N-Terminal pro-Brain Natriuretic Peptide is a biomarker for cardiovascular damage in systemic lupus erythematous: a cross-sectional study.

OBJECTIVES: Prediction models based on traditional risk factors underestimate cardiovascular (CV) risk in systemic lupus erythematosus (SLE). In a large sample of unselected SLE patients, we investigated cross-sectional associations of NT-proBNP with cardiovascular damage (CVD). METHODS: Serum NT-proBNP was measured in SLE patients enrolled in the MUHC Lupus Clinic registry. Serum were collected between March 2022 and April 2023 at annual research visits. The primary outcome was CVD identified on the SLICC Damage Index. Factors associated with CVD and NT-proBNP levels were determined. RESULTS: Overall, 270 SLE patients (female 91%, median age 50.7 [1st quartile- 3rd quartile : 39.6-62.1] years) were analyzed for the primary outcome. Among them, 33 (12%) had CVD. The ROC curve for NT-proBNP demonstrated strong associations with CVD (AUC 0.78, 95% CI 0.69-0.87) with a threshold of 133 pg/ml providing the best discrimination for those with/without CVD. Hypertension (OR 3.3, 95% CI 1.2-9.0), dyslipidaemia (OR 3.6, 95% CI 1.3-9.6) and NT-proBNP > 133 pg/ml (OR 7.0, 95% CI, 2.6-19.1) were associated with CVD in the multivariable logistic regression model. Increased NT-proBNP levels were associated with age (OR 4.2, 95% CI 2.2-8.3), ever smoking (OR 1.9, 95% CI 1.0-3.5), reduced eGFR (4.1, 95% CI 1.3-13.1), prior pericarditis/pleuritis (OR 2.5, 95% CI 1.4-4.5) and aPL antibodies (OR 2.6, 95% CI 1.4-4.9). CONCLUSION: NT-proBNP is a biomarker for CV damage in SLE. The novel associations of NT-proBNP levels with prior pericarditis/pleuritis and aPL antibodies suggest new avenues for research to better understand what drives CV risk in SLE.

Mixture of longitudinal factor analyzers and their application to the assessment of chronic pain.

Multivariate longitudinal data are used in a variety of research areas not only because they allow to analyze time trajectories of multiple indicators, but also to determine how these trajectories are influenced by other covariates. In this article, we propose a mixture of longitudinal factor analyzers. This model could be used to extract latent factors representing multiple longitudinal noisy indicators in heterogeneous longitudinal data and to study the impact of one or several covariates on these latent factors. One of the advantages of this model is that it allows for measurement non-invariance, which arises in practice when the factor structure varies between groups of individuals due to cultural or physiological differences. This is achieved by estimating different factor models for different latent classes. The proposed model could also be used to extract latent classes with different latent factor trajectories over time. Other advantages of the model include its ability to take into account heteroscedasticity of errors in the factor analysis model by estimating different error variances for different latent classes. We first define the mixture of longitudinal factor analyzers and its parameters. Then, we propose an EM algorithm to estimate these parameters. We propose a Bayesian information criterion to identify both the number of components in the mixture and the number of latent factors. We then discuss the comparability of the latent factors obtained between subjects in different latent groups. Finally, we apply the model to simulated and real data of patients with chronic postoperative pain.

Predator home range size mediates indirect interactions between prey species in an arctic vertebrate community.

Indirect interactions are widespread among prey species that share a common predator, but the underlying mechanisms driving these interactions are often unclear, and our ability to predict their outcome is limited. Changes in behavioural traits that impact predator space use could be a key proximal mechanism mediating indirect interactions, but there is little empirical evidence of the causes and consequences of such behavioural-numerical response in multispecies systems. Here, we investigate the complex ecological relationships between seven prey species sharing a common predator. We used a path analysis approach on a comprehensive 9-year data set simultaneously tracking predator space use, prey densities and prey mortality rate on key species of a simplified Arctic food web. We show that high availability of a clumped and spatially predictable prey (goose eggs) leads to a twofold reduction in predator (arctic fox) home range size, which increases local predator density and strongly decreases nest survival of an incidental prey (American golden plover). On the contrary, a scattered cyclic prey with potentially lower spatial predictability (lemming) had a weaker effect on fox space use and an overall positive impact on the survival of incidental prey. These contrasting effects underline the importance of studying behavioural responses of predators in multiprey systems and to explicitly integrate behavioural-numerical responses in multispecies predator-prey models.

Measurement of erythrocyte membrane mannoses to assess splenic function.

Red blood cells (RBCs) lose plasma membrane in the spleen as they age, but the cells and molecules involved are yet to be identified. Sickle cell disease and infection by Plasmodium falciparum cause oxidative stress that induces aggregates of cross-linked proteins with N-linked high-mannose glycans (HMGs). These glycans can be recognised by mannose-binding lectins, including the mannose receptor (CD206), expressed on macrophages and specialised phagocytic endothelial cells in the spleen to mediate the extravascular haemolysis characteristic of these diseases. We postulated this system might also mediate removal of molecules and membrane in healthy individuals. Surface expression of HMGs on RBCs from patients who had previously undergone splenectomy was therefore assessed: high levels were indeed observable as large membrane aggregates. Glycomic analysis by mass spectrometry identified a mixture of Man5-9 GlcNAc2 structures. HMG levels correlated well with manual pit counts (r = 0.75-0.85). To assess further whether HMGs might act as a splenic reticuloendothelial function test, we measured levels on RBCs from patients with potential functional hyposplenism, some of whom exhibited high levels that may indicate risk of complications.

Effect of Biofumigation on Population Densities of Pratylenchus spp. and Verticillium spp. and Potato Yield in Eastern Canada.

Biofumigation has been proposed as an alternative to soil fumigation to manage soil-borne diseases including potato early dying disease complex (PED). This study examined the potential of using brown mustard (Mustard juncea) biofumigation to manage PED under rain-fed potato production in New Brunswick, Canada in two trials between 2017 and 2020 in comparison with chloropicrin fumigation and a conventional barley rotation. Biofumigation increased yield in one trial, but not in a second trial where the potato crop experienced severe drought, whereas chloropicrin fumigation increased yield in both trials. Biofumigation was effective in suppressing root-lesion nematode (RLN, Pratylenchus spp.) counts in both trials, but was ineffective in suppressing V. dahliae population density. Chloropicrin fumigation was effective in suppressing RLN counts and V. dahliae population density only in the hill where injected, but the effect was short-lived as the population density of V. dahliae in the hill increased to the level of the control in one potato growing season. Biofumigation may be an alternative to chloropicrin fumigation in managing PED, particularly in fields with high RLN population but relatively low Verticillium population density. However, neither biofumigation nor fumigation used alone may be sustainable in the short-term potato rotations commonly used in New Brunswick, and additional beneficial practices are required to sustain productivity in the long-term.

La biofumigación se ha propuesto como una alternativa a la fumigación del suelo para manejar las enfermedades transmitidas por el suelo, incluido el complejo de enfermedades de muerte prematura de la papa (PED). Este estudio examinó el potencial del uso de la biofumigación de mostaza marrón (Mustard juncea) para manejar la PED bajo la producción de papa de secano en New Brunswick, Canadá, en dos ensayos entre 2017 y 2020 en comparación con la fumigación con cloropicrina y una rotación de cebada convencional. La biofumigación aumentó el rendimiento en un ensayo, pero no en un segundo ensayo en el que el cultivo de papa experimentó una sequía severa, mientras que la fumigación con cloropicrina aumentó el rendimiento en ambos ensayos. La biofumigación fue efectiva para suprimir los conteos del nematodo lesionador de la raíz (RLN, Pratylenchus spp.) en ambos ensayos, pero fue ineficaz para suprimir la densidad de población de V. dahliae. La fumigación con cloropicrina fue efectiva para suprimir los conteos de RLN y la densidad de población de V. dahliae solo en el lomo del surco donde se inyectó, pero el efecto fue de corta duración ya que la densidad de población de V. dahliae en el surco aumentó al nivel del testigo en un ciclo de cultivo de papa. La biofumigación puede ser una alternativa a la fumigación con cloropicrina en el manejo de la PED, particularmente en campos con alta población de RLN pero densidad de población de Verticillium relativamente baja. Sin embargo, ni la biofumigación ni la fumigación utilizadas por sí solas pueden ser sustentables en las rotaciones de papa a corto plazo comúnmente utilizadas en New Brunswick, y se requieren prácticas benéficas adicionales para mantener la productividad a largo plazo.

Clinical Significance of Raynaud Phenomenon in Systemic Lupus Erythematosus.

OBJECTIVE: There are limited reports of the clinical significance of Raynaud phenomenon (RP) in systemic lupus erythematosus (SLE), with some suggesting RP is associated with less severe lupus. Since most prior studies were small and/or focused on a specific race/ethnic demographic, it is unclear if those results are generalizable. We evaluated whether RP was associated with demographic and clinical factors in a large multiethnic SLE cohort. METHODS: We studied Montreal General Hospital SLE cohort patients who are followed with standardized annual assessments. We included patients with at least 1 visit across 2011-2018 and assessed demographic and clinical variables (using the 1997 American College of Rheumatology criteria and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) at their first visit. We present multivariate logistics regression analyses of cross-sectional associations between these variables and RP in SLE. RESULTS: Of 489 SLE patients, most were female (n = 445, 91%). Mean age at SLE diagnosis was 31.5 (standard deviation, 13.5) years, and 169 (34.6%) had RP. In our fully adjusted model, female sex (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.07-6.03), White race/ethnicity (OR, 1.85; 95% CI, 1.10-3.17), neurological/neuropsychiatric manifestations (OR, 1.98; 95% CI, 1.10-3.56), and anti-RNP antibodies (OR, 3.03; 95% CI, 1.73-5.38) were positively associated with RP, whereas hemolytic anemia and cellular casts were negatively associated. CONCLUSIONS/DISCUSSION: Over one third of our large multiethnic North American SLE cohort had RP. This study confirmed associations between RP and a specific SLE phenotype.

Pathology of growth anomalies in massive Caribbean corals of the family Faviidae.

Growth anomalies (GAs) are a morphologically diverse and poorly understood group of lesions affecting corals. The aim of this study was to describe the prevalence and morphology of GAs affecting the faviid corals Diploria labyrinthiformis, Pseudodiploria strigosa, Psudodiploria clivosa, and Colpophyillia natans on St. Kitts. Three gross morphological variants of GAs (exophytic, nodular, and ruminate) were equally prevalent, together affecting 7.8% of corals surveyed across 5 reefs. Prevalence varied by reef and coral species, being highest in C. natans (35.7%). Median colony diameter was larger in corals with GAs relative to those without (Mann-Whitney U test, P < .001). Histopathological examination of exophytic GAs consistently showed corallite and polyp gigantism (n = 7), characterized by polyp enlargement and retained microanatomical structures. In contrast, nodular GAs (n = 9) were consistently hyperplasia of the basal body wall with skeletal dystrophy, composed of micronodular skeletal deposits with abundant hyaline lamellae, bordered by calicoblastic epithelial hyperplasia, interspersed with distorted gastrovascular canals and islands of mesoglea. Endolithic organisms, particularly fungi and algae, were common among GA and apparently healthy biopsies. While pathogenesis of these lesions remains uncertain, a neoplastic basis for GAs on Caribbean faviids could not be established using diagnostic criteria conventionally applied to tumors of vertebrate taxa, in line with other recent observations of coral GAs.

BSH 2020 Student Essay Prize - 'How are you inspired by haematology and how will you inspire others to become haematologists?'

All medical personnel ponder their future career, and students perhaps more so than professionals. Indeed, there are many old and famous specialties in which we might envision ourselves forging a path, each competing for our attention. Far-off from the clamour and glamour of venerable medicine and surgery, however, there lies younger specialties that reward quiet curiosity and stolid perseverance. Chief amongst them, in my eyes, is the speciality of haematology. Often misunderstood or otherwise unheard of, the subject of haematology and those practice it have steadily plotted a course through the maelstrom of blood disease and unremittingly turned its tide back in favour of the patients, for whom they labour. As the British Society for Haematology celebrates its 60th anniversary, the question rightly posed this year to interested students is, based on our own personal reflections, how should we continue to nourish the buds of enthusiasm and interest for this still-blossoming specialty? In this essay, I put forth those intellectual and historical facets of haematology which have given me great inspiration, and I reflect on how we, as practitioners or as aspirants, can best cultivate the passion we feel for our subject in the hearts of others.

Drainage increases CO2 and N2 O emissions from tropical peat soils.

Tropical peatlands are vital ecosystems that play an important role in global carbon storage and cycles. Current estimates of greenhouse gases from these peatlands are uncertain as emissions vary with environmental conditions. This study provides the first comprehensive analysis of managed and natural tropical peatland GHG fluxes: heterotrophic (i.e. soil respiration without roots), total CO2 respiration rates, CH4 and N2 O fluxes. The study documents studies that measure GHG fluxes from the soil (n = 372) from various land uses, groundwater levels and environmental conditions. We found that total soil respiration was larger in managed peat ecosystems (median = 52.3 Mg CO2  ha-1  year-1 ) than in natural forest (median = 35.9 Mg CO2  ha-1  year-1 ). Groundwater level had a stronger effect on soil CO2 emission than land use. Every 100 mm drop of groundwater level caused an increase of 5.1 and 3.7 Mg CO2  ha-1  year-1 for plantation and cropping land use, respectively. Where groundwater is deep (≥0.5 m), heterotrophic respiration constituted 84% of the total emissions. N2 O emissions were significantly larger at deeper groundwater levels, where every drop in 100 mm of groundwater level resulted in an exponential emission increase (exp(0.7) kg N ha-1  year-1 ). Deeper groundwater levels induced high N2 O emissions, which constitute about 15% of total GHG emissions. CH4 emissions were large where groundwater is shallow; however, they were substantially smaller than other GHG emissions. When compared to temperate and boreal peatland soils, tropical peatlands had, on average, double the CO2 emissions. Surprisingly, the CO2 emission rates in tropical peatlands were in the same magnitude as tropical mineral soils. This comprehensive analysis provides a great understanding of the GHG dynamics within tropical peat soils that can be used as a guide for policymakers to create suitable programmes to manage the sustainability of peatlands effectively.

Neutron Spin Resonance in the 112-Type Iron-Based Superconductor.

We use inelastic neutron scattering to study the low-energy spin excitations of the 112-type iron pnictide Ca_{0.82}La_{0.18}Fe_{0.96}Ni_{0.04}As_{2} with bulk superconductivity below T_{c}=22 K. A two-dimensional spin resonance mode is found around E=11 meV, where the resonance energy is almost temperature independent and linearly scales with T_{c} along with other iron-based superconductors. Polarized neutron analysis reveals the resonance is nearly isotropic in spin space without any L modulations. Because of the unique monoclinic structure with additional zigzag arsenic chains, the As 4p orbitals contribute to a three-dimensional hole pocket around the Γ point and an extra electron pocket at the X point. Our results suggest that the energy and momentum distribution of the spin resonance does not directly respond to the k_{z} dependence of the fermiology, and the spin resonance intrinsically is a spin-1 mode from singlet-triplet excitations of the Cooper pairs in the case of weak spin-orbital coupling.

Risk of atrial fibrillation after atrial flutter ablation: impact of AF history, gender, and antiarrhythmic drug medication.

INTRODUCTION: Atrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identified the predictors of AF occurrence after AFL ablation. METHODS AND RESULTS: A total of 1,121 patients referred for AFL ablation were followed for a mean duration of 2.1 ± 2.7 years. Antiarrhythmic drugs were stopped after ablation in patients with no AF prior to ablation, or continued otherwise. A total of 356 patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be females (OR = 1.35, CI = 1.00-1.83, P = 0.05). After ablation, 260 (23.2%) patients experienced AF. In the multivariable model, AF prior to ablation (OR = 1.90, CI = 1.42-2.54, P < 0.001) and female gender (OR = 1.77, CI = 1.29-2.42, P < 0.001) were associated with a higher risk of AF after ablation. In patients without prior AF, class I antiarrhythmics and amiodarone prior to AFL ablation were independently associated with higher risk of AF after ablation (OR = 2.11, CI = 1.15-3.88, P = 0.02 and OR = 1.60, CI = 1.08-2.36, P = 0.02, respectively). In patients who experienced AF after ablation, 201/260 (77.3%) had a CHA2DS2-VASc ≥1. Two patients with AF prior to ablation had a stroke during the follow-up whereas none of the patients without AF prior to ablation had a stroke. CONCLUSIONS: AF occurrence after AFL ablation is frequent (>20%), especially in patients with a history of AF, in female patients, and in patients treated with class I antiarrythmics/amiodarone prior to AFL. Since most patients who experience AF after AFL ablation have a CHA2DS2-VASc ≥1, the decision to stop anticoagulants after ablation should be considered on an individual basis.

Randomized prospective trial comparing two supraglottic airway devices: i-gel™ and LMA-Supreme™ in paralyzed patients.

PURPOSE: Many features can influence the choice of a supraglottic airway device (SAD), including ease of insertion, adequate ventilation pressures and lack of adverse effects. The goal of this randomized prospective trial was to compare the performance of the i-gel™ with that of the LMA-Supreme™. METHODS: One hundred adult patients (American Society of Anesthesiologists I-III) scheduled to undergo elective surgery under general anesthesia were randomized to either an i-gel (n = 50) or an LMA-Supreme (n = 50). The primary objective was to compare ventilation pressures. Secondary objectives included time and number of attempts needed to introduce the device, adverse effects, and repositioning. The endoscopic view of the glottic aperture and the position of the drain tubes in relation to the esophagus were also evaluated. RESULTS: The devices were inserted successfully in 46 (92%) patients in both groups. There was no significant difference in the [mean (SD)] leak pressure [i-gel: 23 (7) cm H2O vs LMA-Supreme: 21 (8) cm H2O; P = 0.14] or peak inspiratory pressure between both devices. Insertion time was shorter with the i-gel than with the LMA-Supreme [19 (7) sec vs 27 (17) sec, respectively; P = 0.003]. The vocal cords were completely visualized more often through the i-gel (70%) than through the LMA-Supreme (50%) (P = 0.007). Esophageal mucosa was easily visualized through the drain port in all but four patients, two patients in each group. There was no difference between groups regarding preoperative or postoperative complications. Postoperative patient discomfort was generally mild and comparable between both devices. CONCLUSION: Both the LMA-Supreme and the i-gel offer similar performance for positive pressure ventilation in paralyzed patients during general anesthesia. The i-gel was associated with a slightly faster insertion time and better fibrescopic visualization of the glottis. This trial was registered at Clinicaltrials.gov: NCT01001078.

Acceptability of Telerehabilitation: Experiences and Perceptions by Individuals with Stroke and Caregivers in an Early Supported Discharge Program.

INTRODUCTION: Telerehabilitation (TR) is a promising method for facilitating the delivery and access to post-stroke rehabilitation services. OBJECTIVE: The aim of this study was to explore the acceptability of TR and factors influencing its adoption by individuals with stroke and caregivers. METHODS: A qualitative descriptive approach was used. Six individuals with stroke and three caregivers participated in individual online interviews. An abductive thematic analysis was employed to analyze the qualitative data, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) model. RESULTS: Participants reported positive experiences with TR, resulting in improvements in functional abilities, such as manual dexterity, balance, and positive interactions with therapists. They found the technology easy to learn and use, facilitating engagement in TR. Participants' prior experiences with technology, along with support from caregivers and therapists, facilitated acceptance and the use of TR. The COVID-19 pandemic also motivated participants to accept TR. However, technical issues, unstable internet connections, and lack of feedback were barriers to the use of TR. CONCLUSION: Despite existing obstacles, TR can be used to provide rehabilitation services for individuals with stroke. Addressing these barriers is necessary to promote the widespread and effective use of TR in the context of stroke recovery.

Exploring the effect of the menstrual cycle or oral contraception on elite athletes' training responses when workload is not objectively quantifiable: the MILS approach and findings from female Olympians.

Objectives: Develop the Markov Index Load State (MILS) model, based on hidden Markov chains, to assess athletes' workload responses and investigate the effects of menstrual cycle (MC)/oral contraception (OC), sex steroids hormones and wellness on elite athletes' training. Methods: On a 7-month longitudinal follow-up, daily training (volume and perceived effort, n=2200) and wellness (reported sleep quality and quantity, fitness, mood, menstrual symptoms, n=2509) data were collected from 24 female rowers and skiers preparing for the Olympics. 51 MC and 54 OC full cycles relying on 214 salivary hormone samples were analysed. MC/OC cycles were normalised, converted in % from 0% (first bleeding/pill withdrawal day) to 100% (end). Results: MILS identified three chronic workload response states: 'easy', 'moderate' and 'hard'. A cyclic training response linked to MC or OC (95% CI) was observed, primarily related to progesterone level (p=8.23e-03 and 5.72e-03 for the easy and hard state, respectively). MC athletes predominantly exhibited the 'easy' state during the cycle's first half (8%-53%), transitioning to the 'hard' state post-estimated ovulation (63%-96%). OC users had an increased 'hard' state (4%-32%) during pill withdrawal, transitioning to 'easy' (50%-60%) when on the pill. Wellness metrics influenced the training load response: better sleep quality (p=5.20e-04), mood (p=8.94e-06) and fitness (p=6.29e-03) increased the likelihood of the 'easy' state. Menstrual symptoms increased the 'hard' state probability (p=5.92e-02). Conclusion: The MILS model, leveraging hidden Markov chains, effectively analyses cumulative training load responses. The model identified cyclic training responses linked to MC/OC in elite female athletes.

Trpc1 ion channel modulates phosphatidylinositol 3-kinase/Akt pathway during myoblast differentiation and muscle regeneration.

We previously showed in vitro that calcium entry through Trpc1 ion channels regulates myoblast migration and differentiation. In the present work, we used primary cell cultures and isolated muscles from Trpc1(-/-) and Trpc1(+/+) murine model to investigate the role of Trpc1 in myoblast differentiation and in muscle regeneration. In these models, we studied regeneration consecutive to cardiotoxin-induced muscle injury and observed a significant hypotrophy and a delayed regeneration in Trpc1(-/-) muscles consisting in smaller fiber size and increased proportion of centrally nucleated fibers. This was accompanied by a decreased expression of myogenic factors such as MyoD, Myf5, and myogenin and of one of their targets, the developmental MHC (MHCd). Consequently, muscle tension was systematically lower in muscles from Trpc1(-/-) mice. Importantly, the PI3K/Akt/mTOR/p70S6K pathway, which plays a crucial role in muscle growth and regeneration, was down-regulated in regenerating Trpc1(-/-) muscles. Indeed, phosphorylation of both Akt and p70S6K proteins was decreased as well as the activation of PI3K, the main upstream regulator of the Akt. This effect was independent of insulin-like growth factor expression. Akt phosphorylation also was reduced in Trpc1(-/-) primary myoblasts and in control myoblasts differentiated in the absence of extracellular Ca(2+) or pretreated with EGTA-AM or wortmannin, suggesting that the entry of Ca(2+) through Trpc1 channels enhanced the activity of PI3K. Our results emphasize the involvement of Trpc1 channels in skeletal muscle development in vitro and in vivo, and identify a Ca(2+)-dependent activation of the PI3K/Akt/mTOR/p70S6K pathway during myoblast differentiation and muscle regeneration.

Spin excitation anisotropy as a probe of orbital ordering in the paramagnetic tetragonal phase of superconducting BaFe1.904Ni0.09As2.

We use polarized neutron scattering to demonstrate that in-plane spin excitations in electron doped superconducting BaFe1.904Ni0.096As2 (Tc=19.8 K) change from isotropic to anisotropic in the tetragonal phase well above the antiferromagnetic (AFM) ordering and tetragonal-to-orthorhombic lattice distortion temperatures (TN≈Ts=33±2 K) without an uniaxial pressure. While the anisotropic spin excitations are not sensitive to the AFM order and tetragonal-to-orthorhombic lattice distortion, superconductivity induces further anisotropy for spin excitations along the [110] and [110] directions. These results indicate that the spin excitation anisotropy is a probe of the electronic anisotropy or orbital ordering in the tetragonal phase of iron pnictides.

Incidence and prognostic significance of spontaneous and inducible antidromic tachycardia.

AIMS: Orthodromic atrioventricular reentrant tachycardia (ORT) is the most common arrhythmia at electrophysiological study (EPS) in patients with pre-excitation. The purpose of the study was to determine the clinical significance and the electrophysiological characteristics of patients with inducible antidromic tachycardia (ADT). METHODS AND RESULTS: Electrophysiological study was performed in 807 patients with a pre-excitation syndrome in control state and after isoproterenol. Antidromic tachycardia was induced in 63 patients (8%). Clinical and electrophysiological data were compared with those of 744 patients without ADT. Patients with and without ADT were similar in term of age (33 ± 18 vs. 34 ± 17), male gender (68 vs. 61%), clinical presentation with spontaneous atrioventricular reentrant tachycardia (AVRT) (35 vs. 42%), atrial fibrillation (AF) (3 vs. 3%), syncope (16 vs. 12%). In patients with induced ADT, asymptomatic patients were less frequent (24 vs. 37%; <0.04), spontaneous ADT and spontaneous malignant form more frequent (8 vs. 0.5%; <0.001) (16 vs. 6%; <0.002). Left lateral accessory pathway (AP) location was more frequent (51 vs. 36%; P < 0.022), septal location less frequent (40 vs. 56%; P < 0.01). And 1/1 conduction through AP was more rapid. Orthodromic AVRT induction was as frequent (55.5 vs. 55%), but AF induction (41 vs. 24%; P < 0.002) and electrophysiological malignant form were more frequent (22 vs. 12%; P < 0.02). The follow-up was similar; four deaths and three spontaneous malignant forms occurred in patients without ADT. When population was divided based on age (<20/≥20 years), the older group was less likely to have criteria for malignant form. CONCLUSION: Antidromic tachycardia induction is rare in pre-excitation syndrome and generally is associated with spontaneous or electrophysiological malignant form, but clinical outcome does not differ.

Sexual Rehabilitation After a Stroke: A Multi-site Qualitative Study About Influencing Factors and Strategies to Improve Services.

This study aimed to better understand the factors influencing the provision of sexuality-related post-stroke rehabilitation services by clinicians on different sites and to explore strategies to improve post-stroke rehabilitation services with stakeholders. A qualitative study with co-design methods was conducted with 20 clinicians from five post-stroke rehabilitation centers in Canada, 1 manager and 1 patient-partner. Participants either took part in a focus group or in sessions of an adapted version of the LEGO Serious Play method to explore influencing factors and strategies of improvement in relation to post-stroke sexual rehabilitation services. Thematic analysis was conducted semi-deductively using the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation and Behaviour (COM-B) system and the Behaviour Change Wheel (BCW). A total of twenty factors pertaining either to the categories of Capability (n = 8; e.g., Sexual rehabilitation procedural knowledge), Motivation (n = 4; e.g., Professional boundaries) or Opportunity (n = 8; e.g., Workload) were perceived as influencing provision of sexual rehabilitation services by participants. A theoretical model was conceptualized. Strategies (n = 10) were categorized in concordance with the BCW as Training (n = 1), Enablement (n = 5) or Environmental restructuring (n = 4). This study showed that factors influencing provision of post-stroke rehabilitation services were numerous and interrelated, and that various strategies aiming either clinicians or the rehabilitation environment would be relevant to improve services. This study will help guide the design and implementation of future interventions studies aiming at improving post-stroke sexual rehabilitation services.

Potential estimation model in French alpine skiing - Individual evolution curve and progression typology.

Estimating the potential of alpine skiers is an unresolved question, especially because of the complexity of sports performance. We developed a potential estimation model based solely on the evolution of performance as a function of age. A bayesian mixed model allowed to estimate the potential curve and the age at peak performance for the population (24.81 ± 0.2) and for each individual as the uncertainty around this curve. With Gaussian mixtures, we identified among all the estimates four types of curves, clustered according to the performance level and the progression per age. Relying on the uncertainty calculated on the progression curve the model created also allow to estimate a score and an uncertainty associated with each cluster for all individuals. The results allows to: i) describe and explain the relationship between age and performance in alpine skiing from a species point of view (at 0.87%) and ii) to provide to sport staffs the estimation of the potential of each individual and her/his typology of progression to better detect sports potential. The entire methodology is based on age and performance data, but the progression identified may depend on parameters specific to alpine skiing.

Implementation of a sexuality interview guide in stroke rehabilitation: a feasibility study.

BACKGROUND: Although people who sustain a stroke can experience sexual difficulties, few address them during rehabilitation. OBJECTIVES: Explore the feasibility of implementing a Sexuality Interview Guide (SIG) in stroke rehabilitation and describe the factors perceived as influencing its implementation. MATERIALS AND METHODS: Using a mixed research design, the SIG was implemented for four months in a rehabilitation hospital. The frequency with which clinicians addressed sexuality and their level of comfort pre-post implementation was measured. Perceived factors influencing implementation were determined through individual interviews and focus groups with five stroke clients, 15 clinicians and a coordinator. A paired-specimen Wilcoxon test was used to explore differences in pre- post-level of comfort. Qualitative data was analyzed by two independent evaluators using thematic analysis. RESULTS: The SIG was used 28 times and clinicians' level of comfort in addressing sexuality improved significantly (p = 0.001). The factors perceived as influencing implementation were: the acceptability of the SIG, the individual characteristics, the context of the rehabilitation hospital and the implementation process. CONCLUSION: This study showed that the SIG can be used in stroke rehabilitation and that, with sufficient financial and human resources, and training for clinicians, it would be feasible to implement it in usual care.Implications for rehabilitationThe Sexuality Interview Guide (SIG) can be used in stroke rehabilitation and helps clinicians to target stroke clients who want to include sexuality in their rehabilitation.The best time to approach sexuality using the SIG, according to all participants, was in outpatient rehabilitation.For inpatient clients, it was more appropriate to use the SIG as they approach a weekend home trial or rehabilitation discharge.Training for clinicians working in post-stroke sexual rehabilitation, administrative policies and procedures and access to a sexual health specialist for consultation or referral purpose, would be important facilitators in integrating sexuality into clinical practices.