Prevalence and prognostic impact of complex percutaneous coronary intervention among octogenarians.

BACKGROUND: The number of octogenarians referred to percutaneous coronary interventions (PCI) is rising steadily. The prevalence and prognostic impact of complex PCI (CPCI) in this vulnerable population has not been fully evaluated. METHODS: Patients ≥80 years old who underwent PCI between 2012 and 2019 at Mount Sinai Hospital were included. Patients were categorized based on PCI complexity, defined as the presence of at least one of the following criteria: use of atherectomy, total stent length ≥60 mm, ≥3 stents implanted, bifurcation treated with at least 2 stents, PCI involving ≥3 vessels, ≥3 lesions, left main, saphenous vein graft or chronic total occlusion. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), or target-vessel revascularization (TVR), within 1 year after PCI. Secondary outcomes included major bleeding. RESULTS: Among 2657 octogenarians, 1387 (52%) underwent CPCI and were more likely to be men and to have cardiovascular risk factors or comorbidities. CPCI as compared with no-CPCI was associated with a higher 1-year risk of MACE (16.6% vs. 11.1%, adjusted HR 1.3, 95% CI 1.06-1.77, p value 0.017), due to an excess of MI and TVR, and major bleeding (10% vs. 5.8%, adjusted HR 1.64, 95% CI 1.20-2.55, p value 0.002). CONCLUSIONS: Among octogenarians, CPCI was associated with a significantly higher 1-year risk of MACE, due to higher rates of MI and TVR but not of all-cause death, and of major bleeding. Strategies to reduce complications should be implemented in octogenarians undergoing CPCI.

Disseminated histoplasmosis in an HIV/AIDS transgender male-to-female with atypical and persistent GI manifestations.

Disseminated histoplasmosis is a rare complication of infection due to Histoplasma capsulatum. Typically, histoplasmosis is self-limiting and asymptomatic in infected individuals with immunocompetence. Disseminated disease, however, can arise in high-risk populations with primary or acquired cellular immunodeficiency including HIV/AIDS, transplant recipients, and those undergoing immunosuppressive therapy. Here we describe a unique case of extrapulmonary gastrointestinal histoplasmosis by infiltrative Peyer's patch disease with bone marrow involvement in a transgender HIV-infected woman.

Surface Passivation by Sulfur-Based 2D (TEA)2PbI4 for Stable and Efficient Perovskite Solar Cells.

Perovskite solar cells (PSCs) with superior performance have been recognized as a potential candidate in photovoltaic technologies. However, defects in the active perovskite layer induce nonradiative recombination which restricts the performance and stability of PSCs. The construction of a thiophene-based 2D structure is one of the significant approaches for surface passivation of hybrid PSCs that may combine the benefits of the stability of 2D perovskite with the high performance of three-dimensional (3D) perovskite. Here, a sulfur-rich spacer cation 2-thiopheneethylamine iodide (TEAI) is synthesized as a passivation agent for the construction of a three-dimensional/two-dimensional (3D/2D) perovskite bilayer structure. TEAI-treated PSCs possess a much higher efficiency (20.06%) compared to the 3D perovskite (MA0.9FA0.1PbI3) devices (17.42%). Time-resolved photoluminescence and femtosecond transient absorption spectroscopy are employed to investigate the effect of surface passivation on the charge carrier dynamics of the 3D perovskite. Additionally, the stability test of TEAI-treated perovskite devices reveals significant improvement in humid (RH ∼ 46%) and thermal stability as the sulfur-based 2D (TEA)2PbI4 material self-assembles on the 3D surface, making the perovskite surface hydrophobic. Our findings provide a reliable approach to improve device stability and performance successively, paving the way for industrialization of PSCs.

The food-energy-water-carbon nexus of the rice-wheat production system in the western Indo-Gangetic Plain of India: An impact of irrigation system, conservational tillage and residue management.

The conventional rice-wheat system in the western Indo-Gangetic plain of India is energy and water intensive with high carbon footprint. The transition towards resource-efficient eco-friendly production technologies with lower footprint is required for inclusive ecological sustenance. A five-year (2016-17 to 2020-21) field experiment was conducted in RWS with hypothesis that pressurized irrigation systems [drip (DRIP) and mini-sprinkler (MSIS)] in conservation tillage [reduced (RT)/zero (ZT)] and crop residue management [incorporation (RI)/mulch (RM)] might result in higher resource use efficiency with lesser carbon footprint compared to conventional system. Experiment consisted five treatments namely (1) puddled transplanted rice followed by conventionally tilled wheat (PTR/CTW), (2) DRIP irrigated reduced till direct seeded rice (RTDSR) followed by zero-till wheat with 100 % rice residue mulching (ZTW + RM) (DRIP-RTDSR/ZTW + RM), (3) surface irrigated RTDSR followed by ZTW + RM (SIS-RTDSR/ZTW + RM), (4) MSIS irrigated RTDSR followed by ZTW + RM (MSIS-RTDSR/ZTW + RM), and (5) MSIS irrigated RTDSR with 1/3rd wheat residue incorporation followed by ZTW + RM (MSIS-RTDSR + RI/ZTW + RM). The pressurized irrigation system in RWS established under conservational tillage and residue management (DRIP-RTDSR/ZTW + RM and MSIS-DSR + RI/ZTW + RM) produced at par system productivity compared to PTR/CTW. Substantial nitrogen (79-114 ka ha-1) and irrigation water (536-680 mm) savings under pressurized irrigation systems resulted in 41-64 % higher partial factor productivity of nitrogen with 48-61 % lower water footprint. These systems had lower energy consumption attaining 15-21 % higher net energy, 44-61 % higher energy use efficiency, and 31-38 % lower specific energy. Efficient utilization of farm inputs caused lower greenhouse gas emission (39-44 %) and enhanced carbon sequestration (35-62 %) resulting 63-76 % lower carbon footprint over PTR/CTW. The information generated here might useful in developing policies for resource and climate-smart food production system aiming livelihood security and ecological sustainability in the region. Further, trials are needed for wider adaptability under different climate, soil and agronomic practices to develop site-specific climate smart practices.

Use of Proton Pump Inhibitors With Dexamethasone in Patients With COVID-19 Pneumonia: Contributions to Long-Term Polypharmacy.

Introduction  Proton pump inhibitors have been used in conjunction with dexamethasone to treat patients with COVID-19. This is given prophylactically to anticipate possible complications while on steroids, including abdominal pain, gastric ulcers, or gastrointestinal bleeding. Proton pump inhibitors have complications, including Clostridium difficile infection, pneumonia, osteoporosis, and vitamin deficiency. The goal of the following project is to assess if there are any subjective and objective benefits to be treated with this regimen instead of dexamethasone on its own. Another inquiry that will be investigated is if this combination results in more patients being prescribed a proton pump inhibitor on discharge.  Materials and methods The following is a retrospective study involving two groups, the first group taking the aforementioned regimen and the second group on dexamethasone only. Objective findings that will be compared include the change in hemoglobin, blood urea nitrogen, and creatinine levels from admission to discharge between the two groups. Subjective findings include complaints of abdominal pain and reported bloody bowel movements. Medication reconciliation on discharge will also be assessed to observe if patients were discharged with a proton pump inhibitor and how long were they taking this medication as an outpatient.  Results The difference between hemoglobin, blood urea nitrogen, and creatinine between the two groups was not significant as the p-values were .14, .43. and .10, respectively. Therefore, the null hypothesis was accepted that there was no difference in these objective findings between the two populations. In addition, neither set had complaints of abdominal pain. For the investigated population on a proton pump inhibitor, it was found that 53% of these patients were discharged with this medication. This subset was on this medication for an average of three months, with the maximum duration being seven months for one patient. The data supported the hypothesis that there was no subjective or objective benefit to being on this drug combination, and consequentially, most patients continue to take this medication for months after discharge.  Conclusion The data affirms the hypothesis that most patients can tolerate dexamethasone without the need for a proton pump inhibitor. This study was limited to patients without any history of gastritis, peptic ulcer disease, or gastrointestinal bleeding; a separate study would need to be done to investigate the need for prophylaxis for patients with these comorbidities. The concerning finding was that patients are being discharged with a medication that they do not need, some patients are taking proton pump inhibitors for more than half the year. There should be further screening to determine if a patient needs to be on a proton pump inhibitor other than steroids.

Disparities in Healthcare: Evaluation of Equity in Access to Surveillance Colonoscopy After Hemicolectomy in Patients With Colon Cancer During the COVID-19 Pandemic.

INTRODUCTION: Surveillance colonoscopy is rcommended for patients with colon cancer who obtain a hemicolectomy for tumor resection. Guidelines from many organizations require this colonoscopy to be performed within one year after resection. The objective of this study was to evaluate the difference in surveillance colonoscopy rates between white people and African Americans who had their colon tumors resected. The second objective was to determine whether the COVID-19 pandemic affected these colonoscopy rates. The study goal was to shed light on the issue of low colonoscopy rates among African Americans with colon cancer after tumor removal by hemicolectomy and on how the pandemic exacerbated this issue. METHODS: A total of 800 patient charts from Brooklyn Methodist Hospital were reviewed. The selected patients had a history of colon cancer and received hemicolectomy in the past. The patients were divided according to race and their expected surveillance colonoscopy dates. One group included patients with an expected one-year follow-up date for colonoscopy after hemicolectomy before the start of the pandemic. Another group included patients with colonoscopies due to be performed during the pandemic. A two-sample proportions test was used to compare the colonoscopy rates before and during the pandemic for African Americans. The two-sample equal variance t-test was used to compare the average distance from the patients' home to hospital between African Americans and whites. RESULTS: The surveillance colonoscopy rates among African Americans were 54% before and 45% during the pandemic. This difference was significant (p < 0.001). The colonoscopy rates between whites and African Americans differed. The surveillance colonoscopy rates among whites were 97% before and 84% during the pandemic. The distance between the patients' homes and the hospital where the procedure was performed also significantly differed. The average travel distance for whites was 1.33 miles and that for African Americans was 3.98 miles (p < 0.001). A total of 215 of the 416 African American patients included had tumors in the cecum and ascending colon. CONCLUSION: A significant difference was observed in the colonoscopy rates for African Americans before and during the pandemic. A substantial difference was found in the colonoscopy rates between whites and African Americans, which increased during the pandemic. The distance from the patients' home to the hospital performing the colonoscopy was twice as far for African Americans than whites in the borough of Brooklyn. These data support the hypothesis that a significant difference in colonoscopy rates exists between African Americans and whites, probably because of a healthcare disparity in access to this procedure. The study objective was to highlight the long-standing issue of low colonoscopy rates in African Americans and how the pandemic further decreased these low rates.

The Unexpected Formation of a Broncho-Esophageal Fistula of the Right Main Stem Bronchus Status Post Esophageal Stent Placement: A Case Report.

This case presents a patient with a history of non-small cell lung carcinoma who had radiation therapy complicated by esophageal dysphagia. She had a fully covered self-expanding metal stent (SEMS) placed one year ago in the proximal region of her esophagus prior to this admission. She presented to the emergency department (ED) for dyspnea on exertion. Imaging showed a persistent right lower lobe opacity, and bronchoscopy revealed a right broncho-esophageal fistula (BEF). Further investigation by endoscopy found that the fully covered SEMS migrated distally and caused the formation of her fistula. This case presents a patient with a right BEF caused by a migrating esophageal stent.

A Rare Encounter of Mitral Arcade With Anomalous Papillary Muscles.

A congenital mitral arcade is a rare heart structural abnormality that affects the structure of the papillary muscles and chordae tendinae. This structural deviation impacts the mitral valve's functional capability, which is why most patients with this condition develop complications such as mitral stenosis or regurgitation. Some patients can obtain successful mitral valve repair. However, most will still need to get a mitral valve replacement. This case presents a young female who was found to have a mitral arcade and underwent mitral valve repair.

A new technique to resolve Nasal Rhinosporidiosis: A case report with review of literature.

INTRODUCTION AND IMPORTANCE: Rhinosporidiosis is a chronic, localized granulomatous infectious disease caused by Rhinosporidium seeberi that predominantly affects the mucosal membranes of the nose and nasopharynx, conjunctiva, and urethra. Rhinosporidium seeberi is a eukaryotic pathogen that spreads in certain geographical areas, particularly in tropical and subtropical areas, through aquatic exposure. CASE PRESENTATION: We present the case of a young man who had been suffering from a right nasal mass for four months, and whose diagnosis was confirmed after surgical excision and histopathological examination, which revealed distinct pathognomonic findings. Laser-assisted endoscopic excision, in combination with Dapsone, is recommended as a more effective treatment to prevent a recurrence. CLINICAL DISCUSSION: For clinicians, it has been advised to obtain a detailed case history of exposure in patients diagnosed with Rhinosporidiosis. Rhinosporidiosis can be diagnosed with a simple examination of H&E-stained histopathological sections. Because chemotherapy has not been proven to be effective, Laser-assisted endoscopic excision, in combination with Dapsone is the recommended treatment for Rhinosporidiosis. CONCLUSION: One of the differential diagnoses for Rhinosporidiosis in the nasal cavity is masses or abnormal growths without bleeding, which should be kept in mind by clinicians and pathologists.

Using Clinical and Echocardiographic Characteristics to Characterize the Risk of Ischemic Stroke in Patients with COVID-19.

BACKGROUND: COVID-19 has been associated with an increased incidence of ischemic stroke. The use echocardiography to characterize the risk of ischemic stroke in patients hospitalized with COVID-19 has not been explored. METHODS: We conducted a retrospective study of 368 patients hospitalized between 3/1/2020 and 5/31/2020 who had laboratory-confirmed infection with SARS-CoV-2 and underwent transthoracic echocardiography during hospitalization. Patients were categorized according to the presence of ischemic stroke on cerebrovascular imaging following echocardiography. Ischemic stroke was identified in 49 patients (13.3%). We characterized the risk of ischemic stroke using a novel composite risk score of clinical and echocardiographic variables: age <55, systolic blood pressure >140 mmHg, anticoagulation prior to admission, left atrial dilation and left ventricular thrombus. RESULTS: Patients with ischemic stroke had no difference in biomarkers of inflammation and hypercoagulability compared to those without ischemic stroke. Patients with ischemic stroke had significantly more left atrial dilation and left ventricular thrombus (48.3% vs 27.9%, p = 0.04; 4.2% vs 0.7%, p = 0.03). The unadjusted odds ratio of the composite novel COVID-19 Ischemic Stroke Risk Score for the likelihood of ischemic stroke was 4.1 (95% confidence interval 1.4-16.1). The AUC for the risk score was 0.70. CONCLUSIONS: The COVID-19 Ischemic Stroke Risk Score utilizes clinical and echocardiographic parameters to robustly estimate the risk of ischemic stroke in patients hospitalized with COVID-19 and supports the use of echocardiography to characterize the risk of ischemic stroke in patients hospitalized with COVID-19.

Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft.

OBJECTIVES: To evaluate and compare characteristics and clinical outcomes of percutaneous coronary intervention (PCI) among target vessel types in patients with a prior coronary artery bypass graft (CABG) surgery. BACKGROUND: Patients with a prior CABG often require repeat revascularization with PCI. Graft PCI has been associated with worse outcomes compared to native vessel PCI, yet the optimal PCI strategy in prior CABG patients remains unknown. METHODS: We stratified prior CABG patients who underwent PCI at a tertiary-care center between 2009 and 2017 by target vessel type: native vessel, venous graft, and arterial graft. The primary outcome of major adverse cardiac events (MACE) was a composite of all-cause death, myocardial infarction, stent thrombosis, or target vessel revascularization up to 1 year post-PCI. RESULTS: Prior CABG patients (n = 3983) represented 19.5% of all PCI interventions during the study period. PCI was most frequently performed on native vessels (n = 2928, 73.5%) followed by venous (n = 883, 22.2%) and arterial grafts (n = 172, 4.3%). Procedural success and complications were similar among the groups; however, slow- and no-reflow phenomenon was more common in venous graft PCI compared to native vessel PCI (OR 4.78; 95% CI 2.56-8.95; p < 0.001). At 1 year, there were no significant differences in MACE or in its individual components. CONCLUSIONS: Target vessel choice did not appear to affect MACE at 1 year in a large cohort of patients with prior CABG undergoing PCI. Whether PCI of surgical grafts versus native arteries truly results in similar outcomes warrants further investigation in randomized controlled trials.

15.3% Efficiency All-Small-Molecule Organic Solar Cells Achieved by a Locally Asymmetric F, Cl Disubstitution Strategy.

Single junction binary all-small-molecule (ASM) organic solar cells (OSCs) with power conversion efficiency (PCE) beyond 14% are achieved by using non-fullerene acceptor Y6 as the electron acceptor, but still lag behind that of polymer OSCs. Herein, an asymmetric Y6-like acceptor, BTP-FCl-FCl, is designed and synthesized to match the recently reported high performance small molecule donor BTR-Cl, and a record efficiency of 15.3% for single-junction binary ASM OSCs is achieved. BTP-FCl-FCl features a F,Cl disubstitution on the same end group affording locally asymmetric structures, and so has a lower total dipole moment, larger average electronic static potential, and lower distribution disorder than those of the globally asymmetric isomer BTP-2F-2Cl, resulting in improved charge generation and extraction. In addition, BTP-FCl-FCl based active layer presents more favorable domain size and finer phase separation contributing to the faster charge extraction, longer charge carrier lifetime, and much lower recombination rate. Therefore, compared with BTP-2F-2Cl, BTP-FCl-FCl based devices provide better performance with FF enhanced from 71.41% to 75.36% and J sc increased from 22.35 to 24.58 mA cm-2, leading to a higher PCE of 15.3%. The locally asymmetric F, Cl disubstitution on the same end group is a new strategy to achieve high performance ASM OSCs.

Side-Chain Engineering of Diketopyrrolopyrrole-Based Hole-Transport Materials to Realize High-Efficiency Perovskite Solar Cells.

The design and synthesis of a stable and efficient hole-transport material (HTM) for perovskite solar cells (PSCs) are one of the most demanding research areas. At present, 2,2',7,7'-tetrakis[N,N-di(4-methoxyphenyl)amino]-9,9'-spirobifluorene (spiro-MeOTAD) is a commonly used HTM in the fabrication of high-efficiency PSCs; however, its complicated synthesis, addition of a dopant in order to realize the best efficiency, and high cost are major challenges for the further development of PSCs. Herein, various diketopyrrolopyrrole-based small molecules were synthesized with the same backbone but distinct alkyl side-chain substituents (i.e., 2-ethylhexyl-, n-hexyl-, ((methoxyethoxy)ethoxy)ethyl-, and (2-((2-methoxyethoxy)ethoxy)ethyl)acetamide, designated as D-1, D-2, D-3, and D-4, respectively) as HTMs. The variation in the alkyl chain has shown obvious effects on the optical and electrochemical properties as well as on the molecular packing and film-forming ability. Consequently, the power conversion efficiency (PCE) of the PSC under one sun illumination (100 mW cm-2) is shown to increase in the order of D-1 (8.32%) < D-2 (11.12%) < D-3 (12.05%) < D-4 (17.64%). Various characterization techniques reveal that the superior performance of D-4 can be ascribed to the well-aligned highest occupied molecular orbital energy level with the counter electrode, the more compact π-π stacking with a higher coherence length, and the excellent hole mobility of 1.09 × 10-3 cm2 V-1 s-1, thus providing excellent energetics for effective charge transport with minimal charge-carrier recombination. Furthermore, the addition of the dopant Li-TFSI in D-4 is shown to deliver a remarkable PCE of 20.19%, along with a short-circuit current density (JSC), open-circuit voltage (VOC), and fill factor (FF) of 22.94 mA cm-2, 1.14 V, and 73.87%, respectively, and superior stability compared to that of other HTMs. These results demonstrate the effectiveness of side-chain engineering for tailoring the properties of HTMs, thus offering new design tactics to fabricate for the synthesis of highly efficient and stable HTMs for PSCs.

Severe Gastrointestinal Bleed Caused by a Rectal Dieulafoy Lesion.

Dieulafoy lesions are vessels that erode the overlying epithelium without the presence of an ulcer. When these lesions bleed, they can frequently be self-limited, but bleeding can be recurrent and prolonged. Although most commonly found in the lesser curvature of the proximal stomach, there are reports of these lesions in other gastrointestinal tract regions. This case identifies a Dieulafoy lesion found in the rectum, which was the source of this patient's profuse rectal bleeding.

Paradoxical Thromboembolic Ischemic Stroke Following Tissue Plasminogen Activator Instillation for Clogged Central Venous Dialysis Catheter.

Central venous catheters including dialysis catheters are a potential source of venous thrombosis and pose a risk for paradoxical embolic events including ischemic stroke and systemic embolism in patients with a patent foramen ovale (PFO). The adult population with a PFO and patients with a central venous dialysis catheter (CVDC) are at increased risk of a paradoxical embolic event. Since bubble study is not routinely done during echocardiogram in a patient with CVDC, it is difficult to identify at-risk patients for paradoxical embolic events during catheter manipulation, especially for clogged CVDC. We report a rare case of a 79-year-old lady with end-stage renal disease on hemodialysis (HD) using a CVDC who developed a paradoxical embolic ischemic stroke following the use of tissue plasminogen activator (tPA) for unclogging a dialysis catheter. We aimed to highlight the existing risks of thromboembolism associated with the long-term use of central CVDC, especially the potential risk of paradoxical embolism and ischemic stroke with the use of tPA for management of clogged dialysis catheters. We emphasize the questionable need for a bubble study echocardiogram in all patients requiring long-term dialysis catheters.

Effects of Fluorination on Fused Ring Electron Acceptor for Active Layer Morphology, Exciton Dissociation, and Charge Recombination in Organic Solar Cells.

Fluorination is one of the effective approaches to alter the organic semiconductor properties that impact the performance of the organic solar cells (OSCs). Positive effects of fluorination are also revealed in the application of fused ring electron acceptors (FREAs). However, in comparison with the efforts allocated to the material designs and power conversion efficiency enhancement, understanding on the excitons and charge carriers' behaviors in high-performing OSCs containing FREAs is limited. Herein, the impact of fluorine substituents on the active layer morphology, and therefore exciton dissociation, charge separation, and charge carriers' recombination processes are examined by fabricating OSCs with PTO2 as the donor and two FREAs, O-IDTT-IC and its fluorinated analogue O-IDTT-4FIC, as the acceptors. With the presence of O-IDTT-4FIC in the devices, it is found that the excitons dissociate more efficiently, and the activation energy required to split the excitons to free charge carriers is much lower; the charge carriers live longer and suffer less extent of trap-assisted recombination; the trap density is 1 order of magnitude lower than that of the nonfluorinated counterpart. Overall, these findings provide information about the complex impacts of FREA fluorination on efficiently performed OSCs.

Genetic diversity in leafy mustard (Brassica juncea var. rugosa) as revealed by agro-morphological traits and SSR markers.

Leafy mustard (B. juncea var. rugosa) constitutes an important group of vegetable mustard crops in India and is mainly cultivated in home-backyard and hilly regions of Uttarakhand and some North-eastern states. In the present study, various agro-morphological traits, physiological and biochemical traits along with SSR markers were used for genetic diversity evaluation in a germplasm collection of leafy mustard. This study revealed a significant variation among 59 accessions of leafy mustard in both qualitative and quantitative agro-morphological traits indicating the accessions' promising potential for consumption purpose and for use in breeding programs. Maximum variability was recorded for leaf area elongation rate (CV = 53.12%), followed by total plant weight (TPW) (CV = 50.63%) and seed yield per plant (CV = 44.33%). In molecular analysis, 155 SSRs evaluated resulted in 482 alleles and the number of alleles varied form 1 to 8 with an average of 3.11 alleles per marker. A total of 122 (78.70%) SSRs resulted into polymorphic amplicons. PIC value varied from 0.32 to 0.77 with an average value of 0.44 per SSR locus. The unweighted neighbour-joining-based dendrogram analysis divided all the 59 accessions into two major groups on the basis of both agro-morphological traits and SSR markers, whereas, three subpopulations/subgroups were predicted by population STRUCTURE analysis. AMOVA indicated the presence of more variability within population than among population. Overall, agro-morphologically better performing and genetically diverse genotypes have been identified which could be further used as donors for leafy mustard improvement programs.

Characterization of Myocardial Injury in Patients With COVID-19.

BACKGROUND: Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. OBJECTIVES: This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. METHODS: We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. RESULTS: A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. CONCLUSIONS: Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.

A Narrow-Bandgap n-Type Polymer with an Acceptor-Acceptor Backbone Enabling Efficient All-Polymer Solar Cells.

Narrow-bandgap polymer semiconductors are essential for advancing the development of organic solar cells. Here, a new narrow-bandgap polymer acceptor L14, featuring an acceptor-acceptor (A-A) type backbone, is synthesized by copolymerizing a dibrominated fused-ring electron acceptor (FREA) with distannylated bithiophene imide. Combining the advantages of both the FREA and the A-A polymer, L14 not only shows a narrow bandgap and high absorption coefficient, but also low-lying frontier molecular orbital (FMO) levels. Such FMO levels yield improved electron transfer character, but unexpectedly, without sacrificing open-circuit voltage (Voc ), which is attributed to a small nonradiative recombination loss (Eloss,nr ) of 0.22 eV. Benefiting from the improved photocurrent along with the high fill factor and Voc , an excellent efficiency of 14.3% is achieved, which is among the highest values for all-polymer solar cells (all-PSCs). The results demonstrate the superiority of narrow-bandgap A-A type polymers for improving all-PSC performance and pave a way toward developing high-performance polymer acceptors for all-PSCs.