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A lean management practice had been in place in Taizhou Enze Medical Center during the COVID-19 epidemic period, featuring the " principle-system-tool" theory of the Shingo model, in an effort to build a new model of COVID-19 prevention and control. The center upheld such five principles of lean management as overall planning, total involvement, system collaboration, concern with process and continuous improvement, and people-oriented practice. Under such principles, the center set up five supportive systems of lean management tools, namely risk identification, rapid screening, homogeneous treatment, customized follow-up and employee care. Integrated use of multiple tools of lean management, had improved the hospital′s crisis response ability, achieving desirable outcomes in stages in combating COVID-19 epidemic.
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Severity prediction of COVID-19 remains one of the major clinical challenges for the ongoing pandemic. Here, we have recruited a 144 COVID-19 patient cohort consisting of training, validation, and internal test sets, longitudinally recorded 124 routine clinical and laboratory parameters, and built a machine learning model to predict the disease progression based on measurements from the first 12 days since the disease onset when no patient became severe. A panel of 11 routine clinical factors, including oxygenation index, basophil counts, aspartate aminotransferase, gender, magnesium, gamma glutamyl transpeptidase, platelet counts, activated partial thromboplastin time, oxygen saturation, body temperature and days after symptom onset, constructed a classifier for COVID-19 severity prediction, achieving accuracy of over 94%. Validation of the model in an independent cohort containing 25 patients achieved accuracy of 80%. The overall sensitivity, specificity, PPV and NPV were 0.70, 0.99, 0.93 and 0.93, respectively. Our model captured predictive dynamics of LDH and CK while their levels were in the normal range. This study presents a practical model for timely severity prediction and surveillance for COVID-19, which is freely available at webserver https://guomics.shinyapps.io/covidAI/.
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The newly emerged pandemic coronavirus, SARS-CoV-2, has posed a significant public health threat worldwide. However, the mode of virus transmission and tissue tropism is not well established yet. Recent findings of substantial liver damage in patients and ACE2+ cholangiocytes in healthy liver tissues prompted us to hypothesize that human liver ductal organoids could serve as a model to determine the susceptibility and mechanisms underlining the liver damage upon SARS-CoV-2 infection. By single-cell RNA sequencing, we found that long-term liver ductal organoid culture preserved the human specific ACE2+ population of cholangiocytes. Moreover, human liver ductal organoids were permissive to SARS-CoV-2 infection and support robust replication. Notably, virus infection impaired the barrier and bile acid transporting functions of cholangiocytes through dysregulation of genes involved in tight junction formation and bile acid transportation, which could explain the bile acid accumulation and consequent liver damage in patients. These results indicate that control of liver damage caused directly by viral infection should be valued in treating COVID-19 patients. Our findings also provide an application of human organoids in investigating the tropism and pathogenesis of SARS-CoV-2, which would facilitate novel drug discovery.
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Objective To analyze the voice quality of children post operation for complete cleft palate through subjective and objective evaluation and explore the correlation between them. Methods Electroglottography analysis was used in the natural sound/a/of 30 postoper-ative children with complete cleft palate and 34 normal children, and the difference was compared. The natural prolonged sound/a/was as-sessed with GRBAS (grade, roughness, breathiness, asthenia, strain) in the children with complete cleft palate, and the correlation between the subjective and objective results was analyzed. Results F0, harmonic to noise ratio (HNR) were less, and the shimmer, jitter, normalized noise energy (NNE) and nasalance was greater in postoperative children with complete cleft palate than in normal children. For the children with complete cleft palate, G and R mainly rated as levels 1 and 2, B also rated as levels 1 and 2 in less than half of the children. There were low or very low correlation between all subjective and objective results, excepted G, R, B and F0, which showed moderate correlation. Con-clusion The vocal cords vibrate slowly and irregularly in postoperative children with complete cleft palate, suggesting mild and moderate voice disorder, and they sound hoarsely with roughness and breathiness. There are poor correlations between the subjective and objective as-sessment, and need to be used in combination for the children with complete cleft palate.
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Objective To investigate the clinical outcomes of sternoclavicular hook plate in treatment of the anterior sternoclavicular joint dislocation. Methods A new device named sternoclavicular hook plate was devised by our team. Between May 2002 and Octorber 2009, 66 patients with sternoclavicular joint anterior dislocation were treated with the new device, among whom there were 47 males and 19 females,aged 21-68 years old (average, 32.6 years old). Twenty-one cases were caused by crush injury, 5 cases by falling and 40 cases by traffic accident. Anterior fracture-dislocation was found in 41 cases. According to the Allman system, there were 35 cases of type Ⅱ and 31 cases of type Ⅲ. Patients were evaluated with serial clinical and radiographic examinations. Rockwood score were used after the operation to assess the curative effect. Results The average operative time was 33 min (range, 20-48 min). The mean blood loss was 60 ml (range, 20-90 ml). There were no vascular or peripheral nerve injuries in the patients. All incisions healed smoothly. The X-ray and CT showed that the reduction of sternoclavicular joint and the location of internal fixation were satisfactory. All the 66 patients were followed up for 12-37 months (average, 17 months). There was no internal fixation failure, redislocation or other complications. The sternoclavicular hook plate was removed 12 months after operation. The mean Rockwood's score was 13.2 (8 to 15). There were excellent in 50cases, good in 15 cases, and fair in 1 case. Conclusion The sternoclavicular hook plate is a new, safe and liable technique for sternoclavicular fracture-dislocation. This new technique is helpful for early functional exercises.
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ObjectiveTo investigate the accuracy of percutaneous iliosacral screw fixation in sacroiliac joint fracture-dislocation with minimally invasive guider with CT-guided.MethodsFrom January 2011 to May 2011,8 patients with sacroiliac joint fracture-dislocation were treated using percutaneous iliosacral screw fixation assist with minimally invasive guider in CT-guided,which included 5 males and 3 females,with the average age of 32 years (ranged from 26 to 56 years).All patients suffered with vertically unstable pelvic fractures.Bone traction was used in femoral condyle for 6 cases which displaced more than 2cm in sacroiliac joints.Patients were prone position on the CT bed.First sacroiliac joint CT-scan was performed,then marked the needle position on affected side buttocks after measure the best position and track of needle that expected on CT computer screen.According to the data of CT-scan,the angle of the devices was adjusted,which could control 3D direction of the minimally invasive guider,then insert the Kirschner wire into sacroiliac joint guided with the front end of the sleeve of the minimally invasive guider,confirmed the track of needle was excellent with CT-scan (3D),then the guider was moved out and put the hollow screw (dia 7.3 mm Synthes) into the sacroiliac joint along the Kirschner wire.ResultsAll 8 patients were successfully insert the Kirschner wire.The operation time was from 10 to 20 min(mean,14 min).All screws were in the position expected before surgery,no cut out of bone with the CT-scan immediately after operation,the shape of sacroiliac joint was restored satisfied and the fixation was stable.No numbness and radiation-like pain appeared among the operation in the lower limb for all patients,no case had vascular and neurological complications postoperative.ConclusionThe minimally invasive guider can improve the accuracy,security and simplicity of the percutaneous iliosacral screw fixation with CT-guided,and also avoid the deviation of needle insertion angle that determined by operator himself.
