Gastrointestinal bleeding in patients with sars-cov-2 infection managed by interventional radiology

Background: This study was conducted to evaluate the technical and clinical success of trans-arterial embolization (TAE) as a treatment of gastrointestinal bleeding (GIB) in Coronavirus Disease 2019 (COVID-19) patients and to describe its safety; moreover, we describe the characteristics of these patients. Methods: Thirty-four COVID-19 hospitalized patients presented with GIB. Risk factors, drugs administered for COVID-19 infection, and clinical and biological parameters were evaluated. Furthermore, intraprocedural data and outcomes of embolization were analyzed. Results: GIB was more frequent in male. Overweight, hypertension, diabetes, previous cardiac disease, and anticoagulation preadmission (48.5%) were frequently found in our population. Previous or actual COVID Acute respiratory distress syndrome (ARDS) and a high level of D-dimer were encountered in most cases. Upper GIB was more frequent than lower GIB. Technical and clinical success rates of embolization were 88.2% and 94.1%, respectively. The complication rate was 5.9%. Conclusions: Our study highlights the most frequent characteristics of COVID-19 patients with GIB. Embolization is feasible, effective, and safe

Reproducibility of adipogenic responses to metabolism disrupting chemicals in the 3T3-L1 pre-adipocyte model system: An interlaboratory study

The 3T3-L1 murine pre-adipocyte line is an established cell culture model for screening Metabolism Disrupting Chemicals (MDCs). Despite a need to accurately identify MDCs for further evaluation, relatively little research has been performed to comprehensively evaluate reproducibility across laboratories, assess factors that might contribute to varying degrees of differentiation between laboratories (media additives, plastics, cell source, etc.), or to standardize protocols. As such, the goals of this study were to assess interlaboratory variability of efficacy and potency outcomes for triglyceride accumulation and pre-adipocyte proliferation using the mouse 3T3-L1 pre-adipocyte cell assay to test chemicals. Ten laboratories from five different countries participated. Each laboratory evaluated one reference chemical (rosiglitazone) and three blinded test chemicals (tributyltin chloride, pyraclostrobin, and bisphenol A) using: 1) their Laboratory-specific 3T3-L1 Cells (LC) and their Laboratory-specific differentiation Protocol (LP), 2) Shared 3T3-L1 Cells (SC) with LP, 3) LC with a Shared differentiation Protocol (SP), and 4) SC with SP. Blinded test chemical responses were analyzed by the coordinating laboratory. The magnitude and range of bioactivities reported varied considerably across laboratories and test conditions, though the presence or absence of activity for each tested chemical was more consistent. Triglyceride accumulation activity determinations for rosiglitazone ranged from 90 to 100% across test conditions, but 30–70 % for pre-adipocyte proliferation; this was 40–80 % for triglyceride accumulation induced by pyraclostrobin, 80–100 % for tributyltin, and 80–100 % for bisphenol A. Consistency was much lower for pre-adipocyte proliferation, with 30–70 % active determinations for pyraclostrobin, 30–50 % for tributyltin, and 20–40 % for bisphenol A. Greater consistency was observed for the SC/SP assessment. As such, working to develop a standardized adipogenic differentiation protocol represents the best strategy for improving consistency of adipogenic responses using the 3T3-L1 model to reproducibly identify MDCs and increase confidence in reported outcomes.Over-arching project supported by grants [R01 ES016099 to HMS; R00 ES030405 to CDK] from the National Institute of Environmental Health Sciences (NIEHS); University of Turin; European Union's Horizon 2020 research and innovation program under grant agreement GOLIATH No. 825489; Brunel University London; NIEHS (1K22ES026208 and R01ES027863); NIEHS (Z0ES102785); Spanish Institute of Health Carlos III (grant FIS-PI16/01812)

Spontaneous Bleedings in COVID-19 Patients: An Emerging Complication

To the Editor, We read with great interest the ‘‘Joint CIRSE-APSCVIR checklist to prepare IR departments for COVID 19,’’ recently available on the official site of CIRSE society [1], that provides a useful checklist to guarantee the healthcare professionals’ safety and to prevent the spread of the infection, focusing on interventional radiology (IR) departments. In the complex clinical scenario of COVID-19 patients, several IR procedures could be necessary to manage fluid collections, abscesses, acute thromboembolisms and hem- orrhages caused by traumas or gastrointestinal complications. Due to the growing data about the association between coronavirus infection and coagulopathy, anticoagulant therapy with low molecular weight heparin (LMWH) has become part of the medical therapy in hospitalized patients, to reduce the risk of venous thromboembolism [2]. This approach, however, may increase the risks of spontaneous bleeding, especially in elderly patients with comorbidities. Over the past 4 days, four consecutive COVID-19 patients with spontaneous bleedings underwent endovas- cular embolization in our center. The first case was a 74-year-old woman with large left pectoral muscle hema- toma due to rupture of superior thoracic artery, probably occurring during patient’s mobilization while she was on the respirator in the prone position. The second case was 71-year-old male with large hematoma of left iliopsoas muscle; the patient required electrical cardioversion 2 days before due to atrial fibrillation, possibly causing traumatic injury of lumbar arteries [3]. On the 3rd day, we observed a large rectus sheath hematoma extending into the prevesical space of Retzius fed by both the right and left inferior epigastric arteries, in a 71-year-old woman with renal insufficiency. All three cases were prescribed 6000UI LMWH/12 h. The last case was a 81-year-old man with a large hematoma of the left thigh fed by multiple branches of the profunda femoral artery, who was prescribed a unusual high dose of LMWH (8000UI/12 h). All cases were successfully managed by coil embolization. We have organized our IR workflow for COVID-19 patients, paying particular attention to the planning of dedicated workflows and protocols, staff training, prepa- ration of the angiosuite before the patient’s arrival, and accurate staff decontamination and cleaning of the rooms after the procedure. In the specific setting of hemorrhage, we realized the importance of having blood products already available in the angiosuite even in hemodynami- cally stable patients, in case blood transfusion is needed during the procedure. Moreover, while planning the dedi- cated workflows, it is important to take into account the role of the anesthesiologist. In the specific case of a COVID-19 patient, the anesthesiologist accompanies the patient from the intensive care unit to the angiographic suite. This condition implies that he/she is to be considered ‘‘contaminated’’ when entering the angiosuite. To ensure radiation protection, dedicated aprons and thyroid shields should made be available to be worn by the anesthesiolo- gist above the potentially contaminated personal protective equipments, before entering the angiosuite. They would then be decontaminated at the end of the procedure. In conclusion, in the complex clinical scenario of COVID-19 patients, we should take into account also a possible risk of coagulopathy and spontaneous bleeding, which would require active involvement of IRs in an emergency setting. Prophylaxis with LMWH has been recommended in these patients, although it should be administered with caution, taking into account comorbidi- ties, possible disease-related thrombocytopenia and potential interactions with other drugs. IR units must therefore be prepared to manage bleedings, by setting specific workflows and paying attention to any potential source of contamination