Neutrophil-to-Lymphocyte Ratio Predicts Severe Illness Patients with 2019 Novel Coronavirus in the Early Stage

BackgroundSevere ill patients with 2019 novel coronavirus (2019-nCoV) infection progressed rapidly to acute respiratory failure. We aimed to select the most useful prognostic factor for severe illness incidence. MethodsThe study prospectively included 61 patients with 2019-nCoV infection treated at Beijing Ditan Hospital from January 13, 2020 to January 31, 2020. Prognostic factor of severe illness was selected by the LASSO COX regression analyses, to predict the severe illness probability of 2019-CoV pneumonia. The predictive accuracy was evaluated by concordance index, calibration curve, decision curve and clinical impact curve. ResultsThe neutrophil-to-lymphocyte ratio (NLR) was identified as the independent risk factor for severe illness in patients with 2019-nCoV infection. The NLR had a c-index of 0.807 (95% confidence interval, 0.676-0.38), the calibration curves fitted well, and the decision curve and clinical impact curve showed that the NLR had superior standardized net benefit. In addition, the incidence of severe illness was 9.1% in age [≥] 50 and NLR < 3.13 patients, and half of patients with age [≥] 50 and NLR [≥] 3.13 would develop severe illness. Based on the risk stratification of NLR with age, the study developed a 2019-nCoV pneumonia management process. ConclusionsThe NLR was the early identification of risk factors for 2019-nCoV severe illness. Patients with age [≥] 50 and NLR [≥] 3.13 facilitated severe illness, and they should rapidly access to intensive care unit if necessary.

Research advances in the pathogenesis of autoimmune hepatitis / 临床肝胆病杂志

Autoimmune hepatitis (AIH) is a progressive chronic inflammatory liver disease with unknown etiology. At present, genetic susceptibility and environmental factors are universally recognized as the etiological factors for AIH. With the deepening of research in recent years, other etiological factors, such as immune cells, immune factors, liver transplantation, and drugs, have attracted more and more attention. This article briefly describes related research findings in the past five years.

Research advances in non-hormonal therapies for autoimmune hepatitis / 临床肝胆病杂志

Autoimmune hepatitis is a chronic progressive inflammatory disease of the liver, which is mediated by the abnormal autoimmune response. Immunosuppressive therapy is the major therapeutic method for this disease, and liver transplantation can be performed for patients in the advanced stage. At present, the internationally acknowledged standard therapeutic method is prednisone or prednisone combined with azathioprine. Most patients can achieve clinical remission, but the recurrence rate is high and some patients fail to respond to the treatment. This article briefly reviews the therapies except corticosteroid therapy and substitutive therapy after treatment failure, introduces the application of integrated traditional Chinese and Western medicine therapy for autoimmune hepatitis, and points out that non-hormonal therapies are the new directions for the treatment of autoimmune hepatitis, which still needs to be further investigated.

Clinical analysis of 298 cases of liver cirrhosis and renal dysfunction / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the renal function of 298 liver cirrhosis cases among the patient population of Beijing Ditan Hospital.</p><p><b>METHODS</b>The medical database of Beijing Ditan Hospital was retrospectively searched for patients with liver cirrhosis (compensated and decompensated). Patients were excluded from the study according to the presence of concomitant serious diseases, such as hypertension, diabetes, and malignancies.The consistency of renal insufficiency was evaluated by the glomerular filtration rate (eGFR) or serum creatinine (SCr) level, which were applied to the simplified modification of diet in renal disease (MDRD) equation.The renal function was compared between groups stratified according to compensated/decompensated status, sex, and age.The factors affecting renal insufficiency were screened.Measurement data were compared using the t-test and count data were compared using the chi-square test.Multiple sets of data were compared using analysis of variance.Correlations were assessed using multivariate logistic regression analysis, and the confounding variables were controlled with the Mantel-Haenszel method.</p><p><b>RESULTS</b>A total of 298 hospitalized patients with liver cirrhosis were included in the study, among which 41 had compensated cirrhosis and 257 had decompensated cirrhosis.Twenty patients (6.7%) with renal insufficiency were identified by SCr measurement and 62 patients (20.8%) were identified by eGFR, and the number identified was significantly different between the two groups (x2=42.00, P less than 0.05).Fifty-six (21.8%) patients had decompensated cirrhosis and 6 (14.6%) patients had decompensated cirrhosis with renal dysfunction; the eGFR levels for these two groups were (117.75 +/- 32.60) ml/min/(1.73 m2)-1 and (112.72 +/- 24.01) ml/min/(1.73 m2) respectively and the difference was not statistically significant (P more than 0.05).The incidence of renal dysfunction among female patients was 22.7% (17/75), and the incidence among male patients was 20.2% (45/223); the eGFR levels for these two groups were (110.07 +/- 26.60) ml/min/(1.73 m2)1 and (112.49 +/- 33.05) ml/min/(l.73 m2) respectively, and the difference was not statistically significant (P more than 0.05).The rate of renal dysfunction among patients aged 20 to 40 years-old, more than 40 to 60 years-old, and more than 60 years years-old was 5.7% (4/70), 22.5% (40/178), and 36.0%(18/50) respectively; the eGFR values for these two groups were (123.43 +/- 24.42) ml min/(l.73 m2), (111.18+/- 33.57) ml/min/(1.73 m2), and (98.20 +/- 27.04) ml/min/(1.73 m2), and the differences were not statistically significant (P less than 0.05).After stratification of the study population by age, the patient sex and the cirrhosis stage were not significantly different (P more than 0.05).Multivariate logistic regression analysis identified age as a risk factor of hepatitis B-related cirrhosis and renal dysfunction (P less than 0.05).</p><p><b>CONCLUSION</b>The simplified MDRD equation can help clinicians determine whether patients have kidney injury.Development of renal dysfunction in patients with liver cirrhosis is not associated with patient sex and cirrhosis stage, but is precisely correlated with patient age.</p>

Characterization of animal manures using mid-infrared photoacoustic spectroscopy.

The feasibility of using Fourier transform mid-infrared photoacoustic spectroscopy (FTIR-PAS) for rapid characterization of animal manures was investigated. Animal manure samples were collected from various places in China, and probabilistic neural networks (PNN) and partial least squares (PLS) were initially applied in the qualitative and quantitative analysis of animal manures, respectively. The animal manures exhibited distinctive bands, specifically around 2900-3700 cm(-1), 1200-1800 cm(-1) and 500-1100 cm(-1). There were numerous differences in the spectra of different animal manures, and manures were successful identified by PNN model; organic matter contents in animal manure were well predicted by PLS model, and the calibration coefficient (R(2)), validation error and RPD (ratio of standard deviation to predicted error) were 0.93, 2.38% and 2.58%, respectively, suggesting the potential application of FTIR-PAS for the fast characterization of animal manures.