Do Parents Recognize Autistic Deviant Behavior Long before Diagnosis? Taking into Account Interaction Using Computational Methods

BACKGROUND: To assess whether taking into account interaction synchrony would help to better differentiate autism (AD) from intellectual disability (ID) and typical development (TD) in family home movies of infants aged less than 18 months, we used computational methods. METHODOLOGY AND PRINCIPAL FINDINGS: First, we analyzed interactive sequences extracted from home movies of children with AD (N = 15), ID (N = 12), or TD (N = 15) through the Infant and Caregiver Behavior Scale (ICBS). Second, discrete behaviors between baby (BB) and Care Giver (CG) co-occurring in less than 3 seconds were selected as single interactive patterns (or dyadic events) for analysis of the two directions of interaction (CG→BB and BB→CG) by group and semester. To do so, we used a Markov assumption, a Generalized Linear Mixed Model, and non negative matrix factorization. Compared to TD children, BBs with AD exhibit a growing deviant development of interactive patterns whereas those with ID rather show an initial delay of development. Parents of AD and ID do not differ very much from parents of TD when responding to their child. However, when initiating interaction, parents use more touching and regulation up behaviors as early as the first semester. CONCLUSION: When studying interactive patterns, deviant autistic behaviors appear before 18 months. Parents seem to feel the lack of interactive initiative and responsiveness of their babies and try to increasingly supply soliciting behaviors. Thus we stress that credence should be given to parents' intuition as they recognize, long before diagnosis, the pathological process through the interactive pattern with their child

Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene. Objectives: This study sought to test the association between the rs9349379 genotype and SCAD. Methods: Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD. Results: The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence. Conclusions: The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD

Trace elements in hemodialysis patients: a systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Hemodialysis patients are at risk for deficiency of essential trace elements and excess of toxic trace elements, both of which can affect health. We conducted a systematic review to summarize existing literature on trace element status in hemodialysis patients.</p> <p>Methods</p> <p>All studies which reported relevant data for chronic hemodialysis patients and a healthy control population were eligible, regardless of language or publication status. We included studies which measured at least one of the following elements in whole blood, serum, or plasma: antimony, arsenic, boron, cadmium, chromium, cobalt, copper, fluorine, iodine, lead, manganese, mercury, molybdenum, nickel, selenium, tellurium, thallium, vanadium, and zinc. We calculated differences between hemodialysis patients and controls using the differences in mean trace element level, divided by the pooled standard deviation.</p> <p>Results</p> <p>We identified 128 eligible studies. Available data suggested that levels of cadmium, chromium, copper, lead, and vanadium were higher and that levels of selenium, zinc and manganese were lower in hemodialysis patients, compared with controls. Pooled standard mean differences exceeded 0.8 standard deviation units (a large difference) higher than controls for cadmium, chromium, vanadium, and lower than controls for selenium, zinc, and manganese. No studies reported data on antimony, iodine, tellurium, and thallium concentrations.</p> <p>Conclusion</p> <p>Average blood levels of biologically important trace elements were substantially different in hemodialysis patients, compared with healthy controls. Since both deficiency and excess of trace elements are potentially harmful yet amenable to therapy, the hypothesis that trace element status influences the risk of adverse clinical outcomes is worthy of investigation.</p

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Dynamique, synchronie, réciprocité et mamanais dans les interactions des bébés autistes à travers les films familiaux

This thesis studies early functioning of autistic infants, still unclear. Our developmental study of family home movies shows that they lack interest in others since the first year of life, but begin to actively avoid others only during the second year of life. Thus there could be a dynamic leading to this final relational deficit (maybe through a intersubjective deficit). To shed light on this dynamic, we took parents-infant synchrony into account, using computational methods on family home movies: infants show a very early deficit in orienting toward others and then in intersubjectivity; parents do respond normally to their infant but they are more insistent in soilliciting it as early as the first semester. However, may the infant relational deficit have affective consequences on its parents in the long run ? Motherese or infant-directed speech (IDS) reveals emotion in parent-infant interaction; belonging to an interactive loop, it supports both affective interaction and cognitive development: attention, language... May it sustain autistic infant's social engagement ? And may it decrease over time because of the interactive dysfunction (lack of social interest and lack of intersubjectivity) ? An algorithm detecting IDS was created and applied to a pilot study before to use it on all our films. First résults, to be confirm, suggest that IDS may be efficient in sustaining autistic infant's reactivity, but maternal, not paternal IDS efficiency could drop over time. In conclusion, we have laid a groundwork for studying dynamic interactions of autistic infants with their parents in order to approach the processes leading to the final autistic syndrom.Ce travail est centré sur le fonctionnement précoce des bébés autistes, encore mal connu. Notre étude développementale des films familiaux montre qu'ils manquent d'intérêt pour autrui dès la 1e année mais un évitement actif n'apparaît que la 2e année. Il y aurait donc une dynamique aboutissant au "déficit" relationnel final (passant peut-être par un défaut d'intersubjectivité). Pour comprendre cette dynamique, nous avons pris en compte à l'aide de méthodes computationnelles la synchronie parents-bébé sur des films familiaux: les bébés ont un déficit très précoce en orientation vers l'autre puis en "intersubjectivité"; les parents répondent normalement à leur bébé, mais le sollicitent plus intensément dès le premier semestre. Mais le déficit relationnel du bébé a-t-il des répercussions affectives sur ses parents ? Le mamanais (IDS) marque l'émotion dans l'interaction; pris dans une boucle interactive, il stimule à la fois l'engagement social et le développement cognitif (attention, langage). Soutient-il les interactions du bébé autiste ? Décroît-il au fil du temps du fait du dysfonctionnement interactif (manque d'intérêt pour autrui et défaut d'intersubjectivité)? Un algorithme détectant l'IDS a été créé et appliqué à une étude pilote avant d'étudier l'ensemble de nos films. Les premiers résultats, à confirmer, suggèrent que l'IDS soutient efficacement l'interaction du bébé autiste, mais l'efficacité de l'IDS maternel (et non paternel) pourrait chuter au fil du temps. En conclusion, nous avons apporté des bases à l'étude dynamique des interactions des bébés autistes avec leurs parents, en vue d'approcher les processus menant au tableau final

Suivi qualitatif de l’évolution de 120 enfants porteurs de troubles du spectre autistique pris en charge par la méthode des 3i

International audienceAimThe 3i intervention is a developmental play-therapy method that considers that children with Autism Spectrum disorders (ASD) present an altered developmental process. It aims to help the child progress along a natural developmental path. Each developmental deficit is dealt with successively, with full attention to the specific sensory characteristics of each child. The method is based on Intensive Individual Interaction (the 3Is) of the child with adults. The 3i intervention is managed by the parents and selected care-givers, 5 to 6 hours per day, 7 days per week, to favor constant stimulation of the child. A key characteristic of the 3i method is the intervention of numerous selected care-givers, each contributing their preferred way of playing with the child and their enthusiasm. These selected care-givers are mostly non-professionals in the field of ASD. They undergo preliminary screening and receive initial training before interacting with the child in the playroom. They subsequently participate each month in a group session with the other participants, together with the parents, under the supervision of a trained psychologist.GoalThe main objective of this retrospective study was to assess the development of communication and social skills among children diagnosed with autism spectrum disorders (ASD), treated with the 3i method for 2 years.Methods120 subjects who pursued the 3i method for 24 months were included in this study, on the basis of their individual files kept by the psychologist, who conducted the monthly meeting with professionals during the implementation of the 3i method. The psychologist rated six indicators (Imitation, Gaze Quality, Social and Emotional Regulation, Verbal Expression, Non-Verbal Expression and Verbal Comprehension) from 1 to 3 (1: not acquired; 2: partially acquired and 3: competence acquired). Thus a developmental acquisition stage or score was allocated to each patient at the beginning of 3i Method and 24 months later.ResultsFor each indicator, the statistical analysis showed that the group of patients significantly increased their skills over the 24 months of the 3i method. On average, the patients reached a higher level of skills in four of the six skill areas. There was a relatively greater increase in the skills relating to imitation and non-verbal communication.DiscussionBeyond the limitations arising from the retrospective nature of the study, which used a non-standardized assessment scale, these results are consistent with a previous prospective study on 20 subjects using international standardized instruments. These results suggest that disabilities related to autism spectrum disorders decrease as a result of a 3i intervention, enabling better daily-life interaction with parents and as a second step better integration in school with peers.ConclusionThis method could reduce the intensity of the autistic syndrome and improve the ability of ASD children to interact with their environment.ObjectifL’objectif de cette étude rétrospective est de décrire l’évolution des compétences en communication et relation d’un groupe d’enfants porteurs de trouble du spectre autistique et traités par la méthode des 3i pendant 2 ans.MéthodeCent-vingt dossiers d’enfants ayant poursuivi cette méthode pendant 24 mois ont été inclus dans cette étude. Un score de 1 à 3 dans une échelle d’acquisition de compétences (1 : non acquise, 2 : partiellement acquise, 3 : acquise) a été attribué à chaque sujet pour chacun des six indicateurs choisis (Imitation, Qualité du regard, Régulation sociale et émotionnelle, Expression verbale, Expression non verbale et Compréhension verbale). Les scores initiaux sont comparés aux scores finaux après 24 mois de méthode 3i.RésultatsL’analyse statistique montre que pour chaque indicateur le groupe de patients a significativement progressé au cours des 24 mois de méthode 3i. En moyenne, les sujets acquièrent un stade supérieur dans 4 domaines de compétences sur 6. La progression est plus grande dans les domaines de l’imitation et de la communication non verbale.DiscussionMalgré les limites liées au caractère rétrospectif de l’étude et à une grille d’évaluation non standardisée, les résultats sont cohérents avec une précédente étude prospective sur 20 sujets avec des outils internationaux. Ce résultat suggère que les handicaps liés aux troubles du spectre autistique diminuent au cours de la prise en charge 3i.ConclusionCelle-ci pourrait permettre de réduire l’intensité du syndrome autistique et d’améliorer les capacités d’interaction avec l’environnement

EN QUOI LE SYNDROME DE COTARD PEUT-IL ECLAIRER NOTRE REFLEXION PSYCHOPATHOLOGIQUE ? REVUE ET DISCUSSION DE LA LITTERATURE A PROPOS D'UNE OBSERVATION

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Growth and Freeze-Drying Optimization of Bifidobacterium crudilactis

peer reviewedBifidobacterium crudilactis FR62/b/3 belongs to a new population of bifidobacteria isolated from raw milk and raw milk cheese. The objective of this work was to study the large scale culture of the stain and its stability in a dry formulation. Growth rate of Bifidobacterium crudilactis FR62/b/3 was optimal at a pH of 5.0 and a temperature of 37˚C. At a temperature growth of 33˚C and a pH of 5.0, the stationary phase was reached after 22 h, the viable cell number and the mean dry biomass concentration were respectively of 8.3 × 109 CFU/mL and of 2.1 g/L. Resistance of Bifidobacterium crudilactis FR62/b/3 to freeze-drying and effect of a variety of cryoprotectants to maintain the viability were also evaluated. Sorbitol was the most suitable cryoprotectant for freeze-drying as well as storage whereas sucrose and monosodium glutamate were only efficient during storage

Clinical outcomes of interactive, intensive and individual (3i) play therapy for children with ASD: a two-year follow-up study

Abstract Background The outcomes of psycho-educational interventions for Autism Spectrum Disorders (ASDs) comorbid with severe to moderate intellectual disability (ID) are insufficiently documented. In this prospective study, we examined a developmental individual, interactive and intensive approach, called the ‘3i method’, which is based on play therapy. Methods Twenty DSM-IV-TR ASD subjects (mean chronological age 63.8 ± 37.8 months; mean developmental age 19.5 ± 6.6 months) were included and followed the 3i method for 24 months. Developmental and behavioural skills were assessed at baseline and after 24 months using the VABS, PEP-R and Nadel Imitation scale. Autism severity was evaluated using the Child Autism Rating Scale (CARS) and the Autism Diagnostic Interview (ADI-R). Results After 2 years of the 3i method, our 3 primary outcome variables significantly increased (VABS developmental age of socialization increased by 83%, age of communication by 34%, and Nadel Imitation score by 53%). Almost all VABS and PEP-R domains significantly improved. Additionally, increases in the VABS socialization score were positively correlated with the total number of treatment hours and CARS score; all ADI-R areas significantly decreased; and diagnoses had changed in 47.5% of the subjects (37% for PDD-NOS and even 10.5% for ID without PDD). Conclusion Children who followed the 3i method for 2 years had significantly improved behavioural and developmental skills and showed a clear decrease in autism severity. These results suggest that the 3i method may be useful for autistic children by improving their daily interactions with their social environment. Trial registration was retrospectively registered on May 20th, 2014 by the French Agency for drug and health (ANSM) under number ID-RCB 2014-A00542–45, reference: B148558–31