Machine Learning-Based Scoring System for Early Prognosis Evaluation of Patients with Coronavirus Disease 2019

Background The global spread of coronavirus disease 2019 (COVID-19) continues to threaten human health security, exerting considerable pressure on healthcare systems worldwide. While prognostic models for COVID-19 hospitalized or intensive care patients are currently available, prognostic models developed for large cohorts of thousands of individuals are still lacking. Methods Between February 4 and April 16, 2020, we enrolled 3,974 patients admitted with COVID-19 disease in the Wuhan Huo-Shen-Shan Hospital and the Maternal and Child Hospital, Hubei Province, China. (1) Screening of key prognostic factors: A univariate Cox regression analysis was performed on 2,649 patients in the training set, and factors affecting prognosis were initially screened. Subsequently, a random survival forest model was established through machine analysis to further screen for factors that are important for prognosis. Finally, multivariate Cox regression analysis was used to determine the synergy among various factors related to prognosis. (2) Establishment of a scoring system: The nomogram algorithm established a COVID-19 patient death risk assessment scoring system for the nine selected key prognostic factors, calculated the C index, drew calibration curves and drew training set patient survival curves. (3) Verification of the scoring system: The scoring system assessed 1,325 patients in the test set, splitting them into high- and low-risk groups, calculated the C-index, and drew calibration and survival curves. Results The cross-sectional study found that age, clinical classification, sex, pulmonary insufficiency, hypoproteinemia, and four other factors (underlying diseases: blood diseases, malignant tumor;complications: digestive tract bleeding, heart dysfunction) have important significance for the prognosis of the enrolled patients with COVID-19. Herein, we report the discovery of the effects of hypoproteinemia and hematological diseases on the prognosis of COVID-19. Meanwhile, the scoring system established here can effectively evaluate objective scores for the early prognoses of patients with COVID-19 and can divide them into high- and low-risk groups (using a scoring threshold of 117.77, a score below which is considered low risk). The efficacy of the system was better than that of clinical classification using the current COVID-19 guidelines (C indexes, 0.95 vs. 0.89). Conclusions Age, clinical typing, sex, pulmonary insufficiency, hypoproteinemia, and four other factors were important for COVID-19 survival. Compared with general statistical methods, this method can quickly and accurately screen out the relevant factors affecting prognosis, provide an order of importance, and establish a scoring system based on the nomogram model, which is of great clinical significance. © Wolters Kluwer Health, Inc. All rights reserved.

Textual Research on Key Information of Ancient Classical Prescription Dayuanyin.

Dayuanyin,a representative prescription for the treatment of dampness pathogen lodging in pleurodiaphragmatic interspace syndrome,was first recorded in Treatise on Pestilence(<<>>)by Wu Youke in the Ming Dynasty for dealing with pestilence,and it still plays an important role in the treatment of coronavirus disease 2019(COVID-19)differentiated into dampness stagnating in lung syndrome. The related original ancient records were retrieved from the Chinese Classics of Traditional Chinese Medicine(Version 5.0),Full-text Database of Ancient Chinese Medicine Books,and Ancient Books of Traditional Chinese Medicine Database (http://www. gydc. ac. cn:81/),with 'Dayuanyin' and 'Dayuansan' as the search terms,followed by statistical analysis and textual research. The composition,dosage,processing of original medicinal materials,efficacy, indications, processing and administration methods, modern basic research, and clinical applications of Dayuanyin were summarized,so as to provide literature reference for its modern development and clinical application. The findings demonstrated that the composition in most medical records was identical with that of the original prescription,except that some records concerning Angelicae Dahuricae Radix and Tsaoko Fructus differed. In terms of dosage,it did not change much,with the only difference observed in Tsaoko Fructus. The processing methods of medicinal materials in Dayuanyin were not specified in historical records,so the raw medicinal materials were recommended. The processing and administration methods in the original record were basically followed in the later generations,except that some medical records chose Zingiberis Rhizoma Recens as the guide and changed the decocting amount and administration time. In terms of efficacy and indications, Dayuanyin was originally developed for dispelling pathogenic Qi away from the pleurodiaphragmatic interspace, but later employed for the treatment of such diseases as 'pestilence','epidemic malaria',and 'seasonal epidemic'. It was mainly indicated to 'epidemic diseases' with latent pathogen in pleurodiaphragmatic interspace as the pathogenesis and fever as the manifestation. In modern clinical application,ancients physicians considered 'fever' and 'powder-like tongue coating' as the important signs for this prescription. Modern physicians have utilized Dayuanyin for treating fever,diseases in the digestive,respiratory,urinary,and endocrine systems,skin diseases,pediatric diseases,as well as epidemic diseases like influenza,severe acute respiratory syndrome (SARS),and avian flu due to its good effects.Copyright © 2021, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

Effects of the Pandemic on Observing the Global Ocean

The years since 2000 have been a golden age in in situ ocean observing with the proliferation and organization of autonomous platforms such as surface drogued buoys and subsurface Argo profiling floats augmenting ship-based observations. Global time series of mean sea surface temperature and ocean heat content are routinely calculated based on data from these platforms, enhancing our understanding of the ocean's role in Earth's climate system. Individual measurements of meteorological, sea surface, and subsurface variables directly improve our understanding of the Earth system, weather forecasting, and climate projections. They also provide the data necessary for validating and calibrating satellite observations. Maintaining this ocean observing system has been a technological, logistical, and funding challenge. The global COVID-19 pandemic, which took hold in 2020, added strain to the maintenance of the observing system. A survey of the contributing components of the observing system illustrates the impacts of the pandemic from January 2020 through December 2021. The pandemic did not reduce the short-term geographic coverage (days to months) capabilities mainly due to the continuation of autonomous platform observations. In contrast, the pandemic caused critical loss to longer-term (years to decades) observations, greatly impairing the monitoring of such crucial variables as ocean carbon and the state of the deep ocean. So, while the observing system has held under the stress of the pandemic, work must be done to restore the interrupted replenishment of the autonomous components and plan for more resilient methods to support components of the system that rely on cruise-based measurements. © 2023 American Meteorological Society.

Textual Research on Key Information of Ancient Classical Prescription Dayuanyin.

Dayuanyin,a representative prescription for the treatment of dampness pathogen lodging in pleurodiaphragmatic interspace syndrome,was first recorded in Treatise on Pestilence(<<>>)by Wu Youke in the Ming Dynasty for dealing with pestilence,and it still plays an important role in the treatment of coronavirus disease 2019(COVID-19)differentiated into dampness stagnating in lung syndrome. The related original ancient records were retrieved from the Chinese Classics of Traditional Chinese Medicine(Version 5.0),Full-text Database of Ancient Chinese Medicine Books,and Ancient Books of Traditional Chinese Medicine Database (http://www. gydc. ac. cn:81/),with 'Dayuanyin' and 'Dayuansan' as the search terms,followed by statistical analysis and textual research. The composition,dosage,processing of original medicinal materials,efficacy, indications, processing and administration methods, modern basic research, and clinical applications of Dayuanyin were summarized,so as to provide literature reference for its modern development and clinical application. The findings demonstrated that the composition in most medical records was identical with that of the original prescription,except that some records concerning Angelicae Dahuricae Radix and Tsaoko Fructus differed. In terms of dosage,it did not change much,with the only difference observed in Tsaoko Fructus. The processing methods of medicinal materials in Dayuanyin were not specified in historical records,so the raw medicinal materials were recommended. The processing and administration methods in the original record were basically followed in the later generations,except that some medical records chose Zingiberis Rhizoma Recens as the guide and changed the decocting amount and administration time. In terms of efficacy and indications, Dayuanyin was originally developed for dispelling pathogenic Qi away from the pleurodiaphragmatic interspace, but later employed for the treatment of such diseases as 'pestilence','epidemic malaria',and 'seasonal epidemic'. It was mainly indicated to 'epidemic diseases' with latent pathogen in pleurodiaphragmatic interspace as the pathogenesis and fever as the manifestation. In modern clinical application,ancients physicians considered 'fever' and 'powder-like tongue coating' as the important signs for this prescription. Modern physicians have utilized Dayuanyin for treating fever,diseases in the digestive,respiratory,urinary,and endocrine systems,skin diseases,pediatric diseases,as well as epidemic diseases like influenza,severe acute respiratory syndrome (SARS),and avian flu due to its good effects.Copyright © 2021, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

DuDoTrans: Dual-Domain Transformer for Sparse-View CT Reconstruction

While Computed Tomography (CT) is necessary for clinical diagnosis, ionizing radiation in the imaging process induces irreversible injury, thereby driving researchers to study sparse-view CT reconstruction. Iterative models are proposed to alleviate the appeared artifacts in sparse-view CT images, but their computational cost is expensive. Deep-learning-based methods have gained prevalence due to the excellent reconstruction performances and computation efficiency. However, these methods ignore the mismatch between the CNN's local feature extraction capability and the sinogram's global characteristics. To overcome the problem, we propose Dual-Domain Transformer (DuDoTrans) to simultaneously restore informative sinograms via the long-range dependency modeling capability of Transformer and reconstruct CT image with both the enhanced and raw sinograms. With such a novel design, DuDoTrans even with fewer involved parameters is more effective and generalizes better than competing methods, which is confirmed by reconstruction performances on the NIH-AAPM and COVID-19 datasets. Finally, experiments also demonstrate its robustness to noise.

Investigation and Analysis of Online Teaching in Higher Vocational Colleges during the COVID-19 Epidemic

Affected by the COVID-19 epidemic in 2020, responding to the call of "Ensuring learning undisrupted when classes are disrupted" by the Ministry of Education, schools at all levels and types in China had launched online teaching. This paper takes 210 teachers and 3952 students in a local higher vocational college in Anhui Province as the research objects, and investigates from two perspectives of online teaching and learning. The results show that there were some problems in online teaching, such as network jam, interference in home learning and lack of learning monitoring, however, timely online training, abundant online resources, convenient live broadcast tools and stable teaching platform had ensured the orderly development of the online teaching. Teachers and students were highly satisfied with online teaching. In the post-epidemic era, online teaching will be integrated with offline teaching, which become "normalized". Therefore, this research proposes that it is necessary to make more in-depth exploration and efforts in strengthening network technology support and guarantee, improving teachers' and students' information literacy, enhancing teachers' informatization resources construction ability and teaching design ability, and so on.

The impact of COVID-19 on subthreshold depressive symptoms: a longitudinal study.

AIMS: The coronavirus disease 2019 (COVID-19) pandemic represents an unprecedented threat to mental health. Herein, we assessed the impact of COVID-19 on subthreshold depressive symptoms and identified potential mitigating factors. METHODS: Participants were from Depression Cohort in China (ChiCTR registry number 1900022145). Adults (n = 1722) with subthreshold depressive symptoms were enrolled between March and October 2019 in a 6-month, community-based interventional study that aimed to prevent clinical depression using psychoeducation. A total of 1506 participants completed the study in Shenzhen, China: 726 participants, who completed the study between March 2019 and January 2020 (i.e. before COVID-19), comprised the 'wave 1' group; 780 participants, who were enrolled before COVID-19 and completed the 6-month endpoint assessment during COVID-19, comprised 'wave 2'. Symptoms of depression, anxiety and insomnia were assessed at baseline and endpoint (i.e. 6-month follow-up) using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI), respectively. Measures of resilience and regular exercise were assessed at baseline. We compared the mental health outcomes between wave 1 and wave 2 groups. We additionally investigated how mental health outcomes changed across disparate stages of the COVID-19 pandemic in China, i.e. peak (7-13 February), post-peak (14-27 February), remission plateau (28 February-present). RESULTS: COVID-19 increased the risk for three mental outcomes: (1) depression (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.04-1.62); (2) anxiety (OR = 1.47, 95% CI: 1.16-1.88) and (3) insomnia (OR = 1.37, 95% CI: 1.07-1.77). The highest proportion of probable depression and anxiety was observed post-peak, with 52.9% and 41.4%, respectively. Greater baseline resilience scores had a protective effect on the three main outcomes (depression: OR = 0.26, 95% CI: 0.19-0.37; anxiety: OR = 1.22, 95% CI: 0.14-0.33 and insomnia: OR = 0.18, 95% CI: 0.11-0.28). Furthermore, regular physical activity mitigated the risk for depression (OR = 0.79, 95% CI: 0.79-0.99). CONCLUSIONS: The COVID-19 pandemic exerted a highly significant and negative impact on symptoms of depression, anxiety and insomnia. Mental health outcomes fluctuated as a function of the duration of the pandemic and were alleviated to some extent with the observed decline in community-based transmission. Augmenting resiliency and regular exercise provide an opportunity to mitigate the risk for mental health symptoms during this severe public health crisis.

[Recommendations for the treatment of severe coronavirus disease 2019 based on critical care ultrasound].

Severe patients with coronaviras disease 2019 (COVID-19) are characterized by persistent lung damage, causing respiratory failure, secondary circulatory changes and multiple organ dysfunction after virus invasion. Because of its dynamic, real-time, non-invasive, repeatable and other advantages, critical ultrasonography can be widely used in the diagnosis, assessment and guidance of treatment for severe patients. Based on the recommendations of critical care experts from all over the country who fight against the epidemic in Wuhan, this article summarizes the guidelines for the treatment of COVID-19 based on critical ultrasonography, hoping to provide help for the treatment of severe patients. The recommendations mainly cover the following aspects: (1) lung ultrasound in patients with COVID-19 is mainly manifested by thickened and irregular pleural lines, different types of B-lines, shred signs, and other consolidation like dynamic air bronchogram; (2) Echocardiography may show right heart dysfunction, diffuse cardiac function enhancement, stress cardiomyopathy, diffuse cardiac depression and other multiple abnormalities; (3) Critical ultrasonography helps with initiating early treatment in the suspect patient, screening confirmed patients after intensive care unit admission, early assessment of sudden critical events, rapid grading assessment and treatment based on it; (4) Critical ultrasonography helps to quickly screen for the etiology of respiratory failure in patients with COVID-19, make oxygen therapeutic strategy, guide the implementation of lung protective ventilation, graded management and precise off-ventilator; (5) Critical ultrasonography is helpful for assessing the circulatory status of patients with COVID-19, finding chronic cardiopulmonary diseases and guiding extracorporeal membrane oxygenation management; (6) Critical ultrasonography contributes to the management of organs besides based on cardiopulmonary oxygen transport; (7) Critical ultrasonography can help to improve the success of operation; (8) Critical ultrasonography can help to improve the safety and quality of nursing; (9) When performing critical ultrasonography for patients with COVID-19, it needs to implement three-level protection standard, pay attention to disinfect the machine and strictly obey the rules from nosocomial infection. (10) Telemedicine and artificial intelligence centered on critical ultrasonography may help to improve the efficiency of treatment for the patients with COVID-19. In the face of the global spread of the epidemic, all we can do is to share experience, build a defense line, We hope this recommendations can help COVID-19 patients therapy.

[Exploration of omics mechanism and drug prediction of coronavirus-induced heart failure based on clinical bioinformatics].

Objective: Present study investigated the mechanism of heart failure associated with coronavirus infection and predicted potential effective therapeutic drugs against heart failure associated with coronavirus infection. Methods: Coronavirus and heart failure were searched in the Gene Expression Omnibus (GEO) and omics data were selected to meet experimental requirements. Differentially expressed genes were analyzed using the Limma package in R language to screen for differentially expressed genes. The two sets of differential genes were introduced into the R language cluster Profiler package for gene ontology (GO) and Kyoto gene and genome encyclopedia (KEGG) pathway enrichment analysis. Two sets of intersections were taken. A protein interaction network was constructed for all differentially expressed genes using STRING database and core genes were screened. Finally, the apparently accurate treatment prediction platform (EpiMed) independently developed by the team was used to predict the therapeutic drug. Results: The GSE59185 coronavirus data set was searched and screened in the GEO database, and divided into wt group, ΔE group, Δ3 group, Δ5 group according to different subtypes, and compared with control group. After the difference analysis, 191 up-regulated genes and 18 down-regulated genes were defined. The GEO126062 heart failure data set was retrieved and screened from the GEO database. A total of 495 differentially expressed genes were screened, of which 165 were up-regulated and 330 were down-regulated. Correlation analysis of differentially expressed genes between coronavirus and heart failure was performed. After cross processing, there were 20 GO entries, which were mainly enriched in virus response, virus defense response, type Ⅰ interferon response, γ interferon regulation, innate immune response regulation, negative regulation of virus life cycle, replication regulation of viral genome, etc. There were 5 KEGG pathways, mainly interacting with tumor necrosis factor (TNF) signaling pathway, interleukin (IL)-17 signaling pathway, cytokine and receptor interaction, Toll-like receptor signaling pathway, human giant cells viral infection related. All differentially expressed genes were introduced into the STRING online analysis website for protein interaction network analysis, and core genes such as signal transducer and activator of transcription 3, IL-10, IL17, TNF, interferon regulatory factor 9, 2'-5'-oligoadenylate synthetase 1, mitogen-activated protein kinase 3, radical s-adenosyl methionine domain containing 2, c-x-c motif chemokine ligand 10, caspase 3 and other genes were screened. The drugs predicted by EpiMed's apparent precision treatment prediction platform for disease-drug association analysis were mainly TNF-α inhibitors, resveratrol, ritonavir, paeony, retinoic acid, forsythia, and houttuynia cordata. Conclusions: The abnormal activation of multiple inflammatory pathways may be the cause of heart failure in patients after coronavirus infection. Resveratrol, ritonavir, retinoic acid, amaranth, forsythia, houttuynia may have therapeutic effects. Future basic and clinical research is warranted to validate present results and hypothesis.