Indications et techniques actuelles de reconstruction mammaire après mastectomie [Indications and techniques of reconstruction after mastectomy].

Reconstructive surgery takes an important place in breast cancer treatment. Immediate breast reconstruction is performed during the same operation as mastectomy. It is contraindicated following radiotherapy. Reconstruction performed after mastectomy is called differed breast reconstruction. It is completed 6 months after chemotherapy and 1 year after radiotherapy. Prosthetic breast reconstruction is indicated when tissues are of good qualities and breast are small. Autologous reconstruction is performed in case of radiotherapy or large breast. After breast reconstruction, imperfections can be corrected with autologous fat injection.

The application of chemometrics on Infrared and Raman spectra as a tool for the forensic analysis of paints

The aim of this work is to evaluate the capabilities and limitations of chemometric methods and other mathematical treatments applied on spectroscopic data and more specifically on paint samples. The uniqueness of the spectroscopic data comes from the fact that they are multivariate - a few thousands variables - and highly correlated. Statistical methods are used to study and discriminate samples. A collection of 34 red paint samples was measured by Infrared and Raman spectroscopy. Data pretreatment and variable selection demonstrated that the use of Standard Normal Variate (SNV), together with removal of the noisy variables by a selection of the wavelengths from 650 to 1830 cm−1 and 2730-3600 cm−1, provided the optimal results for infrared analysis. Principal component analysis (PCA) and hierarchical clusters analysis (HCA) were then used as exploratory techniques to provide evidence of structure in the data, cluster, or detect outliers. With the FTIR spectra, the Principal Components (PCs) correspond to binder types and the presence/absence of calcium carbonate. 83% of the total variance is explained by the four first PCs. As for the Raman spectra, we observe six different clusters corresponding to the different pigment compositions when plotting the first two PCs, which account for 37% and 20% respectively of the total variance. In conclusion, the use of chemometrics for the forensic analysis of paints provides a valuable tool for objective decision-making, a reduction of the possible classification errors, and a better efficiency, having robust results with time saving data treatments.

Techniques for analytical testing of unconventional samples.

Forensic scientists have long detected the presence of drugs and their metabolites in biological materials using body fluids such as urine, blood and/or other biological liquids or tissues. For doping analysis, only urine has so far been collected. In recent years, remarkable advances in sensitive analytical techniques have encouraged the analysis of drugs in unconventional biological samples such as hair, saliva and sweat. These samples are easily collected, although drug levels are often lower than the corresponding levels in urine or blood. This chapter reviews recent studies in the detection of doping agents in hair, saliva and sweat. Sampling, analytical procedures and interpretation of the results are discussed in comparison with those obtained from urine and blood samples.

Neuroimaging techniques in Alzheimer's disease

Neuroimaging techniques provide valuable tools for diagnosing Alzheimer's disease (AD), monitoring disease progression and evaluating responses to treatment. There is currently a wide array of techniques available including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and, for recording electrical brain activity, electroencephalography (EEG). The choice of technique depends on the contrast between tissues of interest, spatial resolution, temporal resolution, requirements for functional data and the probable number of scans required. For example, while PET, CT and MRI can be used to differentiate between AD and other dementias, MRI is safer and provides better contrast of soft tissues. Neuroimaging is a technique spanning many disciplines and requires effective communication between doctors requesting a scan of a patient or group of patients and those with technical expertise. Consideration and discussion of the most suitable type of scan and the necessary settings to achieve the best results will help ensure appropriate techniques are chosen and used effectively. Neuroimaging techniques are currently expanding understanding of the structural and functional changes that occur in dementia. Further research may allow identification of early neurological signs ofAD, before clinical symptoms are evident, providing the opportunity to test preventative therapies. CombiningMRI and machine learning techniques may be a powerful approach to improve diagnosis ofAD and to predict clinical outcomes.

An infrared reflection-absorption spectroscopic (IRRAS) study of the interaction of lipid A and lipopolysaccharide Re with endotoxin-binding proteins.

Lipopolysaccharides (LPS, endotoxins) are main constituents of the outer membranes of Gram-negative bacteria, with the 'endotoxic principle' lipid A anchoring LPS into the membrane. When LPS is removed from the bacteria by the action of the immune system or simply by cell dividing, it may interact strongly with immunocompetent cells such as mononuclear cells. This interaction may lead, depending on the LPS concentration, to beneficial (at low) or pathophysiological (at high concentrations) reactions, the latter frequently causing the septic shock syndrome. There is a variety of endogenous LPS-binding proteins. To this class belong lactoferrin (LF) and hemoglobin (Hb), which have been shown to suppress and enhance the LPS-induced cytokine secretion in mononuclear cells, respectively. To elucidate the interaction mechanisms of endotoxins with these proteins, we have investigated in an infrared reflection-absorption spectroscopy (IRRAS) study the interaction of LPS or lipid A monolayers at the air/water interface with LF and Hb proteins, injected into the aqueous subphase. The data are clearly indicative of completely different interaction mechanisms of the endotoxins with the proteins, with the LF acting only at the LPS backbone, whereas Hb incorporates into the lipid monolayer. These data allow an understanding of the different reactivities in the biomedicinal systems.

Evaluation of two minimally invasive techniques for electroencephalogram recording in wild or freely behaving animals.

Insight into the function of sleep may be gained by studying animals in the ecological context in which sleep evolved. Until recently, technological constraints prevented electroencephalogram (EEG) studies of animals sleeping in the wild. However, the recent development of a small recorder (Neurologger 2) that animals can carry on their head permitted the first recordings of sleep in nature. To facilitate sleep studies in the field and to improve the welfare of experimental animals, herein, we test the feasibility of using minimally invasive surface and subcutaneous electrodes to record the EEG in barn owls. The EEG and behaviour of four adult owls in captivity and of four chicks in a nest box in the field were recorded. We scored a 24-h period for each adult bird for wakefulness, slow-wave sleep (SWS), and rapid-eye movement (REM) sleep using 4 s epochs. Although the quality and stability of the EEG signals recorded via subcutaneous electrodes were higher when compared to surface electrodes, the owls' state was readily identifiable using either electrode type. On average, the four adult owls spent 13.28 h awake, 9.64 h in SWS, and 1.05 h in REM sleep. We demonstrate that minimally invasive methods can be used to measure EEG-defined wakefulness, SWS, and REM sleep in owls and probably other animals.

Systematized stenting of Baerveldt shunts: techniques to reduce early post-operative hypotony

Purpose: To investigate the effect of the systematized use of intraluminal stents in Baerveldt shunts (BS) on early postoperative IOP control and complication rates. Methods: One hundred and twenty eyes with medically uncontrolled glaucoma were prospectively recruited to undergo BS implantation at Jules Gonin Eye Hospital, Switzerland. Baerveldt shunts were stented (full-length of the intraluminal tube) using a Supramid® 3.0 suture. A minority of shunts (37%) were also ligated intraoperatively and laser suture lysis performed postoperatively. Stent removals, either partial (retraction of 5mm) or complete, were carried out according to a predetermined protocol. Surgery was considered a success when IOP was ≤ 21mmHg and a minimum of 20% reduction from baseline was achieved with/without glaucoma medication (GMs). Hypotony related complications were defined as: choroidal effusions, shallow AC, hypotonous maculopathy or IOP≤5mmHg for over 2 weeks. Results: Mean age was 61.8 years (± standard deviation; ±21.5). Mean follow-up was 17.1 (±7.9) months. Mean preoperative IOP was 26.9 mmHg; mean IOP on the last visit 13.2 mmHg (p<0.001). At year one, the success rate was 87%. In 90% of eyes, IOP was ≤18 mmHg at last visit. Mean number of preoperatively GMs was 3.1; postoperatively 1.4 (p<0.001). Stent removals were performed in 87% of eyes (24% partial; 61% complete). 13% of eyes required no stent removal to reach target IOP. Complications were minor and infrequent (16%) and only 7% were hypotony related. Conclusions: Systematized use of intraluminal stents with Baerveldt aqueous shunts resulted in gradual and controlled IOP lowering with minimal hypotony-related complications. This may have important implications on clinical practice, given the rising rates of aqueous shunt implantation.

Coronary MR angiography: comparison of quantitative and qualitative data from four techniques.

OBJECTIVE: The optimal coronary MR angiography sequence has yet to be determined. We sought to quantitatively and qualitatively compare four coronary MR angiography sequences. SUBJECTS AND METHODS. Free-breathing coronary MR angiography was performed in 12 patients using four imaging sequences (turbo field-echo, fast spin-echo, balanced fast field-echo, and spiral turbo field-echo). Quantitative comparisons, including signal-to-noise ratio, contrast-to-noise ratio, vessel diameter, and vessel sharpness, were performed using a semiautomated analysis tool. Accuracy for detection of hemodynamically significant disease (> 50%) was assessed in comparison with radiographic coronary angiography. RESULTS: Signal-to-noise and contrast-to-noise ratios were markedly increased using the spiral (25.7 +/- 5.7 and 15.2 +/- 3.9) and balanced fast field-echo (23.5 +/- 11.7 and 14.4 +/- 8.1) sequences compared with the turbo field-echo (12.5 +/- 2.7 and 8.3 +/- 2.6) sequence (p < 0.05). Vessel diameter was smaller with the spiral sequence (2.6 +/- 0.5 mm) than with the other techniques (turbo field-echo, 3.0 +/- 0.5 mm, p = 0.6; balanced fast field-echo, 3.1 +/- 0.5 mm, p < 0.01; fast spin-echo, 3.1 +/- 0.5 mm, p < 0.01). Vessel sharpness was highest with the balanced fast field-echo sequence (61.6% +/- 8.5% compared with turbo field-echo, 44.0% +/- 6.6%; spiral, 44.7% +/- 6.5%; fast spin-echo, 18.4% +/- 6.7%; p < 0.001). The overall accuracies of the sequences were similar (range, 74% for turbo field-echo, 79% for spiral). Scanning time for the fast spin-echo sequences was longest (10.5 +/- 0.6 min), and for the spiral acquisitions was shortest (5.2 +/- 0.3 min). CONCLUSION: Advantages in signal-to-noise and contrast-to-noise ratios, vessel sharpness, and the qualitative results appear to favor spiral and balanced fast field-echo coronary MR angiography sequences, although subjective accuracy for the detection of coronary artery disease was similar to that of other sequences.