Peripheral blood inflammatory markers in predicting prognosis in patients with COVID‐19. Some differences with influenza A

BackgroundTo evaluate the ability of peripheral blood inflammatory markers in predicating the typing of COVID‐19, prognosis, and some differences between COVID‐19 and influenza A patients.MethodsClinical data on 285 cases laboratory‐confirmed as SARS‐CoV‐2 infection were obtained from a Wuhan local hospital''s electronic medical records according to previously designed standardized data collection forms. Additional 446 Influenza A outpatients’ hematologic data were enrolled for comparison.ResultsNLR, SII, RLR, PLR, HsCRP, and IL‐6 were significant higher and LMR was lower in severe COVID‐19 patients than in mild COVID‐19 patients (p < .001). PLR and LMR were lower in the individuals with influenza A than those with COVID‐19 (p < .01). COVID‐19 patients with higher levels of NLR, SII, RLR, PLR, HsCRP, and IL‐6 and lower LMR were significantly associated with the severe type. AUC of NLR (0.76) was larger while the specificity of IL‐6 (86%) and sensitivity of HsCRP (89%) were higher than other inflammatory markers in predicating the typing of COVID‐19. PT had obvious correlation with all the inflammatory markers except RPR. NLR showed positive correlations with AST, TP, BUN, CREA, PT, and D‐dimer. Patients with high IL‐6 levels have a relatively worse prognosis (HR = 2.30).ConclusionPeripheral blood inflammatory markers reflected the intensity of inflammation and associated with severity of COVID‐19.NLR was more useful to predict severity as well as IL‐6 to predict prognosis of COVID‐19. PLR and LMR were initially found to be higher in SARS‐CoV‐2 virus‐infected group than in influenza A.     

Reliable Thyroid Carcinoma Detection with Real-Time Intelligent Analysis of Ultrasound Images

Thyroid carcinoma is one of the most common endocrine diseases globally, and the incidence has been on the rise in recent years. Ultrasound imaging is the primary clinical method for early thyroid nodule diagnosis. Regions of interest (ROIs) of nodules in ultrasound images are difficult to detect because of their irregular shape nand vague margins. Accurate real-time thyroid nodule detection can provide ROIs for subsequent nodule diagnosis automatically, avoid variabilities between the subjective interpretations and inter-observer effectively and alleviate the workloads of medical practitioners. The aim of this study was to present a reliable, real-time detection method based on the Faster R-CNN (region-based convolutional network) framework for accurate and fast detection of thyroid nodules in ultrasound images. Our study proposed a faster and more accurate thyroid nodule detection method based on the Faster R-CNN framework by adding three strategies: feature pyramid, spatial remapping and anchor-box redesign. Specifically, the network takes raw ultrasound images as inputs and generates boxes with positions and the possibilities that these boxes contain thyroid nodules. The proposed method could locate and detect target nodules accurately with a mean average precision of 92.79% with more than 9000 patient images. In addition, the detection rate has accelerated to >16 frames per second, four times faster than that of the initial network. Therefore, it can meet the requirements of clinical application. The performance of the fivefold cross-validation was also accurate and robust. The proposed automatic thyroid nodule detection method yields better performance in accuracy and detection speed, which indicates the potential value of our method in assisting clinical ultrasound image interpretation.     

儿童指突状树突细胞肉瘤合并骨髓增生异常综合征一例报告并文献复习

指突状树突细胞肉瘤(interdigitating dendritic cell sarcoma,IDCS)是一种罕见的树突状细胞肿瘤,目前全球仅百余例报道,常以无痛性淋巴结肿大起病,侵袭性较强、预后较差[1-2]。骨髓增生异常综合征(myelodysplastic syndromes,MDS)为起源于造血干、祖细胞的恶性克隆性疾病,以单系或多系病态造血、易向白血病转化为特征,目前被认为是一种老年性疾病[3]。本研究报道1例同患IDCS和MDS的患儿,为国内外首次报道2种肿瘤同时发生,旨在探讨2种肿瘤的诊治要点,避免漏诊、误诊。     

缺氧诱导因子-1α参与肝纤维化形成机制研究进展

目的 肝纤维化是一种由于反复肝损伤而导致肝组织细胞外基质过多沉积导致的疾病。缺氧损伤为肝损伤的一部分,缺氧诱导因子-1α(HIF-1α)是响应缺氧应激的关键转录因子,在肝纤维化组织和活化的肝星状细胞(HSC)表达显著增加。目前,通过对大量HIF-1α依赖性基因和信号通路的研究,确认这些基因及其通路的变化参与肝纤维化发展过程,并可能在肝纤维化发生发展过程中起关键作用。本文综述了HIF-1α相关的信号通路参与肝纤维化发展的相关机制,并对上游影响HIF-1α合成和降解的相关信号通路进行了阐述,为其作为新型治疗靶点的可能潜力提供依据。     

大量饮酒及乙醇戒断后对大鼠脑内维生素C 水平的影响

目的 研究大量饮酒4 d及乙醇戒断后大鼠脑脊液中及各重要脑区内维生素C（VC）水平 及钠依赖性VC 转运体2（SVCT2）蛋白水平的变化。方法 30 只健康Wistar 大鼠随机分为5 组，对照组 （A 组）、大量饮酒4 d（B 组）、大量饮酒4 d 后戒断1 d（C 组）、大量饮酒4 d 后戒断2 d（D组）、大量饮酒 4 d后戒断7 d（E组），每组6只。B、C、D、E组大鼠大量灌胃给予乙醇4 d，乙醇浓度为25% W/V，每8小时 灌胃1次，连续4 d；A组给予等体积蒸馏水。采用Y迷宫实验评价大鼠的空间工作记忆能力；以高效液相- 电化学法（HPLC-ECD）检测大鼠脑脊液及前额叶皮质、顶叶皮质、颞叶皮质、海马脑区内细胞内VC 含量， 免疫印迹法检测大鼠各脑区内SVCT2蛋白水平的变化。结果 （1）Y迷宫实验： C、D组大鼠自发交替反应 率分别为（24.64±15.11）% 和（41.48±13.01）%，均显著低于A 组［（75.47±8.61）%］； E 组大鼠的自发交替 反应率恢复接近正常［（61.64±11.51）%］，与A 组差异无统计学意义（P＞ 0.05）。（2）脑脊液内VC 含量：B 组大鼠脑脊液内VC 含量为（204.54±25.51）μmol/L，显著高于A 组［（145.57±18.98）μmol/L］， 而C、D 组 大鼠脑脊液内VC 水平［分别为（90.24±15.45）、（86.93±14.53）μmol/L］明显低于A、B 组，差异均有统计 学意义（均P＜ 0.001）；E 组大鼠脑脊液中VC 含量［（135.80±17.16） μmol/L］与A 组间差异无统计学意义 （P＞ 0.05）。（3）各脑区内VC 水平：B 组前额叶皮质、顶叶皮质、海马脑区脑组织匀浆（细胞内）VC 水 平变化趋势相同［分别为（1.18±0.13）、（1.14±0.12）、（1.20±0.20）μmol/g］，均显著低于A 组［分别为 （1.64±0.11）、（1.62±0.13）、（2.06±0.27）μmol/g］；C 组在乙醇戒断后，前额叶皮质、顶叶皮质、海马脑区 细胞内VC 水平［分别为（1.20±0.29）、（1.05±0.06）、（1.21±0.15）μmol/g］有所恢复，但仍明显低于A 组 （均P＜ 0.01）；C组大鼠颞叶皮质细胞内VC水平［（1.37±0.04）μmol/g］显著高于顶叶皮质（P＜0.05）；D组 各脑区细胞内VC水平均有回升趋势，前额叶皮质细胞内VC水平显著高于顶叶皮质［（1.63±0.24）μmol/g 比（1.26±0.16）μmol/g，P＜0.05］；E组前额叶皮质、顶叶皮质、颞叶皮质、海马区细胞内VC水平［分别为 （1.72±0.19）、（1.43±0.22）、（1.67±0.19）、（1.86±0.22）μmol/g］均较B组显著升高（均P＜0.01），逐渐恢复至正 常水平，海马区VC水平显著高于顶叶皮质（P＜0.05）。（4）Western blot结果显示，与A组比较，B、C、D组大 鼠前额叶皮质、顶叶皮质及C、D、E组大鼠海马区的SVCT2蛋白均显著升高（均P＜0.05）。结论 大量饮 酒4 d可致大鼠脑损伤，乙醇干预后大鼠脑脊液中及各脑区脑组织匀浆中VC水平呈现负相关的变化过程， 此过程中SVCT2蛋白表达上调，这将有助于脑脊液内的VC被转运至各脑区神经元内发挥抗氧化作用。     

Optimize the management of urological tube-related emergencies during the coronavirus disease 2019 (COVID-19) pandemic

BackgroundTo introduce and determine the value of optimized strategies for the management of urological tube-related emergencies with increased incidence, complexity and operational risk during the global spread of coronavirus disease 2019 (COVID-19).MethodsAll emergent urological patients at Tongji Hospital, Wuhan, during the period of January 23 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 were recruited to form this study’s COVID-19 group and control group, respectively. Tongji Hospital has the most concentrated and strongest Chinese medical teams to treat the largest number of severe COVID-19 patients. Patients in the control group were routinely treated, while patients in the COVID-19 group were managed following the optimized principles and strategies. The case incidence for each type of tube-related emergency was recorded. Baseline characteristics and management outcomes (surgery time, secondary complex operation rate, readmission rate, COVID-19 infection rate) were analyzed and compared across the control and COVID-19 periods.ResultsThe total emergent urological patients during the COVID-19 period was 42, whereas during the control period, it was 124. The incidence of tube-related emergencies increased from 53% to 88% (P<0.001) during the COVID-19 period. In particular, the incidence of nephrostomy tube-related (31% vs. 15%, P=0.027) and single-J stent-related problems (19% vs. 6%, P=0.009) increased significantly. The mean surgery times across the two periods were comparable. The number of secondary complex operations increased from 12 (18%) to 14 (38%) (P=0.028) during the COVID 19-period. The number of 2-week postoperative readmission decreased from 10 (15%) to 1 (3%) (P=0.049). No participants contracted during the COVID-19 period.ConclusionsUrological tube-related emergencies have been found to have a higher incidence and require more complicated and dangerous operations during the COVID-19 pandemic. However, the optimized management strategies introduced in this study are efficient, and safe for both urologists and patients.     

The effects and acceptability of different exercise modes on glycemic control in type 2 diabetes mellitus: A protocol for systematic review and network meta-analysis

Introduction:Exercise has been believed to have positive effects on blood glucose control in patients with type 2 diabetes mellitus. However, few medical evidences have been found to ascertain which type of exercise has the best effect on blood glucose control in diabetes and which type of exercise is more acceptable. The purpose of this study is to compare the effects and acceptability of different exercise modes on glycemic control in type 2 diabetes patients by using systematic review and network meta-analysis.Methods and analysis:Relevant randomized controlled trial studies will be searched from PubMed, EMbase, CochraneCENTRAL, CNKI, VIP, and Chinese medical paper libraries. Primary outcome indicators: glycosylated hemoglobin and dropout rate of the research (number of dropouts/numbers of initially enrolled subjects). Secondary outcome measures: fasting blood glucose, body weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, triglycerides (TG), diastolic pressure, systolic pressure (SBP). Two reviewers are arranged to screen Title, Abstract, and then review full text to further extract data. Standard meta-analysis and network meta-analysis of the data are performed afterward. Methodological quality assessment is planned to be conducted using Cochrane risk of bias tool. The outcome will be analyzed statistically according to Bayesian analysis methods. After that, subgroup analysis is conducted on the duration of intervention, whether there is supervision of intervention, frequency of intervention per week, age, gender, and medication use.Trial registration number:PROSPERO CRD42020175181Discussion:The systematic review and network meta-analysis include evidence of the impact of different exercise modes on blood glucose control in type 2 diabetes mellitus. There are 2 innovative points in this study. One is to conduct a classified study on exercise in as much detail as possible, and the other is to study the acceptability of different exercise modes. The network meta-analysis will reduce the uncertainty of intervention and enable clinicians, sports practitioners, and patients to choose more effective and suitable exercise methods.Ethics and dissemination:The findings of the study will be disseminated through publications in peer-reviewed journals and scientific conferences and symposia. Further, no ethical approval is required in this study.     

Correlation between the sulfamethoxazole-trimethoprim resistance of Shigella flexneri and the sul genes

The aim of this study was to discuss the correlation between the sulfamethoxazole-trimethoprim resistance of Shigella flexneri (S. flexneri) and the antibiotic resistance genes sul1, sul2, and sul3 and SXT element.From May 2013 to October 2018, 102 isolates of S. flexneri were collected from the clinical samples in Jinan. The Kirby–Bauer (K-B) test was employed to determine the antibiotic susceptibility of the S. flexneri isolates. The antibiotic resistance rate was analyzed with the WHONET5.4 software. The isolates were subject to the PCR amplification of the sul genes (sul1, sul2, and sul3) and the SXT element. On the basis of the sequencing results, the correlation between the sulfamethoxazole-trimethoprim resistance of the S. flexneri isolates and the sul genes was analyzed.The antibiotic resistance rates of the 102 S. flexneri isolates to ampicillin, streptomycin, chloramphenicol, tetracycline, and sulfamethoxazole-trimethoprim were 90.2%, 90.2%, 88.2%, 88.2%, and 62.7%, respectively. The antibiotic resistance rates of these isolates to cefotaxime, ceftazidime, and ciprofloxacin varied between 20% and 35%. However, these isolates were 100% susceptible to cefoxitin. Positive fragments were amplified from 59.8% (61/102) of the 102 S. flexneri isolates, the sizes of the sul1 and sul2 genes being 338 bp and 286 bp, respectively. The sequence alignment revealed the presence of the sul1 and sul2 genes encoding for dihydrofolate synthase. The carrying rate of the sul1 gene was 13.7% (14/102), and that of the sul2 gene was 48.0% (49/102). No target gene fragments were amplified from the 3 isolates resistant to sulfamethoxazole-trimethoprim. The sul3 gene and SXT element were not amplified from any of the isolates. The testing and statistical analysis showed that the resistance of the S. flexneri isolates to sulfamethoxazole-trimethoprim correlated to the sul1 and sul2 genes.The acquired antibiotic resistance genes sul1 and sul2 were closely associated with the resistance of the 102 S. flexneri isolates to sulfamethoxazole-trimethoprim.