Déterminants de l’adhésion vaccinale contre la COVID-19 chez les femmes enceintes et en post-partum pendant la troisième vague de la pandémie : une étude transversale multinationale européenne

Introduction

La vaccination contre le coronavirus (COVID-19) est recommandée chez les femmes enceintes, car elles courent un risque plus élevé de développer une forme sévère de la maladie. Cependant, malgré les preuves croissantes de l’intérêt de la vaccination anti-COVID-19 et de sa sécurité pendant la grossesse, l’hésitation vaccinale demeure élevée dans la population obstétricale – 48,6 % selon une méta-analyse de 46 études publiées jusqu’en février 2022. Ainsi, notre objectif était d’évaluer le statut vaccinal et/ou la volonté de se faire vacciner contre la COVID-19 chez les femmes enceintes et en post-partum dans cinq pays européens et d’en rechercher les facteurs associés.

Méthodes

Il s’agissait d’une étude transversale, menée en Belgique, en Norvège, aux Pays-Bas, en Suisse et au Royaume-Uni entre juin et août 2021. Cette enquête en ligne faisait partie d’un projet de recherche international sur la COVID-19 visant à fournir des informations sur les expériences vécues par les femmes enceintes et les mères ayant accouché dans les 3 derniers mois, pendant la troisième vague de la pandémie.

Résultats

Parmi les 5210 femmes ayant participé à l’étude, nous avons exclu 216 femmes enceintes et 140 en post-partum qui n’avaient pas répondu à la question sur leur statut vaccinal. Chez les femmes enceintes (n = 3195), les proportions de femmes déjà vaccinées et/ou souhaitant être vaccinées étaient 80,5 % en Belgique, 78,5 % au Royaume-Uni, 62,6 % aux Pays-Bas, 32,1 %, en Suisse et 21,5 % en Norvège. Les caractéristiques associées à l’adhésion vaccinale contre la COVID-19 pendant la grossesse étaient l’activité professionnelle, une profession dans le secteur de la santé, un niveau d’éducation élevé, le premier trimestre de la grossesse, et la résidence en Belgique comparée à la Norvège, la Suisse et aux Pays-Bas.

Parmi les femmes en post-partum (n = 1659), les proportions de femmes déjà vaccinées et/ou souhaitant être vaccinées étaient 86,0 % au Royaume-Uni, 85,7 % en Belgique, 81 % en Norvège, 72,6 % aux Pays-Bas et 58,6 % en Suisse. Lors du post-partum, les caractéristiques associées à l’adhésion vaccinale contre la COVID-19 étaient l’âge maternel de « 36–40 ans », puis « 31–35 ans », suivi de « 25–30 ans » par rapport à la catégorie « 18–25 ans », une profession dans le domaine de la santé, l’absence d’antécédent d’infection au SARS-CoV-2, l’absence d’allaitement, et la résidence en Belgique par rapport à la Suisse ou aux Pays-Bas.

Conclusion

L’hésitation vaccinale dépend de nombreux facteurs démographiques et socio-culturels. La connaissance de ces notions est nécessaire afin de mieux l’appréhender, et d’encourager respectueusement l’adhésion à la vaccination.

Persistence of Neuronal Alterations in Alcohol-Dependent Patients at Conclusion of the Gold Standard Withdrawal Treatment: Evidence From ERPs

Background: One of the main challenges for clinicians is to ensure that alcohol withdrawal treatment is the most effective possible after discharge. To address this issue, we designed a pilot study to investigate the efficacy of the rehabilitation treatment on the main stages of information processing, using an electroencephalographic method. This topic is of main importance as relapse rates after alcohol withdrawal treatment remain very high, indicating that established treatment methods are not fully effective in all patients in the long run. Method: We examined in alcohol-dependent patients (ADP) the effects of the benzodiazepine-based standard detoxification program on event-related potential components at incoming (D0) and completion (D15) of the treatment, using tasks of increasing difficulty (with and without workload) during an auditory oddball target paradigm. Untreated non-alcohol-dependent-volunteers were used as matching controls. Results: At D0, ADP displayed significantly lower amplitude for all ERP components in both tasks, as compared to controls. At D15, this difference disappeared for the amplitude of the N1 component during the workload-free task, as well as the amplitude of the P3b for both tasks. Meanwhile, the amplitude of the N2 remained lower in both tasks for ADP. At D0, latencies of N2 and P3b in both task conditions were longer in ADP, as compared to controls, whilst the latency of N1 was unchanged. At D15, the N2 latency remained longer for the workload condition only, whereas the P3b latency remained longer for the workload-free task only. Conclusion: The present pilot results provide evidence for a persistence of impaired parameters of ERP components, especially the N2 component. This suggests that neural networks related to attention processing remain dysfunctional. Longitudinal long-term follow-up of these patients is mandatory for further assessment of a link between ERP alterations and a later risk of relapse.

False memory production in schizophrenia: A neurophysiological investigation

Background

The topic of false memory in schizophrenia has been well documented in earlier research contributions. To date, there is no study exploring the implications of specific neural networks during this phenomenon in patients suffering from schizophrenia.

Methods

We compared 17 patients suffering from psychosis (SCZ) to 33 healthy controls (HC) performing a verbal memory task designed to produce false memories, i.e. the Deese-Roediger-McDermott paradigm (DRM). Electroencephalography was used to specifically analyze the P2 and N400 event-related potentials components.

Results

The SCZ patients showed a reduced ability to distinguish between true and false memories as assessed by the A' index which was calculated based on the false and true memory rates. The morphology of the P2 differed in frontal electrode region with a lower amplitude in SCZ. In addition, the amplitude of N400 was more pronounced (more negative) in HC than in SCZ in centro-parietal electrode site.

Conclusions

We suggest that the differences found in P2 amplitude are associated with difficulties of SCZ patients to efficiently compare item-specific features of a mnesic elements to incoming stimuli which impair the subsequent verbal memory information processing reflected by the N400 component amplitude decrease. These results are consistent with the idea that SCZ use a different strategy while they perform the DRM paradigm.

Reducción del contenido de alcohol y pH de vinos tintos Pinot noir y Tannat empleando uvas con diferentes niveles de maduración

El objetivo de esta investigación fue determinar la efectividad de la mezcla de mostos de uvas con diferente grado de maduración para la obtención de vinos Pinot noir y Tannat con menor contenido de alcohol y pH. En envero, se extrajo mosto de uvas inmaduras que se conservó a 4 ∘C hasta su uso. En madurez tecnológica, las uvas cosechadas fueron despalilladas, estrujadas y distribuidas en seis recipientes. Tres fueron vinificados de forma tradicional, mientras que en los otros tres se realizó una sustitución de 3 L del mosto de uva madura por 3 L del mosto de uvas inmaduras. Ambos tratamientos realizaron una maceración fermentativa de 7 días. Se determinó la composición básica del vino, color, concentración de fenoles totales, antocianos, catequinas y proantocianidinas a los dos meses del descube. La sustitución de mosto permitió elaborar vinos Pinot noir y Tannat con menor contenido de alcohol y pH, sin reducir las concentraciones de polifenoles totales, catequinas o antocianos. El efecto sobre la concentración de proantocianidinas fue variable de acuerdo con el cultivar y año de vendimia. Los vinos Tannat reducidos en alcohol presentaron mayor intensidad de color, menor tono e igual cromaticidad que los vinos testigos.

Evaluación de la composición y calidad del color de vinos tintos Tannat elaborados por maceración pre-fermentativa en caliente

Durante la vendimia 2016 se elaboraron vinos tintos Tannat por maceración pre-fermentativa en caliente (una hora de calentamiento a 60–70 ∘C seguido de una maceración fermentativa de 7 días) y maceración tradicional (maceración fermentativa de 7 días) con el objetivo de evaluar su concentración en compuestos fenólicos y color durante la conservación. Las vinificaciones se realizaron por triplicado en recipientes de 10 litros de capacidad. Se determinó la composición básica del vino, color, concentración de fenoles totales, antocianos, catequinas, proantocianidinas y los índices de ionización, copigmentados y PVPP. Los vinos con maceración pre-fermentativa en caliente presentaron mayor concentración de antocianos y taninos, mayor porcentaje de antocianos ionizados, co-pigmentados y condensados. Adicionalmente, presentaron mayor proporcion de delfinidina, petunidina y peonidina al descube. El calentamiento degrada las enzimas polifenoloxidasas por lo que estas formas antociánicas pudieron haber sido preservadas de la oxidación. Las concentraciones de las diferentes formas antociánicas disminuyeron durante la conservación de los vinos de ambos tratamientos, sin observarse diferencias en el perfil antocianico después de dos años. Los vinos elaborados por maceración pre-fermentativa en caliente presentaron mayor intensidad colorante durante todo el período de evaluación sugiriendo una mayor estabilidad del color.

Composición de vinos tintos elaborados por procedimientos alternativos de vinificación

Los procedimientos empleados en la vinificación pueden atenuar el impacto de eventos climáticos extremos, que afectan la calidad de los vinos. El objetivo de este trabajo fue comparar una vinificación por maceración tradicional (MT) con una vinificación con extracción diferida de antocianos y maceración extendida (EDA+ME), en seis variedades de Vitis vinifera L. (Tannat, Cabernet Sauvignon, Merlot, Cabernet Franc, Syrah y Marselan). Los vinos fueron analizados a los 6 meses de la vinificación. Los vinos de Marselan y Cabernet Sauvignon tuvieron pH muy elevados. Los vinos con mayores contenidos fenólicos totales fueron Tannat y Marselan, que también tuvieron los mayores contenidos de antocianos y proantocianidinas. La mayor intensidad colorante se obtuvo en los vinos Marselan y la menor en Syrah. Los vinos producidos con las dos técnicas presentaron diferencias en tonalidad y % de amarillo (mayores en EDA+ME) y rojo (mayores en MT). Los vinos MT tuvieron mayores contenidos de antocianos y taninos más polimerizados. Los vinos EDA+ME tuvieron contenidos significativamente mayores de polifenoles totales, catequinas y mayor reactividad de los taninos. Un Análisis Discriminante Canónico confirmó que la variedad de uva fue el factor que incidió en mayor medida en las características de los vinos.

Safety of sofosbuvir-based regimens after liver transplantation: longitudinal assessment of renal function in the prospective ANRS CO23 CUPILT study

BACKGROUND

In liver transplant recipients with hepatitis C virus recurrence, there is concern about renal safety of sofosbuvir-based regimens. Changes in serum creatinine or in the estimated glomerular filtration rate (eGFR) under treatment are used to look for possible renal toxicity. However, serum creatinine and eGFR are highly variable.

AIM

To analyse renal function trajectory with numerous assays of serum creatinine over a long period of time.

METHODS

In a multicentre cohort of 139 patients, the eGFR was obtained from serum creatinine using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation. Slopes of eGFR were defined as a change in eGFR during a period divided by time. Pre-treatment, on-treatment and post-treatment periods were 9 months, 3-9 months and 4.5 months. Interactions between eGFR slopes and the pre-treatment eGFR, use of ribavirin or mycophenolate mofetil, and stage of fibrosis were addressed. On-treatment eGFR slopes were separated in tertiles. Pre- and post-treatment eGFR slopes were compared globally and according to tertiles.

RESULTS

The post-treatment eGFR slope was significantly better than pre-treatment eGFR slope (+0.18 (IQR -0.76 to +1.32) vs -0.11 (IQR -1.01 to +0.73) mL/min/1.73 m² /month, P = 0.03) independently of the pre-treatment eGFR (P = 0.99), ribavirin administration (P = 0.26), mycophenolate mofetil administration (P = 0.51) and stage of fibrosis (F3 and F4 vs lower stages, P = 0.18; F4 vs lower stages, P = 0.08; F4 Child-Pugh B and C vs lower stages, P = 0.38). Tertiles of on-treatment eGFR slopes were -1.71 (IQR -2.54 to -1.48), -0.78 (IQR -1.03 to -0.36) and +0.75 (IQR +0.28 to +1.47) mL/min/1.73 m² /month. Pre- and post-treatment eGFR slopes were not significantly different according to tertiles (respectively, P = 0.34, 0.08, 0.73).

CONCLUSION

The eGFR varies during treatment and gives a confusing picture of the renal safety of sofosbuvir-based regimens. In contrast, longitudinal assessment of the eGFR shows a rising trajectory over longer time, meaning that these therapies are safe for the kidneys in our cohort of liver transplant recipients.

Pelvic exenteration for gynecologic malignancies: Postoperative complications and oncologic outcomes

INTRODUCTION AND OBJECTIVE

To evaluate complications, morbidity and oncologic outcomes of pelvic exenteration as treatment for gynecologic malignancies.

MATERIALS AND METHODS

Between 2008 and 2015, a total of 35 patients underwent pelvic exenteration, due to recurrence of gynecological cancer. Surgical outcomes, early and late postoperative complications, and recurrence/survival outcomes were assessed.

RESULTS

Mean patient age was 53.8 years. Anterior exenteration was done in 20 patients, while 15 were total exenterations. Ileal conduit was done in 24 patients, while 8 received a neobladder and 3 a cutaneous ureterostomy. Postoperative complications were divided in 2groups, early (<30 days) and late complications (>30 days). A total of 25 patients (71.4%) had one or more early complications; 16 (45.7%) had fever due to a urinary tract infection, pyelonephritis or intra-abdominal collection; 2 (5.7%) developed a vesicovaginal fistula; 4 (11.4%) a rectovaginal fistula; 3 (8.5%) acute kidney failure and one (2.85%) uronephrosis. Regarding to late complications, 8patients (22.8%) had fever. Six (17%) presented with uronephrosis, and 5 (14.2%) with ureteral-pouch stricture. Five patients (14.2%) had acute renal insufficiency, 3 (8,6%) rectovaginal fistula and one (2.85%) urinary fistula. Mean follow up time was 20.3 month (2-60). A total of 22patients (62.8%) were free of disease. Another 13 (37.1%) patients relapsed. Only 4 (11.4%) patients died after pelvic exenteration due to underlying disease.

CONCLUSION

Pelvic exenteration has a high rate of complications and morbidity, but can be the last curative opportunity in patients with recurrent or persistent gynecologic malignancies. This procedure should be performed by multidisciplinary, experienced teams in a tertiary medical center.

Differences in Social Decision-Making between Proposers and Responders during the Ultimatum Game: An EEG Study

The Ultimatum Game (UG) is a typical paradigm to investigate social decision-making. Although the behavior of humans in this task is already well established, the underlying brain processes remain poorly understood. Previous investigations using event-related potentials (ERPs) revealed three major components related to cognitive processes in participants engaged in the responder condition, the early ERP component P2, the feedback-related negativity (FRN) and a late positive wave (late positive component, LPC). However, the comparison of the ERP waveforms between the responder and proposer conditions has never been studied. Therefore, to investigate condition-related electrophysiological changes, we applied the UG paradigm and compared parameters of the P2, LPC and FRN components in twenty healthy participants. For the responder condition, we found a significantly decreased amplitude and delayed latency for the P2 component, whereas the mean amplitudes of the LPC and FRN increased compared to the proposer condition. Additionally, the proposer condition elicited an early component consisting of a negative deflection around 190 ms, in the upward slope of the P2, probably as a result of early conflict-related processing. Using independent component analysis (ICA), we extracted one functional component time-locked to this deflection, and with source reconstruction (LAURA) we found the anterior cingulate cortex (ACC) as one of the underlying sources. Overall, our findings indicate that intensity and time-course of neuronal systems engaged in the decision-making processes diverge between both UG conditions, suggesting differential cognitive processes. Understanding the electrophysiological bases of decision-making and social interactions in controls could be useful to further detect which steps are impaired in psychiatric patients in their ability to attribute mental states (such as beliefs, intents, or desires) to oneself and others. This ability is called mentalizing (also known as theory of mind).

Assessment of mental workload: A new electrophysiological method based on intra-block averaging of ERP amplitudes

The present study contributes to the current debate about electrophysiological measurements of mental workload. Specifically, the allocation of attentional resources during different complexity levels of tasks and its changes over time are of great interest. Therefore, we investigated mental workload using tasks varying in difficulty during an auditory oddball target paradigm. For data analysis, we applied a novel method to compute event-related potentials (ERPs) by intra-block epoch averaging of P2, P3a and P3b amplitude components for the infrequent target stimuli. We obtained eight consecutive blocks of 5 epochs each, which allowed us to develop an electrophysiological parameter to measure mental workload. In both the easy and the more constraining tasks, the amplitude of P2 decreased beginning with the second block of the sequence. In contrast, the amplitudes of P3a and P3b components linearly decreased following the repetition of the target in the more constraining task, but not in the easy task. Statistical analysis revealed intra-block differences on amplitudes of ERPs of interest between the easy and the more constraining tasks, confirming this method as a measure to assess mental workload. Since a subject is his own control, the present method represents an electrophysiological parameter for individual measurement of mental workload and may therefore be applicable in clinical routine.

The Thermosiphon Cooling System of the ATLAS Experiment at the CERN Large Hadron Collider

The silicon tracker of the ATLAS experiment at CERN Large Hadron Collider will operate around –15°C to minimize the effects of radiation damage. The present cooling system is based on a conventional evaporative circuit, removing around 60 kW of heat dissipated by the silicon sensors and their local electronics. The compressors in the present circuit have proved less reliable than originally hoped, and will be replaced with a thermosiphon. The working principle of the thermosiphon uses gravity to circulate the coolant without any mechanical components (compressors or pumps) in the primary coolant circuit. The fluorocarbon coolant will be condensed at a temperature and pressure lower than those in the on-detector evaporators, but at a higher altitude, taking advantage of the 92 m height difference between the underground experiment and the services located on the surface. An extensive campaign of tests, detailed in this paper, was performed using two small-scale thermosiphon systems. These tests confirmed the design specifications of the full-scale plant and demonstrated operation over the temperature range required for ATLAS. During the testing phase the system has demonstrated unattended long-term stable running over a period of several weeks. The commissioning of the full scale thermosiphon is ongoing, with full operation planned for late 2015.

What animals can teach clinicians about the hippocampus

Abnormalities in hippocampal structure and function have been reported in a number of human neuropathological and neurodevelopmental disorders, including Alzheimer's disease, autism spectrum disorders, Down syndrome, epilepsy, and schizophrenia. Given the complexity of these disorders, animal studies are invaluable and remain to date irreplaceable, providing fundamental knowledge regarding the basic mechanisms underlying normal and pathological human brain structure and function. However, there is a prominent ill-conceived view in current research that scientists should be restricted to using animal models of human diseases that can lead to results applicable to humans within a few years. Although there is no doubt that translational studies of this kind are important and necessary, limiting animal studies to applicable questions is counterproductive and will ultimately lead to a lack of knowledge and an inability to address human health problems. Here, we discuss findings regarding the normal postnatal development of the monkey hippocampal formation, which provide an essential framework to consider the etiologies of different neuropathological disorders affecting human hippocampal structure and function. We focus on studies of gene expression in distinct hippocampal regions that shed light on some basic mechanisms that might contribute to the etiology of schizophrenia. We argue that researchers, as well as clinicians, should not consider the use of animals in research only as 'animal models' of human diseases, as they will continue to need and benefit from a better understanding of the normal structure and functions of the hippocampus in 'model animals'.

miRNA regulation of gene expression: a predictive bioinformatics analysis in the postnatally developing monkey hippocampus

Regulation of gene expression in the postnatally developing hippocampus might contribute to the emergence of selective memory function. However, the mechanisms that underlie the co-regulation of expression of hundreds of genes in different cell types at specific ages in distinct hippocampal regions have yet to be elucidated. By performing genome-wide microarray analyses of gene expression in distinct regions of the monkey hippocampal formation during early postnatal development, we identified one particular group of genes exhibiting a down-regulation of expression, between birth and six months of age in CA1 and after one year of age in CA3, to reach expression levels observed at 6–12 years of age. Bioinformatics analyses using NCBI, miRBase, TargetScan, microRNA.org and Affymetrix tools identified a number of miRNAs capable of regulating the expression of these genes simultaneously in different cell types, i.e., in neurons, astrocytes and oligodendrocytes. Interestingly, sixty-five percent of these miRNAs are conserved across species, from rodents to humans; whereas thirty-five percent are specific to primates, including humans. In addition, we found that some genes exhibiting greater down-regulation of their expression were the predicted targets of a greater number of these miRNAs. In sum, miRNAs may play a fundamental role in the co-regulation of gene expression in different cell types. This mechanism is partially conserved across species, and may thus contribute to the similarity of basic hippocampal characteristics across mammals. This mechanism also exhibits a phylogenetic diversity that may contribute to more subtle species differences in hippocampal structure and function observed at the cellular level.

ECP09-03 - Information technologies in psychiatry

Even if technology and information are omnipresent, they rarely meet harmoniously. Either the lack of sufficient means prevents good information to reach its target or the technology is too complex to integrate flawlessly in the daily workflow.

The use and misuse of information technologies (internet, email, e-learning, social networks) has recently significantly increased among psychiatrists and patients and the changes in behavior of communication and seeking informations are real challenges.

Using the European Federation of Psychiatric Trainees network, the self-questionnaires concerning the usage of information technologies and the local patients-therapists communication were distributed among psychiatric trainees of 31 European countries.

A review of the results of this study, as well as recommendations about netiquette and useful websites for psychiatrists and scientists will be presented in detail.

ECP09-02 - Psychiatry training in europe: Implementation and evaluation of training programs

Training schemes in psychiatry are developed and evaluated by national education policy makers in the majority of European countries. However, the requirements that a training program in psychiatry should meet are also defined on the European level in a form of recommendations by the Board of Psychiatry - European Union of Medical Specialists (UEMS).

Recently, the European Federation of Psychiatric Trainees (EFPT) which represent trainees from more then 30 European countries, reported data pertaining to the structure of training programs and to the evaluation of training programs in 30 European countries. Whereas in the majority of European countries the structure of training programs and methods of assessment of trainees' competencies are partially compatible with one another and with the existing recommendations at the European level, the quality assurance of training programs varies significantly among countries. Regular evaluations of training programs and mentors, however, contribute to the proper implementation of training programs and help that the theoretical training principles are followed through in practice. As quality assurance of training schemes is an important mechanism how to improve the delivery of training programs, it should gain more focus by responsible authorities who structure the psychiatric training on the national and international European level.

ECP09-01 - European federation of psychiatric trainees: Visions for the future

There are significant differences in psychiatric training across Europe. In the light of the current direction of Europe (without borders with free movement of workforce) it is inevitable to harmonize at least basic standards of psychiatric education across Europe. Ideally by working in partnership with relevant national and international bodies (European Union of Medical Specialists, Board of Psychiatry - UEMS, European Psychiatric Association - EPA and European Federation of Psychiatric Trainees - EFPT). A qualitative data analysis on the most important challenges of psychiatric trainees across Europe, carried out by the EFPT in 2009, revealed several interesting findings which might be of interest not only for trainees, but for all involved in the process of psychiatric education. As the most important issue trainees reported the imperfect structure of the training programs and problems with implementation of new ones. That is why new training programs based on a competency based framework are being developed lately in number of countries (e.g. United Kingdom, Ireland, Netherlands). However, not only the structure of the training and its implementation remains an issue, trainees are concerned also with topics related to working conditions, insufficient training opportunities, lack of supervision, funding and availability of psychotherapy courses, etc. Based on these findings EFPT will undertake specific actions which in cooperation with other organizations shall lead in the future to better postgraduate training opportunities in Europe.

Synthesis and application of a N-1' fluorescent biotinyl derivative inducing the specific carboxy-terminal dual labeling of a novel RhoB-selective scFv

The fluorescent site-specific labeling of protein would provide a new, easy-to-use alternative to biochemical and immunochemical methods. We used an intein-mediated strategy for covalent labeling of the carboxy-terminal amino acid of a RhoB-selective scFv previously isolated from a phage display library (a human synthetic V(H) + V(L) scFv phage library). The scFv fused to the Mxe intein was produced in E. coli and purified and was then labeled with a newly synthesized fluorescent biotinyl cysteine derivative capable of inducing scFv-Mxe intein splicing. In this study, we investigated the splicing and labeling properties of various amino acids in the hinge domain between scFv and Mxe under thiol activation. In this dual labeling system, the fluorescein is used for antibody detection and biotin is used for purification, resulting in a high specific activity for fluorescence. We then checked that the purified biotinylated fluorescent scFv retained its selectivity for RhoB without modification of its affinity.

High duty factor plasma generator for CERN's Superconducting Proton Linac

CERN's Linac4 is a 160 MeV linear accelerator currently under construction. It will inject negatively charged hydrogen ions into CERN's PS-Booster. Its ion source is a noncesiated rf driven H(-) volume source directly inspired from the one of DESY and is aimed to deliver pulses of 80 mA of H(-) during 0.4 ms at a 2 Hz repetition rate. The Superconducting Proton Linac (SPL) project is part of the luminosity upgrade of the Large Hadron Collider. It consists of an extension of Linac4 up to 5 GeV and is foreseen to deliver protons to a future 50 GeV synchrotron (PS2). For the SPL high power option (HP-SPL), the ion source would deliver pulses of 80 mA of H(-) during 1.2 ms and operate at a 50 Hz repetition rate. This significant upgrade motivates the design of the new water cooled plasma generator presented in this paper. Its engineering is based on the results of a finite element thermal study of the Linac4 H(-) plasma generator that identified critical components and thermal barriers. A cooling system is proposed which achieves the required heat dissipation and maintains the original functionality. Materials with higher thermal conductivity are selected and, wherever possible, thermal barriers resulting from low pressure contacts are removed by brazing metals on insulators. The AlN plasma chamber cooling circuit is inspired from the approach chosen for the cesiated high duty factor rf H(-) source operating at SNS.

Correlation between RhoB and Estrogen Receptor α (ERα) Expressions: From Experimental Data to Human Breast Tumors

Introduction: Hormonotherapy (HT) of breast cancers (BC) is strongly limitated by the resistances. Because Rho proteins are key elements in the cross-talks between ERα and growth factors signaling, they may be involved in the response to HT. RhoB could play a negative role in oncogenesis but there is no valid data regarding RhoB expression in BC. Experimental results: Our data suggest that RhoB participates in the balance of expression of ERα. The inhibition of the expression of RhoB using two sequences of interfering RNA in hormonodependent cell lines (MCF-7, T47D, ZR75) and in anti-estrogen resistant cell lines (LCC2, LCC9), decreases the expression of ERα both at the protein and mRNA levels. Moreover, in Mouse Embryonic Fibroblasts and uteri collected from RhoB knock-out mice, a dramatic decrease of ERα expression is observed. We therefore investigated the expression level of RhoB and ERα in BC tumors. Patients and methods: A tissue microarray (TMA) was constructed from a cohort of 113 patients (pts) enrolled in a randomized trial for adjuvant tamoxifen (median follow-up: 249.9 months). RhoB, ERα, and PR expressions were measured by immunochemistry. Cut-off used for ERα and PR + was 10% of stained cells. The expression of RhoB was calculated with the IRS score. Correlation of RhoB expression score with clinically diagnostic and prognostic variables was assessed using Man Whitney and Spearman's rank tests. Univariate survival analysis was performed for disease free survival (DFS) by applying the log-rank test to RhoB expression levels stratified by median value. TMA results: 65 (58.6%) were grade I-II; 74(66.1%) were ERα+ and 59(52.7%) PR+; 23 (22.1%) presented lymphovascular (LV) invasion. 39 pts (34.8%) had lymph nodes (LN) +. Pts under tamoxifen (n=62) had a less favorable pathological profile regarding + LN (p=0.0039), pathological tumour size (p=0.0486) and number of mitoses (p=0.0556). Age, ERα/PR status, histological grade or type and LV invasion status were similar in the two groups. We found less RhoB IRS expression in pts with tumor grade III (median 8 [1;12]) than in grade I-II (median 9 [3;12], p=0.0142). RhoB IRS expression was much higher in ERa + tumors (median:10.5 [3;12]) than in ERa negative tumors (median=8 [1;12], p=0.0023). RhoB IRS score was not correlated with the presence or not of LV invasion (p=0.26), neither with the presence of LN invasion (p= 0.74). Furthermore, RhoB expression is i) strongly correlated with the % of expression of ERα (Spearman'sρ=0.3659; p = 0.001) and PR (Spearman's ρ=0.2544 ; p=0.0076) ii) inversely correlated with histologic size (Spearman's ρ= -0.2344 ; p = 0.0166) and with number of mitose (Spearman's ρ=-0.2009 ; p=0.0362). The DFS of pts with ERα + tumors under tamoxifen or not was not affected by the level of RhoB expression. Conclusion: The analysis of 113 human breast tumors allowed to confirm experimental results, demonstrating that RhoB expression is strongly correlated with ERα expression. The role of RhoB as a potential suppressor gene of tumours in BC and its role in the response to HT have then to be investigated further.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5146.

Sideroblastic changes of the bone marrow can be predicted by the erythrogram of peripheral blood

The diagnosis of sideroblastic anemia is based on bone marrow aspiration, and the detection of ring sideroblasts (RS) in iron staining. The finding of laboratory parameters to approach this diagnosis still remains a great challenge. In this study, we analyzed the value of a specific erythrogram pattern from peripheral blood, produced by the ADVIA120 cell counter, to predict sideroblastic changes in the bone marrow. In a two step-design study, we first showed that 32/38 consecutive patients reporting > or =15% RS had such a pattern in the erythrogram. In the second step, we prospectively identified over a period of 32 months 21 patients with this typical erythrogram; 20/21 had > or =15% RS in the bone marrow. Hence, by this validation, we confirm that the erythrogram is highly predictive of RS in the bone marrow. The interpretation of the erythrogram should become daily practice in hematology to improve the efficacy to detect sideroblastic changes.

Preclinical study of an ex vivo gene therapy protocol for hepatocarcinoma

Preclinical studies in several animal models as well as clinical trials have shown a reduction in tumor growth following immunotherapy with interleukin-12 (IL-12). This cytokine is appropriate to test in therapeutic clinical trials to treat hepatocarcinoma (HC), a pathology often associated with hepatitis B or C-induced cirrhosis. The local delivery into the liver would be achieved through ex vivo gene transfer using retroviral (rv) vectors in autologous fibroblast carriers. In support of this clinical trial, a rv vector has been constructed to express coordinately both chains p35 and p40 of human IL-12. Here, we have tested good manufacturing practices (GMP) clinical lots of viral vectors derived from the transfected packaging cell line, PG13rvIL-12. We have also devised methods to facilitate the isolation of fibroblasts from freshly harvested skin specimens, enhance their outgrowth in large-scale cultures and assay IL-12 production following transduction, without any selection and irradiation. Twenty-four human skin specimens were processed to obtain fibroblast suspensions that were typically maintained for up to 8 or 12 passages. The mean +/-s.d. overall time for obtaining the required number of transduced cells for the highest IL-12 need was 40 days. The procedure, in accordance with the French medical agency for gene therapy clinical trials, is now ready to begin a clinical trial.