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.     

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.     

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.     

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.     

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.     

Étude des facteurs prédictifs d’acquisition d’une souche épidémique d’Escherichia coli productrice de bêta-lactamase à spectre étendu

The aim of the study was to determine predictive factors of epidemic extended spectrum beta-lactamase-producing Escherichia coli acquisition. All patients presenting any type of culture positive for ESBL-producing E. coli between November 2006 and October 2007 were included. An epidemic case was defined as a patient colonized with a clonal strain having epidemiological link with an another patient harbouring the same strain. Clinical and administrative data were recorded. Groups were compared by univariate and multivariate analysis using SAS software. Were included in this study 148 patients: 60 epidemic and 88 sporadic cases. Multivariate analysis showed several predictive factors of epidemic strain acquisition: female gender, high Charlson index, treatment by amoxicillin or ticarcillin–clavulanic acid, admission to emergency unit and hospitalisation in a high number of different care units. Identification of predictive factors of epidemic ESBL-producing E. coli strains acquisition may help to limit cross transmission of such strains.     

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.     

Mycétomes diagnostiqués au Sénégal de 2008 à 2010

Introduction

Mycetomas are inflammatory pseudotumours of subcutaneous and possibly osseous soft fabrics, generally polyfistulas with chronic mode of evolution.

Patients and methods

This study was carried out at the laboratory of parasitology and mycology of Le Dantec hospital in Dakar, Senegal, including 113 patients, from june 2008 to july 2010.

Results

Patients were from different regions in Senegal and in neighborhood countries, referred to the laboratory for mycetoma diagnosis. Among the 250 patients referred, 113 were positives after direct observation and culture corresponding to 45.2% index of infestation. The age range varies between 13 to 73 years with an average age of 33.9 years. The age bracket ranging between 20–39 years is more infected (27.34%), followed by 40–59 years (25.2%), 60 years and more (4.5%), 30–39 years (16.64%), 13–19 years (7.2%). The infection sex rate were, male: 79.6% and female: 20.4%. Infection prevalence profession dependant was found mainly in farmers and breeders with respectively: 48.7%, and 42.5%. The foot infestation is most represented with 72.5%, then leg (12.3%), knee (7.1%), scalp (2.7%), hand (1.8%). The other localizations are found with less than 1%: back, thigh, chest and ganglion inguinal. According to mycetoma agents, fungy are represented than mycetomas actinomycosic with respectively 70% and 30%. The species found were: Madurella mycetomatis (53.1%), Actinomadura pelletieri (23%), Leptosphaeria senegalensis (9.7%), Streptomyces somaliensis (2.6%), Actinomadura madurae (2,6%), Pseudallescheria boydii (1.8%), Nocardia spp. (1.8%), Scedosporium apiospermum (0.9%), Fusarium solani (0.9%). We found agents of dermatophytes: Microsporum langeronii (1.8%), and Trichophyton mentagrophytes (0.9%).

Conclusion

This study confirms that mycetomas are endemic affections in Senegal, where it still remain a real cause of disability among population leaving in rural area.     

Détermination rapide des paramètres caractéristiques des scolioses en vue frontale

Scolioses are pathologies changing the three-dimensional shape of spines. Numerous biomechanical studies reconstructed spines, from photogrammetric radiography. Each vertebra is represented by several landmarks, of which frontal and sagittal projections are recorded on the digitised film. These reconstructions, involving a great number of points, are accurate, but are time consuming. They describe evolving pathologies but the technique requires a specific radiographic protocol. A new approach has been studied in order to decrease time needed recording and treating data and delivering accurately parameters used clinically. It is applied to frontal deformations due to scoliosis. One numerical radiographic image is only needed. Three-dimensional spine is considered as a continuous beam of which frontal projection is bounded by two continuous curves. A small number of points, from 6 to 9, are recorded representing bounds. A continuous curve (B-spline) is constrained to pass through the recorded landmarks. Interactive software allows experimenter to adapt the global continuous bounding curve to the real projection by acting on local records. A mean curve representing the beam frontal projection is drawn. This mean curve is segmented in regions showing homogeneous concavities. Parameters describing the shape and angular tilting of each region are proposed for clinical applications. Vertebral bodies are located along the mean spinal curve. Analogous techniques are applied estimating axial rotation of vertebrae about the mean line of spine. The new approach is displayed using radiographic files of scoliotic patients. The new technique will be extended to the sagittal view with the goal of three-dimensional reconstructions.