Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study.

OBJECTIVES: Following current cardiopulmonary resuscitation (CPR) guidelines, which recommend chest compressions at "the center of the chest," ~50% of patients experiencing out-of-hospital cardiac arrest (OHCA) undergo aortic valve (AV) compression, obstructing blood flow. We used resuscitative transesophageal echocardiography (TEE) to elucidate the impact of uncompressed vs. compressed AV on outcomes of adult patients experiencing OHCA. DESIGN: Prospective observational cohort study. SETTING: Single center. PATIENTS: This study included adult OHCA patients undergoing resuscitative TEE in the emergency department. Patients were categorized into AV uncompressed or AV compressed groups based on TEE findings. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was sustained return of spontaneous circulation (ROSC). The secondary outcomes included end-tidal co2 (Etco2) during CPR, any ROSC, survival to ICU and hospital discharge, post-resuscitation withdrawal, and favorable neurologic outcomes at discharge. Additional analyses on intra-arrest arterial blood pressure (ABP) were also conducted. The sample size was pre-estimated at 37 patients/group. From October 2020 to January 2023, 76 patients were enrolled, 39 and 37 in the AV uncompressed and AV compressed groups, respectively. Intergroup baseline characteristics were similar. Compared with the AV compressed group, the AV uncompressed group had a higher probability of sustained ROSC (53.8% vs. 24.3%; adjusted odds ratio [aOR], 4.72; p = 0.010), any ROSC (56.4% vs. 32.4%; aOR, 3.30; p = 0.033), and survival to ICU (33.3% vs. 8.1%; aOR, 6.74; p = 0.010), and recorded higher initial diastolic ABP (33.4 vs. 11.5 mm Hg; p = 0.002) and a larger proportion achieving diastolic ABP greater than 20 mm Hg during CPR (93.8% vs. 33.3%; p < 0.001). The Etco2, post-resuscitation withdrawal, and survival to discharge revealed no significant intergroup differences. No patients were discharged with favorable neurologic outcomes. Uncompressed AV seemed critical for sustained ROSC across all subgroups. CONCLUSIONS: Absence of AV compression during OHCA resuscitation is associated with an increased chance of ROSC and survival to ICU. However, its effect on long-term outcomes remains unclear.

Analyzing the Trends of COVID-19 and Human Activity Intensity in Malaysia.

COVID-19 has struck the world with multiple waves. Each wave was caused by a variant and presented different peaks and baselines. This made the identification of waves with the time series of the cases a difficult task. Human activity intensities may affect the occurrence of an outbreak. We demonstrated a metric of time series, namely log-moving-average-ratio (LMAR), to identify the waves and directions of the changes in the disease cases and check-ins (MySejahtera). Based on the detected waves and changes, we explore the relationship between the two. Using the stimulus-organism-response model with our results, we presented a four-stage model: (1) government-imposed movement restrictions, (2) revenge travel, (3) self-imposed movement reduction, and (4) the new normal. The inverse patterns between check-ins and pandemic waves suggested that the self-imposed movement reduction would naturally happen and would be sufficient for a smaller epidemic wave. People may spontaneously be aware of the severity of epidemic situations and take appropriate disease prevention measures to reduce the risks of exposure and infection. In summary, LMAR is more sensitive to the waves and could be adopted to characterize the association between travel willingness and confirmed disease cases.

BatchBMD as an Efficient and Accurate Dual-Energy X-ray Absorptiometry Report Generator.

Dual-energy X-ray absorptiometry is the gold standard for evaluating Bone Mineral Density (BMD); however, a typical BMD report is generated in a time-inefficient manner and is prone to error. We developed a rule-based automated reporting system, BatchBMD, that accelerates DXA reporting while improving its accuracy over current systems. BatchBMD generates a structured report, customized to the specific clinical purpose. To compare BatchBMD to a Web-based Reporting (WBR) system for efficiency and accuracy, 500 examinations were randomly chosen from those performed at the Taipei Municipal Wanfang Hospital from January to March 2021. The final assessment included all 2326 examinations conducted from September 2020 to March 2021. The average reporting times were 6.7 and 10.8 min for BatchBMD and the WBR system, respectively, while accuracy was 99.4% and 98.2%, respectively. Most of the errors made by BatchBMD were digit errors in the appendicular skeletal muscle index. After correcting this, 100% accuracy across all 2326 examinations was validated. This automated and accurate BMD reporting system significantly reduces report production workload for radiologists and technicians while increasing productivity and quality. Additionally, the portable software, which employs a simple framework, can reduce deployment costs in clinical practice.

Revisiting the Effects of High-Speed Railway Transfers in the Early COVID-19 Cross-Province Transmission in Mainland China.

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic that was reported at the end of 2019 in Wuhan, China, and was rapidly disseminated to all provinces in around one month. The study aims to assess the changes in intercity railway passenger transport on the early spatial transmission of COVID-19 in mainland China. Examining the role of railway transport properties in disease transmission could help quantify the spatial spillover effects of large-scale travel restriction interventions. This study used daily high-speed railway schedule data to compare the differences in city-level network properties (destination arrival and transfer service) before and after the Wuhan city lockdown in the early stages of the spatial transmission of COVID-19 in mainland China. Bayesian multivariate regression was used to examine the association between structural changes in the railway origin-destination network and the incidence of COVID-19 cases. Our results show that the provinces with rising transfer activities after the Wuhan city lockdown had more confirmed COVID-19 cases, but changes in destination arrival did not have significant effects. The regions with increasing transfer activities were located in provinces neighboring Hubei in the widthwise and longitudinal directions. These results indicate that transfer activities enhance interpersonal transmission probability and could be a crucial risk factor for increasing epidemic severity after the Wuhan city lockdown. The destinations of railway passengers might not be affected by the Wuhan city lockdown, but their itinerary routes could be changed due to the replacement of an important transfer hub (Wuhan city) in the Chinese railway transportation network. As a result, transfer services in the high-speed rail network could explain why the provinces surrounded by Hubei had a higher number of confirmed COVID-19 cases than other provinces.