Pulmonary vein isolation alone and combined with renal sympathetic denervation in chronic kidney disease patients with refractory atrial fibrillation

Background: Atrial fibrillation (AF) commonly occurs in association with chronic kidney disease (CKD), resulting in adverse outcomes. Combining pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may reduce the recurrence of AF in patients with CKD and hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. Our goal was to compare the impact of PVI + RSD with that of PVI alone in patients with concurrent AF and CKD. Methods: This was a single-center, prospective, longitudinal, randomized, double-blind study. Forty-five patients with controlled hypertension, symptomatic paroxysmal AF and/or persistent AF, stage 2 or 3 CKD, and a dual-chamber pacemaker were enrolled from January 2014 to January 2015. We assessed the 30-second recurrence of AF recorded by the pacemaker, 24-hour ambulatory blood pressure measurements, estimated glomerular filtration rate, albuminuria, echocardiographic parameters, and safety of RSD. Results: No patient developed procedural or other complications. The ambulatory blood pressure measurements did not differ within the PVI + RSD group or between the PVI + RSD and PVI groups throughout the study. Significantly more patients in the PVI + RSD group than in the PVI group were free of AF at the 12-month follow-up evaluation. The PVI group had an unacceptable response to ablation with respect to changes in echocardiographic parameters, whereas these parameters improved in the PVI + RSD group. Conclusion: PVI + RSD were associated with a lower AF recurrence rate than PVI alone; it also improved renal function and some echocardiographic parameters. These encouraging data will serve as baseline information for further long-term studies on larger patient populations

Caracterización física y ecológica del área marina de “Los volcanes de fango del golfo de Cádiz”

Se integra información hidrográfica, geomorfológica, sedimentológica, biológica, sobre hábitats marinos y pesquera, para establecer las bases ecológicas necesarias para la protección y conservación de los volcanes de fango del golfo de Cádiz (suroeste de la península Ibérica, España) y de sus estructuras relacionadas con el escape de fluidos cargados en metano.La zona marina española que consideramos en este documento, el golfo de Cádiz, se ubica en la región biogeográfica atlántica, en la Provincia Lusitánica, subprovincia cálida (código 15, Warm Lusitanean subprovince) de la Región IV de OSPAR (Francia y península Ibérica). Los criterios utilizados para su selección, a los efectos contemplados en la propuesta LIFE+, se basaron en los siguientes aspectos: (1) Su representación biogeográfica; (2) La presencia de estructuras submarinas de interés para su conservación y estudio; (3) La presencia de especies o hábitats vulnerables y/o amenazados; (4) La presencia de áreas naturales potencialmente bien conservadas. El golfo de Cádiz es uno de los casos paradigmáticos en los que el fenómeno de expulsión de fluidos cargados en gas metano ha traído como resultado la formación de una gran diversidad de relieves y hábitats de extraordinario interés ecológico. Los fenómenos de expulsión de fluidos enriquecidos en metano, producen cambios sustanciales en la superficie del fondo marino, así como en el interior de los depósitos sedimentarios que lo constituyen. Estos flujos expulsados desde el fondo hacia la columna de agua, modifican notablemente los relieves preexistentes, generando morfologías de neoformación, que pueden adquirir una naturaleza carbonatada, que evolucionan en función de la intensidad y frecuencia de la expulsión. La alteración natural de los fondos marinos es pues un proceso continuo mientras permanece activo el fenómeno de expulsión, y es precisamente éste el rasgo más característico de la superficie del fondo marino en el golfo de Cádiz. Los valores ecológicos que posee son muy diversos y de gran importancia, destacando de manera particular los siguientes: (1) Su elevado e interactivo hidrodinamismo producto de la convergencia de las masas de agua, vinculadas al intercambio que se realiza a través del estrecho de Gibraltar. (2) La singular diversidad y productividad biológica, fruto de la existencia de un ambiente propicio y heterogéneo facilitado por la convergencia de aguas atlánticas y mediterráneas. (3) La formación de importantes escapes de fluidos en el fondo marino (principalmente metano) producto de la tectónica salina relacionada con la convergencia de las placas litosféricas, africana y europea. (4) La presencia de complejos procesos microbianos que aprovechan energéticamente los flujos metaníferos. Esta actividad provoca la transformación de los fondos sedimentarios disgregados en estructuras carbonatadas consolidadas (substratos duros). El rango de profundidades que ha cubierto el estudio se extiende desde los 40 m hasta los 1200 m, intensificándose la prospección en el talud continental, entre las profundidades de 300 m y 1200 m, lugar en el que se concentra la mayor parte de los rasgos característicos de los fenómenos de expulsión de fluidos.Abstract The Spanish marine area considered in this project, the Gulf of Cadiz, is located in the Atlantic biogeographical region as a part of the Lusitanian Province, warm subprovince (code 15, Warm Lusitanean subprovince) of the OSPAR Region IV (France and the Iberian Peninsula). The criteria used for its selection, focusing the purposes mentioned in the LIFE+ proposal, is based on the following aspects: (1) The biogeographical representation; (2) The presence of sea bottom structures of very high interest for conservation and subject for scientific studies ; (3) The presence of species or sensitive habitats and/or threatened; (4) The presence of potentially well preserved natural areas. The Gulf of Cadiz is one of the paradigmatic cases in which the phenomenon of methane gas expulsion (see pages) and fluid flow has resulted in the formation of a wide variety of reliefs and habitats of outstanding ecological interest. The phenomena of methane enriched fluid flow produced dramatic changes in the seafloor and within the upper sedimentary units forming sea bed deposits. These fluxes ejected from the sea bottom to the water column significantly modify the existing reliefs, generating new morphologies carbonate in nature. The extension of the rocky carbonate outcrops as well as its thickness strongly depends on the intensity and frequency of fluid expulsion and the biological activity of the methane consumers microbial consortium. The natural disturbance of the seabed is a continuous process remains active while the phenomenon of seabed fluid flow keeps active, and this is in fact the characteristic of the seafloor in the Gulf of Cádiz. Ecological importance of benthic communities and marine habitats has very high interest for protection and conservation, particularly highlighting the following points: (1) Its high hydrodynamics and interactive linked to the convergence of water masses related to the changes in the exchange through the Strait of Gibraltar. (2) The unique biological diversity and productivity, resulting from the existence of a suitable heterogeneous environment and facilitated by the convergence of Atlantic and Mediterranean waters. (3) The formation of significant fluxes of leaking gases into the seabed (mainly methane) related to salt tectonics generated under the African and European lithosferic plates convergence. (4) The presence of complex microbial processes (mainly oxidation of gas emissions) that take advantage of methane energy flows. This activity produce the transformation of unconsolidated sea bottom (mainly mud or sandy mud) into aggregation of consolidated carbonate cemented structures (hard substrates). The depth range that has covered the study extends from 40m to 1200m, intensifying seabed exploration along the upper and middle continental slope, between depths of 300 and 1200m, the place where most of the geomorphological features related to fluid flow are recognized.Instituto Español de Oceanografía, Comisión Europea Programa LIFE*, Fundación Biodiversida

Pseudorapidity densities of charged particles with transverse momentum thresholds in pp collisions at √ s = 5.02 and 13 TeV

The pseudorapidity density of charged particles with minimum transverse momentum (pT) thresholds of 0.15, 0.5, 1, and 2 GeV/c is measured in pp collisions at the center of mass energies of √s=5.02 and 13 TeV with the ALICE detector. The study is carried out for inelastic collisions with at least one primary charged particle having a pseudorapidity (η) within 0.8pT larger than the corresponding threshold. In addition, measurements without pT-thresholds are performed for inelastic and nonsingle-diffractive events as well as for inelastic events with at least one charged particle having |η|2GeV/c), highlighting the importance of such measurements for tuning event generators. The new measurements agree within uncertainties with results from the ATLAS and CMS experiments obtained at √s=13TeV.

Real-time-capable prediction of temperature and density profiles in a tokamak using RAPTOR and a first-principle-based transport model

The RAPTOR code is a control-oriented core plasma profile simulator with various applications in control design and verification, discharge optimization and real-time plasma simulation. To date, RAPTOR was capable of simulating the evolution of poloidal flux and electron temperature using empirical transport models, and required the user to input assumptions on the other profiles and plasma parameters. We present an extension of the code to simulate the temperature evolution of both ions and electrons, as well as the particle density transport. A proof-of-principle neural-network emulation of the quasilinear gyrokinetic QuaLiKiz transport model is coupled to RAPTOR for the calculation of first-principle-based heat and particle turbulent transport. These extended capabilities are demonstrated in a simulation of a JET discharge. The multi-channel simulation requires ∼0.2 s to simulate 1 second of a JET plasma, corresponding to ∼20 energy confinement times, while predicting experimental profiles within the limits of the transport model. The transport model requires no external inputs except for the boundary condition at the top of the H-mode pedestal. This marks the first time that simultaneous, accurate predictions of Te, Tiand nehave been obtained using a first-principle-based transport code that can run in faster-than-real-time for present-day tokamaks

Runaway electron beam control

Post-disruption runaway electron (RE) beams in tokamaks with large current can cause deep melting of the vessel and are one of the major concerns for ITER operations. Consequently, a considerable effort is provided by the scientific community in order to test RE mitigation strategies. We present an overview of the results obtained at FTU and TCV controlling the current and position of RE beams to improve safety and repeatability of mitigation studies such as massive gas (MGI) and shattered pellet injections (SPI). We show that the proposed RE beam controller (REB-C) implemented at FTU and TCV is effective and that current reduction of the beam can be performed via the central solenoid reducing the energy of REs, providing an alternative/parallel mitigation strategy to MGI/SPI. Experimental results show that, meanwhile deuterium pellets injected on a fully formed RE beam are ablated but do not improve RE energy dissipation rate, heavy metals injected by a laser blow off system on low-density flat-top discharges with a high level of RE seeding seem to induce disruptions expelling REs. Instabilities during the RE beam plateau phase have shown to enhance losses of REs, expelled from the beam core. Then, with the aim of triggering instabilities to increase RE losses, an oscillating loop voltage has been tested on RE beam plateau phase at TCV revealing, for the first time, what seems to be a full conversion from runaway to ohmic current. We finally report progresses in the design of control strategies at JET in view of the incoming SPI mitigation experiments

Comparison of runaway electron generation parameters in small, medium-sized and large tokamaks - A survey of experiments in COMPASS, TCV, ASDEX-Upgrade and JET

This paper presents a survey of the experiments on runaway electrons (RE) carried out recently in frames of EUROFusion Consortium in different tokamaks: COMPASS, ASDEX-Upgrade, TCV and JET. Massive gas injection (MGI) has been used in different scenarios for RE generation in small and medium-sized tokamaks to elaborate the most efficient and reliable ones for future RE experiments. New data on RE generated at disruptions in COMPASS and ASDEX-Upgrade was collected and added to the JET database. Different accessible parameters of disruptions, such as current quench rate, conversion rate of plasma current into runaways, etc have been analysed for each tokamak and compared to JET data. It was shown, that tokamaks with larger geometrical sizes provide the wider limits for spatial and temporal variation of plasma parameters during disruptions, thus extending the parameter space for RE generation. The second part of experiments was dedicated to study of RE generation in stationary discharges in COMPASS, TCV and JET. Injection of Ne/Ar have been used to mock-up the JET MGI runaway suppression experiments. Secondary RE avalanching was identified and quantified for the first time in the TCV tokamak in RE generating discharges after massive Ne injection. Simulations of the primary RE generation and secondary avalanching dynamics in stationary discharges has demonstrated that RE current fraction created via avalanching could achieve up to 70-75% of the total plasma current in TCV. Relaxations which are reminiscent the phenomena associated to the kinetic instability driven by RE have been detected in RE discharges in TCV. Macroscopic parameters of RE dominating discharges in TCV before and after onset of the instability fit well to the empirical instability criterion, which was established in the early tokamaks and examined by results of recent numerical simulations

Observation of WWWWWW Production in pppp Collisions at s\sqrt s =13 TeV with the ATLAS Detector

International audienceThis Letter reports the observation of $WWW$ production and a measurement of its cross section using 139 fb$^{-1}$ of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. Events with two same-sign leptons (electrons or muons) and at least two jets, as well as events with three charged leptons, are selected. A multivariate technique is then used to discriminate between signal and background events. Events from $WWW$ production are observed with a significance of 8.0 standard deviations, where the expectation is 5.4 standard deviations. The inclusive $WWW$ production cross section is measured to be $820 \pm 100\,\text{(stat)} \pm 80\,\text{(syst)}$ fb, approximately 2.6 standard deviations from the predicted cross section of $511 \pm 18$ fb calculated at next-to-leading-order QCD and leading-order electroweak accuracy

Observation of WWWWWW Production in pppp Collisions at s\sqrt s =13 TeV with the ATLAS Detector

International audienceThis Letter reports the observation of $WWW$ production and a measurement of its cross section using 139 fb$^{-1}$ of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. Events with two same-sign leptons (electrons or muons) and at least two jets, as well as events with three charged leptons, are selected. A multivariate technique is then used to discriminate between signal and background events. Events from $WWW$ production are observed with a significance of 8.0 standard deviations, where the expectation is 5.4 standard deviations. The inclusive $WWW$ production cross section is measured to be $820 \pm 100\,\text{(stat)} \pm 80\,\text{(syst)}$ fb, approximately 2.6 standard deviations from the predicted cross section of $511 \pm 18$ fb calculated at next-to-leading-order QCD and leading-order electroweak accuracy

Observation of WWWWWW Production in pppp Collisions at s\sqrt s =13 TeV with the ATLAS Detector

International audienceThis Letter reports the observation of $WWW$ production and a measurement of its cross section using 139 fb$^{-1}$ of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. Events with two same-sign leptons (electrons or muons) and at least two jets, as well as events with three charged leptons, are selected. A multivariate technique is then used to discriminate between signal and background events. Events from $WWW$ production are observed with a significance of 8.0 standard deviations, where the expectation is 5.4 standard deviations. The inclusive $WWW$ production cross section is measured to be $820 \pm 100\,\text{(stat)} \pm 80\,\text{(syst)}$ fb, approximately 2.6 standard deviations from the predicted cross section of $511 \pm 18$ fb calculated at next-to-leading-order QCD and leading-order electroweak accuracy