Effectiveness and safety of optical coherence tomography-guided PCI in Indian patients with complex lesions: A multicenter, prospective registry

BACKGROUND

Optical coherence tomography (OCT) is reported to be a feasible and safe imaging modality for the guidance of percutaneous coronary intervention (PCI) of complex lesions.

METHODS

This multicenter, prospective registry assessed the minimum stent area (MSA) achieved under OCT guidance. A performance goal of 24% improvement in MSA over and above the recommendation set by the European Association of Percutaneous Cardiovascular Interventions Consensus 2018 (4.5 mm2 MSA for non-left main and 3.5 mm2 for small vessels). The incidence of contrast-induced nephropathy was also assessed. Core lab analysis was conducted.

RESULTS

Five hundred patients (average age: 59.4 ± 10.1 years; 83% males) with unstable angina (36.8%), NSTEMI (26.4%), and STEMI (22%) were enrolled. The primary endpoint was achieved in 93% of lesions with stent diameter ≥2.75 mm (average MSA: 6.44 mm2) and 87% of lesions with stent diameter ≤2.5 mm (average MSA: 4.56 mm2). The average MSA (with expansion ≥80% cutoff) was 6.63 mm2 and 4.74 mm2 with a stent diameter ≥2.75 mm and ≤2.5 mm, respectively. According to the core lab analysis, the average MSA achieved with a stent diameter ≥2.75 mm and ≤2.5 mm was 6.23 mm2 and 3.95 mm2, respectively (with expansion ≥80% cutoff). Clinically significant serum creatinine was noted in two patients (0.45%). Major adverse cardiac events at 1 year were noted in 1.2% (n = 6) of the patients; all were cardiac deaths.

CONCLUSION

PCI under OCT guidance improves procedural and long-term clinical outcomes in patients with complex lesions not just in a controlled trial environment but also in routine clinical practice.

AB0562 LIVER ENZYME ABNORMALITIES IN HOSPITALIZED LUPUS PATIENTS – A RETROSPECTIVE STUDY

Background

Around 25% to 50% of lupus patients may present with alterations in the liver enzymes of variable severity including fulminant hepatic failure.1

Objectives

To study the prevalence, aetiology and the outcome in lupus patients hospitalized with liver enzyme abnormalities.

Methods

We analysed liver enzymes of all hospitalized lupus patients from June 2018–June 2021. Patients with abnormal liver enzymes(>2 times Upper Limit Normal)2 were identified and categorized as per the standard definitions/criteria.3,4 The outcomes and association of liver enzymes to mortality was analysed.

Results

Liver enzymes were available in 461/535 hospitalisations amongst 383 lupus patients of whom abnormalities were detected in 95/461 (20.6%). Among 77 patients with elevated transaminases, 33/77(42.9%) fulfilled criteria for macrophage activation syndrome (MAS) as per HLH criteria and parodie et.al4. Other aetiologies are represented in Table 1. Overall the mortality rate was 12/77(15.58%), highest being MAS 9/12(75%). Higher aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio was associated with adverse outcomes in patients with MAS.

Table 1.

Aetiology and associations of liver enzyme abnormalities

Aetiologies for elevated transaminasesMacrophage activation syndrome33/77(42.9%)Lupus activity16/77(20.8%)Overlap Myositis12/77(15.6%)Autoimmune Hepatitis6/77(7.8%)Sepsis5/77(6.5%)Primary Biliary Cirrhosis3/77(3.9%)Drugs2/77(2.6%)Comparison between patients with and without MASComparison between patients with and without mortality among MAS patientsMAS (N=33)No MAS (N=44)P-valueMortality (N= 9/33)No Mortality (N=24/33)P-valueAST228(169,377.5)(128,281)0.098 *265(232.5,545)209(139.5,360)0.036*ALT73(51.5,121.5)96(54,140)0.52058(46,132.5)94.5(53.5,121.75)0.505ALP202(69.5,382.5)175(90,318)0.794233.5(84,382.2)202(69.5,407.5)0.788GGT232(77.5, 443)179(75,333)0.312402(139.5,995.7)202(70.5,373.0)0.205AST/ALT RATIO3.18(1.96,4.45)2.3(1.4,3.6)0.016*4.33(3.07,6.66)2.58(1.94,3.64)0.032*

ABBREVATIONS- AST- Aspartate aminotransferase; ALT- Alanine aminotransferase; ALP- Alkaline phosphatase, GGT- Gamma glutamyl transferase. Statistically significant *P-value = < 0.05.

Conclusion

MAS was the most frequent cause of elevated transaminases and was associated with mortality in subset with higher AST/ALT ratio.

References

[1]Chowdhary VR, Crowson CS, Poterucha JJ, Moder KG. Liver involvement in systemic lupus erythematosus: case review of 40 patients. The Journal of Rheumatology. 2008 Nov 1;35(11):2159-64.

[2]Her M, Lee Y, Jung E, Kim T, Kim D. Liver enzyme abnormalities in systemic lupus erythematosus: a focus on toxic hepatitis. Rheumatology international. 2011 Jan;31(1):79-84.1.

[3]Henter JI, Horne A, Aricó M, Egeler RM, etal. HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatric blood & cancer. 2007 Feb;48(2):124-31.

[4]Parodi A, Davì S, Pringe AB, Pistorio A, etal. Macrophage activation syndrome in juvenile systemic lupus erythematosus: a multinational multicenter study of thirty-eight patients. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2009 Nov;60(11):3388-99.

Disclosure of Interests

None declared

Validation of the OPtimal Treatment of Angina (OPTA) Questionnaire in Indian Patients with Chronic Stable Angina

BACKGROUND

A rising burden of coronary artery disease (CAD) in India is a major cause of concern, with angina being the leading manifestation. Hence a questionnaire to sensitize the clinicians about stable angina management and to assist in risk stratification is imperative.

OBJECTIVE

To evaluate the content and face validity of a modified questionnaire adapted from the 7-item Seattle Angina Questionnaire (SAQ).

MATERIALS AND METHODS

A panel of six experts in the field of evidence-based practice reviewed and rated the modified instrument for content clarity and relevance based on the 4-point ordinal scale. Face validity was assessed based on the trichotomous rating of "disagreed", "agree" or "neutral". Items on which ≥75% of patients "disagreed" were subjected to further review and revision.

RESULTS

A total of six experts and 51 patients participated in the content and face validity, respectively. As no question received a score ≤2 by two or more experts for either content clarity or relevance, no modification in the questionnaire was required post content validation. During face validation, all patients agreed that the questions correctly measured the specific area of cardiovascular health status and response options correctly captured the answers provided. Demographic and baseline data of the patients were collected.

CONCLUSION

The newly developed 5-item questionnaire demonstrated content and face validity, suggesting it to be a potential instrument to improve management decision and care of angina patients in India.

ACEI-induced cough: A review of current evidence and its practical implications for optimal CV risk reduction

Cough is one of the common adverse effects in patients receiving angiotensin-converting enzyme inhibitors (ACEIs). This review presents the current evidence on incidence and mechanisms of cough associated with ACEIs use, and proposes a practical approach for managing the same for optimal cardiovascular (CV) risk reduction. The incidence of dry cough in patients receiving ACEIs vary among individual ACEIs, and is the lowest with perindopril. Cough is thought to originate from multiple mechanisms, bradykinin theory is the most commonly appealed hypothesis. The strategies for optimal management could be temporarily discontinuation of ACEI upon a reported incidence of cough and reintroduction after its remission. However, studies have reported disappearance of cough despite continuing treatment. Another important approach could be adding calcium channel blockers to ACEIs. Switching to alternative drugs such as angiotensin receptor blockers should be suggested in case intolerable symptoms recur and after exclusion of all other possible causes of cough.

Asymptomatic chronic traumatic aortic valve perforation with severe aortic regurgitation

Here, we present a young asymptomatic male patient incidentally diagnosed to have aortic regurgitation (AR). The patient had a history of a blunt trauma to the thorax two years back but did never have any symptoms. Transthoracic echocardiography showed a moderately dilated left ventricle with normal systolic function and severe AR with normal nondilated aortic root and tri-leaflet aortic valve. To diagnose the etiology of the AR, a transesophageal echocardiogram (TEE) was done, which revealed a perforation in the nonadjacent leaflet (NAL) and confirmed severe AR with two AR jets being clearly visualized, one through the point of incomplete coaptation and other one through the perforated area in the NAL. The patient was treated with aortic valve replacement and was doing well on follow-up.

AB0785 REAL LIFE EXPERIENCE OF METHOTREXATE BASED DUAL COMBINATION DMARDS IN PSORIATIC ARTHRITIS- RESULTS FROM KARNATAKA PSORIATIC ARTHRITIS COHORT (KPsAC)

Background:

Biologics have been the focus of recent treatment guidelines and ‘Treat to Target’ strategies for both psoriasis (PsO) & psoriatic Arthritis (PsA). However, in day-today practice, combination DMARDs anchored around methotrexate are mainstay in majority of patients.

Objectives:

To describe experience and effectiveness of Methotrexate in combination with conventional DMARDs in Karnataka Psoriatic Arthritis Cohort.

Methods:

Treatment information was extracted from KPsAC (n=549) which is a cross sectional, non-interventional study conducted across 17 rheumatology practicing centres in Karnataka, India using a structured proforma. This study was approved by respective Ethical committee. Information on efficacy was extracted for various csDMARDs in combination with methotrexate. Standard disease activity outcome measures were used for assessing the response to therapy (DAPSA, PASI, HAQ, MDA5). All participating rheumatologists underwent training to calculate PASI and other outcome scores.

Results:

Nearly half of the patients in our cohort were on methotrexate (44%) monotherapy. Proportion of patients who received combination csDMARD anchored on methotrexate were 29%. The choice of add on csDMARD was as per clinician discretion or subject preference. Patients were divided in to three groups based on treatments they were receiving at the time of study: Methotrexate (Mtx)+Leflunomide (Lef), Mtx+Sulfasalazine (SSz) and Mtx+Apremilast(Apr). Their characteristics along with outcome measures are depicted in table 1. In Mtx+Apr group: remission or low disease activity was present in 42%, HAQ score of <0.5 was seen in 82%, and only one patient had a PASI of > 10. PASI was significantly lower in the Mtx+Apr group compared to Mtx+Lef group (p<0.009) and Mtx +Ssz group (p < 0.020)

Conclusion:

Apremilast is an orally administered, small molecule inhibitor of phosphodiesterase 4 (PDE4)**. In this observational study, 3 groups of methotrexate plus csDMARD- leflunomide, sulphasalazine and apremilast fared similarly for articular domain of PsA. However, in cutaneous domain, PASI was significantly lower in apremilast + methotrexate group. To our knowledge, this is the first real life report of the use of combination DMARDs in unselected PsA patients demonstrating effectiveness of apremilast in cutaneous domain. Methotrexate remains anchor DMARD for treatment of PsA in 2/3rdof PsA patients. Addition of apremilast to methotrexate inadequate responders appears to be beneficial in PsA with persistent cutaneous disease. However, being an observational study, this needs to be confirmed in controlled clinical trials.

References:

**Apremilast: A Review in Psoriasis and Psoriatic Arthritis, Drugs March 2017, Volume 77, Issue 4.

Table.

Characteristics and comparison of combination csDMARDs

MTX+SSZ(N=39)MTX+LEF (n=77)MTX+APR(N=45)Median Age (years)373935Median disease duration (months)96101112Enthesitis (Ever)6(15%)21(27%)4(8%)Dactylitis (Ever)9((23%)28(36%)12 (26%)DAPSA < 46(15%)9(11%)10(22%) 4-1414(36%)25(32%)13(29%) 14-287(18%)24(31%)11(24%)PASI >107(18%) #14(18%) *1(2%) *#HAQ < 0.530(77%)60(78%)37(82%)MDA 5 achieved16(41%)25(32%)19(42%)

*P value < 0.009 #P value <0.02

Disclosure of Interests:

None declared

AB0790 CLINICAL PROFILING OF PSORIATIC ARTHRITIS (PsA): AN OBSERVATIONAL STUDY FROM A SOUTH INDIAN PSORIATIC ARTHRITIS COHORT

Background:

Clinical patterns and disease burden of PsA varies in different parts of the world. Demographic studies from Indian subcontinent are sparse

Objectives:

To study the cutaneous, articular profile of PsA and describe their disease activity, disability and co-morbidities (CMs)

Methods:

This is a multicenter, cross-sectional, non-interventional study from Karnataka, India. All consecutive PsA patients defined by CASPAR or expert diagnosis were evaluated over 8 months from 17 Rheumatology centers across Karnataka using standard parameters such as PASI, DAPSA, Indian version of HAQ-DI1, psoriatic co-morbidity index2(Cidx) and MDA 5. Patient consent and EC obtained

Results:

549 PsA patients were evaluated and their disease characteristics are shown in Table 1 & 2. PsA preceded psoriasis in in 81 (14.7%).

Table 1.

Patient characteristics (n=549)

DEMOGRAPHICSPsACommonest age group of PsA (yrs)31-40PsA SubclassificationM:F6:5Symmetric polyarthritis216(40.7%)Type 1 PsoriasisType 2 Psoriasis279(55.8%)221(44.2%)Mean duration (yrs)Asymmetric oligoarthritis202(38.1%)Psoriasis8.8(±7.8)DIP predominant88(16.6%)PsA5.2(±6.3)Arthritis mutilans16(4.2%)PsA preceded psoriasis81(14.7%)Dactylitis182(33.9%)Family h/oPsoriasis107(19.7%)Enthesitis109(20.3%)PsA33(6%)Mean TJC686.3(±8.9)AS11(2%)Mean SJC683.5(±5.2)Uveitis5(0.9%)Type of PsoriasisPlaque253(59.9%)IBD3(0.5%)Erythrodermic 31(7.3%)

Type I & II psoriasis did not differ in PASI, DAPSA, HAQ-DI or having a family h/o psoriasis. Type II psoriasis had higher Cidx than type I (p=0.0001). Pt pain VAS, DAPSA, PhyGA, PtGA & SJC significantly correlated with higher HAQ-DI (p<0.0001). TJC, ESR, CRP & PASI had minor correlation with HAQ-DI. Females had higher HAQ-DI compared to males (p=0.02). Knee joint involvement caused disability most frequently. Cidx was higher in males (p=0.008). Minor correlation was found between Cidx with age, HAQ-DI & DAPSA. Mean BMI of our cohort was 26.8(±14.8) kg/m2. 56.5% were overweight. Higher BMI was not associated with age, duration of arthritis, DAPSA, PASI, HAQ-DI & Cidx.

Infections (any time) were recorded in 10.8%, of which skin was the commonest site in 38.9%; 30.5% of these needed hospitalizations.

Conclusion:

Despite mild skin disease in majority, more than half of the patients have moderate to severe joint activity. Mild to moderate functional disability in nearly half of our cohort indicate high burden of damage. High incidence of co-morbidities in PsA compared with general population is in line with published literature. In addition to aggressive control of articular activity, detection and control of co-morbidities must be an integral part of PsA management.

References:

[1]https://doi.org/10.1093/rheumatology/41.12.1457

[2]http://dx.doi.org/10.1136/annrheumdis-2016-eular.4598

Table 2.

Disease characteristics

DISEASE ACTIVITYDISABILITYCO-MORBIDITIESMean PASI: 3.8(7.4)Mean HAQ-DI: 0.3(0.45)Mean Cidx: 0.98(1.6)Mild (PASI 0-5)480(80%)Mild-mod disability260(48.2%)N with 1 or more CMs232(42.3%)Severe (>10)57(10.6%)ADL with most frequent disabilityClimbing a flight of stairs 189(35%)HTNT2DMSmokingPsA severity19.8%16.6%5.4%3.2%Mean DAPSA: 18.8(16.6)ADL with highest disability scoreSitting cross-legged/squattingAnxietyIHDDyslipidemiaOthers3.1%2.3%2%<2% eachRemission100(19.9%)Low DA145(28.8%)Moderate DA137(27.2%)High DA123(24.5%)Family h/o CV dis/stroke72(15.2%)

Disclosure of Interests:

None declared

SAT0227 CLINICAL AND IMMUNOLOGICAL PROFILE OF NEUROPSYCHIATRIC LUPUS IN SOUTH INDIA

Background:

Neuropsychiatric manifestations are one of the least understood aspects of SLE.

Objectives:

To study the prevalence of NPSLE manifestations in our cohort and compare clinical and immunological features of patients with controls.

Methods:

This was a retrospective study in a tertiary care centre. Classification of SLE was as per SLICC criteria. All patients of SLE diagnosed in the last 5 years with NP manifestations as per the ACR definitions were included. Consecutive patients of SLE over last 2 years without NP manifestations were taken as controls.

Results:

Six hundred and thirty one patients with SLE were seen in our centre from Jan 2013 to Jun-2019. NPSLE manifestations as per the ACR definitions were seen in 100 patients (95 females) .137 (130 females) consecutive SLE patients without NP manifestations were included as controls. The commonest NPSLE manifestation was seizures followed by cerebrovascular accident (Table 1). NPSLE manifestation occurred at the first presentation in 77 patients. Forty patients had more than one NPSLE manifestation. Antiphosholipid (APl) antibodies (lupus anticoagulant and anticardiolipin antibody) were tested in 94 patients and positive in 25 (26.3%). Only 10 of the 23 patients with CVA were positive for APl. NPSLE syndromes were similar in APl positive and negative patients. As compared to controls, NPSLE patients had lower prevalence of mucocutaneous and musculoskeletal manifestations. There were no differences in the autoantibody profile in NPSLE patients versus controls. MRI of the brain was available in 65 NP episodes and 51 were abnormal. Ischaemic changes (22) were the commonest followed by T2/FLAIR hyperintensities (16). Cyclophosphamide was used for induction in 46 and Mycophenolate in 19 patients. Follow up of ≥ 6 months duration was available 93 patients. Over a mean follow up duration of 31.1 ± 22.7 months, 6 patiens had a NPSLE relapse and 10 died.

Table 1.

Prevalence of NP SLE manifestations (N=631) and clinical and immunological features

NPSLE manifestationsPrevalence (%)Clinical FeatureNPSLE (n=100)Controls (n=137)P valueAll100(15.85%)Age29.1±11.628.18±9.79NSCentral Nervous System65(10.3%)M:F5:957:130NSAseptic meningitis2(0.3%)Mucocutaneous55(55%)105(76.6%)<0.001Acute Confusional State12(1.9%)Musculoskeletal57(57%)96(70%)0.03Cerebrovascular Disease23(3.6%)Hemolytic Anaemia19(19%)40(29.2%)NSCognitive Dysfunction2(0.3%)Leucopenia25(25%)40(29.2%)NSDemyelinating Syndrome3(0.5%)Thrombocytopenia22(22%)36(26.3%)NSHeadache12(1.9%)Serositis10(10%)16(11.7%)NSMovement Disorder7(1.1%)Lupus Nephritis41(41%)38(27.7%)NSMyelopathy5(0.8%)Direct Coomb’s Test44(44%)55(45.5%)NSSeizures35(5.5%)Lupus anticoagulant15(15%)21(18.6%)NSAnticardiolipin12(12%)14(12.5%)NSPeripheral Nervous system28(4.4%)Low complements78(78%)98(78.4%)NSAIDP3(0.5%)dsDNA44(44%)67(52.8%)NSAutonomic Disorders1(0.1%)Smith38(38%)51(40.8%)NSCranial Neuropathy5(0.8%)Nucleosome43 (43%)52 (41.9%)NSMono neuropathy9(1.4%)Histone27 (27%)40 (32.3%)NSMyasthenia Gravis0Ribo P25(25%)37(29.6%)NSPlexopathy0RNP/Sm43(43%)52(41.6%)NSPolyneuropathy12(1.9%)scl704(4%)5(4%)NSSSA34(34%)42(33.6%)NSPsychiatric17(2.7%)SSB10(10%)18(14.5%)NSMood Disorders8(1.3%)Ro5232(32%)39(31.2%)NSPsychosis13(2.1%)PmScl05(4%)NSAnxiety Disorder4(0.6%)PCNA2(2%)6(4.8%)NS

Conclusion:

Seizures and CVA are the commonest NPSLE syndromes. APl positivity was not associated with NPSLE in our cohort.

Disclosure of Interests:

None declared

Consensus document: management of heart failure in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a known predisposing factor for heart failure (HF). The growing burden of these two conditions and their impact on health of the individual and on society in general needs urgent attention from the health care professionals. Availability of multiple treatment choices for managing T2DM and HF may make therapeutic decisions more complex for clinicians. Recent cardiovascular outcome trials of antidiabetic drugs have added very robust evidence to effectively manage subjects with this dual condition. This consensus statement provides the prevalence trends and the impact of this dual burden on patients. In addition, it concisely narrates the types of HF, the different treatment algorithms, and recommendations for physicians to comprehensively manage such patients.

Hindi LupusPRO: cross cultural validation of disease specific patient reported outcome measure of lupus

Background

LupusPRO is a SLE specific patient reported outcomes measure developed and validated in the USA. This study aimed to validate the Hindi version of LupusPRO in systemic lupus erythematosus (SLE) patients in India.

Methods

Disease activity and damage were assessed using SELENA–SLEDAI and SLICC/ACR damage Index respectively. Demographic and clinical features were recorded. The Hindi Version of LupusPRO and 36-Item Short Form Health Survey (SF-36) were administered for assessment of quality of life. Depression, anxiety and fatigue were assessed using Patient Health Questionnaire 9 (PHQ9), Generalized Anxiety Disorder 7 (GAD7) and Fatigue Severity Scale (FSS) respectively. Internal consistency reliability, test-retest reliability, convergent and discriminant validity (against corresponding domains of the SF-36, fatigue, depression and anxiety), criterion validity (against disease activity and damage) and known group validity were tested.

Results

A total of 144 (140 females) patients with SLE with a mean age of 32.48 ± 7.26 years participated in the study. The median (interquartile range) SELENA SLEDAI was 2 (5.5). The internal consistency reliability of the LupusPRO domains was >0.7 for most domains (except for lupus symptoms, lupus medication, procreation and social support).We noted good convergent validity of LupusPRO domains with corresponding domains of SF-36, pain vitality with fatigue (FSS) and emotional health domain with depression (PHQ9) and anxiety (GAD7). Criterion validity of lupus symptoms with disease activity was observed. Known group validity of the LupusPRO domains with patient reported health status was observed. Confirmatory factor analysis showed a good fit.

Conclusion

The Hindi LupusPRO has fair psychometric properties among Indian patients with SLE.

Paclitaxel-eluting stents versus everolimus-eluting coronary stents in a diabetic population: two-year follow-up of the TUXEDO-India trial

AIMS

The aim of this study was to report whether the superiority of the everolimus-eluting stent (EES) vs. the paclitaxel-eluting stent (PES) at one-year follow-up in the Taxus Element versus Xience Prime in a Diabetic Population (TUXEDO)-India trial was sustained at longer-term follow-up.

METHODS AND RESULTS

One thousand eight hundred and thirty (1,830) patients with diabetes mellitus and coronary artery disease were randomised to EES vs. PES. Follow-up data up to two years were available in 1,701 (92.9%) patients. The primary endpoint was target vessel failure (TVF), defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI), or ischaemia-driven target vessel revascularisation (TVR). Treatment with EES had a lower two-year rate of TVF (4.3% vs. 6.6%, p=0.03). Of the secondary endpoints, EES significantly reduced any MI (1.6% vs. 3.5%, p=0.01), TV-MI (0.7% vs. 3.1%, p=0.0001), ST (0.4% vs. 2.2%, p=0.001), cardiac death or target vessel MI (2.9% vs. 4.8%, p=0.04) and TLR (1.9% vs. 3.7%, p=0.02), compared with PES. Between one year and two years, no significant differences in the clinical outcomes were observed (pinteraction >0.05).

CONCLUSIONS

In this adequately powered trial, the benefits of EES vs. PES in a diabetic population seen at one year were maintained at two years.

Percutaneous Coronary Intervention in Patients With Insulin-Treated and Non-Insulin-Treated Diabetes Mellitus: Secondary Analysis of the TUXEDO Trial

IMPORTANCE

Prior studies have shown that patients with insulin-treated diabetes mellitus (ITDM) have a higher risk of cardiovascular events. However, this finding is controversial, as other studies have shown that the increased risk of cardiovascular events disappears after risk adjustment. In addition, the choice of a drug-eluting stent (limus- vs taxol-eluting) in ITDM is controversial, with studies showing worse outcomes with an everolimus-eluting stent compared with a paclitaxel-eluting stent.

OBJECTIVES

To assess the outcomes of patients with ITDM vs non-ITDM who underwent percutaneous coronary intervention and to assess the efficacy and safety of an everolimus-eluting stent vs a paclitaxel-eluting stent based on insulin use status.

DESIGN, SETTING, AND PARTICIPANTS

A prespecified analysis was conducted of the Taxus Element vs Xience Prime in a Diabetic Population (TUXEDO) clinical trial, which enrolled 1830 patients with ITDM and non-ITDM from June 23, 2011, to March 12, 2014. Patients were randomized 1:1 to receive either a paclitaxel-eluting stent or an everolimus-eluting stent.

MAIN OUTCOMES AND MEASURES

The primary end point was target vessel failure, defined as the composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization at 1 year after the intervention.

RESULTS

Among the 1830 patients (1377 male) in the TUXEDO trial, 747 patients (40.8%) were receiving insulin (ITDM group). Compared with the 1083 patients with non-ITDM, those with ITDM had a significant increase in target vessel failure (42 [5.6%] vs 36 [3.3%]; P = .02), death or myocardial infarction (43 [5.8%] vs 35 [3.2%]; P = .009), death (26 [3.5%] vs 18 [1.7%]; P = .01), and subacute stent thrombosis (8 [1.1%] vs 3 [0.3%]; P = .03). However, in a propensity score-adjusted analysis to account for baseline differences between the 2 groups, the differences in outcomes were no longer significant. In patients with ITDM, everolimus-eluting stents reduced the rate of target vessel failure (13 of 382 [3.4%] vs 29 of 365 [7.9%]; P = .007), major adverse cardiac events (15 of 382 [3.9%] vs 30 of 365 [8.2%]; P = .01), myocardial infarction (5 of 382 [1.3%] vs 16 of 365 [4.4%]; P = .01), stent thrombosis (2 of 382 [0.5%] vs 11 of 365 [3.0%]; P = .009), target lesion revascularization (4 of 382 [1.0%] vs 19 of 365 [5.2%]; P = .001), and target vessel revascularization (4 of 382 [1.0%] vs 19 of 365 [5.2%]; P = .001) when compared with paclitaxel-eluting stents. The results largely trended in the same direction in patients with non-ITDM (P > .05 for the interaction).

CONCLUSIONS AND RELEVANCE

Patients with ITDM had a significant increase in the risk of cardiovascular events in unadjusted models that was largely attenuated after propensity score adjustment. Everolimus-eluting stents reduced the rate of cardiovascular events, including stent thrombosis, when compared with paclitaxel-eluting stents in patients with ITDM.

TRIAL REGISTRATION

ctri.nic.in Identifier: CTRI/2011/06/001830.

Transradial access for coronary diagnostic and interventional procedures: Consensus statement and recommendations for India: Advancing Complex CoronariES Sciences through TransRADIAL intervention in India - ACCESS RADIAL™: Clinical consensus recommendations in collaboration with Cardiological Society of India (CSI)

Radial access for cardiac catheterization and intervention in India has been growing steadily over the last decade with favorable clinical outcomes. However, its usage by interventional cardiologists varies greatly among Indian operators and hospitals due to large geographic disparities in health care delivery systems and practice patterns. It also remains unclear whether the advantages, as well as limitations of transradial (TR) intervention (as reported in the western literature), are applicable to developing countries like India or not. An evidence-based review involving various facets of radial procedure for cardiac catheterization, including practical, patient-related and technical issues was conducted by an expert committee that formed a part of Advancing Complex CoronariES Sciences through TransRADIAL intervention (ACCESS RADIAL™) Advisory Board. Emerging challenges in redefining TR management based on evidence supporting practices were discussed to formulate these final recommendations through consensus.

Impact of Displaying Inpatient Pharmaceutical Costs at the Time of Order Entry: Lessons From a Tertiary Care Center

BACKGROUND

A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital.

OBJECTIVE

To evaluate the impact of cost messaging on the ordering of 9 expensive medications.

DESIGN

Retrospective analysis of an institutional cost-transparency initiative.

SETTING

A 1145-bed, tertiary care, academic medical center.

PARTICIPANTS

Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital.

METHODS

Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications.

RESULTS

Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days; 𝑃 < 0.001), and oral voriconazole was replaced with an alternative antifungal in oncology order sets (-110 orders per 10,000 patient days; 𝑃 = 0.001).

CONCLUSIONS

Prescriber cost transparency alone did not significantly influence medication utilization at our institution. Active strategies to reduce ordering resulted in dramatic reductions in ordering.

Platelets Structure, Function and Modulator Capacity in Replacement Therapy

INTRODUCTION

Patients with severe thrombocytopenia are presumed to be at increased risk for bleeding, and consequently it has been a standard practice for the past four decades to give allogeneic platelet transfusions to severely thrombocytopenic patients as supportive care. Platelet transfusions may be given either prophylactically to reduce the risk of bleeding, in the absence of clinical hemorrhage (prophylactic transfusions), or to control active bleeding when present (therapeutic transfusions).

CONCLUSION

Here we review the structure and function of platelets and discuss the mechanisms of alloimmunization to platelet transfusion.

Performance of pile-up mitigation techniques for jets in [Formula: see text] collisions at [Formula: see text] TeV using the ATLAS detector

The large rate of multiple simultaneous proton-proton interactions, or pile-up, generated by the Large Hadron Collider in Run 1 required the development of many new techniques to mitigate the adverse effects of these conditions. This paper describes the methods employed in the ATLAS experiment to correct for the impact of pile-up on jet energy and jet shapes, and for the presence of spurious additional jets, with a primary focus on the large 20.3 [Formula: see text] data sample collected at a centre-of-mass energy of [Formula: see text]. The energy correction techniques that incorporate sophisticated estimates of the average pile-up energy density and tracking information are presented. Jet-to-vertex association techniques are discussed and projections of performance for the future are considered. Lastly, the extension of these techniques to mitigate the effect of pile-up on jet shapes using subtraction and grooming procedures is presented.

Total arterial anaortic off-pump coronary artery bypass grafting in a patient with heart failure - Case report

A 69-year-old male diabetic patient of heart failure underwent successful off-pump coronary artery bypass grafting (CABG) using both internal thoracic arteries and left radial artery. There was improvement of left ventricular ejection fraction within 4 days. This is the first ever case report of off-pump CABG in a heart failure patient.

Clinical and Business Intelligence: Why It's Important to Your Pharmacy

According to the Healthcare Information Management and Systems Society, "Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making" (http://www.himss.org/library/clinical-business-intelligence). Some say that it is the right information given to the right person at the right time in the right way. No matter how you define it, the fact remains that timely access, synthesis, and visualization of clinical data have become key to how health professionals make patient care decisions and improve care delivery.

Digital Health Solutions: An Important Tool in Patient Engagement

Hospitals and health systems are facing increased pressure to improve quality and outcomes while reducing expense. Quality-based reimbursement models are providing the necessary incentives for health care institutions to focus on issues such as avoidable hospital-acquired conditions and 30-day readmission rates. While our health care facilities certainly play a vital role in achieving optimal outcomes, patient engagement remains at the center of these efforts.

Matrix metalloproteinase (MMP)-9: A realiable marker for inflammation in early human trichinellosis

Matrix Metalloproteinases (MMPs) are involved in many physiological and pathological processes. As regards parasitic infections, the role of these proteins has been particularly studied in malaria, neurocysticercosis and angiostrongyloidosis. Recently, we evaluated serum levels of MMP-9 and -2 (gelatinases) in mice experimentally infected with Trichinella spiralis or Trichinella pseudospiralis, which cause different degrees of myositis and we found their significant increase in the former and, at a lesser extent, in the latter, thus suggesting the possibility that these gelatinases, particularly MMP-9, represent a marker of inflammation. Our aim was to evaluate the levels of MMP-9 and 2 in trichinellosis patients, to assess their possible clinical significance. Serum samples from 31 Trichinella britovi-infected individuals (20 males and 11 females), living in Tuscany, Central Italy, were analysed for MMP-9 and MMP-2 serum levels. Patients acquired infection with Trichinella after consuming raw or undercooked meat of wild boar. Their median age was 49±0.33years (range from 7 to 91). Sera was collected before starting anti-inflammatory treatment, aliquoted and stored at -20°C until use. Sera from healthy subjects was considered as controls. The gelatinolytic activity of MMPs was analysed by gelatin zymography on 8% polyacrylamide-SDS gels containing 0.1% porcine gelatin, under non-reducing conditions. Clear bands corresponding to the digested areas were evaluated with an appropriate software. MMP-9 levels were additionally determined in 15 patients using a commercial ELISA kit for human MMP-9. The zymographic analysis of the gels showed the presence in serum samples of gelatinase bands at approximately 125-kDa, 92-kDa and 72-kDa, corresponding to the MMP-9/Neutrophil gelatinase-associated lipocalin (NGAL) complex and proenzyme forms of MMP-9 and MMP-2, respectively. A significant (p<0.01) increase in gelatinolytic activity in patients compared to the control group was observed for pro-MMP-9 in 25 out of 31. The mean increase in activity was 39.25%±16.67%. No significant differences were observed for pro-MMP-2 activity. The MMP-9 levels detected by ELISA showed significant correlation with zymographic data (r²=0.62, p<0.003) and were higher in more affected patients (suffering diarrhea, facial edemas and myalgia). In conclusion, MMP-9 might be considered as a marker of inflammation in T. britovi patients. On the contrary, MMP-2 did not result significantly different in patients, compared to controls.

Measurement of the centrality dependence of the charged-particle pseudorapidity distribution in proton-lead collisions at [Formula: see text] TeV with the ATLAS detector

The centrality dependence of the mean charged-particle multiplicity as a function of pseudorapidity is measured in approximately 1 [Formula: see text]b[Formula: see text] of proton-lead collisions at a nucleon-nucleon centre-of-mass energy of [Formula: see text] [Formula: see text] using the ATLAS detector at the Large Hadron Collider. Charged particles with absolute pseudorapidity less than 2.7 are reconstructed using the ATLAS pixel detector. The [Formula: see text] collision centrality is characterised by the total transverse energy measured in the Pb-going direction of the forward calorimeter. The charged-particle pseudorapidity distributions are found to vary strongly with centrality, with an increasing asymmetry between the proton-going and Pb-going directions as the collisions become more central. Three different estimations of the number of nucleons participating in the [Formula: see text] collision have been carried out using the Glauber model as well as two Glauber-Gribov inspired extensions to the Glauber model. Charged-particle multiplicities per participant pair are found to vary differently for these three models, highlighting the importance of including colour fluctuations in nucleon-nucleon collisions in the modelling of the initial state of [Formula: see text] collisions.

Time to shift from contemporary to high-sensitivity cardiac troponin in diagnosis of acute coronary syndromes

Early rule-in and rule-out of non-ST-segment elevation myocardial infarction (NSTEMI) is a challenge. In patients with inconclusive findings on ECG, cardiac biomarkers play a crucial role in the diagnosis. The introduction of the new high-sensitive cardiac troponin test (hs-TnI assay) has changed the landscape of NSTEMI diagnosis.

The new hs-TnI assay can detect troponin values at a lower level compared with a contemporary cardiac troponin (cTn) assay. The hs-cTnI assay has a coefficient of variation of ≤10%, well below the 99th percentile value. It reduces the time to diagnose acute myocardial infarction from 6 h to 3 h. A recent study has demonstrated that hs-cTnI can further reduce the time to 1 h in 70% of all patients with chest pain.

The European Society of Cardiology 2015 guidelines recommend including a second sample of hs-cTnI within 3 h of presentation This increases the sensitivity of the hs-TnI assay from 82.3% (at admission) to 98.2% and negative predictive value from 94.7% (at admission) to 99.4%. Combining the 99th percentile at admission with serial changes in troponin increases the positive predictive value to rule in acute coronary syndrome from 75.1% at admission to 95.8% after 3 h.

The 2015 ESC Guidelines recommend the use of a rapid rule out protocol (0 h and 1 h) when hs-cTnI with a validated 0 to1 h algorithm is available.

Training and displaying the clinical algorithm depicting the role of hs-TnI assay in acute cardiac care units and in EDs are an efficient way to deliver the new standard of care to patients. Compared with contemporary troponin assays, the hs-cTn assay accelerates the diagnostic pathway to 0–1 h, thus reducing the time for diagnosis of NSTEMI and hence, its management.

Study of the [Formula: see text] and [Formula: see text] decays with the ATLAS detector

The decays [Formula: see text] and [Formula: see text] are studied with the ATLAS detector at the LHC using a dataset corresponding to integrated luminosities of 4.9 and 20.6 fb[Formula: see text] of pp collisions collected at centre-of-mass energies [Formula: see text] TeV and 8 TeV, respectively. Signal candidates are identified through [Formula: see text] and [Formula: see text] decays. With a two-dimensional likelihood fit involving the [Formula: see text] reconstructed invariant mass and an angle between the [Formula: see text] and [Formula: see text] candidate momenta in the muon pair rest frame, the yields of [Formula: see text] and [Formula: see text], and the transverse polarisation fraction in [Formula: see text] decay are measured. The transverse polarisation fraction is determined to be [Formula: see text], and the derived ratio of the branching fractions of the two modes is [Formula: see text], where the first error is statistical and the second is systematic. Finally, a sample of [Formula: see text] decays is used to derive the ratios of branching fractions [Formula: see text] and [Formula: see text], where the third error corresponds to the uncertainty of the branching fraction of [Formula: see text] decay. The available theoretical predictions are generally consistent with the measurement.

Measurements of the Higgs boson production and decay rates and coupling strengths using pp collision data at [Formula: see text] and 8 TeV in the ATLAS experiment

Combined analyses of the Higgs boson production and decay rates as well as its coupling strengths to vector bosons and fermions are presented. The combinations include the results of the analyses of the [Formula: see text] and [Formula: see text] decay modes, and the constraints on the associated production with a pair of top quarks and on the off-shell coupling strengths of the Higgs boson. The results are based on the LHC proton-proton collision datasets, with integrated luminosities of up to 4.7 [Formula: see text] at [Formula: see text] TeV and 20.3 [Formula: see text] at [Formula: see text] TeV, recorded by the ATLAS detector in 2011 and 2012. Combining all production modes and decay channels, the measured signal yield, normalised to the Standard Model expectation, is [Formula: see text]. The observed Higgs boson production and decay rates are interpreted in a leading-order coupling framework, exploring a wide range of benchmark coupling models both with and without assumptions on the Higgs boson width and on the Standard Model particle content in loop processes. The data are found to be compatible with the Standard Model expectations for a Higgs boson at a mass of 125.36 GeV for all models considered.

ATLAS Run 1 searches for direct pair production of third-generation squarks at the Large Hadron Collider

This paper reviews and extends searches for the direct pair production of the scalar supersymmetric partners of the top and bottom quarks in proton-proton collisions collected by the ATLAS collaboration during the LHC Run 1. Most of the analyses use 20 [Formula: see text] of collisions at a centre-of-mass energy of [Formula: see text] TeV, although in some case an additional [Formula: see text] of collision data at [Formula: see text] TeV are used. New analyses are introduced to improve the sensitivity to specific regions of the model parameter space. Since no evidence of third-generation squarks is found, exclusion limits are derived by combining several analyses and are presented in both a simplified model framework, assuming simple decay chains, as well as within the context of more elaborate phenomenological supersymmetric models.

ATLAS Run 1 searches for direct pair production of third-generation squarks at the Large Hadron Collider

This paper reviews and extends searches for the direct pair production of the scalar supersymmetric partners of the top and bottom quarks in proton-proton collisions collected by the ATLAS collaboration during the LHC Run 1. Most of the analyses use 20 [Formula: see text] of collisions at a centre-of-mass energy of [Formula: see text] TeV, although in some case an additional [Formula: see text] of collision data at [Formula: see text] TeV are used. New analyses are introduced to improve the sensitivity to specific regions of the model parameter space. Since no evidence of third-generation squarks is found, exclusion limits are derived by combining several analyses and are presented in both a simplified model framework, assuming simple decay chains, as well as within the context of more elaborate phenomenological supersymmetric models.

Study of the spin and parity of the Higgs boson in diboson decays with the ATLAS detector

Studies of the spin, parity and tensor couplings of the Higgs boson in the [Formula: see text], [Formula: see text] and [Formula: see text] decay processes at the LHC are presented. The investigations are based on [Formula: see text] of pp collision data collected by the ATLAS experiment at [Formula: see text] TeV and [Formula: see text] TeV. The Standard Model (SM) Higgs boson hypothesis, corresponding to the quantum numbers [Formula: see text], is tested against several alternative spin scenarios, including non-SM spin-0 and spin-2 models with universal and non-universal couplings to fermions and vector bosons. All tested alternative models are excluded in favour of the SM Higgs boson hypothesis at more than 99.9 % confidence level. Using the [Formula: see text] and [Formula: see text] decays, the tensor structure of the interaction between the spin-0 boson and the SM vector bosons is also investigated. The observed distributions of variables sensitive to the non-SM tensor couplings are compatible with the SM predictions and constraints on the non-SM couplings are derived.

Two-particle Bose-Einstein correlations in pp collisions at [Formula: see text] 0.9 and 7 TeV measured with the ATLAS detector

The paper presents studies of Bose-Einstein Correlations (BEC) for pairs of like-sign charged particles measured in the kinematic range [Formula: see text] 100 MeV and [Formula: see text] 2.5 in proton collisions at centre-of-mass energies of 0.9 and 7 TeV with the ATLAS detector at the CERN Large Hadron Collider. The integrated luminosities are approximately 7 [Formula: see text]b[Formula: see text], 190 [Formula: see text]b[Formula: see text] and 12.4 nb[Formula: see text] for 0.9 TeV, 7 TeV minimum-bias and 7 TeV high-multiplicity data samples, respectively. The multiplicity dependence of the BEC parameters characterizing the correlation strength and the correlation source size are investigated for charged-particle multiplicities of up to 240. A saturation effect in the multiplicity dependence of the correlation source size parameter is observed using the high-multiplicity 7 TeV data sample. The dependence of the BEC parameters on the average transverse momentum of the particle pair is also investigated.

Search for Dark Matter in Events with Missing Transverse Momentum and a Higgs Boson Decaying to Two Photons in pp Collisions at sqrt[s]=8 TeV with the ATLAS Detector

Results of a search for new phenomena in events with large missing transverse momentum and a Higgs boson decaying to two photons are reported. Data from proton-proton collisions at a center-of-mass energy of 8 TeV and corresponding to an integrated luminosity of 20.3 fb^{-1} have been collected with the ATLAS detector at the LHC. The observed data are well described by the expected standard model backgrounds. Upper limits on the cross section of events with large missing transverse momentum and a Higgs boson candidate are also placed. Exclusion limits are presented for models of physics beyond the standard model featuring dark-matter candidates.

Search for Higgs boson pair production in the [Formula: see text] final state from pp collisions at [Formula: see text] TeVwith the ATLAS detector

A search for Higgs boson pair production [Formula: see text] is performed with 19.5 fb[Formula: see text] of proton-proton collision data at [Formula: see text] TeV, which were recorded by the ATLAS detector at the Large Hadron Collider in 2012. The decay products of each Higgs boson are reconstructed as a high-momentum [Formula: see text] system with either a pair of small-radius jets or a single large-radius jet, the latter exploiting jet substructure techniques and associated b-tagged track-jets. No evidence for resonant or non-resonant Higgs boson pair production is observed. The data are interpreted in the context of the Randall-Sundrum model with a warped extra dimension as well as the two-Higgs-doublet model. An upper limit on the cross-section for [Formula: see text] of 3.2 (2.3) fb is set for a Kaluza-Klein graviton [Formula: see text] mass of 1.0 (1.5) TeV, at the 95 % confidence level. The search for non-resonant Standard Model hh production sets an observed 95 % confidence level upper limit on the production cross-section [Formula: see text] of 202 fb, compared to a Standard Model prediction of [Formula: see text] fb.

Search for metastable heavy charged particles with large ionisation energy loss in pp collisions at [Formula: see text] TeV using the ATLAS experiment

Many extensions of the Standard Model predict the existence of charged heavy long-lived particles, such as R-hadrons or charginos. These particles, if produced at the Large Hadron Collider, should be moving non-relativistically and are therefore identifiable through the measurement of an anomalously large specific energy loss in the ATLAS pixel detector. Measuring heavy long-lived particles through their track parameters in the vicinity of the interaction vertex provides sensitivity to metastable particles with lifetimes from 0.6 ns to 30 ns. A search for such particles with the ATLAS detector at the Large Hadron Collider is presented, based on a data sample corresponding to an integrated luminosity of [Formula: see text] fb[Formula: see text] of pp collisions at [Formula: see text] TeV. No significant deviation from the Standard Model background expectation is observed, and lifetime-dependent upper limits on R-hadrons and chargino production are set. Gluino R-hadrons with 10 ns lifetime and masses up to 1185 GeV are excluded at 95 [Formula: see text] confidence level, and so are charginos with 15 ns lifetime and masses up to 482 GeV.

Measurements of the Total and Differential Higgs Boson Production Cross Sections Combining the H→γγ and H→ZZ^{*}→4ℓ Decay Channels at sqrt[s]=8 TeV with the ATLAS Detector

Measurements of the total and differential cross sections of Higgs boson production are performed using 20.3  fb^{-1} of pp collisions produced by the Large Hadron Collider at a center-of-mass energy of sqrt[s]=8  TeV and recorded by the ATLAS detector. Cross sections are obtained from measured H→γγ and H→ZZ^{*}→4ℓ event yields, which are combined accounting for detector efficiencies, fiducial acceptances, and branching fractions. Differential cross sections are reported as a function of Higgs boson transverse momentum, Higgs boson rapidity, number of jets in the event, and transverse momentum of the leading jet. The total production cross section is determined to be σ_{pp→H}=33.0±5.3 (stat)±1.6 (syst)  pb. The measurements are compared to state-of-the-art predictions.

Search for heavy long-lived multi-charged particles in pp collisions at [Formula: see text] TeV using the ATLAS detector

A search for heavy long-lived multi-charged particles is performed using the ATLAS detector at the LHC. Data collected in 2012 at [Formula: see text] TeV from pp collisions corresponding to an integrated luminosity of 20.3 fb[Formula: see text]are examined. Particles producing anomalously high ionisation, consistent with long-lived massive particles with electric charges from [Formula: see text] to [Formula: see text] are searched for. No signal candidate events are observed, and 95 % confidence level cross-section upper limits are interpreted as lower mass limits for a Drell-Yan production model. The mass limits range between 660 and 785 GeV.

Search for the Standard Model Higgs boson produced in association with top quarks and decaying into [Formula: see text] in [Formula: see text] collisions at [Formula: see text] with the ATLAS detector

A search for the Standard Model Higgs boson produced in association with a top-quark pair, [Formula: see text], is presented. The analysis uses 20.3 fb-1 of pp collision data at [Formula: see text], collected with the ATLAS detector at the Large Hadron Collider during 2012. The search is designed for the [Formula: see text] decay mode and uses events containing one or two electrons or muons. In order to improve the sensitivity of the search, events are categorised according to their jet and b-tagged jet multiplicities. A neural network is used to discriminate between signal and background events, the latter being dominated by [Formula: see text]+jets production. In the single-lepton channel, variables calculated using a matrix element method are included as inputs to the neural network to improve discrimination of the irreducible [Formula: see text] background. No significant excess of events above the background expectation is found and an observed (expected) limit of 3.4 (2.2) times the Standard Model cross section is obtained at 95 % confidence level. The ratio of the measured [Formula: see text] signal cross section to the Standard Model expectation is found to be [Formula: see text] assuming a Higgs boson mass of 125[Formula: see text].

Search for invisible decays of the Higgs boson produced in association with a hadronically decaying vector boson in pp collisions at [Formula: see text] TeV with the ATLAS detector

A search for Higgs boson decays to invisible particles is performed using 20.3 [Formula: see text] of pp collision data at a centre-of-mass energy of 8 TeV recorded by the ATLAS detector at the Large Hadron Collider. The process considered is Higgs boson production in association with a vector boson ([Formula: see text] or Z) that decays hadronically, resulting in events with two or more jets and large missing transverse momentum. No excess of candidates is observed in the data over the background expectation. The results are used to constrain VH production followed by H decaying to invisible particles for the Higgs boson mass range [Formula: see text] GeV. The 95 % confidence-level observed upper limit on [Formula: see text] varies from 1.6 pb at 115 GeV to 0.13 pb at 300 GeV. Assuming Standard Model production and including the [Formula: see text] contribution as signal, the results also lead to an observed upper limit of 78 % at 95 % confidence level on the branching ratio of Higgs bosons decays to invisible particles at a mass of 125 GeV.

Constraints on the off-shell Higgs boson signal strength in the high-mass ZZ and WW final states with the ATLAS detector

Measurements of the ZZ and WW final states in the mass range above the [Formula: see text] and [Formula: see text] thresholds provide a unique opportunity to measure the off-shell coupling strength of the Higgs boson. This paper presents constraints on the off-shell Higgs boson event yields normalised to the Standard Model prediction (signal strength) in the [Formula: see text], [Formula: see text] and [Formula: see text] final states. The result is based on pp collision data collected by the ATLAS experiment at the LHC, corresponding to an integrated luminosity of 20.3 fb[Formula: see text] at a collision energy of [Formula: see text] TeV. Using the [Formula: see text] method, the observed 95 [Formula: see text] confidence level (CL) upper limit on the off-shell signal strength is in the range 5.1-8.6, with an expected range of 6.7-11.0. In each case the range is determined by varying the unknown [Formula: see text] and [Formula: see text] background K-factor from higher-order quantum chromodynamics corrections between half and twice the value of the known signal K-factor. Assuming the relevant Higgs boson couplings are independent of the energy scale of the Higgs boson production, a combination with the on-shell measurements yields an observed (expected) 95 [Formula: see text] CL upper limit on [Formula: see text] in the range 4.5-7.5 (6.5-11.2) using the same variations of the background K-factor. Assuming that the unknown [Formula: see text] background K-factor is equal to the signal K-factor, this translates into an observed (expected) 95 [Formula: see text] CL upper limit on the Higgs boson total width of 22.7 (33.0) MeV.

Search for a Heavy Neutral Particle Decaying to eμ, eτ, or μτ in pp Collisions at sqrt[s]=8 TeV with the ATLAS Detector

This Letter presents a search for a heavy neutral particle decaying into an opposite-sign different-flavor dilepton pair, e^{±}μ^{∓}, e^{±}τ^{∓}, or μ^{±}τ^{∓} using 20.3  fb^{-1} of pp collision data at sqrt[s]=8  TeV collected by the ATLAS detector at the LHC. The numbers of observed candidate events are compatible with the standard model expectations. Limits are set on the cross section of new phenomena in two scenarios: the production of ν[over ˜]_{τ} in R-parity-violating supersymmetric models and the production of a lepton-flavor-violating Z^{'} vector boson.

Evidence of Wγγ Production in pp Collisions at sqrt[s]=8 TeV and Limits on Anomalous Quartic Gauge Couplings with the ATLAS Detector

This Letter reports evidence of triple gauge boson production pp→W(ℓν)γγ+X, which is accessible for the first time with the 8 TeV LHC data set. The fiducial cross section for this process is measured in a data sample corresponding to an integrated luminosity of 20.3  fb^{-1}, collected by the ATLAS detector in 2012. Events are selected using the W boson decay to eν or μν as well as requiring two isolated photons. The measured cross section is used to set limits on anomalous quartic gauge couplings in the high diphoton mass region.