Contrast enhanced ultrasonography (CEUS) a novel tool to detect intestinal epithelial barrier dysfunction in severe COVID-19 disease

Ten patients with confirmed COVID-19 disease were studied. Nine patients required intensive care treatment, among them four needed extracorporeal membrane oxygenation (ECMO). Contrast enhanced ultrasonography (CEUS) was performed by one experienced investigator as a bolus injection of up to 2.4 ml of sulphur hexafluoride microbubbles via a central venous catheter. B-Mode evaluation and strain elastography showed mural edema of the small bowel with a thickness of up to 10 mm in all patients. We applied color coded Doppler sonography (CCDS) and power mode with flow-adapted parameters and early, dynamic capillary arterial contrast enhancement of bowel wall structures <10 s to assess perfusion of the small bowel. In all patients, reactive hyperemia was seen in the entire small bowel. In a subgroup of seven patients microbubbles translocated into the intestinal lumen. Thus, high-grade intestinal barrier disruption secondary to SARSCoV-2 infection can be postulated in these patients. This is the first description of perfusion changes and a disruption of the small bowel epithelial barrier in COVID-19 Patients using contrast ultrasonography and elastography.

Liver stiffness assessed by shear-wave elastography declines in parallel with immunoregulatory proteins in patients with chronic HCV infection during DAA therapy

BACKGROUND

A rapid decline of liver stiffness (LS) was detected by non-invasive methods in patients with chronic hepatitis C (HCV) infection during treatment with direct-acting antivirals (DAA).

OBJECTIVE

To investigate the influence of inflammation on LS.

METHODS

We prospectively examined LS by sonographic shear-wave elastography in 217 patients during DAA therapy from treatment initiation (BL) to 12 weeks after end of therapy (SVR12). Demographic data, laboratory findings and serum levels of cytokines were determined.

RESULTS

Values of LS decreased from 1.86 m/s to 1.68 m/s (p = 0.01) which was most pronounced in patients who had F4 fibrosis at BL (3.27 m/s to 2.37 m/s; p <  0.001). Initially elevated values of aminotransferases, ferritin, IgG (p <  0.001 each) and international normalized ratio (p <  0.003) declined, thrombocyte count (p = 0.007) increased. Correlations of these laboratory parameters with BL levels of LS measurement (LSM) were most apparent in patients with F1-F3 fibrosis. Tumor necrosis factor (TNF)-α (p = 0.031), interleukin (IL)-10 (p = 0.005) and interferon y inducible protein (IP)-10 (p <  0.001) decreased in parallel with LSM under DAA therapy and corelated with BL values.

CONCLUSION

Decrease of systemic inflammatory parameters correlated with LSM under DAA therapy. We conclude that regression of LSM is attributable to the decline of inflammation rather than reflecting fibrosis.

Interstitial lung opacities in patients with severe COVID-19 pneumonia by bedside high-resolution ultrasound in association to CO2 retention

BACKGROUND

Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS).

OBJECTIVE

This single centre cross-section study aimed to grade the severity of pneumonia by bed-side lung ultrasound (LUS).

METHODS

A scoring system discriminates 5 levels of lung opacities: A-lines (0 points),≥3 B-line (1 point), coalescent B-lines (2 points), marked pleural disruptions (3 points), consolidations (4 points). LUS (convex 1-5 MHz probe) was performed at 6 defined regions for each hemithorax either in supine or prone position. A lung aeration score (LAS, maximum 4 points) was allocated for each patient by calculating the arithmetic mean of the examined lung areas. Score levels were correlated with ventilation parameters and laboratory markers.

RESULTS

LAS of 20 patients with ARDS reached from 2.58 to 3.83 and was highest in the lateral right lobe (Mean 3.67). Ferritin levels (Mean 1885μg/l; r = 0.467; p = 0.051) showed moderate correlation in spearman roh calculation. PaCO2 level (Mean 46.75 mmHg; r = 0.632; p = 0.005) correlated significantly with LAS, while duration of ventilation, Horovitz index, CRP, LDH and IL-6 did not.

CONCUSIONS

The proposed LAS describes severity of lung opacities in COVID-19 patients and correlates with CO2 retention in patients with ARDS.

Safety of Direct-Acting Antiviral Therapy Regarding Renal Function in Post-Liver Transplant Patients Infected with Hepatitis C Virus and a 100% 12-Week Sustained Virologic Response-A Single-Center Study

BACKGROUND

Patients after liver transplantation (LT) with hepatitis C virus (HCV) infection often suffer from renal or hepatic impairment. Treating patients after LT with direct-acting antivirals (DAA) might result in decreasing renal function due to interaction of DAA and immunosuppressive therapy. In this single-center study we analyzed clinical parameters of 18 HCV-infected patients treated with DAA therapy after LT.

METHODS

The primary end points were change of renal function (glomerular filtration rate) and sustained virologic response 12 weeks after therapy (SVR12). For secondary end points, we investigated the influence of DAA therapy on transaminases, bilirubin, international normalized ratio, noninvasive fibrosis measurement, and Model for End-Stage Liver Disease (MELD) score.

RESULTS

Five out of 18 patients treated with DAA suffered from renal impairment stage 2, and 7 patients of renal impairment stage 3. Renal function at SVR12 was not influenced by preexisting renal impairment (P > .5), type of immunosuppressant (P > .5), or type of DAA regimen (P > .5). All patients reached SVR12. The levels of transaminases and bilirubin declined rapidly, as expected. Ten out of 18 patients already suffered from cirrhosis or liver fibrosis >F3 according to noninvasive measurement before initiation of treatment. Single-point acoustic radiation force impulse imaging improved in 9 patients (P = .012). In 7 patients, MELD score improved owing to the decrease of bilirubin levels. In 6 patients it worsened.

CONCLUSIONS

DAA therapy in LT patients was effective and safe in this single-center real-life cohort. Renal function was not influenced by the administered drug combinations, even in patients with preexisting renal impairment.

Repulsion Phenomena in Thin Layers of Alcoholic Solutions of Tetrabutylammonium Iodide

The structural disjoining pressure of methyl-, ethyl-, n-propyl, and n-butyl alcohol was deter-mined in thin layers between highly smooth rutile surfaces when tetrabutylammonium iodide was added. The a verage thickness of the oriented solvation layers per interface turned out to be largest for methyl alcohol (about 1.5 nm) and decreases like the disjoining pressure when passing to the related alcohols with longer chain lengths. Tetrabutylammonium iodide clearly reduces the thickness of the boundary layer with increasing concentration.

Complementary characterization of a hyaluronic acid splitting enzyme from Streptococcus agalactiae

A hyaluronic acid splitting enzyme of Streptococcus agalactiae was characterized by splitting mechanism, Michaelis-constant and inhibition type for sulfated hyaluronic acid: The enzyme splits hyaluronic acid as a hyaluronate lyase [EC 4.2.2.1]. The Km = 8 x 10(-4) mg ml-1 was determined with the influence of substrate inhibition constant Kiu = 2 x 10(-6) mg ml-1. Sulfated hyaluronic acid inhibits the enzyme in a partially non-competitive way. The inhibition constant is Ki = 5.47 x 10(-4) mg ml-1. The GBS-hyaluronate lyase cleaves hyaluronic acid as an endoglycosidase. The work is related with the intention to establish a hyaluronate lyase of microbial origin as a therapeutical enzyme replacing bovine hyaluronidase.

Thermodynamic Investigations of Thin Liquid Layers Between Solid Surfaces III. Benzene Between Differently Polar Fused Silica Surfaces

Former measurements showed that benzene exhibits a disjoining pressure in extremely thin layers between fused silica plates in a temperature range just above the melting point. An extended theory for evaluating the disjoining pressure and various thermodynamic quantities of the liquid surface zone which displays a molecular long range orientation leads to results which indicate a small structural transition range at about 12 - 13 °C in bulk benzene. The splitting effect is more pronounced in layers adjacent to fully hydroxylated surfaces since in this case the benzene mole­cules in the first adsorbed layer are more tightly bound than in the case of surfaces entirely free from hydroxyl groups.

Viskositätsanomalien in Flüssigkeitsgrenzzonen. I. Zur hydrodynamischen Theorie zweier in Flüssigkeit gegeneinander bewegter, verschieden geformter Festkörperflächen

Starting from a hydrodynamic basic equation given by Reynolds a relation is derived which describes the kinetics of the approach of a spherically formed and a plane solid plate in a liquid with a viscosity coefficient η under the action of a force K.

Liquids which show a molecular long range orientation up to a distance of about 10-5 cm in the immediate neighbourhood of a solid surface have an enhanced viscosity coefficient in this surface zone as some authors found by determining the flux emitted from very thin capillaries. The problem of the kinetics of two differently formed solid plates approaching to extremely small distances is solved for this case.