Demonstration of Muon-Beam Transverse Phase-Space Compression.

We demonstrate efficient transverse compression of a 12.5 MeV/c muon beam stopped in a helium gas target featuring a vertical density gradient and crossed electric and magnetic fields. The muon stop distribution extending vertically over 14 mm was reduced to a 0.25 mm size (rms) within 3.5 µs. The simulation including cross sections for low-energy µ^{+}-He elastic and charge exchange (µ^{+}↔ muonium) collisions describes the measurements well. By combining the transverse compression stage with a previously demonstrated longitudinal compression stage, we can improve the phase space density of a µ^{+} beam by a factor of 10^{10} with 10^{-3} efficiency.

A re-examination of antidepressant treatment-emergent mania in bipolar disorders: evidence of gender differences.

OBJECTIVE: To explore the prevalence and clinical profile of males and females who develop antidepressant treatment-emergent mania (ATEM). METHOD: From an original sample of 754 patients with BD, we identified ATEM+ cases (n = 75) and ATEM- controls (n = 135) that met stringent criteria. We specifically examined the combinations of clinical factors that best classified males and females as ATEM+ cases. RESULTS: Seventy-five individuals were classified as ATEM+; 87% of ATEM events occurred during antidepressant monotherapy. Regression analyses demonstrated that the presence of an alcohol and/or substance use disorder [Odds Ratio (OR) 6.37], a history of one or more suicide attempts (OR 4.19) and higher number of depressive episodes per year of illness (OR 1.71) correctly classified 73% of males. In contrast, 84% of females were correctly classified on the basis of a positive history of thyroid disorder (OR 3.23), a positive family history of BD I (OR 2.68) and depressive onset polarity (OR 2.01). CONCLUSION: Using stringent definitions of ATEM status to reduce the probability of inclusion of false-positive cases and false-negative controls, we identified for the first time that the risk profiles for the development of an ATEM differ significantly according to gender.

Childhood trauma and mixed episodes are associated with poor response to lithium in bipolar disorders.

OBJECTIVES: Reliable predictors of response to lithium are still lacking in bipolar disorders (BDs). However, childhood trauma has been hypothesized to be associated with poor response to lithium. METHODS: We included 148 patients with BD, euthymic when retrospectively and clinically assessed for response to lithium and childhood trauma using reliable scales. RESULTS: According to the 'Alda scale', the sample consisted in 20.3% of excellent responders, 49.3% of partial responders and 30.4% of non-responders to lithium. A higher level of physical abuse significantly correlated with a lower level of response to lithium (P = 0.009). As compared to patients not exposed to any abuse, patients with at least two trauma abuses (emotional, physical or sexual) were more at risk of belonging to the non-responders group (OR = 4.91 95% CI (1.01-27.02)). Among investigated clinical variables, lifetime presence of mixed episodes and alcohol misuse were associated with non-response to lithium. Multivariate analyses demonstrated that physical abuse and mixed episodes were independently associated with poor response to lithium (P = 0.005 and P = 0.013 respectively). CONCLUSIONS: Childhood physical abuse might be involved in a poor future response to lithium prophylaxis, this effect being independent of the association between clinical expression of BD and poor response to lithium.

Carotid diaphragm: Atypical fibromuscular dysplasia or atheromatous lesions?

Atypical fibromuscular dysplasia (FMD) is an underdiagnosed cause of ischemic stroke. The typical angiographic pattern of a septum on the posterolateral side of a carotid megabulb is highly suggestive of atypical FMD. We report here on two patients with this highly suggestive pattern of carotid atypical FMD, but which histological examination revealed to be atheromatous lesions. Interestingly, contrast-enhanced ultrasound of the carotid artery showed enhancement of the spur, which should never be the case with an FMD lesion, which has no vasa vasorum. Our findings suggest that the results of studies reporting stenting of atypical FMD in cervical arteries should be interpreted with caution.

Measurement of muon capture on the proton to 1% precision and determination of the pseudoscalar coupling gP.

The MuCap experiment at the Paul Scherrer Institute has measured the rate Λ(S) of muon capture from the singlet state of the muonic hydrogen atom to a precision of 1%. A muon beam was stopped in a time projection chamber filled with 10-bar, ultrapure hydrogen gas. Cylindrical wire chambers and a segmented scintillator barrel detected electrons from muon decay. Λ(S) is determined from the difference between the µ(-) disappearance rate in hydrogen and the free muon decay rate. The result is based on the analysis of 1.2 × 10(10) µ(-) decays, from which we extract the capture rate Λ(S) = (714.9 ± 5.4(stat) ± 5.1(syst)) s(-1) and derive the proton's pseudoscalar coupling g(P)(q(0)(2) = -0.88 m(µ)(2)) = 8.06 ± 0.55.

[Functional MR urography in children]. / Uro-IRM fonctionnelle chez l'enfant.

MR Urography (MRU) provides both morphologic and functional information without radiation exposure. It enables the assessment of split renal function, excretion, and quantification of obstruction. MRU is thus complementary to ultrasonography in the assessment of pre- and post-natal obstructive uropathies in children. If available, MRU should be definitely preferred to intravenous urography.

SEGMENTATION OF ORGANS AT RISK IN THORACIC CT IMAGES USING A SHARPMASK ARCHITECTURE AND CONDITIONAL RANDOM FIELDS.

Cancer is one of the leading causes of death worldwide. Radiotherapy is a standard treatment for this condition and the first step of the radiotherapy process is to identify the target volumes to be targeted and the healthy organs at risk (OAR) to be protected. Unlike previous methods for automatic segmentation of OAR that typically use local information and individually segment each OAR, in this paper, we propose a deep learning framework for the joint segmentation of OAR in CT images of the thorax, specifically the heart, esophagus, trachea and the aorta. Making use of Fully Convolutional Networks (FCN), we present several extensions that improve the performance, including a new architecture that allows to use low level features with high level information, effectively combining local and global information for improving the localization accuracy. Finally, by using Conditional Random Fields (specifically the CRF as Recurrent Neural Network model), we are able to account for relationships between the organs to further improve the segmentation results. Experiments demonstrate competitive performance on a dataset of 30 CT scans.

Circadian genes and lithium response in bipolar disorders: associations with PPARGC1A (PGC-1α) and RORA.

Preliminary studies suggest that lithium (Li) response might be associated with some circadian gene polymorphisms, we therefore performed a pharmacogenetic study on the core clock genes in two independent samples suffering from bipolar disorder (BD) and thoroughly characterized for their Li response. Two independent Caucasian samples (165 and 58 bipolar patients) treated with Li were selected from samples recruited in a French multicenter study and assessed for their Li response using the Alda scale. The two samples were genotyped using the Human660 (H660) and OmniExpress (OE) BeadChips and gene-based association analyses of 22 core clock genes were conducted. In the first sample (H660 chip), the RAR-related orphan receptor-a gene (RORA) and the Peroxisome Proliferator-Activated Receptor Gamma, Coactivator 1 Alpha gene (PPARGC1A or PGC-1α) were significantly associated with the Li response (empirical P-value = 0.0015 and 0.04, respectively), and remained significant only for RORA after Bonferroni correction. In the second sample (OE chip), PPARGC1A was significantly associated with the Li response (empirical P-value = 0.04), and did not remain significant after Bonferroni correction. PPARGC1A is a master regulator of mitochondrial function and a key component of the endogenous clock that stimulates the expression of Bmal1 and Rev-erb-alpha through coactivation of RORA. Although the observed associations deserve further replication and investigation, our results suggest genetic associations between Li response and these two close biological partners: PPARGC1A and RORA involved in circadian rhythms and bioenergetics processes in Li response.

Systemic allergy to human insulin and its rapid and long acting analogs: successful treatment by continuous subcutaneous insulin lispro infusion.

Since the introduction of highly purified human recombinant insulin, allergy to insulin has become a very rare clinical situation, encountered in less than 1% of patients. It results in potentially life-threatening immediate or delayed, local and general manifestations. Different treatments of unequal efficiency have been proposed, the use of insulin analogs showing benefits in certain situations. We report the case of a type 2 diabetic patient who presented local reactions and then an anaphylactic shock after the introduction of insulin analog premixes. Intra-dermal reactions performed with porcine, human and insulin analogs preparations (aspart, lispro, glargine) were all positive, as well as the specific anti-insulin IgE measurement. Because we could not achieve normoglycaemia with maximal oral treatment and low caloric diet, we decided to attempt a desensitisation by continuous subcutaneous infusion of insulin lispro, since the lowest skin reaction was obtained with this insulin. We were able to induce a tolerance, by means of very low basal rate, very slowly increased, without any boluses, and maintaining antihistamine therapy. Six months later, the patient remains free of any symptom and has achieved a quite good glycaemic control. We describe for the first time a case of allergy to human insulin and to all available rapid and long acting analogs. We show the interest of a treatment with CSII of analogs in order to induce tolerance.

Cryogenic distillation facility for isotopic purification of protium and deuterium.

Isotopic purification of the protium and deuterium is an important requirement of many physics experiments. A cryogenic facility for high-efficiency separation of hydrogen isotopes with a cryogenic distillation column as the main element is described. The instrument is portable, so that it can be used at the experimental site. It was designed and built at the Petersburg Nuclear Physics Institute, Gatchina, Russia. Fundamental operating parameters have been measured including a liquid holdup in the column packing, the pressure drops across the column and the purity of the product at different operating modes. A mathematical model describes expected profiles of hydrogen isotope concentration along the distillation column. An analysis of ortho-parahydrogen isomeric composition by gas chromatography was used for evaluation of the column performance during the tuning operations. The protium content during deuterium purification (≤100 ppb) was measured using gas chromatography with accumulation of the protium in the distillation column. A high precision isotopic measurement at the Institute of Particle Physics, ETH-Zurich, Switzerland, provided an upper bound of the deuterium content in protium (≤6 ppb), which exceeds all commercially available products.

Thrombotic carotid megabulb: fibromuscular dysplasia, septae, and ischemic stroke.

The proximal internal carotid artery is most commonly spared in cerebral fibromuscular dysplasia. The authors report the cases of three young black patients with stroke and carotid megabulbs with fibrous components, two of whom had superimposed thrombi.

Resonant formation of d&mgr;t molecules in deuterium: An atomic beam measurement of muon catalyzed dt fusion

Resonant formation of d&mgr;t molecules in collisions of muonic tritium ( &mgr;t) on D2 was investigated using a beam of &mgr;t atoms, demonstrating a new direct approach in muon catalyzed fusion studies. Strong epithermal resonances in d&mgr;t formation were directly revealed for the first time. From the time-of-flight analysis of 2036+/-116 dt fusion events, a formation rate consistent with 0.73+/-(0.16)(meas)+/-(0.09)(model) times the theoretical prediction was obtained. For the largest peak at a resonance energy of 0.423+/-0.037 eV, this corresponds to a rate of (7.1+/-1.8)x10(9) s(-1), more than an order of magnitude larger than those at low energies.

[Magnetic resonance angiography: fields of exploration, main indications and limitations]. / L'angiographie par résonance magnétique: domaines d'exploration, principales indications et limites.

Magnetic resonance angiography (MRA) has become a widely accepted technique with regards to the other available noninvasive techniques in the diagnosis of vascular disease. This paper proposes a review of the different indications of this technique in arterial and venous diseases. Among several MRA pulse sequences, the most frequently used until today consisted of a time-of-flight technique which provided angiograms without any injection of intravascular contrast medium. It required to be performed in a plane perpendicular to the main axis of the vessel to be optimal. New techniques, such as contrast medium bolus-enhanced acquisitions allow examination of vascular segments in a plane parallel to their course (coronal for the aorta and lower limb arteries). An increasing number of clinical applications has raised since the implementation of MRA techniques on MR devices; some of them are widely accepted, whereas some others remain under the scope of extensive validation. With a high level of accuracy in grading carotid artery stenosis, MRA is now routinely used in cerebral arterial occlusive diseases and has in part replaced contrast angiography. MRA of the venous system of the brain plays a major role in the diagnosis and follow up of dural venous thrombosis. Other vascular brain diseases, such as vascular malformations, yet have limited uses. Carotid artery dissections are fairly demonstrated with MRA, which can be used for diagnosis as well as for follow-up. The accuracy of MRA in the diagnosis of venous thrombosis of the cervical/mediastinal veins has been reported as high as 100%. Moreover, MRA allows a precise assessment of collateral vessels in case of complete cervical/mediastinal venous thrombosis.

[Analgesia with oxygen-nitrous oxide mixture during percutaneous renal biopsy in children]. / Analgésie par le protoxyde d'azote pour la réalisation de la biopsie rénale percutanée chez l'enfant.

UNLABELLED: The efficacy of an inhaled equimolar mixture of nitrous oxide and oxygen (Entonox/MEOPA) to prevent procedural pain during renal percutaneous biopsies in children was assessed. PATIENTS AND METHODS: One hundred and seven children who underwent 113 renal biopsies during a 17-month period were included in a prospective uncontrolled pediatric study. Efficacy was evaluated using patients' answers to a questionnaire and nurses' observations. RESULTS: Pain was absent in 86.5% of the cases. Mild adverse events were noted in one-third of the procedures, and were always reversible within a few minutes when the inhalation stopped. Acceptability was good. The use of this gas is easy and safe provided a few precautions are observed. CONCLUSION: Inhaled equimolar mixture of nitrous oxide and oxygen prevents procedural pain during renal percutaneous biopsies.

[Hemodynamic effect of the clamping of the carotid in the surgically treated coronary patient]. / Retentissement hémodynamique du clampage de la carotide chez l'opéré coronarien.

To determine both the incidence of myocardial ischaemia and haemodynamic response to carotid cross-clamping in coronary artery disease, 30 patients undergoing carotid endarterectomy were studied with a clear history of effort related disabling angina pectoris. Myocardial ischaemia was detected by a recording of lead CM5 of the electrocardiogram. A radial arterial and a thermodilution pulmonary catheter were inserted to obtain haemodynamic measurements before and after carotid cross-clamping and unclamping. Anaesthesia was induced with increments of thiopental, fentanyl 6 micrograms X kg-1 and pancuronium. Additional fentanyl (2 micrograms X kg-1) was injected before skin incision and before carotid cross-clamping. Carotid cross-clamping results in a significant increase in both mean arterial blood pressure and capillary wedge pressure. Two patients experienced myocardial ischaemia with ST segment depression during carotid cross-clamping. Nitroglycerin infusion led to the improvement of ST segment depression. When halothane was additionally administered to patients who developed hypertension in response to carotid cross-clamping, arterial blood pressure returned to normal value. These results indicate that carotid cross-clamping increases determinants of myocardial oxygen demand and may cause myocardial ischaemia in patients suffering from angina pectoris.

[Interruption of the inferior vena cava by the DIL filter. Experience apropos of 34 cases]. / Interruption de la veine cave inférieure par le filtre DIL. Expérience à propos de 34 cas.

Endocaval filters are often used to prevent pulmonary embolism but they have a number of disadvantages. The DIL filter, made of a memory metal wire, is intended to male up for some of these disadvantages. It acts by modifying the shape of the inferior vena cava, which it filters through its meshed loops. It is inserted percutaneously, causes little trauma, and its release is progressive. However, it requires measuring the caliber of the inferior vena cava. This filter was inserted in thirty-four patients over a period of 13 months. One filter has migrated. No recurrence of pulmonary embolism and no thrombosis of the inferior vena cave occurred.

[Persistent sciatic artery. Apropos of a case, review of the literature ]. / Artère sciatique persistante. A propos d'une observation, revue de la littérature.

A case is reported of bilateral persisting sciatic arteries: complete on the right side but incomplete on the left, revealed by the onset of a distal embolism on the right side treated by exclusion and a right femoropopliteal shunt operation. The observation of this further case in France led to a review of the literature which demonstrated the rarity of this congenital anomaly, which usually however represents the only vascular axis to the lower limb, and the frequency of aneurysmal transformations with subsequent complications that are best treated by ligature combined with a femoropopliteal shunt.

[Middle-term results of a Silastic prosthesis used as a temporary spacer for unreconstructable radial head fractures]. / Résultats à moyen terme d'un implant en Silastic utilisé comme espaceur transitoire dans les fractures non synthésables de la tête radiale.

This study reports the use of silicone prosthesis as a temporary spacer for comminuted fracture of the radial head. Twelve men and eight women with a mean age of 42 years (17-54) were operated on in an average of five days following a comminuted fracture of the radial head. Silicone radial head prosthesis was implanted with a mean duration of eight months (3-18) between implantation and removal. At a mean period of five years after initial surgery, the mean DASH score was 40 (24-82), the mean MEPS score was 86 (60-100) giving ten excellent results, five good and five means. At the last clinical follow-up, the average flexion was 127° (90-140) and 152° (50-180) for pronation-supination. Regarding our results, early removal of the Silastic implant prevented possible synovitis and failure of silicone implant. The stability of the elbow was obtained in all cases with association of a medial collateral ligament repair in case of instability. The use of a silicone radial head implant as a temporary spacer in case of radial head fracture type Mason III or IV seems to be a possible alternative to metal prostheses, whose implantation technique is demanding and sometimes not recommendable in young patients.