Aortic Annulus Stabilization Technique for Rapid Deployment Aortic Valve Replacement.

NlmCategory="UNASSIGNED">Rapid deployment aortic valve replacement (RDAVR) with the use of rapid deployment valve systems represents a smart alternative to the use of standard aortic bioprosthesis for aortic valve replacement. Nevertheless, its use is still debatable in patients with pure aortic valve regurgitation or true bicuspid aortic valve because of the risk of postoperative paravalvular leak. To address this issue, an optimal annulus-valve size match seems to be the ideal surgical strategy. This article describes a new technique developed to stabilize the aortic annulus and prevent paravalvular leak after RDAVR. To confirm the feasibility, this technique was performed in six patients with severe symptomatic aortic stenosis who were scheduled to undergo aortic valve replacement at our center. All patients survived surgery and were discharged from the hospital. There were no new intracardiac conduction system disturbances observed, and a permanent pacemaker implantation was not required in any of the patients. The intraoperative and postoperative echocardiogram confirmed successful positioning of the valve, and no paravalvular leak was observed. In this preliminary experience, RDAVR through a full sternotomy or an upper hemisternotomy approach with the use of aortic annulus stabilization technique was safe, and no leak was observed. Future studies on large series of patients are necessary to confirm the safety and effectiveness of this technique in preventing paravalvular leak in patients with true bicuspid aortic valves or pure aortic regurgitation.

Parcours de vie, récit et moments forts : entre défis et ressources. Une recherche-intervention à l'Ecole Technique de Ste-Croix

La littérature sur les transitions, en particulier entre l'école obligatoire et l'école professionnelle ou l'école et la vie professionnelle, attire l'attention sur le fait que les parcours personnels sont aujourd'hui moins linéaires. Les transitions professionnelles sont alors décrites comme des moments de difficultés, de ruptures, de vulnérabilité pour les jeunes (Pagnossin & Armi, 2011 ; Rastoldo, Amos & Davaud, 2009). Dans notre domaine en psychologie « socioculturelle », si ces aspects ne sont pas négligés, l'accent est mis sur l'importance du travail de construction de sens par la personne : indépendamment des zigzags de sa vie, l'important est la mise en cohérence, les liens de sens qu'elle peut reconstruire entre les différentes sphères d'expériences qui constituent son identité. Et pour cela, les ressources sociales et institutionnelles (parents, enseignants, groupes de pairs, dispositifs de formation...) mais aussi matérielles et culturelles (chansons, poèmes, films, romans, récits, etc.) peuvent être très importantes (Masdonati & Zittoun, 2012 ; Zittoun, 2012). L'étude-intervention qui sera présentée dans ce document, réalisée auprès d'une classe d'apprentis de l'Ecole technique de Ste-Croix par un groupe d'étudiants en Master en psychologie (UniL), s'inscrit dans un mouvement plus large qui cherche à rendre compte du point de vue des acteurs (Muller Mirza & Perret-Clermont, 2015) liés à la question des transitions des jeunes : il s'agira ici de celui des apprentis eux-mêmes, de manière à explorer ce qu'ils vivent en termes de difficultés, de ressources utilisées et d'apprentissages réalisés, ainsi que celui des personnes qui les accompagnent dans ces processus, les enseignants. Cette étude visait non seulement à recueillir des informations auprès de ces personnes mais également à réaliser un travail de type réflexif, par la mise en place d'activités en classe destinées aux apprentis, basées sur le « récit de vie » comme outil psychologique.

Stabbing simulations and DNA transfer

Technical developments have made it possible to analyze very low amounts of DNA. This has many advantages, but the drawback of this technological progress is that interpretation of the results becomes increasingly complex: the number of mixed DNA profiles increased relatively to single source DNA profiles and stochastic effects in the DNA profile, such as drop-in and drop-out, are more frequently observed. Moreover, the relevance of low template DNA material regarding the activities alleged is not as straightforward as it was a few years ago, when for example large quantities of blood were recovered. The possibility of secondary and tertiary transfer is now becoming an issue. The purpose of this research is twofold: first, to study the transfer of DNA from the handler and secondly, to observe if handlers would transfer DNA from persons closely connected to them. We chose to mimic cases where the offender would attack a person with a knife. As a first approach, we envisaged that the defense would not give an alternative explanation for the origin of the DNA. In our transfer experiments (4 donors, 16 experiments each, 64 traces), 3% of the traces were single DNA profiles. Most of the time, the DNA profile of the person handling the knife was present as the major profile: in 83% of the traces the major contributor profile corresponded to the stabber's DNA profile (in single stains and mixtures). Mixture with no clear major/minor fraction (12%) were observed. 5% of the traces were considered of insufficient quality (more than 3 contributors, presence of a few minor peaks). In that case, we considered that the stabber's DNA was absent. In our experiments, no traces allowed excluding the stabber, however it must be noted that precautions were taken to minimize background DNA as knives were cleaned before the experiments. DNA profiles of the stabber's colleagues were not observed. We hope that this study will allow for a better understanding of the transfer mechanism and of how to assess and describe results given activity level propositions. In this preliminary research, we have focused on the transfer of DNA on the hand of the person. Besides, more research is needed to assign the probability of the results given an alternative activity proposed by the defense, for instance when the source of the DNA is not contested, but that the activities are.

A comprehensive model for quantum noise characterization in digital mammography.

NlmCategory="UNASSIGNED">A version of cascaded systems analysis was developed specifically with the aim of studying quantum noise propagation in x-ray detectors. Signal and quantum noise propagation was then modelled in four types of x-ray detectors used for digital mammography: four flat panel systems, one computed radiography and one slot-scan silicon wafer based photon counting device. As required inputs to the model, the two dimensional (2D) modulation transfer function (MTF), noise power spectra (NPS) and detective quantum efficiency (DQE) were measured for six mammography systems that utilized these different detectors. A new method to reconstruct anisotropic 2D presampling MTF matrices from 1D radial MTFs measured along different angular directions across the detector is described; an image of a sharp, circular disc was used for this purpose. The effective pixel fill factor for the FP systems was determined from the axial 1D presampling MTFs measured with a square sharp edge along the two orthogonal directions of the pixel lattice. Expectation MTFs were then calculated by averaging the radial MTFs over all possible phases and the 2D EMTF formed with the same reconstruction technique used for the 2D presampling MTF. The quantum NPS was then established by noise decomposition from homogenous images acquired as a function of detector air kerma. This was further decomposed into the correlated and uncorrelated quantum components by fitting the radially averaged quantum NPS with the radially averaged EMTF(2). This whole procedure allowed a detailed analysis of the influence of aliasing, signal and noise decorrelation, x-ray capture efficiency and global secondary gain on NPS and detector DQE. The influence of noise statistics, pixel fill factor and additional electronic and fixed pattern noises on the DQE was also studied. The 2D cascaded model and decompositions performed on the acquired images also enlightened the observed quantum NPS and DQE anisotropy.

Transabdominal-pelvic-perineal (TAPP) anterolateral thigh flap: A new reconstructive technique for complex defects following extended abdominoperineal resection.

BACKGROUND: Abdominoperineal resection (APR) following radiotherapy is associated with a high rate of perineal wound complications. The anterolateral thigh (ALT) flap, combined with the vastus lateralis (VL) muscle, can cover complex perineal and pelvic anteroposterior defects. This is used for the first time transabdominally through the pelvis and the perineum (TAPP) in the infero-posterior directions; this technique has been described and illustrated in this study. METHODS: Among over 90 patients who underwent perineal reconstruction between May 2004 and June 2011, six patients presented high-grade tumours invading perineum, pelvis and sacrum, thereby resulting in a continuous anteroposterior defect. ALT + VL TAPP reconstructions were performed after extended APR and, subsequently, sacrectomy. Patients were examined retrospectively to determine demographics, operative time, complications (general and flap-related), time to complete healing and length of hospital stay. Long-term flap coverage, flap volume stability and functional and aesthetic outcomes were assessed. RESULTS: Mean operating time of the reconstruction was 290 min. No deaths occurred. One patient presented partial flap necrosis. Another patient presented a novel wound dehiscence after flap healing, due to secondary skin dissemination of the primary tumour. Following volumetric flap analysis on serial post-operative CT scans, no significant flap atrophy was observed. All flaps fully covered the defects. No late complications such as fistulas or perineal hernias occurred. Donor-site recovery was uneventful with no functional deficits. CONCLUSIONS: The use of the ALT + VL flap transabdominally is an innovative method to reconstruct exceptionally complex perineal and pelvic defects extending up to the lower back. This flap guarantees superior bulk, obliterating all pelvic dead space, with the fascia lata (FL) supporting the pelvic floor.