Decline in Colorectal Cancer Screening Rates in Federally Qualified Health Centers in Los Angeles County From 2019 to 2020

Introduction: Federally Qualified Health Centers (FQHCs) are funded by the Health Resources and Services Administration (HRSA) to provide primary care services to low-income and underinsured individuals. Los Angeles County (LAC) is a large, diverse county with greater than 10.2 million residents and 8 distinct Service Planning Areas (SPAs) that represent specific geographic regions with variable resources. We aimed to describe colorectal cancer (CRC) screening rates (CRCSR) and the screening rate change (SRCs) in LAC overall and for each SPA between 2019 and 2020 to determine where resources are most needed for CRCSR recovery following the COVID-19 pandemic. Method(s): Our data source was the Uniform Data System (UDS), which includes quality data for the FQHCs funded by HRSA. We determined 2019 and 2020 CRCSR for LAC FQHCs overall and for each FQHC, including average-risk patients age 50-74. We then separated FQHCs into quartiles based on SRC and performed mixed-effects logistic regression to determine FQHC-level characteristics associated with the largest decline in CRCSR from 2019 to 2020 (i.e., predictors of category SRC Q1). Lastly, we determined SRC for each SPA in LAC. Result(s): In 2019, there were 58 FQHCs in LAC with 326,473 patients eligible for CRC screening. In 2020, there were 59 FQHCs with 350,405 eligible patients. The median 2020 CRCSR in LAC FQHCs was 37.3%, down from 48.0% in 2019 (2020 median SRC= -9.6%) (Table). In the regression model among all LAC FQHCs, those with higher proportions of patients preferring a non-English language had significantly higher odds of having the largest decline in CRCSR from 2019 to 2020 (SRC Q1) (aOR=3.25, 95% CI=1.22-8.65;data not shown). CRCSR decreased from 2019 to 2020 in all SPAs with SRC ranging from -17.0% (South Bay) to -1.4% (West LA) (Figure). Conclusion(s): In Los Angeles County FQHCs, CRC screening rates were higher than the national FQHC average in 2019 however declined considerably between 2019 and 2020. The decline in CRC screening rates was highest in FQHCs serving a higher proportion of patients with a preference for a non-English language and varied by county region. Our findings highlight the need for targeted measures, including language-appropriate resources, to improve CRC screening uptake in FQHCs that provide care to some of the most historically marginalized individuals.

Few-Shot (Dis)Agreement Identification in Online Discussions with Regularized and Augmented Meta-Learning

Online discussions are abundant with opinions towards a common topic, and identifying (dis)agreement between a pair of comments enables many opinion mining applications. Realizing the increasing needs to analyze opinions for emergent new topics that however tend to lack annotations, we present the first meta-learning approach for few-shot (dis)agreement identification that can be quickly applied to analyze opinions for new topics with few labeled instances. Furthermore, we enhance the meta-learner's domain generalization ability from two perspectives. The first is domain-invariant regularization, where we design a lexicon-based regularization loss to enable the meta-learner to learn domain-invariant cues. The second is domain-aware augmentation, where we propose domain-aware task augmentation for meta-training to learn domain-specific expressions. In addition to using an existing dataset, we also evaluate our approach on two very recent new topics, mask mandate and COVID vaccine, using our newly annotated datasets containing 1.5k and 1.4k SubReddits comment pairs respectively. Extensive experiments on three domains/topics demonstrate the effectiveness of our meta-learning approach. © 2022 Association for Computational Linguistics.

Spectral selective composite mask media for personal cooling and efficient PM 2.5 removal

Face masks are commonly used to protect an individual's respiratory system from inhaling fine particulate matter (PM2.5) in polluted air, as well as the airborne pathogens, especially during the ongoing coronavirus disease 2019 (COVID-19) pandemic. However, all conventional masks with anti-PM2.5 function suffer from insufficient facial thermal comfort, particularly in a hot and humid environment. Herein, we demonstrated a novel infrared-transmittance visible-opaque PM2.5 media for radiative cooling utilizing rutile titanium dioxide particle-embedded polyamide 6 (PA6-TiO2). The transmission of visible light and infrared and PM2.5 removal performance of composite media containing a variety of microstructures, such as TiO2 particles of varying sizes, shapes, and contents, were numerically examined to determine the optimal ranges. Then the PA6-TiO2 media was effectively electrospun by controlling the arrangement of fibers and the morphology of TiO2 particles. By transmitting more than 85% of the thermal radiation from the human body and selectively blocking solar irradiance, the developed PA6-TiO2(flower-shaped) media cooled the simulative skin by 10.3°C as compared with commercial masks under strong solar irradiance. Additionally, they demonstrated a high PM2.5 removal efficiency of 95.3%, a low air resistance of 22.5 Pa (at 5.3 cm/s), and a sound water vapor transmission rate of 0.0169 g cm−2 h−1. This study presents an effective strategy for making thermally comfortable anti-PM2.5 masks, which will significantly benefit the public health prevention and control. © The Author(s) 2022.

Oxygen Therapies and Clinical Outcomes for Patients Hospitalized With COVID-19: First Surge vs Second Surge

Objective: To compare the utilization of oxygen therapies and clinical outcomes of patients admitted for COVID-19 during the second surge of the pandemic to that of patients admitted during the first surge. Design(s): Observational study using a registry database. Setting(s): Three hospitals (791 inpatient beds and 76 intensive care unit [ICU] beds) within the Beth Israel Lahey Health system in Massachusetts. Participant(s): We included 3183 patients with COVID-19 admitted to hospitals. Measurements: Baseline data included demographics and comorbidities. Treatments included low-flow supplemental oxygen (2-6 L/min), high-flow oxygen via nasal cannula, and invasive mechanical ventilation. Outcomes included ICU admission, length of stay, ventilator days, and mortality. Result(s): A total of 3183 patients were included: 1586 during the first surge and 1597 during the second surge. Compared to the first surge, patients admitted during the second surge had a similar rate of receiving low-flow supplemental oxygen (65.8% vs 64.1%, P= .3), a higher rate of receiving high-flow nasal cannula (15.4% vs 10.8%, P= .0001), and a lower ventilation rate (5.6% vs 9.7%, P< .0001). The outcomes during the second surge were better than those during the first surge: lower ICU admission rate (8.1% vs 12.7%, P< .0001), shorter length of hospital stay (5 vs 6 days, P< .0001), fewer ventilator days (10 vs 16, P= .01), and lower mortality (8.3% vs 19.2%, P< .0001). Among ventilated patients, those who received high-flow nasal cannula had lower mortality. Conclusion(s): Compared to the first surge of the COVID-19 pandemic, patients admitted during the second surge had similar likelihood of receiving low-flow supplemental oxygen, were more likely to receive high-flow nasal cannula, were less likely to be ventilated, and had better outcomes. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

Understanding Chinese international students' perception of flu vaccination on U.S. college campuses.

Objective: This study examines Chinese international students' underlying beliefs and overall perception of the flu vaccination to inform effective health promotion efforts on U.S. college campuses. Participants: Data were collected in March 2020. Participants (N = 189) were recruited via email at a southeastern university in the U.S. Methods: Incorporating theory recommendations and recent vaccine-related research findings, this study designs a Four-Factor Measurement Model through confirmatory factor analysis (CFA) to examine Chinese international students' perception of flu vaccination. Results: Chinese international students' health beliefs, particularly their perceived susceptibility of the influenza virus, was the most important factor to explain their perception of flu vaccination. While normative beliefs were the least influential factor to account for Chinese international students' perception of flu vaccination, these students valued healthcare providers' opinions immensely. Conclusions: This study suggests the Four-Factor Measurement Model will help measure Chinese international students' perception of flu vaccination and can be applied to future vaccine-related research.

Analysis of characteristics and meteorological causes of surface ozone pollution in Chengdu during the COVID-19 epidemic

Affected by the COVID-19 epidemic, a series of lockdown control measures adopted by various regions have reduced the emission intensity of air pollutants. Taking Chengdu as an example, this study analyzed the meteorological conditions and pollution concentration characteristics in the first half of 2020 and focused on a detailed analysis of variations in ozone (O3) concentration. The results showed that: ①Compared with 2019, except for O3, all five pollutants in Chengdu showed a decreased trend, and the concentrations of NO2, CO, SO2, PM10 and PM2.5 decreased by 13.60%, 8.96%, 6.30%, 4.56%, 1.80%, respectively. On the contrary, O3 concentration increased abnormally, with the largest increase in February (35.1%) and May (36.1%). ②During the first half of 2020, the high O3 concentration level appeared earlier than in previous years (2015-2019). Meteorological conditions were more supportive to the generation of O3 also. The geopotential heights of 100 hPa and 500 hPa showed positive anomalies, the temperature and sunshine duration was higher than in previous years, and the relative humidity as well as precipitation were lower with a quiet breeze. ③The O3 formation process lasted a long time from April 25th to May 6th, mainly due to the increased emissions of O3 precursors during this period and the relatively stable weather situation, which kept the Chengdu area exposed to unfavorable weather conditions of high temperature (average temperature>30℃), low humidity (40%~60%), and quiet breeze (1.3 m•s-1) for a long time. The backward trajectories and potential sources of air pollution showed that the air quality was affected by the short-distance transportation of high-polluted air masses from the East of Chengdu and southern Sichuan. © 2021, Science Press. All right reserved.

Changes in China's anthropogenic emissions and air quality during the COVID-19 pandemic in 2020

The COVID-19 pandemic lockdowns led to a sharp drop in socio-economic activities in China in 2020, including reductions in fossil fuel use, industry productions, and traffic volumes. The short-term impacts of lockdowns on China's air quality have been measured and reported, however, the changes in anthropogenic emissions have not yet been assessed quantitatively, which hinders our understanding of the causes of the air quality changes during COVID-19. Here, for the first time, we report the anthropogenic air pollutant emissions from mainland China by using a bottom-up approach based on the near-real-time data in 2020 and use the estimated emissions to simulate air quality changes with a chemical transport model. The COVID-19 lockdown was estimated to have reduced China's anthropogenic emissions substantially between January and March in 2020, with the largest reductions in February. Emissions of SO2, NOx, CO, non-methane volatile organic compounds (NMVOCs), and primary PM2.5 were estimated to have decreased by 27ĝ€¯%, 36ĝ€¯%, 28ĝ€¯%, 31ĝ€¯%, and 24ĝ€¯%, respectively, in February 2020 compared to the same month in 2019. The reductions in anthropogenic emissions were dominated by the industry sector for SO2 and PM2.5 and were contributed to approximately equally by the industry and transportation sectors for NOx, CO, and NMVOCs. With the spread of coronavirus controlled, China's anthropogenic emissions rebounded in April and since then returned to the comparable levels of 2019 in the second half of 2020. The provinces in China have presented nearly synchronous decline and rebound in anthropogenic emissions, while Hubei and the provinces surrounding Beijing recovered more slowly due to the extension of lockdown measures. The ambient air pollution presented much lower concentrations during the first 3 months in 2020 than in 2019 while rapidly returning to comparable levels afterward, which have been reproduced by the air quality model simulation driven by our estimated emissions. China's monthly anthropogenic emissions in 2020 can be accessed from 10.6084/m9.figshare.c.5214920.v2 (Zheng et al., 2021) by species, month, sector, and province. © Copyright:

Predictors of mortality in ICU patients with severe COVID-19 and renal failure-the Lahey experience

Rationale: Coronavirus disease 2019 (COVID-19) is currently the third leading cause of death in the United States. During the Spring of 2020, the Commonwealth of Massachusetts, USA experienced a surge of COVID-19 ICU cases. Many of these patients developed acute renal failure (ARF) requiring renal replacement therapy (RRT) with hemodialysis (HD) or continuous veno-venous hemofiltration (CVVH) which taxed our hospital's supply of equipment and staff. The goal of our study was to identify predictors of mortality in ICU patients requiring RRT in the setting of COVID-19, should rationing of ICU care became necessary. Methods: Between March 2020 and April 2020, we prospectively collected data on patients admitted to the Lahey ICUs with severe COVID-19 who required RRT and assessed patient characteristics and mortality. Results: Thirty ICU patients were identified with severe COVID-19 requiring RRT. Twenty-seven patients (90%) required acute initiation of CVVH, while three (10%) only utilized intermittent HD during their hospitalization. Only ten (33%) survived their hospitalization. No significant difference was found between survivors and patients who died with respect to age, comorbidities (BMI, CKD, HTN, DM, alcohol use, heart disease, malignancy, COPD, asthma) or baseline creatinine. All 30 patients (100%) required mechanical ventilation (MV) and 25 (83%) developed shock requiring vasopressors prior to initiation of RRT. Seventy percent of survivors (7/10) had been on either an ACE-inhibitor (ACEI) or an Angiotensin Receptor Blocker (ARB) prior to hospitalization, compared to only 20% (4/20) who died (p=0.0147) Survivors were treated with hydroxychloroquine (HC) significantly more frequently (10/10 vs 8/20;p=0.0016) and treated with systemic corticosteroids (CS) significantly less frequently (5/10 vs 20/20;p=0.0018) than those who died. There was no difference in survival between those who received Vancomycin or Tocilizumab and those who did not. The median hospital stay was significantly longer for survivors (46 days) than for those who died (19 days;p =0.0003). Conclusion: The need for RRT in ICU patients with COVID-19 was associated with significant mortality (66%) and a significant need for MV (100%) and vasopressors (83%). The use of an ACEI or ARB prior to admission was significantly associated with improved survival, the use of CS was associated with higher mortality, and the use of HC was associated with improved survival. These latter findings go against current theories of COVID pathophysiology and may be a result of the small number of patients in our study.

Coronavirus disease-2019 (Review)

From the end of 2019, an ongoing outbreak of a new type of unexplained pneumonia caused by a novel coro- navirus, Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China. Since then, it has spread to most parts of China and worldwide, thus affecting the health of individuals worldwide. Until August 2020, >25 million cases of SARS-CoV-2 infection had been confirmed worldwide, causing >800,000 deaths. This disease was named by the World Health Organization as coronavirus disease 2019 (COVID-19). Similar to SARS and Middle East Respiratory Syndrome, which are also caused by coronavirus infections, COVID-19 mainly causes severe respiratory system damage;however, it also causes damage to multiple organs, including the gastrointestinal tract, the cardiovascular system and the nervous system. The main aim of the present review article was to summarize the current knowledge of COVID-19, such as the transmission process, diagnostic methods, pathological character- istics, potential pathogenic mechanisms and treatment measures. © 2021 Spandidos Publications. All rights reserved.

Outcomes of patients with COVID-19-associated ards treated with hfnc vs. conventional oxygen therapy

INTRODUCTION: Variation in practice regarding the use of High Flow Nasal Cannula (HFNC) existed among hospitals during the COVID-19 pandemic. We hypothesized that patients who received HFNC prior to requiring mechanical ventilation (MV) would have improved mortality when compared to patients treated with conventional oxygen therapy (COT). METHODS: We conducted a prospective observational study of patients admitted to a tertiary care center between March and May 2020. We included consecutive adult patients with confirmed COVID-19 related ARDS who required MV. We excluded patients treated with NIV. Demographic data were collected and outcomes were censored at day 28. HFNC was initiated at the treating provider's discretion as well as availability of equipment and negative pressure rooms. Patients receiving HFNC therapy received oxygen at 20-60L/min with FiO2 to keep oxygen saturation >92%. COT was delivered with a non-rebreather mask or reservoir nasal cannula at 10-15L/min. Decision to proceed with MV was at clinician discretion. We used Student's t-test, Wilcoxon Rank-Sum, Fisher's Exact, and Chi-Square for statistical analysis. RESULTS: 92 patients were included. 58% were male and the mean age was 68±12 years. Thirty (33%) patients were treated with HFNC prior to MV. Patients in the COT group had more CAD and CHF when compared to patients in the HFNC group (13 vs 1, p=0.03 and 8 vs. 0, p=0.05). HFNC was provided for a median of 21 (IQR 9-36) hours vs. COT for 4 (IQR 1-11) hours prior to MV (p=<.0001) There was no difference in the initial PaO2/FiO2 ratio (152±62 HFNC vs. 153±67 COT, p-0.95). The mean SOFA score was significantly lower in the HFNC group compared to the COT group (6.6 vs. 7.7, p=0.05). The mortality rate was 30% in the HFNC group versus 52% in the COT group (p=0.05), with a trend toward lower mortality with HFNC (OR 0.38, 95% CI 0.12-1.15, p=0.09) after controlling for other predictors of mortality. CONCLUSIONS: Our results indicate a trend toward mortality benefit in COVID-19 patients with ARDS who were treated with HFNC compared with COT prior to intubation.

The effect of a tiered staffing model on outcomes for patients with ARDS during the COVID pandemic

INTRODUCTION: Our hospital experienced a surge in ICU capacity during the COVID-19 pandemic and adopted a tiered provider staffing model. We hypothesized that ICUs staffed with a tiered model would result in similar patient outcomes as ICUs staffed with a traditional intensivist model. METHODS: The study was conducted at a tertiary care center with 52 ICU beds staffed with a 24/7 intensivist coverage model. During the pandemic, ICU capacity was doubled and ICUs with COVID-19 patients were staffed by either an intensivist or by a non-intensivist under the direction of an intensivist using a tiered system. We included adult ICU patients with ARDS and suspected or confirmed COVID-19 between March and May of 2020. We collected demographics, COVID-19 and ARDS treatments, and outcomes of interest in traditionally staffed ICUs vs. ICUs staffed with a tiered model. The primary outcome was inpatient mortality. All outcomes were censored at day 28. We used Student's t-test, Wilcoxon Rank-Sum, Fisher's Exact, and Chi-Square for statistical analysis. RESULTS: A total of 138 patients were included: 66 admitted to traditionally staffed ICUs and 52 to tiered staffing ICUs. The mean age was 67±12.1 years, 63% were male, and the mean SOFA score on admission was 7.5±2.9. Baseline characteristics were similar between groups. More patients in the tiered staffing ICUs received convalescent plasma (14 vs 3%, p=0.05) and azithromycin (41 vs 23%, p=0.05). There was no difference in other COVID-19 treatments, including corticosteroids, tocilizumab, and hydroxychloroquine. ARDS treatments were similar in traditionally staffed ICUs vs tiered staffing model ICUs, including daily median tidal volumes (6.2 vs. 6.2mL/kg, p=0.95), median daily fluid balance (159 vs. 92mL, p=0.54), and use of prone ventilation (58 vs. 65%, p=0.45). There was no difference in inpatient mortality between groups (50 vs. 42%, p=0.46). Successful extubation rates were similar between groups (36 vs. 40%, p=0.71). We also found no difference in ventilator-free, ICU-free, vasopressor-free, and dialysis-free days between groups. CONCLUSIONS: Patient outcomes were similar using a traditional vs. a tiered ICU staffing model during a pandemic. Our analysis is limited by its observational nature and confounded by other healthcare team staffing models.

Analysis and Visualization of Novel Coronavirus Pneumonia Based on Python

Objective To study the rule of Chinese medicine prescription According to the prescription novel coronavirus pneumonia;to provide reference for the treatment of epidemic diseases. Methods Through crawling 227 prescriptions of Xinguan TCM collected by Huabing data website intelligent TCM big data platform, we analyzed the web page data by using word cloud analysis, data visualization and the third-party library lxml and request of Python. Results High frequency of drug use of traditional Chinese medicine are: Huoxiang, Atractylodes, Platycodon, honeysuckle, astragalus, Scutellaria, Atractylodes macrocephala, etc. The analysis of clinical symptoms showed that the most common symptoms were fatigue, fever, white fur, cough, chest tightness, diarrhea and so on. Hebei, Sichuan, Heilongjiang, Gansu and other provinces provide more. Conclusion The novel coronavirus pneumonia and almond novel coronavirus pneumonia treatment are better. The results showed that the effective prescriptions and fever, fatigue and other common clinical manifestations, as well as the provinces with higher prescriptions, have important reference significance for the follow-up development of the new crown pneumonia. © 2020 ACM.

Application of "Universal Formula" in the prevention and treatment of COVID-19 and its innovative development

In the history of fighting the plague, traditional Chinese medicine (TCM) has the tradition of using "Universal Formula" with "cauldron boiling medicine". The practice of prevention and treatment of plague with "Universal Formula" is not only one of the important characteristics of TCM, but also deeply embodies the scientific connotation of the plague prevention and control model of "disease differentiation and treatment" combined with "syndrome differentiation and treatment". In the battle against COVID-19, a batch of contemporary anti-epidemic "Universal Formula" represented by "Hanshiyi Formula (Wuhan anti-epidemic prescription)" and "Qingfei Paidu Decoction" were used for both treatment and prevention. It covered a large number of people and had significant clinical effects. It has become a sharp weapon for TCM to intervene in anti-epidemic work. The "Universal Formula" used in the prevention and treatment of COVID-19 not only retains the essence of the traditional "Universal Formula" for anti-epidemic, but also has innovations in legislative prescriptions, drug formulations, drug distribution forms, medication guidance, and drug efficacy research, which reflects the development of the anti-epidemic with "Universal Formula". This article discussed the overview and diagnosis of the plague and treatment model of "disease differentiation and treatment" combined with "syndrome differentiation and treatment", the theoretical basis of anti-epidemic theory of "Universal Formula", and the innovation and development of the application of "Universal Formula". Under the background of science and technology, the important value and strategic path of "Universal Formula" will be used to help the in-depth development of anti-epidemic work of TCM in the face of new and sudden large-scale plagues in the future. © 2020, Chinese Journal of New Drugs Co. Ltd. All right reserved.

Analysis of false negative results in throat swab nucleic acid test of severe acute resporatory syndrome coronavirus 2

Objective To investigate the false negative rate of throat swab nucleic acid test of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to analyze the causes, so as to provide references for the prevention and control of coronavirus disease 2019 (COVID-19) in China. Methods A retrospective analysis was conducted on the throat swab nucleic acid test results of 1 452 COVID-19 patients admitted to Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province from Feb. 19 to Mar. 20, 2020. The negative results before positive results at discharge were judged as false negative results, and the false negative rate was calculated. The discharged patients were followed up to screen for the patients who were positive for nucleic acid test again, and the relationship between the times of consecutive negative nucleic acid tests before discharge and the positive again results was analyzed. Results Among the 1 452 COVID-19 patients, 592 (40.77%) were males and 860 (59.23%) were females. A total of 212 cases (14.60%) had false negative results. Twenty-eight cases (1.93%) were discovered nucleic acid positive again after discharge. Among the 918 patients whose nucleic acid tests were negative for two consecutive times, 24 (2.61%) were positive again, which was significantly higher than that of the patients whose nucleic acid tests were negative for three consecutive times (0.75%, 4/534;χ2=6.21, P=0.012 7). Conclusion The throat swab nucleic acid test of SARS-CoV-2 has a certain proportion of false negative results, which is one of the reasons for COVID-19 patients are found nucleic acid positive again after discharge. Multiple and continuous tests by different testers are recommended before discharge, and negative nucleic acid test for three or more consecutive times can reduce the incidence of nucleic acid positive results again after discharge.

Interpretation of the Traditional Chinese Medicine portion of the diagnosis and treatment protocol for corona virus disease 2019 (Trial Version 7)

The TCM protocol in the Diagnosis and Treatment Protocol for corona virus disease 2019 (COVID-19) (Trial Version 7) has been updated from previous versions. The protocol was formulated under the direct leadership of the National Administration of Traditional Chinese Medicine, based on the experience of a panel of experts, supported by evidence from fever clinics and from the outcomes of emergency (EM) observation rooms and inpatients throughout China (especially in Wuhan, Hubei Province) in combination with the latest scientific research results and data. The present interpretation of the TCM protocol is based on an overall understanding of the revised content, and aims to guide and standardize its clinical application to provide a reference for clinicians.

Laboratory test results of confirmed COVID-19 cases in Tianjin and related influencing factors

Objective: To study the characteristics and influence factors of laboratory test results of confirmed COVID-19 cases in Tianjin. Methods: Sample collection was conducted based on the standard operating procedure. Tianlong automatic magnetic bead nucleic acid extraction reagent was used for RNA extraction. Real-time RT-PCR was performed using four approved COVID-19 nucleic acid detection kits. Related epidemiological data of the cases were collected. One-way analysis of variance and non-parametric test for inter-group differences analysis were conducted using SPSS25.0 software. Results: A total of 162 PCR tests were completed for novel coronavirus nucleic acid detection in 123 confirmed COVID-19 cases. Eleven PCR results were positive for a single target gene and 10 of which were positive for nucleocapsid protein (N) gene. Nineteen cases were tested with two kinds of nucleic acid detection kits and the results of different detection kits were different. Different types of samples were collected form 13 cases for nucleic acid detection and the results showed that the Ct value of sputum sample was lower than that of throat swab sample. No significant difference in Ct values of throat swab samples was observed among patients with different clinical symptoms (PCt-N=0.797, PCt-ORF1a/b=0.551). The 123 cases were divided into different groups according to the time interval between the onset date and the date of the first positive detection of viral nucleic acid. No significant difference in Ct values of throat swab samples was observed among different time interval groups (PCt-N=0.373, PCt-ORF1a/b=0.058). Conclusions: Sputum samples were better than upper respiratory tract samples for viral nucleic acid detection. The sensitivity of N gene detection was higher, but re-sampling was needed when the result was positive for the single target N gene. Appropriate detection kits should be selected according to the actual needs, and samples should be collected at multiple time points, in multiple types and form multiple sites for detection.

Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre observational study.

OBJECTIVES: Since December 2019, the novel coronavirus disease 2019 (COVID-19) that emerged in Wuhan city has spread rapidly around the world. The risk for poor outcome dramatically increases once a patient progresses to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in individuals with mild to moderate COVID-19. METHODS: We conducted a cohort study that included 1007 individuals with mild to moderate COVID-19 from three hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients were followed up for 28 days for observation of disease progression. The end point was the progression to a more severe disease stage. RESULTS: During a follow up of 28 days, 720 patients (71.50%) had recovered or were symptomatically stable, 222 patients (22.05%) had progressed to severe disease, 22 patients (2.18%) had progressed to the critically ill stage and 43 patients (4.27%) had died. Multivariate Cox proportional hazards models identified that increased age (hazard ratio (HR) 2.56, 95% CI 1.97-3.33), male sex (HR 1.79, 95% CI 1.41-2.28), presence of hypertension (HR 1.44, 95% CI 1.11-1.88), diabetes (HR 1.82, 95% CI 1.35-2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38-2.93) and coronary artery disease (HR 1.83, 95% CI 1.26-2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34-0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02-2.90), urea nitrogen (HR 1.72, 95% CI 1.21-2.43), α-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26-7.21) and D-dimer (HR 2.01, 95% CI 1.12-3.58) at baseline were also associated with risk for disease progression. CONCLUSIONS: This study identified a panel of risk factors for disease progression in individuals with mild to moderate COVID-19.

[Comparison of the clinical characteristics between RNA positive and negative patients clinically diagnosed with coronavirus disease 2019].

Objective: To raise awareness about 2019 novel coronavirus pneumonia (NCP) and reduce missed diagnosis rate and misdiagnosis rate by comparing the clinical characteristics between RNA positive and negative patients clinically diagnosed with NCP. Methods: From January 2020 to February 2020, 54 patients who were newly diagnosed with NCP in Wuhan Fourth Hospital were included in this study. RT-PCR method was used to measure the level of 2019-nCov RNA in pharyngeal swab samples of these patients. The patients were divided into RNA positive and negative group, and the differences of clinical, laboratory, and radiological characteristics were compared. Results: There were 31 RNA of 2019-nCov positive cases, and 23 negative cases. Common clinical symptoms of two groups were fever (80.64% vs. 86.96%) , chills (61.29% vs. 52.17%) , cough (80.64% vs. 95.65%) , fatigue (61.30% vs. 56.52%) , chest distress (77.42% vs.73.91%) . Some other symptoms were headache, myalgia, dyspnea, diarrhea, nausea and vomiting. The laboratory and radiological characteristics of two groups mainly were lymphopenia, increased erythrocyte sedimentation rate, increased C-reactive protein, increased lactate dehydrogenase, decreased oxygenation index, normal white blood cell count and bilateral chest CT involvement. There was no statistically significant difference in other clinical characteristics except for dyspnea between two groups. Conclusions: RNA positive and negative NCP patients shared similar clinical symptoms, while RNA positive NCP patients tended to have dyspnea. Therefore, we should improve the understanding of NCP to prevent missed diagnosis and misdiagnosis; In addition, more rapid and accurate NCP diagnostic approaches should be further developed.