Von Willebrand Factor Multimers during Transcatheter Aortic-Valve Replacement.

BACKGROUND: Postprocedural aortic regurgitation occurs in 10 to 20% of patients undergoing transcatheter aortic-valve replacement (TAVR) for aortic stenosis. We hypothesized that assessment of defects in high-molecular-weight (HMW) multimers of von Willebrand factor or point-of-care assessment of hemostasis could be used to monitor aortic regurgitation during TAVR. METHODS: We enrolled 183 patients undergoing TAVR. Patients with aortic regurgitation after the initial implantation, as identified by means of transesophageal echocardiography, underwent additional balloon dilation to correct aortic regurgitation. HMW multimers and the closure time with adenosine diphosphate (CT-ADP), a point-of-care measure of hemostasis, were assessed at baseline and 5 minutes after each step of the procedure. Mortality was evaluated at 1 year. A second cohort (201 patients) was studied to validate the use of CT-ADP in order to identify patients with aortic regurgitation. RESULTS: After the initial implantation, HMW multimers normalized in patients without aortic regurgitation (137 patients). Among the 46 patients with aortic regurgitation, normalization occurred in 20 patients in whom additional balloon dilation was successful but did not occur in the 26 patients with persistent aortic regurgitation. A similar sequence of changes was observed with CT-ADP. A CT-ADP value of more than 180 seconds had sensitivity, specificity, and negative predictive value of 92.3%, 92.4%, and 98.6%, respectively, for aortic regurgitation, with similar results in the validation cohort. Multivariable analyses showed that the values for HMW multimers and CT-ADP at the end of TAVR were each associated with mortality at 1 year. CONCLUSIONS: The presence of HMW-multimer defects and a high value for a point-of-care hemostatic test, the CT-ADP, were each predictive of the presence of aortic regurgitation after TAVR and were associated with higher mortality 1 year after the procedure. (Funded by Lille 2 University and others; ClinicalTrials.gov number, NCT02628509.).

Mid-term outcome of de novo lesions vs. in stent restenosis treated by intravascular lithotripsy procedures: Insights from the French Shock Initiative.

BACKGROUND: Intravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. METHODS: Prospective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. RESULTS: A total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. CONCLUSIONS: In this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted.

Dynamical quantification of schizophrenic speech.

Schizophrenic speech has been studied both at the clinical and linguistic level. Nevertheless, the statistical methods used in these studies do not specifically take into account the dynamical aspects of language. In the present study, we quantify the dynamical properties of linguistic production in schizophrenic and control subjects. Subjects' recall of a short story was encoded according to the succession of macro- and micro-propositions, and symbolic dynamical methods were used to analyze these data. Our results show the presence of a significant temporal organization in subjects' speech. Taking this structure into account, we show that schizophrenics connect micro-propositions significantly more often than controls. This impairment in accessing language at the highest level supports the hypothesis of a deficit in maintaining a discourse plan in schizophrenia.

La performativité généralisée du diagnostic psychologique en médecine / A performatividade generalizada do diagnóstico psicológico em medicina / Generalized performativity of psychological diagnosis in medicine / La performatividad generalizada del diagnóstico psicológico en medicina

Le recours au savoir psychologique dans les services de médecine somatique à l'hôpital relève moins d'une tentative de compréhension du malade que d'une psychologisation de ses conduites. La performativité généralisée du langage psychologique, en ajoutant ainsi un "trouble psychique" à la maladie somatique, permet de se préserver de l'inquiétante étrangeté du malade et de retrouver un pouvoir sur lui. La fonction des psychologues est alors à interroger.

O recurso ao saber psicológico nos serviços de medicina somática em hospital diz respeito menos a uma tentativa de compreensão do doente que de uma psicologização de suas condutas. A performatividade generalizada da linguagem psicológica, acrescentando assim um "transtorno psíquico" a uma doença somática, permite preservar a inquietante estranheza do doente e de reencontrar um poder sobre ele. A função dos psicólogos deve, então, ser interrogada.

The use of psychological knowledge at medical departments in hospitals is closer to being a psychologization of patients' behavior than attempts at understanding the patients. By adding a single extra word the generalized performativity of psychological language can turn a physical illness into a psychic ® disturbance ¼. This allows professionals to keep a distance from their patients and thus maintain power over them. The function of psychologists is thus brought into the debate.

Recurrir al saber psicológico en los servicios hospitalarios de medicina somática, más que ser un intento de comprensión del enfermo, es una psicologización de sus conductas. Al agregar un "trastorno psíquico" a la enfermedad somática, la performatividad generalizada del lenguaje psicológico permite recuperar un poder sobre el paciente y ponerse a salvo, al mismo tiempo, de lo ominoso de su situación. La función de los psicólogos es cuestionable.

Classification of a large microarray data set: algorithm comparison and analysis of drug signatures.

A large gene expression database has been produced that characterizes the gene expression and physiological effects of hundreds of approved and withdrawn drugs, toxicants, and biochemical standards in various organs of live rats. In order to derive useful biological knowledge from this large database, a variety of supervised classification algorithms were compared using a 597-microarray subset of the data. Our studies show that several types of linear classifiers based on Support Vector Machines (SVMs) and Logistic Regression can be used to derive readily interpretable drug signatures with high classification performance. Both methods can be tuned to produce classifiers of drug treatments in the form of short, weighted gene lists which upon analysis reveal that some of the signature genes have a positive contribution (act as "rewards" for the class-of-interest) while others have a negative contribution (act as "penalties") to the classification decision. The combination of reward and penalty genes enhances performance by keeping the number of false positive treatments low. The results of these algorithms are combined with feature selection techniques that further reduce the length of the drug signatures, an important step towards the development of useful diagnostic biomarkers and low-cost assays. Multiple signatures with no genes in common can be generated for the same classification end-point. Comparison of these gene lists identifies biological processes characteristic of a given class.