Factors associated with patent foramen ovale-related stroke: SAFAS study

BACKGROUND

Persistent foramen ovale (PFO) contributes to cryptogenic stroke and is associated with stroke recurrence, although the exact mechanism of ischemic events is not fully understood. Several biomarkers have been developed for the prediction of atrial fibrillation after stroke, but there are currently only limited data on their potential value for the diagnosis of PFO-related stroke.

METHODS

This study was a prospective single-center study that included all patients hospitalized between March 31, 2018, and January 18, 2020, in the stroke department of the Dijon University Hospital for ischemic stroke without obvious cause and without a history of atrial fibrillation. PFO was systematically screened by transthoracic echocardiography and images were reviewed by an independent cardiologist blinded from clinical data. PFO was defined according to the CLOSE trial criteria: PFO associated with interatrial septal aneurysm or significant interatrial shunt (> 30 microbubbles in the left atrium within three cardiac cycles after right atrial opacification). The potential association of PFO-related stroke with biomarkers of cardiac fibrosis and inflammation such as galectin-3, GDF-15, ST-2, osteoprotegerin and NT-proBNP was tested using multivariate backward stepwise logistic regression.

RESULTS

Of the 240 patients included in the SAFAS study, 229 had complete echocardiographic data, and 23 (10%) had PFO-related stroke. Patients with PFO-related stroke were significantly younger (58±14 vs. 69±14, P<0.001), had less frequent previous arterial hypertension (30 vs. 60%, P=0.008), and more frequent cerebellar territory involvement (26 vs. 9%, P=0.014) compared to the other patients. In addition, they had less frequently left atrial dilatation (left atrial index volume>34mL/m2 [9 vs. 35%, P=0.009]). After ROC curve analysis for definition of thresholds, PFO-related stroke patients more often had galectin-3<9.5ng/mL (59 vs. 27%, P=0.002), ST2<13380pg/ml (23 vs. 50%, P=0.007), GDF-15<1200ng/mL (59 vs. 27%, P=0.002), osteoprotegerin<1133pg/mL (82 vs. 58%, P=0.033) and NT-proBNP<300pg/mL (88 vs. 55%, P=0.009). After multivariate analysis, only galectin-3<9.5ng/mL (OR [95% CI] 3.4 [1.18; 9.8], P=0.024) and osteoprotegerin<1133pg/L (OR [95% CI] 5.0 [1.1; 22.9], P=0.038) were independently associated with PFO-related stroke.

CONCLUSION

Patients in whom cryptogenic stroke is attributed to a significant PFO have a specific clinical and biological phenotype. Low levels of galectin-3 and osteoprotegerin may help identify patients with PFO-related strokes.

High prevalence of complex coronary artery lesions in sport-related myocardial infarction. Contemporary data from the RICO survey

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Agence régionale de santé de Bourgogne Franche-Comté

Background

Underlying mechanisms for sport-related acute myocardial infarction (SR-AMI) are only poorly understood. Moreover, their coronary artery disease (CAD) characteristics and lesion complexity are poorly described.

Purpose

To characterize coronary angiographic feature of patients with SR-AMI

Methods

From the RICO database, a large regional acute MI survey, all consecutive patients hospitalized in our University Hospital from 2010 to 2021 who underwent coronary angiography for SR-MI were retrospectively analysed. SR-MI was defined as MI occurring during sport activity or within the first hour of recovery.

Results

Among the 174 patients included, most were male (n=157(91%)). Median (IQR) age was 59 y (48-66), and had ST segment elevation MI (STEMI) (n= 112 (64%)). The SR-MI often occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly experienced pre-hospital (PH) sudden cardiac arrest (SCA) (17%). Atherothrombotic risk factors were dyslipidaemia (32%), current smoking (31%) or hypertension (28%). A history of CAD was documented in 31 (18%) patients. Most (n=156(91%)) had significant lesions, of whom 140 (81%) were considered as culprit. Culprit lesions were located on left anterior descending (39%), circumflex (14%) and right coronary artery (33%). Median (IQR) Syntax score was 10.5 (6-15). The vast majority of patients (n=152 (87%)) had at least one complex lesion; 114 of them had several characteristics of complex lesion. Lesions were eccentric in 68 (39%) patients; an intraluminal thrombus was documented in 85 patients (49%), in 55% of STEMI and 37% of non-STEMI (p =0.027). However, 18 subjects (10%) had optically normal coronary angiogram or non-significant lesions, suggesting alternative mechanism such as type 2 MI. Treatment of the lesions was mainly achieved by PCI and/or stenting (n=132(77%)) or coronary artery bypass grafting (n=11(6%)). In-hospital death occurred in 11 patients (6%), of whom 10 experienced a PH-SCA and one was admitted with a cardiogenic shock during the Covid-19 pandemics lockdown. Among the 5 patients treated with extracorporeal membrane oxygenator, only one survived.

Conclusion

In our large retrospective study, SR-MI was commonly associated with complex coronary lesions, often characterized by intraluminal thrombus. Our findings suggest that the mechanisms of these events could be mainly related to type 1 MI patterns Moreover, PH-SCA was frequent, thus justifying mass-education to basic life support and deployment of automated external defibrillators, especially in the sport settings.

A novel machine learning algorithm has the potential to reduce by 1/3 the quantity of ILR episodes needing review

Background

Implantable Loop Recorders (ILRs) are increasingly used and generate a high workload for timely adjudication of ECG recordings. In particular, the excessive false positive rate leads to a significant review burden.

Purpose

A novel machine learning algorithm was developed to reclassify ILR episodes in order to decrease by 80% the False Positive rate while maintaining 99% sensitivity.

This study aims to evaluate the impact of this algorithm to reduce the number of abnormal episodes reported in Medtronic ILRs.

Methods

Among 20 European centers, all Medtronic ILR patients were enrolled during the 2nd semester of 2020. Using a remote monitoring platform, every ILR transmitted episode was collected and anonymised.

For every ILR detected episode with a transmitted ECG, the new algorithm reclassified it applying the same labels as the ILR (asystole, brady, AT/AF, VT, artifact, normal). We measured the number of episodes identified as false positive and reclassified as normal by the algorithm, and their proportion among all episodes.

Results

In 370 patients, ILRs recorded 3755 episodes including 305 patient-triggered and 629 with no ECG transmitted. 2821 episodes were analyzed by the novel algorithm, which reclassified 1227 episodes as normal rhythm. These reclassified episodes accounted for 43% of analyzed episodes and 32.6% of all episodes recorded.

Conclusion

A novel machine learning algorithm significantly reduces the quantity of episodes flagged as abnormal and typically reviewed by healthcare professionals.

Funding Acknowledgement

Type of funding sources: None. Figure 1. ILR episodes analysis

Exploring the temporal relationship between atrial fibrillation and heart failure development. Analysis from nationwide database

Background

Atrial fibrillation (AF) and heart failure (HF) often coexist and are closely intertwined, each condition worsening the other. The temporal relationships between these two disorders have not yet been fully explored. We assessed, on a nationwide scale, the prognosis of patients hospitalized with HF and AF, based on the timing of AF and HF development.

Methods

From the administrative database covering hospital care for the whole French population, we identified 1,349,638 patients diagnosed with both AF and HF between 2010 and 2018: 956,086 of these AF patients developed HF first (prevalent HF) and 393,552 developed HF after AF (incident HF). The outcome analysis (all-cause death, cardiovascular [CV] death, ischemic stroke or hospitalization for HF) was performed with follow-up starting at the time of last event between AF or HF in the whole cohort and in 427,848 propensity-score-matched patients (213,924 with incident HF and 213,924 with prevalent HF).

Results

During follow-up (mean follow-up 1.6±1.9 year), matched patients with prevalent HF had a higher risk of all-cause death (21.6 vs 19.2%/year), CV death (7.6 vs 6.5%/year) as well as non-cardiovascular death (13.9 vs 12.7%/year) than those with incident HF. The risk for ischemic stroke was lower in the prevalent HF group (1.2 vs 2.4%/year).

Conclusion

In patients hospitalized with both AF and HF, we identified two distinct clinical entities based on the chronological sequence of the two disorders. Patients in whom HF preceded AF (prevalent HF) had higher mortality and higher risk of rehospitalization for HF.

Funding Acknowledgement

Type of funding sources: None.

Sport-related acute myocardial infarction. Contemporary data from IMACS survey

Background

Sport-related (SR) acute cardiovascular (CV) events are the main cause of sudden cardiac death in the setting of sport activities. However, data are very scarce regarding onset and follow-up of SR acute myocardial infarction (AMI).

Methods

From the prospective study IMACS (Infarctus du Myocarde et Arret Cardiaque au cours du Sport) patients admitted for a SR-AMI in our university hospital from April 2018 to March 2020 were included. A 12 months follow-up (FU) was achieved through telephone interview to address CV outcomes and sport practice information. Information was obtained from relatives in case of out of hospital sudden cardiac arrest (OH-SCA).

Results

Among the 55 patients included, all were male, with median (IQR) age at 62 (55–69) y. Most common sports were cycling (n=21), fitness (n=7), swimming (n=5) and hiking (n=5). The SR-AMI occurred during effort for 39 subjects and during recovery for 16. Most SR-AMI occurred in public area (n=24), at home (n=16), or in a specific sport location (n=14). An Automated External Defibrillator (AED) was available in the SR-AMI location in only 10, but was missing in 43 (unknown for 2). In 1 subject with OH-SCA, cardiopulmonary resuscitation (CPR), initiated by witnesses, using a public AED, was unsuccessful. The 4 other patients with OH-SCA underwent successful CPR. Among the 55 subjects, 4 were vapers, of whom 1 was a dual user, 17 were current tobacco smokers, 18 were ex-smokers and 2 experienced cannabis and cocaine use. Among the smokers, most smoked (n=10) or consumed cannabis (n=1) &lt;2h before the event. Strikingly, CV history and/or recent symptoms were present in almost half (n=25). Only 10 felt symptoms exclusively during the sport session. Moreover, a medical advice for recent symptoms was found only for 3 subjects. Three patients who experienced prior AMI have neglected symptoms during the index event. Most were ST segment elevated MI (n=35). Only one patient (with OH-SCA) died &lt;3 days after hospital admission. During hospitalization, most underwent revascularization with coronary stenting (n=44) (drug eluting stent in 43 patients), or coronary artery bypass graft (n=6) and no death nor significant CV event occurred. At 1-FU, most attended a rehabilitation program (n=41) and the majority of smokers quitted (14/17), with 3 persistent smokers starting to vape. Almost half patients (n=23) decreased their physical activity, and 21 increased it. A significant rate of patient (n=9) added fitness in their usual activity, and as a main sport for 4 of them.

Conclusions

In this on-going monocentric prospective survey in SR-AMI, a high proportion of subjects had prodromal symptoms, of whom only few led to sport cessation and medical advices, when requested, failed to prevent the AMI. Our findings highlight that public and medical education are urgently warranted for SR-AMI prevention.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne Franche Comté et ARS Bourgogne Franche Comté

Pigmentation effects of blue light irradiation on skin and how to protect against them

Background

Visible light, in particular blue light, has been identified as an additional contributor to cutaneous photoageing. However, clinical studies demonstrating the clear effect of blue light on photoageing are still scarce, and so far, most studies have focused on broad‐spectrum visible light. Although there is evidence for increased skin pigmentation, the underlying mechanisms of photoageing in vivo are still unclear. Furthermore, there is still a need for active ingredients to significantly protect against blue light‐induced hyperpigmentation in vivo.

Our study had two aims: to detect visible changes in skin pigmentation following repeated irradiation of the skin with LED‐based blue light and to reduce pigmentation using suitable active ingredients.

Method

We conducted a randomized, double‐blind and placebo‐controlled clinical study on 33 female volunteers with skin phototypes III and IV. We used a repetitive blue light (4 × 60 J cm⁻², 450 nm) irradiation protocol on the volunteers’ inner forearms. Using hyperspectral imaging, we assessed chromophore status. In addition, we took chromameter measurements and photographs to assess visible hyperpigmentation.

Results

We measured significant changes in chromophore status (P < 0.001 vs baseline), that is of melanin, haemoglobin and oxygen saturation, immediately after blue light irradiation. In addition, we found visible skin colour changes which were expressed by a significant decrease in ITA° values (delta ITA° = −16.89, P < 0.001 vs baseline for the placebo group) and an increase in a* (delta a* = +3.37, P < 0.001 vs baseline for the placebo group) 24 h post‐irradiation. Hyperpigmentation and skin reddening were mitigated by both a formulation containing 3% of a microalgal product and a formulation containing 3% niacinamide.

Conclusion

Our study sets out an efficient and robust protocol for investigating both blue light‐induced cutaneous alterations, such as changes in skin chromophores, and signs of photoageing, such as hyperpigmentation. Moreover, we have shown evidence that both an extract of the microalga Scenedesmus rubescens and niacinamide (vitamin B3) have the potential to protect against blue light‐induced hyperpigmentation.

Smoking and associated unhealthy lifestyle behaviours in patients with chronic cardiac diseases during COVID-19 related lockdown

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Dijon University Hospital France

OnBehalf

CLEO-CD

Background

  Lockdown can affect tobacco smoking (TS) behaviours. 

Purpose

To evaluate the impact of lockdown on (TS) and associated lifestyle behaviours in patients with Chronic coronary syndrome (CCS) and congestive heart failure (CHF)

Methods

CCS and CHF patients were invited to answer to a phone-call questionnaire during the 1st COVID-19 lockdown start 

Results

(Table) 343 questionnaires were fit for analysis, 43 (12.5%) were current smokers (CS). CS were younger (p < 0.001), none stopped and 13 increased their consumption (main reasons were stress and boredom). CS felt more often cramped (p = 0.023). CS who increased their TS consumption showed a trend toward a higher rate of unhealthy lifestyle behaviours

Conclusions

During the lockdown, more than ¼ of CS with CCS or CHF increased their TS consumption and none quitted. Moreover, TS was often associated with other deleterious behaviours increasing their risk for short and long term

Impact of lockdown in patients with congestive heart failure during the Covid-19 pandemic

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Dijon Football Côte d"Or

OnBehalf

CLEO-CD

Background

Congestive heart failure (CHF) can be destabilized by Covid-19 (C19) lockdown.

Purpose

To evaluate the impact of lockdown in CHF patients.

Methods

150 out-patients from the HF Clinic of our hospital were invited to answer to a phone-call interview during the 7th week of first C19 lockdown .

Results

From 124 questionnaires, more than 1/5 felt worse and almost 1/4 declared a psychologic distress. CHF medications were modified in 10%. Decrease in physical activity was observed in 2/5. Almost 1/2 declared increased screen time;  smokers often increased consumption. Adherence to dietary counselling was reduced by 1/6, increase in weight and HF symptoms were common. Some patients benefitted from a teleconsultation.

Conclusions

Our patients exhibited well-being impairment and unhealthy behaviours. Medication adherence was not diminished and the reduction in care access was counterbalanced by a switch toward telehealth.

Main results

	124 patients	75 Male (M)	49 Female (F)	p value between M and F
Age, years	71.0 ± 14.0	68.9 ± 13.7	74.3 ± 14.0	0.03
Urban/Rural	82/42	49/26	33/16	0.84
HFrEF*	87	62	25	<0.001
Dilated cardiomyopathy	50	37	13	0.02
Ischemic	23	18	5	0.06
Other	51	20	31	<0.0001
Current NYHA class I/II/III/IV	39/48/28/9	29/29/14/3	10/19/14/6	0.66
History of NYHA III-IV class	94	62	32	0.03
Electronic device/Telemonitoring	77/28	54/18	23/10	<0.001/0.66
Increase in dyspnea or edema or fatigue	27	13	14	0.07
Decrease in well-being	27	12	15	0.07
Psychological distress (#)	23	15 (20.0)	8	0.64
Weight gain > 2 kg	34	22 (29.3)	12	0.68
Switch for teleconsultation (##)	16	11 (34.4)	5	1
Teleconsultation (total)	23	14	9	1
Decrease in physical activity	52	25 (33.3)	27	0.02
Increase in screen time	57	31 (41.3)	26	0.27
Increase in cigarette consumption (9 smokers)	4	3	1	1
Decrease in dietary adherence (###)	22 (17.7)	15 (20.0)	7 (14.3)	0.47

*HFrEF; # Kessler-6 score ≥ 5; ## from planned physical examination; ### salt, water, alcohol

Atrial fibrillation with or without structural abnormalities. Analysis from a nationwide database

Background

Atrial Fibrillation (AF) is often associated with underlying heart failure, valvular disease, ischemic heart disease, as well as other structural heart diseases, but can also occur as an independent entity which may be named pure AF or lone AF. Small cohort studies have suggested that lone AF patients may have a favorable prognosis in terms of mortality and ischemic stroke rates. We aimed to assess, at a nationwide scale, the prognosis of patients hospitalized with lone AF and AF associated with cardiac disease.

Methods

From the French administrative hospital-discharge PMSI database (Programme de Médicalisation des Systèmes d'Information) covering hospital care and representative of the whole French population, all consecutive patients with AF diagnosis hospitalized between 2010 and 2018 were included. From this huge database, 2,793,234 patients were included: group lone FA: 665,431, group AF and cardiac disease: 2,727,803. Incidence rates (%/year) for the outcomes (all-cause death, cardiovascular [CV] death, or ischemic stroke) during follow-up were compared between groups using incidence rate ratios (RR) for the whole cohort and also for a subgroup of 539,654 propensity score matched patients for non-cardiovascular conditions (269,827 with AF alone and 269,827 with AF and CD).

Results

The majority of this population had AF associated with a cardiac disease (n=2,127,803; 76.2%). At follow-up (median [IQR] 1.1 [0.1–3.4] years), patients with AF and CD were at higher risk of all-cause mortality (yearly incidence 13.6% vs 9.0%, RR [95% CI] 1.51 [1.50–1.52], p&lt;0.00001) and CV death (4.4% vs 1.9%, RR 2.33 [2.30–2.36], p&lt;0.00001) than those with lone AF. In the propensity score matched population (median follow-up [IQR] 1.9 [0.3–4.4] years), patients with AF and CD also had worse outcomes than patients with lone AF (yearly incidence rates for all-cause mortality: 10.6% vs 7.4%, RR 1.43 [1.42–1.45], p&lt;0.00001; and for CV death: 3.3% vs 2.0%, RR 1.64 [1.61–1.68], p&lt;0.00001). However, lone AF patients were at higher risk of ischemic stroke: yearly incidence rates 2.75% in those with lone AF vs 1.69% in patients with AF and CD (RR 0.62 [0.60–0.63], p&lt;0.00001).

Conclusion

In our large study from a nationwide database about patients hospitalized with AF, two distinct clinical entities were identified, that could explain the results highlighted: 1) the consistently higher mortality in the group associating AF and underlying heart disease (AF may bea marker for poor outcome when there is a structural heart disease; 2) Lone AF group which prognosis may be related to a higher incidence of thromboembolic events. These results could have important implications in terms of thromboembolic prevention but further studies are still needed to investigate the underlying mechanisms of embolic pathophysiology and its specific management.

Funding Acknowledgement

Type of funding source: None

Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) on magnetic resonance imaging in patients with cardiac electronic implantable devices

Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.

Estimation from cross-sectional data under a semiparametric truncation model

Cross-sectional sampling is often used when investigating inter-event times, resulting in left-truncated and right-censored data. In this paper, we consider a semiparametric truncation model in which the truncating variable is assumed to belong to a certain parametric family. We examine two methods of estimating both the truncation and the lifetime distributions. We obtain asymptotic representations of the estimators for the lifetime distribution and establish their weak convergence. Both of the proposed estimators perform better than Wang’s (1991) nonparametric maximum likelihood estimator in terms of the integrated mean squared error, when the parametric family for the truncation is sufficiently close to its true distribution. The full likelihood approach is preferable to the conditional likelihood approach in estimating the lifetime distribution, though not necessarily the truncation distribution. In an application to Alzheimer’s disease data, hypothesis tests reject the uniform truncation distribution, but several other parametric models lead to similar behaviour of the truncation and lifetime distributions after disease onset.

AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study

Background

Previous studies have indicated that accompanying socially underserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improves adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC.

Methods

This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. One hundred African patients were randomly assigned to either an AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy.

Results

We found that AMA was feasible and had significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources.

Conclusion

Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

[Interventional management of atrial fibrillation]

In 2030, the European Union will include 14 to 17 million atrial fibrillation (AF) patients, with 120,000 to 215,000 new cases each year. The increase in the prevalence of this arrhythmia has led to the development of new therapeutic intervention strategies to manage the different aspects of this disease. Thus, endocavitary or epicardial ablation of AF, by radiofrequency or cryoablation, provides superior results to antiarrhythmic therapy in controlling symptoms and preventing heart failure in paroxysmal or persistent AF. In heart failure patients with advanced AF, the ablation of the atrioventricular junction associated with the implantation of a bi-ventricular pacemaker has just demonstrated its clear superiority, bringing this technique up to date. Finally, in the event of a major bleeding risk and contraindication to anticoagulants, percutaneous occlusion of the left atrium has proven its value in preventing AF-related embolic events. The future will certainly see the emergence of new technologies but also personalized strategies based on an optimal selection of the right candidates for these interventions, thanks in particular to the contribution of imaging before the procedure.

Fear of cancer recurrence in Non- and Hodgkin lymphoma survivors during their first three years of survivorship among French patients

The aim of this study was to measure the prevalence of FCR among a sample of French lymphoma survivors and to determine factors associated with clinical levels of FCR. The study was conducted with two cross-sectional measures: sociodemographic and anxiety, depression as well as health-related quality of life (HRQoL) scores were measured at the baseline of the post-cancer period and FCR was evaluated during the first 3 years of survivorship. The prevalence of clinical levels of FCR (≥13) was evaluated by the Fear of Cancer Recurrence Inventory - Short Form (FCRI-SF) among non- and Hodgkin lymphoma survivors undergoing prior first-line chemotherapy. Among 108 lymphoma survivors with an average follow-up of 1.6 years (range 0.3-3.0 years), clinical levels of FCR (≥13) were observed for 44.4% (n = 48). Multivariate analysis indicated that baseline anxiety and low quality of life were related to clinically significant FCR levels.

Temperature-dependent transport measurements with Arduino

The current performances of single-board microcontrollers render them attractive, not only for basic applications, but also for more elaborate projects, amongst which are physics teaching or research. In this article, we show how temperature-dependent transport measurements can be performed by using an Arduino board, from cryogenic temperatures up to room temperature or above. We focus on two of the main issues for this type of experiments: the determination of the sample temperature and the measurement of its resistance. We also detail two student-led experiments: evidencing the magnetocaloric effect in Gadolinium and measuring the resistive transition of a high critical temperature superconductor. Received: 7 July 2018,  Accepted: 27 September 2018; Edited by: A. Marti,  M. Monteiro;  Reviewed by: R. Marotti, Instituto de Física, Facultad de Ingeniería - Universidad de la República, Uruguay; DOI: http://dx.doi.org/10.4279/PIP.100007 Cite as: A Hilberer, G Laurent, A Lorin, A Partier, J Bobroff, F Bouquet, C Even, J M Fischbach, C A Marrache Kikuchi, M Monteverde, B Pilette, Q Quay,  Papers in Physics 10, 100007(2018) This paper, by A Hilberer, G Laurent, A Lorin, A Partier, J Bobroff, F Bouquet, C Even, J M Fischbach, C A Marrache Kikuchi, M Monteverde, B Pilette, Q Quay, is licensed under the Creative Commons Attribution License 4.0.    

Comparative photophysical investigation of doubly-emissive photochromic-fluorescent diarylethenes

Diarylethene molecules showing photochromism and fluorescence properties in both open and closed forms, associated with two different emission colors, are very promising for applications involving ratiometric emissive photoswitches. We report here a complete study on the competition between the multiple photophysical processes involved in the excited states for two sulfone derivatives of benzothiophene-based diarylethene molecules, only differing by the substituent groups on their reactive carbon (methyl for DAE-Me and ethyl for DAE-Et). Steady-state and time-resolved spectroscopy, combined with DFT and TD-DFT calculations, allow a complete determination of the kinetic constants leading to fluorescence and photoreaction pathways in different solvents, and enlighten the specific role of the substituent group in the photophysical properties due to a shielding effect against the solvation environment. The predominant role of the non-radiative deactivation processes in such a family of molecules is shown, and a tentative excited state mechanistic scheme is proposed based on femtosecond transient absorption experiments performed on the closed forms.

The care center influences the management of lymphoma patients in a universal health care system: an observational cohort study

Background

Healthcare providers-related disparities in adherence to the treatment plan among lymphoma patients are found even in a universal healthcare system, but the mechanism remains unclear. We investigated the association between the type of care center and the relative dose intensity and determined whether it persists after adjustment for patients’ recruitment differences.

Methods

Prospective observational cohort study of 294 patients treated with standard protocols for diffuse large B-cell lymphoma (DLBCL) in teaching or community public hospitals or in private centers in the French Midi-Pyrénées region from 2006–2013. To test our assumptions, we used multinomial and mixed-effect logistic models progressively adjusted for patients’ biomedical characteristics, socio-spatial characteristics and treatment-related toxicity events.

Results

Patients treated using standard protocols in the teaching hospital had more advanced stage and poorer initial prognosis without limitation regarding the distance from the residence to the care center. Patients’ recruitment profile across the different types of care center failed to explain the difference in relative dose intensity. Low relative dose intensity was less often observed in teaching hospital than elsewhere.

Conclusion

We showed that even in a universal healthcare system, disparities in the management of DLBCL patients’ do exist according to the types of care center. A main issue may be to find and diffuse the reasons of this benefit in cancer management in the teaching hospital to the other centers.

Y a-t-il un euroconsommateur du luxe? Une analyse comparative des profils sociodémographiques des acheteurs européens

A partir d'une étude paneuropéenne portant sur 12 500 consommateurs et leurs attitudes vis-à-vis de 30 marques internationales, le présent article compare le pouvoir segmentant d'un ensemble d'indicateurs géographiques et socio-économiques susceptibles d'éclairer l'achat de marques de luxe. Bien que certaines différences entre les pays européens soient observées, les résultats obtenus révèlent que le revenu, le niveau d'éducation et la catégorie professionnelle différencient les consommateurs mieux que leur affiliation nationale. Dans cette mesure, on doit conclure à l'existence d'un euroconsommateur du luxe dont le portrait robot peut être dressé avec une relative précision

Minor changes in the macrocyclic ligands but major consequences on the efficiency of gold nanoparticles designed for radiosensitization

Many studies have been devoted to adapting the design of gold nanoparticles to efficiently exploit their promising capability to enhance the effects of radiotherapy. In particular, the addition of magnetic resonance imaging modality constitutes an attractive strategy for enhancing the selectivity of radiotherapy since it allows the determination of the most suited delay between the injection of nanoparticles and irradiation. This requires the functionalization of the gold core by an organic shell composed of thiolated gadolinium chelates. The risk of nephrogenic systemic fibrosis induced by the release of gadolinium ions should encourage the use of macrocyclic chelators which form highly stable and inert complexes with gadolinium ions. In this context, three types of gold nanoparticles (Au@DTDOTA, Au@TADOTA and Au@TADOTAGA) combining MRI, nuclear imaging and radiosensitization have been developed with different macrocyclic ligands anchored onto the gold cores. Despite similarities in size and organic shell composition, the distribution of gadolinium chelate-coated gold nanoparticles (Au@TADOTA-Gd and Au@TADOTAGA-Gd) in the tumor zone is clearly different. As a result, the intravenous injection of Au@TADOTAGA-Gd prior to the irradiation of 9L gliosarcoma bearing rats leads to the highest increase in lifespan whereas the radiophysical effects of Au@TADOTAGA-Gd and Au@TADOTA-Gd are very similar.

Inhibition of aminoglycoside-induced nephrotoxicity in rats by polyanionic peptides

In the present study, we compared poly-L-Asp with poly-L-Glu and poly-D-Glu in vitro and in vivo for their ability to inhibit the GM-induced nephrotoxicity. In vitro, all three polyanions (i) bound GM over a wide range of pH; (ii) displaced GM previously bound to negatively charged phospholipid bilayers at acid pH (i.e. under the conditions prevailing in lysosomes in vivo), and thereby (iii) decreased the inhibitory potency of GM towards lysosomal phospholipase A1. Thus, one was tempted to predict that all three polyanions would have the potential of protecting against AG-induced nephrotoxicity. However, when co-administered to rats with GM, poly-L-Asp and poly-D-Glu completely suppressed the development of lysosomal phospholipidosis, as assessed by biochemical criteria and increased drug accumulation, whereas poly-L-Glu did not offer such protection despite a relatively lower increase in drug accumulation levels. Histoautoradiography also confirmed that poly-L-Asp, but not poly-L-Glu, was a nephroprotectant against the tissue proliferative response induced by GM. Morphologically, poly-L-Asp almost completely and poly-D-Glu totally prevented the accumulation of myeloid bodies in lysosomes. In vitro incubation in the presence of purified lysosomal extracts revealed marked differences in the hydrolysis rate of these peptides (poly-D-Glu:poly-L-Asp:poly-L-Glu = 1:1.2:16.9). Assuming that all three polyanionic peptides are transported and accumulated in lysosomes to the same extent, these results not only suggest that their stability in lysosomes is an essential requisite for protection against lysosomal phospholipidosis, but also strengthen our hypothesis that the site of action of poly-L-Asp is inside the lysosomes but not at the level of the renal membranes. In addition, poly-D-Glu alone or combined with GM induced another type of morphological lesion, not related to AG-induced nephrotoxicity which, to our knowledge, has not yet been described.

Measurement of interatrial dyssynchrony using tissue Doppler imaging predicts functional capacity and cardiac involvement in systemic sclerosis

OBJECTIVES

We aimed to assess the prevalence of interatrial electromechanical dyssynchrony in systemic sclerosis (SSc) patients, and to study the correlation between interatrial delay and standard follow-up parameters.

METHODS

Forty consecutive patients with SSc were studied. Classical echocardiographic measurements were obtained, including indices of left ventricular (LV) systolic and diastolic function, right ventricular function, and pulmonary artery pressure (PAP). Left atrial (LA) function was studied using volume measurements. The interatrial mechanical (IAMD) delay was obtained by measuring the time delay between the peak atrial velocities at the lateral tricuspid and mitral annuli using tissue Doppler imaging. A cut-off value of 35 ms was chosen to define the presence of a significant interatrial delay. The IAMD was compared to NYHA class, six-minute walking test (6MWT), NT proBNP levels, and the carbon monoxide diffusion capacity over alveolar volume ratio (DLCO/VA), as well as to classical echocardiographic parameters.

RESULTS

Forty percent of patients were found to have significant interatrial dyssynchrony with an IAMD of 35 ms or more. Patients with interatrial dyssynchrony were more symptomatic, had a shorter 6MWT, higher NT proBNP levels, and a lower DLCO/VA compared with those without dyssynchrony. Regarding conventional echocardiographic parameters, increased IAMD was associated with more pronounced LV diastolic dysfunction, LA enlargement and dysfunction, altered RV function, and higher PAP.

CONCLUSIONS

IAMD correlated with all of the standard follow-up parameters in SSc, and is probably a sensitive marker of LA involvement. This easy to measure parameter should be added to the routine echocardiographic assessment of these patients.

The serine-threonine kinase p90RSK is a new target of enzastaurin in follicular lymphoma cells

BACKGROUND AND PURPOSE

Follicular lymphoma is the second most common non-Hodgkin's lymphoma and, despite the introduction of rituximab for its treatment, this disease is still considered incurable. Besides genetic alterations involving Bcl-2, Bcl-6 or c-Myc, follicular lymphoma cells often display altered B-cell receptor signalling pathways including overactive PKC and PI3K/Akt systems.

EXPERIMENTAL APPROACH

The effect of enzastaurin, an inhibitor of PKC, was evaluated both in vitro on follicular lymphoma cell lines and in vivo on a xenograft murine model. Using pharmacological inhibitors and siRNA transfection, we determined the different signalling pathways after enzastaurin treatment.

KEY RESULTS

Enzastaurin inhibited the serine-threonine kinase p90RSK which has downstream effects on GSK3β. Bad and p70S6K. These signalling proteins control follicular lymphoma cell survival and apoptosis; which accounted for the inhibition by enzastaurin of cell survival and its induction of apoptosis of follicular lymphoma cell lines in vitro. Importantly, these results were replicated in vivo where enzastaurin inhibited the growth of follicular lymphoma xenografts in mice.

CONCLUSIONS AND IMPLICATIONS

The targeting of p90RSK by enzastaurin represents a new therapeutic option for the treatment of follicular lymphoma.

Photochromic–fluorescent–plasmonic nanomaterials: towards integrated three-component photoactive hybrid nanosystems

Silica-coated gold nanorods functionalized with grafted fluorescent and photochromic derivatives were synthesized and cross-coupled interactions between plasmonic, photochromic, and fluorescence properties have been demonstrated.

Attosecond pulse characterization

In this work we propose a novel procedure for the characterization of attosecond pulses. The method relies on the conversion of the attosecond pulse into electron wave-packets through photoionization of atoms in the presence of a weak IR field. It allows for the unique determination of the spectral phase making up the pulses by accurately taking into account the atomic physics of the photoionization process. The phases are evaluated by optimizing the fit of a perturbation theory calculation to the experimental result. The method has been called iPROOF (improved Phase Retrieval by Omega Oscillation Filtering) as it bears a similarity to the PROOF technique [Chini et al. Opt. Express 18, 13006 (2010)]. The procedure has been demonstrated for the characterization of an attosecond pulse train composed of odd and even harmonics. We observe a large phase shift between consecutive odd and even harmonics. The resulting attosecond pulse train has a complex structure not resembling a single attosecond pulse once per IR period, which is the case for zero phase. Finally, the retrieval procedure can be applied to the characterization of single attosecond pulses as well.

HDAC6 and SIRT2 regulate the acetylation state and oncogenic activity of mutant K-RAS

Activating point mutations in K-RAS are extremely common in cancers of the lung, colon, and pancreas and are highly predictive of poor therapeutic response. One potential strategy for overcoming the deleterious effects of mutant K-RAS is to alter its posttranslational modification. Although therapies targeting farnesylation have been explored, and have ultimately failed, the therapeutic potential of targeting other modifications remains to be seen. Recently, it was shown that acetylation of lysine 104 attenuates K-RAS transforming activity by interfering with GEF-induced nucleotide exchange. Here, the deacetylases HDAC6 and SIRT2 were shown to regulate the acetylation state of K-RAS in cancer cells. By extension, inhibition of either of these enzymes has a dramatic impact on the growth properties of cancer cells expressing activation mutants of K-RAS. These results suggest that therapeutic targeting of HDAC6 and/or SIRT2 may represent a new way to treat cancers expressing mutant forms of K-RAS.

IMPLICATIONS

This study suggests that altering K-RAS acetylation is a feasible approach to limiting tumorigenic potential.

[MIF in head and neck cancer: a new therapeutic target ?]

Macrophage migration inhibitory factor is a critical proinflammatory cytokine produced by cells of innate and adaptive immune system. MIF plays a key role in cell cycle regulation and in the pathogenesis of many cancers. Recently, MIF has been studied in the upper aerodigestive tract cancer for its involvement in tumor progression, invasion, proliferation and cell motility. In addition, MIF appears to be a mediator in angiogenesis and in the development of metastasis and locoregional lymph node, which are often associated with a poor prognosis. The mechanisms of action responsible for MIF involvement in tumor progression are not completely elucidated. However, the main effects of MIF are mediated by the CD74 receptor. MIF binding to its receptor is responsible for the activation of several signaling pathways (ERK1/2 - MAPK, JAB1 - CSN5, PI3K - Akt), the inhibition of p53 and the stimulation of angiogenic factors including VEGF and IL-8. The overexpression of MIF also causes a reduction of the anti-tumor activity of the immune system. Finally, MIF could be an interesting biomarker in the diagnosis and monitoring of upper aerodigestive tract cancers. In this paper, we assess the state of knowledge of MIF involvement in upper aero-digestive tract cancers and we analyze the therapeutic perspectives.

Attosecond control of orbital parity mix interferences and the relative phase of even and odd harmonics in an attosecond pulse train

We experimentally demonstrate that atomic orbital parity mix interferences can be temporally controlled on an attosecond time scale. Electron wave packets are formed by ionizing argon gas with a comb of odd and even high-order harmonics, in the presence of a weak infrared field. Consequently, a mix of energy-degenerate even and odd parity states is fed in the continuum by one- and two-photon transitions. These interfere, leading to an asymmetric electron emission along the polarization vector. The direction of the emission can be controlled by varying the time delay between the comb and infrared field pulses. We show that such asymmetric emission provides information on the relative phase of consecutive odd and even order harmonics in the attosecond pulse train.