Invasive versus conservative management in spontaneous coronary artery dissection: A meta-analysis and meta-regression study.

Abstract Background There is a paucity of data regarding the best treatment for spontaneous coronary artery dissection (SCAD). Purpose To compare the prognostic impact of conservative versus invasive treatment in patients with SCAD. Methods We systematically searched the literature for studies evaluating the comparative efficacy and safety of invasive revascularization versus medical therapy for the treatment of SCAD from 1990 to 2019. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. Results 24 observational studies with 1720 patients were included. After 28±14 months, a conservative approach reduced target vessel revascularization rate compared with invasive treatment (OR=0.50; 95% CI 0.28–0.90; P=0.02). No difference was found regarding all-cause mortality (OR=0.81; 95% CI 0.31–2.08; P=0.66), cardiovascular mortality (OR=0.89; 95% CI 0.15–5.40; P=0.89), myocardial infarction (OR=0.95; 95% CI 0.50–1.81; P=0.87), heart failure (OR 0.96; 95% CI 0.41–2.22; P=0.92) and SCAD recurrence (OR=0.94; 95% CI 0.52–1.72; P=0.85). The meta-regression analysis suggested that male gender, diabetes mellitus, smoking habit, prior coronary artery disease, left main coronary artery involvement and lower ejection fraction at admission are related with higher overall mortality, whereas SCAD recurrence was higher among patients with fibromuscular dysplasia. Conclusion A conservative approach provides similar clinical outcomes and lower target vessel revascularization rates compared to an invasive strategy in the setting of SCAD; therefore, when feasible, it should be preferred in this scenario. Forest plots on the study outcomes Funding Acknowledgement Type of funding source: Non

LEMUR: Large European Module for solar Ultraviolet Research. European contribution to JAXA's Solar-C mission

Understanding the solar outer atmosphere requires concerted, simultaneous solar observations from the visible to the vacuum ultraviolet (VUV) and soft X-rays, at high spatial resolution (between 0.1" and 0.3"), at high temporal resolution (on the order of 10 s, i.e., the time scale of chromospheric dynamics), with a wide temperature coverage (0.01 MK to 20 MK, from the chromosphere to the flaring corona), and the capability of measuring magnetic fields through spectropolarimetry at visible and near-infrared wavelengths. Simultaneous spectroscopic measurements sampling the entire temperature range are particularly important. These requirements are fulfilled by the Japanese Solar-C mission (Plan B), composed of a spacecraft in a geosynchronous orbit with a payload providing a significant improvement of imaging and spectropolarimetric capabilities in the UV, visible, and near-infrared with respect to what is available today and foreseen in the near future. The Large European Module for solar Ultraviolet Research (LEMUR), described in this paper, is a large VUV telescope feeding a scientific payload of high-resolution imaging spectrographs and cameras. LEMUR consists of two major components: a VUV solar telescope with a 30 cm diameter mirror and a focal length of 3.6 m, and a focal-plane package composed of VUV spectrometers covering six carefully chosen wavelength ranges between 17 and 127 nm. The LEMUR slit covers 280" on the Sun with 0.14" per pixel sampling. In addition, LEMUR is capable of measuring mass flows velocities (line shifts) down to 2 km/s or better. LEMUR has been proposed to ESA as the European contribution to the Solar C mission.Comment: 35 pages, 14 figures. To appear on Experimental Astronom

Architectural Exploration of MPSoC Designs Based on an FPGA Emulation Framework

With the growing complexity in consumer embedded products and the improvements in process technology, Multi-Processor System-On-Chip (MPSoC) architectures have become widespread. These new systems are very complex to design as they must execute multiple complex real-time applications (e.g. video processing, or videogames), while meeting several additional design constraints (e.g. energy consumption or time-to-market). Thus, in order to explore all the possible HW-SW configurations in a MPSoC, simulation is not practical anymore due to the large overhead in time of cycle-accurate simulators, which is the desired level for the extraction of statistics. New methods to extract such fine-grained statistics in a faster way are needed. In this paper, we present a new FPGA-based emulation framework that allows designers to rapidly explore a large range of MPSoC design alternatives at the cycle-accurate level. Our experimients using this platform yield a speed-up of three orders of magnitud compared to cycle-accurate MPSoC simulators, while achieving the same level of accuracy as cycle-accurate MPSoC simulation frameworks

A Complete Multi-Processor System-on-Chip FPGA-Based Emulation Framework

With the growing complexity in consumer embedded products and the improvements in process technology, Multi-Processor System-On-Chip (MPSoC) architectures have become widespread. These new systems are very complex to design as they must execute multiple complex real-time applications (e.g. video processing, or videogames), while meeting several additional design constraints (e.g. energy consumption or time-to-market). Therefore, mechanisms to efficiently explore the different possible HW-SW design interactions in complete MPSoC systems are in great need. In this paper, we present a new FPGA-based emulation framework that allows designers to rapidly explore a large range of MPSoC design alternatives at the cycle-accurate level. Our results show that the proposed framework is able to extract a number of critical statistics from processing cores, memory and interconnection systems, with a speed-up of three orders of magnitude compared to cycle accurate MPSoC simulators

Plasmonic antenna hybrids for active control in the near and midinfrared

Resumen del trabajo presentado a la Spanish Conference on Nanophotonics (Conferencia Española de Nanofotónica-CEN), celebrada en Donostia-San Sebastián (España) del 3 al 5 de octubre de 2018.Hybrid platforms combining metallic plasmonic nanoantennas (NAs) and materials with interesting properties as phase-change or spintronics offer excellent technological opportunities for active plasmonics, as they can provide large changes in their optical response. In this talk I will demostrate first how gold NAs grown on vanadium dioxie (VO2), characterized by a reversible insulator-to-metal transition (IMT) at around 68ºC, can improve the performance of this material by providing an efficient enhancement mechanism for both the optically induced excitation and readout. Using picosecond laser pulses a highly localized phase transition is driven in nanoscale regions around the NAs. These antennas-VO2 hybrid solutions provide a conceptual framework to merge field localization and phase transition enabling nanoscale optical memory functionalities. In the second part I will show how the combination of Au microantenna arrays with a Ni81Fe19/Au multilayer supports provide metamaterial platforms with new functionalities. In this case, the plasmon resonance sustained by the NAs alliate with the GMR and MRE effects of the multilayer to allow low magnetic-field controlled modulation in the mid-infrared, where light modulation is very challenging. This approach establishes a roadmap for spintronically-controlled devices in the whole mid-IR to THz band.Peer Reviewe

Herschel Far-IR and submm spectroscopy of the Galactic Centre

Paper conference presented at International Symposium The Universe Explored by Herschel that took place in Noordwijk (Netherlands) during 15-18th October 2013.The Galactic centre (GC), in particular the interstellar material in the immediate vicinity (<5 pc) of the central black hole, represents a unique environment for our understanding of galactic nuclei and galaxy evolution. At a distance d = 8.0 ± 0.5 kpc, the nucleus of our galaxy is a few hundred times closer than the nearest active galactic nuclei (AGNs), thus allowing high spatial resolution studies. Owing to the lower dust extinction at far-IR/Submm wavelengths and because of the strong emission/absorption from the interstellar component related to AGN, star formation activity and the diffuse clouds along the line-of-sight, the relevance of far-IR/Submm spectroscopy to characterise extragalactic nuclei has notably increased thanks to Herschel. The spectrum of the Milky Way¿s nucleus is obviously a key template. In this contribution, we present observations toward the GC taken with the PACS, SPIRE and HIFI spectrometers. The achieved angular resolution allows us to separate, for the first time at these wavelengths, the emission toward the central cavity (gas in the inner central parsec of the galaxy) from that of the surrounding circumnuclear disk (the CND). The spectrum toward Sgr A* is dominated by strong [O iii], [O i], [C ii], [N iii], [N ii], and [C i] fine-structure lines (in decreasing order of luminosity) arising in gas irradiated by UV photons from the central stellar cluster. In addition, rotationally excited lines of 12CO, 13CO, H2O, OH, H3O+, HCO+, and HCN, as well as ground-state absorption lines of OH+, H2O+, H3O+, CH+, H2O, OH, HF, CH, and NH are detected. The excitation of the 12CO ladder is consistent with a hot isothermal component at Tk ¿ 10^3.1 K and n(H2)~10^4 cm¿3. It is also consistent with a distribution of temperature components at higher density with most CO at Tk~300 K. The detected molecular features suggest that, at present, neither very enhanced X-ray nor cosmic-ray fluxes play a dominant role in the heating of the hot molecular gas. The hot CO component results from a combination of UV- and shock-driven heating. We suggest that if irradiated dense clumps/clouds do not exist, shocks likely dominate the heating of the hot molecular gas. This is consistent with the high-velocity gas detected toward Sgr A*

Can Integrated Care Help in Meeting the Challenges Posed on Our Health Care Systems by COVID-19? Some Preliminary Lessons Learned from the European VIGOUR Project

The COVID-19 pandemic puts health and care systems under pressure globally. This current paper highlights challenges arising in the care for older and vulnerable populations in this context and reflects upon possible perspectives for different systems making use of nested integrated care approaches adapted during the work of the EU-funded project VIGOU

Predicting Major Adverse Events in Patients With Acute Myocardial Infarction

Early and accurate detection of short-term major adverse cardiac events (MACE) in patients with suspected acute myocardial infarction (AMI) is an unmet clinical need.; The goal of this study was to test the hypothesis that adding clinical judgment and electrocardiogram findings to the European Society of Cardiology (ESC) high-sensitivity cardiac troponin (hs-cTn) measurement at presentation and after 1 h (ESC hs-cTn 0/1 h algorithm) would further improve its performance to predict MACE.; Patients presenting to an emergency department with suspected AMI were enrolled in a prospective, multicenter diagnostic study. The primary endpoint was MACE, including all-cause death, cardiac arrest, AMI, cardiogenic shock, sustained ventricular arrhythmia, and high-grade atrioventricular block within 30 days including index events. The secondary endpoint was MACE + unstable angina (UA) receiving early (≤24 h) revascularization.; Among 3,123 patients, the ESC hs-cTnT 0/1 h algorithm triaged significantly more patients toward rule-out compared with the extended algorithm (60%; 95% CI: 59% to 62% vs. 45%; 95% CI: 43% to 46%; p < 0.001), while maintaining similar 30-day MACE rates (0.6%; 95% CI: 0.3% to 1.1% vs. 0.4%; 95% CI: 0.1% to 0.9%; p = 0.429), resulting in a similar negative predictive value (99.4%; 95% CI: 98.9% to 99.6% vs. 99.6%; 95% CI: 99.2% to 99.8%; p = 0.097). The ESC hs-cTnT 0/1 h algorithm ruled-in fewer patients (16%; 95% CI: 14.9% to 17.5% vs. 26%; 95% CI: 24.2% to 27.2%; p < 0.001) compared with the extended algorithm, albeit with a higher positive predictive value (76.6%; 95% CI: 72.8% to 80.1% vs. 59%; 95% CI: 55.5% to 62.3%; p < 0.001). For 30-day MACE + UA, the ESC hs-cTnT 0/1 h algorithm had a higher positive predictive value for rule-in, whereas the extended algorithm had a higher negative predictive value for the rule-out. Similar findings emerged when using hs-cTnI.; The ESC hs-cTn 0/1 h algorithm better balanced efficacy and safety in the prediction of MACE, whereas the extended algorithm is the preferred option for the rule-out of 30-day MACE + UA. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587)