Comparison of 90Y PET/CT and 90Y bremsstrahlung SPECT/CT imaging in evaluation of radiation dose after 90Y-selective internal radiation therapy in liver malignancies / 中华核医学与分子影像杂志

Objective:To compare the differences of actual absorbed doses of liver malignant tumors after 90Y-selective internal radiation therapy (SIRT) evaluated by 90Y PET/CT and 90Y bremsstrahlung (BRS) SPECT/CT imaging, and to compare the image quality of the 2 imaging methods. Methods:Twenty-one patients (15 males and 6 females; age: (52.4±15.4) years) with liver malignant tumors (15 cases of primary liver cancer, 6 cases of liver metastases; 39 lesions) between September 2021 and August 2022 were retrospectively analyzed. All patients underwent both 90Y PET/CT imaging and 90Y BRS SPECT/CT imaging in the Department of Nuclear Medicine, Hainan Cancer Hospital. The ratios of the actual absorbed doses based on 90Y PET/CT imaging and 90Y BRS SPECT/CT imaging to the lowest standard absorbed dose(100 Gy) for tumor response were calculated. The image contrast and distinguishability of the two imaging methods were scored. Wilcoxon signed rank test and Wilcoxon rank sum test were used for data analysis. Results:The tumor absorbed doses evaluated by 90Y PET/CT and 90Y BRS SPECT/CT were 143.94(55.91, 233.48) Gy and 107.82(53.59, 157.53) Gy respectively. The doses evaluated by 90Y PET/CT were higher than the standard threshold in 24 lesions, while 19 lesions showed higher evaluated doses by 90Y BRS SPECT/CT than the standard threshold. Compared with 90Y PET/CT, 90Y BRS SPECT/CT underestimated the tumor absorbed dose of -24.25%(-32.32%, -12.14%). The ratio of dose evaluated by 90Y PET/CT to the lowest standard threshold was 1.33(0.56, 1.91), which was higher than that of dose evaluated by 90Y BRS SPECT/CT to the lowest standard threshold (0.97(0.47, 1.25); z=0.04, P<0.001). PET/CT image contrast was scored 0, 1, 2, 3 in 2, 2, 12, 23 lesions respectively, and SPECT/CT image contrast was scored 0, 1, 2, 3 in 2, 3, 16, 18 lesions respectively ( z=-1.29, P=0.199). The distinguishability scores of 0, 1, 2 based on PET/CT images were found in 3, 15, 21 lesions, while those based on SPECT/CT images were found in 4, 32, 3 lesions respectively ( z=-2.79, P=0.005). Conclusion:90Y PET/CT imaging is superior to 90Y BRS SPECT/CT imaging in radiation dose evaluation and tumor focus differentiation in patients with liver malignant tumors after 90Y-SIRT.

Intervention effect of HSP60 on learning and memory impairment induced by combined exposure to lead and hypertension in mice / 中国职业医学

ObjectiveTo investigate the intervention effect of heat shock protein 60 (HSP60) on learning and memory impairment induced by combined exposure to lead and hypertension in mice, and the relative mechanism of triggering receptor expressed on myeloid cells 2 (TREM2). Methods Specific pathogen-free C57BL/6J male mice were randomly divided into control group, hypertension group, lead-exposed group and lead-exposed + hypertension group, or into control group, heat shock protein 60 (HSP60) control group, lead-exposed + hypertension group and HSP60 intervention group, with 10 mice in each group. Mice of hypertension group and lead-exposed + hypertension group were intraperitoneally injected with angiotensin Ⅱ at a dose of 0.5 mg/(kg·d) for seven consecutive days to induce hypertension model. Mice of the lead-exposed group, lead-exposed + hypertension group, and HSP60 intervention group were given lead acetate drinking water with a mass concentration of 250.0 mg/L, while mice in the control group, hypertension group, and HSP60 control group were given purified water for 12 weeks. Mice of the HSP60 control group and HSP60 intervention group were intraperitoneally injected with a solution of HSP60 at a dose of 4 mg/kg body weight, every other day for a total of three times at the 12th week. The learning and memory ability of mice was detected using the Morris water maze test. The enzyme-linked immunosorbent assay was used to detect the levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α) in the hippocampal tissues of the mice. The relative expression of ionized calcium binding adaptor molecule-1 (IBA1) and TREM2 protein in the hippocampus of mice was detected using Western blot. Results i) The number of platform crossings of the mice in the hypertension group and the lead-exposed group was lower than that in the control group (both P<0.05). The escape latency of the mice on the third day was longer and the number of platform crossings was lower in the lead-exposed + hypertension group compared with the control group, hypertension group and lead-exposed group (all P<0.05). The levels of IL-1β, IL-6, and TNF-α in the hippocampus of the other three groups increased compared with the control group (all P<0.05). The relative expression of IBA1 protein in the hippocampus of lead-exposed group and lead-exposed + hypertension group increased (all P<0.05), while the relative protein expression of TREM2 decreased compared with the control group (all P<0.05). The levels of IL-1β, IL-6, TNF-α, and the relative protein expression of IBA1 protein in the hippocampus of the lead-exposed+hypertension group were higher (all P<0.05), and relative expression of TREM2 protein was lower (P<0.05) than those in the hypertension group. The level of TNF-α and the relative expression of IBA1 protein in the hippocampus of lead-exposed+hypertension group were higher than those in lead-exposed group (all P<0.05). ii) The escape latency of mice in the lead-exposed + hypertension group was longer than that in the control group (P<0.05), and the number of platform crossings was fewer than that in the control group (P<0.05). The escape latency of mice in the HSP60 intervention group was shortened (P<0.05), the number of platform crossings increased (P<0.05), and the levels of IL-1β, IL-6, TNF-α and relative expression of IBA1 protein decreased in the hippocampus (all P<0.05), while the relative expression of TREM2 protein increased (P<0.05) compared with the lead-exposed+hypertension group. Conclusion Combined exposure of lead and hypertension has a synergistic effect on learning and memory impairment in mice. The mechanism may be related to the inhibition of TREM2 expression by lead in the hippocampus of hypertensive mice and aggravating the neuroinflammatory response. Intervention with TREM2 receptor agonist HSP60 can alleviate learning and memory impairment in mice exposed to lead and hypertension by up-regulating TREM2 expression in the hippocampus.

Immobilization of lipase by ultrafiltration and cross-linking onto the polysulfone membrane surface.

In this study, a biphasic enzymatic membrane reactor was made by immobilizing Candida Rugosa lipase onto the dense surface of polysulfone ultrafiltration membrane by filtration and then cross-linking with glutaraldehyde solution. The reactor was further applied for the hydrolysis of olive oil, the performance of which was evaluated in respect of apparent reaction rate based on the amount of fatty acids extracted into the aqueous phase per minute and per membrane surface. It was found that the ultrafiltration and cross-linking process greatly improved the reaction rate per unit membrane area and the enzyme lifetime. The highest reaction rate reached 0.089 micromol FFA/min cm2 when the enzyme loading density was 0.098 mg/cm2. The results also indicated that the performance of lipase immobilized on the membrane surface was superior to that immobilized in the pores, and the apparent reaction rate and stability of immobilized lipases were improved greatly after cross-linking. It suggested that immobilization of enzymes by filtration and then cross-linking the enzymes onto the membrane surface is a simple and convenient way to prepare a high-activity immobilized enzyme membrane.

Clinical and genetic findings in Alstrom syndrome: One case with obesity and acanthosis / 中华内分泌代谢杂志

Alstrom syndrome is a rare autosomal recessive multi-organ syndrome caused by variations in ALMS1 gene. We explore the underlying genetic cause in one case of Alstrom syndrome who manifasted childhood obesity, hyperinsulinemia, and acanthosis using the whole-exome sequencing, to improve clinicians′ awareness of the disease. The proband presented with obesity, acanthosis, hyperinsulinemia, and fatty liver in childhood, but without typical manifestations of Alstrom syndrome, such as retinal degeneration, hearing impairment and cardiomyopathty. Whole-exome sequencing revealed that the proband carried a complex heterozygous ALMS1 mutation, including c. 1A>T(p.M1? ) and c. 8971G>C, p. D2991H. Family verification found that his father wass heterozygous for the c. 1A>T mutation, his mother was heterozygous for the c. 8971G>C mutation, and the sister′s ALMS1 gene detection and clinical phenotype were normal, which was consistent with the autosomal recessive inheritance pattern. Through bioinformatics analysis, the new mutations c. 1A>T and c. 8971G>C in the ALMS1 gene were identified as deleterious mutations. In this study, a single case of Alstrom syndrome was reported with childhood obesity, acanthosis nigricans, and hyperinsulinemia as the main manifestations, and two new ALMSl gene mutations were discovered, which expanded the phenotype and pathogenic mutation spectrum of Alstrom syndrome.

A family with hyperinsulinemia caused by a novel mutation of SLC16A1 gene / 中华内分泌代谢杂志

Objective:Congenital hyperinsulinemia is a heterogeneous disorder characterized by severe hypoglycemia due to dysregulated insulin secretion. Sixteen genes have been reported to be associated with congenital hyperinsulinemia. In this study, whole exome sequencing was performed on a patient with obesity, hyperinsulinemia, and postprandial hypoglycemia to further explore its genetic etiology.Methods:The clinical data and peripheral blood of a patient with hyperinsulinemia and his family members were collected. Genomic DNA was extracted from the peripheral blood. Sanger sequencing and pedigree verification were performed on the pathogenic variants filtered by whole-exome sequencing. The function of the mutation sites was analyzed by bioinformatics software.Results:The proband presented with obesity, hyperinsulinemia, and postprandial hypoglycemia, but without exercise-induced hypoglycemia. A heterozygous SCL16A1 gene c. 1259A>G(p.K420R) mutation was identified in the proband. Co-segregated analysis showed that the c. 1259A>G mutation was also found in his father and brother, who had obesity and hyperinsulinemia, which was consistent with autosomal dominant inheritance. The mutation c. 1259A>G was predicted to be pathogenic by the MutationTaster, FATHMM-MKL, PolyPhen2, and CADD programs, and has not been reported in HGDM database yet, which was considered to be a novel mutation.Conclusion:This study reported a patient with hyperinsulinemia caused by a new mutation of SCL16A1 gene, which expanded our understanding of the pathogenic mutation spectrum of hyperinsulinemia.

Three cases of congenital adrenal hypoplasia with hypogonadotropic hypogonadism due to novel NR0B1 mutation / 中华内分泌代谢杂志

Objective:To advance the understanding of X-linked adrenal hypoplasia congenita(XL-AHC)through genetic analysis.Methods:Genomic DNA was extracted from peripheral blood of three patients with XL-AHC and their family members as well. Pathogenic genes were screened with whole exome sequencing followed by Sanger sequencing and pedigree verification.Results:All three probands were diagnosed as primary adrenal insufficiency at early age and developed hypogonadotropic hypogonadism in adolescence. The proband 1 was hemizygous for c. 420delG(p.R141Gfs*123)mutation in exon 1 of NR0B1 gene. His mother was a heterozygous mutation carrier while his brother did not carry the mutation, which was consistent with the X-linked recessive inheritance. A hemizygous mutation c. 212_213delAA(p.K71Rfs*41)of NR0B1 gene was detected in both proband 2 and proband 3. These two novel mutations were not reported in HGMD database.Conclusions:In this study, two novel NR0B1 mutations, c. 420delG and c. 212_213delAA were identified in 3 patients with XL-AHC. For men with early onset of adrenocortical hypofunction, XL-AHC should be considered. Early genetic screening of NR0B1 gene is helpful for early diagnosis.

Automatic Segmentation of Anatomical Areas in X-ray Images Based on Fully Convolutional Networks / 中国医疗器械杂志

OBJECTIVE@#Medical image segmentation is a key step in medical image processing. An architecture of fully convolutional networks was proposed to realize automatic segmentation of anatomical areas in X-ray images.@*METHODS@#Enlightened by the advantages of convolutional neural networks on features extraction, fully convolutional networks consisting of 9 layers were designed to segment medical images. The networks used convolution kernels of various sizes to extract multi-dimensional image features in the images, meanwhile, eliminated pooling layers to avoid the loss of image details during downsampling procedures.@*RESULTS@#The experiment was conducted in accordance with the specific scene of X-ray images segmentation. Compared with traditional segmentation methods, this approach achieved more accurate segmentation of anatomical areas.@*CONCLUSIONS@#Fully convolutional networks can extract representative and multidimensional features of medical images, avoid the loss of image details during downsampling procedures, and complete automatic segmentation of anatomical areas accurately in X-ray images.

Using Parallel Convolutional Neural Networks for Treatment Position Recognition in X-ray Images / 中国医疗器械杂志

Treatment position recognition in medical images is a key technique in medical image processing. Due to the excellent performance of convolutional neural networks on features extraction and classification, an architecture of parallel convolutional neural networks is proposed to recognize treatment positions in X-ray images, which uses convolution kernels of different sizes to extract local features of different sizes in these images. The experimental analysis shows that parallel convolution neural networks, which can extract representative image features with more dimensions, are competent to classify and recognize treatment positions in medical images.

Comparison of values of iDose4 iterative reconstruction and filtered back projection reconstruction for coronary CT angiography / 医疗卫生装备

Objective To explore the value of iDose4 iterative reconstruction for coronary CT angiography (CCTA).Methods Totally 124 coronary heart disease patients underwent iDose4 iterative reconstruction and filtered back projection (FBP) reconstruction,of whom,56 ones with BMI not less than 20 kg/m2 were put into No.1 iteration group using 135 kV tube voltage and 68 ones with BMI less than 20 kg/m2 were into No.2 iteration group using 110 kV tube voltage.FBP reconstruction was executed with 110 kV tube voltage.Comparison analyses were carried out on signal noise ratio (SNR),contrast to noise ratio (CNR) and image quality.Results There were significant differences between the values of SNR,radiation dose and image quality in No.1 iteration group and FBP group (P＜0.05).Statistical differences were also found between the values of CNR and radiation dose in No.2 iteration group and FBP group,while there were no obvious differences between the values of SNR and image quality in the above two groups (P＜0.05).Conclusion Low-voltage iDose reconstruction gains advantages in radiation dose and image quality during 64-slice CCTA,and thus is worthy promoting clinically.

Application of inteins in building protein affinity purification system / 生物工程学报

Intein is a part of polypeptide in the premature protein with the capability of self-splicing, which is widely applied in protein purification, protein conjuction, cyclopeptide preparation, protein labeling and biosensor. In this review, we summarized the development of intein used in protein purification, discussed intein-mediated chromatographic and non-chromatographic purification systems, and summarized the researches in manipulating intein cleavage reaction. This work is to provide clues for improvement of intein-mediated protein purification.

Analysis of different clinical features and mechanism of falciparum malaria in several patients between Chinese and Malian / 中华急诊医学杂志

Objective To investigate the clinical features and the mechanism of falciparum malaria in several patients between Chinese and Malian.Methods The data of Chinese (n =28) and Malian patients (n =35) including general condition,Glasgow Coma Scale (GCS),APACHE Ⅱ,the time of applying ventilator and days of stay in ICU,laboratory examination (plasmodium test,routine blood test,liver and kidney function and C-reactive protein (CRP) assayed before treatment and 1d,3d,7d after treatment,cranial computed tomography and mortality were recorded for investigating the clinical features of the disease.Results There was difference in age range between Chinese patients (ranged from 32 to 50 years old) and Malian patients (ranged from 8 to 72 years old),and difference in severity of the disease between patients of two countries was found and Malian patients were more severely infected than Chinese patients.The results of plasmodium test,routine blood test,liver and kidney function and level of CRP often varied greatly during the entire course of the disease,and the changes were greater in Malian patients.The correlation between APACHE Ⅱ and CRP was found (P ＜ 0.05).The cranial CT displayed ischemia focus in brain.The mortality of Chinese patients was 16.7％ and that of Malian was 25.0％.Conclusions There was difference in composition of residents between Chinese patients and Malian patients.Malian patients were more severely infected with Plasmodium falciparum than Chinese patients,and this difference might be due to the potential correlation between the disease virulence and immune response of patients.

CT manifestation of schistosoma haematobium cystitis / 中华放射学杂志

Objective To analyze CT manifestation of Schistosoma haematobium cystitis.Methods Retrospective analysis 32 patients,who were tested for Schistosoma haematobium cystitis using the urine filtration method.CT scan was performed for each patient with contrast enhancement.Results The vast majority of urinary tract schistomiasis lesions were in the urinary bladder.Calcification of the bladder wall was observed in all patients and mild enhancement in non calcified zone was found after intravenous contrast.Except for 5 patients of bladder cancer,the rest were no abnormality in size of bladder when bladder was filling or emptying.Ureteral wall annular calcification could also be identified in 25 patients.Twenty two patients were companied with ureteric hydronephrosis.Seminal vesicle calcification was seen in 4 patients among 11 male patients,while both uterine and ovarian in female and prostate in men had non calcification.Serious illness can be combined with bladder cancer.In 5 patients of patients with bladder cancer,bladder showed irregular soft tissue mass which was enhanced moderately after post-contrast scan,with vesical calcification in mass medially.Conclusion Bladder calcification is the most prominent CT feature of Schistosoma haematobium cystitis,which is useful in diagnosis the disease.

The estimation of traceability and uncertainty of measurement on the result of HBV DNA with different detecting system / 中华检验医学杂志

Objective To study the uncertainty and traceability of HBV DNA assays and discuss the comparability of results among different detection systems. Methods Different detecting systems were used to detect HBV DNA using the national standard substance as "quality control substance". The uncertainty of the results was evaluated referring "Guidelines for estimating and reporting measurement uncerTAinty of chemical test results" of NATA The results were traced back to the national standard substance. According to the CLSI document EP9-A2, the results were analyzed and subjected to bias estimation with the t(0.05sv) √u2b1+ u2b2 as the criterion clinically accepted to investigate the comparability of different detecting systems. Results The means (-y) measured by 3 HBV DNA assay systems were 6.15,5.88,and 6.31 lg(kIU/L) respectively. Except system A,both the biases of system B and C had statistical significance (all P ＜ 0. 05) and expanded uncertainty of three detection systems was varied, but the difference was within the maximum acceptable range (± 0. 5) of the external quality assessment by National Center for Clinical Laboratory. Being traceable to national standard substance, the results of HBV DNA of the three detecting systems were (5.45 ± 1.23), (5.55 ± 1.32) and (5.42 ± 1.25) lg(kIU/L), respectively.There was significant difference among three systems (F = 5.63, P ＜ 0. 05). Comparing system A and B,there was significant difference in statistic (q = 5. 12, P ＜ 0. 05) and the difference between system B and C also had statistically significant (q = 6. 85, P ＜ 0. 05), but the results between system A and C had no statistical difference (q = 1.85,P ＞ 0. 05). Among these three systems, the difference of any two detection systems had no statistical significance (all P ＞ 0. 05). It showed that system bias was acceptable in clinical application and the results between different systems were comparable. Conclusions It is necessary to estimate the uncertainty and traceability when comparing the HBV DNA assay among the different labs. It also needs to estimate the bias of different systems and evaluate the clinical acceptability to ensure the accuracy and comparability of the results.

Isolation of a methane-utilizing Klebsiella sp. strain and its application for detecting methane / 生物工程学报

We have isolated a strain C611 that used methane as the sole carbon sources for growth from paddy soil in Taiyuan of Shanxi province. Based on the physiological characteristics and 16S rDNA sequence analysis, we identified the strain as Klebsiella sp.. We used statistic-based experimental design (RSM) to optimize the culture conditions for C611 strain. The optimum conditions were as follows: temperature of 24.4 degrees C, inoculum volume of 6.7% and methane content of 25%. We studied the response time and the relationship between consumption of dissolved oxygen and methane gas contents with PVA-H3BO3 immobilized cell of C611 using electrochemical method. The response time was no more than 100 s of this reaction system, and the linear range of detection of methane content was from 0 to 10%. The standard gas sample 3% methane was measured by this method with the mean content value of 3.09%, RSD of 3.48%, and the relative error of 3%. Hence, it has the potential in developing biosensor for methane.

The correlative factors analysis of leptin in type 2 diabetic fatty liver / 中国实用内科杂志

Objective To explore the relationship of leptin、 Glutathione peroxidase (GSH-Px) and other correlative factors with type 2 diabetic fatty liver. Methods From 2003-10 to 2004-01, we examined leptin、GSH-Px、 blood fat in the serum and BMI、FAT% in 23 cases of type 2 diabetic fatty live、30 cases of type 2 diabetic inpatients and 30 healthy people. Compare their level and analyse the correlation. Results (1)The TG、BMI、FAT% of type 2 diabetic fatty liver patients were significantly higher than that of the others groups. (2)Leptin and GSH-Px of each group had significant changes. Leptin was correlative with FAT% and age. GSH-Px was correlative with age and HDL. Conclusion (1)TG、 BMI and FAT% are important risky factors. (2)There are leptin resistance in type 2 diabetic fatty liver and type 2 diabetes patients and it is influenced by obesity and age. (3)The antioxidant enzyme in the serum of type 2 diabetes patients is reduced and is related with age and HDL.

Studies on the relationship between vitamin D receptor gene polymorphism and osteoporosis in postmenopausal women / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To determine the relationship between vitamin D receptor (VDR) gene polymorphism and osteoporosis in postmenopausal women.</p><p><b>METHODS</b>The polymerase chain reaction-restriction fragment length polymorphism was used to detect VDR genotype in 40 patients with osteoporosis and 21 healthy postmenopausal women.</p><p><b>RESULTS</b>In the patients with osteoporosis, the bb, Bb, and BB genotype accounted for 82.5%, 17.5% and 0, respectively; in healthy groups, they were 85.71%, 14.29% and 0, respectively (P>0.05).</p><p><b>CONCLUSION</b>Significant association between VDR genotype and osteoporosis in Chinese women was observed in this study.</p>

Effects of Picrotoxin on the Rate, Contractility and Action Potential of Isolated Frog Heart / 第三军医大学学报

Picrotoxin is an anatagninst of gamma-aminobutyric acid, which is an internal inhibition-transmitter in the central nervous system, Picrotoxin exerts a biphasic action on the blood pressure and heart rate in rats and cats in vivo. That is to say, in the initial stage, picrotoxin can lower the blood pressure and heart rate, and then an elevation of these two even above the original level can be observed, up to the present, from the authors limited literature, there has been no report dealing with the problem whether picrotoxin can act on an isolated heart directly.In this study, the heart of a frog was isolated and routine intubation of the heart was done for its perfusion. Physiological polyconduction instrument was inserted through a mechanical transducer to record the heart rale and myocardial contractility. A suspending glass microelectrode coupling with a microamplifier is used to record the action potential of the ventricular myocardium. Real time analysis of all the data was accomplished with a microcomputer. The dosages of picrotoxin used were 1,5, 3.0, 6.0, and 12.0 mg per kilogram of body weight.It was found that picrotcxin can directly act on the isolated frog heart. The results were as follows.1 ) Picrotoxin exerts inhibition on the special conduction system of the heart,and the A-V node and venous sinus are very sensitive. Complete or partial transmission block can be induced.2 ) It can elicit clearly a fall of the heart rate but no biphasic action can berevealed. 3) It can reduce the myocardial contractility, suggesting that the calciuminflow during the functioning period of the action potential is effected. 4 ) It can reduce the amplitude of the action potential but no effect on themaximal depolarization speed is observed, suggesting that picrotoxin islikely to affect the level of resting potential but not the action potentialin the depolarized period.

A cohort study of 223 patients explores the clinical risk factors for the severity diagnosis of COVID-19

BACKGROUNDCoronavirus Disease 2019 (COVID-19) has recently become a public emergency and a worldwide pandemic. The clinical symptoms of severe and non-severe patients vary, and the case-fatality rate (CFR) in severe COVID-19 patients is very high. However, the information on the risk factors associated with the severity of COVID-19 and of their prognostic potential is limited. METHODSIn this retrospective study, the clinical characteristics, laboratory findings, treatment and outcome data were collected and analyzed from 223 COVID-19 patients stratified into 125 non-severe patients and 98 severe patients. In addition, a pooled large-scale meta-analysis of 1646 cases was performed. RESULTSWe found that the age, gender and comorbidities are the common risk factors associated with the severity of COVID-19. For the diagnosis markers, we found that the levels of D-dimer, C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT) were significantly higher in severe group compared with the non-severe group on admission (D-Dimer: 87.3% vs. 35.3%, P<0.001; CRP, 65.1% vs. 13.5%, P<0.001; LDH: 83.9% vs. 22.2%, P<0.001; PCT: 35.1% vs. 2.2%, P<0.001), while the levels of aspartate aminotransferase (ASP) and creatinine kinase (CK) were only mildly increased. We also made a large scale meta-analysis of 1646 cases combined with 4 related literatures, and further confirmed the relationship between the COVID-19 severity and these risk factors. Moreover, we tracked dynamic changes during the process of COVID-19, and found CRP, D-dimer, LDH, PCT kept in high levels in severe patient. Among all these markers, D-dimer increased remarkably in severe patients and mostly related with the case-fatality rate (CFR). We found adjuvant antithrombotic treatment in some severe patients achieved good therapeutic effect in the cohort. CONCLUSIONSThe diagnosis markers CRP, D-dimer, LDH and PCT are associated with severity of COVID-19. Among these markers, D-dimer is sensitive for both severity and CFR of COVID-19. Treatment with heparin or other anticoagulants may be beneficial for COVID-19 patients. FundingThis study was supported by funding from the National Key Research and Development Program of China (2016YFC1302203); Beijing Nova Program (grant number: xx2018040). Role of the funding sourceThe funding listed above supports this study, but had no role in the design and conduct of the study.

Clinical Characteristics and Progression of 2019 Novel Coronavirus-Infected Patients Concurrent Acute Respiratory Distress Syndrome

BackgroundThe outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in a cluster of coronavirus disease 2019 (COVID-19). We reported the clinical characteristics of COVID-19 patients with acute respiratory distress syndrome (ARDS), and further investigated the treatment and progression of ARDS in COVID-19. MethodsThis study enrolled 109 patients with COVID-19 admitted to the Central Hospital of Wuhan, a designated hospital in Wuhan, China, from January 2 to February 1, 2020. Patients were followed up to February 12, 2020. The clinical data were collected from the electronic medical records. The differences in the treatment and progression with the time and the severity of ARDS were determined. FindingsAmong 109 patients, mean age was 55 years, and 59 patients were male. With a median 15 days (range, 4 to 30 days) follow-up period, 31 patients (28.4%) died, while 78 (71.6%) survived and discharged. Of all patients, 53 (48.6%) developed ARDS. Compared to non-ARDS patients, ARDS patients were elder (mean age, 61 years vs. 49 years), and more likely to have the coexistent conditions, including diabetes (20.8% vs. 1.8%), cerebrovascular disease (11.3% vs. 0%), and chronic kidney disease (15.1% vs. 3.6%). Compared to mild ARDS patients, those with moderate and severe ARDS had higher mortality rates. No significant effect of antivirus, glucocorticoid, or immunoglobulin treatment on survival was observed in patients with ARDS. InterpretationThe mortality rate increased with the severity of ARDS in COVID-19, and the effects of current therapies on the survival for these patients were not satisfactory, which needs more attention from clinicians. FundingHealth and Family Planning Commission of Wuhan Municipality.