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Hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community-acquired pneumonia (CAP) and associated comorbidities are at increased risk of cardiovascular complications. The magnitude of effect of cardiovascular complications and the role of prior comorbidities on clinical outcomes are not well defined.What is the impact of cardiovascular complications on mortality in hospitalized patients with SARS-CoV-2 CAP? What is the impact of co-morbidities and other risk factors on the risk of developing cardiovascular complications and mortality in these patients?This cohort study included 1,645 hospitalized patients with SARS-CoV-2 CAP. Cardiovascular complications were evaluated. The clinical course during hospitalization was described using a multistate model with 4 states: hospitalized with no cardiovascular complications, hospitalized with cardiovascular complications, discharged alive, and dead. Cox proportional hazards regression was used to analyze the impact of prior comorbid conditions on transitions between these states. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.Cardiovascular complications occurred in 18% of patients hospitalized with SARS-CoV-2 CAP. The mortality rate in this group was 45% versus 13% in patients without cardiovascular complications. Males (HR: 1.32, 95% CI: 1.03-1.68), older adults (HR: 1.34, 95% CI: 1.03-1.75), patients with congestive heart failure (HR: 1.59, 95% CI: 1.18-2.15), coronary artery disease (HR: 1.34, 95% CI: 1.00-1.79), atrial fibrillation (HR: 1.43, 95% CI: 1.06-1.95), direct admissions to the ICU (HR: 1.77, 95% CI: 1.36-2.32) and PaO

La industria textil representa una figura decisiva debido a los impactos negativos que generan sus procesos productivos en materia de calidad del agua, aire, suelo y la gestión de sus residuos. En especial, existe gran preocupación sobre el recurso hídrico, por las cantidades y los tipos de químicos que emplea esta industria. Por ello, en este artículo se lleva a cabo una revisión sobre la problemática de las aguas residuales provenientes de la industria textil y los avances tecnológicos para el tratamiento de estas. Como resultado se encuentra que, as pequeñas y medianas empresas corresponden al sector de las empresas más vulnerables en términos de su capacidad para enfrentar la creciente presión social, regulatoria y de fiscalización en materia ambiental, con necesidades de bienes y servicios ambientales que se encrudecen a raíz de la informalidad de muchas empresas, a las que, por ende, no se les realiza ningún tipo de control por parte de las autoridades ambientales. Así mismo, se identificaron diferentes metodologías de tratamiento de aguas residuales textiles, que incluyen técnicas combinadas, como la electrocoagulación y electro-oxidación, procesos avanzados de oxidación (PAO), Fenton (H2O/Fe2+) o foto-Fenton (UV/H2O2/Fe2+), entre otros, que garantizan altos rendimientos en la eliminación, por ejemplo, de parámetros como la demanda química de oxígeno (DQO), la demanda bioquímica de oxígeno (DBO), y el color. Adicional a ello, se resalta el uso de nanomateriales de titania como buenos adsorbentes de metales como plomo (Pb), cadmio (Cd), cobre (Cu), zinc (Zn), y níquel (Ni) y, como alternativa de bajo costo para las pequeñas empresas, materiales de desecho y minerales como buenos adsorbentes de colorantes, que se pueden reutilizar con altas eficiencias en varios ciclos.

The spectrum of disease severity and the insidiousness of clinical presentation make it difficult to recognize patients with coronavirus disease 2019 (COVID-19) at higher risk of worse outcomes or death when they are seen in the early phases of the disease. There are now well-established risk factors for worse outcomes in patients with COVID-19. These should be factored in when assessing the prognosis of these patients. However, a more precise prognostic assessment in an individual patient may warrant the use of predictive tools. In this manuscript, we conduct a literature review on the severity of illness scores and biomarkers for the prognosis of patients with COVID-19. Several COVID-19-specific scores have been developed since the onset of the pandemic. Some of them are promising and can be integrated into the assessment of these patients. We also found that the well-known pneumonia severity index (PSI) and CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) are good predictors of mortality in hospitalized patients with COVID-19. While neither the PSI nor the CURB-65 should be used for the triage of outpatient versus inpatient treatment, they can be integrated by a clinician into the assessment of disease severity and can be used in epidemiological studies to determine the severity of illness in patient populations. Biomarkers also provide valuable prognostic information and, importantly, may depict the main physiological derangements in severe disease. We, however, do not advocate the isolated use of severity of illness scores or biomarkers for decision-making in an individual patient. Instead, we suggest the use of these tools on a case-by-case basis with the goal of enhancing clinician judgment.

Background: IVPac is widely used to treat patients with breast cancer. oPac+E is oral paclitaxel in combination with Encequidar, an oral, minimally absorbed, specific p-glycoprotein inhibitor that enables the absorption of oral paclitaxel. Results of the phase III trial, KX-ORAX-001, were presented at SABCS, 2019, Abstract # GS6-01. At the time of the database lock for the final analysis of the primary endpoint of confirmed tumor response rate, analyses of PFS and OS were performed. The confirmed tumor response rate was significantly higher in the oPac+E group vs IVPac (35.8% vs 23.4%, p=0.011 ITT, population). The median overall survival, as of Sept 2020 presented at SABCS 2020, Abstract# PD1-08 was 22.7 months vs 16.5 months, respectively favoring oPac. Analysis of safety data demonstrated that patients with elevated liver tests (at screening or baseline), were at increased risk of serious and early complications of neutropenia including sepsis, septic shock, febrile neutropenia which could be fatal. A post hoc, subgroup analysis of survival for patients with elevated liver tests was conducted. Methods: Study KX-ORAX-001 was a phase III, randomized, international study in women with mBC for whom treatment with IVPac was recommended. Eligible patients were randomized 2:1 to receive oPac+E or IVPac. Patients received treatment until discontinuation due to progressive disease or toxicity. oPac 205 mg/m2 was given once daily for 3 days weekly. E 12.9 mg was given 1 hour before each dose of oPac. IVPac 175 mg/m2 was infused over 3 hours every 3 weeks. The primary endpoint was efficacy, defined as tumor response confirmed by BICR at two consecutive evaluations. Key secondary endpoints included PFS, OS. Safety was monitored throughout the study. Results: A total of 402 mBC patients were randomized (oPac+E 265: IVPac 137) and represent the ITT population of which 399 subjects were dosed. 122 patients (oPac+E 74, IVPac 48) had elevated AST, or bilirubin (NCI ODWG mild category) at screening or predose/baseline. The subjects were generally balanced between treatment groups for mean age (55 vs 57 years), extent of tumor metastases, and tumor markers ER/PR+ HER2- (62% vs 63%), ER/PR- HER2- (11% vs 15%). For subjects receiving OPac+E, the median survival was 18.9 months vs 10.1 months for subjects receiving IVPac; with a hazard ratio of 0.593 (95.5% CI 0.382 - 0.921) favoring OPac+E.Greater than 65% of subjects had a survival event at the time of this analysis. Conclusion: Although patients with mBC and mild hepatic dysfunction at baseline are at increased risk of early serious neutropenic and infectious/septic complications after treatment with oPAC+E, this risk is counterbalanced by an increase in overall survival. (NCT 02594371) Citation Format: Gerardo Umanzor, Hope S Rugo, Francisco J Barrios, R H Vasallo, Marco A Chivalan, S Bejarano, Julio Roberto Ramirez, Luis Fein, R D Kowalyszyn, D L Cutler, D Kramer, H Wang, R MF Kwan. Oraxol + Encequidar (OPac+E) vs IV paclitaxel (IVPac) in the treatment of patients with metastatic breast cancer (mBC) (Study KX-ORAX-001): Subgroup survival analysis of patients with hepatic dysfunction [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-16-05.

Axonal sprouting of dentate gyrus (DG) afferents after entorhinal cortex (EC) lesion is a model preparation to assess lesion-induced functional reorganization in a denervated target structure. Following a unilateral EC lesion, the surviving contralateral entorhinal projection, termed the crossed temporodentate pathway (CTD), and the heterotypic septal input to the DG, the septodentate pathway (SD), undergo extensive axonal sprouting. We explored whether EC lesion alters the capacity of the SD pathway to influence CTD-evoked granule cell excitability in the DG. We recorded field excitatory postsynaptic potentials (fEPSPs) after CTD stimulation alone and paired SD-CTD stimulation. Male rats were given unilateral EC lesions or sham operations; evoked fEPSPs in the DG were recorded at 4-, 15-, and 90-days post-entorhinal lesion to assess functional reorganization of the CTD and SD pathways. We found significantly increased fEPSP amplitudes in cases with unilateral lesions compared to sham-operates at 15- and 90-days post lesion. Within each time point, paired SD-CTD stimulation resulted in significantly depressed fEPSP amplitudes compared to amplitudes evoked after CTD stimulation alone and this effect was solely seen in cases with EC lesion. In cases where granule cell discharge was observed, SD stimulation increased discharge amplitude elicited by the CTD stimulation at 90-days postlesion. These findings demonstrate that synaptic remodeling following unilateral cortical lesion results in a synergistic interaction between two established hippocampal afferents that is not seen in uninjured models. This work may be important for models of neurodegenerative disease and neural injury that target these structures and associated hippocampal circuitry.

Background Community-acquired pneumonia (CAP) is an important complication in immunocompromised adults (ICAs). In hospitalized patients, the burden of CAP in ICAs is not well defined. The primary objective of this study was to define incidence, epidemiology, and outcomes of ICAs hospitalized with CAP in the city of Louisville. The secondary objective of this study was to estimate the burden of CAP in ICAs in the US. Methods This was a prospective population-based cohort study of consecutive hospitalized adult Louisville residents with CAP at all adult hospitals in Louisville from 1 June 2014 to 31 May 2016. An ICA was defined as a patient with any of the following medical conditions or treatments: (1) primary immunodeficiency disease; (2) advanced-stage cancer (stage III or IV cancer or hematologic cancer); (3) advanced HIV infection (CD4 T-lymphocyte count < 200 cells/mL or < 14%); (4) solid organ transplantation; (5) hematopoietic stem cell transplantation; (6) receiving cancer chemotherapy; (7) receiving biological immune modulators; (8) receiving corticosteroid therapy with a dose ≥ 20 mg prednisone or equivalent daily for at least 14 days prior to hospitalization; or (9) receiving disease-modifying antirheumatic drugs (DMARDs). The annual population-based CAP incidence among ICAs was calculated. Mortality was evaluated during hospitalization and at 30 days, 6 months, and 1 year after hospitalization. Results A total of 7449 unique patients were included, with 854 (11%) ICAs identified. Figure 1 depicts the immunocompromising conditions. Per 100,000 adults in Louisville, each year 75 ICAs are hospitalized with CAP (95% CI: 68-78), corresponding to an estimated 190,106 ICAs hospitalized with CAP in the US. Mortality during hospitalization was 8% in ICAs vs 6% in non-ICAs; at 30 days 23% in ICAs vs 11% in non-ICAs, at 6 months 42% in ICAs vs 20% in non-ICAs, and at 1 year 52% in ICAs vs 27% in non-ICAs. Figure 1:Frequency of Immunocompromising Conditions and TreatmentsImmunocompromising conditions and treatments among 7449 patients hospitalized for community-acquired pneumonia sorted by frequency. Abbreviations: DMARDs: Disease-modifying antirheumatic drugs; HIV: Human immunodeficiency virus. Conclusion This study indicates that nearly one out of nine hospitalized CAP patients are immunocompromised, and 190,000 ICAs may be hospitalized due to CAP each year in the US. We found a twofold increase in mortality at every time point after discharge for ICAs compared to non-ICAs hospitalized due to CAP. Further strategies to prevent CAP and improve outcomes in ICAs hospitalized with CAP are necessary. Disclosures Forest W. Arnold, DO, MSc, Gilead Sciences, Inc.: Grant/Research Support.

Background In hospitalized patients, nasopharyngeal (NP) swabs are the most common samples obtained for Respiratory Syncytial Virus (RSV) PCR testing. However, adding sputum is known to increase diagnostic yield, and saliva has been successfully used for viral respiratory infection diagnosis. We sought to compare RSV prevalence detected by PCR testing of NP swab alone versus NP swab plus saliva and sputum in adult patients hospitalized with acute respiratory illness (ARI). Methods This ongoing, prospective cohort study enrolled patients aged ≥40 years hospitalized for ARI in 4 hospitals in Louisville, Kentucky (Season 1: 27 Dec 21 – 1 Apr 22). NP swab, saliva, and sputum samples were obtained at enrollment or scavenged from standard-of-care specimens (all collected ≤3 days of admission), and PCR tested with Luminex ARIES FluA/B/RSV platform. We produced Venn diagrams of RSV positive samples by sample type for all patients and restricted to those with all 3 sample types. RSV prevalence for NP swab alone was calculated as number of patients with RSV-positive NP swabs divided by total number of patients tested. RSV prevalence by NP swab plus saliva and sputum was calculated as number of patients with RSV-positive NP swab, saliva, or sputum samples divided by total number of patients tested. Results We enrolled 653 patients and collected NP swabs (100% of patients), saliva (96%), and sputum (43% overall and 93% of the 303 sputum-producing patients). Among all patients, 28 patients tested RSV positive (Figure 1A), and when restricted to those with all 3 samples (Figure 1B), 14 tested positive. The overall cohort’s RSV prevalence by NP swab alone was 1.8% (12/653) and by NP swab plus saliva and/or sputum was 4.3% (28/653): 2.33 times higher with addition of saliva and sputum samples. Among patients with all 3 specimen types, the RSV prevalence increase was the same, and none were positive by NP swab only. Figure 1.Venn diagrams of positive RSV PCR tests (Left) A. Positive RSV PCR tests for 653 patients in overall cohort (Right) B. Positive RSV PCR tests for 275 patients with all 3 samples obtained. Conclusion RSV was most commonly detected in saliva samples. Current standard-of-care utilizing NP swab for RSV PCR testing appears to underestimate true RSV prevalence in hospitalized adult patients with ARI by more than 2-fold. Disclosures Alan Junkins, PhD, D(ABMM), Biomerieux: Advisor/Consultant Paul S. Schulz, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria Robin Hubler, MS, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds|Pfizer, Inc: Stocks/Bonds Paula Peyrani, MD, Pfizer, Inc: Employee|Pfizer, Inc: Employee|Pfizer, Inc: Stocks/Bonds|Pfizer, Inc: Stocks/Bonds Qing Liu, M.S., Pfizer Inc.: I am a full time employee of Pfizer and hold Pfizer stocks Bradford J. Gessner, M.D., M.P.H., Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds.

Background Public health surveillance indicates that there is a high population-based incidence of laboratory-confirmed hospitalized CDI cases in the United States. Although reported CDI cases are identified via standard-of-care (SOC) specimen collection and CDI testing practices, the impact of SOC misdiagnosis on the reported CDI incidence is uncertain. Methods Active surveillance from Oct 14, 2019, to Apr 11, 2020, identified inpatients aged ≥50 years with diarrhea (≥3 stools with Bristol score ≥5 in 24 hours) at all wards at 8 of the 9 adult hospitals in Louisville, Kentucky (population >50 years = 276 456). Study stool specimens from inpatients with diarrhea were screened by rapid GDH/toxin membrane enzyme immunoassay and the positive samples tested by PCR and cell cytotoxicity neutralization assay (CCNA). A study CDI case was a patient with PCR positive/CCNA positive stool or PCR positive stool with pseudomembranous colitis (PMC). Incidence (non-recurrent CDI cases/100 000 persons aged >50 years per year [PY]) was adjusted for the hospitalization share of participating hospitals and, in a sensitivity analysis, for patients with diarrhea without a CDI test result. SOC stool specimen CDI testing occurred independent of the study. Results Among 1541 inpatients with diarrhea, study testing identified 109 non-recurrent CDI cases; 18 (16.5%) had PMC, 36 (33.0%) were admitted to intensive care, and 21 (19.3%) died during the 90-day follow-up. Study hospitalized CDI incidence was 154/100 000 PY (202/100 000 PY in the sensitivity analysis). SOC hospitalized CDI incidence was 121/100 000 PY. Of the 109 study CDI cases, 44 (40%) were not SOC-diagnosed (SOC under-diagnosis). Of the 75 SOC CDI cases that also had study testing, 12 (16%) were not study CDI cases (SOC over-diagnosis). SOC-undiagnosed and SOC-diagnosed CDI cases had similar demographics, medical histories, and clinical outcomes. Study testing identified 24% more CDI cases than SOC testing. Conclusion There was a high incidence of hospitalized CDI in persons aged >50 years (154-202/100,000 PY). Of the hospitalized CDI cases, one-third were admitted to ICU and one-fifth died. Public health surveillance estimates of the incidence of laboratory-confirmed hospitalized CDI cases, which are based on SOC testing, may be under-estimated by 24%. Disclosures Frederick Angulo, DVM PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Joann M. Zamparo, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds Elisa Gonzalez, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds Pingping Zhang, MS, Pfizer: Employee|Pfizer: Stocks/Bonds Michael W. Pride, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Sharon Gray, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds Catia Matos Ferreira, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Forest W. Arnold, DO, MSc, Gilead Sciences, Inc.: Grant/Research Support Raul E. Isturiz, MD, Pfizer: Employee|Pfizer: Stocks/Bonds Nadia Minarovic, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Jennifer Moisi, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds Luis Jodar, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds.

Metabolic syndrome (MS) is a combination of risk factors related to the development of mainly type 2 diabetes mellitus, cardiovascular disease (CVD) and nonalcoholic fatty liver disease (NAFLD). Its prevalence has increased worldwide, and healthcare systems will face major challenges in addressing this problem. The aim of this work was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on insulin resistance (IR) and obesity associated with MS in Wistar rats. The experimental design consisted of three groups of sucrose-induced MS rats: the MS group that consumed sucrose (MS-Suc; n=5), the MS group that ingested sucrose and HBOT (MS-Suc-HBOT; n=5), the MS group that did not consume sucrose and that received HBOT (MS-HBOT; n=5) and the control group. The rats received HBOT for 20 d at 2.4 atmospheres absolute (ATA) for 60 min. Subsequently, the rats were euthanized, and body fat weight, serum biochemical parameters and microscopic analysis of adipose tissue were determined. Rats with hyperoxia had decreased body weight, adipose tissue hypertrophy, and abdominal and epididymal fat. Likewise, markers of insulin resistance (glucose, insulin and HOMA-IR), biochemical parameters of dyslipidemia (cholesterol and triglycerides) and nonalcoholic fatty liver (AST and ALT) decreased; in contrast, compared to the control group, HBOT increased the 1/HOMA-IR, HOMA-βCell and McAuley indexes, which were related to the improvement in insulin sensitivity (p

In this work an Elman Recurrent Neural Network (a type of Simple Recurrent Neural Network) is used for predicting the concentration of airborne pollutants O3, PM2.5 and PM10, which have a non-linear behavior, using data from Red Auto´ma´tica de Monitoreo Atmosfe´rico (RAMA), which is spreaded in the Zona Metropolitana del Valle de Me´xico (ZMVM). The study of PM10 and PM2.5 is important because, due to their tiny size, they can penetrate sensitive regions of respiratory system, among other important effects on human health, furthermore, it has been demonstrated that these have an important environmental impact. The study of ozone is important due its high toxicity. This pollutant has been responsible of several environmental contingences in Mexico City. An empirical method for imputing missing data using a series of linear regressions is proposed. A grid searching is used to find the best combination of some hyperparameters so that the variation of root-mean-square error between validation data and predicted data is minimized. A total of 144 experiments is developed measuring the validation root-mean-square error for each one, as well as root- mean-square error variation, in order to find the optimal combination. Two criteria are taken into account to evaluate the performance of network: root-mean-square error variation as mentioned before and evolution of metric values. This network showed a very good performance for ozone, with a maximum accuracy of 95.6 %, moderately good for PM2.5 with 46.4 and 28.6 % for PM10.

As the seismic hazard has been updated for the central U.S., state Departments of Transportation (DOTs) find an increasing need to assess the seismic vulnerability of their bridge network. Traditional methods to perform seismic assessment require developing dynamic models for each bridge. However, this approach requires specialized engineering knowledge and information from structural drawings, and is time-consuming. To streamline this important task, a simplified dynamic modeling procedure is described that leverages readily available information from DOTs’ asset management databases. With a minimal amount of additional data items, the asset management database can be used to identify vulnerable bridges rapidly and with sufficient accuracy for the prioritization of retrofit decisions. A detailed analysis of a 100-bridge sample set identified typical vulnerabilities and established corresponding capacity thresholds. The rapid seismic vulnerability assessment methodology is implemented as an Excel macro-enabled tool for bridge owners and asset managers to rapidly assess the vulnerability of each individual bridge based on current information in the database, and then classify the vulnerability of each individual bridge as low, medium, or high. Current DOT databases used for asset management in regions of low-to-moderate seismicity do require some data items be added for a robust assessment. These data items are identified here and leveraged to demonstrate the method. The rapid assessment methodology presented can be implemented to effectively identify the most vulnerable bridges in a bridge network, thus facilitating a rapid state bridge inventory network assessment to prioritize and inform actions such as maintenance and rehabilitation.

The development of a revolutionary design for transmission lines was recently introduced by shifting phase configurations and sub-conductors into “unconventional” arrangements that were geometrically optimized to maximize natural power. The objective of this paper is to study the electromagnetic transients that result from the simultaneous and sequential line energization and re-energization of the previously developed unconventional high surge impedance loading (HSIL) lines. Statistical switching overvoltage (SSOV) studies are performed using a frequency domain method based on the inverse numerical Laplace transform. Compared to a conventional line, all unconventional HSIL line designs studied in this paper lead to very similar surges for long line lengths (400 km) and similar values for short line lengths (100 km), indicating additional advantages of these lines. The use of a frequency domain method for SSOV studies offers enhanced accuracy, simulation flexibility, and substantially lower computational burden compared with traditional time-domain methods.

BACKGROUND: Although targeted biological treatments have transformed the outlook for patients with rheumatoid arthritis, 40% of patients show poor clinical response, which is mechanistically still unexplained. Because more than 50% of patients with rheumatoid arthritis have low or absent CD20 B cells-the target for rituximab-in the main disease tissue (joint synovium), we hypothesised that, in these patients, the IL-6 receptor inhibitor tocilizumab would be more effective. The aim of this trial was to compare the effect of tocilizumab with rituximab in patients with rheumatoid arthritis who had an inadequate response to anti-tumour necrosis factor (TNF) stratified for synovial B-cell status. METHODS: This study was a 48-week, biopsy-driven, multicentre, open-label, phase 4 randomised controlled trial (rituximab vs tocilizumab in anti-TNF inadequate responder patients with rheumatoid arthritis; R4RA) done in 19 centres across five European countries (the UK, Belgium, Italy, Portugal, and Spain). Patients aged 18 years or older who fulfilled the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria for rheumatoid arthritis and were eligible for treatment with rituximab therapy according to UK National Institute for Health and Care Excellence guidelines were eligible for inclusion in the trial. To inform balanced stratification, following a baseline synovial biopsy, patients were classified histologically as B-cell poor or rich. Patients were then randomly assigned (1:1) centrally in block sizes of six and four to receive two 1000 mg rituximab infusions at an interval of 2 weeks (rituximab group) or 8 mg/kg tocilizumab infusions at 4-week intervals (tocilizumab group). To enhance the accuracy of the stratification of B-cell poor and B-cell rich patients, baseline synovial biopsies from all participants were subjected to RNA sequencing and reclassified by B-cell molecular signature. The study was powered to test the superiority of tocilizumab over rituximab in the B-cell poor population at 16 weeks. The primary endpoint was defined as a 50% improvement in Clinical Disease Activity Index (CDAI50%) from baseline. The trial is registered on the ISRCTN database, ISRCTN97443826, and EudraCT, 2012-002535-28. FINDINGS: Between Feb 28, 2013, and Jan 17, 2019, 164 patients were classified histologically and were randomly assigned to the rituximab group (83 [51%]) or the tocilizumab group (81 [49%]). In patients histologically classified as B-cell poor, there was no statistically significant difference in CDAI50% between the rituximab group (17 [45%] of 38 patients) and the tocilizumab group (23 [56%] of 41 patients; difference 11% [95% CI -11 to 33], p=0·31). However, in the synovial biopsies classified as B-cell poor with RNA sequencing the tocilizumab group had a significantly higher response rate compared with the rituximab group for CDAI50% (rituximab group 12 [36%] of 33 patients vs tocilizumab group 20 [63%] of 32 patients; difference 26% [2 to 50], p=0·035). Occurrence of adverse events (rituximab group 76 [70%] of 108 patients vs tocilizumab group 94 [80%] of 117 patients; difference 10% [-1 to 21) and serious adverse events (rituximab group 8 [7%] of 108 vs tocilizumab group 12 [10%] of 117; difference 3% [-5 to 10]) were not significantly different between treatment groups. INTERPRETATION: The results suggest that RNA sequencing-based stratification of rheumatoid arthritis synovial tissue showed stronger associations with clinical responses compared with histopathological classification. Additionally, for patients with low or absent B-cell lineage expression signature in synovial tissue tocilizumab is more effective than rituximab. Replication of the results and validation of the RNA sequencing-based classification in independent cohorts is required before making treatment recommendations for clinical practice. FUNDING: Efficacy and Mechanism Evaluation programme from the UK National Institute for Health Research. ispartof: LANCET vol:397 issue:10271 pages:305-317 ispartof: location:England status: published

Background: The potential association of the ABO blood group with the risk of COVID-19 and its severity has attracted a lot of interest since the start of the pandemic. While a number of studies have reported an increased risk associated with blood type A and a reduced risk with type O, other studies have did not found a significant effect. This study aimed to define the prevalence of different ABO blood groups in hospitalized COVID-19 patients in the Louisville, KY area and to investigate whether an association exists between the blood group and disease severity. Methods: This was a retrospective observational study of 380 patients with SARS-CoV-2 infection hospitalized to eight of the adult hospitals in the city of Louisville. Patients were divided into four different groups according to their ABO blood type. Demographic characteristics and clinical variables, including laboratory data as well as clinical outcomes were compared. Results: Type O was the most common blood group among the hospitalized patients (51%) followed by type A (31%), B (14%) and AB (4%). The observed blood group distribution among the patients was not significantly different from the distribution expected when compared to a population of similar racial/ethnic composition. No significant associations were found between the blood group and comorbidities, inflammatory biomarkers as well as with recorded outcomes, including the mortality rate and the length of the hospital stay. Conclusions: The data from hospitalized patients in Louisville is is not consistent with the ABO blood group having a significant effect as a risk or severity factor for COVID-19, but it is representative in COVID-19 or its severity of its prevalence among different racial/ethnic populations.

espanolEn este articulo se presenta el diseno, simulacion e implementacion de un cargador de baterias con baja distorsion armonica en corriente, a pequena escala. Se propone un diseno compuesto por dos convertidores boost en cascada, el primero funcionando como PFC y el segundo como un regulador de la corriente que se inyecta a las baterias. Adicionalmente, se presenta el procedimiento necesario para el diseno de los controladores de cada etapa. En la primera etapa se usa un control en modo corriente promedio y en la segunda etapa se usan dos controles que permiten emplear el metodo de carga de baterias, corriente constante - tension constante. Los controladores usados en ambas etapas son de tipo PI y junto con el circuito de potencia fueron simulados en los software PSIM® y MATLAB® y validados experimentalmente, obteniendo factores de potencia cercanos a 0,98 y distorsion armonica en corriente por debajo del 10%, cumpliendo asi con los requerimientos de la norma IEC 61000-3-2. Finalmente, se presentan las conclusiones. EnglishThis paper presents the design, simulation and implementation of a small scale battery charger with low harmonic distortion in current. It was proposed a design composed of two boost converters in cascade, the first operating as PFC and second as a regulator of the injected current to the batteries. Additionally, it was presented the procedure for the controllers design of each stage. In the first stage was used a control in average current mode and in the second stage were used two controls that enable you to employ the method of constant current - constant voltage in order to charge the batteries. In both stages were used the PI controllers and with the power electronic circuit were simulated in the PSIM® and MATLAB® software and validated experimentally In this tests, power factors close to 0.98 and harmonic distortion in current below 10% were obtained, complying with the requirements of the IEC 61000-3-2 standard. Finally, the conclusions are presented.