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BACKGROUND: Severity of radiographic abnormalities on chest radiograph in subjects with COVID-19 has been shown to be associated with worse outcomes, but studies are limited by different scoring systems, sample size, subject age, and study duration. Data regarding the longitudinal evolution of radiographic abnormalities and its association with outcomes are scarce. We sought to evaluate these questions using a well-validated scoring system (the Radiographic Assessment of Lung Edema [RALE] score) using data over 6 months from a large, multihospital health care system. METHODS: We collected clinical and demographic data and quantified ra-diographic edema on chest radiograph obtained in the emergency department (ED) as well as on days 1-2 and 3-5 (in those admitted) in subjects with a nasopharyngeal swab positive for SARS-CoV-2 by polymerase chain reaction (PCR) visiting the ED for coronavirus disease 2019 (COVID)-19-related complaints between March-September 2020. We examined the association of baseline and longitudinal evolution of radiographic edema with severity of hypoxemia and clinical outcomes. RESULTS: Eight hundred and seventy subjects were included (median age 53.6; 50.8% female). Inter-rate agreement for RALE scores was excellent (interclass correlation coefficient 0.84 [95% CI 0.82-0.87], P < .001). RALE scores correlated with hypoxemia as quantified by SpO2/FIO2 (r = -0.42, P < .001). Admitted subjects had higher RALE scores than those discharged (6 [2-11] vs 0 [0-3], P < .001). An increase of RALE score ≥ 4 was associated with worse 30-d survival (P = .006). Larger increases in the RALE score were associated with worse survival. CONCLUSIONS: The RALE score was reproducible and easily implementable in adult subjects presenting to the ED with COVID-19. Its association with physiologic parameters and outcomes at baseline and longitudinally makes it a readily available tool for prognostication and early ICU triage, particularly in patients with worsening radiographic edema. [ABSTRACT FROM AUTHOR]

BackgroundPatients with severe acute respiratory distress syndrome (ARDS) typically receive ultra-protective ventilation after extracorporeal membrane oxygenation (ECMO) is initiated. While the benefit of ECMO appears to derive from supporting “lung rest”, reductions in the intensity of mechanical ventilation, principally tidal volume limitation, may manifest radiologically. This study evaluated the relative changes in radiographic assessment of lung edema (RALE) score upon venovenous ECMO initiation in patients with severe ARDS.MethodsDigital chest x-rays (CXR) performed at baseline immediately before initiation of ECMO, and at intervals post (median 1.1, 2.1, and 9.6 days) were reviewed in 39 Adult ARDS patients. One hundred fifty-six digital images were scored by two independent, blinded radiologists according to the RALE (Radiographic Assessment of Lung Edema) scoring criteria. Ventilatory data, ECMO parameters and fluid balance were recorded at corresponding time points. Multivariable analysis was performed analyzing the change in RALE score over time relative to baseline.ResultsThe RALE score demonstrated excellent inter-rater agreement in this novel application in an ECMO cohort. Mean RALE scores increased from 28 (22–37) at baseline to 35 (26–42) (p < 0.001) on D1 of ECMO; increasing RALE was associated with higher baseline APACHE III scores [ß value +0.19 (0.08, 0.30) p = 0.001], and greater reductions in tidal volume [ß value −2.08 (−3.07, −1.10) p < 0.001] after ECMO initiation. Duration of mechanical ventilation, and ECMO support did not differ between survivors and non-survivors.ConclusionsThe magnitude of reductions in delivered tidal volumes correlated with increasing RALE scores (radiographic worsening) in ARDS patients receiving ECMO. Implications for patient centered outcomes remain unclear. There is a need to define appropriate ventilator settings on venovenous ECMO, counterbalancing the risks vs. benefits of optimal “lung rest” against potential atelectrauma.

The Radiographic Assessment of Lung Edema (RALE) score has been used to estimate the extent of pulmonary damage in patients with acute respiratory distress syndrome and might be useful in patients with COVID-19. To examine factors associated with the need for mechanical ventilation in hospitalized patients with a clinical diagnosis of COVID-19, and to estimate the predictive value of the RALE score. In a series of patients admitted between April 14 and August 28, 2020, with a clinical diagnosis of COVID-19, we assessed lung involvement on the chest radiograph using the RALE score. We examined factors associated with the need for mechanical ventilation in bivariate and multivariate analysis. The area under the receiver operating curve (AUC) indicated the predictive value of the RALE score for need for mechanical ventilation. Among 189 patients, 90 (48%) were judged to need mechanical ventilation, although only 60 were placed on a ventilator. The factors associated with the need for mechanical ventilation were a RALE score >6 points, age >50 years, and presence of chronic kidney disease. The AUC for the RALE score was 60.9% (95% CI 52.9–68.9), indicating it was an acceptable predictor of needing mechanical ventilation. A score for extent of pulmonary oedema on the plain chest radiograph was a useful predictor of the need for mechanical ventilation of hospitalized patients with COVID-19. [ABSTRACT FROM AUTHOR]

Mariana A Vetrici,1,* Soheila Mokmeli,2,* Andrew R Bohm,3 Monica Monici,4 Scott A Sigman5,* 1Department of Biological Sciences, University of Lethbridge, Lethbridge, AB, Canada; 2Training Institute, Canadian Optic and Laser Center, Victoria, BC, Canada; 3Department of Orthopedics, Lenox Hill Hospital, New York, NY, USA; 4ASA Campus J.L., ASA Res. Division – Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; 5Department of Orthopedics, Lowell General Hospital, Lowell, MA, 01863, USA*These authors contributed equally to this workCorrespondence: Scott A SigmanDepartment of Orthopedics, Lowell General Hospital, 295 Varnum Avenue, Lowell, MA, 01863, USATel +1 978 856 7676Email sasigmanmd@icloud.comPurpose: Evidence-based and effective treatments for COVID-19 are limited, and a new wave of infections and deaths calls for novel, easily implemented treatment strategies. Photobiomodulation therapy (PBMT) is a well-known adjunctive treatment for pain management, wound healing, lymphedema, and cellulitis. PBMT uses light to start a cascade of photochemical reactions that lead to local and systemic anti-inflammatory effects at multiple levels and that stimulate healing. Numerous empirical studies of PBMT for patients with pulmonary disease such as pneumonia, COPD and asthma suggest that PBMT is a safe and effective adjunctive treatment. Recent systematic reviews suggest that PBMT may be applied to target lung tissue in COVID-19 patients. In this preliminary study, we evaluated the effect of adjunctive PBMT on COVID-19 pneumonia and patient clinical status.Patients and Methods: We present a small-scale clinical trial with 10 patients randomized to standard medical care or standard medical care plus adjunctive PBMT. The PBMT group received four daily sessions of near-infrared light treatment targeting the lung tissue via a Multiwave Locked System (MLS) laser. Patient outcomes were measured via blood work, chest x-rays, pulse oximetry and validated scoring tools for pneumonia.Results: PBMT patients showed improvement on pulmonary indices such as SMART-COP, BCRSS, RALE, and CAP (Community-Acquired Pneumonia questionnaire). PBMT-treated patients showed rapid recovery, did not require ICU admission or mechanical ventilation, and reported no long-term sequelae at 5 months after treatment. In the control group, 60% of patients were admitted to the ICU for mechanical ventilation. The control group had an overall mortality of 40%. At a 5-month follow-up, 40% of the control group experienced long-term sequelae.Conclusion: PBMT is a safe and effective potential treatment for COVID-19 pneumonia and improves clinical status in COVID-19 pneumonia.Keywords: COVID-19, low-level laser therapy, pneumonia, SMART-COP, BCRSS, RALE

Although are indispensable to telejournalism, camera operators constitute a group of legally relegated agents in the hierarchy of news production. Their role as "ralé" is related to the activity they perform, considered "technical" and manual, reflecting the lack of academic credentials for professional practice. Its consequence is the permanence of the camera operators in the zone of conflict between the laws that regulate the Brazilian radio broadcasters and journalists. Therefore, the term "amateur journalist" is used in this article to designate the academically non-certified cameramen in order to put the following question: How the performance of this agents expose the limits of journalistic authority? We analyzed 15 interviews, taking oral history as a main methodology. [ABSTRACT FROM AUTHOR]

This article aims to contextualize the entrepreneurship of a specific social class, the Brazilian Ralé. This term is used by Jessé Souza’s (2009) perspective to classify a forgotten and excluded working class. Articulately, it is used the concept of Carrieri (2012), ordinary management, to assign to the class mentioned above a work context. It is our interest an approach along the lines of Michel de Certeau (1998), analyzing strategies and tactics developed by these entrepreneurs in everyday business. This paper consists of a qualitative descriptive research in order to introduce and develop the subject from respondents reported. The article aims to enable an understanding of specificities of this kind of entrepreneurship still not present in academic discussions.

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Roasted cassava roots flour is part of a common meal in Africa, it is known as rale in Mozambique. Fifty six samples of rale were collected from homes and markets in Inhambane Province, Mozambique, for cyanogenic potential (CNp) analyses. The names of cassava varieties used for preparing the rale samples could be determined in the home-collected samples, three varieties were recorded. Xinhembwe variety gave rale samples with 30 ± 8 mg CNp/kg (mean + standard error), Precoce de angola with 43 ± 11 mg CNp/kg and Rungo sabonete with 58 ± 22 mg CNp/kg dry weight. The mean cyanogenic value for all the 56 samples collected was 41 ± 16 mg CNp/kg. Cyanogenic potentials in all the rale samples were above 10 mg HCN/kg, the value regarded by the Codex Alimentarius Commission of the FAO/WHO as safe.

Background: Patients with severe acute respiratory distress syndrome (ARDS) typically receive ultra-protective ventilation after extracorporeal membrane oxygenation (ECMO) is initiated. While the benefit of ECMO appears to derive from supporting "lung rest", reductions in the intensity of mechanical ventilation, principally tidal volume limitation, may manifest radiologically. This study evaluated the relative changes in radiographic assessment of lung edema (RALE) score upon venovenous ECMO initiation in patients with severe ARDS., Methods: Digital chest x-rays (CXR) performed at baseline immediately before initiation of ECMO, and at intervals post (median 1.1, 2.1, and 9.6 days) were reviewed in 39 Adult ARDS patients. One hundred fifty-six digital images were scored by two independent, blinded radiologists according to the RALE (Radiographic Assessment of Lung Edema) scoring criteria. Ventilatory data, ECMO parameters and fluid balance were recorded at corresponding time points. Multivariable analysis was performed analyzing the change in RALE score over time relative to baseline., Results: The RALE score demonstrated excellent inter-rater agreement in this novel application in an ECMO cohort. Mean RALE scores increased from 28 (22-37) at baseline to 35 (26-42) ( p < 0.001) on D1 of ECMO; increasing RALE was associated with higher baseline APACHE III scores [ß value +0.19 (0.08, 0.30) p = 0.001], and greater reductions in tidal volume [ß value -2.08 (-3.07, -1.10) p < 0.001] after ECMO initiation. Duration of mechanical ventilation, and ECMO support did not differ between survivors and non-survivors., Conclusions: The magnitude of reductions in delivered tidal volumes correlated with increasing RALE scores (radiographic worsening) in ARDS patients receiving ECMO. Implications for patient centered outcomes remain unclear. There is a need to define appropriate ventilator settings on venovenous ECMO, counterbalancing the risks vs. benefits of optimal "lung rest" against potential atelectrauma., Competing Interests: Author KS is a member of the ECMONet scientific committee, the Asia-Pacific ELSO educational committee, and Australia and New Zealand's Intensive Care Society COVID-19 working group; he is also the lead of an ECMOed research working group and KS acknowledges research support from Metro North Hospital and Health Service. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Worku, Yeung, Anstey and Shekar.)

Objective To summarize the application of analogiczl acupoints, defined as a group of acupoints directed at the same disease. by data mining method on literature related to acupuncture and moxi-bustion treatment on dysmenorrheal in latest 10 years. Methods By the way of computer retrieval of Chinese Journal Full-Text database (CNK1) and Wanfang database ( WF) and VIP database, a total 128 articles from 2010 to 2016 related to acupuncture and moxibustion treatment on dysmenorrheal were searched and sorted out. And the acupoints recorded were input into the computer and analyzed. Results There were 49 analogiczl points, of which 47 points at fourteen meridians and 2 extra points. The leading three points were Sanyinjiao (SP 6) , Guanyuan (CV 4) and Zhongji (RN 3) ; the leading meridians were bladder meridian of foot-Taiyang and Ren meridian; the location of the acupoints were almost located on thoracic abdomen and low back. According to the frequency, the analogiczl points were classified into three grades; 9 of first-grade, 13 of second-grade and 27 of third-grade. Conclusion The concept of “analogiczl acupoints” make a further interpretation of the synergetic effect of combination of acupoints, which would guide the selection of acupuncture prescription to improve the clinical effectiveness. [ABSTRACT FROM AUTHOR]

Imaging plays an important role in assessing the severity of COVID-19 pneumonia. Recent COVID-19 research indicates that the disease progress propagates from the bottom of the lungs to the top. However, chest radiography (CXR) cannot directly provide a quantitative metric of radiographic opacities, and existing AI-assisted CXR analysis methods do not quantify the regional severity. In this paper, to assist the regional analysis, we developed a fully automated framework using deep learning-based four-region segmentation and detection models to assist the quantification of COVID-19 pneumonia. Specifically, a segmentation model is first applied to separate left and right lungs, and then a detection network of the carina and left hilum is used to separate upper and lower lungs. To improve the segmentation performance, an ensemble strategy with five models is exploited. We evaluated the clinical relevance of the proposed method compared with the radiographic assessment of the quality of lung edema (RALE) annotated by physicians. Mean intensities of segmented four regions indicate a positive correlation to the regional extent and density scores of pulmonary opacities based on the RALE. Therefore, the proposed method can accurately assist the quantification of regional pulmonary opacities of COVID-19 pneumonia patients. [ABSTRACT FROM AUTHOR]