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A newborn infant has an extraordinarily vulnerable and immature central nervous system, which is undergoing rapid structural and functional development. As these infants are pre-verbal and their neurological systems are immature, assessing accurately and treating effectively procedure-related pain is a significant challenge. The nociceptive signals caused by the pain are accompanied by changes in regional blood oxygenation and neuronal activity in the infant’s brain. In this study, we developed a dual-mode Near-Infrared Spectroscopy (NIRS) and electroencephalography (EEG) monitor that can measure regional brain oxygenation and neuronal activity concurrently (safe and non-invasive). The neuronal activity is measured by an innovative low-noise EEG amplifier in both conventional and ultra-low frequency bandwidths. This multimodal recording allows us to investigate the coupling of neuronal activity and the neurovascular system as never before. NIRS and EEG electrodes are miniaturized and unified in one sensor. This modification facilitates the use of a NIRS/EEG device for recording from neonatal subjects. Ten infants, born between 27-35 weeks gestational age, are being recruited from the NICU at BCWH. They are monitored during a single, routine blood draw required for clinical care. In this experiment, we investigate the change of cerebral hemodynamic across 3 phases of blood collection, baseline, heel lance, recovery. Variation of blood flow accompanied with the slow shift of EEG has been detected during the pain stimulus phase. Additionally, the increase of gamma-band correlated to a rise in blood flow is also observed

International audience; PurposeStereotactic radiosurgery and hypofractionated stereotactic radiotherapy are standard treatments for brain metastases when they are small in size (at the most 3 cm in diameter) and limited in number, in patients with controlled extracerebral disease and a good performance status. Large inoperable brain metastases usually undergo hypofractionated stereotactic radiotherapy while haemorrhagic brain metastases have often been contraindicated for both stereotactic radiosurgery or hypofractionated stereotactic radiotherapy. The objective of this retrospective study was to assess a six 6 Gy-fractions hypofractionated stereotactic radiotherapy scheme in use at our institution for haemorrhagic brain metastases, large brain metastases (size greater than 15 cm3) or brain metastases located next to critical structures.Material and methodsPatients with brain metastases treated with the 6 × 6 Gy scheme since 2012 to 2016 were included. Haemorrhagic brain metastases were defined by usual criteria on CT scan and MRI. Efficacy, acute and late toxicity were evaluated.ResultsSixty-two patients presenting 92 brain metastases were included (32 haemorrhagic brain metastases). Median follow up was 10.1 months. One-year local control rate for haemorrhagic brain metastases, large brain metastases, or brain metastases next to critical structures were 90.7%, 73% and 86.7% respectively. Corresponding overall survival rates were 61.2%, 32% and 37.8%, respectively. Haemorrhagic complications occurred in 5.3% of patients (N = 5), including two cases of brain metastases with pretreatment haemorrhagic signal. Tolerance was good with only one grade 3 acute toxicity.ConclusionThe 6 × 6 Gy hypofractionated stereotactic radiotherapy scheme seems to yield quite good results in patients with haemorrhagic brain metastases, which must be confirmed in a prospective way.; Objectif de l’étudeLa radiochirurgie et la radiothérapie stéréotaxique sont le standard de traitement des métastases cérébrales lorsqu’elles sont peu nombreuses, de petite taille, chez les patients en bon état général et à la maladie extracérébrale contrôlée. Les métastases plus volumineuses sont souvent acceptées en stéréotaxie, tandis que les métastases hémorragiques restent plutôt contre-indiquées pour ce type de traitement. L’objectif de cette étude rétrospective était de rapporter les résultats obtenus par un schéma de fractionnement 6 × 6 Gy utilisé dans notre centre pour les métastases hémorragiques, de plus de 15 cm3 ou situées proches de structures à risque.Matériel et méthodesLes patients traités par ce schéma dans notre centre de 2012 à 2016 ont été inclus. Le caractère hémorragique était défini sur l’imagerie scanographique et IRM. L’efficacité et la tolérance ont été évaluées.RésultatSoixante-deux patients atteints de 92 métastases (32 hémorragiques) ont été inclus. Le suivi médian était de 10,1 mois. Le taux de contrôle local à 1 an pour les métastases hémorragiques, les grosses métastases, et les métastases proches de structure à risque étaient respectivement de 90,7 %, 73 % et 86,7 %. Les taux correspondants de survie globale étaient de 61,2 %, 32 % et 37,8 %. Des complications hémorragiques ont été observées chez 5,3 % des patients (deux lésions hémorragiques avant le traitement). Un seul cas de toxicité aiguë de grade 3 a été observé, résolutif après traitement symptomatique.ConclusionLe Schéma 6 × 6 Gy semble réalisable et plutôt efficace en traitement des métastases hémorragiques, ce qui reste à confirmer en prospectif.

The degree of realism that Duns Scotus understood his formal distinction to have implied is a matter of dispute going back to the fourteenth century. Both modern and medieval commentators alike have seen Scotus's later, Parisian treament of the formal distinction as less realist in the sense that it would deny any extra-mentally separate formalities or realities. This less realist reading depends in large part on a question known to scholars only in the highly corrupt edition of Luke Wadding, where it is printed as the first of the otherwise spurious Quaestiones miscellaneae de formalitatibus. The present study examines this question in detail. Cited by Scotus's contemporaries as the Quaestio logica Scoti, we establish that it was a special disputation held by Scotus at Paris in response to criticisms of his use of the formal distinction in God, identify its known manuscripts, and provide an analysis based upon a corrected text, showing in particular the total unreliability of the Wadding edition. Our analysis shows that the Logica Scoti does not absolutely prohibit an assertion of formalities as correlates of the formal distinction, even in the divine Person, so long as their non-identity is properly qualified. That is, the positing of formalities does not of itself entail an unqualified or absolute distinction.

Resume Objectifs : La strychnine, autrefois utilisee en therapeutique humaine, est employee aujourd'hui comme rodenticide et sa distribution est reglementee depuis 1982. Les objectifs de l'etude sont d'evaluer la prevalence des intoxications a la strychnine, leurs manifestations cliniques et leur evolution. Methode : Il s'agit d'une etude retrospective de 1973 a 1994 portant sur tous les cas exploitables d'intoxication averee a la strychnine et d'une analyse des donnees epidemiologiques, cliniques et toxicologiques. Resultats : 140 patients ont ete suspectes d'intoxication a la strychnine. Ainsi, 73 dossiers ont pu etre analyses avec precision. Ces intoxications sont dans tous les cas volontaires et d'origine rurale. Elles touchent plutot les hommes durant la periode estivale. Leur nombre est actuellement en recrudescence malgre l'arrete de 1982. Les doses ingerees sont importantes (≅ 600 mg). Les manifestations cliniques et le pronostic ne sont correles ni a la dose ingeree ni aux concentrations seriques. Le traitement repose sur l'utilisation de diazepam a fortes doses avec une efficacite remarquable. La mortalite est elevee (16 p. 100) par arret cardiaque inaugural. L'evolution est en general favorable avec guerison sans sequelles si la prise en charge medicale est precoce.

Background Screening for latent tuberculosis infection (LTBI) using a protocol comprising chest X-ray and tuberculin skin test (TST) interpreted with medical history, Sc1, reduces LTBI reactivation on treatment with anti-tumour necrosis factor-alpha (anti-TNF-α). In the district of Seine-Saint-Denis, France, where tuberculosis (TB) incidence ranges from 30 to >100/100 000 person-years, however, Sc1 might be insensitive as a screening tool. We adopted another protocol, Sc2, comprising Sc1 plus two additional tests: the QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) and chest computed tomography (CT). Methods We screened 123 consecutive patients with inflammatory rheumatic diseases (IRDs), candidates for anti-TNF-α treatment, and evaluated the impact of Sc2 vs. Sc1 on the prescription of prophylactic anti-tuberculosis treatment. Results Sc2 led to a diagnosis of LTBI in 69 patients vs. 59 when using Sc1: eight were QFT-GIT-positive. Diagnosis was based on CT findings in two patients. QFT-GIT had higher diagnostic accuracy than TST, but no single diagnostic test could detect all patients at high risk for LTBI reactivation (respectively 30.2% and 37.5% of patients positive with only TST or QFT-GIT). CT detected TB sequelae in 3/46 rheumatoid arthritis patients who were negative to all tests. Conclusions Testing with both TST and QFT-GIT seems the safest strategy for detecting LTBI in patients with IRD from populations with high incidence of TB. Systematic screening with CT warrants further evaluation.

Loss of residual heat removal has occurred in several PWRs during mid-loop operation after plant shutdown, and is now recognized as an accident situation whose relevant physical phenomena require improved understanding. Several cases have been selected for investigation in the frame of the BETHSY program, with the main purpose of providing an experimental basis for the assessment of safety codes which have been so far especially involved with accident transients initiated during full-power operation. The major results from four experiments are presented in this paper, which addresses two main kinds of physical problem: mechanisms for, and rate of, primary mass inventory reduction in the case of manways opened at various locations in the primary coolant system; cooling of the plant when the primary is only half-open through vent paths and one steam generator is available to remove decay heat in reflux condenser mode with the presence of non-condensable gas.

The sensitivity of Near Infrared Spectroscopy (NIRS) signals to motion artifact can limit practical applications of NIRS monitoring. We describe a wavelet based method for removing motion artifact from NIRS signals. This method was tested on monitoring data collected from leg muscle in 3 patients undergoing surgery to stabilize leg fractures. The results show an average of 18.36 dB attenuation in motion artifact energy in the NIRS signal for our test subjects when using the proposed method, without the introduction of significant distortion in the artifact-free regions of the signal.

The position and influence of Godfrey of Fontaines on the topic of intension and remission of forms have long proved difficult to ascertain. Medieval sources are nearly unanimous in identifying Godfrey as a prominent source for unusual but very influential account of intension and remission known as 'succession of forms'. Modern scholars have repeatedly concluded that Godfrey's writings contain no express endorsement of this theory. Indeed, some have even concluded that Godfrey mentions the theory at all, he rejects it. This disparity between medieval and modern readings of Godfrey is usually traced to a misunderstanding of, or extrapolation from, his admittedly difficult texts on the topic by his contemporaries, especially Duns Scotus. A full examination of medieval testimony on Godfrey's views, particularly among the early fourteenth-century discussions on intension and remission at Paris, shows not only that Godfrey held a traditional version of succession theory but where he held it. Keywords: Duns Scotus; Godfrey of Fontaines; intension; medieval sources; Paris; remission; succession theory of forms

For several years an extensive programme of separate effect tests related to PWR safety has been conducted in France and in particular at the Nuclear Center of Grenoble. Recently the BETHSY integral test facility - three identical loops, full height and pressure - has been constructed with the main objectives of contributing to the verification of the CATHARE calculation code of accidents and to the validation of the physical bases of Emergency Operating Procedures. So far several tests have been (November 1988) carried out, among which natural circulation under various conditions (single phase, two-phase, symmetric or asymmetric conditions, different core power, variable steam generator liquid level), 2 inches cold leg break, steam bubble formation and collapse in the upper head. Summarized results of some of these tests are introduced and compared to a first CATHARE calculation as far as the 2″ cold leg break is concerned.

Isolated acquired factor VII (FVII) deficiency (0.15 U/ml) was identified in a 30-year-old man with pleural liposarcoma. The patient underwent surgery with continuous FVII concentrate infusion. No anti-FVII antibody or FVII/anti-FVII complex was detected. However, the short half-life and low recovery of FVII after concentrate infusion suggested the presence of an antibody. Whatever the mechanism, this FVII deficiency was related to the presence of the liposarcoma. FVII level normalized during tumour regression and fell again when the liposarcoma relapsed.

In order to offer operating information to the monitoring system of a chip refiner, a neural network classifier is proposed for identifying the acoustic emission signals of wood species. In addition to classifying single wood species, the system is required to be able to recognize mixed species. The classification task is accomplished by a multilayer feedforward neural network in which both supervised and unsupervised learning are included. The simulations are run on the testing data, mixing two single species to represent mutually mixed wood species of five categories. If a signal is identified as a mixture, the network will indicate the corresponding component species according to a lookup table. Some expected classification accuracy is obtained on both single and mixed species identification and performance of classification is discussed based on the simulation results.

This report describes a patient without evident underlying disease, in whom an acquired von Willebrand's syndrome was discovered before surgery. Coagulation abnormalities included a borderline bleeding time, a low retention of platelets on glass beads, decreased levels of factor VIII procoagulant activity (VIIIAHF), factor VIII-related antigen (VIIIAg), and ristocetin-induced agglutination cofactor (VIIIVWF). After cryoprecipitate infusion the patient did not have the expected rise and there was no secondary increment in VIIIAHF. The patient was treated with prednisone for three weeks without significant improvement in the laboratory findings. Spontaneous resolution was observed long after this therapy. The haemostatic abnormalities were attributable to the presence of an inhibitor directed against VIIIVWF. The inhibitor was found in the IgM fraction. Its autoimmune nature is probable although we failed to demonstrate any inhibitory effect of Fab obtained from the patient's purified IgM. Despite the lack of inhibitory effect against VIIIAHF and VIIIAg, the low levels of all three activities of the factor VIII complex could be explained by the short half-life of immune complexes between factor VIII and the inhibitor.

A direct technique for fabricating nonparallel dowel core patterns has been described. The technique serves to equate endodontically treated teeth to stressful situations with above normal function and performance. This technique offers maximal use of the surviving tooth structure.

Summary A new congenital dysprothrombinaemia is described in a newborn baby girl who presented severe bleeding from the second day of life. Routine coagulation tests showed very prolonged prothrombin time and activated partial thromboplastin time with about 2% prothrombin activity in a one-stage assay. Staphylocoagulase and Echis carinatus venom prothrombin assays were respectively 35% and 25%. The prothrombin antigen level was 47% and its migration in crossed immuno-electrophoresis was abnormal. Family study revealed the presence of both normal and abnormal prothrombin in the plasma of three family members: the father, the mother and the brother. Thrombin generation in a system free from natural inhibitors showed that the abnormal prothrombin was slowly and incompletely activated. The propositus is thought to be homozygous for a ‘lazy’ dysprothrombin.

A series of 80 dissections was performed to define the anastomoses between the cervical plexus and the hypoglossal nerve (XII), the superior anastomosis between the trunk of XII and the ansa of the atlas from the cervical plexus; the ansa cervicalis, traditionally known as the ansa of the XIIth cranial nerve or hypoglossal ansa, formed by the direct junctional anastomosis of the descending branch of XII and the internal descending branch of the cervical plexus. The origins, form, branches and chief relations are defined in in the present study.