Objective To summarize primary clinical data from Xiao Tang Shan Hospital (XTSH) Information System, to provide evidence for clinical data of emerging diseases. Method The primary data were extracted from XTSH information system, which related to demographic and background information, case history, prescriptions, laboratory tests, physical examination, vital sign, surgery, diagnostics and expenditures. The software for data verification was developed by Delphi language program. The information of SARS management was developed by Oracle Developer. Results XTSH information system for SARS management collected 1.09 million pieces of information covering 680 SARS cases. The database was functionally divided into inquiry window, conditional case list window and case details spread window, which provided information of SARS management and shaped a platform for further investigation. Quality control of clinical data was done by the software of SARS Information Real Control.Conclusions XTSH information system collected complete data of SARS management, which made healthcare, research and policy-making on SARS accessible, and made it possible to share resources and train the professionals.
ObjectiveTo systematically review the efficacy of treatments for β-coronaviruses.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, SinoMed, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) of treatments for β-coronaviruses from inception to June 17th, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 14.0 software.ResultsA total of 109 studies invoving 23 210 patients were included. The results of the systematic review showed that compared with standard of care, corticosteroids could reduce mortality and increase cure rate for COVID-19. However, chloroquine could decrease cure rate. In severe acute respiratory syndrome (SARS) patients, corticosteroids could decrease the cure rate. In Middle East respiratory syndrome (MERS) patients, ribavirin/interferon/both drugs showed higher mortality.ConclusionsThe currently limited evidence shows that corticosteroids may be effective to COVID-19 patients while having limited effects on SARS patients. Hydroxychloroquine or chloroquine may have negative effects on COVID-19 patients. Ribavirin/interferon may be harmful to MERS patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusions.
Objective To explore and establish a more precise and reasonable classification method which is suitable for clinical treatment and scientific research of SARS patients. Methods ① Establishing a computerized classification method: Analyzing the relationship between variable items on the front page of medical records and severity of disease; Identifying the variable items related to patient’s condition by stepwise identification analysis; Creating a function equation and computerized classification system. ② Comparing and analyzing the difference between computerized and clinical classifications regarding to the general condition of patients, clinical manifestations, laboratorial test results, prognosis, period of hospitalization and medical expenditure, etc. Results ① Clinical classification: general cases 642 (94.41%), critical cases 38 (5.59%); Computerized classification: type A 436 (64.12%), type C 237 (34.85%), type D 7 (1.03%), no type B. ② There were statistical significance among groups between two classifications regarding the items of general condition (age, cure rate, mortality and average length of hospitalization), total protein , Alb, BUN and medical expenditure. ③ Comparative analysis of the two classifications: 99.77% of type A cases (general type) by computerized classification were general cases by clinical classification; 97.36% of critical cases by clinical classification were type Camp;D by computerized classification. Conclusions The results are conformity between two classifications and the differences are analogical among thegroups. The statistical difference is significant between general and critical cases with the number of critical cases by computerized classification 6.42 times more than that by clinical classification; Compared with clinical classification, computerized classification has advantages that there is significant difference between the groups while no difference within the groups. With more critical cases and more objective and logic results, the compauterized classification is suitable for study and application in the fields of health service quality management, health economy management and pharmaceutical economics, etc.
Objective To provide evidence for the establishment and improvement of public health system in China by comparing national public health emergency system of some representative countries.Methods The principle and method of evidence-based science were applied to search and evaluate data from the official websites of China, United States, United Kingdom, Australia and Singapore. The performance of each country’s public health emergency response system in SARS prevention and control, as well as their organization structure and mechanism were compared. The existing problems and corresponding countermeasures were then put forward. Results Public health system showed the best performance was in US, UK and Australia. The responding mechanism of Singapore was highly admired by WHO. The organization structure of China was similar to that of developed countries, but its performance was far lagged behind because of insufficient financial support, poor management and inefficient operational mechanism. Conclusions The public health emergency response system in China needs to be reformed by giving priority to mechanism reinforcement. Different models should be taken into account regarding different regional situations in China.
Objective To investigate the accurateness and rapidity of information on SARS , and to provide evidence for decision-making in the construction of the public health information system of China, including information collection, identification and release. Method SARS related information was systematically collected, from ① databases including Medline, CBMdisc and Cochrane Library; ② official websites including WHO, MOH and CDC; ③ non-governmental websites including Sina, Sohu, Yahoo; ④ eleven Chinese Journals and ⑤ gray literatures, These evidence were graded based on their scientific sense, and were analyzed according to their rapidity of release. Results A total of 11 955 pieces of related information were collected. Non-governmental websites were the agents that released the largest number of information (46.7%). Regarding the scientific sense of evidence, hand searched journal was at the top of the evidence pyramid, and followed by Medline, gray literature, CBMdisc, official and non-governmental websites. Regarding the rapidity, official website achieved the most rapid information release, which was followed by nongovernmental website, journal, and database. 71.8 percent of information from official websites was in Chinese, while 65 percent was from database. Conclusions The SARS information from China has contributed enormously to the global information release. Although the amount and rapidity of the information were satisfied, management and deep processing of information should be improved.
Since the first case of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019, the virus has spread rapidly around the world and has become a global public health problem. In the process of this virus epidemic, compared with the general population, cancer patients are considered to be highly susceptible people, especially the lung cancer patients. Some studies have shown that angiotensin converting enzyme 2 (ACE2) may be the pathway for SARS-CoV-2 to infect the host. At the same time, ACE2 is often abnormally expressed in non-small cell lung cancer. Therefore, understanding the respective mechanisms of ACE2 in COVID-19 and non-small cell lung cancer has extremely important reference value for the study of vaccines and therapeutic drugs, and also provides meaningful guidance for the protection of patients with lung cancer during the epidemic. This article reviews the possible invasive mechanism of ACE2 in SARS-CoV-2 and its abnormal expression in non-small cell lung cancer.
ObjectiveTo explore the functional heterogeneity of T lymphocytes in various organs after SARS-CoV-2 infection. Methods Using the public database GEO data (GSE171668, GSE159812, GSE159556, GSE167747) and the analysis method of single-cell technology, the functional differences of T lymphocytes in various organs of patients after infection with SARS-CoV-2 were analyzed. Results Through single-cell data extraction of 16 livers, 19 hearts,2 spleens, 6 brains, 58 lungs, 21 kidneys and 5 pancreases from SARS-CoV-2 infected patients, invasion genes were relatively highly expressed in T lymphocytes of the lung and pancreas. The lung had a special ability to express the interferon signaling pathway, while the expression of other organs was relatively low; at the same time, the T lymphocytes of the lung also highly expressed fatty acid binding sites. Conclusion After SARS-CoV-2 infection, compared with other organs, the lung has a special interferon-activated signaling pathway and fatty acid binding site.
ObjectiveTo investigate whether novel coronavirus pneumonia (COVID-19) patients complicated with digestive tract symptoms and its influence on digestive system related biochemical indexes.MethodsSixteen novel coronavirus pneumonia patients in our hospital were observed, and their epidemiological data, clinical manifestations and clinical laboratory indicators were analyzed statistically.ResultsThe age of the patients ranged from 5 to 75 years old, and the median age was 46.0 years old. Most of them were male (9 cases, 56.25%), the occurrence of COVID-19 appeared in family aggregation (12 cases, 75.00%). Sixt patients (37.50%) were complicated with basic diseases. The initial symptom involving digestive system accounting for 18.75% (3 cases) of all participants. The main manifestation of a diarrhea in 2 (12.5%) and melena in 1 (6.25%) patients, respectively. Five patients (31.25%) had symptoms of digestive system during the course of the disease, the main symptoms were diarrhea in 3 (18.75%), melena in 1 (6.25%) and loss of appetitein in 5 (31.25%) patients, respectively. The SARS-Cov-2 nucleic acid in the feces of the patients were negative in all patients. In 50.00% of the patients, the SARS-Cov-2 nucleic acid in the feces were negative, but the throat swab/sputum nucleic acid were still positive at the same time or later. Two patients (12.50%) had elevated ALT and 1 patient (6.25%) had elevated AST at the time of admission.ConclusionsPatients with COVID-19 will show symptoms of digestive tract.
Objective This study analyzed the medical expenditure and its influential factors, and compared the clinical effectiveness and medical expenditure of three major drugs. Methods We designed the cohort study to compare the difference of medical and pharmaceutical expenditures between patients with and without underlying diseases. Multi-linear regression was applied to analyze the influential factors. Incremental expenditure-effectiveness ratio was applied to study three clinically important drugs. Results The curing rate of non-critical patients was statistically significant than critical patients (73.68%, 99.38%, P=0.000) .The curing rate of non-critical patients without underlying diseases was statistically significant than those with underlying diseases in the cohort (96%, 99.66%, P=0.001 6). No significance was identified in the critical patients cohort. The medical expenditure of non-critical patients with and without underlying diseases were 7 879.22 and 7 172.23 RMB per capita, respectively. Accordingly, the medical expenditure in critical patients was 24 912.89 and 26 433.53 RMB per capita. No significance was identified in the two cohorts. Medical expenditure was positively correlated with age and disease severity, with its equation y=4585.71+79.04X1+17188.87X2 (X1: age, X2: disease severity). Regarding the clinical effectiveness and medical expenditure, no significance was identified in critical patients who administered small and medium dose of Methylprednisolone. The expenditure-effectiveness ratios of Ribavirin that was administered by non-critical patients without underlying dissuades were 6 107 and 4 225 RMB, respectively. Accordingly, the expenditure-effectiveness ratios of Thymosin were 11 651 and 6 107 RMB. Conclusions The curing rate of non-critical patients without underlying diseases was higher than the counterpart in the cohort. No influence of underlying diseases was found in the critical patient cohort. Medical expenditure was positively correlated with age and disease severity. Small-and-medium dose of Methylprednisolone might not influence the curing rate and medical expenditure in critical patients. The effectiveness of Thymosin for non-critical patients with and without underlying diseases was not significantly different. However, additional 5 877 RMB occurred if Thymosin was administrated. Likewise, the effectiveness of Ribavirin for non-critical patients remains the same. However, additional 1 082 RMB was consumed in Ribavirin-administrated patient.