[Interprofessional recommendations on behalf of Société française de radiothérapie oncologique for the prevention, protection and management of cyberattacks in radiation oncology]. / Prévention, protection, et gestion des cyberattaques en oncologie radiothérapie : recommandations interprofessionnelles au nom de la Société française de radiothérapie oncologique.

Cybersecurity is currently a major issue. Large hospitals are no longer the only main targets of attacks, but all healthcare organizations and establishments, without distinction of size or activities. The information system is defined as all the resources needed to collect images, store and process them with general distribution of multiple information within an organization. Systems are therefore crucial for the functioning of a medical department. Radiation oncology is one of the specialties most dependent on digital resources, for imaging, data transfer, dosimetry, treatment and so on.. Radiation oncology departments are therefore a prime target for ransomware attacks, which have increased significantly in recent years. Cybersecurity can be likened to a viral or bacterial attack. It is based on the two usual pillars of antimicrobial protection : hygiene and prophylaxis. In this article, we will detail by analogy the three classic levels of prevention of a bacillary attack: "primary prevention", which acts upstream of the infection; "secondary prevention", which acts at an early stage of its evolution; and "tertiary prevention", which acts on complications and risks of recurrence. This article is the result of an interprofessional group on behalf of SFRO, the French society of radiation oncology, with the aim of helping all teams to implement safety adapted to the specificities of a radiation oncology department in France.

[Radiation induced brachial plexopathy: Diagnosis, risk factors, principles of care]. / La plexite radique : épidémiologie, diagnostic, facteurs de risque et prise en charge.

Radiation plexitis, also known as radiation-induced brachial neuropathy is a rare toxicity following axillary, breast, cervical or thoracic radiotherapy, first described in 1966 by Stoll and Andrew. Although improvements in radiotherapy techniques have greatly reduced its risk over the past seventy years, its severe form remains a dreaded complication that is difficult to manage in patients with increased life expectancy. This article summarizes the epidemiological elements, risk factors, diagnostic methods, doses and constraints to be respected in radiotherapy and the treatment strategies of radiation plexitis.

[Securing the information system of health care organisations]. / Sécurisation du système d'information des structures médicales.

The information system involves all the resources managing information within a team. It mainly relies on the computer network. Prevention and protection measures are vital, especially in a radiotherapy department. They will aim to preserve the whole staff from potential risks connected with passwords, suspicious emails, specific websites, or USB flash drives. Also, they will consist in maintaining updated operating systems and software, activating antivirus programs and firewalls, and getting a map of the whole network and its users. Finally, it is necessary to anticipate failure scenarios and to set up recovery plans to continue the activity with lower resources.

[Low dose radiotherapy for COVID-19 pneumopathy: Biological rationale and literature review]. / Radiothérapie de faible dose pour la pneumopathie covid-19 : rationnel biologique et revue de la littérature.

The world has now been facing the coronavirus disease 2019 (COVID-19) pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since over a year. If most of clinical presentations are benign, fragile patients are at greater risk of developing severe or fatal lung disease. Many therapies have been explored with very low impact on mortality. In this context, Kirkby et Mackenzie have published in April 2020 a report reminding the anti-inflammatory properties of low-dose radiotherapy (delivering less than 1Gy) and its use in the treatment of viral and bacterial pneumopathies before antibiotics era. Large in vivo and in vitro data have demonstrated the biological rationale and anti-inflammatory activity of low-dose radiotherapy in many pathologies. Over the past year, three phase I/II clinical trials have been published, as well as one randomized controlled trial, reporting the feasibility and the clinical and biological improvement of a 0.5 to 1Gy treatment dose to the entire lung. 13 other studies, including a randomized phase III trial, are currently ongoing worldwide. These studies may provide data in the effect of low-dose radiotherapy in the treatment of SARS-CoV-2 pneumonia. This article explains biological rationale of low-dose radiotherapy, and reports already published or ongoing studies on low-dose radiotherapy for SARS-CoV-2 pneumonia.

Environmental matching used to predict range expansion of two invasive corals (Tubastraea spp.).

The scleractinian corals Tubastraea coccinea Lesson, 1829 and T. tagusensis Wells, 1982 have invaded reefs along Brazil's coastline. Over the period 2011-2017 a standard, fast, easily repeatable semi-quantitative method was used to produce maps of distribution and a site (n = 77) specific Relative Abundance Index (RAI) to determine range expansion at Cabo Frio, an upwelling region. Invaded sites doubled from six to 12 over the period (one per year) and mean abundance increased tenfold from 0.2 to 2.6 RAI and 0.22 to 1.8 RAI (T. coccinea and T. tagusensis respectively). Site specific oceanographic conditions (temperature, salinity and water transparency) and distance from currently invaded sites (a proxy for propagule pressure) were chosen and used as determinants of invasion success in order to model the expansion. Model results compared favourably with empirical measurements and the simple, regional, and spatially explicit model predicted future range expansion under 10 and 20 year scenarios.

[Risk analysis study for patients care in radiotherapy: Learning curve and methodological evolution]. / Étude des risques a priori encourus par les patients en radiothérapie : courbe d'apprentissage et évolution méthodologique.

PURPOSE: To describe the evaluation of our risk mapping methodology over the past two years. MATERIALS AND METHODS: Based on the FMEA (failure mode effects analysis) method, some aspects have been adapted, e.g. the concept of risk control and effort scale, some others have been introduced, e.g. the concept of residual risk management. A weekly meeting is scheduled by a multidisciplinary team in order to support the different projects. RESULTS: Experiments and practice have led us to upgrade our scales of gravity and detectability, identify critical points and introduce the residual risk management concept. Some difficulties with regards to the multiplicity of scenarios still prevail. CONCLUSION: Risk mapping is an essential tool in the implementation of risk quality management, specifically when the methodology is progressive and takes into consideration all the members of a pluridisciplinary team.

[Interobserver variability study for daily cone beam computed tomography registration of prostate volumetric modulated arc therapy]. / Tomographie conique quotidienne pour les traitements pelviens et prostatiques: étude interobservateurs.

PURPOSE: This work evaluated the interobserver variability in cone beam computed tomography (CBCT) registration for prostate cancers treated with intensity-modulated radiotherapy. MATERIAL AND METHODS: Twelve technologists realized 286 CBCT/CT registrations (bone registration followed by prostate to prostate registration). The registration results were compared to those obtained by two radiation oncologists (reference). Each technologist reported the shifts calculated by the software in all three axes. A statistical analysis allowed us to calculate the minimum threshold under which 95% of the observers found similar values. A variance analysis followed by the post hoc test were used to find differences in interobserver registration variability and determine whether any individual users performed registrations which differed significantly from those of the other users. RESULTS: The registration differences compared to the reference in the three directions in terms of 95th percentile are: 2.1mm left-right, 3.5mm target-gun, 7.3mm anterior-posterior. In the posterior direction, 4% of the observers have found differences superior to 8mm, margin used in routine without the use of a daily CBCT. The variance test revealed a P-value <0.05 only for target-gun and for all observers there was no significant difference compared to the reference. CONCLUSION: This study confirmed the interest of a 3D tissue registration for prostate treatments. The registration study showed a good interobserver reproducibility. This showed the importance of a daily CBCT/CT registration in prostate treatment with the possibility of a planning target volume margin reduction in the three directions. An evaluation of a partial delegation of registration to technologists should be done by the radiation oncologists.

Energy dependent chest wall thickness equations for male lung monitoring with germanium detectors.

The thickness and fat fraction of the chest wall are important parameters for in vivo lung monitoring. They have been measured from ultrasonic images on 374 male workers of the French nuclear industry using four measurement locations, as dictated by the size and position of the germanium detectors used for monitoring. The plastic muscle equivalent chest wall thickness (PMECWT) and the plastic 50% muscle-50% adipose equivalent chest wall thickness (X5050) have been calculated for each worker at 17, 59.5, and 185.7 keV, respectively. Multi-linear regression models have been tested to predict PMECWT and X5050 as a function of anthropometric measurements. Finally, it was considered whether the average chest wall thickness could be used instead of the material equivalent chest wall thickness. It was found that the mean chest wall thickness was (27 ± 5) mm and the mean fat fraction was (25 ± 8)%. The best and more convenient model for material equivalent chest wall thickness is a linear function of the body mass index. Depending on the energy, the standard errors of estimate for this model range between 3.2-3.4 mm for PMECWT and between 3.2-3.7 mm for X5050. At 59.5 and 185.7 keV, it was determined, to an excellent approximation, that the fat fraction and consideration of an equivalent material are unnecessary, contrary to the case at 17 keV.

[Microscopic extensions of head and neck squamous cell carcinomas: impact for clinical target volume definition]. / Approche anatomopathologique de l'extension microscopique des carcinomes épidermoïdes ORL : implications pour la définition du volume cible anatomoclinique.

PURPOSE: To assess microscopic extensions of head and neck squamous cell carcinomas aiming at a proposal for target volumes of radiation therapy. MATERIALS AND METHODS: Surgical specimens were prospectively analysed macroscopically and microscopically. Tumour borders were identified per macroscopic visual examination and inked on stained slides. Then microscopic implants (perineural or lymphatic involvement, or in situ carcinomas) were looked for with an optic microscope in the macroscopic healthy tissue surrounding the tumour. The maximal length from tumour border was correlated with the maximal length of macroscopically healthy tissues assessable. RESULTS: Twenty-one specimens were analysed and 12 were locally advanced tumours. Mean and median maximal microscopic extensions were 2.9 and 1.0mm (0-15mm), respectively. The 90th and 95th percentiles were 5 and 11mm, respectively. The ratio between healthy tissue length and maximal microscopic tumour extension was 10%. No correlation was found with tumour grade or volume. CONCLUSION: The presence of microscopic tumour was unlikely after 5mm from macroscopic tumour (≤5% of patients in this series) but should be assessed along with other histoclinical factors and particularities of tumour behaviour by anatomic site. A rigorous terminology should authorize a relevant appreciation of local risk of recurrence, particularly in adjuvant setting or for clinical target volume definition. Larger and more homogenous confirmatory series are needed.

Mutagenicity, genotoxicity, and scavenging activities of extracts from the soft coral Chromonephthea braziliensis: a possibility of new bioactive compounds.

Coral reefs are diverse ecosystems that have a high density of biodiversity leading to intense competition among species. These species may produce unknown substances, many with pharmacological value. Chromonephthea braziliensis is an invasive soft coral from the Indo-Pacific Ocean that is possibly transported by oil platforms and whose presence can be a threat to a region's biodiversity. This species produces secondary metabolites that are responsible for inducing damage to the local ecosystem. In the present study, extracts were prepared from dried colonies of C. braziliensis (solvents: hexane, dichloromethane, ethyl acetate, and methanol). We evaluated their mutagenicity using the Salmonella reverse mutation assay (TA97, TA98, TA100, and TA102 strains), their genotoxicity using the DNA breakage analysis and micronucleus assay, and scavenging activity using the 1,1-diphenyl-2-picrylhydrazyl-free radical assay. Cytotoxicity and mutagenicity were not observed for any of the extracts. Genotoxicity was observed for the dichloromethane, ethyl acetate, and methanol extracts at high concentrations, but no DNA damage was observed in the micronucleus assay. Scavenging activity was not detected.

Forces created by mandibular advancement devices in OSAS patients: a pilot study during sleep.

BACKGROUND: The aim of this study was to measure forces created by progressive mandibular advancement with an oral device, during natural sleep, in a sample of adult patients with obstructive sleep apnea syndrome (OSAS). METHODS: A pressure transducer system was placed on the acrylic arms of a two-piece oral appliance (Herbst type) used by nine moderate to severe OSAS patients, in addition to all captors routinely used for polysomnography. Strains on the left and right sides were collected, during stable sleep stages without arousal, for each step of 1 mm advancement. RESULTS: The mean force in this sample was 1.18 N/mm and showed an almost linear evolution. Measurements showed intra- and inter-individual variability. CONCLUSION: The force values recorded in this study may explain the occlusal and skeletal side effects associated with long-term use of these oral appliances. They illustrate the influence of the extent of mandibular advancement, and indicate a possible dose-dependent effect.

Transparent coatings made from spray deposited colloidal suspensions.

The goal of this study is to elaborate few-micrometer thick optically active coatings based on nanoparticles spray-deposited onto a substrate and to control their scattering properties through a progressive suppression of the coffee-ring effect. The modification of the aggregation state of the nanoparticles to be sprayed induces a change of the surface roughness of the films and consequently of their optical transmission. We draw the counterintuitive conclusion that a nonstable colloidal solution gives a smoother coating than a highly stabilized colloidal solution, leading to a more transparent coating. This phenomenon is demonstrated in the case of commercial TiO(2) nanoparticles, as well as of homemade luminescent YVO(4):Eu nanoparticles, and seems to be generalized to a large range of systems.

[Nasopharyngeal cancer]. / Cancers du cavum de l'adulte.

The main objective of this work was to propose recommendations concerning the delineation of the target volume of the nasopharyngeal cancers, the planification of the treatment, and describe the expected results about the efficacity and the toxicities. Theses recommendations are based upon anatomy, natural history of theses tumors, and upon published experiences from different teams working with IMRT.

[Tolerance of normal tissues to radiation therapy: ear]. / Dose de tolérance à l'irradiation des tissus sains: l'oreille.

The main objective of this work was to describe, based on a literature survey, the radiation-induced toxicity of the ear and to try to establish the limiting dose. The limiting toxicity was the sensorineural hearing loss. A dose-effect relationship has been described by several authors. Thirty to 40% of patients who are irradiated for head and neck cancer are concerned, but the intensity of the hearing loss tends to depend on the exact localisation of the primary tumour: nasopharyngeal irradiations, paranasal sinusal and parotid irradiation are at greater risk of complication. High frequencies are more vulnerable than the lower ones. Age of patients, as well as baseline hearing abilities, deeply influence the issue. As far as possible, the dose to the inner ear--the cochlea more precisely--should be kept under 40 Gy. In case of association with other causes of toxicity (such as age, low baseline value, association to cisplatin), this dose should be as low as possible. Should carcinologic constraints lead to toxic doses, then patients should be properly informed.

[The set-up of obstructive sleep apnea treatment]. / Mise en place du traitement du SAHOS.

The therapeutic strategy of obstructive sleep apnea syndrome (OSAS) is dependent on the illness severity, which is influenced by several factors as the presence of comorbidities (particularly cardiovascular comorbidities), the importance of diurnal drowsiness and the number of abnormal respiratory events. Whereas the treatment is most often palliative and uncomfortable, its success is closely dependent on its compliance. The way of starting the treatment of OSAS is therefore an essential topic, which will condition its long-term acceptance.

Titrated mandibular advancement versus positive airway pressure for sleep apnoea.

The aim of this study was to compare mandibular advancement device (MAd) therapy and continuous positive airway pressure (CPAP) for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) after one-night polysomnographic (PSG) titration of both treatments. 59 OSAHS patients (apnoea/hypopnoea index (AHI): 34+/-13 events x h(-1); Epworth scale: 10.6+/-4.5) were included in a crossover trial of 8 weeks of MAd and 8 weeks of CPAP after effective titration. Outcome measurements included home sleep study, sleepiness, health-related quality of life (HRQoL), cognitive tests, side-effects, compliance and preference. The median (interquartile range) AHI was 2 (1-8) events x h(-1) with CPAP and 6 (3-14) events x h(-1) with MAd (p<0.001). Positive and negative predictive values of MAd titration PSG for treatment success were 85% and 45%, respectively. Both treatments significantly improved subjective and objective sleepiness, cognitive tests and HRQoL. The reported compliance was higher for MAd (p<0.001) with >70% of patients preferring this treatment. These results support titrated MAd as an effective therapy in moderately sleepy and overweight OSAHS patients. Although less effective than CPAP, successfully titrated MAd was very effective at reducing the AHI and was associated with a higher reported compliance. Both treatments improved functional outcomes to a similar degree. One-night titration of MAd had a low negative predictive value for treatment success.

[Alcohol problems in drinking drivers and clinical management methods]. / Typologie des contrevenants à l'alcoolémie routière et modalités des prises en charge.

BACKGROUND: In order to improve knowledge on the typology of drinking drivers, their clinical management and their outcome in terms of alcohol consumption following treatment, 1086 drinking drivers attending one of the 18 outpatient centres for the care of alcoholics participating to the study were studied; those requiring long-term therapy or those mandated to treatment were followed-up during one year. Most of them (95%) were men with a mean age of 38 years. The drinking-driving offence was recorded during an alcohol spot-check (62%), following a traffic accident (23%) or a traffic offence (15%). For 35%, it was the second offence and 19% have been mandated to treatment. Alcohol consumption before checking were based on spirits in 67% of cases and only wine or beer for the remaining 33%. Severe alcohol problems (i.e. abuse or dependence) were diagnosed in 38%, both in men and women. Mean blood alcohol level was 1.6 g/l, without any difference according to sex; it was significantly increased in those checked following a traffic accident, in those having drank spirits, wine and beer and in those having a severe alcohol problem. Follow-up was organized for those mandated to treatment and for a third of the others, including mainly those second-offenders and those with a severe alcohol problem. Observance to appointments were similar in both groups. At the end of follow-up (350 subjects were concerned), 75% were either non- or moderate drinkers while the 25% remaining were still abuser or dependent; the single parameter independently and significantly associated to an absence of alcohol behaviour improvement was "to be mandated to treatment" (RR=4.4 CI [2.03-9.69], p<0.001). Our results confirm the high prevalence of severe alcohol problems in drinking drivers and demonstrate that women are concerned as much as men. They assess that since increased blood alcohol levels in drivers are observed whatever the type of alcoholic beverages consumed, all these latter without any exception are dangerous when drank in excess before driving. Finally, our results suggest that mandating to treatment a drinking driver should be discussed and its efficacy revisited.