Fetoscopic laser therapy for twin-twin transfusion syndrome: beyond current gestational age limits.

Both "early" (< 16 weeks' gestation) and "late" (> 26 weeks' gestation) presentations of twin-twin transfusion syndrome (TTTS) are rare and challenging complications of monochorionic/diamniotic twin pregnancies. Growing evidence suggests that fetoscopic laser therapy for both "early" and "late" TTTS is feasible, safe, and yields similar outcomes to cases treated between 16 and 26 weeks' gestation. We suggest reevaluation of conventional gestational age guidelines for laser therapy for TTTS.

Combinations of vascular endothelial growth factor pathway inhibitors with metronomic chemotherapy: Rational and current status.

Chemotherapy given in a metronomic manner can be administered with less adverse effects which are common with conventional schedules such as myelotoxicity and gastrointestinal toxicity and thus may be appropriate for older patients and patients with decreased performance status. Efficacy has been observed in several settings. An opportunity to improve the efficacy of metronomic schedules without significantly increasing toxicity presents with the addition of anti-angiogenic targeted treatments. These combinations rational stems from the understanding of the importance of angiogenesis in the mechanism of action of metronomic chemotherapy which may be augmented by specific targeting of the vascular endothelial growth factor (VEGF) pathway by antibodies or small tyrosine kinase inhibitors. Combinations of metronomic chemotherapy schedules with VEGF pathway targeting drugs will be discussed in this paper.

PhylomeDB v4: zooming into the plurality of evolutionary histories of a genome

Phylogenetic trees representing the evolutionary relationships of homologous genes are the entry point for many evolutionary analyses. For instance, the use of a phylogenetic tree can aid in the inference of orthology and paralogy relationships, and in the detection of relevant evolutionary events such as gene family expansions and contractions, horizontal gene transfer, recombination or incomplete lineage sorting. Similarly, given the plurality of evolutionary histories among genes encoded in a given genome, there is a need for the combined analysis of genome-wide collections of phylogenetic trees (phylomes). Here, we introduce a new release of PhylomeDB (http://phylomedb.org), a public repository of phylomes. Currently, PhylomeDB hosts 120 public phylomes, comprising >1.5 million maximum likelihood trees and multiple sequence alignments. In the current release, phylogenetic trees are annotated with taxonomic, protein-domain arrangement, functional and evolutionary information. PhylomeDB is also a major source for phylogeny-based predictions of orthology and paralogy, covering >10 million proteins across 1059 sequenced species. Here we describe newly implemented PhylomeDB features, and discuss a benchmark of the orthology predictions provided by the database, the impact of proteome updates and the use of the phylome approach in the analysis of newly sequenced genomes and transcriptomes.

Suurnopeushilaohjain IGB-transistoreille

Hilalta ohjattavien tehokytkimien, kuten IGBT tai MOSFET, ohjaaminen toteutetaan ohjausjännitettä muuttamalla. Hilaohjaimen tehtävä on ladata tehokytkimen hilakapasitanssia ohjattuun jännitteeseen. Hilaohjaimen siirtämän varauksen suuruuteen vaikuttaa hilakapasitanssin todellinen suuruus ja käytettävä ohjausjännite. Hilaohjaimen virrankäsittelykyky määrittää hilaohjaimen nopeuden siinä mielessä, että ohjattavan komponentin hilavaraus tulisi pystyä lataamaan ja purkamaan tietyssä suhteessa kytkentätaajuuteen. Kytkentätaajuuksien kasvaessa myös hilaohjaimen virrankäsittelykyky sekä hilaohjaimen teho joutuvat uudelleen arvioitaviksi. Työssä perehdytään IGBT:n toimintaan ja hilaohjainratkaisuihin suurilla kytkentätaajuuksilla. Työssä ontutkittu mahdollisuutta rakentaa IGBT:n hilaohjain jo markkinoilla olevista MOSFET:ien hilaohjaimista. Suurnopeushilaohjaimesta suunnitellaanja rakennetaan prototyyppi. Prototyypin suoriutumista tehtävistään tarkastellaan tekemällä mittauksia. Lopuksi arvioidaan asioita joiden tulee muuttua matkalla kohti megahertsien kytkentätaajuuksia.

La prise en charge par le pharmacien des facteurs de risque des maladies cardiovasculaires chez les patients diabétiques

Résultats d'une revue systématique publiée dans Diabetes Care

Heart transplantation: current practice and outlook to the future.

QUESTIONS UNDER STUDY: The field of heart transplantation has seen substantial progress in the last 40 years. The breakthroughs in long-term survival were followed by a period of stagnation in the last decade. This review summarises current recommendations for the identification of candidates for heart transplantation and their immunological and non-immunological postoperative follow-up. RESULTS: The progress made in the treatment of patients with advanced heart failure has considerably changed the profile of candidates for heart transplantation. Patients are older, and the load of co-morbidities is more important requiring careful evaluation for candidacy. Long-standing research in the field of immunosuppression made available various drugs, which decrease the risk of acute allograft rejection and prolong survival after heart transplantation. Powerful new molecules are entering early phase clinical studies, suggesting further improvement in the near future. As a consequence, treatment of non-immunological co-morbidity after heart transplantation will gain in importance, however, the base of evidence guiding current recommendations is poor. CONCLUSIONS: The substantial progress in heart failure treatment and immunosuppression after heart transplantation has changed the profile of heart transplant recipients. The arrival of new molecules will provide additional alternatives for immunosuppressive treatment while studies have to address non-immunological treatment in order to improve long-term survival after heart transplantation.

Challenging the "inoffensiveness" of regular cannabis use by its associations with other current risky substance use--a census of 20-year-old Swiss men.

3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-occurrence of risky licit substance use among risky cannabis users. Risky cannabis use was defined as at least twice weekly; risky alcohol use as 6+ drinks more than once/monthly, or more than 20 drinks per week; and risky tobacco use as daily smoking. Ninety-five percent of all risky cannabis users reported other risky use. They began using cannabis earlier than did non-risky users, but age of onset was unrelated to other risky substance use. A pressing public health issue among cannabis users stems from risky licit substance use warranting preventive efforts within this age group.

La prise en charge de l'hyper- tension artériette par des médecins en formation suit-elle les recommandations actuettes [Are the guidelines for the management of hypertensive patients followed by primary care residents and fellows?]

Numerous international guidelines are published which define how hypertensive patients should be managed. Are these guidelines followed and applicable? We have assessed the quality of management of 225 hypertensive ambulatory patients followed by young fellows in teaching for primary care medicine. The control rate defined by a blood pressure < 140/90 mmHg was 32,4%. In the last three visits, 60% of hypertensive patients had a blood pressure measurement. 79% of blood pressure readings ended with 0 or 5. Blood pressure control was identical whatever the comorbidities. In conclusion, the quality of management of hypertensive patients by in teaching fellow could potentially be improved. The actual recommendations are limited in their application. The control of high risk vascular patients is not better than those with a lower risk.

Du delirium au syndrome démentiel: prise en charge médicamenteuse dans les EMS fribourgeois [Management of elderly patients with delirium or dementia in Swiss nursing homes].

Management of elderly patients with delirium or dementia in Swiss nursing homes Dementia and delirium are among the most frequent medical conditions in older nursing home residents. Their management require a coordinated interdisciplinary approach, including for drug prescription. Using a systematic literature review of published meta-analyses and guidelines, prescription algorithms were developed adressing the pharmacological management of cognitive symptoms of dementia and delirium in older nursing home residents in the canton of Fribourg.

Are R&D collaborative agreements persistent at the firm level? Empirical evidence for the Spanish case

We provide evidence on the dynamics in firms’ R&D cooperation behaviour. Our main objective is to analyse if R&D collaborative agreements are persistent at the firm level, and in such a case, to study what are the main drivers of this phenomenon. R&D cooperation activities at the firm level can be persistent due to true state dependence, this implying that cooperating in a given period enhances the probability of doing it in the subsequent period and it can also be a consequence of firms’ individual heterogeneity, so that certain firms have certain characteristics that make them more likely to carry out technological alliances.

Are R&D collaborative agreements persistent at the firm level? Empirical evidence for the Spanish case

We provide evidence on the dynamics in firms’ R&D cooperation behaviour. Our main objective is to analyse if R&D collaborative agreements are persistent at the firm level, and in such a case, to study what are the main drivers of this phenomenon. R&D cooperation activities at the firm level can be persistent due to true state dependence, this implying that cooperating in a given period enhances the probability of doing it in the subsequent period and it can also be a consequence of firms’ individual heterogeneity, so that certain firms have certain characteristics that make them more likely to carry out technological alliances.

Attitude de prescription chez la femme enceinte : exemple de prise en charge d'un état dépressif

- Comment prescrire à une femme enceinte? L'attitude optimale réalise un compromis entre d'une part l'indication au traitement, et d'autre part l'importance du risque que celui-ci fait courir au foetus et à la mère. Le respect de quelques principes simples peut aider dans cette démarche: - La relative carence en connaissances dans ce domaine impose avant tout une attitude basée sur le principe de précaution. - La période (1er, 2e ou 3e trimestre) pendant laquelle le foetus sera exposé au traitement envisagé est un élément prépondérant dans la réflexion. - Le traitement de choix est celui qui, parmi les alternatives efficaces, présente le meilleur profil de sécurité pendant la grossesse selon les observations humaines disponibles. - Le rapport bénéfice/risque pour la patiente et le foetus peut s'inverser pendant la grossesse. - Toute exposition médicamenteuse problématique pendant la grossesse doit faire l'objet d'une annonce à l'un des centres suisse de pharmacovigilance. Ces données de tératovigilance sont indispensables pour alimenter les connaissances dans ce domaine. - Afin d'illustrer ces principes généraux, un exemple typique de prescription chez la femme enceinte a été choisi, mettant l'accent sur un problème de tératovigilance récemment identifié: les risques liés à certains antidépresseurs durant la grossesse.