Variation in risk-adjusted cardiac intensive care unit (CICU) length of stay and the association with in-hospital mortality: An analysis from the Critical Care Cardiology Trials Network (CCCTN) registry.

BACKGROUND: Previous studies have suggested that there is wide variability in cardiac intensive care unit (CICU) length of stay (LOS); however, these studies are limited by the absence of detailed risk assessment at the time of admission. Thus, we evaluated inter-hospital differences in CICU LOS, and the association between LOS and in-hospital mortality. METHODS: Using data from the Critical Care Cardiology Trials Network (CCCTN) registry, we included 22,862 admissions between 2017 and 2022 from 35 primarily tertiary and quaternary CICUs that captured consecutive admissions in annual 2-month snapshots. The primary analysis compared inter-hospital differences in CICU LOS, as well as the association between CICU LOS and all-cause in-hospital mortality using a Fine and Gray competing risk model. RESULTS: The overall median CICU LOS was 2.2 (1.1-4.8) days, and the median hospital LOS was 5.9 (2.8-12.3) days. Admissions in the longest tertile of LOS tended to be younger with higher rates of pre-existing comorbidities, and had higher Sequential Organ Failure Assessment (SOFA) scores, as well as higher rates of mechanical ventilation, intravenous vasopressor use, mechanical circulatory support, and renal replacement therapy. Unadjusted all-cause in-hospital mortality was 9.3%, 6.7%, and 13.4% in the lowest, intermediate, and highest CICU LOS tertiles. In a competing risk analysis, individual patient CICU LOS was correlated (r2 = 0.31) with a higher risk of 30-day in-hospital mortality. The relationship remained significant in admissions with heart failure, ST-elevation myocardial infarction and non-ST segment elevation myocardial infarction. CONCLUSIONS: In a large registry of academic CICUs, we observed significant variation in CICU LOS and report that LOS is independently associated with all-cause in-hospital mortality. These findings could potentially be used to improve CICU resource utilization planning and refine risk prognostication in critically ill cardiovascular patients.

Right Ventricular Dysfunction Patterns among Patients with COVID-19 in the Intensive Care Unit: A Retrospective Cohort Analysis.

Rationale: Right ventricular (RV) dysfunction is common among patients hospitalized with coronavirus disease (COVID-19); however, its epidemiology may depend on the echocardiographic parameters used to define it. Objectives: To evaluate the prevalence of abnormalities in three common echocardiographic parameters of RV function among patients with COVID-19 admitted to the intensive care unit (ICU), as well as the effect of RV dilatation on differential parameter abnormality and the association of RV dysfunction with 60-day mortality. Methods: We conducted a retrospective cohort study of ICU patients with COVID-19 between March 4, 2020, and March 4, 2021, who received a transthoracic echocardiogram within 48 hours before to at most 7 days after ICU admission. RV dysfunction and dilatation, respectively, were defined by guideline thresholds for tricuspid annular plane systolic excursion (TAPSE), RV fractional area change, RV free wall longitudinal strain (RVFWS), and RV basal dimension or RV end-diastolic area. Association of RV dysfunction with 60-day mortality was assessed through logistic regression adjusting for age, prior history of congestive heart failure, invasive ventilation at the time of transthoracic echocardiogram, and Acute Physiology and Chronic Health Evaluation II score. Results: A total of 116 patients were included, of whom 69% had RV dysfunction by one or more parameters, and 36.3% of these had RV dilatation. The three most common patterns of RV dysfunction were the presence of three abnormalities, the combination of abnormal RVFWS and TAPSE, and isolated TAPSE abnormality. Patients with RV dilatation had worse RV fractional area change (24% vs. 36%; P = 0.001), worse RVFWS (16.3% vs. 19.1%; P = 0.005), higher RV systolic pressure (45 mm Hg vs. 31 mm Hg; P = 0.001) but similar TAPSE (13 mm vs. 13 mm; P = 0.30) compared with those with normal RV size. After multivariable adjustment, 60-day mortality was significantly associated with RV dysfunction (odds ratio, 2.91; 95% confidence interval, 1.01-9.44), as was the presence of at least two parameter abnormalities. Conclusions: ICU patients with COVID-19 had significant heterogeneity in RV function abnormalities present with different patterns associated with RV dilatation. RV dysfunction by any parameter was associated with increased mortality. Therefore, a multiparameter evaluation may be critical in recognizing RV dysfunction in COVID-19.

Resonant nano-dimer metasurface for ultra-thin a-Si:H solar cells.

Low-cost hydrogenated amorphous silicon solar cells (a-Si:H) can perform better and be more competitive by including nanostructures. An optimized nano-dimer structure embedded in close contact with the back electrode of an aSi:H ultra-thin solar cells can enhance the deliverable short-circuit current up to 27.5 %. This enhancement is the result of an increase in the absorption at the active layer, that is the product of an efficient scattering from the nanostructure. From our calculations, the nano-dimer structure must be made out of a high-index of refraction material, like GaP. The evaluation of the scattering and absorption cross section of the structure supports the calculated enhancement in short-circuit current, that is always accompanied by a decrease in the total reflectance of the cell, which is reduced by about 50 %.

Detección de virus de ARN en cultivos de tomate del Oriente Antioqueño mediante secuenciación de alto rendimiento y RT-qPCR / Detection of RNA viruses in tomato fields in eastern Antioquia using high-throughput sequencing (HTS) and RT-qPCR

RESUMEN En Antioquia, el cultivo de tomate (Solanum lycopersicum) se ve afectado por diversas enfermedades virales, que ocasionan la disminución en la calidad de los frutos y de los rendimientos; sin embargo, pocos estudios han identificado, a nivel de especie, los agentes causales de dichas enfermedades. En los últimos años, la secuenciación de alto rendimiento (HTS), se ha convertido en una herramienta eficiente de diagnóstico de fitopatógenos, permitiendo la detección y la caracterización genómica de un alto número de virus, en diferentes plantas. En este trabajo, se evaluó la presencia de virus de ARN infectando tomate var. Chonto del oriente Antioqueño, mediante HTS y RT-PCR, en tiempo real (RT-qPCR), en muestras de tejido foliar y en semillas. El análisis de HTS indicó la infección de los virus Potato virus S (PVS), Potato virus Y (PVY), Potato yellow vein virus (PYVV), Potato virus X (PVX), Southern tomato virus (STV) y Bell pepper endornavirus (BPEV), en los cultivos de tomate de esta región, obteniéndose los genomas completos de PYVV, STV y BPEV. Las pruebas de RT-qPCR indicaron la presencia de PYVV en el 100% de las muestras foliares analizadas, mientras que PVX, PVY, STV y PVS, se encontraron en niveles de 94,4, 77,8, 72,2 y 5,6%, respectivamente. La evaluación de estos virus en lotes de semilla sexual comercial y no comercial y en sus plantas derivadas evidenció la presencia de cinco virus en dicho material, con niveles de prevalencia del 13 al 93% e infecciones mixtas, que incluyeron combinaciones, desde dos a cinco virus.

ABSTRACT In Antioquia, the tomato crop (Solanum lycopersicum) is seriously affected by a wide range of viral diseases that affect yield and the quality of fruits. Despite of this, there are few studies aimed at identifying these viruses at the species level. With the advent of High-throughput sequencing (HTS) methods, it is now possible to achieve an efficient characterization of viruses infecting plant hosts. In this work, the presence of RNA viruses infecting tomato var. Chonto in eastern Antioquia was tested using HTS and Real-time RT-PCR (RT-qPCR) in leaf tissues and seeds. HTS revealed infection with Potato virus S (PVS), Potato virus Y (PVY), Potato yellow vein virus (PYVV), Potato virus X (PVX), Southern tomato virus (STV) and Bell pepper endornavirus (BPEV). Complete genome sequences were obtained for PYVV, STV and BPEV. RT-qPCR showed prevalence of 100%, 94.4%, 77.8%, 72.2% and 5.6% for PYVV, PVX, PVY, STV and PVS in leaf samples, respectively. These viruses were also found infecting commercial and informal seeds and in their seedlings with a prevalence between 13 and 93%. Mixed infections were found to combine a mixture of two to five viruses.

Overexpression of a modified eIF4E regulates potato virus Y resistance at the transcriptional level in potato.

BACKGROUND: Potato virus Y (PVY) is a major pathogen of potatoes with major impact on global agricultural production. Resistance to PVY can be achieved by engineering potatoes to express a recessive, resistant allele of eukaryotic translation initiation factor eIF4E, a host dependency factor essential to PVY replication. Here we analyzed transcriptome changes in eIF4E over-expressing potatoes to shed light on the mechanism underpinning eIF4E-mediated recessive PVY resistance. RESULTS: As anticipated, modified eIF4E-expressing potatoes demonstrated a high level of resistance, eIF4E expression, and an unexpected suppression of the susceptible allele transcript, likely explaining the bulk of the potent antiviral phenotype. In resistant plants, we also detected marked upregulation of genes involved in cell stress responses. CONCLUSIONS: Our results reveal a previously unanticipated second layer of signaling attributable to eIF4E regulatory control, and potentially relevant to establishment of a broader, more systematic antiviral host defense.

Editor's Choice-Prospective registry of cardiac critical illness in a modern tertiary care Cardiac Intensive Care Unit.

BACKGROUND: The changing landscape of care in the Cardiac Intensive Care Unit (CICU) has prompted efforts to redesign the structure and organization of advanced CICUs. Few studies have quantitatively characterized current demographics, diagnoses, and outcomes in the contemporary CICU. METHODS: We evaluated patients in a prospective observational database, created to support quality improvement and clinical care redesign in an AHA Level 1 (advanced) CICU at Brigham and Women's Hospital, Boston, MA, USA. All consecutive patients (N=2193) admitted from 1 January 2015 to 31 December 2017 were included at the time of admission to the CICU. RESULTS: The median age was 65 years (43% >70 years) and 44% of patients were women. Non-cardiovascular comorbidities were common, including chronic kidney disease (27%), pulmonary disease (22%), and active cancer (13%). Only 7% of CICU admissions were primarily for an acute coronary syndrome, which was the seventh most common individual diagnosis. The top three reasons for admission to the CICU were shock/hypotension (26%), cardiopulmonary arrest (11%), or primary arrhythmia without arrest (9%). Respiratory failure was a primary or major secondary reason for triage to the CICU in 17%. In-hospital mortality was 17.6%. CONCLUSIONS: In a tertiary, academic, advanced CICU, patients are elderly with a high burden of non-cardiovascular comorbid conditions. Care has shifted from ACS toward predominantly shock and cardiac arrest, as well as non-ischemic conditions, and the mortality of these conditions is high. These data may be useful to guide cardiac critical care redesign.

Effect of lysyl oxidase inhibition on angiotensin II-induced arterial hypertension, remodeling, and stiffness.

It is well accepted that angiotensin II (Ang II) induces altered vascular stiffness through responses including both structural and material remodeling. Concurrent with remodeling is the induction of the enzyme lysyl oxidase (LOX) through which ECM proteins are cross-linked. The study objective was to determine the effect of LOX mediated cross-linking on vascular mechanical properties. Three-month old mice were chronically treated with Ang II with or without the LOX blocker, ß -aminopropionitrile (BAPN), for 14 days. Pulse wave velocity (PWV) from Doppler measurements of the aortic flow wave was used to quantify in vivo vascular stiffness in terms of an effective Young's modulus. The increase in effective Young's modulus with Ang II administration was abolished with the addition of BAPN, suggesting that the material properties are a major controlling element in vascular stiffness. BAPN inhibited the Ang II induced collagen cross-link formation by 2-fold and PWV by 44% (P<0.05). Consistent with this observation, morphometric analysis showed that BAPN did not affect the Ang II mediated increase in medial thickness but significantly reduced the adventitial thickness. Since the hypertensive state contributes to the measured in vivo PWV stiffness, we removed the Ang II infusion pumps on Day 14 and achieved normal arterial blood pressures. With pump removal we observed a decrease of the PWV in the Ang II group to 25% above that of the control values (P=0.002), with a complete return to control values in the Ang II plus BAPN group. In conclusion, we have shown that the increase in vascular stiffness with 14 day Ang II administration results from a combination of hypertension-induced wall strain, adventitial wall thickening and Ang II mediated LOX ECM cross-linking, which is a major material source of vascular stiffening, and that the increased PWV was significantly inhibited with co-administration of BAPN.

IDENTIFICACIóN MOLECULAR DE HONGOS AISLADOS DE TEJIDOS DE FRíJOL CON S͍NTOMAS DE ANTRACNOSIS / Molecular Identification of Fungi Isolated from Bean Tissues with Anthracnose Symptoms

En este estudio se realizó el aislamiento de hongos en tejidos foliares y vainas de fríjol con síntomas de antracnosis, procedentes de cultivos de diferentes municipios del departamento de Antioquia (Colombia). La identificación de los aislamientos se realizó con base en la secuenciación de las regiones ITS del ADN ribosomal y se confirmó por observación microscópica de estructuras reproductivas en aquellos aislamientos que esporulaban en medios de cultivo. En todas las muestras sintomáticas, se logró el aislamiento del agente causal de la antracnosis, .Colletotrichum lindemuthianum, siendo confirmada su identidad por PCR dúplex con cebadores específicos CD1/CD2 y CY1/CY2. En adición se obtuvieron 17 hongos endófitos, 14 de los cuales no esporularon en medio de cultivo (.Myceliasterilia), siendo identificados mediante análisis filogenéticos de regiones ITS como miembros de los Ascomycetes .Leptosphaerulina (tres aislamientos), .Diaporthe (tres aislamientos), .Gibberella (un aislamiento), .Plectosphaerella (un aislamiento) y .Biscogniauxia (un aislamiento); y de los géneros mitospóricos: Phoma (dos aislamientos), .Alternaria (dos aislamientos) y .Stemphylium (un aislamiento). Los tres hongos restantes se identificaron con base en caracteres morfológicos y secuenciación como miembros de los géneros Fusarium (dos aislamientos) y de la especie Curvularia lunata (un aislamiento). Este estudio aumenta el conocimiento de la micobiota de leguminosas, como base para el desarrollo de estudios futuros que permitan evaluar el efecto de estos hongos sobre el desarrollo de enfermedades como la antracnosis y de otros problemas bióticos y abióticos del cultivo del fríjol.

In this work, endophytic fungi from leaves and pods of bean presenting anthracnose symptoms were isolated from plants collected at different municipalities in the province of Antioquia (Colombia). Isolates were identified by sequencing the rDNA ITS regions together with the examination of reproductive structures during sporulation in culture media.Colletotrichum lindemuthianum, the causal agent of anthracnose was isolated in all samples showing symptoms of this disease. These results were confirmed by duplex PCR using the specific primers CD1/CD2 and CY1/CY2. Additionally, 17 endophytic fungi were obtained. Fourteen isolates did not sporulate in culture media (.Myceliasterilia) but were identified by phylogenetic analysis of the ITS regions as the Ascomycetes: .Leptosphaerulina (3), .Diaporthe (3), .Gibberella (1), .Plectosphaerella (1) and .Biscogniauxia (1) and the mitosporic genera Phoma (2), .Alternaria (2) and .Stemphylium (1). Three isolates were identified combining morphological and molecular analysis as Fusarium (2) and Curvularia lunata (1). This work increases our knowledge of the mycobiota of legume plants and will serve as support of future studies aimed at determining the effect of these fungi on the development of anthracnose as well as other problems affecting the bean crop.

Técnica modificada de obtención de muestras del mediastino mediante punción transbronquial bajo guía de ecografía endobronquial: resultados de un estudio prospectivo observacional / Modified Technique for Obtaining Mediastinal Samples With Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Results from a Prospective Observational Study

Antecedentes: La aspiración mediante punción transbronquial bajo guía de ecografía transbronquial (EBUS-TBNA) es un método ampliamente aceptado para la obtención de muestras de ganglios linfáticos mediastínicos tanto benignos como malignos. Se presentan los resultados obtenidos con una modificación que simplifica la técnica de obtención de muestras denominada «capilaridad con aguja fina» o EBUS-FNC. Métodos: Estudio prospectivo observacional de 44 pacientes consecutivos a los que se practicó una EBUS en la Clínica de la Universidad de Navarra de Pamplona (España). Todas las muestras se obtuvieron mediante EBUS-FNC en vez de con la EBUS-TBNA convencional. No se aplicó aspiración y en ningún momento se retiró por completo el estilete interno. Resultados: La exploración del mediastino mediante EBUS identificó la presencia de adenopatías o masas mediastínicas en 38 pacientes (86,4%). Se obtuvieron muestras de más de un ganglio linfático en 23 pacientes (52,3%). La EBUS-FNC proporcionó un material adecuado y representativo para realizar la interpretación en todos los pacientes, y el rendimiento diagnóstico fue del 87%. La sensibilidad para la detección del cáncer de pulmón con la EBUS-FNC fue del 84%. Se registraron complicaciones menores tan solo en 2 pacientes (4,5%). Conclusiones: Nuestro estudio sugiere que la EBUS-FNC es una técnica segura y comparable a la EBUS-TBNA en cuanto a su eficacia y obtención de muestras adecuadas(AU)

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely-accepted method for obtaining both benign and malignant mediastinal lymph node samples. We present the results obtained with a modification that simplifies sampling, known as fine-needle capillary sampling or EBUS-FNC. Methods: A prospective observational study with 44 consecutive patients who underwent EBUS at the University of Navarra Clinic in Pamplona, Spain. All samples were obtained by EBUS-FNC instead of by conventional EBUS-TBNA. No suction was used, and the internal stylus was not completely withdrawn at any time. Results: The examination of the mediastinum by means of EBUS identified the presence of lymphadenopathies or mediastinal masses in 38 patients (86.4%). Samples were taken from more than one lymph node in 23 patients (52.3%). EBUS-FNC provided adequate and representative material for interpretation in all patients, and diagnostic performance was 87%. Sensitivity for the detection of lung cancer with EBUS-FNC was 84%. Mild complications were only recorded in two patients (4.5%). Conclusions: Our study suggests that EBUS-FNC is a safe technique, comparable to EBUS-TBNA in efficacy, and is able to obtain adequate samples(AU)

Modified technique for obtaining mediastinal samples with endobronchial ultrasound-guided transbronchial needle aspiration: results from a prospective observational study.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely-accepted method for obtaining both benign and malignant mediastinal lymph node samples. We present the results obtained with a modification that simplifies sampling, known as fine-needle capillary sampling or EBUS-FNC. METHODS: A prospective observational study with 44 consecutive patients who underwent EBUS at the University of Navarra Clinic in Pamplona (Spain). All samples were obtained by EBUS-FNC instead of by conventional EBUS-TBNA. No suction was used, and the internal stylus was not completely withdrawn at any time. RESULTS: The examination of the mediastinum by means of EBUS identified the presence of lymphadenopathies or mediastinal masses in 38 patients (86.4%). Samples were taken from more than one lymph node in 23 patients (52.3%). EBUS-FNC provided adequate and representative material for interpretation in all patients, and diagnostic performance was 87%. Sensitivity for the detection of lung cancer with EBUS-FNC was 84%. Mild complications were only recorded in two patients (4.5%). CONCLUSIONS: Our study suggests that EBUS-FNC is a safe technique, comparable to EBUS-TBNA in efficacy, and is able to obtain adequate samples.