: Gender differences in STEMI

International audienceBACKGROUND: Gender differences in presentation, management and outcome in patients with ST-segment elevation myocardial infarction (STEMI) have been reported. AIM: To determine whether female gender is associated with higher inhospital mortality. METHODS: Data from ORBI, a regional STEMI registry of 5 years' standing, were analysed. The main data on presentation, management, inhospital outcome and prescription at discharge were compared between genders. Various adjusted hazard ratios were then calculated for inhospital mortality (women versus men). RESULTS: The analysis included 5000 patients (mean age 62.6±13 years), with 1174 women (23.5%). Women were on average 8 years older than men, with more frequent co-morbidities. Median ischaemia time was 215 minutes (26 minutes longer in women; P<0.05). Reperfusion strategies in women less frequently involved fibrinolysis, coronary angiography, radial access and thrombo-aspiration. Female gender, especially in patients aged<60 years, was associated with poorer inhospital prognosis (including higher inhospital mortality: 9% vs. 4% in men; P<0.0001), and underutilization of recommended treatments at discharge. Moreover, excess female inhospital mortality was independent of presentation, revascularization time and reperfusion strategy (hazard ratio for women 1.33, 95% confidence interval 1.01-1.76; P=0.04). CONCLUSIONS: One in four patients admitted for STEMI was female, with significant differences in presentation. Female gender was associated with less-optimal treatment, both in the acute-phase and at discharge. Efforts should be made to reduce these differences, especially as female gender was independently associated with an elevated risk of inhospital mortality

Nectar foragers contribute to the pollination of buzz-pollinated plant species

PREMISE OF THE STUDY: Pollination performance may depend on the type of fl oral resource (pollen or nectar) foraged by visitors. In buzz-pollinated plant species, the poricidal anthers release pollen during active pollen collection that induces fl ower vibrations. These buzz-pollinated species generally do not produce nectar. Nevertheless, several Ericaceae are buzz-pollinated and produce nectar. We estimated the relative eff ectiveness of visitors according to the type of resource collected, nectar or pollen (buzzing). M ETHODS: We compared the relative performance of pollen removal, transport, and deposition (eff ectiveness) of the main insect visitors on four ericaceous species: three buzz-pollinated species with diff erent pore sizes, Erica tetralix , Vaccinium myrtillus , and V. vitis-idaea ; and one non-buzz-pollinated species, Calluna vulgaris . KEY RESULTS: Bumblebees were the main pollinators for the three buzz-pollinated species, whereas hoverfl ies were the main pollinators for the nonbuzz- pollinated generalist C. vulgaris . For the studied plant species, we observed no diff erence in pollination eff ectiveness among bumblebee species. Buzzing bumblebees were the most eff ective visitors for pollination per fl ower visit for the two Vaccinium species, whereas nectar foragers were the most eff ective visitors for pollination of E. tetralix . In the case of Vaccinium myrtillus , nectar foragers contributed the most to pollination success because they were more abundant than pollen foragers. C ONCLUSIONS: We showed that consideration of the resource collected by visitors and their behavior is necessary to compare their relative performance. The combination of visitation rate and eff ectiveness per visit reveals that nectar foragers make a substantial contribution to pollination of the buzz-pollinated ericaceous species

Degradación de plaguicidas en dispositivos amortiguadores: barreras de hierba y zonas arboladas: caso del isoproturon

La instalación de zonas amortiguadoras es una de las soluciones propuestas para combatir la contaminación de aguas superficiales por plaguicidas. Estas zonas son eficaces para detener los plaguicidas transportados en las escorrentías pero no hay mucha información sobre el devenir de las moléculas interceptadas. En este trabajo se evaluó la degradación de un herbicida, el isoproturon (IPU) [3-(4-isopropilfenil)-1, 1-dimetilurea], en suelos provenientes de barreras de hierba, zonas arboladas y parcelas de cultivo del sitio experimental de ARVALIS en la Jaillière, Francia. Los experimentos de degradación se realizaron en laboratorio utilizando el isoproturon marcado con 14C en el anillo bencénico. La mineralización del IPU fue especialmente importante en los horizontes superficiales de los suelos de las barreras de hierba y la zona arbolada. La formación de residuos no extraíbles es decir, poco disponibles, fue particularmente importante en los horizontes donde la degradación es más activa. Así, la estabilización de los residuos de isoproturon es máxima en los horizontes superficiales de los dispositivos amortiguadores. La disipación rápida del IPU en los suelos de las zonas amortiguadoras indica una función de descontaminación interesante en comparación con un suelo agrícola, ya que la degradación y la mineralización del IPU aumentan. Sin embargo, el débil potencial de degradación de los horizontes 30-60 cm indica que la eficacia de estos sistemas vía procesos de degradación y estabilización de los productos interesados, es mucho mas importante en los horizontes superficiales de suelo

Pesticide sorption and desorption from soils having different land use

This study was carried out within the framework of a multidisciplinary project for evaluating buffer zones for combating pesticide contamination of surface water. Such areas are effective in removing pesticides transported by run-off; however, little information is available about the fate of the pesticides so intercepted. Two herbicides having contrasting properties (isoproturon, moderately hydrophobic (log Kow = 2.5), diflufenican, strongly hydrophobic (log K ow = 4.9)) and isopropylaniline (an isoproturon metabolite) were used for characterising sorption and desorption from soil having three different land uses: grass buffer strip, woodland and cultivated plot. The experiments were carried out in controlled laboratory conditions using isoproturon labelled with 14C in the benzene ring. The results demonstrated that diflufenican and isopropilaniline retention was more significant than isoproturon in three soils. The three molecules’ Kd values revealed that isoproturon and diflufenicanil retention was more important in woodland soil where carbon content was more significant (ZB 0-2: Kd IPU = 15.1 Ls kg-1; Kd DFF = 169.2 Ls kg-1). Isopropilanilina Kd was higher in grass buffer strip soil (BE 0-2: Kd IPA = 53.1 L kg-1). These differences were related to different organic matter content and nature according to the type of land use

Caracterización de la sorción y desorción de herbicidas en suelos con diferentes tipos de ocupación

Este trabajo se realizó dentro del marco de un proyecto multidisciplinario sobre la evaluación de la utilización de zonas amorti-guadoras como uno de los mecanismos para combatir la contaminación de aguas superficiales por plaguicidas. Estas zonas son eficaces para detener los plaguicidas transportados en las escorrentías, pero no existe mucha información sobre el futuro de las moléculas interceptadas. En el trabajo se evaluó la sorción y la desorción de dos herbicidas con propiedades muy diferentes: el isoproturon, moderadamente hidrófobo (log Kow = 2,5), la diflufenicanil, fuertemente hidrófobo (log Kow = 4,9), y la isopropila-nilina, un metabolito de la isoproturon, en suelos con diferentes tipos de ocupación, barreras de hierba, zonas arboladas y par-celas de cultivo. Los experimentos se realizaron en laboratorio utilizando las moléculas marcadas con 14C. Los resultados mues-tran que la diflufenicanil y la isopropilanilina son más retenidos que el isoproturon en los tres suelos. Los valores de Kd de las tres moléculas revelan que la sorción del isoproturon y la diflufenicanil es más fuerte en el horizonte superficial de la zona arbolada, donde el contenido de carbono es más importante (ZB 0-2: Kd IPU = 15,1 L kg-1; Kd DFF = 169,2 L kg-1). En el caso del isopro-pilanilina, el Kd más elevado es determinado en el horizonte superficial de la barrera de hierba (BE 0-2: Kd IPA = 53.1 L kg-1). Estos resultados están relacionados con el diferente contenido y naturaleza de materia orgánica de acuerdo con el tipo de ocu-pación del suelo.This study was carried out within the framework of a multidisciplinary project for evaluating buffer zones for combating pesticide contamination of surface water. Such areas are effective in removing pesticides transported by run-off; however, little information is available about the fate of the pesticides so intercepted. Two herbicides having contrasting properties (isoproturon, moderately hydrophobic (log Kow = 2.5), diflufenican, strongly hydrophobic (log K ow = 4.9)) and isopropylaniline (an isoproturon metabolite) were used for characterising sorption and desorption from soil having three different land uses: grass buffer strip, woodland and cultivated plot. The experiments were carried out in controlled laboratory conditions using isoproturon labelled with 14C in the benzene ring. The results demonstrated that diflufenican and isopropilaniline retention was more significant than isoproturon in three soils. The three molecules’ Kd values revealed that isoproturon and diflufenicanil retention was more important in woodland soil where carbon content was more significant (ZB 0-2: Kd IPU = 15.1 Ls kg-1; Kd DFF = 169.2 Ls kg-1). Isopropilanilina Kd was higher in grass buffer strip soil (BE 0-2: Kd IPA = 53.1 L kg-1). These differences were related to different organic matter content and nature according to the type of land use

008: Management of ST-elevation myocardial infarction in octogenarian patients. Data from ORBI, a prospective registry of 5000 patients

PurposeTo determine the actual management of ST-elevation myocardial infarction (STEMI) in octogenarian patients and more.MethodsWe analyzed data collected in “ORBI”, a 6 years prospective registry of STEMI patients admitted within 24h of symptoms onset to an interventional cardiology centre of Brittany (France). Main data about management and intra hospital outcome were compared between patients older (Group 1) and younger (Group 2) than 80.Results550 of the 5000 patients (11%, mean age 84.6 ±3) constituted group 1, with a larger female prevalence (51 vs 20% in group 2, p<0.0001). Group 1 had a much longer median delay between onset of symptom and call for medical assistance (65 vs 45min.), and between admission and reperfusion (53 vs 45min.). Table 1 presents data about the management in the 2 groups, both in the acute phase and at discharge. Last, intra hospital mortality is much higher in group 1 (16.5 vs 4.1%, p<0.0001).ConclusionsOctogenarian patients and more represent a large part of patient treated for STEMI, with significant differences in their presentation and management, and a high mortality.Table 1 – *Percentages are calculated only in patients undergoing coronary angiography.Group 1 >80years old n=550Group 2 ≤ 80 years old _=4450Initial managementFibrinolysis38 (7%)723 (16%)<0.0001GP IIb/IIIa receptor inhibitors223 (40%)2674 (60%)<0.0001Coronary angiography493 (89%)4402 (99%)<0.0001Radial access*140 (28%)1511 (34%)<0.0001Primary angioplasty*386 (78%)3197 (72%)0.4Thrombo aspiration*163 (33%)1874 (42%)<0.0001Intra hospital outcomeHigh degree AV block40 (7%)140 (3%)<0.0001Atrial fibrillation59 (10%)161 (3.6%)<0.0001Left ventricular ejection fraction (%)47.2±1250.6±10<0.0001Total length of stay (days)8.2±56.8±4<0.0001Prescription at dischargeAspirine439 (95,6%)4167 (97,7%)0,007Clopidogrel/Prasugrel413 (90,0%)4086 (95,8%)<0,0001β blockers394 (85,8%)3895 (91,3%)<0,0001ACE inhibitor290 (63,2%)2853 (66,9%)0,1Statine373 (81,3%)4057 (95,1%)<0,0001Cardiovascular rehabilitation22 (5,3%)1822 (46,6%)<0,000

Door-to-balloon delays before primary angioplasty in the Regional Acute Myocardial Infarction Registry of Brittany. An analysis of the Observatoire Régional Breton sur l'Infarctus du myocarde (ORBI).

International audienceBACKGROUND: Minimizing delays to coronary reperfusion is critical in the management of acute myocardial infarction (AMI). AIMS: To determine delays in in-hospital management and factors associated with delays of over 45min. METHODS: We analysed data from the Observatoire Régional Breton sur l'Infarctus, a registry of AMI patients admitted within 24h of symptom onset (July 2007 to December 2008) to an interventional cardiology centre in Brittany. Prehospital delay was defined as time between first responder arrival at the patient and patient arrival at an interventional cardiovascular centre. In-hospital delay was defined as time between admission to the interventional cardiovascular centre and first balloon inflation. Patients were grouped according to duration of in-hospital delay (>45 v

Safety of prasugrel in real-world patients with ST-segment elevation myocardial infarction: 1-year results from a prospective observational study (Bleeding and Myocardial Infarction Study).

International audienceBackground - Antiplatelet therapies, including prasugrel, are a cornerstone in the treatment of ST-segment elevation myocardial infarction (STEMI), but are associated with a bleeding risk. This risk has been evaluated in randomized trials, but few data on real-world patients are available. Aim - To evaluate prasugrel safety in real-world patients with STEMI. Methods - Consecutive patients with STEMI were recruited over 1 year. Follow-up was done at 3 months and 1 year to evaluate prasugrel safety from hospital discharge to the STEMI anniversary date. The primary outcome was occurrence of any major bleeding according to the Bleeding Academic Research Consortium (BARC) 3 or 5 definitions, or minor bleeding according to the BARC 2 definition. Results - Overall, 1083 patients were recruited. Compared to patients treated with aspirin+clopidogrel, patients treated with aspirin+prasugrel had fewer BARC 3 or 5 bleedings (two [0.4%] patients vs. nine [1.8%] patients; P=0.04), but more BARC 2 bleedings (45 [9.3%] patients vs. 20 [4.0%] patients; P<0.001). The baseline characteristics of prasugrel- and clopidogrel-treated patients differed because the former were carefully selected (younger, higher body mass index, less frequent history of stroke). In the overall population, rates of in-hospital and out-of-hospital major bleeding were 2.6% (n=28) and 1.3% (n=13), respectively. Conclusion - The rate of major bleeding, particularly out-of-hospital bleeding, in patients treated with prasugrel is low within 1 year after a STEMI. Accurate selection of patient candidates for prasugrel is likely to have reduced the risk of bleeding

Comparison of hydrosedimentary signatures of catchments from the French Critical Zone network

International audienceSoil erosion and sediment transport understanding has important implications for the management of soil and water resources in the critical zone. Water erosion is considered the main threat to soils, causing irreversible losses. The transfer of suspended sediments (SS) downstream poses problems of degradation of the quality of rivers by clogging the bottom and is also a privileged vector for the transport of nutrients, contaminants or pathogens. Particulate transfers arealso very sensitive to changes in land use and in the occurrence and severity of rainfall.Most studies that have sought to synthesise measurements made in different contexts focused on the spatial variability of erosion rates on hillslopes (Cerdan et al., 2010) or on the comparison of integrative variables such as sediment fluxes in different hydrosystems (Milliman and Syvitski, 1992; De Vente et al. 2011; Vanmaercke et al., 2011). However, very few studies have been interested in comparing the relationships between the variables that allow to establish the fluxes (i.e. iquid discharge, turbidity, SS concentrations) whereas their analysis can shed light on hydrosedimentary processes, particularly by exploring their temporal variability (Vercruysse et al., 2017). Within the OZCAR and RZA French networks, many observatories carry out measurements of discharges, turbidities and/or point measurements of SS concentrations at catchment outlets. These datasets are used to address the following questions: i) Are there similar temporal hydrosedimentary signatures at some sites, ii) Is it possible to identify control factors responsible for these signatures? Results show a large diversity of the temporal hydrosedimentary behaviours of the 22 studied catchments as illustrated by some striking features. Indeed, 90% of the SS are transported during less than 0.1% of the time for some sites and during 40% for others. Half of the SS are transported at SS concentrations exceeding 34 g/l for some sites and less than 0.1 g/l for others.First attempts have shown that some of these indicators of temporal variability of SS fluxes can be predicted by site (e.g. area, slope, pedo-geo-morphology, soil use, meteorological forcing) or hydrological characteristics