Modern data regarding incidence and modes of death of patients with aortic stenosis (AS) are restricted to tertiary centers or studies of aortic valve replacement (AVR).
To provide new insights into ...the natural history of outpatients with native AS based on a large regionwide population study with inclusion by all cardiologists regardless of their mode of practice.
Between May 2016 and December 2017, consecutive outpatients with mild (peak aortic velocity, 2.5-2.9 m/s), moderate (peak aortic velocity, 3-3.9 m/s), and severe (peak aortic velocity, ≥4 m/s) native AS graded by echocardiography were included by 117 cardiologists from the Nord-Pas-de-Calais region in France. Analysis took place between August and November 2020.
Natural history, need for AVR, and survival of patients with AS were followed up. Indications for AVR were based on current guideline recommendations.
Among 2703 patients (mean SD age, 76.0 10.8 years; 1260 46.6% women), 233 (8.6%) were recruited in a university public hospital, 757 (28%) in nonuniversity public hospitals, and 1713 (63.4%) by cardiologists working in private practice. A total of 1154 patients (42.7%) had mild, 1122 (41.5%) had moderate, and 427 (15.8%) had severe AS. During a median (interquartile range) of 2.1 (1.4-2.7) years, 634 patients underwent AVR and 448 died prior to AVR. Most deaths were cardiovascular (200 44.7%), mainly associated with congestive heart failure (101 22.6%) or sudden death (60 13.4%). Deaths were noncardiovascular in 186 patients (41.5%) and from unknown causes in 62 patients (13.8%). Compared with patients with mild AS, there was increased cardiovascular mortality in those with moderate (hazard ratio, 1.47 95% CI, 1.07-2.02) and severe (hazard ratio, 3.66 95% CI, 2.52-5.31) AS. The differences remained significant when adjusted for baseline characteristics or in time-dependent analyses considering AS progression. In asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality (hazard ratio, 0.99 95% CI, 0.44-2.21).
While patients in this study with moderate AS had a slightly higher risk of cardiovascular death than patients with mild AS, this risk was much lower than that observed in patients with severe AS. Moreover, in asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality.
Introduction: There is non consensus today for the treatment of PTCL. The five years OS with the CHOP regimen is estimated to 40%. A five years OS of 65% have been expected with an alternating ...VIP/ABVD regimen in a cohort ot 58 patients (pts) retrospectively studied by the same institution in Grenoble FRANCE (results presented at the french haematology society in 2000).
Aim of the study and methods: To confirm the superiority of the VIP/ABVD in first line for pts with PTCL. We have compared the 2 years EFS of pts receiving 8x CHOP21 or 6 alternating VIP/ABVD in a random manner. The VIP/ABVD regimen consisted of an alternance of three VIP regimen (VP16 100 mg/sqm D1 to D3; Ifosfamide 1000 mg/sqm D1 to D5 and Cisplatinum 20 mg/sqm D1 to D5) and three ABVD (Adriblastin 50 mg/sqm, Bleomycin 10 mg/sqm, Vinblastin 10 mg/sqm and Deticene 375 mg/sqm D1 and D14). A 40 grays IF irradiation was systematically used for AA stage I-II and on the tumoral sites larger than 5 cm to complete the treatment plan.
Results: 100 pts were included and 88 retained after a centralized pathologic review. 57 pts were diagnosed as PTCLu, 15 LAI, 10 T and 4 NTNB anaplasic, 1 angiocentric and 1 NK type. 45 pts received the CHOP and 43 the VIP/ABVD.
53/88 pts (60%) achieved a CR (34) or PR>75% (19). With a median Fup of 26.5 months EFS and OS are respectively 40% at 2 years and 40% at 4 y. There is no difference between the two groups. Two factors but not the IPI score have significantly influenced the survivals: histologic types (anaplasic vs no anaplasic) and AA stage (I–II vs III–IV).
Conclusion: The VIP/ABVD is not superior to the CHOP regimen for the treatment of PTCL. The combination Ann Arbor stage and the histologic pattern is the best predictive factor of the survivals. New innovative approach are mandatory to improve the prognostic of PTCL.
The treatment of Mantle Cell Lymphoma (MCL) and the predictive variables of response to chemotherapy and survival are largely discussed. The French Goelams group conducted between 1996 and 2000, a ...first line phase II prospective trial for MCL patients to test the efficacy of the VAD+C regimen, explore the effect of ASCT on patients under 60 and identify prognostic factors.
Treatment: it consisted for the first step of 4 cycles of VAD+C regimen (classical VAD with vincristine, adriblastine, dexamethasone associated with chlorambucil 12 mg/D from D20 to D29. interval between two cycles 35 days). The responders (cheson criteria) went to the second step wich consisted of 4 other VAD+C regimen for patients over 60 years or for patients under 61 years, 2 other VAD+C regimen followed by a ASCT with preparative regimen including Alkeran 140 and a 8 grays TBI.
Results: 90 patients were included and finally 74 retained after the pathologic review. Fifty (78%) were common forms and 24 blastoid variants. For the 74 eligible patients (40 under 61years and 34 over 60), the ORR after 4 cycles of VAD+C was 73% and 46% of the patients were in CR/CRu. ASCT influenced significantly the PFS, with a median survival of 20 months for non transplanted patients versus 37 months for ASCT recipients (p=0,001) and showed a tendency for a better OS (p=0.07). Six independent prognostic factors (PF) were identified as influencing OS: blastic variants, LDH level, lymphocytosis>5G/L, MIB1proliferation index, performance status and B symptoms. This allows to propose a new prognostic index which stratifies patients at diagnosis into 3 prognostic groups, with 0 or 1 PF (n=34, 46%), 2 or 3 PF (n=29, 39%) and 4 or more PF (n=11, 15%). For these three groups, median OS was respectively of 68, 41 and 7 months (p=0.0001).
Conclusion: The VAD+C regimen thus appears as a good regimen for MCL with few prognosis factors, which can effectively be completed by an ASCT for young responders' patients.
Objective: evaluate the predictive value of the FDG-PET on the evolution of Follicular lymphomas.
Methods: FDG-PET was performed in 17 consecutive patients treated for follicular lymphoma during the ...course of their treatment (ttt): 8 were evaluate early (Ea) after the second course of chemotherapy (CT) and 9 later (La) after the third course (5 pts) or the fourth (4 pts). 9 were treated at diagnosis and 8 at relapse. 15 histologic grade 1–2 received 6 courses of Rituximab-VAD-Chlorambucil (n=13) or R-miniCHVP (n=2) and two grade 3 a R-CHOP like regimen. 12 were intensified with haematopoietic stem cell transplantation (10 auto, 2 allo). 6 were Flipi 0–1, 3 Flipi 2 and 8 Flipi 3–4.
Results:
Among the 8 Ea, only 3 negativate their FDG-PET, 4 had a minimal uptake and one remained positive (he relapsed 2 months after the completion of their ttt). 4/4 pts with minimal uptake became negative after the completion of the ttt. 7/7 negative pts remained relapse free (Median Fup 17 months).
Among the 9 La, 8 were negative (5/5 after the third course) and one had a residual uptake after the fifth course (he died disease free from non haematolgical cause). One/8 negative patient have relapsed 5 months after ttt, 7 are alive and disease free. The 2 histologic grades 3 were Ea. Negative. Flipi 0–1(n=6) or Flipi 2 (n=3) were all negative. The Ea. Positive and the La. Residual were Flipi 3.
Conclusion
The best time of evaluation for the follicular lymphoma might be later than for High grade and might be proposed after three courses of chemotherapy when associated with rituximab. The Flipi seems to be correlated to the FDG-Pet response. These preliminary results are encouraging to define the predictive value of FDG-PET for follicular lymphoma survival, especially for the flipi 3.
Recent advances in molecular biomonitoring open new horizons for aquatic ecosystem assessment. Rapid and cost-effective methods based on organismal DNA or environmental DNA (eDNA) now offer the ...opportunity to produce inventories of indicator taxa that can subsequently be used to assess biodiversity and ecological quality. However, the integration of these new DNA-based methods into current monitoring practices is not straightforward, and will require coordinated actions in the coming years at national and international levels.
To plan and stimulate such an integration, the European network DNAqua-Net (COST Action CA15219) brought together international experts from academia, as well as key environmental biomonitoring stakeholders from different European countries. Together, this transdisciplinary consortium developed a roadmap for implementing DNA-based methods with a focus on inland waters assessed by the EU Water Framework Directive (2000/60/EC). This was done through a series of online workshops held in April 2020, which included fifty participants, followed by extensive synthesis work.
The roadmap is organised around six objectives: 1) to highlight the effectiveness and benefits of DNA-based methods, 2) develop an adaptive approach for the implementation of new methods, 3) provide guidelines and standards for best practice, 4) engage stakeholders and ensure effective knowledge transfer, 5) support the environmental biomonitoring sector to achieve the required changes, 6) steer the process and harmonise efforts at the European level.
This paper provides an overview of the forum discussions and the common European views that have emerged from them, while reflecting the diversity of situations in different countries. It highlights important actions required for a successful implementation of DNA-based biomonitoring of aquatic ecosystems by 2030.
In the hybrid laser-arc welding process, a laser beam and an electric arc are coupled in order to combine the advantages of both processes: high welding speed, low thermal load and high depth ...penetration thanks to the laser; less demanding on joint preparation/fit-up, typical of arc welding. Thus the hybrid laser-MIG/MAG (Metal Inert or Active Gas) arc welding has very interesting properties: the improvement of productivity results in higher welding speeds, thicker welded materials, joint fit-up allowance, better stability of molten pool and improvement of joint metallurgical quality. The understanding of the main relevant involved physical processes are therefore necessary if one wants for example elaborate adequate simulations of this process. Also, for an efficient use of this process, it is necessary to precisely understand the complex physical phenomena that govern this welding technique. This paper investigates the analysis of the effect of the main operating parameters for the laser alone, MAG alone and hybrid Laser/MAG welding processes. The use of a high speed video camera allows us to precisely characterize the melt pool 3D geometry such as the measurements of its depression and its length and the phenomena occurring inside the melt pool through keyhole-melt pool-droplet interaction. These experimental results will form a database that is used for the validation of a three-dimensional thermal model of the hybrid welding process for a rather wide range of operating parameters where the 3-D geometry of the melt pool is taken into account.
Summary Multiple sclerosis (MS) is most generally considered as a severe disease with high physical and mental risks of disability. Since the end of the 1990s, several high cost long-term ...disease-modifying treatments provided some clinical efficiency. However, patient's follow-up was needed for the detection and the assessment of their side-effects. The “Observatoire français de la sclérose en plaques” (OFSEP) project aims to improve the clinical, biological and imaging systematic longitudinal follow-up of patients. It should increase the quality, efficiency and safety of patients’ care, with a unique opportunity of large scale, about 41,000 patients followed in 62 French centers using the European Database for Multiple Sclerosis (EDMUS) software. OFSEP is divided into three working groups (clinical, biological and imaging). The imaging working group defines standards for routine MRI follow-up in the whole cohort and contains three subgroups: acquisition, workflow, and data processing. A common and feasible brain and spinal cord acquisition protocol has been defined by the acquisition group, and accepted by the OFSEP steering and scientific committees. This protocol can be implemented in all French MRI centers. The major MRI manufacturers have agreed to provide the dedicated collection of sequences as an “OFSEP box” with every software upgrade or new MRI machine. The new OFSEP protocol will provide a unique opportunity to study a population-based collection of data from people with MS.
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