Introduction
PV reconnection is often the result of catheter instability and tissue edema. High‐power short‐duration (HP‐SD) ablation strategies have been shown to improve atrial linear continuity in ...acute pre‐clinical models. This study compares the safety, efficacy, and long‐term durability of HP‐SD ablation with conventional ablation.
Methods and results
In 6 swine, 2 ablation lines were performed anterior and posterior to the crista terminalis, in the smooth and trabeculated right atrium, respectively; and the right superior PV was isolated. In 3 swine, ablation was performed using conventional parameters (Thermocool‐Smarttouch® SF; 30 W/30 seconds) and in 3 other swine using HP‐SD parameters (QDOT‐MICRO™, 90 W/4 seconds). After 30 days, linear integrity was examined by voltage mapping and pacing, and the heart and surrounding tissues were examined by histopathology. Acute line integrity was achieved with both ablation strategies; however, HP‐SD ablation required 80% less RF time compared with conventional ablation (P ≤ 0.01 for all lines). Chronic line integrity was higher with HP‐SD ablation: all 3 posterior lines were continuous and transmural compared to only 1 line created by conventional ablation. In the trabeculated tissue, HP‐SD ablation lesions were wider and of similar depth with 1 of 3 lines being continuous compared to 0 of 3 using conventional ablation. Chronic PVI without stenosis was evident in both groups. There were no steam‐pops. Pleural markings were present in both strategies, but parenchymal lung injury was only evident with conventional ablation.
Conclusions
HP‐SD ablation strategy results in improved linear continuity, shorter ablation time, and a safety profile comparable to conventional ablation.
Este artículo muestra los principales planteamientos teóricos y explica la función de metodologías interdisciplinares en los Estudios Visuales. Para ello realizamos un recorrido por los conceptos ...centrales del análisis del arte visual (el esencialismo visual, los objetos visuales, la cultura visual, el pensamiento visual, los regímenes escópicos), así como tratamos relevantes debates críticos sobre las carencias de la historia del arte, la teoría del arte o la estética en el análisis de las nuevas imágenes mediáticas. El estudio demuestra que la evolución teórica del análisis visual sobrepasa la interpretación histórica del arte y se extiende en el conocimiento de la construcción social de la experiencia visual, o dicho de otro modo, en la construcción visual de lo social.
Pembrolizumab has shown efficacy in persistent, recurrent, or metastatic cervical cancer. The effect of chemoradiotherapy might be enhanced by immunotherapy. In this phase 3 trial, we assessed the ...efficacy and safety of adding pembrolizumab to chemoradiotherapy in locally advanced cervical cancer.
In this randomised, double-blind, placebo-controlled, phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 clinical trial, adults (age ≥18 years) at 176 medical centres in 30 countries with newly diagnosed, high-risk, locally advanced cervical cancer were randomly assigned (1:1) using an interactive voice-response system with integrated web response to receive 5 cycles of pembrolizumab (200 mg) or placebo every 3 weeks plus chemoradiotherapy, followed by 15 cycles of pembrolizumab (400 mg) or placebo every 6 weeks. Randomisation was stratified by planned external beam radiotherapy type (intensity-modulated radiotherapy or volumetric-modulated arc therapy vs non-intensity-modulated radiotherapy or non-volumetric-modulated arc therapy), cervical cancer stage at screening (International Federation of Gynecology and Obstetrics 2014 stage IB2–IIB node positive vs stage III–IVA), and planned total radiotherapy (external beam radiotherapy plus brachytherapy) dose (<70 Gy vs ≥70 Gy equivalent dose in 2 Gy fractions). Primary endpoints were progression-free survival per Response Evaluation Criteria in Solid Tumours version 1.1—by investigator or by histopathologic confirmation of suspected disease progression—and overall survival. Primary analysis was conducted in the intention-to-treat population, which included all randomly allocated participants. Safety was assessed in the as-treated population, which included all randomly allocated patients who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT04221945, and is closed to new participants.
Between June 9, 2020, and Dec 15, 2022, 1060 participants were randomly assigned to treatment, with 529 assigned to the pembrolizumab–chemoradiotherapy group and 531 to the placebo–chemoradiotherapy group. At data cutoff (Jan 9, 2023), median follow-up was 17·9 months (IQR 11·3–22·3) in both treatment groups. Median progression-free survival was not reached in either group; rates at 24 months were 68% in the pembrolizumab–chemoradiotherapy group versus 57% in the placebo–chemoradiotherapy group. The hazard ratio (HR) for disease progression or death was 0·70 (95% CI 0·55–0·89, p=0·0020), meeting the protocol-specified primary objective. Overall survival at 24 months was 87% in the pembrolizumab–chemoradiotherapy group and 81% in the placebo–chemoradiotherapy group (information fraction 42·9%). The HR for death was 0·73 (0·49–1·07); these data have not crossed the boundary of statistical significance. Grade 3 or higher adverse event rates were 75% in the pembrolizumab–chemoradiotherapy group and 69% in the placebo–chemoradiotherapy group.
Pembrolizumab plus chemoradiotherapy significantly improved progression-free survival in patients with newly diagnosed, high-risk, locally advanced cervical cancer.
Merck Sharp & Dohme, a subsidiary of Merck & Co (MSD).
During pulmonary vein isolation (PVI), a circular lasso catheter is positioned at the junction between the left atrium (LA) and the pulmonary vein (PV) to confirm PVI. The Rhythmia mapping system ...uses the Orion mini-basket catheter with 64 electrodes instead of the lasso catheter. However, its feasibility to determine PVI has not been studied.
The purpose of this study was to compare signals between the mini-basket and lasso catheters at the LA-PV junction.
In 12 patients undergoing PVI using Rhythmia, the mini-basket and lasso catheters were placed simultaneously at the LA-PV junction for baseline and post-PVI signal assessment. Pacing from both catheters was performed to examine the presence of exit block.
At baseline, recordings of LA and PV potentials were concordant in all PVs. However, after PVI, concordance between the catheters was only 68%. Discordance in all cases resulted from loss of PV potentials on the lasso catheter with persistence of PV potentials on the mini-basket catheter. In 9 of 13 PVs (69%), these potentials represented true PV potentials that were exclusively recorded with the smaller and closely spaced mini-basket electrodes. In the other 4 PVs (31%), these potentials originated from neighboring structures and resulted in underestimation of PVI.
The use of the mini-basket catheter alone is sufficient to determine PVI. While it improves recording of PV potentials after incomplete ablation, it is also associated with frequent recording of "PV-like" potentials originating from neighboring structures. In these cases, pacing maneuvers are helpful to determine PVI and avoid excessive ablation.
Rhythmia is a new technology capable of rapid and high-resolution mapping. However, its potential advantage over existing technologies in mapping complex scar-related atrial tachycardias (ATs) has ...not yet been evaluated.
The purpose of this study was to examine the utility of Rhythmia for mapping scar-related ATs in patients who had failed previous ablation procedure(s).
This multicenter study included 20 patients with recurrent ATs within 2 years after a previous ablation procedure (1.8 ± 0.7 per patient). In all cases, the ATs could not be adequately mapped during the index procedure because of scar with fractionated electrograms, precluding accurate time annotation, frequent change in the tachycardia in response to pacing, and/or degeneration into atrial fibrillation. These patients underwent repeat mapping and ablation procedure with Rhythmia.
From a total of 28 inducible ATs, 24 were successfully mapped. Eighteen ATs (75%) terminated during radiofrequency ablation and 4 (16.6%) with catheter pressure or entrainment from the site of origin or isthmus. Two ATs that were mapped to the interatrial septum slowed but did not terminate with ablation. In 21 of 24 ATs the mechanism was macroreentry, while in 3 of 24 the mechanism was focal. Interestingly, in 5 patients with previously failed ablation of an allegedly "focal" tachycardia, high-resolution mapping demonstrated macroreentrant arrhythmia. The mean mapping time was 28.6 ± 17 minutes, and the mean radiofrequency ablation time to arrhythmia termination was 3.2 ± 2.6 minutes. During a mean follow-up of 7.5 ± 3.1 months, 15 of 20 patients (75%) were free of AT recurrences.
The Rhythmia mapping system may be advantageous for mapping complex scar-related ATs.
In this work, we propose a finite volume scheme to simulate two-phase flows in non-homogeneous and non-isotropic 2-D petroleum reservoirs. The governing equations are solved using the IMPES (IMplicit ...Pressure and Explicit Saturation) procedure, where the face fluxes from the pressure equation are approximated by a non-linear two-point flux approximation (NL-TPFA) that guarantees monotone solutions for the absolute pressure field. The scheme is based on the construction of one-sided fluxes on each adjacent cell independently and then, the unique edge flux is built as a linear combination of the one-sided fluxes. In our NL-TPFA finite volume scheme, we use auxiliary variables that are located on the vertices of the primal mesh. The nodal auxiliary unknowns are written as linear combinations of the neighboring cell-centered unknowns reducing our scheme to a fully cell-centered one. To solve the non-linear system of equations and to guarantee monotone solutions for arbitrarily anisotropic permeability tensors, we use the Picard iteration method with the Anderson acceleration technique to improve the computational efficiency. On the other hand, to solve the hyperbolic saturation equation, we propose a modified second-order finite volume method. The basic idea of our method is that the reconstructed saturation on the edge that violates the local Discrete Maximum Principle (DMP) is limited, otherwise, the reconstructed saturation is expressed as a convex combination of its unlimited and limited reconstructed values.
•Our finite volume method handles highly heterogeneous and anisotropic reservoirs and full permeability tensors.•The pressure equation is approximated by a monotone Non-Linear Two Point Flux Approximation (NL-TPFA).•The Anderson Acceleration (AA) strategy is used to speed up the solution of the non-linear system of equations.•The saturation equation is approximated by a Modified High Order MUSCL-type Finite Volume method (M-HOMFV).•The numerical formulation works with general polygonal meshes.
La protesta ciudadana adquiere la categoría de acto vandálico donde el anacronismo de la monumentalidad se convierte en un abuso ideológico del espacio público. La visibilidad pública del franquismo ...provoca una reacción violenta en sectores de la sociedad española que desean eliminar de la memoria colectiva su relato político. El objetivo general de este estudio consiste en explorar el gesto vandálico contra el patrimonio monumental español en la protesta política ciudadana. Este estudio de carácter exploratorio se centra en el acto vandálico sobre la monumentalidad conmemorativa de gran potencia simbólica heredada del franquismo, pero, al mismo tiempo, muestra el efecto del vandalismo sobre el monumento democrático que reivindica la memoria de las víctimas del franquismo en la Guerra Civil y durante la Dictadura. Por ello, abordamos el paisaje ligado a la memoria histórica conformado por aquello que perdura de la monumentalidad franquista y por del conjunto de la monumentalidad democrática: los monumentos levantados durante el primer franquismo en recuerdo a sus caídos, los monumentos del segundo franquismo en los que se omiten los nombres de los mártires, el conjunto monumental simbólico de la etapa democrática en memoria a las víctimas republicanas, represaliados y exiliados y, finalmente, los monumentos a la democracia. En el diseño metodológico hemos recuperado las imágenes de actos vandálicos recogidos por el fotoperiodismo entre 2007 y 2022, periodo entre las dos leyes españolas publicadas en referencia a la Memoria Histórica y Democrática: Ley 52/2007, de 26 de diciembre conocida por “Ley de la Memoria Histórica” y Ley 20/2022 de 19 de octubre, de Memoria Democrática. Se busca la evidencia empírica en el registro de las imágenes que captaron los ataques y sus consecuencias. El análisis se enmarca en los actuales estudios visuales que suman un programa conceptual pluridisciplinar (historia, semiótica, teoría del arte, estética, etc.). Los resultados muestran la complejidad de la significación y la resignificación del patrimonio monumental franquista en España y las características de la movilización ciudadana contra los monumentos relacionados con la Memoria Histórica. La conclusión preferente del estudio afirma que el acto vandálico surge frente a la inoperatividad de las administraciones españolas (municipales, autonómicas o nacionales) en la regeneración urbana de una herencia patrimonial franquista con réplicas combativas populares. Este gesto vandálico de naturaleza ideológica, pese a su ilegalidad, se entiende también como una respuesta insurgente de la ciudadanía contra la contingencia de los contenidos simbólicos del anacronismo visual. Mientras se soluciona su presencia en el espacio público por las autoridades españolas en cumplimiento de la Ley, se ha establecido una guerra de imágenes entre demócratas y reducidos grupos neofascistas alrededor de monumentos y memoriales. El vandalismo como fenómeno visual implica el daño o la destrucción de imágenes, pero esto no siempre implica dejar un vacío. En los resultados se evidencia cómo parte de los actos son utilizados para reemplazar unas imágenes por otras o para imponer la simbología de la ideología de aquel que realiza la acción, dando así muestra del gesto político que conlleva la acción vandálica objeto de este estudio. La agresión a los monumentos levantados en memoria de las víctimas del franquismo evidencia una contienda visual en el espacio público urbano.
One of the main difficulties in the geotechnical design process lies in dealing with uncertainty.Uncertainty is associated with natural variation of properties,and the imprecision and ...unpredictability caused by insufficient information on parameters or models.Probabilistic methods are normally used to quantify uncertainty.However,the frequentist approach commonly used for this purpose has some drawbacks.First,it lacks a formal framework for incorporating knowledge not represented by data.Second,it has limitations in providing a proper measure of the confidence of parameters inferred from data.The Bayesian approach offers a better framework for treating uncertainty in geotechnical design.The advantages of the Bayesian approach for uncertainty quantification are highlighted in this paper with the Bayesian regression analysis of laboratory test data to infer the intact rock strength parameters sci and mi used in the HoekeBrown strength criterion.Two case examples are used to illustrate different aspects of the Bayesian methodology and to contrast the approach with a frequentist approach represented by the nonlinear least squares(NLLS)method.The paper discusses the use of a Student’s t-distribution versus a normal distribution to handle outliers,the consideration of absolute versus relative residuals,and the comparison of quality of fitting results based on standard errors and Bayes factors.Uncertainty quantification with confidence and prediction intervals of the frequentist approach is compared with that based on scatter plots and bands of fitted envelopes of the Bayesian approach.Finally,the Bayesian method is extended to consider two improvements of the fitting analysis.The first is the case in which the HoekeBrown parameter,a,is treated as a variable to improve the fitting in the triaxial region.The second is the incorporation of the uncertainty in the estimation of the direct tensile strength from Brazilian test results within the overall evaluation of the intact rock strength.
•The diffusion equation is solved by a new non-orthodox MPFA-QL finite volume method.•Our method handles highly heterogeneous and anisotropic media.•It reproduces piecewise linear solutions ...exactly.•The formulation works with general polygonal unstructured meshes.•For highly anisotropic media and very distorted meshes, the stencil may be non-local.
In this paper, we present a new linear cell-centered finite volume multipoint flux approximation (MPFA-QL) scheme for discretizing diffusion problems on general polygonal meshes. This scheme uses a quasi-local stencil, based upon the conormal decomposition, to approximate the control face flux when solving the steady state diffusion problem, being able to reproduce piecewise linear solutions exactly and it is very robust when dealing with heterogeneous and highly anisotropic media and severely distorted meshes. In our linear scheme, we first construct the one-sided fluxes on each control surface independently and then a unique flux expression is obtained by a convex combination of the one-sided fluxes. The unknown values at the vertices that define a control surface are interpolated by means of a linearity-preserving interpolation procedure, considering control volumes surrounding these vertices. To show the potential of the MPFA-QL scheme, we solve some benchmark using triangular and quadrilateral meshes and we compare our scheme with other numerical formulations found in literature.
•Incorporation of optical fibers into PDMS microdevices for photometric detection.•Spectrophotometric detection of total polyphenols content in white wine using microfluidics.•Sample throughput of 5 ...determinations per minute.
Absorbance detection in food microdevices has not been thoroughly used due to low levels of sensitivity in measurements. Thus, it is necessary to develop microfluidic methods for improving photometric detection. For this purpose, a simple coupled-optical-fiber-polydimethylsiloxane (PDMS) microdevice was developed, to quantify polyphenols content in white wine employing the Folin-Ciocalteu reaction method. A 6V and 10W halogen lamp with an optical path length of 7mm between optical fibers, which were placed into the microchip, using guides at the outlet of the flow, increased the level of sensitivity during detection. The linear range was from 0.03mmol/L to 0.18mmol/L. Thus, the corresponding equation was: Abs=4.00(±0.16) tannic acid+0.17(±0.017). Intra-laboratory repeatability and reproducibility percentages were 2.95% and 6.84%, respectively. Such results were compared to those obtained from applying the conventional flow-injection analysis method, based on the same type of reaction. The relative error between methods was less than 13%.
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