Cardiac manifestations of MIS-C: cardiac magnetic resonance and speckle-tracking data.

Background: Cardiac involvement is central in MIS-C and represents the main cause of morbidity. In this study, we aimed to assess myocardial damage in patients with MIS-C using cardiac magnetic resonance (CMR) during the acute phase, as well as left ventricular and atrial longitudinal strain on admission, at discharge, and after 3 months. Methods: We performed a single-center prospective cohort study and case-control study. Between September 2020 and February 2022, we enrolled 39 patients hospitalized for MIS-C at our center. We performed left ventricular and atrial longitudinal 2D strain analysis on admission and during follow-up; echocardiographic data were compared to a matched control population. Patients above 4 years old with increased troponin underwent CMR. Results: Of 24 patients (mean age: 8.2 ± 4.9 years) who underwent CMR, 14 (58%) presented myocardial edema and 6 (25%) late gadolinium enhancement (LGE). LGE was associated with older age (p < 0.01), increased BMI (p = 0.03), increased ferritin levels (p < 0.001), lower left ventricular (LV) ejection fraction (p < 0.001), LV longitudinal strain (p = 0.004), left atrial (LA) strain (p = 0.05), and prolonged hospital stay (p = 0.02). On admission, LV ejection fraction, LV longitudinal strain, and LA strain were impaired, but each improved gradually over time; LVEF was the fastest to recover, while global LV longitudinal strain was still impaired as compared to controls after 3 months (p = 0.01). Conclusion: Our study demonstrates that myocardial injury is present in a quarter of MIS-C patients, and impaired LA and LV myocardial deformation persist for at least several weeks after the acute phase. CMR and LV/LA strain could help us to individualize follow-up of MIS-C patients.

Influence of gender on people with disabilities' work relationships: prospects for ergonomics interventions.

Norms and values embedded in what is referred to as 'institutionalised gender,' defined by the distribution of power between genders in the political, educational, religious, medical, cultural or social institutions of a society, exist even today. The above mentioned influential institutions shape societal norms that define, reproduce and justify differing expectations and opportunities for women, men, girls and boys. Using qualitative methods, 41 semi-structured interviews among employed people with deafness/hard of hearing (DHH), blindness/low vision, motor disabilities, or chronic pain from three administrative regions of Québec (Montréal, Outaouais, and Montérégie) were analysed. The results show that while gender is omnipresent in participants' remarks, it is not necessarily associated with exclusion from employment, but most certainly with perpetuating some forms of inequity in work situations. Solutions to raise awareness among ergonomists working with people with disabilities are suggested.Practitioner summary: Based on 41 semi-structured interviews among employed people with disabilities, a relationship between the gender of the participants and factors facilitating or inhibiting their integration into employment were established. Solutions to raise awareness among ergonomists working with a doubly marginalised population-women with disabilities-are suggested.Abbreviations: DEPPI: disability, employment, and public policies initiative; DHH: deaf or hard of hearing; LSQ: québec sign language; M: men; P: participant; s/g: sex and gender; W: women.

Menstrual Toxic Shock Syndrome: A French Nationwide Multicenter Retrospective Study.

BACKGROUND: Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. METHODS: This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between 1 January 2005 and 31 December 2020 in 43 French pediatric (n = 7) or adult (n = 36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as to assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, in critically ill patients with m-TSS. RESULTS: In total, 102 patients with m-TSS (median age, 18 years; interquartile range, 16-24 years) were admitted to 1 of the participating ICUs. All blood cultures (n = 102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for superantigenic toxin gene sequences was performed for 76 of the 92 vaginal samples positive for S. aureus (83%), and toxic shock syndrome toxin 1 was isolated from 66 strains (87%). At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS, and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with antitoxin antibiotic therapy, and 8 (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors, and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU. CONCLUSIONS: In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.

High throughput phenotyping dataset related to seed and seedling traits of sugar beet genotypes.

Several seed and seedling traits are measured to evaluate germination and emergence potential in relation with environmental conditions. More generally, these traits are also measured in the field of ecology as simple traits that can be correlated to other adaptative traits more difficult to measure on adult plants, as for example traits of the rooting system. Methods were developed for deep high throughput phenotyping of hundreds of genotypes from dry seed to the end of heterotrophic growth. The present dataset comes from a project on genotyping and phenotyping of populations of genotypes, with different geographic and genetic origins so as to increase genotypic diversity of sugar beet in terms of germination and early growth traits, evaluated at low temperatures. Data were collected in relation to the creation of the first sugar beet crop ontology. This dataset corresponds to the first automated phenotyping of a population of 198 genotypes and 4 commercial control varieties and is hosted on INRAE public depository under the reference number doi.org/10.15,454/AKNF4Q. The equipment and methods presented here are available on a phenotyping platform opened to collaborative research and adaptable for specific services for characterizing thousands of genotypes on different crops or other species. The phenotyping values can also be linked to genomic information to study the genetic determinism of the trait values.

Decompressive Craniectomy in Children with Severe Traumatic Brain Injury: A Multicenter Retrospective Study and Literature Review.

BACKGROUND: Severe traumatic brain injury (TBI) is the most common cause of disability in children. Refractory increased intracranial pressure can be a therapeutic challenge. Decompressive craniectomy can be proposed when medical management is insufficient, but its place is not clearly defined in guidelines. The aim of this study was to identify prognostic factors in children with TBI. METHODS: We performed a retrospective, multicenter study to analyze long-term outcomes of 150 children with severe TBI treated by decompressive craniectomy and to identify prognostic factors. RESULTS: A satisfactory neurologic evolution (represented by a King's Outcome Scale for Childhood Head Injury score >3) was observed in 62% of children with a mean follow-up of 3.5 years. Mortality rate was 17%. Prognostic factors associated with outcome were age, initial Glasgow Coma Scale score, presence of mydriasis, neuromonitoring values (maximal intracranial pressure >30 mm Hg), and radiologic findings (Rotterdam score ≥4). CONCLUSIONS: This study in a large population confirms that children with severe TBI treated by decompressive craniectomy can achieve a good neurologic outcome. Further studies are needed to clarify the use of this surgery in the management of children with severe TBI.

Severe casualties from Bastille Day Attack in Nice, France.

PURPOSE: To describe the most severe casualties from the July 14th, 2016 terror attack in Nice that were treated at the Lenval University Children's Hospital (LUCH) of Nice (France). METHODS: Retrospective study about casualties treated at LUCH from Bastille Day Attack with injuries resulting in the need for surgery, resuscitation, or death. The type of lesions and surgery, duration of hospitalizations, complications, psychological status, and outcome at discharge were collected. RESULTS: Eleven patients presented severe traumas including three adults. They were triaged and managed first by the Critical Care Physician on duty and by emergency room nurses with no additional staff. Six pediatric casualties needed surgery; seven patients were hospitalized in Pediatric Intensive Care Unit (PICU). Five deaths were reported. The most relevant injuries were: pelvic disjunction, lower limb fracture, vascular injuries, and head or trunk crush. As soon as it was possible, two surgeons attended the emergency room (ER) to help carry out the triage. Overall we performed twenty-eight surgeries, including two neurological, one vascular, and five orthopedic. We performed closed reduction and internal fixation (CRIF) in three cases of limb fractures. A compartment syndrome was observed. Stress disorders were observed in three patients, which merited psychiatric support and treatment. CONCLUSION: We faced uncommon situations with severe casualties without pre-hospital management. The presence of adult patients and unusual lesions increased the complexity. The presence of surgeons in the ER seemed useful for effective clinical decision-making. CRIF has been a valid option for damage control. Competence in vascular, neurological, major trauma surgery and psychic trauma should be available in any pediatric trauma center.

Wide clinical spectrum in ALG8-CDG: clues from molecular findings suggest an explanation for a milder phenotype in the first-described patient.

BACKGROUND: Congenital disorders of glycosylation (CDG) includes ALG8 deficiency, a protein N-glycosylation defect with a broad clinical spectrum. If most of the 15 previously reported patients present an early-onset multisystem severe disease and early death, three patients including the cas princeps, present long-term survival and less severe symptoms. METHODS: In order to further characterize ALG8-CDG, two new ALG8 patients are described and mRNA analyses of the ALG8-CDG cas princeps were effected. RESULTS: One new patient exhibited a hepato-intestinal and neurological phenotype with two novel variants (c.91A > C p.Thr31Pro; c.139dup p.Thr47Asnfs*12). The other new patient, homozygous for a known variant (c.845C > T p.Ala282Val), presented a neurological phenotype with epilepsy, intellectual disability and retinis pigmentosa. The cas princeps ALG8-CDG patient was reported to have two heterozygous frameshift variants predicted to be without activity. We now described a novel ALG8 transcript variant in this patient and the 3D model of the putative encoded protein reveals no major difference with that of the normal ALG8 protein. CONCLUSION: The description of the two new ALG8 patients affirms that ALG8-CDG is a severe disease. In the cas princeps, as the originally described frameshift variants are degraded, the novel variant is promoted and could explain a milder phenotype.

July 14, 2016, Terror Attack in Nice, France.

On July 14, 2016, a terrorist attack by truck occurred in Nice, France, during the traditional fireworks for Bastille Day. The authors present the point of view of the doctors from Lenval University Children's Hospital, which is located near the attack place and which had to manage 47 casualties, including 12 adults.

Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics.

OBJECTIVES: To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. STUDY DESIGN: Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. RESULTS: Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. CONCLUSIONS: RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations.

Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child: A case report.

RATIONALE: Ecthyma gangrenosum (Eg) is a necrotic lesion that is mostly seen in immunocompromised patients. It reflects a severe sepsis, possibly caused by Pseudomonas aeruginosa (Pa). PATIENT CONCERNS: A healthy 3-year-old girl admitted to the Pediatric Emergency Department presented a sepsis-associated purpura with neurological and respiratory distress. INTERVENTIONS: An empiric antibiotherapy (anti-meningococcal) was prescribed. DIAGNOSES: Forty-eight hours after admission, blood and wound cultures were positive for Pa. As a result, the decision was made to change the antibiotic therapy.Unfortunately, on day 3, the patient died. Exhaustive immunologic tests are presently being carried out. OUTCOMES: Eg caused by Pa is uncommon in healthy children, and purpura sepsis is usually caused by Neisseria meningitides infection. LESSONS: Eg should be recognized rapidly so that the appropriate treatment can be prescribed as quickly as possible.

Post-cardiac Arrest Syndrome in Children.

Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation in children, many of the children do not survive to discharge because they developped a post cardiac arrest syndrome. The post-cardiac arrest syndrome includes systemic ischaemia/reperfusion response, post-cardiac arrest brain injury, postcardiac arrest myocardial dysfunction, and persistent precipitating pathology. The main cause of death after ROSC in children is brain injury. Physiopathology and management are reviewed in regards of pediatric specificities. Management according to ABCDE includes airway and ventilation management, oxygen therapy, hemodynamic management with early goal directed therapy and protection of the brain against secondary injury by therapeutic hypothermia, management of seizures and control of glycemia.

Hybrid fluorocarbon-hydrocarbon CO2-philic surfactants. 1. synthesis and properties of aqueous solutions.

Six different hybrid fluorocarbon-hydrocarbon (F-H) sulfate and sulfonate surfactants, with variations in the relative F/H carbon chain length, have been synthesized and characterized in aqueous solution. These compounds have been targeted for potential activity in densified CO2. Tensiometric data and chemical analyses were consistent with surfactants of high chemical purity. Fluorination in terms of the F/H ratio exerts a strong control over all the surfactant physicochemical properties, including critical micelle concentrations (cmc's) and adsorption isotherms. One of these partially fluorinated surfactants (the sulfonate phi-F6H4) achieves very low surface tensions in water (gamma(cmc) approximately 19 mN m(-1)) more reminiscent of fully fluorinated double-chain compounds. Detailed 19F NMR studies revealed that omega'-CF3 groups can exhibit separate signals for monomeric and micellized forms, hence facilitating cmc determinations. Small-angle neutron scattering investigations confirmed the presence of ellipsoidal or extended disklike micelles, depending on the F-H chain asymmetry. For example, a symmetric hybrid F8H8 generates disklike micelles, whereas chain asymmetry in F8H4 or phi-F6H4 tends to drive cylindrical aggregation structures. These changes are consistent with variations in the surfactant packing parameter caused by the different chain F/H ratios. Hence, adsorption and aggregation are shown to respond in a predictable way to the molecular structure of these unusual surfactants.

Hybrid fluorocarbon-hydrocarbon CO2-philic surfactants. 2. formation and properties of water-in-CO2 microemulsions.

Hybrid fluorocarbon-hydrocarbon (F-H) sulfate surfactants are shown to be efficient stabilizers in water-in-CO2 (w/c) microemulsions. The chain structure and F-H ratio affect the regions of P-T phase stability and aggregation structure in these w/c phases. High-pressure near-infrared spectroscopy and small-angle neutron scattering measurements of microemulsified water provide evidence for the stabilization of w/c microemulsion droplets. The relative lengths of the two chains were found to influence the favored aggregation structure: for symmetric chain surfactants (F8H8, F7H7) spherical reverse micelles are present, but for asymmetric chain surfactants (F7H4, F8H4) extended cylinder aggregates form. These changes in aggregation are consistent with different surfactant packing parameters owing to the controlled variations in molecular structure. Furthermore, the general order of w/c phase transition pressures (F8H8 < F7H7 and F8H4 < F7H4) is in line with estimations of surfactant fractional free volume, as proposed by Johnston et al. (J. Phys. Chem. B 2004, 108, 1962-1966). Studies of adsorption at the poly(dimethylsiloxane)-water interface are shown to be valuable for assessing the CO2-philicity of new surfactants. All in all, the symmetric F8H8 and F7H7 analogues are seen to be the most efficient compounds from this class for applications in CO2.

Neutron reflection and small-angle neutron scattering studies of a fluorocarbon telomer surfactant.

Dilute aqueous phase behavior of a novel tris(hydroxymethyl)acrylamidomethane (THAM)-derived telomer bearing a perfluorohexyl hydrophobic chain, F6THAM6, has been investigated. Fluorinated polyhydroxy surfactants of this kind find use in emerging biomedical applications. Neutron reflection (NR) and drop volume surface tension (DVT) methods have been used to determine the critical micelle concentration (cmc=4.7 x 10(-4) mol x dm(-3)) and surface adsorption parameters (at the cmc NR gives a molecular area a(cmc)=67.4 and 62 A(2) and surface excess gamma(cmc)=2.46 x 10(-6) mol x m(-2)). The aggregation structures were determined by small-angle neutron scattering (SANS), indicating globular (polydisperse spheres) micelles of radius approximately 30 A are present. These findings are compared with literature on surfactants with related structures, to identify how the unusual molecular structure of F6THAM6 affects surfactant properties.

Micellization of economically viable surfactants in CO(2).

Stability and aggregation structures of various economically viable surfactants for CO(2) are reported. The compounds are either commercially available octylphenol nonionics (Triton X-100, X-100 reduced, and X-45) or custom-made analogues of aerosol-OT (J. Am. Chem. Soc. 123 (2001) 988). These were selected to reveal the influence of chain terminal group structure, namely highly methylated t-butyl units, on solubility and aggregation in CO(2). In addition the mean ethylene oxide block length is varied for the Triton surfactants (X-100 approximately EO(10), X-45 approximately EO(8)). High-pressure small-angle neutron scattering (SANS) experiments revealed the presence of aggregates, consistent with spheroidal reverse micelles. The nonionics show a temperature and pressure dependence on solubility. These results confirm the special affinity of highly methyl-branched tails for CO(2). However, none of these systems were able to disperse significant amounts of water or brine; therefore hydrated reversed micelles or microemulsion droplets were not stabilized. Hence the utility of these cheap methyl-branched surfactants in CO(2) is limited, and so groups of greater CO(2)-philicity are needed to achieve the goal of water-hydrocarbon surfactant-CO(2) dispersions.