2.24; 95% confidence interval, 1.15–4.36). LNI did not significantly affect survival. Conclusions Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among cN0 to cN2 breast cancer patients with pN0 status after NAC. These results need to be confirmed in a prospective study.

This review briefly recapitulates the existing markers predictive of RA responsiveness to treatment, focusing on MTX alone or combined with a biologic. In addition to the demographic and clinical factors, an update is provided of the predictive biomarkers identified by large-scale gene and protein analyses that generated new insights into the ability of high-throughput analysis of biological systems to select new potential indicators. Among the large-scale analysis tools now available, pharmacogenetics and pharmacogenomics (including transcriptomic and proteomic approaches) have been shown to provide such new putative biomarkers of therapeutic responses.

PATIENTS AND METHODS: All patients with metastatic (ovarian and extraovarian) CRC who underwent resection of ovarian metastases in our institution from April 1988 to August 2006 were analyzed and the response to preoperative chemotherapy was evaluated according to the RECIST criteria, and analyzed with respect to the sites of metastases (ovarian and extraovarian). RESULTS: The studied population consisted of 23 women. At presentation, 20 patients had symptoms. Preoperative chemotherapy resulted in tumor control of measurable extraovarian metastases in 65% of cases. In contrast, no objective tumor response of ovarian metastases was observed, disease stabilization was obtained in only 3 patients (13%), and progression or occurrence of new ovarian metastases were observed in 20 patients (87%) (p=0.0005). With a median follow-up of 54 months [15-229], median overall survival was 30 months, and 3-year overall survival was 18%. CONCLUSION: Ovarian metastases are less responsive to chemotherapy compared to other sites. As these "metastatic sanctuaries" often cause symptoms, surgical resection should always be considered for ovarian metastases, even in the case of associated extraovarian metastases.

Background Amitriptyline is effective in relieving neuropathic pain. Its site of action is thought to be supraspinal and spinal, but a peripheral effect on fibers is also suggested. Methods This double-blind study examined the effects of transcutaneous amitriptyline diluted in hydroalcoholic solution in healthy young male volunteers. Six treatments were randomly applied on different areas of the skin of the back: amitriptyline at 0 (vehicle), 25, 50, and 100 mm; saline (control); and lidocaine-prilocaine cream as a positive control. Up to 24 h after application, mechanical thresholds for touch and nociception, and thermal thresholds for cold, warm, and heat sensation were recorded for each area. Blood samples were collected to assess plasma levels of amitriptyline. A late recording of the tactile thresholds was performed 1 and 3 weeks after the treatment session. Results The thresholds for all sensations did not differ between the vehicle and saline. Lidocaine-prilocaine cream displayed a short-lasting anesthetic effect for all sensations, although this was not significant for warm sensation. Amitriptyline, at the three concentrations studied, induced a mild and short-lasting increase of the tactile and mechanical nociceptive thresholds. It significantly decreased cold thresholds (down to 21.8 degrees C, P = 0.01 vs. 27.5 degrees C for control) and heat thresholds (down to 40.1 degrees C, P = 0.004 vs. 43.4 degrees C for control). These two effects were no longer significant after the fourth hour of observation. Amitriptyline did not change warm thresholds. There was no apparent systemic absorption effect of the drug. Conclusion It is hypothesized that amitriptyline has a differential effect on different fiber structures.

Refrigeration of a solid-state system with light has potential applications for cooling small-scale electronics and photonics. We show theoretically that two coupled semiconductor quantum wells are efficient cooling media for optical refrigeration because they support long-lived indirect electron-hole pairs. Thermal excitation of these pairs to distinct higher-energy states with faster radiative recombination allows an efficient escape channel to remove thermal energy from the system. This allows reaching much higher cooling efficiencies than with single quantum wells. From band-diagram calculations along with an experimentally realistic level scheme we calculate the cooling efficiency and cooling yield of different devices with coupled quantum wells embedded in a suspended nanomembrane. The dimension and composition of the quantum wells allow optimizing either of these quantities, which cannot, however, be maximized simultaneously. Quantum-well structures with electrical control allow tunability of carrier lifetimes and energy levels so that the cooling efficiency can be optimized over time as the thermal population decreases due to the cooling., Comment: 10 pages, 5 figures

International audience; This work presents a single-supply SPARC 32b V8 microprocessor designed with Ultra Low Voltage (ULV) adapted standard cells and memories, aiming at low energy operation and stand by power. The microprocessor, equipped with 10 Transistors ULV bitcell 8KB SRAM cache, has been fabricated in Fully Depleted Silicon On Insulator (FDSOI) 28nm technology. A comparative analysis with similar implementations has been provided highlighting the performance gain and power savings that are achieved by our design methodology and implementation technology. Wafer-level tests showed that our ULV adapted microprocessor has an operating range that is functional down to 0.33V and that the ULV able cache can save from 30% to 62% energy.

Introduction: Stereotactic hypofractionated radiotherapy is an effective treatment for brain metastases in oligometastatic patients. Its planning is however time-consuming because of the number of organs at risk to be manually segmented. This study evaluates 2 automated segmentation commercial software. Methods: Patients were scanned in the treatment position. The computed tomography scan was registered on a magnetic resonance imaging and volumes were manually segmented by a clinician. Then 2 automated segmentations were performed (with iPlan and Smart Segmentation). RT STRUCT files were compared with Aquilab’s Artistruct segment comparison module. We selected common segmented volume ratio as the main judging criterion. Secondary criteria were Dice-Sørensen coefficients, overlap ratio, and additional segmented volume. Results: Twenty consecutive patients were included. Agreement between manual and automated contouring was poor. Common segmented volumes ranged from 7.71% to 82.54%, Dice-Sørensen coefficient ranged from 0.0745 to 0.8398, overlap ratio ranged from 0.0414 to 0.7275, and additional segmented volume ranged from 9.80% to 92.25%. Each software outperformed the other on some organs while performing worse on others. Conclusion: No software seemed clearly better than the other. Common segmented volumes were much too low for routine use in stereotactic hypofractionated brain radiotherapy. Manual editing is still needed.

We present in this paper the application of fault injection to selective hardening by triplication of a pipelined SPARC-V8 microprocessor. Fault injection is applied to identify the most sensitive flip-flops to single-event-upset and stuck-at faults of the design. The most sensitive flip-flops are replaced by triplicated ones during the physical implementation of the design. Selective triplication is applied to about 26% of the flip-flops of the design allowing to gain additional reliability with a low overhead and delay penalty.

A 32b SoC is designed in 28nm FDSOI to operate in either an energy-efficiency (EE) mode, at 0.45V, or low-leakage (LL) mode, at 0.33V, with process-temperature compensation. At near threshold, it overcomes low transistor current at negative temperatures, the need for an extra digital supply IO, and the clocking power costs faced by the internet-of-things (IoT) and wearable systems. The system includes: 1) an all-digital single-supply open-loop clock multiplier achieving 1.51 pJ/cycle; 2) a 0.33V/0.45V dual-mode switched-network-capacitor DC-DC down converter from a 1.1V logic supply, reaching 75% conversion efficiency in both modes; 3) a closed-loop low-invasiveness timing monitoring system dynamically compensating device centering and temperature changes, enabling constant frequency operation down to −40°C at 20MHz (1MHz) in EE (LL) mode. The system fully exploits forward body bias (FBB) available in 28nm UTBB FDSOI with LVT transistors.

International audience; Identity management is a rather general concept that covers technologies, policies and procedures for recognising and authenticating entities in ICT environments. Current identity management solutions often have inadequate usability and scalability, or they provide inadequate authentication assurance. This article describes local user-centric identity management as an approach to providing scalable, secure and user friendly identity management. This approach is based on placing technology for identity management on the user side, instead of on the server side or in the cloud. This approach strengthens authentication assurance, improves usability, minimizes trust requirements, and has the advantage that trusted online interaction can be upheld even in the presence of malware infection in client platforms. More specifically, our approach is based on using an OffPAD (Offline Personal Authentication Device) as a trusted device to support the different forms of authentication that are necessary for trusted interactions. A prototype OffPAD has been implemented and tested in user experiments.

Aims: Hepatocellular carcinoma (HCC) results from cirrhosis and, in Western Europe, hepatitis C virus and alcoholism are the predominant causes of this disease. We recently documented a global transcript repression in hepatocarcinoma nodules. The tumour suppressor activated pathway-6 (TSAP6) transcript codes for a transmembrane molecule that is an inducer of a caspase-3-dependent apoptotic pathway. The down-regulation of TSAP6 transcripts in HCC and perinodular cirrhosis, which contrasts with a sustained transcript level in HCC-free cirrhosis, has suggested that this hepatic protein level may provide a prognostic marker for HCC occurrence. Methods and results: This protein was quantified by semiquantitative assessment of immunohistochemistry on samples from 42 cases HCC-free cirrhosis, 49 cases cirrhosis with HCC, 43 HCC associated with healthy liver and 31 controls. TSAP6 expression was linked to the liver state, healthy or cirrhotic without or with an HCC and to tumour grade. Conclusions: With biopsies periodically performed for surveillance purposes, the decreased expression of TSAP6 in cirrhotic tissue could reflect a decrease in the apoptotic process and could be interpreted as a warning sign. This evaluation of the TSAP6 level in cirrhotic liver conveys predictive information for the development of HCC.

In this paper, we present the heavy-ion radiation test results for a 7-stage SPARC micro-processor. Special software handlers enabled fine grained classification of the types of crashes. The measured crash cross sections are compared with those predicted by fault injection simulation.

Assembling a system on a chip using IP blocks is an error-prone, labor-intensive, and time-consuming process. Emerging high-level tools can help by automating many of the design tasks.

Liver regeneration after partial hepatectomy or liver injury is controlled by a wide variety of growth factors that are proven activators or inhibitors of hepatocyte proliferation. Liver regeneration post-hepatectomy has been proven to be decreased and delayed in cirrhotic vs. normal liver. Apoptosis seems to play an important role in cellular proliferation and in liver regeneration. Therefore, this study has analyzed the expression of apoptosis-associated genes following 2/3 hepatectomy in cirrhotic vs. normal rats. Cirrhosis was induced by a weekly intragastric administration of CCl4 for 16 weeks followed by hepatectomy and histological examination of the resected liver. Rats were sacrificed at 6 h, 12 h, 24 h, or 72 h after liver resection. The expression of proapoptotic (Bad, Bak, Bax) and antiapoptotic (Bcl-2, Bcl-XL) genes was analyzed by quantitative RT-PCR. We have observed an early increase in antiapoptotic mRNA levels and a delayed increase in proapoptotic mRNA levels in normal liver following hepatectomy. Before resection, proapoptotic mRNA levels were significantly higher in cirrhotic vs. normal liver. After hepatectomy, apoptotic mRNA levels were decreased and delayed as compared with that observed following hepatectomy in normal liver. These results indicate that apoptosis takes place in liver during CCl4-induced cirrhosis and could participate in the impaired regenerative response observed in cirrhotic liver.

Background To evaluate the relation between elective cesarean section and vertical transmission of human immunodeficiency virus type 1 (HIV-1), we performed a meta-analysis using data on individual patients from 15 prospective cohort studies. Methods North American and European studies of at least 100 mother-child pairs were included in the meta-analysis. Uniform definitions of modes of delivery were used. Elective cesarean sections were defined as those performed before onset of labor and rupture of membranes. Multivariate logistic-regression analysis was used to adjust for other factors known to be associated with vertical transmission. Results The primary analysis included data on 8533 mother-child pairs. After adjustment for receipt of antiretroviral therapy, maternal stage of disease, and infant birth weight, the likelihood of vertical transmission of HIV-1 was decreased by approximately 50 percent with elective cesarean section, as compared with other modes of delivery (adjusted odds ratio, 0.43; 95 percent confidence interval, 0.33 to 0.56). The results were similar when the study population was limited to those with rupture of membranes shortly before delivery. The likelihood of transmission was reduced by approximately 87 percent with both elective cesarean section and receipt of antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, as compared with other modes of delivery and the absence of therapy (adjusted odds ratio, 0.13; 95 percent confidence interval, 0.09 to 0.19). Among mother-child pairs receiving antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, rates of vertical transmission were 2.0 percent among the 196 mothers who underwent elective cesarean section and 7.3 percent among the 1255 mothers with other modes of delivery. Conclusions The results of this meta-analysis suggest that elective cesarean section reduces the risk of transmission of HIV-1 from mother to child independently of the effects of treatment with zidovudine.

This paper presents the main co-design concepts of distributed embedded hardware/software systems through a detailed presentation of a methodology and an environment for codesign. This presentation gives a comprehensive description of different codesign steps using a codesign of a realistic example: Real-Time Acquisition and Storage Controller acting between analog signals and storage disk. Design starts from a system-level specification and performs hardware/software partitioning, communication synthesis and architecture generation. To produce an efficient solution, the codesign process is guided by performance and constraints that depend on the application context.

Background: The identification and validation of suitable predictive and prognostic factors are a challenge to improve the treatment scheme selection. Discordances in histological grade can be established between core biopsy and surgical specimens. This is important in HR-positive/HER2-negative subgroup where histological grade identifies patients at high risk and is a strong determinant for treatment scheme. Methods: A total of 350 consecutive invasive breast carcinoma biopsies were assessed and compared with surgical specimens in Institut Curie, Paris, France. Clinical, radiological and pathological data were recorded. Results: Histological grade concordance rate in the HR+/HER2− group was 75%. A grade underestimation was mainly due to mitotic index misgrading (23%). Large tumours (P

Impedance boundary condition (IBC) are widely used in computational electromagnetics to model thin coatings on perfectly conducting (PEC) objects. The IBC is used to reduce drastically the number of unknowns in method of moments models and to obtain a better conditioned linear system that can be more efficiently iteratively solved.

Radiation therapy (RT) has demonstrated strong clinical benefits for patients who present a high relapse risk after breast conserving surgery or radical mastectomy. Unfortunately, the benefits of RT can be offset by its possible impacts on cardiac toxicity and increased risk of death from cardiac events. Additionally, recent radiological and radiotherapy techniques have allowed clinicians to better define target volumes and customize irradiation so that doses to the heart and left coronary artery can be accurately quantified. Alternative treatment positions, such as the lateral and prone positions are also being used. These positions can adapt to the patient’s anatomy and thus better protect the heart and lungs. This paper will report the outcomes for a patient who received breast cancer treatment after her treatment position and technique were optimized for ideal target volume coverage and minimum irradiation to organs at risk (OAR), particularly to the heart and lungs.

Objective Because available biomarkers (rheumatoid factors [RF], anti-cyclic citrullinated autoantibodies [anti-CCP2], erythrocyte sedimentation rate at 1st hour [ESR]/C-reactive peptide [CRP] and bone erosions) are insufficient to predict rheumatoid arthritis (RA) structural damage, to determine whether synovium expression of greater or equal to 1 markers could constitute new prognostic factor(s). Method The study was conducted on 18 prospectively enrolled disease-modifying anti-rheumatic drug (DMARD)- and glucocorticoid-naive, VErA cohort patients with very-early arthritis (median duration: 4 months). Recorded at baseline were: clinical and biological (serum ESR, CRP, RF-isotypes, anti-CCP2, osteoprotegerin, receptor activator of nuclear κB-ligand [RANK-L] and cartilage oligomeric matrix protein [COMP] levels) data; synovium expression (HLA-DR, CD163, CD3, CD20, VEGF, osteoprotegerin, RANK-L, Bcl2 and global inflammation index) for a metacarpophalangeal joint-synovium biopsy. Baseline and 3-year hand-and-foot X-rays were graded with the van der Heijde-modified-Sharp score; the judgment criterion was its progression during follow-up. Pearson's product moment correlation statistics were used to test for association between paired samples. Results A baseline, a significant relationship was found between erosive damage and markers of B-cell activation, notably the synovium CD20 expression (r = 0.68; P = 0.0001). Quantified by the modified-Sharp erosion score variation, the 3-year structural damage progression was significantly correlated with: serum levels of RF-IgG (r = 0.75; P = 0.0003), -IgM (r = 0.69; P = 0.001), anti-CCP2 (r = 0.53; P = 0.02) and RANK-L (r = 0.61; P = 0.007); synovium CD20 expression (r = 0.70; P = 0.001). Conclusion This analysis of the prognostic value of a large panel of synovium markers in a limited sample of prospectively followed, well-documented patients suggested that both synovial CD20 and serum RANK-L levels might be new predictors of structural damage progression in very-early RA.

Objective. To analyze the functional impact of the various possible treatments of oropharyngeal squamous cell carcinomas to find the main prognostic factors of dysphagia induced by these treatments. Patients. Clinical data from 254 patients treated for squamous cell carcinoma of the oropharynx between 1998 and 2003 were retrospectively analyzed. A multivariate model enabled us to evaluate the role of each potentially harmful factor on swallowing. Main Outcome Measures. The significant factors influencing the consumption of liquid, pasty, and normal food were the same: the initial T stage and the type of treatment. Conclusion. Whatever the possible and selected treatment was, the impact on the functional capacities, and thus, the quality of life of the patients was considerable. Even though we could not significantly demonstrate exclusive radiotherapy caused more long-term undesirable effects than surgery followed by radiotherapy, our daily practice has shown that we should favour the latter.