Posttraumatic Stress, Anxiety, and Depression in COVID-19 Survivors

OBJECTIVES

This study aims to examine the rates of anxiety, depression, and posttraumatic stress disorder (PTSD) after hospital discharge among COVID-19 survivors and to determine the associated risk factors.

METHODS

Adult COVID-19 survivors discharged from hospitals between March 2020 and March 2021 were asked to complete a questionnaire at 4 weeks after discharge. The Chinese version of the 22-item Impact of Event Scale - Revised (IES-R) was used to measure symptoms of PTSD. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess symptoms of major depressive disorder. The 7-item Generalised Anxiety Disorder Scale (GAD-7) was used to measure symptoms of generalised anxiety disorder. The rates of anxiety, depression, and PTSD among discharged patients were determined, as were associations between psychosocial factors and outcome measures and predictors for moderate-tosevere symptoms of anxiety, depression, and PTSD.

RESULTS

96 men and 103 women aged 18 to 81 years returned the completed questionnaire. 12.1% to 20.1% of them reported symptoms of PTSD, anxiety, or depression. Higher symptom severity was associated with higher perceived life threat, lower emotional support, lower disease severity upon admission, and longer hospital stay. Women had more PTSD symptoms than men, particularly when knowing someone under quarantine.

CONCLUSION

COVID-19 survivors with higher perceived life threat, lower emotional support, lower disease severity upon admission, and longer hospital stay were associated with higher severity of symptoms of PTSD, anxiety, and depression. Timely intervention should provide to at-risk survivors.

Suspected human intravenous immunoglobulin-induced acute haemolytic anaemia in a dog

A 2-year-old mixed breed dog presented with a 1-year history of crust and erosion on the nasal planum. Because histopathological examination revealed ruptured intraepidermal pustules and superficial dermal inflammation, the dog was diagnosed with pemphigus foliaceus. Human intravenous immunoglobulin was administered in two consecutive doses of 0.5 g/kg/day due to poor therapeutic response to previous immunosuppressive therapy. From Day 3 after the first dose of human intravenous immunoglobulin, tachypnoea, pale mucous membrane, haemoglobinuria and haemoglobinemia were observed, thus confirming haemolytic anaemia. Other drug-induced haemolytic anaemias were excluded because no additional drugs had been administered before the haemolysis occurred. Immune-mediated haemolytic anaemia was also excluded because the direct antiglobulin test was negative. Two transfusions were performed, and haemolysis was not observed from Day 4 of haemolytic anaemia onset. In conclusion, human intravenous immunoglobulin-induced haemolytic anaemia should be considered in dogs that develop haemolysis following the administration of human intravenous immunoglobulin.

Immediate Effects of Vibrotactile Biofeedback Instructions on Human Postural Control

Vibrotactile biofeedback can improve balance and consequently be helpful in fall prevention. However, it remains unclear how different types of stimulus presentations affect not only trunk tilt, but also Center of Pressure (CoP) displacements, and whether an instruction on how to move contributes to a better understanding of vibrotactile feedback.Based on lower back tilt angles (L5), we applied individualized multi-directional vibrotactile feedback to the upper torso by a haptic vest in 30 healthy young adults. Subjects were equally distributed to three instruction groups (attractive - move in the direction of feedback, repulsive - move in the opposite direction of feedback & no instruction - with attractive stimuli). We conducted four conditions with eyes closed (feedback on/off, Narrow Stance with head extended, Semi-Tandem stance), with seven trials of 45s each. For CoP and L5, we computed Root Mean Square (RMS) of position/angle and standard deviation (SD) of velocity, and for L5 additionally, the percentage in time above threshold. The analysis consisted of mixed model ANOVAs and t-tests (α-level: 0.05).In the attractive and repulsive groups feedback significantly decreased the percentage above threshold (p<0.05). Feedback decreased RMS of L5, whereas RMS of CoP and SD of velocity in L5 and COP increased (p<0.05). Finally, an instruction on how to move contributed to a better understanding of the vibrotactile biofeedback.

Assessment of Balance Instability by Wearable Sensor Systems During Postural Transitions

Several studies have demonstrated beneficial effects of real-time biofeedback for improving postural control. However, the application for daily activities, which also include postural transitions, is still limited. One crucial aspect is the time point of providing feedback, and thus its reliability. This might depend on the sensor system used, but also on how the threshold is defined. This study investigates which wearable sensor system and what kind of threshold is more reliable in a situation of a postural transition.To this end, we compared three sensor systems regarding their accuracy in timing in a stable and unstable postural transition in 16 healthy young adults: a multiple Inertial Measurement Unit system (IMU), a pressure Insoles System (IS), and a combination of both systems (COMB). Further, we contrasted two threshold parameters for each system: a Quiet Standing-based threshold (QSth) and a Limits of Stability-based threshold (LoSth).Two-way repeated measures ANOVAs and Wilcoxon tests (α = 0.05) indicated highest accuracy in the COMB LoSth, though with small differences to the IS LoSth. The LoSth showed more accurate timing than the QSth, especially in medio-lateral direction for IS and COMB.Consequently, for providing a reliable timing for a potential biofeedback applied by a wearable device in everyday life situations applications should focus on pressure insoles and a functional stability threshold, such as the LoS-based threshold.

The association of stroke rate with low density lipoprotein and statin exposure in patients with atrial fibrillation (AF)

Background

There are limited data on the association between cholesterol levels and stroke risk in atrial fibrillation (AF).

Objective

To quantify the association of stroke rate in AF with low-density lipoprotein (LDL) levels and statin use.

Methods

Using linked administrative databases in Ontario, Canada, we conducted a population-based retrospective cohort study of patients aged ≥66 years, diagnosed with AF between 2009–2019. We used cause-specific hazard regression to determine the association of statin use with stroke rate. We developed a second cause-specific regression model for patients with at least one lipid profile measurement in the year before AF diagnosis to study the association of LDL levels with stroke rate, while adjusting for statin use. LDL levels were modeled using restricted cubic splines (RCS). Both models were adjusted for age, sex, heart failure, hypertension, diabetes, stroke or transient ischemic attack, and vascular disease at baseline, plus anticoagulation as a time-varying covariate.

Results

We studied 261,659 qualifying patients (median age 78 years, 49% female), of whom 3,954 (1.5%) developed a stroke during one-year follow-up. A total of 142,834 (54.6%) patients were treated with statins and 145,775 (55.7%) had lipid measurements before AF diagnosis. The adjusted RCS analyses (see Figure) indicated increasing hazard ratios (HRs) for stroke with increasing low-density lipoprotein (LDL) values above 1.5mmol/L. Statin use was associated with a lower stroke rate relative to non-users (hazard ratio 0.87, 95% confidence interval 0.81–0.93, p-value &lt;0.0001).

Conclusion

LDL levels above 1.5mmol/L were independently associated with higher stroke rates in patients with AF, while statins were associated with lower stroke rates independent of anticoagulation. This suggests that LDL measurements may improve stroke risk stratification in AF, while statins may offer an underutilized pathway to lower stroke risk in AF.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): 1) Heart and stroke foundation of Canada HR for Stroke and LDL level

Homological percolation transitions in growing simplicial complexes

Simplicial complex (SC) representation is an elegant mathematical framework for representing the effect of complexes or groups with higher-order interactions in a variety of complex systems ranging from brain networks to social relationships. Here, we explore the homological percolation transitions (HPTs) of growing SCs using empirical datasets and model studies. The HPTs are determined by the first and second Betti numbers, which indicate the appearance of one- and two-dimensional macroscopic-scale homological cycles and cavities, respectively. A minimal SC model with two essential factors, namely, growth and preferential attachment, is proposed to model social coauthorship relationships. This model successfully reproduces the HPTs and determines the transition types as an infinite-order Berezinskii-Kosterlitz-Thouless type but with different critical exponents. In contrast to the Kahle localization observed in static random SCs, the first Betti number continues to increase even after the second Betti number appears. This delocalization is found to stem from the two aforementioned factors and arises when the merging rate of two-dimensional simplexes is less than the birth rate of isolated simplexes. Our results can provide a topological insight into the maturing steps of complex networks such as social and biological networks.

Cellulose derivatives agglomerated in a fluidized bed: Physical, rheological, and structural properties

Understanding the agglomeration of cellulose derivatives is crucial for the production of instant gum-based food thickeners. In the present study, physical, rheological, and structural properties of agglomerated water-soluble cellulose gums (CGs), such as carboxymethylcellulose (CMC), hydroxypropylmethylcellulose (HPMC), and methylcellulose (MC), were investigated at different concentrations of maltodextrin (MD) as a binder for fluidized-bed agglomeration. Among the CG agglomerates in the presence of MD, CMC exhibited better flowability and lower cohesiveness, showing lower Carr index and Hausner ratio values. The MC agglomerates with 20% MD exhibited higher porosity than the other CGs due to the size enlargement of MC particles, which was confirmed via scanning electron microscopy images and size distribution profiles. The dynamic moduli of the CG agglomerates were significantly decreased by the addition of MD and also decreased with increasing MD concentration. The tan δ values of the agglomerates increased with increasing MD concentration, indicating the enhancement of their viscous properties. These results suggest that the physical, rheological, and structural properties of cellulose derivatives with different types of CG can be greatly influenced by their agglomerate growths during fluidized-bed agglomeration of particles with the different concentrations of MD binder.

A center of pressure progression model for walking with non heeled and heeled footwear

BACKGROUND

Heeled footwear benefits people with movement disorder in the form of shoe lifts, wedges and inserts while its prolonged use causes foot injury in healthy people. There lies a need to detect parameters that affect COP progression of the foot and gait stability due to footwear.

RESEARCH QUESTION

Do we have bipedal models that can estimate gait parameters corresponding to different center of pressure (COP) trajectories?

METHOD

In this study, we propose a COP translation model that can account for non heeled to heeled footwear. We describe the COP progression as a function of the center of mass (COM) state. This model is used to generate stable steady state walking solutions for different COP profiles. We compare these model solutions with experimental data on non-heeled and heeled-gait.

RESULTS

The bipedal model shows stability across different COP profiles. The model estimates GRF profile (R²=0.83 for 1.3 m/s ) for non heeled normal walking qualitatively and on the temporal scale. It estimates GRF due to heeled gait (R²=0.83 for 1.08 m/s) but is limited in estimation of heeled gait parameters.

SIGNIFICANCE

A bipedal model that can generate stable steady state walking solutions for different forward progressing COP profiles can help in design of foot orthotics for patients with gait disorder and understand injuries occurring due to prolonged wear of rigid heeled footwear.

Molecular insights into the development of hepatic metastases in colorectal cancer: a metastasis prediction study

OBJECTIVE

Colorectal cancer is presently the third most commonly diagnosed cancer in the United States. In this study, we identified molecular differences between hepatic and non-hepatic metastases in colorectal cancer and evaluated their prognostic significance.

MATERIALS AND METHODS

We downloaded primary data from the NCBI Gene Expression Omnibus (GSE6988, GSE62321, GSE50760, and GSE28722). To identify the molecular differences, we used the Significance Analysis of Microarray method. We selected nine prognostic genes (SYTL2, PTPLAD1, CDS1, RNF138, PIGR, WDR78, MYO7B, TSPAN3, and ATP5F1) with hepatic metastasis prediction score in colorectal cancer (hereafter referred to as LASSO Score). We confirmed the prognostic significance of the LASSO Score by using Kaplan-Meier survival analysis, multivariate analysis, the time-dependent area under the curve (AUC) of Uno's C-index, and the AUC of the receiver operating characteristic curve at 1-5 years.

RESULTS

Survival analysis revealed that a high LASSO Score is associated with a poor prognosis in colorectal cancer patients with hepatic metastases (p = 0). Analysis of C-indices and AUC values from the receiver operating characteristic curve further supported this prediction by the LASSO Score. Multivariate analysis confirmed the prognostic significance of the LASSO Score (p = 1.13e-06).

CONCLUSIONS

This study reveals the biological mechanisms underlying hepatic metastases in colorectal cancer and will help in developing targeted therapies for colorectal cancer.

The Mars 2020 Engineering Cameras and Microphone on the Perseverance Rover: A Next-Generation Imaging System for Mars Exploration

The Mars 2020 Perseverance rover is equipped with a next-generation engineering camera imaging system that represents an upgrade over previous Mars rover missions. These upgrades will improve the operational capabilities of the rover with an emphasis on drive planning, robotic arm operation, instrument operations, sample caching activities, and documentation of key events during entry, descent, and landing (EDL). There are a total of 16 cameras in the Perseverance engineering imaging system, including 9 cameras for surface operations and 7 cameras for EDL documentation. There are 3 types of cameras designed for surface operations: Navigation cameras (Navcams, quantity 2), Hazard Avoidance Cameras (Hazcams, quantity 6), and Cachecam (quantity 1). The Navcams will acquire color stereo images of the surface with a 96 ∘ × 73 ∘ field of view at 0.33 mrad/pixel. The Hazcams will acquire color stereo images of the surface with a 136 ∘ × 102 ∘ at 0.46 mrad/pixel. The Cachecam, a new camera type, will acquire images of Martian material inside the sample tubes during caching operations at a spatial scale of 12.5 microns/pixel. There are 5 types of EDL documentation cameras: The Parachute Uplook Cameras (PUCs, quantity 3), the Descent stage Downlook Camera (DDC, quantity 1), the Rover Uplook Camera (RUC, quantity 1), the Rover Descent Camera (RDC, quantity 1), and the Lander Vision System (LVS) Camera (LCAM, quantity 1). The PUCs are mounted on the parachute support structure and will acquire video of the parachute deployment event as part of a system to characterize parachute performance. The DDC is attached to the descent stage and pointed downward, it will characterize vehicle dynamics by capturing video of the rover as it descends from the skycrane. The rover-mounted RUC, attached to the rover and looking upward, will capture similar video of the skycrane from the vantage point of the rover and will also acquire video of the descent stage flyaway event. The RDC, attached to the rover and looking downward, will document plume dynamics by imaging the Martian surface before, during, and after rover touchdown. The LCAM, mounted to the bottom of the rover chassis and pointed downward, will acquire 90 ∘ × 90 ∘ FOV images during the parachute descent phase of EDL as input to an onboard map localization by the Lander Vision System (LVS). The rover also carries a microphone, mounted externally on the rover chassis, to capture acoustic signatures during and after EDL. The Perseverance rover launched from Earth on July 30th, 2020, and touchdown on Mars is scheduled for February 18th, 2021.

Non-alcoholic fatty liver disease fibrosis score predicts cardiovascular mortality in post percutaneous coronary intervention patients: a 5-years results from observational registry

Background and aims

The nonalcoholic fatty liver disease fibrosis score (NFS) is comprised of metabolic risk indicators that may accurately predict residual cardiovascular risk in patients with CAD.

Method

This is a nested case control study of the post PCI registry from single tertiary hospital. Among 5589 patients who underwent PCI from 2010 through 2014, previously diagnosed 1510 NAFLD patients and 296 consecutive NAFLD patients who had undergone both PCI and ultrasonography of abdomen within 1 year between the tests were enrolled. (median age, 64y (IQR 55–73)). We applied the NFS to the patients at baseline, using validated NFS cut-offs and 201 patients with higher NFS, defined as NFS &gt;0.67 at PCI, were 1:1 matched with controls, based on propensity scores for higher NFS &gt;0.67.

Results

Higher NFS (NFS &gt;0.67) was more prevalent in patients with left ventricle (LV) dysfuction (LVEF at PCI &lt;40%) than in those without (81.0% vs 33.6%, p&lt;0.001). Baseline higher NFS was significantly associated with LV dysfunction (adjusted OR 1.86, 95% CI 1.36 to 2.55, p&lt;0.001), and baseline higher NFS and persistent higher NFS at 1 year after PCI were independent predictor of a 5-years CV death, after adjustment for LVEF (adjusted HR 1.42, 95% CI 1.03 to 1.95, p=0.023; adjusted HR 1.52, 95% CI 1.08 to 2.64, p=0.033).

Conclusion

With a longitudinal assessment of the association between NAFLD status by NFS and the risk of CV death, we found post-PCI patients with persistent higher NFS were at higher risk of CV death compared with those without.

KM rates of CV death according to NFS

Funding Acknowledgement

Type of funding source: None