Thèse d'exercice : Médecine : Nancy 1 : 2008. / Titre provenant de l'écran-titre.

Aliasing complicates both formal and informal reasoning and is a particular problem in object-oriented languages, where variables denote references to objects rather than object values. Researchers have proposed various approaches to the aliasing problem in object-oriented languages, but all use reference semantics to reason about programs. This thesis describes the design and implementation of Tako—a Java-like language that facilitates value semantics by incorporating alias-avoidance. The thesis describes a non-trivial application developed in the Tako language and discusses some of the object-oriented programming paradigm shifts involved in translating that application from Java to Tako. It introduces a proof rule for procedure calls that uses value semantics and accounts for both repeated arguments and subtyping. / Master of Science

Les anomalies du système nerveux sympathique (SNS) contribuent au développement de certaines pathologies cardiovasculaires comme l'insuffisance cardiaque (IC) et les cardiomyopathies de stress. Ces anomalies impliquent une activation persistante, défavorable du SNS dans l'IC et une activation sympathique épisodique dans les cardiomyopathies de stress. Le rôle du SNS au cours des cardiopathies valvulaires reste quand à lui encore mal connu. Notre travail de thèse avait pour objectif d'analyser par microneurographie l'activité du SNS et sa modulation par les arcs réflexes physiologiques, au cours de l'IC avec ou sans comorbidités (notamment l'anémie, l'insuffisance rénale) ainsi qu'au cours des cardiomyopathies de stress et de la sténose aortique. L'hyperactivité du SNS participe à l'initiation et à la progression de l'IC et constitue un marqueur pronostique mais aussi une cible thérapeutique. Les mécanismes fondamentaux qui sous-tendent l'activation du SNS au cours de l'IC restent encore incertains. Une hypothèse engloberait une diminution des réflexes inhibiteurs, comme le baroréflexe artériel périphérique et une augmentation des réflexes excitateurs, comme le chémoréflexe artériel périphérique. Avec notre premier travail nous rapportons que l'augmentation de l'activité du chémoréflexe périphérique diminue directement la fonction du baroréflexe artériel chez les patients IC et que cette interaction contribue à l'hyperactivité sympathique. Notre équipe avait déjà démontré qu'au cours de l'IC, l'insuffisance rénale (IR) et l'anémie contribuent à l'augmentation de l'activité du SNS. Bien que la dysfonction rénale et l'anémie aient été largement étudiées séparément dans l'IC, des données épidémiologiques suggèrent également que l'IR peut coexister avec l'anémie chez les patients atteints d'IC dans ce qu'on désigne par le "syndrome d'anémie cardio-rénale". Nous avons démontré que ce syndrome au cours de l'IC est associé à une hyperactivité sympathique médiée à la fois par une activation tonique du chémoréflexe périphérique et une atténuation du baroréflexe artériel. Le syndrome du Tako Tsubo est une cardiomyopathie de stress caractérisée par une insuffisance ventriculaire gauche aiguë réversible. La physiopathologie exacte reste inconnue, mais l'hyperactivation sympathique semble jouer un rôle fondamental. Nous avons démontré par microneurographie la présence d'une hyperactivation du SNS dans la phase subaiguë de la maladie associée à une altération du baroréflexe périphérique. La sténose aortique (SA) est, dans les pays développés, la plus fréquente de toutes les maladies cardiaques valvulaires. Le remplacement valvulaire aortique transcathéter (TAVI) est une option thérapeutique émergente chez les patients avec une SA sévère symptomatique à haut risque chirurgical. La SA est associée à une morbi-mortalité cardiovasculaire accrue. Nous avons souhaité apprécier si au cours de la SA il existait une hyperactivité du SNS qui pouvait contribuer à expliquer le pronostic réservé des patients et être la cible du TAVI. Nous avons montré que les patients atteints de SA ont une activité du SNS augmentée et qui est associée à une diminution du gain du baroréflexe périphérique. Le TAVI normalise ces paramètres. Au total, ce travail de thèse a permis d'identifier de nouveaux mécanismes contribuant à l'hyperactivité du tonus sympathique au cours de l'insuffisance cardiaque, de la sténose aortique et de la cardiomyopathie du Tako Tsubo. L'hyperactivité du SNS jouant un rôle critique dans l'insuffisance cardiaque, la connaissance des mécanismes physiopathologiques qui la sous-tendent pourrait permettre l'identification et/ou la validation de nouvelles stratégies pour son traitement. / Sympathetic nervous system (SNS) abnormalities contribute to the development of some cardiovascular diseases such as heart failure (HF) and stress cardiomyopathies. These abnormalities involve persistent, adverse activation of SNS in HF and episodic sympathetic activation in stress cardiomyopathies. Less is still known about the role of SNS in valvular heart diseases. Our PhD work had as a purpose to analyse, by microneurography, the activity of SNS and its modulation by physiological reflex arcs, during HF, with and without comorbidities (including anemia and kidney failure), in stress cardiomyopathies and during aortic stenosis. SNS hyperactivity participates in the initiation and progression of HF being also a prognostic marker and a therapeutic target. The fundamental mechanisms underlying the activation of SNS in HF remain uncertain. One hypothesis would include a decrease in inhibitory reflexes activity, such as peripheral arterial baroreflex and an increase in excitatory reflexes activity, such as peripheral arterial chemoreflex. With our first work we report that the increased activity of peripheral chemoreflex directly decreases the arterial baroreflex function in HF patients and that this interaction contributes to sympathetic hyperactivity. Our team had already shown that during HF, renal dysfunction and anemia contribute to the increased activity of SNS. Although renal dysfunction and anemia have been widely studied separately in HF, epidemiological data also suggest that renal impairment can coexist with anemia in HF patients in the so called "cardio-renal anemia syndrome". We demonstrated that this syndrome during HF is associated with elevated sympathetic activity mediated by both tonic peripheral chemoreflex activation and arterial baroreflex impairment.The Tako Tsubo (TTC) is a stress cardiomyopathy characterized by acute reversible left ventricular failure. The exact pathophysiology remains unknown but sympathetic hyperactivation seems to play a fundamental role. We reported by microneurography the presence of SNS hyperactivation in the subacute phase of the disease associated with impairment in arterial baroreflex.In developed countries, aortic stenosis (AS) is the most prevalent of all valvular heart diseases. Transcatheter aortic valve implantation (TAVI) is an emerging therapeutic option in symptomatic patients with severe AS at high surgical risk. AS is associated with increased cardiovascular morbidity and mortality. We wanted to assess whether in AS sympathetic hyperactivity existed that could help to explain the poor prognosis of these patients and be the target of TAVI. We have shown that AS patients have an increased SNS activity that is associated with reduced peripheral baroreflex gain. The TAVI normalizes these parameters.On the whole this PhD work identified new mechanisms that contribute to SNS hyperactivity in heart failure, aortic stenosis and Tako Tsubo cardiomyopathy. Since SNS hyperactivity plays a critical role in heart failure, knowledge of the pathophysiological mechanisms that underlie it could allow identification and/or validation of new strategies for its treatment.

Introduction: Takotsubo cardiomyopathy is an apical ballooning syndrome, which can be triggeredby stress. Only few case reports describe the onset of Takotsubo as a complication of neurosurgery procedures. Clinical presentation: A case of a 53 year-old female with a spinal neurinoma and surgery-associated Takotsubo cardiomyopathy is demonstrated. The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery. Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis. The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pumpfunction. Conclusion: Interventions in neurosurgery and perioperative care should be kept as stress free as possible. Due to the possibility of neurogenic mechanisms related to cardiomyopathy, Takotsubo cardiomyopathy as an entity of stress-induced complications should be taken into consideration.

An 82-year-old woman presented to the emergency department with chest pain after sustaining a transient ischemic attack 1 week prior to presentation. Electrocardiography revealed ST-segment elevation in leads I, II, aVF, and V3 through V6. Coronary angiography demonstrated nearly normal coronaries but left ventriculography showed apical akinesis and basal hyperkinesis. One month later her follow-up echocardiography showed no wall motion abnormalities. Several reports of tako-tsubo syndrome or transient left ventricular apical ballooning have been described, especially in Japan. We present a case with the typical features of the syndrome after a cerebrovascular accident.

The Composite design pattern is commonly employed in object-oriented languages to design a system of objects that form a part-whole hierarchical structure with composite objects formed out of primitive objects. The client does not differentiate between a composite object and a primitive object. The composite hierarchy effectively forms a tree-like hierarchical grouping of objects. From a software engineering perspective, there are at least two problems with the Composite pattern. First, it does not maintain a separation of concerns between the structure of the objects in a system and the objects themselves. The objects that comprise the system contain information about their relationship to other objects. This limits the ability of programmers to reuse the system's structural information. Secondly, there is no mechanism for encapsulating the system as a whole. This makes it difficult to specify and reason about global system properties. This thesis presents two tree components that can be used as alternatives to the Composite design pattern in systems that are traditionally implemented with the pattern. Both components are data structures that can contain arbitrary objects and maintain the structure of those objects as an ordered-tree. Since the components encapsulate only the tree structure, they only need to be specified and verified once, and they are available for black-box reuse. The first component is a traversable tree that maintains a conceptual "cursor" position. Methods are provided for inserting and removing objects at the cursor position, and for moving the cursor throughout the tree. The second component extends the traversable tree. A formal specification for each tree component is presented in the Tako language — a Java-like language with alias avoidance that is designed to facilitate specification and verification. A case study is presented that shows how the indexed tree can be used and reasoned about in an application — a text-based adventure game. Finally, a similar application is developed in Java, once using the composite pattern and once using the indexed tree data structure, and object-oriented metrics are given for both systems. / Master of Science

Introduction: Takotsubo cardiomyopathy is an apical ballooning syndrome, which can be triggeredby stress. Only few case reports describe the onset of Takotsubo as a complication of neurosurgery procedures. Clinical presentation: A case of a 53 year-old female with a spinal neurinoma and surgery-associated Takotsubo cardiomyopathy is demonstrated. The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery. Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis. The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pumpfunction. Conclusion: Interventions in neurosurgery and perioperative care should be kept as stress free as possible. Due to the possibility of neurogenic mechanisms related to cardiomyopathy, Takotsubo cardiomyopathy as an entity of stress-induced complications should be taken into consideration.

No description available.

The interstellar matter in the Galaxy is concentrated in a thin layer close to the galactic plane, mostly in spiral arms. Most of the interstellar matter is in a form of atomic and molecular gas and only 1% of its mass is in a form of small (0.01 – 0.1 µm) dust grains which absorb and scatter the light of stars and cause the interstellar extinction. A part of interstellar gas and dust are in a diffuse form and fill the space with density which exponentially decreases with the distance from the galactic plane. However, in the spiral arms gigantic molecular clouds are present which play an outstanding role in the evolution of the Galaxy, since in them star forming processes take place. Molecular and dust clouds, young star clusters and associations and other star forming regions are concentrated in the Milky Way plane. However, due to gravitational and radiation interactions between the molecular clouds and the young massive stars, some fragments of spiral arms deviate from the galactic plane. One of such deviating branches from the Local (Orion) spiral arm is a huge elongated system of molecular and dust clouds located in the Cepheus constellation which is known as the Cepheus Flare. Most of the objects investigated in this dissertation belong to this branch of the Local spiral arm. The objects selected for the investigation are star forming regions in the vicinity of the reflection nebula NGC 7023, a group of dark clouds TGU 619, the young open cluster NGC 7129 and the... [to full text] / Paukščių tako Galaktikoje didžioji dalis tarpžvaigždinės medžiagos yra susitelkusi į ploną sluoksnį Galaktikos plokštumoje, daugiausiai spiralinėse vijose. Didžiąją dalį tarpžvaigždinės medžiagos sudaro atominės ir molekulinės dujos ir tik maždaug 1% masės yra mažos (0.01 – 0.1 µm) dydžio dulkelės, kurios sugeria ir išsklaido šviesą ir sukelia tarpžvaigždinės ekstinkcijos reiškinį. Spiralinėse vijose esantys molekuliniai debesys yra svarbūs Galaktikos evoliucijos procese, nes juose vyksta aktyvūs žvaigždžių formavimosi procesai. Molekuliniai ir dulkių debesys, jaunų žvaigždžių spiečiai ir asociacijos bei kitos žvaigždžių susidarymo sritys dažniausiai yra Galaktikos plokštumoje. Tačiau dėl gravitacinės ir radiacinės sąveikos tarp jaunų didelės masės žvaigždžių ir molekulinių debesų kai kuriose Paukščių Tako srityse žvaigždėdaros rajonai nukrypsta nuo Galaktikos plokštumos. Viename iš tokių rajonų Cefėjo žvaigždyno kryptimi dalis tarpžvaigždinių debesų ir žvaigždėdaros rajonų yra nukrypę nuo Galaktikos plokštumos link šiaurinio dangaus poliaus ir sudaro Paukščių Tako atšaką, literatūroje žinomą kaip Cepheus Flare. Dauguma šioje disertacijoje tyrinėjamų objektų priklauso šiai Cefėjo atšakai. Šio darbo tikslas yra Cefėjo žvaigždėdaros rajonų, žinomų kaip atspindžio ūkas NGC 7023, tamsiųjų debesų kompleksas TGU 619 ir jaunas spiečius NGC 7129 fotometrinis tyrimas, siekiant nustatyti šių objektų nuotolį ir tarpžvaigždinę ekstinkciją, jauno spiečiaus NGC 7129 ir... [toliau žr. visą tekstą]

Paukščių Tako Galaktikoje didžioji dalis tarpžvaigždinės medžiagos yra susitelkusi į ploną sluoksnį Galaktikos plokštumoje, daugiausiai spiralinėse vijose. Didžiąją dalį tarpžvaigždinės medžiagos sudaro atominės ir molekulinės dujos ir tik maždaug 1% masės yra mažos (0.01 – 0.1 µm) dydžio dulkelės, kurios sugeria ir išsklaido šviesą ir sukelia tarpžvaigždinės ekstinkcijos reiškinį. Spiralinėse vijose esantys molekuliniai debesys yra svarbūs Galaktikos evoliucijos procese, nes juose vyksta aktyvūs žvaigždžių formavimosi procesai. Molekuliniai ir dulkių debesys, jaunų žvaigždžių spiečiai ir asociacijos bei kitos žvaigždžių susidarymo sritys dažniausiai yra Galaktikos plokštumoje. Tačiau dėl gravitacinės ir radiacinės sąveikos tarp jaunų didelės masės žvaigždžių ir molekulinių debesų kai kuriose Paukščių Tako srityse žvaigždėdaros rajonai nukrypsta nuo Galaktikos plokštumos. Viename iš tokių rajonų Cefėjo žvaigždyno kryptimi dalis tarpžvaigždinių debesų ir žvaigždėdaros rajonų yra nukrypę nuo Galaktikos plokštumos link šiaurinio dangaus poliaus ir sudaro Paukščių Tako atšaką, literatūroje žinomą kaip Cepheus Flare. Dauguma šioje disertacijoje tyrinėjamų objektų priklauso šiai Cefėjo atšakai. Šio darbo tikslas yra Cefėjo žvaigždėdaros rajonų, žinomų kaip atspindžio ūkas NGC 7023, tamsiųjų debesų kompleksas TGU 619 ir jaunas spiečius NGC 7129 fotometrinis tyrimas, siekiant nustatyti šių objektų nuotolį ir tarpžvaigždinę ekstinkciją, jauno spiečiaus NGC 7129 ir... [toliau žr. visą tekstą] / The interstellar matter in the Galaxy is concentrated in a thin layer close to the galactic plane, mostly in spiral arms. Most of the interstellar matter is in a form of atomic and molecular gas and only 1% of its mass is in a form of small (0.01 – 0.1 µm) dust grains which absorb and scatter the light of stars and cause the interstellar extinction. A part of interstellar gas and dust are in a diffuse form and fill the space with density which exponentially decreases with the distance from the galactic plane. However, in the spiral arms gigantic molecular clouds are present which play an outstanding role in the evolution of the Galaxy, since in them star forming processes take place. Molecular and dust clouds, young star clusters and associations and other star forming regions are concentrated in the Milky Way plane. However, due to gravitational and radiation interactions between the molecular clouds and the young massive stars, some fragments of spiral arms deviate from the galactic plane. One of such deviating branches from the Local (Orion) spiral arm is a huge elongated system of molecular and dust clouds located in the Cepheus constellation which is known as the Cepheus Flare. Most of the objects investigated in this dissertation belong to this branch of the Local spiral arm. The objects selected for the investigation are star forming regions in the vicinity of the reflection nebula NGC 7023, a group of dark clouds TGU 619, the young open cluster NGC 7129 and the... [to full text]