[Transition of adolescents and young adults from pediatric to adult care]. / Passage des adolescents et des jeunes adultes atteints de mucoviscidose en centre adulte.

Nowdays adults with cystic fibrosis are no more attended in pediatric centers. Transition from pediatric to adult care centers must be anticipated. It requires the preparation of patients and families and a cooperation between both teams. Now, there are more patients and they are healthier. Adults centers caregivers have to pay particular attention to new young patients, to manage cystic fibrosis adult issues and to deal with more frequent comorbidities and severe complications. Adults centers will need better resources to maintain good quality of cares and improved life expectancy.

[Semi-invasive necrotic aspergillosis in a child with cystic fibrosis]. / Aspergillose nécrosante semi invasive chez un enfant de 14 ans atteint de mucoviscidose.

INTRODUCTION: Aspergillosis colonisation in cystic fibrosis (CF), usually due to Aspergillus fumigatus (AF), classically presents as allergic bronchopulmonary aspergillosis. However, aspergillus infection can produce a range of manifestations: from minor colonization to an invasive infection. CASE REPORT: A 14-year-old CF patient, chronically colonized with Staphylococcus aureus and Pseudomonas aeruginosa, presented with acute right-sided chest pain, a moderate fever and no modification of the sputum. The chest X-ray showed a 5 cm round opacity. Laboratory parameters were WBC 24,500 G/l, CRP 27 mg/l, Total IgE 1527 UI/l, Specific Aspergillus fumigatus IgE 31 UI/l. Bronchoscopy revealed external compression of the middle lobe bronchus with mucopurulent secretions coming from apical segment of the lower lobe. Bronchoalveolar lavage revealed the presence of pseudomonas aeruginosa 103 CFA/ml, staph aureus 107 CFA/ml and one colony of AF. Chest CT scan showed a large necrotic mass with an air-fluid level located in the apical segment of the right lower lobe. Initial therapy with itraconazole and corticosteroid was replaced by voriconazole, caspofungin, metronidazole and linezolide. Treatment was well tolerated and after 8 weeks the chest X-ray appearances had returned to normal. CONCLUSIONS: The possible diagnoses and therapeutic options are discussed. Conventional antifungal treatment with amphotericin B is limited by nephrotoxicity. These newer antifungal agents appear to be effective and well-tolerated.

[Smoking and the adolescent. An inquiry into motivation and knowledge of the effects of tobacco]. / Tabac et adolescence. Enquête sur les motivations et les connaissances des effets du tabac.

INTRODUCTION: The nicotinism at the teenagers is a concern of public health. The objective of our prospective and descriptive investigation was to better include/understand the nicotinic practices of the teenagers. METHODS: A questionnaire was distributed to the children from 12 to 16 years presenting at the Paediatric emergency department of Le Havre from September 2003 on May 2004. The items collected related to the practices and knowledge on the nicotinism. RESULTS: Hundred answers were collected at teenagers with an average age 14 years. We found 35% of smokers. Among smokers, the average age of the beginning of the nicotinism is at 12,2 years. The girls smoke significantly more than the boys (42% versus 22%, p<0.01). Sex ratio is 2,8 (26 girls and 9 boys). The degree of dependence was evaluated by the score of Fagerström. Half of the questioned teenagers are fairly with strongly dependent (score > 5), in spite of a daily consumption of 5 cigarettes on average. The consumption of other "drugs" was announced at 51.5% of the smokers. On the 100 teenagers, 7 stopped smoking, but 3 think of smoking a day again. The teenagers of single-parent family or separate smoke significantly more than if the parents are in couple (58.3% versus 41.6, p<0.01). The class of third represented the peak of making of contact with the tobacco. CONCLUSION: The tobacco at the teenagers is a control at the risk justifying the continuation of the actions of prevention by the whole of the doctors.

Autism spectrum disorders associated with X chromosome markers in French-Canadian males.

It is now well established that genetic factors play an important role in the pathogenesis of autism disorder and converging lines of evidence suggest the implication of the X chromosome. Using a sample of subjects diagnosed with autism spectrum disorders, exclusively composed of males from French-Canadian (FC) origin, we tested markers covering the entire X chromosome using a family-based association study. Our initial analysis revealed the presence of association at two loci: DXS6789 (P=0.026) and DXS8043 (P=0.0101). In a second step, we added support to the association at DXS8043 using additional markers, additional subjects and a haplotype-based analysis (best obtained P-value=0.00001). These results provide support for the existence of a locus on the X chromosome that predisposes the FC to autism spectrum disorders.

[Extra-pulmonary tuberculosis in childhood]. / Les atteintes extrapulmonaires de la tuberculose de l'enfant.

Extra-pulmonary tuberculosis (EPT) accounts for around 25% of cases of the disease, and around 20% in children. In Pott's disease and other forms of bone and joint involvement (globally 10-15% of EPT cases), modern imaging techniques like MRI scan have improved diagnosis and follow-up of treatment outcomes. Tuberculous meningitis has not disappeared even in BCG vaccinated children and remains a severe form of the disease. Techniques like the polymerase chain reaction and MRI contribute to an early diagnosis and controversy persists regarding the role of corticosteroid therapy in the treatment strategy. Other localisations are rare in children, including tuberculosis of the urogenital tract, infection of the digestive tract or pericarditis.

Divided attention between lyrics and tunes of operatic songs: evidence for independent processing.

Excerpts from French operatic songs were used to evaluate the extent to which language and music compete for processing resources. Do these two dimensions conflict? Are they integrated into a single percept? Or are they independent? The final word of each excerpt was either semantically congruous or incongruous relative to the prior linguistic context and was sung either in or out of key. Participants were asked to detect either the semantic or the melodic incongruity (single task) or both (dual task). We predicted a dual-task deficit if these tasks conflicted and no deficit if they were either independent or integrated. In order to distinguish between these last two outcomes, trial-by-trial contingency analyses were also computed, predicting no correlation if the tasks were conflicting or independent, a positive correlation under the assumption of integration and a negative correlation if dividing attention is impossible. Our results show similar levels of performance in single and dual tasks and no correlation between dual-task judgments, thus suggesting that semantic and melodic aspects of language are processed by independent systems. In addition, a comparison between musicians and nonmusicians shows that these conclusions are independent of musical expertise.

Exposure effects on music preference and recognition.

In three experiments, the effects of exposure to melodies on their subsequent liking and recognition were explored. In each experiment, the subjects first listened to a set of familiar and unfamiliar melodies in a study phase. In the subsequent test phase, the melodies were repeated, along with a set of distractors matched in familiarity. Half the subjects were required to rate their liking of each melody, and half had to identify the melodies they had heard earlier in the study phase. Repetition of the studied melodies was found to increase liking of the unfamiliar melodies in the affect task and to be best for detection of familiar melodies in the recognition task (Experiments 1, 2, and 3). These memory effects were found to fade at different time delays between study and test in the affect and recognition tasks, with the latter leading to the most persistent effects (Experiment 2). Both study-to-test changes in melody timbre and manipulation of study tasks had a marked impact on recognition and little influence on liking judgments (Experiment 3). Thus, all manipulated variables were found to dissociate the memory effects in the two tasks. The results are consistent with the view that memory effects in the affect and recognition tasks pertain to the implicit and explicit forms of memory, respectively. Part of the results are, however, at variance with the literature on implicit and explicit memory in the auditory domain. Attribution of these differences to the use of musical material is discussed.

Divided attention between simultaneous auditory and visual signals.

Past studies of simultaneous attention to pairs of visual stimuli have used the "dual-task" paradigm to show that identification of the direction of a change in luminance, whether incremental or decremental, is "capacity-limited," while simple detection of these changes is governed by "capacity-free" processes. On the basis of that finding, it has been suggested that the contrast between identification and detection reflects different processes in the sensory periphery, namely the responses of magno- and parvocellular receptors. The present study questions that assertion and investigates the contribution of central processing in resource limitation by applying the dual task to a situation in which one stimulus is auditory and one is visual. The results are much the same as before, with identification demonstrating the tradeoff in performance generally attributed to a limited capacity but detection showing no loss compared with single-task controls. This implies that limitations on resources operate at a central level of processing rather than in the auditory and visual peripheries.

Dividing attention between the color and the shape of objects.

In many dual-task experiments, the priority observers give to each task is experimentally varied. Most experiments using this methodology have studied the effect of dividing attention between spatially distinct objects. We examined performance when attention had to be divided between stimulus attributes other than spatial location. In the first experiment, observers identified the color and the shape of a single letter. Accuracy was the same for single- and dual-task conditions, and a trial-by-trial analysis revealed a strong positive correlation in the correct identification of the color and the shape. In the second experiment, color and shape judgments were separated in space, with opposite results: Dual-task performance was worse than single-task performance, and the trial-by-trial analysis indicated a strong negative correlation between tasks. The results indicated that often only one dimension was processed within a trial. The results support object and space models of attention.

Switching or sharing in dual-task line-length discrimination?

In two experiments, we tested whether subjects switched or shared attention between two simultaneously relevant line-length discrimination tasks. Switching models that allowed within- as well as between-trial switching were considered. In the first experiment, stimulus duration was varied randomly from trial to trial. With varied durations, many switching models predict negative contingencies: for a given duration and attentional allocation, accurate responses on one task should be associated with inaccurate responses on the other task. The results, however, showed no negative contingencies, which is consistent with sharing models. In the second experiment, stimulus duration was reduced to 20 msec, yet responses were more than 75% correct overall. This implies that information was obtained about both of the tasks within single trials, contradicting those switching models which predict that information can be obtained from, at most, one task within a period of 20 msec or less. In short, the results of both experiments support sharing models.

Attentional effects on concurrent psychophysical discriminations: investigations of a sample-size model.

In two experiments, a concurrent discrimination paradigm was used to study the effects of visual attention on psychophysical judgments and the consistency of these effects with a sample-size model in which attention influences the variance of the internal representation used to make psychophysical judgments. Two pairs of lines were presented simultaneously--one on each side of fixation--and subjects had to indicate for each pair separately whether or not the lines had the same length. Attention was manipulated by instructing subjects to pay 100%, 75%, 50%, 25%, or 0% of their attention to the discrimination on one side, with the complementary amount of attention to the other side. In the first experiment, the relationship between attention and discrimination accuracy was consistent with the sample-size model both when attentional allocation varied from trial to trial and when it varied between blocks, and the relationship held over more widely varying attentional allocations than had previously been studied. In addition, discriminations were more accurate overall with varied than with blocked attentional allocation, suggesting that the two types of allocation do not merely differ in the degree to which attention is focused. The second experiment examined the effects of attentional allocation and stimulus variance, the latter being manipulated by randomly incrementing or decrementing line lengths. These manipulations had additive effects on total Thurstonian variance, and a version of the sample-size model gave an excellent quantitative fit to the obtained results. Besides supporting the sample-size model, the results of Experiment 2 suggest that criterion variance is at least as large as sensory variance and that criterion but not sensory variance increases with stimulus variance.

Influence of bovine somatotropin on the composition and manufacturing properties of milk.

Three studies (84, 140, and 200 d) were performed to examine the effect of injecting dairy cows with various doses (0, 320, 640, or 960 mg/28 d; 0 or 640 mg/28 d; 0, 320 mg/14 d, or 320 or 640 mg/28 d) of bST on milk production, composition, and manufacturing properties. Mean bST response among studies on milk production varied from 0 (trial 1) to 7.3% (trial 2) and from 8.5 to 14.2% (trial 3) in relation to feeding conditions. Neither milk fat nor protein percentages in milk at time of maximum response were affected by the use of bST. Distribution of casein and protein in the whey was not affected by the treatments at any time. The nature of fatty acids varied more with time after injection than with bST doses. Neither coagulation time, standard curd firmness, nor soft or pressed cheese yields were affected by the treatments.

Does attention modulate the perception of luminance changes?

In a previous study assessing the modulation of visual processing by attention, Bonnel, Possamî, and Schmitt showed that, when discriminating line-length, subjects precisely shared processing resources between two pairs of lines presented to the left and right of fixation. In a close replication requiring the detection of luminance increments instead of line-length differences, subjects were unable to follow the instructions and to allocate attention differentially, thus supporting the claim that light detection is fundamentally different from shape discrimination. In a subsequent experiment, we tested and rejected the possibility that luminance perception was not open to modulation by attention due to its physical nature. Replacing brightness detection by brightness identification allowed voluntary control on the quality of processing to be evidenced. The similarity between the latter results and the data from line-length discrimination suggests that task requirements may be crucial in determining the distribution of attention.

Suprathreshold resistive load perception in normal and asthmatic subjects.

The perception of external suprathreshold loads (2.5-44 cm H2O.1-1.s) was determined in 5 normal and 16 asthmatic subjects in order to (1) study the role of the wording given to the subject for rating the inspiratory loads, either 'intensity' or breathing 'discomfort', and (2) compare the sensation to low (2.5-8 cm H2O.1-1.s) and to high (17-44 cm H2O.1-1.s) loads. Normal subjects exhibited accurate rating of the loads regardless of the wording; high loads were estimated as more severe than the low ones, in spite of a long time interval between the two experiments. They were able to discriminate between each pair of loads. On the contrary, asthmatics with chronic airway obstruction demonstrated a poor perception in all experimental conditions. The physiological variables of breathing pattern and mouth pressure were modified in the same manner in the two populations and could not account for the differences in perception. In conclusion, the differences in sensitivity observed between normal and asthmatic subjects were verified for suprathreshold load perception whatever the wording and the level of the loads. Therefore, for this kind of experimental study, it is not useful to study the full scale of the loads. Furthermore, the present methodological approach provides an additional support to the assumption that the asthmatics' poor sensitivity is related to psychological factors such as past experience of loaded breathing.

Breathing discomfort in asthma: role of adaptation level.

In asthmatic patients, Helson's adaptation level theory was applied to breathing discomfort to investigate the discrepancy between the subjective severity of breathlessness and their objective airflow obstruction. The data from a signal detection methodology show a considerable loss of sensitivity in twelve asthmatic patients with permanent airflow obstruction compared to the high sensitivity of six normal subjects to the same four external resistive loads (range 2.5 to 8.0 cmH2O X l-1 X s). Furthermore, when subjective ratings are examined, the absence of any contrast effect between adjacent load intensities in asthmatics suggests that these subjects evaluate the discomfort induced by the loads with reference to a strong internal comparison (adaptation level) rather than to the experimental stimuli. There was no relationship between physiological parameters and the low sensitivity of asthmatics. Also salbutamol-induced bronchodilation in six asthmatics did not improve sensitivity or induce any contrast effect. These two observations bring out the necessity to consider the role of past experience of breathing discomfort on adaptation level and sensitivity.

Effects of airflow resistance variations on resistive load detection in normal subjects.

The sensitivity to airflow resistance variations produced by externally added resistive loads, with modification of background load, was studied in 15 normal subjects, using "Sensory Decision Theory" (SDT), a psychophysical method that gives an index of accuracy, P(A), unaffected by response bias. In six subjects, asked to detect three increasingly added loads (delta R) at different levels of basal resistance (1.6 and 3.6 cmH2O X 1(-1) X s), inspiratory resistive load detection (RLD) improved with background loading, and a highly significant relationship was found between P(A) and peak mouth pressure (Pm). The relationship between P(A) and the change in Pm, i.e. delta Pm, was less significant. These results suggest that, although tension developed by the respiratory muscles reflected by mouth pressure may be an important stimulus to respiratory RLD, other factors must also be considered. In seven subjects, in whom airway resistance was increased at least 50% by inhalation of carbachol, inconsistent variations in P(A) were found. In seven subjects, in whom airflow resistance was decreased by inhalation of heliox, and in six of seven subjects after salbutamol inhalation, RLD was significantly impaired. The results of this study lead us to the conclusion that Weber's law is not verified for weak internal or external background loading.

Labor pain assessment: validity of a behavioral index.

There is a need for adequate and convenient measures for assessing obstetric pain. The present investigation was designed to develop a non-verbal objective measurement of labor pain based on the continuous observation of behavior. Validity and sensitivity of the instrument designed to assess pain throughout labor using standardized observational ratings were tested on a sample of 100 primiparae who were asked periodically to rate pain on a 5-point numerical scale. The use of a behavioral method of observation associated with a self-rating procedure comprises various advantages, especially because they may appreciate different factors of the pain experience. Behavioral and self-rating indices were satisfactorily correlated. The behavioral index correlates with the pre-partum anxiety score but the self-rating index does not. The positive results obtained in this preliminary study lead us to consider this behavioral index as a valid instrument.

Inspiratory and expiratory resistive load detection in normal and asthmatic subjects. A sensory decision theory analysis.

The ability to detect added external inspiratory and expiratory resistive loads was studied in normal and asthmatic subjects using sensory decision theory as a psychophysical method. Performances P(A)/delta R [where P(A) represents the index of sensitivity and delta R the additional resistor] were similar in normal and asthmatic subjects, but when sensitivity was expressed in relation to airway resistance [P(A)/delta R/Raw], asthmatics showed higher inspiratory and expiratory performances than normal subjects. After bronchodilation the relative sensitivity in the asthmatic group was impaired and approached that of normal subjects. Comparing inspiratory and expiratory load detection, normal subjects showed a higher sensitivity for expiratory than for inspiratory loads. In contrast, there was no difference in the asthmatic group. The response bias remained the same across conditions. If one accepts the assumption that the variability of sensitivity presented by asthmatic and normal subjects might be related to the variable state of their pulmonary function, our results can be interpreted as demonstrating a relationship between sensitivity and pulmonary distension or airway obstruction. These results are in agreement with the hypothesis that the site of perception for respiratory load detection is the chest wall.