The increasing importance of terminal privacy in the Unmanned Aerial Vehicle(UAV)network has led to a growing recognition of the crucial role of authentication technology in UAV network security.However,traditional au...The increasing importance of terminal privacy in the Unmanned Aerial Vehicle(UAV)network has led to a growing recognition of the crucial role of authentication technology in UAV network security.However,traditional authentication approaches are vulnerable due to the transmission of identity information between UAVs and cryptographic paradigm management centers over a public channel.These vulnerabilities include brute-force attacks,single point of failure,and information leakage.Blockchain,as a decentralized distributed ledger with blockchain storage,tamper-proof,secure,and trustworthy features,can solve problems such as single-point-of-failure and trust issues,while the hidden communication in the physical layer can effectively resist information leakage and violent attacks.In this paper,we propose a lightweight UAV network authentication mechanism that leverages blockchain and covert communication,where the identity information is transmitted as covert tags carried by normal modulated signals.In addition,a weight-based Practical Byzantine Fault-Tolerant(wPBFT)consensus protocol is devised,where the weights are determined by the channel states of UAVs and the outcomes of past authentication scenarios.Simulation results demonstrate that the proposed mechanism outperforms traditional benchmarks in terms of security and robustness,particularly under conditions of low Signal-to-Noise Ratio(SNR)and short tag length.展开更多
AIM: To evaluate urine β2-microglobulin(β2-M), retinol-binding protein(RBP) excretion, and renal impairment with adefovir dipivoxil(ADV) for chronic hepatitis B. METHODS: We enrolled 165 patients with chronic hepati...AIM: To evaluate urine β2-microglobulin(β2-M), retinol-binding protein(RBP) excretion, and renal impairment with adefovir dipivoxil(ADV) for chronic hepatitis B. METHODS: We enrolled 165 patients with chronic hepatitis B infection who were treated with ADV monotherapy(n = 90) or ADV plus lamivudine combination therapy(n = 75). An additional 165 chronic hepatitis B patients treated with entecavir were recruited as controls. We detected serum creatinine, urine β2-M, and RBP levels, and estimated the glomerular filtration rate(e GFR) at the initiation of antiviral therapy and every 6 mo for a period of five years. RESULTS: Urine β2-M abnormalities were observed in patients during the first(n = 3), second(n = 7), third(n = 11), fourth(n = 16), and fifth(n = 21) year of ADV treatment. Urinary RBP abnormalities were observed in patients during the first(n = 2), second(n = 8), third(n = 12), fourth(n = 15), and fifth(n = 22) year of ADV treatment. e GFR decreased 20%-30% from baseline in 20 patients, 30%-50% in 12 patients, and > 50% in 3 patients during the five years of treatment. Further analysis indicated that decreases in e GFR of ≥ 30% relative to the baseline level correlated significantly with urine RBP and β2-M abnormalities. In contrast, both serum creatinine and e GFR remained stable in patients treated with entecavir, and only one of these patients developed a urine β2-M abnormality, and two developed urine RBP abnormalities during the five years of treatment. CONCLUSION: Urine RBP and β2-M are biomarkers of renal injury during long-term ADV treatment for chronic hepatitis B, and indicate when treatment should be switched to entecavir.展开更多
Background:Currently,there are no drugs that have been proven to be effective against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Because of its broad antiviral activity,interferon(IFN)should be evalua...Background:Currently,there are no drugs that have been proven to be effective against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Because of its broad antiviral activity,interferon(IFN)should be evaluated as a potential therapeutic agent for treatment of coronavirus disease 2019(COVID-19),especially while COVID-19-specific therapies are still under development.Methods:Confirmed COVID-19 patients hospitalized in the First Affiliated Hospital,School of Medicine,Zhejiang University in Hangzhou,China,from January 19 to February 19,2020 were enrolled in a retrospective study.The patients were separated into an IFN group and a control group according to whether they received initial IFN-α2 b inhalation treatment after admission.Propensity-score matching was used to balance the confounding factors.Results:A total of 104 confirmed COVID-19 patients,68 in the IFN group and 36 in the control group,were enrolled.Less hypertension(27.9%vs.55.6%,P=0.006),dyspnea(8.8%vs.25.0%,P=0.025),or diarrhea(4.4%vs.19.4%,P=0.030)was observed in the IFN group.Lower levels of albumin and C-reactive protein and higher level of sodium were observed in the IFN group.Glucocorticoid dosage was lower in the IFN group(median,40 vs.80 mg/d,P=0.025).Compared to the control group,fewer patients in the IFN group were ventilated(13.2%vs.33.3%,P=0.015)and admitted to intensive care unit(ICU)(16.2%vs.44.4%,P=0.002).There were also fewer critical patients in the IFN group(7.4%vs.25.0%,P=0.017)upon admission.Although complications during admission process were comparable between groups,the discharge rate(85.3%vs.66.7%,P=0.027)was higher and the hospitalization time(16 vs.21 d,P=0.015)was shorter in the IFN group.When other confounding factors were not considered,virus shedding time(10 vs.13 d,P=0.014)was also shorter in the IFN group.However,when the influence of other factors was eliminated using propensity score matching,virus shedding time was not significantly shorter than that of the control group(12 vs.15 d,P=0.206).Conclusions:IFN-α2 b spray inhalation did not shorten virus shedding time of SARS-CoV-2 in hospitalized patients.展开更多
Background:A novel coronavirus called severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),first identified in Wuhan,China,has been rapidly spreading around the world.This study investigates the epidemiological...Background:A novel coronavirus called severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),first identified in Wuhan,China,has been rapidly spreading around the world.This study investigates the epidemiological and clinical characteristics of coronavirus disease 2019(COVID-19)patients in Zhejiang Province who did or did not have a history of Wuhan exposure.Methods:We collected data from medical records of confirmed COVID-19 patients in Zhejiang Province from Jan.17 to Feb.7,2020 and analyzed epidemiological,clinical,and treatment data of those with and without recorded recent exposure in Wuhan.Results:Patients in the control group were older than those in the exposure group((48.19±16.13)years vs.(43.47±13.12)years,P<0.001),and more were over 65 years old(15.95%control vs.5.60%exposure,P<0.001).The rate of clustered onset was also significantly higher in the control group than in the exposure group(31.39%vs.18.66%,P<0.001).The symptom of a sore throat in patients in the exposure group was significantly higher than that in the control group(17.30%vs.10.89%,P=0.01);however,headache in the exposure group was significantly lower than that in the control group(6.87%vs.12.15%,P=0.015).More patients in the exposure group had a significantly lower level of lactate dehydrogenase(LDH)and aspartate aminotransferase(AST)than those in the control group.There was no significant difference in any degree of COVID-19 including mild,severe,and critical between the two groups.Conclusions:From the perspective of epidemiological and clinical characteristics,there was no significant difference between COVID-19 patients with and without Wuhan exposure history.展开更多
Accurate and sensitive near-infrared(NIR)luminescent lateralflow immunoassay(LFIA)has attracted considerable attention in thefield of point-of-care testing(POCT).However,the detection accuracy and sensitivity are ofte...Accurate and sensitive near-infrared(NIR)luminescent lateralflow immunoassay(LFIA)has attracted considerable attention in thefield of point-of-care testing(POCT).However,the detection accuracy and sensitivity are often compromised by the lowfluorescence quantum efficiency of the NIRfluorescent probe.(<10%)Herein,ultrabright NIR AIEgen nanoparticles(PS@AIE830NPs)composed of polystyrene(PS)nanoparticles and NIR aggregation-induced emission luminogen(AIEgen)with the maximum emission at 830 nm(AIE830)is reported,and its poten-tial to promote an accurate and sensitive detection of complex samples by LFIA is described.The relative quantum yield(QY)of the PS@AIE830NPs was 14.76%,which was superior to that of the polymer embedding method and indocyanine green(ICG)-based NIR nanoparticles.The PS@AIE830NPs immunolabeled-LFIA com-bined with laboratory-built NIR-LFIA portable quantitative instruments(detected light range 800 nm)completely eliminated background interference and allowed>highly accurate and sensitive detection without any pre-treatment steps.The limits of detection(LODs)for aflatoxin B1(AFB1)in soy sauce,alpha hemolysin(Hla)of Staphylococcus aureus biomarker in jointfluid,and C-reactive protein(CRP)in human haemolysed samples were 0.01 ng mL^(-1),0.02µg mL^(-1),and 0.156 mg L^(-1),respectively,commensurating with those of the corresponding gold standard assays and covering the detection range of interests.It is anticipated that the ultrabright NIR AIEgen nanoparticles will serve as a universally applicable signal probe for NIR-LFIA diagnostics,promising to expand the range of applications for quantitative detection of complex samples.展开更多
Background and Aims:A functional cure,or hepatitis B virus(HBV)surface antigen(HBsAg)loss,is difficult to achieve in patients with hepatitis B virus e antigen(HBeAg)-positive chronic hepatitis B.The HBV vaccine and gr...Background and Aims:A functional cure,or hepatitis B virus(HBV)surface antigen(HBsAg)loss,is difficult to achieve in patients with hepatitis B virus e antigen(HBeAg)-positive chronic hepatitis B.The HBV vaccine and granulocyte-macrophage colony-stimulating factor(GM-CSF)have been reported to help reduce HBsAg levels and promote HBsAg loss.In this prospective randomized trial,we evaluated HBsAg loss in patients receiving pegylated interferon α2b(PEGIFN-α2b)and tenofovir disoproxil fumarate(TDF),with and without GM-CSF and HBV vaccination.Methods:A total of 287 patients with HBeAg positive chronic hepati-tis B and seroconversion after nucleot(s)ide analog treat-ment were assigned randomly to three treatment groups for 48 weeks,TDF alone(control),PEGIFN-α2b+TDF,and PEGIFN-α2b+TDF+GM-CSF+HBV vaccine.The prima-ry endpoints were the proportions of patients with HBsAg loss and seroconversion at 48 and 72 weeks.Resu/ts:The cumulative HBsAg loss rates in the control,PEGIFN-α2b+TDF,and PEGIFN-α2b+TDF+GM-CSF+HBV vaccine groups at week 48 were 0.0%,28.3%,and 41.1%,respec-tively.The cumulative HBsAg seroconversion rates in these groups at week 48 were 0.0%,21.7%,and 33.9%,respec-tively.Multivariate regression analysis showed that GM-CSF use plus HBV vaccination was significantly associated with HBsAg loss(p=0.017)and seroconversion(p=0.030).Con-clusions:In patients with HBeAg-positive chronic hepatitis B and seroconversion after nucleot(s)ide analog treatment,immunomodulatory/antiviral treatment regimens effective-ly improved HBsAg loss,and the regimen including GM-CSF and HBV vaccination was most effective.展开更多
Background The outbreak of coronavirus disease 2019(COVID-19)is now becoming an enormous threat to public health.The clinical spectrum of COVID-19 is extensive,of which critical cases are with rapid disease progressio...Background The outbreak of coronavirus disease 2019(COVID-19)is now becoming an enormous threat to public health.The clinical spectrum of COVID-19 is extensive,of which critical cases are with rapid disease progression and high mortality.The aim of our study is to summarize the characteristics of different subtypes and explore risk factors of illness severity for early identification and prompt treatment.Methods In this retrospective study,we collected data of patients confirmed COVID-19 in Zhejiang Province from 17 January to 12 February 2020.According to the definition of clinical classification,we divided confirmed cases into four types,and summarize epidemiological and clinical characteristics,laboratory and radiograph findings,treatments,and outcomes,respectively.Moreover,we used univariate and multivariate ordinal logistic regression models to explore risk factors for the severity of illness in patients with COVID-19.Results A total of 788 patients were enrolled in our study,of whom 52 cases(6.6%)were mild type,658 cases(83.5%)were common type,61 cases(7.2%)were severe type,and 17 cases(2.2%)were critical type.Multivariate ordinal logistic regression demonstrated increasing odds of the severity of illness in patients with COVID-19 associated with male(odds ratio[OR]=1.7,95%confidence interval[CI]:1.2–2.6 P=0.008),fever(OR=3.6,95%CI:2.1–6.3,P<0.001),cough(OR=1.7,95%CI:1.0–2.9,P=0.041),hemoptysis(OR=3.4,95%CI:1.1–10.3,P=0.032),gastrointestinal symptoms(OR=1.9,95%CI:1.0–3.5,P=0.047),hypertension(OR=2.6,95%CI:1.2–5.6,P=0.013).With the increase of age-grading,risk for the severity of illness was gradually higher(≤18 years[OR=1.0],19–40 years[OR=12.7,95%CI:4.5–36.0,P<0.001],41–65 years[OR=14.8,95%CI:5.2–42.1,P<0.001],≥66 years[OR=56.5,95%CI:17.1–186.5,P<0.001]).Conclusions Clinicians should pay close attention to these features in patients with COVID-19 including older age,male,fever,cough,hemoptysis,gastrointestinal symptoms and hypertension to identify the severity of illness as early as possible.展开更多
基金supported by the Hainan Province Science and Technology Special Fund,China(No.ZDYF2024GXJS292).
文摘The increasing importance of terminal privacy in the Unmanned Aerial Vehicle(UAV)network has led to a growing recognition of the crucial role of authentication technology in UAV network security.However,traditional authentication approaches are vulnerable due to the transmission of identity information between UAVs and cryptographic paradigm management centers over a public channel.These vulnerabilities include brute-force attacks,single point of failure,and information leakage.Blockchain,as a decentralized distributed ledger with blockchain storage,tamper-proof,secure,and trustworthy features,can solve problems such as single-point-of-failure and trust issues,while the hidden communication in the physical layer can effectively resist information leakage and violent attacks.In this paper,we propose a lightweight UAV network authentication mechanism that leverages blockchain and covert communication,where the identity information is transmitted as covert tags carried by normal modulated signals.In addition,a weight-based Practical Byzantine Fault-Tolerant(wPBFT)consensus protocol is devised,where the weights are determined by the channel states of UAVs and the outcomes of past authentication scenarios.Simulation results demonstrate that the proposed mechanism outperforms traditional benchmarks in terms of security and robustness,particularly under conditions of low Signal-to-Noise Ratio(SNR)and short tag length.
基金Supported by National Key Program for Infectious Diseases of China(to Yang YD),No.2013ZX1000200112th FiveYear Significant New Drugs Creation Plan of the Ministry of Science and Technology of China(to Yang YD),No.2011ZX09302-003-03
文摘AIM: To evaluate urine β2-microglobulin(β2-M), retinol-binding protein(RBP) excretion, and renal impairment with adefovir dipivoxil(ADV) for chronic hepatitis B. METHODS: We enrolled 165 patients with chronic hepatitis B infection who were treated with ADV monotherapy(n = 90) or ADV plus lamivudine combination therapy(n = 75). An additional 165 chronic hepatitis B patients treated with entecavir were recruited as controls. We detected serum creatinine, urine β2-M, and RBP levels, and estimated the glomerular filtration rate(e GFR) at the initiation of antiviral therapy and every 6 mo for a period of five years. RESULTS: Urine β2-M abnormalities were observed in patients during the first(n = 3), second(n = 7), third(n = 11), fourth(n = 16), and fifth(n = 21) year of ADV treatment. Urinary RBP abnormalities were observed in patients during the first(n = 2), second(n = 8), third(n = 12), fourth(n = 15), and fifth(n = 22) year of ADV treatment. e GFR decreased 20%-30% from baseline in 20 patients, 30%-50% in 12 patients, and > 50% in 3 patients during the five years of treatment. Further analysis indicated that decreases in e GFR of ≥ 30% relative to the baseline level correlated significantly with urine RBP and β2-M abnormalities. In contrast, both serum creatinine and e GFR remained stable in patients treated with entecavir, and only one of these patients developed a urine β2-M abnormality, and two developed urine RBP abnormalities during the five years of treatment. CONCLUSION: Urine RBP and β2-M are biomarkers of renal injury during long-term ADV treatment for chronic hepatitis B, and indicate when treatment should be switched to entecavir.
基金Project supported by the National Natural Science Foundation of China(No.81700549)the National Major Science and Technology Research Projects for the Control and Prevention of Major Infectious Diseases in China(No.2017ZX10202202)the Medical and Health Research Program of Zhejiang Province(No.2015KYB144),China。
文摘Background:Currently,there are no drugs that have been proven to be effective against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Because of its broad antiviral activity,interferon(IFN)should be evaluated as a potential therapeutic agent for treatment of coronavirus disease 2019(COVID-19),especially while COVID-19-specific therapies are still under development.Methods:Confirmed COVID-19 patients hospitalized in the First Affiliated Hospital,School of Medicine,Zhejiang University in Hangzhou,China,from January 19 to February 19,2020 were enrolled in a retrospective study.The patients were separated into an IFN group and a control group according to whether they received initial IFN-α2 b inhalation treatment after admission.Propensity-score matching was used to balance the confounding factors.Results:A total of 104 confirmed COVID-19 patients,68 in the IFN group and 36 in the control group,were enrolled.Less hypertension(27.9%vs.55.6%,P=0.006),dyspnea(8.8%vs.25.0%,P=0.025),or diarrhea(4.4%vs.19.4%,P=0.030)was observed in the IFN group.Lower levels of albumin and C-reactive protein and higher level of sodium were observed in the IFN group.Glucocorticoid dosage was lower in the IFN group(median,40 vs.80 mg/d,P=0.025).Compared to the control group,fewer patients in the IFN group were ventilated(13.2%vs.33.3%,P=0.015)and admitted to intensive care unit(ICU)(16.2%vs.44.4%,P=0.002).There were also fewer critical patients in the IFN group(7.4%vs.25.0%,P=0.017)upon admission.Although complications during admission process were comparable between groups,the discharge rate(85.3%vs.66.7%,P=0.027)was higher and the hospitalization time(16 vs.21 d,P=0.015)was shorter in the IFN group.When other confounding factors were not considered,virus shedding time(10 vs.13 d,P=0.014)was also shorter in the IFN group.However,when the influence of other factors was eliminated using propensity score matching,virus shedding time was not significantly shorter than that of the control group(12 vs.15 d,P=0.206).Conclusions:IFN-α2 b spray inhalation did not shorten virus shedding time of SARS-CoV-2 in hospitalized patients.
基金the National Major Science and Technology Research Projects for the Control and Prevention of Major Infectious Diseases in China(No.2017ZX10202202)the National Natural Science Foundation of China(No.81770574)。
文摘Background:A novel coronavirus called severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),first identified in Wuhan,China,has been rapidly spreading around the world.This study investigates the epidemiological and clinical characteristics of coronavirus disease 2019(COVID-19)patients in Zhejiang Province who did or did not have a history of Wuhan exposure.Methods:We collected data from medical records of confirmed COVID-19 patients in Zhejiang Province from Jan.17 to Feb.7,2020 and analyzed epidemiological,clinical,and treatment data of those with and without recorded recent exposure in Wuhan.Results:Patients in the control group were older than those in the exposure group((48.19±16.13)years vs.(43.47±13.12)years,P<0.001),and more were over 65 years old(15.95%control vs.5.60%exposure,P<0.001).The rate of clustered onset was also significantly higher in the control group than in the exposure group(31.39%vs.18.66%,P<0.001).The symptom of a sore throat in patients in the exposure group was significantly higher than that in the control group(17.30%vs.10.89%,P=0.01);however,headache in the exposure group was significantly lower than that in the control group(6.87%vs.12.15%,P=0.015).More patients in the exposure group had a significantly lower level of lactate dehydrogenase(LDH)and aspartate aminotransferase(AST)than those in the control group.There was no significant difference in any degree of COVID-19 including mild,severe,and critical between the two groups.Conclusions:From the perspective of epidemiological and clinical characteristics,there was no significant difference between COVID-19 patients with and without Wuhan exposure history.
基金National Natural Science Foundation of China,Grant/Award Numbers:82202642,82302646,32172296Chongqing Postdoctoral Innovation Talent Support Program,Grant/Award Number:CQBX202218+8 种基金China Postdoctoral Science Foundation,Grant/Award Numbers:2022M710558,2023T160771Special foundation of Chongqing Postdoctoral Research Programme,Grant/Award Number:2021XM2036Talent Training Foundation of Key Laboratory of Clinical Laboratory Diagnostics(Ministry of Education)of College of Laboratory Medicine,Grant/Award Number:JYPY202202Chongqing Postdoctoral Science Foundation,Grant/Award Number:CSTB2022NSCQ-BHX0689National Natural Science Foundation Key Program,Grant/Award Numbers:82230032,81930023Key Project of Chongqing Science and Technology Bureau,Grant/Award Number:CSTC2021jscx-gksb-N0010Chongqing Outstanding Scientists Project(2019)Chongqing Chief Medical Scientist Project(2018)Chongqing Science and Technology Bureau Mountaineering Project,Grant/Award Numbers:cyyy-xkdfjh-jcyj-202301,cyyy-xkdfjh-lcyj-202303,cyyy-xkdfjh-cgzh-202302。
文摘Accurate and sensitive near-infrared(NIR)luminescent lateralflow immunoassay(LFIA)has attracted considerable attention in thefield of point-of-care testing(POCT).However,the detection accuracy and sensitivity are often compromised by the lowfluorescence quantum efficiency of the NIRfluorescent probe.(<10%)Herein,ultrabright NIR AIEgen nanoparticles(PS@AIE830NPs)composed of polystyrene(PS)nanoparticles and NIR aggregation-induced emission luminogen(AIEgen)with the maximum emission at 830 nm(AIE830)is reported,and its poten-tial to promote an accurate and sensitive detection of complex samples by LFIA is described.The relative quantum yield(QY)of the PS@AIE830NPs was 14.76%,which was superior to that of the polymer embedding method and indocyanine green(ICG)-based NIR nanoparticles.The PS@AIE830NPs immunolabeled-LFIA com-bined with laboratory-built NIR-LFIA portable quantitative instruments(detected light range 800 nm)completely eliminated background interference and allowed>highly accurate and sensitive detection without any pre-treatment steps.The limits of detection(LODs)for aflatoxin B1(AFB1)in soy sauce,alpha hemolysin(Hla)of Staphylococcus aureus biomarker in jointfluid,and C-reactive protein(CRP)in human haemolysed samples were 0.01 ng mL^(-1),0.02µg mL^(-1),and 0.156 mg L^(-1),respectively,commensurating with those of the corresponding gold standard assays and covering the detection range of interests.It is anticipated that the ultrabright NIR AIEgen nanoparticles will serve as a universally applicable signal probe for NIR-LFIA diagnostics,promising to expand the range of applications for quantitative detection of complex samples.
基金Ministry of science and technology of China(2017ZX10202202)CAMS Innovation Fund for Medical Sciences(2019-I2M-5-045)National Key R&D Program of China(2022YFC2304500).
文摘Background and Aims:A functional cure,or hepatitis B virus(HBV)surface antigen(HBsAg)loss,is difficult to achieve in patients with hepatitis B virus e antigen(HBeAg)-positive chronic hepatitis B.The HBV vaccine and granulocyte-macrophage colony-stimulating factor(GM-CSF)have been reported to help reduce HBsAg levels and promote HBsAg loss.In this prospective randomized trial,we evaluated HBsAg loss in patients receiving pegylated interferon α2b(PEGIFN-α2b)and tenofovir disoproxil fumarate(TDF),with and without GM-CSF and HBV vaccination.Methods:A total of 287 patients with HBeAg positive chronic hepati-tis B and seroconversion after nucleot(s)ide analog treat-ment were assigned randomly to three treatment groups for 48 weeks,TDF alone(control),PEGIFN-α2b+TDF,and PEGIFN-α2b+TDF+GM-CSF+HBV vaccine.The prima-ry endpoints were the proportions of patients with HBsAg loss and seroconversion at 48 and 72 weeks.Resu/ts:The cumulative HBsAg loss rates in the control,PEGIFN-α2b+TDF,and PEGIFN-α2b+TDF+GM-CSF+HBV vaccine groups at week 48 were 0.0%,28.3%,and 41.1%,respec-tively.The cumulative HBsAg seroconversion rates in these groups at week 48 were 0.0%,21.7%,and 33.9%,respec-tively.Multivariate regression analysis showed that GM-CSF use plus HBV vaccination was significantly associated with HBsAg loss(p=0.017)and seroconversion(p=0.030).Con-clusions:In patients with HBeAg-positive chronic hepatitis B and seroconversion after nucleot(s)ide analog treatment,immunomodulatory/antiviral treatment regimens effective-ly improved HBsAg loss,and the regimen including GM-CSF and HBV vaccination was most effective.
文摘Background The outbreak of coronavirus disease 2019(COVID-19)is now becoming an enormous threat to public health.The clinical spectrum of COVID-19 is extensive,of which critical cases are with rapid disease progression and high mortality.The aim of our study is to summarize the characteristics of different subtypes and explore risk factors of illness severity for early identification and prompt treatment.Methods In this retrospective study,we collected data of patients confirmed COVID-19 in Zhejiang Province from 17 January to 12 February 2020.According to the definition of clinical classification,we divided confirmed cases into four types,and summarize epidemiological and clinical characteristics,laboratory and radiograph findings,treatments,and outcomes,respectively.Moreover,we used univariate and multivariate ordinal logistic regression models to explore risk factors for the severity of illness in patients with COVID-19.Results A total of 788 patients were enrolled in our study,of whom 52 cases(6.6%)were mild type,658 cases(83.5%)were common type,61 cases(7.2%)were severe type,and 17 cases(2.2%)were critical type.Multivariate ordinal logistic regression demonstrated increasing odds of the severity of illness in patients with COVID-19 associated with male(odds ratio[OR]=1.7,95%confidence interval[CI]:1.2–2.6 P=0.008),fever(OR=3.6,95%CI:2.1–6.3,P<0.001),cough(OR=1.7,95%CI:1.0–2.9,P=0.041),hemoptysis(OR=3.4,95%CI:1.1–10.3,P=0.032),gastrointestinal symptoms(OR=1.9,95%CI:1.0–3.5,P=0.047),hypertension(OR=2.6,95%CI:1.2–5.6,P=0.013).With the increase of age-grading,risk for the severity of illness was gradually higher(≤18 years[OR=1.0],19–40 years[OR=12.7,95%CI:4.5–36.0,P<0.001],41–65 years[OR=14.8,95%CI:5.2–42.1,P<0.001],≥66 years[OR=56.5,95%CI:17.1–186.5,P<0.001]).Conclusions Clinicians should pay close attention to these features in patients with COVID-19 including older age,male,fever,cough,hemoptysis,gastrointestinal symptoms and hypertension to identify the severity of illness as early as possible.
