Background: Temporary mechanical circulatory support device without sternotomy has been highly advocated for severe cardiogenic shock patient but little is known when coupled with amniotic stem cell therapy. Case presentation: This case reports the first dual therapy of temporary left ventricular extracorporeal device CentriMag with distal banding technique and human amniotic stem cell injection for treating a severe refractory cardiogenic shock of an 68-year-old female patient. A minimally-invasive off-pump LVAD was established by draining from the left ventricle and returning to the right axillary artery with distal arterial banding to prevent right upper extremity hyperperfusion. Amniotic stem cells were injected intramyocardially at the left ventricular apex, lateral wall, inferior wall, and right subclavian vein. Conclusion: The concomitant use of the temporary minimally-invasive off-pump CentriMag placement and stem cell therapy not only provided an alternative to cardiopulmonary bypass and full-median sternotomy procedures but may have also synergistically enhanced myocardial reperfusion and regeneration.

Introduction : Les paramètres éjectionnels d’évaluation de la fonction ventriculaire gauche, sont directement influencés par la post-charge. Dans ce contexte chez l’hypertendu, une analyse complète de la performance du ventricule gauche (VG) doit pouvoir intégrer des paramètres hémodynamiques (variations de volume du VG vs variations de pressions aortique) mais aussi des paramètres de «déplacement » des parois. L’objectif de cette thèse est de déterminer avec des techniques non invasives le couplage ventriculo-aortique chez l’hypertendu.Méthodes : Les courbes de pression-volume ont été obtenues par échographie 3D en temps réel pour les volumes et tonométrie pour la pression carotidienne. A partir des boucles pression-volume, une méthode des moindres carrés non linéaire est utilisée pour construire la droite d’élastance. Le couplage ventriculo-aortique est estimé par le rapport de l’élastance télé-systolique de sortie du VG (Ees) et d’entrée aortique (Ea). Le transfert d’énergie du VG à l’aorte (rendement) est calculé par le rapport de la puissance d’éjection et de la puissance de déformation myocardique.Résultats : L’étude de validation de notre nouvelle méthode de modélisation d’Ees montre une bonne sensibilité et reproductibilité par rapport aux méthodes invasives de référence. Outre sa précision, l’avantage de notre méthode est la simplicité de son application clinique. Les premiers résultats de ce travail montrent que à un stade précoce de l’HTA, l’augmentation simultanée de la puissance d’éjection et d’Ea est compensée par une augmentation du rendement du VG et d’Ees pour un couplage ventriculo-aortique qui reste préservé.Conclusion : Le travail de modélisation de la relation pression-volume de cette thèse a permis son application clinique sur une population de sujets hypertendus. Ces premiers résultats positifs ont permis la mise en place d’une étude randomisée sur l’influence de l’apport sodé sur le couplage ventriculo-aortique chez l’hypertendu. L’avantage de cette nouvelle méthode de calcul d’Ees, basée sur l’échocardiographie 3D en temps réel, permet de se passer de toutes les hypothèses géométriques qui étaient jusqu’alors nécessaires pour les études en imagerie bidimensionnelle. Le recours à l'imagerie reste en revanche plus complexe pour l’analyse des déplacements en 3D qui nécessitent encore un travail de modélisation. / Introduction : In addition to contractility, afterload is one of the main determinants of left ventricular (LV) performance. Thus, analysis of LV function in hypertension not only requires incorporation of hemodynamics parameters such as LV time-varying volume and pressure, but also LV wall strain and stress. The aim of the present study is to evaluate non invasively LV-arterial coupling in hypertension.Method : LV volumes and pressures curves were obtained from real-time 3D echocardiography (RT3DE) and carotid tonometry, respectively. The pressure-volume (P-V) curves thus obtained were fitted with a non linear least squares method. We then computed the slope and the intercept of time varying élastance, and volume intercept V0. LV-aortic coupling is estimated by the ratio of LV and aortic elastance (Ees and Ea). Energy transfer from the left ventricle to aorta is defined as the ratio of external work and myocardial strain work (Pmeca). Cyclic variations of wall thickness and strain rate were measured by 2D speckle-tracking. Pmeca was calculated according to the produce of LV wall stress with strain rate.Result : A good univariate relationship and a good agreement were found between previous invasive calculation of Ees and our new proposed “Ejection P-V Curve” method. In hypertensive patients, increase in Ea and LV efficiency were compensated by a parallel increase in Ees without change in Ea/EesConclusion : Ees and V0 can be estimated non invasively from modeling of the P-V curve during ejection. This approach was found to be reproducible and sensitive enough to detect an expected difference in LV contractility in hypertensive patients. Due to its non invasive nature, our new proposed “Ejection P-V Curve” method is now applicable to a randomized study of the effect of sodium intake on LV performance in hypertension. Among strengths of these new methods based on RT3DE, is to exclude the necessity of geometrics assumptions for the evaluation of LV volumes. However, 3D analysis of LV strain is not yet fully-developed, with the necessity to improve the performance of frame acquisition and modeling.

This study investigated whether fifth-grade students would sing more accurately when responding to pitch stimuli presented to the right ear as compared to left and both ears. Students were also classified as either strongly right-handed or other (left-handed or mixed) to see if ear treatment responses would differ with handedness. Sixty-six students were tested on their attempts to match 12 model pitches. Identical tests were given to each subject on 3 different days, with a different ear treatment each day. Vocal response scores were significantly better for both-ear presentation than for left-ear. No significant difference was found between right and both ears, right and left ears, or between handedness groups.

The Jewish community in Britain has been characterised by its high degree of conformity. This study seeks to extend the parameters of Jewish life by including those hitherto excluded from the historical narrative so that the community can more effectively be viewed as a paradigm for understanding the challenges facing minority communities in their encounter with mainstream society. It sets Jewish involvement within the wider historical, social, economic, political and cultural context, in which it developed, focusing upon political radicalism in Manchester, 1889-1939, and Jewish participation in radical socialism, anarchism, bundism and communism. Nonconformity is here defined in terms of a distancing from both external pressures (e.g. social conformity with the wider community) and internal pressures (e.g. religious beliefs and concerns about communal image). Through the prism of Manchester the chapters will highlight debates surrounding the makeup and impact of pre-First World War involvement; the disproportionate involvement of Jews in radicalism; the nature of Jewish allegiance to communism as an ideological conversion or a convergence of interest and the impact of involvement on Jewish identity, described as ‘Jewish communists’ or ‘communist Jews’.The thesis draws upon new information from the radical Yiddish and English press, revealing the importance of English and foreign influences on pre-war radicalism. Its use of oral testimonies at the Manchester Jewish Museum and elsewhere has revealed in the post-war period, a layering of motivation, commitment and identity. Written chronologically, the periodization of this study enables connections and differences to be drawn. It shows significant discontinuity in involvement and influence between pre and post-First World War radical activity, unlike in London. In Manchester those drawn to communism post-war were almost entirely from an English-born generation. They were more representative of the communist Jew, whose communist identity superseded but did not eradicate their Jewish identity. The thesis shows that conversion to communism was not due to any inherent ethnic characteristics. From 1920-1932 it was a response to the same social and economic factors which influenced non-Jews to communism, but encased in a cultural and historical context. From 1933 that process of conversion continued but was greatly boosted by the desire to fight fascism. The communist led fight against fascism and provision of a popular youth club acted as an attraction to youngsters, who were subsequently influenced in differing degrees or not at all by Marxism. This resulted in different levels of commitment and identification, some of which continued after the war, resulting in the formation of a subculture of Marxist and secular left-wing Jews, who are still seen as nonconformists by the mainstream Jewish community.

Les vertébrés font partie des animaux à symétrie bilatérale mais celle-ci n'est pas parfaite et de nombreuses asymétries sont visibles entre les côtés gauche et droit, notamment au niveau du système nerveux. L'épithalamus s'est imposé comme le modèle de référence pour l'étude des mécanismes de latéralisation du cerveau. Cette structure dérivée du diencéphale dorsal se compose de deux noyaux bilatéraux, les habénulæ et du complexe pinéal, qui regroupe les glandes pinéale et parapinéale. Les habénulæ présentent des asymétries plus ou moins marquées chez tous les grands groupes de vertébrés. La parapinéale est également asymétrique mais elle est absente dans de nombreux taxa. Chez le poisson zèbre, espèce modèle de référence pour l'étude des mécanismes de formation des asymétries épithalamiques, une migration latéralisée de la parapinéale est nécessaire à l'élaboration des asymétries habénulaires. Les mécanismes génétiques sous-jacents ont également été en partie décryptés. La première asymétrie visible dans le diencéphale dorsal correspond à une activité de la voie de signalisation Nodal à gauche. Si cette voie Nodal est essentielle pour induire une asymétrie neurogénétique précoce, elle ne l'est pas pour la formation des asymétries épithalamiques définitives. Son rôle se restreint à biaiser la directionnalité des asymétries en influençant la migration de la parapinéale. Les asymétries habénulaires sont induites par la position finale de la parapinéale. La conservation à l'échelle des vertébrés des mécanismes décrits chez le poisson-zèbre reste une question ouverte. Au cours de ce travail de thèse, j’ai cherché à comprendre l’évolution de ces mécanismes en étudiant un chondrichtyen, la roussette Scyliorhinus canicula et des cyclostomes, les lamproies Petromyzon marinus et Lampetra planeri. Leur position phylogénétique ainsi que les asymétries majeures en taille observées entre les habénulæ gauche et droite font de ces espèces de bons modèles pour comprendre leur origine chez les vertébrés. Mes travaux conduisent à trois conclusions principales :(1) on retrouve, comme chez le poisson zèbre, une expression asymétrique de la voie Nodal dans le diencéphale dorsal gauche de la lamproie et de la roussette; la directionnalité de cette asymétrie est conservée entre les trois espèces, ce qui permet d’exclure une inversion de latéralité précédemment proposée chez la lamproie sur la base d’arguments de taille relative des habénulæ(2) La voie Nodal est essentielle à la formation des asymétries habénulaires chez la roussette et la lamproie, ce qui suggère un rôle ancestral dans l’élaboration des asymétries épithalamiques.(3) une analyse détaillée des patrons de prolifération-différenciation des habénulæ au cours du développement de la roussette met en évidence des asymétries moléculaires et cellulaires multiples ; elle démontre en particulier l’existence d’une neurogenèse asymétrique qui débute plus précocement à gauche. Ces travaux donnent un éclairage nouveau sur l’origine et la diversification des mécanismes contrôlant la formation des asymétries cérébrales chez les vertébrés. L’étude de la roussette et la lamproie, deux organismes modèles non conventionnels, ouvrent de nouvelles perspectives pour leur compréhension. / Vertebrates are part of the bilaterally symmetric animals but this one is not perfect and numerous asymmetries can be seen between the left and right sides, especially in the nervous system. The epithalamus has proven itself to be the model system for brain lateralization mechanisms’ studies. This structure derived from the dorsal diencephalon contains by the bilaterally paired habenular nuclei and the pineal complex, which includes the pineal gland and parapineal organ. The habenulae exhibit more or less marked left-right asymmetries among most of the major vertebrate taxa. The parapineal is also asymmetrical but it is absent in many taxa. Zebrafish is the model system for the studies of the developmental mechanisms of epithalamic asymmetries. In this species, a lateralized parapineal migration is required for the establishment of habenular asymmetries. The underlying genetic mechanisms have also been partially decrypted. The first conspicuous asymmetry in the dorsal diencephalon corresponds to a left-sided expression of components of the Nodal signalling pathway. This asymmetric Nodal signalling activity is essential to induce an early neurogenetic asymmetry but not necessary the formation of epithalamic asymmetries per se. Its role is restricted to provide a bias to the parapineal organ’s lateralized migration, and thus influence the laterality of epithalamic asymmetries. Indeed, habenular asymmetries are induced by the final position of the parapineal organ. Conservation of these mechanisms described in zebrafish across vertebrates remains an open question. During this thesis, I tried to understand the evolution of these mechanisms by studying a Chondrichthyes, the catshark Scyliorhinus canicula and cyclostomes, the lampreys Petromyzon marinus and Lampetra planeri. Their phylogenetic position and the major asymmetries in size observed between their left and right habenulae make these species good model systems to understand the origin of these mechanisms in vertebrates. My work leads to three main conclusions:(1) As in zebrafish, we have found an asymmetric expression of the components of the Nodal signalling pathway in the left dorsal diencephalon of the catshark and the lamprey. The laterality of the asymmetry is conserved between these three species, which allows us to exclude a reversed laterality in lampreys like it was proposed on the basis of arguments related to the size of habenular nuclei.(2) The Nodal signalling pathway is requied for the establishment of habenular asymmetries in the catshark and lamprey thus suggesting an ancestral role in the development of epithalamic asymmetries.(3) A detailed analysis of proliferation-differentiation patterns in the catshark habenulae during their development highlighted multiple cellular and molecular asymmetries. In particular it showed the existence of an earlier left-sided asymmetric neurogenesis.These studies provide new insights about the origin and diversification of the mechanisms controlling the establishment of vertebrates’ brain asymmetries. The study of the lamprey and the dogfish, two unconventional model systems open new perspectives for their understanding.

This essays purpose is to study whether the political ideologies shift depending on the political level. For this purpose two political parties in Swedish parliament have been qualitative studied in a comparative analysis through the terms of social vision, outlook on mankind and economic organization.This study took its form when the authors found a study of Karlsson och Gilljam (2014), whom did a comparative quantitative study of the parties in parliament, asking the individual politicians in parliament, regions and in municipalities to take a stand on the left- and right scale by answering questions about economic organization, social vision and etc. This study gave a result that showed that the politicians of the municipalities had a more radical ideological view than their colleges in parliament. The hypothesis of this study started in the discussion whether politics in smaller scales, local governments and municipalities results in a shifting in ideology from the national manifest, due to the demands of cooperation with political parties with the opposite ideology in coalitions which is most common in Swedish municipalities in modern politics. This study hopes to add to the results from previous studies by comparing the written politics of the parties.This following study is analyzing the political party manifest from both local government and the national party programme/manifest from two political ideologies perspective, liberalism and socialism in a qualitive method. The two parties chosen for this study are both parties of parliament in Sweden since the election year of 2014 and can be found on different sides of the left- and right scale of political ideologies.The results of this essay show that there was no obvious ideological shift between the national and the local government level, though influences of the ideologies were found in both national and local level. This cannot give the conclusion that the ideological shift does not exist, but it may not show in this study. The ideological shift may occur in the daily politics but not in the political ideas written in the manifest.

M.A. (Psychology) / Spatial ability as a cognitive ability has for some time been recognised as a distinct component in the intellectual make-up of the individual. Since the earliest identification of spatial ability in the 1920's, interest has been shown in the fuller understanding of this ability. Many controversies still exist since spatial ability has yet to be defined in a definitive manner. Spatial ability has received relatively little attention. Since a relationship between spatial ability and occupational success has been established, more interest has been shown in this field. Spatial ability is as important as language for survival in the business world and more so in the technical field. Spatial ability is synonymous with the socalled "minor" hemisphere. The importance of the "minor" hemisphere and in particular the link between the right hemisphere and the language centres of the left hemisphere, has recently been. recognised. This recognition is found where the right hemisphere together with the damaged left hemisphere may be included in a rehabilitation programme. Spatial ability is the product of environmental influences which include child rearing practices, education and nutrition. Other influences are of a genetic, hormonal and neurological nature. Associated the concept terms, the associated with of left with the cognitive functions of the brain, is lateralisation of functions.

Heart failure (HF) is a widely prevalent state in developing countries, especially among people over 65, with percentages up to 10% of the population in the US. In all developed countries the expenditure related to congestive heart failure consists of a high percentage of the total health care expenditure, reaching 60% in the UK (1991 1). One of the main strategies for dealing with HF is the use of cardiac assist devices. Among these the most widely used device is the Intra-Aortic balloon pump (IABP). The IABP has as the main aims to increase coronary flow during inflation, and decrease end diastolic pressure and ventricular afterload during deflation. The device was introduced for the first time into clinical practice over 40 years ago, but open issues still remain with the performance of the device. In fact, both inflation and deflation effectiveness are compromised when the balloon operates at an angle to the horizontal, which is often the operating position of the device in intensive care units. The main aim of the work described in this thesis is to investigate the IABP in order to improve the efficacy of this therapy, in terms of IAB design and IABP timing effectiveness. For this purpose the balloon was first filmed in an experimental set-up to visualize its wall-motion with a high speed camera. The results of this investigation were the input for the development of different designs of balloon, tested at horizontal and angled positions. Both, inflation and deflation effectiveness were augmented using different shaped balloons in an experimental set-up characterized by static pressure as well as in one characterized by physiological pressure waveform. The improved performance was associated to an improved clinical outcome on a PV diagram. In addition different pumps and pump settings were studied in an experimental set-up, characterized by physiological aortic pressure waveform, in order to estimate the influence of different pump manufacturers and triggers on the performance of the device. In this case one of the pumps (Teleflex), with the new technology for pressure measurement via a fibre optic sensor, showed to best trigger the IAB after inflation onset, while the highest number of assisted beats was obtained when this pump was set on electrocardiogram (ECG) triggering. Nonetheless a first development of multi-dimensional computational model of the IAB counterpulsation was realized with the aim of establishing the effect of this therapy on relevant areas, such as aortic root, and in order to have an insight on the 3-D flow field in the surrounding of IAB: these information can be crucial for the optimisation of the balloon’s shape. In conclusion, the key finding was that a change in balloon shape influences both, inflation and deflation mechanics at horizontal and semi-recumbent positions, and this strategy can be used for maximising the IABP clinical benefits. With the aid of the computational model it will be possible to further develop the already tested balloon different shapes. Not less important, IABP therapy was demonstrated to be crucially influenced by the pump setting and mode (triggering inflation and deflation onsets), hence the clinical operator is addressed to change the pump mode of operation according to the patient’s condition to maximise the potential benefit of this therapy.

Introduction: Atherosclerosis remains asymptomatic until it progresses to cause flow-limiting disease. Identifying patients at high risk in the early stages of the atherosclerotic process may allow modification of cardiovascular risk by effective preventive strategies. Various non-invasive tests have been studied and have shown promising results in predicting future adverse cardiovascular events. The objective of this study was to establish the carotid ultrasonographic markers that best correlate with angiographic coronary artery disease (CAD) and the relationship between left ventricular geometry, carotid atherosclerosis, biomarkers and CAD in patients with unobstructed coronary arteries, chronic stable angina (CSA) and acute coronary syndromes (ACS). Methods: Carotid ultrasound examination, echocardiography and serum biomarker estimation were performed in consecutive patients who underwent coronary angiography for evaluation of stable or acute chest pain. Results: A total of 146 subjects were recruited into the study with a mean age of 56.9 ± 10.6 (range 29 to 85) years; 120 were men (82%) and 26 (18%) women. Twenty-one percent of the study population had unobstruced coronaries, 42% had stable CAD and 37% had presented with ACS. There was no significant difference in the carotid intima media thickness (CIMT) measurements between the three groups. CIMT correlated with abnormal left ventricular geometry but not with the presence or severity of CAD. The presence of carotid plaque and plaque score correlated with obstructive CAD, but was not significantly different between stable CAD and ACS patients. There was a trend towards more echogenic plaque in the stable CAD group. The composite score of IMT and plaque was positively correlated with the presence and severity of CAD. The averaged myocardial peak systolic and early diastolic velocities were significantly lower in those with obstructive CAD. CRP and osteopontin levels were higher in the ACS patients. Conclusions: Carotid plaque and not CIMT was associated with angiographic coronary artery disease. Averaged systolic and early diastolic myocardial velocities by tissue doppler imaging correlated with obstructive CAD. Novel serum biomarkers are promising and further studies are needed.

Introduction : Le diagnostic de cardiomyopathie hypertrophique (CMH) est difficile chez l’athlète. En effet, le remodelage physiologique induit par l’entraînement physique intense entraîne des modifications électriques et morphologiques qui peuvent mimer une cardiomyopathie. Or il est indispensable de poser le diagnostic de cardiomyopathie avec certitude chez un athlète. Ne pas contre-indiquer un athlète avec une cardiomyopathie l’expose à un risque de mort subite, mais poser un diagnostic par excès l’expose à de lourdes répercussions tant professionnelles que sociales. Méthodes : (1) Nous avons cherché à améliorer les critères ECG actuels de détection de cardiomyopathie chez l’athlète à partir d’une cohorte multicentrique d’athlètes et de CMH. (2) Nous avons cherché à déterminer quel bilan complémentaire réaliser en cas d’anomalie ECG par un suivi longitudinal d’athlètes avec ondes T négatives. (3) Nous avons essayé de mieux caractériser le phénotype des athlètes atteints de CMH par rapport aux CMH sédentaires dans une cohorte multicentrique. (4) Nous avons tenté de déterminer si l’utilisation des nouvelles techniques d’imagerie de déformation myocardique permettait d’améliorer la pertinence diagnostique et pronostique en cas de CMH dans une cohorte de CMH et d’athlètes rennais. Résultats : Nous avons proposé une nouvelle classification ECG permettant de mieux identifier les athlètes avec modifications ECG non pathologiques sans diminuer pour autant la capacité à détecter les CMH. En cas d’ondes T négatives chez l’athlète, nous avons démontré qu’il était indispensable de réaliser une IRM myocardique. En effet l’échocardiographie peut être prise en défaut dans près de 35% des cas. Néanmoins, les critères diagnostiques actuels de CMH peuvent être pris en défaut; en effet les athlètes avec une CMH ont un phénotype différent des CMH sédentaires avec une meilleure fonction systolique, notamment longitudinale, et diastolique. L’évaluation de la fonction longitudinale à l’effort et l’évaluation de la dispersion mécanique sont des paramètres qui semblent prometteurs en terme de diagnostic. En effet l’altération la fonction longitudinale semble être en lien avec la fibrose myocardique. L’échocardiographie d’effort, notamment la présence d’une insuffisance mitrale à l’effort, semble être un facteur pronostic important dans les CMH. Conclusions : les travaux réalisés ont permis de développer des outils pour mieux différencier une hypertrophie ventriculaire gauche (HVG) pathologique d’une HVG physiologique mais également pour mieux caractériser cette HVG et déterminer avec plus de précision le pronostic des CMH . / Introduction: the diagnosis of hypertrophic cardiomyopathy (HCM) in athlete is difficult. Indeed, intense sports practice induces an electrical and morphological physiological remodeling which can be difficult to differentiate from the changes induced in pathology. However, it is essential to diagnose an athlete with a cardiomyopathy. Indeed, in case of underlying cardiomyopathy the athlete will be at risk of sudden cardiac death, but an excessive over diagnosis has strong professional and social consequences. Methods: (1) we have tried to improve the ECG criteria’s, which enable the differentiation between ECG changes induced by exercise and the ECG changes induced by an underlying cardiomyopathy. (2) We tried to define the best investigation algorithm in case of abnormal ECG changes in athletes. (3) We tried to improve the characterization of the phenotype of athletes with HCM as compared to sedentary HCM. (4) We tried to investigate if the use of new imaging technics, i.e. speckle tracking, might improve the diagnostic accuracy and enable a better prognostic evaluation in HCM. Results: We have proposed a new classification of ECG in athletes enabling to decrease the rate of false positive ECG in athletes without decreasing its diagnostic accuracy in HCM. In case of pathological T wave inversion (PTWI) in athletes, we demonstrated that a CMR is mandatory, as echocardiography missed a diagnosis of pathology in 35% of PTWI athletes. Nevertheless, the diagnosis of HCM with current criteria’s of HCM can be challenging. Indeed, HCM athletes have a different phenotype from HCM sedentary, with a better systolic and diastolic function; they also have a better longitudinal function. The assessment of longitudinal function during exercise and mechanical dispersion are promising tool for the diagnosis of HCM in athletes. Indeed, the alteration of longitudinal strain is related to myocardial fibrosis. Exercise echocardiography, i.e. exercise mitral insufficiency, seems to be a prognostic factor in HCM patients. Conclusions: Ours results enabled to develop tools which might help to better differentiate pathological and physiological left ventricular hypertrophy (LVH); but also to better characterize LVH and the prognosis in HCM patients.