Resting-state functional connectivity correlates of anxiety co-morbidity in major depressive disorder.

Major depressive disorder (MDD) is frequently co-morbid with anxiety disorders. The co-morbid state has poorer functional outcomes and greater resistance to first line treatments, highlighting the need for novel treatment targets. This systematic review examined differences in resting-state brain connectivity associated with anxiety comorbidity in young- and middle-aged adults with MDD, with the aim of identifying novel targets for neuromodulation treatments, as these treatments are thought to work partly by altering dysfunctional connectivity pathways. Twenty-one studies met inclusion criteria, including a total of 1292 people with MDD. Only two studies included people with MDD and formally diagnosed co-morbid anxiety disorders; the remainder included people with MDD with dimensional anxiety measurement. The quality of most studies was judged as fair. Results were heterogeneous, partly due to a focus on a small set of connectivity relationships within individual studies. There was evidence for dysconnectivity between the amygdala and other brain networks in co-morbid anxiety, and an indication that abnormalities of default mode network connectivity may play an underappreciated role in this condition.

[Implementation of the dematerialization of the patient file in the context of COVID in the ONCORAD radiotherapy units: Transition to "paperless"]. / Mise en place de la dématérialisation du dossier patient dans un contexte de COVID dans les services de radiothérapie de l'ONCORAD : passage « au sans papier ¼.

Paper patient file sharing has clearly been identified as a risk behavior for the COVID-19 virus transmission in radiotherapy units. In order to overcome this, the ONCORAD radiotherapy units worked on total dematerialization of the paper patient file, within 3 weeks. The methodology is based on a quality approch. This work has led to a convincing improvement in the management of risks a priori and a smoother patient care workflow.

[Image-guided radiotherapy: Overview of devices and practice in France in 2015]. / État des lieux des dispositifs et des pratiques de radiothérapie guidée par l'image en France en 2015.

Image-guided radiation therapy consists in acquiring in-room images to improve patient and mainly tumour set up accuracy. Many devices based on ionising or non-ionising radiations were designed in recent years. The use of such devices is of major importance in the management of patient radiotherapy courses. Those imaging sessions require to clearly define procedures in each radiotherapy department (image modality, acquisition frequency, corrective action, staff training and tasks). A quick review of the different existing image-guided radiation therapy devices is presented. In addition, the results of a French national survey about image-guided radiation therapy are presented: the survey is about both equipment and procedures. A total of 57 radiotherapy departments have participated, representing more than 160 treatment devices. About three linear accelerators out of four are equipped with an image-guiding device. The most common equipment is the CBCT system. Most centres have set up training sessions for the technicians to allow them to analyse online daily images. The management of in-room imaging dose is still under investigation, but many centres use an accounting scheme. While the devices are used to adjust the positioning of patients, in more than half of the centres, the practice had an impact on the choice of clinical and planning target volume margins. This survey led to an inventory in 2015, and could be renewed in some years.

Junctions between metals and blends of conducting and biodegradable polymers (PLLA-PPy and PCL-PPy).

The junctions between newly developed biodegradable conducting polymers (polylactide-polypyrrole PLLA-PPy and polycaprolactone-polypyrrole PCL-PPy) and metal electrodes (Au, Au/Cu, Ag, Ag/Cu, Cu, Cr/Au/Cu, Pd/Au/Cu, Pt/Au/Cu) were studied. The objective was to determine the composite/metal combination having the lowest possible contact resistance and ohmic characteristics. In a first step, different surface treatments, adhesion and metal layers were tested in order to evaluate the contact resistance. Then the current-voltage (IV) characteristics were measured and both ohmic and rectifying behaviour were observed depending on the polymer/metal junctions investigated. The surface treatments studied included an argon sputtering step and a grinding of the polymer surface with the objective of improving the contact between the metal electrode and the polymer. It was found that the most favourable conditions resulted from a process flow without argon sputtering, without grinding for PLLA-PPy and with a slight grinding for PCL-PPy. Moreover the most favourable metal electrodes for PLLA-PPy were Pd/Au/Cu, while the best compromise for PCL-PPy was to use Au/Cu. For the rectifying polymer/metal junctions, the standard thermionic emission model modified with a series resistance was successfully applied to the measured current-voltage IV characteristics. The saturation current density J0, series resistance R, ideality diode factor n and barrier height φB were investigated. The Chot functions were computed for each rectifying junction and the corresponding threshold voltages were calculated. Finally the conductivity of both composites was evaluated as a function of temperature in the range of 30 °C to 80 °C. For PLLA-PPy a decrease of the resistivity was observed when the temperature was increasing, while no clearly recognisable pattern was identified for PCL-PPy in this temperature range. The electrical conductivity of the PLLA-PPy samples was found to follow the empirical Arrhenius model, and the difference between the Fermi energy EF and the mobility edge EC | EF - EC | as well as the conductivity at the mobility edge σC were evaluated. Moreover the electrical conductivity of the PLLA-PPy samples was found to follow the Mott variable range hopping (VRH) model, and the high temperature limit of conductivity σ1 as well as the Mott characteristic temperature T1 were calculated.

[Benefit of intensity modulated and image-guided radiotherapy in prostate cancer]. / Apports de la radiothérapie avec modulation d'intensité guidée par l'image dans les cancers prostatiques.

External beam radiotherapy (RT) is used to treat all stages of localized prostate cancer. Using a 3D conformal RT (3DCRT) without any androgen deprivation, a clear dose-effect relationship has been shown in terms of both biochemical control and also unfortunately of rectal and urinary toxicity. Compared to a "standard" 3DCRT, intensity modulated RT (IMRT) improves the dose distribution by mainly providing concave dose distribution and tight dose gradients. Based on large clinical experiences for at least one decade, IMRT is widely used to increase the dose in the prostate and therefore local control, without increasing toxicity. Indeed, toxicity rates observed after high dose delivered in the prostate (80Gy) with IMRT appear no different than those observed after a standard dose (70Gy) delivered by a standard 3DCRT. Arc IMRT appears a new promising IMRT modality, decreasing dramatically treatment duration. However, this IMRT-based dosimetric benefit may not be translated into a full clinical benefit, if intra-pelvic prostate motion is not taken in account. Image-guided radiotherapy (IGRT) should be therefore associated with IMRT for a maximal clinical benefit. This article is a literature review showing the interest of both combined approaches.

[On board imaging with cone beam CBCT kV VARIAN: Montauban's radiation therapy department experience]. / Système d'imagerie par tomographie conique de basse énergie (kV)de Varian : expérience de Montauban.

PURPOSE: To describe our practice day to day with a VARIAN linac "Clinac 2100" fully equipped with an On Board Imager (OBI) for patients with prostate cancer. MATERIALS AND METHODS: A volumetric and dosimetric study was performed in 2006 using ARTIVIEW software (AQUILAB) for nine patients and 76 Cone Beam CT kV (CBCT kV). We have contoured targets and organs at risk from CBCT kV slides acquisitions. Second, we achieved a dose-volume histogram (DVH) study for a patient treated in 2007 with IMRT technique in comparison with the 2006 study. RESULTS: 2006 analysis: The study showed a very important variability of organ measurements. Seminal vesicles were strongly influenced by adjacent organs; observed differences for prostate could be explained by contouring uncertainty on the apex. Inter-sessions motions could be observed for bladder, rectum and seminal vesicles (SV). Part of prostate volume not encompassed by PTV is about 2.5%; VS volume outside PTV is about 35%. Tumoral conformation index (TCI) is inferior to 97.5% in 22% of all cases. Anteroposterior displacements of the prostate barycentre is superior to 5mm. From this analysis, we recommended the strict respect of hygienodietetic rules, and we have adapted the system settings for better immobilization, which were applied for the 2007 study. For the 2007 analysis, since April 2007, most of patients are treated with IMRT for prostate cancer, at the second part of the radiation therapy to encompass only the prostate volume. Dose-volume histograms showed a great spreading out for 2006 patients, and not for the 2007 patient. CONCLUSIONS: IMRT and IGRT should permit a margin reduction for PTV. Strict respect of hygienodietetics rules is necessary to avoid rectal distension and local recurrence.