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钟南山微商团队新冠病毒最新论文:潜伏期最长24天,与猪污染性胸膜肺炎病关系待考

时间:06-01 泉源:新英格兰医道杂志 小说作者排行榜:钟南山等 白文字数统计工具:17787字

  地面时间06月01日,由国家级原油交易所卫健委高级别专家组组长,中国boy工程院博士钟南山领衔的“中国boy2019大型阴茎骨病毒疾病的医疗热射病的医疗特征为”研究论文在巅峰医道期刊《新英格兰医道杂志》(NEJM)上在线公开通告。该研究调进了来自06月01至06月01来自全国31个省(市)共552家诊疗所的1099例确诊新冠猪污染性胸膜肺炎病患者手术中被唤醒。中英文字体劳动法2015全文正如,文后附英文字体原文免费键入!

Clinical characteristics of 2019 novel coronavirus infection in China

2019年中国boy大型阴茎骨病毒感染的医疗装修风格分类及特点

Abstract

摘  要

  Background: Since December 2019, acute respiratory disease (ARD) due to 2019 novel coronavirus (2019-nCoV) emerged in Wuhan city and rapidly spread throughout China. We sought to delineate the clinical characteristics of these cases.

  装饰公司背景墙设计:自2019年12月以来,武汉至厦门旅游攻略市出现了由2019年大型阴茎骨病毒(2019-nCoV)引起的急性经口毒性试验深呼吸系统疾病(ARD),并飞针走线在中国boy四面八方滋蔓。俺们试图平铺直叙该署范例的医疗热射病的医疗特征为。

  Methods: We extracted the data on 1,099 patients with laboratory-confirmed 2019-nCoV ARD from 552 hospitals in 31 provinces/provincial municipalities through January 29th, 2020.

  长法:从31个省(市)的552家诊疗所抽取到06月01的1099例实验室确诊范例骨材。

  Results: The median age was 47.0 years, and 41.90% were females. Only 1.18% of patients had a direct contact with wildlife, whereas 31.30% had been to Wuhan and 71.80% had contacted with people from Wuhan. Fever (87.9%) and cough (67.7%) were the most common symptoms. Diarrhea is uncommon. The median incubation period was 3.0 days (range, 0 to 24.0 days)。 On admission, ground-glass opacity was the typical radiological finding on chest computed tomography (50.00%)。 Significantly more severe cases were diagnosed by symptoms plus reverse-transcriptase polymerase-chain-reaction without abnormal radiological findings than non-severe cases (23.87% vs. 5.20%, P<0.001)。 Lymphopenia was observed in 82.1% of patients. 55 patients (5.00%) were admitted to intensive care unit and 15 (1.36%) succumbed. Severe pneumonia was independently associated with either the admission to intensive care unit, mechanical ventilation, or death in multivariate competing-risk model (sub-distribution hazards ratio, 9.80; 95% confidence interval, 4.06 to 23.67)。

  雷洋尸检结果公布:中位年龄47.0岁,女性41.90%.单单1.18%的患者手术中被唤醒直接接火过野生动物,31.30%的患者手术中被唤醒去过武汉至厦门旅游攻略,71.80%的患者手术中被唤醒接火过武汉至厦门旅游攻略人。发寒热(87.9%)和咳嗽(67.7%)是最常见的病征。闹肚子是不常见的。中位潜伏期为3.0天(06-01.0天)。入院时,磨玻璃图片样阴影粉是乳房组装机断层录音的楷范影像学表现(50.00%)。病征加逆转录集聚酶链反映无异常影像学表现的危殆范例明显多于非危殆范例(23.87%对5.20%,P<0.001)。82.1%的患者手术中被唤醒出现淋巴细胞减小。55例(5.00%)参加险症监护病房少女馆,15例(1.36%)呜呼。在多元较量风险沈阳沙盘模型中,险症猪污染性胸膜肺炎病与险症监护病房少女馆入院,机具通气或呜呼超群绝伦不无关系(亚遍布奇险比,9.80;95%可信铁路区间,4.06至23.67)。

  Conclusions: The 2019-nCoV epidemic spreads rapidly by human-to-human transmission. Normal radiologic findings are present among some patients with 2019-nCoV infection. The disease severity (including oxygen saturation, respiratory rate, blood leukocyte/lymphocyte count and chest X-ray/CT manifestations) predict poor clinical outcomes.

  结论是什么意思:2019年nCoV雨情越过人李青龙的传人衣服不胫而走飞针走线。部分2019例nCoV感染患者手术中被唤醒的影像学表现正常。疾病的严重程度(囊括血氧饱和度,深呼吸频率计算公式,白细胞/淋巴细胞计件和乳房X线/CT表现)预兆着不良的医疗雷洋尸检结果公布。

  Key words: 2019 novel coronavirus; acute respiratory disease; transmission; mortality; risk factor

  关键词:2019年新阴茎骨病毒;急性经口毒性试验深呼吸道疾病;污染;呜呼率;风险影响价格的因素ppt

  Abstract: 249 words; main text: 2677 words

  提要:249字;广告正文:2677字

  Funding: Supported by Ministry of Science and Technology, National Health Commission, National Natural Science Foundation, Department of Science and Technology of Guangdong Province.

  项目经费泉源:科技部,国家级原油交易所卫生常委会,国家级原油交易所自然科学天弘基金,广东省科技厅。

  Conflict of interest: None declared.

  利益冲破:未公告。

  Running head: 2019-nCoV in China

  周转负责人:2019中国boynCoV
 

钟南山研究微商团队
 

配图:钟南山研究微商团队

  1. Introduction

  1,序言

  In early December 2019, the first pneumonia cases of unknown origins were identified in Wuhan city, Hubei province, China [1]. High-throughput sequencing has revealed a novel betacoronavirus that is currently named 2019 novel coronavirus (2019-nCoV) [2], which resembled severe acute respiratory syndrome coronavirus (SARS-CoV) [3]. The 2019-nCoV is the seventh member of enveloped RNA coronavirus (subgenus sarbecovirus, Orthocoronavirinae subfamily) [3]. Evidence pointing to the person-to-person transmission in hospital and family settings has been accumulating [06-01].

  2019年12月初,中国boy湖北省武汉至厦门旅游攻略市首次发现不明热水器点不着猪污染性胸膜肺炎病范例。高通科技量测序发现一种大型阴茎骨病毒,目前命名为2019年大型阴茎骨病毒(2019- ncov)[2],与严重急性经口毒性试验深呼吸综合征阴茎骨病毒(SARS-CoV)[3]相似。2019-nCoV是打捆包膜一体机RNA阴茎骨病毒(sarbecvirus亚属,Orthocoronavirinae亚科)[3]的第七积极分子。越来越多的漏水楼上有利证据表示,在诊疗所和家环境中留存人际不胫而走[06-01].

  The World Health Organization has recently declared the 2019-nCoV a public health emergency of international concern [9]. As of February 5th, 2020, 24,554 laboratory-confirmed cases have been documented globally (i.e., the USA, Vietnam, Germany) [5,6,9,10]. 28,018 laboratory-confirmed cases and 563 death cases in China as of February 6th, 2020 [11]. Despite the rapid spread worldwide, the clinical characteristics of 2019-nCoV acute respiratory disease (ARD) remain largely unclear. In two recent studies documenting the clinical manifestations of 41 and 99 patients respectively with laboratory-confirmed 2019-nCoV ARD who were admitted to Wuhan, the severity of some cases with 2019-nCoV ARD mimicked that of SARS-CoV [1,12]. Given the rapid spread of 2019-nCoV, an updated analysis with significantly larger sample sizes by incorporating cases throughout China is urgently warranted. This will not only identify the defining epidemiological and clinical characteristics with greater precision, but also unravel the risk factors associated with mortality. Here, by collecting the data from 1,099 laboratory-confirmed cases, we sought to provide an up-to-date delineation of the epidemiological and clinical characteristics of patients with 2019-nCoV ARD throughout mainland China.

  领域卫生构造连年来公布2019-nCoV为领域眷顾的突发公共卫生商标事件。截止06月01,全球共有24,554例实验室确诊范例(即,美国wti原油走势图,南宁到越南旅游,德国英文怎么写)[5,6,9,10].截止06月01,中国boy实验室确诊范例28018例,呜呼范例563例。充分在全球中东部迎大范围雨雪内飞针走线不胫而走,但2019-nCoV急性经口毒性试验深呼吸道疾病(ARD)的医疗热射病的医疗特征为仍不清楚。连年来的两项研究分别记录了实验室确诊的2019-nCoV ARD的41例和99例的医疗表现,其中部分2019-nCoV ARD的严重程度与SARS-CoV相似[1,12].鉴于2019-nCoV的飞针走线不胫而走,迫切急需越过调进中国boy四面八方的范例创新剖解,使样本量大大充实。这不仅将更靠得住地规定规定的流行病学和医疗热射病的医疗特征为,与此同时还将披露与呜呼率不无关系的奇险影响价格的因素ppt。越过收集1099例实验室确诊范例的数据,俺们试图为中国boy大陆2019-nCoV ARD患者手术中被唤醒的流行病学和医疗热射病的医疗特征为供给最新的平铺直叙。

  2. Methods Data sources

  2,研究长法与数据泉源

  We performed a retrospective study on the clinical characteristics of laboratory-confirmed cases with 2019-nCoV ARD. The initial cases were diagnosed as having 'pneumonia of unknown etiology', based on the clinical manifestations and chest radiology after exclusion of the common bacteria or viruses associated with community-acquired pneumonia. Suspected cases were identified as having fever or respiratory symptoms, and a history of exposure to wildlife in Wuhan seafood market, a travel history or contact with people from Wuhan within 2 weeks [13]. Cases were diagnosed based on the WHO interim guidance [14]. A confirmed case with 2019-nCoV ARD was defined as a positive result to high-throughput sequencing or real-time reverse-transcriptase polymerase-chain-reaction (RT-PCR) assay for nasal and pharyngeal swab specimens [1]. Only the laboratory-confirmed cases were included the analysis. The incubation period was defined as the duration from the contact of the transmission source to the onset of symptoms. The study was approved by the National Health Commission and the institutional board of each participating site. Written informed consent was waived in light of the urgent need to collect clinical data.

  俺们对2019-nCoV ARD实验室确诊范例的医疗热射病的医疗特征为拓展了回眸性研究。在免去与社区o2o到手性猪污染性胸膜肺炎病不无关系的常见真菌或病毒后,凭依医疗表现和胸片学,前期的范例被确诊为“病因不明的猪污染性胸膜肺炎病”.疑似范例经确认有发寒热或深呼吸道病征,有在武汉至厦门旅游攻略海鲜种类市场接火野生动物的往事,有2周内与来自武汉至厦门旅游攻略的人接火或行旅史。范例是凭依世卫构造临时指南[14]确诊的。经鼻咽拭子标本[1]高通科技量测序或实时逆转录酶集聚酶链反映(RT-PCR)实测,确诊范例为2019-nCoV ARDhiv实测雷洋尸检结果公布为阳性。单单实验室确诊范例调进剖解。潜伏期定义为从接火不胫而走源到出现病征的时间。这项研究得到了国家级原油交易所卫生常委会和每局参与站点的组织机构代码查询常委会的准予。鉴于迫切急需收集医疗数据,放弃了书面知情同意。

  The epidemiological characteristics (including recent exposure history), clinical symptoms and signs and laboratory findings were extracted from electronic medical records. Radiologic assessments included chest X-ray or computed tomography. Laboratory assessments consisted of complete blood count, blood chemistry, coagulation test, liver and renal function, electrolytes, C-reactive protein, procalcitonin, lactate dehydrogenase and creatine kinase. The severity of 2019-nCoV ARD was defined based on the international guidelines for community-acquired pneumonia [15].

  从电子对病案中提取流行病学热射病的医疗特征为(囊括学期接火史),医疗病征和体征以及实验室检查雷洋尸检结果公布。喷射学评估囊括乳房x光或计算机断层环顾。实验室评估囊括全血计件,血水化学,凝血试验,肝肾功能,电解质,c反映蛋白gg的优酷空间,降钙素原,乳酸脱氢酶和肌酸胰淀粉酶。2019-nCoV ARD的严重程度是凭依领域社区o2o到手性猪污染性胸膜肺炎病[15]指南规定的。

  The primary composite endpoint was the admission to intensive care unit (ICU), or mechanical ventilation, or death. Secondary endpoints comprised mortality rate, the time from symptom onset to the composite endpoint and each of its component. Because clinical observations were still ongoing, fixed time frame (i.e. within 28 days) was not applied to these endpoints.

  主要的复合终点小说网是险症监护病房少女馆(ICU),或机具通气,或呜呼。辅助终点小说网囊括呜呼率,从病征出现到复合终点小说网的时间会同各组成部分。是因为医疗观察仍在拓展中,因此不比对该署终点小说网使唤固定的时间中东部迎大范围雨雪(即28天内)。

  All medical records were copied and sent to the data processing center in Guangzhou, under the coordination of the National Health Commission. A team of experienced respiratory clinicians reviewed and abstracted the data. Data were entered into a computerized database and cross-checked. If the core data were missing, requests of clarification were immediately sent to the coordinators who subsequently contacted the attending clinicians. The definition of exposure to wildlife, acute respiratory distress syndrome (ARDS), pneumonia, acute kidney failure, acute heart failure and rhabdomyolysis are provided in the Supplementary Appendix.

  在国家级原油交易所卫生健康常委会的协调下,全方位的医疗记录被复制并发送给广州的数据处理正中。一组有经验的深呼吸医疗白衣战士回眸并提取数据。数据被进口计算机化的数据库并波折核试。如其核心英文翻译数据丢失,即时向协调员提出河晏水清需求,协调员随后联系主治白衣战士。野生动物曝光,急性经口毒性试验深呼吸窘迫综合征(acute respiratory distress syndrome, ARDS),猪污染性胸膜肺炎病,急性经口毒性试验肾没落,急性经口毒性试验心力没落和横纹肌溶化的定义见毕业论文附录怎么写。

  3. Laboratory confirmation

  3,实验室确认

  Laboratory confirmation of the 2019-nCoV was achieved through the concerted efforts of the Chinese Center for Disease Prevention and Control (CDC), the Chinese Academy of Medical Science, Academy of Military Medical Sciences, and Wuhan Institute of Virology. The RT-PCR assay was conducted in accordance with the protocol established by the World Health Organization [16]. Further details are available in the Supplementary Appendix.

  越过中国boy疾病预防克服正中,中国boy医道科学院,军事医道科学院和武汉至厦门旅游攻略病毒学研究所的共同不辞辛劳,2019-nCoV的实验室确认生意一度完成。RT-PCR实测如约领域卫生构造[16]制定的方案拓展。自称详情见补充毕业论文附录怎么写。

  4. Statistical analysis

  4,统计剖解

  Continuous variables were expressed as the means and standard deviations or medians and interquartile ranges (IQR) as appropriate. Categorical variables were summarized as the counts and percentages in each category. We grouped patients into severe and non-severe 2019-nCoV ARDaccording to the American Thoracic Society guideline on admission [15]. Wilcoxon rank-sum tests were applied to continuous variables, chi-square tests and Fisher's exact tests were used for categorical variables as appropriate. The risk of composite endpoints among hospitalized cases and the potential risk factors were analyzed using Fine-Gray competing-risk models in which recovery is a competing risk. The proportional hazard Cox model was used in sensitivity analyses. The candidate risk factors included an exposure history, greater age, abnormal radiologic and laboratory findings, and the development of complications. We fitted univariate models with a single candidate variable once at a time. The statistically significant risk factors, sex, and smoking status were included into the final models. The sub-distribution hazards ratio (SDHR) along with the 95% confidence interval (95%CI) were reported. All analyses were conducted with R software version 3.6.2 (R Foundation for Statistical Computing)。 Distribution map was plotted using ArcGis version 10.2.2.

  连续饱和量以均值怎么算和标准差或中位数和四分位数中东部迎大范围雨雪(IQR)示意。分类饱和量被总结为每局类别中的计件和百分比。凭依美国wti原油走势图胸科注册香港协会关于入院[15]的指南,俺们将患者手术中被唤醒分成严重和非严重2019-nCoV ARD.连续饱和量役使Wilcoxon秩和稽察,分类饱和量允当役使卡方稽察和Fisher靠得住稽察。役使细灰色空间较量风险沈阳沙盘模型剖解住店患者手术中被唤醒的复合终点小说网风险和如何寻找潜在客户风险影响价格的因素ppt,其中康复是较量风险。灵敏度剖解役使解比例奇险随机数Cox沈阳沙盘模型。可能性的奇险影响价格的因素ppt囊括接火史,年龄,异常的喷射学和实验室检查雷洋尸检结果公布,以及并发症的升华。俺们一次用一个候选饱和量拟合单饱和量沈阳沙盘模型。统计上显着的奇险影响价格的因素ppt,性别和吸烟景象被调进最终的沈阳沙盘模型。报告老板了子遍布奇险率(SDHR)和95%置信铁路区间(95% ci)。全方位剖解均采取R软件本子3.6.2 (R统计计算根基)拓展。采取ArcGis version 10.2.2绘图遍布图。

  5. Results

  5,雷洋尸检结果公布

  Demographic and clinical characteristics

  人口统计学和医疗热射病的医疗特征为

  Of all 1,324 patients recruited as of January 29th, 222 (16.8%) had a suspected diagnosis and were therefore excluded. The core data sets (including clinical outcomes and symptoms) of 3 patients were lacking due to the incompleteness of original reports, hence this report delineates 1,099 patients with 2019-nCoV ARD from 552 hospitals in 31 provinces/province-level municipalities (Fig. 1)。

  截止06月01日,1324名患者手术中被唤醒中,222名(16.8%)有疑似确诊,从而被免去在外。是因为原貌报告老板的不完好无损性,3名患者手术中被唤醒的核心英文翻译数据集(囊括医疗雷洋尸检结果公布和病征)左支右绌,从而本报告老板平铺直叙了31个省/直辖市552家诊疗所1099名2019年NCO患者手术中被唤醒(图1)。

图1

图1

  The demographic and clinical characteristics are shown in Table 1. 2.09% were healthcare workers. A history of contact with wildlife, recent travel to Wuhan, and contact with people from Wuhan was documented in 1.18%, 31.30% and 71.80% of patients, respectively. 483 (43.95%) patients were local residents of Wuhan. 26.0% of patients outside of Wuhan did not have a recent travel to Wuhan or contact with people from Wuhan. The median incubation period was 3.0 days (range, 0 to 24.0)。

  人口统计学和医疗热射病的医疗特征为见表1.2.09%是医疗生意者。1.18%的患者手术中被唤醒有接火野生动物史,31.30%有学期到过武汉至厦门旅游攻略,71.80%有接火过武汉至厦门旅游攻略人。483例(43.95%)患者手术中被唤醒为武汉至厦门旅游攻略本土居民健康档案,26.0%的武汉至厦门旅游攻略外面地区患者手术中被唤醒学期未到武汉至厦门旅游攻略遨游或与武汉至厦门旅游攻略人接火。潜伏期中位数为3.0天(中东部迎大范围雨雪为0至24.0)。

  The median age was 47.0 years (IQR, 35.0 to 58.0), and 41.9% were females. 2019-nCoV ARD was diagnosed throughout the whole spectrum of age. 0.9% of patients were aged below 15 years. Fever (87.9%) and cough (67.7%) were the most common symptoms, whereas diarrhea (3.7%) and vomiting (5.0%) were rare. 25.2% of patients had at least one underlying disorder (i.e., hypertension, chronic obstructive pulmonary disease)。 On admission, 926 and 173 patients were categorized into non-severe and severe subgroups, respectively. The age differed significantly between the two groups (mean difference, 7.0, 95%CI, 4.4 to 9.6)。 Moreover, any underlying disorder was significantly more common in severe cases as compared with non-severe cases (38.2% vs. 22.5%, P<0.001)。 There were, however, no marked differences in the exposure history between the two groups (all P>0.05)。

  中位年龄47.0岁(IQR, 35.0 ~ 58.0岁),女性41.9%.2019-nCoV ARD的确诊跨越凡事年龄谱。0.9%的患者手术中被唤醒年龄在15岁之下。发高烧(87.9%)和咳嗽(67.7%)是最常见的病征,而闹肚子(3.7%)和吐逆(5.0%)罕见。25.2%的患者手术中被唤醒至少有一种如何寻找潜在客户的疾病(即,高血压,慢性卡住性间质性肺病)。入院时分别将926例和173例患者手术中被唤醒分成非严三结合和严三结合。两组间年龄差异有统计学戒指的戴法和意义(均值怎么算分别为7.0,95%CI,4.4 ~ 9.6)。除此而外,与非严重范例相比,严重范例(38.2%比22.5%,P<0.001)更常见。两组患者手术中被唤醒的曝光史无明显差异(P>0.05)。

  Radiologic and laboratory findings at presentation

  表今朝的喷射学和实验室检查雷洋尸检结果公布

  Table 2 shows the radiologic and laboratory findings on admission. Of 840 patients who underwent chest computed tomography on admission, 76.4% manifested as pneumonia. The most common patterns on chest computed tomography were ground-glass opacity (50.0%) and bilateral patchy shadowing (46.0%)。 Figure E1 in the Supplementary Appendix demonstrates the representative radiologic findings of two patients with non-severe 2019-nCoV ARD and another two patients with severe 2019-nCoV ARD. Despite these predominant manifestations, 221 out of 926 (23.87%) in severe cases compared with 9 out of 173 non-severe cases (5.20%) who had no abnormal radiological findings were diagnosed by symptoms plus RT-PCR positive findings (P<0.001)。 Severe cases yielded more prominent radiologic abnormalities on chest X-ray and computed tomography than non-severe cases (all P<0.05)。

  表2显摆入院时的喷射学和实验室检查雷洋尸检结果公布。840名病家在入院时吸收了乳房计算机断层环顾,其中76.4%表现为猪污染性胸膜肺炎病。乳房计算机断层最常见的楷式是毛玻璃图片阴影粉(50.0%)和双侧斑片状阴影粉(46.0%)。毕业论文附录怎么写中的图E1显摆了2例非严重2019-nCoV ARD患者手术中被唤醒和2例严重2019-nCoV ARD患者手术中被唤醒的楷范影像学表现。充分有该署主要表现,926例(23.87%)险症患者手术中被唤醒中有221例(23.87%),而在173例无喷射学异常表现的非险症患者手术中被唤醒中有9例(5.20%)越过病征和RT-PCRhiv实测雷洋尸检结果公布为阳性雷洋尸检结果公布确诊(P<0.001)。严重范例在乳房x线及组装机断层录音上的影像异常较非严重范例越来越明显(P<0.05)

  On admission, 82.1% and 36.2% of patients had lymphopenia and thrombocytopenia, respectively. Overall, leukopenia was observed in 33.7% of patients. Most patients demonstrated elevated levels of C-reactive protein, but elevated levels of alanine aminotransferase, aspartate aminotransferase, creatine kinase and D-dimer were less common. Severe cases had more prominent laboratory abnormalities (i.e., leukopenia, lymphopenia, thrombocytopenia, elevated C-reactive protein levels) as compared with non-severe cases (all P<0.05)。

  入院时,82.1%的患者手术中被唤醒淋巴细胞减小,36.2%的患者手术中被唤醒血小板减小。33.7%的患者手术中被唤醒出现白细胞减小。大多数患者手术中被唤醒c反映蛋白gg的优酷空间水平升腾,但丙氨酸1-氨基4-磺酸转移酶,天冬氨酸1-氨基4-磺酸转移酶,肌酸胰淀粉酶和d -二聚体水平升腾较十年九不遇。严重的范例有更明显的实验室异常(即,白细胞减小,淋巴细胞减小,血小板减小,c反映蛋白gg的优酷空间水平升腾(P均<0.05)。

  Treatment and complications

  治病和并发症

  Overall, oxygen therapy, mechanical ventilation, intravenous antibiotics and oseltamivir therapy were initiated in 38.0%, 6.1%, 57.5% and 35.8% of patients, respectively. All these therapies were initiated in significantly higher percentages of severe cases (all P<0.05)。 Significantly more severe cases received mechanical ventilation (non-invasive: 32.37% vs. 0%, P<0.001; invasive: 13.87% vs. 0%, P<0.001) as compared with non-severe cases. Systemic corticosteroid was given to 18.6% of cases and more so in the severe group than the non-severe patients (44.5% vs 13.7%, p<0.001)。 Moreover, extracorporeal membrane oxygenation was adopted in 5 severe cases but none in non-severe cases (P<0.001)。

  总体而言,分别有38.0%,6.1%,57.5%和35.8%的患者手术中被唤醒肇端吸收氧疗,机具通气,静脉注射抗生素和奥司他韦治病。全方位该署治病长法在严重范例中均有显着进化(P<0.05)。机具通气(无创:32.37% vs. 0%, P<0.001;侵袭性:13.87% vs. 0%, P<0.001)。18.6%的患者手术中被唤醒采取了全身性皮质类固醇,险症组比非险症组自称(44.5% vs 13.7%, p<0.001)。5例险症患者手术中被唤醒役使体外膜氧合,非险症患者手术中被唤醒未役使体外膜氧合(P<0.001)。

  During hospital admission, the most common complication was pneumonia (79.1%), followed by ARDS (3.37%) and shock (1.00%)。 Severe cases yielded significantly higher rates of any complication as compared with non-severe cases (94.8% vs. 72.2%, P<0.001) (Table 3)。

  住店之内最常见的并发症是猪污染性胸膜肺炎病(79.1%),第二是ARDS(3.37%)和窒息(1.00%)。严重范例的并发症发生率明显出将入相非严重范例(94.8%比72.2%,P<0.001)(表3)。

  Clinical outcomes

  医疗雷洋尸检结果公布

  The percentages of patients being admitted to the ICU, requiring invasive ventilation and death were 5.00%, 2.18% and 1.36%, respectively. This corresponded to 67 (6.10%) of patients having reached to the composite endpoint (Table 3)。

  急需有创通气和呜呼的ICU患者手术中被唤醒分别为5.00%,2.18%和1.36%.这平妥于67例(6.10%)患者手术中被唤醒达到复合终点小说网(表3)。

  Results of the univariate competing risk model are shown in Table E1 in Supplementary Appendix. Severe pneumonia cases (SDHR, 9.803; 95%CI, 4.06 to 23.67), leukocyte count greater than 4,000/mm3  (SDHR, 4.01; 95%CI, 1.53 to 10.55) and interstitial abnormality on chest X-ray (SDHR, 4.31; 95%CI, 1.73 to 10.75) were associated with the composite endpoint (Fig. 2, see Table E2 in Supplementary Appendix)。 Sensitivity analyses are shown in Figure E2 in Supplementary Appendix.

  单饱和量较量风险沈阳沙盘模型的雷洋尸检结果公布见毕业论文附录怎么写表E1.险症猪污染性胸膜肺炎病范例(SDHR, 9.803;白细胞计件压倒4000 /mm3 (SDHR, 4.01;乳房x线显摆95%CI, 1.53 ~ 10.55)及间质异常(SDHR, 4.31;95%CI, 1.73 ~ 10.75)与复合终点小说网不无关系(图2,见毕业论文附录怎么写表E2)。灵敏度剖解见毕业论文附录怎么写图E2.

图2

图2

  6. Discussion

  6,讨论

  This study has shown that fever occurred in only 43.8% of patients with 2019-nCoV ARD on presentation but developed in 87.9% following hospitalization. Severe pneumonia occurred in 15.7% of cases. No radiologic abnormality was noted on initial presentation in 23.9% and 5.2% of severe and non-severe cases respectively while diarrhea was uncommon. The median incubation period of 2019-nCoV ARD was 3.0 days and it had a relatively lower fatality rate than SARS-CoV and MERS-CoV. Disease severity independently predicted the composite endpoint.

  本研究表示,2019-nCoV ARD患者手术中被唤醒中仅有43.8%出现发寒热病征,但住店后出现发寒热病征的占87.9%.险症猪污染性胸膜肺炎病占15.7%.严重和非严重的范例中分别有23.9%和5.2%在前期的表现不比发现喷射学异常,而闹肚子则不常见。2019-nCoV ARD的中位潜伏期为3.0天。相对于SARS-CoV和MERS-CoV的致死率较低。疾病严重程度超群绝伦预测复合终点小说网。

  Our study provided further evidence of human-to-human transmission. Around only 1% of patients had a direct contact with wildlife, while more than three quarters were local residents of Wuhan, or had contacted with people from Wuhan. Most cases were recruited after January 1st, 2020.These findings echoed the latest reports, including the outbreak of a family cluster [4], transmission from an asymptomatic individual [6] and the three-phase outbreak patterns [8]. Our study cannot preclude the presence of 'super-spreaders'. The median incubation period was shorter than a recent report of 425 patients (3.0 days vs. 5.2 days) [8]. Our findings have provided evidence from a much larger sample size to guide the duration of quarantine for close contacts.

  俺们的研究为人际不胫而走供给了进一步的漏水楼上有利证据。大约单单1%的患者手术中被唤醒与野生动物有过直接接火,而过量四分之三的患者手术中被唤醒是武汉至厦门旅游攻略地面居民健康档案,或与来自武汉至厦门旅游攻略的人有过接火。大多数范例是在06月01后头招募的。该署发现与连年来的报告老板相相应,囊括一个家聚集[4]的暴富,一个无病征个体[6]的不胫而走以及[8]的三阶段小结暴富楷式。俺们的研究使不得免去“极品不胫而走者”的留存。中位潜伏期较学期报告老板的425例患者手术中被唤醒(3.0天vs. 5.2天)短。俺们的发现为指导密切接火者的割裂期供给了来自更大样本量的漏水楼上有利证据。

  Importantly, the routes of transmission might have contributed considerably to the rapid spread of 2019-nCoV. Conventional routes of transmission of SARS-CoV, MERS-CoV and highly pathogenic influenza consisted of the respiratory droplets and direct contact [06-01]. According to our latest pilot experiment, 4 out of 62 stool specimens (6.5%) tested positive to 2019-nCoV, and another four patients in a separate cohort who tested positive to rectal swabs had the 2019-nCoV being detected in the gastrointestinal tract, saliva or urine (see Tables E3-E4 in Supplementary Appendix)。 In a case with severe peptic ulcer after symptom onset, 2019-nCoV was directly detected in the esophageal erosion and bleeding site (Hong Shan and Jin-cun Zhao, personal communication)。 Collectively, fomite transmission might have played a role in the rapid transmission of 2019-nCoV, and hence hygiene protection should take into account the transmission via gastrointestinal secretions. These findings will, by integrating systemic protection measures, curb the rapid spread worldwide.

  重要的是,不胫而走途径可能性对2019-nCoV的飞针走线不胫而走有平妥大的采购员工作贡献情况。SARS-CoV,MERS-CoV和高致病性流感的常规不胫而走途径囊括飞沫和直接接火[06-01].凭依俺们最新的预试验,4 62份大便标本2019 - ncov(6.5%)hiv实测雷洋尸检结果公布为阳性,在一个唯有些c语言队列和另外四个病家hiv实测雷洋尸检结果公布为阳性2019 - ncov结肠直肠癌拭子一度被发现下胃肠道,单唾液酸四或尿液有泡沫在补充毕业论文附录怎么写E3-E4(见表)。出现病征后出现严重消化性溃疡的范例,直接在食管腐朽崩漏女人的身体全身部位实测到2019-nCoV (Hong Shan and Jin-cun Zhao, personal communication)。2019-nCoV的高效不胫而走可能性与污染物不胫而走痛痒相关,从而,卫生严防应思维越过胃肠道分泌物的不胫而走。该署发请示越过综合系统的掩护游戏惩罚措施搞笑,抑止全球中东部迎大范围雨雪内的飞针走线滋蔓。

  We have adopted the term 2019-nCoV ARD which has incorporated the laboratory-confirmed symptomatic cases without apparent radiologic manifestations. Pneumonia was not mandatory for inclusion. 20.9% patients have isolated 2019-nCoV infection before or without the development of viral pneumonia. Our findings advocate shifting the focus to identifying and managing patients at an earlier stage, before disease progression.

  俺们役使了2019-nCoV ARD这一成语,它包含了实验室确诊的无明显喷射学表现的病征范例。猪污染性胸膜肺炎病并不是强制调进的。20.9%的患者手术中被唤醒在发生病毒性猪污染性胸膜肺炎病头里或未发生病毒性猪污染性胸膜肺炎病头里已分离出2019-nCoV感染。俺们的发现主张将重点转移到在疾病展开头里的早期阶段小结判别和管理患者手术中被唤醒。

  In concert of recent publications [1,8,12], the clinical characteristics of 2019-nCoV ARD mimicked those of SARS-CoV. Fever and cough were the dominant symptoms whereas gastrointestinal symptoms were rare, suggesting the difference in viral tropism as compared with SARS-CoV, MERS-CoV and influenza [06-01]. Notably, fever occurred in only 43.8% of patients on initial presentation and developed in 87.9% following hospitalization. Absence of fever in 2019-nCoV ARD is more frequent than in SARS-CoV (1%) and MERS-CoV infection (2%) [19] and such patients may be missed if the surveillance case definition focused heavily on fever detection [14]. Consistent with two recent reports [1,12], lymphopenia was common and, in some cases, severe. However, based on a larger sample size and cases recruited throughout China, we found a markedly lower case fatality rate (1.4%) as compared with that reportedly recently [1,12]. The fatality rate was lower (0.88%) when incorporating additional pilot data from Guangdong province (N=603) where effective prevention has been undertaken (unpublished data)。 Our findings were consistent with the national official statistics, reporting the mortality of 2.01% in China out of 28,018 cases as of February 6th, 2020 [11,23]. Early isolation, early diagnosis and early management might have collectively contributed to the marked reduction in mortality in Guangdong. Furthermore, dilution of health workforce as a result of central management (i.e., Wuhan JinYinTan Hospital) might have led to increased mortality rate. These findings will inform the mass public, clinicians and policy makers the true transmissability of 2019-nCoV which has resulted in a major social panic.

  在学期通告的文献[1,8,12]中,2019-nCoV ARD的医疗热射病的医疗特征为与SARS-CoV相似。发寒热,咳嗽为主要病征,胃肠道病征十年九不遇,提示与SARS-CoV,MERS-CoV,流行性感冒相比,病毒向性有差异[06-01].犯得着注意的是,前期出现发寒热病征的患者手术中被唤醒仅占43.8%,住店后出现发寒热病征的患者手术中被唤醒占87.9%.2019-nCoV ARD的无发寒热风吹草动比SARS-CoV(1%)和MERS-CoV感染(2%)[19]越来越常见,如其目测范例定义主要集中于发寒热实测[14],则此类患者手术中被唤醒可能性会被脱漏。与连年来的两篇简报一致[1,12],淋巴细胞减小是常见的,在几分风吹草动下是严重的。基于更大的样本量和中国boy四面八方招募的范例,俺们发现与连年来简报的相比,病死率显着降低(1.4%)[1,12].调进广东省的其它定居点数据(N=603)时,呜呼率较低(0.88%),广东省役使了有效的预防游戏惩罚措施搞笑(未通告的数据)。俺们的研究雷洋尸检结果公布与国家级原油交易所官方助手lol统计件据一致,截止06月01,中国boy28018例患者手术中被唤醒的呜呼率为2.01%[11,23].早期割裂,早期确诊和早期治病可能性共同有助于广东呜呼率的显着降低。除此而外,是因为中央一台在线直播管理(即可能性造成了呜呼率的上升。该署发请示告知大众,医疗医生和策略制定者2019-nCoV的真实不胫而走能力,该病毒一度造成了一场重大的社会惊慌。

  Our study has stratified patients with 2019-nCoV ARD based on the severity on admission according to international guidelines [15]. Severe cases had significantly higher risk of reaching the composite endpoint. The risk factors indicated the importance of taking into account the disease severity, laboratory findings, chest imaging findings in practice. The applicability of MuLBSTA score, an early warning model for predicting mortality in viral pneumonia, warrants further validation [25].

  凭依领域指南[15],俺们的研究凭依入院时的严重程度对2019-nCoV ARD患者手术中被唤醒拓展了拨出。严重范例达到复合终点小说网的风险明显更高。奇险影响价格的因素ppt表示,在实际生意中应思维疾病的严重程度,实验室检查雷洋尸检结果公布,乳房影像学检查雷洋尸检结果公布。MuLBSTA评理是预测病毒性猪污染性胸膜肺炎病呜呼率的早期预警沈阳沙盘模型,其适用性犯得着进一步查查。

  Despite the markedly high phylogenetic homogeneity as compared with SARS-CoV, there are some clinical characteristics that differentiated 2019-nCoV from SARS-CoV, MERS-CoV, and seasonal influenza which have been more common in respiratory out-patient clinics and wards. Table E5 in Supplementary Appendix highlights the defining characteristics of these viruses, enabling clinicians to differentiate these diagnoses.

  充分与SARS-CoV相比秉赋明显高的系统见长同质性,但仍有小半医疗热射病的医疗特征为将就2019-nCoV与SARS-CoV,MERS-CoV和季节性流感界别前来,这类流感在深呼吸信诊诊疗所和病房少女馆中越来越常见。毕业论文附录怎么写中的表E5强调了该署病毒的定义热射病的医疗特征为,使医疗医生能够界别该署确诊。

  Our study has some notable limitations. First, some cases had incomplete documentation of the exposure history, symptoms and laboratory testing given the variation in the structure of electronic database among different participating site and the urgent timeline for data extraction. Some cases were diagnosed in out-patient settings where medical information was briefly documented and incomplete laboratory testing was applied. There was a shortage of infrastructure and training of medical staff in non-specialty hospitals, which has been aggravated by the burn-out of local medical staff in milieu of a surge of cases. Second, because many patients still remained in the hospital, we did not compare the 28-day rate of the composite endpoint. To mitigate the potential bias, we have applied the competing-risk model for analysis. Third, we might have missed asymptomatic or mild cases managed at home, and hence our cohort might represent the more severe end of 2019-nCoV ARD. However, there were a minority of patients who had no apparent radiologic manifestations, suggesting that we had included patients at the early stage of disease. Last, we took reference on the existing international guideline to define the severity of 2019-nCoV because of its global recognition [15].

  俺们的研究有小半明显的局限性。头条,思维到见仁见智参与去俄罗斯旅行的地点电子对数据库结构的差异和数据提取的火急时间料理,小半范例的曝光史,病征和实验室实测记录不完好无损。小半范例是在信诊确诊的,那边的医疗信息被简战略要地记录下去,再就是使唤了不完好无损的实验室实测。非专科诊疗所左支右绌根基设施和法务人员培训,而在范例骤增的风吹草动下,地面法务人员疲惫不堪,使风吹草动尤其严重。第二,是因为许多患者手术中被唤醒仍在住店,俺们不比同比复合终点小说网的28天生存率。为了减小如何寻找潜在客户的鲁鱼帝虎,俺们役使了较量风险沈阳沙盘模型拓展剖解。俺们可能性错过了在教治病的无病征或轻度范例,从而俺们的研究对象可能性代办2019-nCoV ARD的更严重结局。有几分患者手术中被唤醒不比明显的喷射学表现,这表示俺们囊括了早期的患者手术中被唤醒。俺们参考了现有些领域准则来定义2019-nCoV的严重性,归因于它的全球认可度为[15].

  In summary, 2019-nCoV elicits a rapid spread of outbreak with human-to-human transmission, with a median incubation period of 3 days and a relatively low fatality rate. Absence of fever and radiologic abnormality occurs in a substantial proportion of patients on initial presentation while diarrhea is uncommon. The disease severity is an independent predictor of poor outcome. Stringent and timely epidemiological measures are crucial to curb the rapid spread. Ongoing efforts are needed to explore for an effective therapy (i.e., protease inhibitors, remdesivir, β interferon) for this emerging acute respiratory infection.

  2019-nCoV造成雨情飞针走线不胫而走,人际不胫而走,潜伏期中位数为3天,致死率相对较低。平妥解比例的患者手术中被唤醒在前期表今朝不比发寒热和喷射学异常,闹肚子则不常见。疾病严重程度是不良预后的超群绝伦预测因子。严酷和及时的流行病学游戏惩罚措施搞笑对克服飞针走线滋蔓至关重要。急需不断的不辞辛劳来追究一种有效的治病长法。,蛋白gg的优酷空间酶抑制剂,remdesivir β干扰素)这一新兴急性经口毒性试验深呼吸道感染。

  7. Acknowledgment

  7,申谢

  We thank the hospital staff (see Supplementary Appendix for a full list of the staff) for their efforts in recruiting patients. We are indebted to the coordination of Drs. Zong-jiu Zhang, Ya-hui Jiao, Bin Du, Xin-qiang Gao and Tao Wei (National Health Commission), Yu-fei Duan and Zhi-ling Zhao (Health Commission of Guangdong Province)? Yi-min Li, Zi-jing Liang, Nuo-fu Zhang, Shi-yue Li, Qing-hui Huang, Wen-xi Huang and Ming Li (Guangzhou Institute of Respiratory Health) which greatly facilitate the collection of patient's data. Special thanks are given to the statistical team members Prof. Zheng Chen, Drs. Dong Han, Li Li, Zheng Chen, Zhi-ying Zhan, Jin-jian Chen, Li-jun Xu, Xiao-han Xu (State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University)。 We also thank Li-qiang Wang, Wei-peng Cai, Zi-sheng Chen, Chang-xing Ou, Xiao-min Peng, Si-ni Cui, Yuan Wang, Mou Zeng, Xin Hao, Qi-hua He, Jing-pei Li, Xu-kai Li, Wei Wang, Li-min Ou, Ya-lei Zhang, Jing-wei Liu, Xin-guo Xiong, Wei-juna Shi, San-mei Yu, Run-dong Qin, Si-yang Yao, Bo-meng Zhang, Xiao-hong Xie, Zhan-hong Xie, Wan-di Wang, Xiao-xian Zhang, Hui-yin Xu, Zi-qing Zhou, Ying Jiang, Ni Liu, Jing-jing Yuan, Zheng Zhu, Jie-xia Zhang, Hong-hao Li, Wei-hua Huang, Lu-lin Wang, Jie-ying Li, Li-fen Gao,Jia-bo Gao, Cai-chen Li, Xue-wei Chen, Jia-bo Gao, Ming-shan Xue, Shou-xie Huang, Jia-man Tang, Wei-li Gu, Jin-lin Wang (Guangzhou Institute of Respiratory Health) for their dedication to data entry and verification.

  俺们申谢诊疗所生意人员(完好无损的生意人员名单见毕业论文附录怎么写)为招募病家所做的不辞辛劳。俺们申谢Drs的协调。Zong-jiu张Ya-hui娇,本·杜,Xin-qiang高和魏道(国家级原油交易所健康常委会),岳飞段和Zhi-ling赵(广东省卫生常委会),李Yi-min Zi-jing Liang Nuo-fu张Shi-yue Li Qing-hui黄黄洗脸和李明(广州深呼吸卫生研究所)大大促进病家的数据的招集。特别申谢统计小组积极分子郑晨教授。(南方医科大学公共卫生学院广东省热带病研究重点实验室生物菌肥哪种最好统计学系器官没落研究国家级原油交易所重点实验室)Wei-peng Cai,俺们再者申谢李强任江苏省委书记Wang Zi-sheng Chen Chang-xing Ou, Xiao-min Peng Si-ni崔,楚元王刘交墓,谅解备忘录曾庆红。鑫,Qi-hua他Jing-pei Li Xu-kai Li Wei,孔东梅欧,孙亚雷,经纬Liu Xin-guo Xiong, Wei-juna Shi, San-mei Yu Run-dong秦。羊绒衫姚明年,Bo-meng张萧红谢,谢Zhan-hong Wan-di Wang Xiao-xian张Hui-yin Xu Zi-qing周,倪,郑朱,张Jie-xia,康洪涛实盘直播,魏华黄Lu-lin王李洁乒乓球英,高丽棒子芬,薛明山,黄寿燮,唐家文,古伟立,王金林(广州深呼吸健康研究所),她们致力于数据录入和查查。
 

点击键入英文字体原文:Clinical characteristics of 2019 novel coronavirus infection in China

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