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Our knowledge of the association between abdominal obesity (AO) and the risk of atrial fibrillation (AF) after adjusting for body mass index (BMI) is limited. We included 11,617 Black and White participants (mean age 63.0 ± 8.4 years) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort study who were free of AF at baseline. A multivariable logistic regression model was used to estimate the odds ratio (OR) with 95% confidence interval (CI) of incident AF associated with AO. We also evaluated the association between waist circumference (WC) and incident AF. Over a median follow-up of 9.4 years, 999 participants developed AF. AO was associated with an increased risk of AF in a multivariable model adjusted for sociodemographic, lifestyle, and cardiovascular risk factors (OR 1.43, 95% CI 1.24 to 1.65, p0.001). The association was attenuated after adjusting for BMI (OR 1.13, 95% CI 0.95 to 1.35, p = 0.16). There was no evidence of interaction between AO and incident AF by age category (age65 vs age ≤65), gender, race, obesity, or BMI category. Conversely, a 10cm increase in WC was associated with a higher incidence of AF after controlling for BMI (OR 1.18 95% CI 1.09 to 1.29, p0.001), in both nonobese (OR 1.14, 95% CI 1.03 to 1.28, p = 0.02) and obese (OR 1.26, 95% CI 1.11 to 1.42, p0.001) people. In conclusion, there was an association between AO and incident AF, but the association was weakened after adjusting for BMI. There was a significant association between WC and incident AF, after taking other AF risk factors and BMI into account. WC is a potentially modifiable risk factor for AF, and further research is warranted to explore the effect of decreasing WC on the population AF burden.

OBJECTIVE: To evaluate the contemporary geographic trends in cardiovascular health in the United States (US) and its relationship with the geographic distribution of cardiovascular mortality. PATIENTS AND METHODS: Using a retrospective cross-sectional design, the 2011–2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose, lipid levels, body-mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0–7 points) and categorical (ideal, intermediate, poor) variables from BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the CDC WONDER database. RESULTS: Among 1,362,529 American adult participants of BRFSS 2011–2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.01 in 2017 (P(trend)

Objective: There has been a substantial decline in patients presenting for emergent and routine cardiovascular care in the United States after the onset of the coronavirus disease 2019 (COVID-19) pandemic. We sought to assess the risk of adverse clinical outcomes among patients undergoing coronary artery bypass graft (CABG) surgery during the 2020 COVID-19 pandemic period and compare the risks with those undergoing CABG before the pandemic in the year 2019. Methods: A retrospective cross-sectional analysis of the TriNetX Research Network database was performed. Patients undergoing CABG between January 20, 2019, and September 15, 2019, contributed to the 2019 cohort, and those undergoing CABG between January 20, 2020, and September 15, 2020, contributed to the 2020 cohort. Propensity-score matching was performed, and the odds of mortality, acute kidney injury, stroke, acute respiratory distress syndrome, and mechanical ventilation occurring by 30 days were evaluated. Results: The number of patients undergoing CABG in 2020 declined by 35.5% from 5534 patients in 2019 to 3569 patients in 2020. After propensity-score matching, 3569 patient pairs were identified in the 2019 and the 2020 cohorts. Compared with those undergoing CABG in 2019, the odds of mortality by 30 days were 0.96 (95% confidence interval [CI], 0.69-1.33; P = .80) in those undergoing CABG in 2020. The odds for stroke (odds ratio [OR], 1.201; 95% CI, 0.96-1.39), acute kidney injury (OR, 0.76; 95% CI, 0.59-1.08), acute respiratory distress syndrome (OR, 1.01; 95% CI, 0.60-2.42), and mechanical ventilation (OR, 1.11; 95% CI, 0.94-1.30) were similar between the 2 cohorts. Conclusions: The number of patients undergoing CABG in 2020 has substantially declined compared with 2019. Similar odds of adverse clinical outcomes were seen among patients undergoing CABG in the setting of COVID-19 compared with those in 2019.

Objective To evaluate the trends in cardiovascular, ischemic heart disease (IHD), stroke, and heart failure mortality in the stroke belt in comparison with the rest of the United States. Patients and Methods We evaluated the nationwide mortality data of all Americans from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2018. Cause-specific deaths were identified in the stroke belt and nonstroke belt populations using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. The relative percentage gap was estimated as the absolute difference computed relative to nonstroke belt mortality. Piecewise linear regression and age-period-cohort modeling were used to assess, respectively, the trends and to forecast mortality across the 2 regions. Results The cardiovascular mortality rate (per 100,000 persons) was 288.3 (95% CI, 288.0 to 288.6; 3,684,273 deaths) in the stroke belt region and 251.2 (95% CI, 251.0 to 251.3; 13,296,164 deaths) in the nonstroke belt region. In the stroke belt region, age-adjusted mortality rates due to all cardiovascular causes (average annual percentage change [AAPC] in mortality rates, −2.4; 95% CI, −2.8 to −2.0), IHD (AAPC, −3.8; 95% CI, −4.2 to −3.5), and stroke (AAPC, −2.8; 95% CI, −3.4 to −2.1) declined from 1999 to 2018. A similar decline in cardiovascular (AAPC, −2.5; 95% CI, −3.0 to −2.0), IHD (AAPC, −4.0; 95% CI, −4.3 to −3.7), and stroke (AAPC, −2.9; 95% CI, −3.2 to −2.2) mortality was seen in the nonstroke belt region. There was no overall change in heart failure mortality in both regions (PAAPC>.05). The cardiovascular mortality gap was 11.8% in 1999 and 15.9% in 2018, with a modest reduction in absolute mortality rate difference (~7 deaths per 100,000 persons). These patterns were consistent across subgroups of age, sex, race, and urbanization status. An estimated 101,953 additional cardiovascular deaths need to be prevented from 2020 to 2025 in the stroke belt to ameliorate the gap between the 2 regions. Conclusion Despite the overall decline, substantial geographic disparities in cardiovascular mortality persist. Novel approaches are needed to attenuate the long-standing geographic inequalities in cardiovascular mortality in the United States, which are projected to increase.

BACKGROUND: The Dietary Approaches to Stop Hypertension (DASH) diet pattern has shown some promise for preventing heart failure (HF), but studies have been conflicting. OBJECTIVE: To determine whether the DASH diet pattern was associated with incident HF in a large biracial and geographically diverse population. METHODS: Among participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study of adults aged ≥45 years who were free of suspected HF at baseline in 2003–2007, DASH diet score was derived from the baseline food frequency questionnaire. The main outcome was incident HF defined as the first adjudicated HF hospitalization or HF death through December 31, 2016. We estimated hazard ratios (HR) for the associations of DASH diet score quartiles with incident HF, and incident HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) using the Lunn-McNeil extension to the Cox model. We tested for several pre-specified interactions including with age. RESULTS: Compared to the lowest quartile, individuals in the 2(nd)-4(th) DASH diet score quartiles had lower risk for incident HF after adjustment for sociodemographic and health characteristics: Q2 HR 0.70, 95%CI[0.56–0.87]; Q3 HR 0.65, 95%CI:[0.52–0.81]; Q4 HR 0.67, 95%CI:[0.52–0.85]. When stratifying results by age, quartiles 2–4 had a lower hazard for incident HF among age

Objective To evaluate the race-stratified trends for prevalence, awareness, treatment, and control of hypertension in young American adults aged 18 to 44 years. Patients and Methods The National Health and Nutrition Examination Survey data from 2005–2016 for adults aged 18 to 44 years was used to calculate age-adjusted (using 2005, 2010, and 2015 US Census population proportions) weighted trends in prevalence, awareness, treatment, and control of hypertension among non-Hispanic white, non-Hispanic black, and Mexican-American participants as per the 2017 American College of Cardiology/American Heart Association guidelines. Trends were estimated by logistic regression models including demographic, socioeconomic, health care access, and Bonferroni correction for multiple comparisons as covariates. Results Among 15,171 young American adults, stable trends for the prevalence, awareness, treatment, and control of hypertension was seen in all racial groups (Plinear trend>.05 for all). The prevalence from 2013 to 2016 was highest in non-Hispanic blacks (30.7%; 95% CI, 27.3 to 34.0%), followed by non-Hispanic whites (21.9%; 95% CI, 19.6 to 24.1%), and Mexican Americans (21.9%; 95% CI, 18.6 to 25.1%). The awareness was stable at ∼43.2% in non-Hispanic blacks, ∼34.8% in non-Hispanic whites, and ∼28.4% in Mexican Americans from 2005 to 2008 through 2013 to 2016. The stable treatment rates at nearly 34.4%, 23.7%, and 20.6%, were seen in non-Hispanic black, non-Hispanic white, and Mexican-Americans, respectively. The optimal control of hypertension was seen in 14.5% (95% CI, 12.1 to 17.0%) non-Hispanic blacks, 12.2% (95% CI, 10.3 to 14.0%) non-Hispanic whites, and 10.3% (95% CI, 7.1 to 13.5%) Mexican Americans from 2013 to 2016. Conclusion Nearly one in every three non-Hispanic young black and one in every five young Mexican American and non-Hispanic white adults have hypertension. Our race-stratified analyses highlight the categorical need to improve the abysmal control of hypertension which is approximately 1 in 10 young adults.

Anemia is a commonly occurring comorbidity among patients of heart failure with preserved ejection fraction (HFpEF) but limited data exists on the cardiovascular phenotype of anemia in HFpEF. We sought to characterize the clinical features, exercise capacity, and outcomes in patients with HFpEF to elucidate the phenotype and pathophysiology of anemia in HFpEF. Post hoc analyses of participants enrolled in the RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure) trial was performed. Anemia was defined as hemoglobin13 g/dL in men and12 g/dL in women. Multivariate adjusted regression modeling was done to assess for differences in peak oxygen uptake. Adjusted hazard ratios were generated to assess difference in hospitalization events using a Cox proportional hazards model. Anemic HFpEF patients were more likely to be older, male, and have worse renal function (p0.05 for all). N-terminal pro-B-type natriuretic peptide, troponin I, pro-collagen III N-terminal peptide, C-telopeptide for type I collagen, uric acid, cystatin-c, and galectin-3 (p0.05 for all) levels were higher in anemic HFpEF patients. In adjusted models, anemic HFpEF patients had worse exercise capacity (peak oxygen uptake: 11.3 vs 12.1 mL/kg/min; p = 0.004). The hazard for cardiac or renal cause of hospitalization in those with anemia was 2.0 (95% confidence interval: 0.9 to 4.3). Anemic HFpEF patients have worse exercise capacity and are more likely to be hospitalized. A better understanding of the physiologic phenotypes of HFpEF patients may allow for greater personalization of treatment and prognostication in HFpEF patients.

Atrial fibrillation (AF) is a common perioperative arrhythmia. However, its occurrence and implications remain poorly defined in the setting of noncardiac procedures. We sought to define the incidence, prevalence, and prognostic implications of AF among patients with atherosclerotic cardiovascular disease (ASCVD) undergoing noncardiac surgery. Using a previously validated approach that employed unique patient-linked variables in the New York State Inpatient Database from January 1, 2012, to December 31, 2014, the frequency of new-onset and pre-existing AF was determined in adults with ASCVD aged ≥18 years undergoing noncardiac surgery. The secondary outcomes were stroke within 1 month and all-cause mortality. Using multivariable logistic regression models, the factors and outcomes associated with new-onset AF after noncardiac surgery were assessed. Nine surgical subgroups of major noncardiac surgery served as exposure. A total of 184,775 patients were identified during the study period. Age ≥65, anemia, history of heart failure, valvular heart disease, and thoracic surgery were predictors of new-onset AF after noncardiac surgery. Among 3,806 patients (2.5%) developed new-onset AF and 31,603 (17.5%) patient had pre-existing AF. After multivariable-adjusted modeling, new-onset AF was associated with increased odds of stroke within 1 month (odds ratio: 1.31, 95% confidence interval: 1.12 to 1.53; p < 0.001)], mortality (odds ratio: 3.74; 95% confidence interval: 3.30 to 4.24; p < 0.001) and longer length of stay in the hospital (10 days; interquartile range: 6 to 16 days; p < 0.001). New-onset AF portends a poor prognosis in patients with ASCVD undergoing noncardiac surgeries. The risk profile of patients that develop new-onset AF differs across patient phenotypes and by surgical procedure.

In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) transitioned their recommendations for lipid management from an approach focused on “titration to goal low-density lipid cholesterol (LDL-C) level” to a “risk-based approach” ([1][1]). Following the

Variable propensity toward cardiovascular disease in the different ethnicities in the United States has been reported. We aimed to characterize the prevalence trends of cardiovascular health, as defined by the American Heart Association's Life's Simple 7 metrics, and cardiovascular diseases amongst Asian-Americans. We used the National Health and Examination Nutrition Survey from 2011 to 2016 to capture self-identified American-born Asian-Americans and foreign-born Asian-Americans. The prevalence trends of cardiovascular health metrics and diseases were evaluated in Asian-Americans and also compared between American-born and foreign-born Asian-Americans. Results were presented as weighted percentages and odds ratios with 95% confidence intervals. From 2011-2012 to 2015-2016, the prevalence of Asian-Americans reporting no physical activity increased from 21.5% to 32.4% (p for linear trend = 0.001) and the prevalence of Asian-American participants reporting a healthy diet decreased from 44.1% to 36.8% (p for quadratic trend = 0.02). There was a concomitant decline in the prevalence of Asian-Americans with normal weight (body mass index25 kg/m

Background Despite numerous advances in the understanding of the pathophysiology, progression, and management of acute respiratory failure (ARF) and acute respiratory distress syndrome (ARDS), there is limited contemporary data on the mortality burden of ARF and ARDS in the United States (US). Research Question What are the contemporary trends and geographic variation in ARF and ARDS-related mortality in the US? Study Design and Methods A retrospective analysis of the National Center for Health ”Statistics’ nationwide mortality data was conducted to assess the ARF and ARDS-related mortality trends from 2014-2018 and the geographic distribution of ARF and ARDS-related deaths in 2018 for all American residents. Piecewise linear regression was used to evaluate the trends in age-adjusted mortality rates (AAMR) in the overall population and various demographic subgroups of age, sex, race, urbanization, and region. Results Among 1,434,349 ARF-related deaths and 52,958 ARDS-related deaths during the study period, the AAMR was highest in older individuals (≥65 years), non-Hispanic Blacks, those living in the non-metropolitan region. The AAMR for ARF-related deaths (per 100,000 persons) increased from 74.9 (95%CI:74.6-75.2) in 2014 to 85.6 (95%CI:85.3-85.9) in 2018 (Annual Percentage Change [APC]: 3.4 [95%CI:2.2-4.6];Ptrend=0.003). The AAMR (per 100,000) for ARDS-related deaths was 3.2 (95%CI:3.2-3.3) in 2014 and 3.0 (95%CI:3.0-3.1) (APC: -0.9 [95%CI:-5.4-3.8]; Ptrend=0.56). The observed increase in rates for ARF mortality was consistent across the subgroups of age, sex, race/ethnicity, urbanization status, and geographical region (Ptrend

Objective To evaluate the race-stratified state-level prevalence of health determinants and the racial disparities in coronavirus disease 2019 (COVID-19) cumulative incidence and mortality in the United States. Patients and Methods The age-adjusted race-stratified prevalence of comorbidities (hypertension, diabetes, dyslipidemia, and obesity), preexisting medical conditions (pulmonary disease, heart disease, stroke, kidney disease, and malignant neoplasm), poor health behaviors (smoking, alcohol abuse, and physical inactivity), and adverse socioeconomic factors (education, household income, and health insurance) was computed in 435,139 American adult participants from the 2017 Behavioral Risk Factor Surveillance System survey. Correlation was assessed between health determinants and the race-stratified COVID-19 crude mortality rate and infection-fatality ratio computed from respective state public health departments in 47 states. Results Blacks had a higher prevalence of comorbidities (63.3%; 95% CI, 62.4% to 64.2% vs 55.1%; 95% CI, 54.7% to 55.5%) and adverse socioeconomic factors (47.0%; 95% CI, 46.0% to 47.9% vs 30.9%; 95% CI, 30.6% to 31.3%) than did whites. The prevalence of preexisting medical conditions was similar in blacks (30.4%; 95% CI, 28.8% to 32.1%) and whites (30.8%; 95% CI, 30.2% to 31.4%). The prevalence of poor health behaviors was higher in whites (57.2%; 95% CI, 56.3% to 58.0%) than in blacks (50.2%; 95% CI,46.2% to 54.2%). Comorbidities and adverse socioeconomic factors were highest in the southern region, and poor health behaviors were highest in the western region. The cumulative incidence rate (per 100,000 persons) was 3-fold higher in blacks (1546.4) than in whites (540.4). The crude mortality rate (per 100,000 persons) was 2-fold higher in blacks (83.2) than in whites (33.2). However, the infection-fatality ratio (per 100 cases) was similar in whites (6.2) and blacks (5.4). Within racial groups, the geographic distribution of health determinants did not correlate with the state-level COVID-19 mortality and infection-fatality ratio (P>.05 for all). Conclusion Racial disparities in COVID-19 are largely driven by the higher cumulative incidence of infection in blacks. There is a discordance between the geographic dispersion of COVID-19 mortality and the regional distribution of health determinants.

Background: Health care personnel (HCP) are at an increased risk of acquiring COVID infection during this pandemic especially in developing countries like India, where they work in resource restricted healthcare settings and return to homes, unfit for safe self-isolation. Thus, many HCP were reluctant to accept COVID-19 duty as they were apprehensive about their safety and concerned about carrying the infection home to their families. Methods: We describe a novel multidimensional HCP-centric evidence-based, dynamic policy to address the expressed concerns of HCPs. The hospital was divided into three zones: high, medium, and low risk zones. In the high risk and medium risk zones, we organized pre-duty holistic training, provided on-duty support, ensured post duty HCP welfare, and send them all home after they tested negative for COVID-19. To minimize transmission, we provided appropriate PPE, ensured its proper use, kept all communication paperless. To reduce morbidity, we recruited only willing low risk HCP, aged

Adsorptive desulfurization of liquid fuels over a wide sulfur (S) concentration range remains as challenging as the regeneration of spent materials. This study describes the efficient desulfurization of the dibenzothiophene (DBT) and thiophene (TH) containing liquid fuels over 300 – 1200 mg L−1 S-concentration range, using a hybrid approach combining adsorptive desulfurization (ADS) and bacterial desulfurization (BDS) sequentially at 30 °C and 1 atm-pressure, with the Ni-doped activated carbon beads and Enterococcus faecium bacterium serving as the ADS and BDS agent, respectively. The novelty is in the successful regeneration of spent adsorbents using the identical bacterium that was used in the BDS step. Notably, the bacterium was isolated from the waste effluent of a petroleum industry, and was characterized via the colony morphology, Gram staining, and identification by 16S rRNA sequencing. ADS step was used over 300 – 1200 mg L−1, before switching over to BDS over the 50 – 300 mg L−1 S- concentration range, the sequential steps indicating an approximately 99% removal of the thiol compounds from the liquid. The spent adsorbents, post sequential test, were regenerated using the bacterial dose of 1% (v/v) of the liquid, and successfully reused up to five cycles of the hybrid method, with ∼97% DBT and 95% TH removal measured in the last cycle. The spent and regenerated materials were physicochemically characterized by FE-SEM, FT-IR and BET analysis. As the regulations decrease the limits of sulfur content in on-road fuels globally, the proposed hybrid approach combining ADS with BDS, in conjunction with bacterial regeneration can be a potentially energy and cost effective solution to the desulfurization of liquid fuels.

BACKGROUND: Coronary chronic total occlusion (CTO) using percutaneous coronary intervention (PCI) presents a distinct challenge in the field of cardiology owing to multiple reasons including the increased risk of peri-procedural complications. We sought to explore rates of hospitalization, outcomes, use of mechanical circulatory support devices, and economic burden associated with single-vessel coronary CTO undergoing PCI for stable coronary artery disease (CAD). METHODS: The National Inpatient Sample spanning from 2008 through 2014 was queried to identify hospitalizations associated with single-vessel coronary CTO-PCI for stable CAD by excluding hospitalizations with ST-elevation and non-ST elevation myocardial infarction. Survey-Specific logistic regression was used to analyze adjusted incidence of in-hospital mortality and acute renal failure. RESULTS: A total of 109,094 hospitalizations were identified as having single-vessel coronary CTO-PCI for stable CAD from 2008–2014. An increasing number of coronary CTO-PCI hospitalizations (2,465 to 2,688 per 100,000 PCI procedures, P(trend)

Objectives The purpose of this study was to compare trends of use, in-hospital mortality, and annual expenditures associated with orthotopic heart transplantation (OHT) and left ventricular assist device (LVAD) implantation. In view of the changing health care landscape, we assessed the impact of federal funding cuts on Medicare and Medicaid beneficiaries seeking these procedures. Background Use and cost trends associated with OHT and LVAD are not well defined. Moreover, little is known about the economic contribution of Medicare and Medicaid for these procedures. Methods Using the National Inpatient Sample from 2009 through 2014, the study identified index hospitalizations for OHT and LVAD. The aforementioned trends and inflation-adjusted cost analyses were performed. Results A total of 28,765 hospitalizations associated with OHT or LVAD were identified. The number of index hospitalizations for OHT increased from 1,795 to 2,140, whereas the number of LVAD implants increased from 2,205 to 3,645 (ptrend Conclusions With increasing use and annual expenditure, OHT and LVAD account for more than 1 billion dollars of the health care budget. In-hospital mortality associated with LVAD has continued to decline but has remained higher than that with OHT. Medicare and Medicaid beneficiaries seeking these procedures would be adversely affected by the proposed cuts.

Randomized controlled trials (RCTs) have shown fractional flow reserve-guided (FFR) multivessel stenting to be superior to infarct-related artery (IRA) only stenting in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease. This effect was mainly driven by a reduction in overall repeat revascularization. However, the ability to assess the effect of this strategy on urgent revascularization or reinfarction was underpowered in individual trials.We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in STEMI with multivessel disease. The outcomes of interest were death, reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios (RR) were pooled using the DerSimonian and Laird random-effects model.After review of 786 citations, 2 RCTs were included. The pooled results demonstrated a significant reduction in the composite of death, reinfarction, or revascularization in the FFR-guided multivessel stenting group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49 [0.33-0.72], p0.001). This risk reduction was driven mainly by a reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p=0.002) and non-urgent revascularization (0.31 [0.19-0.50], p0.001). Pooled RR for reinfarction was lower in the FFR-guided strategy, but was not statistically significant (0.71[0.39-1.31], p=0.28).This systematic review and meta-analysis suggests that a strategy of FFR-guided multivessel stenting in STEMI patients reduces not only overall repeat revascularization but also urgent revascularization. The effect on reinfarction needs to be evaluated in larger trials.

A 4-nitrophenol-degrading bacterial strain PNP was isolated from pesticide-contaminated soil collected from Lucknow. Strain PNP utilized 0.5 mM 4-nitrophenol as its carbon source and degraded it completely within 24 h with stoichiometric release of nitrite ions. Strain PNP was associated with the genus Pseudomonas in a phylogentic tree and exhibited highest 16S rRNA gene sequence similarity to Pseudomonas juntendi BML3 (99.79%) and Pseudomonas inefficax JV551A3 (99.79%). Based on values of average nucleotide identity and digital DNA-DNA hybridization among strain PNP and its closely related type strains, it concluded that strain PNP belongs to Pseudomonas alloputida. The Illumina HiSeq platform was used to sequence the PNP genome. The draft genome sequence of Pseudomonas alloputida PNP was presented here. The total size of the draft assembly was 6,087,340 bp, distributed into 87 contigs with N50 value of 139502. The genome has an average GC content of 61.7% and contains 5461 coding sequences and 77 putative RNA genes. This Whole Genome Shotgun project has been submitted at DDBJ/ENA/GenBank under the accession JAGKJH000000000.

Background We sought to estimate the efficacy and safety outcomes of catheter-directed treatment (CDT) for patients with acute pulmonary embolism (PE). Methods We searched SCOPUS for studies reporting outcomes after CDT for acute PE. Studies were categorized in three groups for analyses due to heterogeneity in the classification of acute PE: 1) patients with PE causing right ventricular dysfunction and haemodynamic instability: unstable haemodynamic status, 2) patients with PE causing right ventricular dysfunction where study outcomes were not stratified by haemodynamic status: stable and unstable haemodynamic status, and 3) patients with PE causing right ventricular dysfunction who remained haemodynamically stable: stable haemodynamic status. Efficacy and safety outcomes were estimated and presented as point estimates with 95% confidence intervals. Results In 35 studies with 1253 patients, 1277 CDTs were performed. The in-hospital mortality rates for the unstable haemodynamic status, stable and unstable haemodynamic status, and stable haemodynamic status groups were 18.1% (7.3–38.2%), 7.1% (5.0–10.1%), and 2.6% (0.8–7.3%), respectively. The major bleeding rates across the groups were estimated to be 4.5, 8.5 and 3.9 per 100 CDTs, respectively. Minor bleeding occurred in 6.2, 11.9 and 9.1 per 100 CDTs, respectively. After CDT, all groups had improvements in mean pulmonary artery pressure and right ventricular function. Conclusions We provide descriptive measures of efficacy and safety for patients who underwent CDT for acute PE.

Severe aortic stenosis (AS) is a progressive life threatening “surgical” illness. Previous studies have shown a substantial improvement in quality of life as well as survival after valve replacement in patients with severe AS [(1)][1]. Transcatheter aortic valve replacement (TAVR) is recommended

Background: Among patients receiving percutaneous coronary intervention (PCI), the role of a genotype-guided approach for antiplatelet therapy compared with usual care is unclear. We conducted a Ba...

A chromium-reducing bacterium designated as strain KNP was isolated from a sample collected from a tannery effluent of Kanpur, India. Phylogenetic analysis based on the 16S rRNA gene sequences revealed that strain KNP belonged to the Bacillus genus and showed 100% similarity with Bacillus licheniformis. Furthermore, average nucleotide identity and digital DNA-DNA hybridization between strain KNP and its closely related strains confirmed its affiliation with Bacillus licheniformis species. Whole-genome sequencing of Bacillus licheniformis KNP was performed using the Illumina Hiseq platform. Here, we present the draft genome sequence of Bacillus licheniformis KNP. The total size of the draft assembly was 4,280,093 bp, distributed into 21 contigs with an N50 value of 4,186,229. The genome has 45.9% G + C content, 4255 coding sequences and 86 putative RNA genes. This Whole Genome Shotgun project has been deposited at DDBJ/ENA/GenBank under the accession JACDXS000000000. The version described in this paper is version JACDXS010000000.

Desulfurization of liquid fuels over a wide concentration range continues to be challenging. This study recommends a novel hybrid route to efficiently desulfurizing the thiols or organosulfur compounds containing liquid fuels. The tests performed on the dibenzothiophene (DBT) and thiophene (TH) containing n-octane over sulfur concentration range 300–1200 mg/L showed adsorptive desulfurization followed by the bacterial treatment to be efficient in decreasing the concentration level to 3–15 mg/L at 30 °C and 1 atm pressure. Adsorption performed using the Ni nanoparticles-dispersed porous carbon beads of ~ 0.8 mm size was effective at relatively higher concentrations. Upon nearly saturation in the adsorption step, further removal of the thiol compounds to low concentrations was possible by bacterial degradation using Bacillus zhangzhouensis isolated from the wastewater effluent of a petroleum industry. Fresh and spent adsorbents were characterized using various analytical techniques. Bacterial characterization involved the Christian gram staining and 16S rRNA sequencing. The data demonstrate for the first time ~ 99% removal of the thiol compounds, at rates faster than adsorption alone. The proposed sequential approach in this study can be effective in meeting the globally ever increasing stringent regulations for low sulfur content in fuel oils.

Background The phenotypically heterogeneous syndrome of heart failure with preserved ejection fraction (HFpEF) is challenging to diagnose. The HFA-PEFF and H2FPEF scores were developed to guide HFpEF diagnosis but have not been directly compared. We evaluated the generalizability and prognostic implications of the two scores in Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) and PDE-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF (RELAX) trial participants and matched controls from Atherosclerosis Risk in Community (ARIC) study. Methods Participants from TOPCAT, RELAX, and ARIC studies were categorized as having low, intermediate, and high likelihood of HFpEF based on the respective scores. Diagnostic performance was evaluated using age, sex, and race matched controls, free of cardiovascular disease from ARIC study. Multivariable-adjusted Cox regression was used to assess the prognostic value of the scores. Results The median HFA-PEFF score in TOPCAT, RELAX and ARIC was 5.0 (IQR:5.0-6.0), 4.0 (IQR:2.0-4.0) and 3 (IQR:2.0-4.0), respectively. The median H2FPEF score in the three populations was 5.0 (IQR:4.0-7.0), 6.0 (IQR:4.0-7.0), and 2.5 (IQR:2.0-4.0), respectively. High HFA-PEFF scores were seen in 75.8%, 20.4%, and 16.5% of in the three populations, respectively. High H2FPEF scores were seen in 42.3%, 55.3%, and 1.9% of the three populations, respectively. Application of HFA-PEFF score categories to patients categorized using H2FPEF score led to 84.2% of TOPCAT, and 50.5% of RELAX participants being reclassified (Figure 1A,B). Using low HFA-PEFF and H2FPEF scores, HFpEF can be ruled-out with high sensitivity (99.5% and 99.9%, respectively) and high negative predictive value (95.7% and 98.5%, respectively). A high HFA-PEFF and H2FPEF score can rule-in HFpEF with good specificity (83.5% and 98.1%, respectively) and positive predictive value (80.6% and 95.5%, respectively). Among TOPCAT participants, the hazard for adverse cardiovascular events per point increase in HFA-PEFF and H2FPEF score was 1.32 (95% CI: 1.03-1.69) and 1.03 (95% CI: 0.91-1.17), respectively (Figure 1 C,D). Conclusion The HFA-PEFF and the H2FPEF scores are reliable diagnostic tools for HFpEF. The scores also provide prognostic value for the risk stratification of HFpEF patients.

This study sought to determine the effect of intensive blood pressure (BP) control on the incidence of new-onset atrial fibrillation/flutter (AF) and to assess the prognostic implications of preexisting and new-onset AF in the randomized, multicenter Systolic Blood Pressure Intervention Trial (

Background: Isolation of free-living amoebae (FLA) is reported sparsely from water taps, ventilators, air conditioners, haemodialysis units and dental irrigation systems of hospitals worldwide. Their prevalence in hospital environment especially in wards having immunocompromised patients may pose a risk to this group of susceptible population as they may cause disease themselves or may carry pathogens inside them. No study from India has performed such surveillance. Objective: To evaluate extent of FLA contamination in water sources of bone marrow transplant (BMT) intensive care unit (ICU), transplant ICU, haemodialysis unit and high dependency unit in a tertiary care hospital in India. Materials and Methods: A total of hundred samples including fifty each of tap water samples and swabs from mouth of taps used for drinking, bathing and hand washing purposes in these units were collected according to standard procedure. Samples were inoculated onto non-nutrient agar plates at room temperature followed by morphological confirmation. Molecular identification including polymerase chain reaction (PCR) and sequencing was performed in culture positive samples. Results: Four tap water samples and ten swab samples showed growth of trophozoites and cyst formation. Morphologically, four amoebae resembled Acanthamoeba spp. which was further confirmed by PCR and sequencing showed them to be of T3 and T4 genotypes. Conclusion: The presence of these FLA in hospital water sources emphasises the urgent need of implementing effective preventive measures. Further studies are required to estimate the true prevalence of FLA in Indian hospitals by taking larger number of samples.

We report design of an universal driver circuit for efficient operation of home made mechanical shutters using electromagnetic relay, dc motor (DCM) and laptop hard disc drive (HDD). The driver puts out high, medium and low currents for overcoming the inertia, fast sweeping and soft landing of the shutters. All the shutters operate with significantly reduced mechanical vibrations and hence produce low levels of acoustic noise. The electromagnetic relay, dc motor and HDD shutters operate at sweeping speeds 1.7(2) m/s, 1.6(2) m/s and 2.8(3) m/s, respectively.

The role of natriuretic peptide (NP)-guided treatment of heart failure (HF) has been evaluated in multiple randomized controlled trials (RCTs) and meta-analyses [(1)][1]. These studies differ in many aspects including type of NP chosen (N-terminal pro–B-type natriuretic peptide [NT-proBNP] vs. B

Background The economic recession of 2008-2009 resulted in unprecedented employment and economic losses leading to deterioration of cardiovascular health. We examined the trends in ideal cardiovascular health as measured by the American Heart Association's (AHA's) Life's Simple 7 metric during the periods of economic recession and subsequent economic recovery. Methods Data on adults ages ≥20 years from the NHANES from economic-recession (2007-2010) and post-recession (2011-2016) periods was analyzed. The AHA's Life's Simple 7 score of 10-14 was used to classify ideal cardiovascular health status. Socioeconomic status was divided into 3 categories: high, middle, and low based on education and income status. Multivariable linear and logistic regression models including demographics, insurance status, health care access, and adjustment for multiple testing were used to analyze the trends in prevalence of ideal cardiovascular health across socioeconomic strata. Results We observed a decline in the multivariable-adjusted mean cardiovascular health score from 8.18 in 2007-2010 to 7.94 in 2015-2016 (Plinear = 0.02). This was primarily driven by the increasing prevalence of obesity (34% in 2007-2010 vs 41% in 2015-2016, Plinear = 0.005) and poor fasting glucose (8% in 2007-2010 vs 12% in 2015-2016, Plinear = 0.003). In multivariable-adjusted models, we observed the decreasing prevalence of ideal cardiovascular health with a nonlinear trend in the participants in the highest (51% in 2007-2010 vs 42% in 2015-2016, Pquadratic = 0.01) and lowest socioeconomic strata (16% in 2007-2010 vs 13% in 2015-2016, Pquadratic = 0.02). The prevalence of ideal cardiovascular health was higher in participants with high-socioeconomic status compared with other socioeconomic status participants. Conclusions Despite economic recovery, ideal cardiovascular health metrics have not yet recovered. Cardiovascular health appears to be further deteriorating for US adults, particularly those in high- and lower-socioeconomic strata.

Natriuretic peptides (NPs) are cardiac derived hormones that promote natriuresis, diuresis, and vasodilation. Preclinical evidence suggests that non-hemodynamic triggers for NP release exist, with a few studies implicating inflammatory cytokines, e.g. interleukin-6 (IL6). The impact of inflammation

Trends of orthotopic heart transplantation (OHT) and left ventricular assist device (LVAD) implantation among African-Americans (AA) and Caucasians (CA) are not well-defined. Additionally, in view of recently proposed funding cuts, we explored the contribution of Medicaid towards the costs of these

Earlier clinical trials have suggested equivalency of rate versus rhythm control strategies in atrial fibrillation (AF) patients who have heart failure with reduced ejection fraction (HFrEF). Recent randomized controlled trials (RCTs) have suggested improvement in left ventricular ejection fraction

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital condition that has historically been misdiagnosed as primary endocardial fibroelastosis (EFE). Due to symptoms of heart failure (HF) and failure to thrive, ALCAPA is often corrected in the 1st year of life. A 2

Chronic Total Occlusion (CTO) of coronary arteries presents a distinct challenge in the field of cardiology owing to the associated increased risk of peri-procedural complications. Data on trends of hospitalizations, in-hospital mortality and use of support devices in single-vessel CTO-PCI have not

Patients with multi-vessel coronary artery disease (CAD) presenting with STEMI, generally undergo primary PCI, which is limited to treating the culprit lesion (CL) rather than complete revascularization (CR). The results from available randomized control trials (RCTs) are conflicting. We performed a