Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis

Parathyroidectomy (PTX) is a mainstay of treating secondary hyperparathyroidism (SHPT) in patients with kidney failure in order to reduce the incidence of cardiovascular events (CVE), increase overall survival and improve quality of life. Perioperative hyperkalemia may lead to devastating cardiac complications. Distinct preoperative thresholds for serum potassium levels (SPL) were defined, but neither their usefulness nor consecutive risks are understood. This study compared the results and efficacy of different clinical procedures in preventing or treating perioperative hyperkalemia, including postoperative urgent hemodialysis (UHD). Methods: Patients from Charité-Universitätsmedizin Berlin and Rheinland Klinikum Lukaskrankenhaus, Neuss, undergoing PTX due to SHPT between 2008 and 2018 were analyzed retrospectively with regard to demographic parameters, surgery specific conditions and perioperative laboratory results. Comparisons of patient values from both centers with focus on perioperative hyperkalemia and the need for UHD were performed. Results: A total of 251 patients undergoing PTX for SHPT were included (Neuss: n = 121 (48%); Berlin: n = 130 (52%)). Perioperative hyperkalemia (SPL ≥ 5.5 mmol/L) was noted in 134 patients (53%). UHD on the day of surgery was performed especially in patients with intraoperative hyperkalemia, in females (n = 40 (16%) vs. n = 27 (11%); p = 0.023), in obese patients (n = 27 (40%) vs. n = 50 (28%), p = 0.040) and more often in patients treated in Neuss (n = 42 (35%) vs. 25 (19%); p = 0.006). For patients treated in Neuss, the intraoperative hyperkalemia cut-off level above 5.75 mmol/L was the most predictive factor for UHD (n = 30 (71%) vs. n = 8 (10%); p < 0.001). Concerning secondary effects of hyperkalemia or UHD, no patient died within the postoperative period, and only three patients suffered from acute CVE, with SPL > 5.5 mmol/L measured in only one patient. Conclusion: Perioperative values could not predict postoperative hyperkalemia with the need for UHD. Previously defined cut-off levels for SPL should be reconsidered, especially for patients undergoing PTX. Early postoperative dialysis in patients with postoperative hyperkalemia can be performed with a low risk for complications and may be indicated for all patients with increased perioperative SPL.

Assessing and improving the validity of COVID-19 autopsy studies - a multi center approach to establish essential standards for immunohistochemical and ultrastructural analyses

Background Autopsy studies have provided valuable insights into the pathophysiology of COVID-19. Controversies remain whether the clinical presentation is due to direct organ damage by SARS-CoV-2 or secondary effects, e.g. by an overshooting immune response. SARS-CoV-2 detection in tissues by RT-qPCR and immunohistochemistry (IHC) or electron microscopy (EM) can help answer these questions, but a comprehensive evaluation of these applications is missing. Methods We assessed publications using IHC and EM for SARS-CoV-2 detection in autopsy tissues. We systematically evaluated commercially available antibodies against the SARS-CoV-2 spike protein and nucleocapsid, dsRNA, and non-structural protein Nsp3 in cultured cell lines and COVID-19 autopsy tissues. In a multicenter study, we evaluated specificity, reproducibility, and inter-observer variability of SARS-CoV-2 nucleocapsid staining. We correlated RT-qPCR viral tissue loads with semiquantitative IHC scoring. We used qualitative and quantitative EM analyses to refine criteria for ultrastructural identification of SARS-CoV-2. Findings Publications show high variability in the detection and interpretation of SARS-CoV-2 abundance in autopsy tissues by IHC or EM. In our study, we show that IHC using antibodies against SARS-CoV-2 nucleocapsid yields the highest sensitivity and specificity. We found a positive correlation between presence of viral proteins by IHC and RT-qPCR-determined SARS-CoV-2 viral RNA load (r=-0.83, p-value <0.0001). For EM, we refined criteria for virus identification and also provide recommendations for optimized sampling and analysis. 116 of 122 publications misinterpret cellular structures as virus using EM or show only insufficient data. We provide publicly accessible digitized EM and IHC sections as a reference and for training purposes. Interpretation Since detection of SARS-CoV-2 in human autopsy tissues by IHC and EM is difficult and frequently incorrect, we propose criteria for a re-evaluation of available data and guidance for further investigations of direct organ effects by SARS-CoV-2.

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Vibrational Stark Fields in Carboxylic Acid Dimers

Carboxylic acids form exceptionally stable dimers and have been used to model proton and double proton transfer processes. The stabilization energies of the carboxylic acid dimers are very weakly dependent on the nature of the substitution. However, the electric field experienced by the OH group of a particular carboxylic acid is dependent more on the nature of the substitution on the dimer partner. In general, the electric field was higher when the partner was substituted with electron-donating group and lower with electron-withdrawing substituent on the partner. The Stark tuning rate (∆μ) of the O–H stretching vibrations calculated at the MP2/aug-cc-pVDZ level was found to be weakly dependent on the nature of substitution on the carboxylic acid. The average Stark tuning rate of O–H stretching vibrations of a particular carboxylic acid when paired with other acids was 5.7 cm–1 (MV cm–1)–1, while the corresponding average Stark tuning rate of the partner acids due to a particular carboxylic acid was 21.9 cm–1 (MV cm–1)–1. The difference in the Stark tuning rate is attributed to the primary and secondary effects of substitution on the carboxylic acid. The average Stark tuning rate for the anharmonic O–D frequency shifts is about 40-50% higher than the corresponding harmonic O–D frequency shifts calculated at B3LYP/aug-cc-pVDZ level, much greater than the typical scaling factors used, indicating the strong anharmonicity of O–H/O–D oscillators in carboxylic acid dimers. Finally, the linear correlation observed between pKa and the electric field was used to estimate the pKa of fluoroformic acid to be around 0.9.

Visual Simulation of Turbulent Foams by Incorporating the Angular Momentum of Foam Particles into the Projective Framework

In this paper, we propose an angular momentum-based advection technique that can express the turbulent foam effect. The motion of foam particles, which are strongly bound to the motion of the underlying fluid, is viscous, and sometimes clumping problems occur. This problem is a decisive factor that makes it difficult to express realistic foam effects. Since foam particles, which are secondary effects, depend on the motion of the underlying water, in order to exaggerate the foam effects or express more lively foam effects, it is inevitable to tune the motion of the underlying water and then readjust the foam particles. Because of such a cumbersome process, the readjustment of the foam effects requires a change in the motion of the underlying water, and it is not easy to produce such a scene because the water and foam effects must change at the same time. In this paper, we present a method to maintain angular momentum-based force from water particles without tuning the motion of the underlying water. We can restore the lost turbulent flow by additional advection of foam particles based on this force. In addition, our method can be integrated with screen-space projection frameworks, allowing us to fully embrace all the advantages of this approach. In this paper, the turbulence of the foam particles was improved by minimizing the viscous motion of the foam particles without tuning the motion of the underlying water, and as a result, lively foam effects can be expressed.

The Role of the Thoracic Spine during Breathing in Osteogenesis Imperfecta: A Combined Traditional Morphometry and 3D Geometric Morphometrics Research

OsteogenesisImperfecta (OI) is a rare disease with respiratory problems, which are usually attributed to the secondary effects of scoliosis and rib fractures and to severe restrictive pulmonary disease. Conventional morphometry has already been studied in OI patients but three-dimensional geometric morphometrics (3D GMM) has never been used to assess how the thoracic spine shape changes during maximal breathing. A total of 6 adult subjects with OI type III and 16 healthy controls underwent a spirometric study and two computed tomography scans in maximal inspiration and expiration. Shape data by means of 3D GMM and Cobb angle values of scoliosis and kyphosis were obtained and their relationship with spirometric values was analysed using regressions and mean shape comparisons. No differences in kyphosis (p = 0.285) and scoliosis Cobb values (p = 0.407) were found between inspiration and expiration in OI patients. The 3D GMM analysis revealed significant shape differences between OI and control subjects (p < 0.001) that were related to the inspiration (p = 0.030) and not to the expiration (p = 0.079). Nevertheless, no significant relation was found between thoracic spine shape, scoliosis, kyphosis and breathing outcomes in both OI patients and controls. There were thoracic spine shape differences during maximal breathing between OI patients and controls that were mainly related to the inspiration.

Prospective Interventional Non-Comparative Non-Randomized Clinical Study of A Topical Synergic Compound to Mitigate Presbyopia Effects

Purpose To assess the safety and efficacy of a novel compound with low -dose pilocarpine, brimonidine and oxymetazoline (PBO) in the near vision of a group of healthy presbyopic individuals. Design Prospective, consecutive, noncomparative, nonrandomized interventional study. Subjects Twenty-six healthy presbyopic patients presented from August to September 2021 to our clinic and were willing to participate in the study. Methods PBO compound was instilled in both eyes to assess its effect in near vision one hour after instillation.Main Outcome Measures Under corrected near visual acuity using the Jaeger notation, under corrected and corrected distance visual acuity, photopic and scotopic pupil diameter was registered before and one hour after instillation of the compound. Results Baseline binocular Jaeger notation was 5.86 +/-1.39 SD range (3-9). One hour after drop instillation, binocular Jaeger was 2.53 +/ 1.71 SD range (1 – 6) (p ≤ 0.0001) Lines gained 3.30 +/-1.40 SD range (0 – 6). Mean photopic pupilar diameter was 3.69 mm +/- 0.67 SD range (2.5 – 5 mm). Mean scotopic pupilar diameter was 4.61 mm +/- 0.78 SD range (3 – 6 mm). The mean photopic pupilar diameter was 2.27 mm +/-052 SD (1.5 – 3) (p ≤ 0.000). Scotopic pupilar diameter was 2.63 mm +/-0.53 SD range (2 – 3) (p ≤ 0.000). One patient reported no improvement in near vision. (3.8%). One patient reported dim vision rated 5 in a VAS (1 –10) (3.8%). Conclusion Low-dose pilocarpine, brimonidine, and oxymetazoline showed efficacy, improving near-distance vision one hour after instillation in a group of presbyopic patients, and safety showed few and transient secondary effects.

Secondary Effects of Body Dissatisfaction Interventions on Adolescent Depressive Symptoms: A Meta-Analysis

Objective: Depression is a leading cause of disability among adolescents, yet existing treatments are variably effective, suggesting needs to identify novel intervention targets. Body dissatisfaction (BD) may be a promising, but understudied, target: BD is common among adolescents; prospectively associated with future depression; and modifiable through intervention. BD interventions are typically evaluated in terms of impacts on eating disorders, but many trials also measure depression-related secondary outcomes. However, BD intervention effects on depression have not been systematically examined. We therefore conducted a meta-analysis to estimate secondary effects of BD interventions on depression symptoms and related outcomes in adolescents (ages 12-19). Method: Our systematic review included RCTs published between January 2006-December 2020. Across-group effect sizes were analyzed using robust variance estimation. Pre-registered methods, data, and analytic code are available at https://osf.io/734n8/. Results: The meta-analysis included thirteen RCTs, 50 effect sizes, and 6,962 participants. BD interventions led to significant post-intervention reductions in depression-related outcomes versus control conditions (g = -.19 at post-intervention, 95% CI -.07, -.31, p = .005). No evidence emerged for moderators of this meta-analytic effect. Discussion: Overall, BD-focused interventions significantly reduced adolescent depression, with mean post-intervention effect sizes comparable to those observed for interventions targeting depression explicitly. Results are bolstered by pre-registered methods and robustness checks. Limitations include a lack of data on participants’ sexual and gender identities and a significant risk of bias in the underlying literature. Future research on BD interventions should measure depression symptom severity as a secondary outcome.

Correlates of Resilience of Older People in Times of Crisis

Since the beginning of the Covid-19 pandemic, efforts have been made to shield older adults from exposure to the virus due to an age-related higher risk for severe health outcomes. While a reduction of in-person contacts was necessary in particular during the first months of the pandemic, concerns about the immediate and longer-term secondary effects of these measures on subjective well-being were raised. In the present study, we focused on self-reported resilience of older people in a longitudinal design to examine risk and protective factors in dealing with the restrictions. Data from independently living people aged 60+ in Luxembourg were collected via a telephone/online survey after the first lockdown in June (N = 611) and September/October 2020 (N = 523), just before the second pandemic wave made restrictions necessary again. Overall, results showed an increase in life-satisfaction from T1 to T2, although life-satisfaction was still rated slightly lower than before the crisis. Also, about a fifth of participants indicated at T2 difficulties to recover from the crisis. Participants who reported higher resilience to deal with the Covid-19 crisis at T2 showed higher self-efficacy, agreed more strongly with measures taken by the country and felt better informed about the virus. In contrast, participants who reported more difficulties in dealing with the pandemic, indicated reduced social contacts to family and friends at T2, and also felt lonelier. Results will be discussed applying a life-span developmental and systemic perspective on risk and protective factors in dealing with the secondary impacts of the pandemic.