P3849Baseline profile of patients treated for acute venous thromboembolism in routine clinical practice according to age and renal function in the RE-COVERY DVT/PE global cohort study

Background

Observational studies provide the opportunity to evaluate routine practice without the selection and treatment criteria imposed in randomized clinical trials (RCTs).

Purpose

Using data from the RE-COVERY DVT/PE global observational study (enrolment January 2016 to May 2017), we describe the baseline profile of patients treated for acute venous thromboembolism (VTE) in routine clinical practice according to age and renal function.

Methods

Baseline patient characteristics, clinical features (comorbidities/medical history), and anticoagulant therapy were tabulated descriptively for the subgroups of age (<75, ≥75 years) and creatinine clearance (<30, 30 to <50 [moderate impairment], 50 to <80 [mild impairment], ≥80 mL/min). Anticoagulant therapy at baseline and at hospital discharge or 14 days after diagnosis (whichever was later) was recorded.

Results

In this observational study of 6122 patients with acute deep vein thrombosis, the proportions of patients at baseline who were ≥75 years of age (25.2%) or who had mild to moderate renal impairment (38.1%) were higher than in RCTs of non-vitamin K antagonist oral anticoagulants (NOACs) for acute VTE treatment (∼12–13% elderly and ∼26–29% with mild or moderate renal impairment) (from analyses of the RE-COVER trials; Hokusai-VTE and AMPLIFY). Older patients and those with renal impairment were more often female and were more likely to have comorbidities than the younger or normal renal function groups (Table). At the time of hospital discharge or 14 days after diagnosis, whichever was later, the majority was treated with NOACs (54%). Vitamin K antagonists were prescribed to approximately 1 in 5 patients. The use of NOACs decreased with worsening renal function, whereas the proportions treated with parenteral anticoagulation alone increased in the moderate renal impairment group compared with patients with normal renal function.

Conclusion

The population treated for acute VTE in routine clinical practice includes more elderly and renally impaired patients than represented in RCTs. These baseline data provide a snapshot of patient characteristics and patterns of anticoagulant therapy.

Acknowledgement/Funding

Funded by Boehringer Ingelheim

P3848Baseline profile of patients treated for acute venous thromboembolism (VTE) in routine clinical practice according to VTE location in the RE-COVERY DVT/PE global cohort study

Background

In contrast to randomized clinical trials, observational studies provide the opportunity to evaluate routine practice in real-world patient populations.

Purpose

Using data from the RE-COVERY DVT/PE global observational study (enrollment January 2016 to May 2017), we have explored patient characteristics and anticoagulant treatment patterns in subgroups defined according to the type and location (proximal or distal lower limb) of acute venous thromboembolism (VTE).

Methods

Baseline patient characteristics, details of hospitalization and choice of anticoagulant therapy were tabulated descriptively for three groups of patients according to the type and location of their index VTE: pulmonary embolism (PE) (± any deep vein thrombosis; DVT); proximal (± distal) lower limb DVT, including the iliac vein; or distal lower limb DVT. Anticoagulant therapy at baseline and at hospital discharge or 14 days after diagnosis (whichever was later) was recorded.

Results

Of the 6122 eligible patients, 324 who had DVT at locations other than the lower limb and no PE were excluded from this analysis (as a key objective was to compare subgroups with DVT in the lower extremities according to whether the location was distal alone or involved the proximal segment). The remaining 5798 patients had either distal DVT (17.7%), proximal (± distal) DVT (40.0%) or PE (± any DVT) (42.3%) (Table). The likelihood of being diagnosed in an emergency department and of being hospitalized for VTE increased in line with the seriousness of the index event (distal DVT to PE). There were corresponding increases in age and the proportion of patients with comorbidities and/or medical history such as hypertension, diabetes mellitus or active cancer across these subgroups. At the time of hospital discharge or 14 days after diagnosis, whichever was later, non-vitamin K antagonist oral anticoagulants were the most commonly used anticoagulants (53% of patients in the PE group and 55–56% in the two DVT groups). The use of parenteral anticoagulant therapy alone appeared to be lower in the PE group than in the DVT groups, but the total use of parenteral therapy (alone or prior to oral anticoagulation) increased across groups from distal DVT (67%) to proximal DVT (74%) to PE (79%).

Conclusion

These data provide an insight into the potential differences in patient characteristics and treatment patterns among patients with PE, proximal/iliac lower limb DVT or distal lower limb DVT.

Acknowledgement/Funding

Funded by Boehringer Ingelheim

First Measurement of Inclusive Muon Neutrino Charged Current Differential Cross Sections on Argon at E_{ν}∼0.8 GeV with the MicroBooNE Detector

We report the first measurement of the double-differential and total muon neutrino charged current inclusive cross sections on argon at a mean neutrino energy of 0.8 GeV. Data were collected using the MicroBooNE liquid argon time projection chamber located in the Fermilab Booster neutrino beam and correspond to 1.6×10^{20} protons on target of exposure. The measured differential cross sections are presented as a function of muon momentum, using multiple Coulomb scattering as a momentum measurement technique, and the muon angle with respect to the beam direction. We compare the measured cross sections to multiple neutrino event generators and find better agreement with those containing more complete treatment of quasielastic scattering processes at low Q^{2}. The total flux integrated cross section is measured to be 0.693±0.010(stat)±0.165(syst)×10^{-38}  cm^{2}.

Ultrasensitive, Superhigh Signal-to-Noise Ratio, Self-Powered Solar-Blind Photodetector Based on n-Ga2O3/p-CuSCN Core-Shell Microwire Heterojunction

Solar-blind photodetectors have captured intense attention due to their high significance in ultraviolet astronomy and biological detection. However, most of the solar-blind photodetectors have not shown extraordinary advantages in weak light signal detection because the forewarning of low-dose deep-ultraviolet radiation is so important for the human immune system. In this study, a high-performance solar-blind photodetector is constructed based on the n-Ga₂O₃/p-CuSCN core-shell microwire heterojunction by a simple immersion method. In comparison with the single device of the Ga₂O₃ and CuSCN, the heterojunction photodetector demonstrates an enhanced photoelectric performance with an ultralow dark current of 1.03 pA, high photo-to-dark current ratio of 4.14 × 10⁴, and high rejection ratio (R₂₅₄/R₃₆₅) of 1.15 × 10⁴ under a bias of 5 V. Excitingly, the heterostructure photodetector shows high sensitivity to the weak signal (1.5 μW/cm²) of deep ultraviolet and high-resolution detection to the subtle change of signal intensity (1.0 μW/cm²). Under the illumination with 254 nm light at 5 V, the photodetector shows a large responsivity of 13.3 mA/W, superb detectivity of 9.43 × 10¹¹ Jones, and fast response speed with a rise time of 62 ms and decay time of 35 ms. Additionally, the photodetector can work without an external power supply and has specific solar-blind spectrum selectivity as well as excellent stability even through 1 month of storage. Such prominent photodetection, profited by the novel geometric construction and the built-in electric field originating from the p-n heterojunction, meets greatly well the "5S" requirements of the photodetector for practical application.

Evaluating Hydrologic Response in Tile-Drained Landscapes: Implications for Phosphorus Transport

Phosphorus (P) loss in agricultural discharge has typically been associated with surface runoff; however, tile drains have been identified as a key P pathway due to preferential transport. Identifying when and where these pathways are active may establish high-risk periods and regions that are vulnerable for P loss. A synthesis of high-frequency, runoff data from eight cropped fields across the Great Lakes region of North America over a 3-yr period showed that both surface and tile flow occurred year-round, although tile flow occurred more frequently. The relative timing of surface and tile flow activation was classified into four response types to infer runoff-generation processes. Response types were found to vary with season and soil texture. In most events across all sites, tile responses preceded surface flow, whereas the occurrence of surface flow prior to tile flow was uncommon. The simultaneous activation of pathways, indicating rapid connectivity through the vadose zone, was seldom observed at the loam sites but occurred at clay sites during spring and summer. Surface flow at the loam sites was often generated as saturation-excess, a phenomenon rarely observed on the clay sites. Contrary to expectations, significant differences in P loads in tiles were not apparent under the different response types. This may be due to the frequency of the water quality sampling or may indicate that factors other than surface-tile hydrologic connectivity drive tile P concentrations. This work provides new insight into spatial and temporal differences in runoff mechanisms in tile-drained landscapes.

Isolation of H8N4 avian influenza virus from wild birds in Shanghai, China

The H8 subtype viruses are rarely isolated from wild ducks. Shanghai is one of the important wintering or stopover sites on the East Asia-Australia Migration Flyway. An influenza virus, subtype H8N4, was firstly isolated from a common teal (Anas crecca) in Shanghai during 2017-2018 in this study. To clarify the genetic characteristics of the H8N4 virus, the whole genome sequences were analyzed. Phylogenetic analysis of the hemagglutinin and neuraminidase genes showed that they shared highest nucleotide identity (99.19%-99.64%) with the Japan duck-origin H8N4 virus collected in 2016 (A/duck/Aichi/231003/2016) and belonged to the Eurasian-like avian lineage. Six other genes of the H8N4 isolated virus were all highly similar to the corresponding genes of a wide range of AIV subtypes including H9N2, H5N7, H3N8, H1N2, H4N6 and H1N1. The results indicated that the H8N4 virus was a multiple reassortant virus. The study emphasized that the continuous surveillance of influenza virus in wild birds should be strengthened. Keywords: avian influenza virus; H8N4; phylogenetic analysis; Shanghai.

Oxygen vacancy-engineered Fe2O3 nanoarrays as free-standing electrodes for flexible asymmetric supercapacitors

The charge storage performance of Fe₂O₃ nanoarrays (NAs) as negative electrodes are limited by their poor conductivity and rate capability. Herein, we have reported the delicate interfacial engineering on carbon cloth (CC) fibers and oxygen vacancy (V_O) generation on Fe₂O₃ nanorod arrays to boost the capacitive performance. Polydopamine-derived nitrogen-doped carbon layers were fabricated on CC fibers to govern the growth of FeOOH NAs. Rich V_Os were generated in Fe₂O₃ NAs to construct a unique heterostructure with a crystalline core and amorphous shell via successive N₂ thermal treatment and chemical reduction. Optimized by 2 h chemical reduction, the V_O-rich Fe₂O₃ NA electrode, featuring a charged voltage of -1.10 V, exhibited a high areal specific capacitance of 2.63 F cm^-2 at 0.5 mA cm^-2 and 0.12 F cm^-2 even at 60 mA cm^-2. Impressively, 86.7% specific capacitance was retained after 10 000 cycles at 10 mA cm^-2. The flexible asymmetric supercapacitor by assembling free-standing CN-Fe₂O₃-2 h (negative electrode) and MnO₂ (positive electrode) showed an energy density of 1.33 mW h cm^-3 at 15.4 mW cm^-3. To the best of our knowledge, these results are the record performance for Fe₂O₃-based electrodes. The two-step interfacial engineering reported in this study may open a new door in the design of high energy-density electrodes for advanced energy storage.

[Application of recurrent neural network in prognosis of peritoneal dialysis]

OBJECTIVE

Deep learning models, including recurrent neural network (RNN) and gated recurrent unit (GRU), were used to construct the clinical prognostic prediction models for peritoneal dialysis (PD) patients based on routine clinical data. The performance of the RNN and GRU were compared with logistic regression (LR), which is commonly used in medical researches. The possible underlining clinical implications based on the result from the GRU model were also investigated.

METHODS

We used the clinical data from the PD center of Peking University Third Hospital as the data source. Both the baseline data at the beginning of dialysis, and the follow-up and prognostic data of the patients were used by the RNN and GRU prediction models. The hyper-parameters were tuned based on the 10-fold cross-validation. The risk prediction performance of each model was evaluated via area under the receiver operation characteristic curve (AUROC), recall rate and F1-score on the testset.

RESULTS

A total of 656 patients with the 261 occurrences of death were included in the experiment. The total number of all diagnostic records were 13 091. The results on the testset showed that the AUROC of the LR model, RNN model, and GRU model was 0.701 4, 0.786 0, and 0.814 7, respectively. The predictive performances of the GRU and RNN models were significantly better than that of the LR model. The performances of the GRU and RNN models assessed by recall rate and F1-score were also significantly better than that of the LR model, in which the GRU model reached the best performance. In addition, the recall rates were different among different causes of death or by different prediction time windows.

CONCLUSION

The recurrent neural network model, especially the GRU model, is more effective in predicting PD patients' prognosis as compared with the LR model. This new model may be helpful for clinicians to provide timely intervention, thus improving the quality of care of PD.

Faecal microbiota transplantation for treatment of recurrent or refractory Clostridioides difficile infection in Hong Kong

INTRODUCTION

Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infection globally, causing significant morbidity and mortality. Faecal microbiota transplantation (FMT) has emerged as a promising option for recurrent and refractory CDI. This study aimed to assess the safety, efficacy, and feasibility of FMT for CDI in Hong Kong.

METHODS

We conducted a single-centre, retrospective study for all consecutive cases of recurrent or refractory CDI who underwent FMT from 2013 to 2018. Clinical demographics, outcome, and safety parameters were collected.

RESULTS

A total of 24 patients with recurrent or refractory CDI (median age 70 years, interquartile range=45.0-78.3 years; 67% male) were included. Over 80% had been recently hospitalised or were long-term care facility residents. Faecal microbiota transplantation was delivered by feeding tube in 11 (45.8%), oesophagogastroduodenoscopy in eight (33.3%), and colonoscopy in six (25%) of the patients. Resolution of diarrhoea without relapse within 8 weeks was achieved in 21 out of 24 patients (87.5%) after FMT. No deaths occurred within 30 days. The FMT was well tolerated and no serious adverse events attributable to FMT were reported.

CONCLUSION

Our results confirm that FMT is a safe, efficacious, and feasible intervention for patients with refractory or recurrent CDI in Hong Kong. Given the increasing disease burden and the lack of effective alternatives in Hong Kong for difficult-to-treat cases of CDI, we recommend that a territory-wide FMT service be established to address increasing demand for this treatment.