The diagnostic yield of transjugular renal biopsy. Experience in 200 cases

Renal histology remains the keystone of diagnosis in most parenchymal renal diseases and especially in glomerulopathies [1–3]. Sampling of renal tissue by percutaneous needle biopsy was described by Iversen and Brun in 1951 [4]. This procedure is usually safe, provided contraindications are respected [5–10]. Such contraindications include uncontrolled hypertension and/or bleeding disorders, which can favor severe perirenal hematoma. Even when these contraindications are heeded, systematic computerized tomography (CT) showed that the incidence of perirenal hematoma discovered by CT scan (irrespective of its clinical manifestation) is 57 to 85% [11, 12].In the absence of contraindications, there are patients in whom the slightest possibility of a complication necessitating lombotomy for hemostasis would be ethically incompatible with renal biopsy. This is the case, for instance, in patients with morbid obesity or with chronic respiratory insufficiency, in whom general anesthesia might represent a considerable hazard. Finally, there are cases where the size or the anatomical location of the kidney makes renal tissue sampling difficult or impossible. Ultrasound or CT scan-guided biopsy [13–15] does not always obviate such pitfalls. Other, more invasive methods have been proposed to sample kidney tissue, for instance by means of a short lombotomy [16–21], but this approach, which in addition necessitates the use of an operating room and several days of hospitalization, is similarly inapplicable in a patient with severe bleeding disorder or morbid obesity.We have described a novel technique of renal biopsy using the transjugular route, inspired from that used for liver biopsy in patients with clotting disorders in whom the percutaneous route would similarly be precluded [22–24]. This new technique was published in abstract form [25], and we reported our preliminary results on 50 cases [26]. The goal of this Technical Note is to analyze our present experience on 200 procedures carried out in 195 patients

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Theia: Faint objects in motion or the new astrometry frontier

In the context of the ESA M5 (medium mission) call we proposed a new satellite mission, Theia, based on relative astrometry and extreme precision to study the motion of very faint objects in the Universe. Theia is primarily designed to study the local dark matter properties, the existence of Earth-like exoplanets in our nearest star systems and the physics of compact objects. Furthermore, about 15 $\%$ of the mission time was dedicated to an open observatory for the wider community to propose complementary science cases. With its unique metrology system and "point and stare" strategy, Theia's precision would have reached the sub micro-arcsecond level. This is about 1000 times better than ESA/Gaia's accuracy for the brightest objects and represents a factor 10-30 improvement for the faintest stars (depending on the exact observational program). In the version submitted to ESA, we proposed an optical (350-1000nm) on-axis TMA telescope. Due to ESA Technology readiness level, the camera's focal plane would have been made of CCD detectors but we anticipated an upgrade with CMOS detectors. Photometric measurements would have been performed during slew time and stabilisation phases needed for reaching the required astrometric precision