Host protection against Omicron BA.2.2 sublineages by prior vaccination in spring 2022 COVID-19 outbreak in Shanghai / 医学前沿

The Omicron family of SARS-CoV-2 variants are currently driving the COVID-19 pandemic. Here we analyzed the clinical laboratory test results of 9911 Omicron BA.2.2 sublineages-infected symptomatic patients without earlier infection histories during a SARS-CoV-2 outbreak in Shanghai in spring 2022. Compared to an earlier patient cohort infected by SARS-CoV-2 prototype strains in 2020, BA.2.2 infection led to distinct fluctuations of pathophysiological markers in the peripheral blood. In particular, severe/critical cases of COVID-19 post BA.2.2 infection were associated with less pro-inflammatory macrophage activation and stronger interferon alpha response in the bronchoalveolar microenvironment. Importantly, the abnormal biomarkers were significantly subdued in individuals who had been immunized by 2 or 3 doses of SARS-CoV-2 prototype-inactivated vaccines, supporting the estimation of an overall 96.02% of protection rate against severe/critical disease in the 4854 cases in our BA.2.2 patient cohort with traceable vaccination records. Furthermore, even though age was a critical risk factor of the severity of COVID-19 post BA.2.2 infection, vaccination-elicited protection against severe/critical COVID-19 reached 90.15% in patients aged ≽ 60 years old. Together, our study delineates the pathophysiological features of Omicron BA.2.2 sublineages and demonstrates significant protection conferred by prior prototype-based inactivated vaccines.

Host protection against Omicron BA.2.2 sublineages by prior vaccination in spring 2022 COVID-19 outbreak in Shanghai / 医学前沿

The Omicron family of SARS-CoV-2 variants are currently driving the COVID-19 pandemic. Here we analyzed the clinical laboratory test results of 9911 Omicron BA.2.2 sublineages-infected symptomatic patients without earlier infection histories during a SARS-CoV-2 outbreak in Shanghai in spring 2022. Compared to an earlier patient cohort infected by SARS-CoV-2 prototype strains in 2020, BA.2.2 infection led to distinct fluctuations of pathophysiological markers in the peripheral blood. In particular, severe/critical cases of COVID-19 post BA.2.2 infection were associated with less pro-inflammatory macrophage activation and stronger interferon alpha response in the bronchoalveolar microenvironment. Importantly, the abnormal biomarkers were significantly subdued in individuals who had been immunized by 2 or 3 doses of SARS-CoV-2 prototype-inactivated vaccines, supporting the estimation of an overall 96.02% of protection rate against severe/critical disease in the 4854 cases in our BA.2.2 patient cohort with traceable vaccination records. Furthermore, even though age was a critical risk factor of the severity of COVID-19 post BA.2.2 infection, vaccination-elicited protection against severe/critical COVID-19 reached 90.15% in patients aged ≽ 60 years old. Together, our study delineates the pathophysiological features of Omicron BA.2.2 sublineages and demonstrates significant protection conferred by prior prototype-based inactivated vaccines.

Post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy on post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation.@*METHODS@#Sixty patients with post-stroke dysphagia were randomly divided into an observation group and a control group, with 30 cases in each group. The neuromuscular electrical stimulation was adopted in the control group. Besides the treatment as the control group, in the observation group, the four-step acupuncture therapy for opening orifices and benefiting throat was supplemented. Step 1: the three areas of scalp acupuncture on the affected side were stimulated. Step 2: pricking method was operated on the posterior pharyngeal wall. Step 3: bleeding technique was operated at Jinjin (EX-HN 12) and Yuye (EX-HN 13). Step 4: deep insertion of needle was operated at three-pharynx points. The needles were retained for 30 min at the three areas of scalp acupuncture and the three-pharynx points. The intervention of each group was delivered once daily, 6 times a week, at the interval of 1 day. One course of treatment was 1 week and 4 successive courses were required. The rating of Kubota water swallow test, the score of standardized swallowing assessment (SSA) and the rating of Rosenbek penetration- aspiration scale (PAS) were observed before and after treatment in patients of the two groups. The incidence of clinical complications and clinical efficacy were compared between the two groups.@*RESULTS@#Compared with those before treatment, the rating of Kubota water swallow test, the scores of SSA and the rating of PAS of patients in the two groups were decreased after treatment (P<0.01), and the values of the observation group were lower than those of the control group after treatment (P<0.05). The incidence of clinical complications in the observation group was 13.3% (4/30), lower than 36.7% (11/30) in the control group (P<0.05). The total effective rate in the observation group was 93.3% (28/30), which was better than 70.0% (21/30) in the control group (P<0.05).@*CONCLUSION@#The four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation can improve the swallowing function of patients with post-stroke dysphagia and reduce the incidence of clinical complications.

A study on diagnostic performance of 3.0 T non-contrast-enhanced Dixon water-fat separation compressed SENSE whole-heart coronary MR angiography / 中华放射学杂志

Objective:To evaluate the diagnostic performance of non-contrast-enhanced Dixon water-fat separation Compressed SENSE (CS-SENSE) whole-heart coronary magnetic resonance angiography (CMRA) at 3.0 T on patients with suspected coronary artery disease (CAD).Method:The study complied with the Declaration of Helsinki. Local ethics committee approved this study and written informed consent was obtained from each patient. In this prospective study, from March 2021 to September 2021, 53 consecutive participants with suspected CAD who were scheduled for X-ray coronary angiography (CAG) were prospectively recruited in Zhongshan Hospital. CMRA was performed with a 3.0 T scanner without contrast agent enhancement during free breathing with Dixon water-fat separation and CS-SENSE methods. The accuracy of CMRA for detecting a ≥ 50% reduction in diameter was determined using CAG as the reference method.Results:Acquisition of whole-heart CMRA images was successfully performed in 46 (86.8%) of 53 patients with an average imaging time of (7.8±1.8) min. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of CMRA according to a patient-based analysis were 95.8%(95%CI 78.9%-99.9%), 81.8%(95%CI 59.7%-94.8%), 85.2%(95%CI 66.3%-95.8%), 94.7%(95%CI 74.0%-99.9%), 89.1%(95%CI 76.4%-96.4%), respectively. The areas under the receiver-operator characteristic curve (AUC) from CMRA images according to patient-, vessel-and segment-based analyses were 0.876(95%CI 0.745-0.955), 0.880(95%CI 0.814-0.929), 0.903(95%CI 0.877-0.926), respectively.Conclusion:3.0 T non-contrast-enhanced Dixon water-fat separation CS-SENSE whole-heart CMRA is a promising technique to detect clinically significant coronary stenosis on patients with suspected CAD.

Effect analysis of day surgery cost control based on propensity value matching / 中华医院管理杂志

Objective:To analyze the composition, the changes of expense structure and the influencing factors of hospitalization expenses, for reference in optimizing the cost control of day surgery.Methods:Collection of the first page data of patients with the top three diseases(varicose veins of lower limbs, chronic cholecystitis and varicocele)in the day surgery volume ranking in three tertiary general hospitals in a city in 2020. The confounding factors were eliminated through propensity matching. The structural change of hospitalization expenses was analyzed by structural change degree, and the influencing factors of hospitalization expenses were analyzed by grey correlation degree and multiple linear regression.Results:After 1∶1 propensity matching of the first page data of 752 patients with day surgery and non day surgery, 98 patients with lower extremity varicose veins, 356 patients with chronic cholecystitis and 38 patients with varicocele were finally included. Compared with non day hand, the total hospitalization cost of day surgical instruments decreased, and the cost structure changes of chronic cholecystitis, varicocele and varicose veins of lower limbs were 14.59%, 6.20% and 16.20% respectively. Among them, the general medical service fee, nursing fee and examination and laboratory fee showed a downward trend, and the fees of materials and drugs showed an upward trend. General medical service fee, nursing fee, examination and laboratory fee, clinical diagnosis fee, treatment fee, drug fee, material fee and other expenses presented a high correlation with the cost of day surgery(grey correlation>0.90). The payment method, wound healing type and discharge diagnosis can influence the cost of day surgery( P<0.05). Conclusions:Compared with non daytime surgery, the total hospitalization cost of day surgery has a certain cost control effect, but it can not reduce the cost of all projects. The main influencing factors are the internal composition of the cost, payment method and so on. The hospitals should focus on tapping the internal cost control potential of day surgery and further expanding the coverage of day surgery diseases.

Risk factors for hospitalization of pregnant women with influenza A / 中华传染病杂志

Objective:To investigate the influencing factors of hospitalization for pregnant women with influenza A.Methods:From December 2018 to February 2019, 261 pregnant women with influenza A were admitted to Beijing Ditan Hospital, Capital Medical University. The clinical data of age, gestational period, underlying diseases, time from onset to treatment, white blood cell count and lymphocyte count of these patients were collected. Data of out-patients were compared with those of inpatients. Chi-square test and multivariate logistic regression were used to analyze the influencing factors of hospitalization in pregnant women with influenza A.Results:Among the 261 cases of pregnancy with influenza A, 36 cases (13.79%) were hospitalized, of which 10 (27.78%) were hospitalized due to severe influenza complications, the other 26 cases (72.22%) were hospitalized due to pregnancy related adverse events. The proportions of hospitalized patients with age ≥30 years old, gestational period ≥28 weeks, combined with underlying diseases and lymphocyte count <1×10 9/L were 75.00%(27/36), 83.33%(30/36), 16.67%(6/36) and 50.00%(18/36), respectively, which were significantly higher than those of out-patients (47.11%(106/225), 35.56%(80/225), 0.89%(2/225) and 13.22%(16/121), respectively; χ2=9.66, 29.05, 26.00 and 22.12, respectively, all P<0.05). The proportions of inpatients and out-patients with white blood cell count ≥4×10 9/L were 97.22%(35/36) and 97.52%(118/121), respectively, and there was no significant difference ( χ2=0.01, P=0.921). Multivariate logistic regression analysis showed that age ≥30 years (odds ratio ( OR)=5.181, 95% confidence interval ( CI) 1.628-16.489, P=0.005), gestational period ≥28 weeks ( OR=11.054, 95% CI 3.233-37.796, P<0.01), lymphocyte count <1×10 9/L ( OR=6.864, 95% CI 2.237-20.729, P=0.001), and time from onset to treatment <24 h ( OR=0.076, 95% CI 0.012-0.468, P=0.005) were the influencing factors for hospitalization of pregnant women with influenza A. Conclusion:Age ≥30 years old, gestational period ≥28 weeks, lymphocyte count <1×10 9/L and time from onset to treatment <24 h are the influencing factors for hospitalization of pregnant women with influenza A.

Clinical features of 9 cases of Brucella endocarditis / 中华心血管病杂志

Objective@#To explore the clinical characteristics of patients with Brucella endocarditis.@*Methods@#The clinical data of 9 patients with Brucella endocarditis admitted to Beijing Ditan Hospital from October 2008 to August 2018 were retrospectively analyzed. Through the electronic medical record system of the hospital. Through assessing the electronic medical record system of the hospital, demographic data, main symptoms, vital signs, blood culture, Rose Bengal Plate Agglutination Test, echocardiography, electrocardiogram, chest imaging and other clinical data of included patients were inquired and recorded. Patients were followed up by telephone for medication, operation and outcome.@*Results@#The 9 patients were all Han nationality, aged from 25 to 66 years, 7 out of 9 patients were male, and they came from Hebei, Shandong, Shanxi, Inner Mongolia and Beijing. Of the 9 patients, 5 were farmers, 2 were self-employed, 1 was a technician, and 1 was unemployed. Of the 9 cases, 8 had a history of close contact with cattle and sheep, and 5 had a history of eating beef and mutton. Rose-Bengal Plate Agglutination Test and blood culture were positive in all 9 patients. Aortic valve was involved in 7 out of 9 patients, mitral and tricuspid valve was involved in 1 patient, respectively, and aortic dissection occurred in 1 patient. Condition of 1 patient rapidly deteriorated after admission and finally died during hospitalization despite antibiotic therapy, the remaining patients received long-term antibiotic treatment. A total of 7 patients who underwent valve replacement were followed up. One patient died of cerebral hemorrhage 6 months after operation, and the remaining 6 patients recovered well after valve replacement. Heart failure occurred in all 9 patients, and pericardial effusion occurred in 8 patients. Electrocardiogram showed low voltage of the QRS complex in the limb in 3 cases and poor R-wave progression in V1-V3 lead in 2 cases, and sinus tachycardia in 2 cases. One patient developed non-specific ST-T abnormalities. All patients had fever, 7 patients complained of weakness, and 6 patients complained of palpitations. Among the 9 patients, 7 cases had anemia, 7 patients had pneumonia, 6 had bilateral pleural effusion, 4 had thrombocytopenia. Creatinine was above normal in 4 patients, urine protein was positive in 3 patients, Delta Bilirubin was higher in 3 cases.@*Conclusions@#Patients with Brucella endocarditis often suffer from heart failure and have severe complications. Adequate antibiotic therapy in combination with valve replacement is effective for the treatment of patients with Brucella endocarditis.

Analysis of relationship between clinical parameters related to acute bacterial dysentery and other infectious diarrhea in adults / 中国医师杂志

Objective@#To investigate the relationship between clinical parameters related to acute bacterial dysentery and other infectious diarrhea in adults.@*Methods@#From April to October 2018, 70 patients with clinical diagnosis of acute bacterial dysentery, 180 patients with clinical diagnosis of infectious diarrhea and 399 patients with diarrhea to be examined were investigated retrospectively. The collected data included gender, age, time from onset to treatment, maximum body temperature, main symptoms, epidemiological history, blood routine, C-reactive protein and stool routine. Analysis of these clinical factors related to acute bacterial dysentery and other infectious diarrhea.@*Results@#A total of 70 patients with acute bacterial dysentery, 180 patients with other infectious diarrhea and 399 patients with diarrhea of unknown origin were investigated. The positive rate of epidemiology in the three groups was statistically significant (P<0.05); the age of onset of bacterial dysentery was younger than that in patients with diarrhea of unknown origin (P<0.05). Compared with the other two groups of patients, the onset to visit time was earlier, the number of vomiting was higher, the incidence of fever and tenesmus was higher, and the levels of white blood cells, neutrophils and C-reactive protein were significantly increased (P<0.05).@*Conclusions@#Patients with acute bacterial dysentery, other infectious diarrhea, and diarrhea of unknown origin have some differences in epidemiological history, age at onset, clinical manifestations, and laboratory tests.

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients / 中华医学杂志(英文版)

BACKGROUND@#A patient's infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence.@*METHODS@#The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients' oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed.@*RESULTS@#In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0-62.0) years were analyzed. After in-hospital treatment, patients' inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0-11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients' stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0-16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0-4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients' urine specimens after throat swabs were negative. Using a multiple linear regression model (F = 2.669, P = 0.044, and adjusted R = 0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients' stools (t = -2.699, P = 0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs. 8.0 days, respectively; t = 2.550, P = 0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs. 11 days, respectively; t = 4.631, P  0.05).@*CONCLUSIONS@#In brief, as the clearance of viral RNA in patients' stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.

Analysis of relationship between clinical parameters related to acute bacterial dysentery and other infectious diarrhea in adults / 中国医师杂志

Objective To investigate the relationship between clinical parameters related to acute bacterial dysentery and other infectious diarrhea in adults.Methods From April to October 2018,70 patients with clinical diagnosis of acute bacterial dysentery,180 patients with clinical diagnosis of infectious diarrhea and 399 patients with diarrhea to be examined were investigated retrospectively.The collected data included gender,age,time from onset to treatment,maximum body temperature,main symptoms,epidemiological history,blood routine,C-reactive protein and stool routine.Analysis of these clinical factors related to acute bacterial dysentery and other infectious diarrhea.Results A total of 70 patients with acute bacterial dysentery,180 patients with other infectious diarrhea and 399 patients with diarrhea of unknown origin were investigated.The positive rate of epidemiology in the three groups was statistically significant (P ＜0.05);the age of onset of bacterial dysentery was younger than that in patients with diarrhea of unknown orion (P＜O.05).Compared with the other two groups of patients,the onset to visit time was earlier,the number of vomiting was higher,the incidence of fever and tenesmus was higher,and the levels of white blood cells,neutrophils and C-reactive protein were significantly increased (P ＜ 0.05).Conclusions Patients with acute bacterial dysentery,other infectious diarrhea,and diarrhea of unknown origin have some differences in epidemiological history,age at onset,clinical manifestations,and laboratory tests.

Clinical features of 9 cases of Brucella endocarditis / 中华心血管病杂志

Objective: To explore the clinical characteristics of patients with Brucella endocarditis. Methods: The clinical data of 9 patients with Brucella endocarditis admitted to Beijing Ditan Hospital from October 2008 to August 2018 were retrospectively analyzed. Through the electronic medical record system of the hospital. Through assessing the electronic medical record system of the hospital, demographic data, main symptoms, vital signs, blood culture, Rose Bengal Plate Agglutination Test, echocardiography, electrocardiogram, chest imaging and other clinical data of included patients were inquired and recorded. Patients were followed up by telephone for medication, operation and outcome. Results: The 9 patients were all Han nationality, aged from 25 to 66 years, 7 out of 9 patients were male, and they came from Hebei, Shandong, Shanxi, Inner Mongolia and Beijing. Of the 9 patients, 5 were farmers, 2 were self-employed, 1 was a technician, and 1 was unemployed. Of the 9 cases, 8 had a history of close contact with cattle and sheep, and 5 had a history of eating beef and mutton. Rose-Bengal Plate Agglutination Test and blood culture were positive in all 9 patients. Aortic valve was involved in 7 out of 9 patients, mitral and tricuspid valve was involved in 1 patient, respectively, and aortic dissection occurred in 1 patient. Condition of 1 patient rapidly deteriorated after admission and finally died during hospitalization despite antibiotic therapy, the remaining patients received long-term antibiotic treatment. A total of 7 patients who underwent valve replacement were followed up. One patient died of cerebral hemorrhage 6 months after operation, and the remaining 6 patients recovered well after valve replacement. Heart failure occurred in all 9 patients, and pericardial effusion occurred in 8 patients. Electrocardiogram showed low voltage of the QRS complex in the limb in 3 cases and poor R-wave progression in V(1)-V(3) lead in 2 cases, and sinus tachycardia in 2 cases. One patient developed non-specific ST-T abnormalities. All patients had fever, 7 patients complained of weakness, and 6 patients complained of palpitations. Among the 9 patients, 7 cases had anemia, 7 patients had pneumonia, 6 had bilateral pleural effusion, 4 had thrombocytopenia. Creatinine was above normal in 4 patients, urine protein was positive in 3 patients, Delta Bilirubin was higher in 3 cases. Conclusions: Patients with Brucella endocarditis often suffer from heart failure and have severe complications. Adequate antibiotic therapy in combination with valve replacement is effective for the treatment of patients with Brucella endocarditis.

Application of fever clinic online consultation for Internet-based hospitals in epidemic prevention and control / 中华医院管理杂志

Based on the transmission characteristics of COVID-19, Internet-based hospitals can effectively cut off its transmission route via online consulting service. The hospital, leveraging the UTAUT model and DST theory, and advantages of Internet-based hospitals, is deploying step by step such four modules, as " pre-hospital screening" , " patient acceptance" , " auxiliary diagnosis and treatment" , and " prevention and control linkage" . These efforts ultimately contribute to an innovative prevention and control pattern against COVID-19 for Internet-based hospitals and based on the UTAUT-DST model. This practice proves an initial success, and provides references for other Internet-based hospitals in epidemic control.

Hereditary gingival fibromatosis: a three-generation case report / 华西口腔医学杂志

Hereditary gingival fibromatosis (HGF) is a familial hereditary disease; while it is rare and usually benign, it is also characterized by the slow and progressive development of gingival tissue. This paper reports on the clinical examina-tion and history of HGF in a family of patients.

Research on the prevention and control of 2019 novel coronavirus pneumonia for Internet-based hospitals using UTAUT-DST model / 中华医院管理杂志

Thanks to the transmission characteristics of 2019 novel coronavirus pneumonia, Internet-based hospitals can effectively cut off the transmission route via online consulting service. The hospital, leveraging the UTAUT model and DST theory, and advantages of Internet-based hospitals, is deploying step by step such four modules, as "pre-hospital screening", "patient acceptance", "auxiliary diagnosis and treatment", and "prevention and control linkage". These efforts ultimately contribute to an innovative prevention and control pattern against the novel coronary pneumonia for Internet-based hospitals and based on the UTAUT-DST model. This practice proves an initial success, and offers useful references for prevention and control of the NCP and development of other Internet-based hospitals.

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients / 中华医学杂志(英文版)

Background@#A patient’s infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence.@*Methods@#The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients’ oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed.@*Results@#In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0–62.0) years were analyzed. After in-hospital treatment, patients’ inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0–11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients’ stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0–16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0–4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients’ urine specimens after throat swabs were negative. Using a multiple linear regression model (F=2.669, P=0.044, and adjusted R2=0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients’ stools (t=-2.699, P=0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs 8.0 days, respectively; t=2.550, P=0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs 11 days, respectively; t=4.631, P <0.001). There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (P >0.05).@*Conclusions@#In brief, as the clearance of viral RNA in patients’ stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.

Research on the coupling and coordination of scale, efficiency and quality of public hospitals in Anhui / 中华医院管理杂志

Objective@#To evaluate the scale, efficiency and quality of secondary and tertiary public hospitals in Anhui province, and analyze the degree of coupling and coordination among the three dimensions.@*Methods@#Thirty-two hospitals′ data were extracted from the direct reporting system of Anhui Health Commission. Hospital efficiency was evaluated by DEA model, hospital quality was evaluated by TOPSIS model, and coupling coordination degree was analyzed by coupling function.@*Results@#In the single-dimension evaluation, there were significant differences in the distribution of the three dimensions among different levels of hospitals, and the efficiency and quality of secondary hospitals were better than those of tertiary hospitals. In the coupling evaluation, the average degree of coupling coordination in Anhui was 0.637, which was in the " primary coordination" level. The overall coupling and coordination degree of the tertiary hospitals were better than that of the secondary hospitals, and the highest score was in central Anhui.@*Conclusions@#Single-dimensional evaluation method cannot objectively represent a general picture of the hospitals. On the other hand, coupling coordination degree evaluation can provide a more comprehensive and objective result. The development strategy of hospitals should be made to fit local conditions and to coordinate the development of scale, efficiency and quality.

Inhibition of the TGF-β/Smad3 signaling pathway by SB431542: A study of the intervention effect of SB431542 on silicotic fibrosis in rats / 中华劳动卫生职业病杂志

Objective@#To investigate the intervention effect of SB431542, which inhibits the TGF-β/Smad3 signaling pathway, on silicotic fibrosis in rats.@*Methods@#A total of 40 specific pathogen-free Sprague-Dawley rats were divided into normal saline control group, model group, SB431542 inhibitor group, and SB431542 inhibitor control group using a random number table, with 10 rats in each group. All rats except those in the normal saline control group were given non-exposed single intratracheal instillation of free silicon dioxide dust suspension 1 mL (50 mg/mL) ; the rats in the SB431542 inhibitor group were given intraperitoneal injection of SB431542 (5 mg/kg) on days 7 and 30 after dust exposure, those in the SB431542 inhibitor control group were given intraperitoneal injection of SB431542 cosolvent (5 mg/kg) on days 7 and 30 after dust exposure, and those in the normal saline control group were given intratracheal instillation of an equal volume of normal saline (5 mg/kg). On day 60 after dust exposure, the paraffin-embedded section of the right upper lobe of lung was collected for HE staining; the left upper lobe of lung was collected to measure the mRNA levels of fibronectin (FN) , collagen type I (COL-I) , and collagen type III (COL-III) by quantitative real-time PCR; the right inferior lobe of lung was collected to measure the protein levels of FN, COL-I, COL-III, phosphorylated Smad3 (p-Smad3) , and Smad3.@*Results@#Compared with the normal saline control group, the model group had nodules with various sizes in lung tissue, with rupture of some alveolar septa, emphysema changes, and pulmonary interstitial fibrosis, as well as significant increases in the mRNA expression of FN, COL-I, and COL-III and the protein expression of FN, COL-I, COL-III, p-Smad3, and Smad3 in lung tissue (P<0.05) . Compared with the SB431542 inhibitor control group, the SB431542 inhibitor group had a relatively complete structure of lung tissue without marked nodules and with a small amount of exudate in alveolar space and the lumen of bronchioles, as well as significant reductions in the mRNA expression of FN, COL-I, and COL-III and the protein expression of FN, COL-I, COL-III, p-Smad3, and Smad3 in lung tissue (P<0.05) . There were no significant differences in the mRNA expression of FN, COL-I, and COL-III and the protein expression of FN, COL-I, COL-III, p-Smad3, and Smad3 between the model group and the SB431542 inhibitor control group (P>0.05) .@*Conclusion@#SB431542 exerts an intervention effect on silicotic fibrosis by blocking the TGF-β/Smad3 signaling pathway and reducing the expression of the downstream fibrosis factors FN, COL-I, and COL-III.

Treatment of an adult case with Japanese encephalitis / 中华实验和临床病毒学杂志

Objective@#The features of clinical, laboratory and radiologic examinations of an adult patient with Japanese encephalitis (JE) were analyzed to understand the differences in clinical characteristics between adult and children patients, and to investigate the method of etiological tests.@*Methods@#The clinical, laboratory tests and radiographic data of an adult case with JE requiring hospitalization were analyzed retrospectively and the related literature was reviewed.@*Results@#The clinical presentation of patients with JE was nonspecific, the patient presented with fever, consciousness and cognitive impairment, convulsion and meningeal irritation. Its main test indicator is IgM antibody of Japanese encephalitis virus(JEV) in acute cerebrospinal fluid and serum specimens.Craniocerebral MRI is an important auxiliary examination for JE, the common sites involved are thalamus, basal ganglia and cerebral cortex, of which thalamus is almost 100% affected.@*Conclusions@#The clinical presentation of patients with JE was nonspecific. Clear diagnosis should be accompanied by the combination of epidemiology, laboratory tests and specific antibodies detection. Neural damages commonly occur in thalamus.

Status survey of informatization infrastructure development of 155 hospitals in Anhui province / 中华医院管理杂志

Objective To learn the informatization infrastructure of Anhui provincial hospitals. Methods Questionnaire data of 155 public hospitals in Anhui province in the year 2017 by CHIMA were analyzed and compared with the national level.Based on the questionnaire survey, hospitals were randomly selected to interview their IT support staff.Descriptive statistics was used to analyze the data.Results Only 5.30% (43/804) of the IT staff had master′s degree or above as found in their IT department.Network trunk bandwidth of 31 hospitals(20.00% , 31/155)reached 10 G; A total of 44 hospitals(28.39% , 44/155)had formulated comprehensive IT development plans. Conclusions Hospitals in Anhui province should strengthen their IT infrastructure construction and IT talent team building.On the other hand, the province should improve the informatization level of primary hospitals, and further hospital informationization by means of innovation in interconnections.

Descriptive Evaluation of the Research on Influencing Factors of Patients' Selection of Institutions / 中国医院管理

Through screening of the literature,published time,published journals,research sites,research objects,research perspectives,influencing factors and countermeasures were listed by multi angle analysis of the bibliometrics method.The results show that the research on influencing factors of patients' selection of institutions in China has reached a certain level,but there are still some deficiencies.Follow-up studies need to define the following points which include the research heat is strongly related with the policy,the research of the patient's referral influencing factors should be strengthened,the depth of research needs to be improved,and the patients is the foundation of the countermeasures.