The Use of Prasugrel and Ticagrelor in Pipeline Flow Diversion

Background: Despite the routine clopidogrel/aspirin anti-platelet therapy, complications like thromboembolism, continue to be encountered with PED. We studied the safety and the efficacy of prasugrel in the management of clopidogrel non-responders treated for intracranial aneurysms. Methods: 437 consecutive neurosurgery patients were identified between January 2011 and May 2016. Patients allergic or having \u3c30% platelet-inhibition with a daily 75mg of clopidogrel were dispensed 10mg of prasugrel daily (n=20) or 90mg of ticagrelor twice daily (n=2). The average follow-up was 15.8 months (SD=12.4 months). Patient clinical well being was evaluated with the modified Rankin Scale (mRS) registered before the discharge and at each follow-up visit. To control confounding we used multivariable mixed-effects logistic regression and propensity score conditioning. Results: 26 of 437(5.9%) patients (mean of age 56.3 years; 62 women [14,2%]) presented with a sub-arachnoid hemorrhage. 1 patient was allergic to clopidogrel and prasugrel simultaneously. All the patients receiving prasugrel (n=22) had a mRS\u3c2 on their latest follow-up visit (mean=0.67; SD=1.15). In a multivariate analysis, clopidogrel did not affect the mRS on last follow-up, p=0.14. Multivariable logistic regression showed that clopidogrel was not associated with an increased long-term recurrence rate (odds ratio[OR], 0.17; 95%Confidence Interval [CI95%], 0.01-2.70; p=0.21) neither with an increased thromboembolic accident rate (OR, 0.46; CI95%, 0.12-1.67; p=0.36) nor with an increased hemorrhagic event rate (OR, 0.39; CI95%,0.91-1.64; p=0.20). None of the patients receiving prasugrel deceased or had a long-term recurrence nor a hemorrhagic event, only 1 patient suffered from mild aphasia subsequent to a thromboembolic event. 3 patients on clopidogrel passed during the study: (2) from acute SAH and (1) from intra-parenchymal hemorrhage. Clopidogrel was not associated with an increased mortality rate (OR, 2.18; CI95%,0.11-43.27; p=0.61). The same associations were present in propensity score adjusted models. Conclusion: In a cohort of patients treated with PED for their intracranial aneurysms, prasugrel (10mg/day) is a safe alternative to clopidogrel resistant, allergic or non-responders

Climate change impacts in the design of drainage systems: case study of Portugal

This paper aims to assess the necessity of updating the intensity-duration-frequency (IDF) curves used in Portugal to design building storm-water drainage systems. A comparative analysis of the design was performed for the three predefined rainfall regions in Portugal using the IDF curves currently in use and estimated for future decades. Data for recent and future climate conditions simulated by a global and regional climate model chain are used to estimate possible changes of rainfall extremes and its implications for the drainage systems. The methodology includes the disaggregation of precipitation up to subhourly scales, the robust development of IDF curves, and the correction of model bias. Obtained results indicate that projected changes are largest for the plains in southern Portugal (5–33%) than for mountainous regions (3–9%) and that these trends are consistent with projected changes in the long-term 95th percentile of the daily precipitation throughout the 21st century. The authors conclude there is a need to review the current precipitation regime classification and change the new drainage systems towards larger dimensions to mitigate the projected changes in extreme precipitation

Risk Factors for Men Who Have Sex with Men

It is typical for men who have sex with men (MSM) to have several sexual partners, unstable partners, unprotected sex, or intersex relationships, all of which increase the risk of contracting human immunodeficiency virus. As a result of their behavior and close connection to acquired immunodeficiency syndrome, MSM individuals have been subjected to a barrage of interrogations, condemnations, and discrimination. Study and analysis of the risk factors of MSMs will not only assist in correctly knowing and comprehending the community, but also aid in the provision of health education, sickness prevention, and treatment

Acoustic Communication for Medical Nanorobots

Communication among microscopic robots (nanorobots) can coordinate their activities for biomedical tasks. The feasibility of in vivo ultrasonic communication is evaluated for micron-size robots broadcasting into various types of tissues. Frequencies between 10MHz and 300MHz give the best tradeoff between efficient acoustic generation and attenuation for communication over distances of about 100 microns. Based on these results, we find power available from ambient oxygen and glucose in the bloodstream can readily support communication rates of about 10,000 bits/second between micron-sized robots. We discuss techniques, such as directional acoustic beams, that can increase this rate. The acoustic pressure fields enabling this communication are unlikely to damage nearby tissue, and short bursts at considerably higher power could be of therapeutic use.Comment: added discussion of communication channel capacity in section

Hache Émilie, Ce à quoi nous tenons. Propositions pour une écologie pragmatique, Paris, La Découverte, collection Les empêcheurs de penser en rond, 2011.

Le futur (et le présent) de l’écologie serait-il le pragmatisme ? C’est à cette réflexion que la philosophe Émilie Hache s’attelle dans Ce à quoi nous tenons : Propositions pour une écologie pragmatique. Nous nous trouvons aujourd’hui à un tournant de l’histoire de l’écologie. Nous avons pris conscience de « ce à quoi nous tenons », en atteste par exemple le nombre croissant de débats ou de conférences sur le sujet. Mais si des initiatives existent en faveur du progrès écologique, la complexi..

Politics and Immanence: State and History in Hegel and Deleuze

The aim of the work is to examine the relationship between the concepts of “immanence” and “politics” in the works of Hegel and Deleuze. Both Hegel and Deleuze are thinkers of immanence and they explicitly think this concept in relation to the problem of political practice. As I show, they attempt to “ground” politics in immanence. The purpose of this work is to prove that there exists an inherent paradox in the undertaking to “ground” politics in immanence. Both philosophers are confronted with a paradox that emerges from this “grounding”. The paradox appears in the form of natural violence. Both authors fail to contain this violence through arguments. In order to show this, I examine the relationship between two further concepts: history and the state. I compare Hegel’s and Deleuze’s formulations of world-history and universal history, tracing the analogies and differences in how they think the relationship of the state to history. Based on the conclusions I then focus on the relationship of politics to immanence. The paradox of natural violence, I show, emerges from the relationship of the state at the “end of history”