Search for an Invisibly Decaying Z^{'} Boson at Belle II in e^{+}e^{-}→μ^{+}μ^{-}(e^{±}μ^{∓}) Plus Missing Energy Final States

Theories beyond the standard model often predict the existence of an additional neutral boson, the Z^{'}. Using data collected by the Belle II experiment during 2018 at the SuperKEKB collider, we perform the first searches for the invisible decay of a Z^{'} in the process e^{+}e^{-}→μ^{+}μ^{-}Z^{'} and of a lepton-flavor-violating Z^{'} in e^{+}e^{-}→e^{±}μ^{∓}Z^{'}. We do not find any excess of events and set 90% credibility level upper limits on the cross sections of these processes. We translate the former, in the framework of an L_{μ}-L_{τ} theory, into upper limits on the Z^{'} coupling constant at the level of 5×10^{-2}-1 for M_{Z^{'}}≤6  GeV/c^{2}.

Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance

Background and Aims:

Subclavian vein (SCV) catheterization via the supraclavicular (SSV) or infraclavicular (ISV) approaches under real time ultrasonographic (USG) guidance is being performed routinely in critically ill patients in ICU.The aim of this study is comparative evaluation of SSV and ISV approaches in terms of success rate, time taken and incidence of complications.

Settings and Design:

In this prospective study, 110 critically ill patients were randomly divided into two groups of 55 each. Right SCV catheterization was performed using real time USG by single experienced operator.

Methods:

Success rate, first attempt success rate, time taken for venous visualization, puncture, catheterization, total procedure, incidence of mechanical, and infectious complications were variables used for comparison among groups.

Statistical Analysis Used:

Normality tests were performed using the Kolmogorov-Smirnov test. All data are expressed as the mean (SD), number (%), or median [interquartile range (IQR)] as indicated. Data were compared using the χ² test, the Mann–Whitney U-test, Fisher's exact test and Student's t-test as appropriate.

Results:

Total procedural time was significantly lesser in SSV group than ISV group (P < 0.0001). Time for visualization, puncture and catheterization were significantly higher in ISV group (P < 0.001). Success rate was 100% in both groups. First attempt success rate was more in SSV (P = 0.171).Two incidence of malposition was found in ISV group. Infectious complications were comparable in both groups.

Conclusions:

Real time USG-guided supraclavicular subclavian approach is a viable and preferable alternative with significantly lesser total procedural time, similar success rate, fewer attempts, faster and lesser complication rates as compared with infraclavicular approach.

Carbapenemase and ESBL genes with class 1 integron among fermenting and nonfermenting bacteria isolated from water sources from India

The present study was aimed to detect the carbapenemase, extended-spectrum β-lactamase (ESBL), and intI1 gene of class 1 integron among fermenting (n = 61) and nonfermenting (n = 10) bacterial isolates recovered from water samples (n = 128). Isolates were identified by 16S rRNA sequencing. These isolates showed reduced-susceptibility to third-generation cephalosporins and carbapenems. The isolates varied in number and size of plasmids (2 kb to >20 kb). Plasmid DNA screening showed 5·6, 7, 11·2 and 26·7% prevalence of bla_KPC , bla_NDM , bla_SHV and bla_TEM genes respectively. Diverse bla_NDM (bla_NDM-1 and bla_NDM-4 ) and bla_SHV subtypes (bla_SHV-2 and bla_SHV-11 ) were recorded, unlike the single allelic bla_KPC (bla_KPC-2 ) and bla_TEM (bla_TEM-1 ) gene. Of the total 27 bla-gene-producing bacterial isolates, seven isolates co-harboured the carbapenemase genes (bla_NDM or bla_KPC or the both) along with the ESBL genes (bla_SHV or bla_TEM ). The intI1 gene of class 1 integron was detected among 12 (44·4%) of ESBL- and/or carbapenemase-harbouring isolates. Gene transferability was seen among four of the 10 Enterobacteriaceae donors. Carbapenemases and ESBLs with class 1 integron among aquatic environmental isolates raise the serious issue of the biosecurity and health of the ecosystem. SIGNIFICANCE AND IMPACT OF THE STUDY: Anthropologically affected and polluted environment harbours the resistance threats, where a diverse bacterial species maintain, develop and exchange genetic determinants that constitute a risk to human and ecological health. The antimicrobial resistance (AMR) in Enterobacteriaceae and non-Enterobacteriaceae bacteria caused the failure of the therapy of last resort (carbapenems) and thus lead to life-threatening infections affecting public health. Surveillance and monitoring of AMR could be important for epidemiological, diagnostic testing and control of pathogens. This is a point-prevalence study reporting the comparative occurrence and co-occurrence of carbapenemase and extended-spectrum β-lactamase genes among fermenting and nonfermenting bacteria isolated from the aquatic environment in India.

P951The factors influencing total ischaemic time in patients presenting with STEMI in an Irish tertiary referral centre

Background

Despite highly functioning primary percutaneous coronary intervention (PPCI) programmes, STEMI is still associated with significant morbidity and mortality. The European Society of Cardiology STEMI guidelines in 2017 introduced a novel metric relating to STEMI patients: “total ischaemic time”. This time-period starts at the onset of chest pain and ends at wire cross, and it is thought to accurately reflect burden of myocardial destruction.

Aims

To assess the total ischaemic time of patients presenting with STEMI in an Irish tertiary referral centre and the factors influencing delays in presentation and treatment.

Methods

Prospective cohort analysis was conducted on all patients presenting with STEMI from October 2017 to January 2019. Patients were included if they had a culprit lesion that was successfully revascularized. All information was recorded at time of presentation. Bayesian statistics were employed to conduct the analysis.

Results

158 patients were recruited. Mean age was 61 (range29–96). Male:female ratio 5:1 in this cohort. Average total ischaemic time was 409.4mins ±501.4. The average time from chest pain to “call for help” (i.e. patient delay) was 208.3mins ±397.8, which represented 50.89% of the total ischaemic time (see Figure 1). The average time from “call for help” to first medical contact (FMC) was 18.4mins ±30.07. Average time from FMC to ECG was 44.9mins ±151.16, and was dependent upon type of FMC (Primary care 127mins vs paramedic 25mins p=0.030932). After FMC, 48.7% of patients had an ECG performed in under 10mins as per guidelines. After ECG was performed, 46.4% of patients had ECG to “wire cross” time under 90mins as per guidelines; 65.8% were within 120 mins and 91.4% were within 180mins. Those presenting to their general practitioner as FMC were significantly less likely to have both an ECG <10mins (NNH 2.84 95% CI 1.79–6.91) and ECG to wire time of <90mins (NNH 6.13 95% CI 2.88–48.70).

As age increased, so too did total ischaemic time (Pearson R=0.164, p=0.043), which was dependent on increasing patient delay with age (Pearson R=0.2181, p=0.0066). Women had a higher total ischaemic time than men (546 vs 382mins p=0.0233). This was determined to be as a result of: a numerically higher patient delay (220 vs 206 mins, p=0.214) and women having a longer time from FMC to ECG (104mins vs 34mins, p=0.0021).

Conclusion

Over 50% of the total ischaemic time was due to patient delay, suggesting a role for cardiovascular awareness programmes. Increasing age was associated with longer patient delay, indicating a need for directed awareness in this demographic. Women had a higher total ischaemic time, and waited a significantly longer time for ECG following FMC; highlighting the need for awareness amongst healthcare professionals of atypical clinical features associated with STEMI in women. Patients who attended their GP waited longer for an ECG and, once performed, were less likely to be revascularised within 90mins.

P2656Real-world Outcomes for STEMI in octogenarians and nonagenarians: A 5-year review from an Irish primary PCI centre

Background

Progress made by modern healthcare has led to improved life expectancy across the globe. This progress, however, also means that individuals are living with more chronic illnesses and co-morbidities than in previous generations. Due to this aging population, we can expect increasing rates of STEMI in octogenarians and nonagenarians in the future. The challenge of older patients with STEMI is that they are particularly high-risk for complications. At present, very little is known about the outcomes of STEMI in the very old population because they were under-represented in previous studies. Many cardiologists around the world have been hesitant in performing primary percutaneous coronary intervention (PPCI) in octogenarians and nonagenarians due to fear of complications and poor outcomes.

Purpose

To review the trend of octogenarians and nonagenarians presenting with STEMI and to assess the 30-day and 1-year mortality rates.

Methods

A single-centre retrospective observational study was conducted. All patients presenting with STEMI between January 2012 and December 2017 were reviewed. Individuals aged 80 years or older were included for the purpose of this analysis. Patient level data was collected by chart review and individuals were identified using the local STEMI database. Standard Bayesian statistics were employed for analysis.

Results

1,268 patients presented with STEMI during this period. 172 (13.6%) were 80 years or older. Of this subgroup, 159/172 (92.4%) were true STEMI (figure 1). 124/159 (77.9%) patients were brought to the catheterization lab and 35/159 (22%) were managed medically on the ward.107/159 (67.29%) were treated with PPCI. Patients in the PPCI group had a 30-day mortality rate of 20.6% while those in the medically managed group had a mortality rate of 37.1%; with a trend towards statistical significance (p=0.07). The one-year mortality rate in patients treated with PPCI was 22.4% which was significantly lower than those who received medical management 48.6% (p=0.005).

Conclusions

This review demonstrates that there is a high mortality rate with STEMI in those aged 80 years or above, however, patients who are treated with PPCI tend to do better and have a significantly lower mortality rate at 1-year. The incidence of STEMI in the very old cohort is likely to continue to rise and this may prove challenging. PPCI remains the most feasible treatment approach towards STEMI and this should not be biased based on age, however, interventionists will need to take into account patient suitability on a case-by case basis. Octogenarians who undergo angiography and PPCI as required have 77.6% survival at 1 year (figure 1) with 92.4% likelihood of going home and don't require long term nursing home care.

Acknowledgement/Funding

University Hospital Limerick

Azimuthal Anisotropy of Heavy-Flavor Decay Electrons in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

Angular correlations between heavy-flavor decay electrons and charged particles at midrapidity (|η|<0.8) are measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. The analysis is carried out for the 0%-20% (high) and 60%-100% (low) multiplicity ranges. The jet contribution in the correlation distribution from high-multiplicity events is removed by subtracting the distribution from low-multiplicity events. An azimuthal modulation remains after removing the jet contribution, similar to previous observations in two-particle angular correlation measurements for light-flavor hadrons. A Fourier decomposition of the modulation results in a positive second-order coefficient (v_{2}) for heavy-flavor decay electrons in the transverse momentum interval 1.5<p_{T}<4  GeV/c in high-multiplicity events, with a significance larger than 5σ. The results are compared with those of charged particles at midrapidity and those of inclusive muons at forward rapidity. The v_{2} measurement of open heavy-flavor particles at midrapidity in small collision systems could provide crucial information to help interpret the anisotropies observed in such systems.

Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review

PURPOSE

This purpose of this systematic review was to determine the safety and efficacy of arterial embolization as the primary treatment for grade III-V liver trauma, excluding the postoperative use of arterial embolization.

MATERIAL AND METHODS

A total of 24 studies published between January 2000 and June 2018 qualified for inclusion in this study. Four of them were prospective studies and 20 were retrospective. A total of 3855 patients (mean age, 33.5 years; range: 22-52.5 years) were treated non-operatively and 659 patients (659/3855; 17.09%) with hepatic hemorrhage underwent primary arterial embolization from 2000 to 2017. Indication for arterial embolization was a contrast blush visible on computed tomography in hemodynamically stable patient in all studies.

RESULTS

The arterial embolization success rate ranged from 80% to 97%. The most commonly reported complication was bile leak, with an incidence of 5.7%. Nineteen bilomas (2.8%) were reported in five studies with a range between 4% and 45%. Hepatic ischemia was reported in eight studies, with a mean incidence of 8.6%.

CONCLUSION

Primary arterial embolization has a high success rate in patients with hepatic trauma. Complications, including biloma and hepatic ischemia, have acceptable rates in the context of a minimally-invasive procedure that allows stabilization of life-threatening, complex liver injuries.

Breeding for robustness: investigating the genotype-by-environment interaction and micro-environmental sensitivity of Genetically Improved Farmed Tilapia (Oreochromis niloticus)

Robustness has become a highly desirable breeding goal in the globalized agricultural market. Both genotype‐by‐environment interaction (G × E) and micro‐environmental sensitivity are important robustness components of aquaculture production, in which breeding stock is often disseminated to different environments. The objectives of this study were (i) to quantify the degree of G × E by assessing the growth performance of Genetically Improved Farmed Tilapia (GIFT) across three countries (Malaysia, India and China) and (ii) to quantify the genetic heterogeneity of environmental variance for body weight at harvest (BW) in GIFT as a measure of micro‐environmental sensitivity. Selection for BW was carried out for 13 generations in Malaysia. Subsets of 60 full‐sib families from Malaysia were sent to China and India after five and nine generations respectively. First, a multi‐trait animal model was used to analyse the BW in different countries as different traits. The results indicate a strong G × E. Second, a genetically structured environmental variance model, implemented using Bayesian inference, was used to analyse micro‐environmental sensitivity of BW in each country. The analysis revealed the presence of genetic heterogeneity of both BW and its environmental variance in all environments. The presence of genetic variation in residual variance of BW implies that the residual variance can be modified by selection. Incorporating both G × E and micro‐environmental sensitivity information may help in selecting robust genotypes with high performance across environments and resilience to environmental fluctuations.

D-Meson Azimuthal Anisotropy in Midcentral Pb-Pb Collisions at sqrt[s]_{NN}=5.02 TeV

The azimuthal anisotropy coefficient v_{2} of prompt D^{0}, D^{+}, D^{*+}, and D_{s}^{+} mesons was measured in midcentral (30%-50% centrality class) Pb-Pb collisions at a center-of-mass energy per nucleon pair sqrt[s_{NN}]=5.02  TeV, with the ALICE detector at the LHC. The D mesons were reconstructed via their hadronic decays at midrapidity, |y|<0.8, in the transverse momentum interval 1<p_{T}<24  GeV/c. The measured D-meson v_{2} has similar values as that of charged pions. The D_{s}^{+} v_{2}, measured for the first time, is found to be compatible with that of nonstrange D mesons. The measurements are compared with theoretical calculations of charm-quark transport in a hydrodynamically expanding medium and have the potential to constrain medium parameters.