Identification of Lung and Blood Microbiota Implicated in COVID-19 Prognosis.

The implications of the microbiome on Coronavirus disease 2019 (COVID-19) prognosis has not been thoroughly studied. In this study we aimed to characterize the lung and blood microbiome and their implication on COVID-19 prognosis through analysis of peripheral blood mononuclear cell (PBMC) samples, lung biopsy samples, and bronchoalveolar lavage fluid (BALF) samples. In all three tissue types, we found panels of microbes differentially abundant between COVID-19 and normal samples correlated to immune dysregulation and upregulation of inflammatory pathways, including key cytokine pathways such as interleukin (IL)-2, 3, 5-10 and 23 signaling pathways and downregulation of anti-inflammatory pathways including IL-4 signaling. In the PBMC samples, six microbes were correlated with worse COVID-19 severity, and one microbe was correlated with improved COVID-19 severity. Collectively, our findings contribute to the understanding of the human microbiome and suggest interplay between our identified microbes and key inflammatory pathways which may be leveraged in the development of immune therapies for treating COVID-19 patients.

Improvement in Patient-Specific Outcomes After Carpal Tunnel Release in Patients Older Than 80 Years.

Outcomes after carpal tunnel release (CTR) may be influenced by age, disease chronicity, and disease severity. Multiple studies report mixed results between age and improvement through a validated instrument, the Brigham and Women's Carpal Tunnel Questionnaire (BWQ). However, these investigations did not control for confounders and had small cohorts of younger patients. We hypothesized that patients older than 80 years have statistically significant improvement in symptom severity and functional status after CTR. Patients completed the BWQ preoperatively and postoperatively. The main outcome measurement was difference in average BWQ scores, verified with Wilcoxon signed rank test. A standardized response mean was used to calculate effect size. Covariates were based on potential confounders, such as body mass index, hypothyroidism, American Society of Anesthesiologists (ASA) status, and thenar electromyography findings. The t test or χ test was used for univariate analysis. Logistical regression predicted odds of large versus small improvement in BWQ scores in a multivariate model, which was assessed with receiver operating characteristic and Hosmer-Lemeshow tests. Statistically significant improvement was seen among the 44 patients who completed the BWQ, with symptom severity scores of 2.97 points; functional status scores, 1.52 points; and combined scores, 2.51 points. Age did not predict effect size; however, ASA status had a statistically significant inverse relation, with a decrease in the odds of large improvement by 77%. Age did not predict improvement in BWQ scores in a regression model analysis in 1 of the largest cohorts of patients older than 80 years who underwent CTR. Patients of this age do benefit from CTR. Although age is not associated with the size of this benefit, ASA status is associated, suggestive that other medical comorbidities adversely affect outcomes after CTR in this elderly population.