Peri-operative Anesthetic Innovations During Pediatric Cardiac Surgery

Congenital heart disease (CHD) refers to a series of birth defects that aff ect the heart and thoracic vessels, aff ecting 6 to 8 out of 1,000 babies being born. In 40% of these children no treatment is indicated because of minimal eff ect on hemodynamics and outcome. In 60% treatment will be required; about half of them will require urgent surgery after birth, while the other half will probably require surgery or medication at some point during childhood. Due to advances in heart surgery, 85% of children with congenital heart disease will

Bulletin agrométéorologique - Situation au 21 juin 2009

Depuis le dernier bulletin publié fin avril, les conditions météorologiques ont été fort proches des normales avec toutefois quelques épisodes orageux qui ont pu causer ça et là des dégâts aux cultures. La végétation semble avoir ralenti davantage sa croissance que ce qui s’observe d’habitude depuis dix ans, cela en particulier dans le Nord et le Nord-Ouest du pays, probablement en raison des conditions pluvieuses rencontrées dans ces zones. Cependant les prévisions de rendements à l’échelle nationale ne semblent pas être affectées. A l’exception du maïs, les rendements s’annoncent meilleurs que la moyenne des quatre dernières années

Virtual reality 3D echocardiography in the assessment of tricuspid valve function after surgical closure of ventricular septal defect

Background. This study was done to investigate the potential additional role of virtual reality, using three-dimensional (3D) echocardiographic holograms, in the postoperative assessment of tricuspid valve function after surgical closure of ventricular septal defect (VSD). Methods. 12 data sets from intraoperative epicardial echocardiographic studies in 5 operations (patient age at operation 3 weeks to 4 years and bodyweight at operation 3.8 to 17.2 kg) after surgical closure of VSD were included in the study. The data sets were analysed as two-dimensional (2D) images on the screen of the ultrasound system as well as holograms in an I-space virtual reality (VR) system. The 2D images were assessed for tricuspid valve function. In the I-Space, a 6 degrees-of-freedom controller was used to create the necessary projectory positions and cutting planes in the hologram. The holograms were used for additional assessment of tricuspid valve leaflet mobility. Results. All data sets could be used for 2D as well as holographic analysis. In all data sets the area of interest could be identified. The 2D analysis showed no tricuspid valve stenosis or regurgitation. Leaflet mobility was considered normal. In the virtual reality of the I-Space, all data sets allowed to assess the tricuspid leaflet level in a single holographic representation. In 3 holograms the septal leaflet showed restricted mobility that was not appreciated in the 2D echocardiogram. In 4 data sets the posterior leaflet and the tricuspid papillary apparatus were not completely included. Conclusion. This report shows that dynamic holographic imaging of intraoperative postoperative echocardiographic data regarding tricuspid valve function after VSD closure is feasible. Holographic analysis allows for additional tricuspid valve leaflet mobility analysis. The large size of the probe, in relation to small size of the patient, may preclude a complete data set. At the moment the requirement of an I-Space VR system limits the applicability in virtual reality 3D echocardiography in clinical practice

Differential regulation of Krüppel-like factor family transcription factor expression in neonatal rat cardiac myocytes: effects of endothelin-1, oxidative stress and cytokines

Krüppel-like transcription factors (Klfs) modulate fundamental cell processes. Cardiac myocytes are terminally-differentiated, but hypertrophy in response to stimuli such as endothelin-1. H2O2 or cytokines promote myocyte apoptosis. Microarray studies of neonatal rat myocytes identified several Klfs as endothelin-1-responsive genes. We used quantitative PCR for further analysis of Klf expression in neonatal rat myocytes. In response to endothelin-1, Klf2 mRNA expression was rapidly increased ( approximately 9-fold; 15-30 min) with later increases in expression of Klf4 and Klf6 ( approximately 5-fold; 30-60 min). All were regulated as immediate early genes (cycloheximide did not inhibit the increases in expression). Klf5 expression was increased at 1-2 h ( approximately 13-fold) as a second phase response (cycloheximide inhibited the increase). These increases were transient and attenuated by U0126. H2O2 increased expression of Klf2, Klf4 and Klf6, but interleukin-1beta or tumor necrosis factor alpha downregulated Klf2 expression with no effect on Klf4 or Klf6. Of the Klfs which repress transcription, endothelin-1 rapidly downregulated expression of Klf3, Klf11 and Klf15. The dynamic regulation of expression of multiple Klf family members in cardiac myocytes suggests that, as a family, they are actively involved in regulating phenotypic responses (hypertrophy and apoptosis) to extracellular stimuli

Preoperative anaemia and outcome after elective cardiac surgery:a Dutch national registry analysis

Background: Previous studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery. Methods: A nationwide, prospective, multicentre registry (Netherlands Heart Registration) of patients undergoing elective cardiac surgery between January 2013 and January 2019 was used for this observational study. Anaemia was defined according to the WHO criteria, and the main study endpoint was 120-day mortality. The association was investigated using multivariable logistic regression analysis. Results: In total, 35 484 patients were studied, of whom 6802 (19.2%) were anaemic. Preoperative anaemia was associated with an increased risk of 120-day mortality (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI]: 1.4–1.9; P<0.001). The risk of 120-day mortality increased with anaemia severity (mild anaemia aOR 1.6; 95% CI: 1.3–1.9; P<0.001; and moderate-to-severe anaemia aOR 1.8; 95% CI: 1.4–2.4; P<0.001). Preoperative anaemia was associated with red blood cell transfusion and postoperative morbidity, the causes of which included renal failure, pneumonia, and myocardial infarction. Conclusions: Preoperative anaemia was associated with mortality and morbidity after cardiac surgery. The risk of adverse outcomes increased with anaemia severity. Preoperative anaemia is a potential target for treatment to improve postoperative outcomes

Measurement of end-expiratory lung volume in intubated children without interruption of mechanical ventilation

Purpose: Monitoring end-expiratory lung volume (EELV) is a valuable tool to optimize respiratory settings that could be of particular importance in mechanically ventilated pediatric patients. We evaluated the feasibility and precision of an intensive care unit (ICU) ventilator with an in-built nitrogen washout/wash

Analyse d'un élément régulateur positif et mise en évidence d'un promoteur alternatif dans le premier intron du gène de l'alpha-foetoprotéine

Doctorat en Sciencesinfo:eu-repo/semantics/nonPublishe

Mécanismes de dégradation des catalyseurs modèles anodiques à base d'iridium dans les électrolyseurs de l'eau PEMWE

With the need for a drastic reduction of greenhouse gases, the deployment of fuel cells is one of the considered solutions. Decarbonated hydrogen production is subsequently a major challenge to enable an efficient energetic transition. From this perspective, Proton Exchange Membrane Water Electrolyser (PEMWE) is a technology of interest, especially if coupled with renewable energy sources. Key challenges are still to be addressed before commercializing this technology, in particular at the anode. Iridium oxide, a costly and rare material, is implemented in anodic catalytic layers to catalyse the Oxygen Evolution Reaction (OER) while being resistant to harsh acidic and oxidative conditions. It nonetheless undergoes some degradations.In this work, different iridium model surfaces for the OER where studied to understand mechanisms involved during the first oxidations step and oxygen evolution. After characterisations by Dynamic Electrochemical Impedance Spectroscopy (DEIS), an innovative technique used to study dynamic systems, structure-activity-stability relationships towards the OER were studied by comparing iridium model surfaces ((111), (210) and nanostructured (210)). Results showed that after few hours at high potential (> 1.6 V vs. Reversible Hydrogen Electrode)), these surfaces, with different initial chemical compositions and structures, tend to the same state. Finally, iridium and nickel@iridium thin films were studied, to model core@shell particles. Results indicate that the nickel dissolution lead to the formation of a porous layer more active towards the OER. These findings could help to design active iridium catalysts for the OER.Face à la nécessité d’une réduction drastique des émissions de gaz à effet de serre, le déploiement des piles à combustibles est présenté comme une solution d’avenir. La production d’hydrogène décarbonée est un des enjeux futurs pour permettre une transition énergétique efficace. Dans cette optique, l’électrolyseur à membrane échangeuse de proton (PEMWE), combiné aux sources énergétiques renouvelables, est une technologie intéressante. De nombreux défis sont encore à relever pour permettre une commercialisation de cette technologie, en particulier côté anodique. L’oxyde d’iridium, matériau coûteux et très rare, est utilisé à l’anode pour sa capacité à catalyser le dégagement d’oxygène tout en résistant aux conditions acide et oxydante. Il subit néanmoins des dégradations au cours de son utilisation.Dans ce travail, différentes surfaces modèles d’iridium pour le dégagement d’oxygène ont été étudiées pour comprendre les mécanismes mis en jeu lors des premières étapes d’oxydation de la surface et du dégagement d’oxygène. Après caractérisations par spectroscopie d’impédance électrochimique dynamique (DEIS), technique innovante permettant d’analyser les systèmes dynamiques, les relations structure-activité-stabilité lors du dégagement d’oxygène ont été étudiées en comparant des surfaces modèles d’iridium ((111), (210) et (210) nanostructurée). Les résultats obtenus mettent en évidence qu’après quelques heures à haut potentiel (> 1,6 V vs. Electrode Réversible à Hydrogène), ces surfaces, de structures et compositions chimiques initiales différentes, tendent vers le même état. Enfin, l’étude de films minces d’iridium et de nickel@iridium, modélisant des particules cœur@coquille, a montré qu’après dissolution du nickel initialement présent, une couche poreuse active pour le dégagement d’oxygène est formée. Ces résultats sont prometteurs pour la synthèse de catalyseurs à base d’iridium pour le dégagement de dioxygène