Objectives
Vitamin D deficiency was previously correlated with incidence and severity of coronavirus disease 2019 (COVID-19). We investigated the association between serum 25-hydroxyvitamin D (25(OH)D) level on admission and radiologic stage and outcome of COVID-19 pneumonia.
Methods
A retrospective observational trial was done on 186 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–infected individuals hospitalized from March 1, 2020, to April 7, 2020, with combined chest computed tomography (CT) and 25(OH)D measurement on admission. Multivariate regression analysis was performed to study if vitamin D deficiency (25(OH)D <20 ng/mL) correlates with survival independently of confounding comorbidities.
Results
Of the patients with COVID-19, 59% were vitamin D deficient on admission: 47% of females and 67% of males. In particular, male patients with COVID-19 showed progressively lower 25(OH)D with advancing radiologic stage, with deficiency rates increasing from 55% in stage 1 to 74% in stage 3. Vitamin D deficiency on admission was not confounded by age, ethnicity, chronic lung disease, coronary artery disease/hypertension, or diabetes and was associated with mortality (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.30-11.55), independent of age (OR, 1.09; 95% CI, 1.03-1.14), chronic lung disease (OR, 3.61; 95% CI, 1.18-11.09), and extent of lung damage expressed by chest CT severity score (OR, 1.12; 95% CI, 1.01-1.25).
Conclusions
Low 25(OH)D levels on admission are associated with COVID-19 disease stage and mortality.
CT with structured CO-RADS scoring has good diagnostic performance for COVID-19 pneumonia in both symptomatic (AUC=0.89) and asymptomatic (AUC=0.70) individuals (P<0.001). • In symptomatic individuals (42% PCR+), CO-RADS ≥ 3 detected positive PCR with acceptable sensitivity (89%) and specificity (73%) resulting in PPV of 70%. • In asymptomatic individuals (5% PCR+), CO-RADS ≥ 3 detected SARS-CoV-2 infection with low sensitivity (45%) but high specificity (89%) and PPV of 18%.
This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.
Decisions about performing coronary CT angiography (CCTA) sometimes depend on calcium scoring. CCTA is highly sensitive for coronary stenosis. With 16-MDCT, however, heavy calcification reduces specificity for significant stenosis. For 64-MDCT (and above), CCTA has high specificity, even with severe coronary calcification.
Perturbations of optic flow can induce changes in walking speed since subjects modulate their speed with respect to the speed perceived from optic flow. The purpose of this study was to examine the effects of optic flow on steady-state as well as on non steady-state locomotion, i.e. on spontaneous overground walk-to-run transitions (WRT) during which subjects were able to accelerate in their preferred way. In this experiment, while subjects moved along a specially constructed hallway, a series of stripes projected on the side walls and ceiling were made to move backward (against the locomotion direction) at an absolute speed of -2 m s(-1) (condition B), or to move forward at an absolute speed of +2 m s(-1) (condition F), or to remain stationary (condition C). While condition B and condition F entailed a decrease and an increase in preferred walking speed, respectively, the spatiotemporal characteristics of the spontaneous walking acceleration prior to reaching WRT were not influenced by modified visual information. However, backward moving stripes induced a smaller speed increase when making the actual transition to running. As such, running speeds after making the WRT were lower in condition B. These results indicate that the walking acceleration prior to reaching the WRT is more robust against visual perturbations compared to walking at preferred walking speed. This could be due to a higher contribution from spinal control during the walking acceleration phase. However, the finding that subjects started to run at a lower running speed when experiencing an approaching optic flow faster than locomotion speed shows that the actual realization of the WRT is not totally independent of external cues.
SUMMARYThe purpose of the present study was to describe the biomechanics of spontaneous walk-to-run transitions (WRTs) in humans. After minimal instructions, 17 physically active subjects performed WRTs on an instrumented runway, enabling measurement of speed, acceleration, spatiotemporal variables, ground reaction forces and 3D kinematics. The present study describes (1) the mechanical energy fluctuations of the body centre-of-mass (BCOM) as a reflection of the whole-body dynamics and (2) the joint kinematics and kinetics. Consistent with previous research, the spatiotemporal variables showed a sudden switch from walking to running in one transition step. During this step there was a sudden increase in forward speed, the so-called speed jump (0.42ms ) and an abrupt change from an out-of-phase to an in-phase organization of the kinetic and potential energy fluctuations. During the transition step a larger net propulsive impulse compared with the preceding and following steps was observed due to a decrease in the braking impulse. This suggests that the altered landing configuration (prepared during the last 40% of the preceding swing) places the body in an optimal configuration to minimize this braking impulse. We hypothesize this configuration also evokes a reflex allowing a more powerful push off, which generates enough power to complete the transition and launch the first flight phase. This powerful push-off was also reflected in the vertical ground reaction force, which suddenly changed to a running pattern.
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