Radio-frequency ablation as primary management of well-tolerated sustained monomorphic ventricular tachycardia in patients with structural heart disease and left ventricular ejection fraction over 30%

Aims Patients with well-tolerated sustained monomorphic ventricular tachycardia (SMVT) and left ventricular ejection fraction (LVEF) over 30% may benefit from a primary strategy of VT ablation without immediate need for a ‘back-up' implantable cardioverter-defibrillator (ICD). Methods and results One hundred and sixty-six patients with structural heart disease (SHD), LVEF over 30%, and well-tolerated SMVT (no syncope) underwent primary radiofrequency ablation without ICD implantation at eight European centres. There were 139 men (84%) with mean age 62 ± 15 years and mean LVEF of 50 ± 10%. Fifty-five percent had ischaemic heart disease, 19% non-ischaemic cardiomyopathy, and 12% arrhythmogenic right ventricular cardiomyopathy. Three hundred seventy-eight similar patients were implanted with an ICD during the same period and serve as a control group. All-cause mortality was 12% (20 patients) over a mean follow-up of 32 ± 27 months. Eight patients (40%) died from non-cardiovascular causes, 8 (40%) died from non-arrhythmic cardiovascular causes, and 4 (20%) died suddenly (SD) (2.4% of the population). All-cause mortality in the control group was 12%. Twenty-seven patients (16%) had a non-fatal recurrence at a median time of 5 months, while 20 patients (12%) required an ICD, of whom 4 died (20%). Conclusion Patients with well-tolerated SMVT, SHD, and LVEF > 30% undergoing primary VT ablation without a back-up ICD had a very low rate of arrhythmic death and recurrences were generally non-fatal. These data would support a randomized clinical trial comparing this approach with others incorporating implantation of an ICD as a primary strateg

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

Recent results from the electron cyclotron heated plasmas in Tokamak à Configuration Variable (TCV)

In noninductively driven discharges, 0.9 MW second harmonic (X2) off-axis co-electron cyclotron current drive deposition is combined with 0.45 MW X2 central heating to create an electron internal transport barrier (eITB) in steady plasma conditions resulting in a 1.6-fold increase of the confinement time (tau(Ee)) over ITER-98L-mode scaling. The eITB is associated with a reversed shear current profile enhanced by a large bootstrap current fraction (up to 80%) and is sustained for up to 10 current redistribution times. A linear dependence of the confinement improvement on the product of the global shear reversal factor (q(0)/q(min)) and the reversed shear volume (rho(q-min)(2)) is shown. In other discharges heated with X2 the sawteeth are destabilized (respectively stabilized) when heating just inside (respectively outside) the q=1 surface. Control of the sawteeth may allow the avoidance of neoclassical tearing modes that can be seeded by the sawtooth instability. Results on H-mode and highly elongated plasmas using the newly completed third harmonic (X3) system and achieving up to 100% absorption are also discussed, along with comparison of experimental results with the TORAY-GA ray tracing code [K. Matsuda, IEEE Trans. Plasma Sci. PS-17, 6 (1989); R. H. Cohen, Phys. Fluids 30, 2442 (1987)]. (C) 2003 American Institute of Physics

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

RÉGULATION OSMOTIQUE ET IONIQUE CHEZ LES CRUSTACÉS

International audienc

RÉGULATION OSMOTIQUE ET IONIQUE CHEZ LES CRUSTACÉS

International audienc

Observations sur les Viscum album et laxum

Boullu Antoine Etienne, Magnin Antoine, Butillon . Observations sur les Viscum album et laxum. In: Annales de la Société botanique de Lyon, tome 6, Compte-rendu des séances – 1877-1878. 1879. p. 150

A Generic Timing Software for Fast Pulsed Magnet Systems at CERN

At CERN, fast pulsed magnet (kicker) systems are used to inject, extract, dump and excite beams. Depending on their operational functionalities and as a result of the evolution of controls solutions over time, the timing controls of these systems were based on hybrid hardware architectures that have resulted in a large disparity of software solutions. In order to cure this situation, a Kicker Timing Software (KiTS), based on a modular hardware and software architecture, has been developed with the objective to increase the homogeneity of fast and slow timings control for all types of fast pulsed magnet systems. The KiTS uses a hardware abstraction layer and a configurable software model implemented within the Front-End Software Architecture (FESA) framework. It has been successfully deployed in the control systems of the different types of kicker systems at CERN like for the PS continuous transfer, the SPS injection and extraction, the SPS tune measurement and the LHC injection

Observations sur le fait précédent

Viviand-Morel Joseph-Victor, Boullu Antoine Etienne, Magnin Antoine. Observations sur le fait précédent. In: Bulletin mensuel - Société botanique de Lyon, tome 1, bulletin 9, 1883. p. 116