Pub Date : 2020-02-15DOI: 10.3760/CMA.J.ISSN.1000-6680.2020.02.007
R. Zhao, Yunguang Liang, Yanrong Lin, N. Lu, Qiu-qiong Li, Youling Li, P. Pan, Wei He
Objective To analysis the clinical characteristics and experiences in diagnosis and treatment of the patients with novel coronavirus pneumonia (NCP). Methods Clinical data of 28 patients with NCP in Nanning Fourth People's Hospital from January 22 to February 5 in 2020 were collected. The clinical manifestations, epidemiological history, laboratory tests, imaging examinations and treatments of patients were analyzed retrospectively. Results The 28 patients with confirmed viral pneumonia included 11 males and 17 females, ranging from 11 to 68 years. They all had history of epidemiological exposure and were all positive for 2019-nCoV nucleic acid in throat swabs. There were one mild case, 25 ordinary cases and two severe cases. There were four groups of family clusters. The illness onset ranged from 1 to 12 days after exposure, and the time from the symptom onset to the positive result of the nucleic acid test was 0 to 13 days. The clinical symptoms were mainly fever and cough, which progressed rapidly in a short period of time. Since the onset of illness, the peak values of axillary temperature of the 28 patients were 36.6~39.5 ℃, while five patients had no fever throughout the course of the disease with the peak temperature of ≤37 ℃. There were two patients presented with decreased white blood cell counts, five patients with elevated C reactive protein, six patients with abnormal alanine aminotransferase, three patients with abnormal aspartate aminotransferase,10 patients with elevated creatine kinase, three patients with elevated creatine kinase isoenzyme, four patients with elevated lactate dehydrogenase, and all with normal procalcitonin levels. The chest computed tomography examinations showed that the common features were ground glass shadows (21 cases), blurred edges (18 cases), speckles and patchy shadows (17 cases), thickening and disorder of some lung textures (7 cases), and visible band shadows (7 cases). Pulmonary lesions often progressed rapidly. One 11-year-old child was treated with alpha-interferon alone, and 27 patients were treated with alpha-interferon inhalation plus lopinavir/ritonavir with 4 withdrawal due to adverse reactions. Up to February 12, nine patients had been discharged from the hospital, who were ordinary cases, without death cases. Conclusions The NCP patients mostly present with fever and cough. Pulmonary lesions often progress rapidly. Respiratory pathogen testing should be conducted as early as possible and repeatedly. Disisolation should be cautious for suspected people who are negative for 2019-nCoV nucleic acid in pharynx swabs. Key words: 2019-nCoV; Pneumonia; Clinical characteristic
{"title":"Clinical characteristics of 28 patients with novel coronavirus pneumonia","authors":"R. Zhao, Yunguang Liang, Yanrong Lin, N. Lu, Qiu-qiong Li, Youling Li, P. Pan, Wei He","doi":"10.3760/CMA.J.ISSN.1000-6680.2020.02.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2020.02.007","url":null,"abstract":"Objective \u0000To analysis the clinical characteristics and experiences in diagnosis and treatment of the patients with novel coronavirus pneumonia (NCP). \u0000 \u0000 \u0000Methods \u0000Clinical data of 28 patients with NCP in Nanning Fourth People's Hospital from January 22 to February 5 in 2020 were collected. The clinical manifestations, epidemiological history, laboratory tests, imaging examinations and treatments of patients were analyzed retrospectively. \u0000 \u0000 \u0000Results \u0000The 28 patients with confirmed viral pneumonia included 11 males and 17 females, ranging from 11 to 68 years. They all had history of epidemiological exposure and were all positive for 2019-nCoV nucleic acid in throat swabs. There were one mild case, 25 ordinary cases and two severe cases. There were four groups of family clusters. The illness onset ranged from 1 to 12 days after exposure, and the time from the symptom onset to the positive result of the nucleic acid test was 0 to 13 days. The clinical symptoms were mainly fever and cough, which progressed rapidly in a short period of time. Since the onset of illness, the peak values of axillary temperature of the 28 patients were 36.6~39.5 ℃, while five patients had no fever throughout the course of the disease with the peak temperature of ≤37 ℃. There were two patients presented with decreased white blood cell counts, five patients with elevated C reactive protein, six patients with abnormal alanine aminotransferase, three patients with abnormal aspartate aminotransferase,10 patients with elevated creatine kinase, three patients with elevated creatine kinase isoenzyme, four patients with elevated lactate dehydrogenase, and all with normal procalcitonin levels. The chest computed tomography examinations showed that the common features were ground glass shadows (21 cases), blurred edges (18 cases), speckles and patchy shadows (17 cases), thickening and disorder of some lung textures (7 cases), and visible band shadows (7 cases). Pulmonary lesions often progressed rapidly. One 11-year-old child was treated with alpha-interferon alone, and 27 patients were treated with alpha-interferon inhalation plus lopinavir/ritonavir with 4 withdrawal due to adverse reactions. Up to February 12, nine patients had been discharged from the hospital, who were ordinary cases, without death cases. \u0000 \u0000 \u0000Conclusions \u0000The NCP patients mostly present with fever and cough. Pulmonary lesions often progress rapidly. Respiratory pathogen testing should be conducted as early as possible and repeatedly. Disisolation should be cautious for suspected people who are negative for 2019-nCoV nucleic acid in pharynx swabs. \u0000 \u0000 \u0000Key words: \u00002019-nCoV; Pneumonia; Clinical characteristic","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43884555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The outbreak of 2019 novel coronavirus (2019 nCoV) pneumonia in China has attracted great attention worldwide. At present, the reported cases of 2019 nCoV infection in children are very limited. Initially, the susceptibility of children to 2019 nCoV is low, and the severity of the condition is also low. However, children are susceptible to respiratory virus infection, and pediatric medical workers need to pay attention to early identification and warning of 2019 nCoV infection in children, scientific prevention and control, and minimize the harm of 2019 nCoV infection to the pediatric population.
{"title":"2019 novel coronavirus infection：pediatric professionals′ perspectives and action","authors":"M. Zeng, Xiao-Ying Zhai","doi":"10.3760/CMA.J.ISSN.1000-6680.2020.02.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2020.02.002","url":null,"abstract":"2019新型冠状病毒(2019 novel coronavirus，2019-nCoV)肺炎在我国的暴发流行引起了全球高度关注。目前报道的儿童2019-nCoV感染病例非常有限，初步来看，儿童对2019-nCoV的易感性较低，而且病情严重程度也低。但是儿童是呼吸道病毒感染的易感人群，儿科医务工作者需要重视儿童2019-nCoV感染的早期识别和预警，科学防控，最大程度地降低2019-nCoV感染对儿科人群的危害。","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41328577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6680.2020.01.006
Hong Wang, Hongping Wang, Linyan Qian, Lingyan Xu
Objective To explore hepatitis B virus (HBV) infection rate of breast feeding to newborn babies of HBV carrying parturient women with hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) double positive. Methods A prospective cohort study was conducted to include HBsAg and HBeAg double-positive HBV carrying parturient women and their babies born from February 2016 to May 2018 at the Women′s Hospital, Zhejiang University School of Medicine, and 323 parturient women and 323 babies were enrolled. The babies were divided into breast feeding group and artificial feeding group. Chemiluminescence immunoassay and polymerase chain reaction-fluorescent probe method were used to detect the positive rates of serum HBV markers and HBV DNA levels in the newborns <24 h and seven-month-old age, respectively. The statistical method was performed using χ2 test. Results A total of 297 parturient women were finally included for the analysis, including 149 in the breast feeding group and 148 in the artificial feeding group. There were no significant differences in the positive rates of HBsAg, hepatitis B surface antibody (anti-HBs), HBeAg and HBV DNA>100 IU/mL between the two groups at birth 0.05). The positive rate of anti-HBs in newborns in the breast feeding group at birth 100 IU/mL in newborns in the breast feeding group were 2.01%(3/149) and 2.68%(4/149) at birth 0.05). In the artificial feeding group, the positive rate of anti-HBs in newborns was 47.97%(71/148) at birth 100 IU/mL in newborns in the artificial feeding group at birth 0.05). Conclusions Breast feeding is not a decisive factor for the risk of vertical transmission in HBsAg and HBeAg double-positive HBV carriers. It is recommended that such women could breastfeed under formal precautions. Key words: Hepatitis B; Breast feeding; Mother-to-child transmission
{"title":"Maternal breast feeding safety of hepatitis B virus carrying parturient women with hepatitis B surface antigen and hepatitis B e antigen double positive","authors":"Hong Wang, Hongping Wang, Linyan Qian, Lingyan Xu","doi":"10.3760/CMA.J.ISSN.1000-6680.2020.01.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2020.01.006","url":null,"abstract":"Objective \u0000To explore hepatitis B virus (HBV) infection rate of breast feeding to newborn babies of HBV carrying parturient women with hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) double positive. \u0000 \u0000 \u0000Methods \u0000A prospective cohort study was conducted to include HBsAg and HBeAg double-positive HBV carrying parturient women and their babies born from February 2016 to May 2018 at the Women′s Hospital, Zhejiang University School of Medicine, and 323 parturient women and 323 babies were enrolled. The babies were divided into breast feeding group and artificial feeding group. Chemiluminescence immunoassay and polymerase chain reaction-fluorescent probe method were used to detect the positive rates of serum HBV markers and HBV DNA levels in the newborns <24 h and seven-month-old age, respectively. The statistical method was performed using χ2 test. \u0000 \u0000 \u0000Results \u0000A total of 297 parturient women were finally included for the analysis, including 149 in the breast feeding group and 148 in the artificial feeding group. There were no significant differences in the positive rates of HBsAg, hepatitis B surface antibody (anti-HBs), HBeAg and HBV DNA>100 IU/mL between the two groups at birth 0.05). The positive rate of anti-HBs in newborns in the breast feeding group at birth 100 IU/mL in newborns in the breast feeding group were 2.01%(3/149) and 2.68%(4/149) at birth 0.05). In the artificial feeding group, the positive rate of anti-HBs in newborns was 47.97%(71/148) at birth 100 IU/mL in newborns in the artificial feeding group at birth 0.05). \u0000 \u0000 \u0000Conclusions \u0000Breast feeding is not a decisive factor for the risk of vertical transmission in HBsAg and HBeAg double-positive HBV carriers. It is recommended that such women could breastfeed under formal precautions. \u0000 \u0000 \u0000Key words: \u0000Hepatitis B; Breast feeding; Mother-to-child transmission","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49454105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6680.2020.01.003
Yinzhong Shen
The novel coronavirus (nCoV) is a coronavirus that has not been found in human before. It often uses animals other than human as its host and intermediate host. The nCoV reported at present includes severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and recently discovered 2019 new coronavirus (2019-nCoV). nCoV is a new type of coronavirus. ncov can cause severe acute respiratory infection (SARI), acute respiratory distress syndrome, septic shock, renal failure and other critical disease states. It is urgent to improve the clinicians' understanding of the diagnosis and treatment of nCoV infection. To improve the ability of outpatient triage and early identification, to strengthen the prevention and control of nosocomial infection, to improve the comprehensive treatment ability of severe patients and to strengthen clinical research are the key to deal with the epidemic situation of nCoV infection. Key words: SARS-CoV-2 infection; Severe acute respiratory infection; Pneumonia of unknown origin
{"title":"Improving the understanding of diagnosis and treatment of novel coronavirus infection","authors":"Yinzhong Shen","doi":"10.3760/CMA.J.ISSN.1000-6680.2020.01.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2020.01.003","url":null,"abstract":"The novel coronavirus (nCoV) is a coronavirus that has not been found in human before. It often uses animals other than human as its host and intermediate host. The nCoV reported at present includes severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and recently discovered 2019 new coronavirus (2019-nCoV). nCoV is a new type of coronavirus. ncov can cause severe acute respiratory infection (SARI), acute respiratory distress syndrome, septic shock, renal failure and other critical disease states. It is urgent to improve the clinicians' understanding of the diagnosis and treatment of nCoV infection. To improve the ability of outpatient triage and early identification, to strengthen the prevention and control of nosocomial infection, to improve the comprehensive treatment ability of severe patients and to strengthen clinical research are the key to deal with the epidemic situation of nCoV infection. \u0000 \u0000 \u0000Key words: \u0000SARS-CoV-2 infection; Severe acute respiratory infection; Pneumonia of unknown origin","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47021168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1000-6680.2020.01.002
Wenhong Zhang
Since December 2019, there has been widespread concern over an unexplained pneumonia epidemic in Wuhan. Less than a month later, the expert team has identified the etiology, a novel coronavirus, which has won a "golden window" for effectively preventing the spread of the emerging infectious diseases. The prompt response of Chinese researchers to emerging infectious diseases has been recognized and appreciated by the World Health Organization, and reflects that the substantially improved ability to identify emerging infectious diseases. However, the strength of the current infectious disease discipline in China has yet to be further strengthened to meet the needs of China's public health development and the challenges of infectious diseases. Faced with urban aging and the spread of drug-resistant bacterial infections, as well as the increase in imported diseases and the uncontrollable risks of unknown infectious diseases, the future demand for infectious disease prevention and control systems in China is diverse, open, and flexible, including but It is not limited to the prevention and control of communicable diseases, diagnosis and treatment of bacterial and fungi infections, nosocomial infection control, and the use of antibiotic-resistant antibacterial drugs. Infectious disease professionals take on important tasks and responsibilities to protect the "Healthy China" strategy. Key words: SARS-CoV-2 infection; New infectious diseases; Identification of virus
{"title":"Identification of a novel coronavirus and the landscape of prevention and control of emerging infectious diseases","authors":"Wenhong Zhang","doi":"10.3760/CMA.J.ISSN.1000-6680.2020.01.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2020.01.002","url":null,"abstract":"Since December 2019, there has been widespread concern over an unexplained pneumonia epidemic in Wuhan. Less than a month later, the expert team has identified the etiology, a novel coronavirus, which has won a \"golden window\" for effectively preventing the spread of the emerging infectious diseases. The prompt response of Chinese researchers to emerging infectious diseases has been recognized and appreciated by the World Health Organization, and reflects that the substantially improved ability to identify emerging infectious diseases. However, the strength of the current infectious disease discipline in China has yet to be further strengthened to meet the needs of China's public health development and the challenges of infectious diseases. Faced with urban aging and the spread of drug-resistant bacterial infections, as well as the increase in imported diseases and the uncontrollable risks of unknown infectious diseases, the future demand for infectious disease prevention and control systems in China is diverse, open, and flexible, including but It is not limited to the prevention and control of communicable diseases, diagnosis and treatment of bacterial and fungi infections, nosocomial infection control, and the use of antibiotic-resistant antibacterial drugs. Infectious disease professionals take on important tasks and responsibilities to protect the \"Healthy China\" strategy. \u0000 \u0000 \u0000Key words: \u0000SARS-CoV-2 infection; New infectious diseases; Identification of virus","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46799118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To analyze the characteristics and abnormalities of electrocardiograms (ECG) in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and to provide evidences for the prevention and treatment of cardiovascular diseases in HIV/AIDS patients. Methods The ECG results of 1 131 HIV/AIDS patients and 5 622 non-HIV/AIDS subjects from Shanghai Public Health Clinical Center were involved. The abnormality rates and characteristics of ECG were compared between the two groups. CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios were measured in HIV/AIDS patients. The comparison between two groups was conducted by chi-square test. Logistic regression model was used to explore the factors associated with ECG abnormalities in HIV/AIDS patients. Results There were 611 cases (54.02%) out of 1 131 HIV/AIDS patients with abnormal ECG. The common abnormal ECG types were sinus tachycardia 239 cases (39.12%), sinus rhythm with ST-T changes 115 cases (18.82%) and sinus bradycardia 55 cases (9.00%). There were 1 958 cases (34.83%) out of 5 622 cases of non-HIV/AIDS subjects with abnormal ECG. The common ECG abnormality types were sinus bradycardia 633 cases (32.33%), sinus rhythm with ST-T changes 463 cases (23.65%) and sinus arrhythmia 256 cases (13.07%). The abnormal rate of ECG in HIV/AIDS patients was significantly higher than that in non-HIV/AIDS subjects (χ2=140.39, P<0.01). The abnormal rates of ECG in HIV/AIDS patients <50 years old and ≥50 years old were both higher than those of non-HIV/AIDS subjects in the corresponding age group, and the differences were statistically significant (χ2=111.92 and 52.12, respectively, both P<0.01). Logistic regression analysis showed an increased risk of abnormal ECG in HIV-infected individuals compared with non-HIV/AIDS individuals (odds ratio (OR)=2.27, 95% confidence interval (CI) 2.00-2.60, P<0.01). The risk of ECG abnormality increased in patients aged ≥50 years(OR=1.60, 95%CI 1.45-1.77, P<0.01). The ECG abnormal distribution patterns were significantly different between different levels of CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios in HIV/AIDS patients (χ2= 12.92, 10.99 and 16.48, respectively, all P<0.05 ). The risk of ECG abnormality increased in HIV/AIDS patients aged ≥50 years (OR=1.50, 95%CI 1.15-1.96, P<0.01). When CD8+ T lymphocyte counts ≥500/μL, the risk of ECG abnormalities reduced (OR=0.75, 95%CI 0.58-0.96, P<0.01). Conclusions The abnormal rate of ECG in patients with HIV/AIDS is high. The sinus tachycardia and sinus rhythm with ST-T segment changes are common. The risk of ECG abnormality increases in HIV/AIDS patients aged ≥50 years old and reduces when the CD8+ T lymphocyte counts ≥500/μL. Type distribution of ECG abnormalities is associated with cellular immune status of patients. Key words: Electrocardiography; Human immunodeficiency virus; Acquired immunodeficiency syndrome; Influencing fact
{"title":"Characteristics and abnormal rate of electrocardiogram in patients with human immunodeficiency virus/acquired immunodeficiency syndrome","authors":"Xiaoqing He, Yinzhong Shen, Fengru Lu, Fang Shen, Xinian Liu, Shuwen Wang","doi":"10.3760/CMA.J.ISSN.1000-6680.2019.12.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2019.12.006","url":null,"abstract":"Objective \u0000To analyze the characteristics and abnormalities of electrocardiograms (ECG) in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and to provide evidences for the prevention and treatment of cardiovascular diseases in HIV/AIDS patients. \u0000 \u0000 \u0000Methods \u0000The ECG results of 1 131 HIV/AIDS patients and 5 622 non-HIV/AIDS subjects from Shanghai Public Health Clinical Center were involved. The abnormality rates and characteristics of ECG were compared between the two groups. CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios were measured in HIV/AIDS patients. The comparison between two groups was conducted by chi-square test. Logistic regression model was used to explore the factors associated with ECG abnormalities in HIV/AIDS patients. \u0000 \u0000 \u0000Results \u0000There were 611 cases (54.02%) out of 1 131 HIV/AIDS patients with abnormal ECG. The common abnormal ECG types were sinus tachycardia 239 cases (39.12%), sinus rhythm with ST-T changes 115 cases (18.82%) and sinus bradycardia 55 cases (9.00%). There were 1 958 cases (34.83%) out of 5 622 cases of non-HIV/AIDS subjects with abnormal ECG. The common ECG abnormality types were sinus bradycardia 633 cases (32.33%), sinus rhythm with ST-T changes 463 cases (23.65%) and sinus arrhythmia 256 cases (13.07%). The abnormal rate of ECG in HIV/AIDS patients was significantly higher than that in non-HIV/AIDS subjects (χ2=140.39, P<0.01). The abnormal rates of ECG in HIV/AIDS patients <50 years old and ≥50 years old were both higher than those of non-HIV/AIDS subjects in the corresponding age group, and the differences were statistically significant (χ2=111.92 and 52.12, respectively, both P<0.01). Logistic regression analysis showed an increased risk of abnormal ECG in HIV-infected individuals compared with non-HIV/AIDS individuals (odds ratio (OR)=2.27, 95% confidence interval (CI) 2.00-2.60, P<0.01). The risk of ECG abnormality increased in patients aged ≥50 years(OR=1.60, 95%CI 1.45-1.77, P<0.01). The ECG abnormal distribution patterns were significantly different between different levels of CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios in HIV/AIDS patients (χ2= 12.92, 10.99 and 16.48, respectively, all P<0.05 ). The risk of ECG abnormality increased in HIV/AIDS patients aged ≥50 years (OR=1.50, 95%CI 1.15-1.96, P<0.01). When CD8+ T lymphocyte counts ≥500/μL, the risk of ECG abnormalities reduced (OR=0.75, 95%CI 0.58-0.96, P<0.01). \u0000 \u0000 \u0000Conclusions \u0000The abnormal rate of ECG in patients with HIV/AIDS is high. The sinus tachycardia and sinus rhythm with ST-T segment changes are common. The risk of ECG abnormality increases in HIV/AIDS patients aged ≥50 years old and reduces when the CD8+ T lymphocyte counts ≥500/μL. Type distribution of ECG abnormalities is associated with cellular immune status of patients. \u0000 \u0000 \u0000Key words: \u0000Electrocardiography; Human immunodeficiency virus; Acquired immunodeficiency syndrome; Influencing fact","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48022829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To explore the risk factors for prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF), and to establish a prognostic model. Methods A total of 193 patients diagnosed with HBV-ACLF who were admitted to the Department of Infectious Diseases of the Third Hospital of Hebei Medical University were collected from 1st January 2013 to 1st November 2018 as a derivation cohort. Thirty-five patients diagnosed with HBV-ACLF who were admitted to the Fifth Hospital of Shijiazhuang during the period from 1st July 2017 to 1st November 2018 were collected as a validation cohort. The survival condition of all patients at week 12 of admission was observed. The risk factors associated with short-term prognosis were analyzed by using multivariate logistic regression analysis, and a logistic regression equation prediction model was established and verified. The diagnostic performance of the prognostic model was evaluated using the receiver operating characteristic (ROC) curve, and was compared with model for end-stage liver disease (MELD) scoring system, Child-Turcotte-Pugh (CTP) scoring system, sequential organ failure assessment (SOFA) scoring system and chronic liver failure (CLIF)-SOFA scoring system. Results Multivariate logistic regression analysis showed that age (odds ratio(OR)=2.133, 95% confidence interval(CI)1.033-4.405), total bilirubin (OR=3.371, 95%CI 1.610-7.060), serum creatinine (OR=4.448, 95%CI 1.697-11.661), hepatic encephalopathy (OR=5.313, 95%CI 2.463-11.461), and ascites (OR=2.959, 95%CI 1.410-6.210) were independent risk factors for predicting the short-term prognosis of patients with HBV-ACLF. The newly established logistic regression model (LRM)=-1.726+ 0.757×age+ 1.215×total bilirubin+ 1.049 2×serum creatinine+ 1.670×hepatic encephalopathy (with=1, without=0) + 1.085×ascites (with=1, without=0). The area under the ROC curve of the LRM for predicting the short-term prognosis of patients with HBV-ACLF was 0.82 (95%CI 0.76-0.88). Furthermore, the areas under the ROC curve of the models of MELD, CTP, SOFA, CLIF-SOFA were 0.67 (95%CI 0.60-0.75), 0.73 (95%CI 0.66-0.80), 0.77 (95%CI 0.70-0.83) and 0.72 (95%CI 0.65-0.80), respectively. The ROC-area under curve of the validation cohort was 0.81 (95%CI 0.65-0.97). Conclusions Age, total bilirubin, serum creatinine, hepatic encephalopathy, and ascites are independent risk factors for the prognosis of HBV-ACLF. The prognostic model established based on these factors can accurately predict the patients′ short-term prognosis, which is superior to MELD, CTP, SOFA and CLIF-SOFA. Key words: Hepatitis B; Acute-on-chronic liver failure; Regression analysis; Prognostic model
{"title":"Analysis of prognostic risk factors and establishment of prognosis model in patients with hepatitis B virus-related acute-on-chronic liver failure","authors":"Ziyue Li, Shitian Yang, Lingling Wu, Liying Tian, Na Li, Luyuan Ma, Chuan Shen, Ya-dong Wang, Xiao-Jing Wang, Caiyan Zhao","doi":"10.3760/CMA.J.ISSN.1000-6680.2019.12.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2019.12.004","url":null,"abstract":"Objective \u0000To explore the risk factors for prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF), and to establish a prognostic model. \u0000 \u0000 \u0000Methods \u0000A total of 193 patients diagnosed with HBV-ACLF who were admitted to the Department of Infectious Diseases of the Third Hospital of Hebei Medical University were collected from 1st January 2013 to 1st November 2018 as a derivation cohort. Thirty-five patients diagnosed with HBV-ACLF who were admitted to the Fifth Hospital of Shijiazhuang during the period from 1st July 2017 to 1st November 2018 were collected as a validation cohort. The survival condition of all patients at week 12 of admission was observed. The risk factors associated with short-term prognosis were analyzed by using multivariate logistic regression analysis, and a logistic regression equation prediction model was established and verified. The diagnostic performance of the prognostic model was evaluated using the receiver operating characteristic (ROC) curve, and was compared with model for end-stage liver disease (MELD) scoring system, Child-Turcotte-Pugh (CTP) scoring system, sequential organ failure assessment (SOFA) scoring system and chronic liver failure (CLIF)-SOFA scoring system. \u0000 \u0000 \u0000Results \u0000Multivariate logistic regression analysis showed that age (odds ratio(OR)=2.133, 95% confidence interval(CI)1.033-4.405), total bilirubin (OR=3.371, 95%CI 1.610-7.060), serum creatinine (OR=4.448, 95%CI 1.697-11.661), hepatic encephalopathy (OR=5.313, 95%CI 2.463-11.461), and ascites (OR=2.959, 95%CI 1.410-6.210) were independent risk factors for predicting the short-term prognosis of patients with HBV-ACLF. The newly established logistic regression model (LRM)=-1.726+ 0.757×age+ 1.215×total bilirubin+ 1.049 2×serum creatinine+ 1.670×hepatic encephalopathy (with=1, without=0) + 1.085×ascites (with=1, without=0). The area under the ROC curve of the LRM for predicting the short-term prognosis of patients with HBV-ACLF was 0.82 (95%CI 0.76-0.88). Furthermore, the areas under the ROC curve of the models of MELD, CTP, SOFA, CLIF-SOFA were 0.67 (95%CI 0.60-0.75), 0.73 (95%CI 0.66-0.80), 0.77 (95%CI 0.70-0.83) and 0.72 (95%CI 0.65-0.80), respectively. The ROC-area under curve of the validation cohort was 0.81 (95%CI 0.65-0.97). \u0000 \u0000 \u0000Conclusions \u0000Age, total bilirubin, serum creatinine, hepatic encephalopathy, and ascites are independent risk factors for the prognosis of HBV-ACLF. The prognostic model established based on these factors can accurately predict the patients′ short-term prognosis, which is superior to MELD, CTP, SOFA and CLIF-SOFA. \u0000 \u0000 \u0000Key words: \u0000Hepatitis B; Acute-on-chronic liver failure; Regression analysis; Prognostic model","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46730112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1000-6680.2019.12.007
Dan Zhao, Weisen Yu, Xiaoyue Zhang, Z. Su, Ruiqin Sun, Zhaoguo Wang
Objective To analyze the molecular epidemiology of norovirus (NoV) genotype GⅡ.15 in Qingdao City. Methods One thousand four hundred and twelve stool samples were collected from suspected NoV infected patients and detected by real-time polymerase chain reaction (PCR). Open reading frame (ORF)1-ORF2 and VP1 gene were amplified by reverse transcription (RT)-PCR and sequenced for genotyping, evolutionary analysis and homology modeling. Results Seven cases of GⅡ.15 type were detected including four sporadic cases and one outbreak.The VP1 gene was highly homologous and had little variation compared with early strain J23/US/1999. The differences of amino acids between strains in Qingdao City were mainly asparagine/asparticacid(N/D)300 and proline/serine(P/S)302.Homology modeling suggested that VP1 of GⅡ.15 strain was composed of S domain and P domain (P1 subdomain included 224-276 and 431-555, P2 subdomain included 277-430). S domain contained eight anti-parallel β-sandwiches and two α-helixes, and P1 subdomain contained one α-helix and seven β-strands, and the P2 subdomain folded into a compact barrel-like structure consisting of six β-strands.Argnine (R)-glycine (G)-valine (V)-motif (289-291) and three specific loci including glutarnine (Q)313, asparagine (N)349 and Q389 were located in the P2 subdomain, with NGR-motif (265-267) located at 22nd upstream of RGV-motif.Site I (SNR-alanine(A)- histidine(H)357-361), Site Ⅱ (D388) and Site Ⅲ (G454, G455) were the main characteristic sites of histo-blood group antigens (HBGA) binding interface, which may be similar to the binding pattern of GⅡ.4 type VA387 and HBGA. Conclusion Although GⅡ.15 type NoV evolves very slowly, it may still have the risk to become an epidemic strain, which needs to be monitored and further studied. Key words: Norovirus GⅡ.15; Epidemiology, molecular
目的分析诺如病毒(NoV) G基因型Ⅱ的分子流行病学。在青岛市有15个。方法收集疑似新型冠状病毒感染患者粪便1412份，采用实时聚合酶链反应(PCR)检测。采用逆转录-PCR扩增开放阅读框(ORF)1-ORF2和VP1基因，并测序进行基因分型、进化分析和同源性建模。结果7例GⅡ。发现15种类型，包括4例散发病例和1例暴发。VP1基因同源性高，与早期菌株J23/US/1999相比差异不大。青岛市菌株间氨基酸差异主要为天冬氨酸/天冬氨酸(N/D)300和脯氨酸/丝氨酸(P/S)302。同源性建模表明GⅡ的VP1。15株菌株由S域和P域组成(P1子域包括224-276和431-555,P2子域包括277-430)。S结构域包含8个反平行的β-三明治和2个α-螺旋，P1子结构域包含1个α-螺旋和7条β-链，P2子结构域折叠成由6条β-链组成的致密桶状结构。Argnine (R)-glycine (G)-valine (V)-motif(289-291)和glutarnine (Q)313、asparagine (N)349和Q389三个特异位点位于P2亚结构域，NGR-motif(265-267)位于RGV-motif上游的第22位。Site I (snr -丙氨酸(A)-组氨酸(H)357-361)、SiteⅡ(D388)和SiteⅢ(G454、G455)是组织血型抗原(HBGA)结合界面的主要特征位点，可能与GⅡ的结合模式相似。4型VA387和HBGA。结论虽然GⅡ。15型新型冠状病毒演变非常缓慢，可能仍有成为流行毒株的风险，需要进一步监测和研究。关键词:诺如病毒GⅡ.15;流行病学、分子
{"title":"Molecular epidemiology of norovirus GII.15 in Qingdao City","authors":"Dan Zhao, Weisen Yu, Xiaoyue Zhang, Z. Su, Ruiqin Sun, Zhaoguo Wang","doi":"10.3760/CMA.J.ISSN.1000-6680.2019.12.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2019.12.007","url":null,"abstract":"Objective \u0000To analyze the molecular epidemiology of norovirus (NoV) genotype GⅡ.15 in Qingdao City. \u0000 \u0000 \u0000Methods \u0000One thousand four hundred and twelve stool samples were collected from suspected NoV infected patients and detected by real-time polymerase chain reaction (PCR). Open reading frame (ORF)1-ORF2 and VP1 gene were amplified by reverse transcription (RT)-PCR and sequenced for genotyping, evolutionary analysis and homology modeling. \u0000 \u0000 \u0000Results \u0000Seven cases of GⅡ.15 type were detected including four sporadic cases and one outbreak.The VP1 gene was highly homologous and had little variation compared with early strain J23/US/1999. The differences of amino acids between strains in Qingdao City were mainly asparagine/asparticacid(N/D)300 and proline/serine(P/S)302.Homology modeling suggested that VP1 of GⅡ.15 strain was composed of S domain and P domain (P1 subdomain included 224-276 and 431-555, P2 subdomain included 277-430). S domain contained eight anti-parallel β-sandwiches and two α-helixes, and P1 subdomain contained one α-helix and seven β-strands, and the P2 subdomain folded into a compact barrel-like structure consisting of six β-strands.Argnine (R)-glycine (G)-valine (V)-motif (289-291) and three specific loci including glutarnine (Q)313, asparagine (N)349 and Q389 were located in the P2 subdomain, with NGR-motif (265-267) located at 22nd upstream of RGV-motif.Site I (SNR-alanine(A)- histidine(H)357-361), Site Ⅱ (D388) and Site Ⅲ (G454, G455) were the main characteristic sites of histo-blood group antigens (HBGA) binding interface, which may be similar to the binding pattern of GⅡ.4 type VA387 and HBGA. \u0000 \u0000 \u0000Conclusion \u0000Although GⅡ.15 type NoV evolves very slowly, it may still have the risk to become an epidemic strain, which needs to be monitored and further studied. \u0000 \u0000 \u0000Key words: \u0000Norovirus GⅡ.15; Epidemiology, molecular","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47018496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1000-6680.2019.12.005
Chun Zhang, Luyuan Tong, Zhaowei Tong
Objective To investigate the efficacy and safety of daclatavir combined with sofosbuvir treatment in chronic hepatitis C (CHC) in the real world. Methods A total of 56 CHC patients administrated with daclatavir (60 mg/d) combined with sofosbuvir (400 mg/d) in Huzhou Central Hospital from February to June in 2018 were enrolled. All patients were administrated with daclatavir combined with sofosbuvir for 12 weeks and followed up for 24 weeks. The virological response and the effect of antiviral therapy on hepatic fibrosis were analyzed. Non-structural protein 5A (NS5A) region mutation sequence was detected by Sanger method. Safety and the adverse events were observed. The t test, chi-square test and Mann-Whitney U test were used to analyze the data. Results Hepatitis C virus (HCV) RNA of all patients treated with daclatavir and sofosbuvir was undectable after eight-week treatment. Sustained virological response at 12 weeks post-treatment (SVR12) was 98.1% (52/53). Gender, globulin, insulin, triglyceride and hemoglobin were correlated with virus clearance (χ2= 4.47, t=2.51, U=1.98, U=2.32 and t=2.03, respectively, all P 0.05). During the treatment, patients developed dizziness, fatigue, nausea and vomiting, panic, insomnia, sleepiness and sexual function enhancement. Conclusion Daclatavir in combination with sophobuvir shows high virological response and good safety in the treatment of chronic hepatitis C, and liver fibrosis is improved after clearance of HCV. Key words: Hepatitis C, chronic; Daclatasvir; Sofosbuvir; Real world study
{"title":"Real world study of daclatavir combined with sofosbuvir treatment in chronic hepatitis C","authors":"Chun Zhang, Luyuan Tong, Zhaowei Tong","doi":"10.3760/CMA.J.ISSN.1000-6680.2019.12.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2019.12.005","url":null,"abstract":"Objective \u0000To investigate the efficacy and safety of daclatavir combined with sofosbuvir treatment in chronic hepatitis C (CHC) in the real world. \u0000 \u0000 \u0000Methods \u0000A total of 56 CHC patients administrated with daclatavir (60 mg/d) combined with sofosbuvir (400 mg/d) in Huzhou Central Hospital from February to June in 2018 were enrolled. All patients were administrated with daclatavir combined with sofosbuvir for 12 weeks and followed up for 24 weeks. The virological response and the effect of antiviral therapy on hepatic fibrosis were analyzed. Non-structural protein 5A (NS5A) region mutation sequence was detected by Sanger method. Safety and the adverse events were observed. The t test, chi-square test and Mann-Whitney U test were used to analyze the data. \u0000 \u0000 \u0000Results \u0000Hepatitis C virus (HCV) RNA of all patients treated with daclatavir and sofosbuvir was undectable after eight-week treatment. Sustained virological response at 12 weeks post-treatment (SVR12) was 98.1% (52/53). Gender, globulin, insulin, triglyceride and hemoglobin were correlated with virus clearance (χ2= 4.47, t=2.51, U=1.98, U=2.32 and t=2.03, respectively, all P 0.05). During the treatment, patients developed dizziness, fatigue, nausea and vomiting, panic, insomnia, sleepiness and sexual function enhancement. \u0000 \u0000 \u0000Conclusion \u0000Daclatavir in combination with sophobuvir shows high virological response and good safety in the treatment of chronic hepatitis C, and liver fibrosis is improved after clearance of HCV. \u0000 \u0000 \u0000Key words: \u0000Hepatitis C, chronic; Daclatasvir; Sofosbuvir; Real world study","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47375094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1000-6680.2019.12.002
X. Miao, B. Pei
对核苷类药物抗乙型肝炎病毒(hepatitis B virus，HBV)治疗后能否安全停药的问题提出一些看法：①在乙型肝炎e抗原(hepatitis B e antigen，HBeAg)阳性的慢性乙型肝炎(chronic hepatitis B，CHB)患者中，HBV DNA低于检测下限、丙氨酸转氨酶复常、HBeAg血清学转换；在HBeAg阴性CHB患者中，HBV DNA不可测、转氨酶复常，是停药的最基本条件。②某些临床参数，如HBV感染途径、初始抗病毒治疗时的年龄和血液HBV DNA载量、HBV DNA达到不可测的时间、既往抗病毒用药情况等，停药时均可作为参考。③乙型肝炎表面抗原(hepatitis B surface antigen，HBsAg)消失伴或不伴血清学转换是停药的理想标准，但血清HBsAg水平与HBV复制和共价闭合环状DNA(covalently closed circular DNA，cccDNA)不完全相关。④肝组织HBV cccDNA的消失代表HBV被清除，但因检测技术因素的限制，尚不能成为停药标准应用于临床。⑤血清HBV RNA有望成为监测抗病毒疗效和安全停药的新型生物标志物。
Some opinions are proposed on whether nucleoside drugs can safely discontinue treatment against hepatitis B virus (HBV): ① In chronic hepatitis B (CHB) patients with positive hepatitis B e antigen (HBeAg), HBV DNA is below the detection limit, alanine aminotransferase is normalized, and HBeAg serological conversion; In HBeAg negative CHB patients, undetectable HBV DNA and normalization of transaminases are the most basic conditions for discontinuation of medication Some clinical parameters, such as the route of HBV infection, age and blood HBV DNA load at the time of initial antiviral treatment, the time when HBV DNA reaches an undetectable level, and previous antiviral medication, can be used as references when discontinuing medication The disappearance of hepatitis B surface antigen (HBsAg) with or without serological conversion is an ideal standard for discontinuation, but serum HBsAg levels are not fully correlated with HBV replication and covalent closed circular DNA (cccDNA) The disappearance of HBV cccDNA in liver tissue represents the clearance of HBV, but due to limitations in detection technology, it cannot be used as a withdrawal standard for clinical use. ⑤ Serum HBV RNA is expected to become a new biomarker for monitoring antiviral efficacy and safe discontinuation of drugs.
{"title":"Predictive markers for safe discontinuation of nucleos(t)ide analogues antiviral therapy in chronic hepatitis B patients","authors":"X. Miao, B. Pei","doi":"10.3760/CMA.J.ISSN.1000-6680.2019.12.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2019.12.002","url":null,"abstract":"对核苷类药物抗乙型肝炎病毒(hepatitis B virus，HBV)治疗后能否安全停药的问题提出一些看法：①在乙型肝炎e抗原(hepatitis B e antigen，HBeAg)阳性的慢性乙型肝炎(chronic hepatitis B，CHB)患者中，HBV DNA低于检测下限、丙氨酸转氨酶复常、HBeAg血清学转换；在HBeAg阴性CHB患者中，HBV DNA不可测、转氨酶复常，是停药的最基本条件。②某些临床参数，如HBV感染途径、初始抗病毒治疗时的年龄和血液HBV DNA载量、HBV DNA达到不可测的时间、既往抗病毒用药情况等，停药时均可作为参考。③乙型肝炎表面抗原(hepatitis B surface antigen，HBsAg)消失伴或不伴血清学转换是停药的理想标准，但血清HBsAg水平与HBV复制和共价闭合环状DNA(covalently closed circular DNA，cccDNA)不完全相关。④肝组织HBV cccDNA的消失代表HBV被清除，但因检测技术因素的限制，尚不能成为停药标准应用于临床。⑤血清HBV RNA有望成为监测抗病毒疗效和安全停药的新型生物标志物。","PeriodicalId":10127,"journal":{"name":"Chinese Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45166305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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