Evaluation de la faisabilité d'une prise en charge adjuvante par trastuzumab du cancer du sein localisé chez le sujet âgé (>= 65 ans)

PARIS-BIUP (751062107) / SudocSudocFranceF

Security Analysis: From model to system analysis

International audienceThere is a wide range of security solutions on cyber-physical systems, most aimed at preventing an adversary from gaining access to the system. However, to make a cyber-physical system more resilient and discover possible attack scenarios, it is necessary to analyze systems by taking into account their interactions with their environment. Standard formal analysis approaches are based on a model of the system. From a quantitative and qualitative point of view, the results of these analyzes depends on the model abstraction relative to the system. Usually, property verification is performed with formulas expressed in specific logics such as LTL or CTL. One of the problems is the semantic gap between textual requirements and these formalisms. In a security context, attacker interests are also necessary to take into account in the properties expression, in addition to system requirements. In this article we propose an approach allowing to analyze a real cyber-physical system while taking into account the interests of an attacker and while reducing the semantic gap between the textual requirements and logic formulas. The proposed methodology relies on the property specification patterns and the specification of an interface related to the state of the deployed embedded software. The motivating example used in this article comes from an industrial partner included in a collaborative project

A Domain-specific Modeling Framework for Attack Surface Modeling

International audienceCybersecurity is becoming vital as industries are gradually moving from automating physical processes to a higher level automation using cyber physical systems (CPS) and internet of things (IoT). In this context, security is becoming a continuous process that runs in parallel to other processes during the complete life cycle of a system. Traditional threat analysis methods use design models alongside threat models as an input for security analysis, hence missing the life-cycle-based dynamicity required by the security concern. In this paper, we argue for an attacker-aware systems modeling language that exposes the systems attack surfaces. For this purpose, we have designed Pimca, a domain specific modeling language geared towards capturing the attacker point of view of the system. This study introduces the formalism along with the Pimca workbench, a framework designed to ease the development and manipulation of the Pimca models. Finally, we present two relevant use cases, serving as a preliminary validation of our approach

The Immune Microenvironment of Chordomas: An Immunohistochemical Analysis

International audienceChordomas are rare sarcomas that are usually treated by surgery and/or radiotherapy since these are chemo-resistant tumors, but immunotherapy could be a possible option for chordoma patients. However, few reports investigating the composition of the chordoma immune microenvironment exist. We immunohistochemically studied 81 chordomas regarding their immune microenvironment factors and compared them with clinicopathological data. Macrophages and CD4 cells were the most prominent inflammatory cell populations, followed by CD8 T cells, while CD20 B cells and high endothelial venules (MECA-79+) were less frequently found. PD-L1 (22C3) expression by inflammatory cells was found in 21 (26%) tumors and was associated with a larger tumor size. None of the cases showed the expression of PD-L1 by tumor cells. Survival analysis showed that younger patients had a better overall survival. Considering the immunohistochemical factors studied, higher CD8, the presence of PD-L1+ immune cells, and higher vascular density were adverse prognostic factors, but in multivariate analysis, only PD-L1+ immune cells retained prognostic significance. To conclude, chordoma tumor cells do not express PD-L1, but PD-L1+ immune cells seem to play a negative prognostic role, supporting the need for further studies in this field and the possible beneficial role of immunotherapy in these patients

Comparison of the validity, perceived usefulness, and usability of I-MeDeSA and TEMAS, two tools to evaluate alert system usability

International audienceObjective: Two tools are currently available in the literature to evaluate the usability of medication alert systems, the instrument for evaluating human factors principles in medication-related decision support alerts (I-MeDeSA) and the tool for evaluating medication alerting systems (TEMAS). This study aimed to compare their convergent validity, perceived usability, usefulness, strengths, and weaknesses, as well as users' preferences.Method: To evaluate convergent validity, two experts mapped TEMAS' items against I-MeDeSA's items with respect to the usability dimensions they target. To assess perceived usability, usefulness, strengths, and weaknesses of both tools, staff with expertise in their medication alerting system were asked to use French versions of the TEMAS and I-MeDeSA. After the use of each tool, participants were asked to complete the System Usability Scale (SUS) and answer questions about the understandability and usefulness of each tool. Finally, participants were asked to name their preferred tool. Numeric scores were statistically compared. Free-text responses were analyzed using an inductive approach.Results: Forty-five participants from 10 hospitals took part in the study. In terms of convergent validity, I-MeDeSA focuses more on the usability of the graphical user interface while TEMAS considers a wider range of usability principles. Both tools have a fair level of perceived usability (I-MeDeSA' SUS score = 61.85 and TEMAS' SUS score = 62.87), but results highlight that revisions are necessary to both tools to improve their usability. Participants found TEMAS more useful than I-MeDeSA (t = -3.63, p =.005) and had a clear preference for TEMAS to identify problems in formative evaluation (39 of 45; 0.867, p <.001) and to compare the usability of alert systems during the procurement process (36 of 45; 0.8, p <.001).Conclusions: The TEMAS is perceived as more useful and is preferred by participants. The I-MeDeSA seems more relevant for quick evaluations that focus on the graphical user interface. The TEMAS seems to be more suitable for in-depth usability evaluations of alert systems. Even if both tools are perceived to be equally usable, they suffer from wording, instructional, and organizational problems that hinder their use. The results of this study will be used to improve the design of I-MeDeSA and TEMAS

Encrusted Urinary Tract Infections Due to Corynebacteria Species

International audienceIntroduction: Encrusted pyelitis and cystitis are peculiar disorders characterized by the calcification of the vesical, the pyelic, and/or the ureteral walls. These calcifications are composed of struvite and calcium carbonate‒apatite due to the presence of Corynebacterium urealyticum.Methods: We have identified the clinical features and outcomes of 17 patients with encrusted pyelitis (n = 15) or encrusted cystitis (n = 2). Diagnosis was based on computed tomography scan and sonography including thickening and calcified lesions of the urinary tract.Results: The main clinical presentation was suggestive of subacute urinary tract infection with fever and urologic symptoms, mostly gross hematuria. Biologic features were characterized by the presence of struvite crystals and alkaline urine. Acute kidney injury was reported in 70.6% of cases. Predisposing factors were mostly due to urologic background (82.4%) with a history of urologic procedure (71%) and prior exposure to antibiotics (59%). All patients received appropriate antibiotherapy and 15 were treated with topical urinary acidification. A significant reduction of encrusted calcifications was observed in 88% of cases. Renal function improved in 71% of the patients. Nevertheless, poor tolerance of the treatment and side effects were common, affecting 71% of patients, with Gram-negative bacilli urinary tract infections (53%) being the most frequent. At last follow-up, 4 patients (23.5%) progressed to end-stage renal disease and only 1 had a clinical relapse.Conclusions: Encrusted urinary tract infections are rare, characterized by a severe renal and overall prognosis in the absence of appropriate treatment. Topical urinary acidification and appropriate antibiotherapy are efficient but may be burdened by significant adverse events