LANDMARK comparison of early outcomes of newer-generation Myval transcatheter heart valve series with contemporary valves (Sapien and Evolut) in real-world individuals with severe symptomatic native aortic stenosis: a randomised non-inferiority trial.

BACKGROUND: Transcatheter aortic valve implantation is an established, guideline-endorsed treatment for severe aortic stenosis. Precise sizing of the balloon-expandable Myval transcatheter heart valve (THV) series with the aortic annulus is facilitated by increasing its diameter in 1·5 mm increments, compared with the usual 3 mm increments in valve size. The LANDMARK trial aimed to show non-inferiority of the Myval THV series compared with the contemporary THVs Sapien Series (Edwards Lifesciences, Irvine, CA, USA) or Evolut Series (Medtronic, Minneapolis, MN, USA). METHODS: In this prospective, multinational, randomised, open-label, non-inferiority trial across 31 hospitals in 16 countries (Germany, France, Sweden, the Netherlands, Italy, Spain, New Zealand, Portugal, Greece, Hungary, Poland, Slovakia, Slovenia, Croatia, Estonia, and Brazil), 768 participants with severe symptomatic native aortic stenosis were randomly assigned (1:1) to the Myval THV or a contemporary THV. Eligibility was primarily decided by the heart team in accordance with 2021 European Society of Cardiology guidelines. As per the criteria of the third Valve Academic Research Consortium, the primary endpoint at 30 days was a composite of all-cause mortality, all stroke, bleeding (types 3 and 4), acute kidney injury (stages 2-4), major vascular complications, moderate or severe prosthetic valve regurgitation, and conduction system disturbances resulting in a permanent pacemaker implantation. Non-inferiority of the study device was tested in the intention-to-treat population using a non-inferiority margin of 10·44% and assuming an event rate of 26·10%. This trial is registered with ClinicalTrials.gov, NCT04275726, and EudraCT, 2020-000137-40, and is closed to new participants. FINDINGS: Between Jan 6, 2021, and Dec 5, 2023, 768 participants with severe symptomatic native aortic stenosis were randomly assigned, 384 to the Myval THV and 384 to a contemporary THV. 369 (48%) participants had their sex recorded as female, and 399 (52%) as male. The mean age of participants was 80·0 years (SD 5·7) for those treated with the Myval THV and 80·4 years (5·4) for those treated with a contemporary THV. Median Society of Thoracic Surgeons scores were the same in both groups (Myval 2·6% [IQR 1·7-4·0] vs contemporary 2·6% [1·7-4·0]). The primary endpoint showed non-inferiority of the Myval (25%) compared with contemporary THV (27%), with a risk difference of -2·3% (one-sided upper 95% CI 3·8, pnon-inferiority<0·0001). No significant difference was seen in individual components of the primary composite endpoint. INTERPRETATION: In individuals with severe symptomatic native aortic stenosis, the Myval THV met its primary endpoint at 30 days. FUNDING: Meril Life Sciences.

LANDMARK comparison of early outcomes of newer-generation Myval transcatheter heart valve series with contemporary valves (Sapien and Evolut) in real-world individuals with severe symptomatic native aortic stenosis: a randomised non-inferiority trial

BACKGROUND Transcatheter aortic valve implantation is an established, guideline-endorsed treatment for severe aortic stenosis. Precise sizing of the balloon-expandable Myval transcatheter heart valve (THV) series with the aortic annulus is facilitated by increasing its diameter in 1•5 mm increments, compared with the usual 3 mm increments in valve size. The LANDMARK trial aimed to show non-inferiority of the Myval THV series compared with the contemporary THVs Sapien Series (Edwards Lifesciences, Irvine, CA, USA) or Evolut Series (Medtronic, Minneapolis, MN, USA). METHODS In this prospective, multinational, randomised, open-label, non-inferiority trial across 31 hospitals in 16 countries (Germany, France, Sweden, the Netherlands, Italy, Spain, New Zealand, Portugal, Greece, Hungary, Poland, Slovakia, Slovenia, Croatia, Estonia, and Brazil), 768 participants with severe symptomatic native aortic stenosis were randomly assigned (1:1) to the Myval THV or a contemporary THV. Eligibility was primarily decided by the heart team in accordance with 2021 European Society of Cardiology guidelines. As per the criteria of the third Valve Academic Research Consortium, the primary endpoint at 30 days was a composite of all-cause mortality, all stroke, bleeding (types 3 and 4), acute kidney injury (stages 2­4), major vascular complications, moderate or severe prosthetic valve regurgitation, and conduction system disturbances resulting in a permanent pacemaker implantation. Non-inferiority of the study device was tested in the intention-to-treat population using a non-inferiority margin of 10•44% and assuming an event rate of 26•10%. This trial is registered with ClinicalTrials.gov, NCT04275726, and EudraCT, 2020-000137-40, and is closed to new participants. FINDINGS Between Jan 6, 2021, and Dec 5, 2023, 768 participants with severe symptomatic native aortic stenosis were randomly assigned, 384 to the Myval THV and 384 to a contemporary THV. 369 (48%) participants had their sex recorded as female, and 399 (52%) as male. The mean age of participants was 80•0 years (SD 5•7) for those treated with the Myval THV and 80•4 years (5•4) for those treated with a contemporary THV. Median Society of Thoracic Surgeons scores were the same in both groups (Myval 2•6% [IQR 1•7­4•0] vs contemporary 2•6% [1•7­4•0]). The primary endpoint showed non-inferiority of the Myval (25%) compared with contemporary THV (27%), with a risk difference of ­2•3% (one-sided upper 95% CI 3•8, pnon-inferiority<0•0001). No significant difference was seen in individual components of the primary composite endpoint. INTERPRETATION In individuals with severe symptomatic native aortic stenosis, the Myval THV met its primary endpoint at 30 days.

Monitoring of bentonite pore water with a probe based on solid-state microsensors.

Repositories for the disposal of radioactive waste generally rely on a multi-barrier system to isolate the waste from the biosphere. This multi-barrier system typically comprises the natural geological barrier provided by the repository host rock and its surroundings and an engineered barrier system (EBS). Bentonite is being studied as an appropriated porous material for an EBS to prevent or delay the release and transport of radionuclides towards biosphere. The study of pore water chemistry within bentonite barriers will permit to understand the transport phenomena of radionuclides and obtain a database of the bentonite-water interaction processes. In this work, the measurement of some chemical parameters in bentonite pore water using solid-state microsensors is proposed. Those sensors are well suited for this application since in situ measurements are feasible and they are robust enough for the long periods of time that monitoring is needed in an EBS. A probe containing an ISFET (ion sensitive field effect transistor) for measuring pH, and platinum microelectrodes for measuring conductivity and redox potential was developed, together with the required instrumentation, to study the chemical changes in a test cell with compacted bentonite. Response features of the sensors' probe and instrumentation performance in synthetic samples with compositions similar to those present in bentonite barriers are reported. Measurements of sensors stability in a test cell are also presented.

Mordedura de majá: presentación de un caso

Adolescente de 12 años de edad, mordido por un majá de Santa María (Epicrates Angulifer) en la región lateral izquierda del cuello, se ingresa por tortícolis, con dolor e inflamación local, tratado con cefazolina intramuscular y analgésicos, empeora en las siguientes 48 horas con extensión de los signos inflamatorios hasta el área torácica. Se incrementa la dosis de antibiótico y se añade Difenhidramina, mejora y se egresa con tratamiento ambulatorio oral. No hay registros de otros casos de mordedura de majá en más de 30 años en nuestro hospital(AU)

Presencia de mosquitos (Diptera: Culicidae) y biorreguladores en criaderos existentes en áreas atendidas por el médico de la familia en el municipio Fomento / Mosquitoes (Diptera: Culicidae) and biological regulators in reservoirs of the Fomento municipality health areas attended to by family doctors

Se estudiaron las áreas que atienden los 52 consultorios del médico de la familia del municipio Fomento en la provincia de Sancti Spíritus en relación con la presencia de mosquitos (Diptera: Culicidae).Se encontraron 19 especies Culex quinquefasciatus y Anopheles Albimanus fueron los más ampliamente distribuidos. En cada criadero se determinaron las especies de peces e insectos acuáticos de importancia como reguladores biológicos. Gambusia punctata resultó ser el pez larvívoro más abundante y ampliamente distribuido. Entre los insectos depredadores los pertenecientes a los Ordenes Odonata y Hemíptera fueron los más encontrados

Presencia de mosquitos (Diptera: Culicidae) y biorreguladores en criaderos existentes en áreas atendidas por el médico de la familia en el municipio Fomento / Mosquitoes (Diptera: Culicidae) and biological regulators in reservoirs of the Fomento municipality health areas attended to by family doctors

Se estudiaron las áreas que atienden los 52 consultorios del médico de la familia del municipio Fomento en la provincia de Sancti Spíritus en relación con la presencia de mosquitos (Diptera: Culicidae).Se encontraron 19 especies Culex quinquefasciatus y Anopheles Albimanus fueron los más ampliamente distribuidos. En cada criadero se determinaron las especies de peces e insectos acuáticos de importancia como reguladores biológicos. Gambusia punctata resultó ser el pez larvívoro más abundante y ampliamente distribuido. Entre los insectos depredadores los pertenecientes a los Ordenes Odonata y Hemíptera fueron los más encontrados.