Morbidly obese (MO) patients are increasingly undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). However, the best ...therapeutic strategy for these patients remains a matter for debate.
Our aim was to compare the periprocedural and mid-term outcomes in MO patients undergoing TAVR versus SAVR.
A multicentre retrospective study including consecutive MO patients (body mass index ≥40 kg/m
, or ≥35 kg/m
with obesity-related comorbidities) from 18 centres undergoing either TAVR (n=860) or biological SAVR (n=696) for severe AS was performed. Propensity score matching resulted in 362 pairs.
After matching, periprocedural complications, including blood transfusion (14.1% versus 48.1%; p<0.001), stage 2-3 acute kidney injury (3.99% versus 10.1%; p=0.002), hospital-acquired pneumonia (1.7% versus 5.8%; p=0.005) and access site infection (1.5% versus 5.5%; p=0.013), were more common in the SAVR group, as was moderate to severe patient-prosthesis mismatch (PPM; 9.9% versus 39.4%; p<0.001). TAVR patients more frequently required permanent pacemaker implantation (14.4% versus 5.6%; p<0.001) and had higher rates of ≥moderate residual aortic regurgitation (3.3% versus 0%; p=0.001). SAVR was an independent predictor of moderate to severe PPM (hazard ratio HR 1.80, 95% confidence interval CI: 1.25-2.59; p=0.002), while TAVR was not. In-hospital mortality was not different between groups (3.9% for TAVR versus 6.1% for SAVR; p=0.171). Two-year outcomes (including all-cause and cardiovascular mortality, and readmissions) were similar in both groups (log-rank p>0.05 for all comparisons). Predictors of all-cause 2-year mortality differed between the groups; moderate to severe PPM was a predictor following SAVR (HR 1.78, 95% CI: 1.10-2.88; p=0.018) but not following TAVR (p=0.737).
SAVR and TAVR offer similar mid-term outcomes in MO patients with severe AS, however, TAVR offers some advantages in terms of periprocedural morbidity.
The surface mycoflora of “chorizo de Cantimpalos”, a Spanish variety of fermented meat sausage characterised by a natural white covering, has been investigated. Among 54 mould strains isolated, 38 ...belonged to
Penicillium subgenus
Penicillium. The major species found (18 isolates) was identified as
Penicillium commune, and the other dominant species (13 isolates) was identified as
P. olsonii. None of the
P. olsonii isolates produced cyclopiazonic acid, mycophenolic acid, roquefortine C, patulin or ochratoxin A, but all
P. commune isolates produced cyclopiazonic acid. Toxicity to
Artemia salina larvae was very high for all
P. commune isolates investigated, while no isolates of
P. olsonii studied were toxic to these crustaceans. The results may assist in selection of nontoxic strains, which could be used as surface starters in the manufacture of this type of sausage. The apparent inability to produce penicillin is a valuable characteristic to take into account in the selection process.
Fifty-four packages (each one belonging to a different lot) of vacuum-packed cold-smoked salmon (30) and trout (24) produced by six Spanish smokehouses were obtained at retail level after 3 weeks ...storage at 2±1 °C. Sensorial, chemical, physicochemical and microbiological characteristics were examined. Overall, pH,
a
w, salt content in water phase, aerobic plate counts at 30 and 25 °C, levels of Enterobacteriaceae, lactic acid bacteria (LAB), fungi and presumptive aeromonads and staphylococci are in agreement with available data on lightly preserved fish products. Psychrotrophic clostridia ranged between 1.71 and 2.21 log CFU/g. Levels of ethanol were highly variable and not significantly related (
p>0.05) to sensory scores or to microbial numbers.
Salmonella,
Escherichia coli and
Listeria monocytogenes were not detected in any sample. Listeriae other than
L.
monocytogenes were isolated from three packages. Levels of
Staphylococcus aureus lower than 4 log CFU/g were also found in three packages. Among 377 bacteria randomly isolated from aerobic 25 °C plate counts, LAB predominated, with
Carnobacterium (
C. piscicola) and
Lactobacillus (eight species) being the genera most frequently found. The second and third major groups were Enterobacteriaceae and Micrococcaceae, respectively.
Proteus vulgaris,
P. mirabilis and
Serratia liquefaciens were dominant among Enterobacteriaceae and coagulase-negative staphylococci among Micrococcaceae. Minor microbial groups such as aerobic Gram-negative bacilli (
Acinetobacter,
Moraxella and
Pseudomonas),
Brochothrix,
Aeromonas,
Bacillus and
Vibrio constituted less than 17% of the total flora.
Context. The BL Lac object 3C 371 was observed by the Transiting Exoplanet Survey Satellite (TESS) for approximately a year, between July 2019 and July 2020, with an unmatched two-minute imaging ...cadence. In parallel, the Whole Earth Blazar Telescope (WEBT) Collaboration organized an extensive observing campaign, providing three years of continuous optical monitoring between 2018 and 2020. These datasets allow for a thorough investigation of the variability of the source. Aims. The goal of this study is to evaluate the optical variability of 3C 371. Taking advantage of the remarkable cadence of TESS data, we aim to characterize the intra-day variability (IDV) displayed by the source and identify its shortest variability timescale. With this estimate, constraints on the size of the emitting region and black hole mass can be calculated. Moreover, WEBT data are used to investigate long-term variability (LTV), including in terms of the spectral behavior of the source and the polarization variability. Based on the derived characteristics, we aim to extract information on the origin of the variability on different timescales. Methods. We evaluated the variability of 3C 371 by applying the variability amplitude tool, which quantifies variability of the emission. Moreover, we employed common tools, such as ANOVA (ANalysis Of VAariance) tests, wavelet and power spectral density (PSD) analyses to characterize the shortest variability timescales present in the emission and the underlying noise affecting the data. We evaluated the short- and long-term color behavior to understand its spectral behavior. The polarized emission was analyzed, studying its variability and possible rotation patterns of the electric vector position angle (EVPA). Flux distributions of the IDV and LTV were also studied with the aim being to link the flux variations to turbulent and/or accretion-disk-related processes. Results. Our ANOVA and wavelet analyses reveal several entangled variability timescales. We observe a clear increase in the variability amplitude with increasing width of the time intervals evaluated. We are also able to resolve significant variations on timescales of as little as ∼0.5 h. The PSD analysis reveals a red-noise spectrum with a break at IDV timescales. The spectral analysis shows a mild bluer-when-brighter (BWB) trend on long timescales. On short timescales, mixed BWB, achromatic and redder-when-brighter signatures can be observed. The polarized emission shows an interesting slow EVPA rotation during the flaring period, where a simple stochastic model can be excluded as the origin with a 3 σ significance. The flux distributions show a preference for a Gaussian model for the IDV, and suggest it may be linked to turbulent processes, while the LTV is better represented by a log-normal distribution and may have a disk-related origin.
Background: Patients with major bleeding who subsequently develop clinically apparent venous thromboembolism (VTE) present a particularly difficult therapeutic dilemma. Methods: RIETE is a ...prospective registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. We retrospectively studied those who had experienced recent major bleeding (< 30 days prior to VTE) to assess the influence of the site of bleeding and the time elapsed to VTE on their 3 month outcome. Results: Of 12 294 patients enrolled up to July 2005, 306 (2.5%) had recent major bleeding: gastrointestinal (GI) tract, 116 (38%); intracranial, 94 (31%); other, 96 (31%). During the study period, 19 patients 6.2%; 95% confidence interval (CI) 3.5–8.9 with recent bleeding rebled (eight died): 13 of them (68%) during the first 2 weeks. Multivariate analysis confirmed that patients with recent GI bleeding had an increased risk for both major rebleeding (hazard ratio 2.8; 95% CI 1.4–5.3) and death (hazard ratio 1.9; 95% CI 1.2–3.1) compared to those with no recent bleeding. Those who bled in other sites had an increased risk only for death (hazard ratio 2.0; 95% CI 1.2–3.3). An elapsed time of < 2 weeks from bleeding to the index VTE event was also associated with an increased risk for major rebleeding (hazard ratio 2.4; 95% CI 1.2–5.0) and death (hazard ratio 2.8; 95% CI 1.8–4.5). Conclusion: The incidence of new bleeding or death depends on the site of prior bleeding and the time elapsed until VTE. This information may help to identify the best therapeutic approach for these high‐risk patients.
Background
Age is a major risk factor for venous thromboembolism (VTE), yet patients aged ≥90 years are under‐represented in clinical trials of anticoagulant therapy. The objectives were to describe ...and compare patient clinical characteristics, treatments, and outcomes (VTE recurrence, bleeding, and mortality) during the first 3 months of anticoagulation between VTE patients aged ≥90 years and those aged <90 years.
Methods
We analyzed data from the Registro Informatizado Enfermedad TromboEmbὀlica (RIETE), an ongoing global observational registry of patients with objectively confirmed acute VTE.
Results
From January 2001 to October 2022, 96,701 patients were registered in RIETE, of whom 3262 (3.4%) were aged ≥90 years. Patients aged ≥90 years were less likely to be men, and to have experienced cancer or recent surgery, but more likely to manifest immobility, chronic heart failure, anemia, renal insufficiency, or dementia than those aged <90 years. Most (99.6%) patients aged ≥90 years were receiving anticoagulant therapy. During the first 3 months, 26 patients aged ≥90 years developed VTE recurrences, 116 experienced major bleeding, and 564 died. Among patients initially presenting with pulmonary embolism (PE), deaths due to PE exceeded those due to fatal bleeding (76 vs. 19). Among those initially presenting with isolated deep‐vein thrombosis (DVT), it was the reverse (2 vs. 11 deaths).
Conclusions
In patients aged ≥90 years, the difference in the outcome of anticoagulant treatment depending on the initial presentation of VTE could suggest a need for different management approaches. Clinical trials evaluating the optimal duration of anticoagulation according to initial VTE presentation are warranted to limit excess deaths in this particular population.
Hypertension is a prevalent condition among SARS-CoV-2 infected patients. Whether renin–angiotensin–aldosterone system (RAAS) inhibitors are beneficial or harmful is controversial.
We have performed ...a national retrospective, nonexperimental comparative study from two tertiary hospitals to evaluate the impact of chronic use of RAAS inhibitors in hypertensive COVID-19 patients. A meta-analysis was performed to strengthen our findings.
Of 849 patients, 422 (49.7%) patients were hypertensive and 310 (73.5%) were taking RAAS inhibitors at baseline. Hypertensive patients were older, had more comorbidities, and a greater incidence of respiratory failure (−0.151 95% CI −0.218, −0.084). Overall mortality in hypertensive patients was 28.4%, but smaller among those with prescribed RAAS inhibitors before (−0.167 95% CI −0.220, −0.114) and during hospitalization (0.090 −0.008,0.188). Similar findings were observed after two propensity score matches that evaluated the benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers among hypertensive patients. Multivariate logistic regression analysis of hypertensive patients found that age, diabetes mellitus, C-reactive protein, and renal failure were independently associated with all-cause mortality. On the contrary, ACEIs decreased the risk of death (OR 0.444 95% CI 0.224–0.881). Meta-analysis suggested a protective benefit of RAAS inhibitors (OR 0.6 95% CI 0.42–0.8) among hypertensive COVID-19.
Our data suggest that RAAS inhibitors may play a protective role in hypertensive COVID-19 patients. This finding was supported by a meta-analysis of the current evidence. Maintaining these medications during hospital stay may not negatively affect COVID-19 outcomes.
La hipertensión es una condición prevalente entre los pacientes infectados por el SARS-CoV-2. Es controvertido si los inhibidores del sistema renina-angiotensina-aldosterona (SRAA) son beneficiosos o perjudiciales.
Hemos desarrollado un estudio comparativo nacional retrospectivo y no experimental en 2 hospitales terciarios para evaluar el impacto del uso crónico de inhibidores del SRAA en pacientes hipertensos con COVID-19. Se realizó un metaanálisis para reforzar los hallazgos.
De 849 pacientes, 422 (49,7%) eran hipertensos y 310 (73,5%) tomaban inhibidores del SRAA al inicio del estudio. Los pacientes hipertensos eran mayores, tenían más comorbilidades y una mayor incidencia de insuficiencia respiratoria (−0,151; IC 95%: −0,218; −0,084). La mortalidad global en los pacientes hipertensos fue del 28,4%, pero fue menor entre los que tenían prescritos inhibidores del SRAA antes (−0,167; IC 95%: −0,220; −0,114) y durante la hospitalización (0,090; −0,008; 0,188). Se observaron hallazgos similares tras 2 emparejamientos de puntuación de propensión que evaluaron el beneficio de los inhibidores de la enzima convertidora de angiotensina y los bloqueadores de los receptores de angiotensina entre los pacientes hipertensos. El análisis de regresión logística multivariante de los pacientes hipertensos reveló que la edad, la diabetes mellitus, la proteína C reactiva y la insuficiencia renal se asociaban de forma independiente con la mortalidad por todas las causas. Por el contrario, los inhibidores de la enzima convertidora de angiotensina disminuyeron el riesgo de muerte (OR 0,444; IC 95%: 0,224-0,881). El metaanálisis indicó un beneficio protector de los inhibidores del SRAA (OR 0,6; IC 95%: 0,42-0,8) entre los hipertensos con COVID-19.
Nuestros datos indican que los inhibidores del SRAA pueden desempeñar un papel protector en los pacientes hipertensos con COVID-19. Este hallazgo fue apoyado por un metaanálisis de la evidencia actual. Su mantenimiento durante la estancia hospitalaria puede no afectar negativamente a los resultados de la COVID-19.
ABSTRACT
In 2021 BL Lacertae underwent an extraordinary activity phase, which was intensively followed by the Whole Earth Blazar Telescope (WEBT) Collaboration. We present the WEBT optical data in ...the BVRI bands acquired at 36 observatories around the world. In mid-2021 the source showed its historical maximum, with R = 11.14. The light curves display many episodes of intraday variability, whose amplitude increases with source brightness, in agreement with a geometrical interpretation of the long-term flux behaviour. This is also supported by the long-term spectral variability, with an almost achromatic trend with brightness. In contrast, short-term variations are found to be strongly chromatic and are ascribed to energetic processes in the jet. We also analyse the optical polarimetric behaviour, finding evidence of a strong correlation between the intrinsic fast variations in flux density and those in polarization degree, with a time delay of about 13 h. This suggests a common physical origin. The overall behaviour of the source can be interpreted as the result of two mechanisms: variability on time-scales greater than several days is likely produced by orientation effects, while either shock waves propagating in the jet, or magnetic reconnection, possibly induced by kink instabilities in the jet, can explain variability on shorter time-scales. The latter scenario could also account for the appearance of quasi-periodic oscillations, with periods from a few days to a few hours, during outbursts, when the jet is more closely aligned with our line of sight and the time-scales are shortened by relativistic effects.
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