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BackgroundTo determine whether granulocyte colony-stimulating factor (G-CSF) improves clinical outcomes after large ST-elevation myocardial infarction (STEMI) when administered early in patients with left ventricular (LV) dysfunction after successful percutaneous coronary intervention (PCI).MethodsSTEM-AMI OUTCOME was designed as a prospective, multicentre, nationwide, randomised, open-label, phase III trial (ClinicalTrials.gov ID: NCT01969890) to demonstrate the efficacy and safety of early G-CSF administration in reducing 2-year cardiac mortality and morbidity in patients with STEMI with LV ejection fraction ≤45% after PCI. The primary outcome was a composite of all-cause death, recurrence of myocardial infarction and hospitalisation for heart failure. Due to low recruitment and event rates, the study was discontinued and did not achieve adequate statistical power to verify the hypothesis.ResultsPatients were randomly allocated to G-CSF (n=260) or standard of care (SOC; n=261). No difference was found in the composite primary outcome between study groups (HR 1.20; 95% CI 0.63 to 2.28). The 2-year mortality was 2.31% in the G-CSF and 2.68% in the control group (HR 0.88; 95% CI 0.29 to 2.60). Adverse events did not differ between the G-CSF (n=65) and SOC groups (n=58; OR 1.17; 95% CI 0.78 to 1.75). In post hoc analyses on the intervention group, we observed a trend towards fewer composite primary outcomes in patients with low bone marrow (BM) cell mobilisation (n=108) versus those with high mobilisation (n=152, with peak leucocyte count >50×109/L; HR 2.86; 95% CI 0.96 to 8.56). Primary outcomes were lower in patients with severe LV systolic dysfunction at discharge treated with G-CSF than in controls (interaction β±SE, −0.08±0.04; p=0.034).ConclusionsAlthough inconclusive, this is the largest trial in the field of cell-based cardiac repair after STEMI providing evidence of the tolerability and long-term safety of G-CSF treatment. The results prompt further studies to understand which patient can benefit most from BM cell mobilisation.Trial registration number NCT01969890.

Rotation is one of the important parameters affecting the evolution and final fate of massive stars but the origin of fast rotators remains unclear (imprint of the star formation process, result of binary interactions). In this work, we aim at investigating the binary status, photometric variability, and runaway status of a statistically meaningful sample of Galactic fast-rotating O stars. We perform a comprehensive multi-epoch analysis of new high-quality spectroscopic observations gathered by the IACOB and OWN surveys. Notably, we find that the total percentage of spectroscopic binaries in the investigated sample range between 25 and 40%, in agreement with previous finding for the case of O-type stars with lower projected rotational velocities. On the contrary, the fraction of runaway stars among fast rotators (∼35–50%) is significantly higher than in the case of slow rotators (∼20–30%). By combining all these observational results we will evaluate each scenario about the origin of fast rotators.

Background: The quality of life of the HIV-infected population in developed countries has substantially improved over the years. Accordingly, the clinical limitations in the surgical treatment of the HIV-infected patients are becoming fewer, and the number of HIV-infected patients undergoing surgical interventions of all types is increasing. However, available data on the incidence and risk factors for post-surgical complications, such as surgical site infections (SSI), in HIVinfected patients are still limited and often controversial. The aim of this study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients. Methods: A 1-year observational prospective multicenter surveillance study was conducted in 11 Italian Infectious Diseases Clinical Centers from which 305 consecutive HIVinfected patients undergoing different surgical procedures were enrolled. Postdischarge surveillance was conducted within 30 days after surgery. A number of variables were included in a multivariate analysis aimed at assessing potential risk factors for SSI, including body mass index, diabetes, Hepatitis C (HCV) and hepatitis B virus infection, lipodistrophy, HIV viral load, CD4 cell count and white blood cell count, preoperative hospital stay, National Nosocomial Infection Surveillance (NNIS) risk score, and any antimicrobial prophylaxis. Results: SSI occurred in 29 of 305 (9.5%) patients, of which 17 (58.6%) SSI occurred during hospital stay, and 12 (41.4%) occurred during the postdischarge period. The SSI of the 29 patients were classified as superficial (21, 72.4%), deep (four, 13.8%), organ/space (one, 3.4%), and sepsis (three, 10.3%). Nearly 50% of the superficial and 50% of the deep SSI occurred during the postdischarge period. Organ/space infection and sepsis accounted for 13.7% of all SSI and were observed during the in-hospital stay. The multivariate analysis revealed that HCV co-infection was significantly associated to SSI occurrence. Total hospital stay was longer among patients with SSI than among those without SSI (p = 0.041). Conclusion: Although 92.5% of our HIV-infected patients presented a NNIS score ≤ 1, the SSI rate was twofold higher than that reported in Italian and European studies for the general population, with more severe clinical presentations. This is the first report of an association between HCV-HIV co-infection and SSI occurrence. Additionally, the viroimmunological status of our patients was not related to SSI occurrence, which suggests the need for further research for other potential risk factors that may be implicated in the occurrence of SSI.

CONTEXT: The unparalleled characteristics of Gaia photometry make it an excellent choice to study stellar variability. AIMS: To measure the phot. dispersion in G+G_BP+G_RP of the 145 677 450 Gaia DR3 5-parameter sources with G <= 17 mag and G_BP-G_RP with -1.0 to 8.0 mag. To use that unbiased sample to analyze stellar variability in the Milky Way, LMC, and SMC. METHODS: We convert from magnitude uncertainties to the observed phot. dispersions, calculate the instrumental component as a function of apparent magnitude and color, and use it to transform the observed dispersions into the astrophysical ones. We give variability indices in the three bands for the whole sample. We use the subsample of Rimoldini et al. that includes light curves and variability types to calibrate our results and establish their limitations. RESULTS: We use information from the MW, LMC, and SMC CAMDs to discuss variability across the HRD. WDs and sdBs are more variable than MS or RC stars but their variability decreases for the former with age. The MS region in the Gaia CAMD has an s_G distribution peaks at low values (~1-2 mmag) and has a large tail dominated by EBs, RR Lyr stars, and YSOs. RC stars are characterized by little variability, with their s_G distribution peaking at 1 mmag or less. The stars in the PMS region are highly variable, with a power law distribution in s_G with slope 2.75 and a cutoff for values lower than 7 mmag. The luminous red stars region of the Gaia CAMD has the highest variability, with its extreme dominated by AGB stars and with a power law in s_G with a slope of ~2.2 that extends from there to a cutoff of 7 mmag. We show that our method can be used to search for LMC Cepheids. We analyze four stellar clusters with O stars and detect a strong difference in s_G between stars that are already in the MS and those that are still in the PMS. [ABRIDGED BUT NOT TOO FAR]

To assess the incidence of nosocomial bloodstream infections (NBSIs) in human immunodeficiency virus (HIV)—infected patients, and to analyze the main associated risk factors, we performed a 1-year multicenter prospective study of patients with advanced HIV infection who were consecutively admitted to 17 Italian infectious diseases wards. As of May 1999, a total of 65 NBSIs (4.7%) occurred in 1379 admissions, for an incidence of 2.45 NBSIs per 1000 patient-days. Twenty-nine NBSIs were catheter-related bloodstream infections, with a rate of 9.6 central venous catheter—associated infections per 1000 device-days. Multivariate analysis indicated that variables independently associated with NBSIs included active injection drug use, a Karnofsky Performance Status score of µ40, presence of a central venous catheter, and length of hospital stay. Mortality rates were 24.6% and 7.2% among patients with and without NBSIs, respectively (P µ .00001). In the era of highly active antiretroviral therapy, NBSIs continue to occur frequently and remain severe and life-threatening manifestations.

CONTEXT. Dynamical interactions in young stellar clusters can eject massive stars early in their lives and significantly alter their mass functions. If all of the most massive stars are lost, we are left with an orphan cluster. AIMS. We study the Bermuda cluster (Villafranca O-014 NW), the most significant young stellar group in the North America and Pelican nebulae, and the massive stars that may have been ejected from it to test if it has been orphaned. METHODS. We use Gaia EDR3 parallaxes and proper motions to search for walkaway/runaway stars in the vicinity of the North America and Pelican nebulae. The candidates are analyzed with spectroscopy and photometry to assess their nature and their trajectories are traced back in time to determine at what time they left the Bermuda cluster. RESULTS. We detect three ejection events (Bajamar, Toronto, and HD 201 795 events) that expelled 5, 2, and 2 systems, respectively, or 6, 3, and 3 stars if we count the individual components in spectroscopic/eclipsing binaries. The events took place 1.611\\(\\pm\\)0.011 Ma, 1.496\\(\\pm\\)0.044 Ma, and 1.905\\(\\pm\\)0.037 Ma ago, respectively, but our analysis is marginally consistent with the first two being simultaneous. We detect bow shocks in WISE images associated with four of the ejected systems. Combining the three events, the Bermuda cluster has lost >200 M_Sol, including its three most massive stars, so it can be considered an orphan cluster. One consequence is that the PDMF of the cluster has been radically altered from its top-heavy initial value to one compatible with a Kroupa-like function. Another one is that the cluster is currently expanding with a dynamical time scale consistent with the cause being the ejection events. A scenario in which the Bermuda cluster was formed in a conveyor belt fashion over several hundreds of ka or even 1 Ma is consistent with all the observables. [ABRIDGED]

The empirical distribution of projected rotational velocities (vsini) in massive O-type stars is characterized by a dominant slow velocity component and a tail of fast rotators. Binary interaction has been proposed to play a dominant role in the formation of this tail. We perform a complete and homogeneous search for empirical signatures of binarity in a sample of 54 fast-rotating stars with the aim of evaluating this hypothesis. This working sample has been extracted from a larger sample of 415 Galactic O-type stars which covers the full range of vsini values. We use new and archival multi-epoch spectra in order to detect spectroscopic binary systems. We complement this information with Gaia proper motions and TESS photometric data to aid in the identification of runaway stars and eclipsing binaries, respectively. The identified fraction of single-lined spectroscopic binary (SB1) systems and apparently single stars among the fast-rotating sample is \\(\\sim\\)18% and \\(\\sim\\)70%, respectively. When comparing these percentages with those corresponding to the slow-rotating sample we find that our sample of fast rotators is characterized by a slightly larger percentage of SB1 systems (\\(\\sim\\)18% vs. \\(\\sim\\)13%) and a considerably smaller fraction of clearly detected SB2 systems (8% vs. 33%). Overall, there seems to be a clear deficit of spectroscopic binaries (SB1+SB2) among fast-rotating O-type stars (\\(\\sim\\)26% vs. \\(\\sim\\)46%). On the contrary, the fraction of runaway stars is significantly higher in the fast-rotating domain (\\(\\sim\\)33-50%) than among those stars with vsini < 200 km/s. Lastly, almost 65% of the apparently single fast-rotating stars are runaways. Our empirical results seem to be in good agreement with the idea that the tail of fast-rotating O-type stars (with vsini > 200 km/s) is mostly populated by post-interaction binary products.

CONTEXT. Gaia EDR3 has produced parallaxes for 1.468x10^9 sources but there are calibration issues that require corrections to the published values and uncertainties. AIMS. We want to characterize the behavior of the uncertainties of the Gaia EDR3 parallaxes. We also aim to provide a procedure for the calculation of distances to stars and stellar clusters. METHODS. We reanalyze some of the data in the calibration papers for QSO and LMC parallaxes and combine those results with measurements for six bright GCs. We calculate the angular covariance of EDR3 parallaxes at small separations based on the LMC results and combine it with the results for larger angles using QSOs to obtain an analytical formula for the angular covariance over the whole sky. The results for the six GCs are used to validate the parallax bias correction as a function of magnitude, color, and ecliptic latitude and to determine the constant used to convert internal uncertainties to external ones. RESULTS. The angular covariance at zero separation is 106.2 muas^2, yielding a minimum uncertainty for EDR3 parallaxes of 10.3 muas for individual stars. That value can be only slightly reduced for GCs after considering the behavior of the angular covariance of the parallaxes for small separations. The Lindegren et al. parallax bias correction works quite well, except for the brighter magnitudes, suggesting improvements may be possible there. The value of k is 1.1-1.7 and depends on G. Stars with moderately large values of RUWE can still provide useful parallaxes albeit with larger values of k. We give accurate and precise Gaia EDR3 distances to the six GCs and for the specific case of 47 Tuc we are able to beat the angular covariance limit and derive a high-precision distance of 4.53+-0.06 kpc. Finally, a recipe for the derivation of distances to stars and stellar clusters using Gaia EDR3 parallaxes is given. [ABRIDGED]

We cross-match the Alma catalog of OB stars with Gaia DR2 astrometry and photometry as a first step towards producing a clean sample of massive stars in the solar neighbourhood with a high degree of completeness. We analyze the resulting colour-absolute magnitude diagram to divide our sample into categories and compare extinction estimates from two sources, finding problems with both of them. The distances obtained with three different priors are found to have few differences among them, indicating that Gaia DR2 distances are robust. An analysis of the 3-D distribution of massive stars in the solar neighbourhood is presented. We show that a kinematically distinct structure we dub the Cepheus spur extends from the Orion-Cygnus spiral arm towards the Perseus arm and is located above the Galactic mid-plane, likely being related to the recently discovered Radcliffe wave. We propose that this corrugation pattern in the Galactic disk may be responsible for the recent enhanced star formation at its crests and troughs. We also discuss our plans to extend this work in the immediate future.

CONTEXT. This is the second paper of a series on Galactic OB groups that uses astrometric and photometric data from Gaia and spectral classifications from GOSSS and LiLiMaRlin. The previous paper was based on Gaia DR2, this is based on Gaia EDR3. AIMS. The two aims of this paper are to revise the results for the sample from paper I using Gaia EDR3 data and to expand the sample of analyzed stellar groups to 26, from Villafranca O-001 to Villafranca O-026. METHODS. We use GOSSS to select Galactic stellar groups with O stars and an updated version of the method in paper 0 of this series, combining Gaia EDR3 G+GBP+GRP photometry, positions, proper motions, and parallaxes to assign memberships and measure distances. We present 99 spectra from GOSSS and 32 from LiLiMaRlin for stars in the analyzed groups or in their foreground. RESULTS. We derive distances to the 26 stellar groups with unprecedented precision and accuracy, with total uncertainties <1% within 1 kpc and of ~3% around 3 kpc, values that are almost 4x better than for Gaia DR2. We provide homogeneous spectral types for 110 stars and correct a number of errors in the literature, especially for objects in the Orion nebula cluster. For each of the groups we discuss its membership and present possible runaway/walkaway stars. At least two groups, Villafranca O-O12 S and Villafranca O-014 NW, are orphan clusters in which the most massive stars have been ejected by dynamical interactions, leaving objects with a capped mass function. The existence of such clusters has important consequences for the study of the IMF, the distribution of SNe across the Galaxy, and the population and dynamics of isolated compact objects. We fit PMS isochrones to four clusters to derive ages of 2.0\\(\\pm\\)0.5 Ma for the sigma Orionis cluster, 4\\(\\pm\\)2 Ma for NGC 2264, 5.0\\(\\pm\\)0.5 Ma for NGC 2362, and 8\\(\\pm\\)2 Ma for the gamma Velorum cluster. [ABRIDGED]