Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Lipid Oxidation/ Frankel

295 hal.; ill., 23 cm

Review The problems of using one-dimensional methods to evaluate multifunctional food and biological antioxidants

Abstract: The activity of antioxidants in foods and biological systems is dependent on a multitude of factors, including the colloidal properties of the substrates, the conditions and stages of oxidation and the localisation of antioxidants in different phases. When testing natural antioxidants in vitro, it is therefore important to consider the system composition, the type of oxidisable substrate, the mode of accelerating oxidation, the methods to assess oxidation and how to quantify antioxidant activity. Antioxidant effectiveness is also determined by the heterogeneity and heterophasic nature of the system, the type of lipid substrate, including its physicochemical state and degree of unsaturation, the types of initiators, notably transition metals, other components and their possible interaction. For this reason there cannot be a short-cut approach to determining antioxidant activity. Each evaluation should be carried out under various conditions of oxidation, using several methods to measure different products of oxidation. Because most natural antioxidants and phytochemicals are multifunctional, a reliable antioxidant protocol requires the measurement of more than one property relevant to either foods or biological systems. Several recent studies on natural phytochemical compounds produced con¯icting results because non-speci®c one-dimensional methods were used to evaluate antioxidant activity. There is a great need to standardise antioxidant testing to minimise the present chaos in the methodologies used to evaluate antioxidants. Several methods that are more speci®c should be used to obtain chemical information that can be related directly to oxidative deterioration of food and biological systems

Principal phenolic phytochemicals in French Syrah and Grenache Rhone wines and their antioxidant activity in inhibiting oxidation of human low density lipoproteins

Wine contains natural plant phenolic antioxidants that may protect circulating lipoproteins from oxidative damage. By inhibition of the copper-catalyzed oxidation of LDL we determined the activity of thirteen Rhône coast wines exclusively from Syrah and Grenache varieties. About 50 p. cent of the wines were made with a long maceration process. Major monomeric phenolic compounds and procyanidin dimers were analyzed in each sample by HPLC and correlated with relative LDL antioxidant activity. Correlations obtained can be grouped in 3 classes: catechin (r = 0.75), procyanidins, BI, B2, B3 (r = 0.43-0.55), malvidin-3-glucoside and cyanidin (r = 0.43), gallic acid, myreeitin, rutin (r = 0.2-0.4). On the same basis total phenol contents of wines gave a correlation with LDL antioxidant activity of r = 0.72. Comparison, at the same total phenol concentration, with different red California wines shows that antioxidant activity of French Syrah and Grenache range between that of Merlot (56-65 p. cent) and Cabernet Sauvignon (37-45 p.cent). In contrast Syrah wines made with a short extraction process gave lower inhibition of LDL oxidation of 16 p. cent which is less than white Califomia wines averaging 36 p. cent. Activity of each wine phenolic compound can play a role in protecting LDL against oxidation

Antioxidant Activity of Selected Spanish Wines in Corn Oil Emulsions

7 páginas, 3 figuras, 4 tablas.Wines contain phenolic compounds that may be useful for preventing lipid oxidation as dietary antioxidants. This study was aimed at evaluating the antioxidant activity in corn oil emulsions of seventeen selected Spanish wines and two California wines. The inhibition of hydroperoxide formation at 10 μM gallic acid equivalents (GAE) varied from 8.4% to 40.2% with the red wines, from 20.9% to 45.8% with the rosé wines, and from 6.5% to 47.0% with the white wines. The inhibition of hydroperoxide formation at 20 μM GAE varied from 11.9% to 34.1% with the red wines, from 0.1% to 34.5% with the rosé wines, and from 3.3% to 37.2% with the white wines. The inhibition of hexanal formation at 10 μM GAE varied from 23.6% to 64.4% with the red wines, from 42.7% to 68.5% with the rosé wines, and from 28.4% to 68.8% with the white wines. The inhibition of hexanal formation at 20 μM GAE varied from 33.0% to 46.3% with the red wines, from 11.3% to 66.5% with the rosé wines, and from −16.7% to +21.0% with the white wines. The antioxidant effect decreased with increasing concentration. This antioxidant activity was related to the five main groups of phenolic compounds identified in wines by HPLC. The relative antioxidant activity correlated positively with the total phenol content of wines (by the Folin−Ciocalteu method and by HPLC), benzoic acids, anthocyanins, flavan-3-ols, and flavonols, for the inhibition of hydroperoxides and hexanal at 10 and 20 μM GAE.Peer reviewe