Prediction of postnatal outcome in fetuses with pulmonary hypoplasia by fetal-MRI: Comparison between lung volumetry and pulmonary signal intensity values

Purpose: Pulmonary hypoplasia is a determinant parameter for extra-uterine life. In the last years, MRI appears as a complement to US in order to evaluate the degree of pulmonary hypoplasia in foetuses with congenital anomalies, by using different methods - fetal lung volumetry (FLV), lung-to-liver signal intensity ratio (LLSIR)-. But until now, information about the correlation between the MRI prediction and the real postnatal outcome is limited. Methods and materials: We retrospectively reviewed the fetal MRI performed at our Institution in the last 8 years and selected the cases with suspicion of fetal pulmonary hypoplasia (n = 30). The pulmonary volumetry data of these foetuses were collected and the lung-to-liver signal intensity ratio (LLSIR) measures performed. These data were compared with those obtained from a control group of 25 foetuses considered as normal at MRI. The data of the study group were also correlated with the autopsy records or the post-natal clinical information of the patients. Results: As expected, the control group showed higher FLV and LLSIR values than the problem group at all gestational ages. Higher values of FLV and LLSIR were associated with a better post-natal outcome. Sensitivity, specificity, positive and negative predictive values and accuracy for the relative LLSIR and the relative FLV showed no significant differences. Conclusion: Our data show that not only the FLV but also the relative LLSIR inform about the degree of fetal lung development. This information may help to predict the fetal outcome and to evaluate the need for neonatal intensive care.

Integration of high-resolution geophysical data for the characterization of alluvial aquifers : new approaches and implications for hydrological predictions

Abstract Accurate characterization of the spatial distribution of hydrological properties in heterogeneous aquifers at a range of scales is a key prerequisite for reliable modeling of subsurface contaminant transport, and is essential for designing effective and cost-efficient groundwater management and remediation strategies. To this end, high-resolution geophysical methods have shown significant potential to bridge a critical gap in subsurface resolution and coverage between traditional hydrological measurement techniques such as borehole log/core analyses and tracer or pumping tests. An important and still largely unresolved issue, however, is how to best quantitatively integrate geophysical data into a characterization study in order to estimate the spatial distribution of one or more pertinent hydrological parameters, thus improving hydrological predictions. Recognizing the importance of this issue, the aim of the research presented in this thesis was to first develop a strategy for the assimilation of several types of hydrogeophysical data having varying degrees of resolution, subsurface coverage, and sensitivity to the hydrologic parameter of interest. In this regard a novel simulated annealing (SA)-based conditional simulation approach was developed and then tested in its ability to generate realizations of porosity given crosshole ground-penetrating radar (GPR) and neutron porosity log data. This was done successfully for both synthetic and field data sets. A subsequent issue that needed to be addressed involved assessing the potential benefits and implications of the resulting porosity realizations in terms of groundwater flow and contaminant transport. This was investigated synthetically assuming first that the relationship between porosity and hydraulic conductivity was well-defined. Then, the relationship was itself investigated in the context of a calibration procedure using hypothetical tracer test data. Essentially, the relationship best predicting the observed tracer test measurements was determined given the geophysically derived porosity structure. Both of these investigations showed that the SA-based approach, in general, allows much more reliable hydrological predictions than other more elementary techniques considered. Further, the developed calibration procedure was seen to be very effective, even at the scale of tomographic resolution, for predictions of transport. This also held true at locations within the aquifer where only geophysical data were available. This is significant because the acquisition of hydrological tracer test measurements is clearly more complicated and expensive than the acquisition of geophysical measurements. Although the above methodologies were tested using porosity logs and GPR data, the findings are expected to remain valid for a large number of pertinent combinations of geophysical and borehole log data of comparable resolution and sensitivity to the hydrological target parameter. Moreover, the obtained results allow us to have confidence for future developments in integration methodologies for geophysical and hydrological data to improve the 3-D estimation of hydrological properties.

Effect of age toxicokinetics among human volunteers exposed to propylene glycol monomethyl ether (PGME)

Rationale: Aging adults represent the fastest growing population segment in many countries. Physiological and metabolic changes in the aging process may alter how aging adults respond to exposures compared to younger workers. Current preventive workplace exposure measures may therefore not be sufficiently protective for the aging workforce. In a controlled human toxicokinetic study (exposure chamber; 12m3), the volunteers (n=11) were men and women over the age of 58 years and exposed to a commonly used, low neurotoxic glycol ether; PGME (CAS no. 107-98- 2) (50 ppm, 6 hours). Oxidative metabolism (Michaelis-Menten) is the major pathway and conjugation the minor in humans. Metabolites, conjugated and free PGME are eliminated through the kidneys, and the elimination kinetics is dose-dependent (0 order). Scope: (1) compare the toxicokinetic profile of PGME obtained in the aging volunteers (58- 62 years) to young volunteers (20-25 years) from a previous study; (2) Test the predictive power of an existing PGME toxicokinetic compartment model for aging persons against urinary PGME concentrations found in volunteers from our experimental study. Experimental procedure: Urine samples were collected before, every 2-hour during exposures for six hours, and ad-lib for additional 20 hours. Urinary analysis of free and total PGME was performed using capillary GC/FID. The toxicokinetic model (Berkley Madonna software) was ageadjusted. Results. Urinary free and total PGME concentration rose rapidly, and did not reach an apparent plateau level during exposure. Less conjugation was observed in the older group. The predictive model developed for the young group predicted well total PGME in the aging group but not free PGME. The age adjusted toxicokinetic model's Vmax1 had to be changed for the aging group, implying slower enzymatic pathway. Conclusion: The toxicokinetic model did not predict well if only the physiological parameters were adjusted for aging adults (existing model); a substance specific metabolic rate parameter was also needed.

Adenocarcinoma of the pancreas: Comparative single centre analysis between ductal and mucinous type.

1. Background¦Adenocarcinomas of the pancreas are exocrine tumors, originate from ductal system, including two morphologically distinct entities: the ductal adenocarcinoma and mucinous adenocarcinoma. Ductal adenocarcinoma is by far the most frequent malignant tumor in the pancreas, representing at least about 90% of all pancreas cancers. It is associated with very poor prognosis, due to the fact that actually there are no any biological markers or diagnostic tools for identification of the disease at an early stage. Most of the time the disease is extensive with vascular and nerves involvement or with metastatic spread at the time of diagnosis (1). The median survival is less than 5% at 5 years, placing it, at the fifth leading cause of death by cancer in the world (2). The mucinous form of pancreatic adenocarcinoma is less frequent, and seems to have a better prognosis with about 57% survival at 5 years (1)(3)(4).¦Each morphologic type of pancreatic adenocarcinoma is associated with particular preneoplastic lesions. Two types of preneoplastic lesions are described: firstly, pancreatic intra-epithelial neoplasia (PanIN) which affects the small and peripheral pancreatic ducts, and the intraductal papillary-mucinous neoplasm (IPMN) interested the main pancreatic ducts and its principal branches. Both of preneoplastic lesions lead by different mechanisms to the pancreatic adenocarcinoma (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).¦The purpose of our study consists in a retrospective analysis of various clinical and histo-morphological parameters in order to assess a difference in survival between these two morphological types of pancreatic adenocarcinomas.¦1.2 Material and methods¦We conducted a retrospective analysis including 35 patients, (20 men and 15 women), beneficed the surgical treatment for pancreas adenocarcinoma at the Surgical Department of University Hospital in Lausanne. The patients involved in our study have been treated between 2003 and 2008, permitting at least 5-years mean follow up. For each patient the following parameters were analysed: age, gender, type of operation, type of preneoplastic lesions, TNM stage, histological grade of the tumor, vascular invasion, lymphatic and perineural invasion, resection margins, and adjuvant treatment.¦The results from these observations were included in a univariate and multivariate statistical analysis and compared with overall survival, as well as specific survival for each morphologic subtype of adenocarcinoma.¦As a low number of mucinous adenocarcinomas (n=5) was insufficient to conduct a pertinent statistical analysis, we compared the data obtained from adenocarcinomas developed on PanIN with adenocarcinomas developed on IPMN including both, ductal or mucinous types.¦1.3 Result¦Our results show that adenocarcinomas developed on pre-existing IPMN including both morphologic types (ductal and mucinous form) are associated with a better survival and prognosis than adenocarciomas developed on PanIN.¦1.4 Conclusion¦This study reflects that the most relevant parameter in survival in pancreatic adenocarcinoma seems to be the type of preneoplastic lesion. The significant difference in survival was noted between adenocarcinomas developing on PanIN as compared to adenocarcinomas developed on IPMN precursor lesions. Ductal adenocarcinomas developped on IPMN present significantly longer survival than those developed on PanIN lesions (P value= 0,01). Therefore we can suggest that the histological type of preneoplastic lesion rather than the histological type of adenocarcinoma should be the determinant prognosis factor in survival of pancreatic adenocarcinoma.

Phosphorylation modulates FOXC2 transcriptional program by controlling the high-order interaction with DNA.

Phosphorylation of transcription factors is a rapid and reversible process linking cell signaling and control of gene expression, therefore understanding how it controls the transcription factor functions is one of the challenges of functional genomics. We performed such analysis for the forkhead transcription factor FOXC2 mutated in human hereditary disease lymphedemadistichiasis and important for the development of venous and lymphatic valves and lymphatic collecting vessels. We found that FOXC2 is phosphorylated in a cell-cycle dependent manner on eight evolutionary conserved serine/threonine residues, seven of which are clustered within a 70 amino acid domain. Surprisingly, the mutation of phosphorylation sites or a complete deletion of the domain did not affect the transcriptional activity of FOXC2 in a synthetic reporter assay. However, overexpression of the wild type or phosphorylation-deficient mutant resulted in overlapping but distinct gene expression profiles suggesting that binding of FOXC2 to individual sites under physiological conditions is affected by phosphorylation. To gain a direct insight into the role of FOXC2 phosphorylation, we performed comparative genome-wide location analysis (ChIP-chip) of wild type and phosphorylation-deficient FOXC2 in primary lymphatic endothelial cells. The effect of loss of phosphorylation on FOXC2 binding to genomic sites ranged from no effect to nearly complete inhibition of binding, suggesting a mechanism for how FOXC2 transcriptional program can be differentially regulated depending on FOXC2 phosphorylation status. Based on these results, we propose an extension to the enhanceosome model, where a network of genomic context-dependent DNA-protein and protein-protein interactions not only distinguishes a functional site from a nonphysiological site, but also determines whether binding to the functional site can be regulated by phosphorylation. Moreover, our results indicate that FOXC2 may have different roles in quiescent versus proliferating lymphatic endothelial cells in vivo.

Evaluation of heterogeneity of DNA ploidy in early gastric cancers.

DNA ploidy has been shown to be a predictive parameter for prognosis in various solid tumours. The prognostic value of DNA-ploidy in gastric cancers is still a matter of controversy. A possible explanation for the discrepant results reported in the literature could be sampling error in tumours with multiple stemlines differing in DNA-ploidy. In order to determine whether or not such heterogeneity exists in early gastric carcinoma, we have performed DNA cytophotometry on multiple samples of a group of 17 early gastric carcinomas, of which 8 were pure intramucosal and 9 were infiltrating into the submucosa. We found an aneuploid DNA-stemline in 8 (47%) early gastric cancers, more often in tumours invading into the submucosa (5/9) than in purely mucosal tumours (3/8). Multiple DNA-stemlines were found more frequently in submucosally infiltrating tumours (4/5). These results confirm the presence of DNA-aneuploid early gastric carcinoma which are frequently heterogeneous and suggest that heterogeneity occurs more frequently in tumours invading the submucosa. This heterogeneity is best detected by analysing multiple samples of tumours for DNA-ploidy.

Front-crawl instantaneous velocity estimation using a wearable inertial measurement unit.

Monitoring the performance is a crucial task for elite sports during both training and competition. Velocity is the key parameter of performance in swimming, but swimming performance evaluation remains immature due to the complexities of measurements in water. The purpose of this study is to use a single inertial measurement unit (IMU) to estimate front crawl velocity. Thirty swimmers, equipped with an IMU on the sacrum, each performed four different velocity trials of 25 m in ascending order. A tethered speedometer was used as the velocity measurement reference. Deployment of biomechanical constraints of front crawl locomotion and change detection framework on acceleration signal paved the way for a drift-free integration of forward acceleration using IMU to estimate the swimmers velocity. A difference of 0.6 ± 5.4 cm · s(-1) on mean cycle velocity and an RMS difference of 11.3 cm · s(-1) in instantaneous velocity estimation were observed between IMU and the reference. The most important contribution of the study is a new practical tool for objective evaluation of swimming performance. A single body-worn IMU provides timely feedback for coaches and sport scientists without any complicated setup or restraining the swimmer's natural technique.

Time-lapse and probabilistic inversion strategies for plane-wave electromagnetic data.

L'utilisation efficace des systèmes géothermaux, la séquestration du CO2 pour limiter le changement climatique et la prévention de l'intrusion d'eau salée dans les aquifères costaux ne sont que quelques exemples qui démontrent notre besoin en technologies nouvelles pour suivre l'évolution des processus souterrains à partir de la surface. Un défi majeur est d'assurer la caractérisation et l'optimisation des performances de ces technologies à différentes échelles spatiales et temporelles. Les méthodes électromagnétiques (EM) d'ondes planes sont sensibles à la conductivité électrique du sous-sol et, par conséquent, à la conductivité électrique des fluides saturant la roche, à la présence de fractures connectées, à la température et aux matériaux géologiques. Ces méthodes sont régies par des équations valides sur de larges gammes de fréquences, permettant détudier de manières analogues des processus allant de quelques mètres sous la surface jusqu'à plusieurs kilomètres de profondeur. Néanmoins, ces méthodes sont soumises à une perte de résolution avec la profondeur à cause des propriétés diffusives du champ électromagnétique. Pour cette raison, l'estimation des modèles du sous-sol par ces méthodes doit prendre en compte des informations a priori afin de contraindre les modèles autant que possible et de permettre la quantification des incertitudes de ces modèles de façon appropriée. Dans la présente thèse, je développe des approches permettant la caractérisation statique et dynamique du sous-sol à l'aide d'ondes EM planes. Dans une première partie, je présente une approche déterministe permettant de réaliser des inversions répétées dans le temps (time-lapse) de données d'ondes EM planes en deux dimensions. Cette stratégie est basée sur l'incorporation dans l'algorithme d'informations a priori en fonction des changements du modèle de conductivité électrique attendus. Ceci est réalisé en intégrant une régularisation stochastique et des contraintes flexibles par rapport à la gamme des changements attendus en utilisant les multiplicateurs de Lagrange. J'utilise des normes différentes de la norme l2 pour contraindre la structure du modèle et obtenir des transitions abruptes entre les régions du model qui subissent des changements dans le temps et celles qui n'en subissent pas. Aussi, j'incorpore une stratégie afin d'éliminer les erreurs systématiques de données time-lapse. Ce travail a mis en évidence l'amélioration de la caractérisation des changements temporels par rapport aux approches classiques qui réalisent des inversions indépendantes à chaque pas de temps et comparent les modèles. Dans la seconde partie de cette thèse, j'adopte un formalisme bayésien et je teste la possibilité de quantifier les incertitudes sur les paramètres du modèle dans l'inversion d'ondes EM planes. Pour ce faire, je présente une stratégie d'inversion probabiliste basée sur des pixels à deux dimensions pour des inversions de données d'ondes EM planes et de tomographies de résistivité électrique (ERT) séparées et jointes. Je compare les incertitudes des paramètres du modèle en considérant différents types d'information a priori sur la structure du modèle et différentes fonctions de vraisemblance pour décrire les erreurs sur les données. Les résultats indiquent que la régularisation du modèle est nécessaire lorsqu'on a à faire à un large nombre de paramètres car cela permet d'accélérer la convergence des chaînes et d'obtenir des modèles plus réalistes. Cependent, ces contraintes mènent à des incertitudes d'estimations plus faibles, ce qui implique des distributions a posteriori qui ne contiennent pas le vrai modèledans les régions ou` la méthode présente une sensibilité limitée. Cette situation peut être améliorée en combinant des méthodes d'ondes EM planes avec d'autres méthodes complémentaires telles que l'ERT. De plus, je montre que le poids de régularisation des paramètres et l'écart-type des erreurs sur les données peuvent être retrouvés par une inversion probabiliste. Finalement, j'évalue la possibilité de caractériser une distribution tridimensionnelle d'un panache de traceur salin injecté dans le sous-sol en réalisant une inversion probabiliste time-lapse tridimensionnelle d'ondes EM planes. Etant donné que les inversions probabilistes sont très coûteuses en temps de calcul lorsque l'espace des paramètres présente une grande dimension, je propose une stratégie de réduction du modèle ou` les coefficients de décomposition des moments de Legendre du panache de traceur injecté ainsi que sa position sont estimés. Pour ce faire, un modèle de résistivité de base est nécessaire. Il peut être obtenu avant l'expérience time-lapse. Un test synthétique montre que la méthodologie marche bien quand le modèle de résistivité de base est caractérisé correctement. Cette méthodologie est aussi appliquée à un test de trac¸age par injection d'une solution saline et d'acides réalisé dans un système géothermal en Australie, puis comparée à une inversion time-lapse tridimensionnelle réalisée selon une approche déterministe. L'inversion probabiliste permet de mieux contraindre le panache du traceur salin gr^ace à la grande quantité d'informations a priori incluse dans l'algorithme. Néanmoins, les changements de conductivités nécessaires pour expliquer les changements observés dans les données sont plus grands que ce qu'expliquent notre connaissance actuelle des phénomenès physiques. Ce problème peut être lié à la qualité limitée du modèle de résistivité de base utilisé, indiquant ainsi que des efforts plus grands devront être fournis dans le futur pour obtenir des modèles de base de bonne qualité avant de réaliser des expériences dynamiques. Les études décrites dans cette thèse montrent que les méthodes d'ondes EM planes sont très utiles pour caractériser et suivre les variations temporelles du sous-sol sur de larges échelles. Les présentes approches améliorent l'évaluation des modèles obtenus, autant en termes d'incorporation d'informations a priori, qu'en termes de quantification d'incertitudes a posteriori. De plus, les stratégies développées peuvent être appliquées à d'autres méthodes géophysiques, et offrent une grande flexibilité pour l'incorporation d'informations additionnelles lorsqu'elles sont disponibles. -- The efficient use of geothermal systems, the sequestration of CO2 to mitigate climate change, and the prevention of seawater intrusion in coastal aquifers are only some examples that demonstrate the need for novel technologies to monitor subsurface processes from the surface. A main challenge is to assure optimal performance of such technologies at different temporal and spatial scales. Plane-wave electromagnetic (EM) methods are sensitive to subsurface electrical conductivity and consequently to fluid conductivity, fracture connectivity, temperature, and rock mineralogy. These methods have governing equations that are the same over a large range of frequencies, thus allowing to study in an analogous manner processes on scales ranging from few meters close to the surface down to several hundreds of kilometers depth. Unfortunately, they suffer from a significant resolution loss with depth due to the diffusive nature of the electromagnetic fields. Therefore, estimations of subsurface models that use these methods should incorporate a priori information to better constrain the models, and provide appropriate measures of model uncertainty. During my thesis, I have developed approaches to improve the static and dynamic characterization of the subsurface with plane-wave EM methods. In the first part of this thesis, I present a two-dimensional deterministic approach to perform time-lapse inversion of plane-wave EM data. The strategy is based on the incorporation of prior information into the inversion algorithm regarding the expected temporal changes in electrical conductivity. This is done by incorporating a flexible stochastic regularization and constraints regarding the expected ranges of the changes by using Lagrange multipliers. I use non-l2 norms to penalize the model update in order to obtain sharp transitions between regions that experience temporal changes and regions that do not. I also incorporate a time-lapse differencing strategy to remove systematic errors in the time-lapse inversion. This work presents improvements in the characterization of temporal changes with respect to the classical approach of performing separate inversions and computing differences between the models. In the second part of this thesis, I adopt a Bayesian framework and use Markov chain Monte Carlo (MCMC) simulations to quantify model parameter uncertainty in plane-wave EM inversion. For this purpose, I present a two-dimensional pixel-based probabilistic inversion strategy for separate and joint inversions of plane-wave EM and electrical resistivity tomography (ERT) data. I compare the uncertainties of the model parameters when considering different types of prior information on the model structure and different likelihood functions to describe the data errors. The results indicate that model regularization is necessary when dealing with a large number of model parameters because it helps to accelerate the convergence of the chains and leads to more realistic models. These constraints also lead to smaller uncertainty estimates, which imply posterior distributions that do not include the true underlying model in regions where the method has limited sensitivity. This situation can be improved by combining planewave EM methods with complimentary geophysical methods such as ERT. In addition, I show that an appropriate regularization weight and the standard deviation of the data errors can be retrieved by the MCMC inversion. Finally, I evaluate the possibility of characterizing the three-dimensional distribution of an injected water plume by performing three-dimensional time-lapse MCMC inversion of planewave EM data. Since MCMC inversion involves a significant computational burden in high parameter dimensions, I propose a model reduction strategy where the coefficients of a Legendre moment decomposition of the injected water plume and its location are estimated. For this purpose, a base resistivity model is needed which is obtained prior to the time-lapse experiment. A synthetic test shows that the methodology works well when the base resistivity model is correctly characterized. The methodology is also applied to an injection experiment performed in a geothermal system in Australia, and compared to a three-dimensional time-lapse inversion performed within a deterministic framework. The MCMC inversion better constrains the water plumes due to the larger amount of prior information that is included in the algorithm. The conductivity changes needed to explain the time-lapse data are much larger than what is physically possible based on present day understandings. This issue may be related to the base resistivity model used, therefore indicating that more efforts should be given to obtain high-quality base models prior to dynamic experiments. The studies described herein give clear evidence that plane-wave EM methods are useful to characterize and monitor the subsurface at a wide range of scales. The presented approaches contribute to an improved appraisal of the obtained models, both in terms of the incorporation of prior information in the algorithms and the posterior uncertainty quantification. In addition, the developed strategies can be applied to other geophysical methods, and offer great flexibility to incorporate additional information when available.

Crescent and star shapes of members of the Chlamydiales order: impact of fixative methods.

Members of the Chlamydiales order all share a biphasic lifecycle alternating between small infectious particles, the elementary bodies (EBs) and larger intracellular forms able to replicate, the reticulate bodies. Whereas the classical Chlamydia usually harbours round-shaped EBs, some members of the Chlamydia-related families display crescent and star-shaped morphologies by electron microscopy. To determine the impact of fixative methods on the shape of the bacterial cells, different buffer and fixative combinations were tested on purified EBs of Criblamydia sequanensis, Estrella lausannensis, Parachlamydia acanthamoebae, and Waddlia chondrophila. A linear discriminant analysis was performed on particle metrics extracted from electron microscopy images to recognize crescent, round, star and intermediary forms. Depending on the buffer and fixatives used, a mixture of alternative shapes were observed in varying proportions with stars and crescents being more frequent in C. sequanensis and P. acanthamoebae, respectively. No tested buffer and chemical fixative preserved ideally the round shape of a majority of bacteria and other methods such as deep-freezing and cryofixation should be applied. Although crescent and star shapes could represent a fixation artifact, they certainly point towards a diverse composition and organization of membrane proteins or intracellular structures rather than being a distinct developmental stage.

CD34/QBEND10 immunostaining in bone marrow biopsies: an additional parameter for the diagnosis and classification of myelodysplastic syndromes.

CD34/QBEND10 immunostaining has been assessed in 150 bone marrow biopsies (BMB) including 91 myelodysplastic syndromes (MDS), 16 MDS-related AML, 25 reactive BMB, and 18 cases where RA could neither be established nor ruled out. All cases were reviewed and classified according to the clinical and morphological FAB criteria. The percentage of CD34-positive (CD34 +) hematopoietic cells and the number of clusters of CD34+ cells in 10 HPF were determined. In most cases the CD34+ cell count was similar to the blast percentage determined morphologically. In RA, however, not only typical blasts but also less immature hemopoietic cells lying morphologically between blasts and promyelocytes were stained with CD34. The CD34+ cell count and cluster values were significantly higher in RA than in BMB with reactive changes (p<0.0001 for both), in RAEB than in RA (p=0.0006 and p=0.0189, respectively), in RAEBt than in RAEB (p=0.0001 and p=0.0038), and in MDS-AML than in RAEBt (p<0.0001 and p=0.0007). Presence of CD34+ cell clusters in RA correlated with increased risk of progression of the disease. We conclude that CD34 immunostaining in BMB is a useful tool for distinguishing RA from other anemias, assessing blast percentage in MDS cases, classifying them according to FAB, and following their evolution.

Regional specificity of MRI contrast parameter changes in normal ageing revealed by voxel-based quantification (VBQ).

Normal ageing is associated with characteristic changes in brain microstructure. Although in vivo neuroimaging captures spatial and temporal patterns of age-related changes of anatomy at the macroscopic scale, our knowledge of the underlying (patho)physiological processes at cellular and molecular levels is still limited. The aim of this study is to explore brain tissue properties in normal ageing using quantitative magnetic resonance imaging (MRI) alongside conventional morphological assessment. Using a whole-brain approach in a cohort of 26 adults, aged 18-85years, we performed voxel-based morphometric (VBM) analysis and voxel-based quantification (VBQ) of diffusion tensor, magnetization transfer (MT), R1, and R2* relaxation parameters. We found age-related reductions in cortical and subcortical grey matter volume paralleled by changes in fractional anisotropy (FA), mean diffusivity (MD), MT and R2*. The latter were regionally specific depending on their differential sensitivity to microscopic tissue properties. VBQ of white matter revealed distinct anatomical patterns of age-related change in microstructure. Widespread and profound reduction in MT contrasted with local FA decreases paralleled by MD increases. R1 reductions and R2* increases were observed to a smaller extent in overlapping occipito-parietal white matter regions. We interpret our findings, based on current biophysical models, as a fingerprint of age-dependent brain atrophy and underlying microstructural changes in myelin, iron deposits and water. The VBQ approach we present allows for systematic unbiased exploration of the interaction between imaging parameters and extends current methods for detection of neurodegenerative processes in the brain. The demonstrated parameter-specific distribution patterns offer insights into age-related brain structure changes in vivo and provide essential baseline data for studying disease against a background of healthy ageing.

Adult native septic arthritis: 10 years in review in order to establish local guidelines on empiric antibiotic therapy.

Objective: Antibiotic stewardship includes development of practice guidelines incorporating local microbiology and resistance patterns. In case of septic arthritis (SA), addition of vancomycin to the empiric therapy and broad-spectrum antibiotherapy in some clinical settings are subjects of discussion. Our objective was to review the local epidemiology of native septic arthritis in adults, in order to establish local guidelines for empiric therapy. Methods: Retrospective study based on positive synovial fluid cultures and hospital discharge diagnoses of SA obtained from 1999 to 2008 in patients _16 years. Medical records were reviewed to assess the diagnosis and complete relevant clinical information. Results: During this ten-year period, we identified 233 SA on native joints in 231 patients. 107 episodes (46%) were obtained through positive synovial fluid cultures, and 126 episodes (54%) through the discharge diagnosis. 147 SA (63%) were large joint infections (LJI). 35 SA (15%) occurred in intravenous drug users. Preexisting arthropathy was present in 51% of cases. 42% of patients with small joint infection (SJI) were diabetic, vs. 23% with LJI (p = 0.003). When available, synovial fluid direct examination was positive in 35% of cases. Etiologic agents are reported in the table. Five of the 11 MRSA SA (45%) occurred in known carriers. SJI were more frequently polymicrobial (24% vs. 1%, p<0.001). For LJI, an empiric treatment with amoxicillin/clavulanate (A/C) would have been appropriate in 85% of cases. MRSA (8 cases) and tuberculous (7 cases) arthritis would have been the most frequently untreated pathogens. Addition of vancomycin to A/C in MRSA carriers would rise the adequacy to 87%. In contrast, A/C would cover only 75% of SJI (82% if restricted to non-diabetic patients). MRSA (3 cases) and P. aeruginosa (9 cases, 7 monomicrobial) would be the main untreated pathogens. An anti-pseudomonal penicillin would have been appropriate in 94% of cases of SJI (P = 0.002 vs. A/C, p = 0.19 if diabetic patients not included). Conclusions: Treatment with A/C seems adequate for empiric coverage of LJI in our setting. Broad-spectrum antibiotherapy was significantly superior for SJI in diabetic patients, due to different causative bacteria. In an area of low MRSA incidence, our results do not justify a systematic empiric therapy for MRSA, which should be considered in a known carrier.

Geostatistical determination of heavy-metal distribution in a contaminated site - A case study

A two stage sampling strategy is necessary in order to optimize the study of distribution of pollution in soils and groundwater. First, detailed sampling from a limited area coupled with statistical analysis of the data are used to determine the microvariability of the parameter(s). The results from this detailed analysis are then used to calculate the optimal spacing between samples for the larger scale study. This two stage sampling strategy can result in significant financial savings during subsequent soil or groundwater remediation. This combined sampling and statistical analysis approach is illustrated with an example from a heavy metal contaminated site.