The use of artificial intelligence algorithms to guide surgical treatment of adolescent idiopathic scoliosis

La scoliose idiopathique de l’adolescent (SIA) est une déformation tri-dimensionelle du rachis. Son traitement comprend l’observation, l’utilisation de corsets pour limiter sa progression ou la chirurgie pour corriger la déformation squelettique et cesser sa progression. Le traitement chirurgical reste controversé au niveau des indications, mais aussi de la chirurgie à entreprendre. Malgré la présence de classifications pour guider le traitement de la SIA, une variabilité dans la stratégie opératoire intra et inter-observateur a été décrite dans la littérature. Cette variabilité s’accentue d’autant plus avec l’évolution des techniques chirurgicales et de l’instrumentation disponible. L’avancement de la technologie et son intégration dans le milieu médical a mené à l’utilisation d’algorithmes d’intelligence artificielle informatiques pour aider la classification et l’évaluation tridimensionnelle de la scoliose. Certains algorithmes ont démontré être efficace pour diminuer la variabilité dans la classification de la scoliose et pour guider le traitement. L’objectif général de cette thèse est de développer une application utilisant des outils d’intelligence artificielle pour intégrer les données d’un nouveau patient et les évidences disponibles dans la littérature pour guider le traitement chirurgical de la SIA. Pour cela une revue de la littérature sur les applications existantes dans l’évaluation de la SIA fut entreprise pour rassembler les éléments qui permettraient la mise en place d’une application efficace et acceptée dans le milieu clinique. Cette revue de la littérature nous a permis de réaliser que l’existence de “black box” dans les applications développées est une limitation pour l’intégration clinique ou la justification basée sur les évidence est essentielle. Dans une première étude nous avons développé un arbre décisionnel de classification de la scoliose idiopathique basé sur la classification de Lenke qui est la plus communément utilisée de nos jours mais a été critiquée pour sa complexité et la variabilité inter et intra-observateur. Cet arbre décisionnel a démontré qu’il permet d’augmenter la précision de classification proportionnellement au temps passé à classifier et ce indépendamment du niveau de connaissance sur la SIA. Dans une deuxième étude, un algorithme de stratégies chirurgicales basé sur des règles extraites de la littérature a été développé pour guider les chirurgiens dans la sélection de l’approche et les niveaux de fusion pour la SIA. Lorsque cet algorithme est appliqué à une large base de donnée de 1556 cas de SIA, il est capable de proposer une stratégie opératoire similaire à celle d’un chirurgien expert dans prêt de 70% des cas. Cette étude a confirmé la possibilité d’extraire des stratégies opératoires valides à l’aide d’un arbre décisionnel utilisant des règles extraites de la littérature. Dans une troisième étude, la classification de 1776 patients avec la SIA à l’aide d’une carte de Kohonen, un type de réseaux de neurone a permis de démontrer qu’il existe des scoliose typiques (scoliose à courbes uniques ou double thoracique) pour lesquelles la variabilité dans le traitement chirurgical varie peu des recommandations par la classification de Lenke tandis que les scolioses a courbes multiples ou tangentielles à deux groupes de courbes typiques étaient celles avec le plus de variation dans la stratégie opératoire. Finalement, une plateforme logicielle a été développée intégrant chacune des études ci-dessus. Cette interface logicielle permet l’entrée de données radiologiques pour un patient scoliotique, classifie la SIA à l’aide de l’arbre décisionnel de classification et suggère une approche chirurgicale basée sur l’arbre décisionnel de stratégies opératoires. Une analyse de la correction post-opératoire obtenue démontre une tendance, bien que non-statistiquement significative, à une meilleure balance chez les patients opérés suivant la stratégie recommandée par la plateforme logicielle que ceux aillant un traitement différent. Les études exposées dans cette thèse soulignent que l’utilisation d’algorithmes d’intelligence artificielle dans la classification et l’élaboration de stratégies opératoires de la SIA peuvent être intégrées dans une plateforme logicielle et pourraient assister les chirurgiens dans leur planification préopératoire.

Cost-effectiveness of Transcatheter Mitral Valve Leaflet Repair for the Treatment of Mitral Regurgitation in Heart Failure

Contexte: La régurgitation mitrale (RM) est une maladie valvulaire nécessitant une intervention dans les cas les plus grave. Une réparation percutanée de la valve mitrale avec le dispositif MitraClip est un traitement sécuritaire et efficace pour les patients à haut risque chirurgical. Nous voulons évaluer les résultats cliniques et l'impact économique de cette thérapie par rapport à la gestion médicale des patients en insuffisance cardiaque avec insuffisance mitrale symptomatique. Méthodes: L'étude a été composée de deux phases; une étude d'observation de patients souffrant d'insuffisance cardiaque et de régurgitation mitrale traitée avec une thérapie médicale ou le MitraClip, et un modèle économique. Les résultats de l'étude observationnelle ont été utilisés pour estimer les paramètres du modèle de décision, qui a estimé les coûts et les avantages d'une cohorte hypothétique de patients atteints d'insuffisance cardiaque et insuffisance mitrale sévère traitée avec soit un traitement médical standard ou MitraClip. Résultats: La cohorte de patients traités avec le système MitraClip était appariée par score de propension à une population de patients atteints d'insuffisance cardiaque, et leurs résultats ont été comparés. Avec un suivi moyen de 22 mois, la mortalité était de 21% dans la cohorte MitraClip et de 42% dans la cohorte de gestion médicale (p = 0,007). Le modèle de décision a démontré que MitraClip augmente l'espérance de vie de 1,87 à 3,60 années et des années de vie pondérées par la qualité (QALY) de 1,13 à 2,76 ans. Le coût marginal était 52.500 $ dollars canadiens, correspondant à un rapport coût-efficacité différentiel (RCED) de 32,300.00 $ par QALY gagné. Les résultats étaient sensibles à l'avantage de survie. Conclusion: Dans cette cohorte de patients atteints d'insuffisance cardiaque symptomatique et d insuffisance mitrale significative, la thérapie avec le MitraClip est associée à une survie supérieure et est rentable par rapport au traitement médical.

Development of microbial treatment of ret liquor generated in a coir retting bioreactor

School of Environmental Studies, Cochin University of Science and Technology

Characterization of laccase from Streptomyces psammoticus: an enzyme for eco-friendly treatment of environmental pollutants

The present study has identified an actinomycete culture (S. psammoticus) which was capable of producing all the three major ligninolytic enzymes. The study revealed that least explored mangrove regions are potential sources for the isolation of actinomycetes with novel characteristics. The laccase production by the strain in SmF and SSF was found to be much higher than the reported values. The growth of the organism was favoured by alkaline pH and salinity of the medium. The enzyme also exhibited novel characteristics such as activity and stability at alkaline pH and salt tolerance. These two characters are quite significant from the industrial point of view making the enzyme an ideal candidate for industrial applications. Many of the application studies to date are focused on enzymes from fungal sources. However, the fungal laccases, which are mostly acidic in nature, could not be used universally for all application purposes especially, for the treatment of effluents from different industries, largely due to the alkaline nature of the effluents. Under such situations the enzymes from organisms like S. psammoticus with wide pH range could play a better role than the fungal counterparts. In the present study, the ability of the isolated strain and laccase in the degradation of dyes and phenolic compounds was successfully proved. The reusability of the immobilized enzyme system made the entire treatment process inexpensive. Thus it can be concluded from the present study that the laccase from this organism could be hopefully employed for the eco-friendly treatment of dye or phenol containing industrial effluents from various sources.

Studies on the treatment of effluents from natural rubber processing units

The present study was undertaken to evaluate the effectiveness of a few physico-chemical and biological methods for the treatment of effluents from natural rubber processing units. The overall objective of this study is to evaluate the effectiveness of certain physico-chemical and biological methods for the treatment of effluents from natural rubber processing units. survey of the chemical characteristics of the effluents discharged from rubber processing units showed that the effluents from latex concentration units were the most polluting

Microbial Treatment Of Rubber Latex Centrifugation Effluent

Many of the existing methods for the treatment of rubber latex centrifugation eflluent are not only unsatisfactory in their efliciency to effect near perfect treatment in bringing down the COD to optimum level, but also time consuming and need a large landspace. As the rate of effluent generation is extremely high (20 litres for kilogram of rubber) there is a need for development of efficient system,capable of rapid reduction of COD and BOD. Though the organic load of the rubber efiluent is very high, it does not contain much processed chemicals and therefore it can be considered as a ‘biological eflluent’. Further, the ratio of the Chemical Oxygen Demand to Biological Oxygen Demand (COD/BOD) of this effluent remain almost as a constant value. According to Montgomery (1967), estimation of BOD is not ideally suited for studies on process design, treatability, control of treatment plants, setting standards for treated effluents and assessing the effect of polluting discharges on the oxygen resources of receiving waters. Hence in the present study COD was measured to determine the impact of treatment system on the effluent. In the present study, attempts were made to evaluate the efficiencies of certain methods such as packed bed reactor using immobilized microbial cells, rotating biological contactor (RBC) and activated sludge process, for rapid and efficient treatment of natural rubber latex centrifugation effluent. In addition, studies were also carn'ed out to develop a suitable bioprocess for the coagulation of skim latex, as an alternative to the presently used acid coagulation process towards reducing the pollution load, besides recovering quality rubber

Penaeus monodon larvae can be protected from Vibrio harveyi infection by pre-emptive treatment of a rearing system with antagonistic or non-antagonistic bacterial probiotics

This study shows that the disease resistance and survival rate of Penaeus monodon in a larval rearing systems can be enhanced by supplementing with antagonistic or non-antagonistic probiotics. The antagonistic mode of action of Pseudomonas MCCB 102 and MCCB 103 against vibrios was demonstrated in larval mesocosm with cultures having su⁄cient concentration of antagonistic compounds in their culture supernatant. Investigations on the antagonistic properties of Bacillus MCCB 101, Pseudomonas MCCB 102 and MCCB 103 and Arthrobacter MCCB 104 against Vibrio harveyi MCCB111under in vitro conditions revealed that Pseudomonas MCCB 102 and MCCB 103 were inhibitory to the pathogen.These inhibitory propertieswere further con¢rmed in the larval rearing systems of P. monodon. All these four probionts signi¢cantly improved larval survival in long-term treatments as well as when challengedwith a pathogenic strain ofV. harveyiMCCB111. We could demonstrate that Pseudomonas MCCB 102 andMCCB103 accorded disease resistance and a higher survival rate in P. monodon larval rearing systems throughactive antagonism of vibrios,whereas Bacillus MCCB 101 and Arthrobacter MCCB 104 functioned as probiotics through immunostimulatory and digestive enzyme-supporting modes of action.

Influence of Major Operational Parameters on Aerobic Granulation for the Treatment of Wastewater

Effective solids-liquid separation is the basic concept of any wastewater treatment system. Biological treatment methods involve microorganisms for the treatment of wastewater. Conventional activated sludge process (ASP) poses the problem of poor settleability and hence require a large footprint. Biogranulation is an effective biotechnological process which can overcome the drawbacks of conventional ASP to a great extent. Aerobic granulation represents an innovative cell immobilization strategy in biological wastewater treatment. Aerobic granules are selfimmobilized microbial aggregates that are cultivated in sequencing batch reactors (SBRs). Aerobic granules have several advantages over conventional activated sludge flocs such as a dense and compact microbial structure, good settleability and high biomass retention. For cells in a culture to aggregate, a number of conditions have to be satisfied. Hence aerobic granulation is affected by many operating parameters. The organic loading rate (OLR) helps to enrich different bacterial species and to influence the size and settling ability of granules. Hence, OLR was argued as an influencing parameter by helping to enrich different bacterial species and to influence the size and settling ability of granules. Hydrodynamic shear force, caused by aeration and measured as superficial upflow air velocity (SUAV), has a strong influence and hence it is used to control the granulation process. Settling time (ST) and volume exchange ratio (VER) are also two key influencing factors, which can be considered as selection pressures responsible for aerobic granulation based on the concept of minimal settling velocity. Hence, these four parameters - OLR, SUAV, ST and VER- were selected as major influencing parametersfor the present study. Influence of these four parameters on aerobic granulation was investigated in this work

Subcutaneous study on the controlled release of Etanidazole and Taxol for the treatment of Glioma

BALB/c nude mice 6 weeks old were inoculated with glioma C6 cell-line and the efficacy of the different amount of Etanidazole-discs and Taxol-microspheres was investigated. Poly (D,L-lactic-co-glycolic acid) (PLGA) was used as the main encapsulating polymer and polyethylene glycol was added to increase the porosity. The 1% drug loading microspheres of each drug were produced by spray drying and the discs were obtained by compressing the Etanidazole-microspheres. Intra-tumoral injection followed by irradiation resulted in high systemic dosage and thus systemic toxicity. Tumors grown for 6 days, 9 days and 16 days were implanted with 0.5 mg or 1.0 mg or 1.5 mg of the drug. A radiation dosage of 2 Gy each time for a number of times was given for animals implanted with Etanidazole and no irradiation was given for animals implanted with Taxol. Increasing the number of doses clearly decreased the rate of tumor growth. The increase in the amount of drug on smaller sized tumors controlled the tumor better and there was agglomeration of the microspheres resulting in deviation of release profile of the drug as compared to the in vitro studies. It was observed that 1.0 mg of Taxol given to a tumor grown for 6 days was able to suppress the tumor for a total period of approximately two months and no tumor resurrection was observed during the second month.

Statistical treatment of grain-size curves and empirical distributions: densities as compositions?

The preceding two editions of CoDaWork included talks on the possible consideration of densities as infinite compositions: Egozcue and D´ıaz-Barrero (2003) extended the Euclidean structure of the simplex to a Hilbert space structure of the set of densities within a bounded interval, and van den Boogaart (2005) generalized this to the set of densities bounded by an arbitrary reference density. From the many variations of the Hilbert structures available, we work with three cases. For bounded variables, a basis derived from Legendre polynomials is used. For variables with a lower bound, we standardize them with respect to an exponential distribution and express their densities as coordinates in a basis derived from Laguerre polynomials. Finally, for unbounded variables, a normal distribution is used as reference, and coordinates are obtained with respect to a Hermite-polynomials-based basis. To get the coordinates, several approaches can be considered. A numerical accuracy problem occurs if one estimates the coordinates directly by using discretized scalar products. Thus we propose to use a weighted linear regression approach, where all k- order polynomials are used as predictand variables and weights are proportional to the reference density. Finally, for the case of 2-order Hermite polinomials (normal reference) and 1-order Laguerre polinomials (exponential), one can also derive the coordinates from their relationships to the classical mean and variance. Apart of these theoretical issues, this contribution focuses on the application of this theory to two main problems in sedimentary geology: the comparison of several grain size distributions, and the comparison among different rocks of the empirical distribution of a property measured on a batch of individual grains from the same rock or sediment, like their composition

Evolution of clinical and functional results after arthroscopic treatment of Discoid Meniscus. A case series study of 31 cases.

Purpose: To evaluate the evolution of clinical and functional outcomes of symptomatic discoid lateral meniscus treated arthroscopically over time and to investigate the relationship between associated intra-articular findings and outcomes. Methods: Of all patients treated arthroscopically between 1995 and 2010, patients treated for symptomatic discoid meniscus were identified in the hospital charts. Baseline data (demographics, previous trauma of ipsilateral knee, and associated intra-articular findings) and medium term outcome data from clinical follow-up examinations (pain, locking, snapping and instability of the operated knee) were extracted from clinical records. Telephone interviews were conducted at long term in 28 patients (31 knees). Interviews comprised clinical outcomes as well as functional outcomes as assessed by the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC). Results: All patients underwent arthroscopic partial meniscectomy. The mean follow-up time for data extracted from clinical records was 11 months (SD ± 12). A significant improvement was found for pain in 77% (p<0.001), locking in 13%, (p=0.045) and snapping in 39 % (p<0.005). The mean follow-up time of the telephone interview was 60 months (SD ± 43). Improvement from baseline was generally less after five years than after one year and functional outcomes of the IKDC indicated an abnormal function after surgery (IKDC mean= 84.5, SD ± 20). In some patients, 5 year-outcomes were even worse than their preoperative condition. Nonetheless, 74% of patients perceived their knee function as improved. Furthermore, better results were seen in patients without any associated intra-articular findings. Conclusions: Arthroscopical partial meniscectomy is an effective intervention to relieve symptoms in patients with discoid meniscus in the medium-term; however, results trend to deteriorate over time. A trend towards better outcome for patients with no associated intra-articular findings was observed.

Conceptual Rapprochement and the Analysis of the Historical, Normative and Jurisprudential Treatment of the Rural Workers, as Regards the Need for Special Protection

This article aims to present an approach to the issue of farm or rural zone workers, including a labour law study of agrarian legal decisions, so as to demonstrate their importance in respect to social, economic and cultural rights in Colombia. The study will serve to illustrate through the history, the applicable law and the jurisprudence, the different ways in which farmers have been treated from the time of the origin until the arrival of modern systems of industrialization. It calls into question the effectiveness of existing laws and the role of the courts, in spite of globalization, to maintain the minimum rights and guarantees of farm workers who are considered to be a vulnerable population. In conclusion, this study seeks to illustrate the current role of the Labor law and the National Health Service in the area of demonstrating of the existence or absence of mechanisms to protect workers in rural areas and the need to create some mechanisms that involve social justice given its prime importance in the Constitution of 1991.

Conceptualization and therapeutic treatment of a compulsive gambling case by Functional Analysis and Acceptance and Commitment Therapy

A clinical case of compulsive gambling is exposed in this article. The subject’s playing behaviour had both positive and negative consequences. The subject tried to practice control over the urge to play. As shown in the functional analysis, the failure to control the urge despite the best efforts worsened the problem due to its negative consequences. A variation of acceptance and commitment therapy (ACT) was applied in order to break down the fight-surrender vicious circle of the playing behaviour. Two treatment strategies were agreed upon: acceptance of the fact that both playing and not playing had negatives consequences and commitment to one of these options despite its disadvantages. Finally, it is proposed that this acceptance and commitment therapy is a useful therapeutic process as it decreases the suffering subject and eliminates the problem: playing bahaviour.

The contribution of the therapist's competence in the treatment of adolescents with generalized social phobia

Resumen tomado de la publicaci??n

Finite field treatment of vibrational polarizabilities and hyperpolarizabilities: on the role of the Eckart conditions, their implementation, and their use in characterizing key vibrations

In the finite field (FF) treatment of vibrational polarizabilities and hyperpolarizabilities, the field-free Eckart conditions must be enforced in order to prevent molecular reorientation during geometry optimization. These conditions are implemented for the first time. Our procedure facilities identification of field-induced internal coordinates that make the major contribution to the vibrational properties. Using only two of these coordinates, quantitative accuracy for nuclear relaxation polarizabilities and hyperpolarizabilities is achieved in π-conjugated systems. From these two coordinates a single most efficient natural conjugation coordinate (NCC) can be extracted. The limitations of this one coordinate approach are discussed. It is shown that the Eckart conditions can lead to an isotope effect that is comparable to the isotope effect on zero-point vibrational averaging, but with a different mass-dependence