The previous part discusses the GI/BSI/DFKI Protection Profile which constitutes after the implementation of the identified improvements as the proposed evaluation methodology for remote electronic voting systems. The result can now be applied to available systems. Currently, there is no system that has been evaluated against the GI/BSI/DFKI Protection Profile or even against the improved version.

Proof of Concept

Orphanet

It is not clear whether intrapartum asphyxia is an important factor in neonatal encephalopathy and seizures in term infants. Antenatal factors have been implicated, but there is no firm evidence that brain damage occurs in utero. This study examined the proposal that neonatal encephalopathy and early postnatal seizures, or both, are sequelae of early adverse antenatal events. Cerebral magnetic resonance imaging (MRI) or autopsy was carried out in 351 full-term infants having encephalopathy and/or seizures within 72 hours of birth. Infants with major congenital malformations or known chromosomal disorders were excluded. The 261 infants placed in group 1 had a diagnosis of neonatal encephalopathy, with or without seizures, as well as evidence of perinatal asphyxia. The 90 group 2 infants presented with seizures but failed to meet diagnostic criteria for encephalopathy. Cerebral MRI disclosed evidence of acutely evolving lesions not related to established injury or atrophy in 80% of group 1 infants. These lesions, which usually were bilateral, were consistent with a hypoxic-ischemic insult. In addition to white matter, abnormalities were found in the basal ganglia, thalamus, or cortex. Only 2 group 1 infants, fewer than 1% of the total, had evidence of established injury. Three of 21 autopsies showed, in addition to an acutely evolving lesion, very small foci of established gliosis in the periventricular white matter. Acute ischemic or hemorrhagic lesions were found in 69% of group 2 infants. Two infants (3%) had, in addition, changes of antenatal injury. Thirteen of the 28 remaining group 2 infants had MRI findings of a specific nonhyoxic-ischemic condition. The other 15 infants had normal scans. Seven of 10 infants with no specific diagnosis continued to have seizures. Antenatal risk factors that were significantly more frequent in infants having apparent antenatal lesion or disorders of genetic or neurometabolic origin included a family history of seizures or neurologic disorder, low birth weight, head circumference below the 10th percentile, and low maternal age. In this study, more than 90% of term infants with neonatal encephalopathy and/or early seizures had evidence of a perinatally acquired insult. Established brain injuries acquired before birth were quite infrequent. The findings do not rule out the change that antenatal (or genetic) factors could predispose some infants to perinatal brain injury.

Origin and timing of brain lesions in term infants with neonatal encephalopathy

Relative Risk and Incidence for Developmental Dysplasia of the Hip.

Hypothermia for newborns with hypoxic-ischemic encephalopathy

Objectives
To investigate the contribution of whole-body post-mortem computed tomography (PMCT) in sudden unexpected death in infants and children.

Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children.

Objective A child presenting with a first attack of migraine with aura usually undergoes magnetic resonance imaging (MRI) to rule out stroke. The purpose of this study was to report vascular and brain perfusion findings in children suffering from migraine with aura on time-of-flight MR angiography (TOF-MRA) and MR perfusion imaging using arterial spin labelling (ASL). Methods We retrospectively included all children who had undergone an emergency MRI examination with ASL and TOF-MRA sequences for acute neurological deficit and were given a final diagnosis of migraine with aura. The ASL perfusion maps and TOF-MRA images were independently assessed by reviewers blinded to clinical data. A mean cerebral blood flow (CBF) value was obtained for each cerebral lobe after automatic data post-processing. Results Seventeen children were finally included. Hypoperfusion was identified in one or more cerebral lobes on ASL perfusion maps by visual assessment in 16/17 (94%) children. Vasospasm was noted within the intracranial vasculature on the TOF-MRA images in 12/17 (71%) children. All (100%) of the abnormal TOF-MRA images were associated with homolateral hypoperfusion. Mean CBF values were significantly lower ( P < 0.05) in visually hypoperfused lobes than in normally perfused lobes. Conclusion ASL and TOF-MRA are two totally non-invasive, easy-to-use MRI sequences for children in emergency settings. Hypoperfusion associated with homolateral vasospasm may suggest a diagnosis of migraine with aura.

Magnetic resonance imaging in children presenting migraine with aura: Association of hypoperfusion detected by arterial spin labelling and vasospasm on MR angiography findings.

Arterial spin labeling (ASL) perfusion-weighted magnetic resonance imaging is the only approach that enables direct and non-invasive quantitative measurement of cerebral blood flow in the brain regions without administration of contrast material and without radiation. ASL is thus a promising perfusion imaging method for assessing cerebral blood flow in the pediatric population. Concerning newborns, there are current limitations because of their smaller brain size and lower brain perfusion. This article reviews and illustrates the use of ASL in pediatric clinical practice and discusses emerging cerebral perfusion imaging applications for children due to the highly convenient implementation of the ASL sequence.

Arterial spin labeling in clinical pediatric imaging.

OBJECTIVES: To propose an easy and reproducible sonographic screening test able to avoid late presentation of developmental dysplasia of the hip (DDH). METHODS: The pubo-femoral distance (PFD) cut-off point was determined on 980 infants who underwent ultrasonography of the hips in comparison with the final diagnosis, based on clinical, ultrasound data and follow-up. PFD reproducibility was tested on 52 hips by both an experienced and an inexperienced radiologist. After teaching this screening method to general radiologists, its impact was evaluated by analysing the rate of late diagnosis in an entire administrative area. RESULTS: An abnormal PFD threshold above 6 mm gave a sensitivity of 97.4 % for the diagnosis of DDH (271 hips) and a specificity of 84 %. Sensitivity increased to 100 % when taking into consideration children of 1 month or older. The PFD measurement stayed reproducible even in inexperienced hands (k = 0.795). For 3 years, following the extension of screening to all female infants, there was no late diagnosis of DDH in girls in amongst a catchment area of 1 million inhabitants. CONCLUSIONS: PFD measurement with a threshold for abnormality of 6 mm at the age of 1 month, without asymmetry above 1.5 mm, could eradicate DDH late diagnosis.

Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip.

https://hal-univ-rennes1.archives-ouvertes.fr/hal-01361507/document

Bertrand Bruneau

Papers

Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children.

Magnetic resonance imaging in children presenting migraine with aura: Association of hypoperfusion detected by arterial spin labelling and vasospasm on MR angiography findings.

Arterial spin labeling in clinical pediatric imaging.

Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip.

Early MRI in neonatal hypoxic-ischaemic encephalopathy treated with hypothermia: Prognostic role at 2-year follow-up