Symptomatic Support Research Articles

Radiation therapy for nonmetastatic medically inoperable upper-tract urothelial carcinoma.

BackgroundThe standard management for upper urinary tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU). However, some patients cannot undergo this procedure for several reasons, such as unresectable disease, old age, and multiple comorbidities. Our study explored the potential safety and effectiveness of radiotherapy as a curative treatment for UTUC patients unfit for surgery.MethodsThe data of patients treated with radiotherapy between December 2017 and November 2019 were retrospectively reviewed. For the literature review, computerized PubMed Medline, Index Medicus, and Web of Science databases and reference lists from the identified publications of interest were used. And “upper-tract urothelial carcinoma” and “radiotherapy” were used as key words in the search.ResultsWe describe 8 patients with UTUC who were treated with radiotherapy. The median follow-up time was 13.5 months (range, 8.6–30.9 months). Local tumor control was achieved in all patients. However, distant metastases were observed in 2 patients with T3-4/N+ status. One patient had T4 status and the other had N2+ status. The patients died of tumor progression at 15.0 and 17.7 months. In addition, the other 6 patients who were still alive had relatively early-stage tumors without nodal involvement. Regarding acute toxicity, according to the CTCAE v5.0, mild side effects were noted, including grade 1 nausea and diarrhea. Four patients developed mild anemia, generally of grade 1–2. One patient experienced grade 3 anemia, but it was manageable and improved with symptomatic support. In addition, no grade 4 acute or late toxicities were observed. No significant long-term impairment of renal function occurred.ConclusionsFor patients with nonmetastatic UTUC who are not suitable for surgery, radiotherapy is a safe treatment and can achieve good local tumor control.

SARS-CoV-2: a view on its origin, transmission, genetic characteristics and pathogenicity

Objective: To describe the origin, transmission, morphological and genetic characteristics of SARS-CoV-2 and its pathogenicity mechanisms. Bibliographic review: At the end of December 2019, health centers in Wuhan, Hubei-China province, observed several cases of pneumonia of unknown origin, associated with a new etiologic agent, a virus, with a similar, but distinct, genomic sequence of SARS-CoV and MERS-CoV, named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most common symptoms at the beginning of the infection are fever, cough, fatigue, olfactory and taste disorders; on the other hand, severe cases include pulmonary impairment and hypoxia. Currently, there are no antiviral agents with proven clinical efficacy and vaccination occurs in slow steps in most countries, with symptomatic treatment and life support still being the main therapeutic interventions available. Final considerations: SARS-CoV-2 presents itself as one of the biggest public health problems in the world nowadays. The search for new drugs to treat COVID-19 is constant, however, so far no new drug is available for use with 100% proven clinical efficacy.

Successful treatment of pulmonary lymphangitic carcinomatosis by anlotinib in 14 Chinese patients with advanced non-small cell lung cancer.

e21064 Background: Pulmonary lymphangitic carcinomatosis (PLC) occurs in 6%-8% of intrathoracic metastases among malignant tumor. The median survival was only 2.0 months from time of pulmonary symptoms to death in cases during 2000-2018, which is a poor prognosis. Effective interventions were needed besides standard chemotherapy and symptomatic support. Anlotinib showed a critical effect on lymphangiogenesis, and lymphatic metastasis in mouse models of lung adenocarcinoma, it might be a therapeutic option for tumor lymphatic metastasis. In this study, we retrospectively analyzed the efficacy and safety of anlotinib for PLC in patients with Non-small Cell Lung Cancer (NSCLC). Methods: We retrospectively investigated NSCLC patients with PLC at our hospital between May 2018 and November 2020, who received anlotinib monotherapy or combined therapy for PLC. Data were analyzed for progression-free survival (PFS), overall survival (OS), objective response rate(ORR), disease control rate(DCR) and adverse events (AE). The impact of clinical and genomic factors on PFS and OS were also assessed. Results: A total of 14 patients were enrolled with a median age of 64 years. 10(71.4%) were male, 4(28.6%) has smoking history, 10(71.4%) of patients had a performance status of 2-3. 9, 3, 2 patients had TP53 mutation, EGFR mutation, ALK fusion respectively. 9(64.3%) patients received anlotinib monotherapy. Of 14 patients, 8 achieved partial response (PR), 5 presented stable disease (SD), 1 had progressed disease. The ORR and DCR were 57.1% and 92.9% respectively. The median PFS was 3.1 months (95% CI: 2.0-4.2), the median OS for 1, 2, ≥3 line were 13 months, 7.2 months, 5.2 months, respectively. Median PFS and OS (≥3 line) were significantly longer for patients with TP53-mutant tumors compared with those with TP53–wild-type tumors (median PFS: 7 vs. 1.1 months, median OS (≥3 line): 6.8 vs. 1.9 months). No difference of PFS and OS (≥3 line) was found between EGFR or ALK alteration and the corresponding wild type patients. The most frequently reported AEs were high blood pressure (11, 78.6%), hand foot syndrome (6, 42.9%), diarrhea (5, 35.7%), fatigue (4, 28.6%), hoarseness (3, 21.4%), proteinuria (2, 14.3%) and stomatitis (2, 14.3%). Conclusions: Anlotinib presented favorable efficacy in patients with pulmonary lymphangitic carcinomatosis and conferred considerable survival benefit compared with previous studies, especially in patients harboring TP53 mutations. The AEs were manageable. These indicated that anlotinib can be a promising therapeutic treatment of PLC. More clinical data is needed to validate this finding.

Successful endoscopic surgery for emphysematous pyelonephritis in a non-diabetic patient with autosomal dominant polycystic kidney disease: A case report

BACKGROUNDEmphysema pyelonephritis (EPN) is a very dangerous type of urinary tract infection. It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly, and it can easily lead to systemic infections and even sepsis. The incidence is extremely low, and it is prevalent in patients with diabetes. We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease (ADPKD). We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early.CASE SUMMARYA 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d. She had a history of autosomal dominant polycystic kidney and polycystic liver. She was diagnosed with left type I EPN and her vital signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission. Two months later, she underwent a second-stage flexible ureteroscopy and lithotripsy. Despite postoperative sepsis, she finally recovered after active symptomatic support treatment and effective anti-infective treatment.CONCLUSIONAlthough EPN is more likely to occur in diabetic patients, for non-diabetic patients with ADPKD and upper urinary tract obstruction, the disease also causes rapid deterioration. Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient’s life.

Airway management in a critically ill patient with novel coronavirus pneumonia undergoing extracorporeal membrane oxygenation

This article summarizes the nursing experience in a critically ill patient with novel coronavirus pneumonia after extracorporeal membrane oxygenation (ECMO) treatment for lung function improvement. After oral intubation-assisted ventilation, anti-infection, and other symptomatic support treatments, the patient was still unable to breathe without the ventilator. For the sustained carbon dioxide retention and severe gas exchange impairment, he was treated with tracheotomy and ECMO. During the treatment, a series of nursing measures to improve lung function were adopted, such as sputum suction care, atomized inhalation therapy, bronchial irrigation, and lateral ventilation combined with postural drainage. After 7 days of ECMO treatment and nursing, the patient's lung function improved and then he was weaned from the machine.

Clinical analysis of seven pediatric patients with coronavirus disease 2019 (COVID-19) in Jingzhou, Hubei, China: a retrospective study.

BackgroundThe novel coronavirus disease 2019 (COVID-19) epidemic has spread globally, along with its incidence among children. The purpose of this study was to evaluate the clinical characteristics and outcomes of children infected with COVID-19 and to provide a reference for clinical work.MethodsThe study retrospectively reviewed the clinical characteristics and prognosis of 7 children diagnosed with COVID-19 infection at The First People’s Hospital of Jingzhou between January 30 and February 29, 2020.ResultsOf the 7 cases, 2 were male and 5 were female, aged 3 months and 14 days to 12 years old (median age 3 years old). There was 1 asymptomatic carrier, 5 cases with mild type infection, which had the main symptoms of cough (4/5) and fever (4/5), and 1 case of moderate type. Among the 7 cases, serum white blood cell count was increased in 1 case, decreased in 1 case, liver transaminase was increased in 1 case, lactate dehydrogenase was increased in 3 cases, creatine kinase MB (CK-MB) was increased in 2 cases, and C-reactive protein was elevated in 2 cases. A total of 4 cases were complicated with mycoplasma pneumoniae and/or influenza B virus infection. A single case of chest computed tomography (CT) showed viral pneumonia. With routine antiviral and symptomatic support therapy, the median time taken for the results of nucleic acid testing by pharyngeal swab to become negative was 14 days (6–26 days) and the median hospital stay was 15 days (8–31 days). All participants were cured and subsequently discharged from hospital. Only 1 case was positive for nucleic acid testing by pharyngeal swab 1 month after being discharged, and the anal swab of 1 case for nucleic acid testing was positive 2 months after being discharged.ConclusionsAll children with COVID-19 who were included in this study in Jingzhou were infected via family clustering, and the laboratory examinations were not specific. Fever and cough were common symptoms, but all cases were mild and had good prognoses.

Diagnosis and treatment of 471 patients with 2019 novel coronavirus disease (COVID-19).

BackgroundWhile the 2019 novel coronavirus disease (COVID-19) outbreak has been largely kept under control in China, it remains a global pandemic, and the source, transmission route, and treatments of SARS-COV-2 are still being investigated. Here, we summarized the clinical features, diagnosis, treatment, and prognosis of COVID-19 patients based on our clinical practice.MethodsThe clinical and imaging findings, treatments, and follow-up data of 471 patients with COVID-19 who were discharged from the Wuhan Jinyintan Hospital prior to February 6, 2020, were retrospectively analyzed.ResultsAmong these patients, there were 2 mild cases, 282 moderate cases, 181 severe cases, and 6 critical cases. There were 250 males and 221 females aged 17 to 90 years. The median age was 54 years in the severe/critical group, which was significantly older than in the mild/moderate group (P<0.05). 44.59% of them had one or more underlying diseases. The most common symptoms were fever, cough, expectoration, and dyspnea. The median body temperature in the severe/critical group was 39°C, which was significantly higher than in the mild/moderate group (P<0.05). The incidences of lymphopenia and CD4+ T lymphocytopenia were 53.5% and 41.86%, respectively. Ground-glass opacity and small patchy shadows were the most common findings on chest computed tomography (CT). Compared with the mild/moderate group, the severe/critical group showed higher proportions of severe lymphocytopenia and CD4+ T lymphocytopenia, along with more ground-glass shadows and large-scale consolidation. After anti-infection, oxygen therapy, and symptomatic support, lymphocytes and CD4+ T lymphocytes were markedly increased, all patients were discharged. The median time of nucleic acid conversion and hospital stay were 9 and 12 days, respectively, which were significantly longer in the severe/critical group than in the mild/moderate group. Of the 390 cases followed, only 19 were hospitalized again due to other diseases. All patients recovered well from COVID-19, with negative nucleic acid test results.ConclusionsLymphocytopenia and CD4+ T lymphocytopenia were found to be associated with COVID-19 and thus may be important indicators in evaluating the severity and prognosis. Multidisciplinary management including antiviral treatment, immune regulation, and symptomatic support is effective, and yields a low recurrence rate.

Nursing of an Infant Diagnosed with Neonatal Intrahepatic Cholestasis Caused by Citrin Deficiency (NICCD) with Respiratory Syncytial Virus (RSV) Infection: A Case Report

<i>Background</i>: Citrin deficiency is an autosomal recessive genetic disorder caused by SLC25A13 genetic mutations. Understandably, Neonatal Intrahepatic Cholestasis caused by Citrin Deficiency (NICCD) was one of its clinical phenotypes, usually occurred in the neonatal period or infancy. The effective treatment of dietary intervention and symptomatic support may provide an avenue for clinicians to reduce liver damage and improve clinical prognosis. <i>Objective</i>: We report a 5-month-old infant diagnosed with Neonatal Intrahepatic Cholestasis caused by Citrin Deficiency (NICCD), coexisting Respiratory Syncytial Virus (RSV) infection. <i>Method</i>: The patient presented with rhinorrhea and cough, jaundiced skin and sclera, fat faces and hepatomegaly. Simultaneously, the child’s mother performed obvious anxious emotion. Infection control, nutrition management, and psychological guidance for the caregiver during hospitalization to discharge were achieved. Meanwhile, effective health education also plays a good role in these interventions. <i>Result</i>: After half a month, the patient’s infection was given controlled. Jaundice and hepatomegaly were improved gradually. Followeing up for 2 months, the clinical symptoms for NICCD were disappeared and the caregiver’s anxiety was alleviated effectively. The importance of follow-up and support longitudinally to improve the quality of life for patients is emphasized. <i>Conclusion</i>: Therefore, this study provided primary while valuable nursing care experience for NICCD with RSV infection patients.

Clinical analysis of 33 cases with neonatal cerebral infarction.

Objective:To investigate the etiology, clinical manifestations, diagnosis, treatment and prognosis of neonatal cerebral infarction (NCI) to further improve the understanding of the disease.Methods:Clinical data and follow-up results of 33 cases of NCI in neonatal intensive care unit of a first-class hospital from September 2009 to September 2019 were retrospectively analyzed.Results:All 33 patients were diagnosed with NCI by MRI. Among them, 31 cases (93.94%) were full-term infants, 25 cases (75.76%) were mother’s first birth, and 18 (54.55%) cases were males. Pregnancy complications were reported in 18 cases (54.55%), and 19 cases (57.58%) had perinatal hypoxia history. Seizures were the most common first symptom and clinical manifestation in the course of disease (81.8%). There were 27 cases (81.82%) of patent foramen ovale (PFO) among NCI cohort. Ischemic cerebral infarction occurred in 32 cases (96.97%). The middle cerebral artery and its branches were more frequently involved, mainly on the left side. The acute stage of NCI was managed by symptomatic support treatment, and the recovery stage involved mainly rehabilitation treatment. Among the 33 cases, five cases were lost to follow-up, two patients died, 26 patients survived without complications, one case had cerebral palsy, one case had language retardation, and six cases had dyskinesia. Poor prognosis was associated with the involvement of deep gray matter nuclei or multiple lobes, and intrapartum complications. Vaginal mode of delivery and longer hospital stay were associated with better prognosis.Conclusions:Complications leading to placental circulation disorder during pregnancy and perinatal hypoxia are common high-risk factors of NCI. The seizure is the most common clinical manifestation. There is a possible correlation between PFO and NCI. Involvement of deep gray matter or multiple lobes and intrapartum complications may indicate poor prognosis, while vaginal delivery and prolonged hospitalizations are associated with better prognosis of NCI.

Effect of methylprednisolone in severe and critical COVID-19: Analysis of 102 cases.

BACKGROUNDThe coronavirus disease 2019 (COVID-19) outbreak has brought great challenges to public health. Aggravation of COVID-19 is closely related to the secondary systemic inflammatory response. Glucocorticoids are used to control severe diseases caused by the cytokine storm, owing to their anti-inflammatory effects. However, glucocorticoids are a double-edged sword, as the use of large doses has the potential risk of secondary infection and long-term serious complications, and may prolong virus clearance time. Nonetheless, the risks and benefits of glucocorticoid adjuvant therapy for COVID-19 are inconclusive.AIMTo determine the effect of methylprednisolone in severe and critically ill patients with COVID-19.METHODSThis single-center retrospective study included 102 adult COVID-19 patients admitted to a ward of a designated hospital in Wuhan, Hubei Province from January to March 2020. All patients received general symptomatic treatment and organ function support, and were given different respiratory support measures according to their conditions. In case of deterioration, considering the hyperinflammatory state of the patients, methylprednisolone was intravenously administered at 0.75-1.5 mg/kg/d, usually for less than 14 d. Patient vital signs and oxygenation were closely monitored, in combination with imaging and routine blood tests such as C-reactive protein, biochemical indicators (liver and kidney function, myocardial enzymes, electrolytes, etc.), and coagulation function. Patient clinical outcomes were discharge or death.RESULTSA total of 102 severe and critically ill COVID-19 patients were included in this study. They were divided into treatment (69, 67.6%) and control groups (33, 32.4%) according to methylprednisolone use. Comparison of baseline data between the two groups showed that the treatment group patients had higher aspartic acid aminotransferase, globulin, hydroxybutyrate dehydrogenase, and lactate dehydrogenase. There was no significant difference in other baseline data between the two groups. With regard to prognosis, 29 (78.4%) patients in the treatment group died as opposed to 40 (61.5%) in the control group. The mortality was higher in the treatment group than in the control group; however, according to the log-rank test and the Kaplan–Meier survival curve, the difference in mortality between both groups was insignificant (P = 0.655). The COX regression equation was used to correct the variables with differences, and the results showed that methylprednisolone treatment did not improve prognosis.CONCLUSIONMethylprednisolone treatment does not improve prognosis in severe and critical COVID-19 patients.

Effect of combined WeChat video and comprehensive medical therapy on severe COVID‐19 with moderate Alzheimer's disease: A case report

ObjectiveWe present a case report of recovery from severe COVID ‐ 19 (novel coronavirus 2019) in a patient with cognitive decline (84‐year old, female), behavioral and psychiatric symptoms, hip arthroplasty, sacroiliac decubital necrosis, cachexia, after comprehensive therapy.BackgroundBecause of cognitive and behavioral disorders, patients with Alzheimer’s disease have poor coordination of treatment especially in an unfamiliar environment. Communicating with close family members through WeChat video can relieve patients' anxiety and other mental symptoms, leading to better cooperating with drug treatment and nasal feeding diet.MethodsPatient received 1 hour daily WeChat video communication with her son at isolation ward, including psychological comfort, care and positive words. The WeChat video communication were last for 4 weeks, during this time, the elderly patient was also treated with methylprednisolone (for 5 days), immunoglobulin (for 5 days), ulinastatin, thymus methoxide (for twice a week), acetylcysteine, antibiotics, low molecular weight heparin, probiotics, nutrition and other symptomatic support therapy.ResultsBefore WeChat video communication about 4 weeks, the patient refused medical treatment, consisting of extraction of infusion set and removal of gastric tube, which greatly affects the treatment of drugs and the nutritional intake of patients; and the state of the patient’s condition became even worse. However, after 4 weeks WeChat video communication, the patient showed a significant improvement in the Mini‐mental state examination scores from 8 to 12 (Education: illiterate) and in the Neuropsychiatric questionnaire scores from 35 to 10. Besides, after 4 weeks WeChat video communication and comprehensive therapy, the patient’s pneumonia improved significantly and the nucleic acid test turned negative.ConclusionsWeChat video communication may be a promising noninvasive approach for patients with Alzheimer’s Disease, which may help alleviate neuropsychiatric behavioral symptoms and can be more cooperative with medical workers.

Psychosocial Effects of the COVID-19 Pandemic: Large-scale Quasi-Experimental Study on Social Media.

BackgroundThe COVID-19 pandemic has caused several disruptions in personal and collective lives worldwide. The uncertainties surrounding the pandemic have also led to multifaceted mental health concerns, which can be exacerbated with precautionary measures such as social distancing and self-quarantining, as well as societal impacts such as economic downturn and job loss. Despite noting this as a “mental health tsunami”, the psychological effects of the COVID-19 crisis remain unexplored at scale. Consequently, public health stakeholders are currently limited in identifying ways to provide timely and tailored support during these circumstances.ObjectiveOur study aims to provide insights regarding people’s psychosocial concerns during the COVID-19 pandemic by leveraging social media data. We aim to study the temporal and linguistic changes in symptomatic mental health and support expressions in the pandemic context.MethodsWe obtained about 60 million Twitter streaming posts originating from the United States from March 24 to May 24, 2020, and compared these with about 40 million posts from a comparable period in 2019 to attribute the effect of COVID-19 on people’s social media self-disclosure. Using these data sets, we studied people’s self-disclosure on social media in terms of symptomatic mental health concerns and expressions of support. We employed transfer learning classifiers that identified the social media language indicative of mental health outcomes (anxiety, depression, stress, and suicidal ideation) and support (emotional and informational support). We then examined the changes in psychosocial expressions over time and language, comparing the 2020 and 2019 data sets.ResultsWe found that all of the examined psychosocial expressions have significantly increased during the COVID-19 crisis—mental health symptomatic expressions have increased by about 14%, and support expressions have increased by about 5%, both thematically related to COVID-19. We also observed a steady decline and eventual plateauing in these expressions during the COVID-19 pandemic, which may have been due to habituation or due to supportive policy measures enacted during this period. Our language analyses highlighted that people express concerns that are specific to and contextually related to the COVID-19 crisis.ConclusionsWe studied the psychosocial effects of the COVID-19 crisis by using social media data from 2020, finding that people’s mental health symptomatic and support expressions significantly increased during the COVID-19 period as compared to similar data from 2019. However, this effect gradually lessened over time, suggesting that people adapted to the circumstances and their “new normal.” Our linguistic analyses revealed that people expressed mental health concerns regarding personal and professional challenges, health care and precautionary measures, and pandemic-related awareness. This study shows the potential to provide insights to mental health care and stakeholders and policy makers in planning and implementing measures to mitigate mental health risks amid the health crisis.

Palliative care in onco-hematology: a perspective.

Palliative care (PC) is focused on individualized symptomatic control, psychological help, and support in the context of severe disease. Oncologic patients are still the most referred to PC and hematologic patients are only 7%. This is a commentary about PC applied to hematologic patients. There is evidence supporting that these patients behave as a special group in PC when compared with other tumors: there is a smaller number of referrals, with more advanced disease status, more symptomatology expressed, and less time between the last treatment date and the referral date or death. This article also expresses the experience of an oncologic palliative care unit. More health education programs in PC are needed for specialized professionals in hematology, as well as a change of nowadays health politics, in order to increase the participation of this specialized care in hematology.

The effect of meditative movement on the quality of life in patients recovering from COVID-19: A protocol for systematic review and meta-analysis.

Background:The outbreak of a novel coronavirus (2019-nCoV)-infected pneumonia is currently ongoing all over the world. The treatment scheme is generally isolation treatment and symptomatic support treatment. While the majority of patients recover from this disease through methods above, COVID-19 Infection severely affect the physical and mental health of rehabilitation patients, as well as their living quality. Thus, meditative movement is needed to improve outcome of COVID-19 patients in recovery period.Methods:We will conduct systematic searches to identify all relevant studies without any language limitation from the following electronic databases from inception to October 2020: Medline, Ovid, PubMed, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Chinese Biomedical Database, Chinese Biomedical Literature Service System and Wan fang Database. At the same time, we will search the following Clinical trial registries to identify records of on-going or completed but not yet published trials, including WHO International Clinical Trials Registry Platform (ICTRP), Trials Register of Promoting Health Interventions (TRoPHI) and Chinese Clinical Trial Registry (ChiCTR). No limits will be placed on language. The article will study the effect of meditative movement on the quality of life of convalescent patients. The main outcome will be the effect of meditative movement on the quality of life of patients in recovery period. The secondary results will select accompanying symptoms (including myalgia, cough, sputum, runny nose, pharyngalgia, anhelation, chest distress, nausea, vomiting, anorexia, diarrhea), disappearance rate, negative COVID-19 results rate on 2 consecutive occasions (not on the same day), the quality of life improved, CT image improvement, average hospitalization time, occurrence rate of common type to severe form, clinical cure rate, and mortality. Data collection and management 3 authors will independently carry out data from eligible studies in a pretested and standardized Microsoft Excel sheet, with reciprocal validation of data extraction results. Data analysis and quantitative data synthesis will be performed using RevMan software (V.5.3).Results:The findings of the study will provide new and relatively high-quality evidence in meditative movement treatment for COVID-19.Conclusion:The conclusion of systematic review will provide evidence to judge whether meditative movement is an effective intervention for patient with COVID-19 in recovery period.PROSPERO registration number:CRD42020210256.

Clinical characteristics and outcomes in elderly with coronavirus disease 2019 in Beijing, China: a retrospective cohort study.

A novel human coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a global pandemic of coronavirus disease 2019 (COVID-19). In this study, we aimed to explore the clinical characteristics and outcomes in older patients with COVID-19. Ninety-one patients with SARS-CoV-2 infection were included in the study, 27 of which (29.67%) were elderly. The median age of these 27 patients was 74.9 years (interquartile range 68–82; range 65–94 years), and 15 (55.56%) were female. Elderly with COVID-19 in Beijing (China) were more likely to have underlying comorbidities and more frequently tended to have critical illness and suffer from more complications. The main treatments of the elderly consisted of symptomatic and respiratory support. The most frequent complications in the elderly were pleural effusion [10, (37.04%)], secondary infection [7, (25.93%)], and kidney damage [7, (25.93%)]. Six (22.22%) of the 27 elderly patients received invasive ventilation (three of them switched to extracorporeal membrane oxygenation). As of March 7, 20 (74.07%) of the 27 elderly patients were discharged, two (7.41%) were still hospitalized, and five died; the mortality in the elderly was 18.52%. Age was associated with the mortality in patients with COVID-19 (OR 0.82; 95% CI 0.70–0.97; P = 0.019). Therefore, more attention should be paid to the treatment of comorbidities and complications in elderly patients.

Clinical study on the application of covered vacuum sealing drainage technology to the bite of venomous snakes of Trimeresurus stejnegeri in Guangxi

To established the diagnostic criteria for venomous snakebite of Trimeresurus stejnegeri in Guangxi by ourselves, and explore the clinical effect and mechanism of covered vacuum sealing drainage (VSD) in the treatment for venomous snakebite of Trimeresurus stejnegeri in Guangxi. According to the Chinese emergency medicine for snakebite and the Chinese snake, the diagnostic criteria for venomous snakebite of Trimeresurus stejnegeri in Guangxi were formulated: (1) the responsible venomous snake was identified as Trimeresurus stejnegeri in Guangxi; (2) the appearance and morphology of the venomous snake described by the patient basically conformed to the characteristics of Trimeresurus stejnegeri in Guangxi; (3) clinical manifestations of hematotoxin included local swelling, severe wound pain, and subcutaneous ecchymosis in some patients; having (1) or both (2) and (3) could be diagnosed. The patients with venomous snakebite of Trimeresurus stejnegeri in Guangxi admitted to Snake Injury Treatment Base in Central and Northern Guangxi/Liuzhou Integrated Chinese and Western Medicine Snake Injury Treatment Center from January 2016 to January 2020 were enrolled. The patients were divided into the general treatment group and the covered VSD technology group, with 60 patients in each group. The general treatment group was treated with antivenom, anti-tetanus, closed injection around the wound, anti-inflammatory, magnesium sulfate gauze applied on the affected limb, symptomatic support treatment. The covered VSD technique was used in the covered VSD technology group based on the treatment options of the general treatment group. Treatment cycle of both groups were calculated from the next day of admission and lasted for 7 days. In the treatment cycle, blood was collected at 08:00 every day. The red blood cell count (RBC) and hemoglobin (Hb) were detected by automatic blood cell analyzer. The prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (Fib) were detected by automatic blood coagulation analyzer, and the affected limb swelling degree and the appearance of subcutaneous ecchymosis were recorded. At different time points in the treatment cycle, the dynamic change trends of PT, APTT and Fib in the covered VSD technology group and the general treatment group were significantly different. Fib in both groups decreased on the 1-4 days, and gradually rose on the 5th day, and the lowest Fib value in the covered VSD technology group on the 4th day was higher than that in the general treatment group (g/L: 0.70±0.03 vs. 0.41±0.01, P < 0.05). In the treatment cycle, PT of both groups increased in the early and middle stage, but decreased in the later stage. The peak value of PT of the covered VSD technology group on the 5th day was significantly lower than that of the general treatment group (s: 25.2±0.1 vs. 35.4±0.2, P < 0.05), and the PT of the covered VSD technology group returned to the normal range on the 7th day, while the PT of the general treatment group was still abnormal. APTT in both groups increased at the beginning of the treatment cycle and gradually decreased. The peak value of APTT of the covered VSD technology group on the 3th day was lower than that in the general treatment group (s: 47.3±0.1 vs. 55.7±0.2, P < 0.05), and the rate of increase and decline was also more gradual than that in the general treatment group. There was no significant difference in RBC or Hb between the two groups. With the passage of time, the degree of affected limb swelling was relieved to different degrees in both groups, and the remission degree in the covered VSD technology group was more obvious than that in the general treatment group, and there was significant difference between the two groups (χ 2 = 86.060, P = 0.000). The occurrence rate of subcutaneous ecchymosis in the covered VSD technology group was significantly lower than that in the general treatment group (13.3% vs. 40.0%, χ 2 = 10.909, P = 0.002). The application of covered VSD technology to the venomous snakebite of Trimeresurus stejnegeri in Guangxi does not aggravate the bleeding. It is beneficial to the reduction of the swelling of the affected limb, and also promotes the recovery of coagulation function, which can better control the occurrence of adverse events caused by coagulation dysfunction.

NLRP3 inflammasomes are involved in the progression of postoperative cognitive dysfunction: from mechanism to treatment.

Postoperative cognitive dysfunction (POCD) involves patient memory and learning decline after surgery. POCD not only presents challenges for postoperative nursing and recovery but may also cause permanent brain damage for patients, including children and the aged, with vulnerable central nervous systems. Its occurrence is mainly influenced by surgical trauma, anesthetics, and the health condition of the patient. There is a lack of imaging and experimental diagnosis; therefore, patients can only be diagnosed by clinical observation, which may underestimate the morbidity, resulting in decreased treatment efficacy. Except for symptomatic support therapy, there is a relative lack of effective drugs specific for the treatment of POCD, because the precise mechanism of POCD remains to be determined. One current hypothesis is that postoperative inflammation promotes the progression of POCD. Accumulating research has indicated that overactivation of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasomes contribute to the POCD progression, suggesting that targeting NLRP3 inflammasomes may be an effective therapy to treat POCD. In this review, we summarize recent studies and systematically describe the pathogenesis, treatment progression, and potential treatment options of targeting NLRP3 inflammasomes in POCD patients.

A systematic review and meta-analysis of the efficacy and safety of western medicine routine treatment combined with Chinese herbal medicine in the treatment of COVID-19.

Background:COVID-19 is a global public health emergency. At present, there is no highly effective medicine for the prevention and treatment of 2019-nCoV. Western medicine for COVID-19 is mainly based on symptomatic support therapy. Chinese herbal medicine has been used to prevent infectious diseases for thousands of years in China. Western medicine routine treatment combined with Chinese herbal medicine is an alternative clinical option but lacks evidence-based medical evidence. The systematic review protocol aims to formulate a research plan that can evaluate the efficacy and safety of western medicine routine treatment combined with Chinese herbal medicine for COVID-19.Methods:We will search the following eight databases: Cochrane Library, PubMed, Embase, Medline, CNKI, Wanfang, VIP, and CBM. The search time is up to the end of July 2020. Two authors will independently complete literature screening, data extraction, and risk of bias assessment. In case of disagreement, the third author will assist in the judgment. The primary outcome will be the clinical cure rate. The secondary outcome will be accounting symptoms, fever time, time of virus nucleic acid turning negative, check the condition by drawing blood, pneumonia absorption rate, patient hospitalization time, severe conversion rate and case fatality rate, adverse reactions, and adverse events. Revman 5.3 will be used for systematic reviews and meta-analysis. The report of the protocol will follow the PRISMA-P statement, and the report of the systematic review and meta-analysis will follow the PRISMA statement.Results:We will provide evidence-based medical evidence of the efficacy and safety of western medicine routine treatment combined with Chinese herbal medicine for COVID-19. The findings will be published in peer-reviewed journals.Registration details:CRD42020190106.

Considerations for the otolaryngologist in the era of COVID-19: a review of the literature.

The SARS-CoV-2 coronavirus pandemic, referred to as COVID-19, has spread throughout the globe since its first case in China in December 2019, leaving a significant number of people infected and clinically ill. The purpose of this review is to provide the current known clinical characteristics of and management for COVID-19 as it relates to otolaryngology. COVID-19 is a highly transmissible respiratory disease with common presenting symptoms of fever, cough, and fatigue. In the absence of available vaccines or antiviral therapies, symptomatic and respiratory support is the current standard of therapy. Measures to prevent further transmission have been enacted globally including social distancing and cancellation of public events. Given elevated viral load in the upper aerodigestive tract, extra precautions in patients with otolaryngology needs have been recommended for protection of both healthcare workers and patients. Otolaryngologists face unique risk from COVID-19. Maintaining appropriate preventive health measures and remaining updated on institutional clinical guidelines is paramount for both caretaker safety and patient care.

Targeting the Immune System for Pulmonary Inflammation and Cardiovascular Complications in COVID-19 Patients.

In December 2019, following a cluster of pneumonia cases in China caused by a novel coronavirus (CoV), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infection disseminated worldwide and, on March 11th, 2020, the World Health Organization officially declared the pandemic of the relevant disease named coronavirus disease 2019 (COVID-19). In Europe, Italy was the first country facing a true health policy emergency, and, as at 6.00 p.m. on May 2nd, 2020, there have been more than 209,300 confirmed cases of COVID-19. Due to the increasing number of patients experiencing a severe outcome, global scientific efforts are ongoing to find the most appropriate treatment. The usefulness of specific anti-rheumatic drugs came out as a promising treatment option together with antiviral drugs, anticoagulants, and symptomatic and respiratory support. For this reason, we feel a duty to share our experience and our knowledge on the use of these drugs in the immune-rheumatologic field, providing in this review the rationale for their use in the COVID-19 pandemic.