Coronary chronic total occlusion intervention: utility or futility.

peer reviewedINTRODUCTION: Despite an incidence of about 18-52% of the patients undergoing coronary angiography, chronic total occlusions (CTO) are rarely revascularised by percutaneous angioplasty (PCI). Nevertheless, current evidence suggests that successful CTO angioplasty improves symptoms, quality of life and long-term survival. During the last decade, the improvement of specific tools and techniques for these complex procedures, and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO angioplasty. Areas covered: This review focuses on the clinical benefits of CTO revascularization and on appropriate patient selection. Expert commentary: Current evidence suggests that successful CTO-PCI improves symptoms, quality of life and long-term survival. During the last years, the improvement of specific techniques for these complex procedures and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO lesion angioplasty

BLOOM: A 176B-Parameter Open-Access Multilingual Language Model

Large language models (LLMs) have been shown to be able to perform new tasks based on a few demonstrations or natural language instructions. While these capabilities have led to widespread adoption, most LLMs are developed by resource-rich organizations and are frequently kept from the public. As a step towards democratizing this powerful technology, we present BLOOM, a 176B-parameter open-access language model designed and built thanks to a collaboration of hundreds of researchers. BLOOM is a decoder-only Transformer language model that was trained on the ROOTS corpus, a dataset comprising hundreds of sources in 46 natural and 13 programming languages (59 in total). We find that BLOOM achieves competitive performance on a wide variety of benchmarks, with stronger results after undergoing multitask prompted finetuning. To facilitate future research and applications using LLMs, we publicly release our models and code under the Responsible AI License

La place des jeunes dans le procès : aspects civils

Place et rôle du mineur d'âge dans le cadre de la procédure civil

Natural regeneration in tropical forests along a disturbance gradient in South-East Cameroon

International audienceThe dynamics of tropical forests are highly dependent on the forest understorey. Understanding its diversity and composition is essential to ensure sustainable management of forest ecosystems. In this study, following a gradient of human disturbance, we analysed the density, diversity and floristic composition of the forest understorey in three land use types of south-eastern Cameroon: a protected area, a selective logging concession and community forests. Vegetation was inventoried in thirty-three permanent one-hectare plots. Woody individuals (tree, shrub, liana) were classified in four strata depending on their diameter: seedling (dbh < 1 cm), sapling (1–9.9 cm), small trees (10–29.9 cm), large tree (≥30 cm). A total of 4,159 individuals (dbh < 10 cm) belonging to 418 species and 232 genera were recorded. They mainly represent tree species (65%) and shade tolerant plants (77%), with diaspores disseminated by animals (74%). Life forms and modes of dissemination were significantly different between land use types. Abundance, species richness and diversity of juveniles varied significantly between strata and land use types: they were globally the highest in plots that have been logged less than five years before inventory. In terms of species composition, the different land use types were not clearly separated, indicating some resilience to disturbance. A low similarity between strata was observed. In all types, most canopy species are light demanding and cannot regenerate in the understorey. This indicates a natural evolution of the forest stands in the absence of silviculture. The presence of species that currently dominate the canopy of these forests will be gradually reduced without human intervention

The France PCI registry: Design, methodology and key findings

International audienceBackground: Obstructive coronary artery disease is the main cause of death worldwide. By tracking events and gaining feedback on patient management, the most relevant information is provided to public health services to further improve prognosis.Aims: To create an inclusive and accurate registry of all percutaneous coronary intervention (PCI) proce-dures performed in France, to assess and improve the quality of care and create research incentives. Also, to describe the methodology of this French national registry of interventional cardiology, and present early key findings. Methods: The France PCI registry is a multicentre observational registry that includes consecutive patients undergoing coronary angiography and/or PCI. The registry was set up to provide online data analysis and structured reports of PCI activity, including process of care measures and assessment of risk-adjusted outcomes in all French PCI centres that are willing to participate. More than 150 baseline data items, describing demographic status, PCI indications and techniques, and in-hospital and 1-year outcomes, are captured into local reporting software by medical doctors and local research technicians, with subsequent encryption and internet transfer to central data servers. Annual activity reports and scoring tools available on the France PCI website enable users to benchmark and improve clinical practices. External validation and consistency assessments are performed, with feedback of data completeness to centres.Results: Between 01 January 2014 and 31 December 2022, participating centres increased from six to 47, and collected 364,770 invasive coronary angiograms and 176,030 PCIs, including 54,049 non-ST -segment elevation myocardial infarction cases and 31,631 ST-segment elevation myocardial infarction cases. Fifteen studies stemming from the France PCI registry have already been published. Conclusions: This fully electronic, daily updated, high-quality, low-cost, national registry is sustainable, and is now expanding. Merging with medicoeconomic databases and nested randomized scientific studies are ongoing steps to expand its scientific potential

Potential alternative land covers on Earth

Abstract Preserving and restoring terrestrial ecosystems is crucial to halting the collapse of life on Earth. To guide global conservation and restoration efforts, we present a comprehensive map, encompassing all ecosystems, revealing the Earth's potential tree, short vegetation, and bareground cover accounting for various land management scenarios such as prescribed fire frequency and trophic rewilding. Our analysis indicates that 43% (5678 Mha) of lands could be covered by trees, 39% (5179 Mha) by shrubs and grasses, and 18% (2347 Mha) by bareground. Approximately 1070 Mha can support alternative land covers, emphasizing the need to consider diverse outcomes in landscape restoration. Our findings also suggest that management scenarios may significantly outweigh the average impact of climate change on resulting land covers, underscoring decision-makers' responsibility for nature’s recovery and a sustainable future

Impact of Routine Fractional Flow Reserve on Management Decision and 1-Year Clinical Outcome of Patients With Acute Coronary Syndromes

International audienc