Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Purpose:We aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy.Methods:All procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient- and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable.Results:A total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16–0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant hemoptysis with borderline statistical significance (P = 0.049).Conclusion:The transpulmonary needle path should be as short as possible to reduce the risk of abundant hemoptysis during CT-guided transthoracic needle biopsy

Outils d’intelligence artificielle pour la détection, la caractérisation et la classification des maladies pulmonaires chronique

Disease staging and monitoring of chronic lung diseases are two major challenges for patient care and evaluation of new therapies. Monitoring mainly relies on pulmonary function testing but morphological assessment is a key point for diagnosis and staging In the first part, we propose different models to score bronchial disease severity on computed tomography (CT) scan. A simple thresholding approach using adapted thresholds and a more sophisticated machine learning approach with radiomics are evaluated In the second part, we evaluate deep learning methods to segment lung fibrosis on chest CT scans in patients with systemic sclerosis. We combine elastic registration to atlases of different thoracic morphology and deep learning to produce a model performing as well as radiologists In the last part of the thesis, we demonstrate that lung deformation assessment between inspiratory and expiratory magnetic resonance images can be used to depict fibrotic lung areas, which show less deformation during respiration and that CT assessment of lung deformation on serial CT scans can be used to diagnose lung fibrosis worseningL’évaluation de la gravité et la surveillance des maladies pulmonaires chroniques représentent deux challenges importants pour la prise en charge des patients et l’évaluation des traitements. La surveillance repose principalement sur les données fonctionnelles respiratoires mais l’évaluation morphologique reste un point essentiel pour le diagnostic et l’évaluation de sévérité. Dans la première partie de cette thèse, nous proposons différents modèles pour quantifier la sévérité de pathologies bronchiques chroniques au scanner. Une approche simple par seuillage adaptatif et une méthode plus sophistiquée de radiomique sont évaluées Dans la seconde partie, nous évaluons une méthode d’apprentissage profond pour contourer automatiquement l’atteinte fibrosante de la sclérodermie en scanner. Nous combinons le recalage élastique vers différents atlas morphologiques thoraciques et l’apprentissage profond pour développer un modèle dont les performances sont équivalentes à celles des radiologues. Dans la dernière partie, nous démontrons que l’étude de la déformation pulmonaire en IRM entre inspiration et expiration peut être utilisée pour repérer les régions pulmonaires en transformation fibreuse, moins déformables au cours de la respiration, et qu’en scanner, l’évaluation de la déformation entre des examens successifs de suivi peut diagnostiquer l’aggravation fibreuse chez les patients sclérodermiques

Albion W. Small’s neglected progressive views : reducing inequalities for a reasonable capitalism

International audienceThis paper sheds light on Albion Small’s views on the inequalities resulting from capital concentration. As a leading intellectual of the Progressive Era, Small sought ways to reduce social injustice, which in his view was key to avoiding class conflict and preserving democracy. He emphasized the need to devise social policies with a view to ensuring the equality of opportunities for all to realize what Small termed their "interests"—through the combination of their labor with "tool-capital". Small entrusted the State with the central role of fighting capital inequalities through social policies, the treatment of inequalities dealing with morals. He embraced the then-fashionable idea of reasonable capitalism, as expounded by fellow progressive scholars, the likes of Richard T. Ely, John Dewey, or John R. Commons, who all sensed that such an economic system would survive only if it improves the social well-being as well as the self-development of all individuals

Systems of ethics for banks that act as private commons : a case study of three Swiss alternative banks

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"Marxian but not Marxist : Albion W. Small’s appraisal on Marx"

International audienceThis paper sheds light on the neglected views of Albion W. Small, the founder of the Department of Sociology at the University of Chicago in 1892. As Small wrote during the American Progressive Era and had a background in political economy, it is natural that he was interested in Marx’s ideas. This paper explains why Small can be affiliated to some extent with Marxian but not Marxist authors. Using Small’s appraisal of Marx’s thoughts, this article examines fundamental issues of both the emergence of overprofit in the workplace and capitalism dynamics. Small called for cooperation between capitalists and workers. For those reasons, Small’s ideas still resonate today

The Societal Responsibility of Banks: A Case Study of Three Swiss Alternative Banks

International audienceThe ‘Great Recession’ of 2008 exposed banks and banking systems as frail economic entities, posing a threat to the real economy and society at large. This context of near economic collapse made clear the societal responsibility of banks to conform to business ethics respectful of both individual and collective interests. We argue that banks are primarily institutions of capitalism that must rely on resilient systems of reasonable values. The paper focuses on three Swiss banks to determine their ethical properties and their social ends. Such a societal dimension that we thrust on banks implies rethinking the responsibility of banks to society and their contributions to the public interest

System of ethics for banks that act as private commons : a case study of three alternative banks

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Les inégalités contre la démocratie industrielle. Une perspective historique progressiste autour de l’œuvre d’Albion W. Small

Ce chapitre essaie de faire la lumière sur la pensée de Small. La première partie du chapitre analyse le contexte des inégalités qui entoure ses recherches. La seconde partie traite de ses principales propositions pour réduire les inégalités au travail. La troisième partie met en perspective la pensée de Small avec les autres contributeurs institutionnalistes de cette période progressiste

Albion W. Small’s neglected progressive views : reducing inequalities for a reasonable capitalism

International audienceThis paper sheds light on Albion Small’s views on the inequalities resulting from capital concentration. As a leading intellectual of the Progressive Era, Small sought ways to reduce social injustice, which in his view was key to avoiding class conflict and preserving democracy. He emphasized the need to devise social policies with a view to ensuring the equality of opportunities for all to realize what Small termed their "interests"—through the combination of their labor with "tool-capital". Small entrusted the State with the central role of fighting capital inequalities through social policies, the treatment of inequalities dealing with morals. He embraced the then-fashionable idea of reasonable capitalism, as expounded by fellow progressive scholars, the likes of Richard T. Ely, John Dewey, or John R. Commons, who all sensed that such an economic system would survive only if it improves the social well-being as well as the self-development of all individuals