Access block and prolonged length of stay in the emergency department are associated with a higher patient mortality rate

Access block,known as exit block or boarding,is defined as a situation in which patients who are admitted or planned for admission remain in the emergency department(ED)as they are unable to be transferred to an inpatient unit within a reasonable time frame(no longer than 8 hours).[1,2]Access block often occurs due to insufficient hospital capacity and is a major issue in emergency medicine.[3]

Pathogen evolution, prevention/control strategy and clinical features of COVID-19: experiences from China

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages,which was defined by the World Health Organization as coronavirus disease 2019(COVID-19).The pandemic is considered a significant threat to global public health till now.In this review,we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2,including its prototype and variants.The overall clinical features of variants of concern(VOC),heterogeneity in the clinical manifestations,radiology and pathology of COVID-19 patients are also discussed,along with advances in therapeutic agents.

Risk of extended viral shedding of Omicron BA.2 in Shanghai:Implications for vaccination strategy optimization

Background:In late March 2022,an outbreak of coronavirus disease 2019(COVID-19)caused by the Omicron BA.2 strain occurred in Shanghai,China.This retrospective study aimed to investigate the clinical characteristics,laboratory parameters,and vaccine protectiveness related to this disease in China.Methods:We conducted a single-center retrospective study on 735 patients with COVID-19 hospitalized from March 17 to May 14,2022.Clinical characteristics were analyzed based on vaccination status and viral shedding time(VST).The least absolute shrinkage and selection operator(LASSO)regression and 5-fold cross-validation were applied to screen factors linked to the rate of the VST.Generalized linear models were further applied to estimate the odds ratios for factors influencing the VST.Results:The median VST of unvaccinated patients was 13(11-16)days,which was longer than that of patients vaccinated with one or two doses(11[9-13]days)and with completed booster doses(11[8-12]days).A LASSO regression model and 5-fold cross-validation showed that age of≥60 years(β=0.01),pneumonia(β=0.53),and higher number of comorbidities(β=0.69)were positively associated with the VST,whereas the platelet count(β=-8.0×10-5)was inversely associated with the VST.Subgroup analysis revealed that the number of vaccinations was significantly associated with a decreased VST among patients with renal dysfunction(odds ratio[OR],0.65;95%confidence interval[CI],0.44-0.97;P=0.034)and patients with two or more comorbidities(OR,0.09;95%CI,0.03-0.28;P<0.001).The lymphocyte count was significantly associated with a decreased VST among patients aged<60 years(OR,0.51;95%CI,0.30-0.85;P=0.011),patients with normal renal function(OR,0.41;95%CI,0.21-0.80;P=0.009),and patients with fewer than two comorbidities(OR,0.49;95%CI,0.30-0.80;P=0.005).Conclusion:Our preliminary results suggest that the complete and booster vaccination contributes to the viral clearance of Omicron BA.2 variants,while the protectiveness of vaccination is most imperative in patients with impaired renal function and more comorbidities.

Inactivated SARS-CoV-2 vaccine does not influence the profile of prothrombotic antibody nor increase the risk of thrombosis in a prospective Chinese cohort

The presence of antiphospholipid antibodies was shown to be associated with thrombosis in coronavirus disease 2019(COVID-19)patients.Recently,according to reports from several studies,the vaccineinduced immune thrombotic thrombocytopenia is mediated by anti-platelet factor 4(PF4)-polyanion complex in adenovirus-vectored COVID-19 vaccine recipients.It is impendent to explore whether inactivated COVID-19 vaccine widely used in China influences prothrombotic autoantibody production and induces thrombosis.In this prospective study,we recruited 406 healthcare workers who received two doses,21 days apart,of inactivated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccine(BBIBP-CorV,Sinopharm).Paired blood samples taken before vaccination and four weeks after the second vaccination were used in detecting prothrombotic autoantibodies,including anticardiolipin(aCL),anti-b2 glycoprotein I(ab2GP1),anti-phosphatidylserine/prothrombin(aPS/PT),and anti-PF4-heparin.The seroconversion rate of SARS-CoV-2 specific antibodies was 95.81%(389/406)four weeks after vaccination.None of the subjects had spontaneous thrombosis or thrombocytopenia over a minimum follow-up period of eight weeks.There was no significant difference in the presence of all ten autoantibodies between samples collected before and after vaccination:for aCL,IgG(7 vs.8,P=0.76),IgM(41 vs.44,P=0.73),IgA(4 vs.4,P=1.00);anti-b2GP1,IgG(7 vs.6,P=0.78),IgM(6 vs.5,P=0.76),IgA(3 vs.5,P=0.72);aPS/PT IgG(0 vs.0,P=1.00),IgM(6 vs.5,P=0.76);aPF4-heparin(2 vs.7,P=0.18),and antinuclear antibody(ANA)(18 vs.21,P=0.62).Notably,seven cases presented with anti-PF4-heparin antibodies(range:1.18–1.79 U/mL)after vaccination,and none of them exhibited any sign of thrombotic disorder.In conclusion,inactivated SARS-CoV-2 vaccine does not influence the profile of antiphospholipid antibody and anti-PF4-heparin antibody nor increase the risk of thrombosis.

EGFR/BRAF/MEK co-inhibition for EGFR-mutated lung adenocarcinoma patients with an acquired BRAF^(V600E) mutation: a case report and review of literature

Despite the promising initial anti-tumor efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs),most advanced non-small-cell lung cancers(NSCLCs)progress eventually due to therapeutic resistance.V-Raf murine sarcoma viral oncogene homolog B1(BRAF)^(V600E) mutation has been considered as an uncommon mutation that contributes to acquired resistance for EGFR-TKIs.In the presented case,BRAF^(V600E) mutation was detected as an acquired resistance-mediated mutation in a patient treated with osimertinib(a third-generation EGFR-TKI).The presented patient achieved partial regression and ongoing PFS of four months after the co-inhibition of osimertinib plus dabrafenib(BRAF inhibitor)and trametinib(MEK inhibitor).Our case further enriches the clinical evidence of the efficacy of EGFR/BRAF/MEK co-inhibition in patients with an acquired BRAF^(V600E) mutation,consistent with the review of the literature(eight cases).Additionally,our case highlights the important role of sample type,method,and platform of gene detection in patient management,life quality,and prognosis,as well as the understanding of acquired resistance mechanism.

Immune profiles of a COVID-19 adolescent with mild symptoms and anti anti-viral antibody deficiency

1.Introduction.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has led to the outbreak of COVID-19 syndrome since December 2019,becoming prevalent worldwide afterward[1,2].Unlike severe acute respiratory syndrome(SARS)and Middle East respiratory syndrome(MERS),which cause severe symptoms and high mortality[1],the morbidity from COVID-19 is relatively low,especially in young people[3].In China,the mortality rate was 1023 of 44,672 confirmed cases by the end of Februaryl 1,2020[4].However,there were no cases of death among 416 patients aged 0-9 years,and only 1 in 549 patients aged 10-19 years[4].The exact reasons for this clinical phenomenon remain unclear.