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BACKGROUNDThe worldwide COVID-19 pandemic is increasing exponentially and demands an effective and promising therapy at most emergency. METHODSWe have assembled a cohort consisting 504 hospitalized COVID-19 patients. Detailed information on patients characteristics and antiviral medication use during their stay at designated hospitals along with their pre and post treatment results were collected. The study objective is to evaluate the treatment efficacy of Arbidol, together with the concurrent drugs Oseltamivir and Lopinavir/Ritonavir on mortality and lesion absorption based on chest CT scan. FINDINGSThe overall mortality rate was 15.67% in the cohort. The older age, lower SpO2 level, larger lesion, early admission date, and the presence of pre-existing conditions were associated with higher mortality. After adjusting for the patients age, sex, pre-existing condition, SpO2, lesion size, admission date, hospital, and concurrent antiviral drug use, Arbidol was found promising and associated with reduced mortality. The OR for Arbidol is 0{middle dot}183 (95% CI, 0{middle dot}075 to 0{middle dot}446; P<0{middle dot}001). Furthermore, Arbidol is also associated with faster lesion absorption after adjusting for patients characteristics and concurrent antiviral drug use (P=0{middle dot}0203). INTERPRETATIONThe broad-spectrum antiviral drug Arbidol was found to be associated with faster
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BackgroundWuhan, China was the epicenter of the 2019 coronavirus outbreak. As a designated hospital, Wuhan Pulmonary Hospital has received over 700 COVID-19 patients. With the COVID-19 becoming a pandemic all over the world, we aim to share our epidemiological and clinical findings with the global community. MethodsIn this retrospective cohort study, we studied 340 confirmed COVID-19 patients from Wuhan Pulmonary Hospital, including 310 discharged cases and 30 death cases. We analyzed their demographic, epidemiological, clinical and laboratory data and implemented our findings into an interactive, free access web application. FindingsBaseline T lymphocyte Subsets differed significantly between the discharged cases and the death cases in two-sample t-tests: Total T cells (p < 2{middle dot}2e-16), Helper T cells (p < 2{middle dot}2e-16), Suppressor T cells (p = 1{middle dot}8-14), and TH/TS (Helper/Suppressor ratio, p = 0{middle dot}0066). Multivariate logistic regression model with death or discharge as the outcome resulted in the following significant predictors: age (OR 1{middle dot}05, p 0{middle dot}04), underlying disease status (OR 3{middle dot}42, p 0{middle dot}02), Helper T cells on the log scale (OR 0{middle dot}22, p 0{middle dot}00), and TH/TS on the log scale (OR 4{middle dot}80, p 0{middle dot}00). The McFadden pseudo R-squared for the logistic regression model is 0{middle dot}35, suggesting the model has a fair predictive power. InterpretationWhile age and underlying diseases are known risk factors for poor prognosis, patients with a less damaged immune system at the time of hospitalization had higher chance of recovery. Close monitoring of the T lymphocyte subsets might provide valuable information of the patients condition change during the treatment process. Our web visualization application can be used as a supplementary tool for the evaluation. FundingThe authors report no funding.
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BackgroundTo date, large amounts of epidemiological and case study data have been available for the Coronavirus Disease 2019 (COVID-19), which suggested that the mortality was related to not just respiratory complications. Here, we specifically analyzed kidney functions in COVID-19 patients and their relations to mortality. MethodIn this multi-centered, retrospective, observational study, we included 193 adult patients with laboratory-confirmed COVID-19 from 2 hospitals in Wuhan, 1 hospital in Huangshi (Hubei province, 83 km from Wuhan) and 1 hospital in Chongqing (754 km from Wuhan). Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected, including data regarding to kidney functions. Data were compared among three groups: non-severe COVID-19 patients (128), severe COVID-19 patients (65) and a control group of other pneumonia (28). For the data from computed tomographic (CT) scans, we also included a control group of healthy subjects (110 cases, without abnormalities in the lung and without kidney diseases). The primary outcome was a common presence of kidney dysfunctions in COVID-19 patients and the occurrence of acute kidney injury (AKI) in a fraction of COVID-19 patients. Secondary outcomes included a survival analysis of COVID-19 patients in conditions of AKI or comorbid chronic illnesses. FindingsWe included 193 COVID-19 patients (128 non-severe, 65 severe (including 32 non-survivors), between January 6th and February 21th,2020; the final date of follow-up was March 4th, 2020) and 28 patients of other pneumonia (15 of viral pneumonia, 13 of mycoplasma pneumonia) before the COVID-19 outbreak. On hospitaladmission, a remarkable fraction of patients had signs of kidney dysfunctions, including 59% with proteinuria, 44% with hematuria, 14% with increased levels of blood urea nitrogen, and 10% with increased levels of serum creatinine, although mild but worse than that in cases with other pneumonia. While these kidney dysfunctions might not be readily diagnosed as AKI at admission, over the progress during hospitalization they could be gradually worsened and diagnosed as AKI. A univariate Cox regression analysis showed that proteinuria, hematuria, and elevated levels of blood urea nitrogen, serum creatinine, uric acid as well as D-dimer were significantly associated with the death of COVID-19 patients respectively. Importantly, the Cox regression analysis also suggested that COVID-19 patients that developed AKI had a [~]5.3-times mortality risk of those without AKI, much higher than that of comorbid chronic illnesses ([~]1.5 times risk of those without comorbid chronic illnesses). InterpretationTo prevent fatality in such conditions, we suggested a high degree of caution in monitoring the kidney functions of severe COVID-19 patients regardless of the past disease history. In addition, upon day-by-day monitoring, clinicians should consider any potential interventions to protect kidney functions at the early stage of the disease and renal replacement therapies in severely ill patients, particularly for those with strong inflammatory reactions or a cytokine storm. FundingNone.
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Objective To investigate the ultrasonic appearance of peripheral neurilemmoma.Methods Ultrasonic appearances of 43 patients with 46 neurilemmomas confirmed by surgery and pathology were analyzed retrospectively and compared with their MRI and pathological features.Results Forty-five neurilemmomas were with regular shape and clear boundary,except one at the root of nerve C4 that was irregular in shape and unclear in boundary,like adumbbell.Sonography showed that there were 30 neurilemmomas displaying as solid tumors,15 as cystic and solid,and 1 as entirely cystic.Posterior echoenhancement,target sign,rat tail sign and vessels accompanying sign were found in 39,21,23 and 17 neurilemmomas,respectively.There were 4 neurilemmomas with ultrasound blood flow grade 0,9 with grade Ⅰ,22 with gradeⅡ,and 11 with grade Ⅲ.The target signs were found in 21 cases (21/46,45.6％) and 26 cases (26/46,56.5 ％) by ultrasound and MRI,respectively.The capability of ultrasound finding the target sign in neurilemmoma was comparable to MRI(Kappa =0.527,P ＜0.001).The diagnostic accuracy rate of neurilemmoma by ultrasonography was 73.9％(34/46).Conclusions The ultrasound has a relatively high detection of the target sign in neurilemmoma,which may provide a new basis for the ultrasonic diagnosis of neurilemmoma.
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Objective To investigate the expression of CD133 protein in primary lesions of hepatocellular carcinoma (HCC) and its clinical significance.Methods The expression of CD133 protein in 190 patients with HCC was detected by immunohistochemical staining ABC method.The correlation of CD133 protein expression with the clinicopathologic parameters and features after operation was analyzed.Results The expression positive rate of CD133 protein in cancer tissues was 22.1％ (42/190).There was significant correlation between the expression of CD133 protein and tumor differentiation (P ＜ 0.001),micro vessel invasion (P =0.016) and hepatitis B virus infection (P =0.024).Univariate analysis of factors demonstrated that differentiation level,lymph node,macro vessel invasion,micro vessel invasion,TNM stage and CD133 expression were correlated with disease-free survival after surgery (all P ＜ 0.05).Multivariate analysis of factors demonstrated that both CD133 expression and micro vessel invasion were independent prognostic factors of disease-free survival after surgery.Prognostic analysis demonstrated that the disease-free survival of CD133 positive group was significantly lower than that of CD133 negative group.Conclusion The CD133 protein expression in HCC tissues is related with development,metastasis and prognosis of HCC.
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In this study, the mechanism by which Ad-p27mt inhibits the growth, invasion and metastasis of transplanted liver tumor was studied by examining the effects of Ad-27mt gene transfer on the expression of Bax, Bcl-2, VEGF and MMP-9 in the transplanted liver tumors in nude mice. The model of transplanted hepatic tumor was established in nude mice. The mice were then divided into three groups, which were injected with PBS, Ad-LacZ and Ad-p27mt and the growth of the transplanted liver tumor was observed. The expressions of P27, Bax and Bcl-2 proteins were detected by Western blotting and the expressions of VEGF and MMP-9 were immunohistochemically determined. Our result showed that the tumor size, expressions of Bax, Bcl-2 proteins, VEGF and MMP-9 were all lower than those in PBS and Ad-LacZ groups and the differences were statistically significant (P<0.05). Our study suggested that Ad-p27mt could inhibit the growth, invasion and metastasis of hepatic cancer by lowering the expressions of VEGF and MMP-9.
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Objective To assess the effects of p27mt gene transfection on the proliferation and apoptosis of human hepatocellular carcinoma cell (HCC) lines SMMC-7721. Methods A replication deficient adenovirus vector encoding p27mt (Ad-p27mt) was used and p27mt cDNA was transfected into human SMMC-7721 cell lines in vitro. The synthesis of DNA in SMMC-7721 cells was determined by using 3H-thymidine incorporation; the cell apoptosis was determined by flow cytometry, TUNEL method and DNA fragmentation analysis. Results The virus titer was 7.95?1012 cfu/ml, the transduction efficiency was 100 % when multiplicity of infection ≥50, FCM analysis revealed a sub-G1 cell peak in Ad-p27mt transduced hepatocellular carcinoma cell lines. Agarose electrophoresis showed marked ladder .The difference of apoptotic index between the Ad-p27mt group and the control group was statistically significant (58.6?4.3, vs 4.5?1.6, P
