The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Processus de Désagrégation dans des Gels d'Argile Thixotropes sous Ecoulement de Cisaillement

International audienc

Influence des Paramètres Physico-chimiques sur les Propriétés Rhéométriques et la Structure des Gels Thixotropes d'Argile

International audienc

Écoulements de Suspensions Thixotropes d'Argile

International audienc

Structure under shear flow of thixotropic clay gels

The thixotropic behavior of colloidal clay dispersions consisting of disc-shaped particles of nanometric size, was studied by using a combination of SAXS, SANS and SLS techniques and rheometric measurements. The aim here is to examine the influence of shear flow on structural changes at various length scales, involved in the thixotropic behavior, and link these with their macroscopic mechanical properties. At rest, the structure of the dispersions is composed of subunits measuring a few tens of nanometers that combine to form dense aggregates measuring about a micrometer. At larger length scales, these micrometer-sized aggregates are rearranged to form a continuous 3-dimensional isotropic structure that has a fractal behavior of dimension D, which gives the gels their texture. The gel state is reached above a volume fraction fv*, for a given ionic strength and gelation time. The influence of the volume fraction on the structure was correlated with the yield stress and the fractal dimension by means of a scaling law (Pignon et al. 1996 ; 1997 a)

Butterfly Light Scattering Pattern and Rheology of a Sheared Thixotropic Clay Gel

International audienceThe behavior of a thixotropic clay gel under shear flow, is studied by combining a static light scattering technique and rheometric measurements. In the rest state, the gel structure is composed of micrometer-sized aggregates associated as a fractal mass. Under steady shear, a butterfly-type light scattering pattern is observed. This can be related to a contraction and a stretching of the micrometer-sized aggregates, perpendicularly to the shear direction. The influence of the shear rate on the disaggregation process is also studied and correlated to rheometric measurements

Etude expérimentale des instabilités thermoconvectives de Rayleigh-Bénard dans les fluides viscoplastiques

Le phénomène de Rayleigh-Bénard correspond à l'état instable dans lequel se trouve une couche horizontale d'un fluide dilatable, soumise à un gradient de température DT. Si ce dernier dépasse une valeur critique DTc, des mouvements convectifs naissent à l'intérieur du fluide. Concernant les fluides à seuil, le phénomène devient plus complexe. Le seuil s'ajoute aux forces stabilisatrices au sein du fluide et modifie de manière fondamentale le transfert de matière et le transfert thermique. Au départ, le fluide est au repos ; le gradient de vitesse est alors nul et la viscosité efficace infinie partout. L'approche de stabilité linéaire est incapable de fournir une solution aux équations d'écoulement car on doit perturber, par les forces d'Archimède, un fluide d'une viscosité infinie. Dans ce travail de thèse, des expériences de Rayleigh-Bénard ont été effectuées sur des solutions à base de Carbopol 940 présentant un seuil de contrainte. Le dispositif expérimental nous a permis d'avoir des résultats quantitatifs et qualitatifs intéressants. Les mouvements thermoconvectifs ont ensuite été filmés par la technique d'ombroscopie. L'effet non-linéaire au début de la convection a été observé.Rayleigh-Bénard convection phenomena correspond to the unstable state of an horizontal and dilatable fluid layer under a temperature gradient DT. If it exceeds a given critical value DTc, convective movements appear. The phenomena becomes more complex for yield stress fluids. This threshold is added to stabilizing forces exerced within the fluid and alters the fundamental heat and mass transfer. The fluid is initially at rest and therefore the velocity gradient is zero, and the effective viscosity is infinite everywhere. The linear stability approach is unable to respond because we have to disturb Archimedes forces in a fluid with infinite viscosity. In this thesis, Rayleigh-Bénard experiments were performed with Carbopol 940 solutions which expressing a yield stress. The experimental apparatus allowed us to obtain interesting quantitative and qualitative results. The non-linear effect at the beginning of convection was observed and thermoconvective movements were observed using shadowgraphy technique.SAVOIE-SCD - Bib.électronique (730659901) / SudocGRENOBLE1/INP-Bib.électronique (384210012) / SudocGRENOBLE2/3-Bib.électronique (384219901) / SudocSudocFranceF

Structure et Rhéologie de Suspensions Thixotropes d'Argile

International audienc

Structure and Pertinent Length Scale of a Discotic Clay Gel

International audienceA characteristic length scale of the structure of a thixotropic colloidal clay suspension of discotic texture was demonstrated by static light scattering. The length scale, of the order of a micron, corresponds to a fractal dimension that increases from 1 to 1.8 close to a critical volume fraction. Simultaneously, the change in yield stress with the volume fraction was studied by the vane method. A scaling law enabled these fractal dimensions to be correlated with the effect of the volume fraction on the yield stress