Objectives
Chest CT has been widely used to screen and to evaluate the severity of COVID-19 disease in the early stages of infection without severe acute respiratory syndrome, but no prospective data ...are available to study the relationship between extent of lung damage and short-term mortality. The objective was to evaluate association between standardized simple visual lung damage CT score (vldCTs) at admission, which does not require any software, and 30-day mortality.
Methods
In a single-center prospective cohort of COVID-19 patients included during 4 weeks, the presence and extent of ground glass opacities(GGO), consolidation opacities, or both of them were visually assessed in each of the 5 lung lobes (score from 0 to 4 per lobe depending on the percentage and out of 20 per patient = vldCTs) after the first chest CT performed to detect COVID-19 pneumonia.
Results
Among 210 confirmed COVID-19 patients, the number of survivors and non-survivors was 162 (77%) and 48 (23%), respectively at 30 days. vldCTs was significantly higher in non-survivors, and the AUC of vldCTs to distinguish survivors and non-survivors was 0.72 (95%CI 0.628–0.807,
p
< 0.001); the best cut-off vldCTs value was 7. During follow-up, significant differences in discharges and 30-day mortality were observed between patients with vldCTs ≥ 7 versus vldCTs < 7: (98 85.2% vs 49 51.6%;
p
< 0.001 and 36 37.9% vs 12 12.4%;
p
< 0.001, respectively. The 30-day mortality increased if vldCTs ≥ 7 (HR, 3.16 (1.50–6.43);
p
= 0.001), independent of age, respiratory rate and oxygen saturation levels, and comorbidities at admission.
Conclusions
By using chest CT in COVID-19 patients, extensive lung damage can be visually assessed with a score related to 30-day mortality independent of conventional risk factors of the disease.
Key Points
• In non-selected COVID-19 patients included prospectively during 4 weeks, the extent of ground glass opacities(GGO) and consolidation opacities evaluated by a simple visual score was related to 30-day mortality independent of age, respiratory rate, oxygen saturation levels, comorbidities, and hs-troponin I level at admission.
• This severity score should be incorporated into risk stratification algorithms and in structured chest CT reports requiring a standardized reading by radiologists in case of COVID-19.
Studies have demonstrated that coronary artery calcification on one hand and non-alcoholic fatty liver disease (NAFLD) on the other hand are strongly associated with cardiovascular events. However, ...it remains unclear whether NAFLD biomarkers could help estimate cardiovascular risk in individuals with type 2 diabetes (T2D). The primary objective of the present study was to investigate whether the biomarkers of NAFLD included in the FibroMax® panels are associated with the degree of coronary artery calcification in patients with T2D.
A total of 157 and 460 patients with T2D were included from the DIACART and ACCoDiab cohorts, respectively. The coronary artery calcium score (CACS) was measured in both cohorts using computed tomography. FibroMax® panels (i.e., SteatoTest®, FibroTest®, NashTest®, and ActiTest®) were determined from blood samples as scores and stages in the DIACART cohort and as stages in the ACCoDiab cohort.
CACS significantly increased with the FibroTest® stages in both the DIACART and ACCoDiab cohorts (p-value for trend = 0.0009 and 0.0001, respectively). In DIACART, the FibroTest® score was positively correlated with CACS in univariate analysis (r = 0.293, p = 0.0002) and remained associated with CACS independently of the traditional cardiovascular risk factors included in the SCORE2-Diabetes model β = 941 ± 425 (estimate ± standard error), p = 0.028. In the ACCoDiab cohort, the FibroTest® F3-F4 stage was positively correlated with CACS in point-biserial analysis (r
= 0.104, p = 0.024) and remained associated with CACS after adjustment for the traditional cardiovascular risk factors included in the SCORE2-Diabetes model (β = 234 ± 97, p = 0.016). Finally, the prediction of CACS was improved by adding FibroTest® to the traditional cardiovascular risk factors included in the SCORE2-Diabetes model (goodness-of-fit of prediction models multiplied by 4.1 and 6.7 in the DIACART and ACCoDiab cohorts, respectively). In contrast, no significant relationship was found between FibroMax® panels other than FibroTest® and CACS in either cohort.
FibroTest® is independently and positively associated with the degree of coronary artery calcification in patients with T2D, suggesting that FibroTest® could be a relevant biomarker of coronary calcification and cardiovascular risk.
ClinicalTrials.gov identifiers NCT02431234 and NCT03920683.
Since 1994 the U.S. Global Drifter Program (GDP) and its international partners cooperating within the Data Buoy Cooperation Panel (DBCP) of the World Meteorological Organization (WMO) and the United ...Nations Education, Scientific and Cultural Organization (UNESCO) have been deploying drifters equipped with barometers primarily in the extratropical regions of the world’s oceans in support of operational weather forecasting. To date, the impact of the drifter data isolated from other sources has never been studied. This essay quantifies and discusses the effect and the impact of in situ sea level atmospheric pressure (SLP) data from the global drifter array on numerical weather prediction using observing system experiments and forecast sensitivity observation impact studies. The in situ drifter SLP observations are extremely valuable for anchoring the global surface pressure field and significantly contributing to accurate marine weather forecasts, especially in regions where no other in situ observations are available, for example, the Southern Ocean. Furthermore, the forecast sensitivity observation impact analysis indicates that the SLP drifter data are the most valuable per-observation contributor of the Global Observing System (GOS). All these results give evidence that surface pressure observations of drifting buoys are essential ingredients of the GOS and that their quantity, quality, and distribution should be preserved as much as possible in order to avoid any analysis and forecast degradations. The barometer upgrade program offered by the GDP, under which GDP-funded drifters can be equipped with partner-funded accurate air pressure sensors, is a practical example of how the DBCP collaboration is executed. Interested parties are encouraged to contact the GDP to discuss upgrade opportunities.
To investigate the mechanisms underlying the SARS-CoV-2 infection severity observed in patients with obesity, we performed a prospective study of 51 patients evaluating the impact of multiple immune ...parameters during 2 weeks after admission, on vital organs' functions according to body mass index (BMI) categories. High-dimensional flow cytometric characterization of immune cell subsets was performed at admission, 30 systemic cytokines/chemokines levels were sequentially measured, thirteen endothelial markers were determined at admission and at the zenith of the cytokines. Computed tomography scans on admission were quantified for lung damage and hepatic steatosis (n = 23). Abnormal BMI (> 25) observed in 72.6% of patients, was associated with a higher rate of intensive care unit hospitalization (p = 0.044). SARS-CoV-2 RNAaemia, peripheral immune cell subsets and cytokines/chemokines were similar among BMI groups. A significant association between inflammatory cytokines and liver, renal, and endothelial dysfunctions was observed only in patients with obesity (BMI > 30). In contrast, early signs of lung damage (ground-glass opacity) correlated with Th1/M1/inflammatory cytokines only in normal weight patients. Later lesions of pulmonary consolidation correlated with BMI but were independent of cytokine levels. Our study reveals distinct physiopathological mechanisms associated with SARS-CoV-2 infection in patients with obesity that may have important clinical implications.
Abstract
Background
COVID-19 diabetic adults are at increased risk of severe forms irrespective of obesity. In patients with type-II diabetes, fat distribution is characterized by visceral and ...ectopic adipose tissues expansion, resulting in systemic inflammation, which may play a role in driving the COVID-19 cytokine storm. Our aim was to determine if cardiac adipose tissue, combined to interleukin-6 levels, could predict adverse short-term outcomes, death and ICU requirement, in COVID-19 diabetic patients during the 21 days after admission.
Methods
Eighty one consecutive patients with type-II diabetes admitted for COVID-19 were included. Interleukin-6 measurement and chest computed tomography with total cardiac adipose tissue index (CATi) measurement were performed at admission. The primary outcome was death during the 21 days following admission while intensive care requirement with or without early death (ICU-R) defined the secondary endpoint. Associations of CATi and IL-6 and threshold values to predict the primary and secondary endpoints were determined.
Results
Of the enrolled patients (median age 66 years IQR: 59–74), 73% male, median body mass index (BMI) 27 kg/m
2
IQR: 24–31) 20 patients had died from COVID-19, 20 required intensive care and 41 were in conventional care at day 21 after admission. Increased CATi and IL-6 levels were both significantly related to increased early mortality (respectively OR = 6.15, p = 0.002; OR = 18.2,
p
< 0.0001) and ICU-R (respectively OR = 3.27,
p
= 0.01; OR = 4.86,
p
= 0.002). These associations remained significant independently of age, sex, BMI as well as troponin-T level and pulmonary lesion extension in CT. We combined CATi and IL-6 levels as a multiplicative interaction score (CATi*IL-6). The cut-point for this score was ≥ 6386 with a sensitivity of 0.90 and a specificity of 0.87 (AUC = 0.88) and an OR of 59.6 for early mortality (
p
< 0.0001).
Conclusions
Cardiac adipose tissue index and IL-6 determination at admission could help physicians to better identify diabetic patients with a potentially severe and lethal short term course irrespective of obesity. Diabetic patients with high CATi at admission,
a fortiori
associated with high IL-6 levels could be a relevant target population to promptly initiate anti-inflammatory therapies.
Patients with type 2-diabetes mellitus (T2D), are characterized by visceral and ectopic adipose tissue expansion, leading to systemic chronic low-grade inflammation. As visceral adiposity is ...associated with severe COVID-19 irrespective of obesity, we aimed to evaluate and compare the predictive value for early intensive care or death of three fat depots (cardiac, visceral and subcutaneous) using computed tomography (CT) at admission for COVID-19 in consecutive patients with and without T2D.
Two hundred and two patients admitted for COVID-19 were retrospectively included between February and June 2020 and distributed in two groups: T2D or non-diabetic controls. Chest CT with cardiac (CATi), visceral (VATi) and subcutaneous adipose tissue (SATi) volume measurements were performed at admission. The primary endpoint was a composite outcome criteria including death or ICU admission at day 21 after admission. Threshold values of adipose tissue components predicting adverse outcome were determined.
One hundred and eight controls median age: 76(IQR:59-83), 61% male, median BMI: 24(22-27) and ninety-four T2D patients median age: 70(IQR:61-77), 70% male, median BMI: 27(24-31), were enrolled in this study. At day 21 after admission, 42 patients (21%) had died from COVID-19, 48 (24%) required intensive care and 112 (55%) were admitted to a conventional care unit (CMU). In T2D, CATi was associated with early death or ICU independently from age, sex, BMI, dyslipidemia, CRP and coronary calcium (CAC). (p = 0.005). Concerning T2D patients, the cut-point for CATi was > 100 mL/m
with a sensitivity of 0.83 and a specificity of 0.50 (AUC = 0.67, p = 0.004) and an OR of 4.71 for early ICU admission or mortality (p = 0.002) in the fully adjusted model. Other adipose tissues SATi or VATi were not significantly associated with early adverse outcomes. In control patients, age and male sex (OR = 1.03, p = 0.04) were the only predictors of ICU or death.
Cardiac adipose tissue volume measured in CT at admission was independently predictive of early intensive care or death in T2D patients with COVID-19 but not in non-diabetics. Such automated CT measurement could be used in routine in diabetic patients presenting with moderate to severe COVID-19 illness to optimize individual management and prevent critical evolution.
Since OceanObs’09, the Global Ocean Observing System (GOOS) has evolved from its traditional focus on the ocean’s role in global climate. GOOS now also encompasses operational services and marine ...ecosystem health, from the open ocean into coastal environments where much of the world’s population resides. This has opened a field of opportunity for new collaborations—across regions, communities, and technologies—facilitating enhanced engagement in the global ocean observing enterprise to benefit all nations. Enhancement of collaboration is considered from the perspectives of regional alliances, global networks, national systems, in situ observing, remote sensing, oceanography, and meteorology. Reinvigoration of GOOS Regional Alliances has been important in connecting the power of this expanded remit to the needs of coastal populations and the capabilities of regional and national marine science communities. An assessment of progress is provided, including issues/challenges with the current structure, and opportunities to increase participation and impact. Meeting the expanded requirements of GOOS will entail new system networks. The Joint Technical Commission for Oceanography and Marine Meteorology Observations Coordination Group has been working with some communities to help assess readiness, including high frequency radars, ocean gliders, and animal tracking. Much more needs to be done, with a range of strategies considered. Other opportunities include partnering with programs such as the Global Ocean Acidification Observing Network, engaging with mature and emerging national ocean observing programs, and learning from multinational projects such as Tropical Pacific Observing System 2020 which are bringing renewed rigor to the design and operation of observing systems. Consideration is given to the expansion and advancement that is coming in both in situ and remote sensing ocean observation platforms over the next decade. In combination they provide the potential to measure new Essential Ocean Variables routinely at global scale. Opportunities provided by the World Meteorological Organization Integrated Global Observing System (WIGOS) in fostering a comprehensive and integrated approach across meteorology and oceanography are also considered. The focus of WIGOS on providing accurate, reliable and timely weather, climate, and related environmental observations and products sits well with the expanded requirements of GOOS, in climate, operational services, and marine ecosystem health.
The air-sea interface is a key gateway in the Earth system. It is where the atmosphere sets the ocean in motion, climate/weather relevant air-sea processes occur and pollutants (i.e., plastic, ...anthropogenic carbon dioxide, radioactive/chemical waste) enter the sea. Hence, accurate estimates and forecasts of physical and biogeochemical processes at this interface are critical for sustainable blue economy planning, growth and disaster mitigation. Such estimates and forecasts rely on accurate and integrated in-situ and satellite surface observations. High-impact uses of ocean-surface observations of Essential Ocean/Climate Variables (EOVs /ECVs) include 1) assimilation into/validation of weather, ocean and climate forecast models to improve their skill, impact and value; 2) ocean physics studies (i.e., heat, momentum, freshwater and biogeochemical air-sea fluxes) to further our understanding and parameterization of air-sea processes; and 3) calibration and validation of satellite ocean products (i.e., currents, temperature, salinity, sea level, ocean color, wind, waves). We review strengths and limitations, impacts, and sustainability of in-situ ocean surface observations of several ECVs and EOVs. We draw a 10-year vision of the global ocean-surface observing network for improved synergy and integration with other observing systems (e.g., satellites), modeling/forecast efforts and for a better ocean observing governance. The context is both the applications listed above and the guidelines of frameworks such as IOC-WMO-UNEP-ICSU GOOS, GCOS, and WIGOS. Networks of multiparametric platforms, such as the global drifter array, offer opportunities for new and improved in-situ observations. Advances in sensor technology (e.g., low-cost wave sensors), high throughput communications, evolving cyberinfrastructures and data information systems with potential to improve the scope, efficiency, integration and sustainability of the ocean surface observing system are explored.
Progress in best medical treatment have made identification of best candidates for carotid surgery more difficult. New diagnostic modalities could be helpful in this perspective. Microwaves (MWs) can ...quantify dielectric properties (complex relative permittivity) of biological tissues and MW technology has emerged as a promising field of research for distinguishing abnormal tissues from healthy ones. We here evaluated the ability of a dedicated MW sensor developed in our laboratory to identify vulnerable carotid lesions.
We included 50 carotid lesions in this study. The plaques were analyzed and classified preoperatively by ultrasound (US) examination, computed tomography angiography and tested postoperatively using a MW sensor. Histopathological analysis was used as a gold standard to separate vulnerable plaques (VPs) from nonvulnerable plaques (NVPs).
VPs were more frequently types 2 or 3 plaques (on US examination), had a greater proportion of low (<60 Hounsfield unit) and moderate (60-130 Hounsfield unit) attenuation components (computed tomography angiography) and displayed higher dielectric constant values (MW) than NVPs, which had an opposite profile. NVPs were more frequently asymptomatic plaques compared with VPs (P = .035). Multivariate analysis showed that US examination and MW identified VPs with a sensitivity of 77% and a specificity of 76% (cutoff value, –0.045; area under the curve, 0.848; P < .0001).
We found that the presence of types 2 to 3 (on US examination) and high dielectric constant plaques in vitro was highly indicative of a VP based on histological analysis. Further studies are needed to determine the potential of MW to identify the most dangerous asymptomatic carotid lesions.
Takotsubo syndrome is an acute cardiac condition involving sudden, transient apical ballooning of the left ventricle of the heart that may be triggered by emotional stress and some non-cardiac ...conditions. Its diagnosis is based on clinical presentation, electrocardiogram, cardiac imaging and biomarkers.
Here, we present a novel and original case report of a patient presenting very soon in the post-partum period with an unusual form of Takotsubo syndrome without clinical symptoms of cardiac disease and accompanied by HELLP syndrome. The overall dynamics of the changes in troponin I, troponin T and NT-proBNP levels after delivery were generally similar, but the amount of troponin I was much greater than that of troponin T and troponin I was already elevated before delivery. NT-proBNP levels peaked around the same time as the troponins and the peak concentration was within the same range as that of troponin I.
Our findings indicate that assaying circulating cardiac biomarkers, especially troponin I and NT-proBNP, may be a useful complement to non-invasive cardiac imaging including transthoracic echocardiography and cardiovascular magnetic resonance imaging, in the diagnosis of Takotsubo syndrome. They illustrate the importance of cardiac biomarkers in assisting diagnosis of this disease.
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