Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study)

Funding Acknowledgements Type of funding sources: None. Background. Unstable reentrant atrial tachycardias (ATs) (i.e. those with frequent circuit modification or conversion to atrial fibrillation) are challenging to ablate. Purpose. We have tested a strategy to convert unstable reentrant ATs into mappable stable ATs based on the detection and ablation of rotors. Methods. From May 2017 to December 2019, we included all consecutive patients scheduled for ablation of reentrant AT, excluding CTI-dependent atrial flutter, in which the tachycardia circuit was unstable. Operators subjectively identified rotors as sites with fractionated continuous (or quasi-continuous) electrical signals on 1-2 adjacent bipoles of conventional high-density mapping catheters, without dedicated software (Figure, A). Focal ablation of these sites was performed in order to stabilize the AT or convert it into sinus rhythm. In patients without rotors or failed rotor ablation, sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles were targeted (Figure, B). Procedural success was defined as the successful ablation of all inducible ATs, without need of cardioversion, final sinus rhythm and non-inducibility. Follow-up included visits with ECG and 24h Holter-ECG at 3, 6 and 12 months. Results. From May 2017 to December 2019, 97 patients were scheduled for reentrant AT ablation, excluding CTI-dependent atrial flutter. Of these, 18 patients (18.6%; 72.1 ± 8.9 years of age, 9 females) presented unstable circuits and were included. 9 patients (50%) had structural cardiomyopathy, 11 patients (61%) prior atrial arrhythmias ablations, and 4 patients (22%) previous cardiac surgery. 13 patients (72%) had detectable rotors (26 rotors; median 2 [1–3] rotors per patient); focal ablation achieved conversion into stable AT or sinus rhythm in 12 (92%). In the other patient, and the 5 patients without detectable rotors, 17 sites with spatiotemporal dispersion were detected and focally ablated, with success to achieve arrhythmia stabilization in 5 patients (83%). Globally, and excluding one patient with spontaneous AT stabilization, ablation success to stabilize the AT was achieved in 16/17 patients (94.1%). Procedural success was achieved in 16/18 patients (88.9%). Rate of one-year freedom from atrial arrhythmias was 66.7%. In the 9 patients with stable ATs ablated during the same period, procedural success (92.4%) and one-year freedom from atrial arrhythmias (65.8%) were similar (Figure, C). Conclusion. Most unstable reentrant ATs show detectable rotors, identified as sites with single-bipole fractionated quasi-continuous signals, or spatiotemporal dispersion plus non-continuous fractionation. Ablation of these sites is highly effective to stabilize the AT or convert it into sinus rhythm. Abstract FIGURE

Conclusion

Anderson’s activities after age 85 are changed fundamentally by a stroke suffered by his wife Joyce. This brings him close to his daughter Susan for the first time. John Maynard Keynes is offered as a similar figure in intellectual history. A career summary leads to the conclusion that Anderson was one of the world’s greatest scientists.

Comparative characteristics of different methods of prevention and treatment of post-medical diseases in cows

The article presents data on the dynamics of postpartum pathology, which was most often recorded in the form of both their pathologists and as acute postpartum cervicitis . So in 2017, this pathology of the organs of the genital system was diagnosed in 7 animals, which made up 37% of the total number of calving cows, in 2018 a similar figure was 8 cases, which is 42.1%, and in 2019 observed an unprecedented decrease the number of cases of postpartum cervicitis is 7, which is 31.82% of the total number of cows. However, fluctuations in the number of families had pathological tendencies th to increase, but this increase was not statistically significant: in 2017 - 7 cases (35%), in 2018 - 8 (42.1%) in 2019 - 9 (39, 34%). For all reasons, pathologic births most frequently reported a delay: in 2017 - 3 (42.85%), in 2018 - 4 (50%), in 2019 - 3 (33.34%), on average over the three reporting years the figure was 41.67% of the total number of causes of pathological births. As can be seen from the data presented in table 6 in sick animals , on the third day from the beginning of treatment there is a probable increase in the level of total protein in the cows of the experimental group, compared with the indicator for treatment by 6.9% (p <0.01), but its content still remains Lower relative to the level of clinically healthy cows by 5.8% (p <0.01). In the control group, this indicator remained almost unchanged from the pre-treatment index, remaining lower by 12.4% (p <0.001) relative to clinically healthy cows and by 7% (p <0.05) compared to the experimental group. In particular, studies concentration of fibrinogen in the blood plasma of cows with different methods of treatment showed that at the third day of treatment fibrinogen level is reduced compared with the rate before treatment to 14.3% (p <0.001) in the experimental group and incredibly on 5% in the control.

Bezlotoxumab (BEZ) for Prevention of Clostridium difficile Infection (CDI) Recurrence (rCDI): Distinguishing Relapse from Reinfection with Whole Genome Sequencing (WGS)

Background Bezlotoxumab (BEZ) and actoxumab (ACT) are monoclonal antibodies against C. difficile toxins B and A, respectively. Patients receiving a single infusion of BEZ alone or with ACT in the MODIFY I/II trials showed an absolute 10% (relative ~40%) reduction in rCDI over 12-weeks compared with placebo (PBO). The addition of ACT did not improve efficacy. This post hoc analysis investigated whether BEZ prevented relapse with the same strain and/or reinfection with a new strain. Methods C. difficile strains isolated from patient stool samples were typed by PCR ribotyping, PCR free library construction and Illumina whole genome sequencing (WGS). rCDI was defined as diarrhea with toxigenic C. difficile in stool. Reinfection and relapse were differentiated by comparing ribotype (RT) and pair-wise single-nucleotide WGS variations (PWSNV). Relapse was assigned if the baseline RT and the RT isolated during rCDI were the same and PWSNVs were ≤2. Reinfection was defined as rCDI cases with a different RT compared with baseline or the same RT with &gt;10 PWSNVs. Patients receiving BEZ or ACT+BEZ were pooled and patients receiving PBO or ACT were pooled. The effect of BEZ on the cumulative incidence of relapse and reinfection was estimated by Fine & Gray’s competing risks survival model. Results Among 514 patients with rCDI in MODIFY I/II, 259 (50.4%) had a baseline and a post-baseline C. difficile isolate. There were 198 (76.4%) relapse and 50 (19.3%) reinfection cases (Table). Among rCDI cases, proportions of reinfection and relapse were similar between treatments. Proportion of relapses was higher for RT 027. Significant differences in crude cumulative incidence for relapse (P &lt; 0.001) were observed for BEZ and ACT+BEZ groups compared with PBO and ACT groups. Similar changes were observed for reinfection but results were not significant. Cumulative incidence curves showed that relapses occurred earlier and at a higher rate than reinfections, but the reduction in rCDI was similar (Figure). Conclusion The BEZ-induced reduction in rCDI observed in MODIFY I/II reflects the prevention of relapses due to the same strain. A reduction in reinfections was also observed, but likely due to a smaller number of reinfection cases, the difference was not significant. Disclosures M. B. Dorr, Merck & Co., Inc.: Employee and Shareholder, may own stock/hold stock options in the Company; Z. Zeng, Merck & Co., Inc.: Employee, May own stock/hold stock options in the Company ; M. Wilcox, Merck & Co., Inc.: Consultant, Consulting fee; Cubist: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Grant recipient and Speaker honorarium; Alere, Actelion Pharma, Astellas, Optimer, sanofi pasteur, Summit Pharma, bioMerieux, Da Volterra, Qiagen, Cerexa, Abbott, AstraZeneca, Pfizer, Durata Therapeutics, Seres Therapeutics, Valneva, Nabriva Therapeutics, Roche, The Medicines Company, Basilea P: Consultant, Consulting fee; Alere, Actelion Pharmaceuticals, Pharmaceuticals, Astellas, Optimer Pharmaceuticals, sanofi pasteur, Summit Pharmaceuticals, bioMerieux, Da Volterra, Qiagen, Cerexa, and Abbott: Grant Investigator, Grant recipient; J. Li, BGI-Shenzhen: Employee, Salary; H. Zhao, BGI-Shenzhen: Employee, Salary; X. Li, BGI-Shenzhen: Employee, Salary; D. Guris, Merck & Co., Inc.: Employee, may own stock/hold stock options in the Company; P. Shaw, Merck & Co., Inc.: Employee, May own stock/hold stock options in Company

Fractal simplices

There are three constructions of which I know that yield higher dimensional analogues of Sierpinski’s triangle. The most obvious is to remove the open convex hull of the midpoints of the edges of the [Formula: see text]-simplex. The complement is a union of simplices. Continue the removal recursively in each of the remaining sub-simplices. The result is an uncountably infinite figure in [Formula: see text]-dimensional space that is Cantor-like in a manner analogous to the Sierpinski triangle. A countable analogue is obtained by means of playing the chaos game in the [Formula: see text]-simplex. In this “game” one chooses a random [Formula: see text]-ary sequence; starting from the initial point (that is identified with a vertex of the simplex), one continues to plot points by moving half-again as much towards the next point in the sequence. The resulting plot converges to the figure described above. Similarly, coloring the multinomial coefficients black or white according to their parity results in a similar figure, when the [Formula: see text]-dimensional analogue of the Pascal triangle is rescaled and embedded in space.

Abstract 17392: Gastrointestinal Bleeding With Edoxaban versus Warfarin: Results From the ENGAGE AF-TIMI 48 Trial

Background: There is more major gastrointestinal bleeding (M-GIB) with most NOACs than with warfarin. The clinical impact of this finding is poorly understood. Methods: The ENGAGE AF-TIMI 48 trial compared the efficacy and safety of higher-dose (HD-E: 60 mg/ 30mg) or lower-dose (LD-E: 30 mg/15 mg) edoxaban regimens with dose-adjusted warfarin for prevention of stroke and systemic embolism in non-valvular atrial fibrillation. ISTH definitions for major and life-threatening (LT) bleeding events were utilized. In this pre-specified analysis, we investigated the adjudicated M-GIB events utilizing pre-defined severity and outcome endpoints. Results: Although the risk of M-GIB was higher with HD-E than with warfarin, the risk of LT or fatal GIB was similar (figure), and surgery for GIB was required less frequently with HD-E than warfarin (HR 0.37; 95%CI, 0.16-0.88; p=0.03). The risk for M-GIB-related permanent drug discontinuation was similar with HD-E and warfarin (HR 0.96; 95% CI, 0.67-1.37, p=0.8), as were the risks of hospitalization (HR 1.14; 95%CI, 0.92-1.40, p=0.2) and Hgb decrease > 5 g/dL (HR 1.01; 95%CI, 0.74-1.38; p=0.9). The risks of M-GIB and of LT or fatal GIB were lower with LD-E than with warfarin (Figure), as were the risks of M-GIB-related permanent drug discontinuation (HR 0.51; 95% CI, 0.33-0.78, p=0.002), hospitalization (HR 0.67; 95%CI, 0.53-0.85; p=0.001), Hgb decrease > 5 g/dL (HR 0.58; 95%CI, 0.40-0.84; p=0.003), and M-GIB requiring transfusion of > 2 units of red cells (HR 0.66; 95%CI, 0.50-0.89; p=0.006). Fatal GIB occurred in 2, 3 and 7 patients treated with HD-E, LD-E and warfarin, respectively. Conclusions: M-GIB and LT-GIB with edoxaban are dose-dependent. Although the risk of M-GIB is higher with HD-E than warfarin, the risk of LT-GIB or fatal GIB is similar and the severity and outcomes are no worse than with warfarin. The risks of M-GIB, and of LT-GIB or fatal GIB, are lower with LD-E than warfarin.

Estimación del valor económico del trabajo no remunerado en Costa Rica. Resultados e ilustración metodológica /// Estimating the Economic Value of Unpaid Work in Costa Rica. Results and Methodological Illustration

En este texto se presenta la primera estimación que se hace en Costa Rica acerca de la valoración económica del trabajo no remunerado, a partir de los resultados de la encuesta “Uso del tiempo de la Gran Área Metropolitana 2011” (EUT-GAM, 2011). El cálculo del valor económico del trabajo no remunerado para la Gran Área Metropolitana equivale a 16% del pib nacional, cifra que se asemeja a la de la industria manufacturera y a la del sector comercio. Los resultados revelan que 95% de este valor se refiere al trabajo doméstico y que existen importantes brechas entre las mujeres y los hombres. Se estimó también el valor económico para todo el país, que representa 30% del PIB. AbstractThis text presents the first estimate made in Costa Rica of the economic value of unpaid work, based on the results of the “Time Use in the Greater Metropolitan Area 2011” Survey (EUT-GAM, 2011). The economic value of unpaid work for the greater metropolitan area is estimated at 16% of GDP, a similar figure to that of the manufacturing in-dustry and trade sector. The results show that domestic work accounts for 95% of this value and that there are significant gaps between women and men. The economic value for the whole country, equivalent to 30% of GDP, is also estimated.

The Reception of Bartolomeo Bermejo’s Saint Augustine

The Art Institute of Chicago’s St. Augustine (oil on panel) is a universally accepted work by the Spanish artist Bartolome Bermejo. Painted around 1475, the writing saint has been identified as various Benedictine saints and St. Augustine, but these proposals are problematic because they do not take into account all of the iconographic elements within the panel or early Renaissance liturgical practices. This essay will examine the many iconographic details of the panel and consider the surviving archival materials, including an original contract for an ecclesiastically similar figure, Sto. Domingo de Silos by Bermejo. Uncommon ecclesiastical circumstances of Sto. Domingo de Silos in Daraco found in a papal document mirror those found in St. Benedict’s foundation in Monte Cassino. These iconogaphic and textual studies in coordination with an understanding of contemporary liturgical and Benedictine practices will reveal that St. Benedict is the single figure whose personal and ecclesiastical life most closely corresponds to the evidence in the Chicago panel.

A Behavior Retargeting Algorithm Based on the Model

This paper analyses the motion of animation with the methods of picking key points and predicting motion trace based on the particle filter for discrete particle track prediction theory. The behavior model has been built for the already existing animation character. During the research, the thesis realized using existed animation motion trace model to drive a similar figure and create a new animation.