Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis: Results of a multicenter, phase II, dose-ranging study.

OBJECTIVE: To assess the efficacy and tolerability of canakinumab, a fully human anti-interleukin-1β monoclonal antibody, for the treatment of acute gouty arthritis. METHODS: In this 8-week, single-blind, double-dummy, dose-ranging study, patients with acute gouty arthritis whose disease was refractory to or who had contraindications to nonsteroidal antiinflammatory drugs and/or colchicine were randomized to receive a single subcutaneous dose of canakinumab (10, 25, 50, 90, or 150 mg; n = 143) or an intramuscular dose of triamcinolone acetonide (40 mg; n = 57). Patients assessed pain using a 100-mm visual analog scale. RESULTS: Seventy-two hours after treatment, a statistically significant dose response was observed for canakinumab. All canakinumab doses were associated with numerically less pain than triamcinolone acetonide; thus, a dose with equivalent efficacy to triamcinolone acetonide 72 hours after treatment could not be determined. The reduction from baseline in pain intensity with canakinumab 150 mg was greater than with triamcinolone acetonide 24, 48, and 72 hours after treatment (differences of -11.5 mm [P = 0.04], -18.2 mm [P = 0.002], and -19.2 mm [P < 0.001], respectively), and 4, 5, and 7 days after treatment (all P < 0.05). Canakinumab significantly reduced the risk of recurrent flares versus triamcinolone acetonide (P ≤ 0.01 for all doses) (relative risk reduction 94% for canakinumab 150 mg versus triamcinolone acetonide). The overall incidence of adverse events was similar for canakinumab (41%) and triamcinolone acetonide (42%); most were mild or moderate in severity. CONCLUSION: Our findings indicate that canakinumab 150 mg provides rapid and sustained pain relief in patients with acute gouty arthritis, and significantly reduces the risk of recurrent flares compared with triamcinolone acetonide.

Prediction of difficult intubation with advanced face recognition techniques: a preliminary study

Introduction: Difficult tracheal intubation remains a constant and significant source of morbidity and mortality in anaesthetic practice. Insufficient airway assessment in the preoperative period continues to be a major cause of unanticipated difficult intubation. Although many risk factors have already been identified, preoperative airway evaluation is not always regarded as a standard procedure and the respective weight of each risk factor remains unclear. Moreover the predictive scores available are not sensitive, moderately specific and often operator-dependant. In order to improve the preoperative detection of patients at risk for difficult intubation, we developed a system for automated and objective evaluation of morphologic criteria of the face and neck using video recordings and advanced techniques borrowed from face recognition. Method and results: Frontal video sequences were recorded in 5 healthy volunteers. During the video recording, subjects were requested to perform maximal flexion-extension of the neck and to open wide the mouth with tongue pulled out. A robust and real-time face tracking system was then applied, allowing to automatically identify and map a grid of 55 control points on the face, which were tracked during head motion. These points located important features of the face, such as the eyebrows, the nose, the contours of the eyes and mouth, and the external contours, including the chin. Moreover, based on this face tracking, the orientation of the head could also be estimated at each frame of the video sequence. Thus, we could infer for each frame the pitch angle of the head pose (related to the vertical rotation of the head) and obtain the degree of head extension. Morphological criteria used in the most frequent cited predictive scores were also extracted, such as mouth opening, degree of visibility of the uvula or thyreo-mental distance. Discussion and conclusion: Preliminary results suggest the high feasibility of the technique. The next step will be the application of the same automated and objective evaluation to patients who will undergo tracheal intubation. The difficulties related to intubation will be then correlated to the biometric characteristics of the patients. The objective in mind is to analyze the biometrics data with artificial intelligence algorithms to build a highly sensitive and specific predictive test.

CT-guided sacroiliac joint injection: Easy or difficult? : 53

Purpose: Fluoroscopy-guided sacroiliac joint (SIJ) injections are technically difficult to perform because of the complex anatomy with helicoidal conformation of the joint. Our study describes the procedure of CT-guided SIJ injection, its feasibility and its rate of success. Methods and materials: Retrospective study included 46 consecutive patients. The procedure was performed by 3 MSK radiologists and consisted in a puncture with a posterior approach in the inferior articular part of SIJ, then in an injection of iodinated contrast agent (1ml) with CT control of SIJ space opacification and finally in an injection of slowacting corticosteroid. The SIJ approach was noticed as correct if there was an inferior articular puncture and if the needle was in the articular space, and as impossible if there was ankylosis or osteophytosis. The study was divided in two successive periods: period 1 (4 first months) and period 2 (12 last months). Results: SIJ opacification was successful in 57% (26/46). We observed a learning curve: opacification was succeeded in 66% (23/35) and there was incorrect approach in 9% (3/35) during period 2 versus respectively 27% (3/11) and 45% (5/11) during period 1. Causes of failure were incorrect approach in 40% (6/20 too low, 2/20 too high), impossible approach in 30% (6/20) and unexplained in 30% (6/20). Mean duration of procedure was about 28 minutes. No complication occurred. Conclusion: CT guided SIJ injection is safe and successful in 66% after a training period. The success depends on SIJ correct approach and also on anatomical lesions.

Note sur le comportement de Sylvisorex megalura

Des observations sur Sylvisorex megalura en captivité montrent un comportement arboricole marqué. Cette espèce se sert de sa longue queue (118%) de la longueur tête et corps) comme auxiliaire efficace pour grimper. La longueur de la queue et sa faculté à s'enrouler autour des rameaux sont des adaptations morphologiques à son mode de vie

Wage cuts and managers' empathy: How a positive emotion can contribute to positive organizational ethics in difficult times

Using the lens of positive organizational ethics, we theorized that empathy affects decisions in ethical dilemmas that concern the well-being of not only the organization but also other stakeholders. We hypothesized and found that empathetic managers were less likely to comply with requests by an authority figure to cut the wages of their employees than were non-empathetic managers. However, when an authority figure requested to hold wages constant, empathy did not affect wage cut decisions. These findings imply that empathy can serve as a safeguard for ethical decision making in organizations during trying times without generally undermining organizational effectiveness. We conclude by discussing the implications of our research.

Voir le monde à travers les lunettes du métacontraste : un modèle mathématique inspiré de la psychologie sociale

Résumé La théorie de l'autocatégorisation est une théorie de psychologie sociale qui porte sur la relation entre l'individu et le groupe. Elle explique le comportement de groupe par la conception de soi et des autres en tant que membres de catégories sociales, et par l'attribution aux individus des caractéristiques prototypiques de ces catégories. Il s'agit donc d'une théorie de l'individu qui est censée expliquer des phénomènes collectifs. Les situations dans lesquelles un grand nombre d'individus interagissent de manière non triviale génèrent typiquement des comportements collectifs complexes qui sont difficiles à prévoir sur la base des comportements individuels. La simulation informatique de tels systèmes est un moyen fiable d'explorer de manière systématique la dynamique du comportement collectif en fonction des spécifications individuelles. Dans cette thèse, nous présentons un modèle formel d'une partie de la théorie de l'autocatégorisation appelée principe du métacontraste. À partir de la distribution d'un ensemble d'individus sur une ou plusieurs dimensions comparatives, le modèle génère les catégories et les prototypes associés. Nous montrons que le modèle se comporte de manière cohérente par rapport à la théorie et est capable de répliquer des données expérimentales concernant divers phénomènes de groupe, dont par exemple la polarisation. De plus, il permet de décrire systématiquement les prédictions de la théorie dont il dérive, notamment dans des situations nouvelles. Au niveau collectif, plusieurs dynamiques peuvent être observées, dont la convergence vers le consensus, vers une fragmentation ou vers l'émergence d'attitudes extrêmes. Nous étudions également l'effet du réseau social sur la dynamique et montrons qu'à l'exception de la vitesse de convergence, qui augmente lorsque les distances moyennes du réseau diminuent, les types de convergences dépendent peu du réseau choisi. Nous constatons d'autre part que les individus qui se situent à la frontière des groupes (dans le réseau social ou spatialement) ont une influence déterminante sur l'issue de la dynamique. Le modèle peut par ailleurs être utilisé comme un algorithme de classification automatique. Il identifie des prototypes autour desquels sont construits des groupes. Les prototypes sont positionnés de sorte à accentuer les caractéristiques typiques des groupes, et ne sont pas forcément centraux. Enfin, si l'on considère l'ensemble des pixels d'une image comme des individus dans un espace de couleur tridimensionnel, le modèle fournit un filtre qui permet d'atténuer du bruit, d'aider à la détection d'objets et de simuler des biais de perception comme l'induction chromatique. Abstract Self-categorization theory is a social psychology theory dealing with the relation between the individual and the group. It explains group behaviour through self- and others' conception as members of social categories, and through the attribution of the proto-typical categories' characteristics to the individuals. Hence, it is a theory of the individual that intends to explain collective phenomena. Situations involving a large number of non-trivially interacting individuals typically generate complex collective behaviours, which are difficult to anticipate on the basis of individual behaviour. Computer simulation of such systems is a reliable way of systematically exploring the dynamics of the collective behaviour depending on individual specifications. In this thesis, we present a formal model of a part of self-categorization theory named metacontrast principle. Given the distribution of a set of individuals on one or several comparison dimensions, the model generates categories and their associated prototypes. We show that the model behaves coherently with respect to the theory and is able to replicate experimental data concerning various group phenomena, for example polarization. Moreover, it allows to systematically describe the predictions of the theory from which it is derived, specially in unencountered situations. At the collective level, several dynamics can be observed, among which convergence towards consensus, towards frag-mentation or towards the emergence of extreme attitudes. We also study the effect of the social network on the dynamics and show that, except for the convergence speed which raises as the mean distances on the network decrease, the observed convergence types do not depend much on the chosen network. We further note that individuals located at the border of the groups (whether in the social network or spatially) have a decisive influence on the dynamics' issue. In addition, the model can be used as an automatic classification algorithm. It identifies prototypes around which groups are built. Prototypes are positioned such as to accentuate groups' typical characteristics and are not necessarily central. Finally, if we consider the set of pixels of an image as individuals in a three-dimensional color space, the model provides a filter that allows to lessen noise, to help detecting objects and to simulate perception biases such as chromatic induction.

The experience of transplantation for patients and their significant ones: A difficult encounter of two worlds

Objectives This paper reports on a longitudinal qualitative study exploring concerns of 60 patients before and after transplantation. Methods Semi-structured interviews were conducted without time constraints in a protected space out of the hospital. Qualitative analysis was performed. Results Prior to transplantation, all patients talked freely about negative feelings, stigmatisation, being misunderstood by others, loneliness and culpability caused by increasing physical dependency or abandoned roles. They mentioned alternative ways to cope (magic, spirituality), and even expressed their right to let go. In a subset of 13 patients, significant ones allowed themselves in the interview, or were integrated on the request of the patients. In this modified setting, two illness-worlds were confronted. If common themes were mentioned (e.g., modified life plans, restricted space, physical and psychological barriers), they were experienced differently. Fear of transplantation or guilt towards the donors was overtly expressed, often for the first time. Mutual hiding of anxiety in order to protect loved ones or to prevent loss of control was disclosed. The significant ones talked about accumulated stress and exhaustion related to the physical degradation of the patient, fear of the unpredictable evolution of illness and financial problems, and stressed their difficulty to adapt adequately to the fluctuating state of the patient. After transplantation, other themes emerged, where difficulty in disclosure was observed: intensive care and near death experiences, being a transplanted person, debt to the donor and his/her family, fear of rejection. Conclusions With the self-imposed strategy of hiding concerns to protect one another, a discrepancy between two illness-worlds was created. When concerns were confronted during the interviews, a new mutual understanding emerged. Patients and their families stated the need for sharing concerns in the course of illness.