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Hiroki Nishikawa

and 5 more

Background and aims: The causal relationship between sarcopenia and sleep disorder in patients with chronic liver disease (CLDs) is unclear. We aimed examine the influence of sarcopenia-related factors (grip strength (GS) and muscle mass) on the progression of sleep disorder in patients with chronic liver disease (n=182, 46 cirrhotic cases, median age=64 years). Methods: Sleep quality was evaluated by the Japanese version of Pittsburgh Sleep Quality Index (PSQI-J). PSQI-J >6 points was defined as sleep disorder. In all analyzed patients, evaluation using PSQI-J questionnaire was performed twice or more during the follow-up period. Time interval from the date of baseline PSQI-J and the first confirmed date of elevation of PSQI-J score was calculated. Our primary endpoint was the elevation of PSQI-J score compared to the baseline PSQI-J score. GS decline was diagnosed with a GS of <26 kg for male and <18 kg for female. Loss of muscle mass was diagnosed by a skeletal muscle index of <7.0 kg/m2 for male and <5.7 kg/m2 for female on bioelectrical impedance analysis. Results: The median PSQI-J score was 5. PSQI-J >6 points at baseline was found in 83 patients (45.6%). In patients with GS decline (n=48), the 3-year cumulative elevation rate of PSQI-J score was 82.4%, while in patients with GS non-decline, that was 36.2% (P<0.0001). In patients with SMI decline (n=64), the 3-year cumulative elevation rate of PSQI-J score was 60.6%, while in patients with SMI non-decline, that was 43.4% (P=0.1822). On the multivariate analysis of factors associated with the elevation of PSQI-J score, only GS decline (P=0.0002) was a significant factor. Conclusions: Reduced GS rather than loss of muscle mass is independently associated with an elevated risk for the progression of sleep disorder in CLD patients.

Jerome Lechien

and 14 more

Objective: To investigate prevalence and epidemiological and clinical factors associated with OD and GD in COVID-19 patients according to the disease severity. Study design: Cross-sectional study. Methods: A total of 2,579 patients with a positive diagnosis of COVID-19 were identified between March 22 and June 3, 2020 from 18 European hospitals. Epidemiological and clinical data were extracted. Otolaryngological symptoms, including OD and GD were collected through patient-reported outcome questionnaire and sniffin-sticks tests were carried out in a subset of patients. Results: A total of 2,579 patients were included, including 2,166 mild (84.0%), 144 moderate (5.6%) and 269 severe-to-critical (10.4%) patients. Mild patients presented an otolaryngological picture of the disease with OD, GD, nasal obstruction, rhinorrhea and sore throat as the most prevalent symptoms. The prevalence of subjective OD, GD were 73.7 and 46.8% and decrease with the severity of the disease. Females had higher prevalence of subjective OD and GD compared with males. Diabetes was associated with a higher risk to develop GD. Among the subset of patients who benefited from psychophysical olfactory evaluations, there were 75 anosmic, 43 hyposmic and 113 normosmic patients. The prevalence of anosmia significantly decreased with the severity of the disease. Anosmia or hyposmia were not associated with any nasal disorder, according to SNOT-22. Conclusion: OD and GD are more prevalent in patients with mild COVID-19 compared with individuals with moderate, severe or critical diseases. Females might have a higher risk of developing OD and GD compared with males.
Objective. This study examined the predictive ability of established Maternal Early Warning systems (MEWS) for different types of maternal morbidity, in order to discern an optimal early warning system. Design. Retrospective cohort study. Setting. Four-hospital urban academic system. Population. All patients admitted to the obstetric services of this hospital system in 2018. Methods. All patient vital signs were collected and three sets of published MEWS criteria were evaluated in relation to maternal morbidity. The test characteristics of each MEWS, as well as for heart rate, blood pressure, and oxygen saturation individually and in different combinations were compared. Main Outcome Measures. Maternal morbidity, defined as a composite of hemorrhage, infection, acute cardiac disease, and acute respiratory disease, ascertained from informatics and administrative data. Results. Of 14,597 obstetric admissions, 2,451 patients experienced composite morbidity (16.8%). The sensitivities (15.3% - 64.8%), specificities (56.8% - 96.1%), and positive predictive values (22.3% - 44.5%) of the three MEWS criteria ranged. Of patients with any morbidity, 28% met criteria for the most liberal vital sign combination, while only 2% met criteria for the most restrictive parameters, compared to 14% and 1% of patients without morbidity, respectively. Sensitivity of all vital sign combinations was low (maximum 28.2%), while specificity ranged from 86.1 – 99.3%. Conclusions. Though all MEWS criteria demonstrated poor sensitivity for maternal morbidity, permutations of the most abnormal vital signs have high specificity, suggesting that MEWS may be better implemented as a trigger tool to target more sensitive screening techniques for maternal morbidity.

Adhyeta Choudhuri

and 13 more

The recent COVID-19 pandemic has created havoc across the globe. Although there are several controversies regarding its origin, the worldwide scientific fraternity currently indulges in developing various therapeutic strategies to combat this threat. Consequently, we aimed to provide a comprehensive evaluation of this pandemic’s global transmission landscape to get an insight into its imminent fate on global populations. For this, we have analyzed the data on daily reported COVID-19 cases for 294 days since inception, i.e., from 31 December 2019 to 19 October 2020, in 210 countries across the five continents available in the ECDC database. Additionally, we have summarised an up-to-date list of currently available/under trial 23 drugs and vaccines to provide a consolidated reference to those who have a growing interest in knowing the status of related repurposed drugs and vaccines and to become acquainted with their mechanism of actions for preventing the pathogenesis of SARS-CoV-2 into the human host. We performed an extensive literature review to justify our findings and get the latest know-how on the COVID-19 pathogenesis. Our findings show that India is presently in the most critical condition, where the maximum COVID-19 cases (19.37%) are reported globally in the last 14 days, which has turned into a major concern. So the government should give priority to deal with this pandemic. Besides, American and European countries are also in a risky position, as they harbor 33.31% and 34.52% of total COVID-19 cases in the last 14 days, respectively. The sudden spurt in the number of COVID-19 cases in Europe due to the beginning of extensive testing probably reflects the relaxation in policies for controlling this pandemic. Nevertheless, we should make predictions on how this virus would evolve further, which might help us design a ‘magic compound’ that can prevent any likely situation.

Aruna Ambagala

and 13 more

Rabbit hemorrhagic disease virus 2 (RHDV2) is a newly emerging Lagovirus belonging to the family Caliciviridae. After its first discovery in 2010 in France, this highly pathogenic virus rapidly spread to neighboring countries and has become the dominant strain, replacing the classical RHDV1 strains. RHDV2 was first reported in North America in 2016 in Mont-Joli, Quebec, Canada and it was reported again in 2018 and 2019 on Vancouver, Island and the southeast mainland of British Columbia (BC). The whole genome sequence of the RHDV2 Quebec isolate resembled the RHDV-N11 isolate from Navarra, Spain identified in 2011 with 97% identity. The epidemiological investigation involved three hobby farms and one personal residence. In December and February 2018, high mortality was reported in first a private feral rabbit refuge and then, a large colony of feral rabbits on the Vancouver Island University Campus, Nanaimo, BC. The virus responsible showed only 93% identity to the Quebec RHDV2 isolate at the nucleotide level. Additional cases of RHDV2 on Vancouver Island and on the BC mainland affecting feral, captive domestic and commercial rabbits were reported subsequently. Vaccination was recommended to control the outbreak and an inactivated bivalent vaccine was made available to the private veterinary practices. In June 2019 an isolated RHDV2 outbreak was reported in an apartment building in Vancouver, BC. This virus showed only 97% identity to the RHDV2 isolate responsible for the BC outbreak in 2018 at the nucleotide level suggesting that it was an independent incursion. In October 2020, there are reports of partial recovery of the feral population in Nanaimo and to date there are no confirmed deaths of native rabbit species in BC.

Tong Heng

and 5 more

Jean Bousquet

and 1 more

To the Editor,We appreciate the interest and comments of Soriano and Ancochea1 regarding our papers 2. Further to the suggestion that “it would be of interest to repeat their statistics conducted during the first wave of COVID-19, again with the current estimates during the ongoing second wave, or later ones”, we would like to emphasize that our geographical observation was a type of anecdotal evidence that contributed to formulating a hypothesis. In a previous paper, we found that after adjusting for potentially relevant country-level confounders, there was a negative ecological association between COVID-19 mortality and the consumption of cabbage and cucumber in European countries 3. In this study, we acknowledged that “As in any ecological study, any inference from the observed association should be made at the country level, as the possibility of ecological fallacy precludes inferences at the individual level; and that further testing in properly designed individual studies would be of interest”. Indeed, what would be useful is testing the hypothesis in robust observational studies and/or clinical trials.Regarding our observation that COVID-19 could be considered as a disease of the Anthropocene 4 , other authors have recently provided a more complete description of the links between the disruption of the natural ecosystems that characterize the Anthropocene and the occurrence of zoonosis 5 6.1. Soriano J and Ancochea J. Saved by cabbage, killed by cabbage, and COVID-19. Allergy 2020; in press.2. Bousquet J, Anto JM, Czarlewski W, et al. Cabbage and fermented vegetables: from death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19. Allergy 2020. DOI: 10.1111/all.14549.3. Fonseca S, Rivas I, Romaguera D, et al. Association between consumption of vegetables and COVID-19 mortality at a country level in Europe. MedRix 2020; 10.1101/2020.07.17.201558464. O’Callaghan C and Anto J. COVID-19: The Disease of the Anthropocene.Env Res 2020; 187: 109683.doi: 109610.101016/j.envres.102020.109683. Epub 102020 May 109615.5. Morens DM and Fauci AS. Emerging Pandemic Diseases: How We Got to COVID-19. Cell 2020; 182: 1077-1092. 2020/08/28. DOI: 10.1016/j.cell.2020.08.021.6. Roche B, Garchitorena A, Guegan JF, et al. Was the COVID-19 pandemic avoidable? A call for a ”solution-oriented” approach in pathogen evolutionary ecology to prevent future outbreaks. Ecol Lett 2020 2020/09/02. DOI: 10.1111/ele.13586.JM AntoISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. IMIM (Hospital del Mar Research Institute), Barcelona, Spain. Universitat Pompeu Fabra (UPF), Barcelona, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.J BousquetCharité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany. MACVIA-France, Montpellier, France.

Paula Lopes

and 3 more

An intense erosive process has recently caused progressive hydrogeomorphological changes in the mouths of two large rivers belonging to the Amazon River Delta, on the estuarine coast of Amapá State, namely: Araguari and Amazonas. Consequently, Araguari River was captured by the Amazon River and it influenced the sediment and water quality dynamics when two tidal channels expanded in opposite directions; this process affected both hydrographic basins and blocked Araguari River mouth. The aim of the current study is to analyze the space-seasonal variations of hydrodynamic and water quality parameters influenced by the following factors: location (channels connected to Araguari and Amazonas rivers), seasonality (dry/rainy) and spring tidal phase (flood/ebb). The herein adopted methodological stages comprised a) flow measurement with Doppler current profiler; b) water sampling (physicochemical and suspended sediments); c) suspended solids transport estimates; and d) multivariate statistical analysis of parameters. Results have indicated significant space-seasonal variation in these parameters (p<0.05). Water balance in the dry period has shown that Urucurituba Channel absorbs 100% of Araguari River flow, distributes 29% of it in the floodplain and discharges 71% of Araguari River flow into the Amazon River. This channel received 86% of Araguari River flow and absorbed 14% of the flow deriving from the floodplain in the rainy season, which totaled 100% of its flow at Amazon River mouth- solid discharge was proportional to 107,982 t of tidal cycle-1. Multivariate analyses have shown significant variations in 90% of the investigated parameters, which were influenced by such as location, seasonality and tidal phase (p<0.05). It was possible concluding that the recent channels have significantly affected the hydrodynamics, sediment transport processes and water quality of both basins. This phenomenon is currently in intense and irreversible hydrogeomorphological evolution, and it mainly affects the Araguari River estuary

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Yue Liang

and 5 more

Internal erosion is one of the most common causes of failure in hydraulic engineering structures, such as embankments and levees. It also plays a vital role in the geohazards (such as landslides and sinkhole developments) and more importantly, the earth landscape evolution, which has a broad environmental and ecosystem impacts. The groundwater seepage is multi-directional, and its multi-dimensional nature could affect the initiation and the progression of internal erosion. With a newly developed apparatus, we carry out nine internal erosion experiments under five different seepage directions. The results reveal that the critical hydraulic gradient increases as the seepage direction varies from the horizontal to the vertical. After a global erosion is triggered, preferential erosion paths distribute randomly from the bottom to the top of the specimen. If the seepage direction is not vertical, small preferential erosion paths merge into a large erosion corridor, in which the loss of fine particles is significant but negligible outside. Results of experiments manifest that the erosion is heterogeneous and three-dimensional, even in the unidirectional seepage flow. The particles are rapidly eroded at the early stage of the erosion, indicating a high erosion rate. With the erosion time increasing, the particle loss slows down and even ceases if the time is long enough. The erosion rate increases if the seepage direction approaches a vertical direction. Overall, the erosion rate approximately decreases with erosion time exponentially. We proposed exponential equations to illustrate the variation of the erosion rate in the erosion process.

Gary Ghahremani

and 2 more

Summary Background: Torus is a protuberant and lobulated exostosis that develops on the lingual aspect of the jaws or hard palate in 10-30% of adults. They can interfere with mastication, speech, oral hygiene, and denture placement. Their enlargement with advancing age may also lead to superficial ulceration, inflammation, osteonecrosis and various other complications. Methods: A retrospective analysis of the authors’ experience with 17 adults who had large symptomatic tori was performed. The patients were examined by intraoral imaging and radiographic or computed tomography of their maxillofacial bones. Their dental and medical records were reviewed along with the pertinent literature concerning the prevalence and reported complications of this entity. Results: This series included 6 men and 11 women, ranging in age from 36 to 85 years (Mean age: 56.5 years).There were 6 patients with torus mandibularis, 8 with torus palatinus, and 3 with torus maxillaris. Four of our 17 patients required surgical excision of their tori because of large size, recurrent superficial erosions and associated symptoms. Conclusion: The majority of tori are asymptomatic and incidental finding, but the more prominent tori are prone to mucosal inflammation and ulceration that may require surgical removal of the lesion. Large tori can also interfere with mastication, speech, dental hygiene, placement and function of prosthetic dentures, and may cause snoring, sleep apnea or other complications. Therefore, the practicing physicians should be familiar with the appearance, radiological features, clinical implications and management of tori.

Wahaj Munir

and 3 more

Background: Acute type A aortic dissection (ATAAD), is a surgical emergency often requiring intervention on the aortic root. There is much controversy regarding root management; aggressively pursuing a root replacement, versus more conservative approaches to preserve native structures. Methods: Electronic database search we performed through PubMed, Embase, SCOPUS, google scholar and Cochrane identifying studies that reported on outcomes of surgical repair of ATAAD through either root preservation or replacement. The identified articles focused on short- and long-term mortalities, and rates of re-operation on the aortic root. Results: There remains controversy on replacing or preserving aortic root in ATAAD. Current evidence supports practice of both trends following an extensive decision-making framework, with conflicting series suggesting favourable results with both procedures as the approach that best defines higher survival rates and lower perioperative complications. Yet, the decision to perform either approach remains surgeon decision and bound to the extent of the dissection and tear entries in strong correlation with status of the aortic valve and involvement of coronaries in the dissection. Conclusions: There exists much controversy regarding fate of the aortic root in ATAAD. There are conflicting studies for impact of root replacement on mortality, whilst some study’s report no significant results at all. There is strong evidence regarding risk of re-operation being greater when root is not replaced. Majority of these studies are limited by the single centred, retrospective nature of these small sample sized cohorts, further hindered by potential of treatment bias.

Nicholas Hess

and 3 more

Background: This study compared outcomes of patients bridged with extracorporeal membrane oxygenation (ECMO) to orthotopic heart transplantation (OHT) following the recent heart allocation policy change. Methods: The United Network of Organ Sharing Registry (UNOS) database was queried to examine OHT patients between 2010-2020 that were bridged with ECMO. Waitlist outcomes and one-year posttransplant survival were compared between patients waitlisted and/or transplanted before and after the heart allocation policy change. Secondary outcomes included posttransplant stroke, renal failure, and one-year rejection. Results: 285 waitlisted patients were included, 173 (60.7%) waitlisted under the old policy and 112 (39.3%) under the new policy. New policy patients were more likely to receive OHT (82.2% vs 40.6%), and less likely to be removed from the waitlist due to death or clinical deterioration (15.0% vs 41.3%) (both P<0.001). 165 patients bridged from ECMO to OHT were analyzed, 72 (43.6%) transplanted during the old policy and 93 (56.3%) under the new. Median waitlist time was reduced under the new policy (4 days [IQR 2-6] vs 47 days [IQR 10-228]). Postoperative renal failure was higher in the new policy group (23% vs 6%; P=0.002), but rates of stroke and one-year acute rejection were equivalent. One-year survival was lower the new policy but was not significant (79.8% vs 90.3%; P=0.3917). Conclusions: The UNOS heart allocation policy change has resulted in decreased waitlist times and higher likelihood of transplant in patients supported with ECMO. Posttransplant one-year survival has remained comparable although absolute rates are lower.

Matthew Sussman

and 9 more

The recognition of fibrinolysis phenotypes in trauma patients has led to a reevaluation of antifibrinolytic therapy (AF). Many cardiac patients also receive AF, however the distribution of fibrinolytic phenotypes in that population is unknown. The purpose of this study was to fill that gap. Methods: Data were retrospectively reviewed from 78 cardiac surgery patients. Phenotypes were defined as hypofibrinolytic (LY30 <0.8%), physiologic (LY30 0.8-3.0%) and hyperfibrinolytic (LY30 >3%). Continuous variables were expressed as M ± SD or median (interquartile range). Results: The study population was 65±10 yrs old, 74% male, average body mass index of 29±5 kg/m2. Fibrinolytic phenotypes were distributed as physiologic=45%, hypo=32% and hyper = 23%. There was no obvious effect of age, gender, race, or ethnicity on the distribution of fibrinolysis phenotypes; 47% received AF. The time with chest tube during post-operative recovery was longer in those who received AF (4[3,5] days) vs no AF (3[2,4] days), P=0.037). All cause morbidity occurred in 51% of patients who received AF vs 25% with no AF (p=0.017). However, with AF vs no AF, apparent differences in median chest tube output (1379 vs 820ml, p=0.075), hospital LOS (13 vs 10 days, P=0.873), estimated blood loss (1100 vs 775 ml, P=0.127), units of transfused RBCs (4 vs 2], P=0.152) or all-cause mortality (5.4% [2/37] vs 10% [4/41], P=0.518) were not statistically significant. Conclusion: This is the first description of three distinctly different fibrinolytic phenotypes in cardiac surgery patients. In this population, the use of AF was associated with increased morbidity.

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