Abstract:Objective To evaluate disease progress and change in lymphocyte count (TLC), ratio of CD4⁺T(Th)to CD8⁺T(Tc)in peripheral blood in patients with coronavirus disease 2019 (COVID-19), and explore the feasibility of TLC and Th/Tc as monitoring indicator for progress of COVID-19. Methods Laboratory test data of 12 patients who were confirmed with COVID-19 in a hospital between January 28 and February 10, 2020 were collected, according to clinical symptoms, they were divided into severe/critical group and mild/common group, TLC in peripheral blood of two groups of patients was detected by flow cytometry, TLC and Th/Tc values of patients with different disease condition were compared. Results The proportion of TLC of COVID-19 patients was lower than the normal range, severe/critical group was lower than mild/common group; proportion of Th cell and Th/Tc of COVID-19 patients was higher than the normal range, severe/critical group was higher than mild/common group. Flow cytometry result showed that the absolute values of T lymphocyte, Th cell and Tc cell in two groups of patients all decreased, mild/common type group and severe/critical group was significantly different in absolute values of T lymphocyte ([913±275]μL vs[526±228]μL), Th cell ([530±99]μL vs[351±41]μL), and Tc cell ([255±84]μL vs[128±70]μL)(all P<0.05). Conclusion Judging the immune status and predicting inflammatory level of COVID-19 patients by TLC and Th/Tc can provide evidence for monitoring disease progress of COVID-19 and determining treatment opportunity for anti-cytokine storm.

Abstract:Objective To understand the clinical data and pharyngeal swab test results of patients with coronavirus disease 2019 (COVID-19) in a hospital, evaluate the clinical value of pharyngeal swab nucleic acid test of SARS-CoV-2, and provide reference for clinical diagnosis of COVID-19. Methods Clinical data of patients who were confirmed with COVID-19 by nucleic acid test of SARS-CoV-2 in Xiangya Hospital of Central South University from January 23 to February 18, 2020 were collected, patients' clinical data, sampling frequency, sampling method, specimen type, and testing method for nucleic acid test were analyzed. Results The average age of 28 confirmed patients was (43.78±14.46) years, male-female ratio was 2.5:1, 46.42% of the patients had a history of living/traveling in Wuhan/Hubei, 14.29% had a history of close contact with COVID-19 patients. The main clinical manifestations of patients were fever (78.57%) and cough (53.57%), laboratory examination showed normal white blood cell count (71.43%) and decreased lymphocyte count (53.57%), pulmonary CT showed multiple ground-glass opacity (92.59%) and patchy opacity (70.37%). Among 28 confirmed cases, the median time from onset to confirmed diagnosis was 5.5 days. 18 cases (64.29%) were positive and 1 case was suspected positive for SARS-CoV-2 for the first test, 5 cases (17.86%) were negative for the first test (including suspected positive) and positive for the second test, 2 cases (7.14%) were negative for the first two test and positive for the third test; 1 case (3.57%) was positive for the fourth test; 2 cases (7.14%) was positive for the fifth test. 26 cases (92.86%) were taken specimen through nasal/oropharyngeal swabs, 2 cases (7.14%) were induced sputum excretion, 27 cases (96.43%) were confirmed by RT-PCR of nasopharyngeal swabs, pharyngeal swabs and sputum specimens, and 1 case (3.57%) was confirmed by next-generation sequencing technology (NGS). Conclusion COVID-19 is usually characterized by fever and dry cough, but there is no specificity, and confirm of diagnosis still rely on nucleic acid test of SARS-CoV-2. Pharyngeal swab is the preferred specimen collection method for nucleic acid test of SARS-CoV-2 in fever clinics, it has the advantage of being simple and easy, but negative result cannot exclude SARS-CoV-2 infection.

Abstract:Objective To analyze clinical characteristics of patients with re-positive of coronavirus disease 2019 (COVID-19), and provide guidance for epidemic prevention and control. Methods Clinical data of 30 patients who were re-admitted to the hospital due to re-positive of 2019-nCoV nucleic acid were collected, clinical data before and after re-positive was compared. Results Clinical symptoms were less when patients was re-positive of 2019-nCoV nucleic acid and re-admitted to the hospital, no fever occurred after re-positive,there were significant difference in fever, cough, throat-drying, sore throat, and main initial clinical symptoms before and after re-positive (all P<0.05). Most laboratory indicators of patients after re-positive and re-admission were normal, there were significant difference in lactate dehydrogenase (LDH), creatine kinase (CK), D-dimer, white blood cell (WBC), lymphocyte (LYM), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactic acid (LAC) before and after re-positive of 2019-nCoV nucleic acid (all P<0.05). There was no change in chest CT after re-positive in patients who had normal CT findings before re-positive, and the absorption was improved in patients who had pneumonia before re-positive. Length of re-hospitalization was shorter than that of first hospitalization ([6.93±3.84] days vs[17.73±7.22] days), difference was significant (P<0.05). Conclusion Condition of patients with re-positive of 2019-nCoV nucleic acid continues to improve, re-positive does not mean relapsing, there is no human- to-human transmission, and no serious public hazard has been caused, but the cause of re-positive of 2019-nCoV nucleic acid still needs further research.

Abstract:Objective To analyze clinical and chest thin-layer CT imaging characteristics of 20 coronavirus disease 2019(COVID-19) patients without fever. Methods Clinical characteristics of 20 COVID-19 patients without fever at the first admission in a hospital were retrospectively analyzed, including symptoms of respiratory tract and digestive tract, as well as laboratory test results of white blood cell count, lymphocyte count and C-reactive protein, meanwhile, the thin-layer CT scanning data of chest were analyzed. Results Clinical symptoms were classified into completely asymptomatic, respiratory or/and digestive symptoms without fever, symptoms of the latter were mild, mainly dry cough, leukopenia and lymphopenia was common in laboratory test results. Chest thin-layer CT in COVID-19 patients without fever mainly showed early and convalescent images, and a few showed progressive images:(1) In the early stage, segmental or multi-segmental ground-glass opacity (GGO) with patchy, nodular, or irregular form distributed along the peripheral of lung or subpleural area, among which vascular thickened and uneven length of linear high density opacity may be found in some patients; (2) In progressive stage, lesions enlarged as irregular form, and multiple pulmonary segments and lobes were involved, showing the "paving stone" sign or even evolved into pulmonary consolidation; (3) In convalescent stage, lesions diminished, completely absorbed, and residual fiber was uncommon. Conclusion Clinical characteristics of COVID-19 patients without fever are occult, while thin-layer CT findings of chest are typical, chest thin-layer CT plays an important role in the early diagnosis and evaluation of COVID-19.

Abstract:In order to cope with epidemic of coronavirus disease 2019(COVID-19), guide the prevention and control infection in all parts of the country, national health administrative departments and relevant industry organizations have successively issued relevant regulations, but there are some differences in regulation norms, which inevitably confuses health care workers. Therefore, this paper compares and analyses the domestic regulations from the aspects of origin of regulations, the environmental cleaning and disinfection regulations, and the use of personal protective equipment for health care workers.

Abstract:Retrospective analysis was performed on the successful treatment of a patient with severe coronavirus disease 2019(COVID-19), suggesting that for COVID-19 patients, antiviral and anti-inflammatory treatment should be given in time at the early stage of onset, and respiratory support treatment should be given in time when oxyge-nation drops. When oxygenation index of acute respiratory distress syndrome decreases progressively and effect of nasal high-flow oxygen therapy is not ideal, early combination of prone position ventilation treatment is crucial to the improvement of successful treatment rate of severe patients, at the same time, it can avoid mechanical ventilation and reduce mortality.

Abstract:Coronavirus disease 2019(COVID-19) has a strong impact on global health safety. As direct contacts of COVID-19 patients, health care workers(HCWs) in isolation ward area are faced with risk factors of occupational injury, including biological, physical, chemical and psychological factors. How to conduct occupational safety protection for HCWs in isolation ward area, and make HCWs fell confident and competent in implementing timely and effective treatment for patients is an urgent problem for medical team to be solved. According to the working experience of epidemic area in Wuhan,in this paper, risk factors of occupational injury of HCWs in isolation ward area were analyzed, the step-down training mode of occupational safety protection was established, personal protective equipment guidance post was set up, emergency plan for occupational exposure and physical discomfort was deve-loped, aiming at ensuring occupational safety of HCWs in COVID-19 isolation ward area, eliminating fear, and enhancing work confidence.

Abstract:Objective To investigation the distribution and antimicrobial resistance of clinical bacterial strains from Xiangya Hospital of Central South University in 2013-2017, and provide basis for clinical rational use of antimicrobial agents. Methods Strains isolated from cultured specimens of outpatients and inpatients were collected, antimicrobial susceptibility testing was performed by Kirby-Bauer method or automated system, bacterial resistance monitoring data were analyzed statistically. Results A total of 38 075 bacterial strains were isolated, including 13 184 (34.6%) strains of gram-positive bacteria and 24 891 (65.4%) strains of gram-negative bacteria. The top five isolated bacteria were Escherichia coli(n=5 158,13.5%),Acinetobacter spp.(n=4 740,12.4%), Klebsiella spp. (n=4 470,11.7%), coagulase-negative staphylococcus (n=4 008,10.5%), and Pseudomonas aeruginosa(n=3 577, 9.4%). Isolation rates of methicillin-resistant Staphylococcus aureus(MRSA) and methicillin-resistant coagu- lase-negative staphylococcus (MRCNS) were 31.7% (980/3 096) and 77.7% (3 113/4 008) respectively, isolation rate of MRSA showed a decreasing tendency(P<0.01); resistance rate of methicillin-resistant strains of Staphylococcus was higher than methicillin-sensitive strains; vancomycin-resistant Staphylococcus and linezolid-resistant Staphylococcus aureus were not found. Resistance rates of Enterococcus faecium to penicillin, ampicillin, high concentration gentamycin, high concentration streptomycin, erythromycin, nitrofurantoin and fluoroquinolones were all much higher than those of Enterococcus faecalis (all P<0.01), resistance rate of Enterococcus faecalis and Enterococcus faecium to vancomycin and linezolid was<3.5%. Linezolid- or vancomycin-resistant Streptococcus spp. was not found. Resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems were 0.6%-3.9% and 6.3%-24.9% respectively. Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 29.5%-34.7% and 69.9%-85.7% respectively. Resistance rates of Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii to carbapenems increased year by year (all P<0.01). Conclusion Resistance rate of Acinetobacter baumannii to carbapenems is high, resistance rate of Klebsiella pneumoniae to carbapenems is rising rapidly. It is necessary to strengthen the rational use of antimicrobial agents, take effective measures to control healthcare-associated infection, and reduce the emergence and spread of antimicrobial-resistant bacteria.

Abstract:Objective To explore the diagnostic value of fever, blood sodium combined with neutrophil prcentage in tuberculous meningitis (TBM) secondary to pulmonary tuberculosis(PTB). Methods Clinical data of PTB patients who were admitted in a hospital from October 2015 to October 2018 were collected, 146 patients with TBM secondary to PTB were selected as study group, 584 patients of PTB patients without secondary TBM were as control group according to the proportion of 1:4 of admission time, diagnostic efficiency of blood sodium, neutrophil percentage, clinical fever symptom and their combination in TBM secondary to PTB were compared, area under the curve (AUC) was calculated, and critical point was determined. Results The critical points of blood sodium and neutrophil prcentage for the diagnosis of TBM secondary to PTB were 135.30mmol/L and 73.40% respectively. The AUC (95% CI) of fever, blood sodium, neutrophil percentage and their combination in diagnosis for TBM secondary to PTB were 0.732 (0.688-0.776), 0.768 (0.719-0.818), 0.727 (0.679-0.776) and 0.845 (0.807-0.882) respectively, with statistical significance (all P<0.05); sensitivity were 80.82%, 56.85%, 65.07% and 63.70% respectively, specificity were 65.58%, 87.50%, 73.46% and 89.38% respectively, there was no significant difference in AUC among the three, diagnostic efficacy of three combination was higher. Conclusion Fever, blood sodium<135.30 mmol/L or neutrophil percentage>73.40% have diagnostic significance for TBM secondary to PTB, there was no difference among the three, but the combination of the three has higher diagnostic value for TBM secondary to PTB.

Abstract:Objective To evaluate feasibility of autoregressive integrated moving average (ARIMA) model in predicting the incidence of tuberculosis (TB). Methods Using statsmodels module-based Python language, incidence of TB in Tianjin City from January 2004 to December 2015 was as training set, the optimal seasonal ARIMA (SARIMA) model was established, data from January to December 2016 were used to evaluate the efficacy of SARIMA model, and monthly incidence of TB in Tianjin City from January 2017 to December 2019 was predicted. Results Epidemiological results showed that monthly incidence of TB in Tianjin showed a overall downward trend from January 2004 to December 2015. There was a of peak disease incidence in 2005-2008, which dropped sharply after 2009 and then stabilized. From January 2017 to December 2019, monthly incidence of TB in Tianjin City declined steadily compared with previous years. The established optimal model was SARIMA(1,1,1)×(3,1,1)₁₂, residual BOX-Ljung statistic of the model was P=0.493, which indicated that the residual was a white noise sequence and the model fitted well. The actual value of predicted results was within 95% confidence interval of predicted value. Conclusion SARIMA (1,1,1)×(3,1,1)₁₂ model can accurately predict the monthly incidence of tuberculosis in Tianjin City.

Abstract:Objective To evaluate the value of bronchoalveolar lavage fluid (BALF) detected by Mycobacterium tuberculosis (MTB) loop-mediated isothermal amplification (TB-LAMP) technique in the diagnosis of smear and culture negative pulmonary tuberculosis (PTB). Methods Clinical data of 254 patients who were clinically diagnosed with smear and culture negative PTB (3 times of both negative sputum smear and negative sputum culture) in a hospital from December 2017 to November 2018 were collected, all patients underwent bronchoscopy for taking bronchoscope brush or BALF specimens, they were divided into LAMP group (performing acid-fast staining smear, Lowenstein-Jensen culture, and TB-LAMP detection) and GeneXpert group (performing acid-fast staining smear, Lowenstein-Jensen culture, and GeneXpert MTB/RIF detection). Results 96 patients and 158 patients with smear and culture negative PTB were included in LAMP group and GeneXpert group respectively, there were no significant differences in gender and age between two groups of patients (both P>0.05). Positive rates of acid-fast staining, Lowenstein-Jensen culture, and TB-LAMP in LAMP group were 4.17%(n=4), 18.75%(n=18), and 52.08%(n=50)respectively;positive rates of acid-fast staining, Lowenstein-Jensen culture, and GeneXpert MTB/RIF in GeneXpert group were 3.80%(n=6), 12.66%(n=20), and 54.43%(n=86)respectively. Positive rates of TB-LAMP and GeneXpert MTB/RIF were both significantly different from acid-fast staining and Lowenstein-Jensen culture(both P<0.05). Positive rates of MTB detected by TB-LAMP and GeneXpert MTB/RIF was not significantly different. Conclusion Application of TB-LAMP for BALF has a good diagnostic efficacy on smear and culture negative PTB, it is fast, simple, accurate and economical, and is worth of promotion in clinical application.

Abstract:Objective To explore pathogenic distribution and epidemic characteristics of hand, foot and mouth disease (HFMD) in Shenyang area, and provide reference for prevention and control as well as clinical diagnosis and treatment for HFMD. Methods Descriptive epidemiological method was used to analyze information and pathogenic monitoring data of HFMD children in Shengjing Hospital Affiliated to China Medical University from 2014 to 2018. Results There were 25 571 cases of HFMD, 17 263 (67.51%) were positive for enterovirus, positive rates in boys and girls were 69.72% (10 305/14 780) and 64.48% (6 958/10 791) respectively, positive rate between boys and girls was statistically significant (χ²=78.167,P<0.001). Among children with positive detection result of HFMD enterovirus, 92.59% were<6 years old, the highest proportion was in the 3- year old group (24.53%). HFMD occurred all year round, but seasonal distribution was obvious, showing a single peak distribution, the highest was in July and August every year, accounting for 29.94%-52.30%. Among pathogens isolated from children with HFMD, EV-71 and CV-A16 accounted for 12.71% and 24.38% respectively, other enterovirus was 62.91%. Conclusion Except EV-71 and CV-A16, other enterovirus causing HFMD in children in Shenyang area are high, July and August every year are peak season, HFMD mainly occurs in children<6 years old, especially boys.

Abstract:Objective To explore the occurrence and risk factors of pulmonary infection(PI) after laparoscopic surgery for gastric cancer, and provide evidence for formulating prevention and control measures. Methods Clinical data of patients with gastric cancer who underwent laparoscopic surgery in a hospital between January 1, 2017 and December 31, 2018 were collected, risk factors that may affect post-operative PI were analyzed by univariate and multivariate logistic regression analysis. Results A total of 856 patients with gastric cancer who underwent laparoscopic surgery were analyzed, 113 patients had post-operative PI, incidence of post-operative PI was 13.20%. Univariate analysis showed that age, gender, smoking, stage of gastric cancer, number of underlying diseases, pulmonary insufficiency, pre-operative chemotherapy, and duration of post-operative indwelling gastric tube were risk factors for post-operative PI (all P<0.05). Multivariate logistic regression analysis showed that age, smoking, pulmonary insufficiency, and pre-operative chemotherapy were independent risk factors for post-operative PI (OR were 2.812, 3.578, 2.719, 2.115, all P<0.05). Conclusion Risk factors for PI after laparoscopic surgery for gastric cancer are age, smoking, pulmonary insufficiency and pre-operative chemotherapy, effective measures should be taken to reduce post-operative PI.

Abstract:Objective To investigate the causes of a clustering event of neonatal septicemia in the neonatal intensive care unit(NICU) of a hospital, evaluate the effectiveness of relevant control measures. Methods The preterm triplets with healthcare-associated neonatal septicemia in NICU of a hospital from April 23 to 25, 2019 were performed epidemiological survey, specimens of breast milk and hospital environment were collected for hygienic monitoring, and control measures were taken for the existing risk factors. Results There was no other neonatal septicemia case except triplets in NICU. Triplets all developed disease 48 hours after the start of breastfeeding, 2 neonates were isolated Enterobacter cloacae from blood culture. Among the 37 collected specimens, bacterial colony number of 4 specimens exceeded the standard, Enterobacter cloacae was only isolated from breast milk, and the colony number was>1 000 CFU/mL. Breastfeeding of triplets was suspended temporarily, antimicrobial treatment was given, and management of various infection prevention and control measures was strengthened, triplets were all cured and discharged from hospital, there was no new case. Conclusion Breast milk contamination may be the cause of this clustering event. In order to minimize the risk of healthcare-associated infection, standardized management of breastfeeding should be implemented in neonatal department.

Abstract:Objective To evaluate the disinfection effect of a new hypochlorous acid disinfectant on fiberbronchoscopes. Methods 60 used fiberbronchoscopes were strictly cleaned in accordance with the operation procedures, then fiberbronchoscopes were performed machine washing and disinfection with hypochlorous acid disinfectant for 3 and 5 minute respectively. ATP bioluminescence assay and membrane filtration method were used to monitor and evaluate the disinfection effect on the outer and inner surface of fiberbronchoscopes,result was compared with before cleaning and enzyme washing. Results The median value of relative light unit(RLU) on the outer surface of 30 used fiberbronchoscopes before cleaning was 911.5, qualified rate was 16.7%; after enzyme washing but before machine washing, the median value of RLU on the outer surface of fiberbronchoscopes was 234.0, qualified rate was 43.3%. After each group of 30 fiberbronchoscopes were immersed in disinfectant for 5 and 3 minutes respectively, median values of RLU of the outer surface of fiberbronchoscopes were 25.0 and 23.5 respectively, qualified rates were both 100.0%. Concentration of hypochlorous acid disinfectant could maintain at effective concentration (≥ 80 mg/L) after continuous use for 7 days. Conclusion The new hypochlorous acid disinfectant can achieve good disinfection effect on fiberbronchoscopes for 3-minute contact time, and improve work efficiency with good safety and stability.

Abstract:Human cytomegalovirus(HCMV) is one of the eight herpes viruses that can infect human, it often infects people with low immunity, especially in patients after renal transplantation, patients with advanced acquired immunodefiency syndrome, and newborns. Mammalian mechanistic target of rapamycin (mTOR) is a serine/threonine protein kinase(AKT) of the downstream of acid-inositol-3-kinase (PI3K) family, which can affect all stages of HCMV infection. mTOR inhibitor(mTORi)can be used as immunosuppressant in patients after renal transplantation, it can reduce incidence of HCMV infection. This paper reviews the advance of mTORi in reducing HCMV infection in renal transplantation recipients.