Experimental investigation of size broadening of a Kα x-ray source produced by high intensity laser pulses.

The size of a hard Kα x-ray source ([Formula: see text] = 17.48 keV) produced by a high intensity femtosecond laser interacting with a solid molybdenum target is experimentally investigated for a wide range of laser intensity (I ~ 1017-2.8 × 1019 W/cm2) and for four values of the temporal contrast ratio (6.7 × 107 < CR < 3.3 × 1010). Results point out the size enlargement of the x-ray source with the increase of laser intensity and with the deterioration of temporal contrast. It amounts up to sixteen times the laser spot size at the highest laser intensity and for the lowest temporal contrast ratio. Using hydrodynamic simulations, we evaluate the density scale length of the pre-plasma L/λ just before the main pulse peak. This allows us to show that a direct correlation with the laser absorption mechanisms is not relevant to explain the large size broadening. By varying the thickness of the molybdenum target down to 4 µm, the impact of hot electron scattering inside the solid is also proved irrelevant to explain the evolution of both the x-ray source size and the Kα photon number. We deduce that the most probable mechanism yielding to the broadening of the source size is linked to the creation of surface electromagnetic fields which confine the hot electrons at the solid surface. This assumption is supported by dedicated experiments where the evolution of the size enlargement of the x-ray source is carefully studied as a function of the laser focal spot size for the highest contrast ratio.

SEOM Clinical Guideline of management of soft-tissue sarcoma (2020)

Soft-tissue sarcomas constitute an uncommon and heterogeneous group of tumors of mesenchymal origin. Diagnosis, treatment, and management should be performed by an expert multidisciplinary team. MRI/CT of the primary tumor and biopsy is mandatory before any treatment. Wide surgical resection with tumor-free tissue margin is the mainstay for localized disease. Radiotherapy is indicated in large, deep, high-grade tumors, or after marginal resection not suitable for re-excision. Perioperative chemotherapy should be discussed for high-risk sarcomas of the extremities and trunk-wall. In the case of oligometastatic disease, patients should be considered for local therapies. First-line treatment with anthracyclines (or in combination with ifosfamide) is the treatment of choice. Other drugs have shown activity in second-line therapy and in specific histological subtypes but options are limited and thus, a clinical trial should always be discussed (AU)

SEOM Clinical Guideline of management of soft-tissue sarcoma (2020).

Soft-tissue sarcomas constitute an uncommon and heterogeneous group of tumors of mesenchymal origin. Diagnosis, treatment, and management should be performed by an expert multidisciplinary team. MRI/CT of the primary tumor and biopsy is mandatory before any treatment. Wide surgical resection with tumor-free tissue margin is the mainstay for localized disease. Radiotherapy is indicated in large, deep, high-grade tumors, or after marginal resection not suitable for re-excision. Perioperative chemotherapy should be discussed for high-risk sarcomas of the extremities and trunk-wall. In the case of oligometastatic disease, patients should be considered for local therapies. First-line treatment with anthracyclines (or in combination with ifosfamide) is the treatment of choice. Other drugs have shown activity in second-line therapy and in specific histological subtypes but options are limited and thus, a clinical trial should always be discussed.

[Cervical spondylolysis : a rare fortuitous finding]. / Cas clinique. Spondylolyse cervicale : une découverte fortuite rare.

A young patient consulted in our physical and rehabilitation medicine department following the onset of pain on the scapula area and at the base of his right upper limb after carrying a heavy load. After a couple of weeks, the patient also developed cervical pain. Fortuitously, the cervical scanner displayed a right C6 spondylolysis. Further evaluation by bone scan confirmed that this lesion was not recent and so probably not the cause of the symptoms. Cervical isthmic spondylolysis is a rare condition, much more common at the lumbar level and often ignored at the cervical one. The etiology, pahophysiology, imaging and treatment options for this cervical pathology are discussed in this article.

Un jeune patient a consulté en médecine physique pour des douleurs aux niveaux de l'omoplate et de la racine du membre supérieur droit apparues suite au port d'une charge lourde. Après quelques semaines, le patient se plaignait également de cervicalgies. Un scanner du rachis cervical a objectivé fortuitement une spondylolyse C6 droite. Un bilan complémentaire par scintigraphie osseuse a révélé que la lésion était ancienne et qu'elle n'était probablement pas la cause de la symptomatologie. La lyse isthmique cervicale est une pathologie peu répandue. Très connue à l'étage lombaire, la spondylolyse est rare et souvent ignorée au niveau cervical. L'étiologie, la physiopathologie, l'imagerie et la prise en charge de cette pathologie cervicale sont discutées dans cet article.

Exploring phase contrast imaging with a laser-based Kα x-ray source up to relativistic laser intensity.

This study explores the ability of a hard Kα x-ray source (17.48 keV) produced by a 10 TW class laser system operated at high temporal contrast ratio and high repetition rate for phase contrast imaging. For demonstration, a parametric study based on a known object (PET films) shows clear evidence of feasibility of phase contrast imaging over a large range of laser intensity on target (from ~1017 W/cm2 to 7.0 × 1018 W/cm2). To highlight this result, a comparison of raw phase contrast and retrieved phase images of a biological object (a wasp) is done at different laser intensities below the relativistic intensity regime and up to 1.3 × 1019 W/cm2. This brings out attractive imaging strategies by selecting suitable laser intensity for optimizing either high spatial resolution and high quality of image or short acquisition time.

High photon flux Kα Mo x-ray source driven by a multi-terawatt femtosecond laser at 100 Hz.

We develop a pulsed hard x-ray Kα source at 17.4 keV produced by the interaction of a multi-terawatt peak power infrared femtosecond laser pulse with a thick molybdenum (Mo) target at a 100 Hz repetition rate. We measure the highest Mo Kα photon production reported to date corresponding to a Kα photon flux of 1×1011 ph/(sr·s) and an estimated peak brightness of ∼2.5×1017 ph/(s·mm2·mrad2(0.1% bandwidth)) at ∼5×1018 W/cm2 driving laser intensity.

Síndrome de fatiga crónica y los trastornos del sueño: relaciones clínicas y dificultades diagnósticas / Chronic fatigue syndrome and sleep disorders: clinical associations and diagnostic difficulties

INTRODUCCIÓN: El síndrome de fatiga crónica (SFC) se caracteriza por la presencia de fatiga intratable y sueño no reparador, síntomas con una alta prevalencia en múltiples enfermedades y/o como efecto secundario de diferentes fármacos. Diferentes trabajos demostraron una alta prevalencia de los trastornos del sueño asociados al SFC. Además, los síntomas de sueño no reparador y fatiga son síntomas frecuentes en los trastornos del sueño, lo que hace que en muchos pacientes con SFC haya que descartar un trastorno de sueño primario. DESARROLLO: Este trabajo se ha realizado a través de una búsqueda sistematizada con términos MeSH ([Sleep] + [Chronic fatigue syndrome]) en la base de datos PubMed. CONCLUSIÓN: La identificación de los diferentes trastornos primarios del sueño en los pacientes con criterios diagnósticos de SFC, nos permitiría realizar un abordaje del paciente más completo, con nuevas estrategias diagnósticas y terapéuticas que podrían mejorar la calidad de vida de estos pacientes

INTRODUCTION: Chronic fatigue syndrome (CFS) is characterised by the presence of intractable fatigue and non-restorative sleep, symptoms which are also very prevalent in multiple diseases and appear as side effects of different drugs. Numerous studies have shown a high prevalence of sleep disorders in patients with CFS. However, non-restorative sleep and fatigue are frequently symptoms of the sleep disorders themselves, so primary sleep disorders have to be ruled out in many cases of CFS. DEVELOPMENT: This review was performed using a structured search of the MeSH terms ([Sleep] + [Chronic fatigue syndrome]) in the PubMed database. CONCLUSION: Identifying primary sleep disorders in patients meeting diagnostic criteria for CFS will allow for a more comprehensive treatment approach involving new diagnostic and therapeutic strategies that may improve quality of life for these patients

Impact of the pulse contrast ratio on molybdenum Kα generation by ultrahigh intensity femtosecond laser solid interaction.

We present an extended experimental study of the absolute yield of Kα x-ray source (17.48 keV) produced by interaction of an ultrahigh intensity femtosecond laser with solid Mo target for temporal contrast ratios in the range of 1.7 × 107-3.3 × 109 and on three decades of intensity 1016-1019 W/cm². We demonstrate that for intensity I ≥ 2 × 1018 W/cm² Kα x-ray emission is independent of the value of contrast ratio. In addition, no saturation of the Kα photon number is measured and a value of ~2 × 1010 photons/sr/s is obtained at 10 Hz and I ~1019 W/cm². Furthermore, Kα energy conversion efficiency reaches the same high plateau equal to ~2 × 10-4 at I = 1019 W/cm² for all the studied contrast ratios. This original result suggests that relativistic J × B heating becomes dominant in these operating conditions which is supposed to be insensitive to the electron density gradient scale length L/λ. Finally, an additional experimental study performed by changing the angle of incidence of the laser beam onto the solid target highlights a clear signature of the interplay between collisionless absorption mechanisms depending on the contrast ratio and intensity.

Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française (summary).

Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.

Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française / Prise en charge des exacerbations de la bronchopneumopathie chronique obstructive (BPCO). Recommandations de la Société de pneumologie de langue française

Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.(AU)

La bronchopneumopathie chronique obstructive (BPCO) est la maladie respiratoire chronique dont le poids sur la santé publique est le plus grand par sa morbidité, sa mortalité et les dépenses de santé qu'elle induit. Pour les individus atteints, la BPCO est une source majeure de handicap du fait de la dyspnée, de la limitation d'activité, des exacerbations, du risque d'insuffisance respiratoire chronique et des manifestations extra-respiratoires qu'elle entraîne. Les précédentes recommandations de la Société de pneumologie de langue française (SPLF) sur la prise en charge des exacerbations BPCO date de 2003. Se fondant sur une méthodologie adaptée de GRADE, le présent document propose une actualisation de la question des exacerbations de BPCO en développant un argumentaire couvrant quatre champs d'investigation : (1) épidémiologie, (2) évaluation clinique, (3) prise en charge thérapeutique et (4) prévention. Les modalités spécifiques de la prise en charge hospitalière et ambulatoire y sont discutées, particulièrement les aspects relevant de l'évaluation de la sévérité de l'exacerbation et de la prise en charge pharmacologique.(AU)

Defining the optimal sequence for the systemic treatment of metastatic breast cancer

Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease (AU)

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Defining the optimal sequence for the systemic treatment of metastatic breast cancer.

Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease.

Two-Dimensional Frequency Resolved Optomolecular Gating of High-Order Harmonic Generation.

Probing electronic wave functions of polyatomic molecules is one of the major challenges in high-harmonic spectroscopy. The extremely nonlinear nature of the laser-molecule interaction couples the multiple degrees of freedom of the probed system. We combine two-dimensional control of the electron trajectories and vibrational control of the molecules to disentangle the two main steps in high-harmonic generation-ionization and recombination. We introduce a new measurement scheme, frequency-resolved optomolecular gating, which resolves the temporal amplitude and phase of the harmonic emission from excited molecules. Focusing on the study of vibrational motion in N_{2}O_{4}, we show that such advanced schemes provide a unique insight into the structural and dynamical properties of the underlying mechanism.

Chronic fatigue syndrome and sleep disorders: clinical associations and diagnostic difficulties. / Síndrome de fatiga crónica y los trastornos del sueño: relaciones clínicas y dificultades diagnósticas.

INTRODUCTION: Chronic fatigue syndrome (CFS) is characterised by the presence of intractable fatigue and non-restorative sleep, symptoms which are also very prevalent in multiple diseases and appear as side effects of different drugs. Numerous studies have shown a high prevalence of sleep disorders in patients with CFS. However, non-restorative sleep and fatigue are frequently symptoms of the sleep disorders themselves, so primary sleep disorders have to be ruled out in many cases of CFS. DEVELOPMENT: This review was performed using a structured search of the MeSH terms ([Sleep]+[Chronic fatigue syndrome]) in the PubMed database. CONCLUSION: Identifying primary sleep disorders in patients meeting diagnostic criteria for CFS will allow for a more comprehensive treatment approach involving new diagnostic and therapeutic strategies that may improve quality of life for these patients.

[Angiosarcoma mimicking recurrent pulmonary embolism]. / Un angiosarcome mimant une embolie pulmonaire récidivante.

INTRODUCTION: Pulmonary artery sarcoma is a rare disease with non-specific symptoms. The clinical and radiological presentation can mimic pulmonary embolism with chronic thromboembolic pulmonary hypertension. Management is essentially surgical but the prognosis remains poor. CASE REPORT: A patient presented with symptoms of pulmonary embolism. Despite vitamin K antagonist therapy, he suffered from extension of the endovascular defects and his pulmonary hypertension increased. Suspicious results of positron emission tomography suggested the diagnosis of pulmonary artery sarcoma that was confirmed by surgery. However, the outcome was unfavourable, leading to death of the patient. CONCLUSION: This case reinforces the idea that the clinical and tomodensitometric presentations of pulmonary arterial sarcoma and chronic thromboembolic pulmonary hypertension are similar. The positron emission tomography seems to be a key to distinguishing these two diagnoses.

Multi-channel electronic and vibrational dynamics in polyatomic resonant high-order harmonic generation.

High-order harmonic generation in polyatomic molecules generally involves multiple channels of ionization. Their relative contribution can be strongly influenced by the presence of resonances, whose assignment remains a major challenge for high-harmonic spectroscopy. Here we present a multi-modal approach for the investigation of unaligned polyatomic molecules, using SF6 as an example. We combine methods from extreme-ultraviolet spectroscopy, above-threshold ionization and attosecond metrology. Fragment-resolved above-threshold ionization measurements reveal that strong-field ionization opens at least three channels. A shape resonance in one of them is found to dominate the signal in the 20-26 eV range. This resonance induces a phase jump in the harmonic emission, a switch in the polarization state and different dynamical responses to molecular vibrations. This study demonstrates a method for extending high-harmonic spectroscopy to polyatomic molecules, where complex attosecond dynamics are expected.

Knowledge of the diagnostic algorithm for pulmonary embolism in primary care.

BACKGROUND: Diagnostic algorithms for pulmonary embolism (PE) have been validated in patients attending hospital emergency departments. However, general practitioners (GPs) are often the professionals of first resort for the majority of non-critical cases of PE. AIM: To evaluate the knowledge of the diagnostic algorithm for PE among GPs in France. DESIGN AND SETTING: Questionnaire-based survey of GPs with a private practice. METHOD: All GPs in the study area were sent a questionnaire including several questions on the diagnosis of PE and two clinical cases scenario with suspected PE. Factors associated with knowledge of the diagnostic algorithm were analysed by univariate and multivariate analyses. RESULTS: Five-hundred and eight questionnaires were distributed and 155 (30.5%) were available for analysis. Only 55% of the GPs did know about clinical scores for the assessment of clinical probability of PE and 42% of the GPs were aware that clinical probability is needed to interpret the result of D-dimer testing. Forty GPs (26%) gave valid responses to both clinical cases, 54 GPs (35%) had one valid case out of the two and 61 (39%) gave invalid responses to both clinical cases. Participation in specific training on PE was significantly associated with valid responses to the two clinical cases in multivariate analysis (p<0.017). CONCLUSION: The majority of GPs were unaware of the diagnostic algorithm for PE. Clinical probability was rarely assessed and knowledge about D-dimers was poor. Specific training on PE and greater awareness of clinical probability scores may promote knowledge of PE algorithm diagnosis.

Brainstem auditory and somatosensory evoked potentials: a methodological study to evaluate the reproducibility of two devices.

We aimed to determine whether statistical significant differences exist between the sets of results obtained from two devices used in our department for measuring brainstem auditory evoked potentials (BAEPs) and somatosensory evoked potentials (SEPs). We obtained BAEP and median and posterior tibial nerve SEP values bilaterally in ten healthy subjects. The tests were performed on the same subject using two devices consecutively. The equipment consisted of a Nicolet Viking-IV (Nicolet, Madison, WI, USA) and a Viking Select (Viasys Healthcare, Madison, WI, USA), and the same recording electrodes and stimulator (auditory and electrical) were used without modifying any postural position of the subject. The stimuli and recording parameters were the same for both devices. We obtained 20 sets of data for each type of test. The Bland­Altman plots as well as the one-sample t-test or Wilcoxon signed rank test were used to compare data between the two groups of data sets. We found no significant differences between the sets of values obtained with the two devices. Our analysis indicates that the two devices are equal in recording all different variables of BAEP and SEP, which allows us to combine the BAEP and SEP data obtained from the two devices for follow-up studies involving quantitative statistical methods. This study received institutional approval (protocol number PRAG-154/2013).