BACKGROUND:Telepathology has emerged as a transformative digital health solution to address the global shortage of pathologists and the unequal distribution of diagnostic services, particularly in underserved and rural areas. In Henan Province, China, high diagnostic demand, rapid population growth, and limited pathology expertise exacerbate regional health care inequities, leading to delayed diagnoses and restricted access to specialist care. OBJECTIVE:This study aimed to design, implement, and evaluate a province-wide telepathology system integrating web and mobile platforms to enhance diagnostic quality, efficiency, and equitable access across health care tiers. METHODS:We conducted a retrospective, multicenter observational study using deidentified data from 120 health care institutions between 2016 and 2024. The system used a 3-tier architecture with virtual private network-secured transmission and a Browser-Server framework, supporting standardized whole-slide image acquisition, remote review, and reporting via web interfaces and a WeChat (Tencent) mini-program. System performance was assessed by consultation volume, turnaround time, concurrency, and diagnostic concordance in a subset of 1027 cases with paired tertiary-hospital expert diagnoses. Economic impact was estimated using previously published per-case savings, reflecting patient travel and ancillary cost reductions. Additional assessments included workflow integration, mobile platform use, and system stability under peak load. RESULTS:Over 8 years, the network processed 72,916 consultations encompassing 355,104 whole-slide images, supporting 220-300 concurrent users with stable performance. Median turnaround time was 10.06 (IQR 1.63-29.10) hours, with 96.41% (70,298/72,916) of cases completed within 72 hours. County-level hospitals contributed 77.63% (56,603/72,916) of consultations, demonstrating substantial engagement from lower-tier institutions. In the diagnostic subset, originating-site preliminary classifications achieved 0.90 sensitivity and 0.75 specificity relative to expert reference diagnoses, with 17.2% discordance corrected through remote expert review. Estimated annual direct cost savings ranged from US $0.14 to $0.63 million. Mobile-enabled access facilitated remote review and reporting without compromising data security, supporting integration into routine clinical workflows across diverse hospital settings. CONCLUSIONS:The Henan Province telepathology system demonstrates that a centrally coordinated, scalable digital health platform can improve diagnostic efficiency, quality, and equity in resource-constrained settings. High county-level hospital use highlights its potential to reduce geographic and structural diagnostic inequities. Future work should explore formal cost-effectiveness evaluation, artificial intelligence-assisted diagnostic support, and cross-regional interoperability to enable broader adoption and sustainable integration into health care systems.

BACKGROUND:Sepsis-induced cardiomyopathy (SIC) is a severe complication of sepsis; however, its pathogenesis remains elusive. This study aims to investigate the role of NMA-related kinase 7 (NEK7) in SIC. METHODS:C57BL/6 mice were stimulated with lipopolysaccharide (LPS) to assess NEK7 expression in the myocardium. AAV-shNEK7 was administered to improve cardiac function and survival rates. HL-1 cardiomyocytes were treated with si-NEK7 after LPS stimulation, and cell viability was measured. Molecular docking analysis and co-immunoprecipitation assays were used to validate the interaction between NEK7 and the NLRP3 inflammasome. RESULTS:NEK7 was significantly upregulated in the myocardium of LPS-stimulated C57BL/6 mice. Administration of AAV-shNEK7 improved cardiac function and enhanced survival rates. In LPS-stimulated HL-1 cardiomyocytes, si-NEK7 treatment increased cell viability compared to control cells, due to the suppression of pyroptosis through attenuation of NLRP3 inflammasome activation. Molecular docking analysis and co-immunoprecipitation assays confirmed that targeting NEK7 inhibits its interaction with NLRP3, thereby suppressing inflammasome activation and providing a protective effect. CONCLUSIONS:NEK7 plays a crucial role in SIC by facilitating NLRP3 inflammasome activation. Targeting NEK7 presents a potential therapeutic approach for SIC.

OBJECTIVE:The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography. METHODOLOGY:A total of 17 patients with ARDS under mechanical ventilation participated in this study, including 8 with moderate ARDS and 9 with severe ARDS. Each patient was initially placed in the supine position (S1), transitioned to sitting position (SP) for 30 min, and then returned to the supine position (S2). Patients were monitored for each period, with parameters recorded. MAIN OUTCOME MEASURES:The primary outcome included the spatial distribution parameters of EIT, regional of interest (ROI), end-expiratory lung impedance (ΔEELI), and parameters of respiratory mechanics. RESULTS:Compared to S1, the SP significantly altered the distribution in ROI1 (11.29 ± 4.70 vs 14.88 ± 5.00 %, p = 0.003) and ROI2 (35.59 ± 8.99 vs 44.65 ± 6.97 %, p ＜ 0.001), showing reductions, while ROI3 (39.71 ± 11.49 vs 33.06 ± 6.34 %, p = 0.009), ROI4 (13.35 ± 8.76 vs 7.24 ± 5.23 %, p ＜ 0.001), along with peak inspiratory pressure (29.24 ± 3.96 vs 27.71 ± 4.00 cmH2O, p = 0.036), showed increases. ΔEELI decreased significantly ventrally (168.3 (40.33 - 189.5), p ＜ 0.0001) and increased significantly dorsally (461.7 (297.5 - 683.7), p ＜ 0.0001). The PaO2/FiO2 ratio saw significant improvement in S2 compared to S1 after 30 min in the seated position (108 (73 - 130) vs 96 (57 - 129) mmHg, p = 0.03). CONCLUSIONS:The sitting position is associated with enhanced compliance, improved oxygenation, and more homogenous ventilation in patients with ventilated ARDS compared to the supine position. IMPLICATIONS FOR CLINICAL PRACTICE:It is important to know the impact of postural changes on patient pulmonary ventilation in order to standardize safe practices in critically ill patients. It may be helpful in the management among ventilated patients.

BackgroundTelemedicine is beneficial for improving treatment efficiency and reducing medical expenses of cancer patients. This study focuses on cancer patients participating in teleconsultations through a regional telemedicine platform in China, analyzes the consultation process, and provides references for the clinical application of telemedicine.MethodsWe collected information on teleconsultations of cancer patients conducted from 2015 to 2022 through the regional telemedicine platform. Utilizing SPSS 23.0 software, we conducted descriptive analysis to summarize the distribution of patient gender, age, region, and disease types. The ordinal logistic regression analysis was adopted to analyze the factors influencing the waiting time and consultation duration for teleconsultations.ResultsFrom 2015 to 2022, a total of 23,060 teleconsultations were conducted for cancer patients via regional telemedicine platform, with an average growth rate of 11.09%. The main types of consultations were for lung cancer, liver cancer, and breast cancer, accounting for 18.14%, 10.49%, and 9.46% respectively. 57.05% of teleconsultations had a waiting time of less than 24 h, while patient age, consultation expert level, and disease type were the main factors influencing the waiting time. 50.06% of teleconsultations had a duration of more than 20 min, and the inviting hospital level and the title of invited consultant were the main factors influencing the consultation duration.ConclusionsIn China, telemedicine has been widely employed in the clinical diagnosis and treatment of cancers, covering various types of oncological diseases. However, the waiting time for teleconsultations was generally more than 12 h, indicating the need to enhance consultation scheduling and allocate more expert resources to further optimize the efficiency of teleconsultations. Additionally, further exploration is required for remote health management of outpatients with cancers outside the hospital.

BackgroundFacing the unknown virus, COVID-19 medical staff kept wearing thick personal protective equipment during their work in the early stage of the outbreak. The survey was designed to investigate the physical discomforts, the feeling of the work intensity and the related risk factors of the frontline medical staff during COVID-19 epidemic in the early outbreak.MethodsAn national survey was carried out in China from March 17th 2020 to March 20th 2020 by applying a standardized WeChat questionnaire survey. The doctors or nurses working in the wards for the confirmed COVID-19 patients on front-line were eligible to participate in the survey. Descriptive analysis and multivariate logistic regression analysis were used.ResultsA total number of 515 COVID-19 medical staff, including 190 physicians and 325 nurses participated in this survey. 375 medical staff (72.8%) experienced physical discomforts at work, mostly consist of dyspnea (45.8%), pain (41.0%), chest distress (24.1%), dizziness (18.8%), and weakness (17.5%), while wearing thick isolation clothes at work. The mean onset time and peak time of these symptoms were 2.4 h and 3.5 h after working, respectively. 337 medical staff (65.4%) suffered from sleep disorders. 51 medical staff (10%) were highly worried about being infected by COVID-19 even during their work breaks. 246 medical staffs (47.8%) felt high work intensity and the independent influential factors were the effective daily sleep time and anxiety levels at break time (p = 0.04).ConclusionThe frontline medical staff during COVID-19 epidemic felt different physical discomforts when they wear thick isolation clothes at work in the early outbreak and they felt high work intensity. These precious data will help optimize the work management strategy to ensure the physical and mental health of medical staff in the face of similar outbreaks in future.

OBJECTIVE:This study aims to evaluate satisfaction and service effectiveness of primary hospital physicians participating in the National Telemedicine Center of China during the COVID-19 period, and to identify potential improvement suggestions.METHODS:An online questionnaire was developed to assess the impact and satisfaction of teleconsultation services. A teleconsultation manager from each of the 98 hospitals randomly invited the medical staff involved in teleconsultation to complete the online questionnaire.RESULTS:A total of 379 health care professionals responded to the online questionnaire, with a mean age of 36.74 years. Out of these respondents, 95.5% had a positive attitude towards teleconsultation during the epidemic. Only 6.6% believed that teleconsultation systems were not useful in preventing and controlling the COVID-19 pandemic. Those respondents who were very satisfied with teleconsultation participated in it 1.81 times per week averagely. Factors related to satisfaction included weekly participation frequency（P=.003）, patient data quality(P=.023), equipment operation proficiency（P=.006）, audio and video clarity and smoothness（P=.004, P=.020）, environmental satisfaction（P=.032）, and incentive measures of title promotion（P=.003）. The main challenges in teleconsultation were the lack of understanding of medical staff and the public, insufficiently advanced software and hardware equipment, and the lack of optimization of service processes.CONCLUSIONS:Primary hospital doctors demonstrate high satisfaction levels, suggesting that teleconsultation could be an effective tool for patients seeking medical care in areas under lockdown during the COVID-19 pandemic. The primary barriers to teleconsultation include lack of public understanding and unadvanced equipment. These findings should inform future efforts to establish regional telemedicine programs in the post-COVID-19 era.

Background The widespread adoption of telehealth services necessitates accurate online department selection based on patient medical records, a task requiring significant medical knowledge. Incorrect triage results in considerable time wastage for both patients and medical professionals. To address this, we propose an intelligent triage model based on a Bidirectional Long Short-Term Memory (Bi-LSTM) neural network with character embedding to enhance the efficiency and capacity of telehealth services. Methods We gathered a 1.3 GB medical dataset comprising 200,000 records, each including medical history, physical examination data, and other pertinent information found on the electronic medical record homepage. Following data preprocessing, a clinical corpus was established to train character embeddings with a medical context. These character embeddings were then utilized to extract features from patient chief complaints, and a 2-layer Bi-LSTM neural network was trained to categorize these complaints, enabling intelligent triage for telehealth services. Results 60,000 chief complaint-department data pairs were extracted from clinical corpus and divided into the training, validation, and test sets of 42,000, 9,000, and 9,000, respectively. The character embedding based Bi-LSTM neural network achieved a macro-precision of 85.50% and an F1 score of 85.45%. Conclusion The telehealth triage model developed in this study demonstrates strong implementation outcomes and significantly improves the efficiency and capacity of telehealth services. Character embedding outperforms word embedding, and future work will incorporate additional features such as patient age and gender into the chief complaint feature to future enhance model performance.

In this study, we aimed to determine whether continuous renal replacement therapy (CRRT) with oXiris filter may alleviate cytokine release syndrome (CRS) in non-AKI patients with severe and critical coronavirus disease 2019 (COVID-19). A total of 17 non-AKI patients with severe and critical COVID-19 treated between February 14 and March 26, 2020 were included and randomly divided into intervention group and control group according to the random number table. Patients in the intervention group immediately received CRRT with oXiris filter plus conventional treatment, while those in the control group only received conventional treatment. Demographic data were collected and collated at admission. During ICU hospitalization, the concentrations of circulating cytokines and inflammatory chemokines, including IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ, were quantitatively measured daily to reflect the degree of CRS induced by SARS-CoV-2 infection. Clinical data, including the severity of COVID-19 white blood cell count (WBC), neutrophil proportion (NEUT%), lymphocyte count (LYMPH), lymphocyte percentage (LYM%), platelet (PLT), C-reaction protein (CRP), high sensitivity C-reactive protein (hs-CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), albumin (ALB), serum creatinine (SCr), D-Dimer, fibrinogen (FIB), IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, number of hospital days and sequential organ failure assessment (SOFA) score were obtained and collated from medical records, and then compared between the two groups. Age, and SCr significantly differed between the two groups. Besides the IL-2 concentration that was significantly lower on day 2 than that on day 1 in the intervention group, and the IL-6 concentrations that were significantly higher on day 1, and day 2 in the intervention group compared to the control group, similar to the IL-10 concentration on day 5, there were no significant differences between the two groups. To sum up, CRRT with oXiris filter may not effectively alleviate CRS in non-AKI patients with severe and critical COVID-19. Thus, its application in these patients should be considered with caution to avoid increasing the unnecessary burden on society and individuals and making the already overwhelmed medical system even more strained (IRB number: IRB-AF/SC-04).

To the Editor: The clinical spectrum of coronavirus disease 2019 (COVID-19) appears to be wide, ranging from asymptomatic to severe progressive pneumonia with respiratory failure, multiorgan failure, and even death. Here, we investigated the clinical and pathological characteristics of a patient who died from severe COVID-19. Our findings will facilitate a deeper understanding of the pathogenesis and progression of COVID-19 and improve clinical strategies to combat the disease. On January 23, 2020, a 57-year-old man without relevant history presented with fatigue and fever after attending a family party 2 days prior. Among the members of the family party, one relative had traveled from Wuhan. Over 9 days, the fever and cough developed, and the patient visited the emergency department. A throat swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) on real-time reverse-transcription polymerase chain reaction. He was admitted to the local hospital and received supportive therapies, anti-viral agents, atomized inhalation of interferon-γ, and oxygen therapy. Cough, fever, and dyspnea further developed on February 8. He received non-invasive mechanical ventilation therapy. On February 18, he was transferred to a superior hospital with shortness of breath. His oxygenation index decreased to 85.8 mmHg, and invasive ventilation was initiated. Comprehensive treatment measures included antibiotic agents, sedative drug injections, vasopressor support, and renal replacement therapy. The next day, his oxygenation index decreased. Extracorporeal membrane oxygenation (ECMO) was initiated. After prone position ventilation for approximately 2 weeks with support from ECMO, his vital signs were still unstable. Severe COVID-19 resulted in leukocytosis and increased levels of inflammatory indicators.[1] Considering the relation between blood cell and the immunologic function, we detected the level of cytokines. The result showed that interleukin (IL)-6: 69.38 pg/mL, IL-10: 32.13 pg/mL. On February 23, we started continuous renal replacement therapy to adsorb endotoxin and cytokines. Laboratory tests revealed that the IL-6 and IL-10 levels were increased (345.51 and 44.77 pg/mL, respectively). Moreover, CD4+ T cell count was 147 cells/μL, and CD8+ T cell count was 114 cells/μL. Also, the lymphocyte count decreased. Lymphopenia is a critical factor associated with disease severity and mortality in patients with COVID-19.[2] The next day, he experienced sudden decreases in his blood pressure and blood oxygenation level, and chest computed tomography images showed right hemopneumothorax. Through thoracoscopy, we observed that the bleeding lobes had formed blood clots. To investigate the pulmonary inflammation, right lung ultrasound guided biopsy was performed on March 16. Histological examination showed that the pathological changes in the lung tissue varied, including exudative inflammation, interstitial inflammation, and fibrosis in the alveoli; in addition, focal hemorrhaging could be seen. Unfortunately, despite intensive treatment, the patient's immunologic function had not been relieved. The patient died on March 20 [Supplementary Table 1, https://links.lww.com/CM9/A588]. The results of the lung biopsy were similar to those reported in the literature.[3] The varied pathological changes in the lung tissue including exudative inflammation, interstitial inflammation, fibrosis in the alveoli, and focal hemorrhaging were typical manifestations of COVID-19 patients. The alveoli were damaged to different degrees, and some alveoli were filled with cellulose-like exudates and mucus-like substances [Figure 1A]. Type II alveolar epithelial cells had proliferated, and some of them had been shed. There were mononuclear cells, macrophages, individual multinuclear giant cells, and atypical enlarged alveolar epithelial cells in the alveolar cavity. The atypical enlarged alveolar epithelial cells had large nuclei, obvious nucleoli, and eosinophilic changes around the nucleoli, showing viral cytopathic changes [Figure 1B]. No obvious intra-nuclear or cytoplasmic inclusion bodies were found. We found the alveolar septum was widened, inflammatory cells had infiltrated, the blood vessels had proliferated and were dilated and congested, and some blood vessel walls had thickened; no clear thrombus was found in the microvasculature [Figure 1C]. Some areas of alveolar interstitial and perivascular fibrosis were observed [Figure 1D]. The excessive mucus secretion with serous and fibrinous exudation, which could aggravate the dysfunction of ventilation, might be one of the pathogenic mechanisms responsible for the hypoxemia.[4] Immunohistochemical staining showed that 2019-novel coronavirus nucleoprotein was expressed in some alveolar epithelial cells [Figure 1E]. Our studies showed thyroid transcription factor 1 expressed in the proliferative type II alveolar epithelium [Figure 1F]. CD68 is a marker for macrophage activation. There were relatively more CD68-positive macrophages infiltrating the alveolar septum and alveoli [Figure 1G]. A small number of CD8-positive T cells and spot CD4-positive T cells were found in the alveolar septum and pulmonary interstitium, but no CD20-positive B cells were observed [Figure 1H–J].Figure 1: (A) The alveolar structure was destroyed in different degrees, necrosis and exudation were seen in the alveolar cavity (Hematoxylin-eosin [HE] staining, Original magnification ×4). (B) Monocytes, macrophages, individual multinucleated giant cells, and atypical enlarged alveolar cells appear in the alveoli, among which the atypical enlarged alveolar cells have large nuclei, obvious nucleoli, and eosinophilic changes around nucleoli, showing viral cytopathic like changes (HE staining, Original magnification ×20). (C) Alveolar septum thickening, inflammatory cell infiltration, vascular proliferation, dilation, hyperemia, some vascular wall thickening, some vascular lumen occlusion (HE staining, Original magnification ×20). (D) Pulmonary interstitial and perivascular fibrosis in some areas (Masson staining, Original magnification ×20). (E) Immunohistochemical staining showed that the expression of 2019-nCoV nucleoprotein was positive in some alveolar epithelial cells (Original magnification ×20). (F) The increased expression of TTF-1 indicates the proliferation of alveolar epithelial cells (Original magnification ×20). (G) More positive macrophages infiltrated in alveolar septum and alveolar cavity (Original magnification ×20). (H) A small number of CD8+ T cells were found in the alveolar septum and pulmonary interstitium (Original magnification ×20). (I) Spot CD4+ T cells were found in the alveolar septum and pulmonary interstitium (Original magnification ×20). (J) CD20+ B cells were not found in alveolar septum and pulmonary interstitium (Original magnification ×20). 2019-nCoV: 2019-Novel coronavirus; TTF-1: Thyroid transcription factor-1.COVID-19 is a novel identified infectious disease and varied fatality. Cytokines and chemokines are involved in immunity and immunopathology, but a maladjusted immune response may lead to lung injury and a reduced survival rate. SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV) have been known to cause fatal pneumonia associated with elevation levels of pro-inflammatory cytokines and inflammatory cell infiltration.[5] The study showed the presence of increased cytokine levels (IL-6 and IL-10) and lymphopenia (CD4+ and CD8+ T cells) in individuals with severe COVID-19.[6] There were increased concentrations of the highly proinflammatory cytokines IL-6 and IL-10 in the peripheral blood of the patient. We found that the counts of CD4+ and CD8+ T cells were reduced throughout the disease course. Despite an increase in the overall white blood cell count, the CD4+ and CD8+ T cell counts are decreased in severe COVID-19 patients (P = 0.018, 0.035, respectively).[7] COVID-19 has certain commonalities with the pathological changes characteristics of SARS and MERS.[8,9] Infection with these viruses leads to pulmonary edema, pulmonary consolidation, and pulmonary hemorrhage. Microscopically, the lung presents with desquamation alveolitis and exudative lesions in the early stage, extensive hyaline membrane formation, a severe inflammatory reaction, and necrosis. There were many monocyte macrophages in the alveoli of patients with SARS, as well as positivity for CD68. In patients with MERS, the lungs develop diffuse exudative alveolar damage, alveolar septum destruction and expansion, and type II alveolar epithelial cell proliferation and exfoliation. Clinical and pathological findings in this patient with severe COVID-19 can help us identify the progression of SARS-CoV-2-related pneumonia. This may be helpful for doctors seeking to develop corresponding treatment strategies for severely ill patients and reduce mortality. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the article. The patient understands that his name and initials will not be published and due efforts will be made to conceal the identity of the patient, although anonymity cannot be guaranteed. Acknowledgements The authors thank the staff of the Severe COVID-19 Intensive Treatment Center of Heilongjiang Province for their work and dedication. Funding This work was supported by grants from the National Natural Science Foundation of China (Nos. 81770276, 81772045, and 81902000), Novel coronavirus pneumonia emergency treatment and diagnosis technology research project of Heilongjiang Provincial Science and Technology Department, Nn10 program of Harbin Medical University Cancer Hospital and Scientific research project of Heilongjiang health and Family Planning Commission (No. 2018086). Conflicts of interest None.

BACKGROUND:The rapid spread of coronavirus disease-19 (COVID-19) poses a global health emergency, and cases entering China from Russia are quite diverse. This study explored and compared the clinical characteristics and outcomes of severe and critically ill COVID-19 patients from Russia with and without influenza A infection, treated in a northern Chinese hospital (Russia imported patients).METHODS:A total of 32 severe and critically ill Russia-imported COVID-19 patients treated in the Heilongjiang Imported Severe and Critical COVID-19 Treatment Center from April 6 to May 11, 2020 were included, including 8 cases (group A) with and 24 cases (group B) without influenza A infection. The clinical characteristics of each group were compared, including prolonged hospital stay, duration of oxygen therapy, time from onset to a negative SARS-CoV-2 qRT-PCR RNA (Tneg) result, and duration of bacterial infection.RESULTS:The results showed that blood group, PaO2/FiO2, prothrombin time (PT), prothrombin activity (PTA), computed tomography (CT) score, hospital stay, duration of oxygenation therapy, Tneg, and duration of bacterial infection were statistically different between the two groups (P<0.05). Multivariant regression analysis showed that the Sequential Organ Failure Assessment (SOFA) score, C-reactive protein (CRP), and influenza A infection were factors influencing hospital stay; SOFA score, CRP, and CT score were factors influencing the duration of oxygenation therapy; PaO2/FiO2, platelet count (PLT), and CRP were factors influencing Tneg; and gender, SOFA score, and influenza A infection were factors influencing the duration of bacterial infection.CONCLUSIONS:Influenza A infection is common in Russia-imported COVID-19 patients, which can prolong the hospital stay and duration of bacterial infection. Routinely screening and treating influenza A should be conducted early in such patients.

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has led to tremendous individuals visit medical institutions for healthcare services. Public gatherings and close contact in clinics and emergency departments may increase the exposure and cross-infection of COVID-19. Objectives: The purpose of this study was to develop and deploy an intelligent response system for COVID-19 voice consultation, to provide suggestions of response measures based on actual information of users, and screen COVID-19 suspected cases. Methods: Based on the requirements analysis of business, user, and function, the physical architecture, system architecture, and core algorithms are designed and implemented. The system operation process is designed according to guidance documents of the National Health Commission and the actual experience of prevention, diagnosis and treatment of COVID-19. Both qualitative (system construction) and quantitative (system application) data from the real-world healthcare service of the system were retrospectively collected and analyzed. Results: The system realizes the functions, such as remote deployment and operations, fast operation procedure adjustment, and multi-dimensional statistical report capability. The performance of the machine-learning model used to develop the system is better than others, with the lowest Character Error Rate (CER) 8.13%. As of September 24, 2020, the system has received 12,264 times incoming calls and provided a total of 11,788 COVID-19-related consultation services for the public. Approximately 85.2% of the users are from Henan Province and followed by Beijing (2.5%). Of all the incoming calls, China Mobile contributes the largest proportion (66%), while China Unicom and China Telecom are accounted for 23% and 11%. For the time that users access the system, there is a peak period in the morning (08:00–10:00) and afternoon (14:00–16:00), respectively. Conclusions: The intelligent response system has achieved appreciable practical implementation effects. Our findings reveal that the provision of inquiry services through an intelligent voice consultation system may play a role in optimizing the allocation of healthcare resources, improving the efficiency of medical services, saving medical expenses, and protecting vulnerable groups.

To investigate the right heart function in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS), a retrospective analysis of 49 COVID-19 patients with ARDS was performed. Patients were divided into severe group and critically-severe group according to the severity of illness. Age-matched healthy volunteers were recruited as a control group. The cardiac cavity diameters, tricuspid annular plane systolic excursion (TAPSE), tricuspid valve regurgitation pressure gradient biggest (TRPG), pulmonary arterial systolic pressure (PASP), maximum inferior vena cava diameter (IVCmax) and minimum diameter (IVCmin), and inferior vena cava collapse index (ICV-CI) were measured using echocardiography. We found that the TAPSE was significantly decreased in pneumonia patients compared to healthy subjects (P < 0.0001), and it was significantly lower in critically-severe patients (P = 0.0068). The TAPSE was less than 17 mm in three (8.6%) severe and five (35.7%) critically-severe patients. In addition, the TAPSE was significantly decreased in severe ARDS patients than in mild ARDS patients. The IVCmax and IVCmin were significantly increased in critically-severe patients compared to healthy subjects and severe patients (P < 0.01), whereas the ICV-CI was significantly decreased (P < 0.05). COVID-19 patients had significantly larger right atrium and ventricle than healthy controls (P < 0.01). The left ventricular ejection fraction (LVEF) in critically-severe patients was significantly lower than that in severe patients and healthy controls (P < 0.05). Right ventricular function was impaired in critically-severe COVID-19 patients. The assessment and protection of the right heart function in COVID-19 patients should be strengthened.

Background. Though intravenous infusion linezolid therapy is common for patients in the intensive care unit (ICU), intragastric linezolid therapy is also provided for those whose gastrointestinal function are feasible. If intragastric linezolid acquired similar pharmacokinetics (PK) and pharmacodynamics (PD) parameters, this might be preferred based on cost and ease of liquid volume management.Methods. Patients in the ICU treated with intragastric and intravenous linezolid were included. Serial blood samples were collected and linezolid concentrations were measured. PK data were analyzed using Pmetrics. Monte Carlo simulations were used to evaluate PD target achievement. Results. Tmax was 1.06 ± 0.82 h of the study period in 10 patients receiving intragastric linezolid and 0.65 ± 0.24 h in 10 patients receiving intravenous linezolid (p<0.001). Cmax was 9.07 ± 4.99 mg/mL of patients with intragastric linezolid and 12.30 ± 4.06 mg/mL of patients with intravenous linezolid (p=0.904). Clearance was 11.99 ± 11.24 L/h in patients with intragastric linezolid and 14.48 ± 3.56 L/h in patients with intravenous linezolid (p=0.342). For infections with a microorganism with a minimum inhibitory concentration (MIC) of 2 mg/L, simulations demonstrated that with 600 mg every 12 hours, 58.22% would have a linezolid concentration greater than the MIC during 100% of the dosing interval (%T > MIC = 100%) in intragastric group, whereas this was 71.36% in intravenous group. Higher SOFA score and body weight were associated with lower probability of target attainment (PTA) of linezolid with standard regimen.Conclusions. Patients in ICU may be at high risk for underexposure to linezolid by intragastric administration, especially when their SOFA score and body weight is high and when infected with pathogens with an MIC ≥ 2 mg/L.

Background: Some patients with coronavirus disease 2019 progress rapidly to acute respiratory distress syndrome (ARDS), septic shock, and multiple organ failure (1).Some experts attribute this sequence of events to a large increase in cytokines (cytokine storm) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or a secondary infection by another organism.Objective: To report cytokine levels in multiple body fluids from a patient with COVID-19 and ARDS, septic shock, and multiple organ failure.Case Report: On 20 January 2020, a 66-year-old man who had been exposed to a patient with COVID-19 developed cough and fever and treated himself at home.On 2 February, his cough and fever gradually worsened, his body temperature reached 38.7 °C, and he developed diarrhea and vomiting.He was treated at a local hospital, where his medical history included vitiligo, gastric ulcer, coronary heart disease, and chronic obstructive pulmonary disease.He developed dyspnea 2 days later, and COVID-19 was diagnosed by a throat swab that was tested for nucleic acid.He received the antiviral drug abidol and supportive care.When his dyspnea worsened, he was transferred to the intensive care unit for noninvasive mechanical ventilation.On 11 February, mechanical ventilation was started because of a progressive decrease in blood oxygen saturation, a blood lactate level of 4 mmol/L, and a PaO 2 -FiO 2 ratio of 186 mm Hg.On 17 February, the patient was transferred to the Severe COVID-19 Intensive Treatment Center of Heilongjiang Province.His COVID-19 status was confirmed as a critical type, according to guidelines from the National Health Commission (trial version 7).We treated him with antiviral drugs, immunoglobulin infusions, lung-protective ventilation, and lung recruitment and prone position ventilation.In addition, we started measuring levels of the cytokines IL-6 and IL-10 in his blood daily and in his bronchoalveolar lavage fluid and pleural fluid intermittently, and we found high levels (Figure).On 23 February, we started continuous renal replacement therapy with an Oxiris filter (Baxter International), which is designed to adsorb uremic toxins, endotoxin, and cytokines.Computed tomography on 24 February showed worsening of pulmonary inflammation.On 1 March, we started extracorporeal membrane oxygenation because we could not maintain the patient's oxygenation with intermittent prone position ventilation.On 2 March, the patient developed septic shock and cardiac insufficiency, and we introduced an intra-aortic balloon pump.On 6 March, every-other-day plasmapheresis was started in another attempt to decrease his cytokine levels.Computed tomography on 9 March showed that the patient's lung consolidation had worsened.Unfortunately, the patient died on 14 March.Discussion: The role of cytokine storm in patients with COVID-19 is uncertain.We measured levels of IL-6 and IL-10 * Drs.

Backgound: To investigate the right heart function in COVID-19 (coronavirus disease 2019) patients with acute respiratory distress syndrome (ARDS). Methods: A retrospective analysis of 49 COVID-19 patients with ARDS was performed. Patients were divided into severe and critically severe group according to severity of illness. Age-matched healthy volunteers were recruited serving as a control group. The cardiac cavity diameters, tricuspid annular plane systolic excursion (TAPSE), tricuspid valve regurgitation pressure gradient biggest (TRPG), pulmonary arterial systolic pressure (PASP), maximum inferior vena cava diameter (IVCmax) and minimum diameter (IVCmin), and inferior vena cava collapse index (ICV-CI) were measured using echocardiography. Results: We found the TAPSE was significantly decreased in pneumonia patients compared to healthy subjects (P<0.0001), which was significantly lower in critically severe patients (P=0.0068). TAPSE was less than 17mm in 3 (8.6%) severe and 5 (35.7%) critically severe patients. There were no significant differences in PASP and TRPG between severe and critically severe patients. The IVCmax and IVCmin were significantly increased in critically severe patients compared to healthy subjects and severe patients (P < 0.01), whereas ICV-CI was significantly decreased (P < 0.05). COVID-19 patients had significantly larger right atrium and ventricle than healthy controls (P < 0.01). The left ventricular ejection fraction (LVEF) in critically severe patients was significantly lower than that in severe patients and healthy controls (P < 0.05). Conclusion: Right ventricular function is impaired in critically severe COVID-19 patients. The assessment and protection of the right heart function in COVID-19 patients should be strengthened.

BACKGROUND This prospective study compared pharmacokinetics (PK) and pharmacodynamics (PD) of linezolid in patients with sepsis receiving continuous venovenous hemofiltration (CVVH) with patients receiving extended daily hemofiltration (EDH). METHODS Patients with sepsis treated with linezolid and CVVH or EDH were included. Serial blood samples were collected and linezolid concentrations measured. PKs were analyzed using Pmetrics. Monte Carlo simulations were used to evaluate PD target achievement. RESULTS From 20 patients, 320 blood samples were collected for PK and PD analysis. PK profiles of linezolid were best described by a 2-compartment model. PK parameters were not significantly different between EDH and CVVH groups and were associated with body weight, renal replacement therapy (RRT) duration, and sequential organ failure assessment score. Monte Carlo simulations showed poor fractional target attainment for a minimum inhibitory concentration (MIC) of 2 mg/L with standard 600 mg intravenous administration every 12 hours. CONCLUSIONS Patients with sepsis receiving RRT exhibited variability in PK/PD parameters for linezolid. PK parameters were not significantly different between CVVH- and EDH-treated patients. Higher probability of target attainment would be achievable at a MIC of 2 mg/L in EDH patients. Higher linezolid doses should be considered for patients on RRT to achieve adequate blood levels.

Low cortisol levels (<276 nmol/L) are regarded as relative adrenal insufficiency (RAI) and associated with adverse events in critical illness. Whether RAI affects cardiac surgery patients is unknown. In this study, serum cortisol and adrenocorticotropic hormone (ACTH) levels were prospectively examined in 90 adult patients who underwent elective cardiac surgery from April to August, 2015. RAI was defined as basal cortisol <276 nmol/L at postoperative day 1. Perioperative outcomes were recorded. It was found that the incidence of RAI was 55.56% (50/90). Patients with RAI did not show worse outcomes as compared with patients with non-RAI (P>0.05). A longer duration of surgery and higher preoperative ACTH levels were shown to significantly delay weaning (B = 0.349, P<0.001; B = 1.367, P = 0.001, respectively) and prolong time spent in the ICU (B = 0.385, P<0.001; B = 1.255, P = 0.003, respectively). Age (B = 0.245, P = 0.012) and operation duration (B = 0.058, P = 0.002) prolonged the hospitalization. Cox proportional hazards regression showed that preoperative ACTH levels and New York Heart Association class were associated with a higher rate of 48-hour ICU hospitalization (hazard rate [HR] 0.977, P = 0.034; HR 0.568, P = 0.005, respectively). These results presented here indicated that RAI after heart surgery does not lead to worse outcomes, and the cut-off value of 276 nmol/L for cortisol is not appropriate for identifying RAI in patients who underwent cardiac surgery.

Intra-aortic balloon pumps (IABP) have saved many patients with cardiogenic shock during the perioperative period of cardiac surgery. However, the ideal insertion timing is controversial. In the present study, we aimed to optimize the insertion timing, in order to increase the survival rate of the patients. A total of 197 patients with cardiogenic shock during the perioperative period of cardiac surgery and implemented IABP from January 2011 to October 2015 were selected for the study. Patients were divided into five groups on the basis of application timing of IABP: 0-60, 61-120, 121-180, 181-240 and > 240 min. The 30-day mortality, application rate of continuous renal replacement therapy (CRRT), duration of mechanical ventilation, duration of hospital stay and hospitalization charges were analyzed in the above groups. The risk factors related to mortality and the occurrence of IABP complications were also analyzed. The mortality in the 0-60, 61-120, 121-180, 181-240 and > 240 min groups were 42.17, 36.6, 77.3, 72.7 and 79.3%, respectively. Earlier IABP insertion resulted in less patients receiving CRRT from acute renal failure and less daily hospitalization charges. However, the IABP application timing had no effect on indexes such as hospitalization duration, duration of mechanical ventilation and total hospitalization charges. Multifactor logistic regression analysis indicated that the independent risk factors of death in patients with cardiogenic shock during cardiac surgery were related to IABP support timing and vasoactive-inotropic score (VIS) before balloon insertion. In the first 120 min of cardiogenic shock during the perioperative period of cardiac surgery, IABP application decreased 30-day mortality. Mortality was related with VIS score of patients, which can be used to predict the prognosis of patients with cardiogenic shock.

Transplantation of mesenchymal stromal cells is a promising strategy for treating sepsis. Natural killer cells are important in the development of sepsis, and their functions can be inhibited by mesenchymal stromal cells, we asked whether mesenchymal stromal cells exert their therapeutic effects through inhibiting the functions of natural killer cells in a septic mouse model generated with cecal ligation puncture method. Using co-cultures of cells, small interfering RNA, enzyme-linked immnuosorbent assays, fluorescence assays, western blotting, and pathological examination, we investigated the levels of inflammatory cytokines, proliferation of natural killer cells, inflammatory infiltration of important organs in mice, and activity of the Janus kinase/signal transducer and activator of transcription signaling pathway and found that mesenchymal stromal cells inhibited the function and proliferation of septic natural killer cells, increased interleukin-10 levels and increased the expression of components, such as Janus kinase 1, Janus kinase 2, and signal transducer and activator of transcription 3 in the Janus kinase/signal transducer and activator of transcription pathway both in vitro and in vivo. We conclude that mesenchymal stromal cells have their therapeutic effect in the septic mouse model through inhibiting the function and proliferation of septic natural killer cells. This biological process may involve interleukin-10 and suppressor of cytokine signaling 3 as well as other pathway components in the Janus kinase/signal transducer and activator of transcription pathway. Transplantation of mesenchymal stromal cells is an effective strategy to treat sepsis.