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BackgroundSince the pandemic outbreak of coronavirus disease 2019 (COVID-19), the health system capacity in highly endemic areas has been overwhelmed. Approaches to efficient management are urgently needed. We aimed to develop and validate a score for early prediction of clinical deterioration of COVID-19 patients. MethodsIn this retrospective multicenter cohort study, we included 1138 mild to moderate COVID-19 patients admitted to 33 hospitals in Guangdong Province from December 27, 2019 to March 4, 2020 (N =818; training cohort), as well as two hospitals in Hubei Province from January 21 to February 22, 2020 (N =320; validation cohort) in the analysis. ResultsThe 14-day cumulative incidences of clinical deterioration were 7.9% and 12.1% in the training and validation cohorts, respectively. An Early WArning Score (EWAS) (ranging from 0 to 4.5), comprising of age, underlying chronic disease, neutrophil to lymphocyte ratio, C-reactive protein, and D-dimer levels, was developed (AUROC: 0.857). By applying the EWAS, patients were categorized into low-, medium-, and high risk groups (cut-off values: two and three). The 14-day cumulative incidence of clinical deterioration in the low-risk group was 1.8%, which was significantly lower than the incidence rates in the medium-(14.4%) and high-risk (40.9%) groups (P <.001). The predictability of EWAS was similar in the validation cohort (AUROC =0.781), patients in the low-, medium-, and high-risk groups had 14-day cumulative incidences of 2.6%, 10.0%, and 25.7%, respectively (P <.001). ConclusionThe EWAS, which is based on five common parameters, can predict COVID-19-related clinical deterioration and may be a useful tool for a rapid triage and establishing a COVID-19 hierarchical management system that will greatly focus clinical management and medical resources to reduce mortality in highly endemic areas.
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BackgroundSince the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) outbreaks in Wuhan, China, healthcare systems capacities in highly endemic areas have been overwhelmed. Approaches to efficient management are urgently needed and key to a quicker control of the outbreaks and casualties. We aimed to characterize the clinical features of hospitalized patients with confirmed or suspected COVID-19, and develop a mortality risk index for COVID-19 patients. MethodsIn this retrospective one-centre cohort study, we included all the confirmed or suspected COVID-19 patients hospitalized in a COVID-19-designated hospital from January 21 to February 5, 2020. Demographic, clinical, laboratory, radiological and clinical outcome data were collected from the hospital information system, nursing records and laboratory reports. ResultsOf 577 patients with at least one post-admission evaluation, the median age was 55 years (interquartile range [IQR], 39 - 66); 254 (44.0%) were men; 22.8% (100/438) were severe pneumonia on admission, and 37.7% (75/199) patients were SARS-CoV-2 positive. The clinical, laboratory and radiological data were comparable between positive and negative SARS-CoV-2 patients. During a median follow-up of 8.4 days (IQR, 5.8 - 12.0), 39 patients died with a 12-day cumulative mortality of 8.7% (95% CI, 5.9% to 11.5%). A simple mortality risk index (called ACP index), composed of Age and C-reactive Protein, was developed. By applying the ACP index, patients were categorized into three grades. The 12-day cumulative mortality in grade three (age [≥] 60 years and CRP [≥] 34 mg/L) was 33.2% (95% CI, 19.8% to 44.3%), which was significantly higher than those of grade two (age [≥] 60 years and CRP < 34 mg/L; age < 60 years and CRP [≥] 34 mg/L; 5.6% [95% CI, 0 to 11.3%]) and grade one (age < 60 years and CRP < 34 mg/L, 0%) (P <0.001), respectively. ConclusionThe ACP index can predict COVID-19 related short-term mortality, which may be a useful and convenient tool for quickly establishing a COVID-19 hierarchical management system that can greatly reduce the medical burden and therefore mortality in highly endemic areas.
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Objective To analyze the changes and clinical significance of serum Endostatin(ES)and vascular endothelial growth factor(VEGF)levels in patients with differentiated thyroid cancer after surgical resection or metastasis.Methods Seventy-three patients with differentiated thyroid carcinoma from January 2014 to January 2016 were enrolled in the study(the case group), all patients underwent radical thyroidectomy.The patients were divided into the distant metastasis group(32 cases),local recurrence group (23 cases)and non recurrence group(18 cases)according to local recurrence or distant metastasis after operation.40 healthy outpatients were selected as the control group.The serum levels of ES and VEGF in each group were compared,and the correlation were analyzed.Results In the preoperative time,the serum ES( (31.27±7.53)μg/mL)and VEGF((456.81 ± 112.49)ng/L)levels in the case group were significantly higher than those in the control group((20.93±4.14)μg/mL,(118.27±34.09)ng/L),the differences were statistically significant(t=8.034,18.540,P<0.05);the postoperative serum ES((25.76±6.69)μg/mL)and VEGF((217.64±56.87)ng/L)levels were significantly lower than the preoperative ones,the differences were statistically significant(t=4.674,16.212,P<0.05); the serum ES((44.56 ± 9.34)μg/mL)and VEGF ((789.24 + 194.63)ng/L)in the distant metastasis group were significantly higher than those in the local recurrence group((36.29± 8.52)μg/mL,(612.07± 186.32)ng/L)and the nonrecurrence group((28.03 ±7.16)μg/mL,(268.95± 79.82)ng/L),the differences among the 3 groups were statistically significant(F=14.052,15.346,P<0.05);the data of the local recurrence group was higher than that in the non recurrent group,the differences were statistically significant(P<0.05);Correlation analysis showed that serum ES and VEGF were positively correlated with thyroglobulin(Thyroglobulin,Tg)in patients with recurrence and metastasis(r=0.583,0.726,P<0.05).Conclusion The serum levels of ES and VEGF in patients with differentiated thyroid cancer after operation were significantly higher than those in patients with differentiated thyroid cancer,which had certain clinical value in evaluating the recurrence or metastasis of differentiated thyroid cancer patients.
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Objective In order to know the application effects of transcatheter hepatic artery chemoembolization for patients with liver cancer. Methods Divided 144 liver cancer patients into the experimental group and the control group randomly, there were 82 cases in each group. Routine nursing cares were used in the control group, humanized nursing were used in the experimental group in addition. Compared the curative effect, incidence rate of complication and scores of SAS and SDS between the two groups. Results The curative effect in the experimental group was significant better than in the control, the incidence rate of complications were lower in the experimental group than those of in the control group. Before out of hospital, the SAS and SDS level in the experimental group was better than in the control group. Conclusions Humanized nursing can enhance the curative effec4 avoid disputs between patients and nurses, and then promote nurses' working interesting.
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BACKGROUND:During the outbreak of severe acute respiratory syndrome(SARS),certain people had been isolated by various reasons and appeared a series of psychological, physical and behavioral reactions. OBJECTIVE:To understand the different defensive features in people with different level of mental health in the isolated population, and explore the relationship between defensive style and mental health. DESIGN:An in investigative study taking the isolated population during outbreak of SARS as the subjects. SETTING:A psychiatric department of a military hospital. PARTICIPANTS:Totally 187 people of different sex,age and education, who were isolated during April and May 2003 due to SARS outbreak in a city of northwest China,were selected as the subjects. INTERVENTIONS:The 187 subjects,who were isolated due to SARS outbreak,were evaluated by using the symptom checklist(SCL 90) and defense style questionnaire(DSQ). RESULTS:About 36.4% people of this population had distinct mental or physical health problems that were characterized by anxiety,horror,depression,hostility and compulsion.There was difference in defensive styles between the high symptom group and low symptom group,among which the score of DSQ factors in the immature type of high and low symptom groups were 5.72± 1.56 and 4.35± 0.96 respectively while the scores in the intermediate type defense were 4.98± 1.44 and 3.72± 0.89 respectively(P< 0.01).Mental health problem was positively correlated with the application of immature defensive style,but had negative correlation with application of mature defensive means. CONCLUSION:There is difference in the defensive styles among the isolated people with different mental health status,and their defensive strategies are closely related to the mental health.
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The relationship of the flow velocity of ovarian artery to the follicular growth and genital endocrine hormone was observed in 36 normal and 32 infertile women by transvaginal color Doppler imaging(TVCD). The result showed that before and after ovulation, the peak flow velocity occurred in 87 % normal women i the diestolic flow waveforms had high amplitude with low impedance, the diameters of the follicles were large, the blood E2 and LH increased and attained the peak values. However, during the time of early follicular development and late stage of luteum, the diastolic flow waveforms had low amplitude with high impedance and the blood levels of E2 and LH were low. This suggests that a close relationship exists in the flow velocity and waveform of ovarian artery to the follicular development and genital endocrine hormone. In most cases of the infertile group, the diastolic flow of ovarian arteries showed with low amplilude with high impedance > there were no mature follicle with irregular change of ovarian steriods. The study indicats that this technique may forecast the time of ovulation and investigate the causes of infertility.
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Objective To solve problems of ice bag in process of physical cooling for high fever patient, which is contacted area small and fixed difficulty and so on, and develop a new ice capsule for all kinds of special-site cooling. Methods Selecting glycol liquor, thin aluminum plate, high-density sponge, flexible plastic and other materials and according to clay characteristics, producing 12 different types of shaping ice capsule. Results "Wear-capsule of medical care" was developed in 2002 and assessed to national patents of utility model. The flexible shaping liquid ice capsule was declared national invention patents in 2007. Conclusion The liquid flexible ice capsule can not be coagulated, wear conveniently, applicable to each kind of different spot and had good cooling effect.
