Percutaneous closure of mitral paravalvular leaks: Focus on imaging and technique

Symptomatic prosthetic paravalvular leakage is a rare clinical condition occurring in up to 5% of patients after valve surgery. Symptoms include haemolytic anaemia, heart failure or both. Leaks tend to be more common in the mitral compared to the aortic position. Three dimensional transoesophageal echocardiography (3D TOE) is essential prior and during percutaneous leak closure. This imaging technique allows to qualify and quantify the leak and to judge feasibility of a percutaneous approach. It also enables the choice of the most appropriated closure device prior to intervention. During the procedure, 3D TOE guides adequate crossing of the leak and device deployment. It also fi nally allows assessment of the acute procedural result. Percutaneous closure should be considered as the fi rstchoice therapy if closure is judged feasible based on 3D TOE assessment. This procedure is currently performed in a limited number of patients by relatively few operators and is characterised by a long learning curve. Currently, literature data are scarce and reported acute procedural success is roughly around 70 to 80%. Intervention is mostly performed with vascular plugs or ventricular septum defect closure devices. Recently, dedicated implants have been made available. Their role has been limited to hybrid procedures from a transapical retrograde approach

Comparative Long-Term Effect of Three Anti-P2Y12 Drugs after Percutaneous Angioplasty: An Observational Study Based on Electronic Drug Adherence Monitoring

Aims: Dual platelet inhibition using anti-P2Y12 drugs and aspirin is the standard of care in patients after percutaneous coronary interventions (PCI). Prasugrel and ticagrelor have been shown to be more potent than clopidogrel with less high on-treatment platelet reactivity. Whether differences in long-term adherence to these drugs can partly explain different antiplatelet efficacy has not been studied so far. The objective was to compare the long-term P2Y12 receptor inhibition and drug adherence to different anti-P2Y12 drugs, and to assess the impact of adherence on the pharmacodynamic effect.Methods: Monocentric, prospective, observational study. Stable outpatients treated with clopidogrel 75 mg once daily, prasugrel 10 mg once daily or ticagrelor 90 mg twice daily after PCI with stent implantation were included. Drug adherence was recorded during 6 months using electronic monitoring. Platelet responsiveness was assessed with the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) at inclusion, 3 and 6 months.Results: 120 patients had VASP-PRI and adherence data available. At 6-months, mean VASP-PRI (±SD) was 17.7 ± 11.0% with ticagrelor, 29.2 ± 15.5% with prasugrel and 47.2 ± 17.6% with clopidogrel (ANOVA, P < 0.0001).Median [IQR] taking adherence was 96 [82–100]% with ticagrelor, 100 [97–101]% with prasugrel and 100 [99–101]% with clopidogrel (p = 0.0001). Median [IQR] correct dosing was 88 [73–95]% with ticagrelor, 97 [92.5–98]% with prasugrel and 98 [96–99]% with clopidogrel (p = 0.0001).Anti-P2Y12 drug (p ≤ 0.001) and diabetes (p = 0.014) emerged as predictors of poor antiplatelet response after adjusting for age, BMI, sex, and CYP2C19∗2 carriers status.Conclusion: Drug adherence to anti-P2Y12 drugs assessed with electronic monitoring was very high. However, anti-P2Y12 drugs showed significant differences in antiplatelet activity, with newer anti-P2Y12 drugs ticagrelor and prasugrel exerting a stronger P2Y12 receptor inhibition.These data suggest that pharmacokinetic-pharmacodynamic differences between oral anti-P2Y12 drugs are more important than adherence in determining antiplatelet efficacy when adherence to prescription is high.The study was registered (Current Controlled Trials ISRCTN85949729)

Rigorous Polynomial Approximation using Taylor Models in Coq

International audienceOne of the most common and practical ways of representing a real function on machines is by using a polynomial approximation. It is then important to properly handle the error introduced by such an approximation. The purpose of this work is to offer guaranteed error bounds for a specific kind of rigorous polynomial approximation called Taylor model. We carry out this work in the Coq proof assistant, with a special focus on genericity and efficiency for our implementation. We give an abstract interface for rigorous polynomial approximations, parameter- ized by the type of coefficients and the implementation of polynomials, and we instantiate this interface to the case of Taylor models with inter- val coefficients, while providing all the machinery for computing them. We compare the performances of our implementation in Coq with those of the Sollya tool, which contains an implementation of Taylor models written in C. This is a milestone in our long-term goal of providing fully formally proved and efficient Taylor models

Quantum Cryptography

Quantum cryptography could well be the first application of quantum mechanics at the individual quanta level. The very fast progress in both theory and experiments over the recent years are reviewed, with emphasis on open questions and technological issues.Comment: 55 pages, 32 figures; to appear in Reviews of Modern Physic

Genotypic variability enhances the reproducibility of an ecological study

Many scientific disciplines are currently experiencing a “reproducibility crisis” because numerous scientific findings cannot be repeated consistently. A novel but controversial hypothesis postulates that stringent levels of environmental and biotic standardization in experimental studies reduces reproducibility by amplifying impacts of lab-specific environmental factors not accounted for in study designs. A corollary to this hypothesis is that a deliberate introduction of controlled systematic variability (CSV) in experimental designs may lead to increased reproducibility. We tested this hypothesis using a multi-laboratory microcosm study in which the same ecological experiment was repeated in 14 laboratories across Europe. Each laboratory introduced environmental and genotypic CSV within and among replicated microcosms established in either growth chambers (with stringent control of environmental conditions) or glasshouses (with more variable environmental conditions). The introduction of genotypic CSV led to lower among-laboratory variability in growth chambers, indicating increased reproducibility, but had no significant effect in glasshouses where reproducibility was generally lower. Environmental CSV had little effect on reproducibility. Although there are multiple causes for the “reproducibility crisis”, deliberately including genetic variation may be a simple solution for increasing the reproducibility of ecological studies performed in controlled environments

Inflammatory Monocytes and Neutrophils Are Licensed to Kill during Memory Responses In Vivo

Immunological memory is a hallmark of B and T lymphocytes that have undergone a previous encounter with a given antigen. It is assumed that memory cells mediate better protection of the host upon re-infection because of improved effector functions such as antibody production, cytotoxic activity and cytokine secretion. In contrast to cells of the adaptive immune system, innate immune cells are believed to exhibit a comparable functional effector response each time the same pathogen is encountered. Here, using mice infected by the intracellular bacterium Listeria monocytogenes, we show that during a recall bacterial infection, the chemokine CCL3 secreted by memory CD8+ T cells drives drastic modifications of the functional properties of several populations of phagocytes. We found that inflammatory ly6C+ monocytes and neutrophils largely mediated memory CD8+ T cell bacteriocidal activity by producing increased levels of reactive oxygen species (ROS), augmenting the pH of their phagosomes and inducing antimicrobial autophagy. These events allowed an extremely rapid control of bacterial growth in vivo and accounted for protective immunity. Therefore, our results provide evidence that cytotoxic memory CD8+ T cells can license distinct antimicrobial effector mechanisms of innate cells to efficiently clear pathogens

Letter of interest for a neutrino beam from Protvino to KM3NeT/ORCA

The Protvino accelerator facility located in the Moscow region, Russia, is in a good position to offer a rich experimental research program in the field of neutrino physics. Of particular interest is the possibility to direct a neutrino beam from Protvino towards the KM3NeT/ORCA detector, which is currently under construction in the Mediterranean Sea 40 km offshore Toulon, France. This proposal is known as P2O. Thanks to its baseline of 2595 km, this experiment would yield an unparalleled sensitivity to matter effects in the Earth, allowing for the determination of the neutrino mass ordering with a high level of certainty after only a few years of running at a modest beam intensity of ≈ 90 kW. With a prolonged exposure (≈1500 kWyear), a 2σ sensitivity to the leptonic CP-violating Dirac phase can be achieved. A second stage of the experiment, comprising a further intensity upgrade of the accelerator complex and a densified version of the ORCA detector (Super-ORCA), would allow for up to a 6σ sensitivity to CP violation and a 10º−17º resolution on the CP phase after 10 years of running with a 450 kW beam, competitive with other planned experiments. The initial composition and energy spectrum of the neutrino beam would need to be monitored by a near detector, to be constructed several hundred meters downstream from the proton beam target. The same neutrino beam and near detector set-up would also allow for neutrino-nucleus cross section measurements to be performed. A short-baseline sterile neutrino search experiment would also be possible

The Control Unit of the KM3NeT Data Acquisition System

The KM3NeT Collaboration runs a multi-site neutrino observatory in the Mediterranean Sea. Water Cherenkov particle detectors, deep in the sea and far off the coasts of France and Italy, are already taking data while incremental construction progresses. Data Acquisition Control software is operating off-shore detectors as well as testing and qualification stations for their components. The software, named Control Unit, is highly modular. It can undergo upgrades and reconfiguration with the acquisition running. Interplay with the central database of the Collaboration is obtained in a way that allows for data taking even if Internet links fail. In order to simplify the management of computing resources in the long term, and to cope with possible hardware failures of one or more computers, the KM3NeT Control Unit software features a custom dynamic resource provisioning and failover technology, which is especially important for ensuring continuity in case of rare transient events in multi-messenger astronomy. The software architecture relies on ubiquitous tools and broadly adopted technologies and has been successfully tested on several operating systems

Characterisation of the Hamamatsu photomultipliers for the KM3NeT Neutrino Telescope

[EN] The Hamamatsu R12199-02 3-inch photomultiplier tube is the photodetector chosen for the first phase of the KM3NeT neutrino telescope. About 7000 photomultipliers have been characterised for dark count rate, timing spread and spurious pulses. The quantum eÿciency, the gain and the peak-to-valley ratio have also been measured for a sub-sample in order to determine parameter values needed as input to numerical simulations of the detector.The authors acknowledge the financial support of the funding agencies: Agence Nationale de la Recherche (contract ANR-15-CE31-0020), Centre National de la Recherche Scientifique (CNRS), Commission Europeenne (FEDER fund and Marie Curie Program), Institut Universitaire de France (IUF), IdEx program and UnivEarthS Labex program at Sorbonne Paris Cite (ANR-10-LABX-0023 and ANR-11-IDEX-0005-02), France; 'Helmholtz Alliance for Astroparticle Physics' funded by the Initiative and Networking Fund of the Helmholtz Association, Germany; The General Secretariat of Research and Technology (GSRT), Greece; Istituto Nazionale di Fisica Nucleare (INFN), Ministero dell'Istruzione, dell'Universita e della Ricerca (MIUR), Italy; Agence de l'Oriental and CNRST, Morocco; Nederlandse organisatie voor Wetenschappelijk Onderzoek (NWO), the Netherlands; National Authority for Scientific Research (ANCS), Romania; Plan Estatal de Investigacion (refs. FPA2015-65150-C3-1-P, -2-P and -3-P, (MINECO/FEDER)), Severo Ochoa Centre of Excellence and MultiDark Consolider (MINECO), and Prometeo and Grisolia programs (Generalitat Valenciana), Spain.Aiello, S.; Akrame, SE.; Ameli, F.; Anassontzis, EG.; Andre, M.; Androulakis, G.; Anghinolfi, M.... (2018). Characterisation of the Hamamatsu photomultipliers for the KM3NeT Neutrino Telescope. Journal of Instrumentation. 13:1-17. https://doi.org/10.1088/1748-0221/13/05/P05035S11713Adrián-Martínez, S., Ageron, M., Aharonian, F., Aiello, S., Albert, A., Ameli, F., … Anghinolfi, M. (2016). Letter of intent for KM3NeT 2.0. Journal of Physics G: Nuclear and Particle Physics, 43(8), 084001. doi:10.1088/0954-3899/43/8/084001Adrián-Martínez, S., Ageron, M., Aharonian, F., Aiello, S., Albert, A., Ameli, F., … Anvar, S. (2014). Deep sea tests of a prototype of the KM3NeT digital optical module. The European Physical Journal C, 74(9). doi:10.1140/epjc/s10052-014-3056-3Adrián-Martínez, S., Ageron, M., Aharonian, F., Aiello, S., Albert, A., Ameli, F., … Anton, G. (2016). The prototype detection unit of the KM3NeT detector. The European Physical Journal C, 76(2). doi:10.1140/epjc/s10052-015-3868-9Herold, B., Kalekin, O., & Reubelt, J. (2011). PMT characterisation for the KM3NeT project. Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 639(1), 70-72. doi:10.1016/j.nima.2010.09.018Timmer, P., Heine, E., & Peek, H. (2010). Very low power, high voltage base for a Photo Multiplier Tube for the KM3NeT deep sea neutrino telescope. Journal of Instrumentation, 5(12), C12049-C12049. doi:10.1088/1748-0221/5/12/c12049Mollo, C. M., Bozza, C., Chiarusi, T., Costa, M., Capua, F. D., Kulikovskiy, V., … Vivolo, D. (2016). A new instrument for high statistics measurement of photomultiplier characteristics. Journal of Instrumentation, 11(08), T08002-T08002. doi:10.1088/1748-0221/11/08/t08002Adrián-Martínez, S., Ageron, M., Aiello, S., Albert, A., Ameli, F., Anassontzis, E. G., … Anton, G. (2016). A method to stabilise the performance of negatively fed KM3NeT photomultipliers. Journal of Instrumentation, 11(12), P12014-P12014. doi:10.1088/1748-0221/11/12/p12014Lubsandorzhiev, B. K., Vasiliev, R. V., Vyatchin, Y. E., & Shaibonov, B. A. J. (2006). Photoelectron backscattering in vacuum phototubes. Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 567(1), 12-16. doi:10.1016/j.nima.2006.05.04

Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene. Objectives: This study sought to test the association between the rs9349379 genotype and SCAD. Methods: Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD. Results: The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence. Conclusions: The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD