Corticosteroids Treatment of Patients with Coronavirus Disease 2019:A Propensity Score Matching Study

The role of corticosteroids in the treatment of coronavirus disease 2019(COVID-19)is controversial.In the present study,we evaluated the effects of adjuvant corticosteroids treatment on the outcome of patients with COVID-19(n=966),using Propensity Score Matching to adjust for potential differences between the corticosteroids group(n=289)and the non-corticosteroids group(n=677).Analysis of data without adjusting differences in baseline characteristics indicated that the proportion of mechanical ventilation and the mortality was higher in the corticosteroids treatment group in total or severe/critical patients.The duration of viral shedding was longer in the non-corticosteroids treatment group in total or general/mild patients.After adjusting the difference between the corticosteroids and non-corticosteroids treatment group,the analysis revealed that the use of corticosteroids had no effect on the duration of viral shedding,in-hospital mortality or 28-day mortality.

Hope During the COVID-19 Epidemic Decreased Anxiety and Depression Symptoms Mediated by Perceived Stress:Coping Style Differences Among Patients with COVID-19

Objective:This study aimed to investigate whether perceived stress mediated the relationship between hope and anxiety/depression symptoms among patients with COVID-19 during the epidemic.In addition,the potential moderating effect of coping styles was examined.Methods:From February 26 to March 10,2020,patients with COVID-19 were asked to complete a questionnaire online,which included demographic characteristics,as well as the SCL-90-Anxiety,SCL-90-Depression,Chinese Perceived Stress Scale(CPSS),Herth Hope Index(HHI),and Trait Coping Style Questionnaire(TCSQ).Hierarchical linear regression was performed to explore independent factors of anxiety/depression.A multi-group structural equation modeling with the collected data from patients in the Negative Coping style(NC)group and Positive Coping style(PC)group was used to test the hypothesized mechanism.Results:In total,382 valid questionnaires of patients were obtained,including 96 from NC patients and 286 from PC patients.In the hierarchical linear regression,hope and perceived stress were independent risk factors for both anxiety and depression in the total sample and PC group.However,hope was not independently related to anxiety/depression in the NC group.As hypothesized,the hope of patients had significant and negative indirect effects on both anxiety and depression that were mediated by perceived stress,However,the direct effect from stress on anxiety and depression was stronger for NC patients than for PC patients.Besides,hope had significant direct effects on anxiety/depression in PC patients,but not in NC patients.Conclusion:During the COVID-19 epidemic,perceived stress could mediate the relationship between hope and anxiety/depression symptoms among COVID-19 patients,with coping style moderating this cultivation process.

Co-infection of SARS-COV-2 and Influenza A Virus:A Case Series and Fast Review

Coronavirus disease 2019(COVID-19)occurs in the influenza season and has become a global pandemic.The present study aimed to examine severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)co-infection with influenza A virus(IAV)in an attempt to provide clues for the antiviral interventions of co-infected patients.We described two patients who were co-infected with SARS-CoV-2 and IAV treated at Wuhan Union Hospital,China.In addition,we performed a review in PubMed,Web of Science and CNKI(from January 1 up to November 1,2020)with combinations of the following key words:“COVID-19,SARS-COV-2,influenza A and co-infection”.A total of 28 co-infected patients were enrolled in the analysis.Of the 28 patients,the median age was 54.5 years(IQR,34.25–67.5)and 14 cases(50.0%)were classified as severe types.The most common symptoms were fever(85.71%),cough(82.14%)and dyspnea(60.71%).Sixteen patients had lymphocytopenia on admission and 23 patients exhibited abnormal radiological changes.The median time from symptom onset to hospital admission was 4 days(IQR,3–6),and the median time of hospital stay was 14 days(IQR,8.5–16.75).In conclusion,patients with SARSCOV-2 and IAV co-infection were similar to those infected with SARS-COV-2 alone in symptoms and radiological images.SARS-COV-2 co-infection with IAV could lead to more severe clinical condition but did not experience longer hospital stay compared with patients infected with SARSCOV-2 alone.

Neuroprotective effect of Cerebralcare Granule after cerebral ischemia/reperfusion injury

Cerebralcare Granule（CG） improves cerebral microcirculation and relieves vasospasm,but studies investigating its therapeutic effect on cerebral ischemia/reperfusion injury are lacking.In the present study,we administered CG（0.3,0.1 and 0.03 g/m L intragastrically） to rats for 7 consecutive days.We then performed transient occlusion of the middle cerebral artery,followed by reperfusion,and administered CG daily for a further 3 or 7 days.Compared with no treatment,high-dose CG markedly improved neurological function assessed using the Bederson and Garcia scales.At 3 days,animals in the high-dose CG group had smaller infarct volumes,greater interleukin-10 expression,and fewer interleukin-1β-immunoreactive cells than those in the untreated model group.Furthermore,at 7 days,high-dose CG-treated rats had more vascular endothelial growth factor-immunoreactive cells,elevated angiopoietin-1 and vascular endothelial growth factor expression,and improved blood coagulation and flow indices compared with untreated model animals.These results suggest that CG exerts specific neuroprotective effects against cerebral ischemia/reperfusion injury.

White matter connection's damage,not cortical activation, leading to language dysfunction of mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes

Mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes (MELAS) is a metabolic disorder characterized by hyperlactic acidemia and stroke-like symptoms.

Evaluation of PIMA Point-of-care CD4 Analyzer in Yunnan, China

Background： CD4 count is used to determine antiretroviral therapy （ART） eligibility. In China, flow cytometers are mostly located in urban areas with limited access by patients residing in remote areas. In an attempt to address this issue, we conducted a study to validate the performance ofAlere PIMA point-of-care CD4 analyzer. Methods： Venous and finger-prick blood specimens were collected from HIV-positive participants from two voluntary counseling and testing sites in Yunnan Province. Both venous and finger-prick blood specimens were tested with the PIMA analyzer. Venous blood specimens tested with the Becton Dickinson FACSCalibur were used as a reference. Results： Venous specimens from 396 and finger-prick specimens from 387 persons were available for analysis. CD4 counts by PIMA correlated well with those from FACSCalibur with an R2 of 0.91 for venous blood and 0.81 for finger-prick blood. Compared to FACSCalibur, the PIMA analyzer yielded lower counts with a mean bias of- 47.0 cells/μl （limit of agreement, [LOA]： -204-110 cells/μl） for venous blood and -71.0 cells/μl （LOA： -295-153 cells/μl） for finger-prick blood. For a CD4 threshold of 350 cells/μl, the positive predictive value （PPV） of PIMA was 84.2% and 75.7% and the negative predictive value （NPV） was 97.6% and 95.8% for venous and finger-prick blood, respectively. For an ART threshold of 500 cells/μl, the corresponding PPV was 90.3% and 84.0% and NPV was 94.3% and 93.4%, respectively. Conclusions： CD4 counting using venous blood with PIMA analyzers is a feasible alternative to a large flow cytometer to determine ART eligibility.

Pretreatment HIV drug resistance in adults initiating antiretroviral therapy in China,2017

Background:After the scale-up of antiretroviral therapy(ART)for HIV infected people,increasing numbers of patients have pretreatment drug resistance(PDR).In this study,the prevalence of PDR was evaluated in adults initiating antiretroviral therapy in China.Methods:Blood samples were obtained from 1943 patients who initiated antiretroviral therapy(ART)in 2017 from 13 provinces or cities in China.Pol sequences were used to analyze drug resistance and construct transmission networks.Logistic regression model was used to estimate the potential factors associated with PDR.Results:In total,1711 eligible patients(76.0%male;87.8%aged≥25 years)were included,of which 117(6.8%)had PDR.The highest rates of PDR were 12.2%in Liangshan Prefecture of Sichuan and 9.3 and 8.9%in Dehong and Lincang Prefecture of Yunnan.A multivariate logistic regression analysis revealed that PDR was significantly higher among intravenous drug users(adjusted Odds Ratio(aOR)=2.64,95%CI:1.57–4.44)and individuals from Liangshan,Dehong,and Lincang(aOR=2.04,95%CI:1.26–3.30).In total,754 sequences were used to generate 164 transmission networks.Five transmission networks had two or three sequences containing the same mutations,two networks contained subjects from Liangshan,and one network contained subjects from Dehong.Conclusions:Overall,the PDR prevalence was moderate,with a particularly high prevalence in areas with severe HIV epidemics.These results indicate the importance of continuous PDR monitoring in patients initiating antiretroviral therapy.