Transapical transcatheter aortic valve implantation using the second-generation self-expanding Symetis ACURATE TA valve

Transapical transcatheter aortic valve implantation (TA-TAVI) is the recognized first choice surgical TAVI access. Expansion of this well-established treatment modality with subsequent broader patient inclusion has accelerated development of second-generation TA-TAVI devices. The Swiss ACURATE TA Symetis valve allows for excellent anatomical positioning, resulting in a very low incidence of paravalvular leaks. The self-expanding stent features an hourglass shape to wedge the native aortic valve annulus. A specially designed delivery system facilitates controlled release aided by tactile operator feedback. The ACURATE TA valve made of three native porcine non-coronary leaflets has received CE approval in September 2011. Since then, this valve is the third most frequently implanted TAVI device with over 1200 implants in Europe and South America. Results from the Symetis ACURATE TA™ Valve Implantation ('SAVI') Registry showed a procedural success rate of 98.0% and a survival rate of 93.2% at 30 days. This presentation provides technical considerations and detailed procedural aspects of device implantation.

What is the influence of randomisation sequence generation and allocation concealment on treatment effects of physical therapy trials? A meta-epidemiological study.

OBJECTIVE To determine if adequacy of randomisation and allocation concealment is associated with changes in effect sizes (ES) when comparing physical therapy (PT) trials with and without these methodological characteristics. DESIGN Meta-epidemiological study. PARTICIPANTS A random sample of randomised controlled trials (RCTs) included in meta-analyses in the PT discipline were identified. INTERVENTION Data extraction including assessments of random sequence generation and allocation concealment was conducted independently by two reviewers. To determine the association between sequence generation, and allocation concealment and ES, a two-level analysis was conducted using a meta-meta-analytic approach. PRIMARY AND SECONDARY OUTCOME MEASURES association between random sequence generation and allocation concealment and ES in PT trials. RESULTS 393 trials included in 43 meta-analyses, analysing 44 622 patients contributed to this study. Adequate random sequence generation and appropriate allocation concealment were accomplished in only 39.7% and 11.5% of PT trials, respectively. Although trials with inappropriate allocation concealment tended to have an overestimate treatment effect when compared with trials with adequate concealment of allocation, the difference was non-statistically significant (ES=0.12; 95% CI -0.06 to 0.30). When pooling our results with those of Nuesch et al, we obtained a pooled statistically significant value (ES=0.14; 95% CI 0.02 to 0.26). There was no difference in ES in trials with appropriate or inappropriate random sequence generation (ES=0.02; 95% CI -0.12 to 0.15). CONCLUSIONS Our results suggest that when evaluating risk of bias of primary RCTs in PT area, systematic reviewers and clinicians implementing research into practice should pay attention to these biases since they could exaggerate treatment effects. Systematic reviewers should perform sensitivity analysis including trials with low risk of bias in these domains as primary analysis and/or in combination with less restrictive analyses. Authors and editors should make sure that allocation concealment and random sequence generation are properly reported in trial reports.

Enabling the Next Generation of Spaceborne Quadrupole Mass Spectrometers

The quadrupole mass spectrometer (QMS) has over 30 years of spaceflight heritage in making important neutral gas and low energy ion observations. Given their geometrical constraints, these instruments are currently operated at the extreme limit of their capabilities. However, a technique called higher order auxiliary excitation provides a set of novel, robust, electronics-based solutions for improving the performance of these sensors. By driving the quadrupole rods with an additional frequency nearly twice that of the normal RF operating frequency, substantially increased abundance sensitivity, maximum attainable mass resolution, and peak stability can be achieved through operation of voltage scan lines through the center of formed upper stability islands. Such improvements are modeled using numerical simulations of ion trajectories in a quadrupole field with and without applied higher order auxiliary excitation. When compared to a traditional QMS with a mass range up to 500Da, sensors can be designed with the same precision electronics to have expected mass ranges beyond 1500Da with a power increase of less than twice that of its heritage implementations.

European experience with the second-generation Edwards SAPIEN XT transcatheter heart valve in patients with severe aortic stenosis: 1-year outcomes from the SOURCE XT Registry

OBJECTIVES The SOURCE XT Registry (Edwards SAPIEN XT Aortic Bioprosthesis Multi-Region Outcome Registry) assessed the use and clinical outcomes with the SAPIEN XT (Edwards Lifesciences, Irvine, California) valve in the real-world setting. BACKGROUND Transcatheter aortic valve replacement is an established treatment for high-risk/inoperable patients with severe aortic stenosis. The SAPIEN XT is a balloon-expandable valve with enhanced features allowing delivery via a lower profile sheath. METHODS The SOURCE XT Registry is a prospective, multicenter, post-approval study. Data from 2,688 patients at 99 sites were analyzed. The main outcome measures were all-cause mortality, stroke, major vascular complications, bleeding, and pacemaker implantations at 30-days and 1 year post-procedure. RESULTS The mean age was 81.4 ± 6.6 years, 42.3% were male, and the mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 20.4 ± 12.4%. Patients had a high burden of coronary disease (44.2%), diabetes (29.4%), renal insufficiency (28.9%), atrial fibrillation (25.6%), and peripheral vascular disease (21.2%). Survival was 93.7% at 30 days and 80.6% at 1 year. At 30-day follow-up, the stroke rate was 3.6%, the rate of major vascular complications was 6.5%, the rate of life-threatening bleeding was 5.5%, the rate of new pacemakers was 9.5%, and the rate of moderate/severe paravalvular leak was 5.5%. Multivariable analysis identified nontransfemoral approach (hazard ratio [HR]: 1.84; p < 0.0001), renal insufficiency (HR: 1.53; p < 0.0001), liver disease (HR: 1.67; p = 0.0453), moderate/severe tricuspid regurgitation (HR: 1.47; p = 0.0019), porcelain aorta (HR: 1.47; p = 0.0352), and atrial fibrillation (HR: 1.41; p = 0.0014), with the highest HRs for 1-year mortality. Major vascular complications and major/life-threatening bleeding were the most frequently seen complications associated with a significant increase in 1-year mortality. CONCLUSIONS The SOURCE XT Registry demonstrated appropriate use of the SAPIEN XT THV in the first year post-commercialization in Europe. The safety profile is sustained, and clinical benefits have been established in the real-world setting. (SOURCE XT Registry; NCT01238497).

Development of a grid connected micro wind generator. A practical activity for the course on electric generation with wind energy

This paper describes a practical activity, part of the renewable energy course where the students have to build their own complete wind generation system, including blades, PM-generator, power electronics and control. After connecting the system to the electric grid the system has been tested during real wind scenarios. The paper will describe the electric part of the work surface-mounted permanent magnet machine design criteria as well as the power electronics part for the power control and the grid connection. A Kalman filter is used for the voltage phase estimation and current commands obtained in order to control active and reactive power. The connection to the grid has been done and active and reactive power has been measured in the system.

High-peak-power pulse generation from a monolithic master oscillator power amplifier at 1.5 μm

We present an experimental study on the generation of high-peak-power short optical pulses from a fully integrated master-oscillator power-amplifier emitting at 1.5 μm. High-peak-power (2.7 W) optical pulses with short duration (100 ps) have been generated by gain switching the master oscillator under optimized driving conditions. The static and dynamic characteristics of the device have been studied as a function of the driving conditions. The ripples appearing in the power-current characteristics under cw conditions have been attributed to mode hopping between the master oscillator resonant mode and the Fabry-Perot modes of the entire device cavity. Although compound cavity effects have been evidenced to affect the static and dynamic performance of the device, we have demonstrated that trains of single-mode short optical pulses at gigahertz frequencies can be conveniently generated in these devices.

Automatic generation of models for abdominal aortic aneurysms and intraluminal thrombus based on hexahedral meshes

To propose an automated patient-specific algorithm for the creation of accurate and smooth meshes of the aortic anatomy, to be used for evaluating rupture risk factors of abdominal aortic aneurysms (AAA). Finite element (FE) analyses and simulations require meshes to be smooth and anatomically accurate, capturing both the artery wall and the intraluminal thrombus (ILT). The two main difficulties are the modeling of the arterial bifurcations, and of the ILT, which has an arbitrary shape that is conforming to the aortic wall.

Physical characterization of laser interaction and shock generation in laser processing: coupled theoretical-experimental analysis

Outline: • Introduction • Fundamental Physics of the Laser-Plasma Interaction in Laser Shock Processing • Theoretical/Computational Model Description • Some Results. Analysis of Interaction Parameters • Experimental Validation. Diagnosis Setup • Discussion and Outlook

Automatic generation of real-time deformable parametric model of the aorta for a VR-based catheterism guidance system

The purpose of this work is twofold: first, to develop a process to automatically create parametric models of the aorta that can adapt to any possible intraoperative deformation of the vessel. Second, it intends to provide the tools needed to perform this deformation in real time, by means of a non-rigid registration method. This dynamically deformable model will later be used in a VR-based surgery guidance system for aortic catheterism procedures, showing the vessel changes in real time.

NGCPV: a new generation of concentrator photovoltaic cells, modules and systems

Starting on June 2011, NGCPV is the first project funded jointly between the European Commission (EC) and the New Energy and Industrial Technology Development Organization (NEDO) of Japan to research on new generation concentration photovoltaics (CPV). The Project, through a collaborative research between seven European and nine Japanese leading research centers in the field of CPV, aims at lowering the cost of the CPVproduced photovoltaic kWh down to 5 ?cents. The main objective of the project is to improve the present concentrator cell, module and system efficiency, as well as developing advanced characterization tools for CPV components and systems. As particular targets, the project aims at achieving a cell efficiency of at least 45% and a CPV module with an efficiency greater than 35%. This paper describes the R&D activities that are being carried out within the NGCPV project and summarizes some of the most relevant results that have already been attained, for instance: the manufacturing of a 44.4% world record efficiency triple junction solar cell (by Sharp Corp.) and the installation of a 50 kWp experimental CPV plant in Spain, which will be used to obtain accurate forecasts of the energy produced at system level.

Accurate depth-color scene modeling for 3D contents generation with low cost depth cameras

In this paper, we present a depth-color scene modeling strategy for indoors 3D contents generation. It combines depth and visual information provided by a low-cost active depth camera to improve the accuracy of the acquired depth maps considering the different dynamic nature of the scene elements. Accurate depth and color models of the scene background are iteratively built, and used to detect moving elements in the scene. The acquired depth data is continuously processed with an innovative joint-bilateral filter that efficiently combines depth and visual information thanks to the analysis of an edge-uncertainty map and the detected foreground regions. The main advantages of the proposed approach are: removing depth maps spatial noise and temporal random fluctuations; refining depth data at object boundaries, generating iteratively a robust depth and color background model and an accurate moving object silhouette.

Implications of data-intensive applications for next generation mobile networks

Lately, the mobile data market has moved into a growth stage triggered by two facts: affordability of mobile broadband, and availability of data-friendly devices. At this stage, market growth is no longer dependent on push strategies from suppliers; on the contrary, demand is now driving the market. However, it will not be easy for mobile operating companies to cope up with the demand to come in the near future. The infrastructure that is needed to support corresponding demand is far from completion. Operators are forced to make heavy investments to upgrade and expand their networks. To decide how to handle the present and upcoming demand, they need to identify and understand the characteristics of the scenarios they face. This is precisely the aim of this article, which provides figures on the consequences for mobile infrastructures of a generalised mobile media uptake. Data from the Spanish mobile deployment case have been used to arrive at practical figures and illustration of results, but the conclusions are easily extended to other countries and regions