Left Ventricular Pacing In Patients With Congestive Heart Failure

Cardiac resynchronisation therapy (CRT) using biventricular (BIV) pacing has proved its effectiveness to correct myocardial asynchrony and improve clinical status of patients with severe congestive heart failure (CHF) and widened QRS. Despite a different effect on left ventricular electrical dispersion, left univentricular (LV) pacing is able to achieve the same mechanical synchronisation as BIV pacing in experimental studies and in humans. This results in clinical benefits of LV pacing at mid-term follow-up, with significant improvement in functional class, quality of life and exercise tolerance at the same extent as those observed with BIV stimulation in non randomised studies. Furthermore these benefits are obtained at lesser costs and with conventional dual-chamber devices. However, LV pacing has to be compared to BIV pacing in randomised trials before being definitely considered as a cost-effective alternative to BIV pacing

The Use of Epicardial Electrogram as a Simple Guide to Select the Optimal Site of Left Ventricular Pacing in Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) has been demonstrated to improve symptoms and survival in patients with left ventricular (LV) systolic dysfunction and dyssynchrony. To achieve this goal, the LV lead should be positioned in a region of delayed contraction. We hypothesized that pacing at the site of late electrical activation was also associated with long-term response to CRT. We conducted a retrospective study on 72 CRT patients. For each patient, we determined the electrical delay (ED) from the onset of QRS to the epicardial EGM and the ratio of ED to QRS duration (ED/QRS duration). After a followup of 30 ± 20 months, 47 patients responded to CRT. Responders had a significantly longer ED and greater ratio of ED/QRS duration than nonresponders. An ED/QRS duration ≥0.38 predicted a response to CRT with 89% specificity and 53% sensitivity

Corrosion Behavior of 6101 Aluminum Alloy Strands for Automotive Wires

Microstructural states produced by each step of the manufacturing process leading to the production of automotive strand arms in 6101 aluminum alloy (AA6101) for wiring harnesses were investigated in relation to their corrosion behavior in NaCl solution. The observed corrosion morphology,i.e., pitting corrosion or intergranular corrosion, was strongly dependent on the precipitation state, i.e., mainly the presence of intergranular Mg2Si precipitates. A ‘grain size – corrosion resistance’ relationship was also evidenced with an ennoblement of the corrosion potential for wires heavily cold drawn, which were characterized by a nanometric grain size. Dislocation density as well as the homogeneity of alloying element distribution were also found to be relevant parameters for explaining the electrochemical behavior of each microstructural state. Plastic deformation and recrystallization phenomena occurring during the manufacturing process were found to be associated with redistribution of alloying elements, which impeded the formation of intergranular Mg2Si precipitates. Therefore, in the present study, the cold drawing process was found to increase the intergranular corrosion resistance of AA6101

La formation du flysch du Bachelard (Néocrétacé-Paléocène) dans l'unité du Pelat

Mémoire HS n° 13 - Géologie Alpine : Le détritisme dans le Sud-Est de la France - Colloque Association des Géologues du Sud-est - Grenoble 11-12 décembre 1986Le flysch néocrétacé-paléocène du l'unité du Pelat (formation du flysch du Bachelard), très singulier dans la zone subbriançonnaise à cette latitude, repose sur des schistes noirs albo-cénomaniens et débute après un épisode tectonique qui a ramené le fond du bassin de ce secteur au-dessus de la CCD. Une sédimentation très détritique en eau profonde s'installe alors pendant que le bassin reprend son approfondissement. Dans le Maastrichtien, puis dans le Paléocène inférieur, les échos de la tectonique provençale (et en particulier du choc du début du Nummulitique qui entraîne l'émersion de toute zone alpine externe) se manifestent par une nette progradation des corps détritiques dans le bassin. Les turbidites du Flysch du Bachelard passent latéralement à des calcaires planctoniques identiques à ceux qui se déposent dans le même temps dans les unités subbriançonnaises voisines . Par cette sédimentation, l'unité du Pelat montre des affinités avec le domaine briançonnais ou se mettent alors en place des calcaires planctoniques qui admettent des intercalaires détritiques

Who benefits from brief motivational intervention among young adults presenting to the emergency department with alcohol intoxication : A latent-class moderation analysis

Background: Research has not identified which patients optimally benefit from brief Motivational Interviewing (bMI) for heavy drinking when delivered to young adults in the Emergency Department (ED). Methods: We conducted secondary analyses of data from a randomized controlled trial in which 344 young adults (18–35 years) presenting to the ED with alcohol intoxication received either bMI or Brief Advice (BA, control group). We used Latent Class Analysis to derive participants' profiles from baseline characteristics (i.e., sex, age, severity of alcohol use disorder, attribution of ED admission to alcohol use, importance, and confidence to change, cognitive discrepancy, anxiety, depression, and trait reactance). We then conducted a moderation analysis to assess the number of heavy drinking days at short-term (1-month) and long-term (12-month) follow-up using negative binomial regressions with interactions between the intervention and derived classes. Results: Fit statistics indicated that a 4-class solution best fit the data. Class 3 (high severity, importance and discrepancy, and low confidence and anxiety) benefitted more from bMI than BA at short- and long-term follow-up than Class 1 (younger; lowest severity, importance, discrepancy, reactance, anxiety and depression, and highest confidence). Class 2 (older; highest severity, importance, discrepancy, reactance, anxiety and depression, and lowest confidence) also benefitted more from bMI than BA than did Class 1 at short-term follow-up. In these significant contrasts, Class 1 benefitted more from BA than bMI. There were no significant interactions involving Class 4 (more likely to be women; low severity; high levels of anxiety, depression, and reactance). Conclusions: This study identified the patient profiles that benefitted more from bMI than BA among nontreatment-seeking young adults who present intoxicated to the ED. The findings have implications for intervention design and argue for the importance of research aimed at developing intervention content tailored to patient profiles