Showing papers in "Journal of Central South University. Medical sciences in 2020"

Chest CT findings and clinical features of coronavirus disease 2019 in children.

Abstract: Objectives To describe the CT features and clinical characteristics of pediatric patients with coronavirus disease 2019 (COVID-19). Methods A total of 9 COVID-19 infected pediatric patients were included in this study. Clinical history, laboratory examination, and detailed CT imaging features were analyzed. All patients underwent the first CT scanning on the same day of being diagnosed by real-time reverse-transcription polymerase chain reaction (rRT-PCR). A low-dose CT scan was performed during follow-up. Results All the child patients had positive results. Four patients had cough and one patient had fever. One patient presented both cough and fever. Two children presented other symptoms like sore throat and stuffy nose. One child showed no clinical symptom. Five patients had positive initial CT findings with subtle lesions like ground-glass opacity (GGO) or spot-like mixed consolidation. Three patients were reported with negative results in the initial and follow-up CT examination. One patient was reported with initial negative CT findings but turning positive during the first follow-up. All patients had absorbed lesions on follow-up CT images after treatment. Conclusions Pediatric COVID-19 patients have certain imaging and clinical features as well as disease prognosis. Children with COVID-19 tend to have normal or subtle CT findings and relatively better outcome.

Clinical characteristics of anti-N-methyl-D-aspartate receptor encephalitis in children.

Abstract: OBJECTIVES To analyze the clinical characteristics and prognosis of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and to provide a basis for early clinical identification of this disease. METHODS The clinical data of 42 cases of anti-NMDAR encephalitis at Department of Pediatrics, Second Xiangya Hospital, Central South University from January 2015 to March 2018 were collected. The clinical features and followed-up outcomes were analyzed retrospectively. RESULTS There were 15 cases (35.7%) of males and 27 cases (64.3%) of females in 42 children, with a ratio of 1꞉1.8. They were aged from 4 months to 17 years, with an average of (9.20±4.66) years. The most common initial symptoms were seizures (47.6%, 20/42) and mental behavior disorder (35.7%, 15/42). During the course of the disease, 85.7% patients(36/42) had mental and behavior disorder, 85.7% patients (36/42) had epilepsy, 76.2% (32/42) had speech disorder, 66.7% patients (28/42) had dyskinesia, 66.7% patients (28/42) had the decreased level of consciousness, 61.9% patients (26/42) had autonomic instability, and 57.1% (24/42) patients had sleep disorder. All the children had positive antibody against NMDA receptor resistance encephalitis in cerebrospinal fluid. Head MRI showed the abnormal incidence was 50.0% (21/42), and the lesions involved in parietal lobe, frontal lobe, temporal lobe, occipital lobe, midbrain, thalamus, basal ganglia and optic nerve. There was a patient with optic nerve damage combined with myelin oligodendrocyte glycoprotein (MOG) antibody positive. Forty cases were examined by electroencephalogram (EEG), 92.5% cases (37/40) were abnormal, mainly showing diffuse slow waves, and δ brushes could be seen in severe cases. And there was 1 patient (2.4%) complicated with mesenteric teratoma. The mRS score (2.14±1.46) at discharge was significantly lower than the highest mRS score (3.88±1.38) during hospitalization (P<0.05). After 3-39 months of follow-up, mRS score at 3 months after discharge was only 0.81±1.29, which was still improved compared with that at discharge, 76.2% cases (32/42) experienced complete or near-complete recovery (mRS score≤2), and 4.8% (2/42) cases relapsed. There was no mortality; the initial time of immunotherapy and the highest mRS score in the course of the disease were the factors affecting the prognosis. The earlier the starting time for immunotherapy and the lower mRS score in the course of the disease were, the better the prognosis was. CONCLUSIONS Seizures, mental and behavior disorder, dyskinesias, speech disorder and autonomic instability are common clinical manifestations of anti-NMDAR encephalitis in children. The effect of immunotherapy is significant, and the time to start immunotherapy and the severity of the disease are important factors affecting the prognosis. Anti-NMDAR encephalitis can be combined with other autoantibodies, but its clinical significance and mechanism need further study.

Medical students' mental health, professional pride, and intention to work in the front-line during coronavirus disease 2019 pandemic.

Abstract: OBJECTIVES To understand medical students' mental health, professional pride, and intention to work in the front-line during coronavirus disease 2019 (COVID-19) pandemic, and provide a reference for psychological intervention. METHODS We used the depression-anxiety-stress scale and self-designed questionnaire on professional pride, intention to work in the front-line and the extent of family support. Medical students from 4 medical schools in Fujian and Hunan were investigated. Their mental health status, professional pride and first-line work willingness with different characteristics were compared, and the influential factors for professional pride and first-line work willingness were analyzed. RESULTS A total of 266 valid questionnaires were collected. During the pandemic, there were significant differences in the proportion of depressed students among different college and universities, majors and stages (P<0.05), and the professional pride was significantly different (P<0.001). Medical students with different mental health status showed significant differences in professional pride (P<0.01). Marriage, pressure and extent of family support were the influential factors for their professional pride (P<0.05). The latter two were also influential factors for their intention to work in the front-line (P<0.05). CONCLUSIONS During the pandemic, students from college and nursing have relatively better mental health and higher professional pride. The professional pride is low in medical students who married, with abnormal stress or low family support. The intention to work in front-line is decreased in students with abnormal stress or low family support.

Mental health status of patients with coronavirus disease 2019 in Changsha.

Abstract: Objectives The epidemic of coronavirus disease 2019 (COVID-19) brought psychological stress to the public, especially to patients. This study aims to investigate the mental health of patients with COVID-19 in Changsha. Methods We took cross-section investigation for the mental health of 112 patients with COVID-19 via questionnaires. Mann-Whitney U test, Chi-square test, and Fisher's exact test were performed to compare general and clinical data between the slight-ordinary patients and severe patients. Single sample t-tests were used to compare the difference between the factor scores of the Symptom Check-List 90 (SCL-90) in COVID-19 patients with the norm of 2015 and factor scores of SCL-90 in patients with the severe acute respiratory syndrome (SARS). Results The obsessive-compulsive, depression, sleep and eating disorders had the highest frequency among the positive symptoms of SCL-90 in patients with COVID-19 in Changsha. The factor scores of somatization, depression, anxiety, phobia anxiety, sleep and eating disorders in patients with COVID-19 were higher than those of the norm (P≤0.001 or P 0.05). Conclusions The levels of somatization, depression, anxiety, phobia anxiety, sleep and eating disorders in patients with COVID-19 in Changsha are higher than those of the norm. However, the mental health of slight-ordinary patients with COVID-19 is better than that of patients with SARS. It needs to provide targeting psychological interventions depending on the severity of patients.

Clinical characteristics and the risk factors for severe events of elderly coronavirus disease 2019 patients

Abstract: OBJECTIVES To investigate the clinical characteristics and risk factors for severe events of coronavirus disease 2019 (COVID-19) in elderly patients. METHODS Retrospective analysis was performed on the clinical data of all elderly COVID- 19 patients treated in Changsha Public Health Treatment Center from January 17, 2020 to March 15, 2020, which included basic diseases, symptoms, test results, and other clinical characteristics, and prognostic indicators such as severity of illness, length of hospital stay, virus shedding time and mortality rate. The differences in clinical characteristics and prognostic indicators between elderly, middle-aged, and young COVID-19 patients were also analyzed. Logistic regression model was used to conduct univariate and multivariate analysis of risk factors for developing severe events in elderly COVID-19 patients; receiver operating characteristic (ROC) curve analysis was used to evaluate the prediction efficacy. RESULTS Of the 230 COVID-19 adult patients, 34 were young patients (14.8%), 136 were middle-aged patients (59.1%), and 60 were elderly (26.1%). Among the 60 elderly patients, 23 were male (38.3%) and 37 were female (61.7%), with a medium age of 66 years old. Common symptoms were fever (66.7%), cough (50.0%), and fatigue (41.7%). C reactive protein (CRP) was increased significantly. The proportion of severe cases was 31.7%, and mortality was 1.7%. The median length of hospitalization and median virus shedding time were 18.5 days and 21 days, respectively. Compared with the young and the middle-aged patients, the elderly had a higher proportion of hypertension, diabetes, and cardiovascular diseases, more common shortness of breath, higher proportions of pneumonia and severe cases (all P<0.05), and the decreased lymphocyte count and lymphocyte percentage (both P<0.05), as well as higher CRP and erythrocyte sedimentation rate (ESR) levels (both P<0.05). Compared with non-severe cases, severe elderly patients demonstrated higher CRP and aspartate aminotransferase (AST) levels (all P<0.05), the reduced lymphocyte count (P<0.05), and the prolonged length of hospitalization and virus shedding duration (both P<0.05). Univariate logistic regression analysis indicated that the lymphocytes proportion, CRP and AST levels were significantly correlated with the risk for developing severe events in elderly COVID-19 patients (all P<0.05). Multivariate logistic regression found that severe events in elderly patients with COVID-19 were significantly correlated with CRP level (OR=1.041, P=0.013). ROC curve analysis revealed that the area under the curve (AUC) for CRP to diagnose severe events in elderly COVID 19 patients was 0.851. CONCLUSIONS The proportion of severe cases in elderly COVID-19 patients is higher than that in young and middle-aged patients. CRP level has a good predictive value for the possibility of severe events in elderly COVID-19 patients.

Anti-inflammatory effects of luteolin on acute gouty arthritis rats via TLR/MyD88/NF-κB pathway.

Abstract: OBJECTIVES To investigate the anti-inflammatory effect of luteolin on the acute gouty arthritis (AGA) rats and the underlying mechanisms. METHODS A total of sixty rats were chosen and randomly divided into 5 groups:A control group, a monosodium urate (MSU) group, a colchicine group, 2 luteolin groups (50 mg/kg, 150 mg/kg). The AGA model of rats was established by injecting monosodium urate (MSU) at the concentration of 25 mg/mL into the ankle joint cavity. Changes of joint swelling index at different time points and the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum and synovial were measured. The mRNA expression of TLR2, TLR4, and MyD88 in synovial tissue was detected by real-time PCR, and the protein expression of TLR2, TLR4, MyD88, and NF-κB in synovial tissues was determined by Western blotting. The inflammatory cells of the ankle joint and its surrounding soft tissues were observed after HE staining, and the expression of NF-κB was determined by immunohistochemistry. RESULTS Compared with the MSU group, the joint swelling indexes of the luteolin group and the colchicine group were significantly decreased (P<0.05), and the levels of IL-1β, IL-6 and TNF-α were also significantly decreased (P<0.01). The mRNA levels of TLR2, TLR4, and MyD88 and the protein levels of TLR2, TLR4, MyD88, and NF-κB were significantly decreased (P<0.01). CONCLUSIONS Luteolin can reduce the inflammatory response of acute gouty arthritis via down-regulating the TLR/MyD88/NF-κB pathway, and it is expected to be an effective drug for the treatment of acute gouty arthritis.

Cholinergic anti-inflammatory pathway and its role in treatment of sepsis.

Abstract: The cholinergic anti-inflammatory pathway (CAP) is a neuro-immunomodulatory pathway,in which acetylcholine (ACh) released by the interaction of vagal nerves with α7 nicotinic acetylcholine receptor (α7nAChR),which prevents the synthesis and release of pro-inflammatory cytokines and ultimately regulates the local or systemic inflammatory response in a feedback manner. It has been shown that there are many possible effective treatments for sepsis, including vagus nerve stimulation by physical therapy, drugs such as acetylcholine receptor agonist and ultrasound therapy.

Role of transient receptor potential cation channel subfamily M member 2 in hepatic ischemia-reperfusion injury in the mouse and the underlying mechanisms.

Abstract: OBJECTIVES To investigate the role of transient receptor potential cation channel subfamily M member 2 (TRPM2) in hepatic ischemia-reperfusion injury of mouse (HIRI) and the possible mechanisms. METHODS Sixty adult male C57BL/6 mice were randomly divided into 4 groups: a sham group (S group), a HIRI model group (M group), a TRPM2 adenovirus interference vector group (T group), and a TRPM2 adenovirus control vector group (C group) (n=15 in each group). The liver tissues of mice before perfusion were obtained. The efficiency of adenovirus infection was detected by fluorescence microscopy, and the silencing efficiency of adenovirus against TRPM2 was detected by real-time PCR.The abdominal aorta blood and liver tissues were collected from mice at 2, 4 and 8 h after reperfusion. The activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum of mice were detected. Hepatic pathological changes were examined by hematoxylin-eosin (HE) staining. The protein expression of TRPM2 and Rac family small GTPase 1 (RAC1) in liver tissues was detected by Western blotting. Changes of malondialdehyde (MDA), superoxide dismutase (SOD) and myeloperoxidase (MPO) activities in liver tissues were detected by enzyme-linked immunosorbent assay. RESULTS A strong signal of green fluorescence was observed in the liver tissues of mice in the T and C groups compared to the S or M group. Compared with the S, M or C group, the expression of TRPM2 mRNA in liver tissue in the T group was significantly down-regulated (all P<0.05). The morphology of hepatocytes was normal in the S group under light microscope.Hepatic sinus dilatation, congestion, hepatocyte degeneration, central necrosis of lobule, and massive inflammatory granulocyte infiltration were observed in the M and C group, respectively. The degree of hepatocyte damage in the T group was significantly reduced compared with that in the M and C group, respectively. Compared with the S group, the serum ALT and AST activities in the M, T and C groups were significantly increased at 2, 4 and 8 h after reperfusion (all P<0.05). Compared with the M or C group, the serum ALT and AST activities in the T group were significantly lower in serum of mice at 2, 4, and 8 h after reperfusion (all P<0.05). Compared with the M or C group, the serum SOD activity in the T group was significantly increased at 2, 4, and 8 h after reperfusion (all P<0.05), while the serum MDA and MPO activities were significantly decreased (all P<0.05). The protein expression of TRPM2 and RAC1 in liver tissues in the T group were significantly lower than those in the M and C groups at 2, 4 and 8 h after reperfusion (all P<0.05). CONCLUSIONS Pretreatment with TRPM2 adenovirus interference vector can effectively silence TRPM2 gene expression in liver tissues of mice and attenuate HIRI, which may be related to inhibiting oxidative stress and reducing the expression of RAC1 protein.

Mental health of front-line staff in prevention of coronavirus disease 2019.

Abstract: OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic is a global public health crisis, which elicits psychological problems in different population. This study is to investigate the impact of COVID-19 on mental health in the front-line staff. METHODS Patient Health Questionnare-9 (PHQ-9), Self-Rating Anxiety Scale (SAS), and Fatigue Self-assessment Scale (FSAS) were used to assess the depression, anxiety, and fatigue in front-line staff. RESULTS The detection rates of depression, anxiety, and fatigue were 49.1%, 21.8%, and 76.0% among the front-line staff. The rates of depression, anxiety, and fatigue in community workers were higher than those in medical workers and other occupational staff (P<0.01). The PHQ-9 of front-line staffs was negatively correlated with age, family income, family members' support, satisfaction of service objects, and sleep quality (all P<0.01), while positively correlated with education level, fatigue, fear of pneumonia, and the duration of daily attention to the COVID-19 (all P<0.01). SAS was negatively correlated with age, family income, family support, satisfaction of objects service, and sleep quality (all P<0.01), while positively correlated with gender, fatigue, fear of pneumonia, and duration of daily attention to the COVID-19 (all P<0.01). CONCLUSIONS The front-line workers should manage work and rest time reasonably to adjust their negative mood and fatigue. The government and the society should pay more attention to the psychological state of the front-line staff, particularly for the staff working in the community or villages and towns in preventing the COVID-19 pandemic. Thus, front-line staff can be obtained mental intervention or be taken a rest from the high-intensive work.

Risk prediction for postpartum depression based on random forest.

Abstract: Objectives To explore the application of random forest algorithm in screening the risk factors and predictive values for postpartum depression. Methods We recruited the participants from a tertiary hospital between June 2017 and June 2018 in Changsha City, and followed up from pregnancy up to 4-6 weeks postpartum.Demographic economics, psychosocial, biological, obstetric, and other factors were assessed at first trimesters with self-designed obstetric information questionnaire and the Chinese version of Edinburgh Postnatal Depression Scale (EPDS). During 4-6 weeks after delivery, the Chinese version of EPDS was used to score depression and self-designed questionnaire to collect data of delivery and postpartum. The data of subjects were randomly divided into the training data set and the verification data set according to the ratio of 3꞉1. The training data set was used to establish the random forest model of postpartum depression, and the verification data set was used to verify the predictive effects via the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and AUC index. Results A total of 406 participants were in final analysis. Among them, 150 of whom had EPDS score ≥9, and the incidence of postpartum depression was 36.9%. The predictive effects of random forest model in the verification data set were at accuracy of 80.10%, sensitivity of 61.40%, specificity of 89.10%, positive predictive value of 73.00%, negative predictive value of 82.80%, and AUC index of 0.833. The top 10 predictive influential factors that screening by the variable importance measure in random forest model was antenatal depression, economic worries after delivery, work worries after delivery, free triiodothyronine in first trimesters, high-density lipoprotein in third trimester, venting temper to infants, total serum cholesterol and serum triglyceride in first trimester, hematocrit and serum triglyceride in third trimester. Conclusions Random forest has a great advantage in risk prediction for postpartum depression. Through comprehensive evaluation mechanism, it can identify the important influential factors for postpartum depression from complex multi-factors and conduct quantitative analysis, which is of great significance to identify the key factors for postpartum depression and carry out timely and effective intervention.

Design, validation, and clinical practice of standardized imaging diagnostic report for COVID-19.

Abstract: OBJECTIVES To design a standardized imaging diagnostic reporting mode for screening coronavirus disease 2019 (COVID-19), and to prospectively verify its effectiveness in clinical practice. METHODS A new classification and standardized imaging diagnosis report mode of viral pneumonia was established by studying and summarizing the imaging findings of various kinds of viral pneumonia, combining with lesion density, interstitial changes, pleural effusion, lymph nodes, and some special signs. After systematic training, the radiologist experienced clinical practice for screening CT features. COVID-19 cases were screened retrospectively in the single-center. The confirmed cases were verified, and the diagnostic efficacy of the standardized imaging reporting system in screening COVID-19 was tested. RESULTS There were 912 patients in this stage receiving the screening imaging examination. Of them, 190 patients were screened in the report mode and 30 patients were diagnosed as COVID-19. The CT manifestation of COVID-19 was characterized by pure ground glass lesions or with a few solid components, predominant subpleural distribution, no lymph node enlargement and pleural effusion, and often with paving-way sign and air bronchus sign. In combination with the above signs, the diagnostic efficacy of COVID-19 was 0.942. CONCLUSIONS The standardized imaging diagnosis report mode based on COVID-19 chest image features is effective and practical, which should be popularized.

Clinical characteristics and prognosis in 269 patients with antineutrophil cytoplasimc antibody associated vasculitis.

Abstract: Objectives To investigate the clinic-pathological characteristics, prognosis and its risk factors for antineutrophil cytoplasimc antibody (ANCA)-associated vasculitis (AAV). Methods The basic information and clinic-pathological characteristics of AAV patients, who was diagnosed from January 2010 to January 2018 in Xiangya Hospital, Central South University, were retrospectively collected. The renal survival and patient survival were regular followed up, and their clinical pathological, prognosis data and risk factors for renal were analyzed. Results Among 269 AAV patients, 225 patients (83.64%) were microscopic polyangiitis (MPA), 33 patients (12.27%) were granulomatosis with polyangiitis (GPA), and 11 patients (4.09%) were eosinophilic granulomatosis with polyangiitis (EGPA). Male-to-female ratio was almost 1∶1 for MPA (147/122), but GPA and EGPA was more frequent among man. The medium time from disease onset to diagnosis was 64.0 (32.5, 148.5) days, 65 patients (24.16%) were diagnosed within 30 days. A total of 94.67% patients had kidney involvement in MPA patients, which was significantly higher than that in patients with GPA (63.63%), but ear, nose, and throat manifestations were more frequent in GPA patients. The 1-year kidney survival rates of GPA and MPA patients in this study were 75% and 59.3%, respectively. The 1-year death rates were 16.7% and 16.9%, respectively. The multivariable logistic regression analysis revealed that the low platelet level, low globulin level, low immunoglobin G, and high serum creatinine level were independent risk factors for the 1-year renal survival rate in AAV patients. Multiple factor logistic regression analysis showed that the serum creatinine level was an independent risk factor for all-cause mortality. Conclusions MPA is the priority in the AAV patients. The proportion of patients with advanced end-stage renal disease and mortality is still high, and the early diagnosis and treatment in time is crucial for the improvement of prognosis for AAV.

Clinical characteristics of 71 patients with coronavirus disease 2019.

Abstract: OBJECTIVES To analyze the clinical characteristics of 71 patients with coronavirus disease 2019 (COVID-19). METHODS The general data, epidemiological data, laboratory tests, imaging examinations, and treatment of 71 patients with COVID-19 admitted to the Sixth People's Hospital of Zhengzhou from January 19, 2020 to March 3, 2020 were retrospectively analyzed. RESULTS Of the 71 COVID-19 patients, the ages were 4-84 (41.29±15.21) years, 38 (53.5%) patients were male, 33 (46.5%) were female, and 52 (73.2%) were in 22 clusters. The main clinical manifestations were fever (78.9%), cough (64.8%), and sputum (38.0%). The fever was mainly low and moderate, with 49 patients (69.0%) at 37.3-39.0 ℃. Most of the leukocytes, neutrophils, and lymphocytes were normal, accounting for 47 (66.2%), 51 (71.8%), and 51 (71.8%) patients, respectively; a few of them were decreased, accounting for 21 (29.6%), 16 (22.5%), and 20 (28.2%) patients, respectively. There were 38 (53.5%) and 31 (43.7%) patients with the decreased CD4+ and CD8+ T cell counts, respectively. There were 41 (57.7%), 38 (53.5%), 32 (45.1%), 26(36.6%), 22 (31.0%), 20 (28.2%), 14 (19.7%), 14 (19.7%), and 9 (12.7%) patients with the increased levels of C-reactive protein, erythrocyte sedimentation rate, procalcitonin, fibrinogen,interleukin 6, lactate dehydrogenase,D-dimer,alanine aminotransferase, and aspartate aminotransferase, respectively. Of the 71 patients, the lung was involved in 60 (84.5%) patients, the double lung was involved in 47 (66.2%) patients, and the single lung was involved in 13 (18.3%) patients. The course of the disease was long, and the time from symptom onset to the second severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid negative transformation was (17.22±6.34) days.There were no significant differences in the incubation period (t=-0.453, P>0.05), the complicates (χ2=0.042, P>0.05), and the time from symptom onset to diagnosis (t=-1.330, P>0.05) in patients between the non-severe group and the severe group. The onset age, gender, SARS-CoV-2 nucleic acid negative time, lymphocyte count, D-dimer, C-reactive protein, total bilirubin, direct bilirubin, lactate dehydrogenase, calcium ion, CD4+ T cell count, CD8+ T cell count, calcitonin, procalcitonin, and troponin were significantly different between the severe group and the non-severe group (all P<0.05). Among the 71 patients, 4 (5.6%) patients were mild, 59 (83.1%) were normal, and 8 (11.3%) were severe or critical. CONCLUSIONS The aggregation phenomenon of COVID-19 is obvious. Fever and cough are the main clinical manifestations. White blood cells, neutrophils, and lymphocytes in the most patients in the early onset are normal. Most COVID-19 patients are light and ordinary type, with good prognosis.

Predictive role of clinical features in patients with coronavirus disease 2019 for severe disease

Abstract: OBJECTIVES Since the outbreak of coronavirus disease 2019 (COVID-19), it has spread rapidly in China and many other countries. The rapid increase in the number of cases has caused widespread panic among people and has become the main public health problem in the world. Severe patients often have difficult breathing and/or hypoxemia after 1 week of onset. A few critically ill patients may not only rapidly develop into acute respiratory distress syndrome, but also may cause coagulopathy, as well as multiple organs failure (such as heart, liver and kidney) or even death. This article is to analyze the predictive role of clinical features in patients with COVID-19 for severe disease, so as to help doctor monitor the severity-related features, restrain the disease progress, and provide a reference for improvement of medical treatment. METHODS The clinical data of 208 patients with COVID-19 who were isolated and treated in Changsha Public Health Treatment Center from January 17, 2020 to March 14, 2020 were collected. All patients were the mild and ordinary adult patients on admission, including 105 males and 103 females from 19 to 84 (median age 44) years old. According to the "Program for the diagnosis and treatment of novel coronavirus (COVID-19) infected pneumonia (Trial version 7)" issued by the General Office of National Health Committee and Office of State Administration of Traditional Chinese Medicine as the diagnostic and typing criteria. According to progression from mild to severe disease during hospitalization, the patients were divided into a mild group (n=183) and a severe transformation group (n=25). The clinical features such as age, underlying disease, blood routine, coagulation function, blood biochemistry, oxygenation index, and so on were analyzed. Among them, laboratory tests included white blood cell (WBC), lymphocytes (LYM), neutrophil (NEU), hemoglobin (Hb), platelet (PLT), prothrombin time (PT), plasma fibrinogen (Fib), activated partial prothrombin time (APTT), thrombin time (TT), D-dimer, total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Cr), creatine kinase (CK), creatine kinase isoenzyme-MB (CK-MB), lactate dehydrogenase (LDH), C-reactive protein (CRP), and oxygen partial pressure in arterial blood. Partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO2/FiO2) was calculated. The variables with statistical significance were analyzed by logistic regression analysis. RESULTS Patients in the severe transformation group had more combined underlying diseases than those in the mild group (P<0.05). From the perspective of disease distribution, patients in the severe transformation group had more combined hypertension (P<0.05). In the severe transformation group, PT was significantly longer, the levels of Fib, ALT, AST, CK, LDH, and CRP were significantly higher than those in the mild group (P<0.05 or P<0.001), while LYM, ALB, and PaO2/FiO2 were significantly lower than those in the mild group (P<0.05 or P<0.001). Logistic regression analysis was performed on clinical features with statistically significant differences. Combined with hypertension, LYM, PT, Fib, ALB, ALT, AST, CK, LDH, and CRP as independent variables, and having severe disease or not was the dependent variable. The results show that combined hypertension, decreased LYM, longer PT, and increased CK level were independent risk factors that affected the severity of COVID-19 (P<0.05). CONCLUSIONS The patients with mild COVID-19 who are apt to develop severe diseases may be related to combined hypertension, decreased LYM, and longer PT, and increased CK level. For the mild patients with these clinical features, early intervention may effectively prevent the progression to severe diseases.

Identification of factors related to fertilization failure in in vitro fertilization-embryo transfer.

Abstract: Objectives To investigate the possible factors relevant to fertilization failure in in vitro fertilization-embryo transfer (IVF-ET). Methods The medical records of 4 205 infertile patients undergoing IVF-ET treatment at the Reproductive Medicine Center, Xiangya Hospital, Central South University from January 2016 to December 2017 were collected. The patients were divided into a complete fertilization failure group, a low fertilization rate group, and a control group based on fertilization rate. We examined the associations among the 3 groups in terms of female age, duration of infertility, duration of stimulation, gonadotropin (Gn) dosage, follicle-stimulating hormone (FSH) dosage, and total number of retrieved oocytes. According to theincidence factors, the patients were divided into a single female factor group, a single male factor group and a unisex factor group, and the correlation analysis of incidence factor among the 3 groups was performed. The patients were divided into a primary infertility and a secondary infertility in accordance with the type of infertility. We analyzed the correlation of infertility type among the three groups. Risk factors for complete fertilization failure and low fertilization rate in IVF-ET were obtained by stepwise multiple linear regression analysis. Results Primary infertility, long infertility duration, total number of retrieved oocytes, and unisex factor were associated with completefertilization failure and low fertilization rate in IVF-ET (P 0.05). Stepwise multiple linear regression analysis showed that the incidence factor, type of infertility, and infertility duration were independent influential factors for complete fertilization failure and low fertilization rate. Conclusions Complete fertilization failure and low fertilization rate in IVF-ET are related to duration of infertility, total number of retrieved oocytes, cause of onset, and type of infertility, but they are not relevant to female age, duration of stimulation, and Gn and FSH dosage.

Knowledge, attitude, and practice survey regarding coronavirus disease 2019 among residents in Hunan Province.

Abstract: OBJECTIVES To evaluate residents' knowledge, attitude and behavior towards coronavirus disease 2019 (COVID-19) in Hunan Province, and to explore the factors influencing behaviors. METHODS A self-designed questionnaire was used to conduct an online survey for 4 139 Hunan residents. The contents included general population information, residents' knowledge, attitude and practice to COVID-19. RESULTS Mean scores of knowledge, attitude, and behavior were 29.82±3.16, 6.71±1.12, and 14.93±1.45, respectively. Residents had the highest score of major symptoms of COVID-19 (3.96±0.39), but the lowest was the main transmission routes (3.47±0.89). A total of 22.68% of the residents were very or relatively afraid of the outbreak, but 95.22% of the residents had confidence in defeating COVID-19. In behavior dimension, "handling of suspicious symptoms" had the lowest score (3.58±0.75). The behavior implementation rate of "keep the surfaces of household items clean" (80.50%), "doing more exercise, reasonable diet, working and resting regularly" (84.59%), and "avoid hand contacting with eyes, mouth or nose" (89.51%) were relatively low. Pearson correlation coefficient showed that the knowledge, attitude, and practices score were correlated with each other (knowledge vs behavior: r=0.366; knowledge vs attitude: r=0.041; attitude vs behavior: r=0.100; all P<0.05). Multiple linear regression analysis showed that the knowledge, attitude and behavior on COVID-19 were mostly influenced by education background (all P<0.05), and the independent factors affecting behavior included knowledge and attitude, gender, permanent residence, education background (all P<0.05). CONCLUSIONS Residents in Hunan Province have a good knowledge, attitude, and behavior to COVID-19. Nevertheless there are still weak links to be improved in all dimensions. It is necessary to strengthen knowledge and behavior of family protection, and care for residents' psychological health, especially persons with low education degree, male and rural residents.

Effect of transfusion convalescent recovery plasma in patients with coronavirus disease 2019.

Abstract: Objectives To evaluate curative effects of coronavirus disease 2019 (COVID-19) patients by the transfusion of other convalescent plasma. Methods Retrospective analysis of the clinical data of 18 patients with severe and critical COVID-19, who were hospitalized in the ICU of Xianghu Branch of the First Affiliated Hospital of Nanchang University from February 1 to March 15, 2020. Patients were subdivided into an experimental group (n=6, who had transfused the plasma) and an observation group (n=12, who had no plasma transfusion). Basic clinical data and prognosis indexes of these two groups were compared. Moreover, for the experimental group, the dynamic changes of blood oxygen saturation before and after the transfusion, the changes of lymphocyte absolute value 48 hours after the transfusion, and the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid were analyzed. Results There were no significant differences in age, gender, blood type and other basic clinical data between the two groups (all P>0.05).There were no significant differences in ventilator machine weaning time, extracorporeal membrane oxygenation (ECMO) weaning time, body temperature recovery to normal time, and hospitalization days between these two groups (all P>0.05). For the experimental group, before, during and after the convalescent plasma transfusion, the blood oxygen saturation of all 6 patients at all time (1, 6, 8, 12, 24, 36, and 48 h) was more than 90%, and there was no significant fluctuation. There were 3 patients whose absolute value of lymphocyte was increased 48 hours after the transfusion, and the remaining was decreased. There were 5 patients whose SARS-CoV-2 nucleic acid detection turned negative 48 hours after the transfusion, accounting for 83.3%. Conclusions Transfusion of convalescent plasma will not affect outcomesof COVID-19 patients, which can neutralize SARS-CoV-2 in patients and reduce the loading capacity of SARS-CoV-2.

Neoadjuvant chemotherapy efficacy and prognostic factors in 187 cervical cancer patients with IB2 and IIA2 stage.

Abstract: OBJECTIVES To investigate the efficacy and prognostic factors for patients receiving neoadjuvant chemotherapy (NACT) before operation in stage IB2 and IIA2 cervical cancer. METHODS A total of 187 patients with IB2 and IIA2 cervical cancer who received NACT combined surgery from January 2005 to January 2016 were enrolled. All patients were divided into an effective group (n=142) and an ineffective group (n=45) according to the chemotherapy efficacy. Clinical characteristics (containing tumor diameter, hematological inflammatory indexes, etc.) before chemotherapy and postoperative pathology between the two groups were compared. Patient survival analysis was performed by Kaplan-Meier method. The methods of univariate and multifactor analysis were used to analyze the relationship between NACT curative effect, postoperative pathological factors, and survival of patients. RESULTS The number of patients with tumor diameter less than 5 cm was more in the chemotherapy effective group than that in the ineffective group (P=0.015). Three hematological inflammatory indexes (systemic inflammatory response index, neutrophil-lymphocyte ratio, and monocyte-lymphocyte ratio) in the effective group were lower than those in the ineffective group, respectively (P<0.05). The rates of pelvic lymph node metastasis and cervical deep myometrial invasion in the effective group were lower than those in the ineffective group (P<0.05). The 3-year and 5-year overall survival of NACT patients were 92.6% and 82.9%, respectively. Univariate analysis showed that chemotherapy efficacy, hematological inflammatory indexes, pelvic lymph node metastasis, and cervical deep myometrial invasion were related to the survival of patients (P<0.05). Further multivariate analysis demonstrated that pelvic lymph node metastasis was an independent risk factor for survival of patients (P<0.001), whereas effective NACT treatment was a protective factor for survival of patients (P<0.001). CONCLUSIONS Tumor diameter and hematologic inflammation indexes before treatment are the relevant factors for NACT efficacy in patients with IB2 and IIA2 cervical cancer. Chemotherapy efficacy and pelvic lymph node metastasis are prognostic factors for NACT patients.

Role of miR-92a-3p/PTEN axis in regulation of pancreatic cancer cell proliferation and metastasis.

Abstract: OBJECTIVES To explore the effect of miR-92a-3p on the proliferation and metastasis of pancreatic cancer cells via targeting phosphatase and tension homolog deleted on chromosome ten (PTEN). METHODS MiR-92a-3p expression and PTEN protein levels were quantified in a normal pancreatic cells (HPDE6-C7) and 5 pancreatic cancer cell lines (Panc-1, BxPC-3, AsPC-1,MIA Paca-2, and Capan-2) by real-time PCR and Western blotting, respectively. BxPC-3 and Panc-1 cells were selected for further experiment. After transfection of normal control (NC) mimics (NC mimics group), miR-92a-3p mimics (miR-92a-3p mimics group), NC inhibitor or miR-92a-3p inhibitor (NC inhibitor group or miR-92a-3p inhibitor group), the proliferation of BxPC-3 and Panc-1 cells was measured by cell counting kit-8 (CCK-8), and the migration of them was measured by Transwell assay, and the levels of PTEN protein were measured by Western blotting. In addition, wild-type PTEN 3'-UTR (wt-PTEN 3'UTR) and mutant-type PTEN 3'-UTR (mut-PTEN 3'UTR) luciferase reporter vectors were constructed and co-transfected with NC mimics, miR-92a-3p mimic, NC inhibitor or miR-92a-3p inhibitor into 293T tool cells, and then the dual luciferase reporter assay was performed to examine the regulative correlation between miR-92a-3p and PTEN. The BxPC-3 cells were divided into 4 groups: a NC inhibitor+si-NC group, a miR-92a-3p inhibitor+si-NC group, a NC inhibitor+si-PTEN group, and a miR-92a-3p inhibitor+si-PTEN group. The Panc-1 cells were also assigned into 4 groups: a NC mimics+NC group, a miR-92a-3p mimics+si-NC group, a NC mimics+ PTEN group, and a miR-92a-3p mimics+PTEN group. The proliferation of Panc-1 cells was measured by CCK-8; the cell migration was measured by Transwell assay, and the levels of PTEN protein were measured by Western blotting. RESULTS The miR-92a-3p was highly expressed in pancreatic cancer cell lines (allP<0.01), while the PTEN protein levels were lower in pancreatic cancer cell lines (allP<0.05)compared with that in the HPDE6-C7 cells. Compared with the NC mimics group, the cell viability of BxPC-3 and Panc-1 cells were both increased in the miR-92a-3p mimics group (bothP<0.01); compared with the inhibitor group, the cell viability of BxPC-3 and Panc-1 cells were both decreased in the miR-92a-3p inhibitor group (bothP<0.01). Compared with the NC mimics group, the cell number of BxPC-3 and Panc-1 cells through micropores were increased in the miR-92a-3p mimics group (bothP<0.01); compared with the inhibitor group, the cell number of BxPC-3 and Panc-1 cells through micropores were decreased in the miR-92a-3p inhibitor group (bothP<0.01). Compared with NC mimics group, the activity of dual luciferaseof wt-PTEN3'-UTR was inhibited in the miR-92a-3p mimics group (P<0.01); compared with the NC inhibitor group, the activity of dual luciferase of wt-PTEN3'-UTR was promoted in the miR-92a-3p inhibitor group (P<0.01). Compared with the miR-92a-3p inhibitor+si-NC group, the suppressive effects of miR-92a-3p on the proliferation and metastasis of BxPC-3 cells was restored in the miR-92a-3p inhibitor+si-PTEN group; while compared with the miR-92a-3p mimics+NC group, the positive effects of miR-92a-3p overexpression on the proliferation and metastasis of Panc-1 cells was restored in the miR-92a-3p mimics+PTEN group. CONCLUSIONS The highly expressed miR-92a-3p in pancreatic cancer cells can decrease the protein levels of PTEN, thereby enhancing the proliferation and metastasis activity of pancreatic cancer cells.

Value of CT application in the screening,diagnosis,and treatment of COVID-19.

Abstract: The coronavirus disease 2019 (COVID-19) has attracted extensive attention all around the world recently. Early screening, early diagnosis, early isolation, and early treatment remain the most effective prevention and control measures. Computed tomography (CT) plays a vital role in the screening, diagnosis, treatment, and follow-up of COVID-19, especially in the early screening, with a higher sensitivity than that of real-time fluorescence RT-PCR. The combination of CT and artificial intelligence has the potential to help clinicians in improving the diagnostic accuracy and working efficiency.

Influence factors and pregnancy outcomes for pernicious placenta previa with placenta accreta.

Abstract: Objectives To explore the influence factors for pernicious placenta previa (PPP) with placenta accreta and pregnancy outcomes of different types of PPP. Methods A case-control study was conducted to collect 410 PPP patients admitted to a general hospital in Changsha from December 2013 to February 2018. Two hundred and fifty cases of PPP with placenta accreta were treated as a case group, and 160 cases of PPP without placenta accreta were treated as a control group. The relationship between clinical data and placenta accreta was analyzed, and the pregnancy outcomes of PPP was observed according to different types of placenta previa. Results Logistic regression showed that delivery times were more than 2 (OR=3.221), cesarean section times were more than 2 (OR=3.048), central placenta previa (OR=3.607), placental attachment site (anterior wall) (OR=4.592) were independent risk factors for PPP with placenta accrete (P 0.05). Preterm delivery rate was higher than that of the marginal and low-set group, and the birth weight was lower than that of the low-set group. Apgar score at 1 min and asphyxia rate were lower and higher than those of the other 3 groups, respectively (P' Conclusions Delivery times (>2), cesarean section times (≥2), central placenta previa, placenta attachment site (anterior wall) are independent risk factors for PPP with placenta accreta. Living in cities, systematic prenatal examination were protective factors. The central PPP is more likely to lead to postpartum hemorrhage, hysterectomy, and increases in the risk of preterm birth, low birth weight as well as asphyxia of fetus, which seriously threatens maternal and fetal life.

Multistage CT features of coronavirus disease 2019.

Abstract: OBJECTIVES To determine imaging features of coronavirus disease 2019 (COVID-19) in different stages, and to provide foundations for early diagnosis and treatment. METHODS CT image data of 187 COVID-19 patients were analyzed in the period of hospitalization. CT scanning was performed on admission and repeated every 3 days. The improvement time of clinical symptoms and the image changes of follow-up CT were statistically analyzed. RESULTS All 187 patients' nucleic acid test were positive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The early CT images of lung in 187 cases (100%) showed multiple patchy and ground-glass opacities with fine mesh and consolidation shade, which mainly distributed in pulmonary band or under the pleura. In the progressive stage, the pulmonary lesions in 146 cases (78.1%) were mainly consolidation, accompanied by air bronchogram, thickening of blood vessels, and interstitial changes. Severe pulmonary CT images in 15 cases (8%) showed diffuse lesions in both lungs, displaying consolidation, or "white lung". The CT imaging features in 185 cases (98.9%) at the absorptive period showed that the lesions diminished and fibrogenesis. The imaging features of 6 times of lung CT examination in one case showed continuous progress. The original lesion in one case was obviously absorbed, but new lesions appeared under the pleura of both lungs at the third review of CT scanning. The changes of CT imaging lesions during follow-up were significantly different in different clinical symptoms improvement time (P< 0.01). CONCLUSIONS Images of COVID-19 in various stages have special characteristics. The change of clinical symptoms is synchronous with the change of reexamination CT. Follow-up CT can reflect the trend of clinical changes. Repeat CT examination plays an important role in the early clinical diagnosis and the evaluation for the therapeutic effect on COVID-19 patient.

Prevalence and risk factors of atopic dermatitis, psoriasis, acne, and urticaria in China.

Abstract: By searching the database of CNKI, Wanfang and PubMed, the prevalence and risk factors of atopic dermatitis, psoriasis, acne, and urticaria were relatively more investigated, which were the skin diseases of more concern in the current epidemiological study of skin diseases. Three national epidemiologic surveys reported that the prevalence of atopic dermatitis increased from 0.69% in 1998, to 3.07% in 2002, and 12.94% in 2014, respectively. The prevalence of psoriasis increased from 0.123% in 1984 to 0.47% in 2009 according to 2 national surveys. The prevalence of acne was 8.1% in a national investigation in 2008. Representative national prevalence data of urticaria is not available. Risk factors for these skin diseases are distinct. Atopic dermatitis, psoriasis, and urticaria are more related to environment and mental stress, while acne is more related to skin type and dietary factors. Owing to the heterogeneities in diagnostic methods used in the dermatoepidemiologic surveys (some of the diagnoses were self-reported) and a lack of follow ups, the reliability of data remained questionable, and the comparability across the surveys was difficult. As a result, it is necessary to conduct population-based cohort studies on skin diseases in China.

Radiomics features of ascending and descending nasopharyngeal carcinoma.

Abstract: Objectives To evaluate the application value of CT-based radiomics features for the ascending and descending types of nasopharyngeal carcinoma (NPC). Methods A total of 217 NPC patients (48 ascending type and 169 descending type), who obtained CT images before radiotherapy in Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University from February 2015 to October 2017, were analyzed retrospectively. All patients were randomly divided into a training set (n=153) and a test set (n=64). Gross tumor volume in the nasopharynx (GTVnx) was selected as regions of interest (ROI) and was analyzed by radiomics. A total of 1 300 radiomics features were extracted via IBEX. The least absolute shrinkage and selection operator (LASSO) logistic regression was performed to choose the significant features. Support vector machine (SVM) and random forest (RF) classifiers were built and verified. Results Six features were selected by the LASSO from 1 300 radiomics features. Compared with SVM classifier, RF classifier showed better classification performance. The area under curve (AUC) of the receiver operating characteristic (ROC) curve, accuracy, sensitivity, and specificity were 0.989, 0.941, 1.000, and 0.924, respectively for the training set; 0.994, 0.937, 1.000, and 0.924, respectively for the validation set. Conclusions CT-based radiomics features possess great potential in differentiating ascending and descending NPC. It provides a certain basis for accurate medical treatment of NPC, and may affect the treatment strategy of NPC in the future.

Effects of propofol on invasion and migration of colon cancer cells and JAK2/STAT3 signaling pathway.

Abstract: OBJECTIVES To investigate the effect of propofol on invasion and migration of human colon cancer cell line SW480 and the JAK2/STAT3 pathway. METHODS Human colon cancer cell line SW480 was divided into a control group, 3 propofol treatment groups (with 2, 4 and 8 μg/mL propofol treatment, respectively), and a propofol+colivelin group. Lactate dehydrogenase (LDH) activity and cell proliferation was evaluated by detection kit and 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) method, respectively. Cell migration and invasion were detected by Transwell assay. Western blotting was performed to detect the protein expression levels of JAK2, p-JAK 2, STAT3 and p-STAT3 in colon cancer cell line SW480. RESULTS Compared with the control group, the LDH activity was significantly increased in the propofol treatment groups (P<0.05). The cell proliferation, migration, invasion as well as p-JAK2 and p-STAT3 in colon cancer cell line SW480 in the propofol treatment groups were significantly decreased (allP<0.05). Compared with the propofol treatment groups, the p-STAT3 level, proliferation, migration and invasion in the colon cancer cell line SW480 were significantly increased in the propofol+colivelin group (allP<0.05). CONCLUSIONS Propofol can inhibit the proliferation, migration and invasion of human colon cancer cells by inhibiting JAK2/STAT3 signaling pathway.

A family outbreak of coronavirus disease 2019.

Abstract: Although continuous outbreak of coronavirus disease 2019, it has been widely reported, there were few reports regarding family cases. We reported a group of family cluster outbreak cases confirmed in Xiangya Hospital, Central South University, China, and their clinical and image characteristics have been analyzed in order to provide reference for the prevention and early diagnosis of this disease. A total of 5 patients from one family, including 4 adults and 1 child, had a history of human contact in Wuhan, Hubei. Four adult patients showed different symptoms, including cough, fever, pharyngeal pain, and dyspnea, while the child patient had no symptoms. Laboratory examination showed no abnormality in all the patients except for slight increase in CRP in 2 patients and mild abnormal liver function index in 1 patient. The chest CT showed that all patients had abnormal images, with different degrees of manifestations.All patients were finally diagnosed by the nucleic acid test.

Selection of PICC catheter location in neonates via evidence-based ACE Star model.

Abstract: OBJECTIVES To explore the most suitable insertion site for neonatal placement of peripherally inserted central venous catheter (PICC) according to the evidence-based ACE Star model. METHODS This study was carried out according to the evidence-based ACE Star model in 5 steps, including discovery research, evidence summary, guidelines translation, practice integration, and outcome evaluation. Based on the results of Meta-analysis, relevant guidelines, expert recommendations, clinical experience of nurses, and characteristics of neonates, the final recommendation was formed. A total of 87 neonates in a tertiary neonatal intensive care unit in Hunan Province were integrated into practice of PICC to evaluate the incidence of catheter-related complications and one-attempt success rate of puncture. RESULTS The results of Meta-analysis showed that the incidence of complications of PICC in neonates via lower limb veins was significantly lower than that of upper limb veins (OR=0.83, 95% CI 0.75 to 0.92, P<0.05). The final result of guideline translation was that PICC should be performed first through lower limb veins if the lower limb vein before PICC catheterization was not damaged.The results of integrated practice showed that the incidence of complications of PICC via lower extremity vein was 17.24%. Compared with the left lower limb catheterization, the incidence of complications and the incidence of catheter blockage of the right lower limb catheterization were significantly lower (both P<0.05). Compared with femoral vein catheterization, one-attempt success rate of puncture via the saphenous vein catheterization was higher and the incidence of complications, the incidence of catheter blockage, and the incidence of infection were lower, with significant difference (all P<0.05). CONCLUSIONS Saphenous vein in right lower limb could be the most suitable insertion site for neonatal PICC.

Predictive value of S100A9 for lymph node metastasis in cervical cancer.

Abstract: OBJECTIVES Lymph node metastasis affects the initial treatment strategy for cervical cancer and is hard to be diagnosed in clinical practice.This paper aims to explore the relationship between calcium-binding A9 (S100A9) and lymph node metastasis (LNM) in cervical cancer, and to determine the predictive value of S100A9 for LNM in cervical cancer. METHODS We performed a retrospective cohort study and collected the pathological data, follow-up data, and paraffin tissue samples of 99 patients with cervical cancer who underwent modified extensive or extensive hysterectomy plus pelvic lymphadenectomy at the Department of Gynecology, Xiangya Hospital, Central South University from January 2013 to December 2018. Immunohistochemistry was used to detect the expression of S100A9 in cervical cancer tissues, and the correlation between S100A9 expression and LNM of cervical cancer, or clinicopathological characteristics were analyzed. The receiver operating characteristic (ROC) curve was used to establish a predictive model for LNM of cervical cancer, and Chi-square test of four-grid table was used to evaluate the diagnostic value of S100A9 for LNM in cervical cancer. RESULTS The expression of S100A9 was significantly correlated with LNM. The S100A9 immunohistochemical semi-quantitative score of the LNM group was significantly higher than that in the non-lymph node metastasis group (P<0.001). Moreover, the expression of S100A9 was significantly correlated with histological type, stromal invasion, lymphatic vessel invasion, or LNM (P<0.05). The cut-off of the ROC curve for predicting LNM was 5, with the Youden index of 0.649 and the area under the ROC curve of 0.863. The disease-free survival and overall survival in the S100A9 positive group were significantly shorter than those in the negative group (P<0.05). S100A9 alone had a sensitivity of 71.4%, a specificity of 91.5%, and an accuracy of 85.1% for diagnosing LNM. Imaging had a sensitivity of 32.1%, a specificity of 74.6%, and an accuracy of 60.9%. Combination of S100A9 with image examination in parallel test had a sensitivity of 85.7%, a specificity of 71.2%, and an accuracy of 75.9%, while combination of S100A9 and image examination in serial test had a sensitivity of 17.9%, a specificity of 98.3%, and an accuracy of 72.4%. CONCLUSIONS S100A9 may be associated with LNM in cervical cancer. S100A9 shows a promising perspective in predicting LNM in cervical cancer. Combination of S100A9 and image examination in serial test has a high specificity for LNM.

Clinical characteristics of coronavirus disease 2019 patients complicated with liver injury.

Abstract: Objectives To analyze the clinical characteristics in patients of coronavirus disease 2019 (COVID-19) complicated with liver injury, to explore the relationship between COVID-19 clinical classification and liver injury, and to elucidate whether COVID-19 complicated with hepatitis B virus can aggravate liver injury. Methods The abnormal liver function in 110 patients in the First Hospital of Changsha, who were confirmed COVID-19 and admitted to the designated hospital from January 17, 2020 to February 20, 2020, wereretrospectively analyzed. The detection indexes included serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBIL). Results A total of 49.1% of the COVID-19 patients had liver injury. There were significant difference in the ALT, AST, ALB (all P 0.05) between the severe (critical) patients and the general (light) patients. There was also no significant difference in the liver function injury between the HBsAg-positive COVID-19 patients and HBsAg-negative COVID-19 patients (P>0.05). Acute liver injury was not found to be a direct cause of death in the patients. Conclusions In the COVID-19 patients, the incidence of liver injury is high with the increase of ALT and AST and the decrease of ALB. Severe and critical patients have obvious liver injury, and those patients complicated with hepatitis B virus infection don't show aggravated liver injury.

CT imaging features and image evolution characteristics of coronavirus disease 2019.

Abstract: Objectives To analyze the imaging features of coronavirus disease 2019 (COVID-19) in different periods, and summarize the characteristics with itsdevelopment. Methods We retrospectively analyzed the CT image data of COVID-19 patients diagnosed by nucleic acid test and CT examination in 57 patients in Zhuzhou Central Hospital and Zhuzhou First People's Hospital, and summarized the characteristics of CT imaging and the development of lesions. Results Most of the cases were characterized by peripheral distribution of lesions. A total of 37 cases (64.91%) were purely peripherally distributed, 16 cases (28.07%) coexisted with peripheral and mid-internal distribution, and 4 cases (7.02%) had simple mid-inner band distribution. In peripherally distributed cases, the long axis of the lesion was mostly parallel to the pleura in 36 cases (63.16%). In the case of inner-middle zone distribution, the long axis of the lesion was mostly parallel and surrounded the bronchial vascular bundle, or distributed along the lung lobules (31.58%). All cases had ground-glass-density foci, 31 cases (54.38%) had fine grid shadows in the lesions, 46 cases (80.70%) had thick vascular shadows in the lesions, and 23 cases (40.35%) showed signs of bronchial inflation. Among the 10 cases of "wrinkling shape" lesions in the first CT examination, except for 1 case without reexamination, the remaining 9 cases had different degrees of absorption in the second CT examination. Among the 26 cases of "wrinkling shape" lesions in the second CT examination, except for 11 cases without reexamination, the other 15 patients had different degrees of absorption in the third CT examination. Conclusions The early CT manifestations of COVID-19 are mostly ground-glass-density foci distributed in the subpleural region, some of which are distributed near the bronchial blood vessel bundle and in the central area of the lobule. As the course of the disease progresses, there may be varying degrees of solid components in the lesion. When the lesions show a "wrinkling shape", it is often suggested that the lesions will evolve towards the direction of absorption. These characteristics are of great value in assisting clinical diagnosis and dynamically observing changes undersuch condition.