Material basis and pharmacodynamic mechanism of YangshenDingzhi granules in the intervention of viral pneumonia:Based on serum pharmacochemistry and network pharmacology

Background:YangshenDingzhi granules(YSDZ)are clinically effective in preventing and treating COVID-19.The present study elucidates the underlying mechanism of YSDZ intervention in viral pneumonia by employing serum pharmacochemistry and network pharmacology.Methods:The chemical constituents of YSDZ in the blood were examined using ultraperformance liquid chromatography-quadrupole/orbitrap high-resolution mass spectrometry(UPLC-Q-Exactive Orbitrap MS).Potential protein targets were obtained from the SwissTargetPrediction database,and the target genes associated with viral pneumonia were identified using GeneCards,DisGeNET,and Online Mendelian Inheritance in Man(OMIM)databases.The intersection of blood component-related targets and disease-related targets was determined using Venny 2.1.Protein-protein interaction networks were constructed using the STRING database.The Metascape database was employed to perform enrichment analyses of Gene Ontology(GO)functions and Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathways for the targets,while the Cytoscape 3.9.1 software was utilized to construct drug-component-disease-target-pathway networks.Further,in vitro and in vivo experiments were performed to establish the therapeutic effectiveness of YSDZ against viral pneumonia.Results:Fifteen compounds and 124 targets linked to viral pneumonia were detected in serum.Among these,MAPK1,MAPK3,AKT1,EGFR,and TNF play significant roles.In vitro tests revealed that the medicated serum suppressed the replication of H1N1,RSV,and SARS-CoV-2 replicon.Further,in vivo testing analysis shows that YSDZ decreases the viral load in the lungs of mice infected with RSV and H1N1.Conclusion:The chemical constituents of YSDZ in the blood may elicit therapeutic effects against viral pneumonia by targeting multiple proteins and pathways.

To explore the mechanism of Fuyang Jiebiao granules against viral pneumonia based on network pharmacology and pharmacodynamics

Objective:To investigate the mechanism of Fuyang Jiebiao granule(FYJBKL)in the treatment of viral pneumonia.Methods:Firstly,a network model was constructed using network pharmacology to study the target expression sites of FYJBKL viral pneumonia,so as to determine the main targets and important signal transduction pathways for the treatment of viral pneumonia.Secondly,the main components of the drug and the main target are docked.Then,the fever,sweating and inflammation rat models were established to explore the antipyretic,sweating and anti-inflammatory mechanisms of FYJBKL.Finally,the contents of IL-17,IL-1β,TNF-αand IL-6 in blood samples of rats were analyzed by ELISA method,and the morphological changes of lung tissue were observed by HE staining.Results:Quercetin,luteolin,kaempferol,etc.,and the main mechanism targets are IL-17,IL-1β,TNF-α,IL-6 and so on.Thirty signal pathways were identified by KEGG enrichment analysis,including interleukin-17 signaling pathway(IL-17 signaling pathway),human cytomegalovirus infection pathway(human cytomegalovirus infection),Kaposi's sarcoma associated herpesvirus infection pathway(Kaposi's sarcoma-as-sociated herpesvirus infection)and so on.After the study of molecular docking,we found that the contact efficiency between active substances and possible key targets is good.The high and middle concentration groups of FYJBKL significantly decreased the expression of IL-17,IL-1β,TNF-αand IL-6 in the blood of rats with inflammation(P<0.05).FYJBKL significantly reduced the foot swelling induced by egg white and inhibited the increase of body temperature induced by yeast in rats(P<0.05).HE staining showed that FYJBKL improved pulmonary fibrosis and inflammatory exudation to varying degrees.Conclusion:The effects of FuyangJiebiao granules on the related signal pathways of anti-virus,anti-immune and anti-inflammation as well as biological and cellular processes may be caused by the binding of quercetin,luteolin,kaempferol and other active ingredients to their shared targets.Fuyang Jiebiao granules can improve the related symptoms caused by viral pneumonia,and its mechanism may be related to the activities of TNF,IL-17,IL-6 and other related channels,which are multiple targets of inflammation regulation.

Efficacy of budesonide/formoterol inhalation powder in treating viral pneumonia in children

BACKGROUND Respiratory viruses are increasingly detected in children with communityacquired pneumonia.Further strategies to limit antibiotic use in children with viral pneumonia are warranted.AIM To explore clinical efficacy of budesonide/formoterol inhalation powder for viral pneumonia in children and its impact on cellular immunity and inflammatory factor production.METHODS A total of 60 children with viral pneumonia were recruited:30 receiving budesonide/formoterol inhalation powder and 30 conventional symptomatic treatment.Outcome measures included peripheral blood levels of inflammatory cytokines,CD4^(+),CD8^(+),Th1,Th2,Th17 and Treg,clinical efficacy,and incidence of adverse reactions.RESULTS Compared with the control group,the observation group showed a significant reduction in interleukin-6 and high-sensitivity C-reactive protein levels after treatment.Compared with the control group,the observation group showed a significant increase in CD4^(+)/CD8^(+)and Th1/Th2 levels,and a decrease in Th17/Treg levels after treatment.The total effective rates in the observation group and the control group were 93.75%and 85.00%,respectively,which was a significant difference(P=0.003).CONCLUSION Budesonide/formoterol inhalation powder significantly improved therapeutic efficacy for viral pneumonia in children.The mechanism of action may be related to downregulation of the inflammatory response and improved cellular immune function.

The Performance of Extracorporeal Membrane Oxygenation in Various Viral Pneumonia Pandemics: A Meta-Analysis and Systematic Review

Objective: To compare the effects of extracorporeal membrane oxygenation (ECMO) and routine mechanical ventilation on mortality and the risk of associated adverse events in patients with severe viral pneumonia. Methods: PubMed, the Cochrane Library, Embase, Web of Science, and other databases were searched to collect case-control or cohort studies on prognoses associated with ECMO treatment for viral pneumonia. Search terms included extracorporeal membrane oxygenation, ECMO, viral pneumonia, COVID-19, influenza, MERS, and others. According to the PICOS principle, two evaluators independently screened the literature, extracted the data, cross-checked the data, and extracted the data again. Two researchers evaluated the risk of bias in the included studies according to the Newcastle-Ottawa Scale (NOS) and cross-checked the results. Meta-analysis was performed using RevMan 5.3 software. Results: Nine studies were included for analysis, encompassing a total of 4,330 patients, which were categorized into ECMO and CMV groups. There were no significant differences between the two groups in most baseline data;however, the ECMO group had a lower oxygenation index, and some studies reported higher SOFA scores in the ECMO group compared to the CMV group. There was no significant difference in in-hospital mortality between the two groups. The length of ICU stay, total hospital stay, and total mechanical ventilation time were longer in the ECMO group than in the CMV group. In terms of adverse events, there was no significant difference in the occurrence of kidney injury between the two groups. Bleeding events were reported in two studies, with more bleeding events occurring in the ECMO group. According to the subgroup analysis of different virus types, there were no statistical differences in the above aspects among patients with swine flu, novel coronavirus, and MERS. Conclusion: ECMO has a certain degree of positive significance in the treatment of severe viral pneumonia, but there is no significant difference in the treatment outcome of ECMO across different epidemic periods. The timing of ECMO treatment, patient management, and withdrawal evaluation still need further research.

COVID-19 or non-COVID viral pneumonia:How to differentiate based on the radiologic findings?

Influenza viruses were responsible for most adult viral pneumonia.Presently,coronavirus disease 2019(COVID-19)has evolved into serious global pandemic.COVID-19 outbreak is expected to persist in months to come that will be synchronous with the influenza season.The management,prognosis,and protection for these two viral pneumonias differ considerably and differentiating between them has a high impact on the patient outcome.Reverse transcriptase polymerase chain reaction is highly specific but has suboptimal sensitivity.Chest computed tomography(CT)has a high sensitivity for detection of pulmonary disease manifestations and can play a key-role in diagnosing COVID-19.We reviewed 47 studies and delineated CT findings of COVID-19 and influenza pneumonia.The differences observed in the chest CT scan can be helpful in differentiation.For instance,ground glass opacities(GGOs),as the most frequent imaging finding in both diseases,can differ in the pattern of distribution.Peripheral and posterior distribution,multilobular distribution,pure or clear margin GGOs were more commonly reported in COVID-19,whereas central or peri-bronchovascular GGOs and pure consolidations were more seen in influenza A(H1N1).In review of other imaging findings,further differences were noticed.Subpleural curvilinear lines,sugar melted sign,intra-lesional vascular enlargement,reverse halo sign,and fibrotic bands were more reported in COVID-19 than H1N1,while air space nodule,tree-in-bud,bronchiectasia,pleural effusion,and cavitation were more seen in H1N1.This delineation,when combined with clinical manifestations and laboratory results may help to differentiate these two viral infections.

Xiaochaihu decoction alleviates viral pneumonia by regulating macrophage polarization

Background:In this investigation,we sought to evaluate the benefits of Xiaochaihu decoction(XCHD)on polyinosinic:polycytidylic acid-induced viral pneumonia in mice and elucidate its mechanisms of action.Method:A viral pneumonia model was established in mice using polyinosinic:polycytidylic acid,with mice being intragastrically administered different doses of XCHD.The benefits of XCHD therapy for mice with viral pneumonia were assessed by determining the weight ratio of lung tissue,wet-to-dry,overall protein concentrations,and total cell counts in bronchoalveolar lavage fluid,and hematoxylin and eosin staining of lung tissues.By determining the interleukin-1βlevels,interleukin-6,tumor necrosis factor-alpha,nitric oxide,interleukin-10,and interleukin-4,and the mRNA and protein expression of nitric oxide synthase 2,arginase-1,and macrophage mannose receptor 1 in bronchoalveolar lavage fluid,we assessed consequences of XCHD on macrophage polarization with mice suffering from viral pneumonia.Results:XCHD was found to significantly reduce lung tissue wet-to-dry and the total protein content and total number of cells of bronchoalveolar lavage fluid,while ameliorating pathological modifications to the lung tissues of rodents suffering from viral pneumonia,thereby indicating that this medicinal preparation has a healing impact on model mice with viral pneumonia.In addition,XCHD was found to reduce the magnitudes of interleukin-1β,interleukin-6,tumor necrosis factor-alpha,and nitric oxide and the mRNA and protein manifestation of nitric oxide synthase 2,and promote an increase in the levels of interleukin-10 and interleukin-4 and the mRNA and protein expression of arginase-1 and macrophage mannose receptor 1,thereby indicating that XCHD can favorably mediate polarization of macrophages in mice with viral pneumonia.Conclusion:XCHD has notable therapeutic effects on viral pneumonia in mice,the fundamental workings of action of which may be connected to regulation of macrophage polarization.

The efficacy and safety of anti-humidification traditional Chinese medicine in the treatment of viral pneumonia: A meta-analysis

Objective A meta-analysis was used to evaluate the efficacy and safety of traditional Chinese medicine(TCM)for dispelling dampness in the treatment of viral pneumonia.Methods The databases of CNKI,CBM,WanFang data,VIP,EMBASE,PubMed,and Cochrane library were searched,and the clinical trials of dispelling dampness TCM in the treatment of viral pneumonia were selected.The retrieval period is from the establishment of the database to December 2022.Stata 17.0 software was used to perform meta-analysis,and review manager 5.3 software was used to assess the risk of bias.Overall efficacy was evaluated by OR,and improvement in major clinical symptoms were evaluated by RR.Results A total of 20 randomized controlled trials were included,with a total of 2136 patients,including 1180 patients in the experimental group and 956 patients in the control group.Meta-analysis showed that TCM for dispelling dampness could significantly improve the efficacy of viral pneumonia patients[OR=2.652,95%CI=(2.187,3.217),Z=9.908,P<0.05];The child with abnormal lung X-rays returned to normal after treatment[RR=4.23,95%CI=(2.42,7.42),Z=5.04,P<0.05];In addition,patients had fewer adverse reactions to dispelling dampness TCM,and the safety of the trial was good.Conclusion This Meta-analysis further clarified the efficacy of TCM for dispelling dampness in the treatment of viral pneumonia by combining clinical data and has suggestive significance for the treatment of novel coronavirus pneumonia.

Comparison of acute pneumonia caused by SARS-CoV-2 and other respiratory viruses in children:a retrospective multi-center cohort study during COVID-19 outbreak

Background:Until January 18,2021,coronavirus disease-2019(COVID-19)has infected more than 93 million individuals and has caused a certain degree of panic.Viral pneumonia caused by common viruses such as respiratory syncytial virus,rhinovirus,human metapneumovirus,human bocavirus,and parainfluenza viruses have been more common in children.However,the incidence of COVID-19 in children was significantly lower than that in adults.The purpose of this study was to describe the clinical manifestations,treatment and outcomes of COVID-19 in children compared with those of other sources of viral pneumonia diagnosed during the COVID-19 outbreak.Methods:Children with COVID-19 and viral pneumonia admitted to 20 hospitals were enrolled in this retrospective multi-center cohort study.A total of 64 children with COVID-19 were defined as the COVID-19 cohort,of which 40 children who developed pneumonia were defined as the COVID-19 pneumonia cohort.Another 284 children with pneumonia caused by other viruses were defined as the viral pneumonia cohort.The epidemiologic,clinical,and laboratory findings were compared by Kolmogorov-Smirnov test,t-test,Mann-Whitney U test and Contingency table method.Drug usage,immunotherapy,blood transfusion,and need for oxygen support were collected as the treatment indexes.Mortality,intensive care needs and symptomatic duration were collected as the outcome indicators.Results:Compared with the viral pneumonia cohort,children in the COVID-19 cohort were mostly exposed to family members confirmed to have COVID-19(53/64 vs.23/284),were of older median age(6.3 years vs.3.2 years),and had a higher proportion of ground-glass opacity(GGO)on computed tomography(18/40 vs.0/38,P<0.001).Children in the COVID-19 pneumonia cohort had a lower proportion of severe cases(1/40 vs.38/284,P=0.048),and lower cases with high fever(3/40 vs.167/284,P<0.001),requiring intensive care(1/40 vs.32/284,P<0.047)and with shorter symptomatic duration(median 5d vs.8d,P<0.001).The proportion of cases with evaluated inflammatory indicators,biochemical indicators related to organ or tissue damage,D-dimer and secondary bacterial infection were lower in the COVID-19 pneumonia cohort than those in the viral pneumonia cohort(P<0.05).No statistical differences were found in the duration of positive PCR results from pharyngeal swabs in 25 children with COVID-19 who received antiviral drugs(lopinavir-ritonavir,ribavirin,and arbidol)as compared with duration in 39 children without antiviral therapy(median 10d vs.9d,P=0.885).Conclusions:The symptoms and severity of COVID-19 pneumonia in children were no more severe than those in children with other viral pneumonia.Lopinavir-ritonavir,ribavirin and arbidol do not shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19.During the COVID-19 outbreak,attention also must be given to children with infection by other pathogens infection.

Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan,China:A Retrospective Multicenter Cohort Study

Currently,little in-depth evidence is known about the application of extracorporeal membrane oxygenation(ECMO)therapy in coronavirus disease 2019(COVID-19)patients.This retrospective multicenter cohort study included patients with COVID-19 at 7 designated hospitals in Wuhan,China.The patients were followed up until June 30,2020.Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning.Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation(IMV)-only therapy.Of 88 patients receiving ECMO therapy,27 and 61 patients were and were not successfully weaned from ECMO,respectively.Additionally,15,15,and 65 patients were further weaned from IMV,discharged from hospital,or died during hospitalization,respectively.In the multivariate logistic regression analysis,a lymphocyte count≤0.5×10^(9)/L and D-dimer concentration>4×the upper limit of normal level at ICU admission,a peak PaCO_(2)>60 mmHg at 24 h before ECMO initiation,and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning.In the propensity scorematched analysis,a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group.The presence of lymphocytopenia,higher D-dimer concentrations at ICU admission and hypercapnia before ECMO initiation could help to identify patients with a poor prognosis.Tracheotomy could facilitate weaning from ECMO.ECMO relative to IMV-only therapy was associated with improved outcomes in critically ill COVID-19 patients.

Epidemiological and clinical characteristics of 65 hospitalized patients with COVID-19 in Liaoning, China

BACKGROUND Coronavirus disease 2019(COVID-19)has spread rapidly to multiple countries through its infectious agent severe acute respiratory syndrome coronavirus 2.The severity,atypical clinical presentation,and lack of specific anti-viral treatments have posed a challenge for the diagnosis and treatment of COVID-19.Understanding the epidemiological and clinical characteristics of COVID-19 cases in different geographical areas is essential to improve the prognosis of COVID-19 patients and slow the spread of the disease.AIM To investigate the epidemiological and clinical characteristics and main therapeutic strategy for confirmed COVID-19 patients hospitalized in Liaoning Province,China.METHODS Adult patients(n=65)with confirmed COVID-19 were enrolled in this retrospective study from January 20 to February 29,2020 in Liaoning Province,China.Pharyngeal swabs and sputum specimens were collected from the patients for the detection of severe acute respiratory syndrome coronavirus 2 nucleic acid.Patient demographic information and clinical data were collected from the medical records.Based on the severity of COVID-19,the patients were divided into nonsevere and severe groups. All patients were followed until March 20,2020.RESULTSThe mean age of 65 COVID-19 patients was 45.5 ± 14.4 years, 56.9% were men,and 24.6% were severe cases. During the 14 d before symptom onset, 25 (38.5%)patients lived or stayed in Wuhan, whereas 8 (12.3%) had no clear history ofexposure. Twenty-nine (44.6%) patients had at least one comorbidity;hypertension and diabetes were the most common comorbidities. Compared withnonsevere patients, severe patients had significantly lower lymphocyte counts[median value 1.3 × 10^(9)/L (interquartile range 0.9-1.95) vs 0.82 × 10^(9)/L (0.44-1.08),P < 0.001], elevated levels of lactate dehydrogenase [450 U/L (386-476) vs 707 U/L(592-980), P < 0.001] and C-reactive protein [6.1 mg/L (1.5-7.2) vs 52 mg/L (12.7-100.8), P < 0.001], and a prolonged median duration of viral shedding [19.5 d (16-21) vs 23.5 d (19.6-30.3), P = 0.001]. The overall median viral shedding time was19.5 d, and the longest was 53 d. Severe patients were more frequently treatedwith lopinavir/ritonavir, antibiotics, glucocorticoid therapy, immunoglobulin,thymosin, and oxygen support. All patients were discharged following treatmentin quarantine.CONCLUSIONOur findings may facilitate the identification of severe cases and inform clinicaltreatment and quarantine decisions regarding COVID-19.

Qingfei oral liquid downregulates TRPV1 expression to reduce airway inflammation and mucus hypersecretion injury caused by respiratory syncytial virus infection and asthma in mice

Objective:Qingfei oral liquid(QF),an experimental Chinese medicine prescription developed from the ancient priscription of traditional Chinese medicines Ma Xin Shi Gan decoction and Tingli Dazao Xie Fei decoction,has been effectively used since decades to treat patients with viral pneumonia and asthma.In our previous study,we had demonstrated that QF can significantly reduce airway hyperresponsiveness,hyperemia,lung tissue edema,inflammatory lung tissue infiltration in mice,airway mucus secretion,and peripheral airway collagen hyperplasia;however,its mechanism of action is unknown.Methods:Fifty 6–8-week-old male BALB/c mice were equally and randomly divided into five groups:the control,ovalbumin(OVA),OVA+respiratory syncytial virus(RSV),QF,and dexamethasone(Dxms)groups.The QF group was administered QF at 1.17 g·kg−1·d−1,the Dxms group received dexamethasone injections at 0.2 mg·kg−1·d−1,and the remaining groups were administered PBS.Inflammation in the lung tissue was assessed by hematoxylin and eosin(HE),periodic acid–Schiff(PAS),and Van Gieson staining.ELISA was used to evaluate the IL-13,IL-25,and IL-33 in the mice.Western blotting was used to examine changes in the proteins levels of transient receptor potential vanilloid-1(TRPV1)and mucin 5AC(MUC5AC)in the lung tissues of mice.Results:Histopathological evaluation revealed that the OVA and OVA+RSV groups exhibited lung tissue edema and inflammatory lung tissue infiltration in the HE staining and airway secretions in the PAS staining;collagen hyperplasia around the airway was increased in these two groups compared with the control group.The QF group exhibited significantly reduced lung tissue edema,inflammatory lung tissue infiltration,airway secretions,and collagen hyperplasia around the airway compared with the OVA+RSV group.We analyzed the serum levels of IL-13,IL-25,and IL-33 in the mice and found that these levels were higher in the OVA and OVA+RSV groups than in the control group(P<0.05 in the OVA group,P<0.01 in the OVA+RSV group).The QF group exhibited significantly decreased serum levels of IL-13,IL-25,and IL-33 compared with the OVA+RSV group(all P<0.05).The Dxms group also exhibited significant decreases in the serum levels of IL-13 and IL-33(all P<0.05)but no significant decrease in the serum levels of IL-25 compared with the RSV+OVA group.Finally,we examined the protein levels of TRPV1 and MUC5AC in the lung tissues of mice using Western blotting.After identifying RSV infection in the mice with asthma,the protein levels of TRPV1 and MUC5AC in the lung tissues of mice were significantly higher than those in the control group(P<0.05,P<0.01).We found that compared with RSV+OVA,QF can significantly downregulate the protein level of TRPV1;further,the protein level of MUC5AC was also significantly reduced(all P<0.001).Conclusion:QF can inhibit RSV replication and reduce airway inflammation and mucus hypersecretion injury caused by RSV infection and asthma,and its mechanism of action may be associated with the downregulation of TRPV1 expression and a decrease in airway mucus hypersecretion injury.

Current status quo on COVID-19 including chest imaging

With each day the number coronavirus disease 2019(COVID-19)cases continue to rise rapidly and our imaging knowledge of this disease is expeditiously evolving.The role of chest computed tomography(CT)in the screening or diagnosis of COVID-19 remains the subject of much debate.Despite several months having passed since identifying the disease,and numerous studies related to it,controversy and concern still exists regarding the widespread use of chest CT in the evaluation and management of COVID-19 suspect patients.Several institutes and organizations around the world have released guidelines,recommendations and statements against the use of CT for diagnosing or screening COVID-19 infection and advocating its use only for those cases with a strong clinical suspicion of complication or an alternate diagnosis.However,these guidelines and recommendations are in disagreement with majority of the widely available literature,which strongly favour CT as a pivotal tool in the early diagnosis,management and even follow-up of COVID-19 infection.This article besides comprehensively reviewing the current status quo on COVID-19 disease in general,also writes upon the current consensus statements/recommendations on the use of diagnostic imaging in COVID-19 as well as highlighting the precautions and various disinfection procedures being employed world-wide at the workplace to prevent the spread of infection.

Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review

Objective To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2(COVID-19),SARS-CoV(SARS)and MERS-CoV(MERS)using a systemic review.Methods Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19,SARS and MERS pneumonia respectively.Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists.Vote-counting method was employed to include cases of each group.Data of patients’manifestations in early chest CT including lesion patterns,distribution of lesions and specific imaging signs for the three groups were extracted and recorded.Data were compared and analyzed using SPSS 22.0.Results A total of 24 studies were included,composing of 10 studies of COVID-19,5 studies of MERS and 9 studies of SARS.The included CT exams were 147,40,and 122 respectively.For the early CT features of the 3 pneumonias,the basic lesion pattern with respect to"mixed ground glass opacity(GGO)and consolidation,GGO mainly,or consolidation mainly"was similar among the 3 groups(χ^2=7.966,P>0.05).There were no significant differences on the lesion distribution(χ^2=13.053,P>0.05)and predominate involvement of the subpleural area of bilateral lower lobes(χ^2=4.809,P>0.05)among the 3 groups.The lesions appeared more focal in COVID-19 pneumonia at early phase(χ^2=23.509,P<0.05).The proportions of crazy-paving pattern(χ^2=23.037,P<0.001),organizing pneumonia pattern(P<0.05)and pleural effusions(P<0.001)in COVID-19 pneumonia were significantly lower than the other two.Although rarely shown in the early CT findings of all three viral pneumonias,the fibrotic changes were more frequent in SARS than COVID-19 and MERS(χ^2=6.275,P<0.05).For other imaging signs,only the MERS pneumonia demonstrated tree-in-buds,cavitation,and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia(χ^2=22.412,P<0.05).No pneumothorax,pneumomediastinum and lymphadenopathy was present for each group.Conclusions Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns,including GGO and consolidation,bilateral distribution,and predominant involvement of the subpleural area and the lower lobes.Early signs of COVID-19 pneumonia showed less severity of inflammation.Early fibrotic changes appeared in SARS only.MERS had more severe inflammatory changes including cavitation and pleural effusion.The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

Predictive Score for Pulmonary Ultrasound and Factors Associated to Mortality and Hospitalization during the Covid-19 Pandemic

Pulmonary ultrasound is a non-invasive bedside resource that has showed to be useful for the assessment of patients presenting with respiratory insufficiency as well as the diagnosis of several pleural and other pulmonary pathologies. The pulmonary ultrasound score (LUS) is a semi quantitative scale that measures the loss of pulmonary aeration cause by many pathologic conditions. Our primary objective was to describe factors associated to death and hospitalization in patients aged 16 or older that were admitted to the emergency department (ED) with signs or symptoms of COVID-19 infection through the diagnosis of viral pneumonia with pulmonary ultrasound (PU). It was a cohort retrospective study through a one-year period. Emergency physicians performed lung ultrasounds and calculated LUS. Results: 672 patients suspected of COVID-19 infection with a PU finding of viral pneumonia were included. 495 patients had a positive COVID-19 PCR test, 73.6% of the population. 258 patients presented with high probability of COVID-19 pneumonia following the patterns in PU. 55% were male with a median age of 45 years old. The average LUS score at admission was 8. Global hospitalization rate was 51.5%, 7.5% were admitted to the ICU. Patients with a LUS > 10 had a mortality of 6%, and patients admitted to the ICU had a 50% mortality rate. They presented with an average LUS score at admission of 15.2. Conclusions: LUS was a good predictor of death, hospitalization to general ward or ICU of patients with COVID-19 admitted from the emergency department.

Experimental study on pharmacodynamics of pudilan xiaoyan oral liquid for preventing and treating respiratory virus infection

Background:Pudilan Xiaoyan Oral Liquid(PDL),a famous traditional Chinese formula for treating acute and chronic inflammation.To evaluate the broad-spectrum antiviral effect of Pudilan Xiaoyan Oral Liquid,and provide a basis for clinical medication.Methods:Its inhibitory effect on different respiratory viruses was observed by cytopathic test.The potential mechanism of the anti-influenza effect was determined by neuraminidase activity.In order to observe the therapeutic effect of PDL on viral pneumonia caused by different respiratory viruses.The viral pneumonia model was established by nasal infection with different respiratory viruses,and then PDL was given Therapeutic and prophylactically to evaluate its pharmacodynamic activity in vivo.Results:The results of in vitro experiments showed that PDL had different inhibitory effects on cytopathic effects caused by different respiratory viruses.And it has obvious inhibitory effect on the neuraminidase activity of influenza A virus,which indicates that it exerts anti-influenza virus effect by inhibiting neuraminidase activity of influenza virus.The results in vivo showed that PDL exhibited an inhibitory effect on pulmonary index(PI)and effectively reduced the degree of lesions in the lungs.The lethal rate of mice was significantly decreased while survival time of mice was dramatically increased by PDL treatment in comparison to infection control,respectively.Conclusions:Our study demonstrates that PDL had a significant protection and treatment effect for respiratory virus infection in vitro and in vivo.

“Pulmonary target sign” as a diagnostic feature in chest computed tomography of COVID-19

BACKGROUND In chest computed tomography(CT)scan,bilateral peripheral multifocal groundglass opacities,linear opacities,reversed halo sign,and crazy-paving pattern are suggestive for coronavirus disease 2019(COVID-19)in clinically suspicious cases,but they are not specific for the diagnosis,as other viral pneumonias,like influenza and some viral pneumonia may show similar imaging findings.AIM To find a specific imaging feature of the disease would be a welcome guide in diagnosis and management of challenging cases.METHODS Chest CT imaging findings of 650 patients admitted to a university Hospital in Tehran,Iran between January 2020 and July 2020 with confirmed COVID-19 infection by RT-PCR were reviewed by two expert radiologists.In addition to common non-specific imaging findings of COVID-19 pneumonia,radiologic characteristics of“pulmonary target sign”(PTS)were assessed.PTS is defined as a circular appearance of non-involved pulmonary parenchyma,which encompass a central hyperdense dot surrounded by ground-glass or alveolar opacities.RESULTS PTS were presented in 32 cases(frequency 4.9%).The location of the lesions in 31 of the 32 cases(96.8%)was peripheral,while 4 of the 31 cases had lesions both peripherally and centrally.In 25 cases,the lesions were located near the pleural surface and considered pleural based and half of the lesions(at least one lesion)were in the lower segments and lobes of the lungs.22 cases had multiple lesions with a>68%frequency.More than 87%of cases had an adjacent bronchovascular bundle.Ground-glass opacities were detectable adjacent or close to the lesions in 30 cases(93%)and only in 7 cases(21%)was consolidation adjacent to the lesions.CONCLUSION Although it is not frequent in COVID-19,familiarity with this feature may help radiologists and physicians distinguish the disease from other viral and noninfectious pneumonias in challenging cases.

Pandemic and modern medicine:Time to recognize and correct previous misconceptions

A sudden increase in the number of viral pneumonias with the onset of the COVID-19 pandemic revealed defects in the provision of medical care for acute pneumonia in the lungs.Localization of the inflammatory process and its functional consequences indicate the identity of all forms of acute pneumonia,regardless of the etiology,and the need to develop treatment principles based on the pathogenesis of the disease.

Evaluation by Survival Analysis on Effect of Traditional Chinese Medicine in Treating Children with Respiratory Syncytial Viral Pneumonia of Phlegm-Heat Blocking Fei Syndrome

Objective:To objectively evaluate the clinical effect of traditional Chinese medicine in treating children s respiratory syncytial viral pneumonia(RSVP) of phlegm-heat blocking Fei(肺) syndrome(PHBFS). Methods:A single-blinded multi-center,blocked,randomized and parallel-controlled method was adopted.The clinical study was carried out on 206 children with RSVP-PHBFS who were assigned to two groups,108 in the test group treated through intravenous dripping of Qingkailing Injection(清开灵注射液) in combination of or...

Analysis of antibiotic usage for viral community-acquired pneumonia in adults

The rationale for the antibiotic treatment of viral community-acquired pneumonia(CAP)in adults was analyzed to develop a clinical reference standard for this condition.Clinical data from 166 patients diagnosed with viral pneumonia across 14 hospitals in Beijing from November 2010 to December 2017 were collected.The indications for medications were evaluated,and the rationale for the use of antibiotics was analyzed.A total of 163(98.3%)patients with viral pneumonia were treated with antibiotics.A combination of C-reactive protein(CRP)and procalcitonin(PCT)was used as markers to analyze the possible indications for antibiotic use.With threshold levels set at 0.25µg/L for PCT and 20 mg/L for CRP,the rate of unreasonable use of antibiotics was 55.2%.By contrast,at a CRP level threshold of 60 mg/L,the rate of antibiotic misuse was 77.3%.A total of 39 of the 163(23.9%)patients did not meet the guidelines for drug selection for viral CAP in adults.The unreasonable use of antibacterial drugs for the treatment of viral CAP in adults is a serious concern.Clinicians must reduce the unnecessary use of antibiotics.

Xiyanping Injection in Treatment of Viral Pneumonia in Children: A Meta-analysis of Random Control Trials

Objective To evaluate the efficacy and safety of Xiyanping Injection in the treatment of viral pneumonia in children. Methods We searched several databases, including Pub Med, CNKI, VIP and Wanfang Data（January— June, 2014）. The references of all selected studies were also retrieved to collect the relevantly randomized controlled trials（RCTs） on Xiyanping Injection for viral pneumonia in children. Two authors screened the literatures in accordance with the inclusive criteria, extracted the data and assessed the methodological quality of the included studies. We used Rev Man 5.2 software for meta-analysis. Results Meta-analysis on the 10 included RCTs showed that the effective rates of defervescing and vanishing of the rashes and cough in the Xiyanping Injection group were better than those in the Ribavirin Injection group. There was no significant difference between the two groups in the incidence of adverse drug reaction. Conclusion The existing research indicated that Xiyanping Injection is a secure and efficient scheme for viral pneumonia in children. Because of the poor quality of present researches, these results should be verified by strictly-designed and large-scale sample RCTs.