Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective To explore the diagnostic value of serum C-reactive protein(CRP),serum amyloid A(SAA)and procalcitonin(PCT)combined with lactate dehydrogenase(LDH)and adenosine deaminase(ADA)in cerebrospinal fluid for elderly patients with central nervous system infection and their differential significance for different infection types.Methods A total of 97 elderly patients with central nervous system infection were enrolled as the infection group,including 31 cases with tuberculous meningitis(tuberculous meningitis group),36 cases with suppurative meningitis(suppurative meningitis group)and 30 cases with viral meningitis(viral meningitis group).A total of 97 patients with normal laboratory examination indexes who were treated due to primary headache during the same period were enrolled as the control group.The samples of fasting elbow venous blood were collected in the early morning of the next day after admission,and the serum was isolated to detect CRP and SAA levels.When consultation,lumbar puncture was performed to collect cerebrospinal fluid for the detection of LDH and ADA levels.The differences in above indexes were compared between groups,and diagnostic efficiency of each index and combined detection for central nervous system infection in elderly was analyzed by receiver operating characteristic(ROC)curves.Results The serum levels of CRP,SAA and PCT,and LDH and ADA in cerebrospinal fluid were higher in the infection group than those in the control group(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)values of serum CRP,SAA and PCT,and cerebrospinal fluid LDH and ADA,and combined detection in the diagnosis of central nervous system infection were all>0.70(P＜0.05),showing good predictive efficiency and diagnostic efficiency,and the diagnostic efficacy of combined detection was the best.The cut-off values of serum CRP,SAA and PCT,cerebrospinal fluid LDH and ADA were 6.32 mg/L,33.86 mg/L,2.81 μg/L,33.53 U/L and 1.99 U/L,respectively.The serum levels of CRP,SAA and PCT were the highest in the suppurative meningitis group,while which were the lowest in the viral meningitis group.The cerebrospinal fluid levels of LDH and ADA were the highest in the tuberculous meningitis group,while which were the lowest in the viral meningitis group(P＜0.05).Conclusion The combined detection of serum CRP,SAA and cerebrospinal fluid PCT and LDH has certain diagnostic value for elderly central nervous system infection,which is beneficial to identify infection types.

Objective To explore the diagnostic value of serum C-reactive protein(CRP),serum amyloid A(SAA)and procalcitonin(PCT)combined with lactate dehydrogenase(LDH)and adenosine deaminase(ADA)in cerebrospinal fluid for elderly patients with central nervous system infection and their differential significance for different infection types.Methods A total of 97 elderly patients with central nervous system infection were enrolled as the infection group,including 31 cases with tuberculous meningitis(tuberculous meningitis group),36 cases with suppurative meningitis(suppurative meningitis group)and 30 cases with viral meningitis(viral meningitis group).A total of 97 patients with normal laboratory examination indexes who were treated due to primary headache during the same period were enrolled as the control group.The samples of fasting elbow venous blood were collected in the early morning of the next day after admission,and the serum was isolated to detect CRP and SAA levels.When consultation,lumbar puncture was performed to collect cerebrospinal fluid for the detection of LDH and ADA levels.The differences in above indexes were compared between groups,and diagnostic efficiency of each index and combined detection for central nervous system infection in elderly was analyzed by receiver operating characteristic(ROC)curves.Results The serum levels of CRP,SAA and PCT,and LDH and ADA in cerebrospinal fluid were higher in the infection group than those in the control group(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)values of serum CRP,SAA and PCT,and cerebrospinal fluid LDH and ADA,and combined detection in the diagnosis of central nervous system infection were all>0.70(P＜0.05),showing good predictive efficiency and diagnostic efficiency,and the diagnostic efficacy of combined detection was the best.The cut-off values of serum CRP,SAA and PCT,cerebrospinal fluid LDH and ADA were 6.32 mg/L,33.86 mg/L,2.81 μg/L,33.53 U/L and 1.99 U/L,respectively.The serum levels of CRP,SAA and PCT were the highest in the suppurative meningitis group,while which were the lowest in the viral meningitis group.The cerebrospinal fluid levels of LDH and ADA were the highest in the tuberculous meningitis group,while which were the lowest in the viral meningitis group(P＜0.05).Conclusion The combined detection of serum CRP,SAA and cerebrospinal fluid PCT and LDH has certain diagnostic value for elderly central nervous system infection,which is beneficial to identify infection types.

OBJECTIVE To explore the molecular mechanism of urolithin A inhibition of human hepatoma cells growth. METHODS Hepatoma Huh-7 cells were treated with different concentrations of urolithin A(Uro-A). The inhibition rate of Huh-7 cells survival was detected by CCK-8 assay and the IC50 was calculated. Cell proliferation was detected by colony formation assay and cell migration ability was assessed by cell wound healing experiment. Glucose uptake and lactate level in culture medium through colorimetry and the ATP production in cell through chemiluminescence method was analyzed. Western blotting was applied to detect protein expression levels of glucose transporter(GLUT1), key enzymes of glycolysis(HK2, PFKM, LDHA), p53, p-p38 and Bcl-2 after treatment with different concentrations of Uro-A. Flow cytometry and TUNEL method were used to detect apoptosis rate. RESULTS The results of CCK-8 showed that Uro-A significantly inhibited the proliferation of Huh-7 cells, and the IC50 was(48.54±1.21) μmol·L−1. The ability of clone formation and migration decreased after Uro-A treatment. Cellular glucose uptake and level of lactic acid and ATP production were down regulated in Huh-7 cells treated with Uro-A. The results showed that expression of glycolytic key proteins GLUT1, PKM2, LDHA and HK2 decreased. Western Blotting further research indicated that the p53 and p-p38 were activated, while the Bcl-2 was down-regulated. Flow cytometry data and TUNEL method revealed that the induction of apoptosis by Uro-A was remarkably increased. CONCLUSION These findings suggest that Uro-A can suppress Huh-7 cell proliferation and migration. The possible mechanism is the inhibition of glycolysis by p53, p-p38 and Bcl-2, which prevent cell growth and finally induce apoptosis.

Objective:To construct a real-time artificial intelligence (AI)-assisted endoscepic diagnosis system based on YOLO v3 algorithm, and to evaluate its ability of detecting focal gastric lesions in gastroscopy.Methods:A total of 5 488 white light gastroscopic images (2 733 images with gastric focal lesions and 2 755 images without gastric focal lesions) from June to November 2019 and videos of 92 cases (288 168 clear stomach frames) from May to June 2020 at the Digestive Endoscopy Center of Renmin Hospital of Wuhan University were retrospectively collected for AI System test. A total of 3 997 prospective consecutive patients undergoing gastroscopy at the Digestive Endoscopy Center of Renmin Hospital of Wuhan University from July 6, 2020 to November 27, 2020 and May 6, 2021 to August 2, 2021 were enrolled to assess the clinical applicability of AI System. When AI System recognized an abnormal lesion, it marked the lesion with a blue box as a warning. The ability to identify focal gastric lesions and the frequency and causes of false positives and false negatives of AI System were statistically analyzed.Results:In the image test set, the accuracy, the sensitivity, the specificity, the positive predictive value and the negative predictive value of AI System were 92.3% (5 064/5 488), 95.0% (2 597/2 733), 89.5% (2 467/ 2 755), 90.0% (2 597/2 885) and 94.8% (2 467/2 603), respectively. In the video test set, the accuracy, the sensitivity, the specificity, the positive predictive value and the negative predictive value of AI System were 95.4% (274 792/288 168), 95.2% (109 727/115 287), 95.5% (165 065/172 881), 93.4% (109 727/117 543) and 96.7% (165 065/170 625), respectively. In clinical application, the detection rate of local gastric lesions by AI System was 93.0% (6 830/7 344). A total of 514 focal gastric lesions were missed by AI System. The main reasons were punctate erosions (48.8%, 251/514), diminutive xanthomas (22.8%, 117/514) and diminutive polyps (21.4%, 110/514). The mean number of false positives per gastroscopy was 2 (1, 4), most of which were due to normal mucosa folds (50.2%, 5 635/11 225), bubbles and mucus (35.0%, 3 928/11 225), and liquid deposited in the fundus (9.1%, 1 021/11 225).Conclusion:The application of AI System can increase the detection rate of focal gastric lesions.

Cloud technology and the Internet of things ( IOT) technology can be used in building the patient-centered critical care medical information platform.The platform could inenable medical staff to efficiently obtain critical care medical information, and raise critical patients′ cure rates. The authors introduced the critical process of rapidly building and improving the urgent care medical information integration platform in a campus of the First Affiliated Hospital of Zhejiang University Medical School.The IOT platform could effectively interconnect a variety of critical care medical equipments, and features such functions as vital signs monitoring and life support, bedside treatment data retrieval, remote diagnosis and treatment, and cloud sharing. The platform featured the advantages of complete information integration, fast construction, and satisfactory system extensibility. It could improve the medical work efficiency, improve the effect of critical care, and reduce the frequency of contact with patients, hence providing references for rapidly establishing a vital care treatment platform for public health events.

The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbialdysbiosis with decreasedprobiotics such as and . Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.

The current epidemic situation of coronavirus disease 2019 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance" strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinary personalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in 10%patients' blood samples at acute period and 50%of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifying cytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance" strategy effectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviral effects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favored the balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short period of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased probiotics such as and , so nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore,we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.
Betacoronavirus ; isolation & purification ; China ; epidemiology ; Coronavirus Infections ; diagnosis ; epidemiology ; therapy ; virology ; Disease Management ; Early Diagnosis ; Feces ; virology ; Humans ; Pandemics ; Pneumonia, Viral ; diagnosis ; epidemiology ; therapy ; virology ; Sputum ; virology

Objective:To explore the effect of amiodarone combined with rivaroxaban on the plasma concentration of rivaroxaban in patients with non-valvular atrial fibrillation.Methods:This study was designed as the prospective cohort study. The subjects were selected from patients with atrial fibrillation who were hospitalized in the Department of Cardiology of Beijing Hospital from January to October 2019 and treated with rivaroxaban (≥3 days). The enrolled patients were divided into the with amiodarone combination group and the without amiodarone combination group. The trough concentration and peak concentration of rivaroxaban were detected by chromogenic substrate method with anti-Xa assay kit. Taking the plasma concentration of patients with a daily dose of 20 mg of rivaroxaban as the standard, plasma concentrations in patients with various daily doses of rivaroxaban were standardized. The measured plasma concentrations, standardized plasma concentrations, and plasma concentrations in patients at daily dose of 20 mg of rivaroxaban were respectively compared between the 2 groups.Results:A total of 65 patients were entered in the study, including 12 patients in the with amiodarone combination group (the daily dose of rivaroxaban was 20 mg) and 53 patients in the without amiodarone combination group (the daily doses of rivaroxaban were 20, 15, and 10 mg in 42, 9, and 2 patients, respectively). The differences in gender, age, weight, body mass index, smoking history, CHA 2DS 2-VASc score, HAS-BLED score, daily dose of rivaroxaban, liver and kidney function, and platelet count of patients between the 2 groups were not statistically significant ( P>0.05 for all). The trough and peak plasma concentrations of rivaroxaban in the with amiodarone combination group were higher than those in the without combination amiodarone group, but the differences were not statistically significant [(43±30) ng/ml vs. (38±26) ng/ml, t=0.569, P=0.571; (294±114) ng/ml vs. (251±87) ng/ml, t=1.473, P=0.146]. The differences in standardized trough and peak plasma concentrations of rivaroxaban [(41±28) ng/ml, (273±108) ng/ml]in patients between the 2 groups, and the trough and peak plasma concentration [(40±27) ng/ml,(249±75) ng/ml]of patients at daily dose of 20 mg of rivaroxaban were not statistically significant ( P>0.05 for all). Conclusion:Amiodarone has no significant effects on the plasma concentration of rivaroxaban in patients with atrial fibrillation, however, it is still necessary to strengthen the patient monitoring in those with combination use of the 2 drugs.

Objective:To explore the effect of amiodarone combined with rivaroxaban on the plasma concentration of rivaroxaban in patients with non-valvular atrial fibrillation.Methods:This study was designed as the prospective cohort study. The subjects were selected from patients with atrial fibrillation who were hospitalized in the Department of Cardiology of Beijing Hospital from January to October 2019 and treated with rivaroxaban (≥3 days). The enrolled patients were divided into the with amiodarone combination group and the without amiodarone combination group. The trough concentration and peak concentration of rivaroxaban were detected by chromogenic substrate method with anti-Xa assay kit. Taking the plasma concentration of patients with a daily dose of 20 mg of rivaroxaban as the standard, plasma concentrations in patients with various daily doses of rivaroxaban were standardized. The measured plasma concentrations, standardized plasma concentrations, and plasma concentrations in patients at daily dose of 20 mg of rivaroxaban were respectively compared between the 2 groups.Results:A total of 65 patients were entered in the study, including 12 patients in the with amiodarone combination group (the daily dose of rivaroxaban was 20 mg) and 53 patients in the without amiodarone combination group (the daily doses of rivaroxaban were 20, 15, and 10 mg in 42, 9, and 2 patients, respectively). The differences in gender, age, weight, body mass index, smoking history, CHA 2DS 2-VASc score, HAS-BLED score, daily dose of rivaroxaban, liver and kidney function, and platelet count of patients between the 2 groups were not statistically significant ( P>0.05 for all). The trough and peak plasma concentrations of rivaroxaban in the with amiodarone combination group were higher than those in the without combination amiodarone group, but the differences were not statistically significant [(43±30) ng/ml vs. (38±26) ng/ml, t=0.569, P=0.571; (294±114) ng/ml vs. (251±87) ng/ml, t=1.473, P=0.146]. The differences in standardized trough and peak plasma concentrations of rivaroxaban [(41±28) ng/ml, (273±108) ng/ml]in patients between the 2 groups, and the trough and peak plasma concentration [(40±27) ng/ml,(249±75) ng/ml]of patients at daily dose of 20 mg of rivaroxaban were not statistically significant ( P>0.05 for all). Conclusion:Amiodarone has no significant effects on the plasma concentration of rivaroxaban in patients with atrial fibrillation, however, it is still necessary to strengthen the patient monitoring in those with combination use of the 2 drugs.