International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

Background Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists (n = 3776, 74.6%), by internal medicine specialists 14.2% (n = 718) and by primary care/general practice physicians 8.2% (n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS2 score was 1.9 (1.2) and CHA2DS2-VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world

Hétérotopie gliale de l’oreille moyenne

International audienceIntroduction : L’ hétérotopie gliale correspond à la présence de tissu cérébral mature normal dans une localisation anormale c’est-à-dire en dehors du système nerveux central. Cas clinique : nous rapportons le cas d’un patient de 63 ans vu en consultation pour une hypoacousie et des acouphènes droits. L’examen ORL, tomodensitométrique ainsi que l’imagerie par résonance magnétique étaient en faveur d’une otite chronique de l’oreille droite. Une mastoïdectomie droite a été réalisée retrouvant une masse charnue de la mastoïde et de l’oreille moyenne, sans défect osseux du tegmen tympani associé. Une analyse anatomopathologique a été réalisée en faveur de tissu cérébral normal. Discussion : l’hétérotopie gliale de l’oreille est rare et doit être différenciée d’une encéphalocèle. Elle est le plus souvent découverte de façon fortuite, lors d’une intervention chirurgicale, où le chirurgien retrouve une masse de l’oreille moyenne et de la mastoïde sans connexion avec le système nerveux central. L’analyse anatomopathologique confirme ensuite la présence de tissu cérébral normal au sein de cette oreille

MRI monitoring of myocardial iron overload: Use of cardiac MRI combined with hepatic MRI in a cohort of multi-transfused patients with thalassaemia

AbstractPurposeWe report the results of combining cardiac and hepatic MRI in the same examination to monitor 48 multi-transfused patients presenting iron overload secondary to their transfusions. This cardiac MRI technique uses acquisition sequences and calculation software that are readily available for 1.5 T systems, and it has been validated to screen for patients at risk of cardiac complications who present myocardial iron overload (T2*<20milliseconds).Patients and methodsA total of 176 combined MRI examinations were performed between May 2006 and January 2012 in 48 patients who had received transfusions due to thalassaemia. This monocentric retrospective study brings together all of the imaging examinations carried out.ResultsThere was a positive correlation between the cardiac T2* values and left ventricular ejection fraction, which were measured in the same examination. At the first assessment 23/48 patients had a T2*<20ms. These patients showed a significant improvement in cardiac T2* over time while their iron chelation therapy was being intensified.ConclusionThis study validates the application of the cardiac MRI technique used to monitor cardiac iron overload in patients who have undergone multiple transfusions

Population structure of the sicklefin lemon shark Negaprion acutidens within the Curieuse Marine National Park, Seychelles

This study produced the first data on population parameters for sicklefin lemon shark Negaprion acutidens at the granitic Seychelles Islands, adding to a limited catalogue of species information. Juveniles at a site in the Curieuse Marine National Park were tagged over two periods, in 2014–2015 and 2015–2016, with measurements of length (precaudal, fork and total) and weight, sex, and state of the umbilical opening recorded. Recapture data were used to calculate growth rates and population size. Mean annual growth rate was 5.40 cm y–1. A mean size at birth of 62.5 cm TL is in line with previous assessments of the species. Population-size estimates were similar for the two sampling periods (comprising 311 and 255 individuals) and higher than anticipated. Movements to outside the lagoon were recorded for early ages, and this, combined with weight loss and a reduction in condition factor as displayed in several individuals, suggests that the study area alone could not support the large number of sharks pupped yearly.Keywords: baseline data, carcharhinid, condition factor, growth rate, mangroves, marine protected area, mark-recapture, neonate, nursery area, population estimat

Role of near-infrared fluorescence imaging in the resection of metastatic lymph nodes in an optimized orthotopic animal model of HNSCC

International audienceKeywords: Near-infrared fluorescence imaging-guided surgery Head and neck squamous cell carcinoma Metastatic adenopathy vˇ3 integrin RAFT-c(RGD)4 a b s t r a c t Objectives: To study the role of near-infrared fluorescence imaging in the detection and resection of metastatic cervical lymph nodes in head and neck cancer. Materials and methods: CAL33 head and neck cancer cells of human origin were implanted in the oral cavity of nude mice. The mice were followed up after tumor resection to detect the development of lymph node metastases. A specific fluorescent tracer for ˛vˇ3 integrin expressed by CAL33 cells was injected intravenously in the surviving mice between the second and the fourth month following tumor resection. A near-infrared fluorescence-imaging camera was used to detect tracer uptake in metastatic cervical lymph nodes, to guide of lymph-node resection for histological analysis. Results: Lymph node metastases were observed in 42.8% of surviving mice between the second and the fourth month following orthotopic tumor resection. Near-infrared fluorescence imaging provided real-time intraoperative detection of clinical and subclinical lymph node metastases. These results were confirmed histologically. Conclusion: Near infrared fluorescence imaging provides real-time contrast between normal and malignant tissue, allowing intraoperative detection of metastatic lymph nodes. This preclinical stage is essential before testing the technique in humans