Severe Pneumococcal Pneumonia Causes Acute Cardiac Toxicity and Subsequent Cardiac Remodeling

Rationale: Up to one-third of patients hospitalized with pneumococcal pneumonia experience major adverse cardiac events (MACE) during or after pneumonia. In mice, Streptococcus pneumoniae caninvade themyocardium, induce cardiomyocyte death, and disrupt cardiac function following bacteremia, but it is unknown whether the same occurs in humans with severe pneumonia. Objectives: We sought to determine whether S. pneumoniae can (1) translocate the heart, (2) induce cardiomyocyte death, (3) causeMACE, and (4) induce cardiac scar formation after antibiotic treatment during severe pneumonia using a nonhuman primate (NHP) model. Methods: We examined cardiac tissue from six adult NHPs with severe pneumococcal pneumonia and three uninfected control animals. Three animals were rescued with antibiotics (convalescent animals). Electrocardiographic, echocardiographic, and serum biomarkers of cardiac damage were measured (troponin T, N-terminal pro-brain natriuretic peptide, and heart-type fatty acid binding protein). Histological examination included hematoxylin and eosin staining, immunofluorescence, immunohistochemistry, picrosirius red staining, and transmission electron microscopy. Immunoblots were used to assess the underlying mechanisms. Measurements and Main Results: Nonspecific ischemic alterations were detected by electrocardiography and echocardiography. Serum levels of troponin T and heart-type fatty acid binding protein were increased (P,0.05) after pneumococcal infection in both acutely ill and convalescent NHPs. S. pneumoniae was detected in the myocardium of all NHPs with acute severe pneumonia. Necroptosis and apoptosis were detected in the myocardium of both acutely ill and convalescent NHPs. Evidence of cardiac scar formation was observed only in convalescent animals by transmission electron microscopy and picrosirius red staining. Conclusions: S. pneumoniae invades the myocardium and induces cardiac injury with necroptosis and apoptosis, followed by cardiac scarring after antibiotic therapy, in anNHP model of severe pneumonia

The transverse momentum dependence of charged kaon Bose-Einstein correlations in the SELEX experiment

CNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOWe report the measurement of the one-dimensional charged kaon correlation functions using 600GeV/c σ-, π- and 540GeV/c p beams from the SELEX (E781) experiment at the Fermilab Tevatron. K±K± correlation functions are studied for three transverse pair momentum, kT, ranges and parameterized by a Gaussian form. The emission source radii, R, and the correlation strength, λ, are extracted. The analysis shows a decrease of the source radii with increasing kaon transverse pair momentum for all beam types. © 2015 The Authors.We report the measurement of the one-dimensional charged kaon correlation functions using 600GeV/c σ-, π- and 540GeV/c p beams from the SELEX (E781) experiment at the Fermilab Tevatron. K±K± correlation functions are studied for three transverse pair momentum, kT, ranges and parameterized by a Gaussian form. The emission source radii, R, and the correlation strength, λ, are extracted. The analysis shows a decrease of the source radii with increasing kaon transverse pair momentum for all beam types.753458464CNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOSem informaçãoSem informaçãoRuss, J.S., Akchurin, N., Andreev, V.A., First charm hadroproduction results from SELEX (1998) ICHEP'98 Proc. Int. Conf. on High Energy Physics II, p. 1259. , arxiv:hep-ex/9812031Goldhaber, G., Fowler, W.B., Goldhaber, S., Hoang, T.F., Kalogeropoulos, T.E., Powell, W.M., Pion-pion correlations in antiproton annihilation events (1959) Phys. Rev. Lett., 3, pp. 181-183Goldhaber, G., Goldhaber, S., Lee, W., Pais, A., Influence of Bose-Einstein statistics on the antiproton-proton annihilation process (1960) Phys. Rev., 120, pp. 300-312Kopylov, G.I., Podgoretsky, M.I., Correlations of identical particles emitted by highly excited nuclei (1972) Sov. J. Nucl. Phys., 15, pp. 219-223Kopylov, G.I., Podgoretsky, M.I., Multiple production and interference of particles emitted by moving sources (1974) Sov. J. Nucl. Phys., 18, pp. 336-341Kopylov, G.I., Like particle correlations as a tool to study the multiple production mechanism (1974) Phys. Lett. B, 50, pp. 472-474Abbiendi, G., Transverse and longitudinal Bose-Einstein correlations in hadronic Z0 decays (2000) Eur. Phys. J. C, 16, pp. 423-433. , arxiv:hep-ex/0002062Chekanov, S., Bose-Einstein correlations in one and two dimensions in deep inelastic scattering (2004) Phys. Lett. B, 583, pp. 231-246. , arxiv:hep-ex/0311030Aamodt, K., Two-pion Bose-Einstein correlations in pp collisions at s=900GeV (2010) Phys. Rev. D, 82. , arxiv:1007.0516Beker, H., MT dependence of boson interferometry in heavy ion collisions at the CERN SPS (1995) Phys. Rev. Lett., 74, pp. 3340-3343Adamczyk, L., Beam-energy-dependent two-pion interferometry and the freeze-out eccentricity of pions measured in heavy ion collisions at the STAR detector (2015) Phys. Rev. C, 92. , arxiv:1403.4972Adams, J., Experimental and theoretical challenges in the search for the quark-gluon plasma: the STAR Collaboration's critical assessment of the evidence from RHIC collisions (2005) Nucl. Phys. A, 757, pp. 102-183. , arxiv:nucl-ex/0501009Adcox, K., Formation of dense partonic matter in relativistic nucleus-nucleus collisions at RHIC: experimental evaluation by the PHENIX Collaboration (2005) Nucl. Phys. A, 757, pp. 184-283. , arxiv:nucl-ex/0410003Back, B.B., The PHOBOS perspective on discoveries at RHIC (2005) Nucl. Phys. A, 757, pp. 28-101. , arxiv:nucl-ex/0410022Arsene, I., Quark-gluon plasma and color glass condensate at RHIC? The perspective from the BRAHMS experiment (2005) Nucl. Phys. A, 757, pp. 1-27. , arxiv:nucl-ex/0410020Akkelin, S.V., Sinyukov, Y.M., The HBT-interferometry of expanding sources (1995) Phys. Lett. B, 356, pp. 525-530Alexander, G., Cohen, I., Levin, E., The dependence of the emission size on the hadron mass (1999) Phys. Lett. B, 452, pp. 159-166. , arxiv:hep-ph/9901341Kittel, W., Bose-Einstein correlations in Z fragmentation and other reactions (2001) Acta Phys. Pol. B, 32, pp. 3927-3972. , arxiv:hep-ph/0110088Chajȩcki, Z., Femtoscopy in hadron and lepton collisions: RHIC results and world systematics (2009) Acta Phys. Pol. B, 40, pp. 1119-1136. , arxiv:0901.4078Aggarwal, M.M., Pion femtoscopy in p+p collisions at s=200GeV (2011) Phys. Rev. C, 83. , arxiv:1004.0925Engelfried, J., The SELEX phototube RICH detector (1999) Nucl. Instrum. Methods A, 431, pp. 53-69. , arxiv:hep-ex/9811001Engelfried, J., The E781 (SELEX) RICH detector (1998) Nucl. Instrum. Methods A, 409, pp. 439-442Sjöstrand, T., Mrenna, S., Skands, P., PYTHIA 6.4 physics and manual (2006) J. High Energy Phys., 5. , arxiv:hep-ph/0603175v2Chajȩcki, Z., Lisa, M., Global conservation laws and femtoscopy of small systems (2008) Phys. Rev. C, 78. , arxiv:0803.0022Lednický, R., Lyuboshitz, V.L., Erazmus, B., Nouais, D., How to measure which sort of particles was emitted earlier and which later (1996) Phys. Lett. B, 373, pp. 30-34Voloshin, S., Lednický, R., Panitkin, S., Xu, N., Relative space-time asymmetries in pion and nucleon production in noncentral nucleus-nucleus collisions at high-energies (1997) Phys. Rev. Lett., 79, pp. 4766-4769. , arxiv:nucl-th/9708044Pratt, S., Shapes and sizes from non-identical-particle correlations (2007) Braz. J. Phys., 37, pp. 871-876. , arxiv:nucl-th/0612006Lednický, R., Finite-size effect on two-particle production (2008) J. Phys. G, Nucl. Part. Phys., 35Lednický, R., Lyuboshitz, V.V., Lyuboshitz, V.L., Final-state interactions in multichannel quantum systems and pair correlations of nonidentical and identical particles at low relative velocities (1998) Phys. At. Nucl., 61, pp. 2050-2063Bowler, M.G., Coulomb corrections to Bose-Einstein corrections have greatly exaggerated (1991) Phys. Lett. B, 270, pp. 69-74Sinyukov, Y., Lednický, R., Akkelin, S.V., Pluta, J., Erazmus, B., Coulomb corrections to Bose-Einstein corrections have greatly exaggerated (1998) Phys. Lett. B, 432, pp. 248-257Adams, J., Pion interferometry in Au+Au collisions at sNN=200GeV (2005) Phys. Rev. C, 71. , arxiv:nucl-ex/0411036Skands, P.Z., Tuning Monte Carlo generators: the Perugia tunes (2010) Phys. Rev. D, 82. , arxiv:1005.3457Abelev, B., Charged kaon femtoscopic correlations in pp collisions at s=7TeV (2013) Phys. Rev. D, 87. , arxiv:1212.5958v2Khachatryan, V., Measurement of Bose-Einstein correlations in pp collisions at s = 0.9 and 7 TeV (2011) J. High Energy Phys., 5. , arxiv:1101.3518Akkelin, S.V., Sinyukov, Y.M., Deciphering nonfemtoscopic two-pion correlations in p+p collisions with simple analytical models (2012) Phys. Rev. D, 85. , arxiv:1106.5120Lednický, R., Progulova, T.B., Influence of resonances on Bose-Einstein correlations of identical pions (1992) Z. Phys. C, 55, pp. 295-305Lisa, M., Pratt, S., Soltz, R., Wiedemann, U., Femtoscopy in relativistic heavy ion collisions: two decades of progress (2005) Annu. Rev. Nucl. Part. Sci., 55, pp. 357-402. , arxiv:nucl-ex/0505014Pratt, S., Pion interferometry for exploding sources (1984) Phys. Rev. Lett., 53, pp. 1219-1221Abbiendi, G., Bose-Einstein study of position-momentum correlations of charged pions in hadronic Z0 decays (2007) Eur. Phys. J. C, 52, pp. 787-803. , arxiv:0708.1122Achard, P., Test of the τ-model of Bose-Einstein correlations and reconstruction of the source function in hadronic Z-boson decay at LEP (2011) Eur. Phys. J. C, 71, p. 1648. , arxiv:1105.4788Aamodt, K., Femtoscopy of pp collisions at s = 0.9 and 7 TeV at the LHC with two-pion Bose-Einstein correlations (2011) Phys. Rev. D, 84. , arxiv:1101.3665Wiedemann, U.A., Heinz, U.W., Resonance contributions to Hanbury-Brown-Twiss correlation radii (1997) Phys. Rev. C, 56, pp. 3265-3286. , arxiv:nucl-th/9611031Werner, K., Karpenko, I., Pierog, T., Bleicher, M., Mikhailov, K., Evidence for hydrodynamic evolution in proton-proton scattering at 900 GeV (2011) Phys. Rev. C, 83. , arxiv:1010.0400Humanic, T.J., Predictions for two-pion correlations for s=14TeV proton-proton collisions (2007) Phys. Rev. C, 76. , arxiv:nucl-th/0612098Alexopoulos, T., Study of source size in pp- collisions at s=1.8TeV using pion interferometry (1993) Phys. Rev. D, 48, pp. 1931-1942Csorgo, T., Kittel, W., Metzger, W.J., Novák, T., Parametrization of Bose-Einstein correlations and reconstruction of the space-time evolution of pion production in e+e- annihilation (2008) Phys. Lett. B, 663, pp. 214-216. , arxiv:0803.3528Bialas, A., Kucharczyk, M., Palka, H., Zalewski, K., Mass dependence of HBT correlations in e+e- annihilation (2000) Phys. Rev. D, 62. , arxiv:hep-ph/0006290Alexander, G., Open questions related to Bose-Einstein correlations in e+e- → hadrons (2004) Acta Phys. Pol. B, 35, pp. 69-76. , arxiv:hep-ph/0311114Alexander, G., Mass and transverse mass effects on the hadron emitter size (2001) Phys. Lett. B, 506, pp. 45-51. , arxiv:hep-ph/0101319The authors are indebted to the staff of Fermi National Accelerator Laboratory and for invaluable technical support from the staffs of collaborating institutions. This project was supported in part by Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie, Consejo Nacional de Ciencia y Tecnología (CONACyT), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fondo de Apoyo a la Investigación (UASLP), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), the Israel Science Foundation founded by the Israel Academy of Sciences and Humanities, Istituto Nazionale di Fisica Nucleare (INFN), the International Science Foundation (ISF), the National Science Foundation, NATO, the Russian Academy of Sciences, the Russian Ministry of Science and Technology, the Russian Foundation for Basic Research (research project No. 11-02-01302-a), the Secretaría de Educación Pública (Mexico), the Turkish Scientific and Technological Research Board (TÜBİTAK), and the U.S. Department of Energy. We thank ITEP and National Research Nuclear University MEPhI (Moscow Engineering Physics Institute) for providing computing powers and support for data analysis and simulations. The authors also would like to thank Prof. Michael Lisa and Prof. Richard Lednický for helpful comments and fruitful discussions

Prevalence and etiology of community-acquired pneumonia in immunocompromised patients

Background. The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods. We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results. At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non\u2013community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions. Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Endothelial adhesion molecules and multiple organ failure in patients with severe sepsis

Objective To determine if serum levels of endothelial adhesion molecules were associated with the development of multiple organ failure (MOF) and in-hospital mortality in adult patients with severe sepsis. Design This study was a secondary data analysis of a prospective cohort study. Setting Patients were admitted to two tertiary intensive care units in San Antonio, TX, between 2007 and 2012. Patients Patients with severe sepsis at the time of intensive care unit (ICU) admission were enrolled. Inclusion criteria were consistent with previously published criteria for severe sepsis or septic shock in adults. Exclusion criteria included immunosuppressive medications or conditions. Interventions None. Measurements Baseline serum levels of the following endothelial cell adhesion molecules were measured within the first 72\ua0h of ICU admission: Intracellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule-1 (VCAM-1), and Vascular Endothelial Growth Factor (VEGF). The primary and secondary outcomes were development of MOF (\u2a7e2 organ dysfunction) and in-hospital mortality, respectively. Main results Forty-eight patients were enrolled in this study, of which 29 (60%) developed MOF. Patients that developed MOF had higher levels of VCAM-1 (p\ua0=\ua00.01) and ICAM-1 (p\ua0=\ua00.01), but not VEGF (p\ua0=\ua00.70) compared with patients without MOF (single organ failure only). The area under the curve (AUC) to predict MOF according to VCAM-1, ICAM-1 and VEGF was 0.71, 0.73, and 0.54, respectively. Only increased VCAM-1 levels were associated with in-hospital mortality (p\ua0=\ua00.03). These associations were maintained even after adjusting for APACHE and SOFA scores using logistic regression. Conclusions High levels of serum ICAM-1 was associated with the development of MOF. High levels of VCAM-1 was associated with both MOF and in-hospital mortality

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac