Trajectories of Clinical and Laboratory Characteristics Associated with COVID-19 in Hemodialysis Patients by Survival

IntroductionThe clinical impact of COVID-19 has not been established in the dialysis population. We evaluated the trajectories of clinical and laboratory parameters in hemodialysis (HD) patients. MethodsWe used data from adult HD patients treated at an integrated kidney disease company who received a RT-PCR test to investigate suspicion of a SARS-CoV-2 infection between 01 May and 01 Sep 2020. Nonparametric smoothing splines were used to fit data for individual trajectories and estimate the mean change over time in patients testing positive or negative for SARS-CoV-2 and those who survived or died within 30 days of first suspicion or positive test date. For each clinical parameter of interest, the difference in average daily changes between COVID-19 positive versus negative group and COVID-19 survivor versus non-survivor group was estimated by fitting a linear mixed effects model based on measurements in the 14 days before (i.e., day-14 to day 0) day 0. ResultsThere were 12,836 HD patients with a suspicion of COVID-19 who received RT-PCR testing (8,895 SARS-CoV-2 positive). We observed significantly different trends (p<0.05) in pre-HD systolic blood pressure (SBP), pre-HD pulse rate, body temperature, ferritin, lymphocytes, albumin, and interdialytic weight gain (IDWG) between COVID-19 positive and negative patient. For COVID-19 positive group, we observed significantly different clinical trends (p<0.05) in pre-HD pulse rate, lymphocytes, albumin and neutrophil-lymphocyte ratio (NLR) between survivors and non-survivors. We also observed that, in the group of survivors, most clinical parameters returned to pre-COVID-19 levels within 60-90 days. ConclusionWe observed unique temporal trends in various clinical and laboratory parameters among HD patients who tested positive versus negative for SARS-CoV-2 infection and those who survived the infection versus those who died. These trends can help to define the physiological disturbances that characterize the onset and course of COVID-19 in HD patients

Transmission of SARS-CoV-2 Considering Shared Chairs in Outpatient Dialysis: A Real-World Case-Control Study

BackgroundSARS-CoV-2 is primarily transmitted through aerosolized droplets; however, the virus can remain transiently viable on surfaces. ObjectiveWe examined transmission within hemodialysis facilities, with a specific focus on the possibility of indirect patient-to-patient transmission through shared dialysis chairs. DesignWe used real-world data from hemodialysis patients treated between February 1st and June 8th, 2020 to perform a case-control study matching each SARS-CoV-2 positive patient (case) to a non-SARS-CoV-2 patient (control) in the same dialysis shift and traced back 14 days to capture possible exposure from chairs sat in by SARS-CoV-2 patients. Cases and controls were matched on age, sex, race, facility, shift date, and treatment count. Setting2,600 hemodialysis facilities in the United States. PatientsAdult (age [≥]18 years) hemodialysis patients. MeasurementsConditional logistic regression models tested whether chair exposure after a positive patient conferred a higher risk of SARS-CoV-2 infection to the immediate subsequent patient. ResultsAmong 170,234 hemodialysis patients, 4,782 (2.8%) tested positive for SARS-CoV-2 (mean age 64 years, 44% female). Most facilities (68.5%) had 0 to 1 positive SARS-CoV-2 patient. We matched 2,379 SARS-CoV-2 positive cases to 2,379 non-SARS-CoV-2 controls; 1.30% (95%CI 0.90%, 1.87%) of cases and 1.39% (95%CI 0.97%, 1.97%) of controls were exposed to a chair previously sat in by a shedding SARS-CoV-2 patient. Transmission risk among cases was not significantly different from controls (OR=0.94; 95%CI 0.57 to 1.54; p=0.80). Results remained consistent in adjusted and sensitivity analyses. LimitationAnalysis used real-world data that could contain errors and only considered vertical transmission associated with shared use of dialysis chairs by symptomatic patients. ConclusionsThe risk of indirect patient-to-patient transmission of SARS-CoV-2 infection from dialysis chairs appears to be low. Primary Funding SourceFresenius Medical Care North America; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK130067)

Measuring COVID-19 and Influenza in the Real World via Person-Generated Health Data

BackgroundSince the beginning of the COVID-19 pandemic, data from smartphones and connected sensors have been used to better understand presentation and management outside the clinic walls. However, reports on the validity of such data are still sparse, especially when it comes to symptom progression and relevance of wearable sensors. ObjectiveTo understand the relevance of Person-Generated Health Data (PGHD) as a means for early detection, monitoring, and management of COVID-19 in everyday life. This type of data include quantifying prevalence and progression of symptoms from self-reports as well as changes in activity and physiological parameters continuously measured from wearable sensors, and contextualizing findings for COVID-19 patients with those from cohorts of flu patients. Design, Setting, and ParticipantsRetrospective digital cohort study of individuals with a self-reported positive SARS-CoV-2 or influenza test followed over the period 2019-12-02 to 2020-04-27. Three cohorts were derived: Patients who self-reported being diagnosed with flu prior to the SARS-CoV-2 pandemic (N=6270, of which 1226 also contributed sensor PGHD); Patients who reported being diagnosed with flu during the SARS-CoV-2 pandemic (N=426, of which 85 also shared sensor PGHD); and patients who reported being diagnosed with COVID-19 (N=230, of which sensor PGHD was available for 41). The cohorts were derived from a large-scale digital participatory surveillance study designed to track Influenza-like Illness (ILI) incidence and burden over time. ExposuresSelf-reported demographic data, comorbidities, and symptoms experienced during a diagnosed ILI episode, including SARS-CoV-2. Physiological and behavioral parameters measured daily from commercial wearable sensors, including Resting Heart Rate (RHR), total step count, and nightly sleep hours. Main Outcomes and MeasuresWe investigated the percentage of individuals experiencing symptoms of a given type (e.g. shortness of breath) across demographic groups and over time. We examined illness duration, and care seeking behavior, and how RHR, step count, and nightly sleep hours deviated from expected behavior on healthy days over the course of the infection episode. ResultsSelf-reported symptoms of COVID-19 present differently from flu. COVID-19 cases tended to last longer than flu (median of 12 vs. 9 days), are uniquely characterized by chest pain/pressure, shortness of breath, and anosmia. The fraction of elevated RHR measurements collected daily from commercial wearable devices rise significantly in the 2 days surrounding ILI symptoms onset, but does not appear to do so in a way specific to COVID-19. Steps lost due to COVID-19 persists for longer than for flu. Conclusion and RelevancePGHD can be a valid source of longitudinal real world data to detect and monitor COVID-19-related symptoms and behaviors at population scale. PGHD may provide continuous, near real-time feedback to intervention effectiveness that otherwise requires waiting for symptoms to develop into contacts with the healthcare system. It has also the potential to increase pre-test probability of other downstream diagnostics. To effectively leverage PGHD for participatory surveillance it is crucial to invest in the creation of trusted, long-term communication channels with individuals through which data can be efficiently collected, consented, and contextualized, while protecting the privacy of individuals and ultimately facilitating the transition in and out of care.

Laparoscopic sleeve gastrectomy for obesity / 中华普通外科杂志

ObjectiveTo explore efficacy and safety of laparoscopic sleeve gastrectomy for the treatment of obesity.MethodsForty patients underwent laparoscopic sleeve gastrectomy as a treatment option for weight reduction between December 2006 and February 2010.Mean preoperative body weight (BW),body mass index (BMI) and exceed body weight (EBW) were(104.2 ±3.3) kg,(36.9 ± 1.0) kg/m2 and (37.8 ±3.0) kg,respectively.Outcome data were collected and assessed prospectively.ResultsLaparoscopic procedures were completed in all patients,with no conversion to open surgery.The operation time averaged (80 ± 18 ) min,and there were no severe postoperative complications.The median postoperative hospital stay was (5.5 ± 1.5 ) days.BMI loss was (4.3 ± 1.7 ) kg/m2,( 7.0 ± 1.9 ) kg/m2,(9.3 ±3.1) kg/m2 and (10.1 ±3.8) kg/m2,respectively,and percentage of EBW loss was 35.0％ ± 13.5％,57.1％ ± 17.7％,74.2％ ±27.2％,and 81.8％ ±29.4％,respectively,at 1,3,6,and 12 months following the procedure.ConclusionLaparoscopic sleeve gastrectomy is an effective and safe surgical option for the treatment of obesity with lower BMI.Additional long-term studies are still needed to accurately compare laparoscopic sleeve gastrectomy with other procedures of weight reduction.

Laparoscopic partial gastrectomy and enterectomy for morbid obesity / 中华普通外科杂志

Objective To explore the short-term result and safety of laparoscopie sleeve gastrectomy and partial enterectomy for the treatment of morbid obesity.Methods Ten patients underwent laparoscopic sleeve gastrectomy,omentectomy,and partial enterectomy as a treatment option for weight reduction between December 2006 and September 2007.The procedure included 70%-75%vertical (sleeve)gastrectomy,omentectomy,and 1/3 to 2/5 enterectomy preserving proximal jejunum and most of the ileum. Results Laparoscopy was completed in all patients,no conversion to open surgery.The operation time averaged at 3.1 hours(range 2.5-3.5 hours),and there was no postoperative complications.The median postoperative hospital stay was 7 days(range 6-8 days).Mean preoperative BMI was 36.1(32.0-40.5)kg/m2.Mean decrease in BMI was 4.1(3.0-4.7)ks/m2,5.6(3.2-9.0)kg/m2,and 7.3(3.2-10.7)kg/m2 respectively,and mean weight loss at postoperative 1,3,and 6 months was 11.7(7-15)kg,17.5(8-25)kg,and 22.0(8-32)kg respectively.Conclusion Laparoscopic sleeve gastrectomy with omentectomy and partial enterectomy is an effective and safe surgical option for the treatment of morbid obesity.

Laparoscopic Management of Acute Cholecystitis with Subtotal Cholecystectomy / 医学研究杂志

Objective To discuss the clinical application of lapraroscopic subtotal cholecystectomy in the acute cholecystitis with severe inflammatory and fibrous adhesions at calot triangle.Methods Retrospective analysis of the clinical data,surgical approaches,and short term and long term complications of 74 cases of acute cholecystitis in the period from January 2002 to September2005 in our hospital.Results In the 74 cases operated by subtotal cholecystectomy using laparoscopy,during laparoscopic procedure,71(95.9%) operations were successful;a case of Mirizzi syndrome could not be confirmed to have the residual stones in cystic duct and another case of the same syndrome was not confirmed to have the duodenum fistula.These two cases were then dealt with by conventional surgery and constituted 2.7% of the total cases.One case was dealtd with by second surgery because of the residual stones of cystic duct after lapraroscopic subtotal cholecystectomy and constituted 1.3% of the total cases.One case was found with minor bile leakage and constituted 1.3% of the total cases.Cholangiography was conducted 41 cases during operation,of whom,39 cases were normal and 2 cases failed.No death occurred with the operation of the lapraroscopic subtotal cholecystectomy.Conclusion It is safe and effective to apply laparoscopic subtotal cholecystectomy to treat acute cholecystitis with severe inflammatory and fibrous adhesions at calot triangle.

Comparison of Liver Function and White Blood Cell after Laparoscopic Versus Open Splenectomy for Cirrhosis / 医学研究杂志

Objective To investigate the changes of liver function and white blood cell of patients with liver cirrhosis,portal hypertension and secondary hypersplenism underwent laparoscopic splenectomy(LS) and open splenectomy(OS).Methods We analyzed 76 clinical data of patients with liver cirrhosis,portal hypertension and secondary hypersplenism,among those 27 underwent LS,49 OS from Mar 2003 to Mar 2006 retrospectively.Blood samples were obtained and analyzed preoperatively and postoperatively on days 1,3, and 7,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),directed bilirubin(DBil) and white blood cell(WBC).Results Between LS and OS,the serum levels of Tbil and Dbil had significant difference on the 1st postoperative day(P

Lapraroscopic Surgery for the Treatment of Achalasia / 医学研究杂志

Objective To investigate the safety and feasibility of lapraroscopic Heller myotomy combined with Dor fundoplication surgery. Methods Three cases with achalasia have been treated with laproroscopic Heller-Dor surgery since February, 2005. Before surgery, patients were examined for generally esophageal barium meal and esophageal manometry. Results The operation time ranged from 110 and 120 minutes with the bleeding volumes between 40 to 50 ml, and the hospitalized time for patients post operation was 6 to 7 days. During a month after surgery, the patients showed the normal lower esophageal sphincter pressure and remnant pressure, increased the rate of relaxation,disappeared reversed peristalsis and gastroesophageal reflux, and no recurred symptoms. Conclusions In comparison to conventional surgery, Heller-Dor procedure results in smaller wound, less pain, fewer complications, faster recovery, shorter hospitalized days, and better therapeutic effectiveness. The Heller-Dor procedure is safe and feasible.

Laparoscopic splenectomy performed in 41 cases / 中国普通外科杂志

Objective To evaluate the feasibility and efficacy of laparoscopic splenectomy(LS). Methods In this study 41 cases were enrolled including 10 cirrhotic splenomegaly cases and 17 idiopathic thrombocytopenic purpura cases. The clinical data of 41 cases undergoing LS was retrospectively reviewed. KG2Result Two cases were shifted to open surgery, LS was successful in 39 cases with average operating time of 238 min, the average spleen weight was 389 g, blood loss 318 ml, postoperative GI movement started from 12 to 24 hrs. The average postoperative hospital stay was 4 days. Postoperative complications occurred in 3 cases including intraabdominal bleeding, subcutaneous emphysema, and stabbing-caused abdominal wall bleeding in one each. Conclusion LS is safe and less traumatic in selected patients indicated for splenectomy, especially for those suffering from haemotologic diseases.

Comparison of different embolism agents in the treatment of uterine leiomyoma / 中国微创外科杂志

0 05). No other embolisms or severe complications occurred in the two groups. Conclusions No substantive differences were detected between outcomes of embolization with PVA and PLES.

Unsuspected gallbladder carcinoma during laparoscopic cholecystectomy:An analysis of 16 cases / 中国微创外科杂志

Objective To explore the causation as well as the prevention and treatment of unsuspected gallbladder carcinoma (UGC) during laparoscopic cholecystectomy (LC). Methods Clinical data of 16 cases of UGC encountered during 6 031 cases of LC (0.26%) in this hospital were retrospectively reviewed. Results Out of the 16 cases of UGC, 9 were diagnosed intraoperatively and the other 7 were identified by histopathologic examination after surgery. The median survival time was 20.3 months. Of the 15 cases with primary tumor over T 2 stage: open operation was performed in 10 cases and the other 5 cases didn’t undergo open surgery after the diagnosis was clarified, the postoperative survival time being (19.9?4.9) and (9.8?2.8) months, respectively; 9 cases underwent radical or aggressive radical cholecystectomy and 6 didn’t undergo redical resection, the postoperative survival time being (21.6?5.3) and (7.8?2.6) months, respectively. Conclusions Recognition and precautions about gallbladder carcinoma should be strengthened before LC. The resected gallbladder should be routinely examined and frozen-section examination should be applied promptly if there have any suspicions of malignancy. Once the UGC is diagnosed, radical or aggressive radical resection should be adopted as early as possible, and necessary measures should be taken to prevent implantation and metastasis of carcinoma.

Clinical application of devascularization of venous traffic branches by endoscope / 中国实用外科杂志

Objective　To discuss the technique,advantages and follow-up results of subfascial endoscopic perforator surgery.Methods　Subfascial Endoscopic Perforator Surgery was performed for 23 patients wth chronic venous insufficiency.Over two years postoperative follow-up was done.Results　21 in 23 cases with ulcers healed.Only one case had wound infection.Conclusion　Subfascial Endoscopic Perforator Surgery is a safe and effective procedure in treating venous insufficiency.

Laparoscopic splenectomy plus esophagogastric devascularization for the treatment of portal hypertension / 中国普通外科杂志

Objective To evaluate the safety and efficacy of laparoscopic splenectomy plus esophagogastric devascularization for the treatment of portal hypertensive variceal bleeding and secondary hypersplenism. Methods Laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach were performed in ten cirrhotic patients between January 2000 and July 2005. Esophageal transection and reanastomosis performed by a stapler at the lower end of the esophagus was added to two patients through a small accessory incision. Results The procedure was successful in all cases without conversion to open surgery. The operation time ranged from 4.5 to 5.5 hours and the blood loss was 100 ~ 400 ml. The postoperative hospital stay was 8-15 days. Conclusion Laparoscopic splenectomy and portaazygous disconnection is a feasible, effective and safe procedure as well as minimally invasive hence is applicable for patients with portal hypertension and hypersplenism.