Conceptual framework for the design, implementation and validation of psychomotor skills’ assessment systems in minimally invasive surgery

Las técnicas de cirugía de mínima invasión (CMI) se están consolidando hoy en día como alternativa a la cirugía tradicional, debido a sus numerosos beneficios para los pacientes. Este cambio de paradigma implica que los cirujanos deben aprender una serie de habilidades distintas de aquellas requeridas en cirugía abierta. El entrenamiento y evaluación de estas habilidades se ha convertido en una de las mayores preocupaciones en los programas de formación de cirujanos, debido en gran parte a la presión de una sociedad que exige cirujanos bien preparados y una reducción en el número de errores médicos. Por tanto, se está prestando especial atención a la definición de nuevos programas que permitan el entrenamiento y la evaluación de las habilidades psicomotoras en entornos seguros antes de que los nuevos cirujanos puedan operar sobre pacientes reales. Para tal fin, hospitales y centros de formación están gradualmente incorporando instalaciones de entrenamiento donde los residentes puedan practicar y aprender sin riesgos. Es cada vez más común que estos laboratorios dispongan de simuladores virtuales o simuladores físicos capaces de registrar los movimientos del instrumental de cada residente. Estos simuladores ofrecen una gran variedad de tareas de entrenamiento y evaluación, así como la posibilidad de obtener información objetiva de los ejercicios. Los diferentes estudios de validación llevados a cabo dan muestra de su utilidad; pese a todo, los niveles de evidencia presentados son en muchas ocasiones insuficientes. Lo que es más importante, no existe un consenso claro a la hora de definir qué métricas son más útiles para caracterizar la pericia quirúrgica. El objetivo de esta tesis doctoral es diseñar y validar un marco de trabajo conceptual para la definición y validación de entornos para la evaluación de habilidades en CMI, en base a un modelo en tres fases: pedagógica (tareas y métricas a emplear), tecnológica (tecnologías de adquisición de métricas) y analítica (interpretación de la competencia en base a las métricas). Para tal fin, se describe la implementación práctica de un entorno basado en (1) un sistema de seguimiento de instrumental fundamentado en el análisis del vídeo laparoscópico; y (2) la determinación de la pericia en base a métricas de movimiento del instrumental. Para la fase pedagógica se diseñó e implementó un conjunto de tareas para la evaluación de habilidades psicomotoras básicas, así como una serie de métricas de movimiento. La validación de construcción llevada a cabo sobre ellas mostró buenos resultados para tiempo, camino recorrido, profundidad, velocidad media, aceleración media, economía de área y economía de volumen. Adicionalmente, los resultados obtenidos en la validación de apariencia fueron en general positivos en todos los grupos considerados (noveles, residentes, expertos). Para la fase tecnológica, se introdujo el EVA Tracking System, una solución para el seguimiento del instrumental quirúrgico basado en el análisis del vídeo endoscópico. La precisión del sistema se evaluó a 16,33ppRMS para el seguimiento 2D de la herramienta en la imagen; y a 13mmRMS para el seguimiento espacial de la misma. La validación de construcción con una de las tareas de evaluación mostró buenos resultados para tiempo, camino recorrido, profundidad, velocidad media, aceleración media, economía de área y economía de volumen. La validación concurrente con el TrEndo® Tracking System por su parte presentó valores altos de correlación para 8 de las 9 métricas analizadas. Finalmente, para la fase analítica se comparó el comportamiento de tres clasificadores supervisados a la hora de determinar automáticamente la pericia quirúrgica en base a la información de movimiento del instrumental, basados en aproximaciones lineales (análisis lineal discriminante, LDA), no lineales (máquinas de soporte vectorial, SVM) y difusas (sistemas adaptativos de inferencia neurodifusa, ANFIS). Los resultados muestran que en media SVM presenta un comportamiento ligeramente superior: 78,2% frente a los 71% y 71,7% obtenidos por ANFIS y LDA respectivamente. Sin embargo las diferencias estadísticas medidas entre los tres no fueron demostradas significativas. En general, esta tesis doctoral corrobora las hipótesis de investigación postuladas relativas a la definición de sistemas de evaluación de habilidades para cirugía de mínima invasión, a la utilidad del análisis de vídeo como fuente de información y a la importancia de la información de movimiento de instrumental a la hora de caracterizar la pericia quirúrgica. Basándose en estos cimientos, se han de abrir nuevos campos de investigación que contribuyan a la definición de programas de formación estructurados y objetivos, que puedan garantizar la acreditación de cirujanos sobradamente preparados y promocionen la seguridad del paciente en el quirófano. Abstract Minimally invasive surgery (MIS) techniques have become a standard in many surgical sub-specialties, due to their many benefits for patients. However, this shift in paradigm implies that surgeons must acquire a complete different set of skills than those normally attributed to open surgery. Training and assessment of these skills has become a major concern in surgical learning programmes, especially considering the social demand for better-prepared professionals and for the decrease of medical errors. Therefore, much effort is being put in the definition of structured MIS learning programmes, where practice with real patients in the operating room (OR) can be delayed until the resident can attest for a minimum level of psychomotor competence. To this end, skills’ laboratory settings are being introduced in hospitals and training centres where residents may practice and be assessed on their psychomotor skills. Technological advances in the field of tracking technologies and virtual reality (VR) have enabled the creation of new learning systems such as VR simulators or enhanced box trainers. These systems offer a wide range of tasks, as well as the capability of registering objective data on the trainees’ performance. Validation studies give proof of their usefulness; however, levels of evidence reported are in many cases low. More importantly, there is still no clear consensus on topics such as the optimal metrics that must be used to assess competence, the validity of VR simulation, the portability of tracking technologies into real surgeries (for advanced assessment) or the degree to which the skills measured and obtained in laboratory environments transfer to the OR. The purpose of this PhD is to design and validate a conceptual framework for the definition and validation of MIS assessment environments based on a three-pillared model defining three main stages: pedagogical (tasks and metrics to employ), technological (metric acquisition technologies) and analytical (interpretation of competence based on metrics). To this end, a practical implementation of the framework is presented, focused on (1) a video-based tracking system and (2) the determination of surgical competence based on the laparoscopic instruments’ motionrelated data. The pedagogical stage’s results led to the design and implementation of a set of basic tasks for MIS psychomotor skills’ assessment, as well as the definition of motion analysis parameters (MAPs) to measure performance on said tasks. Validation yielded good construct results for parameters such as time, path length, depth, average speed, average acceleration, economy of area and economy of volume. Additionally, face validation results showed positive acceptance on behalf of the experts, residents and novices. For the technological stage the EVA Tracking System is introduced. EVA provides a solution for tracking laparoscopic instruments from the analysis of the monoscopic video image. Accuracy tests for the system are presented, which yielded an average RMSE of 16.33pp for 2D tracking of the instrument on the image and of 13mm for 3D spatial tracking. A validation experiment was conducted using one of the tasks and the most relevant MAPs. Construct validation showed significant differences for time, path length, depth, average speed, average acceleration, economy of area and economy of volume; especially between novices and residents/experts. More importantly, concurrent validation with the TrEndo® Tracking System presented high correlation values (>0.7) for 8 of the 9 MAPs proposed. Finally, the analytical stage allowed comparing the performance of three different supervised classification strategies in the determination of surgical competence based on motion-related information. The three classifiers were based on linear (linear discriminant analysis, LDA), non-linear (support vector machines, SVM) and fuzzy (adaptive neuro fuzzy inference systems, ANFIS) approaches. Results for SVM show slightly better performance than the other two classifiers: on average, accuracy for LDA, SVM and ANFIS was of 71.7%, 78.2% and 71% respectively. However, when confronted, no statistical significance was found between any of the three. Overall, this PhD corroborates the investigated research hypotheses regarding the definition of MIS assessment systems, the use of endoscopic video analysis as the main source of information and the relevance of motion analysis in the determination of surgical competence. New research fields in the training and assessment of MIS surgeons can be proposed based on these foundations, in order to contribute to the definition of structured and objective learning programmes that guarantee the accreditation of well-prepared professionals and the promotion of patient safety in the OR.

El cuadro de mando integral : modelo estratégico para el éxito en la gestión en las universidades públicas españolas y su aplicación en la ETSI Minas de la UPM

Este proyecto analiza la situación actual de la estrategia de éxito en las universidades públicas españolas y la utilización del modelo de Cuadro de Mando Integral para optimizarla e implantarla de forma efectiva en la ETSI de Minas de Madrid. En primer lugar se analiza la estrategia para el éxito utilizada en el sistema educativo español y en concreto en las universidades públicas españolas. Posteriormente y a través del Cuadro de Mando Integral (CMI) se establecen las principales líneas estratégicas para el éxito de la gestión estratégica en las universidades españolas y particularmente en la ETSI. Minas. En este sentido, el CMI se diseña en función de la planificación estratégica que prevalezca en cada momento identificando una serie de indicadores e iniciativas para su implantación de forma efectiva y satisfactoria. ABSTRACT This project analyzes the current situation of the successful strategy of the Public Spanish Universities and the utilization of The Balanced Scorecard to optimize it and apply it in the ETSI de Minas de Madrid successfully. The development of this project starts with the analysis of the strategy used in the Spanish Education System focusing in the Public Spanish Universities. The Balanced Scorecard (BSC) is developed and the main strategic lines for the Public Spanish University are established focusing on the ETSI. Minas de Madrid. The BSC is designed following the institution strategy management, identifying a list of indicators and initiatives to implement the strategy successfully

Extracción y recuperación de contenidos basado en vídeo en cirugía de mínima invasión

La introducción de las cirugías de mínima invasión en rutina clínica ha provocado la incorporación de los sistemas de vídeo dentro del quirófano. Así, estas técnicas proporcionan al cirujano imágenes que antes solo podían ser vistas mediante cirugía abierta. Los vídeos obtenidos en las intervenciones son almacenados en repositorios. El uso posterior de estos vídeos se ve limitado generalmente a su reproducción, debido a las dificultades de clasificación y gestión. La información que contienen estos repositorios puede ser explotada, reutilizando el conocimiento obtenido en cirugías similares. En este artículo de investigación se presenta el diseño de un módulo de gestión de conocimiento (MGC) para un repositorio de vídeos de cirugía de mínima invasión (CMI). El objetivo del módulo es gestionar y reutilizar la información contenida en el repositorio de vídeos laparoscópicos, para que puedan ser utilizadas con las experiencias previas en entornos de formación de nuevos cirujanos. Para este fin, se han implementado técnicas de recuperación de imagen y vídeo basadas en sus contenidos visuales (CBIR y CBVR). El MGC permite la recuperación de imágenes/vídeos, proporcionando información sobre la tarea que se está realizando en la escena quirúrgica. Los resultados obtenidos en este trabajo muestran la posibilidad de recuperar vídeos de CMI, a partir del instrumental presente en la escena quirúrgica.

ELEMENTOS DA OBRA FREIREANA E DA TEOLOGIA DA LIBERTAÇÃO NAS DÉCADAS DE 1950 A 1970: UMA ANÁLISE COMBINADA DE SUA GÊNESE E IDENTIDADE

A presente pesquisa se propõe a analisar o contexto histórico, político, social, econômico e ideológico em que surge a pedagogia crítica de Paulo Freire e posteriormente a Teologia da Libertação, visando encontrar influências deste peculiar contexto na gênese do pensamento freireano e nas concepções dos teólogos Rubem Alves e Gustavo Gutiérrez, que foram os primeiros publicar obras sobre Teologia da Libertação, corrente teológica considerada genuinamente latino-americana. Ainda procura observar em que medida as concepções pedagógicas de Freire podem ter sido acolhidas pelos teólogos Alves e Gutiérrez em suas obras aqui analisadas. Em ambos os pensamentos encontramos a visão de valorização do ser humano e de uma práxis que busca sua libertação de sistemas opressores. Tanto em Paulo Freire como nos fundamentos desta corrente teológica se apresentam princípios humanistas e elementos da tradição cristã. A partir da ferramenta metodológica de análise do materialismo histórico dialético marxista, procura identificar temas comuns que são abordados pelos autores em suas obras surgidas entre as décadas de 1950 a 1970, detendo-se ao estudo de alguns temas subjacentes a esse contexto histórico, a saber: práxis, história, humanismo e libertação.

Por falar em ausência...: as pessoas com deficiência

Dissertação de mestrado. No capítulo III intitulado "Pelas frestas da porta teológica: a inclusão das pessoas com deficiência", aborda, nas p.92-99 "1. Inclusão em dois documentos confessionais". Os dois documentos mencionados são os seguintes: nas p.92-97 "A pessoa com deficiência na declaração teológica provisória do CMI em 2005"; e nas p.97-99 "A pessoa com deficiência na Campanha da Fraternidade 2006" (SA)

Candida albicans stimulates in vivo differentiation of haematopoietic stem and progenitor cells towards macrophages by a TLR2-dependent signalling

Toll-like receptors (TLRs) are expressed by haematopoietic stem and progenitor cells (HSPCs), and may play a role in haematopoiesis in response to pathogens during infection. We have previously demonstrated that (i) inactivated yeasts of Candida albicans induce in vitro differentiation of HSPCs towards the myeloid lineage, and (ii) soluble TLR agonists induce in vivo their differentiation towards macrophages. In this work, using an in vivo model of HSPCs transplantation, we report for the first time that HSPCs sense C. albicans in vivo and subsequently are directed to produce macrophages by a TLR2-dependent signalling. Purified lineage-negative cells (Lin−) from bone marrow of C57BL/6 mice (CD45.2 alloantigen) were transplanted into B6Ly5.1 mice (CD45.1 alloantigen), which were then injected with viable or inactivated C. albicans yeasts. Transplanted cells were detected in the spleen and in the bone marrow of recipient mice, and they differentiate preferentially to macrophages, both in response to infection or in response to inactivated yeasts. The generation of macrophages was dependent on TLR2 but independent of TLR4, as transplanted Lin− cells from TLR2−/− mice did not give rise to macrophages, whereas Lin− cells from TLR4−/− mice generated macrophages similarly to control cells. Interestingly, the absence of TLR2, or in a minor extent TLR4, gives Lin− cells an advantage in transplantation assays, as increases the percentage of transplanted recovered cells. Our results indicatethat TLR-mediated recognition of C. albicans by HSPCs may help replace and/or increase cells that constitute the first line of defence against the fungus, and suggest that TLR-mediated signalling may lead to reprogramming early progenitors to rapidly replenishing the innate immune system and generate the most necessary mature cells to deal with the pathogen.

Managing atypical and typical herpetic central nervous system infections: results of a multinational study

There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection.

Evaluation of immune effects of fowlpox vaccine strains and field isolates

The immune effects of fowlpox virus (FPV) field isolates and vaccine strains were evaluated in chickens infected at the age of 1 day and 6 weeks. The field isolates and the obsolete vaccine strain (FPV S) contained integrated reticuloendotheliosis virus (REV) provirus, while the current vaccine strain (FPVST) carries only REV LTR sequences. An indirect antibody ELISA was used to measure the FPV-specific antibody response. The non-specific humoral response was evaluated by injection of two T-cell-dependent antigens, sheep red blood cells (SRBC) and bovine serum albumin (BSA). There was no significant difference in the antibody response to FPV between chickens infected with FPV various isolates and strains at either age. In contrast, antibody responses to both SRBC and BSA were significantly lower in 1-day-old chickens inoculated with field isolates and FPV S at 2-3 weeks post-inoculation. Furthermore, cell-mediated immune (CMI) responses measured by in vitro lymphocyte proliferation assay and in vivo using a PHA-P skin test were significantly depressed in chickens inoculated with field isolates and FPV S at the same periods. In addition, thymus and bursal weights were lower in infected chickens. These immunosuppressive effects were not observed in chickens inoculated with the current vaccine strain, FPVST, at any time. The results of this study suggest that virulent field isolates and FPV S have immunosuppressive effects when inoculated into young chickens, which appeared in the first 3 weeks post infection. REV integrated in the FPV field isolates and FPV S may have played a central role in the development of immunosuppression. (c) 2006 Elsevier B.V. All rights reserved.

Aspectos críticos del Cuadro de Mando Integral: un análisis bibliográfico

Algunos trabajos han destacado el hecho de que a pesar de las inmensas ventajas asociadas a la implementación del Cuadro de Mando Integral (CMI) su uso no se ha generalizado en muchas organizaciones motivado sobre todo por un conjunto de barreras que pueden impedir o limitar sus posibilidades de éxito. Así, este artículo tiene como objetivo identificar y analizar un conjunto de aspectos críticos derivados de la implementación del CMI. Hemos recurrido a los datos obtenidos mediante una extensa revisión bibliográfica. Los resultados obtenidos indican que existe un conjunto de problemas asociados a la implementación del CMI, a la formulación y ejecución de la estrategia, al concepto de CMI, a la definición de los objetivos y de las medidas o indicadores, al establecimiento de relaciones causa-efecto, a la definición de los stakeholders, a la cultura empresarial y al establecimiento de metas.

Variables potencialmente estratégicas en la adopción del Cuadro de Mando Integral en organizaciones públicas y privadas portuguesas

Este artículo tiene como objetivo identificar y analizar un conjunto de variables que pueden potencialmente influir en la adopción del Cuadro de Mando Integral (CMI) en organizaciones públicas y privadas portuguesas. Dichas variables están relacionadas con el entorno (incertidumbre percibida del entorno), con los recursos humanos (apoyo de la alta dirección) y con los sistemas de información y gestión (diseño de mapas estratégicos y establecimiento de relaciones causa-efecto entre indicadores y perspectivas del CMI). Definimos un conjunto de hipótesis de investigación y para comprobar empíricamente las hipótesis formuladas hemos recurrido a los datos obtenidos mediante la aplicación de un cuestionario postal a 591 organizaciones públicas (ayuntamientos, hospitales, empresas municipales y empresas intermunicipales) y 549 organizaciones privadas (grandes empresas y pequeñas y medianas empresas) portuguesas, con una tasa de respuesta del 31,3%. Los resultados obtenidos indican que el compromiso de la alta dirección, el desarrollo de mapas estratégicos y el establecimiento de relaciones causa-efecto son factores que están asociados con la implementación del CMI.

Immuno-potentiating activity of surfactant vesicles in DNA and subunit vaccination

Enhanced immune responses for DNA and subunit vaccines potentiated by surfactant vesicle based delivery systems outlined in the present study, provides proof of principle for the beneficial aspects of vesicle mediated vaccination. The dehydration-rehydration technique was used to entrap plasmid DNA or subunit antigens into lipid-based (liposomes) or non-ionic surfactant-based (niosomes) dehydration-rehydration vesicles (DRV). Using this procedure, it was shown that both these types of antigens can be effectively entrapped in DRV liposomes and DRV niosomes. The vesicle size of DRV niosomes was shown to be twice the diameter (~2µm) of that of their liposome counterparts. Incorporation of cryoprotectants such as sucrose in the DRV procedure resulted in reduced vesicle sizes while retaining high DNA incorporation efficiency (~95%). Transfection studies in COS 7 cells demonstrated that the choice of cationic lipid, the helper lipid, and the method of preparation, all influenced transfection efficiency indicating a strong interdependency of these factors. This phenomenon has been further reinforced when 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE): cholesteryl 3b- [N-(N’ ,N’ -dimethylaminoethane)-carbamoyl] cholesterol (DC-Chol)/DNA complexes were supplemented with non-ionic surfactants. Morphological analysis of these complexes using transmission electron microscopy and environmental scanning electron microscopy (ESEM) revealed the presence of heterogeneous structures which may be essential for an efficient transfection in addition to the fusogenic properties of DOPE. In vivo evaluation of these DNA incorporated vesicle systems in BALB/c mice showed weak antibody and cell-mediated immune (CMI) responses. Subsequent mock challenge with hepatitis B antigen demonstrated that, 1-monopalmitoyl glycerol (MP) based DRV, is a more promising DNA vaccine adjuvant. Studying these DRV systems as adjuvants for the Hepatitis B subunit antigen (HBsAg) revealed a balanced antibody/CMI response profile on the basis of the HBsAg specific antibody and cytokine responses which were higher than unadjuvated antigen. The effect of addition of MP, cholesterol and trehalose 6,6’-dibehenate (TDB) on the stability and immuno-efficacy of dimethyldioctadecylammonium bromide (DDA) vesicles was investigated. Differential scanning calorimetry showed a reduction in transition temperature of DDA vesicles by ~12°C when incorporated with surfactants. ESEM of MP based DRV system indicated an increased vesicle stability upon incorporation of antigen. Adjuvant activity of these systems tested in C57BL/6j mice against three subunit antigens i.e., mycobacterial fusion protein- Ag85B-ESAT-6, and two malarial antigens - merozoite surface protein-1, (MSP1), and glutamate rich protein, (GLURP) revealed that while MP and DDA based systems induced comparable antibody responses, DDA based systems induced powerful CMI responses.

Implementing collaborative practices in the healthcare supply chain:insights into hospital-vendor operations

The paper discusses the characteristics of healthcare supply chains, and puts particular emphasis on the implementation of VMI/CMI in this sector specific context. By the means of case study research the paper provides empirical data on the benefits of the above collaborative practices for both the hospital and vendors. The paper contributes to the stream of research on VMI/CMI in the healthcare sector, where limited research attempts have been conducted so far. In contrast to other surveys this case study shows that specific and measurable cost reductions exist, in addition to other improvements such as better control over the inventories, and also in reduction of administrative work. Results obtained may be also relevant to other hospitals and vendors and as they can form a basis for comparisons. Copyright © 2013 Inderscience Enterprises Ltd.

Perfis de resistência a agentes antimicrobianos de 5 estirpes do género Mycobacterium isoladas de ambiente Hospitalar

As infecções nosocomiais têm aumentado ao longo dos anos, resultando num aumento do tempo de permanência do doente no hospital, e permanecem como elevada causa de elevada morbilidade e mortalidade. As micobactérias são organismos que se encontram amplamente distribuídos no meio ambiente (M. mucogenicum, M. obuense e M. gordonae), incluindo, habitats marinhos (Mycobacterium marinum), sendo muitos deles patogénicos de mamíferos, e causadores de diferentes patologias, como a Lepra e a Tuberculose. M. marinum causa uma doença sistémica tal como tuberculose em peixes e pode causar infecções da pele em seres humanos (Granuloma de Aquário) que se podem propagar para estruturas mais profundas como ossos (osteomielite). Enquanto que M. obuense é causador de infecções do tracto respiratório, M. mucogenicum e M. gordonae promovem bacteremias. Este estudo teve como principal objectivo a identificação das populações bacterianas e o seu isolamento, em particular micobactérias ambientais em dois hospitais, que sabe serem responsáveis, cada vez mais por infecções atípicas como bacteremias (M. mucogenicum e M. gordonae), infecções pulmonares (M. obuense) e infecções cutâneas (M. marinum). Pretendeu-se também avaliar a resistência aos antibióticos e desinfectantes comummente utilizados no tratamento de infecções causadas por micobactérias não tuberculosas (MNT) através do cálculo da Concentração Mínima Inibitória (CMI) para aferir os perfis de resistência. Os resultados deste estudo demonstram a identificação de 186 espécies de bactérias em dois hospitais amostrados das quais se identificaram 5 estirpes de micobactérias – “M. gardonae” (10AIII, 29AIII e 35AIII), “M. obuense” (22DIII) e “M. mucogenicum” (24AIII). Das 5 estirpes de micobactérias identificadas “M. gardonae” 10AIII apresenta perfil de resistência ao imipenemo (CMI = 16 mg/L); “M. gardonae” 29AIII apresenta perfil de resistência à claritromicina (CMI = 8 mg/L) e “M. gardonae” 35AIII apresenta, por sua vez, apenas perfil de susceptibilidade intermédia ao imipenem (CMI = 8 mg/L). M. obuense 22DIII apresenta perfil de resistência ao imipenem (CMI = 32 mg/L), à tobramicina (CMI=32 mg/L) e à ciprofloxacina (CMI = 8 mg/L). “M. mucogenicum” apresenta perfil de resistência ao sulfametoxazol (CMI > 128 mg/L), à doxiciclina (CMI>64 mg/L), à tobramicina (CMI=16 mg/L) e à ciprofloxacina (CMI=4 mg/L).Em conclusão pôde-se verificar que além da presença de um grande leque de bactérias capazes de causar infecções nosocomiais nos hospitais, MNT também existem na forma multirresistente, o que revela uma problemática a ter em atenção. Esta requer mais estudo dos mecanismos de resistência e da sua disseminação, e obtenção de novos medicamentos com novos alvos, mais eficazes para combater as estirpes multirresistentes que ao longo dos anos tem aumentado.

Étude de l'intégrité du génome chloroplastique de l'orge (Hordeum vulgare) en culture de microspores isolées

Un enjeu actuel en biotechnologie est d’obtenir des plantes haploïdes doublées par la technique de la culture de microspores isolées (CMI). Pourtant, la CMI génère parfois une proportion importante de plantes albinos, laquelle peut atteindre 100 % chez certains cultivars. Des travaux antérieurs ont indiqué que des remaniements du génome chloroplastique seraient à l’origine de cet albinisme. Afin de mieux comprendre ce processus menant à l’albinisme, nous avons entrepris d’étudier l’intégrité du génome chloroplastique au sein de microspores d’orge et de plantes albinos via une approche de séquençage à grande échelle. L’ADN total extrait de microspores à un stade précoce de la CMI, d’une feuille de la plante-mère (témoin), et de feuilles albinos, a été séquencé et les séquences chloroplastiques ont été analysées. Ceci nous a permis de documenter pour la première fois une diminution de l’ADN chloroplastique chez les microspores. De plus une étude de variations structurales a démontré un abaissement généralisé de la quantité de génomes chloroplastiques chez les microspores. Enfin, d’importants remaniements du génome chloroplastique ont été observés chez les plantes albinos, révélant une forte abondance de génomes chloroplastiques altérés de forme linéaire.