A Bail Out Solution for an Urgent Situation: Endovascular Exclusion and Embolization of an Infected Femoral Pseudoaneurysm

Purpose: The aim of this study is to show the utility of the combination of thrombin and endograft to solve an urgent situation related to femoral infections. Case: We present the case of a 91-year-old female patient who underwent a femoral endarterectomy and superficial femoral artery angioplasty and developed a surgical site infection. She was readmitted to the hospital because of bleeding and was operated to suture the femoral patch and to do a plasty of sartorius muscle. Six days after the last intervention a femoral pulsatile mass was noted, and the computed tomography showed a big femoral pseudoaneurysm. Taken again to the theater and via a contralateral puncture a viabahn covered endograft was deployed from the external iliac artery to the yet diseased but patent femoral superficial femoral artery and the pseudoaneurysm was punctured, emptied, and filled with thrombin. The patient was discharged 2 weeks after the last procedure and lived for 10 months (she died because of a nonvascular related cause) with a patent graft and with healed lesions. Conclusions: In this case the endovascular solution was a definitive solution in a very old patient with several comorbidities

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Tratamiento endovascular de aneurisma en aloinjerto femoropoplíteo. A propósito de un caso

Introducción. La aparición de aneurismas en los injertos vasculares de vena umbilical humana se describió por primera vez en 1982. El tratamiento más habitual ha sido la cirugía. La llegada de las técnicas endovasculares ha incrementado las posibilidades terapéuticas que podemos ofrecer al paciente así como ha minimizado las complicaciones de la cirugía. Caso clínico. Paciente de 76 años con isquemia crónica de extremidades inferiores, intervenido en varias ocasiones (simpatectomía lumbar izquierda, bypass femoropoplíteo izquierdo a primera porción con politetrafluoroetileno en 1989 y bypass femoropoplíteo izquierdo a tercera porción con bioprótesis homóloga en 1994). Durante el seguimiento apareció dilatación aneurismática en aloinjerto diagnosticado mediante eco-Doppler. Se completó el estudio con tomografía axial computarizada (TAC) y angiografía por resonancia magnética. Como tratamiento, se implantó stent recubierto Viabahn de 8 × 100 mm, quedando el aneurisma completamente excluido. A los seis meses de seguimiento no se aprecian endofugas ni migración, y permanece permeable según eco-Doppler y TAC. Conclusión. El avance en las técnicas endovasculares permite un tratamiento rápido y sencillo de los aneurismas de injertos infrainguinales, especialmente útil en pacientes técnicamente complicados o de alto riesgo quirúrgico

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically

Strategies and performance of the CMS silicon tracker alignment during LHC Run 2

The strategies for and the performance of the CMS silicon tracking system alignment during the 2015–2018 data-taking period of the LHC are described. The alignment procedures during and after data taking are explained. Alignment scenarios are also derived for use in the simulation of the detector response. Systematic effects, related to intrinsic symmetries of the alignment task or to external constraints, are discussed and illustrated for different scenarios

Measurement of the tt¯ charge asymmetry in events with highly Lorentz-boosted top quarks in pp collisions at s=13 TeV

The measurement of the charge asymmetry in top quark pair events with highly Lorentz-boosted top quarks decaying to a single lepton and jets is presented. The analysis is performed using proton-proton collisions at s=13TeV with the CMS detector at the LHC and corresponding to an integrated luminosity of 138 fb−1. The selection is optimized for top quarks produced with large Lorentz boosts, resulting in nonisolated leptons and overlapping jets. The top quark charge asymmetry is measured for events with a tt¯ invariant mass larger than 750 GeV and corrected for detector and acceptance effects using a binned maximum likelihood fit. The measured top quark charge asymmetry of (0.42−0.69+0.64)% is in good agreement with the standard model prediction at next-to-next-to-leading order in quantum chromodynamic perturbation theory with next-to-leading-order electroweak corrections. The result is also presented for two invariant mass ranges, 750–900 and >900GeV

Search for new Higgs bosons via same-sign top quark pair production in association with a jet in proton-proton collisions at s=13TeV

A search is presented for new Higgs bosons in proton-proton (pp) collision events in which a same-sign top quark pair is produced in association with a jet, via the pp→tH/A→ttc‾ and pp→tH/A→ttu‾ processes. Here, H and A represent the extra scalar and pseudoscalar boson, respectively, of the second Higgs doublet in the generalized two-Higgs-doublet model (g2HDM). The search is based on pp collision data collected at a center-of-mass energy of 13 TeV with the CMS detector at the LHC, corresponding to an integrated luminosity of 138fb−1. Final states with a same-sign lepton pair in association with jets and missing transverse momentum are considered. New Higgs bosons in the 200–1000 GeV mass range and new Yukawa couplings between 0.1 and 1.0 are targeted in the search, for scenarios in which either H or A appear alone, or in which they coexist and interfere. No significant excess above the standard model prediction is observed. Exclusion limits are derived in the context of the g2HDM

Observation of triple J/ψ meson production in proton-proton collisions

Protons consist of three valence quarks, two up-quarks and one down-quark, held together by gluons and a sea of quark-antiquark pairs. Collectively, quarks and gluons are referred to as partons. In a proton-proton collision, typically only one parton of each proton undergoes a hard scattering – referred to as single-parton scattering – leaving the remainder of each proton only slightly disturbed. Here, we report the study of double- and triple-parton scatterings through the simultaneous production of three J/ψ mesons, which consist of a charm quark-antiquark pair, in proton-proton collisions recorded with the CMS experiment at the Large Hadron Collider. We observed this process – reconstructed through the decays of J/ψ mesons into pairs of oppositely charged muons – with a statistical significance above five standard deviations. We measured the inclusive fiducial cross-section to be 272−104+141(stat)±17(syst)fb, and compared it to theoretical expectations for triple-J/ψ meson production in single-, double- and triple-parton scattering scenarios. Assuming factorization of multiple hard-scattering probabilities in terms of single-parton scattering cross-sections, double- and triple-parton scattering are the dominant contributions for the measured process

Search for new heavy resonances decaying to WW, WZ, ZZ, WH, or ZH boson pairs in the all-jets final state in proton-proton collisions at s=13TeV

A search for new heavy resonances decaying to WW, WZ, ZZ, WH, or ZH boson pairs in the all-jets final state is presented. The analysis is based on proton-proton collision data recorded by the CMS detector in 2016–2018 at a centre-of-mass energy of 13 TeV at the CERN LHC, corresponding to an integrated luminosity of 138fb−1. The search is sensitive to resonances with masses between 1.3 and 6TeV, decaying to bosons that are highly Lorentz-boosted such that each of the bosons forms a single large-radius jet. Machine learning techniques are employed to identify such jets. No significant excess over the estimated standard model background is observed. A maximum local significance of 3.6 standard deviations, corresponding to a global significance of 2.3 standard deviations, is observed at masses of 2.1 and 2.9 TeV. In a heavy vector triplet model, spin-1 Z′ and W′ resonances with masses below 4.8TeV are excluded at the 95% confidence level (CL). These limits are the most stringent to date. In a bulk graviton model, spin-2 gravitons and spin-0 radions with masses below 1.4 and 2.7TeV, respectively, are excluded at 95% CL. Production of heavy resonances through vector boson fusion is constrained with upper cross section limits at 95% CL as low as 0.1fb

Study of azimuthal anisotropy of ϒ(1S) mesons in pPb collisions at sNN = 8.16 TeV

The azimuthal anisotropy of Image 1 mesons in high-multiplicity proton-lead collisions is studied using data collected by the CMS experiment at a nucleon-nucleon center-of-mass energy of 8.16TeV. The Image 1 mesons are reconstructed using their dimuon decay channel. The anisotropy is characterized by the second Fourier harmonic coefficients, found using a two-particle correlation technique, in which the Image 1 mesons are correlated with charged hadrons. A large pseudorapidity gap is used to suppress short-range correlations. Nonflow contamination from the dijet background is removed using a low-multiplicity subtraction method, and the results are presented as a function of Image 1 transverse momentum. The azimuthal anisotropies are smaller than those found for charmonia in proton-lead collisions at the same collision energy, but are consistent with values found for Image 1 mesons in lead-lead interactions at a nucleon-nucleon center-of-mass energy of 5.02 TeV