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Abstract Resource quality is an important concept in ecology and evolution that attempts to capture the fitness benefits a resource affords to an organism. Yet “quality” is a multivariate concept, potentially affected by many variables pertaining to the resource, its surroundings, and the resource chooser. Researchers often use a small number of proxy variables to simplify their estimation of resource quality, but without vetting their proxies against a wider set of potential quality estimators this approach risks overlooking potentially important characteristics that can explain patterns of resource use in their study systems. Here we used Neolamprologus multifasciatus, a group‐living cichlid fish that utilizes empty snail shells as shelter resources, to examine how shells were used by, and partitioned among, group members in relation to a range of attributes, including shell size, intactness, texture, spatial position, and usage by heterospecifics. This approach generated a comprehensive picture of what characteristics contribute to the attractiveness and quality of each shell resource, confirming the importance of two previously proposed shell characteristics, size and intactness, but highlighting the influences of other unexplored variables, including shell spatial position and usage by heterospecifics. We also present a generally applicable “resource attractiveness index” as a means to estimate resource quality based on resource choice data. This index incorporates information from any number of resource characteristics and is of particular use when researchers wish to quantify resource value, but many characteristics jointly contribute to the value and attractiveness of the resource.

Abstract Straw returning is an important strategy for effectively using straw resources to improve soil fertility and quality, but the effects of this process on reactive intermediates (RIs) formation in paddy water are not fully explored. In this study, we conducted a field experiment to explore the effects of straw returning on RIs formation including triplet chromophoric dissolved organic matter (3CDOM*), hydroxyl radicals (•OH), and singlet oxygen (1O2) in paddy water. It was found that straw returning considerably increased the steady-state concentration of RIs, and the application of rice straw with 25% and 75% organic replacement ratio increased RIs concentration by 2.52 and 2.25 times, respectively. The optical spectroscopy, Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) analysis and structural equation model showed that straw returning produces abundant humified and aromatic DOM containing fulvic acid, lignin and protein-like substances, which could induce more RIs under irradiation. In addition, straw returning significantly accelerated imidacloprid (IMD) degradation, yielding degradation products that were highly toxic to aquatic animals (i.e., fish and daphnia) but less toxic to aquatic plants (i.e., green algae). This study would offer an innovative viewpoint on the effects of straw returning on the photochemistry of paddy water and the naturally occurring abiotic degradation pathway of organic contaminants.

Introduction and Objectives: Ablation of multifocal premature ventricular complexes (PVCs) is challenging. Activation mapping can be performed for the predominant morphology, but may be useless for other less prevalent ones. We aimed to describe the efficacy of an automated pace-mapping software-based ablation strategy for ablating the site of origin of multiple PVC locations. Methods: Consecutive patients referred for ablation of multifocal PVCs were prospectively enrolled. Spontaneous PVC templates were recorded and a detailed pace-mapping map was generated to spot the site of origin of PVCs. Results: A total of 47 PVCs were targeted in 21 patients (five and 16 patients with three or two PVCs morphologies each, respectively). Detailed pace-mapping comprising 73.5±41.6 different pacing locations was performed (best matching 97.2% [IQR 95.9-98.3%] similar to the clinical PVC). Activation points were acquired if possible, although ablation was only based on pace-mapping in 13 (27.6%) foci. Complete acute procedural success was obtained in 14 (66.7%) patients, while one PVC morphology was deliberately not ablated in five patients (23.8%). After 12.3±9.4 months of follow-up, PVC burden decreased from 24.4±10.4% to 5.6±5.0% (p

The article describes how the place of controlling changed with the development of organizations. The set of processes occurring in the activity of a foreign trade participant at the current stage of functioning is listed. The change in the attitude to management in organizations emphasizes the need for the use of controlling technology, which determines the relevance of the study of the prospects for its development. The author presents and describes the main stages of controlling technology in a foreign trade organization, provides a practical example of using controlling technology, and lists the factors that determine the prospects for the development of controlling technology. The research is based on the methodology of the process approach. In the course of the study, the author used the method of comparative analysis of planned and actual indicators.

Background: The number of implantable cardioverter defibrillator (ICD) infections is increasing due to an increased number of ICD implants, higher-risk patients, and more frequent replacement procedures, which carry a higher risk of infection. Reducing the morbidity, mortality, and cost of ICD-related infections requires an understanding of the current rate of this complication and its predictors. Methods: The Shock Implant Evaluation Trial (SIMPLE) trial randomized 2500 ICD recipients to defibrillation testing or not. Over an average of 3.1 years, patients were seen every 6 months and examined for evidence of ICD infection, which was defined as requiring device removal and/or intravenous antibiotics. Results: Within 24 months, 21 patients (0.8%) developed infection. Fourteen patients (67%) with infection presented within 30 days, 20 patients by 12 months, and only 1 patient beyond 12 months. Univariate analysis demonstrated that patients with primary electrical disorders (3 patients, P = 0.009) and those with a secondary prevention indication (13 patients, P = 0.0009) were more likely to develop infection. Among the 2.2% of patients who developed an ICD wound hematoma, 10.4% developed an infection. Among the 8.3% of patients requiring an ICD reintervention, 1.9% developed an infection. Conclusions: This cohort of ICD recipients at high-volume centres have a low risk of device-related infection. However; strategies to reduce wound hematoma and the need for ICD reintervention could further reduce the rate of infection. Résumé: Contexte: L’incidence des cas d’infection du défibrillateur cardioverteur implantable (DCI) augmente en raison du nombre accru d’implantations, de l’emploi de ces dispositifs chez des patients exposés à un risque très élevé et de l’augmentation de la fréquence des interventions de remplacement, qui sont associées à un plus grand risque d’infections. Pour parvenir à réduire la morbidité, la mortalité et les coûts associés aux infections liées à un DCI, il faut connaître la fréquence de cette complication et les facteurs qui permettent de la prédire. Méthodologie: Lors de l’essai Shock Implant Evaluation Trial (SIMPLE), 2 500 patients ayant reçu un DCI ont été répartis aléatoirement en deux groupes, l’un subissant des tests de défibrillation et l’autre, non. Sur une période de 3,1 ans en moyenne, les patients ont été vus en consultation tous les 6 mois et examinés à la recherche de signes d’infection du DCI, définie comme étant une infection exigeant le retrait du dispositif et/ou l’administration d’antibiotiques par voie intraveineuse. Résultats: Au total, 21 patients (0,8 %) ont présenté une infection dans les 24 mois suivant l’implantation. Quatorze patients (67 %) ont présenté une infection dans les 30 jours suivant l’intervention; à 12 mois, 20 patients avaient présenté une infection. Un seul patient a présenté une infection plus de 12 mois après l’intervention. Les résultats d’une analyse univariée ont démontré qu’une infection était plus probable chez les patients qui présentaient un trouble électrique primaire (3 patients, p = 0,009) et chez ceux qui avaient reçu un dispositif en prévention secondaire (13 patients, p = 0,0009). Parmi les patients qui présentaient un hématome après l’implantation du DCI (2,2 %), 10,4 % ont présenté une infection. Parmi les patients qui ont eu besoin d’une nouvelle intervention relative au DCI (8,3 %), 1,9 % ont présenté une infection. Conclusions: Les patients de cette cohorte ayant reçu un DCI dans des établissements à haut volume étaient exposés à un faible risque d’infection du défibrillateur. Des stratégies visant à réduire les hématomes et la nécessité d’une nouvelle intervention sur les DCI pourraient toutefois contribuer à réduire encore plus la fréquence des infections.

Background As in many other countries across sub-Saharan Africa, Malawi’s commercial gambling sector has grown considerably in recent years. Driven by the widespread availability of internet through mobile devices, the industry has penetrated both urban and rural settings. In Malawi the model commonly implemented by gambling companies is similar to that used by mobile phone operators. Agents equipped with cellular devices connect to providers’ servers to place wagers for customers and print receipts using simple printers attached to their devices. This has produced lucrative returns for providers. While increasing attention is being paid to this trend, most research focusses on sports betting and there is a deficit of papers that document gambling-related harms. Methods Here we present a narrative case report of a 16-year-old boy, ‘Wati’ (pseudonym), who lived in rural Malawi and took his own life after gambling and losing money that did not belong to him. As his community is part of a demographic surveillance site, a verbal autopsy was conducted, later supplemented with interviews with Wati’s close friend and uncle, to whom his mother referred us. We triangulated data from these three sources to create a narrative case report of Wati’s suicide and its relationship to his gambling practices. Results We found that the gambling harms leading up to Wati’s suicide were recurrent, that his gambling practices were diverse (lottery, football betting, digital games and cards) and that signs of distress were apparent before his suicide. Conclusions From this case report, we learn that underage individuals participate in gambling in Malawi, can develop harmful habits and that their gambling is not confined to sports betting. We also learn that there is a lack of accessible services for people who develop harmful gambling practices. Wati could have benefited from such services and they may have saved his life.

The COVID-19 pandemic has grown rapidly around the world, bringing about suffering and fear, that may have impact on the mental health of populations. In Cameroon, the weakness of detection devices and treatment infrastructures, coupled with pessimistic forecasts from the UN and WHO, were increasingly potential for stress, anxiety and depression. The study set out to determine the impact of the pandemic on the mental health of Cameroonian populations. The methodology of mental health surveys in the general population was used. The Depression, Anxiety and Stress Scale (DASS 21) was used to carry out the diagnosis. An ethical and administrative clearance was carried out. It respected freedom, confidentiality and informed consent, following the guidelines of the Helsinki Protocol. 254 subjects were interviewed in two cities in the West Cameroon region, one of the 03 regions most affected by the pandemic. The results show a high rate of depression (31.7%) and anxiety (29.5%), as well as a low rate of stress (2,4%). These results indicate that the Covid 19 pandemic is affecting, even if moderately, the mental health of the Cameroonian populations.RésuméLa pandémie du COVID-19 a eu une progression rapide dans le monde. Au Cameroun, la faiblesse des dispositifs de détection et de prise en charge, associée aux prévisions pessimistes de l'ONU et de l'OMS sur l'impact de la pandémie en Afrique, étaient susceptibles d'augmenter son retentissement psychopathologique. L’étude s'est donnée pour objectif de déterminer l'impact de la pandémie sur la santé mentale des populations camerounaises. La méthodologie des enquêtes de santé mentale en population générale a été mise à contribution. L’échelle de dépression, d'anxiété et de stress (EDAS 21) a été l'outil diagnostic utilisé. La collecte des données s'est faite au préalable d'une clairance éthique et administrative, suivant les orientations du protocole d'Helsinki. 254 sujets ont été interviewés. Les résultats montrent un taux de dépression de 31,5%; un taux et d'anxiété de 29,5% et un taux de stress de 2,4%.

The efficacy of beta-blocker treatment in type 3 long QT syndrome (LQT3) remains debated. The purpose of this study was to test the hypothesis that beta-blocker use is associated with cardiac events (CEs) in a French cohort of LQT3 patients. All patients with a likely pathogenic/pathogenic variant in the SCN5A gene (linked to LQT3) were included and followed-up. Documented ventricular tachycardia/ventricular fibrillation, torsades de pointes, aborted cardiac arrest, sudden death, and appropriate shocks were considered as severe cardiac events (SCEs). CEs also included syncope. We included 147 patients from 54 families carrying 23 variants. Six of the patients developed symptoms before the age of 1 year and were analyzed separately. The 141 remaining patients (52.5% male; median age at diagnosis 24.0 years) were followed-up for a median of 11 years. The probabilities of a CE and an SCE from birth to the age of 40 were 20.5% and 9.9%, respectively. QTc prolongation (hazard ratio [HR] 1.12 [1.0–1.2]; P =.005]) and proband status (HR 4.07 [1.9–8.9]; P <.001) were independently associated with the occurrence of CEs. Proband status (HR 8.13 [1.7–38.8]; P =.009) was found to be independently associated with SCEs, whereas QTc prolongation (HR 1.11 [1.0–1.3]; P =.108) did not reach statistical significance. The cumulative probability of the age at first CE/SCE was not lower in patients treated with a beta-blocker. In agreement with the literature, proband status and lengthened QTc were associated with a higher risk of CEs. Our data do not show a protective effect of beta-blocker treatment. [Display omitted] [ABSTRACT FROM AUTHOR]

Brugada syndrome (BS) is a genetic pathological condition associated with a high risk for sudden cardiac death (SCD). Ventricular depolarization disorders have been suggested as a potential electrophysiological mechanism associated with high SCD risk on patients with BS. This paper aims to characterize the dynamic changes of ventricular depolarization observed during physical exercise in symptomatic and asymptomatic BS patients. To this end, cardiac ventricular depolarization features were automatically extracted from 12-lead ECG recordings acquired during standardized exercise stress test in 110 BS patients, of whom 25 were symptomatic. Conventional parameters were evaluated, including QRS duration, R and S wave amplitudes ([Formula: see text], [Formula: see text]), as well as QRS morphological features, such as up-stroke and down-stroke slopes of the R and S waves ([Formula: see text], [Formula: see text] and [Formula: see text]). The effects of physical exercise and recovery on the dynamics of these markers were assessed in both BS populations. Features showing significantly different dynamics between the studied groups were used alone and in combination with the clinical characteristics of the patients in a logistic regression analysis. Results show larger changes in the second half of the QRS complex through [Formula: see text] and [Formula: see text] measured in the right precordial leads for asymptomatic patients, especially during recovery, when the vagal tone is more pronounced. Multivariate analysis involving both types of features resulted in a reduced model of three relevant features ([Formula: see text] in lead V2, Sex and heart rate recovery, HRR), which achieved a suitable discrimination performance between groups; sensitivity = 80% and specificity = 75% (AUC = 83%). However, after controlling the model for possible confounding factors, only one feature ([Formula: see text]) remained meaningful. This adjusted model significantly improved the overall discrimination performance by up to: sensitivity = 84% and specificity = 100% (AUC = 94%). The study highlights the importance of physical exercise test to unmask differentiated behaviors between symptomatic and asymptomatic BS patients through depolarization dynamic analysis. This analysis together with the obtained model may help to identify asymptomatic patients at low or high risk of future cardiac events, but it should be confirmed by further prospective studies.

Abstract Background Almost all attempts to improve patient selection for cardiac resynchronization therapy (CRT) using echo-derived indices have failed so far. We sought to assess: the performance of homemade software for the automatic quantification of integral 3D regional longitudinal strain curves exploring left ventricular (LV) mechanics and the potential value of this tool to predict CRT response. Methods Forty-eight heart failure patients in sinus rhythm, referred for CRT-implantation (mean age: 65 years; LV-ejection fraction: 26%; QRS-duration: 160 milliseconds) were prospectively explored. Thirty-four patients (71%) had positive responses, defined as an LV end-systolic volume decrease ≥15% at 6-months. 3D–longitudinal strain curves were exported for analysis using custom-made algorithms. The integrals of the longitudinal strain signals (I L,peak) were automatically measured and calculated for all 17 LV-segments. Results The standard deviation of longitudinal strain peak (SDI L,peak ) for all 17 LV-segments was greater in CRT responders than non-responders (1.18% s−1 [0.96; 1.35] versus 0.83% s−1 [0.55; 0.99], p = 0.007). The optimal cut-off value of SDI L,peak to predict response was 1.037%.s−1. In the 18-patients without septal flash, SDI L,peak was significantly higher in the CRT-responders. Conclusions This new automatic software for analyzing 3D longitudinal strain curves is avoiding previous limitations of imaging techniques for assessing dyssynchrony and then its value will have to be tested in a large group of patients.

Staphylococcus aureus induces severe infective endocarditis (IE) where embolic complications are a major cause of death. Risk factors for embolism have been reported such as a younger age or larger IE vegetations, while methicillin resistance conferred by the mecA gene appeared as a protective factor. It is unclear, however, whether embolism is influenced by other S. aureus characteristics such as clonal complex (CC) or virulence pattern. We examined clinical and microbiological predictors of embolism in a prospective multicentric cohort of 98 French patients with monomicrobial S. aureus IE. The genomic contents of causative isolates were characterized using DNA array. To preserve statistical power, genotypic predictors were restricted to CC, secreted virulence factors and virulence regulators. Multivariate regularized logistic regression identified three independent predictors of embolism. Patients at higher risk were younger than the cohort median age of 62.5 y (adjusted odds ratio [OR] 0.14; 95% confidence interval [CI] 0.05–0.36). S. aureus characteristics predicting embolism were a CC30 genetic background (adjusted OR 9.734; 95% CI 1.53–192.8) and the absence of pIB485-like plasmid-borne enterotoxin-encoding genes sed, sej, and ser (sedjr; adjusted OR 0.07; 95% CI 0.004–0.457). CC30 S. aureus has been repeatedly reported to exhibit enhanced fitness in bloodstream infections, which might impact its ability to cause embolism. sedjr-encoded enterotoxins, whose superantigenic activity is unlikely to protect against embolism, possibly acted as a proxy to others genes of the pIB485-like plasmid found in genetically unrelated isolates from mostly embolism-free patients. mecA did not independently predict embolism but was strongly associated with sedjr. This mecA-sedjr association might have driven previous reports of a negative association of mecA and embolism. Collectively, our results suggest that the influence of S. aureus genotypic features on the risk of embolism may be stronger than previously suspected and independent of clinical risk factors.

Ventricular arrhythmias in Brugada syndrome (BS) typically occur at rest and especially during sleep, suggesting that changes in the autonomic modulation may play an important role in arrhythmogenesis. The autonomic response to exercise and subsequent recovery was evaluated on 105 patients diagnosed with BS (twenty-four were symptomatic), by means of a time-frequency heart rate variability (HRV) analysis, so as to propose a novel predictive model capable of distinguishing symptomatic and asymptomatic BS populations. During incremental exercise, symptomatic patients showed higher HFnu values, probably related to an increased parasympathetic modulation, with respect to asymptomatic subjects. In addition, those extracted HRV features best distinguishing between populations were selected using a two-step feature selection approach, so as to build a linear discriminant analysis (LDA) classifier. The final features subset included one third of the total amount of extracted autonomic markers, mostly acquired during incremental exercise and active recovery, thus evidencing the relevance of these test segments in BS patients classification. The derived predictive model showed an improved performance with respect to previous works in the field (AUC = 0.92 ± 0.01; Se = 0.91 ± 0.06; Sp = 0.90 ± 0.05). Therefore, based on these findings, some of the analyzed HRV markers and the proposed model could be useful for risk stratification in Brugada syndrome.

Introduction : Les résultats de l’étude de l’European Society for Cataract and Refractive Surgery (ESCRS) en 2006 ont montré une diminution significative du risque d’endophtalmie post-chirurgie de cataracte après injection intracamérulaire de céfuroxime en peropératoire. Nous rapportons la mise place de ce protocole dans notre service et nos résultats sur un an. Patients et méthodes : À partir de 2010, les patients qui se sont fait opérer de chirurgie de cataracte dans le service ont reçu une injection de 1 mg/0,1 ml de céfuroxime en chambre antérieure en fin d’intervention. Nous rapportons la façon pratique dont nous réalisons ces injections ainsi que le taux d’endophtalmie après la mise en place de ce protocole. Résultats : Entre novembre 2014 et novembre 2015, 1265 patients ont été opérés de cataracte dans le service avec une injection de céfuroxime en chambre antérieure en fin d’intervention. Sur cette période, deux endophtalmies ont été comptabilisées : ce qui correspond à un taux d’endophtalmies de 0,15 %(comparé aux années 2009 et 2008 où le taux d’endophtalmie était respectivement de 0.29% et 0.24%). Discussion et conclusion : L’injection en chambre antérieure de 1 mg de céfuroxime en fin d’intervention de cataracte dans la prévention des endophtalmies est un moyen de prévention à considérer. La tolérance de cette injection semble bonne lorsque l’on respecte des règles de préparation adéquates. Une des principales limitations à la généralisation de ce protocole reste l’absence d’un accès facile à une préparation commerciale.

Introduction : Les traumatismes oculaires occupent une place importante dans les urgences ophtalmologiques. Les accidents oculaires professionnels constituent 53 à 70 % des traumatismes oculaires globaux. Les traumatismes oculaires professionnels présentent un caractère urgent soit en raison du type de lésions qu’ils provoquent, soit par la gêne qu’ils engendrent. La prise en charge précoce de ces patients permet de minimiser la gravité des complications et des séquelles, et leur impact socio-économique. Le but de ce travail est d’explorer les principales causes des traumatismes oculaires professionnels à Casablanca afin de formuler des recommandations pratiques de prévention primaire efficace selon les métiers. Patients et méthodes : Étude analytique observationnelle de cas-témoins auprès de 6738 patients victimes d’un traumatisme oculaire de janvier 2015 à juin 2015 au service des urgences ophtalmologiques de notre CHU. Nous avons analysé les paramètres liés aux accidents oculaires professionnels. Nous avons recueillis les données concernant l’identification du patient, le type d’accident, les causes et circonstances de cet accident(activité au moment de l’accident), le port ou non de l’équipement de protection individuelle au moment de l’accident, l’état de conscience de l’employé au moment de l’accident (ivresse ?), la nature de l’agent impactant, la fréquence des accidents professionnels selon le type d’activité, la méthode de prévention en entreprise, la sensibilisation du personnel, et l’existence d’autres employés exposés aux mêmes conditions du travail. Résultats : Nous avons recensé 5016 traumatismes oculaires professionnels ce qui représente 69% de l’ensemble des traumatismes oculaires. Les employés du bâtiment ont présenté le taux d’accidentés le plus élevé soit 39,5 %, suivis par les employés des secteurs de la métallurgie (21,4 %) et du bois (5,6 %). Le processus conduisant le plus couramment à un accident était le meulage (19,3 % de cas) et les agents traumatisant sont des corps étrangers métalliques (64.7 %). Concernant le siège des lésions, il existait une prédominance des localisations cornéennes (84.9 %) dominées par les érosions cornéenne post-ablation de corps étrangers (41,8 %). Nous avons enregistré un taux élevé de manque de sensibilisation (65,8 %). 72,9 % des patients n’étaient pas équipés de protection oculaire au moment de la survenue de l’accident. Enfin l’existence d’autres personnes exposées à la même condition de travail a été rapportée dans 4326 cas (86.2%). Discussion et conclusion : La sécurité au travail et la qualité du travail sont des objectifs de valeur égale pour une entreprise. Malgré de nombreux efforts déployés depuis environ un siècle, notre étude montre que 73 % des accidents oculaires professionnels sont dus à la négligence : défaut de sensibilisation, port de lunettes de protection mal adaptées voir l’absence de port d’équipement de protection individuelle. Lorsque nous y associons les manques observés dans l’organisation des postes de travail, une évidence s’impose : un accent particulier doit être mis dans la prévention primaire. Nous proposons des recommandations pratiques et ambitieuses. Certes le risque zéro n’existe pas, mais nous sommes convaincus que l’application rigoureuse de ces recommandations nous en rapprocherait davantage pour le bien des yeux ; nos organes sensitifs les plus précieux.

Vagus nerve stimulation (VNS) is an established adjunctive therapy for pharmacologically refractory epilepsy and depression and is currently in active clinical research for other applications. In current clinical studies, VNS is delivered in an open-loop approach, where VNS parameters are defined during a manual titration phase. However, the physiological response to a given VNS configuration shows significant inter and intra-patient variability and may significantly evolve through time. VNS closed-loop approaches, allowing for the optimization of the therapy in an adaptive manner, may be necessary to improve efficacy while reducing side effects. This paper proposes a generic, closed-loop control VNS system that is able to optimize a number of VNS parameters in an adaptive fashion, in order to keep a control variable within a specified range. Although the proposed control method is completely generic, an example application using the cardiac beat to beat interval (RR) as control variable will be developed in this paper. The proposed controller is based on a state transition model (STM) that can be configured using a partially or a fully-connected architecture, different model orders and different state-transition algorithms. The controller is applied to the adaptive regulation of heart rate and evaluated on 6 sheep, for 13 different targets, using partially-connected STM with 10 states. Also, partially and fully-connected STM defined by 30 states were applied to 7 other sheep for the same 10 targets. Results illustrate the interest of the proposed fully-connected STM and the feasibility of integrating this control system into an implantable neuromodulator.

Congenital anomalies of the inferior vena cava (IVC) are rare and very often diagnosed in asymptomatic patients during computed tomography performed for other purposes. These anomalies can have significant clinical implications, for example if electrophysiology procedures are needed. Diagnostic and ablation procedures are difficult since catheter manipulation and positioning are more complex. We present here a case of successful atrioventricular nodal reentrant tachycardia ablation in a patient with unexpected IVC agenesis, using an azygos route. Resumo: As anomalias congénitas da veia cava inferior são raras e são, muitas vezes, diagnosticadas em pacientes assintomáticos como achados de tomografia computorizada realizada com outros objetivos. Estas anomalias podem ter implicações clínicas importantes, nomeadamente quando estão programados estudos eletrofisiológicos. Os procedimentos de diagnóstico e de ablação são difíceis, uma vez que o manuseamento e posicionamento do cateter é mais complexo. Apresentamos o caso bem-sucedido de uma ablação de taquicardia por reentrada nodal auriculoventricular num doente com agenesia da veia cava inferior, utilizando uma via trans-ázigos. Keywords: Supraventricular tachycardia, Ablation, Inferior vena cava agenesis, Palavras-chave: Taquicardia supraventricular, Ablação, Agenesia de veia cava inferior

BackgroundThe Brugada syndrome is an inherited cardiac arrhythmia associated with high risk of sudden death. Although 20% of patients with Brugada syndrome carry mutations in SCN5A, the molecular mechanisms underlying this condition are still largely unknown. Methods and ResultsWe combined whole‐exome sequencing and linkage analysis to identify the genetic variant likely causing Brugada syndrome in a pedigree for which SCN5A mutations had been excluded. This approach identified 6 genetic variants cosegregating with the Brugada electrocardiographic pattern within the pedigree. In silico gene prioritization pointed to 1 variant residing in KCNAB2, which encodes the voltage‐gated K+ channel β2‐subunit (Kvβ2‐R12Q). Kvβ2 is widely expressed in the human heart and has been shown to interact with the fast transient outward K+ channel subunit Kv4.3, increasing its current density. By targeted sequencing of the KCNAB2 gene in 167 unrelated patients with Brugada syndrome, we found 2 additional rare missense variants (L13F and V114I). We then investigated the physiological effects of the 3 KCNAB2 variants by using cellular electrophysiology and biochemistry. Patch‐clamp experiments performed in COS‐7 cells expressing both Kv4.3 and Kvβ2 revealed a significant increase in the current density in presence of the R12Q and L13F Kvβ2 mutants. Although biotinylation assays showed no differences in the expression of Kv4.3, the total and submembrane expression of Kvβ2‐R12Q were significantly increased in comparison with wild‐type Kvβ2. ConclusionsAltogether, our results indicate that Kvβ2 dysfunction can contribute to the Brugada electrocardiographic pattern.

While energy efficiency is essential to extend the battery life of embedded devices, performance cannot be ignored. Highperformance superscalar embedded processors are more energy efficient than low performance scalar processors, however,they consume more power which is very limited in battery operated deeply embedded industrial devices. In this paper wepropose an energy efficient dual issue embedded processor that can deliver up to 60% improvement in IPC (instructionper-cycle) performance with less than 20% increase in power consumption compared to a single issue scalar processor. Incontrast to traditional multi-issue embedded processors that use power intensive superscalar techniques to extractinstruction-level parallelism from applications, the proposed processor uses simple hardware techniques to resolveinstruction scheduling conflicts. The processor is optimized for implementation on a low cost FPGA which makes it asuitable candidate for cost sensitive embedded industrial applications.

Although the therapeutic effects of Vagus Nerve Stimulation (VNS) have been recognized in pre-clinical and pilot clinical studies, the effect of different stimulation configurations on the cardiovascular response is still an open question, especially in the case of VNS delivered synchronously with cardiac activity. In this paper, we propose a formal mathematical methodology to analyze the acute cardiac response to different VNS configurations, jointly considering the chronotropic, dromotropic and inotropic cardiac effects. A latin hypercube sampling method was chosen to design a uniform experimental plan, composed of 75 different VNS configurations, with different values for the main parameters (current amplitude, number of delivered pulses, pulse width, interpulse period and the delay between the detected cardiac event and VNS onset). These VNS configurations were applied to 6 healthy, anesthetized sheep, while acquiring the associated cardiovascular response. Unobserved VNS configurations were estimated using a Gaussian process regression (GPR) model. In order to quantitatively analyze the effect of each parameter and their combinations on the cardiac response, the Sobol sensitivity method was applied to the obtained GPR model and inter-individual sensitivity markers were estimated using a bootstrap approach. Results highlight the dominant effect of pulse current, pulse width and number of pulses, which explain respectively 49.4%, 19.7% and 6.0% of the mean global cardiovascular variability provoked by VNS. More interestingly, results also quantify the effect of the interactions between VNS parameters. In particular, the interactions between current and pulse width provoke higher cardiac effects than the changes on the number of pulses alone (between 6 and 25% of the variability). Although the sensitivity of individual VNS parameters seems similar for chronotropic, dromotropic and inotropic responses, the interacting effects of VNS parameters provoke significantly different cardiac responses, showing the feasibility of a parameter-based functional selectivity. These results are of primary importance for the optimal, subject-specific definition of VNS parameters for a given therapy and may lead to new closed-loop methods allowing for the optimal adaptation of VNS therapy through time.

Arthropod-borne viruses (arboviruses) such as dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), and yellow fever virus (YFV) are the most important ‘emerging pathogens’ because of their geographic spread and their increasing impact on vulnerable human populations. To fight against these arboviruses, vector control strategies (VCS) remain one of the most valuable means. However, their implementation and monitoring are labour intensive and difficult to sustain on large scales, especially when transmission and Aedes mosquito densities are low. To increase the efficacy of VCS, current entomological methods should be improved by new complementary tools which measure the risk of arthropod-borne diseases’ transmission. The study of human–Aedes immunological relationships can provide new promising serological tools, namely antibody-based biomarkers, allowing to accurately estimate the human–Aedes contact and consequently, the risk of transmission of arboviruses and the effectiveness of VCS. This review focuses on studies highlighting the concept, techniques, and methods used to develop and validate specific candidate biomarkers of human exposure to Aedes bites. Potential applications of such antibody-based biomarkers of exposure to Aedes vector bites in the field of operational research are also discussed.