Atria assist device to restore transport function of fibrillating atrium

Objective: The Maze procedure can restore sinus rhythm in patients suffering from chronic atrial fibrillation but often fails to restore the mechanical function of the atrium, the so-called atrial kick and requires long-term anticoagulation most of the time. A micro motorless pump (Atripump) based on artificial muscle technology positioned on the external surface of the atrium could compress the heart chamber, restoring atrium transport function. A bench model reproducing the mechanical function of human atrium and human environment has been developed to assess the circulatory support that such a pump can provide. Methods: Atripump (Nanopowers SA, Switzerland) is a dome-shape, silicone-coated nitinol actuator to be sutured on the external surface of the atrium. A pacemaker-like control unit drives the actuator and manages the external compression of the atrium. The bench model consists of an open circuit made of rubber bladder, 60cc in volume, connected to a vertically positioned and scaled tube that is filled at different levels reproducing changes in cardiac pre-load and after-load. The pump was placed on the outer surface of the bladder and both were immersed in water having a constant temperature of 37°C. Pressure, volume and temperature at the interface dome-bladder were recorded. Results: Pump ran 24h for three consecutive months. During the experiment, no technical failure occurred and the pressure and volume values were repeatable during the experience. Nitinol fatigue was assessed measuring the wire's electric resistance that remained 400±10Ω/m. Contraction rate was 1Hz with power supply of 12V, 400m and heating time of 300ms. Pre-load ranged from 11 to 15mmHg. When inserted in the bath at 37±0.5°C, maximal temperature between silicone membrane and rubber bladder was 39°C. Maximal volume pumped was 492ml/min. Conclusions: This artificial muscle pump can reproduce the mechanical effect of a normal human atrium. It is compact, reliable and follows the Starling law. The surface temperature is in the physiologic range and it could represent a new tool to restore the atrial kick in persistent atrial fibrillatio

Experimental evidence for the immediate impact of fertilization and irrigation upon the plant and invertebrate communities of mountain grasslands

The response of montane and subalpine hay meadow plant and arthropod communities to the application of liquid manure and aerial irrigation – two novel, rapidly spreading management practices – remains poorly understood, which hampers the formulation of best practice management recommendations for both hay production and biodiversity preservation. In these nutrient-poor mountain grasslands, a moderate management regime could enhance overall conditions for biodiversity. This study experimentally assessed, at the site scale, among low-input montane and subalpine meadows, the short-term effects (1 year) of a moderate intensification (slurry fertilization: 26.7–53.3 kg N·ha−1·year−1; irrigation with sprinklers: 20 mm·week−1; singly or combined together) on plant species richness, vegetation structure, hay production, and arthropod abundance and biomass in the inner European Alps (Valais, SW Switzerland). Results show that (1) montane and subalpine hay meadow ecological communities respond very rapidly to an intensification of management practices; (2) on a short-term basis, a moderate intensification of very low-input hay meadows has positive effects on plant species richness, vegetation structure, hay production, and arthropod abundance and biomass; (3) vegetation structure is likely to be the key factor limiting arthropod abundance and biomass. Our ongoing experiments will in the longer term identify which level of management intensity achieves an optimal balance between biodiversity and hay production

Comparing Apples with Apples: Robust Detection Limits for Exoplanet High-Contrast Imaging in the Presence of non-Gaussian Noise

Over the past decade, hundreds of nights have been spent on the worlds largest telescopes to search for and directly detect new exoplanets using high-contrast imaging (HCI). Thereby, two scientific goals are of central interest: First, to study the characteristics of the underlying planet population and distinguish between different planet formation and evolution theories. Second, to find and characterize planets in our immediate Solar neighborhood. Both goals heavily rely on the metric used to quantify planet detections and non-detections. Current standards often rely on several explicit or implicit assumptions about the noise. For example, it is often assumed that the residual noise after data post-processing is Gaussian. While being an inseparable part of the metric, these assumptions are rarely verified. This is problematic as any violation of these assumptions can lead to systematic biases. This makes it hard, if not impossible, to compare results across datasets or instruments with different noise characteristics. We revisit the fundamental question of how to quantify detection limits in HCI. We focus our analysis on the error budget resulting from violated assumptions. To this end, we propose a new metric based on bootstrapping that generalizes current standards to non-Gaussian noise. We apply our method to archival HCI data from the NACO-VLT instrument and derive detection limits for different types of noise. Our analysis shows that current standards tend to give detection limit that are about one magnitude too optimistic in the speckle-dominated regime. That is, HCI surveys may have excluded planets that can still exist.Comment: After first iteration with the referee, resubmitted to AJ. Comments welcome

CROCODILE \\ Incorporating medium-resolution spectroscopy of close-in directly imaged exoplanets into atmospheric retrievals via cross-correlation

The investigation of the atmospheres of closely separated, directly imaged gas giant exoplanets is challenging due to the presence of stellar speckles that pollute their spectrum. To remedy this, the analysis of medium- to high-resolution spectroscopic data via cross-correlation with spectral templates (cross-correlation spectroscopy) is emerging as a leading technique. We aim to define a robust Bayesian framework combining, for the first time, three widespread direct-imaging techniques, namely photometry, low-resolution spectroscopy, and medium-resolution cross-correlation spectroscopy in order to derive the atmospheric properties of close-in directly imaged exoplanets. Our framework CROCODILE (cross-correlation retrievals of directly imaged self-luminous exoplanets) naturally combines the three techniques by adopting adequate likelihood functions. To validate our routine, we simulated observations of gas giants similar to the well-studied $\beta$~Pictoris~b planet and we explored the parameter space of their atmospheres to search for potential biases. We obtain more accurate measurements of atmospheric properties when combining photometry, low- and medium-resolution spectroscopy into atmospheric retrievals than when using the techniques separately as is usually done in the literature. We find that medium-resolution ($R \approx 4000$) K-band cross-correlation spectroscopy alone is not suitable to constrain the atmospheric properties of our synthetic datasets; however, this problem disappears when simultaneously fitting photometry and low-resolution ($R \approx 60$) spectroscopy between the Y and M bands. Our framework allows the atmospheric characterisation of directly imaged exoplanets using the high-quality spectral data that will be provided by the new generation of instruments such as VLT/ERIS, JWST/MIRI, and ELT/METIS

Intravenous fish oil blunts the physiological response to endotoxin in healthy subjects

Objective: To assess the effects of intravenous fish oil fat emulsion on the metabolic alterations induced by lipopolysaccharide (LPS) challenge in healthy volunteers. Design: Two groups of eight healthy subjects were randomized to receive either two pharmacological doses of intravenous FO fat emulsion or no treatment. The FO group received twice 0.5 g/kg 10% emulsion (Omegaven) 48 and 24 h before investigation. LPS (2 ng/kg) was injected as abolus on the investigation day. Systemic parameters, indirect calorimetry, heart rate variability, and platelet membrane phospholipid composition were measured. Results: Basal EPA and DHA content in platelet phospholipids was low (0.28% and 2.54%, respectively) and increased significantly after FO to 1.68% and 3.32%. LPS induced reproducible effects in all subjects. Fever was higher in the FO group than in controls; the difference was significant from t 120 until t 360. FO blunted the neuroendocrine response: the rise in plasma norepinephrine was sevenfold lower at t 120 while the ACTH peak was fourfold lower. Tumor necrosis factor α was significantly lower between t 360 and t 180 in the FO group. Conclusions: Two doses of intravenous FO fat emulsion modified the phospholipid composition of platelets in healthy subjects. FO blunted fever and increased the neuroendocrine and the inflammatory responses to LP

Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

Insertion of central venous port (CVP) catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE). However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE), or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3%) at 3 months, and 11.3% (IC95 9.4–13.2%) at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3%) at 3 months, and 15.3% (IC95 13.1–17.6%) at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis

Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3) : analysis of individual data from 258 cancer registries in 61 countries

Background Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings 164563 young people were included in this analysis: 121328 (73·7%) children, 22963 (14·0%) adolescents, and 20272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group.peer-reviewe

Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000–2014 (CONCORD-3)

Background: Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. Methods: We analyzed individual data for adults (15–99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000–2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. Results: The study included 556,237 adults. In 2010–2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%–38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000–2004 and 2005–2009. These improvements were more noticeable among adults diagnosed aged 40–70 years than among younger adults. Conclusions: To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines