Transcatheter aortic valve implantation in very elderly patients: immediate results and medium term follow-up.

OBJECTIVE To evaluate immediate transcatheter aortic valve implantation (TAVI) results and medium-term follow-up in very elderly patients with severe and symptomatic aortic stenosis (AS). METHODS This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly (> 85 years) patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rates from any cause at two years. RESULTS The study included 160 consecutive patients with a mean age of 87 ± 2.1 years (range from 85 to 94 years) and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 (35.6%) patients scoring ≥ 20%. Procedural success rate was 97.5%, with 25 (15.6%) patients experiencing acute complications with major bleeding (the most frequent). Global mortality rate during hospitalization was 8.8% (n = 14) and 30-day mortality rate was 10% (n = 16). Median follow up period was 252.24 ± 232.17 days. During the follow-up period, 28 (17.5%) patients died (17 of them due to cardiac causes). The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique variable associated with overall mortality. CONCLUSIONS TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.

Treball Final de Master - Servidor de Comunicacions Unificades

L'objectiu d'aquest projecte és la creació d'una prova de concepte de comunicacions unificades utilitzant productes de programari lliure existents. Aquesta prova de concepte servirà per poder fer demostracions del funcionament general del programari implicat amb el mínim de preparacions, instal·lacions i configuracions prèvies possibles. El projecte es dividirà en dos appliances o LiveCD, creats a traves de Suse Studio, anomenats Comunicacions Unificades i Comunicacions Unificades 2.Els productes de programari lliure que composen el Servidor de Comunicacions Unificades els podem classificar en productes principals, plugins o addons dels productes i productes secundaris.Com a productes principals tenim els següents servidors que cobreixen les necessitats principals del Servidor de Comunicacions Unificades:Asterisk v1.8.3 : Servidor de telefonia amb veu sobre IP (VoIP).FreePBX v2.9.0beta2 : GUI de control i administració d'Asterisk.Openfire v3.7.0 : Servidor de IM basat en el protocol XMPP.BigBlueButton v0.71a : Sistema de conferència web. Pendent finalitzar-ne l'implementació.I els seguents productes principals que cobreixen les necessitats del servidor de Comunicacions Unificades 2:Zimbra v7.0.1 : Servidor de correu electrònic i de calendari. Pendent resoldre conflicte inicialització LDAP.Funambol v9.0.0 : Sincronització Zimbra amb mòbils.Com a plugins o addons del productes tenim, classificats segons el producte:Asterisk addons: chan_jingle i chan_gtalkZimlets: Asterisk, Google Translator, Funambol i SocialsOpenfire pugins: Asterisk, Facebook i GmailCom a productes secundaris tenim els clients necessaris per poder utilitzar l'appliance:Firefox: Navegador web que servirà com a interfície d'usuari per les diferents eines d'administració i la demostració.Pigdin o Spark: Clients de missatgeria instantània, per l'appliance Comunicacions Unificades.A més d'instal·lar aquests productes, s'implementa una interfície web, mitjançant Drupal, en format HTML per enllaçar les diferents eines d'administració dels productes, per a cadascun dels dos appliances i es realitzara un Kiosk appliance per a familiaritzar-se amb l'entorn SuseStudio.

[Archives de la parole]. , Les cornemuses / [Schmelzer], comp. ; quatuor à cordes

Enregistrement : Paris, Université de Paris, La Sorbonne, 07-05-1913

Interaction of cationic ultrasmall superparamagnetic iron oxide nanoparticles with human melanoma cells.

Ultrasmall superparamagnetic iron oxide nanoparticles (USPIONs) are currently under development for the intracellular delivery of therapeutics. However, the mechanisms of cellular uptake and the cellular reaction to this uptake, independent of therapeutics, are not well defined. The interactions of biocompatible cationic aminoUSPIONs with human cells was studied in 2D and 3D cultures using biochemical and electron microscopy techniques. AminoUSPIONs were internalized by human melanoma cells in 2D and 3D cultures. Uptake was clathrin mediated and the particles localized in lysosomes, inducing activation of the lysosomal cathepsin D and decreasing the expression of the transferrin receptor in human melanoma cells and/or skin fibroblasts. AminoUSPIONs deeply invaded 3D spheroids of human melanoma cells. Thus, aminoUSPIONs can invade tumors and their uptake by human cells induces cell reaction.

Advance care planning for institutionalised older people: an integrative review of the literature.

BACKGROUND: This integrative review of the literature describes the evolution in knowledge and the paradigm shift that is necessary to switch from advance directives to advance care planning. AIMS AND OBJECTIVES: It presents an analysis of concepts, trends, models and experiments that enables identification of the best treatment strategies, particularly for older people living in nursing homes. DESIGN: Based on 23 articles published between 1999 and 2012, this review distinguishes theoretical from empirical research and presents a classification of studies based on their methodological robustness (descriptive, qualitative, associative or experimental). RESULTS: It thus provides nursing professionals with evidence-based information in the form of a synthetic vision and conceptual framework to support the development of innovative care practices in the end-of-life context. While theoretical work places particular emphasis on the impact of changes in practice on the quality of care received by residents, empirical research highlights the importance of communication between the different persons involved about care preferences at the end of life and the need for agreement between them. CONCLUSIONS: The concept of quality of life and the dimensions and factors that compose it form the basis of Advance care planning (ACP) and enable the identification of the similarities and differences between various actors. They inform professionals of the need to ease off the biomedical approach to consider the attributes prioritised by those concerned, whether patients or families, so as to improve the quality of care at the end of life. IMPLICATIONS FOR PRACTICE: It is particularly recommended that all professionals involved take into account key stakeholders' expectations concerning what is essential at the end of life, to enable enhanced communication and decision-making when faced with this difficult subject.

Assessing dystrophies and other muscle diseases at the nanometer scale by atomic force microscopy.

AIM: Atomic force microscopy nanoindentation of myofibers was used to assess and quantitatively diagnose muscular dystrophies from human patients. MATERIALS & METHODS: Myofibers were probed from fresh or frozen muscle biopsies from human dystrophic patients and healthy volunteers, as well as mice models, and Young's modulus stiffness values were determined. RESULTS: Fibers displaying abnormally low mechanical stability were detected in biopsies from patients affected by 11 distinct muscle diseases, and Young's modulus values were commensurate to the severity of the disease. Abnormal myofiber resistance was also observed from consulting patients whose muscle condition could not be detected or unambiguously diagnosed otherwise. DISCUSSION & CONCLUSION: This study provides a proof-of-concept that atomic force microscopy yields a quantitative read-out of human muscle function from clinical biopsies, and that it may thereby complement current muscular dystrophy diagnosis.

F-1, Food Stamp Program State Summary, April

The Food Assistance Monthly Participation Report is a monthly summary of Food Assistance program participation, Statewide and for each Iowa county. Breakouts are reported for participants also in the FIP program, those only receiving Food Assistance, and those that are receiving economic assistance under other programs (primarily Medicaid). This report may also be known as the F-1 Report

Fresh News; The Farmers' Market Newsletter, Fall-Winter 2003

Newsletter produced by Iowa Department of Agriculture and Land Stewardship