IFI27 transcription is an early predictor for COVID-19 outcomes, a multi-cohort observational study.

Purpose: Robust biomarkers that predict disease outcomes amongst COVID-19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID-19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness. Methods: We conducted a multi-cohort observational study to investigate the biology and the prognostic role of interferon alpha-inducible protein 27 (IFI27) in COVID-19 patients. Results: We show that IFI27 is expressed in the respiratory tract of COVID-19 patients and elevated IFI27 expression in the lower respiratory tract is associated with the presence of a high viral load. We further demonstrate that the systemic host response, as measured by blood IFI27 expression, is associated with COVID-19 infection. For clinical outcome prediction (e.g., respiratory failure), IFI27 expression displays a high sensitivity (0.95) and specificity (0.83), outperforming other known predictors of COVID-19 outcomes. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 influenza virus infection, IFI27-like genes were highly upregulated in the blood samples of severely infected patients. Conclusion: These data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet-to-be discovered respiratory virus.

Pectus excavatum surgery: sternochondroplasty versus Nuss procedure.

BACKGROUND: The repair of pectus excavatum (PE) by minimally invasive Nuss surgery is well established, but its complication rate is high and its indication is indiscriminate. Sternochondroplasty (SCP) provides good results with a low complication rate but requires a small transverse incision. METHODS: To compare SCP and Nuss, we analyzed 40 patients with PE who underwent surgery (SCP, n = 20; Nuss, n = 20). Thirty subjects (75.0%) were male and 10 (25.0%) were female. In the SCP group, 9 (45.0%) had symmetric PE, and 11 (55.0%) had asymmetric PE. In the Nuss group, 17 (85%) had symmetric PE, and 3 (15%) had asymmetric PE (p = 0.020). RESULTS: The mean duration of SCP was 229.5 minutes, and the mean duration of Nuss was 54.3 minutes. The average length of hospital stay was 4 days with SCP and 6.3 days with Nuss (p = 0.172). The SCP results were favorable in 18 subjects (90%) and fair in 2 subjects (10%). In the Nuss group, we observed 17 patients (85.0%) with favorable results and 3 (15.0%) with poor results. Patients with asymmetric PE exhibited severe pectus carinatum. No complications were found in 17 patients (85%) in the SCP group. In the Nuss group, 9 patients (45.0%) had 13 complications (65.0%; p = 0.004). CONCLUSIONS: Sternochondroplasty surgery yielded better results than the Nuss procedure and more patients with asymmetric PE, less pain, and fewer complications. Nuss surgery had shorter operating times than SCP, younger patients, more symmetric PE, and 3 patients who experienced severe postoperative asymmetric pectus carinatum. In summary, for asymmetric PE the best indication is SCP.

T3T4 endoscopic sympathetic blockade versus T3T4 video thoracoscopic sympathectomy in the treatment of axillary hyperhidrosis.

BACKGROUND: The use of endoscopic sympathetic blockade (ESB) in the treatment of axillary hyperhidrosis has grown because of its potential reversibility. But it is still not clear whether the rates of success, compensatory sweating, and satisfaction are better than those accomplished with video thoracoscopic sympathectomy (VTS). METHODS: Eighty-four patients were studied to compare the rates of success, satisfaction, and compensatory sweating in patients undergoing either ESB or VTS of the T3T4 ganglion after 2 years' follow-up. RESULTS: Thirty-five patients (83.3%) undergoing ESB and 39 patients (92.8%) undergoing VTS had remission of axillary hyperhidrosis (p = 0.315). Improvement was seen in 7 patients (16.7%) in the ESB group and 1 patient (2.4%) in the VTS group. Two patients (4.8%) had bad results in the VTS group. Absence of or minor compensatory sweating was observed in 25 patients (59.5%) in the ESB group and 28 patients (66.7%) in the VTS group, and moderate compensatory sweating occurred in 13 patients (31.0%) in the ESB group and 10 patients (23.8%) in the VTS group. Severe compensatory sweating was observed in 4 patients (9.5%) in the ESB group versus 4 patients (9.5%) in the VTS group (p = 0.905). In the ESB group, 28 patients (66.7%) were very satisfied, 11 patients (26.2%) were satisfied, and 3 patients (7.1%) were unsatisfied with treatment. In the VTS group, 35 patients (83.3%) were very satisfied, 6 patients (14.3%) were satisfied, and 1 patient (2.4%) was unsatisfied with VTS. CONCLUSIONS: Endoscopic sympathetic blockade and VTS of T3T4 ganglion are efficient in axillary hyperhidrosis treatment. We found no differences regarding therapeutic success, satisfaction rate, and incidence, severity, and location of compensatory sweating.