Dear editor,Factor V deficiency is a rare bleeding disorder,which includes congenital and acquired factor V deficiencies.Congenital factor V deficiency(CFVD)is an autosomal recessive disorder with an estimated prevale...Dear editor,Factor V deficiency is a rare bleeding disorder,which includes congenital and acquired factor V deficiencies.Congenital factor V deficiency(CFVD)is an autosomal recessive disorder with an estimated prevalence of 1:1,000,000.[1]However,acquired factor V deficiency(AFVD)is even rarer.展开更多
Herein we report a case of acute liver failure(ALF) and hemophagocytic lymphohistiocytosis(HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosu...Herein we report a case of acute liver failure(ALF) and hemophagocytic lymphohistiocytosis(HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient's condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy. On the fourth day of admission, pancytopenia emerged, accompanied by hypofibrinogenemia and hyperferritinemia. The patient was diagnosed with ALF. He also met the diagnostic criteria of HLH according to the HLH-2004 guideline. Polymerase chain reaction(PCR) amplifications of varicella-zoster virus(VZV) were positive, confirming that VZV was a causative trigger for ALF and HLH. In view of the devastating immune activation in HLH, immunosuppression therapy with dexamethasone and etoposide was administered, in addition to high dose acyclovir. The patient's symptoms improved dramatically and he finally made a full recovery. To our knowledge, this is only the second report of a successful rescue of ALF associated with HLH, without resorting to liver transplantation. The first case was reported in a neonate infected by herpes simplex virus-1. However, survival data in older children and adults are lacking, most of whom died or underwent liver transplantation. Our report emphasizes the clinical vigilance for the possible presence of HLH, and the necessity of extensive investigation for underlying etiologies in patients presenting with indeterminate ALF. Early initiation of specific therapy targeting the underlying etiology, and watchful immunosuppression such as dexamethasone and etoposide, together with supportive therapy, are of crucial importance in this life-threatening disorder.展开更多
BACKGROUND:A pandemic of coronavirus disease(COVID-19)has been declared by the World Health Organization(WHO)and caring for critically ill patients is expected to be at the core of battling this disease.However,little...BACKGROUND:A pandemic of coronavirus disease(COVID-19)has been declared by the World Health Organization(WHO)and caring for critically ill patients is expected to be at the core of battling this disease.However,little is known regarding an early detection of patients at high risk of fatality.METHODS:This retrospective cohort study recruited consecutive adult patients admitted between February 8 and February 29,2020,to the three intensive care units(ICUs)in a designated hospital for treating COVID-19 in Wuhan.The detailed clinical information and laboratory results for each patient were obtained.The primary outcome was in-hospital mortality.Potential predictors were analyzed for possible association with outcomes,and the predictive performance of indicators was assessed from the receiver operating characteristic(ROC)curve.RESULTS:A total of 121 critically ill patients were included in the study,and 28.9%(35/121)of them died in the hospital.The non-survivors were older and more likely to develop acute organ dysfunction,and had higher Sequential Organ Failure Assessment(SOFA)and quick SOFA(qSOFA)scores.Among the laboratory variables on admission,we identifi ed 12 useful biomarkers for the prediction of in-hospital mortality,as suggested by area under the curve(AUC)above 0.80.The AUCs for three markers neutrophilto-lymphocyte ratio(NLR),thyroid hormones free triiodothyronine(FT3),and ferritin were 0.857,0.863,and 0.827,respectively.The combination of two easily accessed variables NLR and ferritin had comparable AUC with SOFA score for the prediction of in-hospital mortality(0.901 vs.0.955,P=0.085).CONCLUSIONS:Acute organ dysfunction combined with older age is associated with fatal outcomes in COVID-19 patients.Circulating biomarkers could be used as powerful predictors for the in-hospital mortality.展开更多
In order to avoid stress concentration, the shape boundary must be properly designed via shape optimiza- tion. Traditional shape optimization approach eliminates the stress concentration effect by using free-form curv...In order to avoid stress concentration, the shape boundary must be properly designed via shape optimiza- tion. Traditional shape optimization approach eliminates the stress concentration effect by using free-form curve to present the design boundaries without taking the machin- ability into consideration. In most numerical control （NC） machines, linear as well as circular interpolations are used to generate the tool path. Non-circular curves, such as non- uniform rotational B-spline （NURBS）, need other more ad- vanced interpolation functions to formulate the tool path. Forming the circular tool path by approximating the opti- mal free curve boundary with arcs or biarcs is another op- tion. However, these two approaches are both at a cost of sharp expansion of program code and long machining time consequently. Motivated by the success of recent researches on biarcs, a reliable shape optimization approach is pro- posed in this work to directly optimize the shape boundaries with biarcs while the efficiency and precision of traditional method are preserved. Finally, the approach is validated by several illustrative examples.展开更多
BACKGROUND:In the event of a sudden shortage of medical resources,a rapid,simple,and accurate prediction model is essential for the 30-day mortality rate of patients with COVID-19.METHODS:This retrospective study comp...BACKGROUND:In the event of a sudden shortage of medical resources,a rapid,simple,and accurate prediction model is essential for the 30-day mortality rate of patients with COVID-19.METHODS:This retrospective study compared the characteristics of the survivals and non-survivals of 278 patients with COVID-19.Logistic regression analysis was performed to obtain the“COVID-19 death risk score”(CDRS)model.Using the area under the receiver operating characteristic(AUROC)curve and Hosmer-Lemeshow goodness-of-fit test,discrimination and calibration were assessed.Internal validation was conducted using a regular bootstrap method.RESULTS:A total of 63(22.66%)of 278 included patients died.The logistic regression analysis revealed that high-sensitivity C-reactive protein(hsCRP;odds ratio[OR]=1.018),D-dimer(OR=1.101),and respiratory rate(RR;OR=1.185)were independently associated with 30-day mortality.CDRS was calculated as follows:CDRS=−10.245+(0.022×hsCRP)+(0.172×D-dimer)+(0.203×RR).CDRS had the same predictive effect as the sequential organ failure assessment(SOFA)and“confusion,uremia,respiratory rate,blood pressure,and age over 65 years”(CURB-65)scores,with AUROCs of 0.984 for CDRS,0.975 for SOFA,and 0.971 for CURB-65,respectively.And CDRS showed good calibration.The AUROC through internal validations was 0.980(95%confidence interval[CI]:0.965-0.995).Regarding the clinical value,the decision curve analysis of CDRS showed a net value similar to that of CURB-65 in this cohort.CONCLUSION:CDRS is a novel,efficient and accurate prediction model for the early identification of COVID-19 patients with poor outcomes.Although it is not as advanced as the other models,CDRS had a similar performance to that of SOFA and CURB-65.展开更多
In this work, a design procedure extending the B-spline based finite cell method into shape optimization is developed for axisymmetric solids involving the centrifugal force effect. We first replace the traditional co...In this work, a design procedure extending the B-spline based finite cell method into shape optimization is developed for axisymmetric solids involving the centrifugal force effect. We first replace the traditional conforming mesh in the finite element method with structured cells that are fixed during the whole design process with a view to avoid the sophisticated re-meshing and eventual mesh distortion.Then, B-spline shape functions are further implemented to yield a high-order continuity field along the cell boundary in stress analysis. By means of the implicit description of the shape boundary, stress sensitivity is analytically derived with respect to shape design variables. Finally, we illustrate the efficiency and accuracy of the proposed protocol by several numerical test cases as well as a whole design procedure carried out on an aeronautic turbine disk.展开更多
BACKGROUND: Elevated troponin I(TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, t...BACKGROUND: Elevated troponin I(TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients. METHODS: The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality. RESULTS: A total of 166 patients(69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group(P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours(7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality. CONCLUSIONS: Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.展开更多
1.Introduction Sudden cardiac death(SCD)refers to sudden death due to a variety of cardiac causes.It is manifested as a sudden loss of consciousness,cardiac arrest,and respiratory arrest and generally shows early symp...1.Introduction Sudden cardiac death(SCD)refers to sudden death due to a variety of cardiac causes.It is manifested as a sudden loss of consciousness,cardiac arrest,and respiratory arrest and generally shows early symptoms that are atypical and not easily detected[1].According to a recent study,nearly 544000 patients suffer from SCD every year in China[2].展开更多
Background:Acute kidney injury (AKI) is a serious and fatal complication of acute myocardial infarction (AMI).It has high shortand long-term mortality rates and a poor prognosis but is potentially preventable.However,...Background:Acute kidney injury (AKI) is a serious and fatal complication of acute myocardial infarction (AMI).It has high shortand long-term mortality rates and a poor prognosis but is potentially preventable.However,the current incidence,risk factors,and outcomes of AKI in the Chinese population are not well understood and would serve the first step to identify high-risk patients who could receive preventative care.Methods:The medical data of 1124 hospitalized patients diagnosed with AMI from October 2013 to September 2015 were reviewed.AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes criteria.All the patients were divided into either the AKI group or the non-AKI group.A univariate comparison analysis was performed to identify possible risk factors associated with AKI.A multiple logistic regression analysis was used to identify the independent risk factors for AKI in patients with AMI.Results:Overall,the incidence of AKI was 26.0%.The mortality rate of the AKI group was 20.5 %,and the mortality rate of the nonAKI group was 0.6%(P < 0.001).Logistic regression analysis showed that the independent risk factors for AKI in patients with AMI included:age (>60 years old)(odds ratio [OR] 1.04,95% confidence interval [CI] 1.02-1.05,P =0.000),hypertension (OR 2.51,95% CI 1.62-3.87,P =0.000),chronic kidney disease (OR 3.52,95% CI 2.01-6.16,P =0.000),Killip class ≥3 (OR 5.22,95% CI 3.07-8.87,P =0.000),extensive anterior myocardial infarction (OR 3.02,95% CI 1.85--4.93,P =0.000),use of furosemide (OR 1.02,95% CI 1.02-1.03,P =0.000),non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (OR 1.58,95% CI 1.04-2.40,P =0.032).These factors provided an accurate tool to identify patients at high risk of developing AKI.Contusions:Approximately 26.0% of patients undergoing AMI developed AKI,and the development of AKI was strongly correlated with in-hospital mortality.The risk factors for AKI in patients with AMI were determined to help identify high-risk patients and make appropriate clinical decisions.展开更多
文摘Dear editor,Factor V deficiency is a rare bleeding disorder,which includes congenital and acquired factor V deficiencies.Congenital factor V deficiency(CFVD)is an autosomal recessive disorder with an estimated prevalence of 1:1,000,000.[1]However,acquired factor V deficiency(AFVD)is even rarer.
基金Supported by Capital Characteristic Clinic Project,No.Z161100000516045
文摘Herein we report a case of acute liver failure(ALF) and hemophagocytic lymphohistiocytosis(HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient's condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy. On the fourth day of admission, pancytopenia emerged, accompanied by hypofibrinogenemia and hyperferritinemia. The patient was diagnosed with ALF. He also met the diagnostic criteria of HLH according to the HLH-2004 guideline. Polymerase chain reaction(PCR) amplifications of varicella-zoster virus(VZV) were positive, confirming that VZV was a causative trigger for ALF and HLH. In view of the devastating immune activation in HLH, immunosuppression therapy with dexamethasone and etoposide was administered, in addition to high dose acyclovir. The patient's symptoms improved dramatically and he finally made a full recovery. To our knowledge, this is only the second report of a successful rescue of ALF associated with HLH, without resorting to liver transplantation. The first case was reported in a neonate infected by herpes simplex virus-1. However, survival data in older children and adults are lacking, most of whom died or underwent liver transplantation. Our report emphasizes the clinical vigilance for the possible presence of HLH, and the necessity of extensive investigation for underlying etiologies in patients presenting with indeterminate ALF. Early initiation of specific therapy targeting the underlying etiology, and watchful immunosuppression such as dexamethasone and etoposide, together with supportive therapy, are of crucial importance in this life-threatening disorder.
基金supported by the National Key Research and Development Project of the Ministry of Science and Technology,China(2018YFC1313700)“Gaoyuan”Project of Pudong Health and Family Planning Commission(PWYgy2018-6).
文摘BACKGROUND:A pandemic of coronavirus disease(COVID-19)has been declared by the World Health Organization(WHO)and caring for critically ill patients is expected to be at the core of battling this disease.However,little is known regarding an early detection of patients at high risk of fatality.METHODS:This retrospective cohort study recruited consecutive adult patients admitted between February 8 and February 29,2020,to the three intensive care units(ICUs)in a designated hospital for treating COVID-19 in Wuhan.The detailed clinical information and laboratory results for each patient were obtained.The primary outcome was in-hospital mortality.Potential predictors were analyzed for possible association with outcomes,and the predictive performance of indicators was assessed from the receiver operating characteristic(ROC)curve.RESULTS:A total of 121 critically ill patients were included in the study,and 28.9%(35/121)of them died in the hospital.The non-survivors were older and more likely to develop acute organ dysfunction,and had higher Sequential Organ Failure Assessment(SOFA)and quick SOFA(qSOFA)scores.Among the laboratory variables on admission,we identifi ed 12 useful biomarkers for the prediction of in-hospital mortality,as suggested by area under the curve(AUC)above 0.80.The AUCs for three markers neutrophilto-lymphocyte ratio(NLR),thyroid hormones free triiodothyronine(FT3),and ferritin were 0.857,0.863,and 0.827,respectively.The combination of two easily accessed variables NLR and ferritin had comparable AUC with SOFA score for the prediction of in-hospital mortality(0.901 vs.0.955,P=0.085).CONCLUSIONS:Acute organ dysfunction combined with older age is associated with fatal outcomes in COVID-19 patients.Circulating biomarkers could be used as powerful predictors for the in-hospital mortality.
基金supported by the National Natural Science Foundation of China(90916027,11002113,51275424,and 11172236)973 Program(2011CB610304)+1 种基金the 111 Project(B07050)the NPU Foundation for Fundamental Research(JC20120229)
文摘In order to avoid stress concentration, the shape boundary must be properly designed via shape optimiza- tion. Traditional shape optimization approach eliminates the stress concentration effect by using free-form curve to present the design boundaries without taking the machin- ability into consideration. In most numerical control （NC） machines, linear as well as circular interpolations are used to generate the tool path. Non-circular curves, such as non- uniform rotational B-spline （NURBS）, need other more ad- vanced interpolation functions to formulate the tool path. Forming the circular tool path by approximating the opti- mal free curve boundary with arcs or biarcs is another op- tion. However, these two approaches are both at a cost of sharp expansion of program code and long machining time consequently. Motivated by the success of recent researches on biarcs, a reliable shape optimization approach is pro- posed in this work to directly optimize the shape boundaries with biarcs while the efficiency and precision of traditional method are preserved. Finally, the approach is validated by several illustrative examples.
基金This study was supported by the base supporting 2021 mobile digital hospital system engineering research center of the Ministry of Education(2194000024).
文摘BACKGROUND:In the event of a sudden shortage of medical resources,a rapid,simple,and accurate prediction model is essential for the 30-day mortality rate of patients with COVID-19.METHODS:This retrospective study compared the characteristics of the survivals and non-survivals of 278 patients with COVID-19.Logistic regression analysis was performed to obtain the“COVID-19 death risk score”(CDRS)model.Using the area under the receiver operating characteristic(AUROC)curve and Hosmer-Lemeshow goodness-of-fit test,discrimination and calibration were assessed.Internal validation was conducted using a regular bootstrap method.RESULTS:A total of 63(22.66%)of 278 included patients died.The logistic regression analysis revealed that high-sensitivity C-reactive protein(hsCRP;odds ratio[OR]=1.018),D-dimer(OR=1.101),and respiratory rate(RR;OR=1.185)were independently associated with 30-day mortality.CDRS was calculated as follows:CDRS=−10.245+(0.022×hsCRP)+(0.172×D-dimer)+(0.203×RR).CDRS had the same predictive effect as the sequential organ failure assessment(SOFA)and“confusion,uremia,respiratory rate,blood pressure,and age over 65 years”(CURB-65)scores,with AUROCs of 0.984 for CDRS,0.975 for SOFA,and 0.971 for CURB-65,respectively.And CDRS showed good calibration.The AUROC through internal validations was 0.980(95%confidence interval[CI]:0.965-0.995).Regarding the clinical value,the decision curve analysis of CDRS showed a net value similar to that of CURB-65 in this cohort.CONCLUSION:CDRS is a novel,efficient and accurate prediction model for the early identification of COVID-19 patients with poor outcomes.Although it is not as advanced as the other models,CDRS had a similar performance to that of SOFA and CURB-65.
基金supported by the National Natura Science Foundation of China (Grant 51275424)973 Program (Gran2011CB610304)+1 种基金Research Fund for the Doctoral Program of Higher Education of China (Grant 20126102130003)the opening project (Grant KFJJ13-6M) of the State Key Laboratory of Explosion Science and Technology (Beijing Institute of Technology)
文摘In this work, a design procedure extending the B-spline based finite cell method into shape optimization is developed for axisymmetric solids involving the centrifugal force effect. We first replace the traditional conforming mesh in the finite element method with structured cells that are fixed during the whole design process with a view to avoid the sophisticated re-meshing and eventual mesh distortion.Then, B-spline shape functions are further implemented to yield a high-order continuity field along the cell boundary in stress analysis. By means of the implicit description of the shape boundary, stress sensitivity is analytically derived with respect to shape design variables. Finally, we illustrate the efficiency and accuracy of the proposed protocol by several numerical test cases as well as a whole design procedure carried out on an aeronautic turbine disk.
基金supported by a grant from the National Key R&D Program of China(2018YFF0301103).
文摘BACKGROUND: Elevated troponin I(TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients. METHODS: The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality. RESULTS: A total of 166 patients(69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group(P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours(7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality. CONCLUSIONS: Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.
基金Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2019-I2M-5-023)Hainan Provincial Science and Technology Major Project(No.ZDKJ201804)+2 种基金National Natural Science Foundation of China(No.81871611)National Natural Science Foundation of China(No.81760352)Project of Hainan Provincial Department of Education(No.Hnjg2019ZD-16)
文摘1.Introduction Sudden cardiac death(SCD)refers to sudden death due to a variety of cardiac causes.It is manifested as a sudden loss of consciousness,cardiac arrest,and respiratory arrest and generally shows early symptoms that are atypical and not easily detected[1].According to a recent study,nearly 544000 patients suffer from SCD every year in China[2].
文摘Background:Acute kidney injury (AKI) is a serious and fatal complication of acute myocardial infarction (AMI).It has high shortand long-term mortality rates and a poor prognosis but is potentially preventable.However,the current incidence,risk factors,and outcomes of AKI in the Chinese population are not well understood and would serve the first step to identify high-risk patients who could receive preventative care.Methods:The medical data of 1124 hospitalized patients diagnosed with AMI from October 2013 to September 2015 were reviewed.AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes criteria.All the patients were divided into either the AKI group or the non-AKI group.A univariate comparison analysis was performed to identify possible risk factors associated with AKI.A multiple logistic regression analysis was used to identify the independent risk factors for AKI in patients with AMI.Results:Overall,the incidence of AKI was 26.0%.The mortality rate of the AKI group was 20.5 %,and the mortality rate of the nonAKI group was 0.6%(P < 0.001).Logistic regression analysis showed that the independent risk factors for AKI in patients with AMI included:age (>60 years old)(odds ratio [OR] 1.04,95% confidence interval [CI] 1.02-1.05,P =0.000),hypertension (OR 2.51,95% CI 1.62-3.87,P =0.000),chronic kidney disease (OR 3.52,95% CI 2.01-6.16,P =0.000),Killip class ≥3 (OR 5.22,95% CI 3.07-8.87,P =0.000),extensive anterior myocardial infarction (OR 3.02,95% CI 1.85--4.93,P =0.000),use of furosemide (OR 1.02,95% CI 1.02-1.03,P =0.000),non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (OR 1.58,95% CI 1.04-2.40,P =0.032).These factors provided an accurate tool to identify patients at high risk of developing AKI.Contusions:Approximately 26.0% of patients undergoing AMI developed AKI,and the development of AKI was strongly correlated with in-hospital mortality.The risk factors for AKI in patients with AMI were determined to help identify high-risk patients and make appropriate clinical decisions.
