Prospective Cohort Study

Importance The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations. Objective To study the neurologic manifestations of patients with COVID-19. Design, Setting, and Participants This is a retrospective, observational case series. Data were collected from January 16, 2020, to February 19, 2020, at 3 designated special care centers for COVID-19 (Main District, West Branch, and Tumor Center) of the Union Hospital of Huazhong University of Science and Technology in Wuhan, China. The study included 214 consecutive hospitalized patients with laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection. Main Outcomes and Measures Clinical data were extracted from electronic medical records, and data of all neurologic symptoms were checked by 2 trained neurologists. Neurologic manifestations fell into 3 categories: central nervous system manifestations (dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure), peripheral nervous system manifestations (taste impairment, smell impairment, vision impairment, and nerve pain), and skeletal muscular injury manifestations. Results Of 214 patients (mean [SD] age, 52.7 [15.5] years; 87 men [40.7%]) with COVID-19, 126 patients (58.9%) had nonsevere infection and 88 patients (41.1%) had severe infection according to their respiratory status. Overall, 78 patients (36.4%) had neurologic manifestations. Compared with patients with nonsevere infection, patients with severe infection were older, had more underlying disorders, especially hypertension, and showed fewer typical symptoms of COVID-19, such as fever and cough. Patients with more severe infection had neurologic manifestations, such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]), and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]). Conclusions and Relevance Patients with COVID-19 commonly have neurologic manifestations. During the epidemic period of COVID-19, when seeing patients with neurologic manifestations, clinicians should suspect severe acute respiratory syndrome coronavirus 2 infection as a differential diagnosis to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.

https://jamanetwork.com/journals/jamaneurology/articlepdf/2764549/jamaneurology_mao_2020_oi_200025.pdf

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China.

Chest CT had higher sensitivity for diagnosis of COVID-19 as compared with initial reverse-transcription polymerase chain reaction from swab samples in the epidemic area of China.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200642

Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases.

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and Participants Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures SARS-CoV-2 infection confirmed by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and Measures Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network. Results Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2was greater than 50% in 89% of patients. The median Pao2/Fio2was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0];P = .94). Median Fio2was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, −10% [95% CI, −14% to 6%];P = .006), and median Pao2/Fio2was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, −8 to 22];P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68];P  Conclusions and Relevance In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.

/pdf/baseline-characteristics-and-outcomes-of-1591-patients-4y6nwx3pu4.pdf

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy.

In mountain and ravine region of southwest China, several hydropower stations have been built in this area. It is the main national base for hydropower energy development, but under the influence of geological structure and surface erosion, the in-situ stress environment in this area is more complex. The main purpose of this paper is to establish the relationship between measured in-situ stress data and numerical calculation by means of neural network. Therefore, it can be used to analyze the distribution characteristics of large-scale in-situ stress and the failure of regional geological bodies under the action of in-situ stress in Xiluodu area. This paper analyzes the geological conditions and the measured data of in-situ stress in Xiluodu area. The results show that there is obvious surface weathering phenomenon in this area, the stress environment is complex. The depth has a positive impact on the level of in-situ stress, but the impact degree is different. The genetic algorithm-BP artificial neural networks (G-P) method is trained by the measured in-situ stress data. Based on the field measurement data, neural network algorithm and numerical simulation technology, the three-dimensional in-situ stress field distribution characteristics of the project area are carried out. The research shows that the scheme of combining the actual measurement, numerical analysis and neural network inversion is reliable; Depth is an important factor affecting the maximum horizontal stress value in Xiluodu area; Under the action of in-situ stress, the fissures of geological body are relatively developed, and three types of original water storage and flow spaces are formed before dam storage period; The flow and storage space of groundwater includes limestone fracture, basalt fracture and slope fracture aquifer; After the impoundment of the reservoir area, the reservoir water is transmitted downward through the vertical fissures, and finally the reservoir water forms a hydraulic connection with the groundwater. After impoundment, the hydrogeological conditions of the reservoir area would be changed.

/pdf/inversion-method-of-in-situ-stress-and-rock-damage-4cevnkqjjq.pdf

Inversion Method of In-situ Stress and Rock Damage Characteristics in Dam Site Using Neural Network and Numerical Simulation-A Case Study

Physical Unclonable Function (PUF) is a new hardware security primitive that exploits the manufacturing variations of integrated circuits. Traditional arbiter PUF is vulnerable to machine learning based modeling attacks due to its linearity. Current mirror PUF uses non-linear current mirror to bring non-linearity into the challenge-response relationship and is claimed resistant to modeling attacks. This paper further tests its security, and proves that the current mirror PUF is not as secure as claimed. A genetic algorithm based method is proposed to attack the current mirror PUF. By modeling the relationship between the output current and the input current of each current mirror, and fitting the model using genetic algorithm, we are able to predict the responses of current mirror PUF. Experiments prove that the prediction accuracy towards current mirror PUF is up to 99.27%.

Efficient Attack on Non-linear Current Mirror PUF with Genetic Algorithm

The Boolean matching problem is a key procedure in technology mapping for heterogeneous field programmable gate arrays (FPGA), and SAT-based Boolean matching (SAT-BM) provides a highly flexible solution for various FPGA architectures. However, the computational complexity of state-of-the-art SAT-BM prohibits its application practically. In this paper we propose an efficient SAT-BM algorithm by exploring function and architectural symmetries. While the most recent work obtained up to 13times speedup, we achieve up to 200times speedup, when both are compared to the original SAT-BM algorithm.

http://www.ece.ualberta.ca/~bryanhu/pub/iccad07-satbm.pdf

Exploiting symmetry in SAT-based Boolean matching for heterogeneous FPGA technology mapping

The Physical Unclonable Function (PUF) has broad application prospects in the field of hardware security. The arbiter PUF is a typical kind of strong PUF. However, due to its deterministic logic, attackers can use modeling techniques to break it in short time. Therefore, this paper proposes an Obfuscation logic based PUF (OPUF) design. A Boolean obfuscation module is proposed to obfuscate the logic which is employed to select the path segments in the arbiter PUF. In this way, the nondeterminacy of PUF is improved, and the computation complexities of modeling attacks are significantly increased, making the OPUF much safer against modeling attack. Both the theoretical analysis and the experimental results show the proposed OPUF design has good stability and randomness.

OPUF: Obfuscation logic based physical unclonable function

// Junzhang Zhao 2, 3, 4, 5, * , Rui Zhou 2, 3, * , Kaiyuan Hui 4, 6 , Yang Yang 4 , QiuYue Zhang 1 , Yali Ci 4 , Lei Shi 4 , Caimin Xu 4 , Fang Huang 1 , Yu Hu 1 1 Union Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China 2 Department of Gastroenterology, Zhongnan Hospital of Wuhan University of Medicine, Wuhan, China 3 The Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China 4 National Laboratory of Medical Molecular Biology, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China 5 Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China 6 Tumor Laboratory, Department of Radiation Oncology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China * These authors contributed equally to this work Correspondence to: Yu Hu, email: proton948@hotmail.com Fang Huang, email: proton948@126.com Keywords: glutamnase, selenite, colorectal cancer Received: August 01, 2015      Accepted: October 21, 2016      Published: November 25, 2016 ABSTRACT Glutaminolysis is important for metabolism and biosynthesis of cancer cells, and GLS is essential in the process. Selenite is widely regarded as a chemopreventive agent against cancer risk. Emerging evidence suggests that it also has chemotherapeutic potential in various cancer types, but the mechanism remains elusive. We demonstrate for the first time that supranutritional dose of selenite suppresses glutaminolysis by promoting GLS1 protein degradation and apoptosis. Mechanistically, selenite promotes association of APC/C-CDH1 with GLS1 and leads to GLS1 degradation by ubiquitination, this process is related to induction of PTEN expression. In addition, GLS1 expression is increased in human colorectal cancer tissues compared with normal mucosae. Our data provide a novel mechanistic explanation for the anti-cancer effect of selenite from a perspective of cell metabolism. Moreover, our results indicate that glutaminolysis especially GLS1 could be an attractive therapeutic target in colorectal cancer.

/pdf/selenite-inhibits-glutamine-metabolism-and-induces-apoptosis-13a2lbown1.pdf

Yu Hu

Papers

Inversion Method of In-situ Stress and Rock Damage Characteristics in Dam Site Using Neural Network and Numerical Simulation-A Case Study

Efficient Attack on Non-linear Current Mirror PUF with Genetic Algorithm

Exploiting symmetry in SAT-based Boolean matching for heterogeneous FPGA technology mapping

OPUF: Obfuscation logic based physical unclonable function

Selenite inhibits glutamine metabolism and induces apoptosis by regulating GLS1 protein degradation via APC/C-CDH1 pathway in colorectal cancer cells