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Introduction: Periodic breathing (PB) is considered physiological in the neonatal period but must disappear in the first months of life. Few data regarding PB after the neonatal period are available. The objective of this study was to describe the clinical and polysomnographic characteristics of infants presenting with PB after the age of 1 month. Methods: This French multicenter retrospective case series included infants born at term between 2012 and 2021, without underlying disease, and who presented during a polysomnography (PSG) recording more than 1% of PB after 1 month of life. Results: Overall, 10 infants were included, they underwent a PSG for brief resolved unexplained event, desaturation, pauses in breathing, cyanosis, and/or signs of respiratory distress. The percentage of total sleep time spent with PB was 18.1% before 3 months (n=7), 4.7% between 3 and 6 months (n=10), 7.1% between 7 and 12 months (n=2), and 0% after 12 months (n=2). During the first PSG, ≥ 3% desaturations were observed in 77% to 100% of the PB episodes. At the first PSG, 9/10 infants had an obstructive apnea hypopnea index > 10/h and 5/10 had a central apnea index > 5/h. Gastro-esophageal reflux (GER) was suspected in 8/10 infants. All infants showed improvement in initial symptoms during the first year of life. Conclusion: Although PB is rare after 1 month of age, the present study shows that when present, PB is most frequently associated with obstructive and/or central apnea syndrome in term infants without comorbidities other than GER.

Resume La noyade est un probleme de sante publique dans le Monde ayant conduit l’OMS a la mise en place de mesures preventives a l’echelle collective et individuelle. Il s’agit de la 3e cause de deces accidentel dans le monde, concernant aussi bien les pays dits en voie de developpement que les pays industrialises. En France, la forte augmentation des victimes de noyade, durant l’ete 2018, a concerne principalement les enfants âges de moins de 6 ans, avec 332 victimes sur les 2255 noyes. Parmi eux, 51 enfants sont decedes, majoritairement en piscine privee. La noyade est une insuffisance respiratoire, resultat de la submersion ou de l’immersion en milieu liquide. Ce processus ininterrompu conduit a l’arret cardiorespiratoire et au deces en l’absence de secours de la victime. En cas de sauvetage, la victime peut survivre avec ou sans sequelles. Les notions mediatiques de « noyade seche » n’ont pas leur place dans la litterature medicale. Le peu de recommandations recentes a conduit Szpilman a proposer une classification selon la severite de la noyade, ainsi qu’une prise en charge. Les complications principales de la noyade restent respiratoires (pneumopathies d’inhalation) et neurologiques (anoxie cerebrale), fonction notamment de l’âge de la victime, de la duree d’immersion et du milieu de baignade.

The new HIEQ Lab (Health, well-being and Indoor Environmental Quality Laboratory) is presented. It is a living lab, primarily intended for research on human performance, comfort, and well-being, integrated with the energy performance in a completely controlled real space. Users are involved as active players in controlling and assessing building components and design strategies for health, well-being and IEQ requirements. Experimental activities will be addressed through a multi-domain approach that combines lighting, acoustic, air quality and thermal issues. For what concerns lighting, the laboratory is conceived to study the performance of daylighting and electric lighting systems and control solutions, focusing on the relationship between lighting conditions and human performance, comfort, and well-being. The paper reports the results of a literature review on existing lighting research facilities, and then describes the features of the new HIEQ Lab and its main research objectives, with a focus on lighting and daylighting research opportunities.

Resume La bronchite chronique de l’enfant est une entite ancienne, decrite des les annees 1940, tombee dans l’oubli apres la decouverte et l’utilisation massive des antibiotiques mais de regain d’interet depuis nos restrictions d’utilisation de ces derniers. Les bronchites bacteriennes persistantes ou protracted bacterial bronchitis (PBB) sont definies ainsi : (1) presence d’une toux chronique continue (de duree superieure a 4 semaines) grasse et/ou productive ; (2) absence de signes fonctionnels ou cliniques evoquant une autre cause de toux grasse chronique et (3) toux se resolvant apres 2 a 4 semaines d’une antibiotherapie orale appropriee. L’examen clinique respiratoire est habituellement normal. Les explorations paracliniques doivent comprendre une radiographie du thorax et une spirometrie, si l’âge de l’enfant le permet, dont les resultats sont attendus normaux. Le diagnostic de PBB est habituellement porte chez des enfants jeunes (mediane de 10 mois a 4,8 ans). La garde en creche et la presence d’une tracheo-bronchomalacie sont des facteurs de risque reconnus. Un diagnostic differentiel doit etre evoque lorsque des signes cliniques d’alerte sont presents, lorsque le patient ne repond pas a une antibiotherapie de 4 semaines bien conduite ou lorsque les recurrences sont frequentes (> 3/an). Le traitement repose sur une antibiotherapie probabiliste visant les germes impliques dans cette pathologie ( Haemophilus influenzae [HI], Streptococcus pneumoniae et Moraxella catarrhalis ), type amoxicilline-acide clavulanique par voie orale, d’une duree de 2 a 4 semaines. La plupart des enfants presentant une PBB auront des recurrences (plus de 70 %). Ces derniers doivent beneficier de nouvelles cures d’antibiotherapie et certains necessiteront un traitement par antibiotherapie alternee, le plus souvent apres avis specialise.

We present results of U-Pb dating (by MC-ICP-MS) of zircons from samples that cover all of the known lithotypes in the Seis Lagos Carbonatite Complex and associated lateritic mineralization (the Morro dos Seis Lagos Nb deposit). The host rock (gneiss) yielded an age of 1828 ± 09 Ma interpreted as the crystallization time of this unit. The altered feldspar vein in the same gneiss yielded an age of 1839 ± 29 Ma. Carbonatite samples provided 3 groups of ages. The first group comprises inherited zircons with ages compatible with the gneissic host rock: 1819 ± 10 Ma (superior intercept), 1826 ± 5 Ma (concordant age), and 1812 ± 27 Ma (superior intercept), all from the Orosirian. The second and the third group of ages are from the same carbonatite sample: the superior intercept age of 1525 ± 21 Ma (MSWD = 0.77) and the superior intercept age of 1328 ± 58 Ma (MSWD = 1.4). The mineralogical study indicates that the ∼1.3 Ga zircons have affinity with carbonatite. It is, however, a tendence rather than a well-defined result. The data allow state that the age of 1328 ± 58 Ma represents the maximum age of the carbonatite. Without the same certainty, we consider that the data suggest that this age may be the carbonatite age, whose emplacement would have been related to the evolution of the K'Mudku belt. The best age obtained in laterite samples (a superior intercept age of 1828 ± 12 Ma) is considered the age of the main source for the inherited zircons related to the gneissic host rock.

Purpose As Italy faced SARS-CoV-2 outbreak as first country outside China, and our hospital converted most of activities into the ones for COVID-19 patients (pts), we had to manage the need for continuing care of advanced heart failure (HF), heart transplant (HT) and LVAD pts. TM was a possible strategy, but its role in this very sick cohort is unknown. Methods During the lockdown (03-05/2020), we decided to make either a phone (PV) or an in presence (IV) visit, selecting for IV pts listed for HT, with LVAD, recently HT, scheduled for a biopsy within 6 months after HT or a RHC for listing eligibility. In PV, we assessed symptoms, blood pressure, drugs, and programmed a subsequent IV. All pts in IV group were triaged by phone for COVID-19 symptoms or contacts and if scheduled for RHC or biopsy received SARS-CoV-2 swab 48 h before the procedure. Study endpoints were: combined incidence at 6 months of MACE (HF hospitalization, CV death and need for anticipated IV) in HF/VAD group, and MACE, rejection and any cause- hospitalization in HT group. Results Among 448 pts (57±12y, 240 HT, 191 HF, 17 LVAD), 52% were managed by PV and a subsequent IV was scheduled after 3±2 months. Pts managed by PV were healthier: in HF-VAD group they were less frequently listed, had less Afib, LVAD (2/17) (p

Purpose Advanced Heart Failure (A-HF) is a clinical condition which interferes with patient identity and perception. Psychological reactions depend on the nature and severity of patient disease, personality and environmental factors. Our goal was to evaluate quality of life of outpatients with left ventricular assist device (LVAD), heart transplantation (HT) and optimal medical treatment (OMT) for heart failure (HF). We additionally analyzed two cohorts of patients resulting different in terms of objective disease severity, to assess eventual perceived quality of life differences. Methods We included all consecutive adult patients presenting at our outpatient clinic for routine follow-up between January and September 2019. Including criteria were: being subjected to right heart catheterization (RHC), presence of LVAD for at least 2 months, HT for at least 2 months. Clinical severity of HF has been stratified using RHC and 6-minute walk test. Psychological parameters were measured by Kellner Symptom Questionnaire, Brief-Illness Perception Questionnaire, and WHO Quality of Life -BREF. Results Overall population consisted of 179 patients (HT=90, LVAD=15, and OMT-HF =74). OMT-HF patients were stratified into advanced and non-advanced (A-HF/NA-HF). A-HF patients walked significant less meters (p 3 (p=0.89), walked meters (p=0.32), CI (p=0.82). In psychological well-being comparison between OMT, LVAD and HT, patients who underwent advanced surgical therapy showed better results in terms of anxiety (p=0.014), depression (p=0.003), anger (p=0.04) and illness perception (p Conclusion Patients undergoing a major surgical procedure, such as LVAD implantation or Heart Transplantation, showed overall better psychological parameters than patients with chronic heart failure treated with medical therapy.

Purpose Left ventricular assist devices (LVAD) have been developed to support cardiocirculatory function in patients with advanced heart failure, who are refractory to optimal medical treatment. This created the need to identify a professional figure for dedicated management of LVAD patients. Methods In this report, we analyzed all the accesses of all consecutive adult LVAD recipients at our outpatient care unit and the impact of VAD coordinator clinical/technical assessment on patients global management, at the time of COVID-19 pandemic in the period January to August 2020 Results During the study period, 19 LVAD patients had overall 357 contacts with the clinic, for different combinations of: advanced driveline dressing (n=280), log file analysis and technical check-up (n=200), clinical visit (n=102), ramp test (n=17). In the majority of accesses, the patient was seen by the VAD coordinator only, (n=238; 67%), mainly for driveline dressing, which was associated with technical check-ups in 89 cases.Overall, alarms were managed by technical check-ups and log file analyses in 14 cases (6 high priority alarms, 3 cases of high watt or low flow, and 5 cases of low-priority alarms). Ramp tests were performed during right heart catheterization, with contextual echocardiography performed by the VAD coordinator: in 11 out of 17 cases the ramp test led to medical therapy or LVAD settings optimization. Conclusion LVAD patients need frequent outpatients dedicated admissions for proper monitoring. The VAD coordinator is a key healthcare professional representing the main interface for LVAD patients, in support of physicians’ throughout the duration of mechanical support, to preserve optimal outcomes.

The Morro dos Seis Lagos niobium rare earth element, Ti-bearing lateritic deposit (Amazonas, Brazil) is derived from a primary siderite carbonatite. The complex is the only example of a Nb deposit in which Nb-rich rutile is the main Nb ore mineral. Apart from the laterites, at the current level of exposure the complex consists only of siderite carbonatite; silicate rocks are absent. Three types of siderite carbonatite are recognized: (1) a brecciated and oxidized core siderite carbonatite consisting of up to 95 vol% siderite together with: hematite; pyrochlore; Nb-brookite; Ti-maghemite; and thorobastnasite; (2) a REE- and P-rich variety of the core siderite carbonatite consisting of siderite (up to 95 vol%), hematite, minor pyrochlore, monazite and bastnasite; (3) a border hydrothermal siderite carbonatite with ~70 vol% siderite, barite (~15 vol%), gorceixite (~7 vol%) and minor rhabdophane and pyrochlore. The country rock gneiss in which the carbonatite was emplaced was affected by potassic fenitization, with the formation of phlogopite and orthoclase together with monazite, fluorapatite and bastnasite. The siderite carbonatites exhibit a wide variation of δ13C (−5.39‰ to −1.40‰), accompanied by a significant variation in δ18O (17.13‰ to 31.33‰), especially in the REE-rich core siderite carbonatite, and are explained as due to the presence of both H2O and CO2 in the magma. The core siderite carbonatite is the richest in Fe (48.64–70.85 wt% Fe2O3) and the poorest in Ca (up 0.82 wt% CaO) example of a siderite carbonatite yet recognized The ferrocarbonatite has significant contents of Mn, Ba, Th, Pb and LREE, and a very high Nb (up to 7667 ppm) content due to the presence of Nb-brookite. The substitution 3Ti4+ = Fe2+ + 2Nb5+ recognized in Nb-rich brookite explains enrichment of Nb in the core siderite carbonatite and indicates formation in a reducing environment. The high Nb/Ta ratio (1408–11,459) of the carbonatite is compatible with residual liquids derived by fractional crystallization. The 87Sr/86Sr (0.70411–0.70573) and 144Nd/143Nd (0.512663–0.512715) isotopic data suggest the carbonatite is mantle-derived with essentially no crustal contamination and is younger than the maximum age of 1328 ± 58 Ma (U Pb in zircon). We suggest that the Morro dos Seis Lagos carbonatite complex represents the upper-most parts of a differentiated carbonatite magmatic system, and that the siderite carbonatite is related to late-magmatic-to-carbo-hydrothermal processes.

Purpose Paradigm HF trial showed that Sacubitril/Valsartan (LCZ696) 97/103 mg bid reduces the risk of death and hospitalizations for heart failure (HF). We tested the hypothesis that this clinical benefit is reflected by changes in hemodynamic profile in a population of patients (pts) affected by advanced HF. Methods Among pts included in our prospective HF Registry, we enrolled those who underwent two right heart catheterizations (RHC) and started LCZ696 in between, from May 2017 to April 2019. Baseline and follow-up RHC were compared in a matched paired fashion. We collected hemodynamic, clinical and echocardiographic data at both RHC. The dose of LCZ696 was expressed as a percentage of the target dose (TD,97/103 mg bid). The endpoint were hemodynamic changes between the two RHC. Changes in symptoms, echo parameters and medical therapy were also assessed. Results 44 pts (88% males; 54±8 yrs; 50% DCM; systolic blood pressure 108±17 mmHg; LVEF: 27±5%; NYHA III-IV: 46%) underwent a baseline RHC, started LCZ696 few days after, then repeated a RHC 178±59 days after the beginning of LCZ696. All pts were on diuretics (including MRAs), ACE-i/ARBs and beta-blockers at baseline. By comparing the two RHC, we observed a significant reduction in right atrial (from 7.5±2.5 to 5.6±2.5 mmHg), mean pulmonary artery (from 31.0±10.4 to 26.5±10.2 mmHg), pulmonary capillary wedge pressures (from 19.8±7.7 to 17.9±8.5 mmHg), transpulmonary gradient (from 10.4±4.6 to 8.6±3.8 mmHg) and pulmonary vascular resistances (from 2.7±1.5 to 2.2±1.3 WU), (p ≤ 0.01 for all), without significant change in systolic and mean systemic pressure. 50% of pts were taking ≤ 37.5% % of the TD; the hemodynamic changes were not influenced by LCZ696 dose. NYHA class improved (III-IV: 40.4 vs 16.7%, p Conclusion Our study shows that LCZ696 improves hemodynamic profile and symptoms in pts with advanced HF by reducing pulmonary and left ventricular filling pressures. This effect seems to be dose-independent. Our results suggest that LCZ696 can lead to a significant clinical and hemodynamic improvement even at low doses.

Purpose Gene expression profiling (GEP) of endomyocardial biopsies (EMB) by the MMDx system has been shown to estimate the probability of T-cell mediated (TCMR) and antibody-mediated rejection (AMR), improving the histology-based diagnoses in heart transplant (HT) recipients. Second generation analysis allowed to identify an additional phenotype characterised by molecules related to tissue injury (INJ), such as de-differentiation pathways, macrophages transcripts, and heart transcripts. The clinical correlates of this novel profile and its association with ISHLT pathology grading is under development. In this study we analyse the association of MMDx novel profiles with cardiac function and with ISHLT grades for TCMR and AMR. Methods 254 EMBs from 121 patients were analysed with MMDx platform. EMBs were performed according to standard protocol during the first 5 years after transplant and by clinical indication later on. Right heart catheretization was performed at the time of EMB, which were graded by 1990 and 2006 ISHLT classifications for TCMR and 2014 guidelines for AMR. Results Prevalence of molecular phenotypes varied during time course: INJ was frequent in the first months, absent during the first 5 years, and rose again in late for-cause EMBs; AMR peaked early and late after transplant, in line with DSA time-course; TCMR probability was meaningful in the early months only. Cardiac function also varied across the three profiles: INJ was significantly associated with low cardiac index (CI) and high right atrial pressure, AMR with elevated wedge pressure and low CI, and TCMR with low CI only. Overall, GEP was in agreement with pathology readings in most cases, being normal in 90% of the 0 graded EMB, and abnormal in over 70% of the 2R or pAMR2. While current 1R grade showed abnormal GEP only in 37% of cases, the old 1B grade had abnormal GEP in 60% of cases, mostly associated with AMR profile. INJ profile was found in 54% of the 2R or greater EMBs. Conclusion GEP reveals variable molecular patterns during transplant time course; INJ phenotype appears associated mainly with low CI in the context of post-operative injury and severe mixed rejection, while AMR seems to increase markers of graft stiffness. Despite good overall agreement with pathology readings, current ISHLT grading is inaccurate, with the “old” 1B grade being highly associated with AMR molecular profiling.

Purpose Little is known about the role of ECG in heart transplanted (HT) patients (pts). In this study, we sought to identify ECG parameters that could help to identify graft dysfunction and to stratify prognosis. Methods Pts enrolled in a prospective study aimed to test a novel immune monitoring test (Quantiferon monitor), consecutively coming at our Clinic (2014-17) constituted study cohort. We created 3 groups: A) normal graft function (HT 5 yrs); C) LVEF Results Among 153 pts (58±14 yrs, 75%M), 79% had normal graft function (51% A, 28% B). Pts with graft dysfunction (21%), compared with groups A and B respectively, had a different distance from HT (1.2±1.6 vs 15.7±5.7 vs 12.9±7.4 yrs), more frequently CAV (8.8% vs 14.9% vs 64%), longer PQ (181±53 vs 163±38 vs 148±25 ms), wider QRS (131±34 vs 105±18 vs 101±18 ms), longer QTc (473±5 vs 445±4 vs 453±3 ms), more conduction disorders (75% vs 51.2% vs 39.2%) and Afib (9.1% vs 0 vs 4.6%), p≤ 0.01 for all; heart rate was intermediate between A and B. Distance from HT (i.e. >5yrs) and, similarly, CAV, carried a longer PQ, wider QRS, more conduction disturbances (p Conclusion ECG parameters in HT are influenced by many factors, reflecting multiple pathways leading to graft dysfunction. QTc may be a marker of subclinical systolic dysfunction (i.e. microvascular disease, chronic rejection) and help in identifying high risk pts.

La sindrome dell’apnea ostruttiva del sonno e frequente nel bambino e interessa tutte le fasce d’eta. Essa e, il piu delle volte, dovuta a un’ipertrofia delle tonsille e delle vegetazioni adenoidee. La presentazione clinica e diversa da quella dell’adulto. La gestione si basa generalmente su un’adenotonsillectomia in prima intenzione. La polisonnografia e l’esame di riferimento per la diagnosi, ma le indicazioni devono essere riservate a certi casi particolari. Le norme di interpretazione sono specifiche della pediatria. La ventilazione non invasiva assume un ruolo sempre piu importante e permette, in numerosi casi, di evitare di dover ricorrere a una tracheotomia.

Introduction L’allergie alimentaire a la peche est frequente, par reaction croisee pollens-aliments ou comme allergie alimentaire primaire. Au Japon et dans la region de Marseille, la sensibilisation a Pru p 7 a ete proposee recemment comme marqueur de gravite de l’allergie a la peche. Nous avons etudie la distribution et les caracteristiques cliniques de la sensibilisation a Pru p 7 dans la moitie Sud de la France. Methodes Nous avons inclus 316 patients suspects d’allergie a la peche (198 allergies confirmees). Les dosages d’IgE ont ete effectues par methode ImmunoCAP. Les donnees polliniques ont ete obtenues a partir du RNSA. Resultats Parmi les resultats statistiquement significatifs concernant la sensibilisation a Pru p 7 : gradient Sud-Nord, association a 99 % (170/171) avec une sensibilisation au pollen de cypres, frequence plus elevee chez les patients allergiques que chez ceux tolerant la peche (62 vs 41 %), association avec les reactions systemiques (78 %) et correlation inverse avec les reactions de faible gravite, association avec la presence de cofacteurs, monosensibilisation apparente (absence d’IgE detectable vis-a-vis de Pru p 1, Pru p 3, Pru p 4) plus frequente chez les patients allergiques que chez les tolerants (54 % vs 17 %), titres d’IgE Pru p 7 plus eleves chez les patients allergiques que chez les tolerants (mediane 3,4 vs 0,3 kUA/L), correlation entre la gravite des reactions cliniques induites par la peche et la concentration d’IgE Pru p 7. Les tests d’inhibition des IgE entre Pru p 7 et le pollen de cypres suggerent une sensibilisation primaire au pollen de cypres. Conclusion Pru p 7, precedemment ignore en raison de l’absence d’outils biologiques, se revele etre un allergene majeur et severe de la peche. La physiopathologie de la sensibilisation a Pru p 7 en lien avec l’exposition aux pollens de Cupressacees reste a decrire. Compte tenu de la large distribution des pollens de Cupressacees dans le monde entier, Pru p 7 et ses homologues pourraient etre impliques dans des allergies potentiellement severes a de nombreux aliments d’origine vegetale.

International audience; The Morro dos Seis Lagos niobium deposit (2897.9 Mt at 2.81 wt.% Nb2O5) is associated with laterites formed by the weathering of siderite carbonatite. This iron-rich lateritic profile (>100 m in thickness) is divided into six textural and compositional types, which from the top to the base of the sequence is: (1) pisolitic laterite, (2) fragmented laterite, (3) mottled laterite, (4) purple laterite, (5) manganiferous laterite, and (6) brown laterite. All the laterites are composed mainly of goethite (predominant in the lower and upper varieties) and hematite (predominant in the intermediate types, formed from goethite dehydroxylation). The upper laterites were reworked, resulting in goethite formation. In the manganiferous laterite (10 m thick), the manganese oxides (mainly hollandite, with associated cerianite) occur as veins or irregular masses, formed in a late event during the development of the lateritic profile, precipitated from a solution with higher oxidation potential than that for Fe oxides, closer to the water table. Siderite is the source for the Mn. The main Nb ore mineral is Nb-rich rutile (with 11.26 – 22.23 wt.% Nb2O5), which occurs in all of the laterites and formed at expense of a former secondary pyrochlore, together with Ce-pyrochlore (last pyrochore before final breakdown), Nb-rich goethite and minor cerianite. The paragenesis results of lateralization have been extremely intense. Minor Nb-rich brookite formed from Nb-rich rutile occurs as broken spherules with an “oolitic” (or Liesegang ring structure). Nb-rich rutile and Nb-rich brookite incorporate Nb following the [Fe3+ + (Nb, Ta) for 2Ti] substitution and both contain up to 2 wt.% WO3. The laterites have an average Nb2O5 content of 2.91 wt.% and average TiO2 5.00 wt.% in the upper parts of the sequence. Average CeO2 concentration increases with increasing depth, from 0.12 wt.% in the pisolitic type to 3.50 wt.% in the brown laterite. HREE concentration is very low.

Durch die Co-Vergarung von biogenen Abfallen in kommunalen Klaranlagen lassen sich eine sinnvolle Verwertung und die Erzeugung erneuerbarer Energie vereinen. Untersucht wird die Moglichkeit der Co-Fermentation von Backereiabfallen einer Grosbackerei mit Klarschlamm der Abwasserreinigungsanlage Zirl in einem 1-m3-Doppelversuchsreaktor. Ein Fermenter wird nur mit reinem Klarschlamm beschickt, dem anderen wurden zusatzlich die Backereiabfalle im entsprechenden Mengenverhaltnis von 1:28 (Backereiabfalle: Klarschlamm) zugegeben und co-fermentiert. Es kann gezeigt werden, dass die Co-Vergarung keine negativen Auswirkungen auf den normalen Klarschlammbetrieb zur Folge hat. Durch die Zugabe des Co-Substrates kann der Biogasertrag um mehr als 100 % gesteigert werden. Gleichzeitig werden die Backereiabfalle fast vollstandig abgebaut. Das Problem einer Versauerung durch Zugabe schnell abbaubarer Substrate kann anhand stabiler pH-Werte ausgeschlossen werden. Die anschliesende Wirtschaftlichkeitsbetrachtung bestatigt die Rentabilitat dieser Verwertungsmethode am Standort Zirl.

Spondyloarthritis represents a heterogeneous group of articular inflammatory diseases that share common genetic, clinical and radiological features. Recently, novel insights into the epidemiology, pathogenesis and treatment of these diseases have been provided. Herewith, we provide an overview of the most significant literature contributions published over the year.

Inhaled corticosteroids are the cornerstone of asthma management. Inhaled corticosteroid regimens differ slightly in various international guidelines on asthma management but are based on the principles of continuous treatment and titration to the lowest effective dose. Several recent studies, nevertheless, appear to demonstrate the potential value of preemptive or "pro re nata" regimens in infants and children. These studies were included in GINA 2015 for children 5 years of age and younger in whom discontinuous treatment is proposed as a second-line option. Should we change our practices after a critical reading of these studies?

Resume L'observation d'un nourrisson ayant presente deux infections severes a virus respiratoire syncytial (VRS) dans le meme hiver avec atteinte ORL associee nous a amenes a envisager les relations virus–asthme chez l'enfant et la place de l'oreille moyenne dans l'unite des voies aeriennes. Les virus, notamment le VRS et les rhinovirus, sont en effet impliques dans 80 % des exacerbations d'asthme des enfants en âge scolaire. Neanmoins, le role des infections respiratoires virales dans la genese de l'asthme est loin d'etre clairement etabli. Les bronchiolites severes a VRS necessitant l'hospitalisation semblent associees a un risque ulterieur d'asthme atopique contrairement aux formes moins severes. Le VRS serait donc plus revelateur d'une susceptibilite particuliere des voies aeriennes que veritable facteur etiologique. L'effet cytopathique du VRS pourrait en effet etre facilite par une fragilite epitheliale, primum movens du remodelage primaire asthmatique. Une nouvelle entite se degage au sein de l'unite des voies aeriennes : l'oreille moyenne. La sensibilisation IgE mediee et les sifflements sont en effet recemment apparus comme facteurs de risque independants d'otite seromuqueuse. Chez l'atopique, l'infiltrat epithelial de la trompe d'Eustache et l'exsudat situe dans l'oreille moyenne ont un profil Th2. Le concept d'« otorhinobronchite allergique » impose donc une prise en charge therapeutique globale des voies aeriennes des patients presentant une allergie respiratoire, notamment otologique.

Nell’ambito del dibattito sulla valutazione della ricerca, il contributo si sofferma sul vaglio critico dei referee relativo a quel particolare tipo di ricerca empirica pedagogica in cui vengono utilizzati, in forma integrata, approcci e/o metodi di tipo quantitativo e qualitativo (mixed method research o mixed method). Questo anche al fine di sottolineare i rischi e l’amplificarsi dei problemi nella valutazione esterna della produttività scientifica dei ricercatori, in relazione alle metodologie e procedure di indagine utilizzate nei confronti di prodotti di ricerca educativa di tipo empirico e valutativa. Dopo una contestualizzazione politico-istituzionale dei processi di sviluppo della ricerca pedagogica, il contributo illustrata la rilevanza che all’interno di essa stanno assumendo le indagini con i “metodi misti”. Le implicazioni problematiche di questo fenomeno per la valutazione degli esiti della ricerca sono rese evidenti mediante la ricostruzione delle principali voci del dibattito circa l’integrazione tra quantitativo e qualitativo e i criteri di qualità delle ricerche con approccio metodologico misto. Sono infine presentate alcune considerazioni che, alla luce del rilevante ruolo che rivestiranno i “metodi misti”, intendono contribuire alla elaborazione di uno specifico sistema di criteri di qualità di cui sono prefigurate anche possibili ricadute sul sistema generale della ricerca pedagogica.