Twenty-eight-day mortality among patients with severe or critical COVID-19 in Hong Kong during the early stages of the pandemic.

INTRODUCTION: In 2020, patients with critical coronavirus disease 2019 (COVID-19) had a 28-day mortality rate of 30% to 50% worldwide; outcomes among such patients in Hong Kong were unknown. This study investigated 28-day mortality and corresponding risk factors among patients with severe or critical COVID-19 in Hong Kong. METHODS: This retrospective cohort study included adult patients with severe or critical COVID-19 who were admitted to three public hospitals in Hong Kong from 22 January to 30 September 2020. Demographics, comorbidities, symptoms, treatment, and outcomes were examined. RESULTS: Among 125 patients with severe or critical COVID-19, 15 (12.0%) died within 28 days. Overall, the median patient age was 64 years; 48.0% and 54.4% of patients had hypertension and obesity, respectively. Respiratory samples were confirmed severe acute respiratory syndrome coronavirus 2 RNA-positive after a median of 3 days. The most common presenting symptom was fever (80.0% of patients); 45.6% and 32.8% of patients received care in intensive care unit and required mechanical ventilation, respectively. In logistic regression analysis comparing 28-day survivors and non-survivors, factors associated with greater 28-day mortality were older age (odds ratio [OR] per 1-year increase in age=1.12, 95% confidence interval [CI]=1.04-1.21; P=0.002), history of stroke (OR=15.96, 95% CI=1.65-154.66; P=0.017), use of renal replacement therapy (OR=15.32, 95% CI=2.67-87.83; P=0.002), and shorter duration of lopinavir-ritonavir treatment (OR per 1-day increase=0.82, 95% CI=0.68-0.98; P=0.034). CONCLUSION: The 28-day mortality rate among patients with severe or critical COVID-19 in Hong Kong was 12.0%. Older age, history of stroke, use of renal replacement therapy, and shorter duration of lopinavir-ritonavir treatment were independent predictors of 28-day mortality.

Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis.

BACKGROUND & AIMS: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been characterized by fever, respiratory, and gastrointestinal symptoms as well as shedding of virus RNA into feces. We performed a systematic review and meta-analysis of published gastrointestinal symptoms and detection of virus in stool and also summarized data from a cohort of patients with COVID-19 in Hong Kong. METHODS: We collected data from the cohort of patients with COVID-19 in Hong Kong (N = 59; diagnosis from February 2 through February 29, 2020),and searched PubMed, Embase, Cochrane, and 3 Chinese databases through March 11, 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms (loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort) using a random effects model. RESULTS: Among the 59 patients with COVID-19 in Hong Kong, 15 patients (25.4%) had gastrointestinal symptoms, and 9 patients (15.3%) had stool that tested positive for virus RNA. Stool viral RNA was detected in 38.5% and 8.7% among those with and without diarrhea, respectively (P = .02). The median fecal viral load was 5.1 log10 copies per milliliter in patients with diarrhea vs 3.9 log10 copies per milliliter in patients without diarrhea (P = .06). In a meta-analysis of 60 studies comprising 4243 patients, the pooled prevalence of all gastrointestinal symptoms was 17.6% (95% confidence interval [CI], 12.3-24.5); 11.8% of patients with nonsevere COVID-19 had gastrointestinal symptoms (95% CI, 4.1-29.1), and 17.1% of patients with severe COVID-19 had gastrointestinal symptoms (95% CI, 6.9-36.7). In the meta-analysis, the pooled prevalence of stool samples that were positive for virus RNA was 48.1% (95% CI, 38.3-57.9); of these samples, 70.3% of those collected after loss of virus from respiratory specimens tested positive for the virus (95% CI, 49.6-85.1). CONCLUSIONS: In an analysis of data from the Hong Kong cohort of patients with COVID-19 and a meta-analysis of findings from publications, we found that 17.6% of patients with COVID-19 had gastrointestinal symptoms. Virus RNA was detected in stool samples from 48.1% patients, even in stool collected after respiratory samples had negative test results. Health care workers should therefore exercise caution in collecting fecal samples or performing endoscopic procedures in patients with COVID-19, even during patient recovery.

Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises.

BACKGROUND: Deficiencies in non-technical skills (NTS) have been increasingly implicated in avoidable operating theatre errors. Accordingly, this study sought to characterize the impact of surgeon and anaesthetist non-technical skills on time to crisis resolution in a simulated operating theatre. METHODS: Non-technical skills were assessed during 26 simulated crises (haemorrhage and airway emergency) performed by surgical teams. Teams consisted of surgeons, anaesthetists and nurses. Behaviour was assessed by four trained raters using the Non-Technical Skills for Surgeons (NOTSS) and Anaesthetists' Non-Technical Skills (ANTS) rating scales before and during the crisis phase of each scenario. The primary endpoint was time to crisis resolution; secondary endpoints included NTS scores before and during the crisis. A cross-classified linear mixed-effects model was used for the final analysis. RESULTS: Thirteen different surgical teams were assessed. Higher NTS ratings resulted in significantly faster crisis resolution. For anaesthetists, every 1-point increase in ANTS score was associated with a decrease of 53·50 (95 per cent c.i. 31·13 to 75·87) s in time to crisis resolution (P < 0·001). Similarly, for surgeons, every 1-point increase in NOTSS score was associated with a decrease of 64·81 (26·01 to 103·60) s in time to crisis resolution in the haemorrhage scenario (P = 0·001); however, this did not apply to the difficult airway scenario. Non-technical skills scores were lower during the crisis phase of the scenarios than those measured before the crisis for both surgeons and anaesthetists. CONCLUSION: A higher level of NTS of surgeons and anaesthetists led to quicker crisis resolution in a simulated operating theatre environment.

Influenza vaccination status and outcomes among influenza-associated hospitalizations in Columbus, Ohio (2012-2015).

Prior studies suggest that the influenza vaccine is protective against some outcomes in hospitalized patients infected with influenza despite vaccination. We utilized surveillance data from Columbus, Ohio to investigate this association over multiple influenza seasons and age groups. Data on laboratory-confirmed influenza-associated hospitalizations were collected as a part of the Influenza Hospitalization Surveillance Project for the 2012-2013, 2013-2014, and 2014-2015 influenza seasons. The association between influenza vaccination status was examined in relation to the outcomes of severe influenza and diagnosis of pneumonia among patients receiving antiviral treatment. Data were analyzed using multivariable logistic regression. We observed no overall association between influenza vaccination status and severe influenza among hospitalized patients. During the 2013-2014 season, those who were vaccinated were 41% less likely to be diagnosed with pneumonia compared with those who were unvaccinated (OR = 0·59 95% CI 0·41-0·86). The influenza vaccine may provide a secondary preventive function against pneumonia among influenza cases requiring hospitalization. However, a protective effect was only observed in 2013-2014, an influenza H1N1 dominant year. Differences in circulating influenza virus strains and vaccine matching to the circulating strains during influenza seasons may impact this association.

Limits on spin-dependent WIMP-nucleon cross sections from 225 live days of XENON100 data.

We present new experimental constraints on the elastic, spin-dependent WIMP-nucleon cross section using recent data from the XENON100 experiment, operated in the Laboratori Nazionali del Gran Sasso in Italy. An analysis of 224.6 live days×34 kg of exposure acquired during 2011 and 2012 revealed no excess signal due to axial-vector WIMP interactions with 129Xe and 131Xe nuclei. This leads to the most stringent upper limits on WIMP-neutron cross sections for WIMP masses above 6 GeV/c², with a minimum cross section of 3.5×10(-40) cm² at a WIMP mass of 45 GeV/c², at 90% confidence level.

Dark matter results from 225 live days of XENON100 data.

We report on a search for particle dark matter with the XENON100 experiment, operated at the Laboratori Nazionali del Gran Sasso for 13 months during 2011 and 2012. XENON100 features an ultralow electromagnetic background of (5.3 ± 0.6) × 10(-3) events/(keV(ee) × kg × day) in the energy region of interest. A blind analysis of 224.6 live days × 34 kg exposure has yielded no evidence for dark matter interactions. The two candidate events observed in the predefined nuclear recoil energy range of 6.6-30.5 keV(nr) are consistent with the background expectation of (1.0 ± 0.2) events. A profile likelihood analysis using a 6.6-43.3 keV(nr) energy range sets the most stringent limit on the spin-independent elastic weakly interacting massive particle-nucleon scattering cross section for weakly interacting massive particle masses above 8 GeV/c(2), with a minimum of 2 × 10(-45) cm(2) at 55 GeV/c(2) and 90% confidence level.

Dark matter results from 100 live days of XENON100 data.

We present results from the direct search for dark matter with the XENON100 detector, installed underground at the Laboratori Nazionali del Gran Sasso of INFN, Italy. XENON100 is a two-phase time-projection chamber with a 62 kg liquid xenon target. Interaction vertex reconstruction in three dimensions with millimeter precision allows the selection of only the innermost 48 kg as the ultralow background fiducial target. In 100.9 live days of data, acquired between January and June 2010, no evidence for dark matter is found. Three candidate events were observed in the signal region with an expected background of (1.8 ± 0.6) events. This leads to the most stringent limit on dark matter interactions today, excluding spin-independent elastic weakly interacting massive particle (WIMP) nucleon scattering cross sections above 7.0 × 10(-45) cm(2) for a WIMP mass of 50 GeV/c(2) at 90% confidence level.

New technique for removing bone covering miniplates and screws.

Miniplate osteosynthesis has revolutionised the treatment of open reduction and internal fixation in craniomaxillofacial procedures. However, when complications arise necessitating the removal of previously placed miniplates, bony overgrowth may be present and must be eliminated before removal of the hardware is possible. Osteogenesis over the screws prevents proper engagement of the screwdriver with the screw drives. If bone remains embedded in the screw drive during attempted removal of the screw, the contact interference increases the risk of the screwdriver slipping and the screw drive being stripped. There remains a lack of adequate techniques to clear bony overgrowth from miniplates and screws to allow for easy removal, as conventional methods are ineffective, time-consuming, and may damage the screw drives. Herein, we describe a new laser-assisted miniplate removal technique to eliminate bone that has grown over miniplates and screws before the miniplate is removed. This technique is efficient, safe, and simple and, compared with conventional methods, may decrease the complications associated with the removal of miniplates and screws.

Presence of impacted teeth as a determining factor of unfavorable splits in 1256 sagittal-split osteotomies.

OBJECTIVES: The purpose of this study was to determine the incidence of unfavorable mandibular fracture in sagittal-split osteotomies in the presence or absence of impacted third molar teeth. STUDY DESIGN: This retrospective study evaluated 1256 mandibular sagittal-split osteotomies in two groups of patients: Group I had impacted third molar teeth removed during sagittal-split osteotomy; in Group II, the third molar teeth had been removed at least 6 months before the sagittal-split osteotomy. Statistical testing consisted of chi-square analysis of contingency table for p < 0.05. RESULTS: In 1256 mandibular sagittal-split osteotomies there were 24 (1.9%) with unfavorable fractures. Five of 24 occurred when third molar teeth were removed at the time of osteotomy and 19 of 24 mandibular fractures occurred when no impacted third molar tooth was present at the time of osteotomy. However, no significant difference was demonstrated between the groups. CONCLUSION: The result of this study suggests that mandibular fractures may occur with greater frequency when the impacted third molar teeth have been removed at least 6 months before sagittal-split osteotomy as compared with that when third molar teeth are removed concomitant with sagittal-split osteotomy.

[Correspondence of foveal and peripheral areas in subjects with intact binocular vision and patients with strabismus]. / Korrespondenz foveolarer und peripherer Areale bei Personen mit intaktem Binokularsehen und bei Patienten mit Strabismus.

Findings on examination of the binocular correspondence often differ, depending on the methods employed. The authors looked for correspondence in cases of esotropia or manifest exotropia, measured bifoveolarly, foveo-peripherally and between two peripheral locations. Examination with the phase-difference haploscope revealed a tendency to harmonious anomalous correspondence at the periphery of the visual field; this was different from the bifoveal location, which remained unharmonious even when additional fusion stimuli seen by both eyes were given. In contrast to this result the correspondence of foveolae and periphery were found to be equal in cases of primary microstrabism.

Effects of prostaglandin E1 on canine nasal vascular and airway resistances.

We have developed a technique which can measure directly and simultaneously changes in both nasal vascular and airway resistances in the dog. Nasal vascular resistance was measured by either direct monitoring of the arterial inflow or a change in the perfusion pressure of the nasal vascular bed with blood flow maintained constant. Nasal airway resistance was measured by a rhinomanometric method. Intra-arterial infusion of prostaglandin (PG) E1 at the rate of 1 ml/min in doses of 0.001 to 10 micrograms/min caused a dose-dependent decrease in both nasal vascular and airway resistances. When compared with the control, the average maximal effect of PGE1 on vascular resistance was -38.4%, whereas on airway resistance it was -16.4%. The present studies demonstrate that PGE1 has significant vasodilatatory activity in the canine nasal vascular bed and suggest that the vascular and airway responses to PGE1 may be due to a decrease in inflow and outflow vascular resistance and/or opening of arteriovenous anastomoses.

Statistical method for the determination of equivalence of automated test procedures.

In the development of test methods for solid dosage forms, manual test procedures for assay and content uniformity often precede the development of automated test procedures. Since the mode of extraction for automated test methods is often slightly different from that of the manual test method, additional validation of an automated test method is usually required. In addition to compliance with validation guidelines, developers of automated test methods are often asked to demonstrate equivalence between the manual and automated test methods. There are problems associated with using the traditional zero-difference hypothesis tests (such as the Student's t-test) for demonstrating equivalence. The use of the Westlake Interval and Schuirmann's Two One-sided test as more rigorous methods of demonstrating equivalence is discussed.

The saturation characteristics of glucose transport in bovine retinal pigment epithelium.

PURPOSE: To study the saturation characteristics of the glucose transport across the bovine retinal pigment epithelium(RPE). METHODS: The bovine RPE preparations were munted with a modified Ussing chamber. The L-[3H]-glucose and 3-O-methyl-D-[14C]-glucose fluxes across the RPE from the choroid to retina were studied at different glucose concentrations. RESULTS: The glucose transport was found to be stereospecific, with 3-O-methyl-D-glucose (MDG) being transported about three times faster than L-glucose. The glucose transport showed typical saturation characteristics in Michaelis-Menten fashion. The Vmax and the Km of corrected MDG were 2452 nmol cm-2h-1 and 30.8 mM respectively. It was shown that the glucose transport system was saturated at 61.6 mM. CONCLUSIONS: The saturation characteristics of the corrected MDG flux suggested that the capacity of glucose transport through the bovine RPE is immense.