A comparison of ultrafast and conventional spectral Doppler ultrasound to measure cerebral blood flow velocity during inguinal hernia repair in infants

Background: Ultrafast cerebral Doppler ultrasound enables simultaneous quantification and visualization of cerebral blood flow velocity. The aim of this study is to compare the use of conventional and ultrafast spectral Doppler during anesthesia and their potential to show the effect of anesthesiologic procedures on cerebral blood flow velocities, in relation to blood pressure and cerebral oxygenation in infants undergoing inguinal hernia repair. Methods: A single-center prospective observational cohort study in infants up to six months of age. We evaluated conventional and ultrafast spectral Doppler cerebral ultrasound measurements in terms of number of successful measurements during the induction of anesthesia, after sevoflurane induction, administration of caudal analgesia, a fluid bolus and emergence of anesthesia. Cerebral blood flow velocity was quantified in pial arteries using conventional spectral Doppler and in the cerebral cortex using ultrafast Doppler by peak systolic velocity, end diastolic velocity and resistivity index.Results: Twenty infants were included with useable conventional spectral Doppler images in 72/100 measurements and ultrafast Doppler images in 51/100 measurements. Intraoperatively, the success rates were 53/60 (88.3%) and 41/60 (68.3%), respectively. Cerebral blood flow velocity increased after emergence for both conventional (end diastolic velocity, from 2.01 to 2.75 cm/s, p &lt; 0.001) and ultrafast spectral Doppler (end diastolic velocity, from 0.59 to 0.94 cm/s), whereas cerebral oxygenation showed a reverse pattern with a decrease after the emergence of the infant (85% to 68%, p &lt; 0.001). Conclusion: It is possible to quantify cortical blood flow velocity during general anesthesia using conventional and ultrafast spectral Doppler cerebral ultrasound. Cerebral blood flow velocity and blood pressure decreased, while regional cerebral oxygenation increased during general anesthesia. Ultrafast spectral Doppler ultrasound offers novel insights into perfusion within the cerebral cortex, unattainable through conventional spectral ultrasound. Yet, ultrafast Doppler is curtailed by a lower success rate and a more rigorous learning curve compared to conventional method.</p

A comparison of ultrafast and conventional spectral Doppler ultrasound to measure cerebral blood flow velocity during inguinal hernia repair in infants

Background: Ultrafast cerebral Doppler ultrasound enables simultaneous quantification and visualization of cerebral blood flow velocity. The aim of this study is to compare the use of conventional and ultrafast spectral Doppler during anesthesia and their potential to show the effect of anesthesiologic procedures on cerebral blood flow velocities, in relation to blood pressure and cerebral oxygenation in infants undergoing inguinal hernia repair. Methods: A single-center prospective observational cohort study in infants up to six months of age. We evaluated conventional and ultrafast spectral Doppler cerebral ultrasound measurements in terms of number of successful measurements during the induction of anesthesia, after sevoflurane induction, administration of caudal analgesia, a fluid bolus and emergence of anesthesia. Cerebral blood flow velocity was quantified in pial arteries using conventional spectral Doppler and in the cerebral cortex using ultrafast Doppler by peak systolic velocity, end diastolic velocity and resistivity index.Results: Twenty infants were included with useable conventional spectral Doppler images in 72/100 measurements and ultrafast Doppler images in 51/100 measurements. Intraoperatively, the success rates were 53/60 (88.3%) and 41/60 (68.3%), respectively. Cerebral blood flow velocity increased after emergence for both conventional (end diastolic velocity, from 2.01 to 2.75 cm/s, p &lt; 0.001) and ultrafast spectral Doppler (end diastolic velocity, from 0.59 to 0.94 cm/s), whereas cerebral oxygenation showed a reverse pattern with a decrease after the emergence of the infant (85% to 68%, p &lt; 0.001). Conclusion: It is possible to quantify cortical blood flow velocity during general anesthesia using conventional and ultrafast spectral Doppler cerebral ultrasound. Cerebral blood flow velocity and blood pressure decreased, while regional cerebral oxygenation increased during general anesthesia. Ultrafast spectral Doppler ultrasound offers novel insights into perfusion within the cerebral cortex, unattainable through conventional spectral ultrasound. Yet, ultrafast Doppler is curtailed by a lower success rate and a more rigorous learning curve compared to conventional method.</p

Neuropsychological outcome in survivors of congenital diaphragmatic hernia at 5 years of age, what does it tell?

Previous studies have frequently reported neurocognitive deficits in children born with congenital diaphragmatic hernia (CDH) at school age, which may contribute to academic difficulties. Yet, age at onset of these deficits is currently unknown. We evaluated neurocognitive skills with possible determinants in preschool children born with CDH. Eligible 5-year-old children born with CDH (2010–2015) who participated in our prospective structural follow-up program were included. We used the WPPSI-III to assess intelligence, subtests of the Kaufman-ABC for memory, and NEPSY-II to assess inhibition and attention. We included 63 children. Their test scores generally were within or significantly above normal range: total IQ = 103.4 (15.7) (p = 0.13); Verbal memory = 10.2 (2.8) (p = 0.61); Visuospatial memory = 11.4 (2.6) (p < 0.01); Inhibition = 10.5 (2.2), (p = 0.10). In univariable analyses, length of ICU-stay was negatively associated with IQ, and maximum vasoactive inotropic score and open repair were negatively associated with inhibition skills. In multivariable regression analysis, the latter association remained (B = 5.52, p = 0.04 (CI 0.32–10.72)). Conclusions: In these tested 5-year-old children born with CDH, neuropsychological outcome was normal on average. While problems in 8-year-olds are common, we did not detect onset of these problems at age 5. Yet, we cannot rule out that this cohort had a relatively mild level of disease severity; therefore, conclusions should be interpreted with caution. However, given the growing-into-deficit hypothesis, meaning that deviant brain development in early life is revealed once higher cognitive brain functions are demanded, follow-up should be conducted up to school age, and preferably beyond.What is Known:• Children born with CDH are at risk for academic difficulties at school age.• Whether these difficulties can be detected already before school age is unknown.What is New:• At age 5 years, intelligence, inhibition, attention, and memory skills were all within normal range, or even above, in children with CDH. This is supportive of the growing-into-deficit hypothesis in this patient population.• Those who underwent open surgical correction had poorer inhibition skills than those who were corrected with minimal access surgery

User created content: supporting a participative information society

According to this study European interactive websites like video sharing sites and blogs are outgrowing those created in the US. Compared with the US, which hosts the most commonly used websites for content created by users (blogs, texts, videos, music, games and virtual objects), Europe has more contributors. For example, almost 4 in 5 Italian internet users read blogs compared to 60% in the US, 41% of Spanish users write blogs but only 26% in the US, almost 60% of Czech internet users upload photos and 48% of Polish internet users subscribe to RSS feeds, all ahead of the US. To help the emergence of European Flickrs and youtubes that turn this large European creativity into growth and jobs, the Commission’s report highlights the need for new and updated EU rules building a Single Market for content that can be made and shared online by anyone. This study takes place in the context of the i2010 mid-term review. Its particular focus on the user perspective on the one hand and the potential for User-Created Content to support creation and innovation on the other hand has made it necessary for the European Commission to launch a prospective study on the roll-out of UCC and its economic, social, technical and legal challenges. User Created Content as such is not a new phenomenon. Content generated by individuals or groups of individuals already exists as leaflets, brochures and other forms of paper output. Similarly, the possibilities for users to access radio and/or television services have been made possible by both technological developments and regulation. Several member states introduced community media, either with a traditional broadcasting format or by using an open/direct access model such as the "offenere Kanäle" in Germany. The differences lies in the scale, economic potential and impact on traditional supply chains of modern user created content. The creation of new networks, in particular the introduction of the Internet, has created new opportunities for users to create, but more importantly, to distribute content. During the first development phase of the Internet, most content was still produced and distributed in line with the old, rather centralised, broadcasting model. Today\u27s Internet contains more and more content generated by individuals or groups of individuals. Some consider this trend of user generated/created content to be one of the most essential elements of what is called the "Web 2.0". A range of new business models is being developed and tested that operates on the basis of user created content. This content includes video- or audioclips, blogs and photos. Although the fixed Internet is used as the main distribution network, creation and distribution is also expanding into wireless environments (and some wireless environments – i.e. mobile networks - have their own specific form of user created content). Ewout Swar

Persisting Motor Function Problems in School-Aged Survivors of Congenital Diaphragmatic Hernia

Background and Objectives: Children born with congenital diaphragmatic hernia (CDH) and treated with extracorporeal membrane oxygenation (ECMO), are at risk for motor function impairment during childhood. We hypothesized that all children born with CDH are at risk for persistent motor function impairment, irrespective of ECMO-treatment. We longitudinally assessed these children's motor function. Methods: Children with CDH with and without ECMO-treatment, born 1999–2007, who joined our structural prospective follow-up program were assessed with the Movement Assessment Battery for Children (M-ABC) at 5, 8, 12 years. Z-scores were used in a general linear model for longitudinal analysis. Results: We included 55 children, of whom 25 had been treated with ECMO. Forty-three (78%) were evaluated at three ages. Estimated mean (95% CI) z-scores from the general linear model were −0.67 (−0.96 to −0.39) at 5 years of age, −0.35 (−0.65 to −0.05) at 8 years, and −0.46 (−0.76 to −0.17) at 12 years. The 5- and 8-years scores differed significantly (p = 0.02). Motor development was significantly below the norm in non-ECMO treated patients at five years; −0.44 (−0.83 to −0.05), and at all ages in the ECMO-treated-patients: −0.90 (−1.32 to −0.49), −0.45 (−0.90 to −0.02) and −0.75 (−1.2 to −0.34) at 5, 8, and 12 years, respectively. Length of hospital stay was negatively associated with estimated total z-score M-ABC (p = 0.004 multivariate analysis). Conclusion: School-age children born with CDH are at risk for motor function impairment, which persists in those who received ECMO-treatment. Especially for them long-term follow up is recommended

Dictionnaire des conventions

Comment penser l'économie autrement ? Depuis trente ans, des chercheurs de différentes disciplines participent au développement d’une économie des conventions qui construit une nouvelle représentation de l’économie. Les 75 auteurs réunis dans cet ouvrage fournissent un éclairage exceptionnel sur cette approche à partir des travaux de l’un de ses principaux artisans, Olivier Favereau. Plus que tout autre économiste, il a œuvré tout au long de sa carrière aux échanges interdisciplinaires pour renouveler notre compréhension des phénomènes économiques. Les différentes entrées de ce dictionnaire non standard discutent, utilisent ou prolongent ces travaux. Le lecteur dispose ainsi d’une introduction sans équivalent aux débats contemporains sur l’évolution des savoirs économiques : les nouvelles représentations de l’entreprise, du travail, de la finance et plus généralement des comportements économiques et de leur dimension politique.How to think the economy otherwise? For thirty years, researchers from different disciplines involved in the advent of the French convention school