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BackgroundMechanical circulatory supports are used in case of cardiogenic shock (CS) refractory to conventional therapy. Several devices can be employed, but are limited by their availability, benefit risk-ratio, and/or cost.AimsTo investigate the feasibility, safety, and effectiveness of a long-term support by a new available device (IVAC2L) in pigs.MethodsExperiments were carried out in male pigs, divided into healthy (n = 6) or ischemic CS (n = 4) groups for a median support time of 34 and 12 h, respectively. IVAC2L was implanted under fluoroscopic and TTE guidance under general anesthesia. CS was induced by surgical ligation of the left anterior descending artery. An ipsilateral lower limb reperfusion was created with the Solopath® system. Reperfusion was started after 1 h of support in healthy pigs and upon IVAC2L insertion in CS pigs. Hemodynamic and biological parameters were monitored before and during the whole period of support in each group.ResultsOccurrence of an ipsilateral lower limb ischemia was systematic in healthy and CS pigs in a few minutes after IVAC2L implantation, and could be reversed by the arterial reperfusion, as demonstrated by distal transcutaneous pressure in oxygen (TcPO2) and lactate normalization. IVAC2L support decreased pulmonary capillary wedge pressure (PCWP) (15.3 ± 0.3 vs. 7.5 ± 0.9 mmHg, p < 0.001), increased systolic blood pressure (SBP) (70 ± 4.5 vs. 101.3 ± 3.1 mmHg, p < 0.01), and cardiac output (CO) (4.0 ± 0.3 vs. 5.2 ± 0.6 l/min, p < 0.05) in CS pigs; at CS onset and after 12 h of support, without effects on heart rate or pulmonary artery pressure (PAP). Non-sustained ventricular arrhythmias were frequent at implantation (50%). A non-significant hemolysis was observed under support in CS pigs. Bleedings were frequent at the insertion and/or operating sites (30%).ConclusionLong-term support by IVAC2L is feasible and associated with a significant hemodynamic improvement in a porcine model. These preclinical data open the door for a study of IVAC2L in human ischemic CS, keeping in mind the need for systematic reperfusion of the lower limb and the associated risk of bleeding.

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Purpose – With the concept of interconnection among municipal drinking water networks, this paper presents an innovative methodology aiming to identify potential interconnections and new hydropower possibilities between separate municipal networks, at a regional level. Design/methodology/approach – Beside literature research, water framework directive, interviews with local actors and local case studies were employed. To ensure the soundness of the developed methodology and to give more accuracy to the scientific approach, the presented methodology was tested in a Swiss Alp pilot region (Martigny) composed of 23 independent municipal water networks. Findings – A methodology which makes it possible to compile on a unique map complex and dissociated elements describing water networks and their potential interconnections was developed. Furthermore, the methodology brings these elements together giving decision makers an overview focussed on added-value in terms of water resources and consumption as well as economic and energetic impacts. Practical implications – In a bottom-up approach, the targets of this study have been presented and discussed with all local actors. Some of the suggested interconnections are currently being completed. Originality/value – The use of GIS-based framework as a decision support system would improve the current practice of integrated drinking water management. The developed methodology would be useful for other watershed region where the efficiency of water networks can be greatly improved by the means of a systemic approach and the designing of new network interconnections.

Halofantrine chlorhydrate 2 per cent suspension was given to 50 children (mean age 6.2 years in a dose of 8 mg/kg three times a day as a single day treatment. The children were born and lived in Gabon, where malaria transmission is continuous. They all had acute Plasmodium falciparum malaria. The children were kept in hospital for 5 days, and regularly followed over a 15-day period. The 50 children were cured and efficacy was evaluated as good in 44 cases, and excellent in six cases, as judged by improvement in their clinical signs and parasitaemia. Two criterias were considered in the evaluation of efficacy: clearance of parasitaemia (mean day 4), fever clearance (mean hour 24). There were two cases of persistences of parasites at day 15 with a very low parasitaemia rate. Tolerance to halofantrine was good from a clinical and biological point of view. Acceptability was excellent in all cases. Halofantrine 2 per cent suspension is a good alternative in the treatment of acute Plasmodium falciparum malaria in children, especially with the present situation of multidrug-resistant strains in Central Africa.