Neues aus Diagnostik und Therapie der spinalen Erkrankungen [Novel aspects of diagnostics and therapy of spinal cord diseases].

BACKGROUND: Both non-traumatic and traumatic spinal cord injuries have in common that a relatively minor structural lesion can cause profound sensorimotor and autonomous dysfunction. Besides treating the cause of the spinal cord injury the main goal is to restore lost function as far as possible. AIM: This article provides an overview of current innovative diagnostic (imaging) and therapeutic approaches (neurorehabilitation and neuroregeneration) aiming for recovery of function after non-traumatic and traumatic spinal cord injuries. MATERIAL AND METHODS: An analysis of the current scientific literature regarding imaging, rehabilitation and rehabilitation strategies in spinal cord disease was carried out. RESULTS: Novel magnetic resonance imaging (MRI) based techniques (e.g. diffusion-weighted MRI and functional MRI) allow visualization of structural reorganization and specific neural activity in the spinal cord. Robotics-driven rehabilitative measures provide training of sensorimotor function in a targeted fashion, which can even be continued in the homecare setting. From a preclinical point of view, defined stem cell transplantation approaches allow for the first time robust structural repair of the injured spinal cord. CONCLUSION: Besides well-established neurological and functional scores, MRI techniques offer the unique opportunity to provide robust and reliable "biomarkers" for restorative therapeutic interventions. Function-oriented robotics-based rehabilitative interventions alone or in combination with stem cell based therapies represent promising approaches to achieve substantial functional recovery, which go beyond current rehabilitative treatment efforts.

Extent of Hypoattenuation On CT Angiography Source Images In Basilar Artery Occlusion: Prognostic Accuracy Of Posterior Circulation ASPECTS And The Pons-midbrain Score In The Basilar Artery International Cooperation Study

Background: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) and the combined Pons-midbrain score quantify the extent of early ischemic changes in the posterior circulation. We compared the prognostic accuracy of both scores if applied to CT angiography (CTA) source images (CTA-SI) of patients in the Basilar Artery International Cooperation Study (BASICS).Methods: BASICS was a prospective, observational, multi-centre, registry of consecutive patients who presented with acute symptomatic basilar artery occlusion (BAO). Functional outcome was assessed at 1 month. We applied pc-ASPECTS and the combined Pons-midbrain score to CTA-SI by 3-reader-consensus. Readers were blinded to clinical data. We performed multivariable logistic regression analysis, adjusting for thrombolysis, baseline NIHSS score and age, and used the output to derive ROC curves to compare the ability of both scores to discriminate patients with favourable (modified Rankin Scale [mRS] scores 0-3) from patients with unfavourable (mRS scores 4-6) functional outcome.Results: We reviewed CTAs of 158 patients (64% men, mean age 65 _ 15 years, median NIHSS score 25 [0-38], median GCS score 7 [3-15], median onset-to-CTA time 234 minutes [11-7380]). At 1 month, 40 (25%) patients had a favourable outcome, 49 (31%) had an unfavourable outcome (mRS score 4-5) and 69 (44%) were deceased. Both techniques of assessing CTA-SI hypoattenuation in the posterior circulation showed equally good discriminative value in predicting final outcome (C-statistics; area under ROC curve 0.74 versus 0.75, respectively; p_0.37). Pc-ASPECTS dichotomized at _6 versus _6 was an independent predictor of favourable functional outcome (RR _ 2.2; CI95 1.1-4.7; p _ 0.034).Conclusion: Compared to the combined Pons-midbrain score, the pc-ASPECTS score has similar prognostic accuracy to identify patients with a favourable functional outcome in BASICS. Dichotomized pc-ASPECTS (_6 versus _6) is an independent predictor of favourable functional outcome in this population. Author Disclosures: V. Puetz: None. A. Khomenko: None. M.D. Hill: None. I. Dzialowski: None. P. Michel: None. C. Weimar: None. C.A.C. Wijman: None. H. Mattle: None. K. Muir: None. T. Pfefferkorn: None. D. Tanne: None. S. Engelter: None. K. Szabo: None. A. Algra: None. A.M. Demchuk: None. W.J. Schonewille: None.

Le conseil génétique: aspects théoriques et pratique en prénatal [Genetic counselling: theoretical aspects and prenatal practice]

Le conseil génétique doit fournir aux individus une information médicale précise et un soutien psychologique. L'importance des principes d'autonomie et de confidentialité, dogmes du conseil génétique, est renforcée par la nouvelle loi suisse (LAGH). Dans certains pays, une grande partie du conseil génétique est assurée par des conseillers en génétique non médecins ayant une formation postgraduée spécifique. Le conseil génétique joue un rôle grandissant dans différents domaines de la médecine. En particulier, il est indispensable dans le contexte du prénatal où les couples reçoivent des informations complexes et doivent bénéficier d’un soutien pour prendre une décision. Genetic counselling provides families with accurate medical information and psychological support. Respect and concern for the emotional well-being should be taken into account while discussing genetics aspects and recurrence risks. The importance of autonomy and confidentiality, central to genetic counselling, is reinforced by the new Swiss law (LAGH). In many countries, most of the genetic counselling is provided by genetic counsellors who have a specialised post-graduate training. Genetic counselling plays an increasing role in different medical specialities. In particular, it is essential in the context of prenatal and pre-conceptual care, where couples are confronted to complex information and should have access to appropriate support during the decision-making process

Le rôle de la matérialité dans l'apprentissage de la lecture : aspects du curriculum enseigné, pratique enseignante et développement chez l'élève : une étude de cas à l'école primaire française

Notre étude consiste en une recherche longitudinale pour laquelle une cohorte d'élèves a été suivie depuis la Grande Section de l'école maternelle française (élèves de 5-6 ans) jusqu'au Cours Élémentaire 1re année de l'école élémentaire française (élèves de 7-8 ans) dans des situations ordinaires de classe. À ces niveaux scolaires, l'un des principaux objectifs du curriculum est l'apprentissage de la lecture. Nous considérons que l'élève construit les compétences de lecture à acquérir, i.e. les compétences caractérisant son développement potentiel, en s'appuyant sur les compétences caractérisant son développement actuel (Vygotski, 1934/1997). Lorsqu'il apprend à lire, l'élève a à sa disposition des moyens sémiotiques relatifs à la connaissance des objets et leurs usages, ainsi qu'aux gestes et leur signification (Moro & Rodriguez, 2005), ce que nous appelons globalement la matérialité. En conséquence, dans cette recherche, nous faisons l'hypothèse que ces premières habiletés relatives à la matérialité, constituent une ressource dans les situations d'enseignement- apprentissage de la lecture. Nous réalisons une étude de cas dont le recueil des données, à caractère ethnographique, est constitué de moments de classe enregistrés en vidéo, et ce, quatre fois par année scolaire. Ces douze enregistrements vidéo sont complétés par deux entretiens semi-directifs et un entretien d'auto- confrontation ; ils sont aussi mis en lien avec les Instructions officielles (programmes scolaires). L'analyse est à la fois macrogénétique et microgénétique. Pour chaque observation, concernant l'analyse macrogénétique, nous réalisons le synopsis à partir duquel nous sélectionnons des épisodes significatifs porteurs de matérialité. Les épisodes significatifs sont constitués des événements remarquables dont les analyses microgénétiques nécessitent l'utilisation d'outils, à savoir les tableaux des matérialités et les photogrammes. Notre étude montre que la matérialité permet aux élèves de devenir lecteurs et que les formes de cette matérialité changent en fonction de l'avancée des acquisitions des élèves et des dimensions de la lecture (code et compréhension) à apprendre. - Our research consists of a longitudinal study in which one group of pupils in ordinary classroom situations has been followed from the top level of French pre-elementary school (5- to 6 year-old pupils) to the second level of French primary school (7- to 8 year-old pupils). For these three school grades, one of the main objectives in the curriculum is learning to read. We consider that pupils build their new reading skills, i.e. the skills characterizing their potential development, by relying on skills characterizing their actual development (Vygotski, 1934/1997). When learning to read, pupils yet have at their disposal semiotic abilities related to knowledge both of material objects and their uses, and of basic gestures and their meaning (Moro & Rodriguez, 2005), all of this we sum up under the term of materiality. Consequently, in our research, we make the hypothesis that the children's basic abilities related to materiality constitute a resource in teaching-learning situations. We have chosen to carry out a case study. The data collected consist of videos of class sequences carried out four times a year for three years. These twelve videos are supplemented by two semi- structured interviews with the teacher, one "self-confronting" interview in which the teacher is brought to discuss her actions and by the analysis of the ministry's school curricula. Our analysis is both macrogenetic and microgenetic. For each teaching sequence, on the level of macrogenetic analysis, we have made up the synopsis from which we have selected significant episodes in terms of materiality. The significant episodes are composed of remarkable events the microgenetic analysis of which requires the use of tools such as materiality boards and photograms. Our study shows that materiality enables pupils to develop reading skills and that the forms that materiality takes on change according to the pupils' acquisition progress and the aspects of reading (code and comprehension) still to be learned.

Modelling the mechanical aspects of the curing process of magneto-sensitive elastomeric materials

In this paper, a phenomenologically motivated magneto-mechanically coupled finite strain elastic framework for simulating the curing process of polymers in the presence of a magnetic load is proposed. This approach is in line with previous works by Hossain and co-workers on finite strain curing modelling framework for the purely mechanical polymer curing (Hossain et al., 2009b). The proposed thermodynamically consistent approach is independent of any particular free energy function that may be used for the fully-cured magneto-sensitive polymer modelling, i.e. any phenomenological or micromechanical-inspired free energy can be inserted into the main modelling framework. For the fabrication of magneto-sensitive polymers, micron-size ferromagnetic particles are mixed with the liquid matrix material in the uncured stage. The particles align in a preferred direction with the application of a magnetic field during the curing process. The polymer curing process is a complex (visco) elastic process that transforms a fluid to a solid with time. Such transformation process is modelled by an appropriate constitutive relation which takes into account the temporal evolution of the material parameters appearing in a particular energy function. For demonstration in this work, a frequently used energy function is chosen, i.e. the classical Mooney-Rivlin free energy enhanced by coupling terms. Several representative numerical examples are demonstrated that prove the capability of our approach to correctly capture common features in polymers undergoing curing processes in the presence of a magneto-mechanical coupled load.

Physicochemical aspects and efficiency of albuterol nebulization: comparison of three aerosol types in an in vitro pediatric model.

BACKGROUND: Advances in nebulizer design have produced both ultrasonic nebulizers and devices based on a vibrating mesh (vibrating mesh nebulizers), which are expected to enhance the efficiency of aerosol drug therapy. The aim of this study was to compare 4 different nebulizers, of 3 different types, in an in vitro model using albuterol delivery and physical characteristics as benchmarks. METHODS: The following nebulizers were tested: Sidestream Disposable jet nebulizer, Multisonic Infra Control ultrasonic nebulizer, and the Aerogen Pro and Aerogen Solo vibrating mesh nebulizers. Aerosol duration, temperature, and drug solution osmolality were measured during nebulization. Albuterol delivery was measured by a high-performance liquid chromatography system with fluorometric detection. The droplet size distribution was analyzed with a laser granulometer. RESULTS: The ultrasonic nebulizer was the fastest device based on the duration of nebulization; the jet nebulizer was the slowest. Solution temperature decreased during nebulization when the jet nebulizer and vibrating mesh nebulizers were used, but it increased with the ultrasonic nebulizer. Osmolality was stable during nebulization with the vibrating mesh nebulizers, but increased with the jet nebulizer and ultrasonic nebulizer, indicating solvent evaporation. Albuterol delivery was 1.6 and 2.3 times higher with the ultrasonic nebulizer and vibrating mesh nebulizers devices, respectively, than with the jet nebulizer. Particle size was significantly higher with the ultrasonic nebulizer. CONCLUSIONS: The in vitro model was effective for comparing nebulizer types, demonstrating important differences between nebulizer types. The new devices, both the ultrasonic nebulizers and vibrating mesh nebulizers, delivered more aerosolized drug than traditional jet nebulizers.