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Resume Introduction La decouverte de tumeurs primitives pulmonaires multifocales synchrones n’est pas exceptionnelle. Distinguer les metastases pulmonaires d’une tumeur, de tumeurs primitives multiples synchrones represente un challenge pour le pathologiste et pour le clinicien. Nous presentons l’observation d’un patient presentant trois tumeurs pulmonaires correspondant a trois adenocarcinomes pour lesquels l’examen en biologie moleculaire a eu un impact determinant dans la stadification. Observation Un homme de 61 ans, fumeur, presente trois lesions suspectes dans chaque lobe au sein du poumon droit. Une pneumonectomie droite avec curage ganglionnaire lymphatique est realisee. L’examen anatomopathologique montre qu’il s’agit d’un adenocarcinome pour chaque tumeur. Pour mieux preciser la parente de ces tumeurs, un examen de biologie moleculaire a ete realise par sequencage multiple massif parallele (NGS, Panel Colon Lung V2). Cet examen montre la presence de mutations differentes sur chaque tumeur. Le diagnostic final retenu est donc celui de trois tumeurs distinctes, synchrones, devant chacune faire l’objet d’une stadification distincte, soit respectivement pT2aN1, pT1bN0, pT1bN0. Conclusions Dans une pratique moderne d’oncologie thoracique et d’anatomie pathologique la biologie moleculaire represente un complement a la stadification des tumeurs en cas de tumeurs multiples.

The digital age has greatly expanded the terrain and opportunities for a range of foreign influence efforts. A growing number of countries have invested significantly in their capabilities to disseminate online propaganda and disinformation worldwide, while simultaneously establishing information dominance at home. This introductory essay provides a brief examination of terms, concepts, and examples of these efforts and concludes by reviewing how the articles of this issue of the Journal of Advanced Military Studies contribute to our understanding of political warfare and propaganda.

Protecting nature's contributions to people requires accelerating extinction risk assessment and better integrating evolutionary, functional and used diversity with conservation planning. Here, we report machine learning extinction risk predictions for 1,381 palm species (Arecaceae), a plant family of high socio-economic and ecological importance. We integrate these predictions with published assessments for 508 species (covering 75% of all palm species) and we identify top-priority regions for palm conservation on the basis of their proportion of threatened evolutionarily distinct, functionally distinct and used species. Finally, we explore palm use resilience to identify non-threatened species that could potentially serve as substitutes for threatened used species by providing similar products. We estimate that over a thousand palms (56%) are probably threatened, including 185 species with documented uses. Some regions (New Guinea, Vanuatu and Vietnam) emerge as top ten priorities for conservation only after incorporating machine learning extinction risk predictions. Potential substitutes are identified for 91% of the threatened used species and regional use resilience increases with total palm richness. However, 16 threatened used species lack potential substitutes and 30 regions lack substitutes for at least one of their threatened used palm species. Overall, we show that hundreds of species of this keystone family face extinction, some of them probably irreplaceable, at least locally. This highlights the need for urgent actions to avoid major repercussions on palm-associated ecosystem processes and human livelihoods in the coming decades.

Purpose There is paucity of data on rectal cancer with uncommon histologic types. The objective was to describe managements of care and outcomes in patients with rectal cancer of histologic types other than adenocarcinoma. Material and methods This monoinstitutional retrospective study included all patients with rectal cancer undergoing rectal radiotherapy. Results From 2004 to 2015, 744 patients were treated for rectal cancer, and ten had a histologic type other than adenocarcinoma. The median age was 60.7 years (range: 34.6–80.4 years). Histologic types were neuroendocrine (four), adenosquamous (one), undifferentiated with large cell (one), clear cell (one), anaplastic with small cell (one), signet ring cell (one) and adenocarcinoma with choriocarcinomatous differentiation (one). Four patients were initially diagnosed with a stage IV rectal cancer, and two ultimately became metastatic. Six patients underwent surgery, with four neoadjuvant chemoradiotherapies. None experienced complete response and two had incomplete resections. First-line and concomitant chemotherapies were adapted to histology results, mainly with etoposide and platinum salts for neuroendocrine and small cells tumours. Four patients experienced progression before first line treatments were achieved. Median progression free survival and overall survival were 3.8 and 10.1 months respectively. Two patients were long survivors (22 and 54.7 months, both still alive). All other died of rectal cancer. Conclusion The present study highlights the rarity and the specificities of uncommon histologic types of rectal cancer. We report the real-life management and outcome of rare histologic types of rectal cancers, with dismal prognosis of stage IV tumours. We also report that treatments were adapted to histology.

The presence of multiple synchronous lung tumors is not a rare event. Distinguishing intra-pulmonary metastases from multiple synchronous lung adenocarcinoma is a challenge for pathologists and physicians. We present observation of a patient with three lung tumors corresponding to three adenocarcinomas for which molecular analysis had a significant impact on tumor staging.Three suspect lesions were discovered in a 61-year-old patient, a smoker, in each lobe of the right lung. Right pneumonectomy with lymph node dissection was performed. Pathological examination showed that each tumor was in fact an adenocarcinoma. In order to more precisely indicate tumor staging, molecular analysis was performed with next generation sequencing showing a different point mutation in a driver gene on each tumor. The final diagnosis is that the three tumors are distinct synchronous tumors, which must be staged separately.In modern-day practice of thoracic oncology and of surgical pathology, molecular biology represents a complement for tumor staging in the event of multiple lung tumors.

Silicosis and sarcoidosis are two very distinct entities in the literature. All the additional non-invasive examinations, including the chest CT scan, often do not differentiate them. The history, including occupational exposure to identified silica particles, is a discriminating factor. However, due to the pathogenic power of silica, it would be possible to have the simultaneous development of these two pathologies in the same patient. To illustrate this situation, here is the case of a 62-year-old patient, who presented initially with a picture of dyspnea and productive cough. The chest CT showed micronodular peribronchovascular infiltrates and mediastinal lymphadenopathy. The other additional examinations did not find anything specific. In the diagnostic process, the patient had multiple endoscopic samples which did not make it possible to be conclusive on one or the other of these pathologies. He therefore underwent a surgical lung biopsy which revealed histological lesions compatible with the two pathologies. Recent studies suggest that inhaled particles, especially silica, could be responsible for the pattern of sarcoidosis. However, it is difficult to say whether, in this case, silica was responsible for the development of sarcoidosis.

Resume Nous rapportons le cas d’un patient âge de 60 ans pris en charge pour une hypertension pulmonaire compatible avec une maladie veino-occlusive. Au cours du suivi, une opacite parenchymateuse etait decouverte. Nous decrivons la prise en charge de cette suspicion de cancer bronchopulmonaire ainsi que les modifications de strategie diagnostique et therapeutique du fait de l’hypertension pulmonaire. Les pneumologues doivent etre capables d’adapter leur prise en charge diagnostique et therapeutique en cas de neoplasie chez un patient souffrant d’hypertension pulmonaire.

International audience; Anaplastic oligodendroglioma (AO), IDH‐mutant and 1p/19q codeleted (IDHmut+/1p19qcodel), is a high‐grade glioma with only limited prognostic markers. The primary objective of this study was to evaluate, by immunohistochemistry, the prognostic value of two proliferation markers, MCM6 and Ki‐67, in a large series of IDHmut+/1p19qcodel AO included in the POLA (“Prise en charge des Oligodendrogliomes Anaplasiques”) French national multicenter network. We additionally examined the transcriptome obtained from this series to understand the functional pathways dysregulated with the mRNA overexpression of these two markers. The labelling indices (LI) of MCM6 and Ki‐67 were obtained via computer‐assisted color image analyses on immunostained AO tissues of the cohort (n=220). Furthermore, a subgroup of AO (n=68/220) was used to perform transcriptomic analyses. A high LI of either MCM6 (≥50%) or Ki‐67 (≥ 15%) correlated with shorter overall survival, both in univariate (P=0.013 and P=0.004, respectively) and multivariate analyses (P=0.027; multivariate Cox model including age, mitotic index, MCM6 and Ki‐67). MCM6 and Ki‐67 LI also correlated with overall survival in an additional retrospective cohort of 30 grade II IDHmut+/1p19qcodel oligodendrogliomas. The prognostic value of MCM6 mRNA level was confirmed in The Cancer Genome Atlas (TCGA) IDHmut+/1p19qcodel gliomas. The transcriptomic approach revealed that high transcriptional expressions of MCM6 and MKI67 were both linked positively with cell cycle progression, DNA replication, mitosis, pro‐neural phenotype as well as neurogenesis, and negatively with microglial cell activation, immune response, positive regulation of myelination, oligodendrocyte development, beta‐amyloid binding, and postsynaptic specialization.In conclusion, the overexpression of MCM6 and/or Ki‐67 is independently associated to shorter overall survival in IDHmut+/1p19qcodel AO. These two easy‐to‐use and cost‐effective markers could thus be used concurrently in routine pathology practice. Additionally, the transcriptomic analyses showed that AO with high proliferation index have down‐regulated immune response and lower microglial cells activation, and bears pro‐neural phenotype.

Laser Plasma Acceleration (LPA) is capable of producing a GeV beam within a cm accelerating distance, but with a rather high initial divergence and large energy spread. COXINEL aims to demonstrate a compact Free Electron Laser using such a source, where a specific transport line with adequate elements is used, such as tunable high gradient quadrupoles for handling the divergence. An innovative permanent magnet based quadrupole (QUAPEVA) made of two quadrupoles superimposed capable of generating a gradient of 200 T/m is presented. The first quadrupole consists of magnets shaped as a ring and attaining a constant gradient of 155 T/m, and the second one made of four cylindrical magnets surrounding the ring and capable of rotating around their axis to achieve a gradient tunability of $\pm$ 46 T/m. Each tuning magnet is connected to a motor and controlled independently, enabling the gradient to be tuned with a rather good magnetic center stability ($\pm$10 $\mu$m) and without any field asymmetry. The measurements and field optimization of seven quadrupoles with different magnetic lengths are reported. A set of QUAPEVA triplet, installed at COXINEL, achieved good focusing and enabled beam based alignment., Comment: 4 pages, 9 figures

High gradient quadrupoles are necessary for different applications such as laser plasma acceleration, colliders, and diffraction limited light sources. Permanent magnet quadrupoles provide a higher field strength and compactness than conventional electro-magnets. An original design of permanent magnet based quadrupole (so-called "QUAPEVA"), composed of a Halbach ring placed in the center with a bore radius of 6 mm and surrounded by four permanent magnet cylinders capable of providing a gradient of 210 T/m, is presented. The design of the QUAPEVAs, including magnetic simulation modeling, and mechanical issues are reported. Magnetic measurements of seven systems of different lengths are presented and confirmed the theoretical expectations. The variation of the magnetic center while changing the gradient strength is +/- 10 micrometer. A triplet of three QUAPEVA magnets are used to focus a beam with large energy spread and high divergence that is generated by Laser Plasma Acceleration source for a free electron laser demonstration., 4 pages, 9 figures

A 60-year-old patient was under follow-up for pulmonary hypertension consistent with pulmonary veno-occlusive disease. During his follow-up, a parenchymal opacity was discovered. We describe the management of the suspicion of lung cancer, highlighting the modification of the conventional diagnostic and therapeutic strategy on account of the pulmonary hypertension. Chest physicians should be able to adapt their diagnostic and therapeutic management in the case of neoplasia in patients with severe pulmonary hypertension.

Rhabdomyosarcoma, most common soft tissue tumor in children, represent 8% of solid tumors in children. Conversely, in adults, this histology is very rare and no consensual recommendation is supported. If gynecological localization is one of the most frequent in children, it is a minority in adults. The management of this type of tumor is based on treatment multimodality combining surgery, chemotherapy, radiotherapy and brachytherapy. This pathological separate entity differs from other sarcomas by its greater sensitivity to chemotherapy and radiotherapy. The aim of this study is to conduct a general review of diagnostic and treatment of genital tract rhabdomyosarcoma in adults, and to report pathological characteristics of this type of tumor.

Resume Introduction L’encephalite a anticorps anti-recepteur N-methyl- d -aspartate (NMDA) du glutamate (Ac anti-NMDA-r) est de description recente. Nous rapportons deux observations illustrant sa presentation clinique, sa curabilite et l’implication de l’immunite B. Observations Ces deux observations retrouvent les caracteristiques cliniques des encephalites a Ac anti-NMDA-r : predominance feminine, âge jeune, tableau severe comportant troubles psychiatriques, confusion, epilepsie, mutisme, hypovigilance, mouvements anormaux et liquide cephalorachidien inflammatoire. Les deux patientes s’ameliorerent avec un traitement immunomodulateur. Dans l’observation 1, l’encephalite etait associee a un teratome de l’ovaire qui comportait un contingent neuronal. Dans l’observation 2, il n’y avait pas de tumeur. Une biopsie cerebrale montrait de nombreux infiltrats de lymphocytes B perivasculaires et quelques lymphocytes T parenchymateux. Conclusion L’encephalite a Ac anti-NMDA-r n’est sans doute pas rare ; elle peut etre reversible si elle est diagnostiquee et traitee precocement. Elle n’est pas toujours paraneoplasique et implique l’immunite humorale.

Resume Objectif de l’etude L’introduction du temozolomide dans la prise en charge des glioblastomes a permis d’ameliorer le devenir des patients. Cependant, la duree optimale du traitement d’entretien apres la chimioradiotherapie reste incertaine. Ce travail retrospectif evalue la faisabilite, la tolerance et l’interet potentiel a prolonger la chimiotherapie par temozolomide au-dela des six cycles du traitement de reference. Patients et methodes Au total, 46 patients etaient inclus dans l’analyse. L’âge median au moment du diagnostic etait de 61 ans (de 40 a 77 ans). Quarante-cinq patients ont recu une radiotherapie conformationnelle avec une chimiotherapie concomitante a base de temozolomide, a l’issue de laquelle 37 patients ont recu une chimiotherapie adjuvante. Le traitement par temozolomide d’entretien etait poursuivi jusqu’a progression ou de toxicite. Resultats Pendant la phase d’entretien, aucun arret pour toxicite n’a ete necessaire, mais une reduction des doses de temozolomide etait effectuee pour cause de toxicite chez huit patients pour cause toxicite. Sur les 37 patients de la phase d’entretien, 32 etaient en situation de progression tumorale. La duree mediane de survie etait de 12,3 mois (de 11 a 13,2 mois) et celle de survie sans progression de 7,6 mois (de 5,6 a 9,6 mois). Conclusion Ces resultats suggerent la faisabilite d’un traitement d’entretien prolonge au-dela des six mois du protocole standard, avec une toxicite moderee et des resultats au moins comparables a ceux de la litterature en termes de survie. Des evaluations prospectives d’une telle strategie sont en cours.

Resume Propos L’autopsie medicale a pour but de preciser les causes du deces d’un individu. Malgre le declin majeur et mondial de sa pratique depuis plusieurs annees, elle demeure un outil essentiel pour l’evaluation de la prise en charge diagnostique et therapeutique des patients. Nous avons mene une enquete au CHU de Saint-Etienne afin d’essayer d’identifier les facteurs pouvant influencer l’acceptation d’une autopsie et sa perception a l’echelle individuelle. Methodes Un questionnaire a ete distribue, d’une part, a des patients et, d’autre part, a des professionnels de sante de notre etablissement. Les reponses etaient anonymes et les questions portaient sur l’âge, le sexe, la profession, l’acceptation ou le refus de la pratique d’une autopsie sur leur propre corps en cas de deces, les motifs invoques pour l’expliquer et l’information (ou la formation) concernant cet acte recue anterieurement a l’enquete. Resultats Cent quatre-vingt-six patients ont accepte de repondre sur 197 interroges et 112 professionnels de sante ont renvoye le questionnaire rempli (77 medecins, 13 internes, 13 infirmieres, cinq cadres de sante et quatre aides-soignantes). Les resultats montrent une bonne acceptation de l’autopsie, puisque 86 % du public et 94,6 % des professionnels de sante ne seraient pas opposes a la pratique de cet examen (pour faire connaitre a leurs proches les causes du deces, pour permettre plus facilement le deuil, pour faire avancer la medecine). Les raisons de refus de l’autopsie sont relatives a la religion, a l’atteinte a l’integrite du corps, a la dignite et au respect du defunt et de sa famille. Par ailleurs, seulement 42,5 % des patients avaient deja entendu parler de l’autopsie medicale, 33,9 % des professionnels de sante avaient recu une formation sur ce sujet et 40,2 % d’entre eux avaient deja reflechi a l’eventualite d’un tel examen en cas de deces. Conclusion En recherchant un consentement direct aupres des individus, le taux de refus de l’autopsie est faible, mais l’information du public et la formation du personnel de sante restent insuffisante. La recherche d’une non-opposition, comme l’exige la loi actuelle, notamment en consultant les proches du defunt dans une periode douloureuse de deuil nuit considerablement aux prelevements d’organes sur personnes decedees. L’amenagement de la loi par la recherche d’un consentement direct inscrit dans le dossier medical (au meme titre que l’identite de la personne de confiance) serait vraisemblablement un des meilleurs moyens de lutte contre le declin de l’autopsie medicale (favorisant, tres probablement, du meme coup les dons d’organes). Cet amenagement de la loi devrait egalement s’accompagner d’une formation specifique des professionnels de sante et de campagnes d’information aupres du public.

International audience; The FFAG method is nowadays seen as a potential candidate for the acceleration of protons and light ions for hadrontherapy. This has motivated the design of a principle protontherapy installation, in the frame of the RACCAM project. This article presents the design study, a medical spiral scaling FFAG assembly, capable of producing variable energy proton beams, with potentially high repetition and dose delivery rates.

RESUMO – Para a obtencao de altos rendimentos em biomassa e etanol em cultivos de Zymomonas mobilis, tem sido empregadas tecnicas de reciclo celular, com destaque para a utilizacao de membranas. Neste trabalho foi comparado o reciclo de celulas atraves de sistemas de membranas cerâmica e polimericas (fibras ocas). Z. mobilis foi cultivada em reator de 0,5 L. Ao final da batelada, o caldo fermentado foi introduzido nas membranas ate o esgotamento. As celulas foram entao re-introduzidas no reator, iniciando nova fermentacao. Incremento medio de 38% na concentracao celular foi atingido com o uso de membrana cerâmica. Por outro lado foi observada queda em termos de biomassa com uso de fibras ocas devido a dificuldade de reciclo total. Consequentemente, maiores conversoes de substrato em celulas e em etanol foram atingidas com membrana cerâmica, sendo nas condicoes testadas, a alternativa mais indicada para este proposito.

The generic affiliation of Cyanella amboensis Schinz has been uncertain since the species was excluded from the genus Cyanella L. in 1991. The species has two leaves, a divaricately branching inflorescence, ebracteolate pedicels, and acti- nomorphic flowers with monomorphic anthers. It is endemic to the western parts of central and northern Namibia. Other species of Cyanella have several leaves, racemose inflorescences, bracteolate pedicels, zygomorphic flowers with dimor­phic anthers, and are endemic or near-endemic to the winter rainfall region in southwestern South Africa and southern Namibia. These differences are consistent with the recognition of the species as a distinct genus within the family. Phylogenetic analysis of plastid DNA sequences indicates that C. amboensis Schinz is sister to the other species of Cyanella, a relationship that also supports its independent generic status. The monotvpic genus Eremiolirion is according­ly erected to accommodate the species. Minor differences in flower colour and vegetative morphology in Cyanella alba L.f. are shown to correlate with the three disjunct groups of populations in which the species occurs, and these populations are recognized at the level of subspecies.