Le rôle des associations de patients face au don d'organes en Suisse romande [Organ donation and the role of patients' associations in Western Switzerland].

In the context of lay mobilization in health-related areas, this article addresses the role and activities of patients' associations in connection with organ donation, on the basis of interviews carried out with thirty members of transplant patients' associations in the French-speaking part of Switzerland. First, we describe the three main categories of activities conducted by these associations. While self-help and public awareness activities are predominant, policy-oriented actions are marginal. Then, we examine the factors likely to explain why these associations have a limited capacity to be active, especially in the public sphere. Such a lack of social visibility is all the more important in the current political context, characterized by the implementation of a national action plan designed to improve organ donation.

Waddlia chondrophila induces systemic infection, organ pathology, and elicits Th1-associated humoral immunity in a murine model of genital infection.

Waddlia chondrophila is a known bovine abortigenic Chlamydia-related bacterium that has been associated with adverse pregnancy outcomes in human. However, there is a lack of knowledge regarding how W. chondrophila infection spreads, its ability to elicit an immune response and induce pathology. A murine model of genital infection was developed to investigate the pathogenicity and immune response associated with a W. chondrophila infection. Genital inoculation of the bacterial agent resulted in a dose-dependent infection that spread to lumbar lymph nodes and successively to spleen and liver. Bacterial-induced pathology peaked on day 14, characterized by leukocyte infiltration (uterine horn, liver, and spleen), necrosis (liver) and extramedullary hematopoiesis (spleen). Immunohistochemistry demonstrated the presence of a large number of W. chondrophila in the spleen on day 14. Robust IgG titers were detected by day 14 and remained high until day 52. IgG isotypes consisted of high IgG2a, moderate IgG3 and no detectable IgG1, indicating a Th1-associated immune response. This study provides the first evidence that W. chondrophila genital infection is capable of inducing a systemic infection that spreads to major organs, induces uterus, spleen, and liver pathology and elicits a Th1-skewed humoral response. This new animal model will help our understanding of the mechanisms related to intracellular bacteria-induced miscarriages, the most frequent complication of pregnancy that affects one in four women.

Histopathology and prognosis of de novo bladder tumors following solid organ transplantation.

BACKGROUND: Patients following solid organ transplantation have an increased risk of developing de novo bladder tumors, but their biology is poorly characterized. METHODS: We studied 1743 patients who underwent a transurethral resection of a newly diagnosed bladder tumor at a single institution. The histopathology, treatment, recurrence-free survival and overall survival were evaluated and compared between transplant and non-transplant patients. RESULTS: We identified 74 transplant patients who developed a de novo bladder tumor after a median post-transplantation interval of 62 months. The tumor was malignant in 29 patients (39 %). The most common benign lesion was nephrogenic adenoma (84 %), which neither coexisted with nor developed into malignant tumors during follow-up. Compared with non-transplant patients (n = 1669), transplant patients were significantly younger (median 55 vs 69 years, P < 0.001) and had a 9.0-fold higher odds of benign tumors (P < 0.001), while there were no differences in pathology among patients with urothelial carcinoma of the bladder (UCB). In a multivariable analysis for non-muscle-invasive UCB that was adjusted for the risk group, patients with a transplant had a 1.8-fold increased risk of recurrence (P = 0.048). Four of five transplant patients did not respond to Bacillus Calmette-Guérin instillations. There were no differences in overall survival after radical cystectomy (P = 0.87). CONCLUSIONS: The majority of bladder tumors in transplant patients are benign, and they neither coexist with nor develop into malignant tumors. Transplant patients with non-muscle-invasive UCB show an increased risk of disease recurrence, while those treated with radical cystectomy have similar outcomes to patients without a transplant.

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation.

Infectious diseases after solid organ transplantation (SOT) are a significant cause of morbidity and reduced allograft and patient survival; however, the influence of infection on the development of chronic allograft dysfunction has not been completely delineated. Some viral infections appear to affect allograft function by both inducing direct tissue damage and immunologically related injury, including acute rejection. In particular, this has been observed for cytomegalovirus (CMV) infection in all SOT recipients and for BK virus infection in kidney transplant recipients, for community-acquired respiratory viruses in lung transplant recipients, and for hepatitis C virus in liver transplant recipients. The impact of bacterial and fungal infections is less clear, but bacterial urinary tract infections and respiratory tract colonization by Pseudomonas aeruginosa and Aspergillus spp appear to be correlated with higher rates of chronic allograft dysfunction in kidney and lung transplant recipients, respectively. Evidence supports the beneficial effects of the use of antiviral prophylaxis for CMV in improving allograft function and survival in SOT recipients. Nevertheless, there is still a need for prospective interventional trials assessing the potential effects of preventive and therapeutic strategies against bacterial and fungal infection for reducing or delaying the development of chronic allograft dysfunction.

Elders and the ITCs use to communicate with children and grandchildren

Past research in using ICTs (Information and Communication Technologies) in interpersonal communication showed that age plays an important role. There is a general assumption that the elderly are left behind regarding the adoption and the use of ICTs. Furthermore, elders tend to use ICTs mainly for instrumental purposes and the use is rather non-sophisticated. When elders are using ICTs to maintain their social network, similar patterns could be found: They start using internet, or intensify its use, when their children move abroad while they might decrease using the tool if the motivation ends. In this research we explore elders' incentives to go online and use internet services to communicate; the type of agencies they use to communicate with children and grandchildren abroad; and the situations that make them stop using the ICTs or even reject internet mediated communications. We base our discussion on the empirical evidence the two authors gathered in different cities and countries: Barcelona, Romania, Toronto, Los Angeles, Montevideo and Lima, through semi-structured interviews and observation, with people aged 60 years old and over. The results show that the ability for using ICT tools in an autonomous way is a better explanation than age. In this, we distinguish between assisted users and autonomous users. We found that oldest seniors and those seniors who are less socially active are more likely to be assisted users than those who are socially or professionally active. For them communication with their children and grandchildren abroad follows no agency or it is mediated by significant others from their local social network, who are able to use ICTs and select specific information to share, in the second step, with the elder. For some younger participants the use of ICTs is rather situational and imposed by their children or grandchildren, who installed the tool in the first place and assisted them in using it. Finally, other elders describe a proficient and independent use of ICTs so they use the devices and services the way they want to.We discuss the implications of the patterns in using ICTs, for elders' social life and their relationships with children and grandchildren. First, we emphasis the fact that those elders rejecting the ICTs or being unskilled in using them to communicate might be left out from their family circle, particularly when children are abroad -they would experience more isolation. Second, we underline the fact that when children and grandchildren are the ones that control the ICTs used by their parents and grandparents, they are controlling also the information flow and this will redefine the power relations between elders and their younger relatives.

On Variational Ensemble Kalman Filtering

The Extended Kalman Filter (EKF) and four dimensional assimilation variational method (4D-VAR) are both advanced data assimilation methods. The EKF is impractical in large scale problems and 4D-VAR needs much effort in building the adjoint model. In this work we have formulated a data assimilation method that will tackle the above difficulties. The method will be later called the Variational Ensemble Kalman Filter (VEnKF). The method has been tested with the Lorenz95 model. Data has been simulated from the solution of the Lorenz95 equation with normally distributed noise. Two experiments have been conducted, first with full observations and the other one with partial observations. In each experiment we assimilate data with three-hour and six-hour time windows. Different ensemble sizes have been tested to examine the method. There is no strong difference between the results shown by the two time windows in either experiment. Experiment I gave similar results for all ensemble sizes tested while in experiment II, higher ensembles produce better results. In experiment I, a small ensemble size was enough to produce nice results while in experiment II the size had to be larger. Computational speed is not as good as we would want. The use of the Limited memory BFGS method instead of the current BFGS method might improve this. The method has proven succesful. Even if, it is unable to match the quality of analyses of EKF, it attains significant skill in forecasts ensuing from the analysis it has produced. It has two advantages over EKF; VEnKF does not require an adjoint model and it can be easily parallelized.

Integração de técnicas analíticas e proposta de experimentos para cursos de graduação em análise instrumental: uso de espectrômetro de absorção atômica para medidas de absorção molecular

Simple experiments are proposed for measuring molecular absorption of chromate and dichromate ions using an atomic absorption spectrometer. The experiments can help undergraduate students in instrumental analysis courses understand important aspects involving conceptual and instrumental similarities and differences between frequently used analytical techniques. Hollow cathode lamps were selected with wavelengths in the region of molecular absorption of chromate and dichromate. Calibration curves were obtained and the linear dynamic range was evaluated. Results were compared with those obtained in a molecular absorption spectrometer. The molar absorptivities obtained were also compared.

Automatic evaluation and data generation for analytical chemistry instrumental analysis exercises

In general, laboratory activities are costly in terms of time, space, and money. As such, the ability to provide realistically simulated laboratory data that enables students to practice data analysis techniques as a complementary activity would be expected to reduce these costs while opening up very interesting possibilities. In the present work, a novel methodology is presented for design of analytical chemistry instrumental analysis exercises that can be automatically personalized for each student and the results evaluated immediately. The proposed system provides each student with a different set of experimental data generated randomly while satisfying a set of constraints, rather than using data obtained from actual laboratory work. This allows the instructor to provide students with a set of practical problems to complement their regular laboratory work along with the corresponding feedback provided by the system's automatic evaluation process. To this end, the Goodle Grading Management System (GMS), an innovative web-based educational tool for automating the collection and assessment of practical exercises for engineering and scientific courses, was developed. The proposed methodology takes full advantage of the Goodle GMS fusion code architecture. The design of a particular exercise is provided ad hoc by the instructor and requires basic Matlab knowledge. The system has been employed with satisfactory results in several university courses. To demonstrate the automatic evaluation process, three exercises are presented in detail. The first exercise involves a linear regression analysis of data and the calculation of the quality parameters of an instrumental analysis method. The second and third exercises address two different comparison tests, a comparison test of the mean and a t-paired test.

The Regulation of Skeletal and Cardiac Muscle Blood Flow in Humans. Studies by positron emission tomography with special reference to exercise, adenosine and nitric oxide

Virtually every cell and organ in the human body is dependent on a proper oxygen supply. This is taken care of by the cardiovascular system that supplies tissues with oxygen precisely according to their metabolic needs. Physical exercise is one of the most demanding challenges the human circulatory system can face. During exercise skeletal muscle blood flow can easily increase some 20-fold and its proper distribution to and within muscles is of importance for optimal oxygen delivery. The local regulation of skeletal muscle blood flow during exercise remains little understood, but adenosine and nitric oxide may take part in this process. In addition to acute exercise, long-term vigorous physical conditioning also induces changes in the cardiovasculature, which leads to improved maximal physical performance. The changes are largely central, such as structural and functional changes in the heart. The function and reserve of the heart’s own vasculature can be studied by adenosine infusion, which according to animal studies evokes vasodilation via it’s a_2A receptors. This has, however, never been addressed in humans in vivo and also studies in endurance athletes have shown inconsistent results regarding the effects of sport training on myocardial blood flow. This study was performed on healthy young adults and endurance athletes and local skeletal and cardiac muscle blod flow was measured by positron emission tomography. In the heart, myocardial blood flow reserve and adenosine A_2A receptor density, and in skeletal muscle, oxygen extraction and consumption was also measured. The role of adenosine in the control of skeletal muscle blood flow during exercise, and its vasodilator effects, were addressed by infusing competitive inhibitors and adenosine into the femoral artery. The formation of skeletal muscle nitric oxide was also inhibited by a drug, with and without prostanoid blockade. As a result and conclusion, it can be said that skeletal muscle blood flow heterogeneity decreases with increasing exercise intensity most likely due to increased vascular unit recruitment, but exercise hyperemia is a very complex phenomenon that cannot be mimicked by pharmacological infusions, and no single regulator factor (e.g. adenosine or nitric oxide) accounts for a significant part of exercise-induced muscle hyperemia. However, in the present study it was observed for the first time in humans that nitric oxide is not only important regulator of the basal level of muscle blood flow, but also oxygen consumption, and together with prostanoids affects muscle blood flow and oxygen consumption during exercise. Finally, even vigorous endurance training does not seem to lead to supranormal myocardial blood flow reserve, and also other receptors than A_2A mediate the vasodilator effects of adenosine. In respect to cardiac work, atheletes heart seems to be luxuriously perfused at rest, which may result from reduced oxygen extraction or impaired efficiency due to pronouncedly enhanced myocardial mass developed to excel in strenuous exercise.

Determination of copper at wide range concentrations using instrumental features of high-resolution continuum source flame atomic absorption spectrometry

This work describes a method to determine Cu at wide range concentrations in a single run without need of further dilutions employing high-resolution continuum source flame atomic absorption spectrometry. Different atomic lines for Cu at 324.754 nm, 327.396 nm, 222.570 nm, 249.215 nm and 224.426 nm were evaluated and main figures of merit established. Absorbance measurements at 324.754 nm, 249.215 nm and 224.426 nm allows the determination of Cu in the 0.07 - 5.0 mg L-1, 5.0 - 100 mg L-1 and 100 - 800 mg L-1 concentration intervals respectively with linear correlation coefficients better than 0.998. Limits of detection were 21 µg L-1, 310 µg L-1 and 1400 µg L-1 for 324.754 nm, 249.215 nm and 224.426 nm, respectively and relative standard deviations (n = 12) were £ 2.7%. The proposed method was applied to water samples spiked with Cu and the results were in agreement at a 95% of confidence level (paired t-test) with those obtained by line-source flame atomic absorption spectrometry.

Transcriptional Profiling of Organ‐Specific Autoimmunity in Human

Our understanding of the pathogenesis of organ‐specific autoinflammation has been restricted by limited access to the target organs. Peripheral blood, however, as a preferred transportation route for immune cells, provides a window to assess the entire immune system throughout the body. Transcriptional profiling with RNA stabilizing blood collection tubes reflects in vivo expression profiles at the time the blood is drawn, allowing detection of the disease activity in different samples or within the same sample over time. The main objective of this Ph.D. study was to apply gene‐expression microarrays in the characterization of peripheral blood transcriptional profiles in patients with autoimmune diseases. To achieve this goal a custom cDNA microarray targeted for gene‐expression profiling of human immune system was designed and produced. Sample collection and preparation was then optimized to allow gene‐expression profiling from whole‐blood samples. To overcome challenges resulting from minute amounts of sample material, RNA amplification was successfully applied to study pregnancy related immunosuppression in patients with multiple sclerosis (MS). Furthermore, similar sample preparation was applied to characterize longitudinal genome‐wide expression profiles in children with type 1 diabetes (T1D) associated autoantibodies and eventually clinical T1D. Blood transcriptome analyses, using both the ImmunoChip cDNA microarray with targeted probe selection and genome‐wide Affymetrix U133 Plus 2.0 oligonucleotide array, enabled monitoring of autoimmune activity. Novel disease related genes and general autoimmune signatures were identified. Notably, down‐regulation of the HLA class Ib molecules in peripheral blood was associated with disease activity in both MS and T1D. Taken together, these studies demonstrate the potential of peripheral blood transcriptional profiling in biomedical research and diagnostics. Imbalances in peripheral blood transcriptional activity may reveal dynamic changes that are relevant for the disease but might be completely missed in conventional cross‐sectional studies.

The Peace and Security Council of the African Union : its relationship with the United Nations, African Union and sub-regional mechanisms

Avhandlingen undersöker den Afrikanska Unionens freds- och säkerhetsråd och dess roll i framhävandet och upprätthållandet av fred, säkerhet och stabilitet i Afrika. Detta freds- och säkerhetsråd etablerades formellt 2004 och opererar under den Afrikanska Unionen (AU) som å sin sida upprättades 2002. Den Afrikanska Unionens freds- och säkerhetsråds roll i framhävandet av fred, säkerhet och stabilitet gör rådet till en hörnsten inom ramen för konfliktförebyggande och -hantering, samt konfliktlösning på den afrikanska kontinenten. Den Afrikanska Unionens freds- och säkerhetsråd spelar också en högst viktig roll i implementeringen av ansvaret att beskydda civilbefolkningen i konfliktsituationer. För uppfyllandet av sitt mandat att framhäva och upprätthålla fred, säkerhet och stabilitet i Afrika krävs det att freds- och säkerhetsrådet samarbetar med andra institutioner och mekanismer som handhar internationella och regionala freds- och säkerhetsärenden. Avhandlingen analyserar tre dimensioner av denna typ av relationer som freds- och säkerhetsrådet bör etablera med dessa organ och mekanismer för att kunna utföra sitt mandat effektivt. Först analyseras relationen mellan Afrikanska Unionens freds- och säkerhetsråd och Förenta Nationernas säkerhetsråd som också beskrivs i artikel 17 (1) i protokollet som förde till etablerandet av AU:s freds- och säkerhetsråd. Analysen understryker FN:s säkerhetsråd som det organ som bär det primära ansvaret i förhållande till fred och säkerhet, medan AU:s freds- och säkerhetsråd fungerar som en kompletterande komponent i sin roll som ett regionalt organ. Avhandlingen fortsätter med att analysera förhållandet mellan AU:s freds- och säkerhetsråd och andra organ inom AU, samt andra relevanta institutioner som framgår av artikel 10, 18 (1), 19 och 20 i protokollet för rådets etablerande. Avhandlingen diskuterar i detalj hur samarbetet mellan AU:s freds- och säkerhetsråd och dessa institutioner och organ kunde förstärkas till fördel för effektivt framhävande och upprätthållande av fred och säkerhet i Afrika. Slutligen analyserar avhandlingen samarbetet mellan AU:s freds- och säkerhetsråd och sub-regionala mekanismer etablerade under regionala ekonomiska gemenskaper som beskrivs i artikel 16 i protokollet för etablerandet av rådet. Avhandlingen diskuterar i detalj rollen för de sub-regionala mekanismerna i den afrikanska freds- och säkerhetsarkitekturen. Avhandlingen diskuterar vidare förhållandet mellan de sub-regionala mekanismerna och den afrikanska stand-by styrkan ASF och förutsättningarna för detta arrangemang att bemöta afrikanska konflikter. Avhandlingen fokuserar också på en harmoniserings- och samarbetsprocess i förhållande till de sub-regionala mekanismerna, de regionala ekonomiska gemenskaperna och den Afrikanska Unionens freds- och säkerhetsråd. Kort sagt beskriver avhandlingen hur förhållandet mellan AU:s freds- och säkerhetsråd och de ovan nämnda organ och mekanismer har en faktisk och potentiell möjlighet att effektivt bidra till fred, säkerhet och stabilitet i Afrika. Avhandlingen identifierar utmaningarna kring att göra detta till ett fungerande förhållande samtidigt som den genererar både generella och specifika rekommendationer om hur dessa utmaningar bäst kan bemötas. Några av dessa utmaningar utgörs av följande aspekter: konflikten mellan AU:s och FN:s reglemang i bemötandet av freds- och säkerhetsutmaningar; de olika metoderna i FN och AU vid implementeringen av principen av universell jurisdiktion; konflikten mellan de olika mandaten som AU:s freds- och säkerhetsråd och FN:s säkerhetsråd har i förhållande till implementeringen av principen om intervention; och konflikten mellan lagarna och metoderna i förhållande till AU:s freds- och säkerhetsråd och de regionala mekanismerna. En av de huvudsakliga rekommendationerna i avhandlingen i bemötandet av de ovan nämnda utmaningarna är att harmonisera de olika systemen för att försäkra att det föreligger ett samordnat bemötande av konflikter i Afrika. Efter att ha identifierat luckorna i AU:s freds- och säkerhetsprotokoll med speciell fokus på förhållandet mellan rådet och de relevanta organen och mekanismerna rekommenderar avhandlingen ett antal tillägg och modifieringar till instrumentet ifråga för att effektivera, stärka och upprätthålla detta förhållande. Avhandlingen föreslår att dessa tillägg och modifieringar skulle företas under 2014 då detta år markerar 10 år efter att AU:s freds- och säkerhetsråd etablerades. Idén bakom detta företagandet ligger i att 10 år torde vara en tillfredställande tidsperiod för att mäta hur freds- och säkerhetsrådet har fungerat och hur dess förhållande med de relevanta institutionerna och mekanismerna kunde förbättras. Avhandlingen representerar den bredaste och nyaste studien inom ramen för artikel 16, 17, 18, 19 och 20 i protokollet för AU:s freds- och säkerhetsråd och introducerar ett innovativt bemötande av utmaningar till fred, säkerhet och stabilitet på den afrikanska kontinenten. Avhandlingen bidrar till teorin och praxisen i AU:s freds- och säkerhetsråd vilket kan vara av intresse för både forskare och praktiker i folkrätt såväl som i internationella freds- och säkerhetsstudier, speciellt i Afrika.

Risk factors for mortality in blunt abdominal trauma with surgical approach

ABSTRACTObjective:identify risk factors for mortality in patients who underwent laparotomy after blunt abdominal trauma.Methods:retrospective study, case-control, which were reviewed medical records of blunt trauma victims patients undergoing laparotomy, from March 2013 to January 2015, and compared the result of the deaths group with the group healed.Results:of 86 patients, 63% were healed, 36% died, and one patient was excluded from the study. Both groups had similar epidemiology and trauma mechanism, predominantly young adults males, automobilistic accident. Most cases that evolved to death had hemodynamic instability as laparotomy indication - 61% against 38% in the other group (p=0.02). The presence of solid organ injury was larger in the group of deaths - 80% versus 48% (p=0.001) and 61% of them had other associated abdominal injury compared to 25% in the other group (p=0.01). Of the patients who died 96% had other serious injuries associated (p=0.0003). Patients requiring damage control surgery had a higher mortality rate (p=0.0099). Only one of 18 patients with isolated hollow organ lesion evolved to death (p=0.0001). The mean injury score of TRISS of cured (91.70%) was significantly higher than that of deaths (46.3%) (p=0.002).Conclusion:the risk factors for mortality were hemodynamic instability as an indication for laparotomy, presence of solid organ injury, multiple intra-abdominal injuries, need for damage control surgery, serious injury association and low index of trauma score.

On Glucose Metabolism in Patients with the m.3243A>G Mutation

Background: The m.3243A>G mutation in mitochondrial DNA is the most common cause for mitochondrial diabetes. In addition, unexpected deaths related to the m.3243A>G associate with encephalopathy and cardiomyopathy. Failing mitochondrial respiratory chain in neurons, myocytes and beta cells is considered to underlie the multiorgan manifestations of the m.3243A>G. Aims: The primary aim of the study was to characterize the organ-specific glucose metabolism in patients with m.3243A>G and secondly, to study patients with or without signs of diabetes, cardiomyopathy or encephalopathy. The insulin-stimulated glucose metabolism in brain, heart, skeletal muscle, adipose tissue and liver were measured with 2-deoxy-2-[18F]fluoro-α-D-glucose in 15 patients and 14 controls. Brain oxygen metabolism was assessed with [15O]oxygen and insulin secretion was modelled based on oral glucose tolerance test. Results: The glucose oxidation in brain was globally decreased in patients with or without clinical encephalopathy. The insulin-stimulated glucose influx to skeletal muscle and adipose tissue was decreased in patients with or without diabetes as the hepatic glucose metabolism was normal. Impaired beta cell function and myocardial glucose uptake were associated with the high m.3243A>G heteroplasmy. Conclusions: This cross-sectional study suggests that: 1) The ability of insulin to stimulate glucose metabolism in skeletal muscle and adipose tissue is weakened before the beta cell failure results in mitochondrial diabetes. 2) Glucose oxidation defect is detected in otherwise unaffected cerebral regions in patients with the m.3243A>G, thus it likely precedes the clinical encephalopathy. 3) Uneconomical glucose hypometabolism during hyperinsulinemia contributes to the cardiac vulnerability in patients with high m.3243A>G heteroplasmy

Vegetative organ anatomy of Ianthopappus corymbosus Roque & Hind (Asteraceae-Mutisieae)

A study on the vegetative organ anatomy of Ianthopappus corymbosus was conducted in order to provide a basis for comparison with the genus Richterago, since this species had been previously included in that genus. The anatomical characters of I. corymbosus that support its exclusion from the genus Richteragon are: epithelial cell organization of adventitious root secretory canals, non-glandular trichomes, and presence of cortical vascular bundles in the stem. In Ianthopappus corymbosus, the underground system consists of rhizophore from which adventitious roots branch off. The subapical meristem of the adventitious root revealed that the ground meristem forms the inner layer which in a meristematic phase, forms 2/3 of the cortex. This layer will differentiate in the endodermis, with Casparian strips, and is referred to as meristematic endodermis. Endodermic secretory canals, limited by four epithelial cells, appear in the region adjacent to the primary phloem.