Medicine

IntroductionThe optimal dosage of dexmedetomidine (DEX) as an adjuvant combined with ropivacaine for postoperative analgesia in laparoscopic myomectomy is still controversial. The main aim of this prospective clinical trial was to evaluate the analgesic effect and relevant adverse effects of different doses of dexmedetomidine applied locally for ropivacaine-induced bilateral transmuscular quadratus lumborum block (TQLB). MethodsTQLB was conducted using different doses of dexmedetomidine per side (R group: control group; DEX1 group: 0.1g/kg; DEX2 group: 0.3g/kg; DEX3 group: 0.5g/kg). Numeric rating scales (NRS) of pain score, heart rate (HR) and blood pressure (BP) were assessed at different time points after performing TQLB. Dosage of additional analgesics via patient-controlled analgesia pump, recovery time for anal exsufflation, hospital stay and clinical events such as nausea, vomiting and pruritus were also compared among groups. ResultsA total of 200 patients underwent laparoscopic myomectomy were enrolled in this study and divided into 4 groups (R, DEX1, DEX2 and DEX3 group) randomly, 50 for each group. Compared with R group, NRS pain score was significantly lower in DEX2 group and DEX3group (p<0.001) 10 minutes after TQLB. Twenty minutes after TQLB, statistical significance of NRS pain score appeared between DEX1 group and R group (p<0.05) and between DEX2, 3 group and DEX1 group (p<0.001). In comparison to R group and DEX1 group, NRS pain score in DEX2 and DEX3 group were lower within 24 hours postoperatively (p<0.05). HR in DEX2 group and DEX3 group was significantly lower than DEX1 group and R group (p<0.05). 2 patients in DEX2 and DEX3 group were developed severe low HR of which HR was below 50bpm. Even 6 hours after surgery, patients in DEX3 group still remained severe low HR. Patients in DEX2 group and DEX3 group needed fewer PCA bolus deliveries than patients in R group and DEX1 group (p<0.001). Satisfaction score of postoperative analgesia was higher in DEX2 group and DEX3 group in comparison to DEX1 group and R group (p<0.001).group and DEX3 group in comparison to DEX1 group and R group (p<0.001). Conclusion0.3g/kg per side of dexmedetomidine as an adjuvant for TQLB was recommended to effectively relieve postoperative pain after laparoscopic myomectomy. Trial registrationChinese Clinical Trial Registry with registration number ChiCTR1900028509. Date of registration: 24 November 2019. http://www.chictr.org.cn/edit.aspx?pid=42635=htm=4

BackgroundSince December 2019, Coronavirus Disease 2019 (COVID-19) emerged in Wuhan city and rapidly spread throughout China. The mortality of novel coronavirus pneumonia (NCP) in severe and critical cases is very high. Facing this kind of public health emergency, high efficient administrative emergency responsive mode in designated hospital is needed. MethodAs an affiliated hospital of Sun Yat-sen University, our hospital is the only designated one for diagnosis and treatment of COVID-19 in Zhuhai, a medium-sized city. Novel coronavirus pneumonia department, which is administrative led by the president of hospital directly, has been established at early stage of epidemic crisis in my hospital. In NCP department, there are core members of Pulmonary and Critical Care Medicine (PCCM) specialist and multidisciplinary team. Dont stick to national guidelines of NCP, based on professional opinion by respiratory professor and expert group, we focused on individualized treatment and timely adjustment of treatment and management strategies in working about COVID-19 patients. Results1. High working efficiency: By Mar 02, 2020, we have completed 2974 citywide consultations and treatment of 366 inpatients, including 101 patients diagnosed with COVID-19. 2. Excellent therapeutic effect: Among 101 hospitalized patients with confirmed COVID-19, all were cured and discharged, except for one death. No secondary hospital infection, no pipeline infection and no pressure sore were found in all patients. 3. Finding and confirming person-to-person transmission characteristic of COVID-19 prior to official release conference: Strengthened protection is key point to zero infection in healthcare group and medical faculty and lower rate of second generation infectious patients. 4. Timely adjustment management and treatment strategy prior to guideline update: The first evidence of digestive tract involvement in COVID-19 has been found, and the earliest clinical trial of chloroquine in the treatment of COVID-19 has been carried out in our hospital. ConclusionsIn our hospital, establishment of NCP department, which is administratively led by the president of hospital directly and specialized conduct by respiratory professor, is the key to success in management and treatment of COVID-19 patients. This hospital emergency responsive mode could provide reference for other hospitals and cities in epidemic situation.

BackgroundFibrosis in most organs has proven to be an critical factor related to high risk of morbidity and mortality, but an adequate assessment of fibrosis severity is still challenging. This study tried to evaluate fibrosis severity through a fibrosis transcriptional signature. MethodsA fibrosis transcriptional signature was developed through an integrated analysis of multiple expression profiling datasets of human organs with fibrosis-related diseases. A fibrosis severity score for each sample was the calculated through gene set variation analysis (GSVA), and its role in evaluating fibrosis severity was then analyzed. ResultsTen expression profiling datasets of human tissues with organ failure were integrated with robust rank aggregation method, and a fibrosis severity score consisting of 149 genes. Most of those included genes were involved in fibrogenic pathways. GSEA analysis revealed that fibrosis transcriptional signature was significantly enriched in the fibrogenic tissues. Additionally, we found that fibrosis transcriptional signature could effectively differentiate fibrosis tissues and non-fibrosis tissues. ConclusionThis study developed an useful fibrosis transcriptional signature involved in fibrosis-related diseases. This fibrosis transcriptional signature is helpful in precisely evaluating the fibrosis severity in common organs at the transcriptional level.

Although immune checkpoint inhibitors have illustrated strong benefits in patient survival and have been widely acknowledged in treating lung cancer, they may be subject to increased risk of immune-related adverse effects (irAEs). Although existing literature have studied the mechanisms of irAEs of immunotherapy, it is difficult to quantify such effect, especially at a large-scale real-world population level. In this paper, the autoimmune-related risk of multiple immune checkpoint inhibitors is compared with that of chemotherapy based on Medicaid and CHIP TAF (T-MSIS Analytic File) data of over 100,000 patient samples from 2012 to 2018. Results show that the irAEs of immunotherapy is significantly higher than chemotherapy in both unadjusted and adjusted samples from the dataset. Analysis on subpopulation and specific disease types further shows that certain immunotherapy treatments are associated with higher risk of irAEs, and the risk of certain autoimmune diseases may vary. We also illustrate the robustness of our conclusion through additional sensitivity analysis, confirming the necessity of keeping track of autoimmune side effects of immune checkpoint inhibitors for medicine researchers. Our methods are also available to evaluate effectiveness and side effects of novel therapies at a large-scale population level.

PurposeTo explore the influence of preoperative vagus nerve block (VNB) on postoperative nausea and vomiting (PONV) in patients undergoing thoracic or abdominal laparoscopic surgery. MethodsPatients were randomly divided into the VNB group (V group, n=60) and the control group (C group, n=60). The V group received left VNB before anesthesia induction, while the C group did not receive any intervention. The incidence and severity of PONV within one day after surgery were compared between the two groups to evaluate the effect of left VNB on PONV in patients. ResultsThe incidence of PONV in the V group (25%) was significantly lower than that in the C group (60%) ({chi}2 = 15.038, P < 0.001). The incidences of mild and severe PONV in the V group were 16.67% and 8.33%, respectively, while those in the C group were 36.67% and 23.33%, respectively. The differences between the two groups were significant (mild: {chi}2 = 6.136, P = 0.013; severe: {chi}2 = 5.065, P = 0.024). ConclusionLeft VNB can reduce the incidence and severity of PONV caused by thoracic or abdominal laparoscopic surgery.

IntroductionWith the widely used technique of One Lung Ventilation (OLV) in patients throughout thoracic surgery, its unclear whether inhaled or intravenous anesthetics were associated with postoperative complications. The purpose of the current study is to compare the effects of intravenous and inhaled anesthetics on the postoperative complications within the patients suffering OLV. MethodsWe searched the related randomized controlled trials in PubMed\EMBASE\Medline and the Cochrane library up to 09\2021.Inclusive criteria were as follows: We included all the randomized controlled trials which compared the effects of intravenous and inhaled anesthetics on the postoperative complications[listed as: (a) major complications; (b)postoperative pulmonary complications (PPCs); (c) postoperative cognitive function (MMSE score); (d) length of hospital stay; (e) 30-days mortality] for the patients undergoing one lung ventilation. ResultsThirteen randomized controlled trials with 2522 patients were included for analysis. Overall, there were no significant differences in the postoperative major complications between inhaled and intravenous anesthetics groups (OR 0.78, 95%CI 0.54 to 1.13, p=0.19; I2=0%). However, more PPCs were detected in intravenous groups when compared to inhaled groups (OR 0.62, 95%CI 0.44 to 0.87, p=0.005; I2=37%). Both the postoperative MMSE scores (SMD -1.94, 95%CI -4.87 to 0.99, p=0.19; I2=100%) and the length of hospital stay (SMD 0.05, 95%CI -0.29 to 0.39, p=0.76; I2=73%) were comparable between two groups. Besides, the 30-day mortality didnt differ significantly across groups either (OR 0.79, 95%CI 0.03 to 18, p=0.88; I2=63%). ConclusionsIn patients undergoing OLV, generous anesthesia with inhaled anesthetics could reduce PPCs compared with intravenous anesthetics, but no evident advantages were provided over other major complications, cognitive function, hospital stay or mortality.

BackgroundNowadays, the combination of CAG regimen with targeted therapy and immunotherapy has greatly improved the prognosis of AML patients, but there are controversies about the prognostic factors of CAG regimen alone, especially in AML elders. ObjectiveBy investigating the survival status of elder patients who received induction CAG regimen in our hospital at the beginning of this century and analyzing the factors affecting survival, we aim to provide scientific evidence for improving the survival of current patients. MethodThe AML elder patients treated with induction CAG regimen including low-dose cytarabine (10 mg/m2 per 12 hours, day 1 to 14), aclarubicin(14 mg/m 2 per day, day 1 to 4), and G-CSF priming (200 ug / m2 per day, day 1 to 14) in Fujian Medical University Union Hospital from January 2001 to December 2009 were involved in this research. ResultsAmong 92 elderly AML patients, 44 (47.8%) showed clinical efficacy, while 48 (52.2%) experienced treatment failure (including 12 deaths (13.0%)). The main adverse reactions of chemotherapy were bone marrow suppression, with mild non hematological adverse reactions. The median recurrence time was 7 months. The risk factors related efficacy were high blasts, elevated LDH and HBDH. ConclusionThe CAG regimen is suitable for elderly patients and can be used for the treatment of relapsed refractory AML and secondary AML. The CAG regimen has mild non hematological adverse reactions. After chemotherapy, there is a longer bone marrow suppression period and a higher infection rate; The reason for the improved efficacy of CAG regimen in current patients may be related to the effective reduction of tumor burden during induction combined with target or immunotherapy.

ImportanceTraditional Chinese Medicine (TCM) becomes popular in Switzerland, however, Swiss TCM research activity and scientific output have not been investigated. ObjectiveTo describe the Swiss TCM research activities and main health conditions studied. Data SourceA systematic literature search of PubMed and Embase was performed from database inception to December 31st, 2023. Study SelectionArticles describing a TCM-related therapy modality in humans with at least one author affiliated with a Swiss institution. Data ExtractionPrimary and secondary outcomes, as well as study and author characteristics were extracted from included articles. Main Outcomes and MeasuresThe main outcome was the main health condition studied. Secondary outcomes are the total number of articles published over time, the TCM therapies used, and the Swiss institutions involved. ResultsOf the 223 articles included, 68.2% of published articles originated from the top 3 of 73 (4.1%) Swiss institutions, namely the University of Zurich (32.3%), University of Bern (30.0%) and University of Basel (7.6%). Overall, 116 (52.0%) articles described original studies including 36 (31.0%) articles reporting findings from randomized clinical trials, 29 (25.0%) from cross-sectional studies, 20 (17.2%) from prospective cohort studies, 19 (16.4%) from case reports and 12 (10.3%) from retrospective studies. The top health categories studied were Pain Management (16.4%), Psychology and Behaviour (8.6%), Neurology (6.9%), and Oncology (6.9%). The most used TCM therapies were acupuncture or moxibustion (61.2%), combination of several treatments (15.5%), herbal medicine (10.3%), and Qi Gong or martial arts (9.5%). Conclusion and RelevanceUntil 2023, the total number of scientific TCM output by Swiss authors is steadily increasing but remains small. More effort to conducted TCM research and to elucidate the TCM therapy effects in Switzerland is warranted. RegistrationPROSPERO No. CRD42023432693.

ObjectiveThis study aims to conduct a systematic review of the effectiveness and safety of Tripterygium Glycosides interventions in the treatment of Chinese patients with thyroid-associated orbitopathy (TAO). MethodsA literature search was conducted using PubMed for English sources, and the CNKI, Chinese Biomedical Database, Wanfang Database, and VIP Database for Chinese sources. The search period extended from the beginning of the databases creation to Dec. 2023. The keywords used in the search were hyperthyroidism, thyroid-related immune orbitopathy (TRIO), ophthalmopathy, and Tripterygium Glycosides. Various combinations of search terms were used, depending on the database being queried. All the trials included in the study were clinical randomized controlled trials (RCTs). Results33 RCTs or quasi-RCTs that met the inclusion criteria were included. The meta-analysis included 27 RCTs. 6 RCTs were excluded from the analysis due to the absence of a control group, but they were still included in the systematic review. 27 RCTs or quasi-RCTs involving 2,134 patients were included in the meta-analysis. The TRIO patients in the treatment group received Tripterygium Glycosides in combination with Thiamazole, Prednisone, Levothyroxine sodium, or a combination of these medications. While the TRIO patients in the control group were treated with Thiamazole, Prednisone, Levothyroxine sodium, or a combination of these treatments, the meta-analysis results show that the overall effectiveness rate of the treatment group and the control group was P = 0.05, I2 = 0.33 < 0.5 [MD = 4.45, 95% CI (3.31, 5.99), P < 0. 00001]. The former was significantly superior to the latter. At the same time, a risk assessment was conducted for the study of the 2 groups. The former was significantly superior to the latter. Furthermore, the clinical effectiveness rate of eyeball prominence was P < 0. 00001, I2 = 0.98 > 0.5 [MD = 2.40, 95% CI (2.28, 2.51), P < 0. 00001]. The clinical effectiveness rate of CAS score was P < 0. 00001, I2 = 0.89 > 0.5 [MD = 1.68, 95% CI (1.50, 1.85), P < 0. 00001]. The clinical effectiveness rate of FT3 was P < 0. 00001, I2 = 0.98 > 0.5 [MD = 0.95, 95% CI (0.81, 1.08), P < 0. 00001], the clinical effectiveness rate of FT4 was P < 0. 00001, I2 = 0.95 > 0.5 [MD = 2.12, 95% CI (1.99, 2.25), P < 0. 00001], and the clinical effectiveness rate of TSH was P < 0. 00001, I2 = 0.89 > 0.5 [MD = -0.19, 95% CI (-0.21, -0.17), P < 0. 00001]. ConclusionThe experience with the treatment of TAO using Tripterygium Glycosides was promising. The existing evidence suggests that treatment with Tripterygium Glycosides may be more effective in enhancing the response rate, quality of life, and FT3 levels compared to treatment with Prednisone, Levothyroxine sodium, and/or Thiamazole alone.

ObjectivesTo investigate the clinical efficacy of long-term of low-dose inhaled glucocorticoid (ICS) in the treatment on children with bronchial asthma, and to evaluate its effects on the height, weight and expression of serum insulin-like growth factor of children with bronchial asthma. Methods91 children with bronchial asthma treated in our hospital from January 2017 to December 2017 were chosen, and 31 healthy children without asthma history in our hospital were selected as the control group (Group C); For the different treatment methods comparison, 91 children with bronchial asthma were divided into treatment group A (48 children) and treatment group B (43 children) randomly. In treatment group A, children were treated with low-dose ICS for more than 1 year; in treatment group B, children were treated with low-dose ICS for less than 1 year or received low-dose ICS for less than 2 months/year. For treatment evaluation, the asthma control test (C-ACT) were scored at 0 months, 12 months and 24 months in three groups, and the height and weight of children, the levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) in serum in each group were also measured. ResultsIn the control group, the C-ACT scores were increased with time (P<0.01); the C-ACT scores of treatment group A at 12 months and at 24 months was significantly higher than that of treatment group B (P<0.05); there was no significant difference in height and weight between the treatment group and the control group at months, 12 months and 24 months after treatment (P>0.05); there was no significant difference in the expression levels of IGF-1 and IGFBP-3 in serum between treatment group and control group (P>0.05). Compared with the C-ACT scores in treatment group A and treatment group B at 0 month, the C-ACT scores were significantly higher at 12 months and at 24 months, and there was a statistical difference among 0 month, 12 months and at 24 months in treatment group A and treatment group B (P<0.01); The C-ACT score of treatment group A at the 12 month was significantly higher than that in treatment group B at the 12 months(P<0.05), and the C-ACT score in treatment group A at the 24 months was significantly higher than that of treatment group B (P<0.001). ConclusionsTreatment for children with bronchial asthma by long-term use of low-dose ICS is safe and effective, it does not affect health and development of children with bronchial asthma; children with bronchial asthma were treated with low-dose ICS for more than 1 year had a better effective than children were treated with low-dose ICS for less than 1 year or received low-dose ICS for less than 2 months/year.

BACKGROUNDGiven a low first-pass success rate of the conventional SAX (short-axis) or LAX (long-axis) approach, ultrasound-guided radial artery cannulation in adults with radial artery diameter less than 2.2 mm may be still challenging. OBJECTIVETo assess the efficacy of modified long-axis in-plane(M-LAIP) versus short-axis out-of-plane (SAOP) or conventional palpation(C-P) approaches for ultrasound-guided radial artery cannulation. DESIGNA prospective, randomized and controlled trial. SETTINGOperating room in a tertiary university hospital, from 1 July 2018 to 24 November 2018. PATIENTSA total of 201 patients (age 18 to 85 years, the diameter of the radial artery less 2.2 mm) were included. Patients with history of forearm surgery, ulnar artery occlusion, abnormal Allen test, etc, were excluded from this study. INTERVENTIONSAll patients were randomized 1:1:1 to M-LAIP, SAOP or C-P. MAIN OUTCOME MEASURESThe primary outcome was the cannulation success rate. Secondary outcomes included first location time and cannulation time, number of attempts. RESULTSThe cannulation success rate was significantly higher in the M-LAIP group than in the SAOP group or C-P group (first success rate: 80.3% vs 53.8% or 33.8%; p =0.000; total success rate: 93.9% vs 78.5% or 50.8%; p =0.000). First location time (s) was significantly longer in the M-LAIP group compared with the SAOP group (31(28-35[12-44]) vs 15(14-17[10-21]); p =0.000) and the C-P group (31(28-35[12-44]) vs 12(8-13.5 [6-37]); p =0.000). However, the time of cannulation in the M-LAIP group (29(24-45[16-313])) was significantly shorter than that in the SAOP group (45(28.5-135.5[14-346]), p =0.002) and in the C-P group(138(27-308[12-363]), p =0.000). The number of attempts decreased in the M-LAIP group compared with SAOP or C-P group (1.29{+/-}0.63 vs 1.8{+/-}0.89 or 2.22{+/-}0.93, p =0.000). CONCLUSIONThe M-LAIP procedure for ultrasound-guided radial artery cannulation can offer a higher success rate of the first-attempt and total cannulation, fewer attempts and less time of cannulation. TRIAL REGISTRATIONThe study was registered at ClinicalTrials.gov (http://www.chictr.org.cn/index.aspx, number: ChiCTR-IOR-17011474).

ObjectiveThe WT1 gene is considered as a poor prognostic factor for acute myeloid leukemia (AML) after Allogeneic hematopoietic stem cell transplantation (Allo-HSCT). However, the effect of the expression threshold of WT1 on the prognosisis controversial, which is evaluated in this meta-analysis. MethodsRelevant studies about the expression threshold of WT1 on the prognosis of AML after Allo-HSCT were searched in online databases. Data were extracted from them and analyzed by Stata16.0 software. ResultsFive studies involving 739 patients were screened out, including 433 cases experimental group and 306 cases control group. The experimental group and control group were compared for 1-year disease-free survival rate (DFS) [RR=1.19, 95%CI (1.03, 1.38), P =0.02] and 4-year DFS [RR= 1.18, 95%CI (0.98, 1.42), P =0.09]. The experimental group was lower than the control group in 1-year DFS, and there was no statistical significance in 4-year DFS. 1-year overall survival rate (OS) [RR=1.06, 95%CI (0.92, 1.23), P =0.40] and 4-year OS [RR= 1.16, 95%CI (1.03, 1.32), P =0.02], suggesting that the experimental group had a lower 4-year OS than the control group, and 1-year OS had no statistical significance. ConclusionsHigh WT1 expression is unfavorable to the prognosis of AML patients undergoing Allo-HSCT. A threshold of 250 copies/104ABL of WT1 may be the best value for predicting the poor prognosis in these patients.

We investigated the potential of intravenous lidocaine to reduce pain on awakening in a dose- dependent manner and aimed to determine the median effective dose of lidocaine in 200 children aged 3-12 years (American Society of Anesthesiologists physical status I-II) who underwent elective tonsillectomy with or without adenoidectomy at Yichang Central Peoples Hospital. The patients were randomized into four dose groups (A-D: 0.0, 1.0, 1.5, and 2.0 mg/kg, respectively), and they underwent the same anesthetic induction and maintenance protocols. The primary outcome was pain on awakening, while secondary outcomes included pain scores at 1, 4, 12, and 24 h after awakening; incidences of laryngospasm, bronchospasm, or perioperative stridor; and time to extubation. Intraoperative cardiac events were classified as safety events. Our findings indicated that intravenous lidocaine dose-dependently reduced pain on awakening, with the median effective dose being 1.75 mg/kg. Significant differences were observed between groups A and D (P [&le;] 0.001). No incidents of laryngospasm, bronchospasm, or perioperative stridor were observed. Furthermore, there were significant between-group differences in time to extubation (P [&le;] 0.05). In conclusion, our study demonstrated that lidocaine dose-dependently reduced pain on awakening in children undergoing tonsillectomy with or without adenoidectomy, with no severe adverse events.

BackgroundHysteroscopy is considered the gold standard for the evaluation and treatment of uterine and endometrial lesions, but the operation is accompanied by severe pain, so it needs to be performed under anesthesia. Currently, a new sedative drug, remimazolam tosilate, can be used in digestive endoscopy and bronchoscopy. We will study its effect on hysteroscopy and its impact on patient recovery time and hospital discharge time. MethodsNinety-five patients undergoing hysteroscopy were randomly divided into two groups and received an initial dose of 0.2 mg/kg remimazolam tosilate (R group) and an initial dose of 2 mg/kg propofol (P group) as anesthetics during the examination. The primary end point was anesthesia recovery time (the time required for the patients MOAA/S score to reach 5 from the cessation of drug use) and hospital discharge time (the time required for the patients PADS score to reach 9 from the cessation of drug use). Secondary endpoints were first-dose sedation success rate, incidence of hypotension, and injection pain. ResultsAge(P = 0.825), height(P = 0.174), weight(P = 0.667) and ASA grade (P = 0.972) were not significantly different between the two groups. The recovery time in the R group was significantly shorter than that in the P group (P = 0.019), and the data kurtosis in the R group was higher than that in the P group (1.19 vs -0.56), but there was no significant difference in the time to hospital discharge (P = 0.696). There was no significant difference in the success rate of the first dose of sedation between the two groups (P = 0.362), but the incidence of hypotension during anesthesia (P = 0.001) and the incidence of injection pain (P = 0.001) in the R group was significantly lower than those in P group. ConclusionsRemimazolam tosilate is suitable for hysteroscopy anesthesia and can reduce intraoperative hypotension and injection pain during the examination, a more optimal dosage or target-controlled infusion model still needs to be further explored.

BackgroundAccording to a report from the World Health Organization, traumatic brain injury (TBI) will surpass many diseases by 2020 and become the main cause of death and disability. Therefore, post-acute care (PAC) is immediately given active integrated care during the golden period of post-acute care to restore its function, which will reduce the medical expenses of subsequent rehospitalization. ObjectiveThe purpose of this study was to explore the effectiveness of post-acute care for the patients with traumatic brain injury. MethodsThis is a retrospective cohort study that enrolled 168 patients over 18 years of age (inclusive) before and after PAC. The researcher collected the differences between the before and after receiving PAC collected about the Barthel Index (ADL), Lawton-Brody IADL Scale (IADL), and EuroQoL-5D(EQ-5D) by using purposive sampling. It was using machine learning and Power BI to analyze research results statistically. ResultsThe results show that traumatic brain injury patients who received PAC rehabilitation had significant functional recovery effects(p-value <0.001). Additionally, the relationship between Barthel index, IADL and EQ-5D, the results show that when the Barthel index score is higher (Pearson correlation coefficient =1), the IADL score will also be higher (Pearson correlation coefficient =0.481), showing a positive correlation. When the Barthel index score is higher (Pearson correlation coefficient =1), the EQ-5D score will be lower (Pearson correlation coefficient =-0.582), showing a negative correlation. When the IADL score is higher (Pearson correlation coefficient =1), the Barthel index score will be higher (Pearson correlation coefficient =0.481), showing a positive correlation, while the EQ-5D score will be lower (Pearson correlation coefficient =-0.496), showing there is a negative correlation. ConclusionThe results of this study confirm that PAC has essential effects. This result can be used as a reference for national planning health policies, cross-disciplinary professional design cases, and family PAC intervention plans to restore activity functions as soon as possible, improve the quality of life, and reduce the burden of family and social care.

BackgroundThe clinical outcomes of COVID-19 patients in Hubei and other areas are different. We aim to investigate the epidemiological and clinical characteristics of patient with COVID-19 in Hunan which is adjacent to Hubei. MethodsIn this double-center, observational study, we recruited all consecutive patients with laboratory confirmed COVID-19 from January 23 to February 14, 2020 in two designated hospitals in Hunan province, China. Epidemiological and clinical data from patients electronic medical records were collected and compared between mild, moderate and severe/critical group in detail. Clinical outcomes were followed up to February 20, 2020. Findings291 patients with COVID-19 were categorized into mild group (10.0%), moderate group (72.8%) and severe/critical group (17.2%). The median age of all patients was 46 years (49.8% were male). 86.6% patients had an indirect exposure history. The proportion of patients that had been to Wuhan in severe/critical group (48.0% vs 17.2%, p=0.006) and moderate group (43.4% vs 17.2%, p=0.007) were higher than mild group. Fever (68.7%), cough (60.5%), and fatigue (31.6%) were common symptoms especially for severe and critical patients. Typical lung imaging finding were bilateral and unilateral ground glass opacity or consolidation. Leukopenia, lymphopenia and eosinopenia occurred in 36.1%, 22.7% and 50.2% patients respectively. Increased fibrinogen was detected in 45 of 58 (77.6%) patients with available results. 29 of 44 (65.9%) or 22 of 40 (55.0%) patients were positive in Mycoplasma pneumonia or Chlamydia pneumonia antibody test respectively. Compared with mild or moderate group, severe/critical group had a relative higher level of neutrophil, Neutrophil-to-Lymphocyte Ratio, h-CRP, ESR, CK, CK-MB, LDH, D-dimer, and a lower level of lymphocyte, eosinophils, platelet, HDL and sodium (all p<0.01). Most patients received antiviral therapy and Chinese Medicine therapy. As of February 20, 2020, 159 (54.6%) patients were discharged and 2 (0.7%) patients died during hospitalization. The median length of hospital stay in discharged patients was 12 days (IQR: 10-15). InterpretationThe epidemiological and clinical characteristics of COVID-19 patients in Hunan is different from patients in Wuhan. The proportion of patients that had been to Wuhan in severe/critical group and moderate group were higher than mild group. Laboratory and imaging examination can assist in the diagnosis and classification of COVID-19 patients.

IntroductionMedulloblastoma (MB) is the most common childhood malignant brain tumor worldwide. Recently, molecular classification was established and started to play a role in the management of MB; however, studies involving molecular defined MB in Southeast Asia have been limited. We aimed to describe, and correlate clinical characteristics and molecular subgroups with therapeutic outcomes of Thai pediatric patients with MB. Materials and MethodsPediatric MB patients treated at King Chulalongkorn Memorial Hospital in Thailand from 2008 to 2018 were recruited. Patients were classified by clinical characteristics into standard- and high-risk groups, which determined treatment regimen. Retrospectively, available tumor tissues were classified into 3 molecular subgroups using immunohistochemistry: 1) WNT, 2) SHH, and 3) non-WNT/non-SHH. The primary outcome was 5-year overall survival (OS). Risk factors associated with OS were analyzed using cox regression analysis. ResultsFifty-three Thai pediatric patients with MB were enrolled. The median follow-up time was 60 months. The 5-year OS for all patients, and patients with standard-risk and high-risk were 74.2%, 76.3% and 71.4%, respectively. Tumor tissues of 24 patients were available, of which 23 could be molecularly classified. Two, one and 20 were in the WNT, SHH and non-WNT/non-SHH subtypes with 5-year OS of 100%, 100% and 78.9%, respectively. Using multivariate analysis, the interval of more than 8 weeks between surgery and radiotherapy was significantly correlated with a decrease in the 5-year OS. ConclusionInterval between surgery and radiotherapy within 8 weeks was associated with good therapeutic outcomes among Thai pediatric patients with MB. Simplified molecular subtyping combined with clinical characteristics is practical in risk classification of patients with MB in institutes with limited resources.

BackgroundCOVID-19 is a new and highly contagious respiratory disease that has caused global spread, high case fatality rate in severe patients, and a huge medical burden due to invasive mechanical ventilation. The current diagnosis and treatment guidelines are still need to be improved, and more excellent clinical experience is needed to provide reference. MethodsWe analyzed and summarized clinical data of 97 confirmed COVID-19 adult patients (including 26 severe cases) admitted to the Fifth Affiliated Hospital of Sun Yat-sen University from January 17, 2020 to March 10, 2020, included laboratory examination results, imaging findings, treatment effect, prognosis, etc, in order to put forward prediction index of severe COVID-19 patients, principles of early intervention and methylprednisolone usages in COVID-19 patients. ResultsO_LIHypoxemia, hyperlactic acid, hypoproteinemia, and hypokalemia were prevalent in COVID-19 patients. The significant low lymphocyte count, hypoproteinemia, hypokalemia, the persistent or worsen high CRP, high D-dimer, and high BNP, and the occurrence of hemoptysis and novel coronavirus (SARS-CoV-2) viremia were important indicators for early diagnosis and prediction of severe disease progression. C_LIO_LICharacteristic images of lung CT had a clear change in COVID-19, Ground-glass opacity (GGO) and high-density linear combinations may indicate different pathological changes. Rapid lobular progression of GGO suggests the possibility of severe disease. C_LIO_LIBasic principles of early intervention treatment of COVID-19: on the premise of no effective antiviral drugs, treatment is based on supportive and symptomatic therapy (albumin supplementation, supplement of potassium, supplement blood plasma, etc.) in order to maintain the stability of the intracellular environment and adequately reactivate body immunity to clean up SARS-CoV-2. C_LIO_LIAccording to severity, oxygenation index, body weight, age, underlying diseases, appropriate amount methylprednisolone application on severe/critical COVID-19 patients on demand, improved blood oxygen and reduced the utilization rate of invasive mechanical ventilation, case fatality rate and medical burden significantly. The most common indications for invasive mechanical ventilation should be strictly control in critical COVID-19 patients. C_LI ConclusionsO_LIAccurate and timely identification of clinical features in severe risks, and early and appropriate intervention can block disease progression. 2. Appropriate dose of methylprednisolone can effectively avoid invasive mechanical ventilation and reduce case fatality rate in critical COVID-19 patients. C_LI

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, Hubei, China. This study sought to elucidate a novel predictor of disease severity in patients with coronavirus disease-19 (COVID-19) cased by SARS-CoV-2. MethodsPatients enrolled in this study were all hospitalized with COVID-19 in the Central Hospital of Wuhan, China. Clinical features, chronic comorbidities, demographic data, and laboratory and radiological data were reviewed. The outcomes of patients with severe pneumonia and those with non-severe pneumonia were compared using the Statistical Package for the Social Sciences (IBM Corp., Armonk, NY, USA) to explore clinical characteristics and risk factors. The receiver operating characteristic curve was used to screen optimal predictors from the risk factors and the predictive power was verified by internal validation. ResultsA total of 377 patients diagnosed with COVID-19 were enrolled in this study, including 117 with severe pneumonia and 260 with non-severe pneumonia. The independent risk factors for severe pneumonia were age [odds ratio (OR): 1.059, 95% confidence interval (CI): 1.036-1.082; p < 0.001], N/L (OR: 1.322, 95% CI: 1.180-1.481; p < 0.001), CRP (OR: 1.231, 95% CI: 1.129-1.341; p = 0.002), and D-dimer (OR: 1.059, 95% CI: 1.013-1.107; p = 0.011). We identified a product of N/L*CRP*D-dimer as having an important predictive value for the severity of COVID-19. The cutoff value was 5.32. The negative predictive value of less than 5.32 for the N/L*CRP*D-dimer was 93.75%, while the positive predictive value was 46.03% in the test sets. The sensitivity and specificity were 89.47% and 67.42%. In the training sets, the negative and positive predictive values were 93.80% and 41.32%, respectively, with a specificity of 70.76% and a sensitivity of 89.87%. ConclusionsA product of N/L*CRP*D-dimer may be an important predictor of disease severity in patients with COVID-19.

PurposeCoronavirus disease (COVID-19) pandemic is now a global health concern. However, there is no detailed analysis of the factors related to patients improvement. Patients and methodsWe compared the clinical characteristics, laboratory findings, CT images, and treatment of COVID-19 patients from two different cities in China. One hundred and sixty-nine patients were recruited from January 27 to March 17, 2020 at five hospitals in Hubei and Guangxi. They were divided into four groups according to age and into two groups according to presence of comorbidities. Multivariate statistical analyses were performed for the prognosis of the disease. ResultsFifty-two patients (30.8%) had comorbidities, and the percentage of critical COVID-19was higher in the comorbidities group (11.6%vs.0.9%, p<0.05). Older patients had higher proportion of severe or critical disease. The results showed that lymphocyte count was significantly associated with the number of days from positive COVID-19 nucleic acid test to negative test; number of days from onset of symptoms to confirmation of diagnosis was significantly associated with the time it took for symptoms to improve; and number of days from onset of symptoms to confirmation of diagnosis and disease severity were significantly associated with chest computed tomography improvement. ConclusionsAge, comorbidities, lymphocyte count, and SpO2 may predict the risk of severity of COVID-19. Early isolation, early diagnosis, and early initiation of management can slow down the progression and spread of COVID-19. Key PointsAge and comorbidities can predict the risk of severity of COVID-19, Lymphocyte count and SpO2 may predict the risk of severity of COVID-19. Early isolation, Early diagnosis can slow down the progression of COVID-19