Adjuvant strategies for patients with T1b invasion after endoscopic submucosal dissection for esophageal squamous cell carcinoma / 上海交通大学学报（医学版）

Objective·To compare the prognostic effects of radical resection of esophageal cancer,concurrent chemoradiotherapy and simple follow-up observation on the prognosis of patients with T1b invasion of superficial esophageal squamous cell carcinoma after endoscopic submucosal dissection(ESD).Methods·From May 2016 to May 2021,the clinical data of 67 patients with esophageal squamous cell carcinoma who were pathologically confirmed as pT1b after ESD and treated in Shanghai Chest Hospital were retrospectively analyzed.According to the additional treatment after ESD,the patients were divided into additional surgery group(S group),chemoradio-therapy group(CRT group)and observation group(O group).χ2 test was used to compare the clinical baseline data and pathological information of the three groups of patients.The Kaplan-Meier survival curve and log-rank test were used to compare the disease free survival(DFS)and recurrence free survival(RFS)of the three groups of patients,and the Cox proportional hazards regression model was used on DFS and RFS by univariate and multivariate analysis.Results·Among all 67 patients,there were 23 cases in the S group,19 cases in the CRT group,and 25 cases in the O group.There was no significant difference in age(P=0.080),gender(P=0.078),tumor length(P=0.485),tumor location(P=0.655),lesion circumferential ratio(P= 0.310),histological grading(P=0.084),depth of tumor invasion(P=0.066)and lymphovascular invasion(P=0.279)among the three groups.During(42.6±16.7)months of follow-up,tumor recurrence was observed in 10 cases(14.9%),including 6 patients(60%)with local recurrence,2 patients(20%)with regional lymph recurrence and 2 patients(20%)with distant metastasis.The median recurrence time of group S,group CRT,and group O was 40.1,36.6,and 22.1 months,and the 3-year DFSs were 100%,89.5%,and 74.5%(P-trend=0.040).Multivariate Cox analysis showed that additional esophagectomy was the key to improving independent protective factors of RFS(HR=0.097,95%CI 0.010?0.956,P=0.046).Conclusion·For patients with superficial esophageal squamous cell carcinoma confirmed as pT1b after ESD,additional surgery can significantly reduce the possibility of long-term recurrence.

Research progress in effect of chewing-side preference on temporomandibular joint and its relationship with temporo-mandibular disorders / 浙江大学学报·医学版

Chewing-side preference is one of the risk factors for temporomandibular disorders (TMD), and people with chewing-side preference is more prone to have short and displaced condyles, increased articular eminence inclination and glenoid fossa depth. The proportion of TMD patients with chewing-side preference is often higher than that of the normal subjects. Clinical studies have shown a strong correlation between chewing-side preference and TMD symptoms and signs; and animal studies have shown that chewing-side preference can affect the growth, development, damage and repair of the mandible. After long-term unilateral mastication, changes in the stress within the joint cause the imbalance of temporomandibular joint (TMJ) structural reconstruction, the transformation and even destruction of the fiber structure of masticatory muscle, resulting in uncoordinated movement of bilateral muscles. The joint neurogenic diseases caused by the increase of neuropeptide substance P and calcitonin-gene-related-peptide (CGRP) released locally by TMJ may be the mechanism of TMD. This article reviews the research progress of the influence of chewing-side preference on the structure of TMJ, the relationship between chewing-side preference and TMD, and the related mechanisms.

Analysis of factors influencing the frequency of health check-up and health check-up behavior in healthy population / 中华行为医学与脑科学杂志

Objective:To analyze the relevant factors affecting the frequency and behavior of health check-up among the population of medical examinees.Methods:From January to June 2022, 491 health examinees who had health check-ups at the Second Affiliated Hospital of Shandong First Medical University were included.Basic information of the check-up population and their needs for check-up services (form of check-up, content of check-up, cost of check-up, form of feedback on check-up results, and needs for check-up providers) were obtained based on a questionnaire survey.According to the frequency of previous medical check-up, the examinees were divided into never-check-up group (frequency of check-up was 0, n=45), the irregular check-up group (the interval between two physical examinations >1 year, n=49) and the regular check-up group (frequency of check-up=1 year, n=347). The frequency of previous medical check-up was used as the dependent variable, and the age, gender, education level, income, form of medical check-up and cost of medical check-up were used as independent variables to analyse the relevant factors affecting the frequency of their medical check-ups.The above count data were analyzed by one-way analysis using chi-square test, and the count data with statistically significant differences in one-way analysis were analyzed by binary logistic regression.The statistical software was SPSS 21.0. Results:The study included 491 medical examinees, of which 9.16%(45/491) were in the never-check-up group, 20.16%(99/491) in the irregular check-up group and 70.68%(347/491) in the regular check-up group. The impact of demography characteristics of physical examinees on the frequency of health check-up, and there were statistically significant differences in the frequency of health check-up in terms of gender, job, education, and income ( χ2=21.826, 157.113, 104.764, 45.486, all P<0.05). The understanding of health check-up and the attention paid to one's own health were influencing factors that affected the frequency of health check-up. There were statistically significant differences in the frequency of health check-up in necessity of health check-up, attention to one's own health, health check-up forms, health check-up institutions, health check-up price and health check-up contents ( χ2=9.277, 25.863188.239, 59.115, 39.250, 28.314, all P<0.05). Logistic regression analysis showed gender, job type, monthly income, necessity of health check-up, concerns for items of check-up, forms and institutions of check-up were influencing factor of health check-up frequency(all P<0.05). Conclusion:The health check-up behavior of the population and the frequency of regular medical check-ups are influenced by the factors such as gender, education, occupation, income, form of medical check-up, price of medical check-up, choice of medical check-up institution and the degree of concern for one’s own health. The popularisation of health check-ups for special groups such as men, low-income people, low literacy and insufficient awareness of the importance of one’s own health will help improve the overall health awareness of the population.

KCTD4 interacts with CLIC1 to disrupt calcium homeostasis and promote metastasis in esophageal cancer

Increasing evidences suggest the important role of calcium homeostasis in hallmarks of cancer, but its function and regulatory network in metastasis remain unclear. A comprehensive investigation of key regulators in cancer metastasis is urgently needed. Transcriptome sequencing (RNA-seq) of primary esophageal squamous cell carcinoma (ESCC) and matched metastatic tissues and a series of gain/loss-of-function experiments identified potassium channel tetramerization domain containing 4 (KCTD4) as a driver of cancer metastasis. KCTD4 expression was found upregulated in metastatic ESCC. High KCTD4 expression is associated with poor prognosis in patients with ESCC and contributes to cancer metastasis in vitro and in vivo. Mechanistically, KCTD4 binds to CLIC1 and disrupts its dimerization, thus increasing intracellular Ca2+ level to enhance NFATc1-dependent fibronectin transcription. KCTD4-induced fibronectin secretion activates fibroblasts in a paracrine manner, which in turn promotes cancer cell invasion via MMP24 signaling as positive feedback. Furthermore, a lead compound K279-0738 significantly suppresses cancer metastasis by targeting the KCTD4‒CLIC1 interaction, providing a potential therapeutic strategy. Taken together, our study not only uncovers KCTD4 as a regulator of calcium homeostasis, but also reveals KCTD4/CLIC1-Ca2+-NFATc1-fibronectin signaling as a novel mechanism of cancer metastasis. These findings validate KCTD4 as a potential prognostic biomarker and therapeutic target for ESCC.

Antibacterial effect of a novel sequence type Acinetobacter baumannii isolate on Acinetobacter spp with different drug-resistant phenotypes / 中华检验医学杂志

Objectives:To investigate the antibacterial effects of Acinetobacter baumannii on Acinetobacter SPP. Methods:A Acinetobacter baumannii strain named SL- A.baumannii that can inhibit other Acinetobacter baumannii strains was isolated from the bronchoalveolar lavage fluid of a critically infected patient in the department of neurology, Henan Provincial Hospital on December 10, 2020. To better understand this inhibition effect, the drug resistance, homology and protein fingerprint of the new Acinetobacter baumannii strain, along with 40 other Acinetobacter SPP isolates, were analyzed. Results:Multilocus sequence typing (MLST) revealed that a novel allele combination (gltA/gyrB/gdhB/recA/cpn60/gpi/rpoD) 33, 12, 40, 26, 48, 54, 5 was found in SL- A.baumannii, and ST-2442 was assigned by PubMLST (Oxford). Moreover, 36 isolates, including 30 Acinetobacter baumannii strains, 2 Acinetobacter lwoffii strains, 3 Acinetobacter pittii strains and 1 Acinetobacter ursingii strain, were inhibited by SL- A.baumannii, the inhibition rate was 90% (36/40). Among those strains, 18 (50%) were sensitive to all the antibacterial drugs; 16 (44.44%) showed multi-drug resistance(MDR), including 2 pan-drug resistance(PDR) and 11 extensive drug resistance (XDR) strains; the other 2 (5.56%) were only resistant to Trimethoprim/Sulfamethoxazole(SXT). Conclusion:The new sequence type (ST-2442) Acinetobacter baumannii isolate SL- A.baumannii (PubMLST/Acinetobacter baumannii isolates database/id: 6942) had shown a significantinhibitory effect on Acinetobacter SPP with different drug-resistant phenotypes.

Evidence-based practice in the management of maternal discharge preparation services / 中国实用护理杂志

Objective:To implement evidence-based practice of discharge preparation service in maternal and to explore the clinical effect.Methods:Based on the evidence-based continuous quality improvement framework, apply the evidence on the clinical through evidence acquisition, baseline evaluation, evidence introduction, and after-effect evaluation. Sixty women hospitalized in the obstetrics department of the Affiliated Hospital of Chengde Medical College from January to March 2021 were selected as the baseline group, and 60 women hospitalized in the obstetrics department of the hospital from April to July 2021 were selected as the evidence application group, to evaluate and compare the quality of discharge guidance for practitioners, discharge readiness level, maternal and newborn management knowledge level, incidence of maternal and newborn complications and the compliance of practitioners to evidence.Results:Finally, 10 pieces of evidence applied to clinical practice were included and 15 review indicators were translated. After the application of evidence, the quality of discharge guidance of practitioners increases from (141.83±24.66) to (166.13±10.30), the maternal discharge readiness increased from (127.12 ± 26.29) to (137.63 ± 22.59) , the score of maternal knowledge level increased from (164.58 ± 20.10) to (176.08 ± 24.25) , t values were -7.04, -2.39 and -2.83, all P<0.05. The incidence of postpartum women breast disease, postnatal constipation and newborn eczema, newborn red buttocks, newborn diarrhea, newborn jaundice decreased significantly, the difference were statistically significant, χ2 values were 5.21-7.50, all P<0.05. After the application of evidence, the implementation rate of the review indicators increased from ≤31.67% to ≥86.66%. Conclusions:The evidence-based practice of discharge preparation service in postpartum women improve the quality of discharge guidance for practitioners and compliance with evidence, promote clinical quality improvement, can be used for clinical reference.

Short term and long-term clinical effects of total hip arthroplasty and hemiarthroplasty on elderly patients with femoral neck fracture / 中国医师杂志

Objective:To investigate the clinical effect and short-term and long-term effect of total hip replacement (THA) and hemiarthroplasty of hip (HA) in elderly patients with femoral neck fracture (FNF).Methods:59 elderly patients with FNF in South District of Guang′anmen Hospital, Chinese Academy of Traditional Chinese Medicine from March 2017 to January 2019 were retrospectively analyzed. The observation group ( n=29) was treated with THA; The control group ( n=30) was treated with HA. The operation related indexes, short-term and long-term clinical effect (average follow-up of 24.1 months), hip function improvement, pain and complications were compared between the two groups. Short term and long-term clinical effects: the short-term and long-term clinical effects of the two groups were observed by the Harris Hip Score (HHS) of the first month, the third month, the sixth month, the ninth month and the first year after operation. Results:Both THA and HA were effective on elderly FNF, but the effective rate of THA (96.6%) was significantly higher than that of HA (90.0%), with statistically significant difference ( P<0.05); in terms of operation related indicators, compared with the control group, the observation group had longer operation time [ (104.46±3.24)min vs (84.34±3.64)min], more amount of bleeding [(296.64±15.16)ml vs (281.44±12.16)ml], lower postoperative drainage volume [(101.24±4.15)ml vs (74.56±3.24)ml], while the functional recovery of the observation group was better than the control group by HHS ( P<0.05); the postoperative complications and HHS score of observation group were significantly lower than the control group ( P<0.05). Conclusions:THA has the advantages of low complication, fast functional recovery and better effect. The clinical decision should be based on the patient′s physical condition. THA should be used for elderly patients with good basic condition, good surgical tolerance and more daily activities. HA should be used for elderly patients with poor basic condition, low surgical tolerance and less daily activities.

Preliminary exploration of reserved talents training in thoracic surgery / 中华医学教育探索杂志

Based on the Nanshan class of clinical medicine in Guangzhou Medical University, the center established an interest-oriented thoracic surgery learning collaboration group. All recruited students received the full-range cultivation, including "MDT" learning collaboration with characteristics of early clinical practice, early scientific research, English training and thoracic surgery collaboration group as thecore, accelerated clinical skills training under the naked-eye 3D thoracoscopic system, and scientific research thinking which recommended by new media — "WeChat public platform". A total of 10 undergraduate students from 2013 to 2017 batch were recruited into the this group and they showed advantages in clinical technique, scientific research and higher education enrollment after cultivation, demonstrating that part of the clinical teaching and scientific research thinking of thoracic surgery gave to undergraduates in advance can pave the way for the training of thoracic surgeons and formulate more detailed and individualized programs to teach students in accordance with their aptitude in the future.

Clinical Observation of Xingnaojing Injection Combined with Butylphthalide in the Treatment of Middle Cerebral Artery Infarction / 中国药房

OBJECTIVE:To investigate the effects and safety of Xingnaojing injection combined with butylphthalide on neuro-logical function,cognitive function,coagulation function and living activity. METHODS:A total of 106 patients with middle cere-bral artery infarction in Wuhan University People's Hospital during Jun. 2014-Dec. 2015 were divided into control group and obser-vation group according to random number table,with 53 cases in each group. Besides routine symptomatic treatment,control group was given Butylphthalide soft capsules 0.2 g,po,tid. Observation group was additionally given Xingnaojing injection 20 mL added into 0.9% Sodium chloride injection 250 mL,ivgtt,qd. Both groups were treated for 14 d. The neurological function score (NI-HSS,NFDS),cognitive function score (MoCA,MMSE),coagulation function indexes (PT,APTT,FIB),BI score were ob-served in 2 groups before and after treatment. The occurrence of secondary remote damage and ADR were recorded. RESULTS:Eight patients withdrew from the study,including 3 patients of control group and 5 of observation group. Before treatment,there was no statistical significance in neurological function scores(NIHSS,NFDS),cognitive function scores(MoCA,MMSE),coag-ulation function indexes or BI scores between 2 groups (P>0.05). After treatment,NIHSS,NFDS scores and FIB of 2 groups were decreased significantly compared to before treatment,and the observation group was significantly lower than the control group,with statistical significance (P0.05). CONCLUSIONS:For middle cerebral artery infarction,the application of Xingnaojing injection combined with butylphthalide can reduce the risk of remote damage,promote the recovery of neurological function and cognitive func-tion,and improve coagulation function and living activity with good safety.

Effect of interferon-γ and exogenous indole on the growth of Chlamydia trachomatis / 中国人兽共患病学报

We investigated the effects of γ-interferon and exogenous indole on the growth of domestic dominant standard strains and clinical straìns of Chlamydia trachomatis E-UW-5/Cx,and compared with the dominant strains of D-UW-5/Cx abroad.We used DMEM-10,DMEM-10 containing 5 ng/mL recombinant human interferon gamma (referred to as DMEM-10+IFN) and DMEM-10 containing 5 ng/mL recombinant human interferon gamma and 50 μM exogenous indole (referred to as DMEM-10+IFN+IND) to culture C.trachomatis,and then we fixed it with methanol to count inclusions after 48 hours,observing the influence of r-interferon and exogenous indole on the growth of C.trachomatis standard strains(E,D) and clinical strains.Results showed that the count of Chlamydia inclusion bodies in DMEM-10+IFN group was significantly lower than others (P＜0.05);no significant difference was found (P＞0.05) between the count of DMEM-10 group between DMEM-10+IFN+IND group.There were no significant difference between the E and D standard or clinical strains (P＞0.05).Under the effect of IFN-γ,the growth of domestic dominant strain E-UW-5/Cx C.trachomatis was significantly inhibited.After adding exogenous indole,C.trachomatis can escape the scavenging activity of IFN-γγto restore the infection vitality.

Keratitis, ichthyosis, and deafness syndrome: a case report / 中华皮肤科杂志

A 10 year-old female child developed erythema on the scalp,perioral area,neck,trunk,buttocks,palms and soles within 1 month after birth.Her skin was dry and rough,and the hairs were fine,soft,sparse and easily broken.As age advanced,typical hyperkeratosis and thickening of the skin occurred on an erythematous base.At the age of 5 years,the child developed photophobia and vision impairment.When the child was 8 years old,progressive hearing loss was observed.Physical examination revealed that the height and weight were 109 centimeters and 19 kilograms respectively.Skin examination showed fine,soft,sparse and easily-broken hair,large areas of brown plaques with crusts on the scalp,perioral area,neck,trunk and buttocks,and fissured,purulent and foul-smelling verrucous hyperplasia over these plaques.Brown to black hyperkeratotic plaques were scattered over the extremities,and diffuse hyperkeratosis occurred on the palms and soles.Both fingernails and toenails became thickened,cloudy and white with distal separation and deformation of the nail plate.As ophthalmic examination showed,the patient had photophobia,bilateral bulbar conjunctival hyperemia,corneal opacity and corneal vascular proliferation,and the visual acuity was 0.5 in the left eye and 0.2 in the right eye.Otolaryngological examination revealed moderate binaural sensorineural deafness.Stomatological examination showed enamel hypoplasia and diastema widening.Genetic testing showed a heterozygous mutation (c.C50T) in exon 2 of the gap junction protein beta 2 (GJB2) gene.Based on these clinical manifestations and examinations,the patient was diagnosed with keratitis,ichthyosis,and deafness (KID) syndrome.Skin lesions of the patient were significantly improved after the treatment with oral acitretin.

Polymorphism of HLA-D QA1 alleles in Chinese Han patients with persistent Chlamydia trachomatis genital infection / 中华皮肤科杂志

ObjectiveTo analyze the association of HLA-DQA1 gene polymorphism with persistent Chlamydia trachomatis genital infection.Methods Blood samples were collected from 80 patients with persistent genital Chlamydial infection,80 patients with common genital Chlamydial infection(who tested negative for Chlamydia trachomatis after one course of standard systemic treatment) and 80 normal human controls.HLA-DQA1 alleles were genotyped by PCR followed by gene sequencing.ResultsThe frequency of HLA-DQA1*0102 allele and HLA-DQA1*0501 allele was 22.5％ and 5.0％ respectively in patients with persistent genital Chlamydial infection,5％ and 20％ respectively in those with common genital Chlamydial infection,2.5％ and 17.5％ respectively in normal human controls.Compared with the patients with common genital Chlamydial infection and controls,the patients with persistent genital Chlamydial infection had a higher frequency of HLA-DQA1*0102(x2 =14.6286,P ＜ 0.001 ),but a lower frequency of DQA1*0501 (x2 =6.2598,P ＜ 0.05).ConclusionsHLA-DQA1*0102 allele may be a susceptible gene or closely linked with the susceptible genes of persistent genital Chlamydial infection.HLA-DQA1*0501 allele may have protective effects against persistent genital Chlamydial infection.

Changes in synaptophysin and growth associated protein-43 mRNA around a cerebral infarction after mobility training / 中华物理医学与康复杂志

Objective To investigate the effects of mobility training on mobility and the mRNA levels of both synaptophysin and growth associated protein 43 (GAP-43) in the region around an infarction in rats with acute cerebral infarction. Methods Models of cerebral infarction were created in 100 rats through middle cerebral artery occlusion. They were then randomly divided into training and control groups. The motor skill of the rats was examined using a beam walking test. The mRNA levels of both synaptophysin and GAP-43 in the region around the infarction were observed at the 1st, 3rd, 7th, 14th and 28th days after model-creation using a semi-quantitive reverse transcrip-tion polymerase chain reaction. Results The rats' mobility scores increased with training, and significant differ-ences were observed between the average scores of the two groups at the 3rd, 7th and 14th days. The scores were higher in the training group. The mRNA levels of both synaptophysin and GAP-43 in the region around the infarction increased significantly from the 1st to the 3rd and 7th days. Synaptophysin mRNA levels were significantly higher in the trained group at each time point, but the levels of GAP-43 mRNA were significantly higher in the trained group only on the 3rd and 7th days. Conclusions Motor skill and the mRNA levels of synaptophysin and GAP-43 in the region around an infarction can be increased by motor skill training, at least in rats with model acute cerebral infarc-tion.

Epidemiological and clinical features of 4430 cases of measles in Shenzhen Municipality / 中华全科医师杂志

Since the attenuated live vaccine against measles was developed,the epidemic of measles has been controlled effectively,however,there is a trend of gradual increase of measles cases in recent years.The epidemiological and clinical features of 4430 measles patients in Shenzhen Municipality in last 10 years were reviewed.The data showed that the epidemic season was postponed with the peak of June to September;the prevalent age groups were infants and adults,the number of severe cases increased;and the positive rate of serological antibody in infants with measles was the lowest.

Rehabilitation of mental disability in Hubei / 中华物理医学与康复杂志

Objective To investigate the present mental disability situation in Hubei provinee and the reha- bilitation strategies in use. Methods Provincial data from the Second China Sampling Survey of Disability was ana- lyzed. The 31 districts sampled in the survey were divided into a city group and a countryside group. The incidence of mental disability reported in the two groups was compared. Results Reported mental disability was found to be sig- nifieantly more prevalent in the countryside than in the city. However, the proportion of severe mental disability was significantly lower. Conclusion The need for rehabilitation of mental disability is huge in Hubei province. Society and the government should pay more attention to the rehabilitation of mental disability.

A neuroelectrophysiological study of the effect of mild hypothermia on acute severe cerebrovascular disease / 中华物理医学与康复杂志

Objective To evaluate the effect of mild hypothermia on acute cerebrovascular diseases. Methods Sixty-two cases of severe cerebrovascular diseases were randomized into hypothermia group and control group. In hypothermia group the patients were cooled to 34～35℃ for 48h ,while the patients in the control group treated by routine methods. Median nerve short latency somatosensory evoked potentials (SLSEP) and brain-stem auditory evoked potentials (BAEP) were recorded before cooling and 30 minutes, 24, 72, and 120 hours after cooling. The changes of EP were analyzed statistically. Results After treatment with mild hypothermia, the N13-N20 interpeak latency (IPL) of SLSEP and I-V IPL of BAEP were significantly reduced as compared with those of the control group ( P

The effect of mild hypothermia on the content of Ca~(2+)、Mg~(2+)、EAA in rat brain tissue and ET in plasma after acute cerebral infarction / 中华物理医学与康复杂志

Objective To investigate the effect of m il d hypothermia on the content of Ca 2+、Mg 2+、EAA in rat brain tissue and ET in plasma after acute cerebral infarction. Methods Forty-eight Sprague-Dawley rats were randomly assigned into trial group and control group. Using the method of reformed line-thrombosis,the cerebral in farction models were established. The rats in the trial-group were cooled by mi ld hypothermia for half an hour, while those in the control group were subjected to no disposal. Every group was divided into 4 sub-groups according to the pos t-infarction disposal time. Every sub-group was composed of 6 SD rats and kill ed at the time points of 1 hour,2 hour,4 hour and 8 hour after infarction, respe ctively. Then the content of Ca 2+、Mg 2+、EAA in rat brain tissue an d ET in plasma were measured. ResultsThe post-infar ction content of Ca 2+、EAA and ET of trial-group increased mildly and Mg 2+ reduced very little. There was a significant statistical difference bet ween the trial group and the control group. Conclusion Mild hypothermia may significantly reverse the increase of the content of Ca 2+ and EAA and the fall of Mg 2+ and the increment of ET in plasma as well after acute cerebral infarction in experimental animals. So as a result, m ild hypothermia possesses protective effect on brain.

Clinical analysis and early differential diagnosis of suspected pediatric patients with 2019 novel coronavirus infection

BackgroundWe aimed to identify clinical features of coronavirus disease 2019 (COVID-19) in children and evaluate the role of procalcitonin in early differential diagnosis. MethodsA retrospective analysis was performed on all suspected pediatric cases. Results39 (50.6%) of 77 suspected cases were comfirmed, 4 (5.2%) of them had viral coinfection. Compared with non-COVID-19 group (n=33), COVID-19 confirmed group (n=39) had fewer fever(OR[95% CI]0.467[0.314-0.694]; P=.000) and symptoms of acute respiratory infection (0.533[0.36-0.788]; P=.001), more asymptomatic (13.568[1.895-96.729]; P=.000), and more family cluster infections (5.077[2.224-11.591]; P=.000), while computed tomography had more positive findings of viral pneumonia (1.822[1.143-2.906]; P=.008). Age (6.9[3.6-10.5] vs 5[2.1-7.6]; P=. 088) and gender were statistically insignificant. Procalcitonin (0.05[0.029-0.076] vs 0.103[0.053-0.21]; P= 000) of COVID-19 alone group (n=35) was significantly reduced. While compared with coinfection group (n=4), procalcitonin (0.05[0.029-0.076] vs 0.144[0.109-2.26]; P=.010) was also reduced. The area under curve of model is 0.834 ([95% CI][0.741-0.926]; P=.000). Procalcitonin as a differential indicator of COVID-19 alone, its area under curve is 0.809 ([0.710-0.909]; P=.000). The optimal cut-off value is 0.1 ng/mL, the sensitivity, specificity, positive and negative predictive value of differentiating are 65.9%, 78.6%, 82.9%, and 59.2%, respectively. ConclusionsAsymptoms or mild symptoms, positive computed tomography findings and family cluster infection are the main clinical features of COVID-19 in children. With good performance, procalcitonin can provide an important basis for differentiating COVID-19 alone and other viral infection or viral coinfection.

Clinical characteristics of 82 death cases with COVID-19

BackgroundA recently developing pneumonia caused by SARS-CoV-2 was originated in Wuhan, China, and has quickly spread across the world. We reported the clinical characteristics of 82 death cases with COVID-19 in a single center. MethodsClinical data on 82 death cases laboratory-confirmed as SARS-CoV-2 infection were obtained from a Wuhan local hospitals electronic medical records according to previously designed standardized data collection forms. ResultsAll patients were local residents of Wuhan, and the great proportion of them were diagnosed as severe illness when admitted. Most of the death cases were male (65.9%). More than half of dead patients were older than 60 years (80.5%) and the median age was 72.5 years. The bulk of death cases had comorbidity (76.8%), including hypertension (56.1%), heart disease (20.7%), diabetes (18.3%), cerebrovascular disease (12.2%), and cancer (7.3%). Respiratory failure remained the leading cause of death (69.5%), following by sepsis syndrome/MOF (28.0%), cardiac failure (14.6%), hemorrhage (6.1%), and renal failure (3.7%). Furthermore, respiratory, cardiac, hemorrhage, hepatic, and renal damage were found in 100%, 89%, 80.5%, 78.0%, and 31.7% of patients, respectively. On the admission, lymphopenia (89.2%), neutrophilia (74.3%), and thrombocytopenia (24.3%) were usually observed. Most patients had a high neutrophil-to-lymphocyte ratio of >5 (94.5%), high systemic immune-inflammation index of >500 (89.2%), increased C-reactive protein level (100%), lactate dehydrogenase (93.2%), and D-dimer (97.1%). A high level of IL-6 (>10 pg/ml) was observed in all detected patients. Median time from initial symptom to death was 15 days (IQR 11-20), and a significant association between aspartate aminotransferase (p=0.002), alanine aminotransferase (p=0.037) and time from initial symptom to death were interestingly observed. ConclusionOlder males with comorbidities are more likely to develop severe disease, even die from SARS-CoV-2 infection. Respiratory failure is the main cause of COVID-19, but either virus itself or cytokine release storm mediated damage to other organ including cardiac, renal, hepatic, and hemorrhage should be taken seriously as well. FundingNo founding. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSAs the seventh member of enveloped RNA coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV)-2 causes a cluster of severe respiratory disease which is similar to another two fatal coronavirus infection caused by SARS-CoV and Middle Eastern respiratory syndrome coronavirus (MERS-CoV). Through searching PubMed and the China National knowledge infrastructure databases up to February 20, 2020, no published article focusing on hospitalized dead patients was identified. Added value of this studyWe conducted a single-center investigation involving 82 hospitalized death patients with COVID-19 and focused on their epidemiological and clinical characteristics. 66 of 82 (80.5%) of patients were older than 60 years and the median age was 72.5 years. The bulk of death cases had comorbidity (76.8%). Respiratory failure remained the leading cause of death, following by sepsis syndrome/MOF, cardiac failure, hemorrhage, and renal failure. Most patients had a high neutrophil-to-lymphocyte ratio, high systemic immune-inflammation index, and increased levels of proinflammatory cytokines. Implications of all the available evidenceSARS-CoV-2 causes a cluster of severe respiratory illness which is similar to another two fatal coronavirus infection caused by SARS-CoV and MERS-CoV. Death is more likely to occur in older male patients with comorbidity. Infected patients might develop acute respiratory distress and respiratory failure which was the leading cause of death, but damages of other organs and systems, including cardiac, hemorrhage, hepatic, and renal also contribute to the death. These damages might be attributable to indirect cytokines storm initiated by immune system and direct attack from SARS-CoV-2 itself.