Carcinoma epidermoide de tiroides localmente avanzado irresecable tratado con quimio-radioterapia radical / Unreseccable locally advanced thyroid squamous carcinoma treated with radical chemio-radiotherapy

Se presenta el caso de una mujer de 71 años que, a raíz de un cuadro de disfonía y opresión cervical, es diagnosticada de carcinoma epidermoide del estrecho torácico superior, de origen tiroideo como opción más probable. La singularidad de la histología en esta localización hace difícil filiar la masa, por lo que se plantean dos posibles opciones como origen del tumor primario: carcinoma epidermoide de tráquea versus carcinoma epidermoide primario de tiroides, siendo esta última estirpe extremadamente poco frecuente. A esta condición se le añade el carácter multidisciplinar en el proceso diagnóstico con la implicación de varias especialidades en el caso y la excelente respuesta al tratamiento no quirúrgico. Se trata de un caso de curación mediante quimio-radioterapia concomitante dada la condición de irresecable al diagnóstico, con evidente respuesta tanto clínica como radiológica en las sucesivas consultas hasta el momento actual, que continúa en seguimiento. (AU)

We present the case of a 71-year-old woman who, due to symptoms of hoarseness and cervical oppression, was diagnosed with squamous cell carcinoma of the upper thoracic outlet, of thyroid origin as the most likely option. The singularity of the histology in this location makes it difficult to identify the mass, which is why two possible options are considered as the origin of the primary tumor: squamous cell carcinoma of the trachea versus primary squamous cell carcinoma of the thyroid, the latter being an extremely rare lineage.To this condition is added the multidisciplinary nature of the diagnostic process with the involvement of various specialties in the case and the excellent response to non-surgical treatment. This is a case of cure by means of concomitant chemo-radiotherapy given the unresectable condition at diagnosis, with an evident clinical and radiological response in successive consultations up to the present time, which continues under follow-up. (AU)

The Clinical Outcome of Custom-Made Implants in Primary and Revision Hip Arthroplasty.

PURPOSE OF THE STUDY Facing the increasing number of priary and revision hip arthroplasties, the therapy of complex osseus defects becomes a crucial issue. Large acetabular defects cannot be treated with standard implant. Individual, customized implants based on 3D computed tomography (CT) scans are used for reconstruction. However, high complication and revision rates come along with final favorable outcomes. MATERIAL AND METHODS Eight patients underwent primary or revision total hip arthroplasty by an anterolateral surgical approach using patient matched implants based on 3D CT scans. Six patients with a Paprosky type IIIB acetabular defect, one patient with a nonunion acetabular and femoral neck fracture and one patient with a severe hip dysplasia were included. The clinical data and the Merle d'Aubigné score assessing the clinical outcome pre- and postoperatively were analyzed retrospectively. RESULTS Patient matched implants were used for eight patients (four male and four female). The mean Merle d'Aubigné score improved from 8.1 (range 2-11) pre-operatively to 13 (range 9-17) at the final follow-up (p < 0.01). Postoperative complications were recorded in 3 cases. CONCLUSIONS Customized implants of severe acetabular defects provide a solution with a favorable outcome. Nevertheless, dislocation presents a significant complication. A reduction of complications in order to achieve the optimal custome-made implant is desirable. Key words: revision arthroplasty, patient-matched implants, Paprosky IIIB defects, clinical outcome.

French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy.

AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.

Impact of 10-weeks of yoga practice on flexibility and balance of college athletes.

BACKGROUND: With clearer evidence of its benefits, coaches, and athletes may better see that yoga has a role in optimizing performance. AIMS: To determine the impact of yoga on male college athletes (N = 26). METHODS: Over a 10-week period, a yoga group (YG) of athletes (n = 14) took part in biweekly yoga sessions; while a nonyoga group (NYG) of athletes (n = 12) took part in no additional yoga activity. Performance measures were obtained immediately before and after this period. Measurements of flexibility and balance, included: Sit-reach (SR), shoulder flexibility (SF), and stork stand (SS); dynamic measurements consisted of joint angles (JA) measured during the performance of three distinct yoga positions (downward dog [DD]; right foot lunge [RFL]; chair [C]). RESULTS: Significant gains were observed in the YG for flexibility (SR, P = 0.01; SF, P = 0.03), and balance (SS, P = 0.05). No significant differences were observed in the NYG for flexibility and balance. Significantly, greater JA were observed in the YG for: RFL (dorsiflexion, l-ankle; P = 0.04), DD (extension, r-knee, P = 0.04; r-hip; P = 0.01; flexion, r-shoulder; P = 0.01) and C (flexion, r-knee; P = 0.01). Significant JA differences were observed in the NYG for: DD (flexion, r-knee, P = 0.01: r-hip, P = 0.05; r-shoulder, P = 0.03) and C (flexion r-knee, P = 0.01; extension, r-shoulder; P = 0.05). A between group comparison revealed the significant differences for: RFL (l-ankle; P = 0.01), DD (r-knee, P = 0.01; r-hip; P = 0.01), and C (r-shoulder, P = 0.02). CONCLUSIONS: Results suggest that a regular yoga practice may increase the flexibility and balance as well as whole body measures of male college athletes and therefore, may enhance athletic performances that require these characteristics.

Coherent Population Trapping of a Single Nuclear Spin Under Ambient Conditions.

We demonstrate coherent population trapping of a single nuclear spin in a room-temperature solid. To this end, we exploit a three-level system with a Λ configuration in the microwave domain, which consists of nuclear spin states addressed through their hyperfine coupling to the electron spin of a single nitrogen-vacancy defect in diamond. Moreover, the Λ-scheme relaxation is externally controlled through incoherent optical pumping and separated in time from consecutive coherent microwave excitations. Such a scheme allows us (i) to monitor the sequential accumulation of population into the dark state and (ii) to reach a novel regime of coherent population trapping dynamics for which periodic arrays of dark resonances can be observed, owing to multiple constructive interferences. This Letter offers new prospects for quantum state preparation, information storage in hybrid quantum systems, and metrology.

The nature of domain walls in ultrathin ferromagnets revealed by scanning nanomagnetometry.

The capacity to propagate magnetic domain walls with spin-polarized currents underpins several schemes for information storage and processing using spintronic devices. A key question involves the internal structure of the domain walls, which governs their response to certain current-driven torques such as the spin Hall effect. Here we show that magnetic microscopy based on a single nitrogen-vacancy defect in diamond can provide a direct determination of the internal wall structure in ultrathin ferromagnetic films under ambient conditions. We find pure Bloch walls in Ta/CoFeB(1 nm)/MgO, while left-handed Néel walls are observed in Pt/Co(0.6 nm)/AlOx. The latter indicates the presence of a sizable interfacial Dzyaloshinskii-Moriya interaction, which has strong bearing on the feasibility of exploiting novel chiral states such as skyrmions for information technologies.

Probing the dynamics of a nuclear spin bath in diamond through time-resolved central spin magnetometry.

Using fast electron spin resonance spectroscopy of a single nitrogen-vacancy defect in diamond, we demonstrate real-time readout of the Overhauser field produced by its nuclear spin environment under ambient conditions. These measurements enable narrowing the Overhauser field distribution by postselection, corresponding to a conditional preparation of the nuclear spin bath. Correlations of the Overhauser field fluctuations are quantitatively inferred by analyzing the Allan deviation over consecutive measurements. This method allows us to extract the dynamics of weakly coupled nuclear spins of the reservoir.

Nanoscale imaging and control of domain-wall hopping with a nitrogen-vacancy center microscope.

The control of domain walls in magnetic wires underpins an emerging class of spintronic devices. Propagation of these walls in imperfect media requires defects that pin them to be characterized on the nanoscale. Using a magnetic microscope based on a single nitrogen-vacancy (NV) center in diamond, we report domain-wall imaging on a 1-nanometer-thick ferromagnetic nanowire and directly observe Barkhausen jumps between two pinning sites spaced 50 nanometers apart. We further demonstrate in situ laser control of these jumps, which allows us to drag the domain wall along the wire and map the pinning landscape. Our work demonstrates the potential of NV microscopy to study magnetic nano-objects in complex media, whereas controlling domain walls with laser light may find an application in spintronic devices.

Magnetometry with nitrogen-vacancy defects in diamond.

The isolated electronic spin system of the nitrogen-vacancy (NV) centre in diamond offers unique possibilities to be employed as a nanoscale sensor for detection and imaging of weak magnetic fields. Magnetic imaging with nanometric resolution and field detection capabilities in the nanotesla range are enabled by the atomic-size and exceptionally long spin-coherence times of this naturally occurring defect. The exciting perspectives that ensue from these characteristics have triggered vivid experimental activities in the emerging field of 'NV magnetometry'. It is the purpose of this article to review the recent progress in high-sensitivity nanoscale NV magnetometry, generate an overview of the most pertinent results of the last years and highlight perspectives for future developments. We will present the physical principles that allow for magnetic field detection with NV centres and discuss first applications of NV magnetometers that have been demonstrated in the context of nano magnetism, mesoscopic physics and the life sciences.

Stray-field imaging of magnetic vortices with a single diamond spin.

Despite decades of advances in magnetic imaging, obtaining direct, quantitative information with nanometre scale spatial resolution remains an outstanding challenge. Recently, a technique has emerged that employs a single nitrogen-vacancy defect in diamond as an atomic-size magnetometer, which promises significant advances. However, the effectiveness of the technique when applied to magnetic nanostructures remains to be demonstrated. Here we use a scanning nitrogen-vacancy magnetometer to image a magnetic vortex, which is one of the most iconic objects of nanomagnetism, owing to the small size (~10 nm) of the vortex core. We report three-dimensional, vectorial and quantitative measurements of the stray magnetic field emitted by a vortex in a ferromagnetic square dot, including the detection of the vortex core. We find excellent agreement with micromagnetic simulations, both for regular vortex structures and for higher-order magnetization states. These experiments establish scanning nitrogen-vacancy magnetometry as a practical and unique tool for fundamental studies in nanomagnetism.

[Giant ameloblastoma of the mandible]. / Améloblastome géant mandibulaire.

INTRODUCTION: Giant ameloblastomas are more common in developing countries. They raise a serious problem of management. We present the case of one of the largest ameloblastoma ever reported. CASE REPORT: A 48-year-old Congolese female patient was referred for mandibular swelling having begun 23 years before and now inducing severe functional disorders. A cephalic CT scan revealed a multicystic mass, 30×18×10cm in size, with a typical "soap bubble" presentation, and with thinned and inflated cortical bone. The treatment was sub-total segmental mandibulectomy with immediate reconstruction using a fibular free flap, modeled on the sampling site by four ostectomies. The pathological examination confirmed the diagnosis of a benign follicular and plexiform ameloblastoma. The excess of soft tissue was treated with a right commissuroplasty on the 15th postoperative day. There was no complication. DISCUSSION: Radical treatment followed by immediate reconstruction using a free flap is the treatment of choice for giant mandibular ameloblastomas, when considering immediate functional and esthetic benefits. This is a prime concern for patients with a difficult access to health care and for whom long-term follow-up is not feasible.

Single-shot readout of multiple nuclear spin qubits in diamond under ambient conditions.

We use the electronic spin of a single nitrogen-vacancy defect in diamond to observe the real-time evolution of neighboring single nuclear spins under ambient conditions. Using a diamond sample with a natural abundance of (13)C isotopes, we first demonstrate high fidelity initialization and single-shot readout of an individual (13)C nuclear spin. By including the intrinsic (14)N nuclear spin of the nitrogen-vacancy defect in the quantum register, we then report the simultaneous observation of quantum jumps linked to both nuclear spin species, providing an efficient initialization of the two qubits. These results open up new avenues for diamond-based quantum information processing including active feedback in quantum error correction protocols and tests of quantum correlations with solid-state single spins at room temperature.

Second-harmonic generation from coupled plasmon modes in a single dimer of gold nanospheres.

We show that a dimer made of two gold nanospheres exhibits a remarkable efficiency for second-harmonic generation under femtosecond optical excitation. The detectable nonlinear emission for the given particle size and excitation wavelength arises when the two nanoparticles are as close as possible to contact, as in situ controlled and measured using the tip of an atomic force microscope. The excitation wavelength dependence of the second-harmonic signal supports a coupled plasmon resonance origin with radiation from the dimer gap. This nanometer-size light source might be used for high-resolution near-field optical microscopy.

Hybrid quantum circuit with a superconducting qubit coupled to a spin ensemble.

We report the experimental realization of a hybrid quantum circuit combining a superconducting qubit and an ensemble of electronic spins. The qubit, of the transmon type, is coherently coupled to the spin ensemble consisting of nitrogen-vacancy centers in a diamond crystal via a frequency-tunable superconducting resonator acting as a quantum bus. Using this circuit, we prepare a superposition of the qubit states that we store into collective excitations of the spin ensemble and retrieve back into the qubit later on. These results constitute a proof of concept of spin-ensemble based quantum memory for superconducting qubits.

Dose and image quality comparison between prospectively gated axial and retrospectively gated helical coronary CT angiography.

OBJECTIVE: Our aim was to compare image quality, coronary segment assessability and radiation dose in prospectively gated axial (PGA) coronary CT angiography (CTA) and conventional retrospectively gated helical (RGH) coronary CTA. METHODS: Institutional review committee approval and informed consent were obtained. RGH CTA was performed in 41 consecutive patients (33 males, 8 females; mean age 52.6 years), then the PGA CTA technique was evaluated in 41 additional patients (24 males, 17 females; mean age 57.3 years) all with a pre-scan heart rate of ≤70 beats per minute (bpm). Two radiologists, blinded to clinical information, independently scored subjective image quality on a five-point ordinal scale. RESULTS: The mean effective dose in the PGA group was 4.7±0.9 mSv, representing a 69% dose reduction compared with the RGH CTA group (15.1±1.9 mSv, p<0.001). The mean segmental image quality score was significantly higher in the PGA group (3.4 vs 3.2) than in the RGH CTA group (p<0.005). The percentage of assessable segments was 98.1% in the PGA group and 97.3% in the RGH group (p = 0.610). CONCLUSION: PGA CTA offers a significant reduction in radiation dose compared with RGH CTA, with comparable image quality for patients with heart rates below 70 bpm.

Impaired laryngeal mobility and entrapment neuropathies.

Entrapment neuropathies are rarely mentioned in phoniatrics because a definite diagnosis is very difficult to make. However, several clinical examples described here strongly support this etiology, which should now be considered in the diagnosis of both partial and complete laryngeal immobility as well as in minor neuromuscular disorders.

Temporomandibular dysfunction and dysphonia (TMD).

Freedom of the manducatory apparatus is critical to economical and accurate vocal production. Two types of dysfunction will be discussed: global muscular hypertonia of the muscular manducatory system and dysfunction of the temporomandibular joint (TMJ). Hypertonia occurs in a high number of dysphonic patients. It impairs mandibular mobility and also induces chronic hypertonia of the tongue muscles, hyoid apparatus and occipitocervical joint through the neuromuscular facilitation process. TMJ can be a major source of mandibular kinetics impairment. Its pathogenic effects are most deeply felt in singers, who often have their mouths wide open, especially when singing notes in the upper register. Affected singers generally use an avoidance or compensation strategy which is detrimental to optimal use of resonance cavities and vocal sound articulation. It is consequently vital to understand TMJ pathophysiology and to include an examination of the manducatory apparatus in any clinical evaluation of dysphonia.

Strong coupling of a spin ensemble to a superconducting resonator.

We report the realization of a quantum circuit in which an ensemble of electronic spins is coupled to a frequency tunable superconducting resonator. The spins are nitrogen-vacancy centers in a diamond crystal. The achievement of strong coupling is manifested by the appearance of a vacuum Rabi splitting in the transmission spectrum of the resonator when its frequency is tuned through the nitrogen-vacancy center electron spin resonance.