Le reflux gastro-oesophagien de l'enfant: indications chirurgicales, techniques et suivi.

Contexte: Présent sous forme physiologique chez environ 60% des nourrissons normaux de moins de quatre mois, le reflux gastro-oesophagien (RGO) n'est symptomatique que chez 10% d'entre eux. Il est également plus fréquent chez les enfants atteints de troubles neurologiques quelque soit leur âge. Non traité, il peut avoir des conséquences graves (oesophagite, sténose peptique, endobrachyoesophage (Barrett) puis adénocarcinome de l'oesophage). Il s'agit donc d'un problème qu'il faut savoir détecter et traiter précocement. Les signes et symptômes du RGO sont multiples et varient en fonction de l'âge. Ils ne se limitent pas au seul vomissement. Le traitement initial du RGO chez l'enfant est médical. En cas d'échec de celui-ci ou dans certaines indications (comme les RGO récidivants, les malformations congénitales, les anomalies morphologiques ou les pathologies neurologiques) un traitement chirurgical est nécessaire. L'évolution des traitements conservateurs et des techniques chirurgicales lors de ces dernières années en font un bon sujet pour une étude rétrospective. Objectif: Le but de cette étude est de mettre en évidence dans une population d'enfants ayant bénéficié d'une cure chirurgicale anti-reflux la fréquence relative des symptômes selon la pathologie initiale de l'enfant, puis de préciser le choix de traitement et sa durée. Nous analyserons également les risques d'échec qui s'y rapportent. Ces conclusions devraient nous permettre de proposer un algorithme décisionnel de prise en charge du RGO de l'enfant en pré et post-opératoire. Méthodologie: Étude rétrospective sur 9 ans se basant sur les dossiers médicaux-chirurgicaux de 132 enfants opérés d'un reflux gastro-oesophagien dans le Service de Chirurgie Pédiatrique du Centre Hospitalier Universitaire Vaudois (CHUV) par le Professeur Olivier Reinberg et son équipe entre le 1er janvier 2003 et le 31 décembre 2012. Résultats: Sur les 132 enfants, 93 ont bénéficié d'une fundoplicature selon Toupet, 34 selon Nissen et 5 selon Dor. 57% des enfants présentant un déficit neurologique ont été opérés selon la technique de Nissen contre 7% des enfants "sains". Les taux de démontage et de récidive sont respectivement 5.4% et 3.5 % pour la technique selon Toupet et 2.9% et 0% pour la technique de Nissen. Le taux de démontage global de la fundoplicature est de 4.6% (N=6) Conclusions: La fundoplicature est une méthode de choix pour les enfants chez qui tous les autres traitements ont échoué ou chez qui la présence concomitante du RGO et des comorbidités est délétère à une croissance harmonieuse. Grâce à la chirurgie, la qualité de vie d'au moins 95% des enfants est grandement améliorée après la disparition de symptômes quotidiens et qui peuvent donner lieu à des complications graves.

Classification of textures seen from different distances and under varying illumination direction

Changes in the angle of illumination incident upon a 3D surface texture can significantly alter its appearance, implying variations in the image texture. These texture variations produce displacements of class members in the feature space, increasing the failure rates of texture classifiers. To avoid this problem, a model-based texture recognition system which classifies textures seen from different distances and under different illumination directions is presented in this paper. The system works on the basis of a surface model obtained by means of 4-source colour photometric stereo, used to generate 2D image textures under different illumination directions. The recognition system combines coocurrence matrices for feature extraction with a Nearest Neighbour classifier. Moreover, the recognition allows one to guess the approximate direction of the illumination used to capture the test image

The Pelosi-type versus the modified Misgav-Ladach: a randomized trial of two surgical techniques for cesarean section

Cesarean section (CS) is now the most common major surgical procedure performed on women worldwide. A quarter of deliveries in Spain are performed by cesarean section. With the increasing rates of the operation, there is the need to use evidence-based techniques to optimize outcomes and minimize complications. The goal of this study is to employ a well-designed randomized controlled trial to evaluate the intraoperative blood loss of two surgical techniques for cesarean section, the Pelosi-type and the modified Misgav-Ladach. The trial will take place in Hospital Universitari de Girona Dr. Josep Trueta From 2014 to 2015, 512 pregnant women undergoing delivery by their first lower segment cesarean section in this center will be selected through a consecutive nonprobability sampling. We will collect the main obstetrical characteristics, intraoperative outcomes, short-term outcomes for the baby and postoperative outcomes. We will evaluate the intraoperative blood loss by comparing the changes in hemoglobin levels, pre and postoperatively. Patients will be followed during the postoperative period and in a two-week postoperative appointment. We will analyze the continuous variables, such as the differences in hemoglobin levels, using an unpaired two-sided Student’s t-test, while for the categorical variables Fischer’s exact test will be used

Reconstruction and analysis of surface variation using photometric stereo

In many industrial applications, accurate and fast surface reconstruction is essential for quality control. Variation in surface finishing parameters, such as surface roughness, can reflect defects in a manufacturing process, non-optimal product operational efficiency, and reduced life expectancy of the product. This thesis considers reconstruction and analysis of high-frequency variation, that is roughness, on planar surfaces. Standard roughness measures in industry are calculated from surface topography. A fast and non-contact method to obtain surface topography is to apply photometric stereo in the estimation of surface gradients and to reconstruct the surface by integrating the gradient fields. Alternatively, visual methods, such as statistical measures, fractal dimension and distance transforms, can be used to characterize surface roughness directly from gray-scale images. In this thesis, the accuracy of distance transforms, statistical measures, and fractal dimension are evaluated in the estimation of surface roughness from gray-scale images and topographies. The results are contrasted to standard industry roughness measures. In distance transforms, the key idea is that distance values calculated along a highly varying surface are greater than distances calculated along a smoother surface. Statistical measures and fractal dimension are common surface roughness measures. In the experiments, skewness and variance of brightness distribution, fractal dimension, and distance transforms exhibited strong linear correlations to standard industry roughness measures. One of the key strengths of photometric stereo method is the acquisition of higher frequency variation of surfaces. In this thesis, the reconstruction of planar high-frequency varying surfaces is studied in the presence of imaging noise and blur. Two Wiener filterbased methods are proposed of which one is optimal in the sense of surface power spectral density given the spectral properties of the imaging noise and blur. Experiments show that the proposed methods preserve the inherent high-frequency variation in the reconstructed surfaces, whereas traditional reconstruction methods typically handle incorrect measurements by smoothing, which dampens the high-frequency variation.

Overvoltage Mitigation Techniques in Wind Power Generators

Advancements in power electronic semiconductor switching devices have lead to significantly faster switching times. In motor and generator applications, the fast switching times of pulse width modulated (PWM) inverters lead to overvoltages caused by voltage reflections with shorter and shorter cables. These excessive overvoltages may lead to a failure of the electrical machine in a matter of months. In this thesis, the causes behind the overvoltage phenomenon as well as its different mitigation techniques are studied. The most suitable techniques for mitigating the overvoltage phenomenon in wind power generator applications are chosen based on both simulations and actual measurements performed on a prototype. An RC filter at the terminals of the electrical machine and an inverter output filter designed to reduce the rise and fall times of voltage pulses are presented as a solution to the overvoltage problem. The performance and losses of both filter types are analysed.

Alternative Techniques of Neural Signal Processing in Neuroengineering

Neural signal processing is a discipline within neuroengineering. This interdisciplinary approach combines principles from machine learning, signal processing theory, and computational neuroscience applied to problems in basic and clinical neuroscience. The ultimate goal of neuroengineering is a technological revolution, where machines would interact in real time with the brain. Machines and brains could interface, enabling normal function in cases of injury or disease, brain monitoring, and/or medical rehabilitation of brain disorders. Much current research in neuroengineering is focused on understanding the coding and processing of information in the sensory and motor systems, quantifying how this processing is altered in the pathological state, and how it can be manipulated through interactions with artificial devices including brain–computer interfaces and neuroprosthetics.

Computational Techniques for Spectral Image Analysis

Multispectral images are becoming more common in the field of remote sensing, computer vision, and industrial applications. Due to the high accuracy of the multispectral information, it can be used as an important quality factor in the inspection of industrial products. Recently, the development on multispectral imaging systems and the computational analysis on the multispectral images have been the focus of a growing interest. In this thesis, three areas of multispectral image analysis are considered. First, a method for analyzing multispectral textured images was developed. The method is based on a spectral cooccurrence matrix, which contains information of the joint distribution of spectral classes in a spectral domain. Next, a procedure for estimating the illumination spectrum of the color images was developed. Proposed method can be used, for example, in color constancy, color correction, and in the content based search from color image databases. Finally, color filters for the optical pattern recognition were designed, and a prototype of a spectral vision system was constructed. The spectral vision system can be used to acquire a low dimensional component image set for the two dimensional spectral image reconstruction. The data obtained by the spectral vision system is small and therefore convenient for storing and transmitting a spectral image.

Photometric and Halpha observations of LSI+61·303: detection of a 26 day V and JHK band modulation

We present new optical and infrared photometric observations and high resolution H α spectra of the periodic radio star LSI+61◦303. The optical photometric data set covers the time interval 1985-1993 and amounts to about a hundred nights. A period of ∼26 days is found in the V band. The infrared data also present evidence for a similar periodicity, but with higher amplitude of variation ((0.m 2). The spectroscopic observations include 16 intermediate and high dispersion spectra of LSI+61◦303 collected between January 1989 and February 1993. The H α emission line profile and its variations are analyzed. Several emission line parameters -- among them the H α EW and the width of the H α red hump -- change strongly at or close to radio maximum, and may exhibit periodic variability. We also observe a significant change in the peak separation. The H α profile of LSI+61◦303 does not seem peculiar for a Be star. However, several of the observed variations of the H α profile can probably be associated with the presence of the compact, secondary star.

Review of Robust Cooperative Spectrum Sensing Techniques for Cognitive Radio Networks

Cognitive radio networks sense spectrum occupancy and manage themselvesto operate in unused bands without disturbing licensed users. The detection capability of aradio system can be enhanced if the sensing process is performed jointly by a group of nodesso that the effects of wireless fading and shadowing can be minimized. However, taking acollaborative approach poses new security threats to the system as nodes can report falsesensing data to reach a wrong decision. This paper makes a review of secure cooperativespectrum sensing in cognitive radio networks. The main objective of these protocols is toprovide an accurate resolution about the availability of some spectrum channels, ensuring thecontribution from incapable users as well as malicious ones is discarded. Issues, advantagesand disadvantages of such protocols are investigated and summarized.

Color ad spectral image assessment using novel quality and fidelity techniques

The ongoing development of the digital media has brought a new set of challenges with it. As images containing more than three wavelength bands, often called spectral images, are becoming a more integral part of everyday life, problems in the quality of the RGB reproduction from the spectral images have turned into an important area of research. The notion of image quality is often thought to comprise two distinctive areas – image quality itself and image fidelity, both dealing with similar questions, image quality being the degree of excellence of the image, and image fidelity the measure of the match of the image under study to the original. In this thesis, both image fidelity and image quality are considered, with an emphasis on the influence of color and spectral image features on both. There are very few works dedicated to the quality and fidelity of spectral images. Several novel image fidelity measures were developed in this study, which include kernel similarity measures and 3D-SSIM (structural similarity index). The kernel measures incorporate the polynomial, Gaussian radial basis function (RBF) and sigmoid kernels. The 3D-SSIM is an extension of a traditional gray-scale SSIM measure developed to incorporate spectral data. The novel image quality model presented in this study is based on the assumption that the statistical parameters of the spectra of an image influence the overall appearance. The spectral image quality model comprises three parameters of quality: colorfulness, vividness and naturalness. The quality prediction is done by modeling the preference function expressed in JNDs (just noticeable difference). Both image fidelity measures and the image quality model have proven to be effective in the respective experiments.

Determination of moisture content and water activity in algae and fish by thermoanalytical techniques

The water content in seafoods is very important since it affects their sensorial quality, microbiological stability, physical characteristics and shelf life. In this study, thermoanalytical techniques were employed to develop a simple and accurate method to determine water content (moisture) by thermogravimetry (TG) and water activity from moisture content values and freezing point depression using differential scanning calorimetry (DSC). The precision of the results suggests that TG is a suitable technique to determine moisture content in biological samples. The average water content values for fish samples of Lutjanus synagris and Ocyurus chrysurus species were 76.4 ± 5.7% and 63.3 ± 3.9%, respectively, while that of Ulva lactuca marine algae species was 76.0 ± 4.4%. The method presented here was also successfully applied to determine water activity in two species of fish and six species of marine algae collected in the Atlantic coastal waters of Bahia, in Brazil. Water activity determined in fish samples ranged from 0.946 - 0.960 and was consistent with values reported in the literature, i.e., 0.9 - 1.0. The water activity values determined in marine algae samples lay within the interval of 0.974 - 0.979.

Experimental analysis of optimization techniques on the road passenger transportation problem

Analyzing the state of the art in a given field in order to tackle a new problem is always a mandatory task. Literature provides surveys based on summaries of previous studies, which are often based on theoretical descriptions of the methods. An engineer, however, requires some evidence from experimental evaluations in order to make the appropriate decision when selecting a technique for a problem. This is what we have done in this paper: experimentally analyzed a set of representative state-of-the-art techniques in the problem we are dealing with, namely, the road passenger transportation problem. This is an optimization problem in which drivers should be assigned to transport services, fulfilling some constraints and minimizing some function cost. The experimental results have provided us with good knowledge of the properties of several methods, such as modeling expressiveness, anytime behavior, computational time, memory requirements, parameters, and free downloadable tools. Based on our experience, we are able to choose a technique to solve our problem. We hope that this analysis is also helpful for other engineers facing a similar problem

Simultaneous spectrophotometric determination of ezetimibe and simvastatin in pharmaceutical preparations using chemometric techniques

Two spectrophotometric methods are described for the simultaneous determination of ezetimibe (EZE) and simvastatin (SIM) in pharmaceutical preparations. The obtained data was evaluated by using two different chemometric techniques, Principal Component Regression (PCR) and Partial Least-Squares (PLS-1). In these techniques, the concentration data matrix was prepared by using the mixtures containing these drugs in methanol. The absorbance data matrix corresponding to the concentration data matrix was obtained by the measurements of absorbances in the range of 240 - 300 nm in the intervals with Δλ = 1 nm at 61 wavelengths in their zero order spectra, then, calibration or regression was obtained by using the absorbance data matrix and concentration data matrix for the prediction of the unknown concentrations of EZE and SIM in their mixture. The procedure did not require any separation step. The linear range was found to be 5 - 20 µg mL-1 for EZE and SIM in both methods. The accuracy and precision of the methods were assessed. These methods were successfully applied to a pharmaceutical preparation, tablet; and the results were compared with each other.

Micro- and nanostructuring of poly(ethylene-2,6-naphthalate) surfaces, for biomedical applications, using polymer replication techniques

Here we investigate the formation of superficial micro- and nanostructures in poly(ethylene-2,6-naphthalate) (PEN), with a view to their use in biomedical device applications, and compare its performance with a polymer commonly used for the fabrication of these devices, poly(methyl methacrylate) (PMMA). The PEN is found to replicate both micro- and nanostructures in its surface, albeit requiring more forceful replication conditions than PMMA, producing a slight increase in surface hydrophilicity. This ability to form micro/nanostructures, allied to biocompatibility and good optical transparency, suggests that PEN could be a useful material for production of, or for incorporation into, transparent devices for biomedical applications. Such devices will be able to be autoclaved, due to the polymer's high temperature stability, and will be useful for applications where forceful experimental conditions are required, due to a superior chemical resistance over PMMA.