Initial PE Research Articles

Pulmonary embolism in hospitalized COVID-19 patients: Short- and long-term clinical outcomes

IntroductionPulmonary embolism (PE) is a frequent complication in COVID-19. However, the influence of PE on the prognosis of COVID-19 remains unclear as previous studies were affected by misclassification bias. Therefore, we evaluated a cohort of COVID-19 patients whom all underwent systematic screening for PE (thereby avoiding misclassification) and compared clinical outcomes between patients with and without PE. Materials and methodsWe included all COVID-19 patients who were admitted through the ED between April 2020 and February 2021. All patients underwent systematic work-up for PE in the ED using the YEARS-algorithm. The primary outcome was a composite of in-hospital mortality and ICU admission. We also evaluated long-term outcomes including PE occurrence within 90 days after discharge and one-year all-cause mortality. Results637 ED patients were included in the analysis. PE was diagnosed in 46 of them (7.2%). The occurrence of the primary outcome did not differ between patients with PE and those without (28.3% vs. 26.9%, p = 0.68). The overall rate of PE diagnosed in-hospital (after an initial negative PE screening in the ED) and in the first 90 days after discharge was 3.9% and 1.2% respectively. One-year all-cause mortality was similar between patients with and without PE (26.1% vs. 24.4%, p = 0.83). ConclusionsIn a cohort of COVID-19 patients who underwent systematic PE screening in the ED, we found no differences in mortality rate and ICU admissions between patients with and without PE. This may indicate that proactive PE screening, and thus timely diagnosis and treatment of PE, may limit further clinical deterioration and associated mortality in COVID-19 patients.

Crosslinked networks in electron beam irradiated polyethylenes evaluated by proton low-field NMR spectroscopy

Effect of electron beam (EB) irradiation is analyzed in low and high density polyethylenes (LDPE and HDPE, respectively) at different doses. Parameters as important as degree of crystallinity, melting or crystallization temperatures are dependent on the initial PE molecular architecture, which also controls the gel content developed by action of EB irradiation and the EB dose applied. Thus, this gel amount, ascribed to formation of chain crosslinkings, is raised as irradiation dose increases, being larger in the HDPE than in the LDPE. In both, a plateau value is reached at the highest doses. The molecular changes that take place in both PEs during EB irradiation lead to a hindrance in their crystallization capacity, once macrochains are molten, and, accordingly, to a reduction in crystallinity and to formation of thinner crystallites. Variation with temperature of rigid and soft fractions together with their respective relaxation times is followed in the irradiated LDPE and HDPE specimens by pulse mixed magic-sandwich echo nuclear magnetic resonance (MSE-NMR) measurements. The network structure promoted in these PEs is evaluated by using the multiple-quantum nuclear magnetic resonance (MQ-NMR) approach, showing important differences caused by EB irradiation due to their intrinsic molecular characteristics.

A RARE PRESENTATION FOR PULMONARY EMBOLISM

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: With the evolution of diagnostic and treatment modalities for venous thrombo-embolic disease we have seen a significant reduction in the case fatality rate as well as a steady increase in the total number of cases diagnosed worldwide. While pulmonary infarction is an uncommon complication of PE, it's further evolution to cavitaty formation is exceedingly rare and we would like to present and discuss such a case. CASE PRESENTATION: Our case is that of a 68 year old gentleman with a known history of severe obstructive lung disease and HIV who initially presented to the hospital with complaints of acute severe dyspnea. He was diagnosed with a pneumothorax, and after successful chest tube placement a non contrast computer tomography (CT) scan of his chest showed a cavitary lesion in the superior segment of the right lower lobe. Subsequent testing also revealed an acinetobacter baumanii infection for which he was treated with a prolonged course of antibiotics. Three months after the initial admission, he returned to the hospital with dyspnea at which time a CT of his chest with contrast showed extensive bilateral PE with radiological signs of chronicity and a new left lower lobe infiltrate with cavitation. The distribution of his chronic PE was consistent with both his previously noted right lung and current left lung cavities. During his second hospitalization, no causative organisms could be isolated however he was treated empirically with antibiotics. His PE was treated with anticoagulation and he was successfully followed in the outpatient setting with serial CT imaging which showed resolution of both cavitary lesions and no new PE's on subsequent CT scans. DISCUSSION: The dual blood supply to the lungs make pulmonary infarction an uncommon sequela of PE. Less than 1% of PE's have been noted to lead to cavitation after infarction. While multiple risk factors have been noted for cavitation after a PE, including old age, chronic lung disease, a history of heart failure and the size of the infarct area, the average time to cavitation is 2-3 weeks. Areas of infarct are usually aseptic however secondary infections can lead to hastening of the formation of a cavitary lesion. Our patient presented to the hospital with a formed cavity implying that he had suffered from the initial PE a few weeks before. While cavity formation after pulmonary infarcts has been well described in the literature, our case is unique because of the presentation as well as because he developed multiple cavitations at different times over the course of treatment which is an extremely unusual and rare clinical course for a PE and has not been previously noted in the literature. CONCLUSIONS: While cavitary lesions are a rare complication of pulmonary infarcts, PE must always be considered as part of the differential diagnosis. Early appropriate treatment can prevent complications that have been noted with acute and chronic PE. Reference #1: Sonmez, M., Aboussouan, L. S., Farver, C. A. R. O. L., Murthy, S. C., & Kaw, R. (2018). Pulmonary infarction due to pulmonary embolism. Reference #2: Konstantinides, Stavros V., et al. "Management of pulmonary embolism: an update.” Journal of the American College of Cardiology 67.8 (2016): 976-990. Reference #3: Koroscil, Matthew T., and Timothy R. Hauser. "Acute pulmonary embolism leading to cavitation and large pulmonary abscess: a rare complication of pulmonary infarction.” Respiratory medicine case reports 20 (2017): 72-74. DISCLOSURES: No relevant relationships by Taaran Cariappa Ballachanda Subbaiah, source=Web Response No relevant relationships by Jason George, source=Web Response

Recurrent hospitalization and healthcare resource use among patients with deep vein thrombosis and pulmonary embolism: findings from a multi-payer analysis.

The objective of this study was to assess deep vein thrombosis and pulmonary embolism (DVT/PE) recurrence rates and resource utilization among patients with an initial DVT or PE event across multiple payer perspectives. Retrospective analyses were performed using a software tool that analyzes health plan claims to evaluate treatment patterns and resource utilization for various cardiovascular conditions. Six databases were analyzed from three payer perspectives (Commercial, Medicare, and Medicaid). Patients were ≥18 years old with a primary diagnosis of DVT or PE associated with an inpatient and/or emergency room claim, had received an antithrombotic within 7 days before or 14 days after index, and had no diagnosis of atrial fibrillation during follow-up. Outcomes were assessed over a 1 year period following index. More PE patients were hospitalized for their index event than DVT patients (42–59 % DVT and 69–86 % PE) and had longer mean length of stay (2.35–2.95 days DVT and 3.26–3.76 days PE). Recurrent event rates among PE patients (12–32 %) were higher than those for DVT patients (6–16 %) across all payers. The highest rate of recurrence was observed among the Medicaid population [23 % overall (VTE); 16 % DVT; 32 % PE]. All-cause hospitalization in the year following their VTE episode occurred in 23–67 % DVT patients and 30–68 % PE patients. Medicaid had the highest proportion of patients with hospitalizations and ER visits. Recurrent VTE events and all-cause hospitalizations are relatively common, especially for patients who had a PE, and among those in the Medicaid payer population.

Guidelines on oral anticoagulation with warfarin – fourth edition

Guidelines on oral anticoagulation with warfarin – fourth edition

Phosphorus Budget and Soil Extractable Dynamics in Field Crop Rotations in Mollisols

A better understanding of the P cycle is necessary to provide insights into management strategies that could enhance P bioavailability for crops. Our objectives were to evaluate the effects of continuous P fertilization on (i) the P budget, (ii) soil‐extractable P (Pe) dynamics, and (iii) the relationship between these variables. Two crop rotations during a 6‐yr period were analyzed in seven on‐farm experiments: corn (Zea mays L.)–double cropped wheat (Triticum aestivum)/soybean [Glycine max (L.) Merr.] (C‐W/S), and corn–soybean–double cropped wheat/soybean (C‐S‐W/S). Calculations of net P input considered only P removal (output) and fertilization (input). Initial soil‐test P was 13.4 mg P kg−1 (average for the four sites) for the C‐W/S rotation and 37.9 mg P kg−1 for the C‐S‐W/S rotation (average for the three sites). Treatment combinations were two annual rates: unfertilized and grain P removal estimation +10% (average 34 kg P ha−1 yr−1). Not applying P to soils testing 45 to 68 mg kg−1 of initial Pe resulted in a steep Pe decline (slope 0.2 mg kg−1 per unit of negative P budget). Nevertheless, soils with <25 mg kg−1 of initial Pe levels resulted in a very small and gradual decline (slope 0.02 mg kg−1). Use of current P rates applied by local farmers probably results in a small soil‐test P buildup with time. The P required to increase Pe by 1 mg P kg−1 was 11 and 8 kg P ha−1 yr−1 for the C‐W/S and C‐S‐W/S rotations, respectively.

THE BIFURCATION PERIODS IN LOW-MASS X-RAY BINARIES: THE EFFECT OF MAGNETIC BRAKING AND MASS LOSS

The bifurcation period in low-mass X-ray binaries is the initial orbital pe- riod which separates the formation of converging systems (which evolve with decreasing orbital periods until the donor becomes degenerate) from the diverging systems (which evolve with increasing orbital periods until the donor star loses its envelope and a wide detached binary is formed). We calculate systematically the bifurcation periods of binary systems with a 1.4M_\sun neutron star and a 0.5-2M_\sun donor star, taking into account different kinds of magnetic braking and mass loss mechanisms. Our results show that the saturated magnetic braking can considerably decrease the values of bifurcation period compared to the traditional magnetic braking, while the influence of mass loss mechanisms on bifurcation periods is quite weak. We also develop a semi-analytical method to compute the bifurcation period, the result of which agrees well with the numerical method in the leading order.

Low [Mg 2+ ] e Enhances Arterial Spontaneous Tone via Phosphatidylinositol 3-Kinase in DOCA-Salt Hypertension

Phosphatidylinositol 3-kinase (PI3K) has been implicated in low extracellular Mg2+ concentration ( [Mg2+]e)-induced aortic contraction, and Mg2+ deficiency has been associated with hypertension. Moreover, arterial PI3K activity is increased in hypertensive deoxycorticosterone (DOCA)-salt rats. We hypothesized that low [Mg2+]e activates PI3K, eliciting enhanced vascular contraction, PI3K activity, and norepinephrine (NE)-induced contraction. Spontaneous tone was monitored in endothelium-denuded aortic strips from sham and DOCA-salt rats exposed to low Mg2+ (0.15 mmol/L), high Mg2+ (4.8 mmol/L), or normal (1.17 mmol/L) physiologic salt solution (PSS) in isolated tissue baths. LY294002 (20 micromol/L), a PI3K inhibitor, or vehicle was added (30 minutes), followed by NE (10(-9) to 3 x10(-5) mol/L). Low [Mg2+]e significantly enhanced tone in aortas from DOCA-salt and sham rats compared with normal PSS (DOCA-salt low [Mg2+]e, +51.5 +7.0 vs DOCA-salt normal PSS, +7.1 +1.4 % of initial phenylephrine [PE] contraction). LY294002 and incubation with high Mg2+ PSS decreased tone in aortas from DOCA-salt rats (low [Mg2+]e LY294002, --87.5 +8.8; normal PSS LY294002, -81.7 +13.7; and high [Mg2+]e, -31.2 +10.8 % of initial PE contraction). Low [Mg2+]e leftward-shifted NE-induced aortic contractions in sham and thus matched the shift observed with DOCA (-log EC50 mol/L: sham PSS, -7.7 +0.1; DOCA-salt PSS, -8.2 +0.1; sham low [Mg2+]e, -8.2 +0.1; and DOCA-salt low [Mg2+]e, -8.1 +0.1). Moreover, this shift was inhibited by LY294002. In conclusion, low [Mg2+]e might activate PI3K, leading to enhanced tone and agonist-induced contraction observed in aortas from DOCA-salt hypertensive rats.

OFSTED Revisited: Re-living the Experience of an Initial Teacher Training PE Inspection

The Office for Standards in Education (OFSTED) inspects the quality of all Initial Teacher Training (ITT) provision in England on behalf of the Teacher Training Agency. This paper represents a sequel to an earlier paper which was published by colleagues following the first OFSTED inspection of secondary Physical Education Initial Teacher Training (ITT) at Loughborough University in 1996/97. Fired by dismay and frustration for the practices OFSTED demonstrated, Hardy and Evans (2000: 58) commented `we write... in fear that recent legislation will ensure that, in the future, we may receive more of the same'. This paper considers the extent to which `more of the same' was received during a second inspection in 1999/2000. It presents a commentary on staff experiences and reflections of the process and highlights the key issues encountered. The authors conclude that while `more of the same' was not experienced in terms of `outcomes' in 1999/2000, it was with respect to `process'. Given the many limitations of ITT inspection, they suggest that the credibility of the process remains questionable.

Nature and progression of pericardial effusion in patients with a first myocardial infarction: Relationship to age and free wall rupture

Background Left ventricular free wall rupture (FWR) usually develops within the first days of acute myocardial infarction (AMI) without warning, but it is uncertain whether a mild pericardial effusion might herald this complication. Methods A 2-dimensional echocardiogram (2DE) was performed in patients with first AMI with (1149) or without (324) ST-segment elevation within 2 days. A second 2DE was performed 2 to 4 days later in 300 patients, 100 with and 200 without an initial mild PE (3-9 mm), and in those with initial moderate-severe PE (≥10 mm) (MSPE) or who developed hypotension or died. Results The first 2DE showed mild PE in 177 patients and MSPE in 51 patients, whereas a late (>2 days) MSPE occurred in 27 with a second routine 2DE, 15 (15%) with and 12 (6%) without initial mild PE (P =.01). Fourteen additional patients, 5 of 77 (6%) with and 9 of 1045 (1%) without initial PE, presented with hypotension and late MSPE (P <.002). Of 92 patients with MSPE, 90 had ST-segment elevation (98%), 60 had tamponade (65%), and 38 died of FWR or were operated on (41%). Results of pericardiocentesis performed in 64 patients were positive in 58, with hemopericardium in 57 (98%). Multivariant analysis showed mild PE on first 2DE and age of >60 years as the only independent predictors of late MSPE or late tamponade. Conclusions Mild PE within the first 2 days in patients aged >60 years with a first ST-segment elevation AMI is associated with an increased risk of late MSPE. Moreover, in this setting MSPE is most frequently associated with hemopericardium, and two thirds of these patients may develop tamponade/FWR. (Am Heart J 2002;144:251-8.)

Polyethylene–polystyrene grafting reaction: effects of polyethylene molecular weight

Blending of different thermoplastic polymers usually results in segregated and low value materials for almost any mixing condition. Nevertheless, a synergetic combination of properties can be obtained by an adequate compatibilization via reactive blending. In this work a Friedel–Crafts alkylation reaction is used to graft polyethylene chains onto polystyrene. The relation between the initial PE molecular weight (MW) and the structure of the compatibilizer copolymer is studied by a combination of size exclusion chromatography and Fourier transform infrared spectroscopy. The amount of copolymer formed is estimated from the amount of polystyrene reacted. The relative lengths of the grafted polyethylene chains are assessed. It is found that lower MW PE produces, upon reaction, a greater amount of short chain length grafted PE onto PS than higher MW PE. The results are in agreement with theories relating the component MW to the reaction localization at the interface. The low cost Friedel–Crafts alkylation results in a convenient reaction for the in situ compatibilization of PE/PS blends. It produces enough graft copolymer to compatibilize the phases without causing PS crosslinking and PE chain scission.

Estimation and study of mesoscale variability in the strait of Sicily

Abstract Considering mesoscale variability in the Strait of Sicily during September 1996, the four-dimensional physical fields and their dominant variability and error covariances are estimated and studied. The methodology applied in real-time combines an intensive data survey and primitive equation dynamics based on the error subspace statistical estimation approach. A sequence of filtering and prediction problems are solved for a period of 10 days, with adaptive learning of the dominant errors. Intercomparisons with optimal interpolation fields, clear sea surface temperature images and available in situ data are utilized for qualitative and quantitative evaluations. The present estimation system is shown to be a comprehensive nonlinear and adaptive assimilation scheme, capable of providing real-time forecasts of ocean fields and associated dominant variability and error covariances. The initialization and evolution of the error subspace is explained. The dominant error eigenvectors, variance and covariance fields are illustrated and their multivariate, multiscale properties described. Five coupled features associated with the dominant variability in the Strait during August–September 1996 emerge from the dominant decomposition of the initial PE variability covariance matrix: the Adventure Bank Vortex, Maltese Channel Crest, Ionian Shelf Break Vortex, Strait of Messina Vortex, and subbasin-scale temperature and salinity fronts of the Ionian slope. From the evolution of the estimated fields and dominant predictability error covariance decompositions, several of the primitive equation processes associated with the variations of these features are revealed, decomposed and studied. In general, the estimation of the evolving dominant decompositions of the multivariate predictability error and variability covariances appears promising for ocean sciences and technology. The practical feedbacks of the present approach which include the determination of data optimals and the refinements of dynamical and measurement models are considered.

Structure and molecular mobility of polymer carriers and metallocomplexes based on them as revealed by NMR relaxation

Using NMR pulse methods the authors have studied from the drops in free induction and the relaxation times the structure and molecular mobility of HDPE, polymer carriers based on polyacrylic acid grafted to PE and the metallocomplexes Cu(II), Ni(II) and V(IV) fixed on them in the temperature interval 333–403 K. It was established that the initial PE contains a crystalline and two amorphous phases-intermediate and surface. Grafting the acid and formation of the metallocomplexes did not change the polymer structure. It is shown that the metallocomplexes form in the loose surface layer of the polymer carrier.

Postharvest creasing of Robinson tangerines as affected by harvest date, pectinesterase activity and calcium content

SummaryRobinson tangerines were harvested on 8 and 22 October. The more mature fruits of the 22 October harvest were susceptible to postharvest creasing when stored for 2 weeks at 21°C, whereas the less mature fruit (8 October) did not manifest this disorder. Freshly harvested fruit of the 8 October harvest had an average pectinesterase activity (PE µmg−1 protein) of 1.11, and after 2 weeks storage this activity increased to 2.10. Fruit of the 22 October harvest showed an initial PE of 2.19 which increased to 2.48 after storage. Ca contents in the peel of both the 8 October (1 765 µg g−1 fr. wt) and 22 October (1 762 µg g−1 fr. wt) harvests were similar, and decreased to about the same level after storage, namely 1 549 and 1484 µg, respectively. Postharvest creasing appears related to both fruit maturity and initial PE activity.

Magnetic resonance imaging of the female pelvis: initial experience.

The potential of magnetic resonance imaging (MRI) was evaluated in 21 female subjects: seven volunteers, 12 patients scanned for reasons unrelated to the lower genitourinary tract, and two patients referred with gynecologic disease. The uterus at several stages was examined: the premenarcheal uterus (one patient), the uterus of reproductive age (12 patients), the postmenopausal uterus (two patients), and in an 8 week pregnancy (one patient). The myometrium and cyclic endometrium in the reproductive age are separated by a low-intensity line (probably stratum basale), which allows recognition of changes in thickness of the cyclic endometrium during the menstrual cycle. The corpus uteri can be distinguished from the cervix by the transitional zone of the isthmus. The anatomic relation of the uterus to bladder and rectum is easily outlined. The vagina can be distinguished from the cervix, and the anatomic display of the closely apposed bladder, vagina, and rectum is clear on axial and coronal images. The ovary is identified; the signal intensity from the ovary depends on the acquisition parameter used. Uterine leiomyoma, endometriosis, and dermoid cyst were depicted, but further experience is needed to ascertain the specificity of the findings.