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Background Killip classification is a simple clinical tool for risk stratification in patients with acute myocardial infarction (AMI). However, predictors of high Killip class at admission and its prognostic role in myocardial infarction with non-obstructive coronary artery (MINOCA) are still poorly explored. Purpose To identify clinical predictors of high Killip class and its potential prognostic role in patients with MINOCA compared to patients with myocardial infarction with obstructive coronary artery (MIOCA). Methods We included patients with AMI undergoing coronary angiogram from January 2016 to June 2021. MINOCA were defined according to the current European guidelines criteria. We compared the Killip classes of MINOCA with those of MIOCA and defined a high Killip class if greater than 1. Kaplan-Meier (KM) curves were developed for the comparison of all-cause mortality among MIOCA and MINOCA with high Killip class (>1) compared to the others. Multivariate logistic regression analysis was used to determine the predictors of high Killip class. Results Among 3261 AMI, 261 were MINOCA. The median follow-up time was 36.1±15.2 months. Killip class >1 occurred in 24 (8.8%) MINOCA patients compared to 518 (17.3%) MIOCA cases (p=0.001). During long-term follow-up, a high Killip class was associated with a 3-fold increased mortality both in MIOCA and MINOCA populations (p Conclusions High Killip class at admission is a high-risk marker of adverse cardiovascular events even in patients with MINOCA. Simple baseline characteristics (such as older age, diabetes, ST-segment-elevation) predict a high Killip class in MINOCA subjects and can help to identify a high-risk population who might benefit from a stricter management. Furthermore, LVEF and elevated cardiac troponin were identified as predictors of a high Killip class in MIOCA but they did not show a similar impact in the setting of MINOCA. This may reflect the different pathogenesis and myocardial damage extent in MINOCA compared to MIOCA. Funding Acknowledgement Type of funding sources: None.

Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a significant proportion of acute myocardial infarction (AMI) population. MINOCA is a working diagnosis and an accurate investigation of the underlying causes should always be performed. In this setting, cardiac magnetic resonance (CMR) imaging plays a pivotal diagnostic role. However, a prognostic stratification based on the CMR findings in ischemic MINOCA is still unavailable. Purpose To evaluate the potential prognostic impact of specific CMR findings - especially ischemic late gadolinium enhancement (LGE) patterns - in order to look for measurable parameters that may guide the management of this still troubled clinical entity. Methods We assessed 461 MINOCA from January 2016 to June 2021. We excluded acute myocarditis, Tako-tsubo syndromes, cardiomyopathies, or non-pathological CMR. According to CMR findings, MINOCA were classified in two phenotypes: LGE-positive (an ischemic subendocardial or transmural LGE pattern) or LGE-negative (cases without LGE but exhibiting regional myocardial injury defined by myocardial edema in a coronary territory with a typically ischemic “wave-front” and/or regional wall motion abnormality consistent with coronary distribution). All-cause mortality, re-infarction, stroke, heart failure (HF) and the composite endpoint (MACE) were evaluated. Extended LGE was considered as the presence of >2 segments with transmural LGE. The mean follow-up was 36.1±15.2 months and CMR was performed at a mean of 6±2.9 days from the acute presentation. Results The final cohort included 175 MINOCA with a likely-ischemic etiology: 121 (69.1%) constituted the LGE-positive group. The mean age of the study population was 62.3±12.9 years and more than 61% were females. During follow-up, HF (15.7% vs 1.9%, p=0.008) and MACE (20.7% vs 7.4%, p=0.029) occurred more frequently in MINOCA “LGE-positive” compared to the “LGE-negative” ones. Extended LGE was significantly more prevalent in patients with versus without subsequent HF. On multivariable Cox regression, extended LGE was an independent predictor of HF occurrence (HR 18.49, 95% CI 4.65–73.61, p Conclusions Our data suggest that in MINOCA patients the detection of LGE is correlated with the incidence of major cardiovascular events and heart failure during long-term follow-up. In fact, LGE extension was identified as the strongest predictor of cardiac adverse events. The early execution of CMR is useful in the prognostic stratification of MINOCA and this could guide the subsequent clinical and therapeutic management. Funding Acknowledgement Type of funding sources: None.

Background Cardiac masses (CM) are an extremely heterogeneous clinical entity, including benign and malignant neoformations. 2D Echocardiography is nowadays the first-line approach to define nature and management of CM. Purpose The purpose of our study was to identify the echocardiographic predictors of malignancy and create a multiparametric score to further increase the diagnostic yield and accurately suggest the nature of CM. Material and methods 249 consecutive patients undergoing a complete echocardiographic assessment for suspected cardiac mass were enrolled from January 2004 to December 2020. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. Logistic regression was performed to evaluate the ability of echocardiography to discriminate benign versus malignant masses. Results A scoring system was developed in a derivation cohort of 178 (70%) and validated in 71 (30%) patients. A weighted score [Diagnostic Echocardiographic Mass (DEM) Score] ranging from 0 to 9 was obtained from 6 variables: infiltration, polylobate mass, moderate-severe pericardial effusion, inhomogeneity, sessile and non-left localization. The AUC for the score was 0.965 (95% CI 0.938–0.993). In a logistic regression analysis using the DEM score as a predictor, the likelihood of malignancy increased more than 4 times for a 1-unit increase of the score (OR=4.468; 95% CI 2.733–7.304). The prognostic validity of the score was confirmed by its ability to predict survival during follow-up (median time of 31 months). Conclusions The application of a multiparametric echocardiographic score in the approach to CM accurately predicts mass malignancy thereby reducing the need for second-level investigations, and minimizing the diagnostic delay in such a complex clinical scenario. Funding Acknowledgement Type of funding sources: None.

Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical entity and in its complex diagnostic approach cardiovascular magnetic resonance (CMR) plays a pivotal role. Purpose To characterize the differences of MINOCA patients with and without late gadolinium enhancement (LGE) at CMR and to identify the predictors for ischemic LGE development and extension. Methods We assessed 461 MINOCA cases from January 2016 to June 2021. MINOCA were defined according to the current European guidelines criteria. We excluded acute myocarditis, Tako-tsubo syndromes, cardiomyopathies, or non-pathological CMR. According to CMR imaging findings, our cohort was divided into two CMR phenotypes based on regional myocardial necrosis detected throughout LGE (“LGE-positive MINOCA”) or regional ischemic injury without LGE (“LGE-negative MINOCA”). Extended LGE was considered as the presence of >2 segments with transmural LGE. Multivariate logistic regression analysis was used to determine the predictors of LGE and extended LGE. Results The final cohort included 175 MINOCA: 121 (69.1%) constituted the LGE-positive group. The mean time delay between acute clinical presentation and CMR was 6±2.9 days. At admission MINOCA LGE-patients more frequently presented angina and ST segment elevation (24% vs 7.4%, p=0.01), compared to LGE negative ones. Furthermore, the LGE positive group had a significantly greater infarct size, measured by peak hs-Troponin I values and left ventricular function (LVEF). The only predictor of LGE was the peak troponin value (OR 1.64, 95% CI 1.18–2.28, p=0.003), while predictors of extended LGE were ST-segment elevation at admission (OR 7.44, 95% CI 1.57–35.22, p=0.01), peak troponin values (OR 1.07, 95% CI 1.02–1.13, p=0.01) and the presence of non-obstructive coronary artery disease at coronary angiography (OR 5.49, 95% CI 1.20–25.09, p=0.028). Conclusion The presence and extension of LGE at early CMR evaluation is an important feature in the setting of MINOCA. In addition, simple baseline characteristics (such as ST elevation, peak troponin value and LVEF) may aid the identification of a greater ischemic necrosis burden at CMR and therefore these high-risk MINOCA subjects could be benefit from a stricter management effort. Funding Acknowledgement Type of funding sources: None.

Background The Fourth Universal Definition of Myocardial Infarction (UDMI) defines acute myocardial infarction (AMI) as an acute myocardial injury associated with clinical evidence of acute myocardial ischemia. However, the prognostic role of each single diagnostic criteria has never been explored. Purpose To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI in patients with non-ST-segment elevation myocardial infarction. Methods We enrolled all consecutive patients with NSTEMI undergoing coronary angiography at our Centre. The admission diagnosis was performed according to the current guidelines criteria, namely the detection of an increase and/or decrease of high-sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischemia, ECG changes (new ST depression or negative T-waves), echocardiographic evidence of new regional wall motion abnormality. Patients with very high-risk NSTEMI were excluded. Patients were then divided into different subgroups according to the combination of diagnostic criteria presented at admission. A composite endpoint of all-cause mortality, re-hospitalization for myocardial reinfarction or heart failure was collected. The predictive value of AMI diagnostic criteria alone and their combination were evaluated using Kaplan-Meier survival curves and subsequent Cox-regression analysis to find independent predictors of major adverse events. Results Our study population consisted of 2791 patients. The mean age was 68.3±13.4 and 31.5% were female. The mean follow-up time was 23.3±14.5 months. Depending on the AMI diagnostic criteria and their combination, patients were divided into three subgroups: 196 patients fulfilling only clinical criteria (group A), 187 with clinical and ECG-graphic criteria (group B) and 829 patients with clinical, ECG-graphic and echo-graphic criteria (group C). Baseline characteristics of the three groups were similar. At two-year follow-up, patients with clinical criteria alone exhibited the best outcome, whereas those with all three criteria fulfilled showed the worse prognosis (14.8% for group A vs 23.6% for group B vs 28.0% for group C; p-value Conclusions In non-very high-risk NSTEMI, not all diagnostic criteria have the same prognostic value. In fact, prognosis is significantly more favorable in patients exhibiting only the clinical criteria at admission. We hypothesize that the absence of ECG-graphic and echocardiographic alterations may indirectly indicate smaller infarct sizes that contribute to patients' outcomes. These findings could enhance the current risk stratification in patients admitted with NSTEMI. Funding Acknowledgement Type of funding sources: None.

Communities throughout the globe are increasingly being given the responsibility of resource management, making it necessary to understand the factors that lead to success in community-based management (CBM). Here, we assessed whether and how institutional design principles affect the ecological outcomes of CBM schemes for Arapaima sp., an important common-pool fishery resource of the Amazon Basin. We quantified the degree of presence of Ostrom’s (Science 325:419–422, 1990) institutional design principles in 83 communities using a systematic survey, and quantitatively linked the design principles to a measure of ecological outcome (arapaima density) in a subset of 39 communities to assess their influence. To understand regional patterns of institutional capacity for CBM, we evaluated the degree of presence of each principle in all 83 communities. The principle scores were positively related to arapaima density in the 39 CBM schemes, explaining about half of the variation. Design principles related to defined boundaries and graduated sanctions exerted the strongest influence on the capacity of CBM to increase arapaima density. The degree to which most principles were present in all 83 communities was generally low, however, with the two most influential principles (defined boundaries and graduated sanctions) being the least present of all. Although the roles of the other principles (management rules, conflict resolution, collective action, and monitoring systems) are probably important, our results indicate that efforts aimed at strengthening the presence of defined boundaries and graduated sanctions in communities hold promise to improve the effectiveness of arapaima CBM regionally. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s13280-021-01575-1) contains supplementary material, which is available to authorized users.

Background Myocardial Infarction (MI) with Non–Obstructive Coronary Arteries (MINOCA) accounts above 6 % of patients presenting with acute MI (AMI) and it’s known to be more prevalent in females. Differences in terms of clinical features and prognosis in MINOCA patients according to gender have been poorly understood. Purpose: To evaluate clinical and prognostic differences between male and female patients with MINOCA. Methods We included all consecutive patients with AMI undergoing coronary angiography between 2016 and 2020 in our multicentric Registry. We considered as MINOCA all patients fulfilling the European Society of Cardiology diagnostic criteria. We analyzed the baseline clinical characteristics of MINOCA patients by dividing the population according to gender. We performed a multivariate logistic regression analysis including all AMI patients to determine independent predictors of MINOCA at admission. We considered the composite endpoint (MACE) of death, re AMI, stroke and heart failure at follow–up (FU, mean of 36 ± 14.8 months). Outcomes were evaluated also using Kaplan–Meier survival curves. Results Among 289 patients affected by MINOCA, 191 were female (66%). Males were more frequently smokers (56.1% vs 33.9 %, p=0.001) while females were older (68.9± 13.1 vs 58.4±14.5 years, p=0.0001), more affected by hypertension (69.3% vs 55.1%, p=0.017) and dyslipidemia (65.6% vs 49%, p=0.005), more frequently on beta–blockers (39% vs 20%, p=0.002) and statins (33% vs 19%, p=0.015) and had a lower degree of coronary stenosis (9.1% vs 15.5%, p=0.019) than males. During follow–up, females had more MACE (33% vs 19.3%, p=0.015), also shown at Kaplan Meier curves (χ2 = 5.997, p=0.014). Finally, multivariate analysis revealed that age is an independent predictor of MINOCA (HR 1.04, CI 1.01–2.07, p=0.006), rather than sex, diabetes, and hypertension. Conclusions In our MINOCA population, females had a higher incidence of MACE than males: this could reflect the different pathogenesis of myocardial damage in our subgroups. Statins and estrogens have a well–known protective role towards the progression of atherosclerosis, but they have less impact on other causes of MINOCA more frequent in females.

Background Although an early invasive strategy (coronary angiography performed Purpose This study tested the hypothesis that, compared to early ( Methods From 2016 to 2020, all consecutive MINOCA patients diagnosed according to the current ESC diagnostic criteria (angiographic conventional cut–off of Results 198 NSTE–MINOCA patients were enrolled, of which 79 underwent coronary angiography Conclusions We demonstrated for the first time that in the MINOCA population the prognosis is not influenced by an early versus deferred coronary angiography, as opposed to AMI patients with obstructive coronary arteries. These results add another piece to the puzzle and pave the way for the initial use of a non–invasive imaging strategy (eg. Coronary–CT), mostly in patients with NSTEMI and high clinical suspicion of non–obstructive coronary arteries.

An 85–year–old woman experienced cardiac arrest while she was at the supermarket. Cardiopulmonary resuscitation was promptly performed with ROSC after DC shock on ventricular fibrillation and immediate hemodynamic and neurological recovery. The first ECG performed by the rescuers did not show acute ischemic changes and the patient was admitted to the Cardiological Intensive Care Unit. Past medical history revealed only a previous episode of acute pulmonary embolism for which she was on oral anticoagulant therapy for a limited period of time. She had not family history of sudden cardiac death or cardiomyopathies. Before admission she was completely asymptomatic and she never complained of angina pectoris, palpitation or dyspnoea. The echocardiogram at admission showed moderate left atrial enlargement and hypokinesia of left ventricle apex and mid–apical lateral wall with global EF of 50%. Pulmonary and aortic CT angiography showed no pathological findings. In order to rule out an ACS, the patient underwent a coronary angiography which documented the absence of critical coronary stenosis. Finally, a cardiac MRI with gadolinium was performed, revealing the presence of two small areas of transmural LGE affecting inferior basal and lateral mid–apical segments with no edema, consistent with ischaemic myocardial scars. In light of this findings and to rule out paradoxical coronary artery embolism we decided to perform a transcranial echocolordoppler that showed the absence of a patent foramen ovale. Furthermore, continuous ECG monitoring during the hospital stay did not document arrhythmic recurrences. In consideration of the high probability of ischemic heart disease, therapy with antiplatelet agent, beta–blocker, ace–inhibitor and statin was introduced and the patient was discharged after ICD implantation. Three months later, during her first follow–up visit, we documented short episodes of atrial fibrillation at ICD interrogation. This was in line with the hypothesis of a ventricular fibrillation and cardiac arrest in the contest of an ischemic heart disease with myocardial scars probably due to undatale coronary artery embolism. Oral anticoagulant therapy was started in addition to previous therapy.

Background Although the majority of patients with NSTEMI share similar risk factors and similar pathophysiology, their outcomes differ considerably. The Fourth Universal Definition of Myocardial Infarction (UDMI) defined acute myocardial infarction (AMI) by an acute myocardial injury together with clinical evidence of acute myocardial ischaemia. However, the prognostic role of each single diagnostic criteria has never been explored. Purpose To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI in NSTEMI patients. Methods We enrolled all consecutive patients with AMI undergoing coronary angiogram at our Centre. We used a combination of criteria, according to the current ESC guidelines, to meet the diagnosis, namely the detection of an increase and/or decrease of high–sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischaemia; ECG changes (new ST–T changes or new LBBB); development of pathological Q waves in the ECG; echocardiographic evidence of new loss of viable myocardium or new regional wall motion abnormality. Patients with STEMI and very high risk NSTEMI were excluded. A composite endpoint of all–cause mortality, re–hospitalization for heart failure, and myocardial reinfarction was collected. The predictive value of diagnostic criteria alone and their association were evaluated using Kaplan–Meier survival curves and subsequent Cox–regression analysis to find independent predictors of adverse events. Results 2791 patients with NSTEMI were evaluate. At admission 196 had clinical criteria alone, 187 had clinic + ECG and 829 had clinic + ECG + echo. The total number of events was 689. The median follow–up was 23.3±14.5 months. We found that patients with clinical criteria alone had a better prognosis at 2 years follow–up (p Conclusions Our data suggest that in NSTEMI the prognosis is considerably better if clinical criteria alone is present at admission. We hypothesize that the absence of electrocardiographic and echocardiographic alterations in NSTEMI could indirectly indicate smaller infarct sizes or other causes of acute myocardial injury.

Reintroducing species into landscapes with persistent threats is a conservation challenge. Although historic threats may not be eliminated, they should be understood in the context of contemporary landscapes. Regenerating landscapes often contain newly emergent habitat, creating opportunities for reintroductions. The Endangered St Croix ground lizard Pholidoscelis polops was extirpated from the main island of St Croix, U.S. Virgin Islands, as a result of habitat conversion to agriculture and predation by the small Indian mongoose Herpestes auropunctatus. The species survived on two small cays and was later translocated to two islands. Since the 1950s, new land-cover types have emerged on St Croix, creating a matrix of suitable habitat throughout the island. Here we examined whether the new habitat is sufficient for a successful reintroduction of the St Croix ground lizard, utilizing three complementary approaches. Firstly, we compared a map from 1750 to the current landscape of St Croix and found statistical similarity of land-cover types. Secondly, we determined habitat suitability based on a binomial mixture population model developed as part of the programme monitoring the largest extant population of the St Croix ground lizard. We estimated the habitat to be sufficient for > 142,000 lizards to inhabit St Croix. Thirdly, we prioritized potential reintroduction sites and planned for reintroductions to take place during 2020–2023. Our case study demonstrates how changing landscapes alter the spatial configuration of threats to species, which can create opportunities for reintroduction. Presuming that areas of degraded habitat may never again be habitable could fail to consider how regenerating landscapes can support species recovery. When contemporary landscapes are taken into account, opportunities for reintroducing threatened species can emerge.

The US Fish and Wildlife Service (USFWS) has initiated a re-envisioned approach for providing decision makers with the best available science and synthesis of that information, called the Species Status Assessment (SSA), for endangered species decision making. The SSA report is a descriptive document that provides decision makers with an assessment of the current and predicted future status of a species. These analyses support all manner of decisions under the US Endangered Species Act, such as listing, reclassification, and recovery planning. Novel scientific analysis and predictive modeling in SSAs could be an important part of rooting conservation decisions in current data and cutting edge analytical and modeling techniques. Here, we describe a novel analysis of available data to assess the current condition of eastern black rail Laterallus jamaicensis jamaicensis across its range in a dynamic occupancy analysis. We used the results of the analysis to develop a site occupancy projection model where the model parameters (initial occupancy, site persistence, colonization) were linked to environmental covariates, such as land management and land cover change (sea-level rise, development, etc.). We used the projection model to predict future status under multiple sea-level rise and habitat management scenarios. Occupancy probability and site colonization were low in all analysis units, and site persistence was also low, suggesting low resiliency and redundancy currently. Extinction probability was high for all analysis units in all simulated scenarios except one with significant effort to preserve existing habitat, suggesting low future resiliency and redundancy. With the results of these data analyses and predictive models, the USFWS concluded that protections of the Endangered Species Act were warranted for this subspecies.

Leptospirosis is a global zoonotic disease caused by pathogenic bacteria of the genus Leptospira. We sought to determine if rodents in U.S. Virgin Islands (USVI) are carriers of Leptospira. In total, 140 rodents were sampled, including 112 Mus musculus and 28 Rattus rattus. A positive carrier status was identified for 64/140 (45.7%); 49 (35.0%) were positive by dark-field microscopy, 60 (42.9%) by culture, 63 (45.0%) by fluorescent antibody testing, and 61 (43.6%) by real-time polymerase chain reaction (rtPCR). Molecular typing indicated that 48 isolates were L. borgpetersenii and 3 were L. kirschneri; the remaining nine comprised mixed species. In the single culture-negative sample that was rtPCR positive, genotyping directly from the kidney identified L. interrogans. Serotyping of L. borgpetersenii isolates identified serogroup Ballum and L. kirschneri isolates as serogroup Icterohaemorrhagiae. These results demonstrate that rodents are significant Leptospira carriers and adds to understanding the ecoepidemiology of leptospirosis in USVI.

During 2019–2020, the Virgin Islands Department of Health investigated potential animal reservoirs of Leptospira spp., the bacteria that cause leptospirosis. In this cross-sectional study, we investigated Leptospira spp. exposure and carriage in the small Indian mongoose (Urva auropunctata, syn: Herpestes auropunctatus), an invasive animal species. This study was conducted across the three main islands of the U.S. Virgin Islands (USVI), which are St. Croix, St. Thomas, and St. John. We used the microscopic agglutination test (MAT), fluorescent antibody test (FAT), real-time polymerase chain reaction (lipl32 rt-PCR), and bacterial culture to evaluate serum and kidney specimens and compared the sensitivity, specificity, positive predictive value, and negative predictive value of these laboratory methods. Mongooses (n = 274) were live-trapped at 31 field sites in ten regions across USVI and humanely euthanized for Leptospira spp. testing. Bacterial isolates were sequenced and evaluated for species and phylogenetic analysis using the ppk gene. Anti-Leptospira spp. antibodies were detected in 34% (87/256) of mongooses. Reactions were observed with the following serogroups: Sejroe, Icterohaemorrhagiae, Pyrogenes, Mini, Cynopteri, Australis, Hebdomadis, Autumnalis, Mankarso, Pomona, and Ballum. Of the kidney specimens examined, 5.8% (16/270) were FAT-positive, 10% (27/274) were culture-positive, and 12.4% (34/274) were positive by rt-PCR. Of the Leptospira spp. isolated from mongooses, 25 were L. borgpetersenii, one was L. interrogans, and one was L. kirschneri. Positive predictive values of FAT and rt-PCR testing for predicting successful isolation of Leptospira by culture were 88% and 65%, respectively. The isolation and identification of Leptospira spp. in mongooses highlights the potential role of mongooses as a wildlife reservoir of leptospirosis; mongooses could be a source of Leptospira spp. infections for other wildlife, domestic animals, and humans., Author summary Leptospirosis is a zoonotic disease caused by bacteria of the genus Leptospira. To better understand local reservoirs and risk factors to humans and animals, during 2019–2020, the Virgin Islands Department of Health (VIDOH) investigated Leptospira spp. in association with the small Indian mongoose (Urva auropunctata, syn: Herpestes auropunctatus) across the three main islands of the United States Virgin Islands (USVI) (St. Croix, St. Thomas, and St. John). Mongoose blood and kidney samples were evaluated by laboratory testing: microscopic agglutination test, fluorescent antibody test (FAT), real-time polymerase chain reaction (lipl32 rt-PCR), and culture. Of 256 mongooses, 34% were exposed to Leptospira spp. To assess active infection in mongooses, kidney samples were examined resulting 5.8% (16/270) FAT-positive, 10% (27/274) culture-positive, and 12.4% (34/274) rt-PCR-positive. Validity was compared between test types showing higher positive predictive value for FAT and rt-PCR testing for predicting successful culture, the reference standard for diagnosis. Through the detection and isolation of Leptospira spp. in mongooses across the USVI, we identified mongooses as potential disease vectors to the local population and added to the limited data for the Caribbean region. Furthermore, a validity assessment of reference testing provides data to potentially inform future leptospirosis diagnostics.

In a letter in this issue of Diabetes Care , Madias suggests that norepinephrine, as mediator of admission hyperglycemia (AH), is an index of increased underlying sympathetic overactivity and/or diabetes comorbidity in patients with takotsubo syndrome (TTS) (1). Indeed, the 28 patients with AH versus the 48 patients without AH had a higher prevalence of diabetes (39.3% vs. 14.6%) (1,2). Notably, AH was a predictor of long-term prognosis in TTS patients (2). Moreover, the patients with AH showed lower left ventricular ejection fraction on admission and discharge and higher B-type natriuretic peptide and inflammatory markers, with the glucose values correlating with serum norepinephrine levels …

Background Cancer is increasingly recognized as strictly related to atrial fibrillation (AF). In patients with AF, the relationship between cancer and cardioembolic or bleeding risk during oral anticoagulant therapy is unknown. Purpose To assess the bleeding and ischaemic burden of a baseline or newly diagnosed cancer in patients treated with direct oral anticoagulants (DOACs) for non-valvular atrial fibrillation (NVAF). Methods All consecutive patients treated with DOACs were enrolled among those with new-onset atrial fibrillation and indication for oral anticoagulant between January 2017 and March 2019. During follow-up, bleeding events, newly diagnosed primitive or metastatic malignancy and major cardiovascular events (MACE) were evaluated. At baseline, CHA2DS2-VASc, HAS-BLED, ATRIA, and ORBIT scores were used to assess the hemorrhagic and ischaemic risk. Major bleedings (MB) were defined according to the ISTH definition. Anemia was defined as haemoglobin levels below 11 g/dL in women and 12 mg/dL in men. Results 1258 patients constituted the study population and followed for a mean time of 21.6±9.5 months. Overall, 66 patients (5.2%) were affected by malignant neoplasia at baseline, whereas 59 (4.7%) were diagnosed with a malignancy during follow-up. Among baseline characteristics, anemia was associated with cancer at enrolment (43.9% vs 22.5%, p Conclusion Bleeding risk assessment is an ongoing challenge in patients with NVAF on DOACs. During follow-up, newly diagnosed primitive or metastatic cancer is a strong predictor of bleeding regardless of baseline haemorrhagic risk assessment. In contrast, such association is not observed with malignancy at baseline. A proper diagnosis and treatment could therefore decrease cancer-related bleeding risk. On the contrary, our study shows that cancer is not an ischaemic risk modifier, either diagnosed at baseline or follow-up. Funding Acknowledgement Type of funding sources: None.

Background The CHA2DS2-VASc score is the most used in predicting thromboembolic risk in patients with atrial fibrillation (AF). However, a higher CHA2DS2-VASc score predicts cardiovascular events even in patients without AF. Up to date, there is limited evidence about the association between CHA2DS2-VASc score and the embolic risk in patient with cardiac tumours (CT). Purpose To evaluate the role of the CHA2DS2-VASc score in predicting embolism and to identify other markers of embolization in patients with CT. Methods We included all patients with a CT who had a complete echocardiographic evaluation and a histologic diagnosis. We excluded patients with cardiac thrombi because of their higher embolic risk. Results Our sample consisted of 221 patients (mean age 60.9±15.6, 7% female). 132 (59.7%) patients had benign CT, usually left-sided (84.8%). In the malignant tumours, 28 (31.5%) were primary and 61 (68.5%) were metastasis. Compared to benign tumours, malignant ones were predominantly right-sided (47.2%) or with pericardial (20.2%) or great-vessels involvement (16.9%). A total of 59 patients (26.6%) experienced an embolic event, of which 33 patients had peripheral embolism, while 28 had pulmonary embolism (PE), 2 patients had both. Patients with embolism were older (p=0.013), had a higher prevalence of diabetes or previous stroke (p=0.019 and p3 had an AUC=0.835 in predicting a peripheral embolic event in the overall population (p Also in patients with right-sided CT, CHA2DS2-VASc score (p=0.017), together with some tumours characteristics (mobility, pericardial effusion and absence of myocardial infiltration (p Embolization did not impact survival when considering the overall population. Otherwise, when focusing on patients with malignant CT, those who had an embolic event had a worse prognosis (p=0.02), as well as those with PE (p=0.037). Conclusions CHA2DS2-VASc and left-side localization are the best markers of embolism. In particular, CHA2DS2-VASc seems to predict embolization in CT, regardless of histology or localization. Many patients with CT and embolism may not be offered surgical treatment given their assumed high-risk profile. By contrast, our analysis showed that survival is not related to the embolic event per se, but by histology. In patients with CT and high CHA2DS2-VASc score, further studies are needed to evaluate the best therapeutic strategy to minimize the embolic risk. Funding Acknowledgement Type of funding sources: None.

Background In patients with atrial fibrillation (AF), baseline kidney function is used to guide oral anticoagulant (OA) selection and dosing, and chronic kidney disease (CKD) is a significant outcome predictor. However, the incidence of worsening renal function (WRF) and its prognostic role during treatment with direct oral anticoagulants (DOACS) has been poorly explored. Purpose To assess the prognostic role of WRF in terms of bleedings and major adverse cardiovascular events (MACEs) in a cohort of patients with newly diagnosed non-valvular AF (NVAF) treated with DOACs. Methods Between January 2017 and March 2019, we enrolled all the patients with newly diagnosed NVAF and OA indication, treated with DOACs. Renal function was assessed using the mean value of the estimated glomerular filtration rates (eGFR) calculated using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. CHA2DS2-VASc and HAS-BLED scores were used at baseline to estimate the ischemic and hemorrhagic risk, respectively. At follow-up, WRF was identified as a decrease in eGFR of at least 20% while bleedings were classified according to the international society of thrombosis and hemostasis (ISTH) criteria. Finally, we defined AF progression as the transition from paroxysmal to persistent or permanent AF or from persistent to permanent AF. Results 1009 patients with newly diagnosed NVAF started on DOAC were enrolled. They were followed-up for 21.6±9.5 months. Overall, WRF was observed in 181 cases (18%). Patients with WRF had higher rates of progression of atrial fibrillation (18.5% vs 11.8%, p=0.02), MACEs (20.4% vs 12.9%, p=0.09) and major bleedings (MB) (9,4% vs 4,7%, p=0.013). WRF did not correlate with all bleedings, stroke, or acute coronary syndrome (ACS). However, those who presented WRF using CKD-EPI formula had higher ACS incidence (6.1% vs 2.5%, p=0.015), and generally better-predicted MACEs. At multivariate analysis adjusted for age, hypertension, baseline HAS-BLED score and WRF, the latter emerged as an independent predictor of MB (OR 1.9 95% C.I, 1,059–3,51). Conclusion In patients with newly diagnosed NVAF treated with DOACs, WRF is associated with atrial fibrillation progression and MACEs, and emerged as an independent predictor of major bleedings. WRF evaluated with CKD-EPI formula better predicted MACEs. Funding Acknowledgement Type of funding sources: None.

Background The term acute myocardial infarction (AMI) reflects cell death of cardiac myocytes caused by ischaemia. The Fourth Universal Definition of Myocardial Infarction (UDMI) defined AMI by a typical rise and fall in the level of biochemical markers of myocardial necrosis together with criteria of myocardial ischaemia. However, the prognostic role of each single diagnostic criteria has never been explored. Purpose To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI. Methods We enrolled all consecutive patients with AMI admitted from 2016 to 2019. We used a combination of criteria, according to the current ESC guidelines, to meet the diagnosis, namely the detection of an increase and/or decrease of high-sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischaemia; ECG changes (new ST-T changes or new LBBB); development of pathological Q waves in the ECG; imaging evidence of new loss of viable myocardium or new regional wall motion abnormality, in our study evaluated by transthoracic echocardiogram. All-cause mortality and a composite endpoint of all-cause mortality, re-hospitalization for heart failure and myocardial re-infarction were collected. The predictive value of diagnostic criteria alone and its association were evaluated using Kaplan-Meier survival curves and subsequent Cox-regression analysis to find independent predictors of adverse events. Results 2386 patients were evaluated. The median follow-up time was 23.3±14.5 months. The total number of events was 703 (29.3%). Kaplan-Meier curves showed that major adverse cardiac events (MACE) were statistically different depending on the diagnostic criteria of AMI at admission. Particularly, clinical criteria alone showed a better predictive value (p Conclusions Our data suggest that the prognosis is considerably better among patients with a diagnosis of AMI if clinical criteria alone are present at admission. We also demonstrated that clinical criteria are a strong prognostic predictor of good outcomes in patients with AMI. We hypothesize that the absence of electrocardiographic and echocardiographic alterations could indirectly indicate a smaller infarct sizes that contribute to patients' outcome. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): None

This experiment compared milk production, milk composition, and physiological responses in lactating dairy cows supplemented with or without a mixture of condensed tannins, encapsulated cinnamaldehyde, curcumin, capsaicin, and piperine. Thirty-six lactating, multiparous, pregnant ¾ Holstein × ¼ Gir cows were maintained in a single drylot pen with ad libitum access to water and a total-mixed ration and were milked twice daily (d –7 to 84). On d 0, cows were ranked by days in milk (86 ± 3 d), milk yield (27.8 ± 1.0 kg), body weight (BW; 584 ± 10 kg), and body condition score (BCS; 3.04 ± 0.06) and assigned to receive (SUPP; n = 18) or not (CON; n = 18) 30 g/cow daily (as-fed basis) of Actifor Pro (Delacon Biotechnik GmbH; Steyregg, Austria). From d 0 to 84, SUPP cows individually received (as-fed basis) 15 g of Actifor Pro mixed with 85 g of finely ground corn through self-locking headgates before each milking of the day. Each CON cow concurrently received 85 g (as-fed basis) of finely ground corn through self-locking headgates. Throughout the experimental period (d –7 to 84), cows from both treatments were administered 500 mg of sometribove zinc at 14-d intervals and were monitored daily for morbidity, including clinical mastitis. Individual milk production was recorded daily, whereas milk samples were collected weekly for analysis of milk composition. Cow BW, BCS, and blood samples were also collected weekly. Cows receiving SUPP gained more BCS (P = 0.05) and had greater (P = 0.04) milk yield during the experiment compared with CON cows (0.22 vs. 0.07 of BCS, SEM = 0.05; 29.5 vs. 27.9 kg/d, SEM = 0.5). Milk composition did not differ (P ≥ 0.15) between SUPP and CON cows; hence, SUPP cows also had greater (P ≤ 0.02) production of fat-corrected and energy-corrected milk. Incidence of clinical mastitis did not differ (P ≥ 0.49) between SUPP and CON cows. No treatment differences were also detected (P ≥ 0.21) for serum concentrations of glucose and serum urea N. Mean serum haptoglobin concentration during the experiment was greater (P = 0.05) in CON vs. SUPP cows. Cows receiving SUPP had less (P ≤ 0.04) serum cortisol concentrations on d 21 and 42, and greater (P ≤ 0.05) serum concentrations of insulin-like growth factor-I on d 7, 35, and 63 compared with CON cows (treatment × day interactions; P ≤ 0.02). Collectively, supplementing phytogenic feed ingredients improved nutritional status and milk production of lactating ¾ Holstein × ¼ Gir cows.

BackgroundThe prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients.MethodsMulticenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140 mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality.ResultsaHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality.ConclusionsaHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy.Trial registrationdata were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

Mongooses, a nonnative species, are a known reservoir of rabies virus in the Caribbean region. A cross-sectional study of mongooses at 41 field sites on the US Virgin Islands of St. Croix, St. John, and St. Thomas captured 312 mongooses (32% capture rate). We determined the absence of rabies virus by antigen testing and rabies virus exposure by antibody testing in mongoose populations on all three islands. USVI is the first Caribbean state to determine freedom-from-rabies for its mongoose populations with a scientifically-led robust cross-sectional study. Ongoing surveillance activities will determine if other domestic and wildlife populations in USVI are rabies-free., Author summary Mongooses in the Caribbean region are known to carry rabies and infect and kill humans with the deadly virus. While many countries in the Caribbean region assume they are rabies-free, there is a lack of scientifically based surveillance. We prospectively designed a statistically valid study to determine that mongoose populations in the US Virgin Islands are rabies-free and pose no risk of transmission to human or animal populations. We are pursuing further surveillance efforts to establish rabies freedom in all wildlife and domestic animal population in the US Virgin Islands.

There is growing evidence of cardiac injury in COVID-19. Our purpose was to assess the prognostic value of serial electrocardiograms in COVID-19 patients.We evaluated 269 consecutive patients admitted to our center with confirmed SARS-CoV-2 infection. ECGs available at admission and after 1 week from hospitalization were assessed. We evaluated the correlation between ECGs findings and major adverse events (MAE) as the composite of intra-hospital all-cause mortality or need for invasive mechanical ventilation. Abnormal ECGs were defined if primary ST-T segment alterations, left ventricular hypertrophy, tachy or bradyarrhythmias and any new AV, bundle blocks or significant morphology alterations (e.g., new Q pathological waves) were present.Abnormal ECG at admission (106/216) and elevated baseline troponin values were more common in patients who developed MAE (p = .04 and p = .02, respectively). Concerning ECGs recorded after 7 days (159), abnormal findings were reported in 53.5% of patients and they were more frequent in those with MAE (p = .001). Among abnormal ECGs, ischemic alterations and left ventricular hypertrophy were significantly associated with a higher MAE rate. The multivariable analysis showed that the presence of abnormal ECG at 7 days of hospitalization was an independent predictor of MAE (HR 3.2; 95% CI 1.2-8.7; p = .02). Furthermore, patients with abnormal ECG at 7 days more often required transfer to the intensive care unit (p = .01) or renal replacement therapy (p = .04).Patients with COVID-19 should receive ECG at admission but also during their hospital stay. Indeed, electrocardiographic alterations during hospitalization are associated with MAE and infection severity.

The genus Sphaerodactylus is a very species-rich assemblage of sphaerodactylid lizards that has undergone a level of speciation in parallel to that of the well-known Anolis lizards. Nevertheless, molecular phylogenetic research on this group consists of a handful of smaller studies of regional focus (e.g., western Puerto Rico, the Lesser Antilles) or large-scale analyses based on relatively limited sequence data. Few medium-scale multi-locus studies exist— for example, studies that encompass an entire radiation on an island group. Building upon previous work done in Puerto Rican Sphaerodactylus, we performed multi-locus sampling of Sphaerodactylus geckos from across the Puerto Rico Bank. We then used these data for phylogeny estimation with near-complete taxon sampling. We focused on sampling the widespread nominal species S. macrolepis and in so doing, we uncovered a highly divergent and morphologically distinct lineage of Sphaerodactylus macrolepis from Puerto Rico, Culebra, and Vieques islands, which we recognize as S. grandisquamis (Stejneger, 1904) on the basis of molecular and morphological characters. S. grandisquamis co-occurs with S. macrolepis only on Culebra Island but is highly genetically differentiated and morphologically distinct. Sphaerodactylus macrolepis is now restricted to the eastern Puerto Rico Bank, from Culebra east through the Virgin Islands and including the topotypic population on St. Croix. We include additional discussion of the evolutionary history and historical biogeography of the Sphaerodactylus of the Puerto Rican Bank in the context of these new discoveries.

OBJECTIVE To investigate admission hyperglycemia effects on the sympathetic system and long-term prognosis in Takotsubo syndrome (TTS). RESEARCH DESIGN AND METHODS In patients with TTS and hyperglycemia (n = 28) versus normoglycemia (n = 48), serum norepinephrine and 123I-labeled metaiodobenzylguanidine (MIBG) cardiac scintigraphy were assessed. Heart failure (HF) occurrence and death events over 2 years were evaluated. RESULTS At hospitalization, those with hyperglycemia versus normoglycemia had higher levels of inflammatory markers and B-type natriuretic peptide and lower left ventricular ejection fraction. Glucose values correlated with norepinephrine levels (R2 = 0.39; P = 0.001). In 30 patients with TTS, 123I-MIBG cardiac scintigraphy showed lower late heart-to-mediastinum ratio values in the acute phase (P < 0.001) and at follow-up (P < 0.001) in those with hyperglycemia. Patients with hyperglycemia had higher rates of HF (P < 0.001) and death events (P < 0.05) after 24 months. In multivariate Cox regression analysis, hyperglycemia (P = 0.008), tumor necrosis factor-α (P = 0.001), and norepinephrine (P = 0.035) were independent predictors of HF events. CONCLUSIONS Patients with TTS and hyperglycemia exhibit sympathetic overactivity with a hyperglycemia-mediated proinflammatory pathway, which could cause worse prognosis during follow-up.

BackgroundThe research of circulating biomarkers in the field of chronic arthritis is still an unmet need, especially for the subgroup of seronegative arthritis [e.g., negative for anti-citrullinated peptides autoantibodies (ACPA) and/or rheumatoid factors (RF)]. In fact, in this clinical subset, there is a lack of soluble molecules which could help for a diagnostic or prognostic purpose, and the differential diagnosis between psoriatic arthritis (PsA) and seronegative rheumatoid arthritis (RA) is still a challenge. C-X-C motif chemokine 13 (CXCL13) is one of the most promising biomarkers recently identified, because of its association with active synovitis (1) and with a poor prognosis in RA (2), although there are still inadequate results to justify its routine use. No data are available of the determination of CXCL13 serum levels in PsA.ObjectivesTo analyze CXCL13 serum levels in a cohort of PsA patients with a history of peripheral involvement in comparison with RA.MethodsCross sectional analysis of consecutive patients with peripheral PsA [n:81; male/female=44/37; median age (25°-75° percentile)=54 (46-62) years; 28-joint Disease Activity Score-C Reactive Protein (CRP-DAS28)=1.9 (1.6-2.5); active psoriasis=43%; DAPSA (Disease Activity in PSoriatic Arthritis) score=8 (3-14)] and RA [n:143; male/female=30/113; age =62 (50-70) years; seropositive=67%; CRP-DAS28=2.1 (1.5-2.8)] was performed. 100 sex and age-matched healthy controls (HC) were enrolled. CXCL13 serum levels were assessed through commercial ELISA test (R&D).ResultsCXCL13 serum levels were higher in all the subgroups of patients [PsA: 50.9 (34.5-80.2) pg/mL, pConclusionThese results confirm the value of CXCL13 as a biomarker in the field of chronic arthritis. Its higher levels in seronegative RA than in PsA suggests its possible value in the differential diagnosis of these two subsets of arthritis.References[1]Bechman et al. BMC Rheumatology 2020;[2]Bugatti et al. Rheumatology 2014.Disclosure of InterestsNone declared

BackgroundInterstitial lung disease (ILD) could be the first and only manifestation of idiopathic inflammatory myopathies (IIMs). Myositis-associated (MAA) or myositis-specific autoantibodies (MSA) are found in 60%-65% of cases [1, 2], but only anti-Jo1 have been included in EULAR 2017 criteria [3].ObjectivesAim of this work is to evaluate the presence of MSA/MAA in patients with ILD on serum analyzed by line blot (LB) immunoassay, the associated clinical diagnoses and the consistency of these diagnoses with antibody specificity.MethodsBetween march 2017 and march 2021, 267 sera were analyzed for MSA/MAA, 84 (31.4%) of which requested after a pneumological evaluation. The search was performed by LB (EUROLINE, Autoimmune Inflammatory Myopathies 16 Ag Profile). Medical records were analyzed for patients with at least one MSA/MAA and diagnosis divided in: connective tissue disease (CTD), interstitial pneumonia with autoimmune features (IPAF) or only pneumological diagnosis.ResultsA positivity for at least one MSA/MAA was found in 37/84 (44%) patients that had the following pneumological diagnosis: 13 non-specific interstitial pneumonia (NSIP, 35.1%), 10 organizing pneumonia (OP, 27%), 10 usual interstitial pneumonia (UIP, 27%), 1 acute interstitial pneumonia (AIP, 2.7%), 1 lymphoid interstitial pneumonia (LIP, 2.7%), 1 iatrogenic ILD for amiodarone (2.7%) and 1 idiopathic pulmonary artery hypertension (IPAH, 2.7%).Distribution of antibodies is reported in Table 1. The most frequent autoantibody was anti-Ro52 (13 sera, 35.2%), while anti-Mi2 was the most frequent MSA (10 sera, 32.4%) followed by anti-Jo1 and anti-SRP with 5 (13.5%) positive sera each. In Figure 1 the heat-map represents the frequency of MSA/MAA and their mutual associations. Multiple autoantibodies were found in 17 (46%) sera. More than one MSA was found in 8 (21.6%) sera of patients with the following diagnosis: 4 only pneumological diseases, 3 ASS and 1 IPAF.Table 1.Distribution of MSA/MAA and associated autoimmune diseasesAutoantibodies distribution N (%)Sera with a single MSA/MAA (N/positive; %)CTD* (N/positive; %)IPAF (N/positive; %)MSAJo-1 = 5 (13.5)2/5 (40)3/5 (60)0PL7 = 4 (10.8)02/4 (50)1/4 (25)PL12 = 6 (16.2)3/6 (50)3/6 (50)0OJ = 3 (8.1)2/3 (66.6)1/3 (33.3)2/3 (66.6)EJ = 1 (2.7)1/1 (100)1/1 (100)0Mi-2 = 10 (32.4)3/10 (30)2/10 (20)0NXP2 = 1 (2.7)001/1 (100)SRP = 5 (13.5)2/5 (40)2/5 (40)0TIF1gamma = 2 (5.4)01/2 (50)0MAARo-52 = 13 (35.2)3/13 (23)9/13 (69.2)1/13 (7.6)PM/Scl = 6 (18.9)4/6 (66.6)01/6 (16.6)For some patients there are multiple positive antibodies.*The following diagnosis were included: antisynthetase syndrome, dermatomyositis, polymyositis and systemic sclerosis.During the diagnostic work-up, at least one MSA/MAA were detected in 13 patients diagnosed with a CTD (35%), 5 with a IPAF (13%), 19 (51%) only a pneumological diagnosis. Of these 19 patients, 11 (57.9%) had a single autoantibody positivity (8 for a MSA, 3 for a MAA) while 8 (42.1%) had multiple positivity (4 with a MSA plus MAA and 4 with multiple MSA positivity).The most frequently diagnosed CTD was ASS with 9 patients (24.3%), followed by 2 polymyositis (5.4%), 1 dermatomyositis (2.7%) and 1 systemic sclerosis (2.7%). Pulmonary involvement in patients with CTD was represented by 9 cases of NSIP (69,3%) and 4 UIP (30,7%).ConclusionDuring the last 4 years about 1/3 of research for MSA/MAA requests to our laboratory had a pneumological indication and MSA/MAA were found in 44% of these patients. In patients with pulmonary involvement and MSA/MAA positivity 35% developed a CTD. Interstitial lung disease could be the first manifestation of a systemic autoimmune disease: research for MSA/MAA and a collaboration between rheumatologist and pneumologist allows a correct diagnostic work-up and therapeutic approach.References[1]Betteridge Z, et al. J Autoimmun 2019;101:48-55[2]Vojinovic T, et al. Clin Rev Allergy Immunol. 2021 Feb;60(1):87-94[3]Lundberg IE, et al. Ann Rheum Dis 2107;76:1955-1964Disclosure of InterestsNone declared

BackgroundIdiopathic Inflammatory Myopathies (IIM) are a group of disorders sharing the common feature of immune-mediated muscle injury. In IIM autoantibodies specific for (MSA) or associated to (MAA) myositis are present in 60-65% of cases (1). Although only anti-Jo-1 (2) are included in the EULAR 2017 criteria, the presence of MSA allows to identify clinical and prognostic phenotypes.ObjectivesAim of the work is to evaluate the positivity rate on sera analyzed by a line blot (LB) immunoassay able to detect MSA or MAA, the associated clinical diagnoses and the consistency with the antibody specificity.Methods267 sera were analyzed using a commercial LB (Autoimmune Inflammatory Myopathies 16 Ag Profile EUROLINE) between March 2017 and March 2021. The diagnosis was identified by analyzing the medical records.ResultsA positivity for at least one MSA/MAA was found in 118/267 sera (44.2%); MAA isolated in 22% of cases and a double/multiple positivity for MSA in 12.7%.The distribution of antibody positivity and the associated clinical diagnoses are shown in Table 1.Table 1.Autoantibody distribution and associated clinical diagnosis; for some patients there are multiple positivityAutoantibody specificityConsistent diagnosisTotal positivity n. (%)Isolated positivity n. (%)Concomitant presence of at least one MAA n. (%)Concomitant presence of MSA +/- MAA n. (%)n. (%)Type of IIMMSAMi-227 (22.9)16 (59.3)2 (7.4)9 (33.3)5 (18.6)2 DM/2 PM/1 ASSTif-1γ12 (10.2)4 (33.3)4 (33.3)4 (33.3)9 (75)5 CAM/4 DMPL-711 (9.4)4 (36.4)3 (27.3)4 (36.4)5 (45.5)ASSNXP-28 (6.8)3 (37.5)1 (12.5)4 (50)3 (37.5)DMSRP8 (6.8)3 (37.5)1 (12.5)4 (50)1 (12.5)PMJo-18 (6.8)2 (25)3 (37.5)3 (37.5)6 (75)ASSPL-127 (5.9)3 (42.9)04 (57.1)4 (57.1)ASSMDA55 (4.2)3 (60)02 (40)4 (80)2 CADM/1 DM/1 ASSOj4 (3.4)3 (75)01 (25)3 (75)ILDSAE3 (2.5)2 (66.7)1 (33.3)02 (66.7)DMEj2 (1.7)1 (50)1 (50)01 (50)ASSMAARo-5233 (28)12 (36.3)2 (6.1)19 (57.6)-PM-Scl19 (16.1)11 (57.9)3 (15.8)5 (26.3)-Ku6 (5.1)3 (50)1 (16.7)2 (33.3)-DM: Dermatoyositis, PM: Polymiositis, ASS: Antisynthetase Syndrome, CAM: Cancer-Associated Myositis, CADM: Clinical Amyopatic Dermatomyositis, ILD: Interstitial Lung DiseaseIn our cohort, the most common antibodies were anti-Ro52kD, positive in 33 sera (28%), while the most frequent MSA were anti-Mi-2, positive in 27 sera (22.9%).MSA most frequently found as an isolated positivity were anti-Oj (75%), while anti-Jo-1 as an isolated positivity were present only in 25% of cases.Considering the 118 sera with at least one MSA/MAA a diagnosis of IIM was made in 52 cases (44%); in 11 cases others systemic autoimmune diseases were identified.The consistency between antibody specificity with the clinical diagnoses was analyzed: for some antibodies, as anti-Jo-1 (80%), anti-MDA5 (75%) and anti-Tif-1gamma (75%), LB results were consistent with clinical diagnoses; while for others, as anti-Mi-2 (18,6%) and anti-SRP (12,5%), the agreement was lower.ConclusionThe use of LB in the diagnostic workout of IIM allowed the detection of MSA previously not found with routine methods. In our court low prevalence of anti-Jo-1 was found. This may be justified by the fact that anti-Jo-1 are included in the assays routinely used to identify anti-ENA antibodies, therefore these sera were not tested with an additional LB.With LB, a higher prevalence of double/multiple MSA positivity was found, compared to the 0.1% described with immunoprecipitation (IP) (3). LB give a semiquantitative result: low, medium or high titer, so the analysis of different titers, according with clinical data or IP, could be helpful in the interpretation of the co-existence of multiple MSA (4).References[1]Betteridge Z, et al. J Autoimmun.2019;101:48-55[2]Lundberg IE, et al. Ann Rheum Dis.2017;76:1955-1964[3]Cavazzana I, et al. J Immunol Methods.2016;433:1-5[4]Cavazzana I, et al. Ann Rheum Dis.2020;79:e152Disclosure of InterestsNone declared

Background: There is growing evidence of cardiac injury in COVID-19. Our purpose was to assess the prognostic value of serial electrocardiograms in COVID-19 patients. Methods: We evaluated 269 consecutive patients admitted to our center with confirmed SARS-CoV-2 infection. ECGs available at admission and after 1week from hospitalization were assessed. We evaluated the correlation between ECGs findings and major adverse events (MAE) as the composite of intra-hospital all-cause mortality or need for invasive mechanical ventilation. Abnormal ECGs were defined if primary ST-T segment alterations, left ventricular hypertrophy, tachy or bradyarrhythmias and any new AV, bundle blocks or significant morphology alterations (e.g., new Q pathological waves) were present. Results: Abnormal ECG at admission (106/216) and elevated baseline troponin values were more common in patients who developed MAE (p=.04 and p=.02, respectively). Concerning ECGs recorded after 7days (159), abnormal findings were reported in 53.5% of patients and they were more frequent in those with MAE (p=.001). Among abnormal ECGs, ischemic alterations and left ventricular hypertrophy were significantly associated with a higher MAE rate. The multivariable analysis showed that the presence of abnormal ECG at 7days of hospitalization was an independent predictor of MAE (HR 3.2; 95% CI 1.2–8.7; p=.02). Furthermore, patients with abnormal ECG at 7days more often required transfer to the intensive care unit (p=.01) or renal replacement therapy (p=.04). Conclusions: Patients with COVID-19 should receive ECG at admission but also during their hospital stay. Indeed, electrocardiographic alterations during hospitalization are associated with MAE and infection severity.

Background Hyperglycemia has been associated with increased inflammatory indexes and larger infarct sizes in patients with obstructive acute myocardial infarction (obs-AMI). In contrast, no studies have explored these correlations in non-obstructive acute myocardial infarction (MINOCA). We investigated the relationship between hyperglycemia, inflammation and infarct size in a cohort of AMI patients that included MINOCA. Methods Patients with AMI undergoing coronary angiography between 2016 and 2020 were enrolled. The following inflammatory markers were evaluated: C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-platelet ratio (NPR). Myocardial infarct size was measured by peak high sensitivity troponin I (Hs-TnI) levels, left-ventricular-end-diastolic-volume (LVEDV) and left ventricular ejection fraction (LVEF). Results The final study population consisted of 2450 patients with obs-AMI and 239 with MINOCA. Hyperglycemia was more prevalent among obs-AMI cases. In all hyperglycemic patients—obs-AMI and MINOCA—NLR, NPR, and LPR were markedly altered. Hyperglycemic obs-AMI subjects exhibited a higher Hs-TnI (p Conclusions Our data confirm the association of hyperglycemic obs-AMI with elevated inflammatory markers and larger infarct sizes. MINOCA patients exhibited modest myocardial damage, regardless of admission glucose levels.

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): S. Orsola Hospital Background Differential diagnosis of cardiac masses represents a challenging issue with important implications for therapeutic management and patient’s prognosis. Cardiac Magnetic Resonance (CMR) is a non-invasive imaging technique used to characterize morphologic and functional features of masses. Integration of these information can lead an accurate diagnosis. Purpose To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. Methods : Ninety-three patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certainty. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion. Tissue characterization resulted from an estimation of contrast enhancement - early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) sequences - and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours. Results The descriptive analysis of the morphologic features showed that diameter > 50mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p < 0.001). As for tissue characteristics, heterogeneous signal intensity - independently from T1 and T2 weighted acquisitions - and EGE were more common in malignant lesions (p Furthermore, using classification and regression tree (CART) analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes was a common characteristic of malignancy and identifies itself malignant tumors. In the absence of invasive features, gadolinium enhancement was evaluated: the lack of contrast uptake was able to exclude a pseudotumor diagnosis and reduced the probability of a primary benign tumor. Conclusions Cardiac magnetic resonance is a very powerful diagnostic tool for differential diagnosis of cardiac masses as it correctly addresses malignancy. Furthermore, an accurate evaluation of the several CMR features, may discriminate primary benign masses and pseudotumours. Abstract Figure. Benign and malignant cardiac masses

Background Cardiac masses (CMs) include benign and malignant formations. So far, clinical presentation and prognosis have been reported only in small series without discriminating between subtypes. We investigated the clinical presentation and long-term prognosis of patients with cardiac masses stratifying our results according to the lesions' nature. Methods We enrolled all consecutive patients admitted to our Institution between 1999 and 2018 with imaging evidence of CMs. Definitive diagnosis was achieved by histologic examination or by radiological evidence of thrombotic resolution after anticoagulant treatment. The study population was classified as benign or malignant and subsequently into 4 subtypes: pseudo-tumours, primary benign tumours, primary malignant tumours and secondary tumours. Cardiovascular and non-cardiovascular mortality was described. Results We identified 172 patients with CMs, 125 benign and 47 malignant. Benign lesions were often incidentally diagnosed in the left heart chambers whereas malignancies were usually detected in the pericardium and right sections, resulting in more advanced symptoms. Over time – median follow-up of 48 months - survival of patients with benign formations was three-fold greater than patients with malignancies (p Conclusions CMs are a heterogeneous entity where advanced symptoms and a pericardial involvement suggest malignant forms, which exhibit a poor outcome. Among patients with benign lesions, pseudo-tumours were associated with reduced survival, supposedly as a consequence of the different underlying conditions. Funding Acknowledgement Type of funding source: None

Background Chronic kidney disease (CKD) is an important outcome predictor in patients with atrial fibrillation (AF). Moreover, renal function at baseline is used to guide oral anticoagulant (OA) selection and dosing at initial treatment. The prognostic role of worsening renal function (WRF) during treatment with direct oral anticoagulants (DOACS) has been poorly explored. Purpose To estimate the prognostic role of WRF in terms of major adverse cardiovascular events (MACEs) in a series of patients with newly diagnosed non-valvular AF (NVAF) treated with DOACs. Methods Among all patients with newly diagnosed NVAF and indication for OA between January 2017 and December 2018, we enrolled those treated with DOACs. Renal function at baseline and during follow-up was assessed with estimated glomerular filtration rates (eGFR). eGFR was calculated as a mean value of Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. The hemorrhagic risk at baseline was estimated with the main available scores (HAS-BLED, ATRIA and ORBIT). WRF was defined as a decrease in eGFR of at least 20%. MACEs were evaluated according to the type of DOAC and the WRF. Major bleedings (MB) were defined according to the ISTH definition. Results The study population was constituted by 249 patients with newly diagnosed NVAF started on DOAC and followed for a median time of 14.1±8.6 months. Overall, WRF was observed in 58 cases (23.3%). Patients with WRF had significative higher rates of death (10.3% versus 3.1%, p=0.025) and MB (13.8% versus 4.7%, p=0.016). The incidence of bleeding events, acute coronary syndromes and stroke was not affected by WRF. Interestingly, CG formula better predicted the incidence of MB as compared to the other formulas (p=0.006). The type of DOAC did not significantly impact the observed renal impairment and had no effect on the occurrence of MACEs in patients showing WRF. The predictors of WRF were found to be age, female sex, low hemoglobin level and left ventricle end telediastolic volume. At multivariate analysis, WRF was identified as an independent predictor of MB (OR 3.1, 95% C.I, 1.12–8.58), regardless of the baseline bleeding risk. Conclusion This is the first prospective study to evaluate the impact of worsening renal function on cardiovascular events in patients with atrial fibrillation treated with DOACs. A significant WRF emerged as an independent predictor of death and MB. The specific DOAC did not affect either the entity of worsening renal function or the incidence of cardiovascular events. Funding Acknowledgement Type of funding source: None

Background Myocardial infarction (MI) is mainly caused by atherosclerotic plaque thrombosis but several registries show that in 1–13% of cases MI occurs in the absence of obstructive coronary artery disease (MINOCA) utilizing the conventional cut-off of Purpose To evaluate the clinical characteristics of patients with MINOCA and the angiographic indices in MINOCA-co versus MINOCA-nco. Methods Among all consecutive patients undergoing coronary angiogram at our Centre for MI based on the 4th Definition of Myocardial Infarction, the ones showing 180 mmHg, DAP >110 mmHg, HR >110 bpm, Hb 40 for the left anterior descending artery, >27 for the right coronary artery and >24 for the left circumflex. Results 453 patients were retrospectively evaluated and 112 (24.7%) met the inclusion criteria. Mean age was 68±13.2 years and 41 (36.6%) were males. MINOCA-co was the more prevalent entity accounting for 73 (65.2%) patients while 39 (34.8%) were MINOCA-nco. The two subgroups presented similar baseline characteristics with regards to gender and classic cardiovascular risk factors including hypertension, hypercholesterolemia, diabetes and smoking habit. Peripheral vasculopathy was more prevalent in MINOCA-nco patients (MINOCA-nco=15.4% vs. MINOCAco= 4.2%; p=0.04). Regarding the angiographic indices, there was no statistically significant difference in TFG between subgroups; conversely, the number of patients with a slow flow phenomenon as defined by CTFC was significantly higher in the MINOCA-nco group (MINOCAnco= 25.7% vs. MINOCA-co=9.8%; p=0.039). Conclusions Our data suggest that among patients with MINOCA clinical characteristics were not useful in differentiating between the two disease entities (MINOCA-nco vs. MINOCA-co). However, MINOCA-nco patients had higher coronary flow impairment as evaluated by CTFC. The pathophysiological reason is still not clear; we hypothesized that, in this clinical setting, an increased heart rate, systemic arterial pressure or low oxygen supply might worsen unbalanced coronary perfusion. Funding Acknowledgement Type of funding source: None

Background In patients with Acute Myocardial Infarction (AMI) the levels of cardiac troponin T and absolute neutrophil count have been shown to correlate with infarct scar size and left ventricular ejection fraction (LVEF) as well as conferring a risk for major cardiovascular adverse events (MACE). In the context of myocardial infarction with non-obstructive coronary arteries (MINOCA) the prognostic role of such indicators has never been explored. Purpose To evaluate the prognostic role of known myocardial infarct size indicators in a MINOCA population compared to patients with obstructive AMI (Ob – AMI). Methods Among 1990 patients admitted to our coronary care unit from 2016 to 2019 with AMI, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. We compared troponin peak levels, absolute neutrophil count at the time of hospital admission and LVEF in MINOCA patients versus Ob–AMI. Furthermore we assessed the prognostic value of these indicators. All-cause mortality and a composite end - point of all-cause mortality and myocardial re-infarction were evaluated. The median follow-up time was 19.6±12.9 months. Results MINOCA patients were more frequently females (64,9% vs 35,1%; p Among our MINOCA patients, 13 (10.6%) all-cause deaths and 3 (4.3%) myocardial re-infarction were observed during follow-up. Multivariable Cox-regression model demonstrated that mean troponin level, absolute neutrophil count and LVEF were not independent predictors of MACE (HR = 1.0, 95% CI: 0.9–1.1, p=0.6; HR = 0.96, 95% CI: 0.9–1.1, p=0.187; HR = 0.9, 95% CI: 0.79–1.02, p=0. 12 respectively). Conclusion MINOCA patients show a similar prognosis compared to the worldwide AMI population. However, in this study the outcome in the MINOCA population was not influenced by commonly used infarct size predictors, in contrast to what is observed in Ob-AMI patients. These results once again emphasize both the complexity of MINOCA patients and the importance of a better understanding of the different underlying pathophysiological mechanisms. Funding Acknowledgement Type of funding source: None

Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinically entity and represents 5% to 10% of all patients with myocardial infarction (MI). Besides type 2 diabetes mellitus (DM), which is a common comorbidity in patients hospitalized for an acute coronary syndrome, high glucose levels (HGL) at admission are frequently observed in this context. The risk of major adverse cardiovascular events following acute coronary syndrome is increased in people with DM and HGL. However, evidence regarding diabetes and high glucose level among MINOCA patients is lacking. Purpose To examine the incidence of major adverse cardiovascular events (MACEs) in diabetic and non-diabetic MINOCA patients as well as according to HGL at presentation. Methods Among 1995 patients with acute MI admitted to our coronary care unit from 2016 to 2018, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. HGL at admission was defined as serum glucose level above 180 mg/dl. All-cause mortality and a composite end-point of all-cause mortality and myocardial re-infarction were compared. The median follow-up time was 19.6±12.9 months. Results Diabetic MINOCA patients were older (mean age 75.5±9.6 vs 66.5±14.7; p=0.002) and with higher prevalence of hypertension (p=0.016). Conversely, there were no significant differences in gender, BMI, dyslipidemia and atrial fibrillation. Similarly, no significant differences were observed regarding clinical and ECG presentation, echocardiographic features and laboratory tests. The rates of death (30.8% vs 8.3%; p=0.013) and MACEs (22.2% vs 6.8%; p=0.025) were significantly higher in MINOCA-DM patients; conversely, no significant differences were observed for re-MI (p=0.58). At multivariate regression model adjusted for age and sex, type 2 DM was not an independent predictor of all cause deaths (p=0.36) and MACE (p=0.24). Patients with admission HGL had similar baseline characteristics, cardiovascular risk factors, clinical presentations, echocardiographic features and troponin values as compared to patients with no-HGL. HGL at admission was associated with higher incidence of all-cause-death (p Conclusion In MINOCA patients, HGL was an independent risk factor for both MACEs and death while type 2 DM was not correlated with these hard endpoints. As a consequence, HGL could have a still unexplored pathophysiological role in MINOCA. Properly powered randomized trials are warranted. Funding Acknowledgement Type of funding source: None

Simple Summary Stress is a common issue faced by ruminants throughout their productive lives, with significant effects on health and performance of the herd. Hence, strategies that alleviate stress-induced responses with a concomitant increase in performance and health are warranted. Administration of the bovine appeasing substance improved performance and reduced the costs related to pharmacological intervention of pre-weaning dairy calves. Therefore, the utilization of the bovine appeasing substance is a feasible alternative to improve health and performance of the dairy cattle herd. Abstract (1) Background: Ruminants often face stressful situations throughout their productive lives. More specifically, pre-weaning dairy calves are exposed to novel environments, feedstuffs, and pathogens that affect their health and performance. Hence, alternatives that reduce stress and promote growth of pre-weaning dairy calves are warranted. Therefore, this study evaluated the effects of biweekly bovine appeasing substance (BAS) administration on performance and disease incidence in dairy Gir × Holstein female calves prior to weaning. (2) Methods: At birth, 140 female Gir × Holstein calves were randomly assigned to receive BAS (SecureCattle; (IRSEA Group, Quartier Salignan, France; n = 70) or placebo (BAS carrier, diethylene glycol monoethyl ether; CON; n = 70) biweekly until weaning (70 days of age). Calves were allocated into individual housing at random, with no physical contact between treatments to avoid cross-contamination. Experimental treatments (5 mL) were applied topically to the nuchal skin area of each calf. Throughout the experimental period, all animals were observed daily for medical conditions (diarrhea, pneumonia, and others), medical/pharmacological interventions were recorded, and the costs related to these procedures were analyzed. Concurrently with treatment application, calves were individually weighed, and data were analyzed using animal as the experimental unit. (3) Results: Treatment × day and treatment × period (14-day interval) interactions were observed for body weight (BW) and average daily gain (ADG; p ≤ 0.05), respectively. Calves receiving BAS had greater BW at weaning (p = 0.02) and tended to have a greater BW on day 56 (p = 0.06). Similarly, ADG was greater for BAS from days 42 to 56 (p = 0.04) and tended to be greater from days 56 to weaning (p = 0.10). No differences were observed on the overall occurrence of diseases (p = 0.92), whereas the most common observed diseases were diarrhea and pneumonia. The incidence and mean age at which animals were detected with these diseases did not differ (p ≥ 0.46). Nonetheless, CON calves detected with disease had a reduced ADG vs. BAS-administered counterparts (p < 0.01). No differences were observed between disease-diagnosed BAS vs. healthy CON, but healthy BAS had a greater ADG vs. healthy CON (p = 0.03). A treatment effect was observed for the cost per head of each pharmacological intervention (p = 0.05). (4) Conclusions: In summary, BAS administration at a 14-day interval improved performance and reduced the costs of pharmacological interventions of pre-weaning Gir × Holstein dairy calves.

Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with relevant long-term major cardiovascular events. Several trials have demonstrated that dual antiplatelet therapy (DAPT), β-blocker, renin-angiotensin-aldosterone system (RAAS) inhibitor and statin therapy improve the prognosis in patients with obstructive myocardial infarction (ob-MI). However, evidence on the best medical therapy for secondary prevention in MINOCA patients is lacking. Purpose To investigate the effects of secondary prevention treatments at discharge on mid-term outcomes in MINOCA. Methods Patients with acute myocardial infarction (MI) undergoing early coronary angiography between 2016 and 2018 were extracted from a clinical database. The diagnosis of MINOCA was made according to 2016 ESC MINOCA Position Paper criteria. Second-level diagnostic work-up including cardiac magnetic resonance was performed to exclude non-ischemic troponin elevation cause. The relationship between treatments and outcomes was evaluated by using Kaplan-Meier survival analysis and Cox regression models. All confirmed MINOCA were followed in our outpatient clinics. The primary end-points were all-cause mortality, re-hospitalization for MI and a composite outcome including all-cause mortality, hospitalization for MI and ischemic stroke (MACE). Results Out of 1,141 AMI who underwent coronary angiography, 134 were initially diagnosed as MINOCA. Patients with MINOCA were less likely to receive secondary prevention treatments than patients with obstructive coronary artery disease (CAD) MI (respectively, 42.1% vs 81.8% for DAPT; 75.5% vs 89.6% for β-blockers; 64.7% vs 80.3% for RAAS inhibitor and 63.9% vs 83% for statins). Based on the diagnostic work-up completed during the first month after discharge, a final sample of 88 patients had confirmed MINOCA. During an average follow-up of 19.35 ± 10.65 months, all-cause mortality occurred in 11 (12.5%) patients, recurrence of MI in 4 (4.5%), and MACE in 15 (17.0%) patients. Patients treated with RAAS inhibitors and statins had a significantly longer survival. On the contrary, no increase in survival was found in patients treated with β-blockers or DAPT. Cox multivariable analysis, including all secondary prevention drugs, showed that only RAAS inhibitors were associated with reduced all cause-mortality and MACE. Conclusion This prospective study suggests that RAAS inhibitor therapy provides mid-term beneficial effects on outcomes in MINOCA patients; in contrast, dual antiplatelet, β-blocker and statin therapy had no effects on mortality and MACE. These results should be considered preliminary and warrant confirmation from larger studies.

Background Several scores have been proposed to assess the stroke risk in patients with non-valvular atrial fibrillation (NVAF). However, type 2 diabetes mellitus (T2DM) is considered a major stroke risk factor regardless of glycemic control. Whether basal blood glucose level modifies the risk of stroke in NVAF is still unclear. Purpose To evaluate the risk of ischemic stroke according to the presence of T2DM and admission blood glucose (ABG) level in patients with new-onset NVAF starting direct oral anticoagulants (DOACs). Methods We analyzed all consecutive patients with NVAF at our outpatient clinic from January to December 2018. The study population was constituted by 1014 patients with new-onset NVAF starting DOACs. Baseline characteristics were evaluated in the overall cohort whereas outcomes were assessed for 915 patients. The median follow-up time was 19.6±12.9 months. Results Overall, 50.3% were male with a mean age of 73.9±12.5 years. Diabetic NVAF patients were more frequently male (p=0.04) with higher prevalence of dyslipidemia (p During a 2 year-follow up period, we collected 27 (3.0%) ischemic stroke. As expected, the rates of stroke were significantly higher in diabetic NVAF (7.6% vs 2.3%, p At multivariate Cox-regression model adjusted for age, sex and presence of T2DM, blood glucose level at admission was the only independent predictor of ischemic stroke at follow up (HR 1.01, 95% CI 1.001–1.02; p=0.03). Finally, another multivariate Cox-regression model, adjusted for the mean CHA2DS2-VASc score, showed that the ABG level still remained a strong independent predictor of ischemic stroke at follow up (HR 1.012, 95% CI 1.003–1.02; p=0.01). Conclusions Diabetic NVAF had a worse baseline profile and higher stroke risk compared to non-diabetic NVAF. Baseline blood glucose level was an independent predictor of stroke regardless of the presence of T2DM or stroke risk profile. These findings underline the role of basal blood glucose level as a potential stroke risk modifier and therefore emphasize the importance of its routine determination to better stratify the stroke risk in NVAF starting DOACs. Funding Acknowledgement Type of funding source: None

Despite the propensity of species introductions to disrupt ecosystems through community disassembly, the use of species translocations is becoming more widely accepted. In this paper, we examine ethical investigations into human migration in an attempt to evaluate how translocation may be justified. Previous attempts to make the analogy between human and species migration have been prone to black and white thinking. We argue that the disagreement between nativist and cosmopolitan approaches to introduced species can be defused by extending the analogy through the migration ethics literature. Additionally, by extending the discussion to the special status of refugees, we are able to develop a theoretical framework for species migrations that acknowledges the risk of species introduction while recognising that special obligations towards endangered species may necessitate the use of translocations.

Modern biology builds upon the historic exploration of the natural world. Recognizing the origin of a species’ name is one path to honor the historic exploration and description of the natural world and the indigenous peoples that lived closely with organisms prior to their description. While digitization of historic papers catalogued in databases such as the Biodiversity Heritage Library (BHL) allows for searching of the first use and origin of names, the rapid pace of taxonomic publishing can occlude a thorough search for etymologies. The etymological origin of the genus name Ameiva is one such case; while unattributed in multiple recent works, it is of Tupí language origin. The first description was in the Historiae Rerum Naturalium Brasiliae by George Marcgrave (1648). Ameiva was the name used by Marcgrave’s Amerindian hosts in 17th century Dutch Brazil, where local people spoke the now extinct language Tupí. The Tupí origin was not lost, however, until as recently as the 2000s. Herein, the pre- and post-Linnaean use of the name Ameiva is traced and when the name is attributed to the Tupí language and to Marcgrave through time it is noted. The opportunity to discover and/or recover etymological origins, especially names from extinct and indigenous languages, provides insight into the early Western sciences. Careful study of etymology by naturalists is consistent with the idea that science is an evolving process with many predecessors to appreciate.

Social behaviors often are context dependent; behaviors at high density may change or disappear at lower population densities. We analyzed spatial dispersion patterns and habitat associations at high and low population densities of male Espadarana (Centrolene) prosoblepon that declined following the invasion of a pathogenic fungus, Batrachochytrium dendrobatidis (Bd). We mapped the spatial location of male frogs on four permanent 200-m stream transects over 4 pre- and 7 postdecline yr. We calculated distances between nearest neighbors and between hot spots—defined as areas of high male density—and compared habitat associations of frogs at high and low densities. Average predecline density across transects was 0.034 ± 0.02 males m−1 (mean ± SE) and dropped to 0.019 ± 0.02 males m−1 postdecline. Nearest neighbor and between cluster distances did not change significantly between pre- and post-decline yrs. Nine of 21 hot spots persisted in the same location across 12 yrs, whereas 8 hot spots disappea...

Translocation to areas free of exotic predators, habitat degradation, or disease may be the most viable restoration option for many endangered species. We report on a successful translocation of the critically endangered St. Croix ground lizard, Ameiva polops, extirpated from St. Croix, U.S. Virgin Islands, Caribbean, by predation from introduced mongooses (Herpestes auropunctatus). We translocated 57 adult A. polops from Green Cay to Buck Island in May 2008. We placed 4 females and 3 males each in eight, 100 m 2 , enclosures on Buck Island for 71 days, then the enclosures were opened. During the enclosure period, 20 individuals were identified and 32 others were seen. The average number sighted per survey was only 5.28 (range = 2–10). One hatchling was sighted in an enclosure, indicating a translocated female successfully nested. Body condition of the translocated individuals increased significantly by the end of the enclosure period. Population monitoring surveys at 61 sites across Buck Island showed that 5 years after the initial translocation in June 2013, the new population had grown to an estimated 1,473 individuals and occupied 58.9% of the island. We attribute eradication of mongoose, life history of the species, large propagule size, condition of habitat, soft-release, use of adults, interagency collaboration, and systematic assessment as primary factors that facilitated this successful translocation. Our findings provide meaningful insights on factors that enhance the potential for successful translocations, and point to new strategies aimed at restoring populations of endangered reptiles in their native ranges.

Author(s): Shiels, Aaron B.; Piaggio, Antoinette J.; Bogardus, Tyler; Lombard, Claudia D.; Angeli, Nicole F.; Hopken, Matthew W. | Abstract: A common challenge for land managers is knowing which vertebrate pest species are present in areas they manage, especially if such areas are remote like isolated habitats, rugged terrain, or infrequently traveled islands. Most invasive predator species, such as feral dogs, cats, mongoose, and commensal rodents pose great threat to human health and key resources such as native species. Animal trapping to determine the presence of a pest species can be expensive and dangerous, requiring permits, experienced personnel, multiple days, and multiple trapping methods. Furthermore, many invasive pest species may go unnoticed because they are nocturnal, secretive, or leave little evidence of their presence. Tracking tunnels, trail cameras, and environmental DNA (eDNA) are non-trapping methods that can be used to rapidly assess if vertebrate pest species are present in a given habitat or ecosystem, including before, during, and after pest suppression techniques are implemented. We share tracking tunnel dimensions and specifications so readers can make their own tracking tunnels for rodent and other small mammal sampling, and we provide some common distributers where tracking tunnels can be purchased. A brief overview of trail camera technology and eDNA forensic uses are described, as well as their applications for vertebrate pest identification, surveillance, and damage management. To demonstrate these methods, we share example case studies from the Caribbean, including first time records of house mouse presence at Sandy Point National Wildlife Refuge in St. Croix (US Virgin Islands) and along a rainforest elevation gradient in the Luquillo National Forest, Puerto Rico. Additionally, we describe case studies of trail camera use on Desecheo Island (Puerto Rico) to determine brodifacoum bait consumption, and eDNA use in Wyoming to determine native bird depredation events. Tracking tunnels and trail cameras are recommended as quick and inexpensive ways to reveal the vertebrate pest species that are present at a site or habitat. These non-trapping, non-invasive techniques can provide quick and efficient methods of surveillance, detection, and monitoring of vertebrate pests, and otherwise may be used as effective tools to aid in wildlife damage management.

The future for the Reptilia will be one of continued discovery of the extant diversity of species in every group and continued challenges for their conservation. Most species will persist, albeit in smaller and increasingly fragmented geographic ranges, and highly vulnerable species will require active conservation measures to ensure their survival. There are more than 10,500 species of reptiles, up from 8,700 less than 10 years ago. Transfer of laboratory techniques, computational resources, and access to literature to herpetologists throughout the world is fueling the increase in systematic studies of reptiles. The bulk of reptiles are the squamates, lizards and snakes, with impressive diversity on most continents. Habitat loss, landscape fragmentation, exploitation, invasive species, environmental contamination, and global warming are persistent challenges to all biodiversity, including reptiles. Endemism, ecological specialization, and restricted ranges generally make species more vulnerable to anthropogenic disturbances. Moreover, the natural history information that is so important for informing conservation aims is lacking for most newly described forms, whether they represent completely novel discoveries or result from taxonomic revisions. The major lineages of reptiles exhibit enormous variation in life history traits, ranging from extremely long-lived species with low fecundity to those with short generation times and high fecundity. Reptiles vary in their degree of ecological specialization, and many live in difficult-to-sample habitats. It is implausible, if not impossible, to gather detailed information on thousands of species of reptiles, many of which are secretive and difficult to study. However, evaluating where species are likely to fit along life history gradients of time to maturity, brood size, and frequency of reproduction reveals much about their abilities to persist in the face of anthropogenic disturbance. Combined with information on geographic distribution and the severity of anthropogenic pressures, consideration of life history strategies reveal important implications for conservation of reptile species. Modern approaches to conservation of reptiles, including conservation translocations, regulation of the international trade in reptiles, management of imperiled species in the context of landscapes, progress in confronting emerging diseases, and resolving human–wildlife conflict in all its forms, are showing much promise for ensuring the persistence of the great diversity of the Reptilia in the Anthropocene.

Orexin (hypocretin) and melanin-concentrating hormone (MCH) neurons are unique to the lateral hypothalamic (LH) region, but project throughout the brain. These cell groups have been implicated in a variety of functions, including reward learning, responses to stimulants, and the modulation of attention, arousal and the sleep/wakefulness cycle. Here, we examined roles for LH in two aspects of attention in associative learning shown previously to depend on intact function in major targets of orexin and MCH neurons. In experiments 1 and 2, unilateral orexin-saporin lesions of LH impaired the acquisition of conditioned orienting responses (ORs) and bilaterally suppressed FOS expression in the amygdala central nucleus (CeA) normally observed in response to food cues that provoke conditioned ORs. Those cues also induced greater FOS expression than control cues in LH orexin neurons, but not in MCH neurons. In experiment 3, unilateral orexin-saporin lesions of LH eliminated the cue associability enhancements normally produced by the surprising omission of an expected event. The magnitude of that impairment was positively correlated with the amount of LH damage and with the loss of orexin neurons in particular, but not with the loss of MCH neurons. We suggest that the effects of the LH orexin-saporin lesions were mediated by their effect on information processing in the CeA, known to be critical to both behavioral phenomena examined here. The results imply close relations between LH motivational amplification functions and attention, and may inform our understanding of disorders in which motivational and attentional impairments co-occur.

Population size is widely used as a unit of ecological analysis, yet to estimate population size requires accounting for observed and latent heterogeneity influencing dispersion of individuals across landscapes. In newly established populations, such as when animals are translocated for conservation, dispersal and availability of resources influence patterns of abundance. We developed a process to estimate population size using N-mixture models and spatial models for newly established and dispersing populations. We used our approach to estimate the population size of critically endangered St. Croix ground lizards (Ameiva polops) five years after translocation of 57 individuals to Buck Island, an offshore island of St. Croix, United States Virgin Islands. Estimates of population size incorporated abiotic variables, dispersal limits, and operative environmental temperature available to the lizards to account for low species detection. Operative environmental temperature and distance from the translocation site were always important in fitting the N-mixture model indicating effects of dispersal and species biology on estimates of population size. We found that the population is increasing its range across the island by 5-10% every six months. We spatially interpolated site-specific abundance from the N-mixture model to the entire island, and we estimated 1,473 (95% CI, 940-1,802) St. Croix ground lizards on Buck Island in 2013 corresponding to survey results. This represents a 26-fold increase since the translocation. We predicted the future dispersal of the lizards to all habitats on Buck Island, with the potential for the population to increase by another five times in the future. Incorporating biologically relevant covariates as explicit parameters in population models can improve predictions of population size and the future spread of species introduced to new localities.