In Vivo Characterization of a Wireless Telemetry Module for a Capsule Endoscopy System Utilizing a Conformal Antenna

This paper describes the design, fabrication, packaging, and performance characterization of a conformal helix antenna created on the outside of a 10 mm ×30 mm capsule endoscope designed to operate at a carrier frequency of 433 MHz within human tissue. Wireless data transfer was established between the integrated capsule system and an external receiver. The telemetry system was tested within a tissue phantom and in vivo porcine models. Two different types of transmission modes were tested. The first mode, replicating normal operating conditions, used data packets at a steady power level of 0 dBm, while the capsule was being withdrawn at a steady rate from the small intestine. The second mode, replicating the worst-case clinical scenario of capsule retention within the small bowel, sent data with stepwise increasing power levels of –10, 0, 6, and 10 dBm, with the capsule fixed in position. The temperature of the tissue surrounding the external antenna was monitored at all times using thermistors embedded within the capsule shell to observe potential safety issues. The recorded data showed, for both modes of operation, a low error transmission of 10−3 packet error rate and 10−5 bit error rate and no temperature increase of the tissue according to IEEE standards

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Background: Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective: To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources: Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods: Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results: Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations: The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions: The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. Study registration: This study is registered as PROSPERO CRD42016039494. Funding: The National Institute for Health Research Health Technology Assessment programme

Life-long diseases need life-long treatment: long-term safety of ciclosporin in canine atopic dermatitis

Ciclosporin (Atopica; Novartis Animal Health) has been licensed for canine atopic dermatitis (AD) since 2002. Adverse events (AEs) have been reported in 55 per cent of 759 dogs in 15 clinical trials, but are rare in pharmacovigilance data (71.81 AEs/million capsules sold). Gastrointestinal reactions were most common, but were mild and rarely required intervention. Other AEs were rare (≤1 per cent in clinical trials; <10/million capsules sold). Hirsutism, gingival hyperplasia and hyperplastic dermatitis were rarely significant and resolved on dose reduction. Ciclosporin decreases staphylococcal and Malassezia infections in AD, and at the recommended dose is not a risk factor for other infections, neoplasia, renal failure or hypertension. The impact on glucose and calcium metabolism is not clinically significant for normal dogs. Concomitant treatment with most drugs is safe. Effects on cytochrome P450 and MDR1 P-glycoprotein activity may elevate plasma ciclosporin concentrations, but short-term changes are not clinically significant. Monitoring of complete blood counts, urinalysis or ciclosporin levels is not justified except with higher than recommended doses and/or long-term concurrent immunosuppressive drugs. Ciclosporin is not a contraindication for killed (including rabies) vaccines, but the licensed recommendation is that live vaccination is avoided during treatment. In conclusion, ciclosporin has a positive risk-benefit profile for the long-term management of canine AD

Quinze années de gestion des feux pastoraux dans les Pyrénées : du blocage à la concertation

International audienceLe débroussaillement et l'entretien des pâturages par le feu sont des pratiques généralisées dans les Pyrénées, indispensables en raison des dynamiques végétales des landes pastorales. L'usage du feu, autrefois bien maîtrisé, pose aujourd'hui des problèmes croissants en raison de l'enfrichement des pâturages et de la multiplication des enjeux non pastoraux. Des opérations de concertation locale ont eu lieu depuis une quinzaine d'années dans chaque département pyrénéen, sous la forme de cellules de brûlage dirigé ou de commissions locales d'écobuage, afin d'améliorer les pratiques, diminuer les risques et concilier le feu avec les divers enjeux locaux. Le feu apparaît ainsi comme un révélateur des problèmes d'aménagement de l'espace en montagne : contraintes liées à l'enfrichement, entretien du milieu à des fins pastorales ou paysagères, choix touristiques, écologiques ou forestiers, etc

Modular spectral imaging (MOSI) system for discrimination of pigments in cells and microbial communities

Here we describe a spectral imaging system for minimally invasive identification, localization, and relative quantification of pigments in cells and microbial communities. The modularity of the system allows pigment detection on spatial scales ranging from the single-cell level to regions whose areas are several tens of square centimeters. For pigment identification in vivo absorption and/or autofluorescence spectra are used as the analytical signals. Along with the hardware, which is easy to transport and simple to assemble and allows rapid measurement, we describe newly developed software that allows highly sensitive and pigment-specific analyses of the hyperspectral data. We also propose and describe a number of applications of the system for microbial ecology, including identification of pigments in living cells and high-spatial-resolution imaging of pigments and the associated phototrophic groups in complex microbial communities, such as photosynthetic endolithic biofilms, microbial mats, and intertidal sediments. This system provides new possibilities for studying the role of spatial organization of microorganisms in the ecological functioning of complex benthic microbial communities or for noninvasively monitoring changes in the spatial organization and/or composition of a microbial community in response to changing environmental factor

Hyperspectral imaging of the microscale distribution and dynamics of microphytobenthos in intertidal sediments

We describe a novel, field-deployable hyperspectral imaging system, called Hypersub, that allows noninvasive in situ mapping of the microphytobenthos (MPB) biomass distribution with a high spatial (sub-millimeter) and temporal (minutes) resolution over areas of 1 x 1 m. The biomass is derived from a log-transformed and near-infrared corrected reflectance hyperspectral index, which exhibits a linear relationship (R-2 > 0.97) with the chlorophyll a (Ch1 a) concentration in the euphotic zone of the sediment and depends on the sediment grain size. Deployments of the system revealed that due to factors such as sediment topography, bioturbation, and grazing, the distribution of MPB in intertidal sediments is remarkably heterogeneous, with Ch1 a concentrations varying laterally by up to 400% of the average value over a distance of 1 cm. Furthermore, due to tidal cycling and diel light variability, MPB concentrations in the top 1 mm of sediments are very dynamic, changing by 40-80% over a few hours due to vertical migration. We argue that the high-resolution hyperspectral imaging method overcomes the inadequate resolution of traditional methods based on sedimentary Ch1 a extraction, and thus helps improve our understanding of the processes that control benthic primary production in coastal sediments

Plate osteosynthesis combined with bone cement provides the highest stability for tibial head depression fractures under high loading conditions

Older patients sustaining tibial head depression fractures often cannot follow the post-operative rehabilitation protocols with partial weight-bearing of the affected limb, leading to osteosynthesis failure, cartilage step-off and arthritis development. Therefore, the aim of this study was to analyse the biomechanical performance of different types of osteosyntheses alone and in combination with bone cement simulating cyclically high loading conditions of tibial head depression fractures. Lateral tibial head depression fractures (AO: 41-B2.2; Schatzker type III) were created in synthetic bones and stabilized using three different osteosyntheses alone and in combination with a commonly used bone cement (chronOS™): 2 screws, 4 screws in the jail technique and a lateral angle-stable buttress plate. After fixation, the lateral tibial plateau was axially loaded in two, from each other independent testing series: In the first test protocol, 5000 cycles with 500 N and in the end load-to-failure tests were performed. In the second test protocol, the cyclic loading was increased to 1000 N. Parameters of interest were the displacement of the articular fracture fragment, the stiffness and the maximum load. The osteosyntheses revealed a higher stiffness in combination with bone cement compared to the same type of osteosynthesis alone (e.g., 500 N level: 2 screws 383 ± 43 N/mm vs. 2 screws + chronOs 520 ± 108 N/mm, increase by 36%, p < 0.01; 4 screws 368 ± 97 N/mm vs. 4 screws + chronOS 516 ± 109 N/mm, increase by 40%, p < 0.01; plate: 509 ± 73 N/mm vs. plate + chronOs 792 ± 150 N/mm, increase by 56%, p < 0.01). Bone cement reduced the displacement of the plate significantly (500 N level: plate: 8.9 ± 2.8 mm vs. plate + chronOs: 3.1 ± 1.4 mm, reduction by 65%, p < 0.01; 1000 N level: 16.9 ± 3.6 mm vs 5.6 ± 1.3 mm, reduction by 67%, p < 0.01). Thus, the highest stiffness and lowest displacement values were found when using the plate with bone cement in both loading conditions (500 N level: 2 screws + chronOs 3.7 ± 1.3 mm, 4 screws + chronOs 6.2 ± 2.4 mm; 1000 N level: 2 screws + chronOs 6.5 ± 1.2 mm, 4 screws + chronOs 5.7 ± 0.8 mm). From a biomechanical perspective, plate osteosynthesis of tibial head depression fractures should always be combined with bone cement, provides higher stability than 2-screw and 4-screw fixation and is a valid treatment option in cases where extraordinary stability is required

Premiers romans

Les premiers romans ne sont-ils qu'un bruyant phénomène éditorial et médiatique ? N'offrent-ils pas plutôt au chercheur ou à l'écrivain l'occasion de saisir comment se dessine, à la croisée de l'ordinal et du générique, une entrée en littérature dans ce qu'elle suppose de jeux parfois complexes d'identités et d'identifications ? Mais que les premiers romans aient pour seul souci de commencer, rien n'est moins sûr : entre fantômes et mélancolie, entre relecture et réécriture, ils ne cessent en fait de se débattre avec les questions de la disparition et de la fin. Ainsi, bien plus qu'ils ne renseignent sur une improbable mort de la littérature, les premiers romans nous invitent à relever un défi, celui de cette méconnaissance fondamentale qui préside, selon Giorgio Agamben, à toute visée critique

La France des écrivains

Des lendemains de la Seconde Guerre mondiale à nos jours, « La France » a été pour nombre d'écrivains un enjeu passionnel, cristallisant amour et haine, culte et indifférence, violence et nostalgie. Comment la littérature s'est-elle fait l'écho des interrogations souterraines, critiques ou angoissées, qui ont travaillé le pays sur la possible dissolution de son ethos ? Et comment les écrivains se sont-ils confrontés à un mythe de la France hérité du XIXe siècle que les orages de l'Histoire ont parfois mis à mal jusqu'à l'éclatement ? Ce volume essaie de représenter la richesse des émotions, croyances et mémoires que le mythe a engendrées. Parcourant le demi-siècle dans sa diversité tant politique qu'esthétique (genres, formes, tonalités), il propose de confronter les regards d'écrivains de langue française, venus d'horizons géographiques, idéologiques et culturels fortement contrastés