Severe COVID-19 and its cardiopulmonary effects 6 and 18 months after hospital discharge.

Introduction: SARS-CoV-2 infection affects the cardiopulmonary system in the acute as well as long-term phase. The aim of the present study was to comprehensively assess symptoms and possible long-term impairments 6 and 18 months after hospitalization for severe COVID-19 infection. Methods: This prospective registry included patients with PCR-confirmed COVID-19 infection requiring hospitalization. Follow-up approximately 6 months post discharge comprised a detailed patient history, clinical examination, transthoracic echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a laboratory panel. At the time of the second follow-up visit at 18 months, patients without pathologic findings during the first study visit were contacted by phone to inquire about the course of their symptoms. In all other patients all initial examinations were repeated. Results: Two hundred Patients, who were hospitalized for COVID-19, were contacted by phone and were recruited for the study. Due to dropouts the second study visit was performed in 170 patients. A comparison between the two study visits at 6 and 18 months post discharge showed the following results: Six months after discharge, 73% and 18 months after discharge 52% fulfilled the criteria for Long COVID with fatigue being the most common symptom (49%). Echocardiography at 6 months post discharge showed an impaired left ventricular function in 8% of which 80% returned to normal. Six months post discharge, cMRI revealed pericardial effusion in 17% which resolved in 47% of the 15 patients who underwent a control cMRI. Signs of peri- or myocarditis were present in 5% of the patients and were resolved in all 4 patients who attended control studies. At 6 months, chest CT scans identified post-infectious residues in 24%. In the 25 repeated chest CT scans 20% showed full recovery. Length of in-hospital stay was identified as a significant predictor for persisting Long COVID (95% CI: 1.005-1.12, p = 0.03). Conclusion: Comparing 6 to 18 months, the prevalence of Long COVID decreased over time, but a high symptom burden remained. Structural and functional abnormalities were less frequent than the portrayed symptoms, and it thus remains a challenge to substantiate the symptoms.

Systematic classification of maternal and fetal intervention-related complications following open fetal myelomeningocele repair - results from a large prospective cohort.

OBJECTIVE: To systematically categorise all maternal and fetal intervention-related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. DESIGN: A prospective cohort study. SETTING: Single centre. POPULATION: Mothers and fetuses after fMMC repair. METHODS: Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien-Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. MAIN OUTCOME MEASURES: Systematic classification of maternal and fetal complications following fMMC repair. RESULTS: Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention-related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. CONCLUSION: This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. TWEETABLE ABSTRACT: Systematic classification of all maternal and fetal intervention-related complications following open fMMC repair.

Blood group O: A novel risk factor for increased postpartum blood loss?

INTRODUCTION: Blood group O is known to be associated with lower levels of von Willebrand factor (VWF) and with increased bleeding complications. The influence of blood group O on postpartum blood loss was assessed by a few studies, however, without adjustment for important obstetric risk factors for postpartum blood loss. AIM: Aim of this study was to investigate whether women with blood group O exhibit increased blood loss after delivery in consideration of established risk factors for postpartum bleeding. METHODS: A total of 1487 patients were prospectively included into this cohort study. Blood loss was assessed by estimated blood loss (in mL), and drop of haemoglobin (Δ haemoglobin) was calculated. Association of blood loss with risk factors (such as blood group O, cervical tears, morbidly adherent placenta, placenta praevia and uterine atony amongst others) was assessed with appropriate tests. Significant variables were entered into a stepwise multivariate regression analysis. RESULTS: Women with blood group O showed a significantly higher blood loss when compared to women with blood group non-O (529.2 mL ± 380.4 mL and 490.5 mL ± 276.4 mL, respectively, P = .024)). The increased blood loss in women with blood group O remained significant after multivariate regression analysis (difference 47 mL, P = .019). CONCLUSION: This is the first study reporting significantly increased blood loss following delivery in women with blood group O after adjustment for major risk factors for postpartum blood loss. Albeit having a statistically significant, but clinically minor effect on absolute blood loss, blood group O carriers may suffer from aggravated bleeding in the presence of additional obstetric bleeding pathologies.

Growth and nutrition of birch seedlings at varied relative addition rates of magnesium.

Growth and nutrition of hydroponically cultivated birch seedlings (Betula pendula Roth.) were investigated at various magnesium (Mg) availabilities. Suboptimum Mg conditions were created by adding Mg once per hour in exponentially increasing amounts at one of four relative addition rates (R(Mg)): 0.05, 0.10, 0.15 or 0.20 day(-1). Seedlings given free access to Mg were used as controls. After an acclimation period, the relative growth rate of the seedlings attained the same value as the corresponding relative rate of Mg addition. In all suboptimum Mg treatments, deficiency symptoms in the form of chloroses and necroses developed in the older leaves, both during and after the phase of growth acclimation. The severity of these symptoms was correlated with the availability of Mg. The relative growth rate of seedlings was linearly correlated with plant Mg status. The root fraction of the total biomass decreased from 22% in control plants to 8% in plants receiving the lowest rate of Mg addition. A shift in Mg availability from free access to R(Mg) = 0.05 day(-1) decreased the photosynthetically active leaf area per plant weight, despite a concomitant increase in the leaf weight ratio (leaf dry weight/plant dry weight) from 0.61 to 0.75. The loss in assimilating leaf area was mainly a consequence of enhanced leaf mortality and formation of necroses, and to a minor extent attributable to increased carbon costs for leaf area production. A decrease in starch concentration was observed in leaves showing Mg-deficiency symptoms, whereas the starch concentration in healthy leaves was unaffected by Mg availability. It was concluded that shortage of carbohydrates constituted the major growth constraint, particularly for roots, under Mg-limiting conditions.

Analysis of hydrocarbon dendrimers by laser desorption time-of-flight and fourier transform mass spectrometry.

The first mass spectrometric analysis of a new class of hydrocarbon dendrimers that result from a convergent synthetic approach is reported. Molecular weights of a series of phenylacetylene dendrimers (715 to 14776 u MW) are characterized by ultraviolet matrix-assisted laser desorption (MALDltime-of-flight (TOF) mass spectrometry, direct and silver chemical ionization infrared laser desorption Fourier transform mass spectrometry @I'MSl, and ultraviolet matrix-assisted laser desorption silver chemical ionization Fourier transform mass spectromeby. New matrices and techniques were developed to facilitate analysis of the dendrimers. Mass measurement accuracies between 10 and 25 ppm are obtained for molecular ion species of the five dendrimers analyzed. Laser desorption time-of-flight and FI'MS techniques are shown to be complementary, with FTMS providing high mass resolution (27,000-67,000 resolving power) and accuracy for lower mass dendrimers (10-14 ppm) and MALD TOF yielding the highest resolution (1100 resolving power) and accuracy (25 ppm) for the largest dendrimer. These results are consistent with proposed empirical formulas.

Silver nitrate chemical ionization for analysis of hydrocarbon polymers by laser desorption fourier transform mass spectrometry.

Addition of silver nitrate to nonpolar hydrocarbon polymer solutions prior to their analysis by laser desorption Fourier transform mass spectrometry is shown to allow efficient silver ion chemical ionization. High-quality mass spectra are thus obtained for polymers, such as polystyrene, polyisoprene, polybutadiene, and polyethylene, that previously failed to yield useful mass spectra using conventional laser desorption. Accurate mass measurement experiments and isotopic ratios verify that the spectra are those of silver-attached oligomer ion distributions. Mass measurement errors for complete oligomer distributions average between 3 and 12 ppm for oligomers with masses between 400 and 6000 D whereas unit mass resolution is maintained throughout the entire spectral range.