Navigation intérieure . Règlement général de police. Décret du 6 février 1932 modifié et complété [par les décrets des 31 mars 1934, 15 août 1936 et 2 mai 1956 du Ministère des travaux publics, des transports et du tourisme]

[Code]

Personalized drug administrations using Support Vector Machine

The decision-making process regarding drug dose, regularly used in everyday medical practice, is critical to patients' health and recovery. It is a challenging process, especially for a drug with narrow therapeutic ranges, in which a medical doctor decides the quantity (dose amount) and frequency (dose interval) on the basis of a set of available patient features and doctor's clinical experience (a priori adaptation). Computer support in drug dose administration makes the prescription procedure faster, more accurate, objective, and less expensive, with a tendency to reduce the number of invasive procedures. This paper presents an advanced integrated Drug Administration Decision Support System (DADSS) to help clinicians/patients with the dose computing. Based on a support vector machine (SVM) algorithm, enhanced with the random sample consensus technique, this system is able to predict the drug concentration values and computes the ideal dose amount and dose interval for a new patient. With an extension to combine the SVM method and the explicit analytical model, the advanced integrated DADSS system is able to compute drug concentration-to-time curves for a patient under different conditions. A feedback loop is enabled to update the curve with a new measured concentration value to make it more personalized (a posteriori adaptation).

Etude radio-clinique comparant les résultats à court terme des prothèses totales du genou implantées soit à l'aide d'une instrumentation manuelle soit à l'aide d'un système de navigation assisté par ordinateur

Résumé: La qualité de l'implantation d'une prothèse totale du genou est un facteur essentiel déterminant le résultat clinique à long terme. L'alignement postopératoire des membres inférieurs est considéré comme le facteur influençant le plus la survie à long terme d'une arthroplastie du genou. Au vu du haut degré de corrélation entre les complications post-opératoires et les malpositionnements prothétiques, les chirurgiens ont tenté de développer durant ces deux dernières décennies des instruments chirurgicaux améliorant la précision d'implantation. Depuis le début des années 90, de nouvelles instrumentations assistées par ordinateur ont été proposées. Actuellement, en chirurgie prothétique du genou, la plus utilisée de ces techniques est le système de navigation OrthoPilot® qui permet, grâce à une station de navigation et des émetteurs infrarouges, de contrôler en continu pendant l'opération, l'axe mécanique du membre inférieur et de vérifier la précision des coupes osseuses. Le but de cette étude de cohorte appareillée rétrospective est de comparer les résultats clinique et radiologiques de deux collectifs de patients (32 patients dans chaque groupe) comparables (âge, sexe, BMI, degré d'arthrose, recul postopératoire), opérés avec le même type de prothèse (prothèse à glissement tricompartimental postérieurement stabilisée), soit avec le système de navigation Orthopilot®, soit à l'aide de l'instrumentation ancillaire mécanique classique. Les résultats obtenus montrent que la technique chirurgicale supportée par le système de navigation Orthopilot® est fiable et aisément reproductible. Par rapport à l'instrumentation manuelle, l'instrumentation assistée améliore significativement la précision de pose du composant tibial dans le plan frontal. Cependant entre des mains expérimentées, la technique d'alignement mécanique classique, plus simple, reste performante (coût modique, temps opératoire plus court et sans risque de défaillance technique).

Should biomarkers be used to design personalized medicine for the treatment of glioblastoma?

Significant progress has been made in understanding the molecular pathogenesis of gliomas and in predicting general outcome depending on a limited set of clinical parameters and molecular markers. However, methylation of the O⁶-methylguanine DNA methyltransferase (MGMT) gene promoter is the only molecular marker linked to sensitivity of a specific treatment, that is, alkylating agent chemotherapy, and this predictive value may be limited to glioblastoma. Moreover, in the absence of potent alternative drugs, temozolomide chemotherapy should not be withheld from patients with newly diagnosed glioblastoma without MGMT promoter methylation in general practice. In the context of clinical trials, however, irrespective of whether classical cytotoxic drugs, tyrosine kinase inhibitors or antiangiogenic agents are used, tissue should be centrally collected. Appropriate research programs should seek to define enriched patient populations for future trials and ultimately facilitate individualized cancer treatments.

Infrastructure Provisioning in Web Portals

Web portaalit tarjoavat ainutlaatuisia apuvälineitä erilaisien sisältöjen luomiseksi, monenlaisia navigointipolkuja, henkilökohtaisia sivuja ja turvapalveluja. Portaali on monimutkainen systeemi, joka sisältää monta yhteistyötä tekevää komponenttia, yleensä toteutuu valmiiksi tehdyillä ongelmistoilla. Tämä tutkimus kansittelee portaalin toteutusta IBM/Tivolin tuotteella. Portaalin komponenttien integraatio on kriittinen koko järjestelmä arkkitehtuurille ja saattaa vaatia lisää ohjelmistokehittelyä. Tutkimuksen ensisijainen tavoite on kehittää räätälöityä komponenttia kahta portaali-alijärjestelmä varten, tilaaja - turvapalvelu. Tutkimuksessa Tivoli Personalized Services Manager (TPSM) ja Tivoli SecureWay Policy Director (PD) on tutkittu. Integraatio sisältää TPSM tietokaunan ja PD User Registry tiedon synkronisointia. Integraatio-ohjelmisto on suunniteltu ja tehty olemassaoloevien alijärjestelmien perusteella.

Targeting the undruggable: immunotherapy meets personalized oncology in the genomic era.

Owing to recent advances in genomic technologies, personalized oncology is poised to fundamentally alter cancer therapy. In this paradigm, the mutational and transcriptional profiles of tumors are assessed, and personalized treatments are designed based on the specific molecular abnormalities relevant to each patient's cancer. To date, such approaches have yielded impressive clinical responses in some patients. However, a major limitation of this strategy has also been revealed: the vast majority of tumor mutations are not targetable by current pharmacological approaches. Immunotherapy offers a promising alternative to exploit tumor mutations as targets for clinical intervention. Mutated proteins can give rise to novel antigens (called neoantigens) that are recognized with high specificity by patient T cells. Indeed, neoantigen-specific T cells have been shown to underlie clinical responses to many standard treatments and immunotherapeutic interventions. Moreover, studies in mouse models targeting neoantigens, and early results from clinical trials, have established proof of concept for personalized immunotherapies targeting next-generation sequencing identified neoantigens. Here, we review basic immunological principles related to T-cell recognition of neoantigens, and we examine recent studies that use genomic data to design personalized immunotherapies. We discuss the opportunities and challenges that lie ahead on the road to improving patient outcomes by incorporating immunotherapy into the paradigm of personalized oncology.

L'échographie dans le dépistage du cancer du sein: un outil efficace dans un dépistage personnalisé [Ultrasound for Breast Cancer Screening: an Effective Tool in a Personalized Screening].

Screening mammography is the only imaging modality with proved decrease in breast cancer mortality. Ultrasound has been proposed as additional tool for screening. Controversies remain about the real value of sonography in this setting. In Caucasian women with dense breast, sonography improves significantly breast cancer detection, but also increases the false positive cases, biopsies and costs. A careful selection of women who may benefit from additional screening with sonography is mandatory.

Personalized approaches to active immunotherapy in cancer

Immunotherapy is emerging as a promising anti-cancer curative modality. However, in contrast to recent advances obtained employing checkpoint blockade agents and T cell therapies, clinical efficacy of therapeutic cancer vaccines is still limited. Most vaccination attempts in the clinic represent "off-the shelf" approaches since they target common "self" tumor antigens, shared among different patients. In contrast, personalized approaches of vaccination are tailor-made for each patient and in spite being laborious, hold great potential. Recent technical advancement enabled the first steps in the clinic of personalized vaccines that target patient-specific mutated neo-antigens. Such vaccines could induce enhanced tumor-specific immune response since neo-antigens are mutation-derived antigens that can be recognized by high affinity T cells, not limited by central tolerance. Alternatively, the use of personalized vaccines based on whole autologous tumor cells, overcome the need for the identification of specific tumor antigens. Whole autologous tumor cells could be administered alone, pulsed on dendritic cells as lysate, DNA, RNA or delivered to dendritic cells in-vivo through encapsulation in nanoparticle vehicles. Such vaccines may provide a source for the full repertoire of the patient-specific tumor antigens, including its private neo-antigens. Furthermore, combining next-generation personalized vaccination with other immunotherapy modalities might be the key for achieving significant therapeutic outcome.

Blocking and unblocking in a navigation task

Rodrigo, Chamizo, McLaren, & Mackintosh (1997) demonstrated the blocking effect in a navigational task using a swimming pool: rats initially trained to use three landmarks (ABC) to find an invisible platform learned less about a fourth landmark (X) added later than did rats trained from the outset with these four landmarks (ABCX). The aim of the experiment reported here was to demonstrate unblocking using a similar procedure as in the previous work. Three groups of rats were initially trained to find an invisible platfom in the presence of three landmarks: ABC for the Blocking and Unblocking groups and LMN for the Control group. Then, all animals were trained to find the platform in the presence of four landmarks, ABCX. In this second training, unlike animals in the Blocking group to which only a new landmark (X) was added in comparison to the first training, the animals in the Unblocking group also had a change in the platform position. In the Control group, both the four landmarks and the platform position were totally new at the beginning of this second training. As in Rodrigo et al. (1997) a blocking effect was found: rats in the Blocking group learned less with respect to the added landmark (X) than did animals in the Control group. However, rats in the Unblocking group learned about the added landmark (X) as well as did animals in the Control group. The results are interpreted as an unblocking effect due to a change in the platform position between the two phases of training, similarly to what is normal in classical conditioning experiments, in which a change in the conditions of reinforcement between the two training phases of a blocking design produce an attenuation or elimination of this effect. These results are explained within an error-correcting connectionist account of spatial navigation (McLaren, 2002).

The introduction of navigation in liver surgery in Brazil

The authors thoroughly report the development, the technical aspects and the performance of the first navigated liver resections, by laparotomy and laparoscopy, in Brazil, done at the National Cancer Institute, Ministry of Health, using a surgical navigator.