Partial cricotracheal resection for paediatric subglottic stenosis: update of the Lausanne experience with 129 cases.

OBJECTIVES: Partial cricotracheal resection (PCTR) is widely accepted for treating severe paediatric laryngotracheal stenosis (LTS). However, it remains limited to a few experienced centres. Here we report an update of the Lausanne experience in paediatric PCTR performed or supervised by a senior surgeon (Philippe Monnier). METHODS: An ongoing database of 129 paediatric patients who underwent PCTR for benign LTS between March 1978 and July 2012 at our hospital was retrospectively reviewed. Demographic characteristics and information on preoperative status, stenosis and surgery were collected. Primary outcomes were measured as overall and operation-specific decannulation rates (ODR and OSDR, respectively), and secondary outcomes as morbidity, mortality and postoperative functional results. RESULTS: A total of 129 paediatric patients [79 males and 50 females; mean age, 4.1 years (1 month-16 years, median age of 2 years old)] underwent PCTR during the study period. ODR and OSDR were 90 and 81%, respectively. The decannulation rates were significantly superior for single-stage PCTR compared with double-stage PCTR in both ODR and OSDR. Eight patients died postoperatively for reasons unrelated to surgery. Partial anastomotic dehiscence was seen in 13 patients, 9 of whom were successfully treated by revision surgery. Respiratory, voice and swallowing functions were near normal or only minimally impaired in 86, 65 and 81% of patients, respectively. CONCLUSIONS: PCTR is effective and feasible with good ODR and OSDR for highgrade / severe LTS. Glottic involvement and the presence of comorbidities were negative predictive factors of decannulation. Early detection and reintervention of postoperative incipient dehiscence contribute to avoiding the progress to late restenosis; however, voice improvement remains a challenge

Global regulatory architecture of human, mouse and rat tissue transcriptomes

Background Predicting molecular responses in human by extrapolating results from model organisms requires a precise understanding of the architecture and regulation of biological mechanisms across species. Results Here, we present a large-scale comparative analysis of organ and tissue transcriptomes involving the three mammalian species human, mouse and rat. To this end, we created a unique, highly standardized compendium of tissue expression. Representative tissue specific datasets were aggregated from more than 33,900 Affymetrix expression microarrays. For each organism, we created two expression datasets covering over 55 distinct tissue types with curated data from two independent microarray platforms. Principal component analysis (PCA) revealed that the tissue-specific architecture of transcriptomes is highly conserved between human, mouse and rat. Moreover, tissues with related biological function clustered tightly together, even if the underlying data originated from different labs and experimental settings. Overall, the expression variance caused by tissue type was approximately 10 times higher than the variance caused by perturbations or diseases, except for a subset of cancers and chemicals. Pairs of gene orthologs exhibited higher expression correlation between mouse and rat than with human. Finally, we show evidence that tissue expression profiles, if combined with sequence similarity, can improve the correct assignment of functionally related homologs across species. Conclusion The results demonstrate that tissue-specific regulation is the main determinant of transcriptome composition and is highly conserved across mammalian species

Meyer's surgical procedure for the treatment of lip carcinoma.

Lip carcinomas are generally treated by surgery. A reconstruction is often required if the resected segment exceeds one-third of the lip. Meyer's plasty is an alternate way of reconstructing the lower or upper lip. The aim of this study is to describe the technique, its indications and results. A retrospective review of all patients who underwent a Meyer's plasty in our institution is presented. Twenty-four consecutive patients were treated in Lausanne for T1 and T2 lip carcinomas between 1983 and 2001. Primary surgery associated with Meyer's plasty was performed in all cases. Data were collected from the medical records, and eight patients were recalled for clinical evaluation. The oncological, functional and aesthetic results were analyzed. The 5-year local control was 100%. Three patients developed metachronous lymph node metastasis. No patient died from the disease. A hindering microstomy was found in three cases, and two patients suffered from temporary oral leakage. No speech difficulty was encountered. The aesthetics was described as satisfying or good in 87% of the patients. Meyer's plasty following lip surgery of the upper or lower lip allows an aesthetic and functional one-stage reconstruction without compromising the oncological outcome

Medical record: systematic centralization versus secure on demand aggregation

<p>Abstract</p> <p>Background</p> <p>As patients often see the data of their medical histories scattered among various medical records hosted in several health-care establishments, the purpose of our multidisciplinary study was to define a pragmatic and secure on-demand based system able to gather this information, with no risk of breaching confidentiality, and to relay it to a medical professional who asked for the information via a specific search engine.</p> <p>Methods</p> <p>Scattered data are often heterogeneous, which makes the task of gathering information very hard. Two methods can be compared: trying to solve the problem by standardizing and centralizing all the information about every patient in a single Medical Record system or trying to use the data "as is" and find a way to obtain the most complete and the most accurate information. Given the failure of the first approach, due to the lack of standardization or privacy and security problems, for example, we propose an alternative that relies on the current state of affairs: an on-demand system, using a specific search engine that is able to retrieve information from the different medical records of a single patient.</p> <p>Results</p> <p>We describe the function of Medical Record Search Engines (MRSE), which are able to retrieve all the available information regarding a patient who has been hospitalized in different hospitals and to provide this information to health professionals upon request. MRSEs use pseudonymized patient identities and thus never have access to the patient's identity. However, though the system would be easy to implement as it by-passes many of the difficulties associated with a centralized architecture, the health professional would have to validate the information, i.e. read all of the information and create his own synthesis and possibly reject extra data, which could be a drawback. We thus propose various feasible improvements, based on the implementation of several tools in our on-demand based system.</p> <p>Conclusions</p> <p>A system that gathers all of the currently available information regarding a patient on the request of health-care professionals could be of great interest. This low-cost pragmatic alternative to centralized medical records could be developed quickly and easily. It could also be designed to include extra features and should thus be considered by health authorities.</p

The deep-sea hub of the ANTARES neutrino telescope

The ANTARES neutrino telescope, currently under construction at 2500 m depth off the French Mediterranean coast, will contain 12 detection lines, powered and read out through a deep-sea junction box (JB) hub. Electrical energy from the shore station is distributed through a transformer with multiple secondary windings and a plugboard with 16 deep sea-mateable electro-optic connectors. Connections are made to the JB outputs using manned or remotely operated submersible vehicles. The triply redundant power management and slow control system is based on two identical AC-powered systems, communicating with the shore through 160 Mb/s fibre G-links and a third battery-powered system using a slower link. We describe the power and slow control systems of the underwater hub

Dectin-1 binding to annexins on apoptotic cells induces peripheral immune tolerance via NADPH oxidase-2

Summary Uptake of apoptotic cells (ACs) by dendritic cells (DCs) and induction of a tolerogenic DC phenotype is an important mechanism for establishing peripheral tolerance to self-antigens. The receptors involved and underlying signaling pathways are not fully understood. Here, we identify Dectin-1 as a crucial tolerogenic receptor binding with nanomolar affinity to the core domain of several annexins (annexin A1, A5, and A13) exposed on ACs. Annexins bind to Dectin-1 on a site distinct from the interaction site of pathogen-derived β-glucans. Subsequent tolerogenic signaling induces selective phosphorylation of spleen tyrosine kinase (SYK), causing activation of NADPH oxidase-2 and moderate production of reactive oxygen species. Thus, mice deficient for Dectin-1 develop autoimmune pathologies (autoantibodies and splenomegaly) and generate stronger immune responses (cytotoxic T cells) against ACs. Our data describe an important immunological checkpoint system and provide a link between immunosuppressive signals of ACs and maintenance of peripheral immune tolerance

Radiation thermo-chemical models of protoplanetary disks II. Line diagnostics

Methods. We use the recently developed disk code ProDiMo to calculate the physico-chemical structure of protoplanetary disks and apply the Monte-Carlo line radiative transfer code RATRAN to predict observable line profiles and fluxes. We consider a series of Herbig Ae type disk models ranging from 10^-6 M_Sun to 2.2 10^-2 M_Sun (between 0.5 and 700 AU) to discuss the dependency of the line fluxes and ratios on disk mass for otherwise fixed disk parameters. Results. We find the [CII] 157.7 mum line to originate in LTE from the surface layers of the disk, where Tg > Td . The total emission is dominated by surface area and hence depends strongly on disk outer radius. The [OI] lines can be very bright (> 10^-16 W/m^2) and form in slightly deeper and closer regions under non-LTE conditions. The high-excitation [OI] 145.5 mum line, which has a larger critical density, decreases more rapidly with disk mass than the 63.2 mum line. Therefore, the [OI] 63.2 mum/145.5 mum ratio is a promising disk mass indicator, especially as it is independent of disk outer radius for Rout > 200 AU. CO is abundant only in deeper layers A_V >~ 0.05. For too low disk masses (M_disk <~10^-4 M_Sun) the dust starts to become transparent, and CO is almost completely photo-dissociated. For masses larger than that the lines are an excellent independent tracer of disk outer radius and can break the outer radius degeneracy in the [OI] 63.2 mum/[CII]157.7 mum line ratio. Conclusions. The far-IR fine-structure lines of [CII] and [OI] observable with Herschel provide a promising tool to measure the disk gas mass, although they are mainly generated in the atomic surface layers. In spatially unresolved observations, none of these lines carry much information about the inner, possibly hot regions < 30 AU.Comment: accepted for publication in A&

Continuum and line modeling of disks around young stars II. Line diagnostics for GASPS from the DENT grid

Aims. We want to understand the chemistry and physics of disks on the basis of a large unbiased and statistically relevant grid of disk models. One of the main goals is to explore the diagnostic power of various gas emission lines and line ratios for deriving main disk parameters such as the gas mass. Methods. We explore the results of the DENT grid (Disk Evolution with Neat Theory) that consists of 300 000 disk models with 11 free parameters. Through a statistical analysis, we search for correlations and trends in an effort to find tools for disk diagnostic. Results. All calculated quantities like species masses, temperatures, continuum and line fluxes differ by several orders of magnitude across the entire parameter space. The broad distribution of these quantities as a function of input parameters shows the limitation of using a prototype T Tauri or Herbig Ae/Be disk model. The statistical analysis of the DENT grid shows that CO gas is rarely the dominant carbon reservoir in disks. Models with large inner radii (10 times the dust condensation radius) and/or shallow surface density gradients lack massive gas phase water reservoirs. Also, 60% of the disks have gas temperatures averaged over the oxygen mass in the range between 15 and 70 K; the average gas temperatures for CO and O differ by less than a factor two. Studying the observational diagnostics, the [CII] 158 \mum fine structure line flux is very sensitive to the stellar UV flux and presence of a UV excess and it traces the outer disk radius (Rout). In the submm, the CO low J rotational lines also trace Rout. Low [OI] 63/145 line ratios (< a few) can be explained with cool atomic O gas in the uppermost surface layers leading to self-absorption in the 63 \mum line; this occurs mostly for massive non-flaring, settled disk models without UV excess. ... abbreviatedComment: 15 pages, 25 figures, accepted for publication in A&

Grand Challenges: Improving HIV Treatment Outcomes by Integrating Interventions for Co-Morbid Mental Illness.

In the fourth article of a five-part series providing a global perspective on integrating mental health, Sylvia Kaaya and colleagues discuss the importance of integrating mental health interventions into HIV prevention and treatment platforms. Please see later in the article for the Editors' Summary