Vasopressin in Patients with Septic Shock and Dynamic Left Ventricular Outflow Tract Obstruction.

PURPOSE: Left ventricular outflow tract obstruction (LVOTO) is a relatively uncommon but severe condition that may lead to hemodynamic impairment. It can be elicited by morphological (left ventricular hypertrophy, sigmoid septum, prominent papillary muscle, prolonged anterior mitral valve leaflet) and functional (hypovolemia, low afterload, hypercontractility, catecholamines) factors. We sought to determine the incidence of the most severe form of LVOTO in septic shock patients and describe the therapeutic effects of vasopressin. METHODS: Over a period of 29 months, 527 patients in septic shock were screened for LVOTO. All were mechanically ventilated and treated according to sepsis bundles, including pre-load optimization and norepinephrine infusion. Vasopressin was added in addition to norepinephrine to reduce the adrenergic burden and decrease LVOTO. RESULTS: Ten patients were diagnosed with the most severe form of LVOTO, including systolic anterior mitral valve motion (SAM) and severe mitral regurgitation (MR) with pulmonary oedema. The median norepinephrine dosage to obtain a mean arterial pressure of ≥70 mmHg was 0.58 mcg/Kg/min (IQR 0.40-0.78). All patients had a hyper-contractile left ventricle, septal hypertrophy, significant LVOTO (peak gradient 78 [56-123] mmHg) associated with SAM and severe MR with pulmonary oedema. Vasopressin (median 4 IU/h) allowed a significant reduction of norepinephrine (0.18 [0.14-0.30] mcg/kg/min; p = 0.01), LVOT gradient (35 [24-60] mmHg; p = 0.01) and MR with a significant paO2/FiO2 increase (174 [125-213] mmHg; p = 0.01). CONCLUSION: Vasopressin allowed a reduction of norepinephrine with subsequent LVOTO reduction and hemodynamic improvement of the most severe form of LVOTO, which represented 1.9% of all septic shock patients.

What factors contribute to e-scooter crashes: A first look using a naturalistic riding approach.

INTRODUCTION: Shared dockless electric scooters (e-scooters) are a popular shared mobility service providing an accessible last-mile transportation option in urban and campus environments. However, city and campus stakeholders may hesitate to introduce these scooters due to safety concerns. While prior e-scooter safety studies have collected injury data from hospitals or riding data under controlled or naturalistic conditions, these datasets are limited and did not identify risk factors associated with e-scooter riding safety. To address this gap in e-scooter safety research, this study collected the largest naturalistic e-scooter dataset to date and quantified the safety risks associated with behavioral, infrastructure, and environmental factors. METHOD: A fleet of 200 e-scooters was deployed on Virginia Tech's campus in Blacksburg, VA for a 6-month period. Fifty were equipped with a unique onboard data acquisition system, using sensors and video to capture e-scooter trips in their entirety. The resulting dataset consisted of 3,500 hours of data spanning over 8,500 trips. Algorithms were developed to identify safety critical events (SCEs) in the dataset and analyses were conducted to determine the prevalence of various SCE risk factors and associated odds ratios. RESULTS: Results from this study indicate that infrastructure-related factors, behavior of e-scooter riders and other actors, and environmental factors all contributed to the SCE risk for e-scooter riders in Virginia Tech's pedestrian-dense campus environment. CONCLUSIONS: To help mitigate unsafe rider behavior, educational outreach programs should quantify the significant risks associated with infrastructure, behavioral, and environmental risk factors and provide clear recommendations to riders. Improved infrastructure maintenance and design may also improve safety for e-scooter riders. PRACTICAL APPLICATIONS: The infrastructure, behavioral, and environmental risk factors quantified in this study can be applied by e-scooter service providers, municipalities, and campus administrators to develop mitigation strategies to reduce the safety risks associated with e-scooter deployments in the future.

Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial.

PURPOSE: Acute onset supraventricular arrhythmias can contribute to haemodynamic compromise in septic shock. Both amiodarone and propafenone are available interventions, but their clinical effects have not yet been directly compared. METHODS: In this two-centre, prospective controlled parallel group double blind trial we recruited 209 septic shock patients with new-onset arrhythmia and a left ventricular ejection fraction above 35%. The patients were randomised in a 1:1 ratio to receive either intravenous propafenone (70 mg bolus followed by 400-840 mg/24 h) or amiodarone (300 mg bolus followed by 600-1800 mg/24 h). The primary outcomes were the proportion of patients who had sinus rhythm 24 h after the start of the infusion, time to restoration of the first sinus rhythm and the proportion of patients with arrhythmia recurrence. RESULTS: Out of 209 randomized patients, 200 (96%) received the study drug. After 24 h, 77 (72.8%) and 71 (67.3%) were in sinus rhythm (p = 0.4), restored after a median of 3.7 h (95% CI 2.3-6.8) and 7.3 h (95% CI 5-11), p = 0.02, with propafenone and amiodarone, respectively. The arrhythmia recurred in 54 (52%) patients treated with propafenone and in 80 (76%) with amiodarone, p < 0.001. Patients with a dilated left atrium had better rhythm control with amiodarone (6.4 h (95% CI 3.5; 14.1) until cardioversion vs 18 h (95% CI 2.8; 24.7) in propafenone, p = 0.05). CONCLUSION: Propafenone does not provide better rhythm control at 24 h yet offers faster cardioversion with fewer arrhythmia recurrences than with amiodarone, especially in patients with a non-dilated left atrium. No differences between propafenone and amiodarone on the prespecified short- and long-term outcomes were observed.

The Impact of Sustainability Goals on Productivity Growth: The Moderating Role of Global Warming.

The objective of this paper was to gain novel insights into the complex relationships among Sustainable Development Goals (SDGs) in shaping productivity (GDP/capita) growth. Using dynamic panel regressions on data collected in 138 countries between 2000 and 2017, we found that rising temperatures negatively affect growth and mitigate the impact of other SDGs on growth. We also found that CO2 emissions have a U-shaped relationship with growth; life expectancy negatively influences growth (positively moderated by rising temperatures), and food security positively impacts growth (negatively moderated by rising temperatures). This study highlights the difficulty of simultaneously implementing SDGs and elucidates novel research perspectives and policies to decrease the negative impacts of climate change on socio-economic and environmental well-being.

Administration of the Probiotic Escherichia coli Strain A0 34/86 Resulted in a Stable Colonization of the Human Intestine During the First Year of Life.

Colinfant New Born (CNB) is an orally administered probiotic preparation containing the Escherichia coli strain A0 34/86, which is specially marketed for use in newborns and infants. Although the impact of different probiotics on the composition of the human gut microbiota has been previously described, the effects of E. coli probiotic consumption during infancy on the development of intestinal microbiota are not known. The effect of oral administration of CNB on the Enterobacteriaceae population was mapped using 16S rRNA gene sequencing in DNA samples isolated from the stools of one infant collected at 177 different time points during the first year of life. E. coli strains turnover was analyzed based on the detection of 26 genetic determinants, phylogroups, and pulsed-field gel electrophoresis (PFGE) analysis. Administration of CNB during the second and third month of life introduced the Escherichia genus to the infant's intestinal tract, and Escherichia became dominant among the Enterobacteriaceae family (p < 0.01). Genetic determinants, typical for probiotic E. coli A0 34/86 strain, were detected on the first day after application of CNB and persisted all year. In addition, nine transient E. coli strains were identified; these strains harbored different genetic determinants and showed different PFGE profiles. Transient strains were detected from 2 to 24 days in the stool samples. The first Escherichia colonizer originated from the application of the CNB probiotic preparation. Probiotic E. coli A0 34/86 successfully colonized the intestinal tract of an infant and became resident during the first year of life.

Performance of Targeted Library Preparation Solutions for SARS-CoV-2 Whole Genome Analysis.

Single next-generation sequencing (NGS) proved to be an important tool for monitoring the SARS-CoV-2 outbreak at the global level Until today, thousands of SARS-CoV-2 genome sequences have been published at GISAID (Global Initiative on Sharing All Influenza Data) but only a portion are suitable for reliable variant analysis. Here we report on the comparison of three commercially available NGS library preparation kits. We discuss advantages and limitations from the perspective of required input sample quality and data quality for advanced SARS-CoV-2 genome analysis.