Training and accreditation in cardiovascular magnetic resonance in Europe: a position statement of the working group on cardiovascular magnetic resonance of the European Society of Cardiology.

Cardiovascular magnetic resonance (CMR) has become an established imaging modality which provides often unique information on a wide range of cardiovascular diseases. The European Society of Cardiology (ESC) training curriculum reflects the emerging role of CMR by recommending that all trainees obtain a minimum level of training in CMR and by defining criteria for subspecialty training in CMR. 1 The wider use of CMR requires the definition of standards for data acquisition, reporting, and training in CMR across Europe. At the same time, training and accreditation in all cardiac imaging methods should be harmonized and integrated to promote the training of cardiac imaging specialists. The recommendations presented in this document are intended to inform the discussion about standards for accreditation and certification in CMR in Europe and the discussion on integrated imaging training. At present, the recommendations in this position statement are not to be interpreted as guidelines. Until such guidelines are available and nationally ratified, physicians will be able to train and practice CMR according to current national regulations.

Two specific populations of GABAergic neurons originating from the medial and the caudal ganglionic eminences aid in proper navigation of callosal axons.

The corpus callosum (CC) plays a crucial role in interhemispheric communication. It has been shown that CC formation relies on the guidepost cells located in the midline region that include glutamatergic and GABAergic neurons as well as glial cells. However, the origin of these guidepost GABAergic neurons and their precise function in callosal axon pathfinding remain to be investigated. Here, we show that two distinct GABAergic neuronal subpopulations converge toward the midline prior to the arrival of callosal axons. Using in vivo and ex vivo fate mapping we show that CC GABAergic neurons originate in the caudal and medial ganglionic eminences (CGE and MGE) but not in the lateral ganglionic eminence (LGE). Time lapse imaging on organotypic slices and in vivo analyses further revealed that CC GABAergic neurons contribute to the normal navigation of callosal axons. The use of Nkx2.1 knockout (KO) mice confirmed a role of these neurons in the maintenance of proper behavior of callosal axons while growing through the CC. Indeed, using in vitro transplantation assays, we demonstrated that both MGE- and CGE-derived GABAergic neurons exert an attractive activity on callosal axons. Furthermore, by combining a sensitive RT-PCR technique with in situ hybridization, we demonstrate that CC neurons express multiple short and long range guidance cues. This study strongly suggests that MGE- and CGE-derived interneurons may guide CC axons by multiple guidance mechanisms and signaling pathways. © 2013 Wiley Periodicals, Inc. Develop Neurobiol 73: 647-672, 2013.

Iowa's Leadership in Research and Development, 2010

Pentagon-classified navigation systems are designed and tested. Genetically-superior, drought resistant triple-stacked corn hybrids exponentially improve corn and soybean yields. Scientists discover a simple flower, the marigold, unlocks astonishing potential as a change agent to improve the world’s health. All achieved or discovered in Iowa, the common denominator among all of these extraordinary activities is the intensive research and development efforts involved in bringing them to market. For businesses heavily dependent on research and development, one of their strategic advantages of conducting that world-changing research in Iowa is the state’s Research Activities Credit, commonly referred to as the Research and Development tax credit. Whether a company’s specific strategy is planting a stake into emerging markets, expanding its market leadership position, or paving technological inroads to gain market share, the success of those efforts is largely dependent on the company’s preceding work in research and development. Iowa recognizes how significant these resulting innovations are to long-term business growth and stability. Even though the federal research credits have fluctuated with intermittent expiration dates and reinstatement periods, Iowa has remained consistent in its support for the Research Activities Credit over theyears.

Effect of the Glenosphere Position and Size on Reverse Shoulder Prostheses Mobility

Introduction: Several methods have already been proposed to improve the mobility of reversed prostheses (lateral or inferior displacement, increase of the glenosphere size). However, the effect of these design changes have only been evaluated on the maximal range of motion and were not related to activities of daily living (ADL). Our aim was thus to measure the effect of these design changes and to relate it to 4 typical ADL. Methods: CT data were used to reconstruct a accurate geometric model of the scapula and humerus. The Aequalis reversed prosthesis (Tornier) was used. The mobility of a healthy shoulder was compared to the mobility of 4 different reversed designs: 36 and 42 mm glenospheres diameters, inferior (4 mm) and lateral (3.2 mm) glenospheres displacements. The complete mobility map of the prosthesis was compared to kinematics measurement on healthy subjects for 4 ADL: 1) hand to contra lateral shoulder, 2) hand to mouth, 3) combing hair, 4) hand to back pocket. The results are presented as percentage of the allowed movement of the prosthestic shouder relative to the healthy shoulder, considered as the control group. Results: None of the tested designs allowed to recover a full mobility. The differences of allowed range of motion among each prosthetic designs appeared mainly in two of the 4 movements: hand to back pocket and hand to contra lateral shoulder. For the hand to back pocket, the 36 had the lowest mobility range, particularly for the last third of the movement. The 42 appeared to be a good compromise for all ADL activities. Conclusion: Reverse shoulder prostheses does not allow to recover a full range of motion compared to healthy shoulders, even for ADL. The present study allowed to obtain a complete 3D mobility map for several glenosphere positions and sizes, and to relate it to typical ADL. We mainly observed an improved mobility with inferior displacement and increased glenosphere size. We would suggest to use larger glenosphere, whenever it is possible.

Major impact of body position on arterial stiffness indices derived from radial applanation tonometry in pregnant and non pregnant woman

Pendant la grossesse, la pression artérielle reste stable malgré une nette augmentation du volume d'éjection systolique et du débit cardiaque. Cette stabilité vient d'un côté d'une vasodilatation périphérique entraînant une diminution des résistances périphériques et d'un autre côté d'une moindre rigidité des principales artères notamment l'aorte. En conséquence, l'amplitude des ondes de pouls est atténuée, de même que leur vitesse de propagation dans le sens tant antérogade que rétrograde (ondes réfléchies). Les ondes réfléchies tendent ainsi à atteindre l'aorte ascendante plus tard durant la systole, voire durant la diastole, ce qui peut contribuer à diminuer la pression puisée. La prééclampsie perturbe massivement ce processus d'adaptation. Il s'agit d'une maladie hypertensive de la grossesse engendrant une importante morbidité et mortalité néonatale et maternelle. Il est à remarquer que la diminution de la rigidité artérielle n'est pas observée chez les patientes atteintes avec pour conséquence une forte augmentation de la pression systolique centrale (aortique) par les ondes réfléchies. Ce fait a été établi grâce à l'existence de la tonométrie d'aplanation, une méthode permettant l'évaluation non invasive de l'onde de pouls centrale. Dans cette méthode, un senseur de pression piézo-électrique permet de capter l'onde de pouls périphérique, le plus souvent sur l'artère radiale. Par la suite, un algorithme validé permet d'en déduire la forme de l'onde de pouls centrale et de visualiser à quel moment du cycle cardiaque s'y ajoutent les ondes réfléchies. Plusieurs études font état d'une forte augmentation de la pression systolique centrale par les ondes réfléchies chez les patientes atteintes de prééclampsie, suggérant l'utilisation de cette méthode pour le diagnostic et le monitoring voire pour le dépistage de ces patientes. Pour atteindre ce but, il est nécessaire d'établir des normes en rapport notamment avec l'âge gestationnel. Dans la littérature, les données pertinentes actuellement disponibles sont variables, voire contradictoires. Par exemple, les ondes réfléchies proéminentes dans la partie diastolique de l'onde de pouls centrale disparaissaient chez des patientes enceintes au 3eme trimestre comparées à des contrôles non enceintes dans une étude lausannoise, alors que deux autres études présentent l'observation contraire. Autre exemple, certains auteurs décrivent une diminution progressive de l'augmentation systolique jusqu'à l'accouchement alors que d'autres rapportent un nadir aux environs du 6ème mois, suivi d'un retour à des valeurs plus élevées en fin de grossesse. Les mesures effectuées dans toutes ces études différaient dans leur exécution, les patientes étant notamment dans des postions corporelles différentes (couchées, semi-couchées, assises, en décubitus latéral). Or nous savons que le status hémodynamique est très sensible aux changements de position, particulièrement durant la grossesse où l'utérus gravide est susceptible d'avoir des interactions mécaniques avec les veines et possiblement les artères abdominales. Ces différences méthodologiques pourraient donc expliquer, au moins en partie, l'hétérogénéité des résultats concernant l'onde de pouls chez la femme enceinte, ce qui à notre connaissance n'a jamais été exploré. Nous avons mesuré l'onde de pouls dans les positions assise et couchée chez des femmes enceintes, au 3eme trimestre d'une grossesse non compliquée, et nous avons effectué une comparaison avec des données similaire obtenues chez des femmes non enceintes en bonne santé habituelle. Les résultats montrent que la position du corps a un impact majeur sur la forme de l'onde de pouls centrale. Comparée à la position assise, la position couchée se caractérise par une moindre augmentation systolique et, par contraste, une augmentation diastolique plus marquée. De manière inattendue, cet effet s'observe aussi bien en présence qu'en l'absence de grossesse, suggérant que la cause première n'en réside pas dans les interactions mécaniques de l'utérus gravide avec les vaisseaux sanguins abdominaux. Nos observations pourraient par contre être expliquées par l'influence de la position du corps, via un phénomène hydrostatique simple, sur la pression transmurale des artères éloignées du coeur, tout particulièrement celles des membres inférieurs et de l'étage abdominal. En position verticale, ces vaisseaux augmenteraient leur rigidité pour résister à la distension de leur paroi, ce qui y accroîtrait la vitesse de propagation des ondes de pression. En l'état, cette explication reste hypothétique. Mais quoi qu'il en soit, nos résultats expliquent certaines discordances entre les études conduites à ce jour pour caractériser l'influence de la grossesse physiologique sur la forme de l'onde de pouls central. De plus, ils indiquent que la position du corps doit être prise en compte lors de toute investigation utilisant la tonométrie d'applanation pour déterminer la rigidité des artères chez les jeunes femmes enceintes ou non. Il sera aussi nécessaire d'en tenir compte pour établir des normes en vue d'une utilisation de la tonométrie d'aplanation pour dépister ou suivre les patientes atteintes de prééclampsie. Il serait enfin intéressant d'évaluer si l'effet de la position sur la forme de l'onde de pouls central existe également dans l'autre sexe et chez des personnes plus âgées.

Membrane-destabilizing activity of pH-responsive cationic lysine-based surfactants: role of charge position and alkyl chain length

Many strategies for treating diseases require the delivery of drugs into the cell cytoplasm following internalization within endosomal vesicles. Thus, compounds triggered by low pH to disrupt membranes and release endosomal contents into the cytosol are of particular interest. Here, we report novel cationic lysine-based surfactants (hydrochloride salts of N¿- and N¿-acyl lysine methyl ester) that differ in the position of the positive charge and the length of the alkyl chain. Amino acid-based surfactants could be promising novel biomaterials in drug delivery systems, given their biocompatible properties and low cytotoxic potential. We examined their ability to disrupt the cell membrane in a range of pH values, concentrations and incubation times, using a standard hemolysis assay as a model of endosomal membranes. Furthermore, we addressed the mechanism of surfactant-mediated membrane destabilization, including the effects of each surfactant on erythrocyte morphology as a function of pH. We found that only surfactants with the positive charge on the ¿-amino group of lysine showed pH-sensitive hemolytic activity and improved kinetics within the endosomal pH range, indicating that the positive charge position is critical for pH-responsive behavior. Moreover, our results showed that an increase in the alkyl chain length from 14 to 16 carbon atoms was associated with a lower ability to disrupt cell membranes. Knowledge on modulating surfactant-lipid bilayer interactions may help us to develop more efficient biocompatible amino acid-based drug delivery devices.

Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®). Executive Summary of the 2010 Position Development Conference on Interpretation and use of FRAX® in clinical practice.

The International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) convened the FRAX(®) Position Development Conference (PDC) in Bucharest, Romania, on November 14, 2010, following a two-day joint meeting of the ISCD and IOF on the "Interpretation and Use of FRAX(®) in Clinical Practice." These three days of critical discussion and debate, led by a panel of international experts from the ISCD, IOF and dedicated task forces, have clarified a number of important issues pertaining to the interpretation and implementation of FRAX(®) in clinical practice. The Official Positions resulting from the PDC are intended to enhance the quality and clinical utility of fracture risk assessment worldwide. Since the field of skeletal assessment is still evolving rapidly, some clinically important issues addressed at the PDCs are not associated with robust medical evidence. Accordingly, some Official Positions are based largely on expert opinion. Despite limitations inherent in such a process, the ISCD and IOF believe it is important to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry and provide an important focus for the scientific community to consider. This report describes the methodology and results of the ISCD-IOF PDC dedicated to FRAX(®).

Relationship between Speed and Lateral Position on Curves, September 2012

Excessive speed is often cited as a primary driver factor in crashes, particularly rural two-lane crashes. It has also been suggested that speed plays a significant role in crashes on curves. However, the relationship between speed and crashes on curves is not well documented because it is difficult to determine driver speed after the fact when investigating a crash. One method to begin documenting this relationship is to explore the relationship between lateral position and speed as a crash surrogate. For this study, the researchers collected speed and lateral position data for three rural two-lane curves. The relationship between lateral position and speed was assessed by comparing the odds of a near-lane crossing for vehicles traveling 5 or more mph over the advisory speed to those for vehicles traveling below that threshold.

Effect of orthographic processes on letter identity and letter-position encoding in dyslexic children.

The ability to identify letters and encode their position is a crucial step of the word recognition process. However and despite their word identification problem, the ability of dyslexic children to encode letter identity and letter-position within strings was not systematically investigated. This study aimed at filling this gap and further explored how letter identity and letter-position encoding is modulated by letter context in developmental dyslexia. For this purpose, a letter-string comparison task was administered to French dyslexic children and two chronological age (CA) and reading age (RA)-matched control groups. Children had to judge whether two successively and briefly presented four-letter strings were identical or different. Letter-position and letter identity were manipulated through the transposition (e.g., RTGM vs. RMGT) or substitution of two letters (e.g., TSHF vs. TGHD). Non-words, pseudo-words, and words were used as stimuli to investigate sub-lexical and lexical effects on letter encoding. Dyslexic children showed both substitution and transposition detection problems relative to CA-controls. A substitution advantage over transpositions was only found for words in dyslexic children whereas it extended to pseudo-words in RA-controls and to all type of items in CA-controls. Letters were better identified in the dyslexic group when belonging to orthographically familiar strings. Letter-position encoding was very impaired in dyslexic children who did not show any word context effect in contrast to CA-controls. Overall, the current findings point to a strong letter identity and letter-position encoding disorder in developmental dyslexia.

Peri-operative management of antiplatelet therapy in patients with coronary artery disease. Joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC).

An increasing number of patients suffering from cardiovascular disease, especially coronary artery disease (CAD), are treated with aspirin and/or clopidogrel for the prevention of major adverse events. Unfortunately, there are no specific, widely accepted recommendations for the perioperative management of patients receiving antiplatelet therapy. Therefore, members of the Perioperative Haemostasis Group of the Society on Thrombosis and Haemostasis Research (GTH), the Perioperative Coagulation Group of the Austrian Society for Anesthesiology, Reanimation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society of Cardiology (ESC) have created this consensus position paper to provide clear recommendations on the perioperative use of anti-platelet agents (specifically with semi-urgent and urgent surgery), strongly supporting a multidisciplinary approach to optimize the treatment of individual patients with coronary artery disease who need major cardiac and non-cardiac surgery. With planned surgery, drug eluting stents (DES) should not be used unless surgery can be delayed for ≥12 months after DES implantation. If surgery cannot be delayed, surgical revascularisation, bare-metal stents or pure balloon angioplasty should be considered. During ongoing antiplatelet therapy, elective surgery should be delayed for the recommended duration of treatment. In patients with semi-urgent surgery, the decision to prematurely stop one or both antiplatelet agents (at least 5 days pre-operatively) has to be taken after multidisciplinary consultation, evaluating the individual thrombotic and bleeding risk. Urgently needed surgery has to take place under full antiplatelet therapy despite the increased bleeding risk. A multidisciplinary approach for optimal antithrombotic and haemostatic patient management is thus mandatory.

Mobile robot experimental modeling and control strategies using sensor fusion

This research work deals with the problem of modeling and design of low level speed controller for the mobile robot PRIM. The main objective is to develop an effective educational, and research tool. On one hand, the interests in using the open mobile platform PRIM consist in integrating several highly related subjects to the automatic control theory in an educational context, by embracing the subjects of communications, signal processing, sensor fusion and hardware design, amongst others. On the other hand, the idea is to implement useful navigation strategies such that the robot can be served as a mobile multimedia information point. It is in this context, when navigation strategies are oriented to goal achievement, that a local model predictive control is attained. Hence, such studies are presented as a very interesting control strategy in order to develop the future capabilities of the system. In this context the research developed includes the visual information as a meaningful source that allows detecting the obstacle position coordinates as well as planning the free obstacle trajectory that should be reached by the robot

Comparisons of Preoperative Three-Dimensional Planning and Surgical Reconstruction in Primary Cementless Total Hip Arthroplasty

La planification scanographique (3D) a démontré son utilité pour une reconstruction anatomique plus précise de la hanche (longueur du fémur, centre de rotation, offset, antéversion et rétroversion). Des études ont montré que lors de la planification 2D 50% seulement correspondaient à l'implant définitif du fémur alors que dans une autre étude ce taux s'élevait à 94% pour une planification 3D. Les erreurs étaient liées à l'agrandissement des radiographies. L'erreur sur la taille de la tige est liée à l'estimation inadéquate de la morphologie osseuse ainsi qu'à la densité osseuse. L'erreur de l'antéversion, augmentée par l'inclinaison du bassin, a pu être éliminée par la planification 3D et l'offset restauré dans 98%. Cette étude est basée sur une nouvelle technique de planification scanographique en trois dimensions pour une meilleure précision de la reconstruction de la hanche. Le but de cette étude est de comparer l'anatomie post-opératoire à celle préopératoire en comparant les tailles d'implant prévu lors de la planification 3D à celle réellement utilisée lors de l'opération afin de déterminer l'exactitude de la restauration anatomique avec étude des différents paramètres (centre de rotation, densité osseuse, L'offset fémoral, rotations des implants, longueur du membre) à l'aide du Logiciel HIP-PLAN (Symbios) avec évaluation de la reproductibilité de notre planification 3D dans une série prospective de 50 patients subissant une prothèse totale de hanche non cimentée primaire par voie antérieure. La planification pré-opératoire a été comparée à un CTscan postopératoire par fusion d'images. CONCLUSION ET PRESPECTIVE Les résultats obtenus sont les suivants : La taille de l'implant a été prédit correctement dans 100% des tiges, 94% des cupules et 88% des têtes (longueur). La différence entre le prévu et la longueur de la jambe postopératoire était de 0,3+2,3 mm. Les valeurs de décalage global, antéversion fémorale, inclinaison et antéversion de la cupule étaient 1,4 mm ± 3,1, 0,6 ± 3,3 0 -0,4 0 ± 5 et 6,9 ° ± 11,4, respectivement. Cette planification permet de prévoir la taille de l'implant précis. Position de la tige et de l'inclinaison de la cupule sont exactement reproductible. La planification scanographique préopératoire 3D permet une évaluation précise de l'anatomie individuelle des patients subissant une prothèse totale de hanche. La prédiction de la taille de l'implant est fiable et la précision du positionnement de la tige est excellente. Toutefois, aucun avantage n'est observée en termes d'orientation de la cupule par rapport aux études impliquant une planification 2D ou la navigation. De plus amples recherches comparant les différentes techniques de planification pré-opératoire à la navigation sont nécessaire.