Advancements in Sensor Technologies and Control Strategies for Lower-Limb Rehabilitation Exoskeletons: A Comprehensive Review.

Lower-limb rehabilitation exoskeletons offer a transformative approach to enhancing recovery in patients with movement disorders affecting the lower extremities. This comprehensive systematic review delves into the literature on sensor technologies and the control strategies integrated into these exoskeletons, evaluating their capacity to address user needs and scrutinizing their structural designs regarding sensor distribution as well as control algorithms. The review examines various sensing modalities, including electromyography (EMG), force, displacement, and other innovative sensor types, employed in these devices to facilitate accurate and responsive motion control. Furthermore, the review explores the strengths and limitations of a diverse array of lower-limb rehabilitation-exoskeleton designs, highlighting areas of improvement and potential avenues for further development. In addition, the review investigates the latest control algorithms and analysis methods that have been utilized in conjunction with these sensor systems to optimize exoskeleton performance and ensure safe and effective user interactions. By building a deeper understanding of the diverse sensor technologies and monitoring systems, this review aims to contribute to the ongoing advancement of lower-limb rehabilitation exoskeletons, ultimately improving the quality of life for patients with mobility impairments.

Contamination of personal protective equipment and environmental surfaces in Fangcang shelter hospitals.

BACKGROUND: Fangcang shelter hospitals emerged as a new public health concept after COVID-19. Data regarding contamination of Fangcang shelter environments remains scarce. This study aims to investigate the extent of SARS-CoV-2 contamination on personal protective equipment and surfaces in Fangcang hospitals. METHODS: Between March and May 2022, during wave of omicron variant, a prospective study was conducted in 2 Fangcang hospitals in Shanghai, China. Swabs of personal protective equipment worn and environmental surfaces of contaminated areas, doffing rooms, and potentially contaminated areas were collected. SARS-CoV-2 RNA was detected by reverse transcription quantitative polymerase chain reaction. If viral RNA was detected, sampling was repeated after cleaning and disinfection. RESULTS: A total of 602 samples were collected. 13.3% of the personal protective equipment were contaminated. Positive rate was higher in the contaminated areas (48.4%) than in the doffing rooms (11.7%) and the potentially contaminated areas (0; P<.05). Contamination was highest in patient occupied areas (67.5%). After cleaning, samples taken at previously contaminated surfaces are all negative. CONCLUSIONS: SARS-CoV-2 RNA contamination is prevalent in Fangcang hospitals and healthcare workers are under risk of infection. Potentially contaminated areas and surfaces after cleaning and disinfection are negative, underlying the importance of infection control policy.

Evaluation of respiratory samples in etiology diagnosis and microbiome characterization by metagenomic sequencing.

BACKGROUND: The application of clinical mNGS for diagnosing respiratory infections improves etiology diagnosis, however at the same time, it brings new challenges as an unbiased sequencing method informing all identified microbiomes in the specimen. METHODS: Strategy evaluation and metagenomic analysis were performed for the mNGS data generated between March 2017 and October 2019. Diagnostic strengths of four specimen types were assessed to pinpoint the more appropriate type for mNGS diagnosis of respiratory infections. Microbiome complexity was revealed between patient cohorts and infection types. A bioinformatic pipeline resembling diagnosis results was built based upon multiple bioinformatic parameters. RESULTS: The positive predictive values (PPVs) for mNGS diagnosing of non-mycobacterium, Nontuberculous Mycobacteria (NTM), and Aspergillus were obviously higher in bronchoalveolar lavage fluid (BALF) demonstrating the potency of BALF in mNGS diagnosis. Lung tissues and sputum were acceptable for diagnosis of the Mycobacterium tuberculosis (MTB) infections. Interestingly, significant taxonomy differences were identified in sufficient BALF specimens, and unique bacteriome and virome compositions were found in the BALF specimens of tumor patients. Our pipeline showed comparative diagnostic strength with the clinical microbiological diagnosis. CONCLUSIONS: To achieve reliable mNGS diagnosis result, BALF specimens for suspicious common infections, and lung tissues and sputum for doubtful MTB infections are recommended to avoid the false results given by the complexed respiratory microbiomes. Our developed bioinformatic pipeline successful helps mNGS data interpretation and reduces manual corrections for etiology diagnosis.

Role of risk perception and government regulation in reducing over-utilization of veterinary antibiotics: Evidence from hog farmers of China.

Antibiotic residues and resistance caused by farmers' overuse of veterinary antibiotics have severely damaged global food safety, the ecological environment, and public health. How to lessen the overutilization of antibiotics is of prime concern nowadays; however, the existing literature has paid little attention. So, to fill this gap, the current study explores the role of risk perception and government regulation in reducing the over-utilization of veterinary antibiotics by gathering data from 675 hog farmers in the Hebei, Henan, Hubei, and Shandong provinces of China. The Heckman two-stage model is employed to explore the phenomenon. Meanwhile, risk perception is categorized into food security risk perception (FSRP), ecological security risk perception (ESRP), and public health risk perception (PHRP), and government regulation is measured from antibiotic prescribed policy (APP), withdrawal period policy (WPP), and antibiotic recorded policy (ARP). The results showed that the PHRP (ODC: ME = -0.073, SE = 0.018; ODG: ME = -0.125, SE = 0.047) significantly inhibits farmers' overuse of antibiotics. In contrast, the ESRP and PHRP have not shown significant results in influencing farmers' overuse of antibiotics. Moreover, the APP (ODC: ME = -0.035, SE = 0.016; ODG: ME = -0.088, SE = 0.040) and WPP (ODC: ME = -0.072, SE = 0.039; ODG: ME = -0.175, SE = 0.097) significantly reduce antibiotics overuse, but the influence of the ARP on farmers' antibiotics overuse is not apparent. Further, a moderating effect model is used to analyze the moderating effect of government regulation on farmers' overuse of antibiotics influenced by risk perception. The results showed that the APP (ODC: ME = -0.041, SE = 0.012; ODG: ME = -0.075, SE = 0.018) and WPP (ODC: ME = -0.058, SE = 0.015; ODG: ME = -0.076, SE = 0.019) positively influence farmers' overuse of antibiotics impacted by public health risk perception. In contrast, the ARP has no positive reinforcement effect. Finally, the study proposes that government should devolve the supervision power to veterinarians, strengthen the regulation policy advocacy, conduct training programs for farmers regarding skills to use antibiotics, and strengthen biosafety measures.

Assessing the role of internet in reducing overuse of livestock antibiotics by utilizing combination of novel damage control and 2-SLS approaches: Risk, responsibility, and action.

Reducing farmers' overuse of livestock antibiotics is very essential to ensure food, environment, and public health safety. Currently, the "internet + " has emerged as a new initiative to stimulate the development of rural industries by alleviating farmers' information constraints, lack of skills, and knowledge deficiencies. However, very few studies have focused on this issue, and studies specifically focused on the role of the Internet in reducing the overuse of livestock antibiotics are still very limited. To fill this existing research gap, this study aims to investigate the role of the Internet in reducing the overuse of livestock antibiotics using data of 426 farmers based in three provinces, including the Hebei, Henan, and Hubei provinces of China. To analyze the collected data, we first employ a damage control model to estimate the marginal productivity of farmer use of livestock antibiotics and then use a two-stage least squares (2SLS) approach to assess the role of the Internet in reducing antibiotic overuse. The findings of our study show that the marginal productivity of farmers' use of livestock antibiotics by farmers is 0.0079 (approaching 0), indicating that the overuse of antibiotics has become the realistic response of farmers. Our results further reveal that the Internet has a significant inhibitory effect on the overuse of livestock antibiotics by farmers. The Internet can reduce the use of antibiotics by 1.3147 yuan/head by improving your knowledge and skills about antibiotics. The further findings of our study reveal that the educational level and organizational participation of farmers are also important driving factors to reduce the overuse of livestock antibiotics. Furthermore, the findings of this study validate the role of gender, age, and educational level in the non-linear effect of the Internet on farmers' overuse of antibiotics. In conclusion, the findings of this study provide insight for policy makers in motivating farmers to reduce antibiotic overuse by strengthening rural internet infrastructure, implementing skill training, improving supervision, and establishing an incentive mechanism for the standard use of antibiotics.

Assessing Increased Activities of the Forearm Muscles Due to Anti-Vibration Gloves: Construct Validity of a Refined Methodology.

OBJECTIVE: The primary aim was to test the construct validity of a surface electromyography (EMG) measurement protocol, indirectly assessing the effects of anti-vibration (AV) gloves on activities of the forearm muscles. BACKGROUND: AV gloves impose a relatively higher grip demand and thus a higher risk for musculoskeletal disorders. Consequently, activities of the forearm muscles should be considered when assessing AV glove performance. METHOD: Effects of AV gloves on activities of the forearm muscles (ECR: extensor carpi radialis longus; ED: extensor digitorum; FCR: flexor carpi radialis; FDS: flexor digitorum superficialis) were measured via EMG, while gripping a handle with two grip force levels. Fifteen subjects participated with 11 glove conditions, including one with bare hand. RESULTS: Activities of ECR, FCR, mean of ECR and FCR (ECR_FCR), and mean of all four muscles were sensitive to wearing gloves. Compared with bare hand, combined ECR_FCR activities increased by 22%-78% (mean = 48%, SD = 28%) with gloves. The correlation coefficient (r) of ECR_FCR activities with glove thickness and manual dexterity scores were 0.74 (p < .05) and 0.90 (p < .001), respectively. CONCLUSIONS: A refined EMG methodology was the most sensitive to AV gloves with specific forearm muscles (ECR and FCR) and the 50-N handgrip force. Its construct validity was further substantiated by correlations with glove thickness and manual dexterity. APPLICATION: Assessment of the effect of AV gloves on activities of the forearm muscles can yield design guidance for AV gloves to reduce grip exertion by the gloved hand.

Risk Preference, Health Risk Perception, and Environmental Exposure Nexus: Evidence from Rural Women as Pig Breeders, China.

Rural women are an integral part of the agricultural economy. Still, their exposure to environmental pollution, especially in the context of risk preference and health risk perception, has not gained much attention in the existing literature. So to explore this notion, a survey and experimental data of 714 rural Chinese women as pig breeders are taken, we innovatively evaluate the degree of environmental exposure from the pre-exposure, in-exposure, post-exposure intervention of women breeders, and two-stage least squares (2SLS) method is employed to address the endogeneity issue between health risk perception and environmental exposure. The results show that rural women breeders suffer from severe environmental exposure, and the degree of environmental exposure is up to 72.102(Min = 0, Max = 100). Risk preference also emerges as a crucial determinant behind their environmental exposure, but health risk perception significantly deters the degree of environmental exposure. The health risk perception can offset risk preference effects on women breeders' environmental exposure by 15.15%. Moreover, considering the heterogeneity of the breeding scale, it is found that the impact of risk preference and health risk perception on women breeders' environmental exposure is an inverted U-shaped relationship, i.e., the results are at the turning stage when the breeding scale is 31-40 heads. Based on the empirical findings, the study offers guidelines for policymakers to enhance awareness amongst women breeders regarding health and pollution and encourage them to opt for environment-friendly breeding. Moreover, this research also has substantial guiding significance for related research on environmental exposure of rural women in other developing countries.

Unpacking the myth between increased government initiatives and reduced selling of dead live stocks in China: An approach towards exploring hidden danger of zoonotic diseases.

Prohibiting the unsafe sale of livestock that have died in production and harmlessly disposing of them are key measures to control and prevent outbreaks of zoonotic diseases and exert a great significance for maintaining meat-derived food and public health safety. However, under the strict implementation of governmental initiatives, some farmers still choose to sell dead livestock unsafely in developing countries such as China, Brazil, Mexico, and Kenya, which have become an important hidden danger in preventing and controlling zoonotic diseases. Based on data from 496 pig farmers in Hebei, Henan, and Hubei, China, the Double Hurdle Model was employed to explore the impact of governmental initiatives on the willingness and proportion of dead pigs sold unsafely by farmers. Besides, based on the heterogeneity of organization participation and breeding scale, the impact of governmental initiatives on different scale farmers' unsafely selling behaviors is also discussed. The results showed that the harmless disposal subsidy significantly reduces farmers' willingness to unsafely sell dead pigs (SW, RC = -0.0666, and SE = 0.0261). Still, the impact on the proportion is weak (SP, RC = -0.0502, and SE = 0.0474). Though the effect of supervision punishment is greatly weakened (SW, RC =-0.0381, and SE = 0.0324; SP, RC = -0.0204 and SE = 0.0263), it can significantly enhance the effect of harmless disposal subsidy by creating a good law-abiding environment (SW, RC = -0.1370, and SE = 0.0374; SP, RC = -0.0820, and SE = 0.0431). Governmental initiatives have an undue impact on the unsafe sale of dead livestock by farmers participating in cooperatives. The effects of these measures on different scale farmers' unsafe sale of dead pigs are highly heterogeneous. In addition, the study also found that food and public health safety risk perceptions are important endogenous drivers for curbing farmers selling dead pigs. This research can also provide important inspiration for other countries. The government should raise farmers' risk perception level of food and public safety, optimize governmental initiatives, play the key role of cooperative organization, increase the proportion of dead pigs harmlessly disposed of, and finally eliminate new hidden dangers in the prevention and control of zoonotic diseases.

Low CD4 T cell count predicts radiological progression in severe and critically ill COVID-19 patients: a case control study.

BACKGROUND: Novel coronavirus disease (COVID-19) has spread globally and caused over 3 million deaths, posing great challenge on public health and medical systems. Limited data are available predictive factors for disease progression. We aim to assess clinical and radiological predictors for pulmonary aggravation in severe and critically ill COVID-19 patients. METHODS: Patients with confirmed COVID-19 in Renmin Hospital of Wuhan University, China, between Feb. 6th, 2020 and Feb. 21st, 2020 were retrospectively collected. Enrolled patients were divided into non-progression group and progression group based on initial and follow-up chest CTs. Clinical, laboratory, and radiological variables were analyzed. RESULTS: During the study period, 162 patients were identified and a total of 126 patients, including 97 (77.0%) severe cases and 29 (23.0%) critically ill cases were included in the final analysis. Median age was 66.0 (IQR, 56.0-71.3) years. Median time from onset to initial chest CT was 15.0 (IQR, 12.0-20.0) days and median interval to follow-up was 7.0 (IQR, 5.0-7.0) days. Compared with those who did not progress (n=111, 88.1%), patients in the progression group (n=15, 11.9%) had significantly higher percentage of peak body temperature >38 °C (P=0.002), lower platelet count (P=0.011), lower CD4 T cell count (P=0.002), lower CD8 count (P=0.011), higher creatine kinase level (P=0.002), and lower glomerular filtration rate (P=0.018). On both univariate and multivariable analysis, only CD4 T cell count <200/µL was significant (OR, 6.804; 95% CI, 1.450-31.934; P=0.015) for predicting pulmonary progression. CONCLUSIONS: Low CD4 T cell count predicts progression of pulmonary change in severe and critically ill patients with COVID-19.

Investigating the Links Between Vaccination Against COVID-19 and Public Attitudes Toward Protective Countermeasures: Implications for Public Health.

The COVID-19 pandemic caused by the novel coronavirus, SARS-CoV-2, is spreading globally at an unprecedented rate. To protect the world against this devastating catastrophe, vaccines for SARS-CoV-2 have been produced following consistent clinical trials. However, the durability of a protective immune response due to vaccination has not been confirmed. Moreover, COVID-19 vaccination against SARS-CoV-2 is not 100% guaranteed, as new variants arise due to mutations. Consequently, health officials are pleading with the public to take extra precautions against the virus and continue wearing masks, wash hands, and observe physical distancing even after vaccination. The current research collected data from 4,540 participants (1,825 vaccinated and 2,715 not vaccinated) in China to analyze this phenomenon empirically. The propensity score matching (PSM) model is employed to analyze the impact of vaccination against COVID-19 on participants' attitudes toward protective countermeasures. The findings showed that gender, age, education level, occupation risk, individual health risk perception, public health risk perception, social responsibility, peer effect, and government supervision are the main drivers for participants to be vaccinated with COVID-19's vaccines. The results further show that vaccination lessened participants' frequency of hand washing by 1.75 times and their compliance frequency intensity of observing physical distancing by 1.24 times. However, the rate of mask-wearing did not reduce significantly, implying that China's main countermeasure of effective mask-wearing effectively controls COVID-19. Moreover, the findings indicate that a reduction in the frequency of hand washing and observing physical distance could cause a resurgence of COVID-19. In conclusion, factors leading to the eradication of SARS-CoV-2 from the world are complex to be achieved, so the exploration of COVID-19 vaccination and people's attitude toward protective countermeasures may provide insights for policymakers to encourage vaccinated people to follow protective health measures and help in completely defeating the COVID-19 from the globe.

Influence of contract commitment system in reducing information asymmetry, and prevention and control of livestock epidemics: Evidence from pig farmers in China.

The prevention and control of infectious diseases in livestock is of great significance for maintaining the food and health of people. The main bottleneck in preventing and controlling the epidemic is asymmetrical information between farmers and the livestock department regarding dead livestock. In this pursuit, China has levied the contract commitment system to ensure farmers to cooperate with livestock departments, cooperative organizations, and other farmers by proper contract in order to combat the livestock epidemic by reporting the status of dead livestock on time. Based on the data of 514 pig farmers in Hebei, Henan, and Hubei, this research employed the Heckprobit model to explore the contract commitment system's effect on pig farmers' behavior in reporting the status of dead livestock. The outcome showed that the contract commitment system encouraged the farmers to report dead pig information promptly. Moreover, modern information channels such as mobile phones or the Internet further enhanced the contract commitment system's effectiveness. Besides, the impacts of the contract commitment system on different scale farmers are found substantially heterogeneous. Based on the empirical findings, it is confirmed that the contract commitment system should not exclude government regulatory measures and economic incentive policies. It is a useful remedy to encourage farmers to report dead livestock information on time and supports in preventing and controlling livestock epidemics. Additionally, the government should enhance and strengthen the contract commitment system, establish the channels and platforms required to deliver necessary information about epidemics, and implement differentiated policy programs for different scale farmers. More importantly, these countermeasures can also provide important guidelines for other developing countries, facing livestock epidemics.

Diagnostic accuracy of metagenomic next-generation sequencing for active tuberculosis in clinical practice at a tertiary general hospital.

BACKGROUND: To evaluate the diagnostic accuracy of metagenomic next-generation sequencing (mNGS) for active tuberculosis (TB). METHODS: We retrospectively collected 820 samples at Zhongshan Hospital, Fudan University in Shanghai, China, between 1 April 2017 and 31 March 2018. They were classified into TB cases (125, 15.2%) and NOT TB cases (695, 84.8%) according to the clinical diagnosis. Specimens were evaluated by a regular clinical microbiological assay and mNGS performed in parallel. RESULTS: Sixty-one confirmed TB cases and 64 clinical TB cases were included. The overall sensitivity of mNGS was 49.6% [95% confidence interval (95% CI), 40.6-58.6%], and the specificity was 98.3% (95% CI, 96.9-99.1%), with peak sensitivities of 88.9% (95% CI, 50.7-99.4%) for lung tissue, 55.0% (95% CI, 32.0-76.2%) for bronchoalveolar lavage fluid (BALF), and 50.0% (95% CI, 32.8-67.2%) for serous fluids. The overall sensitivity of mNGS was superior to that of the culture assay (35.2%, 95% CI, 27.0-44.3), but no superior sensitivity for sputum was observed in mNGS compared with the culture assay (mNGS: 52.3%, 95% CI, 31.1-72.6%; culture: 60.9%, 95% CI, 38.8-79.5%). In clinical TB cases, mNGS detected additional positive results (40.6%, 26/64). mNGS reduced the turnaround time from 2-6 weeks to 32-36 hours. CONCLUSIONS: mNGS may be a promising technology for the early auxiliary diagnosis of active TB, especially sputum-negative pulmonary TB (PTB) and tuberculous serous effusion.

Erratum to the effect of RAS blockers on the clinical characteristics of COVID-19 patients with hypertension.

[This corrects the article DOI: 10.21037/atm.2020.03.229.].

The clinical value of metagenomic next-generation sequencing in the microbiological diagnosis of skin and soft tissue infections.

BACKGROUND: Metagenomic next-generation sequencing (mNGS), with its comprehensiveness, is widely applied in microbiological diagnosis. Etiological diagnosis is of paramount clinical importance in patients with skin and soft tissue infections (SSTIs). However, the clinical application of mNGS in SSTIs is relatively less studied. MATERIALS AND METHODS: From April 1, 2017 to December 31, 2019, 96 SSTI cases were collected. The positive rates of pathogens detected by mNGS and culture were compared by analyzing tissue samples, pus, swabs, and/or interstitial fluids obtained from the infected parts. Modification of the antibiotic treatment strategy due to mNGS was also assessed. RESULTS: The sensitivity of mNGS for detecting pathogens in SSTI cases was superior to that of culture testing (67.7% vs 35.4%; p < 0.01). Significantly higher identification rates for viruses (10.4% vs 0.0%; p < 0.01) and anaerobes (11.5% vs 1.0%; p < 0.01) were obtained with mNGS compared to culture. Of note, rare pathogens such as Vibrio vulnificus and Bartonella henselae were also detected by mNGS. Importantly, the proportion of multi-pathogen SSTIs detected by mNGS was higher than that of multi-pathogen SSTIs detected by culture (16.7% vs 6.3%; p = 0.035). The rate of targeted antibiotic treatment was significantly higher in mNGS-positive cases than in mNGS-negative cases (41.7% vs 3.8%; p < 0.01). In culture-negative and mNGS-positive cases, the improvement rate was higher than that in mNGS-negative cases, but this was not statistically significant (75.0% vs 73.1%; p = 0.864). CONCLUSIONS: mNGS is a promising tool for the etiological diagnosis of SSTIs, particularly in identifying viruses, anaerobes, and multi-pathogen infections. The application of mNGS testing in clinical practice could change antibiotic treatment strategies and partly benefit clinical outcomes.

Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19 patients with no prior cardiovascular disease.

Introduction: To explore the involvement of the cardiovascular system in coronavirus disease 2019 (COVID-19), we investigated whether myocardial injury occurred in COVID-19 patients and assessed the performance of serum high-sensitivity cardiac Troponin I (hs-cTnI) levels in predicting disease severity and 30-day in-hospital fatality. Methods: We included 244 COVID-19 patients, who were admitted to Renmin Hospital of Wuhan University with no preexisting cardiovascular disease or renal dysfunction. We analyzed the data including patients' clinical characteristics, cardiac biomarkers, severity of medical conditions, and 30-day in-hospital fatality. We performed multivariable Cox regressions and the receiver operating characteristic analysis to assess the association of cardiac biomarkers on admission with disease severity and prognosis. Results: In this retrospective observational study, 11% of COVID-19 patients had increased hs-cTnI levels (>40 ng/L) on admission. Of note, serum hs-cTnI levels were positively associated with the severity of medical conditions (median [interquartile range (IQR)]: 6.00 [6.00-6.00] ng/L in 91 patients with moderate conditions, 6.00 [6.00-18.00] ng/L in 107 patients with severe conditions, and 11.00 [6.00-56.75] ng/L in 46 patients with critical conditions, P for trend=0.001). Moreover, compared with those with normal cTnI levels, patients with increased hs-cTnI levels had higher in-hospital fatality (adjusted hazard ratio [95% CI]: 4.79 [1.46-15.69]). The receiver-operating characteristic curve analysis suggested that the inclusion of hs-cTnI levels into a panel of empirical prognostic factors substantially improved the prediction performance for severe or critical conditions (area under the curve (AUC): 0.71 (95% CI: 0.65-0.78) vs. 0.65 (0.58-0.72), P=0.01), as well as for 30-day fatality (AUC: 0.91 (0.85-0.96) vs. 0.77 (0.62-0.91), P=0.04). A cutoff value of 20 ng/L of hs-cTnI level led to the best prediction to 30-day fatality. Conclusions: In COVID-19 patients with no preexisting cardiovascular disease, 11% had increased hs-cTnI levels. Besides empirical prognostic factors, serum hs-cTnI levels upon admission provided independent prediction to both the severity of the medical condition and 30-day in-hospital fatality. These findings may shed important light on the clinical management of COVID-19.

D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study.

BACKGROUND: Over 5,488,000 cases of coronavirus disease-19 (COVID-19) have been reported since December 2019. We aim to explore risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a biomarker for disease severity and clinical outcome. METHODS: We retrospectively analyzed the clinical, laboratory, and radiological characteristics of 248 consecutive cases of COVID-19 in Renmin Hospital of Wuhan University, Wuhan, China from January 28 to March 08, 2020. Univariable and multivariable logistic regression methods were used to explore risk factors associated with in-hospital mortality. Correlations of D-dimer upon admission with disease severity and in-hospital mortality were analyzed. Receiver operating characteristic curve was used to determine the optimal cutoff level for D-dimer that discriminated those survivors versus non-survivors during hospitalization. RESULTS: Multivariable regression that showed D-dimer > 2.0 mg/L at admission was the only variable associated with increased odds of mortality [OR 10.17 (95% CI 1.10-94.38), P = 0.041]. D-dimer elevation (≥ 0.50 mg/L) was seen in 74.6% (185/248) of the patients. Pulmonary embolism and deep vein thrombosis were ruled out in patients with high probability of thrombosis. D-dimer levels significantly increased with increasing severity of COVID-19 as determined by clinical staging (Kendall's tau-b = 0.374, P = 0.000) and chest CT staging (Kendall's tau-b = 0.378, P = 0.000). In-hospital mortality rate was 6.9%. Median D-dimer level in non-survivors (n = 17) was significantly higher than in survivors (n = 231) [6.21 (3.79-16.01) mg/L versus 1.02 (0.47-2.66) mg/L, P = 0.000]. D-dimer level of > 2.14 mg/L predicted in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3% (AUC 0.85; 95% CI = 0.77-0.92). CONCLUSIONS: D-dimer is commonly elevated in patients with COVID-19. D-dimer levels correlate with disease severity and are a reliable prognostic marker for in-hospital mortality in patients admitted for COVID-19.

The effect of RAS blockers on the clinical characteristics of COVID-19 patients with hypertension.

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus (designated as SARS-CoV-2) has become a pandemic worldwide. Based on the current reports, hypertension may be associated with increased risk of sever condition in hospitalized COVID-19 patients. Angiotensin-converting enzyme 2 (ACE2) was recently identified to functional receptor of SARS-CoV-2. Previous experimental data revealed ACE2 level was increased following treatment with ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). Currently doctors concern whether these commonly used renin-angiotensin system (RAS) blockers-ACEIs/ARBs may increase the severity of COVID-19. METHODS: We extracted data regarding 50 hospitalized hypertension patients with laboratory confirmed COVID-19 in the Renmin Hospital of Wuhan University from Feb 7 to Mar 03, 2020. These patients were grouped into RAS blockers group (Group A, n=20) and non-RAS blockers group (Group B, n=30) according to the basic blood pressure medications. All patients continued to use pre-admission antihypertensive drugs. Clinical severity (symptoms, laboratory and chest CT findings, etc.), clinical course, and short time outcome were analyzed after hospital admission. RESULTS: Ten (50%) and seventeen (56.7%) of the Group A and Group B participants were males (P=0.643), and the average age was 52.65±13.12 and 67.77±12.84 years (P=0.000), respectively. The blood pressure of both groups was under effective control. There was no significant difference in clinical severity, clinical course and in-hospital mortality between Group A and Group B. Serum cardiac troponin I (cTnI) (P=0.03), and N-terminal (NT)-pro hormone BNP (NT-proBNP) (P=0.04) showed significant lower level in Group A than in Group B. But the patients with more than 0.04ng/mL or elevated NT-proBNP level had no statistical significance between the two groups. In patients over 65 years or under 65 years, cTnI or NT-proBNP level showed no difference between the two groups. CONCLUSIONS: We observed there was no obvious difference in clinical characteristics between RAS blockers and non-RAS blockers groups. These data suggest ACEIs/ARBs may have few effects on increasing the clinical severe conditions of COVID-19.

Distributed vibration isolation and manual dexterity of anti-vibration gloves: is there a correlation?

This study focuses on the integrated performance of anti-vibration (AV) gloves in terms of manual dexterity and distributed palm and fingers' vibration transmissibility. Experiments were designed to measure vibration transmission and manual dexterity performance of 10 different gloves using 15 subjects. The results showed all gloves impeded manual dexterity, while five gloves satisfied the AV glove screening criteria. Glove type yielded a significant effect on manual dexterity (p < 0.001) and vibration transmissibility (p ≤ 0.001). Manual dexterity decreased nearly linearly with an increase in glove thickness (p < 0.05), while palm and fingers' vibration transmissibility in high-frequency range was negatively correlated with glove thickness (R2 > 0.70). A strong correlation was evident between glove material stiffness and the H-frequency range palm vibration transmissibility (R2 ≥ 0.8). While the vibration isolation of a glove is strongly related to material properties at the palm, the dexterity performance is dependent on design factors such as thickness and bulkiness. Practitioner summaryAnti-vibration gloves are used to isolate hand from power tools vibration, while these may adversely affect manual dexterity. Vibration isolation was correlated with material properties and thickness, while dexterity was correlated with thickness alone. Glove thickness is a vital parameter for realising a compromise between vibration isolation and manual dexterity. Abbreviations: HTV: hand-transmitted vibration; AV: anti-vibration; MANOVA: multivariate analysis of variance; TR: vibration transmissibility; ASTM: ASTM F2010 standard test; Minnesota: Two-Hand Turning and Placing Minnesota test; rANOVA: repeated-measures analysis of variance; rms: root mean square; CoV: coefficient of variations; S: score.

Microbiological Diagnostic Performance of Metagenomic Next-generation Sequencing When Applied to Clinical Practice.

Background: Metagenomic next-generation sequencing (mNGS) was suggested to potentially replace traditional microbiological methodology because of its comprehensiveness. However, clinical experience with application of the test is relatively limited. Methods: From April 2017 to December 2017, 511 specimens were collected, and their retrospective diagnoses were classified into infectious disease (347 [67.9%]), noninfectious disease (119 [23.3%]), and unknown cases (45 [8.8%]). The diagnostic performance of pathogens was compared between mNGS and culture. The effect of antibiotic exposure on detection rate was also assessed. Results: The sensitivity and specificity of mNGS for diagnosing infectious disease were 50.7% and 85.7%, respectively, and these values outperformed those of culture, especially for Mycobacterium tuberculosis (odds ratio [OR], 4 [95% confidence interval {CI}, 1.7-10.8]; P < .01), viruses (mNGS only; P < .01), anaerobes (OR, ∞ [95% CI, 1.71-∞]; P < .01) and fungi (OR, 4.0 [95% CI, 1.6-10.3]; P < .01). Importantly, for mNGS-positive cases where the conventional method was inconclusive, 43 (61%) cases led to diagnosis modification, and 41 (58%) cases were not covered by empirical antibiotics. For cases where viruses were identified, broad-spectrum antibiotics were commonly administered (14/27), and 10 of 27 of these cases were suspected to be inappropriate. Interestingly, the sensitivity of mNGS was superior to that of culture (52.5% vs 34.2%; P < .01) in cases with, but not without, antibiotic exposure. Conclusions: mNGS could yield a higher sensitivity for pathogen identification and is less affected by prior antibiotic exposure, thereby emerging as a promising technology for detecting infectious diseases.