Telementoring during endovascular treatment of abdominal aortic aneurysms: a prospective study.

PURPOSE: To explore the use of telementoring for distant teaching and training in endovascular aortic aneurysm repair (EVAR). METHODS: According to a prospectively designed study protocol, 48 patients underwent EVAR: the first 12 patients (group A) were treated at a secondary care center by an experienced interventionist, who was training the local team; a further 12 patients (group B) were operated by the local team at their secondary center with telementoring by the experienced operator from an adjacent suite; and the last 24 patients (group C) were operated by the local team with remote telementoring support from the experienced interventionist at a tertiary care center. Telementoring was performed using 3 video sources; images were transmitted using 4 ISDN lines. EVAR was performed using intravascular ultrasound and simultaneous fluoroscopy to obtain road mapping of the abdominal aorta and its branches, as well as for identifying the origins of the renal arteries, assessing the aortic neck, and monitoring the attachment of the stent-graft proximally and distally. RESULTS: Average duration of telementoring was 2.1 hours during the first 12 patients (group B) and 1.2 hours for the remaining 24 patients (group C). There was no difference in procedural duration (127+/-59 minutes in group A, 120+/-4 minutes in group B, and 119+/-39 minutes in group C; p=0.94) or the mean time spent in the ICU (26+/-15 hours in group A, 22+/-2 hours in group B, and 22+/-11 hours for group C; p=0.95). The length of hospital stay (11+/-4 days in group A, 9+/-4 days in group B, and 7+/-1 days in group C; p=0.002) was significantly different only for group C versus A (p=0.002). Only 1 (8.3%) patient (in group A: EVAR performed by the experienced operator) required conversion to open surgery because of iliac artery rupture. This was the only conversion (and the only death) in the entire study group (1/12 in group A versus 0/36 in groups B + C, p=0.31). CONCLUSIONS: Telementoring for EVAR is feasible and shows promising results. It may serve as a model for development of similar projects for teaching other invasive procedures in cardiovascular medicine.

Web Presence Building and Performance Measuring in Business-to-Business Markets

Tutkimuksen tavoite oli selvittää yrityksen web toiminnan rakentamisen vaiheita sekä menestyksen mittaamista. Rakennusprosessia tutkittiin viisiportaisen askelmallin avulla. Mallin askeleet ovat; arviointi, strategian muotoilu, suunnitelma, pohjapiirros ja toteutus. Arviointi- ja toteutusvaiheiden täydentämiseksi sekä erityisesti myös internet toiminnan onnistumisen mittaamisen avuksi internet toiminnan hyödyt (CRM,kommunikointi-, myynti-, ja jakelukanava hyödyt markkinoinnin kannalta) käsiteltiin. Toiminnan menestyksen arvioinnin avuksi esiteltiin myös porrasmalli internet toimintaan. Porrasmalli määrittelee kauppakulissi-, dynaaminen-, transaktio- ja e-businessportaat. Tutkimuksessa löydettiin menestystekijöitä internet toimintojen menestykselle. Nämä tekijät ovat laadukas sisältö, kiinnostavuus, viihdyttävyys, informatiivisuus, ajankohtaisuus, personoitavuus, luottamus, interaktiivisuus, käytettävyys, kätevyys, lojaalisuus, suoriutuminen, responssiivisuus ja käyttäjätiedon kerääminen. Mittarit jaettiin tutkimuksessa aktiivisuus-, käyttäytymis- ja muunnosmittareihin. Lisäksi muita mittareita ja menestysindikaattoreita esiteltiin. Nämä menestyksen elementit ja mittarit koottiin yhteen uudessa internet toimintojen menestyksenarviointimallissa. Tutkielman empiirisessä osuudessa,esitettyjä teorioita peilattiin ABB:n (ABB:n sisällä erityisesti ABB Stotz-Kontakt) web toimintaan. Apuna olivat dokumenttianalyysi sekä haastattelut. Empiirinen osa havainnollisti teoriat käytännössä ja toi ilmi mahdollisuuden teorioiden laajentamiseen. Internet toimintojen rakentamismallia voidaan käyttää myös web toimintojen kehittämiseen ja porrasmalli sopii myös nykyisten internet toimintojen arvioimiseen. Mittareiden soveltaminen käytännössä toi kuitenkin ilmi tarpeen niiden kehittämiseen ja aiheen lisätutkimukseen. Niiden tulisi olla myös aiempaatiiviimmin liitetty kokonaisvaltaisen liiketoiminnan menestyksen mittaamiseen.

Study of the incorporation and the anti-tumour efficacy of radio-iododeoxyuridine according to the cellular cycle and in presence of synthesis inhibitor of thymidine

Résumé La iododeoxyuridine (IdUrd), une fois marqué au 123I ou au 125I, est un agent potentiel pour des thérapies par rayonnements Auger. Cependant, des limitations restreignent son incorporation dans l'ADN. Afin d'augmenter celle-ci, différents groupes ont étudié la fluorodeoxyuridine (FdUrd), qui favorise l'incorporation d'analogue de la thymidine, sans toutefois parvenir à une toxicité associé plus importante. Dans notre approche, 3 lignées cellulaires de glioblastomes humains et une lignée de cancer ovarien ont été utilisées. Nous avons observé, 16 à 24 h après un court pré-traitement à la FdUrd, un fort pourcentage de cellules s'accumulant en phase S. Plus qu'une accumulation, c'était une synchronisation des cellules, celles-ci restant capables d'incorporer la radio-IdIrd et repartant dans le cycle cellulaire. De plus, ces cellules accumulées après un pré-traitement à la FdUrd étaient plus radio-sensibles. Après le même intervalle de 16 à 24 h suivant la FdUrd, les 4 lignées cellulaires ont incorporé des taux plus élevés de radio-IdUrd que sans ce prétraitement. Une corrélation temporelle entre l'accumulation des cellules en phase S et la forte incorporation de radio-IdUrd a ainsi été révélée 16 à 24 h après pré-traitement à la FdUrd. Les expériences de traitement par rayonnements Auger sur les cellules accumulées en phase S ont montré une augmentation significative de l'efficacité thérapeutique de 125I-IdUrd comparé aux cellules non prétraitées à la FdUrd. Une première estimation a permis de déterminer que 100 désintégrations de 125I par cellules étant nécessaires afin d'atteindre l'efficacité thérapeutique. De plus, p53 semble jouer un rôle dans l'induction directe de mort cellulaire après des traitements par rayonnements Auger, comme indiqué par les mesures par FACS d'apoptose et de nécrose 24 et 48 h après le traitement. Concernant les expériences in vivo, nous avons observé une incorporation marquée de la radio-IdUrd dans l'ADN après un pré-traitement à la FdUrd dans un model de carcinomatose ovarienne péritonéale. Une augmentation encore plus importante a été observée après injection intra-tumorale dans des transplants sous-cutanés de glioblastomes sur des souris nues. Ces modèles pourraient être utilisés pour de plus amples études de diffusion de radio-IdUrd et de thérapie par rayonnement Auger. En conclusion, ce travail montre une première application réussie de la FdUrd afin d'accroître l'efficacité de la radio-IdUrd par traitements aux rayonnements Auger. La synchronisation des cellules en phase S combinée avec la forte incorporation de radio-IdUrd dans l'ADN différées après un pré-traitement à la FdUrd ont montré le gain thérapeutique attendu in vitro. De plus, des études in vivo sont tout indiquées après les observations encourageantes d'incorporation de radio-IdUrd dans les models de transplants sous-cutanés de glioblastomes et de tumeurs péritonéales ovariennes. Summary Iododeoxyuridine (IdUrd), labelled with 123I or 125I, could be a potential Auger radiation therapy agent. However, limitations restrict its DNA incorporation in proliferating cells. Therefore, fluorodeoxyuridine (FdUrd), which favours incorporation of thymidine analogues, has been studied by different groups in order to increase radio-IdUrd DNA incorporation, however therapeutic efficacy increase could not be reached. In our approach, 3 human glioblastoma cell lines with different p53 expression and one ovarian cancer line were pre-treated with various FdUrd conditions. We observed a high percentage of cells accumulating in early S phase 16 to 24 h after a short and non-toxic FdUrd pre-treatment. More than an accumulation, this was a synchronization, cells remaining able to incorporate radio-IdUrd and re-entering the cell cycle. Furthermore, the S phase accumulated cells post FdUrd pre-treatment were more radiosensitive. After the same delay of 16 to 24 h post FdUrd pre-treatment, the 4 cell lines were incorporating higher rates of radio-IdUrd compared with untreated cells. A time correlation between S phase accumulation and high radio-IdUrd incorporation was therefore revealed 16 to 24 h post FdUrd pre-treatment. Auger radiation treatment experiments performed on S phase enriched cells showed a significant increase of killing efficacy of 125I-IdUrd compared with cells not pre-treated with FdUrd. A first estimation indicates further that about 100 125I decays were required to reach killing in the targeted cells. Moreover, p53 might play a role on the direct induction of cell death pathways after Auger radiation treatments, as indicated by differential apoptosis and necrosis induction measured by FACS 24 and 48 h after treatment initiation. Concerning in vivo results, we observed a marked DNA incorporation increase of radio-IdUrd after FdUrd pre-treatment in peritoneal carcinomatosis in SCID mice. Even higher incorporation increase was observed after intra-tumoural injection of radio-IdUrd in subcutaneous glioblastoma transplants in nude mice. These tumour models might be further useful for diffusion of radio-IdUrd and Auger radiation therapy studies. In conclusion, these data show a first successful application of thymidine synthesis inhibition able to increase the efficacy of radio-IdUrd Auger radiation treatment. The S phase synchronization combined with a high percentage DNA incorporation of radio-IdUrd delayed post FdUrd pre-treatment provided the expected therapeutic gain in vitro. Further in vivo studies are indicated after the observations of encouraging radio-IdUrd uptake experiments in glioblastoma subcutaneous xenografts and in an ovarian peritoneal carcinomatosis model.

Can eukaryotic cells monitor the presence of unreplicated DNA?

Completion of DNA replication before mitosis is essential for genome stability and cell viability. Cellular controls called checkpoints act as surveillance mechanisms capable of detecting errors and blocking cell cycle progression to allow time for those errors to be corrected. An important question in the cell cycle field is whether eukaryotic cells possess mechanisms that monitor ongoing DNA replication and make sure that all chromosomes are fully replicated before entering mitosis, that is whether a replication-completion checkpoint exists. From recent studies with smc5–smc6 mutants it appears that yeast cells can enter anaphase without noticing that replication in the ribosomal DNA array was unfinished. smc5–smc6 mutants are proficient in all known cellular checkpoints, namely the S phase checkpoint, DNA-damage checkpoint, and spindle checkpoint, thus suggesting that none of these checkpoints can monitor the presence of unreplicated segments or the unhindered progression of forks in rDNA. Therefore, these results strongly suggest that normal yeast cells do not contain a DNA replication-completion checkpoint.

Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction.

PURPOSE: Implanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques. METHODS AND MATERIALS: Through a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new "mechanical adhesiolysis" maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication. RESULTS: Eighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted. CONCLUSION: These IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.

Effects of P300-based BCI use on reported presence in a virtual environment

Brain-computer interfaces (BCIs) are becoming more and more popular as an input device for virtual worlds and computer games. Depending on their function, a major drawback is the mental workload associated with their use and there is significant effort and training required to effectively control them. In this paper, we present two studies assessing how mental workload of a P300-based BCI affects participants" reported sense of presence in a virtual environment (VE). In the first study, we employ a BCI exploiting the P300 event-related potential (ERP) that allows control of over 200 items in a virtual apartment. In the second study, the BCI is replaced by a gaze-based selection method coupled with wand navigation. In both studies, overall performance is measured and individual presence scores are assessed by means of a short questionnaire. The results suggest that there is no immediate benefit for visualizing events in the VE triggered by the BCI and that no learning about the layout of the virtual space takes place. In order to alleviate this, we propose that future P300-based BCIs in VR are set up so as require users to make some inference about the virtual space so that they become aware of it,which is likely to lead to higher reported presence.

The Banzhaf Value in the Presence of Externalities

[eng] We propose two generalizations of the Banzhaf value for partition function form games. In both cases, our approach is based on probability distributions over the set of possible coalition structures that may arise for any given set of agents. First, we introduce a family of values, one for each collection of the latter probability distributions, defined as the Banzhaf value of an expected coalitional game. Then, we provide two characterization results for this new family of values within the framework of all partition function games. Both results rely on a property of neutrality with respect to amalgamation of players. Second, as this collusion transformation fails to be meaningful for simple games in partition function form, we propose another generalization of the Banzhaf value which also builds on probability distributions of the above type. This latter family is characterized by means of a neutrality property which uses an amalgamation transformation of players for which simple games are closed.

The Banzhaf Value in the Presence of Externalities

[eng] We propose two generalizations of the Banzhaf value for partition function form games. In both cases, our approach is based on probability distributions over the set of possible coalition structures that may arise for any given set of agents. First, we introduce a family of values, one for each collection of the latter probability distributions, defined as the Banzhaf value of an expected coalitional game. Then, we provide two characterization results for this new family of values within the framework of all partition function games. Both results rely on a property of neutrality with respect to amalgamation of players. Second, as this collusion transformation fails to be meaningful for simple games in partition function form, we propose another generalization of the Banzhaf value which also builds on probability distributions of the above type. This latter family is characterized by means of a neutrality property which uses an amalgamation transformation of players for which simple games are closed.

Architecture for a Session Initiation Protocol Based Presence Client

Mitä on läsnäolo? Tämä työ määrittelee läsnäolon tietyn henkilön, laitteen tai palvelun halukkuudeksi kommunikoida. Nykyään on olemassa lukuisia läsnäolotietoa levittäviä sovelluksia, joista jokainen käyttää erilaista protokollaa tehtävän suorittamiseen. Vasta viime aikoina sovellusten kehittäjät ovat huomanneet tarpeen yhdelle sovellukselle, joka kykenee tukemaan lukuisia läsnäoloprotokollia. Session Initiation Protocol (SIP) voi levittää läsnäolotietoa muiden ominaisuuksiensa lisäksi. Kun muita protokollia käytetään vain reaaliaikaiseen viestintään ja läsnäolotiedon lähetykseen, SIP pystyy moniin muihinkin asioihin. Se on alunperin suunniteltu aloittamaan, muuttamaan ja lopettamaan osapuolien välisiä multimediaistuntoja. Arkkitehtuurin toteutus käyttää kahta Symbian –käyttöjärjestelmän perusominaisuutta: asiakas-palvelin rakennetta ja kontaktitietokantaa. Asiakaspalvelin rakenne erottaa asiakkaan protokollasta tarjoten perustan laajennettavalle usean protokollan arkkitehtuurille ja kontaktitietokanta toimii läsnäolotietojen varastona. Työn tuloksena on Symbianin käyttöjärjestelmässä toimiva läsnäoloasiakas.

Agricultural land use and human presence around breeding sites increase stress-hormone levels and decrease body mass in barn owl nestlings.

Human activities can have a suite of positive and negative effects on animals and thus can affect various life history parameters. Human presence and agricultural practice can be perceived as stressors to which animals react with the secretion of glucocorticoids. The acute short-term secretion of glucocorticoids is considered beneficial and helps an animal to redirect energy and behaviour to cope with a critical situation. However, a long-term increase of glucocorticoids can impair e.g. growth and immune functions. We investigated how nestling barn owls (Tyto alba) are affected by the surrounding landscape and by human activities around their nest sites. We studied these effects on two response levels: (a) the physiological level of the hypothalamus-pituitary-adrenal axis, represented by baseline concentrations of corticosterone and the concentration attained by a standardized stressor; (b) fitness parameters: growth of the nestlings and breeding performance. Nestlings growing up in intensively cultivated areas showed increased baseline corticosterone levels late in the season and had an increased corticosterone release after a stressful event, while their body mass was decreased. Nestlings experiencing frequent anthropogenic disturbance had elevated baseline corticosterone levels, an increased corticosterone stress response and a lower body mass. Finally, breeding performance was better in structurally more diverse landscapes. In conclusion, anthropogenic disturbance affects offspring quality rather than quantity, whereas agricultural practices affect both life history traits.

Tratamento endovascular da oclusão das artérias ilíacas

A oclusão das artérias ilíacas é uma patologia freqüente. Várias opções cirúrgicas existem para o seu tratamento, como a ponte aorto-bifemoral, a ponte femoro-femoral cruzada, o implante de endoprótese e outros. A ponte aorto-bifemoral é considerada o tratamento com melhores resultados. O tratamento endovascular da oclusão das artérias apresenta alta taxa de sucesso e baixo índice de complicações. Realizamos este tratamento em 24 pacientes, com idade média de 61 anos, variando de 39 a 82 anos. A indicação foi claudicação intermitente em 19 pacientes e isquemia crítica em cinco. O fator de risco mais freqüente foi tabagismo em 19 pacientes. A taxa de sucesso técnico na ultrapassagem da lesão foi de 91,7% e a taxa de patência foi de 71% em um ano. Os bons resultados com o tratamento endovascular nas oclusões das artérias ilíacas, com baixas taxas de morbidade e mortalidade, sugerem a inclusão deste procedimento no arsenal terapêutico.