The International Society on Thrombosis and Hemostasis (ISTH) recently released the first ISTH guideline for antithrombotic treatment of COVID-19, which provides recommendations on anticoagulant and antiplatelet agents for patients with COVID-19 in different clinical settings. The target audience includes clinicians in internal medicine, intensive care, infectious diseases, hematology, vascular medicine, residents, family physicians, and other health care providers providing inpatient or outpatient care to COVID-19 patients. This article interprets the important parts of ISTH guideline.
Since the first case of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019, the virus has spread rapidly around the world and has become a global public health problem. In the process of this virus epidemic, compared with the general population, cancer patients are considered to be highly susceptible people, especially the lung cancer patients. Some studies have shown that angiotensin converting enzyme 2 (ACE2) may be the pathway for SARS-CoV-2 to infect the host. At the same time, ACE2 is often abnormally expressed in non-small cell lung cancer. Therefore, understanding the respective mechanisms of ACE2 in COVID-19 and non-small cell lung cancer has extremely important reference value for the study of vaccines and therapeutic drugs, and also provides meaningful guidance for the protection of patients with lung cancer during the epidemic. This article reviews the possible invasive mechanism of ACE2 in SARS-CoV-2 and its abnormal expression in non-small cell lung cancer.
ObjectiveTo investigate whether novel coronavirus pneumonia (COVID-19) patients complicated with digestive tract symptoms and its influence on digestive system related biochemical indexes.MethodsSixteen novel coronavirus pneumonia patients in our hospital were observed, and their epidemiological data, clinical manifestations and clinical laboratory indicators were analyzed statistically.ResultsThe age of the patients ranged from 5 to 75 years old, and the median age was 46.0 years old. Most of them were male (9 cases, 56.25%), the occurrence of COVID-19 appeared in family aggregation (12 cases, 75.00%). Sixt patients (37.50%) were complicated with basic diseases. The initial symptom involving digestive system accounting for 18.75% (3 cases) of all participants. The main manifestation of a diarrhea in 2 (12.5%) and melena in 1 (6.25%) patients, respectively. Five patients (31.25%) had symptoms of digestive system during the course of the disease, the main symptoms were diarrhea in 3 (18.75%), melena in 1 (6.25%) and loss of appetitein in 5 (31.25%) patients, respectively. The SARS-Cov-2 nucleic acid in the feces of the patients were negative in all patients. In 50.00% of the patients, the SARS-Cov-2 nucleic acid in the feces were negative, but the throat swab/sputum nucleic acid were still positive at the same time or later. Two patients (12.50%) had elevated ALT and 1 patient (6.25%) had elevated AST at the time of admission.ConclusionsPatients with COVID-19 will show symptoms of digestive tract.
The severe situation of the spread of novel coronavirus pneumonia (COVID-19) poses a huge challenge to the admission and management of patients undergoing selective thoracic surgery. In order to ensure that patients can receive surgical treatment in time, and we can effectively prevent the outbreak and spread of the disease in the surgical department, the department should comb the relevant content from multiple aspects in accordance with the specific situation. It is necessary to adopt a new admission process of patients undergoing selective surgery and COVID-19 investigation process for patients and their families during the epidemics. We should improve the companion and suspected patient management system during the epidemic. Patients who are planning to undergo surgery need to be strictly checked for COVID-19 infection before surgery. The treatment and management strategies of patients undergoing thoracic surgery in our department are summarized in this paper.
Evidence-based research in traditional Chinese medicine (TCM) has made many important achievements and promoted the modernization and internationalization of TCM. The ability to produce research evidence to guide clinical practice in an emergency treatment situation is a major test of the development of evidence-based Chinese medicine (EBCM) when emerging infectious diseases outbreaks. Along with the development of EBCM, TCM has experienced emerging infectious disease events such as atypical pneumonia (SARS), influenza A (HIN1), and corona virus disease 2019 (COVID-19), and the ability of TCM to conduct clinical research in emergency treatment work has been continuously improved. This article provides an overview of the clinical research conducted in TCM to resist emerging infectious diseases in the past, focusing on the clinical research results obtained in the present time of COVID-19 rescue and treatment, and discusses the role of EBCM development to enhance the clinical research capacity of TCM in emerging infectious diseases.
Objective To evaluate the perioperative safety of lung surgery for patients with corona virus disease 2019 (COVID-19). Methods We retrospectively analyzed the clinical data of the patients recovered from COVID-19 infection and received lung surgery from December 2022 to February 2023 in the Department of Thoracic Surgery at Beijing Hospital. Patients who received lung surgery and without COVID-19 at the same time were selected as a control group. Perioperative data between the two groups were compared. Results A total of 103 patients were included with 44 males and 49 females at an average age of (62.2±12.1) years. All surgeries were performed by uniportal video-assisted thoracoscopic surgery (VATS). Among patients who recovered from COVID-19, 53 (51.5%) received lobectomy, 30 (29.1%) received segmentectomy, and 20 (19.4%) received wedge resection. The interval between diagnosis of infection and lung surgery was ≤1 month in 32 (31.1%) patients, and >1 month in 71 (68.9%) patients. The results of virus nucleic acid test for all patients before surgery were negative. A total of 13 (12.6%) patients had positive IgM, and 100 (97.1%) patients had positive IgG. A total of 20 patients experienced perioperative complications (13 patients with pulmonary air leakage, 3 patients with chylothorax, 2 patients with atrial fibrillation, and 2 patients with severe pulmonary complications). There was one perioperative death. Comparing the patients who recovered from COVID-19 with those without COVID-19, we found no statistical difference in perioperative outcomes including surgical duration, postoperative drainage, duration of thoracic tube, and duration of postoperative stay (P>0.05). There was no significant difference in perioperative complications between the two groups (P>0.05). Multivariable logistical regression analysis demonstrated that positive IgM before surgery (OR=7.319, 95%CI 1.669 to 32.103, P=0.008), and longer duration of surgery (OR=1.016, 95%CI 1.003 to 1.028, P=0.013) were independent risk factors of perioperative complications for patients who recovered from COVID-19. Conclusion It is safe for patients recover from COVID-19 to receive lung surgery when symptoms disappear and the nucleic acid test turn negative. However, positive COVID-19 IgM is an independent risk factor for perioperative complications. We suggest that lung surgery could be performed when the nucleic acid test and COVID-19 IgM are both negative for patients recover from COVID-19 infection.
ObjectiveTo explore the functional heterogeneity of T lymphocytes in various organs after SARS-CoV-2 infection. Methods Using the public database GEO data (GSE171668, GSE159812, GSE159556, GSE167747) and the analysis method of single-cell technology, the functional differences of T lymphocytes in various organs of patients after infection with SARS-CoV-2 were analyzed. Results Through single-cell data extraction of 16 livers, 19 hearts,2 spleens, 6 brains, 58 lungs, 21 kidneys and 5 pancreases from SARS-CoV-2 infected patients, invasion genes were relatively highly expressed in T lymphocytes of the lung and pancreas. The lung had a special ability to express the interferon signaling pathway, while the expression of other organs was relatively low; at the same time, the T lymphocytes of the lung also highly expressed fatty acid binding sites. Conclusion After SARS-CoV-2 infection, compared with other organs, the lung has a special interferon-activated signaling pathway and fatty acid binding site.
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic at the end of December 2019, more than 85% of the population in China has been infected. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly affects the respiratory system, especially the lungs. The mortality rate of patients with severe infection is high. A percentage of 6% to 10% of patients will eventually develop into COVID-related acute respiratory distress syndrome (CARDS), which requires mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support. Some patients who survive acute lung injury will subsequently develop post COVID-19 pulmonary fibrosis (PCPF). Both fully treated CARDS and severe PCPF are suitable candidates for lung transplantation. Due to the special course, evaluation strategies are different from those used in patients with common end-stage lung disease. After lung transplantation in COVID-19 patients, special treatment is required, including standardized nucleic acid testing for the novel coronavirus, adjustment strategy of immunosuppressive drugs, and rational use of antiviral drugs, which is a big challenge for the postoperative management of lung transplantation. This consensus was evidence-based written and was reached by experts after multiple rounds of discussions, providing reference for assessment and postoperative management of patients with interstitial pneumonia after COVID-19 infection.
At present, there has been no report in China that novel coronavirus specific immune globulin has been used to treat coronavirus disease 2019 (COVID-19). Recently, we had successfully treated one COVID-19 patient with intravenous injection of human immunoglobulin (COVID-19-IVIG). The female patient, aged 57 years, had clinical diagnosis: (1) COVID-19, common type; (2) postoperative colon cancer; (3) leukopenia; (4) low cellular immunity. 75 mL COVID-19 human immunoglobulin (Sinoptic Wuhan Blood Products Co., Ltd.) was intravenously injected twice. The patient was hospitalized for 49 days and had a good prognosis.
The Rapid Advice Guidelines (RAGs), prepared in the form of evidence-based guidelines for responding to public health emergencies in a short period, are characterized by their capability to significantly reduce the time for the development of guidelines to the maximum extent while ensuring quality. Therefore, the RAGs are primarily used to guide and respond to public health emergencies. This article will introduce the definition, characteristics, current situation, applicable situation, development methods, advantages and limitations of the RAGs. Our study proposes several suggestions for RAGs developers and researchers to improve development of RAGs in China.