Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement: The Randomized BRAVO-3 Trial.

BACKGROUND Anticoagulation is required during transcatheter aortic valve replacement (TAVR) procedures. Although an optimal regimen has not been determined, heparin is mainly used. Direct thrombin inhibition with bivalirudin may be an effective alternative to heparin as the procedural anticoagulant agent in this setting. OBJECTIVES The goal of this study was to determine whether bivalirudin offers an alternative to heparin as the procedural anticoagulant agent in patients undergoing TAVR. METHODS A total of 802 patients with aortic stenosis were randomized to undergo transfemoral TAVR with bivalirudin versus unfractionated heparin during the procedure. The 2 primary endpoints were major bleeding within 48 h or before hospital discharge (whichever occurred first) and 30-day net adverse clinical events, defined as the combination of major adverse cardiovascular events (all-cause mortality, myocardial infarction, or stroke) and major bleeding. RESULTS Anticoagulation with bivalirudin versus heparin did not meet superiority because it did not result in significantly lower rates of major bleeding at 48 h (6.9% vs. 9.0%; relative risk: 0.77; 95% confidence interval [CI]: 0.48 to 1.23; p = 0.27) or net adverse cardiovascular events at 30 days (14.4% vs. 16.1%; relative risk: 0.89; 95% CI: 0.64 to 1.24; risk difference: -1.72; 95% CI: -6.70 to 3.25; p = 0.50); regarding the latter, the prespecified noninferiority hypothesis was met (pnoninferiority < 0.01). Rates of major adverse cardiovascular events at 48 h were not significantly different (3.5% vs. 4.8%; relative risk: 0.73; 95% CI: 0.37 to 1.43; p = 0.35). At 48 h, the bivalirudin group had significantly fewer myocardial infarctions but more acute kidney injury events than the heparin group; at 30 days, these differences were no longer significant. CONCLUSIONS In this randomized trial of TAVR procedural pharmacotherapy, bivalirudin did not reduce rates of major bleeding at 48 h or net adverse cardiovascular events within 30 days compared with heparin. Although superiority was not shown, the noninferiority hypothesis was met with respect to the latter factor. Given the lower cost, heparin should remain the standard of care, and bivalirudin can be an alternative anticoagulant option in patients unable to receive heparin in TAVR. (International, Multi-center, Open-label, Randomized Controlled Trial in Patients Undergoing TAVR to Determine the Treatment Effect [Both Safety and Efficacy] of Using Bivalirudin Instead of UFH [BRAVO-2/3]; NCT01651780).

Ms. Ff. Mus. 1323 - Am 2 post Epiphan. : Sehet an die Exempel der Alten, und pp. ; C. A. T. B. , 1 cornettino, 3 tromboni, 2 violini, 2 hautbois se piace, 1 viola, violoncello et organo.

von Telemann. [Textverf.: Gottfried Simonis]

Magnetic anomaly map of the Weddell Sea Region, Antarctic (Scale 1:2 500 000)

This paper describes a 1 : 2 500 000 scale aeromagnetic anomaly map produced by the joint efforts of VNIIOkeangeologia, Polar Marine Geological Research Expedition (PMGRE) and the Alfred Wegener Institute for Polar and Marine Research (AWl) for the Weddell Sea region covering 1 850 000 km' of West Antarctica. Extensive regional magnetic survey flights with line-spacing of about 20 km and 5 km were carried out by the PMGRE between 1977 and 1989. In course of these investigations the PMGRE flew 9 surveys with flight-line spacing of 20 km and 6 surveys with flight-line spacing of 5 km mainly over the mountain areas of southern Palmer Land, western Dronning Maud Land, Coats Land and Pensacola Mountains, over the Ronne lee Shelf and the Filchner Ice Shelf and the central part of the Weddell Sea. More than 215 000 line-kilometers of total field aeromagnetic data have been acquired by using an Ilyushin Il-14 ski-equipped aircraft. Survey operations were centered on the field base stations Druzhnaya-1, -2, and -3, from which the majority of the Weddell Sea region network was completed. The composite map of the Weddell Sea region is prepared in colour, showing magnetic anomaly contours at intervals of 50-100 nT with supplemental contours at an interval of 25 nT in low gradient areas, on a polar stereographic projection. The compiled colour magnetic anomaly map of the Weddell Sea region demonstrates that features of large areal extent, such as geologic provinces, fold-belts, ancient eratonic fragments and other regional structural features can be readily delineated. The map allows a comparison of regional magnetic features with similar-scale geological structures on geological and geophysical maps. It also provides a database for the future production of the ''Digital Magnetic Anomaly Map of Antarctica'' in the framework of the Scientific Committee on Antarctic Research/International Association of Geomagnetism and Aeronomy (SCAR/IAGA) compilation.

(Table 1) Biovolume variations of cyanobacteria and total phytoplankton in the Frederiksborg Slotsso, Denmark

Several studies have shown that submerged macrophytes provide a refuge for zooplankton against fish predation, whereas the role of emergent and floating-leaved species, which are often dominant in eutrophic turbid lakes, is far less investigated. Zooplankton density in open water and amongst emergent and floating-leaved vegetation was monitored in a small, eutrophic lake (Frederiksborg Slotsso) in Denmark during July-October 2006. Emergent and floating-leaved macrophytes harboured significantly higher densities of pelagic as well as plant-associated zooplankton species, compared to the open water, even during periods where the predation pressure was presumably high (during the recruitment of 0+ fish fry). Zooplankton abundance in open water and among vegetation exhibited low values in July and peaked in August. Bosmina and Ceriodaphnia dominated the zooplankton community in the littoral vegetated areas (up to 4,400 ind/l among Phragmites australis and 11,000 ind/l between Polygonum amphibium stands), whereas the dominant species in the pelagic were Daphnia (up to 67 ind/l) and Cyclops (41 ind/l). The zooplankton density pattern observed was probably a consequence of concomitant modifications in the predation pressure, refuge availability and concentration of cyanobacteria in the lake. It is suggested that emergent and floating-leaved macrophytes may play an important role in enhancing water clarity due to increased grazing pressure by zooplankton migrating into the plant stands. As a consequence, especially in turbid lakes, the ecological role of these functional types of vegetation, and not merely that of submerged macrophyte species, should be taken into consideration.

Analysis of Manganese nodules from Sonne cruises SO06/1 and /2, "Hawaii-Tahiti-Transect", Teilprojekt ICIME

Manganese nodules research has focused on the area between the Clarion Fracture Zone to the North and the Clipperton Fracture Zone to the South where significant concentrations were found ni Ni-Cu. During the CCOP/SOPAC-IOC/IDOE International workshop on the "Geology Mineral Resources and Geophysics of the South Pacific" held in Fiji in September 1975, a working group on manganese nodules was formed by scientists from: CNEXO, Brest, the Institute of Oceanography, New Zealand, Imperial College, London and the Technical University of Aachen. A draft project was presented in July 1976 by J. Andrews, University of Hawaii and G. Pautot, Cnexo on a joint survey under the name of: "Hawaii-Tahiti Transect program". Further details were worked on in September 1976 during the International Geological Congress in Sydney with the participation of D. Cronan, Imperial College, Glasby, New Zealand Geological Survey and G. Friedrich, Aachen TU. The scientific final program was established in July 1977, planning on the participation of three research vessels: the Suroit (CNEXO), the Kana Keoki (U. of Hawaii) and the Sonne (Aachen TU). Several survey areas were selected across the Pacific Ocean (Areas A, B, C, D, E, F, G and H) with about the same crustal age (about 40 million years) and a similar water depths. Being near large fault zones, the ares would be adequate to study the influences of biological productivity, sedimentation rate and possibly volcanic activity on the formation and growth of manganese nodules. The influnece of volcanic activity study would particularly apply to area G being situated near the Marquesas Fracture Zone. The cruise from R/V Sonne started in August 1978 over areas C, D, F, G K. The R/V suroit conducted a similar expedition in 1979 over areas A, B, C, D, E, H and I. Others cruises were planned during the 1979-1980 for the R/V Kana Keoki. The present text relates the R/V Sonne Cruises SO-06/1 and SO-06/2 held within the frame work of this international cooperative project.