Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 26
Filter
1.
Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences ; 49(2):147-157, 2020.
Article in Chinese | EuropePMC | ID: covidwho-1772475

ABSTRACT

当前2019冠状病毒病(COVID-19)疫情仍处于胶着状态。浙江大学医学院附属第一医院是国家感染性疾病临床医学中心,浙江省COVID-19患者救治中心。疫情一线的专家集智攻关,以国家卫生健康委员会和国家中医药管理局发布的COVID-19诊治指南为依据,以抗病毒、抗休克、抗低氧血症、抗继发感染、维持水电解质和酸碱平衡、维持微生态平衡的“四抗二平衡”救治策略为核心,总结完善诊治方案,聚焦临床实践的一些具体问题,为COVID-19患者临床诊治提供借鉴。推荐以多学科协作诊治个性化治疗提高COVID-19患者救治质量。建议病原学检测、炎症指标监测和肺部影像学动态观察指导临床诊治。痰液的病毒核酸检测阳性率最高,约10%的急性期患者血液中检测到病毒核酸,50%的患者粪便中检测到病毒核酸,粪便中可分离出活病毒,须警惕粪便是否具有传染性;开展细胞因子等炎症指标监测有助于发现是否出现细胞因子风暴,判断是否需要人工肝血液净化治疗。通过以“四抗二平衡”为核心的综合治疗提高治愈率、降低病死率;早期抗病毒治疗能减少重症、危重症发生,前期使用阿比多尔联合洛匹那韦/利托那韦抗病毒显示出一定效果。休克和低氧血症多为细胞因子风暴所致,人工肝血液净化治疗能迅速清除炎症介质,阻断细胞因子风暴,对维持水电解质酸碱平衡也有很好的作用,可以提高危重型患者的疗效。重型病例疾病早期可适量、短程应用糖皮质激素。氧疗过程中,患者氧合指数小于200 mmHg时应及时转入重症医学科治疗;采用保守氧疗策略,不推荐常规进行无创通气;机械通气患者应严格执行集束化呼吸机相关性肺炎预防管理策略;氧合指数大于150 mmHg时,及早减、停镇静剂并撤机拔管。不推荐预防性使用抗菌药物,对于病程长,体温反复升高和血降钙素原水平升高的患者可酌情使用抗菌药物;要关注COVID-19患者继发真菌感染的诊治。COVID-19患者有肠道微生态紊乱,肠道乳酸杆菌、双歧杆菌等有益菌减少,推荐对所有患者进行营养和胃肠道功能评估,以营养支持和补充大剂量肠道微生态调节剂,纠正肠道微生态失衡,减少细菌移位和继发感染。COVID-19患者普遍存在焦虑和恐惧心理,应建立动态心理危机干预和处理。提倡中西医结合辨证施治;优化重型患者护理促进康复。严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染后病毒清除规律仍不明了,出院后仍须居家隔离2周,并定期随访。以上经验和建议在本中心实行,取得较好效果,但COVID-19是一种新的疾病,其诊治方案及策略仍有待进一步探索与完善。

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-325314

ABSTRACT

As coronavirus disease 2019 (COVID-19) spreads worldwide, there have been few reports of infections among the cancer population, although more than six million cases have been confirmed. Here we studied a surgical specimen from a patient with colon cancer and COVID-19 and two tissue microarrays comprising 103 colorectal cancer and 108 enterocyte cases pathologically. The results showed that, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid antibody was positively expressed in colon cancer tissues. Moreover, the angiotensin converting enzyme 2 (ACE2) was overexpressed in both colorectal cancer tissue microarray and tumor tissue from this patient, with a positive rate as high as 93.2%. Finally, this case of SARS-CoV-2 infection in colon cancer tumor microenvironment (TME) is a failure of immune homeostasis, due to the decrease in TIA + and Granzyme B+ (GrB) CD8 + T cell proportion and the increase in PD-1 + CD8 + T cell proportion. In summary, we speculate that these three factors may have contributed significantly to infection risk and severity in the patient.

3.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-324166

ABSTRACT

Utilizing computed tomography (CT) images to quickly estimate the severity of cases with COVID-19 is one of the most straightforward and efficacious methods. Two tasks were studied in this present paper. One was to segment the mask of intact lung in case of pneumonia. Another was to generate the masks of regions infected by COVID-19. The masks of these two parts of images then were converted to corresponding volumes to calculate the physical proportion of infected region of lung. A total of 129 CT image set were herein collected and studied. The intrinsic Hounsfiled value of CT images was firstly utilized to generate the initial dirty version of labeled masks both for intact lung and infected regions. Then, the samples were carefully adjusted and improved by two professional radiologists to generate the final training set and test benchmark. Two deep learning models were evaluated: UNet and 2.5D UNet. For the segment of infected regions, a deep learning based classifier was followed to remove unrelated blur-edged regions that were wrongly segmented out such as air tube and blood vessel tissue etc. For the segmented masks of intact lung and infected regions, the best method could achieve 0.972 and 0.757 measure in mean Dice similarity coefficient on our test benchmark. As the overall proportion of infected region of lung, the final result showed 0.961 (Pearson's correlation coefficient) and 11.7% (mean absolute percent error). The instant proportion of infected regions of lung could be used as a visual evidence to assist clinical physician to determine the severity of the case. Furthermore, a quantified report of infected regions can help predict the prognosis for COVID-19 cases which were scanned periodically within the treatment cycle.

4.
Front Med (Lausanne) ; 8: 756922, 2021.
Article in English | MEDLINE | ID: covidwho-1551515

ABSTRACT

Background: The probable impact of a maintenance immunosuppressant (IS) on liver transplant (LT) recipients with coronavirus disease 2019 (COVID-19) remains unexplored. Our specific aim was to approximate the prognosis of LT recipients with COVID-19 on the standard maintenance IS. Method: We searched separate databases for the qualified studies in between December 2019 and June 25, 2021. Ultimately, a meta-analysis was carried out using a fixed-effect or random-effect model based on the heterogeneity. Results: In a total of eight studies and 509 LT recipients with COVID-19, the pooled rates of severity and mortality during all the combined immunosuppressive therapies were 22.4 and 19.5%, respectively. Our study sufficiently showed that an immunosuppressive therapy in LT recipients with COVID-19 was significantly associated with a non-severe COVID-19 [odds ratio (OR): 11.49, 95% CI: 4.17-31.65; p < 0.001] and the survival of the patients (OR: 17.64, 95% CI: 12.85-24.22; p < 0.001). Moreover, mammalian target of rapamycin inhibitor (mTORi) typically had the lowest rate of severity and mortality compared to other ISs such as calcineurin inhibitors (CNIs), steroids, and antimetabolites, i.e., severity (13.5 vs. 21.1, 24.7, and 26.3%) and mortality (8.3 vs. 15, 17.2, and 12.1%), respectively. Contrary to the general opinions, our meta-analysis showed comorbidities such as diabetes, hypertension, cardiopulmonary disorders, chronic kidney disease (CKD), age >60, the duration of LT to the diagnosis of COVID-19, primary disease for LT, and obesity were not significantly associated with the severity and mortality in LT recipients with COVID-19 under an immunosuppressive therapy. However, our pooled analysis found that LT recipients with COVID-19 and without comorbidities have a less severe disease and low mortality rate compared to those with both COVID-19 and comorbidities. Conclusions: In conclusion, LT recipients with COVID-19 undergoing immunosuppressive therapies are not significantly associated with the severity and mortality. Therefore, taking the risk of organ rejection into a key consideration, a complete withdrawal of the IS may not be wise. However, mycophenolate mofetil (MMF) might be discontinued or replaced from an immunosuppressive regimen with the CNIs- or mTORis-based immunosuppressive therapy in some selected LT recipients with COVID-19, depending upon the severity of the disease.

5.
Biotechnol J ; 16(11): e2100207, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1351201

ABSTRACT

BACKGROUND: The emergence of COVID-19 pandemic resulted in an urgent need for the development of therapeutic interventions. Of which, neutralizing antibodies play a crucial role in the prevention and resolution of viral infection. METHODS: We generated antibody libraries from 18 different COVID-19 recovered patients and screened neutralizing antibodies to SARS-CoV-2 and its mutants. After 3 rounds of panning, 456 positive phage clones were obtained with high affinity to RBD (receptor binding domain). Clones were then reconstituted into whole human IgG for epitope binning assay and all 19 IgG were classified into 6 different epitope groups or Bins. RESULTS: Although all antibodies were found to bind RBD, the antibodies in Bin2 had superior inhibitory ability of the interaction between spike protein and angiotensin converting enzyme 2 receptor (ACE2). Most importantly, the antibodies from Bin2 showed stronger binding affinity or ability to mutant RBDs (N501Y, W463R, R408I, N354D, V367F, and N354D/D364Y) derived from different SARS-CoV-2 strains as well, suggesting the great potential of these antibodies in preventing infection of SARS-CoV-2 and its mutations. Furthermore, such neutralizing antibodies strongly restricted the binding of RBD to hACE2 overexpressed 293T cells. Consistently, these antibodies effectively neutralized wildtype and more transmissible mutant pseudovirus entry into hACE2 overexpressed 293T cells. In Vero-E6 cells, one of these antibodies can even block the entry of live SARS-CoV-2 into cells at 12.5 nM. CONCLUSIONS: These results indicate that the neutralizing human antibodies from the patient-derived antibody libraries have the potential to fight SARS-CoV-2 and its mutants in this global pandemic.


Subject(s)
Antibodies, Viral/immunology , COVID-19 , SARS-CoV-2 , Antibodies, Neutralizing , COVID-19/therapy , Humans , Immunization, Passive , Pandemics , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/immunology
8.
Eur J Pharm Sci ; 157: 105631, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-893750

ABSTRACT

BACKGROUND: Effective antiviral drugs for COVID-19 are still lacking. This study aims to evaluate the clinical outcomes and plasma concentrations of baloxavir acid and favipiravir in COVID-19 patients. METHODS: Favipiravir and baloxavir acid were evaluated for their antiviral activity against SARS-CoV-2 in vitro before the trial initiation. We conducted an exploratory trial with 3 arms involving hospitalized adult patients with COVID-19. Patients were randomized assigned in a 1:1:1 ratio into baloxavir marboxil group, favipiravir group, and control group. The primary outcome was the percentage of subjects with viral negative by Day 14 and the time from randomization to clinical improvement. Virus load reduction, blood drug concentration and clinical presentation were also observed. The trial was registered with Chinese Clinical Trial Registry (ChiCTR 2000029544). RESULTS: Baloxavir acid showed antiviral activity in vitro with the half-maximal effective concentration (EC50) of 5.48 µM comparable to arbidol and lopinavir, but favipiravir didn't demonstrate significant antiviral activity up to 100 µM. Thirty patients were enrolled. The percentage of patients who turned viral negative after 14-day treatment was 70%, 77%, and 100% in the baloxavir marboxil, favipiravir, and control group respectively, with the medians of time from randomization to clinical improvement was 14, 14 and 15 days, respectively. One reason for the lack of virological effect and clinical benefits may be due to insufficient concentrations of these drugs relative to their antiviral activities. One of the limitations of this study is the time from symptom onset to randomization, especially in the baloxavir marboxil and control groups, which is higher than the favipiravir group. CONCLUSIONS: Our findings could not prove a benefit of addition of either baloxavir marboxil or favipiravir under the trial dosages to the existing standard treatment.


Subject(s)
Amides , COVID-19 , Dibenzothiepins , Morpholines , Pyrazines , Pyridones , Triazines , Amides/administration & dosage , Amides/blood , Amides/pharmacokinetics , Antiviral Agents/administration & dosage , Antiviral Agents/blood , Antiviral Agents/pharmacokinetics , COVID-19/blood , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/physiopathology , Dibenzothiepins/administration & dosage , Dibenzothiepins/blood , Dibenzothiepins/pharmacokinetics , Drug Monitoring/methods , Female , Humans , Inhibitory Concentration 50 , Male , Middle Aged , Morpholines/administration & dosage , Morpholines/blood , Morpholines/pharmacokinetics , Pyrazines/administration & dosage , Pyrazines/blood , Pyrazines/pharmacokinetics , Pyridones/administration & dosage , Pyridones/blood , Pyridones/pharmacokinetics , SARS-CoV-2/drug effects , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology , Symptom Assessment , Treatment Outcome , Triazines/administration & dosage , Triazines/blood , Triazines/pharmacokinetics , Viral Load/drug effects
9.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 198-202, 2020 05 25.
Article in Chinese | MEDLINE | ID: covidwho-807608

ABSTRACT

OBJECTIVE: To analyze the CT findings of patients with different clinical types of coronavirus disease 2019 (COVID-19). METHODS: A total of 67 patients diagnosed as COVID-19 by nucleic acid testing were included and divided into 4 groups according to the clinical staging based on Diagnosis and treatment of novel coronavirus pneumonia (Trial version 6). The CT imaging characteristics were analyzed among patients with different clinical types. RESULTS: Among 67 patients, 3 (4.5%) were mild cases, 35 (52.2%) were ordinary cases, 22 (32.8%) were severe cases, and 7 (10.4%) were critically ill. There were no abnormal CT findings in mild cases. In 35 ordinary cases, there were single lesions in 3 cases (8.6%) and multiple lesions in 33 cases (91.4%), while in severe case 1 case had single lesion (4.5%) and 21 had multiple lesions (95.5%). CT images of ordinary patients were mainly manifested as solid plaque shadow and halo sign (18/35, 51.4%); while fibrous strip shadow with ground glass shadow was more frequent in severe cases (7/22, 31.8%). Consolidation shadow as the main lesion was observed in 7 cases, and all of them were severe or critical ill patients. CONCLUSIONS: CT images in patients with different clinical types of COVID-19 have characteristic manifestations, and solid shadow may predict severe and critical illness.


Subject(s)
Coronavirus Infections/diagnostic imaging , Lung/pathology , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Humans , Lung/diagnostic imaging , Pneumonia, Viral/pathology , SARS-CoV-2 , Severity of Illness Index
12.
Acad Radiol ; 27(12): 1665-1678, 2020 12.
Article in English | MEDLINE | ID: covidwho-778296

ABSTRACT

OBJECTIVE: This study was to investigate the CT quantification of COVID-19 pneumonia and its impacts on the assessment of disease severity and the prediction of clinical outcomes in the management of COVID-19 patients. MATERIALS METHODS: Ninety-nine COVID-19 patients who were confirmed by positive nucleic acid test (NAT) of RT-PCR and hospitalized from January 19, 2020 to February 19, 2020 were collected for this retrospective study. All patients underwent arterial blood gas test, routine blood test, chest CT examination, and physical examination on admission. In addition, follow-up clinical data including the disease severity, clinical treatment, and clinical outcomes were collected for each patient. Lung volume, lesion volume, nonlesion lung volume (NLLV) (lung volume - lesion volume), and fraction of nonlesion lung volume (%NLLV) (nonlesion lung volume / lung volume) were quantified in CT images by using two U-Net models trained for segmentation of lung and COVID-19 lesions in CT images. Furthermore, we calculated 20 histogram textures for lesions volume and NLLV, respectively. To investigate the validity of CT quantification in the management of COVID-19, we built random forest (RF) models for the purpose of classification and regression to assess the disease severity (Moderate, Severe, and Critical) and to predict the need and length of ICU stay, the duration of oxygen inhalation, hospitalization, sputum NAT-positive, and patient prognosis. The performance of RF classifiers was evaluated using the area under the receiver operating characteristic curves (AUC) and that of RF regressors using the root-mean-square error. RESULTS: Patients were classified into three groups of disease severity: moderate (n = 25), severe (n = 47) and critical (n = 27), according to the clinical staging. Of which, a total of 32 patients, 1 (1/25) moderate, 6 (6/47) severe, and 25 critical (25/27), respectively, were admitted to ICU. The median values of ICU stay were 0, 0, and 12 days, the duration of oxygen inhalation 10, 15, and 28 days, the hospitalization 12, 16, and 28 days, and the sputum NAT-positive 8, 9, and 13 days, in three severity groups, respectively. The clinical outcomes were complete recovery (n = 3), partial recovery with residual pulmonary damage (n = 80), prolonged recovery (n = 15), and death (n = 1). The %NLLV in three severity groups were 92.18 ± 9.89%, 82.94 ± 16.49%, and 66.19 ± 24.15% with p value <0.05 among each two groups. The AUCs of RF classifiers using hybrid models were 0.927 and 0.929 in classification of moderate vs (severe + critical), and severe vs critical, respectively, which were significantly higher than either radiomics models or clinical models (p < 0.05). The root-mean-square errors of RF regressors were 0.88 weeks for prediction of duration of hospitalization (mean: 2.60 ± 1.01 weeks), 0.92 weeks for duration of oxygen inhalation (mean: 2.44 ± 1.08 weeks), 0.90 weeks for duration of sputum NAT-positive (mean: 1.59 ± 0.98 weeks), and 0.69 weeks for stay of ICU (mean: 1.32 ± 0.67 weeks), respectively. The AUCs for prediction of ICU treatment and prognosis (partial recovery vs prolonged recovery) were 0.945 and 0.960, respectively. CONCLUSION: CT quantification and machine-learning models show great potentials for assisting decision-making in the management of COVID-19 patients by assessing disease severity and predicting clinical outcomes.


Subject(s)
Coronavirus Infections , Lung , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Humans , Lung/diagnostic imaging , Machine Learning , Prognosis , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
14.
J Affect Disord ; 277: 337-340, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-722855

ABSTRACT

BACKGROUND: In December 2019, the novel coronavirus (SARS-CoV-2) infection was first reported in Wuhan city, central China, which has spread rapidly. The common clinical features of patients with SARS-CoV-2 infection included fever, fatigue, and damage to the respiratory or digestive system. However, it is still unclear whether SARS-CoV-2 infection could cause damage to the central nervous system (CNS) inducing psychiatric symptoms. CASE REPORT: Herein, we present the first case of SARS-CoV-2 infection with manic-like symptoms and describe the diagnosis, clinical course, and treatment of the case, focusing on the identifications of SARS-CoV-2 in the specimen of cerebrospinal fluid (CSF). The patient developed manic-like symptoms when his vital signs recovered on illness day 17. After manic-like attack, the detection of SARS-CoV-2 specific IgG antibody in CSF was positive, while the reverse transcriptase-polymerase chain reaction (RT-PCR) on CSF for the SARS-CoV-2 was negative. The patient received Olanzapine for treatment and his mood problems concurrently improved as indicated by scores of Young Manic Rating Scale (YMRS). LIMITATION: This is a single case report only, and the RT-PCR test for SARS-CoV-2 in CSF was not performed simultaneously when SARS-CoV-2 was positive in samples of sputum and stool. CONCLUSION: This first case of COVID-19 patient with manic-like symptoms highlights the importance of evaluation of mental health status and may contribute to our understanding of potential risk of CNS impairments by SARS-CoV-2 infection.


Subject(s)
Bipolar Disorder/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Antibodies, Viral/cerebrospinal fluid , Antipsychotic Agents/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus , Bipolar Disorder/cerebrospinal fluid , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Brain/diagnostic imaging , COVID-19 , COVID-19 Testing , Chest Pain , China , Clinical Laboratory Techniques , Cobicistat/therapeutic use , Coronavirus Infections/cerebrospinal fluid , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Darunavir/therapeutic use , Dyspnea , Fever , Glucocorticoids/therapeutic use , Humans , Indoles/therapeutic use , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Middle Aged , Moxifloxacin/therapeutic use , Olanzapine/therapeutic use , Pandemics , Pharyngitis , Pneumonia, Viral/cerebrospinal fluid , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2
16.
Front Med (Lausanne) ; 7: 347, 2020.
Article in English | MEDLINE | ID: covidwho-643256

ABSTRACT

Background: Liver injury commonly occurs in patients with COVID-19. There is limited data describing the course of liver injury occurrence in patients with different disease severity, and the causes and risk factors are unknown. We aim to investigate the incidence, characteristics, risk factors, and clinical outcomes of liver injury in patients with COVID-19. Methods: This retrospective observational study was conducted in three hospitals (Zhejiang, China). From January 19, 2020 to February 20, 2020, patients confirmed with COVID-19 (≥18 years) and without liver injury were enrolled and divided into non-critically ill and critically ill groups. The incidence and characteristics of liver injury were compared between the two groups. Demographics, clinical characteristics, treatments, and treatment outcomes between patients with or without liver injury were compared within each group. The multivariable logistic regression model was used to explore the risk factors for liver injury. Results: The mean age of 131 enrolled patients was 51.2 years (standard deviation [SD]: 16.1 years), and 70 (53.4%) patients were male. A total of 76 patients developed liver injury (mild, 40.5%; moderate, 15.3%; severe, 2.3%) with a median occurrence time of 10.0 days. Critically ill patients had higher and earlier occurrence (81.5 vs. 51.9%, 12.0 vs. 5.0 days; p < 0.001), greater injury severity (p < 0.001), and slower recovery (50.0 vs. 61.1%) of liver function than non-critically ill patients. Multivariable regression showed that the number of concomitant medications (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.05-1.21) and the combination treatment of lopinavir/ritonavir and arbidol (OR: 3.58, 95% CI: 1.44-9.52) were risk factors for liver injury in non-critically ill patients. The metabolism of arbidol can be significantly inhibited by lopinavir/ritonavir in vitro (p < 0.005), which may be the underlying cause of drug-related liver injury. Liver injury was related to increased length of hospital stay (mean difference [MD]: 3.2, 95% CI: 1.3-5.2) and viral shedding duration (MD: 3.0, 95% CI: 1.0-4.9). Conclusions: Critically ill patients with COVID-19 suffered earlier occurrence, greater injury severity, and slower recovery from liver injury than non-critically ill patients. Drug factors were related to liver injury in non-critically ill patients. Liver injury was related to prolonged hospital stay and viral shedding duration in patients with COVID-19. Clinical Trial Registration: World Health Organization International Clinical Trials Registry Platform, ChiCTR2000030593. Registered March 8, 2020.

17.
Engineering (Beijing) ; 6(10): 1122-1129, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-623838

ABSTRACT

The real-time reverse transcription-polymerase chain reaction (RT-PCR) detection of viral RNA from sputum or nasopharyngeal swab had a relatively low positive rate in the early stage of coronavirus disease 2019 (COVID-19). Meanwhile, the manifestations of COVID-19 as seen through computed tomography (CT) imaging show individual characteristics that differ from those of other types of viral pneumonia such as influenza-A viral pneumonia (IAVP). This study aimed to establish an early screening model to distinguish COVID-19 from IAVP and healthy cases through pulmonary CT images using deep learning techniques. A total of 618 CT samples were collected: 219 samples from 110 patients with COVID-19 (mean age 50 years; 63 (57.3%) male patients); 224 samples from 224 patients with IAVP (mean age 61 years; 156 (69.6%) male patients); and 175 samples from 175 healthy cases (mean age 39 years; 97 (55.4%) male patients). All CT samples were contributed from three COVID-19-designated hospitals in Zhejiang Province, China. First, the candidate infection regions were segmented out from the pulmonary CT image set using a 3D deep learning model. These separated images were then categorized into the COVID-19, IAVP, and irrelevant to infection (ITI) groups, together with the corresponding confidence scores, using a location-attention classification model. Finally, the infection type and overall confidence score for each CT case were calculated using the Noisy-OR Bayesian function. The experimental result of the benchmark dataset showed that the overall accuracy rate was 86.7% in terms of all the CT cases taken together. The deep learning models established in this study were effective for the early screening of COVID-19 patients and were demonstrated to be a promising supplementary diagnostic method for frontline clinical doctors.

18.
Emerg Microbes Infect ; 9(1): 1474-1488, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-599992

ABSTRACT

The mutations in the SARS-CoV-2 virus genome during COVID-19 dissemination are unclear. In 788 COVID-19 patients from Zhejiang province, we observed decreased rate of severe/critical cases compared with patients in Wuhan. For mechanisms exploration, we isolated one strain of SARS-CoV-2 (ZJ01) from a mild COVID-19 patient. Thirty-five specific gene mutations were identified. Phylogenetic and relative synonymous codon usage analysis suggested that ZJ01 may be a potential evolutionary branch of SARS-CoV-2. We classified 54 global virus strains based on the base (C or T) at positions 8824 and 28247 while ZJ01 has T at both sites. The prediction of the Furin cleavage site (FCS) and sequence alignment indicated that the FCS may be an important site of coronavirus evolution. ZJ01 mutations identified near the FCS (F1-2) caused changes in the structure and electrostatic distribution of the S surface protein, further affecting the binding capacity of Furin. Single-cell sequencing and ACE2-Furin co-expression results confirmed that the Furin expression was especially higher in glands, liver, kidneys, and colon. The evolutionary pattern of SARS-CoV-2 towards FCS formation may result in its clinical symptom becoming closer to HKU-1 and OC43 caused mild flu-like symptoms, further showing its potential in differentiating into mild COVID-19 subtypes.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/virology , Furin/metabolism , Pneumonia, Viral/virology , Adult , Betacoronavirus/genetics , COVID-19 , China/epidemiology , Codon , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Disease Progression , Evolution, Molecular , Female , Humans , Male , Middle Aged , Mutation , Pandemics , Phylogeny , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Retrospective Studies , SARS-CoV-2 , Sequence Analysis, RNA
19.
Am J Gastroenterol ; 115(7): 1075-1083, 2020 07.
Article in English | MEDLINE | ID: covidwho-459522

ABSTRACT

INTRODUCTION: Elevated liver enzyme levels are observed in patients with coronavirus disease 2019 (COVID-19); however, these features have not been characterized. METHODS: Hospitalized patients with COVID-19 in Zhejiang Province, China, from January 17 to February 12, 2020, were enrolled. Liver enzyme level elevation was defined as alanine aminotransferase level >35 U/L for men and 25 U/L for women at admission. Patients with normal alanine aminotransferase levels were included in the control group. Reverse transcription polymerase chain reaction was used to confirm severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and patients symptomatic with SARS-CoV-2 infection were defined as patients with COVID-19. Epidemiological, demographic, clinical, laboratory, treatment, and outcome data were collected and compared. RESULTS: Of 788 patients with COVID-19, 222 (28.2%) patients had elevated liver enzyme levels (median [interquartile range {IQR}] age, 47.0 [35.0-55.0] years; 40.5% women). Being male, overweight, and smoking increased the risk of liver enzyme level elevation. The liver enzyme level elevation group had lesser pharyngalgia and more diarrhea than the control group. The median time from illness onset to admission was 3 days for liver enzyme level elevation groups (IQR, 2-6), whereas the median hospitalization time for 86 (38.7%) discharged patients was 13 days (IQR, 11-16). No differences in disease severity and clinical outcomes were noted between the groups. DISCUSSION: We found that 28.2% of patients with COVID-19 presented with elevated liver enzyme levels on admission, which could partially be related to SARS-CoV-2 infection. Male patients had a higher risk of liver enzyme level elevation. With early medical intervention, liver enzyme level elevation did not worsen the outcomes of patients with COVID-19.


Subject(s)
Coronavirus Infections , Hepatitis, Viral, Human/enzymology , Liver Function Tests , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Cross-Sectional Studies , Female , Hepatitis, Viral, Human/virology , Humans , Liver Diseases/enzymology , Liver Diseases/virology , Male , Middle Aged , Pneumonia, Viral/complications , Retrospective Studies , Risk Factors , SARS-CoV-2
20.
J Infect Dis ; 222(3): 367-371, 2020 07 06.
Article in English | MEDLINE | ID: covidwho-436918

ABSTRACT

The viral RNA shedding time (VST) for severe acute respiratory syndrome coronavirus 2 has not been well characterized. Clinical data were collected and compared between patients with short and long VSTs (in the lower and upper quartiles, respectively). The probability of recurrent positive reverse-transcription polymerase chain reaction results decreased sharply to 4.8% after 3 consecutive negative results. A series of ≥3 consecutive negative results was suitable as a criterion for the end of viral RNA shedding. The VST for shedding from the respiratory tract was significantly shorter in patients with normal B-cell counts on admission than in those with decreased B-cell counts (median [interquartile range], 11 [9-13] vs 16 [12-20] days, respectively; P = .001).


Subject(s)
B-Lymphocytes/physiology , Betacoronavirus/genetics , Coronavirus Infections/immunology , Coronavirus Infections/virology , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Respiratory System/virology , Virus Shedding , Betacoronavirus/immunology , COVID-19 , Case-Control Studies , China , Cytokines/metabolism , Female , Humans , Logistic Models , Lymphocyte Count , Male , Middle Aged , Pandemics , Proportional Hazards Models , RNA, Viral/metabolism , Real-Time Polymerase Chain Reaction , Retrospective Studies , Risk Factors , SARS-CoV-2 , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL