Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19

BackgroundThe impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19).ObjectiveTo evaluate the association between patient sociodemographics and neighborhood disadvantage with frequencies of death, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission in patients hospitalized with COVID-19.DesignRetrospective cohort study.SettingFour hospitals in an integrated health system serving southeast Michigan.ParticipantsAdult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction.Main MeasuresPatient sociodemographics, comorbidities, and clinical outcomes were collected. Neighborhood socioeconomic variables were obtained at the census tract level from the 2018 American Community Survey. Relationships between neighborhood median income and clinical outcomes were evaluated using multivariate logistic regression models, controlling for patient age, sex, race, Charlson Comorbidity Index, obesity, smoking status, and living environment.Key ResultsBlack patients lived in significantly poorer neighborhoods than White patients (median income: $34,758 (24,531–56,095) vs. $63,317 (49,850–85,776), p < 0.001) and were more likely to have Medicaid insurance (19.4% vs. 11.2%, p < 0.001). Patients from neighborhoods with lower median income were significantly more likely to require IMV (lowest quartile: 25.4%, highest quartile: 16.0%, p < 0.001) and ICU admission (35.2%, 19.9%, p < 0.001). After adjusting for age, sex, race, and comorbidities, higher neighborhood income ($10,000 increase) remained a significant negative predictor for IMV (OR: 0.95 (95% CI 0.91, 0.99), p = 0.02) and ICU admission (OR: 0.92 (95% CI 0.89, 0.96), p < 0.001).ConclusionsNeighborhood disadvantage, which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19. Measures of neighborhood disadvantage should be used to inform policies that aim to reduce COVID-19 disparities in the Black community.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06527-1.KEY WORDS: COVID-19, disparities, disadvantage, socioeconomic status, race     

The α chain of laminin-1 is independently secreted and drives secretion of its β- and γ-chain partners

A mammalian recombinant strategy was established to dissect rules of basement membrane laminin assembly and secretion. The α-, β-, and γ-chain subunits of laminin-1 were expressed in all combinations, transiently and/or stably, in a near-null background. In the absence of its normal partners, the α chain was secreted as intact protein and protein that had been cleaved in the coiled-coil domain. In contrast, the β and γ chains, expressed separately or together, remained intracellular with formation of ββ or βγ, but not γγ, disulfide-linked dimers. Secretion of the β and γ chains required simultaneous expression of all three chains and their assembly into αβγ heterotrimers. Epitope-tagged recombinant α subunit and recombinant laminin were affinity-purified from the conditioned medium of αγ and αβγ clones. Rotary-shadow electron microscopy revealed that the free α subunit is a linear structure containing N-terminal and included globules with a foreshortened long arm, while the trimeric species has the typical four-arm morphology of native laminin. We conclude that the α chain can be delivered to the extracellular environment as a single subunit, whereas the β and γ chains cannot, and that the α chain drives the secretion of the trimeric molecule. Such an α-chain-dependent mechanism could allow for the regulation of laminin export into a nascent basement membrane, and might serve an important role in controlling basement membrane formation.     

Correction: Click chemistry approaches to expand the repertoire of PEG-based fluorinated surfactants for droplet microfluidics

Correction for ‘Click chemistry approaches to expand the repertoire of PEG-based fluorinated surfactants for droplet microfluidics’ by Randall Scanga et al., RSC Adv., 2018, 8, 12960–12974.

The authors regret that during production of the published version of their article the bold formatting in the NMR data to indicate the nuclei of interest was lost. The correctly formatted Synthesis section of the Materials and methods is presented below.     

Controlling nanodomain morphology of epoxy thermosets templated by poly(caprolactone)-block-poly(dimethylsiloxane)-block-poly(caprolactone) ABA triblock copolymer

In this paper, triblock copolymer was incorporated into epoxy to prepare nano thermosets. After studying the compatibility between polydimethylsiloxane (PDMS), polycaprolactone (PCL) and bisphenol A epoxy resin (E-54), poly(caprolactone)–poly(dimethylsiloxane)–poly(caprolactone) (PCL-b-PDMS-b-PCL) triblock copolymer was incorporated into bisphenol A epoxy resin (E-54) and cured with DDS. A nano structure was formed and the size of the spherical phase became larger with increasing PCL-b-PDMS-b-PCL. According to the fact that TGDDM/PCL was compatible and TGDDM/PDMS was incompatible during the curing reaction, the mechanism of nano structure formation was self-assembly. The factors of influencing nano structure formation were discussed with regard to different curing temperatures and accelerators. Curing kinetics was utilized to study the effect of accelerator on nano structure formation.

FTIR spectrum of PDMS and PCL-b-PDMS-b-PCL triblock copolymer..     

What is the diagnostic accuracy of single nerve conduction studies and muscle ultrasound to identify critical illness polyneuromyopathy: a prospective cohort study

Background

Critical illness polyneuromyopathy (CIPNM) is a major cause of weakness in intensive care unit (ICU) patients, but current diagnostic tests are limited. We evaluated the generalizability and validity of single nerve conduction studies (NCS) and muscle ultrasound testing to identify CIPNM, and we also assessed the ability of muscle ultrasound to prognosticate patient outcomes.

Methods

This was a prospective cohort study of mechanically ventilated medical, cardiac, surgical, and neurosurgical ICU patients. We performed weekly strength testing, NCS, electromyography (EMG), and muscle ultrasound. We calculated the sensitivity, specificity, and other test characteristics of single NCS and muscle ultrasound, and we used multivariable regression models to assess the prognostic ability of muscle ultrasound.

Results

Ninety-five patients were enrolled. The incidence of probable CIPNM was 18% and did not differ significantly by type of ICU (p?=?0.49). For diagnosing probable CIPNM, the peroneal motor NCS had a sensitivity of 94% (95% confidence interval (CI) 71–100%) and specificity of 91% (95% CI 82–96%), the sural sensory NCS had a sensitivity of 100% (95% CI 80–100%) and specificity of 42% (95% CI 31–54%), and abnormal muscle ultrasound echogenicity had a sensitivity of 82% (95% CI 48–98%) and specificity of 57% (95% CI 43–70%). Abnormal echogenicity was associated with reduced likelihood of discharge to home (9% vs 50%, p?=?0.0001), fewer ICU-free days (median 3 (interquartile range 0–15) days vs 16 (9.3–19.3) days, p?=?0.0002), and increased ICU mortality (42% vs 12%, p?=?0.004).

Conclusions

In a diverse cohort of critically ill patients, single NCS and muscle ultrasound achieved diagnostic accuracy for patients at risk for CIPNM. The routine utilization of these tests could be beneficial for all critically ill patients at risk for CIPNM.

     

宫颈妊娠12例诊治分析

目的:探讨宫颈妊娠的诊断和治疗。方法:回顾性分析宜昌市第二人民医院收治的12例宫颈妊娠患者的临床资料。结果:12例患者中3例行B超检查,9例行彩色多普勒超声检查,10例患者行血清β-h CG检查。1例初诊被误诊为难免流产。10例患者中单纯手术治疗1例,9例行药物+手术治疗,2例行介入+手术治疗。除1例切除子宫外,其余11例治疗均成功保留子宫。结论:超声检查和血清β-h CG是宫颈妊娠的主要诊断方法,药物+手术以及介入+手术是治疗宫颈妊娠的有效方法,可保留患者生育功能。     

微肾镜联合大功率钬激光与大通道经皮肾镜取石术治疗老年复杂肾结石的疗效及安全性比较

目的:探讨微肾镜取石术(MPCNL)联合大功率钬激光与大通道经皮肾镜取石术(PCNL)治疗老年复杂肾结石的疗效及安全性,为老年复杂肾结石PCNL治疗通道的选择提供参考。方法:选择老年复杂肾结石患者92例,随机分为MPCNL组(n=47)和大通道组(n=45),MPCNL组采用MPCNL治疗,大通道组采用大通道PCNL治疗,比较两组手术时间、术中出血量、一次结石取净率、尿液转清时间、术后住院时间、并发症发生情况和肾功能恢复情况。结果:MPCNL手术时间长于大通道组,术中出血量、并发症发生率明显低于大通道组(P<0.05)。两组一次结石取净率差异无统计学意义(P>0.05),MPCNL组术后尿液转清时间、术后住院时间、肾造瘘管留置时间明显短于大通道组(P<0.05)。MPCNL组患者血肌酐水平于术后24 h达高峰,术后30 d恢复至术前水平;大通道组血肌酐水平术后48 h达高峰,术后30 d仍高于术前水平。MPCNL组血肌酐术后24 h、48 h、7 d、30 d均明显低于大通道组(P<0.05)。结论:MPCNL较大通道PCNL术中出血量、并发症明显减少,术后肾功能恢复更快,安全性更高,是老年复杂肾结石患者较适宜的一种术式。     

Do wave heights and water levels increase ocean lifeguard rescues?

Objective

To investigate the association of wave height and tidal water level changes with the frequency of ocean lifeguard rescues.

局部晚期鼻咽癌患者诱导化疗与IMRT同期化疗的远期疗效观察

目的:研究局部晚期鼻咽癌患者诱导化疗与IMRT同期化疗的远期疗效。方法:选择2008年1-12月我院接诊的130例局部晚期鼻咽癌患者进行研究。随机均分为观察组和对照组。观察组采用诱导化疗联合IMRT同期化疗对患者进行治疗,对照组采用IMRT同期化疗对患者进行治疗。治疗后,分析比较两组患者的不良反应、治疗失败情况及随访5年的远期生存情况。结果:两组患者的总生存率、无远处转移生存率、无复发生存率及无进展生存率无显著性差异(P>0.05);两组患者的急性和晚期不良反应无显著性差异(P>0.05);两组患者的治疗失败情况无显著性差异(P>0.05)。结论:对局部晚期鼻咽癌患者,与IMRT同期化疗相比,诱导化疗联合IMRT同步化疗并未明显改善患者预后。诱导化疗在局部晚期鼻咽癌同期放化疗中的作用仍需进一步研究。     

Validating the Psychometric Characteristics of the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) in a Chinese Context

Background

Perinatal posttraumatic stress disorder (PPTSD) is a common stress-induced mental disorder worldwide. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) is an excellent questionnaire that measures the symptoms of PPTSD, but has not been translated into Chinese yet.