Contrast-enhanced ultrasound of polyp malignant transformation with multiple metastases in a patient with Peutz-Jeghers syndrome.

Multi-systemic metastasis in patients with Peutz-Jeghers syndrome (PJS) is very rare, and there are nearly no relevant imaging reports, especially in contrast-enhanced ultrasound (CEUS). We present here a 40-year-old male patient who underwent several partial small bowel resections and endoscopic polypectomy for intestinal polyps. After reviewing the patient's clinical diagnosis and treatment process, CEUS with sulfur hexafluoride microbubbles (SonoVue, Bracco, Milan, Italy) in the liver and gastrointestinal tract was performed. We imaged multiple abnormal masses with sonographic features consistent with malignancies. Combined with other imaging examinations and 18 gauge core-needle puncture biopsy of liver masses, multiple metastases outside the gastrointestinal tract were considered. This case report suggests CEUS may be an easy, effective, and supplementary method for evaluating PJS patients with suspected multi-systemic malignant lesions including the gastrointestinal tract.

ICOS costimulation in combination with CTLA-4 blockade remodels tumor-associated macrophages toward an antitumor phenotype.

We have previously demonstrated synergy between ICOS costimulation (IVAX; ICOSL-transduced B16-F10 cellular vaccine) and CTLA-4 blockade in antitumor therapy. In this study, we employed CyTOF and single-cell RNA sequencing and observed significant remodeling of the lymphoid and myeloid compartments in combination therapy. Compared with anti-CTLA-4 monotherapy, the combination therapy enriched Th1 CD4 T cells, effector CD8 T cells, and M1-like antitumor proinflammatory macrophages. These macrophages were critical to the therapeutic efficacy of anti-CTLA-4 combined with IVAX or anti-PD-1. Macrophage depletion with clodronate reduced the tumor-infiltrating effector CD4 and CD8 T cells, impairing their antitumor functions. Furthermore, the recruitment and polarization of M1-like macrophages required IFN-γ. Therefore, in this study, we show that there is a positive feedback loop between intratumoral effector T cells and tumor-associated macrophages (TAMs), in which the IFN-γ produced by the T cells polarizes the TAMs into M1-like phenotype, and the TAMs, in turn, reshape the tumor microenvironment to facilitate T cell infiltration, immune function, and tumor rejection.

Real-World Systemic Treatment Patterns after Atezolizumab and Bevacizumab in Patients with Hepatocellular Carcinoma in the United States.

Real-world (RW) evidence is needed to evaluate atezolizumab plus bevacizumab (atezo + bev) utilization for hepatocellular carcinoma (HCC) in clinical practice. This retrospective cohort study used administrative claims databases to evaluate treatment patterns in individuals with HCC ≥18 years of age who were initiated on atezo + bev between June 2020 and June 2022. The endpoints of this study were the proportion of individuals who discontinued atezo + bev and received subsequent systemic therapies, time to discontinuation (TTD), and time to next treatment. Overall, 825 individuals were eligible (median age 67 years; 80% male). Over a median follow-up of 15.3 months, most (72%) discontinued atezo + bev, with a median TTD of 3.5 months. A minority (19%) received subsequent therapies, with the most common second-line agents being lenvatinib (6%), cabozantinib (4%), and nivolumab (4%). The median time from index to next treatment post-atezo + bev was 5.4 months. Further research is needed to identify the patients who are most likely to benefit from atezo + bev as well as later-line HCC therapies to optimize overall survival.

Handheld interventional ultrasound/photoacoustic puncture needle navigation based on deep learning segmentation.

Interventional ultrasound (US) has challenges in accurate localization of the puncture needle due to intrinsic acoustic interferences, which lead to blurred, indistinct, and even invisible needles in handheld linear array transducer-based US navigation, especially the incorrect needle tip positioning. Photoacoustic (PA) imaging can provide complementary image contrast, without additional data acquisition. Herein, we proposed an internal illumination to solely light up the needle tip in PA imaging. Then deep-learning-based feature segmentation alleviates acoustic interferences, enhancing the needle shaft-tip visibility. Further, needle shaft-tip compensation aligned the needle shaft in US image and the needle tip in the PA image. The experiments on phantom, ex vivo chicken breast, preclinical radiofrequency ablation and in vivo biopsy of sentinel lymph nodes were piloted. The target registration error can reach the submillimeter level, achieving precise puncture needle tracking ability with in-plane US/PA navigation.

Foreign body accompanied with thrombosis in the right internal jugular vein: A case report.

A rare foreign body accompanied by thrombosis in the right internal jugular vein was accidentally observed. We collected the medical history of this special patient, analyzed the causes and characteristics of the foreign body and thrombosis formation, and subsequently observed the changes in thrombosis. Finally, we discussed the diagnostic value of ultrasound for such rare intravascular lesions.

Age-related trends in the incidence of metastatic colorectal cancer from 2010 to 2019 in the USA.

Aim: To evaluate temporal changes in metastatic colorectal cancer (mCRC), incidence, and use of chemotherapy treatment by age group using real-world data (RWD) from the USA. Methods: A retrospective, observational study describing temporal trends in mCRC incidence and FOLFOXIRI treatment by age group using a nationwide database of commercially and Medicare Advantage-insured patients from 2010 to 2019. Results: Incidence of mCRC increased by 22.1 and 14.9% in the 18-49 and 50-64 years cohorts, respectively, and decreased by 21.6% in the ≥65 years cohort. Overall, younger patients were more likely to receive FOLFOXIRI treatment versus older patients. Conclusion: The shifting age distribution of mCRC should be considered when recommending screening and treatment. Further research is needed to inform age-specific treatment guidelines.

What is this article about? This article reports the results of a study that used a US database of commercially and Medicare Advantage-insured adults to evaluate how the number of adults with metastatic colorectal cancer (mCRC) in three age groups (18­49 years, 50­64 years and 65 years and over) changed from 2010 to 2019. The study also looked at the use of an aggressive chemotherapy treatment, known as 5-fluorouracil, oxaliplatin, leucovorin calcium and irinotecan (FOLFOXIRI), by age group. What were the results? Overall, 23,970 adults with mCRC were included in the study. From 2010 to 2019, the number of adults with mCRC increased by 22.1% among those aged 18­49 years, increased by 14.9% among those aged 50­64 years, and decreased by 21.6% among those aged 65 years and over. There were some differences between age groups; a higher percentage of younger patients (18­49 years) were Hispanic or Asian, and from the South compared with the older age groups. In comparison, those aged 65 years and over were more likely to be from the West and Northeast of the USA. The study also found that a higher proportion of those aged 18­49 years received FOLFOXIRI (8.4%) compared with adults aged 50­64 years (4.4%) and 65 years and over (1.9%). What do the results of the study mean? Healthcare providers should be aware that early-onset mCRC is becoming more common and consider this when recommending screening and treatment.

PM2.5-bound metals and blood metals are associated with pulmonary function and Th17/Treg imbalance: A panel study of asthmatic adults.

Growing research has demonstrated that exposure to fine particulate matter (PM2.5) was associated with decreased pulmonary function and obvious inflammatory response. However, few pieces of research focus on the effects of PM2.5-bound metals on people with asthma. Here, we assessed whether PM2.5 and PM2.5-bound metals exposure could worsen pulmonary function in asthmatic patients and further elucidate the possible mechanisms. Thirty-four asthmatic patients were recruited to follow up for one year with eight visits in 2019-2020 in Taiyuan City, China. The index of pulmonary function was detected and blood and nasal epithelial lining fluid (ELF) samples were acquired for biomarkers measurement at each follow-up. Linear mixed-effect (LME) models were used to evaluate the relations between PM2.5, PM2.5-bound metals, and blood metals with lung function and biomarkers of Th17/Treg balance. The individual PM2.5 exposure concentration varied from 37 µg/m3 to 194 µg/m3 (mean: 59.63 µg/m3) in the present study. An interquartile range (IQR) increment of PM2.5 total mass was associated with a faster decline in maximal mid-expiratory flow (MMEF) and higher interleukin-23 (IL-23). PM2.5-bound metals [e.g. copper (Cu), nickel (Ni), manganese (Mn), titanium (Ti), and zinc (Zn)] were significantly associated with IL-23 (Cu: 5.1126%, 95% CI: 9.3708, 0.8544; Mn: 14.7212%, 95% CI: 27.926, 1.5164; Ni: 1.0269%, 95% CI: 2.0273, 0.0264; Ti: 16.7536%, 95% CI: 31.6203, 1.8869; Zn: 24.5806%, 95% CI: 46.609, 2.5522). Meanwhile, blood lead (Pb) and Cu were associated with significant declines of 0.382-3.895% in MMEF and maximum ventilatory volume (MVV). Blood Pb was associated with descending transforming growth factor ß (TGF-ß). In conclusion, exposure to PM2.5-bound metals and blood metals is a risk factor for decreased pulmonary function, especially in small airways. These alterations might be partially attributed to the imbalance of Th17/Treg.

Theoretical Study on Adsorption Behavior of SF6 Decomposition Components on Mg-MOF-74.

SF6 gas is an arc extinguishing medium that is widely used in gas insulated switchgear (GIS). When insulation failure occurs in GIS, it leads to the decomposition of SF6 in partial discharge (PD) and other environments. The detection of the main decomposition components of SF6 is an effective method to diagnose the type and degree of discharge fault. In this paper, Mg-MOF-74 is proposed as a gas sensing nanomaterial for detecting the main decomposition components of SF6. The adsorption of SF6, CF4, CS2, H2S, SO2, SO2F2 and SOF2 on Mg-MOF-74 was calculated by Gaussian16 simulation software based on density functional theory. The analysis includes parameters of the adsorption process such as binding energy, charge transfer, and adsorption distance, as well as the change in bond length, bond angle, density of states, and frontier orbital of the gas molecules. The results show that Mg-MOF-74 has different degrees of adsorption for seven gases, and chemical adsorption will lead to changes in the conductivity of the system; therefore, it can be used as a gas sensing material for the preparation of SF6 decomposition component gas sensors.

Comparative cost analysis of liquid embolization systems for brain arteriovenous malformation using a real-world US hospital database: TRUFILL® versus OnyxTM.

BACKGROUND: Liquid embolic systems (LES) such as n-butyl cyanoacrylate-based TRUFILL® and ethylene vinyl-alcohol copolymer-based OnyxTM are widely used for the embolization of brain arteriovenous malformations (bAVMs). The purpose of this study was to compare hospital cost and length of stay (LOS) among unruptured bAVM patients undergoing embolization procedures with TRUFILL versus Onyx LES. METHODS: Adult patients with unruptured bAVMs undergoing endovascular embolization with TRUFILL or Onyx LES between January 1, 2010 and June 30, 2020 were identified from the Premier Healthcare Database. Baseline covariates among the two groups were balanced using propensity score matching. Outcomes including total procedure cost, supply cost, and LOS were examined. A Generalized Estimating Equation model was used to assess outcomes in the matched cohorts. RESULTS: A total of 1072 patients were included in the study; 140 embolized with TRUFILL (mean age 47.06 [15.72] years, 45.70% male) and 932 embolized with Onyx (mean age 46.80 [16.65] years, 52.30% male). In the post-match cohort, the total procedure costs were lower for the TRUFILL (n = 130) versus Onyx (n = 333) group, though not significantly ($36,798 vs. $40,988; odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.73-1.10; p = 0.30). However, supply cost was significantly lower for hospitalizations with TRUFILL compared to Onyx use ($13,281 vs. $16,371, OR = 0.81, 95% CI: 0.68, 0.98; p = 0.026). Hospital LOS was similar in these two groups (TRUFILL: 4.05 vs. Onyx: 4.06 days; OR = 1.00, 95% CI: 0.70, 1.42; p = 0.99). CONCLUSIONS: In a large, multi-center, real-world sample of patients undergoing bAVM embolization, TRUFILL use was associated with significantly lower supply cost compared to Onyx use.

Comparative risk of dementia among patients with atrial fibrillation treated with catheter ablation versus anti-arrhythmic drugs.

Atrial fibrillation (AF) is associated with an increased risk of dementia. Emerging evidence suggests AF suppression is associated with reduced risk of dementia, but the optimal strategy to achieve this is unknown. We sought to compare the risk of dementia in patients with AF who underwent catheter ablation (CA) versus anti-arrhythmic drug (AAD) treatment. METHODS AND RESULTS: Using the 2000 to 2021 Optum Clinformatics database, patients with AF who underwent CA versus AAD treatment (≥1 prescription fill for ≥2 different AADs) were identified and propensity score matched overall and within sex subgroups. A cause-specific hazard model was performed to assess dementia overall and in sex-specific subgroups. After matching, there were 19,088 patients per group. CA was associated with a 41% lower risk of dementia compared with AAD alone (1.9% vs 3.3%; hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.52-0.67, log-rank P < .0001). When examined by sex, dementia risk reduction associated with CA versus AAD use alone was observed among both males (HR 0.55, 95% CI 0.46-0.66) and females (HR 0.60, 95% CI 0.50-0.72). Though not studied as a primary outcome, patients treated with CA were also observed to have 49% lower associated risk of mortality compared with AAD only (HR 0.51 95% CI 0.46-0.55, P < .0001). CONCLUSIONS: Among patients treated for AF, CA was associated with significantly lower risk of dementia and death compared with AADs only. These reductions in risk associated with CA versus AAD were seen in both males and females.

Power requirements for bat-inspired flapping flight with heavy, highly articulated and cambered wings.

Bats fly with highly articulated and heavy wings. To understand their power requirements, we develop a three-dimensional reduced-order model, and apply it to flights of Cynopterus brachyotis, the lesser dog-faced fruit bat. Using previously measured wing kinematics, the model computes aerodynamic forces using blade element momentum theory, and incorporates inertial forces of the flapping wing using the measured mass distribution of the membrane wing and body. The two are combined into a Lagrangian equation of motion, and we performed Monte Carlo simulations to address uncertainties in measurement errors and modelling assumptions. We find that the camber of the armwing decreases with flight speed whereas the handwing camber is more independent of speed. Wing camber disproportionately impacts energetics, mainly during the downstroke, and increases the power requirement from 8% to 22% over flight speed U = 3.2-7.4 m s-1. We separate total power into aerodynamic and inertial components, and aerodynamic power into parasitic, profile and induced power, and find strong agreement with previous theoretical and experimental studies. We find that inertia of wings help to balance aerodynamic forces, alleviating the muscle power required for weight support and thrust generation. Furthermore, the model suggests aerodynamic forces assist in lifting the heavy wing during upstroke.

Molecular Dynamics Study of the Influence of Nano SiO2 on the Thermodynamic Properties of PMIA Composites.

The poly-m-phenyleneisophthalamide (PMIA) is widely used in the electrical field due to its numerous favorable characteristics, but its poor thermal conductivity limits its application. In this study, PMIA was modified with nano-silica (SiO2) to improve its thermal and mechanical properties. Using iso-phthalic acid and m-phenylenediamine as monomers, the changes in the thermodynamic properties and microstructure parameters of SiO2-modified PMIA were analyzed using molecular dynamics before and after modification in the temperature range of 250~450 K. It was found that adding SiO2 improves the Young's modulus and Shear modulus of PMIA, and the mechanical properties of PMIA, and SiO2/PMIA composites deteriorate with increasing temperature, but the mechanical properties of SiO2/PMIA composites are always better than those of pure PMIA in the temperature range of electrical equipment. Meanwhile, after doping SiO2 with the radius of 8 Å, the glass transition temperature of PMIA increases by 27.11 K, and its thermal conductivity increases from 0.249 W m-1 K-1 to 0.396 W m-1 K-1. When SiO2 is added to PMIA, the thermal expansion coefficient of PMIA will decrease in both glass and rubber states, and its thermal stability will improve. In terms of microstructure parameters, the free volume distribution of the SiO2/PMIA model is less easily dispersed than that of the PMIA model, indicating that the addition of SiO2 can improve the related properties of PMIA by hindering the movement of molecular chains.

Preparation and Performance Analysis of Transformer Aramid Nanopaper-Based Insulating Material Based on Deep Learning.

Transformers are an essential part of power production. Insulating paper began to be widely used in transformers in the 1990s. The superior aramid nanofiber as the matrix gives the aramid nano-insulating paper excellent mechanical properties, insulation performance, temperature resistance, and flexibility. At first, the heat resistance and service life of insulating paper should be satisfied for use in electrical equipment. With the continuous development of power equipment, people have put forward higher requirements on the properties of insulating paper, especially heat resistance and electrical properties. Insulation paper made of aramid fibers have better thermal stability and more advantages in electrical and mechanical properties, which can significantly improve the service life and safety of electrical appliances. The purpose of this article is to study the use of aramid nanopaper-based insulating materials in transformers to explore the effect of transformer discharge mechanism on aramid nanopaper-based insulating materials. This paper proposes to design multiple deep learning models to identify the discharge mode of the voltage transformer, find the characteristic signal, and carry out related tests on the discharge signal of different modes, and find the maximum temperature value of the aramid nanopaper-based insulating material for industrial use. The experimental results in this paper show that the aramid nanopaper-based insulating material can be used in transformers discharge detection well, and the safety rate is increased by 20%.

Cystic fibrosis transmembrane conductance regulator prevents ischemia/reperfusion induced intestinal apoptosis via inhibiting PI3K/AKT/NF-κB pathway.

BACKGROUND: Intestinal ischemia/reperfusion (I/R) injury is a fatal syndrome that occurs under many clinical scenarios. The apoptosis of intestinal cells caused by ischemia can cause cell damage and provoke systemic dysfunction during reperfusion. However, the mechanism of I/R-induced apoptosis remains unclear. Cystic fibrosis transmembrane conductance regulator (CFTR) is a cAMP-activated chloride channel. Few researchers have paid attention to its role in intestinal I/R injury, or the relationship between CFTR and intestinal apoptosis induced by hypoxia/reoxygenation (H/R). AIM: To investigate the effects of CFTR on I/R-induced intestinal apoptosis and its underlying molecular mechanisms. METHODS: An intestinal I/R injury model was established in mice with superior mesenteric artery occlusion, and Caco2 cells were subjected to H/R for the simulation of I/R in vivo. RESULTS: The results suggested that CFTR overexpression significantly increased the Caco2 cell viability and decreased cell apoptosis induced by the H/R. Interestingly, we found that the translocation of p65, an NF-κB member, from the cytoplasm to the nucleus after H/R treatment can be reversed by the overexpression of CFTR, the NF-κB P65 would return from the nucleus to the cytoplasm as determined by immunostaining. We also discovered that CFTR inhibited cell apoptosis in the H/R-treated cells, and this effect was significantly curbed by the NF-κB activator BA, AKT inhibitor GSK690693 and the PI3K inhibitor LY294002. Moreover, we demonstrated that CFTR overexpression could reverse the decreased PI3K/AKT expression induced by the I/R treatment in vivo or H/R treatment in vitro. CONCLUSION: The results of the present study indicate that the overexpression of CFTR protects Caco2 cells from H/R-induced apoptosis; furthermore, it also inhibits H/R-induced apoptosis through the PI3K/AKT/NF-κB signaling pathway in H/R-treated Caco2 cells and intestinal tissues.

Insulation Performance and Simulation Analysis of SiO2-Aramid Paper under High-Voltage Bushing.

The long-term safe and stable operation of oil-impregnated paper (OIP) bushings is of great significance to the operation of power systems. With the growth of OIP bushing, its internal insulation will gradually decay. Aramid insulation paper has excellent thermal aging characteristics and its insulation performance can be improved by using nano-modification technology. In this paper, the nano-SiO2 particles were used as the modified additives, and the modified aramid insulation paper was prepared through four steps: ultrasonic stirring, fiber dissociation, paper sample copying and superheated calendering. The microscopic physical morphology and chemical components of the insulation specimens before and after modification were analyzed by atomic force microscopy (AFM), scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS), and an OIP bushing model based on the modified aramid insulation paper was constructed and its electric field distribution was analyzed. The simulation results show that the use of SiO2-modified aramid insulation paper can improve the electric field distribution of OIP bushings and increase the operating life of power transformers.

Evaluating outcomes of same-day discharge after catheter ablation for atrial fibrillation in a real-world cohort.

BACKGROUND: As same-day discharge (SDD) after catheter ablation (CA) for atrial fibrillation (AF) is increasingly utilized, it is important to further investigate this approach. OBJECTIVE: To investigate the safety and efficacy of SDD after CA for AF in a large nationwide administrative sample. METHODS: The IBM MarketScan Commercial Claims and Encounters database was used to identify adult patients under 65 years undergoing CA for AF (2016-2020). Eligible patients were indexed to date of first CA and classified into SDD or overnight stay (ONS) groups based on length of service. A 1:3 propensity score matching was used to create comparable SDD:ONS samples. Study outcomes were CA-related complications within 30 days after index procedure and AF recurrence within 1 year. Cox proportional hazards models were estimated for outcome comparison. RESULTS: In the postmatch 30-day cohort, there were 1610 SDD and 4637 ONS patients with mean age 56.1 (± 7.6) years. There was no significant difference in composite 30-day postprocedural complication rate between SDD and ONS groups (2.7% vs 2.8%, respectively; P = .884). The most common complications were cerebrovascular events (0.7% vs 0.7%; P = .948), vascular access events (0.6% vs 0.6%; P = .935), and pericardial complications (0.6% vs 0.5%; P = .921). Further, no significant difference in composite AF recurrence rate at 1 year was observed among SDD and ONS groups (10.2% vs 8.8%; hazard ratio = 1.167; 95% confidence interval 0.935-1.455; P = .172). CONCLUSION: In a large, propensity-matched, real-world sample, SDD appears to be safe and have similar outcomes compared with overnight observation following CA for AF.

Same-day discharge after catheter ablation in patients with atrial fibrillation in a large nationwide administrative claims database.

BACKGROUND: Catheter ablation (CA) is a common treatment for atrial fibrillation (AF). This study evaluated outcomes of same day discharge (SDD) versus overnight stay (ONS) among AF patients undergoing outpatient CA. METHODS: The Optum SES Clinformatics Extended Data Mart database was used to identify patients ≥18 years of age undergoing outpatient CA for AF (2016-2020). Eligible patients were indexed to the date of first CA and classified into SDD and ONS groups based on the length of service. A 1:3 propensity score matching was used to create comparable SDD:ONS samples. The primary safety outcome was CA-related complications within 30 days of index procedure. The primary efficacy outcome was AF recurrence within 1 year. Cox proportional hazards models were estimated for outcome comparison. RESULTS: In the postmatch 30-day cohort for safety evaluation, there were 6600 patients (1660 [25.2%] SDD; 4940 [74.8%] ONS), with a mean age of 66.6 years. There was no significant difference in the 30-day composite rate of postablation complications (4.7% [78/1660] vs. 3.8% [187/4940]; p = 0.100) and 1-year composite rate of AF recurrence (14.3% [142/996] vs. 14.5% [430/2972]; p = 0.705) between the SDD and ONS groups. CONCLUSION: This study demonstrated that SDD following CA to treat patients with AF is safe, with low rates of postablation complications and AF recurrence, which were comparable to rates in patients with an ONS after CA.

Research of Fluorescent Properties of a New Type of Phosphor with Mn2+-Doped Ca2SiO4.

Fluorescent optical fiber temperature sensors have attracted extensive attention due to their strong anti-electromagnetic interference ability, good high-voltage insulation performance, and fast response speed. The fluorescent material of the sensor probe directly determines the temperature measurement effect. In this paper, a new type of fluorescent material with a Mn2+-doped Ca2SiO4 phosphor (CSO:Mn2+) is synthesized via the solid-state reaction method at 1450 °C. The X-ray diffraction spectrum shows that the sintered sample has a pure phase structure, although the diffraction peaks show a slight shift when dopants are added. The temperature dependence of the fluorescence intensity and lifetime in the range from 290 to 450 K is explored with the help of a fluorescence spectrometer. Green emission bands peaking at 475 and 550 nm from Mn2+ are observed in the fluorescence spectra, and the intensity of emitted light decreases as the temperature rises. The average lifetime of CSO:Mn2+ is 17 ms, which is much higher than the commonly used fluorescent materials on the market. The fluorescence lifetime decreases with increasing temperature and shows a good linear relationship within a certain temperature range. The research results are of great significance to the development of a new generation of fluorescence sensors.

Evolving Treatment Patterns for Hospitalized COVID-19 Patients in the United States in April 2020-July 2020.

We sought to examine the trend (April-July) in the treatment patterns among hospitalized COVID-19 patients using the Premier Healthcare Database (PHD). In the analysis, we identified 53,264 patients from 302 hospitalsthat continuously provided inpatient data from April 1, 2020 to July 31, 2020 to the PHD, a nationwide, population-based multihospital research database in the US. We used generalized estimating equations (GEE) models to assess changes in the proportion of therapies used during the study period. After adjusting for patient and provider factors, a decline in hydroxychloroquine and an increase in azithromycin and dexamethasone were observed among COVID-19 patients during the 4-month study period.