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How do German general practitioners manage Long-/Post-COVID? A qualitative study in primary care
(2023)
Background: Many patients with ongoing complaints after a SARS-CoV-2 infection are treated in primary care. Existing medical guidelines on how to diagnose and treat Long-/Post-COVID are far from being comprehensive. This study aims to describe how German general practitioners (GPs) deal with this situation, what problems they experience when managing such patients, and how they solve problems associated with the diagnosis and treatment of Long-/Post-COVID.
Methods and Findings: We conducted a qualitative study and interviewed 11 GPs. The most commonly described symptoms were ongoing fatigue, dyspnea, chest tightness and a decrease in physical capacity. The most common way to identify Long-/Post-COVID was by exclusion. Patients suffering from Long-/Post-COVID were generally treated by their GPs and rarely referred. A very common non-pharmacological intervention was to take a wait-and-see approach and grant sick leave. Other non-pharmacological interventions included lifestyle advices, physical exercise, acupuncture and exercises with intense aromas. Pharmacological treatments focused on symptoms, like respiratory symptoms or headaches. Our study’s main limitations are the small sample size and therefore limited generalizability of results.
Conclusions: Further research is required to develop and test pharmaceutical and non-pharmaceutical interventions for patients with Long-/Post-COVID. In addition, strategies to prevent the occurrence of Long-/Post-COVID after an acute infection with SARS-CoV-2 have to be developed. The routine collection of data on the diagnosis and management of Long-/Post-COVID may help in the formulation of best practices. It is up to policymakers to facilitate the necessary implementation of effective interventions in order to limit the huge societal consequences of large groups of patients suffering from Long-/Post-COVID.
We present cross sections for the reaction e+e−→K0SK0L at center-of-mass energies ranging from 3.51 GeV to 4.95 GeV using data samples collected in the BESIII experiment, corresponding to a total integrated luminosity of 26.5 fb−1. The ratio of neutral-to-charged kaon form factors at large momentum transfers (12 GeV2<Q2<25 GeV2) is determined to be 0.21±0.01, which indicates a small but significant effect of flavor-SU(3) breaking in the kaon wave function, and consequently excludes the possibility that flavor-SU(3) breaking is the primary reason for the strong experimental violation of the pQCD prediction |F(π±)|/|F(K±)|=f2π/f2K, where F(π±) and F(K±) are the form factors, and fπ and fK are the decay constants of charged pions and kaons, respectively. We also observe a significant signal for the charmless decay ψ(3770)→K0SK0L for the first time. Within a 1σ contour of the likelihood value, the the branching fraction for ψ(3770)→K0SK0L is determined to be B=(2.63+1.40−1.59)×10−5, and the relative phase between the continuum and ψ(3770) amplitudes is ϕ=(−0.39+0.05−0.10)π. The branching fraction is in good agreement with the S- and D-wave charmonia mixing scheme proposed in the interpretation of the "ρπ puzzle" between J/ψ and ψ(3686) decays.
With a data sample corresponding to an integrated luminosity of 11.5~fb−1 collected with the BESIII detector operating at the BEPCII storage ring, for the first time the light hadron decay χc1(3872)→π+π−η is searched for. While no significant signal is observed, the upper limits at the 90\% confidence level for σ[e+e−→γχc1(3872)]B[χc1(3872)→π+π−η] at center-of-mass energies from 4.13 to 4.34 GeV are determined. By normalizing to the χc1(3872)→π+π−J/ψ decay channel, a 90\% confidence level upper limit for the branching fraction ratio R=B[χc1(3872)→π+π−η]/B[χc1(3872)→π+π−J/ψ]<0.12 is given. These measurements provide important inputs for understanding the internal structure of the χc1(3872) resonance.
A massless particle beyond the Standard Model is searched for in the two-body decay Σ+→p+invisible using (1.0087±0.0044)×1010 J/ψ events collected at a center-of-mass energy of s√=3.097 GeV with the BESIII detector at the BEPCII collider. No significant signal is observed, and the upper limit on the branching fraction B(Σ+→p+invisible) is determined to be 3.2×10−5 at the 90% confidence level. This is the first search for a flavor-changing neutral current process with missing energy in hyperon decays which plays an important role in constraining new physics models.
The low-threshold L-type calcium channel Cav1.3 accelerates the pacemaker rate in the heart, but its functional role for the extended dynamic range of neuronal firing is still unresolved. Here, we show that Cav1.3 calcium channels act as unexpectedly simple, full-range linear amplifiers of firing rates for lateral dopamine substantia nigra (DA SN) neurons in mice. This means that they boost in vitro or in vivo firing frequencies between 2 and 50 hertz by about 30%. Furthermore, we demonstrate that clinically relevant, low nanomolar concentrations of the L-type channel inhibitor isradipine selectively reduce the in vivo firing activity of these nigrostriatal DA SN neurons at therapeutic plasma concentrations. Thus, our study identifies the pacemaker function of neuronal Cav1.3 channels and provides direct evidence that repurposing dihydropyridines such as isradipine is feasible to selectively modulate the in vivo activity of highly vulnerable DA SN subpopulations in Parkinson's disease.
Marine stratocumuli are the most dominant cloud type by area coverage in the Southern Ocean (SO). They can be divided into different self-organized cellular morphological regimes known as open and closed mesoscale-cellular convective (MCC) clouds. Open and closed cells are the two most frequent types of organizational regimes in the SO. Using the liDAR-raDAR (DARDAR) version 2 retrievals, we quantify 59 % of all MCC clouds in this region as mixed-phase clouds (MPCs) during a 4-year time period from 2007 to 2010. The net radiative effect of SO MCC clouds is governed by changes in cloud albedo. Both cloud morphology and phase have previously been shown to impact cloud albedo individually, but their interactions and their combined impact on cloud albedo remain unclear.
Here, we investigate the relationships between cloud phase, organizational patterns, and their differences regarding their cloud radiative properties in the SO. The mixed-phase fraction, which is defined as the number of MPCs divided by the sum of MPC and supercooled liquid cloud (SLC) pixels, of all MCC clouds at a given cloud-top temperature (CTT) varies considerably between austral summer and winter. We further find that seasonal changes in cloud phase at a given CTT across all latitudes are largely independent of cloud morphology and are thus seemingly constrained by other external factors. Overall, our results show a stronger dependence of cloud phase on cloud-top height (CTH) than CTT for clouds below 2.5 km in altitude.
Preconditioning through ice-phase processes in MPCs has been observed to accelerate individual closed-to-open cell transitions in extratropical stratocumuli. The hypothesis of preconditioning has been further substantiated in large-eddy simulations of open and closed MPCs. In this study, we do not find preconditioning to primarily impact climatological cloud morphology statistics in the SO. Meanwhile, in-cloud albedo analysis reveals stronger changes in open and closed cell albedo in SLCs than in MPCs. In particular, few optically thick (cloud optical thickness >10) open cell stratocumuli are characterized as ice-free SLCs. These differences in in-cloud albedo are found to alter the cloud radiative effect in the SO by 21 to 39 W m−2 depending on season and cloud phase.
Acute myeloid leukemia (AML) is a heterogeneous malignancy characterized by the accumulation of undifferentiated white blood cells (blasts) in the bone marrow. Valosin-containing protein (VCP) is an abundant molecular chaperone that extracts ubiquitylated substrates from protein complexes and cellular compartments prior to their degradation by the proteasome. We found that treatment of AML cell lines with the VCP inhibitor CB-5083 leads to an accumulation of ubiquitylated proteins, activation of unfolded protein response (UPR) and apoptosis. Using quantitative mass spectrometry-based proteomics we assessed the effects of VCP inhibition on the cellular ubiquitin-modified proteome. We could further show that CB-5083 decreases the survival of the AML cell lines THP-1 and MV4-11 in a concentration-dependent manner, and acts synergistically with the antimetabolite cytarabine and the BH3-mimetic venetoclax. Finally, we showed that prolonged treatment of AML cells with CB-5083 leads to development of resistance mediated by mutations in VCP. Taken together, inhibition of VCP leads to a lethal unfolded protein response in AML cells and might be a relevant therapeutic strategy for treatment of AML, particularly when combined with other drugs. The toxicity and development of resistance possibly limit the utility of VCP inhibitors and have to be further explored in animal models and clinical trials.
Background: Only one previously published study by Nocera et al. addressed the risk of upstaging to ≥pT3 in cT1 clear cell renal cell carcinoma (ccRCC) by using characteristics of the R.E.N.A.L and PADUA score (age, tumor size, rim location, exophytic rate, polar involvement) developing an accurate nomogram. However, this nomogram has never been externally validated yet.
Material and methods: The study cohort consisted of 288 patients with cT1a-b ccRCC, diagnosed between 2008-2021 at the University Hospital Frankfurt, Germany. Analyses addressed clinical, tumor and radiographic characteristics. The external validation of the nomogram relied on accuracy calculations derived from the area under the curve of the receiver operator characteristic analysis.
Results: Overall, 11.8% (n=34) patients harbored ≥pT3 ccRCC. Median radiographic tumor size (3.6 vs. 5.3cm), R.E.N.A.L. (8 vs. 9 points) and PADUA score (9 vs. 11 points), as well as proportions of renal sinus involvement (82.4% vs. 51.6%), renal hilus involvement (44.1 vs. 13.0%), and medial rim location significantly differed between the pT1-2 and ≥pT3 group (all p ≤ 0.01). In subgroup analyses of small renal mass ccRCC patients (<4cm, cT1a), only 3.8% (n=6) patients had ≥pT3 pathology. Upstaged patients were significantly older and more frequently had endophytic tumor than pT1-2 counterparts (p<0.05). The external validation of the Nocera nomogram showed a good accuracy of 76.6%. Using the suggested cut-off of 21%, 26.5% of patients exhibited ≥pT3 ccRCC. Conversely, within patients below cut-off, 5.9% patients exhibited ≥pT3 ccRCC.
Conclusion: We reported the first external validation of the nomogram addressing the risk of ≥pT3 in cT1 ccRCC patients, demonstrating a good accuracy, with a low false-negative rate. Therefore, the nomogram can accurately be used for patients’ counselling and treatment decision making.
Implementation and evaluation of a Tele-OSCE in oral and maxillofacial surgery – a pilot report
(2022)
Background: The ongoing changes in learning and education towards digitalisation have been rapidly accelerated by the COVID-19 pandemic. Especially in dental education where contact to the oral cavity is an integral part of training the chosen digital examination methods and training formats must undergo high requirements to full fill the goal of a real alternative to face-to-face exams. Therefore, this study compared student performance in a newly developed Tele-OSCE with a prior OSCE examinations in presence within an oral- and maxillofacial surgery curriculum.
Methods: Study participants were fourth-year (in a five year curriculum) dental students and board certified maxillofacial surgeons (examiners) that took part in a newly developed Tele-OSCE that comprised three five-minute stations (structured facial examination, management mandibular fracture and squamous cell carcinoma) using the zoom® software. Student performance was measured using validated OSCE-Checklists and compared to a previous OSCE examination from the winter term 2019 with the same OSCE stations that was conducted in presence. Significant differences were tested using the Mann-Whitney U test. Furthermore, the new Tele-OSCE was evaluated by students and examiners using previously developed questionnaires.
Results: Sixty-six dental students (study group: n=34, summer term 2021, control group: n=32 winter term 2019) and nine examiners participated in the study. Compared to previous non-pandemic OSCEs, there were no significant (p=0.53) differences in overall student performance. Evaluation of the Tele-OSCE showed that the demonstration and rating of practical skills was limited due to missing standard patients or phantoms, however, students did not fear to be misjudged. The demonstration and rating of anamnestic and consultation competencies was seen as unproblematic by students and examiners.
Discussion: This pilot-study showed the feasibility of a Tele-OSCE as a formative examination in dental education. However, both students and examiners felt that the demonstration and assessment of practical skills was limited due the new examination format. Nevertheless, Tele-OSCEs might offer an alternative to enable students to complete their dental training.
Seismic arrays provide tools for the localization of events without clear phases or events outside the network, where the station coverage prohibits classical localization techniques. Beam forming allows the determination of the direction (back azimuth) and horizontal (apparent) velocity of an incoming wavefront. Here we combine multiple arrays to retrieve event epicentres from the area of intersecting beams without the need to specify a velocity model. The analysis is performed in the time domain, which allows selecting a relatively narrow time window around the phase of interest while preserving frequency bandwidth. This technique is applied to earthquakes and hybrid events in the region of Fogo and Brava, two islands of the southern chain of the Cape Verde archipelago. The results show that the earthquakes mainly originate near Brava, whereas the hybrid events are located on Fogo. By multiple-event beam stacking we are able to further constrain the epicentral locations of the hybrid events in the northwestern part of the collapse scar of Fogo. In previous studies, these events were attributed to shallow hydrothermal processes. However, we obtain relatively high apparent velocities at the arrays, pointing to either deeper sources or complex ray paths. For a better understanding of possible errors of the multi-array analysis, we also compare slowness values obtained from the array analysis with those derived from earthquake locations from classical (local network) localizations. In general, the results agree well. Nevertheless, some systematic deviations of the array-derived back-azimuth and slowness values occur that can be quantified for certain event locations.