ABSTRACT
BACKGROUNDCoronavirus Disease 2019 (COVID-19) has recently become a public emergency and a worldwide pandemic. The clinical symptoms of severe and non-severe patients vary, and the case-fatality rate (CFR) in severe COVID-19 patients is very high. However, the information on the risk factors associated with the severity of COVID-19 and of their prognostic potential is limited. METHODSIn this retrospective study, the clinical characteristics, laboratory findings, treatment and outcome data were collected and analyzed from 223 COVID-19 patients stratified into 125 non-severe patients and 98 severe patients. In addition, a pooled large-scale meta-analysis of 1646 cases was performed. RESULTSWe found that the age, gender and comorbidities are the common risk factors associated with the severity of COVID-19. For the diagnosis markers, we found that the levels of D-dimer, C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT) were significantly higher in severe group compared with the non-severe group on admission (D-Dimer: 87.3% vs. 35.3%, P<0.001; CRP, 65.1% vs. 13.5%, P<0.001; LDH: 83.9% vs. 22.2%, P<0.001; PCT: 35.1% vs. 2.2%, P<0.001), while the levels of aspartate aminotransferase (ASP) and creatinine kinase (CK) were only mildly increased. We also made a large scale meta-analysis of 1646 cases combined with 4 related literatures, and further confirmed the relationship between the COVID-19 severity and these risk factors. Moreover, we tracked dynamic changes during the process of COVID-19, and found CRP, D-dimer, LDH, PCT kept in high levels in severe patient. Among all these markers, D-dimer increased remarkably in severe patients and mostly related with the case-fatality rate (CFR). We found adjuvant antithrombotic treatment in some severe patients achieved good therapeutic effect in the cohort. CONCLUSIONSThe diagnosis markers CRP, D-dimer, LDH and PCT are associated with severity of COVID-19. Among these markers, D-dimer is sensitive for both severity and CFR of COVID-19. Treatment with heparin or other anticoagulants may be beneficial for COVID-19 patients. FundingThis study was supported by funding from the National Key Research and Development Program of China (2016YFC1302203); Beijing Nova Program (grant number: xx2018040). Role of the funding sourceThe funding listed above supports this study, but had no role in the design and conduct of the study.
ABSTRACT
Objective To assess the value of free-hand transperineal multiparametric nagnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted biopsy (TB) for the diagnosis of prostate cancer(PCa).Methods Patients with elevated PSA level and/or an abnormal DRE finding were recruited prospectively between January 2015 and September 2016.Patients were classified to various scores from 2 to 5 according to prebiopsy mpMRI PI-RADS.Based on free-hand transperineal mpMRI/TRUS fusion-guiding,a 2-cores TB for each cancer-suspicious lesion were carried out and followed 12-cores systematic biopsy (SB) protocol.Pathological findings of biopsy and radical prostatectomy (RP) specimens were analyzed.Results A total of 397 patients were enrolled in this study.The median age of the patients was (68.2 ± 7.4) years old,ranging 42-78 years.The median PSA level was (15.0 ±12.4)ng/ml,ranging 3.0-88.3 ng/ml.DRE showed abnormality in 28 patients(7.1％).The median prostate volume was (41.6 ± 16.4)cm3,ranging 24.6-89.8 cm3.The PCa detection rate of TB was significantly increased compared with SB (44.8 ％ vs.34.8％) (P =0.003),especially in clinically significant PCa (P ＜ 0.001) and intermediate/high-risk PCa (P =0.003),respectively.Of the all 588 mpMRI targeted lesions,277 lesions were positive.A total of 105 index tumors were identified in RP specimens,the locations of TB-proven cancer showed 96.6％ (85/88) in correspondence with the location of the index lesion in RP specimens.Conclusions Free-hand transperineal mpMRI/TRUS fusion-guided TB providing greater detection of intermediate-high risk PCa while limits over detection of low risk PCa.Moreover,TB can reliably predict the location of an index tumor.
ABSTRACT
Objective To observe the clinical effects and safety of scalp-body acupuncture and spine-manipulation therapy on preventively treating cervical cancer patients with postoperative urinary retention. Methods A total of 160 cases of cervical cancer patients with postoperative urinary retention were randomized into treatment group and control group, 80 cases in each group. Both groups were given conventional western medical treatment including preoperative indwelling of urethral catheter, clamping of urethral catheter 5 d after operation and release of the urine every 2-3 h, and trying to remove the urethral catheter 10-12 d after operation. Additionally, the treatment group received scalp acupuncture in the foot motor sensory area, body acupuncture of bilateral Shenshu (BL23) , Pangguangshu (BL28) , Ciliao (BL32) acupoints, and spine-manipulation therapy 5 d after operation. The clinical outcomes covered the incidence of urinary retention, residual urine volume, reset rate of catheter, and the clinical effect and safety in the two groups were evaluated. Results ( 1) The therapeutic effect of the treatment group was superior to that of the control group, and then the difference was significant (P<0.05). (2) After treatment, the incidence of urinary retention, residual urine volume, reset rate of catheter and average hospitalization days were less in the treatment group than those in the control group, the differences being significant ( P<0.05). ( 3) There was no adverse reaction during the treatment course. Conclusion Scalp acupuncture in the foot motor sensory area combined with body acupuncture and spine-manipulation therapy can promote the recovery of micturation function, and have satisfactory clinical effect and high safety in preventively treating cervical cancer with postoperative urinary retention.
