Experimental demonstration of optical stochastic cooling

Particle accelerators and storage rings have been transformative instruments of discovery, and, for many applications, innovations in particle-beam cooling have been a principal driver of that success¹. Stochastic cooling (SC), one of the most important conceptual and technological advances in this area^2–6, cools a beam through granular sampling and correction of its phase-space structure, thus bearing resemblance to a ‘Maxwell’s demon’. The extension of SC from the microwave regime up to optical frequencies and bandwidths has long been pursued, as it could increase the achievable cooling rates by three to four orders of magnitude and provide a powerful tool for future accelerators. First proposed nearly 30 years ago, optical stochastic cooling (OSC) replaces the conventional microwave elements of SC with optical-frequency analogues and is, in principle, compatible with any species of charged-particle beam^7,8. Here we describe a demonstration of OSC in a proof-of-principle experiment at the Fermi National Accelerator Laboratory’s Integrable Optics Test Accelerator^9,10. The experiment used 100-MeV electrons and a non-amplified configuration of OSC with a radiation wavelength of 950 nm, and achieved strong, simultaneous cooling of the beam in all degrees of freedom. This realization of SC at optical frequencies serves as a foundation for more advanced experiments with high-gain optical amplification, and advances opportunities for future operational OSC systems with potential benefit to a broad user community in the accelerator-based sciences.

Stochastic cooling at optical frequencies is demonstrated in an experiment at the Fermi National Accelerator Laboratory’s Integrable Optics Test Accelerator, substantially increasing the bandwidth of stochastic cooling compared with conventional systems.

Temporary spinal cord stimulation to prevent postoperative atrial fibrillation after coronary surgery. First results of the feasibility study

Background

Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery with typical appearance at early days after operation and leads to increase morbidity and mortality in the short and long term follow up. Spinal cord stimulation (SCS) was proven to be effective in chronic pain and intractable angina pectoris treatment. Recently, animal studies demonstrated that spinal cord stimulation could suppress AF and reduce AF burden.

Aim

To test safety and efficacy of the temporary SCS in early postoperative period in patients undergoing coronary artery bypass grafting

Methods

Fifteen patients (10 men, mean age 61±7.5 years) with indications for coronary artery bypass grafting (CABG) and history of paroxysmal AF underwent percutaneous lead placement for temporary SCS. Under local anesthesia and fluoroscopic guidance, the leads were placed at C7-Th4 level according to patient's sense of paresthesia and connected with spinal cord stimulator externally fixed on patient's chest. Temporary SCS was performed 3 days before CABG and turned off during surgery. At the end of CABG, the SCS was turned on in the intensive care unit and continued for 7 days. After that the temporary leads were removed. The primary safety objective was to test safety of the temporary SCS in early postoperative period, including 30 days occurrence of MACE (Death, stroke or TIA, myocardial infarction), acute spinal cord and kidney injury. The efficacy endpoint included occurrence of AF or any atrial tachyarrhythmias lasting ≥30 seconds during 30 days after surgery. All patients had continuous external ECG monitoring for 30 days after surgery.

Results

In all (100%) patients temporary leads for SCS were implanted successfully and standard on-pump elective CABG was performed thereafter. There were no any adverse events related to temporary SCS in either patient till the end of follow up. There were no significant differences in CK-MB and creatinine levels as compared with baseline data (p=0.2 and 0.3, respectively). No patients developed AF or atrial tachyarrhythmias during follow up according 30-days ECG monitoring.

Conclusions

The first results of the temporary spinal cord stimulation to prevent AF after coronary surgery demonstrated safety and efficacy of this therapy. The parallel group randomizes study is under way (NCT 03539354)

Funding Acknowledgement

Type of funding source: None

[; HISTORICAL ANALYSIS AND ANALYTICAL REVIEW OF THE CREATION OF "MEMORY CLINICS" IN THE WORLD PRACTICE]

The number of elderly and senile people with severe senile asthenia syndrome and cognitive disorders, which eventually develop into dementia, is increasing every year in the world. It is this disease that is the highest priority in the health care of the entire world community.; The article provides a historical overview of the creation of memory clinics that operate in the paradigm of providing community-based psychiatric care. The results of changes in the clinical-dynamic and epidemiological indicators of the prevalence of dementia in the direction of early detection of pre-dementia conditions with mild cognitive decline syndrome are presented. Global trends in the development of memory clinics for outpatient patients are considered.; The purpose of the study: to provide a comprehensive analysis of the available literature data on the feasibility of a multi-faceted approach in the development of the concept of memory clinics.

P430Antiarrhythmic drug therapy in Russian patients undergoing atrial fibrillation ablation: a sub-analysis of the ESC-EHRA EORP registry

OnBehalf

EHRA-ESC EORP AFA LT registry

Introduction

Despite the effectiveness of atrial fibrillation (AF) catheter ablation (CA), antiarrhythmic therapy (AAT) remains an important part of the complex treatment.

Purpose

To analyze AAT dynamics in Russian patients undergoing AF ablation, and to reveal potential factors associated with ongoing AAT in patients without arrhythmia recurrence.

Methods

The ESC-EHRA AF ablation registry was conducted in 2012-2016 in EHRA countries. The current analysis included 476 patients (57.1 male; 57.1 ± 8.7 years) who underwent AF ablation in 13 Russian clinics. AAT before, during and at 12-month follow-up (12-FU) was assessed. At baseline, paroxysmal AF was present in 320 (67.2%) patients, persistent AF - in 94 (19.7%), long-standing persistent AF- in 53 (11,1%), in 9 (1.9%) AF type was unknown. Hypertension (H) was present in 355 (74.6%) patients; congestive heart failure (CHF) (NYHA≥2) in 184 (38.7%) patients; coronary artery disease (CAD) in 132 (27.7%) patients. The CA was the first in 396 (83.2%) cases, redo ablation was performed in 80 (16.8%) cases. AF recurrences were registered according to local clinical practice. Any atrial tachyarrhythmia >30s was considered as a recurrence.

Results

A three-month FU (3-FU) visit was performed in 476 (100%) patients, 12-FU - in 390 (81.9%). Prior to PV isolation 439 (92.2%) patients received AAT, while after ablation there was an increase in the number of patients on AAT - 459 (96.4%). The highest number of patients on AAT was detected at 3-FU - 463 (97.3%). During 12 months at least one episode of arrhythmia recurrence was documented in 203 (52.1%) patients, and 370 (94.8%) patients were on AAT at the 12-month visit. After the 12-month visit 307 (78.7%) patients continued to receive AAT, and in 187 (47.9%) of them there was no arrhythmia recurrence after the index ablation. Five (2.7%) of these patients continued a Ic class AAT drug, 35 (18.7%) patients - class III, 129 (69.0%) patients - β-blockers (BB) and 18 (9.6%) patients - calcium channel blockers (CCB). All 187 patients had co-morbidities (75.4% - H; 41.7% - CHF (NYHA≥2; 31.6% - CAD). There were no statistically significant predictors of AAT use in patients without arrhythmia reccurence. According to the univariant regression analysis, the use of AAT III class (mainly-sotalol) at 12 months had a small but statistically significant negative association with left atrial size enlargement (OR = 0.917; 0.860-0.997); class III AAT was negatevely associated with BB therapy (OR = 0.057; 0.016-0.198); CCB therapy was associated with an older age (OR = 1.073; 1.053-1.151).

Conclusions

About one-half of patients without apparent arrhythmia recurrence following AF ablation do receive AAT. There were no clinical or procedure-related factors associated with AAT after effective AF ablation. Paradoxically, patients with a smaller left atrial size and without arrhythmia recurrence had more chances to receive class III AAT, what requires further analysis.

4282Pulmonary artery denervation in patients with residual pulmonary hypertension after pulmonary endarterectomy: one-year results of the first -in-man, sham-controlled, pilot randomized clinical trial

Background

Pulmonary endarterectomy (PE) is the method of choice in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Despite the positive effect after surgery combined with medical treatment, 10–40% of patients develop residual CTEPH. Pulmonary artery denervation (PAD) is a novel treatment in PAH with optimistic results but was not tested in patients with residual CTEPH.

Objective

To assess the safety and efficacy of PAD using remote magnetic navigation system in patients with residual CTEPH after PE.

Methods

278 patients with CTEPH after PE were screened. 50 patients (mean age 47.6±14.3, 50% female) with a history of residual CTEPH (a resting pulmonary artery pressure ≥25 mm Hg or pulmonary vascular resistance >400 dyn sec cm–5 despite medical therapy 6 months after PE) were randomized into two groups: PAD (n=25; PAD group) or medical therapy with riociguat (n=25; MED group). In both groups right heart catheterization (RHC)was performed after randomization. In the PAD group, remote magnetic navigation systemwas used to target sympathetic nerve fibers, located near bifurcation and ostia of the main brunches of right and left pulmonary arteries. This study was conducted as double-blind and sham-controlled and the primary endpoint was change in pulmonary vascular resistance (PVR) by RHC at 12 months. Secondary endpoints included 6-minute walk test (6MWT), pulmonary artery pressure, and clinical outcomes. All patients were followed for 12 months after randomization. Unpaired t-test and Fisher's exact test were used for between-group comparisons of continuous and categorical variables, respectively. A p value of less than 0.05 was considered statistically significant.

Results

Two patients (one in each group) developed groin hematoma which resolved without any consequences. At the end of 12 month, the PVR was significantly low in PAD group as compared with MED group (343±149 dyn sec cm–5 vs 444±145 dyn sec cm–5, respectively; mean difference −101, 95% confidence interval: −193 to −10; p=0.032). The mean, systolic and diastolic PA pressure was also reduced significantly in PAD group compared to MED group (25.8±7.3mm Hg vs 33.8±6.4 mm Hg, 46.2±14.1mm Hg vs 54.2±8.1 mm Hg,13.2±5.3mm Hg vs 20.2±4.8mm Hg; p<0.001, p=0.002, p<0.001, respectively). The PAD group demonstrated significant improvement of the 6MWT over MED group (470±84 m vs 399±116 m, respectively, p=0.031). In the PADN group 1 (4%) patient was hospitalized due to heart failure progression compared to 7 (29%) patients in MED group (p=0.049). One patient in PAD group and two patients in MED group died.

Conclusions

Pulmonary artery denervation in patients with residual pulmonary hypertension was safe and effective, and resulted in substantial reduction of pulmonaryvascular resistance and pulmonary artery pressure during 12 months follow up, accompanied by improved 6-minute walk test and reduced need for hospitalization. Clinical Trials Registration: NCT02745106

Acknowledgement/Funding

Grant from Biosense Webster

Acid-sensing ion channels regulate spontaneous inhibitory activity in the hippocampus: possible implications for epilepsy

Acid-sensing ion channels (ASICs) play an important role in numerous functions in the central and peripheral nervous systems ranging from memory and emotions to pain. The data correspond to a recent notion that each neuron and many glial cells of the mammalian brain express at least one member of the ASIC family. However, the mechanisms underlying the involvement of ASICs in neuronal activity are poorly understood. However, there are two exceptions, namely, the straightforward role of ASICs in proton-based synaptic transmission in certain brain areas and the role of the Ca(2+)-permeable ASIC1a subtype in ischaemic cell death. Using a novel orthosteric ASIC antagonist, we have found that ASICs specifically control the frequency of spontaneous inhibitory synaptic activity in the hippocampus. Inhibition of ASICs leads to a strong increase in the frequency of spontaneous inhibitory postsynaptic currents. This effect is presynaptic because it is fully reproducible in single synaptic boutons attached to isolated hippocampal neurons. In concert with this observation, inhibition of the ASIC current diminishes epileptic discharges in a low Mg(2+) model of epilepsy in hippocampal slices and significantly reduces kainate-induced discharges in the hippocampus in vivo Our results reveal a significant novel role for ASICs.This article is part of the themed issue 'Evolution brings Ca(2+) and ATP together to control life and death'.

Relationship between the incidence of type 1 diabetes and maternal enterovirus antibodies: time trends and geographical variation

AIMS/HYPOTHESIS

We have previously observed an inverse correlation between the incidence of type 1 diabetes and enterovirus infections in the background population. The aim of this study was to analyse whether maternal enterovirus antibody status, which reflects both the frequency of enterovirus infections and the protection conferred by the mother on the offspring, also correlates with the incidence of type 1 diabetes.

METHODS

Maternal enterovirus antibodies were analysed from serum samples taken from pregnant women between 1983 and 2001 in Finland and Sweden using enzyme immunoassay and neutralisation assays. Comparable samples were also taken between 1999 and 2001 in countries with a lower incidence of diabetes (Estonia, Germany, Hungary, Israel, Lithuania, Russia).

RESULTS

A clear decrease was observed in maternal enterovirus antibody levels over the past 20 years (p<0.0001). The frequency of enterovirus antibodies was higher in countries with a low or intermediate incidence of type 1 diabetes compared with high-incidence countries (p<0.0001).

CONCLUSIONS/INTERPRETATION

These findings are in line with our previous observations supporting the hypothesis that a low frequency of enterovirus infection in the background population increases the susceptibility of young children to the diabetogenic effect of enteroviruses.