Late Time Periods Research Articles

Isotope values reveal “canopy effect” in deer territoriality and maize consumption for dogs from archaeological sites in Kentucky dating to the Middle Woodland through Late Fort Ancient time periods

This research analyzes stable carbon, nitrogen, and oxygen isotope values in tooth collagen and enamel to investigate foraging and territorial behavior in white-tailed deer (Odocoileus virginianus Zimmermann) and maize (Zea mays Linneaus) consumption in dogs (Canis familiaris Linneaus). The study analyzed 22 deer teeth from 13 archaeological sites in Kentucky covering a span of approximately 1,500 years of human occupation. The article presents evidence of foraging and territorial behavior in white-tailed deer, identified through the “canopy effect” observed in deer stable carbon isotope values in remains spanning from the Middle Woodland (200 BCE – CE 500) to Late Fort Ancient (CE 1400 – 1680) time periods in Kentucky. Additionally, teeth samples from nine dog and one wolf (Canis lupus Linneaus) were analyzed and indicate significant consumption of maize in seven of the dog samples. These specimens came from seven archaeological sites in Kentucky dating from the Early through Late Fort Ancient (CE 1400 – 1680) time periods. The study also contributes to the growing database of isotope studies in the Eastern Woodlands by presenting carbon and nitrogen isotope values on deer bone collagen from nine deer bone samples from three of the same archaeological sites dating to the Middle Woodland to Early Late Woodland.

Is 90 the new 80? Temporal trends in nonagenarians undergoing percutaneous coronary interventions

BackgroundCoronary artery disease (CAD) is a leading cause of death in the elderly population. Data regarding percutaneous coronary interventions (PCIs) in nonagenarians are scarce, and differences in long term outcomes between generations remain unclear. We aimed to study the pattern and temporal trends of nonagenarians treated with PCI. Materials and Methods: A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. Materials and MethodsA total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. ResultsThe number of nonagenarians undergoing PCI has increased substantially during the study time period, from 89 patients in the earlier time period (2009-2014) to 133 patients in the later time period (2015-2020). At 1-year, nonagenarians had significantly higher rates of both death (24.3% vs. 14.9%, p<0.01), and MACE (30.6% vs. 22.0%, p<0.01), as compared to octogenarians. The cumulative survival rate was higher among octogenarians both in the early and late time period (p<0.01 and p=0.039, respectively). A significant reduction in nonagenarian MACE rates were observed during the study time period, resulting in a non-significant difference in MACE rates in the later time period between both groups. ConclusionThe number of nonagenarians who undergo PCI is on the rise. While their clinical outcomes are inferior as compared to younger age groups, improvement was noted in the late time period.

An Analysis on the Effect of Income Changes in the Resection of Early-Stage Pancreatic Adenocarcinoma.

The impact of socioeconomic inequalities on cancer care and outcomes has been well recognized and the underlying causes are likely multifactorial. Income is regarded as a cornerstone of socioeconomic status and has been assumed to correlate with access to care. We therefore sought to investigate whether income and changes in income would affect the rate of patients undergoing surgical resection for early-stage pancreatic cancer. Inflation-adjusted income data were obtained from the United States Census Bureau from 2010 to 2019. The cancer data were obtained from the SEER database. Counties present in both data sets were included in the analysis. Patients with stage I or II pancreatic cancer who underwent formal resection were deemed to have undergone appropriate surgical management. Patients were grouped into an early (2010-2014) and late (2015-2019) time period. The final analysis included 23968 patients from 173 counties across 11 states. The resection rate was 45.1% for the entire study and rose from 42.8% to 47.4% from the early to late time periods (P < .001). The median change in income between the two time periods was an increase by $2387. The rate of resection was not dependent on income class or income change in our study population. Our surgical care of pancreatic cancer is improving with more patients undergoing resection. In addition, there are now fewer disparities between patients of lower-income and higher-income groups with respect to receiving surgical intervention. This implies that our access to care has improved over the past decade. This is an encouraging finding with regards to reducing health care disparities.

Effects by geothermal gradient on thermal response tests for boreholes

A thermal response test (TRT) on a borehole provides information needed in the design of ground heat exchangers for ground source heat pump systems. Conventional analysis of TRT data sets uses the late-time period to estimate the ground thermal conductivity and the effective borehole resistance. During this quasi-steady-state period, the transient average fluid temperature has a logarithmic linear trend, which is consistent with conventional heat transfer models that assume a uniform undisturbed ground temperature. As the depth of the borehole increases the undisturbed ground temperature increases with depth following the geothermal gradient. This paper focuses on how the geothermal gradient affects a TRT. As the geothermal gradient increases, the required time to reach the conventional logarithmic linear trend may increase beyond any practical testing duration in coaxial boreholes. Then, conventional analysis methods based on a quasi-steady-state period incorrectly estimate the ground thermal conductivity. The magnitude of this effect is controlled through a dimensionless parameter |qratio|, which includes the geothermal gradient and other test parameters. In place of conventional models, a transient model that includes the geothermal gradient and fluid thermal storage can estimate the ground thermal conductivity and local borehole resistance within the typical TRT testing duration.

Allogeneic transplantation of bone marrow versus peripheral blood stem cells from HLA-identical sibling donors for hematological malignancies in 6064 adults from 2003 to 2020: different impacts on survival according to time period

BackgroundMobilized peripheral blood stem cells (PBSC) have been widely used instead of bone marrow (BM) as the graft source for allogeneic hematopoietic cell transplantation (HCT). Although early studies demonstrated no significant differences in survival between PBSC transplantation (PBSCT) and BM transplantation (BMT) from human leukocyte antigen (HLA)-identical sibling donors to adults with hematological malignancies, recent results have been unclear. ObjectiveThe objective of this retrospective study was to compare overall survival (OS), relapse, non-relapse mortality (NRM), hematopoietic recovery and graft-versus-host disease (GVHD) between PBSCT and BMT according to the time period of HCT (2003–2008, 2009–2014, or 2015–2020). Study designWe retrospectively compared the outcomes after PBSCT versus BMT in 6064 adults with hematological malignancies using a Japanese registry database between 2003 and 2020. ResultsThe adjusted probability of OS was significantly higher in BMT recipients compared to PBSCT recipients during the early period of 2003–2008 (adjusted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.70–0.91; P < 0.001) and the middle period of 2009–2014 (adjusted HR, 0.80; 95% CI, 0.70–0.91; P < 0.001). However, during the late period of 2015–2020, the adjusted probability of OS was comparable between BMT and PBSCT recipients (adjusted HR, 0.94; 95% CI, 0.79–1.13; P = 0.564), which were mainly due to the reduction of NRM. There was no significant difference in the relapse rate between the groups, irrespective of the time period. Compared to BMT, PBSCT led to faster neutrophil and platelet recovery and the cumulative incidences of grades II–IV and grades III–IV acute and overall and extensive chronic GVHD were significantly higher in PBSCT recipients, irrespective of the time period. ConclusionsPBSCT and BMT had similar survival outcomes and relapse rates in adult patients with hematological malignancies during the late time period of 2015–2020 despite the hematopoietic recovery and acute and chronic GVHD being higher in PBSCT recipients in all time periods.

Application of Physics-Informed Neural Networks for Estimation of Saturation Functions from Countercurrent Spontaneous Imbibition Tests

Summary In this work, physics-informed neural networks (PINNs) are used for history matching data from core-scale countercurrent spontaneous imbibition (COUCSI) tests. To our knowledge, this is the first work exploring the variation in saturation function solutions from COUCSI tests. 1D flow was considered, in which two phases flow in opposite directions driven by capillary forces with one boundary open to flow. The partial differential equation (PDE) depends only on a saturation-dependent capillary diffusion coefficient (CDC). Static properties such as porosity, permeability, interfacial tension, and fluid viscosities are considered known. In contrast, the CDC or its components [relative permeability (RP) and capillary pressure (PC)], are considered unknown. We investigate the range of functions (CDCs or RP/PC combinations) that explain different (synthetic or real) experimental COUCSI data: recovery from varying extents of early-time and late-time periods, pressure transducers, and in-situ saturation profiles. History matching was performed by training a PINN to minimize a loss function based on observational data and terms related to the PDE, boundary, and initial conditions. The PINN model was generated with feedforward neural networks, Fourier/inverse-Fourier transformation, and an adaptive tanh activation function, and trained using full batching. The trainable parameters of both the neural networks and saturation functions (parameters in RP and PC correlations) were initialized randomly. The PINN method successfully matched the observed data and returned a range of possible saturation function solutions. When a full observed recovery curve was provided (recovery data reaching close to its final value), unique and correct CDC functions and correct spatial saturation profiles were obtained. However, different RP/PC combinations composing the CDC were calculated. For limited amounts of recovery data, different CDCs matched the observations equally well but predicted different recovery behavior beyond the collected data period. With limited recovery data, when all points were still following a square root of time trend, a CDC with a low magnitude and peak shifted to high saturations gave the same match as a CDC with a high magnitude and peak shifted to low saturations. Recovery data with sufficient points not being proportional to the square root of time strongly constrained how future recovery would behave and thus which CDCs could explain the results. Limited recovery data combined with an observed in-situ profile of saturations allowed for accurate determination of CDC and prediction of future recovery, suggesting in-situ data allowed for shortened experiments. With full recovery data, in-situ PC data calibrated the PC toward unique solutions matching the input. The RPs were determined, where their phase had much lower mobility than the others. The CDC is virtually independent of the highest fluid mobility, and RPs could not be matched at their high values. Adding artificial noise in the recovery data increased the variation of the estimated CDCs.

Postoperative Seizure Prophylaxis in Meningioma Resection: A Systematic Review and Meta-Analysis.

Seizures in the early postoperative period may impair patient recovery and increase the risk of complications. The aim of this study is to determine whether there is any advantage in postoperative seizure prophylaxis following meningioma resection. This systematic review was conducted in accordance with PRISMA guidelines. PUBMED, Web of Science, Embase, Science Direct, and Cochrane were searched for papers until April 2023. Among nine studies, a total of 3249 patients were evaluated, of which 984 patients received antiepileptic drugs (AEDs). No significant difference was observed in the frequency of seizure events between patients who were treated with antiepileptic drugs (AEDs) and those who were not. (RR 1.22, 95% CI 0.66 to 2.40; I2 = 57%). Postoperative seizures occurred in 5% (95% CI: 1% to 9%) within the early time period (<7 days), and 9% (95% CI: 1% to 17%) in the late time period (>7 days), with significant heterogeneity between the studies (I2 = 91% and 97%, respectively). In seizure-naive patients, the rate of postoperative seizures was 2% (95% CI: 0% to 6%) in the early period and increased to 6% (95% CI: 0% to 15%) in the late period. High heterogeneity led to the use of random-effects models in all analyses. The current evidence does not provide sufficient support for the effectiveness of prophylactic AED medications in preventing postoperative seizures in patients undergoing meningioma resection. This underscores the importance of considering diagnostic criteria and conducting individual patient analysis to guide clinical decision-making in this context.

Assessment of the sustainability of groundwater utilization and crop production under optimized irrigation strategies in the North China Plain under future climate change

Over-exploitation of groundwater due to intensive irrigation and anticipated climate change pose severe threats to the water and food security worldwide, particularly in the North China Plain (NCP). Limited irrigation has been recognized as an effective way to improve crop water productivity and slow the rapid decline of groundwater levels. Whether optimized limited irrigation strategies could achieve a balance between groundwater pumping and grain production in the NCP under future climate change deserves further study. In this study, an improved Soil and Water Assessment Tool (SWAT) model was used to simulate climate change impacts on shallow groundwater levels and crop production under limited irrigation strategies to suggest optimal irrigation management practices under future climate conditions in the NCP. The simulations of eleven limited irrigation strategies for winter wheat with targeted irrigations at different growth stages and with irrigated or rainfed summer maize were compared with future business-as-usual management. Climate change impacts showed that mean wheat (maize) yield under adequate irrigation was expected to increase by 13.2% (4.9%) during the middle time period (2041–2070) and by 11.2% (4.6%) during the late time period (2071–2100) under three SSPs compared to the historical period (1971–2000). Mean decline rate of shallow groundwater level slowed by approximately 1 m a−1 during the entire future period (2041–2100) under three SSPs with a greater reduction for SSP5–8.5. The average contribution rate of future climate toward the balance of shallow groundwater pumping and replenishment was 62.9%. Based on the simulated crop yields and decline rate of shallow groundwater level under the future climate, the most appropriate limited irrigation was achieved by applying irrigation during the jointing stage of wheat with rainfed maize, which could achieve the groundwater recovery and sustainable food production.

Unveiling the time course mechanism of bone fracture healing by transcriptional profiles.

Bone fracture healing is a time-consuming and high-priority orthopedic problem worldwide. Discovering the potential mechanism of bone healing at a time course and transcriptional level may better help manage bone fracture. In this study, we analyze a time-course bone fracture-healing transcriptional data set in a rat model (GSE592, GSE594, and GSE1371) of Gene Expression Omnibus (GEO). RNA was obtained from female Sprague-Dawley rats with femoral fracture at the initial time (day 3) as well as early (week 1), middle (week 2), and late (week 4) time periods, with nonfracture rats used as control. Gene Ontology (GO) functional analysis and pathway examinations were performed for further measurements of GSEA and hub genes. Results indicated that the four stages of bone fracture healing at the initial, early, middle, and late time periods represent the phases of hematoma formation, callus formation, callus molding, and mature lamellar bone formation, respectively. Extracellular organization was positively employed throughout the four stages. At the hematoma formation phase, the muscle contraction process was downregulated. Antibacterial peptide pathway was downregulated at all phases. The upregulation of Fn1 (initial, early, middle, and late time periods), Col3a1 (initial, early, and middle time periods), Col11a1 (initial and early time periods), Mmp9 (middle and late time periods), Mmp13 (early, middle, and late time periods) and the downregulation of RatNP-3b (initial, early, middle, and late time periods) were possible symbols for bone fracture healing and may use as therapeutic targets. These findings suggest some new potential pathways and genes in the process of bone fracture healing and further provide insights that can be used in targeted molecular therapy for bone fracture healing.

Use of dry-matter intake recorded at multiple time periods during lactation increases the accuracy of genomic prediction for dry-matter intake and residual feed intake in dairy cattle

Context Feed is the largest expense on a dairy farm, therefore improving feed efficiency is important. Recording dry-matter intake (DMI) is a prerequisite for calculating feed efficiency. Genetic variation of feed intake and feed efficiency varies across lactation stages and parities. DMI is an expensive and difficult-to-measure trait. This raises the question of which time periods during lactation would be most appropriate to measure DMI. Aims The aim was to evaluate whether sequence variants selected from genome-wide association studies (GWAS) for DMI recorded at multiple lactation time periods and parities would increase the accuracy of genomic estimated breeding values (GEBVs) for DMI and residual feed intake (RFI). Methods Data of 2274 overseas lactating cows were used for the GWAS to select sequence variants. GWAS was performed using the average of the DMI phenotypes in a 30-day window of six different time periods across the lactation. The most significant sequence variants were selected from the GWAS at each time period for either first or later parities. GEBVs for DMI and RFI in Australian lactating cows were estimated using BayesRC with 50 k single nucleotide polymorphisms (SNPs) and selected GWAS sequence variants. Key results There were differences in DMI genomic correlations and heritabilities between first and later parities and within parity across lactation time periods. Compared with using 50 k single-nucleotide polymorphisms (SNPs) only, the accuracy of DMI GEBVs increased by up to 11% by using the 50 k SNPs plus the selected sequence variants. Compared with DMI, the increase in accuracy for RFI was lower (by 6%) likely because the sequence variants were selected from GWAS for DMI not RFI. The accuracies for DMI and RFI GEBVs were highest by using selected sequence variants from the DMI GWAS in the mid- to late-lactation periods in later parity. Conclusions Our results showed that DMI phenotypes in late lactation time periods could capture more genetic variation and increase genomic prediction accuracy through the use of custom genotype panels in genomic selection. Implications Collecting DMI at the optimal time period(s) of lactation may help develop more accurate and cost-effective breeding values for feed efficiency in dairy cattle.

Impact of timing of midazolam administration on incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery: A randomized, double-blinded, controlled study

ABSTRACT Background A frequently used anxiolytic, midazolam, has recently been recognized for its antiemetic activity during the perioperative period. This study sought to investigate the best time to provide midazolam in order to decrease the frequency of postoperative nausea and vomiting (PONV) without increasing the risk of sedation. Methods A total of 120 women aged 20–60 years who underwent laparoscopic gynecological surgeries were distributed randomly to three groups: group M1 (n = 40) received intravenous 2 mg midazolam 15 min prior anesthesia induction, group M2 (n = 40) received intravenous 2 mg midazolam approximately 30 min prior surgery conclusion, and group C (n = 40) received intravenous normal saline. The frequency of PONV and the rescue antiemetics needs were measured as the primary outcomes during the first 24 hr postoperatively. The secondary outcomes were the severity of nausea, timing of initial emetic attack, time of PACU discharge, patient sedation, and pain scores. Results The frequencies of vomiting and rescue antiemetic use were lower in midazolam groups than controls during early (0–2) and late (0–24) time periods after surgery (P < 0.05), with insignificant difference between M1 and M2 groups. The timing of the first emetic episode was significantly longer in M2 than in C groups (458.3 vs 128.8 minutes) (P < 0.01). Insignificant differences with regard to frequency and severity of nausea, time of PACU discharge, and sedation score were detected among the three groups. Conclusion Midazolam was effective in reducing PONV, whether it was given prior induction of anesthesia or prior end of surgery, without influencing recovery duration or sedation level of the patients.

A multi-fractured well performance model for unconventional reservoirs

Due to the ultra-low permeability of unconventional reservoirs, transient state prevails for a considerable period. Despite this, fracture interference can cause an apparent no-flow boundary. Consequently, the Duong's model, which was developed for transient-state period, yields unreliable estimates during the late-time period. In this paper, the Duong's model is modified to account for boundary effects caused by fracture interference and/or unstimulated reservoir regions that serve as no-flow boundaries. Specifically, an empirical correction function, which assumes an exponential decline, has been used as a “modifier” to extend the Duong's model to boundary-dominated flow period. The correction function ensures that during boundary-dominated flow period, an exponential-decline behaviour dominates. The proposed rate-decline model encompasses a gamma function, which converges at large times. Results show that a fractured-well production behaviour is characterised by a decaying power-law during early-time period and tends to exponential decline during late-time period. The results also suggest that although the conventional Duong's model gives good estimates during the transient-state period, it yields optimistic estimates during the boundary-dominated flow period. The proposed model gives a good match and estimates not only in the transient-state period, but also in the boundary-dominated flow period. A major advantage of the proposed model is that it converges to estimated ultimate recovery at large times without imposing any rate and time limits. A good agreement of the estimated ultimate recovery with analytical and semi-analytical models was obtained. Also, results suggest that the proposed model gives conservative estimates. The proposed model will be useful for analysing and predicting both the early- and late-time production performance of a multi-fractured well producing from an unconventional reservoir.

Complications and chemotherapy have little impact on postoperative quality of life after pancreaticoduodenectomy - a cohort study.

With the poor prognosis of pancreatic cancer and the high rate of postoperative complications after pancreaticoduodenectomy, it is important to evaluate how the operation affects patients' quality of life. This single-centre study included all patients undergoing pancreaticoduodenectomy from 2006 to 2016. Quality of life was measured with two questionnaires preoperatively, and at 6 and 12 months postoperatively. Comparisons between groups were made using a linear mixed models analysis. Of 279 patients planned for pancreaticoduodenectomy, 245 underwent the operation. The postoperative response rates were all 80% or more. Differences were found in one domain between the early and late time periods and three domains between patients receiving and not receiving adjuvant chemotherapy. No significant differences were found between patients with and without severe postoperative complications. However, the demographic variables of age group, sex, preoperative diabetes and smoking all exerted a significant impact on postoperative quality of life. While little or no impact was shown for the factors of postoperative complications, time period and adjuvant chemotherapy, demographic data, such as age, sex, preoperative diabetes and smoking, had considerable impacts on postoperative quality of life after pancreaticoduodenectomy.

Multimodal explainable AI predicts upcoming speech behavior in adults who stutter.

A key goal of cognitive neuroscience is to better understand how dynamic brain activity relates to behavior. Such dynamics, in terms of spatial and temporal patterns of brain activity, are directly measured with neurophysiological methods such as EEG, but can also be indirectly expressed by the body. Autonomic nervous system activity is the best-known example, but, muscles in the eyes and face can also index brain activity. Mostly parallel lines of artificial intelligence research show that EEG and facial muscles both encode information about emotion, pain, attention, and social interactions, among other topics. In this study, we examined adults who stutter (AWS) to understand the relations between dynamic brain and facial muscle activity and predictions about future behavior (fluent or stuttered speech). AWS can provide insight into brain-behavior dynamics because they naturally fluctuate between episodes of fluent and stuttered speech behavior. We focused on the period when speech preparation occurs, and used EEG and facial muscle activity measured from video to predict whether the upcoming speech would be fluent or stuttered. An explainable self-supervised multimodal architecture learned the temporal dynamics of both EEG and facial muscle movements during speech preparation in AWS, and predicted fluent or stuttered speech at 80.8% accuracy (chance=50%). Specific EEG and facial muscle signals distinguished fluent and stuttered trials, and systematically varied from early to late speech preparation time periods. The self-supervised architecture successfully identified multimodal activity that predicted upcoming behavior on a trial-by-trial basis. This approach could be applied to understanding the neural mechanisms driving variable behavior and symptoms in a wide range of neurological and psychiatric disorders. The combination of direct measures of neural activity and simple video data may be applied to developing technologies that estimate brain state from subtle bodily signals.

Brief Report: Contralateral Lobectomy for Second Primary NSCLC: Perioperative and Long-Term Outcomes

IntroductionAnatomical resection—often by lobectomy—is the standard of care for patients with early stage NSCLC. With increased diagnosis, survival, and prevalence of persons with early stage NSCLC, the incidence of second primary NSCLC, and consequently, the need for contralateral lobectomy for a metachronous cancer, is increasing. Perioperative outcomes after contralateral lobectomy are unknown. MethodsAmong patients who underwent contralateral lobectomy for second primary NSCLC during 1995 to 2020, we evaluated 90-day mortality and major morbidity (Clavien-Dindo grades 3–5) rates and their association with clinicopathologic variables, including the year of contralateral lobectomy and duration between lobectomies. ResultsA total of 98 patients underwent contralateral lobectomy for second primary NSCLC; 51 during an early time period (1995–2009) and 47 from a late time period (2010–2020). There were five mortalities and 23 patients with major morbidities after contralateral lobectomy; both rates decreased in 2010 to 2020 compared with 1995 to 2009 (mortality 10%–0%, major morbidity 35%–11%). Major morbidity was associated with an interval of less than 1 year between lobectomies, a diffusing capacity of the lung for carbon monoxide <80%, and right lower lobe resections. Mortality was associated with squamous cell carcinoma. Patients who underwent contralateral lobectomy for stage I NSCLC had 74% (95% confidence interval: 64%–85%) 3-year overall survival and 15% (95% confidence interval: 6.5%–24%) 3-year lung cancer cumulative incidence of death. ConclusionsContralateral lobectomy for second primary early stage NSCLC was associated with poor outcomes before 2010. Since 2010, perioperative and long-term outcomes of contralateral lobectomy have been comparable with reported outcomes after unilateral lobectomy.

468. Delayed Mortality Among Solid Organ Transplant Recipients Hospitalized for Covid-19: An International Multicenter Study

Abstract Background Studies of solid organ transplant recipients (SOTr) hospitalized for Covid-19 have focused on short-term outcomes with approximately 30 days of follow-up time. Intermediate-term mortality and associated risk factors for intermediate-term death have not previously been reported. Methods Using data from a multi-center registry, we assessed mortality by 90 days among SOTr hospitalized for Covid-19 between 3/1/2020 and 12/31/2020. Multivariable Cox-proportional hazard models were used to compare risk factors for mortality by 28 and 90 days. Covariates were selected a priori based on known predictors of death in SOTr hospitalized for Covid-19. All patients were followed for 90 days or were censored at the time of death or last clinical contact, if this occurred prior to day 90 after diagnosis. Results Among SOTr hospitalized for Covid-19, 198/979 (20%) died within 90 days of diagnosis and 37/198 (19%) of deaths occurred between days 29 and 90. Risk factors for mortality by day 90 days included age &amp;gt;65 years (1.8, 95% CI 1.3-2.4, P&amp;lt; 0.001), lung transplant (compared to non-lung) (1.6, 95% CI 1.1-2.4, P=0.02), chronic lung disease (2.2, 95% CI 1.5-3.4, P=0.002) and heart failure (1.9, 95% CI 1.2-2.9), which were similar to risk factors reported for 28-day mortality (Table 1). Diagnosis during the second half of 2020 (6/20-12/31/20) was associated with lower mortality by 28 days (aHR 0.7, 95% CI 0.5-1.0, P=0.03) compared to diagnosis during the early half of 2020 (3/1-6/19/20); however, mortality by 90 days was similar in the late and early time periods (aHR 0.9, 95% CI 0.7-1.2, P=0.54). Obesity and mTOR inhibitor use were also associated with death by 28 but not 90 days. Kaplan-Meier survival curves by time period of diagnosis are shown in Figure 1. Table 1. Multivariable Cox-Proportional Hazard Model for Mortality at 28 and 90-days Among Solid Organ Transplant Recipients Hospitalized for Covid-19 (N=979) Figure 1. Survival among SOT recipients hospitalized for Covid-19 by diagnosis time period Vertical tick marks represent censored cases. Early 2020 refers to cases diagnosed between March 1 and June 19, 2020 and late 2020 refers to cases diagnosed between June 20 and December 31, 2020. Conclusion Approximately 20% of deaths among SOTr hospitalized for Covid-19 occurred between days 29 and 90. Future investigations are required to discern the mechanism(s) for the improvement in early, but not late, mortality among SOTr with Covid-19 during the course of the pandemic. Disclosures Madeleine R. Heldman, MD, Cigna Lifesource (Other Financial or Material Support, Speaking honoraria)Thermo Fisher Scientific (Other Financial or Material Support, Speaking honoraria) Olivia S. Kates, MD, Merk (Scientific Research Study Investigator) Ajit P. Limaye, MD, astellas (Scientific Research Study Investigator)CTI (Scientific Research Study Investigator)GSK (Consultant)Johnson&amp;Johnson (Other Financial or Material Support, Adjudication Committee)merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)moderna (Scientific Research Study Investigator)Novartis (Other Financial or Material Support, DMC member)Novo Nordisk (Consultant)

Markers of Immune Activation and Inflammation in Individuals With Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

The biological processes associated with postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) are unknown. We measured soluble markers of inflammation in a SARS-CoV-2 recovery cohort at early (<90 days) and late (>90 days) timepoints. We defined PASC as the presence of 1 or more coronavirus disease 2019 (COVID-19)-attributed symptoms beyond 90 days. We compared fold-changes in marker values between those with and without PASC using mixed-effects models with terms for PASC and early and late recovery time periods. During early recovery, those who went on to develop PASC generally had higher levels of cytokine biomarkers including tumor necrosis factor-α (1.14-fold higher mean ratio [95% confidence interval {CI}, 1.01-1.28]; P = .028) and interferon-γ-induced protein 10 (1.28-fold higher mean ratio [95% CI, 1.01-1.62]; P = .038). Among those with PASC, there was a trend toward higher interleukin 6 levels during early recovery (1.29-fold higher mean ratio [95% CI, .98-1.70]; P = .07), which became more pronounced in late recovery (1.44-fold higher mean ratio [95% CI, 1.11-1.86]; P < .001). These differences were more pronounced among those with a greater number of PASC symptoms. Persistent immune activation may be associated with ongoing symptoms following COVID-19. Further characterization of these processes might identify therapeutic targets for those experiencing PASC.

Management and outcome across the spectrum of high-risk patients with myocardial infarction according to the thrmobolysis in myocardial infarction (TIMI) risk-score for secondary prevention.

BackgroundPatients with myocardial infarction (MI) are at increased risk for recurrent cardiovascular events, yet some patients, such as the elderly and those with prior comorbidities, are particularly at the highest risk. Whether these patients benefit from contemporary management is not fully elucidated.MethodsIncluded were consecutive patients with MI who underwent percutaneous coronary intervention (PCI) in a large tertiary medical center. Patients were stratified according to the thrombolysis in myocardial infarction (TIMI) risk score for secondary prevention (TRS2°P) to high (TRS2°P = 3), very high (TRS2°P = 4), or extremely high‐risk (TRS2°P = 5–9). Excluded were low and intermediate‐risk patients (TRS2°P < 3). Outcomes included 30‐day/1‐year major adverse cardiac events (MACE) and 1‐year mortality. Temporal trends were examined in the early (2004–2010) and late (2011–2016) time‐periods.ResultsAmong 2053 patients, 50% were high‐risk, 30% very high‐risk and 20% extremely high‐risk. Extremely high‐risk patients were older (age 74 ± 10 year) and had significant comorbidities (chronic kidney disease 68%, prior CABG 40%, heart failure 78%, peripheral artery disease 29%). Drug‐eluting stents and potent antiplatelets were more commonly used over time in all risk‐strata. Over time, 30‐day MACE rates have decreased, mainly attributed to the very high (11.3% to 5.1%, p = .006) and extremely high‐risk groups (15.9% to 8.0%, p = .016), but not the high‐risk group, with similar quantitative results for 1‐year MACE. The rates of 1‐year mortality remained unchanged in either group.ConclusionWithin a particularly high‐risk cohort of MI patients who underwent PCI, the implementation of guideline‐recommended therapies has improved over time, with the highest‐risk groups demonstrating the greatest benefit in outcomes.

117. Minimally invasive transforaminal lumbar interbody fusion increases late-term rates of pseudarthrosis versus open approach

<h3>BACKGROUND CONTEXT</h3> Lumbar fusion has developed into an effective surgical treatment option for patients with various lumbar pathologies including discogenic pain, stenosis and spinal instability. Popular minimally-invasive (MI) fusion techniques, such as transforaminal lumbar interbody fusion (TLIF) have been increasingly utilized by spinal surgeons, offering similar clinical outcomes to traditional open approaches and often reporting decreased blood loss and complications in the long term. Despite a number of reports comparing open versus MI-TLIF, literature stratifying return to OR (RTO) complications between the two approaches by time after surgery is limited. Therefore, the purpose of this study was to determine the differences in early, late and long-term revision rates between open and MI-TLIF. <h3>PURPOSE</h3> To determine differences in early, late and long-term revision rates between MI and open TLIF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> This study included 423 consecutive patients from 2012-2018 with a minimum follow-up of 2 years. Of the total, 127 underwent open TLIF and 296 underwent MI-TLIF. <h3>OUTCOME MEASURES</h3> (1) Return to OR revision rate, (2) pseudarthrosis proportion, (3) ASD proportion. <h3>Methods</h3> A retrospective review was performed to identify all patients between 2012-2018 who underwent 1- or 2-level open or MI-TLIF with a minimum follow-up of 2 years. Demographic data were compared between groups. RTO complications were noted and grouped according to categories related to infection, neurologic, fusion status, hardware and global alignment. These complications were then stratified by early (<6 months), late (6 months-2 years), and long-term (>2 years) time periods. Standard binominal and categorical comparative analyses were performed. <h3>Results</h3> A total of 423 consecutive patients were included; 127 in the open TLIF cohort and 296 in the MI-TLIF cohort. There were 67 males and 60 females in the open TLIF group compared to 177 males and 119 females in the MI-TLIF group (p= 0.180). Mean age was 54.1 years (21.9-79.2). Mean follow-up for the open TLIF and MI-TLIF groups were 67.9 and 69.6 months, respectively (p= 0.633). The overall RTO rate was 10.8% in the MI-TLIF cohort and 11.8% in the open TLIF cohort (p= 0.764). The open TLIF cohort had a significantly lower incidence of pseudarthrosis requiring RTO at the late-term time point (p= 0.042). There were no significant differences with respect to rates of adjacent segment disease (ASD) or any other particular complication requiring RTO. RTO rates at respective time points were 2.4%, 5.7%, and 2.7% for the MI-TLIF group and 5.5%, 0.8%, and 5.5% for the open TLIF group. Subgroup analysis of single-level operations only (75 open TLIF vs 255 MI-TLIF) demonstrated a significantly lower incidence of pseudarthrosis and ASD at both the late- and long-term time points (p= <0.001) in the open TLIF cohort, with no significant differences between overall RTO rates or any other complication (p= 0.333). <h3>Conclusions</h3> Open and MI-TLIF have both been shown to provide equivalent long-term clinical outcomes. In this study, patients undergoing open TLIF had significantly lower rates of pseudarthrosis compared to MI-TLIF. Open TLIF should be considered in patients with risk factors for nonunion; however, larger cohort studies are required to corroborate these findings. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Representation of women in vascular surgery science and societies

ObjectiveMedical schools and surgical residencies have seen an increase in the proportion of female matriculants, with 30% of current vascular surgery trainees being women over the past decade. There is widespread focus on increasing diversity in medicine and surgery in an effort to provide optimal quality of patient care and the advancement of science. The presence of gender diversity and opportunities to identify with women in leadership positions positively correlates with women choosing to enter traditionally male-dominated fields. The purpose of this study was to evaluate the representation of women in regional and national vascular surgical societies over the last 20 years. MethodsA retrospective review of the meeting programs of vascular surgery societies was performed. Data were collected on abstract presenters, moderators, committee members and chairs, and officers (president, president-elect, vice president, secretary, and treasurer). The data were divided into early (1999-2009) and late (2010-2019) time periods. ResultsFive regional and five national societies' data were analyzed, including 139 meetings. The mean percentage of female abstract presenters increased significantly from 10.9% in the early period to 20.6% in the late period (P < .001). Female senior authors increased slightly from 8.7% to 11.5%, but this change was not statistically significant (P = .22). Female meeting moderators increased significantly from 7.8% to 17.2% (P < .001), as well as female committee members increased from 10.9% to 20.3% (P = .003). Female committee chairs increased slightly from 10.9% to 16.9%, but this difference was not statistically significant (P = .13). Female society officers increased considerably from 6.4% to 14.8%. (P = .002). Significant variation was noted between societies, with five societies (three regional and two national) having less than 10% women at the officer level in 2019. There was a wide variation noted between societies in the percentage of female abstract presenters (range, 7.6%-34.9%), senior authors (3.9%-17.9%), and meeting moderators (5.4%-40.7%). ConclusionsOver the past two decades, there has been a significant increase in the representation of women in vascular surgery societies among those presenting scientific work, serving as meeting moderators, and serving as committee members. However, the representation of women among committee chairs, senior authors, and society leadership has not kept up pace with the increase noted at other levels. Efforts to recruit women into the field of vascular surgery as well as to support the professional development of female vascular surgeons are facilitated by the presence of women in leadership roles. Increasing the representation of women in vascular society leadership positions may be a key strategy in promoting gender diversity in the vascular surgery field.