Since the emergence of novel coronavirus pneumonia in late 2019, it has quickly spread to many countries and regions around the world, causing a significant impact on human beings and society, posing a great threat to the global public health system. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was highly infectious, and some complications emerged rapidly in some patients, including acute respiratory distress syndrome, and multiple organ failure. The virus could trigger a series of immune responses, which might lead to excessive immune activation, thereby bringing about the immune system imbalance of the body. Up to now, there was no specific antiviral drug, and we conjectured that immunomodulatory therapy might play an essential part in the treatment of coronavirus disease 2019 (COVID-19) as adjuvant therapy. Therefore, we analyzed the possible mechanism of immune imbalance caused by the new coronavirus, and summarized the immunotherapeutic means of COVID-19 based on the mechanisms, to provide some reference for follow-up research and clinical prevention and treatment of COVID-19.
From December 2022 to January 2023, 4 lung transplant recipients (3 males and 1 female, aged 52-60 years, all received transplantation less than 1 year) were hospitalized in the Department of Thoracic Surgery of the First Affiliated Hospital of Xi'an Jiaotong University due to COVID-19 after surgery. The clinical manifestations were mostly characterized by elevated body temperature accompanied by shortness of breath, and indicators such as heart rate, oxygen saturation, and oxygenation index could reflect the severity of the condition. The therapy was timely adjusted to immunosuppressive drugs, upgraded oxygen therapy, anti-bacterial and anti-fungal therapy, prone ventilation, general treatment, and anticoagulant therapy, depending on the situation. Finally, 3 patients were cured and discharged from hospital, and 1 died.
Patients with coronavirus disease 2019 may have systemic symptoms of varying degrees. These symptoms are related to inflammatory response, massive release of pro-inflammatory cytokines and cytokine storm. In recent years, programmed necrosis, as a controllable type of necrosis, is considered to be an important factor that mediates inflammation. Recent studies have shown that programmed necrosis is involved in the inflammatory response and pulmonary fibrosis of coronavirus disease 2019. This article mainly reviews the mechanism of programmed necrosis, its participation in the occurrence and development of coronavirus disease 2019, and the research progress of programmed necrosis inhibitors in the treatment of coronavirus disease 2019, aiming to provide a certain basis for the diagnosis and treatment of coronavirus disease 2019.
Coronavirus disease 2019 (COVID-19) has spread rapidly around the world. In order to diagnose COVID-19 more quickly, in this paper, a depthwise separable DenseNet was proposed. The paper constructed a deep learning model with 2 905 chest X-ray images as experimental dataset. In order to enhance the contrast, the contrast limited adaptive histogram equalization (CLAHE) algorithm was used to preprocess the X-ray image before network training, then the images were put into the training network and the parameters of the network were adjusted to the optimal. Meanwhile, Leaky ReLU was selected as the activation function. VGG16, ResNet18, ResNet34, DenseNet121 and SDenseNet models were used to compare with the model proposed in this paper. Compared with ResNet34, the proposed classification model of pneumonia had improved 2.0%, 2.3% and 1.5% in accuracy, sensitivity and specificity respectively. Compared with the SDenseNet network without depthwise separable convolution, number of parameters of the proposed model was reduced by 43.9%, but the classification effect did not decrease. It can be found that the proposed DWSDenseNet has a good classification effect on the COVID-19 chest X-ray images dataset. Under the condition of ensuring the accuracy as much as possible, the depthwise separable convolution can effectively reduce number of parameters of the model.
Objective To conduct a scoping review on the clinical research evidence for the treatment of coronavirus disease 2019 (COVID-19) with traditional Chinese medicine, identify relevant problems in the literature, and provide ideas for the follow-up research. Methods PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Digital Journal Full-text Database, and China Biomedical Literature Database were searched from inception to July 21st, 2022. The clinical research evidence for the treatment of COVID-19 with traditional Chinese medicine was included, the data information was sorted out, and the results were descriptively analyzed. Results A total of 132 studies were included, including 53 randomized controlled trials, 17 non-randomized controlled trials, and 62 retrospective cohort studies, all of which were published between 2020 and 2022. The clinical studies were carried out in 19 provincial level regions, among which Hubei province had the largest number of studies (49.2%, 65/132). The sample sizes of the studies were mostly between 50 and 100 cases (43.2%, 57/132). Most of the studies had a treatment course of 0-14 days (50.0%, 66/132). The most compared intervention measures were traditional Chinese medicine + conventional western medicine treatment vs. conventional western medicine treatment, accounting for 75.0% (99/132) of the studies. The COVID-19 patients included in the studies were mainly mild and moderate. Outcome indicators included changes in symptoms/signs, laboratory indicators, CT indicators, clinical outcomes, safety indicators, functional scales, etc. The main adverse reactions/events in intervention/exposure groups were gastrointestinal reactions. Conclusions There has been a lot of clinical research evidence on the treatment of COVID-19 by traditional Chinese medicine. To provide strong evidence support for the treatment of COVID-19 by traditional Chinese medicine, more clinical trials with large samples and international collaboration are needed in the future.
When a clustered coronavirus disease 2019 epidemic occurs, how to prevent and control hospital infection is a challenge faced by each medical institution. Under the normalization situation, building an effective prevention and control system is the premise and foundation for medical institutions to effectively prevent and control infection when dealing with clustered epidemics. According to the principles of control theory, medical institutions should quickly switch to an emergency state, and effectively deal with the external and internal infection risks brought by clustered epidemics by strengthening source control measures, engineering control measures, management control measures and personal protection measures. This article summarizes the experience of handling clustered outbreaks in medical institutions in the prevention and control of coronavirus disease 2019, and aims to provide a reference for medical institutions to take effective prevention and control measures when dealing with clustered outbreaks.
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
ObjectiveTo provide recommendations for the management of intensive care unit patients without novel coronavirus disease 2019 (COVID-19).MethodsWe set up a focus group urgently and identified five key clinical issues through discussion. Total 23 databases or websites including PubMed, National Guideline Clearing-House, Chinese Center for Disease Control and Prevention and so on were searched from construction of the library until February 28, 2020. After group discussion and collecting information, we used GRADE system to classify the evidence and give recommendations. Then we apply the recommendations to manage pediatric intensive care unit in the department of critical care medicine in our hospital. ResultsWe searched 13 321 articles and finally identified 21 liteteratures. We discussed twice, and five recommendations were proposed: (1) Patients should wear medical surgical masks; (2) Family members are not allowed to visit the ward and video visitation are used; (3) It doesn’t need to increase the frequency of environmental disinfection; (4) We should provide proper health education about the disease to non-medical staff (workers, cleaners); (5) Medical staff do not need wear protective clothing. We used these recommendations in intensive care unit management for 35 days and there was no novel coronavirus infection in patients, medical staff or non-medical staff. ConclusionThe use of evidence-based medicine for emergency recommendation is helpful for the scientific and efficient management of wards, and is also suitable for the management of general intensive care units in emergent public health events.
ObjectiveTo explore the postoperative characteristics and management experience of patients with coronavirus disease 2019 (COVID-19) undergoing cardiac and vascular surgery. MethodsFrom December 7, 2022 to January 5, 2023, the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected. The clinical history, surgical information, postoperative recovery process and treatment plan were analyzed retrospectively. ResultsThere were 18 patients in this group, including 11 (61.1%) males and 7 (38.9%) females, with an average age of 58.1±10.9 years. There were 7 patients of hypertension, 5 patients of diabetes, 3 patients of respiratory diseases, and 2 patient of chronic renal insufficiency. There were 5 (27.8%) patients receiving emergency operations and 13 (72.2%) elective operations. All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19, and the time between the last positive nucleic acid test and the surgery was 1.50 (1.00, 6.25) days. There were 8 patients of pulmonary imaging changes, including 3 patients with chest patch shadow, 3 patients with thickened and disordered lung markings, and 2 patients with exudative changes before operation. Antiviral therapy was not adopted in all patients before operation. Three patients were complicated with viral pneumonia after operation, including 2 patients with high risk factors before operation, who developed into severe pneumonia after operation, and underwent tracheotomy. One patient with thrombus recovered after anticoagulation treatment. Another patient of mild pneumonia recovered after antiviral treatment. The other 15 patients recovered well without major complications. There was no operation-related death in the whole group. One patient died after surgery, with a mortality rate of 5.6%. Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery, and patients with high-risk factors may rapidly progress to severe pneumonia. Patients with preoperative lung imaging changes or other basic visceral diseases should consider delaying the operation. Early antiviral combined with immunomodulation treatment for emergency surgery patients may help improve the prognosis.
Objective To investigate the status of frailty in patients with coronavirus disease 2019 (COVID-19), and to analyze the influence of COVID-19 disease on the prevalence of frailty. Methods This study was conducted using a cross-sectional survey method. COVID-19 patients admitted to a centralized isolation point in Guangzhou were selected for an questionnaire survey by “questionnaire star”, between November and December 2022. The questionnaire included the general information questionnaire, Tilburg Frailty Indicator (TFI), the COVID-19 symptom scale and Mental Resilience Scale (RS-11). Multi-model logistic regression analysis was used to explore the influence of COVID-19 on the occurrence of debilitation. Results A total of 667 questionnaires were distributed, of which 594 were valid, with an effective rate of 89.1%. There were 150 patients (25.3%) were frail, 444 patients (74.7%) were non-frail, and 51 patients (8.6%) were newly frail after infected COVID-19. The median TFI score before COVID-19 was 3 (2, 4) points, 16.7% (99/594) were in a weak state. The median TFI score after COVID-19 was 3 (2, 5) points, 25.3% (150/594) were in a weak state. There were statistically significant differences in TFI scores (Z=−6.596, P＜0.001) and the incidence of debilitation (χ2=351.648, P＜0.001) before and after COVID-19. The results of multivariate logistic regression analysis showed that after controlling disease factors, demographic factors and psychosocial factors, the score of the COVID-19 symptom score was always the influencing factor of COVID-19 patients. The overall change trend of COVID-19 symptom score was statistically significant (P<0.001). Conclusions The COVID-19 symptom score is an important risk factor or predictor of frailty in patients with COVID-19. As the level of COVID-19 symptom score increases, the risk of frailty in COVID-19 patients increases.