Evaluation of enhanced nanofiltration membranes for improving magnesium recovery schemes from seawater/brine: Integrating experimental performing data with a techno-economic assessment

The global demand for valuable metals and minerals necessitates the exploration of alternative, sustainable approaches to mineral recovery. Seawater mining has emerged as a promising option, offering a vast reserve of minerals and an environmentally friendly alternative to land-based mining. Among the various techniques, Nanofiltration (NF) has gained significant attention as a preliminary treatment step in Minimum Liquid Discharge (MLD) and Zero Liquid Discharge (ZLD) schemes. This study focused on the potential of two underexplored commercial polyamide based NF membranes, Synder NFX and Vontron VNF1, with enhanced divalent over monovalent separation factors, in optimizing the extraction of magnesium hydroxide (Mg(OH)2) from seawater and seawater reverse osmosis (SWRO) brines. The research encompassed a thorough characterization of the membranes utilizing advanced physic-chemical analytical techniques, followed by rigorous experimental assessments using synthetic seawater and SWRO brine in concentration configuration. The findings highlighted the superior selectivity of NFX for magnesium recovery from SWRO brine and the promising concentration factors of VNF1 for seawater treatment. Cross-validation of experimental data with a mathematical model demonstrated the model's reliability as a process design tool in predicting membrane performance. A comprehensive techno-economic evaluation demonstrates the potential of NFX, operating optimally at 23 bar pressure and 70% permeate recovery rate, to yield an estimated annual revenue of 5.683 M€/yr through Mg(OH)2 production from SWRO brine for a plant with a nominal capacity of 0.8 Mm3/y. This research shed light on the promising role of NF membranes in enhancing mineral recovery taking benefit of their separation factors and emphasizes the economic viability of leveraging NF technology for maximizing magnesium recovery from seawater and SWRO brines.

Simulating drifting fish aggregating device trajectories to identify potential interactions with endangered sea turtles

Purse-seine fishers using drifting fish aggregating devices (dFADs), mainly built with bamboo, plastic buoys, and plastic netting, to aggregate and catch tropical tuna, deploy 46,000-65,000 dFADs per year in the Pacific Ocean. Some of the major concerns associated with this widespread fishing device are potential entanglement of sea turtles and other marine fauna in dFAD netting; marine debris and pollution; and potential ecological damage via stranding on coral reefs, beaches, and other essential habitats for marine fauna. To assess and quantify the potential connectivity (number of dFADs deployed in an area and arriving in another area) between dFAD deployment areas and important oceanic or coastal habitat of critically endangered leatherback (Dermochelys coriacea) and hawksbill (Eretmochelys imbricata) sea turtles in the Pacific Ocean, we conducted passive-drift Lagrangian experiments with simulated dFAD drift profiles and compared them with known important sea turtle areas. Up to 60% of dFADs from equatorial areas were arriving in essential sea turtle habitats. Connectivity was less when only areas where dFADs are currently deployed were used. Our simulations identified potential regions of dFAD interactions with migration and feeding habitats of the east Pacific leatherback turtle in the tropical southeastern Pacific Ocean; coastal habitats of leatherback and hawksbill in the western Pacific (e.g., archipelagic zones of Indonesia, Papua New Guinea, and Solomon Islands); and foraging habitat of leatherback in a large equatorial area south of Hawaii. Additional research is needed to estimate entanglements of sea turtles with dFADs at sea and to quantify the likely changes in connectivity and distribution of dFADs under new management measures, such as use of alternative nonentangling dFAD designs that biodegrade, or changes in deployment strategies, such as shifting locations.

Non-invasive in-utero quantification of vascular reactivity in human placenta

OBJECTIVE

Placental vascular reactivity (PlVR) indicates the ability of the placental vasculature to match blood supply to fetal demand. Many pregnancy disorders alter the characteristics of PlVR, resulting in suboptimal oxygen delivery, although current understanding is limited by the lack of non-invasive, repeatable methods to measure PlVR in utero. Our objective was to quantify PlVR by measuring the placental response to transient changes in maternal carbon dioxide (CO2) using blood-oxygen-level-dependent (BOLD) magnetic resonance imaging (MRI). We hypothesized that PlVR will increase with gestational age to meet the changing demands of a growing fetus, and that PlVR will be driven by a maternal response to changes in CO2 concentration.

METHODS

This was a cross-sectional study of 35 women with a healthy singleton pregnancy, of whom 31 were included in the analysis. The median gestational age was 32.6 (range, 22.6-38.4) weeks. Pregnant women were instructed to follow audiovisual breathing cues during a MRI scan. Maternal end-tidal CO2 (EtCO2) was measured concurrently with resting placental BOLD MRI for a total of 7-8 min. Preprocessing of magnetic resonance images consisted of manual delineation of placental anatomy and motion correction. In each placental voxel, vascular reactivity was computed using a coherence-weighted general linear model between MRI signal and EtCO2 stimulus. Global PlVR was computed as the mean of voxel-wise PlVR values across the placenta.

RESULTS

PlVR, quantified by the placental response to induced, transient changes in maternal CO2, was consistently measured in utero using BOLD MRI. PlVR increased non-linearly with advancing gestational age (P < 0.001) and was higher on the fetal side of the placenta. PlVR was associated positively with fetal brain volume after accounting for gestational age. PlVR did not show any significant associations with maternal characteristics.

CONCLUSIONS

We present, for the first time, a non-invasive paradigm to quantify PlVR in ongoing human pregnancies without the use of exogenous gases or contrast agents. Our findings suggest that PlVR is driven by a fetal response to changes in maternal CO2. Ease of translation to the clinical setting makes PlVR a promising biomarker for the identification and management of high-risk pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

What does "Advanced" mean in 2023? reflecting on 10 years of the ESTRO advanced Skills in modern radiotherapy course

The roles and responsibilities of radiation therapists (RTTs) are many and varied. Professional expectations are influenced by the technology available, as well as the level of autonomy RTTs have in their daily practice. This professional range requires RTTs to possess a unique set of ever evolving skills, posing challenges from an educational perspective. Teaching these "advanced skills" has been the ambition the ESTRO Advanced Skills in Modern Radiotherapy course. In the 10th year of this course, the Faculty look back and reflect on how our programme has evolved and what it has achieved.

Sleep spindles in adolescents with major depressive disorder

Sleep spindle differences in adolescents with major depressive disorder (MDD) compared to healthy adolescents is an ongoing debate. Results mostly indicate decreased sleep spindle activity in adolescents with MDD. Given that sleep spindles predominate NREM and that acutely delaying the sleep period via a "sleep delay challenge" (SDC) increases non-rapid eye movement (NREM) sleep duration, it may be possible to increase spindle density in adolescents with MDD, which may provide a therapeutic benefit to depression symptoms. Here, we examined the impact of a SDC on spindle density and depression symptomology in adolescents with MDD (n = 66) and healthy controls (n = 62) tested across three nights: adaptation, normal sleep, and a SDC night which delayed bedtime by three hours. The results showed that; (1) there was no difference in spindle density between groups on the normal sleep night, (2) following the SDC, both males and females with MDD had a decrease in the frequency of slow spindles, while only females with MDD had an increase in the frequency of fast spindles, (3) acute SDC reduced depression symptoms in both groups, and (4) light sleep on the normal sleep night and slow spindle frequency at SDC predicted an 8 % improvement in depression symptoms, regardless of sex or MDD diagnosis. Taken together, these results suggest that; (a) spindles may be a useful biological marker of depression symptomatology regardless of clinical MDD diagnosis, and (b) that acute SDC may help alleviate depression symptoms in adolescents with MDD.

Compliance to genomic test recommendations to guide adjuvant chemotherapy decision-making in the case of hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, in real-life settings

BACKGROUND

Genomic tests are a useful tool for adjuvant chemotherapy decision-making in the case of hormone receptor-positive (HR+), and human epidermal growth factor receptor 2-negative (HER2-) breast cancer with intermediate prognostic factors. Real-life data on the use of tests can help identify the target population for testing.

METHODS

French multicentric study (8 centers) including patients, all candidates for adjuvant chemotherapy for HR-positive, HER2-negative early breast cancer. We describe the percentage of tests performed outside recommendations, according to the year of testing. We calculated a ratio defined as the number of tests required to avoid chemotherapy for one patient, and according to patient and cancer characteristics. We then performed a cost-saving analysis using medical cost data over a period of 1 year from diagnosis, calculated from a previous study. Finally, we calculated the threshold of the ratio (number of tests required to avoid chemotherapy for one patient) below which the use of genomic tests was cost-saving.

RESULTS

A total of 2331 patients underwent a Prosigna test. The ratio (performed test/avoided chemotherapy) was 2.8 [95% CI: 2.7-2.9] in the whole population. In the group following recommendations for test indication, the ratio was 2.3 [95% CI: 2.2-2.4]. In the case of non-abidance by recommendations, the ratio was 3 [95% CI: 2.8-3.2]. Chemotherapy was avoided in 841 patients (36%) following the results of the Prosigna test. The direct medical costs saved over 1 year of care were 3,878,798€ and 1,718,472€ in the group of patients following test recommendations. We calculated that the ratio (performed test/avoided chemotherapy) needed to be under 6.9 for testing to prove cost-saving.

CONCLUSION

The use of genomic testing proved cost-saving in this large multicentric real-life analysis, even in certain cases when the test was performed outside recommendations.

Framing the mobility transition: public communication of industry, science, media, and politics in Germany

BACKGROUND

Applying the Multi-Level Perspective (MLP) on socio-technical transitions, paired with the interdisciplinary framing approach, this paper investigates how incumbent actors of automobility in Germany framed the issue of a "transition of mobility and transport" ("Verkehrs/Mobilitätswende") in their public communication in 2020. We first identified representatives of industry, science, policy, and media, since the Verkehrs/Mobilitätswende and its implementation measures are contested among these actors. Employing qualitative content analysis, we then screened 325 public documents according to the elements of the framing approach problem definition, causal interpretation, moral evaluation, and treatment recommendation.

RESULTS

Findings show that most of the actors frame a transformation of transport and mobility as a necessity. Their arguments encompass environmental and climate-related issues as well as infrastructural problems for bikes and public transport caused by the hegemony of automobility. The actors propose a variety of solutions, primarily focusing on technical innovations for cars or on the expansion of different infrastructures to achieve a modal shift towards sustainable mobility.

CONCLUSION

This paper demonstrates that there is no common understanding of the problems and solutions to foster a mobility transition, as the diversity of problems and solutions proposed within the frame elements is high and complicates the prevailing implementation gap of the mobility transition. Therefore, MLP should be conceptually and methodologically bridged with the interdisciplinary framing approach, particularly with regard to the transition of mobility and transport.

FTO variant RS 1121980 interact with metabolic response after weight loss with a meal replacement hypocaloric diet in Caucasian obese subjects

OBJECTIVE

One genetic variant (rs1121980) of FTO gene has been related with body mass index and visceral adiposity. The objective of our study was to investigate the role of rs1121980 genetic variant of FTO gene on weight loss and metabolic changes secondary to a partial meal replacement (pMR) hypocaloric diet.

PATIENTS AND METHODS

We conducted an interventional study on 219 obese Caucasian subjects with body mass index (BMI) > 30 kg/m2. The subjects received two intakes per day of a normocaloric hyperproteic formula for 12 weeks. Adiposity and biochemical parameters (lipid profile, insulin, homeostasis model assessment (HOMA-IR) and glucose) were determined.

RESULTS

After the pMR diet, body weight, BMI, fat mass, waist circumference, blood pressure, total-cholesterol, LDL-cholesterol, triglyceride, fasting insulin levels and HOMA-IR decreased in both genotype groups. The improvements in adiposity parameters and some biochemical parameters (insulin, HOMA-IR, triglyceride levels) were bigger in non-T allele carriers than in T allele carriers. The percentage of patients who achieved 7.5% weight loss was higher in the non-T carriers (76.7% vs. 48.4%), also with a different average of weight loss (-12.3±0.3 kg vs. -5.9±0.5 kg: p=0.01). The odds ratio to achieve 7.5% of weight loss was (OR= 2.22, 95% CI=1.24-4.01; p=0.02).

CONCLUSIONS

Non-T allele carriers of rs1121980 show a higher magnitude of weight loss and improvement in adiposity parameters, insulin, HOMA-IR and triglyceride levels resulting from a pMR diet than T allele carriers.

Fused silica ablation by double ultrashort laser pulses with dual wavelength and variable delays

Today, glass and other similar dielectric materials are widely used in modern manufacturing. However, glass is a brittle and a heat sensitive material. Laser technology is used to process glass but quality and throughput are still a key issue. In the present paper, we investigate dual-wavelength double ultrashort laser pulses in order to control free electrons dynamics and subsequent ablation for fused silica processing, and further improve the understanding of this laser-material interaction. We used a high average power Yb-doped femtosecond laser source (100 W) with two optical lines exhibiting different pulse durations and wavelengths (500 fs at 515 nm; and 1 or 10 ps at 1030 nm) with various fluences and delays. The best configuration in terms of ablation efficiency is expected to take place when the green pulse first induces free electrons, followed by their heating by the red pulse. The obtained results are discussed in terms of optical transmission as well as ablated volume, and are compared with single pulse ablation. Our experimental results are supported by absorbed energy density calculations based on a model considering the two-color laser induced electron dynamics, including photoionization, laser heating of free electrons, and their recombination. We demonstrate that there is an optimal cooperating effect between the two sub-pulses for a 1-ps delay, nevertheless there is no beneficial effect in splitting the beam for optimizing fused silica ablation compared with the single-pulse green configuration.

COVID-19 among migrants, refugees, and IDPs: a synthesis of the global empirical literature

Background

The COVID-19 syndemic reveals social and health inequalities, putting marginalized groups such as migrants at greater risk. Yet health systems fail to routinely monitor the health of migrants, refugees, and internally displaced persons. Our systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 infection risk, transmission, outcome of disease and risk of severe course of disease among migrant populations. It further aims to compile extant evidence on COVID-19 vaccination coverage among these groups, and on the effects of pandemic control measures on their health.

Methods

Following PRISMA guidelines, we registered a review protocol, searched 14 scientific databases and 4 pre-print servers using the WHO database of global literature on COVID-19, and hand-searched relevant websites for grey literature. The search period covers the time from 12/2019 to 11/30/2021. Articles in English, German and Spanish and all study designs were included.

Results

A total of 6966 references were identified for title and abstract screening. 518 records were screened in full-text, out of which 204 articles were included so far (conflict solving at full-text stage and data extraction are ongoing). Our review presents a broad landscape of different study designs, migrant populations and COVID-19 outcomes. Based on previous work, we expect to find a higher risk of infection in migrants and their disproportionate share among COVID-19 cases, and consolidate the (mental) health impacts of pandemic control measures. Our preliminary findings indicate a vast knowledge gap on vaccination coverage among migrant groups.

Conclusions

Two years into the syndemic, this review summarizes the global empirical evidence on the impact of the COVID-19 syndemic on migrant populations. With health systems often lacking related data, the review provides an important evidence base for the consideration of migrants in future pandemic preparedness policies.

Key messages

• The systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 among diverse migrant populations globally.

• Knowledge on vaccination coverage in migrants remains patchy.

Racial disparities in the contemporary utilization and outcomes of left atrial appendage occlusion in the United States

Background

Racial and socioeconomic disparities in the utilization of percutaneous structural heart disease interventions have been described in previous years, reflecting significant gaps. However, it is unclear if increased awareness has created meaningful changes in the utilization of left atrial appendage occlusion (LAAO) in underrepresented populations.

Purpose

We aim to further clarify current practices in the United States and answer questions to help guide further efforts in attenuating health disparities.

Methods

The National Inpatient Sample (NIS) was queried from 2016–2019 to identify all patients &gt;65 years of age diagnosed with atrial fibrillation or atrial flutter who underwent left atrial appendage occlusion (LAAO) using the international classification of diseases, tenth revision clinical modification (ICD-10-CM) codes. We selected this age cutoff to minimize confounding bias from lack of insurance coverage as patients age 65 and older qualify for the Center of Medicare & Medicaid Services. We excluded patients with missing race information. In addition, we confined our analysis to patients of White, Black, and Hispanic ethnicity because the number of other races was insufficient for meaningful analysis. Multivariate linear and logistic regression analysis was performed to compare the odds of procedure utilization, in-hospital mortality, and significant periprocedural complications among study groups.

Results

We identified a total of 14,103,690 patients &gt;65 years of age diagnosed with either atrial fibrillation or atrial flutter. Of those, 53,350 (0.38%) underwent LAAO. The mean age of the sample was 79±7.6 years. Compared to White patients, Black patients had lesser odds of undergoing LAAO when controlling for multiple confounders (AOR = 0.49, 95% CI 0.44–0.55, p&lt;0.001). Among Hispanic patients, there was no statistically significant difference in the odds of undergoing LAAO compared to White patients. There was no statistically significant difference in mortality, vascular complications, non-home discharge, stroke, transient ischemic attack, pericardial tamponade, and length of stay in patients undergoing LAAO among different ethnicities.

Conclusions

Significant disparities, including procedure utilization and patient characteristics prior to the procedure, such as household income, still exist among Black patients compared to White patients undergoing the LAAO in the United States. Nevertheless, adjusted odds of in-hospital outcomes were similar among Black, Hispanic, and White patients. Further research is necessary to identify what mitigation strategies could be effective and what can be changed to close the remaining gap.

Funding Acknowledgement

Type of funding sources: None.

Tricuspid regurgitation worsening after transcatheter or surgical aortic valve replacement

Background

Tricuspid regurgitation (TR) often occurs concomitantly with severe aortic stenosis. Post-operative worsening of tricuspid regurgitation has been observed after surgical and transcatheter aortic valve replacement (SAVR, TAVR) [1,2].

Purpose

Pre-procedural severe tricuspid regurgitation has been shown to be a predictor of all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR) [3,4]. However, little is known about the incidence of worsening tricuspid regurgitation after SAVR and TAVR and the impact on post-procedural outcomes. This study aims to evaluate, characterize and compare the incidence of worsening TR after TAVR and SAVR.

Methods

Retrospective single-center study of patients undergoing Transcatheter and Surgical Aortic Valve Replacement for severe aortic stenosis between 2014 and 2020. Incidence of tricuspid regurgitation was noted on echocardiogram at baseline and 1 year after TAVR or SAVR. This study enrolled 430 patients in the TAVR group and 237 patients in the SAVR group. The SAVR group only included patients who underwent isolated SAVR without any other valve intervention. Patients with severe TR at baseline were excluded from the study. Progression of TR severity was defined as deterioration by at least 1 grade of severity compared to baseline on echocardiography. Multivariable logistic regression analysis was performed to identify associations with worsening TR.

Results

Mean age of TAVR patients was higher than the SAVR patients (79±9 vs 68±12 years, p&lt;0.0001). TAVR patients also had a significantly higher EuroSCORE than the SAVR patients (8.0±7 vs 3.5±4, p&lt;0.0001). TAVR group was more likely to have atrial fibrillation than the SAVR group (34% vs 24%, p=0.006). Baseline right ventricular dysfunction and right ventricular enlargement were significantly higher in the TAVR group compared to the SAVR group [9% vs 4%, (p=0.009) and 10% vs 6%, (p=0.04), respectively]. Progression of TR severity occurred in 21.8% (94/430) of TAVR patients and 31.2% (74/237) of SAVR patients. Majority of these patients progressed from absent TR to mild TR [13.2% (57) in TAVR group vs 19.8% (47) in SAVR group (p=0.02)]. 6.3% (27) of patients in the TAVR group and 8.8% (21) of patients in the SAVR group had mild to moderate worsening of TR (p=0.22). 1.63% (7) in the TAVR group and 2.1% (5) in the SAVR group had progression from moderate to severe TR (p=0.65). On multivariable analysis, SAVR (Odds ratio, 2.46 [CI, 1.6–3.7]) and age (Odds ratio, 1.03 [CI, 1.03–1.05]) were associated with worsening TR severity.

Conclusions

In this retrospective observational study, SAVR and age were found to be associated with worsening tricuspid regurgitation. Majority of these patients progressed from absent TR to mild TR after SAVR. Further studies are necessary to determine long term outcomes of worsening tricuspid regurgitation after TAVR and SAVR.

Funding Acknowledgement

Type of funding sources: None.

Effect of frailty on in-hospital outcomes after transcatheter mitral valve repair

Background

Mitral regurgitation (MR) is a common valvular disorder associated with significant morbidity and mortality. Transcatheter mitral valve repair (TMVr) is a minimally invasive procedure indicated for the treatment of selected patients with moderate-severe or severe primary MR. Despite a lack of a universal definition, frailty has been associated with poor post-procedural outcomes. Albeit several trials have examined individual prognostic factors in this population, there is a paucity of data regarding the effect of frailty on in-hospital outcomes after TMVr.

Purpose

To further elucidate the association of frailty with in-hospital outcomes in patients undergoing TMVr.

Methods

The national inpatient sample (NIS) database, which is part of the Healthcare Cost and Utilization Project (HCUP), was queried from 2016 to 2019 to identify all who underwent TMVr. International classification of diseases, tenth revision clinical modification (ICD-10-CM) codes were used to divide patients into frail and non-frail study groups. Frailty was defined using Johns Hopkins Adjusted Clinical Groups diagnosis cluster for frailty. Multivariate linear and logistic regression analysis was performed to compare in-hospital mortality, hospital length of stay, non-home discharge, and iatrogenic cardiac complications among Frail and Non-Frail groups.

Results

A total of 30,660 patients who underwent TMVr were identified. The mean age was 76±11.6 years. Of those, 2,950 (9.6%) were identified as frail. The overall in-hospital mortality rate for the entire study population was 1.89%. Compared to non-frail patients, those identified as frail had greater odds of in-hospital mortality (AOR= 2.13, 95% CI 1.29–3.51, p&lt;0.001) and non-home discharge (AOR= 4.34, 95% CI 3.54–5.32, p&lt;0.001). However, there was no statistically significant difference in hospital length of stay and rates of iatrogenic cardiac complications.

Conclusions

Frailty models continue to be underutilized as a prognostic tool in clinical practice. After following HCUP guidelines, our analysis found that frailty is independently associated with increased in-hospital mortality and non-home discharge in patients undergoing TMVr. Therefore, we recommend that further efforts in incorporating frailty models in the pre-procedural assessment of patients undergoing TMVr should be sought along with a standardized predictive model for defining frailty.

Funding Acknowledgement

Type of funding sources: None.

Impact of left bundle branch block in patients with takotsubo cardiomyopathy

Background

Takotsubo cardiomyopathy (TCM) is a syndrome characterized by reversible left-ventricular regional systolic dysfunction in the absence of obstructive coronary artery disease (CAD). The presence of left bundle branch block (LBBB) has been described as an independent predictor of mortality in patients with CAD. One study using the National Inpatient Sample (NIS) for 2016 found that the presence of LBBB was associated with worse outcomes in patients with TCM.

Purpose

To better clarify the association between LBBB and various in-hospital outcomes in patients with TCM.

Methods

The NIS database was queried from 2016–2019 to identify all admissions with a primary diagnosis of TCM that had a cardiac catheterization to improve the specificity of the diagnosis. International classification of diseases, tenth revision clinical modification (ICD-10-CM) codes were used to divide patients based on the presence or absence of LBBB. A 1:3 propensity score matching based on age, race, gender, and risk factor stratification was used to reduce selection bias. Multivariate linear and logistic regression analysis was performed to compare various outcomes among both groups.

Results

A total of 27,125 patients admitted with a primary diagnosis of TCM that also underwent diagnostic coronary angiography were identified. In the study sample, 955 (3.5%) were determined to have a LBBB. After calculating propensity scores, 955 patients with LBBB were paired to 2,865 patients without LBBB. LBBB was associated with higher rates of ventricular arrhythmias (AOR=3.098, 95% CI 1.483–6.471, p=0.003); however, it was not statistically associated with cardiogenic shock, sudden cardiac arrest (SCA), acute kidney injury, acute heart failure, and hospital length of stay. In addition, there was no statistical difference in intra-hospital mortality.

Conclusions

LBBB is associated with left ventricular dyssynchrony. It has been proposed that intraventricular dyssynchrony might be a predisposing factor for ventricular arrhythmias (VA) and SCA. Several trials have demonstrated that cardiac resynchronization therapy alone (i.e., without defibrillation) reduces the rate of VA and SCA. The mechanism for this improvement is unclear but may be related to hemodynamic improvement from ventricular synchrony in heart failure (HF). In fact, LBBB has been reported as an independent risk factor for all-cause mortality and SCA at one year in patients with HF. Our analysis did not find any significant association between LBBB and SCA but did find an association with VA. Moreover, there were not enough events of intra-hospital mortality to assess a possible association between LBBB and mortality. Therefore, a prospective study with a longer follow-up would be needed to clarify the role of LBBB in mortality and establish causality between LBBB and VA in patients with TCM.

Funding Acknowledgement

Type of funding sources: None.

AB1008 CHARACTERIZATION OF THE RISK OF OSTEOPOROSIS IN A COHORT OF RHEUMATIC PATIENTS DURING 10 YEARS OF FOLLOW-UP

Background

Osteoporosis is the most common cause of fractures. The lifetime risk of fracture after age 50 is 40% for women and 13% for men.

Objectives

Patients with rheumatological diseases are at greater risk for the development of osteoporosis, either due to the natural history of their disease or due to the side effects of the medications used. We proposed to carry out this study.

Methods

Retrospective study aimed at determining the presence of risk factors in patients over 50 years of age who attend the Rheumatology service of a hospital in Venezuela during a follow-up from January 2010 to December 2020 in order to know these risk factors and thus generate strategies that allow better orienting the care of these patients.

Results

The main group of patients was constituted by the female gender and the ages between 50 and 65 years. The main rheumatological pathology was rheumatoid arthritis, followed by Lupus, Osteoarthritis in 3 place and finally in the last box other entities other than those indicated.

Graph 1. Prevalence of Osteoporosis due to rheumatological pathologies.

Conclusion

The 2 main risk factors for the development of osteoporosis were the use of steroids and obesity. The main type of osteoporosis of the 2 categories described was non-severe. The main group of rheumatological patients most associated with osteoporosis were those with rheumatoid arthritis. 12% of the patients with rheumatic disease and osteoporosis did not have appropriate therapy.

References

[1]Tella SH, Gallagher JC. Prevention and treatment of postmenopausal osteoporosis. J Steroid Biochem Mol Biol. 2014 Jul;142:155-70. doi: 10.1016/j.jsbmb.2013.09.008.

[2]Gambacciani M, Levancini M. Management of postmenopausal osteoporosis and the prevention of fractures. Panminerva Med. 2014 Jun;56(2):115-31.

[3]McLendon AN, Woodis CB. A review of osteoporosis management in younger premenopausal women. Womens Health (Lond). 2014 Jan;10(1):59-77. doi: 10.2217/whe.13.73.

[4]Eriksen EF, Díez-Pérez A, Boonen S. Update on long-term treatment with bisphosphonates for postmenopausal osteoporosis: a systematic review. Bone. 2014 Jan;58:126-35. doi: 10.1016/j.bone.2013.09.023.

Disclosure of Interests

None declared

Cholesteryl ester transfer protein rs5833 genetic variant affect HDL-cholesterol levels and ratio total cholesterol/HDL-cholesterol in postmenopausal obese female patient

OBJECTIVE

One SNP in exon 9 (r5883) has been involved with high risk of cardiovascular disease in hypertensive subjects. The goal of the present study was to test the role of this genetic variant on lipid levels and Metabolic Syndrome (MS) in menopausal obese females.

PATIENTS AND METHODS

The study enrolled a sample of 112 menopausal obese females. Measurements of adiposity parameters, blood pressure, fasting blood glucose, insulin concentration, insulin resistance (HOMA-IR), lipid profile, C reactive protein and prevalence of MS were recorded. Genotype of CETP gene polymorphism (rs5883) was studied.

RESULTS

The distribution of the rs5883 polymorphism in this menopausal obese population was 83.9% (n=94) (CC), 15.2% (n=17) (CT) and 0.9% (n=1) (TT). Adiposity parameters, blood pressure, fasting glucose levels, insulin levels, HOMA-IR, C reactive protein, total cholesterol, LDL-cholesterol and triglycerides were similar in both genotype groups (CC vs. CT+TT). Moreover, HDL cholesterol (8.5+1.2 mg/dl; p=0.01) and ratio total cholesterol/HDL-cholesterol (0.5±0.2; p=0.04) were higher in T allele carriers (dominant model). MS percentage was similar in both genotypes (37.6% vs. 27.2%; p=0.43). Logistic regression analysis showed a decreased risk of low-HDL cholesterol in T allele carriers (OR=0.18, 95% CI=0.02-0.77, p=0.03) after adjusting by dietary fatty acid intakes, body mass index and age.

CONCLUSIONS

The results reported here support that CETP variant rs5883 is related with HDL-cholesterol levels and ratio total cholesterol/HDL-cholesterol.

Impact of frailty on elderly patients with infective endocarditis

Introduction

Frailty studies focused on patients with infective endocarditis (IE) are scarce and its potential impact on patient outcomes is not well known.

The aim of this study is to describe the clinical profile and prognosis of elderly patients with IE, comparing patients who met the frailty criteria versus those who did not.

Methods

A total of 121 cases of confirmed IE were consecutively collected in three tertiary hospitals between 2017 and 2019. The patients were classified into two groups: Group I (n=49), patients with IE who met the Frail criteria for frailty, and Group II (n=72), those patients without frailty by this scale.

Results

The median age of our cohort was 77 years (69–82), and 62.8% were men. Frail patients were older than those in Group II, as shown in Table 1.

Regarding comorbidity, chronic anemia (40.8% vs 25%; p&lt;0.060) was more common in Group I, as well as rheumatic manifestations at admission (12.2% vs 1.4%; p=0.014).

The most frequently isolated microorganisms were S. aureus (n=25), coagulase negative staphylococci (n=25), viridans group streptococci (n=14), and enterococci (n=14). Enterococci (16.3% vs 8.3%, p=0.177) and non-viridans streptococci (10.2% vs 2.8%); p=0.086) were more frequent in frail patients.

Vegetation (79.6% vs 80.6%; p=0.896) and periannular complications (24.5% vs 29.2%; p=0.571) were similar in both groups. No significant differences were found regarding the location of the infection.

The incidence of in-hospital complications was similar between both groups. Frail patients underwent surgery less frequently than those in Group II, and had higher predicted mortality on surgical risk scale scores. However, the percentage of patients who met the surgical criteria and were considered inoperable was similar (33.3% vs 26.2%; p=0.415). In-hospital mortality was similar in both groups. When analyzing in-hospital mortality according to the therapeutic strategy in Group I, a mortality of 34.5% was observed in frail patients with conservative medical treatment, compared to 47.1% in those patients who underwent surgery in the same group.

One third of our patients received outpatient antibiotic treatment, being significantly more frequent in Group I (39.6% vs 29.0%; p=0.232).

Conclusions

The elderly patients with IE and frailty criteria were older and more frequently had rheumatic symptoms at admission. Enterococci and non-viridans streptococci were isolated more frequently than in non-frailty patients. Surgery was less performed among frail patients, who had a higher predicted surgical risk. Although complications and in-hospital mortality were similar between both groups, in the group of frail patients, those with conservative management showed lower mortality compared to surgery.

Funding Acknowledgement

Type of funding sources: None.

Outcomes of ST-Elevation Myocardial Infarction due to spontaneous coronary artery dissection: a nationwide cohort sample

Background

Spontaneous coronary artery dissection (SCAD) is a common, non-atherosclerotic cause of myocardial infarction (MI). While conservative therapy is preferred in most cases, its role among those presenting as ST-elevation myocardial infarction (STEMI) remains undefined.

Purpose

We aimed to explore outcomes of SCAD causing STEMI, stratifying cases by involved coronary artery and revascularization status.

Methods

We used the Nationwide Readmission Database (2015–2018) to identify patients hospitalized with STEMI by using ICD-10-Clinical modification codes, and then stratified them into SCAD or no-SCAD groups. Each group was further subdivided by involved coronary artery (i.e., left main, left anterior descending, left circumflex, or right coronary artery), and if revascularization (i.e., percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)) was performed. We excluded patients &gt;55 years old or with iatrogenic dissection. The age restriction allows us to compare a similarly aged group of patients. The primary outcome was in-hospital mortality. Cardiogenic shock, acute kidney injury, mechanical complications, length of stay, and 30-day readmission for all-cause, heart failure or MI were secondary outcomes.

Results

Of the 17,556 patients with STEMI identified, 338 (1.9%) had SCAD. Patients with SCAD were younger (median age (IQR) 46.0 (33–90) vs 49.0 (41–57); p&lt;0.001) and more likely to be female (67% vs 21.6%, p&lt;0.001). They were less likely to have PCI (55.3% vs. 80.7%; p&lt;0.001), more likely to undergo CABG (4.7% vs 1.3%; p&lt;0.001), with left main and left anterior descending coronary arteries more often affected (2.4% vs 1.1%, and 53.3% vs 48.6%; p for both =0.05, respectively). In-hospital mortality did not differ between groups (3.6% vs 3.3, p=0.81). Revascularization was associated with lower in-hospital mortality among no-SCAD patients (2.6% vs 7.0%, p&lt;0.001), but not among SCAD patients (4.0% vs 3.1%, p=0.76) even when stratified by involved coronary artery. Revascularization among SCAD patients was associated with lower 30-day readmission rates for MI (0.0% vs 2.8%, p=0.05). SCAD patients were less likely to have acute kidney injury (6.5% vs 11.2%, p=0.01), but had a longer length of stay (median (IQR) 3.0 (1.0–6.0) vs 2.0 (1.0–4.0), p&lt;0.001). Both groups had similar rates of cardiogenic shock (11.8% vs 10.6%, p=0.56), mechanical complications (0.6% vs 0.3%, p=0.22), and 30-day readmission rates for all-cause, and heart failure.

Conclusion

In-hospital mortality did not differ between patients with STEMI due to SCAD or no-SCAD. Although revascularization was not associated with lower in-hospital mortality among SCAD patients (regardless of involved coronary artery), their 30-day readmission rate for MI was lower suggesting further studies are warranted to explore patient subsets of SCAD that may benefit from revascularization.

Funding Acknowledgement

Type of funding sources: None.