Acute left ventricular dysfunction secondary to right ventricular septal pacing in a woman with initial preserved contractility: a case report

<p>Abstract</p> <p>Introduction</p> <p>Right ventricular apical pacing-related heart failure is reported in some patients after long-term pacing. The exact mechanism is not yet clear but may be related to left ventricular dyssynchrony induced by right ventricular apical pacing. Right ventricular septal pacing is thought to deteriorate left ventricular function less frequently because of a more normal left ventricular activation pattern.</p> <p>Case presentation</p> <p>We report the case of a 55-year-old Tunisian woman with preserved ventricular function, implanted with a dual-chamber pacemaker for complete atrioventricular block. Right ventricular septal pacing induced a major ventricular dyssynchrony, severe left ventricular ejection fraction deterioration and symptoms of congestive heart failure. Upgrading to a biventricular device was associated with a decrease in the symptoms and the ventricular dyssynchrony, and an increase of left ventricular ejection fraction.</p> <p>Conclusion</p> <p>Right ventricular septal pacing can induce reversible left ventricular dysfunction and heart failure secondary to left ventricular dyssynchrony. This complication remains an unpredictable complication of right ventricular septal pacing.</p

Le langage du corps dans la poésie mystique de Paul Éluard

Surrealist poetry of Paul Éluard is organically centered on body image. The body appariait as sense producer in the analysis of the relationship between poetic discourse and mystical discourse. Indeed, the body takes the form of a bridge linking the physical universe and the abstract and mystical world. This article attempts to examine the role of the body in the representation of the mystical adventure and the construction of meaning structure. The question is therefore how the body, physical and palpable by nature, allows to found a spiritual experience?La poesía surrealista de Paul Éluard, se centra en el cuerpo hasta el punto, incluso para aquellos que investigan sobre la representación del mundo interior del alma en el texto eluardiano. Este tema resulta como productor de sentido, simbolizado así como puente tendido entre el universo físico de aquí y el universo abstracto del más allá. El objetivo de este artículo es examinar el papel del cuerpo en la puesta en marcha de la aventura mística y la estructura del significado. La cuestión es saber cómo el cuerpo, físico y concreto por definición permite fundar una experiencia espiritual

Body Language in the mystical poetry of Paul Eluard

La poesía surrealista de Paul Eluard, se centra en el cuerpo hasta el punto, incluso para aquellos que investigan sobre la representación del mundo interior del alma en el texto eluardiano. Este tema resulta como productor de sentido, simbolizado así como puente tendido entre el universo físico de aquí y el universo abstracto del más allá. El objetivo de este artículo es examinar el papel del cuerpo en la puesta en marcha de la aventura mística y la estructura del significado. La cuestión es saber cómo el cuerpo, físico y concreto por definición permite fundar una experiencia espiritual.Surrealist poetry of Paul Eluard is organically centered on body image. The body appariait as sense producer in the analysis of the relationship between poetic discourse and mystical discourse. Indeed, the body takes the form of a bridge linking the physical universe and the abstract and mystical world. This article attempts to examine the role of the body in the representation of the mystical adventure and the construction of meaning structure. The question is therefore how the body, physical and palpable by nature, allows to found a spiritual experience

Ordonnancement multicritère des job-shops flexibles (formulation, bornes inférieures et approche évolutionniste coopérative)

Ce travail de thèse sur les problèmes d'ordonnancement concerne la mise en œuvre d'une méthodologie coopérative et multicritère pour résoudre les problèmes des job-shops flexibles. Il s'articule autour de deux parties principales. La première partie expose l'état de l'art et explique la difficulté et la diversité des problèmes d'ordonnancement, et par la suite, met en évidence la nécessité de la coopération et présente l'approche hybride proposée. Ces travaux s'articulent autour de deux modèles. Le premier modèle concerne l'évaluation multicritère et est présenté dans le troisième chapitre. Le deuxième est dédié à la résolution et à l'optimisation et est décrit dans le quatrième chapitre. Le modèle d'évaluation multicritère vise à élaborer un moyen de mesure de la qualité des solutions. Cette notion peut intégrer (en utilisant la puissance de la représentation floue) des préférences subjectives dans un cadre coopératif. Elle peut aussi chercher à identifier les solutions dominantes (au sens de Pareto) en faisant un bon usage de bornes inférieures intégrées dans le modèle. Le modèle d'optimisation et de résolution représente un noyau pour construire les solutions de "bonne qualité".Deux approches ont été développées dans ce modèle. La première est l'Approche par Localisation (AL). Elle permet de construire un ensemble de solutions en minimisant les critères liés à la répartition des ressources dans le cas des job-shops flexibles. La deuxième est une approche basée sur des techniques à stratégie d'évolution contrôlées pour améliorer la qualité des solutions données par l'AL. Dans ce cadre, trois nouveaux codages ont été mis en œuvre tout en développant les opérateurs génétiques associés. En outre, quelques aspects modulaires de cette méthode sont également présentés dans le troisième chapitre. Dans le cinquième chapitre, nous illustrons la mise en oeuvre des différentes approches proposées sur un jeu de données afin d'évaluer leurs performances. Nous présentons également quelques comparaisons à d'autres méthodes. De plus, nous validons la méthode proposée sur une grande série d'exemples pratiques. Enfin, nous concluons ce mémoire en rappelant les grandes lignes des travaux menés et en présentant quelques perspectives de recherche futures concernant les possibles applications réelles de l'approche développée.LILLE1-BU (590092102) / SudocSudocFranceF

ForMAAD Method: An Experimental Design for Air Traffic Control

This paper proposes a formal methodology for designing multi-agent systems based on stepwise refinements.The main contribution consists in providing a set of methodological principles and hints which help the user to build, in a systematic and incremental way, a correct design specification starting from an abstract requirements one. This method will be illustrated by developing a multi-agent solution for an air traffic control application

Successful pregnancies after transvenous cardiac resynchronization therapy in a woman with congenitally corrected transposition of the great arteries

Congenitally corrected transposition of the great arteries is a rare heart defect that can be associated with systemic ventricular dysfunction and conduction disturbances. The use of cardiac resynchronization therapy in patients with congenital heart disease is not fully established, and achievement of successful pregnancies after implantation of transvenous, biventricular system has never been described, and which resulted in a significant clinical improvement. We describe a 33-year-old female with congenitally corrected transposition of the great arteries, who achieved six pregnancies and successful vaginal deliveries. The two last pregnancies were achieved after cardiac resynchronization therapy for systemic ventricular dysfunction and complete heart block. A congenital cardiac disease has been identified in only one offspring

Frequency of D222G haemagglutinin mutant of pandemic (H1N1) pdm09 influenza virus in Tunisia between 2009 and 2011

BACKGROUND: The novel pandemic A (H1N1) pdm09 virus was first identified in Mexico in April 2009 and since then it spread worldwide over a short period of time. Although the virus infection is generally associated with mild disease and a relatively low mortality, it is projected that mutations in specific regions of the viral genome, especially within the receptor binding domain of the haemagglutinin (HA) protein could result in more virulent virus stains, leading to a more severe pathogenicity. METHODS: To monitor the genetic polymorphisms at position 222 of Haemagglutinin of influenza A(H1N1)pdm09 viruses from both outpatients with mild influenza and individuals with severe disease requiring hospitalization, during 2009-2010 and 2010-2011 seasons, a sequence-based genotypic assessment of viral populations to understand the prevalence of D222G mutation. RESULTS: The D222G was identified in clinical specimens from 3 out of 42 cases analyzed in Tunisia with severe outcome (7%). Interestingly, in one fatal case out of four viruses taken from fatal cases studied (25%). Also this mutation was found in one mild case out of 8 mild cases studied (0.1%). D222E substitution was found in virus taken from one patient with severe clinical syndrome (2%) out of 42 severe cases analyzed and E374K substitution was found in two severe cases (4%) out of 42 severe cases studied. CONCLUSIONS: A specific mutation in the viral haemagglutinin (D222G) was found in fatal, severe and mild case. Further virological, clinical and epidemiological investigations are needed to ascertain the role of this and other mutations that may alter the virulence and transmissibility of the pandemic influenza A (H1N1)pdm09. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1027334947811255.S

Virological Surveillance of Influenza Viruses during the 2008-09, 2009-10 and 2010-11 Seasons in Tunisia

BACKGROUND: The data contribute to a better understanding of the circulation of influenza viruses especially in North-Africa. OBJECTIVE: The objective of this surveillance was to detect severe influenza cases, identify their epidemiological and virological characteristics and assess their impact on the healthcare system. METHOD: We describe in this report the findings of laboratory-based surveillance of human cases of influenza virus and other respiratory viruses' infection during three seasons in Tunisia. RESULTS: The 2008-09 winter influenza season is underway in Tunisia, with co-circulation of influenza A/H3N2 (56.25%), influenza A(H1N1) (32.5%), and a few sporadic influenza B viruses (11.25%). In 2010-11 season the circulating strains are predominantly the 2009 pandemic influenza A(H1N1)pdm09 (70%) and influenza B viruses (22%). And sporadic viruses were sub-typed as A/H3N2 and unsubtyped influenza A, 5% and 3%, respectively. Unlike other countries, highest prevalence of influenza B virus Yamagata-like lineage has been reported in Tunisia (76%) localised into the clade B/Bangladesh/3333/2007. In the pandemic year, influenza A(H1N1)pdm09 predominated over other influenza viruses (95%). Amino acid changes D222G and D222E were detected in the HA gene of A(H1N1)pdm09 virus in two severe cases, one fatal case and one mild case out of 50 influenza A(H1N1)pdm09 viruses studied. The most frequently reported respiratory virus other than influenza in three seasons was RSV (45.29%). CONCLUSION: This article summarises the surveillance and epidemiology of influenza viruses and other respiratory viruses, showing how rapid improvements in influenza surveillance were feasible by connecting the existing structure in the health care system for patient records to electronic surveillance system for reporting ILI cases.This research was supported by Unit Virology, Microbiology Laboratory Charles Nicolle's Hospital as National Influenza Centre-Tunis and Influenza and Respiratory Laboratory, Instituto de Salud Carlos III as National Influenza Centre-Madrid. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. It is just an informal statement of the study and the members of the ethic committee of Charles Nicolle's hospital have previously always approved the work of the NICS