Mastectomies prophylactiques épargnant le complexe aréolo-mamelonnaire: sécurité oncologique, satisfaction des patientes et résultats esthétiques

Résumé Introduction L’efficacité de la mastectomie prophylactique est bien démontrée. La mastectomie NSM (nipple-sparing mastectomy) peut potentiellement améliorer les résultats esthétiques, mais elle n’est pas pratiquée d’emblée en raison de doutes face à sa sécurité oncologique. Objectif Évaluer la faisabilité et la sécurité oncologique de la NSM dans un contexte prophylactique ainsi que les résultats esthétiques et la satisfaction des patientes. Méthodologie Une étude rétrospective fut conduite chez toutes les femmes ayant subi une mastectomie prophylactique suivie d’une reconstruction mammaire immédiate au centre hospitalier de l’Université de Montréal (CHUM) entre1997 et 2008. Les données concernant les facteurs de risque de cancer, les complications post-opératoires et les incidences de cancer furent notées. La satisfaction des patientes était évaluée par questionnaire. Deux chirurgiens ont évalué les résultats esthétiques sur des photos. Résultats Soixante et onze patientes ont subi 86 mastectomies prophylactiques, dont 21 NSM et 65 SSM (skin-sparing mastectomy). Suivant une SSM, 34 CAM (complexe aréolo- mamelonaire) furent reconstruits. Une nécrose totale s’est produite dans 2 CAM préservés et dans 2 CAM reconstruits. Le taux général de complications était significativement plus élevé parmi les CAM reconstruits. La satisfaction des patientes quant à l’apparence du CAM était significativement plus élevée dans le groupe NSM et les résultats esthétiques, meilleurs. Avec un temps de suivi moyen de 50 mois, aucune incidence au niveau du CAM n’est survenue. i Conclusion Les NSM offrent de meilleures résultats, n’augmentent pas les complications post- opératoire et semblent sécuritaires au plan oncologique.

A detailed assessment of adverse perioperative outcomes of the elderly treated with radical cystectomy for bladder cancer

Objectifs: Les données provenant des centres de soins tertiaires suggèrent que le taux de mortalité péri-opératoire (MPO) après cystectomie notés pour les patients âgés (septuagénaires et octogénaires) n’excède pas celle des patients plus jeunes. Toutefois, les données provenant de la communauté démontrent un phénomène inverse. Spécifiquement, la MPO est plus élevés chez les ainés. Dans cette thèse nous allons présenter une réévaluation contemporaine du taux de MPO après cystectomie. Méthodes: Entre 1988 et 2006, 12722 cystectomies radicales pour le carcinome urothéliale de la vessie ont été enregistrées dans la banque de données SEER. Le taux de MPO a été évalué dans les analyses de régression logistique univariées et multivariées à 90 jours après cystectomie radicale. Les covariables incluaient: le sexe, l’ethnie, l’année de chirurgie, la région d’origine du patient ainsi que le grade et le stade de la tumeur. Résultats: Parmi tous les patients, 4480 étaient des septuagénaires (35.2%) et 1439 étaient des octogénaires (11.3%). Le taux de MPO à 90 jours était de 4% pour la cohorte entière vs. 2% pour les patients moins de 69 ans vs. 5.4% pour les septuagénaires vs. 9.2% pour les octogénaires. Dans les analyses de régression logistiques multivariées, les septuagénaires (OR=2.80; <0.001) et les octogénaires (OR=5.02; <0.001) avaient reçu un taux de MPO plus augmenté que les patients moins de 70 ans après une cystectomie radicale. Conclusion: Cette analyse épidémiologique basée sur les donnés le plus contemporaines démontre que l’âge avancée représente un facteur de risque pour un taux de MPO plus élevé.

Growth and Characterization of ZnO based Heterojunction diodes and ZnO Nanostructuresby Pulsed Laser Ablation

Transparent conducting oxides (TCO’s) have been known and used for technologically important applications for more than 50 years. The oxide materials such as In2O3, SnO2 and impurity doped SnO2: Sb, SnO2: F and In2O3: Sn (indium tin oxide) were primarily used as TCO’s. Indium based oxides had been widely used as TCO’s for the past few decades. But the current increase in the cost of indium and scarcity of this material created the difficulty in obtaining low cost TCO’s. Hence the search for alternative TCO material has been a topic of active research for the last few decades. This resulted in the development of various binary and ternary compounds. But the advantages of using binary oxides are the easiness to control the composition and deposition parameters. ZnO has been identified as the one of the promising candidate for transparent electronic applications owing to its exciting optoelectronic properties. Some optoelectronics applications of ZnO overlap with that of GaN, another wide band gap semiconductor which is widely used for the production of green, blue-violet and white light emitting devices. However ZnO has some advantages over GaN among which are the availability of fairly high quality ZnO bulk single crystals and large excitonic binding energy. ZnO also has much simpler crystal-growth technology, resulting in a potentially lower cost for ZnO based devices. Most of the TCO’s are n-type semiconductors and are utilized as transparent electrodes in variety of commercial applications such as photovoltaics, electrochromic windows, flat panel displays. TCO’s provide a great potential for realizing diverse range of active functions, novel functions can be integrated into the materials according to the requirement. However the application of TCO’s has been restricted to transparent electrodes, ii notwithstanding the fact that TCO’s are n-type semiconductors. The basic reason is the lack of p-type TCO, many of the active functions in semiconductor originate from the nature of pn-junction. In 1997, H. Kawazoe et al reported the CuAlO2 as the first p-type TCO along with the chemical design concept for the exploration of other p-type TCO’s. This has led to the fabrication of all transparent diode and transistors. Fabrication of nanostructures of TCO has been a focus of an ever-increasing number of researchers world wide, mainly due to their unique optical and electronic properties which makes them ideal for a wide spectrum of applications ranging from flexible displays, quantum well lasers to in vivo biological imaging and therapeutic agents. ZnO is a highly multifunctional material system with highly promising application potential for UV light emitting diodes, diode lasers, sensors, etc. ZnO nanocrystals and nanorods doped with transition metal impurities have also attracted great interest, recently, for their spin-electronic applications This thesis summarizes the results on the growth and characterization of ZnO based diodes and nanostructures by pulsed laser ablation. Various ZnO based heterojunction diodes have been fabricated using pulsed laser deposition (PLD) and their electrical characteristics were interpreted using existing models. Pulsed laser ablation has been employed to fabricate ZnO quantum dots, ZnO nanorods and ZnMgO/ZnO multiple quantum well structures with the aim of studying the luminescent properties.

Design and Development of data mining models for the predictions of manpower placement in the technical Domain

Data mining is one of the hottest research areas nowadays as it has got wide variety of applications in common man’s life to make the world a better place to live. It is all about finding interesting hidden patterns in a huge history data base. As an example, from a sales data base, one can find an interesting pattern like “people who buy magazines tend to buy news papers also” using data mining. Now in the sales point of view the advantage is that one can place these things together in the shop to increase sales. In this research work, data mining is effectively applied to a domain called placement chance prediction, since taking wise career decision is so crucial for anybody for sure. In India technical manpower analysis is carried out by an organization named National Technical Manpower Information System (NTMIS), established in 1983-84 by India's Ministry of Education & Culture. The NTMIS comprises of a lead centre in the IAMR, New Delhi, and 21 nodal centres located at different parts of the country. The Kerala State Nodal Centre is located at Cochin University of Science and Technology. In Nodal Centre, they collect placement information by sending postal questionnaire to passed out students on a regular basis. From this raw data available in the nodal centre, a history data base was prepared. Each record in this data base includes entrance rank ranges, reservation, Sector, Sex, and a particular engineering. From each such combination of attributes from the history data base of student records, corresponding placement chances is computed and stored in the history data base. From this data, various popular data mining models are built and tested. These models can be used to predict the most suitable branch for a particular new student with one of the above combination of criteria. Also a detailed performance comparison of the various data mining models is done.This research work proposes to use a combination of data mining models namely a hybrid stacking ensemble for better predictions. A strategy to predict the overall absorption rate for various branches as well as the time it takes for all the students of a particular branch to get placed etc are also proposed. Finally, this research work puts forward a new data mining algorithm namely C 4.5 * stat for numeric data sets which has been proved to have competent accuracy over standard benchmarking data sets called UCI data sets. It also proposes an optimization strategy called parameter tuning to improve the standard C 4.5 algorithm. As a summary this research work passes through all four dimensions for a typical data mining research work, namely application to a domain, development of classifier models, optimization and ensemble methods.

Growth and characterisation of tin dichalcogenide crystals

During the past few decades, a wide spread interest in the structural, optical, electrical and other physical properties of the transition metal dichalcogenide layer compounds has evolved. The members of this family of compounds can be regarded as strongly bonded two dimensional chalcogen-metal~chalcogen layers which are loosely coupled to one another by the weak ven der Waal's forces. Because of this type of bonding, the crystals are easily cleavable along the basal plane and show highly anisotropic properties. This thesis contains the growth and the study of the physical properties of certain tin dichalcogenide crystals (SnS2 and SnSe2). Tin disulphide and tin diselenide crystallize in the hexagonal CdI2 type crystal structure. This structure consists of layers of tin atoms sandwiched between two layers of chalcogen atoms. A tin atom is surrounded by six chalcogen atoms octahedrally.In the layers the atoms are held together by covalent bonding and in between the layers there is van der Waal's bonding.

Growth and characterisation of certain organic crystals

The thesis presents the results of the investigations on the crystallisation ‘behaviour, detect structure end electrical properties of certain organic crystals---phthslic snhydride end potsssiun scid phthalate Hollow crystals of phthalic snhydride were grown from vapour. the norpholog of these hollow crystals were studied in detail and s. mechanism for their growth has been proposed. A closed crystal—vapour system was used to study the basal plane growth of the whiskers and the sequential growth, observed, confirmed the mechanism suggested for hollow crystals. The dendritic crystals of phthslic enhydride were grown, both iron the melt and solution. The observed morphologies of these dendrites ere described. Bpherulites of phthalic anhydride have been grown by the artificial initiation of nucleation, from melt and solution. The variation of the substructure oi’ these spherulites with the growth tenperature wee investigated. The spherulitic filll having ribbon substructure were etched to reveal dislocations. A mechanism for the formation of the observed etch pattern has been suggested. the slip occurring in these ribbons were studied and the results are presented

Growth And Characterization Of Diammonium Hydrogen Citrate And Citric Acid Monohydrate Single Crystals

Over the past years there has been considerable interest in the growth of single crystals both from the point of view of basic research and technological application. With the revolutionary emergence of solid state electronics which is based on single crystal technolo8Ys basic and applied studies on crystal growth and characterization _have gained a-more significant role in material science. These studies are being carried out for single crystals not only of semiconductor and other electronic materials but also of metals and insulators. Many organic crystals belonging to the orthorhombic class exhibit ferroelectric, electrooptic, triboluminescent and piezoelectric properties. Diammonium Hydrogen Citrate (DAHC) crystals are reported to be piezoelectric and triboluminescent /1/. Koptsik et al. /2/ have reported the piezoelectric nature of Citric Acid Monohydrate (CA) crystals. And since not much work has been done on these crystals, it has been thought useful to grow and characterize these crystals. This thesis presents a study of the growth of these crystals from solution and their defect structures. The results of the microindentation and thermal analysis are presented. Dielectric, fractographic, infrared (IR) and ultraviolet (UV) studies of DAHC crystals are also reported

Growth And Characterization Of Te-Se System And Some Tei.I.Urioes

The physical properties of solid matter are basically influenced by the existence of lattice defects; as a result the study of crystal defects has assumed a central position in solid state physics and materials science. The study of dislocations ixa single crystals can yield a great deal of information on the mechanical properties of materials. In order to secure a full understanding of the processes taking place in semiconducting materials, it is important to investigate the microhardness of these materials-—the most reliable method of determining the fine structure of crystals, the revelation of micro—inhomogenities in the distribution of impurities, the effect of dislocation density on the mechanical properties of crystals etc. Basically electrical conductivity in single crystals is a defect controlled phenomenon and hence detailed investigation of the electrical properties of these materials is one of the best available methods for the study of defects in them. In the present thesis a series of detailed studies carried out in Te—Se system, Bi2Te3 and In2Te3 crystals using surface topographical, dislocation and microindentation analysis as well as electrical measurements are presented

Desenlaces del tratamiento de pacientes adultos con tuberculosis multiresistente y con resistencia extendida. Revisión sistemática.

Introducción: La tuberculosis es considerada una enfermedad de alta prevalencia a nivel mundial y un problema de salud pública por la disminución en la tasa de cura desde la aparición de TB con resistencia múltiple y extendida, por lo cual se requiere diseñar estrategias de manejo emergentes que permitan frenar el aumento en la incidencia de la TB a nivel mundial. Métodos: Se realizó una búsqueda sistemática de la literatura a través de PubMed y HINARI, dirigida a estudios que evaluaran los desenlaces de manejo de la TB MDR según los objetivos planteados por la última guía de la OMS1. Resultados: Se recolectaron 9 artículos de seguimiento a una cohorte en diferentes lugares del mundo según los criterios de inclusión, de la muestra recolectada en los 9 artículos, 4720 personas recibieron tratamiento desde el inicio, 4163 (88%) fueron TB MDR y 557 (12%) TB XDR. De esta muestra se excluyeron los transferidos a otras instituciones al hacer el análisis, quedando un total de 4455 casos. Se encontró de las muestras con el manejo individualizado, sin embargo la mortalidad continua siendo representativa y mayor en relación con algunas variables. Conclusiones: Los estudios evaluaron las múltiples estrategias de manejo en diferentes países sin obtener resultados contundentes sobre una estrategia de manejo estandarizada. La realización de un meta análisis no es posible por la pobre caracterización de los esquemas de tratamiento usados en los diferentes estudios y definiciones mal delineadas.

Ablación cardiaca en niños y adolescentes: experiencia en la Fundación Cardioinfantil-IC años 2010 -2013

Introducción: Se ha demostrado que la técnica de radiofrecuencia en ablación cardiaca es altamente efectiva en el tratamiento de arritmias cardiacas en pediatría, además de tener un mínimo de complicaciones. En este estudio se exponen los resultados de este procedimiento en un grupo de pacientes pediátricos en la Fundación Cardioinfantil. Población y Métodos: Entre enero de 2010 y diciembre de 2013 se realizaron un total de 231 ablaciones cardiacas. Al aplicar criterios de inclusión y exclusión se obtienen 192 pacientes, de los cuales 58% eran de sexo masculino y 42% de sexo femenino, 43.2% pertenecían a un rango de edad entre 11-15 años. Resultados: La ablación fue exitosa en 185/192 pacientes (Tasa de éxito global 96.3%). Pérdidas durante el seguimiento al primer día 0%, tasa de éxito 100% con cero recurrencias. Control de los 30 días: pérdidas del 8.3%, tasa de éxito del 90.6% y dos recurrencias. Control de los 90 días se tuvieron pérdidas de 30.2%, tasa de éxito de 95.4% y seis recurrencias, finalmente a los 180 días con un porcentaje de pérdidas de 51.5% y siete recurrencias, la tasa de éxito es de 92.5%. En el seguimiento se encontraron 7 recurrencias, las cuales fueron llevadas a un segundo procedimiento que fue efectivo en 7/7 (100)%. No hubo complicaciones ni muertes. Conclusiones: Los resultados obtenidos no difieren de los resultados de estudios de ablación pediátrica en el mundo, definiéndose así como un procedimiento seguro y eficaz en la Fundación Cardioinfantil.

Earthworms produce granules of intricately zoned calcite

Earthworms of the family Lumbricidae, which includes many common species, produce and secrete up to millimeter-sized calcite granules, and the intricate fine-scale zoning of their constituent crystals is unique for a biomineral. Granule calcite is produced by crystallization of amorphous calcium carbonate (ACC) that initially precipitates within the earthworm calciferous glands, then forms protogranules by accretion on quartz grain cores. Crystallization of ACC is mediated by migrating fluid films and is largely complete within 24 11 of ACC production and before granules leave the earthworm. Variations in the density of defects formed as a byproduct of trace element incorporation during calcite crystall growth have generated zoning that can be resolved by cathodoluminescence imaging at ultraviolet to blue wavelengths and using the novel technique of scanning electron microscope charge contrast imaging. Mapping of calcite crystal orientations by electron backscatter diffraction reveals an approximate radial fabric to the granules that reflects crystal growth from internal nucleation sites toward their margins. The survival within granules of ACC inclusions for months after they enter soils indicates that they crystallize only within the earthworm and in the presence of fluids containing biochemical catalysts. The earthworm probably promotes crystallization of ACC in order to prevent remobilization of the calcium carbonate by dissolution. Calcite granules vividly illustrate the role of transient precursors in biomineralization, but the underlying question of why earth-worms produce granules in volumes sufficient to have a measurable impact on soil carbon cycling remains to be answered.

Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

Functional benefits of predator species diversity depend on prey identity

1. Determining the functional significance of species diversity in natural enemy assemblages is a key step towards prediction of the likely impact of biodiversity loss on natural pest control processes. While the biological control literature contains examples in which increased natural enemy diversity hinders pest control, other studies have highlighted mechanisms where pest suppression is promoted by increased enemy diversity. 2. This study aimed to test whether increased predator species diversity results in higher rates of predation on two key, but contrasting, insect pest species commonly found in the rice ecosystems of south-east Asia. 3. Glasshouse experiments were undertaken in which four life stages of a planthopper (Nilaparvata lugens) and a moth (Marasmia patnalis) were caged with single or three-species combinations of generalist predators. 4. Generally, predation rates of the three-species assemblages exceeded expectation when attacking M. patnalis, but not when attacking N. lugens. In addition, a positive effect of increased predator species richness on overall predation rate was found with M. patnalis but not with N. lugens. 5. The results are consistent with theoretical predictions that morphological and behavioural differentiation among prey life stages promotes functional complementarity among predator species. This indicates that emergent species diversity effects in natural enemy assemblages are context dependent; they depend not only on the characteristics of the predators species, but on the identity of the species on which they prey.

The effect of selective decontamination of the digestive tract on mortality in multiple trauma patients: a multicenter randomized controlled trial

Objective: Evaluation of selective decontamination of the digestive tract (SDD) on late mortality in ventilated trauma patients in an intensive care unit (ICU). Methods: A multicenter, randomized controlled trial was undertaken in 401 trauma patients with Hospital Trauma Index-Injury Severity Score of 16 or higher. Patients were randomized to control (n = 200) or SDD (n = 201), using polymyxin E, tobramycin, and amphotericin B in throat and gut throughout ICU treatment combined with cefotaxime for 4 days. Primary endpoint was late mortality excluding early death from hemorrhage or craniocerebral injury. Secondary endpoints were infection and organ dysfunction. Results: Mortality was 20.9% with SDD and 22.0% in controls. Overall late mortality was 15.3% (57/372) as 29 patients died from cerebral injury, 16 SDD and 13 control. The odds ratio (95% confidence intervals) of late mortality for SDD relative to control was 0.75 (0.40-1.37), corresponding to estimates of 13.4% SDD and 17.2% control. The overall infection rate was reduced in the test group (48.8% vs. 61.0%). SDD reduced lower airway infections (30.9% vs. 50.0%) and bloodstream infections due to aerobic Gram-negative bacilli (2.5% vs. 7.5%). No difference in organ dysfunction was found. Concluson: This study demonstrates that SDD significantly reduces infection in multiple trauma, although this RCT in 401 patients was underpowered to detect a mortality benefit.

Antagonistic activities of selected fungal isolates against Armillaria mellea

The antagonistic activities of six selected fungal isolates against Armilloria mellea were studied on two different concentrations of three media, on fungicides-amended malt extract agar (MEA) medium, and in glasshouse pots filled with John Innes No.2 compost and natural field soil. Trichoderma hamatum isolate Tham1 was found the most effective in reducing Armillaria growths on both the low and high concentrations of malt extract, potato dextrose and V-8 juice in MEA, potato dextrose agar (PDA) and V-8 juice agar (VJA), respectively, followed by T. harzianum isolate Th2 and T. viride isolate Tv3. Neither dose rate (200 or 2000 mg l(-1)) of fenpropidin allowed any growth of Armillaria on MEA, while that of the antagonists was also completely inhibited or greatly restricted. However, both dose rates of fosetyl-A1 allowed the growth of Armillaria and almost all the antagonists. Data on colony diameters of Armillaria showed Tham1 as the most effective antagonist along with Th2, Th23 and Tv3. Tham1 was also found the most effective in protecting hazel billets from colonization by Armillaria, followed by Th2 and Th23. Compared with 7.1 colonized billets in the inoculated controls, only 1.3, 2.6 and 2.7 billets (out of ten) were colonized, respectively, when protected with these antagonists. The results indicate that the Trichoderma isolates are able to maintain their antagonistic effects on A. mellea under a variety of nutritional, chemical and edaphic regimes. More investigations are needed to develop a system of control for the disease with these potential antagonists.