Events Research Articles

Role of thoracoabdominal imaging on diagnosis and management in patients with suspected infective endocarditis

Abstract Background/Introduction Embolic events (EEs) are a common complication of infective endocarditis (IE) and their presence can impact diagnosis and modify the therapeutic plan. Purpose The present study aimed to describe the role of thoracoabdominal imaging (TA-Im) on diagnosis and management of patients with suspected IE. Methods This study was conducted at a university hospital, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria. Results Among 966 episodes with IE suspicion and TA-Im, 740 (77%) contrast-enhanced CT, 158 (16%) 18F-FDG PET/CT and 68 (7%) non-contrast-enhanced CT. The majority of patients (528; 55%) were without thoracoabdominal symptoms. At least one EE was found in 205 (21%) episodes. Based on TA-Im findings, the diagnosis was reclassified from rejected to possible or from possible to definite IE in 6 (1%) and 10 (1%) episodes, respectively [2 (0.5%) and 5 (1%) in asymptomatic episodes, respectively]. Table shows the type of embolic events and their impact on diagnosis in episodes with suspected IE. Among the 413 patients with possible or definite IE, at least one EE was found on TA-Im in 143 (35%) episodes. Together with the presence of left-side valvular vegetation >10mm, the results of TA-Im established a surgical indication (prevention of embolism) in 15 (4%) episodes, 7 of which were asymptomatic. Among the subgroup of episodes (n=127) with left-side vegetation >10mm, TA-Im established a surgical indication in 12% of episodes (15 patients), 10% among asymptomatic episodes (7 out of 73). Figure shows the changes in diagnostic classification and management due to TA-Im results in patients suspected (A) and those with IE (B). Conclusion TA-Im performed in asymptomatic patients with IE suspicion improved the diagnosis of IE in only a small proportion of patients; this proportion was similarly low in symptomatic patients. The role of systematic TA-Im in the clinical management of asymptomatic IE patients remains unclear, since it identified a new indication for valvular surgery in only a small proportion of patients. The scenario, where the benefit of TA-Im on management is a patient with a vegetation >10mm; in those patients, systematic TA-Im may lead to a new surgical indication in 10% of cases.Embolic eventsDiagnosis and mangement

Impact of thoracoabdominal imaging on diagnosis and management in patients with suspected infective endocarditis

BackgroundEmbolic events (EEs) are a common complication of infective endocarditis (IE) and their presence can impact diagnosis and modify the therapeutic plan. The present study aimed to describe the role of thoracoabdominal imaging, either thoracoabdominal-pelvic Computed Tomography or 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography, on diagnosis and management of patients with suspected IE. MethodsThis study was conducted at a university hospital, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria. ResultsAmong 966 episodes with suspected IE and thoracoabdominal imaging, 528 (55%) patients were asymptomatic. At least one EE was found in 205 (21%) episodes. Based on thoracoabdominal imaging findings, the diagnosis was reclassified from rejected to possible or from possible to definite IE in 6 (1%) and 10 (1%) episodes, respectively. Among the 413 patients with IE, at least one EE was found on thoracoabdominal imaging in 143 (35%) episodes. Together with the presence of left-side valvular vegetation >10 mm, the results of thoracoabdominal imaging established a surgical indication (prevention of embolism) in 15 (4%) episodes, 7 of which were asymptomatic. ConclusionsThoracoabdominal imaging performed in asymptomatic patients with suspected IE improved the diagnosis in only a small proportion of patients. Thoracoabdominal imaging led to a new surgical indication (in association with left-side valvular vegetation >10 mm) in only a small percentage of patients.

El Abad del Monasterio de Poblet como Limosnero Real y su rendición de cuentas (S. XIV)

El artículo, una vez hecha una síntesis de las características del siglo XIV en la Corona de Aragón y Cataluña y de los acontecimientos históricos y económicos más relevantes, ofrece unas líneas sobre el monasterio de Poblet, su creación en 1150 a partir de los terrenos entregados por el conde de Barcelona, la evolución hasta llegar al siglo XIV, época en la que el rey Pedro el Ceremonioso instituye al limosnero real, que representa el núcleo central de nuestro estudio. A partir de unos manuscritos datados a finales del siglo XIV por el limosnero real y que son las anotaciones correspondientes a los movimientos de entrada y salida de las limosnas y de las Ordenanzas dictadas por el rey Pedro IV, tenemos conocimiento de las cantidades que éste disponía que debían ser entregadas en forma de dádivas a los beneficiarios de las mismas, así como sus destinatarios, que abarcan a casi todos los estamentos sociales, puesto que además de ser recibidas por los pobres menesterosos en auxilio de pitanza o de vestimenta, también son destinatarios los mo nasterios, los clérigos para recibir alimento tanto para el cuerpo como para la mente -formación-, las pecadoras para redimirse y los peregrinos, así como algún noble sobre el que pendiera la desgracia. Los documentos nos permiten conocer como se donaba la limosna real, las personas que intervenían (dos limosneros, dos monaguillos y un asistente o servidor), el lugar que ocupaban en la corte real -privilegios y obligaciones-, y lo que para nosotros ha sido más importante, los documentos que toda su administración conllevaba, así como conocer el proceso sobre el que se sustentaba la rendición de las cuentas de la limosna real, y como se produce un endurecimiento en el control de los registros a medida que nos acercamos a las postrimerías del siglo XIV.

Towards a pan-European coastal flood awareness system: Skill of extreme sea-level forecasts from the Copernicus Marine Service

European coasts are regularly exposed to severe storms that trigger extreme water-level conditions, leading to coastal flooding and erosion. Early Warning Systems (EWS) are important tools for the increased preparedness and response against coastal flood events, hence greatly reducing associated risks. With this objective, a proof-of-concept for a European Coastal Flood Awareness System (ECFAS) was developed in the framework of the H2020 ECFAS project, which capitalizes on the Copernicus products. In this context, this manuscript evaluates for the first time the capability of the current Copernicus Marine operational ocean models to forecast extreme coastal water levels and hence to feed coastal flood awareness applications at European scale. A methodology is developed to focus the assessment on storm-driven extreme sea level events (EEs) from tide-gauge records. For the detected EEs, the event peak representation is validated, and the impact of forecast lead time is evaluated. Results show satisfactory performance but a general underprediction of peak magnitudes of 10% for water levels and 18% for surges across the detected EEs. In average, the models are capable of independently flagging 76% of the observed EEs. Forecasts show limited lead time impact up to a 4-day lead time, demonstrating the suitability of the systems for early warning applications. Finally, by separating the surge and tidal contributions to the extremes, the potential sources of the prediction misfits are discussed and consequent recommendations for the evolution of the Copernicus Marine Service forecasting models towards coastal flooding applications are provided.

A likely geological record of deep tremor and slow slip events from a subducted continental broken formation

Fluids in subduction zones play a key role in controlling seismic activity, drastically affecting the rheology of rocks, triggering mineral reactions, and lowering the effective stress. Fluctuating pore pressure is one important parameter for the switch between brittle and ductile deformation, thus impacting seismogenesis. Episodic tremor and slow slip events (ETS) have been proposed as a common feature of the geophysical signature of subduction zones. Their geological record, however, remains scanty. Only the detailed and further characterization of exhumed fossil geological settings can help fill this knowledge gap. Here we propose that fluctuating pore pressure linked to metamorphic dehydration reactions steered cyclic and ETS-related brittle and ductile deformation of continental crustal rocks in the subduction channel of the Apennines. Dilational shear veins and ductile mylonitic shear zones formed broadly coevally at minimum 1 GPa and 350 °C, corresponding to ~ 30–40 km depth in the subduction zone. We identify carpholite in Ca-poor metasediments as an important carrier of H2O to depths > 40 km in cold subduction zones. Our results suggest that the described (micro)structures and mineralogical changes can be ascribed to deep ETS and provide a useful reference for the interpretation of similar tectonic settings worldwide.

We, the disturbing animal: effects of anthropogenic noise in a Brazilian zoo

The negative effects of loud anthropic sounds on non-human health and welfare urges attention. We report here the results of a technical study we conducted attending a Public Prosecutor’s request at Ribeirão Preto, SP, Brazil. A Civil Inquiry informed against nocive effects of human concentration on captive and free-living animals around the municipal zoo. The zoo is part of a natural protected area that paradoxically was used as a locale for public festivities. We aimed to compare two weekends, one of a traditional Italian event (EV) and another with no event (NE), and check sound level and behavioral changes in a sample of captive animals and in the soundscape. We employed three procedures: (1) Sound Pressure level (SPL) assessment at different localities; (2) Comparative behavior analysis; and (3) Soundscape description. Our results provided cues of how the festivities may be affecting free-living animals in the APA Morro do São Bento and captive ones. Peak SPL exposure was higher in EV in almost all the localities of the zoo; the six monitored individuals (two ocelots, two crassow, the European cervid and the maned-wolf) changed their activity and resting patterns and the soundscape was more diverse and intense in vocal activity than in NE.

Disentangling relations between urban form and urban accessibility for resilience to extreme weather and climate events

The rapid urbanization progress has placed large populations and expensive civil infrastructure at locations exposed to climatic and weather-related hazards (e.g., wind storms and floods), which demands informed and effective planning approaches that help human communities adapt to these adverse events. Emerging research highlights the importance of maintaining sufficient and equitable access to facilities that provide essential resources (e.g., gas and food) and services (e.g., healthcare and banking) and support city residents’ daily activities to avoid exacerbated event impacts. Extant studies suggest that urban forms, including the spatial arrangement of facilities, influence place accessibility. However, these studies are mostly semantic and ontological without quantitative investigations into their dynamic interactions under the impact of extreme (weather and climate) events (EEs). Therefore, we propose to evaluate the relations between urban form characteristics (i.e., compacity, polycentricity, and mixed land use) and urban accessibility with simulations. We used Cellular Automata (CA) to simulate four land-use change scenarios for the City of Tallahassee in the United States, and calculated the resource/service-seeking travel paths for “residents” living in the four “simulated cities” characterized by different urban form characteristics across three scenarios, i.e., business-as-usual (BAU), limited resource provision (LRP), and built environment disruption (BED) scenarios. We measured accessibility for a simulated city as the distribution (i.e., median values and cumulative distribution functions) of the calculated travel path lengths for that city. The simulation results indicate that “residents” living in cities with mixed land use and decentralized population and commercial centers are associated with higher-level accessibilities and experience fewer perturbations during EE. The research findings could inform future land use and landscape planning practices and policies that help hazard-prone communities adapt to recurring EEs and thus enhance community resilience.

Effect of antimicrobial therapy on the embolic events in patients with infective endocarditis

Abstract Background Embolic events (EE) are presented in up to 50% of the cases of infective endocarditis (IE). Main approach in prevention of the embolisms is properly timed surgery and antimicrobial therapy. But specific antimicrobial drug to prevent embolic events is not yet established. Purpose To analyze effect of a distinct group of an antimicrobials on association with embolic events in patients with IE. Methods 255 patients with verified IE (DUKE 2009, 2015), hospitalized and treated from January 2010 to January 2020, were included in the study. Patients underwent clinical investigation including physical examination, laboratory and instrumental studies. Results About one quarter (27.5%) of the patients had an embolic event after initiation of antimicrobial therapy. Embolism localizations include: brain (30%), lungs (47%), kidneys (20%), spleen (14%), coronary (8%) and peripheral arteries (5.7%). Most common causative agent was Staphylococcus aureus (25.5%). There were no clinical association between a certain group of antimicrobials and embolic outcome (table). However, effectiveness of the first-line antimicrobial, eradication of pathogen and abscence of infection persistence was associated with lower rate of embolism Conclusion In correspondence to guidelines adequate antimicrobial therapy (eradication of a pathogen and abscence of infection persistence) is associated with lower thromboembolic risk regardless of certain group of antimicrobials. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): RUDN University Strategic Academic Leadership Program.

Nutrients and solids removal in bioretention columns using recycled materials under intermittent and frequent flow operations

This research investigated the fate and removal of nitrite (NO2–N), nitrate (NO3–N), orthophosphate (PO4–P), and total suspended solids (TSS) in two bioretention columns, which were designed with three recycled materials. The first column was packed with Recycled Concrete Aggregate (RCA). The second column was a Layered Media (LM), which has layers of RCA with crushed glass and rice husks. The columns were tested under intermittent and frequent operations of synthetic runoff with low and high feed concentrations. The effect of inflow concentration, antecedent dry days (ADD), column age, and the anticipated number of events (EN) was also statistically analyzed on the performance of columns. Depending on column types, nutrient removal was significantly (p < 0.05) increased under frequent flow operations by 26–53% over intermittent. However, TSS removal was notably (p < 0.05) increased by 23–35% under intermittent operations over frequent. Overall, LM showed an increased NO2–N (92 ± 2%) and NO3–N (88% ± 2%) removal under low feed frequent operations and TSS removal (97% ± 2%) under initial intermittent operations. On the contrary, RCA showed a maximum of 99% PO4–P removal under high feed frequent operations. Results showed that the nutrient outflow concentration was found to have a negative correlation with EN and column age and a positive correlation with ADDs throughout the experiments.

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A series of unlikely events: from washing machine to new species

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