Background Although mortality due to COVID-19 is, for the most part, robustly tracked, its indirect effect at the population level through lockdown, lifestyle changes, and reorganisation of health-care systems has not been evaluated. We aimed to assess the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in an urban region during the pandemic, compared with non-pandemic periods. MethodsWe did a population-based, observational study using data for non-traumatic OHCA (N=30 768), systematically collected since May 15, 2011, in Paris and its suburbs, France, using the Paris Fire Brigade database, together with in-hospital data. We evaluated OHCA incidence and outcomes over a 6-week period during the pandemic in adult inhabitants of the study area. Findings Comparing the 521 OHCAs of the pandemic period (March 16 to April 26, 2020) to the mean of the 3052 total of the same weeks in the non-pandemic period (weeks 12-17, 2012-19), the maximum weekly OHCA incidence increased from 13•42 (95% CI 12•77-14•07) to 26•64 (25•72-27•53) per million inhabitants (p<0•0001), before returning to normal in the final weeks of the pandemic period. Although patient demographics did not change substantially during the pandemic compared with the non-pandemic period (mean age 69•7 years [SD 17] vs 68•5 [18], 334 males [64•4%] vs 1826 [59•9%]), there was a higher rate of OHCA at home (460 [90•2%] vs 2336 [76•8%]; p<0•0001), less bystander cardiopulmonary resuscitation (239 [47•8%] vs 1165 [63•9%]; p<0•0001) and shockable rhythm (46 [9•2%] vs 472 [19•1%]; p<0•0001), and longer delays to intervention (median 10•4 min [IQR 8•4-13•8] vs 9•4 min [7•9-12•6]; p<0•0001). The proportion of patients who had an OHCA and were admitted alive decreased from 22•8% to 12•8% (p<0•0001) in the pandemic period. After adjustment for potential confounders, the pandemic period remained significantly associated with lower survival rate at hospital admission (odds ratio 0•36, 95% CI 0•24-0•52; p<0•0001). COVID-19 infection, confirmed or suspected, accounted for approximately a third of the increase in OHCA incidence during the pandemic.Interpretation A transient two-times increase in OHCA incidence, coupled with a reduction in survival, was observed during the specified time period of the pandemic when compared with the equivalent time period in previous years with no pandemic. Although this result might be partly related to COVID-19 infections, indirect effects associated with lockdown and adjustment of health-care services to the pandemic are probable. Therefore, these factors should be taken into account when considering mortality data and public health strategies.

Рабочая группа по диагностике и лечению гипертрофической кардиомиопатии Европейского общества кардиологов (ESC)Авторы/члены рабочей группы: perry M. Elliott* (Председатель) (великобритания) Aris Anastasakis (Греция), Michael A. borger (Германия), Martin borggrefe (Германия), Franco Cecchi (Италия), philippe Charron (Франция), Albert Alain Hagege (Франция), Antoine Lafont (Франция), Giuseppe Limongelli (Италия), Heiko Mahrholdt (Германия), William J. McKenna (великобритания), Jens Mogensen (дания), petros Nihoyannopoulos (великобритания), Stefano Nistri (Италия), petronella G. pieper (Нидерланды), burkert pieske (Австрия), Claudio Rapezzi (Италия), Frans H. Rutten (Нидерланды), Christoph Tillmanns (Германия), Hugh Watkins (великобритания). Дополнительный участник: Constantinos O'Mahony (великобритания).Комитет ESC по подготовке практических рекомендаций (КПР): Jose Luis Zamorano (Председатель) (Испания), Stephan Achenbach (Германия), Helmut baumgartner (Германия), Jeroen J. bax (Нидерланды), Héctor bueno (Испания), Veronica Dean (Франция), Christi Deaton (великобритания), Çetin Erol (Турция), Robert Fagard (Бельгия), Roberto Ferrari (Италия), David Hasdai (Израиль), Arno W. Hoes (Нидерланды), paulus Kirchhof (Германия/великобритания), Juhani Knuuti (Финляндия), philippe Kolh (Бельгия), patrizio Lancellotti (Бельгия), Ales Linhart (Чехия), petros Nihoyannopoulos (великобритания), Massimo F. piepoli (Италия), piotr ponikowski (Польша), per Anton Sirnes (Норвегия), Juan Luis Tamargo (Испания), Michal Tendera (Польша), Adam Torbicki (Польша), William Wijns (Бельгия), Stephan Windecker (Швейцария).Рецензенты: David Hasdai (Израиль) (КПР координатор рецензирования), piotr ponikowski (Польша) (КПР координатор рецензирования), Stephan Achenbach (Германия), Fernando Alfonso (Испания), Cristina basso (Италия), Nuno Miguel Cardim (Португалия), Juan Ramón Gimeno (Испания), Stephane Heymans (Нидерланды), per Johan Holm (Швеция), Andre Keren(Израиль), paulus Kirchhof (Германия/великобритания), philippe Kolh (Бельгия), Christos Lionis (Греция), Claudio Muneretto (Италия), Silvia priori (Италия), Maria Jesus Salvador (Испания), Christian Wolpert (Германия), Jose Luis Zamorano (Испания).Формы раскрытия конфликта интересов авторов и рецензентов рекомендаций доступны на сайте ESC www.escardio.org/guidelines

We carried out a prospective evaluation of a new vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay in order to detect patients with high-risk coronary subacute stent thrombosis (SAT) despite thienopyridine regimen. Twenty healthy donors (group 1) without any medication were compared to 16 stented patients (group 2) treated by ticlopidin or clopidogrel initiated 2 days before stenting and aspirin (250 mg/day). No difference in platelet reactivity was noted between group 1 and group 2 treated only with aspirin (72.00% +/- 4.17% vs. 69.73% +/- 5.62%, respectively; P = NS). Significant differences were found between patients of group 2 treated with aspirin alone (69.73% +/- 5.62%), after 2.0 days (60.14% +/- 9.60%; P < 0.05), and after 4.8 +/- 1.3 days (48.37% +/- 11.19%; P < 0.05) with thienopyridine-aspirin. Among 1,684 consecutive stented patients, 16 patients who presented an SAT (group 3) were compared with 30 other stented patients free of SAT (group 4). We found a significant difference between group 3 (63.28% +/- 9.56%) and group 4 (39.80% +/- 10.9%; P < 0.0001). VASP phosphorylation analysis may be useful for the detection of coronary SAT.

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Stent misdeployment was constant in bicuspid valves and occurred in one-third of cases of tricuspid valves. Premature failure of implanted VS (secondary to valve distortion or traumatic injury to the leaflets by calcific excrescences) might be an important concern in the future.

The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter [FRANCE TAVI]; NCT01777828).

The gum has an exceptional capacity for healing. To examine the basis for this property and explore the potential of conferring it to organs with inferior healing capacity, we sought the presence of progenitor cells in gingival connective tissue. Colony-forming units of fibroblast-enriched cells from gingival fibroblast cultures were assessed for expression of membrane markers of mesenchymal stem cells; capacity to differentiate into osteoblasts, chondroblasts, and adipocytes; and engraftment efficiency after in vivo transfer. On the basis of their ability to differentiate into several lineages, proliferate from single cells, induce calcium deposits, and secrete collagen in vivo after transfer on hydroxyapatite carriers, we suggest that this population represents gingival multipotent progenitor cells. The discovery of progenitor cells in gingival connective tissue may help improve our understanding of how the wounded gum is capable of almost perfect healing and opens the prospect of cellular therapy for wound healing using readily available cells at limited risk to the patient.