3例并发于糖尿病新型冠状病毒肺炎肺曲霉病的诊断和治疗

目的探讨并发于糖尿病新型冠状病毒肺炎(COVID-19)肺曲霉病的诊断及治疗方法。方法对3例并发于糖尿病COVID-19肺曲霉病患者的诊断及治疗过程作回顾性分析。结果3例男性患者,因“发热、咳嗽咳痰7~15 d”入院,入院时空腹血糖12.3~15.7 mmol/L,入院后胸部CT检查均可见双肺多发磨玻璃密度影,新型冠状病毒核酸检测均阳性,诊断为重型COVID-19、糖尿病。入院后3例患者均予呼吸支持、糖皮质激素、抗病毒、抗感染、托珠单抗、胰岛素等治疗,治疗6~18 d后症状减轻,再次出现发热、咳嗽及咳痰,胸部CT检查可见双肺病灶密度增高、部分形成中央空洞,痰曲霉菌培养黄曲霉阳性2例,血清曲霉菌半乳甘露聚糖(GM)试验阳性2例,3例均诊断肺曲霉病。3例患者均予伏立康唑(200 mg,12小时/次)治疗,治疗后患者体温正常,咳嗽、胸闷憋气症状好转,胸部CT检查可见肺部空洞影缩小。结论并发于糖尿病COVID-19肺曲霉病主要临床表现为发热、咳嗽及咳痰,胸部CT检查可见肺部多发磨玻璃密度影、中央空洞,痰曲霉菌培养及血清曲霉菌GM试验结果阳性;影像学检查及病原学检查结合可诊断;治疗方法为抗病毒治疗联合抗真菌治疗,同时应注意控制血糖。

甘肃省新型冠状病毒肺炎中医药防治策略与方法

对新型冠状病毒肺炎(Corona Virus Disease 2019,COVID-19)(简称新冠肺炎)发生以来,甘肃省中医药防治的策略和方法进行梳理,认为关口前移、避其毒气,扶正御邪、分类预防,早期介入、截断扭转,立足肺脾、分期论治,中西结合、优势互补的防治策略与方法是甘肃省中医药防治疫情取得阶段性成效的关键。

新型冠状病毒诱发的炎症后肺纤维化治疗新进展

新型冠状病毒(SARS-CoV-2)感染属于全球重大突发公共卫生事件,对全球卫生系统造成重大威胁。SARS-CoV-2感染康复后部分患者长时间存在多种呼吸道症状,这被称为SARS-CoV-2感染急性期后遗症,SARSCoV-2感染后肺纤维化(PCPF)作为其中一种后遗症可不同程度影响患者的呼吸功能和生活质量。有关PCPF的治疗是目前研究的热点,本文就PCPF的治疗方法做一综述,旨在改善PCPF患者的预后。

新型冠状病毒肺炎相关性肺曲霉病的临床特征分析

目的探讨新型冠状病毒肺炎相关性肺曲霉病(COVID-19 associated pulmonary aspergillosis,CAPA)患者的临床特征。方法收集2022年12月16日—2023年02月02日苏州大学附属第一医院收治的临床诊断为CAPA患者的临床资料,并进行分析总结。结果入组的43例患者中,16例患者需有创机械通气,44.19%(19/43)为危重型新型冠状病毒肺炎患者,86.05%(37/43)患者患有基础疾病。新型冠状病毒感染后14~28 d是CAPA的好发时段(48.84%,21/43)。实验室检查结果中,86.05%的患者淋巴细胞有不同程度的降低,淋巴细胞计数0.63(0.33,0.96)×10^(9)/L,降钙素原、CRP及红细胞沉降率中位数均高于参考值,38.89%(14/36)患者血清GM试验检测阳性,75.00%(9/12)患者支气管肺泡灌洗液GM试验阳性。烟曲霉是最常见的菌种。伏立康唑是使用最多(86.05%)的抗真菌药物,其他药物还包括卡泊芬净、泊沙康唑、艾沙康唑、两性霉素B,有2例患者接受了气管镜下两性霉素B局部治疗。经治疗共有27例患者好转出院。结论CAPA症状、体征及影像学表现无明显特异性,容易漏诊及误诊,并且死亡率高,对于疑诊CAPA及具有CAPA危险因素的患者应及时完善相关检查,以提高诊疗效率。

金银花口服液治疗新型冠状病毒感染(湿热蕴肺证)有效性和安全性的随机、对照、开放式临床研究

目的:评估金银花口服液治疗新型冠状病毒感染(湿热蕴肺证)的有效性与安全性。方法:选取2022年1-11月华中科技大学同济医学院附属武汉市金银潭医院收治的314例无症状/轻型新型冠状病毒肺炎(COVID-19)奥密克戎阳性患者,依据临床研究中央化随机系统(网络版)随机分为治疗组157例和对照组157例。最终治疗组152例,对照组139例。对照组轻型患者仅给予标准治疗,无症状患者不服用药物,治疗组轻型患者在上述标准治疗的基础上加用金银花口服液,无症状患者仅给予金银花口服液治疗。比较两组呼吸道标本中新型冠状病毒核酸转阴时间、住院时间、住院期间新发症状及症状缓解时间、胸部CT病理改变、病毒载量循环阈值(Ct)、转重症及不良反应发生情况。结果:与对照组相比,治疗组核酸转阴时间、住院时间均短于对照组,差异均有统计学意义(P<0.05)。治疗组新发症状发生率低于对照组(P<0.05)。治疗组咳嗽、咽痛、咳痰等新发症状发生率低于对照组(P<0.05)。治疗组咳嗽、咽痛、咳痰症状缓解时间均短于对照组(P<0.05)。两组基线和治疗14 d胸部CT病理改变情况比较,差异均无统计学意义(P>0.05)。两组治疗5、7、14 d的病毒载量循环阈值(Ct)比较,差异均有统计学意义(P<0.05)。两组治疗1、3 d的病毒载量循环阈值(Ct)比较,差异均无统计学意义(P>0.05)。两组均无患者转为重症。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:金银花口服液治疗新型冠状病毒奥密克戎变异株阳性患者是一种安全有效的治疗方法,可加速无症状和轻型患者病毒清除并促进临床症状恢复。

危重型新型冠状病毒感染合并侵袭性肺曲霉病的临床特征和高危因素分析

目的:确定ICU中新型冠状病毒感染(COVID-19)相关性肺曲霉菌病(CAPA)的患病率与预后,并分析CAPA的高危因素,为早期诊断、及时治疗提供依据。方法:选择南京鼓楼医院重症医学科2022年12月至2023年1月诊断为危重型COVID-19的74例患者,根据诊断标准分为CAPA组(22例)和非CAPA组(52例),比较两组患者的基本信息、起病症状、实验室检查、影像特征,分析其疾病严重程度及预后指标。采用多因素logistic回归模型分析CAPA的危险因素。结果:22例CAPA中确诊病例1例,临床拟诊21例;诊断CAPA的时间为入院后(8±5)d。CAPA组和非CAPA组患者淋巴细胞[(0.33±0.25)×109/L vs.(0.58±0.55)×109/L,t=4.233,P=0.019]、C反应蛋白[(95±80)mg/L vs.(63±45)mg/L,t=8.940,P=0.012]、白细胞介素6(IL-6)[225(14,15432)ng/L vs.52(5,2245)ng/L,Z=4.949,P=0.024]、人类白细胞DR抗原(HLA-DR)[(31±24)%vs.(42±27)%,t=4.553,P=0.042]、激素治疗时间≥7 d(13/22 vs.16/52,χ^(2)=5.200,P=0.023)、应用托珠单抗治疗(4/22 vs.1/52,χ^(2)=4.157,P=0.041)及预后不良情况(16/22 vs.24/52,χ^(2)=4.401,P=0.036)比较,差异均有统计学意义。多因素logistic回归分析结果显示,入院时淋巴细胞<0.35×109/L[比值比(OR)=1.970,95%置信区间(CI)(1.044,3.675),P=0.038]、C反应蛋白>63.5 mg/L[OR=3.441,95%CI(1.609,7.324),P=0.006]及激素治疗时间≥7 d[OR=4.276,95%CI(2.043,8.433),P=0.012]为CAPA发生的危险因素。结论:1/4以上的危重型COVID-19患者合并CAPA,并导致不良的临床预后。淋巴细胞减少、严重炎症反应及长时间应用糖皮质激素均可导致CAPA的发生,临床需针对高危人群及早筛查及治疗,改善预后。

新型冠状病毒感染后肺纤维化病变诊治进展

新型冠状病毒(SARS-CoV-2)感染引起了全球出现大量急性新型冠状病毒肺炎(COVID-19)患者,随着病程演变,部分患者在急性期过后出现肺纤维化问题逐渐突显。目前学者们称之为新型冠状病毒感染后肺纤维化(PCPF)。由于SARS-CoV-2不断突变及全球医疗水平大相径庭,PCPF发生率及诊治亦存在差异。肺纤维化程度显著影响患者临床表现,患者症状迁延,需要大量医疗资源及长期的专业照护。目前PCPF诊断依靠临床结合CT及肺功能检查,治疗依靠既往其他肺纤维化疾病的治疗经验,缺乏统一、规范的处置方案。尽管许多学者为此开展研究,但仍没有十分有效的治疗方法。本文就PCPF发病及其机制进行概述,重点回顾相关诊断及治疗研究进展。

Associated factors of professional identity among nursing undergraduates during COVID-19:A cross-sectional study

Objectives Professional identity plays an important role in the long-term development of nurses,and it will change when public health emergency occurs.The objective of this study is to investigate the factors associated with the professional identity of nursing undergraduates in the epidemic of COVID-19.Methods A cross-sectional survey design with convenience sampling was used.A total of 3,875 nursing undergraduates were recruited from seven universities across China from March to April 2020.A general information questionnaire was used to collect students’information,and the Professional Identity Questionnaire for Nurse Students was used to survey their professional identity during the early and later stages of the first wave of the COVID-19 epidemic.Results The score of professional identity in the later stage(59.49±12.41)was higher than that in the early stage(56.96±12.61).The stepwise regression indicated that several factors were associated with professional identity,including gender,residential area,major,impact of the epidemic on intention to work after graduation,reasons for choosing nursing major and students’scores of professional identity in early stage.Conclusions Nursing educators can utilize the positive impact of responding to public health emergencies to increase the professional identity of students.Meanwhile,educators should give those students with lower professional identity more targeted education to cultivate their professional identity after the occurrence of public health emergencies.

Resilience of nurses at the epicenter of the COVID-19 pandemic in Lebanon

Objective:The study aimed to investigate the level and factors associated with the resilience of nurses practicing at the main COVID-19 referral center in Lebanon.Methods:The study utilized a cross-sectional survey design.Data were collected electronically in the spring of 2020 from 265 nurses.The questionnaire included five sections:demographic characteristics,job satisfaction,turnover intentions,exposure to violence,and resilience levels.Multiple linear regression was used to determine factors associated with resilience.Results:Results showed that the overall score of resilience among nurses was 66.91±13.34.Most nurses were satisfied with their job(67.8%),and most nurses reported that it is unlikely for them to quit their present work in the coming year(76.2%).Over the last year,three-quarters of nurses(74.7%)reported being ever exposed to a form of occupational violence.The resilience of nurses was directly associated with job satisfaction and male gender and inversely associated with intention-to-quit and exposure to violence(P<0.05).Conclusions:Enhancing the resilience of nurses at the frontline of the COVID-19 pandemic improves their job satisfaction and retention and would help support the effectiveness and efficiency of care services.Nurse managers can regularly investigate the resilience of nurses and offer interventions that would strengthen it,especially at times of crisis.

A reflection on the anti-epidemic response of COVID-19 from the perspective of disaster management

The outbreak of coronavirus disease 2019(COVID-19)shocked the world as it spread rapidly from continent to continent,and finally,it became a pandemic resulting in many infected patients,with an increasing number of deaths,and a devastating effect on worldwide economics.People only know that epidemic or pandemic is a rapid spread of infection,but in fact it can also be regarded as a biological disaster,which can be managed from a perspective of disaster management.This article discusses the current situation of the anti-epidemic response of COVID-19,and suggests using a disaster management approach to better handle this pandemic situation through mitigation,preparedness,response and recovery.

Possible link between new coronavirus variants and atmospheric lightning and seawater intrusion

SARS-CoV-2(COVID-19) has been affecting the world for more than one year.The appearance of the new coronavirus variants makes the current situation full of uncertainty.In this respect,the authors discuss the connection between virus mutation and atmospheric factors.Based on the process of nitrogen fixation and transformation of nitrate inside the human body,the authors propose that the new coronavirus variants might be related to lightning and seawater intrusion.This study provides a new perspective in terms of the possible mechanism underlying the emergence of new coronavirus variants.

Hospital ethical climate associated with the professional quality of life among nurses during the early stage of COVID-19 pandemic inWuhan,China:A cross-sectional study

Objectives:To describe the professional quality of life and explore its associated factors among nurses coming from other areas of China to assist with the anti-epidemic fight inWuhan and especially examine whether the hospital ethical climate was independently associated with nurses’professional quality of life.Methods:A cross-sectional online survey was conducted from March 2020 to April 2020.The nurses working in Wuhan from the other parts of China were the target population.The Professional Quality of Life Scale version 5,the Hospital Ethical Climate Survey,and a basic information sheet were used to collect data.Descriptive statistics,t-test,ANOVA,Pearson correlation,and multiple linear regression analysis were used to analyze the data.Results:In total,236 nurses participated in this study,and 219 valid questionnaires were analyzed.The average age of the participants was 31.2±5.0 years.Most nurses were female(176/219;80.4%)and married(145/219;66.2%).In term of professional quality of life,nurses reported moderate(129/219;58.9%)to high(90/219;41.1%)levels of compassion satisfaction,low(119/219;54.3%)to moderate(100/219;45.7%)levels of burnout,and low(67/219;36.0%)to high(10/219;4.6%)levels of secondary traumatic stress.Regarding hospital ethical climate,nurses reported moderately high hospital ethical climates with an average score of 4.46.After controlling for socio-demographic characteristics,the multiple linear regression models showed that the hospital ethical climate subscale of“relationship with physicians”was independently associated with the compassion satisfaction(b=0.533,P<0.01)and burnout(b=0.237,P<0.05);the hospital ethical climate subscale of“relationship with peers”(b=0.191,P<0.01)was independently associated with the secondary traumatic stress.Conclusions:During the early stage of the pandemic,nurses demonstrated moderate to high level of compassion satisfaction,low to moderate level of burnout,and all nurses experienced secondary traumatic stress.Nurses perceived a high level of hospital ethical climate,and the perceived hospital ethical climate played an important role in promoting nurses’professional quality of life during a lifethreatening infectious disease pandemic.

Identification of Potential Flavonoid Inhibitors of the SARS-CoV-2 Main Protease 6YNQ:A Molecular Docking Study

Objective Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the causative agent for coronavirus disease 2019(COVID-19),is responsible for the recent global pandemic.As there are no effective drugs or vaccines available for SARS-CoV-2,we investigated the potential of flavonoids against SARS-CoV-2 main protease 6YNQ.Methods In silico molecular simulation study against SARS-CoV-2 main protease 6YNQ.Results Among the 21 selected flavonoids,rutin demonstrated the highest binding energy(−8.7 kcal/mol)and displayed perfect binding with the catalytic sites.Conclusions Our study demonstrates the inhibitory potential of flavonoids against SARS-CoV-2 main protease 6YNQ.These computational simulation studies support the hypothesis that flavonoids might be helpful for the treatment of COVID-19.

Quality 4.0 technologies to enhance traditional Chinese medicine for overcoming healthcare challenges during COVID-19

The Quality 4.0 concept is derived from the industrial fourth revolution,i.e.,Industry 4.0.Quality 4.0 is the future of quality,where new digital and disruptive technologies are used to maintain quality in organizations.It is also suitable for traditional Chinese medicine(TCM)to maintain quality.This quality revolution aims to improve industrial and service sectors’quality by incorporating emerging technologies to connect physical systems with the natural world.The proposed digital philosophy can update and enhance the entire TCM treatment methodology to become more effective and attractive in the current competitive structure of the pharmaceutical and clinical industries.Thus,in healthcare,this revolution empowers quality treatment during the COVID-19 pandemic.There is a major requirement in healthcare to maintain the quality of medical tools,equipment,and treatment processes during a pandemic.Digital technologies can widely be used to provide innovative products and services with excellent quality for TCM.In this paper,we discuss the significant role of Quality 4.0 and how it can be used to maintain healthcare quality and fulfill challenges during the pandemic.Additionally,we discuss 10 significant applications of Quality 4.0 in healthcare during the COVID-19 pandemic.These technologies will provide unique benefits to maintain the quality of TCM throughout the treatment process.With Quality 4.0,quality can be maintained using innovative and advanced digital technologies.

Systematic Pharmacological Strategies to Explore the Regulatory Mechanism of Ma Xing Shi Gan Decoction on COVID-19

Objective To use systematic pharmacological strategies to explore the regulatory mechanisms of Ma Xing Shi Gan Decoction(MXSGD)against the coronavirus disease 2019(COVID-19).Methods Data on the compounds and targets of MXSGD were collected from the Traditional Chinese Medicene Systems Parmacology Database and Analysis Platform(TCMSP)and TCM Databases@Taiwan.Data on ACE2-related targets and the protein-protein interaction(PPI)were collected from the String database.The Cytoscape 3.7.2 was used to construct and analyze the networks.The DAVID platform was used for Gene Ontology(GO)and pathway enrichment analyses.Results Data on 272 MXSGD targets and 21 SARS-CoV-2 potential targets were collected.Four networks were constructed and analyzed based on the data:(1)compound-target network of MXSGD;(2)MXSGD-SARS-CoV-2-PPI network;(3)cluster of MXSGD-SARS-CoV-2-PPI network;(4)Herb-Pathway-Target network.The core targets included AKT1,MAPK3,IL-6,TP53,VEGFA,TNF,CASP3,EGFR,EGF and MAPK1.The antiviral biological processes were inflammatory responses(inflammatory cells,inflammatory cytokines and their signaling pathways),immune responses(T cells,monocytes,B cells and other immune cells),immune factors(IFN-γ,TNF-αand so on),virus defense,humoral immunity and mucosal innate immune response.The antivirus-related signaling pathways included TNF,NOD-like receptor,FoxO,PI3K-AKT and Toll-like receptor signaling pathways.Conclusions MXSGD can control disease progression by regulating multiple compounds and targets;it can reduce inflammation and balance immunity by regulating several proteins that interact with ACE2 and signaling pathways closely related to disease development.

Novel pyrimidine-benzimidazole hybrids with antibacterial and antifungal properties and potential inhibition of SARS-CoV-2 main protease and spike glycoprotein

Objective The study aimed to synthesize and characterize pyrimidine-linked benzimidazole hybrids,define their antimicrobial and antifungal activities in vitro,and determine their ability to inhibit the main protease and spike glycoprotein of SARS-CoV-2.Methods The ability of the synthesized compounds to inhibit the main protease and spike glycoprotein inhibitory of SARS-CoV-2 was investigated by assessing their mode of binding to the allosteric site of the enzyme using molecular docking.The structures of pyrimidine-linked benzimidazole derivatives synthesized with microwave assistance were confirmed by spectral analysis.Antibacterial and antifungal activities were determined by broth dilution.Results Gram-negative bateria(Escherichia coli and Pseudomonas aeruginosa)were more sensitive than gram-positive bateria(Staphylococcus aureus and Streptococcus pyogenes)to the derivatives.Candida albicans was sensitive to the derivatives at a minimal inhibitory concentration(MIC)of 250μg/mL.The novel derivatives had better binding affinity(kcal/mol)than nelfinavir,lopinavir,ivermectin,remdesivir,and favipiravir,which are under investigation as treatment for SARS-CoV-2 infection.Compounds 2c,2e,and 2g formed four hydrogen bonds with the active cavity of the main protease.Many derivatives had good binding affinity for the RBD of the of SARS-CoV-2 spike glycoprotein with the formation of up to four hydrogen bonds.Conclusion We synthesized novel pyrimidine-linked benzi-midazole derivatives that were potent antimicrobial agents with ability to inhibit the SARS-CoV-2 spike glycoprotein.Understanding the pharmacophore features of the main protease and spike glycoprotein offers much scope for the development of more potent agents.We plan to optimize the properties of the derivatives using models in vivo and in vitro so that they will serve as more effective therapeutic options against bacterial and SARS-CoV-2 infections.

Role of social distancing in tackling COVID-19 during the first wave of pandemic in Nordic region:Evidence from daily deaths,infections and needed hospital resources

Objectives:To measure the effect of social distancing on reducing daily deaths,infections and hospital resources needed for coronavirus disease 2019(COVID-19)patients during the first wave of the pandemic in Nordic countries.Methods:The observations of social distancing,daily deaths,infections along with the needed hospital resources for COVID-19 patient hospitalizations including the numbers of all hospital beds,beds needed in ICUs and infection wards,nursing staffs needed in ICUs and infection wards were collected from the Institute for Health Metrics and Evaluation(IHME)by the University of Washington.The observations of social distancing were based on the reduction in human contact relative to background levels for each location quantified by cell phone mobility data collected from IHME.The weighted data per 100,000 population gathered in a 40-day period of the first wave of the pandemic in Denmark,Finland,Iceland,Norway and Sweden.Statistical technique of panel data analysis is used to measure the associations between social distancing and COVID-19 indicators in long-run.Results:Results of dynamic long-run models confirm that a 1%rise in social distancing by reducing human contacts may decline daily deaths,daily infections,all hospital beds needed,beds/nurses needed in ICUs and beds/nurses needed in infection wards due COVID-19 pandemic by 1.13%,15.26%,1.10%,1.17%and 1.89%,respectively.Moreover,results of error correction models verify that if the equilibriums between these series are disrupted by a sudden change in social distancing,the lengths of restoring back to equilibrium are 67,62,40,22 and 49 days for daily deaths,daily infections,all hospital beds needed,nurses/beds needed in ICUs and nurses/beds needed in infection wards,respectively.Conclusion:Proper social distancing was a successful policy for tackling COVID-19 with falling mortality and infection rates as well as the needed hospital resources for patient hospitalizations in Nordic countries.The results alert governments of the need for continuously implementing social distancing policies while using vaccines to prevent national lockdowns and reduce the burden of patient hospitalizations.

Discussion on Etiology and Pathogenesis of Corona Virus Disease 2019 from“Cold-dampness and Insidious Dryness”

Based on the characteristics of the epidemic situation and the authors’understanding of the related ancient books and documents,this paper explores the etiology and pathogenesis of Corona Virus Disease 2019(COVID-19)from 5 aspects:abnormal climate in"warm winter",unique geographical location,pathogenesis evolution of cold and dampness mixed with insidious dryness,transmission and change of"triple energizer"of toxic pathogens,and game between healthy Qi and toxic pathogens.Combined with the special treatment of traditional Chinese medicine(TCM),the purpose is to make a modest contribution to curbing the epidemic situation with TCM.

Network Pharmacology Approach to Investigate the Preventive Mechanism of Hunan Expert Group Recommended Chinese Medicine Prevention No.2 Prescription Against COVID-19

Objective To explore the possible preventive mechanism of Hunan expert group recommended Chinese medicine prescription of No.2(Pre-No.2)against coronavirus disease 2019(COVID-19)by network pharmacology method.Methods The target proteins of effective components and active compounds in Pre-No.2 were screened by searching the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).A component-target-disease interaction network of Pre-No.2 was constructed by Cytoscape 3.7.2,gene ontology(GO)analysis,and Kyoto encyclopedia of genes and genomes(KEGG)analysis of target protein pathway by DAVID.Results A total of 163 compounds and 278 target protein targets in Pre-No.2 were collected from the TCMSP database.Kaempferol,wogonin,7-methoxy-2-methyl isoflavone,formononetin,isorhamnetin,and licochalcone A were the most frequent targets in the regulatory network.GO enrichment analysis showed that Pre-No.2 regulated response to virus,viral processes,humoral immune responses,defense responses to virus and viral entry into host cells.KEGG enrichment analysis showed that the formula regulated the NF-κB signaling pathway,B cell receptor signaling pathway,viral carcinogenesis,T cell signaling pathway and FcγR-mediated phagocytosis signaling pathway.Conclusions Pre-No.2 may play a preventive role against COVID-19 through regulation of the Toll-like signaling,T cell signaling,B cell signaling and other signaling pathways.It may regulate the immune system to protect against anti-influenza virus.