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Patients with type 1 diabetes (T1D) may develop severe outcomes during coronavirus disease 2019 (COVID-19), but their ability to generate an immune response against the SARS-CoV-2 mRNA vaccines remains to be established. We evaluated the safety, immunogenicity, and glycometabolic effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines in patients with T1D. A total of 375 patients (326 with T1D and 49 subjects without diabetes) who received two doses of the SARS-CoV-2 mRNA vaccines (mRNA-1273, BNT162b2) between March and April 2021 at ASST Fatebenefratelli Sacco were included in this monocentric observational study. Local and systemic adverse events were reported in both groups after SARS-CoV-2 mRNA vaccination, without statistical differences between them. While both patients with T1D and subjects without diabetes exhibited a parallel increase in anti-SARS-CoV-2 spike titers after vaccination, the majority of patients with T1D (70% and 78%, respectively) did not show any increase in the SARS-CoV-2-specific cytotoxic response compared with the robust increase observed in all subjects without diabetes. A reduced secretion of the T-cell-related cytokines interleukin-2 and tumor necrosis factor-α in vaccinated patients with T1D was also observed. No glycometabolic alterations were evident in patients with T1D using continuous glucose monitoring during follow-up. Administration of the SARS-CoV-2 mRNA vaccine is associated with an impaired cellular SARS-CoV-2-specific cytotoxic immune response in patients with T1D.

Purpose/objective(s) To conduct the first global individual patient data (IPD) meta-analysis of randomized trials to assess the impact of androgen deprivation therapy (ADT) use and duration with definitive radiotherapy (RT) in localized prostate cancer. Materials/methods The MARCAP Consortium was formed from international trial groups (NRG/RTOG, EORTC, TROG, DART/GICOR, and ICORG). IPD for 10,131 patients enrolled across 11 RT trials were available for three pre-specified meta-analyses: addition of ADT to RT (5 trials; n = 4736), addition of long-term adjuvant ADT (12-30 months) to short-term ADT (4 trials; n = 3674), and addition of longer neoadjuvant ADT (3-7 months) to short-term ADT (3 trials; n = 2213). The primary endpoint of all meta-analyses was overall survival (OS), with metastasis-free survival (MFS) as a secondary endpoint. Interaction tests between treatment and receipt of dose-escalated RT (≥74 Gy in 2 Gy fractions) were performed. Results After a median follow-up of 12.0 years, the addition of ADT to RT improved 12-year OS (absolute 7.2%, HR 0.87, 95% CI 0.8-0.95) and 12-year MFS (absolute 8.3%, HR 0.85, 95% CI 0.79-0.92). After a median follow-up of 10.9 years, prolongation of adjuvant ADT improved 12-year OS (absolute 6.3%, HR 0.86, 95% CI 0.78-0.94) and 12-year MFS (absolute 6.3%, HR 0.83, 95% CI 0.77-0.90). After a median follow-up of 10.3 years, prolongation of neoadjuvant ADT was not associated with a significant benefit in any endpoint (MFS HR 0.95, 95% CI 0.83-1.09; OS HR 0.94, 95% CI 0.82-1.09). On subgroup analysis, there was no evidence of a treatment effect interaction between RT dose and ADT use (OS P-interaction 0.59) or adjuvant ADT prolongation (OS P-interaction 0.13). In the setting of dose-escalated RT, adjuvant ADT prolongation significantly improved OS (HR 0.70, 95% CI 0.53-0.92). Conclusion This study represents the strongest evidence to support ADT use and prolongation of adjuvant ADT to at least 18 months in localized prostate cancer in conjunction with definitive RT. The relative benefit of ADT use and adjuvant ADT prolongation was consistent irrespective of RT dose-escalation. In contrast, prolongation of neoadjuvant ADT beyond 2 months did not improve survival outcomes and should not routinely be employed.

The first European superconducting winding pack (WP) and the first set of coil cases [toroidal field coil cases (TFCC)] for ITER are going to be delivered in 2017. The TFCC are steel structures that provide structural integrity to the WP, contribute to neutron shielding capacity, provide support to operating forces, and offer interface connections with the rest of the ITER machine. The TFCC assembly is formed by four main parts: two sectors with U-shaped section and two closure plates, which, after being welded together, enclose the WP. Each TFCC weights about 150 t and presents a wall thickness from 60 to 120 mm. The presence of distortions when welding such thick structures is particularly problematic in these components, which require tight tolerances and include several interfaces with other parts of the machine. In order to compensate the distortions, extra material is present in the critical areas to allow postwelding machining. The amount of extra material has to be optimized to reduce machining time and therefore the cost of the manufacturing. Thus, the evaluation of the welding-caused distortions is essential in order to confirm the extra-material strategy. In this scenario, an experimental and simulation campaign has been set up to predict the deformation of the TFCC during welding. First, welding coupons were welded in representative configurations. Then, these data were used to build a preliminary finite element method (FEM) model tool, using ANSYS software, which was then benchmarked against a “blind test” coupon and three TFCC-like mock-ups of 1-m length. Finally, a full FEM model was constructed using the previous outputs and is currently under assessment to predict the deformation of the TFCC during the welding process. This paper presents the numerical and experimental activities carried out so far, being EnginSoft S.p.A. the developer of FEM models, SIMIC S.p.A. the responsible of welding processes and data acquisition, and Fusion for Energy the contractual and technical supervisor.

Service Quality can be obtained if what is expected by the patient to the service provider is in accordance with the patient's requirements. This study aims to determine the quality of patient health services by health workers at the Sonimanu health center in 2019. The sample in this study was all In patients with a total sample of 73 people the sampling technique in this study was totally sampling. Data collection was carried out with 20 items of hope and reality questionnaire, which is a quantitative description of this type of study. The analysis conducted is univariate using Importance Performance Analysis. The results of this study indicate that the value of conformity between expectations and quality of inpatient services of health workers to the tangible dimension is 97.28% (Very Satisfied), reliably 95.27% (Very Satisfied), responsiveness 86.38% (Satisfied), assurance 98.14% (Very Satisfied), empathy 97.21% (Very Satisfied). There is one attribute of inadequate quality of service that is a good nutrition officer providing and helping patients with dietary needs (58.42%), it is expected that the health staff at the Sonimanu health center need to prioritize and be more responsive in paying attention to the rights or needs of Inpatients. It is recommended that the quality of inpatient health services by health workers need to be further improved, especially in the dimension of responsiveness.

The ITER magnetic system includes 18 toroidal field (TF) coils constructed using a Nb3Sn cable-in-conduit superconductor. Each TF coil comprises a winding pack (WP) composed of seven double pancake (DP) modules stacked together, impregnated, and inserted into a stainless steel coil case. Ten TF coils are being produced in Europe, under the responsibility of Fusion for Energy (F4E) (the European Domestic Agency), whereas the remaining nine TF coils are being produced in Japan. F4E has implemented a procurement strategy aimed to minimize costs and risks by subdividing the procurement into three main packages, each foreseeing first an R&D and a qualification phase. One procurement package is related to the construction of 72 radial plates (RP), another to the fabrication of the ten WPs, and a third to the cold test and coil-case insertion of ten WPs. All industrial contracts have now been signed and are running. The situation as of September 2015 is as follows: 2 RP prototypes and 32 production RPs (enough for four TF coils) have been successfully (enough for four TF coils) produced and delivered to the winding pack supplier. A full-size superconducting DP prototype has been successfully fabricated and subjected to a thermal cycle at 80 K. So far, 33 DPs have been wound, 27 DPs have been heat treated, and 26 DPs have been successfully transferred into the RP grooves. The cover plate welding has been successfully completed on 18 DPs. Regarding the insertion contract, an alternative way to insert the WP inside the coil case has been devised, and the corresponding transfer tooling is being procured. The qualification for the most important manufacturing processes is underway.

In this randomized controlled study we analyse and compare the acute and chronic effects of visual and acoustic cues on gait performance in Parkinson’s Disease (PD). We enrolled 46 patients with idiopathic PD who were assigned to 3 different modalities of gait training: (1) use of acoustic cues, (2) use of visual cues, or (3) overground training without cues. All patients were tested with kinematic analysis of gait at baseline (T0), at the end of the 4-week rehabilitation programme (T1), and 3 months later (T2). Regarding the acute effect, acoustic cues increased stride length and stride duration, while visual cues reduced the number of strides and normalized the stride/stance distribution but also reduced gait speed. As regards the chronic effect of cues, we recorded an improvement in some gait parameters in all 3 groups of patients: all 3 types of training improved gait speed; visual cues also normalized the stance/swing ratio, acoustic cues reduced the number of strides and increased stride length, and overground training improved stride length. The changes were not retained at T2 in any of the experimental groups. Our findings support and characterize the usefulness of cueing strategies in the rehabilitation of gait in PD.

[1] Despite the wide spectrum of perturbations of flow and sediment transport experienced by rivers as a result of hydrologic variations, the paradigm of morphodynamic equilibrium has long been present in the geomorphological literature where it is traditionally associated with the semiempirical notion of formative discharge, whereby the unsteady forcing is taken as morphologically equivalent to some effective steady forcing. Here we investigate the mechanisms responsible for maintaining a quasi-equilibrium bed profile of a river reach sufficiently short to have no significant tributary inputs. More importantly, we assume the channel banks to be fixed, hence, the case we have in mind is that of rivers protected by levees which cannot respond to hydrologic forcing by changing their width like natural rivers. Employing a 1-D model of river morphodynamics, we first determine the equilibrium profile of the river reach for given steady forcing conditions and discuss the capability of this approach for interpreting bed profiles observed in the field by applying it to the terminal reach of the Magra River, Italy. Field observations turn out to be reasonably well fitted by the equilibrium profile associated with a steady effective discharge, which however differs from the typical formative discharge (mean annual flood) for natural channels with erodible banks. Finally, we clarify how fluctuations of the hydrodynamic forcing associated with the recorded historical sequence of hydrologic events of variable intensities have acted to maintain the river equilibrium.

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Evidence suggests that falls and associated bone fractures are more frequent in patients suffering from Parkinson's disease (PD) than in the general population. In this cross-sectional study we evaluated the clinical and biochemical characteristics that are associated to falls, fractures and bone health in a population of PD subjects.Forty-two consecutive subjects suffering from idiopathic PD (mild-to-moderate severity) with/without falls in the previous year were included. They were characterized as regards functional independence, balance, fear of falling, bone density (ultrasound densitometry) and plasma levels of vitamin D. Twenty-one age- and sex-matched healthy subjects were evaluated as controls.We detected a greater degree of osteoporosis in PD subjects as compared to controls, more pronounced in males than in females (Z-score: M -3.8 ± 1.6, F -2.28 ± 0.92, p = 0.0006). A positive correlation was found between independence levels and bone density or vitamin D levels. Twenty seven patients (64%) reported falls in the previous year. These were associated to post-traumatic fractures in 16 subjects (59% of fallers). Women fell more than men (fallers: 20 F/7 M; non fallers: 4 F/11 M, χ² test p = 0.02), although the occurrence of post-traumatic fractures among fallers did not differ between sexes (F 11/9, M 5/2, χ² test p0.05). Fallers with post-traumatic fractures showed higher degrees of motor impairment.These findings confirm that falls and osteoporosis represent major health issues in PD, already in the middle stages of disease.

The combination of radiotherapy and androgen suppression with luteinizing hormone releasing hormone agonist has become a standard of care for locally advanced prostate cancer. Phase III randomized trials have shown that for locally advanced prostate cancer a 4-month complete androgen blockade initiated 2 months prior radiotherapy and stopped at the completion of radiotherapy increased overall survival in patients with Gleason score 2-6, meanwhile an adjuvant long term androgen suppression (2.5-3 years) improved significantly overall survival.

Resume En 2011, le cancer de la prostate se positionne clairement comme un probleme de sante publique. La radiotherapie a connu ces vingt dernieres annees des avancees significatives avec l’avenement de la radiotherapie de conformation tridimensionnelle comme standard dans la prise en charge des adenocarcinomes prostatiques et maintenant avec l’apport de la modulation d’intensite qui permet d’envisager un increment de dose sur le volume cible previsionnel sans toxicite surajoutee pour les organes a risque. L’association radio-hormonotherapie pour les cancers de haut risque est egalement rentree dans la pratique courante. La medecine nucleaire a travers de nouveaux traceurs et de nouvelles indications va probablement permettre aux praticiens prenant en charge ces patients de mieux definir les indications et de mieux determiner les patients qui beneficieront authentiquement d’une strategie therapeutique plus que d’une autre, voire meme de les associer…

Background: Familial hemiplegic migraine (FHM) is a rare, dominantly inherited subtype of migraine with transient hemiplegia during the aura phase. Mutations in at least three different genes can produce the FHM phenotype. The mutated FHM genes code for ion transport proteins that animal and cellular studies have associated with disturbed ion homeostasis, altered cellular excitability, neurotransmitter release, and decreased threshold for cortical spreading depression. The common forms of migraine are characterized interictally by a habituation deficit of cortical and subcortical evoked responses that has been attributed to neuronal dysexcitability. FHM and the common forms of migraine are thought to belong to a spectrum of migraine phenotypes with similar pathophysiology, and we therefore examined whether an abnormal habituation pattern would also be found in FHM patients. Methods: In a group of genotyped FHM patients (five FHM-1, four FHM-2), we measured habituation of visual evoked potentials (VEP), auditory evoked potentials including intensity dependence (IDAP), the nociception-specific blink reflex (nsBR) and compared the results to a group of healthy volunteers (HV). Results: FHM patients had a more pronounced habituation during VEP (P = 0.025) and nsBR recordings (P = 0.023) than HV. There was no difference for IDAP, but the slope tended to be steeper in FHM. Conclusion: Contrary to the common forms of migraine, FHM patients are not characterized by a deficient, but rather by an increased habituation in cortical/brain stem evoked activities. These results suggest differences between FHM and the common forms of migraine, as far as central neuronal processing is concerned.

Background: Clinical studies indicated that nitric oxide (NO) donors cause regional changes in cerebral blood flow (CBF), similar to those reported in spontaneous migraine. Systemic nitroglycerin (NTG), a NO donor, is a well-accepted experimental model of migraine. In this study we have examined the effects of NTG on the meningeal and cortical blood flow in rats. Methods: Regional blood flow was monitored in male Sprague-Dawley rats using laser Doppler flowmetry before and after NTG/saline injection over 150 minutes. The effect of pre-treatment with Nω-nitro-L-arginine ester (L-NAME) or 7-nitroindazole (7-NI) on NTG-induced changes on blood flow was also investigated. Results: In the dura NTG caused a biphasic response represented by an initial decrease in blood flow followed by a significant increase. At variance, in the cortex NTG caused only an increase in blood flow. Pre-treatment with either L-NAME or 7-NI prevented NTG-induced increase in blood flow in both districts, while only L-NAME also prevented NTG-induced decrease in dural blood flow. Conclusion: The present findings provide additional information on the timing of effects of NTG on blood flow at both the meningeal and cortical levels. These effects seem to be related to vasoregulatory mechanisms and/or metabolic activity in response to the synthesis of endogenous NO.

Resume Utilisee depuis 60 ans dans le traitement des cancers de prostate metastatiques, l’hormonotherapie a desormais une place bien definie dans le traitement des cancers de prostate localement avances. En effet, l’hormonotherapie adjuvante associee a la radiotherapie est aujourd’hui devenu le traitement de references de ces cancers localement avances. Cette association therapeutique a fait la preuve de son efficacite sur l’amelioration des resultats carcinologiques. Pourtant la toxicite de l’hormonotherapie n’est pas negligeable, avec des effets secondaires cardiovasculaires, metaboliques, osseux et neuropsychologiques importants. Ceux-ci peuvent etre a l’origine d’une reduction des benefices du traitement et d’une mortalite propre quand l’hormonotherapie est utilisee seule. Pour autant, de grandes etudes randomisees ont montre que ces effets nefastes n’entrainaient pas une mortalite significativement plus importante par rapport aux patients traites par radiotherapie seule. Ils ne sont donc pas un obstacle a cette association therapeutique. Toutefois, il est necessaire d’obtenir un recul plus important et d’effectuer des etudes plus precises de morbidite. Par ailleurs la duree exacte de cette hormonotherapie adjuvante reste a determiner.

For the second year, the French Radiotherapy Database presents information from French radiation oncology centers. Among 179 centers, 159 have participated (90 %). The number of accelerators increased from 371 to 384 between 2006 and 2007, 11 % of these machines are more than 15 years old. On average, centers are open 50 hours per week for treatment and 9.5 % more for maintenance. The lack of dedicated CT remains a difficulty: 158 from 159 centers have an access to a CT, but only 50 % have a dedicated scanner. There is no progress compared to 2006. The proportion of centers having a MU double calculation system has increased from 51 to 58 %. Two thirds of centers do not implement in vivo dosimetry. The activity is stable around 190 000 treatments per year. Three-dimension conformal radiotherapy is used for more than half of treatments in 77.2 % of private centers and 50 % of public hospitals. Intensity modulated radiotherapy remains rarely used. The number of radiation oncologists and technologists remains stable. The number of radiophysicists has increased from 7.6 %. Despite some progress, the difficulties of this speciality persist in France and are equally distributed across all regions, and between private and public centers. In 2009, the French Society for Radiation Oncology and the associated partners will continue this survey, which interest is recognized by both professionals and health administrations.

Background and purpose: The main aims of this study were to evaluate: the diffusion, use and perception of the usefulness of the 2004 EFNS guidelines on neurophysiological testing in non-acute headache patients; the frequency with which the different neurophysiological tests were recommended in non-acute migraine patients by physicians aware or unaware of the guidelines; and the appropriateness of the reasons given for recommending neurophysiological tests. Methods: One hundred and fifty physicians selected amongst the members of the Italian societies of general practitioner (GPs), neurologists and headache specialists were contacted via e-mail and invited to fill in a questionnaire specially created for the study. Results: Ninety-two percent of the headache specialists, 8.6% of the neurologists and 0% of the GPs were already aware of the EFNS guidelines. A significantly higher proportion of headache specialists had not recommended any neurophysiological tests to the migraine patients they had seen in the previous 3 months, whereas these tests had frequently been prescribed by the GPs and neurologists. Overall, 80%, 42% and 42.6% of the reasons given by headache specialists, neurologists and GPs, respectively, for recommending neurophysiological testing in their migraine patients were appropriate (P < 0.01). Conclusions: The diffusion of the EFNS guidelines on neurophysiological tests and neuroimaging procedures was found to be very limited amongst neurologists and GPs. The physicians aware of the EFNS guidelines recommended neurophysiological tests to migraine patients less frequently and more appropriately than physicians who were not aware of them. The most frequent misconceptions regarding neurophysiological tests concerned their perceived capacity to discriminate between migraine and secondary headaches or between migraine and other primary headaches.

Further to the Epinal events, Health Ministers P. Bas then R. Bachelot-Narquin have launched a plan of work devoted to radiotherapy; they have also committed the SFRO President, within the framework of a mission, to make proposals taking into account the demography of professionals and their level of competence, valorization of careers, cooperation with medical oncologists, delegations of authorities, mutualisation of human and material resources. Due to the numerous actions of the roadmap managed by the tutelages, the aim of the mission was focused on the modalities of work of the professionals linked to radiotherapy: radiation oncologists, radiographers and physicists.

Accidents which recently occured in external radiotherapy led the French Ministry of Health to implement a programme aimed at increasing quality and safety of treatments. We report the actions of the French society of radiation oncology in the field of this programme called Feuille de route.

NCX 4016 is a nitric oxide (NO)-donating derivative of acetylsalicylic acid. NO and salicylate, in vivo metabolites of NCX 4016, were shown to be potential actors in controlling glucose homeostasis. In this study, we evaluated the action of NCX 4016 on the capacity of 3T3-L1 adipocytes to transport glucose in basal and insulin-stimulated conditions. NCX 4016 induced a twofold increase in glucose uptake in parallel with the translocation of the glucose transporters GLUT1 and GLUT4 to the plasma membrane, leaving unaffected their total expression levels. Importantly, NCX 4016 further increased glucose transport induced by a physiological concentration of insulin. The stimulatory effect of NCX 4016 on glucose uptake appears to be mediated by its NO moiety. Indeed, it is inhibited by a NO scavenger and treatment with acetylsalicylic or salicylic acid had no effect. Although NO is involved in the action of NCX 4016, it did not mainly depend on the soluble cGMP cyclase/protein kinase G pathway. Furthermore, NCX 4016-stimulated glucose transport did not involve the insulin-signaling cascade required to stimulate glucose transport. NCX 4016 induces a small activation of the mitogen-activated protein kinases p38 and c-Jun NH2-terminal kinase and no activation of other stress-activated signaling molecules, including extracellular signal-regulated kinase, inhibitory factor κB, or AMP-activated kinases. Interestingly, NCX 4016 modified the content of S-nitrosylated proteins in adipocytes. Taken together, our results indicate that NCX 4016 induced glucose transport in adipocytes through a novel mechanism possibly involving S-nitrosylation. NCX 4016 thus possesses interesting characteristics to be considered as a candidate molecule for the treatment of patients suffering from metabolic syndrome and type 2 diabetes.

Resume Objectifs La recherche du ganglion sentinelle (GS) a fait la preuve de son efficacite uniquement dans la detection d’un envahissement lymphatique axillaire des tumeurs mammaires de petite taille (cT1N0). Ce travail cherche a montrer que la revelation, grâce a l’injection peritumorale du traceur, d’un ganglion sentinelle mammaire interne peut presenter un impact therapeutique pour les patientes concernees. Materiel et methodes Cinq cent trente-huit biopsies du GS, realisees sur une cohorte de 529 patientes, ont ete analysees. L’injection peritumorale de nanocolloides techneties, completee d’une injection sous-tumorale prepectorale, etait realisee sous controle echographique. Resultats Un GS a pu etre identifie 524 fois, dont 147 fois (28,1 %) en chaine mammaire interne (CMI). Dix fois, le GS en CMI n’etait associe a aucun GS axillaire. Cent trente-cinq biopsies mammaires internes ont pu etre realisees, sans morbidite appreciable liee au geste. Seize patientes presentaient un envahissement du GS en CMI, dont sept fois de maniere isolee. Pour six patientes, cette information a conduit a proposer une chimiotherapie adjuvante. Pour 308 patientes, en l’absence d’envahissement mammaire interne, l’irradiation prophylactique de la CMI aurait pu etre evitee (95% des indications theoriques d’irradiation). Conclusion L’injection peritumorale, associee au prelevement systematique des nœuds lymphatiques mammaires internes mis en evidence, permet de personnaliser le traitement des patientes atteintes de cancer mammaire de stade cT1, cela sans alterer les performances habituelles de la technique ni engendrer un surcroit notable de complications. L’interet en terme de survie et de morbidite de ces modifications therapeutiques, notamment radiotherapiques, devra cependant etre demontre.

But. - Etudier l'impact du complement d'irradiation du lit tumoral dans le cadre du traitement conservateur sur le controle local, le resultat cosmetique, la fibrose et la survie globale chez des patientes atteintes de cancer du sein de petit stade. Patients et methodes. - Cinq mille cinq cent soixante-neuf patientes ont ete randomisees apres resection de la tumeur primitive suivie d'une irradiation du sein entier de 50 Gy. Apres resection microscopiquement complete (5318 patients), les doses du complement d'irradiation du lit tumoral etaient 0 Gy ou 16 Gy, alors qu'apres resection incomplete (251 patients), la randomisation etait entre 10 et 26 Gy. Les resultats avec un suivi median de dix ans sont presentes. Resultats. - A dix ans, les taux cumulatifs d'incidence des rechutes locales etaient de 10,2 % contre 6,2 % pour des complements d'irradiation du lit tumoral respectivement de 0Gy et de 16Gy (p 0,1). Il n'y avait aucune interaction statistiquement significative par categorie d'âge mais les rechutes avaient tendance a survenir plus tot chez les patientes plus jeunes. Comme le risque cumulatif a dix ans etait plus grand pour les patientes jeunes, l'importance de la reduction absolue du risque de rechute locale obtenue avec un complement d'irradiation du lit tumoral diminuait avec l'âge. Le developpement d'une fibrose a significativement dependu de la dose du complement d'irradiation du lit tumoral avec des taux a dix ans de fibrose grave de 1,6% apres 0 Gy, de 3,3 % apres 10 Gy, de 4,4% apres 16 Gy et de 14,4 % apres 26 Gy. Conclusion. - Une augmentation de dose de 16 Gy ameliore le taux de controle local des tumeurs apres resection complete. Le developpement de la fibrose depend de la dose. Apres dix ans de suivi median, nous n'avons pas observe d'impact sur la survie globale.

Resume Objectif de l'etude Apres prostatectomie radicale retropubienne pour cancer de la prostate localise, le risque de recidive est significatif en cas d'envahissement capsulaire, d'atteinte des vesicules seminales et/ou d'atteinte des tranches de section chirurgicales. Patients et methodes Apres prostatectomie radicale, 1005 patients atteints de cancer de la prostate classe pN0 M0 presentant des facteurs de pronostic defavorables ont ete randomises de 1999 a 2001 entre une surveillance clinique et biochimique, et une radiotherapie postoperatoire classique de 60 Gy, en 30 fractions et six semaines, commencee dans les quatre mois suivant la chirurgie. Le critere majeur de l'etude etait la survie sans rechute biochimique. Resultats Avec un recul median de cinq ans, le taux de survie sans rechute biochimique etait significativement meilleur dans le groupe irradie (respectivement 52,6 % [intervalle de confiance a 98 % : 46,6–58,5] et 74,0 % [68,7–79,3], p Conclusion Apres prostatectomie radicale, la radiotherapie postoperatoire immediate offre chez les patients atteints de cancer de la prostate classe pT3 de meilleurs resultats que la chirurgie : elle ameliore significativement le taux de survie sans rechute clinique et/ou biochimique et le taux de controle local ; un plus long recul est necessaire pour apprecier l'impact sur la survie globale et la survie sans metastases.

Un dialogue continu entre les medecins en formation (internes et chefs de clinique) organises en association, la SFjRO et les enseignants de la SFRO et du college CNEC a permis de creer une dynamique de formation des internes en oncologie radiotherapie.

Background Chronic migraine (CM) has a high impact on functional performance and quality of life (QoL). CM also has a relevant burden on the National Health Service (NHS), however precise figures are lacking. In this pilot study we compared the impact in terms of costs of CM and episodic migraine (EM) on the individual and on the National Health System (NHS). Furthermore, we comparatively evaluated the impact of CM and EM on functional capability and on QoL of sufferers. Methods We enrolled 92 consecutive patients attending the Pavia headache centre: 51 subjects with CM and 41 with EM. Patients were tested with disability scales (MIDAS, HIT-6, SF-36) and with an ad hoc semi-structured questionnaire. Results The direct mean annual cost (in euro) per patient suffering from CM was €2250.0 ± 1796.1, against €523.6 ± 825.8 per patient with EM. The cost loaded on NHS was €2110.4 ± 1756.9 for CM, €468.3 ± 801.8 for EM. The total economic load and the different sub-items were significantly different between groups (CM vs. EM p = 0.001 for each value). CM subjects had higher scores than EM for MIDAS (98.4 ± 72,3 vs 15.5 ± 17.7, p = 0.001) and for HIT-6 (66.1 ± 8.4 vs 58.7 ± 10.1, p = 0.001). The SF-36 score was 39.9 ± 14,74 for CM and 66.2 ± 18.2 for EM (p = 0.001). Conclusions CM is a disabling condition with a huge impact on the QoL of sufferers and a significant economic impact on the NHS. The adequate management of CM, reverting it back to EM, will provide a dual benefit: on the individual and on the society.

This paper presents a hybrid technique for measuring conversion gain that blends spatial and temporal information, allowing users to calculate an accurate conversion gain with little knowledge of sensor defects. It blends a single pixel method with multiple pixel methods. We present measured data from a visible CMOS image sensor using two multiple pixel methods and the hybrid method. Additionally, we provide arguments for validity of the hybrid method. To our knowledge, this is the first report of this technique. Conversion gain (e-/DN) directly relates measured digital numbers (DN) to input-referred electrons (e-) for an image sensor. Conversion gain can be directly measured by considering the sensor under varying illumination states in coordination with Poisson statistics. Typically, there are two approaches: measure a single pixel over time or measure a group of pixels at one point in time after correcting for gain non-uniformity. The plotted statistics from these measurements are called either mean-variance or photon-transfer curves. The measurement of a single pixel is relatively straightforward and requires collection of many consecutive frames to get meaningful statistics not dominated by thermal noise. The data volume for an accurate single-pixel measurement can become unwieldy in terms of number of frames required. This is especially true for large format image sensors. In contrast, the measurement of a group of pixels requires fewer consecutive frames, but needs non-uniformity adjustments to correctly calculate statistics.

Decrease treatment uncertainties is one of the most important challenge in radiation oncology. Numerous techniques are available to quantify prostate motion and visualise prostate location day after day before each irradiation: CT-scan, cone-beam-CT-Scan, ultrason, prostatic markers... The knowledge of prostate motion is necessary to define the minimal margin around the target volume needed to avoid mispositioning during treatment session. Different kind of prostate movement have been studied and are reported in the present work: namely, those having a large amplitude extending through out the whole treatment period on one hand; and those with a shorter amplitude happening during treatment session one the other hand. The long lasting movement are mostly anterior-posterior (3 mm standard deviation), secondary in cranial-caudal (1-2 mm standard deviation) and lateral directions (0.5-1 mm standard deviation). They are mostly due to the rectal state of filling and mildly due to bladder filling or inferior limbs position. On the other hand, the shorter movement that occurs during the treatment session is mostly variation of position around a steady point represented by the apex. Ones again, the rectal filling state is the principle cause. This way, during the 20 minutes of a treatment session, including the positioning of the patient, a movement of less than 3 mm could be expected when the rectum is empty. Ideally, real time imaging tools should allow an accurate localisation of the prostate and the adaptation of the dosimetry before each treatment session in a time envelope not exceeding 20 minutes.

The developed loading device with opened hydrostatic circuit for measurement of speed and dynamic characteristics of the tractor engine by power take off is presented. This loading device may also be used as a portable type for field measurement. At present for development of these loading devices controlled hydrogenerators and electro-hydraulic proportional pressure valves directed by computer may by used to adjust geometrical volume of the hydrogenerator from zero to maximum value. There is a possibility to built these devices which consist of one hydro - generator and one by-pass valve for the maximum power of internal combustion engine 420 kW which is sufficient from the point of view of practical need. Thus optional loading regime may be used according to the tractor engine horsepower to achieve the required accuracy of measurement.

Resume Le Lawrence Berkeley Laboratory a ete le pionnier de l’hadrontherapie par ions legers avec pres de 2500 patients traites entre 1957 et 1993 par helium et neon. Le NIRS ( National Institute For Radiological Science , Chiba, Japon) a ete le premier centre medical dedie au traitement des cancers, avec plus de 1200 patients irradies depuis 1994 exclusivement par ions carbone. Des taux de controle local de 70 a 100 % a 3 ans pour des cancers radioresistants ont ete rapportes, justifiant l’utilisation de particules de haut TEL (tranfert d’energie lineique). Les possibilites d’hypofractionnement ont ete particulierement explorees pour les cancers du poumon et du foie (4 fractions actuellement), sans majoration de la toxicite. Les etudes d’escalade de dose ont mis en evidence un effet de la dose totale sur le controle tumoral et ont permis de preciser les contraintes de dose pour les tissus sains, en particulier pour le rectum. Plus de 140 patients ont ete irradies depuis 1997 dans le cadre du laboratoire de recherche GSI ( Gesellschaft Fur Schwerionenforschung , Darmstadt, Allemagne) pour des cancers radioresistants de la base du crâne par ions carbone seuls ou en association avec des photons, avec egalement un taux de controle local tres eleve. Les donnees medicales preliminaires semblent donc confirmer le gain therapeutique escompte de l’hadrontherapie par ions legers du fait de leurs proprietes balistiques et radiobiologiques et justifient les cinq projets europeens actuels de creation de centres medicaux dedies au traitement des cancers. Le projet francais « Etoile » s’integre dans le reseau europeen Enlight, dont l’objectif est de coordonner ces projets sur le plan technologique, medical et economique.

The relation between isoperimetric properties and Laplacian spectra of weighted graphs is investigated. The vertices are classified into k clusters with „few" inter-cluster edges of „small" weights (area) and „similar" cluster sizes (volumes). For k=2 the Cheeger constant represents the minimum requirement for the area/volume ratio and it is estimated from above by v?1(2-?1), where ?1 is the smallest positive eigenvalue of the weighted Laplacian. For k?2 we define the k-density of a weighted graph that is a generalization of the Cheeger constant and estimated from below by Si=1k-1?i and from above by c2 Si=1k-1 ?i, where 01=…=Sk-1 are the smallest Laplacian eigenvalues and the constant c?1 depends on the metric classification properties of the corresponding eigenvectors. Laplacian spectra are also related to canonical correlations in a probabilistic setup.