基于COVID 19传播特性的传染病模型的构建与研究

为了更好地揭示新冠肺炎(COVID 19)的传播机理,通过分析新冠病毒(2019 nCoV)的传播特性,考虑隐性潜伏者的自愈以及潜伏者的提前隔离,引入“入院隔离状态”,“隐性治愈状态”,考虑防控强度的变化,引入“发病状态”,提出了SEAIHR动力学模型。利用真实疫情数据,考虑不同阶段参数的变化,进行了多模型对比试验。实验结果表明,SEAIHR模型拟合和预测精度有明显提升,较经典模型在疫情前中期降低了34.4%~72.8%拟合误差,为疫情防控提供了参考与指导。

驱动压指导的肺保护性通气策略对COVID 19感染康复期患者术后发生肺部并发症的影响

目的探究驱动压指导的肺保护性通气策略(LPVS)预防新冠感染康复期患者术后肺部并发症(PPCs)的价值,为优化术中呼吸管理提供临床依据。方法选择2022年12月~2023年2月经历新冠病毒感染,年龄≥18岁,ASA I~III级,择期在全身麻醉下行非心脏手术患者118例,采用计算机随机分为两组(每组59例)。LPVS组设VT为6 mL/kg,呼气末正压(PEEP)采用驱动压指导个体化滴定,每隔30 min进行1次肺复张;对照组采取常规机械通气。主要比较两组患者PPCs和低氧血症的发生风险,肺部超声评分等结局指标。结果两组患者一般资料比较,差异无统计学意义(P>0.05)。LPVS组患者PPCs发生率(16.95%vs 35.59%,χ^(2)=5.294,P=0.021)、低氧血症发生率(15.25%vs 30.51%,χ^(2)=3.890,P=0.049)及肺部超声评分(5.31±1.07 vs 8.32±2.34,t=8.986,P<0.001)均低于对照组;LPVS组患者PEEP值、气道压及平台压高于对照组(P<0.05),驱动压和潮气量低于对照组(P<0.05)。结论驱动压指导的肺保护性通气策略可改善新冠感染康复患者氧合,降低术后肺部并发症发生风险。

How Can Lean Manufacturing Lead the Manufacturing Sector during Health Pandemics Such as COVID 19: A Multi Response Optimization Framework

Lean manufacturing has been used for the last few decades as a process and performance improvement tool.Initially known as Toyota production system(TPS),lean is now used in almost all service and manufacturing sectors to deliver favorable results such as decreased operational cost,increased customer satisfaction,decreased cycle time,and enhanced profits.During the coronavirus disease(COVID 19)pandemic,the manufacturing sector struggled immensely and could not function well even after lockdown was eased in many countries.Many companies found out there are not ready to conform with new regulations made by authorities in many countries.This paper proposes the use of simulation and multi response optimization in addition to other typical lean tools in order to arrive at optimum performance at the end of each project through an established optimization framework.The framework is used in a real case study performed at an aluminum extrusion factory.Lean manufacturing helps organizations to operate with smaller number of resources.It standardizes all processes so that most of the jobs can be done by most of the workers,but this is not enough to create a healthy,sanitized work place.Our framework utilizes the strengths of lean tools and adds pandemic readiness factor to them to ensure improvement in performance and health pandemic readiness.Implementation of the framework in the case company resulted in 50%reduction in labor,$730000 in expected annual cost savings,reduction in inventory levels,improved employee morale and the achievement of pandemic ready status.

Normal Body Temperature and Negative Covid 19 Questionnaire Sufficient Prior to Diagnostic Neurological Testing to Prevent Covid 19 Transmission to Health Personnel

The aim of this study was to find a simple and effective way to screen patients for Covid 19, prior to them being submitted to neurophysiological or neuro-psycholoigical testing in order to protect employees from being infected during the pandemic from patient contact. On May 18, 2020 when Michigan, a critically affected pandemic area, reopened for medical business after lockdown declared by the Governor on March 23, 2020, medical personnel in our office-which is an academic neurology practice-EEG and sleep technicians, medical Assistants, physician assistants and myself fretted about potential Covid 19 transmission during neuro-diagnostic procedures-EEG, video-EEG, ambulatory EEG, PSG, MSLT, CPAP titration, neuropsychological testing, EMG/NCV, VNG/Balance test and autonomic testing including the tilt table test, which require an intimate patient contact and risk of exposure. We screened all unselected and consecutive patients who were scheduled for neuro-diagnostic testing in our facility by infrared thermometer, a standard Covid 19 questionnaire and a single Covid 19 PCR nasal/throat swab prior to these tests. 542 consecutive unselected neurological or sleep/wake disorder patients aged 18 - 90, 65% males, 35% females were tested over six months as a part of this project. A total of 1109 diagnostic tests were performed. No test was limited in scope or duration. Standard PPE precautions were still taken despite the negative screening, room door left open and relatives’ presence limited during the test procedure. All were afebrile and negative on questionnaire and only 3 were found to be positive for Covid 19 PCR, indicating that a negative infrared temperature reading and a standard Covid 19 questionnaire is over 99 percent effective in prescreening for intimate neurological diagnostic testing. The technician, administering most of these tests, never contracted the virus. The technician collecting the nasal/throat swab never contracted the virus. One PA, two sleep technicians and one medical assistant came down with Covid 19 but were all felt to have contracted that from domestic exposure from family members or friends and not when at the job. All had mild disease and rapidly recovered. Infrared temperature testing and standard Covid 19 questionnaire are sufficient prior to intimate neuro-diagnostic testing when combined with standard PPE precautions to limit exposure to Covid 19 in medical personnel in a neurology office with on-site diagnostic testing.

The Effect of the COVID 19 Pandemic on Elective Surgical Services in Jos, North Central, Nigeria

Background. The COVID 19 pandemic affected healthcare delivery systems worldwide. There was a redistribution of health care resources in order to deal with the effects of the pandemic, with a corresponding consequence on other clinical services rendered. The extent of this effect on other non COVID 19 related services has been reported in other centres worldwide. In our own setting, health care resources are limited with suboptimal access even in normal situations. Objective. We sought to evaluate the effects of the COVID 19 pandemic on elective surgical services in our hospital. Methods. This was a cross sectional comparative study carried out at the Jos University Teaching hospital, (North central, Nigeria) of the elective surgical services rendered during the first wave of the COVID 19 pandemic lockdown covering the period April to June 2020 with a corresponding period of the preceding year 2019. Data was obtained from the hospital records department, theatres and service areas for clinic attendance, elective surgeries and ward occupancy. The paired sample t-test was used to compare the assessed variables across the three months of both years with a level of significance of P < 0.05. Results. There was mean clinic attendance of 2859.33 ± 223.36 covering the three months in 2019 as against a mean attendance of 648.67 ± 578.24 covering a similar period in 2020, P = 0.037. The elective surgical procedures carried out across the surgical specialties over the period in 2019 gave a mean of 352.33 ± 44.60 as opposed to 64.001 ± 7.32 over the corresponding period in 2020, P = 0.018. Ward occupancy over April to June 2019 was a mean 297.33 ± 18.58 across the various surgical wards and 158.33 ± 25.70 in the same period in 2020, P = 0.007. Conclusion. There was a significant reduction in the elective surgical services rendered in the hospital during the first wave of the COVID 19 pandemic compared to a corresponding period in the preceding year. This decline in elective surgical services would have negatively affected the access to health care. Thus measures to clear the backlog of elective surgical procedures would be required.

Is Cancer Still the Villain, Even during COVID 19 Outbreak?

Background :Anxiety and depression are two common psychiatric conditions encountered in cancer treatment. Prevalence rate and risk factors show wide variations in different countries and the environment. COVID 19 outbreak has increased psychological disorders in general public and health workers. Whether this pandemic has increased the psychiatric morbidity in cancer patients needs to be addressed for planning strategies. Methods: This cross-sectional study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in the state of Kerala, India. The aim was to assess hospital prevalence and risk factors of anxiety and depression among cancer patients during COVID 19 pandemic. Patients on treatment for cancer and willing for the study were recruited. Hospital Anxiety and Depression Scale (HADS), a self-assessment valid tool for screening both anxiety (HADS-A) and depression (HADS-D) are used. HADS-A & D were calculated separately & categorized as normal, borderline and abnormal with a score of 0 - 7, 8 - 10 & 11 - 21 respectively. Separate structured questionnaire for COVID19 related questions and patient master file for patient & treatment characteristics were used in risk assessment. Data were entered in an Excel sheet and SPSS version 22 for statistical analysis. Findings: 208 patients were included in this study. The overall prevalence rate of anxiety was 7.2%, with borderline cases 4.3% and abnormal cases 2.9%. The overall prevalence of the rate of depression was 5.3% (3.4% borderline & 1.9% abnormal). Risk factors like age, sex, socioeconomic status, primary site, stage of the disease and default of disease had no statistical significance. Interpretation: The prevalence rate of anxiety and depression among cancer patients in this study is one among the lowest ever reported. COVID 19 outbreak has not brought any impact in the rate of psychological distress in our patients and the low rate may be due to the robust medical care including mental health interventions and reassurance by the Government.

Telehealth Combined with Differentiated ART Delivery Improves ART Pick Up during COVID 19 at a Large HIV Treatment Facility in Trinidad and Tobago

Objective: To describe the implementation and outcomes of using telehealth in combination with a differentiated ART delivery model to improve HIV antiretroviral therapy pick up at a large treatment facility in Trinidad and Tobago during COVID-19. Design and Methods: Beginning in April 2020, a list of patients was generated daily prior to their scheduled ART appointments. Nurses, doctors and social workers conducted telephone consultations to first screen patients for COVID-19 symptoms, conducted brief medical and behavioural health screenings, and helped patients to identify barriers to ART retention. Patients were recommended for 1) fast track ART refill collection at facility, 2) community ART refills, and 3) ART pick-up through patient peers. The uptake and outcomes of telehealth and ART pick up were compared with the corresponding period in 2019. Data was analyzed using SPSS 21.0. Results: During the period April-June 2020, 1361 patients were identified for telephone consultations, 1084 (80%) were successfully contacted and 984 patients (88%) participated in phone session. The independent t test showed a significant increase in ART pick-up when compared to the corresponding period in 2019. 59% of patients collected via fast-track ART refill, 30% had community refills, and 11% pick-up medications through patient peers. Conclusion: Telehealth is an integral component of DSD as part of the COVID-19 response at the MRF. Understanding the medium and longer-term outcomes of Telehealth can provide additional insights on the scale up of telehealth as a component of DSD to improve ART outcomes for patients in the context of the developing countries of the Caribbean.

A Year to Evaluate the Neonatal and Obstetric Outcome in Covid 19 Positive Pregnant Women in Abu Dhabi UAE

Covid 19 epidemic has caused a lot of concern especially in the obstetric and neonatal populations. The fact that it is a new disease and the fact that there are sparse studies available have doubled our worries. Our study provides some answers. This a retrospective study carried out in Mediclinic Al-Noor hospital in Abu Dhabi. Our study revealed no adverse effects on the neonates and no vertical transmission. Given the physiologic and immune function changes in pregnancy, they might be considered at a higher risk of developing more complications, but it needs a longer duration of the study with larger sample size. Statistical analysis could not be possible in our study due to the smaller sample size, and we plan to continue the study further in the future to obtain a larger pool of data to validate the findings more accurately. The incidence of covid positive mothers might not reflect today’s covid situation because we carried out the study during the lockdown and there might be an increase in the incidence after lockdown.

COVID 19知识图谱构建与应用研究

为方便科研人员了解COVID 19的致病机理、人体免疫、药物治疗和疫苗研发等科研动态,本文对COVID 19知识图谱进行构建与应用研究。采用半自动化知识图谱构建方法,设计构建流程,搭建COVID 19知识图谱模式层。从核心医学期刊、核心中医药期刊、权威药物数据库及百科等数据源获取数据,并采用爬虫爬取和人工结合的方法进行数据获取、解析和存储工作。同时,基于Neo4J构建COVID 19科学文献知识图谱、中药治疗知识图谱和西药治疗知识图谱,并实现知识图谱的融合。为保证知识图谱的质量,对知识图谱三元组进行统计与校验,实现知识图谱质量控制,并在COVID 19知识图谱的数据基础上,进行中药方剂频次分析、中药材频次分析、中药有效成分频次分析及西药研究热度分析。分析结果表明,麻杏石甘汤、疏风解毒胶囊、连花清瘟方是中医临床中常用于治疗新冠肺炎的中药方剂;而Remdesivir、Chloroquine、Darunavir是研究热度最高的新冠临床治疗西药。说明COVID 19知识图谱在中药有效成分挖掘、中药方剂潜在作用机制研究、药物相互作用等方面都具有研究价值。该研究在弘扬传统中医药文化、推进中医现代化、探索中药方剂的有效成分和潜在作用机制等方面具有重要意义。

法院、调解和COVID 19(上)

法律实践的根本在于适应人类社会不断变化的现实需求。2019年底暴发的新冠肺炎疫情(COVID-19)要求律师、法院、法官以及参与司法系统的其他人员(ADR从业者)重新评估他们如何在快速变化的环境中发挥作用,这一环境要求他们使用远程操作技术,然而这些技术工具原本并不是为了支持司法部门工作而开发的。虽然不同法域的法院和ADR从业者应对COVID-19的措施大不相同,但大多采用的是临时性的危机管理办法。在这种情况下,一贯怠于革新的司法部门迫切需要思考,如何运用技术确保司法系统既能够在不加剧拖延的情况下完成工作,又能够在纠纷呈指数增长的情况下确保经济复苏。面对这些压力,本文试图在先前技术发展的基础上为法院和ADR服务如何应对COVID-19探索相关路径。考虑到某些法域的应对措施几乎每天都在变化,因此,作者所考察的某些应对措施可能随着法院和其他部门的不断革新已经发生了改变。

COVID 19 Diagnostic Tests: A Study of 12,270 Patients to Determine Which Test Offers the Most Beneficial Results

COVID 19 has caused capitulation from healthcare entities all over the world. First described in Hubei, China, the virus has spread to 185 countries, showing little signs of eradication or eradication. There does not exist a medical treatment regimen or a vaccine to address COVID 19 definitively. The best response, to date, has been early diagnosis and immediate isolation or quarantine of the patient, with supportive care. As medical institutions all around the world struggle to keep up with this pandemic, there is not a consensus amongst medical professionals in the rapid diagnosis of this disease entity. Purpose: The purpose of our study was to review the literature and establish a test, or tests, that would aid the clinician in attaining a swift, yet accurate diagnosis. Methods: We searched PubMed and Google scholar and reviewed 32 articles. Keyword searches consisted of COVID 19, pandemic, diagnoses, diagnostic testing, pandemic amongst others. We compared the data obtained from these studies in an effort to find the best diagnostic test. Results: There were a total of 12,270 patients that were in our study [1]-[32]. This is the largest study to date in the literature addressing diagnosis of COVID 19. Fever, cough and fatigue, in that respective order were the most common clinical symptoms. Laboratory findings consisted of leukopenia, elevated erythrocyte sedimentation (ESR) and elevated C-reactive protein, CRP. The gold standard test described in multiple studies was the RT-PCR. Serum assays of IgM and IgG were also drawn and found to be accurate in 93% of the time. CT Chest was both sensitive and specific, 90% and 86%. This diagnostic imaging was even more successful when coupled with clinical symptoms and approaching days 7 - 12 since the onset of clinical symptoms. Discussion: This is the largest study compiled to address diagnostic testing in COVID 19 patients. The patient population is spread vastly around the world, with access to many reported tests limited in certain countries. Given the significant sensitivity and specificity of diagnostic imaging, in the setting of clinical symptoms, we recommend patient undergo CT Chest in the face of COVID 19 exposure and clinical symptoms. While RT-PCR, IgM-IgG assays are beneficial, isolation, treatment, and possible quarantine of presumptive positive COVID 19 patients (based upon clinical symptoms and imaging) should not be delayed, for fear of increased infectivity and further risk to society at large.

新型冠状病毒感染(COVID-19)流行期间妊娠期肝生化指标异常情况分析

目的分析比较新型冠状病毒感染(COVID-19)流行期和非COVID-19流行期孕妇的肝生化指标异常情况。方法回顾性分析2017年10月—2022年3月北京大学第一医院产科出院的肝生化指标ALT、AST、GGT、TBil、总胆汁酸中至少一项异常的孕妇共539例次。按照COVID-19流行期和非流行期两组分析患者的病因、凝血指标、转氨酶、胆汁酸、肾功能。计量资料两组间比较采用独立样本t检验,计数资料两组间比较采用χ^(2)检验。结果非COVID-19流行期产科出院患者中262例次肝生化指标异常,占同期产科出院患者的1.46%,COVID-19流行期为277例次,占比1.73%,差异有统计学意义(χ^(2)=3.947,P=0.047)。两个时期肝生化指标异常患者病因分析提示,四种妊娠期特有肝病(妊娠剧吐、子痫前期和子痫、妊娠期肝内胆汁淤积症、妊娠期急性脂肪肝)的比例,差异均无统计学意义(P值均>0.05)。COVID-19流行期的妊娠肝生化指标异常的患者中肌酐及估算的肾小球滤过率均正常的比例与非COVID-19流行期相比无统计学意义(86.78%vs 87.90%,χ^(2)=0.141,P=0.708)。COVID-19流行期和非流行期ALT达到正常值上限5倍以上的比例分别为7.94%和9.54%(χ^(2)=0.433,P=0.511);重度胆汁淤积(总胆汁酸>40μmol/L)的比例分别为7.75%和9.27%(χ^(2)=0.392,P=0.531),差异均无统计学意义。COVID-19流行期产科出血的比例较非流行期明显下降,分别为14.61%和24.19%(χ^(2)=489.334,P<0.001)。结论COVID-19流行期妊娠期肝生化指标异常的患者中,妊娠期特有肝病的比例较非流行期无差别。COVID-19流行期这些患者中肌酐及估算的肾小球滤过率均正常的比例无变化。

基于CiteSpace及VOSviewer的COVID-19相关心律失常的文献计量学分析

目的:分析新型冠状病毒感染(COVID-19)相关心律失常的文献,探索该领域的研究现状、热点并预测未来的趋势,为后来的研究者提供借鉴。方法:选择Web of Science的核心合集数据库,每项研究都进行了文献计量和视觉分析,使用CiteSpace和VOSviewer软件生成知识图谱。结果:共鉴定出768篇文章,发文涉及美国、意大利和中国为首的319个国家/地区和4 366个机构,领先的研究机构是梅奥诊所和哈佛医学院。New England Journal of Medicine是该领域最常被引用的期刊。在6 687位作者中,Arbelo Elena撰写的研究最多,Guo T被共同引用的次数最多,心房纤颤是最常见的关键词。结论:随着COVID-19的暴发,对COVID-19所致新发/进行性心律失常事件的研究蓬勃发展,未来的研究者可能会对COVID-19感染后新发或遗留的快速性心律失常/缓慢性心律失常的发生机制进行进一步的探索。

脐带血造血干细胞移植患者合并COVID-19的临床特征分析

目的:探讨脐带血造血干细胞移植患者合并新型冠状病毒感染的临床特点及治疗策略,从而提升此类患者的临床诊疗水平。方法:回顾性分析16例脐带血移植患者的一般情况、临床诊断、新型冠状病毒感染特征、细胞植活时间、治疗方案以及预后。结果:15例患者以发热伴咳嗽为首发症状,均为轻型,1例为中型。14例患者造血干细胞顺利植活并出仓,1例继发植入失败但桥接同胞异基因造血干细胞移植,1例死亡。结论:新型冠状病毒感染增加了脐带血干细胞移植的难度,但仍需要更多临床数据进一步佐证。

Noninvasive Respiratory Strategies in Patients with Acute Hypoxemic Respiratory Failure and COVID-19 in Gabon: A Prospective Observational Study

Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO2/FiO2 ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanical ventilation is a risk factor for death.

基于SEAIQR模型与Dropout-LSTM模型的西安市COVID-19疫情趋势预测

目的基于传染病动力学SEAIQR(susceptible-exposed-asymptomatic-infected-quarantined-removed)模型和Dropout-LSTM(Dropout long short term memory network)模型预测西安市新型冠状病毒肺炎(COVID-19)疫情的发展趋势,为评估“动态清零”策略防控效果提供科学依据。方法考虑到西安市本轮疫情存在大量的无症状感染者、依时变化的参数以及采取的管控举措等特点,构建具有阶段性防控措施的时变SEAIQR模型。考虑到COVID-19疫情数据的时序性特征及它们之间的非线性关系,构建深度学习Dropout-LSTM模型。选用2021年12月9日-2022年1月31日西安市新增确诊病例数据进行拟合,用2022年2月1日-2022年2月7日数据评估预测效果,计算有效再生数(R_(t))并评价不同参数对疫情发展的影响。结果SEAIQR模型预测的新增确诊病例拐点预计在2021年12月26日出现,约为176例,疫情将于2022年1月24日实现“动态清零”,模型R^(2)=0.849。Dropout-LSTM模型能够体现数据的时序性与非线性特征,预测出的新增确诊病例数与实际情况高度吻合,R^(2)=0.937。Dropout-LSTM模型的MAE和RMSE均较SEAIQR模型低,说明预测结果更为理想。疫情暴发初期,R 0为5.63,自实施全面管控后,R_(t)呈逐渐下降趋势,直到2021年12月27日降至1.0以下。随着有效接触率不断缩小、管控措施的提早实施及免疫阈值的提高,新增确诊病例在到达拐点时的人数将会持续降低。结论建立的Dropout-LSTM模型实现了较准确的疫情预测,可为COVID-19疫情“动态清零”防控决策提供借鉴。

COVID-19诊疗信息、中医证型分布及组方用药规律的文献研究

目的利用数据挖掘技术深入探究新型冠状病毒感染(COVID-19,简称新冠感染)患者的诊断、中医证型分布以及药物使用规律,以期为中医药治疗新冠感染提供有效的参考依据。方法通过搜索,可以获取来自国家卫生健康委员会和全国各地的《新型冠状病毒肺炎诊疗方案》内涉及的中医证型和中医药防治方案,以及中国生物医学文献服务系统、知网、维普、万方数据库收录的治疗新冠感染相关文献共249份。对文献通过筛选、整理和去重并建立中药复方数据库、诊疗信息数据库、证型数据库,运用频数分析、频率分析进行探究。结果新冠感染患者常见的症状频数较高的为咳嗽、咽干咽痛、发热、纳差、乏力;大多数患者呈淡红舌、红舌,脉象为滑脉、滑数脉;中医证型频数较高的有湿毒郁肺证、湿热蕴肺证、肺脾气虚证、寒湿郁肺证、气阴两伤证、兼夹瘀血证。此外,共纳入491首治疗新冠感染中药复方,涉及中药227味,得到高频中药共64个,药物类别以清热药、补益药、解表药、化痰止咳平喘药、化湿药为主;药性以温、平、寒为主,药味以甘、辛、苦为主,归经中归肺、脾、胃经中药居多;聚类分析结果根据中药性能将治疗新冠感染的高频药物聚为8类较好。结论中医药治疗新型冠状病毒感染用药具有以下特点:补益药用药次数较多体现攻邪不忘扶正;解表、清热、攻下、化湿、利湿、渗湿药物俱全体现多种逐邪之法;药类以清热药、补益药、化湿药、化痰止咳平喘药、解表药为主,彰显新冠感染基本治法为清热化湿、止咳平喘、补养气阴。可为指导临床用药及研发新药提供一定的参考与借鉴。

集成磁共振成像技术评估COVID-19康复患者神经损伤

【目的】应用集成磁共振成像技术(SyMRI)评估COVID-19康复患者脑灰质微结构的改变。【方法】29例COVID-19康复患者分为重症患者组(SG=11例)和普通患者组(OG=18例),选取年龄、性别、体质指数(BMI)和教育年限相匹配的健康志愿者作为健康对照组(HC=23例)。所有受试者均行SyMRI扫描,生成T1、T2定量图谱,利用自动解剖标记(AAL)模板将T1和T2图谱分割成90个感兴趣区(ROIs)。通过对ROI内的所有体素进行平均得到每个ROI的T1、T2弛豫值。分析比较三组间90个脑区的T1、T2值。【结果】HC相比,SG在双侧眶内额上回、双侧海马旁回、双侧豆状壳核、双侧颞中回、双侧颞下回、左侧眶部额上回、左侧眶部额下回、左侧直回、左侧前扣带与旁扣带脑回、右侧内侧和旁扣带脑回、左侧后扣带回、左侧缘上回的T2值显著升高(P<0.05);与OG相比,SG在左侧直回、左侧海马旁回、双侧颞中回、双侧颞下回的T2值显著升高(P<0.05)。与HC相比SG在双侧眶内额上回、左侧直回、左侧前扣带和旁扣带脑回、右侧后扣带回、左侧海马旁回、左侧舌回、左侧豆状壳核、左侧丘脑的T1值显著升高(P<0.05);与OG相比,SG在右侧后扣带回、右侧距状裂周围皮层、左侧豆状壳核的T1值显著升高(P<0.05)。【结论】COVID-19患者即使在康复后脑灰质微结构仍可能存在持续性或迟发性损伤,且损伤程度与病情严重程度相关;SyMRI可作为一项敏感的工具评估中枢神经系统(CNS)微结构损伤情况,有助于早期临床诊断。

低频脉冲磁场诱导TRPC1改善COVID-19患者康复期下肢的肌肉无力症状

背景:肌肉无力是新型冠状病毒(COVID-19)感染后的常见症状,影响康复期人体日常活动能力。在强度1.5 mT,频率3300 Hz的低频脉冲磁场刺激下可通过诱导和激活经典瞬时感受器电位通1(classical transient receptor potential channel 1,TRPC1),提升人体骨骼肌的最大自主收缩力与力量耐力,对肌肉组织产生一系列生理支持效应,该手段是否会改善新型冠状病毒肺炎患者康复期的肌无力症状尚无研究。目的:选用低频脉冲磁场对新型冠状病毒肺炎患者下肢肌群进行磁刺激,以观察该刺激对新型冠状病毒肺炎患者康复期下肢肌群肌无力改善的影响。方法:招募胶体金法抗原检测试剂(COVID-19)为阳性并伴有肌肉无力症状的新型冠状病毒(奥密克戎毒株)感染患者14例,将所有受试者随机分成2组,分别为接受磁场刺激的试验组和接受假治疗的对照组。试验总时长3周,试验组每隔48 h对腿部进行低频脉冲磁刺激,对照组与试验组干预流程一致但给予假刺激,两组患者均不被告知磁刺激仪器是否运行,两组患者共进行9次操作,随后观察两组患者下肢局部肌群最大自主收缩力、腿部爆发力与力量耐力的变化情况。结果与结论:①在采集的8个局部肌群中,试验组患者7个局部肌群在经过3周的低频脉冲磁场刺激,最大自主收缩力值均增长。对照组除3个肌群最大自主收缩力自行增长改善以外,其他肌群肌力无提升。②试验组的左腿前群与双腿后群提升率显著高于对照组。③两组的纵跳摸高高度与膝关节峰值角速度相比试验前测均提升,试验组摸高高度提升率高于对照组。④在疲劳状态下,试验组膝关节峰值角速度下降率显著下降,对照组膝关节峰值角速度下降率无显著性变化;试验组摸高高度下降率显著下降,而对照组摸高高度下降率无显著性变化。⑤上述数据证实,在强度1.5 mT,频率3300 Hz的低频脉冲磁场刺激方案下,新型冠状病毒肺炎患者在康复期经过3周的低频脉冲磁场刺激相比人体自愈过程可使更多的下肢局部肌群肌力获得提升,对基于腿部爆发力的全身协调发力能力及功能状态明显改善。因此,低频脉冲磁场刺激可作为一种改善新冠感染患者下肢肌肉无力症状的有效、非运动的康复手段。

新型冠状病毒疫苗接种对维持性血液透析合并COVID-19患者的价值

目的探讨接种新型冠状病毒疫苗(新冠疫苗)对维持性血液透析(MHD)患者新型冠状病毒感染(COVID-19)严重程度的影响。方法回顾性分析2022年12月至2023年1月安徽医科大学附属阜阳人民医院肾内科收治的166例终末期肾脏病行MHD合并COVID-19患者的临床资料。依据疫苗接种情况分为未接种组(接种0针)及接种组(接种≥2针)。比较两组患者临床特征及短期预后,并应用logistic回归模型分析患者住院及重症风险增加的独立危险因素。结果166例MHD合并COVID-19患者中,未接种组91例(54.8%),接种组75例(45.2%)。未接种组年龄与吸烟比例高于接种组(P<0.05)。感染新型冠状病毒肺炎后,患者临床表现多样,发热(73.1%)、乏力(65.6%)、食欲减退(57.5%)最常见。接种组使用激素、中心吸氧、住院、重症比例明显减少,治愈患者比例显著增加(P<0.05)。接种新冠疫苗可减少MHD患者住院(OR=0.364,95%CI:0.147~0.901)及重症(OR=0.182,95%CI:0.037~0.901)发生风险。合并糖尿病、冠状动脉粥样硬化性心脏病(冠心病)是MHD合并COVID-19患者住院及重症风险增加的独立危险因素,年龄是其重症风险增加的独立危险因素。结论终末期肾脏病接受MHD合并COVID-19患者临床表现多样,合并糖尿病、冠心病患者住院及重症风险均增加,年龄增加患者重症风险增加,接种新冠疫苗可减少住院及重症风险。