Incidence, predictors and clinical impact of permanent pacemaker insertion in women following transcatheter aortic valve implantation: insights from a prospective multinational registry

To describe the incidence, predictors, and clinical impact of permanent pacemaker insertion (PPI) following transcatheter aortic valve replacement (TAVR) in women. Background: Data on pacemaker insertion complicating TAVR in women are scarce. Methods: The Women''s International Transcatheter Aortic Valve implantation (WIN-TAVI) is a prospective registry evaluating the safety and efficacy of TAVR in women. We included patients without preprocedural pacemakers and divided them into two groups: (1) PPI and (2) no-PPI. We identified PPI predictors using logistic regression and studied its clinical impact on the Valve Academic Research Consortium (VARC)-2 efficacy and safety endpoints. Results: Out of 1019 patients, 922 were included in the analysis. Post-TAVR PPI occurred in 132 (14.3%) patients. Clinical and procedural characteristics were similar in both groups. Pre-existing right bundle branch block (RBBB) was associated with a high risk of post-TAVR PPI (OR 3.62, 95% CI 1.85–7.06, p < 0.001), while implantation of balloon-expandable prosthesis was associated with a lower risk (OR 0.47, 95% CI 0.30–0.74, p < 0.001). Post-TAVR PPI prolonged in-hospital stay by a median of 2 days (11 [9–16] days in PPI vs. 9 [7–14] days in no-PPI, p = 0.005), yet risks of VARC-2 efficacy and safety endpoints at 1 year were similar in both groups (adjHR 0.95, 95% CI 0.60–1.52, p = 0.84 and adjHR 1.22, 95% CI 0.83–1.79, p = 0.31, respectively). Conclusion: Pacemaker implantation following TAVR is frequent among women and is associated with pre-existing RBBB and valve type. PPI prolongs hospital stay, albeit without any significant impact on 1-year outcomes

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

Relationship of edge localized mode burst times with divertor flux loop signal phase in JET

A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM

Management of mixed urinary incontinence: IUGA committee opinion

Introduction and hypothesis Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI. Methods A working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion. Results The R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations. Conclusions Mixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail

Glutamina e nucleotídeos na dieta de frangos de corte criados no sistema alternativo

The experiment was conducted to evaluate the effect of supplementing glutamine and nucleotides on growth performance and develop- ment intestinal morphology in broiler chicks. In the trial, 600 male broiler chicks distributed in randomized blocks in a 3x2 factorial arrangement (consisting of a uniform basal diet supplemented with: 0.0, 0.5 or 1.0% glutamine, and 0.0 or 0.04% nucleotides), for a total of 6 treatments with 25 birds each. Means of performance (weight, weight gain, feed intake, feed conversion and mortality) were obtained 7, 21 and 42 days of age. At the end of the experiment 4 broilers per treatment were used to determine organs weight and development intestinal morphology. Glutamine supplementation (1%) improved the body weight, feed intake and feed conversion in the first week. Glutamine and nucleotides supplementation did not affect perfor- mance in broiler chicks in the period one to 21 and one to 42 days of age. In conclusion, it was de- monstrated that feeding 1.0% glutamine improved growth performance of broiler birds at 21 days of age.Objetivou-se avaliar o efeito da suplementação com glutamina e nucleotídeos na dieta sobre o desempenho e morfologia da mucosa intestinal de frangos de corte criados no sistema alternativo. Foram utilizados 600 pintos de corte machos distribuídos em delineamento em blocos casualizados, no esquema fatorial 3x2 (três níveis de glutamina: 0,0; 0,5 e 1,0% e dois níveis de nucleotídeos purificados na dieta: 0,0 e 0,04%), totalizando 6 tratamentos, com 4 repetições de 25 aves cada. Foram obtidos os dados de desempenho (peso corporal, ganho de peso, consumo de ração, conversão alimentar e mortalidade) aos 7, 21 e 42 dias de idade. Ao final do experimento foram abatidas 4 aves/tratamento para avaliação do peso de órgãos e da morfologia intestinal. A adição de 1% na dieta melhorou o ganho de peso, consumo de raçao e conversão alimentar na primeira semana de idade. Não sendo encontra- dos resultados positivos nos períodos de 21 e 42 dias de idade. A suplementação de glutamina e nucleotídeos em dietas de frangos de corte cria- dos no sistema alternativo não influencia o desempenho e a morfologia intestinal, a inclusão de 1,0% de glutamina no período de 1 a 21 dias de idade, favorece o desempenho das aves