Clearance Test Research Articles

Time to SARS-CoV-2 clearance among patients with cancer and COVID-19.

BackgroundFor cancer patients, coronavirus disease 19 (COVID‐19) infection can lead to delays in cancer therapy both due to the infection itself and due to the need to minimize exposure to other patients and to staff. Clearance guidelines have been proposed, but expected time to clearance has not been established.MethodsWe identified all patients at a tertiary care hospital cancer center between 25 March 2020 and 6 June 2020 with a positive nasopharyngeal reverse transcriptase polymerase chain reaction (RT‐PCR) test for the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), a cancer‐related visit within 3 years, and at least one follow‐up assay. We determined the time to clearance using American Society of Clinical Oncology (ASCO), the UK National Institute for Health and Care Excellence (UK‐NICE), and Centers for Disease Control and Prevention (CDC) criteria. A matched non‐cancer comparison cohort was also identified.ResultsThirty‐two cancer patients were identified. Nineteen were cleared by ASCO criteria, with estimated median time to clearance of 50 days. Fourteen patients resumed chemotherapy prior to clearance. Using UK‐NICE criteria, median time to clearance would have been 31 days, and using CDC criteria, it would have been 13 days. The matched non‐cancer cohort had similar clearance time, but with less frequent testing.ConclusionSARS‐CoV‐2 clearance times differ substantially depending on the criteria used and may be prolonged in cancer patients. This could lead to a delay in cancer care, increased use of clearance testing, and extension of infection control precautions.

Interrater and Intrarater Reliability and Discriminant Validity of a Pediatric Lower Extremity Physical Therapy Clearance Test.

Background:Few studies have validated when an athlete can safely return to sports, and even fewer have identified when he or she no longer requires physical therapy after surgery. Discontinuing physical therapy is often dictated by insurance restrictions, but most studies have suggested that the decision should be multifactorial, stemming from patient-derived subjective outcome questionnaires, clinical examination, and isokinetic and functional testing.Purpose/Hypothesis:The purpose of this study was to establish discriminant validity and reliability of an objective physical therapy clearance (PTC) test in a clinical setting. The hypotheses were that the PTC test (1) will demonstrate different scores between normal and postoperative cohorts and (2) will have acceptable inter- and intraobserver reliability.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:Four cohorts (27 total participants; age range, 12-18 years) underwent the PTC test: 9 adolescents 6 months after anterior cruciate ligament reconstruction, 4 adolescents 6 weeks after partial meniscectomy, 5 adolescents with nonstructural knee pain, and 9 control/healthy participants without any lower extremity complaint. The PTC test included a dynamic warm-up, objective measures (knee range of motion, thigh girth, and muscle motor tone), functional strength tests (heel raises, single-leg dips, hop tests, tuck jumps), and agility tests (shuffle and sprint T-test). Each testing session was videotaped and scored live by the physical therapist administering the test, and then scored via the video recording by an independent physical therapist and 2 orthopaedic surgeons.Results:The PTC test was found to have discriminant validity between the control cohort and both cohorts with previous surgery. The single-leg dip, single-leg hop, and vertical tuck jump were the most discriminatory components. The PTC test had moderate to almost perfect intrarater reliability (κ = 0.57-1), but only fair to moderate interrater reliability among video graders (κ = 0.29-0.58) and slight to substantial reliability between video graders and the live PT rater (κ = 0.19-0.63).Conclusion:The PTC test was found to have moderate inter- and intraobserver agreement, with the ability to discriminate between postoperative and control patients.

Three Statistical Approaches for Assessment of Intervention Effects: A Primer for Practitioners.

IntroductionStatistical methods to assess the impact of an intervention are increasingly used in clinical research settings. However, a comprehensive review of the methods geared toward practitioners is not yet available.Methods and MaterialsWe provide a comprehensive review of three methods to assess the impact of an intervention: difference-in-differences (DID), segmented regression of interrupted time series (ITS), and interventional autoregressive integrated moving average (ARIMA). We also compare the methods, and provide illustration of their use through three important healthcare-related applications.ResultsIn the first example, the DID estimate of the difference in health insurance coverage rates between expanded states and unexpanded states in the post-Medicaid expansion period compared to the pre-expansion period was 5.93 (95% CI, 3.99 to 7.89) percentage points. In the second example, a comparative segmented regression of ITS analysis showed that the mean imaging order appropriateness score in the emergency department at a tertiary care hospital exceeded that of the inpatient setting with a level change difference of 0.63 (95% CI, 0.53 to 0.73) and a trend change difference of 0.02 (95% CI, 0.01 to 0.03) after the introduction of a clinical decision support tool. In the third example, the results from an interventional ARIMA analysis show that numbers of creatinine clearance tests decreased significantly within months of the start of eGFR reporting, with a magnitude of drop equal to −0.93 (95% CI, −1.22 to −0.64) tests per 100,000 adults and a rate of drop equal to 0.97 (95% CI, 0.95 to 0.99) tests per 100,000 per adults per month.DiscussionWhen choosing the appropriate method to model the intervention effect, it is necessary to consider the structure of the data, the study design, availability of an appropriate comparison group, sample size requirements, whether other interventions occur during the study window, and patterns in the data.

Robotic ALPPS for intrahepatic cholangiocarcinoma

Background: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for intrahepatic cholangiocarcinoma (ICC) demonstrated good long-term outcomes and can increase the rate of resectability in locally advanced ICC; however, the rates of postoperative complications (Clavien-Dindo grade III) and mortality range between 13.6 and 44% and 0 and 29%, respectively. Minimally invasive strategies may reduce the risk of postoperative morbidity, with the same oncologic outcomes. We herein report a full robotic ALPPS for advanced ICC. Methods: The patient was a 61-year-old male diagnosed with a 6.5 cm ICC involving segments IV, V, and VIII. The total clean liver volume was 1553 cc, with a future liver remnant (FLR) volume of 21.6% (segments I, II, and III: 337 cc). Results: Computed tomography scan on postoperative day (POD) 9 after stage 1 showed that FLR increased up to 38%. The indocyanine green clearance test showed a plasma disappearance rate of 19.8%/min and a retention rate at 15 min of 5.1%. ALPPS was completed on POD 14, the postoperative course was uneventful, and the patient was discharged in good general condition on POD 5. Final pathology showed a 6 cm ICC, G3, R0 margin (10 mm), T2-N0-M0. The patient started adjuvant capecitabine, and after 16 months he is in good general condition without signs of local or systemic recurrence. Conclusion: Robotic ALPPS combines the opportunity to perform a curative resection in patients presenting with insufficient FLR with the advantages of a minimally invasive approach. It is feasible and oncologically accurate for ICC when performed in fully trained HPB centers.

Fluorescent nanodiamond - hyaluronate conjugates for target-specific molecular imaging.

Despite wide investigation on molecular imaging contrast agents, there are still strong unmet medical needs to enhance their signal-to background ratio, brightness, photostability, and biocompatibility with multimodal imaging capability. Here, we assessed the feasibility of fluorescent nanodiamonds (FNDs) as carbon based photostable and biocompatible materials for molecular imaging applications. Because FNDs have negatively charged nitrogen vacancy (NV) centers, they can emit bright red light. FNDs were conjugated to hyaluronate (HA) for target-specific molecular imaging. HA is a biocompatible, biodegradable, and linear polysaccharide with abundant HA receptors in the liver, enabling liver targeted molecular imaging. In vitro cell viability tests revealed the biocompatibility of HA–FND conjugates and the competitive cellular uptake test confirmed their target-specific intracellular delivery to HepG2 cells with HA receptors. In addition, in vivo fluorescence lifetime (FLT) assessment revealed the imaging capability of FNDs and HA–FND conjugates. After that, we could confirm the statistically significant liver-targeted delivery of HA–FND conjugates by in vivo imaging system (IVIS) analysis and ex vivo biodistribution tests in various organs. The renal clearance test and histological analysis corroborated the in vivo biocompatibility and safety of HA–FND conjugates. All these results demonstrated the feasibility of HA–FND conjugates for further molecular imaging applications.

The Impact of Different Induction Immunosuppressive Therapy on Long Term Kidney Transplant Function When Measured by Iothalamate Clearance

Background: Improvement in short-term outcomes after kidney transplant has been achieved by using different induction and maintenance therapeutic approaches. Long-term outcomes have not matched the expectations of the transplant stakeholders. Our study aimed to address the early impact of induction agents on long-term outcome of kidney transplant when measured by iothalamate clearance. Methods: All adult kidney transplant recipients between January of 2012 and December of 2016 were reviewed. Six hundred forty-nine patients were divided into three groups based on the induction agent (basiliximab, alemtuzumab, and thymoglobulin). Protocoled 4 months and 48 months kidney allograft function evaluations with iothalamate clearance test were compared among the three groups. Results: Patients who received basiliximab were significantly older with no difference among African American and Caucasians. The 48 months assessment showed significant decline in median iothalamate clearance in basiliximab group at 49 mL/min vs. alemtuzumab group 64.8 mL/min and thymoglobulin 60 mL/min with P = 0.007. The basiliximab group developed a significant higher proteinuria measured by spot urine to creatinine ratio at 48 months. Conclusions: The use of basiliximab as an induction agent for kidney transplant is associated with significant decline in kidney function 4 years post transplantation when measured by iothalamate clearance. J Clin Med Res. 2020;12(12):787-793 doi: https://doi.org/10.14740/jocmr4369

Evaluation of the immunomodulatory and anti-inflammatory activity of Bakuchiol using RAW 264.7 macrophage cell lines and in animal models stimulated by lipopolysaccharide (LPS)

Bakuchiol (BAK) has been reported to have a diverse pharmacological property as an antibiotic, anti-cancer, anti-hypolipidemic, anti-inflammatory and anti-convulsant agent. This study aimed to elucidate the immunomodulation and anti-inflammatory mechanism of bakuchiol using lipopolysaccharide stimulated RAW 264.7 macrophages and various animal models. The present study has shown that BAK significantly suppressed the pro-inflammatory cytokine expression in a dose-dependent manner and its oral administration significantly decreased delayed hypersensitivity responses as compared to control group. The assessment of immunomodulatory activity was carried out by the testing Hemagglutinating antibody (HA) titer, delayed type hypersensitivity (DTH) responses and phagocytic index by carbon clearance test. On the other hand, it showed significant decrease in circulating antibody titer and carbon clearance assay in a concentration-dependent manner. BAK has significantly potentiated the cellular immunity as well as humoral immunity by facilitating the footpad thickness responses in sheep RBCs in sensitized mice by significantly decreasing circulating antibody titer. Molecular studies revealed that BAK inhibited the activation of upstream mediator nuclear factor-κB by suppressing the phosphorylation of IκBα and p65. The responses were statistically significant as compared with the control (*p < 0.05, **p < 0.01).

Gastroprotective effect of the root extract of Alpinia officinarum Hance (Zingiberoside) against acute indomethacin-induced gastric injuries in rats: Involvement of H+/K+-ATPase and prostaglandin E receptors

Purpose: To investigate the protective effects of Alpinia officinarum root ethanol extract (AOE) and galangin against acute indomethacin-induced injury on rat gastric mucosaMethods: Sprague-Dawley rats were daily treated with bismuth potassium citrate (0.08 g/kg), AOE at doses of 0.09, 0.18 and 0.36 g/kg; and galangin (0.2 g/kg) for 15 days. Then, gastric injury on rats was induced by intragastric administration of indomethacin (30 mg/kg). Blood flow and thickness of gastric mucosa were determined using neutral red clearance test and Alcian blue staining. The activity of H+/K+-ATPase was assayed using a biochemical kit. Prostaglandin E receptor expressions were assayed by western blotting.Results: High doses of ethanol extract of Alpinia officinarum root significantly inhibited H+/K+-ATPase activity by 8.12 % (p &lt; 0.01), increased gastric mucosal blood flow (p &lt; 0.001), enhanced mucus thickness (p &lt; 0.05), and elevated the activities of prostaglandin E receptors 1 and 4 (p &lt; 0.05).Galangin significantly inhibited H+/K+-ATPase activity by 4.82 % (p &lt; 0.05) and increased gastric mucosal blood flow (p &lt; 0.01).Conclusion: The ethanol extract of Alpinia officinarum root attenuates indomethacin-induced gastric injury by reinforcing gastric mucosal barrier and inhibiting excessive gastric acid secretion. Thus, the extract can be potentially developed for management of gastric injuries.&#x0D; Keywords: Galangin, Gastric mucosal barrier, Gastric acid, Prostaglandin, Indomethacin

Assessment of mucociliary clearance as an indicator of nasal function in patients with COVID-19: a cross-sectional study.

PurposeWe assessed the effects of COVID-19 infection on nasal mucociliary activity.MethodsThe study was conducted in the pandemic wards of Adiyaman University Training and Research Hospital during April and May 2020. All patients admitted to the COVID-19 pandemic wards during the study period were invited to participate in the study. The study included 40 adults who agreed to participate and underwent a mucociliary clearance test successfully. The primary outcome was mucociliary clearance time and the secondary variables of interest were age, sex, and sino-nasal outcome test-22 scores. The control group included 40 concomitant healthy patients who visited the outpatient ear, nose and throat clinic with non-nasal symptoms.ResultsThe study included 40 COVID-19-positive patients and 40 healthy controls. The mean mucociliary clearance times of the study (15.53 ± 5.57 min) and control (9.50 ± 3.70 min) groups were significantly different (Z = 4.675, p < 0.001). However, the mucociliary clearance time was not significantly different between males and females (t = 0.590, p = 0.558).ConclusionsNasal mucociliary clearance time was prolonged in COVID-19 patients compared to healthy controls. Thus, we conclude that smell and taste are crucial symptoms that should not be overlooked in patients suspected of COVID-19 disease.

The technique of 3D reconstruction combining with biochemistry to build an equivalent formula of indocyanine green (ICG) clearance test to assess the liver reserve function

BackgroundThe indocyanine green (ICG) clearance test is the main method of evaluating the liver reserve function before hepatectomy. However, some patients may be allergic to ICG or the equipment of ICG clearance test was lack, leading to be difficult to evaluate liver reserve function. We aim to find an alternative tool to assist the clinicians to evaluate the liver reserve function for those who were allergic to the ICG or lack of equipment before hepatectomy.MethodsWe retrospected 300 patients to investigate the risk factors affecting the liver reserve function and to build an equivalent formula to predict ICG 15 min retention rate (ICG-R15) value.ResultsWe found that the independent risk factors affecting ICG clearance test were total bilirubin, albumin, and spleen-to-non-neoplastic liver volume ratio (SNLR). The equivalent formula of the serological index combining with SNLR was: ICG-R15 = 0.36 × TB (umol/L) − 0.78 × ALB(g/L) + 7.783 × SNLR + 0.794 × PT (s) − 0.016 × PLT(/109) − 0.039 × ALT (IU/L) + 0.043 × AST (IU/L) + 23.846. The equivalent formula of serum index was: ICG-R152 = 24.665 + 0.382 × TB (umol/L) − 0.799 × ALB(g/L) − 0.025 × PLT(/109) + 0.048 × AST(IU/L) − 0.045 × ALT(IU/L). And the area under the ROC curve (AUC) of predicting ICG-R15 ≥ 10% was 0.861 and 0.857, respectively.ConclusionWe found that SNLR was an independent risk factor affecting liver reserve function. Combining with SNLR to evaluate the liver reserve function was better than just basing on serology.

The use of inertial measurement units to assess gait and postural control following concussion

BackgroundImpairments in gait and balance function are typical after concussion. There is evidence that these neuromuscular deficits persist past the typical time of symptom resolution. The ability to quantify these changes in gait and balance may provide useful information when making return to play decisions in clinical settings. Research QuestionAre changes in gait function and postural control evident across the course of a concussion management program? MethodsA retrospective analysis of a convenience sample of 38 patients who were seen for concussion between October 2017 and May 2019 was performed. Gait and balance measures were assessed at their initial clinic visit post-injury and at their clearance visit using inertial measurement units. During dual-task walking trials, the medial-lateral motion of the center of mass and gait velocity were measured. Postural sway complexity and jerk index were measured during both eyes-open and eyes-closed balance trials. ResultsPaired samples t-tests and Wilcoxon signed rank tests were used to determine whether statistically significant changes occurred for the gait and balance variables, respectively. Medial-lateral sway decreased (4.4 ± 1.3 cm to 4.0 ± 1.2 cm, p = 0.018) and gait velocity increased (0.78 ± 0.23 m/s to 0.91 ± 0.18 m/s, p < 0.001) from initial to clearance testing. Jerk index decreased (6.41 ± 11.06 m2/s5 to 5.73 ± 4.28 m2/s5, p = 0.031) and (11.87 ± 26.42 m2/s5 to 7.87 ± 8.38 m2/s5, p = 0.003) from initial to clearance testing for the eyes-open and eyes-closed conditions, respectively. Complexity index increased (2.38 ± 1.08–2.86 ± 0.72, p = 0.010) from initial to clearance testing for the eyes-closed condition. There was no change in complexity index for the eyes-open condition. SignificanceThese preliminary results support the potential use of measures of gait and postural control to assess recovery following a concussion in a clinical setting.

Temperature sensitive self-assembling hydroxybutyl chitosan nanoparticles with cationic enhancement effect for multi-functional applications

Hydroxybutyl chitosan (HBC) with different degree of substitution (DS) were prepared using a homogeneous reaction system (KOH/urea), which could achieve temperature-dependent reversible morphological transition in aqueous solution. During hydrophobic assembly, amino groups on HBC chains exposed on the surface of nanoparticles formed a poly-cationic structure. The structure of HBCs was characterized by FTIR, 13C NMR, XRD, TGA and rheology. The morphology and assembly mechanism of HBC nanoparticles were studied by TEM, AFM and DLS. Also, the results of coagulation, bacteriostatic, superoxide anion clearance and anionic contaminant removal tests suggested that HBC nanoparticles had excellent flocculation and removal effect of anionic composites. Moreover, the cytocompatibility test indicated that HBC could effectively promote proliferation and division of mouse fibroblast, mouse embryonic fibroblast and rat bone marrow mesenchymal stem cells. These cationic HBC nanoparticles exhibited great potential in multi-functional applications.

IDIOPATHIC DIFFUSE PULMONARY OSSIFICATION: A RARE CAUSE OF CALCIFIED PULMONARY NODULES

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Idiopathic diffuse pulmonary ossification is an extremely rare disease that often presents incidentally on chest imaging. While the initial course can often be indolent, the disease course can be severe, and in some cases, fatal. Here, we describe a case of a 21-year-old female who was incidentally diagnosed with diffuse pulmonary ossification. CASE PRESENTATION: The patient underwent tuberculin skin test for school clearance and was noted to have induration to 16 mm with subsequent negative QuantiFERON gold testing. Chest radiograph showed diffuse bilateral peribronchial thickening and nodular interstitial abnormality. The patient reported mild progressive dyspnea on exertion and intermittent dry cough. Her vital signs were unremarkable including an oxygen saturation of 97% on room air. On exam, her lungs were clear to auscultation. Initial computed tomography (CT) scan of the chest showed extensive bilateral centrilobular and peribronchvascular nodules with varying levels of calcification (image 1). Repeat CT scan at 3 months showed no change. Laboratory investigations including calcium, phosphate, sputum acid-fast bacilli, fungal serologies, and rheumatologic screen were normal. Spirometry showed an isolated mild reduction in the DLCO. Bronchoscopy with transbronchial cryobiopsy of the RLL showed pulmonary parenchyma with focal ossification without granulomas, malignancy or amyloid. Cultures were negative. DISCUSSION: Diffuse pulmonary ossification involves the formation of mature bone in the lung and occurs in two forms: nodular and dendriform, both of which can have idiopathic and secondary forms [1, 2]. Ossification typically presents in older men, though has been reported in women or younger adults. Commonly, patients present with absent to minimal symptoms of dyspnea and radiographic findings are out of proportion to symptoms. Spirometry testing is often initially normal but can develop a restrictive pattern with decreased DCLO in later stages. Chest imaging findings include bilateral diffuse calcified micronodules or dense ground glass opacities, with predilection for the lower lobes. Pathology typically reveals ossification and calcification within the alveoli. In later stages, alveolar septal thickening and interstitial fibrosis may develop. Diagnosis can often be made on imaging findings alone, though it can be confirmed with bronchoscopic or surgical biopsy if diagnosis is uncertain. Therapies target lowering serum calcium levels, though no treatments have been shown to affect the progression of disease. For patients with a more aggressive course, lung transplant may be considered [3]. CONCLUSIONS: Pulmonary ossification is a rare, often asymptomatic disorder, that should be suspected in patients with characteristic imaging findings. Early identification can help to monitor progression, though no clear disease modifying therapies have been identified. Reference #1: 1.Tseung J, Duflou J. Diffuse pulmonary ossification: an uncommon incidental autopsy finding. Pathology 38: 45-48, 2006. Reference #2: 2. Reddy TL, von der Thüsen J, Walsh SL. Idiopathic dendriform pulmonary ossification. J Thorac Imaging 27: W108-W110, 2012. Reference #3: 3. Matsuo H. et al, Progressive Restrictive Ventilatory Impairment in Idiopathic Diffuse Pulmonary Ossification Intern Med. 2018 Jun 1; 57(11): 1631–1636 DISCLOSURES: No relevant relationships by Jessica Channick, source=Web Response My spouse/partner as a Consultant relationship with Actelion Please note: $20001 - $100000 Added 04/20/2020 by Colleen Channick, source=Web Response, value=Consulting fee My spouse/partner as a Consultant relationship with Bayer Please note: $5001 - $20000 Added 04/20/2020 by Colleen Channick, source=Web Response, value=Consulting fee No relevant relationships by Tamas Dolinay, source=Web Response

Abstract PO-029: Operationalizing a prioritized COVID-19 testing strategy at a Canadian tertiary care cancer center

Abstract Background: Available data suggest that cancer patients who contract COVID-19 may have worse outcomes, including a higher mortality compared to noncancer patients. In an effort to inform and guide our clinicians in the ongoing management of cancer patients during the COVID-19 pandemic, CancerControl Alberta (CCA) implemented targeted fast-track testing for symptomatic, immunocompromised cancer patients in the ambulatory setting. We report the results of the first 7 weeks of testing at the Tom Baker Cancer Centre (TBCC), a comprehensive tertiary cancer center serving southern Alberta (population approximately 2 million). Methods: Referral for prioritized COVID-19 testing (results within 24 hours) was intended for ambulatory cancer patients who were identified to have symptoms consistent with an influenza-like illness and confirmed to meet at least one of the following criteria: stem cell transplant recipient, hematologic malignancy, cancer diagnosis receiving &amp;gt;0.5 mg/kg/day of prednisone or equivalent, patients on immunotherapy treatment, patients on active chemotherapy within the last 3 weeks, neutropenia (ANC &amp;lt;500), lung cancer, chronic lung disease (e.g., COPD), or patients receiving curative radiation. Testing occurred on site at the TBCC at a designated drive-through testing area where staff, using PPE, tested patients who remained in their cars. The assay for COVID-19 was nucleic acid-based test, and patients were also tested for a standard respiratory virus panel. Patients received either a nasopharyngeal or throat swab, for hematologic and solid tumors diagnoses, respectively. Descriptive analyses were performed. Results: Between April 15th and June 1st, 2020, 80 patients received prioritized testing at the Tom Baker Cancer Centre. Patients who were tested for COVID-19 had the following characteristics: median age of 60.5 years (range 19, 85) and 31% were male. The majority of tested patients (80%) met the criteria as outlined to prioritize testing. Patients with the following tumor types comprised over 80% of those tested: breast (n=22), hematologic (n=16), lung (n=9), gynecologic (n=9), and GI (n=9). The average time from screening to testing was 26.5 hours, and the average time from test to result was 12.8 hours. At the time of reporting, only one breast cancer patient, who just finished chemotherapy, tested positive via the fast-track testing process; this patient received repeat clearance testing, undergoing a total of 6 tests over one month before achieving 2 negative tests. Conclusions: Our experience demonstrates that prioritized testing for COVID-19 among those who are potentially the most susceptible, namely immunocompromised cancer patients, is feasible. Very few (1%) positive cases of COVID-19 were identified, among 80 patients tested in the first 47 days of operationalizing the fast-track testing process. Expedited testing should be considered as an ongoing strategy to provide guidance to clinicians in managing cancer patients during the COVID-19 pandemic. Citation Format: April A. Hildebrand, Desiree Hao, Safiya Karim, Winson Y. Cheung, Don Morris, Daniel Y. C. Heng. Operationalizing a prioritized COVID-19 testing strategy at a Canadian tertiary care cancer center [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-029.

Is esophageal manometry essential for the diagnosis of achalasia? Identifying patients with achalasia by the esophageal clearance method.

Achalasia is a disease characterized by inadequate relaxation of the lower esophageal sphincter (LES) and impaired peristalsis, for which esophageal motor function testing is essential in making a definitive diagnosis. However, the diffusion rate of esophageal pressure testing in Japan is low. We, therefore, examined whether achalasia could be identified by esophageal clearance testing with low-density barium (Timed Barium Esophagogram: TBE). 126 cases (62 males, median age of 46years), excluding those who had not undergone TBE during their initial laparoscopic Heller-Dor surgery, were chosen as the subjects from among those who were diagnosed with achalasia from November 2012 when HRM was introduced. The type of dilation, maximum esophageal transverse diameter, and esophageal clearance measurements by TBE were retrospectively examined. With respect to TBE, 200mL of 45 weight% low-density barium was ingested as quickly as possible, after which the barium column heights (H0, H1, H2, and H5) were measured 1min, 2min, and 5min following ingestion. The types of dilation indicated included: straight type (105 cases, 83%); sigmoid type (20 cases, 16%); and advanced sigmoid type (1 case, 1%). The maximum transverse diameter of the esophagus was 45 (34-54) mm, with Grade I (d < 30mm) in 33 cases, Grade II (35mm < d < 60mm) in 75 cases, and Grade III (d < 60mm) in 18 cases. The values for H0, H1, H2, and H5 were 162 (117-201) mm, 142 (98-199) mm, 130 (94-183) mm, and 119 (77-178) mm, respectively. 114 cases (90.5%) were not cleared after 5min, while 12 cases (9.5%) were cleared by 5min later (H1 = 0 + H2 = 0 + H5 = 0) and 7 cases (5.6%) by 2min later (H1 = 0 + H2 = 0), with only 6 cases (4.8%) having complete clearance within 1min (H1 = 0). Moreover, the degree of dilatation in patients with complete clearance within 1min was three patients (2.4%) each for Grade I and Grade II, respectively. Approximately 2.4% of achalasia cases had mostly normal esophageal clearance and no esophageal dilation. Based on the state of esophageal clearance by TBE and the maximum transverse diameter of the esophagus, it seems by and large possible to identify achalasia cases.

Increased immunocompetence and network centrality of allogroomer workers suggest a link between individual and social immunity in honeybees

The significant risk of disease transmission has selected for effective immune-defense strategies in insect societies. Division of labour, with individuals specialized in immunity-related tasks, strongly contributes to prevent the spread of diseases. A trade-off, however, may exist between phenotypic specialization to increase task efficiency and maintenance of plasticity to cope with variable colony demands. We investigated the extent of phenotypic specialization associated with a specific task by using allogrooming in the honeybee, Apis mellifera, where worker behaviour might lower ectoparasites load. We adopted an integrated approach to characterize the behavioural and physiological phenotype of allogroomers, by analyzing their behavior (both at individual and social network level), their immunocompetence (bacterial clearance tests) and their chemosensory specialization (proteomics of olfactory organs). We found that allogroomers have higher immune capacity compared to control bees, while they do not differ in chemosensory proteomic profiles. Behaviourally, they do not show differences in the tasks performed (other than allogrooming), while they clearly differ in connectivity within the colonial social network, having a higher centrality than control bees. This demonstrates the presence of an immune-specific physiological and social behavioural specialization in individuals involved in a social immunity related task, thus linking individual to social immunity, and it shows how phenotypes may be specialized in the task performed while maintaining an overall plasticity.

A COVID-19 pandemic guideline in evidence-based medicine.

Data sources This review article scrutinised 16 clinical studies (clinical trials and observational studies) concerning coronavirus disease of 2019 (COVID-19). Additionally, 18 guidelines about the COVID-19 were reviewed and the key points were represented in this study.Study selection The review included human trials, in-vitro studies, review articles, and credible news reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 complications, treatment guidelines, management strategies, and epidemiological features. There were no exclusion criteria reported in this review and the included information was in English and Chinese languages.Data extraction and synthesis A descriptive review of the literature was conducted, taking a comprehensive approach. The paper consisted of three main parts: introduction, presentation, and management. The introduction part presented basic information about the SARS-CoV-2, its evolution and transmission, and the course of disease. The presentation section introduced the signs and symptoms, diagnosis, high risk groups, and complications of COVID-19. Eventually, some evidence was presented about the prevention, medical management, and measuring responses to the treatments in the management section.Results Based on the results of this study, non-pharmaceutical interventions, including strict social isolation and distancing measures, might reduce the spread of the SARS-CoV-2 by nearly 99.3 percent (reproduction number mitigating from 406 to 2.5 in 30 days). In the supportive management section, monitoring vital signs and neonatal feeding were stated as the most important factors to consider. For symptomatic neonates, medical management and intervention were mentioned as essential. It was claimed that for adults with mild infection, the best option would be home quarantine with further medical monitoring or hospitalisation if required. The following sequence was also suggested as early supportive therapy and monitoring: intravenous fluid administration, oxygen therapy, and application of corticosteroids. Management of critical patients with critical COVID-19 included admission to intensive care unit, use of continuous positive airway pressure and bi-level positive airway pressure in certain circumstances, endotracheal intubation, invasive mechanical ventilation, extracorporeal membrane oxygenation, and fluid resuscitation and vasopressors. Additionally, this study suggested oseltamivir, iopinavir, remdesivir, chloroquine, baricitinib, ruxolitinib, and fedratinib as possible drugs to help manage COVID-19. A soaring c-reactive protein level and decreased albumin content in the blood were reported to be associated with a deteriorating status in COVID-19 patients. To keep the number of exposures to a minimum, two separate viral clearance tests taken at least 24 hours apart, were stated as necessary laboratory results before the discharge of patients with COVID-19.Conclusions The study warns about possible exponential spread of COVID-19 and proposes to adhering to tighter restrictions of social distancing. Besides the clinical guidelines presented within the study, it also encourages further up-to-date and evidence-based management guidelines for patients with COVID-19.

Indocyanine Green Clearance Test for the Preoperative Assessment of Chemotherapy-Related Hepatic Injury in Patients with Colorectal Liver Metastasis.

PurposeThe aim of the present study was to determine the value of the indocyanine green (ICG) clearance test in the preoperative assessment of chemotherapy-related hepatic injury in patients with liver metastasis from colorectal cancer.MethodsA total of 218 patients who underwent hepatic dissection due to colorectal cancer liver metastasis at the Peking University Cancer Hospital between January 2016 and December 2017 were retrospectively evaluated; 179 patients who received chemotherapy prior to hepatic resection were further examined. Patient- and chemotherapy-related factors were analyzed in both groups with normal and abnormal ICG retention rate at 15 min (ICG-R15), and their intraoperative and postoperative outcomes were compared.ResultsThe chemotherapy group had a higher mean ICG-R15 value and a higher number of patients who exhibited abnormal ICG-R15, compared with the no-chemotherapy group. Under the guidance of ICG test, no patients experienced severe complications in the abnormal ICG-R15 group compared with the normal ICG-R15 group, and the overall morbidity was also not significantly different between the two groups. However, the incidence of severe complications was higher in patients who underwent major resection with a normal ICG-R15 value compared with patients with an abnormal ICG-R15 value who underwent minor resection (P<0.05). Multivariable logistic regression analyses revealed that body mass index (BMI) ≥28 and oxaliplatin use were independent predictors of abnormal ICG-R15. The ICG-R15 value was significantly higher in the two-risk factors group compared with the no-risk factor group (P=0.012), but not statistically different compared with the one risk factor group.ConclusionScreening of patients with chemotherapy-associated liver injury using the IGC test may help in performing safe hepatectomy by avoiding major resection. BMI ≥28 and oxaliplatin use were independent preoperative predictors of abnormal ICG-R15.

Association between effective hepatic blood flow and the severity and prognosis of hepatitis B virus-related acute on chronic liver failure.

Hepatic inflammation resulted in hepatocyte necrosis and microcirculatory dysfunction in acute on chronic liver failure (ACLF) with cirrhosis or not. The influence of effective hepatic blood flow (EHBF) on the severity of liver failure has not been fully elucidated. The aim of this study was to assess the correlation between the EHBF and the severity and the prediction of 90-day mortality rate of hepatitis B virus-related ACLF (HBV-ACLF). In this retrospective study, patients hospitalized for HBV-ACLF or decompensated cirrhosis and who underwent an indocyanine green (ICG) clearance test between June 2016 and July 2018 were enrolled. EHBF was measured by the ICG clearance test and patients were categorized into the ACLF without cirrhosis (HBV-ACLF-no-Cir), ACLF with cirrhosis (HBV-ACLF-Cir) and decompensated cirrhosis (HBV-De-Cir). A total of 522 patients (HBV-ACLF-no-Cir: 84, HBV-ACLF-Cir: 111 and HBV-De-Cir: 327) were enrolled. The mean EHBF in the HBV-De-Cir was significantly higher than that in the HBV-ACLF-no-Cir and HBV-ACLF-Cir (0.36 vs. 0.21 vs. 0.20 L/min, P < 0.001). EHBF was significantly correlated with the total bilirubin, prothrombin activity and model for end-stage liver disease (MELD) in the HBV-ACLF-no-Cir. The predicted 90-day mortality rate using the MELD, EHBF, ICG-retention rate at 15 min (R15%) and EHBF-R15% scores were similar. The sensitivity and specificity of the EHBF varied between 68.5-80.2% and 45.8-73.7%, respectively. The EHBF-MELD score had the highest specificity. EHBF was significantly lower in the patients with ACLF compared to decompensated cirrhosis. The EHBF were closely related to the severity of HBV-ACLF and can be used for predicting the 90-day mortality rate of HBV-ACLF.

Flexibility in peritoneal dialysis prescription: Impact on technique survival.

Patient burnout is a major cause of technique failure on peritoneal dialysis (PD). Reducing the PD prescription on an individual basis, dependent upon residual kidney function (RKF), may have a role in prolonging time on PD by reducing dialysis burden. This retrospective study aimed to determine the safety and impact of flexible PD prescribing on technique and patient survival. All patients (186) from our centre starting PD from 1st January 2012 to 31st December 2016 were included. Data on dialysis prescription were collected for each patient from the time they had started PD, and dialysis adequacy measured regularly (3-6 monthly) using PD Adequest. Median age at start of dialysis was 61 years. Only 49% started on PD 7 days a week and this dropped to 27% at 3 months following the first clearance test. Over 90% achieved creatinine clearance > 50 L/week/1.73 m2 up to 2 years of follow-up, with 87% achieving this standard at 3 years. Patient and technique survival at 1, 2 and 3 years were 91%, 81%, and 72%, and 89%, 87% and 78% respectively. Factors on univariate analysis affecting technique survival included increasing age (HR 0.98, p = 0.04, 95% CI (0.96-0.999)), two or more episodes of PD-associated peritonitis (HR 4.52, p = 0.00, 95% CI (1.87-10.91)) and increasing PD intensity (HR 3.30, p = 0.02, 95% CI (1.22-8.93)). After multivariate adjustment which included baseline kidney function, low PD intensity continued to be associated with better technique survival (HR 0.17, p = 0.03, 95% CI (0.03-0.85)). Tailoring the PD prescription to RKF enables days off dialysis while still maintaining recommended levels of small solute clearance. This approach reduces dialysis burden and is associated with higher technique survival.