In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
An acute respiratory disease,caused by a novel coronavirus(SARS-CoV-2,previously known as 2019-nCoV),the coronavirus disease 2019(COVID-19)has spread throughout China and received worldwide attention.On 30 January 202...An acute respiratory disease,caused by a novel coronavirus(SARS-CoV-2,previously known as 2019-nCoV),the coronavirus disease 2019(COVID-19)has spread throughout China and received worldwide attention.On 30 January 2020,World Health Organization(WHO)officially declared the COVID-19 epidemic as a public health emergency of international concern.The emergence of SARS-CoV-2,since the severe acute respiratory syndrome coronavirus(SARSCoV)in 2002 and Middle East respiratory syndrome coronavirus(MERS-CoV)in 2012,marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century.As of 1 March 2020,a total of 87,137 confirmed cases globally,79,968 confirmed in China and 7169 outside of China,with 2977 deaths(3.4%)had been reported by WHO.Meanwhile,several independent research groups have identified that SARS-CoV-2 belongs toβ-coronavirus,with highly identical genome to bat coronavirus,pointing to bat as the natural host.The novel coronavirus uses the same receptor,angiotensin-converting enzyme 2(ACE2)as that for SARS-CoV,and mainly spreads through the respiratory tract.Importantly,increasingly evidence showed sustained human-tohuman transmission,along with many exported cases across the globe.The clinical symptoms of COVID-19 patients include fever,cough,fatigue and a small population of patients appeared gastrointestinal infection symptoms.The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes,which may be associated with acute respiratory distress syndrome(ARDS)and cytokine storm.Currently,there are few specific antiviral strategies,but several potent candidates of antivirals and repurposed drugs are under urgent investigation.In this review,we summarized the latest research progress of the epidemiology,pathogenesis,and clinical characteristics of COVID-19,and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.展开更多
Background Since early December 2019,the 2019 novel coronavirus disease(COVID-19)has caused pneumonia epidemic in Wuhan,Hubei province of China.This study aimed to investigate the factors affecting the progression of ...Background Since early December 2019,the 2019 novel coronavirus disease(COVID-19)has caused pneumonia epidemic in Wuhan,Hubei province of China.This study aimed to investigate the factors affecting the progression of pneumonia in COVID-19 patients.Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia.Methods Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study.Patients were admitted to 3 tertiary hospitals in Wuhan between December 30,2019,and January 15,2020.Individual data,laboratory indices,imaging characteristics,and clinical data were collected,and statistical analysis was performed.Based on clinical typing results,the patients were divided into a progression group or an improvement/stabilization group.Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test.Categorical variables were analyzed using Chi-squared test or Fisher’s exact test.Logistic regression analysis was performed to explore the risk factors for disease progression.Results Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study.Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients(14.1%)had deteriorated,and 67 patients(85.9%)had improved/stabilized.The patients in the progression group were significantly older than those in the disease improvement/stabilization group(66[51,70]vs.37[32,41]years,U=4.932,P=0.001).The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group(27.3%vs.3.0%,χ^2=9.291,P=0.018).For all the 78 patients,fever was the most common initial symptom,and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group(38.2[37.8,38.6]vs.37.5[37.0,38.4]°C,U=2.057,P=0.027).Moreover,the proportion of patients with respiratory failure(54.5%vs.20.9%展开更多
Background:The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan,Hubei Province of China since December 2019.This study was performed to analyze the clinical characteristics of p...Background:The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan,Hubei Province of China since December 2019.This study was performed to analyze the clinical characteristics of patients who succumbed to and who recovered from 2019 novel coronavirus disease(COVID-19).Methods:Clinical data were collected from two tertiary hospitals in Wuhan.A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19(death group)and we compare them with recovered patients(recovered group).Continuous variables were analyzed using the Mann-WhitneyU test.Categorical variables were analyzed byχ2 test or Fisher exact test as appropriate.Results:Our study enrolled 109 COVID-19 patients who died during hospitalization and 116 recovered patients.The median age of the death group was older than the recovered group(69[62,74]vs.40[33,57]years,Z=9.738,P<0.001).More patients in the death group had underlying diseases(72.5%vs.41.4%,χ2=22.105,P<0.001).Patients in the death group had a significantly longer time of illness onset to hospitalization(10.0[6.5,12.0]vs.7.0[5.0,10.0]days,Z=3.216,P=0.001).On admission,the proportions of patients with symptoms of dyspnea(70.6%vs.19.0%,χ2=60.905,P<0.001)and expectoration(32.1%vs.12.1%,χ2=13.250,P<0.001)were significantly higher in the death group.The blood oxygen saturation was significantly lower in the death group(85[77,91]%vs.97[95,98]%,Z=10.625,P<0.001).The white blood cell(WBC)in death group was significantly higher on admission(7.23[4.87,11.17]vs.4.52[3.62,5.88]×109/L,Z=7.618,P<0.001).Patients in the death group exhibited significantly lower lymphocyte count(0.63[0.40,0.79]vs.1.00[0.72,1.27]×109/L,Z=8.037,P<0.001)and lymphocyte percentage(7.10[4.45,12.73]%vs.23.50[15.27,31.25]%,Z=10.315,P<0.001)on admission,and the lymphocyte percentage continued to decrease during hospitalization(7.10[4.45,12.73]%vs.2.91[1.79,6.13]%,Z=5.242,P<0.001).Alanine transaminase(22.00[15.00,34.00]vs.18.70[13.00,30.38]U/L,Z=2.592,P=0展开更多
The Delphi technique is a systematic process of forecasting using the collective opinion of panel members.The structured method of developing consensus among panel members using Delphi methodology has gained acceptanc...The Delphi technique is a systematic process of forecasting using the collective opinion of panel members.The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine.The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited,ethically/logistically difficult or evidence is conflicting.However,the attempts to assess the quality standard of Delphi studies have reported significant variance,and details of the process followed are usually unclear.We recommend systematic quality tools for evaluation of Delphi methodology;identification of problem area of research,selection of panel,anonymity of panelists,controlled feedback,iterative Delphi rounds,consensus criteria,analysis of consensus,closing criteria,and stability of the results.Based on these nine qualitative evaluation points,we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019.There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members,defining consensus,closing criteria for rounds,and presenting the results.We propose our evaluation points for researchers,medical journal editorial boards,and reviewers to evaluate the quality of the Delphi methods in healthcare research.展开更多
Background:The coronavirus disease 2019(COVID-19)is rapidly spreading in China and more than 30 countries over last two months.COVID-19 has multiple characteristics distinct from other infectious diseases,including hi...Background:The coronavirus disease 2019(COVID-19)is rapidly spreading in China and more than 30 countries over last two months.COVID-19 has multiple characteristics distinct from other infectious diseases,including high infectivity during incubation,time delay between real dynamics and daily observed number of confirmed cases,and the intervention effects of implemented quarantine and control measures.Methods:We develop a Susceptible,Un-quanrantined infected,Quarantined infected,Confirmed infected(SUQC)model to characterize the dynamics of COVID-19 and explicitly parameterize the intervention effects of control measures,which is more suitable for analysis than other existing epidemic models.Results:The SUQC model is applied to the daily released data of the confirmed infections to analyze the outbreak of COVID-19 in Wuhan,Hubei(excluding Wuhan),China(excluding Hubei)and four first-tier cities of China.We found that,before January 30,2020,all these regions except Beijing had a reproductive number R>\,and after January 30,all regions had a reproductive number/?<1,indicating that the quarantine and control measures are effective in preventing the spread of COVID-19.The confirmation rate of Wuhan estimated by our model is 0.0643,substantially lower than that of Hubei excluding Wuhan(0.1914),and that of China excluding Hubei(0.2189),but it jumps to 0.3229 after February 12 when clinical evidence was adopted in new diagnosis guidelines.The number of unquarantined infected cases in Wuhan on February 12,2020 is estimated to be 3,509 and declines to 334 on February 21,2020.After fitting the model with data as of February 21,2020,we predict that the end time of COVID-19 in Wuhan and Hubei is around late March,around mid March for China excluding Hubei,and before early March 2020 for the four tier-one cities.A total of 80,511 individuals are estimated to be infected in China,among which 49,510 are from Wuhan,17,679 from Hubei(excluding Wuhan),and the rest 13,322 from other regions of China(excluding Hubei).Note that the esti展开更多
Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreve...Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory failure.Lung transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.Methods:From February 10 to March 10,2020,three male patients were urgently assessed and listed for transplantation.After conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.Results:Two of the three recipients survived post-LT and started participating in a rehabilitation program.Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved.The pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the disease.Government health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.Conclusions:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis.If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical staffs.By ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.展开更多
Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)has posed a significant threat to global health.It caused a total of 80868 confirmed cases and 3101 deaths in Chin...Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)has posed a significant threat to global health.It caused a total of 80868 confirmed cases and 3101 deaths in Chinese mainland until March 8,2020.This novel virus spread mainly through respiratory droplets and close contact.As disease progressed,a series of complications tend to develop,especially in critically ill patients.Pathological findings showed representative features of acute respiratory distress syndrome and involvement of multiple organs.Apart from supportive care,no specific treatment has been established for COVID-19.The efficacy of some promising antivirals,convalescent plasma transfusion,and tocilizumab needs to be investigated by ongoing clinical trials.展开更多
Background:Medicines for the treatment of 2019-novel coronavirus(2019-nCoV)infections are urgently needed.However,drug screening using live 2019-nCoV requires high-level biosafety facilities,which imposes an obstacle ...Background:Medicines for the treatment of 2019-novel coronavirus(2019-nCoV)infections are urgently needed.However,drug screening using live 2019-nCoV requires high-level biosafety facilities,which imposes an obstacle for those institutions without such facilities or 2019-nCoV.This study aims to repurpose the clinically approved drugs for the treatment of coronavirus disease 2019(COVID-19)in a 2019-nCoV-related coronavirus model.Methods:A 2019-nCoV-related pangolin coronavirus GX_P2V/pangolin/2017/Guangxi was described.Whether GX_P2V uses angiotensin-converting enzyme 2(ACE2)as the cell receptor was investigated by using small interfering RNA(siRNA)-mediated silencing of ACE2.The pangolin coronavirus model was used to identify drug candidates for treating 2019-nCoV infection.Two libraries of 2406 clinically approved drugs were screened for their ability to inhibit cytopathic effects on Vero E6 cells by GX_P2V infection.The anti-viral activities and anti-viral mechanisms of potential drugs were further investigated.Viral yields of RNAs and infectious particles were quantified by quantitative real-time polymerase chain reaction(qRT-PCR)and plaque assay,respectively.Results:The spike protein of coronavirus GX_P2V shares 92.2%amino acid identity with that of 2019-nCoV isolate Wuhanhu-1,and uses ACE2 as the receptor for infection just like 2019-nCoV.Three drugs,including cepharanthine(CEP),selamectin,and mefloquine hydrochloride,exhibited complete inhibition of cytopathic effects in cell culture at 10μmol/L.CEP demonstrated the most potent inhibition of GX_P2V infection,with a concentration for 50%of maximal effect[EC50]of 0.98μmol/L.The viral RNA yield in cells treated with 10μmol/L CEP was 15,393-fold lower than in cells without CEP treatment([6.48±0.02]×10-4vs.1.00±0.12,t=150.38,P<0.001)at 72 h post-infection(p.i.).Plaque assays found no production of live viruses in media containing 10μmol/L CEP at 48 h p.i.Furthermore,we found CEP had potent anti-viral activities against both viral entry(0.46±0.12,vs.1.00�展开更多
Pneumonia caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection emerged in Wuhan City,Hubei Province,China in December 2019.By Feb.11,2020,the World Health Organization(WHO)officially named th...Pneumonia caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection emerged in Wuhan City,Hubei Province,China in December 2019.By Feb.11,2020,the World Health Organization(WHO)officially named the disease resulting from infection with SARS-Co V-2 as coronavirus disease 2019(COVID-19).COVID-19 represents a spectrum of clinical manifestations that typically include fever,dry cough,and fatigue,often with pulmonary involvement.SARS-CoV-2 is highly contagious and most individuals within the population at large are susceptible to infection.Wild animal hosts and infected patients are currently the main sources of disease which is transmitted via respiratory droplets and direct contact.Since the outbreak,the Chinese government and scientific community have acted rapidly to identify the causative agent and promptly shared the viral gene sequence,and have carried out measures to contain the epidemic.Meanwhile,recent research has revealed critical aspects of SARS-CoV-2 biology and disease pathogenesis;other studies have focused on epidemiology,clinical features,diagnosis,management,as well as drug and vaccine development.This review aims to summarize the latest research findings and to provide expert consensus.We will also share ongoing efforts and experience in China,which may provide insight on how to contain the epidemic and improve our understanding of this emerging infectious disease,together with updated guidance for prevention,control,and critical management of this pandemic.展开更多
Based on the announcement of the World Health Organization(WHO) in 2018, the Wuhan pneumonia caused by an unknown etiology should be recognized as the first Disease X. Later, the pathogen was identified to be a novel ...Based on the announcement of the World Health Organization(WHO) in 2018, the Wuhan pneumonia caused by an unknown etiology should be recognized as the first Disease X. Later, the pathogen was identified to be a novel coronavirus denoted 2019-nCoV, which has 79.5% and 96% whole genome sequence identify to SARS-CoV and bat SARS-related coronavirus(SARSr-CoV-RaTG13), respectively, suggesting its potential bat origin. With high human-to-human transmission rate(R0), 2019-nCoV has quickly spread in China and other countries, resulting in 34,953 confirmed cases and 725 deaths as of 8 February 2020, thus calling for urgent development of therapeutics and prophylactics. Here we suggest renaming 2019-nCoV as "transmissible acute respiratory syndrome coronavirus(TARS-CoV)" and briefly review the advancement of research and development of neutralizing antibodies and vaccines targeting the receptor-binding domain(RBD) and viral fusion inhibitors targeting the heptad repeat 1(HR1) domain in spike protein of 2019-nCoV.展开更多
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
基金by the National Natural Science Foundation of China(81870019)Guangdong Provincial Natural Science Foundation(2018A030313554)+2 种基金National Key R&D Program of China(2018YFC0910601)the National Medical Research Council,Singapore(NMRC/CIRG/1458/2016)a recipient of fellowship support from European Allergy and Clinical Immunology(EAACI)Research Fellowship 2019。
文摘An acute respiratory disease,caused by a novel coronavirus(SARS-CoV-2,previously known as 2019-nCoV),the coronavirus disease 2019(COVID-19)has spread throughout China and received worldwide attention.On 30 January 2020,World Health Organization(WHO)officially declared the COVID-19 epidemic as a public health emergency of international concern.The emergence of SARS-CoV-2,since the severe acute respiratory syndrome coronavirus(SARSCoV)in 2002 and Middle East respiratory syndrome coronavirus(MERS-CoV)in 2012,marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century.As of 1 March 2020,a total of 87,137 confirmed cases globally,79,968 confirmed in China and 7169 outside of China,with 2977 deaths(3.4%)had been reported by WHO.Meanwhile,several independent research groups have identified that SARS-CoV-2 belongs toβ-coronavirus,with highly identical genome to bat coronavirus,pointing to bat as the natural host.The novel coronavirus uses the same receptor,angiotensin-converting enzyme 2(ACE2)as that for SARS-CoV,and mainly spreads through the respiratory tract.Importantly,increasingly evidence showed sustained human-tohuman transmission,along with many exported cases across the globe.The clinical symptoms of COVID-19 patients include fever,cough,fatigue and a small population of patients appeared gastrointestinal infection symptoms.The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes,which may be associated with acute respiratory distress syndrome(ARDS)and cytokine storm.Currently,there are few specific antiviral strategies,but several potent candidates of antivirals and repurposed drugs are under urgent investigation.In this review,we summarized the latest research progress of the epidemiology,pathogenesis,and clinical characteristics of COVID-19,and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.
文摘Background Since early December 2019,the 2019 novel coronavirus disease(COVID-19)has caused pneumonia epidemic in Wuhan,Hubei province of China.This study aimed to investigate the factors affecting the progression of pneumonia in COVID-19 patients.Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia.Methods Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study.Patients were admitted to 3 tertiary hospitals in Wuhan between December 30,2019,and January 15,2020.Individual data,laboratory indices,imaging characteristics,and clinical data were collected,and statistical analysis was performed.Based on clinical typing results,the patients were divided into a progression group or an improvement/stabilization group.Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test.Categorical variables were analyzed using Chi-squared test or Fisher’s exact test.Logistic regression analysis was performed to explore the risk factors for disease progression.Results Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study.Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients(14.1%)had deteriorated,and 67 patients(85.9%)had improved/stabilized.The patients in the progression group were significantly older than those in the disease improvement/stabilization group(66[51,70]vs.37[32,41]years,U=4.932,P=0.001).The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group(27.3%vs.3.0%,χ^2=9.291,P=0.018).For all the 78 patients,fever was the most common initial symptom,and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group(38.2[37.8,38.6]vs.37.5[37.0,38.4]°C,U=2.057,P=0.027).Moreover,the proportion of patients with respiratory failure(54.5%vs.20.9%
文摘Background:The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan,Hubei Province of China since December 2019.This study was performed to analyze the clinical characteristics of patients who succumbed to and who recovered from 2019 novel coronavirus disease(COVID-19).Methods:Clinical data were collected from two tertiary hospitals in Wuhan.A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19(death group)and we compare them with recovered patients(recovered group).Continuous variables were analyzed using the Mann-WhitneyU test.Categorical variables were analyzed byχ2 test or Fisher exact test as appropriate.Results:Our study enrolled 109 COVID-19 patients who died during hospitalization and 116 recovered patients.The median age of the death group was older than the recovered group(69[62,74]vs.40[33,57]years,Z=9.738,P<0.001).More patients in the death group had underlying diseases(72.5%vs.41.4%,χ2=22.105,P<0.001).Patients in the death group had a significantly longer time of illness onset to hospitalization(10.0[6.5,12.0]vs.7.0[5.0,10.0]days,Z=3.216,P=0.001).On admission,the proportions of patients with symptoms of dyspnea(70.6%vs.19.0%,χ2=60.905,P<0.001)and expectoration(32.1%vs.12.1%,χ2=13.250,P<0.001)were significantly higher in the death group.The blood oxygen saturation was significantly lower in the death group(85[77,91]%vs.97[95,98]%,Z=10.625,P<0.001).The white blood cell(WBC)in death group was significantly higher on admission(7.23[4.87,11.17]vs.4.52[3.62,5.88]×109/L,Z=7.618,P<0.001).Patients in the death group exhibited significantly lower lymphocyte count(0.63[0.40,0.79]vs.1.00[0.72,1.27]×109/L,Z=8.037,P<0.001)and lymphocyte percentage(7.10[4.45,12.73]%vs.23.50[15.27,31.25]%,Z=10.315,P<0.001)on admission,and the lymphocyte percentage continued to decrease during hospitalization(7.10[4.45,12.73]%vs.2.91[1.79,6.13]%,Z=5.242,P<0.001).Alanine transaminase(22.00[15.00,34.00]vs.18.70[13.00,30.38]U/L,Z=2.592,P=0
文摘The Delphi technique is a systematic process of forecasting using the collective opinion of panel members.The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine.The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited,ethically/logistically difficult or evidence is conflicting.However,the attempts to assess the quality standard of Delphi studies have reported significant variance,and details of the process followed are usually unclear.We recommend systematic quality tools for evaluation of Delphi methodology;identification of problem area of research,selection of panel,anonymity of panelists,controlled feedback,iterative Delphi rounds,consensus criteria,analysis of consensus,closing criteria,and stability of the results.Based on these nine qualitative evaluation points,we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019.There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members,defining consensus,closing criteria for rounds,and presenting the results.We propose our evaluation points for researchers,medical journal editorial boards,and reviewers to evaluate the quality of the Delphi methods in healthcare research.
基金We are grateful to Drs.Yongbiao Xue and Liping Wang for motivating this project,to Dr.Hongyu Zhao and the anonymous reviewers for their valuable comments.This project was supported by the National Natural Science Foundation of China(Nos.31571370,91631106 and 91731302)the“Strategic Priority Research Program”of the Chinese Academy of Sciences(No.XDB13000000)the National Key R&D Program of China(No.2018YFC1406902),and the One Hundred Talents Program of the Chinese Academy of Sciences.
文摘Background:The coronavirus disease 2019(COVID-19)is rapidly spreading in China and more than 30 countries over last two months.COVID-19 has multiple characteristics distinct from other infectious diseases,including high infectivity during incubation,time delay between real dynamics and daily observed number of confirmed cases,and the intervention effects of implemented quarantine and control measures.Methods:We develop a Susceptible,Un-quanrantined infected,Quarantined infected,Confirmed infected(SUQC)model to characterize the dynamics of COVID-19 and explicitly parameterize the intervention effects of control measures,which is more suitable for analysis than other existing epidemic models.Results:The SUQC model is applied to the daily released data of the confirmed infections to analyze the outbreak of COVID-19 in Wuhan,Hubei(excluding Wuhan),China(excluding Hubei)and four first-tier cities of China.We found that,before January 30,2020,all these regions except Beijing had a reproductive number R>\,and after January 30,all regions had a reproductive number/?<1,indicating that the quarantine and control measures are effective in preventing the spread of COVID-19.The confirmation rate of Wuhan estimated by our model is 0.0643,substantially lower than that of Hubei excluding Wuhan(0.1914),and that of China excluding Hubei(0.2189),but it jumps to 0.3229 after February 12 when clinical evidence was adopted in new diagnosis guidelines.The number of unquarantined infected cases in Wuhan on February 12,2020 is estimated to be 3,509 and declines to 334 on February 21,2020.After fitting the model with data as of February 21,2020,we predict that the end time of COVID-19 in Wuhan and Hubei is around late March,around mid March for China excluding Hubei,and before early March 2020 for the four tier-one cities.A total of 80,511 individuals are estimated to be infected in China,among which 49,510 are from Wuhan,17,679 from Hubei(excluding Wuhan),and the rest 13,322 from other regions of China(excluding Hubei).Note that the esti
基金This study was supported by grants from the Chen Jingyu team of“Sanming Project of Medicine”in Shenzhen(No.SZSM201812058)the Foundation for Special Projects of COVID-19 Prevention and Control in Wuxi City.
文摘Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory failure.Lung transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.Methods:From February 10 to March 10,2020,three male patients were urgently assessed and listed for transplantation.After conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.Results:Two of the three recipients survived post-LT and started participating in a rehabilitation program.Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved.The pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the disease.Government health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.Conclusions:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis.If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical staffs.By ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
文摘Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)has posed a significant threat to global health.It caused a total of 80868 confirmed cases and 3101 deaths in Chinese mainland until March 8,2020.This novel virus spread mainly through respiratory droplets and close contact.As disease progressed,a series of complications tend to develop,especially in critically ill patients.Pathological findings showed representative features of acute respiratory distress syndrome and involvement of multiple organs.Apart from supportive care,no specific treatment has been established for COVID-19.The efficacy of some promising antivirals,convalescent plasma transfusion,and tocilizumab needs to be investigated by ongoing clinical trials.
基金This work was supported by a project from Ministry of Science and Technology of China(No.2020YFC0840805)Key Project of Beijing University of Chemical Technology(No.X K 1803-06),Fundamental Research Funds for Central Universities(No.BUCTRC201917),and a.start-up funding for Dr.Yi-Gang Tong from Beijing Advanced Innovation Center for Soft Matter Science and Engineering.
文摘Background:Medicines for the treatment of 2019-novel coronavirus(2019-nCoV)infections are urgently needed.However,drug screening using live 2019-nCoV requires high-level biosafety facilities,which imposes an obstacle for those institutions without such facilities or 2019-nCoV.This study aims to repurpose the clinically approved drugs for the treatment of coronavirus disease 2019(COVID-19)in a 2019-nCoV-related coronavirus model.Methods:A 2019-nCoV-related pangolin coronavirus GX_P2V/pangolin/2017/Guangxi was described.Whether GX_P2V uses angiotensin-converting enzyme 2(ACE2)as the cell receptor was investigated by using small interfering RNA(siRNA)-mediated silencing of ACE2.The pangolin coronavirus model was used to identify drug candidates for treating 2019-nCoV infection.Two libraries of 2406 clinically approved drugs were screened for their ability to inhibit cytopathic effects on Vero E6 cells by GX_P2V infection.The anti-viral activities and anti-viral mechanisms of potential drugs were further investigated.Viral yields of RNAs and infectious particles were quantified by quantitative real-time polymerase chain reaction(qRT-PCR)and plaque assay,respectively.Results:The spike protein of coronavirus GX_P2V shares 92.2%amino acid identity with that of 2019-nCoV isolate Wuhanhu-1,and uses ACE2 as the receptor for infection just like 2019-nCoV.Three drugs,including cepharanthine(CEP),selamectin,and mefloquine hydrochloride,exhibited complete inhibition of cytopathic effects in cell culture at 10μmol/L.CEP demonstrated the most potent inhibition of GX_P2V infection,with a concentration for 50%of maximal effect[EC50]of 0.98μmol/L.The viral RNA yield in cells treated with 10μmol/L CEP was 15,393-fold lower than in cells without CEP treatment([6.48±0.02]×10-4vs.1.00±0.12,t=150.38,P<0.001)at 72 h post-infection(p.i.).Plaque assays found no production of live viruses in media containing 10μmol/L CEP at 48 h p.i.Furthermore,we found CEP had potent anti-viral activities against both viral entry(0.46±0.12,vs.1.00�
文摘Pneumonia caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection emerged in Wuhan City,Hubei Province,China in December 2019.By Feb.11,2020,the World Health Organization(WHO)officially named the disease resulting from infection with SARS-Co V-2 as coronavirus disease 2019(COVID-19).COVID-19 represents a spectrum of clinical manifestations that typically include fever,dry cough,and fatigue,often with pulmonary involvement.SARS-CoV-2 is highly contagious and most individuals within the population at large are susceptible to infection.Wild animal hosts and infected patients are currently the main sources of disease which is transmitted via respiratory droplets and direct contact.Since the outbreak,the Chinese government and scientific community have acted rapidly to identify the causative agent and promptly shared the viral gene sequence,and have carried out measures to contain the epidemic.Meanwhile,recent research has revealed critical aspects of SARS-CoV-2 biology and disease pathogenesis;other studies have focused on epidemiology,clinical features,diagnosis,management,as well as drug and vaccine development.This review aims to summarize the latest research findings and to provide expert consensus.We will also share ongoing efforts and experience in China,which may provide insight on how to contain the epidemic and improve our understanding of this emerging infectious disease,together with updated guidance for prevention,control,and critical management of this pandemic.
文摘Based on the announcement of the World Health Organization(WHO) in 2018, the Wuhan pneumonia caused by an unknown etiology should be recognized as the first Disease X. Later, the pathogen was identified to be a novel coronavirus denoted 2019-nCoV, which has 79.5% and 96% whole genome sequence identify to SARS-CoV and bat SARS-related coronavirus(SARSr-CoV-RaTG13), respectively, suggesting its potential bat origin. With high human-to-human transmission rate(R0), 2019-nCoV has quickly spread in China and other countries, resulting in 34,953 confirmed cases and 725 deaths as of 8 February 2020, thus calling for urgent development of therapeutics and prophylactics. Here we suggest renaming 2019-nCoV as "transmissible acute respiratory syndrome coronavirus(TARS-CoV)" and briefly review the advancement of research and development of neutralizing antibodies and vaccines targeting the receptor-binding domain(RBD) and viral fusion inhibitors targeting the heptad repeat 1(HR1) domain in spike protein of 2019-nCoV.
