Tangential velocity constraint for orbital maneuvers with Theory of Functional Connections.

Maneuvering a spacecraft in the cislunar space is a complex problem, since it is highly perturbed by the gravitational influence of both the Earth and the Moon, and possibly also the Sun. Trajectories minimizing the needed fuel are generally preferred in order to decrease the mass of the payload. A classical method to constrain maneuvers is mathematically modeling them using the Two Point Boundary Value Problem (TPBVP), defining spacecraft positions at the start and end of the trajectory. Solutions to this problem can then be obtained with optimization techniques like the nonlinear least squares conjugated with the Theory of Functional Connections (TFC) to embed the constraints, which recently became an effective method for deducing orbit transfers. In this paper, we propose a tangential velocity (TV) type of constraints to design orbital maneuvers. We show that the technique presented in this paper can be used to transfer a spacecraft (e.g. from the Earth to the Moon) and perform gravity assist maneuvers (e.g. a swing-by with the Moon). In comparison with the TPBVP, solving the TV constraints via TFC offers several advantages, leading to a significant reduction in computational time. Hence, it proves to be an efficient technique to design these maneuvers.

[Evaluation of dental medical devices: Focus on the definition of needs]. / Évaluation des dispositifs médicaux dentaires pour un appel d'offres : privilégier la haute définition des besoins.

OBJECTIVES: As a university teaching hospital, the call for tender for dental medical devices (dental implants and consumables) is done with the help of a team of hospital pharmacists and users. In order to optimize the definition of needs and evaluation criteria, an exhaustive review of the products was carried out. METHODS: Dental medical devices suppliers were consulted in 2017 for reviewing their products. Their technical, clinical and economic data were compared. The products have been gathered into categories and its results had been submitted to a commission of dental experts of our university hospital for clinical opinion. RESULTS: More than 30,000 references from 30 different suppliers were analyzed (orthodontics, dental implants, membranes and bone substitutes, various dental consumables). Relating to oral implantology, the opinions converged on clinical studies. On the contrary, diverging opinions have been proffered on the systematic use of single-use drills and customized guides for surgery and on the implant's choice. The definition of needs has been specified for orthodontics and consumables. Other criteria played a great role: single packaging (unit doses), product's sterility, paediatric needs, presence of allergens, traceability of devices and supplier diversity. CONCLUSIONS: This review led to the identification of new needs in more precise terms. The complexity and diversity of dental products and techniques requires this careful review and a better collaboration with practitioners.

[Review of patient-specific instrumentation for total knee prosthesis]. / Revue des guides personnalisés à usage unique dans les prothèses totales de genou.

OBJECTIVES: Single use patient-specific instruments (PSI) for total knee prosthesis are introduced as a new alternative to conventional ancillaries and computer assisted surgery by improving implants positioning. An exhaustive review was carried out to identify their specific characteristics, with their advantages and disadvantages. METHODS: Medical devices suppliers were consulted in 2015 for reviewing their PSI. Their technical, clinical and economic data were compared. The results had been submitted to an orthopaedics expert commission of our university hospital for clinical and financial opinion. RESULTS: Ten companies have provided the documentation for the analysis. PSI are manufactured by suppliers using a three dimensional printing method based on CT scans or MRI images. PSI are produced according to the surgeon's preferences after a preliminary data check, which can be performed by the suppliers' engineers, the surgeon and automatic calculation. Five suppliers can produce sterile PSI with optional delivery of 3D bone models. According to the experts, the studies failed to demonstrate the superiority of a PSI or hospital economic gain. The prices listed remain high and operating room time is not always significantly reduced. CONCLUSIONS: With the development of personalized medicine, the role of PSI grows in importance. They facilitate the surgeon's work by fully respecting the anatomy. These systems offer an interesting perspective in their technical and pedagogical aspects. But it seems premature to take them into routine use given the low number of high-level studies that were currently done.

[Perspective of the transition from reusable instruments to single use ancillary in orthopedic surgery]. / Ancillaires orthopédiques : évolution du matériel restérilisable vers l'usage unique, quels impacts ?

OBJECTIVES: Since 2009, single-use (SU) ancillaries for total knee arthroplasty (TKA) and total hip arthroplasty (THA) have been marketed to replace reusable ancillaries. The concept is not innovative but their use in orthopedics is still uncommon. An assessment has been done for the use of SU ancillary in Assistance publique-hôpitaux de Paris with the consequences for the patient, the surgeon and the hospital. METHODS: A technical and a clinical review has been done with those devices in 2015. The economic and organizational impacts were identified and submitted for opinion to committee experts in orthopedics. RESULTS: Three SU ancillaries are commercialized. No clinical studies are currently available. There is no reimbursement for SU ancillaries whereas reusable ancillaries are included in prosthesis reimbursement price. Although SU ancillaries (TKA and THA) saving costs for sterilization, the annual additional budget estimated for their purchase would approximately be 2.5 times higher. Nevertheless, indirect savings could be also considered in the long-term period (global costs for sterilization, volume effect…). For the same quality, according to the experts, organizational impacts are low for the patient and the surgeon but potentially important for the hospital, the nursing and pharmaceutical staff, and logistical activities. CONCLUSIONS: On logistic, clinical and financial aspects, SU ancillaries need more evaluation. The switch to SU ancillaries allows saving sterilization costs and time, and provided an immediate mobilization of the equipment but their interest must be demonstrated by clinical and economic data.

[Serious adverse events after microbial sealant application in paediatric patients]. / Évènements indésirables graves à l'occasion de l'emploi d'un dispositif filmogène en pédiatrie.

BACKGROUND: Integuseal(®) is a cyanoacrylate-based medical device (IIa class), used in surgery after skin preparation to reduce bacterial contamination. It is not officially contraindicated for children. OBJECTIVES: To describe a case series of skin lesions in pediatric patients after using Integuseal(®) in cardiac surgery. METHODS: Case series. RESULTS: Between September 2012 and February 2013, 153 pediatric patients were treated by Integuseal(®) to prepare for a cardiac surgery in our center: 5 patients (2%) had serious cutaneous reactions. The average age of patients having had lesions is 16months (the youngest patient being 1month old and the oldest being 5years and 8months old). ISSUES: The risk factor in the development of skin lesion seems to be particularly related to the patient's age and sternal location. Other medical literature reports instances of cyanoacrylate intolerance in a variety of other situations. CONCLUSION: Using Integuseal(®) on children does not appear to be safe.

HIV, hepatitis B/C and syphilis prevalence and risk behaviors among gay, transsexuals and men who have sex with men, Dominican Republic.

This study investigated HIV, hepatitis B (HBV) and C (HCV) and syphilis prevalence and associated behavioural correlates to HIV infection among gay, transsexuals and men who have sex with men (GTMSM) in the Dominican Republic using respondent-driven sampling. Eligible men were aged ≥15 years, reported engaging in anal/oral sex with another man within the past six months and living in one of the four cities sampled. GTMSM were recruited in Santo Domingo (n = 510), Barahona (n = 281), La Altagracia (n = 270) and Santiago (n = 327). HIV seroprevalence ranged from 5.1% to 7.6%. HBV ranged from 0.6% to 3.5%, HCV from 0.8% to 6.9% and syphilis from 3.5% to 6.9%. GTM practice numerous risky sexual behaviours including having multiple sex partners and practising inconsistent condom use with male and female, including transactional, sex partners. Although we found lower HIV prevalence compared with previous studies, the high level of extremely risky sexual behaviours practised by GTM in the Dominican Republic will most likely result in increases in HIV and other infections if action is not taken to scale-up effective prevention programmes for this population.

[Diagnostic techniques described in the study of Duchenne/Becker muscular dystrophy]. / Técnicas diagnósticas descritas en el estudio de la distrofia muscular de Duchenne/Becker.

INTRODUCTION: Duchenne/Becker muscular dystrophy (DMD/B) is one of the commonest myopathies, with an incidence of 1/3,500 male live births. It is characterized by the slow degeneration of muscle fibres, so that the patient has become an invalid by the age of 10 years, followed by death from respiratory or cardiac failure. It has a sex linked recessive mode of inheritance. DEVELOPMENT: The gene causing this disorder is the DMD gene and is found on the short arm of the X chromosome. The commonest mutations of this gene are deletions. Many molecular techniques for study of the disorder have been developed over the years. These include the Southern Blot, polymerase chain reaction (PCR), use of the Short Tandem Repeat (STR), polymorphic length restriction fragments (RFLP), Western Blot for the study of the protein and others. CONCLUSIONS: In this paper we review the diagnostic tests most widely used in this disease. These have permitted improved study of the various families affected and thus improved the quality of life of the families at risk.

Técnicas diagnósticas descritas en el estudio de la distrofia muscular de Duchenne/Becker / Diagnostic techniques described in the study of Duchenne/Becker muscular dystrophy

Introducción. La distrofia muscular de Duchenne/Becker (DMD/ B) es una de las miopatías mas frecuentes, con un intervalo de incidencia de 1/3.500 varones nacidos vivos. Se caracteriza por una degeneración lenta de las fibras musculares, que provoca la invalidez en la primera década de vida de estos pacientes y luego la muerte por fallos respiratorios o cardíacos. Presenta un patrón de herencia recesivo ligado al sexo. Desarrollo. El gen responsable de esta enfermedad se conoce como gen DMD y se localiza en el brazo corto del cromosoma X. Las mutaciones más frecuentes encontradas en este gen son las deleciones. Existen numerosas técnicas moleculares para el estudio de esta enfermedad, que se han desarrollado durante años, entre las que podemos destacar el Southern Blot, la reacción en cadena de la polimerasa (PCR), utilización de short tandem repeat (STR), los fragmentos de restricción de longitud polimórficos (RFLP) y el Western Blot para el estudio de la proteína. Conclusiones. En este trabajo analizamos los estudios diagnósticos más utilizados en esta enfermedad, que han permitido realizar un mejor estudio de las diversas familias afectadas y mejorar así la calidad de vida de las familias con riesgo (AU)

Diagnóstico prenatal y de portadores en familia con distrofia muscular de Duchenne. Introducción de nuevos marcadores / diagnosis, prenatal and of carriers, in families with Duchenne muscular dystrophy

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[Malignant gliomas. Oncogenic considerations]. / Gliomas malignos. Apuntes oncogenéticos.

INTRODUCTION: There is evidence that cancer is the result of an accumulation of genetic alterations which lead to uncontrolled cell proliferation with loss of the processes of cell differentiation. DEVELOPMENT: In this review we try to explain the molecular alterations which occur in the anaplastic degeneration of astrocyte gliomas, conditioned by loss of genetic material on chromosomes 10 and 17, mutation of gene p53, amplification of the receptor of the epidermic growth factor, translocations of chromosomes 9p, 13q, 19q and 22q amongst others. On clinical and molecular studies two basic genetic pathways in the development of glioblastoma multiform have been identified. One of progressive degeneration of an astrocytoma of low-grade malignancy and the other from normal neuroglial cells such as a glioblastoma multiform de novo. CONCLUSIONS: The oncogens and tumor suppressive genes are the basis of the lack of control and abnormal cellular proliferation. An understanding of the changes which they cause will in future permit the application of new therapeutic options in patients with malignant astroglial neoplasias.

Glioma malignos. Apuntes oncogenéticos / Malignant gliomas. Oncogenetic notes

Introducción. Existen evidencias de que el cáncer es el resultado de una acumulación de alteraciones genéticas que ocasionan una proliferación celular incontrolada con pérdida de los procesos de diferenciación celular. Desarrollo. Esta revisión es un intento de aproximación al entendimiento de las alteraciones moleculares que ocurren en la degeneración anaplásica de los gliomas astrocíticos, condicionada por pérdida de material genético en los cromosomas 10 y 17, mutación del gen p53, amplificación del receptor del factor de crecimiento epidérmico, así como translocaciones del cromosoma 9p, 13q, 19q y 22q, entre otros. Estudios clínicos y moleculares han identificado dos vías genéticas fundamentales en el desarrollo del glioblastoma multiforme: una a partir de la degeneración progresiva de un astrocitoma de bajo grado de malignidad y otra desde células neurogliales normales, como un glioblastoma multiforme de novo.Conclusiones. Los oncogenes y los genes supresores tumorales son la base del descontrol y la proliferación celular anormal. El conocimiento de los cambios que ellos ocasionan permitirá en el futuro la aplicación de nuevas opciones terapéuticas en los pacientes con neoplasias astrogliales malignas (AU)

Gliomas malignos. Apuntes oncogenéticos / Malignant gliomas. Oncogenetic notes

Existen evidencias de que el cáncer es el resultado de una acumulación de alteraciones genéticas que ocasiona una proliferación celular incontrolada con pérdida de los procesos de diferenciación celular. Esta revisión es un intento de aproximación al entendimiento de las alteraciones moleculares que ocurren en la degeneración anaplásica de los gliomas astrocíticos, condicionada por pérdida de material genético en los cromosomas 10 y 17, mutación del gen p53, amplificación del receptor del factor de crecimiento epidérmico, así como translocaciones del cromosoma 9p, 13q, 19q, 22q, entre otros. Estudios clínicos y moleculares han identificado dos vías genéticas fundamentales en el desarrollo del crioblastoma multiforme: una a partir de la degeneración progresiva de un astrocitoma de bajo grado de malignidad y otra desde células neurogliales normales, como un glioblastoma multiforme de novo. Los oncogenes y los genes supresores tumorales son la base del descontrol y la proliferación celular anormal. El conocimiento de los cambios que ellos ocasionan permitirá en el futuro la aplicación de nuevas opciones terapéuticas en los pacientes con neoplasias astrogliales malignas

[Werdnig-Hoffmann disease. The first prenatal diagnosis in Cuba]. / Enfermedad de Werdnig-Hoffmann. Primer diagnóstico prenatal en Cuba.

INTRODUCTION: Spinal muscular atrophy (SMA) is an autosomal recessive disorder characterized by the degeneration of cells of the spinal cord. The gene was localized on chromosome 5q13 and exists in two almost identical forms, which are distinguished by the change of base on exones 7 and 8. Mutations of the gene of survival motoreneuron (SMN) are the cause of illness. CLINICAL CASE: We report, for the first time in Cuba, the prenatal diagnosis of a type II SMA carrier, using molecular methods for direct detection of the mutation on exones 7 and 8 of the SMN gene, and haplo-identification with microsatellite markers of chromosome 5q as an indirect method. A sample of amniotic liquid was taken at 18 weeks of gestation and the DNA extracted. No deletions were detected on exones 7 and 8 of the foetal DNA, which was therefore normal. CONCLUSIONS: Detection of deletions on the SMN gene is a method which permits detection of the condition (healthy or unhealthy) of the foetus, quickly and reliably, without requiring investigation of the entire family to obtain a result. The method does not require radio-active PCR, the results are clear and precise and may be obtained within 24 hours. It may also take the place of invasive methods such as muscle biopsy and electro-myography and contribute to genetic assessment in families in which there is no DNA of the affected child.

Water reservoir: another stage for water treatment process

El articulo analiza los aspectos tecnicos y economicos del manejo de la calidad del agua en los reservorios, y la forma de evaluar la eficiencia y la seguridad de la gestion. Para ello se analizan casos de reservorios de distintas ciudades del mundo

Water reservoir: another stage for water treatment process

El articulo analiza los aspectos tecnicos y economicos del manejo de la calidad del agua en los reservorios, y la forma de evaluar la eficiencia y la seguridad de la gestion. Para ello se analizan casos de reservorios de distintas ciudades del mundo

Effectiveness of earplugs in high-intensity impulse noise.

The efficiency of different types of earplugs was assessed by means of Békésy audiometry following the exposure of 42 human subjects to weapon impulses. The peak pressure of the impulses ranged from 2.3-27.8 kPa (from 161 to 183-dB peak SPL) and the A-weighted equivalent level (over 8 h) of each exposure ranged from 100-114 dB. All subjects wore earplugs fitted by an experienced individual. The devices tested included one brand of conventional foam earplugs and a number of different models of perforated earplugs, one type of which had been previously shown to provide nonlinear attenuation. Perforated earplugs were tested because they provide better speech communication than conventional passive earplugs, and in the nonlinear case also afford attenuation that increases with the peak pressure of the impulses. The temporary threshold shifts (TTSs) observed in these experiments were very small and indicated no significant hazard for hearing. Well-fitted perforated earplugs seem to be able to protect the ear from infrequent exposures to the high-level impulses produced by small and large weapons while allowing good speech communication, and without impairing the operational capacity of soldiers who must remain aware of their acoustic environment.

Delayed temporary threshold shift induced by impulse noises (weapon noises) in men.

Most of the available information on the effects of impulse noise on hearing is derived from temporary threshold shift (TTS2) measurements performed 2 min after a single exposure to small-weapon noises. TTS is known to recover as a linear function of the logarithm of time when it is induced by a continuous noise of moderate intensity. Following the exposure to impulse noise, several investigators have reported individual exceptions to the log-time relation, e.g. increases in TTS during the first hour of recovery. These authors observed a 'rebound recovery function' for most of the exposed men, and they conclude that this phenomenon '... has implications for the use of TTS in the construction of damage risk criteria for hazardous noise exposure ..., a single measure, such as the widely used TTS2 may not be an adequate index of the magnitude of the TTS'. In order to thoroughly investigate in man the existence of 'delayed' TTS following the exposure to actual weapon noises, the 'French Committee on Weapon Noises' carried out the following study. Three groups of soldiers (28 subjects) wearing no hearing protection were exposed in the free field over 2 days to impulse noises produced by a rifle. Békésy audiograms were obtained from each subject just before the exposure, and at 5 min, 1 h and 4 h after exposure. All audiometric tests were carried out even when no TTS was observable in the first postexposure audiogram. A significant number of subjects showed a 'delayed TTS' and/or 'rebound recovery'. The maximum TTS was observed at 1 h after exposure, but the observation of a delayed recovery and a rebound recovery indicate that audiometric tests should be performed in all cases at least up to 4 h after the exposure. More detailed work is necessary to establish what changes may be necessary in the present damage risk criteria for impulse noises of a very high level.