Rivaroxabananddabigatraninpatientsundergoing catheter ablation of atrial fibrillation

Aims: The recent availability of the novel oral anticoagulants (NOACs) may have led to a change in the anticoagulation regimens of patients referred to catheter ablation of atrial fibrillation (AF). Preliminary data exist concerning dabigatran, but information regarding the safety and efficacy of rivaroxaban in this setting is currently scarce. Methods: and results Of the 556 consecutive eligible patients (age 61.0 ± 9.6; 74.6% men; 61.2% paroxysmal AF) undergoing AF catheter ablation in our centre (October 2012 to September 2013) and enroled in a systematic standardized 30-day follow-up period: 192 patients were under vitamin K antagonists (VKAs), 188 under rivaroxaban, and 176 under dabigatran. Peri-procedural mortality and significant systemic or pulmonary thromboembolism (efficacy outcome), as well as bleeding events (safety outcome) during the 30 days following the ablation were evaluated according to anticoagulation regimen. During a 12-month time interval, the use of the NOACs in this population rose from <10 to 70%. Overall, the rate of events was low with no significant differences regarding: thrombo-embolic events in 1.3% (VKA 2.1%; rivaroxaban 1.1%; dabigatran 0.6%; P = 0.410); major bleeding in 2.3% (VKA 4.2%; rivaroxaban 1.6%; dabigatran 1.1%; P = 0.112), and minor bleeding 1.4% (VKA 2.1%; rivaroxaban 1.6%; dabigatran 0.6%; P = 0.464). No fatal events were observed. Conclusion: The use of the NOAC in patients undergoing catheter ablation of AF has rapidly evolved (seven-fold) over 1 year. These preliminary data suggest that rivaroxaban and dabigatran in the setting of catheter ablation of AF are efficient and safe, compared with the traditional VKA

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Micro-ondes: cours et exercices

Ce volume comprend deux parties : la première concerne les lignes qui sont utilisées pour la transmission et les circuits micro-ondes; la seconde concerne les guides d'ondes et les cavités

Contribution à la modélisation des couplages antenne/structure par technique multidomaine

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Utilisation du lancer de rayons pour le calcul de l'interaction d'un rayonnement électromagnétique avec des objets complexes métalliques et diélectriques

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Modélisation par la méthode des faisceaux gaussiens vectoriels et multimodes de l'interaction d'une onde électromagnétique avec un diélectrique épais ou un réflecteur métallique/

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Modélisation électromagnétique des radômes par des techniques basées sur les faisceaux gaussiens

In many configurations, an antenna has to be protected from the outer environment by a radome. In this thesis, we propose to use gaussian beam based techniques to take into account the radome effect on the antenna radiation. These beams are approximate analytical solutions of the propagation equation. They depend on the paraxial approximation (low diverging field assumption).We first develop a new approach to expand an electromagnetic field on a set of elementary beams, overcoming some limitations of the two existing expansions (Multimodal and Gabor). Then, we study the interaction between an incident field and a multilayer dielectric object. So, we develop a shooting and bouncing gaussian beam algorithm which assumes that one incident gaussian beam crossing a dielectric interface gives one reflected and one transmitted gaussian beams. Another original technique is proposed using gaussian beam transmission and reflection coefficients. They provide analytical expressions for the transmitted and reflected fields on a dielectric interface (or on a thin dielectric multilayer) illuminated by a gaussian beam. These two techniques are compared with a conventional plane wave approach on several test cases. The results show their rapidity and accuracy. In order to deal with the problem of aircraft or missiles front-end sharp radomes, we finally explore novel expansions requiring a new kind of beams, called conformal gaussian beams . Some comparisons with simulations performed with an existing industrial software show their efficiency.TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Etude des diffusions de surface et de volume par une surface rugueuse diélectrique (calcul des interactions entre un objet 3D et une surface naturelle)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Diffusion par une cible complexe d'une onde électromagnétique se propageant en milieu hétérogène au-dessus d'une surface irrégulière

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF