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Administration of methylprednisolone reduced the risk of death (hazard ratio, 0.38; 95% CI, 0.20-0.72; P = .003).
eTable 1. Initial symptoms of patients with COVID-19 pneumonia
eTable 2. The Pneumonia Severity Index (PSI) of patients with COVID-19 pneumonia
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13. iPhone 提醒China’s reserves have fallen for nine of 11 months this year and stand at $3.43tn, as investors sell renminbi assets to protect themselves against depreciation and the central bank sells dollars from its reserves to curb renminbi weakness. Falling interest rates in China and expectations of an imminent rate rise by the US Federal Reserve have also fuelled outflows. Reserves rebounded mildly in October, suggesting outflows had diminished.学校获得的好处似乎显而易见：它们有了优秀的毕业生任教，否则这些学生将会直接进入咨询行业。camp（n 田野，营地），aign名词后缀－营地－备战的地方“如果我们能找到在两个地方都购物的人，那就非常有价值。你知道他们是谁，他们买什么，他们哪些方面花钱，”哈勃补充说。“你可以给他们更加个人化的体验。”"Quality supervision authorities at all levels must intensify quality supervision and keep cracking down on law violations to improve the quality of products and protect consumers' rights," said Mei Kebao, deputy head of the administration.
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Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–943. doi:10.1001/jamainternmed.2020.0994
What clinical characteristics are associated with the development of acute respiratory distress syndrome (ARDS) and progression from ARDS to death among patients with coronavirus disease 2019 (COVID-19) pneumonia?
In this cohort study involving 201 patients with confirmed COVID-19 pneumonia, risk factors associated with the development of ARDS and progression from ARDS to death included older age, neutrophilia, and organ and coagulation dysfunction. Treatment with methylprednisolone may be beneficial for patients who develop ARDS.
Risk for developing ARDS included factors consistent with immune activation; older age was associated with both ARDS development and death, likely owing to less robust immune responses.
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated.
To describe the clinical characteristics and outcomes in patients with COVID-19 pneumonia who developed acute respiratory distress syndrome (ARDS) or died.
Design, Setting, and Participants
Retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital in China between December 25, 2019, and January 26, 2020. The final date of follow-up was February 13, 2020.
Confirmed COVID-19 pneumonia.
Main Outcomes and Measures
The development of ARDS and death. Epidemiological, demographic, clinical, laboratory, management, treatment, and outcome data were also collected and analyzed.
Of 201 patients, the median age was 51 years (interquartile range, 43-60 years), and 128 (63.7%) patients were men. Eighty-four patients (41.8%) developed ARDS, and of those 84 patients, 44 (52.4%) died. In those who developed ARDS, compared with those who did not, more patients presented with dyspnea (50 of 84 [59.5%] patients and 30 of 117 [25.6%] patients, respectively [difference, 33.9%; 95% CI, 19.7%-48.1%]) and had comorbidities such as hypertension (23 of 84 [27.4%] patients and 16 of 117 [13.7%] patients, respectively [difference, 13.7%; 95% CI, 1.3%-26.1%]) and diabetes (16 of 84 [19.0%] patients and 6 of 117 [5.1%] patients, respectively [difference, 13.9%; 95% CI, 3.6%-24.2%]). In bivariate Cox regression analysis, risk factors associated with the development of ARDS and progression from ARDS to death included older age (hazard ratio [HR], 3.26; 95% CI 2.08-5.11; and HR, 6.17; 95% CI, 3.26-11.67, respectively), neutrophilia (HR, 1.14; 95% CI, 1.09-1.19; and HR, 1.08; 95% CI, 1.01-1.17, respectively), and organ and coagulation dysfunction (eg, higher lactate dehydrogenase [HR, 1.61; 95% CI, 1.44-1.79; and HR, 1.30; 95% CI, 1.11-1.52, respectively] and D-dimer [HR, 1.03; 95% CI, 1.01-1.04; and HR, 1.02; 95% CI, 1.01-1.04, respectively]). High fever (≥39 °C) was associated with higher likelihood of ARDS development (HR, 1.77; 95% CI, 1.11-2.84) and lower likelihood of death (HR, 0.41; 95% CI, 0.21-0.82). Among patients with ARDS, treatment with methylprednisolone decreased the risk of death (HR, 0.38; 95% CI, 0.20-0.72).
Conclusions and Relevance
Older age was associated with greater risk of development of ARDS and death likely owing to less rigorous immune response. Although high fever was associated with the development of ARDS, it was also associated with better outcomes among patients with ARDS. Moreover, treatment with methylprednisolone may be beneficial for patients who develop ARDS.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, Hubei Province, China and has subsequently spread to other regions of China and 37 countries, including the United States, Japan, Australia, and France.1 SARS-CoV-2, which belongs to a unique clade of the sarbecovirus subgenus of the Orthocoronavirinae subfamily, was identified as the pathogen of coronavirus disease 2019 (COVID-19) in January 2020.2
As reported by Huang et al,3 patients with COVID-19 present primarily with fever, myalgia or fatigue, and dry cough. Although most patients are thought to have a favorable prognosis, older patients and those with chronic underlying conditions may have worse outcomes. Patients with severe illness may develop dyspnea and hypoxemia within 1 week after onset of the disease, which may quickly progress to acute respiratory distress syndrome (ARDS) or end-organ failure.4 Certain epidemiological features and clinical characteristics of COVID-19 have been previously reported.3-5 However, these studies were based on relatively small sample sizes, and risk factors leading to poor clinical outcomes have not been well delineated. In this study, we report the clinical characteristics and factors associated with developing ARDS after hospital admission and progression from ARDS to death in patients with COVID-19 pneumonia from a single hospital in Wuhan, China.
This is a retrospective cohort study of 201 patients aged 21 to 83 years with confirmed COVID-19 pneumonia hospitalized at Jinyintan Hospital in Wuhan, China. All patients were diagnosed with COVID-19 pneumonia according to World Health Organization interim guidance.6 According to hospital data, patients were admitted from December 25, 2019, to January 26, 2020. Of 201 patients, 10 have been described previously by Chen et al4 and Huang et al.3 The ethics committee of Jinyintan Hospital approved this study and granted a waiver of informed consent from study participants.
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To identify SARS-CoV-2 infection, throat swab samples were obtained from all patients at admission and tested using real-time reverse transcriptase–polymerase chain reaction assays according to the same protocol described previously.3 The pathogenic detection was determined in 4 institutions (Chinese Center for Disease Control and Prevention, Chinese Academy of Medical Sciences, Academy of Military Medical Sciences, and Wuhan Institute of Virology of the Chinese Academy of Sciences) as described previously.4 Other respiratory pathogens, including respiratory syncytial virus, adenovirus, parainfluenza virus, influenza A virus, and influenza B virus, were also detected by real-time reverse transcriptase–polymerase chain reaction assays in 173 patients. Possible bacterial or fungal pathogens were detected by sputum culture. Additionally, patients underwent blood gas, blood routine test, coagulation, and biochemical tests and chest x-rays or computed tomography. The most intense level of oxygen support during hospitalization (nasal cannula, noninvasive mechanical ventilation [NMV], invasive mechanical ventilation [IMV], or IMV with extracorporeal membrane oxygenation [ECMO]) was recorded. The majority of the clinical data used in this study was collected from the first day of hospital admission unless indicated otherwise. To minimize interference of treatment during hospitalization, the highest patient temperature was defined using the self-reported highest temperature prior to hospital admission. Older age was classified as 65 years or older. Fever and high fever were classified as 37.3 °C or higher and 39 °C or higher, respectively.
Two outcomes were evaluated: development of ARDS and death among those with ARDS. World Health Organization interim guidance was used to define ARDS.6
codeIntel welcomes its new employees to the company by rolling out the red carpet -- literally -- once a quarter. During the first day of orientation, hires walk along a pathway lined with Intel Studios' photographers and videographers before introducing themselves onstage and receiving their welcome packages (and a round of applause from an audience of new colleagues).The new numbers, reported by a tracking initiative called the Global Carbon Project and published in the journal Nature Geoscience, came on the eve of a United Nations summit meeting meant to harness fresh political ambition in tackling climate change. Scientists said the figures showed that vastly greater efforts would be needed to get long-term global warming within tolerable limits.n. 非法移民不过，人们并没有对周二的峰会寄予过高期望，因为没有任何迹象表明，各国能在政治上实现突破，进而采取更有力的举措。科学家表示，要想如愿把全球变暖控制在各国五年前一致同意的上限，那么未来几年里，就必须扭转排放量上升的势头。现有的所有方案，与实现这一目标都相距甚远。adv.
Bivariate Cox proportional hazard ratio (HR) models were used to determine HRs and 95% CIs between individual factors on the development of ARDS or progression from ARDS to death. Sample size varied because of missing data (summarized in Tables 1 and 2). Survival curves were developed using the Kaplan-Meier method with log-rank test. Time to events (ARDS or death) were defined as the time from hospital admission to events.
The analyses regarding different factors were based on nonmissing data, and missing data were not imputed. All tests were 2-sided, and a P value less than .05 was considered statistically significant. All analyses were performed with SPSS, version 23.0 (IBM SPSS), or R software, version 3.6.0 (R Foundation for Statistical Computing).
A total of 201 patients were included in this study (Table 1). The median age was 51 years (IQR, 43-60 years), and 128 (63.7%) were male. The most commonly self-reported symptoms at onset of illness were fever (n = 188 [93.5%]), cough (n = 163 [81.1%]), productive cough (n = 83 [41.3%]), dyspnea (n = 80 [39.8%]), and fatigue or myalgia (n = 65 [32.3%]). The majority (n = 154 [76.6%]) of patients had fever with cough; 74 (36.8%) had fever with dyspnea; 66 (32.8%) had fever with fatigue, myalgia, or headache; and only 13 (6.5%) presented with fever alone (eTable 1 in the Supplement). A total of 191 (95.0%) patients had findings of bilateral infiltrates on radiographic imaging, while 10 (5.0%) patients had unilateral infiltrates. Sixty-six (32.8%) patients had comorbidities, including hypertension (n = 39 [19.4%]), diabetes (n = 22 [10.9%]), liver disease (n = 7 [3.5%]), nervous system disease (n = 7 [3.5%]), chronic lung disease (n = 5 [2.5%]), chronic kidney disease (n = 2 [1.0%]), endocrine system diseases not including diabetes (n = 2 [1.0%]), and tumors (n = 1 [0.5%]). Most (n = 173 [86.1%]) patients were tested for 9 additional respiratory pathogens. Bacteria and fungi cultures were collected from 148 (73.6%) patients. Only 1 patient was coinfected with influenza A virus.
Of the 201 patients, 165 (82.1%) required oxygen support in the hospital (Table 1). The most intense level was recorded, including nasal cannula (n = 98 [48.8%]), NMV (n = 61 [30.3%]), IMV (n = 5 [2.5%]), or IMV with ECMO (n = 1 [0.5%]). Among 201 patients, most (n = 196 [97.5%]) received empirical antibiotic treatment and antiviral therapy (n = 170 [84.6%]), including oseltamivir (n = 134 [66.7%]), ganciclovir (n = 81 [40.3%]), lopinavir/ritonavir (n = 30 [14.9%]), and interferon alfa (n = 22 [10.9%]). More than half (n = 106 [52.7%]) of patients received antioxidant therapy, including glutathione and N-acetyl-L-cysteine. Methylprednisolone was given to 62 (30.8%) patients, and immunomodulators, including immunoglobulin, thymosin, and recombinant human granulocyte colony stimulating factor, were given to 70 (34.8%) patients.
Laboratory findings on hospital admission are summarized in Table 2. Of 194 patients, 166 (85.6%) demonstrated increased high-sensitivity C-reactive protein. More than half (126 of 197 [64.0%]) of this cohort had lymphocytopenia. About one-third (68 of 197 [34.5%]) of patients had neutrophilia. Approximately one-quarter (46 of 197 [23.4%]) of patients had leukocytosis. Some patients demonstrated liver injury with elevated aspartate aminotransferase (AST; 59 of 198 [29.8%]) and alanine aminotransferase (ALT; 43 of 198 [21.7%]). Most patients presented with an elevated myocardial indices: 135 of 198 (68.2%) had elevated lactate dehydrogenase (LDH), and 9 of 198 (4.5%) had an elevated creatine kinase muscle-brain isoform. Few patients had kidney injury indicated by elevated plasma urea (9 of 198 [4.5%]) and serum creatinine (9 of 198 [4.5%]). Of 195 patients, 4 (2.1%) presented with prolonged prothrombin times (PTs).
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Table 3 demonstrates that when compared with patients without ARDS, patients with ARDS were older (difference, 12.0 years; 95% CI, 8.0-16.0 years; P < .001) and had higher temperature prior to admission (difference, 0.30 °C; 95% CI, 0.00-0.50 °C; P = .004). More patients with ARDS presented with initial symptoms of dyspnea compared with those without ARDS (difference, 33.9%; 95% CI, 19.7%-48.1%; P < .001). Compared with patients without ARDS, patients with ARDS had a higher proportion of comorbidities, including hypertension (difference, 13.7%; 95% CI, 1.3%-26.1%; P = .02) and diabetes (difference, 13.9%; 95% CI, 3.6%-24.2%; P = .002). In addition, when compared with patients who did not have ARDS, patients who developed ARDS were less likely to be treated with antiviral therapy (difference, −14.4%; 95% CI, −26.0% to −2.9%; P = .005) and more likely to be treated with methylprednisolone (difference, 49.3%; 95% CI, 36.4%-62.1%; P < .001). Of 84 patients with ARDS, 61 (72.6%) received NMV, 17 (20.2%) received nasal cannula, 5 (6.0%) received IMV, and 1 (1.2%) received IMV with ECMO.
Compared with patients without ARDS, for patients with ARDS, the value of liver damage indices (total bilirubin [difference, 1.90 μM; 95% CI, 0.60-3.30 μM; P = .004]), renal dysfunction indices (urea [difference, 1.69 mM; 95% CI, 1.10-2.29 mM; P < .001]), inflammation-related indices (interleukin-6 [IL-6] [difference, 0.93 pg/mL; 95% CI, 0.07-1.98 pg/mL; P = .03]), and coagulation function indices (D-dimer [difference, 0.52 μg/mL; 95% CI, 0.21-0.94 μg/mL; P < .001]) were significantly elevated. However, lymphocyte counts (difference, −0.34 ×109/L; 95% CI, −0.47 to −0.22 ×109/L; P < .001) and CD8 T cells (difference, −66.00 cells/μL; 95% CI, −129.00 to −7.00 cells/μL; P = .03) were significantly decreased.
As summarized in Table 4, older age (≥65 years old), high fever (≥39 °C), comorbidities (eg, hypertension, diabetes), neutrophilia, lymphocytopenia (as well as lower CD3 and CD4 T-cell counts), elevated end-organ related indices (eg, AST, urea, LDH), elevated inflammation-related indices (high-sensitivity C-reactive protein and serum ferritin), and elevated coagulation function–related indicators (PT and D-dimer) were significantly associated with higher risks of the development of ARDS. Patients who received treatment with methylprednisolone appear to have been sicker than patients who did not receive it. Specifically, a higher proportion of patients who received methylprednisolone were classified into a higher grade on the Pneumonia Severity Index7 compared with patients who did not receive methylprednisolone (P = .01; eTable 2 in the Supplement).
In the subgroup of patients who developed ARDS, patients who ultimately died were older (difference, 18.0 years; 95% CI, 13.0-23.0 years; P < .001) and had lower proportion of high fever (difference, −31.8%; 95% CI, −56.5% to −7.1%; P = .007) than those who survived. They also had higher proportions of hypertension (difference, 18.9%; 95% CI, −2.0% to 39.7%; P = .05). The patients who died were less likely to be treated with antiviral therapy (difference, −40.7%; 95% CI, −58.5% to −22.9%; P < .001). Regarding the most intense level of oxygen support among the 44 ARDS patients who died, 38 (86.4%) received NMV, 5 (11.4%) received IMV, and 1 (2.3%) received IMV with ECMO.
For patients with ARDS who died, the value of liver damage indices (total bilirubin [difference, 2.60 μM; 95% CI, 0.30-5.20 μM; P = .03]), renal dysfunction indices (urea [difference, 1.50 mM; 95% CI, 0.50-2.70 mM; P = .004]), inflammation-related indices (IL-6 [difference, 3.88 pg/mL; 95% CI, 2.20-6.13 pg/mL; P < .001]), and coagulation function indices (D-dimer [difference, 2.10 μg/mL; 95% CI, 0.89-5.27 μg/mL; P = .001]) were significantly elevated compared with patients with ARDS who survived. However, lymphocyte counts (difference, −0.23 ×109/L; 95% CI, −0.41 to −0.07 ×109/L; P = .004) and CD8 T cells (difference, −134 cells/μL; 95% CI, −221 to −10 cells/μL; P = .05) were significantly decreased (Table 3).
Bivariate Cox models showed that several factors related to the development of ARDS were not associated with death, which included comorbidities, lymphocyte counts, CD3 and CD4 T-cell counts, AST, prealbumin, creatinine, glucose, low-density lipoprotein, serum ferritin, and PT. However, IL-6 was statistically significantly associated with death (Table 4). Although high fever was associated with higher likelihood of developing ARDS (HR, 1.77; 95% CI, 1.11-2.84), it was negatively associated with death (HR, 0.41; 95% CI, 0.21-0.82).
Finally, among the patients with ARDS, of those who received methylprednisolone treatment, 23 of 50 (46.0%) patients died, while of those who did not receive methylprednisolone treatment, 21 of 34 (61.8%) died. The administration of methylprednisolone appears to have reduced the risk of death in patients with ARDS (HR, 0.38; 95% CI, 0.20-0.72; P = .003) (Figure).
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The risk factors related to the development of ARDS and progression from ARDS to death included older age, neutrophilia, and organ and coagulation dysfunction (eg, higher LDH and D-dimer). In addition, we observed that several factors associated with the development of ARDS were not associated with death (eg, comorbidities, lymphocyte counts, CD3 and CD4 T-cell counts, AST, prealbumin, creatinine, glucose, low-density lipoprotein, serum ferritin, PT). Moreover, the difference in median D-dimer between the death and survival groups was larger than that between the ARDS and non-ARDS groups, which suggests that disseminated intravascular coagulation was on the pathway to death in some patients. Interestingly, although high fever was positively associated with development of ARDS, it was negatively related to death, which is consistent with results noted in a study by Schell-Chaple et al.8 However, the differences in patient temperature between the groups were very small and self-reported before hospital admission, thus the data regarding high fever should be cautiously interpreted.
The pathogenesis of highly pathogenic human coronavirus is still not completely understood. Cytokine storm and viral evasion of cellular immune responses are thought to play important roles in disease severity.9 Neutrophilia was found in both the peripheral blood10 and lung11 of patients with SARS-CoV. The severity of lung damage correlated with extensive pulmonary infiltration of neutrophils and macrophages and higher numbers of these cells in the peripheral blood in patients with Middle East respiratory syndrome.12-14 Neutrophils are the main source of chemokines and cytokines. The generation of cytokine storm can lead to ARDS, which is a leading cause of death in patients with severe acute respiratory syndrome 15 and Middle East respiratory syndrome.14 In this study, patients with COVID-19 pneumonia who had developed ARDS had significantly higher neutrophil counts than did those without ARDS, perhaps leading to the activation of neutrophils to execute an immune response against the virus, but also contributing to cytokine storm. This may partly explain the positive association of high fever and ARDS found at the early stages of COVID-19. In addition, considering that older age is associated with declined immune competence,16 the results of the present study showed that older age was associated with both ARDS and death. Therefore, older age related to death may be due to less robust immune responses.
The results of this study show that higher CD3 and CD4 T-cell counts might protect patients from developing ARDS, but similar results were not observed when examined for death, possibly because of limited sample size. CD8 counts were significantly higher in those who were alive. These results indicate the important roles of CD4 and CD8 T cells in COVID-19 pneumonia. Earlier studies have revealed that SARS-CoV, which was reported to share the same cell entry receptors with SARS-CoV-2,17,18 could infect immune cells, including T lymphocytes, monocytes, and macrophages.19 The CD3, CD4, and CD8 T-cell counts decreased at the onset of illness; this decrease persisted until the recovery period of SARS-CoV pneumonia.19 In addition, CD4 and CD8 T-cell counts decreased in the peripheral blood specimen of patients with fatal SARS-CoV pneumonia10,20,21, which was consistent with these results that patients with COVID-19 pneumonia and ARDS presented with lymphocytopenia (CD3, CD4, and CD8 T cells). Studies demonstrated that T-cell responses can inhibit the overactivation of innate immunity.22 T cells were reported to help clear SARS-CoV, and a suboptimal T-cell response was found to cause pathological changes observed in mice with SARS-CoV.23 We hypothesized that persistent and gradual increases in lymphocyte responses might be required for effective immunity against SARS-CoV-2 infection. Further studies are needed to characterize the role of the neutrophil and lymphocyte response or that of CD4 and CD8 T-cell immune response in SARS-CoV-2 infection.
Lawrence Yun, the trade group's chief economist, expects the average 30-year fixed-rate mortgage to hit 5.5% at year-end, up from 4.5% late last year and 3.5% in the first half of 2013. That's a sharp runup in a short period of time, one that could harm affordability and spook even more buyers.ceremony时间：2010-02-24 编辑：vicki萨默塞特?毛姆（Somerset Maugham）曾形容法国里维埃拉（French Rivier）为“阴暗人物的阳光之地”。环视着酒店大堂里的“模特”，带着黑超的男人们似乎与他们相识，我似乎理解了毛姆。戛纳华丽的外表下有着其并不光彩的一面，就如湛蓝的海水下垃圾成堆。电影节开幕前，法国潜水员，同时也是环保人士的Laurent Lombard(劳伦?隆巴德)拍摄的戛纳河床沉积着大量垃圾废物的视频被疯传。我们被告知在此游泳并无危险。据《每日邮报》报道，市长已下令清理。但是小镇确实不再那么闪耀迷人了。In this Jan. 7, 1997, file photo, Steve Jobs, chief executive of Pixar, speaks at the MacWorld trade show in San Francisco.“我……学会了与来自其他文化及社会的人们进行互动，”一位来自瑞典的毕业生说。学会控制自己的情绪，控制自己的想法，克服对被拒绝的恐惧，学会向别人敞开心扉。Successful entrepreneurs often worked for others in their field of choice before striking out on their own. Spending a few years in the industry under an excellent mentor will provide a good launching pad. Learn from your predecessors’ mistakes and brainstorm about how to improve upon their model. Find someone willing to teach, and think about starting your business elsewhere when you leave.Over 90 percent of them attended schools in English-speaking countries, such as the US, the UK and Australia, and over 70 percent pursue at least a bachelor's degree, according to the MOE.“…called the interviewer by the wrong name.”
“We are currently investigating how this could have happened, and deeply regret that this occurred,” PwC said. “We appreciate the grace with which the nominees, the Academy, ABC, and Jimmy Kimmel handled the situation.”But the struggle for white identity is not just a political problem; it is about the “deep story” of feeling stuck while others move forward.Mr Draghi hit back the day after the December vote, saying that there was no “limit” to what eurozone policymakers could do to return inflation to its target.It’s no surprise that credit is “pro-cyclical.” When asset prices are booming, optimistic lenders tend to make more loans and often feed the euphoria. When markets sink, lenders rein in risk and sometimes make the downturn worse.‘Faultless performance, you are stunning and you could win this competition,’ Amanda said.节目35 歌曲《美丽中国》，沙宝亮 徐千雅Like any college kid, Evan Wray loved using the tiny pictograms known as emoji. But he hated that there was no emoji to express his Fighting Irish pride with fellow University of Notre Dame students. So, alongside co-founder Sean O’Brien, he built a modest business on that disconnect. TextPride, as it was called, licensed images from brands in the sports and entertainment world and sold them as sticker packs. Within a messaging app like Kik, users could buy a packet of stickers for Disney’s Frozen for $1.99, for example.“人们已习惯于这样的套路：美联储称要进行紧缩，结果当市场波动或其他风险浮出水面时，政策制定者便收回紧缩言论，呈现出‘如有疑问，按兵不动’的规律，”克普克说。Summly attempts to solve this problem by creating “snapshots” of stories that allow readers to browse more quickly than reading full articles. The app will close down but Mr D’Aloisio’s technology will be integrated into Yahoo’s mobile apps.While Switzerland’s University of St Gallen retains the top spot, French and British business schools, with 24 and 18 programmes respectively, are the backbone of the 2017 FT ranking of 95 programmes around the world. More than half of UK schools move up the ranking, compared with one in France. A third of British schools rise five places, in contrast to the two-thirds of French schools that drop five or more places.As inevitably happens with all things trade in this White House a vigorous debate has erupted over the future of Korus, as the pact is known in Washington. Among the biggest opponents within the administration are the Trump security team, which thinks breaking commercial ties with an important ally in the middle of a geopolitical crisis is probably not a great idea. US business doesn’t like the idea either. Both are likely to mean at least some short-term delays in Washington carrying out any threats. But then again the politics are also volatile in Seoul. Might the new government there exercise its own right to pull out?
Published Online: March 13, 2020. doi:家具卖场扩张过快 数量远超市场消费容量
Correction: This article was corrected on May 11, 2020, to fix data errors and correct units of measure used in the Results section and Tables 2, 3, and 4.
Accepted for Publication: March 3, 2020.
Corresponding Authors: Yuanlin Song, MD, Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China (firstname.lastname@example.org); Junhua Zheng, MD, Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Rd, Shanghai 200080, China (email@example.com).
Author Contributions: Drs Song and Zheng had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Wu, X. Chen, Cai, and Xia contributed equally and share first authorship. Drs Song and Zheng contributed equally to the study.
Study concept and design: Wu, X. Chen, Cai, Xia, Zheng, Y. Song.
Acquisition, analysis, or interpretation of data: X. Chen, Xing Zhou, S. Xu, Huang, L. Zhang, Xia Zhou, Du, Y. Zhang, J. Song, Wang, Chao, Yang, J. Xu, Xin Zhou, D. Chen, Xiong, L. Xu, F. Zhou, Jiang, Bai.
Drafting of the manuscript: X. Chen, Xia, Xing Zhou, S. Xu, Huang, L. Zhang, Xia Zhou, Du, Y. Zhang, J. Song, Wang, Chao, Yang, J. Xu, Xin Zhou, D. Chen, Xiong, L. Xu, F. Zhou, Jiang, Bai.
Critical revision of the manuscript for important intellectual content: Wu, X. Chen, Cai, Xia, Du, Zheng, Y. Song.
Statistical analysis: X. Chen, Y. Song.
Obtained funding: Wu, Zheng, Y. Song.
Administrative, technical, or material support: Cai, Xia, Xing Zhou, S. Xu, Huang, L. Zhang, Xia Zhou, Yang, J. Xu, Xin Zhou, D. Chen, Xiong, L. Xu, F. Zhou, Jiang, Bai, Zheng, Y. Song.
Study supervision: Zheng, Y. Song.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported by a grant from Prevention and Treatment of Infection in Novel Coronavirus Pneumonia Patients from the Shanghai Science and Technology Committee (to Dr Yuanlin Song), the Special Fund of Shanghai Jiaotong University for Coronavirus Disease 2019 Control and Prevention (2020RK47 to Dr Junhua Zheng), and Academic Leader of Shanghai Qingpu District Healthcare Commission (WD2019-36 to Dr Chaomin Wu).
Role of the Funder/Sponsor The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Weibing Wang, PhD, from the Department of Epidemiology, School of Public Health, Fudan University; Yan Liu, MD, and Hongcai Shang, PhD, from Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine; Xiaojia Huang, PhD, from the Institute of Biomedical Engineering and Health Sciences, Changzhou University; and Yaohui Li, MD, from Zhongshan Hospital, Fudan University for their statistical analysis discussion. We also thank Dongni Hou, MD, Sucheng Mu, MD, Donghui Zhang, MD, and Ke Lang, BD, from Zhongshan Hospital, Fudan University for their data collection. They were not compensated for their contributions.