Research on multi-modal autonomous diagnosis algorithm of COVID-19 based on whale optimized support vector machine and improved D-S evidence fusion.

Aiming at the problem that the single CT image signal feature recognition method in the self-diagnosis of diseases cannot accurately and reliably classify COVID-19, and it is easily confused with suspected cases. The collected CT signals and experimental indexes are extracted to construct different feature vectors. The support vector machine is optimized by the improved whale algorithm for the preliminary diagnosis of COVID-19, and the basic probability distribution function of each evidence is calculated by the posterior probability modeling method. Then the similarity measure is introduced to optimize the basic probability distribution function. Finally, the multi-domain feature fusion prediction model is established by using the weighted D-S evidence theory. The experimental results show that the fusion of multi-domain feature information by whale optimized support vector machine and improved D-S evidence theory can effectively improve the accuracy and the precision of COVID-19 autonomous diagnosis. The method of replacing a single feature parameter with multi-modal indicators (CT, routine laboratory indexes, serum cytokines and chemokines) provides a more reliable signal source for the diagnosis model, which can effectively distinguish COVID-19 from the suspected cases.

Research on multi-modal autonomous diagnosis algorithm of COVID-19 based on whale optimized support vector machine and improved D-S evidence fusion

Aiming at the problem that the single CT image signal feature recognition method in the self-diagnosis of diseases cannot accurately and reliably classify COVID-19, and it is easily confused with suspected cases. The collected CT signals and experimental indexes are extracted to construct different feature vectors. The support vector machine is optimized by the improved whale algorithm for the preliminary diagnosis of COVID-19, and the basic probability distribution function of each evidence is calculated by the posterior probability modeling method. Then the similarity measure is introduced to optimize the basic probability distribution function. Finally, the multi-domain feature fusion prediction model is established by using the weighted D-S evidence theory. The experimental results show that the fusion of multi-domain feature information by whale optimized support vector machine and improved D-S evidence theory can effectively improve the accuracy and the precision of COVID-19 autonomous diagnosis. The method of replacing a single feature parameter with multi-modal indicators (CT, routine laboratory indexes, serum cytokines and chemokines) provides a more reliable signal source for the diagnosis model, which can effectively distinguish COVID-19 from the suspected cases.

A new perspective to improve the treatment of Lianhuaqingwen on COVID-19 and prevent the environmental health risk of medication.

Lianhuaqingwen (LH), one traditional Chinese medicine (TCM), has been used to treat the coronavirus disease 2019 (COVID-19), but its ecotoxicity with potential human health security has not been well investigated. To overcome such adverse effects and improve its medication efficacy, an intelligent multi-method integrated dietary scheme, screening, and performance evaluation approach was developed. Thirteen LH compounds were selected, and the main protease (Mpro) was used as the potential drug target. Resulted information showed that the more compounds of LH added, the higher medication efficacy obtained using multi-method integrated screening system, expert consultation method, and molecular dynamics simulation. Pharmacodynamic mechanism analysis showed that low total energy and polar surface area of LH active compound (i.e., ß-sitosterol) will contribute to the best therapeutic effect on COVID-19 using quantitative structure-activity relationships (QSAR) and sensitivity models. Additionally, when mild COVID-19 patients take LH with the optimum dietary scheme (i.e., ß-lactoglobulin, α-lactalbumin, vitamin A, vitamin B, vitamin C, carotene, and vitamin E), the medication efficacy were significantly improved (23.58%). Pharmacokinetics and toxicokinetics results showed that LH had certain human health risks and ecotoxicity. This study revealed the multi-compound interaction mechanism of LH treatment on COVID-19, and provided theoretical guidance for improving therapeutic effect, evaluating TCM safety, and preventing human health risk.

Interpretation for the group standard of the Requirements for preservation of SARS-CoV-2 samples

As the original source of the SARS-CoV-2 and the pathogen of the coronavirus disease 2019. SARS-CoV-2 samples are important basic materials for clinical treatment, scientific research, drug screening, and vaccine research and development. They are important national strategic resources and should be preserved. In order to do a good job in the management of the collection of SARS-CoV-2 samples and provide technical support for relevant institutions, China CDC took the lead in formulationg and issuing the group standard of the Chinese Preventive Medicine Association, the Requirements for preservation of SARS-CoV-2 samples (T/CPMA 019-2020). Under the framework of the basic requirements, the standard includes two parts: the preservation information and preservation conditions of SARS-CoV-2 samples. The preservation information describes the necessary and non-essential information items required for the preservation of SARS-CoV-2 samples in the form of a table. The preservation conditions describes the safety and other requirements of SARS-CoV-2 samples container, and also show the optimal preservation conditions and requirements of SARS-CoV-2 samples in the form of a table. It is very important to do a good job in the management of SARS-CoV-2 strains and samples, regulate the preservation of strains and samples, and ensure biosafety and resource securirty.

Acute graft-versus-host disease after liver transplantation in a close contact with COVID-19: A case report.

Acute graft-versus-host disease (aGVHD) is a rare complication after liver transplantation that characterized by high mortality. We presented a case of aGVHD after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). The patient suffered from fever, oral ulcer, rashes and diarrhea and had a co-infection with Cytomegalovirus (CMV). Short tandem repeat (STR) analysis for cluster of differentiation (CD3) cells and skin biopsy indicated aGVHD. His regimens included high dose of steroids, ruxolitinib, basiliximab, local liver radiotherapy and antibiotics prophylaxis, with the withdrawal of tacrolimus and MMF. Unfortunately, he developed an acute rejection followed by cytomegalovirus infection and lung infection. Soon afterwards he was sent to "isolation ward" due to high suspicion for clinical coronavirus disease 2019 (COVID-19). Fortunately, He was excluded from COVID-19 after nucleic acid and antibody tests. Though closely contact with other COVID-19 patients for a month, the patient was not affected with COVID-19 through his careful protective measures. Finally, the patient recovered after antiviral and antifungal treatment. To our knowledge, this is the first case report of a patient recovered from aGVHD as a close contact.

Low serum calcium: a new, important indicator of COVID-19 patients from mild/moderate to severe/critical.

BACKGROUND:  Coronavirus disease 2019 (COVID-19) virus is still spreading, finding out the initial hits of viral infection is important to minimize the mild/moderate population, prevent disease aggravation and organs dysfunction. Objective: We investigated COVID-19 patients with different serum calcium levels. DESIGN:  We checked the serum calcium level of the patients based on days after symptom onset as well as the severity of COVID-19. We also checkeed multi-organ injuries and immune cytokines level in their blood. RESULTS:  Both mild/moderate and severe critical cases we observed showed low calcium level in the early stage of viral infection, while the severe/critical cases showed significant lower calcium level than mild/moderate cases in the early stage. We also found that low calcium level related to severe/critical multi-organ injuries especially in the mild/moderate population. Proinflammatory cytokine IL-6 also correlated to calcium change in both mild/moderate and severe/critical cases. CONCLUSIONS:  Our finding indicates that calcium balance is a primal hit of COVID-19 and a biomarker of clinical severity at the beginning of symptom onset. Calcium is closely associated with virus-associated multiple organ injuryes and the increase of inflammatory cytokines. Our results provide a new, important indicator of COVID-19 patients from mild/moderate to severe/critical: serum calcium.

Immunology of Transplant Patients with SARS-CoV-2 Infection: Transmission, Immune Response, and Therapeutic Strategy.

Coronavirus disease (COVID-19), caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a huge impact on global human health and was declared a worldwide distributed pandemic by the World Health Organization. SARS-CoV-2 has strong transmission and pathogenicity; so far, there are more than 16,000,000 cases of infections around the world and COVID-19 has caused more than 656,000 deaths. Current data indicate risk factors of patients infected by SARS-CoV-2 are older age, male sex, and chronic underlying diseases such as hypertension, diabetes, cardiovascular diseases, chronic respiratory disease, and cancer. After the outbreak of COVID-19, concern whether transplant patients are more susceptible to SARS-CoV-2 has been raised. It is inconclusive whether patients after transplantation on chronic immunosuppressive therapy are more susceptible to developing a more severe disease course. There is limited literature mainly aimed at post-transplantation populations whose immunity was suppressive before the disease occurred. Therefore, we attempted to systematically introduce the characteristics of transplant recipients with COVID-19, immunology in SARS-CoV-2 infection, and potential therapeutic strategy.

Prolonged shedding of SARS-CoV-2 in an elderly liver transplant patient infected by COVID-19: a case report.

Coronavirus disease 2019 (COVID-19) pandemic gripped the globe. SARS-CoV-2 is highly infectious and is susceptible to all populations. Immunosuppressed patients have greater risk for opportunistic infections. However, the understanding regarding the biological characteristics of SARS-CoV-2 in immunosuppressed patients remains unclear. Herein, we present a case of prolonged shedding of SARS-CoV-2 in a liver transplant patient with COVID-19. A 61-year-old male post liver transplant was confirmed COVID-19 infection on day 10 of illness onset. The patient has received immunosuppressive treatment for over 11 years and has a history of hypertension for 10 years. With antiviral treatment and temporary discontinuation of tacrolimus immunosuppression, he had complete clinical symptoms relieve on day 24. However, recurrently positive tests of SARS-CoV-2 RNA were presented on day 35 and on day 39 after two consecutive negative tests. IgG antibody test for SARS-CoV-2 was positive with IgM negative on day 41. The final shedding duration lasted 52 days. Prolonged shedding of SARS-CoV-2 should be a matter of concern and might attribute to long-term immunosuppression. Therefore, dynamic surveillance and prolonged quarantine are required for immunocompromised individuals. Further data should be collected to investigate if there is a universal prolonged shedding window of SARS-CoV-2 in immunosuppressed patients.

Pilot Study of Robot-Assisted Teleultrasound Based on 5G Network: A New Feasible Strategy for Early Imaging Assessment During COVID-19 Pandemic.

Early diagnosis is critical for the prevention and control of the coronavirus disease 2019 (COVID-19). We attempted to apply a protocol using teleultrasound, which is supported by the 5G network, to explore the feasibility of solving the problem of early imaging assessment of COVID-19. Four male patients with confirmed or suspected COVID-19 were hospitalized in isolation wards in two different cities. Ultrasound specialists, located in two other different cities, carried out the robot-assisted teleultrasound and remote consultation in order to settle the problem of early cardiopulmonary evaluation. Lung ultrasound, brief echocardiography, and blood volume assessment were performed. Whenever difficulties of remote manipulation and diagnosis occurred, the alternative examination was repeated by a specialist from another city, and in sequence, remote consultation was conducted immediately to meet the consensus. The ultrasound specialists successfully completed the telerobotic ultrasound. Lung ultrasound indicated signs of pneumonia with varying degrees in all cases and mild pleural effusion in one case. No abnormalities of cardiac structure and function and blood volume were detected. Remote consultation on the issue of manipulation practice, and the diagnosis in one case was conducted. The cardiopulmonary information was delivered to the frontline clinicians immediately for further treatment. The practice of teleultrasound protocol makes early diagnosis and repeated assessment available in the isolation ward. Ultrasound specialists can be protected from infection, and personal protective equipment can be spared. Quality control can be ensured by remote consultations among doctors. This protocol is worth consideration as a feasible strategy for early imaging assessment in the COVID-19 pandemic.

Serologic Detection of SARS-CoV-2 Infections in Hemodialysis Centers: A Multicenter Retrospective Study in Wuhan, China.

RATIONALE & OBJECTIVE: Patients receiving maintenance hemodialysis (MHD) are highly vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current study was designed to evaluate the prevalence of SARS-CoV-2 infection based on both nucleic acid testing (NAT) and antibody testing in Chinese patients receiving MHD. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: From December 1, 2019, to March 31, 2020, a total of 1,027 MHD patients in 5 large hemodialysis centers in Wuhan, China, were enrolled. Patients were screened for SARS-CoV-2 infection by symptoms and initial computed tomography (CT) of the chest. If patients developed symptoms after the initial screening was negative, repeat CT was performed. Patients suspected of being infected with SARS-CoV-2 were tested with 2 consecutive throat swabs for viral RNA. In mid-March 2020, antibody testing for SARS-CoV-2 was obtained for all MHD patients. EXPOSURE: NAT and antibody testing results for SARS-CoV-2. OUTCOMES: Morbidity, clinical features, and laboratory and radiologic findings. ANALYTICAL APPROACH: Differences between groups were examined using t test or Mann-Whitney U test, comparing those not infected with those infected and comparing those with infection detected using NAT with those with infection detected by positive serology test results. RESULTS: Among 1,027 patients receiving MHD, 99 were identified as having SARS-CoV-2 infection, for a prevalence of 9.6%. Among the 99 cases, 52 (53%) were initially diagnosed with SARS-CoV-2 infection by positive NAT; 47 (47%) were identified later by positive immunoglobulin G (IgG) or IgM antibodies against SARS-CoV-2. There was a spectrum of antibody profiles in these 47 patients: IgM antibodies in 5 (11%), IgG antibodies in 35 (74%), and both IgM and IgG antibodies in 7 (15%). Of the 99 cases, 51% were asymptomatic during the epidemic; 61% had ground-glass or patchy opacities on CT of the chest compared with 11.6% among uninfected patients (P<0.001). Patients with hypertensive kidney disease were more often found to have SARS-CoV-2 infection and were more likely to be symptomatic than patients with another primary cause of kidney failure. LIMITATIONS: Possible false-positive and false-negative results for both NAT and antibody testing; possible lack of generalizability to other dialysis populations. CONCLUSIONS: Half the SARS-CoV-2 infections in patients receiving MHD were subclinical and were not identified by universal CT of the chest and selective NAT. Serologic testing may help evaluate the overall prevalence and understand the diversity of clinical courses among patients receiving MHD who are infected with SARS-CoV-2.

Clinical characteristics of patients with uremia undergoing maintenance hemodialysis complicated with COVID-19.

This study aimed to evaluate the onset characteristics of patients with uremia undergoing maintenance hemodialysis complicated with COVID-19, so as to improve the understanding, diagnosis, and treatment.26 cases were confirmed cases of COVID-19. Confirmed patients with COVID-19 undergoing maintenance hemodialysis in the blood purification center were recruited. The general data of patients, including age, sex, duration of dialysis, and basic diseases, were analyzed. The clinical features included fever, respiratory symptoms, and gastrointestinal symptoms. The items for laboratory tests included blood routine examination, liver function, C-reactive protein, procalcitonin, creatine kinase, creatine kinase-MB, markers of myocardial injury, B-type natriuretic peptide, D-dimer, and so forth. The imaging examinations referred mainly to computed tomography imaging findings of the lungs.Twenty-one cases were complicated with chronic basic diseases, such as hypertension or diabetes. In terms of clinical manifestations, 13 cases had fever, which was close to the number of cases without fever (13 cases). The respiratory symptoms included dry cough (19 cases), shortness of breath (9 cases), fatigue (11 cases), and so forth. Further, 15 patients had hypoxemia, indicating more severe patients. Sore throat (2 cases) was not significant, and a few patients reported gastrointestinal symptoms (3 cases). The results of blood routine examination showed decreased absolute lymphocyte count (0.7 ±â€Š0.4 × 10∼9/L), lower hemoglobin level (105.2 ±â€Š20 g/L), and normal absolute neutrophil count 4.2 (3.0, 5.9) × 10∼9/L. Of the inflammatory indexes, procalcitonin was 0.69 (0.24, 2.73) ng/mL; C reactive protein was 17.2 (5.2, 181.6) mg/L, which was higher than normal. Blood biochemistry revealed lower albumin level (38.0 ±â€Š4.0 g/L) and higher troponin 0.11(0.035, 6.658) ng/mL and myoglobin levels (538.5 ±â€Š240.5 ng/mL), suggesting myocardial injury.The patients with uremia and confirmed COVID-19 undergoing maintenance hemodialysis are more common in males. Although the proportion of fever patients is 50%, the proportion of hypoxemia patients is high (58%). With poor cardiac function. They were prone to respiratory failure complicated with heart failure. According to the onset characteristics of this population, early diagnosis and treatment could help reduce the risk of developing a critical illness and control the spread of the COVID-19 epidemic.

Management of transplant patients outside hospital during COVID-19 epidemic: A Chinese experience.

Coronavirus disease 2019 (COVID-19) pandemic poses an increasing challenge for transplant community. Aggressive management measures are conductive to improve compliance and to lower the risk of intra-hospital infection. In this Personal Viewpoint essay, we shared experiences about management strategies of transplant patients outside hospital amid the epidemic. With the aid of Cloud Clinic service and telemedicine care, transplant patients could be regularly followed up and get medical consultation online. Furthermore, personal health education and mental health assistance are enrolled in our practice.

Successful treatment of severe COVID-19 pneumonia in a liver transplant recipient.

Coronavirus disease 2019 (COVID-19) pandemic spreads rapidly and may be an increasing challenge for transplant community. Clinical data on COVID-19 infection in transplant population is very limited. Herein we presented the clinical course and outcome of a 50-year-old male post liver transplantation who contracted COVID-19, with subsequent infection of his wife. The process of illness was representative. A therapeutic regime with temporary immunosuppression withdrawal and systemic low-dose corticosteroid as principle was involved in the management of the patient which made him recover from severe COVID-19 pneumonia.