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Background: Human infections with zoonotic coronaviruses (CoVs), including severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV, have raised great public health concern globally. Here, we report a novel bat-origin CoV causing severe and fatal pneumonia in humans. Methods: We collected clinical data and bronchoalveolar lavage (BAL) specimens from five patients with severe pneumonia from Jin Yin-tan Hospital, Wuhan, Hubei province, China. Nucleic acids of the BAL were extracted and subjected to next-generation sequencing. Virus isolation was carried out, and maximum-likelihood phylogenetic trees were constructed. Results: Five patients hospitalized from December 18 to December 29, 2019 presented with fever, cough, and dyspnea accompanied by complications of acute respiratory distress syndrome. Chest radiography revealed diffuse opacities and consolidation. One of these patients died. Sequence results revealed the presence of a previously unknown β-CoV strain in all five patients, with 99.8–99.9% nucleotide identities among the isolates. These isolates showed 79.0% nucleotide identity with the sequence of SARS-CoV (GenBank NC_004718) and 51.8% identity with the sequence of MERS-CoV (GenBank NC_019843). The virus is phylogenetically closest to a bat SARS-like CoV (SL-ZC45, GenBank MG772933) with 87.6–87.7% nucleotide identity, but is in a separate clade. Moreover, these viruses have a single intact open reading frame gene 8, as a further indicator of bat-origin CoVs. However, the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV, indicating that these viruses might use the same receptor. Conclusion: A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans. Key words: Bat-origin; Coronavirus; Zoonotic transmission; Pneumonia; Etiology; Next-generation sequencing

Background: Current randomized trials have demonstrated the effects of short-term rosuvastatin therapy in preventing contrast-induced acute kidney injury (CIAKI). However, the consistency of these effects on patients administered different volumes of contrast media is unknown. Methods: In the TRACK-D trial, 2998 patients with type 2 diabetes and concomitant chronic kidney disease (CKD) who underwent coronary/peripheral arterial angiography with or without percutaneous intervention were randomized to short-term (2 days before and 3 days after procedure) rosuvastatin therapy or standard-of-care. This prespecified analysis compared the effects of rosuvastatin versus standard therapy in patients exposed to (moderate contrast volume [MCV], 200-300 ml, n = 712) or (high contrast volume [HCV], ≥300 ml, n = 220). The primary outcome was the incidence of CIAKI. The secondary outcome was a composite of death, dialysis/hemofiltration or worsened heart failure at 30 days. Results: Rosuvastatin treatment was associated with a significant reduction in CIAKI compared with the controls (2.1% vs. 4.4%, P = 0.050) in the overall cohort and in patients with MCV (1.7% vs. 4.5%, P = 0.029), whereas no benefit was observed in patients with HCV (3.4% vs. 3.9%, P = 0.834). The incidence of secondary outcomes was significantly lower in the rosuvastatin group compared with control group (2.7% vs. 5.3%, P = 0.049) in the overall cohort, but it was similar between the patients with MCV (2.0% vs. 4.2%, P = 0.081) or HCV (5.1% vs. 8.8%, P = 0.273). Conclusions: Periprocedural short-term rosuvastatin treatment is effective in reducing CIAKI and adverse clinical events for patients with diabetes and CKD after their exposure to a moderate volume of contrast medium.

Chinese Medical Journal (CMJ), founded in 1887 and the oldest medical journal in China, is one of our beloved journals. We began to read the journal from the days when we were medical students. We remembered Prof. Chuan-Han Feng, the former Editor-in-Chief's words: “The journal is mainly devoted to international communication, reporting the recent progress and achievements in preventive and clinical medicine and biomedical sciences, with experience characteristic of China in particular, to be shared by the world medical family.”[1] What Prof. Feng said 10 years ago is still the main mission of the journal today. When we have to obtain the information of “Cause-specific mortality for 240 causes in China during 1990–2013” from Lancet,[2] when we have to get the results of “National survey of drug-resistant tuberculosis in China” from New England Journal of Medicine,[3] we feel a great pressure. There is competition between international and local journals. Meanwhile, it is also a strong motivation for us to step forward. In the coming year, what is our main task? We should first realize that CMJ is of readers and authors. Our editorial office should identify our faithful readers and their needs through surveys done in hospitals, institutes, as well as scientific conferences. The interaction between readers and editorial office via our website is not always active. Mutual communication should be encouraged, and comments from readers should be collected and responded timely. Second, it is important for CMJ editorial office to gather our good authors with high citations. Reviewing the top cited article list in CMJ website, we were astonished that the top cited article is a case report titled “Bilateral papilloedema associated with lumbo-sacral intraspinal tumor.”[4] Case reports are indeed important for studying and teaching in rare diseases, but what we need more are high-qualified clinical studies such as randomized controlled trials and prospective cohort studies, which can be applied into recommendations for clinical practice. We feel happy to find that we have published a number of clinical studies of high quality: “Normative values of pulmonary function testing in Chinese adults,”[5] “A 5-year follow-up study on the pathological changes of gastric mucosa after Helicobacter pylori eradication,”[6] and “A randomized control trial on interruption of hepatitis B virus transmission in uterus.”[7] However, it is still far from enough. We understand that authors are more likely to publish their good work on more influential international journals such as Lancet or New Engl J Med. However, such journals can only publish a minority of them after all. As the top local journal, CMJ still has grand space to publish promising studies from a large amount of Chinese clinicians and scientists. Our editorial office can also get to know the authors, research teams, and their working progress through academic websites (ClinicalTrial.gov, Chinese Clinical Trial Registry, Cochrane, and PubMed) and invite the authors to submit their recent work to our journal. Authors may ask: Why should we submit our important work to CMJ? What is the difference of CMJ from other journals with higher impact factors? The answer is exactly what we are making our efforts to do so. Though we are living in a time that our work is evaluated by the impact factor of the journal where it is published, valuable work will never fade. CMJ has already earned the reputation in China by high quality, integrity, and novelty. CMJ not only tries to publish valuable work but also has the responsibility to help the studies known by readers and let their work cited by researchers throughout China and worldwide. We took the responsibility to help CMJ to earn reputation what it deserves. We will be successful when respected doctors and researchers are happy to publish their novel findings and thoughtful viewpoints on CMJ. It is our mission and responsibility.

The 2009 pandemic H1N1 (pH1N1) influenza showed that relatively young adults accounted for the highest rates of hospital admission and death. In preparation for pH1N1, the aim of the study is to identify factors associated with the mortality of patients with 2009 pH1N1 infection, especially for young patients without chronic medical conditions.Retrospective observational study of 2151 severe or critical adult cases (≥ 14 years old) admitted to a hospital with pH1N1 influenza from September 1, 2009 to December 31, 2009 from 426 hospitals of 27 Chinese provinces. A confirmed case was a person whose pH1N1 virus infection was verified by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). Severe and critical cases were defined according to the H1N1 2009 Clinical guidelines (Third Edition, 2009) released by the Ministry of Health of China.Among the 2151 patients, the mean age was 34.0 years. Two hundred and ninty-three (13.6%) died during hospital stay. One thousand four hundred and forty-two patients (67.0%) had no comorbidities and 189 (13.1%) of them died. Pregnancy (OR 8.03), pneumonia (OR 8.91), dyspnea (OR 3.95), central nervous system (CNS) symptom (OR 1.55), higher APACHE (Acute Physiology and Chronic Health Evaluation) II score (OR 1.06), Alanine aminotransferase (ALT) (OR 1.002), and the lactate dehydrogenase (LDH) level (OR 1.001) were independent risk factors for death among adults without chronic medical conditions. Higher APACHE II score (OR 1.08) and age (OR 1.06) were independent risk factors for death among adults with respiratory diseases. A multivariate analysis showed an association between mortality and CNS symptoms (OR 2.66), higher APACHE II score (OR 1.03), ALT (OR 1.006), and LDH level (OR 1.002) in patients with cardiovascular diseases. Dyspnea (OR 11.32) was an independent risk factor for patient death in patients with diabetes mellitus.Clinical knowledge of identified prognostic factors for mortality may aid in the management of adult influenza infection.

It is the first multicenter clinical study in China to investigate zanamivir use among Chinese adolescents and adults with influenza-like illness (ILI) since 2009, when inhaled zanamivir (RELENZA(®)) was marketed in China.An uncontrolled open-label, multicentre study to evaluate the antiviral activity, and safety of inhaled zanamivir (as Rotadisk via Diskhaler device); 10 mg administered twice daily for 5 days in subjects ≥ 12 years old with ILI. Patients were enrolled within 48 hours of onset and followed for eight days. Patients were defined as being influenza-positive if the real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) test had positive results.A total of 400 patients ≥ 12 years old were screened from 11 centers in seven provinces from March 2010 to January 2011. Three hundred and ninety-two patients who took at least one dose of zanamivir were entered into the safety analysis. The mean age was 33.8 years and 50% were male. Cardiovascular diseases and diabetes were the most common comorbidities. All the reported adverse events, such as rash, nasal ache, muscle ache, nausea, diarrhea, headache, occurred in less than 1% of subjects. Mild sinus bradycadia or arrhythmia occurred in four subjects (1%). Most of the adverse events were mild and did not require any change of treatment. No severe adverse events (SAE) or fatal cases were reported. Bronchospasm was found in a 38 years old woman whose symptoms disappeared after stopping zanamivir and without additional treatment. All the 61 influenza virus isolates (43 before enrollment, 18 during treatment) proved to be sensitive to zanamivir.Zanamivir is well tolerated by Chinese adolescents and adults with ILIs. There is no evidence for the emergence of drug-resistant isolates during treatment with zanamivir.

The clinical spectrum of the 2009 pandemic influenza A (H1N1) infection ranged from self-limited mild illness to progressive pneumonia, or even a fatal outcome. We summarize the clinical manifestations, risk factors for severe and fatal cases, pathologic findings and treatment of this disease in this paper based on current reports from different regions of the world.

Nosocomial infection in early post-transplantation period is a tough problem for kidney transplantation. Few reports have explored the relations between biochemical parameters and nosocomial infection in kidney transplantation. This retrospective study was carried out to describe the characteristics of nosocomial infection in the very early period of kidney transplantation and to determine the risk factors in biochemical parameters and their alterations.Patients who underwent their first kidney transplantation from January 2001 to March 2009 in Beijing Chao-Yang Hospital were recruited and the nosocomial infectious episodes were collected for this study. Gender, age, donor type, delayed graft function (DGF) and biochemical parameters such as serum uric acid, lipids files and albumin on day 0 (before transplantation) and day 1 (24 hours after transplantation) and their changes were analyzed with Logistic regression models for nosocomial infection.A total of 405 patients (315 men and 90 women) were involved in this study. There were 80 patients experiencing 113 infection episodes and 105 strains of microorganism were identified. In univariate analysis, there were significant differences in DGF, albumin on day 0, lipoprotein (a) (Lp(a)) on day 1, change in low density lipoprotein-cholesterol (LDL-C, day 1-day 0) and change in uric acid (day 1-day 0) between nosocomial infection patients and noninfectious patients (P0.05). In multivariate analysis, change in uric acid (day 1-day 0) (OR 5.139, 95%CI 1.176-22.465, P0.05), change in LDL-C (day 1-day 0) (OR 4.179, 95%CI 1.375-12.703, P0.05) and DGF (OR 14.409, 95%CI 1.603-129.522, P0.05) were identified as independent risk factors for nosocomial infection in kidney transplantation.Most nosocomial infections in early postoperative period of kidney transplantation are bacterial, especially with Gram-negative bacteria. The most common infection sites are respiratory tract, urinary tract and surgical site. DGF, decrease of LDL-C and increase of uric acid could increase the risk for nosocomial infections.