Circuit et expérience de la gestion pharmaceutique des produits locaux utilisés dans un essai clinique contrôlé par un placebo

La spiruline, une algue douée de propriétés thérapeutiques et immunostimulantes, est fréquemment utilisée par les personnes infectées par le VIH (PvVIH). Un essai clinique contrôlé par un placebo, a été menée chez les personnes infectées par le VIH de type 1 (PvVIH-1) avec la spiruline enrichi en zinc et en sélénium, et appelée «spiruline plus». L’objectif de l’étude était de définir un circuit d’approvisionnement et de gestion de la « spiruline plus » et du placebo. L’étude qui a eu l’approbation du Comité d’Ethique National des Sciences et de la Santé a duré 12 mois. Les patients inclus dans l’étude ont été randomisés dans six séries. Les quatre-vingt-dix-sept patients de l’étude étaient composés de 52,6% des sujets sous placebo contre 47,4% sous « la spiruline plus ». Les 63.7% des patients étaient sous traitement antirétroviraux contre 36.3% sans traitement. Neuf cent cinq traitements ont été dispensés aux quatre-cent-quatre-vingt-neuf patients sous placebo et quatre cent seize patients sous « spiruline plus ». Le circuit défini a permis la dispensation de la « spiruline plus » et du placebo aux patients de l’étude pendant 12 mois.Mots clés: Circuit, gestion, «spiruline plus», PvVIH-

ОПТИМАЛЬНАЯ МАРШРУТИЗАЦИЯ ВОЗДУШНЫХ СУДОВ И МАШИН СКОРОЙ ПОМОЩИ В ЛОГИСТИКЕ ПРИ СТИХИЙНЫХ БЕДСТВИЯХ

One of the most vital aspects of emergency management studies is the development and examination of post-disaster search and rescue activities and treatment facilities. One of such issues to be considered while performing these operations is to reach the disaster victims within minimum time and to plan disaster logistics in the most efficient manner possible. In this study, the problem of planning debris scanning activities with Unmanned Aerial Vehicles after an earthquake and transporting the injured people to the hospitals by ambulances within minimum time was discussed, and mathematical models were developed to solve the problem. The ambulance routing problem and the mathematical model to be used in the solution to the problem are discussed for the first time in the literature. The developed model was tested on the problem sets created by taking into account the data of the province under investigation.Одним из наиболее важных аспектов исследований по управлению рисками и чрезвычайными ситуациями является разработка и изучение поисково-спасательных мероприятий и очистных сооружений после стихийных бедствий. Одним из вопросов, которые необходимо учитывать при выполнении этих операций, является обеспечение доступа к жертвам стихийных бедствий в минимальные сроки и планирование логистики в случае стихийных бедствий наиболее эффективным способом. В данном исследовании рассматривается проблема планирования работ по спасению с помощью беспилотных летательных аппаратов после землетрясения и транспортировки пострадавших людей в больницы на машинах скорой помощи за минимальное время. Для решения этой проблемы были разработаны и предложены математические модели. Впервые рассматривается задача маршрутизации скорой помощи и математическая модель, которая будет использоваться для решения этой задачи. Разработанная модель была протестирована на множествах задач, созданных с учетом реальных данных исследуемой провинции Турции

OPTIMUM ROUTING OF AERIAL VEHICLES AND AMBULANCES IN DISASTER LOGISTICS

One of the most vital aspects of emergency management studies is the development and examination of post-disaster search and rescue activities and treatment facilities. One of such issues to be considered while performing these operations is to reach the disaster victims within minimum time and to plan disaster logistics in the most efficient manner possible. In this study, the problem of planning debris scanning activities with Unmanned Aerial Vehicles after an earthquake and transporting the injured people to the hospitals by ambulances within minimum time was discussed, and mathematical models were developed to solve the problem. The ambulance routing problem and the mathematical model to be used in the solution to the problem are discussed for the first time in the literature. The developed model was tested on the problem sets created by taking into account the data of the province under investigation

Risk calculator for prediction of treatment-related urethroplasty failure in patients with penile urethral strictures

Purpose To design a dedicated risk calculator for patients with penile urethra stricture who are scheduled to urethroplasty that might be used to counsel patients according to their pre-operative risk of failure. Methods Patients treated with penile urethroplasty at our center (1994-2018) were included in the study. Patients received 1-stage or staged penile urethroplasty. Patients with failed hypospadias repair, lichen sclerosus or incomplete clinical records were excluded. Treatment failure was defined as any required postoperative instrumentation, including dilation. Univariable Cox regression identified predictors of post-operative treatment failure and Kaplan-Meier analysis plotted the failure-free survival rates according to such predictors. Multivariable Cox regression-based risk calculator was generated to predict the risk of treatment failure at 10 years after surgery. Results 261 patients met the inclusion criteria. Median follow-up was 113 months. Out of 216 patients, 201 (77%) were classified as success and 60 (23%) failures. Former smoker (hazard ratio [HR] 2.12, p = 0.025), instrumentation-derived stricture (HR 2.55, p = 0.006), and use of grafts (HR 1.83, p = 0.037) were predictors of treatment failure. Model-derived probabilities showed that the 10-year risk of treatment failure varied from 5.8 to 41.1% according to patient's characteristics. Conclusions Long-term prognosis in patients who underwent penile urethroplasty is uncertain. To date, our risk-calculator represents the first tool that might help physicians to predict the risk of treatment failure at 10 years. According to our model, such risk is largely influenced by the etiology of the stricture, the use of graft, and patient's smoking habits

Focus on Internal Urethrotomy as Primary Treatment for Untreated Bulbar Urethral Strictures: Results from a Multivariable Analysis

Background: The use of internal urethrotomy for treatment of urethral stricture remains a controversial topic in urology.Objective: To investigate outcomes and predictors of failure for internal urethrotomy as primary treatment for untreated bulbar urethral strictures.Design, setting, and participants: We performed a retrospective analysis of patients who underwent internal urethrotomy. Patients with bulbar urethral stricture who did not receive any previous treatment were included. Patients with traumatic, penile or posterior urethral strictures, lichen sclerosus, failed hypospadias repair, or stricture length >4 cm were excluded.Outcome measurements and statistical analysis: The primary outcome was treatment failure. Kaplan-Meyer plots were used to depict treatment failure-free survival. Univariate and multivariable Cox regression analyses were used to test the association between predictors (age, body mass index, diabetes, history of smoking, etiology, stenosis type and length, preoperative maximum flow [pQ(max)]) and treatment failure.Results and limitations: Overall, 136 patients were included. The median stricture length was 2 cm. Median follow-up was 55 mo. At 5-yr follow-up the failure-free survival rate was 57%. On univariate analysis, diabetes, nonidiopathic etiology, stricture length of 3-4 cm, and pQ(max) were significantly associated with treatment failure. These predictors were included in a multivariable analysis, in which pQ(max) was the only significant predictor of treatment failure.Conclusions: Failure of internal urethrotomy for untreated bulbar urethral strictures greatly depends on pQ(max) flow at uroflowmetry. Patients with pQ(max >) 8 ml/s have a high probability of success, while patients with pQ(max) <5 ml/s have a low probability of success.Patient summary: The use of internal urethrotomy in patients with an untreated bulbar urethral stricture should only be considered in selected cases. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved

Control of neoclassical tearing modes by Sawtooth control

The onset of a neoclassical tearing mode (NTM) depends on the existence of a large enough seed island. It is shown in the Joint European Torus that NTMs can be readily destabilized by long-period sawteeth, such as obtained by sawtooth stabilization from ion-cyclotron heating or current drive. This has important implications for burning plasma scenarios, as alpha particles strongly stabilize the sawteeth. It is also shown that, by adding heating and current drive just outside the inversion radius, sawteeth are destabilized, resulting in shorter sawtooth periods and larger beta values being obtained without NTMs

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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Transcriptome-wide association study of breast cancer risk by estrogen-receptor status

Previous transcriptome-wide association studies (TWAS) have identified breast cancer risk genes by integrating data from expression quantitative loci and genome-wide association studies (GWAS), but analyses of breast cancer subtype-specific associations have been limited. In this study, we conducted a TWAS using gene expression data from GTEx and summary statistics from the hitherto largest GWAS meta-analysis conducted for breast cancer overall, and by estrogen receptor subtypes (ER+ and ER-). We further compared associations with ER+ and ER- subtypes, using a case-only TWAS approach. We also conducted multigene conditional analyses in regions with multiple TWAS associations. Two genes, STXBP4 and HIST2H2BA, were specifically associated with ER+ but not with ER- breast cancer. We further identified 30 TWAS-significant genes associated with overall breast cancer risk, including four that were not identified in previous studies. Conditional analyses identified single independent breast-cancer gene in three of six regions harboring multiple TWAS-significant genes. Our study provides new information on breast cancer genetics and biology, particularly about genomic differences between ER+ and ER- breast cancer.Peer reviewe

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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