ÉTUDE COÛT-EFFICACITÉ DE LA FILIÈRE STEMI DU CHUV À COURT TERME

Introduction : Les maladies cardiovasculaires sont la première cause de mortalité dans le monde selon l'organisation mondiale de la santé. La prise en charge optimale d'un infarctus du myocarde avec sus décalage du segment ST nécessite une reperfusion de l'artère coronaire, qui doit être la plus rapide possible afin de limiter des complications pouvant être mortelles. L'un des points principaux des recommandations 2012 de la société européenne de cardiologie est la nécessité du développement de « filières STEMI » pour permettre une prise en charge optimale en minimisant les délais. La filière STEMI du CHUV a été mise en place le 7 janvier 2013 dans le but d'optimiser le parcours de soin des patients avec un diagnostic de STEMI. Elle permet l'orientation des patients porteurs du diagnostic de STEMI dans un chemin prédéfini. But : Le but de cette étude est d'analyser l'impact à court terme de la mise en place de la filière STEMI du CHUV, en comparant les trajectoires cliniques des patients avec un diagnostic STEMI arrivant au CHUV en 2012 et 2013, ainsi qu'une analyse des coûts liés à la prise en charge de ces patients et de l'impact économique sur le CHUV. Méthode : Nous avons effectué une étude rétrospective sur les patients du CHUV, avec un STEMI en 2012 et 2013 en comparant entre les deux années les caractéristiques des patients, les caractéristiques de la prise en charge hospitalière, le devenir des patients à la sortie et les coûts moyen des séjours. Résultats : La distribution des facteurs de risques des patients nous montre un résultat similaire, sans évolution significative entre les deux années. On observe que 50% des patients sont connus pour une hypertension artérielle, 50% pour une dyslipidémie et 15% pour être diabétiques. La comparaison des complications intra-hospitalières 2012 et 2013 ne montre pas d'évolution particulière. Les taux observés de mortalité de 3,9% en 2012 et de 4,9% en 2013 sont bas. Le nouveau protocole STEMI a permis à 63 % des patients admis en 2013 d'être orientés directement vers les soins continus. Le coût interne médian de prise en charge des séjours au CHUV a augmenté d'un facteur 1,10 en 2013, passant de CHF 15'718 en 2012 à CHF 17'328 en 2013. Le financement SwissDRG ne couvre pas les coûts internes de prise en charge des patients STEMI en 2012 et en 2013. Perspectives : Le design de notre étude n'a pas permis d'établir un rapport coût-efficacité par année de vie sauvée. Idéalement, une étude coût-efficacité de la prise en charge des patients STEMI devrait adopter la perspective de la société. L'analyse devrait être élargie aux différents types de coûts et aux différents centres hospitaliers de Suisse

The major human AP endonuclease (Ape1) is involved in the nucleotide incision repair pathway

In nucleotide incision repair (NIR), an endonuclease nicks oxidatively damaged DNA in a DNA glycosylase-independent manner, providing the correct ends for DNA synthesis coupled to the repair of the remaining 5'-dangling modified nucleotide. This mechanistic feature is distinct from DNA glycosylase-mediated base excision repair. Here we report that Ape1, the major apurinic/apyrimidinic endonuclease in human cells, is the damage- specific endonuclease involved in NIR. We show that Ape1 incises DNA containing 5,6-dihydro-2'-deoxyuridine, 5,6-dihydrothymidine, 5-hydroxy-2'-deoxyuridine, alpha-2'-deoxyadenosine and alpha-thymidine adducts, generating 3'-hydroxyl and 5'-phosphate termini. The kinetic constants indicate that Ape1-catalysed NIR activity is highly efficient. The substrate specificity and protein conformation of Ape1 is modulated by MgCl2 concentrations, thus providing conditions under which NIR becomes a major activity in cell-free extracts. While the N-terminal region of Ape1 is not required for AP endonuclease function, we show that it regulates the NIR activity. The physiological relevance of the mammalian NIR pathway is discussed

Synthesis and Properties of Dipyridylcyclopentenes

A short and general route to the substituted dipyridylcyclopentenes was explored and several new compounds belonging to this new group of diarylethenes were synthesized. The study of their photochromic and thermochromic properties shows that the rate of the thermal ring opening is strongly dependent on the polarity of the solvent.

Integral models for bubble, droplet, and multiphase plume dynamics in stratification and crossflow

We present the development and validation of a numerical modeling suite for bubble and droplet dynamics of multiphase plumes in the environment. This modeling suite includes real-fluid equations of state, Lagrangian particle tracking, and two different integral plume models: an Eulerian model for a double-plume integral model in quiescent stratification and a Lagrangian integral model for multiphase plumes in stratified crossflows. Here, we report a particle tracking algorithm for dispersed-phase particles within the Lagrangian integral plume model and a comprehensive validation of the Lagrangian plume model for single- and multiphase buoyant jets. The model utilizes literature values for all entrainment and spreading coefficients and has one remaining calibration parameter (Formula presented.), which reduces the buoyant force of dispersed phase particles as they approach the edge of a Lagrangian plume element, eventually separating from the plume as it bends over in a crossflow. We report the calibrated form (Formula presented.), where b is the plume half-width, and r is the distance of a particle from the plume centerline. We apply the validated modeling suite to simulate two test cases of a subsea oil well blowout in a stratification-dominated crossflow. These tests confirm that errors from overlapping plume elements in the Lagrangian integral model during intrusion formation for a weak crossflow are negligible for predicting intrusion depth and the fate of oil droplets in the plume. The Lagrangian integral model has the added advantages of being able to account for entrainment from an arbitrary crossflow, predict the intrusion of small gas bubbles and oil droplets when appropriate, and track the pathways of individual bubbles and droplets after they separate from the main plume or intrusion layer

Projected Wavefunctions and High Temperature Superconductivity

We study the Hubbard model with parameters relevant to the cuprates, using variational Monte Carlo with projected d-wave states. For doping 0 < x < 0.35 we obtain a superconductor whose order parameter tracks the observed nonmonotonic Tc(x). The variational parameter Delta_{var}(x) scales with the (pi,0) ``hump'' and T* seen in photoemission. Projection leads to incoherence in the spectral function, and from the singular behavior of its moments we obtain the nodal quasiparticle weight Z which vanishes linearly in x, though the Fermi velocity remains finite as x approaches zero. The Drude weight D_{low} and superfluid density are consistent with experiments, and D_{low} scales with Z.Comment: 4 pages, 5 EPS figures. (1) Many improvements including discussion of n(k) and superfluid density. (2) Added comparison with slave boson mean field theory. (3) Added new reference

On the vanishing of negative K-groups

Let k be an infinite perfect field of positive characteristic p and assume that strong resolution of singularities holds over k. We prove that, if X is a d-dimensional noetherian scheme whose underlying reduced scheme is essentially of finite type over the field k, then the negative K-group K_q(X) vanishes for every q < -d. This partially affirms a conjecture of Weibel.Comment: Math. Ann. (to appear

Modeling the electronic behavior of γ\gamma-LiV2O5: a microscopic study

We determine the electronic structure of the one-dimensional spin-1/2 Heisenberg compound $\gamma$-LiV$_2$O$_5$, which has two inequivalent vanadium ions, V(1) and V(2), via density-functional calculations. We find a relative V(1)-V(2) charge ordering of roughly $70:30$. We discuss the influence of the charge ordering on the electronic structure and the magnetic behavior. We give estimates of the basic hopping matrix elements and compare with the most studied $\alpha '$-NaV$_2$O$_5$.Comment: Final version. To appear in Phys. Rev. Let

TiOCl, an orbital-ordered system?

We present first principles density functional calculations and downfolding studies of the electronic and magnetic properties of the layered quantum spin system TiOCl. We discuss explicitely the nature of the exchange pathes and attempt to clarify the concept of orbital ordering in this material. An analysis of the electronic structure of slightly distorted structures according to the phononic modes allowed in this material suggests that this system is subject to large orbital fluctuations driven by the electron-phonon coupling. Based on these results, we propose a microscopic explanation of the behavior of TiOCl near the phase transition to a spin-gapped system.Comment: Some figures are compressed, for higher quality please contact the author

Differential T Cell Function and Fate in Lymph Node and Nonlymphoid Tissues

The functions and fate of antigen-experienced T cells isolated from lymph node or nonlymphoid tissues were analyzed in a system involving adoptive transfer of in vitro–activated T cells into mice. Activated T cells present in the lymph nodes could be stimulated by antigen to divide, produce effector cytokines, and migrate to peripheral tissues. By contrast, activated T cells that had migrated into nonlymphoid tissues (lung and airway) produced substantial effector cytokines upon antigen challenge, but were completely unable to divide or migrate back to the lymph nodes. Therefore, activated T cells can undergo clonal expansion in the lymph node, but are recruited and retained as nondividing cells in nonlymphoid tissues. These distinct regulatory events in lymph node and nonlymphoid tissues reveal simple key mechanisms for both inducing and limiting T cell immunity