Mechanical Thrombectomy for Tandem Occlusions of the Internal Carotid Artery—Results of a Conservative Approach for the Extracranial Lesion

Background: Mechanical thrombectomy (MT) is of clinical benefit for patients with extracranial-intracranial tandem lesions of anterior circulation. However, the optimal approach to the cervical lesion of the internal carotid artery (ICA) during MT has yet to be established. Data on a conservative approach for the proximal lesion during the acute phase are scarce.Methods: A retrospective study on an institutional, prospective database was conducted. We included patients with anterior circulation stroke presenting with a tandem lesion that was approached conservatively during MT.Results: Thirty-five 35 patients were included, of whom 25 (71.4%) had an atheromatous ICA lesion and 10 (28.6%) a dissection. Despite implementing a conservative strategy, acute percutaneous transluminal angioplasty (PTA) and/or stenting was necessary in 8 (22.9%) and 3 patients (8.6%), respectively. Of 27 surviving patients, 7 (25.9%) underwent delayed treatment of the ICA lesion. No new embolic events occurred between MT and delayed treatment. A favorable clinical outcome (mRS ≤ 2) was achieved in 15/35 patients (45.7%) and was associated with higher baseline ASPECTS (OR 1.62, 95% CI 1.08–2.45, p = 0.002) and successful recanalization (OR 9.39, 95% CI 1.92–45.80, p = 0.0005). Successful recanalization (TICI ≥ 2B) itself was observed in 54.3% of patients and was more likely with acute treatment of the proximal ICA lesion (OR 6.3, 95% CI 11–35.67, p = 0.03) and, more importantly, by the use of distal access catheters (OR 16.25, 95% CI 3.06–86.41, p = 0.0001).Conclusion: A conservative approach for ICA lesions during MT is feasible and offers favorable outcomes and successful recanalization for a significant proportion of patients. However, acute treatment of the cervical lesion is often necessary (31.4%) to make the distal occlusion accessible. Clinical outcome is influenced by the size of the baseline ischemic core and by successful recanalization; the latter is strongly favored by the use of distal access catheters to pass the proximal lesion. The fact that acute treatment of the ICA lesion favored intracranial recanalization but had no effect on clinical outcome is probably due to sample size, emphasizing the need for large scale, randomized studies to determine the optimal treatment strategy for this pathology

Large-Scale Mitochondrial DNA Analysis of the Domestic Goat Reveals Six Haplogroups with High Diversity

Background. From the beginning of domestication, the transportation of domestic animals resulted in genetic and demographic processes that explain their present distribution and genetic structure. Thus studying the present genetic diversity helps to better understand the history of domestic species. Methodology/Principal Findings. The genetic diversity of domestic goats has been characterized with 2430 individuals from all over the old world, including 946 new individuals from regions poorly studied until now (mainly the Fertile Crescent). These individuals represented 1540 haplotypes for the HVI segment of the mitochondrial DNA (mtDNA) control region. This large-scale study allowed the establishment of a clear nomenclature of the goat maternal haplogroups. Only five of the six previously defined groups of haplotypes were divergent enough to be considered as different haplogroups. Moreover a new mitochondrial group has been localized around the Fertile Crescent. All groups showed very high haplotype diversity. Most of this diversity was distributed among groups and within geographic regions. The weak geographic structure may result from the worldwide distribution of the dominant A haplogroup (more than 90% of the individuals). The large-scale distribution of other haplogroups (except one), may be related to human migration. The recent fragmentation of local goat populations into discrete breeds is not detectable with mitochondrial markers. The estimation of demographic parameters from mismatch analyses showed that all groups had a recent demographic expansion corresponding roughly to the period when domestication took place. But even with a large data set it remains difficult to give relative dates of expansion for different haplogroups because of large confidence intervals. Conclusions/Significance. We propose standard criteria for the definition of the different haplogroups based on the result of mismatch analysis and on the use of sequences of reference. Such a method could be also applied for clarifying the nomenclature of mitochondrial haplogroups in other domestic species

FEM modelling of Piezo-actuated Microswitches

International audienceThis article presents a study of microswitches with piezoelectric actuation. With the help of analysis modelling and FEM commercial software (ANSYS), we investigated the potentiality of AlN as piezoelectric actuator. Firstly, we compared AlN with PZT to actuate simple structures by bimorph effect as cantilever or clamped-clamped membrane. After this investigation, we focused on means to improve the deflection and the contact force of structures, by mechanical considerations, in case of an AlN actuation. This resulted in several designs of microswitches, with two different actuation mechanisms: bending or buckling. To go further, we evaluated some technological aspects as the influence of residual stresses and the shape of membrane on an AlN piezo-actuated structure

Comparison of two preventive dual antiplatelet regimens for unruptured intracranial aneurysm embolization with flow diverter/disrupter: A matched-cohort study comparing clopidogrel with ticagrelor

International audiencePurpose: Standard dual antiplatelet therapy (DAPT) for complex aneurysms treated with flow diversion and flow disruption is acetylsalicylic acid (ASA) plus clopidogrel. However, clopidogrel resistance frequently occurs and can lead to thromboembolic events. Ticagrelor is an alternative not requiring platelet inhibition testing. We compared two DAPT regimens (ASA with clopidogrel or ticagrelor) on morbi-mortality, safety and efficacy of unruptured aneurysm embolization with flow diverter/disrupter.Materials and methods: This retrospective analysis of a 1:1 matched cohort compares patients treated with ASA + clopidogrel (March 2013-December 2015) vs. ASA + ticagrelor (January 2016-March 2017). No platelet inhibition testing was conducted. Patients matched for age (±10 years), type of treatment and aneurysm sac size ( ± 2 mm). Primary outcome measures were morbidity and mortality at 1-month; secondary outcomes were thromboembolic and hemorrhagic complications [on angiography and magnetic resonance imaging (MRI)] and groin complications. Outcomes were compared using bivariate analyses.Results: Ninety patients fulfilled inclusion criteria, of which 80 remained after matching (40 per group). There was no statistical difference in 1-month morbidity between the ticagrelor and clopidogrel groups (2.5% vs. 10%, P = 0.36) and no deaths reported. We observed no significant differences between ticagrelor and clopidogrel groups in terms of angiographic thromboembolic complications (5% vs. 12.5%, P = 0.43), territorial infarction on DWI (2.5% vs. 7.5%, P = 0.61), angiographic (0% vs. 0%, P = 1) and MRI (5% vs 5%, P = 1) hemorrhagic complications, new microbleeds (57.5% vs. 40%, P = 0.12) and groin puncture complications (2.5% vs. 0%, P = 1). At three months, there was no delayed territorial infarction or hemorrhage in either group.Conclusions: Ticagrelor is safe and effective in replacing clopidogrel as DAPT for unruptured aneurysms

Éclairages sur le marketing de demain : prises de décisions, efficacité et légitimité

For the twentieth anniversary of Décisions Marketing, seven editors-in-chief of the journal, from the origin to nowadays, are sharing their vision of the future of marketing decision-making. Their analysis highlights the difficulty of conciliating efficiency and ethics objectives, internal and external legitimacy, in a liquid society.A l'occasion des 20 ans de la revue Décisions Marketing, sept rédacteurs en chef successifs, de l'origine de la revue à nos jours, apportent leur éclairage sur l'évolution de la prise de décision en marketing et ses enjeux, et sur la difficile conciliation des objectifs d'efficacité et d'éthique, de la légitimité interne et externe, dans une société désormais liquide

Topology Challenge for the Assessment of Living Cell Deposits with Shear Bulk Acoustic Biosensor

International audienceShear bulk acoustic type of resonant biosensors, such as the quartz crystal microbalance (QCM), give access to label-free in-liquid analysis of surface interactions. The general understanding of the sensing principles was inherited from past developments in biofilms measurements and applied to cells while keeping the same basic assumptions. Thus, the biosensor readouts are still quite often described using 'mass' related terminology. This contribution aims to show that assessment of cell deposits with acoustic biosensors requires a deep understanding of the sensor transduction mechanism. More specifically, the cell deposits should be considered as a structured viscoelastic load and the sensor response depends on both material and topological parameters of the deposits. This shifts the paradigm of acoustic biosensor away from the classical mass loading perspective. As a proof of the concept, we recorded QCM frequency shifts caused by blood platelet deposits on a collagen surface under different rheological conditions and observed the final deposit shape with atomic force microscopy (AFM). The results vividly demonstrate that the frequency shift is highly impacted by the platelet topology on the bio-interface. We support our findings with numerical simulations of viscoelastic unstructured and structured loads in liquid. Both experimental and theoretical studies underline the complexity behind the frequency shift interpretation when acoustic biosensing is used with cell deposits

Microacoustic biosensor for label-free assessment of von Willebrand factor function in primary haemostasis

International audienceUnder shear rate conditions prevailing in the microcirculation, vWF- platelet GpIb interaction is a prerequisite of haemostatic plug formation (primary haemostasis: platelet adhesion followed by aggregation). In order to better investigate von Willebrand disease (vWD) and platelet disorders associated with bleeding, we propose to perform real-time evaluation under several shear rates at which the contribution of vWF in platelet plug formation differs. We designed a label-free assessment with a microacoustic biosensor based on quartz crystal microbalance (QCM), Figure 1. The biosensor frequency shift was prior compared with atomic force microscopy (AFM) images of the biointerface after perfusion and found to be in agreement with both coverage and average height of platelet deposits, Figure 2. The test results for 5 minutes perfusion of anticoagulated normal whole blood are shown in Figures 3(a)-4(a). Defective adhesion was induced by inhibition of GpIb platelet receptor with a monoclonal antibody at 10ug/mL. Perfusion results are shown in Figures 3(b)-4(b). Inhibition of GpIb ; affected initial platelet plug formation in all cases but less at 200 1/s when the contribution of vWF is expected to be the lowest. The approach we developed is intended to improve evaluation of vWD in a label-free manner by integrative shear dependent phenotyping that is not realised by currently  existing devices

Assessment of shear-dependent kinetics of primary haemostasis with a microfluidic acoustic biosensor

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Non syndromic childhood onset congenital sideroblastic anemia: A report of 13 patients identified with an ALAS2 or SLC25A38 mutation.

The most frequent germline mutations responsible for non syndromic congenital sideroblastic anemia are identified in ALAS2 and SLC25A38 genes. Iron overload is a key issue and optimal chelation therapy should be used to limit its adverse effects on the development of children. Our multicentre retrospective descriptive study compared the strategies for diagnosis and management of congenital sideroblastic anemia during the follow-up of six patients with an ALAS2 mutation and seven patients with an SLC25A38 mutation. We described in depth the clinical, biological and radiological phenotype of these patients at diagnosis and during follow-up and highlighted our results with a review of available evidence and data on the management strategies for congenital sideroblastic anemia. This report confirms the considerable variability in manifestations among patients with ALAS2 or SLC25A38 mutations and draws attention to differences in the assessment and the monitoring of iron overload and its complications. The use of an international registry would certainly help defining recommendations for the management of these rare disorders to improve patient outcome

L’Impressionnisme, les arts, la fluidité

La « subtile fluidité contemporaine » célébrée par Mallarmé, défenseur et critique perspicace de la mouvance impressionniste, est devenue aussi bien un objet central de réflexion pour la philosophie contemporaine qu'une caractéristique déterminante de la modernité artistique. Déjà associée aux productions de Watteau, Boucher ou Fragonard au XVIIIe siècle, la fluidité l'est aussi à celles de Turner, Hugo, et plus encore à Monet : le « Raphaël de l'eau » (Antonin Proust) dont la « prodigieuse fluidité » (Ernest Chesnau) sera louée des origines du mouvement impressionniste jusqu'aux Nymphéas, décrites comme « un échange d'impondérables à travers des fluides » (Louis Gillet). Ce qui est à la fois un thème, une catégorie technique et stylistique, un concept esthétique déterminant pour l'impressionnisme et, plus largement, pour la culture moderne et contemporaine, est ici étudié grâce au concours d'historiens de l'art, de philosophes, de musicologues et de spécialistes de la littérature, de la photographie et du cinéma