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Intellectual assessment in preschool autistic children bears many challenges, particularly for those who have lower language and/or cognitive abilities. These challenges often result in underestimation of their potential or exclusion from research studies. Understanding how different instruments and definitions used to identify autistic preschool children with global developmental delay (GDD) affect sample composition is critical to advance research on this understudied clinical population. This study set out to examine the extent to which using different instruments to define GDD affects sample composition and whether different definitions affect resultant cognitive and adaptive profiles. Data from the Mullen Scales of Early Learning and the Vineland Adaptive Behavior Scales-Second Edition, a parent-report tool, were analyzed in a sample of 64 autistic and 73 neurotypical children (28-69 months). Our results highlight that cognitive assessment alone should not be used in clinical or research practices to infer a comorbid diagnosis of GDD, as it might lead to underestimating autistic children's potential. Instead, using both adaptive and cognitive levels as a stratification method to create subgroups of children with and without GDD might be a promising approach to adequately differentiate them, with less risk of underestimating them.

The current prospective cohort study investigated whether early perceptual abilities, measured at preschool age, could predict later intellectual abilities at school age in a group of 41 autistic (9 girls, 32 boys) and 57 neurotypical children (29 girls, 28 boys). More than 80% of the autistic children were considered minimally verbal. Participants were assessed at three time points between the age of 2 and 8 years using the Wechsler Preschool and Primary Scales of Intelligence–Fourth Edition as a measure of full-scale IQ and the Raven’s Colored Progressive Matrices as a measure of fluid reasoning abilities (Gf). The performance on two perceptual tests (Visual Search and Children Embedded Figures Test) and the frequency of early non-verbal behaviors served as predictors of later intellectual abilities. Early performance on perceptual tests measured at preschool age was positively related to later full-scale IQ in both autistic and neurotypical children. Furthermore, both early non-verbal behaviors and performance on perceptual tests measured at preschool age were associated with later Gf in the autistic group. In contrast, only the performance on Children Embedded Figures Test was associated with later Gf in the neurotypical group. Early perceptual abilities\and non-verbal behaviors may be indicators of general intelligence and Gf abilities. Lay Abstract At the time of diagnosis, parents of autistic children frequently wonder what the future holds for their children in terms of intellectual development. It remains however difficult to answer this question at such a young age. Indeed, while early precursors of intelligence are well known for children following a typical development, these precursors remain to be identified for autistic children. Some theoretical models of intelligence suggest that perceptual abilities or behaviors, as seen early in autistic cognitive development, could be early indicators of intelligence. However, research examining the relation between early perceptual predictors and autistic intelligence over time is needed. This article is the first to consider a variety of early perceptual abilities and behaviors as precursors/predictors of intelligence at school age in autistic children. We showed that better performance in perceptual tasks at preschool age predicted better intellectual abilities measured later in autistic children. Importantly, our sample of autistic children represented the whole spectrum, including children with few to no spoken words, who are an important proportion of autistic preschoolers. While early perceptual abilities and behaviors may not substitute for a formal intellectual assessment, our results support that these indices may help estimate later intellectual level in autistic children. Perceptual abilities have the advantage to be easy to observe at preschool age and seem to fit the cognitive style of autistic children. Assessment methods could probably gain from including and focusing more on the perceptual strengths of autistic children.

Background The question of cognitive prognosis is frequently asked at the time of autism diagnosis, often at preschool age. It remains however difficult to answer this question at such a young age, given the considerable heterogeneity of cognitive development trajectories and the challenges associated with intellectual assessment in autistic children, particularly among minimally verbal children. Methods The current prospective cohort study investigated whether early perceptual abilities measured at preschool age could predict later intellectual abilities at school age in a group of 41 autistic (9 girls, 32 boys) and 57 neurotypical children (29 girls, 28 boys). Participants were assessed at three time points during the childhood period (between the age of 2 and 8 years old) using the Wechsler Preschool and Primary Scales of Intelligence – Fourth edition as a measure of full-scale IQ and the Raven’s Colored Progressive Matrices as a measure of non-verbal IQ. The performance on two perceptual tests (Visual Search and Children Embedded Figures Test) as well as the frequency of perceptual behaviors served as predictors of later intellectual abilities. Results Early performance on perceptual tests measured at preschool age was positively related to later full-scale IQ in both autistic and neurotypical children. Furthermore, both perceptual behaviors and performance on perceptual tests measured at preschool age were associated with later non-verbal IQ in the autistic group. In contrast, only the performance on Children Embedded Figures Test was associated with later non-verbal IQ in the neurotypical group. Limitations: The sample size was relatively modest, with some attrition across time points, as expected in a sample including preschool minimally and non-verbal children. Conclusions Our findings support the important role of perception in autistic cognition. Early perceptual abilities may be a valid avenue for estimating general intelligence and non-verbal abilities at preschool age, particularly for minimally verbal autistic children.

Introduction Although cognitive-behavioral therapy (CBT) is effective in treating post-traumatic stress disorder (PTSD), some clients remain symptomatic after treatment. Some individuals with PTSD may present more severe dysfunctional cognitive schemas and use dysfunctional coping strategies. Objectives The review aims to answer the following questions: 1) Is there a relation between pre-treatment core beliefs or coping strategies and PTSD outcomes following CBT? 2) Are core beliefs or coping strategies modified following CBT for PTSD? Method PsycNet, PubMed, Cinahl, Embase, Web of Science, Scopus, Cochrane, ProQuest and EBSCO were systematically searched for the literature published between 1975 and May 2015, for papers including adults with PTSD, CBT for PTSD, and quantitative measures of cognitive schemas or coping strategies. Results, study characteristics and risks of bias were examined for the included studies. Results The search led to the inclusion of 10 studies. Regarding schemas, the only study included shows that they change positively with psychotherapy and that some of these changes predict changes in symptoms after treatment. Regarding coping, four studies report either positive or negative links between dysfunctional coping strategies and post-treatment symptoms, six studies report a positive change in coping strategies, and one study does not report any change. Conclusion Although more studies are needed to unequivocally answer the research questions, this systematic review demonstrates the relevance of considering coping strategies, and possibly schemas, in CBT studies in the context of PTSD.

Intelligence in minimally verbal children on the autism spectrum (AS) is at risk of being underestimated. The present study investigated testability and cognitive profile of preschool autistic children using conventional tools and strength-informed tools. Fifty-two AS children and fifty-four typical children matched on age (31-77 months) were assessed. Testability increased with age in both groups, was generally lower in AS children, but not related to their test performance. Typical children performed significantly better than AS children on conventional tools, but performance of both groups was similar on strength-informed tools. Differences of performance across tests were much greater in the AS group. These results emphasize the heterogenous, yet characteristic, cognitive profile in preschool children, and introduce the usefulness of flexible testing.

The burden of paediatric Hepatitis C virus (HCV) infection across Europe is unknown, as are current policies regarding monitoring and treatment. This collaborative study aimed to collect aggregate data to characterise the population of = 6 years and 90% vertically infected. HCV genotype 1 was the most common (n 380; 57.3%), followed by genotype 3, 4 and 2. Seventeen children (3%) with chronic HCV infection were diagnosed with cirrhosis, and six were reported to have received liver transplantation for HCV-related liver disease. The majority (n 425; 64.1%) of the European children with HCV infection remained treatment-naive in 2016. Age affected clinicians’ attitudes towards treatment; 94% reported being willing to use direct-acting antivirals, if available, in adolescents (aged >= 11 years), 78% in children aged 6-10 and 42% in those 3-5 years of age (Pearson correlation coefficient -0.98; P 0.0001). This survey provides the largest characterisation of the population of children in clinical follow-up for chronic HCV infection in Europe, alongside important contextual information on their management and treatment. Discussion is needed around strategies and criteria for use of direct-acting antivirals in these children.

L’industrialisation du bras hydraulique Maestro a retour d’efforts, demarree en 2001, a debou - che sur le concept CEA du “systeme Maestro”. Fruit de la R&D de la Direction de l’Energie Nucleaire et de la Direction de la Recherche Technologique, le “systeme Maestro” se com - pose de briques modulaires pour repondre au mieux aux chantiers du CEA.Apres qualification d’un systeme prototype en 2003 (1400 h de fonctionnement et tenue sous irradiation a 10 kGy), le CEA a decide d’un projet de chantier pilote pour la mise en oeuvre du systeme en actif. Une cellule comportant des elements de procede chimique irradiants de l’Atelier Pilote de Marcoule a ete retenue. Cette cellule est representative des operations communement rencontrees sur les chantiers de demantelement.A Fontenay-aux-Roses, un projet de demantelement de la chaine Petrus a ete lance et la conception des equipements est basee sur le systeme Maestro.Cet article s’attache a presenter et decrire les solutions retenues, les tests effectues, et les ameliorations permettant d’accroitre la fiabilite des equipements.Sont presentes tous les tests faits en inactif pour preparer les operations en actif. Outre la faisabilite et la validation des scenarios de decoupe retenus, les tests ont egalement porte sur : le montage des equipements en actif (tenue rouge, masque, 3 paires de gants, …), les performances des equipements (mecanique, outils, controle-commande, video…), la maintenance des equipements en actif (porteur, bras, centrale, moyens de vision, procede, …), le rapatriement des equipements en cas de defaillance (modes degrades).Ces essais en inactif ont genere des evolutions, a la fois sur le systeme Maestro en termes d’industrialisation augmentant sa fiabilite mais aussi sur les equipements et la mise en oeuvre des procedes. Ces evolutions sont integrees sur les equipements en cours de realisation. Elles serviront des la conception de nouveaux equipements mettant en oeuvre le systeme Maestro.

Since I was kindly invited to contribute a commentary on this publication, perhaps because of my long familiarity with Asia, and certainly because I was the Asia Europe Foundation’s Executive Director between 2008 and 2011, I will provide some purely personal views on ‘perceptions’ in foreign affairs. I shall first show how the sudden perception of themselves as a forgotten part of the world brought a fifth of the French voters out of the political mainstream in the 2012 presidential election. I shall then make a few remarks about how history has shaped the mutual perception between Europe and Asia as much as it has been shaped by it and give a personal estimate of the most significant elements of today’s perceptions between the two regions. Finally, after a brief description of how ASEM and ASEF are interesting, if insufficient, answers to our perception gap, I will explain how Asia and Europe run the risk of being distracted from their healthy attempt at dialogue by resurgent xenophobia and demagoguery. In the concluding section I will explore how perceptions studies are now an available and indispensable instrument, which, nonetheless, needs to be supplemented by the development of a multifaceted dialogue similar to what ASEF has been engaged with over the last 15 years.

Hostility has been associated with higher basal levels of inflammation. The present study evaluated the association of hostility with acute stress-induced changes in inflammatory activity. One hundred and ninety-nine healthy men and women, aged 19-64 years, were exposed to a stress protocol involving four interpersonal stressors. Participants completed the Cook-Medley Hostility questionnaire and provided two blood samples for the measurement of inflammatory biomarkers (CRP, Il-6, MPO, TNF-α, MCP-1, Il-8, Il-10, and Il-18), prior to and following exposure to a standardized stress protocol. In univariate analyses, hostility was associated with significantly higher TNF-α, but lower Il-8 and Il-18 values post-stress, though only Il-8 remained significant after controlling for baseline differences. In multivariate analyses, a significant Age by Hostility interaction emerged for Il-6, while sex moderated the relation between hostility and Il-10 reactivity. Following stress, hostility was associated with greater pro-inflammatory Il-6 activity among younger individuals and to decreased anti-inflammatory Il-10 activity in women. Future research is needed to replicate these findings and to evaluate their implication for disease.

An outbreak of bald sea urchin disease was detected affecting intertidal popula- tions of the edible temperate species Paracentrotus lividus at its southernmost geographical limit. The mortality event was detected in three sites (Gu¨imar, Palmar and Alcala´) off Tenerife, Canary Islands (Northeastern Atlantic), in October 2003, coinciding with the highest sea surface temperatures (SST) and the lowest wave heights of the year. The prevalence of infection reached 100% but did not affect equally all studied sites or the different size classes. The dis- ease was more prevalent in large sea urchins (>40 mm). The prevalence appeared to be positively correlated with the environmental variable SST and negatively correlated with wave height. In October 2004, only two infected urchins were found (prevalence 1%) at one of the studied sites. However, dur- ing 2004 no such extreme values of temperature and wave height were observed. We conclude that high SSTs and low wave heights such as those observed during 2003 are conditions that may trigger outbreaks of urchin disease.

Aquaculture activities have introduced European sea bass (Dicentrarchus labrax) along the coasts of some of the Canary Islands. We present the first record of simultaneous male and female gonad maturation of escaped sea bass in the wild, indicating that this species is finding its essential fish habitat (EFH). Individuals with ripe gonads were only caught during January and February 2009, although the maturation and spawning season may last from November to February in the studied area (Tenerife island). Bass infected by Sphaerospora testicularis were found and the incidence of the parasite was checked. This represents the southernmost record of the parasite, probably introduced together with sea bass stock. The results are discussed from the point of view of risk assessment and the ecology of invasions being valuable for aquaculture management in Central North Atlantic and Mediterranean areas.

Large populations of the sea urchin Diadema aff. antillarum occur in the east Atlantic archipelagos. The origin and stability of these large herbivorous populations are not well known. Variability in settlement, recruitment and adult urchin density were quantified and compared over a 7 yr period (2002 to 2008) within the Canary Islands. Variables that potentially affect urchin settle- ment such as gonad index, temperature and primary productivity (phytoplankton) were measured. Settlement was found to be high during warm years; temperatures >24°C induced important settle- ment pulses. Postsettlement survival in barren areas of Tenerife was exponentially and positively cor- related with seawater temperature changes, while very low to 0 survival was found at macroalgal beds off El Hierro. Assuming that climate change predictions are correct, the strong positive relation- ship between thermal history and postsettlement survival of this ecologically important species sug- gests that barren grounds will persist as seawater warms up if no mass mortality occurs. This future scenario will have important implications for the stability of algal beds and coastal ecosystems as a whole.

When the Asia–Europe Meeting (ASEM) was created in 1996, a full vision of time was involved: The past, because if Europe and Asia shared the privilege of having given birth to most of the civilisations, the religions, philosophies and concepts which have survived until the twentieth century, they had also been tragically opposed by a long period of confrontation: colonial exploitation and imperialist aggression had divided the huge Eurasian continent where, since time immemorial, contacts had been an exceptional source of mutual enrichment and fascination. The present, because globalisation does not allow any region or country to live in isolation even from its most distant real or potential partners. Europe needed to organise its relations with Asia beyond the bilateral ties it entertained with Asian nations and even beyond the links it has started establishing as an entity with economic partners whose growth was becoming more and more impressive. The future, because although nobody could then predict what the notion of “emerging powers” would encompass a dozen years later, it was already understood that after the demise of the Soviet Union, Asia’s renaissance would be the next determining event in the world’s history. This probably explains why, despite many difficult tests, from the 1997 economic crisis in Asia to the question of its enlargement and to the sometimes apparent lack of productivity of its official functioning, ASEM has lasted until now, and does not stop attracting new candidates: its eighth Summit is welcoming Australia, New Zealand and Russia this October 2010, and that suffices to show the enduring validity and relevance of this unique informal dialogue structure. Let us be clear: the world also needs more directly efficient bodies to tackle new issues and to integrate a quickly evolving balance of power. G7, G8, G20, the transition is now an Asia Eur J (2010) 8:123–126 DOI 10.1007/s10308-010-0265-8

There are three main species of regular sea urchins in the Canary Islands. To establish the optimal fishing seasons for two of them, we studied the evolution of the gonadal index in several years and locations, of Paracentrotus lividus (April 2006 to March 2008 on Tenerife island in two locations: Las Galletas and La Jaca and from April 2006 to January 2009 in Gran Canaria island in two locations: Ojos de Garza and Gando), and Diadema africanum (January 2010 to May 2011 on Gran Canaria island in three locations: Risco Verde, Arguineguin and Agaete). In the case of P. lividus, located on the southern edge of their distribution, the presence of several annual maximum gonadal indez peak was observed, probably related to the temperature. These times of gonadal index increases corresponded to the stages of maturation. The main period of maturity coincided with the fall and early winter (August, October and December). There was sporadic emissions of gametes depending on location, in April, during the summer (June, July or August), autumn (September or October) and winter (December, January or February). This fragmented situation is possibly due to exposure to the hydrodynamic area’s and food abundance. The maximum presence of D. africanum occurred in the months of May to June, with virtually no variations throughout the year, in the southernmost locality (Arguineguin). In conclusion, the two species of sea urchins would be complementary shellfish resources, as their periods of maximum GI (Gonadal Index, capture time) do not overlap during the year. Con el fin de establecer las épocas óptimas de explotación como posible recurso marisquero de dos especies de erizos de mar en Canarias, se estudió la evolución temporal del índice gonadal en diferentes años y localidades de Paracentrotus lividus (abril de 2006 a marzo de 2008 en la isla de Tenerife y en dos localidades: Las Galletas y La Jaca; abril de 2006 a enero de 2009 en la isla de Gran Canaria y en dos localidades: Ojos de Garza y Gando), y de Diadema africanum (de enero de 2010 a mayo de 2011 en la isla de Gran Canaria y en tres localidades: Risco Verde, Arguineguín y Agaete). En el caso de P. lividus, que se encuentra en el límite sur de su distribución, se constató la presencia de varios picos máximos anuales en el índice gonadal, probablemente relacionados con la temperatura. Estas épocas de mayor índice gonadal se correspondieron con los estados de maduración de las gónadas. La principal época de madurez coincidió con el otoño y comienzo del invierno (agosto, octubre y diciembre). Existió emisión de gametos esporádicos en el año según la localidad, en abril, en verano (junio, julio o agosto), otoño (septiembre u octubre) e invierno (diciembre, enero o febrero). Posiblemente esta situación tan dispar sea debido a la exposición al hidrodinamismo de la zona y a la presencia o no de abundante alimento. Para D. africanum se presentó el máximo índice en los meses de mayo-junio, con prácticamente pocas variaciones anuales en la localidad situada más al sur (Arguineguín). En conclusión, las dos especies de erizos serían complementarias como recursos marisqueros, ya que no se superponen sus periodos de máximos IG (época de captura) en el año.

Oxytocin receptor (OTR) expression is suppressed by progesterone (P4) during the luteal phase of the estrous cycle and then it increases at the time of luteolysis, but its regulation is still not completely understood. The objective of this work was to characterize P4 metabolism by endometrial cells in vitro and determine if metabolites were able to modify prostaglandin secretion in response to oxytocin (OT). Endometrial epithelial and stromal cells were incubated with 3H-P4 or 3H-pregnenolone (P5) for 6 or 24 h. Metabolites in the medium were separated by HPLC. The results showed that P4 and P5 were converted to two major polar metabolites and a less polar metabolite that was identified as 5alpha- or 5beta-pregnanedione by LC/MS. Progesterone metabolism was similar in both stromal and epithelial cells. To determine if 5alpha- or 5beta-pregnanedione were able to modify PGF(2)alpha synthesis, cells were cultured with P4, 5alpha- or 5beta-pregnanedione (100 ng ml(-1)) for 48 h and then each group of cells was incubated for a further 4-6 h with or without OT (200 ng ml(-1)). Results showed that only P4 caused significant (P0.001) increase in basal, but not OT-stimulated, PGF(2)alpha synthesis. OT binding assays showed no significant effect of progesterone or its metabolites on OTR concentration. In conclusion, bovine endometrial cells are able to metabolize pregnenolone and progesterone but neither 5alpha- nor 5beta-pregnanedione altered prostaglandin synthesis or OTR number in endometrial epithelial cells. These data suggest that 5-pregnanediones do not play a role in the regulation OT-stimulated PGF(2)alpha secretion during the bovine estrous cycle.

The fear of producing CO(2) retention and a secondary increase of intracranial pressure (ICP) sometimes precludes the use of sedation for the spontaneously breathing patient in the presence of an intracranial space-occupying lesion. In this study we assessed the effect of moderately deep propofol sedation on the ICP of patients undergoing stereotactic brain tumor biopsy under regional anesthesia. Thirty patients were randomized into 2 groups to receive propofol titrated to a level of 2 on the Observer's Assessment of Alertness/Sedation Scale or no sedation. ICP was measured via the biopsy needle. Preoperative data were similar in both groups. During surgery, patients receiving propofol had a higher arterial Pco(2) (48 +/- 8 mm Hg versus 41 +/- 3 mm Hg; P = 0.005) (95% confidence interval, 43-53 mm Hg and 39-43 mm Hg, respectively), resulting in a lower arterial pH (P = 0.002) than patients in the no-sedation group. The median ICP (95% confidence interval) for both groups was similar-13 mm Hg (8.2-16.2 mm Hg) and 15 mm Hg (8.3-21.7 mm Hg)-for the propofol and no-sedation groups, respectively (P = 0.66). Cerebral perfusion pressure was lower in the propofol group (76 +/- 18 mm Hg versus 89 +/- 18 mm Hg; P = 0.003). Moderately deep propofol sedation does not result in a higher ICP than no sedation in patients undergoing stereotactic brain tumor biopsy. Further studies are needed to assess the effect on ICP of other sedative medications.

This retrospective study was designed to assess the quality of postoperative pain control and the facility of transition from epidural to oral analgesia in lung transplant recipients.After institutional review board approval, data were collected from the charts of all patients who underwent lung transplantation at our institution between 1998 and 2002. The study group consisted of the patients for whom an epidural was the first postoperative pain management modality. To serve as a control group we reviewed the charts of 30 patients, randomly selected over the same period, who underwent a thoracotomy for indications other than transplantation and who received postoperative epidural analgesia.Eighty-three patients were available for analysis. Unilateral and bilateral lung transplant recipients had equivalent quality of pain control. However, lung transplant recipients had a lower incidence of adequate pain relief than patients undergoing thoracotomy for other indications (73% vs 87%, p0.05). Lung transplant recipients also had a higher incidence of epidural to oral analgesia transition failure (47% vs 20%, p0.01).This is the first study to assess the quality of postoperative pain control and success of transition from epidural to oral analgesia in lung transplant recipients. Prospective studies are needed to assess the impact of our findings on patients' outcome.

To assess the role of postoperative analgesia on myocardial ischemia after aortic surgery, we compared intravenous patient-controlled analgesia (PCA) with thoracic epidural analgesia (TEA). One hundred twenty-four patients were prospectively randomized to the PCA or TEA group. In the TEA group, a T6-7 or T7-8 epidural catheter was inserted before the induction of general anesthesia. Within 1 h of the end of surgery, analgesia and 24-h two-channel Holter monitoring were begun. Myocardial ischemia was defined as ST segment depressionor = 1 mm, 0.06 s after the J point, and lasting for more than 1 min. In the PCA group, a bolus of morphine, 0.05 mg/kg, was given, followed by 0.02 mg/kg of morphine on demand every 10 min. Bupivacaine 0.125% and fentanyl 10 microg/mL was used in the TEA group. Analgesics were titrated to maintain a visual analog scale scoreor = 3. The overall incidence of myocardial ischemia was 18.4%-18.2% for TEA and 18.6% for PCA (P = not significant). There were no differences between the groups in the total duration of ischemia per patient (22.2 +/- 119.8 min for TEA and 20.5 +/- 99 min for PCA) and the number of episodes per patient (0.69 +/- 2.1 for TEA and 1.2 +/- 4.9 for PCA). Twenty-three patients had an adverse cardiac outcome, although there were no differences between the groups. The postoperative pain control was superior with TEA. In these patients undergoing elective aortic surgery, the use of postoperative TEA did not result in a lower incidence of early myocardial ischemia compared with intravenous PCA with morphine, despite better analgesia with TEA.Postoperative myocardial ischemia is associated with adverse cardiac outcome. Using Holter monitoring after aortic surgery, this study shows that the use of thoracic epidural analgesia with bupivacaine and fentanyl did not result in a lower incidence of myocardial ischemia compared with intravenous patient-controlled analgesia with morphine.

Abdominal wall retraction (AWR) was recently proposed as an alternative for CO2 pneumopentoneum. In this study we evaluated the cardiorespiratory effects of AWR during laparoscopic cholecystectomy. Fifteen patients were studied during laparoscopic cholecystectomy using AWR. Monitoring included heart rate (HR). mean arterial pressure (MAP), pulse oxymetry (SpO2), end-tidal CO2 (P1, CO2), minute ventilation, and peak inspiratory pressure (PIP). Using transoesophageal echocardiography, the transgastric short axis view was obtained to derive the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). These parameters were measured at predetermined periods: I) five minutes after anaesthetic induction, 2) five minutes after AWR insertion, 3) 15 min after AWR insertion, and 4) after the end of surgery. No change in any measured parameter was observed over time in the AWR group except for an increase in MAP (P < 0.05) after AWR insertion. There were no changes in EDA, ESA and EF dunng the study, reflecting stable global cardiac function. In addition, no embolic episodes were observed dunng surgery. Our results demonstrate that the use of gasless abdominal distention for laparoscopic cholecystectomy results in a stable haemodynamic profile in healthy patients without cardiac disease, except for a bnef increase in MAP after the AWR insertion. The advantages of AWR over conventional pneumoperitoneum should be confirmed in higher risk patients in a prospective, randomized study.

T RANSESOPHAGEAL echocardiography (TEE) is useful for intraoperative monitoring of cardiac function 1,z and for evaluating valve repair. 3 Recently, TEE has been proposed as a useful intraoperative tool improving diagnostic accuracy and assisting in surgical repair of pediatric congenital heart malformations. 4 Its role in the diagnosis of congemtal cardiac malformations in adults has not been widely discussed. The sinus venosus variant of atrial septal defect (SVASD) occurs in up to 20% of adults with an atrial septal defect (ASD) and is the most difficult to Identify. 5 This defect is frequently associated with anomalous connection of the right pulmonary veins to the junction of the right atrium and the superior vena cava. 6 The authors describe two cases of adult cardmc surgery where intraoperative TEE helped to diagnose previously unsuspected SVASD associated with partial anomalous pulmonary venous connections (PAPVC) and discuss how the echocardiography results led to modification of the planned operation.

The pharmacodynamics of muscle relaxants in patients with oculopharyngeal muscular dystrophy (OPMD) have never been studied. We designed this study to compare the pharmacodynamics of cisatracurium in OPMD patients versus a control group. Forty patients were enrolled: 20 OPMD patients requiring general anesthesia for cricopharyngeal myotomy and 20 age-matched controls undergoing an operation of similar duration and expected blood loss. Anesthesia was standardized, and both groups received a bolus of cisatracurium 0.1 mg/kg. Onset time, time to 10% T1 recovery, and the intervals 10%-25% and 25%-75% were calculated for both groups. A subgroup analysis was performed in patients with a more severe form of OPMD. Demographic and intraoperative data were similar. Onset time was significantly longer in OPMD patients compared with the control group (4.6 +/- 1.5 min versus 3.4 +/- 1.0 min; P = 0.001). There was no difference in recovery times or indices between groups, regardless of the severity of the disease. In conclusion, there was no difference in the duration of a cisatracurium-induced neuromuscular block between OPMD patients and a control group. A delayed onset of action of the drug may occur.

UNLABELLED Several pharmacological interventions reduce perioperative stress hormone release during surgery under general anesthesia. Listening to music and therapeutic suggestions were also studied, but mostly in awake patients, and these have a positive effect on postoperative recovery and the need for analgesia. In this study, we evaluated the effect of listening to music under general anesthesia on the neurohormonal response to surgical stress as measured by epinephrine, norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) blood levels. Thirty female patients scheduled for abdominal gynecological procedures were enrolled and randomly divided into two groups: group NM (no music) and group M (music). In group M, music was played from after the induction of anesthesia until the end of surgery. In the NM group, the patients wore the headphones but no music was played. We established three sample times for hormonal dosage during the procedure and one in the recovery room. Hemodynamic data were recorded at all times, and postoperative consumption of morphine in the first 24 h was noted. There was no group difference at any sample time or in the postoperative period in terms of mean arterial blood pressure, heart rate, isoflurane end-tidal concentration, time of the day at which the surgery was performed, bispectral index (BIS) value, doses of fentanyl, or consumption of postoperative morphine. There was no difference between the two groups with regard to plasmatic levels of norepinephrine, epinephrine, cortisol, or ACTH at any sample time, although the blood level of these hormones significantly increased in each group with surgical stimulation. In conclusion, we could not demonstrate a significant effect of intraoperative music on surgical stress when used under general anesthesia. IMPLICATIONS Listening to music under general anesthesia did not reduce perioperative stress hormone release or opioid consumption in patients undergoing gynecological surgery.

UNLABELLED To prevent hypercapnia, voluntary hyperventilation is recommended for patients with increased intracranial pressure before the induction of general anesthesia. We sought to determine whether this maneuver results in a lower PaCO2 than breathing 3 min of oxygen 100% by face mask (preoxygenation) after intubation. Thirty patients requiring general anesthesia were randomly assigned to breathe either 3 min of oxygen 100% by face mask (Group P) or 1 min of oxygen 100% followed by 2 min of voluntary hyperventilation with oxygen 100% (Group H). All patients received a standard rapid-sequence induction of anesthesia followed by a 90-s period of apnea. Patients were then tracheally intubated and mechanically ventilated. Five arterial blood gas samples were taken: with room air, after preoxygenation or hyperventilation, after 60 and 90 s of apnea, and after tracheal intubation. Voluntary hyperventilation decreased PaCO2 before rapid-sequence induction (hyperventilation, 30.0 +/- 3.5 mm Hg versus preoxygenation, 37.9 +/- 5.2 mm Hg; P < 0.0001), but after 60 s of apnea, both groups had similar PaCO2 (hyperventilation, 36.1 +/- 3.3 mm Hg versus preoxygenation, 35.6 +/- 3.4 mm Hg; P = 0.673), and no benefit was found after intubation (hyperventilation, 40.5 +/- 3.9 mm Hg versus preoxygenation, 41.4 +/- 2.7 mm Hg; P = 0.603). We conclude that voluntary hyperventilation before rapid-sequence induction does not provide protection against potential hypercapnia during intubation. IMPLICATIONS Voluntary hyperventilation before anesthesia induction is recommended for patients with increased intracranial pressure to prevent hypercapnia. This randomized, prospective study demonstrated that this maneuver does not result in a lower postintubation PaCO2 than standard preoxygenation.

Girard Dominique. Point de vue personnel d'un témoin. In: Mots, n°64, décembre 2000. Autour d'une crise franco-australienne. Stéréotypies xénophiles et xénophobes, sous la direction de Albane Cain, Christine Develotte et Pierre Fiala. pp. 115-129.

Pulsed Doppler measurement of pulmonary venous flow (PVF) in the left superior pulmonary vein has been suggested as a noninvasive method to evaluate pulmonary capillary wedge pressure (PCWP). In previous studies, PVF was measured at end-expiration, and it is unknown to what extent PVF is affected by the respiratory cycle. It is hypothesized that phasic variations of PVF during mechanical ventilation may be used to estimate PCWP.Prospective clinical study.Tertiary care university hospital.Thirty patients undergoing elective cardiac surgery.At multiple intervals during the surgery, the PVF was measured with transesophageal pulsed Doppler echocardiography, and measurements of PCWP and airway pressure were simultaneously obtained.Components of PVF evaluated were the systolic (X), diastolic (Y), and atrial (Z) waves with their velocity-time integrals (VTI). The systolic fraction (SF = VTI X/[VTI X + VTI Y]) and respiratory variations of each component of PVF were determined and compared with PCWP. There was a greater respiratory variation of the X wave (X expiratory-X inspiratory/X expiratory) in patients with PCWP18 mmHg than in patients with PCWPor = 18 mmHg (0.19 +/- 0.19 v 0.14 +/- 0.13, respectively, p0.01). PVF components measured at end-expiration that related best with PCWP were the X/Y peak velocities (r = -0.53), VTI X/VTI Y ratio (r = -0.42), and the SF (r = -0.49). When measured during end-inspiration, the relation of the X/Y ratio, VTI X/VTI Y, and SF with the PCWP were r = -0.54, r = -0.41, and r = -0.50, respectively.It has been documented that PVF velocity is influenced by the respiratory cycle during mechanical ventilation in patients undergoing cardiac surgery, and the magnitude of this variation is influenced by PCWP. However, it is not actually possible to predict PCWP accurately using these findings. Further studies are needed in which preload is varied acutely to confirm the usefulness of the results.

Using transesophageal echocardiography (TEE), 16 patients (ASA physical status I-III), undergoing laparoscopic cholecystectomy, were assessed for the occurrence of episodes of gas embolism and cardiovascular changes related to those emboli. The long-axis four-chamber view was monitored continuously, except for predetermined intervals where the transgastric short-axis view was obtained to derive the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). In one patient, we monitored the longitudinal view of the superior and the inferior vena cava. The monitoring of the patients also included: heart rate (HR), mean arterial pressure (MAP), arterial saturation by pulse oximetry (Spo2), end-tidal CO2 (ETCO2), minute ventilation (VE), and peak inspiratory pressure (PIP). Embolic events were defined as the appearance of gas bubbles in the right cardiac chambers. We observed gas embolism in 11/16 patients (five during peritoneal insufflation and six during gallbladder dissection). Using the longitudinal view of the superior and inferior vena cava (IVC), we found that these emboli were transmitted through the IVC. No episode of cardiorespiratory instability (decrease in MAP > or = 10 mm Hg, Spo2 < 90%) was observed. There was no significant difference in cardiorespiratory variables between patients who presented gas embolism (n = 11) and patients who did not (n = 5) during the studied period. In this small group of patients, we conclude that gas embolism occurs commonly during laparoscopic cholecystectomy but that these gas emboli cause minimal cardiorespiratory instability.

Background. Bradyarrhythmia has been reported with vecuronium when given with high dose narcotics. We hypothesized that if the bradycardic response is dependent on a vagal reaction mediated by narcotics, it should be independent of the vecuronium dose. A dose-related response of vecuronium on heart rate (HR) would be in favour of a chronotropic action of this agent. Methods. We examined three induction techniques using high doses of fentanyl in which vecuronium was given in increasing doses. In addition, a reference group received a low dose of atracurium. Forty patients scheduled for elective CABG surgery were anaesthetized with fentanyl (50 μg) given over 5 min, and were randomly assigned to receive either 0.056, 0.14, 0.28 mg/kg of vecuronium or 0.28 mg/kg of atracurium. Haemodynamic measurements were obtained at the following intervals: before induction (time 0), after the administration of fentanyl (at 5 min), and 1, 2 and 5 min after tracheal intubation (at 10, 11 and 15 min). Results. In vecuronium-treated groups, there were significant decreases in HR, mean arterial pressure, and cardiac output (P

We evaluated the effects of CO2 embolism on end-tidal carbon dioxide (ETCO2) and compared four methods for detection of gas embolism. Fourteen pigs were monitored for CO2 embolism with transesophageal echocardiography (TEE), changes in ETCO2, changes in mean pulmonary artery pressure (MPAP), and precordial auscultation (AUSC). Serial injections of CO2 (ranging from 0.05 to 5.0 mL/kg) were performed in seven pigs (Group 1). In the other seven pigs, CO2 was infused at rates between 0.01 and 0.4 mL.kg-1.min-1 (Group 2). Positive responses were defined as an acute change in heart sounds (AUSC), visualization of gas bubbles in the right cardiac chambers on TEE, an increase in MPAP > or = 3 mm Hg, and an acute change (increase or decrease) in ETCO2 > or = 3 mm Hg. In both groups, positive responses to CO2 embolism were represented by an initial decrease in ETCO2. The frequency with which positive responses were observed revealed that TEE was the most sensitive method (P < 0.05), whereas no differences were found among the other methods. In conclusion, in this model, positive response to CO2 embolism was represented by a decrease in ETCO2. TEE was the most sensitive method of detection of CO2 embolism, and ETCO2, MPAP, and AUSC were equally sensitive.

The effects of shivering on hemodynamics and systemic oxygenation, as well as the effectiveness of therapeutic interventions in decreasing shivering and increasing mixed venous oxygen saturation, were studied. Thirty adult patients undergoing cardiopulmonary bypass with systemic hypothermia were observed for 1 1/2 to 5 hours postoperatively for signs of shivering associated with a simultaneous decrease in oxygen transport. Systemic and pulmonary hemodynamic measurements were made, blood temperature and mixed venous oxygen saturation were monitored via the pulmonary arterial catheter, and oxygen consumption and delivery were calculated. Shivering was graded by a single investigator on scale of 0 to 4, with 0 = no shivering and 4 = continuous violent muscle activity. Therapy was instituted when shivering reached grade 4 or when SvO2 decreased to less than two thirds of its value on arrival in the intensive care unit (ICU). Patients were randomly assigned to receive either morphine sulfate, 5 to 10 mg, or meperidine, 25 to 50 mg intravenously (IV), followed by the other narcotic if the initial drug failed to improve SvO2 or decrease shivering within ten minutes. The end-point for successful treatment was a return of SvO2 to within 5% to 10% of its value upon arrival in the ICU or a cessation of shivering that did not recur within 45 minutes. Twenty of the thirty patients shivered sufficiently to decrease SvO2 by more than one third of its initial value, thus requiring pharmacologic therapy. As shivering increased from a score of 0.8 +/- 1.1 to 3.4 +/- 0.9, SvO2 decreased from 74 +/- 6% to 57 +/- 12%.(ABSTRACT TRUNCATED AT 250 WORDS)

The pulse oximeter continuously and non-invasively measures arterial saturation. The objective of the current study was to assess the value of this monitor during thoracic surgery with one-lung ventilation. A total of 108 pulse oximeter saturation readings (SaO2[O]) were compared with PaO2 and calculated saturation (SaO2[C]) values. Hypoxia (PaO2 less than 70 mmHg) always resulted in a SaO2 (O) value below 95%. For the detection of hypoxia, the pulse oximeter had a sensitivity of 100%, a specificity of 91% and a predictability of 70%. The correlation between SaO2(C) and SaO2(O) was good (r = 0.895). In the samples with a PaO2 below 100 mmHg the correlation between SaO2(C) and SaO2(O) was significantly better when the temperature was at least 36 degrees C (r = 0.956 vs. r = 0.706; p less than 0.005) or when the cardiac index was greater than 2.5 l/min/m2 (r = 0.896 vs r = 0.417; p less than 0.01).

During the different phases of iceberg utilization, it will be necessary to gather and maintain an accurate knowledge of the submerged part of the iceberg. This would involve divers, manned submersibles and remote-controlled vehicles. These three different means of going below the surface of the seas would bring an important contribution to the successful utilization of icebergs.

The safety and efficacy of esmolol during high-dose fentanyl anesthesia were studied in 37 patients undergoing coronary artery bypass grafting (CABG). The anesthetic management consisted of fentanyl 75 micrograms/kg, pancuronium 0.15 mg/kg, and O2. To assess the safety of esmolol, it was administered in a double-blind manner to 17 anesthetized patients prior to surgical incision. Infusion of the drug was increased in stepwise fashion to obtain administration rates between 100 and 300 micrograms X kg-1 X min-1. Esmolol produced small but significant increases in pulmonary capillary wedge pressure (PCWP) (8.3 +/- 1.7 to 13.2 +/- 2.0 mmHg) when compared with placebo (10.9 +/- 1.0 to 12.1 +/- 0.6 mmHg) (P less than 0.05). For the other studied parameters (heart rate, mean arterial pressure, central venous pressure, cardiac index, stroke index, left ventricular stroke work index, systemic vascular resistance, and peripheral vascular resistance), no significant differences were observed between esmolol and placebo. To evaluate the efficacy of esmolol, 20 patients were randomly assigned to an esmolol group (n = 11) or a placebo group (n = 9). The study medication was infused from 5 min before induction through initiation of cardiopulmonary bypass. Infusion of esmolol at 200 micrograms X kg-1 X min-1 prevented tachycardia in response to intubation. In the esmolol group the heart rate increased from 63.4 +/- 2.7 to 67.6 +/- 2.9 beats/min after intubation, while in the placebo group it increased from 61.4 +/- 4.3 to 72.4 +/- 3.4 beats/min (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Malgré de nombreuses recherches dans le domaine de la cognition en autisme, l'application des résultats de recherche au sein des milieux cliniques demeure ardue. Le présent article vise à diminuer l'écart existant entre les résultats de recherche et la pratique clinique dans ce domaine. Une revue critique de la littérature sur l'intelligence, le raisonnement et l'apprentissage en autisme, mène à des recommandations cliniques pour l'évaluation et l'intervention auprès des enfants sur le spectre de l’autisme., Despite a vast amount of research on autistic cognition, implementation of research findings in clinical settings remains challenging. The present paper aims at reducing the gap between research results and clinical work in this domain. A critical review of the literature on intelligence, reasoning and learning in autism leads to clinical recommendations for assessment and intervention with children on the autism spectrum.