33 research outputs found

    Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

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    Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

    Learning by association in plants

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    In complex and ever-changing environments, resources such as food are often scarce and unevenly distributed in space and time. Therefore, utilizing external cues to locate and remember high-quality sources allows more efficient foraging, thus increasing chances for survival. Associations between environmental cues and food are readily formed because of the tangible benefits they confer. While examples of the key role they play in shaping foraging behaviours are widespread in the animal world, the possibility that plants are also able to acquire learned associations to guide their foraging behaviour has never been demonstrated. Here we show that this type of learning occurs in the garden pea, Pisum sativum. By using a Y-maze task, we show that the position of a neutral cue, predicting the location of a light source, affected the direction of plant growth. This learned behaviour prevailed over innate phototropism. Notably, learning was successful only when it occurred during the subjective day, suggesting that behavioural performance is regulated by metabolic demands. Our results show that associative learning is an essential component of plant behaviour. We conclude that associative learning represents a universal adaptive mechanism shared by both animals and plants

    Seam weld shell element model for thin walled structure FE fatigue design

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    In automotive industry, the FE fatigue analysis of mechanical structures made of steel thin walled parts and seam welded assemblies uses a dedicated technique based on shell element modelling for components and on 1D rigid elements for welds. This method has been validated with several intensive fatigue test campaigns using gas metal arc welded samples with different assemblies, for both bending and torsional loads. The fatigue results are relative to crack initiation at the weld toe with bending normal stress or with longitudinal shear stress for several load ratios. The purpose of the current work is the transposition of the initial method to another FE welded model. In a recent IIW guideline for the assessment of weld root fatigue, a shell element weld model has been proposed for seam weld fatigue assessment in case of weld root crack initiation. The idea is to analyse the possible extension of this FEA weld element model for weld toe fatigue analysis and several comparisons of stress results are detailed and discussed. Different fatigue criteria are used to verify the correlation with the fatigue test results. First, the approach is based on maximum shear stress, then structural stress is calculated and results are compared to IIW S/N curves

    Intensity-dependent modulatory effects of vagus nerve stimulation on cortical excitability

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    Objectives: Vagus nerve stimulation (VNS) is an effective treatment for refractory epilepsy. It remains unknown whether VNS efficacy is dependent on output current intensity. The present study investigated the effect of various VNS output current intensities on cortical excitability in the motor cortex stimulation rat model. The hypothesis was that output current intensities in the lower range are sufficient to significantly affect cortical excitability. Material and methods: VNS at four output current intensities (0 mA, 0.25 mA, 0.5 mA and 1 mA) was randomly administered in rats (n = 15) on four consecutive days. Per output current intensity, the animals underwent five-one-hour periods: (i) baseline, (ii) VNS1, (iii) wash-out1, (iv) VNS2 and (v) wash-out2. After each one-hour period, the motor seizure threshold (MST) was measured and compared to baseline (i.e. {increment}MSTbaseline, {increment}MSTVNS1, {increment}MSTwash-out1, {increment}MSTVNS2 and {increment}MSTwash-out2). Finally, the mean {increment}MSTbaseline, mean {increment}MSTwash-out1, mean {increment}MSTwash-out2 and mean {increment}MSTVNS per VNS output current intensity were calculated. Results: No differences were found between the mean {increment}MSTbaseline, mean {increment}MSTwash-out1 and mean {increment}MSTwash-out2 within each VNS output current intensity. The mean {increment}MSTVNS at 0 mA, 0.25 mA, 0.5 mA and 1 mA was 15.3 ± 14.6 μA, 101.8 ± 23.5 μA, 108.1 ± 24.4 μA and 85.7 ± 18.1 μA respectively. The mean {increment}MSTVNS at 0.25 mA, 0.5 mA and 1 mA were significantly larger compared to the mean {increment}MSTVNS at 0 mA (P = 0.002 for 0.25 mA; P = 0.001 for 0.5 mA; P = 0.011 for 1 mA). Conclusions: This study confirms efficacy of VNS in the motor cortex stimulation rat model and indicates that, of the output current intensities tested, 0.25 mA is sufficient to decrease cortical excitability and higher output current intensities may not be required. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

    Les leviers politiques et organisationnels

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    International audienceLes chapitres précédents ont montré qu’il existe aujourd’hui des connaissances et savoir-faire permettant de transformer les systèmes agricoles afin de développer de nouvelles manières de protéger les cultures contre les bioagresseurs. De nouvelles pistes de recherche visant à aller jusqu’au bout du chemin vers une agriculture sans pesticides ont également été identifiées. Mais les solutions techniques seules ne suffisent pas et, pour être adoptées par le plus grand nombre d’agriculteurs, doivent être accompagnées de solutions à la fois politiques et organisationnelles. Les solutions politiques font référence à l’ensemble des moyens dont disposent les pouvoirs publics pour soutenir l’effort de transition. Les solutions organisationnelles, quant à elles, incluent les initiatives privées qui, sans s’opposer aux initiatives publiques, émanent directement des acteurs de la transition implantés dans les territoires
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