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Objectives: To determine frequency of left ventricular thrombus (LVT) in acute ST elevation myocardial infarction (STEMI) and to find out the correlation of risk factors with development of left ventricular thrombus. Study Design: Hospital-based observational cross sectional study. Place and Duration of Study: AFIC/NIHD Rawalpindi, from Nov 2016 to Feb 2017. Material and Methods: One hundred and fifty consecutive patients presented with first episode of acute STEMI were included. Patients with previous history of myocardial infarction, valvular heart disease, dilated Cardiomyopathy and mural thrombus were excluded. 2-D echocardiography was performed after 24 hours, 48 hours and 72 hours of admission. Descriptive and inferential statistical analysis was performed using SPSS version 23.0. Results: Mean age of patients was 59.84 ± 11.16 years. Thrombus was seen in 35 (23.3%) patients out of which 21 (60%) were males and 14 (40%) were females. left ventricular thrombus occurred in 8 (22.8%) after 24 hours and 27 (77.2%) patients after 72 hours. LV thrombus was seen in 20 (57.1%) patients whose EF was less than 30% while it occurred in 10 (28.5%) patients having EF 30-45% and 5 (14.2%) patients with EF >45%. Among risk factor LV thrombus was seen in 17 (48.5%) diabetic patients, 4 (11.4%) patients had hypertension and 14 (40%) were those who had both diabetes and hypertension. Conclusion: LVT is important complication of acute myocardial infarction. If diagnosed and anticoagulated earlier, risk of complications and its potential to embolise can be minimized. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To evaluate the efficacy and safety of triptorelin after radical prostatectomy (RP) in patients with negative lymph nodes.PRIORITI (NCT01753297) was a prospective, open‐label, randomized, controlled, phase 4 study conducted in China and Russia. Patients with high‐risk (Gleason score ≥ 8 and/or pre‐RP prostate‐specific antigen [PSA] ≥ 20 ng/mL and/or primary tumor stage 3a) prostate adenocarcinoma without evidence of lymph node or distant metastases were randomized to receive triptorelin 11.25 mg at baseline (≤ 8 weeks after RP) and at 3 and 6 months, or active surveillance. The primary endpoint was biochemical relapse‐free survival (BRFS), defined as the time from randomization to biochemical relapse (BR; increased PSA > 0.2 ng/mL). Patients were monitored every 3 months for at least 36 months; the study ended when 61 BRs were observed.The intention‐to‐treat population comprised 226 patients (mean [standard deviation] age, 65.3 [6.4] years), of whom 109 and 117 were randomized to triptorelin or surveillance, respectively. The median BRFS was not reached. The 25th percentile time to BRFS (95% confidence interval) was 39.1 (29.9–not estimated) months with triptorelin and 30.0 (18.6–42.1) months with surveillance (p = 0.16). There was evidence of a lower risk of BR with triptorelin versus surveillance but this was not statistically significant at the 5% level (p = 0.10). Chemical castration was maintained at month 9 in 93.9% of patients who had received triptorelin. Overall, triptorelin was well tolerated and had an acceptable safety profile.BRFS was observed to be longer with triptorelin than surveillance, but the difference was not statistically significant. [ABSTRACT FROM AUTHOR]

Urban mobility is in the midst of a revolution, driven by the convergence of technologies such as artificial intelligence, on-demand ride services, and Internet-connected and self-driving vehicles. Technological advancements often lead to new hazards. Coupled with the increased levels of automation and connectivity in the new generation of autonomous vehicles, cybersecurity is emerging as a key threat affecting these vehicles. Traditional hazard analysis methods treat safety and security in isolation and are limited in their ability to account for interactions among organizational, sociotechnical, human, and technical components. In response to these challenges, the cybersafety method, based on System Theoretic Process Analysis (STPA and STPA-Sec), was developed to meet the growing need to holistically analyze complex sociotechnical systems. We applied cybersafety to coanalyze safety and security hazards, as well as identify mitigation requirements. The results were compared with another promising method known as Combined Harm Analysis of Safety and Security for Information Systems (CHASSIS). Both methods were applied to the Mobility-as-a-Service (MaaS) and Internet of Vehicles (IoV) use cases, focusing on over-the-air software updates feature. Overall, cybersafety identified additional hazards and more effective requirements compared to CHASSIS. In particular, cybersafety demonstrated the ability to identify hazards due to unsafe/unsecure interactions among sociotechnical components. This research also suggested using CHASSIS methods for information lifecycle analysis to complement and generate additional considerations for cybersafety. Finally, results from both methods were backtested against a past cyber hack on a vehicular system, and we found that recommendations from cybersafety were likely to mitigate the risks of the incident. [ABSTRACT FROM AUTHOR]

Background: The open-label RECOVERY study reported improved survival in hospitalized, SARS-CoV-2 seronegative patients treated with casirivimab and imdevimab (CAS + IMD)., Methods: In this phase 1/2/3, double-blind, placebo-controlled trial conducted prior to widespread circulation of Delta and Omicron, hospitalized COVID-19 patients were randomized (1:1:1) to 2.4 g or 8.0 g CAS + IMD or placebo, and characterized at baseline for viral load and SARS-CoV-2 serostatus., Results: In total, 1336 patients on low-flow or no supplemental (low-flow/no) oxygen were treated. The primary endpoint was met in seronegative patients, the least-squares mean difference (CAS + IMD versus placebo) for time-weighted average change from baseline in viral load through day 7 was -0.28 log10 copies/mL (95% confidence interval [CI], -.51 to -.05; P = .0172). The primary clinical analysis of death or mechanical ventilation from day 6 to 29 in patients with high viral load had a strong positive trend but did not reach significance. CAS + IMD numerically reduced all-cause mortality in seronegative patients through day 29 (relative risk reduction, 55.6%; 95% CI, 24.2%-74.0%). No safety concerns were noted., Conclusions: In hospitalized COVID-19 patients on low-flow/no oxygen, CAS + IMD reduced viral load and likely improves clinical outcomes in the overall population, with the benefit driven by seronegative patients, and no harm observed in seropositive patients., Clinical Trials Registration: NCT04426695., Competing Interests: Potential conflicts of interest. S. S.-K., S. A., Y. Sun, R. B., J. Mei, J. Miller, E. F.-N., C. P., V. P., Y. Z., A. M., J. D. D., Y. K., A. C., B. K., Y. Soo, A. T. D., G. P. G., L. L., N. B., and D. M. W. are employees/stockholders of Regeneron Pharmaceuticals, Inc, and report grants from Biomedical Advanced Research and Development Authority (BARDA). E. M. reports payments to his institution received from National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases, NIH/National Institute of General Medical Sciences, SciClone Pharmaceuticals, Regeneron Pharmaceuticals, Inc, Pfizer, Chemic Labs/KODA Therapeutics, Cidara, and Leidos Biomedical Research Inc/NCI. V. P. M. and J. C. W. report grants from BARDA. S. S. is an Excision BioTherapeutics employee/stockholder and former Regeneron Pharmaceuticals, Inc, employee and current stockholder, and reports grants from BARDA. L. C. is a Regeneron Pharmaceuticals, Inc employee and reports grants from BARDA. A. T. H. is a Regeneron Pharmaceuticals, Inc employee/stockholder, a former Pfizer employee and current stockholder, has a patent pending with Regeneron Pharmaceuticals, Inc and reports grants from BARDA. J. D. H., K. C. T., and G. A. H. are employees/stockholders of Regeneron Pharmaceuticals, Inc and have a patent pending, which has been licensed and receiving royalties, with Regeneron Pharmaceuticals, Inc. R. H. is a former employee and current stockholder of Regeneron Pharmaceuticals, Inc, and reports grants from BARDA. N. S. and G. D. Y. are employees/stockholders of Regeneron Pharmaceuticals, Inc, and have issued patents (US Patent Nos. 10 787 501, 10 954 289, and 10 975 139) and pending patents, which have been licensed and receiving royalties, with Regeneron Pharmaceuticals, Inc, and reports grants from BARDA. Funding to pay the Open Access publication charges for this article was provided by Regeneron Pharmaceuticals, Inc., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: REGEN-COV (previously known as REGN-COV2), a combination of the monoclonal antibodies casirivimab and imdevimab, has been shown to markedly reduce the risk of hospitalization or death among high-risk persons with coronavirus disease 2019 (Covid-19). Whether subcutaneous REGEN-COV prevents severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and subsequent Covid-19 in persons at high risk for infection because of household exposure to a person with SARS-CoV-2 infection is unknown., Methods: We randomly assigned, in a 1:1 ratio, participants (≥12 years of age) who were enrolled within 96 hours after a household contact received a diagnosis of SARS-CoV-2 infection to receive a total dose of 1200 mg of REGEN-COV or matching placebo administered by means of subcutaneous injection. At the time of randomization, participants were stratified according to the results of the local diagnostic assay for SARS-CoV-2 and according to age. The primary efficacy end point was the development of symptomatic SARS-CoV-2 infection through day 28 in participants who did not have SARS-CoV-2 infection (as measured by reverse-transcriptase-quantitative polymerase-chain-reaction assay) or previous immunity (seronegativity)., Results: Symptomatic SARS-CoV-2 infection developed in 11 of 753 participants in the REGEN-COV group (1.5%) and in 59 of 752 participants in the placebo group (7.8%) (relative risk reduction [1 minus the relative risk], 81.4%; P<0.001). In weeks 2 to 4, a total of 2 of 753 participants in the REGEN-COV group (0.3%) and 27 of 752 participants in the placebo group (3.6%) had symptomatic SARS-CoV-2 infection (relative risk reduction, 92.6%). REGEN-COV also prevented symptomatic and asymptomatic infections overall (relative risk reduction, 66.4%). Among symptomatic infected participants, the median time to resolution of symptoms was 2 weeks shorter with REGEN-COV than with placebo (1.2 weeks and 3.2 weeks, respectively), and the duration of a high viral load (>10 4 copies per milliliter) was shorter (0.4 weeks and 1.3 weeks, respectively). No dose-limiting toxic effects of REGEN-COV were noted., Conclusions: Subcutaneous REGEN-COV prevented symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection in previously uninfected household contacts of infected persons. Among the participants who became infected, REGEN-COV reduced the duration of symptomatic disease and the duration of a high viral load. (Funded by Regeneron Pharmaceuticals and others; ClinicalTrials.gov number, NCT04452318.)., (Copyright © 2021 Massachusetts Medical Society.)