ABSTRACT
Background: Lung transplantation (LTx) has been demonstrated to be a feasible therapy in patients with irreversible lung injury due to SARS-CoV-2. Aim of this retrospective study was to present our experience with LTx in SARS-CoV-2 patients. Method(s): Records of the 136 patients who underwent LTx between January 2021 and August 2022 at our institution were retrospectively reviewed. LTx was performed in SARS-CoV-2 patients who showed radiological evidence of irreversible lung failure, after failed attempts of weaning off mechanical ventilation (MV) and ECMO;showed single-organ dysfunction;were SARS-CoV-2 negative, preferably <65 years old and awake under MV and ECMO support. Graft survival was compared between COVID-19 LTx patients and contemporary patients transplanted for other indications. Median follow-up amounted to 7.6 (5.2-14.5) months. Result(s): Among the 79 patients with SARS-CoV-2 lung failure referred for LTx, 9 (11%) patients were listed, 8 of them being transplanted between January 2021 and August 2022. One patient died while on the waiting list. All were on MV and ECMO support (awake in 6 cases) for a median ECMO support time of 75 (38.5-152.8) days. Four (50%) patients were male and median age was 52 (37-57) years. All patients underwent bilateral LTx on ECMO support that was weaned off in all patients at the end of Tx. After LTx, 2 (25%) patients showed a primary graft dysfunction (PGD) score grade 3 at 72 hours and required reinstitution of veno-venous (n = 1) and veno-arterial (n = 1) ECMO support that was successfully weaned after 7 and 6 days, respectively. One patient (12.5%) required rethoracotomy for bleeding, and two (25%) patients required new hemodialysis treatment, with recovery of renal function in all patients. Median MV time amounted to 8 days (1-30), median intensive care unit stay to 19 (13-26) days, and median hospital stay to 91 (62-103) days. No patient died in-hospital. At 1-year follow-up, graft survival was 100% in SARS-CoV-2 LTx patients and 95% for patients (n = 128) transplanted for other indications (p = 0.539). Conclusion(s): Lung transplantation in highly selected SARS-CoV-2 patients yielded excellent posttransplant results. Graft survival was comparable between patients transplanted for SARS-COV-2 pneumonia and patients transplanted for other indications. A multidisciplinary approach is of paramount importance to successfully bridge these patients to transplantation and to guarantee a complete patient functional recovery after transplantation.
ABSTRACT
Patients with end-stage lung diseases on the MHH waiting list for lung transplantation (LTx) have been vaccinated against the SARS-CoV-2 spike protein with usually three doses of the mRNA vaccine. Hence, they are supposed to develop robust antibody and T cell responses when immunized prior to LTx without the influence of immunosuppression. Therefore, we hypothesized the induction of high spike-specific IgG levels and protection against SARS-CoV-2 infection and severe COVID-19. To proof this, we aimed to analyze the IgG levels specific for the spike S1-, RBD- and S2-domains in patients on a waiting list (WL-LTx) longitudinally before and after their transplantation. Plasma obtained pre (n=70) and post LTx (n=28) of WL-LTx patients was analyzed for spike-specific IgG by Luminex-based multiplex assays. The threshold for positivity was set separately for each spike domain based on the median MFI +2σ in a healthy, unexposed pre-pandemic control group. Patients with previous SARS-CoV-2-infection were excluded. 95.7% of WL-LTx patients had seroconverted for either RBD-, S1- or S2-specific IgG pre LTx and still 92.86% were positive post LTx. Overall, S1-, S2- and RBD-specific IgG MFI values did not significantly differ between pre vs. post LTx. A subanalysis of matched plasma samples (n=25) revealed that 52% of the WL-LTx patients showed a higher IgG response pre than post LTx for all three spike protein domains and 28% showed even elevated antibody levels post LTx. Interestingly, S2-specific IgG MFI values were significantly elevated compared to RBD-specific IgG MFI values, both pre (S2 vs. RBD p<0.0001) and post LTx (S2 vs. RBD p=0.0225). The majority of WL-LTx patients mounted high SARS-CoV-2 spike-specific IgG responses following vaccination pre LTx. Based on the more efficient antibody production against the S2-domain compared to RBD- and S1-domains, S2-specific IgG responses should be included also in the general evaluation of humoral immune responses to SARS-CoV-2. As expected, WL-LTx patients showed a superior antibody response to vaccination compared to LTx-recipients vaccinated only after LTx, which could even be maintained after LTx in some patients. Therefore, both patients on waiting list and LTx recipients may benefit from additional booster vaccinations after LTx. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Although chart rounds is an established quality assurance process, there remains minimal evidence on various forms of peer review, and some studies report relatively low error-detection rates. One question faced by both academic and community practices is whether to structure chart rounds as practice-site specific (PS) or disease-specific (DS). The global COVID pandemic may also offer new opportunities for structuring peer-review by enhancing virtual connectivity of people and practices. The purpose of this study was to determine if changes to treatment plans were recommended more often and assess perceptions following the transition to DS chart rounds. Data was prospectively collected for 6 months before and 6 months after transition to DS chart rounds at a multi-practice institution. Observed data included frequency of questions asked, educational remarks, and recommended changes to the presented plan or future patients. Time spent per case was recorded. Participants were not aware of data collection. Following 10 months of practicing DS chart rounds, a survey was distributed to faculty, dosimetrists, and trainees to assess perceptions of DS chart rounds. Two-tailed t-testing and chi-square testing were used to analyze the data. Criteria for statistical significance was p<0.05. The study was IRB-approved. Over 1 year, 1460 patients were peer reviewed;781 were reviewed by PS chart rounds and 679 by DS chart rounds. A question was asked more often in DS (49.3%) than PS (31.9%) chart rounds (p<0.001). A change to a presented plan was recommended more often in DS (4.9%) than PS (1.4%) chart rounds (p<0.001). A change was recommended for future patients more often in DS (4.4%) than PS (0.9%) chart rounds (p<0.001). An educational point was raised more often in DS (12.5%) than PS (9.3%) chart rounds (p=0.05). Time spent per case was more for DS (2.7 min) than PS (1.6 min) chart rounds (p<0.001). Overall, there were 35 survey respondents (54% response rate). Among attendings, the response rate was 74%. Of all respondents, 89% agreed DS chart rounds improve the quality of patient plans, 83% agreed DS chart rounds improve patient safety, 86% agreed DS chart rounds encourage more discussion, and 77% agreed DS chart rounds are more educational. Only 37% of respondents agreed DS chart rounds are more time efficient;however, 95% of attendings and 89% of all respondents favored continuing DS chart rounds;no respondents disagreed. Time efficiency was not associated with preference for continuing DS chart rounds (p=0.10). Favoring continuing DS chart rounds was associated with the belief that DS chart rounds improve patient safety (p<0.001), quality of patient plans (p<0.001), and education (p<0.001). DS chart rounds were associated with more discussion and recommended changes to treatment plans than PS chart rounds. Most respondents favored continuing DS chart rounds and reported that this format improved the quality of patient treatment plans and safety. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
The Undergraduate Student Instrumentation Project (USIP) was a NASA program created to engage undergraduate students in rigorous scientific research for the purposes of innovation and developing the next generation of professionals in space research. It is now run by the University of Houston using local resources. This student-led project, based on the 5E instructional model, is executed by the students from initial ideation of research objectives to the design, testing, and deployment of scientific payloads. The 5E Instructional model places the student at the center of knowledge building, while instructors facilitate interaction with content and guide the inquiry process. Since 2013, this project has been not only an effective vehicle for delivering STEM education but is also effective in increasing classroom engagement and interest in space. Space research is inherently interdisciplinary and crosscuts Geoscience, Engineering, and Technology. The project is designed to integrate engineering, technology, physics, material science, and earth and atmospheric sciences as an important opportunity for the students to gain access to cross-disciplinary experiential research. In addition to classroom engagement, the students build their own payloads and ground instruments. This project increases students’ command of essential skills such as teamwork, collaboration, problem solving, technology, communication, innovation, and leadership. For the faculty, the project was an extended exercise in professional development, learning how to implement project level inquiry-based education on this scale. For the students, this formative experience continues to encourage the development of a much broader range of technical skills than is typically offered within an undergraduate degree. Furthermore, the extensive time and energy that students commit to this project promotes a strong sense of personal and professional responsibility and emphasizes the necessity of coherent teamwork. Not only do students make valuable connections with each other during this process, but also to the broader space science community. They often work with professionals from outside of the USIP structure, and regularly attend and present at conferences and student competitions throughout the project. This paper will present a web-based scaffolding used to simulate the traditional face to face 5E experience during COVID. Student projects have included subjects ranging from atmospheric trace gas chemistry, LiDAR study of snow and sand avalanche dynamics, auroral electron precipitation, gravity wave modulation of the hydroxyl layer, search for stratospheric microplastics, and monitoring auroral radio emissions, among others. This program is a for-credit course of two to three years duration. Copyright © 2021 by the International Astronautical Federation (IAF). All rights reserved.