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Background Secondary pulmonary infections (SPI) have not been well described in COVID-19 patients. Our study aims to examine the incidence and risk factors of SPI in hospitalized COVID-19 patients with pneumonia. Methods This was a retrospective, single-center study of adult COVID-19 patients with radiographic evidence of pneumonia admitted to a regional tertiary care hospital. SPI was defined as microorganisms identified on the respiratory tract with or without concurrent positive blood culture results for the same microorganism obtained at least 48 hours after admission. Results Thirteen out of 244 (5%) had developed SPI during hospitalization. The median of the nadir lymphocyte count during hospitalization was significantly lower in patients with SPI as compared to those without SPI [0.4 K/uL (IQR 0.3-0.5) versus 0.6 K/uL (IQR 0.3-0.9)]. Patients with lower nadir lymphocyte had an increased risk of developing SPI with odds ratio (OR) of 1.21 (95% CI: 1.00 to 1.47, p=0.04) per 0.1 K/uL decrement in nadir lymphocyte. The baseline median inflammatory markers of CRP [166.4 mg/L vs. 100.0 mg/L, p=0.01] and D-dimer (18.5 mg/L vs. 1.4 mg/L, p

Background Cardiac surgery–associated acute kidney injury (CS-AKI) is common in infants and is associated with negative outcomes. Nadir indexed oxygen delivery (DO2i) during cardiopulmonary bypass (CPB) is associated with the occurrence of postoperative CS-AKI, with critical thresholds for DO2i reported to be 262 to 300 mL/min/m2 in adults. However, given that infants have a higher metabolic rate and oxygen demand, the critical DO2i in infants is not comparable with existing adult standards. This study aimed to explore the critical DO2i threshold during pediatric CPB. Methods Between March 2019 and April 2020, 106 consecutive infants undergoing cardiac surgery with CPB were admitted to this prospective observational cohort study. The DO2i levels of each patient were monitored during CPB. Pre- and intraoperative factors were tested for independent association with CS-AKI. The postoperative outcomes of patients with or without CS-AKI were compared. Results In our patient population (n = 83), we identified 25 patients (38.5%) with postoperative CS-AKI. Multivariate analysis revealed 2 independent risk factors for onset of CS-AKI: CPB duration and nadir DO2i. The lowest suitable DO2i during CPB in the present population was 353 mL/min/m2 (sensitivity, 65.6%; specificity, 74.5%). CS-AKI during pediatric CPB remained significantly associated with an increased morbidity, related mainly to a postoperative low cardiac output syndrome, but not to mortality. Conclusions The lowest suitable DO2i during CPB in the infant population undergoing cardiac surgery was 353 mL/min/m2. Below this threshold, there was a high probability of inducing CS-AKI.

Posterior urethral valve (PUV) is a leading cause of chronic kidney failure in children. Studies have shown that a creatinine nadir above historical cutoff values of 0.8 or 1.0 mg/dL correlates with worse kidney outcomes. The ability to use nadir creatinine more discriminately as a test of kidney outcomes is otherwise limited. We performed a retrospective review of 102 infants treated with primary valve ablation prior to 1 year of age. Patient factors including creatinine at presentation (Cr-P), nadir within 6 weeks after ablation (Cr-6 W), and nadir within 1 year after ablation (Cr-1Y) were assessed as predictors of final chronic kidney disease (CKD) severity. An optimal threshold for four CKD levels was defined in incremental fashion using binary outcome with receiver operating characteristic (ROC). Multivariable logistic regression models compared Cr-P, Cr-6 W, and Cr-1Y while adjusting for patient factors. Boys were ablated at mean age of 36.3 days and followed for 6.6 years (± 3.7). When compared to other demographics, only creatinine remained independently predictive of CKD outcomes on multivariable analysis. ROC analysis demonstrated excellent diagnostic accuracy for Cr-6 W and Cr-1Y (p

Background Outcomes after definitive chemoradiation for squamous cell carcinoma are generally favorable. However, biomarkers to further yield prognostic information are desired. Treatment-related lymphopenia as well as an elevated baseline neutrophil-lymphocyte ratio have been associated with worse survival in several cancer types. We evaluated absolute lymphocyte count and neutrophil-lymphocyte ratio at baseline and at treatment-related nadir in patients with anal cancer for associations with oncologic endpoints. Methods We conducted a retrospective analysis of 428 consecutive patients with non-metastatic anal cancer treated with definitive, intensity-modulated radiation therapy-based chemoradiation. We analyzed absolute neutrophil and lymphocyte counts at several timepoints: pretreatment, weekly during treatment, and in the six weeks following treatment completion. Neutrophil-lymphocyte ratio was calculated at baseline and treatment-related nadir. We estimated oncologic endpoints using life tables and compared them using the log-rank test. We conducted univariate and multivariable time-to-event analyses using Cox proportional hazards. Results Median absolute lymphocyte count at baseline and nadir were 1.80 [interquartile range (IQR), 1.45-2.32] k/µL and 0.26 (IQR, 0.18-0.36) k/µL, respectively, and 31% developed treatment-related grade 4 lymphopenia. Median neutrophil-lymphocyte ratio at baseline and nadir were 2.34 (IQR, 1.68-3.30) and 8.80 (IQR, 5.86-12.68), respectively. Estimates of overall survival, local failure-free survival, distant metastasis-free survival (DMFS), and freedom from colostomy at 5 years were 87%, 86%, 82%, and 88%, respectively. Baseline and nadir absolute lymphocyte count were not associated with selected outcomes on univariate analysis. On multivariable analysis, factors independently associated with death included T3-T4 disease, HIV-positive status, treatment break, and baseline neutrophil-lymphocyte ratio >3. Baseline neutrophil-lymphocyte ratio showed a trend toward association with distant progression or death (P=0.07). The 5-year overall survival estimates for patients with baseline neutrophil-lymphocyte ratios ≤3 and >3 were 92.3% and 80.6%, respectively. Conclusions Lymphopenia during and after chemoradiation for anal cancer is common but does not appear to be associated with worse survival, recurrence, or metastases. However, elevated baseline neutrophil-lymphocyte ratio was independently associated with overall survival, local recurrence-free survival, and DMFS. Further studies are needed to determine the clinical utility of baseline neutrophil-lymphocyte ratio to guide treatment and follow-up.

Despite advances in medicine, some children will always die; a decline in pediatric intensive care unit (PICU) mortality to zero will never be achieved. The mortality decline is correspondingly asymptotic, yet we remain preoccupied with mortality outcomes. Are we at the nadir, and are we, thus, as good as we can get? And what should we focus to benchmark our units, if not mortality? In the face of changing case-mix and rising complexity, dramatic reductions in PICU mortality have been observed globally. At the same time, survivors have increasing disability, and deaths are often characterized by intensive life-sustaining therapies preceded by prolonged admissions, emphasizing the need to consider alternate outcome measures to evaluate our successes and failures. What are the costs and implications of reaching this nadir in mortality outcomes? We highlight the failings of our fixation with survival and an imperative to consider alternative outcomes in our PICUs, including the costs for both patients that survive and die, their families, healthcare providers, and society including perspectives in low resource settings. We describe the implications for benchmarking, research, and training the next generation of providers. Conlusion: Although survival remains a highly relevant metric, as PICUs continue to strive for clinical excellence, pushing boundaries in research and innovation, with endeavors in safety, quality, and high-reliability systems, we must prioritize outcomes beyond mortality, evaluate “costs” beyond economics, and find novel ways to improve the care we provide to all of our pediatric patients and their families.

When Columbus arrived in the New World, he found large numbers of people whom he named Indians. As Europeans occupied the Americas, Indians declined in both power and numbers. Some scholars have argued that the first European contacts with Indian peoples occurred too late to measure the full extent of the original population. To create a reliable estimate of the North American population in 1492, scholars will either have to find new evidence or develop better methods of handling existing evidence. To calculate the 1492 population for a specific area, they determine its nadir population and multiply by the general depopulation ratio. When population can be calculated for one area, while a similar area nearby provides scant data, some scholars have argued that the latter area must have had a population similar to the former. The bottom-up school dominated the North American population topic from about 1910 to 1955.

Purpose In patients with advanced non-small cell lung cancer (NSCLC) and oncogenic driver mutations treated with effective targeted therapy, a characteristic pattern of tumor volume dynamics with an initial regression, nadir, and subsequent regrowth is observed on serial computed tomography (CT) scans. We developed and validated a linear model to predict the tumor volume nadir in EGFR-mutant advanced NSCLC patients treated with EGFR tyrosine kinase inhibitors (TKI). Materials and methods Patients with EGFR-mutant advanced NSCLC treated with EGFR-TKI as their first EGFR-directed therapy were studied for CT tumor volume kinetics during therapy, using a previously validated CT tumor measurement technique. A linear regression model was built to predict tumor volume nadir in a training cohort of 34 patients, and then was validated in an independent cohort of 84 patients. Results The linear model for tumor nadir prediction was obtained in the training cohort of 34 patients, which utilizes the baseline tumor volume before initiating therapy (V0) to predict the volume decrease (mm3) when the nadir volume (Vp) was reached: V0-Vp=0.717×V0-1347 (P=2×10-16; R2=0.916). The model was tested in the validation cohort, resulting in the R2 value of 0.953, indicating that the prediction model generalizes well to another cohort of EGFR-mutant patients treated with EGFR-TKI. Clinical variables were not significant predictors of tumor volume nadir. Conclusion The linear model was built to predict the tumor volume nadir in EGFR-mutant advanced NSCLC patients treated with EGFR-TKIs, which provide an important metrics in treatment monitoring and therapeutic decisions at nadir such as additional local abrasive therapy.

The article considers the little-studied pages of the development of light music in Kazan on the example of the cooperation of graphic artist Nadir Almeev with “Prometheus” Student Design Bureau under the guidance of physicist Bulat Galeev. The artist Nadir Almeev is a master of graphics, professionally proficient in various etching techniques: etching, aquatint, reserve, dry needle. In 1977-1990, he regularly studied at the Senezh Studio-the Central Educational and Experimental Studio of the Union of Artists of the USSR under Evgeniy Sidorkin and Sergey Zarovniy. The artist’s creative search was reflected in such series as “Icarus” (1969),” Memory of running “(1977),” Bullfight “(1980),” Per aspera” (1996),”Spleen” (1995) and others, combining the unrestrained imagination with strict organization. No matter what topics Nadir Almeev touches on, no matter what technique he works in, he surprisingly constructs an entire Universe at once from individual strokes and inconspicuous details. Since 1966 Nadir Almeev collaborated with the Tatar Book Publishing house, with the newspaper “YashLeninchy”, since 1975 with the Kazan newsreel studio: he participated in the creation of the films “Jalil, the Wanderer of Struggle” (1976), “Cosmic Sonata” (1982), illustrated books and booklets. He is member of the Union of Artists of the USSR since 1985. A bright, but little-studied stage of the artist’s work was the film “Small Triptych” (1975). The film appeared to be an attempt to combine several types of art together, while expressing deep, philosophical thoughts. So, the activity of the members of “Prometheus” Student Design Bureau was to create a new, independent art of light music, where sound, light and image will be equal components of a single design, a reflection of the real “polyphony” of the surrounding reality. This article for the first time reveals the features of the creative method and the innovative role of the artist Nadir Almeev in the development of the Kazan school of light-music on the example of the first in the Soviet Union rolling light-music film to the music of Grigoriy Sviridov “Small Triptych”. The original sketches created by the artist for the film in the author’s technique using hydrotype pigments on wet paper are analyzed. A series of abstract sketches, devoid of any illustrative content, are arranged according to the musical development of the work. The purpose of this article is to reveal the role and significance of Nadir Almeev in the activities of “Prometheus” Student Design Bureau. Key words: synthesis of arts, synthesis, light-music, graphics, hydrotype printing, Grigoriy Sviridov, Bulat Galeev, Nadir Almeev.

Background Effective dose to immune cell (EDIC), an estimated radiation dose to the circulating lymphocytes, is of significance for overall survival (OS) in non-small cell lung cancer. This study aimed to validate the EDIC’s OS effect on limited-stage small cell lung cancer (LS-SCLC). Method and materials This study included LS-SCLC patients received definitive chemo-radiation in one single center from 2012 to 2017. All patients had multiple complete-blood-count tests including lymphocyte count at pre-, during- and end- radiotherapy. EDIC, computed according to doses of the lung, heart, and the total body, was assessed for its correlation with lymphocyte nadir, OS and progression free survival (PFS). Results Of 503 eligible patients, the mean EDIC was 7.34 Gy. The mean lymphocyte nadir was 0.48 × 109 cells/L, significantly lower than 1.65 × 109 cells/L at pre-radiotherapy (p Conclusions This study demonstrated that EDIC is an independent predictor for lymphocyte nadir, PFS and OS. EDIC may serve as a predictor for lymphocyte nadir and a surrogate marker for OS in LS-SCLC. More attention should be paid to EDIC to decease the lymphocyte toxicity and improve survival.

Background Patients undergoing cardiac operation are susceptible to anemia. Low hemoglobin concentration is a risk factor for composite adverse events and death after cardiac operation. Here we investigated the association of postoperative nadir hemoglobin with adverse outcomes in patients undergoing on-pump cardiac operation. Methods Adult patients in 2 medical centers were retrospectively analyzed. The primary outcome was postoperative composite adverse events. The secondary outcome was all-cause death in the hospital. Results Of the 8206 patients analyzed, 1628 (19.8%) experienced composite adverse events after operation and 109 (1.3%) died. Patients receiving on-pump cardiac operation with nadir hemoglobin of 9.0 to 9.9 g/L showed a low incidence of composite adverse events (175 of 1423 [12.3%]) and death (5 of 1423 [0.4%]). Compared with nadir hemoglobin at 9.0 to 9.9 g/dL, the relative risk (RR) of composite adverse events increased stepwise as nadir hemoglobin fell below 9.0 g/dL: adjusted RR was 1.44 (95% confidence interval [CI], 1.14-1.83) for 8.5 to 8.9 g/dL, 1.56 (95% CI, 1.23-1.99) for 8.0 to 8.4 g/dL, 1.66 (95% CI, 1.31-2.11) for 7.5 to 7.9 g/dL, 2.22 (95% CI, 1.75-2.83) for 7.0 to 7.4 g/dL, and 4.00 (95% CI, 3.18-5.04) for less than 7 .0 g/dL. Furthermore, the risk of death was significantly higher when nadir hemoglobin was below 7.0 g/dL than when it was 9.0 to 9.9 g/dL (RR, 5.36; 95% CI, 2.20-16.12). Conclusions Compared with the risks when nadir hemoglobin is 9.0 to 9.9 g/dL, the risk of composite adverse events increases when postoperative nadir hemoglobin is below 9.0 g/dL, whereas risk of death increases when nadir hemoglobin is below 7.0 g/dL.

Currently we are at the peak of the second wave of pandemic. Availability of beds & oxygen is at nadir. The patients coming to us for surgery are the ones where surgery cannot wait. Mainly the load is obstetric. As a matter of COVID pandemic policy we are using regional anaesthesia unless contraindicated or the surgery demands general anaesthesia. The aim is to avoid/reduce aerosolization which is part & parcel of GA, despite the efforts to minimise it. The policy is to protect the anaesthesiologists, surgeons, OT staff & other patients as well. The present manuscript is to review the role of regional anaesthesia & its safe performance.

The authors thank the two anonymous referees and the editor Melody Sandells for their useful comments, which greatly improved the manuscript. Work on software QGIS and the HDF-EOS to GeoTIFF Conversion Tool (HEG) is acknowledged. Special thanks go to Jaume Fons-Esteve at the Department of Geography, Universitat Autònoma de Barcelona., The continued loss of sea ice in the Northern Hemisphere due to global warming poses a threat to biota and human activities, evidencing the necessity of efficient sea ice monitoring tools. Aiming at the creation of an improved sea ice extent indicator covering the European regional seas, the new IceMap500 algorithm has been developed to classify sea ice and water at a resolution of 500m at nadir. IceMap500 features a classification strategy built upon previous MODIS sea ice extent algorithms and a new method to reclassify areas affected by resolution-breaking features inherited from the MODIS cloud mask. This approach results in an enlargement of mapped area, a reduction of potential error sources and a better delineation of the sea ice edge, while still systematically achieving accuracies above 90 %, as obtained by manual validation. Swath maps have been aggregated at a monthly scale to obtain sea ice extent with a method that is sensitive to spatio-temporal variations in the sea ice cover and that can be used as an additional error filter. The resulting dataset, covering the months of maximum and minimum sea ice extent (i.e. March and September) over 2 decades (from 2000 to 2019), demonstrates the algorithm's applicability as a monitoring tool and as an indicator, illustrating the sea ice decline at a regional scale. The European sea regions located in the Arctic, NE Atlantic and Barents seas display clear negative trends in both March (-27.98 +/- 6.01 x 10(3) km(2) yr(-1)) and September (-16.47 +/- 5.66 x 10(3) km(2) yr(-1)). Such trends indicate that the sea ice cover is shrinking at a rate of similar to 9% and similar to 13% per decade, respectively, even though the sea ice extent loss is comparatively similar to 70% greater in March.

Depressive symptoms are more prevalent in persons with HIV (PWH) than HIV‐uninfected individuals. In HIV‐uninfected individuals, depression has been associated with atrophy in the hippocampus and other brain regions. In the present study, we investigated the impact of depression on brain structure in PWH. One hundred PWH participated in a cross‐sectional study (56.6 ± 6.4 yrs, range 41–70 yrs, 24 females, 63 African Americans). The Beck's Depression Inventory‐II (BDI‐II) was used to assess depressive symptoms. Structural MRI images were collected. Both the voxel‐based morphometry (VBM) technique and a region of interest (ROI) based approach were used to examine the relationship between hippocampal gray matter volume (GMv) and depressive symptoms. The impact of HIV CD4 nadir and antidepressants was also investigated. Both VBM and ROI approaches revealed that higher BDI‐II scores (implicating more severe depressive symptoms) were associated with loss of hippocampal GMv, especially in the right hippocampus and the right entorhinal cortex. Low CD4 nadir predicted additional hippocampal volume loss independent of depressive symptoms. Taking antidepressants did not have a detectable effect on hippocampal volume. In summary, having more depressive symptoms is associated with smaller hippocampal volume in PWH, and a history of severe immunosuppression (i.e., low CD4 nadir) correlates with additional hippocampal volume reduction. However, the impact of depression on hippocampal volume may be independent of HIV‐disease severity such as low CD4 nadir., In people with HIV infection, having more depressive symptoms is associated with smaller hippocampal volume. A history of severe immunosuppression (i.e., low CD4 nadir) correlates with additional hippocampal volume reduction. However, the impact of depression on hippocampal volume may be independent of HIV‐disease severity such as low CD4 nadir.

OBJECTIVE To demonstrate the predictive effect of PSA derivatives and time markers that is prostate-specific antigen (PSA) doubling time (PSADT) and PSA velocity (PSAV) on survival in men with hormone-refractory prostate cancer (HRPCa). STUDY DESIGN Descriptive, analytical study. PLACE AND DURATION OF STUDY Department of Urology, Erciyes University, Faculty of Medicine, Kayseri, Turkey, between 2012 and 2020. METHODOLOGY One hundred patients, who were treated with prostate cancer, were subjected. The PSA values were noted, nadir PSA values were detected, times to nadir PSA, HRPCa, and follow-up times were recorded. PSADT and PSAV were calculated. The relationships between the groups were analyzed. Kaplan-Meier curves were used to estimate overall survival between the groups. RESULTS The patients were grouped according to the mean PSADT, median PSAV, median nadir PSA, and mean time to HRPCA. The survival of those with high PSADT, low PSAV and low nadir PSA were found to be significantly longer (p=0.006, p

The article "Nadir Shah's determination to statehood" is a scientific analysis of Nadir Shah's legacy of statehood, his historical perspectives, and state-building resources in general, who fought strongly and decisively for the ideas of Azerbaijanism and the renaissance of statehood. In short, the exceptional services of this great and powerful commander in the history of Azerbaijan have been studied from a wide angle. The article highlights Nadir Shah's success, ability and restraint in state and military affairs as a special case. It is not overlooked that these processes played a significant role in the Shah's determination to win, emphasizing security as a key issue. It turns out that Nadir Shah, like Shah Khatai, had always considered the internal strife that dragged our country into the abyss to be extremely urgent, and used his political wisdom, rich management experience, rescue and creative mission to conquer large areas in difficult, extreme conditions. Basically, he took decisive steps to solve these fateful tasks quickly, and the implementation of his multi-vector action plan was one of the important tasks for Nadir Shah at that time. Key words: Nadir Shah, Tahmasib, Khatai, statehood, warlord

INTRODUCTION Fetal bradycardia due to sentinel events such as placental abruption, cord prolapse or uterine rupture is associated with an increased risk of acidemia at birth. In the absence of a sentinel event, data regarding neonatal prognosis are scarce, and it seems plausible that the depth of bradycardia might be associated with an increased risk of acidosis at birth. The objective was to determine whether the depth of bradycardia is associated with a higher risk of umbilical artery acidemia at birth in term singleton pregnancies requiring cesarean delivery during labor. MATERIAL AND METHODS A retrospective comparative study of all cesarean deliveries for bradycardia in an academic tertiary center in the 6-year period of 2013-2018, among term singleton pregnancies. Bradycardia associated with a sentinel event such as placental abruption, cord prolapse or uterine rupture, were excluded. The nadir of the bradycardia was defined as the lowest fetal heart rate baseline lasting at least 3 minutes during bradycardia. Women who delivered an infant with an umbilical pH at birth

Objective Sudden cardiac death (SCD) is one of the causes of death among patients infected with human immunodeficiency virus (HIV). The T peak to T end interval (Tp-e interval) is a parameter that is used in the prediction of SCD. The aim of this study was to investigate the difference in Tp-e interval and Tp: QT and Tp: corrected QT interval (QTc) ratios between patients infected with HIV and healthy individuals as well as in other factors affecting patients infected with HIV. Methods A total of 83 patients infected with HIV with negative HIV ribonucleic acid (RNA) levels who were receiving antiretroviral therapy (ART) and 83 healthy individuals were included in this study. All the participants underwent electrocardiography, their Tp-e and QT intervals were measured, and QTc intervals and Tp-e: QT and Tp-e: QTc ratios were calculated. In addition, in the patients infected with HIV, CD4 and CD8 T-cell count and HIV RNA levels were measured. Results The Tp-e interval was found to be longer and the Tp-e: QT and Tp-e: QTc ratios were found to be higher in patients infected with HIV. Nadir CD4 was observed to be an independent predictor of Tp-e interval (p=0.014, β=‒0.28). Furthermore, correlation analysis revealed a negative correlation of the nadir CD4 level and CD4: CD8 ratio with Tp-e interval and Tp-e: QT ratio. Conclusion Low nadir CD4 and a reversed CD4: CD8 ratio in patients infected with HIV receiving ART were found to be associated with a prolonged Tp-e interval and increased Tp-e: QT and Tp-e: QTc ratios. Thus, more attention should be taken in terms of SCD in patients infected with HIV, especially in those with low nadir CD4 and reversed CD4: CD8 ratio.

Purpose To determine the effect of coronavirus disease 2019 (COVID-19) on CT volumes in the United States during and after the first wave of the pandemic. Methods CT volumes from 2,398 US radiology practices participating in the ACR Dose Index Registry from January 1, 2020, to September 30, 2020, were analyzed. Data were compared to projected CT volumes using 2019 normative data and analyzed with respect to time since government orders, population-normalized positive COVID-19 tests, and attributed deaths. Data were stratified by state population density, unemployment status, and race. Results There were 16,198,830 CT examinations (2,398 practices). Volume nadir occurred an average of 32 days after each state-of-emergency declaration and 12 days after each stay-at-home order. At nadir, the projected volume loss was 38,043 CTs per day (of 71,626 CTs per day; 53% reduction). Over the entire study period, there were 3,689,874 fewer CT examinations performed than predicted (of 18,947,969; 19% reduction). There was less reduction in states with smaller population density (15% [169,378 of 1,142,247; quartile 1] versus 21% [1,894,152 of 9,140,689; quartile 4]) and less reduction in states with a lower insured unemployed proportion (13% [279,331 of 2,071,251; quartile 1] versus 23% [1,753,521 of 7,496,443; quartile 4]). By September 30, CT volume had returned to 84% (59,856 of 71,321) of predicted; recovery of CT volume occurred as positive COVID-19 tests rose and deaths were in decline. Conclusion COVID-19 substantially reduced US CT volume, reflecting delayed and deferred care, especially in states with greater unemployment. Partial volume recovery occurred despite rising positive COVID-19 tests.

Author(s): Yang, Fan Nils; Bronshteyn, Margarita; Flowers, Sarah A; Dawson, Matthew; Kumar, Princy; Rebeck, George William; Turner, Raymond Scott; Moore, David J; Ellis, Ronald J; Jiang, Xiong | Abstract: ObjectiveNearly half of individuals living with HIV in the USA are now 50 or older. This rapidly ageing populace may be at an increasingly greater risk of Alzheimer's disease. However, the potential interaction between HIV-disease and Alzheimer's disease pathogenesis (i.e. Alzheimer's disease genetic risk factors) on brain function remains an open question. The present study aimed to investigate the impact of APOE e4 on brain function in middle-aged to older people with HIV (PWH), as well as the putative interaction between e4 and HIV disease severity.MethodsNinety-nine PWH participated in a cross-sectional study (56.3 ± 6.5 years, range 41-70 years, 27 women, 26 e4 carriers and 73 noncarriers). Structural MRI and resting-state functional MRI were collected to assess alterations in brain structure and functional connectivity, respectively.ResultsAPOE e4 was associated with worse memory performance and reduced functional connectivity in the memory network. The functional connectivity reduction was centred at the caudate nucleus rather than hippocampus and correlated with worse memory performance. In e4 carriers, low CD4+ cell count nadir was associated with reduced functional connectivity in the memory network, but this association was absent in noncarriers. Furthermore, there was an indirect detrimental impact of e4 on memory performance through memory network functional connectivity. However, this indirect effect was contingent on CD4+ cell count nadir, that is the indirect effect of e4 on memory was only significant when CD4+ cell count nadir was low.InterpretationAPOE e4 is associated with reduced memory and reduced functional connectivity within the memory network, and low CD4+ cell count nadir -- indicating a history of severe immunosuppression -- may exacerbate the effects of e4.

Introduction Aims of this study were (a) to assess the development ratio of hyponatremia during treatment with linezolid and (b) to evaluate the relationship between the risk of hyponatremia and linezolid exposure and patient background. Method Clinical data including linezolid serum concentrations and serum sodium values were collected at Toyama University Hospital and Kyorin University Hospital. Data from 89 patients were used for the analysis, and a nadir serum sodium level ≤130 mmol/L during the treatment with linezolid was defined as hyponatremia. Mann-Whitney's U test was used to evaluate the effects of the area under the time-concentration curve (AUC) of linezolid at the nadir sodium level, clinical characteristics (e.g. laboratory data), and baseline serum sodium levels on the development of hyponatremia. Results The hyponatremia was occurred in 21 of 89 patients (23.6%). Data are compared for baseline and nadir serum sodium levels of patients with and without hyponatremia. In both groups, nadir serum sodium levels were significantly different from those of the baseline values (P Conclusions Linezolid exposure, age, and baseline sodium levels were detected as the risk factors for linezolid-related hyponatremia. Our findings suggest that regular monitoring of serum sodium levels is desirable during treatment with linezolid, especially for the elderly and patients with low serum sodium levels before the start of linezolid administration.

Objective To investigate the relationship of preoperative prostate size, urinary retention, positive urine culture, and histopathological evidence of prostatitis or incidental prostate cancer on baseline and 3‐month nadir prostate‐specific antigen (PSA) value after Holmium laser enucleation of prostate (HoLEP). Patients and methods Data from 90 patients who underwent a HoLEP by En‐bloc technique were analyzed. PSA values at baseline and at 3‐month follow‐up, preoperative urinary retention and urine culture status, weight of resected tissue, and histopathological evidence of prostatitis or prostate cancer were recorded. We performed univariable and multivariable gamma‐regression analyses to determine the impact of the aforementioned perioperative variables on preoperative PSA, 3‐month postoperative PSA, and change in PSA. Results Serum PSA reduced significantly at 3 months from 6.3 ± 5.9 ng/mL to 0.6 ± 0.6 ng/mL. On both univariable and multivariable analysis, 3‐month nadir level was independent of all preoperative factors examined, except preoperative urinary retention status. Although patients with smaller prostate (resected tissue weight 80 g) (77.67% vs 89.06%; P

Broad human immunodeficiency virus type 1 (HIV-1) Gag-specific cellular responses can control viremia and provide slow progression to Acquired immunodeficiency syndrome (AIDS). In this study, we evaluate multiple HIV-1 Gag-specific lymphoproliferative responses and find their connection with cluster of differentiation 4 (CD4)+ T cell count and viral load from chronically HIV-1-infected patients. We further search for the correlation between multiple Gag-specific lymphoproliferative responses and changes in highly active antiretroviral therapy (HAART) regimen. We found correlation between Gag-specific responses and higher CD4+ T cells nadir and low HIV-1 viral load. Additionally, we observed that HIV-1-infected subjects did not need to change HAART regimen, when multiple Gag responses are present. We concluded that the start of HAART when CD4+ T cell nadir is the highest as possible may promote Gag-specific cellular responses conservation. Multiple Gag responses must be important to suppress HIV-1 replication. Preserved Gag-specific responses reduce HIV-1 viral load and are associated with stability of HAART regimen. Keywords: HIV-1; Gag; lymphoproliferation; viral load; HAART.

Purpose The purpose of this study was to identify the time to achieve a prostate-specific antigen (PSA) nadir of ≤0.2 ng/mL and the related factors to achieve this goal. Materials and Methods We retrospectively reviewed 2218 Japanese prostate cancer patients who received 125I brachytherapy with or without external beam radiotherapy between 2003 and 2013 at one institution. Among them, patients followed up for ≥72 months and without luteinizing hormone–releasing hormone (LH-RH) agonist/antagonist were included (total of 1089 patients). The time to a PSA nadir of ≤0.2 ng/mL (months) was defined as the time between the date of implantation and the first time the lowest PSA value reached ≤0.2 ng/mL. Biochemical recurrence (BCR) was determined using the Phoenix definition. Multivariate linear regression analysis was performed to detect the related factors to achieve this nadir. Results We assigned 409, 592, and 88 patients to the low-, intermediate-risk, and high-risk groups, respectively. The median followup time was 9.5 years. The median time to achieve a PSA nadir of ≤0.2 ng/mL was 44.0 (95% confidence interval: 42.3–45.7) months. The percentage of patients that achieved the nadir was 89.1%. BCR was noted in 107 (9.8%) patients. In the multivariate analysis of patients without BCR, younger age, larger prostate volume at implantation, higher initial PSA level, and monotherapy were significantly associated with longer time to achieve the PSA nadir. Conclusion The median time to achieve a PSA nadir of ≤0.2 ng/mL was 44.0 months. Some patients, however, may require a lengthy period of time to do so.

Objective To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM).Methods HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration.Results Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited.Conclusion This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.

book review

Sklerozan stromal tümör (SST) over seks kord stromal tümörleri arasında yer alan oldukça nadir görülen benign bir stromal tümördür. Bu olgu sunumunda sağ overde SST saptanan hastanın, radyolojik bulguları ve histopatolojik özellikleri literatür eşliğinde kısaca tartışılmıştır. 23 yaşında kadın hasta, pelvik ağrı şikayeti ile başvurduğu dış merkezde yapılan abdominal ultrasonografisinde sağ adnekste kistik ve solid komponenti olan kitle lezyon saptanması üzerine ileri tanı ve tedavi için hastanemiz kadın doğum polikliniğine yönlendirildi. Cinsiyet değiştirme istemi de olan hastaya yapılan laboratuvar incelemelerinde herhangi bir hormonal anormallik saptanmadı. Kitlenin frozen incelemesi sonrasında total abdominal histerektomi ve bilateral salpingoooferektomi (TAH+BSO) yapılması kararlaştırıldı. Frozen kesitlerin incelenmesi sonucu “seks kord stromal tümör” olarak değerlendirilen tümörün mikroskopik incelemesinde, kollajenöz ve ödemli hiposellüler alanlar ile hipersellüler alanların oluşturduğu psödolobüler patern, belirgin vasküler proliferasyon izlendi. Morfolojik ve immunhistokimyasal bulgular ışığında sağ overde izlenen tümör “SST” olarak tanı almıştır. Sklerozan stromal tümör olgularının büyük bir kısmı vasküler açıdan zengin solid kitle olduğundan radyolojik olarak öncelikle malign tümör olasılığı akla gelmektedir. SST’nin benign biyolojik davranışa sahip olması ve konservatif cerrahinin gerekli olduğu genç hastalarda görülmesi nedeniyle intraoperatif patolojik tanısı oldukça önemlidir.

This present article examines aspects of Iran’s trade and diplomatic relations with Imperial Russia during the reign of the Afsharid Nadir Shah (r. 1735–1747) focusing on a previously unpublished l...

This article examines the life stories of adults in Israel who were defined as ‘at-risk children’ in their childhood and removed from their homes by court order to therapeutic boarding schools agai...

Geomorphic reclamation creates variable topography and surface architecture, including rolling hillslopes and drainages. In contrast, traditional methods of reclamation result in landscapes susceptible to erosion due to steep, linear gradients. Geomorphic approaches to surface mine reclamation are relatively new, and hypotheses suggest the use of geomorphic principles in reclamation will improve vegetation outcomes relative to traditional methods. Topographic variability created by geomorphic reclamation likely results in more environmental heterogeneity, which should correlate with greater plant diversity. We examined revegetation outcomes of traditional and geomorphic reclamation on two reclaimed surface mines in Wyoming using nadir image sampling. Functional group diversity and measures of cover were compared between reclamation methods and undisturbed rangeland. Geomorphic reclamation supported greater total richness and greater native functional group richness relative to traditional reclamation. Native species cover on geomorphic reclamation, particularly for native perennial grasses, was either similar to undisturbed rangeland or greater than undisturbed rangeland and traditional reclamation. Reclamation shrub cover differed significantly from undisturbed sites, but was greater in geomorphic treatments. Results of nadir image analysis are compared to line-point intercept data from the same locations and outcomes are discussed in light of different reclamation techniques and sampling methods. Significant differences in cover categories were observed between nadir image and line-point intercept methods, however both methods revealed similar patterns between study sites.

ObjectiveTo identify which cortical regions are associated with direct electrical stimulation (DES)–induced alteration of breathing significant enough to impair pulse oximetry (SpO2).MethodsEvolution of SpO2 after 1,352 DES was analyzed in 75 patients with refractory focal epilepsy who underwent stereo-EEG recordings. For each DES, we assessed the change in SpO2 from 30 seconds prior to DES onset to 120 seconds following the end of the DES. The primary outcome was occurrence of stimulation-induced transient hypoxemia as defined by decrease of SpO2 ≥5% within 60 seconds after stimulation onset as compared to pre-DES SpO2 or SpO2 nadir ResultsA stimulation-induced transient hypoxemia was observed after 16 DES (1.2%) in 10 patients (13%), including 6 in whom SpO2 nadir was 2 was significantly associated with the localization of DES (p = 0.019).ConclusionThough rare, a significant decrease of SpO2 could be elicited by cortical direct electrical stimulation outside the temporo-limbic structures, most commonly after stimulation of the perisylvian cortex.

At the bicentenary of his birth, Frederick Engels's reputation as an original thinker is, among Anglophone academics at least, at its nadir. Despite the recent global economic crisis and associated increases in inequality that have tended to confirm Karl Marx and Engels's general critique of capitalism, Marxism is an optimistic doctrine that has not fared well in a context dominated by working-class retreat and demoralization. But if this context has been unpropitious for Marxism generally, criticisms of Engels's thought have a second, quite separate, source. Over the course of the twentieth century, a growing number of commentators have claimed that Engels fundamentally distorted Marx's thought, and that "Marxism" and especially Stalinism emerged out of this one-sided caricature of Marx's ideas.

Myxofibrosarcoma is a rare soft tissue sarcoma. It is mostly localized at extremities. Although definitive diagnosis is made by histopathological examination, imaging modalities play an important role in grading and treatment planning. Although axillary region can be involved rarely, there is no reported case in the literature. Given that tumor has an abundant neurovascular structure, it is challenging to excise tumor with wide surgical margins. Our case is striking as it is the first case with axillary localization in the literature. The surgical excision with wide margin is the most important step of the treatment. The R0 resection has an important impact on survival. In conclusion, we think that, in axillary MFS, wide surgical excision followed by chemotherapy will have positive contribution in reducing local recurrence.

Objective: To investigate low point autobiographical narratives among cancer survivors and romantic partners.Design: Cancer survivors (Study 1) and romantic partners (Study 2) narrated the low poin...

A number of studies devoted to the campaigns of Nadir Shah in Dagestan were published in the form of monographs and articles, the preparation of which involved an extensive range of sources and diverse literature. However, some interesting information resources about the events of 1741-43 in Dagestan have not been properly studied. To such we can attribute the information of Europeans who visited the region in the 30s – 40s of the 18th century. Among those, who left written evidence, are an English traveler Jonas Hanway and a Frenchman Lois Bazin, who were well acquainted with each other. The first one published a four-volume collection, entitled “An historical account of the British trade over the Caspian Sea” (London, 1753). The fourth volume contains the information on Nadir Shah. The events of 1741-43 in Dagestan are given in Chapter XXIX. The translation of parts of the chapter is provided in this paper. The second of them, in a letter written in 1751, describes events he was an eyewitness to, since he was in Derbent at the time Nadir Shah arrived there. The article provides a translation of a fragment of the letter, published in the “Lettres edifiantes et curieuses” (Paris, 1780). The texts of Hanway and Bazin have much in common; some theses, although set out in different variations, are similar in meaning and subordinate to the same logic. However, Hanway’s text is noticeably more filled with facts and describes the Nadir’s Dagestan campaign wider. A comparative analysis of narratives shows that Bazin's stories served as the main source for Hanway. At the same time, he had messages from Europeans in Russian and Persian service, from Russian military men and officials, as well as, possibly, Persian subjects, which allowed him to provide a more informative report.

Purpose. The main objective of this paper is to assess the quality of the 3D model of industrial buildings generated from Unmanned Aerial Vehicle (UAV) imagery datasets, including nadir (N), oblique (O), and Nadir and Oblique (N+O) UAV datasets. Methodology. The quality of a 3D model is defined by the accuracy and density of point clouds created from UAV images. For this purpose, the UAV was deployed to acquire images with both O and N flight modes over an industrial mining area containing a mine shaft tower, factory housing and office buildings. The quality assessment was conducted for the 3D point cloud model of three main objects such as roofs, facades, and ground surfaces using CheckPoints (CPs) and terrestrial laser scanning (TLS) point clouds as the reference datasets. The Root Mean Square Errors (RMSE) were calculated using CP coordinates, and cloud to cloud distances were computed using TLS point clouds, which were used for the accuracy assessment. Findings. The results showed that the point cloud model generated by the N flight mode was the most accurate but least dense, whereas that of the O mode was the least accurate but most detailed level in comparison with the others. Also, the combination of O and N datasets takes advantages of individual mode as the point clouds accuracy is higher than that of case O, and its density is much higher than that of case N. Therefore, it is optimal to build exceptional accurate and dense point clouds of buildings. Originality. The paper provides a comparative analysis in quality of point cloud of roofs and facades generated from UAV photogrammetry for mining industrial buildings. Practical value. Findings of the study can be used as references for both UAV survey practices and applications of UAV point cloud. The paper provides useful information for making UAV flight planning, or which UAV points should be integrated into TLS points to have the best point cloud.

Ira Frederick Aldridge is often believed by historians to herald the zenith of Black theatre, but he may instead herald the nadir of Black theatre. So argues actor, director, dramatic critic, and playwright Clifford Mason in his book Macbeth in Harlem, which presents thoughtful and provocative interpretations of musicals and plays by and about Black people before, during, and after freedom.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made., We present observations of terminator CO2 ice clouds events in three groups: Equatorial dawn, Equatorial dusk (both between 20°S and 20°N) and Southern midlatitudes at dawn (45°S and 55°S east of Hellas Basin) with ESA ExoMars Trace Gas Orbiter's Nadir and Occultation for MArs Discovery instrument. CO2 ice abundance is retrieved simultaneously with water ice, dust, and particle sizes, and rotational temperature and CO2 column profiles in 16 of 26 cases. Small particles (, ExoMars is a space mission of the European Space Agency (ESA) and Roscosmos. The NOMAD experiment is led by the Royal Belgian Institute for Space Aeronomy (IASB-BIRA), assisted by Co-PI teams from Spain (IAA-CSIC), Italy (INAF-IAPS), and the United Kingdom (Open University). This project acknowledges funding by the Belgian Science Policy Office (BELSPO), with the financial and contractual coordination by the ESA Prodex Office (PEA 4000103401, 4000121493), by the Spanish MICINN through its Plan Nacional and by European funds under grants PGC2018-101836-B-I00 and ESP2017-87143-R (MINECO/FEDER), as well as by UK Space Agency through grants ST/V002295/1, ST/V005332/1, ST/R001405/1 and ST/S00145X/1 and Italian Space Agency through grant 2018-2-HH.0. The IAA/CSIC team acknowledges financial support from the State Agency for Research of the Spanish MCIU through the “Center of Excellence Severo Ochoa” award for the Instituto de Astrofísica de Andalucía (SEV-2017-0709). This work was supported by NASA's Mars Program Office under WBS 604796, “Participation in the TGO/NOMAD Investigation of Trace Gases on Mars” and by NASA's SEEC initiative under Grant Number NNX17AH81A, “Remote sensing of Planetary Atmospheres in the Solar System and Beyond”. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 101004052. U.S. investigators were supported by the National Aeronautics and Space Administration.

PURPOSE To investigate the association between tumor volume growth rate after the nadir and survival in patients with EGFR-mutant advanced non–small-cell lung cancer (NSCLC) treated with erlotinib. MATERIALS AND METHODS Seventy-one patients with EGFR-mutant advanced NSCLC treated with erlotinib were studied for computed tomography tumor volume kinetics during therapy. The tumor growth rate after nadir was obtained using a previously published analytic module for longitudinal volume tracking to study its relationship with overall survival (OS). RESULTS The median tumor volume for the cohort was 19,842 mm3 at baseline and 4,083 mm3 at nadir. The median time to nadir was 6.2 months. The tumor growth rate after nadir for logeV (the natural logarithm of tumor volume measured in mm3) was 0.11/mo on average for the cohort (SE: 0.014), which was very similar to the previously validated reference value of 0.12/mo to define slow and fast tumor growth. The OS of 48 patients with slow tumor growth (≤ 0.12/mo) was significantly longer compared with 23 patients with fast tumor growth (> 0.12/mo; median OS: 37.8 v 25.0 months; P = .0012). In Cox models, tumor growth rate was also associated with survival (regression coefficient: 3.9903; P = .0024; faster rate leads to increased hazards), after adjusting for time to nadir (regression coefficient: –0.0863; P = .0008; longer time to nadir leads to decreased hazards) and smoking history. CONCLUSION In patients with EGFR-mutant advanced NSCLC treated with erlotinib, slower tumor growth rates after nadir were associated with longer OS, providing a rationale for using tumor growth rates to guide precision therapy for lung cancer.

The objective of this study was to evaluate the nadir CA-125 in patients with epithelial ovarian cancer. A total of 168 patients who achieved complete remission (no clinical and radiological signs, CA-125 ≤ 35 U/ml) after first-line treatment were enrolled in the study. The relationship between CA-125 and survival was examined by applying generalized additive models to the Cox proportional hazards model. The median CA-125 concentration after the treatment was 10 U/ml (2.7–35 U/ml). The nadir CA-125 was related to progression-free survival but not to overall survival. The risk of recurrence in patients with 11–25 U/ml and 26–35 U/ml compared to patients with ≤ 10 U/ml was 1.87 (p p

INTRODUCTION AND OBJECTIVE:Posterior urethral valves (PUV) are a leading cause of chronic renal failure in childhood. A consistently validated prognostic indicator of renal outcomes is the creatini...

Flowing water and brine have been proposed to cause seasonally reappearing dark streaks called recurring slope lineae (RSL) on steep warm slopes on Mars, along with other formation mechanisms that do not involve water. This study aims to examine whether the evaporation of water vapor from the RSL, whether from fresh water or brine, is detectable by observing water vapor and/or clouds. In this study, we summarize the possible rate and duration of water-vapor emission from RSL in different scenarios, simulate how the emitted water vapor behaves in a global climate model, and discuss the detectability of water vapor in nadir observations during existing and future explorations. We found that, in typical cases, rapid horizontal dissipation within the planetary boundary layer (PBL) following the release of water vapor prohibits cloud formation and the excess water vapor from being distinguished from the background with existing observations. Thus, we conclude that the lack of correlation between the RSL activities and the overlying water-vapor column density does not necessarily rule out the wet origin of RSL. Nevertheless, we also found that water vapor tends to accumulate in basins and valleys in some cases due to the combined effects of topography and low PBL; we suggest the locations of such configuration as targets for future atmospheric studies of Mars dedicated to quantifying water-vapor release (associated with RSL) to elucidate the formation mechanism(s) of the RSL on the planet., 52 pages, 15 figures, accepted for publication in Icarus. Supplementary movies will become available from the journal

This study investigated treatment characteristics of Guillain-Barré syndrome (GBS) in a real-world setting between 2000 and 2019. We analyzed clinical improvement between nadir and last follow-up in patients with severe GBS (defined as having a GBS disability scale > 2 at nadir) and aimed to detect clinical factors associated with multiple treatments. We included 121 patients (74 male; median age 48 [IQR 35–60]) with sensorimotor (63%), pure motor (15%), pure sensory (10%) and localized GBS (6%) as well as Miller Fisher syndrome (6%). 44% of patients were severely affected. All but one patient received at least one immunomodulatory treatment with initially either intravenous immunoglobulins (88%), plasma exchange (10%) or corticosteroids (1%), and 25% of patients received more than one treatment. Severe GBS but not age, sex, GBS subtype or date of diagnosis was associated with higher odds to receive more than one treatment (OR 4.22; 95%CI 1.36–13.10; p = 0.01). Receiving multiple treatments had no adjusted effect (OR 1.30, 95%CI 0.31–5.40, p = 0.72) on clinical improvement between nadir and last follow-up in patients with severe GBS. This treatment practice did not change over the last 20 years.

This study presents an analysis of radar signature at Ku-band for incidences ranging from 0° to 10° over the major bioclimatic zones, soil and vegetation types encountered in West-Africa, using data from Jason-3 and SWIM. Time-series of radar responses were built over the following environments: stone and sand deserts, Sahelian savannah and floodplain, flooded and non-flooded equatorial forests. Deserts and non-flooded equatorial forest exhibit almost constant responses, decreasing as the incidence angle increases. Similar seasonal variations of the backscattering coefficient between the dry and the wet season are observed at nadir for Jason-3 and SWIM with a decrease in dry season level and amplitude with the increase of the incidence angle. Backscattering at Ku-band can be related to soil roughness, vegetation cover and soil wetness.

Objective: This study aims to analyze the correlation between the initial creatinine and the nadir creatinine values and the risk of chronic kidney disease in patients with posterior urethral valves. Materials and methods: The medical records of all patients with PUV treated in the surgery department of The Emergency Children’s Hospital “Marie Curie” between January 2007 – January 2020 were analyzed. The age at presentation, serum creatinine, nadir creatinine, and glomerular filtration rate were noted. The patients were divided in three groups based on the marker values. Results: 77 patients were studied. The high-risk group (13%) was represented by patients with initial creatinine and nadir creatinine >0.85 mg/dL, with 100% progression to CKD. The low-risk group (33%) showed a very low development of renal insufficiency for values of

Background A two-dose hepatitis B (HBV) vaccine with an immunostimulatory adjuvant (HBV-ISS, Heplisav-B), was FDA approved in 2017 for adults 18 years and older. In randomized controlled trials (RCTs), HBV-ISS demonstrated a seroprotection rate (SPR) of 90–95% versus 65–80% for Engerix-B (HBV-Eng). No RCTs, however, included people with HIV (PWH), and the SPR and its predictors in this population are unknown. Methods This retrospective cohort study enrolled PWH ages 18 years and older without current HBV seroprotection at an HIV clinic at a tertiary care center. HBV seroprotection was defined as an anti-HBV surface antibody level >= 10 mIU/mL. Patients without follow-up titers after immunization were excluded. The primary outcome was the SPR, the proportion of patients with HBV seroprotection at any point following the first HBV-ISS vaccination. Results Among the 51 PWH included, 50 received 2 doses of HBV-ISS (1 patient who received 1 dose developed seroprotection) (Table 1). Median time to antibody titer measurement was 11 weeks (IQR 7–19 weeks). Median age was 59 years, 90% were men, and 96% had VL < 200. There were no pregnant or breastfeeding patients. The SPR was 82% (42/51) in the cohort, and 86% (38/44) when patients with significant non-HIV immunosuppression (decompensated cirrhosis, solid organ transplantation, active chemotherapy) were excluded. There were no significant differences in SPR based on age, sex, BMI, diabetes mellitus, chronic kidney disease, history of remote anti-HBV surface or core antibody positivity, or prior HBV vaccination (Table 2). Lower current and nadir CD4+ counts were associated with progressively lower SPRs (P for trend < 0.0001 for both) (Figure 1). Table 1. Baseline Demographics and Characteristics Table 2. Seroprotection Rate (SPR) by Variables of Interest Figure 1. Seroprotection Rate (SPR) by Current and Nadir CD4+ Count Conclusion The SPR from HBV-ISS in PWH appears comparable to the immunocompetent patients included in RCTs, especially when patients with significant non-HIV immunosuppression are excluded. The SPR demonstrated in this single-arm, retrospective study was higher than that of HBV-Eng in immunocompetent patients, and consideration should be given to establishing HBV-ISS as first-line HBV vaccination in PWH. Finally, SPR is significantly reduced in those with lower current and nadir CD4+ counts. Further research on the effectiveness of a repeat vaccination series or higher dosing in these subgroups is needed. Disclosures Jennifer Cocohoba, PharmD, AAHIVP, BCPS, Viiv (Grant/Research Support)