Perception Disparity of Telemedicine Use between Outpatients and Medical Staff during the COVID-19 Pandemic.

We assessed the characteristics and perception of telephone appointments among outpatients and medical staff during the COVID-19 pandemic in Taiwan. Our survey was performed by giving self-administered questionnaires to the enrollees. Basic socioeconomic status data were collected. We used a valid and reliable telehealth usability questionnaire (TUQ) to assess the telemedicine experience among outpatients and medical staff. Only outpatients with chronic illness and who had regular visits before the pandemic were enrolled. We delivered the questionnaire survey to participants who used telephone appointments from 20 May 2021 to 31 July 2021 in Taichung Veterans General Hospital. A total of 471 outpatients and 203 medical staff completed the survey. Most of the respondents were aged 30-69, college-educated, women, and married. Outpatients have higher scores in all dimensions of TUQ than medical staff, especially in the dimensions of ease of use and effectiveness. Age, gender, education, and marriage have no significant associations in the medical staff group. In the outpatient group, gender is the only significant factor in the six dimensions of TUQ. We found a significant disparity in the perception gap of telemedicine among outpatient and medical staff. Outpatients are satisfied with telephone appointments during the COVID-19 pandemic, but medical staff are concerned about the ease of use and effectiveness.

Target capture sequencing of SARS-CoV-2 genomes using the ONETest Coronaviruses Plus.

We introduce a target capture next-generation sequencing methodology, the ONETest Coronaviruses Plus, to sequence the SARS-CoV-2 genome and select loci of other respiratory viruses. We applied the ONETest on 70 respiratory samples (collected in Florida, USA between May and July, 2020), in which SARS-CoV-2 had been detected by a PCR assay. For 48 of the samples, we also applied the ARTIC protocol. Of the 70 ONETest libraries, 45 (64%) had a (near-)complete sequence (>29,000 bases and >90% covered by >9 reads). Of the 48 ARTIC libraries, 25 (52%) had a (near-)complete sequence. In 19 out of 25 (76%) samples in which both the ONETest and ARTIC yielded (near-)complete sequences, the lineages assigned were identical. As a target capture approach, the ONETest is less prone to loss of sequence coverage than amplicon approaches, and thus can provide complete genomic information more often to track and monitor SARS-CoV-2 variants.

Differential change in expression of pulmonary ET-1 and eNOS in rats after chronic left ventricular pressure overload.

Pressure overload in the left ventricle of the heart follows a chronic and progressive course, resulting in eventual left heart failure and pulmonary hypertension (PH). The purpose of this research was to determine whether a differential pulmonary gene change of endothelin (ET)-1 and endothelial nitric oxide synthase (eNOS) occurred in adult rats with left ventricular overload. Eight groups of eight rats each were used (four rats with banding and four rats with sham operations). The rats underwent ascending aortic banding for 1 day, 2 weeks, 4 weeks, and 12 weeks before sacrifice. Significant medial hypertrophy of the pulmonary arterioles developed in two groups (4 and 12 weeks). Increased pulmonary arterial pressures were noted in three groups (1 day, 4 weeks, and 12 weeks). The aortic banding led to significant increases in pulmonary preproET-1 messenger RNA (mRNA) at 1 day and 12 weeks, and in pulmonary eNOS mRNA at 1 day and 12 weeks. In addition, there was increased pulmonary eNOS content at 1 day and 12 weeks in the banded rats, and increased lung cGMP levels were observed at 1 day. Increased lung ET-1 levels were also noted at 1 day (banded, 310 +/- 12 ng/g protein; sham, 201 +/- 12 ng/g protein; P < 0.01), 4 weeks (banded, 232 +/- 12 ng/g protein; sham, 201 +/- 12 ng/g protein; P < 0.01) and 12 weeks (banded, 242 +/- 12 ng/g protein; sham, 202 +/- 12 ng/g protein; P < 0.01). This indicates that the upregulated expression of ET-1 developed at least 4 weeks before eNOS expression in the course of PH, and, thus, medication against ET-1 could play a crucial role in treating PH with cardiac dysfunction secondary to aortic banding.

Right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum: a case report.

Pulmonary atresia with intact ventricular septum (PAIVS) is a morphologically heterogeneous lesion and accounts for 1-3% of critically ill infants with congenital heart disease. Numerous surgical approaches have been attempted with varying degrees of success, but the mortality rate is still high in most series. The optimal surgical procedure depends on the size and morphology of the tricuspid valve and right ventricle and the presence or absence of right ventricle-dependent coronary circulation. Therefore, it is pivotal to define the precise morphologic and hemodynamic characteristics, especially coronary artery anatomy. In this report, we describe a full-term female neonate with cyanosis soon after birth. Two-dimensional and color Doppler echocardiography corroborated the diagnosis of PAIVS and showed a small right ventricle. Cardiac catheterization indicated PAIVS and further revealed right ventricle-dependent coronary circulation. A systemic-to-pulmonary artery shunt was constructed with a positive immediate result.

The recommended frequency of echocardiography in follow-up evaluation of patients with Kawasaki disease.

To assess the value of follow-up echocardiograms for patients with Kawasaki disease (KD). During a period of 5 years, children diagnosed with KD were enrolled in this study if at least three echocardiograms were documented, including one at admission, one at 1 to 2 months and one beyond 2 months following the onset of fever. The cohort study recruited 176 patients, and 120 patients were included in the final analysis. Most (116 patients, 97%) of the patients were under 5 years of age, and the male-to-female ratio was 1.93: 1. During the study period, KD was more common during the summer (35.8%). Of the 120 patients, 67 (56%) had normal echocardiograms, and 53 (44%) had abnormal echocardiograms at admission. Of the 53 patients with abnormal echocardiograms, 35 had coronary artery dilatation, and 18 had aneurysm. The mean interval between the onset of illness and the documentation of echocardiographic abnormality was 13 days (range 3-37 days). The abnormal echocardiographic findings resolved in 48 of the 53 (90%) patients in 2 years. No patient who had normal echocardiographic findings at 1-2 months developed subsequent abnormalities. There was no difference in the proportion of persistent abnormal follow-up echocardiographic findings in patients with initial coronary dilatation or aneurysm between the 2m-6m and 6m-12m follow-up echocardiograms (p = 0.78, p = 0.09, respectively). The proportion of patients with echocardiographic findings of coronary dilatation and aneurysm changed significantly between the 2m-6m and 12m-18m follow-up echocardiograms (p = 0.007, p = 0.045, respectively). Additional echocardiographic studies beyond 8 weeks for coronary artery morphology are not necessary if previous studies have produced normal results in patients with KD. Patients who have coronary artery abnormalities at the acute or subacute stage should receive an additional follow-up echocardiogram one year after the convalescent stage of the disease.

Real-time three-dimensional echocardiography provides novel and useful anatomic insights of perimembranous ventricular septal aneurysm.

BACKGROUND: Real-time three-dimensional echocardiography (RT3DE) is a new image modality, and it can display a unique image reconstruction in a variety of heart diseases. However, clinical assessment of ventricular septal aneurysm (VSA) by RT3DE has not been reported. This pilot prospective study is to survey what kinds of new insights of VSA can be provided by RT3DE as compared with conventional 2-dimensional echocardiography (2DE). METHODS: We investigated the diagnostic value of RT3DE and 2DE in 60 consecutive patients with VSA. From different transthoracic windows, structures of interest can be displayed from any orientation through adjusting cropping and slicing the RT3DE datasets. The results were compared with those in 2DE. RESULTS: RT3DE reconstruction of VSA was feasible in 56 of 60 patients (93%). When compared with 2DE, additional information provided by RT3DE included blood flow through left ventricle to right ventricle, visualization of VSD enface border in 56 patients (93%), morphology of the VSA from apical short axis view in 48 patients (86%), hypertrophied margin of the interventricular septum in 26 patients (43%), dynamic changes of VSA and tricuspid valve in 18 patients (30%), adhesion of chordae tendineae in VSA in 16 patients (26%). CONCLUSIONS: Structures of interest can be evaluated from unique RT3DE in any orientation during scanning. RT3DE offers additional novel views and has the advantages of not only displaying better visualization of VSA, but also adequately showing the spatial relationship with its adjacent structures. It can provide novel and useful anatomic insights than 2DE while assessing patients with VSA.

Virtual intraluminal evaluation of aortico-left ventricular tunnel by multislice computed tomography.

The aortico-left ventricular tunnel (ALVT) is a rare abnormal channel that arises from the right coronary sinus through the right ventricular outflow tract to enter the left ventricle below the aortic valve. The unique ability of multislice computed tomography (CT), as applied in the virtual coloscopy, has not been well established in patients with cardiovascular diseases. We herein investigate the virtual intraluminal image in a patient with an ALVT. An 18-year-old male was admitted with a 6-month-long history of progressive exertional dyspnea. He was diagnosed to suffer from ALVT at 5 months of age and received prosthetic patch closure of the aortic opening of the tunnel with mild residual aortic regurgitation. On admission this time, physical examination revealed a grade 3/6 diastolic murmur over the right upper sternal border. A 16-row multislice CT angiography demonstrated an ALVT. In the 3D reconstructed images, the orifice and intraluminal structure of ALVT were clearly visualized at different levels, similar to a real intracardiac endoscopic images. The patient was then referred for aortic valve replacement due to heart failure caused by severe degenerative aortic insufficiency. Our case displayed successfully not only the entire location of ALVT but also demonstrated the virtual intraluminal imaging mimicking endoscopy. This technique provides the virtual visualization of the entire inner image of AVLT, which may not be possible with other imaging modalities.