Système de télésurveillance sonore pour la détection de situations de détresse

The telemedicine and medical remote monitoring in particular, today represents an effective solution to the health professional shortcomings facing to the increasing older population. In addition to the comfort of being at home, this system decreases the cost of long hospitalization. The proposed system achieves the home medical telesurveillance by means of microphones and medical sensors to detect a distress situation. This system is designed for elderly people at home or for the patient with chronic illness. The experimental apartment is equipped with medical sensors (tensiometer, oxymeter, balance, etc.), infrared position sensors, and acoustic sensors (1 microphone/room). The originality of the system comes from the replacement of the video surveillance with a sound surveillance. The sound analysis system is divided in two stages: firstly, the detection/extraction of the sounds is operated and secondly, a classification of these sounds in known classes takes place. A wavelet-based algorithm with good performance when applied in noisy environments is proposed. The acoustical classification step uses a Gaussian Mixture Models to classify the sounds according to the 7 predefined classes. The detection algorithm allows an equal error rate of 0% for the signal to noise ratio superior or equal to 10 dB and 4% for the 0 dB. The proposed system coupled with a classical medical telesurveillance system will bring extra information needed for the reliability of the global system.     

Évaluation de l'activité de la personne en maintien à domicile-Classification des transferts posturaux à l'aide d'accéléromètres

The home healthcare of fragile or elderly people may be facilitated by IC technologies in order to monitor continuously the health level and to assist professionals, physicians and social workers. The assessment of the level of autonomy is one of the main indicators for adapting the level of care. The standardized tools (AGGIR or ADL) evaluate the capacities to perform autonomously the daily activities. These are user dependant. This paper presents scientific works on acquisition and interpretation of the signals derived from accelerometers in a Micro system, called “actimometer”. It can be embedded in the underwear to monitor continuously the level of activity, the capacities to displacements and transfers. The interpretation is so accurate to classify between different kinds of transfers in an ecological scenario. Results show that accelerometers data reproducibility depend on the two criteria: velocity and subject. In addition, a new method is able to differentiate BtS (Back-to-Sit) and StS (Sit-to-Stand) at the three velocities with a overall sensitivity and specificity equal to 95.32 and 96.10% respectively. Finally, the transition duration is determined for all trials.     

Innovation et évaluation des technologies innovantes de la e-santé à Lille

The university hospital of Lille and the Lille school of medicine always encouraged the development of tehcnological researches. For this purpose, they supported technological research and innovation with the ITM, but also technological evaluation with « Evalab », the first « usability lab » in Europe dedicated to the assessment of healthcare computer applications. This research closely associates searchers, companies, but also the future users (mainly healthcare professionals but also patients) to improve the acceptability of the systems, to avoid errors and adverse effects and increase the patient's safety.     

Sensibilité génétique à l’encéphalite herpétique

Herpes simplex encephalitis (HSE) is a rare but severe complication of frequent and mostly benign infection with herpes simplex virus (HSV). Although rapid and sensitive diagnosis tools and active antiviral drugs are available, HSE morbidity/mortality levels remain unsatisfactory. Molecular and cellular determinants of HSE are incompletely understood. The rarity and severity of the disease have suggested an increased susceptibility of some subjects to HSV infection. Numerous experimental studies have investigated the respective role of host and viral factors in HSE. The results of these studies have illustrated the major role of the innate immune response, in particular interferons (IFNs), in limiting access of the virus into and/or virus replication in the central nervous system (CNS). In a few children with HSE, specific defects of the immune innate response have been identified, which impair the IFN-α/β and IFN-λ production of fibroblasts and/or neurons infected with HSV and render these cells more permissive to infection. The mutations affect proteins involved in the IFN pathway induced by stimulation of the TLR3 receptor. The patients’ susceptibility to infection is restricted to HSV CNS invasion, underlining the major role of TLR3 in CNS protection against viral infection. The incomplete clinical penetrance of these molecular defects suggests that other factors (age, infectious dose) are involved in HSE. Whether pathogenesis of adult HSE is similar has not been investigated.     

椎板切除；脊柱；硬膜；粘连；预防

目的观察应用可吸收医用膜预防椎板切除术后硬膜外粘连的效果.方法在14例患者行椎板切除减压后,于硬膜外放置可吸收医用膜,并定期随访观察.结果全部患者的切口均一期愈合,无不良反应,防粘连效果优良.结论可吸收医用膜是一种良好的预防硬膜外粘连的材料.     

Une alternative à la chromatographie pour la détection de la macroprolactine : calcul du rapport de deux immunodosages de la prolactine : Immulite 2000® et Kryptor®

Macroprolactin is a high molecular mass form of prolactin with minimal bioactivity in vivo. The presence of macroprolactin must be considered for the differential diagnosis of hyperprolactinemia because prolactin-immunoassays present various reactivity with macroprolactin. So we compared to the reference technique (size-exclusion chromatography) a new screening test: calculation of the ratio between results obtained from two prolactin assays: Immulite^® with high cross reactivity with macroprolactin and Kryptor^® with no reactivity. In this study, serums from 69 patients with various macroprolactinemia (between 8 and 88% with chromatography) were selected and the ratio of the results of two prolactin assays was calculated for 49 hyperprolactinemic serums (prolactinemia > 636 mUI/l, Immulite 2000^®). According to ROC curves analysis, a low Immulite^®/Kryptor^® ratio (< 1.45) indicates the presence of less than 20% of macroprolactin (sensitivity = 100% specificity = 85%), and a high ratio (> 1.80) indicates the presence of more than 50% of macroprolactin (sensitivity = 95%, specificity = 100%). However, this screening test must be confirmed by size-exclusion chromatography for the rare samples presenting an Immulite^®/Kryptor^® ratio between 1.45 and 1.80.     

Comparaison entre les tests de surcharge et le dosage radio-immunologique des anticorps antithyroglobuline pour la validation des dosages de la thyroglobuline

Rationale and ObjectiveThe goal of this work was to evaluate the correlations between the results of assays of antithyroglobulin antibody by various techniques and recovery tests.Materials and MethodsWe have measured antithyroglobulin antibodies by 3 different immunoassay methods (TGAB IRMA Pasteur, Thyrak assay Behring and Anti-Tgn DYNOtest Brahms) in 724 serums samples from 301 patients under clinical, morphological and biological follow-up after primary treatment for papillofollicular thyroid cancers. Thyroglobulin was measured by an immunoradiometric assay (Thyroglobulin IRMA Pasteur) using 5 monoclonal antibodies. Antithyroglobulin autoantibodies concentrations were compared with percent thyroglobulin recovery performed in the same samples.ResultsAn absence of relation between the two methods aiming at identifying the probability of interferences in thyroglobulin assays. These results confirm previous observations and show that it is not a problem.ConclusionNo statistically significant relationships could be demonstrated between the concentration of thyroglobulin autoantibodies, whatever the assay used, and percent recoveries.     

Micro-imagerie anatomofonctionelle hépatobiliaire de la souris normale par tomodensitométrie X et scintigraphie planaire sténopée

Objective

Develop the methodology of data acquisition and processing for functional hepatobiliary scintigraphic imaging in normal mice.

Material and methods

The scintigraphic study was done on 11 female adult CD1 mice under gazeous anaesthesia using a small animal dedicated gamma-camera. A dynamic serie of 40 frames with 1 minute per frame was acquired after injection of Tc-99m mebrofenin. Two individuals were used for tomodensitometric morphological acquisitions using an X-ray micro-CT and the injection of a contrast agent and contributed to the choice of the scintigraphic regions of interest. Four analytical models: corrected and deconvolved hepatogram (A), bi-compartmental model (B), fast kinetics compartmental model (C) and factorial analysis (D) were applied to the scintigraphic data starting from areas of interest centered to the cardiac cavities and the liver.

Results

The mebrofenin kinetics is characterized by a time of the maximum t_max ranging between 4.5 and 4.6 min, a time of the center of gravity t_cdg from 6.2 to 7.0 min, a half-life of exponential decay t_1/2decr from 5.4 to 6.8 min, a fraction of hepatic extraction of 100%. Uptake and excretion half-lives are 2.3 and 5.8 min for the bicompratmental model and are 3.2 and 3.3 min for the fast kinetics compartmental model. Comparisons do not find significant differences between the right and left livers nor between models A, B, C and D for uptake time constants nor between models A, B and D for excretion time constants.

Conclusion

Reference values of hepatobiliary function in normal CD1 mice were obtained using different compartmental models.     

Épigénétique et pseudohypoparathyroïdies

Parental imprinting and the type of the genetic alteration play a determinant role in the phenotype expression of GNAS locus associated to pseudohypoparathyroidism (PHP). This imprint is tissue-specific, mainly localized in the kidney and the thyroid. Only the maternal allele is expressed at this level. An alteration in the coding sequence of the gene leads to an haplo-insufficiency and a dysmorphic phenotype (Albright's syndrome). If the alteration is on the maternal allele, there is a hormonal resistance to the PTH at the kidney level and to the TSH at the thyroid level. The phenotype is known as a PHP1a. If the alteration is on the paternal allele, there are few clinical signs with no hormonal resistance and the phenotype is known as pseudo-pseudo-hypoparathyroidism (PPHP). Methylation anomalies of GNAS locus, in particular of exon 1A, are responsible for a lack of expression of Gαs at kidney and thyroid levels only. If these anomalies concern the maternal allele (the only one expressed) with a paternal pattern, there is no haplo-insufficiency and no dysmorphic syndrome. The hormonal resistance is yet again limited to PTH and TSH. The phenotype is known as PHP1b. In the familial forms, these methylation anomalies are associated with a deletion of the syntaxine 16 gene in the maternal allele. This gene contains probably the imprinting center of the locus.