Background
Published data about nonagenarians with acute coronary syndrome (ACS) were mainly descriptive and limited by small sample sizes and unadjusted outcomes. We aim to describe the ...characteristics, management, and the impact of an invasive strategy on major adverse events in elderly patients hospitalized with ACS with focus on the nonagerians.
Methods and Results
We analyzed data collected as part of the AMI‐OPTIMA study, a cluster‐randomized study of knowledge translation intervention versus usual care on optimal discharge medications in patients admitted with ACS at 24 Canadian hospitals. To determine whether an invasive strategy improved outcomes in the elderly, we used inverse probability weighting to adjust for confounders between patients who underwent invasive versus conservative strategies. Of 4,569 consecutive patients: 2,395 (52%) were <70 years old, 1,031 (23%) were septuagenarians, 941 (21%) were octogenarians, and 202 (4.4%) were nonagenarians. An invasive strategy was associated with reduced in‐hospital all‐cause mortality in all age groups: 1.1% versus 3.8% in patients <70 years old (P < 0.001), 2.9% versus 7.4% in septuagenarians (P < 0.001), 5.1% versus 14.7% in octogenarians (P < 0.001), and 12.0% versus 25.1% in nonagenarians (P = 0.001). An invasive strategy was also associated with higher thrombolysis in myocardial infarction major bleeds in the nonagenarians (9.0% vs. 2.0%; P = 0.003).
Conclusions
The reduction in in‐hospital mortality associated with an invasive strategy in elderly and nonagenarians presented with ACS is generating hypothesis and merits further studies to confirm these benefits and to guide clinicians in the management of these high‐risk patients.
Cardiac rehabilitation programs provide a valuable opportunity to promote the adoption of healthy lifestyle behaviors in patients with atherosclerotic cardiovascular diseases (ASCVD) and metabolic ...comorbidities, including metabolic syndrome and prediabetes. However, strategies to reverse these conditions remain to be explored. The DIABEPIC-1 study aimed to assess the feasibility of an enhanced six-month cardiac rehabilitation program for patients with ASCVD while investigating prediabetes and metabolic syndrome remission.
The study combined exercise training with a comprehensive nutritional intervention, emphasizing reducing ultra-processed foods, adopting a Mediterranean diet, and implementing time-restricted eating. Baseline, three-month, and six-month assessments included segmental body composition measurements, blood analysis, maximal exercise testing, nutritional diaries recorded with the Keenoa™ AI App, and lifestyle questionnaires. Remission criteria included a return to <5.7% of HbA1c and <3 NCEP/ATP-III Criteria for prediabetes and metabolic syndrome, respectively.
36 participants were recruited. The study demonstrated completion rates of 94.4% at three months and 88.9% at six months and a mean compliance rate of 92.5% for planned clinical appointments. Significant reductions in waist circumference (-9.2 cm, p<0.001) and weight (-8.0 kg, p<0.001) were observed. Improved glycemic and lipid profiles, insulin resistance markers, and liver health were noted. Participants enhanced cardiorespiratory fitness, reduced ultra-processed food consumption, and increased adherence to the Mediterranean diet and time-restricted eating. Notably, 50% achieved prediabetes remission, and 70% with metabolic syndrome at baseline achieved remission.
The study demonstrates the possibility of enhancing cardiac rehabilitation with an intensive nutritional intervention, yielding clinically significant outcomes, including remission of key risk factors in a substantial number of ASCVD patients.
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Objectives To determine whether catheter-based near-infrared spectroscopy (NIRS) signals obtained with a novel catheter-based system from coronaries of patients are similar to those from autopsy ...specimens and to assess initial safety of NIRS device. Background An intravascular NIRS system for detection of lipid core-containing plaques (LCP) has been validated in human coronary autopsy specimens. The SPECTACL (SPECTroscopic Assessment of Coronary Lipid) trial was a parallel first-in-human multicenter study designed to demonstrate the applicability of the LCP detection algorithm in living patients. Methods Intracoronary NIRS was performed in patients undergoing percutaneous coronary intervention. Acquired spectra were blindly compared with autopsy NIRS signals with multivariate statistics. To meet the end point of spectral similarity, at least two-thirds of the scans were required to have >80% of spectra similar to the autopsy spectra. Results A total of 106 patients were enrolled; there were no serious adverse events attributed to NIRS. Spectroscopic data could not be obtained in 17 (16%) patients due to technical limitations, leaving 89 patients for analysis. Spectra from 30 patients were unblinded to test the calibration of the LCP detection algorithm. Of the remaining 59 blinded cases, after excluding 11 due to inadequate data, spectral similarity was demonstrated in 40 of 48 spectrally adequate scans (83% success rate, 95% confidence interval: 70% to 93%, median spectral similarity/pullback: 96%, interquartile range 10%). The LCP was detected in 58% of 60 spectrally similar scans from both cohorts. Conclusions This intravascular NIRS system safely obtained spectral data in patients that were similar to those from autopsy specimens. These results demonstrate the feasibility of invasive detection of coronary LCP with this novel system. (SPECTACL: SPECTroscopic Assessment of Coronary Lipid; NCT00330928 )
The automatic and connected scales measuring the weight of the hives during the honeydew are used bybeekeepers, and by research and development actors, in order to collect real-time information on ...thestate of the honeydew. This information is shared among beekeepers or service providers and scalemanufacturers, and not capitalized. The work carried out during the Casdar MIELLEES project (2017-2020) showed that it is possible to bring together a chain of competent and multidisciplinary actors todevelop tools and better use and enhance digital data from the connected scales of beekeepers. Acomputer system called SI MIELLEES was created. It collects, structures, and prepares time series foranalysis using computerized routines developed specifically. Prototypes of service applications weredesigned and tested to enhance the value of the collected data.
Les balances automatiques et connectées mesurant le poids des ruches au fil des miellées sont utiliséespar les apiculteurs, comme par les acteurs de la recherche et du développement, afin d’acquérir desinformations en temps réel sur la progression de la miellée. Ces informations sont diffusées chez lesapiculteurs ou les fournisseurs de services et constructeurs de balances mais non capitalisées. Le travailréalisé pendant le projet Casdar MIELLEES (2017-2020) montre qu’il est possible de créer une chaîned’acteurs compétents et pluridisciplinaires pour développer des outils afin de mieux utiliser et valoriserdes données numériques issues des balances connectées des apiculteurs. Un système informatique (SI)appelé le SI MIELLEES a été réalisé. Il collecte, structure, prépare et développe spécifiquement desséries temporelles pour les analyser grâce à des routines informatisées. Des prototypes d’applicationsde services ont été conçus et testés pour la valorisation des références acquises.
Contribution of piezometric measurement on knowledge and management of low water levels. Examples on the chalk aquifer in the Champagne Ardennes region.
This article is based on a BRGM study on ...piezometric indicators, threshold values of discharges and groundwater levels for the assessment of potentially pumpable volumes of chalky watersheds. A method for estimating low water levels from groundwater levels is presented from three examples of chalk aquifer ; the first one is located in Picardy and the two other in the Champagne Ardennes region. Piezometers with “ annual” cycles, used in these examples, are supposed to be representative of the aquifer hydrodynamics. The analysis leads to relatively precise and satisfactory relationships between groundwater levels and observed discharges for this chalky context. These relationships may be useful for monitoring, validation, extension or reconstruction of the low water flow. On the one hand, they allow defining the piezometric levels corresponding to the different alert thresholds of river discharges. On the other hand, they clarify the distribution of low water flow from runoff or drainage of the aquifer. Finally, these correlations give an assessment of the minimum flow for the coming weeks. Nevertheless these correlations cannot be used in order to optimize the value of pumpable volumes because it seems to be difficult to integrate the value of the effective rainfall that could occur during the draining period. Moreover, these relationships are not exploitable for multi-annual systems. Thus, in these cases, the solution seems to lie on the realization of a rainfall-runoff-piezometric level model.
Cet article s’appuie sur une étude du BRGM portant sur les indicateurs piézométriques, les valeurs seuils de débits et de niveaux de nappes pour in fine permettre une évaluation des volumes potentiellement prélevables sur les bassins versants crayeux. Une méthode permettant d’estimer les débits d’étiage à partir des niveaux piézométriques est présentée à partir de trois exemples de la nappe de la craie, en Picardie pour le premier et en Champagne Ardennes pour les deux autres. Les piézomètres à cycles «annuels » utilisés dans ces exemples sont considérés comme représentatifs du fonctionnement de leur nappe associée. L’analyse réalisée a permis d’établir, dans ce contexte crayeux, des relations univoques et relativement satisfaisantes entre niveaux piézométriques et débits observés. Ces relations peuvent être utiles à des fins de contrôle, validation, d’extension voire de reconstitution des débits d’étiage d’un cours d’eau. Elles permettent d’une part de définir les cotes piézométriques correspondant aux différents seuils d’alerte de débit des cours d’eau ; d’autre part de préciser la répartition du débit d’étiage provenant du ruissellement ou de la vidange de l’aquifère et finalement d’évaluer le débit minimal le plus critique des semaines à venir à l’aide de la vitesse de vidange de l’aquifère. Néanmoins l’utilisation de ces corrélations ne permettent pas d’optimiser la valeur des volumes potentiellement prélevables dans la mesure où il apparait difficile d’y intégrer le montant de la pluie efficace pouvant survenir durant la période de vidange. En outre, ces relations ne sont pas exploitables avec des systèmes à cycles pluri-annuels. La solution semble donc, dans ces cas-là, passer par la réalisation d’un modèle pluiedébit-niveau piézométrique.
Stollsteiner Philippe, Nicolas Jérôme, Allier Delphine, Bessière Hélène. Apport de la mesure piézométrique sur la connaissance et la gestion des étiages. Exemples sur la nappe de la Craie en Champagne Ardennes. In: 35es journées de l’hydraulique de la Société Hydrotechnique de France. Hydrométrie 2013. Paris, 15-16 mai 2013. 2013.
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