Asymptotic analysis of acoustic black hole effect in cylindrical shells

The acoustic black hole (ABH) effect is investigated within the framework of thin shell theory. Asymptotic solutions to the dispersion equation for the thin cylindrical shell are obtained, and the ABH effect is examined using analytical formulas for group velocities and anti-derivatives of the asymptotic expansions of wave numbers. It is shown that the ABH effect is achievable in thin cylindrical shells with variable thickness, in a similar manner as for beams and plates. However, it should not be expected to exist in the low-frequency range where the flexural wave motion in the wall of a shell is strongly coupled with uniform longitudinal wave motion.

Exploring the microbial landscape: uncovering the pathogens associated with community-acquired pneumonia in hospitalized patients

Objectives

This study aimed to investigate the etiology, clinical features, and outcomes of community-acquired pneumonia (CAP) in adults. Understanding the causative pathogens is essential for effective treatment and prevention.

Design

Between 2016-2018, 518 hospitalized adults with CAP and 241 controls without symptoms were prospectively enrolled. Urine samples were collected for pneumococcal urinary antigen tests and nasopharyngeal swabs for viral and bacterial analysis, combined with routine diagnostic care.

Results

Among the included CAP patients, Streptococcus pneumoniae was the most common pathogen, detected in 28% of patients, followed by Haemophilus influenzae in 16%. Viruses were identified in 28%, and concurrent viruses and bacteria were detected in 15%. There was no difference in mortality, length of stay, or symptoms at hospitalization when comparing patients with bacterial, viral, or mixed etiologies. Among the control subjects without respiratory symptoms, S. pneumoniae, H. influenzae, or Moraxella catarrhalis were detected in 5-7%, and viruses in 7%.

Conclusion

Streptococcus pneumoniae emerged as the predominant cause of CAP, followed closely by viruses and H. influenzae. Intriguingly, symptoms and outcome were similar regardless of etiology. These findings highlight the complexity of this respiratory infection and emphasize the importance of comprehensive diagnostic and treatment strategies.Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT03606135].

Impact of patch age and size on forest soil characteristics in European agricultural landscapes

Many landscapes worldwide are characterized by the presence of a mosaic of forest patches with contrasting age and size embedded in a matrix of agricultural land. However, our understanding of the effects of these key forest patch features on the soil nutrient status (in terms of nitrogen, carbon, and phosphorus) and soil pH is still limited due to a lack of large-scale data. To address this research gap, we analyzed 830 soil samples from nearly 200 forest patches varying in age (recent versus ancient forests) and size (small versus larger patches) along a 2500-km latitudinal gradient across Europe. We also considered environmental covariates at multiple scales to increase the generality of our research, including variation in macroclimate, nitrogen deposition rates, forest cover in a buffer zone, basal area and soil type. Multiple linear mixed-effects models were performed to test the combined effects of patch features and environmental covariates on soil nutrients and pH. Recent patches had higher total soil phosphorus concentrations and stocks in the mineral soil layer, along with a lower nitrogen to phosphorus ratio within that layer. Small patches generally had a higher mineral soil pH. Mineral soil nitrogen stocks were lower in forest patches with older age and larger size, as a result of a significant interactive effect. Additionally, environmental covariates had significant effects on soil nutrients, including carbon, nitrogen, phosphorus, and their stoichiometry, depending on the specific covariates. In some cases, the effect of patch age on mineral soil phosphorus stocks was greater than that of environmental covariates. Our findings underpin the important roles of forest patch age and size for the forest soil nutrient status. Long-term studies assessing edge effects and soil development in post-agricultural forests are needed, especially in a context of changing land use and climate.

Fungal Planet description sheets: 1550-1613

Novel species of fungi described in this study include those from various countries as follows: Argentina, Neocamarosporium halophilum in leaf spots of Atriplex undulata. Australia, Aschersonia merianiae on scale insect (Coccoidea), Curvularia huamulaniae isolated from air, Hevansia mainiae on dead spider, Ophiocordyceps poecilometigena on Poecilometis sp. Bolivia, Lecanora menthoides on sandstone, in open semi-desert montane areas, Sticta monlueckiorum corticolous in a forest, Trichonectria epimegalosporae on apothecia of corticolous Megalospora sulphurata var. sulphurata, Trichonectria puncteliae on the thallus of Punctelia borreri. Brazil, Catenomargarita pseudocercosporicola (incl. Catenomargarita gen. nov.) hyperparasitic on Pseudocercospora fijiensis on leaves of Musa acuminata, Tulasnella restingae on protocorms and roots of Epidendrum fulgens. Bulgaria, Anthracoidea umbrosae on Carex spp. Croatia, Hymenoscyphus radicis from surface-sterilised, asymptomatic roots of Microthlaspi erraticum, Orbilia multiserpentina on wood of decorticated branches of Quercus pubescens. France, Calosporella punctatispora on dead corticated twigs of Aceropalus. French West Indies (Martinique), Eutypella lechatii on dead corticated palm stem. Germany, Arrhenia alcalinophila on loamy soil. Iceland, Cistella blauvikensis on dead grass (Poaceae). India, Fulvifomes maritimus on living Peltophorum pterocarpum, Fulvifomes natarajanii on dead wood of Prosopis juliflora, Fulvifomes subazonatus on trunk of Azadirachta indica, Macrolepiota bharadwajii on moist soil near the forest, Narcissea delicata on decaying elephant dung, Paramyrothecium indicum on living leaves of Hibiscus hispidissimus, Trichoglossum syamviswanathii on moist soil near the base of a bamboo plantation. Iran, Vacuiphoma astragalicola from stem canker of Astragalus sarcocolla. Malaysia, Neoeriomycopsis fissistigmae (incl. Neoeriomycopsidaceae fam. nov.) on leaf spots on flower Fissistigma sp. Namibia, Exophiala lichenicola lichenicolous on Acarospora cf. luederitzensis. Netherlands, Entoloma occultatum on soil, Extremus caricis on dead leaves of Carex sp., Inocybe pseudomytiliodora on loamy soil. Norway, Inocybe guldeniae on calcareous soil, Inocybe rupestroides on gravelly soil. Pakistan, Hymenagaricus brunneodiscus on soil. Philippines, Ophiocordyceps philippinensis parasitic on Asilus sp. Poland, Hawksworthiomyces ciconiae isolated from Ciconia ciconia nest, Plectosphaerella vigrensis from leaf spots on Impatiens noli-tangere, Xenoramularia epitaxicola from sooty mould community on Taxus baccata. Portugal, Inocybe dagamae on clay soil. Saudi Arabia, Diaporthe jazanensis on branches of Coffea arabica. South Africa, Alternaria moraeae on dead leaves of Moraea sp., Bonitomyces buffels-kloofinus (incl. Bonitomyces gen. nov.) on dead twigs of unknown tree, Constrictochalara koukolii on living leaves of Itea rhamnoides colonised by a Meliola sp., Cylindromonium lichenophilum on Parmelina tiliacea, Gamszarella buffelskloofina (incl. Gamszarella gen. nov.) on dead insect, Isthmosporiella africana (incl. Isthmosporiella gen. nov.) on dead twigs of unknown tree, Nothoeucasphaeria buffelskloofina (incl. Nothoeucasphaeria gen. nov.), on dead twigs of unknown tree, Nothomicrothyrium beaucarneae (incl. Nothomicrothyrium gen. nov.) on dead leaves of Beaucarnea stricta, Paramycosphaerella proteae on living leaves of Protea caffra, Querciphoma foliicola on leaf litter, Rachicladosporium conostomii on dead twigs of Conostomium natalense var. glabrum, Rhamphoriopsis synnematosa on dead twig of unknown tree, Waltergamsia mpumalanga on dead leaves of unknown tree. Spain, Amanita fulvogrisea on limestone soil, in mixed forest, Amanita herculis in open Quercus forest, Vuilleminia beltraniae on Cistus symphytifolius. Sweden, Pachyella pulchella on decaying wood on sand-silt riverbank. Thailand, Deniquelata cassiae on dead stem of Cassia fistula, Stomiopeltis thailandica on dead twigs of Magnolia champaca. Ukraine, Circinaria podoliana on natural limestone outcrops, Neonematogonum carpinicola (incl. Neonematogonum gen. nov.) on dead branches of Carpinus betulus. USA, Exophiala wilsonii water from cooling tower, Hygrophorus aesculeticola on soil in mixed forest, and Neocelosporium aereum from air in a house attic. Morphological and culture characteristics are supported by DNA barcodes. Citation: Crous PW, Costa MM, Kandemir H, et al. 2023. Fungal Planet description sheets: 1550-1613. Persoonia 51: 280-417. doi: 10.3767/persoonia.2023.51.08.

Radiographically confirmed community-acquired pneumonia in hospitalized adults due to pneumococcal vaccine serotypes in Sweden, 2016-2018-The ECAPS study

Objectives

In Sweden, pneumococcal serotype distribution in adults with community-acquired pneumonia (CAP) and potential coverage of currently licensed pneumococcal conjugate vaccines (PCVs) is unknown.

Methods

During 2016-2018, patients aged ≥18 years hospitalized with radiologically confirmed (RAD+) CAP were enrolled at Skåne University Hospital in a study on the etiology of CAP in Sweden (ECAPS). Urine samples and blood cultures were collected per-protocol. Streptococcus pneumoniae (Spn) culture isolates were serotyped and urine samples tested for the pan-pneumococcal urinary antigen (PUAT) and multiplex urine antigen detection (UAD) assay, detecting 24 serotypes.

Results

Analyses included 518 participants with RAD+CAP; 67.4% were ≥65 years of age, 73.4% were either immunocompromised or had an underlying chronic medical condition. The proportion of CAP due to Spn identified by any method was 24.3% of which 9.3% was detected by UAD alone. The most frequently identified serotypes were 3 (26 cases, 5.0% of all CAP), and 8, 11A and 19A (10 cases each, 1.9%). In individuals aged 18-64 and ≥65 years, respectively, PCV20 serotypes contributed to 35 of 169 (20.7%) and 53 of 349 cases of all CAP (15.2%), and PCV13 serotypes caused 21 of 169 (12.4%) and 35 of 349 (10.0%) cases. PCV15 coverage was 23 of 169 (13.6%) and 42 of 349 (12.0%) in individuals aged 18-64 and ≥65 years, respectively. Overall, PCV20 increases the coverage of all CAP from 10.8% (PCV13) to 17.0%.

Conclusion

Compared to earlier pneumococcal vaccines, PCV20 expands the coverage of all-cause CAP. Routine diagnostic tests underestimate the proportion of CAP caused by Spn.

Does bone mobilization interfere with energy metabolism in transition cows?

The onset of lactation represents a challenge for both mineral homeostasis and energy metabolism in high-performing dairy cows. It has been shown that subclinical and clinical hypocalcemia increases the risk of ketosis and recent studies suggest that bone-derived endocrine factors could play a role in intermediary metabolism. Therefore, we analyzed serum samples from calculated d -7, calculated d -3, d +1, d +3, and d +7 relative to calving from 15 multiparous cows for total Ca, the bone resorption marker CrossLaps, the bone formation marker intact osteocalcin, undercarboxylated osteocalcin (ucOC), insulin, glucose, nonesterified fatty acids, β-hydroxybutyrate, and insulin-like growth factor 1. Serum concentrations of Ca on d -3 and d +1 were associated with parameters of energy metabolism on d +3 and d +7. As we found large variations for serum concentrations of ucOC already on d -7, we allocated the cows retrospectively to 3 groups: low ucOC, medium ucOC, and high ucOC. These groups differed not only in their ucOC dynamics, but also in insulin sensitivity estimated using the revised quantitative insulin sensitivity index (RQUICKI). High ucOC cows presented with the highest RQUICKI throughout the entire observation period. Our data further support the hypothesis that low serum Ca precedes disturbances of energy metabolism. Furthermore, from our preliminary results it can be assumed that the potential link between mineral homeostasis, bone turnover, and intermediary metabolism should be further investigated.

Prognostic implications of cardiac 82-rubidium positron emission tomography in angina patients with no perfusion defects

Background

Myocardial perfusion imaging with 82-Rubidium positron emission tomography (82Rb-PET) is increasingly used in the assessment of stable coronary artery disease (CAD). Among other variables, it provides quantitative measures of myocardial blood flow (MBF) which has shown the prognostic significance of coronary microvascular dysfunction (CMD), also in patients without perfusion defects. However, other 82Rb-PET variables may also be of prognostic significance in these patients.

Purpose

The purpose of this study was to evaluate the prognostic value of 82Rb-PET in patients with symptoms suggestive of CAD but no perfusion defects.

Methods

A study was conducted with 3726 consecutive patients who underwent 82Rb-PET on the suspicion of stable CAD between January 2018 and August 2020. After exclusion of patients with regional perfusion defects, we examined the association of 82Rb-PET derived parameters with a composite endpoint: all-cause mortality, hospitalization for unstable angina pectoris, acute myocardial infarction, heart failure or ischemic stroke in 2175 patients. CMD was defined as myocardial blood flow reserve (MBFR) <2. Analyses were further stratified to assess differences across gender.

Results

Resting and stress MBF were higher in women, while MBFR was lower and CMD more prevalent (30.5% among women versus 25.3% among men, p=0.008). Over a median follow-up of 1.7 years (IQR 1.1–2.5 years) a total of 148 events were observed. In unadjusted analyses, MBF during stress, MBFR, left ventricular ejection fraction (LVEF), LVEF-reserve, heart rate reserve and Ca-score were associated with adverse outcomes in both genders (Figure 1). A joint multivariable Cox model, for both genders, adjusted for patient characteristics, cardiovascular risk factors and 82Rb-PET variables showed reduced MBFR <2 (HR 1.75, 95% CI 1.24–2.48), resting LVEF (HR 1.38 per 10% decrease, 95% CI 1.24–1.54) and LVEF-reserve (HR 1.19 per 5% decrease, 95% CI 1.07–1.31) to be significant predictors of outcomes (Figure 2). Results were consistent in subgroups defined by gender, previous history of ischemic heart disease (IHD), reduced LVEF and atrial fibrillation.

Conclusion

MBFR, LVEF and LVEF-reserve derived from 82Rb-PET are predictors of adverse outcome and provide prognostic information in patients with no perfusion defects. This may aid in identifying patients at risk and provide opportunity of prevention.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Bispebjerg Frederiksberg Hospital, Copenhagen

Coronary microvascular disease assessed by 82Rb-PET-CT is an independent prognostic marker of all-cause mortality

Background

Coronary microvascular disease (CMD) is a major contributor to e.g. heart failure and angina pectoris, as well as being associated with an increased risk of adverse events. CMD is diagnosed by reduced myocardial blood flow reserve (MBFR), preferably by Positron emission tomography myocardial perfusion CT (PET-CT).

Purpose

We aim to determine whether reduced MBFR is associated with an increased hazard of all-cause mortality independently of the extent of perfusion defects in patients suspected of obstructive coronary artery disease.

Method

We conducted a multicenter study of all patients referred for 82Rubidium PET-CT imaging between January 2018 and August 2020. Rest and stress examinations were performed using standard imaging protocols. Percentage of perfusion defects were calculated based on summed rest- and difference score. CMD was defined as MBFR ≤2. Patients were followed for all-cause mortality through national registries with no loss to follow-up.

Results

Among the 7156 patients studied, 61.8% were men, median age was 69 [61–76 IQR] years, 14.1% had LVEF ≤40%, 58.4% had a previous diagnosis of ischemic heart disease (IHD), 20.1% had atrial fibrillation and 38.9% had MBFR ≤2.

A total of 571 (7.8) deaths were observed, more frequently in MBFR ≤2 compared to MBFR >2 (4.2% vs 13.2%, p<0.001). MBFR was significantly associated with reversible hypoperfusion (r2=−0.33, p<0.0001). In Kaplan-Meier estimation MBFR ≤2 was significantly associated to all-cause mortality in the overall population as well as in clinically relevant subgroups defined by the extent of reversible and/or irreversible perfusion defects (p<0.05 for all, fig. 1). In multivariate Cox-analysis adjusting for age, sex, Charlson's Co-morbidity index, eGFR, LVEF and LVEF-reserve and stratifying by diabetes, MBFR ≤2 remained a robust predictor of all-cause mortality with a HR 1.73, 95% CI: 1.62–2.19, p<0.0001 (fig. 2). No interaction was found between MBFR and reversible hypoperfusion. In subgroup analysis including only patients with no reversible perfusion defects (n=3095), MBFR ≤2 was still strongly associated with a HR of 2.00, 95% CI: 1.29–3.11, p<0.001 for all-cause mortality.

Conclusion

MBFR ≤2 is a robust predictor of all-cause mortality independently of the extent of reversible- and/or irreversible perfusion defects. Information of MBFR should be incorporated in the clinical risk stratification of patients being investigated for ischemia.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Research Committee, Bispebjerg & Frederiksberg University Hospital, scientific scholarship

Myocardial blood flow reserve assessed by 82Rb-PET-CT is associated with small-vessel disease in the kidney and brain

Background

Coronary microvascular dysfunction (CMD) may be linked to small-vessel disease in other vascular beds as a part of multisystem disorder. However, there are limited data in support of this.

Purpose

We aim to determine whether reduced myocardial blood flow reserve (MBFR) is associated with an increased hazard of small-vessel disease in the kidneys and brain.

Method

We conducted a multicenter study of all patients consecutively referred for 82Rubidium-Positron emission tomography (82Rb-PET) myocardial perfusion CT imaging between January 2018 and August 2020. CMD was defined as MBFR ≤2. Patients were followed through national registries using ICD-10 codes with no loss to follow-up for microvascular events (ME) defined as chronic kidney disease, stroke, affective disorders, and dementia. Despite the heterogeneity of outcomes, they all play a crucial role in ME, with vascular dementia, affective disorders, and both ischemic and hemorrhagic strokes being major contributors to cerebral ME.

Results

Among the 7156 patients studied, 61.8% were men, median age was 69 [61–76 IQR] years, 14.1% had LVEF ≤40%, 58.4% had a previous diagnosis of ischemic heart disease (IHD) and 20.1% had atrial fibrillation. 38.9% had MBFR ≤2. MBFR was significantly associated with eGFR at baseline (r2=0.22, p<0.0001). After multivariable adjustment for demographics, cardiovascular risk factors, LVEF and reversible perfusion defects, MBFR remained significantly associated with eGFR, also in patients with no perfusion defects (β=0.039, 95% Cl 0.03–0.05, p<0.001 in all patients and β=0.039, 95% Cl 0.02–0.05, p<0.001, in patients with ≤5% reversible- and ≤5% irreversible hypoperfusion). During follow-up, a total of 677 (9.5%) ME were observed (480 (6.7%) cerebral ME and 197 (2.7%) renal ME). ME was more frequent in patients with MBFR ≤2 compared to MBFR >2 (11.2% vs. 5.5%, p<0.001).

In crude analysis MBFR ≤2 was significantly associated with ME (p<0.0001, Fig. 1) as well as renal- and cerebral ME (both p<0.001). Similar results were found in subgroup analysis of patients with diabetes, normal kidney function (eGFR ≥60) or no perfusion defects, respectively (Fig. 1). After multivariate adjusting for demographics, IHD, cardiovascular risk factors, Charlson's Comorbidity index, atrial fibrillation and stratifying by chronic kidney disease stages, MBFR remained a significant predictor of ME (HR 1.43, 95% CI 1.15–1.78, p<0.001, fig. 2). In subgroup analysis including only patients with no reversible perfusion defects, MBFR ≤2 was associated with a HR of 2.04, 95% CI 1.43–2.91, p<0.0001 for ME.

Conclusion

This is the first larger cohort study relating CMD to microvascular outcome in the kidneys and brain. We conclude that CMD is an independent predictor of cerebral and renal ME. Data support the hypothesis that CMD is part of a systemic vascular disorder.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Research Committee, Bispebjerg & Frederiksberg University Hospital, scientific scholarship

Efficacy and Safety of Rovalpituzumab Tesirine Compared With Topotecan as Second-Line Therapy in DLL3-High SCLC: Results From the Phase 3 TAHOE Study

INTRODUCTION

DLL3, an atypical Notch ligand, is expressed in SCLC tumors but is not detectable in normal adult tissues. Rovalpituzumab tesirine (Rova-T) is an antibody-drug conjugate containing a DLL3-targeting antibody tethered to a cytotoxic agent pyrrolobenzodiazepine by means of a protease-cleavable linker. The efficacy and safety of Rova-T compared with topotecan as second-line therapy in patients with SCLC expressing high levels of DLL3 (DLL3-high) was evaluated.

METHODS

The TAHOE study was an open-label, two-to-one randomized, phase 3 study comparing Rova-T with topotecan as second-line therapy in DLL3-high advanced or metastatic SCLC. Rova-T (0.3 mg/kg) was administered intravenously on day 1 of a 42-day cycle for two cycles, with two additional cycles available to patients who met protocol-defined criteria for continued dosing. Topotecan (1.5 mg/m2) was administered intravenously on days 1 to 5 of a 21-day cycle. The primary end point was overall survival (OS).

RESULTS

Patients randomized to Rova-T (n = 296) and topotecan (n = 148) were included in the efficacy analyses. The median age was 64 years, and 77% had the extensive disease at initial diagnosis. The median OS (95% confidence interval) was 6.3 months (5.6-7.3) in the Rova-T arm and 8.6 months (7.7-10.1) in the topotecan arm (hazard ratio, 1.46 [95% confidence interval: 1.17-1.82]). An independent data monitoring committee recommended that enrollment be discontinued because of the shorter OS observed with Rova-T compared with topotecan. Safety profiles for both drugs were consistent with previous reports.

CONCLUSIONS

Compared with topotecan, which is the current standard second-line chemotherapy, Rova-T exhibited an inferior OS and higher rates of serosal effusions, photosensitivity reaction, and peripheral edema in patients with SCLC. A considerable unmet therapeutic need remains in this population.

Fusarium: more than a node or a foot-shaped basal cell

Recent publications have argued that there are potentially serious consequences for researchers in recognising distinct genera in the terminal fusarioid clade of the family Nectriaceae. Thus, an alternate hypothesis, namely a very broad concept of the genus Fusarium was proposed. In doing so, however, a significant body of data that supports distinct genera in Nectriaceae based on morphology, biology, and phylogeny is disregarded. A DNA phylogeny based on 19 orthologous protein-coding genes was presented to support a very broad concept of Fusarium at the F1 node in Nectriaceae. Here, we demonstrate that re-analyses of this dataset show that all 19 genes support the F3 node that represents Fusarium sensu stricto as defined by F. sambucinum (sexual morph synonym Gibberella pulicaris). The backbone of the phylogeny is resolved by the concatenated alignment, but only six of the 19 genes fully support the F1 node, representing the broad circumscription of Fusarium. Furthermore, a re-analysis of the concatenated dataset revealed alternate topologies in different phylogenetic algorithms, highlighting the deep divergence and unresolved placement of various Nectriaceae lineages proposed as members of Fusarium. Species of Fusarium s. str. are characterised by Gibberella sexual morphs, asexual morphs with thin- or thick-walled macroconidia that have variously shaped apical and basal cells, and trichothecene mycotoxin production, which separates them from other fusarioid genera. Here we show that the Wollenweber concept of Fusarium presently accounts for 20 segregate genera with clear-cut synapomorphic traits, and that fusarioid macroconidia represent a character that has been gained or lost multiple times throughout Nectriaceae. Thus, the very broad circumscription of Fusarium is blurry and without apparent synapomorphies, and does not include all genera with fusarium-like macroconidia, which are spread throughout Nectriaceae (e.g., Cosmosporella, Macroconia, Microcera). In this study four new genera are introduced, along with 18 new species and 16 new combinations. These names convey information about relationships, morphology, and ecological preference that would otherwise be lost in a broader definition of Fusarium. To assist users to correctly identify fusarioid genera and species, we introduce a new online identification database, Fusarioid-ID, accessible at www.fusarium.org. The database comprises partial sequences from multiple genes commonly used to identify fusarioid taxa (act1, CaM, his3, rpb1, rpb2, tef1, tub2, ITS, and LSU). In this paper, we also present a nomenclator of names that have been introduced in Fusarium up to January 2021 as well as their current status, types, and diagnostic DNA barcode data. In this study, researchers from 46 countries, representing taxonomists, plant pathologists, medical mycologists, quarantine officials, regulatory agencies, and students, strongly support the application and use of a more precisely delimited Fusarium (= Gibberella) concept to accommodate taxa from the robust monophyletic node F3 on the basis of a well-defined and unique combination of morphological and biochemical features. This F3 node includes, among others, species of the F. fujikuroi, F. incarnatum-equiseti, F. oxysporum, and F. sambucinum species complexes, but not species of Bisifusarium [F. dimerum species complex (SC)], Cyanonectria (F. buxicola SC), Geejayessia (F. staphyleae SC), Neocosmospora (F. solani SC) or Rectifusarium (F. ventricosum SC). The present study represents the first step to generating a new online monograph of Fusarium and allied fusarioid genera (www.fusarium.org).

Investigation of prospective effects of emotion-regulation difficulties and empathic dimensions on depressive symptoms during the COVID-19 outbreak in poland

Introduction

During the COVID-19 pandemic people experience higher levels of negative emotions, as well as face many negative and intense emotions felt by others. Thus, it is important to look for risk and protective factors that allow and help individuals to regulate these negative emotions and adapt to the hardships of the COVID-19 pandemic.

Objectives

The main aims of the study were to (i) test how empathic dimensions (perspective taking, empathic concern and personal distress) and emotion regulation abilities were related to intensity of depressive symptoms during the COVID-19 lockdown in Poland, as well as to (ii) check if emotion regulation difficulties and personal distress predicted slower decrease in depressive symptoms over the two months in which the number of COVID-19 cases declined in Poland.

Methods

A total of 792 participants took part in the three-wave panel study. The sample was representative of the Polish population in terms of gender, age, and place of residence. Participants completed the following online questionnaires: The Patient Health Questionnaire-9, The Difficulties in Emotion Regulation Scale Short Form, and Brief version of the Empathic Sensitivity.

Results

Significant positive correlations were found between depressive symptoms and both personal distress and emotion regulation difficulties during the lockdown. Moreover, emotion regulation difficulties were the only significant predictor of slower decrease in depressive symptoms over time during the COVID-19 pandemic.

Conclusions

It seems that interventions focused on improvement of emotion regulation abilities could be particularly beneficial in reducing depressive symptoms during the pandemic and preventing potential negative long-term outcomes.

The International Federation for Emergency Medicine report on emergency department crowding and access block: a brief summary

Objective

To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block

Methods

Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020.

Results

A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force.

Conclusions

The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.

Cost-effectiveness of adding a non-invasive acoustic rule-out test in the evaluation of patients with suspected stable angina pectoris. Design of the randomized multicenter FILTER-SCAD trial

Background

Patients with suspected stable coronary artery disease (CAD) are selected for further non-invasive or invasive diagnostic tests depending on their pre-test probability (PTP) of obstructive CAD. However, the PTP, based on age, sex, and type of angina, has shown to grossly overestimate the likelihood of obstructive CAD. Consequently, the use of diagnostic tests has increased over the last decades despite a low diagnostic yield (6–7%). The CAD-score is a risk stratification score for obstructive CAD measured using a novel non-invasive acoustic device, and when added to PTP has shown excellent rule-out capabilities.

Purpose

To investigate if the addition of the CAD-score to a standard diagnostic examination is superior in terms of reducing overall number of diagnostic procedures and non-inferior in terms of safety as compared to a standard PTP-guided strategy when evaluating patients with suspected stable CAD.

Methods

The FILTER-SCAD trial is a randomized, controlled, multicenter trial expected to include 2000 subjects ≥30 years of age without known CAD referred for outpatient assessment for suspected CAD at 5 hospitals in Denmark and Sweden. First subject was randomized on October 22, 2019.

Subjects will be randomized 1:1 to either 1) a control group undergoing standard diagnostic examination (SDE) according to current guidelines, or 2) an intervention group undergoing SDE plus a CAD-score measurement, using permuted block randomization stratified by study site and PTP (very low vs. low-intermediate). Follow-up will be 12 months for a primary endpoint of cumulative number of diagnostic tests and a combined secondary safety endpoint of all-cause death, non-fatal myocardial infarction, unstable angina pectoris, heart failure, and ischemic stroke. Questionnaires assessing symptom severity, quality of life, life style measures, and medical treatment will be collected at baseline, 3 months, and 12 months after randomization.

The study is powered to detect superiority in terms of cumulative number of diagnostic tests with a power of 80% and a significance level of 0.05, and non-inferiority on the safety endpoint with a power of 90% and a significance level of 0.05. The study is conducted in compliance to the principles of the Declaration of Helsinki of the World Medical Association. ClinicalTrials.gov ID: NCT04121949.

Results

One study site is currently enrolling. Preliminary baseline data is available on the first 77 (44% males) enrolled patients (median age 61 years IQR (51–72) and PTP 22% IQR (13–38)) showing successful randomization with even distribution of baseline characteristic between the two groups including sex, age, and PTP.

Perspectives

The FILTER-SCAD trial will investigate whether it is feasible to reduce resource consumption without compromising safety in the outpatient assessment of patients with suspected CAD using a simple, non-invasive acoustic device. Enrollment and follow-up are expected to be completed spring 2022.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The company Acarix A/S har provided an unrestricted grant for the study. The Foundation “Fonden for Faglig Udvikling i Speciallægepraksis” has provided a grant for the study.

Phylogenetic origins and family classification of typhuloid fungi, with emphasis on Ceratellopsis, Macrotyphula and Typhula (Basidiomycota)

Typhuloid fungi are a very poorly known group of tiny clavarioid homobasidiomycetes. The phylogenetic position and family classification of the genera targeted here, Ceratellopsis, Macrotyphula, Pterula sensu lato and Typhula, are controversial and based on unresolved phylogenies. Our six-gene phylogeny with an expanded taxon sampling shows that typhuloid fungi evolved at least twice in the Agaricales (Pleurotineae, Clavariineae) and once in the Hymenochaetales. Macrotyphula, Pterulicium and Typhula are nested within the Pleurotineae. The type of Typhula (1818) and Sclerotium (1790), T. phacorrhiza and S. complanatum (synonym T. phacorrhiza), are encompassed in the Macrotyphula clade that is distantly related to a monophyletic group formed by species usually assigned to Typhula. Thus, the correct name for Macrotyphula (1972) and Typhula is Sclerotium and all Typhula species but those in the T. phacorrhiza group need to be transferred to Pistillaria (1821). To avoid undesirable nomenclatural changes, we suggest to conserve Typhula with T. incarnata as type. Clavariaceae is supported as a separate, early diverging lineage within Agaricales, with Hygrophoraceae as a successive sister taxon to the rest of the Agaricales. Ceratellopsis s. auct. is polyphyletic because C. acuminata nests in Clavariaceae and C. sagittiformis in the Hymenochaetales. Ceratellopsis is found to be an earlier name for Pterulicium, because the type, C. queletii, represents Pterulicium gracile (synonym Pterula gracilis), deeply nested in the Pterulicium clade. To avoid re-combining a large number of names in Ceratellopsis we suggest to conserve it with C. acuminata as type. The new genus Bryopistillaria is created to include C. sagittiformis. The families Sarcomyxaceae and Phyllotopsidaceae, and the suborder Clavariineae, are described as new. Six new combinations are proposed and 15 names typified.

Spontaneous Electron Emission from Hot Silver Dimer Anions: Breakdown of the Born-Oppenheimer Approximation

We report the first experimental evidence of spontaneous electron emission from a homonuclear dimer anion through direct measurements of Ag_{2}^{-}→Ag_{2}+e^{-} decays on milliseconds and seconds timescales. This observation is very surprising as there is no avoided crossing between adiabatic energy curves to mediate such a process. The process is weak, yet dominates the decay signal after 100 ms when ensembles of internally hot Ag_{2}^{-} ions are stored in the cryogenic ion-beam storage ring, DESIREE, for 10 s. The electron emission process is associated with an instantaneous, very large reduction of the vibrational energy of the dimer system. This represents a dramatic deviation from a Born-Oppenheimer description of dimer dynamics.

Hagen Bræ: A Surging Glacier in North Greenland-35 Years of Observations

We use remotely sensed ice velocities in combination with observations of surface elevation and glacier area change to investigate the dynamics of Hagen Bræ, North Greenland in high detail over the last 35 years. From our data, we can establish for the first time that Hagen Bræ is a surge-type glacier with characteristics of both Alaskan- and Svalbard-type surging glaciers. We argue that the observed surge was preconditioned by the glacier geometry and triggered by englacially stored meltwater. At present, the glacier is in a transitional state between active and quiescence phases and is not building up to its pre-surge geometry. We suggest that the glacier is adjusting to the loss of its floating section, general thinning, and changes in fjord conditions that occurred over the study period which are unrelated to the surge behavior. The high temporal resolution of the ice velocity data gives insight to the sub-annual glacier flow.

Pindara revisited - evolution and generic limits in Helvellaceae

The Helvellaceae encompasses taxa that produce some of the most elaborate apothecial forms, as well as hypogeous ascomata, in the class Pezizomycetes (Ascomycota). While the circumscription of the Helvellaceae is clarified, evolutionary relationships and generic limits within the family are debatable. A robust phylogeny of the Helvellaceae, using an increased number of molecular characters from the LSU rDNA, RPB2 and EF-1α gene regions (4 299 bp) and a wide representative sampling, is presented here. Helvella s.lat. was shown to be polyphyletic, because Helvella aestivalis formed a distant monophyletic group with hypogeous species of Balsamia and Barssia. All other species of Helvella formed a large group with the enigmatic Pindara (/Helvella) terrestris nested within it. The ear-shaped Wynnella constitutes an independent lineage and is recognised with the earlier name Midotis. The clade of the hypogeous Balsamia and Barssia, and H. aestivalis is coherent in the three-gene phylogeny, and considering the lack of phenotypic characters to distinguish Barssia from Balsamia we combine species of Barssia, along with H. aestivalis, in Balsamia. The closed/tuberiform, sparassoid H. astieri is shown to be a synonym of H. lactea; it is merely an incidental folded form of the saddle-shaped H. lactea. Pindara is a sister group to a restricted Helvella, i.e., excluding the /leucomelaena lineage, on a notably long branch. We recognise Pindara as a separate genus and erect a new genus Dissingia for the /leucomelaena lineage, viz. H. confusa, H. crassitunicata, H. leucomelaena and H. oblongispora. Dissingia is supported by asci that arise from simple septa; all other species of Helvellaceae have asci that arise from croziers, with one exception being the /alpina-corium lineage of Helvella s.str. This suggests ascus development from croziers is the ancestral state for the Helvellaceae and that ascus development from simple septa has evolved at least twice in the family. Our phylogeny does not determine the evolutionary relationships within Helvella s.str., but it is most parsimonious to infer that the ancestor of the helvelloids produced subsessile or shortly stipitate, cup-shaped apothecia. This shape has been maintained in some lineages of Helvella s.str. The type species of Underwoodia, Underwoodia columnaris, is a sister lineage to the rest of the Helvellaceae.

Thrombospondin-2 regulates extracellular matrix production, LOX levels, and cross-linking via downregulation of miR-29

Collagen fibrillogenesis and crosslinking have long been implicated in extracellular matrix (ECM)-dependent processes such as fibrosis and scarring. However, the extent to which matricellular proteins influence ECM protein production and fibrillar collagen crosslinking has yet to be determined. Here we show that thrombospondin 2 (TSP2), an anti-angiogenic matricellular protein, is an important modulator of ECM homeostasis. Specifically, through a fractionated quantitative proteomics approach, we show that loss of TSP2 leads to a unique ECM phenotype characterized by a significant decrease in fibrillar collagen, matricellular, and structural ECM protein production in the skin of TSP2 KO mice. Additionally, TSP2 KO skin displays decreased lysyl oxidase (LOX), which manifests as an increase in fibrillar collagen solubility and decreased levels of LOX-mediated fibrillar collagen crosslinking. We show that these changes are indirectly mediated by miR-29, a major regulator of ECM proteins and LOX, as miR-29 expression is increased in the TSP2 KO. Altogether, these findings indicate that TSP2 contributes to ECM production and assembly by regulating miR-29 and LOX.

Radiative cooling of cationic carbon clusters, CN+, N = 8, 10, 13-16

The radiative cooling of highly excited carbon cluster cations of sizes N = 8, 10, 13-16 has been studied in an electrostatic storage ring. The cooling rate constants vary with cluster size from a maximum at N = 8 of 2.6 × 10⁴ s^-1 and a minimum at N = 13 of 4.4 × 10³ s^-1. The high rates indicate that photon emission takes place from electronically excited ions, providing a strong stabilizing cooling of the molecules.

Non-scrambling of hydrogen in NH4+(H2O)3 clusters

We have measured the metastable decay of protonated, ammonia-doped, deuterated water clusters produced in an electrospray source, d_n-NH₄⁺(H₂O)₃, n = 0–6. The mass spectra show a very strong odd–even effect, consistent with a low degree of scrambling of the hydrogen bound to water and to the ammonia. The relative evaporation rate constant for light water was almost twice the one for heavy water, with the rate for mixed protium–deuterium water molecule intermediate between these two values.

We have measured the metastable decay of protonated, ammonia-doped, deuterated water clusters produced in an electrospray source, d_n-NH₄⁺(H₂O)₃, n = 0–6.

The response of soil solution chemistry in European forests to decreasing acid deposition

Acid deposition arising from sulphur (S) and nitrogen (N) emissions from fossil fuel combustion and agriculture has contributed to the acidification of terrestrial ecosystems in many regions globally. However, in Europe and North America, S deposition has greatly decreased in recent decades due to emissions controls. In this study, we assessed the response of soil solution chemistry in mineral horizons of European forests to these changes. Trends in pH, acid neutralizing capacity (ANC), major ions, total aluminium (Al_tot ) and dissolved organic carbon were determined for the period 1995-2012. Plots with at least 10 years of observations from the ICP Forests monitoring network were used. Trends were assessed for the upper mineral soil (10-20 cm, 104 plots) and subsoil (40-80 cm, 162 plots). There was a large decrease in the concentration of sulphate (SO42-) in soil solution; over a 10-year period (2000-2010), SO42- decreased by 52% at 10-20 cm and 40% at 40-80 cm. Nitrate was unchanged at 10-20 cm but decreased at 40-80 cm. The decrease in acid anions was accompanied by a large and significant decrease in the concentration of the nutrient base cations: calcium, magnesium and potassium (Bc = Ca²⁺  + Mg²⁺  + K⁺ ) and Al_tot over the entire dataset. The response of soil solution acidity was nonuniform. At 10-20 cm, ANC increased in acid-sensitive soils (base saturation ≤10%) indicating a recovery, but ANC decreased in soils with base saturation >10%. At 40-80 cm, ANC remained unchanged in acid-sensitive soils (base saturation ≤20%, pHCaCl2 ≤ 4.5) and decreased in better-buffered soils (base saturation >20%, pHCaCl2 > 4.5). In addition, the molar ratio of Bc to Al_tot either did not change or decreased. The results suggest a long-time lag between emission abatement and changes in soil solution acidity and underline the importance of long-term monitoring in evaluating ecosystem response to decreases in deposition.

Environment and host as large-scale controls of ectomycorrhizal fungi

Explaining the large-scale diversity of soil organisms that drive biogeochemical processes-and their responses to environmental change-is critical. However, identifying consistent drivers of belowground diversity and abundance for some soil organisms at large spatial scales remains problematic. Here we investigate a major guild, the ectomycorrhizal fungi, across European forests at a spatial scale and resolution that is-to our knowledge-unprecedented, to explore key biotic and abiotic predictors of ectomycorrhizal diversity and to identify dominant responses and thresholds for change across complex environmental gradients. We show the effect of 38 host, environment, climate and geographical variables on ectomycorrhizal diversity, and define thresholds of community change for key variables. We quantify host specificity and reveal plasticity in functional traits involved in soil foraging across gradients. We conclude that environmental and host factors explain most of the variation in ectomycorrhizal diversity, that the environmental thresholds used as major ecosystem assessment tools need adjustment and that the importance of belowground specificity and plasticity has previously been underappreciated.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

The effect of hydraulic retention time in onsite wastewater treatment and removal of pharmaceuticals, hormones and phenolic utility substances

Micropollutants such as pharmaceuticals, hormones and phenolic utility chemicals in sewage water are considered to be an emerging problem because of increased use and observed adverse effects in the environment. The study provides knowledge on the removal efficiency of micropollutants with a range of physical and chemical properties in three commercially available onsite wastewater treatment facilities (OWTFs), tested on influent wastewater collected from 2500 person equivalents in Bildchen, Germany. A longer hydraulic retention time would in theory be expected to have a positive effect, and this study presents results for three different OWTFs in full-scale comparable tests under natural conditions. A range of 24 different pharmaceuticals, five phenols and three hormones were analyzed. Flow-proportional consecutive sampling was performed in order to determine the removal efficiency. Twenty-eight substances were detected in the effluent wastewater out of 32 substances included. Average effluent concentrations of Simvastatin, Estrone, Estradiol and Ethinylestradiol were above the indicative critical-effect concentration of pharmacological effect on fish in all facilities. Average effluent concentrations of both Diclofenac and Estradiol were higher than the Environmental Quality Standards applied in Sweden (190-240 times and 9-35 times respectively). The removal efficiency of micropollutants was high for substances with high logK_ow, which enhance the adsorption and removal with sludge. Low removal was observed for substances with low logK_ow and acidic characteristics, and for substances with stabilizing elements of the chemical structure. Facilities that use activated sludge processes removed hormones more efficiently than facilities using trickling filter treatment technique. Moreover, longer hydraulic retention time increased the removal of pharmaceuticals, hormones, turbidity and total nitrogen. Removal of Caffeine, Ibuprofen, Estrone, Naproxen and Estradiol, was strongly correlated to the sludge and particles removal. Thus, the efficiency of the tested OWTFs could be improved by adjusting the technical methods and increasing the hydraulic retention time.

Habitat properties are key drivers of Borrelia burgdorferi (s.l.) prevalence in Ixodes ricinus populations of deciduous forest fragments

BACKGROUND

The tick Ixodes ricinus has considerable impact on the health of humans and other terrestrial animals because it transmits several tick-borne pathogens (TBPs) such as B. burgdorferi (sensu lato), which causes Lyme borreliosis (LB). Small forest patches of agricultural landscapes provide many ecosystem services and also the disservice of LB risk. Biotic interactions and environmental filtering shape tick host communities distinctively between specific regions of Europe, which makes evaluating the dilution effect hypothesis and its influence across various scales challenging. Latitude, macroclimate, landscape and habitat properties drive both hosts and ticks and are comparable metrics across Europe. Therefore, we instead assess these environmental drivers as indicators and determine their respective roles for the prevalence of B. burgdorferi in I. ricinus.

METHODS

We sampled I. ricinus and measured environmental properties of macroclimate, landscape and habitat quality of forest patches in agricultural landscapes along a European macroclimatic gradient. We used linear mixed models to determine significant drivers and their relative importance for nymphal and adult B. burgdorferi prevalence. We suggest a new prevalence index, which is pool-size independent.

RESULTS

During summer months, our prevalence index varied between 0 and 0.4 per forest patch, indicating a low to moderate disservice. Habitat properties exerted a fourfold larger influence on B. burgdorferi prevalence than macroclimate and landscape properties combined. Increasingly available ecotone habitat of focal forest patches diluted and edge density at landscape scale amplified B. burgdorferi prevalence. Indicators of habitat attractiveness for tick hosts (food resources and shelter) were the most important predictors within habitat patches. More diverse and abundant macro- and microhabitat had a diluting effect, as it presumably diversifies the niches for tick-hosts and decreases the probability of contact between ticks and their hosts and hence the transmission likelihood.

CONCLUSIONS

Diluting effects of more diverse habitat patches would pose another reason to maintain or restore high biodiversity in forest patches of rural landscapes. We suggest classifying habitat patches by their regulating services as dilution and amplification habitat, which predominantly either decrease or increase B. burgdorferi prevalence at local and landscape scale and hence LB risk. Particular emphasis on promoting LB-diluting properties should be put on the management of those habitats that are frequently used by humans. In the light of these findings, climate change may be of little concern for LB risk at local scales, but this should be evaluated further.

Environmental drivers of Ixodes ricinus abundance in forest fragments of rural European landscapes

BACKGROUND

The castor bean tick (Ixodes ricinus) transmits infectious diseases such as Lyme borreliosis, which constitutes an important ecosystem disservice. Despite many local studies, a comprehensive understanding of the key drivers of tick abundance at the continental scale is still lacking. We analyze a large set of environmental factors as potential drivers of I. ricinus abundance. Our multi-scale study was carried out in deciduous forest fragments dispersed within two contrasting rural landscapes of eight regions, along a macroclimatic gradient stretching from southern France to central Sweden and Estonia. We surveyed the abundance of I. ricinus, plant community composition, forest structure and soil properties and compiled data on landscape structure, macroclimate and habitat properties. We used linear mixed models to analyze patterns and derived the relative importance of the significant drivers.

RESULTS

Many drivers had, on their own, either a moderate or small explanatory value for the abundance of I. ricinus, but combined they explained a substantial part of variation. This emphasizes the complex ecology of I. ricinus and the relevance of environmental factors for tick abundance. Macroclimate only explained a small fraction of variation, while properties of macro- and microhabitat, which buffer macroclimate, had a considerable impact on tick abundance. The amount of forest and the composition of the surrounding rural landscape were additionally important drivers of tick abundance. Functional (dispersules) and structural (density of tree and shrub layers) properties of the habitat patch played an important role. Various diversity metrics had only a small relative importance. Ontogenetic tick stages showed pronounced differences in their response. The abundance of nymphs and adults is explained by the preceding stage with a positive relationship, indicating a cumulative effect of drivers.

CONCLUSIONS

Our findings suggest that the ecosystem disservices of tick-borne diseases, via the abundance of ticks, strongly depends on habitat properties and thus on how humans manage ecosystems from the scale of the microhabitat to the landscape. This study stresses the need to further evaluate the interaction between climate change and ecosystem management on I. ricinus abundance.

Mechanical Thrombectomy with the Embolus Retriever with Interlinked Cages in Acute Ischemic Stroke: ERIC, the New Boy in the Class

BACKGROUND AND PURPOSE

The Embolus Retriever with Interlinked Cages (ERIC) device is a novel stent retriever for mechanical thrombectomy. It consists of interlinked cages and could improve procedural benchmarks and clinical outcome compared with classic stent retrievers. This study compares the rates of recanalization, favorable clinical outcome, procedural adverse events, and benchmarks between the ERIC device and classic stent retrievers.

MATERIALS AND METHODS

From 545 patients treated with thrombectomy between 2012 and 2015, 316 patients were included. The mean age was 69 ±13 years, the mean baseline NIHSS score was 17 ± 5, and 174 (55%) were men. The ERIC was used as the primary thrombectomy device in 59 (19%) patients. In a propensity score matched analysis including the NIHSS score, clot location, delay to groin puncture, neurointerventionalist, and anesthetic management, 57 matched pairs were identified.

RESULTS

Patients treated with the ERIC device compared with classic stent retrievers showed equal rates of recanalization (86% versus 81%, P = .61), equal favorable 3-month clinical outcome (mRS 0-2: 46% versus 40%, P = .71), and procedural adverse events (28% versus 30%, P = 1.00). However, in patients treated with the ERIC device, thrombectomy procedures were less time-consuming (67 versus 98 minutes, P = .009) and a rescue device was needed less often (18% versus 39%, P = .02) compared with classic stent retrievers.

CONCLUSIONS

Mechanical thrombectomy with the ERIC device is effective and safe. Rates of favorable procedural and clinical outcomes are at least as good as those with classic stent retrievers. Of note, the ERIC device might be time-saving and decrease the need for rescue devices. These promising results call for replication in larger prospective clinical trials.

Abstract P4-12-05: Extracellular vesicles from young women's and postpartum breast cancer display unique proteomic content, alter breast cancer aggressive behavior, and influence immune cell function

Background: Young women's breast cancer[YWBC] affects 27,000 US women age ≤45 annually. Half of these cancers occur within 5-10 years of a prior childbirth, a postpartum breast cancer[PPBC], incurring a 3 fold increased risk for metastasis and death. Recently, extracellular vesicles[EV] have been identified in human circulation, released from cancer cells, that have paracrine and autocrine effects, alter the tumor microenvironment and establish metastatic niches. EVs isolated from breast cancer lines increase proliferation and invasion of other breast cancer cells in vitro. However, the impact of EVs isolated from primary breast cancer patients on tumor invasion, metastasis and their role in tumor immune suppression is largely unknown. We hypothesized that EVs from YWBC/PPBC patients may contain unique pro-metastatic cargo, influence aggressive breast cancer cell behavior and may demonstrate the ability to alter immune cell function.

Method: We isolated EVs using size-exclusion chromatography [SEC] from the plasma of 10 unaffected young women and 20 YWBC patients balanced for parity, age, subtype and stage. We compared the breast cancer-specific EV proteins within various clinical groups of YWBC and PPBC to identify significant proteomic differences by parity, sub-type, stage, and disease recurrence. We determined the functional impact of these EVs on tumor cell motility and proliferation, and analyzed the effect of breast cancer derived EVs on immune cell phenotype, function, and T cell proliferation assays.

Results: Of the 582 proteins, 22 proteins are significantly increased in the EVs of YWBC compared to unaffected donors. The protein set includes breast cancer antigens [MUC 1, 2, 5b], transcriptional regulators [Myc target protein], enzymes [catalase, MMP inhibitor 1], and signaling molecules [Annexin 1, latent TGFb binding protein 1], among others. Several identified proteins specifically track with those YWBC cases with subsequent metastases. Furthermore, 8 unique proteins track with PPBC, including cartilage oligomeric matrix protein, a novel breast cancer biomarker that correlates with increased invasiveness, and decreased recurrence-free survival. EVs isolated from the plasma of newly diagnosed YWBC increase breast cancer invasion and EVs derived from breast cancer are engulfed by the majority of monocytic immune cells, including dendritic cells, classical and activated monocytes, but not by lymphocytes. Specifically, CD14+ monocytic myeloid derived suppressor cells engulfed the EVs while the CD15+ granulocytic subset did not. Once engulfed, phenotypic changes occurr in the EV containing monocytes and a significantly reduction in T cell stimulation in standard mixed-lymphocyte reactions is observed.

Conclusion: EVs isolated from YWBC & PPBC cases have unique protein content and increase breast cancer invasiveness, which suggests potential mechanistic roles for EVs as increasing metastatic risk and provides novel candidate biomarkers. We identified an immunomodulatory effect of breast cancer EVs on human monocytes that may contribute to immunosuppression in breast cancer and a role for EVs as directly modulating the host and tumor microenvironment.

Citation Format: Borges VF, Jordan KR, Hall JK, Schedin T, Hansen K, Schedin P. Extracellular vesicles from young women's and postpartum breast cancer display unique proteomic content, alter breast cancer aggressive behavior, and influence immune cell function [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-12-05.