Search

BACKGROUND: Corona virus disease 2019 (COVID-19) showed a significant difference in case fatality rate between different regions at the early stage of the epidemic. In addition to the well-known factors such as age structure, detection efficiency, and race, there was also a possibility that medical resource shortage caused the increase of the case fatality rate in some regions. METHODS: Medline, Cochrane Library, Embase, Web of Science, CBM, CNKI, and Wan fang of identified articles were searched through 29 June 2020. Cohort studies and case series with duration information on COVID-19 patients were included. Two independent reviewers extracted the data using a standardized data collection form and assessed the risk of bias. Data were synthesized through description and analysis methods including a meta-analysis. RESULTS: A total of 109 articles were retrieved. The time interval from onset to the first medical visit of COVID-19 patients in China was 3.38±1.55 days (corresponding intervals in Hubei province, non-Hubei provinces, Wuhan, Hubei provinces without Wuhan were 4.22±1.13, 3.10±1.57, 4.20±0.97, and 4.34±1.72 days, respectively). The time interval from onset to the hospitalization of COVID-19 patients in China was 8.35±6.83 days (same corresponding intervals were 12.94±7.43, 4.17±1.45, 14.86±7.12, and 5.36±1.19 days, respectively), and when it was outside China, this interval was 5.27±1.19 days. DISCUSSION: In the early stage of the COVID-19 epidemic, patients with COVID-19 did not receive timely treatment, resulting in a higher case fatality rate in Hubei province, partly due to the relatively insufficient and unequal medical resources. This research suggested that additional deaths caused by the out-of-control epidemic can be avoided if prevention and control work is carried out at the early stage of the epidemic. TRIAL REGISTRATION: CRD42020195606.

Gap junctions are the main form of interaction between cardiomyocytes, through which the electrochemical activities between cardiomyocytes can be synchronized to maintain the normal function of the heart. Connexins are the basis of gap junctions. Changes in the expression, structural changes (e.g., phosphorylation and dephosphorylation), and distribution of connexins can affect the normal electrophysiological activities of the heart. Myocardial infarction (MI) and concurrent arrhythmia, shock, or heart failure can endanger life. The structural and functional damage of connexin (Cx) 43 in cardiomyocytes is a central part of the pathological progression of MI and is one of the main pathological mechanisms of arrhythmia after MI. Therefore, increasing Cx43 expression has become one of the main measures to prevent MI. Also, intervention in Cx43 expression can improve the structural and electrical remodeling of the myocardium to improve MI prognosis. Here, research progress of Cx43 in MI and its prevention and treatment using Traditional Chinese Medicine formulations is reviewed.

Background. Arrhythmia after myocardial infarction is the leading cause of death in clinical heart disease. Increasing studies have shown that the response to endoplasmic reticulum (ER) stress (ERS) caused by myocardial infarction is related to prognosis and the development of arrhythmias. The unfolded protein response (UPR) could serve as an important regulatory signaling pathway following myocardial infarction. The traditional Chinese medicine Wenxin Granules improve arrhythmias following myocardial infarction, which may be related to ERS intervention and the activation of the UPR and apoptosis. We aimed to investigate the involvement of Wenxin Granules in the activation of the UPR and apoptosis following myocardial infarction. Left coronary artery ligation was established as a rat model of myocardial infarction. The rats were randomly divided into the model group, low-dose Wenxin Granule group, high-dose Wenxin Granule group, and metoprolol group. Rats with only wire insertion and no ligature were used as the sham group. Small animal ultrasound systems were used to detect changes in heart structure and function, and the electrical stimulation threshold for ventricular fibrillation was detected. The expression of glucose-regulated protein (GRP)78, activating transcription factor (ATF)6, X-box binding protein (XBP)1, protein kinase–like ER kinase (PERK), phosphorylated (p)-PERK, Bax, Bcl2, C/EBP homologous protein (CHOP), caspase 12, caspase 8, and caspase 3 were detected by western blot, and terminal deoxynucleotidyl transferase dUTP Nick end labeling (TUNEL) was used to determine the cardiomyocyte apoptosis index. Compared with the sham group, rats in the model group displayed immediate ST-segment elevation and pathological Q waves after 24 hours. After 2 weeks, the left ventricular (LV) anterior wall thickness (LVAW) became thinner, and the inner diameter (LVID) increased. The end-diastolic LVAW (LVAWd), end-systolic LVAW (LVAWs), ejection fraction (EF), and fractional shortening (FS) were significantly reduced ( P < 0.01 ), whereas the LVIDd, LVIDs, diastolic LV volume (LV Vold), and systolic LV volume (LV Vols) significantly increased ( P < 0.01 ). The ventricular fibrillation threshold decreased significantly ( P < 0.01 ). ERS proteins GRP78, p-PERK, PERK, ATF6, and XBP1 and apoptotic proteins CHOP, Bax, caspase 12, caspase 8, and caspase 3 significantly increased ( P < 0.01 , P < 0.05 ), whereas Bcl-2 expression and the Bcl-2/Bax ratio decreased ( P < 0.01 ). Compared with the sham group, LVAWd, LVAWs, FS, and Bcl-2 protein expression were significantly increased in the low-dose Wenxin Granule group ( P < 0.01 , P < 0.05 ), and p-PERK and ATF6 decreased ( P < 0.01 , P < 0.05 ). Compared with the sham group, LVAWd, LVAWs, EF, FS, and the ventricular fibrillation threshold significantly increased in the high-dose Wenxin Granule and metoprolol groups ( P < 0.01 , P < 0.05 ), whereas LVIDs, LV Vols, and ERS proteins were significantly decreased ( P < 0.01 , P < 0.05 ). CHOP, Bax, caspase 12, caspase 8, and caspase 3 protein expression decreased in the Wenxin Granule group ( P < 0.01 , P < 0.05 ), whereas Bcl-2 and the Bcl-2/Bax ratio increased ( P < 0.01 , P < 0.05 ). LVIDd and Bax decreased in the metoprolol group ( P < 0.01 , P < 0.05 ), and the Bcl-2/Bax ratio increased ( P < 0.05 ). The cardiomyocyte apoptosis index values for the low- and high-dose Wenxin Granule and metoprolol groups were significantly reduced ( P < 0.05 ). This study suggested that the UPR is an essential mechanism underlying pathological injury after myocardial infarction. Wenxin Granule treatment can improve ventricular remodeling and cardiac function and inhibit arrhythmia by preventing excessive ERS from activating the UPR and apoptosis.

Constipation and depression are tightly related and often co-occur and coexist in clinic. Yet, the relationships and the underlying mechanisms are still unclear. Fecal metabolomics and network pharmacology were, for the first time, applied to investigate the potential correlations from multiple levels including classic behaviors, metabolomics, and gene targets. The behavioral indicators were analyzed, providing behavioral correlations at a macrolevel. Besides, fecal samples were analyzed by nuclear magnetic resonance spectroscopy to screen the shared and the unique metabolites and pathways, revealing correlations from a metabolic perspective. Finally, the disease targets and the functional pathways were obtained via network pharmacology, demonstrating correlations at the molecular level. The correlations between constipation and depression were demonstrated and supported by four-level evidence: (1) general behaviors, (2) gastrointestinal functions, (3) fecal metabolites and pathways, and (4) common gene targets and functional pathways. Especially, the correlations of behaviors and common metabolites showed that metabolites, including choline, betaine, and glycine, were significantly associated with constipation and depression. Besides, inflammation and immune abnormalities and energy metabolism were significantly involved in the mechanisms. The current findings prove the correlations between constipation and depression, and provide a basis for deeply understanding the comorbidities of constipation and depression.

Medical hyperspectral imagery has recentlyattracted considerable attention. However, for identification tasks, the high dimensionality of hyperspectral images usually leads to poor performance. Thus, dimensionality reduction (DR) is crucial in hyperspectral image analysis. Motivated by exploiting the underlying structure information of medical hyperspectral images and enhancing the discriminant ability of features, a discriminant tensor-based manifold embedding (DTME) is proposed for discriminant analysis of medical hyperspectral images. Based on the idea of manifold learning, a new discriminant similarity metric is designed, which takes into account the tensor representation, sparsity, low-rank and distribution characteristics. Then, an inter-class tensor graph and an intra-class tensor graph are constructed using the new similarity metric to reveal intrinsic manifold of hyperspectral data. Dimensionality reduction is achieved by embedding this supervised tensor graphs into the low-dimensional tensor subspace. Experimental results on membranous nephropathy and white bloodcells identification tasks demonstrate the potential clinical value of the proposed DTME.

Aim This study aimed to explore the effect of organisational innovation climate on nurse innovation behaviour and the mediating role of psychological empowerment. Background Encouraging nurses to generate more innovative behaviours has become an important development direction for improving the quality of nursing services. Method We employed a self-report questionnaire to collect data in Jinan City, China. A total of 2018 valid surveys were obtained. Hierarchical multiple regression model analysis was conducted to test the study hypothesis. Result The mean values of innovation behaviour and organisational innovation climate were 35.29 and 83.30, respectively. Psychological empowerment was found to have partially mediating effect on the relationship between organisational innovation climate and innovation behaviour. Conclusion Organisational innovation climate has significant impact on innovation behaviour, and it can indirectly affect innovation behaviour via the mediating role of psychological empowerment. Implications for nursing management Nursing managers should enhance innovation climate through formal rules, procedures and training activities. They can establish resource guarantee system and information sharing platform, and strengthen work autonomy for nurses to improve their psychological empowerment.

Objective Since the beginning of the COVID‐19 epidemic, a large number of guidelines on diagnosis and treatment of COVID‐19 have been developed, but the quality of those guidelines and the consistency of recommendations are unclear. The objective of this study is to evaluate the quality of the diagnosis and treatment guidelines on COVID‐19 and analyze the consistency of the recommendations of these guidelines. Methods We searched for guidelines on diagnosis and/or treatment of COVID‐19 through PubMed, CBM, CNKI, and WanFang Data, from January 1, 2020 to August 31, 2020. In addition, we also searched official websites of the US CDC, European CDC and WHO, and some guideline collection databases. We included diagnosis and/or treatment guidelines for COVID‐19, including rapid advice guidelines and interim guidelines. Two trained researchers independently extracted data and four trained researchers evaluated the quality of the guidelines using the AGREE II instruments. We extracted information on the basic characteristics of the guidelines, guideline development process, and the recommendations. We described the consistency of the direction of recommendations for treatment and diagnosis of COVID‐19 across the included guidelines. Results A total of 37 guidelines were included. Most included guidelines were assessed as low quality, with only one of the six domains of AGREE II (clarity of presentation) having a mean score above 50%. The mean scores of three domains (stakeholder involvement, the rigor of development and applicability) were all below 30%. The recommendations on diagnosis and treatment were to some extent consistent between the included guidelines. Computed tomography (CT), X‐rays, lung ultrasound, RT‐PCR, and routine blood tests were the most commonly recommended methods for COVID‐19 diagnosis. Thirty guidelines were on the treatment of COVID‐19. The recommended forms of treatment included supportive care, antiviral therapy, glucocorticoid therapy, antibiotics, immunoglobulin, extracorporeal membrane oxygenation (ECMO), convalescent plasma, and psychotherapy. Conclusions The methodological quality of currently available diagnosis and treatment guidelines for COVID‐19 is low. The diagnosis and treatment recommendations between the included guidelines are highly consistent. The main diagnostic methods for COVID‐19 are RT‐PCR and CT, with ultrasound as a potential diagnostic tool. As there is no effective treatment against COVID‐19 yet, supportive therapy is at the moment the most important treatment option.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective and curative treatment for acute myeloid leukemia (AML). We explored the outcome of haploidentical donor (HID) transplantation for intermediate-risk AML and compared to that of matched sibling donor (MSD) transplants. One hundred twenty-seven consecutive patients with intermediate-risk AML in the first complete remission (CR1) who underwent allo-HSCT between January 1, 2015, and August 1, 2016, were enrolled. Thirty-seven patients received MSD grafts, and 90 received HID grafts. The 2-year leukemia-free survival (LFS) of the HID group was comparable to that of the MSD group: 82.0% ± 4.1% versus 82.7% ± 6.4%, P = 0.457. The 2-year cumulative incidences of relapse and transplantation-related mortality (TRM) were comparable between the HID and MSD groups (relapse, 4.5% ± 0.1%, versus 11.5% ± 0.3%, P = 0.550; TRM, 13.4% ± 0.1% vs. 5.8% ± 0.2%, P = 0.154). The HID recipients had a trend of a lower 2-year cumulative incidence of positive posttransplant flow cytometry (FCM+) and relapse than the MSD recipients (5.6% ± 0.1% vs. 19.9% ± 0.5%, P = 0.092). These results suggest that the outcomes of allo-HSCT with HIDs are comparable to those with MSDs in terms of LFS, TRM, and relapse for intermediate-risk AML in CR1. HIDs could be an alternative to MSDs for intermediate-risk AML.

Uni-directional multi-state fluorochromic scaffolds are valuable photofunctional molecules and yet scarce. We report a general approach for their design, i.e., mechanodonor-acceptor coupling (MDAC). A photochromic molecule is a mechanodonor, due to its capability to convert photonic energy into mechanical force. Upon proper coupling, it can be used to drive a mechanochromic molecule for uni-directional multi-state fluorochromism. The embodiment of this approach is a rhodamine-dithienylethylene hydride (RDH), which has been successfully employed in super-resolution localization microscopy

Immune imbalance has become an important factor in the progression of chronic kidney disease (CKD). Molecular typing of CKD may be key to achieving precise treatment. xCell allows immune cell phenotyping in CKD. We integrated two independent microarray datasets and divided 87 CKD patients into two subgroups using unsupervised consensus clustering to study the correlation between CKD and patient sex, age, and CKD stage. We found different expression patterns and clinical characteristics between the two groups. CKD stage was more advanced in cluster I than in cluster II, and the weighted gene coexpression network analysis module characteristics showed enrichment of interferon and leukocyte-associated immune pathways in cluster I. Differentially expressed gene analysis revealed the 12 most significantly changed genes, of which sirtuin 1 (SIRT1) was significantly downregulated in cluster I. Gene set enrichment analysis identified multiple immune-related processes involved in CKD. xCell immune infiltration analysis revealed the significant upregulation of natural killer T (NKT) cells and the significant downregulation of most T and B cell types in cluster I. SIRT1 showed a significant negative correlation with NKT cell infiltration but a positive correlation with CD4+ T cell and natural killer cell infiltration. We systematically studied the molecular typing of the CKD transcriptome and estimated the degree of immune cell infiltration based on molecular subtypes. Our results indicate that different subgroups may have unique gene expression patterns and immune dysregulation patterns, thus providing a basis for precise treatment and immune research in CKD.

The ablation and acceleration of diamond-like high-density carbon foils irradiated by thermal X-ray radiations are investigated with radiation hydrodynamics simulations. The time-dependent front of the ablation wave is given numerically for radiation temperatures in the range of 100–300 eV. The mass ablation rates and ablation pressures can be derived or implied from the coordinates of ablation fronts, which agree well with reported experiment results of high-density carbon with radiation temperatures Trad in the range of 160–260 eV. It is also found that the $T_{{\rm rad}}^3$ scaling law for ablation rates does not apply to Trad above 260 eV. The trajectories of targets and hydrodynamic efficiencies for different target thicknesses can be derived from the coordinates of ablation fronts using a rocket model and the results agree well with simulations. The peak hydrodynamic efficiencies of the acceleration process are investigated for different foil thicknesses and radiation temperatures. Higher radiation temperatures and target thicknesses result in higher hydrodynamic efficiencies. The simulation results are useful for the design of fusion capsules.

Background: Fulvestrant 500 mg monotherapy is recommended as the first-line endocrine treatment in postmenopausal women with hormone receptor-positive metastatic breast cancer (MBC). It is also used in MBC maintenance treatment. However, few studies have compared the efficacy of fulvestrant during the initial treatment with that during maintenance treatment. Patients and Methods: MBC patients who were treated with fulvestrant either as initial therapy for metastatic disease or after progression following one line of chemotherapy between January 2016 and December 2017 were identified from the database of the Affiliated Hospital of Qingdao University. The primary end point was progression-free survival (PFS). Results: The study included 135 MBC patients who were treated with fulvestrant; 116 patients who received fulvestrant as first-line treatment were divided into 2 groups: the no-chemotherapy treatment (NCT) group received fulvestrant as initial therapy during disease progression, and the chemotherapy treatment (CT) group received fulvestrant as maintenance following disease stabilization or response to previous chemotherapy. The median PFS was 16 months in NCT patients and 8 months in the CT group. Patients who had a longer disease-free survival, no visceral metastasis and one metastasis site, benefited from fulvestrant as first-line treatment during disease progression. Patients with 2 or more metastasis sites benefited from chemotherapy as first-line treatment and fulvestrant as maintenance treatment. Conclusions: Fulvestrant monotherapy showed good clinical activity and safety in patients with MBC who were treated upon disease progression and in those receiving maintenance therapy.

The aim of this study was to evaluate the incidence, risk factors, and outcomes of primary prolonged isolated thrombocytopenia (PT) after haploidentical hematopoietic stem cell transplant (haplo-HSCT). We retrospectively analyzed patients who received haplo-HSCT for various hematologic malignancies at Peking University Institute of Hematology between January 2015 and December 2016. Of the 918 patients, 93 (10.1%) developed primary PT. We designed a propensity score method-based study. For each primary PT patient control subjects (1:3) were selected using a propensity score–matching method. A total of 372 recipients were enrolled in the study: 93 in the PT group and 279 in the control group. Multivariate analysis showed that age older than 25 years (P = .002), median mononuclear cells (P = .000), median CD34+ counts (P = .003), history of grades II to IV acute graft-versus-host disease (GVHD; P = .000), and Epstein-Barr virus (EBV) infection after haplo-HSCT (P = .016) were independent risk factors for primary PT. Primary PT was significantly associated with higher transplant-related mortality (TRM; P

Temporary teams quickly adapt to changes in the external environment with members diversity, task importance, and limited time, have attracted more and more attention from scholars. Therefore, this paper uses the bibliometric method to sort out of the temporary teams research systematically. In the process of collecting the literature of temporary teams, we find that the current research scope is narrow, and the research hot spots are scattered. Through a systematic literature review of the temporary teams research, this paper identifies the core authors, core literature, current research hot spots, and future research directions of temporary teams. Besides, according to the core literature, the core theory in current temporary teams research is summarized. Finally this paper presents the idea of applying temporary teams to controllers and pilots in the field of civil aviation and hopes to provide some reference value for scholars to study temporary teams in the future.

What is known and objective Vancomycin removal by dialysis uses methods that differ in type of dialysis membrane, dialysis fluxes and duration, ultrafiltration rate and Kt/Vurea (K = dialyser urea clearance, t = time on dialysis and V = total body water) in case of nephrotoxicity. We applied continuous venous-venous haemodiafiltration (CVVHDF) to treat a paediatric case of vancomycin nephrotoxicity caused by high serum trough concentrations. Case summary We report the case of a 4-year and 7-month-old boy with serum trough concentration of vancomycin of 86.0 mg/L after a 2-day treatment with vancomycin. His serum creatinine increased from 13.3 μmol/L at baseline to 227.0 μmol/L. We discontinued vancomycin and performed a 22-hours CVVHDF with high-flux membrane. Vancomycin decreased by 69.4% (82.1-25.1 mg/L), and renal function improved. What is new and conclusion Therapeutic drug monitoring and laboratory indicator measurements should be performed early during vancomycin treatment in paediatric patients with nephrotoxicity risk factors. Vancomycin removal by CVVHDF can be effective in paediatric acute kidney injury (AKI) associated with vancomycin-associated nephrotoxicity (VAN).

The effect of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) has been recognized as a factor in graft failure (GF) in patients who underwent umbilical cord blood transplantation (UBT), matched unrelated donor transplantation (MUDT), or haploidentical stem cell transplantation (haplo-SCT). Presently, we know little about the prevalence of and risk factors for having anti-HLA antibodies among older transplant candidates. Therefore, we analyzed 273 older patients with hematologic disease who were waiting for haplo-SCT. Among all patients, 73 (26.7%) patients had a positive panel-reactive antibody (PRA) result for class I, 38 (13.9%) for class II, and 32 (11.7%) for both. Multivariate analysis showed that females were at a higher risk for having a PRA result for class II (P = 0.001) and for having antibodies against HLA-C and HLA-DQ. Prior pregnancy was a risk factor for having a PRA result for class I (P P = 0.014) and class II (P P = 0.042). In addition, previous total transfusions were at high risk for having higher numbers of antibodies to specific HLA loci (P = 0.005), and disease course (7.5 months or more) (P = 0.020) were related to higher MFI of PRAs for class I. Our findings indicated that female sex, prior pregnancy, platelet transfusions and disease courses are independent risk factors for older patients with hematologic disease for having anti-HLA antibodies, which could guide anti-HLA antibody monitoring and be helpful for donor selection.

Background Coronary artery bypass graft (CABG) surgery has become the most common surgical procedure among all cardiac surgeries. Hyperglycaemia and hypoglycaemia occur frequently during this type of surgery and are associated with a variety of postoperative outcomes. Therefore, intraoperative glycaemic control is an important issue for patients undergoing CABG surgery. This systematic review and meta-analysis aim to evaluate the effects of different intraoperative glycaemic control strategies on postoperative outcomes. Methods We will perform a systematic review and meta-analysis of randomized controlled trials (RCTs) according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Relevant studies will be searched in the Medline, Embase, Cochrane Library and Web of Science databases. Two independent reviewers will conduct study selection, data extraction, risk of bias assessment and quality of evidence assessment. The primary outcome will be postoperative mortality, and the secondary outcomes will include time on a ventilator in the intensive care unit (ICU), incidence of postoperative myocardial infarction (MI), incidence of postoperative atrial fibrillation (AF), rate of postoperative infection, incidence of acute kidney failure (AKF), length of stay (LOS) in the ICU, and LOS in the hospital. χ2 (Cochran Q) and I2 methods will be used to assess statistical heterogeneity. Sensitivity analysis will also be performed to explore the source of clinical heterogeneity, and subgroup analyses will be performed to detect possible heterogeneity of the results. Review Manager (RevMan) 5.4 will be used for data management and statistical analysis. The Cochrane risk-of-bias tool 2.0 and GRADEpro will be applied for risk of bias and quality assessment of the evidence. Discussion We assume that intensive glycaemic control in patients undergoing CABG will reduce postoperative mortality and complications, which seriously compromise a patient’s quality of life and may even cause premature death. To address limitations in our study, corresponding methodologies will be adopted to optimize the results as much as possible. The results of our study are expected to provide strong evidence supporting the relationship between intensive intraoperative glycaemic control strategies and the reduction of postoperative complications in patients undergoing CABG surgery. Systematic review registration PROSPERO CRD42021240841.

Background: Neck pain is a common disorder and is more frequent in females than in males worldwide. Recently, more attention is being paid to precautions for and treatment of neck pain. Current therapeutic methods for neck pain include pharmaceutical, complementary and alternative therapies. Tuina, acupuncture and cupping are effective in the treatment of neck pain, which enrich patients’ options. In this study, we aim to evaluate the efficacy of different interventions using randomised controlled trials to identify a prioritised treatment for neck pain.Methods: We will search five English databases (Web of Science, MEDLINE, EMBASE, OVID and Cochrane Library) and four Chinese databases (CNKI, SinoMed, Wanfang Database and VIP) from database inception to December 2020. Two reviewers will independently perform article screening (title, keywords, abstract and full text); data extraction; risk of bias (RoB) assessment and grading of recommendations assessment, development and evaluation. We will use RevMan 5.3 software to carry out statistical analysis of the RoB and risk ratio to analyse the dichotomous data. Finally, we will use GeMTC V.0.8.1 package of R-3.3.2 software for network meta-analysis based on a Bayesian framework.Discussion: We will compare these three interventions to determine the most effective therapy for neck pain in terms of improving pain, anxiety, depression and QoL. In this way, we will provide powerful evidence for future clinical practice guidelines for patients with neck pain who want to receive a suitable treatment.Systematic review registration: PROSPERO CRD42020206853.

With the advent of the era of big data, key-value storage systems based on LSM-Tree have been widely used. Because of its excellent writing performance, it is favored by data centers. LSM-Tree is divided into two parts, one that SkipList structure located in the memory and the other that level structure resident in the disk. The SkipList structure involves two modules, MemTable and Immutable MemTable, which speed up its read and write performance. However, Immutable MemTable is only single and unchangeable, which will cause the thread to block and affect access efficiency in terms of write-intensive workloads. To solve the issue, we propose multiple Immutable MemTables for rotating storage to improve write performance. Furthermore, due to the increase of memory-resident data in the MemTables, the read rate is also enhanced. Through running the benchmarks of the LevelDB system, In the case of less than 1000,000 key-value items, the read performance can be improved by 15%~65%, and when it comes to less than 10000,000 key-value items, the write performance can be improved by 15%~71%.

Simple linear iterative clustering (SLIC) is a fast and effective method for superpixel segmentation. However, the similarity measurement method of typical SLIC based on spatial and spectral features fails to get precise segmentation boundaries, especially for the images with complex and irregular shapes. To address this issue, a modified SLIC (MSLIC) method based on spectral, color, and texture information is proposed for medical hyperspectral cell images. The Gabor filter is used to exploit detailed texture features, which processes the image by using signal Fourier transform in the frequency domain. The MSLIC employs normalization, Gamma correction, and principal component analysis (PCA) to preprocess medical hyperspectral images, in which the texture features are integrated with spectral and spatial features to measure the distance. The under-segmentation error and boundary recall are used as the criterion of segmentation. Experiments for two medical datasets indicate that MSLIC achieves better segmentation performance than the typical SLIC method.

Least squares regression (LSR)-based classifiers are effective in multi-classification tasks. For hyperspectral image (HSI) classification, the spatial structure information usually helps to improve the performance, however, most existing LSRbased methods use the spectral-vector as input which ignore the important correlations in the spatial domain. To solve the drawback, a tensor-patch-based discriminative marginalized least squares regression (TPDMLSR) is proposed to modify discriminative marginalized least squares regression (DMLSR) with consideration of inter-class separability by employing the region covariance matrix (RCM). RCM is adopted to exploit a region of interest around each hyperspectral pixel to characterize the intrinsic spatial geometric structure of HSI. Specifically, TPDMLSR not only maintains the ascendancy of DMLSR, but also preserves the spatial-spectral structure and enhances the ability of class discrimination for regression by learning the tensor-patch manifold term with a new region covariance descriptor and measuring the inter-class similarity more accurately. The experimental results on membranous nephropathy (MN) dataset validate that TPDMLSR significantly outperforms LSR-based methods reflected in sensitivity, overall accuracy (OA), average accuracy (AA) and Kappa coefficient (Kappa).

AimTo identify the safety, immunogenicity, and protective efficacy of COVID-19 vaccine in children and adolescents.MethodsWe conducted a systematic review. Databases including PubMed, Web of Science, WHO COVID-19 database, and CNKI were searched on 23 July 2021. International Clinical Trials Registry Platform (ICTRP) was also searched to collect ongoing trials. We included published researches or ongoing clinical trials related to the safety, immunogenicity, and efficacy of COVID-19 vaccine in children or adolescents (aged ≤18 years). Meta-analysis was performed if the consistency of the included studies was high. If not, descriptive analyses were performed.ResultsEight published studies with 2851 children or adolescents and 28 ongoing clinical trials were included. Among eight published studies, two (25.0%) were RCTs, two (25.0%) case series, and four (50.0%) case reports. The results showed selected COVID-19 vaccines had a good safety profile in children and adolescents. Injection site pain, fatigue, headache, and chest pain were the most common adverse events. Some studies reported a few cases of myocarditis and pericarditis. Two RCTs showed that the immune response to BNT162b2 in adolescents aged 12-15 years was non-inferior to that in young people aged 16-25 years, while a stronger immune response was detected with 3μg CoronaVac injection. Only one single RCT showed the efficacy of BNT162b2 was 100% (95% CI: 75.3 to 100). Of the 28 ongoing clinical trials, twenty-three are interventional studies. Fifteen countries are conducting interventional clinical trials of COVID-19 vaccines in children and adolescents. Among them, China (10, 43.5%) and United Stated (9, 39.1%) were the top two countries with the most trials. BNT162b2 was the most common vaccine, which is under testing.ConclusionSome of the COVID-19 vaccines have potential protective effects in children and adolescents, but awareness is needed to monitor possible adverse effects after injection. Clinical trials of the COVID-19 vaccine in children and adolescents with long follow-up, large sample size, and different vaccines are still urgently needed.

Chronic graft-versus-host disease (cGVHD) is a major complication following unmanipulated haploidentical hematopoietic stem cell transplantation (haplo-HSCT). We aimed to identify the risk factors for cGVHD in patients who underwent anti-thymocyte globulin-based haplo-HSCT for acute myeloid leukemia (n = 280). The diagnosis of cGVHD was in accordance with the National Institutes of Health consensus criteria. A total of 169 patients suffered from cGVHD. The patients who had 3 loci mismatched had a higher 8-year incidence of cGVHD (total, 66.0% vs. 53.7%, P = 0.031; moderate to severe, 42.4% vs. 30.1%, P = 0.036) than the patients who had 1 to 2 loci mismatched. The patients who had maternal donors had a higher 8-year incidence of moderate to severe cGVHD (49.2% vs. 32.9%, P = 0.024) compared with the patients who had other donors. The patients who had grades III to IV acute GVHD (aGVHD) had higher 8-year incidence of cGVHD (total, 88.0% vs. 50.4%, P < 0.001; moderate to severe, 68.0% vs. 27.0%, P < 0.001) compared with the patients without aGVHD. In multivariate analysis, grades III to IV aGVHD was the only independent risk factor for cGVHD. Thus, further interventions should be considered in patients with severe aGVHD to prevent cGVHD.

As one of the three successful approaches for haplo-identical stem cell transplantation (haplo-SCT) in recent decades, "Beijing protocol" was based on immune tolerance induced by granulocyte colony-stimulating factor plus anti-thymocyte globulin, which included individualized conditioning regimens, novel donor selection algorithm, and risk-directed strategies for GvHD and relapse, etc. Haplo-HSCT following "Beijing protocol" demonstrated similar efficacy to HLA-matched SCT, which has become the predominant strategy for allogeneic SCT in China as well as inspiration for refinement of global practice. This review will focus on recent progressions and prospective of this approach in (1) the indications from hematological malignancies to non-malignant diseases; (2) microenvironment for hematopoietic recovery; and (3) improving T cells function.

Although support vector classifiers for hyperspectral imagery traditionally exploit spectral information alone, there has been increasing interest in spatial–spectral classifiers that incorporate spatial context due to the potential for significant performance improvement over spectral-only approaches. Accordingly, a new approach for spatial–spectral classification is introduced which incorporates spatial information into a prior hyperspectral classifier driven by functional data analysis (FDA) applied to continuous spectral functions. FDA permits functional properties—such as the smoothness inherent to spectral signatures—to inform hyperspectral classification. The proposed spatial FDA (SFDA) incorporates an additional spatial coherency factor that attempts to ensure that each pixel is represented with a spectral curve that is similar to those of its nearest spatial neighbors. Experimental results demonstrate that the proposed SFDA coupled with a support vector classifier yields results superior to other state-of-the-art spatial–spectral techniques for hyperspectral classification.

Purpose: Although myeloablative HLA haploidentical hematopoietic stem cell transplantation (haplo-HSCT) following pretransplant anti-thymocyte globulin (ATG) and granulocyte colony-stimulating factor (G-CSF) stimulated grafts (ATG+G-CSF) has been confirmed as an alternative to HSCT from HLA-matched sibling donors (MSD), the effect of haplo-HSCT on postremission treatment of patients with acute myeloid leukemia (AML) with intermediate risk (int-risk AML) who achieved first complete remission (CR1) has not been defined. Patients and Methods: In this prospective trial, among 443 consecutive patients ages 16–60 years with newly diagnosed de novo AML with int-risk cytogenetics, 147 patients with molecular int-risk AML who achieved CR1 within two courses of induction and remained in CR1 at 4 months postremission either received chemotherapy (n = 69) or underwent haplo-HSCT (n = 78). Results: The 3-year leukemia-free survival (LFS) and overall survival (OS) were significantly higher in the haplo-HSCT group than in the chemotherapy group (74.3% vs. 47.3%; P = 0.0004 and 80.8% vs. 53.5%; P = 0.0001, respectively). In the multivariate analysis with propensity score adjustment, postremission treatment (haplo-HSCT vs. chemotherapy) was an independent risk factor affecting the LFS [HR 0.360; 95% confidence interval (CI), 0.163–0.793; P = 0.011], OS (HR 0.361; 95% CI, 0.156–0.832; P = 0.017), and cumulative incidence of relapse (HR 0.161; 95% CI, 0.057–0.459; P = 0.001) either in entire cohort or stratified by minimal residual disease after the second consolidation. Conclusions: Myeloablative haplo-HSCT with ATG+G-CSF is superior to chemotherapy as a postremission treatment in patients with int-risk AML during CR1. Haplo-HSCT might be a first-line postremission therapy for int-risk AML in the absence of HLA-MSDs. Haplo-HSCT might be superior to chemotherapy as a first-line postremission treatment of intermediate-risk AML in CR1.

The immune mechanism underlying graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (HSCT) remains unclear. Natural killer (NK) cells play a crucial role in mediating pathogen-specific immunity and are the first donor-derived lymphocytes reconstituted post-HSCT. However, NK cells vary at different stages after HSCT. Here, we found that the absolute NKG2A+ subset cell counts and the percentages of NKG2A+ among NK cells were significantly reduced in GVHD patients after HSCT compared with those from non-GVHD patients. Moreover, the reduction in NKG2A+ NK cells in post-HSCT GVHD patients was ascribed to increased apoptosis and a decreased proliferation capacity while retaining a strong graft-versus-leukemia effect. In vitro assays showed that co-culture of T cells with NKG2A+ NK cells significantly reduced IFN-γ secretion by T cells and increased IL-4 secretion. Moreover, the CD25 expression level was decreased, whereas the number of cells with the CD4+CD25+FOXP3+ phenotype was increased. In addition, the NKG2A+ NK cells induced T cell apoptosis and decreased T cell proliferation during the co-culture process. Importantly, NKG2A+ NK cells mainly regulated activated but not resting T cells. In vivo assays showed that the serologic IL-10 level was evidently lower in GVHD than in non-GVHD patients, whereas the IL-1β, IFN-γ, and tumor necrosis factor-α levels were higher in GVHD patients. Furthermore, the NKG2A+ NK cell ratio from GVHD patients was markedly increased by the presence of exogenous IL-10 but not by other cytokines. In contrast, the NKG2A+ cell ratio from non-GVHD patients was not increased by IL-10. Therefore, post-HSCT GVHD may be ascribed to the reduced induction of NKG2A+ NK cells by IL-10, which further overactivates T cells.

Optical kidney biopsy, serological examination, and clinical symptoms are the main methods for membranous nephropathy (MN) diagnosis. However, false positives and undetectable biochemical components in the results of optical inspections lead to unsatisfactory diagnostic sensitivity and pose obstacles to pathogenic mechanism analysis. In order to reveal detailed component information of immune complexes of MN, microscopic hyperspectral imaging technology is employed to establish a hyperspectral database of 68 patients with two types of MN. Based on the characteristic of the medical HSI, a novel framework of tensor patch-based discriminative linear regression (TDLR) is proposed for MN classification. Experimental results show that the classification accuracy of the proposed model for MN identification is 98.77%. The combination of tensor-based classifiers and hyperspectral data analysis provides new ideas for the research of kidney pathology, which has potential clinical value for the automatic diagnosis of MN.

Background The aim of this review was to explore the quality assessment checklists development methods in previous researches using standardized patients (SPs), as well as to propose an evidence-based checklist development procedure for quality assessment of common conditions in primary health care (PHC) settings. Methods We conducted a systematic review of studies that described checklist development method and extracted the methodology in terms of the developer, the basis and processes. Based on that, we formulated the development procedure according to the recommendations of the WHO Handbook for Guideline Development. Results We identified a total of 13 articles, and proposed the following five key steps: (I) forming a multidisciplinary team; (II) selecting and evaluating relevant references; (III) extracting medical information and forming the basic items; (IV) clinical expert consensus on the items; and (V) pre-testing the item pool and determining final items. Discussion SP has been proven to be an effective method to assess performance in practice. There are still some deficiencies in the developing of case-specific checklists using SPs. To ensure the validity and reliability of checklists, the development processes need to be more standardized and procedural.

The traditional fusion method for polarization image and color image is difficult to be satisfied in practice, so the method based on SCM in the fusion of polarization image and color image is designed and combined with HSV color field adaptive enhancement, so as to achieve the effect of distinguishing objects under shadow or reflection. Using the multi-scale decomposition of guided filter and Gaussian filter, different fusion schemes are proposed for different scale information: the average energy fusion method is used for the low-frequency coefficients, and the SCM with the edge energy (EOE) as the stimulation is used to replace the traditional high-frequency fusion rules, so as to enhance the spatial information expression. Finally, the parameters are corrected by the consistency test. Experiments show that this method not only has a good color expression ability, but also effectively adds the polarization information of the target object, and achieves good performance in objective and supervisor evaluation.

The traditional differential diagnosis of membranous nephropathy (MN) mainly relies on clinical symptoms, serological examination and optical renal biopsy. However, there is a probability of false positives in the optical inspection results, and it is unable to detect the change of biochemical components, which poses an obstacle to pathogenic mechanism analysis. Microscopic hyperspectral imaging can reveal detailed component information of immune complexes, but the high dimensionality of microscopic hyperspectral image brings difficulties and challenges to image processing and disease diagnosis. In this paper, a novel classification framework, including spatial-spectral density peaks-based discriminant analysis (SSDP), is proposed for intelligent diagnosis of MN using a microscopic hyperspectral pathological dataset. SSDP constructs a set of graphs describing intrinsic structure of MHSI in both spatial and spectral domains by employing density peak clustering. In the process of graph embedding, low-dimensional features with important diagnostic information in the immune complex are obtained by compacting the spatial-spectral local intra-class pixels while separating the spectral inter-class pixels. For the MN recognition task, a support vector machine (SVM) is used to classify pixels in the low-dimensional space. Experimental validation data employ two types of MN that are difficult to distinguish with optical microscope, including primary MN and hepatitis B virus-associated MN. Experimental results show that the proposed SSDP achieves a sensitivity of 99.36%, which has potential clinical value for automatic diagnosis of MN.

Background: Adoptive transfer of cytomegalovirus (CMV)-specific T cells (CTLs) from original transplant donors or third-party donors was effective for CMV infection after allogenic stem cell transplantation (allo-SCT), but the safety and antiviral activity of CTL types have not been compared. Additionally, mechanisms driving sustained antiviral immunity induced by these CTLs need to be established and compared. Methods: i) We compared antiviral abilities of transplant donor and third-party CTLs for CMV infection in two mouse models, compared the in vivo recovery of CMV-specific immunity and analyzed underlying mechanisms driving sustained antiviral immunity induced by these CTLs therapies. ii) We collected data from 31 patients receiving third-party CTLs and selected matched pairs of 62 individuals who received donor CTLs for refractory CMV infection after allo-SCT, compared the safety and efficacy of the CTLs types for CMV infection, and evaluated the recovery of virus-specific immunity in patients. Findings: i) In mouse models, we observed that both donor and third-party CTLs effectively combated systemic CMV infection by reducing CMV pathology and tumor burden 28 days post-infusion. The in vivo recovery of CMV-specific immunity after CTLs infusion was comparable in both groups. A detailed analysis of the source of recovered CTLs showed the proliferation and expansion of graft-derived endogenous CTLs in both groups. ii) In patients, adoptive therapy with donor or third-party CTLs had comparable clinical responses without significant therapy-related toxicity. We observed strong expansion of CD8 + tetramer + T cells and the proliferation of recipient’s endogenous CTLs after CTLs infusion, which were associated with a reduced or cleared of viral load. Interpretation: Adoptive therapy with transplant donor or third-party CTLs triggered comparable antiviral responses to CMV infection by helping to restore CMV-specific immunity. Funding: National Key Research and Development Program of China, National Natural Science Foundation of China. Declaration of Interest: The authors have no competing financial interests to declare. Ethical Approval: This study was approved by the ethics committee of Peking University People's Hospital

BackgroundPrevious studies suggested that plasma B-type natriuretic peptide (BNP) level was often elevated in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and was associated with increased mortality. However, most studies did not consider the fact that conditions such as coronary ischemic heart disease can also increase BNP level. Therefore, we aimed to explore the association between BNP level and in-hospital mortality in patients with AECOPD without a history of coronary ischemic heart disease.MethodsIn this retrospective cohort study, data on patients with AECOPD but without a history of coronary ischemic heart disease who were admitted in a comprehensive hospital from January 2017 to December 2019 and were identified using International Statistical Classification of Diseases and Related Health Problems, Nineth Revision (ICD-9) codes were included. BNP level was determined within 24 hours after admission, and the value was log2 transformed. The primary outcome was in-hospital mortality, and the secondary outcome was a composite outcome of in-hospital mortality or invasive mechanical ventilation.ResultsA total of 300 patients were included in this study (mean ages, 76.88 years; SD, 9.87; men, 63.33%). Sixteen patients (5.33%) showed in-hospital mortality; 29(9.67%) and 22 (6.67%) patients were assisted with invasive mechanical ventilators and noninvasive positive pressure ventilators, respectively. Univariate cox regression analysis showed that the unadjusted HRs of the primary and secondary outcomes were 1.85 (95% CI, 1.39-2.47) and 1.42 (95% CI, 1.19-1.71), respectively. After adjustment for age, sex, past medical history, smoking status, drinking status, CURB65 (Confusion, Urea > 7mmol/L, Respiratory rate≥30/min, Blood pressure systolic < 90 mmHg or diastolic 65 years), arterial partial pressure of O2(PaO2), arterial partial pressure of CO2 (PaCO2), neutrophil count, and D-dimer level (only secondary outcome), the adjusted HRs of the primary and secondary outcomes were 2.44 (95% CI, 1.43-4.14) and 1.36 (95% CI, 1.07-1.74), respectively. The results of subgroup analysis by age, sex, and lung function were robust.ConclusionsThe plasma log2BNP level was significantly associated with in-hospital mortality and a composite outcome of in-hospital mortality or invasive mechanical ventilation

Microscopic hyperspectral imaging has become an emerging technique for various medical applications. However, high dimensionality of hyperspectral image (HSI) makes image processing and extraction of important diagnostic information challenging. In this paper, a novel dimensionality reduction method named spatial-spectral density peaks based discriminant projection (SSDP) is proposed by considering spatial-spectral density distribution characteristics of immune complexes. The proposed SSDP coupled with support vector machine classifier (SVM) yields high-precision automatic diagnosis of membranous nephropathy (MN). Detailed ex-vivo validation of the proposed method demonstrates the potential clinical value of the system in identifying hepatitis B virus-associated membranous nephropathy (HBV-MN) and primary membranous nephropathy (PMN).

The worldwide spread of the 2019 novel coronavirus has become a profound threat to human health. As the use of medication without established effectiveness may result in adverse health consequences, the development of evidence-based guidelines is of critical importance for the clinical management of coronavirus disease (COVID-19). This research presents methods used to develop rapid advice guidelines on treating COVID-19 with traditional Chinese medicine (TCM). We have followed the basic approach for developing WHO rapid guidelines, including preparing, developing, disseminating and updating each process. Compared with general guidelines, this rapid advice guideline is unique in formulating the body of evidence, as the available evidence for the treatment of COVID-19 with TCM is from either indirect or observational studies, clinical first-hand data together with expert experience in patients with COVID-19. Therefore, our search of evidence not only focuses on clinical studies of treating COVID-19 with TCM but also of similar diseases, such as pneumonia and influenza. Grading of recommendations assessment, development and evaluation (GRADE) methodology was adopted to rate the quality of evidence and distinguish the strength of recommendations. The overall certainty of the evidence is graded as either high, moderate, low or very low, and to give either “strong” or “weak” recommendations of each TCM therapy. The output of this paper will produce the guideline on TCM for COVID-19 and will also provide some ideas for evidence collection and synthesis in the future development of rapid guidelines for COVID-19 in TCM as well as other areas.

Traditional Chinese medicines (TCMs) have attracted more attentions in the treatment of depression. Xiaoyaosan (XYS), a classic anti-depression TCM prescription, contains eight herbs. However, the compatibility effects of XYS in modern pharmacology need to be investigated in depth. In this study, the chronic unpredictable mild stress (CUMS) depression-like model was constructed. Afterwards, XYS was divided into the Shugan and the Jianpi groups according to the research strategy ofefficacy groups. Meanwhile, a proton nuclear magnetic resonance spectrometry (1H NMR) based serum metabolomics was applied. XYS and its efficacy groups significantly regulated the abnormal levels of differential metabolites related to depression, but to different degrees. Metabolic profiling by orthogonal partial least squares discriminant analysis showed that XYS at high dose (XH) exhibited the strongest effects than other treatment groups. Ten metabolites related to depression were identified as differential metabolites. Besides, relative distance (Rd) was calculated to quantitatively evaluate the effects. We found that XH group had the highest Rd value. Moreover, among the five metabolic pathways of depression, XYS and Jianpi groups significantly regulated all pathways while Shugan group regulated four pathways. These findings lay a solid foundation for comprehensively and deeply understanding the compatibility effects of XYS against depression.

Bone is a frequent site for the occurrence of metastasis of thyroid cancer (TC). TC with bone metastasis (TCBM) is associated with skeletal-related events (SREs), with poor prognosis and low overall survival (OS). Therefore, it is necessary to develop a predictive nomogram for prognostic evaluation. This study aimed to construct an effective nomogram for predicting the OS and cancer-specific survival (CSS) of TC patients with BM. Those TC patients with newly diagnosed BM were retrospectively examined over a period of 6 years from 2010 to 2016 using data from the Surveillance, Epidemiology and End Results (SEER) database. Demographics and clinicopathological data were collected for further analysis. Patients were randomly allocated into training and validation cohorts with a ratio of ∼7:3. OS and CSS were retrieved as research endpoints. Univariate and multivariate Cox regression analyses were performed for identifying independent predictors. Overall, 242 patients were enrolled in this study. Age, histologic grade, histological subtype, tumor size, radiotherapy, liver metastatic status, and lung metastatic status were determined as the independent prognostic factors for predicting the OS and CSS in TCBM patients. Based on the results, visual nomograms were separately developed and validated for predicting 1-, 2-, and 3-year OS and CSS in TCBM patients on the ground of above results. The calibration, receiver operating characteristic (ROC) curve and decision curve analysis (DCA) also demonstrated the reliability and accuracy of the clinical prediction model. Our predictive model is expected to be a personalized and easily applicable tool for evaluating the prognosis of TCBM patients, and may contribute toward making an accurate judgment in clinical practice.

Aim This study aimed to investigate the household medication-taking behavior and affordability of patients with chronic diseases in Gansu Province. As well as to propose suggestions to assist improvement of related policies. Methods A multistage stratified cluster sampling technique was used to select the research sites and households according to the WHO manual for the "Household Survey to Measure Access and Use of Medicines". The impact factors of medication-taking behavior were estimated using binary logistic regression models. Medication treatment affordability of hypertension patients was evaluated. Results A total of 1,080 completed questionnaires were collected, in which 690 families reported to have chronic patients in their home. The total number of chronic disease patients were 915. About 93% of the patient reported scheduled medicine intake. Approximately 86.60% of patients with chronic medical conditions were able to adhere to the physicians' prescriptions. Age, gender, and the number of household chronic disease patients were the main factors influencing whether the patients take medication. Respondents' self-reported monthly expenditure on household medicine accounted for 16.95% of their total monthly expenditure. The total cost of irbesartan and valsartan for hypertension treatment was two-fold higher than the minimum daily wage of the families. Conclusion This study found that patients with chronic diseases have a high proportion of medication and medication compliance. However, family drug burden, especially for those living with hypertension are among the key challenges. Related policy needs to be revised to promote the affordability of medication under chronic conditions.

Background Supportive treatment is an important and effective part of the management for patients with life-threatening diseases. This study aims to identify and evaluate the forms of supportive care for patients with respiratory diseases. Methods An umbrella review of supportive care for patient with respiratory diseases was undertaken. We comprehensively searched the following databases: Medline, EMBASE, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang Data and CBM (SinoMed) from their inception to 31 March 2020, and other sources to identify systematic reviews and meta-analyses related to supportive treatments for patient with respiratory diseases including Coronavirus Disease 2019 (COVID-19), severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and influenza. We assessed the methodological quality using the AMSTAR score and the quality of the evidence for the primary outcomes of each included systematic review and meta-analysis. Results We included 18 systematic reviews and meta-analyses in this study. Most studies focused on the respiratory and circulatory support. Ten studies were of high methodological quality, five studies of medium quality, and three studies of low quality. According to four studies extracorporeal membrane oxygenation did not reduce mortality in adults [odds ratio/relative risk (OR/RR) ranging from 0.71 to 1.28], but two studies reported significantly lower mortality in patients receiving venovenous extracorporeal membrane oxygenation than in the control group (OR/RR ranging from 0.38 to 0.73). Besides, monitoring of vital signs and increasing the number of medical staff may also reduce the mortality in patients with respiratory diseases. Conclusions Our overview suggests that supportive care may reduce the mortality of patients with respiratory diseases to some extent. However, the quality of evidence for the primary outcomes in the included studies was low to moderate. Further systematic reviews and meta-analyses are needed to address the evidence gap regarding the supportive care for SARS, MERS and COVID-19.

Abstract Human leukocyte antigen (HLA) haploidentical stem cell transplantation (haplo-SCT) as a postremission treatment for standard risk Philadelphia chromosome-negative acute lymphoblastic leukemia (SR Ph-ALL) in the first complete remission (CR1) has not been defined. In this multicenter, phase 3 study (NCT02042690), of the 131 consecutive Ph-ALL young adult patients (YA, aged 18–39 years) without high-risk features who achieved CR1, 114 patients without HLA-matched donors received consolidation with an adult chemotherapy regimen (n = 55) or haplo-SCT (n = 59). In the landmark analysis, haplo-SCT resulted in a lower 2-year cumulative incidence of relapse (CIR, 12.8% vs 46.7%, P = 0.0017) and superior 2-year leukemia-free survival (LFS, 80.9% vs 51.1%, P = 0.0116) and 2-year overall survival (OS, 91.2% vs 75.7 [64.8–93.2] %, P = 0.0408) than chemotherapy. In the time-dependent multivariate analysis with propensity score adjustment, postremission treatment (haplo-SCT vs chemotherapy) was an independent risk factor for the CIR (HR 0.195, 95% CI 0.076–0.499, P = 0.001), LFS (HR 0.297, 95% CI 0.131–0.675, P = 0.003), and OS (HR 0.346, 95% CI 0.140–0.853, P = 0.011). In all subgroups, CIR was lower in haplo-SCT. Myeloablative haplo-SCT with ATG+G-CSF might be one of the preferred therapies for YA patients with standard-risk Ph-ALL. Trial registration ClinicalTrials.gov. Registered on 23 January 2014, https://clinicaltrials.gov/ct2/show/NCT02042690

This project aims to evaluate the methods and reporting quality of practice guidelines of five different viruses that have caused Public Health Emergencies of International Concern (PHEIC) over 20 past years: the severe acute respiratory syndrome coronavirus (SARS-CoV), Ebola virus, Middle East respiratory syndrome coronavirus (MERS-CoV), Zika virus and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We systematically searched databases, guideline websites and government health agency websites from their inception to February 02, 2020 to extract practice guidelines for SARS-CoV, Ebola virus, MERS-CoV, Zika virus, SARS-CoV-2 and the diseases they caused. The literature was screened independently by four researchers. Then, fifteen researchers evaluated the quality of included guidelines using the AGREE-II (Appraisal of Guidelines for Research and Evaluation II, for methodological quality) instrument and RIGHT (Reporting Items for practice Guidelines in Healthcare, for reporting quality) statement. Finally, a total of 81 guidelines were included, including 21 SARS-CoV guidelines, 11 Ebola virus (EBOV) guidelines, 9 MERS-CoV guidelines, 10 Zika Virus guidelines and 30 SARS-CoV-2 guidelines. The evaluation of the methodological quality indicated that the mean scores of each domain for guidelines of each virus were all below 60%, the scores for guidelines in the domains of "clarity of presentation" being the highest and in the "editorial independence" lowest. The mean reporting rate of each domain for guidelines of each virus was also less than 60%: the reporting rates for the domain "background" were highest, and for the domain "funding and interests" lowest. The methodological and reporting quality of the practice guidelines for SARS-CoV, Ebola virus, MERS-CoV, Zika virus and SARS-CoV-2 guidelines tend to be low. We recommend to follow evidence-based methodology and the RIGHT statement on reporting when developing guidelines.

BackgroundSupportive treatment is an important and effective part of the management for patients with life-threatening diseases. This study aims to identify and evaluate the forms of supportive care for patients with respiratory diseases.MethodsAn umbrella review of supportive care for patient respiratory diseases was undertaken. We comprehensively searched the following databases: Medline, EMBASE, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang Data and CBM (SinoMed) from their inception to 31 March 2020, and other sources to identify systematic reviews and meta-analyses related to supportive treatments for patient with respiratory diseases including COVID-19, SARS, MERS and influenza. We assessed the methodological quality using the AMSTAR score and the quality of the evidence for the primary outcomes of each included systematic review and meta-analysis.ResultsWe included 18 systematic reviews and meta-analyses in this study. Most studies focused on the respiratory and circulatory support. Ten studies were of high methodological quality, five studies of medium quality, and three studies of low quality. According to four studies extracorporeal membrane oxygenation did not reduce mortality in adults (OR/RR ranging from 0.71 to 1.28), but two studies reported significantly lower mortality in patients receiving venovenous extracorporeal membrane oxygenation than in the control group (OR/RR ranging from 0.38 to 0.73). Besides, monitoring of vital signs and increasing the number of medical staff may also reduce the mortality in patients with respiratory diseases.ConclusionsOur overview suggests that supportive care may reduce the mortality of patients with respiratory diseases to some extent. However, the quality of evidence for the primary outcomes in the included studies was low to moderate. Further systematic reviews and meta-analyses are needed to address the evidence gap regarding the supportive care for SARS, MERS and COVID-19.

BackgroundThe outbreak of the coronavirus disease 2019 (COVID-19) has had a massive impact on the whole world. Computed tomography (CT) has been widely used in the diagnosis of this novel pneumonia. This study aims to understand the role of CT for the diagnosis and the main imaging manifestations of patients with COVID-19.MethodsWe conducted a rapid review and meta-analysis on studies about the use of chest CT for the diagnosis of COVID-19. We comprehensively searched databases and preprint servers on chest CT for patients with COVID-19 between 1 January 2020 and 31 March 2020. The primary outcome was the sensitivity of chest CT imaging. We also conducted subgroup analyses and evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsA total of 104 studies with 5694 patients were included. Using RT-PCR results as reference, a meta-analysis based on 64 studies estimated the sensitivity of chest CT imaging in COVID-19 was 99% (95% CI, 0.97-1.00). If case reports were excluded, the sensitivity in case series was 96% (95% CI, 0.93-0.99). The sensitivity of CT scan in confirmed patients under 18 years old was only 66% (95% CI, 0.11-1.00). The most common imaging manifestation was ground-glass opacities (GGO) which was found in 75% (95% CI, 0.68-0.82) of the patients. The pooled probability of bilateral involvement was 84% (95% CI, 0.81-0.88). The most commonly involved lobes were the right lower lobe (84%, 95% CI, 0.78-0.90) and left lower lobe (81%, 95% CI, 0.74-0.87). The quality of evidence was low across all outcomes.ConclusionsIn conclusion, this meta-analysis indicated that chest CT scan had a high sensitivity in diagnosis of patients with COVID-19. Therefore, CT can potentially be used to assist in the diagnosis of COVID-19.

Background In December 2019, a pneumonia caused by a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China and has rapidly spread around the world since then. Aim This study aims to understand the research gaps related to COVID-19 and propose recommendations for future research. Methods We undertook a scoping review of COVID-19, comprehensively searching databases and other sources to identify literature on COVID-19 between 1 December 2019 and 6 February 2020. We analysed the sources, publication date, type and topic of the retrieved articles/studies. Results We included 249 articles in this scoping review. More than half (59.0%) were conducted in China. Guidance/guidelines and consensuses statements (n = 56; 22.5%) were the most common. Most (n = 192; 77.1%) articles were published in peer-reviewed journals, 35 (14.1%) on preprint servers and 22 (8.8%) posted online. Ten genetic studies (4.0%) focused on the origin of SARS-CoV-2 while the topics of molecular studies varied. Nine of 22 epidemiological studies focused on estimating the basic reproduction number of COVID-19 infection (R0). Of all identified guidance/guidelines (n = 35), only ten fulfilled the strict principles of evidence-based practice. The number of articles published per day increased rapidly until the end of January. Conclusion The number of articles on COVID-19 steadily increased before 6 February 2020. However, they lack diversity and are almost non-existent in some study fields, such as clinical research. The findings suggest that evidence for the development of clinical practice guidelines and public health policies will be improved when more results from clinical research becomes available.

Background: The objectives were to explore the real world treatment of T3 breast cancer (maximum diameter of tumor bigger than 5 centimeters). Materials and Methods: We selected T3 breast cases diagnosed from 2011 to 2017 in the CSCO BC database. These cases were categorized into two groups: non-NAC group and NAC group. Adjusted hazard ratios for known predictors of event free survival (EFS) using Kaplan-Meier and Cox proportional hazards regression. Results: The study included 868 patients: 49.0%(425/868) of patients chose NAC after diagnosis, 51.0%(443/868) chose surgery as their initial therapeutic strategy(non-NAC group). Compared with non-NAC group, patients in NAC group were correlated with clinical positive lymph nodes, hormonal receptor(HR) negative and human epidermal receptor growth factor 2(HER2) positive. For non-NAC group, only 87.1%(386/443) of patients were pathologic T3 after surgery, the overestimation of clinical examination of tumor lesion was 12.9%(57/443). In addition, there was no significance of EFS between the NAC group and non-NAC group(HR=0.82, 95%CI: 0.64-1.05). However, for T3 breast cancer patients with positive lymph nodes, HR negative and HER2 positive tumors, the NAC group had a better survival than the non-NAC group. Cox proportional analysis showed that lymph node negative, HER2 negative status and neoadjuvant chemotherapy were associated with a longer survival time. Conclusion: As the initial option for T3 breast cancer patients with positive lymph nodes, HR negative and HER2 positive tumors, neoadjuvant chemotherapy is the first therapy.

Opalski syndrome is a rare variation of lateral medullary syndrome (LMS) accompanied by ipsilateral hemiparesis. Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) is a rare headache syndrome which belongs to the trigeminal autonomic cephalalgias. SUNCT syndrome has been previously described in association with LMS. We here describe a case of SUNCT syndrome with Opalski syndrome caused by dorsolateral medullary infarction.

Brain metastasis (BM) is a typical type of metastasis in renal cell carcinoma (RCC) patients. The early detection of BM is likely a crucial step for RCC patients to receive appropriate treatment and prolong their overall survival. The aim of this study was to identify the independent predictors of BM and construct a nomogram to predict the risk of BM. Demographic and clinicopathological data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database for RCC patients between 2010 and 2015. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors, and then, a visual nomogram was constructed. Multiple parameters were used to evaluate the discrimination and clinical value. We finally included 42577 RCC patients. Multivariate logistic regression analysis showed that histological type, tumor size, bone metastatic status, and lung metastatic status were independent BM-associated risk factors for RCC. We developed a nomogram to predict the risk of BM in patients with RCC, which showed favorable calibration with a C -index of 0.924 (0.903-0.945) in the training cohort and 0.911 (0.871-0.952) in the validation cohort. The calibration curves and decision curve analysis (DCA) also demonstrated the reliability and accuracy of the clinical prediction model. The nomogram was shown to be a practical, precise, and personalized clinical tool for identifying the RCC patients with a high risk of BM, which not only will contribute to the more reasonable allocation of medical resources but will also enable a further improvements in the prognosis and quality of life of RCC patients.

Aims. To investigate the effect of preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgery in diabetic and nondiabetic patients. Methods and Results. The MEDLINE (via PubMed), Cochrane Library, Web of Science, Embase, Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) databases were used to search the effects of different preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgical treatment in diabetic and nondiabetic patients from inception to December 2018. Two review authors worked in an independent and duplicate manner to select eligible studies, extract data, and assess the risk of bias of the included studies. We used a meta-analysis to synthesize data and analyze subgroups, sensitivity, and publication bias as well as the GRADE methodology if appropriate. The literature search retrieved 886 records initially, and 23 cohort studies were included in the meta-analysis. In this meta-analysis, we found that there was a reduced incidence of surgical site infections (OR=2.94, 95% CI 2.18-3.98), renal failure events (OR=1.63, 95% CI 1.13-2.33), and myocardial infarction events (OR=1.69, 95% CI 1.16-2.47), as well as a shortened hospital stay (MD=1.08, 95% CI 0.46-1.71), in diabetic patients after coronary artery disease surgical treatment with lower preoperative HbA1c levels. For nondiabetic patients, a higher preoperative HbA1c level resulted in an increase in the incidence of mortality (OR=2.23, 95% CI 1.01-4.90) and renal failure (OR=2.33, 95% CI 1.32-4.12). No significant difference was found between higher and lower preoperative HbA1c levels in the incidence of mortality (OR=1.06, 95% CI 0.88-1.26), stroke (OR=1.49, 95% CI 0.94-2.37), or atrial fibrillation (OR=0.94, 95% CI 0.67-1.33); the length of ICU stay (MD=0.20, 95% CI -0.14-0.55); or sepsis incidence (OR=2.49, 95% CI 0.99-6.25) for diabetic patients or for myocardial infarction events (OR=1.32, 95% CI 0.27-6.31) or atrial fibrillation events (OR=0.99, 95% CI 0.74-1.33) for nondiabetic patients. The certainty of evidence was judged to be moderate or low. Conclusion. This meta-analysis showed that higher preoperative HbA1c levels may potentially increase the risk of surgical site infections, renal failure, and myocardial infarction and reduce the length of hospital stay in diabetic subjects after coronary artery disease surgical treatment and increase the risk of mortality and renal failure in nondiabetic patients. However, there was great inconsistency in defining higher preoperative HbA1c levels in the studies included; we still need high-quality RCTs with a sufficiently large sample size to further investigate this issue in the future. This trial is registered with CRD42019121531.