Anti-chemokine antibodies after SARS-CoV-2 infection correlate with favorable disease course

Infection by SARS-CoV-2 leads to diverse symptoms, which can persist for months beyond the acute phase of the disease. While antiviral antibodies are protective, the presence of antibodies against interferons and other immune factors is associated with adverse COVID-19 outcomes. Instead, we discovered that antibodies against specific chemokines are omnipresent after COVID-19, associated with favorable disease, and predictive of lack of long COVID symptoms at one year post infection. Autoantibody levels against some chemokines are sustained or even increasing over time. Anti-chemokine antibodies are present also in HIV-1 and autoimmune disorders, but they target different chemokines than those in COVID-19. Finally, monoclonal antibodies derived from COVID-19 convalescents that bind to the chemokine N-loop impair cell migration. Given the role of chemokines in orchestrating immune cell trafficking, naturally arising anti-chemokine antibodies that are associated with favorable COVID-19 may be beneficial through modulation of the inflammatory response and thus bear therapeutic potential.

DUV-LED packaging using high density TSV in silicon cavity and laser-glass-frit-bonded UV transmitting glass cap

This paper reports an improved deep ultraviolet LED (DUV-LED) packaging based on Si Micro-Electro-Mechanical Systems (MEMS) process technology. The Si package (Si-PKG) consists of a cavity formed by Si crystalline anisotropic wet etching and through-silicon vias (TSVs) filled with electroplated Cu. The Si-PKG is hermetically sealed by laser local heating of screen-printed glass frit. This technology allows for the use of a DUV-transparent glass substrate, which has an unmatched coefficient of thermal expansion (CTE). Using a high-density array of TSV capped with AuSn solder bumps, the cooling performance of the DUV-LED has been greatly improved. And the contribution by the Si (111) side reflection of Si-PKG to the total light output was confirmed 13 %. As a result, an optical output of 114 % (50 mW) and a volumetric light power density of 380 % (14 mW/mm3) were recorded compared with the conventional AlN-packaged device. The developed compact low-cost Si-PKG is promising for wider applications of the DUV-LED including the disinfection of the new coronaviruses. © 2022 Elsevier B.V.

Breaking out of the pandemic: How can firms match internal competence with external resources to shape operational resilience?

This study explores how firms sought to effectively match their internal competence with external resources from the supply chain network to improve operational resilience (OR) during the COVID-19 pandemic. Drawing upon matching theory, this study provides an internal-external matching perspective based on flexibility-stability features of OR to explain the operational mechanisms underlying the different matchings between internal flexibility (i.e., product diversity)/stability (i.e., operational efficiency) and external flexibility (i.e., structural holes)/stability (i.e., network centrality). We find that more heterogeneous matchings between internal (external) flexibility and external (internal) stability have a complementary effect that enhances OR, whereas more homogeneous matchings between internal flexibility (or stability) and external flexibility (or stability) have a substitutive effect that reduces OR. This study provides valuable contributions to research focusing on the supply chain, organizational resilience, and operations management.

Management of Advanced Heart Failure Patients with the Combined Use of CardioMEMS™ and Telehealth: A Single Center Experience in a Veteran's Affairs Population

Background: Due to the Coronavirus Disease of 2019 pandemic many clinics began to utilize virtual visits in lieu of traditional office visits. It is unclear what effect this will have on outcomes and admission rates for heart failure (HF). We describe our approach and outcomes in managing HF in a Veteran's Affairs population with previously implanted CardioMEMS™ during this time.Methods: Starting February 15th 2020, virtual visits were utilized in patients with CardioMEMS™ during which their symptoms were discussed and medications adjusted. Patients also received weekly phone calls to ensure that they had medications and to adjust diuretics based on pulmonary artery (PA) pressure readings. They received text message reminders if a reading was missed. A nurse was also tasked to follow up on lab results. Data was collected by reviewing the charts of CardioMEMS™ patients followed in our clinic by cardiology fellows and divided into pre pandemic period of July 1st 2018 to February 14th 2020 and a post pandemic period of February 15th 2020 to May 15th 2020. Data collected included baseline demographics, number of in-office and virtual visits, hospital admissions for HF, PA pressures, and compliance with CardioMEMS™ readings. Phone calls to adjust diuretics or review labs were not counted as virtual visits.Results: In the pre-pandemic period we identified 49 patients with prior CardioMEMS™;baseline demographics are shown in Table 1A. Table 1B shows our results comparing the pre pandemic and post pandemic periods when our telemedicine program was started. Although in the post pandemic period our encounter rate was lower, our virtual program was able to maintain stable PA pressures and a lower overall hospital admission rate. Compliance with CardioMEMS™ also increased though this was not statistically significant.Conclusion: Both CardioMEMS™ and virtual visits may be used effectively to maintain low PA pressures and reduce hospital admissions for in patients with chronic HF.

Left Ventricular Assist Device Implantation in a COVID-19 Positive Patient

Introduction Coronavirus disease-2019 (COVID) in patients with advanced heart failure presents unprecedented challenges in management of cardiogenic shock. Recommendations for perioperative triaging of cardiac surgery have been proposed but none regarding LVAD implantation. To our knowledge, we are the first to report on LVAD implantation in a patient with COVID and cardiogenic shock Case Report A 37-year-old-male with Stage D, NYHA class IV heart failure on chronic milrinone was admitted for cardiogenic shock. Despite uptitration of milrinone and addition of dobutamine,the patient remained in cardiogenic shock . Our Selection Committee discussed and approved him for an LVAD. Institutional protocol required COVID screening prior to surgery and returned positive. Given the absence of clinical signs of COVID infection contrasted with the severity of shock, the decision was made to proceed with implantation. Temporary mechanical support was considered but not thought to mitigate risks of thrombosis rather adding procedural risk with ECMO cannulation and left ventricular unloading. He successfully underwent LVAD implantation as INTERMACS 1. He required high doses of heparin to achieve ACT for cardiopulmonary bypass. On day 2, he developed left-sided weakness with imaging revealing multifocal acute cerebral infarcts. Despite normal LVAD function, the embolic infarcts to multiple organs led to further deterioration and death Summary LVAD implantation in COVID patients appears inevitable. Centers must risk stratify this cohort to reduce susceptibility to thrombosis and improve outcomes. We propose an algorithm that triages patients for elective and urgent LVAD implantation based on specific coagulation and inflammatory markers (figure 1) and have successfully implanted an LVAD in a COVID patient using this. We acknowledge this method has not been validated in a large cohort and are unable to recommend anticoagulation protocols. Further research is necessary to address safety of LVAD implantation in COVID patients

When Third Time's a Charm: Successful Outcome after Third Orthotopic Heart Transplantation

Introduction: Cardiac re-transplantation represents a small but growing proportion of total transplants being performed. Medical, ethical, moral and social dynamics continue to remain individualized and highly debated but more evolved with advancement in medicine for patients needing cardiac re-transplantation. We describe a case of a successful outcome in a patient requiring her third orthotopic heart transplant. Case: A 26 year old female with history of orthotopic heart transplant at age 11 for hypertrophic cardiomyopathy and subsequent re-transplantation for cardiac allograft vasculopathy (CAV) ten years later presented to our emergency room with cardiac arrest. Prior to the index hospitalization, the patient had an echocardiogram with a mildly reduced ejection fraction and an angiogram with chronic total occlusions of the right coronary artery and left circumflex artery with excellent collaterals and preserved cardiac output. Nuclear stress test showed no evidence of ischemia. Cardiac allograft vasculopathy prophylaxis with aspirin and pravastatin in addition to a triple regimen of immunosuppression of tacrolimus, sirolimus and mycophenolate mofetil were verified. The hospitalization was complicated by rapidly deteriorating biventricular function and three more episodes of cardiac arrest ultimately requiring extracorporeal membrane oxygenation (ECMO). Fortunately, the patient had negative HLAs with 0% CPRA and preserved end organ function. The selection committee thoughtfully considered her history of intermittent social marijuana use, active COVID 19 precautions in the hospital and a third sternotomy at such a young age, with likely need of possible 4th heart transplant in the future, but ultimately approved the patient for listing. Despite being Status 1, the patient had near daily loss of pulsatility for greater than 10-15 minutes which made us consider the possibility of total artificial heart. Fortunately, the patient received a local heart due to the COVID travel restrictions with total ischemic time of 98 minutes. She was induced with basiliximab and had negative retrospective and prospective crossmatches. There were no intra-op complications and post-op the patient had mild RV dysfunction requiring 4 days of inotropes. Patient was successfully discharged 9 days following her third OHT. Conclusion: Patients undergoing re-transplantation have overall poorer outcomes than those undergoing primary transplantation. Several factors influence these outcomes including timing from prior transplant, previous sternotomy, sensitization status, and renal dysfunction. With advances in medicine and pediatric patients living well into adulthood, there will be more patients requiring re-transplantation. As these trends emerge, individualized patient selection remains the key factor to improved outcomes. Our case presents an otherwise healthy young woman with graft failure without evidence of sensitization who underwent a successful third transplantation.