Objective To investigate the expression of dipeptidyl peptidase 4 (DPP4) and angiotensin-converting enzyme 2 (ACE2) in lung tissues of patients with four different diseases including coronavirus disease 2019 (COVID-19), chronic obstructive pulmonary disease (COPD), pulmonary sarcoidosis and pulmonary bullae, and to find out the potential risk factors affecting COVID-19. Methods This study retrospectively analyzed the clinical data of 40 patients admitted to Renmin Hospital of Wuhan University with COVID-19 (COVID-19 group), COPD (COPD group), pulmonary sarcoidosis (pulmonary sarcoidosis group) and pulmonary bullae (pulmonary bullae group) and surgically resected paraffin-embedded pathological lung tissues were obtained from their lung tissue pathological specimens after surgery and paraffin embedding. The GEO database (https://www.ncbi.nlm.nih.gov/geo/) was used for bioinformatics analysis to explore the expression difference of DPP4 and ACE2 mRNA in COVID-19, COPD, pulmonary sarcoidosis and normal lung tissues. Immunohistochemistry method was used to detect the expression of DPP4 and ACE2 protein in lung tissues of each group and the average optical density was measured by image analysis software. Results The results of GEO database analysis showed that compared with pulmonary bullae group, the expression level of DPP4 mRNA had no significant difference in the COPD group and pulmonary sarcoidosis group (both P>0.05), but it was increased in the COVID-19 group (P<0.05); There was no significant difference in the expression level of ACE mRNA in the pulmonary sarcoidosis group (P>0.05), but it was increased in the lung tissue of COVID-19 group and COPD group (both P<0.05). The results of immunohistochemistry showed that DPP4 and ACE2 proteins were lowly expressed in the pulmonary sarcoidosis group and pulmonary bullae group, while their expression level was high in COVID-19 and COPD groups without significant difference (P>0.05). The expression of DPP4 and ACE2 proteins in COVID-19 group was not related to the patient’s gender and age (P>0.05), but was related to smoking and long smoking duration (P<0.05), and there was a positive correlation between DPP4 and ACE2 expression (P<0.05). Conclusions DPP4 and ACE2 proteins are lowly expressed in the pulmonary sarcoidosis group and pulmonary bullae group, while their expression level is high in COVID-19 and COPD groups. There is no significant difference in the expression level of DPP4 and ACE2 protein in the COVID-19 and COPD lung tissues. There may be a positive correlation between DPP4 and ACE2 proteins expression in lung tissue, and smoking may be a potential risk factor for COVID-19.
The coronavirus disease 2019 (COVID-19) epidemic has had a serious impact in the world. In the absence of vaccines and therapeutic drugs, disinfection has become an important technical means to block the spread of the virus. By analyzing the characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we studied a series of disinfection technologies for COVID-19. During the outbreak of COVID-19, Jinan Second Center for Disease Control and Prevention disinfected the houses of the cases to be investigated in a community. The effectiveness of the disinfection technology was verified through the process of disinfection preparation, sampling before disinfection, field disinfection, sampling after disinfection and evaluation of disinfection effect. Compared the data before and after disinfection, the killing rate of the total bacterial colonies in the air and on the surface of the object was more than or equal to 90%, and no SARS-CoV-2 was detected after disinfection. The results show that the disinfection effect of the disinfection technology meets the standard. Finally, through the analysis of the wrong way of disinfection and the harm of over disinfection, the importance of scientific disinfection and precise disinfection are emphasized, and the research has a good guiding value for prevention and control of the epidemic.
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.
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.
Objective To investigate the problems and needs of teachers and international bachelor of medicine and bachelor of surgery (MBBS) students in the online clerkship since the outbreak of coronavirus disease 2019. Methods In May 2020, questionnaires, telephone communication and face-to-face interviews were conducted among 85 international MBBS students and clinical teachers of 10 related departments in West China Hospital, Sichuan University. Teachers and students perceptions towards online clerkship were collected from five aspects including department orientation, attendance, teaching plan, assignment & assessment, and overall evaluation. Results Four departments and 43 students (50.6%) thought that online clerkship increased time input, while 3 departments thought that students’ enthusiasm decreased significantly compared to ordinary clerkship. Six departments reported that students’ compliance was poor; 58 students (68.2%) reported that they could not experience the real clinical environment. All departments reported difficulties in completing procedures and skills, and believed the teaching objectives were only partially achieved; 78 students (91.8%) thought that the effect of online clerkship met with their expectations; 16 students (18.8%) were very satisfied, and 59 students (69.4%) were satisfied. The majority of students believed that the advantages of online clerkship were that they had more time to prepare for their licensing examination [66 students (77.6%)] and could ask questions online at any time [48 students (56.5%)]. Conclusions There are both pros and cons in the online clerkship. It has put forward higher requirements for the efficiency and accuracy of English communication between teachers and students, and for the self-restraint and discipline of students. Under the current global epidemic situation, we should make full use of the information technology to constantly strengthen the practical education.
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 analyze the clinical characteristics, prognosis and predisposing factors of coronavirus disease 2019 (COVID-19) associated pulmonary mucormycosis (CAPM), so as to improve people's understanding of the disease.MethodsFrom from September 1, 2021 to July 31, 2024, 11 patients with CAPM who were hospitalized in Beijing Chaoyang Hospital affiliated to Capital Medical University were retrospectively collected, and 22 patients with non-CAPM were included after matching according to the ratio of 1:2. The clinical manifestations, laboratory examinations, imaging features, tracheoscopy, treatment and prognosis of the two groups were analyzed. ResultsThe average age of patients in CAPM group was 59.5 ± 10.6 years, with 81.8% of males; diabetes mellitus (90.9%) was the most common complication. In CAPM group, the median time after the occurrence of mucor after COVID-19 was 13.0 (10.0, 24.0) days. The utilization rate of glucocorticoids in the CAPM group was 63.6% (7/11), which was significantly higher than that in non-CAPM group [13.6% (3/22)], and the difference between the groups was statistically significant (P=0.006). The C-reactive protein level in CAPM group was significantly higher at 93.90 (75.00, 129.00) mg/L than that in non-CAPM group at 26.10 (4.83, 114.03) mg/L, with a statistically significant difference (P=0.040). The CD4+T lymphocyte counts and B lymphocyte counts in CAPM group were 223.00 (66.75, 336.75)/µL and 32.00 (21.75, 55.25)/µL, respectively, which were significantly lower than those in the non-CAPM group 394.00 (206.00, 610.00)/µL and 112.50 (56.00, 159.25)/µL, with statistical differences between the groups (P=0.040, P=0.040). In terms of imaging, the main imaging findings were the involvement of multiple lobes in both groups. 63.6% (7/11) of patients with pulmonary aspergillosis in CAPM group were significantly higher than those(4/22, 18.2%) in non-CAPM group (P=0.017). The incidence of dyspnea in CAPM group was significantly higher than that in non-CAPM group (90.9% vs. 50.0%, 0.027%).ConclusionThe proportion of glucocorticoid use and the proportion of pulmonary aspergillosis in CAPM group are significantly higher, and they are in a more serious state of immunosuppression. Once combined with pulmonary aspergillus , the mortality rate is higher.
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.
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.
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.