Search

Acute respiratory distress syndrome remains an uncommon condition during pregnancy. In patients with severe acute respiratory distress syndrome, when oxygenation or ventilation cannot be supported sufficiently using best practice conventional mechanical ventilation and additional therapies, veno-venous extracorporeal membrane oxygenation may be considered. In the past two decades, there has been increasing adoption of this technique to support adult patients with refractory acute respiratory distress syndrome. However, its use for the management of pregnant women is rare and remains a challenge. This narrative review addresses acute respiratory distress syndrome and its management during pregnancy, and then focuses on indications, contraindications, challenges, potential complications, and outcomes of the use of veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome in the pregnant patient.

In the ongoing quest for hybridizing discrete reasoning with neural nets, there is an increasing interest in neural architectures that can learn how to solve discrete reasoning or optimization problems from natural inputs. In this paper, we introduce a scalable neural architecture and loss function dedicated to learning the constraints and criteria of NP-hard reasoning problems expressed as discrete Graphical Models. Our loss function solves one of the main limitations of Besag's pseudo-loglikelihood, enabling learning of high energies. We empirically show it is able to efficiently learn how to solve NP-hard reasoning problems from natural inputs as the symbolic, visual or many-solutions Sudoku problems as well as the energy optimization formulation of the protein design problem, providing data efficiency, interpretability, and \textit{a posteriori} control over predictions., 10 pages, 2 figures, 6 tables. Published in IJCAI'2023 proceedings

We aimed at determining whether the Erector Spinae Plane (ESP) block is useful for providing anti-nociception and analgesia to patients beneficiating from lumbar spine surgery. Using the keywords “Erector Spinae Plane block” and “lumbar” or “spinal surgery” in Pubmed, the Cochrane Library Database, and Google Scholar (end of search in March 2021), we identified 19 relevant papers involving 534 patients. Injection levels, and type, dilution, or volume of local anesthetic agent solution differed between studies. The main studied outcomes were postoperative pain control, and opioid consumption. Only one study compared the ESP block with another loco- regional technique. All published papers conclude that ESP block reduces postoperative pain scores and rescue medication use. As a corollary, ESP block appears promising in this indication for several reasons. First, it is easy to perform and does not have the same adverse effects or complications as neuraxial techniques. Second, even if the best site of injection as not been determined yet, skin puncture can be performed at distance from the surgical site, hence reducing the risk of surgical site infection by the loco-regional technique, and allowing its use as a rescue analgesic technique after surgery. Last, the incidence of ESP block complications seems low even if the number of studied patients is not wide enough to ascertain this fact for sure. Several unresolved questions are still pending. None of the published studies were randomized controlled trials with a group receiving a sham block, length of follow-up was limited to 48 hours, chronic pain was an exclusion criteria, and the pain scores were evaluated at rest. We conclude that the ESP block appears to be a safe and promising technique to be used as part of a multimodal analgesia protocol in lumbar spine surgery. Several studies are needed to precise its superiority and safety as compared to other techniques, its intraoperative opioid sparing effect, and its influence on longer term outcomes such as the development of chronic pain.

Supplementary Methods, Tables 1-2 from Preconditioned Endothelial Progenitor Cells Reduce Formation of Melanoma Metastases through SPARC-Driven Cell–Cell Interactions and Endocytosis

The “autism spectrum disorder” (ASD) construct and its current diagnostic criteria have led to the inclusion of increasingly heterogeneous and decreasingly atypical individuals under its definition. This broad category, based on the polymorphic clinical expression of common genetic variants underpinning the risk of autism, is likely beneficial for certain individuals. However, determining the boundaries between ASD and typical individuals, as well as those with other neurodevelopmental conditions, remains an issue of which the importance is growing with the increase in ASD prevalence. We identified four clinical contexts associated with a questionable, poorly justified, or unhelpful ASD diagnosis: (1) those in which diagnostic instruments raise uncertainties, (2) in the context of a subclinical presentation, (3) when early autistic signs tend to fade away during development, and (4) when comorbidities are prominent. We argue that in certain cases, a diagnosis of ASD may not be the most suitable, timely, or helpful medical act and provide recommendations for clinical practice when facing such situations.

Background In the spring of 2020, Belgian authorities enforced a full lockdown period to contain the spread of the SARS-CoV-2 virus. This lockdown drastically disrupted the daily life of autistic individuals’ and that of their families. In the midst of these extraordinary circumstances, we assessed the impact of social restrictions on autistic individuals’ behavior and their parents’ or caregivers’ quality of life; we also sought to identify individual characteristics that may influence such changes. Methods We designed an online survey targeting caregivers living with an autistic child or adult. The questionnaire included 125 five-point Likert questions which targeted changes in families’ quality of life and in autistic individuals’ behavior, as well as factors likely to influence the extent and direction of these changes. Results We collected data from 209 French-speaking Belgian respondents. Respondents reported that the lockdown brought about a higher frequency of nonfunctional socio-communicative behaviors, as well as a decrease in families’ quality of life. Parents who had less access to respite care experienced a steeper decrease in their quality of life. Autistic individuals with comorbidities, and whose parents had less access to respite care and implemented fewer rules at home during lockdown were more likely to display nonfunctional socio-communicative behaviors. Conclusion COVID-19 lockdown restrictions had a negative impact on both autistic individuals and their parents.

Objective Published reports on directional deep brain stimulation (DBS) have been limited to small, single-center investigations. Therapeutic window (TW) is used to describe the range of stimulation amplitudes achieving symptom relief without side effects. This crossover study performed a randomized double-blind assessment of TW for directional and omnidirectional DBS in a large cohort of patients implanted with a DBS system in the subthalamic nucleus for Parkinson's disease. Materials and methods Participants received omnidirectional stimulation for the first three months after initial study programming, followed by directional DBS for the following three months. The primary endpoint was a double-blind, randomized evaluation of TW for directional vs. omnidirectional stimulation at three months after initial study programming. Additional data recorded at three- and six-month follow-ups included stimulation preference, therapeutic current strength, Unified Parkinson's Disease Rating Scale (UPDRS) part III motor score, and quality of life. Results The study enrolled 234 subjects (62 ± 8 years, 33% female). TW was wider using directional stimulation in 183 of 202 subjects (90.6%). The mean increase in TW with directional stimulation was 41% (2.98 ± 1.38 mA, compared to 2.11 ± 1.33 mA for omnidirectional). UPDRS part III motor score on medication improved 42.4% at three months (after three months of omnidirectional stimulation) and 43.3% at six months (after three months of directional stimulation) with stimulation on, compared to stimulation off. After six months, 52.8% of subjects blinded to stimulation type (102/193) preferred the period with directional stimulation, and 25.9% (50/193) preferred the omnidirectional period. The directional period was preferred by 58.5% of clinicians (113/193) vs. 21.2% (41/193) who preferred the omnidirectional period. Conclusion Directional stimulation yielded a wider TW compared to omnidirectional stimulation and was preferred by blinded subjects and clinicians.

En 2020, un enseignant de l’Éducation nationale, qu’il soit à temps complet, à temps partiel ou incomplet, perçoit en moyenne 2 530 euros nets par mois : 2 650 euros lorsqu’il est à temps complet, 1 800 euros lorsqu’il est à temps partiel ou incomplet. Le statut, le corps et les fonctions exercées par l’enseignant expliquent en premier lieu les écarts de salaire entre enseignants, allant du simple au double. Ainsi, les professeurs agrégés et de chaire supérieure gagnent 1,5 fois plus que les professeurs des écoles et 2 fois plus que les professeurs contractuels. En 2020, sous l’effet des mesures prévues dans le cadre du protocole PPCR et de celles relatives aux heures supplémentaires, de l’extension en année pleine de l’augmentation de la prime REP+ à la rentrée 2019, du versement exceptionnel de la prime « Covid-19 » et de l’indemnité exceptionnelle perçue par les directeurs d’école du premier degré public, le salaire moyen des enseignants rémunérés par le ministère chargé de l’Éducation nationale à la fois en 2019 et en 2020 a augmenté de 2,3 % en euros constants. Parmi les enseignants présents en 2019 et 2020, 58 % observent une hausse de leur salaire net.

Connected consciousness, assessed by response to command, occurs in at least 5% of general anaesthetic procedures and perhaps more often in young people. Our primary objective was to establish the incidence of connected consciousness after tracheal intubation in young people aged 18-40 yr. The secondary objectives were to assess the nature of these responses, identify relevant risk factors, and determine their relationship to postoperative outcomes.This was an international, multicentre prospective cohort study using the isolated forearm technique to assess connected consciousness shortly after tracheal intubation.Of 344 enrolled subjects, 338 completed the study (mean age, 30 [standard deviation, 6.3] yr; 232 [69%] female). Responses after intubation occurred in 37/338 subjects (11%). Females (13%, 31/232) responded more often than males (6%, 6/106). In logistic regression, the risk of responsiveness was increased with female sex (odds ratio [ORConnected consciousness occured after intubation in 11% of young adults, with females at increased risk. Continuous exposure to anaesthesia between induction of anaesthesia and tracheal intubation should be considered to reduce the incidence of connected consciousness. Further research is required to understand sex-related differences in the risk of connected consciousness.

Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are associated with motor impairments, with some children holding a comorbid diagnosis of Developmental Coordination Disorder (DCD). However, DCD is underdiagnosed in these populations and the volume abnormalities that contribute to explaining these motor impairments are poorly understood. In this study, motor abilities as measured by the Developmental Coordination Disorder Questionnaire (DCDQ) were compared between children with ADHD, children with ASD and typically developing (TD) children, aged 8-12 years old. Additionally, the association between the DCDQ scores (general coordination, fine motor/handwriting, control during movement, total) and regional volume abnormalities were explored in 6 regions of interest (pre-central gyrus, post-central gyrus, inferior parietal cortex, superior frontal gyrus, middle frontal gyrus, medial frontal gyrus), within each group and across all participants. Children with ASD and children with ADHD showed impaired motor abilities in all the DCDQ-derived scores compared to TD children. Additionally, most children with ASD or ADHD had an indication or suspicion of DCD. Within the ASD group, coordination abilities were associated with the volume of the right medial frontal gyrus, and within the ADHD group, the total DCDQ score was associated with the volume of the right superior frontal gyrus. This study underlines the importance of routinely checking motor abilities in populations with ASD or ADHD in clinical practise and contributes to the understanding of structural abnormalities subtending motor impairments in these disorders., info:eu-repo/semantics/published

En 2019, un enseignant de l�����ducation nationale, qu���il soit �� temps complet, �� temps partiel ou incomplet, per��oit en moyenne 2 490 euros nets par mois. Le rythme de travail est le premier facteur de diff��rences de salaire : un enseignant �� temps complet gagne en moyenne 2 600 euros nets par mois contre 1 750 euros pour un enseignant �� temps partiel ou incomplet. Le statut, le corps et les fonctions exerc��es par l���enseignant expliquent aussi les ��carts de salaire, allant du simple au double. Ainsi, les professeurs agr��g��s et de chaire sup��rieure gagnent 1,6 fois plus que les professeurs des ��coles et 2,1 fois plus que les professeurs contractuels. Si, en 2018, le salaire moyen des enseignants r��mun��r��s en 2017 et 2018 par le minist��re en charge de l�����ducation nationale a stagn�� en euros constants, en 2019, sous l���effet des mesures pr��vues dans le cadre du protocole PPCR ainsi que de la r��glementation en vigueur concernant les heures suppl��mentaires, le salaire moyen des enseignants r��mun��r��s en 2018 et 2019 par le minist��re en charge de l�����ducation nationale a augment�� de 1,2 % en euros constants. Parmi les enseignants pr��sents en 2018 et 2019, 48 % observent une hausse de leur salaire net.

The overlap/distinctiveness between Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) has been increasingly investigated in recent years, particularly since the DSM-5 allows the dual diagnosis of ASD and ADHD, but the underlying brain mechanisms remain unclear. Although both disorders are associated with brain volumetric abnormalities, it is necessary to unfold the shared and specific volume abnormalities that could contribute to explain the similarities and differences in the clinical and neurocognitive profiles between ADHD and ASD. In this voxel-based morphometry (VBM) study, regional grey matter volumes (GMV) were compared between 22 children with ADHD, 18 children with ASD and 17 typically developing (TD) children aged 8 to 12 years old, controlling for age and total intracranial volume. When compared to TD children or children with ASD, children with ADHD had a larger left precuneus, and a smaller right thalamus, suggesting that these brain abnormalities are specific to ADHD relative to ASD. Overall, this study contributes to the delineation of disorder-specific structural abnormalities in ADHD and ASD., info:eu-repo/semantics/published

Background: Knowledge is increasing about TSC-Associated Neuropsychiatric Disorders (TAND), but little is known about the potentially confounding effects of intellectual ability (IA) on the rates of TAND across age, sex, and genotype. We evaluated TAND in (a) children vs. adults, (b) males vs. females, and (c) TSC1 vs. TSC2 mutations, after stratification for levels of IA, in a large, international cohort.Methods: Individuals of any age with a documented visit for TSC in the 12 months prior to enrolment were included. Frequency and percentages of baseline TAND manifestations were presented by categories of IA (no intellectual disability [ID, intelligence quotient (IQ)>70]; mild ID [IQ 50–70]; moderate-to-profound ID [IQ

Noxious stimulation influences the autonomic nervous system activity. Sympathetic tone monitoring is currently used to assess the adequacy of the balance between nociception and anti-nociception during general anesthesia. The Surgical Plethysmographic Index (SPI) and the EBMi software (Custos©) are commercial devices that use different algorithms to measure it. We aimed at determining whether those devices provide similar information during routine surgical procedures under general anesthesia. Data acquired during a previously published study in patients undergoing surgery under general anesthesia were retrospectively analyzed and passed through the EBMi software. The occurrence of EBMi alarms of increased sympathetic tone was compared to the occurrence of SPI values ≥ 60, a commonly recommended intraoperative SPI threshold. Trends in classical parameters of sympathetic tone during the 5 min preceding a SPI ≥ 60, namely blood pressure, heart rate, and plethysmographic pulse amplitude were assessed. SPI ≥ 60 episodes (n = 307) were more frequent than EBMi alerts (n = 240). Approximately 70% of EBMi alerts occurred during periods where the SPI was below 60. Among all episodes of SPI ≥ 60, absence of any EBMi alerts was much more frequent than the inverse. A majority, but not all SPI ≥ 60 episodes were consistently preceded by an increase in heart rate and/or a decrease in pulse amplitude. Blood pressure did not significantly change before SPI ≥ 60. Longer SPI ≥ 60 episodes were associated with lower anti-nociception anesthetic regimen. Different methods of sympathetic tone assessment during general anesthesia provide conflicting information. Prospective studies should be undertaken to clarify the clinical indications of both techniques.

International audience; Computational Protein Design (CPD) has produced impressive results for engineering new proteins, resulting in a wide variety of applications. In the past few years, various efforts have aimed at replacing or improving existing design methods using Deep Learning technology to leverage the amount of publicly available protein data. Deep Learning (DL) is a very powerful tool to extract patterns from raw data, provided that data are formatted as mathematical objects and the architecture processing them is well suited to the targeted problem. In the case of protein data, specific representations are needed for both the amino acid sequence and the protein structure in order to capture respectively 1D and 3D information. As no consensus has been reached about the most suitable representations, this review describes the representations used so far, discusses their strengths and weaknesses, and details their associated DL architecture for design and related tasks.

Chronic hepatitis B virus (HBV) infection and HBV-related hepatitis in children remains an unmet medical need, as current treatments are only partially effective, and only in a limited number of affected children. So-called "immunotolerant" children have not shown increased serological responses to available treatments. In cases involving more active disease, serological response has only been obtained in approximately one-third of patients when using interferon, while other cases exhibited virological response solely under continuous treatment with nucleoside analogs. Guidelines have recently been established to aid pediatricians in effectively managing this condition. With the available medications, no treatment is so far indicated for immunotolerant children, but only for cases presenting increased alanine aminotransferase levels to over 1.5-2 times the upper limit of normal for over 6 months, and without spontaneous HB envelope antigen to antibody seroconversion. The therapeutic arsenal approved by the Food and Drugs Administration and European Medicines Agency for children remains limited because of the lack of large-scale clinical trials validating treatments already approved for the adult population. Yet, the recent discovery of a specific HBV-cell surface receptor, NTCP, allows for new treatment perspectives regarding the future.

Background The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice. Methods Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted. Results The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 ± 17 vs. 51 ± 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 ± 20 vs. 42 ± 14; P = 0.02) and after (52 ± 16 vs. 43 ± 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age. Conclusions Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.

TSC; Resource use; TOSCA TSC; Uso de recursos; TOSCA TSC; Ús de recursos; TOSCA Tuberous Sclerosis Complex (TSC) is a rare autosomal-dominant disorder caused by mutations in the TSC1 or TSC2 genes. Patients with TSC may suffer from a wide range of clinical manifestations; however, the burden of TSC and its impact on healthcare resources needed for its management remain unknown. Besides, the use of resources might vary across countries depending on the country-specific clinical practice. The aim of this paper is to describe the use of TSC-related resources and treatment paterns within the TOSCA registry. A total of 2,214 patients with TSC from 31 countries were enrolled and had a follow-up of up to 5 years. A search was conducted to identify the variables containing both medical and non-medical resource use information within TOSCA. This search was performed both at the level of the core project as well as at the level of the research projects on epilepsy, subependymal giant cell astrocytoma (SEGA), lymphangioleiomyomatosis (LAM), and renal angiomyolipoma (rAML) taking into account the timepoints of the study, age groups, and countries. Data from the quality of life (QoL) research project were analyzed by type of visit and age at enrollment. Treatments varied greatly depending on the clinical manifestation, timepoint in the study, and age groups. GAB Aergics were the most prescribed drugs for epilepsy, and mTOR inhibitors are dramatically replacing surgery in patients with SEGA, despite corrent recommendations proposing both treatment options.mTOR inhibitors are also becoming common treatments in rAML and LAMpatients. Forty-two out of the 143 patients (29.4%) who participated in the QoL research project reported inpatient stays over the last year. Data from non-medical resource use showed the critical impact of TSC on job status and capacity. Disability allowances were more common in children than adults (51.1% vs 38.2%). Psychological counseling, social services and social worker services were needed by

SEGA; TOSCA; Tuberous sclerosis complex SEGA; TOSCA; Complex d’esclerosi tuberosa SEGA; TOSCA; Complejo de esclerosis tuberosa The onset and growth of subependymal giant cell astrocytoma (SEGA) in tuberous sclerosis complex (TSC) typically occurs in childhood. There is minimal information on SEGA evolution in adults with TSC. Of 2,211 patients enrolled in TOSCA, 220 of the 803 adults (27.4%) ever had a SEGA. Of 186 patients with SEGA still ongoing in adulthood, 153 (82.3%) remained asymptomatic, and 33 (17.7%) were reported to ever have developed symptoms related to SEGA growth. SEGA growth since the previous scan was reported in 39 of the 186 adults (21%) with ongoing SEGA. All but one patient with growing SEGA had mutations in TSC2. Fourteen adults (2.4%) were newly diagnosed with SEGA during follow-up, and majority had mutations in TSC2. Our findings suggest that surveillance for new or growing SEGA is warranted also in adulthood, particularly in patients with mutations in TSC2. The study was funded by Novartis Pharma AG.

General anesthesia reversibly alters consciousness, without shutting down the brain globally. Depending on the anesthetic agent and dose, it may produce different consciousness states including a complete absence of subjective experience (unconsciousness), a conscious experience without perception of the environment (disconnected consciousness, like during dreaming), or episodes of oriented consciousness with awareness of the environment (connected consciousness). Each consciousness state may potentially be followed by explicit or implicit memories after the procedure. In this respect, anesthesia can be considered as a proxy to explore consciousness. During the recent years, progress in the exploration of brain function has allowed a better understanding of the neural correlates of consciousness, and of their alterations during anesthesia. Several changes in functional and effective between-region brain connectivity, consciousness network topology, and spatio-temporal dynamics of between-region interactions have been evidenced during anesthesia. Despite a set of effects that are common to many anesthetic agents, it is still uneasy to draw a comprehensive picture of the precise cascades during general anesthesia. Several questions remain unsolved, including the exact identification of the neural substrate of consciousness and its components, the detection of specific consciousness states in unresponsive patients and their associated memory processes, the processing of sensory information during anesthesia, the pharmacodynamic interactions between anesthetic agents, the direction-dependent hysteresis phenomenon during the transitions between consciousness states, the mechanisms of cognitive alterations that follow an anesthetic procedure, the identification of an eventual unitary mechanism of anesthesia-induced alteration of consciousness, the relationship between network effects and the biochemical or sleep-wake cycle targets of anesthetic agents, as well as the vast between-studies variations in dose and administration mode, leading to difficulties in between-studies comparisons. In this narrative review, we draw the picture of the current state of knowledge in anesthesia-induced unconsciousness, from insights gathered on propofol, halogenated vapors, ketamine, dexmedetomidine, benzodiazepines and xenon. We also describe how anesthesia can help understanding consciousness, we develop the above-mentioned unresolved questions, and propose tracks for future research.

In this narrative review, different aspects of electroencephalogram (EEG) monitoring during anesthesia are approached, with a special focus on cardiothoracic and vascular anesthesia, from the basic principles to more sophisticated diagnosis and monitoring utilities. The available processed EEG-derived indexes of the depth of the hypnotic component of anesthesia have well-defined limitations and usefulness. They prevent intraoperative awareness with recall in specific patient populations and under a specific anesthetic regimen. They prevent intraoperative overdose, and they shorten recovery times. They also help to avoid lengthy intraoperative periods of suppression activity, which are known to be deleterious in terms of outcome. Other than those available indexes, the huge amount of information contained in the EEG currently is being used only partially. Several other areas of interest regarding EEG during anesthesia have emerged in terms of anesthesia mechanisms elucidation, nociception monitoring, and diagnosis or prevention of brain insults.

SEGA; TOSCA; Tuberous sclerosis complex SEGA; TOSCA; Complejo de esclerosis tuberosa SEGA; TOSCA; Complex d'esclerosi tuberosa Background: This study evaluated the characteristics of subependymal giant cell astrocytoma (SEGA) in patients with tuberous sclerosis complex (TSC) entered into the TuberOus SClerosis registry to increase disease Awareness (TOSCA). Methods: The study was conducted at 170 sites across 31 countries. Data from patients of any age with a documented clinical visit for TSC in the 12 months preceding enrollment or those newly diagnosed with TSC were entered. Results: SEGA were reported in 554 of 2,216 patients (25%). Median age at diagnosis of SEGA was 8 years (range, 18 years. SEGA were symptomatic in 42.1% of patients. Symptoms included increased seizure frequency (15.8%), behavioural disturbance (11.9%), and regression/loss of cognitive skills (9.9%), in addition to those typically associated with increased intracranial pressure. SEGA were significantly more frequent in patients with TSC2 compared to TSC1 variants (33.7 vs. 13.2 %, p < 0.0001). Main treatment modalities included surgery (59.6%) and mammalian target of rapamycin (mTOR) inhibitors (49%). Conclusions: Although SEGA diagnosis and growth typically occurs during childhood, SEGA can occur and grow in both infants and adults. The study was funded by Novartis Pharma AG. Novartis has contributed to the study design, data analysis, and the decision to publish. Novartis authors reviewed the draft for submission.

International audience; The efficiency in HIT (Heterojunction with Intrinsic Thin film) solar cells strongly depends on the passivation of dangling bonds at the a-Si:H/c-Si interface by hydrogen, introduced in the plasma enhanced CVD process. Here in, we study controlled defects that are introduced by Ar ion irradiation. We observe by hard X-ray photoemission spectroscopy (HAXPES) that during Ar ion implantation, Si-H bonds in the a-Si:H layer are broken and become dangling bonds. We quantify the number of dangling bonds in the a-Si:H layer, and we identify the electronic states associated to them, which explains previously observed photoluminescence transitions.

Background: This study evaluated the characteristics of subependymal giant cell astrocytoma (SEGA) in patients with tuberous sclerosis complex (TSC) entered into the TuberOus SClerosis registry to increase disease Awareness (TOSCA). Methods: The study was conducted at 170 sites across 31 countries. Data from patients of any age with a documented clinical visit for TSC in the 12 months preceding enrollment or those newly diagnosed with TSC were entered. Results: SEGA were reported in 554 of 2,216 patients (25%). Median age at diagnosis of SEGA was 8 years (range, 18 years. SEGA were symptomatic in 42.1% of patients. Symptoms included increased seizure frequency (15.8%), behavioural disturbance (11.9%), and regression/loss of cognitive skills (9.9%), in addition to those typically associated with increased intracranial pressure. SEGA were significantly more frequent in patients with TSC2 compared to TSC1 variants (33.7 vs. 13.2 %, p < 0.0001). Main treatment modalities included surgery (59.6%) and mammalian target of rapamycin (mTOR) inhibitors (49%). Conclusions: Although SEGA diagnosis and growth typically occurs during childhood, SEGA can occur and grow in both infants and adults.

The onset and growth of subependymal giant cell astrocytoma (SEGA) in tuberous sclerosis complex (TSC) typically occurs in childhood. There is minimal information on SEGA evolution in adults with TSC. Of 2,211 patients enrolled in TOSCA, 220 of the 803 adults (27.4%) ever had a SEGA. Of 186 patients with SEGA still ongoing in adulthood, 153 (82.3%) remained asymptomatic, and 33 (17.7%) were reported to ever have developed symptoms related to SEGA growth. SEGA growth since the previous scan was reported in 39 of the 186 adults (21%) with ongoing SEGA. All but one patient with growing SEGA had mutations in TSC2. Fourteen adults (2.4%) were newly diagnosed with SEGA during follow-up, and majority had mutations in TSC2. Our findings suggest that surveillance for new or growing SEGA is warranted also in adulthood, particularly in patients with mutations in TSC2. © 2019 Jansen, Belousova, Benedik, Carter, Cottin, Curatolo, D'Amato, Beaure d'Augères, de Vries, Ferreira, Feucht, Fladrowski, Hertzberg, Jozwiak, Lawson, Macaya, Marques, Nabbout, O'Callaghan, Qin, Sander, Sauter, Shah, Takahashi, Touraine, Youroukos, Zonnenberg and Kingswood.

Summary Objective To present the baseline data of the international TuberOus SClerosis registry to increase disease Awareness (TOSCA) with emphasis on the characteristics of epilepsies associated with tuberous sclerosis complex (TSC). Methods Retrospective and prospective patients’ data on all aspects of TSC were collected from multiple countries worldwide. Epilepsy variables included seizure type, age at onset, type of treatment, and treatment outcomes and association with genotype, seizures control, and intellectual disability. As for noninterventional registries, the study protocol did not specify any particular clinical instruments, laboratory investigations, or intervention. Evaluations included those required for diagnosis and management following local best practice. Results Epilepsy was reported in 83.6% of patients (1852/2216) at baseline; 38.9% presented with infantile spasms and 67.5% with focal seizures. The mean age at diagnosis of infantile spasms was 0.4 year (median

The development of liver cell transplantation (LCT), considered a major biotechnological breakthrough, was intended to provide more accessible treatments for liver disease patients. By preserving the native recipient liver and decreasing hospitalization time, this innovative approach has progressively gained interest among clinicians. LCT initially targets inborn errors of liver metabolism, enabling the compensation of deficient metabolic functions for up to 18 months post-transplantation, supporting its use at least as a bridge to transplantation. The rigorous clinical development and widespread use of LCT depends strongly on controlled and consistent clinical trial data, which may help improve several critical factors, including the standardization of raw biological material and immunosuppression regimens. Substantial effort has also been made in defining and optimizing the most efficient cell population to be transplanted in the liver setting. Although isolated hepatocytes remain the best cell type, showing positive clinical results, their widespread use is hampered by their poor resistance to both cryopreservation and in vitro culture, as well as ever-more-significant donor shortages. Hence, there is considerable interest in developing more standardized and widely accessible cell medicinal products to improve engraftment permanency and post-cell transplantation metabolic effects. Significance In this therapeutic approach to liver disease, new solutions are being designed and evaluated to bypass the documented limitations and move forward toward wide clinical use. Future developments also require a deep knowledge of regulatory framework to launch specific clinical trials that will allow clear assessment of cell therapy and help patients with significant unmet medical needs.

We report on the decrease in photoluminescence (PL) intensity with the increase of the sample temperature (thermal quenching) in crystalline silicon and its suppression after ion irradiation. The crystalline silicon surface was passivated with intrinsic and doped hydrogenated amorphous silicon (a-Si:H) layer stacks as for making silicon heterojunction solar cell precursors. Low energy argon ion irradiation, in the range between 5 and 17 keV, was used for controlled defect formation either in the thin a-Si:H top layer or at the interface with the crystalline silicon beneath. The irradiation defects introduce radiative recombination centers in the a-Si:H as can be measured from PL at low temperature. Moreover, the irradiation and annealing result in a strong modification of the thermal quenching of the PL intensity up to 500 K, showing evidence for the strong reduction of thermally activated non-radiative recombinations at the amorphous-crystalline interface. This result can have implications in the field of crystalline silicon surface passivation.

National audience; L'égalité professionnelle entre les femmes et les hommes est au coeur des valeurs et des missions de la fonction publique. Toutefois, l'égalité salariale de « droits » entre les deux sexes n'est pas forcément une égalité de « faits ». En 2015, dans le secteur public, une enseignante titulaire perçoit en moyenne un salaire net inférieur de 14 % à celui d'un enseignant. Alors que les règles de recrutement, d'emploi et de rémunération ne font intervenir aucune différenciation sexuée, pourquoi constate-ton ces écarts de salaire ? Les enseignantes et enseignants n'ont pas les mêmes caractéristiques. D'une part, les femmes sont majoritaires dans le corps des professeurs des écoles, dont la rémunération est moins avantageuse que dans le second degré. D'autre part, elles effectuent plus souvent leur service à temps partiel et accèdent moins souvent à des fonctions offrant des compléments de salaire. La méthode d'Oaxaca et Blinder, devenue standard dans l'analyse des inégalités de salaire, permet d'isoler le rôle de ces facteurs et de les hiérarchiser. Elle consiste à décomposer l'écart de salaire moyen entre les enseignantes et les enseignants entre une part qui vient des effets de composition (position dans la hiérarchie des emplois, rythme d'activité, fonctions exercées par les enseignants, âge, zone d'affectation), appelée part « expliquée », et une part qui reste « inexpliquée » après prise en compte des différences structurelles. Prises dans leur ensemble, les différences de situation permettent d'interpréter 80 % à 90 % des écarts de salaire entre enseignantes et enseignants.

International audience; Zirconium alloys used as cladding tubes for the fuel of Pressurized Water Reactors can undergo high applied stress during power transients. In these conditions, biaxial loading may lead to plastic deformation of the cladding. A comprehensive understanding of the material mechanical response during loading-path change tests is an important step toward the prediction of the behavior in these specific conditions. Using a non-standard mechanical testing machine, loading-path change tests have been conducted at 623 K on as-received recrystallized Zircaloy-4 tubes. These tests consist of an axial tensile loading and unloading followed by an internal pressure (or pure hoop tension) loading and unloading. These tests are able to examine the kinematic and isotropic hardening components of the strain hardening behavior of the thin cladding tubes. The isotropic hardening is attributed to dislocation multiplication and dislocation-dislocation interactions. The kinematic hardening is attributed to the interaction of the grains with each other. A polycrystalline model has also been used and improved in order to simulate the tests. A good prediction of the isotropic and kinematic hardening is provided by the modeling.

In this chapter, all aspects of electroencephalography (EEG) clinical applications in anesthesia and neurocritical care are reviewed. A large panel of EEG-based monitors is described, with emphasis on their basic principles, indications, and contraindications in clinical practice, and effects of anesthetic agents. Aside from a description of each type of equipment, cues for adequate reading and interpretation of the information provided by those monitors are given, as well as their main advantages and disadvantages. The chapter finishes with a few words on the current opinion of the authors on the clinical utility of all those monitors, and with a few suggested readings in the domain of EEG applied to anesthesia and critical care.

The ability to incorporate a low concentration of defects at different near-surface or interface locations in a silicon heterojunction solar cell is reported here using argon ion implantation. Optical properties of the irradiated layers are addressed using spectroscopic ellipsometry while non-radiative recombinations through defects are addressed using photoconductance and photoluminescence measurements. Low energy ion irradiation at 1 keV under fluences up to 7 × 10 13 cm −2 induces no cell degradation while higher ion energies associated to larger penetration depths close to the amorphous/crystalline interface show increased degradation with ion fluence. This behavior allows to estimate some interface defect concentration threshold for cell degradation.

Background The isolated forearm test (IFT) is the gold standard test of connected consciousness (awareness of the environment) during anaesthesia. The frontal alpha-delta EEG pattern (seen in slow wave sleep) is widely held to indicate anaesthetic-induced unconsciousness. A priori we proposed that one responder with the frontal alpha-delta EEG pattern would falsify this concept. Methods Frontal EEG was recorded in a subset of patients from three centres participating in an international multicentre study of IFT responsiveness following tracheal intubation. Raw EEG waveforms were analysed for power–frequency spectra, depth-of-anaesthesia indices, permutation entropy, slow wave activity saturation and alpha-delta amplitude-phase coupling. Results Volitional responses to verbal command occurred in six out of 90 patients. Three responses occurred immediately following intubation in patients (from Sites 1 and 2) exhibiting an alpha-delta dominant (delta power >20 dB, alpha power >10 dB) EEG pattern. The power–frequency spectra obtained during these responses were similar to those of non-responders (P>0.05) at those sites. A further three responses occurred in (Site 3) patients not exhibiting the classic alpha-delta EEG pattern; these responses occurred later relative to intubation, and in patients had been co-administered ketamine and less volatile anaesthetic compared with Site 1 and 2 patients. None of the derived depth-of-anaesthesia indices could robustly discrimate IFT responders and non-responders. Conclusions Connected consciousness can occur in the presence of the frontal alpha-delta EEG pattern during anaesthesia. Frontal EEG parameters do not readily discriminate volitional responsiveness (a marker of connected consciousness) and unresponsiveness during anaesthesia. Clinical trial registration NCT02248623

Background: The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice. Methods: Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted. Results: The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 +/- 17 vs. 51 +/- 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 +/- 20 vs. 42 +/- 14; P = 0.02) and after (52 +/- 16 vs. 43 +/- 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age. Conclusions: Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.

In this era of technology, available monitoring devices in the operating room are multiplying and becoming less and less invasive. They provide insight into multiple systems physiology and help achieving the maintenance of homeostasis, which is of particular importance during neuroanesthesia procedures to avoid secondary insult to an already suffering central nervous system. We here review all monitors that are of potential interest during neurosurgical procedures, with special emphasis on their clinical utility and the interest of multimodality monitoring. The monitors that are routinely used during all anesthetic procedures are left apart. We start with temperature, and go on with the monitors that allow checking for adequate oxygen delivery to the brain, adequate brain hemodynamics, and metabolism, including arterial blood pressure, cardiac output, intravascular volume status, hemoglobin concentration, jugular venous oxygen saturation, near infrared spectroscopy, and transcranial Doppler ultrasonography. Intracranial pressure monitoring follows, as well as electroencephalography and depth of anesthesia monitoring. We finish with a few words on decision-helping systems and with some interesting clinical trick in the monitoring domain.

Background Intraoperative recruitment manoeuvres (RMs) combined with PEEP reverse the decrease in functional residual capacity (FRC) associated with anaesthesia and improve intraoperative oxygenation. Whether these benefits persist after operation remains unknown. We tested the hypothesis that intraoperative RMs associated with PEEP improve postoperative spirometry including FRC and reduce the incidence of postoperative hypoxaemia in morbidly obese (MO) patients undergoing laparoscopic gastric bypass. Methods After IRB approval and informed consent, 50 MO patients undergoing laparoscopic gastric bypass under volume-controlled ventilation (tidal volume 6 ml kg −1 of IBW) were randomly ventilated with either 10 cm H 2 O PEEP or with 10 cm H 2 O PEEP and one RM carried out after induction of pneumoperitoneum, and another after exsufflation. Anaesthesia and analgesia were standardized. Spirometry was assessed before operation and 24 h after surgery. Postoperative oxygenation and the apnoea–hypopnoea index (AHI) were recorded during the first postoperative night. Results Age, BMI, and STOP BANG score were similar in both groups. FRC decrease after surgery was minimal [0.15 (0.14) litre in control and 0.38 (0.19) litre in the RM group] and similar between the groups ( P =0.35). FVC, FEV 1 , mean S p O 2 , percentage of time spent with S p O 2 below 90%, and AHI did not differ significantly between the groups. Conclusions This study demonstrates that when added to a protective mechanical ventilation combining low tidal volume and high PEEP, two RMs do not improve postoperative lung function including FRC, arterial oxygenation, and the incidence of obstructive apnoea in MO patients after laparoscopic upper abdominal surgery. Clinical trial registration EudraCT 2011-000999-33.

The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice.Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted.The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 ± 17 vs. 51 ± 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 ± 20 vs. 42 ± 14; P = 0.02) and after (52 ± 16 vs. 43 ± 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age.Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.

A-Si:H/c-Si heterojunction solar cells have reached record efficiencies of 24.7%. The passivation of c-Si is the key to achieve a high-efficiency. Indeed, the abrupt discontinuity in the crystal structure at the amorphous/crystal interface induces a high density of dangling bonds creating a high density of defects in the band gap. These defects act as recombination centers for electron-hole pairs photogenerated in c-Si. Several dielectric layers can be used to passivate n-type and p-type wafers: (i) SiO₂ produced by thermal growth, (ii) Al₂O₃ deposited by ALD, (iii) a-SiNₓ:H and a-Si:H deposited by PECVD. The most versatile passivation layer is a-Si: H because it is effective for both p-type and n-type wafers. In addition, this process has a low thermal budget since the deposition is made at 200°C. The drawback of this passivation layer, in particular when p-type doped, is that it does not withstand temperatures above 200°C. However, in order to have a good electrical contact, TCO and metal electrodes require high temperature annealing (between 300°C and 500°C).We implanted Argon ions in solar cell precursors with energies between 1 and 30 keV, which allows to control the depth to which we are creating defects. By varying the fluence between 10¹² Ar.cm⁻² and 10¹⁵ Ar.cm⁻² we control the concentration of defects. We show that implantation with an energy of 5 keV and a fluence of 10¹⁵ Ar.cm⁻² is not sufficient to damage the a-Si:H/c-Si interface. The effective lifetime of the minority charge carriers, measured using a photoconductance technique (decay time of photoconductivity), decreases only from 3 ms to 2.9 ms after implantation. On the other hand the implantations at 10 keV, 10¹⁴ Ar.cm⁻² or at 17 keV, 10¹² Ar.cm⁻² are sufficient to degrade the effective lifetime by more than 85%.Following implantation the solar cells have been annealed in a controlled atmosphere at different temperatures and this up to 420°C. We show that annealing can heal the implantation defects. Moreover, under certain conditions, we obtain lifetimes after implantation and annealing greater than the initial effective lifetime. Combining ion implantation and annealing leads to robust passivation with effective carrier lifetimes above 2 ms even after annealing our solar cell precursors at 380°C. We used a large variety of techniques such as photoconductance, photoluminescence, spectroscopic ellipsometry, Transmission Electron Microscopy, Secondary Ion Mass Spectrometry, Raman spectroscopy and hydrogen exodiffusion to characterize and analyze the physico-chemical phenomena involved in the modification of solar cells precursors. We discuss here several effects such as the increase of the effective lifetime and the temperature robustness by the preservation of hydrogen in amorphous silicon layer and this even after annealing. This hydrogen preservation can be explained by the increase of the number of Si–H bonds in amorphous silicon and the formation of cavities during implantation. In the course of annealing the hydrogen which diffuses is trapped and then released by cavities and dangling bonds, which limits its exodiffusion and makes it available for dangling bonds passivation.; Les cellules solaires à hétérojonction a-Si:H/c-Si atteignent un rendement record de 24.7% en laboratoire. La passivation de la surface du c-Si est la clé pour obtenir de hauts rendements. En effet, la brusque discontinuité de la structure cristalline à l'interface amorphe/cristal induit une forte densité de liaisons pendantes créant une grande densité de défauts dans la bande interdite. Ces défauts sont des centres de recombinaison pour les paires électron-trou photogénérées dans le c-Si. Différentes couches diélectriques peuvent être utilisées pour passiver les wafers dopés n et dopés p : (i) le SiO₂ réalisé par croissance thermique, (ii) l’Al₂O₃ déposé par ALD, (iii) le a-SiNₓ:H et l’a-Si:H déposés par PECVD. La couche de passivation la plus polyvalente est a Si:H puisqu’elle peut passiver aussi bien les wafers dopés n que ceux dopés p. De plus sa production est peu coûteuse en énergie car sa croissance est réalisée à une température d’environ 200°C. L’inconvénient de cette couche de passivation est que lorsqu’elle est dopée p elle ne supporte pas des températures supérieures à 200°C, en raison de l’exodiffusion des atomes d’hydrogène qu’elle contient. Cependant, afin d'avoir un bon contact électrique, TCO et électrodes métalliques, il est souhaitable de recuire à plus haute température (entre 300°C et 500°C). Nous avons implanté des ions Argon de façon contrôlée dans des précurseurs de cellules solaires à des énergies comprises entre 1 et 30 keV, pour contrôler la profondeur à laquelle nous créons les défauts. En variant la fluence entre 10¹² Ar.cm⁻² et 10¹⁵ Ar.cm⁻² nous contrôlons la concentration de défauts créés. Nous montrons qu’une implantation à une énergie de 5 keV avec une fluence de 10¹⁵ Ar.cm⁻² n’est pas suffisante pour endommager l’interface a-Si:H/c-Si. La durée de vie effective des porteurs minoritaires mesurée par photoconductance (temps de décroissance de la photoconductivité) passe de 3 ms à 2,9 ms après implantation. En revanche les implantations à 10 keV, 10¹⁴ Ar.cm⁻² ou à 17 keV, 10¹² Ar.cm⁻² sont suffisantes pour dégrader la durée de vie effective de plus de 85%. Suite aux implantations les cellules solaires ont subi des recuits sous atmosphère contrôlée à différentes températures et ce jusqu’à 420°C. Nous avons découvert que le recuit permet de guérir les défauts introduits par l’implantation. Mais surtout, dans certains cas, d’obtenir des durées de vie après implantation et recuit supérieures aux durées de vies initiales. En combinant l’implantation ionique et les recuits, nous conservons de bonnes durées de vies effectives des porteurs de charges (supérieures à 2 ms) même avec des recuits jusqu’à 380°C. Nous avons utilisé une grande variété de techniques telles que la photoconductance, la photoluminescence, l’ellipsométrie spectroscopique, la microscopie électronique en transmission, la Spectroscopie de Masse d’Ions Secondaires, la spectroscopie Raman et l’exodiffusion de l’hydrogène pour caractériser et analyser l’ensemble des résultats et phénomènes physico-chimique intervenant dans la modification des précurseur de cellules solaires. Nous discutons ici de plusieurs effets tels que l’augmentation de la durée de vie et la tenue en température par la conservation de l’hydrogène dans la couche de silicium amorphe et ceci même après les recuits. Cette conservation peut s’expliquer par l’augmentation du nombre de liaisons Si-H au sein du silicium amorphe et par la formation de cavités lors de l’implantation. Durant les recuits l’hydrogène qui diffuse est piégé puis libéré par les cavités et/ou les liaisons pendantes, ce qui limite son exo-diffusion et le rend de nouveau disponible pour la passivation des liaisons pendantes.