Exploration of Infection Prevention and Control Practice of Designated Hospitals in During Corona Virus Disease 2019 Epidemic Period

Corona Virus Disease 2019(COVID-19)is a new infectious disease that appeared in whan in December 2019 Since January23,the national health and fitmess commission has required hospitals to be designated in accordance with the principle of"concentrating patients,experts,resources and treatment".Designated hospitals are often the strength of the general hospital and general hospital complex layers of various kinds of personnel,campus area is large,multi-channel,ordinary outpatient accepts people more,for emergency and severe cases treatment in patients with normal difficulty pressuure big,suspected/confirmed cases,combined with the COVID-19 occurred when the traditional holiday,the country launched the emergency response since,process reform faces a difficult labor,shortage of mampower,protective shortages,short time limit,and many other difficulties,hospital infection prevention and control is facing unprecedented pressure.In this paper,the West China-Guang'an Hospital,Sichuan University(Guang'an people's hospital)as a designated hospital,on the basis of the relevant scheme of the national health committee,epidemic prevention and control of the actual,combined with comprehensive hospital leadership,mampower allocation,protection,security,patient management,disinfection isolation,preview triage,preventive measures,training,monitoring,etc.,with practical experience summary for the COVID-19 diring the hospital infection prevention and control to improve the practice exploration.

一类具有脉冲干预措施的COVID-19模型的稳定性分析

建立了一类对易感人群实施脉冲干预措施的COVID-19模型,得出了模型的基本再生数R_(0)和无病周期解。当R_(0)<1时,根据脉冲微分不等式和Lyapunov函数分析了无病周期解的全局稳定性,并数值模拟了这一结论。最后,探讨了脉冲预防策略在COVID-19传染病预防中的效果。

COVID-19型与非COVID-19型ARDS患者炎症反应和细胞免疫的差异性研究

目的探讨新型冠状病毒感染(COVID-19)型急性呼吸窘迫综合征(ARDS)与非COVID-19型ARDS患者炎症反应和细胞免疫的差异性。方法选取2022年1月至2023年12月郑州市第一人民医院收治的COVID-19型ARDS患者120例纳入观察组(中度89例,重度31例),根据1∶1配对原则,另选取同期其他肺部致病菌导致ARDS患者120例纳入对照组,同期健康体检者120例纳入健康组。比较三组受检者及不同病情程度COVID-19型ARDS患者血清炎性相关因子[白介素-6(IL-6)、白介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]及细胞免疫相关因子[T细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))、自然杀伤细胞(NK细胞)]水平,采用Spearman分析炎性及细胞免疫相关因子与COVID-19感染及COVID-19型ARDS患者病情严重程度的相关性,采用偏回归分析COVID-19型患者ARDS发生的影响因素。结果观察组患者血清IL-6、IL-4、TNF-α、CRP水平[(47.52±6.25)ng/L、(21.53±3.59)ng/L、(1.55±0.36)ng/L、(20.69±3.81)mg/L]明显高于对照组[(15.83±2.67)ng/L、(13.68±2.46)ng/L、(1.27±0.30)ng/L、(12.35±2.67)mg/L],且对照组明显高于健康组[(3.12±0.79)ng/L、(2.76±0.54)ng/L、(0.88±0.25)ng/L、(3.98±1.12)mg/L],差异均有统计学意义(P<0.05);观察组患者的CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平[(59.03±3.03)%、(19.56±1.04)%、(27.81±3.97)%、(22.59±3.40)%]明显低于对照组[(64.42±3.26)%、(28.10±1.91)%、(40.11±4.05)%、(35.31±3.97)%],且对照组明显低于健康组[(70.35±4.18)%、(43.38±3.06)%、(50.88±4.67)%、(40.64±4.06)%],差异均有统计学意义(P<0.05);COVID-19型ARDS重度患者的血清IL-6、IL-4、TNF-α、CRP水平[(66.58±6.10)ng/L、(30.66±5.47)ng/L、(1.92±0.45)ng/L、(28.96±3.70)mg/L]明显高于中度患者[(40.88±4.62)ng/L、(18.35±3.07)ng/L、(1.42±0.33)ng/L、(17.81±2.93)mg/L],而CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平[(52.54±4.07)%、(15.20±1.09)%、(22.13±1.81)%、(18.03±1.46)%]明显低于中度患者[(61.29±3.62)%、(21.08±1.35)%、(29.79±2.02)%、(24.18±2.25)%],差异均有统计学意义(P<0.05);Spearman分析结果显示,IL-6(r=0.675、0.609)、IL-4(r=0.632、0.614)、TNF-α(r=0.585、0.566)、CRP(r=0.619、0.587)水平与COVID-19感染及COVID-19型ARDS患者病情严重程度均呈正相关(P<0.05),CD3^(+)(r=-0.539、-0.505)、CD4^(+)(r=-0.592、-0.554)、CD8^(+)(r=-0.588、-0.570)、NK细胞(r=-0.601、-0.592)水平与COVID-19感染及COVID-19型ARDS患者病情严重程度均呈负相关(P<0.05);偏回归分析结果显示,血清IL-6、IL-4、TNF-α、CRP、CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平均是COVID-19型患者发生ARDS的危险因素(P<0.05)。结论炎症及细胞免疫相关因子表达在COVID-19型及非COVID-19型ARDS患者中存在差异性,且与COVID-19感染及COVID-19型ARDS病情严重程度均具有一定相关性,可辅助临床识别COVID-19感染,评估病情严重程度。

Review of inflammatory bowel disease and COVID-19

The first cases of a novel corona virus infection were reported in Wuhan China in December of 2019,followed by the declaration of an international pandemic by the World Health Organization in March 2020.Early reports of the virus,now known as severe acute respiratory syndrome coronavirus 2,and its clinical disease coronavirus disease 2019(COVID-19),has shown higher rates of morbidity and mortality in the elderly and those with pre-existing medical conditions.Of particular concern is the safety of those with compromised immune systems.Inflammatory Bowel disease(IBD)is itself caused by a disordered immune response,with the most effective medical therapies being immune suppressing or modifying.As such,the risk of COVID-19,virus related outcomes,and appropriate management of IBD patients during the global pandemic is of immediate concern to gastroenterologists worldwide.There has been a rapid accumulation of clinical data and expert opinion on the topic.This review will highlight the latest source information on clinical observation/outcomes of the IBD population and provide a concise summary of the most up to date perspectives on IBD management in the age of COVID-19.

Impact of X-radiation in the management of COVID-19 disease

Coronaviruses are a diverse group of viruses that infect both animals and humans.Even though the existence of coronavirus and its infection to humans is not new,the 2019-novel coronavirus(nCoV)caused a major burden to individuals and society i.e.,anxiety,fear of infection,extreme competition for hospitalization,and more importantly financial liability.The nCoV infection/disease diagnosis was based on non-specific signs and symptoms,biochemical parameters,detection of the virus using reverse-transcription polymerase chain reaction(RTPCR),and X-ray-based imaging.This review focuses on the consolidation of potentials of X-ray-based imaging modality[chest-X radiography(CXR)and chest computed tomography(CT)]and low-dose radiation therapy(LDRT)for screening,severity,and management of COVID-19 disease.Reported studies suggest that CXR contributed significantly toward initial rapid screening/diagnosis and CT-imaging to monitor the disease severity.The chest CT has high sensitivity up to 98%and low specificity for diagnosis and severity of COVID-19 disease compared to RT-PCR.Similarly,LDRT compliments drug therapy in the early recovery/Less hospital stays by maintaining the physiological parameters better than the drug therapy alone.All the results undoubtedly demonstrated the evidence that X-ray-based technology continues to evolve and play a significant role in human health care even during the pandemic.

Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019(COVID-19)epidemic

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions.Chronic kidney disease(CKD)is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China.Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis,leading to proteinuria,hematuria and elevated serum creatinine.Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor,some doctors question its ability to increase the risk and severity of developing COVID-19.Neither clinical data nor basic scientific evidence supports this assumption.Therefore,patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy.Patients with CKD are generally the elderly population suffering from multiple comorbidities.Moreover,some patients with CKD might need to take glucocorticoids and immunosuppressants.Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week.Considering all the above reasons,patients with CKD are more vulnerable to COVID-19 than the general population.The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death.Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD.In this review,we provide some practical management recommendations for health care providers,patients with CKD,dialysis patients and dialysis facilities.

1例危重型COVID-19患者的诊治经过

新型冠状病毒感染(COVID-19)是由新型冠状病毒引起的突发传染性呼吸道疾病,具有传染性强、致病率高、症状多样的特点,评估病情演变可借助临床症状、血气、化验、影像学检查等项目,早期、规范治疗极为重要。高龄、合并基础疾病的患者治疗不当时易转为危重型疾病甚至进展为肺间质纤维化病变,主要表现为急性呼吸窘迫综合征,给予适宜的抗炎、氧疗、抑制炎症风暴、营养支持、调节免疫等治疗可有效提高救治成功率。

2019冠状病毒病(COVID-19)实验室诊断方法的应用现状

严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)系通过分析鉴定2019年武汉不明原因的肺炎病例而被发现。世界卫生组织将该新型冠状病毒感染的肺炎命名为2019冠状病毒病(corona virus disease 2019,COVID-19)。COVID-19的实验室诊断方法主要有基于病毒核酸的病原学检查、通过特异性抗体检测的血清学检测以及一般检查。目前,实时逆转录PCR是COVID-19确诊的金标准,但该方法存在漏检和假阴性的问题,因此,为了更有效防控COVID-19,有必要发展高质量、高敏感的诊断方法。本文综述了COVID-19实验室诊断方法的应用现状及最新进展,以期为快速准确诊断COVID-19提供参考。

Can Chinese Medicine Be Used for Prevention of Corona Virus Disease 2019 (COVID-19)? A Review of Historical Classics, Research Evidence and Current Prevention Programs

Objective:Since December 2019,an outbreak of corona virus disease 2019(COVID-19)occurred in Wuhan,and rapidly spread to almost all parts of China.This was followed by prevention programs recommending Chinese medicine(CM)for the prevention.In order to provide evidenee for CM recommendations,we reviewed ancient classics and human studies.Methods:Historical records on prevention and treatment of infections in CM classics,clinical evidence of CM on the prevention of severe acute respiratory syndrome(SARS)and H1N1 in flue nza,and CM preve ntion programs issued by health authorities in China since the COVID-19 outbreak were retrieved from differe nt databases and websites till 12 February,2020.Research evide nee in eluded data from clinical trials,cohort or other population studies using CM for preventing contagious respiratory virus diseases.Results:The use of CM to prevent epidemics of infectious diseases was traced back to ancient Chinese practice cited in Huangdi's Internal Classic(Huang Di Nei Jing)where preventive effects were recorded.There were 3 studies using CM for prevention of SARS and 4 studies for H1N1 influenza.None of the participants who took CM contracted SARS in the 3 studies.The infection rate of H1N1 in flue nza in the CM group was significantly lower than the non-CM group(relative risk 0.36,95%confidence interval 0.24-0.52;n=4).For prevention of COVID-19,23 provinces in China issued CM programs.The main principles of CM use were to tonify qi to protect from external pathoge ns,disperse wind and discharge heat,and resolve damp ness.The most frequently used herbs in eluded Radix astragali(Huangqi),Radix glycyrrhizae(Gancao),Radix saposhnikoviae(Fangfeng),Rhizoma Atractylodis Macrocephalae(Baizhu),Lonicerae Japonicae Flos(Jinyinhua),and Fructus forsythia(Lianqiao).Conclusions:Based on historical records and human evidenee of SARS and H1N1 influenza prevention,Chinese herbal formula could be an alternative approach for prevention of COVID-19 in high-risk population.Prospective,rigorous population studies are warranted to confirm the potential preventive effect of CM.

逆转“白肺”——重症COVID-19的治疗及思考

新型冠状病毒感染(COVID-19)近期在我国全国范围大流行。本文报道了1例重症COVID-19感染患者的救治过程,以期为临床治疗重症COVID-19患者提供相关诊疗思路。本文对治疗过程中遇到的问题进行了总结与探讨:针对抗炎药物的选择及应用,介绍了糖皮质激素甲泼尼龙、托珠单抗、巴瑞替尼的应用;针对抗炎和抗感染治疗过程中的注意事项,介绍了COVID-19患者的自然病程可以分为3个阶段,不同时间段进行抗炎和抗感染治疗应有不同的侧重;针对患者D-二聚体迅速升高,分析了重症COVID-19患者凝血异常的原因,并探讨了抗凝治疗方案。COVID-19可通过炎症风暴累及全身多个系统/器官,临床医师应广泛借鉴国内外治疗经验,及时采取适当措施予以施治,以提高救治成功率。

妊娠期接种COVID-19疫苗对妊娠结局影响的研究进展

新型冠状病毒肺炎(corona virus disease 2019,COVID-19)是一种以呼吸道症状为主的急性传染病,迄今尚无特效的治疗方法。除一般的预防措施外,接种疫苗是一种安全、有效的措施。然而,由于孕产妇及哺乳期妇女的群体特殊性,对COVID-19疫苗的安全性和有效性存在疑虑,导致COVID-19疫苗的接种率低,相关数据相对缺乏。但随着妊娠期发生的一系列生理变化,孕妇更容易感染新型冠状病毒,不良妊娠结局发生风险也随之增加。因此,总结COVID-19疫苗在孕产妇中的安全性及有效性证据十分必要,为后续开展相关研究以及COVID-19疫苗的安全性评价提供参考。

5例COVID-19危重病人应用无创呼吸机联合俯卧位通气治疗的护理

总结5例新型冠状病毒肺炎(COVID-19)危重病人应用无创呼吸机联合俯卧位通气治疗的护理。提示护理人员应加强俯卧位翻身前的准备、翻身过程中生命体征的观察、体位管理、并发症的预防、血气分析监测、无创通气护理等,护理过程中应注意防护,做好消毒隔离工作。

新型冠状病毒(COVID-19)感染性肺炎现代中医诊疗建议方案与探讨

自2019年12月以来,以我国湖北武汉地区为中心,以人群集散辐射传播为特点,全国各地病例陆续出现增加。疫情发源地罹患患者早期以身热不扬、干咳气促、身楚乏力为主要症状,以脉濡缓、舌苔厚腻、胸部X线检查显示炎性反应性改变为特征的新型冠状病毒(COVID-19)感染性肺炎为主的新型传染病。疫情传入地的患者早期症状由于地域的不同,有所差异。各地传统中医、现代医学先后集体或个人出台了相关诊疗方法和建议方案。作为现代中医,按照习近平主席:“遵循中医发展规律,传承精华,守正创新”和“中西并重”的指示精神。为规范这一新型传染病“瘟疫”的认知和诊疗,综合相关资料,根据疫情演变规律,结合个人经验与体会,特此探讨COVID-19感染性肺炎的诊疗建议方案。

基于加权平均樽海鞘群算法和BP神经网络的COVID-19预测

新型冠状病毒肺炎以其高传染性和高致病性成为全球关注的问题之一.有效预测COVID-19的累计确诊人数对COVID-19的防控具有重要价值.本文提出加权平均樽海鞘群算法(AVSSA),通过23个基准函数验证了AVSSA的有效性,进而利用AVSSA优化BP神经网络建立预测模型AVSSA-BP,实现COVID-19的预测.实验结果表明预测模型AVSSA-BP有最小的误差和最高的确定性系数,验证了AVSSA-BP的有效性.

COVID-19疑似病例合并肝母细胞瘤多学科临床讨论

目的:探讨疫情期间新型冠状病毒感染(corona virus disease 2019,COVID-19)疑似病例合并肝母细胞瘤(hepatoblastoma,HB)患儿的诊治流程和管理体会。方法:2020年2月浙江大学医学院附属儿童医院收治1例疑似严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)感染合并HB患儿,通过多学科协作体系(multidisciplinary team,MDT)的诊治过程。经MDT讨论后,对患儿进行SARS-CoV-2核酸及抗体、血常规、肿瘤标记物、胸腹部CT以及超声等必要的辅助检查;化疗采用顺铂+5-氟尿嘧啶+长春新碱(C5V)方案,同时予头孢噻肟抗感染以及对症支持治疗。结果:患儿确诊为HB低危组,排除COVID-19,并顺利完成HB的第一阶段化疗疗程。住院1周后患儿体温恢复正常,精神食欲好转,各项指标达到出院标准,继续完成14天隔离治疗后出院。结论:疫情期间,对于疑似SARS-CoV-2感染的新发HB患儿,医务人员在尽可能快速地诊断和治疗肿瘤的同时,一定要兼顾对病毒的防控。MDT协作诊疗模式,有利于保障整个诊疗过程安全顺利地实施。

COVID-19疫情期间临床研究生焦虑、抑郁情况调查及相关因素分析

目的探究新型冠状病毒肺炎(COVID-19,简称新冠肺炎)疫情后已复学的临床研究生焦虑及抑郁的流行情况以及相关影响因素。方法在复学后对来自北京协和医学院(PUMC)的临床研究生进行在线问卷调查。问卷包括7项广义焦虑症量表(GAD-7),9项患者健康问卷(PHQ-9)和可能担心的7个因素。结果共303名临床研究生纳入分析,筛查焦虑阳性占45.87%,筛查抑郁阳性占45.54%。多因素Logistic分析显示,担心“感染新冠”“论文写作”“毕业延期”“就业”等,易产生焦虑及抑郁情绪。结论复学时临床研究生仍有焦虑及抑郁心理问题。高校应继续关注返校生心理健康并采取一定干预措施。

COVID-19疫情中医务人员的医学应急沟通职责与方式

新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情已成为席卷全球的突发公共卫生事件,此时医务人员除实施疾病救治外,还肩负着疫情下医学应急沟通的重任,需在社会的不同层面给公众提供专业性的指导与建议。这种应急状况下的医学沟通有别于既往临床上的医患沟通,不仅具备专业性、公众性和及时性的特点,传播方式也更为多样化。结合COVID-19疫情,将医务人员的医学应急沟通职责与方式进行梳理,以建立更有效的应急沟通策略。

基于阶段式传播模型COVID-19防控措施的量化评估分析

基于病毒动力学传染机制,构建了考虑不同时期防控措施影响下的新型冠状病毒肺炎(COVID-19)阶段式传播模型.依据空间上的严重性将全国划分为三类疫情区,对各疫情区传染人数进行了阶段式模拟.结合上述模拟结果,进一步量化评估了各疫情区所采取的如武汉交通管制、对口支援湖北和小区封闭式管理等措施对抑制病毒传播的影响.结果表明,阶段式传播模型能够较好地模拟出各疫情区不同时期传染人数的变化特征,政府采取的交通管制和小区封闭式管理等防控措施大幅减少了传染人数,感染人数呈现出大幅下降的趋势,有效抑制了COVID-19的大规模扩散.

COVID-19疫情中的生物力学问题

新型冠状病毒肺炎自爆发以来,已成为全球关注的焦点。由于疫情来势迅猛,给医疗制度体系、医疗资源、应急处置、医疗器械等提出了严峻的挑战,也暴露出其中诸多不足。以病毒的体外活性规律研究、气溶胶传播的生物力学问题、呼吸性疾病对心血管疾病影响的研究、公共交通和公共场所中通风方式的改进、医疗器械的生物力学研究为例,应用生物力学的原理、观点和方法,认识和剖析其中所存在和亟待改进的问题,期望生物力学能在疫情防控中发挥学科优势和力量,以此促进生物力学学科发展。

新型冠状病毒肺炎(COVID-19)CT表现初步探讨

目的:探讨新型冠状病毒肺炎(COVID-19)的CT表现。方法:搜集武汉大学中南医院2019年12月20日-2020年1月22日收治的33例确诊为COVID-19患者的病例资料(男13例,女20例),对其CT表现进行分析。结果:33例COVID-19患者均进行胸部CT检查,30例累及双肺,25例弥漫分布,33例均见磨玻璃密度影,15例合并纤维条索影,23例伴小叶间隔增厚,11例见支气管充气征,22例见胸膜肥厚,3例见双侧少量胸腔积液,1例合并淋巴结肿大,2例呈"白肺"。早期胸部CT主要表现为肺内磨玻璃密度影,肺外带胸膜下分布常见,以多发为主,进展期可引起网格样改变呈"铺路石"征,重症期病灶弥漫分布,甚至呈"白肺",胸腔积液及纵隔淋巴结肿大少见。结论:了解COVID-19的CT表现对早诊断、早治疗和疗效评估具有重要作用。