Refine
Document Type
- Article (4)
Has Fulltext
- yes (4)
Is part of the Bibliography
- no (4)
Keywords
- Ablation (1)
- Anticoagulant (1)
- Atrial fibrillation (1)
- Cardiac implantable electronic devices (1)
- Cardiac rehabilitation (1)
- Cardiac resynchronization therapy (1)
- Consensus document (1)
- Edoxaban (1)
- Exercise training (1)
- Heart failure (1)
We report on the successful implementation and characterization of a cryogenic solid hydrogen target in experiments on high-power laser-driven proton acceleration. When irradiating a solid hydrogen filament of 10 μm diameter with 10-Terawatt laser pulses of 2.5 J energy, protons with kinetic energies in excess of 20 MeV exhibiting non-thermal features in their spectrum were observed. The protons were emitted into a large solid angle reaching a total conversion efficiency of several percent. Two-dimensional particle-in-cell simulations confirm our results indicating that the spectral modulations are caused by collisionless shocks launched from the surface of the the high-density filament into a low-density corona surrounding the target. The use of solid hydrogen targets may significantly improve the prospects of laser-accelerated proton pulses for future applications.
Für die Pflanzenarten der Anhänge II und IV der FFH-Richtlinie wurde im Rahmen der FFH-Berichtspflicht Deutschlands an die EU-Kommission ein Monitoringsystem eingerichtet. Hierfür sind die Bundesländer verantwortlich. In Sachsen-Anhalt gibt es aktuell drei Vorkommen von Angelica palustris, eines von Apium repens, 107 von Cypripedium calceolus, 20 von Jurinea cyanoides, fünf von Liparis loeselii und fünf von Orthotrichum rogeri. Für alle Vorkommen dieser Arten wurden in den Jahren 2011/2012 Monitoringflächen eingerichtet (für Cypripedium calceolus nur an 10 Vorkommen, für Jurinea cyanoides an 18 Vorkommen). Diese Vorkommen wurden erfasst und bewertet. Für Coleanthus subtilis, Lindernia procumbens und Luronium natans konnten die in den zurückliegenden Jahren letztmalig bestätigten Vorkommen aktuell (2011/2012) nicht nachgewiesen werden. Aufgrund des natürlicherweise unsteten Auftretens dieser Arten wurden an den letzten bekannten Fundorten Monitoringflächen eingerichtet. Die drei Hauptkriterien des Monitorings: Zustand der Population, Habitatstruktur und Beeinträchtigungen sowie artspezifische Unterkriterien sind durch bundeseinheitliche Vorgaben festgelegt, ebenso die Häufigkeit der Erfassung dieser Kriterien während der jeweils sechsjährigen Berichtsperiode. Darüber hinaus sieht das Landesmonitoring teilweise eine detailliertere Untersuchungstiefe und -frequenz vor.
Aims: This post hoc analysis of ELIMINATE-AF evaluated requirements of unfractionated heparin (UFH) and procedure-related bleeding in atrial fibrillation (AF) patients undergoing ablation with uninterrupted edoxaban or vitamin K antagonist (VKA) therapy.
Methods and results: Patients were randomized 2:1 to once-daily edoxaban 60 mg (or dose-reduced 30 mg) or dose-adjusted VKA (target international normalized ratio: 2.0–3.0). Uninterrupted anticoagulation was mandated for 21–28 days’ pre-ablation and 90 days’ post-ablation. During ablation, UFH administration targeted an activated clotting time (ACT) of 300–400 s. Periprocedural bleeding was differentiated between procedure-related (bleeding at puncture side, cardiac tamponade) and unrelated events. Of 614 randomized patients, 553 received study drug and underwent catheter ablation (edoxaban n = 375; VKA n = 178). The median (Q1–Q3) time from last dose to ablation procedure was 14.8 (13.3–16.5) vs. 16.5 (14.8–19.5) h (edoxaban vs. VKA group, respectively). Mean ACT (SD) ≥300 s was observed in 52% edoxaban- vs. 76% VKA-treated patients, despite a higher mean (SD) UFH dose in the edoxaban vs. VKA group [14 261 (6397) IU vs. 11 473 (4300) IU; exploratory P-value < 0.0001]. In the edoxaban group, 13 patients (3.5%) had procedure-related bleeds of whom 9 had received an UFH dose above the median (13 000 IU). In the VKA arm, 7 patients (3.9%) had procedure-related bleeds of whom 3 had received an UFH dose above the median (10 225 IU).
Conclusion: The rate of procedure-related major/clinically relevant non-major bleeding did not differ between the treatment arms despite higher doses of UFH used with edoxaban vs. VKA to achieve a target ACT during AF ablation.
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.