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The long-term prospective multi-centre nationwide (French) observational study FRANCISCO will provide new information on perimembranous ventricular septal defect with left ventricular overload but no pulmonary hypertension in children older than 1 year. Outcomes will be compared according to treatment strategy (watchful waiting, surgical closure, or percutaneous closure) and anatomic features of the defect. The results are expected to provide additional guidance about the optimal treatment of this specific population, which is unclear at present.
The International Pediatric and Congenital Cardiac Code (IPCCC) states that visceral heterotaxy is defined as “a congenital malformation in which the internal thoraco-abdominal organs demonstrate abnormal arrangement across the left-right axis of the body. By convention, in congenital cardiology, heterotaxy syndrome does not include patients with complete mirror-imaged arrangement of the internal organs along the left-right axis also known as “total mirror imagery” or “situs inversus totalis”.” [www.ipccc.net]
In patients with heterotaxy, it is important to describe both the cardiac relations and the junctional connections of the cardiac segments, with documentation of the arrangement of the atrial appendages, the ventricular topology, the nature of the unions of the segments across the atrioventricular and the ventriculoarterial junctions, the infundibular morphologies, and the relationships of the arterial trunks in space. Particular attention is required for the venoatrial connections, since these are so often abnormal. The relationship and arrangement of the remaining thoraco-abdominal organs, including the lungs, the spleen, the liver, and the intestines, also must be described separately, because, although common patterns of association have been identified, there are frequent exceptions to these common patterns. Therefore, in patients with heterotaxy, it is important to describe each thoracic and abdominal organ independently.
Extensive screening in a newborn with prenatal suspicion of VACTERL syndrome identified an anomalous origin of the left pulmonary artery from the descending aorta with an arterial duct and left aortic arch, and normal intra-cardiac anatomy. Other anatomical anomalies suggested heterotaxy syndrome. At one-month-old, re-implantation of the 3.5 mm left pulmonary artery was performed by direct tension-low anastomosis. Post-operative course was complicated by severe left pulmonary atelectasis, and the patient died 20 days later.
This article presents a computational approach for determining the optimal slip velocities on any given shape of an axisymmetric micro-swimmer suspended in a viscous fluid. The objective is to minimize the power loss to maintain a target swimming speed, or equivalently to maximize the efficiency of the micro-swimmer. Owing to the linearity of the Stokes equations governing the fluid motion, we show that this PDE-constrained optimization problem reduces to a simpler quadratic optimization problem, whose solution is found using a high-order accurate boundary integral method. We consider various families of shapes parameterized by the reduced volume and compute their swimming efficiency. Among those, prolate spheroids were found to be the most efficient micro-swimmer shapes for a given reduced volume. We propose a simple shape-based scalar metric that can determine whether the optimal slip on a given shape makes it a pusher, a puller or a neutral swimmer.
Coronary artery compression by epicardial leads is a rare complication in children and can be difficult to identify with potentially lethal outcomes. Herein, we report the case of a previously asymptomatic paced-dependant 5-year-old girl who presented to our institution with resuscitated cardiac arrest. We describe the atypical sequence of clinical findings misleading initial diagnosis. Hardware failure and the commonly occurring lead fracture were incriminated in the mechanism of cardiac arrest, precipitating implantation of a new pacing system while concealing dynamic compression of the left anterior descending coronary artery.
The hybrid perventricular approach for the closure of trabecular ventricular septal defects is an attractive treatment modality for small children. Worldwide experience has shown that procedure success is influenced by the defect anatomical accessibility, operators’ expertise, and device technical features. In May 2018, a new promising device, the KONAR-Multi-functional™ ventricular septal defect occluder (Lifetech, Shenzhen, China), obtained CE-marking for septal defect transcatheter closure after the first-in-man implantation in 2013. Herein, this is the first report of successful perventricular closure of ventricular septal defect using this new device in a child with significant co-morbidities.
In this article we estimate the relative contributions to the gender pension gap of career duration and income earned at different points along the pension income distribution, as well as the role played by minimum pensions and other partly or wholly non-contributory policies in reducing this gap. Our research covers all retirees in France in 2012 employed in the public or private sector at least once in their lifetimes. We first highlight that at every point in the distribution, the gender pension gap is wider for private-sector retirees than for those in the public sector. This is because public sector careers are less fragmented and because the calculation of the public sector reference wage does not penalize career interruptions so heavily. This relative advantage of women in the public sector is probably an additional factor explaining their over-representation in this sector. Applying the decomposition method proposed by Firpo et al. (2007, 2009), we show that composition differences in the gender pension gap are essentially due to differences in contribution periods and wages, with a smaller effect of career duration in the public sector than in the private. In the first deciles, the gap can be attributed largely to differences in career duration. This effect gradually weakens, and differences in the reference wage become the main explanation. We also show that minimum contributory pensions play an extremely important role in limiting the gender pension gap in the first deciles, essentially in the private sector. Last, we show that in all cases the unexplained share of the pension gap is substantial only at the bottom of the distribution and, to a lesser extent, in the top decile. The unexplained share is generally smaller than the explained one and favours men.
Percutaneous closure is the gold standard treatment for atrial septal defects, but the procedure can be complex in case of femoral thrombosis. Although unusual for congenital interventionists, transhepatic atrial septal defect closure is an attractive alternative to the internal jugular vein, especially when approaching the interatrial septum. Herein, we report the case of an adult patient with significant co-morbidities who had successful transhepatic atrial septal defect closure after a failed transjugular attempt. We describe the use of an absorbable haemostatic gelatin sponge to efficiently and safely achieve haemostasis after the use of a large vascular sheath with combined anticoagulation and antiplatelet therapy.
L’étude de la mémoire autobiographique dans l’autisme a été principalement réalisée chez l’adulte  et plus rarement chez l’enfant, révélant principalement des déficits en mémoire épisodique . Il n’existe qu’une étude chez l’adolescent  cherchant à caractériser les souvenirs épisodiques, incluant notamment leurs propriétés sensorielles. L’objectif de notre étude est d’évaluer les productions épisodiques d’événements à la fois passés et futurs, chez des adolescents avec trouble du spectre autistique, en utilisant un support et en explorant les détails phénoménologiques, émotionnels et les capacités de récollection.
Matériel et méthodes
Un échantillon de 16 adolescents avec un diagnostic de trouble du spectre autistique sans déficience intellectuelle (TSA-SDI), et un groupe de 16 enfants au développement typique, ont réalisé une tâche de mémoire autobiographique originale, ludique et contrôlée, comprenant à la fois une évaluation rapide et indicée de la composante sémantique et plus détaillée de la composante épisodique.
Les participants avec TSA-SDI présentent des difficultés de restitution des souvenirs épisodiques comparés aux témoins et bénéficient significativement de l’indiçage. Au niveau des propriétés perceptives, les adolescents avec TSA fournissent moins de couleurs que les témoins, alors que le nombre total de détails perceptifs ne diffère pas entre les deux groupes. Enfin, la reviviscence diffère selon la période évoquée : la reviviscence d’évènements passés est moins précise que la projection dans le futur.
Ces résultats confirment l’existence de troubles en mémoire épisodique chez les adolescents avec TSA-SDI, améliorés en présence d’un support visuel. Les propriétés sensorielles semblent être impliquées différemment dans l’organisation des souvenirs, notamment les couleurs, probablement en relation avec une perception atypique chez les personnes avec TSA-SDI . L’impact de la perception des couleurs sur la mémoire est une piste de recherche à approfondir.
Clinical experiences in war areas: Croatia for Bosnian Women, Rwanda and kabul
1. Immediate reaction
1.1 Disclose of war rape in medical secrecy following
- Mental health acute disorder
- Genital Infections or haemorrhages
- and mostly when women got unwanted pregnancy
1.2 Unwanted pregnancies may be an indicator of war rape
- Some women disclose rape during the first trimester and ask for terminations even if the country has not legalized abortion in its law.
- Other book lately their pregnancy because either they conceal it to their family or they deny it. Some experience harmful or violent thoughts against the fetus. Newborns are at risk of neonaticide and abandonment at birth. Some do not want to disclose their identity while coming to maternity wards.
1.3 A collective panic may happen if the war rape is disclosed in the media. In this case every effort should be made to prevent stigmatization of babies born as the result of war rape.
2. Long-term reaction
Most of women victim of war rape keep silent for a long time.If they develop symptoms like depression, PTSD, social phobia, sexual dysfunction, psychosomatic diseases, etc., they may disclose later the abuse during a medical examination, another pregnancy, a psychiatry follow up or a psychotherapy.
Women who have brought up children as the result of rape may ask child psychiatrists for managing their boundings and their questions.
Healthcare professionals working in migrant centre need to be trained to detec such war rape consequences.
Adolescent depressive symptoms are recognized as having number of consequences on academic and social achievement (Glied & Pine, 2002). Many studies highlighted the specific implication of emotion regulation deficits to explain depression or affective disorders (Garnefski & Kraaij, 2006). Despite these findings, little studies focused on the relations between emotional deficits (such as low emotional awareness) and subjective emotional intensity in adolescent depressive symptoms. The aim of this study was to examine the relationships between emotion awareness as defined by Lane & Schwartz (1987), subjective emotional intensity, and depressive symptoms. We hypothesized that lack of emotional awareness associated to strong emotional intensity may explain depressive symptoms among adolescents.
448 adolescents (age: 15.54 years 0.66) were administered the following self report questionnaires:
• The Level of Emotional Awareness Scale (Lane & al. 1990).
• The Differential Emotion Scale (Izard & al. 1991).
• The Centre for Epidemiological Study Depression scale (Radloff, 1977).
Statistical analysis shows significant negative correlations between emotional awareness and depression(r=-.23, p=.004), and positive correlations between subjective emotional intensity and depression r=.44, p< .0001). Moreover, multiple regressions revealed that level of emotional awareness (t= -4,75, β= -.20., p< .0001) and emotional intensity (t= 9,71, β=.41, p< .0001) were each related to depression in a significant model (R2=.25, F=48,01, p< .001). Lack of emotional awareness may lead to high level of subjective emotional intensity, and constitute a real vulnerability for affective disorders. This suggests that emotional awareness skills training could be an effective intervention for depressive symptoms at adolescence.
From 1987 to 2002, I followed nine women who killed their baby newborn and nearly ninety women who denied their pregnancy or their delivery in Paris area. A comparison between the clinical findings of the two groups led me to identify prevention strategy at a prenatal stage:
1. Detecting harmful thoughts towards the baby before birth
Among the women who denied or concealed their pregnancy some revealed having negative or violent impulse thoughts against the foetus after the end of pregnancy denial. Some also displayed suicidal impulse thoughts. These harmful thoughts decreased after they spoke out past traumatic sexual abuse, especially if the foetus was the result of rape.
2. Listening and planning the delivery time
Some were not able to content their thoughts and act out them in beating up their abdomen and consequently the foetus. They felt so guilty they avoided planning the delivery time as a consequence. Some have killed their child because they were afraid to explain this to healthcare professionals. They denied the birth and delivered alone.
3. Offering an anonymous welcome if they wish to do so
I observed that to welcome with anonymity before birth increased their care for the future of the newborn.
Deregulations of peripheral control of food intake in anorexia nervosa (AN), hunger signals (Ghrelin & obestatin) and satiety signals (leptin & insulin), have been reported. However, these differences could be a consequence or a risk factor of the disease. The genetic approach seems to be a good strategy to analyse this issue. Indeed, AN has a high heritability of ~50-80%.
The aims of this study are to confirm deregulation of hunger and satiety signals in AN and to analyze these results according to genetic polymorphisms. Furthermore, we search for an endophenotype by the screening of the AN mothers.
This work recruited 3 populations: 100 anorexic patients recruited at CMME (Sainte-Anne Hospital, Paris), their mothers, and 200 control women, matched with the patients or relatives for age. All subjects were assessed during a morning day at CMME. They arrived at 8:30am, fasting since the day before, to take a blood sample, in order to carry out genetic and physiologic analyses. Then, they were analysed for Body Mass Index and eating behaviors, including a psychiatric interview (DSM-IV-TR criteria) and self-questionnaires. Dosage of ghrelin, obestatin, and leptin were done by EIA or RIA. Single nucleotide polymorphisms were genotyped by Taqman assay.
We have confirmed that peripheral control mechanism of food intake is deregulated in AN patients and we observe difference also between mothers and controls.
Leptin dosage might be an endophenotype for anorexia nervosa.
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.
Understanding of the causes and correlations for algorithmic decisions is currently one of the major challenges of computer science, addressed under an umbrella term “explainable AI (XAI)”. Being able to explain an AI-based system may help to make algorithmic decisions more satisfying and acceptable, to better control and update AI-based systems in case of failure, to build more accurate models, and to discover new knowledge directly or indirectly. On the legal side, the question whether the General Data Protection Regulation (GDPR) provides data subjects with the right to explanation in case of automated decision-making has equally been the subject of a heated doctrinal debate. While arguing that the right to explanation in the GDPR should be a result of interpretative analysis of several GDPR provisions jointly, the authors move this debate forward by discussing the technical and legal feasibility of the explanation of algorithmic decisions. Legal limits, in particular the secrecy of algorithms, as well as technical obstacles could potentially obstruct the practical implementation of this right. By adopting an interdisciplinary approach, the authors explore not only whether it is possible to translate the EU legal requirements for an explanation into the actual machine learning decision-making, but also whether those limitations can shape the way the legal right is used in practice.