A 27 year-old man initially considered as a schizophrenic patient was later diagnosed as having Kleine-Levin syndrome.

Depuis plusieurs années, la nécessité des interventions précoces dans le champ du trouble des spectres autistiques est mise au premier plan. Trois grandes questions peuvent être posées autour des interventions précoces : pourquoi intervenir précocement ? Quels objectifs visés précocement ? Et enfin comment intervenir précocement ? Pourquoi intervenir précocement ? La première raison est liée à la physiopathologie du trouble neurodéveloppemental qu’est l’autisme et aux avancées majeures dans la compréhension du fonctionnement cérébral obtenu ces dernières années. On sait en effet que le développement cérébral précoce est marqué par une très forte plasticité qui rend compte en partie de la complexité de la cyto-architecture cérébrale, plasticité sur laquelle s’appuie l’efficacité des rééducations neurofonctionnelles précoces dans la communication sociale. Quels objectifs visés précocement ? Les interventions précoces doivent être mises en place après une évaluation clinique et fonctionnelle individualisée extrêmement précise pour caractériser pour chaque enfant le ou les secteurs de développement qui sont plus particulièrement atteints et dans chacun de ces secteurs de développement quelles sont les étapes qui ne sont pas acquises, à l’âge chronologique de l’enfant. La connaissance de la clinique est donc particulièrement importante avec non seulement les deux dimensions principales de l’autisme (aloneness et sameness) mais également la compréhension du développement dans les autres secteurs du développement. Comment intervenir précocement ? Un ensemble de thérapies types développementales précoces sont ainsi répertoriées. On peut citer la thérapie d’échange et de développement qui a pour but le développement des fonctions de synchronisation sociale en tenant compte des particularités individuelles. Ces thérapies individuelles sont toujours associées à des prises en charges en petit groupe où sont également exercées ces fonctions d’habilité de communication sociale. L’enjeu de la pise en place de ces traitements précoces est crucial pour garantir les meilleures conditions d’évolution clinique.

Pulmonary hypertension is a complex and progressive condition that is either idiopathic or heritable, or associated with one or multiple health conditions, with or without congenital or acquired cardiovascular disease. Recent developments have tremendously increased the armamentarium of diagnostic and therapeutic approaches in children and young adults with pulmonary hypertension that is still associated with a high morbidity and mortality. These modalities include non-invasive imaging, pharmacotherapy, interventional and surgical procedures, and supportive measures. The optimal, tailored diagnostic and therapeutic strategies for pulmonary hypertension in the young are rapidly evolving but still face enormous challenges: Healthcare providers need to take the patient’s age, development, disease state, and family concerns into account when initiating advanced diagnostics and treatment. Therefore, there is a need for guidance on core and advanced medical training in paediatric pulmonary hypertension. The Association for European Paediatric and Congenital Cardiology working group “pulmonary hypertension, heart failure and transplantation” has produced this document as an expert consensus statement; however, all recommendations must be considered and applied in the context of the local and national infrastructure and legal regulations.

The influence of a strong external magnetic field on the collimation of a high Mach number plasma flow and its collision with a solid obstacle is investigated experimentally and numerically. The laser irradiation ( $I\sim 2\times 10^{14}~\text{W}\cdot \text{cm}^{-2}$ ) of a multilayer target generates a shock wave that produces a rear side plasma expanding flow. Immersed in a homogeneous 10 T external magnetic field, this plasma flow propagates in vacuum and impacts an obstacle located a few mm from the main target. A reverse shock is then formed with typical velocities of the order of 15–20 $\pm$ 5 km/s. The experimental results are compared with 2D radiative magnetohydrodynamic simulations using the FLASH code. This platform allows investigating the dynamics of reverse shock, mimicking the processes occurring in a cataclysmic variable of polar type.

The Lembo clay deposit occurs on orthogneiss, but it also comprises clays with litho-relicts of volcanic rocks. In this study, ten samples from two sites were investigated. The mineralogical compositions consisted of kaolinite + halloysite + illite + quartz + hematite + anatase ± rutile ± orthoclase ± sanidine ± magnetite ± maghemite ± goethite ± Ba-Al-Fe-phosphates ± carbonates ± sulphates. Kaolinite-halloysite and quartz are the prevailing minerals. Some volcanicderived clays contain Fe-rich kaolinite-halloysite (9.6–14.1 wt.% Fe2O3). The chemical compositions, colours and specific surface area (SSA) measurements reveal two groups of clays: one with a positive whiteness index (IB), small SSA and small Fe content, and the other showing a large SSA, negative IB and relatively large Fe contents. The compositions of the first group are close to those of clays from the Mayouom deposit (Cameroon), and from some European commercial kaolins used in ceramics. Relatively Fe-rich clay materials may conform to most formulations of earthen bricks. As a whole, the Lembo clay deposit comprises various compositions of kaolinitic clays, which may yield the opportunity for extensive application in ceramics.

A new target design is presented to model high-energy radiative accretion shocks in polars. In this paper, we present the experimental results obtained on the GEKKO XII laser facility for the POLAR project. The experimental results are compared with 2D FCI2 simulations to characterize the dynamics and the structure of plasma flow before and after the collision. The good agreement between simulations and experimental data confirms the formation of a reverse shock where cooling losses start modifying the post-shock region. With the multi-material structure of the target, a hydrodynamic collimation is exhibited and a radiative structure coupled with the reverse shock is highlighted in both experimental data and simulations. The flexibility of the laser energy produced on GEKKO XII allowed us to produce high-velocity flows and study new and interesting radiation hydrodynamic regimes between those obtained on the LULI2000 and Orion laser facilities.

Animal health planning activities are not always providing a satisfactory positive impact on herd health and welfare. Moreover, evaluating the impact of advisory programmes is complex due to multiple interacting elements that influence its outcome. Therefore, measuring solely health outcomes is not sufficient: the whole process of the implementation and use of such programmes should be evaluated. In order to evaluate the impact of an intervention with a Herd Health and Production Management (HHPM) programme a process evaluation framework was designed and used. The intervention involved 20 organic dairy cattle farmers and their advisors, in both France and Sweden. In both countries 20 organic dairy farms were selected as control herds. The evaluation of the HHPM programme was based on: (a) the compliance to the programme; (b) the programme’s functions influencing herd health management practices and stimulating dialogue between farmers and advisors; (c) its effectiveness in terms of improving herd health compared with control farms. Complete compliance to the programme was fulfilled by 21 out of 40 farmers–advisors. Results from a questionnaire showed that the programme functioned as intended (e.g. by allowing early identification of herd health problems), stimulated change in farmers’ herd health management practices and farmer–advisor dialogue. Even though the majority of the users perceived that the programme contributed to herd health improvements, no significant differences in health outcomes were found when compared with control farms 12 months after the start of the intervention. The programme allowed creating an environment promoting the exchange of information between farmers and advisors, necessary to define pertinent advice in a farm-specific situation. Future research should aim at improving methods for the evaluation of the effect of advisory programmes, by identifying early indicators for effective advice and developing methods to evaluate the quality of advisory situations without interfering with them.

Different treatment options for pulmonary hypertension have emerged in recent years, and evidence-based management strategies have improved quality of life and survival in adults. In children with pulmonary vascular disease, therapeutic algorithms are not so clearly defined; this study determined current treatment initiation in children with pulmonary hypertension in participating centres of a registry.

Through the multinational Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension registry, patient demographics, diagnosis, and treatment as judged and executed by the local physician were collected. Inclusion criteria were >3 months and <18 years of age and diagnostic cardiac catheterisation consistent with pulmonary hypertension (mean pulmonary arterial pressure ⩾25 mmHg, pulmonary vascular resistance index ⩾3 Wood units×m2, and mean pulmonary capillary wedge pressure ⩽12 mmHg).

At diagnostic catheterisation, 217/244 patients (88.9%) were treatment naïve for pulmonary hypertension-targeted therapy. Targeted therapy was initiated after catheterisation in 170 (78.3%) treatment-naïve patients. A total of 19 patients received supportive therapy, 28 patients were not started on therapy, and 26 patients (10.7%) were on targeted treatment before catheterisation. Among treatment-naïve subjects, treatment was initiated with one targeted drug (n=112, 51.6%), dual therapy (n=39, 18%) or triple-therapy (n=5, 2.3%), and calcium channel blockers with one targeted medication in one patient (0.5%). Phosphodiesterase inhibitors type 5 were used frequently; some patients with pulmonary hypertension related to lung disease received targeted therapy.

There is a diverse therapeutic approach for children with pulmonary hypertension with a need of better-defined treatment algorithms based on paediatric consensus for different aetiologies including the best possible diagnostic workup.

Both white and brown adipose tissues are recognized to be differently involved in energy metabolism and are also able to secrete a variety of factors called adipokines that are involved in a wide range of physiological and metabolic functions. Brown adipose tissue is predominant around birth, except in pigs. Irrespective of species, white adipose tissue has a large capacity to expand postnatally and is able to adapt to a variety of factors. The aim of this review is to update the cellular and molecular mechanisms associated with pre- and postnatal adipose tissue development with a special focus on pigs and ruminants. In contrast to other tissues, the embryonic origin of adipose cells remains the subject of debate. Adipose cells arise from the recruitment of specific multipotent stem cells/progenitors named adipose tissue-derived stromal cells. Recent studies have highlighted the existence of a variety of those cells being able to differentiate into white, brown or brown-like/beige adipocytes. After commitment to the adipocyte lineage, progenitors undergo large changes in the expression of many genes involved in cell cycle arrest, lipid accumulation and secretory functions. Early nutrition can affect these processes during fetal and perinatal periods and can also influence or pre-determinate later growth of adipose tissue. How these changes may be related to adipose tissue functional maturity around birth and can influence newborn survival is discussed. Altogether, a better knowledge of fetal and postnatal adipose tissue development is important for various aspects of animal production, including neonatal survival, postnatal growth efficiency and health.

Arid Mediterranean regions that shelter unique biodiversity are threatened by increasing anthropogenic pressures, such as urbanization, overgrazing and climate change. In Morocco, one of the main bush species in arid areas, the jujube (Ziziphus lotus), suffers from officially promoted programmes of removal. The Moorish tortoise (Testudo graeca soussensis) is threatened by such habitat loss. Like most animals, the Moorish tortoise must navigate between microhabitats to find essential feeding resources and thermal refuges. This study combined radio-tracking of free-ranging individuals, microhabitat temperature monitoring and transects in a range of habitats. Tortoises were found to depend on the occurrence of large and relatively abundant bushes to escape lethal overheating. Thus, (1) current official encouragements for the destruction of the jujube bushes should be reappraised; (2) habitat restoration relying on replanting jujube bush should be encouraged; and (3) large-scale monitoring of critical bush densities should be used to better organize conservation plans (protection and/or restoration of areas) for the Moorish tortoise.

Three different stages of pig antral follicles have been studied in a granulosa-cell transcriptome analysis on nylon microarrays (1152 clones). The data have been generated from seven RNA follicle pools and several technical replicates were made. The objective of this paper was to state the feasibility of a transcriptomic protocol for the study of folliculogenesis in the pig. A statistical analysis was chosen, relying on the linear mixed model (LMM) paradigm. Low variability within technical replicates was hence checked with a LMM. Relevant genes that might be involved in the studied process were then selected. For the most significant genes, statistical methods such as principal component analysis and unsupervised hierarchical clustering were applied to assess their relevance, and a random forest analysis proved their predictive value. The selection of genes was consistent with previous studies and also allowed the identification of new genes whose role in pig folliculogenesis will be further investigated.

Various sources of germination heterogeneity of carrot (Daucus carota L.) seeds were investigated: germination conditions (temperature, oxygen tension), size of seeds, position of the umbels on the mother plants, and pollination conditions of male-sterile plants in hybrid seed production. All seeds tested germinated over a large range of temperatures (5–35°C). However, low temperatures (5–10°C) and temperatures above 30°C reduced germination. Seeds were also sensitive to oxygen deprivation, but their sensitivity to hypoxia depended on the cultivar. The germination responses of seeds to temperature and oxygen depended on their size, particularly at sub- and supra-optimal temperatures. The largest seeds (1.8–2.1 mm) of commercial lots usually germinated better at 5°C and were more sensitive to oxygen deprivation than the smallest ones (1.2–1.8 mm). Experiments performed with open pollinated plants showed that seeds produced by umbels of first and second orders germinated faster and at higher percentages than those collected on third-order umbels. Evidence for the involvement of pollination conditions in the germination quality of carrot seeds was given by pollination by honey bees of male-sterile plants cultivated at various distances from the pollen donors. The longer the distance of the mother plants from the pollinating plants, the lower the seed yield, the heavier the mean seed weight, the more difficult the germination of seeds, and the higher their sensitivity to oxygen deprivation.

An outbreak of infection with vancomycin-resistant Enterococcus faecium occurred at Hôtel-Dieu Hospital (Clermont-Ferrand, France). A case-control study was performed in the infectious diseases and hematology units of the hospital. Urinary catheter use (odds ratio [OR], 12 [95% confidence interval {CI}, 1.5-90]; P<.02), prior exposure to a third-generation cephalosporin (OR, 22 [95% CI, 3-152]; P = .002), and prior exposure to antianaerobials (OR, 11 [95% CI, 1.5-88]; P<.02) were independently predictive of vancomycin-resistant Enterococcus faecium carriage.

Summary

Background and objective: Inhalation induction with sevoflurane provides acceptable conditions for tracheal intubation. Opioids significantly decrease the alveolar concentration needed to achieve tracheal intubation. The purpose of this study was to determine the target concentration of remifentanil providing excellent conditions for tracheal intubation with sevoflurane at 1 minimum alveolar concentration without muscle relaxant. Methods: Twenty-four consecutive patients, aged 18–50 yr, ASA I or II, were studied. Induction of anaesthesia was performed with sevoflurane at age-adjusted minimum alveolar concentration. Remifentanil was simultaneously administered using target-controlled infusion with the Minto model. Target plasma concentration of remifentanil was selected for each patient according to an up-and-down method. Results: The mean target concentration of remifentanil for successful tracheal intubation was 3.3 ng mL−1 (95% confidence interval: 2.6–3.9 ng mL−1). Arterial pressure, heart rate and bispectral index did not increase after tracheal intubation in the group of patients with successful intubation. Conclusions: Remifentanil at 3.3 ng mL−1 together with sevoflurane at 1 minimum alveolar concentration provides excellent conditions for tracheal intubation in 50% of patients.