Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study

Background Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. Objectives To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. Methods This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. Results A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53–7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88–5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. Conclusions Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693.

Borole-based half-sandwich complexes of germanium and tin

The synthesis and initial observations regarding the reactivity of borole-based half-sandwich complexes with apical divalent group 14 elements germanium and tin are described.

Clinical Features of Excyclotorsion in the Non-Paretic Eye of Patients with Congenital Unilateral Superior Oblique Palsy

Background To investigate preoperative clinical features and postoperative results according to the correspondence between excyclotorsion and the paretic eye in patients with congenital unilateral superior oblique palsy (USOP).MethodsA retrospective review of medical charts was performed. The patients were divided into the accordance (ocular excyclotorsion in the paretic eye) and discordance (ocular excyclotorsion in the non-paretic eye) groups. The degree of excyclotorsion (scale, 0–4) was measured. Age, sex, hypertropia at the primary position, fixation preference, inferior oblique overaction, and degree of excyclotorsion were measured.ResultsNinety-eight patients were included in this study. There were 70 (71.4%) and 28 patients (28.6%) in the accordance and discordance groups. Sixteen patients (22.9%) in the accordance group and 12 patients (42.9%) in the discordance group were aged under 2 years (p = 0.04). A fixation preference of the paretic eye was observed in 2 (2.9%) and 8 (28.6%) patients in the accordance and discordance groups (p < 0.01). The postoperative degree of excyclotorsion in the accordance group (0.14 ± 0.39) was lower than that in the discordance group (0.28 ± 0.71) (p = 0.01). The residual postoperative excyclotorsion (>1) in the discordance group were observed in the discordance group (14 patients, 50%) and accordance group (16 patients, 22.9%) (p = 0.01).Conclusion Preoperative discordance between excyclotorsion and the paretic eye was observed in patients who were under 2 years of age and preferred fixation of the paretic eye. The postoperative degree of excyclotorsion was lower in the accordance group.

The Effect of Tranexamic Acid and Epsilon-Aminocaproic Acid on Bleeding During Hip and Knee Arthroplasty：A Retrospective Study

PurposeTo compare the hemostatic effect and risk of thrombosis between tranexamic acid and epsilon-aminocaproic acid.MethodsA retrospective study of 140 cases of joint replacement, including 93 cases in the tranexamic acid (TXA) group and 47 cases in the epsilon-aminocaproic acid (EACA) group. TXA or EACA was injected intravenously 30 minutes before surgery, and TXA or EACA was infused into the joint cavity after the wound was closed. The drainage, blood loss and plasma albumin loss were observed after operation.ResultsThe postoperative hemoglobin loss in the two groups was 19.1±11.4g/L, 20.3±13.6g/L, P>0.05. However, the drainage volume of the TXA group was less than that of the EACA group, which were 103.3±92.1ml and 117.4±120.9ml, respectively, P<0.05. The blood transfusion rate in the TXA group was higher than that in the EACA group, 14% and 34%, respectively, P<0.05. The postoperative plasma albumin loss of the two groups of patients was 7.4±8.0g/L and 7.3±5.5g/L respectively, P=0.05.ConclusionsThe hemostatic effect of TXA was slightly better than that of EACA, and the proportion of transfusion of TXA was lower.Level of Evidence: Level III

Leptomeningeal disease and brain control after postoperative stereotactic radiosurgery with or without immunotherapy for resected brain metastases

PurposeImmunotherapy has shown activity in patients with brain metastases (BM) and leptomeningeal disease (LMD). We have evaluated LMD and intraparenchymal control rates for patients with resected BM receiving postoperative stereotactic radiosurgery (SRS) and immunotherapy or postoperative SRS alone. We hypothesize that postoperative SRS and immunotherapy will result in a lower rate of LMD with acceptable toxicity compared with postoperative SRS.Patients and methodsOne hundred and twenty-nine patients with non-small-cell lung cancer (NSCLC) and melanoma BM who received postoperative fractionated SRS (fSRS; 3×9 Gy) in combination with immunotherapy or postoperative fSRS alone for completely resected BM were retrospectively evaluated. The primary endpoint of the study was the rate of LMD after treatments. The secondary endpoints were local failure, distant brain parenchymal failure (DBF), overall survival (OS), and treatment-related toxicity.ResultsSixty-three patients received postoperative SRS and immunotherapy, either nivolumab or pembrolizumab, and 66 patients received postoperative SRS alone to the resection cavity. With a median follow-up of 15 months, LMD occurred in 19 patients: fSRS group, 14; fSRS and immunotherapy, 5. The 12-month LMD cumulative rates were 22% (95% CI 14% to 37%) in the fSRS group and 6% (95% CI 2% to 17%) in the combined treatment group (p=0.007). Resection cavity control was similar between the groups, whereas DBF and OS were significantly different; the 1-year DBF rates were 31% (95% CI 20% to 46%) in the fSRS and immunotherapy group and 52% (95% CI 39% to 68%) in the fSRS group; respective OS rates were 78% (95% CI 67% to 88%) and 58.7% (95% CI 47% to 70%). Twenty-two patients undergoing postoperative fSRS and immunotherapy and nine subjected to postoperative fSRS experienced treatment-related imaging changes suggestive of radiation-induced brain necrosis (p=0.02).ConclusionsPostoperative fSRS in combination with immunotherapy decreases the incidence of LMD and DBF in patients with resected BM from NSCLC and melanoma as compared with fSRS alone, reducing the rate of neurological death and prolonging survival.

Randomized non-inferiority TrIal comParing reverse T And Protrusion versus double-kissing and crush Stenting for the treatment of complex left main bifurcation lesions

Background The treatment of left main bifurcation stenoses remains challenging. Aims We compare the “Reverse T and Protrusion” (reverse-TAP) technique to Double-Kissing and crush (DK-crush). Methods The study was designed as non-inferiority trial, the primary endpoint was percentage stent expansion in the ostial side branch at optical coherence tomography. Results 52 consecutive patients (13 females, 17 diabetics, Syntax score 25 [22–29]) with complex coronary bifurcation lesions of the left main were randomized in a 1:1 ratio to Reverse-TAP or DK-crush stenting. The intervention was performed according to protocol in all patients in both randomization groups. Side branch stent expansion was 75 [67–90]% in the DK-crush group and 86 [75–95]% in the reverse-TAP group (one-sided 97.5% lower parametric confidence interval: − 0.28%; P < 0.01 for non-inferiority; P = 0.037 for superiority). Side branch balloon pressure during final kissing was higher in the DK-crush group (14 [12–16] vs. reverse-TAP: 13 [12–14]; P = 0.043). Procedural time was shorter with reverse-TAP (DK-crush: 32 [24–44] min vs reverse–TAP: 25 [22–33] min; P = 0.044). Other procedural parameters were not different between groups. There was no difference in any of the safety endpoints up to 1 month. Conclusions A reverse-TAP strategy for the interventional treatment of complex coronary lesions was non-inferior and superior to DK-crush for the primary endpoint side branch expansion while requiring less time. A larger study testing long-term clinical outcomes is warranted. Trail Registration NCT: NCT03714750. Graphical abstract

The bis(Biphenyl)phosphorus Fragment in Trivalent and Tetravalent P-Environments

Diaryl substituted phosphorus (III) compounds are commonly used motifs in synthesis. Although the basic synthetic routes to these molecules starting from PCl3 are well reported, sterically hindered aryl substituents can be difficult to introduce, especially if the P atom is in ortho position to another group. This work explores the chemistry of the bis(biphenyl)phosphorus(III) fragment. As third substituents, H, M, Cl, NR2, two group 14 element substituents and also Li were introduced in high-yielding processes offering a wide chemical variety of the bis(biphenyl) phosphine motif. In addition, also a tetravalent phosphine borane adduct was isolated. All structures were thoroughly investigated by heteronuclear NMR spectroscopic analysis. Furthermore, the reaction conditions are discussed in connection with the structures and four crystal structures of the aminophosphine, phosphine, phosphine borane and phosphide are provided. The latter crystallized as a dimer with a unique planar P2Li2 ring, which is stabilized by the non-covalent C⋯Li interaction arising from the biphenyl motif and represents a rare example of a donor-free planar P2Li2 ring.