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biodegradable stents of various designs are reportedly used in pancreato-biliary conditions with promising results. Their major advantage is the avoidance of repeat endoscopic procedure for stent removal, thereby reducing overall costs and endoscopic retrograde cholangiopancreatography (ERCP) associated adverse events. The aim of the study was to evaluate the feasibility and safety of a new biodegradable stent in patients with pancreato-biliary diseases.a prospective multicenter pilot study was performed. All consecutive patients ≥ 18 years old who underwent biliary or pancreatic stenting using the new biodegradable Archimedes stent were included in the study. There were three biodegradation profiles. Technical and clinical success and feasibility and safety were assessed during a pre-established follow-up schedule.fifty-three patients (mean age: 48.54 ± 19.29, 66 % male) with biliary (n = 29, 54.7 %) or pancreatic (n = 24, 45.3 %) indications were included. The distribution of stents used according to degradation properties were as follows: fast (n = 11, 20.8 %), medium (n = 16, 30.2 %) and slow (n = 26, 49.1 %). The technical and clinical success were 100 % and 77.8 %, respectively. Thirty-five patients were followed for a median of 26 weeks (range: 4-56, 66 %). There were nine procedure-related adverse events (17 %), all mild, including one uneventful stent-related event (external migration).the biodegradable Archimedes stent placement is feasible and safe in pancreato-biliary diseases.

INTRODUCTION: Enteroscopy resection of small bowel polyps in Peutz-Jeghers syndrome has only been described in small case series. Herein, we aimed to assess the efficacy of enteroscopy resection of small bowel polyps within a specialised tertiary care centre and the impact on intraoperative enteroscopy. METHODS: This was an observational single-centre study. All adult Peutz-Jeghers syndrome patients followed in the Predisposition Digestive Ile-de-France network who underwent an endoscopic resection of at least one small bowel polyp ≥ 1 cm by enteroscopy between 2002–2015 were included. Small bowel polyps were detected under a dedicated screening programme by previous capsule endoscopy and/or magnetic resonance enterography, performed every 2–3 years. Complete treatment was defined as the absence of polyps ≥ 1 cm after conventional endoscopic resection. Intraoperative enteroscopy or surgical resection were indicated in incomplete treatments. The overall complete treatment rate including conventional enteroscopy and intraoperative enteroscopy was also considered. RESULTS: Endoscopic resection of 216 small bowel polyps (median: 8.6 per patient, size: 6–60 mm) was performed by 50 enteroscopies in 25 patients (mean age: 36 years, range: 18–71, 56% male) with small bowel polyp ≥ 1 cm. Twenty-three patients (92%) underwent 42 screening capsule endoscopies and 14 (57%) had 23 magnetic resonance enterographies during a median follow-up of 60 months. Complete treatment was achieved in 76%. Intraoperative enteroscopy and surgical resection were performed in four (16%) and two (8%) patients. Intraoperative enteroscopy improved by 16% the complete treatment rate and the overall rate was 92%. The complication rate was 6%. CONCLUSION: This long-term study confirmed the efficacy and safety of endoscopic resection of small bowel polyps in Peutz-Jeghers syndrome. Intraoperative enteroscopy can be a complementary approach in selected cases.

In this work, we propose a two-layered descriptive model for motion processing from retina to the cortex, with an event-based input from the asynchronous time-based image sensor (ATIS) camera. Spatial and spatiotemporal filtering of visual scenes by motion energy detectors has been implemented in two steps in a simple layer of a lateral geniculate nucleus model and a set of three-dimensional Gabor kernels, eventually forming a probabilistic population response. The high temporal resolution of independent and asynchronous local sensory pixels from the ATIS provides a realistic stimulation to study biological motion processing, as well as developing bio-inspired motion processors for computer vision applications. Our study combines two significant theories in neuroscience: event-based stimulation and probabilistic sensory representation. We have modeled how this might be done at the vision level, as well as suggesting this framework as a generic computational principle among different sensory modalities.

The neural encoding of visual features in primary visual cortex (V1) is well understood, with strong correlates to low-level perception, making V1 a strong candidate for vision restoration through neuroprosthetics. However, the functional relevance of neural dynamics evoked through external stimulation directly imposed at the cortical level is poorly understood. Furthermore, protocols for designing cortical stimulation patterns that would induce a naturalistic perception of the encoded stimuli have not yet been established. Here, we demonstrate a proof of concept by solving these issues through a computational model, combining (1) a large-scale spiking neural network model of cat V1 and (2) a virtual prosthetic system transcoding the visual input into tailored light-stimulation patterns which drive in situ the optogenetically modified cortical tissue. Using such virtual experiments, we design a protocol for translating simple Fourier contrasted stimuli (gratings) into activation patterns of the optogenetic matrix stimulator. We then quantify the relationship between spatial configuration of the imposed light pattern and the induced cortical activity. Our simulations in the absence of visual drive (simulated blindness) show that optogenetic stimulation with a spatial resolution as low as 100 $$\upmu$$ μ m, and light intensity as weak as $$10^{16}$$ 10 16 photons/s/cm$$^2$$ 2 is sufficient to evoke activity patterns in V1 close to those evoked by normal vision.

Vision restoration is an ideal medical application for optogenetics, because the eye provides direct optical access to the retina for stimulation. Optogenetic therapy could be used for diseases involving photoreceptor degeneration, such as retinitis pigmentosa or age-related macular degeneration. We describe here the selection, in non-human primates, of a specific optogenetic construct currently tested in a clinical trial. We used the microbial opsin ChrimsonR, and showed that the AAV2.7m8 vector had a higher transfection efficiency than AAV2 in retinal ganglion cells (RGCs) and that ChrimsonR fused to tdTomato (ChR-tdT) was expressed more efficiently than ChrimsonR. Light at 600 nm activated RGCs transfected with AAV2.7m8 ChR-tdT, from an irradiance of 1015 photons.cm−2.s−1. Vector doses of 5 × 1010 and 5 × 1011 vg/eye transfected up to 7000 RGCs/mm2 in the perifovea, with no significant immune reaction. We recorded RGC responses from a stimulus duration of 1 ms upwards. When using the recorded activity to decode stimulus information, we obtained an estimated visual acuity of 20/249, above the level of legal blindness (20/400). These results lay the groundwork for the ongoing clinical trial with the AAV2.7m8 - ChR-tdT vector for vision restoration in patients with retinitis pigmentosa., Gauvain et al demonstrate that optogenetic therapy using the AAV2.7m8- ChR-tdT construct can partially restore vision in non-human primates to levels above those considered legally-blind. This study enables the identification of the most suitable construct for ongoing clinical trials attempting vision restoration in patients with retinitis pigmentosa.

Post-laparoscopic sleeve gastrectomy (LSG) fistula is a major complication, responsible for high morbidity. Endoscopic treatment represents an alternative to surgical management, with variable approaches and success rates. In this study, we aimed to evaluate the efficacy of endoscopic treatment in a tertiary care center. Between March 2010 and March 2015, all patients referred to our center for endoscopic treatment of fistula related to laparoscopic sleeve gastrectomy were included. The primary endpoint was defined as a complete closure of the fistula without recurrence within the 2 months. A total of 26 patients were retrospectively included (73% female). The mean time between fistula diagnosis and first endoscopy was 27.4 days (± 22). Twenty-three (88.4%) patients had a complete fistula closure after endoscopic treatment. The healing delay was 76.4 days (± 42.8), and an average of 3.5 (± 1.4) endoscopic procedures were required. Clinical efficacy was 100% when the endoscopic treatment was performed within the first 3 weeks, or 70% afterwards (p = 0.046). The fistula closure rate was similar between patients with endoscopic drainage (with or without other endoscopic techniques) and patient with closing techniques alone (85.7% vs. 89.5%, respectively). Endoscopic treatment of fistula after LSG is efficient but requires early procedures within the first 3 weeks. Endoscopic strategies involving closing procedure or drainage procedure seem to be similar, but these data must be confirmed in large prospective clinical studies.

Objective.To evaluate the types of experiences and treatment access challenges of patients with psoriatic arthritis (PsA) using self-reported online narratives.Methods.English-language patient narratives reported between January 2010 and May 2016 were collected from 31 online sources (general health social networking sites, disease-focused patient forums, treatment reviews, general health forums, mainstream social media sites) for analysis of functional impairment and 40 online sources for assessment of barriers to treatment. Using natural language processing and manual curation, patient-reported experiences were categorized into 6 high-level concepts of functional impairment [social, physical, emotional, cognitive, role activity (SPEC-R), and general] and 6 categories to determine barriers to treatment access (coverage ineligibility, out-of-pocket cost, issues with assistance programs, clinical ineligibility, formulary placement/sequence, doctor guidance). The SPEC-R categorization was also applied to 3 validated PsA patient-reported outcome (PRO) instruments to evaluate their capacity to collect lower-level subconcepts extracted from patient narratives.Results.Of 15,390 narratives collected from 3139 patients with PsA for exploratory analysis, physical concepts were the most common (81.5%), followed by emotional (50.7%), cognitive (20.0%), role activity (8.1%), and social (5.6%) concepts. Cognitive impairments and disease burden on family and parenting were not recorded by PsA PRO instruments. The most commonly cited barriers to treatment were coverage ineligibility (51.6%) and high out-of-pocket expenses (31.7%).Conclusion.Patients often discussed physical and emotional implications of PsA in online platforms; some commonly used PRO instruments in PsA may not identify cognitive issues or parenting/family burden. Nearly one-third of patients with PsA reported access barriers to treatment.

Introduction Online communities contain a wealth of information containing unsolicited patient experiences that may go beyond what is captured by guided surveys or patient-reported outcome (PRO) instruments used in clinical settings. This study described patient experiences reported online to better understand the day-to-day disease burden of ankylosing spondylitis (AS). Methods Unguided, English-language patient narratives reported between January 2010 and May 2016 were collected from 52 online sources (e.g., general/health social networking sites, patient–physician Q&A sites, AS forums). Using natural language processing combined with manual curation, patient-reported experiences within narratives were evaluated and categorized into social, physical, emotional, cognitive, and role activity (SPEC-R) concepts to assess functional impairment. The same SPEC-R categorization was applied to 5 AS-specific PRO instruments to evaluate their coverage of concepts extracted from patient narratives. Results A total of 34,780 narratives from 3449 patients with AS were included. Physical aspects of AS (e.g., pain and mobility) were most commonly reported by patients (86.7%), followed by emotional (32.5%), cognitive (23.6%), role activity (8.7%) and social (5.1%). Some frequently discussed subconcepts were effectively captured by ≥ 2 PRO instruments, such as pain (65.3%), asthenia (19.9%), musculoskeletal impairment (19.9%), depression (9.9%), and anger/frustration (5.4%); others [e.g., anxiety (19.1%), mental impairment (3.2%), impulsivity (2.9%)] were not addressed by any of the PRO instruments. Conclusion These findings highlight the importance of analyzing patient experiences beyond clinical trial settings and physician reports; continuous assessment of existing PRO instruments in collaboration with patients may increase their utility in real-world settings. Funding Novartis Pharmaceuticals Corporation. Electronic supplementary material The online version of this article (10.1007/s12325-018-0669-1) contains supplementary material, which is available to authorized users.

Background Salvage transjugular intrahepatic portosystemic shunts (TIPS) are associated with poor prognosis, especially in patients with Child-Pugh C cirrhosis. Since preemptive TIPS improved prophylaxis of variceal bleeding in those patients, recourse to salvage TIPS may now affect patients with a better prognosis. Aim To assess the impact of the preemptive TIPS policy on outcomes after salvage TIPS placement. Methods We conducted a retrospective monocentric study on cirrhotic patients undergoing salvage TIPS with polytetrafluoroethylene-covered stents from 2002 to 2017 (period 1 until February 2011; period 2 after the preemptive TIPS policy in March 2011). The primary endpoint was one-year transplant-free survival. Results We included 106 patients (period 1/2 = 53/53 patients, male gender 82%, age 54 ± 9 years, alcoholic cirrhosis 70%, Child-Pugh score B/C 94%). One-year transplant-free survival was 46.0% during period 1 compared to 40.2% during period 2 (p = 0.65). Amongst 61 patients with history of variceal bleeding, 32 (52.5%) had an inadequate secondary prophylaxis, including 19 (59.4%) with a previous indication of preemptive TIPS. One-year transplant-free survival was 33.2% if inadequate secondary prophylaxis vs 65.2% if adequate (p = 0.008). Independent factors associated with survival were a lower Child-Pugh or MELD score, infection, failure to control bleeding, and hepatic encephalopathy after TIPS. Conclusion Prognosis after salvage TIPS remained poor in our series. Optimizing secondary prophylaxis, including preemptive TIPS placement, should be the main concern to improve prognosis.

International audience; The optic quality of the eyes is, at least in part, determined by pupil size. Large pupils let more light enter the eyes, but degrade the point spread function, and thus the spatial resolution that can be achieved (Campbell & Gregory, 1960). In natural conditions, the pupil is mainly driven by the luminance (and possibly the color and contrast) at the gazed location, but is also modulated by attention and cognitive factors. Whether changes in eyes' optics related to pupil size modulation by luminance and attention impacts visual processing was assessed in two experiments. In Experiment 1, we measured pupil size using a constantly visible display made of four disks with different luminance levels, with no other task than fixating the disks in succession. The results confirmed that pupil size depends on the luminance of the gazed stimulus. Experiment 2, using similar settings as Experiment 1, used a two-interval forced-choice design to test whether discriminating high spatial frequencies that requires covert attention to parafoveal stimuli is better during the fixation of bright disks that entails a small pupil size, and hence better eyes' optics, as compared to fixating dark disks that entails a large pupil size, and hence poorer eyes' optics. As in Experiment 1, we observed large modulations of pupil size depending on the luminance of the gazed stimulus, but pupil dynamics was more variable, with marked pupil dilation during stimulus encoding, presumably because the demanding spatial frequency discrimination task engaged attention. However, discrimination performance and mean pupil size were not correlated. Despite this lack of correlation, the slopes of pupil dilation during stimulus encoding were correlated to performance, while the slopes of pupil dilation during decision-making were not. We discuss these results regarding the possible functional roles of pupil size modulations.

This letter introduces a study to precisely measure what an increase in spike timing precision can add to spike-driven pattern recognition algorithms. The concept of generating spikes from images by converting gray levels into spike timings is currently at the basis of almost every spike-based modeling of biological visual systems. The use of images naturally leads to generating incorrect artificial and redundant spike timings and, more important, also contradicts biological findings indicating that visual processing is massively parallel, asynchronous with high temporal resolution. A new concept for acquiring visual information through pixel-individual asynchronous level-crossing sampling has been proposed in a recent generation of asynchronous neuromorphic visual sensors. Unlike conventional cameras, these sensors acquire data not at fixed points in time for the entire array but at fixed amplitude changes of their input, resulting optimally sparse in space and time—pixel individually and precisely timed only if new, (previously unknown) information is available (event based). This letter uses the high temporal resolution spiking output of neuromorphic event-based visual sensors to show that lowering time precision degrades performance on several recognition tasks specifically when reaching the conventional range of machine vision acquisition frequencies (30–60 Hz). The use of information theory to characterize separability between classes for each temporal resolution shows that high temporal acquisition provides up to 70% more information that conventional spikes generated from frame-based acquisition as used in standard artificial vision, thus drastically increasing the separability between classes of objects. Experiments on real data show that the amount of information loss is correlated with temporal precision. Our information-theoretic study highlights the potentials of neuromorphic asynchronous visual sensors for both practical applications and theoretical investigations. Moreover, it suggests that representing visual information as a precise sequence of spike times as reported in the retina offers considerable advantages for neuro-inspired visual computations.

The aim of this study was to evaluate the accuracy of procalcitonin (PCT) in predicting bacterial infection and survival without transplantation upon admission in the ICU for acute liver failure (ALF).From January 2009 until October 2015, all cases of ALF patients admitted in our ICU were retrospectively reviewed and included in the study if the PCT level upon admission was available. Patients with pre-existing liver pathology or ALF in a context of already advanced multiorgan failure were excluded. The main clinical and biological characteristics of patients were recorded, as well as the etiology of ALF, diagnosis of bacterial infection (bacteriologically documented or suspected), and outcome.35 patients were included: 46% men, mean age 42 years, initial prothrombin ratio 31%, PCT 9.8 mg/l (0.7-49), and PCT more than 2 mg/l in 54% of cases. Etiology was acetaminophen intoxication in 18/35 (51%) cases. Sepsis was diagnosed in 9/35 (26%) cases, most frequently pneumonia with 4/9 cases. Survival without liver transplantation (LT) was observed in 28 (80%) cases. The median PCT was not different in patients with or without bacterial infection [6.3 mg/l (0.6-16) vs. 1.2 mg/l (0.8-9.7), P=0.8]. The median PCT was not different in patients who survived without LT [7.1 mg/l (0.9-16.1) vs. 0.75 mg/l (7.7-11.5), P=0.06]. In patients with ALF unrelated to acetaminophen intoxication, the median PCT was higher in patients with bacterial infection [1.1 mg/l (0.9-4) vs. 0.5 mg/l (0.3-0.8), P=0.01], but was similar in patients who did not survive without LT [0.7 mg/l (0.4-1.1) vs. 0.8 mg/l (0.4-2.2), P=0.6]. In the overall cohort, the median C-reactive protein (CRP) and leukocyte count were higher in patients who developed bacterial infection [40 mg/l (19-60) vs. 16 mg/l (6-34), P=0.04; 11.9 G/l (8.3-19) vs. 7.9 G/l (6-12.6), P=0.05]. The median CRP and leukocyte count were not significantly different in survivors versus nonsurvivors without LT.PCT was an accurate predictor for the diagnosis of bacterial infection only in patients with ALF unrelated to acetaminophen intoxication. CRP was higher in patients who developed infection and could also be an interesting tool in ALF patients.

Blindness affects tens of million people worldwide and its prevalence constantly increases along with population aging. In some pathologies leading to vision loss, prosthetic approaches are currently the only hope for the patient to recover some visual perception. Here, we review the latest advances in visual prosthetic strategies with their respective strength and weakness. The principle is to electrically stimulate neurons along the visual pathway. Ocular approaches target the remaining retinal cells whereas brain stimulation aims at stimulating higher visual structures directly. Even though ocular approaches are less invasive and easier to implement, brain stimulation can be applied to diseases where the connection between the retina and the brain is lost such as in glaucoma and could therefore benefit to patients with different pathologies. Today, numbers of groups are investigating these strategies and the first devices start being commercialized. However, critical bottlenecks still impair our scientific efforts towards efficient visual implants. These challenges include electrode miniaturization, material optimization, multiplexing of stimulation channels and encoding of visual information into electrical stimuli.

The objective of this paper is to investigate if bioelectrical signals, generated from trunk muscles identified in an electrocardiogram (ECG) signal presented in this paper as ECG-Trunk Muscles Signals amplitude (Ecg-TMSA) are correlated with Heart rate (HR) during different levels of physical activity and also if Ecg-TMSA is not influenced by mental activity. HR and Ecg-TMSA were derived from ECG in 14 subjects when walking and jogging at different treadmill velocities from 4-10 (km h(-1)). The mean relationship for all 14 subjects was HR = (42.3 ± 0.2) + (45.3 ± 2.8) Ecg-TMSA, r(2 )= 0.91. The result of one individual data points example for a 21 min experiment was (r(2 )= 0.93, p 0.0001, n = 336). The obtained results show a linear relationship between Ecg-TMSA and HR. Moreover, the Ecg-TMSA was not affected by mental activity.

Le goitre ectopique endothoracique est une maladie rare, il représente moins de 1% de l’ensemble des goitres endothoracique, son diagnostic positif est parfois difficile et repose sur les données de l’imagerie. Le traitement est chirurgical en raison des risques de compression et de dégénérescence maligne. Nous rapportant un cas particulier d’un goitre ectopique endothoracique prenant la forme d’une masse kystique du médiastin avec des signes de compression du nerf phrénique.Key words: Etiologie, kyste médiatisnal, goitre ectopique endothoracique

This paper introduces a process to compute optical flow using an asynchronous event-based retina at high speed and low computational load. A new generation of artificial vision sensors has now started to rely on biologically inspired designs for light acquisition. Biological retinas, and their artificial counterparts, are totally asynchronous and data driven and rely on a paradigm of light acquisition radically different from most of the currently used frame-grabber technologies. This paper introduces a framework for processing visual data using asynchronous event-based acquisition, providing a method for the evaluation of optical flow. The paper shows that current limitations of optical flow computation can be overcome by using event-based visual acquisition, where high data sparseness and high temporal resolution permit the computation of optical flow with micro-second accuracy and at very low computational cost.

In this study, a bio-inspired approach for extracting efficient features prior to the recognition of scenes is proposed. It is highly inspired from the model of the mammals visual system. The retina contains many levels of neurons (bipolar, amacrine, horizontal and ganglion cells) accurately organized from cones and rods to the optic nerve up till the lateral geniculate nucleus (LGN) which is the main thalamic relay for inputs to the visual cortex. This structure probably eases other brain areas tasks in preprocessing the visual information. This paper is focusing on the study of these specific structures, relying on a bottom up approach to propose a comprehensive mathematical model of the low level image processing performed within the eye. The presented system takes into account the foveolar structure of the retina to produce a low-resolution representation of observed images by decomposing them into a local summation of elementary gaussian color histograms. This representation corresponds to the LGN biological organization. It has been thought that due to short timings, some very quick localization tasks involving particularly fast information processing pathways cannot be provided by the classical ones passing through higher level cortical areas. This work proposes a model of retinal coding and LGN-visual representation that we show provides reliable and sufficient early features for scenes recognition and localization. Experiments on real scenes using the developed model are presented showing the efficiency of the approach on localization.

International audience; There has been significant research over the past two decades in developing new platforms for spiking neural computation. Current neural computers are primarily developed to mimic biology. They use neural networks, which can be trained to perform specific tasks to mainly solve pattern recognition problems. These machines can do more than simulate biology; they allow us to rethink our current paradigm of computation. The ultimate goal is to develop brain-inspired general purpose computation architectures that can breach the current bottleneck introduced by the von Neumann architecture. This work proposes a new framework for such a machine. We show that the use of neuron-like units with precise timing representation, synaptic diversity, and temporal delays allows us to set a complete, scalable compact computation framework. The framework provides both linear and nonlinear operations, allowing us to represent and solve any function. We show usability in solving real use cases from simple differential equations to sets of nonlinear differential equations leading to chaotic attractors.

A 27-year-old male with no medical history was admitted to ur institution for acute dysphagia and odynophagia. Symptoms ppeared just after awakening, 12 h after a meal. Physical examiation was normal, and laboratory tests only showed leukocytosis 12,700/mm3) without eosinophilia. Because he had eaten underooked hake fillets the evening before, an oesophageal fishbone njury was suspected; upper gastrointestinal endoscopy was erformed 21 h after the meal revealing 8 spontaneously moving hite worms, adhering to the mucosa of the lower oesophagus ust above the Z-line and of the stomach (Fig. 1). The worms ere removed through the endoscope with a biopsy forceps; the

This letter presents a novel computationally efficient and robust pattern tracking method based on a time-encoded, frame-free visual data. Recent interdisciplinary developments, combining inputs from engineering and biology, have yielded a novel type of camera that encodes visual information into a continuous stream of asynchronous, temporal events. These events encode temporal contrast and intensity locally in space and time. We show that the sparse yet accurately timed information is well suited as a computational input for object tracking. In this letter, visual data processing is performed for each incoming event at the time it arrives. The method provides a continuous and iterative estimation of the geometric transformation between the model and the events representing the tracked object. It can handle isometry, similarities, and affine distortions and allows for unprecedented real-time performance at equivalent frame rates in the kilohertz range on a standard PC. Furthermore, by using the dimension of time that is currently underexploited by most artificial vision systems, the method we present is able to solve ambiguous cases of object occlusions that classical frame-based techniques handle poorly.

Summary Background The aim of this study was to assess the tolerance and report obtained results with a stable prostacyclin analogue (iloprost) in diabetic patients with severe forms of permanent lower limb ischaemia. Methods Sixty-four consecutive unselected patients, in stage III and IV of Leriche and Fontaine, turned down for vascular surgery after angiography and treated with iloprost during 28 days, were enrolled in this study. Patients were followed-up clinically (ischemic pain, trophic change, walking distance) and with transcutaneous oxymetry (D28). Long-term assessment (6 and 12 months) was expressed as rate of death, major amputation and of live patients with viable limbs and walking. There was no manifestation of intolerance to iloprost. Were considered as responders patients offering a lack or significant decrease in pain, a reduction of trophic lesions and improvement or recovery of walking. Results Response at two months is lasting: 29 responders (45.3%) and 35 non-responders (54.7%). At 6 months and one year, we observed that 8 (12.5%) and 15 (24.1%) patients respectively had died; 19 (29.6%) and 22 (34.3%) patients underwent major amputation, but 41 (64%) and 34 (53.1%) patients were still alive with their limb and conservative walking. In responder group, at 6 months, 28 (96.5%) patients were alive without amputation for only 13 (37.1%) among non-responders. At one year, 79.3% of the responders and 31.4% of the non-responders were alive without amputation. A total loss of walking, a segmental amputation and a previous amputation of opposite limb were more often noted in no responder group. But no predictive factor was referred to TcPO 2 in particular. Results ware similar in the group of 136 non diabetic patients treated during the same period (67.9% alive with limb at 6 months). Conclusions This retrospective study, despite its limitations, underlines the clinical particularities of critical ischaemia in diabetics and the good tolerance to iloprost. This point allowed patients, in non-surgical chronic critical ischaemia, to avoid being confined to bed and to access to benefits of a early physiotherapy, in association with local treatment. However, no predictive criterion of long-term results could be established, except initial clinical severity and clinical change one month after treatment.

Cisplatin-derived anticancer therapy has been used for three decades despite its side effects. Other types of organometallic complexes, namely, some ruthenium-derived compounds (RDC), which would display cytotoxicity through different modes of action, might represent alternative therapeutic agents. We have studied both in vitro and in vivo the biological properties of RDC11, one of the most active compounds of a new class of RDCs that contain a covalent bond between the ruthenium atom and a carbon. We showed that RDC11 inhibited the growth of various tumors implanted in mice more efficiently than cisplatin. Importantly, in striking contrast with cisplatin, RDC11 did not cause severe side effects on the liver, kidneys, or the neuronal sensory system. We analyzed the mode of action of RDC11 and showed that RDC11 interacted poorly with DNA and induced only limited DNA damages compared with cisplatin, suggesting alternative transduction pathways. Indeed, we found that target genes of the endoplasmic reticulum stress pathway, such as Bip, XBP1, PDI, and CHOP, were activated in RDC11-treated cells. Induction of the transcription factor CHOP, a crucial mediator of endoplasmic reticulum stress apoptosis, was also confirmed in tumors treated with RDC11. Activation of CHOP led to the expression of several of its target genes, including proapoptotic genes. In addition, the silencing of CHOP by RNA interference significantly reduced the cytotoxicity of RDC11. Altogether, our results led us to conclude that RDC11 acts by an atypical pathway involving CHOP and endoplasmic reticulum stress, and thus might provide an interesting alternative for anticancer therapy. [Cancer Res 2009;69(13):5458–66]

SummaryBackground Early-TIPSS (transjugular intrahepatic portosystemic shunt) placement may improve rebleeding and reduce 1-year mortality, compared to standard management in high-risk patients with cirrhosis and variceal bleeding. Aim To obtain external validation of this therapeutic approach. Methods We performed a prospective study including all consecutive patients with Child–Pugh C 10–13 cirrhosis or Child–Pugh B with active bleeding at endoscopy admitted to our ICU between March 2011 and February 2013 for variceal bleeding. TIPSS were placed within 72 h after stabilisation. Patients were matched for gender, age, Child–Pugh score, MELD score and to patients from a historical cohort hospitalised before March 2011. Results 31/128 patients with cirrhosis (77.4% men, mean age 53.2 ± 9.0 years old, MELD score 20.9 ± 6.9, Child–Pugh C: 77.4%) admitted for acute variceal bleeding between March 2011 and February 2013 (TIPSS+ group) were matched to 31 historical patients (TIPSS− group). Uncontrolled bleeding occurred in 1/31 patients in the TIPSS+ group vs. 2/31 patients in TIPSS− group (P = 0.55). The 1-year probability of being free of rebleeding was higher in the TIPSS+ group (97% vs. 51%, P

We present a novel event-based stereo matching algorithm that exploits the asynchronous visual events from a pair of silicon retinas. Unlike conventional frame-based cameras, recent artificial retinas transmit their outputs as a continuous stream of asynchronous temporal events, in a manner similar to the output cells of the biological retina. Our algorithm uses the timing information carried by this representation in addressing the stereo-matching problem on moving objects. Using the high temporal resolution of the acquired data stream for the dynamic vision sensor, we show that matching on the timing of the visual events provides a new solution to the real-time computation of 3-D objects when combined with geometric constraints using the distance to the epipolar lines. The proposed algorithm is able to filter out incorrect matches and to accurately reconstruct the depth of moving objects despite the low spatial resolution of the sensor. This brief sets up the principles for further event-based vision processing and demonstrates the importance of dynamic information and spike timing in processing asynchronous streams of visual events.

We report a case of amelanotic pulmonary melanoma in a 52-year-old man. Histological diagnosis was established after right lower lobectomy. The primary source was not found. We describe the diagnosis, treatment and surgical follow-up of this type of pulmonary tumour.

All trials on severe alcoholic hepatitis (AH) have included patients with "pure" AH, i.e., without concomitant gastrointestinal bleeding (GIB). Severe AH is often suspected in cirrhotic patients with GIB. We aimed at (1) assessing the prevalence of AH in patients with GIB and Maddrey discriminant function (DF) ⩾32; (2) comparing the outcome in AH patients with or without GIB (AH-GIB+, AH-GIB-); and (3) assessing the performance of the Lille model for survival in AH-GIB+ patients.We retrospectively included all patients with alcoholic cirrhosis admitted between January 2005 and March 2011 with the following: (1) jaundice3 months; (2) DF ⩾32 at admission; (3) bilirubin level50 μmol/L; and (4) active drinking. Exclusion criteria were advanced hepatocellular carcinoma, other etiology of cirrhosis, severe comorbidities and DF32 after stabilization. In our centre, we systematically plan a liver biopsy for these patients. Patients with severe AH received prednisolone.We screened 161 patients (86 GIB+, 75 GIB-), and analyzed data for 58 and 47 patients in each group, respectively. The 2 groups did not differ in prevalence of AH (77.3% vs. 81%), demographic data, MELD/Child-Pugh score, or DF. The 2 groups were similar in 6-month probability of survival (73.9 ± 6.0% vs. 69.9 ± 7%, p=0.49). The probability of developing infection was lower for AH-GIB+ patients (24.1% vs. 44.7%, p=0.04). The AUC for the Lille model in predicting 6-month survival was 0.71 ± 0.06 for all patients and 0.74 ± 0.06 for AH-GIB+ patients (p0.05).Prevalence of AH is 80% for patients with cirrhosis and GIB, recent jaundice and DF ⩾32. Infection was lower for AH-GIB+ patients, which suggests a beneficial role of antibiotic prophylaxis treatment. Survival among subjects with GIB was the same as among subjects without GIB.

Hydatid disease is an infection caused by ingestion of eggs from the dog tapeworm Echinococcus granulosis [1]. It can also occur in cattle-raising and sheep-raising areas of the world. The parasite lives in the intestinal tract of carnivores. Its head is composed of a doublecrown of hooklike structures, and three or four rings form the body. The eggs reside in the last ring and are eliminated with the feces. The eggs, which contaminate grazing fields and irrigated land, are consumed by herbivores. Humans become affected from water, food, or direct contact with carnivores. Once the eggs reach the human stomach the hexacanth embryos are released. These larvae undergo encystation in the small intestine, penetrate the intestinal wall, and are carried by mesenteric vasculature to various sites within the body including the liver, lung, and, rarely, the kidney, the brain, or other sites. A single fluid-filled cyst forms and contains multiple protoscoleces, one of which is capable of creating a new cyst. Symptoms develop when the cyst enlarges sufficiently to be a space-occupying mass. The liver is the most common location, resulting in abdominal pain and signs of cholestasis. Rupture of a hydatid cyst may occur spontaneously or after blunt trauma and can precipitate anaphylactic shock. The spillage of protoscoleces leads to multiple daughter cysts, which develop months to years later. Intrathoracic rupture is a rare complication with an incidence of 0.6% to 16% of cases [2‐ 4]. Bronchobiliary fistula is a serious complication and requires prompt surgical treatment.

Objective: Desmoid tumors of the chest wall are uncommon fibromatous tumors characterized by their local invasion and frequent recurrences. They are considered low-grade malignant sarcomas. We analyze our results and evaluate our experience in their surgical treatment. Patients and methods: From 1980 and 1999, eight patients were operated in our service for desmoid tumors of the chest wall. There were five males and three females with a mean age of 32 years old (17‐52 years). The diagnosis was established on the basis of clinical signs and imaging studies (Chest X-ray and computed tomography). Surgery was done by direct approach of the tumors. Results: None of the patients had Gardner’s syndrome. Complete resection was done in seven of the eight cases. Histology confirmed all cases. The follow-up ranged from 24 and 180 months, for a mean of 82 months. There was one death from cardiac and renal failure 3 months after a fifth resection associated with adjuvant radiation therapy. No other post-operative complications were observed. Recurrences occurred in 50% of cases, all treated by surgery, associated to radiotherapy in one case. Conclusion: Surgical treatment of primary desmoid tumors of the chest wall requires wide local resection. In cases of recurrences, multimodality therapies should be considered. q 2001 Elsevier Science B.V. All rights reserved.

L'hydatidose est un problème de santé publique dans les pays d'endémie dont le Maghreb. L'atteinte péricardique reste rare, le diagnostic est parfois tardif à cause de la non spécificité des symptômes, et repose essentiellement sur les données de l'imagerie. Nous rapportons deux observations d'hydatidose péricardique sans atteinte cardiaque.

Intrapleural rupture of pulmonary hydatid cyst (PHC) is a rare but dangerous complication. The purpose of this study was to report the characteristics of this form of thoracic hydatidosis and analyze the favoring factors.Between 1996 and 2011, 75 patients were operated in our department for PHC ruptured in the pleura (PHCP). The characteristics of this group were compared with those of a control group of 300 patients randomly selected from patients operated during the same period for PHC.PHCP patients were younger than controls (23 years old vs. 27,56) (P=0.03) with male predominance (70% vs. 46%) (P=0.01). The PHCP were often located in the lower lobes (64% vs. 48%) (P=0.03). Anatomic resections were more used in control group (P=0.03) whereas decortication and pleurectomy were more frequently in PHCP (P=0.001).Young age, male sex, and basal locations of PHC promote their rupture in the pleura. Surgical treatment of these cysts requires less anatomic resections but more decortication and pleurectomy.

Spontaneous chylothorax is a rare condition, lymph node tuberculosis is an exceptional etiology of chylothorax, we report an exceptional case of a patient with mediastinal and abdominal lymph node tuberculosis presenting with spontaneous bilateral chylothorax treated successfully by symptomatic medical treatment and antibacillary.

The aim of this study was to compare the characteristics of myasthenic patients with and without thymoma, and the results of thymectomy in both types of patients.A retrospective study was conducted among 66 patients who underwent thymectomy for myasthenia gravis in our department over a 10-year period (2000-2010). The surgical approach was sternotomy or anterolateral thoracotomy. Patients were divided into two groups according to the presence of thymoma: with (T-MG) and without (NT-MG) thymoma. Complete stable remission (CSR) was the primary endpoint.Median age was 35.09±9.89 years. The NT-MG group had 38 patients (57.57%) and the T-MG group 28 patients (42.43%). There was no difference between the two groups regarding the surgical approach (P=0.52). T-MG patients were older (40.54±15.16 vs. 31.37±9.46) (P=0.008) and predominantly male. There were more generalized forms (P=0.01) and more bulbar involvement (P=0.02) in the T-MG group. The rate of CSR at 5 years was 7% and 17% in the T-MG and NT-MG patients respectively (P=0.70). At 10 years, it was 36% and 94.73% respectively (P=0.03).Thymomatous myasthenia gravis is characterized by the severity of its clinical features. Remission rate at 10 years was significantly lower in the myasthenia with thymoma group.

This paper presents a novel N-ocular 3D reconstruction algorithm for event-based vision data from bio-inspired artificial retina sensors. Artificial retinas capture visual information asynchronously and encode it into streams of asynchronous spike-like pulse signals carrying information on, e.g., temporal contrast events in the scene. The precise time of the occurrence of these visual features are implicitly encoded in the spike timings. Due to the high temporal resolution of the asynchronous visual information acquisition, the output of these sensors is ideally suited for dynamic 3D reconstruction. The presented technique takes full benefit of the event-driven operation, i.e. events are processed individually at the moment they arrive. This strategy allows us to preserve the original dynamics of the scene, hence allowing for more robust 3D reconstructions. As opposed to existing techniques, this algorithm is based on geometric and time constraints alone, making it particularly simple to implement and largely linear.

L′actinomycose est une affection bactérienne granulomateuse, suppurative, étendue et chronique provoquée par la bactérie anaérobique gram positif Actinomyces israelii. La localisation thoracique est rare, elle peut simuler une pathologie néoplasique ou une tuberculose. Il s’agit d’un patient de 54ans sans antécédents pathologiques, qui s’est présenté avec deux tuméfactions pariétales basithoarciques droites, l’une antérieure et l’autre postérieure s’accompagnant d’une altération de l’état général. L’examen clinique ainsi que le bilan radiologique ont montré deux masses de la paroi thoracique et une atteinte parenchymateuse basale droite. L’examen anatomopathologique de la biopsie de la masse antérieure a montré des foyers d’actinomycose permettant d’établir le diagnostic d’actinomycose thoraco-pulmonaire. Un bilan immunologique s’est révélé normal. Le patient est alors mis sous traitement antibiotique à base d’amoxicilline protégée avec bonne évolution clinique et radiologique. Le but de cette observation est de rappeler les aspects radio-clinique, histologiques, thérapeutiques et évolutifs ainsi que les difficultés diagnostiques de cette affection.

l'hémangiome caverneux de l'os est une tumeur bénigne rare; sa localisation costale est exceptionnelle. Nous rapportons le cas d'un patient de 17 ans qui consultait pour une masse pariétale. La tomodensitométrie a objectivé une tumeur de la 6less than e greater than côte droite avec une rupture partielle de la corticale osseuse. Le traitement a consisté en une résection chirurgicale et l'examen microscopique de la pièce opératoire a conclu à un hémangiome costal de type caverneux. Aucune récidive n'a été notée 7 mois après l'intervention. L'hémangiome costal est une tumeur rare de la paroi thoracique. Son diagnostic de certitude est histopathologique car l'imagerie peut prêter confusion avec une origine maligne ou infectieuse.

La maladie de Castleman est une affection rare qui peut toucher le thorax. La localisation diaphragmatique est exceptionnelle. Nous rapportons le cas d'une patiente de 47 ans, chez qui une thoracotomie exploratrice a permis l'exérèse d'une masse du sinus médiastinal antérieur droit, en continuité avec le diaphragme et dont l'histologie est en faveur de la maladie de Castleman de type hyalino-vasculaire. Les particularités cliniques, radiologiques et évolutives ont été revues.

Les sarcomes ténosynoviaux ou synovialosarcomes sont des tumeurs malignes des tissus mous, l'atteinte primitive de la paroi thoracique est rare. Nous rapportons l'observation d'un patient suivi pour des douleurs thoraciques avec à l'examen une masse pariétale, le bilan radiologique a montré un développement également endothoracique de la tumeur. L'analyse anatomopathologique de la biopsie de la masse a conclu à un synovialosarcome, le patient a eu une résection de la tumeur associé à une radio chimiothérapie, le suivi a été marqué par la récidive au bout d'un an. A travers cette observation, nous insistons sur la rareté de la localisation, les caractères histologiques, les différentes approches thérapeutiques et le pronostic de ces tumeurs qui reste péjoratif.

Les carcinomes adénoïdes kystiques (CAK), ou cylindromes, sont des tumeurs malignes de la trachée qui représentent 0,1% des cancers des voies respiratoires. Il s'agissait d'une étude rétrospective à propos de quatre patients opérés dans notre service (deux femmes et deux hommes), ayant un âge moyen de 35,8; avec un suivi moyen de 7,2 plus ou moins 3,1 ans. Ils ont été admis pour tumeur trachéale se manifestant par une dyspnée inspiratoire. La bronchoscopie a montré une tumeur lisse de la trachée, dont la biopsie a révélé un CAK. Tous les malades ont bénéficié d’une résection de la tumeur avec recoupe trachéale et anastomose termino-terminale. La radiothérapie adjuvante a été indiquée dans un cas. L’évolution était marquée par la récidive locale avec des métastases pulmonaires après 6 ans chez un patient, et l'apparition des adénopathies cervicales métastatiques après 8 ans de suivi chez une autre. Les carcinomes adénoïdes kystiques sont des lésions de croissance lente, de découverte souvent tardive. La symptomatologie clinique est longtemps bien tolérée. Le traitement optimal est la chirurgie, la radiothérapie est indiquée quand la résection est incomplète ou impossible, ou après une récidive locale.

Nous rapportons un cas de tuberculose costale chez une patiente de 44ans ayant des antécédents de miliaire tuberculeuse. L’atteinte costale était pseudotumorale ayant conduit à une biopsie exérèse chirurgicale de la masse costale dont l’étude histologique est revenue en faveur d’une tuberculose. Cette observation ainsi que celles de la littérature, confirment les difficultés diagnostiques de cette forme rare de tuberculose.

Hydatid disease is a zoonosis resulting from the growth in man of the larval form of Echinococcus granulosus. Involvement of the bones is rare and localisation to the ribs is exceptional. The aim of our study is to present the pathophysiological and diagnostic characteristics of hydatid disease of the ribs and to define the radiological features.We undertook a retrospective study, over a period of 10 years, of 12 cases of hydatid rib disease. We have analysed the demographic, clinical and biological parameters and we examined the radiological details as well as the effect of surgery on the progress of the disease.The mean age of the patients was 33.5±10 years. There was no sexual predominance. The clinical picture was characterised by chest pain in ten cases and by swelling in five. General health was satisfactory in all patients. The chest X-rays showed a shadow of water density with lytic rib lesions. Thoracic CT scans showed the relationships with the neighbouring structures, particularly the spinal column. In three cases T1- and T2-weighted MRI scans showed the extent of intraspinal extension and in two cases excluded medullary involvement. Hydatid serology was positive in five cases. All our patients were operated on, with rib resection and vertebral curettage in three cases, and resection of the transverse process in two. Histological examination of the surgical specimens confirmed the diagnosis. Eight patients were treated with albendazole. All patients were reviewed for a mean of 3 years and the progress was favourable.Hydatid disease of the ribs is a very rare disorder and the diagnosis is difficult. It is sometimes an unexpected surgical finding but careful examination of the chest X-ray, supplemented by a CT scan, thanks to the liquid density of the lesions, is a great help in diagnosis. However, in the light of the results of our series, the radiological picture may be atypical and the interpretaion difficult.

We consider a mathematical model describing evolution of normal and leukemic hematopoietic stem cells (HSC) and differentiated cells in bone marrow. We focus on chronic myeloid leukemia (CML), a cancer of blood cells resulting from a malignant transformation of hematopoietic stem cells. The dynamics are given by a system of ordinary differential equations for normal and leukemic cells. Homeostasis regulates the proliferation of normal HSC and leads the dynamics to an equilibrium. This mechanism is partially efficient for leukemic cells. We define homeostasis by a functional of either hematopoietic stem cells, differentiated cells or both cell lines. We determine the number of hematopoietic stem cells and differentiated cells at equilibrium. Conditions for regeneration of hematopoiesis and persistence of CML are obtained from the global asymptotic stability of equilibrium states. We prove that normal and leukemic cells can not coexist for a long time. Numerical simulations illustrate our analytical results. The study may be helpful in understanding the dynamics of normal and leukemic hematopoietic cells.

The mathematical modelling of hematopoiesis received a significant attention in the last few years. However, the treatment of hematological diseases is less investigated by optimal control tools. In this paper, we consider the dynamics of chronic myeloid leukemia based on a four dimensional model. First we analyze the global dynamics of normal and cancer hematopoietic stem cells and differentiated cells using the principle of Bendixson-Dulac. Then we introduce some nonlinear effects of imatinib treatment over a fixed period of time. We represent therapy effects as an optimal control problem to minimize the cost of treatment and the level of cancer cells. The influence of imatinib onto the division and the mortality rates of cancer cells produces the suboptimal response, resistance and recovery forms.

Boerhaave's syndrome is a rare condition involving spontaneous rupture of the oesophagus. The diagnosis is difficult and the prognosis depends on early diagnosis and treatment.We report a case of spontaneous rupture of the oesophagus in a 70-year-old woman where the diagnosis was delayed. Initial treatment comprised dual antibiotic therapy and feeding via a jejunostomy. Three months later, direct suture of the oesophagus was performed successfully. A routine pleural biopsy performed during the surgery revealed pleural tuberculosis. Antituberculous treatment was given for 6 months with good progress after 16 months follow up.Boerhaave's syndrome is a rare condition, the diagnosis of which remains difficult. The prognosis is related essentially to the speed of diagnosis. The treatment is always surgical within the framework of appropriate medical management (intensive care, antibiotic therapy). There should be a systematic search for associated pathology.

Paraoesophagial cyst is an extremely rare congenital malformation of the oesophagus often discovered incidentally in adults. We report the case of a paraoesophageal cyst in a 45 year old man revealed by recurrent chest infections and confirmed by examination at surgery.

Bilio-bronchial fistula of hydatid origin is a rare but serious complication of hepatic hydatid cyst, the treatment of which is now well established.We report a case of bilateral bilio-bronchial fistula, successfully managed by bilateral thoracotomy with an interval of one week, and complicated by dyspnoea that resolved quickly.If the indication for thoracotomy is indisputable in case of unilateral bilio bronchial fistula, an initial laparotomy should be considered in the case of bilateral bilio-bronchial fistula.

Enlargement of the thymus following remission of a cancer treated by chemotherapy poses a problem of differential diagnosis between benign thymic hyperplasia and relapse of a mediastinal tumour.We report the case of a thymic tumour developing 6 months after chemotherapy for ovarian cancer in a woman of 31 years. Because of the risk of a mediastinal recurrence, the patient was submitted to thymectomy by mediastinotomy. Histopathological examination revealed benign thymic hyperplasia in reaction to the chemotherapy. The postoperative course was uneventful.Benign thymic hyperplasia may develop after chemotherapy. It is an inflammatory reaction that subsides after a few months. A multidisciplinary discussion to consider the possibility of benign hyperplasia may save the patient unnecessary surgery.