Une nouvelle méthode pour estimer la torsion géométrique en scoliose idiopathique de l’adolescent

La scoliose idiopathique de l’adolescent (SIA) est une déformation tridimensionnelle (3D) de la colonne vertébrale. Pour la plupart des patients atteints de SIA, aucun traitement chirurgical n’est nécessaire. Lorsque la déformation devient sévère, un traitement chirurgical visant à réduire la déformation est recommandé. Pour déterminer la sévérité de la SIA, l’imagerie la plus utilisée est une radiographie postéroantérieure (PA) ou antéro-postérieure (AP) du rachis. Plusieurs indices sont disponibles à partir de cette modalité d’imagerie afin de quantifier la déformation de la SIA, dont l’angle de Cobb. La conduite thérapeutique est généralement basée sur cet indice. Cependant, les indices disponibles à cette modalité d’imagerie sont de nature bidimensionnelle (2D). Celles-ci ne décrivent donc pas entièrement la déformation dans la SIA dû à sa nature tridimensionnelle (3D). Conséquemment, les classifications basées sur les indices 2D souffrent des mêmes limitations. Dans le but décrire la SIA en 3D, la torsion géométrique a été étudiée et proposée par Poncet et al. Celle-ci mesure la tendance d’une courbe tridimensionnelle à changer de direction. Cependant, la méthode proposée est susceptible aux erreurs de reconstructions 3D et elle est calculée localement au niveau vertébral. L’objectif de cette étude est d’évaluer une nouvelle méthode d’estimation de la torsion géométrique par l’approximation de longueurs d’arcs locaux et par paramétrisation de courbes dans la SIA. Une première étude visera à étudier la sensibilité de la nouvelle méthode présentée face aux erreurs de reconstructions 3D du rachis. Par la suite, deux études cliniques vont présenter la iv torsion géométrique comme indice global et viseront à démontrer l’existence de sous-groupes non-identifiés dans les classifications actuelles et que ceux-ci ont une pertinence clinique. La première étude a évalué la robustesse de la nouvelle méthode d’estimation de la torsion géométrique chez un groupe de patient atteint de la SIA. Elle a démontré que la nouvelle technique est robuste face aux erreurs de reconstructions 3D du rachis. La deuxième étude a évalué la torsion géométrique utilisant cette nouvelle méthode dans une cohorte de patient avec des déformations de type Lenke 1. Elle a démontré qu’il existe deux sous-groupes, une avec des valeurs de torsion élevées et l’autre avec des valeurs basses. Ces deux sous-groupes possèdent des différences statistiquement significatives, notamment au niveau du rachis lombaire avec le groupe de torsion élevée ayant des valeurs d’orientation des plans de déformation maximales (PMC) en thoraco-lombaire (TLL) plus élevées. La dernière étude a évalué les résultats chirurgicaux de patients ayant une déformation Lenke 1 sous-classifiées selon les valeurs de torsion préalablement. Cette étude a pu démontrer des différences au niveau du PMC au niveau thoraco-lombaire avec des valeurs plus élevées en postopératoire chez les patients ayant une haute torsion. Ces études présentent une nouvelle méthode d’estimation de la torsion géométrique et présentent cet indice quantitativement. Elles ont démontré l’existence de sous-groupes 3D basés sur cet indice ayant une pertinence clinique dans la SIA, qui n’étaient pas identifiés auparavant. Ce projet contribue dans la tendance actuelle vers le développement d’indices 3D et de classifications 3D pour la scoliose idiopathique de l’adolescent.

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

Patients who have no residual invasive cancer following neoadjuvant chemotherapy for breast carcinoma have a better overall survival than those with residual disease. Many classification systems assessing pathological response to neoadjuvant chemotherapy include residual ductal carcinoma in situ (DCIS) only in the definition of pathological complete response. The purpose of this study was to investigate whether patients with residual DCIS only have the same prognosis as those with no residual invasive or in situ disease. A retrospective analysis of a prospectively maintained database identified 435 patients, who received neoadjuvant chemotherapy for operable breast cancer between February 1985 and February 2003. Of these, 30 (7%; 95% CI 5-9%) had no residual invasive disease or DCIS and 20 (5%; CI 3-7%) had residual DCIS only. With a median follow-up of 61 months, there was no statistical difference in disease-free survival, 80% (95% CI 60-90%) in those with no residual invasive or in situ disease and 61% (95% CI 35-80%) in those with DCIS only (P = 0.4). No significant difference in 5-year overall survival was observed, 93% (95% CI 75-98%) in those with no residual invasive or in situ disease and 82% (95% CI 52-94%) in those with DCIS only (P = 0.3). Due to the small number of patients and limited number of events in each group, it is not possible to draw definitive conclusions from this study. Further analyses of other databases are required to confirm our finding of no difference in disease-free and overall survival between patients with residual DCIS and those with no invasive or in situ disease following neoadjuvant chemotherapy for breast cancer.

Stimulating design reuse through automated coding

In designing new product the ability to retrieve drawings of existing components is important if costs are to be controlled by preventing unnecessary duplication if parts. Component coding and classification systems have been used successfully for these purposes but suffer from high operational costs and poor usability arising directly from the manual nature of the coding process itself. A new version of an existing coding system (CAMAC) has been developed to reduce costs by automatically coding engineering drawings. Usability is improved be supporting searches based on a drawing or sketch of the desired component. Test results from a database of several thousand drawings are presented.

Structuring of Ranked Models

Prognostic procedures can be based on ranked linear models. Ranked regression type models are designed on the basis of feature vectors combined with set of relations defined on selected pairs of these vectors. Feature vectors are composed of numerical results of measurements on particular objects or events. Ranked relations defined on selected pairs of feature vectors represent additional knowledge and can reflect experts' opinion about considered objects. Ranked models have the form of linear transformations of feature vectors on a line which preserve a given set of relations in the best manner possible. Ranked models can be designed through the minimization of a special type of convex and piecewise linear (CPL) criterion functions. Some sets of ranked relations cannot be well represented by one ranked model. Decomposition of global model into a family of local ranked models could improve representation. A procedures of ranked models decomposition is described in this paper.

Signal processing of physiological signals for automated assessment of stress in computer users

The need to provide computers with the ability to distinguish the affective state of their users is a major requirement for the practical implementation of affective computing concepts. This dissertation proposes the application of signal processing methods on physiological signals to extract from them features that can be processed by learning pattern recognition systems to provide cues about a person's affective state. In particular, combining physiological information sensed from a user's left hand in a non-invasive way with the pupil diameter information from an eye-tracking system may provide a computer with an awareness of its user's affective responses in the course of human-computer interactions. In this study an integrated hardware-software setup was developed to achieve automatic assessment of the affective status of a computer user. A computer-based "Paced Stroop Test" was designed as a stimulus to elicit emotional stress in the subject during the experiment. Four signals: the Galvanic Skin Response (GSR), the Blood Volume Pulse (BVP), the Skin Temperature (ST) and the Pupil Diameter (PD), were monitored and analyzed to differentiate affective states in the user. Several signal processing techniques were applied on the collected signals to extract their most relevant features. These features were analyzed with learning classification systems, to accomplish the affective state identification. Three learning algorithms: Naïve Bayes, Decision Tree and Support Vector Machine were applied to this identification process and their levels of classification accuracy were compared. The results achieved indicate that the physiological signals monitored do, in fact, have a strong correlation with the changes in the emotional states of the experimental subjects. These results also revealed that the inclusion of pupil diameter information significantly improved the performance of the emotion recognition system. ^

Gravidade do olho seco em pacientes internados em unidade de terapia intensiva: análise de conceito e construção de definições

Dry eye syndrome is a multifactorial disease of the tear film, resulting from the instability of the lacrimal functional unit that produces volume change, up or tear distribution. In patients in intensive care the cause is enhanced due to various risk factors, such as mechanical ventilation, sedation, lagophthalmos, low temperatures, among others. The study's purpose is to build an assessment tool of Dry Eye Severity in patients in intensive care units based on the systematization of nursing care and their classification systems. The aim of this study is to build an assessment tool of Dry Eye Severity in hospitalized patients in Care Unit Intensiva.Trata is a methodological study conducted in three stages, namely: context analysis, concept analysis, construction of operational definitions and magnitudes of nursing outcome. For the first step we used the methodological framework for Hinds, Chaves and Cypress (1992). For the second step we used the model of Walker and Avant and an integrative review Whitemore seconds, Knalf (2005). This step enabled the identification of the concept of attributes, background and consequent ground and the construction of the settings for the result of nursing severity of dry eye. For the construction of settings and operational magnitudes, it was used Psicometria proposed by Pasquali (1999). As a result of context analysis, visualized from the reflection that the matter should be discussed and that nursing needs to pay attention to the problem of eye injury, so minimizing strategies are created this event with a high prevalence. With the integrative review were located from the crosses 19 853 titles, selected 215, and from the abstracts 96 articles were read in full. From reading 10 were excluded culminating in the sample of 86 articles that were used to analyze the concept and construction of settings. Selected articles were found in greater numbers in the Scopus database (55.82%), performed in the United States (39.53%), and published mainly in the last five years (48.82). Regarding the concept of analysis were identified as antecedents: age, lagophthalmos, environmental factors, medication use, systemic diseases, mechanical ventilation and ophthalmic surgery. As attributes: TBUT <10s, Schimer I test <5 mm in Schimer II test <10mm, reduced osmolarity. As consequential: the ocular surface damage, ocular discomfort, visual instability. The settings were built and added indicators such as: decreased blink mechanism and eyestrain.

Análisis y reformulación de la organización del conocimiento en las Ciencias de la Comunicación: aplicación para la codificación UNESCO

Se estudia la codificación y organización del campo de las Ciencias de la Comunicación, fundamentalmente los códigos Unesco. El objetivo es plantear un cambio en estos códigos, puesto que la forma de clasificar y organizar un dominio científico tiene consecuencias de naturaleza operativa y epistemológica en el propio trabajo científico. En este trabajo se estudia la clasificación actual, que muestra una presencia escasa y dispersa de los términos vinculados a Comunicación. Se describen las dificultades prácticas y teóricas que conlleva su reorganización, las posibles fuentes (planes de estudio, congresos, revistas científicas, propuestas documentales y palabras clave) y los métodos de trabajo que se pueden emplear, tomando como bases teóricas el dominio de la Organización del Conocimiento y el de la Comunicación. Por último, se analizan dos ámbitos disciplinares diferentes (Historia de la Comunicación y Tecnologías de la Comunicación), mediante la información recogida, en una base de datos, de asignaturas en grado y en másteres oficiales de 12 universidades españolas. También se observa que este tipo de propuesta requiere el conocimiento derivado de instrumentos documentales como las clasificaciones y los tesauros.

PEG-based solid dispersions enhanced the solubility and dissolution of eprosartan mesylate in-vitro

Abstract - This study investigates the effect of solid dispersions prepared from of polyethylene glycol (PEG) 3350 and 6000 Da alone or combined with the non-ionic surfactant Tween 80 on the solubility and dissolution rate of a poorly soluble drug eprosartan mesylate (ESM) in attempt to improve its bioavailability following its oral administration.

INTRODUCTION

ESM is a potent anti-hypertension [1]. It has low water solubility and is classified as a Class II drug as per the Biopharmaceutical Classification Systems (BCS) leading to low and variable oral bioavailability (approximately 13%). [2]. Thus, improving ESM solubility and/or dissolution rate would eventually improve the drug bioavailability. Solid dispersion is widely used technique to improve the water solubility of poorly water-soluble drugs employing various biocompatible polymers. In this study, we aimed to enhance the solubility and dissolution of EMS employing solid dispersion (SD) formulated from two grades of poly ethylene glycol (PEG) polymers (i.e. PEG 3350 & PEG 6000 Da) either individually or in combination with Tween 80.

MATERIALS AND METHODS

ESM SDs were prepared by solvent evaporation method using either PEG 3350 or PEG 6000 at various (drug: polymer, w/w) ratios 1:1, 1:2, 1:3, 1:4, 1:5 alone or combined with Tween 80 added at fixed percentage of 0.1 of drug by weight?. Physical mixtures (PMs) of drug and carriers were also prepared at same ratios. Drug solid dispersions and physical mixtures were characterized in terms of drug content, drug dissolution using dissolution apparatus USP II and assayed using HPLC method. Drug dissolution enhancement ratio (ER %) from SD in comparison to the plain drug was calculated. Drug-polymer interactions were evaluated using Differential Scanning Calorimetry (DSC) and FT-IR.

RESULTS AND DISCUSSION

The in vitro solubility and dissolution studies showed SDs prepared using both polymers produced a remarkable improvement (p<0.05) in comparison to the plain drug which reached around 32% (Fig. 1). The dissolution enhancement ratio was polymer type and concentration-dependent. Adding Tween 80 to the SD did not show further dissolution enhancement but reduced the required amount of the polymer to get the same dissolution enhancement. The DSC and FT-IR studies indicated that using SD resulted in transformation of drug from crystalline to amorphous form.

CONCLUSIONS

This study indicated that SDs prepared by using both polymers i.e. PEG 3350 and PEG 6000 improved the in-vitro solubility and dissolution of ESM remarkably which may result in improving the drug bioavailability in vivo.

Acknowledgments

This work is a part of MSc thesis of O.M. Ali at the Faculty of Pharmacy, Aleppo University, Syria.

REFERENCES

[1] Ruilope L, Jager B: Eprosartan for the treatment of hypertension. Expert Opin Pharmacother 2003; 4(1):107-14

[2] Tenero D, Martin D, Wilson B, Jushchyshyn J, Boike S, Lundberg, D, et al. Pharmacokinetics of intravenously and orally administered Eprosartan in healthy males: absolute bioavailability and effect of food. Biopharm Drug Dispos 1998; 19(6): 351- 6.

Valoración nutricional mediante curvas de crecimiento de la OMS y las clasificaciones de Gómez / Waterlow. Estudio de prevalencia. Cuenca-2015

Objetivo: Determinar la prevalencia de malnutrición mediante las curvas de crecimiento (OMS) y de desnutrición según la clasificación Gómez/Waterlow; establecer ventajas y desventajas del empleo de ambos sistemas de clasificación. Métodos: Estudio de prevalencia realizado en el Subcentro de Salud Sinincay, con una población de 737 niños/as registrados en la matriz de vigilancia alimentaria y nutricional (SIVAN) durante Enero-Junio 2015, que identificó la malnutrición infantil mediante el uso de criterios OMS y de desnutrición según Gómez/ Waterlow. Resultados: De 47.6% niñas y 52.4% niños, divididos en lactantes (35.8%) y preescolares (64.2%), se determinó la prevalencia de malnutrición según las tablas de OMS (bajo peso 4.6%, bajo peso severo 0.4%, talla baja 20.8%, talla baja severa 2.8%, sobrepeso 0.5% y obesidad 0.3%) y de desnutrición según la clasificación de Gómez/Waterlow (desnutrición aguda 0.1%, desnutrición crónica agudizada 0.1% y enanismo nutricional 30.3%). No hubo variaciones estadísticamente significativas (p>0.05) entre sexo/grupo etario y ambos sistemas de clasificación, pero si existió variación estadística (p<0.05) entre la relación de la OMS y la clasificación Gómez/Waterlow. Conclusiones: El método de Gómez/Waterlow permitió detectar mayor número de casos de desnutrición mientras que las curvas OMS, detectaron sobrepeso y obesidad

Complicaciones perioperatorias en el manejo de corrección de escoliosis en un hospital de tercer nivel en la ciudad de Bogotá entre el 2010-2014

Introducción: la escoliosis, definida como una deformidad de la columna vertebral en más de 10 grados, se agrupa en 4 orígenes distintos: idiopática, congénita, neuromuscular y sindromática. Cada una de ellas con diferente riesgo de progresión en severidad, lo que determina la necesidad de corrección quirúrgica para cada caso en su tratamiento. Conocer las probabilidades de complicación en la etapa peri operatoria, abre la posibilidad de dar asesoría integral que mida la relación riesgo - beneficio de la medida terapéutica. Métodos: se realiza un estudio retrospectivo de corte transversal. La información se obtiene de los registros de las historias clínicas desde el año 2010 al 2014, de pacientes intervenidos quirúrgicamente para la corrección de escoliosis. Resultados: Se obtuvieron 318 registros de procedimientos en 230 pacientes. El tipo de escoliosis presentado con mayor frecuencia es de origen idiopático 108 (47%); en los 4 tipos de escoliosis se observa mayor número de mujeres 169 (73,4%). La edad donde se concentran la mayor cantidad de cirugías para corrección de escoliosis está entre 10 - 14 años. De 13 complicaciones seleccionadas, aquellas de origen respiratorio son las de mayor probabilidad de ocurrencia (OR 30 - sig 0,000). La característica sociodemográfica “edad” logra predecir el 46% de las complicaciones perioperatorias. Discusión: La corrección de escoliosis va acompañada de comorbilidades, datos sociodemográficos y diagnósticos que en conjunto determinan el grado de complicación peri operatoria. Se necesitan registros clínicos muy completos para poder determinar la asociación entre la etiología de la escoliosis con las complicaciones más comunes. Este trabajo propone y evidencia los datos de los registros clínicos como predictores de complicaciones quirúrgicas de escoliosis. Esto exige un trabajo institucional interno que garantice la calidad en los registros de datos clínicos.

Síntomas y factores ergonómicos asociados con trastornos musculoesqueléticos (TME) en una población de trabajadores administrativos de una empresa de servicios, 2015

Introducción. Los Trastornos Musculoesqueléticos (TME) son lesiones de músculos, tendones, nervios y articulaciones que tienen como principal síntoma el dolor y se presentan con gran frecuencia en trabajos que requieren una actividad física importante o como consecuencia de malas posturas sostenidas durante largos periodos de tiempo. Objetivo: Determinar la prevalencia de síntomas osteomusculares y su asociación con factores ergonómicos en una población de trabajadores administrativos de una empresa de servicios en Bogotá, Colombia, en el año 2015. Método: Se realizó un estudio de corte transversal. Se analizaron datos secundarios correspondientes a una base de datos de una población de 450 trabajadores pertenecientes al área administrativa de una empresa de servicios, de los cuales se incluyeron 150 registros que tenían la información completa de las variables del estudio. Se tuvieron en cuenta variables sociodemográficas, ocupacionales y la presencia de síntomas osteomusculares. Incluyó también el registro de condiciones de la estación de trabajo recolectada mediante inspecciones de puestos de trabajo (registro fotográfico y formato estandarizado para condiciones observadas). Se realizó un análisis descriptivo considerando las medidas de tendencia central para las variables cuantitativas y distribución de frecuencias para las variables cualitativas. Resultados: Predominó el género femenino (56%) dentro de la población estudiada, con una edad media para ambos géneros de 35 años (75%), (DS ± 7.0). El síntoma más frecuentemente reportado fue el dolor en cuello (17%) seguido por dolor en muñeca (11%) y dolor lumbar (8.7%). Del total de los trabajadores evaluados, el 80% correspondió al cargo ejecutivo, que reúne funciones administrativas especializadas complejas y/o de supervisión directa. De la población femenina objeto de estudio el 76% se desempeñaban en el cargo ejecutivo. Las condiciones ergonómicas por mejorar de mayor frecuencia fueron altura y distancia de la pantalla (42%) y cables sueltos (30%). La frecuencia de síntomas fue más alta en el rango de edad de 31 a 45 años. Conclusiones: En este estudio se encontró que los síntomas osteomusculares más frecuentes se ubicaron en el segmento axial (cuello y región lumbar) y en mano y que las condiciones de altura y distancia de la pantalla y cables sueltos presentaron las frecuencias más altas de condiciones por mejorar. Se hace necesaria la implementación de programas de prevención de TME, la vigilancia de casos y la intervención de las condiciones de los puestos de trabajo. Se debe promover la identificación y promoción de conductas saludables dentro del ámbito laboral y la prevención de condiciones que favorezcan la aparición del riesgo biomecánico.

Comparative evaluation of underlying causes of death processed by the Automated Classification of Medical Entities and the Underlying Cause of Death Selection Systems

INTRODUCTION: The correct identification of the underlying cause of death and its precise assignment to a code from the International Classification of Diseases are important issues to achieve accurate and universally comparable mortality statistics These factors, among other ones, led to the development of computer software programs in order to automatically identify the underlying cause of death. OBJECTIVE: This work was conceived to compare the underlying causes of death processed respectively by the Automated Classification of Medical Entities (ACME) and the "Sistema de Seleção de Causa Básica de Morte" (SCB) programs. MATERIAL AND METHOD: The comparative evaluation of the underlying causes of death processed respectively by ACME and SCB systems was performed using the input data file for the ACME system that included deaths which occurred in the State of S. Paulo from June to December 1993, totalling 129,104 records of the corresponding death certificates. The differences between underlying causes selected by ACME and SCB systems verified in the month of June, when considered as SCB errors, were used to correct and improve SCB processing logic and its decision tables. RESULTS: The processing of the underlying causes of death by the ACME and SCB systems resulted in 3,278 differences, that were analysed and ascribed to lack of answer to dialogue boxes during processing, to deaths due to human immunodeficiency virus [HIV] disease for which there was no specific provision in any of the systems, to coding and/or keying errors and to actual problems. The detailed analysis of these latter disclosed that the majority of the underlying causes of death processed by the SCB system were correct and that different interpretations were given to the mortality coding rules by each system, that some particular problems could not be explained with the available documentation and that a smaller proportion of problems were identified as SCB errors. CONCLUSION: These results, disclosing a very low and insignificant number of actual problems, guarantees the use of the version of the SCB system for the Ninth Revision of the International Classification of Diseases and assures the continuity of the work which is being undertaken for the Tenth Revision version.

Colorectal Cancer Classification and Cell Heterogeneity: A Systems Oncology Approach.

Colorectal cancer is a heterogeneous disease that manifests through diverse clinical scenarios. During many years, our knowledge about the variability of colorectal tumors was limited to the histopathological analysis from which generic classifications associated with different clinical expectations are derived. However, currently we are beginning to understand that under the intense pathological and clinical variability of these tumors there underlies strong genetic and biological heterogeneity. Thus, with the increasing available information of inter-tumor and intra-tumor heterogeneity, the classical pathological approach is being displaced in favor of novel molecular classifications. In the present article, we summarize the most relevant proposals of molecular classifications obtained from the analysis of colorectal tumors using powerful high throughput techniques and devices. We also discuss the role that cancer systems biology may play in the integration and interpretation of the high amount of data generated and the challenges to be addressed in the future development of precision oncology. In addition, we review the current state of implementation of these novel tools in the pathological laboratory and in clinical practice.

Evolution in software systems: foundations of the SPE classification scheme

The SPE taxonomy of evolving software systems, first proposed by Lehman in 1980, is re-examined in this work. The primary concepts of software evolution are related to generic theories of evolution, particularly Dawkins' concept of a replicator, to the hermeneutic tradition in philosophy and to Kuhn's concept of paradigm. These concepts provide the foundations that are needed for understanding the phenomenon of software evolution and for refining the definitions of the SPE categories. In particular, this work argues that a software system should be defined as of type P if its controlling stakeholders have made a strategic decision that the system must comply with a single paradigm in its representation of domain knowledge. The proposed refinement of SPE is expected to provide a more productive basis for developing testable hypotheses and models about possible differences in the evolution of E- and P-type systems than is provided by the original scheme. Copyright (C) 2005 John Wiley & Sons, Ltd.