Sci-Fri PM: Planning-04: Dose escalation study using anatomy-based aperture IMRT and SPECT perfusion images for lung cancer.

In the case of non-small cell lung cancer, doses typically prescribed (60-66 Gy) are not sufficient to ensure a satisfactory tumor control probability. Dose escalation needs to be realized, but dose to organs at risk (OARs) must be kept under widely accepted clinical thresholds. Also, lung functionality is not homogeneously distributed over all the volume: single-photon emission computed tomography (SPECT) allows spatial characterization of perfusion, open the way to the design of treatments plans that could preferentially avoid highly-functional lung. In this study, three cases of lung cancer were retrospectively used to assess the capacity of an anatomy-based aperture inverse planning system to realize dose escalation while limiting dose to perfused lung. Plans were generated for four-beam non-coplanar configurations, mixing 6 and 23 MV photon beams. All dose calculations were performed using Pinnacle3 superposition/convolution algorithm. An increasing dose was prescribed to a subvolume of the initial planning target volume. Levels of escalation achieved for the three cases studied were 81 Gy, 111 Gy and 66 Gy to the subvolume. Escalation was limited in two cases by the dose to the esophagus and in the other case by the presence of overdosages near beam entry ports. Calculation of dose-volume parameters for OARs shows that they respect clinical thresholds. Plans generated by the system are less complex than plans generated in beamlet-based IMRT, because of the use of few, large segments. The approach used in this study allows important dose escalation, potentially improving treatment outcome.

Effects of acaricides, pyrethroids and predator distributions on populations of Tetranychus urticae in apple orchards.

We sampled mites in three apple orchards in Nova Scotia, Canada, that had been inoculated with pyrethroid-resistant Typhlodromus pyri and had a history of Tetranychus urticae outbreaks. The objective of this study was to monitor populations of T. urticae and phytoseiid predators on the ground and in trees and to track dispersal between the two habitats. Pesticides were the chief cause of differences in mite dynamics between orchards. In two orchards, application of favourably selective acaricides (abamectin, clofentezine) in 2002, coupled with predation by T. pyri in trees and Neoseiulus fallacis in ground cover, decreased high T. urticae counts and suppressed Panonychus ulmi. By 2003 phytoseiids kept the tetranychids at low levels. In a third orchard, application of pyrethroids (cypermethrin, lambda-cyhalothrin), plus an unfavourably selective acaricide (pyridaben) in 2003, suppressed phytoseiids, allowing exponential increases of T. urticae in the ground cover and in tree canopies. By 2004 however, increasing numbers of T. pyri and application of clofentezine strongly reduced densities of T. urticae in tree canopies despite high numbers crawling up from the ground cover. Another influence on T. urticae dynamics was the distribution of the phytoseiids, T. pyri and N. fallacis. When harsh pesticides were avoided, T. pyri were numerous in tree canopies. Conversely, only a few N. fallacis were found there, even when they were present in the ground cover and on tree trunks. Low numbers were sometimes due to pyrethroid applications or to scarcity of prey. Another factor was likely the abundance of T. pyri, which not only competes with N. fallacis, but also feeds on its larvae and nymphs. The scarcity of a specialist predator of spider mites in trees means that control of T. urticae largely depends on T. pyri, a generalist predator that is not particularly effective in regulating T. urticae.

Poor performance in smooth pursuit and antisaccadic eye-movement tasks in healthy siblings of patients with schizophrenia.

This study examines the area of eye movement dysfunctions as an indicator of vulnerability to schizophrenia. Eye movement performance was investigated with three different paradigms: Smooth Pursuit Eye Movements (SPEM); Visually Guided Saccades (VGS); and Antisaccades (AS) in 21 clinically stable patients with schizophrenia, 21 of their healthy, biological full siblings and 21 healthy control subjects. The three groups did not differ on VGS performance, whereas both patients and their siblings showed lower SPEM gain, an increased catch-up Saccades (CUS) rate, reduced AS accuracy and an increased number of AS errors in comparison to control subjects. In addition, patients with schizophrenia exhibited increased AS latency. Among the patients with schizophrenia, eye movement abnormalities did not correlate with age, gender, clinical state or duration of illness. These data suggest that abnormalities of SPEM and AS may represent neurobiological markers of the vulnerability to schizophrenia in individuals at high genetic risk for the disease.

Initiation and supervisory processes in schizophrenia and depression.

Clinical studies show that schizophrenic and depressive subjects have problems with daily life activities, and neuropsychological studies tend to explain these problems in terms of a dysexecutive syndrome. Verbal fluency and sentence arrangement are tasks considered to focus on two aspects of the dysexecutive syndrome known as initiation and supervision processes, respectively. In this study, we assessed performance in these two tasks in schizophrenia and depression. Twenty-six schizophrenic subjects (chronic schizophrenia, DSM IV definition) were compared with 26 control subjects balanced for sex, age and educational level, and 16 depressive subjects (major depression episode, DSM IV) were compared with 11 similarly balanced control subjects. Switching and clustering scores were evaluated during a semantic fluency task as two components underlying the initiation and organization processes. Capture errors specific to failure of the supervisory system and differences between the number of correct responses in two conditions (valid/invalid) were evaluated as indexes of the supervision process in a sentence arrangement task. In the semantic fluency task, switching scores were significantly lower in the schizophrenic and depressive subjects than in their respective controls. In the sentence arrangement task, only the schizophrenic subjects made significantly more capture errors than their controls and had significantly fewer correct sequences in invalid conditions than in valid conditions. This study shows a dissociation between supervision and initiation processes in two different psychiatric populations. Initiation is impaired, but supervision is preserved in depression, whereas both initiation and supervision are impaired in schizophrenia.

[Bronchial casts associated with pulmonary lymphatic anomalies]. / Moules bronchiques associés à des anomalies lymphatiques pulmonaires.

We report a case of a patient who presented with bronchial moulds. The classic causes, particularly bronchopulmonary aspergillosis could not be found. The pulmonary radiology and CT of thorax revealed an alveolar syndrome. Lymphography and lymphoscintigraphy showed evidence of lymphatic anomalies including the non-visualisation of the thoracic canal. In the absence of evidence for other diseases, we would suggest that these anomalies were responsible for the symptomatology.

Insufficiency fractures of the sacrum. Ten cases and a review of the literature.

We report ten cases of insufficiency fracture of the sacrum, a recently individualized pathological entity. These fractures occur in elderly women with pronounced osteopenia of the pelvis. The clinical symptoms are low back pain and sometimes mechanical radiculalgia. Histories of previous injury are rare. In 50 per cent of the cases X-ray films of the pelvis show fractures of the anterior pelvic arch (iliopubic and ischiopubic rami). Computerized tomography or radionuclide bone scanning provide an almost certain diagnosis of sacral insufficiency fracture. This diagnosis is confirmed by a favorable clinical outcome after 2 months.