A New Clinically Driven Classification for Acute Aortic Dissection.

Objectives: To report a new classification scheme for acute aortic dissection (AAD) that considers the aortic arch as a separate entity and integrates patterns of malperfusion syndrome (MPS). The proposed classification was evaluated retrospectively in a large population. Materials and Methods: We retrospectively reviewed pre-therapy CT angiograms of 226 consecutive patients (mean ± SD age: 64 ± 12 years) with AAD. AADs were reclassified with a new classification scheme that included three aortic dissection types (A, involving at least the ascending aorta; B, involving exclusively the descending aorta; and C, involving the aortic arch with/without the descending aorta) and four malperfusion grades (0: no MPS; 1: dynamic MPS; 2: static MPS; 3: static and dynamic MPS). AAD features were assessed and correlated to patient outcomes. Results: According to the new classification, we identified 152 type A dissections (92 A0, 11 A1, 38 A2, 11 A3); 50 type B (38 B0, 5 B1, 6 B2, 1 B3); and 24 type C (17 C0, 6 C2, 1 C3). Type C represented 11% of all AADs. MPS occurred in 39, 24, and 29% in type A, B, and C, respectively. Type C was treated with significantly more endovascular or hybrid interventions (37%) than in types A (3%) and B (20%) (p < 0.001). Conclusion: The new AAD classification was feasible, and type C was easily identified ("non-A, non-B"). Preliminary findings supported the usefulness of this classification for the decision-making process and subsequent treatments

Shunt dysfunction patterns after transjugular intrahepatic portosystemic shunt creation using a combination of a generic stent-graft and bare-stents.

Even though transjugular intrahepatic portosystemic shunt (TIPS) using Fluency Stent-grafts provides good shunt patency rates, shunt dysfunction is a great concern after TIPS creation, occurring in up to 20% of cases within one year. The objective of this study was to describe shunt dysfunction patterns after TIPS creation using a combination of generic stent-grafts/bare-stents. Single-center retrospective study of all TIPS revisions between January 2005 and December 2020. TIPS revision angiograms were analyzed for stents' positions, stenoses' diameters, and stenoses' locations. Out of 99 TIPS, a total of 33 TIPS revisions were included. The median time to TIPS revision was 10.4 months. Angiograms showed four patterns of TIPS dysfunction-associated features (DAF), defined as follows: Type 1 was defined as stenosis located after the stent end in the hepatic vein (HV), type 2 as intra-stent stenosis located in the hepatic vein, type 3 as intra-stent stenosis or a kink in the parenchymal tract or the portal vein end of the TIPS, and type 4 as a complete TIPS occlusion. Types 1, 2, 3, and 4 were seen in 23 (69.7%), 5 (15.2%), 2 (6.1%), and 3 (9.1%) TIPS respectively. TIPS revision was successful in 30 (90.1%) patients with median pre- and post-TIPS revision PSG of 18.5 mmHg and 8 mmHg respectively (p < .001). Our results illustrate the four angiographic patterns of TIPS DAF after TIPS creation using a combination of generic stent-grafts/bare-stents and emphasize the need for appropriate stent length extending to the HV/inferior vena cava junction

The birds of the Loyalty Islands (New Caledonia): census, ecological and biogeographical issues

The avifauna of the Loyalty Islands comprises 62 species, including 14 breeding or erratic seabirds, 5 migratory birds, 7 herons, ducks and rails, 4 birds of prey, 28 indigenous land breeders (belonging to 33 subspecies) and 2 species introduced from the Grande Terre (main island of New Caledonia). Six species are endemic: 3 on the Grande Terre and in the Loyalty Islands (New Caledonian Friarbird Philemon diemenensis, Green-backed White-eye Zosterops xanthochrous, Striated Starling Aplonis striatus) and 3 only found in the Loyalty Islands (Ouvea Parakeet Eunymphicus uvaeensis, Large Lifou White-eye Zosterops inornatus and Small Lifou White-eye Z. minutus). Eunymphicus is an endemic genus of New Caledonia. Eight subspecies are endemic to both the Grande Terre and the Loyalty Islands and 11 are exclusive of the Loyalty Islands. Of the 24 taxa whose geographical origin could be identified, 58% are identical or similar to those on the Grande Terre, 105 km away, and 42% have affinities with birds in Vanuatu, twice as far away (225 km). The paths of cyclones could explain the specific influence of Vanuatu. The correlation between the islands’land area and the number of species that have successfully settled is very close (r = 0.97) and confirms this biogeographical standard. The land breeding species frequencies vary, with rare localized species limited to some islands (Bluefaced Parrotfinch Erythrura trichroa, Ouvea Parakeet), or possibly extinct (Island Thrush Turdus poliocephalus) and others whose frequency varies widely from place to place (Fan-tailed Cuckoo Cacomantis flabelliformis, Gerygone Gerygone flavolateralis, Silvereye Zosterops lateralis), while others show high (Red-bellied Fruit-Dove Ptilinopus greyii), average (Melanesian Flycatcher Myiagra caledonica, Sacred Kingfischer Todiramphus sanctus) or low (Emerald Dove Chalcophaps indica) frequencies that remain comparable between these islands. The species ecology has been determined with some species associated with wide forests, e.g. the Ouvea Parakeet, while others are typical of the open settings. The threats onto this avifauna are mainly linked to habitat destruction and the impact of introduced species. A specific effort should be made to ensure the protection of populations of that species for which there is the greatest concern, i.e. the Ouvea ParakeetL'avifaune des Loyauté comprend 62 espèces, dont 14 marines nicheuses ou erratiques, 5 migratrices, 7 hérons, canards et râles, 4 rapaces/chouette, 28 oiseaux terrestres nicheurs indigènes (appartenant à 33 sous-espèces) et 2 espèces introduites de Grande Terre. Six espèces sont endémiques à l'archipel néo-calédonien: 3 présentes à la fois en Grande Terre et aux Loyauté: Polochion moine Philemon diemenensis, Zostérops à dos vert Zosterops xanthochrous, Stourne des Loyauté Aplanis striatus et 3 pour les seules Loyauté: Perruche d'Ouvéa Eunymphicus uvaeensis, Zostérops de Lifou Zosterops inornatus et Zostérops minute Z. minutus. Eunymphicus est un genre endémique de Nouvelle-Calédonie. Huit sous-espèces sont endémiques à la fois de Grande Terre et des Loyauté et 11 sont exclusives des Loyauté. Sur 24 taxons dont l'origine géographique peut être établie, 58 % sont identiques ou proches de ceux de Grande Terre distante de 105 km, et 42 % ont des affinités avec des oiseaux du Vanuatu, deux fois plus éloigné (225 km). La trajectoire des cyclones pourrait expliquer cette influence ni-vanuatu particulière. La corrélation entre la surface des îles et le nombre d'espèces qui y ont réussi leur implantation est très étroite (r = 0,97) et vérifie bien cette règle de la biogéographie. La fréquence des espèces terrestres nicheuses est variable, avec des espèces rares et localisées, limitées à certaines îles (Diamant de Kittlitz Erythrura trichroa, Perruche d'Ouvéa) et qui ont peut-être disparu (Merle des Iles Turdus poliocephalus), d'autres dont la fréquence est très inégalement répartie (Coucou à éventail Cacomantis flabelliformis, Gérygone Gerygone flavolateralis, Zostérops à dos noir Zosterops lateralis), d'autres enfin aux fréquences élevées (Ptilope de Grey Ptilinopus greyii), moyennes (Monarque Myiagra caledonica, Martin-chasseur Todiramphus sanctus) ou faibles (Colombine turvert Chalcophaps indica), mais comparables entre les îles. L'écologie des espèces a pu être précisée avec des espèces inféodées aux grandes forêts, parmi lesquelles la Perruche d'Ouvéa, et des espèces typiques des milieux ouverts. Les menaces pesant sur cette avifaune sont essentiellement liées aux destructions d'habitat et à l'impact des espèces introduites. Un effort particulier doit être consenti pour sécuriser les populations de l'espèce dont le statut est le plus préoccupant: la Perruche d'Ouvéa

Model-based engineering of widgets, user applications and servers compliant with ARINC 661 specification

International audienceThe purpose of ARINC 661 specification [1] is to define interfaces to a Cockpit Display System (CDS) used in any types of aircraft installations. ARINC 661 provides precise information for communication protocol between application (called User Applications) and user interface components (called widgets) as well as precise information about the widgets themselves. However, in ARINC 661, no information is given about the behaviour of these widgets and about the behaviour of an application made up of a set of such widgets. This paper presents the results of the application of a formal description technique to the various elements of ARINC 661 specification within an industrial project. This formal description technique called Interactive Cooperative Objects defines in a precise and non-ambiguous way all the elements of ARINC 661 specification. The application of the formal description techniques is shown on an interactive application called MPIA (Multi Purpose Interactive Application). Within this application, we present how ICO are used for describing interactive widgets, User Applications and User Interface servers (in charge of interaction techniques). The emphasis is put on the model-based management of the feel of the applications allowing rapid prototyping of the external presentation and the interaction techniques. Lastly, we present the CASE (Computer Aided Software Engineering) tool supporting the formal description technique and its new extensions in order to deal with large scale applications as the ones targeted at by ARINC 661 specification

ORB5: a global electromagnetic gyrokinetic code using the PIC approach in toroidal geometry

This paper presents the current state of the global gyrokinetic code ORB5 as an update of the previous reference [Jolliet et al., Comp. Phys. Commun. 177 409 (2007)]. The ORB5 code solves the electromagnetic Vlasov-Maxwell system of equations using a PIC scheme and also includes collisions and strong flows. The code assumes multiple gyrokinetic ion species at all wavelengths for the polarization density and drift-kinetic electrons. Variants of the physical model can be selected for electrons such as assuming an adiabatic response or a ``hybrid'' model in which passing electrons are assumed adiabatic and trapped electrons are drift-kinetic. A Fourier filter as well as various control variates and noise reduction techniques enable simulations with good signal-to-noise ratios at a limited numerical cost. They are completed with different momentum and zonal flow-conserving heat sources allowing for temperature-gradient and flux-driven simulations. The code, which runs on both CPUs and GPUs, is well benchmarked against other similar codes and analytical predictions, and shows good scalability up to thousands of nodes

The in-plane electrodynamics of the superconductivity in Bi2Sr2CaCu2O8+d: energy scales and spectral weight distribution

The in-plane infrared and visible (3 meV-3 eV) reflectivity of Bi2Sr2CaCu2O8+d (Bi-2212) thin films is measured between 300 K and 10 K for different doping levels with unprecedented accuracy. The optical conductivity is derived through an accurate fitting procedure. We study the transfer of spectral weight from finite energy into the superfluid as the system becomes superconducting. In the over-doped regime, the superfluid develops at the expense of states lying below 60 meV, a conventional energy of the order of a few times the superconducting gap. In the underdoped regime, spectral weight is removed from up to 2 eV, far beyond any conventional scale. The intraband spectral weight change between the normal and superconducting state, if analyzed in terms of a change of kinetic energy is ~1 meV. Compared to the condensation energy, this figure addresses the issue of a kinetic energy driven mechanism.Comment: 13 pages with 9 figures include

Linearized model Fokker-Planck collision operators for gyrokinetic simulations. II. Numerical implementation and tests

A set of key properties for an ideal dissipation scheme in gyrokinetic simulations is proposed, and implementation of a model collision operator satisfying these properties is described. This operator is based on the exact linearized test-particle collision operator, with approximations to the field-particle terms that preserve conservation laws and an H-Theorem. It includes energy diffusion, pitch-angle scattering, and finite Larmor radius effects corresponding to classical (real-space) diffusion. The numerical implementation in the continuum gyrokinetic code GS2 is fully implicit and guarantees exact satisfaction of conservation properties. Numerical results are presented showing that the correct physics is captured over the entire range of collisionalities, from the collisionless to the strongly collisional regimes, without recourse to artificial dissipation.Comment: 13 pages, 8 figures, submitted to Physics of Plasmas; typos fixe

Duplications of the critical Rubinstein-Taybi deletion region on chromosome 16p13.3 cause a novel recognisable syndrome

Background The introduction of molecular karyotyping technologies facilitated the identification of specific genetic disorders associated with imbalances of certain genomic regions. A detailed phenotypic delineation of interstitial 16p13.3 duplications is hampered by the scarcity of such patients. Objectives To delineate the phenotypic spectrum associated with interstitial 16p13.3 duplications, and perform a genotype-phenotype analysis. Results The present report describes the genotypic and phenotypic delineation of nine submicroscopic interstitial 16p13.3 duplications. The critically duplicated region encompasses a single gene, CREBBP, which is mutated or deleted in Rubinstein-Taybi syndrome. In 10 out of the 12 hitherto described probands, the duplication arose de novo. Conclusions Interstitial 16p13.3 duplications have a recognizable phenotype, characterized by normal to moderately retarded mental development, normal growth, mild arthrogryposis, frequently small and proximally implanted thumbs and characteristic facial features. Occasionally, developmental defects of the heart, genitalia, palate or the eyes are observed. The frequent de novo occurrence of 16p13.3 duplications demonstrates the reduced reproductive fitness associated with this genotype. Inheritance of the duplication from a clinically normal parent in two cases indicates that the associated phenotype is incompletely penetrant