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Selecting patients most likely to benefit from venoarterial extracorporeal membrane oxygenation (V-A ECMO) to treat refractory drug-induced cardiovascular shock remains a difficult challenge for physicians. This study reported short-term survival outcomes and factors associated with mortality in V-A ECMO-treated patients for poisoning. Twenty-two patients placed on V-A ECMO after drug intoxication from January 2014 to December 2020 were retrospectively analyzed. he primary endpoint of this study was survival at hospital discharge. Univariate descriptive analysis was performed to compare survivors and nonsurvivors during hospitalization. The overall survival at hospital discharge was 45.4% (n = 10/22). Survival rate tended to be higher in patients treated for refractory shock (n = 7/10) compared with those treated for refractory cardiac arrest (n = 3/12, p = 0.08). Low-flow duration and time from admission to ECMO cannulation were shorter in survivors (p = 0.02 and p = 0.03, respectively). Baseline characteristics before ECMO, including the class of drugs involved in the poisoning, between survivors and nonsurvivors were not statistically different except pH, bicarbonate, serum lactate, Sequential Organ Failure Assessment, and Survival After Veno-arterial-ECMO (SAVE) score. All patients with SAVE-score risk classes II/III survived whereas 85.7% (n = 12/14) of those with SAVE-score risk classes IV/V died. A lactic acid >9 mmol/L predicts mortality with a sensitivity/specificity ratio of 83.3%/100%. V-A ECMO for severe drug intoxication should be reserved for highly selected poisoned patients who do not respond to conventional therapies. Shortening the timing of V-A ECMO initiation should be a key priority in improving outcomes. Low-flow time >60min, lactic acid >9mmol/L, and SAVE-score may be good indicators of a worse prognosis.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive leukemia for which we developed a nationwide network to collect data from new cases diagnosed in France. In a retrospective, observational study of 86 patients (2000-2013), we described clinical and biological data focusing on morphologies and immunophenotype. We found expression of markers associated with plasmacytoid dendritic cell origin (HLA-DRhigh, CD303+, CD304+, and cTCL1+) plus CD4 and CD56 and frequent expression of isolated markers from the myeloid, B-, and T-lymphoid lineages, whereas specific markers (myeloperoxidase, CD14, cCD3, CD19, and cCD22) were not expressed. Fifty-one percent of cytogenetic abnormalities impact chromosomes 13, 12, 9, and 15. Myelemia was associated with an adverse prognosis. We categorized chemotherapeutic regimens into 5 groups: acute myeloid leukemia (AML)–like, acute lymphoid leukemia (ALL)–like, lymphoma (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP])–like, high-dose methotrexate with asparaginase (Aspa-MTX) chemotherapies, and not otherwise specified (NOS) treatments. Thirty patients received allogeneic hematopoietic cell transplantation (allo-HCT), and 4 patients received autologous hematopoietic cell transplantation. There was no difference in survival between patients receiving AML-like, ALL-like, or Aspa-MTX regimens; survival was longer in patients who received AML-like, ALL-like, or Aspa-MTX regimens than in those who received CHOP-like regimens or NOS. Eleven patients are in persistent complete remission after allo-HCT with a median survival of 49 months vs 8 for other patients. Our series confirms a high response rate with a lower toxicity profile with the Aspa-MTX regimen, offering the best chance of access to hematopoietic cell transplantation and a possible cure.

Background Medications with lifestyle are the cornerstone of diabetes management and routine monitoring and follow-up are essential to the delivery of quality care. Documented follow-up rates by pharmacists for people with diabetes are low despite good uptake of initial medication assessments in medication review programs. Objectives Identify the barriers and facilitators to routine monitoring and follow-up for people with diabetes by community pharmacists. Methods Pharmacists were invited to complete a survey designed using the Theoretical Domains Framework Version 2 TDF (v2) consisting of 39 questions based on the 14 domains of the TDFv2 with quantitative response options using a 7 point Likert scale and 2 open-ended questions. Baseline information about the respondents and their practice sites were summarized using descriptive statistics. Mean scores and standard deviations were calculated for each of the Likert scale responses. Responses to open-ended questions were analyzed and coded using an inductive thematic approach. Results 346 pharmacists completed the survey (4.76% response rate). The TDF domains found to be positively influencing the delivery of routine monitoring and follow-up activities were beliefs about consequences for people with diabetes (6.08 ± 1.13), pharmacist knowledge (5.93 ± 0.99), pharmacist skills (5.44 ± 1.44), social influences (5.36 ± 1.32) and optimism (5.20 ± 1.58). The domains found to be negatively influencing were reinforcement (3.0 ± 1.89) and environmental context and resources (3.30 ± 1.81). Themes emerging from the thematic analysis included time and competing priorities, reimbursement, patient engagement, workflow and human resources, access to labs and clinical information, information technology and support from the owner/manager. Conclusions Our research concludes that pharmacists report that their knowledge, skills, and beliefs about their role and responsibility, social influences and optimism are positive influences on routine monitoring and follow-up while reinforcement and the environmental context/resources are the greatest negative influences. Strategies to improve follow-up should be focused in these areas.

BACKGROUND After an emergent surgery for type A acute aortic syndrome, medical management is based on optimal blood pressure (BP) control. We assessed the prognostic significance of BP monitoring and its relationship with aortic morphology following type A acute aortic syndrome. METHODS The data of 120 patients who underwent BP monitoring after a type A acute aortic syndrome from January 2005 to June 2016 were retrospectively collected. The first CT angiogram performed after surgery was used for the morphological analysis. RESULTS The population included 79 males, with an overall mean age of 60 ± 12 years. Seven patients (5.8%) died during a median follow-up of 5.5 years. The median delay between BP monitoring and discharge was 3 (1-5) months. The mean 24-hour BP of the cohort was 127/73 mm Hg ± 10/17. During follow-up, different parameters of BP monitoring were not associated with the risk of aortic events. However, the diameter of the false lumen of the descending thoracic aorta was the best predictor associated with the risk of new aortic events during follow-up, particularly for the threshold of 28 mm or more (P

International audience; The recent discovery of anionic redox as a means to increase the energy density of transition-metal oxide positive electrodes is now a well-established approach in the Li-ion battery field. However, the science behind this new phenomenon pertaining to various Li-rich materials is still debated. Thus, it is of paramount importance to develop a robust set of analytical techniques to address this issue. Herein, we use a suite of synchrotron-based X-ray spectroscopies as well as diffraction techniques to thoroughly characterize the different redox processes taking place in a model Li-rich compound, the tridimensional hyperhoneycomb β-Li2IrO3. We clearly establish that the reversible removal of Li+ from this compound is associated with a previously described reductive coupling mechanism and the formation of the M-(O-O) and M-(O-O)∗ states. We further show that the respective contributions to these states determine the spectroscopic response for both Ir L3-edge X-ray absorption spectroscopy and X-ray photoemission spectroscopy. Although the high covalency and the robust tridimensional structure of this compound enable a high degree of reversible delithiation, we found that pushing the limits of this charge compensation mechanism has significant effects on the local as well as average structure, leading to electrochemical instability over cycling and voltage decay. Overall, this work highlights the practical limits to which anionic redox can be exploited and sheds some light on the nature of the oxidized species formed in certain lithium-rich compounds.

espanolIntroduccion: Esta poco estudiado el comportamiento del strain longitudinal regional y global en relacion al valor de la reserva coronaria. Objetivos: Comparar el comportamiento del strain longitudinal apical y global con el valor de la reserva coronaria de la arteria descendente anterior y secundariamente comparar estas respuestas con el analisis visual de la motilidad parietal durante el eco-estres con dipiridamol. Material y metodos: Estudio retrospectivo de 179 pacientes (edad 68,7 ± 7,8), 90 hombres (50,3%). En el pico del efecto de dipiridamol, se midio la reserva coronaria, simultaneamente al strain longitudinal y el analisis visual de la contractilidad. Se organizo a los pacientes en dos grupos: grupo 1: reserva coronaria ≥ 2 y grupo 2: Resultados: Se incluyeron 113 pacientes (63,12%) en el grupo 1 y 66 (36,87%) en el grupo 2. Strain apical: el 96,77% del grupo 1 incrementaron su valor con el apremio, mientras que, en el grupo 2, el 95,31% presentaron una caida (p Analisis de la motilidad parietal posdipiridamol: el 96,46% del grupo 1 tenian motilidad parietal conservada y el 54,5% del grupo 2 (solo en 4 pacientes aumento el strain apical). Conclusiones: Se comprobo una estrecha correlacion entre la reserva coronaria y el strain longitudinal. El strain longitudinal apical resulto ser superior del global. El strain apical demostro tener una mejor correlacion con la reserva coronaria que con el analisis visual de la contractilidad. EnglishBackground: The behavior of regional and global longitudinal strain in relation to the value of the coronary reserve is poorly studied. Objectives: Compare the behavior of the Apical and global longitudinal Strain with the value of the coronary reserve of the anterior descending artery and as a secondary aim compare these responses with the visual analysis of parietal motility during Echo Stress with Dipyridamole. Materials and methods: Retrospective study of 179 patients (age 68.7±7.8), 90 patients (50.3%) were men. At the peak of the dipyridamole effect, the coronary reserve was measured, simultaneously with the Longitudinal Strain and the visual analisis of contractility. Two groups were divided: Group 1: Coronary reserve ≥2 and Group 2: 82.8% of Group 1 had an increase in their values, while in Group 2, 78.8% showed worsening (p Conclusions: There was a close correlation between the coronary reserve of the anterior descending artery and the contractile reserve evaluated by regional apical longitudinal strain of the 4 apical segments, which was superior to the use of global strain. The Apical Strain showed a better correlation with ADA coronary reserve than with the visual analysis of contractility.

Background: We aimed to investigate the relationship between anti-activated Factor X (anti-FXa) and activated Partial Thromboplastin Time (aPTT), and its modulation by other haemostasis co-variables during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. We further investigated their association with serious bleeding and thrombotic complications. Methods: This retrospective single-center study included 265 adults supported by VA-ECMO for refractory cardiogenic shock from January 2015 to June 2019. The concordance of anti-FXa and aPTT and their correlations were assessed in 1699 paired samples. Their independent associations with serious bleeding or thrombotic complications were also analysed in multivariate analysis. Results: The concordance rate of aPTT with anti-FXa values was 50.7%, with 39.3% subtherapeutic aPTT values. However, anti-FXa and aPTT remained associated (β = 0.43 (95% CI 0.4–0.45) 10−2 IU/mL, p &lt, 0.001), with a significant modulation by several biological co-variables. There was no association between anti-FXa nor aPTT values with serious bleeding or with thrombotic complications. Conclusion: During VA-ECMO, although anti-FXa and aPTT were significantly associated, their values were highly discordant with marked sub-therapeutic aPTT values. These results should favour the use of anti-FXa. The effect of biological co-variables and the failure of anti-FXa and aPTT to predict bleeding and thrombotic complications underline the complexity of VA-ECMO-related coagulopathy.

The physico-chemical characteristics of particulate matter (PM) in African cities remain poorly known due to scarcity of observation networks. Magnetic parameters of PM are robust proxies for the emissions of Fe-bearing particles. This study reports the first magnetic investigation of PM2.5 (PM with aerodynamic size below 2.5 m) in Africa performed on weekly PM2.5 filters collected in Abidjan (Ivory Coast) and Cotonou (Benin) between 2015 and 2017. The magnetic mineralogy is dominated by magnetite-like low coercivity minerals. Mass normalized SIRM are 1.65e−2A□m/kg and 2.28e−2A□m/kg for Abidjan and Cotonou respectively. Hard coercivity material (S-ratio = 0.96 and MDF = 33 mT) is observed during the dry dusty season. Wood burning emits less iron oxides by PM2.5 mass when compared to traffic sources. PM2.5 magnetic granulometry has a narrow range regardless of the site or season. The excellent correlation between the site-averaged element carbon concentrations and SIRM suggests that PM2.5 magnetic parameters are linked to primary particulate emission from combustion sources.

La comunicación interauricular (CIA) ostium secundum es la cardiopatía congénita más frecuente en la edad adulta. Se presenta el caso de un varón de 45 años, asintomático, con gran sobrecarga de cavidades derechas al que se detecta una CIA de gran tamaño. Debido a su gran tamaño y la ausencia de bordes suficientes, es dificultosa la clasificación del tipo de defecto, revisando el diagnóstico diferencial con el tipo seno venoso inferior. Se discuten también las dificultades de valoración no invasiva de la presión pulmonar ante un reflujo tricúspide de escasa magnitud y pobre representación espectral.

Background: The behavior of regional and global longitudinal strain in relation to the value of the coronary reserve is poorlystudied.Objectives: Compare the behavior of the Apical and global longitudinal Strain with the value of the coronary reserve of theanterior descending artery and as a secondary aim compare these responses with the visual analysis of parietal motility duringEcho Stress with Dipyridamole.Materials and methods: Retrospective study of 179 patients (age 68.7±7.8), 90 patients (50.3%) were men. At the peak of thedipyridamole effect, the coronary reserve was measured, simultaneously with the Longitudinal Strain and the visual analisis ofcontractility. Two groups were divided: Group 1: Coronary reserve ≥2 and Group 2

Objective: Whether endotheliopathy only mirrors coronavirus disease 2019 (COVID-19) severity or plays an intrinsic role in microvascular thrombosis and organ failure remains unanswered. We assessed whether markers of endothelial damage and immune dysregulation were associated with organ failure, thrombus formation, and death. Approach and Results: Markers of endothelial damage (VWF:Ag [von Willebrand factor antigen], PAI-1 [plasminogen activator inhibitor-1], syndecan-1, TFPI [tissue factor pathway inhibitor], and soluble thrombomodulin), complement activation (C5a and C5b-9), cytokines (IL [interleukin]-6, TNF [tumor necrosis factor]-α, and IL-2R), and neutrophil extracellular traps (cell-free DNA, nucleosomes, and myeloperoxidase-DNA) were measured at intensive care unit admission in 82 patients with COVID-19. We also analyzed the histological composition of thrombi collected in critically ill living patients successfully weaned from extracorporeal membrane oxygenation. Beside respiratory failure, VWF:Ag, PAI-1, TFPI, and syndecan-1 were independently associated with liver injury and multiorgan failure development, underlining the direct role of endotheliopathy in organ failure. Nucleosomes were also associated with liver injury, multiorgan failure, and death which occurred in 38%, 60%, and 27% of patients, respectively. Moreover, dysregulated immune response including cytokines, complement, and neutrophil extracellular traps was associated with markers of endothelial damage, respiratory failure, and liver injury. COVID-19 thrombi retrieved from extracorporeal membrane oxygenation circuitry contained accumulation of neutrophils, VWF, and significantly higher amount of neutrophil extracellular traps when compared with non-COVID-19 thrombi. Conclusions: We provide new associative data supporting that endotheliopathy and dysregulated immune responses are involved in respiratory and liver failure through microvascular damage in patients with severe COVID-19.

Mechanical circulatory support (MCS) devices are effective tools in managing refractory cardiogenic shock (CS). Data comparing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and IMPELLA® are however scarce. We aimed to assess outcomes of patients implanted with these two devices and eligible to both systems. From 2004 to 2020, we retrospectively analyzed 128 patients who underwent VA-ECMO or IMPELLA® in our institution for refractory left ventricle (LV) dominant CS. All patients were eligible to both systems: 97 patients were first implanted with VA-ECMO and 31 with IMPELLA®. The primary endpoint was 30-day all-cause death. VA-ECMO patients were younger (52 vs. 59.4, p = 0.006) and had a higher lactate level at baseline than those in the IMPELLA® group (6.84 vs. 3.03 mmol/L, p &lt, 0.001). Duration of MCS was similar between groups (9.4 days vs. 6 days in the VA-ECMO and IMPELLA® groups respectively, p = 0.077). In unadjusted analysis, no significant difference was observed between groups in 30-day mortality: 43.3% vs. 58.1% in the VA-ECMO and IMPELLA® groups, respectively (p = 0.152). After adjustment, VA-ECMO was associated with a significant reduction in 30-day mortality (HR = 0.25, p = 0.004). A higher rate of MCS escalation was observed in the IMPELLA® group: 32.3% vs. 10.3% (p = 0.003). In patients eligible to either VA-ECMO or IMPELLA® for LV dominant refractory CS, VA-ECMO was associated with improved survival rate and a lower need for escalation.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Investigaciones Médicas, Cardiodiagnostic Introduction. The behavior of the ejection fraction (EF) during exercise stress echocardiography (ESE) is used to measure the left ventricular (LV) contractile reserve (CR). Ventricular Elastance or Force defined as the ratio between systolic blood pressure (SBP) and LV end-systolic volume (ESV) could be better as it is less dependent of heart rate, preload, and afterload conditions. Objective. To establish the relative prognostic value of EF-based and novel Force-based LVCR in patients (pts) without ischemia during ESE. Materials and methods. In a retrospective analysis of prospectively enrolled pts, we enrolled 904 pts, (61.92 ± 12.59 years, 509 men, 56.3%) with negative ESE for RWMA. LV volumes were measured with biplane Simpson’s rule. LVCR was assessed based on EF ≥5 points increase at peak over rest and based on Force peak/rest ratio > 2. The average follow-up was 17.7 ± 5.44 months. Major cardiovascular event was defined as: death, acute myocardial infarction, cerebrovascular accident and/or need for hospitalization due to cardiovascular causes. Results. LVCR by EF was present in 536 (59.3%) and absent in 368 (40.7%) pts. LVCR by Force was present in 200 pts (22.1%) and absent in 704 pts (77.9%) pts. The overall concordance between LVCR assessed by EF and Force was 538 pts (89.6%) with presence of CR by EF and not by Force being the most frequent source of discrepant result in 336 pts. In the long-term follow up, 52 pts experienced events: 0 all-cause death, 3 acute myocardial infarctions, 5 cerebrovascular accidents and 44 for hospitalization due to cardiovascular causes. Lack of LVCR based on EF identified patients at higher risk (see Figure) but Force-based LVCR allowed to further separate patients with EF-based LVCR (n = 536) into a lower risk with (n = 200, event rate 2%) and higher risk subgroup without Force-based LVCR (n= 336, event rate 5.3 %, p Conclusions. In patients with negative SE for RWMA, the evaluation of LVCR based on EF allows a better stratification of outcome, which is further refined by addition of Force-based LVCR, especially useful in the subset with LVCR by EF not confirmed by Force. Force-based LVCR allowed to identify a subgroup of worse long-term prognosis outperforming EF-based LVCR. Abstract Figure. LVCR by EF and Event Free Survival

Heterologous polyclonal antibodies might represent an alternative to the use of convalescent plasma or monoclonal antibodies (mAbs) in coronavirus disease (COVID‐19) by targeting multiple antigen epitopes. However, heterologous antibodies trigger human natural xenogeneic antibody responses particularly directed against animal‐type carbohydrates, mainly the N‐glycolyl form of the neuraminic acid (Neu5Gc) and the α1,3‐galactose, potentially leading to serum sickness or allergy. Here, we immunized cytidine monophosphate‐N‐acetylneuraminic acid hydroxylase and α1,3‐galactosyl‐transferase (GGTA1) double KO pigs with the Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) spike receptor binding domain to produce glyco‐humanized polyclonal neutralizing antibodies lacking Neu5Gc and α1,3‐galactose epitopes. Animals rapidly developed a hyperimmune response with anti‐SARS‐CoV‐2 end‐titers binding dilutions over one to a million and end‐titers neutralizing dilutions of 1:10 000. The IgG fraction purified and formulated following clinical Good Manufacturing Practices, named XAV‐19, neutralized spike/angiotensin converting enzyme‐2 interaction at a concentration, GGTA1/CMAH double KO pigs produced high titers of XAV‐19, an anti‐SARS‐Cov‐2 RBD glyco‐humanized polyclonal antibody. XAV‐19 is presented with a high complement activation and a high neutralization potency in vitro and in cell‐based neutralization assays. XAV‐19 does not interact with human Fc gamma receptors, preventing Fc‐dependent enhancement or immune cells skewing.

Funding Acknowledgements Type of funding sources: None. Background. 3-dimensional transoesophageal echocardiography (3D-TEE) is frequently used as an initial screening tool in the evaluation of patients who are candidates to Transcatheter Mitral Valve Replacement (TMVR). However, little is known about the imaging correlation with the gold-standard computed tomography (CT) imaging. We aimed at testing the quantitative differences between these two modalities and finding the best 3D-TEE parameters for TMVR screening. Methods. We included 57 patients referred to our Heart Valve Clinic for TMVR with prostheses specifically designed for the mitral valve. Mitral annulus (MA) analyses were performed using commercially available software in 3D-TEE and CT. Results. 3D-TEE was feasible in 52 patients (91%). Although 3D-TEE measurements were slightly lower than in CT, both measurements of projected MA area and perimeter showed excellent correlation with small differences between the two modalities (r = 0.88 and r = 0.92 respectively, p Abstract Figure.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Investigaciones Médicas. Cardiodiagnóstico. Buenos Aires Introduction. Left ventricle Global Longitudinal Strain(GLS) at rest has shown prognostic value in patients(pts) with severe aortic stenosis(SAS). Contractile reserve(CR) during exercise stress echo(ESE) estimated by GLS(CR-GLS) could better stratify the asymptomatic patients who could benefit from early intervention. Objective. To establish the long-term prognostic value of CR-GLS in pts with asymptomatic SAS during ESE. Secondly, to compare if the CR evaluated by ejection fraction(CR-EF) presented similar results to those of CR-GLS. Methodology. In a single center, prospective study carried out between May 2013 to Oct 2019, we enrolled 101 pts(69 ± 12 years,54 men) with asymptomatic SAS(aortic valve area 55%). GLS value was considered as the average of the 16 segments, obtained from the apical views of 3, 4 and 2 chambers at rest and peak ESE. CR was considered present with stress-rest increase of >5points with EF and >2 absolute points by GLS. The pts were divided into 2 groups(G): G1:Pts with presence of CR-GLS and G2:Pts with absence of CR-GLS. Major cardiovascular event was considered to be: need for valve replacement due to the presence of symptoms, death, acute myocardial infarction and stroke. All patients were followed-up. Results. Of the 101 pts analyzed, 56pts(55.4%) were included in G1(CR-GLS) and 45pts(44.6%) in G2(no CR-GLS). The G2 patients were older(G2 72.2 ± 8.5 vs G1 66.5 ± 14.1) with lower METS(G1 5.6 ± 2 vs G2 4.2 ± 1.1,p 0.004), a higher percentage of flat blood pressure response(G1 19.6% vs. G2 37.8%,p 0.036), lower peak EF(G1 71.5%±5.8 vs G2 66.8 ± 7.9,p0.001),peak GLS(G1 -22.2%±2.8 vs G2 -18.45%±2.4 p 0.001) and lower ΔGLSstress-rest(G1 GLS 3.07 ± 0.85 vs G2 0.08 ± 1.9 p 0.003). The same behaviour with the EF response(G1 7.32 ± 2.9 vs G2 4.7 ± 5.3,p 0.024). The average follow-up was 46.6 ± 3.4 months, and events occurred in 45 patients: 12 all-cause deaths(9 cardiac), 31 valve replacement, 1 myocardial infarctions, 1 strokes. G2 pts had more events compared to G1 pts (G2 = 26 events 57.8% vs G1 = 19 events 42.2%,p Conclusions In patients with asymptomatic SAS, the absence of CR-GLS during ESE identifies a group of patients with a worse prognosis and the need for aotic valve intervention. CR-GLS proved to be superior tan CR-EF. Baselin characteristic between groups Abstract Figure. Left ventricle RC-GLS and survival

International audience; Background: Three-dimensional (3D) transesophageal echocardiographic (TEE) imaging is frequently used as an initial screening tool in the evaluation of patients who are candidates for transcatheter mitral valve replacement (TMVR). However, little is known about the imaging correlation with the gold standard, computed tomographic (CT) imaging. The aims of this study were to test the quantitative differences between these two modalities and to determine the best 3D TEE parameters for TMVR screening.Methods: Fifty-seven patients referred to the heart valve clinic for TMVR with prostheses specifically designed for the mitral valve were included. Mitral annular (MA) analyses were performed using commercially available software on 3D TEE and CT imaging.Results: Three-dimensional TEE imaging was feasible in 52 patients (91%). Although 3D TEE measurements were slightly lower than those obtained on CT imaging, measurements of both projected MA area and perimeter showed excellent correlations, with small differences between the two modalities (r = 0.88 and r = 0.92, respectively, P < .0001). Correlations were significant but lower for MA diameters (r = 0.68-0.72, P < .0001) and mitroaortic angle (r = 0.53, P = .0001). Receiver operating characteristic curve analyses showed that 3D TEE imaging had a good ability to predict TMVR screening success, defined by constructors on the basis of CT measurements, with ranges of 12.9 to 15 cm2 for MA area (area under the curve [AUC] = 0.88-0.91, P < .0001), 128 to 139 mm for MA perimeter (AUC = 0.85-0.91, P < .0001), 35 to 39 mm for anteroposterior diameter (AUC = 0.79-0.84, P < .0001), and 37 to 42 mm for posteromedial-anterolateral diameter (AUC = 0.81-0.89, P < .0001).Conclusions: Three-dimensional TEE measurements of MA dimensions display strong correlations with CT measurements in patients undergoing TMVR screening. Three-dimensional TEE imaging should be proposed as a reasonable alternative to CT imaging in this vulnerable population.

International audience; BACKGROUND: Although recommendations encourage daily moderate activities in post aortic dissection, very little data exists regarding cardiopulmonary exercise testing (CPET) to personalize those patient's physical rehabilitation and assess their cardiovascular prognosis.METHODS: We aimed at testing the prognostic insight of CPET regarding aortic and cardiovascular events by exploring a prospective cohort of patients followed-up after acute aortic dissection.METHODS: Patients referred to our department after an acute (type A or B) aortic dissection were prospectively included in a cohort between September 2012 and October 2017. CPET was performed once optimal blood pressure control was obtained. Clinical follow-up was done after CPET for new aortic event and major cardio-vascular events (MCE) not directly related to the aorta.RESULTS: Among the 165 patients who underwent CPET, no adverse event was observed during exercise testing. Peak oxygen pulse was 1.46(1.22-1.84) mlO2/beat, that is, 97 (83-113) % of its predicted value, suggesting cardiac exercise limitation in a population under beta blockers (92% of the population). During a follow-up of 39(20-51) months from CPET, 42 aortic event recurrences and 22 MCE not related to aorta occurred. Low peak oxygen pulse (

Background The best valvular substitute remains controversial in young adults with active aortic valve endocarditis. The Ross procedure has gained interest because of its theoretical resistance to infection. We aimed to report our long-term outcomes of the Ross procedure in this indication. Methods Between March 1992 and January 2019, 511 patients underwent a Ross procedure in our institution. Among them, we included 38 patients who suffered from an active aortic valve infective endocarditis. The mean age was 33.9 ± 8.1 years. Six patients had emergent procedures and 17 patients had perivalvular involvement. A pulmonary autograft was implanted using the full root technique in 78.9% of patients. Median follow-up was 12 (interquartile range, 1.75-16.25) years. Results The hospital mortality rate was 5.3%. Estimated overall survival was 84.2% ± 6.6% at 10 years. There were 2 cases of recurrent endocarditis, both requiring reoperation. Six other patients required reoperation on an autograft or homograft. Estimated freedom from recurrent endocarditis or reoperation was 89.4% ± 5.9% at 10 years. Conclusions In experienced centers, the Ross procedure is a reliable alternative to prosthetic or homograft valve replacement in young adults experiencing active aortic valve endocarditis, with a low operative risk and good long-term results.

International audience; CD30 transmembrane receptor, a member of the tumor necrosis factor receptor family, is expressed in different lymphomas. Brentuximab vedotin (BV), a CD30 monoclonal antibody (Ab)-drug conjugate, is effective in CD30-positive lymphomas. However, the response to BV is not always correlated to CD30 expression detected by immunohistochemistry (IHC). The objectives of this study were to standardize and evaluate CD30 intensity by flow cytometry (FCM) in non-Hodgkin's lymphomas. Twelve centers analyzed 161 cases on standardized cytometers using normalized median fluorescence intensity (nMFI30) of three different Abs, of which one clone can recognize the same epitope as BV. FCM distinguished four groups of cases: negative group (n = 110) which showed no expression with the three clones; high positive group (n = 13) which gave nMFI30 > 5% with all tested clones; dim positive group (n = 17) which showed nMFI30 > 1% with all tested clones and

Neoplasms involving plasmacytoid dendritic cells (pDC) include blastic pDC neoplasms (BPDCN) and other pDC proliferations, where pDC are associated with myeloid malignancies: most frequently chronic myelomonocytic leukemia (CMML) but also acute myeloid leukemia (AML), hereafter named pDC-AML. We aimed to determine the reactive or neoplastic origin of pDC in pDC-AML, and their link with the CD34+ blasts, monocytes or conventional DC (cDC) associated in the same sample, by phenotypic and molecular analyses (targeted next-generation sequencing, 70 genes). We compared 15 pDCAML at diagnosis with 21 BPDCN and 11 normal pDC from healthy donors. CD45low CD34+ blasts were found in all cases (10-80% of medullar cells), associated with pDC (4-36%), monocytes in 14 cases (1-10%) and cDC (two cases, 4.8-19%). pDC in pDC-AML harbor a clearly different phenotype from BPDCN: CD4+ CD56– in 100% of cases, most frequently CD303+, CD304+ and CD34+; lower expression of cTCL1 and CD123 with isolated lymphoid markers (CD22/CD7/CD5) in some cases, suggesting a prepDC stage. In all cases, pDC, monocytes and cDC are neoplastic since they harbor the same mutations as CD34+ blasts. RUNX1 is the most commonly mutated gene: detected in all AML with minimal differentiation (M0-AML) but not in the other cases. Despite the low number of cases, the systematic association between M0-AML, RUNX1 mutations and an excess of pDC is puzzling. Further evaluation in a larger cohort is required to confirm RUNX1 mutations in pDC-AML with minimal differentiation and to investigate whether it represents a proliferation of blasts with macrophage and DC progenitor potential.

Background.The diagnostic and prognostic utility of coronary flow reserve(CFR) during dipyridamole Stress echo(EchoDipi) has been recognized when the contractile response is positive and even in absence of wall motion abnormalities. Less studied is the behavior of regional longitudinal strain(RLS) and global(GLS) in relation of CFR in the territory of the left anterior descending artery(LADA). Objectives Compare the behavior of the Apical LS and GLS with the value of the CFR in the LADA and as a secondary objective to compare these responses with a simultaneous visual analysis of the motility during EchoDipi. Materials and methods 179 patients (p) were included (age 68.7 ± 7 years). Of them, 113p(65%) were men. At the peak of the effect of Dipi(0.84mg/kg in 4m) the CFR was measured in the distal region of the LADA(Normal Value≥2). The subjects were divided into 2 groups(G): G1: p with CFR of the LAD≥2 and G2 p with LADA CFR Results Of 179 p, 113p(63.12%) were included in G1 and 66p(36.87%) in G2. G1 were older(65.9 ± 10.27 vs 72.2 ± 9.31,p Conclusions.There was a close correlation between LADA coronary flow reserve and the contractile reserve evaluated by regional longitudinal strain of the 4 apical segments, which was superior to the use of global longitudinal strain. The Apical Strain showed a better correlation with the LADA coronary flow reserve than with the visual analysis of wall motion.

Background Several mechanisms are suspected to thrombocytopenia under Extracorporeal Membrane Oxygenation (ECMO) such as platelet-consumption or sepsis. Shedding of glycoprotein-(GP)Ibα is a recently identified mechanism of platelet clearance. ECMO generates high shear stress forces that could impact GPIbα-shedding. We hypothesized that ECMO continuous-flow devices could directly induce thrombocytopenia through shear-induced GPIbα-shedding. Aims Determine if ECMO induce GpIb-shedding in vitro and in vivo and determinates the kinetic evolution of platelet-count and GpIb-shedding after patient's implantation. Methods Platelet GPIbα-shedding was first investigated in vitro using a high-shear pump loop model. Plasma with normal platelet count (plasma-NPC) was obtained by dilution of platelet-rich plasma obtained from healthy donors in fresh-frozen-plasma. Samples were collected before and after (5, 30, 60 and 180 min) perfusion at 37°C of plasma-NPC at intermediate and high speed (2.6 and 3.6 L min–1 respectively, n=4 each). Platelet count and GPIbα-shedding were next investigated in 20 ECMO patients before/after implantation (WITECMO trial) and in 20 healthy volunteers. The geometric mean-fluorescence-intensity (gMFI) of platelet GPIbα (PE-staining) and GPIX (FITC-staining) was measured with a Navios flow cytometer (Beckman Coulter, Miami, FL). Results are expressed as GPIbα/GPIX gMFI-ratio. Results A significant time-dependent loss of GPIbα/GPIX gMFI-ratio was already apparent after 30 min in vitro and was significantly more pronounced at high-speed compared to intermediate-speed (pANOVA Figure 1. A. Significant time-dependent loss of platelet GPIbα/GPIX gMFI-ratio (pANOVA

International audience; Background: The main risk factor for bleeding in patients with continuous-flow mechanical circulatory support (CF-MCS) is the acquired von Willebrand factor (VWF) defect related to the high shear-stress forces developed by these devices. Although a higher bleeding rate has been reported in CF-MCS recipients who had reduced pulsatility, the relation between pulsatility and the VWF defect has never been studied.Objectives: The purpose of this study was to investigate the relation between pulsatility and VWF under CF-MCS.Methods: We assessed the effect of 2 CF-MCS on VWF multimer degradation in a mock circulatory loop (model 1). Using these devices, we investigated in a dose-effect model (model 2) 3 levels of pulsatility in 3 groups of swine. In a cross-over model (model 3), we studied the effects of sequential changes of pulsatility on VWF. We reported the evolution of VWF multimerization in a patient undergoing serial CF-MCS and/or pulsatile-MCS.Results: We demonstrated the proteolytic degradation of VWF multimers by high shear CF-MCS in a circulatory loop without pulsatility. We observed both in swine models and in a patient that the magnitude of the VWF degradation is modulated by the pulsatility level in the high shear-stress level condition, and that the restoration of pulsatility is a trigger for the endothelial release of VWF.Conclusions: We demonstrated that the VWF defect reflects the balance between degradation induced by the shear stress and the endothelial release of new VWF triggered by the pulsatility. This modulation of VWF levels could explain the relationship between pulsatility and bleeding observed in CF-MCS recipients. Preservation of pulsatility may be a new target to improve clinical outcomes of patients.

Introduction: B-cell immunophenotype could be swiftly assessed by flow cytometry on blood samples or bone marrow aspirate specimens. It provides crucial information later refined with histologic, genetic and molecular features to assert accurate diagnosis of chronic B-cell lymphoproliferative disorders (B-CLPD). Besides Matutes score we identified additional useful markers, i.e. CD148 and CD180 to classify mantle cell lymphoma (MCL) and marginal zone lymphoma (MZL), respectively. Furthermore, CD200 is known to be highly expressed in chronic lymphoid leukemia (CLL) while absent in MCL. Hypothesis: The determination of CD148, CD180 and CD200 expression on B-cells by flow cytometry on blood samples and/or bone marrow aspirates could be a potent tool to accurately identify B-CLPD. We postulated the existence of the following specific expression patterns in B-CLPD: CD148 dim/CD180 dim/CD200 bright for CLL, CD148 dim/CD180 dim/CD200 dim for lymphoplasmocytic lymphoma (LPL), CD148 bright/CD180 dim/CD200 neg/dim for MCL and CD148 dim/CD180 bright/CD200 dim for MZL . Methods: In a prospective study we investigated the expression of CD148/CD180/CD200 on B-cells from 673 patients at the time of B-CLPD diagnosis in our hospital from 2014 to 2020. We analyzed 440 blood and 233 bone marrow aspirate specimens using a BD FACSCanto II flow cytometry instrument. Based solely on CD148/CD180/CD200 specific expression patterns we postulated a diagnosis of CLL, LPL, MCL or MZL. These postulated diagnoses were later confronted to the final diagnoses when all histologic, genetic and molecular features were finalized. Sensitivity, specificity, positive and negative predictive values of the expression profiles were determined. In addition, to investigate the relative importance of these three CD markers we then normalized their mean fluorescence intensities (MFI) and applied several supervised machine learning algorithms including Logistic Regression, Random Forest and Light Gradient Boosting Machine (LightGBM). Results: Out of the 673 clinical samples the CD148/CD180/CD200 expression patterns classified 212 specimens as CLL/SLL (30.8%), 160 as LPL (23.8%), 76 as MCL (11.28%) and 169 as MZL (25%). These diagnosis hypotheses were retrospectively compared to the final diagnoses based on all histologic, genetic and molecular features These diagnosis hypotheses of CLL, LPL, MCL and MZL were consistent with the final diagnosis in 583 out of the 617 corresponding cases (94%) with high positive and negative predictive values. The characteristics of the diagnosis accuracy are detailed in the table below. HCL and FL were not further investigated as their immunophenotype usually do not overlap with those of other B-CLPD. Seventeen out of 617 patients (17/617, 5.3%) did not displayed a clear CD148/CD180/CD200 pattern: 9 LPL, 4 CLL and 4 MZL. In sixteen patients (16/617, 5.0%) the diagnosis hypothesis based on this strategy was not confirmed after completion of the exploration including karyotype, MYD88 L265P mutational status, CCND1 overexpression and pathology explorations. We next investigated the relative importance of these 3 markers. We focused on MFI values of CD148, CD180 and CD200 and three categorical "positive or negative" markers (CD5, CD23, FMC7) that were assembled into a composite marker. After Cox-box normalization of CD148, CD180 and CD200 MFIs, a set of supervised machine learning algorithms including Logistic Regression, Random Forest and Light Gradient Boosting Machine (LightGBM) were applied to the cohort of CLL, LPL, MCL and MZL. We established that the highest diagnosis weights were obtained for CD200 in CLL, CD200 and CD148 in MCL (negatively and positively, respectively), CD180 in MZL. In LPL, CD148, CD180 and CD200 had the highest weights using LightGBM and Random Forest algorithms, while Logistic Regression determined that CD5 and CD23 had the highest (negative) weights. In conclusion, the determination of CD148/CD180/CD200 surface expression patterns by flow cytometry, along with morphology, allowed to assert an accurate diagnosis hypothesis in CLL, MCL, LPL and MZL with high positive and negative predictive values. Machine learning algorithms allowed to measure the relative importance of these markers, that could be of great help in case of discordant expression of the main diagnosis markers. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

As in other parts of the world, air pollution over West and Central Africa has major health and meteorological impacts. Air quality assessment and its possible sanitary impact have become essential even in medium-sized towns, therefore amplifying the need for easy-to-implement monitoring methods with low environmental impact. We present here the potential of magnetic methods to monitor air quality at street level in the medium-sized city of Maroua (northern Cameroon) affected by dust-laden desert winds. More than five hundred (544) samples of bark and leaves taken from Neem trees in Maroua were analyzed. Magnetic susceptibility, saturation remanence, and S-ratio were found to determine the concentration and nature of magnetic particles. They are dominated by magnetite-like particle signals as a part of particulate emissions due to urban activities, including both traffic, composed of a substantial proportion of motorcycles, and wood burning for food preparation. We show that both bark and leaves from Neem trees are adequate passive bio-recorders. The use of both enables different times and heights to be sampled, allowing for the high-resolution monitoring, in terms of spatialization, of various urban environments. Particle emissions require assessment and screening that could be carried out rapidly and efficiently by magnetic methods on bio-recorders, even in cities impacted by dust-laden wind.

AIMS Transcatheter mitral valve replacement (TMVR) is a promising therapeutic solution to treat high-risk patients with severe mitral regurgitation (MR) contraindicated to surgery. Optimal selection of patients who will benefit from the procedure is of paramount importance. We aimed to investigate factors associated with TMVR screening. METHODS AND RESULTS From November 2016 to July 2018, we examined conditions associated with TMVR screening success in patients referred to the two French heart valve clinics with the greatest TMVR experience. Among a total of 40 consecutively screened patients, 16 (40%) were selected for TMVR (8 Twelve Intrepid, 7 Tendyne and 1 HighLife), while 24 patients (60%) were refused for TMVR mainly because of a too large mitral annulus (MA) (n=15, 62% of those refused), or too small anatomy and risk of neo-left ventricular outflow tract (LVOT) obstruction (n=6, 25% of those refused). Patients with suitable anatomy for TMVR were more often male and more frequently suffered from secondary MR (p=0.01) associated with previous myocardial infarction and presented a commissure-to-commissure diameter less than 39 mm (AUC=0.72, p=0.0085) and LVESD greater than 32 mm (AUC=0.83, p

Flow cytometry is broadly used for the identification, characterization, and monitoring of hematological malignancies. However, the use of clinical flow cytometry is restricted by its lack of reproducibility across multiple centers. Since 2006, the EuroFlow consortium has been developing a standardized procedure detailing the whole process from instrument settings to data analysis. The FranceFlow group was created in 2010 with the intention to educate participating centers in France about the standardized instrument setting protocol (SOP) developed by the EuroFlow consortium and to organise several rounds of quality controls (QCs) in order to evaluate the feasibility of its application and its results. Here, we report the 5 year experience of the FranceFlow group and the results of the seven QCs of 23 instruments, involving up to 19 centers, in France and in Belgium. The FranceFlow group demonstrates that both the distribution and applicability of the SOP have been successful. Intercenter reproducibility was evaluated using both normal and pathological blood samples. Coefficients of variation (CVs) across the centers were

Prospective data on the recovery of coordination in dogs suffering acute thoracolumbar intervertebral disc herniations (TL-IVDH) are limited. The purpose of this study was to use treadmill based and open field scores (OFS) to quantify recovery of stepping ability and forelimb, hindlimb coordination in the 6 weeks following surgical decompression of dogs with TL-IVDH. Sixty-three dogs were grouped at presentation as grades 3 (non-ambulatory paraparetic), 4 (paraplegic) or 5 (paraplegic without pain sensation) and were evaluated 2, 4, and 6 weeks post-operatively. Stepping scores and Regularity Index (RI), a measure of coordination, were calculated from treadmill walking, and an OFS incorporating supported and unsupported walking was assigned. Outcomes for the three measures were compared between groups and correlation between scoring methods was assessed. Grade 3 and 4 dogs recovered ambulation by 2 weeks, reaching median stepping scores of 96 and 90% by 6 weeks, respectively. Recovery of coordination differed between groups 3 and 4 with median RI scores of 93.9% and 63%, respectively, by 6 weeks. Eight grade 5 dogs failed to recover independent ambulation by 6 weeks. Nine dogs recovered with scores that were significantly worse than the grade 3 and 4 dogs at 6 weeks for stepping score (P

Background Aortic root replacement with a pulmonary autograft (Ross procedure) can be performed as a treatment of aortic valve endocarditis, avoiding prosthetic valve implantation in septic context. We sought to assess long-term outcomes of the Ross procedure in this indication. Methods From April 1992 to March 2009, the intervention was performed in 42 patients (mean age 34±8years) suffering from an active or ancient aortic valve endocarditis. 36% of the patients had extensive perivalvular involvement, and surgery was urgent in 18 patients (43%). We performed a prospective clinical and echocardiographic follow-up of this population. Results Median follow-up was 10years (4–21years). Overall survival at 10 and 15years was respectively 87±5% and 81±8%. Perioperative mortality was 4.7% (2 patients) and no late cardiac death was reported. Eight patients (19%) underwent repeat surgery for autograft and/or homograft dysfunction at a median time of 8.4years (3months–18years). Rate of recurrent endocarditis was low (7%—3 patients), including 1 in a context of persistent intravenous drug abuse. Clinical follow-up showed good functional status for all patients with NYHA≤II, and less than 25% of patients requiring cardiovascular medication. Late echocardiographic follow-up demonstrated well-functioning autograft and homograft, with only one severe aortic regurgitation, and one significant increase in pulmonary mean gradient. Conclusion The Ross procedure in aortic valve endocarditis is an interesting alternative to prosthetic valvular replacement in a selected population, with a high rate of survival free from any cardiovascular event or medication requirement.

Out-of-Hospital refractory Cardiac Arrest (OHrCA) has a mortality rate between 90 and 95%. Since 2009, French medical academic societies have recommended the use of extracorporeal life support (ECLS) for OHrCA. According to these guidelines, patients were eligible for ECLS support if vital signs were still present during cardiopulmonary resuscitation (CPR), or if cardiac arrest was secondary to intoxication or hypothermia (≤32°C). Otherwise, patients would receive ECLS if (i) no-flow duration was less than 5 min; (ii) time delays from CPR to ECLS start (low flow) were less than 100 min; and (iii) expiratory end tidal CO2 (ETCO2 ) was more than 10 mm Hg 20 min after initiating CPR. We have reported here our experience with ECLS in OHrCA according to the previous guidelines. We retrospectively analyzed mortality rates of patients supported with ECLS in case of OHrCA. From December 2009 to December 2013, 183 patients were assisted with ECLS, among which 32 cases were of OHrCA. Mean age for the OHrCA patients was 43.6 years. Over two-thirds were male (71.9%). Causes of OHrCA included intoxication, isolated hypothermia

In optical tomography, the radiative properties of the medium under investigation are estimated from information contained in measurements provided by a set of light sources and sensors located on the frontier of the probed medium. Such a non-linear ill-posed inverse problem is usually solved through optimization with the help of gradient-type methods. Since it is well known that such inverse problems are ill-posed, regularization is required. This paper compares three distinct regularization strategies for two different optimization algorithms, namely the damped Gauss–Newton and BFGS algorithms, for the two-dimensional diffuse approximation to the radiative transfer equation in the frequency domain. More specifically, the mesh-based regularization is combined with the Tikhonov regularization in the damped Gauss–Newton algorithm. For the BFGS algorithm, the mesh-based regularization is combined with the Sobolev gradients method. Moreover, a space-dependent Sobolev gradients method is proposed for the first time. The performance of the proposed algorithms are compared by utilizing synthetic data. The deviation factor and correlation coefficient are used to quantitatively compare the final reconstructions. Also, three levels of noise are considered to characterize the behaviour of the proposed methods against measurement noises. Numerical results indicate that the BFGS algorithm outperforms the damped Gauss–Newton in many aspects.

This paper deals with the estimation of optical property distributions of participating media from a set of light sources and sensors located on the boundaries of the medium. This is the so-called diffuse optical tomography problem. Such a non-linear ill-posed inverse problem is solved through the minimization of a cost function which depends on the discrepancy, in a least-square sense, between some measurements and associated predictions. In the present case, predictions are based on the diffuse approximation model in the frequency domain while the optimization problem is solved by the L-BFGS algorithm. To cope with the local convergence property of the optimizer and the presence of numerous local minima in the cost function, a wavelet multi-scale method associated with the L-BFGS method is developed, implemented, and validated. This method relies on a reformulation of the original inverse problem into a sequence of sub-inverse problems of different scales using wavelet transform, from the largest scale to the smallest one. Numerical results show that the proposed method brings more stability with respect to the ordinary L-BFGS method and enhances the reconstructed images for most of initial guesses of optical properties.

Grégoire Couvrat-Desvergnes, Apolline Salama, and Ludmilla Le Berre contributed equally to this work.; International audience; BACKGROUND: Rabbit-generated antithymocyte globulins (ATGs), which target human T cells, are widely used as immunosuppressive agents during treatment of kidney allograft recipients. However, ATGs can induce immune complex diseases, including serum sickness disease (SSD). Rabbit and human IgGs have various antigenic differences, including expression of the sialic acid Neu5Gc and α-1-3-Gal (Gal), which are not synthesized by human beings. Moreover, anti-Neu5Gc antibodies have been shown to preexist and be elicited by immunization in human subjects. This study aimed to assess the effect of SSD on long-term kidney allograft outcome and to compare the immunization status of grafted patients presenting with SSD following ATG induction treatment.METHODS: We analyzed data from a cohort of 889 first kidney graft recipients with ATG induction (86 with SSD [SSD(+)] and 803 without SSD [SSD(-)]) from the Données Informatisées et Validées en Transplantation data bank. Two subgroups of SSD(+) and SSD(-) patients that had received ATG induction treatment were then assessed for total anti-ATG, anti-Neu5Gc, and anti-Gal antibodies using ELISA assays on sera before and after transplantation.RESULTS: SSD was significantly associated with long-term graft loss (>10 years, P = 0.02). Moreover, SSD(+) patients exhibited significantly elevated titers of anti-ATG (P = 0.043) and anti-Neu5Gc (P = 0.007) IgGs in late post-graft samples compared with SSD(-) recipients.CONCLUSION: In conclusion, our data indicate that SSD is a major contributing factor of late graft loss following ATG induction and that anti-Neu5Gc antibodies increase over time in SSD(+) patients.FUNDING: This study was funded by Société d'Accélération du Transfert de Technologies Ouest Valorisation, the European FP7 "Translink" research program, the French National Agency of Research, Labex Transplantex, the Natural Science and Engineering Research Council of Canada, and the Canadian Foundation for Innovation.

CD180, a related member of the Toll-like receptor family, is lost or underexpressed at the plasma membrane in circulating cells of various B-cell lymphomas except marginal zone lymphomas (MZL). In order to confirm its clinical relevance in routine analysis, we evaluated prospectively the expression of CD180 in 236 patients from 5 French University Hospital laboratories on behalf of the GEIL. Highly comparable results were obtained in all centers using the EuroFlow standardization protocol. We observed that CD180 median fluorescence (MdFI) was significantly higher in MZL and hairy cell leukaemia (HCL) compared to all other B-cell proliferations (P < 0.05). CD180 intensity could distinguish lymphomas with numerous villous lymphocytes from other MZL. ROC curve analysis identified a CD180 MdFI threshold for which the diagnosis of MZL could be assessed with 77% sensitivity and 92% specificity. This study showed that CD180 can be considered as a single positive robust marker of MZL and should be therefore included in flow cytometry panels for the diagnosis of mature B-cell neoplasms. Harmonization process is of great interest in order to evaluate new markers in multicentric studies and to set up decisional thresholds. © 2015 International Clinical Cytometry Society.

The French nuclear safety authority is responsible for the control of radiation protection in radiotherapy since 2002. Controls are based on the public health and the labour codes and on the procedures defined by the controlled health care facility for its quality and safety management system according to ASN decision No. 2008-DC-0103. Inspectors verify the adequacy of the quality and safety management procedures and their implementation, and select process steps on the basis of feedback from events notified to ASN. Topics of the inspection are communicated to the facility at the launch of a campaign, which enables them to anticipate the inspectors' expectations. In cases where they are not physicians, inspectors are not allowed to access information covered by medical confidentiality. The consulted documents must therefore be expunged of any patient-identifying information. Exchanges before the inspection are intended to facilitate the provision of documents that may be consulted. Finally, exchange slots between inspectors and the local professionals must be organized. Based on improvements achieved by the health care centres and on recommendations from a joint working group of radiotherapy professionals and the nuclear safety authority, changes will be made in the control procedure that will be implemented when developing the inspection program for 2016-2019.

The problem of Vortex-Induced Vibrations (VIV) on spool and jumper geometries is known to present several drawbacks when approached with conventional engineering tools used in the study of VIV on risers. Current recommended practices can lead to over-conservatism that the industry needs to quantify and minimize within notably cost reduction objectives. Within this purpose, the paper will present a brief critical review of the Industry standards and more particularly focus on both experimental and Computational Fluid Dynamic (CFD) approaches. Both qualitative and quantitative comparisons between basin tests and CFD results for a 2D ‘M-shape’ spool model will be detailed. The results presented here are part of a larger experimental and numerical campaign which considered a number of current velocities, heading and geometry configurations. The vibratory response of the model will be investigated for one of the current velocities and compared with the results obtained through recommended practices (e.g. Shear7 and DNV guidelines). The strategy used by the software K-FSI to solve the fluid-structure interaction (FSI) problem is a partitioned coupling solver between fluid solver (FINE™/Marine) and structural solvers (ARA). FINE™/Marine solves the Reynolds-Averaged Navier-Stokes Equations in a conservative way via the finite volume method and can work on structured or unstructured meshes with arbitrary polyhedrons, while ARA is a nonlinear finite element solver with a large displacement formulation. The experiments were conducted in the BGO FIRST facility located in La Seyne sur Mer, France. Particular attention was paid towards the model design, fabrication, instrumentation and characterization, to ensure an excellent agreement between the structural numerical model and the actual physical model. This included the use of a material with low structural damping, the performance of stiffness and decay tests in air and in still water, plus the rationalization of the instrumentation to be able to capture the response with the minimum flow perturbation or interaction due to instrumentation.

Background CD180, a related member of the Toll-like receptor family, seems to be underexpressed at the plasma membrane in circulating B cells of auto-immune disease (systemic lupus especially),1 and is lost in various B-cell lymphomas except marginal zone lymphomas (MZL), the most severe complication of primary Sjogren’s Syndrome (pSS).2 Objectives To define the expression of CD180 at the plasma membrane of circulating B cells of pSS and determine its association with systemic disease activity. Methods The expression of CD180 at the plasma membrane of circulating B cells was studied by flow cytometry, in 69 successive patients with pSS, in comparison to patients with systemic lupus (SLE) (n=7) and healthy controls (n=28). Results The cohort of pSS was composed of 65 women for 4 men, median age of 59 years.25–89 Median clinESSDAI was 2 [0–18], 46 patients with a clinESSDAI >0 (low disease activity), 18 patients with a clinESSDAI >5 (moderate disease activity) and 6 patients≥14 (high disease activity). The more frequently involved domains of the ESSDAI were biological (39%, n=27), glandular (32%, n=22), articular (20%, n=14), and peripheral neurological (9%, n=6) domains. Fourty patients were anti-SSA+, 16 anti-SSA and anti-SSB+. 18 had a hypergammaglobulinemia, 17 a hypocomplementemia, 7 a cryoglobulinemia, 18 a rheumatoid factor and 9 a lymphopenia. - CD180-negative B cells in pSS, SLE and controls The proportion of total lymphocytes, B cells, T cells, NK cells or CD180-negative B cells (0.85% vs 0.95%, p=0.64) was not significantly different between pSS patients and healthy controls. Patients with SLE had significantly fewer lymphocytes (860 vs 1544, p=0.0012), B cells and T cells than those with pSS (p=0.023 and p=0.0016); CD180-negative B cells tended have a higher proportion in SLE than in pSS patients (1.9% vs 0.85%, p=0.055). - Increase of CD180-negative B cells in patients with pSS and high systemic disease activity CD180-negative B cells subset was significantly higher in patients with high systemic disease activity (2.55% CD180-negative B cells in patients with clinESSDAI ≥14 vs 0.8% in patients with clinESSDAI Conclusions Blood CD180-negative B cells are increased in pSS patients with high systemic disease activity or in immunologically active pSS. Fonctionnality of CD180 and the prognostic interest of CD180 staining on blood B cells to predict lymphoma in pSS patients, have now to be studied. Reference [1] Kikuchi Y, et al. RP105-negative B cells in patients with Sjogren’s syndrome. [2] Mayeur-Rousse C, et al. CD180 expression in B-cell lymphomas: A multicenter GEIL study. Disclosure of Interest None declared

Background Stentless porcine roots (SPV) have been proposed for right ventricular outflow tract reconstruction in the Ross procedure due to the relative availability of pulmonary homografts in large diameters. We report here our experience with SPV used in the Ross procedure. Methods Between March 1992 and February 2011, 360 patients had a Ross procedure; 61 patients received a SPV in pulmonary position and they represent the study population. Mean age was 38 ± 7.6 years. Indication for surgery was an infective endocarditis in 15 cases, there were 3 redo operations. Median SPV diameter was 29 mm (range, 25 to 29 mm). Pulmonary stenosis was defined as a peak transvalvular gradient of more than 50 mm Hg. Results Perioperative mortality was 4.9% (3 patients) and late mortality was 3.3% (2 patients). Median follow-up was 4 years (range, 7 days to 14.9 years). There was no reoperation on the right ventricle outflow tract, and freedom from pulmonary stenosis was 100% at 5 years. Mean transpulmonary gradients were 7.1 ± 3.1 mm Hg and 13.5 ± 6.8 mm Hg postoperatively and at 5 years, respectively. Mean transpulmonary gradient increased faster over time when the SPV diameter was less than 29 mm ( p = 0.03). Conclusions The SPV could represent an alternative to cryopreserved pulmonary homografts during the Ross procedure in adult patients. Hemodynamic results were improved by using large diameter SPV, but longer follow-up is mandatory to confirm those results.

The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics.

The analysis of events is crucial for accident prevention. In 2007, ASN set up a system for the notification of radiation protection events. The majority of them concern the exposure of patients undergoing therapeutic or diagnostic procedures and, to a lesser extent, occupational exposures and the management of radioactive effluents. The most significant events concern interventional radiological procedures and nuclear medicine, in which there are exceedances of mandatory dose limits and staff contaminations, respectively. Deterministic effects in patients were observed following interventional procedures and in nuclear medicine. Many events involve leakage of radioactive effluents and highlight the need to improve the monitoring and maintenance of radioactive effluent facilities. The causes are mainly of organisational and human origin. The lessons learned emphasise the importance of the role of medical physicists and radiation protection officers and the need to implement quality and risk management measures and to conduct clinical audits.