Traitement du cancer pulmonaire non à petites cellules par radiothérapie stéréotaxique d’ablation

Les néoplasies pulmonaires demeurent la première cause de décès par cancer au Québec représentant près de 6000 décès par année. Au cours des dernières années, la radiothérapie stéréotaxique d’ablation (SABR) s’est imposée comme un traitement alternatif à la résection anatomique pour les patients inopérables atteints d’un cancer pulmonaire non à petites cellules de stade précoce. Il s’agit d’une modalité de traitement qui permet d’administrer des doses élevées, typiquement 30-60 Gy en 1-8 fractions, dans le but de cibler précisément le volume de traitement tout en épargnant les tissus sains. Le Centre Hospitalier de l’Université de Montréal s’est muni en 2009 d’un appareil de SABR de fine pointe, le CyberKnife™ (CK), un accélérateur linéaire produisant un faisceau de photons de 6 MV dirigé par un bras robotisé, permettant d’administrer des traitements non-coplanaires avec une précision infra-millimétrique. Ce mémoire est dédié à la caractérisation de certains enjeux cliniques et physiques associés au traitement par CK. Il s’articule autour de deux articles scientifiques revus par les pairs. D’une part, une étude prospective clinique présentant les avantages de la SABR pulmonaire, une technique qui offre un excellent contrôle tumoral à long terme et aide au maintien de la qualité de vie et de la fonction pulmonaire. D’autre part, une étude de physique médicale illustrant les limites de l’acquisition d’images tomodensitométriques en auto-rétention respiratoire lors de la planification de traitement par CK.

Protein-Expressions-Analysen zur Etablierung prädiktiver Biomarker bei der Behandlung fortgeschrittener Tumoren der Mamma und der Prostata

Aktuelle Entwicklungen auf dem Gebiet der zielgerichteten Therapie zur Behandlung maligner Erkrankungen erfordern neuartige Verfahren zur Diagnostik und Selektion geeigneter Patienten. So ist das Ziel der vorliegenden Arbeit die Identifizierung neuer Zielmoleküle, die die Vorhersage eines Therapieerfolges mit targeted drugs ermöglichen. Besondere Aufmerksamkeit gilt dem humanisierten monoklonalen Antikörper Trastuzumab (Herceptin), der zur Therapie Her-2 überexprimierender, metastasierter Mammakarzinome eingesetzt wird. Jüngste Erkenntnisse lassen eine Anwendung dieses Medikamentes in der Behandlung des Hormon-unabhängigen Prostatakarzinoms möglich erscheinen. Therapie-beeinflussende Faktoren werden in der dem Rezeptor nachgeschalteten Signaltransduktion oder Veränderungen des Rezeptors selbst vermutet. Mittels Immunhistochemie wurden die Expressions- und Aktivierungsniveaus verschiedener Proteine der Her-2-assoziierten Signaltransduktion ermittelt; insgesamt wurden 37 molekulare Marker untersucht. In Formalin fixierte und in Paraffin eingebettete korrespondierende Normal- und Tumorgewebe von 118 Mammakarzinom-Patientinnen sowie 78 Patienten mit Prostatakarzinom wurden in TMAs zusammengefasst. Die in Zusammenarbeit mit erfahrenen Pathologen ermittelten Ergebnisse dienten u.a. als Grundlage für zweidimensionales, unsupervised hierarchisches clustering. Ergebnis dieser Analysen war für beide untersuchten Tumorentitäten die Möglichkeit einer Subklassifizierung der untersuchten Populationen nach molekularen Eigenschaften. Hierbei zeigten sich jeweils neue Möglichkeiten zur Anwendung zielgerichteter Therapien, deren Effektivität Inhalt weiterführender Studien sein könnte. Zusätzlich wurden an insgesamt 43 Frischgeweben die möglichen Folgen des sog. shedding untersucht. Western Blot-basierte Untersuchungen zeigten hierbei die Möglichkeit der Selektion von Patienten aufgrund falsch-positiver Befunde in der derzeit als Standard geltenden Diagnostik. Zusätzlich konnte durch Vergleich mit einer Herceptin-sensitiven Zelllinie ein möglicher Zusammenhang eines Therapieerfolges mit dem Phosphorylierungs-/ Aktivierungszustand des Rezeptors ermittelt werden. Fehlende klinische Daten zum Verlauf der Erkrankung und Therapie der untersuchten Patienten lassen keine Aussagen über die tatsächliche Relevanz der ermittelten Befunde zu. Dennoch verdeutlichen die erhaltenen Resultate eindrucksvoll die Komplexität der molekularen Vorgänge, die zu einem Krebsgeschehen führen und damit Auswirkungen auf die Wirksamkeit von targeted drugs haben können. Entwicklungen auf dem Gebiet der zielgerichteten Therapie erfordern Verbesserungen auf dem Gebiet der Diagnostik, die die sichere Selektion geeigneter Patienten erlauben. Die Zukunft der personalisierten, zielgerichteten Behandlung von Tumorerkrankungen wird verstärkt von molekularen Markerprofilen hnlich den hier vorgestellten Daten beeinflusst werden.

Libro de Producción del documental: Operación sin Libertad

Este documental pretende reconstruir la memoria de las víctimas de la detención masiva ocurrida en la población de Quinchía, Risaralda el 28 de Septiembre de 2003. Con el fin de analizar las consecuencias de las acciones llevadas a cabo por el Estado colombiano, encaminadas a capturar miembros de la insurgencia en las diferentes regiones del país, surgió la idea de realizar este trabajo. El documental se concentró en el fenómeno de las detenciones masivas producidas en el primer mandato del presidente Álvaro Uribe Vélez, quien en su política de Seguridad Democrática, ha procurado acabar con el flagelo de los grupos armados ilegales, especialmente con la guerrilla, a través de organismos estatales como Ejército, Policía y Fiscalía, quienes se dieron a la tarea de perseguir a los insurgentes y a sus colaboradores.

Tamizaje combinado de primer trimestre para aneuploidias en una población bogotana

El tamizaje combinado prenatal de primer trimestre para la detección de aneuploidías, ajusta la edad materna, la medida de sonolucencia nucal fetal y concentraciones séricas maternas de PAPP-A y B-hCG para calcular este riesgo. Se han observado variaciones en los MoM s de los analítos séricos maternos de acuerdo a variables como raza, peso, numero de fetos y técnicas de reproducción asistida. Objetivo: calcular los valores de PAPP-A y B-hCG y sus MoM s en la población estudiada comparándolos con población caucásica, evaluando el desempeño de la prueba. Metodología: este es un estudio retrospectivo realizado en 926 mujeres embarazadas con 10 a 13,6 semanas. Se calculan concentraciones séricas y MoM s corregidos para peso, raza y técnicas de reproducción asistida de la PAPP-A y B-hCG, el riesgo de presentar síndrome Down al nacimiento, sensibilidad y tasa de falsos positivos para la prueba. Resultados: la edad materna media fue de 33,6 años (rango entre 20 y 45 años). Los MoM s de PAPP-A fueron 11,8% inferiores respecto a la población caucásica. El 9.4% de las pacientes obtuvieron un riesgo positivo y el 3,3% presento alteraciones citogenéticas en el cariotipo fetal. La sensibilidad del tamizaje fue del 100% con una tasa de falsos positivos del 5,7% en un punto de corte de 1 en 250. Conclusión: el tamizaje combinado de primer trimestre es un método efectivo para la detección de aneuploidías. Los MoM s de la PAPP-A son un 11,8% inferiores en la población estudiada y esto debe ajustarse para disminuir la tasa de resultados falsos positivos.

Evaluación de la vía aérea superior en pacientes con sahos mediante cefalometría 3D y multiplanar

Objetivo: determinar parámetros biométricos para evaluación y diagnóstico de pacientes con SAHOS por medio de Cefalometría Tridimensional y reconstrucción Multiplanar escanográfica. Materiales y Métodos: se realizó estudio observacional tipo cross-sectional, con 25 pacientes diagnosticados con SAHOS, a los cuales se les hizo TAC simple de cara con reconstrucción multiplanar y tridimensional, evaluando volumen de vía aérea, longitud, promedio del área en corte transversal, área retropalatal, área reglosal, espacio retrogloso lateral y anteroposterior. Resultados: se incluyeron 25 pacientes y realizaron medidas de volumen, longitud, promedio del área en corte transversal, área retropalatal, área retroglosal y espacios regloso lateral y anteroposterior, realizando análisis estadístico mediante el programa SPSS 17.0 reportando medidas de tendencia central como promedio, media, moda, rango, desviación estándar, y concordancia inter e intra observador. Conclusión: la Cefalometría tridimensional con reconstrucción multiplanar ha mostrado ser un excelente método de evaluación de vía aérea en pacientes con SAHOS, obteniendo propias clasificaciones dentro del estudio de estos pacientes. Sin embargo, ante la escasa literatura y difícil obtención de parámetros de referencia es necesario promover el estudio y la investigación de este método diagnostico en pacientes con SAHOS.

Hallazgos radiológicos de la enfermedad pulmonar en pacientes Colombianos con esclerodermia

La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta principalmente la piel, los pulmones, el tracto gastrointestinal, el corazón y los riñones. La enfermedad pulmonar, presente en casi el 100% de los casos, es el factor con mayor influencia en la mortalidad. El propósito de este estudio es realizar un análisis detallado de la enfermedad pulmonar por tomografía computarizada de alta resolución(TCAR) en pacientes Colombianos con ES, para lo cual se realizó un estudio de prevalencia analítica en 44 pacientes con ES valorados en el Hospital Universitario Mayor Méderi en los últimos 7 años. Los resultados mostraron características demográficas y clínicas similares a las previamente descritas. La prevalencia de enfermedad pulmonar intersticial fue alta, y los hallazgos de fibrosis pulmonar como vidrio esmerilado y panal de abejas se asociaron con la presencia del autoanticuerpo antiSCL70. La medida del diámetro esofágico por TCAR fue mayor en los pacientes con disfagia, antiSCL 70 y linfopenia, los cuales son marcadores de mal pronóstico.

Estudo da presença de Mycobacterium avium subespécie paratuberculosis numa exploração leiteira no Litoral Centro de Portugal Continental

A Paratuberculose, conhecida também como Doença de Johne, é uma afeção infecciosa que provoca uma enterite granulomatosa crónica causada pelo agente Mycobacterium avium subespécie paratuberculosis (Map). É uma doença de carácter contagioso, de distribuição mundial, atingindo os mamíferos, particularmente os pequenos e grandes ruminantes, equinos, suínos, búfalos, coelhos, etc. Tem um grande impacto económico, nomeadamente na redução da produção leiteira, na redução dos teores de proteína no leite, na susceptibilidade a outras doenças, no refugo de animais e no aumento dos custos na sanidade. Pensa-se que também terá impacto a nível de Saúde Pública uma vez que o Map pode estar associado á doença de Crohn em humanos em que o leite cru, leite em pó ou leite pasteurizado podem ser os veículos de transmissão, porém não existem estudos suficientes para sustentar este acontecimento. A técnica de diagnóstico “Gold Standard” é a cultura microbiológica de fezes, no entanto é um procedimento muito demorado podendo levar até 4 meses para se observarem as colónias bacterianas, uma vez que o seu crescimento é muito lento. Deste modo, existem outros testes, tais como o PCR e ELISA, com elevada especificidade para o agente que fornecem resultados mais rápidos e que permitem minimizar os falsos-positivos, apesar da sua reduzida sensibilidade (por volta dos 50%). Este estudo é baseado na observação das instalações da exploração e consequente comparação com parâmetros analisados e documentados em literatura. Para além disso, são utilizadas informações fornecidas pelo Software da exploração com o intuito de estudar a incidência da Paratuberculose, ao longo dos anos, de modo a comprovar se as medidas de maneio e de higiene adotadas pela exploração afetada contribuem ou não de alguma maneira para o controlo/erradicaçãoda doença de Johne.

Use of airborne remote sensing to detect riverside Brassica rapa to aid in risk assessment of transgenic crops

High resolution descriptions of plant distribution have utility for many ecological applications but are especially useful for predictive modelling of gene flow from transgenic crops. Difficulty lies in the extrapolation errors that occur when limited ground survey data are scaled up to the landscape or national level. This problem is epitomized by the wide confidence limits generated in a previous attempt to describe the national abundance of riverside Brassica rapa (a wild relative of cultivated rapeseed) across the United Kingdom. Here, we assess the value of airborne remote sensing to locate B. rapa over large areas and so reduce the need for extrapolation. We describe results from flights over the river Nene in England acquired using Airborne Thematic Mapper (ATM) and Compact Airborne Spectrographic Imager (CASI) imagery, together with ground truth data. It proved possible to detect 97% of flowering B. rapa on the basis of spectral profiles. This included all stands of plants that occupied >2m square (>5 plants), which were detected using single-pixel classification. It also included very small populations (<5 flowering plants, 1-2m square) that generated mixed pixels, which were detected using spectral unmixing. The high detection accuracy for flowering B. rapa was coupled with a rather large false positive rate (43%). The latter could be reduced by using the image detections to target fieldwork to confirm species identity, or by acquiring additional remote sensing data such as laser altimetry or multitemporal imagery.

Flood detection in urban areas using TerraSAR-X

Flooding is a major hazard in both rural and urban areas worldwide, but it is in urban areas that the impacts are most severe. An investigation of the ability of high resolution TerraSAR-X Synthetic Aperture Radar (SAR) data to detect flooded regions in urban areas is described. The study uses a TerraSAR-X image of a 1 in 150 year flood near Tewkesbury, UK, in 2007, for which contemporaneous aerial photography exists for validation. The DLR SAR End-To-End simulator (SETES) was used in conjunction with airborne scanning laser altimetry (LiDAR) data to estimate regions of the image in which water would not be visible due to shadow or layover caused by buildings and taller vegetation. A semi-automatic algorithm for the detection of floodwater in urban areas is described, together with its validation using the aerial photographs. 76% of the urban water pixels visible to TerraSAR-X were correctly detected, with an associated false positive rate of 25%. If all urban water pixels were considered, including those in shadow and layover regions, these figures fell to 58% and 19% respectively. The algorithm is aimed at producing urban flood extents with which to calibrate and validate urban flood inundation models, and these findings indicate that TerraSAR-X is capable of providing useful data for this purpose.

Detection of flood extent in urban areas using high resolution TerraSAR-X data

Flooding is a major hazard in both rural and urban areas worldwide, but it is in urban areas that the impacts are most severe. An investigation of the ability of high resolution TerraSAR-X data to detect flooded regions in urban areas is described. An important application for this would be the calibration and validation of the flood extent predicted by an urban flood inundation model. To date, research on such models has been hampered by lack of suitable distributed validation data. The study uses a 3m resolution TerraSAR-X image of a 1-in-150 year flood near Tewkesbury, UK, in 2007, for which contemporaneous aerial photography exists for validation. The DLR SETES SAR simulator was used in conjunction with airborne LiDAR data to estimate regions of the TerraSAR-X image in which water would not be visible due to radar shadow or layover caused by buildings and taller vegetation, and these regions were masked out in the flood detection process. A semi-automatic algorithm for the detection of floodwater was developed, based on a hybrid approach. Flooding in rural areas adjacent to the urban areas was detected using an active contour model (snake) region-growing algorithm seeded using the un-flooded river channel network, which was applied to the TerraSAR-X image fused with the LiDAR DTM to ensure the smooth variation of heights along the reach. A simpler region-growing approach was used in the urban areas, which was initialized using knowledge of the flood waterline in the rural areas. Seed pixels having low backscatter were identified in the urban areas using supervised classification based on training areas for water taken from the rural flood, and non-water taken from the higher urban areas. Seed pixels were required to have heights less than a spatially-varying height threshold determined from nearby rural waterline heights. Seed pixels were clustered into urban flood regions based on their close proximity, rather than requiring that all pixels in the region should have low backscatter. This approach was taken because it appeared that urban water backscatter values were corrupted in some pixels, perhaps due to contributions from side-lobes of strong reflectors nearby. The TerraSAR-X urban flood extent was validated using the flood extent visible in the aerial photos. It turned out that 76% of the urban water pixels visible to TerraSAR-X were correctly detected, with an associated false positive rate of 25%. If all urban water pixels were considered, including those in shadow and layover regions, these figures fell to 58% and 19% respectively. These findings indicate that TerraSAR-X is capable of providing useful data for the calibration and validation of urban flood inundation models.

Statistical methods for examining genetic influences of resistance to anti-epileptic drugs

It is generally accepted that genetics may be an important factor in explaining the variation between patients’ responses to certain drugs. However, identification and confirmation of the responsible genetic variants is proving to be a challenge in many cases. A number of difficulties that maybe encountered in pursuit of these variants, such as non-replication of a true effect, population structure and selection bias, can be mitigated or at least reduced by appropriate statistical methodology. Another major statistical challenge facing pharmacogenetics studies is trying to detect possibly small polygenic effects using large volumes of genetic data, while controlling the number of false positive signals. Here we review statistical design and analysis options available for investigations of genetic resistance to anti-epileptic drugs.

A critical assessment of a desk study comparing crop production systems: The example of the 'system of rice intensification' versus 'best management practice'

When assessing hypotheses, the possibility and consequences of false-positive conclusions should be considered along with the avoidance of false-negative ones. A recent assessment of the system of rice intensification (SRI) by McDonald et al. [McDonald, A.J., Hobbs, P.R., Riha, S.J., 2006. Does the system of rice intensification outperform conventional best management? A synopsis of the empirical record. Field Crops Res. 96, 31-36] provides a good example where this was not done as it was preoccupied with avoiding false-positives only. It concluded, based on a desk study using secondary data assembled selectively from diverse sources and with a 95% level of confidence, that 'best management practices' (BMPs) on average produce 11% higher rice yields than SRI methods, and that, therefore, SRI has little to offer beyond what is already known by scientists.

Use of airborne remote sensing to detect riverside Brassica rapa to aid in risk assessment of transgenic crops

High resolution descriptions of plant distribution have utility for many ecological applications but are especially useful for predictive modeling of gene flow from transgenic crops. Difficulty lies in the extrapolation errors that occur when limited ground survey data are scaled up to the landscape or national level. This problem is epitomized by the wide confidence limits generated in a previous attempt to describe the national abundance of riverside Brassica rapa (a wild relative of cultivated rapeseed) across the United Kingdom. Here, we assess the value of airborne remote sensing to locate B. rapa over large areas and so reduce the need for extrapolation. We describe results from flights over the river Nene in England acquired using Airborne Thematic Mapper (ATM) and Compact Airborne Spectrographic Imager (CASI) imagery, together with ground truth data. It proved possible to detect 97% of flowering B. rapa on the basis of spectral profiles. This included all stands of plants that occupied >2m square (>5 plants), which were detected using single-pixel classification. It also included very small populations (<5 flowering plants, 1-2m square) that generated mixed pixels, which were detected using spectral unmixing. The high detection accuracy for flowering B. rapa was coupled with a rather large false positive rate (43%). The latter could be reduced by using the image detections to target fieldwork to confirm species identity, or by acquiring additional remote sensing data such as laser altimetry or multitemporal imagery.

Face verification using Gabor wavelets and AdaBoost

This paper presents a new face verification algorithm based on Gabor wavelets and AdaBoost. In the algorithm, faces are represented by Gabor wavelet features generated by Gabor wavelet transform. Gabor wavelets with 5 scales and 8 orientations are chosen to form a family of Gabor wavelets. By convolving face images with these 40 Gabor wavelets, the original images are transformed into magnitude response images of Gabor wavelet features. The AdaBoost algorithm selects a small set of significant features from the pool of the Gabor wavelet features. Each feature is the basis for a weak classifier which is trained with face images taken from the XM2VTS database. The feature with the lowest classification error is selected in each iteration of the AdaBoost operation. We also address issues regarding computational costs in feature selection with AdaBoost. A support vector machine (SVM) is trained with examples of 20 features, and the results have shown a low false positive rate and a low classification error rate in face verification.

Design and evaluation of intelligent classifier based intrusion detection system

We have discovered a novel approach of intrusion detection system using an intelligent data classifier based on a self organizing map (SOM). We have surveyed all other unsupervised intrusion detection methods, different alternative SOM based techniques and KDD winner IDS methods. This paper provides a robust designed and implemented intelligent data classifier technique based on a single large size (30x30) self organizing map (SOM) having the capability to detect all types of attacks given in the DARPA Archive 1999 the lowest false positive rate being 0.04 % and higher detection rate being 99.73% tested using full KDD data sets and 89.54% comparable detection rate and 0.18% lowest false positive rate tested using corrected data sets.