A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: A clinical case

Complex congenital heart disease characterized by the underdevelopment of one ventricular chamber (single ventricle (SV) circulation) is normally treated with a three-stage surgical repair. This study aims at developing a multiscale computational framework able to couple a patient-specific three-dimensional finite-element model of the SV to a patient-specific lumped parameter (LP) model of thewhole circulation, in a closed-loop fashion. A sequential approach was carried out: (i) cardiocirculatory parameters were estimated by using a fully LP model; (ii) ventricular material parameters and unloaded geometry were identified by means of the stand-alone, three-dimensional model of the SV; and (iii) the three-dimensional model of SV was coupled to the LP model of the circulation, thus closing the loop and creating a multiscale model. Once the patient-specific multiscale model was set using pre-operative clinical data, the virtual surgery was performed, and the post-operative conditions were simulated. This approach allows the analysis of local information on ventricular function aswell as global parameters of the cardiovascular system. This methodology is generally applicable to patients suffering from SV disease for surgical planning at different stages of treatment. As an example, a clinical case from stage 1 to stage 2 is considered here

Fast simulations of patient-specific haemodynamics of coronary artery bypass grafts based on a POD-Galerkin method and a vascular shape parametrization

In this work a reduced-order computational framework for the study of haemodynamics in three-dimensional patient-specific configurations of coronary artery bypass grafts dealing with a wide range of scenarios is proposed. We combine several efficient algorithms to face at the same time both the geometrical complexity involved in the description of the vascular network and the huge computational cost entailed by time dependent patient-specific flow simulations. Medical imaging procedures allow to reconstruct patient-specific configurations from clinical data. A centerlines-based parametrization is proposed to efficiently handle geometrical variations. POD-Galerkin reduced-order models are employed to cut down large computational costs. This computational framework allows to characterize blood flows for different physical and geometrical variations relevant in the clinical practice, such as stenosis factors and anastomosis variations, in a rapid and reliable way. Several numerical results are discussed, highlighting the computational performance of the proposed framework, as well as its capability to carry out sensitivity analysis studies, so far out of reach. In particular, a reduced-order simulation takes only a few minutes to run, resulting in computational savings of 99% of CPU time with respect to the full-order discretization. Moreover, the error between full-order and reduced-order solutions is also studied, and it is numerically found to be less than 1% for reduced-order solutions obtained with just O(100) online degrees of freedom. (C) 2016 Elsevier Inc. All rights reserved

Hemophagocytic inflammatory syndrome in ADA-SCID: report of two cases and literature review

Hemophagocytic inflammatory syndrome (HIS) is a rare form of secondary hemophagocytic lymphohistiocytosis caused by an impaired equilibrium between natural killer and cytotoxic T-cell activity, evolving in hypercytokinemia and multiorgan failure. In the context of inborn errors of immunity, HIS occurrence has been reported in severe combined immunodeficiency (SCID) patients, including two cases of adenosine deaminase deficient-SCID (ADA-SCID). Here we describe two additional pediatric cases of ADA-SCID patients who developed HIS. In the first case, HIS was triggered by infectious complications while the patient was on enzyme replacement therapy; the patient was treated with high-dose corticosteroids and intravenous immunoglobulins with HIS remission. However, the patient required HLA-identical sibling donor hematopoietic stem cell transplantation (HSCT) for a definitive cure of ADA-SCID, without HIS relapse up to 13 years after HSCT. The second patient presented HIS 2 years after hematopoietic stem cell gene therapy (GT), secondarily to Varicella-Zoster vaccination and despite CD4+ and CD8+ lymphocytes’ reconstitution in line with other ADA SCID patients treated with GT. The child responded to trilinear immunosuppressive therapy (corticosteroids, Cyclosporine A, Anakinra). We observed the persistence of gene-corrected cells up to 5 years post-GT, without HIS relapse. These new cases of children with HIS, together with those reported in the literature, support the hypothesis that a major dysregulation in the immune system can occur in ADA-SCID patients. Our cases show that early identification of the disease is imperative and that a variable degree of immunosuppression could be an effective treatment while allogeneic HSCT is required only in cases of refractoriness. A deeper knowledge of immunologic patterns contributing to HIS pathogenesis in ADA-SCID patients is desirable, to identify new targeted treatments and ensure patients’ long-term recovery

Think and Act: Reflective Tool for professionals working with families (TART). Summary version

The IO3 aims to help organise and articulate reflection by the professional who works with families in situations of vulnerability or that are at risk and encourages professionals to continue questioning themselves about the processes of accompanying families with a broad, systemic, and ecological perspective. - The content of TART (IO3) is focused on a series of specific challenges of attention and intervention with today’s families in Europe. These challenges are listed in the previous IO by describing situations (IO1) and mentioning the main challenges that were identified by the professionals, parents, and young people (IO2). - The tool can be used both by the direct care professionals themselves to address their own practice, as well as by professionals who are dedicated to supervising teams, or by professionals who guide the professional practices of university students

Think and Act: Reflective Tool for professionals working with families (TART)

This tool, Think and Act: Reflective Tool for Professionals working with Families (TART) (hereinafter TART) has been created within the framework of the Erasmus + Grow in Family Today project (hereinafter GIFT) (2018-FR01-KA202-0488115) with the participation of 4 European countries (France, Spain, Italy and Romania) represented by 4 entities and/or professional services that attend families in vulnerable situations (Caminante-FR, Consell Comarcal del Vallès Occidental-ESP, Casa di Ramia-IT and Holtis-RO) and the universities of 4 European countries (Pau et Pays de l’Adour University-UPPA-FR; Barcelona University and Lleida University-ESP; Padova University and Verona University-IT; Iasi University-RO). Within the framework of the GIFT project, two previous intellectual outputs have been created that are antecedents to and complement this current output. The first of them "Growing in family today: the challenge of diversity" addresses the issue of the family and the exercise of parenthood in the family today from the perspective of diversity, and identifies the main challenges in terms of intervention, defined by the components of the aforementioned partnership. The second output, entitled “Representations of growing in family today” focuses on the view held by families, fathers, mothers, sons and daughters, as well as professionals, of what it means to grow in a family today. Both intellectual outputs are antecedents of this third intellectual output and contribute valuable elements to nurture the reflective processes that are proposed here..

Instrumentos de evaluación. Evaluación de la vulnerabilidad de madres e hijos durante el período perinatal

Este texto es el resultado de un trabajo colectivo entre cuatro equipos de profesionales de distintas nacionalidades en la combinación entre la práctica profesional y las perspectivas teóricas. El documento pretende resaltar los diferentes objetos y marcos teóricos involucrados y analizar su complementariedad y diferencias mediante el análisis de los instrumentos para la evaluación de la vulnerabilidad que cada equipo ha adoptado durante la práctica profesional.Proyecto Europeo CapeVfair. Erasmus

Instrumentos de diagnóstico de la vulnerabilidad durante el período perinatal

El presente documento es el resultado de la reflexión común de los profesionales y académicos involucrados en el proyecto CAPEvFAIR, sobre los instrumentos para el diagnóstico de la vulnerabilidad de la díada madre-hijo durante el período perinatal. El documento empieza con una descripción de la fase de diagnóstico de la vulnerabilidad durante la perinatalidad dentro del marco lógico del proyecto, seguido por las cuestiones que se tuvieron en cuenta al describir los instrumentos de diagnóstico específicos para cada grupo objetivo (madres con adicción, madres adolescentes, madres migrantes, madres en situaciones de pobreza). La presentación sintética y la descripción de los instrumentos son sistematizadas dependiendo de los grupos objetivo, gracias a la contribución de las organizaciones que cuentan con experiencia trabajando con aspectos específicos de la vulnerabilidad, compañeros en el proyecto CAPEvFAIR desde Francia, España, Italia y Rumanía. Este material puede ser usado por varios especialistas que trabajan con la madre y su hijo durante el período perinatal, como fuente de inspiración para adaptar los instrumentos proporcionados a contextos específicos. Las plantillas de los instrumentos descritos se presentan en los anexos del documento.Proyecto Europeo CapeVfair. Erasmus