The transcaval (TCv) vascular approach is increasingly used in transcatheter aortic valve replacement (TAVR) in patients unsuitable for the criterion-standard transfemoral approach. We aimed to ...evaluate the efficacy, safety, and clinical outcomes associated with TCv-TAVR.
A systematic review and meta-analysis was conducted by searching PubMed/Medline, Embase, and the Cochrane Library for all articles assessing the TCv approach published through December 2023. Outcomes included 30-day and 1-year all-cause mortality (ACM), 30-day rehospitalisation, perioperative complications and postoperative complications at 30 days. The meta-analysis was registered on the PROSPERO database with the identifier CRD42024501921.
A total of 8 studies with 467 patients were included. TCv-TAVR procedures achieved a success rate of 98.5%. TCv-TAVR was associated with a 30-day ACM rate of 6.4% (95% confidence interval CI: 3.9%-8.2%), a 1-year ACM rate of 14.4% (95% CI 2.3%-27.6%) and a 30-day rehospitalisation rate at of 4.4% (95% CI 2.2%-10.6%). Postoperative stroke or transient ischemic attack, major vascular complications, and major or life-threatening bleeding occurred in 3.9%, 8.5%, and 10.1% of cases, respectively. Cumulative meta-analyses showed a trend of decreasing rates of vascular complications.
The TCv approach in TAVR demonstrated a reassuring efficacy and safety profile, with mortality and postoperative complication rates similar to those reported for supra-aortic alternative TAVR access routes. The temporal decrease in vascular complications suggests potential improvements in procedural techniques and device technology. These findings further support the TCv approach as a viable option in patients ineligible for the transfemoral access.
CRD42024501921
La voie d’abord trans-cavale (TC) est de plus en plus utilisée pour pratiquer une implantation trans-cathéter de valvule aortique (ITVA) lorsque la voie d’abord de référence, la voie trans-fémorale, ne convient pas. Nous nous sommes employés à évaluer l’efficacité, l’innocuité et les résultats cliniques associés à l’ITVA utilisant la voie d’abord TC (ITVA-TC).
Nous avons réalisé une revue systématique et une méta-analyse en recherchant dans les bases de données PubMed/Medline, Embase et Cochrane Library tous les articles portant sur la voie d’abord TC publiés jusqu’en décembre 2023. Les paramètres évalués étaient la mortalité toutes causes confondues à 30 jours et à 1 an, la réadmission à l’hôpital dans les 30 jours, les complications périopératoires et les complications postopératoires à 30 jours. La méta-analyse a été enregistrée dans la base de données PROSPERO sous l’identifiant CRD42024501921.
Au total, 8 études totalisant 467 patients ont été incluses. Le taux de réussite des interventions d’ITVA-TC a été de 98,5 % . L’ITVA-TC a été associée à un taux de mortalité toutes causes confondues à 30 jours de 6,4 % (intervalle de confiance IC à 95 % : 3,9 à 8,2 %), à un taux de mortalité toutes causes confondues à 1 an de 14,4 % (IC à 95 % : 2,3 à 27,6 %) et à un taux de réadmission à l’hôpital dans les 30 jours de 4,4 % (IC à 95 % : 2,2 à 10,6 %). Un AVC ou un accident ischémique transitoire, des complications vasculaires majeures et une hémorragie majeure ou menaçant le pronostic vital après l’intervention ont été observés dans 3,9 %, 8,5 % et 10,1 % des cas, respectivement. Les méta-analyses cumulatives ont mis en évidence une tendance à la baisse des taux de complications vasculaires.
La voie d’abord TC utilisée pour pratiquer une ITVA s’est avérée d’une efficacité et d’une innocuité rassurantes, les taux de mortalité et de complications postopératoires étant similaires à ceux signalés lorsque les voies d’accès supra-aortiques sont utilisées. La diminution temporelle des complications vasculaires indique une amélioration possible des techniques et de la technologie. Ces résultats viennent confirmer la viabilité de l’utilisation de la voie d’abord TC lorsque la voie d’abord trans-fémorale ne convient pas.
CRD42024501921
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Understanding prognosis, especially long-term outcome, in advanced nonsmall cell lung cancer (NSCLC) is crucial to inform patients, guide treatment and plan supportive and palliative care.
Prognostic ...factors influencing overall survival (OS) and progression-free survival (PFS) in 2082 patients with wild-type (WT)-NSCLC (629 M1a, 249 M1b, 1204 M1c) are reported. Patients were included in the prospective German CRISP registry recruiting in >150 centres. Analysis for pre-therapeutic factors was based on results from Cox proportional hazard models.
Current M-descriptors of the Union for International Cancer Control-8 staging system were validated: M1a and M1b patients had significantly longer median time to events compared to M1c (OS/PFS 16.4/7.2 months, 17.8/6.7 months and 10.9/5.4 months, respectively). OS and PFS were influenced by number and location of metastatic organ systems. M1c and four or more metastatic organs involved had shorter OS and PFS than M1c with one to three organs (OS hazard ratio (HR) 1.69, p<0.001; PFS HR 1.81, p<0.001). M1b-liver metastases had shorter OS/PFS than M1b involving other organs (OS HR 2.70, p=0.006; PFS HR 2.48, p=0.007). Based on number of involved organs (orgsys) and liver metastases, two risk groups (low-risk: M1a, M1b-non-liver, M1c-1-3-orgsys-non-liver; high-risk: M1c-liver, M1b-liver, M1c-4+-orgsys) with significantly different prognoses could be amalgamated (median OS/PFS 14.3/6.5 months and 7.7/4.1 months, respectively). Other favourable factors were female gender and Eastern Cooperative Oncology Group stage 0, with age showing no impact. Those with T1- or N0-status were associated with longer OS than T2-4 or N2-3.
In this large observational dataset, we further defined factors for outcome in WT-NSCLC, including increased number of involved metastatic organ systems and liver metastases, as those with overall poorer prognosis and reduced survival chance.
The factories of the future will be highly digitalized in order to enable flexible and interconnected manufacturing processes. Especially wireless technologies will be beneficial for industrial ...automation. However, the high density of metallic objects is challenging for wireless systems due to multipath fading. In order to understand the signal propagation in industrial environments, this paper provides results from a number of channel measurement campaigns funded by the German research initiative “Reliable wireless communication in the industry”. We give an overview of different measurement scenarios covering visible light communication and radio communication below 6 GHz. We analyze large and small scale parameters as well as delay statistics of the wireless channels. Finally, we discuss the importance of the results for the definition of industrial channel models.
Background and Purpose:
To identify factors associated with prior stroke at presentation in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO).
Methods:
We studied cross-sectional ...data from the International PFO Consortium Study (NCT00859885). Patients with first-ever stroke and those with prior stroke at baseline were analyzed for an association with PFO-related (right-to-left shunt at rest, atrial septal aneurysm, deep venous thrombosis, pulmonary embolism, and Valsalva maneuver) and PFO-unrelated factors (age, gender, BMI, hypertension, diabetes mellitus, hypercholesterolemia, smoking, migraine, coronary artery disease, aortic plaque). A multivariable analysis was used to adjust effect estimation for confounding, e.g., owing to the age-dependent definition of study groups in this cross-sectional study design.
Results:
We identified 635 patients with first-ever and 53 patients with prior stroke. Age, BMI, hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease, and right-to-left shunt (RLS) at rest were significantly associated with prior stroke. Using a pre-specified multivariable logistic regression model, age (Odds Ratio 1.06), BMI (OR 1.06), hypercholesterolemia (OR 1.90) and RLS at rest (OR 1.88) were strongly associated with prior stroke.Based on these factors, we developed a nomogram to illustrate the strength of the relation of individual factors to prior stroke.
Conclusion:
In patients with CS and PFO, the likelihood of prior stroke is associated with both, PFO-related and PFO-unrelated factors.
In industrial environments an increasing amount of wireless devices are used, which utilize licence-free bands. As a consequence of this mutual interferences of wireless systems might decrease the ...state of coexistence. Therefore, a central coexistence management system is needed, which allocates conflict-free resources to wireless systems. To ensure a conflict-free resource utilization, it is useful to predict the prospective medium utilisation before resources are allocated. This paper presents a self learning concept, which is based on reinforcement learning. A simulative evaluation of reinforcement learning agents based on neural networks, called deep Q-networks and double deep Q-networks, was realised for exemplary and practically relevant coexistence scenarios. The evaluation of the double deep Q-network showed, that a prediction accuracy of at least 98 % can be reached in all investigated scenarios.
The means by which cortical neural networks are able to efficiently solve inference problems remains an open question in computational neuroscience. Recently, abstract models of Bayesian computation ...in neural circuits have been proposed, but they lack a mechanistic interpretation at the single-cell level. In this article, we describe a complete theoretical framework for building networks of leaky integrate-and-fire neurons that can sample from arbitrary probability distributions over binary random variables. We test our framework for a model inference task based on a psychophysical phenomenon (the Knill-Kersten optical illusion) and further assess its performance when applied to randomly generated distributions. As the local computations performed by the network strongly depend on the interaction between neurons, we compare several types of couplings mediated by either single synapses or interneuron chains. Due to its robustness to substrate imperfections such as parameter noise and background noise correlations, our model is particularly interesting for implementation on novel, neuro-inspired computing architectures, which can thereby serve as a fast, low-power substrate for solving real-world inference problems.
Molecular methods are used widely to measure genetic diversity within populations and determine relationships among species. However, it is difficult to observe genomic evolution in action because ...these dynamics are too slow in most organisms. To overcome this limitation, we sampled genomes from populations of Escherichia coli evolving in the laboratory for 10,000 generations. We analyzed the genomes for restriction fragment length polymorphisms (RFLP) using seven insertion sequences (IS) as probes; most polymorphisms detected by this approach reflect rearrangements (including transpositions) rather than point mutations. The evolving genomes became increasingly different from their ancestor over time. Moreover, tremendous diversity accumulated within each population, such that almost every individual had a different genetic fingerprint after 10,000 generations. As has been often suggested, but not previously shown by experiment, the rates of phenotypic and genomic change were discordant, both across replicate populations and over time within a population. Certain pivotal mutations were shared by all descendants in a population, and these are candidates for beneficial mutations, which are rare and difficult to find. More generally, these data show that the genome is highly dynamic even over a time scale that is, from an evolutionary perspective, very brief.
THE ARCTIC Druckenmiller, M. L.; Moon, T.; Thoman, R.
Bulletin of the American Meteorological Society,
08/2021, Letnik:
102, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Industrial wireless communication in license-free spectrum bands such as the 2.4-GHz-ISM band suffer from motion and multipath effects, which cause a high time- and frequency-variant channel ...attenuation. Additionally, mutual interference from heterogeneous wireless technologies limits real-time capabilities of industrial wireless technologies. Therefore, performance validations of industrial wireless technologies within appropriate industrial wireless environments are necessary. In this paper, we present the first raw measurement data set publication of an industrial wireless environment characterization in a data repository for free public access to enable transparent industrial wireless technology validation and to enhance their comparability. We characterize the whole license-free 2.4-GHz-ISM band with a time resolution of 110 μs and a frequency resolution of 1MHz in a coexistence scenario with four antennas obstructed by robot arm movements. Additionally, the frequency and time variance of the measured channel attenuations are analyzed.
Simple cyclic disulfides under high tension mediate the uptake of giant substrates, that is, liposomes and polymersomes with diameters of up to 400 nm, into HeLa Kyoto cells. To place them at the ...surface of the vesicles, the strained disulfides were attached to the head‐group of cationic amphiphiles. Bell‐shaped dose response curves revealed self‐activation of the strained amphiphiles by self‐assembly into microdomains at low concentrations and self‐inhibition by micelle formation at high concentrations. Poor colocalization of internalized vesicles with endosomes, lysosomes, and mitochondria indicate substantial release into the cytosol. The increasing activity with disulfide ring tension, inhibition with Ellman's reagent, and inactivity of maleimide and guanidinium controls outline a distinct mode of action that deserves further investigation and is promising for practical applications.
Die spannungs‐ und thiolvermittelte zelluläre Aufnahme riesiger Substrate wurde für Lipo‐ und Polymersomen erreicht. Der Prozess ist charakterisiert durch eine Zunahme der Aktivität mit der Disulfid‐Ringspannung, Inaktivität positiver Ladungen und Maleimide, Inhibition durch Ellman‐Reagens, Selbstaktivierung in Mikrodomänen und Selbstinhibition durch Mizellenbildung.
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