Increased circulating level of interleukin-6 and CD8+ T cell exhaustion are associated with progression of COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is pandemic. It is critical to identify COVID-19 patients who are most likely to develop a severe disease. This study was designed to determine the clinical and epidemiological features of COVID-19 patients associated with the development of pneumonia and factors associated with disease progression. METHODS: Seventy consecutive patients with etiologically confirmed COVID-19 admitted to PLA General Hospital in Beijing, China from December 27, 2019 to March 12, 2020 were enrolled in this study and followed-up to March 16, 2020. Differences in clinical and laboratory findings between COVID-19 patients with pneumonia and those without were determined by the χ2 test or the Fisher exact test (categorical variables) and independent group t test or Mann-Whitney U test (continuous variables). The Cox proportional hazard model and Generalized Estimating Equations were applied to evaluate factors that predicted the progression of COVID-19. RESULTS: The mean incubation was 8.67 (95% confidence interval, 6.78-10.56) days. Mean duration from the first test severe acute respiratory syndrome coronavirus 2-positive to conversion was 11.38 (9.86-12.90) days. Compared to pneumonia-free patients, pneumonia patients were 16.5 years older and had higher frequencies of having hypertension, fever, and cough and higher circulating levels of neutrophil proportion, interleukin-6, low count (< 190/µl) of CD8+ T cells, and neutrophil/lymphocyte ratio. Thirteen patients deteriorated during hospitalization. Cox regression analysis indicated that older age and higher serum levels of interleukin-6, C-reactive protein, procalcitonin, and lactate at admission significantly predicted the progression of COVID-19. During hospitalization, circulating counts of T lymphocytes, CD4+ T cells, and CD8+ T cells were lower, whereas neutrophil proportion, neutrophil/lymphocyte ratio, and the circulating levels of interleukin-6, C-reactive protein, and procalcitonin were higher, in pneumonia patients than in pneumonia-free patients. CD8+ lymphocyte count in pneumonia patients did not recover when discharged. CONCLUSIONS: Older age and higher levels of C-reactive protein, procalcitionin, interleukin-6, and lactate might predict COVID-19 progression. T lymphocyte, especially CD8+ cell-mediated immunity is critical in recovery of COVID-19. This study may help in predicting disease progression and designing immunotherapy for COVID-19.

Whole-Process Emergency Training of Personal Protective Equipment Helps Healthcare Workers Against COVID-19: Design and Effect.

OBJECTIVE: To develop an emergency training program of personal protective equipment (PPE) for general healthcare workers (HCWs) who may be under the threat of Corona Virus Disease 2019 (COVID-19) and evaluate the effect of the program. METHODS: A three-stage training program was designed. The complete clinical workflow together with infectious disease ward was simulated. To verify the effect of the program, an experimental training with pre- and post-test was conducted before large-scale training. RESULTS: Post-test scores were significantly improved when compared with the pre-test scores. Among all PPE, N95 respirator and protective coverall needed training most. Meanwhile, "proficiency level" and "mutual check & help" also needed to be strengthened as independent scoring points. CONCLUSION: This training program significantly improved the performances of participants. It may therefore be applied for general HCWs on a larger scale.

Clinical and pathological investigation of patients with severe COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has become a pandemic. This study addresses the clinical and immunopathological characteristics of severe COVID-19. METHODS: Sixty-nine patients with COVID-19 were classified into severe and nonsevere groups to analyze their clinical and laboratory characteristics. A panel of blood cytokines was quantified over time. Biopsy specimens from 2 deceased cases were obtained for immunopathological, ultrastructural, and in situ hybridization examinations. RESULTS: Circulating cytokines, including IL-8, IL-6, TNF-α, IP10, MCP1, and RANTES, were significantly elevated in patients with severe COVID-19. Dynamic IL-6 and IL-8 were associated with disease progression. SARS-CoV-2 was demonstrated to infect type II and type I pneumocytes and endothelial cells, leading to severe lung damage through cell pyroptosis and apoptosis. In severe cases, lymphopenia, neutrophilia, depletion of CD4+ and CD8+ T lymphocytes, and massive macrophage and neutrophil infiltrates were observed in both blood and lung tissues. CONCLUSIONS: A panel of circulating cytokines could be used to predict disease deterioration and inform clinical interventions. Severe pulmonary damage was predominantly attributed to both cytopathy caused by SARS-CoV-2 and immunopathologic damage. Strategies that prohibit pulmonary recruitment and overactivation of inflammatory cells by suppressing cytokine storm might improve the outcomes of patients with severe COVID-19.

Sfrp5/Wnt Pathway: A Protective Regulatory System in Atherosclerotic Cardiovascular Disease.

Adipose tissue stores energy and is the largest endocrine organ in the body, producing several adipokines. However, among these adipokines, few play a role in the positive metabolism that promotes good health. Secreted frizzled-related protein (Sfrp)-5, an antagonist that directly binds to Wnt, has attracted interest due to its favorable effects on atherosclerotic cardiovascular disease (ASCVD). This review focuses on Sfrp5 biology and the roles of the Sfrp5/Wnt system in ASCVD.

Systematic analysis of molecular mechanisms for HCC metastasis via text mining approach.

OBJECTIVE: To systematically explore the molecular mechanism for hepatocellular carcinoma (HCC) metastasis and identify regulatory genes with text mining methods. RESULTS: Genes with highest frequencies and significant pathways related to HCC metastasis were listed. A handful of proteins such as EGFR, MDM2, TP53 and APP, were identified as hub nodes in PPI (protein-protein interaction) network. Compared with unique genes for HBV-HCCs, genes particular to HCV-HCCs were less, but may participate in more extensive signaling processes. VEGFA, PI3KCA, MAPK1, MMP9 and other genes may play important roles in multiple phenotypes of metastasis. MATERIALS AND METHODS: Genes in abstracts of HCC-metastasis literatures were identified. Word frequency analysis, KEGG pathway and PPI network analysis were performed. Then co-occurrence analysis between genes and metastasis-related phenotypes were carried out. CONCLUSIONS: Text mining is effective for revealing potential regulators or pathways, but the purpose of it should be specific, and the combination of various methods will be more useful.

Molecular characterization of Tb, a new approach for an ancient Brucellaphage.

Tb (Tbilisi), the reference Brucellaphage strain, was classified as a member of the Podoviridae family with icosahedral capsids (57 +/- 2 nm diameter) and short tails (32 +/- 3 nm long). Brucellaphage DNA was double stranded and unmethylated; its molecular size was 34.5 kilobase pairs. Some sequences were found through RAPD analysis, TA cloning technology, and structural proteins were observed by using SDS-PAGE. Thus, the results have laid the foundation for the wider use of Brucellaphage's basic mechanisms and practical applications.

DNA synthesis of rat bone marrow mesenchymal stem cells through alpha1-adrenergic receptors.

Multipotential bone marrow mesenchymal stem cells (BMSCs) are important in maintaining the microenvironment of the bone marrow (BM). Sympathetic nerves histologically innervate the BM; however, their role remains unclear. In this study, the effects of norepinephrine on DNA synthesis and the related signaling molecules involved in rBMSCs were examined. mRNA levels of the alpha1-adrenergic receptor subtypes increased following norepinephrine stimulation (10(-5) M for 30 min). DNA synthesis increased in dose- and time-dependent manners as determined by [(3)H]thymidine incorporation. Intracellular Ca(2+) concentration and translocation of protein kinase C from the cytosol to the membrane were also found to be elevated in rBMSCs. Phentolamine was able to suppress translocation of PKC. Norepinephrine also induced phosphorylation of ERK1/2, which was prevented by staurosporine treatment. Pretreatment with PD98059 inhibited ERK1/2 phosphorylation and DNA synthesis in rBMSCs. These findings indicate that norepinephrine stimulates DNA synthesis via alpha1-adrenergic receptors and downstream Ca(2+)/PKC and ERK1/2 activation in rBMSCs.

Semen quality of 1346 healthy men, results from the Chongqing area of southwest China.

BACKGROUND: Large studies on semen quality of the general healthy population from China are rare. METHODS: A cross-sectional study was performed to evaluate the semen quality of 1346 healthy men residing in Chongqing area of southwest China in 2007. The semen parameters were measured and compared with the World Health Organization (WHO) criteria. A linear regression model was used to examine the determinants of semen quality. RESULTS: The medians were 2.3 ml for semen volume, 77.8 x 10(6) per ml for semen concentration, 167.7 x 10(6) for total sperm count, 33% for sperm rapid progressive motility, 52.6% for sperm progressive motility and 70.9% for total motility. According to WHO criteria, 61.1% of healthy males had at least one semen parameter below normal threshold values. Season and abstinence duration were found to be significantly associated with semen quality (P < 0.001). Age, smoking, alcohol use and BMI had little or no effect on semen parameters. CONCLUSIONS: A high proportion of healthy males in Chongqing area of southwest China had abnormal semen parameters values according to WHO criteria. The semen parameters in the study population were markedly different from those reported for the other Chinese, USA and European populations. The differences remain unexplained and may be due to demographic characteristics, lifestyle, environmental factors or genetic variation.

Polymorphisms of STAT-6, STAT-4 and IFN-gamma genes and the risk of asthma in Chinese population.

BACKGROUND: Asthma is a complex disease resulting from multiple gene-gene and gene-environment interactions. Study on gene-gene interactions could provide insight into the pathophysiologic mechanisms of the disease. OBJECTIVES: We investigated the single nucleotide polymorphisms and interactions among three different loci in three candidate genes (STAT-6 G2964A, STAT-4 T90089C and IFN-gamma T874A) in 95 Chinese asthmatic subjects and 95 matched controls to determine the possible associations with asthma. METHODS: Genotyping of the gene polymorphisms was performed by means of PCR-SSCP analysis. Genotype-phenotype associations were examined in dominant and recessive genetic models using logistic regression. The method of multifactor dimensionality reduction was used to analyze gene-gene interactions. RESULTS: No statistically significant difference was found in the distribution of the STAT-6 G2964A polymorphisms between asthmatic patients and controls in this case-control study. The STAT-4 T90089C polymorphisms were significantly associated with asthma in the dominant model (p=0.007). As for the IFN-gamma T874A, the significant associations were found in both dominant model (p=0.004) and recessive model (p=0.006). A significant gene-gene interaction was found among STAT-6, STAT-4 and IFN-gamma on the risk of asthma. In the best 3-locus model, the odds ratio for the high-risk to the low-risk group was 6.9 (95% CI, 3.5-13.7; p<0.0001). CONCLUSIONS: Our findings suggest that STAT-4 T90089C and IFN-gamma T874A polymorphisms might be the genetic factors for the risk of asthma in the Chinese population. In addition, the significant interactions among STAT-6 G2964A, STAT-4 T90089C and IFN-gamma T874A may increase an individual's susceptibility and contribute to the pathogenesis of asthma.

[Development of a model for the diagnosis and risk classification on anthrax through artificial neural network].

OBJECTIVE: Based on data through clinical and epidemiological studies, a model regarding the diagnosis and risk classification on anthrax was developed by artificial neural network (ANN). The model could integrally diagnose anthrax cases, judge the risk tendency in time, and increase the ability of recognizing the anthrax accidents. METHODS: Clinical, laboratory and epidemiological data from anthrax cases was collected and analyzed. The important factors which could greatly influence the results on diagnosis and judgment was chosen and used as the neural units. Through the use of artificial neural network analytic method (back propagation, BP), an intelligent model on the diagnosis and risk classification was developed. RESULTS: Results from the multivariate analysis revealed that: 11 factors including incubation period, chest radiographic and microscopic findings, characteristics on professions etc. were associated with the judgment on the diagnosis and intensity of the epidemics. Through 500 times training on the neural network, the performance error decreased from 6.669 59 to 5.051 19 x 10(-11). The model was then validated. With 100% average correct rate, the predictive value was good. CONCLUSION: It was feasible to use the disease information to develop a diagnosis and risk classification model on anthrax by artificial neural network. With 100% average correct rate, the established model was valuable in practice.