OR [95%CI, 95% confidence interval] per doubling NT-proBNP 1.26 [1.07-1.49]; per 10 mL/min/1.73 m2 eGFR decrease 1.16 [1.03-1.31]). Higher loop diuretic doses, lower aldosterone antagonist doses, and higher eGFR predicted WRF (furosemide per 40 mg increase 1.32 [1.08-1.62]; spironolactone per 25 mg decrease 1.76 [1.07-2.89]; per 10 mL/min/1.73 m2 eGFR increase 1.40 [1.20-1.63]). WRF and higher rank of tubular injury individually entailed higher risk of the composite endpoint (adjusted hazard ratios, adj. find more HR [95%CI] WRF 1.9 [1.1-3.4], tubular 8.4 [2.6-27.9]; when combined risk was highest 15.0 [2.0-111.0]). CONCLUSION Slopes of tubular damage and WRF biomarkers had different clinical determinants. Both predicted clinical outcome, but this association was stronger for tubular injury. Prognostic effects of both appeared independent and additive. © 2020 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.BACKGROUND AND METHODS There is an added level of complexity in the management of head and neck cancer patients with underlying immunosuppressive disorders during the COVID-19 pandemic. Head and neck oncologists are tasked with balancing the dual risks of cancer progression in the setting of impaired tumor immunity and increased susceptibility to life-threatening complications from exposure to viral infection for patients and providers. Through two cases of immunocompromised patients with newly diagnosed head and neck malignancies, we aim to provide guidance to clinicians struggling with how to best counsel and manage this unique subset of patients under these difficult circumstances. RESULTS After careful consideration of the options, we took different approaches in the care of these two patients. CONCLUSIONS Ultimately, there is no uniform set of rules to apply to this heterogeneous group of immunocompromised patients. We provide some general principles to help guide patient management during the current pandemic. © 2020 Wiley Periodicals, Inc.OBJECTIVE To evaluate the impact of 2016 ASE/EACVI guidelines on Diastolic Function (DF) reporting during routine clinical practice. METHODS Transthoracic echos performed 9 months before and 18 months after the 2016 guidelines (DF2016) were retrospectively analyzed. RESULTS Twenty thousand eight hundred forty three echos performed between July 1, 2015, and September 30, 2017, were analyzed. Quarterly trends showed a stable proportion of normal DF (nDF), diastolic dysfunction (DD), indeterminate DF (DF-I), and nonreported DF (DF-NR) for 3 quarters preceding DF2016. After DF2016 release, reporting of DD decreased by 57% (P  less then  .001), nDF increased by 76% (P  less then  .001), DF-NR increased by 266% (P  less then  .001), and DF-I did not change significantly (P = .40). Grade 1 DD decreased by 64% (P  less then  .001), grade 2 DD decreased by 51% (P  less then  .001), and grade 3 DD did not change significantly (P = .18). Provider level analysis showed increased heterogeneity in grade 1 DD reporting and decreased heterogeneity in DD grades 2 or higher, after DF2016. Systolic dysfunction reporting remained relatively stable (22%→21%→20%) compared to a significant decrease in isolated DD (35%→21%→10%). CONCLUSION The 2016 guidelines update has impacted DF reporting patterns significantly. The likelihood of reporting DD decreased significantly, especially for grades 1 and 2. Inter-provider heterogeneity in DF reporting improved for grades 2 and 3 but worsened for grade 1. There was more than threefold increase in failure to report DF, suggesting a decrease in provider confidence. © 2020 Wiley Periodicals, Inc.INTRODUCTION Pedicled perforator flaps are widely used for soft tissue reconstruction, but evidence in literature about risk factors associated with complications is still controvert. The aim of this study is to evaluate risk factors and outcomes associated with pedicled perforator-based flaps harvested at different anatomical sites. PATIENTS AND METHODS Seventy-one propeller and 59 V-Y advancement flaps were performed to reconstruct defects of the face (24 cases), trunk (47 cases), and extremities (59 cases). Mean defect and flap area were 32.43 and 43.2 cm2 , respectively. The average age recorded was 66 years. We statistically analyzed whether patient and flap-related variables had an impact on flap vascular complications rate. Patients were asked to rate on a 5-point Likert scale the aesthetic and functional outcomes of the surgery. RESULTS Overall flap complications rate was 23.07%. Coronary heart disease was an independent risk factor for flap complications (p = .010), while hypertension was associated with a lower complication rate (p = .010). The increasing degree of pedicle rotation had a significant impact on the development of flap vascular complications (p = .008). Mean patients’ aesthetic and functional ratings were 4.23 of 5 and 4.37 of 5, respectively. CONCLUSIONS We found a positive correlation between both coronary heart disease and increasing degree of pedicle rotation and complications. Other factors tested were not significantly associated with complications. Patients were overall satisfied with both the aesthetic and functional outcomes of the procedure. The decisional algorithm hereby suggested yields a 93.1% overall success rate and we believe it could be of help to plastic surgeons approaching soft tissue defects. © 2020 Wiley Periodicals, Inc.As social animals, many primates use acoustic communication to maintain relationships. Vocal individuality has been documented in a diverse range of primate species and call types, many of which have presumably different functions. Auditory recognition of one’s neighbors may confer a selective advantage if identifying conspecifics decreases the need to participate in costly territorial behaviors. Alternatively, vocal individuality may be nonadaptive and the result of a unique combination of genetics and environment. Pair-bonded primates, in particular, often participate in coordinated vocal duets that can be heard over long distances by neighboring conspecifics. In contrast to adult calls, infant vocalizations are short-range and used for intragroup communication. Here, we provide two separate but complementary analyses of vocal individuality in distinct call types of coppery titi monkeys (Plecturocebus cupreus) to test whether individuality occurs in call types from animals of different age classes with presumably different functions.