bluuebunny/crossref_metadata_2025 huggingface dataset:
Life-threatening arrhythmias in anterior ST-segment elevation myocardial infarction patients treated by percutaneous coronary intervention: adverse impact of morphine
Authors: Sauer François , Jesel Laurence , Marchandot Benjamin , Derimay François , Bochaton Thomas , Amaz Camille , Roubille François , Cayla Guillaume , Rioufol Gilles , Garcia-Dorado David , Claeys Marc , Angoulvant Denis , Bonnefoy-Cudraz Eric , Guérin Patrice , Trinh Annie , Matsushita Kensuke , Ohlmann Patrick , Jossan Claire , Mewton Nathan , Ovize Michel , Morel Olivier
Published: January 2021

Aims

Important controversies remain concerning the determinants of life-threatening arrhythmias during ST-segment elevation myocardial infarction (STEMI) and their impact on late adverse events. This study sought to investigate which factors might facilitate ventricular tachycardia (VT) and ventricular fibrillation (VF), in a homogeneous population of anterior STEMI patients defined by abrupt left anterior descending coronary artery (LAD) occlusion and no collateral flow.

Methods and results

The 967 patients, who entered into the CIRCUS (Does Cyclosporine ImpRove Clinical oUtcome in ST elevation myocardial infarction patients) study, were assessed for further analysis. Acute VT/VF was defined as VT (run of tachycardia >30 s either self-terminated or requiring electrical/pharmacological cardioversion) or VF documented by electrocardiogram or cardiac monitoring, during transportation to the cathlab or initial hospitalization. VT/VF was documented in 136 patients (14.1%). Patients with VT/VF were younger and had shorter time from symptom onset to hospital arrival. Site of LAD occlusion, thrombus burden, area at risk, pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow, and ST-segment resolution were similar to that of patients without VT/VF. There was no impact of VT/VF on left ventricular remodelling or clinical outcomes. By multivariate analysis, the use of morphine (odds ratio 1.71; 95% confidence interval (1.13–2.60); P = 0.012) was the sole independent predictor of VT/VF occurrence.

Conclusions

In STEMI patients with LAD occlusion, our findings support the view that morphine could favour severe ventricular arrhythmias.
Clinical risk scores identify more patients at risk for cardiovascular events within 30 days as compared to standard ACS risk criteria: the WESTCOR study
Authors: Steiro Ole-Thomas , Tjora Hilde L , Langørgen Jørund , Bjørneklett Rune , Nygård Ottar K , Skadberg Øyvind , Bonarjee Vernon V S , Lindahl Bertil , Omland Torbjørn , Vikenes Kjell , Aakre Kristin M
Published: January 2021

Aims

Troponin-based algorithms are made to identify myocardial infarctions (MIs) but adding either standard acute coronary syndrome (ACS) risk criteria or a clinical risk score may identify more patients eligible for early discharge and patients in need of urgent revascularization.

Methods and results

Post-hoc analysis of the WESTCOR study including 932 patients (mean 63 years, 61% male) with suspected NSTE-ACS. Serum samples were collected at 0, 3, and 8–12 h and high-sensitivity cTnT (Roche Diagnostics) and cTnI (Abbott Diagnostics) were analysed. The primary endpoint was MI, all-cause mortality, and unplanned revascularizations within 30 days. Secondary endpoint was non-ST-elevation myocardial infarction (NSTEMI) during index hospitalization. Two combinations were compared: troponin-based algorithms (ESC 0/3 h and the High-STEACS algorithm) and either ACS risk criteria recommended in the ESC guidelines, or one of eleven clinical risk scores, HEART, mHEART, CARE, GRACE, T-MACS, sT-MACS, TIMI, EDACS, sEDACS, Goldman, and Geleijnse–Sanchis. The prevalence of primary events was 21%. Patients ruled out for NSTEMI and regarded low risk of ACS according to ESC guidelines had 3.8–4.9% risk of an event, primarily unplanned revascularizations. Using HEART score instead of ACS risk criteria reduced the number of events to 2.2–2.7%, with maintained efficacy. The secondary endpoint was met by 13%. The troponin-based algorithms without evaluation of ACS risk missed three-index NSTEMIs with a negative predictive value (NPV) of 99.5% and 99.6%.

Conclusion

Combining ESC 0/3 h or the High-STEACS algorithm with standardized clinical risk scores instead of ACS risk criteria halved the prevalence of rule-out patients in need of revascularization, with maintained efficacy.
Effect of primary percutaneous coronary intervention on in-hospital outcomes among active cancer patients presenting with ST-elevation myocardial infarction: a propensity score matching analysis
Authors: Mohamed Mohamed O , Van Spall Harriette G C , Kontopantelis Evangelos , Alkhouli Mohamad , Barac Ana , Elgendy Islam Y , Khan Safi U , Kwok Chun Shing , Shoaib Ahmad , Bhatt Deepak L , Mamas Mamas A
Published: January 2021

Aims

Primary percutaneous coronary intervention (pPCI) is the gold standard, guideline-recommended revascularization strategy in patients presenting with ST-elevation myocardial infarction (STEMI). However, there are limited data on its use and effectiveness among patients with active cancer presenting with STEMI.

Methods and results

All STEMI hospitalizations between 2004 and 2015 from the National Inpatient Sample were retrospectively analysed, stratified by cancer type. Propensity score matching was performed to estimate the average treatment effect of pPCI in each cancer on in-hospital adverse events, including major adverse cardiovascular and cerebrovascular events (MACCE) and its individual components, and compare treatment effect between cancer and non-cancer patients. Out of 1 870 815 patients with STEMI, 38 932 (2.1%) had a current cancer diagnosis [haematological: 11 251 (28.9% of all cancers); breast: 4675 (12.0%); lung: 9538 (24.5%); colon: 3749 (9.6%); prostate: 9719 (25.0%)]. Patients with cancer received pPCI less commonly than those without cancer (from 54.2% for lung cancer to 70.6% for haematological vs. 82.3% in no cancer). Performance of pPCI was strongly associated with lower adjusted probabilities of MACCE and all-cause mortality in the cancer groups compared with the no cancer group. There was no significant difference in estimated average pPCI treatment effect between the cancer groups and non-cancer group.

Conclusion

Primary percutaneous coronary intervention is underutilized in STEMI patients with current cancer despite its significantly lower associated rates of in-hospital all-cause mortality and MACCE that is comparable to patients without cancer. Further work is required to assess the long-term benefit and safety of pPCI in this high-risk group.
Diagnostic value of circulating microRNAs compared to high-sensitivity troponin T for the detection of non-ST-segment elevation myocardial infarction
Authors: Biener Moritz , Giannitsis Evangelos , Thum Thomas , Bär Christian , Costa Alessia , Andrzejewski Thomas , Stoyanov Kiril M , Vafaie Mehrshad , Meder Benjamin , Katus Hugo A , de Gonzalo-Calvo David , Mueller-Hennessen Matthias
Published: January 2021

Aims

To assess the diagnostic value of microRNAs (miRNAs) for the detection of non-ST-segment elevation myocardial infarction (NSTEMI).

Methods and results

A total of 1042 patients presenting between August 2014 and April 2017 to the emergency department with the suspected acute coronary syndrome were included. Non-ST-segment elevation myocardial infarction was diagnosed per criteria of the fourth Universal definition of myocardial infarction (UDMI) using high-sensitivity troponin T (hs-cTnT). Expression levels of eleven microRNAs (miR-21, miR-22, miR-29a, miR-92a, miR-122, miR-126, miR-132, miR-133, miR-134, miR-191, and miR-423) were determined using RT-qPCR. Discrimination of NSTEMI was assessed for individual and a panel of miRNAs compared to the hs-cTnT reference using C-statistics and reclassification analysis. NSTEMI was diagnosed in 137 (13.1%) patients. The area under the curve (AUC) of the hs-cTnT based reference was 0.937. In a multivariate model, three miRNAs (miR-122, miR-133, and miR-134) were found to be associated with NSTEMI with AUCs between 0.506 and 0.656. A panel consisting of these miRNAs revealed an AUC of 0.662 for the diagnosis of NSTEMI. The AUC of the combination of the miRNA panel and troponin reference was significantly lower than the reference standard (AUC: 0.897 vs. 0.937, P = 0.006). Despite a significant improvement of NSTEMI reclassification measured by IDI and NRI, miRNAs did not improve the specificity of hs-cTnT kinetic changes for the diagnosis of NSTEMI (ΔAUC: 0.04).

Conclusion

Although single miRNAs are significantly associated with the diagnosis of NSTEMI a miRNA panel does not add diagnostic accuracy to the hs-cTnT reference considering baseline values and kinetic changes as recommended by the fourth version of UDMI.

Clinical Trials Identifier

NCT02116153
Sex differences for predicting metabolic syndrome by adipose dysfunction markers in institutionalized elderly
Authors: Alvero-Cruz Jose Ramon , Fernández Vázquez Rosalia , Martínez Blanco Javier , Diaz Antonio Jesus , Rosety Ignacio , Rosety Miguel Angel , Rosety-Rodriguez Manuel , Ordonez Francisco Javier
Published: January 2021

Aims

Recent studies have emphasized that metabolic syndrome (MetS) was the most important modifiable risk factor for cardiovascular and cerebrovascular diseases in the institutionalized elderly. In addition, the occurrence of MetS was higher in those with longer age-adjusted institutionalization time. The present study was conducted to assess predictive value of markers of adipose tissue dysfunction for the early screening of MetS in this population.

Methods and results

Two hundred and eleven institutionalized older adults (132 women, aged 74.3 ± 7.3 years; 79 men, aged 71.5 ± 7.3 years) were enrolled in the current cross-sectional study. Lipid accumulation product (LAP), visceral adiposity index (VAI), body adiposity index (BAI), and triglycerides (TG)/high-density lipoprotein (HDL)-cholesterol ratio were determined. The receiver operating characteristic curve was calculated to compare the area under the curve of each index. The total prevalence of MetS was 23.8%. In female group, VAI and TG/HDL ratio presented moderate–high sensitivity (77.78% and 78.38%, respectively) and specificity (77.62% and 73.49%, respectively). In males group, LAP presented moderate–high sensitivity (75%) and specificity (76.9%).

Conclusion

Gender played a key role on the prediction of MetS by adipose dysfunction markers in institutionalized elderly. Accordingly, VAI and TG/HDL-cholesterol ratio showed the highest predictive value for MetS in female elderly. LAP was the strongest predictor of MetS in male elderly.
The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study
Authors: Andersen Julie , Gerds Thomas A , Hlatky Mark A , Gislason Gunnar , Schou Morten , Torp-Pedersen Christian , Møller Sidsel , Madelaire Christian , Strandberg-Larsen Katrine
Published: January 2021

Aims 

Patients with heart failure and low income have a high mortality risk. We examined whether lower survival among low-income patients with heart failure could be explained by different use of β -blockers, renin-angiotensin system inhibitors (RASi), and implanted devices compared with high-income patients.

Methods and results 

We linked Danish national registries to identify patients with new-onset heart failure between 2005 and 2016. A total of 18 308 patients was included in the main analysis. We collected information on medical treatment and device therapy after discharge. We investigated the remaining income disparity if everybody had the same probability of treatment as the high-income patients. We used causal mediation analysis to examine to what extent treatment differences mediate the association between income and 1-year mortality in strata defined by sex and cohabitation status. If low-income patients had the same probability of initiating β-blockers and RASi treatment as high-income patients, low-income men who lived alone would increase initiation of treatment by 12.4% (CI: 10.0% to 14.9%) and as a result reduce their absolute 1-year mortality by 1.0% (CI: −1.4% to −0.5%). If low-income patients had the same probability of not having breaks in medical treatment and getting device therapy, as high-income patients, low-income patients would increase the probability of not having breaks in treatment between 1.8% and 5.8% and increase the probability of getting device therapy between 1.0% and 3.8%, across strata of sex and cohabitation status.

Conclusion 

Lower rates of treatment initiation appear to mediate the poorer survival seen among patients with heart failure and low income, but only in males living alone.
Exercise capacity is related to attenuated responses in oxygen extraction and left ventricular longitudinal strain in asymptomatic type 2 diabetes patients
Authors: Van Ryckeghem Lisa , Keytsman Charly , Verboven Kenneth , Verbaanderd Elvire , Frederix Ines , Bakelants Elise , Petit Thibault , Jogani Siddharth , Stroobants Sarah , Dendale Paul , Bito Virginie , Verwerft Jan , Hansen Dominique
Published: January 2021

Aims

Type 2 diabetes mellitus (T2DM) is associated with reduced exercise capacity and cardiovascular diseases, both increasing morbidity and risk for premature death. As exercise intolerance often relates to cardiac dysfunction, it remains to be elucidated to what extent such an interplay occurs in T2DM patients without overt cardiovascular diseases. Design: Cross-sectional study, NCT03299790.

Methods and results

Fifty-three T2DM patients underwent exercise echocardiography (semi-supine bicycle) with combined ergospirometry. Cardiac output (CO), left ventricular longitudinal strain (LS), oxygen uptake (O2), and oxygen (O2) extraction were assessed simultaneously at rest, low-intensity exercise, and high-intensity exercise. Glycaemic control and lipid profile were assessed in the fasted state. Participants were assigned according to their exercise capacity being adequate or impaired (EXadequate: O2peak <80% and EXimpaired: O2peak ≥80% of predicted O2peak) to compare O2 extraction, CO, and LS at all stages. Thirty-eight participants (EXimpaired: n = 20 and EXadequate: n = 18) were included in the analyses. Groups were similar regarding HbA1c, age, and sex (P > 0.05). At rest, CO was similar in the EXimpaired group vs. EXadequate group (5.1 ± 1 L/min vs. 4.6 ± 1.4 L/min, P > 0.05) and increased equally during exercise. EXimpaired patients displayed a 30.7% smaller increase in O2 extraction during exercise compared to the EXadequate group (P = 0.016) which resulted in a lower O2 extraction at high-intensity exercise (12.5 ± 2.8 mL/dL vs. 15.3 ± 3.9 mL/dL, P = 0.012). Left ventricular longitudinal strain was similar at rest but increased significantly less in the EXimpaired vs. EXadequate patients (1.9 ± 2.5% vs. 5.9 ± 4.1%, P = 0.004).

Conclusions

In asymptomatic T2DM patients, an impaired exercise capacity is associated with an impaired response in oxygen extraction and myocardial deformation (LS).

Trial registry

Effect of High-intensity Interval Training on Cardiac Function and Regulation of Glycemic Control in Diabetic Cardiomyopathy (https://clinicaltrials.gov/ct2/show/NCT03299790).
Short-term effects of particulate matter on cardiovascular morbidity in Italy: a national analysis
Authors: Stafoggia Massimo , Renzi Matteo , Forastiere Francesco , Ljungman Petter , Davoli Marina , de’ Donato Francesca , Gariazzo Claudio , Michelozzi Paola , Scortichini Matteo , Solimini Angelo , Viegi Giovanni , Bellander Tom ,   the BEEP Collaborative Group
Published: January 2021

Aims

We aimed at investigating the relationship between particulate matter (PM) and daily admissions for cardiovascular diseases (CVDs) at national level in Italy.

Methods and results

Daily numbers of cardiovascular hospitalizations were collected for all 8084 municipalities of Italy, in the period 2013–2015. A satellite-based spatiotemporal model was used to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km2 resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and cardiovascular admissions. Flexible functions were estimated to explore the shape of the associations at low PM concentrations, also in non-urban areas. We analysed 2 154 810 acute hospitalizations for CVDs (25% stroke, 24% ischaemic heart diseases, 22% heart failure, and 5% atrial fibrillation). Relative increases of total cardiovascular admissions, per 10 µg/m3 variation in PM10 and PM2.5 at lag 0–5 (average of last 6 days since admission), were 0.55% (95% confidence intervals: 0.32%, 0.77%) and 0.97% (0.67%, 1.27%), respectively. The corresponding estimates for heart failure were 1.70% (1.28%, 2.13%) and 2.66% (2.09%, 3.23%). We estimated significant effects of PM10 and PM2.5 also on ischaemic heart diseases, myocardial infarction, atrial fibrillation, and ischaemic stroke. Associations were similar between less and more urbanized areas, and persisted even at low concentrations, e.g. below WHO guidelines.

Conclusion

PM was robustly associated with peaks in daily cardiovascular admissions, especially for heart failure, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines for PM10 and PM2.5 are not sufficient to protect public health.
Drug-resistant hypertension in primary aldosteronism patients undergoing adrenal vein sampling: the AVIS-2-RH study
Authors: Rossi Gian Paolo , Rossitto Giacomo , Amar Laurence , Azizi Michel , Riester Anna , Reincke Martin , Degenhart Christoph , Widimsky Jiri , Naruse Mitsuhide , Deinum Jaap , Schultze Kool Leo , Kocjan Tomaz , Negro Aurelio , Rossi Ermanno , Kline Gregory , Tanabe Akiyo , Satoh Fumitoshi , Rump Lars Christian , Vonend Oliver , Willenberg Holger S , Fuller Peter J , Yang Jun , Chee Nicholas Yong Nian , Margill Steven B , Shafigullina Zulfiya , Quinkler Marcus , Oliveras Anna , Lee Bo-Ching , Wu Vin Cent , Kratka Zuzana , Seccia Teresa M , Lenzini Livia
Published: January 2021

Aims

We aimed at determining the rate of drug-resistant arterial hypertension in patients with an unambiguous diagnosis of primary aldosteronism (PA). Moreover, we sought for investigating the diagnostic performance of adrenal vein sampling (AVS), and the effect of adrenalectomy on blood pressure (BP) and prior treatment resistance in PA patients subtyped by AVS in major referral centres.

Methods and results

The Adrenal Vein Sampling International Study-2 (AVIS-2) was a multicentre international study that recruited consecutive PA patients submitted to AVS, according to current guidelines, during 15 years. The patients were over 18 years old with arterial hypertension and had an unambiguous diagnosis of PA. The rate of resistant hypertension was assessed at baseline and after adrenalectomy using the American Heart Association (AHA) 2018 definition. Information on presence or absence of resistant hypertension was available in 89% of the 1625 enrolled PA patients. Based on the AHA 2018 criteria, resistant hypertension was found in 20% of patients, of which about two-thirds (14%) were men and one-third (6%) women (χ2 = 17.1, P < 1*10−4) with a higher rate of RH in men than in women (23% vs. 15% P < 1*10−4). Of the 292 patients with resistant hypertension, 98 (34%) underwent unilateral AVS-guided adrenalectomy, which resolved BP resistance to antihypertensive treatment in all.

Conclusions

(i) Resistant hypertension is a common presentation in patients seeking surgical cure of PA; (ii) AVS is key for the optimal management of patients with PA due to resistant hypertension; and (iii) AVS-guided adrenalectomy allowed resolution of treatment-resistant hypertension.
Association of inflammatory disease and long-term outcomes among young adults with myocardial infarction: the Mass General Brigham YOUNG-MI Registry
Authors: Weber Brittany , Biery David W , Singh Avinainder , Divakaran Sanjay , Berman Adam N , Wu Wanda Y , Brown Jenifer M , Hainer Jon , Nasir Khurram , Liao Katherine , Bhatt Deepak L , Di Carli Marcelo F , Blankstein Ron
Published: January 2021

Aims

Autoimmune systemic inflammatory diseases (SIDs) are associated with an increased risk of cardiovascular (CV) disease, particularly myocardial infarction (MI). However, there are limited data on the prevalence and effects of SID among adults who experience an MI at a young age. We sought to determine the prevalence and prognostic implications of SID among adults who experienced an MI at a young age.

Methods and results

The YOUNG-MI registry is a retrospective cohort study from two large academic centres, which includes patients who experienced a first MI at 50 years of age or younger. SID was ascertained through physician review of the electronic medical record (EMR). Incidence of death was ascertained through the EMR and national databases. The cohort consisted of 2097 individuals, with 53 (2.5%) possessing a diagnosis of SID. Patients with SID were more likely to be female (36% vs. 19%, P = 0.004) and have hypertension (62% vs. 46%, P = 0.025). Over a median follow-up of 11.2 years, patients with SID experienced an higher risk of all-cause mortality compared with either the full cohort of non-SID patients [hazard ratio (HR) = 1.95, 95% confidence interval (CI) (1.07–3.57), P = 0.030], or a matched cohort based on age, gender, and CV risk factors [HR = 2.68, 95% CI (1.18–6.07), P = 0.018].

Conclusions

Among patients who experienced a first MI at a young age, 2.5% had evidence of SID, and these individuals had higher rates of long-term all-cause mortality. Our findings suggest that the presence of SID is associated with worse long-term survival after premature MI.
The male disadvantage in life expectancy: can we close the gender gap?
Authors: Hossin Muhammad Zakir
Published: January 2021

Men are usually considered to be the stronger sex. However, when it comes to health, they are evidently weaker than their female counterparts. In almost all countries around the world, men consistently live shorter lives than women. The gender gap in longevity has once again been evident during the ongoing coronavirus disease 2019 (COVID-19) pandemic, which kills men disproportionately. Drawing on the relevant scientific literature and updated information, this article aimed to provide useful insights into the biological and social mechanisms that potentially underlie the gender gap in life expectancy.
Characteristics of Pediatric Recurrent Bacterial Meningitis in Beijing Children’s Hospital, 2006–2019
Authors: Chen Tian-ming , Chen He-ying , Hu Bing , Hu Hui-li , Guo Xin , Guo Ling-yun , Li Shao-ying , Liu Gang
Published: January 2021

Background

Few data on recurrent bacterial meningitis (RBM) in children are available. Here, we estimated the frequency of RBM in children and investigated the predisposing conditions, etiology, and clinical characteristics of RBM in children.

Methods

Cases of RBM in the Beijing Children’s Hospital medical record database between January 2006 and December 2019 were collected.

Results

In total, 1905 children with bacterial meningitis (BM) were documented in the Beijing Children’s Hospital medical record database. A total of 43 patients had RBM. The rate of RBM in children was 2.3% (43/1905). Forty (93.0%) patients had predisposing conditions, including 15 (34.9%) cases of inner ear malformations, 5 (11.6%) cases of dermal sinus tracts, 9 (20.9%) cases of head injury, 5 (11.6%) cases of congenital cranial meningocele, 3 (7.0%) cases of congenital skull base defects, 3 (7.0%) cases of immunodeficiency, and other 3 (7.0%) cases of unknown reason. Among all the 121 BM episodes, a total of 64 episodes were etiologically confirmed BM and the other 57 episodes were probable BM. Streptococcus pneumoniae (n = 52) was accounted for 81.3% of confirmed BM episodes. Thirty-four of the 37 patients with congenital or acquired anatomical defects were available to follow up after surgeries, and all of them had no BM after surgeries. Three patients with antibody deficiencies got intravenous immunoglobulin therapy and they did not suffer BM anymore.

Conclusions

RBM is rare in children. The majority of children with RBM had predisposing conditions including congenital/acquired anatomical defects and immunodeficiency. Interventions should be implemented to solve the underlying conditions to avoid RBM.
Who Counts? Measuring Disability Cross-Nationally in Census Data
Authors: Pettinicchio David , Maroto Michelle
Published: January 2021

Despite established recommended standard definitions, measures, and methods by the UN Washington Group on Disability Statistics and the International Classification of Functioning, Disability and Health (ICF) to assess dimensions of disability, national censuses vary widely in the questions used to identify people with disabilities. Although many seek to conform ex-ante to ICF definitions, they also deviate from this basic framework in different ways. This complicates ex-post harmonization and standardization for cross-national comparisons of disability prevalence and outcomes influenced by disability status, such as labor market participation. Addressing these issues, this study uses IPUMS International Census microdata since 2,000 to examine disability measurement across 65 countries. We find that definitions, terminology, measurement, and instructions to both respondents and enumerators matter for understanding disability prevalence cross-nationally. For instance, questions that included potentially stigmatizing language were associated with lower rates of disability reporting, but questions that listed specific limitations were associated with higher rates. Beyond disability, our findings also speak more broadly to ongoing challenges in survey harmonization for cross-national comparison.
SN 2017gci: a nearby Type I Superluminous Supernova with a bumpy tail
Authors: Fiore A , Chen T-W , Jerkstrand A , Benetti S , Ciolfi R , Inserra C , Cappellaro E , Pastorello A , Leloudas G , Schulze S , Berton M , Burke J , McCully C , Fong W , Galbany L , Gromadzki M , Gutiérrez C P , Hiramatsu D , Hosseinzadeh G , Howell D A , Kankare E , Lunnan R , Müller-Bravo T E , O’ Neill D , Nicholl M , Rau A , Sollerman J , Terreran G , Valenti S , Young D R
Published: January 2021

We present and discuss the optical spectrophotometric observations of the nearby (z = 0.087) Type I superluminous supernova (SLSN I) SN 2017gci, whose peak K-corrected absolute magnitude reaches Mg = −21.5 mag. Its photometric and spectroscopic evolution includes features of both slow- and of fast-evolving SLSN I, thus favoring a continuum distribution between the two SLSN-I subclasses. In particular, similarly to other SLSNe I, the multiband light curves (LCs) of SN 2017gci show two re-brightenings at about 103 and 142 d after the maximum light. Interestingly, this broadly agrees with a broad emission feature emerging around 6520 Å after ∼51 d from the maximum light, which is followed by a sharp knee in the LC. If we interpret this feature as Hα, this could support the fact that the bumps are the signature of late interactions of the ejecta with a (hydrogen-rich) circumstellar material. Then we fitted magnetar- and CSM-interaction-powered synthetic LCs on to the bolometric one of SN 2017gci. In the magnetar case, the fit suggests a polar magnetic field Bp ≃ 6 × 1014 G, an initial period of the magnetar Pinitial ≃ 2.8 ms, an ejecta mass $M_{\rm ejecta}\simeq 9\, \mathrm{M}_\odot $ and an ejecta opacity $\kappa \simeq 0.08\, \mathrm{cm}^{2}\, \rm{g}^{-1}$. A CSM-interaction scenario would imply a CSM mass $\simeq 5\, \mathrm{M}_\odot $ and an ejecta mass $\simeq 12\, \mathrm{M}_\odot $. Finally, the nebular spectrum of phase  + 187 d was modeled, deriving a mass of $\sim 10\, {\rm M}_\odot$ for the ejecta. Our models suggest that either a magnetar or CSM interaction might be the power sources for SN 2017gci and that its progenitor was a massive ($40\, {\rm M}_\odot$) star.
The Centromere Histone Is Conserved and Associated with Tandem Repeats Sharing a Conserved 19-bp Box in the Holocentromere of Meloidogyne Nematodes
Authors: Despot-Slade Evelin , Mravinac Brankica , Širca Saša , Castagnone-Sereno Philippe , Plohl Miroslav , Meštrović Nevenka
Published: January 2021

Although centromeres have conserved function, centromere-specific histone H3 (CenH3) and centromeric DNA evolve rapidly. The centromere drive model explains this phenomenon as a consequence of the conflict between fast-evolving DNA and CenH3, suggesting asymmetry in female meiosis as a crucial factor. We characterized evolution of the CenH3 protein in three closely related, polyploid mitotic parthenogenetic species of the Meloidogyne incognita group, and in the distantly related meiotic parthenogen Meloidogyne hapla. We identified duplication of the CenH3 gene in a putative sexual ancestral Meloidogyne. We found that one CenH3 (αCenH3) remained conserved in all extant species, including in distant Meloidogyne hapla, whereas the other evolved rapidly and under positive selection into four different CenH3 variants. This pattern of CenH3 evolution in Meloidogyne species suggests the subspecialization of CenH3s in ancestral sexual species. Immunofluorescence performed on mitotic Meloidogyne incognita revealed a dominant role of αCenH3 on its centromere, whereas the other CenH3s have lost their function in mitosis. The observed αCenH3 chromosome distribution disclosed cluster-like centromeric organization. The ChIP-Seq analysis revealed that in M. incognita αCenH3-associated DNA dominantly comprises tandem repeats, composed of divergent monomers which share a completely conserved 19-bp long box. Conserved αCenH3-associated DNA is also confirmed in the related mitotic Meloidogyne incognita group species suggesting preservation of both centromere protein and DNA constituents. We hypothesize that the absence of centromere drive in mitosis might allow for CenH3 and its associated DNA to achieve an equilibrium in which they can persist for long periods of time.
1. Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large U.S. Academic Medical Center
Authors: Rhee Chanu , Baker Meghan , Vaidya Vineeta , Tucker Robert , Resnick Andrew S , Morris Charles , Klompas Michael
Published: January 2021

Background

Many patients are avoiding essential care for fear of contracting Covid-19 in healthcare settings. However, the incidence of nosocomial Covid-19 infection in U.S. acute care hospitals is unknown.

Methods

We conducted an observational study of all patients admitted to Brigham and Women’s Hospital in Boston, Massachusetts between March 7 (when the first Covid-19 patient was admitted) and May 30, 2020. During this period, a comprehensive infection control program was implemented including dedicated Covid-19 units with airborne infection isolation rooms, personal protective equipment (PPE) in accordance with CDC recommendations, PPE donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients. We reviewed the medical records of all patients who tested positive for SARS-CoV-2 by RT-PCR on hospital day 3 or later or within 14 days of hospital discharge to determine whether infection was community or hospital-acquired based on timing of RT-PCR tests, clinical course, and exposures.

Results

Over the 12-week period, 9,149 patients were admitted, in whom 7,394 SARS-CoV-2 RT-PCR tests were performed and 697 Covid-19 cases were confirmed, translating into a total 8,656 days of Covid-19-related care (Figure). The inpatient Covid-19 census peaked at 171 on April 21. Twelve of the 697 Covid-19 patients (1.7%) were first diagnosed by RT-PCR on hospital day 3 or later (median 4 days, range 3–15 days). Of these, only one was deemed hospital-acquired and was most likely acquired from his pre-symptomatic spouse who was visiting daily and diagnosed with Covid-19 before visitor restrictions were implemented. Amongst 8,370 non-Covid-19 patients discharged through June 17, 11 (0.1%) subsequently tested positive within 14 days (median time to diagnosis 6 days, range 1–14). Only one was deemed likely to have been hospital-acquired, albeit with no known exposures.

Figure. Timeline of implementation of major infection control policies and cumulative number of hospitalized COVID-19 cases (total and hospital-onset)

Conclusion

Nosocomial Covid-19 infection was exceedingly rare during the height of the pandemic in a hospital with rigorous infection control measures. Our findings may inform practices in other institutions and provide reassurance to patients regarding the safety of receiving care in acute care hospitals.

Disclosures

All Authors: No reported disclosures
2. Median Income is Associated with Need for Mechanical Ventilation in COVID-19
Authors: Shallal Anita , Quan Daniel , Wong Lucía Luna , Opara Ijeoma N , Zervos Marcus
Published: January 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic unmasked the devastating impact of social and health disparities on communities of color. Black race, body mass index (BMI), and presence of comorbidities have been associated with increased severity of disease and need for mechanical ventilation (MV). We examined socioeconomic variables including social support, highest level of education, median income, housing, food insecurity, and employment status, and poverty rate to determine their impact on the need for MV.

Methods

Retrospective cohort study of 2,038 adult patients with positive SARS-CoV2 test admitted to four large hospitals within the Henry Ford Health System from March 12-April 24 and followed until May 27, 2020. Collected data included patient demographics, employment status, health insurance status, and comorbidities via Charlson Comorbidity Index (CCI). Census tracts were obtained from patient addresses and used to obtain socioeconomic data from the 2018 American Community Survey and the Food Access Research Atlas. The primary outcome assessed was frequency of MV. Univariate and multivariate analysis was performed on prehospital variables to identify independent predictors for mechanical ventilation.

Results

Patients who required MV were significantly more likely to be male (p=0.0006), black race (p=0.012), and have higher CCI (p< 0.0001) and BMI (p< 0.0001). Using census tract data, patients who required MV lived in neighborhoods with lower median income (p< 0.0001), educational attainment (p< 0.0001), and higher levels of food insecurity (p=0.0007). Multivariate analysis revealed male sex, high BMI, CCI, and lower median income to be independent predictors of need for MV. The remaining results are summarized in Tables 1 and 2.

Table 1

Table 2

Conclusion

This study demonstrates the significant impact of socioeconomic status on frequency of MV in COVID-19 patients. Healthcare providers must be aware of disparities in order to address the systematic inequities that harm vulnerable populations.

Disclosures

Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)
6. MF59 ASSURANCE 2: A Real-world Study to Estimate the Relative Vaccine Effectiveness of Adjuvanted Trivalent Influenza Vaccine Compared to Egg-based Trivalent High-dose Among U.S. Older Adults During 2018–19 Influenza Season
Authors: Pelton Stephen I , Postma Maarten , Divino Victoria , Shah Drishti , Mould-Quevedo Joaquin F , DeKoven Mitchell , Krishnarajah Girishanthy
Published: January 2021

Background

In the 2018–19 influenza season, influenza resulted in almost 280,000 hospitalizations and over 25,000 deaths in U.S. adults > 65 years. This study aimed to evaluate the relative vaccine effectiveness (rVE) of adjuvant trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD), against influenza-related hospitalizations/emergency room (ER) visits, office visits and hospitalization/ER visit for cardio-respiratory disease (CRD) among older adults for the 2018–19 flu season.

Methods

A retrospective cohort analysis of older adults (> 65 years) was conducted using professional fee, prescription claims and hospital charge master data in the U.S. Baseline characteristics included age, gender, payer type, region, Charlson Comorbidity Index (CCI), comorbidities, indicators of frail health status, and pre-index hospitalization rates. Adjusted analyses were conducted through inverse probability of treatment weighting (IPTW) to control for selection bias. Poisson regression was used to estimate the adjusted pairwise rVE against influenza-related hospitalizations/ER visits and office visits and any hospitalization/ER visit for CRD (based on diagnoses codes). An unrelated outcome, urinary tract infection (UTI) hospitalization, was assessed.

Results

During 2018–19 flu season, following IPTW analyses, 561,315 recipients of aTIV and 1,672,779 of TIV-HD were identified. After IPTW adjustment and Poisson regression, aTIV was more effective in reducing influenza-related office visits compared to TIV-HD (6.6%; 95% CI: 2.8%-10.3%). aTIV was statistically comparable to TIV-HD (2.0%; 95% CI: -3.7%-7.3%) for prevention of influenza-related hospitalizations/ER visits but more effective than TIV-HD (2.6%; 95% CI: 2.0%-3.2%) in reducing hospitalizations/ER visits for CRD. No treatment effect was identified for control condition (UTI hospitalization).

Conclusion

In adjusted analyses, aTIV reduced influenza-related office visits and CRD hospitalizations/ER visits compared to TIV-HD. aTIV and TIV-HD demonstrated comparable reductions in influenza-related hospitalizations/ER visits.

Disclosures

Stephen I. Pelton, MD, Merck vaccine (Consultant, Grant/Research Support)Pfizer (Consultant, Grant/Research Support)Sanofi Pasteur (Consultant, Other Financial or Material Support, DSMB)Seqirus Vaccine Ltd. (Consultant) Maarten Postma, Dr., IQVIA (Consultant) Victoria Divino, PhD, Seiqrus Vaccines Ltd. (Consultant) Drishti Shah, PhD, Seqirus Vaccines Ltd. (Consultant) Joaquin F. Mould-Quevedo, PhD, Seqirus Vaccines Ltd. (Employee, Shareholder) Mitchell DeKoven, PhD, Seqirus Vaccines Ltd. (Consultant) Girishanthy Krishnarajah, PhD, Seqirus Vaccines Ltd. (Employee, Shareholder)
10. The Impact of the Verigene® Gram-positive Blood Culture Panel on the Management of Vancomycin Resistant enterococci Bloodstream Infections in a Multi-site Cohort Study
Authors: Jackson Christopher , Bandy Sarah , Godinez Will , Gawrys Gerard , Lee Grace
Published: January 2021

Background

Vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) are associated with high morbidity and mortality. PCR-based rapid diagnostic tests provide prompt identification of infectious etiologies within hours. This study evaluated the impact of the Verigene® Gram-positive blood culture (GP-BC) panel on the outcomes on patients with VRE BSIs.

Methods

A multi-center pre- and post-implementation retrospective cohort study was conducted at four large HCA Healthcare facilities. The implementation of Verigene® GP-BC and VigiLanz® surveillance software with real-time notifications to clinical pharmacists occurred in 2015. Adults > 18 years with VRE BSIs were evaluated over two time periods; pre-implementation (Pre; May 2011 - May 2013) and post-implementation (Post; May 2015 - May 2017). Patients were excluded if not admitted or were discharged/deceased before blood culture results. The primary outcome of this study was to compare time to optimal therapy (TOT). Secondary outcomes included hospital mortality, length of stay (LOS), and TOT comparing clinical pharmacy staffing models. Multivariable logistic regression models were used to identify independent predictors. Adjusted ORs (aOR) and their 95% CIs were reported.

Results

A total of 104 patients with VRE BSIs were included in the study; 50 and 54 in the pre- and post-implementation periods, respectively. There were no differences in baseline characteristics between the groups. TOT was significantly shorter in the post vs. pre group (29 hrs ± 36 vs. 67 hrs ± 124, p=0.03). There was significantly lower hospital mortality when comparing the pre- and post-implementation periods (32% vs. 11%, p< 0.01). After adjusting for age, sex, severity of illness, treatment/dose, the post implementation period was independently associated with reduced hospital mortality (aOR 0.21, CI 0.61–0.73, p=0.01). There were no significant differences in LOS or clinical pharmacy staffing models on TOT.

Baseline Characteristics

Primary and secondary outcomes data

Conclusion

The implementation of the Verigene® BC-GP with VigiLanz® substantially decreased TOT for VRE BSIs and was associated with reduced hospital mortality. This study highlights the positive impact of RDTs on shorter TOT and associated clinical outcomes.

Disclosures

All Authors: No reported disclosures
13. Evaluation of Etest for Antibiotic Susceptibility and Minimum Inhibitory Concentration (MIC) Agreement Against pseudomonas Aeruginosa (psa) from Patients with Cystic Fibrosis (CF)
Authors: Lasko Maxwell J , Huse Holly , Kuti Joseph L , Nicolau David P
Published: January 2021

Background

CF acute pulmonary exacerbations are often caused by PSA, including multi-drug resistant strains. Optimal antibiotic therapy is required to return lung function and should be guided by in vitro susceptibility results. There are sparse data on the performance of Etest relative to reference broth microdilution (BMD) for many newer drugs against CF PSA. Herein, we describe Etest performance with 10 anti-PSA antibiotics against CF isolates.

Methods

Contemporary, clinical PSA (n=105) isolated during pulmonary exacerbation from patients with CF were acquired from 3 US hospitals. MICs were assessed by BMD (reference) and Etest for aztreonam (ATM), cefepime (FEP), ceftazidime (CAZ), ceftazidime/avibactam (CZA), ceftolozane/tazobactam (C/T), ciprofloxacin (CIP), levofloxacin (LVX), meropenem (MEM), piperacillin/tazobactam (TZP), and tobramycin (TOB). Each respective MIC was completed in at least triplicate using the same inoculum between methods. Modal MICs for each method were compared by rates of essential agreement (EA), categorical agreement (CA), minor error (miE), major error (ME), and very major error (VME) rates. All miE, ME and VME were adjusted if within EA.

Results

Of the 105 PSA, 46% had a mucoid phenotype. Results are summarized in the Table. Median modal Etest MICs read 0–1 dilution higher (IQR: 0–1) than BMD. CA and EA ranged from 64–93% and 63–86%, respectively. Single VMEs occurred for ATM (2.9%) and CAZ (4.2%). For CZA, 2 VMEs were observed and both were within EA. Major errors were ≤3% except for ATM (3.3%), MEM (3.3%), CZA (5.3% with adjusted ME 2.1%*), and FEP (13%). Minor error rates were < 10% except for TZP, CIP, LEV, TOB, and FEP (13–29%), for which majority of miE were within EA (3/14, 11/16, 10/18, 13/19, 20/31, respectively). Performance was similar for non-mucoid and mucoid populations.

Etest Performance

Conclusion

Etest methods performed well for most antibiotics against this challenging collection of PSA from CF patients. Laboratories should be cautious of miE and ME that may occur with certain antibiotics. Furthermore, our observations suggest laboratories confirm CZA results for isolates with MICs near the breakpoint.

Disclosures

Joseph L. Kuti, PharmD, Allergan (Speaker’s Bureau)bioMérieux (Research Grant or Support, Other Financial or Material Support, Speaker Honorarium)Melinta (Research Grant or Support)Merck & Co., Inc. (Research Grant or Support)Paratek (Speaker’s Bureau)Summit (Other Financial or Material Support, Research funding (clinical trials)) David P. Nicolau, PharmD, Cepheid (Other Financial or Material Support, Consultant, speaker bureau member or has received research support.)Merck & Co., Inc. (Consultant, Grant/Research Support, Speaker’s Bureau)Wockhardt (Grant/Research Support)
15. Leveraging Data to Explore the Consequences of Urine Testing and Antibiotic Use During the Spinal Cord Injury Annual Evaluation
Authors: May Sarah B , Walder Annette , Holmes S Ann , Poon Ivy , Evans Charlesnika T , Trautner Barbara , Skelton Felicia
Published: January 2021

Background

The Veterans’ Health Administration (VHA), currently mandates that every spinal cord injury and disorder (SCI/D) patient receives a screening urinalysis and urine culture (UC) during the annual evaluation (AE). Our pilot study at a single VHA center showed that 87% of the UCs obtained during the AE represented asymptomatic bacteriuria (ASB), and that 35% of those UC were treated with antibiotics unnecessarily. The objective of the current study is to determine the association between UC and antibiotic use using a national VHA sample of SCI/D patients.

Methods

Retrospective cohort of Veterans who presented to a VHA SCI/D clinic for their AE in FY18 or FY19. Demographic and clinical characteristics as well as information on primary outcomes (receipt of urine culture and antibiotics) were extracted from the VHA Corporate Data Warehouse. Associations between covariates and outcomes were assessed using logistic regression. P values < 0.05 were considered significant.

Results

9447 veterans with SCI/D were included, of whom 5088 (54%) had a UC obtained. Of those with a UC, 2910 (57%) were classified as positive (Figure 1). 1054 (11%) veterans were prescribed antibiotics within 7 days of their AE. Of these, 515 had a positive UC, 202 had a negative UC, and 2878 did not have a UC obtained during the AE. Age, ethnicity, neurologic level of injury (NLI), comorbidity score, frequently identified organism on positive culture, and receipt of antibiotics within 7 days of AE were significantly associated with obtaining a UC during the AE. Race, NLI, bladder management strategy, comorbidity score, frequently identified organism on positive culture, and having a UC obtained during the AE were significantly associated with receipt of antibiotics within 7 days of AE.

Flowchart of SCI/D Veterans who had a urine culture and/or received antibiotics during their FY18/19 AE

Conclusion

Over half of Veterans with SCI/D presenting for their AE receive a screening UC, contrary to other national guidelines recommending against this practice. Age and type or organism identified on UC drive antibiotic use, which was similar to our previous findings and reflect themes identified during our qualitative interviews with SCI/D providers. The knowledge gained from this national VA study will assist the development of interventions to reduce unnecessary urine testing and antibiotic use in the SCI/D population.

Disclosures

All Authors: No reported disclosures