A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV) infected pneumonia(standard version)

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

Creep damage characterization of UNS N10003 alloy based on a numerical simulation using the Norton creep law and Kachanov–Rabotnov creep damage model

The calculation of inelastic creep damage is important for the structural integrity evaluation of the elevated temperature structure in a thorium molten salt reactor(TMSR). However, a creep damage theory model and numerical simulation method have not been proposed for the key materials(UNS N10003 alloy) in the TMSR. In this study, creep damage characterization of UNS N10003 alloy is investigated using the Norton creep law and Kachanov–Rabotnov(K–R) creep damage model. First, the creep experimental data of the UNS N10003 alloy at 650 °C were adopted to fit the material constants of the two models. Then, the creep damage behavior of the UNS N10003 alloy was analyzed and discussed under uniaxial and multi-axial stress states. The results indicated that the K–R creep damage model is more suitable for the UNS N10003 alloy than the Norton model. Finally, the numerical simulation method was developed by a user-defined UMAT subroutine and subsequently verified through a finite element analysis(FEA). The FEA results were in agreement with the theoretical solutions. This study provides an effective method for the inelastic creep damage analysis of the elevated temperature structure in the TMSR.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline(updated version)

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

机器人辅助高度肥胖型低位直肠癌根治术1例

直肠癌合并高度肥胖具有手术难度高、术中风险大、术后并发症发生率高等难题。达芬奇机器人在胃肠道肿瘤中的运用日趋成熟,其运用于低位直肠癌合并高度肥胖患者具有鲜明的优势。南京中医药大学附属医院收治1例51岁女性患者,术前诊断为直肠恶性肿瘤,BMI 34.60 kg/m^(2)。经术前多学科评估后,行机器人辅助腹腔镜下直肠全系膜切除术,手术顺利,效果满意。

Updating the diagnostic criteria of COVID-19 “suspected case” and “confirmed case” is necessary

On 6 February 2020,our team had published a rapid advice guideline for diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infection,and this guideline provided our experience and make well reference for fighting against this pandemic worldwide.However,the coronavirus disease 2019(COVID-19)is a new disease,our awareness and knowledge are gradually increasing based on the ongoing research findings and clinical practice experience;hence,the strategies of diagnosis and treatment are also continually updated.In this letter,we answered one comment on our guideline and provided the newest diagnostic criteria of"suspected case"and"confirmed case"according to the latest Diagnosis and Treatment Guidelines for COVID-19(seventh version)that issued by the National Health Committee of the People’s Republic of China.

Small balloon strategy associated with low pacemaker implantation rate after self-expanding transcatheter valve implantation

BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.

Simplified SEBAL method for estimating vast areal evapotranspiration with MODIS data

The SEBAL （surface energy balance algorithm for land） model provides an efficient tool for estimating the spatial distribution of evapotranspiration, and performs a simple adjustment procedure to calculate sensible heat flux using the wind speed data set from only one weather station. This paper proposes a simplified method to modify the traditional SEBAL model for calculating the 24-hour evapotranspiration （ ETduly ） in the Haihe Basin with data from 34 weather stations. We interpolated the wind speeds using the inverse distance weighting method to establish a wind field and then used it to calculate the friction velocity directly. This process also simplifies the iterative computation process of sensible heat flux. To validate the feasibility of this simplified method, we compared the results with those obtained with an appropriate but more complex method proposed by Tasumi, which separates a vast area into several sub-areas based on the weather conditions, and runs the SEBAL model separately in each sub-area. The results show good agreement between the evapotranspiration generated by the two methods, with a coefficient of determination （r2） of 0.966, which indicates the feasibility of estimating evapotranspiration over a large region with the simplified method.

Flood disaster monitoring based on Sentinel-1 data:A case study of Sihu Basin and Huaibei Plain,China

Summer floods occur frequently in many regions of China,affecting economic development and social stability.Remote sensing is a new technique in disaster monitoring.In this study,the Sihu Basin in Hubei Province of China and the Huaibei Plain in Anhui Province of China were selected as the study areas.Thresholds of backscattering coefficients in the decision tree method were calculated with the histogram analysis method,and flood disaster monitoring in the two study areas was conducted with the threshold method using Sentinel-1 satellite images.Through satellite-based flood disaster monitoring,the flooded maps and the areas of expanded water bodies and flooded crops were derived.The satellite-based monitoring maps were derived by comparing the expanded area of images during a flood disaster with that before the disaster.The difference in spatiotemporal distribution of flood disasters in these two regions was analyzed.The results showed that flood disasters in the Sihu Basin occurred frequently in June and July,and flood disasters in the Huaibei Plain mostly occurred in August,with a high interannual vari-ability.Flood disasters in the Sihu Basin were usually widespread,and the affected area was between Changhu and Honghu lakes.The Huaibei Plain was affected by scattered disasters.The annual mean percentages of flooded crop area were 14.91%and 3.74% in the Sihu Basin and Huaibei Plain,respectively.The accuracies of the extracted flooded area in the Sihu Basin in 2016 and 2017 were 96.20% and 95.19%,respectively.

Stress and thickness calculation of a bolted flat cover with double metal sealing rings

The design of a bolted flat cover is extremely important for the structural integrity of pressure vessels.The present design codes provide the thickness calculation equations for a bolted flat cover with single metal gasket.However,the rules for a bolted flat cover with double metal sealing rings are not developed to date.In the study,a new thickness calculation equation for the bolted flat cover with double metal sealing rings is proposed.First,the theoretical stress solution for bolted flat cover with the double metal sealing rings is obtained,based on the theory of simply supported circular plate and then verified using the results from finite element analyses.The results indicate that the influence of double metal sealing ring on the stress of the flat cover is more serious compared to single metal gasket.Second,a more accurate and reasonable equation is proposed to calculate the thickness of bolted flat cover with double metal sealing rings based on the derived theoretical equations of maximum stress.Finally,the influence of linear load and the spacing between rings on the thickness are discussed.Subsequently,a few suggestions are provided to design low-pressure or atmosphere pressure vessels.The study provides a theoretical foundation to develop design codes of pressure vessels in nuclear reactors.

Numerical simulation of stress behavior of dowel–brick structures in TMSR

As essential elements of the graphite reflector in thorium-based molten salt reactor,dowel–brick structures are used to withstand complex working loads in the reactor core and their failure may lead to serious damage of the graphite reactor core.It is crucial to investigate the stress behavior of dowel–brick structures for safe operation of the graphite reactor.In this study,three groups of finite element analyses and a strain test were carried out to investigate how the geometric parameters of the dowels affect the stress behavior of the dowel–brick structure.The numerical results indicate that the stress behavior of a dowel–brick structure is significantly affected by the diameter,length,and aspect ratio of the dowels.The maximum stress in the lower and upper bricks decreases with an increase in the dowel length.The location of maximum stress on both lower and upper bricks shifts from the root of the socket to the edge of that socket beside the contact region,as the length of the dowel increases.The shift of the maximum stress location occurs earlier for the upper bricks than for the lower bricks.The results of strain tests show good agreement with those of numerical analyses.

新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(完整版)

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染的肺炎,因2019年12月发生在武汉的不明原因病毒性肺炎病例而被发现,并于2020年1月12日被世界卫生组织(World Health Organization,WHO)命名。在之后的一个月时间内,2019-nCoV在湖北省内外甚至其他国家传播造成了数以千计的病例出现,同时也引起了民众一定程度的恐慌。本指南的制订希望能够从疾病流行病学、病因学、诊断、治疗、护理、医院感染控制等方面给临床医生、社区居民等提供医疗护理及居家照护相关指导。

新型冠状病毒肺炎药物预防、诊断、治疗与出院管理临床指南计划书

本计划书为《新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(标准版)》更新版的研究方案。计划书涵盖指南制定方法学、指南的目标用户、指南的目标人群、利益冲突调查与声明、临床问题和结局指标的遴选与确定、证据的检索、合成与评价、证据与推荐意见分级标准、推荐意见的形成、指南的更新,并附录指南临床问题清单、文献检索策略及利益冲突调查表。