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Summary: Effective laboratory markers for the estimation of disease severity and predicting the clinical progression of coronavirus disease‐2019 (COVID‐19) is urgently needed. Laboratory tests, including blood routine, cytokine profiles and infection markers, were collected from 389 confirmed COVID‐19 patients. The included patients were classified into mild (n = 168), severe (n = 169) and critical groups (n = 52). The leukocytes, neutrophils, infection biomarkers [such as C‐reactive protein (CRP), procalcitonin (PCT) and ferritin] and the concentrations of cytokines [interleukin (IL)‐2R, IL‐6, IL‐8, IL‐10 and tumor necrosis factor (TNF)‐α] were significantly increased, while lymphocytes were significantly decreased with increased severity of illness. The amount of IL‐2R was positively correlated with the other cytokines and negatively correlated with lymphocyte number. The ratio of IL‐2R to lymphocytes was found to be remarkably increased in severe and critical patients. IL‐2R/lymphocytes were superior compared with other markers for the identification of COVID‐19 with critical illness, not only from mild but also from severe illness. Moreover, the cytokine profiles and IL‐2R/lymphocytes were significantly decreased in recovered patients, but further increased in disease‐deteriorated patients, which might be correlated with the outcome of COVID‐19. Lymphopenia and increased levels of cytokines were closely associated with disease severity. The IL‐2R/lymphocyte was a prominent biomarker for early identification of severe COVID‐19 and predicting the clinical progression of the disease. [ABSTRACT FROM AUTHOR]

Background Epidemiological data evaluating sleep problems in clinical nurses in mainland China are scarce and an association between sleep problems and occupational stress has not been investigated. Aims To assess the prevalence of sleep problems and associated factors and determine their association with occupational stress among clinical nurses in general hospitals. Methods Nurses were selected through random cluster sampling. They answered a self-administered questionnaire, which included sociodemographic and occupational variables, the Pittsburgh Sleep Quality Index (PSQI) scoring system and the Job Content Questionnaire for evaluating occupational stress. Logistic regression analysis was used to evaluate factors associated with sleep problems. Results There were 5012 participants. Mean PSQI score of 4951 subjects included in the final analysis was 7.32 ± 3.24, with 2713 subjects having PSQI ≥8, accounting for 55% of participants. Female subjects in the intensive care unit and emergency departments were at higher risk of sleep problems. The following factors also presented a risk for sleep problems: multiple years of service, high monthly night shift frequency, primary and intermediate professional status, temporary employment status and high occupational stressors (including high psychological job demands, low job control and low workplace's social support). Conclusions The overall prevalence rate of sleep problems among clinical nurses in general hospitals in mainland China was high. Many factors could affect the sleep quality of nurses, although occupational stress facilitates development of sleep problems. Various risk factors associated with sleep problems among nurses should be studied extensively and measures for relieving occupational stress should be undertaken. [ABSTRACT FROM AUTHOR]

The immunomodulatory ability of mesenchymal stem cells (MSCs) may be used to develop therapies for autoimmune diseases. Flk-1+ MSCs are a population of MSCs with defined phenotype and their safety has been evaluated in Phase 1 clinical trials. We designed this study to evaluate whether Flk-1+ MSCs conferred a therapeutic effect on collagen-induced arthritis (CIA), an animal model of rheumatic arthritis, and to explore the underlying mechanisms. Flk-1+ MSCs, 1–2 × 106, were injected into CIA mice on either day 0 or day 21. The clinical course of arthritis was monitored. Serum cytokine profile was determined by cytometric bead array kit or enzyme-linked immunosorbent assay. Flk-1+ MSCs and splenocytes co-culture was conducted to explore the underlying mechanisms. Flk-1+ MSCs did not confer therapeutic benefits. Clinical symptom scores and histological evaluation suggested aggravation of arthritis in mice treated with MSCs at day 21. Serum cytokine profile analysis showed marked interleukin (IL)-6 secretion immediately after MSC administration. Results of in vitro culture of splenocytes confirmed that the addition of Flk-1+ MSCs promoted splenocyte proliferation and increased IL-6 and IL-17 secretion. Moreover, splenocyte proliferation was also enhanced in mice treated with MSCs at day 21. Accordingly, MSCs at low concentrations were found to promote lipopolysaccharide-primed splenocytes proliferation in an in vitro co-culture system. We propose that Flk-1+ MSCs aggravate arthritis in CIA model by at least up-regulating secretion of IL-6, which favours Th17 differentiation. When Flk-1+ MSCs are used for patients, we should be cautious about subjects with rheumatoid arthritis. [ABSTRACT FROM AUTHOR]