The Pandemic as a Catalyst for Digital Pathology Adoption as an LDT

Whole-slide images (WSI) are the basis for the application of artificial intelligence/machine learning and other informatics methods to histological diagnosis and will further blur the line separating anatomic and clinical pathology. FDA classified WSI systems for primary diagnosis as class III (highest risk) medical devices until 2017. This discouraged anatomic pathology laboratories at risk-averse domestic institutions like mine from investing in these digital pathology (DP) platforms. In 2017, FDA downgraded WSI to class II (moderate risk) when they de-novo approved a system marketed by Philips. We were not interested in that system at my institution, but the downgrade caused us to reset our perception of the risk of validating a RUO system for primary diagnosis. Cost remained a barrier. In April 2020, FDA issued temporary guidance stating they would not enforce premarket approval of WSI systems to facilitate pathologists working remotely during the SARS-CoV-2 pandemic. The guidance included a statement that "laboratories and hospitals consider performing a validation study.” In January 2021, FDA proposed making the temporary non-enforcement guidance permanent. So, in a little more than three years, WSI for primary diagnosis had gone from class III to exempted from pre-market approval! This nicely aligned the approval framework for WSI with the approval framework for our conventional optical microscopes, which are statutorily exempted from approval, and further reset our perception of risk. In April 2021, FDA withdrew the proposal to make non-enforcement permanent, but the temporary non-enforcement guidance is still in effect at the time of writing. Amid all this FDA activity, the College of American Pathologists updated and reissued their consensus guidelines for validating WSI systems for diagnostic purposes in March 2021. The narrative mentions the FDA's recent approval of a few WSI systems and anticipates more, but the expert panel recommendations do not include any related to the approval status of systems. The reissue of this document reminded us that, as clinical laboratorians, we are capable of safely validating WSI as a laboratory-developed test and are supported in doing so by consensus guidelines from one of our leading professional organizations. In early 2021 we committed to funding a DP initiative to make WSI part of our routine histological process for 10% of our anatomic pathology cases. The initial capital investment is $1.5M. When realized, the microscope slides for designated pathology services will be transported directly from the cover slipper to a slide scanner and electronically distributed to pathologists using a clinical-grade image management system that we share with our radiology department. We made the decision to fund this in the context of the regulatory (decreased perception of risk), sociological (demand for remote telepathology), and technological (availability of scalable WSI systems) changes that occurred during the pandemic.

Postmortem detectability and viability of SARS-CoV-2 virus in various biological specimens

Introduction Without a comprehensive postmortem investigation it is impossible to determine the cause of death among the SARS-CoV-2-suspected and-positive patients. We present two cases to discuss the postmortem detectability of SARS-CoV-2 virus and RNA stability in biological samples. Outline of cases Case No. 1: a 40-year-old man on whom the autopsy was performed four days after death. The body was stored at 4°C. Bilateral pneumonia was confirmed grossly and histopathologicaly. Molecular testing was positive for IgM antibodies, but negative for SARS-CoV-2 RNA. Case No. 2: a 28-year-old profes-sional basketball player who suffered from SARS-CoV-2 about a month earlier. The autopsy was performed two days after death. The body was stored at 15°C. Gross autopsy findings revealed advanced putrefactive changes and an enlarged heart, with visible fibrotic focuses. The histopathological finding corresponded to the sudden cardiovascular death due to the cardiac dysrhythmia most probably formed in one of the fibrotic focuses. Tests for SARS-CoV-2 RNA and antibodies (IgM, IgG) were positive in the analyzed samples. Conclusion This report suggests that SARS-CoV-2 virus can be isolated in the biological samples even after a long post-mortem prolongation of molecular analyses. We emphasize the necessity of wider studies that will define the infectiveness and biological stability of the virus in postmortem tissues. © 2023, Serbia Medical Society. All rights reserved.

Pathology Detector System in the Bronchopulmonary System of Asthmatic patients visualized through a radiofrequency of the chest

The arrival of COVID-19 caused devastation to humanity by spreading rapidly around the world and seriously affecting the entire health system. To date, the peculiar symptoms of COVID-19 and the problems it generates in those asthmatic people are already known, which is complicated if they have not had an adequate treatment of their disease, since bronchial asthma is one of the complex bronchopulmonary diseases and for its diagnosis some methods are used that do not provide enough information about the patient's condition, being inefficient methods, therefore, it is necessary to use tools to diagnose pathologies to patients in a comfortable way for an efficient treatment by providing the greatest amount of information about the patient's condition for continuous treatment and in addition to facilitating constant access to several patients with asthma. In view of this problem, in this article a pathology detection system was made in the bronchopulmonary system of asthmatic patients visualized through a radiofrequency of the chest, in such a way that an early diagnosis is made, and some pathological change can be detected in the patient's bronchopulmonary system, with this, an efficient treatment of the patient can be carried out. Through the development of the system, it was possible to observe that the operation was done correctly in the tests conducted, the positioning equipment will move the radiant module on the patient's body for the detection of some pathology with an accuracy of 97.86% efficiency. © 2023 IEEE.

Air Pollutants and Their Impact on Chronic Diseases—A Retrospective Study in Bucharest, Romania

Air pollution is a serious problem in Romania, with the country ranking 13th among the most polluted countries in Europe in the 2021 World Air Quality Report. Despite the recognized impact of pollutants on health, there has been a lack of large-scale studies conducted in Romania. This study investigated the impact of air pollutants on patients with chronic respiratory, cardiovascular, cerebrovascular, or metabolic diseases in Bucharest and its metropolitan area from 20 August 2018 to 1 June 2022. The daily limit values for particulate matter PM10 and PM2.5 were exceeded every month, especially during the cold season, with a decrease during the COVID-19 pandemic restrictions. A significant statistical correlation was found between the monthly average values of PM2.5 and PM10 and hospitalizations for respiratory and cardiovascular diseases. A 10 µg/m3 increase in monthly average values resulted in a 40–60% increase in admissions for each type of pathology, translating to more than 2000 admissions for each pathology for the study period. This study highlights the urgent need for national and local measures to ensure a cleaner environment and enhance public health in Romania according to international regulations. © 2023 by the authors.

Kidney dysfunction and in-hospital complications in patients with acute cardiovascular pathology infected with COVID-19

This study aimed to assess kidney function and its significance for the development of in-hospital complications in patients hospitalized with acute cardiovascular pathology infected with COVID-19. Methods. This prospective cohort single-center study included 139 patients with acute cardiovascular pathology diagnosed with COVID-19. Sixty-nine (49.6%) patients had acute coronary syndrome (47 with acute myocardial infarction (AMI), 33 (23.7%) patients had hypertension urgencies, 24 (17.3%) patients had acute decompensated heart failure, 9 (6.5%) patients had tachysystolic paroxysms of atrial fibrillation, 2 (1.4%) patients had an acute pulmonary embolism, and 2 (1.4%) patients had syncope. The mean age was 67.9±12.7 years, and 70 (50.4%) patients were male. Arterial hypertension was present in 87.1% of patients, diabetes mellitus in 20.9%, congestive heart failure in 30.9%, chronic obstructive pulmonary disease in 9.4%, AMI in 20.1%, and ischemic stroke in 9.4%. Results. The initial creatinine level was 110.7±66.1 μmol/l and eGFR (CKD-EPI) was 63.3±20.3 ml/min/1.73m2 (eGFR<60 ml/min/1.73m2 was diagnosed in 46.0% of the patients). The patients with eGFR<60 ml/min/1.73m2 were older, more often female, frequently had a history of atrial fibrillation, had lower hemoglobin and blood pressure on admission, a greater number of complications (need for noninvasive ventilation, inotropic therapy), and higher in-hospital mortality (25.0% vs. 5.3 %, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (increase in creatinine level ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR<60 ml/min/1.73m2, p<0.05). These patients did not differ significantly in basic clinical and anamnestic data from patients without AKI but had lower spO2 on admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), venous thromboembolism (14.3% vs. 0.9%, p=0.070), death from all causes (47.6% vs. 7.0%, p=0.002) and more often required organ supportive therapy: non-invasive/invasive pulmonary ventilation (52.4% vs. 11.3%, p<0.001), inotropic therapy (57.1% versus 5.2%, p<0.001). Using the simplified criterion of AKI, the category of patients at high risk for hospital complications and death could also be distinguished (37.9% vs. 8.2%, p=0.004). Vaccination against COVID-19 (at least 2 weeks before hospitalization) prevented the development of AKI (16.5% vs. 5.0%, p=0.046) and tended to prevent in-hospital mortality (15.7% vs. 5.0%, p=0.076). Conclusions. Renal dysfunction in patients with acute cardiovascular pathology infected with COVID-19 is associated with in-hospital complications and can be prevented by prophylactic vaccination. © Y. Lutai, O. Parkhomenko, O. Irkin, D. Khomyakov, 2023. All rights reserved.

ANALYSIS OF MORTALITY AMONG PATIENTS SUFFERING FROM HEART FAILURE, USING THE EXAMPLE OF A MEGALOPOLIS

The medical documentation (n = 146912) introduced into the system "Regional fragment of the unified state information system in the field of healthcare” of Saint Petersburg for 2019–2021 was analyzed. To evaluate the mortality of patients due to heart failure, all deceased patients from 2019 to 2021 in Saint Petersburg (n = 192133) were taken as a basis, and based on a thorough study of medical documentation, patients who died from cardiovascular diseases and because of heart failure were singled out separately. The total mortality from all causes in Saint Petersburg in 2019 was 53025 people;in 2020, 66468 people;and in 2021, 72640 people. The analysis of mortality due to cardiovascular diseases from 2019 to 2021 showed an upward trend of 20.1% over the 3-year period of data analysis. When analyzing the prevalence of heart failure among deceased patients, an increase of 129.4% was noted over this period. The obtained results of the prevalence, mortality, and mortality of patients due to heart failure on the example of a megalopolis are the most relevant at the current time;they indicate a steady increase in the number of patients suffering from heart failure with an increase in the burden on the city's healthcare system. Simultaneously, there is insufficient continuity in the provision of medical care to patients suffering from heart failure, which is because of not only a shortage of medical personnel at all stages of medical care but also insufficient compliance of patients who either do not want to be treated or cannot continue treatment. Moreover, a significant disconnect was found in the continuity of medical care at the stages of pre-hospital and hospital treatment, as well as further outpatient follow-up of patients suffering from heart failure in the metropolis. All this leads to a significant increase in the mortality and mortality of patients suffering from heart failure, despite all the existing modern effective drug therapies. It appears critical to create a unified register platform for recording patients with heart failure, which will allow for a more accurate understanding of epidemiological aspects, the solution of which will improve the quality of medical care, identify the need for the crucial medicines, and reduce mortality, and mortality rates due to heart failure. All rights reserved © Eco-Vector, 2022.

Comparative Analysis of Laboratory and Radiation Methods of Studies with the Degree of Severity of Patients with COVID-19

The study is devoted to a comparative analysis and retrospective evaluation of laboratory and instrumental data with the severity of lung tissue damage in COVID-19 of patients with COVID-19. An improvement was made in the methodology for interpreting and analyzing dynamic changes associated with COVID-19 on CT images of the lungs. The technique includes the following steps: pre-processing, segmentation with color coding, calculation and evaluation of signs to highlight areas with probable pathology (including combined evaluation of signs). Analysis and interpretation is carried out on the emerging database of patients. At the same time the following indicators are distinguished: the results of the analysis of CT images of the lungs in dynamics;the results of the analysis of clinical and laboratory data (severity course of the disease, temperature, saturation, etc.). The results of laboratory studies are analyzed with an emphasis on the values of the main indicator - interleukin-6. This indicator is a marker of significant and serious changes characterizing the severity of the patient's condition. © 2023 IEEE.

Near-infrared photobiomodulation therapy for rehabilitation of patients with long COVID

About 80% of the patients recovering from COVID-19 have inflammation symptoms, like brain fog, myopathy, myalgia, muscle weariness, headache, mental tiredness, asthenia, adynamia, dizziness, tinnitus, hearing loss, telogenic effluvium and mood disturbances. Here, we demonstrate how transcranial and systemic photobiomodulation using near-infrared LEDs emitting 850 nm wavelength light enhanced cognition and reduced pain. Participants were separated into transcranial photobiomodulation with near-infrared LEDs (850 nm, 10W, 10 minutes), photobiomodulation with a punctual cutaneous application (850nm, 10W, 10-40 minutes), and both treatments. All patients underwent 10-day treatments at least. © 2023 SPIE.

Thromboembolic complications in patients with acute surgical pathology with coronavirus infection of COVID-19

Background. Coronavirus disease (COVID-19) is a highly contagious infection, the etiological factor of which is the SARS-CoV2 virus. In COVID-19, hemostasis disorders vary widely: from latent hypercoagulation, which occurs only on the basis of laboratory tests, to severe clinical manifestations in the form of cerebral, coronary arterial or venous thrombosis complicated by pulmonary embolism. The purpose was to study of clinical manifestations of hemostasis disorders according to laboratory studies. Materials and methods. The observation data of 96 patients who were treated for surgical pathology and in whom COVID-19 was detected are presented. Patients were hospitalized in the intensive care unit, thrombotic complications were detected in 37 %. Both venous (64 %) and arterial (36 %) thrombosis occurred. Results. According to a survey of patients with a confirmed diagnosis of COVID-19, pulmonary embolism was detected in 11.4 %, deep vein thrombo-sis and catheter-associated thrombosis in 1.2 %, ischemic stroke in 1.3 % of patients. The cumulative frequency of thrombosis was 28 %. Attention should be paid to the complexity of the diagnosis of thrombotic complications in patients who underwent artificial lung ventilation. possible thrombotic complications, regardless of clinical manifestations. Conclusions. Preference should be given to low molecular weight heparins in a standard prophylactic dose, an alternative to which are direct oral anticoagulants used in surgical protocols to prevent postoperative thrombosis. The duration of post-hospital thromboprophylaxis is determined individually taking into account the risk factors of thrombosis until the normalization of D-dimer and fibrinogen, but not less than 2 weeks after discharge. © 2022. The Authors. This is an open access article under the terms of the Creative Commons Attribution 4.0 International License, CC BY, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.

Assessment of the course of coagulopathies in patients with surgical pathology on the background of COVID-19

Background. Coronavirus disease (COVID-19) is a highly contagious infection, the etiological factor of which is the SARS-CoV-2. In COVID-19, hemostasis disorders vary widely: from latent hypercoagulation, which is detected only by the results of laboratory tests, to severe clinical manifestations in the form of cerebral, coronary arterial or venous thrombosis complicated by pulmonary embolism. The purpose: to study clinical manifestations of hemostasis disorders according to laboratory studies. Materials and methods. The observation data of 89 patients who were treated for surgical pathology associated with COVID-19 are presented. All individuals were hospitalized in the intensive care unit, thrombotic complications were detected in 37 % of them. Both venous (64 %) and arterial (36 %) thrombosis occurred. Hemorrhagic complications were found in 15.7 % of patients. Results. According to a survey of people with a confirmed diagnosis of COVID-19, pulmonary embolism was detected in 11.4 %, deep vein thrombosis and catheter-associated thrombosis — in 1.2 %, ischemic stroke — in 1.3 % of patients. The cumulative frequency of thrombosis was 28 %. Attention should be paid to the comple xity of the diagnosis of thrombotic complications in patients who underwent artificial lung ventilation. The overall cumulative incidence of thrombosis on days 7, 14 and 21 of hospitalization was 12, 28 and 36 %, respectively, while the frequency of thrombotic complications with clinical manifestations was only 7, 14 and 21 %, which is almost 2 times less common. This once again suggests the need to examine all patients with COVID-19 for possible thrombotic complications, regardless of clinical manifestations. Conclusions. Patients should receive continuous thromboprophylaxis after discharge from a hospital. Preference should be given to low molecular weight heparins in a standard prophylactic dose, an alternative to which are direct oral anticoagulants used in surgical protocols to prevent postoperative thrombosis. The duration of post-hospital thromboprophylaxis is determined individually taking into account the risk factors of thrombosis until the normalization of D-dimer and fibrinogen, but not less than 2 weeks after discharge. © 2022. The Authors.

Intrinsic Kidney Pathology Following COVID-19 Infection in Children and Adolescents: A Systematic Review.

Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently been reported in adults since the onset of the global COVID-19 pandemic in December 2019. Gradually, there have been an increased number of COVID-19-associated intrinsic kidney pathologies in children and adolescents reported as well. The pathophysiological mechanisms between COVID-19 and the onset of kidney pathology are not fully known in children; it remains a challenge to distinguish between intrinsic kidney pathologies that were caused directly by COVID-19 viral invasion, and cases which occurred as a result of multisystem inflammatory syndrome due to the infection. This challenge is made more difficult in children, due to the ethical limitations of performing kidney biopsies to reach a biopsy-proven diagnosis. Although previous systematic reviews have summarized the various pathological kidney manifestations that have occurred in adults following acute COVID-19 infection, such reviews have not yet been published for children and adolescents. We describe the results of a systematic review for intrinsic kidney pathology following COVID-19 infection in children and adolescents. Methods: A systematic literature search of published data up until 31 October was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Research articles reporting new-onset or relapsed intrinsic kidney pathology in children or adolescents (≤18 years) following acute COVID-19 infection were included for qualitative review. COVID-19 infection status was defined by a positive result from a RT-PCR, or nuclear antibody testing. Only full-text articles published in the English language were selected for review. Results: Twenty-nine cases from fifteen articles were included in the qualitative synthesis of this systematic review. Nephrotic syndrome, as an umbrella condition, appeared as the most frequently observed presentation (20 cases) with disease remission noted in all cases with steroid treatment. Other cases included numerous glomerulonephritides, such as acute necrotizing glomerulonephritis, MPO vasculitis and collapsing glomerulopathy, and thrombotic microangiopathies, such as aHUS. For patients with transplanted kidneys, T-cell-mediated rejection and mild tubular interstitial infiltration were noted following testing positive for COVID-19. There were no mortalities reported in any of the included cases, although two patients remained dialysis dependent at hospital discharge. Conclusion: This systematic review highlights the various intrinsic pathological kidney manifestations in children and adolescents as a result of acute COVID-19 infection. The clinical timeline and presentation of these cases support the mechanistic hypothesis between COVID-19 infection and the onset of intrinsic kidney pathologies within this context. The progressive introduction of vaccination programs for children and adolescents may hopefully reduce the severity of COVID-19-associated illnesses, and pathological kidney manifestations in this population.

Frontline Workers in the Backrooms of COVID-19.

OBJECTIVES: To review the response to the coronavirus disease 2019 (COVID-19) pandemic in a forensics center that integrates an academic department of pathology with multiple regional county medical examiners' offices. METHODS: Faculty and staff were asked to volunteer stories, data, and photographs describing their activities from March through May 2020. The information was assembled into a narrative summary. RESULTS: Increased deaths challenged capacity limits in a hospital morgue and a large urban medical examiner's office (MEO) successfully managed by forensic teams and monitored by an institutional command center. Autopsies of suspected and proven cases of COVID-19 were performed in both facilities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of decedents was performed in a MEO serving a large urban area. Scene investigators worked directly with families to meet needs unique to a pandemic. Artful photographs of decedent's hands and/or tattoos were offered to those unable to have in-person viewings. Pathologists and social workers were available to families of the deceased and created novel solutions to facilitate the grieving process. CONCLUSIONS: Forensic pathology is important to successfully navigating emerging diseases like the COVID-19 pandemic. Direct conversations with families are common in forensic pathology and serve as a model for patient- and family-centered care.

Immune Responses and Pathogenesis following Experimental SARS-CoV-2 Infection in Domestic Cats.

Several reports demonstrated the susceptibility of domestic cats to SARS-CoV-2 infection. Here, we describe a thorough investigation of the immune responses in cats after experimental SARS-CoV-2 inoculation, along with the characterization of infection kinetics and pathological lesions. Specific pathogen-free domestic cats (n = 12) were intranasally inoculated with SARS-CoV-2 and subsequently sacrificed on DPI (days post-inoculation) 2, 4, 7 and 14. None of the infected cats developed clinical signs. Only mild histopathologic lung changes associated with virus antigen expression were observed mainly on DPI 4 and 7. Viral RNA was present until DPI 7, predominantly in nasal and throat swabs. The infectious virus could be isolated from the nose, trachea and lungs until DPI 7. In the swab samples, no biologically relevant SARS-CoV-2 mutations were observed over time. From DPI 7 onwards, all cats developed a humoral immune response. The cellular immune responses were limited to DPI 7. Cats showed an increase in CD8+ cells, and the subsequent RNA sequence analysis of CD4+ and CD8+ subsets revealed a prominent upregulation of antiviral and inflammatory genes on DPI 2. In conclusion, infected domestic cats developed a strong antiviral response and cleared the virus within the first week after infection without overt clinical signs and relevant virus mutations.

Leading Pathogens Involved in Co-Infection and Super-Infection with COVID-19: Forensic Medicine Considerations after a Systematic Review and Meta-Analysis.

The COVID-19 pandemic raised concerns about the potential for co-infection or over-infection with other respiratory infections, as they can complicate the diagnosis, treatment and prognosis of the disease. This is also a challenge for forensic pathologists, who may come across cases where the presence of co-infection or over-infection is suspected or confirmed, and it is important that they take this into account when determining the cause of death. The aim of this systematic review is to analyse the prevalence of each specific pathogen co-infecting or over-infecting patients with SARS-CoV-2 infection. In total, 575 studies were selected from the Scopus and Pub-Med online databases and 8 studies were included in a meta-analysis. Male gender, advanced age and nursing home care are risk factors associated with the development of co-infection, whereas age, tachypnoea, hypoxaemia and bacterial infection are predictors of mortality. Overall, however, having a SARS-CoV-2 infection does not represent a real risk for the development of co-infections/super-infections.

Rapid transition to telepractice across the lifespan in speech-language pathology: Insight from a survey of clinicians in Canada.

PURPOSE: This study aims to describe the experiences and needs of Canadian speech-language pathologists (SLPs) who conducted communication assessments via telepractice across the lifespan during the first year (2020) of the COVID-19 pandemic. METHOD: The present study consisted of an online survey that aimed to capture both quantitative aspects of telepractice-based communication assessment and the qualitative experience of shifting to telepractice. One hundred sixty-eight practicing SLPs across Canada participated in the survey, between September 2020 and January 2021. Quantitative results were analysed using descriptive statistics while open-ended responses were analysed using thematic analysis. RESULT: SLPs identified challenges and opportunities relating to client and family engagement, access to and knowledge of technology, and the reliability of assessment tools. SLPs also identified a future need for online assessment materials and training, such as materials adapted for different communication needs (e.g. augmentative and alternative communication). CONCLUSION: The present study contributes to a growing understanding worldwide of potential benefits and challenges related to telepractice, fuelled by the necessary shift in practices in our field during the COVID-19 pandemic. The results provide direction for continuing to build a valid and inclusive approach to telepractice in the future.

Impact of Holding Immunosuppressive Therapy in Patients with Inflammatory Bowel Disease Around mRNA COVID-19 Vaccine Administration on Humoral Immune Response and Development of COVID-19 Infection.

BACKGROUND AND AIMS: The BNT162b2 and mRNA-1273 COVID-19 vaccines are efficacious in patients with inflammatory bowel disease; but there are a lack of data examining if holding immunosuppressive therapy around vaccination improves immune response. We studied the effect of holding IBD medications around the time of vaccination on antibody response and breakthrough COVID-19 infection. METHODS: Partnership to Report Effectiveness of Vaccination in populations Excluded from iNitial Trials of COVID is a prospective cohort of individuals with IBD receiving COVID-19 vaccination. Quantitative measurement of anti-receptor binding domain IgG antibodies to SARS-CoV-2 was performed 8 weeks after completing a vaccination series. RESULTS: 1,854 patients were included; 59% were on anti-TNF (10% of these on combination therapy), 11% on vedolizumab, and 14% on ustekinumab. 11% of participants held therapy before or after vaccine administration for at least 2 weeks. Antibody levels were similar in participants continuing versus holding anti-TNF monotherapy before or after the second vaccine (BNT162b2: 10 µg/mL vs 8.9 µg/mL, mRNA-1273: 17.5 µg/mL vs 14.5 µg/mL). Comparable results were seen in those on combination therapy. Antibody titers in those on ustekinumab or vedolizumab were higher compared to anti-TNF users, but there was no significant difference if drug was held or continued (BNT162b2: 22.5 µg/mL vs 23 µg/mL, mRNA-1273: 88 µg/mL vs 51 µg/mL). Holding therapy was not associated with decreased rate of COVID-19 infection compared to those not holding therapy (BNT162b2: 28% vs 29%; mRNA-1273 19% vs 31%). CONCLUSION: We recommend continuing IBD medications while receiving mRNA COVID-19 vaccination without interruption.

Ultrahigh-Resolution Photon-Counting Detector CT of the Lungs: Association of Reconstruction Kernel and Slice Thickness With Image Quality.

BACKGROUND. Prior work has shown improved image quality for photon-counting detector (PCD) CT of the lungs compared with energy-integrating detector CT. A paucity of the literature has compared PCD CT of the lungs using different reconstruction parameters. OBJECTIVE. The purpose of this study is to the compare the image quality of ultra-high-resolution (UHR) PCD CT image sets of the lungs that were reconstructed using different kernels and slice thicknesses. METHODS. This retrospective study included 29 patients (17 women and 12 men; median age, 56 years) who underwent noncontrast chest CT from February 15, 2022, to March 15, 2022, by use of a commercially available PCD CT scanner. All acquisitions used UHR mode (1024 × 1024 matrix). Nine image sets were reconstructed for all combinations of three sharp kernels (BI56, BI60, and BI64) and three slice thicknesses (0.2, 0.4, and 1.0 mm). Three radiologists independently reviewed reconstructions for measures of visualization of pulmonary anatomic structures and pathologies; reader assessments were pooled. Reconstructions were compared with the clinical reference reconstruction (obtained using the BI64 kernel and a 1.0-mm slice thickness [BI641.0-mm]). RESULTS. The median difference in the number of bronchial divisions identified versus the clinical reference reconstruction was higher for reconstructions with BI640.4-mm (0.5), BI600.4-mm (0.3), BI640.2-mm (0.5), and BI600.2-mm (0.2) (all p < .05). The median bronchial wall sharpness versus the clinical reference reconstruction was higher for reconstructions with BI640.4-mm (0.3) and BI640.2-mm (0.3) and was lower for BI561.0-mm (-0.7) and BI560.4-mm (-0.3) (all p < .05). Median pulmonary fissure sharpness versus the clinical reference reconstruction was higher for reconstructions with BI640.4-mm (0.3), BI600.4-mm (0.3), BI560.4-mm (0.5), BI640.2-mm (0.5), BI600.2-mm (0.5), and BI560.2-mm (0.3) (all p < .05). Median pulmonary vessel sharpness versus the clinical reference reconstruction was lower for reconstructions with BI561.0-mm (-0.3), BI600.4-mm (-0.3), BI560.4-mm (-0.7), BI640.2-mm (-0.7), BI600.2-mm (-0.7), and BI560.2-mm (-0.7). Median lung nodule conspicuity versus the clinical reference reconstruction was lower for reconstructions with BI561.0-mm (-0.3) and BI560.4-mm (-0.3) (both p < .05). Median conspicuity of all other pathologies versus the clinical reference reconstruction was lower for reconstructions with BI561.0 mm (-0.3), BI560.4-mm (-0.3), BI640.2-mm (-0.3), BI600.2-mm (-0.3), and BI560.2-mm (-0.3). Other comparisons among reconstructions were not significant (all p > .05). CONCLUSION. Only the reconstruction using BI640.4-mm yielded improved bronchial division identification and bronchial wall and pulmonary fissure sharpness without a loss in pulmonary vessel sharpness or conspicuity of nodules or other pathologies. CLINICAL IMPACT. The findings of this study may guide protocol optimization for UHR PCD CT of the lungs.

SARS-CoV-2-Induced Autoimmune Hepatitis.

Few case reports discuss the incidences of autoimmune hepatitis (AIH) in patients after SARS-CoV-2 infection. Here, we present a case of SARS-CoV-2-induced AIH in a male patient who came into the emergency department with complaints of weight loss, poor oral intake, nausea, dark-colored urine, clay-colored stools, and scleral icterus, which began two weeks after he tested positive for SARS-CoV-2 PCR. Liver biopsy and subsequent histology confirmed the diagnosis of AIH with the most probable etiology being SARS-CoV-2 infection. The patient was treated with N-acetylcysteine (NAC) and steroids with clinical improvement and eventual discharge home. Our goal is to provide a clinical presentation, treatment, and outcome in a patient with SARS-CoV-2-induced AIH.

The promise and challenge of spatial omics in dissecting tumour microenvironment and the role of AI.

Growing evidence supports the critical role of tumour microenvironment (TME) in tumour progression, metastases, and treatment response. However, the in-situ interplay among various TME components, particularly between immune and tumour cells, are largely unknown, hindering our understanding of how tumour progresses and responds to treatment. While mainstream single-cell omics techniques allow deep, single-cell phenotyping, they lack crucial spatial information for in-situ cell-cell interaction analysis. On the other hand, tissue-based approaches such as hematoxylin and eosin and chromogenic immunohistochemistry staining can preserve the spatial information of TME components but are limited by their low-content staining. High-content spatial profiling technologies, termed spatial omics, have greatly advanced in the past decades to overcome these limitations. These technologies continue to emerge to include more molecular features (RNAs and/or proteins) and to enhance spatial resolution, opening new opportunities for discovering novel biological knowledge, biomarkers, and therapeutic targets. These advancements also spur the need for novel computational methods to mine useful TME insights from the increasing data complexity confounded by high molecular features and spatial resolution. In this review, we present state-of-the-art spatial omics technologies, their applications, major strengths, and limitations as well as the role of artificial intelligence (AI) in TME studies.