Considérations sur la vascularisation de la moelle épinière chez les patients atteints d'anévrisme de l'aorte thoracique descendante, la moelle épinière s'entraîne-t-elle à être ischémique ?

Introduction: L'anévrisme de l'aorte correspond à une dilatation de plus de 1.5 fois du diamètre aortique normal. Les anévrismes de l'aorte thoracique descendante ont une incidence estimée à 5.9 à 10.4 cas/100 000 habitants par an et la survie à 5 ans est de 20-55% si l'anévrisme n'est pas traité. L'opération de remplacement du segment aortique atteint est associée à un risque de paraplégie (3% dans les grandes séries). Actuellement, les techniques de monitoring par potentiels évoqués moteurs (PEM), drainage du liquide céphalo-rachidien, hypothermie ont permis de diminuer le risque de paraplégie. Dans cette étude, le but est d'identifier des facteurs de risque d'être paraplégique après la chirurgie, sur la base des angio-CT et des PEM. Méthode : Il s'agit d'une étude rétrospective comprenant 8 patients sélectionnés parmi 16 avec le diagnostic d'anévrisme de l'aorte thoracique descendante du service de chirurgie cardiaque et vasculaire du CHUV, ayant été opérés par voie ouverte ou endovasculaire (TEVAR) entre décembre 2012 et février 2014. Sur la base des données préopératoires des angio-CT et du monitoring par PEM, nous avons évalué la perméabilité des artères de la moelle épinière et cherché des facteurs de risque au développement d'une paraplégie. Résultats : Le nombre moyen d'artères intercostales ouvertes est plus élevé dans le groupe à risque (moyenne=12.75 pour « à risque » et 10 pour « pas à risque »). D'après nos résultats, le sacrifice des artères intercostales pendant l'opération ne met pas à risque les patients (p=0.42) et les antécédents de chirurgie sont associés avec un risque moins grand (p=0.029). Il serait intéressant d'étudier plus en détail l'association entre le nombre d'artères intercostales ouvertes et le risque. Conclusion: Nous proposons une méthode pour étudier la vascularisation de la moelle épinière en préopératoire. Notre population n'est pas assez grande pour établir des corrélations statistiques, mais nous avons observé une tendance chez les patients ayant déjà été opérés de l'aorte à avoir un risque de paraplégie plus faible. Notre hypothèse est que la moelle épinière peut développer des mécanismes de preconditionning, elle « s'entraîne à être ischémique

The Serums Tool-Chain:Ensuring Security and Privacy of Medical Data in Smart Patient-Centric Healthcare Systems

Digital technology is permeating all aspects of human society and life. This leads to humans becoming highly dependent on digital devices, including upon digital: assistance, intelligence, and decisions. A major concern of this digital dependence is the lack of human oversight or intervention in many of the ways humans use this technology. This dependence and reliance on digital technology raises concerns in how humans trust such systems, and how to ensure digital technology behaves appropriately. This works considers recent developments and projects that combine digital technology and artificial intelligence with human society. The focus is on critical scenarios where failure of digital technology can lead to significant harm or even death. We explore how to build trust for users of digital technology in such scenarios and considering many different challenges for digital technology. The approaches applied and proposed here address user trust along many dimensions and aim to build collaborative and empowering use of digital technologies in critical aspects of human society

A Hierarchy of Scheduler Classes for Stochastic Automata

Stochastic automata are a formal compositional model for concurrent stochastic timed systems, with general distributions and non-deterministic choices. Measures of interest are defined over schedulers that resolve the nondeterminism. In this paper we investigate the power of various theoretically and practically motivated classes of schedulers, considering the classic complete-information view and a restriction to non-prophetic schedulers. We prove a hierarchy of scheduler classes w.r.t. unbounded probabilistic reachability. We find that, unlike Markovian formalisms, stochastic automata distinguish most classes even in this basic setting. Verification and strategy synthesis methods thus face a tradeoff between powerful and efficient classes. Using lightweight scheduler sampling, we explore this tradeoff and demonstrate the concept of a useful approximative verification technique for stochastic automata

The quantitative verification benchmark set

We present an extensive collection of quantitative models to facilitate the development, comparison, and benchmarking of new verification algorithms and tools. All models have a formal semantics in terms of extensions of Markov chains, are provided in the Jani format, and are documented by a comprehensive set of metadata. The collection is highly diverse: it includes established probabilistic verification and planning benchmarks, industrial case studies, models of biological systems, dynamic fault trees, and Petri net examples, all originally specified in a variety of modelling languages. It archives detailed tool performance data for each model, enabling immediate comparisons between tools and among tool versions over time. The collection is easy to access via a client-side web application at qcomp.org with powerful search and visualisation features. It can be extended via a Git-based submission process, and is openly accessible according to the terms of the CC-BY license

Can a flavoured spray (Pill Glide) help children swallow their medicines? A pilot study

Pediatric pharmacists are constantly faced with the challenges of supporting children and caregivers for whom the difficulties of swallowing medicines can be a daily struggle. Most medicines are only available as tablets and capsules, and where liquid alternatives exist, these products often have issues with palatability and high costs. The objective of this study was to evaluate whether the swallowing spray, Pill Glide, could help children in taking their solid and liquid medicines. This open label pilot study compared the spray with a behavioral approach alone, the current standard of care at the pediatric hospital. Patients were children on long-term drug therapies, either transitioning from liquid preparations to tablets and capsules, or known to be experiencing swallowing difficulties. Using age-adapted diaries, patients self-reported the difficulty of taking medicines on a 6-point hedonic scale for 2 weeks before the intervention, and then for 1 week while using Pill Glide. Data were analyzed from 10 children aged 6 to 16 years, with an average burden of 3.5 tablets per day. Pill Glide (strawberry was the most popular flavor) was shown to significantly decrease the overall medicine taking difficulty score by 0.93 (range, 0.33–1.53), almost 1 hedonic face point on the scale used (P = .002). There was insufficient data for liquid medicines. Pill Glide could help children with pill swallowing, thus improving patient acceptability of medicines and potentially adherence. It could also be implemented as a useful cost-saving intervention because solid dosage forms are cheaper

Compared to conventional, ecological intensive management promotes beneficial proteolytic soil microbial communities for agro-ecosystem functioning under climate change-induced rain regimes

Projected climate change and rainfall variability will affect soil microbial communities, biogeochemical cycling and agriculture. Nitrogen (N) is the most limiting nutrient in agroecosystems and its cycling and availability is highly dependent on microbial driven processes. In agroecosystems, hydrolysis of organic nitrogen (N) is an important step in controlling soil N availability. We analyzed the effect of management (ecological intensive vs. conventional intensive) on N-cycling processes and involved microbial communities under climate change-induced rain regimes. Terrestrial model ecosystems originating from agroecosystems across Europe were subjected to four different rain regimes for 263 days. Using structural equation modelling we identified direct impacts of rain regimes on N-cycling processes, whereas N-related microbial communities were more resistant. In addition to rain regimes, management indirectly affected N-cycling processes via modifications of N-related microbial community composition. Ecological intensive management promoted a beneficial N-related microbial community composition involved in N-cycling processes under climate change-induced rain regimes. Exploratory analyses identified phosphorus-associated litter properties as possible drivers for the observed management effects on N-related microbial community composition. This work provides novel insights into mechanisms controlling agro-ecosystem functioning under climate change

Au-Ag template stripped pattern for scanning probe investigations of DNA arrays produced by Dip Pen Nanolithography

We report on DNA arrays produced by Dip Pen Nanolithography (DPN) on a novel Au-Ag micro patterned template stripped surface. DNA arrays have been investigated by atomic force microscopy (AFM) and scanning tunnelling microscopy (STM) showing that the patterned template stripped substrate enables easy retrieval of the DPN-functionalized zone with a standard optical microscope permitting a multi-instrument and multi-technique local detection and analysis. Moreover the smooth surface of the Au squares (abput 5-10 angstrom roughness) allows to be sensitive to the hybridization of the oligonucleotide array with label-free target DNA. Our Au-Ag substrates, combining the retrieving capabilities of the patterned surface with the smoothness of the template stripped technique, are candidates for the investigation of DPN nanostructures and for the development of label free detection methods for DNA nanoarrays based on the use of scanning probes.Comment: Langmuir (accepted

Management versus site effects on the abundance of nitrifiers and denitrifiers in European mountain grasslands

It is well established that the abundances of nitrogen (N) transforming microbes are strongly influenced by land-use intensity in lowland grasslands. However, their responses to management change in less productive and less fertilized mountain grasslands are largely unknown. We studied eight mountain grasslands, positioned along gradients of management intensity in Austria, the UK, and France, which differed in their historical management trajectories. We measured the abundance of ammonia-oxidizing bacteria (AOB) and archaea (AOA) as well as nitrite-reducing bacteria using specific marker genes. We found that management affected the abundance of these microbial groups along each transect, though the specific responses differed between sites, due to different management histories and resulting variations in environmental parameters. In Austria, cessation of management caused an increase in nirK and nirS gene abundances. In the UK, intensification of grassland management led to 10-fold increases in the abundances of AOA and AOB and doubling of nirK gene abundance. In France, ploughing of previously mown grassland caused a 20-fold increase in AOA abundance. Across sites the abundance of AOB was most strongly related to soil NO3−-N availability, and AOA were favored by higher soil pH. Among the nitrite reducers, nirS abundance correlated most strongly with N parameters, such as soil NO3−-N, microbial N, leachate NH4+-N, while the abundance of nirK-denitrifiers was affected by soil total N, organic matter (SOM) and water content. We conclude that alteration of soil environmental conditions is the dominant mechanism by which land management practices influence the abundance of each group of ammonia oxidizers and nitrite reducers