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.
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.
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 explore the thromboembolic events and mortality in patients with different types of severe pneumonia, and to analyze the related high-risk factors. Methods A total of 161 severe pneumonia patients who admitted in intensive care unit from January 2018 to February 2023 were included in the study. The patients were divided into a COVID-19 group (n=88) and a community-acquired pneumonia (CAP) group (n=73) according to the type of pneumonia, and divided into a thrombosis group and a non-thrombosis group according to the occurrence of thrombosis. The patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events. Results During the in-hospital stay, 32.9% of CAP and 36.4% of COVID-19 patients experienced thrombotic events (P>0.05). In CAP group all the events (including 24 paitents) were venous thromboses, while in COVID-19 group 31 patients were venous and 3 were arterial thromboses (2 were cerebral infarction, and 1 with myocardial infarction). There were statistically significant difference in gender, age, venous thromboembolism score (VTE score), activated partial thromboplastin time (APTT), and procalcitonin (PCT) between the TE group and the Non-TE group. Logistic regression analysis showed that thrombotic events was associated with sex, age and APTT; gender (female: OR=2.47, 95%CI 1.13 - 5.39, P<0.05) and age (OR=1.04, 95%CI 1.01 - 1.07, P<0.05) were positively associated with thrombotic events. During the in-hospital follow-up, 44.3% of CAP patients and 42.5% of COVID-19 patients died (P>0.05). Receiver operator characteristic (ROC) curve analysis showed that APACHEⅡ score was more accurate in predicting mortality of severe pneumonia, and the area under the ROC curve (AUC) was 0.77 (95%CI 0.70 - 0.84, sensitivity 74.3%, specificity 68.1%), the AUC of the VTE score was 0.61 (95%CI 0.53 - 0.70, Sensitivity 31.4%, specificity 81.7%); the AUC of the creatinine was 0.64 (95%CI 0.56 - 0.73, sensitivity 72.9%, specificity 51.2%). While the Kappa value for kidney disease was 0.409 (P<0.05) presenting moderate consistency. Conclusions The incidence of thromboembolic events and mortality are high in patients with different types of severe pneumonia. Thrombophilia was associated with sex, age, and APTT. APACHEⅡ score, VTE score, and creatinine value were independent risk factors for predicting death from severe pneumonia.
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.
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.
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.
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.
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.
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.