Treatment of drug-eluting stent restenosis: an emerging challenge.

Drug eluting stent (DES) restenosis has emerged as a significant clinical entity owing to the increasing use of DES in complex lesions and patients. However, to date, there is a paucity of studies that have addressed the management of DES restenosis and the resulting outcome, leaving the interventional cardiologist with a therapeutic dilemma. The purpose of this paper is therefore to provide a concise review of available data's dealing with the treatment of DES restenosis, including the outcome of patients treated for DES restenosis, the prognostic importance of the angiographic pattern and the available therapeutic modalities.

Organismos filantrópicos y no gubernamentales en el desarrollo de nuevas ciencias y tecnologías: el caso de las micro y nanotecnologías en México

RESUMEN: La emergencia de nuevas ciencias y tecnologías vienen acompañadas de nuevas dinámicas en la producción, el uso y la diseminación de nuevos conocimientos científicos y tecnológicos. Estas nuevas dinámicas se reflejan en la reorganización de las actividades científicas, en la creación o la reorientación de nuevas temáticas en la investigación, en la emergencia de nuevas preocupaciones y debates sobre los riesgos e implicaciones sociales, y en la participación de nuevos actores en el desarrollo de la ciencia y la tecnología, entre otros factores. En este artículo se presentan los resultados del estudio sobre las funciones de un organismo con orígenes filantrópicos y no gubernamental que ha sido central en el desarrollo de los sistemas microelectromecánicos (MEMS) en México. Las funciones que se analizan han sido y son desarrolladas en las diferentes etapas del desarrollo de esta tecnología emergente en este país. Además de mostrar las funciones desempeñadas por este tipo de organismo, este texto se cuestiona sobre la modelización de las relaciones entre las diferentes entidades presentes en el desarrollo e instalación de nuevas tecnologías. En las conclusiones intentamos avanzar algunos elementos para tomar en cuenta estos organismos y enriquecer los estudios sociales sobre las nuevas ciencias y tecnologías. ABSTRACT: The emergence of new sciences and technologies come with new dynamics in the production, use and dissemination of new scientific and technological knowledge. These new dynamics are reflected in the reorganization of scientific activities, in creating or redirecting new topics in research, in the emergence of new concerns and debates about the risks and social implications, and the participation of new actors in the development of science and technology, among other factors. This article presents the results of the study on the functions of an organism with philanthropic and non-governmental sources that has been central to the development of microelectromechanical systems (MEMS) in Mexico. The functions have been discussed and are developed at different stages of development of this emerging technology in this country. In addition to showing the functions of such a body, this text is questioned on modeling the relationships between the various entities in the development and deployment of new technologies. In the conclusions we try moving some elements to take into account these organisms and enrich social studies on the new sciences and technologies.

Treatment implications of the emerging molecular classification system for melanoma.

Melanoma is an aggressive disease with few standard treatment options. The conventional classification system for this disease is based on histological growth patterns, with division into four subtypes: superficial spreading, lentigo maligna, nodular, and acral lentiginous. Major limitations of this classification system are absence of prognostic importance and little correlation with treatment outcomes. Recent preclinical and clinical findings support the notion that melanoma is not one malignant disorder but rather a family of distinct molecular diseases. Incorporation of genetic signatures into the conventional histopathological classification of melanoma has great implications for development of new and effective treatments. Genes of the mitogen-associated protein kinase (MAPK) pathway harbour alterations sometimes identified in people with melanoma. The mutation Val600Glu in the BRAF oncogene (designated BRAF(V600E)) has been associated with sensitivity in vitro and in vivo to agents that inhibit BRAF(V600E) or MEK (a kinase in the MAPK pathway). Melanomas arising from mucosal, acral, chronically sun-damaged surfaces sometimes have oncogenic mutations in KIT, against which several inhibitors have shown clinical efficacy. Some uveal melanomas have activating mutations in GNAQ and GNA11, rendering them potentially susceptible to MEK inhibition. These findings suggest that prospective genotyping of patients with melanoma should be used increasingly as we work to develop new and effective treatments for this disease.

Cyberadministration : un tremplin pour les pays émergents : illustration à travers un exemple, constats et perspectives

Nous assistons actuellement à une diffusion, à l'échelle planétaire, des Technologies de l'Information et de la Communication (TIC) même si elle se fait à des rythmes différents selon les nations (voire entre les régions d'un même pays) créant ainsi un fossé dit « numérique », en sus des multiples inégalités déjà présentes. Cette révolution informatique et technologique engendre de nombreux changements dans les rapports sociaux et permet de nombreuses applications destinées à simplifier la vie quotidienne de tout un chacun. Amine Bekkouche se penche sur la problématique de la cyberadministration comme conséquence importante des TIC, à l'instar du commerce électronique. Il présente, d'abord, une synthèse des principaux concepts de la cyberadministration ainsi qu'un panorama de la situation mondiale en ce domaine. Par la suite, il appréhende la cyberadministration dans la perspective des pays émergents, notamment, à travers l'illustration d'un pays en développement représentatif. Il propose alors des solutions concrètes qui prennent comme point de départ le secteur éducatif pour permettre une « alphabétisation informatique » de la société afin de contribuer justement à réduire le fossé numérique. Il élargit, ensuite, ces propositions à d'autres domaines et formule des recommandations facilitant leur mise en oeuvre. Il conclut, enfin, sur des perspectives qui pourraient constituer autant de pistes de recherches futures et permettre l'élaboration de projets de développement, à travers l'appropriation de ces TIC, pour améliorer la condition de l'administré, et plus globalement, du citoyen. - We are currently witnessing a distribution of Information and Communication Technologies (ICT) on a global scale. Yet, this distribution is carried out in different rhythms within each nation (and even among regions in a given country), which creates a "digital" gap, in addition to multiple inequalities already present. This computing and technological revolution engenders many changes in social relationships and permits numerous applications that are destined to simplify our lives. Amine Bekkouche takes a closer look at the issue of e-government as an important consequence of ICTs, following the example of electronic commerce. First, he presents a synthesis of the main concepts in e- government as well as a panoramic view of the global situation in this domain. Subsequently, he studies e-government in view of emerging countries, in particular through the illustration of a country in representative development. Then, he offers concrete solutions, which take the education sector as their starting point, to allow for a "computed digitalisation" of society that contribute to reduce the digital gap. Thereafter, he broadens these proposals to other domains and formulates recommendations that help their implementation. Finally, he concludes with perspectives that may constitute further research tracks and enable the elaboration of development projects, through the appropriation of ICTs, in order to improve the condition of the administered, and more generally, that of the citizen.

Kernel-based Mapping of Meteorological Fields in Complex Orography

Due to the advances in sensor networks and remote sensing technologies, the acquisition and storage rates of meteorological and climatological data increases every day and ask for novel and efficient processing algorithms. A fundamental problem of data analysis and modeling is the spatial prediction of meteorological variables in complex orography, which serves among others to extended climatological analyses, for the assimilation of data into numerical weather prediction models, for preparing inputs to hydrological models and for real time monitoring and short-term forecasting of weather.In this thesis, a new framework for spatial estimation is proposed by taking advantage of a class of algorithms emerging from the statistical learning theory. Nonparametric kernel-based methods for nonlinear data classification, regression and target detection, known as support vector machines (SVM), are adapted for mapping of meteorological variables in complex orography.With the advent of high resolution digital elevation models, the field of spatial prediction met new horizons. In fact, by exploiting image processing tools along with physical heuristics, an incredible number of terrain features which account for the topographic conditions at multiple spatial scales can be extracted. Such features are highly relevant for the mapping of meteorological variables because they control a considerable part of the spatial variability of meteorological fields in the complex Alpine orography. For instance, patterns of orographic rainfall, wind speed and cold air pools are known to be correlated with particular terrain forms, e.g. convex/concave surfaces and upwind sides of mountain slopes.Kernel-based methods are employed to learn the nonlinear statistical dependence which links the multidimensional space of geographical and topographic explanatory variables to the variable of interest, that is the wind speed as measured at the weather stations or the occurrence of orographic rainfall patterns as extracted from sequences of radar images. Compared to low dimensional models integrating only the geographical coordinates, the proposed framework opens a way to regionalize meteorological variables which are multidimensional in nature and rarely show spatial auto-correlation in the original space making the use of classical geostatistics tangled.The challenges which are explored during the thesis are manifolds. First, the complexity of models is optimized to impose appropriate smoothness properties and reduce the impact of noisy measurements. Secondly, a multiple kernel extension of SVM is considered to select the multiscale features which explain most of the spatial variability of wind speed. Then, SVM target detection methods are implemented to describe the orographic conditions which cause persistent and stationary rainfall patterns. Finally, the optimal splitting of the data is studied to estimate realistic performances and confidence intervals characterizing the uncertainty of predictions.The resulting maps of average wind speeds find applications within renewable resources assessment and opens a route to decrease the temporal scale of analysis to meet hydrological requirements. Furthermore, the maps depicting the susceptibility to orographic rainfall enhancement can be used to improve current radar-based quantitative precipitation estimation and forecasting systems and to generate stochastic ensembles of precipitation fields conditioned upon the orography.

Haemophilia registry of the medical committee of the Swiss Haemophilia Society. Update and annual survey 2009.

The Swiss Haemophilia Registry of the Medical Committee of the Swiss Haemophilia Society started in 1996 but was set as an internet-based, double password-protected facility in the year 2000. With the inclusion of patients' data from two new centres in 2009, we assume a coverage rate of about 90% of all patients with inherited bleeding disorders in our country. Data concerning the phenotype and genotype of the disorder, its severity, its therapy, the prevalence of inhibitors are readily available to the registered users, allowing quality control of haemophilia therapy at a national level, but also rapid care of the patient visiting the emergency room of another treatment centre. Basing on the available data, about two thirds of the WFH global survey can be answered; the mortality statistics shows that bleeding remains a cause of death in haemophiliacs, also in the 21th century. The Registry allows for comparisons with international datasets, especially with respect to treatment (prophylaxis vs. on-demand therapy), factor consumption and costs.

Evaluation des technologies médicales : travaux présentés pendant le Congrès TEKMED 87 = Assessment of medical technologies : the papers presented during the TEKMED 87 Congress

[Table des matières] Technology assessment in health care in the United States: an historical review / S. Perry. - The aims and methods of technology assessment / JH Glasser. - Evaluation des technologies de la santé / A. Griffiths. - Les données nécessaires pour l'évaluation des technologies médicales / R. Chrzanowski, F. Gutzwiller, F. Paccaud. - Economic issues in technology assessment/DR Lairson, JM Swint. - Two decades of experience in technology assessment: evaluating the safety, performance, and cost effectiveness of medical equipment / JJ Nobel. - Demography and technology assessment / H. Hansluwka. - Méthodes expérimentale et non expérimentale pour l'évaluation des innovations technologiques / R. Chrzanowski, F. Paccaud. - Skull radiography in head trauma: a successful case of technology assessment / NT Racoveanu. - Complications associées à l'anesthésie: une étude prospective en France / L. Tiret et al. - Impact de l'information publique sur les taux opératoires: le cas de l'hystérectomie / G. Domenighetti, P. Luraschi, A. Casabianca. - The clinical effectiveness of acupuncture for the relief of chronic pain / MS Patel, F. Gutzwiller, F. Paccaud, A. Marazzi. - Soins à domicile et hébergement à long terme: à la recherche d'un développement optimum / G. Tinturier. - Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or ESWL / MS Patel et al. - Technology assessment and medical practice / F. Gutzwiller. - Technology assessment and health policy / SJ Reiser. - Global programme on appropriate technology for health, its role and place within WHO / K. Staehr Johansen.

Emerging viral infections after hematopoietic cell transplantation.

This overview summarizes recent data on emerging viruses after hematopoietic cell transplantation (HCT), including adenovirus, BK virus, human metapneumovirus (hMPV), and human herpesvirus (HHV) 6. The increased recognition of these infections is due to improved molecular detection methods, increased surveillance and more profound immunosuppression in the host. Adenovirus can cause serious disease especially in T-cell depleted transplant recipients. Adenovirus viremia is an important risk factor for disease in this setting. BK virus has been associated with hemorrhagic cystitis in HCT recipients. BK viremia is significantly associated with hemorrhagic cystitis. hMPV shows a seasonal distribution and can cause fatal pneumonia in HCT recipients. hMPV may be the etiology of some cases previously categorized as idiopathic pneumonia syndrome. HHV-6 commonly leads to viremia in HCT recipients. HHV-6 has been strongly associated with encephalitis and delayed platelet engraftment. Prospective studies are needed to further examine epidemiology, disease associations, and management strategies for these viruses.