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A doença de Chagas é uma enfermidade endêmica nas Américas e tem como agente etiológico o protozoário flagelado Trypanosoma cruzi, que infecta uma diversidade de mamíferos e tem como vetores os insetos triatomíneos. Os cães são considerados reservatórios de importância epidemiológica devido ao seu papel de sentinela, proximidade com os seres humanos e manutenção do ciclo de transmissão em ambientes domésticos e peridomésticos. O objetivo deste trabalho foi evidenciar os aspectos clínicos e epidemiológicos da doença de Chagas em cães enfatizando a etiologia, ciclo biológico, terapêutica e profilaxia. Foi realizada uma revisão bibliográfica no banco de dados do Public Medline (PUBMED), Scientific Electronic Library (SCIELO), Biblioteca Virtual em Medicina Veterinária e Zootecnia (BVS-Vet), Biblioteca Virtual em Saúde Brasil (BVS Brasil), Elsevier, Pubvet e Oxford academy no período de 2007 a 2022. Os critérios de inclusão foram artigos publicados nos idiomas inglês e português. No Brasil, as espécies de triatomíneos apresentam ampla distribuição espacial e potencial invasor, facilitada por alterações frequentes no ambiente natural, causadas por atividades antrópicas. A infecção apresenta-se sob duas fases distintas, a fase aguda com uma miocardite ou encefalite em cães jovens e a fase crônica, uma cardiomiopatia dilatada em cães idosos. Os cães infectados geralmente apresentam uma cardiomiopatia, sendo o principal sintoma responsável pela alta morbidade e mortalidade dos animais. Os estudos apontaram que a doença é de difícil diagnóstico, em virtude de diversos fatores, dentre eles, a ausência de um teste padrão ouro, a possibilidade de reação sorológica cruzada com anticorpos para Leishmania, a ocorrência inconsistente de parasitemia e a rara detecção de amastigotas do parasita em cortes histológicos. O tratamento da doença de Chagas constitui um grande desafio, pois os medicamentos disponíveis, benznidazol (BZ) e nifurtimox (NF), apresentam eficácia limitada e efeitos colaterais graves, principalmente na fase crônica. A prevenção e o controle da doença de Chagas estão amplamente focados na redução do contato do cão com os vetores.

O SARS-CoV-2 é altamente contagioso e é transmitido rapidamente por via respiratória. Os focos iniciais de transmissão da COVID-19 no Brasil ocorreram nos estados de São Paulo e do Rio de Janeiro, com disseminação célere para as restantes das capitais. Nos primeiros meses, o Ceará liderou posições no Nordeste e no Brasil em número de casos confirmados da doença. Esta não apresenta distribuição de forma homogênea nas regiões do país, especialmente em regiões interioranas. Dessa forma, este estudo tem como objetivo avaliar a dinâmica dos dados epidemiológicos dos casos de COVID-19 na Região Metropolitana do Cariri cearense. Efetuou-se uma pesquisa descritiva de natureza qualitativa e método dedutivo, a qual foi verificada a distribuição de casos na Região Metropolitana do Cariri (RMC) através de dados por meio do Boletim Epidemiológico Novo Coronavírus (COVID-19), disponível no site do IntegraSUS da Secretaria da Saúde do Ceará. Os resultados mostraram que, até o dia 30 de junho de 2022, contabilizam 245.382 casos notificados, sendo 94.408 confirmados da COVID-19, distribuídos em todos os 9 municípios da RMC. Desse total de casos confirmados, 89.400 casos são casos recuperados, equivalente a 94,69%. O número de óbitos notificados foi 1.500, sendo a taxa de letalidade em 1,6%. Atualmente, foram registrados 266.369 exames, sendo 36,2% testes rápidos para antígenos, seguidos de 35,4% de testes rápidos para pesquisa de anticorpos IGG, 24,3% RT-PCR e os demais números somam teste sorológico para pesquisa de anticorpos IgG e IgM, ECLIA, ELISA, RT-LAMP e Imunocromatografia. Em relação ao quadro sociodemográfico, há predominância da contaminação em mulheres, em indivíduos pardos e na faixa etária de 20 a 44 anos. Desse modo, embora o auge da pandemia causada pelo vírus SARS-CoV-2 já tenha sido superado em grande parte do mundo graças, principalmente, à vacinação em massa, a COVID-19 persiste como um problema de saúde pública que deve ser constantemente monitorado e estudado, com o fito de demonstrar caminhos para a criação de estratégias que visem o enfrentamento de epidemias.

Introduction:The management of out-of-hospital traumatic cardiac arrest (TCA) for professional rescuers entails Advanced Life Support (ALS) with specific actions to treat the potential reversible causes of the arrest: hypovolemia, hypoxemia, tension pneumothorax (TPx), and tamponade. The aim of this study was to assess the impact of specific rescue measures on short-term outcomes in the context of resuscitating patients with a TCA.Methods:This retrospective study concerns all TCA patients treated in two emergency medical units, which are part of the Northern French Alps Emergency Network (RENAU), from January 2004 through December 2017. Utstein variables and specific rescue measures in TCA were compiled: fluid expansion, pelvic stabilization, tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at Day 30 with good neurological status (Cerebral Performance Category [CPC] score CPC 1 and CPC 2).Results:In total, 287 resuscitation attempts in TCA were included and 279 specific interventions were identified: 262 fluid expansions, 41 pelvic stabilizations, five tourniquets, and 175 bilateral thoracostomies (including 44 with TPx).Conclusion:Among the standard resuscitation measures to treat the reversible causes of cardiac arrest, this study found that bilateral thoracostomy and tourniquet application on a limb hemorrhage improve survival in TCA. A larger sample for pelvic stabilization is needed.

Purpose During thermal laser processes, heat transfer and fluid flow in the melt pool are primary driven by complex physical phenomena that take place at liquid/vapor interface. Hence, the choice and setting of front description methods must be done carefully. Therefore, the purpose of this paper is to investigate to what extent front description methods may bias physical representativeness of numerical models of laser powder bed fusion (LPBF) process at melt pool scale. Design/methodology/approach Two multiphysical LPBF models are confronted: a Level-Set (LS) front capturing model based on a C++ code and a front tracking model, developed with COMSOL Multiphysics® and based on Arbitrary Lagrangian–Eulerian (ALE) method. To do so, two minimal test cases of increasing complexity are defined. They are simplified to the largest degree, but they integrate multiphysics phenomena that are still relevant to LPBF process. Findings LS and ALE methods provide very similar descriptions of thermo-hydrodynamic phenomena that occur during LPBF, providing LS interface thickness is correctly calibrated and laser heat source is implemented with a modified continuum surface force formulation. With these calibrations, thermal predictions are identical. However, the velocity field in the LS model is systematically underestimated compared to the ALE approach, but the consequences on the predicted melt pool dimensions are minor. Originality/value This study fulfils the need for comprehensive methodology bases for modeling and calibrating multiphysical models of LPBF at melt pool scale. This paper also provides with reference data that may be used by any researcher willing to verify their own numerical method.

International audience; INTRODUCTION: Traumatic cardiac arrest (TCA) guidelines emphasize specific actions that aim to treat the potential reversible causes of the arrest. The aim of this study was to measure the impact of these recommendations on specific rescue measures carried out in the field, and their influence on short-term outcomes in the resuscitation of TCA patients. METHODS: We conducted a retrospective study of all TCA patients treated in two emergency medical units, which are part of the Northern Alps Emergency Network, from January 2004 to December 2017. We categorised cases into three periods: pre-guidelines (from January 2004 to December 2007), during guidelines (from January 2008 to December 2011), and post-guidelines (from January 2012 to December 2017). Local guidelines, a physician education programme, and specific training were set up during the post-guidelines period to increase adherence to recommendations. Utstein variables, and specific rescue measures were collected: advanced airway management, fluid administration, pelvic stabilisation or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at day 30 with good neurological status (cerebral performance category scores 1 and 2) in each period, considering the pre-guidelines period as the reference. RESULTS: There were 287 resuscitation attempts in the TCA cases included, and 279 specific interventions were identified with a significant increase in the number of fluid expansions (+16%), bilateral thoracostomies (+75%), and pelvic stabilisations (+25%) from the pre- to post-guidelines periods. However, no improvement in survival over time was found. CONCLUSION: Reversible measures were applied but to a varying degree, and may not adequately capture pre-hospital performance on overall TCA survival.

Atualmente compreende-se os coronavírus como importantes agentes virais causadores de infecções em animais e humanos, sendo de interesse da saúde única. Realizou-se uma revisão de literatura acerca da infecção do SARS- CoV-2, analisando brevemente evidências desse agente patógeno em felinos domésticos, suas implicações na saúde única e as provas de diagnóstico em animais. Verificou-se que o coronavírus felino (FCoV), causador da Peritonite Infecciosa Felina, apresenta semelhanças ao coronavírus humano (HCoV) que acarreta a infecção da Síndrome Respiratória Aguda Grave (SARS). Nesse contexto, urge a necessidade de investigar criteriosamente o patógeno Sars-CoV-2 no intuito de compreender melhor seu ciclo biológico.

Although lithium is widely used in current practice to treat bipolar disorder (BD) and treatment-resistant major depressive disorder (MDD) among older adults, little is known about its efficacy and tolerability in this population, which is generally excluded from randomized clinical trials. The objective of this study was to evaluate the efficacy and tolerability of long-term use of lithium among older adults with BD and MDD.Data from the Cohort of individuals with Schizophrenia and mood disorders Aged 55 years or more (CSA) were used. Two groups of patients with BD and MDD were compared: those who were currently receiving lithium versus those who were not. The effects of lithium on psychiatric (i.e., depressive symptoms severity, perceived clinical severity, rates of psychiatric admissions in the past-year), geriatric (overall and cognitive functioning) and physical outcomes (i.e., rates of non-psychiatric medical comorbidities and general hospital admissions in the past-year) were evaluated. All analyses were adjusted for age, sex, duration of disorder, diagnosis, smoking status, alcohol use, and use of antipsychotics, antiepileptics or antidepressants.Among the 281 older participants with BD or MDD, 15.7% were taking lithium for a mean duration of 12.5(SD = 11.6) years. Lithium use was associated with lower intensity of depressive symptoms, reduced perceived clinical global severity and lower benzodiazepine use (all p 0.05), without being linked to greater rates of medical comorbidities, except for hypothyroidism.Data were cross-sectional and data on lifetime history of psychotropic medications was not assessed.Our results suggest that long-term lithium use may be efficient and relatively well-tolerated in older adults with BD or treatment-resistant MDD.

International audience; The lactic acid bacterium Streptococcus thermophilus was believed to display only two distinct proteases at the cell surface, namely, the cell envelope protease PrtS and the housekeeping protease HtrA. Using peptidomics, we demonstrate here the existence of an additional active cell surface protease, which shares significant homology with the SepM protease of Streptococcus mutans. Although all threeproteases—PrtS, HtrA, and SepM—are involved in the turnover of surface proteins, they demonstrate distinct substrate specificities. In particular, SepM cleaves proteins involved in cell wall metabolism and cell elongation, and its inactivation has consequences for cell morphology. When all three proteases are inactivated, the residual cell-surface proteolysis of S. thermophilus is approximately 5% of that of the wildtype strain.IMPORTANCE Streptococcus thermophilus is a lactic acid bacterium used widely as a starter in the dairy industry. Due to its “generally recognized as safe” status and its weak cell surface proteolytic activity, it is also considered a potential bacterial vector for heterologous protein production. Our identification of a new cell surface protease made it possible to construct a mutant strain with a 95% reduction in surface proteolysis, which could be useful in numerous biotechnological applications

Background: Anomalous aortic origin of the right coronary artery is known to be a cause of sudden cardiac death in athletes. There are no specific guidelines concerning treatment strategy in the literature. The aim of this study is to describe and report our experience of direct reimplantation technique in the treatment of this anomaly. Methods: This was a retrospective single center study of 30 patients who underwent surgery in the congenital heart disease unit of Louis Pradel Heart and Lung Hospital between January 2003 and December 2016. The mean follow-up was seven years (3 months-17 years). Results: Thirty patients underwent surgery. The median age was 17 years (0.2-52 years). There were 24 males. The median weight was 58 kg (3.6-118 kg). Fourteen patients were actively engaged in sports. Twenty-six patients had exertional chest pain or syncope. The median time lapse between diagnosis and intervention was 4.5 months (0.5-179 months). Twenty-seven (90%) patients underwent reimplantation of the anomalous coronary artery without transverse aortotomy, while in 3 (10%) patients transverse aortotomy was used to facilitate reimplantation to avoid tension at the anastomosis. There was no early death; one late death occurred in the third postoperative month. At the last follow-up, all patients had returned to normal physical activity without evidence of ischemia. Conclusions: Direct reimplantation allows for a complete restoration of the coronary anatomy and enables patients to return to normal physical activity. Our study shows encouraging results using a direct reimplantation technique without aortotomy.

Apparently, balanced chromosomal rearrangements usually have no phenotypic consequences for the carrier. However, in some cases, they may be associated with an abnormal phenotype. We report herein the case of a 4-year-old boy presenting with clinically isolated supravalvular aortic stenosis (SVAS). No chromosomal imbalance was detected by array CGH. The karyotype showed a balanced paracentric chromosome 7 inversion. Breakpoint characterization using paired-end whole-genome sequencing (WGS) revealed an ELN gene disruption in intron 1, accounting for the phenotype. Family study showed that the inversion was inherited, with incomplete penetrance. To our knowledge, this is the first case of a disruption of the ELN gene characterized by WGS. It contributes to refine the genotype-phenotype correlation in ELN disruption. Although this disruption is a rare etiology of SVAS, it cannot be detected by the diagnostic tests usually performed, such as array CGH or sequencing methods (Sanger, panel, or exome sequencing). With the future perspective of WGS as a diagnostic tool, it will be important to include a structural variation analysis in order to detect balanced rearrangements and gene disruption.

O novo coronavírus, SARS-COV-2, foi declarado como uma pandemia pela Organização Mundial da Saúde (OMS), devido a rápida transmissão entre humanos e a disseminação intercontinental. Por causar graves problemas de saúde humana, com altos números de taxas de mortalidade e enormes encargos econômicos que exigem uma demanda urgente de um desenvolvimento seguro e eficaz de vacinas. Esse trabalho teve como objetivo analisar o atual cenária das pesquisas de Sars-Cov-2 frente aos ensaios laboratoriais utilizando modelos de animais na busca promissora de vacinas e agentes terapêuticos eficazes. Foi realizado uma pesquisa de revisão de literatura no banco de dados do Public Medline, na Biblioteca Virtual de Medicina Veterinária e Zootecnia (BVS Vet), BioRxiv, PUBMED, Elsevier e na Revista da Sociedade Brasileira de Ciência em Animais de Laboratório (RESBCAL). Cada artigo teve suas informações compiladas em uma planilha, incluindo ano, autores, bases de dados e revista no qual foi publicado. Até o momento, há muito a se conhecer sobre o vírus, suas interações e potencial de transmissão, bem como a patogênese da doença, o desenvolvimento das candidatas às vacinas, terapias, diagnósticos mais precisos e ferramentas de controle da doença. Um dos principais desafios encontrados atualmente na pesquisa em COVID-19 é a disponibilização de modelos animais que mimetize a fisiopatogênese da doença humana. Lacunas sobre a cascata de eventos imunológicos e a resposta imune do organismo humano frente à infecção pela exposição a diferentes cargas virais e modelos que respondam essa questão são o ponto mais urgente para haja o desenvolvimento de vacinas. É consolidado a importância da investigação em animais e dos estudos pré-clínicos para solucionar esta e próximas pandemias que possam vir a ocorrer na história da saúde pública mundial, pesquisas necessárias para o embasamento e o delineamento de medidas de prevenção e controle da doença.

International audience; The aim of this work is to understand the granular behavior of metal powder during the spreading phase of the LBM process in order to study the effect of powder properties and process parameters on the quality of the layer deposited before laser fusion. This is a numerical work performed with simulations based on the discrete element method where each powder grain is simulated. The numerical model takes into account different interactions such as repulsion, dissipation, friction and adhesion that occur when there is contact between two bodies. The powder grains are assumed to be perfectly spherical. The surface roughness of the plate and spreader is taken into account in the simulations as it has a significant impact on the powder bed spreading. The effect of material parameters such as friction and adhesion is studied. The influence of the spreading speed is also studied. The results show that different friction values give the same results on the final properties of the powder bed while adhesion plays a significant role. Finally, lower spreading speed result in a better powder bed.

Background:Progress in the management of complex congenital heart disease (CHD) led to an improvement in survival rates of adults with a Fontan-like circulation. The objective of this study was to assess the subjective health status and quality of life of this population.Methods and results:Patients aged more than 18 years at the time of the study, who underwent a Fontan-like procedure. Subjective health status was assessed by the SF-36 questionnaire and a linear analog scale was used to score patients’ self-perception of their quality of life; cardiac and demographic parameters were collected.Results:Among 65 eligible patients, 60 (23 females; mean ± SD age: 25.7 ± 7.2 years) answered the SF-36 questionnaire and 46 of these were interviewed to evaluate their perceived quality of life. Among them, 20 (33.3%) were working full-time and 21 (35%) experienced arrhythmias. The physical SF-36 scores were lower in patients than in the general population (p ≤ 0.05). The New York Hear Association (NYHA) class and occupation were correlated with SF-36 scores of physical activity (respectively, p = 0.0001 and p = 0.025). SF-36 scores of psychological status were associated with the number of drugs and occupation (respectively, p = 0.0001 and p = 0.02). The mean ± SD quality of life score measured using a linear analog scale was 7.02 ± 1.6 and was linked to education and occupation (p ≤ 0.05) but not with cardiac parameters.Conclusion:Adult Fontan patients perceive an impaired physical health but report a good overall quality of life. Education and occupation impacts significantly on Fontan patients’ quality of life.

International audience; Objectives Data are scarce regarding the potential clinical differences between non-late onset schizophrenia (NLOS, i.e., disorder occurring before 40 years of age), late-onset schizophrenia (LOS, occurring between ages 40 and 60 years) and very-late-onset schizophrenia-like psychosis (VLOSLP, occurring after 60 years of age). Furthermore, previous research compared LOS patients with non-age matched NLOS patients. In this study, we sought to examine potential clinical differences between patients of similar age with LOS and NLOS. Methods/Design This is a cross-sectional multicentre study that recruited in- and outpatients older adults (aged >= 55 years) with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder with NLOS and LOS. Sociodemographic and clinical characteristics, comorbidity, psychotropic medications, quality of life, functioning, and mental health care utilization were drawn for comparison. Results Two hundred seventy-two participants (79.8%) had NLOS, 61 (17.9%) LOS, and 8 (2.3%) VLOSLP. LOS was significantly and independently associated with greater severity of emotional withdrawal and lower severity of depression (all p < 0.05). However, the magnitude of these associations was modest, with significant adjusted odds ratios ranging from 0.71 to 1.24, and there were no significant between-group differences in other characteristics. Conclusion In an age-matched multicenter sample of elderly patients with schizophrenia, older adults with LOS were largely similar to older adults with NLOS in terms of clinical characteristics. The few differences observed may be at least partially related to symptom fluctuation with time. Implications of these findings for pharmacological and nonpharmacological management is yet to be determined.

International audience; A Finite Element (FE) model is developed with a commercial code, to investigate the keyhole dynamics and stability at keyhole threshold, a fusion regime characteristic to laser micro-welding or to Laser Powder Bed Fusion (LPBF). The model includes relevant physics to treat the hydrodynamic problemsurface tension, Marangoni stress and recoil pressure-as well as a self-consistent ray-tracing algorithm to account for the "beam-trapping" effect. Implemented in both static and scanning laser configurations, the model successfully reproduces some key features that most recent x-ray images have exhibited. The dynamics of the liquid/gas interface is analyzed, in line with the distribution of the absorbed intensity as well as with the increase of the keyhole energy coupling. Based on these results, new elements are provided to discuss our current understanding of the keyhole formation and stability at threshold.

A Finite element model is developed with a commercial code to investigate the keyhole dynamics and stability at keyhole threshold, a fusion regime characteristic to laser microwelding or to Laser Powder Bed Fusion. The model includes relevant physics to treat the hydrodynamic problems - surface tension, Marangoni stress, and recoil pressure - as well as a self-consistent ray-tracing algorithm to account for the "beam-trapping"effect. Implemented in both static and scanning laser configurations, the model successfully reproduces some key features that most recent x-ray images have exhibited. The dynamics of the liquid/gas interface is analyzed, in line with the distribution of the absorbed intensity as well as with the increase of the keyhole energy coupling. Based on these results, new elements are provided to discuss our current understanding of the keyhole formation and stability at threshold. The authors are grateful to Anthony D. Rollett and Tao Sun for helpful discussion on their x-ray experiments. This work has been supported by Safran Additive Manufacturing and Association Nationale de la Recherche et de la Technology (ANRT).

Supplemental Material, sj-docx-1-pch-10.1177_21501351211027478 for Direct Reimplantation Procedure in Anomalous Aortic Origin of the Right Coronary Artery: Long-Term Single Center Outcomes by Daouda Amadou, Julia Mitchell, Christian Bulescu, Olivier Metton, Roland Henaine and Jean Ninet in World Journal for Pediatric and Congenital Heart Surgery

The management of Out of hospital Traumatic Cardiac Arrest (TCA) for professional rescuers combines advanced life support with specifics actions to treat potential reversible causes of the arrest: hypovolemia, hypoxemia, Tension Pneumothorax (TPx) and tamponade. The aim of this study was to assess the impact of specific rescue gestures on short-term outcomes in the context of resuscitation of patients with a pre-hospital TCA.Methods: We conducted a retrospective study of all TCA treated in two emergency medical units (EM unit), which are part of the Northern Alps emergency network, from January 2004 to December 2017. Utstein variables and specific rescue actions in TCA were compiled: advanced airway management, fluid administration, pelvic stabilization or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary end point was the survival rate at day 30 with good neurologic outcome (cerebral performance category [CPC] score 1 & 2).Results: 287 resuscitations attempt in TCA were included and 279 specific interventions were Identified: 262 Fluid expansion, 41 External Pelvic stabilizations, 5 tourniquets, 175 bilateral thoracostomies, (including 44 with TPx).Conclusion: Among standard resuscitation measures to treat reversible causes of cardiac arrest, we were able to show that bilateral thoracostomy and tourniquet application on a limb hemorrhage improves survival of TCA. A larger sample for pelvic stabilization is necessary.

International audience; A finite element model of Laser Powder Bed Fusion (LPBF) process applied to metallic alloys at a mesoscopic scale is presented. This Level-Set model allows to follow melt pool evolution and track development during building. A volume heat source model is used for laser/powder interaction considering the material absorption coefficients, while a surface heat source is used to consider the high laser energy absorption by dense metal alloys. An energy solver is applied considering convection and conductivity evolution in the system. Shrinkage during consolidation from powder to dense material is modelled by a compressible Newtonian constitutive law. An automatic remeshing strategy is also used to provide a good compromise between accuracy and computing time. Different cases are investigated to demonstrate the influence of the vaporisation phenomena, of material properties and of laser scan strategy on bead morphology.

In streptococci, intracellular quorum sensing pathways are based on quorum-sensing systems that are responsible for peptide secretion, maturation, and reimport. These peptides then interact with Rgg or ComR transcriptional regulators in the Rap, Rgg, NprR, PlcR, and PrgX (RRNPP) family, whose members are found in Gram-positive bacteria. Short hydrophobic peptides (SHP) interact with Rgg whereas ComS peptides interact with ComR regulators. To date, in Streptococcus thermophilus, peptide secretion, maturation, and extracellular fate have received little attention, even though this species has several (at least five) genes encoding Rgg regulators and one encoding a ComR regulator. We studied pheromone export in this species, focusing our attention on PptAB, which is an exporter of signaling peptides previously identified in Enterococcus faecalis, pathogenic streptococci and Staphylococcus aureus. In the S. thermophilus strain LMD-9, we showed that PptAB controlled three regulation systems, two SHP/Rgg systems (SHP/Rgg1358 and SHP/Rgg1299), and the ComS/ComR system, while using transcriptional fusions and that PptAB helped to produce and export at least three different mature SHPs (SHP1358, SHP1299, and SHP279) peptides while using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Using a deep sequencing approach (RNAseq), we showed that the exporter PptAB, the membrane protease Eep, and the oligopeptide importer Ami controlled the transcription of the genes that were located downstream from the five non-truncated rgg genes as well as few distal genes. This led us to propose that the five non-truncated shp/rgg loci were functional. Only three shp genes were expressed in our experimental condition. Thus, this transcriptome analysis also highlighted the complex interconnected network that exists between SHP/Rgg systems, where a few homologous signaling peptides likely interact with different regulators.

Knowing that Rhodomyrtus tomentosa is known to have antibacterial effects, this study investigated the skin microbiota with a focus on Cutibacterium acnes (C. acnes) phylotypes in subjects with acne, and determined microbiota changes after 28 days of treatment with berries Rhodomyrtus tomentosa as an active ingredient (RT). Skin swabs from seventeen acne subjects were collected and the skin microbiome was analyzed using 16S rRNA gene sequencing. A culture-independent next-generation sequencing (NGS)-based SLST (single-locus sequence typing) approach was aimed at evaluating RT extract effects on C. acnes phylotype repartition. Clinical evaluations (lesion counts) were performed at baseline (D0) and after 28 days (D28) of twice-daily application of the RT active ingredient. We determined: (1) the skin microbiota at D0 was dominated by Actinobacteria followed by Firmicutes and Proteobacteria, (2) at the genus level, Cutibacterium was the most abundant genus followed by Staphylococcus and Corynebacterium, (3) C. acnes was the major species in terms of mean abundance, followed by Staphylococcus epidermidis (S. epidermidis) and Staphylococcus hominis (S. hominis), and (4) phylotype IA1 was most represented, with a predominance of SLST type A1, followed by phylotypes II, IB, IA2, IC, and III. After 28 days of RT extract treatment, phylotype repartition were modified with a decrease in abundance (approximately 4%) of phylotype IA1 and an increase in phylotype II and III. Cutibacterium granulosum (C. granulosum) abundance also decreased. Reduction of retentional and inflammatory lesions was also noted only after RT treatment, thus, RT extract acts as a microbiota-regulating agent.

International audience; The world is facing a pandemic involving the Covid-19. One potential consequence of such crisis is the possibility of contamination of a bystander or a rescuer during resuscitation. Indeed, early cardiopulmonary resuscitation (CPR) is a key factor in out-of-hospital cardiac arrest (OHCA).

International audience; BACKGROUND: Anomalous aortic origin of a coronary artery, particularly in the presence of inter-arterial course between the great arteries, has been found to be associated with sudden death in young people. METHODS: This study reports a single-center experience in the management of anomalous aortic origin of a coronary artery, with or without inter-arterial course, by focusing specifically on presentation, diagnosis, and patient outcome. RESULTS: From March 1993 to February 2018, 100 patients (70 males) were diagnosed with anomalous aortic origin of a coronary artery, including 27 left coronary artery from the right sinus, 60 right coronary artery from the left sinus, and 13 other anomalies. Patients with inter-arterial course between the great arteries presented more frequently with syncope and/or sudden death compared to patients without (23.4% vs. 0%, p = 0.026). Diagnosis was reached using first-line transthoracic echocardiography in 65% of cases. Surgical repair was performed in 61 patients (61%). All operated patients (60 direct implantations, 1 unroofing) had been diagnosed with inter-arterial course between the great arteries, and were asymptomatic at a mean (±SD) postoperative follow-up of 4.9 ± 5.3 years. CONCLUSIONS: An inter-arterial course of the anomalous right or left coronary arteries arising from the opposite sinus is associated with life-threatening events. Direct reimplantation of coronary artery is reliable, and should be discussed even in asymptomatic patients.

Although metal vaporisation has been observed in several laser processes such as drilling or welding, vapour plume expansion and its induced side effects are not fully understood. Especially, this phenomenon is garnering scientific and industrial interest since recent investigations in laser powder bed fusion (LPBF) have designated metal vaporisation as main source of denudation and powder spattering. The present study aims to provide a new insight on the dynamics of laser-induced vaporisation and to assess the potential of different gases for particle entrainment. A self-consistent finite element model of laser-induced keyhole and plume is thus presented for this purpose, built from a comprehensive literature review. The model is validated with dedicated experimental diagnostics, involving high-speed imaging to measure the ascent velocity of the vapour plume. The transient dynamics of vapour plume is thus quantified for different laser incident intensities and gas flow patterns such as the mushroom-like structure of the vapour plume are analysed. Finally, the model is used as a tool to quantify the entrainment flow expected in LPBF and an analytical model is derived to define a velocity threshold for particle entrainment, expressed in term of background gas properties. Doing so it is possible to predict how denudation evolves when the gaseous atmosphere is changed.

Introdução: As vias aéreas superiores são importantes sítios para o surgimento e proliferação de muitos patógenos, devido, principalmente, ao contato direto com o meio externo, presença de oxigênio, umidade, nutrientes e temperatura adequada, promovendo um processo infeccioso, inflamatório e irritativo no local acometido, caracterizando-se como um dos problemas mais frequentes encontrados em serviços de saúde pública. Objetivo: Avaliar o perfil de sensibilidade aos antimicrobianos em culturas de secreção orofaringe e de escarros positivas na região do Cariri cearense. Metodologia: Trata-se de um estudo epidemiológico, documental, em corte transversal, com coleta retrospectiva dos materiais, no período de 01/07/18 a 30/06/19, a partir da base de dados do Laboratório de Análises Clínicas do Cariri Vicente Lemos, que coleta o material de moradores da região do Cariri. Resultados: Foram avaliadas 132.124 amostras positivas de secreção de orofaringe e de escarro com os testes de antimicrobianos, nos quais revelaram 85.691 (64,85%) sensíveis, 43.338 (33,05%) resistentes e 3.099 (2,35%) de caráter intermediário em relação à sua eficácia aos antibióticos utilizados. Além disso, foi revelado o perfil de maior prevalência dos microrganismos nas amostras como: de Streptococcus pyogenes, Staphylococcus coagulase-negativa, Escherichia coli, Enterococcus sp., Pseudomonas aeruginosa e Acinetobacter baumannii/ calcoaceticus complexo, que estão diretamente relacionados com diversas infecções sistêmicas. Conclusão: Nesse contexto, diversos microrganismos vêm apresentando um grau maior de resistência a alguns antimicrobianos na região do cariri cearense, prejudicando na prática clínica em relação ao diagnóstico e ao tratamento de certas doenças.

Atrial septal defect (ASD) is a common congenital heart defect. Transcatheter closure become now the standard approach for ostium secondum type ASD closure against surgery. However, this procedure is not free of complications Device migration is the most common complication. We report a case of an obstruction of tricuspid valve by migration of a transcatheter ASD device occlude in a 9 years-old girl reveled by severe ventricular arrhythmias. She underwent successful emergent surgical removal under cardiopulmonary bypass and ASD closure with a synthetic patch. The postoperative course was favorable.

The objective of this study was to assess long-term outcome and factors associated wih mortality in children after arterial switch operation (ASO) for transposition of the great arteries (TGA). Material and methods Retrospective analysis of all ASO performed from 2000 to 2016 in patients with TGA. Demographics, clinical and biological data, surgical techniques, echocardiographic measurements, and outcomes were collected. Pronostic factors for mortality were assessed. Results 364 patients were included (263 males). Antenatal diagnosis was made in 60,4%. Birth weight was 3207,5±511.2g, gestational age was 39.1±1.6weeks. Intramural coronary artery was present in 24 cases (6.6%). Long term follow-up was 9.2±4.8 years. Rashkind procedure was performed in 88.7% of the cases. Ventilatory support was needed in 56% and prostaglandins in 85% preoperatively. ASO occurred at the age of 7.44±6.26 days (1 to 56) and 5.6±4.6 days after admission. Bypass duration was 123.1±33.3mn. Overall and postoperative hospital stay were respectively 19.9±8.6 and 14.4±7.3 days. Survival rates were 95.3% at 1 month, 94.8% at 3, 6 and 12 months and 94.5% at 2.5 years and up to 18 years after surgery. Twenty patients died (5.5%): 17 early postoperatively (4.7%). Time from surgery to death was 64.2±207.9 days (0 to 919). Long-term events occurred in 49.6% of the patients: pulmonary stenosis, aortic or mitral regurgitation, residual shunt, coronary lesions (1.7%), arrhythmias (5.5%), cardiac failure. Freedom from late reintervention was 99.7%, 97.4%, 96.2% at 1, 3 and 6 months, 95.9%, 95%, 92.3% and 90.3% at respectively 1, 2, 5 and beyond 8 years after ASO. No Rashkind, postoperative ECMO support, delayed chest closure, bypass duration, troponine level and small birth weight were significant predictive factors of mortality (respectively p=0.006, p Conclusion This study showed that Rashkind procedure may have a favourable impact on prognosis of neonates with TGA. Postoperative ECMO support and troponine level, and small birth weight were associated with worse outcome.

The objective of this study was to evaluate the accuracy of echocardiographic to assess coronary arteries (CA) anatomy in transposition of the great arteries (TGA) and determine impact on outcomes. Material and methods Retrospective analysis of data in neonates diagnosed with TGA (isolated or associated with VSD). Preoperative echocardiographic (TTE) coronary artery pattern and surgical intraoperative reports (SURG) were compared. Mismatch between TTE and SURG, and its impact on perioperative outcome were assessed. Coronary patterns were classified in 4 groups: I= normal CA, II= CA with intramural course, III= CA loop, IV= CA loop and intramural segment. Results 108 neonates who underwent arterial switch operation (ASO) for isolated TGA (67 cases) or TGA+VSD (41) were included in the study: 68 ranged in group I, 7 in group II, 32 in group III and 1 in group IV. Five patients died (4.6%), from coronary cause in 3. Survival rates were 96% at 1-month and 95.2% beyond. Intraoperative complications occurred in 10 cases. TTE and SURG CA diagnosis differed in 19 cases = 17.6% (mismatch). Diagnosis of CA anatomy differed in 4.4%, 42.8%, 37.5% and 100% of respectively groups I, II, III and IV. Mortality was 28.6% in group II (intramural CA) compared to 2.9% in group I, 3.1% in group III and 0% in group IV (p=0.002). Death rates was 15.8% if TTE/SURG mismatch and 2.2% if TTE and SURG were concordant (p=0.0108). Mortality in group II (intramural CA) increased up to 50% in case of mismach TTE/SURG versus 0% if concordance, and was similar in the other groups. Survival rates were 84.2% in TTE misdiagnosed CA anomalies compared to 97.6% if TTE assessment correlated with surgical reports. By multivariate analysis, groups II and III coronary anatomy were risk factors for mismatch between TTE and SURG (respectively p=0.008 and p=0.0005), and mismatch TTE/SURG was the only risk factor for perioperative mortality (p=0.045). Conclusion Echocardiography can accurately assess coronary artery anatomy in neonates with TGA. Intramural coronary course is often misdiagnosed. Missed diagnosis of coronary artery anomaly preoperatively may impact on perioperative mortality.

Laser Beam Melting (LBM) is currently garnering industrial attention and many numerical researches have been carried out in order to understand the physics behind the process. However, due to the gap between the grain scale (micrometres) and the bead scale (millimetres), current state-of-the-art multi-physical models are computationally expensive as each powder grain is individually represented. Hence, simulating more than a single LBM track in a reasonable computational time is a challenging task. To overcome this limitation, a new mesoscopic approach is proposed, which intends to bridge the fine thermo-hydrodynamic representation and the macroscopic thermal models. The powder bed is represented by a homogeneous medium with both equivalent thermal and fluid properties. A bulk heat source is considered when the laser heats the powder bed whereas a surface heat flux is imposed on the melted powder bed surface. Apparent viscosity and surface tension are attributed to the homogenized medium so that modelling powder densification, melting and spheroidization of the melt pool is made possible by solving compressible Navier-Stokes equations. In addition, thermocapillary effects as well as vaporisation-induced recoil pressure are implemented, so that realistic thermo-hydrodynamic phenomena are successfully taken into account.

Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder.We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder.Depression and cognitive impairment were positively associated (r = 0.24, p 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively.Because of the cross-sectional design of this study, measures of association do not imply causal associations.Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.

Résumé Interest has recently emerged for the manufacture of aeronautical parts by Laser Beam Melting (LBM) additive process. This energy efficient process can for instance be used to build complex geometries, which cannot be made with traditional processes. However, complex phenomena occur during powder melting and track development : vaporisation phenomena influence laser-matter interaction by creating metal vapours that are responsible for the reduction of absorbed energy. The recoil pressure generated by the vaporisation counteracts the surface tension between the melt pool and the inert gas, also inducing liquid instabilities. The study of laser-matter interaction and induced phenomena can help understand the origin of defects such as porosities or cracks. In this approach, a level-set modelling of the LBM process at a mesoscopic scale is proposed to follow melt pool evolution and track development during build. A volume heat source model is used for laser/powder interaction considering the material absorption coefficient. A surface heat source is used to take into account the high laser energy absorption by dense metal alloys. An energy solver is coupled with thermodynamic database and pre-determined solidification path. Shrinkage during consolidation from powder to liquid and compact medium is modelled by a compressible Newtonian constitutive law. An automatic remeshing adaptation is also used to save time and avoid high computational cost. In the future, the computation of multiple beads or the build of a wall in a context of lattice structures will have to be considered.

Resume Introduction L’isolement est une mesure indispensable a la prise en charge de certaines situations psychiatriques aigues, mais souleve de nombreuses questions cliniques et ethiques invitant a en limiter la frequence d’utilisation et la duree. Connaitre les facteurs associes a la duree des isolements pourrait permettre l’elaboration de mesures de reduction. Cette etude explore les facteurs predictifs d’une longue duree d’isolement. Methode L’etude EPIC est une etude multicentrique observationnelle prospective des mesures de contention et d’isolement de sept etablissements du sud-francilien. Notre objectif etait de determiner les facteurs predictifs d’une duree d’isolement ≥ 7 jours en s’appuyant sur des analyses statistiques descriptives, bivariees et multivariees. Resultats Deux cent trente-six mesures d’isolements ont ete incluses pour cette etude. Les analyses bivariees montrent que les diagnostics de trouble de l’humeur et de trouble psychotique, l’hospitalisation sous contrainte prealable et l’administration d’un traitement sedatif sont associes a un isolement ≥ 7 jours. Les analyses multivariees montrent que les diagnostics de trouble de l’humeur [OR = 2,7, IC95 % (1,4–4,9), p = 0,002] et de trouble psychotique [OR = 3,3, IC95 % (1,2–8,4), p = 0,01] sont associes a un isolement ≥ 7 jours. L’administration d’un traitement sedatif est egalement associee dans ces 2 modeles a une duree ≥ 7 jours [OR humeur = 8,1 et OR psychotique = 2,4]. Pour les patients ayant un trouble psychotique l’hospitalisation sous contrainte prealable est egalement un facteur associe a une longue duree d’isolement. Conclusion Les patients presentant un trouble de l’humeur ou un trouble psychotique necessitant un traitement sedatif lors de l’isolement pourraient etre une bonne cible de mesures de reduction de la duree en isolement.

The severity of psychopathology has a strong negative impact on quality of life (QoL) among older adults with schizophrenia spectrum disorder. However, because these subjects generally experience multiple psychiatric symptoms, it remains unclear whether decreased QoL in this population is due to specific symptoms (e.g., hallucinations), specific dimensions of psychopathology (e.g., negative symptoms), a general psychopathology dimension representing the shared effect across all psychiatric symptoms, or a combination of these explanations. Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia spectrum disorder recruited from French public-sector psychiatric departments. We used structural equation modeling to examine the shared and specific effects of psychiatric symptoms on QoL, while adjusting for sociodemographic characteristics, general medical conditions, global cognitive functioning and psychotropic medications. Psychiatric symptoms and QoL were assessed face-to-face by psychiatrists using the Brief Psychiatric Rating Scale (BPRS) and the Quality of Life Scale (QLS). Among older adults with schizophrenia spectrum disorder, effects of psychiatric symptoms on QoL were exerted mostly through a general psychopathology dimension (β = − 0.43, p

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Introduction Direct oral anticoagulants (DOACs) also influence cell signaling in various cell types, thus affecting biological systems other than coagulation, whose markers are uncertain. Material and methods To perform a pilot study of variations in plasma protein by means of Liquid chromatography–high resolution tandem mass spectrometry (LC-HRMS/MS) in 5 patients with newly-diagnosed non-valvular atrial fibrillation (NVAF) starting rivaroxaban anti-FXa DOAC treatment. Results A total of 260 proteins could be identified in plasma samples obtained before treatment and at one month of treatment. A significant sustained variation in their concentrations (doubling or halving) was evidenced in at least one patient. These variations were heterogeneous and inconstant from one patient to another. Their most striking feature was the downregulation of proteins participating in the inflammatory system reaction, and of proteins related to intravascular hemolysis. Other variations were rarer and more erratic. Conclusions Individual rivaroxaban treatment-associated variations in protein were evidenced in patients with NVAF starting rivaroxaban. This should now be tested and confirmed with a large series of carefully annotated patients. Confirming these established variations would open the door to the search for clinically-relevant correlations and consequences, if any.

Crustacean shellfish allergy ranks among the most frequent and severe food allergies for adults, demanding rugged and sensitive analytical routine methods. The objective of this study was therefore to develop a mass spectrometric approach for the detection of contamination with shrimp and lobster, two economically important types of crustaceans, in complex food matrices. Following a biomarker approach, we identified proteotypic peptides and developed a multiple reaction monitoring (MRM) method allowing for the identification and differentiation of shrimp and lobster in the food matrix at concentrations down to 0.1%. To further enhance sensitivity, we employed the MRM-cubed (MRM(3)) mode, which allowed us to detect crustaceans down to concentrations of 25 μg/g (crustacean/food, 0.0025%). We hereby present the first mass spectrometric method for the detection of shrimp and lobster in food matrices.

OBJECTIVESA double orifice of the left atrioventricular valve (LAVV) associated with atrioventricular septal defects (AVSD) can significantly complicate surgical repair. This study reports our experience of AVSD repair over 3 decades, with special attention to the zone of apposition (ZoA) of the main orifice, and presents a technique of hemivalve pericardial extension in specific situations.METHODSWe performed a retrospective study from 1987 to 2016 on 1067 patients with AVSD of whom 43 (4%) had a double orifice, plus 2 additional patients who required LAVV pericardial enlargement. Median age at repair was 1.3 years. Mean follow-up was 8.2 years (1 month–32 years).RESULTSAssociated abnormalities of the LAVV subvalvular apparatus were found in 7 patients (5 parachute LAVV and 2 absence of LAVV subvalvular apparatus). ZoA was noted in 4 patients (9%): partially closed in 15 (35%) and completely closed in 24 (56%). Four patients required, either at first repair or secondarily, a hemivalve enlargement using a pericardial patch without closure of the ZoA. The early mortality rate was 7% (n = 3), all before 2000. Two patients had unbalanced ventricles and the third had a single papillary muscle. There were no late deaths. Six patients (14%) required 7 reoperations (3 early and 4 late reoperations) for LAVV regurgitation and/or dysfunction, of whom 4 (9%) required mechanical LAVV replacement (all before 2000). Freedom from late LAVV reoperation was 97% at 1 year, 94% at 5 years and 87% at 10, 20 and 30 years. Unbalanced ventricles (P = 0.045), subvalvular abnormalities (P = 0.0037) and grade >2 LAVV postoperative regurgitation (P = 0.017) were identified as risk factors for LAVV reoperations. Freedom from LAVV mechanical valve replacement was 95% at 1 year, 90% at 5 years and 85% at 10, 20 and 30 years. An anomalous LAVV subvalvular apparatus was identified as a risk factor for mechanical valve replacement (P = 0.010). None of the patients who underwent LAVV pericardial extension had significant LAVV regurgitation at the last follow-up examination.CONCLUSIONSRepair of AVSD and double orifice can be tricky. Preoperative LAVV regurgitation was not identified as an independent predictor of surgical outcome. LAVV hemivalve extension appears to be a useful and effective alternate surgical strategy when the ZoA cannot be closed.

International audience; Aurantiochytrium limacinum is an osmo-heterotrophic Stramenopile and a pioneering mangrove decomposer which is taxonomically assigned to the family of Thraustochytriaceae (class: Labyrinthulomycetes). The life cycle of A. limacinum involves different cell types including mono- and multi-nucleated cells as well as flagellated zoospores which colonize new fallen leaves. The ecological relevance of thraustochytrids is underestimated and eclipsed by their biotechnological importance, due to their ability to accumulate large amount of lipids, mainly triacylglycerols (TAGs). In this study, we aimed to understand the ecophysiological parameters that trigger zoospore production and the interplay between the life cycle of A. limacinum and its lipid metabolism. When grown in a rich medium, cells accumulated large amounts of TAGs at the end of their growth period, but no zoospores were produced. In poor media such as artificial sea water, zoospores were produced in massive quantities. In the absence of organic carbon, the zoospores remained swimming for at least 6 days, consuming their TAGs in the process. Addition of glucose rapidly triggered the maturation of the zoospores. On the basis of these data, we propose a life cycle for A. limacinum integrating the potential perturbations/changes in the environment surrounding a mangrove leaf that could lead to the production of zoospores and colonization of new areas.

Resume La maladie de Niemann-Pick de type C (NPC) est une maladie neuro-viscerale rare, de transmission autosomique recessive, ayant une presentation clinique extremement heterogene. La forme adulte de la maladie, d’expression habituellement neurologique, peut egalement se manifester sous la forme de troubles psychiatriques isoles et non specifiques. Depuis 2009, la mise sur le marche du miglustat a permis d’en ameliorer l’evolution. Nous exposerons le cas d’une fratrie suivie au sein d’un meme service de psychiatrie et presentant une clinique psychotique atypique. Le frere, chez qui a initialement ete diagnostiquee une schizophrenie, est atteint d’une maladie de NPC. Il est actuellement stabilise sous miglustat. Sa sœur ainee, egalement traitee pour une schizophrenie, est heterozygote pour une des deux mutations portees par son frere mais presente aussi des symptomes neurologiques qui nous ont interroges. Parce qu’il s’agit d’une maladie a transmission autosomique recessive, les sujets heterozygotes, ne transportant qu’une seule mutation pathogene du gene, sont generalement asymptomatiques. Plusieurs hypotheses sont discutees : expression psychiatrique chez des heterozygotes, facteur genetique de predisposition a la schizophrenie, comorbidite ou association fortuite. Des investigations supplementaires aupres des patients et de leurs familles seraient necessaires pour nous orienter vers une reponse.

In psychiatric inpatient settings seclusion is a last resort to ensure the safety of the patient, other patients, and staff from disturbed behaviors. Despite its major interest for patients, seclusion could negatively impact treatment adherence and patient/staff relationships. Indeed, some secluded patients report a feeling of guilt during the measure and do not consider seclusion to be a healthcare intervention. To be more beneficial and to reduce the feeling by patients of being forced, seclusions should be as short and rare as possible. In other words, measures to reduce seclusion are available and have been clearly identified. Such measures could be applied, in the first instance, in patients with longer duration. In this way, the aim of this study was to investigate predictive factors of a seclusion of long duration.Our study was based on the dataset of the EPIC study, an observational prospective French multicenter study of seclusion and restraint. The EPIC study occurred in seven French psychiatric hospitals in the southern region of Paris. Inclusions were realized for 73days and allowed a data collection of 302 seclusion measures. Of these measures 236 were effectively a seclusion in a standardized room. Because the median duration was 7days, we defined two groups of patients: duration7days and duration ≥ 7 days. Our variable to be explicated was duration ≥ 7 days. Explicative variables available in EPIC study were age, sex, forced hospitalization, autoagressivity, heteroagressivity, use of sedative treatment (oral or intramuscular), history of seclusion and patient diagnoses. We used bivariate and multivariate analyses to explore the association between a seclusion duration ≥ 7 days and explicative variables. Diagnoses were classified as psychotic disorders, mood disorders and others diagnoses. To be included in multivariate logistic regressions, diagnoses were treated as dummy variables (mood disorder vs psychotic disorders; psychotic disorders vs others; mood disorders vs others). Statistical analyses were performed using SPSS software 20.0 and R 3.4.0.Of the 236 measures of seclusion the mean age was 38.2 (±12.8), 196 (83%) patients were forcibly hospitalized prior to their seclusion, 147 (62%) had a diagnosis of psychotic disorder, 43 (18%) a diagnosis of mood disorder and 33 (14%) an "other diagnosis". Mean duration was 10.2 (1.5) days and median was 7.1 days. One hundred and thirty-five (47%) patients were in the group of duration ≥ 7 days. In bivariate analyses, variables associated with a duration ≥ 7 days were: being in forced hospitalization prior to the seclusion (P=0.04), administration of a sedative treatment (P=0.01) and against the group of others diagnoses the diagnosis of mood disorders (P0.0005) and psychotic disorders (P=0.001). Multivariate analyses showed that, against the group of other diagnoses, the group of psychotic disorders [OR=3.3, CI 95% (1.3-8.4), P=0.01], the group of mood disorder [OR=2.7, CI 95% (1.4-4.9), P=0.002] and administration of sedative treatment [OR=8.1, CI 95% (2.0-32.5), P=0.003] were significantly associated with a duration ≥ 7 days. These results were independent from other confusion variables. Considering the hospitalization status, psychotic disorders was the only diagnosis which showed an association between duration ≥ 7 days and forced hospitalization [OR=2.9 CI 95% (1.1-7.8), P=0.03].Our study highlighted two profiles of higher risk to remain ≥ 7days in seclusion. The first one is patients with a diagnosis of mood disorder who needed sedative treatment. The second one is patients with a diagnosis of psychotic disorder who needed sedative treatment and forced hospitalized before seclusion. Thus, these two profiles could be a good target to practice, in the first instance, measures to reduce seclusion duration in psychiatry settings.

After suicidal attempt, the rate of specialized out treatment engagement (SOTE) does not exceed 30-50%. We designed a multisite prospective naturalistic study, in order to investigate predictive factors of SOTE after emergency department discharge among 107 suicidal attempters without current psychiatric ambulatory care. Both bivariate and multivariate analyses highlighted that booking an appointment with a mental health professional before discharge was significantly associated with higher SOTE rate. Psychiatric caregivers of emergency departments should be informed that this approach is a simple, fast way to improve SOTE among this population.

JCTCV:21(2), Introduction: Anomalous connection of the right coronary artery to the opposite coronary sinus is associated with an inter-arterial course, an intramural course and ostia anomalies. They are known to cause sudden death in athletes. However, no recommendation for therapy is available, and the surgical treatment is very controversial, especially in adults. Material and method: A retrospective study of 30 patients who underwent operations in our center between January 2003 and December 2016. Results: Sixteen patients were under 18 years of age, and 10 were over 30 years. Fourteen patients practiced sport. Of the cases, 86.6 % were symptomatic with five sudden deaths. The average time between diagnosis and intervention was 18.5 months (range: 0.5 –179). All patients benefited from a coroscanner and re-implantation in anatomical position. The average time of follow-up was 25.6 months (range: 1–701), with a death at 3 post-operative months. When patients were informed of their condition, 92.8% were classified as NYHA I, and 60% returned to physical activity. Conclusion: Only re-implantation allows the restoration of coronary anatomy and enables patients to practice sports safely. The evolution, or long-term appearance, of a coronaropathy on the right re-implanted coronary artery needs further investigation.