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Objectives This study sought to compare a continuous infusion diuretic strategy versus an intermittent bolus diuretic strategy, with the addition of low-dose dopamine (3 μg/kg/min) in the treatment of hospitalized patients with heart failure with preserved ejection fraction (HFpEF). Background HFpEF patients are susceptible to development of worsening renal function (WRF) when hospitalized with acute heart failure; however, inpatient treatment strategies to achieve safe and effective diuresis in HFpEF patients have not been studied to date. Methods In a prospective, randomized, clinical trial, 90 HFpEF patients hospitalized with acute heart failure were randomized within 24 h of admission to 1 of 4 treatments: 1) intravenous bolus furosemide administered every 12 h; 2) continuous infusion furosemide; 3) intermittent bolus furosemide with low-dose dopamine; and 4) continuous infusion furosemide with low-dose dopamine. The primary endpoint was percent change in creatinine from baseline to 72 h. Linear and logistic regression analyses with tests for interactions between diuretic and dopamine strategies were performed. Results Compared to intermittent bolus strategy, the continuous infusion strategy was associated with higher percent increase in creatinine (continuous infusion: 16.01%; 95% confidence interval [CI]: 8.58% to 23.45% vs. intermittent bolus: 4.62%; 95% CI: −1.15% to 10.39%; p = 0.02). Low-dose dopamine had no significant effect on percent change in creatinine (low-dose dopamine: 12.79%; 95% CI: 5.66% to 19.92%, vs. no-dopamine: 8.03%; 95% CI: 1.44% to 14.62%; p = 0.33). Continuous infusion was also associated with greater risk of WRF than intermittent bolus (odds ratio [OR]: 4.32; 95% CI: 1.26 to 14.74; p = 0.02); no differences in WRF risk were seen with low-dose dopamine. No significant interaction was seen between diuretic strategy and low-dose dopamine (p > 0.10). Conclusions In HFpEF patients hospitalized with acute heart failure, low-dose dopamine had no significant impact on renal function, and a continuous infusion diuretic strategy was associated with renal impairment. (Diuretics and Dopamine in Heart Failure With Preserved Ejection Fraction [ROPA-DOP]; NCT01901809)

Background: The reemergence of Ebola in the Democratic Republic of Congo (DRC) has developed into the largest and most challenging Ebola Virus Disease (EVD) outbreak in the country's history. Violence has hindered response efforts, including the administration of the investigational EVD vaccine, rVSV-ZEBOV. During a crisis of this magnitude, decision-makers often look to predictive models to inform operational strategy. Methods: We used an agent-based model to forecast the additional EVD case burden in North Kivu & Ituri health zones, by the end of July 2019, at different levels of vaccine administration and contact-finding. Our model incorporated countermeasure strategies like social distancing, school closure, hospital isolation, and ring vaccination, while varying rates of contact-finding and vaccine administration to generate case incidence estimates. Findings: Our model estimated that if the response continues as-is, approximately 1,039 additional cases will occur between May 20th and July 31st, for a cumulative total of 2,688 EVD cases by the end of July. If vaccine administration were discontinued, we estimated a 13.4% higher incidence of EVD cases by the end of July. Increased contact-finding and vaccination administration resulted in 10.3% fewer additional EVD cases. Interpretation: Near real-time forecasting can generate potential outbreak trajectories dependent on the magnitude and success of public health response efforts. Although the ongoing vaccination campaign has reduced the overall number of EVD cases that would be expected in the ongoing outbreak, simultaneous delivery of other countermeasures at high rates is necessary to bring the outbreak to a close. While our projections should be interpreted cautiously due to evolving outbreak dynamics, the estimated magnitude can be used to inform public health response planning for the international community. Funding Statement: This study was funded by the Defense Threat Reduction Agency's (DTRA) Technical Reachback contract, (HDTRA1-09-D-0009-0003) and the contract to Virginia Polytechnic Institute and State University (HDTRA1-17-D-0023-0001). Declaration of Interests: All authors declare they have nothing to disclose.

Demonstration of a novel technique to safely exclude long aneurysmal segments that require multiple covered stents in a single segment. In addition, these images and video series demonstrate the usefulness of balloon-assisted GuideLiner tracking to pass bulky equipment to the distal segments of heavily diseased vessels.

Heart failure with preserved ejection fraction (HFpEF) has been described as a disease of elderly subjects with female predominance and hypertension. Our clinical experience suggests patients with HFpEF from an urban population are far more heterogenous, with greater co-morbidities and significant inhospital morbidity. There are limited data on the hospitalization course and outcomes in acute decompensated HFpEF. Hospitalizations for acute heart failure at our institution from July 2011 to June 2012 were identified by International Classification of Diseases, Ninth Revision, codes and physician review for left ventricular ejection fraction ≥50% and were reviewed for patient characteristics and clinical outcomes. Worsening renal function (WRF) was defined as creatinine increase of ≥0.3 mg/dl by 72 hours after admission. Hospital readmission and mortality data were captured from electronic medical records and the Social Security Death Index. Of 434 heart failure admissions, 206 patients (47%) with HFpEF were identified. WRF developed in 40%, the highest reported in HFpEF to date, and was associated with higher blood pressure and lower volume of diuresis. Compared to previous reports, hospitalized patients with HFpEF were younger (mean age 63.2 ± 13.6 years), predominantly black (74%), and had more frequent and severe co-morbidities: hypertension (89%), diabetes (56%), and chronic kidney disease (55%). There were no significant differences in 1- and 12-month outcomes by gender, race, or WRF. In conclusion, we found hospitalized patients with HFpEF from an urban population develop a high rate of WRF are younger than previous cohorts, often black, and have greater co-morbidities than previously described.