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.

One of the design challenges for the emerging 3D ICs is the power integrity. With multiple dies stacked vertically, the voltage droop may result in severe power integrity issues. In this paper, we first analyze the impact of application behaviors on voltage droop in a 3D power supply network (PDN) and observe that voltage droop is extremely imbalanced either across different layers or among the cores in the same layer. Based on the observation, we propose Swimming Lane, a hardware/software co-design method with two key schemes: (1) Mitigating the interference among different dies via a layer-independent scheme, and (2) balancing the intra-layer voltage droop and reducing the worst-case margin via OS scheduling. Compared to conventional designs, our method can reduce power consumption by 18%, worst-case voltage droops by 13%, and the number of voltage violations by 40%.

SwimmingLane: A composite approach to mitigate voltage droop effects in 3D power delivery network

An experimental investigation on the impermeability and durability of concrete with a novel and multifunctional hydrophobic admixture addition

OBJECTIVE: To investigate the signaling pathways involved in brain derived neurotrophic factor (BDNF) -induced angiogenesis and to provide a novel pathway to anti-angiogenesis in multiple myeloma. METHODS: The phosphorylation of AKT and endothelial NO synthase (eNOS) in human umbilical venous epithelial cells (HUVEC) were detected by Western blot. The angiogenic activity in vitro was evaluated by transwell migration assay and tube formation assay. BDNF-induced in vivo angiogenic activity was evaluated by Matrigel plug assay. The concentration of NO was detected by nitric acid deoxidizase assay. Cell apoptosis was detected by FITC-Annexin V/PI double staining and flow cytometry. RESULTS: BDNF activated the phosphatidylinositol-3-kinase (PI3K)/AKT/eNOS pathway in HUVEC in a time- and dose-dependent manner. BDNF-stimulated NO production was blocked by LY294002, a PI3K inhibitor. In vitro, BDNF induced HUVEC migration and tube formation on Matrigel, which could be significantly blocked by LY294002 and N(G)-nitro-L-arginine methyl ester (L-NAME) respectively; but BDNF induced HUVEC apoptosis could be blocked only by LY294002. In vivo, BDNF increased capillary ingrowth into subcutaneously implanted Matrigel plugs in mice, which could be significantly reduced in L-NAME treated mice. CONCLUSION: BDNF induces angiogenesis through the AKT/eNOS signaling kinase pathway. It may be a novel target for the anti-angiogenesis therapy for multiple myeloma.

Involvement of AKT/eNOS in brain derived neurotrophic factor-induced angiogenesis

With the success of Transformers in the computer vision field, the automated design of vision Transformers has attracted significant attention. Recently, MetaFormer found that simple average pooling can achieve impressive performance, which naturally raises the question of how to design a search space to search diverse and high-performance Transformer-like architectures. By revisiting typical search spaces, we design micro-meso-macro space to search for Transformer-like architectures, namely BurgerFormer. Micro, meso, and macro correspond to the granularity levels of operation, block and stage, respectively. At the microscopic level, we enrich the atomic operations to include various normalizations, activation functions, and basic operations (e.g., multi-head self attention, average pooling). At the mesoscopic level, a hamburger structure is searched out as the basic BurgerFormer block. At the macroscopic level, we search for the depth, width, and expansion ratio of the network based on the multi-stage architecture. Meanwhile, we propose a hybrid sampling method for effectively training the supernet. Experimental results demonstrate that the searched BurgerFormer architectures achieve comparable even superior performance compared with current state-of-the-art Transformers on the ImageNet and COCO datasets. The codes can be available at https://github.com/xingxing-123/BurgerFormer. settings. The experimental results demonstrate that our hybrid sampling search method outperforms random search,

Searching for BurgerFormer with Micro-Meso-Macro Space Design

The extensive use of sacrificial agents and the low carrier separation and utilization efficiency remain important factors limiting the development of photocatalytic hydrogen production. We report a three-layered, dual-functional photocatalysts of Cu [email protected]2(U6N)/ZnIn2S4 nanosheets (ZIS), for the simultaneous production of photocatalytic hydrogen and degradation of organic pollutants. When common and highly toxic organic pollutants (phenolic compounds and antibiotics) were substituted for the sacrificial agents, [email protected]/ZIS exhibited superior sustained hydrogen production, approximately 28 times greater than that of pure ZIS. The experimental results suggested that the window size of U6N (< organic pollutants molecular size) separates the reaction sites of organic pollutants oxidation and reduction of hydrogen ions (H+), thereby achieving spatial separation of redox sites. Besides, the structure of [email protected]/ZIS, which was anchored Cu within U6N and encapsulated by ZIS nanosheets, forming Z-type heterojunctions, achieved the control of the directional transfer of photogenerated electrons. And the coupled system can effectively enhance water quality by reducing the biological toxicity of the wastewater. This study suggests new avenues for environmental restoration and non-fossil fuel production. 

Yu Hu

Papers

SwimmingLane: A composite approach to mitigate voltage droop effects in 3D power delivery network

An experimental investigation on the impermeability and durability of concrete with a novel and multifunctional hydrophobic admixture addition

Involvement of AKT/eNOS in brain derived neurotrophic factor-induced angiogenesis

Searching for BurgerFormer with Micro-Meso-Macro Space Design

Cu atoms on UiO-66-NH2 / ZnIn2S4 nanosheets enhance photocatalytic performance for recovering hydrogen energy from organic wastewater treatment