Clinical outcome and predictors for adverse events after transcatheter aortic valve implantation with the use of different devices and access routes

Background Transcatheter aortic valve implantation (TAVI) is a treatment option for high-risk patients with severe aortic stenosis. Previous reports focused on a single device or access site, whereas little is known of the combined use of different devices and access sites as selected by the heart team. The purpose of this study is to investigate clinical outcomes of TAVI using different devices and access sites. Methods A consecutive cohort of 200 patients underwent TAVI with the Medtronic CoreValve Revalving system (Medtronic Core Valve LLC, Irvine, CA; n = 130) or the Edwards SAPIEN valve (Edwards Lifesciences LLC, Irvine, CA; n = 70) implanted by either the transfemoral or transapical access route. Results Device success and procedure success were 99% and 95%, respectively, without differences between devices and access site. All-cause mortality was 7.5% at 30 days, with no differences between valve types or access sites. Using multivariable analysis, low body mass index (<20 kg/m2) (odds ratio [OR] 6.6, 95% CI 1.5-29.5) and previous stroke (OR 4.4, 95% CI 1.2-16.8) were independent risk factors for short-term mortality. The VARC-defined combined safety end point occurred in 18% of patients and was driven by major access site complications (8.0%), life-threatening bleeding (8.5%) or severe renal failure (4.5%). Transapical access emerged as independent predictor of adverse outcome for the Valve Academic Research Consortium–combined safety end point (OR 3.3, 95% CI 1.5-7.1). Conclusion A heart team–based selection of devices and access site among patients undergoing TAVI resulted in high device and procedural success. Low body mass index and history of previous stroke were independent predictors of mortality. Transapical access emerged as a risk factor for the Valve Academic Research Consortium–combined safety end point.

Traffic Routes and Signals for the Tonoplast

Tonoplast, the membrane delimiting plant vacuoles, regulates ion, water and nutrient movement between the cytosol and the vacuolar lumen through the activity of its membrane proteins. Correct traffic of proteins from the endoplasmic reticulum (ER) to the tonoplast requires (i) approval by the ER quality control, (ii) motifs for exit from the ER and (iii) motifs that promote sorting to the tonoplast. Recent evidence suggests that this traffic follows different pathways that are protein-specific and could also reflect vacuole specialization for lytic or storage function. The routes can be distinguished based on their sensitivity to drugs such as brefeldin A and C834 as well as using mutant plants that are defective in adaptor proteins of vesicle coats, or dominant-negative mutants of Rab GTPases.

Male and female routes to success

Much of the recent interest in educational gender differences is based on differences in academic performance. Several studies have shown that young women now out-perform males in terms of school grades and university degrees. But while there is a lot of research into the reasons for this shift, and into gender gaps in reading and maths achievement, little research has been done on the consequences of these differences in educational and early occupational success. - See more at: https://cerp.aqa.org.uk/perspectives/male-and-female-routes-success#sthash.HR8fFTen.dpuf

How Do Second-Generation Immigrant Students Access Higher Education? The Importance of Vocational Routes to Higher Education in Switzerland, France, and Germany

We analyse the access to different institutional pathways to higher education for second-generation students, focusing on youths that hold a higher-education entrance certificate. The alternative vocational pathway appears to compensate to some degree, compared to the traditional academic one, for North-African and Southern-European youths in France, those from Turkey in Germany, and to a lesser degree those from Portugal, Turkey, Ex-Yugoslavia, Albania/Kosovo in Switzerland. This is not the case in Switzerland for Western-European, Italian, and Spanish youths who indeed access higher education via the academic pathway more often than Swiss youths. Using youth panel and survey data, multinomial models are applied to analyse these pathway choices.