Diagnostic evaluation and management of seizures and status epilepticus in children with known epilepsy or new-onset seizures: A retrospective and comparative analysis.

OBJECTIVES: The purpose of this study was to describe and compare the initial management, including clinical/biological investigation and treatment, of new-onset seizures and status epilepticus (SE) in children versus seizures and SE in those with known epilepsy. METHODS: This was a retrospective, single-center, observational study conducted in an urban pediatric hospital in Paris. All patients, aged from 1 month to 18 years, admitted to the pediatric intensive care unit, the high-dependency care unit, and those who required hospitalization in the short-term unit of the emergency department between January 1 and December 31, 2014 for seizures and/or SE were included. RESULTS: We analyzed the data of 190 children: new-onset seizures (N=118; group A) versus those with known epilepsy (N=72; group B). At least one diagnostic test was performed on 156 patients (82.1%) (group A, N=104, 88.1%; group B, N=52, 72.2%; P=0.05). In group B, blood levels of antiepileptic drugs were measured in 14 of the 38 patients with SE, of whom six were under dosed. Treatments were: first line, diazepam (group A, 80%; group B, 46%; P<0.001); second line, diazepam (group A, 56%; group B, 34%; P=0.02) or clonazepam (group A, 24%; group B, 46%; P=0.001); third line, phenytoin (group A, 54%; group B, 22%; P<0.001) or clonazepam (group A, 18%; group B, 61%; P<0.001). CONCLUSION: Diagnostic evaluation and treatment should be individualized for children with known epilepsy.

Numerical modelling of the suspended particulate matter dynamics in a regulated river network.

Understanding and predicting the propagation, deposition and resuspension of suspended particulate matter (SPM) in river networks is important for managing water resources, ecological habitat, pollution, navigation, hydropower generation, reservoir sedimentation, etc. Observational data are scarce and costly, and there is little feedback on the efficiency of numerical simulation tools for compensating the lack of data on a river scale of several hundreds of kilometers. This paper aims at exploring the use of a one-dimensional (1-D) hydrodynamical model for understanding the source and fate of SPM during complex events. The numerical model was applied to the May-June 2008 flood in the Lower Rhône River, France. This event was a combination of floods of the Isère (including dam flushing operations in the Lower Isère River) and Durance tributaries over a two-week period. The simulation code was used to model the SPM fluxes at a high spatial and temporal resolution using a multi-class approach. Approximately half of the 4.9 Mt of SPM measured at the outlet at Beaucaire were found to come from the Isère River and the other half from the Durance River, whereas previous studies estimated that most of the SPM flux at the outlet came from the Durance River. The amount of SPM trapped within the river network, mainly behind the first hydropower structure downstream of the Isère confluence, was estimated to be 3.7 Mt due to the deposition of the coarsest particles. Such a model proved to be able to compute the interaction of various grain size classes with dams and other structures. In turn, the quality of the results of SPM fluxes and deposition is highly sensitive to particle parameters, especially grain size distribution, and to the operational rules of reservoirs.

A multi-technique approach for evaluating sand dynamics in a complex engineered piedmont river system.

A multi-technique approach is proposed to study sand dynamics in an engineered piedmont river. Only a few studies focused on such systems and innovative methodological protocols still need to be designed to better understand sand transport in piedmont rivers where bedload dynamics has been largely modified with nowadays a residual sand transport on a fixed gravel matrix. The proposed methodology is based on an analysis of bathymetry and turbidity measurements and on modelling, including the development of sediment rating curves and 2D numerical modelling, and using sediment budgeting for cross-validation. Its application to the Isère-Rhône confluence (France) provided some insights of sand fluxes in this complex river system where few sediment flux data are available. Indeed, a substantial amount of sand sporadically reaches the downstream part of the Isère River because of the presence of a series of dams, and jeopardizes navigation and flood management at the confluence. Based on the analysis of the 2015 flushing event, it was found that the sediment transport capacity was reached during the event whereas sand supply can be considered as null when dam bottom gates are closed. Suspended load of sand was prevailing downstream of the last dam but quickly settled down at the confluence. The sand deposit was eventually evacuated from the confluence during the small floods occurring after the flushing event with a minimum discharge of approximately 500 m3/s in the Isère River and 1000 m3/s in the headrace canal of the Rhône River. The presented methodology can be transferred to other sites with similar issues.

Sampling of suspended particulate matter using particle traps in the Rhône River: Relevance and representativeness for the monitoring of contaminants.

Monitoring hydrophobic contaminants in surface freshwaters requires measuring contaminant concentrations in the particulate fraction (sediment or suspended particulate matter, SPM) of the water column. Particle traps (PTs) have been recently developed to sample SPM as cost-efficient, easy to operate and time-integrative tools. But the representativeness of SPM collected with PTs is not fully understood, notably in terms of grain size distribution and particulate organic carbon (POC) content, which could both skew particulate contaminant concentrations. The aim of this study was to evaluate the representativeness of SPM characteristics (i.e. grain size distribution and POC content) and associated contaminants (i.e. polychlorinated biphenyls, PCBs; mercury, Hg) in samples collected in a large river using PTs for differing hydrological conditions. Samples collected using PTs (n = 74) were compared with samples collected during the same time period by continuous flow centrifugation (CFC). The grain size distribution of PT samples shifted with increasing water discharge: the proportion of very fine silts (2-6 µm) decreased while that of coarse silts (27-74 µm) increased. Regardless of water discharge, POC contents were different likely due to integration by PT of high POC-content phytoplankton blooms or low POC-content flood events. Differences in PCBs and Hg concentrations were usually within the range of analytical uncertainties and could not be related to grain size or POC content shifts. Occasional Hg-enriched inputs may have led to higher Hg concentrations in a few PT samples (n = 4) which highlights the time-integrative capacity of the PTs. The differences of annual Hg and PCB fluxes calculated either from PT samples or CFC samples were generally below 20%. Despite some inherent limitations (e.g. grain size distribution bias), our findings suggest that PT sampling is a valuable technique to assess reliable spatial and temporal trends of particulate contaminants such as PCBs and Hg within a river monitoring network.

[Value of procalcitonin for infants with bronchiolitis in an emergency department]. / Dosage de la procalcitonine et bronchiolites vues dans un service d'accueil des urgences pédiatriques.

CONTEXT: Very few studies have evaluated the role of procalcitonin (PCT) in infants with bronchiolitis. AIMS: To describe infants who had both a diagnosis of bronchiolitis at the emergency department and a blood test including PCT, and to compare the characteristics of children according to the PCT value. METHODS: Infants admitted to the Pediatric Emergency Department between 1 January 2014 and 31 December 2014 who had a diagnosis of bronchiolitis and a blood test including PCT were included. The clinical, biological, and radiological characteristics of the infants with PCT <1 or ≥1g/L were compared. RESULTS: One hundred thirty six infants were included. Patients with high PCT (n=20) had a higher temperature (38.5°C, IQR=37.8-38.6 vs. 37.5°C, IQR=37.1-38.2; P<0.01), C-reactive protein (50mg/L, IQR=25-83 vs. 5mg/L, IQR=0-19; P<0.01), and neutrophils (7.8×109/L, IQR=6.0-8.5 vs 4.5×109/L, IQR=2.9-6.6; P<0.01) higher than patients with low PCT (n=116). Presence on the chest x-ray of alveolar condensation did not differ between the two PCT groups. Infants coming from the low-PCT group received fewer antibiotics (14.7% vs 65%; P<0.01). CONCLUSION: In a Pediatric Emergency Department, PCT with a value of 1 or more cannot predict the presence of alveolar condensation on the chest x-ray. It seems to be associated with the antibiotics prescription, even if this could not be proved because of the design of the study.

Using multi-frequency acoustic attenuation to monitor grain size and concentration of suspended sediment in rivers.

Multi-frequency acoustic backscatter profiles recorded with side-looking acoustic Doppler current profilers are used to monitor the concentration and size of sedimentary particles suspended in fluvial environments. Data at 300, 600, and 1200 kHz are presented from the Isère River in France where the dominant particles in suspension are silt and clay sizes. The contribution of suspended sediment to the through-water attenuation was determined for three high concentration (> 100 mg/L) events and compared to theoretical values for spherical particles having size distributions that were measured by laser diffraction in water samples. Agreement was good for the 300 kHz data, but it worsened with increasing frequency. A method for the determination of grain size using multi-frequency attenuation data is presented considering models for spherical and oblate spheroidal particles. When the resulting size estimates are used to convert sediment attenuation to concentration, the spheroidal model provides the best agreement with optical estimates of concentration, but the aspect ratio and grain size that provide the best fit differ between events. The acoustic estimates of size were one-third the values from laser grain sizing. This agreement is encouraging considering optical and acoustical instruments measure different parameters.

Changes in motility, ATP content, morphology and fertilisation capacity during the movement phase of tetraploid Pacific oyster (Crassostrea gigas) sperm.

Changes in sperm features during the movement phase are especially interesting to study in external fertilization species whose sperm duration movement is long because this implies a significant adaptation of moving cells to the external medium. This study describes the changes in tetraploid Pacific oyster sperm characteristics in relation to time post activation. Sperm individually collected on three tetraploid males were activated in seawater. Their features were analysed over a 24h period and compared to a sperm pool collected on three diploid males as a reference. The percentage of motile spermatozoa, the intracellular ATP content, and the fine structure of spermatozoa were studied in relation to time post activation. Furthermore, the fertilisation capacity of sperm individually collected on five diploid males was assessed after 1 and 24h post activation. A forward progressive movement was maintained for at least a 20h duration. Compared to diploid males, the percentage of motile spermatozoa was lower in tetraploid males. The intracellular ATP concentration was higher in spermatozoa from tetraploid males than in spermatozoa from diploid males. A decrease in ATP content was observed in the first 6h post activation and severe alterations were observed in sperm morphology after 24h. Then, a lower fertilisation capacity of sperm from diploid males was observed at the end of the movement phase. The cessation of Pacific oyster sperm motility was unlikely caused by ATP consumption as ATP concentration was still high at the end of sperm movement but rather caused by drastic changes in sperm morphology. Compared to sperm collected on diploid males, the lower quality of sperm from tetraploid males was emphasized by a shorter movement duration and deeper morphological alterations at the end of the movement phase.

Comparison of Thoracic Injury Risk in Frontal Car Crashes for Occupant Restrained without Belt Load Limiters and Those Restrained with 6 kN and 4 kN Belt Load Limiters.

In France, as in other countries, accident research studies show that a large proportion of restrained occupants who sustain severe or fatal injuries are involved in frontal impacts (65% and 50%, respectively). In severe frontal impacts with restrained occupants and where intrusion is not preponderant, the oldest occupants very often sustain severe thoracic injuries due to the conventional seat belt. As we have been observing over the last years, we will expect in the coming years developments which include more solidly-built cars, as offset crash test procedures are widely used to evaluate the passive safety of production vehicles. The reduction of intrusion for the most severe frontal impacts, through optimization of car deformation, usually translates into an increase in restraint forces and hence thoracic injury risk with a conventional retractor seat belt for a given impact severity. It is, therefore essential to limit the restraint forces exerted by the seat belt on the thorax in order to reduce the number of road casualties. In order to address thoracic injury risk in frontal impact, Renault cars have been equipped with the Programmed Restraint System (PRS) since 1995. The PRS is a restraint system that combines belt load limitation and pyrotechnic belt pretension. In an initial design of the Programmed Restraint System (PRS1), the belt load limiter was a steel component designed to shear at a given shoulder force, namely 6 kN. It was mounted between the retractor and the lower anchorage point of the belt. The design of the PRS was modified in 1998 (PRS2), but the principle of load limitation was maintained. The threshold was decreased to 4 kN and this lower belt belt-force limiter has been combined with a specially designed airbag. This paper reports on 347 real-world frontal accidents where the EES (Equivalent Energy Speed) ranged from 35 to 75 km/h. One hundred and ninety-eight (198) of these accidents involved cars equipped with the 6 kN load limiter, and 149 involved cars equipped with the 4 kN load limiter. Based on this accident data, the study compares the thoracic injury risk for two occupant populations: belted occupants involved in accidents in which the vehicle was not equipped with a load limiter (378 cases with pyrotechnic pretensioners), and belted occupants involved in accidents in which the vehicles were equipped with 4 or 6 kN load limiters and pyrotechnic pretensioners (347 cases). One observes that a 4 kN load limitation results in a very important reduction of thoracic injury risk for all AIS levels, compared to others samples. 50 to 60% reduction for AIS 2+ was observed, as well as 75 to 85% for AIS 3+. The complete absence of AIS 4+ with a 4 kN load limiter must be stressed, though it remains more than 8% for the other samples (no limiter and 6 kN limiter).

Incorporation of microalgae sterols by scallop Pecten maximus (L.) larvae.

Changes in sterol composition of Pecten maximus larvae during the larval development stage with standard algal mixtures and unialgal diets were analysed. The sterol composition of four microalgae currently used in mollusc hatchery were also examined. Under standard algal conditions, the larvae quickly use the steryl ester from larvae reserves during the endotrophic and the mixotrophe phases. The preferential incorporation of Pavlova lutheri and T-Isochrysis sterols, rather than Skeletonema costatum sterols, during the larval development stage would indicate that S. costatum cells were poorly ingested and digested by larvae. Among the ingested sterols, cholesterol and stigmasterol were preferentially incorporated by the larvae. Conversely, the larvae appeared able to limit the incorporation of methylpavlovol, ethylpavlovol, and 4alpha-methylporiferasterol. In the unialgal experiment, the best growths were obtained with the diet richest in cholesterol (Chaetoceros calcitrans) and the best compromise of good growth and settlement rate was observed with the diet richest in C24 ethyl sterol. The selective incorporation of the cholesterol was confirmed by the larval rearing with C. calcitrans. The strong sterol dietary imprint in larvae corroborated the absence of an important capacity in P. maximus larvae to convert or biosynthesise sterol.

Adenylate energy charge: a possible trophic index for management of oyster intensive aquaculture.

1. O. edulis and C. gigas both exhibit a seasonal variation in AEC with minimum values in summer. Two factors, food and temperature, were examined to explain these low summer values. 2. The AEC level varied with food level but a seasonal pattern was still observed. Two age groups of oysters were tested, giving a similar response. 3. The effect of temperature on the seasonal variations in AEC was confirmed by a significant correlation between AEC and temperature. This relationship allows us to calculate an AEC standard that only retains the trophic information. 4. Different trophic levels were identified in Marennes-Oléron Bay with AEC standard but growth rate was not related to them. So, AEC may inform on the carrying capacity of a given area but does not predict growth performances which will depend on other parameters.