Creating a Kind and Just World: The Power of Literature to Create Hope for Foster Youth

Within our community, there are children in the foster care system who suffer for various reasons. As these children journey through life, they do not always come across caring adults, worthy peer relationships, or are given a voice to talk about their experience when wanted. Yet, as adults, and as educators, we are responsible for providing children with a “kind and just parent” (Ayers) whether in the classroom, at home, or in foster care placements. This capstone documents how Jacqueline Woodson’s young adult novel, After Tupac and D Foster, and William Ayer’s, A Kind and Just Parent, were woven together into a curriculum for adults that work with at risk youth. The curriculum guides teachers to recognize what children in the foster care system might experience and how we educators can support them. The curriculum was designed with the goal of helping all of society’s children, but especially the most vulnerable, to understand their own lives through the characters in the novel, and, in turn, use the novel as a tool to enable peers to relate more deeply to foster youth. By using young adult literature to bring to light what foster care youth experience, educators can “normalize” the idea of the foster care system, hopefully presenting it in a new, more positive, light. The curriculum, is designed to help children and teachers within our community feel more comfortable talking about foster care by giving children the chance to talk about their experience, while building healthy peer relationships, thus, building a kind and just world along the way

The Role of Multimodality Imaging in Patients with Congenital Heart Disease and Infective Endocarditis

Infective endocarditis (IE) represents an important medical challenge, particularly in patients with congenital heart diseases (CHD). Its early and accurate diagnosis is crucial for effective management to improve patient outcomes. Multimodality imaging is emerging as a powerful tool in the diagnosis and management of IE in CHD patients, offering a comprehensive and integrated approach that enhances diagnostic accuracy and guides therapeutic strategies. This review illustrates the utilities of each single multimodality imaging, including transthoracic and transoesophageal echocardiography, cardiac computed tomography (CCT), cardiovascular magnetic resonance imaging (CMR), and nuclear imaging modalities, in the diagnosis of IE in CHD patients. These imaging techniques provide crucial information about valvular and intracardiac structures, vegetation size and location, abscess formation, and associated complications, helping clinicians make timely and informed decisions. However, each one does have limitations that influence its applicability

Prognostic value of CMR-derived extracellular volume in AL amyloidosis: a multicenter study

Background: This study aimed to assess the prognostic value of cardiac magnetic resonance (CMR) variables and compare them with biological and echocardiographic markers in patients with AL cardiac amyloidosis (CA). Methods: We conducted a prospective study across three tertiary centres, where patients underwent clinical examination, blood tests, echocardiography, and CMR. The primary endpoint was all-cause mortality. Results: A total of 176 patients with AL CA were included, with a median age of 68 years (IQR 58-75). According to the 2004 Mayo Clinic staging, 121 patients (69%) were in stage 3. During a median follow-up of 22 months (IQR 8-48), 45 patients died, and 55 were hospitalized for heart failure. Patients who died had higher NT-proBNP and troponin levels, and lower LVEF, cardiac output, and longitudinal strain. Among CMR variables, extracellular volume (ECV) was most strongly associated with all-cause mortality. In multivariate Cox models, including Mayo Clinic staging, ECV ≥ 0.45 was independently associated with mortality (HR 2.36, CI 95% 1.47-5.60) and also with heart failure hospitalizations (HR 4.10, 95%CI 2.15-8.8). Conclusion: ECV is a powerful predictor of outcomes in AL CA, providing additional prognostic value on top of Mayo Clinic staging

Mass cytometry: exploring the immune landscape of systemic autoimmune and inflammatory diseases in the past fourteen years

Auto-immune and inflammatory diseases are heterogenous in their clinical manifestations and prognosis, even among individuals presenting with the same pathology. Understanding the immunological alterations involved in their pathogenesis provides valuable insights in different clinical phenotypes and treatment responses. Immunophenotyping could lead to significant improvements in diagnosis, monitoring, initial treatment decisions and follow-up in autoimmune and inflammatory diseases. Mass cytometry provides measurement of over 40 simultaneous cellular parameters at single-cell resolution, and therefore holds immense potential to evaluate complex cellular systems and for high-dimensional single-cell analysis. The high dimensionality of mass cytometry provides better coverage of immune populations dynamics, with sufficient power to identify rare cell types compared to flow cytometry. In this comprehensive review, we explore how mass cytometry findings contributed in the past decade to a deeper understanding of the cellular actors involved in systemic auto-immune and auto-inflammatory diseases with their respective therapeutic and prognostic impact. We also delve into the bioinformatical approaches applied to mass cytometry to analyze the high volumes of data generated, as well as the impact of the use of complementary single cell RNA sequencing, and their spatial modalities. Our analysis highlights the fact that mass cytometry captures major information on cell populations providing insights on the complex pathogenesis of autoimmune diseases. Future research designs could include mass cytometry findings in association to other -omics to stratify patients in adequate therapeutic arms and provide advancements in personalized therapies in the field of auto-immune and inflammatory diseases

Case Report: Relapsing pleural effusions and coated aorta revealing Erdheim–Chester disease

Erdheim–Chester disease (ECD) is a rare histiocytic disorder with localized presentations or multisystem disease. Clinical presentations of ECD are usually non-specific and depends on the site of involvement. ECD can involve one or several organs. Clinical manifestations range from asymptomatic lesions to severe and life-threatening organ dysfunction. Hence, accurate and timely diagnosis is challenging given the rarity and varied presentation of ECD. The most common clinical manifestations are bone pain related to osteosclerosis, usually in the lower limbs. We report here a case with no obvious clinical manifestation of ECD preceding initial recurrent pleural effusions. The diagnosis of ECD was suggested based on pleural thickening revealed by relapsing pleural effusions combined with radiological finding of a coated aorta and slight perirenal infiltrate. Pleural biopsy revealed collagen fibrosis, and immunohistochemistry with the anti-CD163 antibody showed an important infiltration by histiocytes, strong cytoplasmic phosphorylated ERK in the lesional cells, and positive factor XIIIa staining. A cell-free DNA from peripheral blood revealed negative BRAF mutation and the presence of MAP2K1 mutation, a key driver mutation in ECD. The diagnosis is often suggested based on clinic-radiological presentation but requiring histopathology to establish a final diagnosis of ECD. Plasma cell-free DNA is a promising and non-invasive tool to detect key driver mutations

Évaluation du couplage auriculo-ventriculaire gauche par imagerie cardiovasculaire multimodale

Cardiovascular diseases remain a major public health problem, which is accompanied by extremely significant direct and indirect costs, estimated at more than 169 billion euros per year within the European Union, and more than 350 billion dollars per year in the United States. Thus, it is absolutely crucial to develop an early prognostic stratification tool capable of detecting patients most at risk of presenting these cardiovascular events to offer them personalized care. For this purpose, multimodality cardiovascular imaging represents a non-invasive tool of choice. While several studies have shown the prognostic interest of evaluating the structural and functional parameters of the left ventricle and the left atrium separately, no study has until now measured the benefit of simultaneously evaluating both the left ventricle and left atrium. Thus, due to the close physiological relationship that exists between the left atrium and the left ventricle, the hypothesis of this work was that the evaluation of the left atrioventricular coupling could make it possible to reflect the existence of early atrioventricular dysfunction, and then constitute a better tool for early prediction of the risk of cardiovascular events. To do this, we developed the first index of left atrioventricular coupling described in the literature based on cardiac MRI examinations from the American MESA cohort. MESA is a multicenter study carried out in 6 American centers with prospective recruitment ranging from 2000 to 2002, having made it possible to recruit 6,814 participants aged 45 to 84 years. This left atrioventricular coupling index (LACI) is defined simply by the ratio of the volume of the left atrium in end-diastole to the volume of the left ventricle in end-diastole. This index then expresses the percentage of left atrioventricular dysfunction. A first study (Study no. 1) showed that LACI was independently associated with the occurrence of cardiovascular events including atrial fibrillation, heart failure, and mortality from cardiovascular causes. To propose routine use of this new index, we have determined its best prognostic discrimination threshold which is 25%. Furthermore, the LACI had a greater prognostic value than any measured parameter of the left atrium and/or left ventricular evaluated separately. In Study no. 2, we explored the determinants of the LACI and its annual variation over 10 years, in other words its deterioration over time. In Study no. 3, we showed that menopause played a significant role in accelerating the degradation of this left atrioventricular coupling implying a role for sex hormones. In Studies no. 4 and 5, we highlighted the prognostic value of the annual variation in LACI over 10 years as a powerful independent prognostic factor for the occurrence of the risk of atrial fibrillation and heart failure. Then, we were able to validate this prognostic value of the LACI on a French external validation cohort (Study no. 6). Finally, after having carried out the first six studies based on a measurement of the LACI by cardiac MRI, in Study no. 7 we validated the prognostic value of the LACI using measurements taken on a cardiac CT. Indeed, the validation of this index on a cardiac CT ensures a much broader development of this measurement, throughout the world, taking into account the fact that the scanner is much more accessible routinely than cardiac MRI. To conclude, this thesis work made it possible to develop the first left atrioventricular coupling index as a prognostic marker of cardiovascular event risk from an American cohort, with double external validation.Les maladies cardiovasculaires restent un problème de santé publique majeur, ce qui s'accompagne de coûts directs et indirects extrêmement importants, évalués à plus de 169 milliards d'euros par an au sein de l'Union Européenne, et plus de 350 milliards de dollars par an aux États-Unis. Ainsi, il est absolument crucial de d'élaborer un outil de stratification pronostique précoce capable de détecter les patients les plus à risque de présenter ces évènements cardiovasculaires afin de leur offrir une prise en charge personnalisée. Dans ce but, l'imagerie cardiaque multimodale représente un outil non invasif de choix. Alors que de nombreuses études ont montré l'intérêt pronostique de l'évaluation des paramètres structurels et fonctionnels du ventricule gauche et de l'oreillette gauche séparément, aucune étude n'avait jusqu'alors mesuré l'intérêt d'évaluer simultanément le ventricule gauche et l'oreillette gauche. Ainsi, du fait de l'étroite relation physiologique qui existe entre l'oreillette et le ventricule gauches, l'hypothèse de ce travail de thèse de science était que l'évaluation du couplage auriculo-ventriculaire gauche pourrait permettre de refléter l'existence d'une dysfonction auriculo-ventriculaire précoce, et constituer alors un meilleur outil de prédiction précoce du risque d'évènement cardiovasculaire. Pour ce faire, nous avons développé le premier indice de couplage auriculo-ventriculaire gauche décrit dans la littérature à partir d'examens d'IRM cardiaque issus de la cohorte américaine MESA. MESA est étude multicentrique réalisée sur 6 centres américains avec un recrutement prospectif allant de 2000 à 2002, ayant permis de recruter 6 814 participants âgés de 45 à 84 ans. Cet indice de couplage auriculo-ventriculaire gauche (LACI) est défini simplement par le ratio du volume de l'oreillette gauche en télédiastole sur le volume du ventricule gauche en télédiastole. Cet indice exprime alors le pourcentage de dysfonction auriculo-ventriculaire gauche. Une première étude (étude n°1) a montré que le LACI était indépendamment associé à la survenue des évènements cardiovasculaires incluant fibrillation atriale, insuffisance cardiaque, et mortalité de cause cardiovasculaire. Afin de pouvoir proposer une utilisation en routine de ce nouvel indice, nous avons déterminé son meilleur seuil de discrimination pronostique qui est de 25%. De plus, le LACI avait une valeur pronostique supérieure à n'importe quel paramètre mesuré de l'oreillette gauche et/ou du ventriculaire gauches évalués séparément. Dans l'étude n°2, nous avons exploré les déterminants du LACI et de sa variation annuelle sur 10 ans, autrement dit de sa dégradation avec le temps. Dans l'étude n°3, nous avons montré que la ménopause jouait un rôle significatif dans l'accélération de la dégradation de ce couplage auriculoventriculaire gauche impliquant un rôle des hormones sexuels. Dans les études n°4 et 5, nous avons mis en évidence la valeur pronostique de la variation annuelle du LACI sur 10 ans comme un puissant facteur pronostique indépendant de survenue du risque de fibrillation atriale et d'insuffisance cardiaque. Ensuite, nous avons pu valider cette valeur pronostique du LACI sur une cohorte de validation externe française (étude n°6). Enfin, après avoir réalisé les six premiers travaux à partir d'une mesure du LACI par l'IRM cardiaque, nous avons dans l'étude n°7 validé la valeur pronostique du LACI à l'aide de mesures réalisées sur un scanner cardiaque. En effet, la validation de cet indice sur un scanner cardiaque permet d'assurer un développement beaucoup plus large de cette mesure, à travers le monde, compte tenu du fait que le scanner soit largement plus accessible en routine que l'IRM cardiaque. Pour conclure, ce travail de thèse a permis de développer le premier indice de couplage auriculo-ventriculaire gauche comme marqueur pronostique de risque d'évènements cardiovasculaire à partir d'une cohorte américaine, avec double validation française

Brief von Christoph Pezel an Unbekannt, [08.07.[15]79]

Abschrift Bemerkungen: Pezel, erklärt sich bereit, nach Bremen zu kommen, setzt aber das Einverständnis des Landesherren voraus.Handschrif

Brief von Christoph Pezel an Johannes Hildebrand, [23.02.1582]

AutografHandschrif