Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

Background: The MitraClip procedure was established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, the aim was to evaluate 5-year outcomes after MitraClip.Methods: Consecutive patients undergoing the MitraClip system were prospectively included. All patients underwent clinical follow-up and transthoracic echocardiography.Results: Two hundred sixty-five patients (age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60.5% secondary MR [sMR]). Although high procedural success of 91.3% was found, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04). Five years after the MitraClip procedure, the majority of patients presented with reduced symptoms and improved functional capacity (functional NYHA class: p = 0.0001; 6 minutes walking test: p = 0.04). Sustained MR reduction (≤ grade 2) was found in 74% of patients, and right ventricular (RV) function was significantly increased (p = 0.03). Systolic pulmonary artery pressure (sPAP) was significantly reduced during follow-up only in sMR patients (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, 5-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (MVG) (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality.Conclusions: Transcatheter mitral valve repair with the MitraClip system showed low complication rates and sustained MR reduction with improved RV function and sPAP 5 years after the procedure was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher 5-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and 5-year mortality

Modeling of Individual Fruit-Bearing Capacity of Trees Is Aimed at Optimizing Fruit Quality of Malus x domestica Borkh. 'Gala'

The capacity of apple trees to produce fruit of a desired diameter, i.e., fruit-bearing capacity (FBC), was investigated by considering the inter-tree variability of leaf area (LA). The LA of 996 trees in a commercial apple orchard was measured by using a terrestrial two-dimensional (2D) light detection and ranging (LiDAR) laser scanner for two consecutive years. The FBC of the trees was simulated in a carbon balance model by utilizing the LiDAR-scanned total LA of the trees, seasonal records of fruit and leaf gas exchanges, fruit growth rates, and weather data. The FBC was compared to the actual fruit size measured in a sorting line on each individual tree. The variance of FBC was similar in both years, whereas each individual tree showed different FBC in both seasons as indicated in the spatially resolved data of FBC. Considering a target mean fruit diameter of 65 mm, FBC ranged from 84 to 168 fruit per tree in 2018 and from 55 to 179 fruit per tree in 2019 depending on the total LA of the trees. The simulated FBC to produce the mean harvest fruit diameter of 65 mm and the actual number of the harvested fruit >65 mm per tree were in good agreement. Fruit quality, indicated by fruit's size and soluble solids content (SSC), showed enhanced percentages of the desired fruit quality according to the seasonally total absorbed photosynthetic energy (TAPE) of the tree per fruit. To achieve a target fruit diameter and reduce the variance in SSC at harvest, the FBC should be considered in crop load management practices. However, achieving this purpose requires annual spatial monitoring of the individual FBC of trees

Online Talent Platforms, Labour Market Intermediaries and the Changing World of Work. Independent study prepared by CEPS and IZA for the World Employment Confederation-Europe and UNI Europa May 2018

By comparing the online talent platform economy and the temporary agency work sector, this study aims to contribute to a rapidly growing literature on new forms of work and their impact on the labour market. It shows that online talent platforms and temporary work agencies do have features in common, but there are also significant differences between the two, which make it difficult to use temporary agency work as a model for the online talent platform economy; in many cases, it would not be a good fit. That being said, the call by policy-makers, social partners and other stakeholders for a level playing field should not be overlooked. Furthermore, the study also confirms that any comparison of the online talent platform economy and the temporary agency work sector is hampered by a lack of data. In order to address this issue, continued monitoring and much more transparency of online talent platforms will be needed, as well as further data collection and analysis of both the online talent platforms and the temporary work agencies. These efforts are important because more flexible forms of work are likely to become increasingly prevalent in the future

CAD increases the long noncoding RNA PUNISHER in small extracellular vesicles and regulates endothelial cell function via vesicular shuttling

Long noncoding RNAs (lncRNAs) have emerged as biomarkers and regulators of cardiovascular disease. However, the expression pattern of circulating extracellular vesicle (EV)-incorporated lncRNAs in patients with coronary artery disease (CAD) is still poorly investigated. A human lncRNA array revealed that certain EV-lncRNAs are significantly dysregulated in CAD patients. Circulating small EVs (sEVs) from patients with (n = 30) or without (n = 30) CAD were used to quantify PUNISHER (also known as AGAP2-antisense RNA 1 [AS1]), GAS5, MALAT1, and H19 RNA levels. PUNISHER (p = 0.002) and GAS5 (p = 0.02) were significantly increased in patients with CAD, compared to non-CAD patients. Fluorescent labeling and quantitative real-time PCR of sEVs demonstrated that functional PUNISHER was transported into the recipient cells. Mechanistically, the RNA-binding protein, heterogeneous nuclear ribonucleoprotein K (hnRNPK), interacts with PUNISHER, regulating its loading into sEVs. Knockdown of PUNISHER abrogated the EV-mediated effects on endothelial cell (EC) migration, proliferation, tube formation, and sprouting. Angiogenesis-related gene profiling showed that the expression of vascular endothelial growth factor A (VEGFA) RNA was significantly increased in EV recipient cells. Protein stability and RNA immunoprecipitation indicated that the PUNISHER-hnRNPK axis regulates the stability and binding of VEGFA mRNA to hnRNPK. Loss of PUNISHER in EVs abolished the EV-mediated promotion of VEGFA gene and protein expression. Intercellular transfer of EV-incorporated PUNISHER promotes a pro-angiogenic phenotype via a VEGFA-dependent mechanism

The integrated microbial genomes (IMG) system

The integrated microbial genomes (IMG) system is a new data management and analysis platform for microbial genomes provided by the Joint Genome Institute (JGI). IMG contains both draft and complete JGI genomes integrated with other publicly available microbial genomes of all three domains of life. IMG provides tools and viewers for analyzing genomes, genes and functions, individually or in a comparative context. IMG allows users to focus their analysis on subsets of genes and genomes of interest and to save the results of their analysis. IMG is available at

Clinical scenarios for use of transvalvular microaxial pumps in acute heart failure and cardiogenic shock – A European experienced users working group opinion

Abstract For patients with myocardial infarct-related cardiogenic shock (CS), urgent percutaneous coronary intervention is the recommended treatment strategy to limit cardiac and systemic ischemia. However, a specific therapeutic intervention is often missing in non-ischemic CS cases. Though drug treatment with inotropes and/or vasopressors may be required to stabilize the patient initially, their ongoing use is associated with excess mortality. Coronary intervention in unstable patients often leads to further hemodynamic compromise either during or shortly after revascularization. Support devices like the intra-aortic balloon pump failed to improve clinical outcomes in infarct-related CS. Currently, more powerful and active hemodynamic support devices unloading the left ventricle such as transvalvular microaxial pumps are available and are being increasingly used. However, as for other devices large randomized trials are not yet available, and device use is based on registry data and expert consensus. In this article, a multidisciplinary group of experienced users of transvalvular microaxial pumps outlines the pathophysiological background on hemodynamic changes in CS, the available mechanical support devices, and current guideline recommendations. Furthermore, different hemodynamic situations in several case-based scenarios are used to illustrate candidate settings and to provide the theoretic and scientific rationale for left-ventricular unloading in these scenarios. Finally, organization of shock networks, monitoring, weaning, and typical complications and their prevention are discussed

Improved low dark current MWIR/LWIR MCT detectors: first results of ROIC and MCT tests

Within the TRP program “Development of Low Dark Current MWIR/LWIR Detectors” ne MCT material was tested with reduced dark current for low photon flux applications. A specific ROIC design was set up within this program to allow a proper characterization of the material and act as a demonstrator for further ROIC derivates. Demonstrator assemblies were prepared and tested. The poster will highlight the specific design approaches for the ROIC and the MCT. Four different topologies for the input stage on the ROIC were implemented to allow direct assessment of the impact of the design approach. A part of these input stages were designed using radiation hardened cell library. The ROIC doesn’t contain any internal state machine but id fully controlled via a high speed SPI interface driven by an external sequencer. A test setup will be highlighted. A liquid helium cryostat was prepared to allow dark current measurements in an environment which does not suffer from parasitic radiation sources. The same setup is capable for operation with external illumination and optical filers, which can be moved into the beam. The detector assemblies are presented. A two-step approach is shown which is initially scanning the performance of the different input topologies. A final detector assembly is selected upon the best performance; final assemblies are shown, the test results will be given on the poster

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

Purpose In the pathogenesis of severe COVID-19 complications, derangements of renin-angiotensin-aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. Methods We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. Results Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. Conclusions Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group. Key summary pointsAim To review current cardiovascular medications for benefits and potential harms during COVID-19. Findings Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on observational studies and age-specific data are scarce. Message Most current cardiovascular drugs can be safely continued during COVID-19, but general conditions common in older patients must be considered.Peer reviewe