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1.
Clin Infect Dis ; 71(15): 841-843, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32047895

RESUMO

The 2019 novel coronavirus (2019-nCoV) was detected in the self-collected saliva of 91.7% (11/12) of patients. Serial saliva viral load monitoring generally showed a declining trend. Live virus was detected in saliva by viral culture. Saliva is a promising noninvasive specimen for diagnosis, monitoring, and infection control in patients with 2019-nCoV infection.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Saliva/virologia , Adulto , Idoso , Animais , COVID-19 , Linhagem Celular , Chlorocebus aethiops , Feminino , Hong Kong , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Células Vero , Carga Viral/métodos
2.
Euro Surveill ; 25(16)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32347204

RESUMO

BackgroundThe ongoing coronavirus disease (COVID-19) pandemic has major impacts on health systems, the economy and society. Assessing infection attack rates in the population is critical for estimating disease severity and herd immunity which is needed to calibrate public health interventions. We have previously shown that it is possible to achieve this in real time to impact public health decision making.AimOur objective was to develop and evaluate serological assays applicable in large-scale sero-epidemiological studies.MethodsWe developed an ELISA to detect IgG and IgM antibodies to the receptor-binding domain (RBD) of the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated its sensitivity and specificity in combination with confirmatory microneutralisation (MN) and 90% plaque reduction neutralisation tests (PRNT90) in 51 sera from 24 patients with virologically confirmed COVID-19 and in age-stratified sera from 200 healthy controls.ResultsIgG and IgM RBD ELISA, MN and PRNT90 were reliably positive after 29 days from illness onset with no detectable cross-reactivity in age-stratified controls. We found that PRNT90 tests were more sensitive in detecting antibody than MN tests carried out with the conventional 100 tissue culture infectious dose challenge. Heparinised plasma appeared to reduce the infectivity of the virus challenge dose and may confound interpretation of neutralisation test.ConclusionUsing IgG ELISA based on the RBD of the spike protein to screen sera for SARS-CoV-2 antibody, followed by confirmation using PRNT90, is a valid approach for large-scale sero-epidemiology studies.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Ensaio de Imunoadsorção Enzimática , Pandemias , Pneumonia Viral , Estudos Soroepidemiológicos , Testes Sorológicos/métodos , Glicoproteína da Espícula de Coronavírus/imunologia , Adolescente , Adulto , Idoso , Animais , Betacoronavirus/imunologia , COVID-19 , Teste para COVID-19 , Chlorocebus aethiops , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Neutralização , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus/análise , Células Vero , Adulto Jovem
3.
J Oral Maxillofac Surg ; 73(6): 1143-58, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25795181

RESUMO

PURPOSE: We describe an alternative workup protocol for virtual surgical planning of orthognathic surgery using an intraoral fiducial marker, clinical photography, and the digital transfer of occlusal data. We also discuss our initial experience using this protocol in a series of patients. PATIENTS AND METHODS: A retrospective cohort study was performed of consecutive patients who had undergone combined maxillary and mandibular osteotomies for the correction of dentofacial deformities at 1 center. These patients underwent treatment planning using the modified virtual surgical planning protocol described in the present report. The primary outcome evaluated was the accuracy of the method, which was determined through superimposition of the surgical plan to the postoperative cone-beam computed tomography (CBCT) scan. The secondary outcomes included the accuracy of the natural head position readings and the adequacy of the CBCT scanned stone models for the fabrication of occlusal splints. RESULTS: The population included 25 patients. The root mean standard deviation (RMSD) from the preoperative plan to the postoperative scan at the maxillary cephalometric points was 1.2, 1.4, and 2.1 mm in the axial, sagittal, and coronal planes, respectively. The RMSD of the superimposed plan to the postoperative scan at the 3 mandibular cephalometric points was 1.2, 0.8, and 0.7 mm in the axial, sagittal, and coronal planes, respectively. The average variance from the axial, sagittal, and coronal planes for the natural head position was 0.05, 2.22, and 0.69 mm, respectively. All splints fabricated from the CBCT occlusal data fit the stone models and were used intraoperatively. In the subset of patients whose models were both digitally transferred and laser scanned, the superimposition of the laser scan data to the CBCT scanned data was found to have a maximum variation of 0.2 mm at the occlusal level. CONCLUSIONS: The use of an intraoral fiducial marker changed the workflow for the data collection needed for virtual surgical planning of the correction of dentofacial deformities, while still obtaining accurate results. Because the device does not cause lip distortion, the possibility of virtually predicting a more expectant postoperative lip position exists without the need for additional scans. Furthermore, this work flow allows the transfer of data to be isolated to digital media.


Assuntos
Desenho Assistido por Computador , Marcadores Fiduciais , Procedimentos Cirúrgicos Ortognáticos/métodos , Planejamento de Assistência ao Paciente , Interface Usuário-Computador , Estudos de Coortes , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Registro da Relação Maxilomandibular/métodos , Lasers , Masculino , Osteotomia Mandibular/métodos , Osteotomia Mandibular/estatística & dados numéricos , Osteotomia Maxilar/métodos , Osteotomia Maxilar/estatística & dados numéricos , Modelos Dentários , Placas Oclusais , Procedimentos Cirúrgicos Ortognáticos/estatística & dados numéricos , Osteotomia de Le Fort/métodos , Osteotomia de Le Fort/estatística & dados numéricos , Osteotomia Sagital do Ramo Mandibular/métodos , Osteotomia Sagital do Ramo Mandibular/estatística & dados numéricos , Fotografação/métodos , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos , Cirurgia Assistida por Computador/estatística & dados numéricos , Resultado do Tratamento
4.
Anal Chem ; 86(20): 10099-105, 2014 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-25291206

RESUMO

Combination therapy has become one of the leading approaches for treating complex diseases because it coadministers clinically proven drugs to concurrently target multiple signaling pathways of diseased cells. Identification of synergic drug combinations at their respective effective doses without unwanted accumulative side effects is the key to success for such therapy. In this work, we demonstrate the feasibility of the vortex-assisted microfluidic electroporation system for direct drug cocktail analyses where drug substances were individually delivered into cytosols in a sequential and dosage-controlled manner. Through quantitative analyses, the synergic combinational dosage ratios of the chemotherapeutic drug and the anticancer flavonoid were identified. When integrated with high-throughput label-free rare cell purification techniques, the presented system has the potential for development of personalized medicines as the system would be capable of comprehensively assessing drug combinations directly on patients' cellular samples.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/análise , Eletroporação/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Linhagem Celular Tumoral , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Desenho de Equipamento , Humanos , Microfluídica
5.
SAGE Open Med ; 12: 20503121241226591, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38249952

RESUMO

Background: Hospital readmissions remain a significant and pressing issue in our healthcare system. In 2010, the Affordable Care Act helped establish the Hospital Readmissions Reduction Program, which incentivized reducing readmission rates by instituting penalties. Hospital readmission, specifically unplanned, refers to a patient returning to the hospital shortly after discharge due to the same or a related medical condition, signaling potential issues in initial care, discharge processes, or post-hospitalization management. For this study, we defined readmission as a return to the hospital within 30 days. In 2018, Staten Island University Hospital started a multidisciplinary and coordinated initiative to reduce patient readmissions. The approach involved the departments of emergency medicine, medicine, cardiology, case management, nursing, pharmacy, and transitional care management. This study aimed to determine if this approach reduced 30-day readmissions. Methods: This case-control retrospective study reviewed electronic health records between January 2018 and November 2019. Readmission rates within 30 days of index discharge were compared between patients who received transitional care management before and after establishing a multidisciplinary communication of transitional care. Readmission rates were unadjusted and adjusted for patient demographics and predisposed risk for readmission and compared across demographics and select clinical characteristics. Results: A total of 772 patients were included in the analyses; 323 were in the control group (41.8%), and 449 were in the intervention group (58.2%). After the hospital adopted the workflow for multidisciplinary communication of transitional care, there was 45.2% less adjusted incidence of readmission, or approximately seven fewer overall readmissions per 100 patients (16.4% readmission vs 9.0% readmission; incident rate ratio, 0.55; 95% CI: 0.34-0.88). Conclusions: Multidisciplinary communication approaches led by emergency medicine can help reduce readmissions significantly. Adopting a structured communication workflow can enhance co-managing patients with a high risk of readmission between the emergency department and hospital medicine teams.

6.
Clin Imaging ; 110: 110162, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38691910

RESUMO

PURPOSE: Because incidental thyroid nodules (ITNs) are common extrapulmonary findings in low-dose computed tomography (LDCT) scans for lung cancer screening, we aimed to investigate the frequency of ITNs on LDCT scans separately on baseline and annual repeat scans, the frequency of malignancy among the ITNs, and any association with demographic, clinical, CT characteristics. METHODS: Retrospective case series of all 2309 participants having baseline and annual repeat screening in an Early Lung and Cardiac Action Program (MS-ELCAP) LDCT lung screening program from January 2010 to December 2016 was performed. Frequency of ITNs in baseline and annual repeat rounds were determined. Multivariable regression analysis was performed to identify significant predictors. RESULTS: Dominant ITNs were seen in 2.5 % of 2309 participants on baseline and in 0.15 % of participants among 4792 annual repeat LDCTs. The low incidence of new ITNs suggests slow growth as it would take approximately an average of 16.8 years for a new ITN to be detected on annual rounds of screening. Newly detected ITNs on annual repeat LDCT were all smaller than 15 mm. Regression analysis showed that the increasing of age, coronary artery calcifications score and breast density grade were significant predictors for females having an ITN. No significant predictors were found for ITNs in males. CONCLUSION: ITNs are detected at LDCT however, no malignancy was found. Certain predictors for ITNs in females have been identified including breast density, which may point towards a common causal pathway.


Assuntos
Neoplasias Pulmonares , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Estudos Retrospectivos , Idoso , Achados Incidentais , Nódulo da Glândula Tireoide/diagnóstico por imagem , Detecção Precoce de Câncer/métodos
7.
Vaccines (Basel) ; 12(6)2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38932386

RESUMO

It is important to understand real-world BNT162b2 COVID-19 vaccine effectiveness (VE), especially among racial and ethnic minority groups. We performed a test-negative case-control study to measure BNT162b2 COVID-19 VE in the prevention of COVID-19-associated acute respiratory illness (ARI) hospitalizations at two Atlanta hospitals from May 2021-January 2023 and adjusted for potential confounders by multivariate analysis. Among 5139 eligible adults with ARI, 2763 (53.8%) were enrolled, and 1571 (64.5%) were included in the BNT162b2 analysis. The median age was 58 years (IQR, 44-68), 889 (56.6%) were female, 1034 (65.8%) were African American, 359 (22.9%) were White, 56 (3.6%) were Hispanic ethnicity, 645 (41.1%) were SARS-CoV-2-positive, 412 (26.2%) were vaccinated with a primary series, and 273 (17.4%) had received ≥1 booster of BNT162b2. The overall adjusted VE of the BNT162b2 primary series was 58.5% (95% CI 46.0, 68.1), while the adjusted VE of ≥1 booster was 78.9% (95% CI 70.0, 85.1). The adjusted overall VE of primary series for African American/Black individuals was 64.0% (95% CI 49.9, 74.1) and 82.7% (95% CI 71.9, 89.4) in those who received ≥1 booster. When analysis was limited to the period of Omicron predominance, overall VE of the primary series decreased with widened confidence intervals (24.5%, 95% CI -4.5, 45.4%), while VE of ≥1 booster was maintained at 60.9% (95% CI 42.0, 73.6). BNT162b2 primary series and booster vaccination provided protection against COVID-19-associated ARI hospitalization among a predominantly African American population.

8.
bioRxiv ; 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38645196

RESUMO

Neuronal reconstruction-a process that transforms image volumes into 3D geometries and skeletons of cells- bottlenecks the study of brain function, connectomics and pathology. Domain scientists need exact and complete segmentations to study subtle topological differences. Existing methods are diskbound, dense-access, coupled, single-threaded, algorithmically unscalable and require manual cropping of small windows and proofreading of skeletons due to low topological accuracy. Designing a data-intensive parallel solution suited to a neurons' shape, topology and far-ranging connectivity is particularly challenging due to I/O and load-balance, yet by abstracting these vision tasks into strategically ordered specializations of search, we progressively lower memory by 4 orders of magnitude. This enables 1 mouse brain to be fully processed in-memory on a single server, at 67× the scale with 870× less memory while having 78% higher automated yield than APP2, the previous state of the art in performant reconstruction.

9.
Open Forum Infect Dis ; 11(8): ofae443, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39183814

RESUMO

Background: Coronavirus disease 2019 (COVID-19) continues to cause hospitalizations and severe disease in children and adults. Methods: This study compared the risk factors, symptoms, and outcomes of children and adults hospitalized for COVID-19 from March 2020 to May 2023 across age strata at 5 US sites participating in the Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence consortium. Eligible patients had an upper respiratory swab that tested positive for severe acute respiratory syndrome coronavirus 2 by nucleic acid amplification. Adjusted odds ratios (aOR) of clinical outcomes were determined for children versus adults, for pediatric age strata compared to adolescents (12-17 years), and for adult age strata compared to young adults (22-49 years). Results: Of 9101 patients in the Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence cohort, 1560 were hospitalized for COVID-19 as the primary reason. Compared to adults (22-105 years, n = 675), children (0-21 years, n = 885) were less commonly vaccinated (14.3% vs 34.5%), more commonly infected with the Omicron variant (49.5% vs 26.1%) and had fewer comorbidities (P < .001 for most comparisons), except for lung disease (P = .24). After adjusting for confounding variables, children had significantly lower odds of receiving supplemental oxygen (aOR, 0.57; 95% confidence interval, .35-.92) and death (aOR, 0.011; 95% confidence interval, <.01-.58) compa--red to adults. Among pediatric age strata, adolescents 12-17 years had the highest odds of receiving supplemental oxygen, high-flow oxygen, and ICU admission. Among adults, those 50-64 years had the highest odds of mechanical ventilation and ICU admission. Conclusions: Clinical outcomes of COVID-19 differed across pediatric and adult age strata. Adolescents experienced the most severe disease among children, whereas adults 50-64 years experienced the most severe disease among adults.

10.
J Neurol Surg B Skull Base ; 84(4): 405-412, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37405234

RESUMO

Objective The Model for End-stage Liver Disease-Sodium (MELD-Na) score was designed for prognosis of chronic liver disease and has been predictive of outcomes in a variety of procedures. Few studies have investigated its utility in otolaryngology. This study uses the MELD-Na score to investigate the association between liver health and ventral skull base surgical complications. Methods The National Surgical Quality Improvement Program database was used to identify patients who underwent ventral skull base procedures between 2005 and 2015. Univariate and multivariate analyses were performed to investigate the association between elevated MELD-Na score and postoperative complications. Results We identified 1,077 patients undergoing ventral skull base surgery with laboratory values required to calculate the MELD-Na score. The mean age was 54.2 years. The mean MELD-Na score was 7.70 (standard deviation = 2.04). Univariate analysis showed that elevated MELD-Na score was significantly associated with increased age (58.6 vs 53.8 years) and male gender (70.8 vs 46.1%). Elevated MELD-Na score was associated with increased rates of postoperative acute renal failure, transfusion, septic shock, surgical complications, and extended length of hospital stay. On multivariate analysis, associations between elevated MELD-Na and increased risk of perioperative transfusions (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.20-2.93; p = 0.007) and surgical complications (OR, 1.58; 95% CI, 1.25-2.35; p = 0.009) remained significant. Conclusions This analysis points to an association between liver health and postoperative complications in ventral skull base surgery. Future research investigating this association is warranted.

11.
Ann Otol Rhinol Laryngol ; 131(11): 1252-1260, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34918565

RESUMO

BACKGROUND: To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. METHODS: Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher's exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. RESULTS: A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection (P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications (P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay (P < .001) and risk of overall complications (P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection (P = .049), postoperative bleeding (P = .036), and failure to wean off ventilator (P = .027). CONCLUSIONS: Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.


Assuntos
Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica , Humanos , Tempo de Internação , Modelos Logísticos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia
12.
Laryngoscope ; 132(9): 1707-1713, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-34643275

RESUMO

OBJECTIVES/HYPOTHESIS: Preoperative anemia has been shown to be a predictor of complications in different surgeries. This has not been exclusively studied in skull base surgery. This study investigates the impact of preoperative hematocrit on complications following ventral skull base (VSB) surgery. STUDY DESIGN: Retrospective database review. METHODS: The National Surgical Quality Improvement Program was queried for all cases of VSB surgery from 2005 to 2015. Univariate and multivariate analyses were performed to investigate the impact of preoperative anemia on complications following VSB procedures. RESULTS: 3,053 patients meeting inclusion criteria were identified. On univariate analysis, low hematocrit was found in 39.7% of patients and was associated with increased mean age (55.71 vs. 53.25 years), male gender (63.6% vs. 36.4%), and Black race (18.5% vs. 10.9%). Preoperative anemia was also associated with increased incidences of postoperative pneumonia, blood transfusions, sepsis, medical complications, surgical complications, extended length of hospital stay (LOS), and mortality. On multivariate analysis, associations between low preoperative hematocrit and perioperative transfusions (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.88-3.50, P < .001), total surgical complications (OR 2.12, 95% CI 1.60-2.80, P < .001), and extended LOS (OR 1.29, 95% CI 1.05-1.57, P = .013) remained significant. CONCLUSIONS: Low preoperative hematocrit is associated with increased risk of postoperative complications and extended LOS in patients undergoing VSB surgery. This study highlights the importance of careful preoperative assessment and management of anemia in these patients. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1707-1713, 2022.


Assuntos
Anemia , Anemia/complicações , Anemia/epidemiologia , Hematócrito , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Base do Crânio/cirurgia
13.
EBioMedicine ; 79: 103986, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35398786

RESUMO

BACKGROUND: SARS-CoV-2 Omicron variant evades immunity from past infection or vaccination and is associated with a greater risk of reinfection among recovered COVID-19 patients. We assessed the serum neutralizing antibody (NAb) activity against Omicron variant (Omicron NAb) among recovered COVID-19 patients with or without vaccination. METHODS: In this prospective cohort study with 135 recovered COVID-19 patients, we determined the serum NAb titers against ancestral virus or variants using a live virus NAb assay. We used the receiver operating characteristic analysis to determine the optimal cutoff for a commercially-available surrogate NAb assay. FINDINGS: Among recovered COVID-19 patients, the serum live virus geometric mean Omicron NAb titer was statistically significantly higher among BNT162b2 recipients compared to non-vaccinated individuals (85.4 vs 5.6,P < 0.0001). The Omicron seropositive rates in live virus NAb test (NAb titer ≥10) were statistically significantly higher among BNT162b2 (90.6% [29/32];P < 0.0001) or CoronaVac (36.7% [11/30]; P = 0.0115) recipients when compared with non-vaccinated individuals (12.3% [9/73]). Subgroup analysis of CoronaVac recipients showed that the Omicron seropositive rates were higher among individuals with two doses than those with one dose (85.7% vs 21.7%; P = 0.0045). For the surrogate NAb assay, a cutoff of 109.1 AU/ml, which is 7.3-fold higher than the manufacturer's recommended cutoff, could achieve a sensitivity and specificity of 89.5% and 89.8%, respectively, in detecting Omicron NAb. INTERPRETATION: Among individuals with prior COVID-19, one dose of BNT162b2 or two doses of CoronaVac could induce detectable serum Omicron NAb. Our result would be particularly important for guiding vaccine policies in countries with COVID-19 vaccine shortage. FUNDING: Health and Medical Research Fund, Richard and Carol Yu, Michael Tong (see acknowledgments for full list).


Assuntos
Vacinas contra COVID-19 , COVID-19 , Anticorpos Bloqueadores , Anticorpos Neutralizantes , Anticorpos Antivirais , Vacina BNT162 , COVID-19/prevenção & controle , Humanos , Estudos Prospectivos , SARS-CoV-2
14.
World Neurosurg ; 152: e429-e435, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34062298

RESUMO

OBJECTIVE: We sought to investigate the association between diabetes mellitus and incidence of adverse outcomes in patients who underwent meningioma surgery. METHODS: The 2012-2014 National Inpatient Sample database was used. Prolonged length of stay was indicated by values greater than the 90th percentile of the sample. The Fisher exact test and analysis of variance were used to compare demographics, hospital characteristics, comorbidity, and complications among race cohorts. Logistic regression was used to analyze the independent effect of diabetes on adverse outcomes. RESULTS: After selecting for patients with primary diagnosis of meningioma who underwent a resection procedure, 7745 individuals were identified and divided into diabetic (n = 1518) and nondiabetic (n = 6227) cohorts. Demographics, hospital characteristics, and comorbidities were significantly different among the 2 cohorts. Average length of stay was longer in diabetic patients (8.15 vs. 6.04 days, P < 0.001), and total charges were higher in diabetic patients ($139,462.66 vs. $123,250.71, P < 0.001). Multivariate regression indicated diabetic patients have higher odds of experiencing a complication (odds ratio [OR] 1.442, 95% confidence interval [CI] 1.255-1.656, P < 0.001) and in-hospital mortality (OR 1.672, 95% CI 1.034-2.705, P = 0.036) after meningioma surgery. Analysis of individual postoperative complications revealed that diabetic patients experienced increased odds of pulmonary (OR 1.501, 95% CI 1.209-1.864, P < 0.001), neurologic (OR 1.690, 95% CI 1.383-2.065, P < 0.001), and urinary/renal complications (OR 2.618, 95% CI 1.933-3.545, P < 0.001). In addition, diabetic patients were more likely to have a prolonged length of stay (OR 1.694, 95% CI 1.389-2.065, P < 0.001). CONCLUSIONS: Diabetes is an important factor associated with complications after meningioma surgery. Preventative measures must be taken to optimize postoperative outcomes in these patients.


Assuntos
Neoplasias Encefálicas/cirurgia , Complicações do Diabetes/patologia , Diabetes Mellitus/patologia , Meningioma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/economia , Estudos de Coortes , Comorbidade , Efeitos Psicossociais da Doença , Feminino , Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Meningioma/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Resultado do Tratamento , Adulto Jovem
15.
Cell Rep ; 31(9): 107725, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-33500101

RESUMO

The World Health Organization has declared the ongoing outbreak of COVID-19, which is caused by a novel coronavirus SARS-CoV-2, a pandemic. There is currently a lack of knowledge about the antibody response elicited from SARS-CoV-2 infection. One major immunological question concerns antigenic differences between SARS-CoV-2 and SARS-CoV. We address this question by analyzing plasma from patients infected by SARS-CoV-2 or SARS-CoV and from infected or immunized mice. Our results show that, although cross-reactivity in antibody binding to the spike protein is common, cross-neutralization of the live viruses may be rare, indicating the presence of a non-neutralizing antibody response to conserved epitopes in the spike. Whether such low or non-neutralizing antibody response leads to antibody-dependent disease enhancement needs to be addressed in the future. Overall, this study not only addresses a fundamental question regarding antigenicity differences between SARS-CoV-2 and SARS-CoV but also has implications for immunogen design and vaccine development.


Assuntos
Formação de Anticorpos , COVID-19/imunologia , Reações Cruzadas , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/imunologia , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Animais , Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/imunologia , Antígenos/imunologia , COVID-19/sangue , COVID-19/virologia , Teste Sorológico para COVID-19 , Chlorocebus aethiops , Epitopos/imunologia , Feminino , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Testes de Neutralização , Ligação Proteica , Domínios Proteicos , Síndrome Respiratória Aguda Grave/sangue , Síndrome Respiratória Aguda Grave/virologia , Células Sf9 , Glicoproteína da Espícula de Coronavírus/imunologia , Células Vero
16.
Science ; 369(6508): 1210-1220, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32788292

RESUMO

Coronavirus disease 2019 (COVID-19) represents a global crisis, yet major knowledge gaps remain about human immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We analyzed immune responses in 76 COVID-19 patients and 69 healthy individuals from Hong Kong and Atlanta, Georgia, United States. In the peripheral blood mononuclear cells (PBMCs) of COVID-19 patients, we observed reduced expression of human leukocyte antigen class DR (HLA-DR) and proinflammatory cytokines by myeloid cells as well as impaired mammalian target of rapamycin (mTOR) signaling and interferon-α (IFN-α) production by plasmacytoid dendritic cells. By contrast, we detected enhanced plasma levels of inflammatory mediators-including EN-RAGE, TNFSF14, and oncostatin M-which correlated with disease severity and increased bacterial products in plasma. Single-cell transcriptomics revealed a lack of type I IFNs, reduced HLA-DR in the myeloid cells of patients with severe COVID-19, and transient expression of IFN-stimulated genes. This was consistent with bulk PBMC transcriptomics and transient, low IFN-α levels in plasma during infection. These results reveal mechanisms and potential therapeutic targets for COVID-19.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , COVID-19 , Citocinas/sangue , DNA Bacteriano/sangue , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Feminino , Citometria de Fluxo , Antígenos HLA-DR/análise , Humanos , Imunidade , Imunidade Inata , Imunoglobulinas/sangue , Imunoglobulinas/imunologia , Mediadores da Inflamação/sangue , Interferon Tipo I/metabolismo , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Lipopolissacarídeos/sangue , Masculino , Células Mieloides/imunologia , Células Mieloides/metabolismo , Pandemias , SARS-CoV-2 , Transdução de Sinais , Análise de Célula Única , Biologia de Sistemas , Serina-Treonina Quinases TOR/metabolismo , Transcrição Gênica , Transcriptoma
17.
Cell Rep ; 31(9): 107725, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32426212

RESUMO

The World Health Organization has declared the ongoing outbreak of COVID-19, which is caused by a novel coronavirus SARS-CoV-2, a pandemic. There is currently a lack of knowledge about the antibody response elicited from SARS-CoV-2 infection. One major immunological question concerns antigenic differences between SARS-CoV-2 and SARS-CoV. We address this question by analyzing plasma from patients infected by SARS-CoV-2 or SARS-CoV and from infected or immunized mice. Our results show that, although cross-reactivity in antibody binding to the spike protein is common, cross-neutralization of the live viruses may be rare, indicating the presence of a non-neutralizing antibody response to conserved epitopes in the spike. Whether such low or non-neutralizing antibody response leads to antibody-dependent disease enhancement needs to be addressed in the future. Overall, this study not only addresses a fundamental question regarding antigenicity differences between SARS-CoV-2 and SARS-CoV but also has implications for immunogen design and vaccine development.


Assuntos
Anticorpos Antivirais/imunologia , Antígenos Virais/imunologia , Betacoronavirus/imunologia , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/imunologia , Glicoproteína da Espícula de Coronavírus/imunologia , Animais , Anticorpos Neutralizantes/imunologia , COVID-19 , Chlorocebus aethiops , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Reações Cruzadas/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Testes de Neutralização , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Receptores Virais/metabolismo , SARS-CoV-2 , Síndrome Respiratória Aguda Grave/imunologia , Síndrome Respiratória Aguda Grave/prevenção & controle , Células Sf9 , Células Vero , Vacinas Virais/imunologia
18.
bioRxiv ; 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32511317

RESUMO

The World Health Organization has recently declared the ongoing outbreak of COVID-19, which is caused by a novel coronavirus SARS-CoV-2, as pandemic. There is currently a lack of knowledge in the antibody response elicited from SARS-CoV-2 infection. One major immunological question is concerning the antigenic differences between SARS-CoV-2 and SARS-CoV. We address this question by using plasma from patients infected by SARS-CoV-2 or SARS-CoV, and plasma obtained from infected or immunized mice. Our results show that while cross-reactivity in antibody binding to the spike protein is common, cross-neutralization of the live viruses is rare, indicating the presence of non-neutralizing antibody response to conserved epitopes in the spike. Whether these non-neutralizing antibody responses will lead to antibody-dependent disease enhancement needs to be addressed in the future. Overall, this study not only addresses a fundamental question regarding the antigenicity differences between SARS-CoV-2 and SARS-CoV, but also has important implications in vaccine.

19.
Lancet Infect Dis ; 20(5): 565-574, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32213337

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes severe community and nosocomial outbreaks. Comprehensive data for serial respiratory viral load and serum antibody responses from patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not yet available. Nasopharyngeal and throat swabs are usually obtained for serial viral load monitoring of respiratory infections but gathering these specimens can cause discomfort for patients and put health-care workers at risk. We aimed to ascertain the serial respiratory viral load of SARS-CoV-2 in posterior oropharyngeal (deep throat) saliva samples from patients with COVID-19, and serum antibody responses. METHODS: We did a cohort study at two hospitals in Hong Kong. We included patients with laboratory-confirmed COVID-19. We obtained samples of blood, urine, posterior oropharyngeal saliva, and rectal swabs. Serial viral load was ascertained by reverse transcriptase quantitative PCR (RT-qPCR). Antibody levels against the SARS-CoV-2 internal nucleoprotein (NP) and surface spike protein receptor binding domain (RBD) were measured using EIA. Whole-genome sequencing was done to identify possible mutations arising during infection. FINDINGS: Between Jan 22, 2020, and Feb 12, 2020, 30 patients were screened for inclusion, of whom 23 were included (median age 62 years [range 37-75]). The median viral load in posterior oropharyngeal saliva or other respiratory specimens at presentation was 5·2 log10 copies per mL (IQR 4·1-7·0). Salivary viral load was highest during the first week after symptom onset and subsequently declined with time (slope -0·15, 95% CI -0·19 to -0·11; R2=0·71). In one patient, viral RNA was detected 25 days after symptom onset. Older age was correlated with higher viral load (Spearman's ρ=0·48, 95% CI 0·074-0·75; p=0·020). For 16 patients with serum samples available 14 days or longer after symptom onset, rates of seropositivity were 94% for anti-NP IgG (n=15), 88% for anti-NP IgM (n=14), 100% for anti-RBD IgG (n=16), and 94% for anti-RBD IgM (n=15). Anti-SARS-CoV-2-NP or anti-SARS-CoV-2-RBD IgG levels correlated with virus neutralisation titre (R2>0·9). No genome mutations were detected on serial samples. INTERPRETATION: Posterior oropharyngeal saliva samples are a non-invasive specimen more acceptable to patients and health-care workers. Unlike severe acute respiratory syndrome, patients with COVID-19 had the highest viral load near presentation, which could account for the fast-spreading nature of this epidemic. This finding emphasises the importance of stringent infection control and early use of potent antiviral agents, alone or in combination, for high-risk individuals. Serological assay can complement RT-qPCR for diagnosis. FUNDING: Richard and Carol Yu, May Tam Mak Mei Yin, The Shaw Foundation Hong Kong, Michael Tong, Marina Lee, Government Consultancy Service, and Sanming Project of Medicine.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Saliva/virologia , Adulto , Idoso , Betacoronavirus/genética , Betacoronavirus/imunologia , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , SARS-CoV-2 , Índice de Gravidade de Doença , Carga Viral
20.
J Can Acad Child Adolesc Psychiatry ; 27(1): 57-62, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29375635

RESUMO

OBJECTIVE: This study compared levels of self-concept among youth who were currently receiving inpatient versus outpatient mental health services. METHOD: Forty-seven youth were recruited from the Child & Youth Mental Health Program at McMaster Children's Hospital. Self-concept was measured using the Self-Perception Profile for Children and Adolescents. RESULTS: The mean age was 14.5 years and most participants were female (70.2%). ANOVAs comparing self-concept with population norms showed large significant effects (d = 0.77 to 1.93) indicating compromised self-concept among youth receiving mental health services. Regression analyses controlling for patient age, sex, family income, and diagnoses of major depressive disorder, generalized social phobia, and generalized anxiety showed that the inpatient setting was a significant predictor of lower global self-worth (ß=-.26; p=.035). CONCLUSIONS: Compared to outpatients, inpatients generally reported lower self-concept, but differences were significant only for global self-worth. Future research replicating this finding and assessing its clinical significance is encouraged.


OBJECTIF: Cette étude comparait les niveaux du concept de soi chez des adolescents recevant présentement des services de santé mentale pour patients hospitalisés par opposition aux services ambulatoires. MÉTHODE: Quarantesept adolescents ont été recrutés au programme de santé mentale pour enfants et adolescents de l'hôpital pour enfants McMaster. Le concept de soi était mesuré à l'aide du Self-Perception Profile for Children and Adolescents. RÉSULTATS: L'âge moyen était 14,5 ans et la plupart des participants étaient de sexe féminin (70,2 %). Les analyses de variance comparant le concept de soi aux normes de la population ont montré de larges effets significatifs (d = 0,77 à 1,93) ce qui indiquait un concept de soi compromis chez les adolescents recevant des services de santé mentale. Les analyses de régression contrôlant l'âge, le sexe, le revenu familial du patient ainsi que les diagnostics de trouble dépressif majeur, de phobie sociale généralisée, et d'anxiété généralisée indiquaient que le contexte d'hospitalisation était un prédicteur significatif d'un concept de soi général plus faible (ß =−0,26; p = 0,035). CONCLUSIONS: Comparativement aux patients ambulatoires, les patients hospitalisés déclaraient généralement un concept de soi plus faible, mais les différences n'étaient significatives que pour le concept de soi général. Une future recherche qui reproduirait ces résultats et en évaluerait la signification clinique est encouragée.

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