MRI-based prostate brachytherapy seed localization.

A magnetic resonance imaging (MRI) pulse sequence and a corresponding image processing algorithm to localize prostate brachytherapy seeds during or after therapy are presented. Inversion-Recovery with ON-resonant water suppression (IRON) is an MRI methodology that generates positive contrast in regions of magnetic field susceptibility, as created by prostate brachytherapy seeds. Phantoms comprising of several materials found in brachytherapy seeds were created to assess the usability of the IRON pulse sequence for imaging seeds. Resulting images show that seed materials are clearly visible with high contrast using IRON, agreeing with theoretical predictions. A seed localization algorithm to process IRON images demonstrates the potential of this imaging technique for seed localization and dosimetry.

Towards a consensus view on understanding nanomaterials hazards and managing exposure

The aim of this article is to present an overview of salient issues of exposure, characterisation and hazard assessment of nanomaterials as they emerged from the consensus-building of experts undertaken within the four year European Commission coordination project NanoImpactNet. The approach adopted is to consolidate and condense the findings and problem-identification in such a way as to identify knowledge-gaps and generate a set of interim recommendations of use to industry, regulators, research bodies and funders. The categories of recommendation arising from the consensual view address: significant gaps in vital factual knowledge of exposure, characterisation and hazards; the development, dissemination and standardisation of appropriate laboratory protocols; address a wide range of technical issues in establishing an adequate risk assessment platform; the more efficient and coordinated gathering of basic data; greater inter-organisational cooperation; regulatory harmonization; the wider use of the life-cycle approaches; and the wider involvement of all stakeholders in the discussion and solution-finding efforts for nanosafety.

Gait and foot clearance parameters obtained using shoe-worn inertial sensors in a large-population sample of older adults

In order to distinguish dysfunctional gait; clinicians require a measure of reference gait parameters for each population. This study provided normative values for widely used parameters in more than 1400 able-bodied adults over the age of 65. We also measured the foot clearance parameters (i.e., height of the foot above ground during swing phase) that are crucial to understand the complex relationship between gait and falls as well as obstacle negotiation strategies. We used a shoe-worn inertial sensor on each foot and previously validated algorithms to extract the gait parameters during 20 m walking trials in a corridor at a self-selected pace. We investigated the difference of the gait parameters between male and female participants by considering the effect of age and height factors. Besides; we examined the inter-relation of the clearance parameters with the gait speed. The sample size and breadth of gait parameters provided in this study offer a unique reference resource for the researchers.

Souffle cardiaque et indications à léchocardiographie [Cardiac murmurs: when to refer for echography?].

Management of cardiac murmur varies with its characteristics and clinical features. Cardiac echography should not be done systematically, as proposed by the guidelines. The aim of this article is to define which situations do require a cardiac echography, and which do not, thus restricting the expenses without harming the patients care.

Bioéthique

(Résumé de l'ouvrage) Cette publication s'inscrit dans une perspective sociale et culturelle : articuler des données historiques par rapport à leurs significations, leurs résonances imaginaires, leurs effets sociaux, leur statut de références symboliques. Elle offre ainsi au lecteur un panorama du protestantisme d'aujourd'hui, avec ses forces et ses faiblesses. Cette nouvelle édition (coédition avec Labor et Fides) est entièrement revue, corrigée et augmentée. Elle est constituée de 48 "grands dossiers" et d'environ 1400 "petites rubriques" consacrés soit à des personnalités soit à des notions significatives du "fait protestant". Cette encyclopédie s'inscrit dans les débats contemporains où le rapport au religieux s'impose comme objet de réflexion au coeur d'une Europe construite dans une matrice chrétienne.

HIV Testing Practices by Clinical Service before and after Revised Testing Guidelines in a Swiss University Hospital.

OBJECTIVES: To determine 1) HIV testing practices in a 1400-bed university hospital where local HIV prevalence is 0.4% and 2) the effect on testing practices of national HIV testing guidelines, revised in March 2010, recommending Physician-Initiated Counselling and Testing (PICT). METHODS: Using 2 hospital databases, we determined the number of HIV tests performed by selected clinical services, and the number of patients tested as a percentage of the number seen per service ('testing rate'). To explore the effect of the revised national guidelines, we examined testing rates for two years pre- and two years post-PICT guideline publication. RESULTS: Combining the clinical services, 253,178 patients were seen and 9,183 tests were performed (of which 80 tested positive, 0.9%) in the four-year study period. The emergency department (ED) performed the second highest number of tests, but had the lowest testing rates (0.9-1.1%). Of inpatient services, neurology and psychiatry had higher testing rates than internal medicine (19.7% and 9.6% versus 8%, respectively). There was no significant increase in testing rates, either globally or in the majority of the clinical services examined, and no increase in new HIV diagnoses post-PICT recommendations. CONCLUSIONS: Using a simple two-database tool, we observe no global improvement in HIV testing rates in our hospital following new national guidelines but do identify services where testing practices merit improvement. This study may show the limit of PICT strategies based on physician risk assessment, compared to the opt-out approach.

Water-filtered infrared-A radiation (wIRA) is not implicated in cellular degeneration of human skin.

BACKGROUND: Excessive exposure to solar ultraviolet radiation is involved in the complex biologic process of cutaneous aging. Wavelengths in the ultraviolet-A and -B range (UV-A and UV-B) have been shown to be responsible for the induction of proteases, e. g. the collagenase matrix metalloproteinase 1 (MMP-1), which are related to cell aging. As devices emitting longer wavelengths are widely used in therapeutic and cosmetic interventions and as the induction of MMP-1 by water-filtered infrared-A (wIRA) had been discussed, it was of interest to assess effects of wIRA on the cellular and molecular level known to be possibly involved in cutaneous degeneration. OBJECTIVES: Investigation of the biological implications of widely used water-filtered infrared-A (wIRA) radiators for clinical use on human skin fibroblasts assessed by MMP-1 gene expression (MMP-1 messenger ribonucleic acid (mRNA) expression).Methods: Human skin fibroblasts were irradiated with approximately 88% wIRA (780-1400 nm) and 12% red light (RL, 665-780 nm) with 380 mW/cm(2) wIRA(+RL) (333 mW/cm(2) wIRA) on the one hand and for comparison with UV-A (330-400 nm, mainly UV-A1) and a small amount of blue light (BL, 400-450 nm) with 28 mW/cm(2) UV-A(+BL) on the other hand. Survival curves were established by colony forming ability after single exposures between 15 minutes and 8 hours to wIRA(+RL) (340-10880 J/cm(2) wIRA(+RL), 300-9600 J/cm(2) wIRA) or 15-45 minutes to UV-A(+BL) (25-75 J/cm(2) UV-A(+BL)). Both conventional Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) and quantitative real-time RT-PCR techniques were used to determine the induction of MMP-1 mRNA at two physiologic temperatures for skin fibroblasts (30 degrees C and 37 degrees C) in single exposure regimens (15-60 minutes wIRA(+RL), 340-1360 J/cm(2) wIRA(+RL), 300-1200 J/cm(2) wIRA; 30 minutes UV-A(+BL), 50 J/cm(2) UV-A(+BL)) and in addition at 30 degrees C in a repeated exposure protocol (up to 10 times 15 minutes wIRA(+RL) with 340 J/cm(2) wIRA(+RL), 300 J/cm(2) wIRA at each time). RESULTS: Single exposure of cultured human dermal fibroblasts to UV-A(+BL) radiation yielded a very high increase in MMP-1 mRNA expression (11 +/-1 fold expression for RT-PCR and 76 +/-2 fold expression for real-time RT-PCR both at 30 degrees C, 75 +/-1 fold expression for real-time RT-PCR at 37 degrees C) and a dose-dependent decrease in cell survival. In contrast, wIRA(+RL) did not produce cell death and did not induce a systematic increase in MMP-1 mRNA expression (less than twofold expression, within the laboratory range of fluctuation) detectable with the sensitive methods applied. Additionally, repeated exposure of human skin fibroblasts to wIRA(+RL) did not induce MMP-1 mRNA expression systematically (less than twofold expression by up to 10 consecutive wIRA(+RL) exposures and analysis with real-time RT-PCR). CONCLUSIONS: wIRA(+RL) even at the investigated disproportionally high irradiances does not induce cell death or a systematic increase of MMP-1 mRNA expression, both of which can be easily induced by UV-A radiation. Furthermore, these results support previous findings of in vivo investigations on collagenase induction by UV-A but not wIRA and show that infrared-A with appropriate irradiances does not seem to be involved in MMP-1 mediated photoaging of the skin. As suggested by previously published studies wIRA could even be implicated in a protective manner.

Ein unbekanntes Fragment der "Alexandreis" Walters von Châtillon

Das im letzten Viertel des 12. Jahrhunderts entstandene Alexander-Epos Walters von Châtillon, schon im 13. Jahrhundert in den ,,status of a classic" (Colker) und überdies zum Schultext avanciert, gehört zu den am reichhaltigsten überlieferten Erzähltexten der lateinischen Literatur des Mittelalters. Der Beitrag kann ausser den in der Ausgabe Colkers (1987) nachgewiesenen 209 Textzeugen 15 weitere Handschriften und Fragmente belegen und zudem einen Neufund vorstellen: Im Archiv der Bürgergemeinde Frauenfeld, Schweiz, erhielt sich als einzelnes Doppelblatt ein glossiertes Fragment des Textes aus dem späten 13. oder frühen 14. Jahrhundert. Sein Layout verrät, dass es für die begleitende Kommentierung von vornherein angelegt war und vermutlich einem Schulbuch entstammt. Die erhaltenen Scholien scheinen dem ,,Standardkommentar" (Killermann) zur ,Alexandreis' nahezustehen, könnten aber auch Bezüge zum Kommentar des Geoffrey de Vitry aufweisen, der in einer mit seinem Namen auktorial verbundenen, aus Rheinau stammenden Handschrift erhalten ist. In vergleichsweise dichter räumlicher und zeitlicher Nähe zu diesem Textzeugen entstand die Handschrift, aus der das neue Frauenfelder Fragment stammt: Die Untersuchung der Akte, als deren Schutzumschlag das Doppelblatt aus der ,Alexandreis' diente, zeigt, dass sie sich seit dem frühen 15. Jahrhundert im jetzigen Kontext, den Beständen des heutigen Archivs der Frauenfelder Bürgergemeinde, befunden hat, das auf eine seit dem 13. Jahrhundert geführte Sammlung zurückgeht. Da zudem in Frauenfeld eine Lateinschule seit dem 14. Jahrhundert nachweisbar und schon im 13. Jahrhundert zu vermuten ist, liegt es nahe, dass der Fundort des neuen Textzeugen auch der seiner Entstehung oder doch zumindest seiner Benutzung im Unterricht war. Das Fragment bietet einen trotz schlechter Abschrift (mit häufigen Korrekturen durch den Glossator) unverkennbar guten Text, in kritischer Hinsicht dabei nur geringen Gewinn. Seine textgeschichtliche Verortung kann angesichts der nach wie vor weitgehend unaufgearbeiteten Überlieferung der ,Alexandreis' nur in groben Zügen vorgenommen werden. - Mit einem durch einen kritischen Apparat erschlossenen diplomatischen Abdruck und zwei Abbildungen des neuen Fragments.

Bone mineral density (BMD), micro-architecture estimation (TBS) and vertebral fracture assessment (VFA) extracted from a single DXA device in combination with clinical risk factors improve significantly the identification of women at high risk of fracture.

Osteoporosis (OP) is a systemic skeletal disease characterized by a low bone mineral density (BMD) and a micro-architectural (MA) deterioration. Clinical risk factors (CRF) are often used as a MA approximation. MA is yet evaluable in daily practice by the trabecular bone score (TBS) measure. TBS is very simple to obtain, by reanalyzing a lumbar DXA-scan. TBS has proven to have diagnosis and prognosis values, partially independent of CRF and BMD. The aim of the OsteoLaus cohort is to combine in daily practice the CRF and the information given by DXA (BMD, TBS and vertebral fracture assessment (VFA)) to better identify women at high fracture risk. The OsteoLaus cohort (1400 women 50 to 80 years living in Lausanne, Switzerland) started in 2010. This study is derived from the cohort COLAUS who started in Lausanne in 2003. The main goal of COLAUS is to obtain information on the epidemiology and genetic determinants of cardiovascular risk in 6700 men and women. CRF for OP, bone ultrasound of the heel, lumbar spine and hip BMD, VFA by DXA and MA evaluation by TBS are recorded in OsteoLaus. Preliminary results are reported. We included 631 women: mean age 67.4 ± 6.7 years, BMI 26.1 ± 4.6, mean lumbar spine BMD 0.943 ± 0.168 (T-score − 1.4 SD), and TBS 1.271 ± 0.103. As expected, correlation between BMD and site matched TBS is low (r2 = 0.16). Prevalence of VFx grade 2/3, major OP Fx and all OP Fx is 8.4%, 17.0% and 26.0% respectively. Age- and BMI-adjusted ORs (per SD decrease) are 1.8 (1.2-2.5), 1.6 (1.2-2.1), and 1.3 (1.1-1.6) for BMD for the different categories of fractures and 2.0 (1.4-3.0), 1.9 (1.4-2.5), and 1.4 (1.1-1.7) for TBS respectively. Only 32 to 37% of women with OP Fx have a BMD < − 2.5 SD or a TBS < 1.200. If we combine a BMD < − 2.5 SD or a TBS < 1.200, 54 to 60% of women with an osteoporotic Fx are identified. As in the already published studies, these preliminary results confirm the partial independence between BMD and TBS. More importantly, a combination of TBS subsequent to BMD increases significantly the identification of women with prevalent OP Fx which would have been misclassified by BMD alone. For the first time we are able to have complementary information about fracture (VFA), density (BMD), micro- and macro architecture (TBS and HAS) from a simple, low ionizing radiation and cheap device: DXA. Such complementary information is very useful for the patient in the daily practice and moreover will likely have an impact on cost effectiveness analysis.

Le pergélisol dans les terrains sédimentaires à forte déclivité: distribution, régime thermique et instabilités

Résumé: Dans le contexte d'un climat de plus en plus chaud, la localisation du pergélisol dans les terrains sédimentaires à forte déclivité et l'évaluation des mouvements de terrain qui y ont cours s'avèrent primordiales. S'insérant dans cette problématique, ce travail de thèse s'articule autour de deux axes de recherche différents. D'un point de vue statique, cette recherche propose une étude de la distribution et des caractéristiques du pergélisol dans les éboulis de la zone périglaciaire alpine. D'un point de vue dynamique, une analyse de l'influence des caractéristiques du pergélisol (teneur en glace, température du pergélisol, etc.) et des variations des températures de l'air et du sol sur les vitesses de fluage des corps sédimentaires gelés est effectuée. Afin de répondre à ce double objectif, l'approche "terrain" a été privilégiée. Pour déterminer la répartition et les caractéristiques du pergélisol, les méthodes traditionnelles de prospection du pergélisol ont été utilisées, à savoir la mesure de la température du sol à la base du manteau neigeux (BTS), la mesure de la température du sol en continu ainsi que la méthode géoélectrique. Les mouvements de terrain ont pour leur part été mesurés à l'aide d'un GPS différentiel. L'étude de la distribution du pergélisol a été effectuée dans une quinzaine d'éboulis situés dans les régions du Mont Gelé (Verbier-Nendaz) et d'Arolla principalement. Dans la plupart des cas, un pergélisol a pu être mis en évidence dans la partie inférieure des accumulations sédimentaires, alors que la partie médiane des éboulis n'est, le plus souvent, pas gelée. Si cette absence de pergélisol se prolonge parfois dans les portions sommitales des pentes, les mesures réalisées montrent que dans d'autres cas des sédiments gelés y sont à nouveau présents. Les résistivités électriques mesurées dans les portions gelées des éboulis étudiés sont dans la plupart des cas nettement inférieures à celles mesurées sur les glaciers rocheux. Des études préalables ont montré que des circulations d'air internes sont responsables de l'anomalie thermique négative et, lorsqu'il existe, du pergélisol que l'on trouve dans la partie inférieure d'éboulis situés plus de 1000 m plus bas que la limite inférieure régionale du pergélisol discontinu. L'étude de quatre sites de basse altitude (1400-1900 m), et notamment l'équipement du site de Dreveneuse (Préalpes Valaisannes) avec deux forages, des capteurs de température de surface et un anémomètre a permis de vérifier et de préciser le mécanisme de ventilation actif au sein des éboulis froids de basse altitude. Ce mécanisme fonctionne de la manière suivante: en hiver, l'air contenu dans l'éboulis, plus chaud et plus léger que l'air extérieur, monte à l'intérieur de l'accumulation sédimentaire et est expulsé dans ses parties sommitales. Cet effet de cheminée provoque une aspiration d'air froid à l'intérieur de la partie inférieure de l'éboulis, causant ainsi un sur-refroidissement marqué du terrain. En été, le mécanisme s'inverse, l'éboulis étant plus froid que l'air environnant. De l'air froid est alors expulsé au bas de la pente. Une ventilation ascendante hivernale a pu être mise en évidence dans certains des éboulis de haute altitude étudiés. Elle est probablement en grande partie responsable de la configuration particulière des zones gelées observées. Même si l'existence d'un effet de cheminée n'a pu être démontrée dans tous les cas, du fait notamment de la glace interstitielle qui entrave le cheminement de l'air, des indices laissant présager son possible fonctionnement existent dans la quasi totalité des éboulis étudiés. L'absence de pergélisol à des altitudes qui lui sont favorables pourrait en tous les cas s'expliquer par un réchauffement du terrain lié à des expulsions d'air relativement chaud. L'étude des mouvements de terrain a été effectuée sur une dizaine de sites, principalement sur des glaciers rocheux, mais également sur une moraine de poussée et - II - Résumé ? abstract quelques éboulis. Plusieurs glaciers rocheux présentent des formes de déstabilisation récente (niches d'arrachement, blocs basculés, apparition de la matrice fine à la surface, etc.), ce qui témoigne d'une récente accélération des vitesses de déplacement. Ce phénomène, qui semble général à l'échelle alpine, est probablement à mettre sur le compte du réchauffement du pergélisol depuis une vingtaine d'années. Les vitesses mesurées sur ces formations sont souvent plus élevées que les valeurs habituellement proposées dans la littérature. On note par ailleurs une forte variabilité inter-annuelle des vitesses, qui semblent dépendre de la variation de la température moyenne annuelle de surface. Abstract: In the context of a warmer climate, the localisation of permafrost in steep sedimentary terrain and the measurement of terrain movements that occur in these areas is of great importance. With respect to these problems, this PhD thesis follows two different research axes. From a static point of view, the research presents a study of the permafrost distribution and characteristics in the talus slopes of the alpine periglacial belt. From a dynamic point of view, an analysis of the influence of the permafrost characteristics (ice content, permafrost temperature, etc.) and air and soil temperature variations on the creep velocities of frozen sedimentary bodies is carried out. In order to attain this double objective, the "field" approach was favoured. To determine the distribution and the characteristics of permafrost, the traditional methods of permafrost prospecting were used, i.e. ground surface temperature measurements at the base of the snow cover (BTS), year-round ground temperature measurements and DC-resistivity prospecting. The terrain movements were measured using a differential GPS. The permafrost distribution study was carried out on 15 talus slopes located mainly in the Mont Gelé (Verbier-Nendaz) and Arolla areas (Swiss Alps). In most cases, permafrost was found in the lower part of the talus slope, whereas the medium part was free of ice. In some cases, the upper part of the talus is also free of permafrost, whereas in other cases permafrost is present. Electrical resistivities measured in the frozen parts of the studied talus are in most cases clearly lower than those measured on rock glaciers. Former studies have shown that internal air circulation is responsible for the negative thermal anomaly and, when it exists, the permafrost present in the lower part of talus slopes located more than 1000 m below the regional lower limit of discontinuous permafrost. The study of four low-altitude talus slopes (1400-1900 m), and notably the equipment of Dreveneuse field site (Valais Prealps) with two boreholes, surface temperature sensors and an anemometer permitted to verify and to detail the ventilation mechanism active in low altitude talus slopes. This mechanism works in the following way: in winter, the air contained in the block accumulation is warmer and lighter than the surrounding air and therefore moves upward in the talus and is expelled in its upper part. This chimney effect induces an aspiration of cold air in the interior of the lower part of talus, that causes a strong overcooling of the ground. In summer, the mechanism is reversed because the talus slope is colder than the surrounding air. Cold air is then expelled in the lower part of the slope. Evidence of ascending ventilation in wintertime could also be found in some of the studied high-altitude talus slopes. It is probably mainly responsible for the particular configuration of the observed frozen areas. Even if the existence of a chimney effect could not be demonstrated in all cases, notably because of interstitial ice that obstructs Résumé ? abstract - III - the air circulation, indices of its presence exist in nearly all the studied talus. The absence of permafrost at altitudes favourable to its presence could be explained, for example, by the terrain warming caused by expulsion of relatively warm air. Terrain movements were measured at about ten sites, mainly on rock glaciers, but also on a push moraine and some talus slopes. Field observations reveal that many rock glaciers display recent destabilization features (landslide scars, tilted blocks, presence of fine grained sediments at the surface, etc.) that indicate a probable recent acceleration of the creep velocities. This phenomenon, which seems to be widespread at the alpine scale, is probably linked to the permafrost warming during the last decades. The measured velocities are often higher than values usually proposed in the literature. In addition, strong inter-annual variations of the velocities were observed, which seems to depend on the mean annual ground temperature variations.