Objective:With the increasing use of a peripherally inserted central catheter(PICC)in clinical application,the breaking of the PICC is increasing as well,which would turn into the emboli and drift to the heart and pul...Objective:With the increasing use of a peripherally inserted central catheter(PICC)in clinical application,the breaking of the PICC is increasing as well,which would turn into the emboli and drift to the heart and pulmonary artery,causing severe consequences.However,few cases have been reported on the rescue of patients with a broken PICC.Patient concerns:A 33-year-old man,diagnosed with chronic hepatitis B-related decompensated cirrhosis and cryptococcal meningitis,was treated with amphotericin B combined with flucytosine and fluconazole by means of PICC catheterization.The patient was discharged with a catheter;when he returned for re-examination,a 50cm length of PICC broke and slipped into the vein after his sudden dysphoria.First aid was immediately administered,and then the intervention therapy to extricate the tube,including pulmonary artery angiography and intravascular removal of foreign matter,was performed based on the consensus of the in-hospital vein treatment group.At last,the broken PICC fragment was successfully taken out of the vessel.Re-examination after surgery showed that he recovered well.Conclusions:Once the catheter is broken,the X-ray examination should be performed at the first instance and re-examined frequently.Moreover,the involvement of a multidisciplinary team should be formed to decide the appropriate method of treatment to ensure a successful rescue.展开更多
SARS-CoV-2 induced marked lymphopenia in severe patients with COVID-19.However,whether lymphocytes are targets of viral infection is yet to be determined,although SARS-CoV-2 RNA or antigen has been identified in T cel...SARS-CoV-2 induced marked lymphopenia in severe patients with COVID-19.However,whether lymphocytes are targets of viral infection is yet to be determined,although SARS-CoV-2 RNA or antigen has been identified in T cells from patients.Here,we confirmed that SARS-CoV-2 viral antigen could be detected in patient peripheral blood cells(PBCs)or postmortem lung T cells,and the infectious virus could also be detected from viral antigen-positive PBCs.We next prove that SARS-CoV-2 infects T lymphocytes,preferably activated CD4+T cells in vitro.Upon infection,viral RNA,subgenomic RNA,viral protein or viral particle can be detected in the T cells.Furthermore,we show that the infection is spike-ACE2/TMPRSS2-independent through using ACE2 knockdown or receptor blocking experiments.Next,we demonstrate that viral antigen-positive T cells from patient undergone pronounced apoptosis.In vitro infection of T cells induced cell death that is likely in mitochondria ROS-HIF-1a-dependent pathways.Finally,we demonstrated that LFA-1,the protein exclusively expresses in multiple leukocytes,is more likely the entry molecule that mediated SARS-CoV-2 infection in T cells,compared to a list of other known receptors.Collectively,this work confirmed a SARS-CoV-2 infection of T cells,in a spike-ACE2-independent manner,which shed novel insights into the underlying mechanisms of SARS-CoV2-induced lymphopenia in COVID-19 patients.展开更多
文摘Objective:With the increasing use of a peripherally inserted central catheter(PICC)in clinical application,the breaking of the PICC is increasing as well,which would turn into the emboli and drift to the heart and pulmonary artery,causing severe consequences.However,few cases have been reported on the rescue of patients with a broken PICC.Patient concerns:A 33-year-old man,diagnosed with chronic hepatitis B-related decompensated cirrhosis and cryptococcal meningitis,was treated with amphotericin B combined with flucytosine and fluconazole by means of PICC catheterization.The patient was discharged with a catheter;when he returned for re-examination,a 50cm length of PICC broke and slipped into the vein after his sudden dysphoria.First aid was immediately administered,and then the intervention therapy to extricate the tube,including pulmonary artery angiography and intravascular removal of foreign matter,was performed based on the consensus of the in-hospital vein treatment group.At last,the broken PICC fragment was successfully taken out of the vessel.Re-examination after surgery showed that he recovered well.Conclusions:Once the catheter is broken,the X-ray examination should be performed at the first instance and re-examined frequently.Moreover,the involvement of a multidisciplinary team should be formed to decide the appropriate method of treatment to ensure a successful rescue.
基金the Natural Science Foundation of China(excellent scholars 81822028,82041013,and 81772199 to P.Z.,and 81974456 and 82170081 to H.L.Z.)Strategic Priority Research Program of the CAS(grant number XDB29010204)to P.Z.
文摘SARS-CoV-2 induced marked lymphopenia in severe patients with COVID-19.However,whether lymphocytes are targets of viral infection is yet to be determined,although SARS-CoV-2 RNA or antigen has been identified in T cells from patients.Here,we confirmed that SARS-CoV-2 viral antigen could be detected in patient peripheral blood cells(PBCs)or postmortem lung T cells,and the infectious virus could also be detected from viral antigen-positive PBCs.We next prove that SARS-CoV-2 infects T lymphocytes,preferably activated CD4+T cells in vitro.Upon infection,viral RNA,subgenomic RNA,viral protein or viral particle can be detected in the T cells.Furthermore,we show that the infection is spike-ACE2/TMPRSS2-independent through using ACE2 knockdown or receptor blocking experiments.Next,we demonstrate that viral antigen-positive T cells from patient undergone pronounced apoptosis.In vitro infection of T cells induced cell death that is likely in mitochondria ROS-HIF-1a-dependent pathways.Finally,we demonstrated that LFA-1,the protein exclusively expresses in multiple leukocytes,is more likely the entry molecule that mediated SARS-CoV-2 infection in T cells,compared to a list of other known receptors.Collectively,this work confirmed a SARS-CoV-2 infection of T cells,in a spike-ACE2-independent manner,which shed novel insights into the underlying mechanisms of SARS-CoV2-induced lymphopenia in COVID-19 patients.
