Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19.

BACKGROUND: The long-term consequences of COVID-19 remain unclear. There is concern a proportion of patients will progress to develop pulmonary fibrosis. We aimed to assess the temporal change in CXR infiltrates in a cohort of patients following hospitalisation for COVID-19. METHODS: We conducted a single-centre prospective cohort study of patients admitted to University Hospital Southampton with confirmed SARS-CoV2 infection between 20th March and 3rd June 2020. Patients were approached for standard-of-care follow-up 12-weeks after hospitalisation. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates; 0-4 per lung (Nil = 0, < 25% = 1, 25-50% = 2, 51-75% = 3, > 75% = 4). RESULTS: 101 patients with paired CXRs were included. Demographics: 53% male with a median (IQR) age 53.0 (45-63) years and length of stay 9 (5-17.5) days. The median CXR follow-up interval was 82 (77-86) days with median baseline and follow-up CXR scores of 4.0 (3-5) and 0.0 (0-1) respectively. 32% of patients had persistent CXR abnormality at 12-weeks. In multivariate analysis length of stay (LOS), smoking-status and obesity were identified as independent risk factors for persistent CXR abnormality. Serum LDH was significantly higher at baseline and at follow-up in patients with CXR abnormalities compared to those with resolution. A 5-point composite risk score (1-point each; LOS ≥ 15 days, Level 2/3 admission, LDH > 750 U/L, obesity and smoking-status) strongly predicted risk of persistent radiograph abnormality (0.81). CONCLUSION: Persistent CXR abnormality 12-weeks post COVID-19 was common in this cohort. LOS, obesity, increased serum LDH, and smoking-status were risk factors for radiograph abnormality. These findings require further prospective validation.

Potential of an in vitro toolbox combined with exposure data as a first step for the risk assessment of dietary chemical contaminants.

In vitro risk assessment of dietary contaminants has become a priority in human food safety. This paper proposes an in vitro approach associating different complementary tools in an original toolbox and aims to improve the assessment of the toxicological impact of dietary contaminants at realistic human exposure levels, with a special focus on the intestinal compartment. The system is based on the use of four complementary cellular tools, namely stress gene induction in transgenic strains of Escherichia coli, modulation of the activity of key biotransformation enzymes (cytochrome P-450 (CYP) 1A1 and 3A4) in a human intestinal cell line, and activation of aryl hydrocarbon receptor (AhR) and oestrogenic receptor (ER)-dependent genes in agonistic and antagonistic assays with luciferase reporter cells. It was applied to four chosen model molecules: ochratoxin A (OTA) and deoxynivalenol (DON), two common food-borne mycotoxins, and imazalil (IMA) and benomyl (BEN), two fungicides widely occurring in foodstuffs. All these assays were performed at or around a realistic intestinal concentration, determined through a deterministic approach based on the calculation of a theoretical maximum daily intake (TMDI). Using the four model molecules, it is clearly highlighted that induction of CYP1A1 activity and inhibition of CYP3A4 activity occurred in Caco-2 cells at a realistic intestinal concentration of IMA. Furthermore, some bacterial stress genes were induced in a range of realistic concentrations, following exposure to DON and IMA. In addition, BEN clearly provoked an ER agonistic activity in a human oestrogen sensitive reporter cell line. All these results are in accordance with the literature, suggesting that the in vitro toolbox constitutes an interesting approach in order to obtain a first 'fingerprint' of dietary contaminants at realistic human exposure for further risk assessment.

Hospitalisations for sport-related concussions in US children aged 5 to 18 years during 2000-2004.

OBJECTIVES: To describe patient and hospital characteristics associated with hospitalisation for a diagnosis of non-fatal sport-related concussion, and to determine factors associated with these hospitalisations. METHODS: Children aged 5-18 years with a primary diagnosis of a sport-related concussion in the Nationwide Inpatient Sample (2000-2004) were identified. Length of stay and hospital charges for sport-related concussions were documented. Logistic regression was used to assess the association of patient or hospital characteristics with hospitalisations for sport-related concussion. RESULTS: Between 2000 and 2004, a total of 755 non-fatal paediatric sport-related hospitalisations for concussion were identified. Nationwide, this represents 3712 hospitalisations and over US$29 million total hospital charges, with nearly US$6 million in total hospital charges per year. Over half (52.3%) of patients with concussion experienced loss of consciousness. Over 80% of the patients hospitalised for concussion received no procedures during their average 1.1 day (median 0.8 day) of hospital stay. Older age, but not gender, was associated with increased odds of sport-related hospitalisations for concussion. Non-teaching hospitals or hospitals in rural areas had significantly greater odds of admitting sport-related concussions versus other sport-related traumatic brain injuries compared with teaching or urban hospitals. CONCLUSIONS: Management of paediatric sport-related concussions varied, depending on the patient and the hospital. Better guidelines are needed for the identification and management of sport-related concussions. Standardised procedures for hospitals treating concussive injuries may also be warranted.

Immune response inhibition by irrigating subchondral bone with cytotoxic agents.

Attempts have been made (in the recent past) to inhibit the immune response to fresh osteoarticular (shell) allografts because the occurrence and the magnitude of this response is considerably greater and more harmful than that seen after frozen bone and soft tissue allografts. To decrease in immunogenicity of these fresh grafts, the subchondral bone of rat distal femur allografts was irrigated with Betadine scrub solution (n = 10) or Triton-X (n = 11) before transplantation (Study 1). The Triton-X significantly reduced the immunogenicity of the grafts, but the Betadine scrub solution had no effect. A similar experiment with Triton-X was done in sheep where trochlear knee autografts (n = 3) were compared with unirrigated allografts (n = 3) and allografts receiving irrigation with Triton-X (n = 3) (Study 2). All 3 Triton-X irrigated allografts had no immune response, and showed much improved grafts compared with the control allografts (where an immune response developed in 2 of 3). Neither of the 2 allograft groups were as good as the autografts. These techniques may prove useful for inhibiting the recipient immune responses to fresh osteoarticular allografts in humans requiring partial joint reconstruction.