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.

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

On Commutation and Conjugacy of Rational Languages and the Fixed Point Method

The research on language equations has been active during last decades. Compared to the equations on words the equations on languages are much more difficult to solve. Even very simple equations that are easy to solve for words can be very hard for languages. In this thesis we study two of such equations, namely commutation and conjugacy equations. We study these equations on some limited special cases and compare some of these results to the solutions of corresponding equations on words. For both equations we study the maximal solutions, the centralizer and the conjugator. We present a fixed point method that we can use to search these maximal solutions and analyze the reasons why this method is not successful for all languages. We give also several examples to illustrate the behaviour of this method.

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.

Fiscal sustainability across government tiers: an assessment of soft budget constraints

This paper analyses how fiscal adjustment comes about when both central and sub-national governments are involved in consolidation. We test sustainability of public debt with a fiscal rule for both the federal and regional government. Results for the German Länder show that lower tier governments bear a relatively smaller part of the burden of debt consolidation, if they consolidate at all. Most of the fiscal adjustment occurs via central government debt. In contrast, both the US federal and state levels contribute to consolidation of public finances.

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.

Candidate counterparts to the soft gamma-ray flare in the direction od LSI+61303

A short duration burst reminiscent of a soft gamma-ray repeater/anomalous X-ray pulsar behaviour was detected in the direction of LS I +61 303 by the Swift satellite. While the association with this well known gamma-ray binary is likely, a different origin cannot be excluded. Aims. We explore the error box of this unexpected flaring event and establish the radio, near-infrared and X-ray sources in our search for any peculiar alternative counterpart. Methods. We carried out a combined analysis of archive Very Large Array radio data of LS I +61 303 sensitive to both compact and extended emission. We also reanalysed previous near infrared observations with the 3.5 m telescope of the Centro Astronómico Hispano Alemán and X-ray observations with the Chandra satellite. Results. Our deep radio maps of the LS I +61 303 environment represent a significant advancement on previous work and 16 compact radio sources in the LS I +61 303 vicinity are detected. For some detections, we also identify near infrared and X-ray counterparts. Extended emission features in the field are also detected and confirmed. The possible connection of some of these sources with the observed flaring event is considered. Based on these data, we are unable to claim a clear association between the Swift-BAT flare and any of the sources reported here. However, this study represents the most sophisticated attempt to determine possible alternative counterparts other than LS I +61 303.

Análises quali- e quantitativa de cafés comerciais via ressonância magnética nuclear

Coffee is one of the beverages most widely consumed in the world and the "cafezinho" is normally prepared from a blend of roasted powder of two species, Coffea arabica and Coffea canephora. Each one exhibits differences in their taste and in the chemical composition, especially in the caffeine percentage. There are several procedures proposed in the literature for caffeine determination in different samples like soft drinks, coffee, medicines, etc but most of them need a sample workup which involves at least one step of purification. This work describes the quantitative analysis of caffeine using ¹H NMR and the identification of the major components in commercial coffee samples using 1D and 2D NMR techniques without any sample pre-treatment.

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.