Clinical efficacy of tocilizumab treatment in severe and critical COVID-19 patients

BACKGROUND The main pathophysiological basis of coronavirus disease 2019(COVID-19)causing respiratory failure is a cytokine storm and interleukin-6(IL-6)is an important component of the COVID-19 cytokine storm.As a specific antagonist of IL-6,tocilizumab may block the cytokine storm of COVID-19.The Diagnosis and Treatment Guidelines of New Coronavirus Pneumonia(7 th Edition)includes tocilizumab as a recommended drug for immunotherapy in severe and critical COVID-19 patients.However,the specific clinical efficacy of tocilizumab in the treatment of COVID-19 patients is worth studying.AIM To determine the clinical efficacy of tocilizumab in inhibiting the cytokine storm in COVID-19.METHODS In total,19 severe and critical COVID-19 patients were enrolled in this study,and were treated with tocilizumab in Optical Valley Campus of Hubei Maternal and Child Health Care Hospital from February 20 to March 31,2020.The imaging manifestations and clinical data before and after treatment were analyzed retrospectively,including routine peripheral venous blood tests,routine blood biochemical tests,coagulation test,C-reactive protein(CRP),IL-6,and arterial blood gas analysis.RESULTS Of the 19 patients in this group,13(68.4%)had significantly improved symptoms of COVID-19(5 patients were discharged directly and 8 patients were transferred after improvement)following treatment.One case was invalid,1 case was exacerbated,and 4 deaths(21.1%)were observed(all critical cases).The lymphocyte count,CRP,lactic acid,oxygenation index,fibrinogen(FIB)and IL-6 levels were significantly different in the improved group.CONCLUSION Tocilizumab treatment is effective against IL-6 in COVID-19 patients,but it does not completely inhibit the inflammation and cytokine storm in all patients with COVID-19.In the clinical treatment of COVID-19 patients,attention should be paid to the timing of drug administration and other adjuvant treatments.

手术治疗背部巨大窦道1例

国际伤口愈合学会将慢性创面定义为不能通过正常有序而且及时的修复过程达到解剖和功能上完整状态的创面[1]。临床一般指由各种原因所致,经过1个月以上治疗未能愈合,且无愈合倾向的创面[2]。近年来,慢性创面患者越来越多,而治疗方法各式各样,疗效各不相同,现就1 例背部巨大窦道患者通过手术治愈病例报道如下。

Giant cutaneous squamous cell carcinoma of the popliteal fossa skin:A case report

BACKGROUND Cutaneous squamous cell carcinoma(cSCC)is a common malignant hyperplasia of the skin epithelium.However,cSCC progressing to giant squamous cell carcinoma of the popliteal fossa skin has not been reported.We used full-thickness skin graft from the lower left quadrant of the abdomen to reconstruct the popliteal fossa skin defect in our patient.CASE SUMMARY A 64-year-old woman presented with a 3-year history of a progressively enlarged integumentary tumor located on her left popliteal fossa,which was surgically treated.The resultant defect(15 cm×25 cm)was repaired using full-thickness skin graft from the lower left quadrant of the abdomen.CONCLUSION Full-thickness skin graft is a good choice to repair popliteal fossa defect.

Systemic treatment for severe concentrated sulfuric acid burns in an adult male at high altitude:A case report

BACKGROUND The aim of this study was to report a case of a patient who suffered from severe concentrated sulfuric acid burns while working at high altitude.This patient recovered after systemic treatment.We also provide a literature review for a better understanding of the disease.CASE SUMMARY A 30-year-old male,who was working in a local chemical plant in Xining at an altitude of 2261 m,suffered from 85%burns(Ⅲ°70%,deep Ⅱ°15%)after a tank containing 80%concentration of sulfuric acid exploded.The patient immediately received a series of first aid treatments,as well as rigorous wound managements after admission,which included protection for the whole body and organs,prevention and treatment of eye burns,and the appropriate oxygen therapy.After 65 d of treatment,the burn wounds had completely healed,and the patient was transferred to another specialized hospital for further eye treatment.The first aid before admission and the emergency treatment of wounds following admission were appropriate.No severe complications of sepsis,severe renal insufficiency,septic costal chondritis,corneal perforation or other burns occurred during the treatment.CONCLUSION The main causes of concentrated sulfuric acid burns consisted of accidental burns at work,accidents in the outside,factitious injuries and improper laboratory operations.The clinical manifestations were mostly deep Ⅱ°and Ⅲ°burns,with a formation of brown-black,leather-like eschar on the wound surface and locally embolized dendrite-like vessels.The clear cause of the injury and typical clinical manifestations in this case made it easy to diagnosis.However,adult cases with severe concentrated sulfuric acid burns in high altitude areas are rare,so the successful treatment of this case is of great significance.