Deterioration is sometimes unexpected in SARS-CoV2 infection. The aim of our study is to establish laboratory predictors of mortality in COVID-19 disease which can help to identify high risk ...patients. All patients admitted to hospital due to Covid-19 disease were included. Laboratory biomarkers that contributed with significant predictive value for predicting mortality to the clinical model were included. Cut-off points were established, and finally a risk score was built. 893 patients were included. Median age was 68.2 ± 15.2 years. 87(9.7%) were admitted to Intensive Care Unit (ICU) and 72(8.1%) needed mechanical ventilation support. 171(19.1%) patients died. A Covid-19 Lab score ranging from 0 to 30 points was calculated on the basis of a multivariate logistic regression model in order to predict mortality with a weighted score that included haemoglobin, erythrocytes, leukocytes, neutrophils, lymphocytes, creatinine, C-reactive protein, interleukin-6, procalcitonin, lactate dehydrogenase (LDH), and D-dimer. Three groups were established. Low mortality risk group under 12 points, 12 to 18 were included as moderate risk, and high risk group were those with 19 or more points. Low risk group as reference, moderate and high patients showed mortality OR 4.75(CI95% 2.60-8.68) and 23.86(CI 95% 13.61-41.84), respectively. C-statistic was 0-85(0.82-0.88) and Hosmer-Lemeshow p-value 0.63. Covid-19 Lab score can very easily predict mortality in patients at any moment during admission secondary to SARS-CoV2 infection. It is a simple and dynamic score, and it can be very easily replicated. It could help physicians to identify high risk patients to foresee clinical deterioration.
The role of direct oral anticoagulants as compared with vitamin K antagonists for atrial fibrillation after successful transcatheter aortic-valve replacement (TAVR) has not been well studied.
We ...conducted a multicenter, prospective, randomized, open-label, adjudicator-masked trial comparing edoxaban with vitamin K antagonists in patients with prevalent or incident atrial fibrillation as the indication for oral anticoagulation after successful TAVR. The primary efficacy outcome was a composite of adverse events consisting of death from any cause, myocardial infarction, ischemic stroke, systemic thromboembolism, valve thrombosis, or major bleeding. The primary safety outcome was major bleeding. On the basis of a hierarchical testing plan, the primary efficacy and safety outcomes were tested sequentially for noninferiority, with noninferiority of edoxaban established if the upper boundary of the 95% confidence interval for the hazard ratio did not exceed 1.38. Superiority testing of edoxaban for efficacy would follow if noninferiority and superiority were established for major bleeding.
A total of 1426 patients were enrolled (713 in each group). The mean age of the patients was 82.1 years, and 47.5% of the patients were women. Almost all the patients had atrial fibrillation before TAVR. The rate of the composite primary efficacy outcome was 17.3 per 100 person-years in the edoxaban group and 16.5 per 100 person-years in the vitamin K antagonist group (hazard ratio, 1.05; 95% confidence interval CI, 0.85 to 1.31; P = 0.01 for noninferiority). Rates of major bleeding were 9.7 per 100 person-years and 7.0 per 100 person-years, respectively (hazard ratio, 1.40; 95% CI, 1.03 to 1.91; P = 0.93 for noninferiority); the difference between groups was mainly due to more gastrointestinal bleeding with edoxaban. Rates of death from any cause or stroke were 10.0 per 100 person-years in the edoxaban group and 11.7 per 100 person-years in the vitamin K antagonist group (hazard ratio, 0.85; 95% CI, 0.66 to 1.11).
In patients with mainly prevalent atrial fibrillation who underwent successful TAVR, edoxaban was noninferior to vitamin K antagonists as determined by a hazard ratio margin of 38% for a composite primary outcome of adverse clinical events. The incidence of major bleeding was higher with edoxaban than with vitamin K antagonists. (Funded by Daiichi Sankyo; ENVISAGE-TAVI AF ClinicalTrials.gov number, NCT02943785.).
A general synthetic strategy for the systematic synthesis of group 4 MIV heterometallic complexes LMIII(H)(μ-O)Si(μ-O)(OtBu)2} n MIV(NR2)4–n (L = {HC{C(Me)N(2,6- i Pr2C6H3)}2; MIII = Al or ...Ga; n = 1 or 2; MIV = Ti, Zr, Hf; R = Me, Et), based on alumo- or gallosilicate hydride ligands bearing a Si–OH moiety, is presented. The challenging isolation of these metalloligands involved two strategies. On the one hand, the acid–base reaction of LAlH2 with (HO)2Si(OtBu)2 yielded LAlH(μ-O)Si(OH)(OtBu)2 (1), while on the other hand, the oxidative addition of (HO)2Si(OtBu)2 to LGa produced the gallium analog (2). These metalloligands successfully stabilized two hydrogen atoms with different acid–base properties (MIII–H and SiO–H) in the same molecule. Reactivity studies between 1 and 2 and group 4 amides MIV(NR2)4 (MIV = Ti, Zr, Hf; R = Me, Et) and tuning the reactions conditions and stoichiometry led to isolation and structural characterization of heterometallic complexes 3–11 with a 1:1 or 2:1 metalloligand/MIV ratio. Notably, some of these molecular heterometallic silicate complexes stabilize for the first time terminal (O3Si–O−)MIV(NR2)3 moieties known from single-site silica-grafted species. Furthermore, the aluminum-containing heterometallic complexes possess Al–H vibrational energies similar to those reported for modified alumina surfaces, which makes them potentially suitable models for the proposed MIV species grafted onto silica/alumina surfaces with hydride and dihydride architectures.
SO2 Capture and Oxidation in a Pd6L8 Metal–Organic Cage Valencia-Loza, Sergio de Jesús; López-Olvera, Alfredo; Martínez-Ahumada, Eva ...
ACS applied materials & interfaces,
04/2021, Letnik:
13, Številka:
16
Journal Article
Recenzirano
The facile and green preparation of novel materials that capture sulfur dioxide (SO2) with significant uptake at room temperature remains challenging, but it is crucial for public health and the ...environment. Herein, we explored for the first time the SO2 adsorption within microporous metal–organic cages using the palladium(II)-based Pd6L8 ( NO 3 ) 36 tetragonal prism 1, assembled in water under mild conditions. Notably and despite the low BET surface area of 1 (111 m2 g–1), sulfur dioxide was found to be irreversibly and strongly adsorbed within the activated cage at 298 K (up to 6.07 mmol g–1). The measured values for the molar enthalpy of adsorption (ΔH ads) coupled to the FTIR analyses imply a chemisorption process that involves the direct interaction of SO2 with Pd(II) sites and the subsequent oxidation of this toxic chemical by the action of the nitrate anions in 1. To the best of our knowledge, this is the first reported metal–organic cage that proves useful for SO2 adsorption. Metallosupramolecular adsorbents such as 1 could enable new detection applications and suggest that the integration of soft metal ions and self-assembly of molecular cages are a potential means for the easy tuning of SO2 adsorption capabilities and behavior.
The synergy between porosity and soft properties in metal–organic frameworks (MOFs) can result in materials with adaptability of the pore size/shape to the adsorbate. Herein, we present a new ...guest-responsive flexible MOF: CCIQS-1. This material consists of threefold interpenetrated subnetworks comprising Sc3(μ3-O)(H2O)2(OH)(μ-O2CR)6 nodes interconnected by 4,4′-(9,10-anthracenediyl)dibenzoate ligands. This arrangement gives rise to the formation of hydrophilic and hydrophobic channels. Although the activated material is permanently porous, a crystal-to-crystal phase transition takes place upon solvent removal, leading to the contraction of the hydrophobic pores while 1D hydrophilic channels remain open. As a result, CCIQS-1 exhibits a higher affinity for guests with moderate polarity tetrahydrofuran (THF), MeOH, and acetone than for non-polar ones (toluene, cyclohexene, and hexane). X-ray diffraction studies on the contracted-pore phase (cp-CCIQS-1) after exposure to different solvents indicate that only adsorbates with a suitable polarity and molecular size trigger the recovery of the open-pore phase (op-CCIQS-1) via the combination of a breathing effect and subnetwork displacement.
Selective anion sensing by luminescent chemosensors capable of operating in aqueous conditions is a central field of modern supramolecular chemistry that impacts analytical and biological chemistry. ...A cationic cyclometalated Pt(N^C^N)NCCH3OTf complex, 1 N^C^N = 1,3-bis(1-(p-tolyl)-benzimidazol-2′-yl)benzene, OTf = triflate, was prepared, structurally described by single-crystal X-ray diffraction and studied in-depth as a luminescent chemosensor for anions in aqueous phase and solid state. A series of related neutral Pt(N^C^N)X complexes (X = Cl, 2; CN, 3 and I, 4) were formed readily upon treatment of 1 with the respective NaX salt in aqueous media and were described structurally by X-ray diffraction. Complex 1 is hydrostable with phosphorescent green emission originated by intraligand transitions, and d yz (Pt) → π*(N^C^N) charge transfer transitions, as evidenced by TD-DFT calculations and lifetime. Additions of halides, pseudohalides, oxyanions, and dicarboxylates to a neutral aqueous solution of 1 modified its green emission intensity with a pronounced affinity (K = 1.5 × 105 M–1) and turn-on signal toward Cl– within the micromolar concentration range. Pt complex 1 is two orders of magnitude more selective for Cl– than the other halides, CN– and basic oxyanions. Such Cl– affinity for a metal-based chemosensor in aqueous media is still rare. On the basis of X-ray crystallographic analysis and multiple spectroscopic tools (NMR, UV–vis, luminescence, MS, lifetimes) the origin of this selectivity hinges on the cooperative three-point recognition involving one coordination bond (Pt–Cl) and two convergent short C–H···Cl– contacts. This strong affinity and efficient optical response can be utilized in quantitative Cl– sensing in real samples and solid–liquid extractions. Additionally, chloro-Pt complex, 2 may be relevant to bioimaging as a marker for cell nuclei, as revealed by its emission within living cells and intracellular distribution by confocal microscopic studies. These results demonstrate the usefulness of the new water-stable luminescent Pt-N^C^N complexes as effective analytical tools in anion sensing and extraction agents.
Ramipril in High-Risk Patients With COVID-19 Amat-Santos, Ignacio J.; Santos-Martinez, Sandra; López-Otero, Diego ...
Journal of the American College of Cardiology,
07/2020, Letnik:
76, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory-syndrome coronavirus-2 that interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting ...enzyme 2. This interaction has been proposed as a potential risk factor in patients treated with RAAS inhibitors.
This study analyzed whether RAAS inhibitors modify the risk for COVID-19.
The RASTAVI (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation) trial is an ongoing randomized clinical trial randomly allocating subjects to ramipril or control groups after successful transcatheter aortic valve replacement at 14 centers in Spain. A non-pre-specified interim analysis was performed to evaluate ramipril’s impact on COVID-19 risk in this vulnerable population.
As of April 1, 2020, 102 patients (50 in the ramipril group and 52 in the control group) were included in the trial. Mean age was 82.3 ± 6.1 years, 56.9% of the participants were male. Median time of ramipril treatment was 6 months (interquartile range: 2.9 to 11.4 months). Eleven patients (10.8%) have been diagnosed with COVID-19 (6 in control group and 5 receiving ramipril; hazard ratio: 1.150; 95% confidence interval: 0.351 to 3.768). The risk of COVID-19 was increased in older patients (p = 0.019) and those with atrial fibrillation (p = 0.066), lower hematocrit (p = 0.084), and more comorbidities according to Society of Thoracic Surgeons score (p = 0.065). Admission and oxygen supply was required in 4.9% of patients (2 in the ramipril group and 3 in the control group), and 4 of them died (2 in each randomized group). A higher body mass index was the only factor increasing the mortality rate (p = 0.039).
In a high-risk population of older patients with cardiovascular disease, randomization to ramipril had no impact on the incidence or severity of COVID-19. This analysis supports the maintenance of RAAS inhibitor treatment during the COVID-19 crisis. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation RASTAVI; NCT03201185)
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Abstract Objectives We aimed to determine whether body mass index (BMI) is a prognostic indicator for long-term, all-cause mortality in patients undergoing transcatheter aortic valve implantation ...(TAVI). Background Obesity in patients with established cardiovascular disease has previously been identified as an indicator of good prognosis, a phenomenon known as the “obesity paradox”. The prognostic significance of BMI in patients with severe aortic stenosis (AoS) undergoing TAVI is a matter of current debate, as published studies are scarce and their results conflicting. Methods This is an observational, retrospective study involving 770 patients who underwent TAVI for AoS. The cohort was divided into three groups based on their BMI: normal weight (≥ 18.5 to < 25 kg/m2 ), overweight (≥ 25 to < 30 kg/m2 ) and obese (≥ 30 kg/m2 ). The predictive effect of BMI on all-cause mortality 3 years following TAVI intervention was analysed using a Cox regression. Results 155 patients died during follow-up. The overweight group ( n = 302, 38.97%), experienced a lower mortality rate compared to the normal weight and obese groups (15.9% vs 25.7% and 21.0%, respectively log-rank p -value = 0.036). After adjustment by logistic EuroSCORE, being overweight was found to be an independent protective factor against mortality (HR: 0.63 95% CI: 0.42 to 0.94, p = 0.024). This was not the case for obesity (HR: 0.92 95% CI: 0.63 to 1.35, p = 0.664). We therefore describe for the first time, a “J-shaped” regression curve describing the relationship between BMI and mortality. Conclusions BMI is a predictive factor of all-cause mortality in AoS patients undergoing TAVI. This relationship takes the form of a “J-shaped” curve in which overweight patients are associated with the lowest mortality rate at follow-up.
•Impact of pressure wires on FFR values is a crucial consideration for physicians.•The placement of wires during FFR measurements lead to increase pressure drop.•The wire influences the flow, ...especially in severe lesions (diameter reduction>50 %).•Use a wire during FFRct computation improved the correlation between FFR and FFRct.
Fractional Flow Reserve (FFR) is generally considered the gold standard in hemodynamics to assess the impact of a stenosis on the blood flow. The standard procedure to measure involves the displacement of a pressure guide along the circulatory system until it is placed next to the lesion to be analyzed. The main objective of the present study is to analyze the influence of the pressure guide on the invasive FFR measurements and its implications in clinical practice.
We studied the influence of pressure wires on the measurement of Fractional Flow Reserve (FFR) through a combination of Computational Fluid Dynamics (CFD) simulations using 45 clinical patient data with 58 lesions and ideal geometries. The analysis is conducted considering patients that were subjected to a computer tomography and also have direct measurements using a pressure guide. Influence of the stenosis severity, degree of occlusion and blood viscosity has also been studied.
The influence of pressure wires specifically affects severe stenosis with a lumen diameter reduction of 50 % or greater. This type of stenosis leads to reduced hyperemic flow and increased coronary pressure drop. Thus, we identified that the placement of wires during FFR measurements results in partial obstruction of the coronary artery lumen, leading to increased pressure drop and subsequent reduction in blood flow. The severity of low FFR values associated with severe stenosis may be prone to overestimation when compared to stenosis without severe narrowing. These results have practical implications, particularly in the interpretation of lesions falling within the “gray zone” (0,75−0,80).
The pressure wire's presence significantly alters the flow on severe lesions, which has an impact on the FFR calculation. In contrast, the impact of the pressure wire appears to be reduced when the FFR is larger than 0.8. The findings provide critical information for physicians, emphasizing the need for cautious interpretation of FFR values, particularly in severe stenosis. It also offers insights into improving the correlation between FFRct models and invasive measurements by incorporating the influence of pressure wires.
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