Strengthening pharmacotherapy research for COVID-19-induced pulmonary fibrosis

The global spread of severe acute respiratory syndrome coronavirus 2 has resulted in a significant number of individuals developing pulmonary fibrosis(PF),an irreversible lung injury.This condition can manifest within a short inter-val following the onset of pneumonia symptoms,sometimes even within a few days.While lung transplantation is a potentially lifesaving procedure,its limited availability,high costs,intricate surgeries,and risk of immunological rejection present significant drawbacks.The optimal timing of medication administration for coronavirus disease 2019(COVID-19)-induced PF remains controversial.Despite this,it is crucial to explore pharmacotherapy interventions,involving early and preventative treatment as well as pharmacotherapy options for advanced-stage PF.Additionally,studies have demonstrated disparities in anti-fibrotic treatment based on race and gender factors.Genetic mutations may also impact therapeutic efficacy.Enhancing research efforts on pharmacotherapy interventions,while considering relevant pharmacological factors and optimizing the timing and dosage of medication administration,will lead to enhanced,personalized,and fair treatment for individuals impacted by COVID-19-related PF.These measures are crucial in lessening the burden of the disease on healthcare systems and improving patients'quality of life.

Pulmonary artery stent thrombosis and symptomatic pulmonary hypertension following COVID-19 infection in Alagille patient:A case report

BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.

COVID-19相关肺纤维化的病因机制及治疗的研究进展

新型冠状病毒肺炎(COVID-19)是一种由SARS-CoV-2感染所引起的急性呼吸道传染性疾病。随着近期COVID-19疫情的常态化流行,COVID-19患者的影像学及病理学研究表明,部分患者SARS-CoV-2感染后可出现肺纤维化改变,COVID-19相关肺纤维化正成为影响患者预后生存质量的重要影响因素,严重威胁患者的生命健康。目前,COVID-19相关肺纤维化的发病机制尚未明确,治疗方案多基于既往肺纤维化疾病的诊治经验,本文通过总结SARS-CoV-2感染后肺损伤及纤维化的发生机制和相关治疗方案,为临床的防治及干预提供一定参考。

Current remarks and future directions on the interactions between metabolic dysfunction-associated fatty liver disease and COVID-19

During the outbreak of the coronavirus disease 2019(COVID-19)pandemic,particular interest rose regarding the interaction between metabolic dysfunctionassociated fatty liver disease(MAFLD)and the COVID-19 infection.Several studies highlighted the fact that individuals with MAFLD had higher probability of severe acute respiratory syndrome coronavirus 2 infection and more severe adverse clinical outcomes.One of the proposed mechanisms is the inflammatory response pathway,especially the one involving cytokines,such as interleukin 6,which appeared particularly elevated in those patients and was deemed responsible for additional insult to the already damaged liver.This should increase our vigilance in terms of early detection,close follow up and early treatment for individuals with MAFLD and COVID-19 infection.In the direction of early diagnosis,biomarkers such as cytokeratin-18 and scoring systems such as Fibrosis-4 index score are proposed.COVID-19 is a newly described entity,expected to be of concern for the years to come,and MAFLD is a condition with an ever-increasing impact.Delineating the interaction between these two entities should be brought into the focus of research.Reducing morbidity and mortality of patients with COVID-19 and MAFLD should be the ultimate objective,and the optimal way to achieve this is by designing evidence-based prevention and treatment policies.

Therapeutic prospects of mesenchymal stem/stromal cells in COVID-19 associated pulmonary diseases:From bench to bedside

The ongoing outbreak of coronavirus disease 2019(COVID-19)caused by the novel severe acute respiratory syndrome coronavirus 2 has become a sudden public emergency of international concern and seriously threatens millions of people’s life health.Two current studies have indicated a favorable role for mesenchymal stem/stromal cells(MSCs)in clinical remission of COVID-19 associated pulmonary diseases,yet the systematical elaboration of the therapeutics and underlying mechanism is far from satisfaction.In the present review,we summarize the therapeutic potential of MSCs in COVID-19 associated pulmonary diseases such as pneumonia induced acute lung injury,acute respiratory distress syndrome,and pulmonary fibrosis.Furthermore,we review the underlying mechanism of MSCs including direct-and trans-differentiation,autocrine and paracrine anti-inflammatory effects,homing,and neovascularization,as well as constitutive microenvironment.Finally,we discuss the prospects and supervision of MSC-based cytotherapy for COVID-19 management before large-scale application in clinical practice.Collectively,this review supplies overwhelming new references for understanding the landscapes of MSCs in the remission of COVID-19 associated pulmonary diseases.

3-to 24-month Follow-up on COVID-19 with Pulmonary Tuberculosis Survivors after Discharge:Results from a Prospective,Multicenter Study

Objective Coronavirus disease 2019(COVID-19)and tuberculosis(TB)are major public health and social issues worldwide.The long-term follow-up of COVID-19 with pulmonary TB(PTB)survivors after discharge is unclear.This study aimed to comprehensively describe clinical outcomes,including sequela and recurrence at 3,12,and 24 months after discharge,among COVID-19 with PTB survivors.Methods From January 22,2020 to May 6,2022,with a follow-up by August 26,2022,a prospective,multicenter follow-up study was conducted on COVID-19 with PTB survivors after discharge in 13 hospitals from four provinces in China.Clinical outcomes,including sequela,recurrence of COVID-19,and PTB survivors,were collected via telephone and face-to-face interviews at 3,12,and 24 months after discharge.Results Thirty-two COVID-19 with PTB survivors were included.The median age was 52(45,59)years,and 23(71.9%)were men.Among them,nearly two-thirds(62.5%)of the survivors were moderate,three(9.4%)were severe,and more than half(59.4%)had at least one comorbidity(PTB excluded).The proportion of COVID-19 survivors with at least one sequela symptom decreased from 40.6%at 3 months to 15.8%at 24 months,with anxiety having a higher proportion over a follow-up.Cough and amnesia recovered at the 12-month follow-up,while anxiety,fatigue,and trouble sleeping remained after 24months.Additionally,one(3.1%)case presented two recurrences of PTB and no re-positive COVID-19during the follow-up period.Conclusion The proportion of long symptoms in COVID-19 with PTB survivors decreased over time,while nearly one in six still experience persistent symptoms with a higher proportion of anxiety.The recurrence of PTB and the psychological support of COVID-19 with PTB after discharge require more attention.

Pulmonary contusion mimicking COVID-19:A case report

BACKGROUND Coronavirus disease 2019(COVID-19)is a major public health emergency with obvious characteristics of human-to-human transmission,and there are infective asymptomatic carriers.Early identification and proper management of patients with COVID-19 are important.Features in chest computed tomography(CT)can facilitate identifying newly infected individuals.However,CT findings of some lung contusions are similar to those of COVID-19,as shown in the present case.CASE SUMMARY A 46-year-old woman was admitted to hospital for backache and foot pain caused by a fall injury 1 d before hospitalization.She was suspected of having COVID-19,since there was a confirmed COVID-19 case near her residence.But she had no fever,cough,chest tightness,difficult breathing,nausea,vomiting,or diarrhea,etc.On physical examination,the lower posterior chest of both sides showed dullness on percussion and moist rales at the end of inspiration on auscultation.The white blood cell count and lymphocyte count were 10.88×109/L and 1.04×109/L,respectively.CT performed on February 7,2020 revealed that both lungs were scattered with patchy ground-glass opacity.The patient was diagnosed with pulmonary contusion with thoracic spinal fracture(T12),calcaneal fracture,and pelvic fracture.On day 9 after conservative treatment,her condition was alleviated.On review of the chest CT,the previous shadows were significantly reduced.CONCLUSION Differential diagnosis of lung contusion and COVID-19 must be emphasized.Both conditions require effective prompt actions,especially COVID-19.

体外功能性肺组织模型构建、调控及在肺纤维化和COVID-19中的应用

肺纤维化是很多肺部疾病发生发展过程中出现的病理现象。近年出现的2019冠状病毒病(coronavirus disease 2019,COVID-19)引发的呼吸系统综合征也会出现弥漫性肺泡损伤,并诱发肺纤维化。因此,开展肺纤维化和COVID-19体外模型构建与调控研究在肺部疾病治疗和药物筛选方面意义重大。目前,现有研究已建立了多种体外肺组织二维、三维细胞培养模型,本文将全面概述这些模型的构建方法,并结合这些模型在肺纤维化及COVID-19中的应用研究,对体外肺组织模型在药物传递、高通量药物筛选及发病机制研究等生物医学领域中的应用前景进行综述,为其进一步研究提供参考。

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.

“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.

Resolutive Results with Oral Corticosteroids for Patients with COVID-19 in Pulmonary Inflammatory Phase. Successful Outpatient Experience during the Collapse of Belem Do Para Health System—Brazil

In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well-known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belem (Para, Brazil) Health System. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of 40 mg prednisolone, 40 mg enoxaparin and macrolides (500 mg clarithromycin, 500 mg axetylcefuroxime) associated and followed in outpatient facilities. Two hundred and eight patients had an excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.

Pulmonary arterial hypertension confirmed by right heart catheterization following COVID-19 pneumonia: A case report and review of literature

BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.

Pulmonary Thromboembolism in a Soccer Player after COVID-19 Infection: Case Report

Background:Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which causes COVID-19,is characterized by an increased risk of thromboembolic events.However,more than 80%of patients are asymptomatic or have only minor/mild symptoms.In addition,diagnosing thromboembolism in athletes is challenging,as symptoms can be confused with musculoskeletal complaints or physical deconditioning.Case presentation:Here we report the case of a previously healthy 34-year-old professional soccer player with COVID-19 infection and genetic predisposition to thrombosis.At baseline,he was fit,had no symptoms,did not require hospital admission due to a COVID-19 infection,and was started on a five-day course of azithromycin and dexamethasone therapy.After 10 days of returning to professional activity,he developed pulmonary embolism following a COVID-19 infection during a physical exercise session.Angiotomography showed positive acute and subacute pulmonary thromboembolism,being treated with rivaroxaban 20 mg/day continuously.The shared decision-making between the medical team and the athlete was not to return to professional soccer,given the quantifiable risk.Considerations:This case illustrates the potential risk of COVID-19-induced pulmonary thromboembolism,which can be affected by genetic predisposition and dexamethasone therapy or the consequences of COVID-19.In this clinical period,the athlete’s condition may be overlooked due to the masking effects of other clinical conditions and physical abnormalities.The residual effects of COVID-19 disease can appear late,requiring caution and follow-up by the medical team before releasing the athlete into a training program.

COVID-19继发肺纤维化的病因病机及治则治法探讨

新型冠状病毒感染肺炎(Corona Virus Disease 2019,COVID-19)致病力强,疾病进展迅速,部分患者常遗留有肺纤维化情况,痰瘀阻络、气阴耗伤为COVID-19继发肺纤维化的病机关键,早期介入,治疗前移,活血化痰,固护正气,改善肺泡炎和微循环障碍,减少炎性渗出,减轻肺部病灶损害,使其得到充足的供血和营养,助肺脏恢复其功能,一方面有助于COVID-19疾病尽快恢复,另一方面也可降低COVID-19继发肺纤维化的风险,加快已成肺纤维化的好转速度,对于提高COVID-19患者的疗效和治愈出院后的生活质量具有重大意义。

基于网络药理学和分子对接方法的肺维康颗粒治疗COVID-19相关肺纤维化的机制分析

目的运用网络药理学与分子对接方法分析肺维康颗粒治疗COVID-19相关肺纤维化(COVID-19-PF)的关键成分和潜在靶点,并探讨其可能的作用机制。方法在中药系统药理学分析平台(TCMSP)获得肺维康颗粒所含活性成分与相关靶点,通过OMIM和Genecards数据库收集COVID-19-PF相关基因,取交集后采用Cytoscape软件建立"肺维康颗粒-化合物-靶点-COVID-19-PF"网络模型;通过STRING、Metascape平台分析药物-疾病靶点蛋白相互作用,并进行网络构建和模块分析;对靶点进行GO分析和KEGG通路富集分析,对关键靶点进行核心化合物分子对接。结果肺维康颗粒治疗COVID-19-PF的关键靶点涉及蛋白激酶B1(AKT1)、血管内皮生长因子A(VEGFA)、白细胞介素6(IL-6)等,靶点基因功能倾向于调控细胞因子受体、影响细胞因子分泌水平和G蛋白偶联胺受体活性、激活细胞转录因子等;关键的KEGG通路包括白细胞介素17(IL-17)信号通路、肿瘤坏死因子(TNF)信号通路、磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(AKT)信号通路等,其中薯蓣皂苷元、二氢丹参酮Ⅰ、木犀草素可与血管紧张素转化酶2(ACE2)、血管内皮生长因子受体(VEGFR)、AKT1等关键靶点形成稳定构象。结论肺维康颗粒可能通过调控PI3K/AKT等炎症和纤维化相关通路、抑制细胞因子活化和血管生成、减轻胶原沉积和肺组织结构重塑等机制发挥对COVID-19-PF的治疗作用。

High serum lactate dehydrogenase and dyspnea:Positive predictors of adverse outcome in critical COVID-19 patients in Yichang

BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)outbreak in China,constitutes a Public Health Emergency of International Concern.It is well known that COVID-19 patients may have increased serum lactate dehydrogenase(LDH)levels in the early stage.The clinical changes in LDH may have predictive value in disease evolution and prognosis in critically ill COVID-19 patients.AIM To examine serum LDH and clinical characteristics in patients with COVID-19 and their predictive value for prognosis.METHODS This retrospective study analyzed the clinical data of forty-seven critical COVID-19 patients in the intensive care unit of the Third People's Hospital of Yichang City from January 27 to March 25,2020 and divided them into survivors and nonsurvivors.The patients were diagnosed according to the World Health Organization interim guidance and critical cases met any one of the following criteria:Respiratory failure and required mechanical ventilation,the occurrence of shock,and the combined failure of other organs that required intensive care unit monitoring and treatments,according to the diagnostic criteria of critical COVID-19.Clinical data including symptoms,detection of SARS-CoV-2,chest computed tomography(CT)images,changes in serum LDH in different clinical phases,and prognosis were collected.Statistical analysis of the data was performed.Continuous variables were expressed as median(interquartile range)and compared with the Mann-Whitney U test.Categorical variables were compared with the Chi-square test.Survival data were analyzed using Kaplan-Meier survival curves and log-rank tests.RESULTS According to chest CT images,we observed the alveolitis and fibrosis stages in all critical patients in this study.Most non-survivors died in the fibrosis stage.Nonsurvivors had fewer days of hospitalization,shorter disease duration,shorter duration of alveolitis and fibrosis,and had dyspnea symptoms at disease onset(P=0.05).Both first and lowest LDH values in the alveolitis stage were more pronounced in non-survivors than in survivors(449.0 U/L vs 288.0 U/L,P=0.0243;445.0 U/L vs 288.0 U/L,P=0.0199,respectively),while the first,lowest and highest values of serum LDH in non-survivors were all significantly increased compared to survivors in the fibrosis phase(449.0 U/L vs 225.5 U/L,P=0.0028;432.0 U/L vs 191.0 U/L,P=0.0007;1303.0 U/L vs 263.5 U/L,P=0.0001,respectively).The cut-off points of first LDH values in the alveolitis and fibrosis phase for distinction of non-survivors from survivors were 397.0 U/L and 263.0 U/L,respectively.In the fibrosis stage,non-survivors had more days with high LDH than survivors(7.0 d vs 0.0 d,P=0.0002).Importantly,patients with high LDH had a significantly shorter median survival time than patients with low LDH in the alveolitis phase(22.0 d vs 36.5 d,P=0.0002),while patients with high LDH also had a significantly shorter median survival time than patients with low LDH in the fibrosis phase(27.5 d vs 40.0 d,P=0.0008).The proportion of non-survivors with detectable SARS-CoV-2 until death in the alveolitis stage was significantly increased compared with that in the fibrosis stage(100%vs 35.7%,P=0.0220).CONCLUSION High LDH and dyspnea symptoms were positive predictors of an adverse outcome in critical COVID-19.The rapid progressive fibrosis stage was more perilous than the alveolitis stage,even if SARS-CoV-2 is undetectable.

Stem cell therapy for COVID-19 and other respiratory diseases:Global trends of clinical trials

Respiratory diseases,including coronavirus disease 2019 and chronic obstructive pulmonary disease(COPD),are leading causes of global fatality.There are no effective and curative treatments,but supportive care only.Cell therapy is a promising therapeutic strategy for refractory and unmanageable pulmonary illnesses,as proved by accumulating preclinical studies.Stem cells consist of totipotent,pluripotent,multipotent,and unipotent cells with the potential to differentiate into cell types requested for repair.Mesenchymal stromal cells,endothelial progenitor cells,peripheral blood stem cells,and lung progenitor cells have been applied to clinical trials.To date,the safety and feasibility of stem cell and extracellular vesicles administration have been confirmed by numerous phase I/II trials in patients with COPD,acute respiratory distress syndrome,bronchial dysplasia,idiopathic pulmonary fibrosis,pulmonary artery hypertension,and silicosis.Five routes and a series of doses have been tested for tolerance and advantages of different regimes.In this review,we systematically summarize the global trends for the cell therapy of common airway and lung diseases registered for clinical trials.The future directions for both new clinical trials and preclinical studies are discussed.

Triple rule-out computed tomography angiography:Evaluation of acute chest pain in COVID-19 patients in the emergency department

BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

Multimodality imaging in COVID-19 patients:A key role from diagnosis to prognosis

The integrated clinical,laboratory and ultrasound approach is essential for the diagnosis,evaluation and monitoring of the patient's therapy in coronavirus disease 2019 pneumonia.The ideal imaging approach in this context is not yet well defined.Chest X-ray is characterized by low sensitivity in identifying earlier lung changes.The"bedside"pulmonary ultrasound has an undeniable series of advantages in the patient at high infectious risk and can provide incremental data in the respiratory intensive care for the serial control of the individual patient as well as for the home delivery of the stabilized subjects.Pulmonary computed tomography shows high sensitivity but should not be routinely performed in all patients,because in the first 48 h it can be absolutely negative and in the late phase the imaging findings may not change the therapeutic approach.Echocardiography should be limited to patients with hemodynamic instability to assess ventricular function and pulmonary pressures.

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。