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Highlights • COVID-19 has a great threat to world health. • We investigated clinical features of patients with abnormal imaging findings. • Those with abnormal images have more obvious clinical and laboratory features. • Combing clinical data with imaging scores can predict severe/critical type., Purpose To investigate the epidemiological and clinical characteristics of COVID-19 patients with abnormal imaging findings. Methods Patients confirmed with SARS-CoV-2 infection in Zhejiang province from January 17 to February 8 who had undergone CT or X-ray were enrolled. Epidemiological and clinical data were analyzed among those with abnormal or normal imaging findings. Results Excluding 72 patients with normal images, 230 of 573 patients showed abnormalities affecting more than two lung lobes. The median radiographic score was 2.0, and there was a negative correlation between that score and the oxygenation index (ρ = −0.657, P < 0.001). Patients with abnormal images were older (46.65 ± 13.82), with a higher rate of coexisting condition (28.8%), a lower rate of exposure history, and longer time between onset and confirmation (5 days) than non-pneumonia patients (all P < 0.05). A higher rate of fever, cough, expectoration and headache, a lower level of lymphocytes, albumin, and serum sodium levels and a higher total bilirubin, creatine kinase, lactate dehydrogenase, and C-reactive protein levels and a lower oxygenation index were observed in pneumonia patients (all P < 0.05). Muscle ache, shortness of breath, nausea and vomiting, lower lymphocytes levels, and higher serum creatinine and radiographic score at admission were predictive factors for the severe/critical subtype. Conclusion Patients with abnormal images have more obvious clinical manifestations and laboratory changes. Combing clinical features and radiographic scores can effectively predict severe/critical types.

The real-time reverse transcription-polymerase chain reaction (RT-PCR) detection of viral RNA from sputum or nasopharyngeal swab had a relatively low positive rate in the early stage of coronavirus disease 2019 (COVID-19). Meanwhile, the manifestations of COVID-19 as seen through computed tomography (CT) imaging show individual characteristics that differ from those of other types of viral pneumonia such as Influenza-A viral pneumonia (IAVP). This study aimed to establish an early screening model to distinguish COVID-19 pneumonia from IAVP and healthy cases through pulmonary CT images using deep learning techniques. A total of 618 CT samples were collected: 219 samples from 110 patients with COVID-19 (mean age 50 years; 63 (57.3%) male patients); 224 samples from 224 patients with IAVP (mean age 61 years; 156 (69.6%) male patients); and 175 samples from 175 healthy cases (mean age 39 years; 97 (55.4%) male patients). All CT samples were contributed from three COVID-19-designated hospitals in Zhejiang Province, China. First, the candidate infection regions were segmented out from the pulmonary CT image set using a 3D deep learning model. These separated images were then categorized into the COVID-19, IAVP, and irrelevant to infection (ITI) groups, together with the corresponding confidence scores, using a location-attention classification model. Finally, the infection type and overall confidence score for each CT case were calculated using the Noisy-or Bayesian function. The experimental result of the benchmark dataset showed that the overall accuracy rate was 86.7% in terms of all the CT cases taken together. The deep learning models established in this study were effective for the early screening of COVID-19 patients and were demonstrated to be a promising supplementary diagnostic method for frontline clinical doctors.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and represents a potentially fatal disease of great global public health importance. As of March 26, 2020, the outbreak of COVID-19 has resulted in 462,801 confirmed cases and 20,839 deaths globally, which is more than those caused by SARS and Middle East respiratory syndrome (MERS) in 2003 and 2013, respectively. The epidemic has posed considerable challenges worldwide. Under a strict mechanism of massive prevention and control, China has seen a rapid decrease in new cases of coronavirus; however, the global situation remains serious. Additionally, the origin of COVID-19 has not been determined and no specific antiviral treatment or vaccine is currently available. Based on the published data, this review systematically discusses the etiology, epidemiology, clinical characteristics, and current intervention measures related to COVID-19 in the hope that it may provide a reference for future studies and aid in the prevention and control of the COVID-19 epidemic.

Background: The SARS-CoV-2 epidemic is currently spreading across the world A better knowledge of viral loads at different stages of disease progression would

Background: The virus shedding time (VST) of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was of significant importance in Coronavirus Disease 2

Background: The urgency of the 2019 novel coronavirus outbreak has led to demand of effective antiviral agents Preliminary experiment indicated that Arbidol co

Background: An outbreak of a novel coronavirus (SARS-CoV-2) that began in Wuhan, has spread rapidly to more than 26 countries False negative diagnosis of respi

Background The aim of the present study was to determine the specific role of different types of bacterial infections (BIs) on the prognosis of cirrhotic patients with acute decompensation (AD). Methods We performed a prospective, observational cohort study consisting of 492 cirrhotic patients with AD at our center from February 2014 to March 2015. Clinical, laboratory and survival data were collected. The relationship between BIs and mortality was analyzed. Results BIs were identified in 157 of 492 patients at the time of admission or during the hospital stay. Among the patients, 65 had community-acquired (CA) or healthcare-associated (HCA) BIs, 54 developed hospital-acquired (HA) BIs, and 38 had CA/HCA with HA BIs. Patients with CA/HCA BIs had higher 90-day, 1-year and 2-year mortality rates (29.2%, 44.6% and 52.3%, respectively) and CA/HCA BIs remained an independent risk factor for long-term mortality on multivariate analysis (1 year: hazard ratio = 1.60; 95% CI: 1.07-2.41; P = 0.023 and 2 year: hazard ratio = 1.54; 95% CI: 1.05-2.25; P = 0.026). In contrast, patients with HA BIs had a higher 28-day mortality rate than patients with CA/HCA BIs. Logistic regression analysis showed previous ascites and prior BIs within 3 months were independent risk factors for CA/HCA BIs, whereas invasive minor surgical procedures with acute-on-chronic liver failure throughout the hospital stay and high chronic liver failure-sequential organ failure assessment scores were associated with nosocomial BIs. Conclusions CA/HCA BIs were associated with increased long-term mortality in cirrhotic patients with AD, whereas nosocomial BIs may be related to poor short-term prognosis.

BackgroundIn mainland China, peginterferon (PEG-IFN) alfa-2b 1.0μg/kg/wk for 24 weeks is the approved treatment for HBeAg-positive chronic hepatitis B.ObjectiveThis multicenter, randomized trial evaluated the safety and efficacy of regimens utilizing increased dose or treatment duration in treatment-naive Chinese patients with chronic hepatitis B.Study design670 HBeAg-positive patients from China, Malaysia, Taiwan area, Singapore, and Thailand were enrolled. Patients received PEG-IFN alfa-2b 1.0μg/kg/wk (arm A) or 1.5μg/kg/wk (arm B) for 24 weeks, or 1.5μg/kg/wk for 48 weeks (arm C). The primary end point was loss of HBeAg 24 weeks after end of treatment.ResultsAt the end of follow-up, HBeAg loss was significantly greater in arm C compared with arm A (31.3% vs. 17.3%; P=0.001) and arm B (31.3% vs. 18.1%; P=0.001). No significant difference in the rate of HBeAg loss was observed between arms A and B. The proportions of patients with HBe seroconversion, HBV DNA levels

Durable post-treatment response is uncommon in chronic hepatitis B (CHB) patients on nucleos(t)ide analogue therapy. Response, response predictors and safety were assessed in patients who switched from long-term entecavir (ETV) to peginterferon alfa-2a.Hepatitis B e antigen (HBeAg)-positive CHB patients who had received ETV for 9-36 months, with HBeAg100 PEIU/ml and HBV DNA ⩽1000 copies/ml, were randomised 1:1 to receive peginterferon alfa-2a 180 μg/week or ETV 0.5mg/day for 48 weeks. The primary endpoint was HBeAg seroconversion at week 48 (ClinicalTrials.gov: NCT00940485).200 patients were randomised; 197 received ⩾1 study drug dose. Five patients who were anti-HBe-positive at baseline were excluded from the modified intention-to-treat population (peginterferon alfa-2a, n = 94; ETV, n = 98). Patients who switched to peginterferon alfa-2a achieved higher week 48 HBeAg seroconversion rates vs. those who continued ETV (14.9% vs. 6.1%; p = 0.0467). Only patients receiving peginterferon alfa-2a achieved HBsAg loss (8.5%). Among peginterferon alfa-2a-treated patients with HBeAg loss and HBsAg1500 IU/ml at randomisation, 33.3% and 22.2% achieved HBeAg seroconversion and HBsAg loss, respectively. Early on-treatment HBsAg decline predicted response at week 48; highest rates were observed in patients with week 12 HBsAg200 IU/ml (HBeAg seroconversion, 66.7%; HBsAg loss, 77.8%). Alanine aminotransferase elevations were not associated with viral rebound (n = 38). Peginterferon alfa-2a was well-tolerated.For patients who achieve virological suppression with ETV, switching to a finite course of peginterferon alfa-2a significantly increases rates of HBeAg seroconversion and HBsAg loss. A response-guided approach may identify patients with the greatest chance of success.

Summary Background Human infection with avian influenza A H7N9 virus emerged in eastern China in February, 2013, and has been associated with exposure to poultry. We report the clinical and microbiological features of patients infected with influenza A H7N9 virus and compare genomic features of the human virus with those of the virus in market poultry in Zhejiang, China. Methods Between March 7 and April 8, 2013, we included hospital inpatients if they had new-onset respiratory symptoms, unexplained radiographic infiltrate, and laboratory-confirmed H7N9 virus infection. We recorded histories and results of haematological, biochemical, radiological, and microbiological investigations. We took throat and sputum samples, used RT-PCR to detect M, H7, and N9 genes, and cultured samples in Madin-Darby canine kidney cells. We tested for co-infections and monitored serum concentrations of six cytokines and chemokines. We collected cloacal swabs from 86 birds from epidemiologically linked wet markets and inoculated embryonated chicken eggs with the samples. We identified and subtyped isolates by RT-PCR sequencing. RNA extraction, complementary DNA synthesis, and PCR sequencing were done for one human and one chicken isolate. We characterised and phylogenetically analysed the eight gene segments of the viruses in the patient's and the chicken's isolates, and constructed phylogenetic trees of H, N, PB2, and NS genes. Findings We identified four patients (mean age 56 years), all of whom had contact with poultry 3–8 days before disease onset. They presented with fever and rapidly progressive pneumonia that did not respond to antibiotics. Patients were leucopenic and lymphopenic, and had impaired liver or renal function, substantially increased serum cytokine or chemokine concentrations, and disseminated intravascular coagulation with disease progression. Two patients died. Sputum specimens were more likely to test positive for the H7N9 virus than were samples from throat swabs. The viral isolate from the patient was closely similar to that from an epidemiologically linked market chicken. All viral gene segments were of avian origin. The H7 of the isolated viruses was closest to that of the H7N3 virus from domestic ducks in Zhejiang, whereas the N9 was closest to that of the wild bird H7N9 virus in South Korea. We noted Gln226Leu and Gly186Val substitutions in human virus H7 (associated with increased affinity for α-2,6-linked sialic acid receptors) and the PB2 Asp701Asn mutation (associated with mammalian adaptation). Ser31Asn mutation, which is associated with adamantane resistance, was noted in viral M2. Interpretation Cross species poultry-to-person transmission of this new reassortant H7N9 virus is associated with severe pneumonia and multiorgan dysfunction in human beings. Monitoring of the viral evolution and further study of disease pathogenesis will improve disease management, epidemic control, and pandemic preparedness. Funding Larry Chi-Kin Yung, National Key Program for Infectious Diseases of China.

Liver transplantation is one of the most effective therapeutic options for patients with end-stage liver diseases, and gut microbiota is actively involved in potential infections in pretransplant and posttransplant patients. However, the diversity of gut microbiota and its relationship with the immune parameter of liver transplantation recipients are not well understood.We collected fresh feces and blood samples from 190 participants in China from November 2004 to May 2008, including 28 healthy volunteers, 51 cirrhotic patients and 111 liver-transplanted patients. Six interesting gut bacteria, plasma endotoxin, serum cytokines (i.e., tumor necrosis factor alpha and interleukin-6) and fecal secretory IgA (SIgA) were investigated by real-time quantitative PCR, chromogenic limulus amoebocyte assay, sandwich-type enzyme-linked immunosorbent assay and radioimmunoassay, respectively.All Eubacteria, Bifidobacterium spp., Faecalibacterium prausnitzii and Lactobacillus spp. were significantly lower in the liver transplantation recipients while Enterobacteriaceae and Enterococcus spp. were significantly higher (P0.05). Except for Enterococcus spp., other bacteria showed a tendency to restore to normal level along with the time after liver transplantation. Plasma endotoxin, interleukin-6 and fecal SIgA in cirrhotic patients increased significantly, but not in liver transplantation recipients. Plasma endotoxin and interleukin-6 were negatively correlated with all Eubacteria and the Bacteroides-Prevotella group, while tumor necrosis factor alpha was not significantly correlated with these six gut bacteria in cirrhotic patients.Our study demonstrates that abundant gut bacteria were altered significantly in both cirrhotic and liver transplantation patients, while plasma endotoxin and interleukin-6 increased remarkably in cirrhotic patients, showing significant correlations with gut microbiota. Interestingly, our data show a tendency for these gut bacteria to restore to normal levels in liver transplantation recipients.

Acute and chronic hepatic failure is a devastating illness of varied causes with considerable mortality. Human augmenter of liver regeneration (hALR) is a hepatotrophic protein and the unique cytokine which can specially stimulate hepatic origin cells to grow regardless of genus. It has been proven that ALR can promote regeneration and avoid all kinds of injury in rat and canine models. In this study, the recombinant protein hALR was expressed successfully with recombinant prokaryotic expression vector pET28a(+) in Escherichia coli BL21 (DE3). We constructed the recombinant expression vector pET28a(+)/hALR with a full-length cDNA encoding hALR protein from normal human liver tissue by one-step reverse transcription-polymerase chain reaction and his-tag recognition sequence encoding polyhistidine (6 x His). Under IPTG (isopropyl-beta-d-thiogalactopyranoside) induction for 2 h at 37 degrees C, recombinant protein hALR was expressed. The expression of recombinant polyhistidine-tagged hALR was increased under low temperature and was confirmed that the temperature of 23 degrees C was the most suitable IPTG induction condition. Under low temperature induction of IPTG, recombinant protein can be expressed as a soluble protein. Recombinant protein hALR was also purified with His Bind Kits and characterized with SDS-PAGE and Western blotting. The results showed that recombinant hALR could be expressed as a soluble protein under low temperature induction of IPTG. The successful expression of ALR in E. coli makes it possible to further study its biological function and purified recombinant hALR could be developed into a new anti-hepatic damage product.

WITHDRAWN TABLE 1. compared the results between the two groups Group A Group B P value cycles 59 30 Age of female 30.73 4.16 29.60 3.36 0.201 Cycles of no embryo to transfer 7 3 1.000 D0 oocytes 17.44 8.03 18.53 10.26 0.583 2PN/D0 oocytes 57.05%(587/1029) 57.19%(318/556) 0.955 D3 embryos 491 249 D3 embryos /D0 oocytes 47.72%(491/1029) 47.78%(249/556) 0.264 good blastocysts 147 135 good blastocysts /D3 embryos 29.94% (147/491) 54.22% (135/249) 0.000 genetic balance embryos 142 82 genetic balance embryos/D3 embryos 28.92% (142/491) 32.93% (82/249) 0.262 available embryos 88 82 available embryos /D3 embryos 17.92% (88/491) 32.93% (82/249) 0.000 ongoing pregnancy patients 20 18 ongoing pregnancy ratespregnancy rates 38.46% (20/52) 69.23% (18/26) 0.000 P-92 Tuesday, October 21, 2014 CELL FREE FETALDNATESTINGAND INFERTILITY PATIENTS: WILL DISCORDANT GENDER RESULTS BE MORE COMMON THAN PREVIOUSLY EXPECTED? A PLEA FOR CAUTION AND RESEARCH. S. Tsai, N. M. Grindler, E. Beaver, R. Longman, A. Cooper. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO; Division ofMaternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University, St. Louis, MO. OBJECTIVE: Noninvasive prenatal testing by analysis of cell free fetal DNA (cffDNA) in maternal circulation is a rapidly evolving field with clinical applications including detection of fetal aneuploidy, Rh genotyping and fetal gender. CffDNA originates from sloughing trophectoderm cells and clears maternal plasmawithin hours of delivery. Prior studies have confirmed similar levels of circulating cffDNA in maternal circulation for IVF pregnancies compared to naturally occurring pregnancies. Our institution has been tracking gender discordant cffDNA results. Our objective was to analyze these patients to determine the risk factors for discordant gender cffDNA results. DESIGN: Descriptive case series. FERTILITY & STERILITY MATERIALS AND METHODS: Patient #1: 37yo G1, singleton pregnancy conceived after IVF utilizing endometrial cell coculture, derived from previously frozen maternal endometrial biopsy cells; cffDNA testing at 12.5 weeks. Patient #2: 36yo G4P0, heterotopic pregnancy conceived after the transfer of 3 embryos during a fresh IVF cycle. Underwent laparoscopic right salpingectomy at 7.6 weeks; cffDNA testing at 12.3 weeks. Patient #3: 33yo G1, spontaneously conceived dichorionic, triamniotic triplet pregnancy with demise of 2 of the fetuses diagnosed on ultrasound at 8.3 weeks. cffDNA testing at 20.3 weeks. Patient #4: 35yo G3P1, spontaneously conceived singleton pregnancy; cffDNA testing at 10.2 weeks. RESULTS: Patient #1: cffDNA 46,XX, ultrasound (US) male fetus; amniocentesis mosaic 45X/46XY; normal healthy male at birth. Patient #2: cffDNA 46,XY, US female fetus, healthy female at birth. Patient #3: cffDNA 46,XY, US female fetus, IUGR at term, healthy female at birth. Patient #4: cffDNA 46,XX, US male fetus; healthy male at birth. CONCLUSION: ART pregnancies represent 1-2% of live births in the US. Yet, ART and multiple pregnancies are overrepresented in this case series. We postulate that this discordance may be a result of multiple implantation sites and continued sloughing trophectoderm despite removal or demise, underlying mosaicism not clinically detected, or alterations in implantation from laboratory techniques and/or gamete/embryo micromanipulation. We believe this case series should heighten awareness, caution and further research in this unique patient population with regard to gender discordance in cffDNA testing. Supported by: 1K12HD063086-01 (ARC). P-93 Tuesday, October 21, 2014 WHICH IS BETTER FOR ROBERTSONIAN TRANSLOCATION’S PGD CYCLES,BLASTOMERE FISH OR TROPHECTODERM ARRAY? J. Huang, Y. Lian, N. Zhao, P. Liu, J. Qiao. Peking University Third Hospital, Beijing, China. OBJECTIVE: To explore a better protocol of the PGD cycles for Robertsonian translocations. DESIGN: Retrospective study. MATERIALS ANDMETHODS: From January 2012 to June 2013, a total of 89 PGD cycles for Robertsonian translocations were done in our reproductive center, including 59 blastomere FISH cycles (defined as GroupA) and 30 trophectoderm array cycles (defined as Group B). In group A, one blastomere was biopsied at D3, then FISHed by two chromosomal probes. After diagnosed and blastocyst culture, one or two blastocysts were transferred in each fresh cycle or one or two surplus blastocysts were transferred in several thawing cycles. In group B, several trophectoderm cells were biopsied at D5 or D6, then diagnosed by CGH or SNP arrays with 24 chromosomes. All the transfer cycles in groupBwere in thawing cycles with single blastocyst transferred. Compared the oocytes number, 2PN, D3 embryos, genetic balance embryos, good blastocysts, available embryos and ongoing pregnancy rates between the two groups.

FSH DIRECTLY DOWN-REGULATED HUMAN ENDOMETRIAL AQP8, AND RESULTED IN DECREASED ENDOMETRIAL RECEPTIVITY VIA DISREGULATION OF ENDOMETRIAL RECEPTIVE FACTORS, INCLUDING LIF AND OLFM1. D. Zhang, G. Xu, J. Li, Y. Zhu, F. Qu, J. Sheng. Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Reproductive Genetics, Ministry of Education of China, Hangzhou, Zhejiang Province, China.