Background In the recent outbreak of novel coronavirus infection in Wuhan, China, significantly abnormal coagulation parameters in severe novel coronavirus pneumonia (NCP) cases were a concern. Objectives To describe the coagulation feature of patients with NCP. Methods Conventional coagulation results and outcomes of 183 consecutive patients with confirmed NCP in Tongji hospital were retrospectively analyzed. Results The overall mortality was 11.5%, the non‐survivors revealed significantly higher D‐dimer and fibrin degradation product (FDP) levels, longer prothrombin time and activated partial thromboplastin time compared to survivors on admission (P < .05); 71.4% of non‐survivors and 0.6% survivors met the criteria of disseminated intravascular coagulation during their hospital stay. Conclusions The present study shows that abnormal coagulation results, especially markedly elevated D‐dimer and FDP are common in deaths with NCP.

Background:A relatively high mortality of severe coronavirus disease 2019 is worrying, and the application of heparin in COVID-19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated. Methods:Coagulation results, medications, and outcomes of consecutive patients being classified as having severe COVID-19 in Tongji hospital were retrospectively analyzed. The 28-day mortality between heparin users and nonusers were compared, as was a different risk of coagulopathy, which was stratified by the sepsis-induced coagulopathy (SIC) score or D-dimer result.Results: There were 449 patients with severe COVID-19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin) for 7 days or longer. D-dimer, prothrombin time, and age were positively, and platelet count was negatively, correlated with 28-day mortality in multivariate analysis. No difference in 28-day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P = .910). But the 28-day mortality of heparin users was lower than nonusers in patients with SIC score ≥4 (40.0% vs 64.2%, P = .029), or D-dimer >6-fold of upper limit of normal (32.8% vs 52.4%, P = .017). Conclusions:Anticoagulant therapy mainly with low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer. K E Y W O R D Scoagulopathy, coronavirus disease 2019, D-dimer, low molecular weight heparin, sepsis

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MERGENCY DEPARTMENTS (EDS) are unique portals for health care in the United States because services are provided to all persons regardless of insurance or ability to pay. 1 As such, the Institute of Medicine has labeled EDs as "the Safety Net of the Safety Net . . . the provider of last resort for millions of patients who are uninsured or lack adequate access to care from community providers." 2 Among all EDs, the Centers for Disease Control and Prevention (CDC) further identified a subset as safety-net EDs because these EDs provide a disproportionate share of services to Medicaid and uninsured persons. Specifically, safety-net EDs are facilities that provide more than 30% of total ED visits to persons with Medicaid, more than 30% of total ED visits to uninsured individuals, or a combined Medicaid and uninsured patient population greater than 40%. 3 Since the 1990s, visits to US EDs have steadily increased and the total number of EDs has declined. 4,5 Meanwhile, the number of uninsured persons has increased from 38.8 million in 1999 to 46.3 million in 2008 and Medicaid enrollment has increased from 28.5 million in 1999 to 42.6 million in 2008. 6 Previous research shows that privately insured persons accounted for most of the increase in ED visits be-tween 1996 and 2001. 7 However, recent studies suggest an increasing number of uninsured and underinsured persons contributing to ED visits. [8][9][10] Patients who cannot obtain timely access to primary care often make frequent ED visits and often present with more severe illness and complications. 11,12 This study examines changes in ED visit rates in the United States between 1997 and 2007, detailing differences between sociodemographic sub-groups. To evaluate the hypothesis that EDs are serving in a safety-net role for an increasing segment of the US population, we specifically examined trends in ED visit rates according to insur-See also p 679.

Severe coronavirus disease 2019 is commonly complicated with coagulopathy, the difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2 has not been analyzed. Coagulation results and clinical features of consecutive patients with severe pneumonia induced by SARS-CoV2 (COVID group) and non-SARS-CoV2 (non-COVID group) in Tongji hospital were retrospectively analyzed and compared. Whether patients with elevated D-dimer could benefit from anticoagulant treatment was evaluated. There were 449 COVID patients and 104 non-COVID patients enrolled into the study. The 28-day mortality in COVID group was approximately twofold of mortality in non-COVID group (29.8% vs. 15.4%, P = 0.003), COVID group were older (65.1 ± 12.0 vs. 58.4 ± 18.0, years, P < 0.001) and with higher platelet count (215 ± 100 vs. 188 ± 98, ×10 9 /L, P = 0.015), comparing to non-COVID group. The 28-day mortality of heparin users were lower than nonusers In COVID group with D-dimer > 3.0 μg/mL (32.8% vs. 52.4%, P = 0.017). Patients with severe pneumonia induced by SARS-CoV2 had higher platelet count than those induced by non-SARS-CoV2, and only the former with markedly elevated D-dimer may benefit from anticoagulant treatment.

The overall history and recent advancements in Surface-Enhanced Laser Desorption/Ionization (SELDI) affinity technology is reviewed. A detailed account of SELDI technology, utilizing Immobilized-Metal Affinity surfaces, pseudo-specific chromatographic surfaces, and biospecific interactive surfaces, is presented with particular emphasis placed upon examination of fundamental characteristics as well as specific applications for each. Finally, a detailed review of the specific use of such affinity surfaces in fundamental aspects of clinical, process, and research proteomics activity is presented.

The outbreak of novel coronavirus disease 2019 (COVID-19) has now become a global pandemic. Coagulopathy has been reported widely in critically ill COVID-19 patients and was related to high mortality. However, the comprehensive coagulation profiles have not been examined and the underlying mechanism of the coagulopathy in COVID-19 patients is unclear. To study the coagulation profiles of routine hemostasis tests, natural anticoagulants, coagulant factors and antiphospholipid antibodies in critically ill COVID-19 patients. This single-center and cross-section study included 19 patients with COVID-19, who were admitted to intensive care unit (ICU) at Tongji hospital in Wuhan, China, from Feb 23 to Mar 3, 2020. Demographic data, laboratory parameters, treatments and clinical outcomes of the patients were collected and analyzed. The final date of follow-up was Mar 31, 2020. In this study, 12 thrombotic events occurred in 9 patients, including 4 cerebral infarctions, 7 acro-ischemia and 1 internal jugular vein thrombosis. The common abnormalities of routine coagulation tests included evelated D-Dimer level (100%), prolonged prothrombin time (73.7%) and hyperfibrinogenemia (73.7%). The median activities of natural anticoagulants including protein C, protein S and antithrombin were all below the normal range. Factor VIII activities were significantly above normal range (median value 307%, IQR 198-441) in all patients. Factor V and factor VII activities were significantly lower in near-terminal stage patients. Anti-phospholipid antibodies were present in 10 patients. Strikingly, 4 cerebral infarction events were in patients had anti-phospholipid antibodies of multiple isotypes. Sustained hypercoagulable status and thrombotic events were common in critically ill patients with COVID-19. The low activities of natural anticoagulants, elevated factor VIII level and the presence of antiphospholipid antibodies, together, may contribute to the etiopathology of coagulopathy in COVID-19 patients.

High-water-content hydrogels that are both mechanically robust and conductive could have wide applications in fields ranging from bioengineering and electronic devices to medicine; however, creating such materials has proven to be extremely challenging. This study presents a scalable methodology to prepare superelastic, cellular-structured nanofibrous hydrogels (NFHs) by combining alginate and flexible SiO nanofibers. This approach causes naturally abundant and sustainable alginate to assemble into 3D elastic bulk NFHs with tunable water content and desirable shapes on a large scale. The resultant NFHs exhibit the integrated properties of ultrahigh water content (99.8 wt%), complete recovery from 80% strain, zero Poisson's ratio, shape-memory behavior, injectability, and elastic-responsive conductivity, which can detect dynamic pressure in a wide range (>50 Pa) with robust sensitivity (0.24 kPa ) and durability (100 cycles). The fabrication of such fascinating materials may provide new insights into the design and development of multifunctional hydrogels for various applications.