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The aim of this study was to describe and compare clinical characteristics and outcomes in critically ill septic patients with and without COVID-19. From February 2020 to March 2021, patients from surgical and medical ICUs at the University Hospital Dresden were screened for sepsis. Patient characteristics and outcomes were assessed descriptively. Patient survival was analyzed using the Kaplan-Meier estimator. Associations between in-hospital mortality and risk factors were modeled using robust Poisson regression, which facilitates derivation of adjusted relative risks. In 177 ICU patients treated for sepsis, COVID-19 was diagnosed and compared to 191 septic ICU patients without COVID-19. Age and sex did not differ significantly between sepsis patients with and without COVID-19, but SOFA score at ICU admission was significantly higher in septic COVID-19 patients. In-hospital mortality was significantly higher in COVID-19 patients with 59% compared to 29% in Non-COVID patients. Statistical analysis resulted in an adjusted relative risk for in-hospital mortality of 1.74 (95%-CI=1.35–2–24) in the presence of COVID-19 compared to other septic patients. Age, procalcitonin maximum value over 2 ng/ml, need for renal replacement therapy, need for invasive ventilation and septic shock were identified as additional risk factors for in-hospital mortality. COVID-19 was identified as independent risk factor for higher in-hospital mortality in sepsis patients. The need for invasive ventilation and renal replacement therapy as well as the presence of septic shock and higher PCT should be considered to identify high-risk patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Objective The study objective was to study the electrophysiologic mechanism of atrial fibrillation using a noninvasive, beat-by-beat, 3-dimensional mapping technique in patients with persistent and long-standing persistent atrial fibrillation undergoing concomitant surgical ablation. Methods In this pilot trial, 10 patients (6 male; mean age, 70 ± 10 years) with persistent atrial fibrillation were mapped preoperatively with a noninvasive surface system (ECVUE, CardioInsight, Medtronic Inc, Minneapolis, Minn). Eight patients were candidates for mitral valve surgery, 1 patient was a candidate for aortic valve and ascending aortic replacement, and 1 patient was a candidate for coronary bypass surgery. In 5 patients, tricuspid valve repair was also performed. The Cox-Maze III/IV was performed using combined cryoablation and bipolar radiofrequency, and the left appendage was removed in all cases. The median preprocedural duration of atrial fibrillation was 30 months, and the diameter of the left atrium was 63 mm. Atrial regions were divided according to the Bordeaux classification. Results Preoperative mapping was successful in all patients with clear identification of the potential mechanism of atrial fibrillation. Biatrial pathology was recognized in all subjects. Rotor and macro re-entry activity were present in all patients, whereas focal activity was demonstrated in only 6 patients. Rotor activity in the right atrium was documented in all patients. Conclusions This is the first report on the preoperative use of the ECUVE in surgical candidates for concomitant surgical procedures. The fact that a biatrial mechanism for atrial fibrillation was detected in all patients emphasizes the importance of a Cox-Maze III/IV procedure to treat patients with valvular heart disease and nonparoxysmal atrial fibrillation. Preoperative mapping has the potential to significantly improve our understanding of the pathophysiology in atrial fibrillation and better guide the surgical ablation procedure of choice in a single patient. Graphical abstract [ABSTRACT FROM AUTHOR]

Abstract: Nutrient enrichment is a threat to botanical diversity in Europe, and its assessment is part of biodiversity monitoring schemes. In Switzerland, this is done by calculating the average nutrient (N) indicator value of the vegetation based on a country-wide systematic vegetation survey. However, it is questionable whether N values indicate eutrophication and resulting species loss equally well across an entire country, which includes wide topographic gradients and distinct biogeographic regions. Here we analyze vascular plant species lists from 415 grassland plots (10m2) between 365 and 2770m a.s.l. throughout Switzerland to investigate how the relationship between N value and species richness differs with altitude and among regions. The N value strongly decreased with altitude (piecewise regression: r 2 =0.77), particularly between 800 and 2000m a.s.l., where this decrease was related to a decreasing proportion of fertilized grasslands. In the alpine belt, lower N values were associated with a greater frequency of acidic soils and a restricted species pool. Vascular plant species richness was maximal at intermediate altitude (piecewise regression: r 2 =0.33) and intermediate N value (polynomial regression: r 2 =0.46). When analyzed separately by altitudinal belt, the relationship between species richness and N value was negative in the lowlands and montane belt but unimodal in the subalpine belt. In the alpine belt, soil pH (R indicator values) explained most of the variation in species richness. Two indices of between-plot diversity (floristic dissimilarity and the contribution of individual plots to total species richness) were negatively related to N values from the lowlands to the subalpine belt but not in the alpine belt. All relationships differed little among the biogeographic regions of Switzerland, but they might be modified by changes in management and by the expansion of common lowland species into mountain grasslands. [Copyright &y& Elsevier]

Abstract: One standardised way to determine the performance of thermal solar systems is based on component testing and system simulation. The approach is to test the solar collector, the store, the controller and other selected components separately and to carry out system simulations using the determined parameters. Due to increasingly complex control strategies, particularly implemented within so-called multi-function controllers for solar combisystems, the available test method for controllers – for the time being defined in ENV 12977-2, Annex B – has to be extended. In order to substitute temperature sensors by variable resistors and to document the response of a tested controller, a computer based test facility featuring an input/output-emulator between the controller and a PC has been developed. The emulator generates varying resistance values as input signals for the controller and records the status of the different outputs as its response. Both, manual adjustment and programmed temperature profiles provided by the PC are possible. All transmitted inputs as well as the response of the controller are stored in a data file. Experience gained from testing controllers used in thermal solar systems for combined hot water preparation and space heating, commonly called combisystems shows that alleged advanced control algorithms or fancy features do not inevitably result in an improvement of system performance or increased reliability. The extended test method and the set-up of the test facility described in this paper enable detailed investigations of nearly all kinds of controllers. Particularly with respect to multi-function controller testing, the introduced test method will be one basis for the upcoming standard prCEN/TS 12977-5, replacing ENV 12977-2, Annex B. [Copyright &y& Elsevier]

Ultrasound-guided intermediate cervical plexus blockade with perivascular infiltration of the carotid artery bifurcation perivacular block (PVB) is a reliable technique for regional anesthesia in carotid endarterectomy (CEA). We investigated the effect of the carotid bifurcation level (CBL) on PVB efficacy and safety in patients undergoing CEA. This prospective observational cohort study included 447 consecutive CEA patients who received PVB over a 6-y period. Vascular and neurologic puncture-related complications were recorded. The CBL was localized at the low level (C4 and C5 vertebra, low-level [LL] group) in 381 (85.2%) patients and at the high level (C2 and C3 vertebra, high-level [HL] group) in 66 (14.8%) patients. Local anesthetic supplementation by surgeons was necessary in 64 (14.3%) patients in the LL group and 38 (59.4%) patients in the HL group (p < 0.001) and was associated with a higher rate of central neurologic complications in the HL group (p = 0.031). Therefore, the efficacy of the PVB may be influenced by the CBL. [ABSTRACT FROM AUTHOR]

There is still a strong need for additional diversity and new chemical scaffolds to allow for the exploration of improved tissue selectivity and finding better selective estrogen receptor modulators (SERMs). Using a de novo design technology a diphenylnaphthyl propylene scaffold, exemplified by (E)-9b, with ER antagonist activity has been generated. It was prepared by alkylating 1-[4-methoxyphenyl)-2-(4-(2-chloroethoxy)phenyl]-1-propanone under metal halogen exchange conditions with 1-iodo-6-methoxy-naphthalene. Following dehydration and cleavage of the methoxy groups, (E)-9b was formed by displacement of the chloro group with pyrrolidine. (E)-9b binding to ER generated calculated Ki values of 3.7 nM for hERα and 72 nM for hERβ. The antagonism of (E)-9b was demonstrated in cell transfection assays using the ERE from the vitA2 promotor and the natural ER-responsive pS2 promotor. With increasing concentrations of (E)-9b, the E2-dependent response was efficiently inhibited demonstrating that (E)-9b could function as an anti-estrogen in these assays. Interestingly, ERα activity was inhibited even below basal levels suggesting that ligand-independent activity of ERα was also inhibited. Computational docking studies suggest that the placement of the hydroxyl group on the naphthalene group may not be optimal and we are currently exploring additional analogues. [Copyright &y& Elsevier]