Long-term corticosteroid therapy for patients with severe coronavirus disease 2019 (COVID-19)

Summaryearlier and longer corticosteroid therapy with methylprednisolone could reduce the mortality and/or rate of ICU admission by 26% in patients with severe COVID-19, hospitalized in conventional medical ward.BackgroundLow dose of dexamethasone reduced mortality in hospitalized COVID-19 patients who required respiratory support. Less is known about the efficacy of other corticosteroids in severe COVID-19 patients. This study was designed to determine if longer and earlier corticoid therapy in severe COVID-19 patients is associated with reduced mortality and/or reduced rate of ICU admission for worsening of respiratory state.MethodsWe performed a retrospective study with patients aged ≥ 18 years, with epidemiological and/or radiological suspected COVID-19, hospitalized in a regional hospital GHRMSA Mulhouse, France. Twenty-three patients received methylprednisolone (MP) as compassionate use, 1 mg/kg/day for seven days followed by prednisolone at a gradually reduced dosage, for 4 to 6 weeks. MP was started one week after COVID-19 symptoms first appeared. The primary composite outcome was mortality and/or ICU admission during hospitalisation.ResultsBetween March 14th to June 5th 2020, 255 patients were screened, 181 were included, and 92 were analysed, 23 patients treated with MP and 69 received standard care. SARS-CoV2 infection was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) in 82.3%. The overall composite outcome was higher in the control group: 42/69 patients (60.9%) versus 8/23 (34.8%) in the interventional group (p= 0.018). The correction of lymphopenia between days 1 to 7 was associated with better outcome (p=0.006).ConclusionThese results suggest that earlier and longer corticosteroid therapy with methylprednisolone could reduce the mortality and/or rate of ICU admission in patients with severe COVID-19, hospitalized in conventional medical ward.

Multiprofessional perinatal care in a pregnant patient with acute respiratory distress syndrome due to COVID-19

Background The coronavirus disease (COVID-19) pandemic has caused ongoing challenges in health services worldwide. Despite the growing body of literature on COVID-19, reports on perinatal care in COVID-19 cases are limited. Case presentation We describe a case of severe acute respiratory distress syndrome (ARDS) in a 36-year-old G5/P2 pregnant woman with morbid obesity, confirmed severe acute respiratory syndrome coronavirus 2 infection, and fulminant respiratory failure. At 28+ 1 gestational weeks, the patient delivered an uninfected newborn. Using ImmunoCAP ISAC® technology, we found no immunoglobulin (Ig) M antibodies, suggesting that no mother-to-child viral transmission occurred during pregnancy or delivery. The maternal respiratory state improved rapidly after delivery; both maternal and neonatal outcomes were encouraging given the early gestational age and fulminant course of respiratory failure in our patient. Conclusions The management of ARDS in pregnant women with COVID-19 is complex and requires an individualized, multidisciplinary approach, while considering maternal and fetal outcomes.

A Robust 4D Treatment Planning Approach For Lung Radiotherapy

4D treatment plans are optimized to compensates for a patient's individual respiratory motion. However, changes in the time spent in the each respiratory state may render a 4D plan invalid. We introduced and evaluate two robust treatment planning approaches to compensate for respiratory motion variations. Robust 4D plans can be designed either using an average pdf approach or a worst case pdf approach. We tested these approaches on two motion variation scenarios and compared them with nominal 4D optimization and ITV plans. The nominal 4D plans were very sensitive to the variation in respiration pattern while the average pdf and worst case pdf plans were less sensitive under the similar variations. The average and worst case pdf plans were not as robust as the ITV plans but had better healthy tissue sparing. The worst case pdf approach was found to be the most promising for robust 4D plan optimization.

A Robust 4D Treatment Planning Approach For Lung Radiotherapy

4D treatment plans are optimized to compensates for a patient's individual respiratory motion. However, changes in the time spent in the each respiratory state may render a 4D plan invalid. We introduced and evaluate two robust treatment planning approaches to compensate for respiratory motion variations. Robust 4D plans can be designed either using an average pdf approach or a worst case pdf approach. We tested these approaches on two motion variation scenarios and compared them with nominal 4D optimization and ITV plans. The nominal 4D plans were very sensitive to the variation in respiration pattern while the average pdf and worst case pdf plans were less sensitive under the similar variations. The average and worst case pdf plans were not as robust as the ITV plans but had better healthy tissue sparing. The worst case pdf approach was found to be the most promising for robust 4D plan optimization.

The influence of the respiratory cycle on reaction times in sensory-cognitive paradigms

Behavioural and electrophysiological studies point to widespread influence of the state of respiration on brain activity and cognitive performance. Still, the prevalence and relevance of such respiratory-behavioural relations in typical sensory-cognitive tasks remain unclear. We here used a battery of six tasks probing sensory detection, discrimination and short-term memory to address the questions of whether and by how much behaviour covaries with the respiratory cycle. Our results show that participants tended to align their respiratory cycle to the experimental paradigm. Furthermore, their reaction times, but not so much their response accuracy, consistently and significantly covaried with the respiratory cycle, and this effect was strongest when analyzed contingent on the respiratory state at participants' responses. The respective effect sizes where comparable to those seen in many typical neurocognitive experimental manipulations. These results support a prominent relation between respiration and sensory-cognitive function and suggest that sensation is intricately linked to rhythmic bodily or interoceptive functions.

The Analysis of How Apnea Influences the Autonomic Nervous System Using Short-Term Heart Rate Variability Indices

Objective. Frequent cessations of respiration can greatly increase the prevalence rate of arrhythmia. It has been confirmed that cardiac modulation is regulated by the autonomic nervous system (ANS). And heart rate variability (HRV) is widely used as a method to evaluate the function of the ANS. Therefore, we analyzed whether apnea can affect the balance and normal function of the ANS using short-term HRV indices. Methods. Forty-five healthy subjects were asked to breathe normally and hold their breathing to simulate 10 times apnea. Thirty-six patients from the dataset of a sleep laboratory for the diagnosis of sleep disorders with 10 times apnea were included in analysis. We calculated short-term HRV indices of subjects in normal respiratory and apneic states, respectively. Results. Compared with the normal respiratory state, respiration cease would lead to the values of Mean-RR, nLF, LF/HF, and α1 which significantly increased, whereas the values of rMSSD and nHF significantly decreased. Conclusions. Cessations of respiration would lead to an imbalance in the function of the ANS, as well as an increase in fractal characteristics of the heart. These changes in the physiological state are likely to induce and cause the occurrence of arrhythmia, which is regulated by the ANS.

High-Resolution Respirometry Reveals MPP+ Mitochondrial Toxicity Mechanism in a Cellular Model of Parkinson’s Disease

MPP+ is the active metabolite of MPTP, a molecule structurally similar to the herbicide Paraquat, known to injure the dopaminergic neurons of the nigrostriatal system in Parkinson’s disease models. Within the cells, MPP+ accumulates in mitochondria where it inhibits complex I of the electron transport chain, resulting in ATP depletion and neuronal impairment/death. So far, MPP+ is recognized as a valuable tool to mimic dopaminergic degeneration in various cell lines. However, despite a large number of studies, a detailed characterization of mitochondrial respiration in neuronal cells upon MPP+ treatment is still missing. By using high-resolution respirometry, we deeply investigated oxygen consumption related to each respiratory state in differentiated neuroblastoma cells exposed to the neurotoxin. Our results indicated the presence of extended mitochondrial damage at the inner membrane level, supported by increased LEAK respiration, and a drastic drop in oxygen flow devoted to ADP phosphorylation in respirometry measurements. Furthermore, prior to complex I inhibition, an enhancement of complex II activity was observed, suggesting the occurrence of some compensatory effect. Overall our findings provide a mechanistic insight on the mitochondrial toxicity mediated by MPP+, relevant for the standardization of studies that employ this neurotoxin as a disease model.

New acute respiratory management in tracheal rupture caused by chest trauma

We report a case who is a 33-year-old man admitted to our Emergency room for chest trauma caused by the factory’s mechanical arm. Despite the endotracheal tube, the patient’s respiratory state was poor and the oxygen saturation did not improve and the subcutaneous emphysema progressed. To improve distressed breathing, we first proposed the concept “mechanical ventilation with dual ventilator” to maintain oxygen saturation of the patient. This is, to our knowledge, the first report of using a special mechanical ventilation method in emergency surgery.

Evaluation of Autonomic Nervous System Changes Using Short-term Heart Rate Variability During Apnea

Background: Frequent cessations of respiration can greatly increase the prevalence rate of arrhythmia. It has been confirmed that cardiac activity is regulated by autonomic nervous system (ANS). And heart rate variability (HRV) is widely used as a method to evaluate the function of ANS. Therefore, we analyzed whether apnea can affect the balance and normal function of ANS using short-term HRV indices. Methods: Forty-five healthy subjects were asked to breathe normally and hold their breathing to simulate 10 times apnea. Thirty-six patients from the dataset of a sleep laboratory for the diagnosis of sleep disorders with 10 times apnea were included in analysis. We calculated short-term HRV indices of subjects in normal respiratory and apneic states, respectively. Results: Compared with normal respiratory state, respiration cease would lead to the values of the mean-RR, nLF, LF/HF, and α1 were significantly increase whereas the values of rMSSD and nHF were significantly decrease. Conclusions: Cessations of respiration would lead to an imbalance in function of ANS, as well as an increase in fractal characteristics of the heart. These changes in physiological state are likely to induce and cause the occurrence of arrhythmia, which is regulated by ANS.