Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis.

Transcatheter aortic valve replacement is increasingly performed in frail older patients who were previously ineligible for a standard surgical procedure. The objectives of this study are to determine delirium incidence, predictors, and relationship with cognitive performance at 3-month follow-up in older patients undergoing aortic valve replacement (AVR). Patients (N = 93) aged 70 years and older, undergoing transcatheter (TAVR, N = 66) or surgical (SAVR, N = 27) aortic valve replacement in an academic medical center were enrolled in this prospective cohort study. Delirium was assessed using the Confusion Assessment Method (CAM) on postoperative days 1, 2, 3, and 7. Data on patients' socio-demographics, functional status (including instrumental activities of daily living (IADL), and surgical risk scores (including Society of Thoracic Surgeons (STS) risk score), were collected at baseline. Cognitive status was assessed with the Mini-Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) at baseline and 3 months after AVR. Delirium occurred in 21 (23%) patients, within the first three postoperative days in 95% (20/21) of the cases. Delirium incidence was lower in TAVR (13/66 = 20%) than SAVR (8/27 = 30%) patients, but this difference was not statistically significant (p = .298). Patients with delirium had lower baseline cognitive performance (median MMSE score 27.0 ± 3.0 vs 28.0 ± 3.0, p = .029), lower performance in IADL (7.0 vs 8.0, p = .038), and higher STS risk scores (4.7 ± 2.7 vs 2.9 ± 2.3, p = .020). In multivariate analyses, patients with intermediate (score > 3 to ≤8) and high (score > 8) STS risk scores had 4.3 (95%CI 1.2-15.1, p = .025) and 16.5 (95%CI 2.0-138.2, p = .010), respectively, higher odds of incident delirium compared to patients with low (score ≤ 3) STS risk scores. At 3-month follow-up (N = 77), patients with delirium still had lower MMSE score (27.0 ± 8.0 vs 28.0 ± 2.0, p = .007) but this difference did not remain significant once adjusting for baseline MMSE (β-coefficient 1.11, 95%CI [- 3.03-0.80], p = .248). Delirium occurred in about one in five older patients undergoing AVR, almost essentially within the first three postoperative days. Beside cognitive performance, STS risk score could enhance the identification of high-risk older patients to better target preventative interventions

Exact and explicit probability densities for one-sided Levy stable distributions

We study functions g_{\alpha}(x) which are one-sided, heavy-tailed Levy stable probability distributions of index \alpha, 0< \alpha <1, of fundamental importance in random systems, for anomalous diffusion and fractional kinetics. We furnish exact and explicit expression for g_{\alpha}(x), 0 \leq x < \infty, satisfying \int_{0}^{\infty} exp(-p x) g_{\alpha}(x) dx = exp(-p^{\alpha}), p>0, for all \alpha = l/k < 1, with k and l positive integers. We reproduce all the known results given by k\leq 4 and present many new exact solutions for k > 4, all expressed in terms of known functions. This will allow a 'fine-tuning' of \alpha in order to adapt g_{\alpha}(x) to a given experimental situation.Comment: 4 pages, 3 figures and 1 tabl

Dry-season length and runoff control annual variability in stream DOC dynamics in a small, shallowgroundwater-dominated agricultural watershed

International audienceAs a phenomenon integrating climate conditions and hydrological control of the connection betweenstreams and terrestrial dissolved organic carbon (DOC) sources, groundwater dynamics controlpatterns of stream DOC characteristics (concentrations and fluxes). Influence of intra-annualvariations in groundwater level, discharge and climatic factors on DOC concentrations and fluxeswere assessed over 13 years at the headwater watershed of Kervidy-Naizin (5 km²) in westernFrance. Four seasonal periods were delineated within each year according to groundwaterfluctuations (A: rewetting, B: high flow, C: recession, and D: drought). Annual and seasonal baseflow vs stormflow DOC concentrations were defined based on daily hydrograph readings. Highinter-annual variability of annual DOC fluxes (5.4-39.5 kg.ha-1.yr-1) indicates that several years ofdata are required to encompass variations in water flux to evaluate the actual DOC export capacity ofa watershed. Inter-annual variability of mean annual DOC concentrations was much lower (4.9-7.5mg C.l-1), with concentrations decreasing within each year from ca. 9.2 mg C.l-1 in A to ca. 3.0 mgC.l-1 in C. This indicates an intra-annual pattern of stream DOC concentrations controlled by DOCsource characteristics and groundwater dynamics very similar across years. Partial least squareregressions combined with multiple linear regressions showed that the dry season characteristics(length and drawdown) determine the mean annual DOC concentration while annual runoffdetermines the annual flux. Antagonistic mechanisms of production-accumulation and dilution depletioncombined with an unlimited DOC supply from riparian wetland soils can mitigate theresponse of stream concentrations to global changes and climatic variations

Loss of human Scribble cooperates with H-Ras to promote cell invasion through deregulation of MAPK signalling

Activating mutations in genes of the Ras-mitogen-activated protein kinase (MAPK) pathway occur in approximately 30% of all human cancers; however, mutation of Ras alone is rarely sufficient to induce tumour development. Scribble is a polarity regulator recently isolated from a Drosophila screen for events that cooperate with Ras mutation to promote tumour progression and cell invasion. In mammals, Scribble regulates directed cell migration and wound healing in vivo; however, no role has been identified for mammalian Scribble in oncogenic transformation. Here we show that in human epithelial cells expressing oncogenic Ras or Raf, loss of Scribble promotes invasion of cells through extracellular matrix in an organotypic culture system. Further, we show that the mechanism by which this occurs is in the regulation of MAPK signalling by Scribble. The suppression of MAPK signalling is a highly conserved function of Scribble as it also prevents Raf-mediated defects in Drosophila wing development. Our data identify Scribble as an important mediator of MAPK signalling and provide a molecular basis for the observation that Scribble expression is decreased in many invasive human cancers. © 2008 Macmillan Publishers Limited All rights reserved

SCRIB expression is deregulated in human prostate cancer, and its deficiency in mice promotes prostate neoplasia

Loss of cellular polarity is a hallmark of epithelial cancers, raising the possibility that regulators of polarity have a role in suppressing tumorigenesis. The Scribble complex is one of at least three interacting protein complexes that have a critical role in establishing and maintaining epithelial polarity. In human colorectal, breast, and endometrial cancers, expression of the Scribble complex member SCRIB is often mislocalized and deregulated. Here, we report that Scrib is indispensable for prostate homeostasis in mice. Scrib heterozygosity initiated prostate hyperplasia, while targeted biallelic Scrib loss predisposed mice to prostate intraepithelial neoplasia. Mechanistically, Scrib was shown to negatively regulate the MAPK cascade to suppress tumorigenesis. Further analysis revealed that prostate-specific loss of Scrib in mice combined with expression of an oncogenic Kras mutation promoted the progression of prostate cancer that recapitulated the human disease. The clinical significance of the work in mice was highlighted by our observation that SCRIB deregulation strongly correlated with poor survival in human prostate cancer. These data suggest that the polarity network could provide a new avenue for therapeutic intervention

Process Developments And Applications Around The Powder In Tube Technique

The purpose of this presentation is to give an overview of techniques available to produce original optical fibers and application dedicated. Some alternative fabrication solutions to the well-know stack and draw technique will be developed, following by the interest to join the stack and draw technique to other ones like Repusil® Technique, Rod in Tube and finally the Powder in Tube methods, first described by the Bell Lab in the seventies and up to date since some years by several groups in the world. Realization of performing optical devices such as light sources or optical sensors can be purposed by this two last original ways

Outcomes of listing for lung and heart–lung transplantation in pulmonary hypertension: comparative experience in France and the UK

\ua9 The authors 2024.Background Lung or heart–lung transplantation (LT/HLT) for severe pulmonary hypertension (PH) as the primary disease indication carries a high risk of waiting list mortality and post-transplant complications. France and the UK both have coordinated PH patient services but with different referral pathways for accessing LT services. Methods We conducted a comparative analysis of adult PH patients listed for LT/HLT in the UK and France. Results We included 211 PH patients in France (2006–2018) and 170 in the UK (2010–2019). Cumulative incidence of transplant, delisting and waiting list death within 3 years were 81%, 4% and 11% in France versus 58%, 10% and 15% in the UK (p&lt;0.001 for transplant and delisting; p=0.1 for death). Median nonpriority waiting time was 45 days in France versus 165 days in the UK (p&lt;0.001). High-priority listing occurred in 54% and 51% of transplanted patients respectively in France and the UK (p=0.8). Factors associated with achieving transplantation related to recipients’ height, male sex, clinical severity and priority listing status. 1-year post-transplant survival was 78% in France and 72% in the UK (p= 0.04). Conclusion Access to transplantation for PH patients is better in France than in the UK where more patients were delisted due to clinical deterioration because of longer waiting time. High rates of priority listing occurred in both countries. Survival for those achieving transplantation was slightly better in France. Ensuring optimal outcomes after transplant listing for PH patients is challenging and may involve early listing of higher risk patients, increasing donor lung utilisation and improving allocation rules for these specific patients

Proceedings of the third French-Ukrainian workshop on the instrumentation developments for HEP

The reports collected in these proceedings have been presented in the third French-Ukrainian workshop on the instrumentation developments for high-energy physics held at LAL, Orsay on October 15-16. The workshop was conducted in the scope of the IDEATE International Associated Laboratory (LIA). Joint developments between French and Ukrainian laboratories and universities as well as new proposals have been discussed. The main topics of the papers presented in the Proceedings are developments for accelerator and beam monitoring, detector developments, joint developments for large-scale high-energy and astroparticle physics projects, medical applications.Comment: 3rd French-Ukrainian workshop on the instrumentation developments for High Energy Physics, October 15-16, 2015, LAL, Orsay, France, 94 page

Antitumour necrosis factor-α therapy for hidradenitis suppurativa: results from a national cohort study between 2000 and 2013

International audienceHidradenitis suppurativa (HS) is a frequent chronic inflammatory skin disease typically characterized by recurrent painful, deep inflammatory nodules of the axillary, breast, groin and gluteal areas. European recommendations are mainly based on expert opinion. Drug treatments are heterogenous (e.g., antibiotics, corticosteroids, retinoids) and lack consensus among expert centres. The most severe disease forms or those failing to respond to conventional drugs may be associated with worsened functional prognosis. Anti-tumor necrosis factor α (anti-TNFα) drugs have been prescribed in these cases. The results of randomized controlled trials (RCTs) are discordant. Three RCTs concluded to the efficacy of adalimumab (ADA), and two others did not detect any difference between infliximab (IFX) or etanercept (ETA) and placebo. Finally, data from the literature and reported experiences do not conclude on the efficacy of anti-TNFα drugs for HS. This article is protected by copyright. All rights reserve