Showing papers by "St Thomas' Hospital published in 2020"
NewYork–Presbyterian Hospital1, University of Insubria2, University of Texas Health Science Center at Houston3, Chinese PLA General Hospital4, University of Vermont Medical Center5, Harvard University6, Beth Israel Deaconess Medical Center7, Loyola University Medical Center8, University of Chicago9, University of Milan10, Auckland City Hospital11, St Thomas' Hospital12, Hofstra University13, University of Michigan14, Hamilton Health Sciences15, Population Health Research Institute16, Ottawa Hospital Research Institute17, Brigham and Women's Hospital18, Vanderbilt University19, Universidad Católica San Antonio de Murcia20, University of Mainz21, McMaster University22, University of Liverpool23, Aalborg University24
TL;DR: The current understanding of the pathogenesis, epidemiology, management and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, and of those with preexistingThrombotic disease who develop CO VID-19 are reviewed.
2,222 citations
Université de Sherbrooke1, World Health Organization2, McMaster University3, University of Indonesia4, Geneva College5, University of California, San Francisco6, Peking Union Medical College Hospital7, Royal Melbourne Hospital8, Ziauddin University9, St Thomas' Hospital10, All India Institute of Medical Sciences11, Aga Khan University12, Guy's and St Thomas' NHS Foundation Trust13, St. George's University14, University of Colombo15, University of São Paulo16, Charité17, Ghent University18, Andrés Bello National University19, King's College London20, Hanoi Medical University21, Stellenbosch University22, University of Oxford23, Lanzhou University24, University of Liverpool25
TL;DR: A standing international panel of content experts, patients, clinicians, and methodologists, free from relevant conflicts of interest, produce recommendations for clinical practice, containing a strong recommendation for systemic corticosteroids in patients with severe and critical covid-19, and a weak or conditional recommendation against systemic cortiosteroids for non-severe patients.
Abstract: Clinical question What is the role of drug interventions in the treatment of patients with covid-19? New recommendation Increased attention on ivermectin as a potential treatment for covid-19 triggered this recommendation. The panel made a recommendation against ivermectin in patients with covid-19 regardless of disease severity, except in the context of a clinical trial. Prior recommendations (a) a strong recommendation against the use of hydroxychloroquine in patients with covid-19, regardless of disease severity; (b) a strong recommendation against the use of lopinavir-ritonavir in patients with covid-19, regardless of disease severity; (c) a strong recommendation for systemic corticosteroids in patients with severe and critical covid-19; (d) a conditional recommendation against systemic corticosteroids in patients with non-severe covid-19, and (e) a conditional recommendation against remdesivir in hospitalised patients with covid-19. How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development group (GDG) of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the new recommendation There is insufficient evidence to be clear to what extent, if any, ivermectin is helpful or harmful in treating covid-19. There was a large degree of uncertainty in the evidence about ivermectin on mortality, need for mechanical ventilation, need for hospital admission, time to clinical improvement, and other patient-important outcomes. There is potential for harm with an increased risk of adverse events leading to study drug discontinuation. Applying pre-determined values and preferences, the panel inferred that almost all well informed patients would want to receive ivermectin only in the context of a randomised trial, given that the evidence left a very high degree of uncertainty on important effects. Updates This is a living guideline. It replaces earlier versions (4 September, 20 November, and 17 December 2020) and supersedes the BMJ Rapid Recommendations on remdesivir published on 2 July 2020. The previous versions can be found as data supplements. New recommendations will be published as updates to this guideline. Readers note This is the fourth version (update 3) of the living guideline (BMJ 2020;370:m3379). When citing this article, please consider adding the update number and date of access for clarity.
660 citations
TL;DR: In this article, the authors proposed a method to solve the problem of the problem: this article ] of "uniformity" of the distribution of data points in the data set.
Abstract: Abstract
583 citations
TL;DR: Radiomics is a rapidly evolving field of research concerned with the extraction of quantitative metrics-the so-called radiomic features-within medical images as discussed by the authors, which capture tissue and lesion characteristics such as heterogeneity and shape and may, alone or in combination with demographic, histologic, genomic, or proteomic data, be used for clinical problem solving.
Abstract: Radiomics is a rapidly evolving field of research concerned with the extraction of quantitative metrics-the so-called radiomic features-within medical images. Radiomic features capture tissue and lesion characteristics such as heterogeneity and shape and may, alone or in combination with demographic, histologic, genomic, or proteomic data, be used for clinical problem solving. The goal of this continuing education article is to provide an introduction to the field, covering the basic radiomics workflow: feature calculation and selection, dimensionality reduction, and data processing. Potential clinical applications in nuclear medicine that include PET radiomics-based prediction of treatment response and survival will be discussed. Current limitations of radiomics, such as sensitivity to acquisition parameter variations, and common pitfalls will also be covered.
440 citations
Tel Aviv University1, Tel Aviv Sourasky Medical Center2, University Medical Center Groningen3, Utrecht University4, Sheba Medical Center5, Leiden University6, Sapienza University of Rome7, Paris Descartes University8, Lund University9, Aarhus University Hospital10, University of Giessen11, St Thomas' Hospital12, University Medical Center Freiburg13
TL;DR: The updated EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression.
Abstract: To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.
440 citations
Tufts Medical Center1, Charité2, American Medical Association3, Erasmus University Rotterdam4, Harvard University5, University of British Columbia6, University of Washington7, University of Pittsburgh8, Veterans Health Administration9, Yale University10, Children's Hospital at Westmead11, Great Ormond Street Hospital for Children NHS Foundation Trust12, American Society of Nephrology13, University of Maryland, Baltimore14, Royal Free London NHS Foundation Trust15, University of Pennsylvania16, University Medical Center Groningen17, Mayo Clinic18, University of Calgary19, University of Michigan20, Keele University21, University of Oklahoma Health Sciences Center22, St Thomas' Hospital23, University of Paris24, French Institute of Health and Medical Research25, Heidelberg University26, National Kidney Foundation27, University College London28, Cliniques Universitaires Saint-Luc29, Baylor College of Medicine30
TL;DR: Recommendations to use "kidney" rather than "renal" or "nephro-" when referring to kidney disease and kidney function and to use the KDIGO definition and classification of chronic kidney disease rather than alternative descriptions to define and classify severity of CKD.
347 citations
University of Washington1, University of Florida2, University of Düsseldorf3, University of Iowa4, Oregon Health & Science University5, University of California, Irvine6, Alfred I. duPont Hospital for Children7, Thomas Jefferson University8, University of Texas Southwestern Medical Center9, St Thomas' Hospital10, Columbia University11, Maastricht University12, University of Regensburg13, Emory University14
TL;DR: These guidelines are not meant to replace sound clinical judgment or specialist consultation but rather to strengthen provision and clinical management of ECMO specifically, in the context of the COVID-19 pandemic.
Abstract: Disclaimer: The Extracorporeal Life Support Organization (ELSO) Coronavirus Disease 2019 (COVID-19) Guidelines have been developed to assist existing extracorporeal membrane oxygenation (ECMO) centers to prepare and plan provision of ECMO during the ongoing pandemic. The recommendations have been put together by a team of interdisciplinary ECMO providers from around the world. Recommendations are based on available evidence, existing best practice guidelines, ethical principles, and expert opinion. This is a living document and will be regularly updated when new information becomes available. ELSO is not liable for the accuracy or completeness of the information in this document. These guidelines are not meant to replace sound clinical judgment or specialist consultation but rather to strengthen provision and clinical management of ECMO specifically, in the context of the COVID-19 pandemic.
294 citations
TL;DR: Rigid safe distancing rules are an oversimplification based on outdated science and experiences of past viruses, argue Nicholas R Jones and colleagues.
Abstract: Rigid safe distancing rules are an oversimplification based on outdated science and experiences of past viruses, argue Nicholas R Jones and colleagues
293 citations
282 citations
University of Calgary1, McGill University Health Centre2, Libin Cardiovascular Institute of Alberta3, Cardiovascular Institute of the South4, University of British Columbia5, Université du Québec à Trois-Rivières6, University of Ottawa7, Ottawa Hospital Research Institute8, Winnipeg Regional Health Authority9, Northern Ontario School of Medicine10, Concordia University Wisconsin11, University of Western Ontario12, Centre Hospitalier Universitaire Sainte-Justine13, Heart and Stroke Foundation of Canada14, McMaster University15, McGill University16, Université de Montréal17, University of Ontario Institute of Technology18, Université de Sherbrooke19, Brown University20, St. Michael's Hospital21, Montreal Heart Institute22, National Institutes of Health23, Université du Québec à Montréal24, University of Toronto25, University of Alberta26, University Health Network27, St Thomas' Hospital28, Alberta Health Services29, Laval University30, University of Manitoba31, Centre for Addiction and Mental Health32, Population Health Research Institute33, University of Saskatchewan34, University of Pennsylvania35, Hôpital Maisonneuve-Rosemont36
TL;DR: The 2020 guidelines include new guidance on themanagement of resistant hypertension and the management of hypertension in women planning pregnancy.
275 citations
St Thomas' Hospital1, University of Münster2, Cincinnati Children's Hospital Medical Center3, Mayo Clinic4, University of California, San Diego5, University of Pittsburgh6, Karolinska University Hospital7, University of Surrey8, Innsbruck Medical University9, University of California, San Francisco10, University College Dublin11, Radboud University Nijmegen12, University of Padua13, Queen Mary University of London14, Boston Children's Hospital15, University of Virginia Health System16, University of Alberta17
TL;DR: Recommendations were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management ofAKI.
Abstract: Importance In the last decade, new biomarkers for acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice. Objective To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers. Evidence Review At the 23rd Acute Disease Quality Initiative meeting, a meeting of 23 international experts in critical care, nephrology, and related specialties, the panel focused on 4 broad areas, as follows: (1) AKI risk assessment; (2) AKI prediction and prevention; (3) AKI diagnosis, etiology, and management; and (4) AKI progression and kidney recovery. A literature search revealed more than 65 000 articles published between 1965 and May 2019. In a modified Delphi process, recommendations and consensus statements were developed based on existing data, with 90% agreement among panel members required for final adoption. Recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluations system. Findings The panel developed 11 consensus statements for biomarker use and 14 research recommendations. The key suggestions were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management of AKI. Conclusions and Relevance Current evidence from clinical studies supports the use of new biomarkers in prevention and management of AKI. Substantial gaps in knowledge remain, and more research is necessary.
St Thomas' Hospital1, PSL Research University2, University of North Carolina at Chapel Hill3, Weizmann Institute of Science4, University of Toronto5, Sunnybrook Research Institute6, RWTH Aachen University7, Ruhr University Bochum8, Imperial College London9, French Institute of Health and Medical Research10, Eindhoven University of Technology11
TL;DR: Inspired by optical microscopy, ultrasound localization microscopy has bypassed the classic compromise between penetration and resolution in ultrasonic imaging and is being applied pre-clinically and clinically for imaging of the microvasculature of the brain, kidney, skin, tumors and lymph nodes.
Abstract: The majority of exchanges of oxygen and nutrients are performed around vessels smaller than 100 μm, allowing cells to thrive everywhere in the body. Pathologies such as cancer, diabetes and arteriosclerosis can profoundly alter the microvasculature. Unfortunately, medical imaging modalities only provide indirect observation at this scale. Inspired by optical microscopy, ultrasound localization microscopy has bypassed the classic compromise between penetration and resolution in ultrasonic imaging. By localization of individual injected microbubbles and tracking of their displacement with a subwavelength resolution, vascular and velocity maps can be produced at the scale of the micrometer. Super-resolution ultrasound has also been performed through signal fluctuations with the same type of contrast agents, or through switching on and off nano-sized phase-change contrast agents. These techniques are now being applied pre-clinically and clinically for imaging of the microvasculature of the brain, kidney, skin, tumors and lymph nodes.
Yale University1, NewYork–Presbyterian Hospital2, University of Alcalá3, Harvard University4, Beth Israel Deaconess Medical Center5, University of Insubria6, University of Texas Health Science Center at Houston7, University of Liverpool8, Chinese PLA General Hospital9, Huazhong University of Science and Technology10, Jean Monnet University11, Leonard Davis Institute of Health Economics12, Hospital of the University of Pennsylvania13, Veterans Health Administration14, University of Vermont15, University of Montpellier16, Westmead Hospital17, Loyola University Medical Center18, University of Chicago19, NorthShore University HealthSystem20, University of Milan21, Auckland City Hospital22, St Thomas' Hospital23, Hofstra University24, University of Michigan25, Population Health Research Institute26, McMaster University27, I.M. Sechenov First Moscow State Medical University28, Ottawa Hospital Research Institute29, Brigham and Women's Hospital30, Vanderbilt University31, Icahn School of Medicine at Mount Sinai32, University of Cologne33, Universidad Católica San Antonio de Murcia34, University of Mainz35, Aalborg University36
TL;DR: Novel dosing approaches are described for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithsombotic drugs in the absence of confirmed thrombosis.
Abstract: Coronavirus disease 2019 (COVID-19), currently a worldwide pandemic, is a viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The suspected contribution of thrombotic events to morbidity and mortality in COVID-19 patients has prompted a search for novel potential options for preventing COVID-19-associated thrombotic disease. In this article by the Global COVID-19 Thrombosis Collaborative Group, we describe novel dosing approaches for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithrombotic drugs in the absence of confirmed thrombosis. Although these therapies may have direct antithrombotic effects, other mechanisms of action, including anti-inflammatory or antiviral effects, have been postulated. Based on survey results from this group of authors, we suggest research priorities for specific agents and subgroups of patients with COVID-19. Further, we review other agents, including immunomodulators, that may have antithrombotic properties. It is our hope that the present document will encourage and stimulate future prospective studies and randomized trials to study the safety, efficacy, and optimal use of these agents for prevention or management of thrombosis in COVID-19.
TL;DR: The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012 and offers updated guidance for definitions and outcome measurements in research in different settings.
Abstract: The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012(1-3). The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings.
Flinders Medical Centre1, University of Queensland2, QIMR Berghofer Medical Research Institute3, Case Western Reserve University4, National Institute for Health Research5, Macquarie University6, University of Sydney7, St Thomas' Hospital8, Menzies Research Institute9, University of Melbourne10, Royal Adelaide Hospital11, University of Auckland12, University of Edinburgh13, University of Mainz14, University of Bern15, Johns Hopkins University16, National Institutes of Health17, Heidelberg University18, Icahn School of Medicine at Mount Sinai19, University of Southampton20, University of Liverpool21, Royal Liverpool University Hospital22, University of Erlangen-Nuremberg23, Erasmus University Rotterdam24, University of Adelaide25, University of Western Australia26, Massachusetts Eye and Ear Infirmary27
TL;DR: This glaucoma PRS will facilitate the development of a personalized approach for earlier treatment of high-risk individuals, with less intensive monitoring and treatment being possible for lower-risk groups.
Abstract: Glaucoma, a disease characterized by progressive optic nerve degeneration, can be prevented through timely diagnosis and treatment. We characterize optic nerve photographs of 67,040 UK Biobank participants and use a multitrait genetic model to identify risk loci for glaucoma. A glaucoma polygenic risk score (PRS) enables effective risk stratification in unselected glaucoma cases and modifies penetrance of the MYOC variant encoding p.Gln368Ter, the most common glaucoma-associated myocilin variant. In the unselected glaucoma population, individuals in the top PRS decile reach an absolute risk for glaucoma 10 years earlier than the bottom decile and are at 15-fold increased risk of developing advanced glaucoma (top 10% versus remaining 90%, odds ratio = 4.20). The PRS predicts glaucoma progression in prospectively monitored, early manifest glaucoma cases (P = 0.004) and surgical intervention in advanced disease (P = 3.6 × 10-6). This glaucoma PRS will facilitate the development of a personalized approach for earlier treatment of high-risk individuals, with less intensive monitoring and treatment being possible for lower-risk groups.
TL;DR: Acute myocardial injury is common in patients with COVID-19 and is associated with adverse prognosis, including death, admission to an intensive care unit (ICU), need for mechanical ventilation, treatment with vasoactive agents and classification of disease severity.
Abstract: Objective We sought to explore the prevalence and immediate clinical implications of acute myocardial injury in a cohort of patients with covid-19 in a region of China where medical resources are less stressed than in Wuhan (the epicentre of the pandemic). Methods We prospectively assessed the medical records, laboratory results, chest CT images and use of medication in a cohort of patients presenting to two designated covid-19 treatment centres in Sichuan, China. Outcomes of interest included death, admission to an intensive care unit (ICU), need for mechanical ventilation, treatment with vasoactive agents and classification of disease severity. Acute myocardial injury was defined by a value of high-sensitivity troponin T (hs-TnT) greater than the normal upper limit. Results A total of 101 cases were enrolled from January to 10 March 2020 (average age 49 years, IQR 34–62 years). Acute myocardial injury was present in 15.8% of patients, nearly half of whom had a hs-TnT value fivefold greater than the normal upper limit. Patients with acute myocardial injury were older, with a higher prevalence of pre-existing cardiovascular disease and more likely to require ICU admission (62.5% vs 24.7%, p=0.003), mechanical ventilation (43.5% vs 4.7%, p Conclusion Acute myocardial injury is common in patients with covid-19 and is associated with adverse prognosis.
Innsbruck Medical University1, University of Surrey2, Royal Surrey County Hospital3, Mayo Clinic4, St Thomas' Hospital5, Queen Mary University of London6, Barts Health NHS Trust7, University of Alberta8, University of Eastern Piedmont9, Paris Diderot University10, Sorbonne11, Saint Louis University Hospital12, Fudan University13, University of Hamburg14, Ghent University Hospital15, University Hospital Regensburg16, University of Zurich17, University of Münster18, University College Dublin19, Boston Children's Hospital20, Medical University of Vienna21, Hochschule Hannover22, University of Padua23, University of Pittsburgh24
TL;DR: Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence found in the ADQI 21 conference.
Abstract: Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). A consensus conference on the spectrum of lung–kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with acute kidney injury and/or kidney dysfunction among patients with acute respiratory failure/acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung–kidney interactions to improve care processes and outcomes in critical illness.
TL;DR: COVID-19 has been reported in association with acute limb ischaemia, stroke and the so called “paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection” and PAMM and AMN have similar underlying pathophysiology.
Abstract: This report cases of two patients who presented with a new paracentral scotoma following SARS-CoV-2 infection. Patient 1 is a 37-year-old Caucasian female in week 14 of an uncomplicated pregnancy presented with a 1-day history of abrupt onset, faintly colourful, left eye paracentral scotoma. This was 35 days following the onset of a febrile illness with cough and anosmia. SARS-CoV-2 nasopharyngeal swab was not performed during the infection, but subsequently positive serology (IgG) has been confirmed. Past medical history included acephalgic visual migraine aura and right toxoplasma chorioretinitis. Examination showed normal visual acuity, no uveitis and fundoscopy was normal in the left eye. OCT changes correlated with the location of the scotoma. A focal area of hyper-reflective change in the inner and outer plexiform layers with inner nuclear layer volume loss was seen consistent with paracentral acute middle maculopathy (PAMM). Bloods were normal, including ESR, CRP, lipids, glucose, ANA and anti-phospholipid antibodies. An electrocardiogram and carotid Doppler ultrasound were normal. Patient 2 is a 32-year-old Caucasian male presented with a 4-day history of abrupt onset, faintly colourful, right eye paracentral scotoma. This was 16 days following the onset of nasopharyngeal swab confirmed COVID-19. Past medical history included acephalgic visual migraine aura. Examination showed normal visual acuity, no uveitis and fundoscopy was normal. Changes on infrared reflectance (white arrow) and OCT correlated with the location of the scotomaA focal area of faint outer plexiform layer hyper-reflective change and disruption of the interdigitation zone were seen consistent with acute macular neuroretinopathy. These patients developed PAMM and AMN soon after confirmed SARS-CoV-2 infection and possibly represent postinfectious complications.
TL;DR: A novel 4D (3D + time) deep learning-based reconstruction network, termed 4D CINENet, for prospectively undersampled 3D Cartesian CINE imaging, which outperforms iterative reconstructions in visual image quality and contrast and finds good agreement in LV function.
Abstract: Cardiac CINE magnetic resonance imaging is the gold-standard for the assessment of cardiac function. Imaging accelerations have shown to enable 3D CINE with left ventricular (LV) coverage in a single breath-hold. However, 3D imaging remains limited to anisotropic resolution and long reconstruction times. Recently deep learning has shown promising results for computationally efficient reconstructions of highly accelerated 2D CINE imaging. In this work, we propose a novel 4D (3D + time) deep learning-based reconstruction network, termed 4D CINENet, for prospectively undersampled 3D Cartesian CINE imaging. CINENet is based on (3 + 1)D complex-valued spatio-temporal convolutions and multi-coil data processing. We trained and evaluated the proposed CINENet on in-house acquired 3D CINE data of 20 healthy subjects and 15 patients with suspected cardiovascular disease. The proposed CINENet network outperforms iterative reconstructions in visual image quality and contrast (+ 67% improvement). We found good agreement in LV function (bias ± 95% confidence) in terms of end-systolic volume (0 ± 3.3 ml), end-diastolic volume (− 0.4 ± 2.0 ml) and ejection fraction (0.1 ± 3.2%) compared to clinical gold-standard 2D CINE, enabling single breath-hold isotropic 3D CINE in less than 10 s scan and ~ 5 s reconstruction time.
TL;DR: The pathways involved in creatinine generation and metabolism as well as the techniques involved in measuring Creatinine concentrations are discussed, allowing for the discussion of the value and pitfalls in using creat inine as a marker of kidney function.
Tel Aviv University1, University of British Columbia2, Copenhagen University Hospital3, Mayo Clinic4, Rabin Medical Center5, University Hospital of Bern6, French Institute of Health and Medical Research7, Hospital Clínico San Carlos8, Erasmus University Medical Center9, University of Catania10, University Hospital Bonn11, Hadassah Medical Center12, St Thomas' Hospital13, Emory University Hospital14, Helsinki University Central Hospital15, McGill University16, Medical University of Vienna17, Ljubljana University Medical Centre18, Montefiore Medical Center19, Brighton and Sussex University Hospitals NHS Trust20, Vancouver General Hospital21, Columbia University Medical Center22
TL;DR: Redo-TAVR is a relatively safe and effective option for selected patients with valve dysfunction after TAVR, and results are important for applicability of T AVR in patients with long life expectancy in whom THV durability may be a concern.
TL;DR: An overview of the atopic march and immune mechanism underlying the sensitization and effector phase of food allergy is provided and experimental models and human data that support the concept of epicutaneous sensitization are presented, forming one half of the dual‐allergen exposure hypothesis.
Abstract: There is increasing evidence regarding the importance of allergic sensitization through the skin. In this review, we provide an overview of the atopic march and immune mechanism underlying the sensitization and effector phase of food allergy. We present experimental models and human data that support the concept of epicutaneous sensitization and how this forms one half of the dual-allergen exposure hypothesis. We discuss specific important elements in the skin (FLG and other skin barrier gene mutations, Langerhans cells, type 2 innate lymphoid cells, IL-33, TSLP) that have important roles in the development of allergic responses as well as the body of evidence on environmental allergen exposure and how this can sensitize an individual. Given the link between skin barrier impairment, atopic dermatitis, food allergy, allergic asthma, and allergic rhinitis, it is logical that restoring the skin barrier and prevention or treating atopic dermatitis would have beneficial effects on prevention of related allergic diseases, particularly food allergy. We present the experimental and human studies that have evaluated this approach and discuss various factors which may influence the success of these approaches, such as the type of emollient chosen for the intervention, the role of managing skin inflammation, and differences between primary and secondary prevention of atopic dermatitis to achieve the desired outcome.
Ghent University Hospital1, University of Florida2, University of Pittsburgh3, Allegheny General Hospital4, St Thomas' Hospital5, Otto-von-Guericke University Magdeburg6, Goethe University Frankfurt7, Northwestern University8, University of Michigan9, Rutgers University10, Vanderbilt University Medical Center11, University of Chicago12, Barts Health NHS Trust13, Innsbruck Medical University14, University of Surrey15, Veterans Health Administration16
TL;DR: Elevated urinary C–C motif chemokine ligand 14 (CCL14) was the most predictive of persistent stage 3 AKI with an area under the receiver operating characteristic curve (AUC) of 0.83, which could help identify new therapeutic approaches to AKI.
Abstract: The aim of the RUBY study was to evaluate novel candidate biomarkers to enable prediction of persistence of renal dysfunction as well as further understand potential mechanisms of kidney tissue damage and repair in acute kidney injury (AKI). The RUBY study was a multi-center international prospective observational study to identify biomarkers of the persistence of stage 3 AKI as defined by the KDIGO criteria. Patients in the intensive care unit (ICU) with moderate or severe AKI (KDIGO stage 2 or 3) were enrolled. Patients were to be enrolled within 36 h of meeting KDIGO stage 2 criteria. The primary study endpoint was the development of persistent severe AKI (KDIGO stage 3) lasting for 72 h or more (NCT01868724). 364 patients were enrolled of whom 331 (91%) were available for the primary analysis. One hundred ten (33%) of the analysis cohort met the primary endpoint of persistent stage 3 AKI. Of the biomarkers tested in this study, urinary C–C motif chemokine ligand 14 (CCL14) was the most predictive of persistent stage 3 AKI with an area under the receiver operating characteristic curve (AUC) (95% CI) of 0.83 (0.78–0.87). This AUC was significantly greater than values for other biomarkers associated with AKI including urinary KIM-1, plasma cystatin C, and urinary NGAL, none of which achieved an AUC > 0.75. Elevated urinary CCL14 predicts persistent AKI in a large heterogeneous cohort of critically ill patients with severe AKI. The discovery of CCL14 as a predictor of persistent AKI and thus, renal non-recovery, is novel and could help identify new therapeutic approaches to AKI.
TL;DR: The role of cholesterol level in the process of the coronavirus infection is elaborated and a critical appraisal on the potential of statins in reducing the severity, duration, and complications of COVID-19 is provided.
Abstract: Current data suggest that infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing corona virus disease-19 (COVID-19) seems to follow a more severe clinical course in patients with cardiovascular disease (CVD), hypertension, and overweight/obesity. It appears that lipid-lowering pharmacological interventions, in particular statins, might reduce the risk of cardiovascular complications caused by COVID-19 and might potentially have an additional antiviral activity. It has been shown that high cholesterol levels are associated with more lipid rafts, subdomains of the plasma membrane that can harbour angiotensin-converting enzyme 2 (ACE2) receptors for the S-protein of SARS-CoV-2. Evidence of the importance of cholesterol for viral entry into host cells could suggest a role for cholesterol-lowering therapies in reducing viral infectivity. In addition to their lipid-lowering and plaque-stabilisation effects, statins possess pleiotropic effects including anti-inflammatory, immunomodulatory, and antithrombotic activities. Lower rates of mortality and intubation have been reported in studies investigating statin therapy in influenza infection, and statin therapy was shown to increase viral clearance from the blood during chronic hepatitis C infection. Statins may also serve as potential SARS-CoV-2 main protease inhibitors, thereby contributing to the control of viral infection. In this review, we elaborate on the role of cholesterol level in the process of the coronavirus infection and provide a critical appraisal on the potential of statins in reducing the severity, duration, and complications of COVID-19.
Royal College of Surgeons in Ireland1, University College Cork2, Charité3, Hospital Clínico San Carlos4, Imperial College London5, Goethe University Frankfurt6, Karolinska Institutet7, Carlos III Health Institute8, Lille University of Science and Technology9, University of Padua10, University of Manchester11, University Hospital Southampton NHS Foundation Trust12, University of Strasbourg13, University of California, San Francisco14, King's College London15, St Thomas' Hospital16
TL;DR: AR101 oral immunotherapy treatment led to rapid desensitisation to peanut protein, with a predictable safety profile that improved with treatment, and an associated improvement in self-reported and caregiver-reported food allergy-related quality of life.
TL;DR: This meta-analysis recommends self-isolation and testing, where possible, for patients complaining smell or taste impairment during COVID-19 pandemic in order to prevent spread of disease and proposes the inclusion of loss of smell and taste as recognized symptoms of SARS-CoV-2 in the World Health Organization and other relevant regulatory body's lists.
Abstract: Background Emerging reports suggest that new onset of smell or taste loss are potential early clinical markers of SARS-CoV-2 infection, but it remains unclear as to what extent. Therefore, the purpose of this study is to systematically assess the prevalence of self-reported altered sense of smell or taste in patients with confirmed SARS-CoV-2 infection, overcoming the limitations of individual studies by meta-analysis of pooled data. Methods The databases Medline, Embase, Web of Science, Scopus and MedRxiv's set were searched from inception to the 4th May 2020. This study was conducted following the PRISMA checklist. Results 18 studies met the eligibility criteria out of the 171 initially screened citations. The overall prevalence of alteration of the sense of smell or taste was 47% , but estimates were 31% and 67% in severe and mild-to-moderate symptomatic patients, respec- tively. The loss of smell and taste preceded other symptoms in 20% of cases and it was concomitant in 28%. Conclusions Based on this meta-analysis, we recommend self-isolation and testing, where possible, for patients complaining smell or taste impairment during COVID-19 pandemic in order to prevent spread of disease and propose the inclusion of loss of smell and taste as recognized symptoms of SARS-CoV-2 in the World Health Organization and other relevant regulatory body's lists.
TL;DR: Venous thrombosis is common in patients with severe COVID-19 pneumonia and many of these thromBoses may be immunothromboses due to local inflammation, rather than thromboembolic disease.
Cliniques Universitaires Saint-Luc1, University of Amsterdam2, Ghent University Hospital3, Copenhagen University Hospital4, University of Barcelona5, Karolinska University Hospital6, Ghent University7, St Thomas' Hospital8, University of Helsinki9, University of Cologne10, Medical University of Graz11, University of Düsseldorf12
TL;DR: A panel of international experts in the field of Rhinology reviewed the available literature with the aim of providing recommendations for the use of systemic steroids in treating upper airway disease.
Abstract: Because of the inflammatory mechanisms of most chronic upper airway diseases such as rhinitis and chronic rhinosinusitis, systemic steroids have been used for their treatment for decades. However, it has been very well documented that—potentially severe—side-effects can occur with the accumulation of systemic steroid courses over the years. A consensus document summarizing the benefits of systemic steroids for each upper airway disease type, as well as highlighting the potential harms of this treatment is currently lacking. Therefore, a panel of international experts in the field of Rhinology reviewed the available literature with the aim of providing recommendations for the use of systemic steroids in treating upper airway disease.
TL;DR: This document aims to provide practical guidance for the assessment and management of patients with thrombocytopenia during the COVID‐19 pandemic, with a particular focus on immune throm bocy topenia (ITP), during the coagulation disorders pandemic.
Abstract: This document aims to provide practical guidance for the assessment and management of patients with thrombocytopenia, with a particular focus on immune thrombocytopenia (ITP), during the COVID-19 pandemic. The intention is to support clinicians and, although recommendations have been provided, it is not a formal guideline. Nor is there sufficient evidence base to conclude that alternative approaches to treatment are incorrect. Instead, it is a consensus written by clinicians with an interest in ITP or coagulation disorders and reviewed by members of the UK ITP forum.
TL;DR: This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral and to adopt a lifespan model of care for girls and women with ADHD.
Abstract: There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD. The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan. A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them. This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.