Device-related infection in de novo transvenous implantable cardioverter-defibrillator Medicare patients

BACKGROUND: Cardiac device infection is a serious complication of implantable cardioverter-defibrillator (ICD) placement and requires complete device removal with accompanying antimicrobial therapy for durable cure. Recent guidelines have highlighted the need to better identify patients at high risk of infection to assist in device selection. OBJECTIVE: To estimate the prevalence of infection in de novo transvenous (TV) ICD implants and assess factors associated with infection risk in a Medicare population. METHODS: A retrospective cohort study was conducted using 100% Medicare administrative and claims data to identify patients who underwent de novo TV-ICD implantation (7/2016-12/2017). Infection within 720 days of implantation was identified using ICD-10 codes. Baseline factors associated with infection were identified by univariable logistic regression analysis of all variables of interest, including conditions in Charlson and Elixhauser comorbidity indices, followed by stepwise selection criteria with a p≤0.25 for inclusion in a multivariable model and a backwards, stepwise elimination process with p≤0.1 to remain in the model. A time-to-event analysis was also conducted. RESULTS: Among 26,742 patients with de novo TV-ICD, 519 (1.9%) developed an infection within 720 days post-implant. While more than half (54%) of infections occurred during the first 90 days, 16% of infections occurred after 365 days. Multivariable analysis revealed several significant predictors of infection: age <70 years, renal disease with dialysis, and complicated diabetes mellitus. CONCLUSION: The rate of de novo TV-ICD infection was 1.9% and identified risk factors associated with infection may be useful in device selection

The potential benefits of low-molecular-weight heparins in cancer patients

Cancer patients are at increased risk of venous thromboembolism due to a range of factors directly related to their disease and its treatment. Given the high incidence of post-surgical venous thromboembolism in cancer patients and the poor outcomes associated with its development, thromboprophylaxis is warranted. A number of evidence-based guidelines delineate anticoagulation regimens for venous thromboembolism treatment, primary and secondary prophylaxis, and long-term anticoagulation in cancer patients. However, many give equal weight to several different drugs and do not make specific recommendations regarding duration of therapy. In terms of their efficacy and safety profiles, practicality of use, and cost-effectiveness the low-molecular-weight heparins are at least comparable to, and offer several advantages over, other available antithrombotics in cancer patients. In addition, data are emerging that the antithrombotics, and particularly low-molecular-weight heparins, may exert an antitumor effect which could contribute to improved survival in cancer patients when given for long-term prophylaxis. Such findings reinforce the importance of thromboprophylaxis with low-molecular-weight heparin in cancer patients

Geological record of fluid flow and seismogenesis along an erosive subducting plate boundary

Tectonic erosion of the overriding plate by the downgoing slab isbelieved to occur at half the Earth’s subduction zones. In situinvestigation of the geological processes at active erosive marginsis extremely difficult owing to the deep marine environment andthe net loss of forearc crust to deeper levels in the subduction zone.Until now, a fossil erosive subduction channel—the shear zonemarking the plate boundary—has not been recognized in thefield, so that seismic observations have provided the only information on plate boundary processes at erosive margins. Here we show that a fossil erosive margin is preserved in the Northern Apennines of Italy. It formed during the Tertiary transition from oceanic subduction to continental collision, and was preserved by the late deactivation and fossilization of the plate boundary. The outcropping erosive subduction channel is 500m thick. It is representative of the first 5km of depth, with its deeper portions reaching 150 C. The fossil zone records several surprises. Two decollements were simultaneously active at the top and base of the subduction channel. Both deeper basal erosion and near-surface frontal erosion occurred. At shallow depths extension was a key deformation component within this erosive convergent plate boundary, and slip occurred without an observable fluid pressure cycle. At depths greater than about 3km a fluid cycle is clearly shown by the development of veins and the alternation of fast (co-seismic) and slow (inter-seismic) slip. In the deepest portions of the outcropping subduction channel, extension is finally overprinted by compressional structures. In modern subduction zones the onset of seismic activity is believed to occur at 150 C, but in the fossil channel the onset occurred at cooler palaeo-temperatures

Multi-proxy analysis in defining sedimentary processes in very recent prodelta deposits: the Northern Phlegraean offshoreexample (Eastern Tyrrhenian Margin)

A multi-proxy analysis of Volturno River prodelta deposits in the outer shelf of Northern Phlegraean margin (Eastern Tyrrhenian Sea) has been carried out to reconstruct the sedimentary processes acting during recent times. The late Holocene sediments were characterized through Subbottom Chirp profiles coupled with sedimentological and petrophysical data. The chronostratigraphic framework was achieved by means of colorimetric parameter a* correlations with nearby dated marine sediment. A time interpretation of about 2,300 years BP is estimated for the sedimentary record collected in the cores. Seismic stratigraphic analysis shows late Holocene outer shelf deposits, characterized by fluid escape features and small-offset faults. However, the undisturbed sedimentation and the preservation of an internal geometry at decimetre scale, as detected by the sedimentological and petrophysical analysis, indicates a slow sliding without sediment reworking for this sedimentological body. So far a possible recent (\2,300 years BP) shear dominated downward displacement of high water content sediments, triggered by the occurrence of seismic activity, is inferred. Based on the depth-age conversion of the detected lithological features, a regular climatically driven change in the sediment supply of the prodelta depositional environment is suggested. The detection of spectrophotometry correlations of Holocene shelf margin sediments, several km apart, goes beyond the previous work and confirms even for continental shelf area the potential value of spectrophotometer data in high-resolution stratigraphic correlations