Local approach to fracture based prediction of the ∆T56J and ∆T K1C100 shifts due to irradiation for an A508 pressure vessel steel

International audienceA material model integrating a description of viscoplasticity, ductile damage and brittle fracture is used to simulate both the impact (Charpy) test and the toughness (CT) fracture test. The model is calibrated on the Charpy data obtained on an unirradiated A508 Cl.3 steel. It is then applied to irradiated material assuming that irradiation affects solely hardening. Comparison with Charpy energy data for different amounts of irradiation shows that irradiation probably also affects brittle fracture. The model is then used to predict the DTKIc100 shifts for different levels of irradiation

Cleavage fracture micromechanisms related to WPS effect in RPV steel

International audienceThe main objective of this paper is to characterise the changes caused by warm pre-stress (WPS) on the cleavage fracture micromechanisms of a 18MND5 (A533B) reactor pressure vessel (RPV) steel. In this purpose, different WPS fracture test results obtained on compact tensile (CT) and notched tensile (NT) geometries are presented and compared with isothermal test data. While confirming some well-established features of WPS, these experimental results, analysed through extensive fractographic investigations and finite element (FE) calculations, demonstrate a strong material aspect to WPS. One unveiled characteristic of the WPS effect is the deactivation of particles at high temperature through plastic straining under low stress, which enables breaking, or detaching from the matrix, the most critical particles without causing unstable cleavage propagation. In 18MND5 steel, these particles are TiN and carbide particles: according to the pre-stress level and fracture geometry, there is a progressive shift from TiN- to carbide-induced cleavage, up to the replacement of both by ductile type nucleation mechanisms

Transferability of cleavage fracture parameters between notched and cracked geometries

International audienceThe present study investigates the temperature ...

Local approach to fracture based prediction of the ΔT56J and ΔTKIc 100 shifts due to irradiation for an A508 pressure vessel steel

International audienceNuclear pressure vessel steels are subjected to irradiation embrittlement which is monitored using Charpy tests. Reference index temperatures, such as the temperature for which the mean Charpy rupture energy is equal to 56 J (T56J), are used as embrittlement indicators. The safety integrity evaluation is performed assuming that the shift of the nil-ductility reference temperature RTNDT due to irradiation is equal to the shift of T56J. A material model integrating a description of viscoplasticity, ductile damage and cleavage brittle fracture is used to simulate both the Charpy test and the fracture toughness test (CT geometry). The model is calibrated on the Charpy data obtained on an unirradiated A508 Cl.3 steel. It is then applied to irradiated materials assuming that irradiation affects solely hardening. Comparison with Charpy energy data for different amounts of irradiation shows that irradiation possibly also affects brittle fracture. The model is then applied to predict the fracture toughness shifts (ΔTKIc,100) for different levels of irradiation

Marketing authorization procedures for advanced cancer drugs: exploring the views of patients, oncologists, healthcare decision makers and citizens in France

International audienceBackground. The past decades have seen advances in cancer treatments in terms of toxicity and side effects but progress in the treatment of advanced cancer has been modest. New drugs have emerged improving progression free survival but with little impact on overall survival, raising questions about the criteria on which to base decisions to grant marketing authorizations and about the authorization procedure itself. For decisions to be fair, transparent and accountable, it is necessary to consider the views of those with relevant expertise and experience. Methods. We conducted a Q-study to explore the views of a range of stakeholders in France, involving: 54 patients (18 months after diagnosis); 50 members of the general population; 27 oncologists; 19 healthcare decision makers; and 2 individuals from the pharmaceutical industry. Results. Three viewpoints emerged, focussing on different dimensions entitled: 1) ‘Quality of life (QoL), opportunity cost and participative democracy’; 2)‘QoL and patient-centeredness’; and 3) ‘Length of life’. Respondents from all groups were associated with each viewpoint, except for healthcare decision makers, who were only associated with the first one. Conclusion. Our results highlight plurality in the views of stakeholders, emphasize the need for transparency in decision making processes, and illustrate the importance of a re-evaluation of treatments for all 3 viewpoints. In the context of advanced cancer, our results suggest that QoL should be more prominent amongst authorization criteria, as it is a concern for 2 of the 3 viewpoints

Diagnosis and management of anaemia and iron deficiency in patients with haematological malignancies or solid tumours in France in 2009-2010: the AnemOnHe study

OBJECTIVE: To describe the management of anaemia in 2009-2010 in France in patients with haematological malignancies (HM) or solid tumours (ST). METHODS: Retrospective observational study in 57 centres, enrolling adult patients with HM or ST treated for an episode of anaemia (duration of the episode >/= 3 months occurring in the last 12 months). RESULTS: 220 patients with ST (breast, 18%; lung, 18%) and 56 with HM (lymphoma, 60%) were included (median age, 68 years; female, 53%). Mean haemoglobin level at anaemia diagnosis was 9.3 +/- 1.4 g/dL (<8 g/dL for 16%) and 9.8 +/- 1.1g/dL (<8 g/dL for 6%) in HM and ST patients, respectively. At least one parameter of iron deficiency (ferritin, transferrin saturation) was assessed in 26% of HM and 19% of ST patients. Treatment of anaemia included erythropoiesis-stimulating agents (ESA) for 98% of HM and 89% of ST patients. Iron was prescribed to 14% (oral, 12%; intravenous, 2%) of HM patients and to 42% (oral, 17%; intravenous, 25%) of ST patients. The rates of blood transfusions were high: 70% in HM and 46% in ST patients; transfusions alone or administrated with ESA were more frequent in patients with Hb <8 g/dL. CONCLUSION: Although recent guidelines recommend evaluating iron deficiency and correcting anaemia by using intravenous iron, our study in cancer patients evidenced that ESA and blood transfusions are still frequently used as the treatment of anaemia in cancer patients. Iron deficiency is insufficiently assessed (only one patient among five) and as a consequence iron deficiency is most likely insufficiently treated

Place du médecin généraliste dans la nouvelle organisation des soins en cancérologie

La prise en charge des patients atteints de cancer sollicite les médecins généralistes (MG). Le MG partage son action entre la prévention, le dépistage, l'annonce et le suivi. Le suivi des patients atteints de cancer est lui-même réparti entre la gestion des effets indésirables de la maladie et les complications dues au cancer lui-même. A Toulouse, l'Institut Universitaire du cancer (IUC) ouvre ses portes prochainement. L'interface de la médecine libérale et hospitalière sera donc un enjeu important pour permettre à tous les patients de la région de recevoir des soins mais également de rentrer à domicile dans de bonnes conditions. Les liens entre l'oncologie et la MG vont devoir se resserrer et les disciplines devront se comprendre. La première partie du travail consiste à explorer les différentes phases de l'annonce du diagnostic de cancer par le MG. Les résultats indiquent que l'annonce du cancer se réalise en trois phases : la " pré-annonce ", l'annonce institutionnelle et la " post annonce ". La seconde partie consiste à d'étudier le rôle du MG dans l'information du patient et de sa famille, lors de l'entrée en phase palliative des patients atteints de cancer du poumon. 77% des patients ont vu leur MG après l'annonce du diagnostic initial et 53% attendaient une information sur le pronostic. Les MG disent avoir des difficultés à répondre aux attentes d'information des patients et de leurs familles en situation palliative. Un troisième travail a été de comprendre l'enjeu pour la MG de repérer les patients âgés " fragiles " et " pré-fragiles ". Ils constituent une population cible pouvant bénéficier d'interventions spécifiques pour retarder l'entrée dans la dépendance. Ces patients ne sont, à ce stade, pas encore vus par le gériatre. Près d'un tiers des cancers surviennent chez les plus de 75 ans. La vitesse de marche a été testée et s'avère être un outil décisif. Dans une quatrième partie, nous avons développé des fiches descriptives des effets indésirables des chimiothérapies anti-cancéreuses et des conduites à tenir pour les MG. L'évaluation s'est déroulée en 3 temps : le recueil des attentes, l'opinion sur les fiches et l'utilité des fiches. 200 MG concernés ayant des patients en cours de chimiothérapie ont été interrogés. Plus de 70% les ont utilisées et les ont trouvées utiles. Un projet de surveillance alternée des patientes atteintes de cancer du sein en Midi-Pyrénées, cinquième partie de mon travail de thèse, a été lancé en 2010. Les résultats de cette étude prospective interventionnelle ont été obtenus à la fin de l'année 2013. Le modèle de surveillance que nous avons proposé est décevant. Les oncologues adhèrent peu au dispositif et les MG ne tracent pas les consultations de surveillance de façon systématique. Enfin, dans le but de réduire les inégalités de santé face aux cancers, nous avons développé un projet permettant d'améliorer la reconnaissance des cancers en maladies professionnelles. Ce projet prospectif et interventionnel permet de repérer les patients concernés, de reconstruire leur parcours professionnel et d'aider les MG dans les démarches de déclaration. Tous les dossiers proposés ont été reconnus en maladie professionnelle. Cette thèse permet de mettre en place des actions concrètes dans le but d'améliorer la prise en charge des patients atteints de cancer. Ces travaux permettent de faire le lien entre l'oncologie et la médecine générale en redonnant aux médecins généralistes leur place dans l'organisation des soins en cancérologie.The overall management of cancer patients requests general practitioners (GPs). GP takes part in prevention, screening, announcement and follow-up. Cancer patients' follow-up is divided into management of adverse effects of the disease and complications due to cancer itself. In Toulouse, the University Cancer Institute is about to open. Coordination between private practices and public hospital is key to ensure that all patients receive care and support from hospital bedside to home. Oncology and general practice will have to strengthen the ties and gain better understanding of eachother. The first part of the work is to explore the various phases of the diagnosis of cancer by GPs. The results indicate that the announcement of cancer is done in three phases: "pre-announcement " institutional announcement and "post-announcement". The second part is to investigate GP's role in informing patient and his family at the entry into palliative patients with lung cancer. 77% of patients saw their GP after the announcement of the initial diagnosis and 53 % expected prognostic information. GPs say they have difficulty in meeting the expectations of information for patients and their families in palliative situation. A third study was to understand the challenge for the GPs to identify older patients "frail" and "pre- frail". They are a target population can benefit from specific interventions to delay entry into dependency. These patients are at this stage, not yet seen by the geriatrician. Nearly a third of all cancers occur in people over 75 years. Walking speed has been tested and proved to be a decisive tool. In the fourth part, we developed sheets of adverse effects of anti-cancer chemotherapy and guidelines for GPs. The evaluation was conducted in three stages: collection of expectations, GPs opinion and sheets' utility. 200 GPs concerned with patients undergoing chemotherapy were interviewed. Over 70% have used them and found them useful. A draft alternate follow-up of patients with breast cancer in Midi- Pyrenees, fifth part of my thesis, was launched in 2010. The results of this prospective interventional study were obtained at the end of 2013. The monitoring model we proposed is disappointing. Oncologists adhere little device and GPs do not draw follow-up consultations systematically. Finally, in order to reduce inequalities between patient facing cancer, we developed a project to recognize cancer as occupational disease. This prospective and interventional project identifies these patients to rebuild their career (" Cursus Laboris ") and to assist in GP's approaches statement. All available records have been recognized as occupational disease. This thesis points out field actions that could improve cancer patient care. The main idea is to narrow the gap between oncology and general practice by putting GPs at the heart of french cancer care planning

Approche locale de la propagation de l'arrêt de fissure fragile

Quatorze essais de chocs thermiques sur disques pré-fissurés ont été réalisés. Ils ont permis de mettre en évidence la dépendance à la géométrie de la ténacité à l'arrêt lorsque ce paramètre est déterminé à partir d'une analyse élasto-statique. Cette dépendance provient des effets dynamiques : en effet l'amplification dynamique en fin de propagation dépend de la complaisance initiale de l'éprouvette. L'analyse en dynamique et en élasto-viscoplastique montre que la contrainte locale en pointe de fissure augmente avec l'avancée de la fissure lorsque celle-ci se propage dans la zone de fort gradient, vers la zone ductile. Ce résultat rend difficile toute interprétation élasto-statique de l'arrêt de fissure d'où l'introduction d'une contrainte critique de clivage, de type RKR, en pointe de fissure qui évoluerait avec la température. Les premiers résultats obtenus, avec ce critère, montrent une assez bonne corrélation entre les résultats expérimentaux et les simulations numériques

A long-term survivor of repeated inguinal nodes recurrence of papillary serous adenocarcinoma of CUP: case report

BACKGROUND: Tumor spread beyond the peritoneal cavity in cases of papillary serous adenocarcinoma of the unknown primary (CUP) is a rare late event and carries a poor prognosis. CASE PRESENTATION: A 71-year-old female was referred to our hospital because of a large right inguinal tumor with biopsy evidence of carcinoma as well as an elevated serum CA125 (cancer antigen 125). She underwent complete resection of the right inguinal tumor and multiple pelvic tumors, which involved the rectum, ovary and uterus. Pathological examination revealed the tumors to be metastases of a papillary serous adenocarcinoma with a psammoma body of CUP. On the 28th postoperative day, newly developed asymptomatic small left inguinal node metastases in the setting of a normal CA125 level were removed. Four and a half years after the primary resection, the CA125 level increased again and newly developed asymptomatic metastases were found in the right deep inguinal nodes and extirpated at that time. All surgical resections followed the modified FAM (5FU, Adriamycin; ADM, MMC) regimen, including protracted dairy oral administration of UFT or 5'-FDUR, Cimetidine and PSK (protein-bound polysaccharide K) as an immunomodulator or biological response modifier in conjunction with intermittent one-day continuous infusion (ADM+MMC) or intermittent single bolus injection of ADM+MMC. At present, the patient has been living in good health for almost 7 years with no evidence of relapse. CONCLUSION: Aggressive resection surgery followed by effective adjuvant chemotherapy is necessary for surviving long time without relapse of poorly prognostic patients with metastases outside of the abdominal cavity from peritoneal papillary serous adenocarcinomas