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Implantation of permanent pacemakers (PPMs) or implantable cardiac defibrillators (ICDs) may be complicated by the development of pocket hematomas. To evaluate bleeding complications in patients taking apixaban and undergoing a pacemaker or ICD implantation in everyday clinical practice. It is a multicenter, observational, prospective study of patients with non-valvular atrial fibrillation (AF) undergoing a pacemaker or implantable cardioverter defibrillator [ICD]. Eligible patients had been taking apixaban (2.5 or 5 mg twice daily) for ≥ 3 weeks before the procedure, and were followed for 30 days afterwards. A total of 115 patients (80 [72,85] years, 63% male, mean CHA2DS2-VASc score 3, mean HAS BLED score 3) were enrolled at 25 academic/non-academic centres in France; 68 patients (59%) were receiving apixaban 10 mg/day and 47 (41%) 5 mg/day. The most prevalent concomitant disorders were hypertension (55% of patients), diabetes (15%), vascular disease (10%) and a history of stroke (6%). Mean creatinine value was 93 ± 25 μmol/L, median weight was 83 ± 18 kg and mean creatinine clearance (Cockroft − Gault) was 82 ± 34 mL/min. The implantation was a planned procedure in 102 (89%) of cases. The mean duration of procedure was 51 min. The management of apixaban in the periprocedural period was let to the investigators preference. Median withdrawal time was 25 h. Bleeding events were detected in 4 (3.5%) cases. One of them was a pocket hematoma with infection treated by the extraction of the device. Three patients presented minor bleedings according to ISTH classification without prolongation of hospitalization. These observational data of patients on apixaban undergoing pacemaker/ICD implantation in everyday practice show a management of apixaban according to guidelines with a low rate of bleeding events. [ABSTRACT FROM AUTHOR]

To evaluate thromboembolic complications in patients taking apixaban and undergoing a cardioversion procedure in everyday clinical practice. It is a multicenter, observational, prospective study of patients with non-valvular atrial fibrillation (AF) undergoing cardioversion (electric or medical). Eligible patients had been taking apixaban (2.5 or 5 mg twice daily) for ≥ 3 weeks before the procedure, and were followed for 30 days afterwards. A total of 278 patients (68 [61,76] years, 71% male, mean CHA2DS2-VASc score 2, mean HAS BLED score 2) were enrolled at 25 academic/non-academic centres in France; 248 patients (89%) were receiving apixaban 10 mg/day and 29 (11%) 5 mg/day. The most prevalent concomitant disorders were hypertension (50% of patients) and diabetes (15%). The mean creatinine clearance (Cockroft − Gault) was 81 ± 34 mL/min. The majority of patients had an electric cardioversion (264, 95%)and 14 patients (5%) received amiodarone only. Cardioversion was a planned procedure in the most of cases (97%). Sixty-seven patients (24%) had a transeophageal echocardiogram before procedure. There were no reported thromboembolic events. These observational data of patients on apixaban undergoing cardiversion in everyday practice show no thromboembolic events on a follow-up of 30 days. [ABSTRACT FROM AUTHOR]

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper. [ABSTRACT FROM AUTHOR]

The intrinsic irreversible strain limit εirr,0 of Nb3Sn superconducting wires, made by the restacked-rod process and doped with either Ti or Ta, undergoes a precipitous change as a function of temperature θ of the final heat-treatment for forming the A15 phase. Nb3Sn transitions from a highly brittle state where it cracks as soon as it is subjected to an axial tensile strain of any measurable amount, to a state more resilient to tensile strain as high as 0.4%. The remarkable abruptness of this transition (as most of it occurs over a range of only 10 °C) could pose real challenges for the heat-treatment of large magnets, such as those fabricated for the high-luminosity upgrade of the Large Hadron Collider (LHC). We named this behavior the strain irreversibility cliff (SIC) to caution magnet developers. The approach to fulfilling application requirements just in terms of the conductor’s residual resistivity ratio RRR and critical-current density Jc is incomplete. Along with RRR and Jc wire specifications, and sub-element size requirements that reduce wire magnetization and instabilities effects, SIC imposes additional constraints on the choice of heat-treatment conditions to ensure mechanical integrity of the conductor. [ABSTRACT FROM AUTHOR]

In Part 2 of these articles, an extensive analysis of pinning-force curves and raw scaling data was used to derive the Extrapolative Scaling Expression (ESE). This is a parameterization of the Unified Scaling Law (USL) that has the extrapolation capability of fundamental unified scaling, coupled with the application ease of a simple fitting equation. Here in Part 3, the accuracy of the ESE relation to interpolate and extrapolate limited critical-current data to obtain complete Ic(B,T,ε) datasets is evaluated and compared with present fitting equations. Accuracy is analyzed in terms of root mean square (RMS) error and fractional deviation statistics. Highlights from 92 test cases are condensed and summarized, covering most fitting protocols and proposed parameterizations of the USL. The results show that ESE reliably extrapolates critical currents at fields B, temperatures T, and strains ε that are remarkably different from the fitted minimum dataset. Depending on whether the conductor is moderate-Jc or high-Jc, effective RMS extrapolation errors for ESE are in the range 2–5 A at 12 T, which approaches the Ic measurement error (1–2%). The minimum dataset for extrapolating full Ic(B,T,ε) characteristics is also determined from raw scaling data. It consists of one set of Ic(B,ε) data at a fixed temperature (e.g., liquid helium temperature), and one set of Ic(B,T) data at a fixed strain (e.g., zero applied strain). Error analysis of extrapolations from the minimum dataset with different fitting equations shows that ESE reduces the percentage extrapolation errors at individual data points at high fields, temperatures, and compressive strains down to 1/10th to 1/40th the size of those for extrapolations with present fitting equations. Depending on the conductor, percentage fitting errors for interpolations are also reduced to as little as 1/15th the size. The extrapolation accuracy of the ESE relation offers the prospect of straightforward implementation of the USL in several new areas: (l) A five-fold reduction in the measurement space for unified temperature-strain apparatuses through extrapolation of minimum datasets; (2) Combination of data from separate temperature and strain apparatuses, which provides flexibility and productive use of more limited data; and (3) Full conductor characterization from as little as a single Ic(B) curve when a few core parameters have been measured in a similar conductor. Default core scaling parameter values are also given, based on analysis of a wide range of practical Nb3Sn conductors. [ABSTRACT FROM AUTHOR]

A scaling study of several thousand Nb3Sn critical-current (Ic) measurements is used to derive the Extrapolative Scaling Expression (ESE), a relation that can quickly and accurately extrapolate limited datasets to obtain full three-dimensional dependences of Ic on magnetic field (B), temperature (T), and mechanical strain (ε). The relation has the advantage of being easy to implement, and offers significant savings in sample characterization time and a useful tool for magnet design. Thorough data-based analysis of the general parameterization of the Unified Scaling Law (USL) shows the existence of three universal scaling constants for practical Nb3Sn conductors. The study also identifies the scaling parameters that are conductor specific and need to be fitted to each conductor. This investigation includes two new, rare, and very large Ic(B,T,ε) datasets (each with nearly a thousand Ic measurements spanning magnetic fields from 1 to 16 T, temperatures from ∼2.26 to 14 K, and intrinsic strains from –1.1% to +0.3%). The results are summarized in terms of the general USL parameters given in table 3 of Part 1 (Ekin J W 2010 Supercond. Sci. Technol.23 083001) of this series of articles. The scaling constants determined for practical Nb3Sn conductors are: the upper-critical-field temperature parameter v = 1.50 ± 0.04; the cross-link parameter w = 3.0 ± 0.3; and the strain curvature parameter u = 1.7 ± 0.1 (from equation (29) for bc2(ε) in Part 1). These constants and required fitting parameters result in the ESE relation, given by I c ( B , T , ε ) B = C [ b c 2 ( ε ) ] s ( 1 − t 1.5 ) η − μ ( 1 − t 2 ) μ b p ( 1 – b ) q with reduced magnetic field b ≡ B/Bc2*(T,ε) and reduced temperature t ≡ T/Tc*(ε), where: B c 2 * ( T , ε ) = B c 2 * ( 0 , 0 ) ( 1 − t 1.5 ) b c 2 ( ε ) T c * ( ε ) = T c * ( 0 ) [ b c 2 ( ε ) ] 1/3 and fitting parameters: C, Bc2*(0,0), Tc*(0), s, either η or μ (but not both), plus the parameters in the strain function bc2(ε). The pinning-force shape parameters p and q are also preferably fitted (simultaneously with the other parameters), but default values p = 0.5 and q = 2.0 also give high fitting accuracy when the range of relative magnetic fields is not extensive. Default values are also essential when the magnetic field data range is insufficient to determine p and q. The scaling constants are remarkably stable (changes less than ∼1%) with respect to different values of p and q, Nb3Sn conductor configurations, magnetic self-field corrections, and pinning-force trim values. The results demonstrate that the scaling of transport critical current holds down to the lowest temperatures measured ∼2.2 K, for both magnetic self-field corrected and uncorrected data. An initial comparison is also made between transport and magnetization scaling data in matched Nb3Sn samples and significant differences are found, especially for the upper critical field Bc2*(T,ε), which may be a result of inhomogeneous shielding currents. In Part 3 of this topical review series (Ekin J W 2017 Supercond. Sci. Technol. at press), the smallest practical minimum dataset for extrapolating full Ic(B,T,ε) datasets is derived. Application of the ESE relation is illustrated in several new areas, including full characterization of Nb3Sn conductors from as little as a single Ic(B) curve when a few core parameters have been determined for similar conductors. [ABSTRACT FROM AUTHOR]

As part of an international project to benchmark facilities for measuring the strain dependence of critical current in International Thermonuclear Experimental Reactor (ITER) Nb3Sn strands, direct measurement of local strain exerted on Nb3Sn filaments was attempted at cryogenic temperature by means of a pulsed neutron technique. The lattice axial strain increased linearly with a slope close to unity against applied strain, while the thermal axial strain was −0.22% at 8.5 K. As a result, the force-free strain was evaluated to be 0.22–0.23%. This key parameter should provide an accurate estimate of the peak location of critical current versus applied strain. The lattice transverse strain decreased linearly as a function of applied strain with a slope of 0.33–0.34. The lattice strains of the Nb and Cu components were also measured and their behavior was analyzed by computing diffraction elastic moduli based on micromechanics theories. The stress–strain curve calculated according to the rule of mixtures described quite well the macroscopic curve measured for the present ITER Nb3Sn strand. [ABSTRACT FROM AUTHOR]

Systematic studies of the intrinsic irreversible strain limit εirr,0, microstructure, and microchemistry were made on several internal-tin Nb3Sn pre-production wires, fabricated for the domestic agencies of the USA and China participating in the International Thermonuclear Experimental Reactor. These wires were produced by Luvata, Oxford Superconducting Technology (OST), and Western Superconducting Technologies (WST), and were intended for the tokamak’s toroidal-field coils. The results of this study show that, for a final heat-treatment at 650 °C to form the A15 phase, both εirr,0 and the de-pinning field Bc2* improved by increasing heat-treatment duration beyond 100 h for the Luvata wires. On the other hand, we saw no improvement in these two parameters as a function of heat-treatment duration in the OST wires. Furthermore, micro-chemical analysis of OST wires revealed that some Nb3Sn filaments have a Sn- and Ti-rich phase at the interface between Cu(Sn) matrix and Nb3Sn in the form of a shell around individual filaments. This phase is far less prominent in the Luvata and WST conductors, and could inhibit diffusion of Sn and Ti into Nb3Sn filaments during the reaction and may potentially be the reason for the lack of noticeable change in Bc2* with heat-treatment duration in the OST wires. The increase of εirr,0 and Bc2* with heat-treatment duration in the Luvata wires and the lack of increase in the OST wires may suggest a possible correlation between εirr,0 and the stoichiometry of the A15 composition. Investigation of the samples’ microstructure revealed only a small number of cracked Nb3Sn filaments despite the significant and permanent degradation of their critical current Ic when subjected to longitudinal tensile strain ε beyond εirr,0. The scarcity of cracks indicate that Ic(ε) measurements are highly sensitive to crack formation in Nb3Sn filaments, especially at low electric-field criteria ≦̸0.1 μV cm−1, even when the sizes of the individual filaments are only few micrometers. All the strands contained substantial Kirkendall porosity, but we found that the quantity and distribution of the Kirkendall voids vary significantly with strand design. Luvata wires have the least porosity, followed by WST wires, and then by OST strands. However, even though the presence of cracks in the Nb3Sn filaments that are in close proximity to Kirkendall voids suggest a correlation between crack initiation and the proximity of the filaments to these voids, the porosity investigation established no definitive relationship between porosity and εirr,0 in the wires studied. [ABSTRACT FROM AUTHOR]

To limit the adverse effects of diabetes, a personalized and long-term management strategy that includes appropriate medication, exercise and diet has become of paramount importance and necessity. Compartment-based mathematical control models for diabetes usually result in objective functions whose terms are conflicting, preventing the use of single-objective-based models for obtaining appropriate personalized strategies. Taking into account the conflicting aspects when controlling the diabetic population dynamics, this paper introduces a multi-objective approach consisting of four steps: (a) modeling the problem of controlling the diabetic population dynamics using a multi-objective mathematical model, (b) discretizing the model using the trapezoidal rule and the Euler–Cauchy method, (c) using swarm-intelligence-based optimizers to solve the model and (d) structuring the set of controls using soft clustering methods, known for their flexibility. In contrast to single-objective approaches, experimental results show that the multi-objective approach obtains appropriate personalized controls, where the control associated with the compartment of diabetics without complications is totally different from that associated with the compartment of diabetics with complications. Moreover, these controls enable a significant reduction in the number of diabetics with and without complications, and the multi-objective strategy saves up to 4% of the resources needed for the control of diabetes without complications and up to 18% of resources for the control of diabetes with complications. [ABSTRACT FROM AUTHOR]

Aims The aim of this article was to assess whether abnormal dobutamine stress echocardiography (DSE) can be due to a dobutamine-induced coronary spasm in patients with angiographically documented vasospastic coronary arteries. Methods and results Between January 2004 and April 2008, we prospectively evaluated all patients with known or suspected coronary artery disease (CAD) referred to the echocardiography laboratory for dobutamine stress tests (6061 examinations). Those with abnormal DSE underwent coronary angiogram with a systematic methylergometrine intracoronary injection in the case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients who had spontaneous occlusive coronary spasm or positive methylergometrine test, but no significant stenoses, were ultimately included in this study. About 581 patients had abnormal DSE, among them only 20 (3.4%) fulfilled the inclusion criteria. There were 15 males and 5 females, and mean age was 64.35 years (range 52–85); 8 patients had a known history of CAD and all of them had at least two established cardiovascular risk factors. The culprit vessel was the left anterior descending artery in 10 cases (50%), right coronary artery in 8 cases (40%), and left circumflex in 2 cases (10%). There was a systematic correspondence between the culprit arteries and dobutamine-induced wall motion abnormality territories. No complications occurred during examination or during the provocation test. All the patients were discharged with a calcium channel blocker and were doing well after 13 months of mean follow-up. Conclusion Coronary artery spasm can be induced at DSE, but is a rare finding; it could, though, be clinically relevant as it may partly explain some erroneously labelled ‘false-positive’ examinations. Methylergometrine provocation test is a safe and advisable approach in such situations. [ABSTRACT FROM AUTHOR]

This survey evaluated hypnosis practice in French centres in June 2020. The survey was sent via email to different rhythmology centres in France and responses from cardiologists and nurses were obtained. We present here the preliminary results of this survey. Hypnosis was used on a regular basis in 7.5% of the centres and 13% of the participants received education on hypnosis. 75% of the participants were interested to have an education of hypnosis. The survey points the different possibilities of improvement of management of patients while having the different procedures. [ABSTRACT FROM AUTHOR]

A colorimetric microassay for the quantitative determination of galactose in the blood was taken and updated. This method helps in diagnosis and follow-up of several inherited metabolic diseases connected to galactose metabolism deficiency such as galactosemia, glycogenosis, glycosylation, tyrosinemia and citrin deficiency. Galactose assay in the blood presents difficulties due to interference with glucose. In this study, we update a method to get around these difficulties. This procedure was based on the incubation of whole blood with orcinol in a strongly acidic solution to form a galactose and glucose complexes able to absorb at two different wavelengths. The standard curve analysis for the individual solutions of these two sugars showed a wide range of linearity from 0 to 200 mg / l. Under optimal experimental conditions, the stirring time of the orcinol is 3 minutes, the heating time of the reaction is 20 minutes at 56 ° C, and the duration of the incubation in the dark is 40 minutes. The analysis is carried out on fresh blood. The maximum absorbance of galactose and glucose is respectively 569 nm and 421 nm. An adapted diagnosis algorithm was developed based on our results. this method could help in screening and identifying patients with hypergalactosemia that need further investigations. It could represent a promising method for neonatal screening in countries with limited resources. Image 1 • The biological importance of galactose goes beyond its importance as a nutrient and a metabolite. • Genetic disorders that impair the galactose metabolism inevitably cause several diseases. • The hypergalactosemia is a biomarker of a spectrum of diseases connected to galactose metabolism. • The galactose level in blood could orient the diagnosis of some inherited metabolic disorders with liver impairment. [ABSTRACT FROM AUTHOR]

Polychaetes are one of the most important groups of macrobenthic organisms in coastal and marine environments, in terms of diversity and abundance, and play an important role in the functioning of ecosystem. This study aims to describe the structure and spatial distribution of polychaete communities along Essaouira's rocky shoreline (Atlantic coast of Morocco) in relation to the major environmental variables such as granulometry, salinity, temperature, pH, and intertidal range. Twelve sites from these intertidal rocky shores were sampled using a quadrat method during the summer 2016. A total of 4 435 individuals belonging to 34 taxa were recorded. Among the families, Sabellaridae (24%) and Nereididae (23%) were ranked first in terms of abundance of individuals. Sabellaria alveolata (24%) and Perinereis cultrifera (13%) were the dominant species. Diversity (H′) values varied from 2.28 to 3.95. Pielou's index (J′) varied between 0.62 and 0.89. This was essentially due to the low dominance of few species. Cluster analysis was used to characterise Essaouira's rocky shores on the basis of benthic polychaete communities. SIMPER analysis confirmed the presence of three distinct communities. According to canonical correspondence analysis, the structure and distribution of faunal assemblages of benthic polychaetes was mainly related to topographical complexity, water temperature, hydrodynamic conditions and upwelling. We conclude that these rocky shores show typically high benthic polychaete diversity compared to the taxonomic list of other rocky coasts. In addition, these results constitute a baseline data for the development of a sustainable network for long-term monitoring of benthic polychaete community changes due to ecological factor influences and anthropogenic activity impacts. [ABSTRACT FROM AUTHOR]

Highlights • An extensive rainfall-runoff-erosion database was compiled in the Mediterranean basin. • We analyzed the relationships between weather types, rainfall, runoff and sediment yield. • Most rainfall, runoff, and sediment yield occurred in a small number of weather types. • Four spatial classes driven by N-NW, E-NE, S-SE and W-SW flows dominated rainfall/runoff. • Three classes were identified for sediment yield, comprising N-NE, E and W-SW flows. Abstract Soil degradation by water is a serious environmental problem worldwide, with specific climatic factors being the major causes. We investigated the relationships between synoptic atmospheric patterns (i.e. weather types, WTs) and runoff, erosion and sediment yield throughout the Mediterranean basin by analyzing a large database of natural rainfall events at 68 research sites in 9 countries. Principal Component Analysis (PCA) was used to identify spatial relationships of the different WTs including three hydro-sedimentary variables: rainfall, runoff, and sediment yield (SY, used to refer to both soil erosion measured at plot scale and sediment yield registered at catchment scale). The results indicated 4 spatial classes of rainfall and runoff: (a) northern sites dependent on North (N) and North West (NW) flows; (b) eastern sites dependent on E and NE flows; (c) southern sites dependent on S and SE flows; and, finally, (d) western sites dependent on W and SW flows. Conversely, three spatial classes are identified for SY characterized by: (a) N and NE flows in northern sites (b) E flows in eastern sites, and (c) W and SW flows in western sites. Most of the rainfall, runoff and SY occurred during a small number of daily events, and just a few WTs accounted for large percentages of the total. Our results confirm that characterization by WT improves understanding of the general conditions under which runoff and SY occur, and provides useful information for understanding the spatial variability of runoff, and SY throughout the Mediterranean basin. The approach used here could be useful to aid of the design of regional water management and soil conservation measures. [ABSTRACT FROM AUTHOR]

Résumé Introduction La gestion du traitement antiagrégant au moment de l’implantation de dispositifs intracardiaques reste controversée. Cette étude vise à évaluer le risque de complications hémorragiques chez les patients implantés de prothèses cardiaques sous ticagrelor. Méthodes Nous avons effectué une étude multicentrique ( n = 4), rétrospective, du mois de janvier 2015 et jusqu’à janvier 2016. Ont été inclus tous les patients ayant eu une implantation de stimulateur cardiaque, de défibrillateur automatique implantable (DAI) ou de changement de boîtier sous ticagrelor. Nous rapportons les complications postopératoires hémorragiques à 1 mois. Une complication hémorragique significative a été définie par un hématome de loge nécessitant une évacuation chirurgicale ou une prolongation de l’hospitalisation, un hémothorax, un épanchement péricardique, ou une tamponnade. Résultats Au total 20 patients ont été inclus. L’âge moyen des patients était de 65 ± 9 ans, 95 % étaient des hommes, 25 % des patients étaient diabétiques, 55 % étaient hypertendus et 50 % présentaient des antécédents d’insuffisance cardiaque. Tous les patients avaient des antécédents de syndrome coronarien aigu (6 [4–26] mois avant la procédure). La majorité des dispositifs implantés étaient des DAI (17, 85 %) avec 5 mono chambre, 4 double chambre et 9 triple chambre. La voie veineuse sous-clavière a été utilisée chez 9 patients. La durée moyenne de la procédure était de 60 minutes. Un saignement per-procédural a été décrit et était secondaire à une pression veineuse élevée au moment de la procédure, sans être compliqué d’un hématome postopératoire. Un seul hématome de la loge a été constaté. L’approche sous-clavière a été utilisée pour les 2 patients. Aucune transfusion sanguine n’a été nécessaire pour les 2 cas. Conclusion Le traitement par ticagrelor au cours des procédures d’implantation de dispositifs électroniques intracardiaques, ne semble pas être associé à un risque accru de saignement. Dans notre étude, 2 patients ont eu des complications hémorragiques non significatives. Introduction Management of antiplatelet therapy at the time of device implantation remains controversial. This study aimed to assess the risk of bleeding complications in patients receiving ticagrelor at the time of cardiac device surgery. Methods We performed a multicentre ( n = 4), retrospective study from January 2015 to January 2016. The survey included all patients (pts) treated with ticagrelor before undergoing pacemaker, implantable cardioverter-defibrillator (ICD) implantation or generator replacement. We report hemorrhagic post-procedural complications at 1 month. A significant bleeding complication was defined as pocket hematoma requiring a surgical evacuation or prolonged hospitalization, hemothorax, pericardial effusion, or tamponade. Results A total of 20 patients underwent a permanent pacemaker or ICD implantation while taking a combination of antipatelet therapy with ticagrelor and aspirin. The mean age of the patients was 65 ± 9 years, 95% were male, 25% of patients were diabetics, 55% had hypertension and 50% presented a history of heart failure. All the patients had a history of acute coronary syndrome [6 (4–26) months before the procedure]. The majority of implanted devices were ICDs (17, 85%) with 5 single chamber, 4 dual chambers and 9 triple chambers ICDs. Subclavian venous approach was utilized in 9 patients. The mean duration of procedure was 60 minutes. One per-procedure bleeding was described due to high venous pressure, without post-procedure hematoma. A post-procedure pocket hematoma has been experienced by one patient. The subclavian approach was used for the 2 patients. No blood transfusion was needed for these 2 cases. Conclusion Ticagrelor treatment at the time of heart rhythm device procedures does not seem to be associated with an increased risk of significant bleeding complications. In our study, 2 patients experienced nonsignificant bleeding complications. [ABSTRACT FROM AUTHOR]

Résumé: La dénervation rénale par radiofréquence est une technique utilisée depuis peu dans le traitement de l’HTA réfractaire. Elle est en principe réalisée sous anesthésie générale car l’application des points d’ablation sur les artères rénales est douloureuse. Nous proposons une alternative à l’anesthésie générale consistant en l’association de morphine 0,1mg/kg IV au MEOPA, mélange gazeux d’oxygène et de protoxyde d’azote délivré au masque. Dans notre série de 12 patients consécutifs traités par dénervation rénale entre octobre 2011 et juin 2013, les 5 premiers patients (groupe 1) ont reçu une simple sédation hydroxyzine morphine. Tous les 5 ont ressenti la procédure comme douloureuse, à 2 reprises une douleur supportable (EVA<5), à 3 reprises une douleur intense (EVA>5) nécessitant d’augmenter dans 2 cas de façon importante la dose de morphine (dose totale 0,25mg/kg) dans 1 cas de façon modérée (dose totale : 0,15mg/kg). Les 7 patients suivants (groupe 2) ont bénéficié d’un protocole hydoxyzine morphine MEOPA au masque. Un seul patient a ressenti une douleur EVA 5 ayant nécessité l’adjonction d’une dose de morphine (dose totale : 0,17mg/kg). Les 6 autres patients du groupe 2 n’ont ressenti aucune douleur per procédure. La dose moyenne de morphine dans le groupe 1 est de 0,17mg/kg, dans le groupe 2 de 0,11mg/kg. Cette étude préliminaire, si elle est confirmée, permettrait à de nombreux centres hospitaliers ne disposant pas d’équipe d’anesthésie de réaliser les procédures de dénervation rénale avec ce protocole. Conclusion : le protocole MEOPA Morphine a permis de réaliser dans des conditions d’analgésie confortables pour 6 des 7 patients les procédures de dénervation rénale, contrairement au groupe de 5 patients sous morphine seule et ce malgré des doses plus importantes de morphine dans ce dernier groupe. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To assess the prevalence of coronary artery spasm during dobutamine stress chocardiography (DSE), to describe clinical and echocardiographic characteristics and prognosis. Patients and methods: We evaluated all the patients with known or suspected coronary artery disease (CAD) referred to our echocardiography laboratory for dobutamine stress test between January 2004 and June 2012, (10013 exams). Those with abnormal DSE underwent coronary angiograms with a systematic methylergometrine intracoronary injection in case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients who had spontaneous occlusive coronary spasm or positive methylergometrine test but no significant stenoses were included. Results: One thousand and four patients had abnormal DSE, 78 (7.7%) fulfilled the inclusion criteria. There were 57 males and 21 females, mean age was 57.9 years, 37 patients had a known history of CAD. Twenty-four patients had a spasm on the left anterior artery (31%), 37 on the right coronary artery (47%) and 17 on the circumflex (22%). There was a good correlation between spastic arteries and dobutamine induced wall motion abnormalities territories. No complications occurred during the exams or during the provocation test. After 46 months mean follow up; one case of myocardial infarction with normal coronary arteries was noted and six patients experienced recurrent angina responding to treatment intensification. Conclusion: Coronary artery spasm during DSE but is a rare and under-diagnosed finding; it has, though, to be recognized as it may partly explain some erroneously labelled “false positive” exams. Methylergometrine provocation test should be performed in such a situation to establish the diagnosis. Prognosis appears favourable. [Copyright &y& Elsevier]