New research models and novel signal analysis in studies on preterm labor: a key to progress?

Preterm labor affects up to 20% of pregnancies, is considered a main cause of associated neonatal morbidity and mortality and is responsible for neonatal care costs of multimillion euros. In spite of that, the commercial market for this clinical indication is rather limited, which may be also related to high liability. Consequently, with only a few exceptions, preterm labor is not in the orbit of great interest of the pharmaceutical industry. Coordinated effort of research community may bring the change and help required to reduce the influence of this multifactorial syndrome on society. Between the novel techniques that are being explored in a SAFE (The Special Non-Invasive Advances in Fetal and Neonatal Evaluation Network) group, there are new research models of preterm labor as well as novel methodology of analysis of biological signals. In this article, we briefly describe new clinical and nonclinical human models of preterm labor as well as summarize some novel methods of data processing and analysis that may be used in the context of preterm labor

Przerastające łożysko jako przyczyna samoistnego pęknięcia macicy we wczesnym drugim trymestrze u wieloródki bez wywiadu zabiegów na macicy

Background: Prevalence of uterine rupture at delivery has been recently estimated at less than 1 in 2500 deliveries. Spontaneous uterine rupture in the early mid-trimester (16 weeks gestation or less), is far less frequent. We report a case of uterine rupture due to placenta percreta in otherwise uncomplicated pregnancy. Case: A 35-year-old, gravida 5, para 5, at 15wk 2d gestation (menstrual age) with negative history of uterine scarring suddenly developed symptoms of incipient hypovolemic shock while being hospitalized for imminent miscarriage. On exploratory laparotomy we found a midline uterine rupture infi ltrated by the placenta. Supracervical hysterectomy was performed. Postoperative lab analysis confi rmed the elevated serum AFP levels. Conclusion: Abnormal placentation and subsequent uterine rupture should be taken into consideration also in women in the second trimester who have no history of uterine instrumentation.Częstość występowania okołoporodowego pęknięcia macicy szacuje się na 1 na 2500 porodów, powikłanie to występuje zwykle po rozpoczęciu porodowej czynności skurczowej. Jedną z przyczyn tego nagłego stanu położniczego jest przerastanie łożyska, do czego predysponują wcześniej wykonywane zabiegi na macicy (na przykład łyżeczkowanie). Samoistne pęknięcie macicy we wczesnym drugim trymestrze (poniżej 16 tygodnia) zdarza się natomiast wyjątkowo rzadko. Praca przedstawia przypadek samoistnego pęknięcia macicy z powodu przerastania łożyska u pacjentki bez wywiadu zabiegów na macicy. Opis przypadku: 35 letnia wieloródka bez wywiadu zabiegów na macicy w 16. tygodniu (15 tyg. 2 dni) piątej ciąży, zgłosiła ból narastający brzucha z towarzyszącymi objawami hipowolemii podczas pobytu w klinice z powodu zagrażającego poronienia. Podczas zabiegu laparotomii zwiadowczej stwierdzono pośrodkowe pęknięcie macicy nacieczone przez przerastające łożysko. Wykonano zabieg nadpochwowego wycięcia macicy. Pooperacyjne badania dodatkowe potwierdziły znacznie podwyższone poziomy alfa fetoproteiny (AFP) Wniosek: Nieprawidłowo przebiegający rozwój łożyska i następowe pęknięcie macicy powinny być brane pod uwagę jako jedna z przyczyn bólu i nagłej hipowolemii także u kobiet w drugim trymestrze ciąży bez wywiadu zabiegów na macicy

Anaesthesia management of acute aortic dissection type B in Marfan syndrome complicating end-stage pregnancy

Pregnancy in women with Marfan syndrome (MFS) is linked to approximately a 4.4% risk of acute aortic dissection (AAD). The natural history of pregnancy and the ability to deliver a viable fetus depends on the interaction between the pace of changes in the cardiovascular system and the advancement of pregnancy. We report the management of a type B acute aortic dissection in a woman in her 36th week of pregnancy. The anaesthesiologist has the unique task of managing complicated and mutually exclusive physiologic goals and acts as a consultant bridging the mother’s well-being and fetal management

Changes in gene expression following trauma are related to the age of transfused packed red blood cells

BACKGROUND Transfusion of packed red blood cells (PRBCs) is associated with an increased incidence of nosocomial infections and an increased risk of death. The duration of storage before transfusion may influence these outcomes. Here, we explore the association between the age of transfused PRBCs and specific patterns of inflammatory gene expression in severely injured trauma patients. METHODS Severely injured trauma patients requiring intensive care unit treatment and receiving transfusion of PRBCs within 24 hours of the injury were recruited. Blood samples were obtained within 2 hours of the trauma, at 24 hours, and at 72 hours. Messenger RNA was extracted from whole blood, and gene expression was quantified using quantitative polymerase chain reaction. The median age of the units of PRBCs transfused to each patient was recorded. The primary outcome measure was the change in candidate gene expression over the initial 72 hours. RESULTS Sixty-four patients were studied. Fifty-three patients (83%) were male, and the median age was 40.5 years (interquartile range [IQR], 31-59). Median Injury Severity Score (ISS) was 31.5 (IQR, 23-43), and 55 patients (86%) experienced a blunt injury. Forty-one patients (64%) developed a nosocomial infection, and 15 patients (23%) died before hospital discharge. Each patient received a median of 5 U of PRBCs (IQR, 4-9.8 U) during the first 24 hours of hospital admission. The median age of the units of PRBCs transfused in each patient was 20 days (IQR, 17-22 days). Older blood was associated with greater decreases in interleukin 12 (IL-12), IL-23, and RORγt (all p's < 0.05) gene expression over the initial 24 hours, greater decreases in IL-12 gene expression over 72 hours, and a rise in transforming growth factor β gene expression over the first 72 hours. A multivariate analysis confirmed the independence of these associations. CONCLUSION Increasing the duration of storage of PRBCs before transfusion is associated with a pattern of gene expression consistent with more severe immunosuppression. LEVEL OF EVIDENCE Epidemiologic study, level III

Serum soluble Fas ligand (sFasL) in patients with primary squamous cell carcinoma of the esophagus.

Esophageal carcinomas have been shown to express Fas ligand (FasL) and down-regulate Fas to escape from host immune surveillance. Circulating soluble FasL (sFasL) has been suggested to provide protection from Fas-mediated apoptosis. The aim of this study was to assess serum sFasL levels in esophageal cancer. The pretreatment levels of sFasL in the serum of 100 patients with esophageal squamous cell cancer and 41 healthy volunteers were determined by ELISA. Probability of survival was calculated according to the method of Kaplan-Meier. The prognostic influence of high and low level of sFasL was analyzed with the log-rank test. The mean serum level of sFasL in patients with esophageal cancer was significantly higher than that in healthy donors (1.567+/-1.786 vs 0.261+/-0.435,

Importance of spike timing in touch: an analogy with hearing?

Touch is often conceived as a spatial sense akin to vision. However, touch also involves the transduction and processing of signals that vary rapidly over time, inviting comparisons with hearing. In both sensory systems, first order afferents produce spiking responses that are temporally precise and the timing of their responses carries stimulus information. The precision and informativeness of spike timing in the two systems invites the possibility that both implement similar mechanisms to extract behaviorally relevant information from these precisely timed responses. Here, we explore the putative roles of spike timing in touch and hearing and discuss common mechanisms that may be involved in processing temporal spiking patterns

Development of a Wearable Sensor-Based Framework for the Classification and Quantification of High Knee Flexion Exposures in Childcare

Repetitive cyclic and prolonged joint loading in high knee flexion postures has been associated with the progression of degenerative knee joint diseases and knee osteoarthritis (OA). Despite this association, high flexion postures, where the knee angle exceeds 120°, are commonly performed within occupational settings. While work related musculoskeletal disorders have been studied across many occupations, the risk of OA development associated with the adoption of high knee flexion postures in childcare workers has until recently been unexplored; and therefore, occupational childcare has not appeared in any systematic reviews seeking to prove a causal relationship between occupational exposures and the risk of knee OA development. Therefore, the overarching goal of this thesis was to explore the adoption of high flexion postures in childcare settings and to develop a means by which these could be measured using non-laboratory-based technologies. The global objectives of this thesis were to (i) identify the postural demands of occupational childcare as they relate to high flexion exposures at the knee, (ii) apply, extend, and validate sensor to segment alignment algorithms through which lower limb flexion-extension kinematics could be measured in multiple high knee flexion postures using inertial measurement units (IMUs), and (iii) develop a machine learning based classification model capable of identifying each childcare-inspired high knee flexion posture. In-line with these global objectives, four independent studies were conducted.   Study I – Characterization of Postures of High Knee Flexion and Lifting Tasks Associated with Occupational Childcare Background: High knee flexion postures, despite their association with increased incidences of osteoarthritis, are frequently adopted in occupational childcare. High flexion exposure thresholds (based on exposure frequency or cumulative daily exposure) that relate to increased incidences of OA have previously been proposed; yet our understanding of how the specific postural requirements of this childcare compare to these thresholds remains limited. Objectives: This study sought to define and quantify high flexion postures typically adopted in childcare to evaluate any increased likelihood of knee osteoarthritis development. Methods: Video data of eighteen childcare workers caring for infant, toddler, and preschool-aged children over a period of approximately 3.25 hours were obtained for this investigation from a larger cohort study conducted across five daycares in Kingston, Ontario, Canada. Each video was segmented to identify the start and end of potential high knee flexion exposures. Each identified posture was quantified by duration and frequency. An analysis of postural adoption by occupational task was subsequently performed to determine which task(s) might pose the greatest risk for cumulative joint trauma. Results: A total of ten postures involving varying degrees of knee flexion were identified, of which 8 involved high knee flexion. Childcare workers caring for children of all ages were found to adopt high knee flexion postures for durations of 1.45±0.15 hours and frequencies of 128.67±21.45 over the 3.25 hour observation period, exceeding proposed thresholds for incidences of knee osteoarthritis development. Structured activities, playing, and feeding tasks were found to demand the greatest adoption of high flexion postures. Conclusions: Based on the findings of this study, it is likely that childcare workers caring for children of all ages exceed cumulative exposure- and frequency-based thresholds associated with increased incidences of knee OA development within a typical working day. Study II – Evaluating the Robustness of Automatic IMU Calibration for Lower Extremity Motion Analysis in High Knee Flexion Postures Background: While inertial measurement units promise an out- of-the-box, minimally intrusive means of objectively measuring body segment kinematics in any setting, in practice their implementation requires complex calculations in order to align each sensor with the coordinate system of the segment to which they are attached. Objectives: This study sought to apply and extend previously proposed alignment algorithms to align inertial sensors with the segments on which they are attached in order to calculate flexion-extension angles for the ankle, knee, and hip during multiple childcare-inspired postures. Methods: The Seel joint axis algorithm and the Constrained Seel Knee Axis (CSKA) algorithm were implemented for the sensor to segment calibration of acceleration and angular velocity data from IMUs mounted on the lower limbs and pelvis, based on a series of calibration movements about each joint. Further, the Iterative Seel spherical axis (ISSA) extension to this implementation was proposed for the calibration of sensors about the ankle and hip. The performance of these algorithms was validated across fifty participants during ten childcare-inspired movements performed by comparing IMU- and gold standard optical-based flexion-extension angle estimates. Results: Strong correlations between the IMU- and optical-based angle estimates were reported for all joints during each high flexion motion with the exception of a moderate correlation reported for the ankle angle estimate during child chair sitting. Mean RMSE between protocols were found to be 6.61° ± 2.96° for the ankle, 7.55° ± 5.82° for the knee, and 14.64° ± 6.73° for the hip. Conclusions: The estimation of joint kinematics through the IMU-based CSKA and ISSA algorithms presents an effective solution for the sensor to segment calibration of inertial sensors, allowing for the calculation of lower limb flexion-extension kinematics in multiple childcare-inspired high knee flexion postures. Study III – A Multi-Dimensional Dynamic Time Warping Distance-Based Framework for the Recognition of High Knee Flexion Postures in Inertial Sensor Data Background: The interpretation of inertial measures as they relate to occupational exposures is non-trivial. In order to relate the continuously collected data to the activities or postures performed by the sensor wearer, pattern recognition and machine learning based algorithms can be applied. One difficulty in applying these techniques to real-world data lies in the temporal and scale variability of human movements, which must be overcome when seeking to classify data in the time-domain. Objectives: The objective of this study was to develop a sensor-based framework for the detection and measurement of isolated childcare-specific postures (identified in Study I). As a secondary objective, the classification accuracy movements performed under loaded and unloaded conditions were compared in order to assess the sensitivity of the developed model to potential postural variabilities accompanying the presence of a load. Methods: IMU-based joint angle estimates for the ankle, knee, and hip were time and scale normalized prior to being input to a multi-dimensional Dynamic Time Warping (DTW) distance-based Nearest Neighbour algorithm for the identification of twelve childcare inspired postures. Fifty participants performed each posture, when possible, under unloaded and loaded conditions. Angle estimates from thirty-five participants were divided into development and testing data, such that 80% of the trials were segmented into movement templates and the remaining 20% were left as continuous movement sequences. These data were then included in the model building and testing phases while the accuracy of the model was validated based on novel data from fifteen participants. Results: Overall accuracies of 82.3% and 55.6% were reached when classifying postures on testing and validation data respectively. When adjusting for the imbalances between classification groups, mean balanced accuracies increased to 86% and 74.6% for testing and validation data respectively. Sensitivity and specificity values revealed the highest rates of misclassifications occurred between flatfoot squatting, heels-up squatting, and stooping. It was also found that the model was not capable of identifying sequences of walking data based on a single step motion template. No significant differences were found between the classification of loaded and unloaded motion trials. Conclusions: A combination of DTW distances calculated between motion templates and continuous movement sequences of lower limb flexion-extension angles was found to be effective in the identification of isolated postures frequently performed in childcare. The developed model was successful at classifying data from participants both included and precluded from the algorithm building dataset and insensitive to postural variability which might be caused by the presence of a load. Study IV – Evaluating the Feasibility of Applying the Developed Multi-Dimensional Dynamic Time Warping Distance-Based Framework to the Measurement and Recognition of High Knee Flexion Postures in a Simulated Childcare Environment Background: While the simulation of high knee flexion postures in isolation (in Study III) provided a basis for the development of a multi-dimensional Dynamic Time Warping based nearest neighbour algorithm for the identification of childcare-inspired postures, it is unlikely that the postures adopted in childcare settings would be performed in isolation. Objectives: This study sought to explore the feasibility of extending the developed classification algorithm to identify and measure postures frequently adopted when performing childcare specific tasks within a simulated childcare environment. Methods: Lower limb inertial motion data was recorded from twelve participants as they interacted with their child during a series of tasks inspired by those identified in Study I as frequently occurring in childcare settings. In order to reduce the error associated with gyroscopic drift over time, joint angles for each trial were calculated over 60 second increments and concatenated across the duration of each trial. Angle estimates from ten participants were time windowed in order to create the inputs for the development and testing of two model designs wherein: (A) the model development data included all templates generated from Study III as well as continuous motion windows here collected, or (B) only the model development data included only windows of continuous motion data. The division of data into the development and testing datasets for each 5-fold cross-validated classification model was performed in one of two ways wherein the data was divided: (a) through stratified randomized partitioning of windows such that 80% were assigned to model development and the remaining 20% were reserved for testing, or (b) by partitioning all windows from a single trial of a single participant for testing while all remaining windows were assigned to the model development dataset. When the classification of continuously collected windows was tested (using division strategy b), a logic-based correction module was introduced to eliminate any erroneous predictions. Each model design (A and B) was developed and tested using both data division strategies (a and b) and subsequently their performance was evaluated based on the classification of all data windows from the two subjects reserved for validation. Results: Classification accuracies of 42.2% and 42.5% were achieved when classifying the testing data separated through stratified random partitioning (division strategy a) using models that included (model A, 159 classes) or excluded (model B, 149 classes) the templates generated from Study III, respectively. This classification accuracy was found to decrease when classifying a test partition which included all windows of a single trial (division strategy b) to 35.4% when using model A (where templates from Study III were included in the model development dataset); however, this same trial was classified with an accuracy of 80.8% when using model B (whose development dataset included only windows of continuous motion data). This accuracy was however found to be highly dependent on the motions performed in a given trial and logic-based corrections were not found to improve classification accuracies. When validating each model by identifying postures performed by novel subjects, classification accuracies of 24.0% and 26.6% were obtained using development data which included (model A) and excluded (model B) templates from Study III, respectively. Across all novel data, the highest classification accuracies were observed when identifying static postures, which is unsurprising given that windows of these postures were most prevalent in the model development datasets. Conclusions: While classification accuracies above those achievable by chance were achieved, the classification models evaluated in this study were incapable of accurately identifying the postures adopted during simulated childcare tasks to a level that could be considered satisfactory to accurately report on the postures assumed in a childcare environment. The success of the classifier was highly dependent on the number of transitions occurring between postures while in high flexion; therefore, more classifier development data is needed to create templates for these novel transition movements. Given the high variability in postural adoption when caring for and interacting with children, additional movement templates based on continuously collected data would be required for the successful identification of postures in occupational settings. Global Conclusions Childcare workers exceed previously reported thresholds for high knee flexion postures based on cumulative exposure and frequency of adoption associated with increased incidences of knee OA development within a typical working day. Inertial measurement units provide a unique means of objectively measuring postures frequently adopted when caring for children which may ultimately permit the quantification of high knee flexion exposures in childcare settings and further study of the relationship between these postures and the risk of OA development in occupational childcare. While the results of this thesis demonstrate that IMU based measures of lower limb kinematics can be used to identify these postures in isolation, further work is required to expand the classification model and enable the identification of such postures from continuously collected data

Editorial

Les articles présentés dans ce numéro ont tous été exposés par leurs auteurs lors du colloque « Nouvelles dynamiques migratoires : activités régulières et irrégulières sur le marché du travail européen » organisé par l’Urmis à Nice du 6 au 8 décembre 2007 avec le soutien financier du programme ANR JCJC Migragri, du programme New migration dynamics EUROCORES-ECRP de la Fondation européenne de la Science, de la MSH Nice et du Fond Pascal du Ministère français de la culture. Ce colloque s’appuy..

Comment “y mettre les mains” ?

Les agents du monde funéraire auxquels nous nous intéresserons ici n’ont pas suivi de formation professionnalisante. Ces travailleurs se forment « sur le tas ». Dans ce contexte de transgression et face aux cadavres, le plaisir et les émotions esthétiques qu’ils éprouvent dans leur travail, soulèvent des interrogations complexes et douloureuses. Ils se suspectent quelquefois de n’être pas « normaux » et évoquent les efforts à réitérer perpétuellement pour faire face au réel de leur activité. Ces travailleurs développent des réponses collectives ou plus individuelles. Nous creuserons principalement deux pistes. La première aborde les tensions observables autour de la notion de déchet dès lors que celle-ci est susceptible de s’appliquer aux cadavres. La deuxième concerne le « travail à-côté ». Les agents sont nombreux à développer, parallèlement à leur activité professionnelle, d’autres activités rémunérées. Celles-ci s’inscrivent dans des rapports signifiants vis-à-vis des manipulations de cadavres et fonctionnent parfois à la façon d’antidotes.The public agents of the funeral world in whom we shall be interested here, didn’t have any professional training. These workers learn “by-doing”. In this context of transgression and confrontation with corpses, the pleasure and the esthetic feelings they experiment in their work, raise complex and painful questions. They sometimes suspect themselves not to be “normal” and evoke the perpetual and repeating efforts to face the reality of their activity. These agents develop collective or more individual answers. In this article, we will emphasize more particularly two research axis. The first one deals with the observable tensions around the notion of waste when this concept applies to corpses. The second one speaks about the “travail à-côté” which could be translated by “side job”: in addition to their jobs, many funeral workers develop other paid activities. These ones are significantly related to the manipulations of corpses and sometimes work like antidotes

Immunoexpression of P16INK4a, Rb and TP53 proteins in bronchiolar columnar cell dysplasia (BCCD) in lungs resected due to primary non-small cell lung cancer.

Lung cancer is the leading cause of death worldwide. High mortality comes out mainly of the fact that majority of the cases are diagnosed in advanced stadium. An expanded diagnostics of precancerous conditions would certainly contribute to lowering the mortality rate. Many of the molecular changes accompanying the multistep cancer development could be observed using the immunohistochemistry method. In this paper we describe the morphology and cell cycle proteins immunoexpression of the novel probable preinvasive lesion - bronchiolar columnar cell dysplasia (BCCD). Thirty cases of BCCD selected out of 193 patients population, treated for primary non-small cell lung cancer were investigated. Loss of P16INK4a protein was observed in 70% of all cases and was statistically significant in patients with adenocarcinoma. Two cases show abnormal cytoplasmic localization of this protein. TP53 protein accumulates in 26.7% of all BCCD. Rb protein was active in 48.3% of the BCCD cases. In two cases we observed differentiation of the cells composing BCCD into multilayer epithelium of the squamous type, which occurs with formation of desmosomes. We suppose that BCCD may be preneoplastic lesion leading to adenocarcinoma as well as to peripheral squamous cell lung cancer