Measurement with an automated oscillometric wrist device with position sensor leads to lower values than measurements obtained with an automated oscillometric arm device from the same manufacturer in elderly persons.

OBJECTIVE: Home blood pressure (BP) monitoring is recommended by several clinical guidelines and has been shown to be feasible in elderly persons. Wrist manometers have recently been proposed for such home BP measurement, but their accuracy has not been previously assessed in elderly patients. METHODS: Forty-eight participants (33 women and 15 men, mean age 81.3±8.0 years) had their BP measured with a wrist device with position sensor and an arm device in random order in a sitting position. RESULTS: Average BP measurements were consistently lower with the wrist than arm device for systolic BP (120.1±2.2 vs. 130.5±2.2 mmHg, P<0.001, means±SD) and diastolic BP (66.0±1.3 vs. 69.7±1.3 mmHg, P<0.001). Moreover, a 10 mmHg or greater difference between the arm and wrist device was observed in 54.2 and 18.8% of systolic and diastolic measures, respectively. CONCLUSION: Compared with the arm device, the wrist device with position sensor systematically underestimated systolic as well as diastolic BP. The magnitude of the difference is clinically significant and questions the use of the wrist device to monitor BP in elderly persons. This study points to the need to validate BP measuring devices in all age groups, including in elderly persons.

The pressure cooker technique for the treatment of brain AVMs.

Arteriovenous malformations (AVMs) may be cured by injecting liquid embolic agents such as Onyx. Reflux, however, can sometimes be difficult to control and may jeopardize a complete embolization. The pressure cooker technique (PCT) was designed to create an anti-reflux plug by trapping the detachable part of an Onyx-compatible microcatheter with coils and glue in order to obtain wedge-flow conditions, thereby enabling a better understanding of macrofistulous AVMs and a more comprehensive, forceful and controlled Onyx embolization. The PCT might enlarge the range of AVMs amenable to endovascular cure. Three illustrative cases are presented.

Detection of the movement of the humerus during daily activity.

A new ambulatory technique for qualitative and quantitative movement analysis of the humerus is presented. 3D gyroscopes attached on the humerus were used to recognize the movement of the arm and to classify it as flexion, abduction and internal/external rotations. The method was first validated in a laboratory setting and then tested on 31 healthy volunteer subjects while carrying the ambulatory system during 8 h of their daily life. For each recording, the periods of sitting, standing and walking during daily activity were detected using an inertial sensor attached on the chest. During each period of daily activity the type of arm movement (flexion, abduction, internal/external rotation) its velocity and frequency (number of movement/hour) were estimated. The results showed that during the whole daily activity and for each activity (i.e. walking, sitting and walking) the frequency of internal/external rotation was significantly higher while the frequency of abduction was the lowest (P < 0.009). In spite of higher number of flexion, abduction and internal/external rotation in the dominant arm, we have not observed in our population a significant difference with the non-dominant arm, implying that in healthy subjects the arm dominance does not lie considerably on the number of movements. As expected, the frequency of the movement increased from sitting to standing and from standing to walking, while we provide a quantitative value of this change during daily activity. This study provides preliminary evidence that this system is a useful tool for objectively assessing upper-limb activity during daily activity. The results obtained with the healthy population could be used as control data to evaluate arm movement of patients with shoulder diseases during daily activity.

MDCT Arthrography of the Hip: Value of the Adaptive Statistical Iterative Reconstruction Technique and Potential for Radiation Dose Reduction

Au cours des deux dernières décennies, la technique d'imagerie arthro-scanner a bénéficié de nombreux progrès technologiques et représente aujourd'hui une excellente alternative à l'imagerie par résonance magnétique (IRM) et / ou arthro-IRM dans l'évaluation des pathologies de la hanche. Cependant, elle reste limitée par l'exposition aux rayonnements ionisants importante. Les techniques de reconstruction itérative (IR) ont récemment été mis en oeuvre avec succès en imagerie ; la littérature montre que l'utilisation ces dernières contribue à réduire la dose d'environ 40 à 55%, comparativement aux protocoles courants utilisant la rétroprojection filtrée (FBP), en scanner de rachis. A notre connaissance, l'utilisation de techniques IR en arthro-scanner de hanche n'a pas été évaluée jusqu'à présent. Le but de notre étude était d'évaluer l'impact de la technique ASIR (GE Healthcare) sur la qualité de l'image objective et subjective en arthro-scanner de hanche, et d'évaluer son potentiel en terme de réduction de dose. Pour cela, trente sept patients examinés par arthro-scanner de hanche ont été randomisés en trois groupes : dose standard (CTDIvol = 38,4 mGy) et deux groupes de dose réduite (CTDIvol = 24,6 ou 15,4 mGy). Les images ont été reconstruites en rétroprojection filtrée (FBP) puis en appliquant différents pourcentages croissants d'ASIR (30, 50, 70 et 90%). Le bruit et le rapport contraste sur bruit (CNR) ont été mesurés. Deux radiologues spécialisés en imagerie musculo-squelettique ont évalué de manière indépendante la qualité de l'image au niveau de plusieurs structures anatomiques en utilisant une échelle de quatre grades. Ils ont également évalué les lésions labrales et du cartilage articulaire. Les résultats révèlent que le bruit augmente (p = 0,0009) et le CNR diminue (p = 0,001) de manière significative lorsque la dose diminue. A l'inverse, le bruit diminue (p = 0,0001) et le contraste sur bruit augmente (p < 0,003) de manière significative lorsque le pourcentage d'ASIR augmente ; on trouve également une augmentation significative des scores de la qualité de l'image pour le labrum, le cartilage, l'os sous-chondral, la qualité de l'image globale (au delà de ASIR 50%), ainsi que le bruit (p < 0,04), et une réduction significative pour l'os trabuculaire et les muscles (p < 0,03). Indépendamment du niveau de dose, il n'y a pas de différence significative pour la détection et la caractérisation des lésions labrales (n=24, p = 1) et des lésions cartilagineuses (n=40, p > 0,89) en fonction du pourcentage d'ASIR. Notre travail a permis de montrer que l'utilisation de plus de 50% d'ASIR permet de reduire de manière significative la dose d'irradiation reçue par le patient lors d'un arthro-scanner de hanche tout en maintenant une qualité d'image diagnostique comparable par rapport à un protocole de dose standard utilisant la rétroprojection filtrée.

The NLRP3 inflammasome: a sensor for metabolic danger?

Interleukin-1beta (IL-1beta), reactive oxygen species (ROS), and thioredoxin-interacting protein (TXNIP) are all implicated in the pathogenesis of type 2 diabetes mellitus (T2DM). Here we review mechanisms directing IL-1beta production and its pathogenic role in islet dysfunction during chronic hyperglycemia. In doing so, we integrate previously disparate disease-driving mechanisms for IL-1beta, ROS, and TXNIP in T2DM into one unifying model in which the NLRP3 inflammasome plays a central role. The NLRP3 inflammasome also drives IL-1beta maturation and secretion in another disease of metabolic dysregulation, gout. Thus, we propose that the NLRP3 inflammasome contributes to the pathogenesis of T2DM and gout by functioning as a sensor for metabolic stress.

Ross procedure: is the root replacement technique superior to the sub-coronary implantation technique? Long-term results.

There is controversy over the use of the Ross procedure with regard to the sub-coronary and root replacement technique and its long-term durability. A systematic review of the literature may provide insight into the outcomes of these two surgical subvariants. A systematic review of reports between 1967 and February 2013 on sub-coronary and root replacement Ross procedures was undertaken. Twenty-four articles were included and divided into (i) sub-coronary technique and (ii) root replacement technique. The 10-year survival rate for a mixed-patient population in the sub-coronary procedure was 87.3% with a 95% confidence interval (CI) of 79.7-93.4 and 89.1% (95% CI, 85.3-92.1) in the root replacement technique category. For adults, it was 94 vs 95.3% (CI, 88.9-98.1) and in the paediatric series it was 90 vs 92.7% (CI, 86.9-96.0), respectively. Freedom from reoperation at 10 years was, in the mixed population, 83.3% (95% CI, 69.9-93.4) and 93.3% (95% CI, 89.4-95.9) for sub-coronary versus root replacement technique, respectively. In adults, it was 98 vs 91.2% (95% CI, 82.4-295.8), and in the paediatric series 93.3 vs 92.0% (95% CI, 86.1-96.5) for sub-coronary versus root replacement technique, respectively. The Ross procedure arguably has satisfactory results over 5 and 10 years for both adults and children. The results do not support the advantages of the sub-coronary technique over the root replacement technique. Root replacement was of benefit to patients undergoing reoperations on neoaorta and for long-term survival in mixed series.

Friction Stir Processing : a new microstructure improvement technique

In the present work, microstructure improvement using FSP (Friction Stir Processing) is studied. In the first part of the work, the microstructure improvement of as-cast A356 is demonstrated. Some tensile tests were applied to check the increase in ductility. However, the expected results couldn’t be achieved. In the second part, the microstructure improvement of a fusion weld in 1050 aluminium alloy is presented. Hardness tests were carried out to prove the mechanical propertyimprovements. In the third and last part, the microstructure improvement of 1050 aluminium alloy is achieved. A discussion of the mechanical property improvements induced by FSP is made. The influence of tool traverse speed on microstructure and mechanical properties is also discussed. Hardness tests and recrystallization theory enabled us to find out such influence

Risk Evaluation for Spoofing against a Sensor Supplied with Liveness Detection

The aim of this paper is to evaluate the risks associated with the use of fake fingerprints on a livescan supplied with a method of liveness detection. The method is based on optical properties of the skin. The sensor uses several polarizations and illuminations to capture the information of the different layers of the human skin. These experiments also allow for the determination under which conditions the system is deceived and if there is an influence respectively of the nature of the fake, the mould used for the production or the individuals involved in the attack. These experiments showed that current multispectral sensors can be deceived by the use of fake fingerprints created with or without the cooperation of the subject. Fakes created from direct casts perform better than those produced by fakes created from indirect casts. The results showed that the success of the attack is influenced by two main factors. The first is the quality of the fakes, and by extension the quality of the original fingerprint. The second is the combination of the general patterns involved in the attacks since an appropriate combination can strongly increase the rates of successful attacks.

Block of the superior cervical ganglion, description of a novel ultrasound-guided technique in human cadavers.

OBJECTIVE.: Injection of opioids to the superior cervical ganglion (SCG) has been reported to provide pain relief in patients suffering from different kinds of neuropathic facial pain conditions, such as trigeminal neuralgia, postherpetic neuralgia, and atypical facial pain. The classic approach to the SCG is a transoral technique using a so-called "stopper" to prevent accidental carotid artery puncture. The main disadvantage of this technique is that the needle tip is positioned distant from the actual target, possibly impeding successful block of the SCG. A further limitation is that injection of local anesthetics due to potential carotid artery puncture is contraindicated. We hypothesized that the SCG can be identified and blocked using ultrasound imaging, potentially increasing precision of this technique. INTERVENTIONS.: In this pilot study, 20 US-guided simulated blocks of the SCG were performed in 10 human cadavers in order to determine the accuracy of this novel block technique. After injection of 0.1 mL of dye, the cadavers were dissected to evaluate the needle position and coloring of the SCG. RESULTS.: Nineteen of the 20 needle tips were located in or next to the SCG. This corresponded to a simulated block success rate of 95% (95% confidence interval 85-100%). In 17 cases, the SCG was completely colored, and in two cases, the caudal half of the SCG was colored with dye. CONCLUSIONS.: The anatomical dissections confirmed that our ultrasound-guided approach to the SCG is accurate. Ultrasound could become an attractive alternative to the "blind" transoral technique of SCG blocks.

Antibiotic lock technique combined with systemic antimicrobial therapy for management of port-related bloodstream infections in onco-haematological patients without catheter removal

Background : Port-related bloodstream infection (PRBSI) is a common complication associated with long-term use of ports systems. Systemic antimicrobial therapy (ST) and removal of the device is the standard management of PRBSI. However, a conservative management combining ST with antibiotic lock therapy (ALT) without port removal has been suggested as an alternative management option for infections due to gram-positive skin colonizers with low virulence.¦Objectives : i) to assess the frequency of management of PRBSI in onco-hematological patients by combining the ALT with ST, without catheter removal and ii) to analyze the efficacy of such an approach.¦Methods : Retrospective observational study over a 6-year period between 2005 and 2010, including patients who where diagnosed with PRBSI and who were treated with ST and ALT. PRBSI diagnosis consisted in clinical signs of bacteremia with blood cultures positive for gram-positive skin colonizers. The primary endpoint was failure to cure the PRBSI.¦Results : 61 port infections were analysed, of which 23 PRBSI met the inclusion criteria. All the patients were suffering from haematological conditions and 75% were neutropenic at the time of PRBSI diagnosis. S. epidermidis was responsible for 91% of PRBSI (21/23). The median duration of ST was 14 days (range 7-35) and the median duration of ALT was 15 days (range 8-41). Failure to cure the PRBSI requiring port removal was observed in 4 patients, but was not associated with severe infectious complications. Kaplan-Meier analysis showed a success rate in port salvage at day 180 (6 months) of 78% (95%CI 59-97%).¦Conclusion : The success rate observed in the present study suggests that combining ST and ALT is an effective option to conservatively treat PRBSI caused by pathogens of low virulence such as S. epidermidis.

Desenvolupament d'un node sensor sense fils autoalimentat. Mòdul piezo-magnètic

En aquest projecte es pretén implementar un dispositiu capaç de ser auto-suficient i no dependre de cap tipus de pila, bateria o fil elèctric que l’abasteixi d’energia elèctrica. El dispositiu recol·lectarà la energia magnètica generada per la corrent elèctrica a un fil i la transformarà en energia elèctrica, que serà emmagatzemada per el seu posterior ús. A demès, aquest projecte s’ha desenvolupat en col·laboració amb un segon projecte, dintre del qual s’implementarà una xarxa de sensors, mitjançant el protocol MIWI. Aquest projecte es divideix en tres grans blocs. El primer bloc del projecte serà una introducció teòrica de tots els coneixements relacionats amb el concepte d’energy harvesting i els mecanismes físic implicats. Al segon bloc podrem veure com s’han realitzat els càlculs, simulacions i posada en marxa, dels diferents elements que formaran el dispositiu recol·lector d’energia. Per últim en el tercer bloc veurem el prototip ja implementat. Es valoraran els resultats obtinguts, i es veuran els temps que necessitarà per alimentar al microcontrolador.

Measurement of the dynamics in ski jumping using a wearable inertial sensor-based system.

Abstract Dynamics is a central aspect of ski jumping, particularly during take-off and stable flight. Currently, measurement systems able to measure ski jumping dynamics (e.g. 3D cameras, force plates) are complex and only available in few research centres worldwide. This study proposes a method to determine dynamics using a wearable inertial sensor-based system which can be used routinely on any ski jumping hill. The system automatically calculates characteristic dynamic parameters during take-off (position and velocity of the centre of mass perpendicular to the table, force acting on the centre of mass perpendicular to the table and somersault angular velocity) and stable flight (total aerodynamic force). Furthermore, the acceleration of the ski perpendicular to the table was quantified to characterise the skis lift at take-off. The system was tested with two groups of 11 athletes with different jump distances. The force acting on the centre of mass, acceleration of the ski perpendicular to the table, somersault angular velocity and total aerodynamic force were different between groups and correlated with the jump distances. Furthermore, all dynamic parameters were within the range of prior studies based on stationary measurement systems, except for the centre of mass mean force which was slightly lower.