Association of blood viscosity and device-free days among hospitalized patients with COVID-19.

BACKGROUND: Increased estimated whole blood viscosity (eWBV) predicts higher mortality in patients hospitalized for coronavirus disease 2019 (COVID-19). This study assesses whether eWBV is an early predictor of non-fatal outcomes among patients hospitalized for acute COVID-19 infection. METHODS: This retrospective cohort study included 9278 hospitalized COVID-19 patients diagnosed within 48 h of admission between February 27, 2020 to November 20, 2021 within the Mount Sinai Health System in New York City. Patients with missing values for major covariates, discharge information, and those who failed to meet the criteria for the non-Newtonian blood model were excluded. 5621 participants were included in the main analysis. Additional analyses were performed separately for 4352 participants who had measurements of white blood cell count, C-reactive protein and D-dimer. Participants were divided into quartiles based on estimated high-shear blood viscosity (eHSBV) and estimated low-shear blood viscosity (eLSBV). Blood viscosity was calculated using the Walburn-Schneck model. The primary outcome was evaluated as an ordinal scale indicating the number of days free of respiratory organ support through day 21, and those who died in-hospital were assigned a value of -1. Multivariate cumulative logistic regression was conducted to evaluate the association between quartiles of eWBV and events. RESULTS: Among 5621 participants, 3459 (61.5%) were male with mean age of 63.2 (SD 17.1) years. The linear modeling yielded an adjusted odds ratio (aOR) of 0.68 (95% CI 0.59-0.79, p value < 0.001) per 1 centipoise increase in eHSBV. CONCLUSIONS: Among hospitalized patients with COVID-19, elevated eHSBV and eLSBV at presentation were associated with an increased need for respiratory organ support at 21 days. These findings are highly relevant, as they demonstrate the utility of eWBV in identifying hospitalized patients with acute COVID-19 infection at increased risk for non-fatal outcomes in early stages of the disease.

South Korea's Medical Tourism Competitiveness and Future Strategy: Focused on Cancer Treatment: A Review.

Background: Medical tourism is a leading industry of South Korea. Since the transition from the latest health pandemic to endemic, foreign patients have been on a rapid increase. The Korean government regards medical tourism as a major national industry and pursues medical, legal, and policy strategies with the goal of attracting 700,000 foreign patients by 2027. Methods: Examining objective data and statistics as well as academic articles, we investigated the strengths and advantages, which might persuade foreign medical tourists to visit South Korea by performing a comparative analysis with high-income or medically advanced countries among Organization for Economic Co-operation and Development (OECD) and other competing Asian countries. Results: Cancer is one of the leading causes of death in the world. Compared with other advanced countries and Asian competitors in cancer treatment, South Korea shows excellent result of major cancers treatments, accessibility to hospitals and medical professionals, and competitiveness in terms of surgery and treatment costs. Conclusion: South Korea has excellent competitiveness both in price and in cancer treatment with the outstanding results of cancer mortality rates and 5-year survival rates. The achievement of Korea's cancer treatments is due to accurate diagnosis with the advantage of PET-CT, 64-sllice CT, 3.0 TESLA MRI, etc., and the use of cutting-edge equipment, such as CyberKnife and Da Vince robotic surgery. Besides, the Korean central and local governments actively support for the promotion of Korea's medical tourism industry, such as issuance of visas for foreigners, the hospital certification system, and medical tourism convergence cluster project.

Lipoprotein-X and Lipoprotein-Z Induced Hyperviscosity Syndrome in the Setting of Cholestatic Liver Failure.

We describe a case referred for worsening hypercholesterolemia in the setting of atorvastatin and fenofibrate-induced liver injury. The patient reported neurological complaints attributed to hyperviscosity syndrome (induced by lipoprotein-X and lipoprotein-Z). Hepatic recovery was associated with reduction of whole blood viscosity and amelioration of neurological symptoms. (Level of Difficulty: Advanced.).

Association of Blood Viscosity With Mortality Among Patients Hospitalized With COVID-19.

BACKGROUND: Coronavirus disease-2019 (COVID-19) is characterized by a dysfunctional immune response and abnormal blood rheology that contribute to endothelial dysfunction and thrombotic complications. Whole blood viscosity (WBV) is a clinically validated measure of blood rheology and an established predictor of cardiovascular risk. We hypothesize that increased WBV is associated with mortality among patients hospitalized with COVID-19. OBJECTIVES: This study sought to determine the association between estimated BV (eBV) and mortality among hospitalized COVID-19 patients. METHODS: The study population included 5,621 hospitalized COVID-19 patients at the Mount Sinai Health System from February 27, 2020, to November 27, 2021. eBV was calculated using the Walburn-Schneck model. Multivariate Cox proportional hazards models were used to evaluate the association between eBV and mortality. Considered covariates included age, sex, race, cardiovascular and metabolic comorbidities, in-house pharmacotherapy, and baseline inflammatory biomarkers. RESULTS: Estimated high-shear BV (eHSBV) and estimated low-shear BV were associated with increased in-hospital mortality. One-centipoise increases in eHSBV and estimated low-shear BV were associated with a 36.0% and 7.0% increase in death, respectively (P < 0.001). Compared with participants in the lowest quartile of eHSBV, those in the highest quartile of eHSBV had higher mortality (adjusted HR: 1.53; 95% CI: 1.27-1.84). The association was consistent among multiple subgroups, notably among patients without any comorbidities (adjusted HR: 1.69; 95% CI: 1.28-2.22). CONCLUSIONS: Among hospitalized COVID-19 patients, increased eBV is significantly associated with higher mortality. This suggests that eBV can prognosticate patient outcomes in earlier stages of COVID-19, and that future therapeutics aimed at reducing WBV should be evaluated.

Blood hyperviscosity in acute and recent COVID-19 infection.

BACKGROUND: Elevated estimated blood viscosity (EBV), derived from hematocrit and globulins, is associated with thrombotic complications, organ failure, and higher mortality in COVID-19 patients. Although informative, EBV does not account for cellular interactions or fibrinogen. OBJECTIVE: Investigate whether patients with acute and recent COVID-19 have altered whole blood viscosity (WBV) when measured at both high and low shear rates using in vitro blood samples from patients. METHODS: Cross-sectional study of 58 patients: 15 in the intensive care unit with acute COVID-19, 32 convalescent (9 < 8weeks [W] from acute infection, 23 > 8 W), and 11 controls without COVID-19. WBV was measured at high (300 s-1) and low (5 s-1) shear rates (HSR, LSR) using a scanning capillary viscometer.RESULTSAcute and convalescent patients < 8 W had mean WBV at LSR (16.0 centipoise [cP] and 15.1 cP) and HSR (5.1 cP and 4.7 cP). Mean WBV of convalescent > 8 W and control patients were 12.3 cP and 13.0 cP at LSR, and 4.1 cP and 4.2 cP at HSR. Acute and < 8 W patients had significantly higher WBV at both HSR and LSR compared to patients > 8 W (all p≤0.01). No significant differences in WBV were observed between acute and < 8 W patients, or between patients > 8 W and controls. CONCLUSIONS: Hyperviscosity provides a possible explanation for thrombotic risk in acute and convalescent (< 8 W) patients. These findings have important implications for thromboprophylaxis.

The Turning Point of China's Rural Public Health during the Cultural Revolution Period: Barefoot Doctors: A Narrative.

BACKGROUND: According to Mao Zedong's orders, the Communist Party of China made efforts to perform the system of 'barefoot doctors' even during the political mayhem of the Cultural Revolution. This pioneering medical system made a great contribution to medical services for rural communities and the public health system from 1960s to 1970s. Attracting new attention in the beginning of the 21st century, the barefoot doctor system influenced the formation of the Chinese medical system of unique structure. METHODS: Utilizing and analyzing the currently existing research outcomes on 'barefoot doctors', we investigated the two overlooked characteristics in the Chinese medical system originated from the barefoot doctor system; i) why the barefoot doctor system attracts new attention in the 21st century and ii) why and how Western and Chinese medicine could systematically be combined, which is the unique phenomenon in the world. RESULTS: The barefoot doctor system satisfied the Chinese government's political aims and realistic request under the banner of Cultural Revolution simultaneously. In reality, this system gratified prevention-oriented modernized public health policy, reducing serious gap of medical services between cities and rural areas. Yet, this leading system was abolished in 1980s without timely use. CONCLUSION: In the present, the barefoot doctor system is holding limelight again as a successful precedent to intensify preventive public health service all over China, especially for underdeveloped areas. Moreover, Chinese medicine-friendly stance to utilize 'doctors of Chinese medicine', absolute majority over those of Western medicine, created the uniqueness of integrative medicine.

Application of pulsed spark discharge for calcium carbonate precipitation in hard water.

The effect of underwater pulsed spark discharge on the precipitation of dissolved calcium ions was investigated in the present study. Water samples with different calcium hardness were prepared by continuous evaporation of tap water using a laboratory cooling tower. It was shown that the concentration of calcium ions dropped by 20-26% after 10-min plasma treatment, comparing with no drop for untreated cases. A laser particle counting method demonstrated that the total number of solid particles suspended in water increased by over 100% after the plasma treatment. The morphology and the crystal form of the particles were identified by both scanning electron microscopy and X-ray diffraction. Calcite with rhombohedron morphology was observed for plasma treated cases, comparing with the round structure observed for no-treatment cases. It was hypothesized that the main mechanisms for the plasma-assisted calcium carbonate precipitation might include electrolysis, local heating in the vicinity of plasma channel and a high electric field at the tip of plasma streamers, inducing structural changes in the electric double layer of hydrated ions.