Clinical, Imaging, and Lab Correlates of Severe COVID-19 Leukoencephalopathy

BACKGROUND AND PURPOSE

Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology.

MATERIALS AND METHODS

Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included. Seven (7/27, 26%) developed an unusual pattern of "leukoencephalopathy with reduced diffusivity" on diffusion-weighted MR imaging. The remaining patients did not exhibit this pattern. Clinical and laboratory indices, as well as neuroimaging findings, were compared between groups.

RESULTS

The reduced-diffusivity group had a significantly higher body mass index (36 versus 28 kg/m², P < .01). Patients with reduced diffusivity trended toward more frequent acute renal failure (7/7, 100% versus 9/20, 45%; P = .06) and lower estimated glomerular filtration rate values (49 versus 85 mL/min; P = .06) at the time of MRI. Patients with reduced diffusivity also showed lesser mean values of the lowest hemoglobin levels (8.1 versus 10.2 g/dL, P < .05) and higher serum sodium levels (147 versus 139 mmol/L, P = .04) within 24 hours before MR imaging. The reduced-diffusivity group showed a striking and highly reproducible distribution of confluent, predominantly symmetric, supratentorial, and middle cerebellar peduncular white matter lesions (P < .001).

CONCLUSIONS

Our findings highlight notable correlations between severe COVID-19 leukoencephalopathy with reduced diffusivity and obesity, acute renal failure, mild hypernatremia, anemia, and an unusual brain MR imaging white matter lesion distribution pattern. Together, these observations may shed light on possible SARS-CoV-2 pathophysiologic mechanisms associated with leukoencephalopathy, including borderzone ischemic changes, electrolyte transport disturbances, and silent hypoxia in the setting of the known cytokine storm syndrome that accompanies severe COVID-19.

Dynamics of relativistic laser-plasma interaction on solid targets

A novel time-resolved diagnostic is used to record the critical surface motion during picosecond-scale relativistic laser interaction with a solid target. Single-shot measurements of the specular light show a redshift decreasing with time during the interaction, corresponding to a slowing-down of the hole boring process into overdense plasma. On-shot full characterization of the laser pulse enables simulations of the experiment without any free parameters. Two-dimensional particle-in-cell simulations yield redshifts that agree with the data, and support a simple explanation of the slowing-down of the critical surface based on momentum conservation between ions and reflected laser light.

An evaluation of high energy bremsstrahlung background in point-projection x-ray radiography experiments

Backlit pinhole x-ray radiography has provided high-resolution images in many recent high-energy-density laser experiments. Its aim is to image the object of interest with a roughly monochromatic Kα source. However, despite the high intrinsic brightness achieved by the technique, data on x-ray film have shown a signal to background ratio near one, with data on image plates producing a higher background. This has been attributed, without direct evidence, to the interaction of suprathermal electrons with the (high Z) pinhole substrate. We present here the first direct measurement of the hard x-rays produced by such a backlighter target and a test of an approach to reducing the background. Specifically, a thick, low-Z layer was added on the side of the substrate toward the detector, intended to stop the energetic electrons and produce smaller emissions. Results from the Omega-60 laser experiment showed that the oft-seen background signal is in the range of 60-80 keV, a plausible energy range for energetic electrons produced in the laser-irradiated plasma. It also showed a comparable level of background signal in both types of targets. The work presented here includes target design and motivating theory, as well as the unexpected findings about x-ray background production.

Detecting protein sequence conservation via metric embeddings

MOTIVATION

Comparing two protein databases is a fundamental task in biosequence annotation. Given two databases, one must find all pairs of proteins that align with high score under a biologically meaningful substitution score matrix, such as a BLOSUM matrix (Henikoff and Henikoff, 1992). Distance-based approaches to this problem map each peptide in the database to a point in a metric space, such that peptides aligning with higher scores are mapped to closer points. Many techniques exist to discover close pairs of points in a metric space efficiently, but the challenge in applying this work to proteomic comparison is to find a distance mapping that accurately encodes all the distinctions among residue pairs made by a proteomic score matrix. Buhler (2002) proposed one such mapping but found that it led to a relatively inefficient algorithm for protein-protein comparison.

RESULTS

This work proposes a new distance mapping for peptides under the BLOSUM matrices that permits more efficient similarity search. We first propose a new distance function on peptides derived from a given score matrix. We then show how to map peptides to bit vectors such that the distance between any two peptides is closely approximated by the Hamming distance (i.e. number of mismatches) between their corresponding bit vectors. We combine these two results with the LSH-ALL-PAIRS-SIM algorithm of Buhler (2002) to produce an improved distance-based algorithm for proteomic comparison. An initial implementation of the improved algorithm exhibits sensitivity within 5% of that of the original LSH-ALL-PAIRS-SIM, while running up to eight times faster.