Transfemoral versus transcarotid access for transcatheter aortic valve replacement

Objectives: To compare the outcomes after transcatheter aortic valve replacement (TAVR) through a transfemoral (TF) and transcarotid (TC) access at our institution. Methods: From January 2014 to January 2020, 62 TC-TAVR and 449 TF-TAVR were performed using 2 prosthesis devices (Edwards SAPIEN 3, n = 369; Medtronic Evolut R, n = 142). Propensity score matching was used to adjust for imbalance in the baseline characteristics of the study groups. Results: Propensity score matching provided 62 matched pairs with comparable operative risk (mean European System for Cardiac Operative Risk Evaluation II, TC-TAVR 7.6% vs TF-TAVR 6.6%, P = .17). Thirty-day mortality (4.8% vs 3.2%, P = 1.00) and 2-year mortality (11.3% vs 12.9%, P = .64) after TC-TAVR were comparable with TF-TAVR. Strokes were numerically more frequent after TC-TAVR compared with TF-TAVR (3.2% vs 0%, P = .23), but the difference did not reach statistical significance. TF-TAVR was associated with a significantly greater risk of permanent pacemaker implantation (29.0% vs 12.9%, P = .04) compared with TC-TAVR. Other complications were not frequent and were similarly distributed between the matched groups. Conclusions: TC access for TAVR was associated with satisfactory results compared to the femoral access. TC-TAVR could be considered a valid and safe alternative to TF-TAVR when femoral access is contraindicated. © 2022</p

The SURFEXv7.2 land and ocean surface platform for coupled or offline simulation of Earth surface variables and fluxes

CC Attribution 3.0 License.Final revised paper also available at http://www.geosci-model-dev.net/6/929/2013/gmd-6-929-2013.pdfInternational audienceSURFEX is a new externalized land and ocean surface platform that describes the surface fluxes and the evolution of four types of surface: nature, town, inland water and ocean. It can be run either coupled or in offline mode. It is mostly based on pre-existing, well validated scientific models. It can be used in offline mode (from point scale to global runs) or fully coupled with an atmospheric model. SURFEX is able to simulate fluxes of carbon dioxide, chemical species, continental aerosols, sea salt and snow particles. It also includes a data assimilation module. The main principles of the organization of the surface are described first. Then, a survey is made of the scientific module (including the coupling strategy). Finally the main applications of the code are summarized. The current applications are extremely diverse, ranging from surface monitoring and hydrology to numerical weather prediction and global climate simulations. The validation work undertaken shows that replacing the pre-existing surface models by SURFEX in these applications is usually associated with improved skill, as the numerous scientific developments contained in this community code are used to good advantage

Is there loss or qualitative changes in the expression of thyroid peroxidase protein in thyroid epithelial cancer?

There is disagreement concerning the expression of thyroid peroxidase (TPO) in thyroid cancer, some studies finding qualitative as well as quantitative differences compared to normal tissue. To investigate TPO protein expression and its antigenic properties, TPO was captured from a solubilizate of thyroid microsomes by a panel of murine anti-TPO monoclonal antibodies and detected with a panel of anti-human TPO IgGκ Fab. TPO protein expression in 30 samples of malignant thyroid tissue was compared with TPO from adjacent normal tissues. Virtual absence of TPO expression was observed in 8 cases. In the remaining 22 malignant thyroid tumours the TPO protein level varied considerably from normal to nearly absent when compared to normal thyroid tissue or tissues from patients with Graves' disease (range less than 0.5 to more than 12.5 μg mg−1 of protein). When expressed TPO displayed similar epitopes, to that of TPO from Graves' disease tissue. The results obtained by the TPO capturing method were confirmed by SDS-PAGE and Western blot analysis with both microsomes and their solubilizates. The present results show that in about two-thirds of differentiated thyroid carcinomas, TPO protein is expressed, albeit to a more variable extent than normal; when present, TPO in malignant tissues is immunologically normal. © 2001 Cancer Research Campaignhttp://www.bjcancer.co

Global off-line evaluation of the ISBA-TRIP flood model

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L., 1996, P 3 INT C WORKSH INT VOROSMARTY C J, 1989, Global Biogeochemical Cycles, V3, P241, DOI 10.1029/GB003i003p00241 Decharme, B. Alkama, R. Papa, F. Faroux, S. Douville, H. Prigent, C. Papa, Fabrice/D-3695-2009 Papa, Fabrice/0000-0001-6305-6253 French "Agence Nationale pour la Recherche" (ANR); CYMENT of the RTRA STAE Toulouse; "Centre National de Recherches Meteorologiques" (CNRM) of Meteo-France; "Centre National de la Recherche Scientifique" (CNRS) of the French research ministry This work is supported by the program IMPACT-BOREAL of the French "Agence Nationale pour la Recherche" (ANR), the CYMENT project of the RTRA STAE Toulouse, the "Centre National de Recherches Meteorologiques" (CNRM) of Meteo-France, and the "Centre National de la Recherche Scientifique" (CNRS) of the French research ministry. The authors would like to thank Christine Delire (CNRS/CNRM) as well as anonymous reviewers for their useful comments on this study. 22 SPRINGER NEW YORK CLIM DYNAMThis study presents an off-line global evaluation of the ISBA-TRIP hydrological model including a two-way flood scheme. The flood dynamics is indeed described through the daily coupling between the ISBA land surface model and the TRIP river routing model including a prognostic flood reservoir. This reservoir fills when the river height exceeds the critical river bankfull height and vice versa. The flood interacts with the soil hydrology through infiltration and with the overlying atmosphere through precipitation interception and free water surface evaporation. The model is evaluated over a relatively long period (1986-2006) at 1 degrees resolution using the Princeton University 3-hourly atmospheric forcing. Four simulations are performed in order to assess the model sensitivity to the river bankfull height. The evaluation is made against satellite-derived global inundation estimates as well as in situ river discharge observations at 122 gauging stations. First, the results show a reasonable simulation of the global distribution of simulated floodplains when compared to satellite-derived estimates. At basin scale, the comparison reveals some discrepancies, both in terms of climatology and interannual variability, but the results remain acceptable for a simple large-scale model. In addition, the simulated river discharges are improved in term of efficiency scores for more than 50% of the 122 stations and deteriorated for 4% only. Two mechanisms mainly explain this positive impact: an increase in evapotranspiration that limits the annual discharge overestimation found when flooding is not taking into account and a smoothed river peak flow when the floodplain storage is significant. Finally, the sensitivity experiments suggest that the river bankfull depth is potentially tunable according to the river discharge scores to control the accuracy of the simulated flooded areas and its related increase in land surface evaporation. Such a tuning could be relevant at least for climate studies in which the spatio-temporal variations in precipitation are generally poorly represented

The detailed snowpack scheme Crocus and its implementation in SURFEX v7.2

International audienceDetailed studies of snow cover processes require models that offer a fine description of the snow cover properties. The detailed snowpack model Crocus is such a scheme, and has been run operationally for avalanche forecasting over the French mountains for 20 yr. It is also used for climate or hydrological studies. To extend its potential applications, Crocus has been recently integrated within the framework of the externalized surface module SURFEX. SURFEX computes the exchanges of energy and mass between different types of surface and the atmosphere. It includes in particular the land surface scheme ISBA (Interactions between Soil, Biosphere, and Atmosphere). It allows Crocus to be run either in stand-alone mode, using a time series of forcing meteorological data or in fully coupled mode (explicit or fully implicit numerics) with atmospheric models ranging from meso-scale models to general circulation models. This approach also ensures a full coupling between the snow cover and the soil beneath. Several applications of this new simulation platform are presented. They range from a 1-D standalone simulation (Col de Porte, France) to fully-distributed simulations in complex terrain over a whole mountain range (Massif des Grandes Rousses, France), or in coupled mode such as a surface energy balance and boundary layer simulation over the East Antarctic Ice Sheet (Dome C)

Transcarotid Access Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

Background: The transfemoral (TF) route is the gold-standard access for transcatheter aortic valve replacement (TAVR). In 10-15% of patients, alternative accesses are needed, such as the transcarotid (TC) access. We performed a meta-analysis to compare 30-day mortality and complications between TC-TAVR and TF-TAVR. Methods: We searched PubMed/MEDLINE and EMBASE from inception to January 2021 to identify articles comparing TC-TAVR and TF-TAVR. Patients' baseline characteristics, procedural outcomes, and clinical 30-day outcomes were extracted. Results: We identified 9 studies, among which 2 used propensity-score matching, including 1,374 TC patients and 3,706 TF patients. TC-TAVR was associated with significantly higher EuroSCORE II and Logistic EuroSCORE values (respectively 8.0 ± 6.7 vs. 6.3 ± 5.4, p = 0.002 and 20.8 ± 14.2% vs. 20.0 ± 13.4%, p = 0.04), a higher prevalence of peripheral artery disease (52.6 vs. 32.8%, p = 0.001), previous cardiac surgery (26.3 vs. 22.4%, p = 0.008) and coronary artery disease (64.6 vs. 60.5%, p = 0.020). The pooled results found TC-TAVR to be associated with a significantly higher 30-day mortality risk (RR, 1.41, 95% CI, 1.02-1.96, p = 0.040), and a lower rate of 30-day major vascular complications (RR, 0.48, 95% CI, 0.25-0.92, p = 0.030). No significant difference was found regarding permanent pacemaker implantation, major bleeding and acute kidney injury. A subgroup analysis of the two propensity-score matched studies found a statistically increased risk of 30-day neurovascular complications (RR, 1.61, 95% CI, 1.02-2.55, p = 0.040). Conclusion: Compared with TF-TAVR, TC-TAVR was associated with an increased risk of 30-day mortality, likely related to a higher surgical risk and comorbidity burden, and with an increased risk of 30-day neurovascular complications. Careful preprocedural patient selection and close periprocedural neurological monitoring are paramount