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In situ investigations of cracks propagating at up to 2.5 km s−1 along an (001) plane of a silicon single crystal are reported, using X-ray diffraction megahertz imaging with intense and time-structured synchrotron radiation. The studied system is based on the Smart Cut process, where a buried layer in a material (typically Si) is weakened by microcracks and then used to drive a macroscopic crack (10−1 m) in a plane parallel to the surface with minimal deviation (10−9 m). A direct confirmation that the shape of the crack front is not affected by the distribution of the microcracks is provided. Instantaneous crack velocities over the centimetre-wide field of view were measured and showed an effect of local heating by the X-ray beam. The post-crack movements of the separated wafer parts could also be observed and explained using pneumatics and elasticity. A comprehensive view of controlled fracture propagation in a crystalline material is provided, paving the way for the in situ measurement of ultra-fast strain field propagation.

Introduction and methods Different clinical and histological variants of lichen planus (LP) exist, such as lichen planopilaris, pigmentosus, linear, or atrophic LP. Recently, some cases came to our attention of hyperpigmented and atrophic linear lesions of the face with lichenoid histology, suggesting a combination of these different variants. We carried out a single-center, retrospective descriptive study of 6 similar cases selected from our database and compared them with a literature review. Results There were 4 males and 2 females of mean age 42 years. Each had linear lesions located on one side of the face. All lesions were initially itchy; they appeared hyperpigmented in all patients and atrophic in 5 cases. Biopsies indicated lichen planopilaris in 5 patients, with deep peri-eccrine involvement in 4 of them. Only 2 of the 6 patients had extra-facial lesions. Discussion and literature review We found 24 cases in the literature having similar clinical and histological aspects. Men aged around 37 years seemed particularly affected. An atrophic course was noticed in 10 patients. Such a clinicopathological picture may suggest differential diagnoses like lichen striatus, lupus erythematosus, lichen sclerosus atrophicus, or Moulin's linear atrophoderma. Early histopathological examination could be of precious assistance in allowing the initiation of effective treatment immediately as of the initial inflammatory phase, thereby limiting the risk of cosmetic sequelae such as atrophy or residual pigmentation. Conclusion We describe a form of facial lichen planus that is highly particular in terms of its follicular tropism, its blaschkoid distribution, its pigmented character, and its atrophic progression.

Livedoid vasculopathy (LV) is a chronic dermatosis associated with micro-thrombosis of the vessels of the dermis, leading to ischemic lesions and painful skin ulcerations of the lower limbs. This thrombosing occlusive vasculopathy, clearly distinct from 'classical vasculitis' (not related to alteration of vessel walls), may lead to peripheral neuropathy.To clarify the main clinical, electrophysiological and pathological characteristics of peripheral neuropathy linked to LV.We presented a series of personal cases of peripheral neuropathy due to LV. We also conducted a review of the literature (since the first description of LV in 1974) using multiple combinations of keywords from 'PubMed', 'Google Scholar' and 'ScienceDirect' databases according to the 'Preferred Reporting Items for Systematic reviews and Meta-Analyses' guidelines.We identified 16 patients (6 personal cases and 10 cases from the medical literature). Our personal cases were five females and one male, with a median age (at the onset of cutaneous signs of LV) of 38 (range 25-62). Several types of skin lesions of the lower limbs were observed. Median age at the onset of peripheral neuropathy symptoms was 48 years (range 29-66), with a main clinical and electrophysiological pattern of mononeuropathy multiplex.We observed a typical pattern of peripheral neuropathy, mostly mononeuropathy multiplex, whose pathophysiology might be related to occlusions of the small vessels of the nerves, as seen in the dermis. Moreover, LV may also be associated with other types of peripheral neuropathies (sometimes of autoimmune etiology) not directly related to the skin lesions.The 'ischemic form' of peripheral neuropathy linked to LV is mainly responsible for sensory disturbances (with multifocal distribution), sometimes for motor disturbances. This type of peripheral neuropathy has to be distinguished from 'classical vasculitic neuropathies' which are usually treated with antithrombotic therapies.

Resume Introduction La plasmocytose cutanee est une dermatose rare decrite en 1976 et observee surtout chez des patients d’ascendance asiatique. Elle forme habituellement des macules et des plaques erythemateuses a brunâtres du tronc et du visage, avec en histologie des infiltrats dermiques composes de plasmocytes matures bien differencies. La pathogenese et la place nosographique de cette affection sont encore mal etablies. Nous presentons un cas de plasmocytose cutanee chez une femme d’ascendance europeenne, particuliere par la presence d’un signe de Darier. Observation Une femme de 56 ans, d’ascendance europeenne, presentait depuis plusieurs annees des macules asymptomatiques brunâtres du dos. Un signe de Darier etait present de facon inconstante. La biopsie cutanee montrait, sur toute la hauteur du derme, des infiltrats moderement denses, pericapillaires ou interstitiels, contenant de nombreux plasmocytes bien differencies. En immunohistochimie, les plasmocytes exprimaient les chaines legeres kappa et lambda sans monotypie ; il n’y avait pas d’expression de l’HHV8 ni de marquage avec l’anticorps anti-treponeme. Biologiquement, il existait une hypergammaglobulinemie polyclonale. La tomodensitometrie thoraco-abdomino-pelvienne etait normale. Le diagnostic de plasmocytose cutanee etait retenu. Une simple surveillance etait instituee dans un premier temps. Discussion La presentation anatomoclinique caracteristique et l’association a une hypergammaglobulinemie polyclonale ont permis d’evoquer le diagnostic de plasmocytose cutanee, bien que cette entite soit exceptionnelle chez les personnes d’ascendance europeenne. Le signe de Darier est parfois observe dans cette affection. Les principaux diagnostics differentiels, infiltrat plasmocytaire d’origine infectieuse et lymphome B de la zone marginale, ont ete ecartes.

Background In addition to general measures, pharmacological treatment is the basis of the management of scabies. No recent data in real-life are available on the efficacy and safety of 10% benzyl benzoate emulsion for skin application administered as monotherapy. Method This prospective, multicenter, French observational study comprised a registry and a prospective cohort with a follow-up at 28 days and a telephone call at week 12. To participate in the registry, patients had to be over 1 month old, ambulatory, presenting common, nonhyperkeratotic, untreated scabies. To be included in the cohort, patients had to be included in the registry and treated with two applications of 10% benzyl benzoate emulsion 8 days apart. The primary endpoint was cure at day 28. Results Of the 186 patients included in the registry, 116 were included in the cohort. Fourteen patients were included in the cohort without being included in the registry, which led to a total of 130 patients in the cohort. At day 28, 119/130 (91.5%; 95% CI 85.4-95.6%) were clinically cured. The cure was confirmed by dermoscopy in 44/47 patients (93%). Among the 130 patients, the cure rate was 82% at week 12. Of the 119 patients cured at day 28, the rate of cure at week 12 was 89.9%. Conclusion In real life, two applications of 10% benzyl benzoate emulsion 8 days apart provides high cure rates in patients with common scabies.

Background Leishmaniases are regularly seen in non-endemic areas due to the increase of international travels. They include cutaneous leishmaniases (CL) and mucocutaneous (MC) caused by different Leishmania species, and visceral leishmaniases (VL) which present with non-specific symptoms. Methods We reviewed all consecutive leishmaniasis cases seen between September 2012 and May 2020. The diagnostic strategy included microscopy after May-Grünwald-Giemsa staining, a diagnostic quantitative PCR (qPCR) assay, and species identification based on sequencing of the cytochrome b gene. Results Eighty-nine patients had a definitive leishmaniasis diagnosis. Nine patients had VL with Leishmania infantum. Eighty patients had CL. Twelve patients acquired CL after trips in Latin America (7 Leishmania guyanensis, 2 Leishmania braziliensis, 2 Leishmania mexicana, and 1 Leishmania panamensis). Species could be identified in 63 of the 68 CLs mainly after travel in North Africa (59%) with Leishmania major (65%), Leishmania tropica/killicki (24%), and L. infantum (11%), or in West Sub-Saharan Africa (32%), all due to L. major. The median day between appearance of the lesions and diagnosis was 90 [range 60–127]. Conclusions Our diagnostic strategy allows both positive diagnoses and species identifications. Travelers in West Sub-Saharan Africa and North Africa should be better aware of the risk of contracting leishmananiasis., Highlights Imported leishmaniases are regularly seen in non-endemic areas.Cutaneous forms are due to different species that need to be correctly identified for adapting treatment and epidemiologic purposes.The index of suspicion for the visceral form is often low because of the non-specificity of the clinical symptoms and the notion of travel in endemic areas often remote.The strategy, based on diagnostic quantitative PCR followed by sequencing for species identification, allows for rapid and safe diagnoses in a routine laboratory.

International audience; Background: Describe the characteristics, patterns of care, and predictive geriatric factors of elderly patients with IDHm high-grade glioma (HGG) included in the French POLA network. Material and Methods: The characteristics of elderly (≥70 years) patients IDHm HGG were compared to those of younger patients IDHm HGG (

Background Some keloids show cystic cavities that give rise to acute inflammatory flares and oozing. These suppurative keloids (SK) have rarely been systematically studied. We conducted a retrospective cohort study to evaluate SK frequency and its risk factors. We also reviewed microbiological analyses as well as the histological features of removed SKs. Methods Between July 1, 2015, and September 30, 2016, all adult patients attending a specialized keloid clinic were asked to participate. Clinical information and microbiological results were extracted from each patient's file. Histological features were observed and interpreted. Results In this study, we observed an SK rate of 26% for a mean keloid history of 17.2 years. Male gender, African ancestry, and a family history of keloids were significantly associated with suppuration. Microbiological examination revealed commensal skin flora 7/9 (77.8%), Staphylococcus aureus 1/9 (11.1%), and Enterococcus faecalis 1/9 (11.1%). Conclusion Suppuration is a common complication of keloids occurring in patients with severe keloid disease and may arise from pilosebaceous occlusion and aseptic inflammation.

International audience; Purpose The fusion of pre/intraoperative images may improve catheter manipulation during radioembolization (RE) interventions by adding relevant information. The objective of this work is to propose and evaluate the performance of a RE guidance strategy relying on structure-driven intensity-based registration between preoperative CTA and intraoperative X-ray images. Methods The navigation strategy is decomposed into three image fusion steps, supporting the catheter navigation from the femoral artery till reaching the injection site (IS). During the pretreatment assessment intervention, the aorta and the origins of its side branches are projected on the intraoperative 2D fluoroscopy following a 3D/2D bone-based registration process, to assist the celiac trunk access. Subsequently, a similar approach consisting in projecting the hepatic vasculature on intraoperative DSA through 3D/2D vessel-based registration is performed to assist the IS location. Lastly, the selected IS is reproduced during the treatment intervention by employing 2D/2D image-based registration between pretreatment and treatment fluoroscopic images. Results The three fusion steps were independently evaluated on subsets of 20, 19 and 5 patient cases, respectively. Best results were obtained with gradient difference as similarity measure and with a delimited preoperative vascular structure for vessel-based registration. The approach resulted in qualitatively appropriate anatomical correspondences when projecting the preoperative structures on intraoperative images. With the best configuration, the registration steps showed accuracy and feasibility in aligning data, with global mean landmarks errors of 1.59 mm, 2.32 mm and 2.17 mm, respectively, a computation time that never exceeded 5 s, 25 s and 11 s, respectively, and a user interaction limited to manual initialization of the 3D/2D registration. Conclusion An image fusion-based approach has been specifically proposed for RE procedures guidance. The catheter manipulation strategy based on the fusion of pre- and intraoperative images has the potential to support different steps of the RE clinical workflow and to guide the overall procedure.

Resume Introduction Le lupus erythemateux neonatal (LENN) est une affection rare secondaire au passage transplacentaire d’anticorps anti-nucleaires maternels le plus souvent de type anti-SSA/Ro. Les manifestations les plus frequentes sont dermatologiques et cardiaques. L’erytheme orbitaire en lunettes et les maculopapules erythemato-squameuses bipolaires constituent l’association clinique la plus frequemment rapportee. Cependant, de nombreuses variantes semiologiques pouvent etre a l’origine d’erreurs ou de retards diagnostiques. Patients et methodes Il s’agit d’une etude observationnelle retrospective monocentrique, colligeant tous les cas de LENN vus en consultation de dermatologie pediatrique entre 2010 et 2018. Le diagnostic de LENN avait ete confirme par la presence d’anticorps antinoyaux (AAN) specifiques chez la mere. Le but etait de decrire les differentes formes cliniques du LENN et d’en discuter les diagnostics differentiels. Resultats et discussion Nous avons identifie dix cas de LENN, tous adresses sans diagnostic ou avec un diagnostic errone. Ils ont ete repartis en 3 groupes en fonction de la semiologie des lesions cutanees : 5 avaient des maculopapules inflammatoires de l’extremite cephalique et du siege ; 3 avaient une depigmentation orbitaire acquise ; 2 avaient des lesions atrophiques et diffuses a disposition livedoide. Aucun n’avait d’atteinte cardiaque et les atteintes associees hematologiques et hepatiques etaient peu severes. Une remission spontanee etait constatee dans tous les cas avant l’âge de 6 mois. Les meres, majoritairement asymptomatiques ou pauci-symptomatique, avaient des AAN de type anti-SSA/Ro. Conclusion La reconnaissance des differentes formes cliniques de LENN permet de proposer une prise en charge adaptee precoce et de surveiller les grossesses ulterieures.

Resume Introduction L’hemophilie A acquise (AHA) est une coagulopathie rare secondaire au developpement d’anticorps anti-facteur VIII. Les causes en sont variees et plusieurs cas ont ete rapportes en association avec des dermatoses bulleuses auto-immunes (DBAI). Nous rapportons une nouvelle observation de cette association revelee par une atteinte œsophagienne specifique de la DBAI. Observation Un homme etait suivi pour une DBAI. Alors que le patient etait traite par une corticotherapie generale en raison de l’echec des dermocorticoides et de l’apparition de bulles buccales et laryngees, il developpait brutalement une hemorragie digestive compliquee d’un choc hemorragique. La fibroscopie mettait en evidence un decollement complet du tiers inferieur de l’œsophage. Le bilan biologique montrait un TCA allonge, un facteur VIII effondre et la presence d’anticorps anti-facteur VIII. Le diagnostic d’AHA dans un contexte de DBAI etait evoque. La corticotherapie generale etait poursuivie et un traitement par rituximab etait debute, permettant une regression des manifestations cutaneomuqueuses et une normalisation du bilan d’hemostase. Discussion La DBAI et l’AHA evoluent generalement de maniere concomitante, comme chez notre patient. Les complications hemorragiques sont severes. Le traitement de l’AHA a pour but de stopper le saignement aigu et d’eradiquer les auto-anticorps, raison pour laquelle nous avons choisi le rituximab. Conclusion Les decollements bulleux de l’œsophage sont rares au cours des DBAI mais cette observation spectaculaire montre qu’ils peuvent etre responsables d’une hemorragie massive en cas d’AHA associee. Cela renforce l’interet d’un controle des parametres d’hemostase chez tout patient atteint de DBAI, lors du bilan initial et lors des poussees.