Positron emission tomography/computed tomography (PET/CT) is a nuclear medicine functional imaging technique with proven clinical value in oncology. PET/CT indications are continually evolving with ...fresh advances made through research. French practice on the use of PET in oncology was framed in recommendations based on Standards–Options–Recommendations methodology and coordinated by the French federation of Comprehensive Cancer Centres (FNLCC). The recommendations were originally issued in 2002 followed by an update in 2003, but since then, a huge number of scientific papers have been published and new tracers have been licenced for market release. The aim of this work is to bring the 2003 version recommendations up to date. For this purpose, a focus group was set up in collaboration with the French Society for Nuclear Medicine (SFMN) to work on developing good clinical practice recommendations. These good clinical practice recommendations have been awarded joint French National Heath Authority (HAS) and French Cancer Institute (INCa) label status—the stamp of methodological approval. The present document is the outcome of comprehensive literature review and rigorous appraisal by a panel of experts, organ specialists, clinical oncologists, surgeons and imaging specialists. These data were also used for the EANM referral guidelines.
Bladder cancer (BC) is the 10th most common cancer worldwide. Approximately one quarter of patients with BC have muscle-invasive disease (MIBC). Muscle-invasive disease carries a poor prognosis and ...choosing the optimal treatment option is critical to improve patients’ outcomes. Ongoing research supports the role of 2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography (18F-FDG PET) in guiding patient-specific management decisions throughout the course of MIBC. As an imaging modality, 18F-FDG PET is acquired simultaneously with either computed tomography (CT) or MRI to offer a hybrid approach combining anatomical and metabolic information that complement each other. At initial staging, 18F-FDG PET/CT enhances the detection of extravesical disease, particularly in patients classified as oligometastatic by conventional imaging. 18F-FDG PET/CT has value in monitoring response to neoadjuvant and systemic chemotherapy, as well as in localizing relapse after treatment. In the new era of immunotherapy, 18F-FDG PET/CT may also be useful to monitor treatment efficacy as well as to detect immune-related adverse events. With the advent of artificial intelligence techniques such as radiomics and deep learning, these hybrid medical images can be mined for quantitative data, providing incremental value over current standard-of-care clinical and biological data. This approach has the potential to produce a major paradigm shift toward data-driven precision medicine with the ultimate goal of personalized medicine. In this review, we highlight current literature reporting the role of 18F-FDG PET in supporting personalized management decisions for patients with MIBC. Specific topics reviewed include the incremental value of 18F-FDG PET in prognostication, pre-operative planning, response assessment, prediction of recurrence, and diagnosing drug toxicity.
In 2018 we celebrated 25 years of development of radar altimetry, and the progress achieved by this methodology in the fields of global and coastal oceanography, hydrology, geodesy and cryospheric ...sciences. Many symbolic major events have celebrated these developments, e.g., in Venice, Italy, the 15th (2006) and 20th (2012) years of progress and more recently, in 2018, in Ponta Delgada, Portugal, 25 Years of Progress in Radar Altimetry. On this latter occasion it was decided to collect contributions of scientists, engineers and managers involved in the worldwide altimetry community to depict the state of altimetry and propose recommendations for the altimetry of the future. This paper summarizes contributions and recommendations that were collected and provides guidance for future mission design, research activities, and sustainable operational radar altimetry data exploitation. Recommendations provided are fundamental for optimizing further scientific and operational advances of oceanographic observations by altimetry, including requirements for spatial and temporal resolution of altimetric measurements, their accuracy and continuity. There are also new challenges and new openings mentioned in the paper that are particularly crucial for observations at higher latitudes, for coastal oceanography, for cryospheric studies and for hydrology.
The paper starts with a general introduction followed by a section on Earth System Science including Ocean Dynamics, Sea Level, the Coastal Ocean, Hydrology, the Cryosphere and Polar Oceans and the “Green” Ocean, extending the frontier from biogeochemistry to marine ecology. Applications are described in a subsequent section, which covers Operational Oceanography, Weather, Hurricane Wave and Wind Forecasting, Climate projection. Instruments’ development and satellite missions’ evolutions are described in a fourth section. A fifth section covers the key observations that altimeters provide and their potential complements, from other Earth observation measurements to in situ data. Section 6 identifies the data and methods and provides some accuracy and resolution requirements for the wet tropospheric correction, the orbit and other geodetic requirements, the Mean Sea Surface, Geoid and Mean Dynamic Topography, Calibration and Validation, data accuracy, data access and handling (including the DUACS system). Section 7 brings a transversal view on scales, integration, artificial intelligence, and capacity building (education and training). Section 8 reviews the programmatic issues followed by a conclusion.
This study shows and quantifies the effect of the presence of wind turbines on lightning stroke location, density, polarity, peak current and annual distribution in areas where they are installed. We ...analyze the CG lightning activity recorded by Météorage during 21 years (1995–2015) over a 0.5° × 0.5° area in southwestern France (2.5°E-3°E; 44°N-44.5°N). The study area includes 8 farms with 2 to 29 turbines each, most of them installed between 2007 and 2010. The results show that the rate of increase of the cumulative number and the proportion of CG strokes are significantly larger around the turbines when they are installed, e.g. ~ 4.7 and 3.4 times, respectively, in a radius of 100 m. The proportion of positive CG strokes is lower around the turbines, e.g. ~ 3 times in a radius of 200 m. The annual distribution of CG strokes around the turbines is very different from that of the whole study area, with a total proportion of 36.9% and 2.3% in winter, respectively. Case studies of daily winter storm activity show that up to 93% of the strokes detected in the study area are located in the vicinity of wind turbines. The strokes are classified in three categories: first strokes of CG flashes (~31%), subsequent strokes of CG flashes (42%) and upward self-initiated discharges produced after a previous flash in the surrounding area (~27%).
•The enhancement of the lightning strokes in the vicinity of the wind turbines is highlighted and quantified in a 0.5° × 0.5° area in southern France including 8 farms.•In the vicinity of the wind turbines, the stroke rate density is larger by a factor ~ 3, the proportion of positive CG flash is lower, the multiplicity of the negative CG flash is larger, and the proportion of winter flash is much larger.•The strokes detected close to the turbines are classified in three categories thanks to the identification of the event previously detected. Thus, about 72% are first or subsequent strokes of CG flashes and about 28% are upward discharges self-initiated on a turbine thanks to conditions created by a previous flash in the area.
As part of the EUREC4A (Elucidating the role of cloud–circulation coupling in climate) field campaign, which took place in January and February 2020 over the western tropical Atlantic near Barbados, ...the French SAFIRE ATR42 research aircraft (ATR) conducted 19 flights in the lower troposphere. Each flight followed a common flight pattern that sampled the atmosphere around the cloud base level, at different heights of the subcloud layer, near the sea surface and in the lower free troposphere. The aircraft's payload included a backscatter lidar and a Doppler cloud radar that were both horizontally oriented; a Doppler cloud radar looking upward; microphysical probes; a cavity ring-down spectrometer for water isotopes; a multiwavelength radiometer; a visible camera; and multiple meteorological sensors, including fast rate sensors for turbulence measurements. With this instrumentation, the ATR characterized the macrophysical and microphysical properties of trade-wind clouds together with their thermodynamical, turbulent and radiative environment. This paper presents the airborne operations, the flight segmentation, the instrumentation, the data processing and the EUREC4A datasets produced from the ATR measurements. It shows that the ATR measurements of humidity, wind and cloud base cloud fraction measured with different techniques and samplings are internally consistent; that meteorological measurements are consistent with estimates from dropsondes launched from an overflying aircraft (the High Altitude and LOng Range Research Aircraft, HALO); and that water-isotopic measurements are well correlated with data from the Barbados Cloud Observatory. This consistency demonstrates the robustness of the ATR measurements of humidity, wind, cloud base cloud fraction and water-isotopic composition during EUREC4A. It also confirms that through their repeated flight patterns, the ATR and HALO measurements provided a statistically consistent sampling of trade-wind clouds and of their environment. The ATR datasets are freely available at the locations specified in Table .
Despite many efforts devoted toward the design of covalent organic frameworks (COFs) at the framework level by selecting the building blocks, their organization in the nano to meso regimes is often ...neglected. Moreover, the importance of processability for their applications has recently emerged and the synthesis of COF nanostructures without agglomeration is still a challenge. Herein, the first example of hybrid COF‐polymer particles for which polymers are used to manipulate the 2D COF growth along a specific direction is reported. The study examines how the nature, chain‐end functionality, and molar mass of the polymer influence the shaping of hybrid 2D boronate ester‐linked COF‐polymer particles. Catechol‐poly(N‐butyl acrylate) leads to the self‐assembly of crystallites into quasi‐spherical structures while catechol‐poly(N‐isopropylacrylamide) mediates the synthesis of raspberry‐like COF‐polymer particles with radial grain orientation. Scanning and transmission electron microscopies (SEM and TEM) and 4D‐STEM‐ACOM (automated crystal orientation mapping) highlight the single‐crystal character of these domains with one plane family throughout the particles. Interestingly, the presence of PNIPAm on the particle surface allows their drying without co‐crystallization and enables their resuspension. Kinetic investigations show that catechol‐PnBuA acts as a modulator and catechol‐PNIPAm induces a template effect, introducing supramolecular self‐assembly properties into particles to create new morphologies with higher structural complexity, beyond the framework level.
Catechol chain‐end functionalized polymers can act either as modulators or impart supramolecular self‐assembly properties into colloidal covalent organic framework (COF)‐5 to mediate the synthesis of well‐defined raspberry‐like particles with a radial single‐crystal orientation. The presence of macromolecular chains on the hybrid particle surface allows their drying without co‐crystallization and enables their resuspension.
Growth monitoring of apparently healthy children aims at early detection of serious underlying disorders. However, existing growth-monitoring practices are mainly based on suboptimal methods, which ...can result in delayed diagnosis of severe diseases and inappropriate referrals. We did a systematic review to address two key and interconnected questions underlying growth monitoring: which conditions should be targeted, and how should abnormal growth be defined? We systematically searched for studies reporting algorithms for growth monitoring in children and studies comparing the performance of new WHO growth charts with that of other growth charts. Among 1556 identified citations, 69 met the inclusion criteria. Six target conditions have mainly been studied: Turner syndrome, coeliac disease, cystic fibrosis, growth hormone deficiency, renal tubular acidosis, and small for gestational age with no catch-up after 2 or 3 years. Seven algorithms to define abnormal growth have been proposed in the past 20 years, but their level of validation is low, and their overall sensitivities and specificities vary substantially; however, the Grote and Saari clinical decision rules seem the most promising. Two studies reported that WHO growth charts had poorer performance compared with other existing growth charts for early detection of target conditions. Available data suggest a large gap between the widespread implementation of growth monitoring and its level of evidence or the clinical implications of early detection of serious disorders in children. Further investigations are needed to standardise the practice of growth monitoring, with a consensus on a few priority target conditions and with internationally validated clinical decision rules to define abnormal growth, including the selection of appropriate growth charts.
Intracranial haemorrhage in infective endocarditis Salaun, Erwan; Touil, Anissa; Hubert, Sandrine ...
Archives of cardiovascular diseases,
December 2018, 2018-Dec, 2018-12-00, 20181201, 2018-12, Letnik:
111, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Although intracranial cerebral haemorrhage (ICH) complicating infective endocarditis (IE) is a critical clinical issue, its characteristics, impact, and prognosis remain poorly known.
To assess the ...incidence, mechanisms, risk factors and prognosis of ICH complicating left-sided IE.
In this single-centre study, 963 patients with possible or definite left-sided IE were included from January 2000 to December 2015.
Sixty-eight (7%) patients had an ICH (mean age 57±13 years; 75% male). ICH was classified into three groups according to mechanism: ruptured mycotic aneurysm (n=22; 32%); haemorrhage after ischaemic stroke (n=27; 40%); and undetermined aetiology (n=19; 28%). Five variables were independently associated with ICH: platelet count<150×109/L (odds ratio OR 2.3, 95% confidence interval CI 1.01–5.4; P=0.049); severe valve regurgitation (OR 3.2, 95% CI 1.3–7.6; P=0.008); ischaemic stroke (OR 4.2, 95% CI 1.9–9.4; P<0.001); other symptomatic systemic embolism (OR 14.1, 95% CI 5.1–38.9; P<0.001); and presence of mycotic aneurysm (OR 100.2, 95% CI 29.2–343.7; P<0.001). Overall, 237 (24.6%) patients died within 2.3 (0.7–10.4) months of follow-up. ICH was not associated with increased mortality (P not significant). However, the 1-year mortality rate differed according to ICH mechanism: 14%, 15% and 45% in patients with ruptured mycotic aneurysm, haemorrhage after ischaemic stroke and undetermined aetiology, respectively (P=0.03). In patients with an ICH, mortality was higher in non-operated versus operated patients when cardiac surgery was indicated (P=0.005). No operated patient had neurological deterioration.
ICH is a common complication of left-sided IE. The impact on prognosis is dependent on mechanism (haemorrhage of undetermined aetiology). We observed a higher mortality rate in patients who had conservative treatment when cardiac surgery was indicated compared with in those who underwent cardiac surgery.
Les hémorragies intracrâniennes (HIC) compliquant les endocarditis infectieuses (EI) sont une situation clinique cruciale, cependant leurs caractéristiques, impacts, et pronostic restent mal connus.
Analyser l’incidence, les mécanismes, les facteurs de risque, et le pronostic des HIC compliquant les EI.
Cette étude monocentrique a inclus 963 patients avec une EI du cœur gauche possible ou certaine entre janvier 2000 et décembre 2015.
Soixante-huit (7 %) présentaient une HIC (âge moyen de 57±13 ans et 75 % d’hommes). L’HIC était classée selon trois mécanismes : rupture d’anévrysme mycotique (n=22, 32 %) patients, hémorragie secondaire à un accident ischémique cérébral (n=27, 40 %), étiologie non déterminée (n=19, 28 %). Cinq paramètres étaient associés à l’HIC : thrombopénie (OR 2,3, IC 95 % 1,01–5,4 ; p=0,049), fuite sévère valvulaire (OR 3,2, IC 95 % 1,3–7,6 ; p=0,008), accident ischémique cérébral (OR 4,2, IC 95 % 1,9-9,4 ; p<0,001), autre embolie systémique symptomatique (OR 14,1, IC 95 % 5,1–38,9 ; p<0,001), et la présence d’un anévrysme mycotique (OR 100,2, IC 95 % 29,2–343,7 ; p<0,001). La présence d’une HIC n’était pas associée à une surmortalité (p=NS). Cependant, le taux de décès à un an était différent selon le mécanisme : 14 %, 15 % et 45 % respectivement en cas de rupture d’anévrysme mycotique, hémorragie secondaire à un accident ischémique cérébral, et d’étiologie indéterminée (p=0,03). Chez les patients présentant une HIC, la mortalité était plus élevée avec un traitement conservateur malgré l’indication de chirurgie cardiaque par rapport à ceux qui en bénéficiaient (p=0,005). Aucune détérioration neurologique n’est survenue chez les patients ayant bénéficiés d’une chirurgie cardiaque.
L’HIC représente une complication commune aux EI. L’impact pronostique est dépendant du mécanisme de l’HIC (étiologie indéterminée). Nous observons une surmortalité en cas de traitement conservateur lorsqu’il existe une indication chirurgicale cardiaque.
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