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1.
Optics in Health Care and Biomedical Optics XI 2021 ; 11900, 2021.
Article in English | Scopus | ID: covidwho-1621985

ABSTRACT

Acquisition of the genes encoding variable regions of paired heavy and light chains (VH:VL) is crucial, but it is a labor and cost-intensive process in traditional methods. This study presents a novel method in which all processing steps for acquiring natively paired VH:VL genes from single cells are finished in a single microfluidic chip. The microfluidic chip performs single-cell trap/in situ fluorescent examination of antibody specificity/cell lysis/gene amplification all at single-cell level. By a proof-of-concept validation of efficiently acquiring paired VH:VL genes of anti-RBD (which is a key protein of SARS-CoV-2 virus) mAbs from single hybridomas, the microfluidic chip has been proved capable of remarkably improving cell loss/human labor/time cost, and more importantly, determinacy of native VH:VL genes pairing which is one of the most decisive factors of effectiveness for antibody discovery. © 2021 SPIE.

2.
American Journal of Translational Research ; 13(12):13811-13814, 2021.
Article in English | EMBASE | ID: covidwho-1615384

ABSTRACT

Consensus guidelines to protect airway managers during COVID-19 were developed to encourage safe, accurate and swift performance in intubation and extubation, but reintubation was not considered. With the massive surge of patients requiring mechanical ventilation in this COVID-19 pandemic, great incidence of difficult airways may necessitate reintubation. Equipments could be used now in extubation and reintubation are either too expensive and time-consuming in decontamination, or have not gained wide acceptance. Here, we adapted an extubation device from an intubating stylet, which is provided as accessory of endotracheal tube. Such stylet could provide safe access for expediting reintubation both during and after the COVID-19 pandemic, which is inexpensive, single-use, readily available, straightforward to handle, and well-tolerated, thereby benefiting both the patients and healthcare providers.

3.
American Journal of Translational Research ; 13(12):14157-14167, 2021.
Article in English | EMBASE | ID: covidwho-1610152

ABSTRACT

Background: Previous studies have unveiled the occurrence of re-detectable positive (RP) RNA test result after hospital discharge among recovered COVID-19 patients, but the clinical characteristics of RP patients (RP patients) and the potential features affecting RP RNA test outcome remain unclear. Methods: A total of 742 COVID-19 patients discharged between March 1st, 2020 and March 20th, 2020 were enrolled. All patients were followed-up for SARS-CoV-2 RNA test and RP patents were identified. The clinical characteristics between RP patients and NRP patients were compared, and the potential features affecting re-detectable RNA test outcome were further evaluated. Results: Up to April 9th, 2020, 60 recovered patients (8.09%) had been re-detected to be SARS-CoV-2 RNA positive. Among those 60 RP patients, the median RP time was 12 days from the last negative result of SARS-CoV-2 RNA test or 10 days from hospital discharge. RP patients were prone to be older, having mild/moderate conditions, unilateral lung involvement and fatigue, chills, stuffy or runny nose, with high lymphocyte count. Multivariate logistic analysis and COX regression analysis demonstrated that age, lymphocyte count, urea nitrogen, stuffy or runny nose as well as lung involvement were independently associated with RP RNA test (P<0.05). Conclusions: Older patients accompanied with stuffy or runny nose, low urea nitrogen as well as unilateral lung involvement were more likely to develop RP RNA test result after hospital discharge. Therefore, we strongly suggest using broncho-alveolar lavage fluid for RNA detection, extending quarantine time, and conducting continual follow-up medical examination for those discharged patients.

4.
Gastroenterology ; 160(6):S-430, 2021.
Article in English | EMBASE | ID: covidwho-1594492

ABSTRACT

Background and Aims: In addition to pulmonary and thrombotic sequalae, gastrointestinal (GI) manifestations of COVID-19 are common. Although enterocytes express ACE2 and TMPRSS2, the proteins that determine SARS-CoV-2 tropism, prior studies have suggested that the virus is inactivated by gastric acid and other luminal fluids as it transits the gastrointestinal tract. However, we reason here that individuals with intestinal metaplasia of the esophagus and stomach might have ectopic, proximal SARS-CoV-2 receptor expression that would predispose them to infection from ingested oral secretions or respiratory sputum. Methods: Histology, immunohistochemistry, and immunofluorescence were performed on human tissue and organoid cultures derived from biopsied human Barrett’s esophagus. Organoid cultures were infected with a chimeric virus expressing the SARS-CoV-2 spike protein (rVSV-eGFP-SARS-CoV-2). Both fixed and live cells were imaged by light, epifluorescence, and live confocal microscopy. Results: Unlike normal esophagus and stomach, Barrett’s esophagus and gastric intestinal metaplasia both strongly express apical ACE2 and TMPRSS2 at the protein level. Organoids derived from Barrett’s esophagus are readily infected by the chimeric rVSV-eGFP-SARSCoV- 2 virus as demonstrated by the GFP fluorescence observed in both epifluorescence as well as three-dimensional, time-lapse confocal imaging of live infected organoids. We observed that fluorescence persisted for greater than 2 weeks in culture suggesting ongoing viral infection and intestinal identity correlated with increased viral entry. Conclusions: SARS-CoV-2 has a previously undescribed tropism for Barrett’s esophagus and gastric intestinal metaplasia, placing these individuals at higher risk of infection via the orogastric route.

5.
Discovery Medicine ; 31(163):79-87, 2021.
Article in English | MEDLINE | ID: covidwho-1589658

ABSTRACT

OBJECTIVE: We aimed to compare the dynamic differences of immunological parameters between severe and non-severe COVID-19 patients. METHODS: The cytokine profiles and lymphocyte subsets of 664 patients with COVID-19 (31 severe cases and 633 non-severe cases) were longitudinally analyzed. RESULTS: Compared with non-severe cases, severe cases had a higher age (64 vs. 40 years, p<0.001), more common comorbidity (74.2% vs. 20.5%, p<0.001), and lymphopenia (0.7 vs. 1.4x109/L, p<0.001). Severe cases had markedly higher levels of IL-6, IL-8, and IL-10 from baseline to 35 days after admission than non-severe cases (p<0.001). No significant differences were observed in the dynamic levels of IL-1beta, IL-2, IL-4, IL-5, IL-12, IL-17, TNF-alpha, IFN-alpha, and IFN-gamma between severe and non-severe COVID-19 patients (p>0.05). The absolute counts of lymphocytes, CD3+ T cells, CD4+ T cells, CD8+ T cells, and CD45+ T cells were markedly lower in severe patients with COVID-19 compared with those in non-severe patients from baseline to 35 days after admission (p<0.001). No significant differences were observed in the dynamic levels of white cells count, CD19+ B cells count, and NK cells count between severe and non-severe COVID-19 patients (p>0.05). The decrease of T lymphocyte subsets reached its peak at day 1 to 3 after admission, and they gradually increased in the non-severe group, but sustained at low levels in the severe group at day 4 to 35 after admission. CONCLUSION: The dynamic changes of cytokine profiles and T lymphocyte subsets are related with the severity of COVID-19.

6.
European Review for Medical and Pharmacological Sciences ; 25(23):7585-7597, 2021.
Article in English | Web of Science | ID: covidwho-1576100

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) spread around the world in 2020. Abnormal pulmonary function and residual CT abnormalities were observed in COVID-19 patients during recovery. Appropriate rehabilitation training is around the corner. The correlation between spirometric impairment and residual CT abnormality remains largely unknown. PATIENTS AND METHODS: A cross-sectional study conducted on the pulmonary function of 101 convalescent COVID-19 patients before discharge. Multivariate analysis was used to establish a scoring system to evaluate the spirometric abnormality based on residual chest CT. RESULTS: Lung consolidation area >25% and severe-type COVID-19 were two independent risk factors for severe pulmonary dysfunction. Besides, a scoring system was established. People scoring more than 12 points have more chances (17 times) to get severe pulmonary function impairment before discharge. CONCLUSIONS: For the first time, a chest CT characteristics-based grading system was suggested to predict the pulmonary dysfunction of COVID-19 patients during convalescence in this study. This study may provide suggestions for pulmonary rehabilitation.

7.
Ieee Internet of Things Journal ; 8(21):15965-15976, 2021.
Article in English | Web of Science | ID: covidwho-1570216

ABSTRACT

This article presents a novel extended reality (XR) and deep-learning-based Internet-of-Medical-Things (IoMT) solution for the COVID-19 telemedicine diagnostic, which systematically combines virtual reality/augmented reality (AR) remote surgical plan/rehearse hardware, customized 5G cloud computing and deep learning algorithms to provide real-time COVID-19 treatment scheme clues. Compared to existing perception therapy techniques, our new technique can significantly improve performance and security. The system collected 25 clinic data from the 347 positive and 2270 negative COVID-19 patients in the Red Zone by 5G transmission. After that, a novel auxiliary classifier generative adversarial network-based intelligent prediction algorithm is conducted to train the new COVID-19 prediction model. Furthermore, The Copycat network is employed for the model stealing and attack for the IoMT to improve the security performance. To simplify the user interface and achieve an excellent user experience, we combined the Red Zone's guiding images with the Green Zone's view through the AR navigate clue by using 5G. The XR surgical plan/rehearse framework is designed, including all COVID-19 surgical requisite details that were developed with a real-time response guaranteed. The accuracy, recall, F-1-score, and area under the ROC curve (AUC) area of our new IoMT were 0.92, 0.98, 0.95, and 0.98, respectively, which outperforms the existing perception techniques with significantly higher accuracy performance. The model stealing also has excellent performance, with the AUC area of 0.90 in Copycat slightly lower than the original model. This study suggests a new framework in the COVID-19 diagnostic integration and opens the new research about the integration of XR and deep learning for IoMT implementation.

8.
Antiviral Research ; 196:9, 2021.
Article in English | Web of Science | ID: covidwho-1559093

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent of Coronavirus Disease 2019 (COVID-19) pandemic. Despite intensive and global efforts to discover and develop novel antiviral therapies, only Remdesivir has been approved as a treatment for COVID-19. Therefore, effective antiviral therapeutics are still urgently needed to combat and halt the pandemic. Viral RNA-dependent RNA polymerase (RdRp) of SARS-CoV-2 demonstrates high potential as a reliable target for the development of antivirals. We previously developed a cell-based assay to assess the efficiency of compounds that target SARS-CoV-2 RdRp, as well as their tolerance to viral exoribonuclease-mediated proof-reading. In our previous study, we discovered that 2-((1H-indol-3-yl)thio)-N-phenyl-acetamides specifically targets the RdRp of both respiratory syncytial virus (RSV) and influenza A virus. Thus, we hypothesize that 2-((1H-indol-3-yl)thio)-N-phenyl-acetamides may also have the ability to inhibit SARS-CoV-2 replication by targeting its RdRp activity. In this research, we test a compound library containing 103 of 2-((1H-indol-3-yl)thio)-N-phenyl-acetamides against SARS-CoV-2 RdRp, using our cell-based assay. Among these compounds, the top five candidates strongly inhibit SARS-CoV-2 RdRp activity while exhibiting low cytotoxicity and resistance to viral exoribonuclease. Compound 6-72-2a is the most promising candidate with the lowest EC50 value of 1.41 mu M and highest selectivity index (CC50/EC50) (above 70.92). Furthermore, our data suggests that 4-46b and 6-72-2a also inhibit the replication of HCoV-OC43 and HCoV-NL63 virus in a dose-dependent manner. Compounds 4-46b and 6-72-2a exhibit EC50 values of 1.13 mu M and 0.94 mu M, respectively, on HCoV-OC43 viral replication. However, higher concentrations of these compounds are needed to effectively block HCoV-NL63 replication. Together, our findings successfully identified 4-46b and 6-72-2a as promising inhibitors against SARS-CoV-2 RdRp.

9.
Zhonghua Nei Ke Za Zhi ; 59(8): 610-617, 2020 Aug 01.
Article in Chinese | MEDLINE | ID: covidwho-1555470

ABSTRACT

Objective: To explore the feasibility of direct renin inhibitor aliskiren for the treatment of severe or critical coronavirus disease 2019 (COVID-19) patients with hypertension. Methods: The antihypertensive effects and safety of aliskiren was retrospectively analyzed in three severe and one critical COVID-19 patients with hypertension. Results: Four patients, two males and two females, with an average age of 78 years (66-87 years), were referred to hospital mainly because of respiratory symptoms. Three were diagnosed by positive novel coronavirus 2019 (2019-nCoV) nucleic acid or antibody, and the critical patient with cardiac insufficiency was clinically determined. Two patients were treated with calcium channel antagonist (CCB), one with angiotensin converting enzyme inhibitor (ACEI), and one with angiotensin Ⅱ receptor antagonist (ARB). After admission, ACEI and ARB were discontinued, one patient with heart failure was treated by aliskiren combined with diuretic.Three patients were treated with aliskiren combined with CCB among whom two withdrew CCB due to low blood pressure after 1 to 2 weeks. Based on comprehensive treatment including antiviral and oxygenation treatment, blood pressure was satisfactorily controlled by aliskiren after three to four weeks without serious adverse events. All patients were finally discharged. Conclusion: Our preliminary clinical data shows that antihypertensive effect of aliskiren is satisfactory and safe for severe COVID-19 patients complicated with hypertension.

10.
2021 IEEE International Conference on Digital Health, ICDH 2021 ; : 234-243, 2021.
Article in English | Scopus | ID: covidwho-1537725

ABSTRACT

While the COVID-19 epidemic expands among multiple countries, diverse measures have been exploited to halt the spread of COVID-19. In Mainland China, the containment measures can be categorized into two types, i.e., intra-city quarantine and isolation, and inter-city travel restriction. Both information acquisition and local economy play an important role while implementing the measures. In order to understand the relationship between the containment measures and pulic responses to the COVID-19 pandemic, we study the correlation among three factors, i.e., the information acquisition of containment measures, the public responses to the COVID-19 pandemic, and local economy of cities in Mainland China. We combine Markov Chain Monte Carlo (MCMC) and SIR-X to estimate the parameters related to the pandemic. Then, we investigate the correlations among multiple representative parameters including mobility, local economy, and information acquisition to understand the implementation of containment measures. We utilize the mobility data from Baidu Maps, the COVID-19 related search frequency data from Baidu Search Engine, and the data of Gross Domestic Product (GDP). From the analysis, we evidence that the the information acquisition is strongly correlated with the local economy. In addition, we find that the cities with stronger local economy have bigger inflows from Wuhan, while the citizens of the cities perform COVID-19- related searches more frequently and take the quarantine measure more strictly. © 2021 IEEE.

11.
Preprint in English | PUBMED | ID: ppcovidwho-292901

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects cells through binding to angiotensin-converting enzyme 2 (ACE2). This interaction is mediated by the receptor-binding domain (RBD) of the viral spike (S) glycoprotein. Structural and dynamic data have shown that S can adopt multiple conformations, which controls the exposure of the ACE2-binding site in the RBD. Here, using single-molecule Forster resonance energy transfer (smFRET) imaging we report the effects of ACE2 and antibody binding on the conformational dynamics of S from the Wuhan-1 strain and the B.1 variant (D614G). We find that D614G modulates the energetics of the RBD position in a manner similar to ACE2 binding. We also find that antibodies that target diverse epitopes, including those distal to the RBD, stabilize the RBD in a position competent for ACE2 binding. Parallel solution-based binding experiments using fluorescence correlation spectroscopy (FCS) indicate antibody-mediated enhancement of ACE2 binding. These findings inform on novel strategies for therapeutic antibody cocktails.

12.
American Journal of Gastroenterology ; 116(SUPPL):S513, 2021.
Article in English | EMBASE | ID: covidwho-1534718

ABSTRACT

Introduction: The COVID-19 pandemic has dramatically imperiled the health system worldwide. It may also negatively impact the cascade of care of hepatitis C virus (HCV) infection and the progress on WHO 2030 goal of HCV elimination. In this study, we used a multinational, multicenter cohort to estimate the change in the completion of DAA therapy, HCV RNA testing, and clinical encounter during pandemic. Methods: We collected data patients who underwent DAA therapy at three tertiary medical centers in Los Angeles (US), Xi'an (China), and Nanjing (China) between January 1, 2019 to June 30, 2020 and followed until November 30, 2020. We compared the proportions of HCV patients who completed DAA therapy as well as had HCV RNA testing and follow-up visits during and after the end of the HCV therapy between COVID-19 pandemic and the periods before pandemic. Additionally, we determined the frequency and predictive factors of utilization of telemedicine. Results: A total of 256 patients with HCV infection were included. Despite no significant reduction in the completion of DAA before and during the pandemic, the proportion of patients undergoing HCV RNA testing during DAA treatment decreased from about 80% before pandemic to 67% during the pandemic, with a more prominent decrease in the US. There were less than 10% of patients who had HCV RNA testing 12 weeks post-treatment during COVID-19 era. Compared to pre-pandemic period, post-treatment clinic encounter decreased significant in China but elevated in the US. Further analysis showed that the increase was due to the surge in utilization of telemedicine. However, the increased number of follow-up visits during COVID-19 pandemic period did not result in an increase in HCV RNA testing. Conclusion: COVID-19 pandemic carried profound impact on the cascade of care for HCV patients in both the US and China. Despite the increased use of telemedicine in the US, the adherence to recommendations for HCV RNA testing was still disappointingly low. Stakeholders should identify the modifiable barriers and reinforce the care while withstanding the pandemic.

13.
Kexue Tongbao/Chinese Science Bulletin ; 66(31):3925-3931, 2021.
Article in Chinese | Scopus | ID: covidwho-1523391

ABSTRACT

Left unmitigated, climate change poses a catastrophic risk to human health, demanding an urgent and concerted response from every country. The 2015 Lancet Commission on Health and Climate Change and The Lancet Countdown: Tracking Progress on Health and Climate Change have been initiated to map out the impacts of climate change and the necessary policy responses. To meet these challenges, Tsinghua University, partnering with the University College London and 17 Chinese and international institutions, has prepared the Chinese Lancet Countdown report, which has a national focus and builds on the work of the global Lancet Countdown: Tracking Progress on Health and Climate Change. Drawing on international methodologies and frameworks, this report aims to deepen the understanding of the links between public health and climate change at the national level and track them with 23 indicators. This work is part of the Lancet's Countdown broader efforts to develop regional expertise on this topic, and coincides with the launch of the Lancet Countdown Regional Centre in Asia, based at Tsinghua University. The data and results of this report are presented at the provincial level, where possible, to facilitate targeted response strategies for local decision-makers. Based on the data and findings of the 2020 Chinese Lancet Countdown report, five recommendations are proposed to key stakeholders in health and climate change in China: (1) Enhance inter-departmental cooperation. Climate change is a challenge that demands an integrated response from all sectors, urgently requiring substantial inter-departmental cooperation among health, environment, energy, economic, financial, and education authorities. (2) Strengthen health emergency preparedness. Knowledge and findings on current and future climate-related health threats still lack the required attention and should be fully integrated into the emergency preparedness and response system. (3) Support research and raise awareness. Additional financial support should be allocated to health and climate change research in China to enhance health system adaptation, mitigation measures, and their health benefits. At the same time, media and academia should be fully motivated to raise the public and politicians' awareness of this topic. (4) Increase climate change mitigation. Speeding up the phasing out of coal is necessary to be consistent with China's pledge to be carbon neutral by 2060 and to continue to reduce air pollution. Fossil fuel subsidies must also be phased out. (5) Ensure the recovery from COVID-19 to protect health now and in the future. China's efforts to recover from COVID-19 will shape public health for years to come. Climate change should be a priority in these interventions. © 2021, Science Press. All right reserved.

14.
Macromolecular Materials and Engineering ; 2021.
Article in English | Scopus | ID: covidwho-1513915

ABSTRACT

Paper-based flexible pressure sensors have received extensive attention owing to their recoverability and accessibility. This study, proposes a graphical pressure sensor array with a multilayered structure. A simple writing method is adopted to realize the adsorption of sensitive materials on the fiber structure of cellulose paper. Pressure sensors with 1, 3, 5, and 7 stacked layers are fabricated and compared. The results show that the seven-layer sensor achieves a high sensitivity (44 kPa–1) and fast time response (less than 150 ms). The highly sensitive stacked paper-based sensor array realizes the pressure detection in objects and special-shaped surfaces. A pressure sensor based on a commercial corrugated box is also fabricated for comparison. The corrugated carton array is used to switch the reminder devices for convenience and accessibility. Because many scenarios require a safe distance to be maintained, particularly under the influence of COVID-19, the writable paper-based sensor array is used to realize graphical distance perception and provide warnings. © 2021 Wiley-VCH GmbH

15.
27th Annual Americas Conference on Information Systems, AMCIS 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1513673

ABSTRACT

Research indicates that Information Technology (IT) is an indispensable part of crisis management by helping managers respond to disruptive and unexpected events (Riemer et al., 2020;Sakurai & Chughtai, 2020). However, the impact of a crisis on IT is less clear. This research investigates the interplay of crisis response and IT transformation in the context of the 2020- 2021 Covid-19 pandemic. We use punctuated equilibrium theory to interpret how a multi-billion-dollar Supply Chain Company (SupplyCo) responded to the Covid-19 crisis. Our case study illustrates how managers apply IT in crisis response and how crisis drives IT transformation. This research shows that IT functions as a safety net and shields companies and employees along three dimensions. The research offers recommendations for re-orienting IT and the workforce in response to a crisis. © AMCIS 2021.

16.
Medical Journal of Peking Union Medical College Hospital ; 12(1):44-48, 2021.
Article in Chinese | Scopus | ID: covidwho-1513192

ABSTRACT

Objective To explore the application of ultrasound-guided arterial line placement in severe patients with COVID-19. Methods From February to April 2020, we retrospectively collected and analyzed the clinical data of critical patients with COVID-19 with an indwelling peripheral arterial catheter treated by the medical team of Peking Union Medical College Hospital. Patients with ultrasound-guided peripheral arterial catheterization were taken as the study group, while patients whose arterial catheter was placed by traditional palpation were taken as the control group. The puncture condition and complication rate were compared between the two groups. Results A total of 60 severe patients with COVID-19 who met the inclusion and exclusion criteria were enrolled in this study. There were 30 cases in the study group and 30 cases in the control group. In the study group, the success rate of the first catheterization of the peripheral artery (63.3% vs. 26.7%) and the total puncture success rate [(79.43± 25.79)% vs. (53.07±30.21)%] were higher than those in the control group (all P < 0.05), the puncture times(1.43±0.56 vs. 2.50±1.28) were less than those of the control group (P < 0.05). The rates of 24-hour disuse (6.7% vs. 30.0%), local hematoma (10.0% vs. 36.7%), occlusion, and tortuous (3.3% vs. 40.0%) in the study group were lower than those in the control group (all P < 0.05). Conclusion Under the three-level protection, ultrasound-guided arterial catheter placement for severe patients with COVID-19 can improve the success rate of catheter placement, reduce puncture times, and reduce the incidence of complications. © 2021, Peking Union Medical College Hospital. All rights reserved.

17.
24th International Conference on Medical Image Computing and Computer Assisted Intervention, MICCAI 2021 ; 12906 LNCS:86-96, 2021.
Article in English | Scopus | ID: covidwho-1469648

ABSTRACT

Computed tomography (CT) reconstruction from X-ray projections acquired within a limited angle range is challenging, especially when the angle range is extremely small. Both analytical and iterative models need more projections for effective modeling. Deep learning methods have gained prevalence due to their excellent reconstruction performances, but such success is mainly limited within the same dataset and does not generalize across datasets with different distributions. Hereby we propose ExtraPolationNetwork for limited-angle CT reconstruction via the introduction of a sinogram extrapolation module, which is theoretically justified. The module complements extra sinogram information and boots model generalizability. Extensive experimental results show that our reconstruction model achieves state-of-the-art performance on NIH-AAPM dataset, similar to existing approaches. More importantly, we show that using such a sinogram extrapolation module significantly improves the generalization capability of the model on unseen datasets (e.g., COVID-19 and LIDC datasets) when compared to existing approaches. © 2021, Springer Nature Switzerland AG.

18.
Journal of Minimally Invasive Gynecology ; 28(11, Supplement):S73-S74, 2021.
Article in English | ScienceDirect | ID: covidwho-1466648

ABSTRACT

Study Objective An isthmocele is a cesarean scar site defect with a depth of >2mm and can lead to both obstetric and gynecologic complications. The primary objective was to evaluate the feasibility of a study protocol comparing different cesarean section closure techniques amongst our own patients/physicians, with the ultimate goal of a larger scale randomized controlled trial (RCT). Secondary objectives included isthmocele incidence, measurements on postoperative ultrasound, and adverse surgical outcomes related to suture technique. Design A single-center parallel-group pilot RCT comparing locked vs. unlocked first-layer uterine closure. Outpatient transvaginal ultrasound to evaluate isthmocele formation was performed at least six months postoperatively. Setting Operating room and outpatient ultrasound clinic. Patients or Participants All term pregnant patients >18 years old undergoing a primary caesarean section were eligible. Exclusion criteria included previous uterine hysterotomy, known uterine anomalies, active labour, and maternal bleeding and/or connective tissue disorders. Interventions Locked or unlocked closure of the first uterine layer. Measurements and Main Results Forty-one subjects were randomized, and 23 completed the follow-up ultrasound, with 12 in the locked group and 11 in the unlocked group. Barriers to feasibility included hesitance to participate in research during pregnancy, difficulty attending follow-up ultrasound with a newborn, and mainly Covid-19 pandemic related delays in study activities and fear of potential exposures. Isthmocele was present in 10/12 patients receiving locked closure, and in 11/11 of the unlocked group. Mean sagittal depth was 0.36 cm and 0.40 cm in the locked vs. unlocked groups, respectively. Sagittal adjacent myometrial thickness was 1.03 cm in the locked group, and 1.12 cm in the unlocked group. No adverse outcomes were noted with either surgical technique. Conclusion The study design is feasible outside of the pandemic setting. A larger trial is needed to determine differences regarding isthmocele rates and measurements between groups.

19.
China CDC Weekly ; 2(6):83-86, 2020.
Article in English | MEDLINE | ID: covidwho-1445121
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