Clinical efficacy of tocilizumab treatment in severe and critical COVID-19 patients

BACKGROUND The main pathophysiological basis of coronavirus disease 2019(COVID-19)causing respiratory failure is a cytokine storm and interleukin-6(IL-6)is an important component of the COVID-19 cytokine storm.As a specific antagonist of IL-6,tocilizumab may block the cytokine storm of COVID-19.The Diagnosis and Treatment Guidelines of New Coronavirus Pneumonia(7 th Edition)includes tocilizumab as a recommended drug for immunotherapy in severe and critical COVID-19 patients.However,the specific clinical efficacy of tocilizumab in the treatment of COVID-19 patients is worth studying.AIM To determine the clinical efficacy of tocilizumab in inhibiting the cytokine storm in COVID-19.METHODS In total,19 severe and critical COVID-19 patients were enrolled in this study,and were treated with tocilizumab in Optical Valley Campus of Hubei Maternal and Child Health Care Hospital from February 20 to March 31,2020.The imaging manifestations and clinical data before and after treatment were analyzed retrospectively,including routine peripheral venous blood tests,routine blood biochemical tests,coagulation test,C-reactive protein(CRP),IL-6,and arterial blood gas analysis.RESULTS Of the 19 patients in this group,13(68.4%)had significantly improved symptoms of COVID-19(5 patients were discharged directly and 8 patients were transferred after improvement)following treatment.One case was invalid,1 case was exacerbated,and 4 deaths(21.1%)were observed(all critical cases).The lymphocyte count,CRP,lactic acid,oxygenation index,fibrinogen(FIB)and IL-6 levels were significantly different in the improved group.CONCLUSION Tocilizumab treatment is effective against IL-6 in COVID-19 patients,but it does not completely inhibit the inflammation and cytokine storm in all patients with COVID-19.In the clinical treatment of COVID-19 patients,attention should be paid to the timing of drug administration and other adjuvant treatments.

Clinical diagnosis,treatment,and medical identification of specific pulmonary infection in naval pilots:Four case reports

BACKGROUND Specific pulmonary infection could seriously threaten the health of pilots and their companions.The consequences are serious.We investigated the clinical diagnosis,treatment,and medical identification of specific pulmonary infections in naval pilots.CASE SUMMARY We analyzed the medical waiver and clinical data of four pilots with specific pulmonary infections,who had accepted treatment at the Naval Medical Center of Chinese People’s Liberation Army between January 2020 and November 2021,including three cases of tuberculosis and one of cryptococcal pneumonia.All cases underwent a series of comprehensive treatment courses.Three cases successfully obtained medical waiver for flight after being cured,while one was grounded after reaching the maximum flight life after being cured.CONCLUSION Chest computed tomography scanning should be used instead of chest radiography in pilots’physical examination.Most pilots with specific pulmonary infection can be cured and return to flight.

Analysis of two naval pilots’ ejection injuries: Two case reports

BACKGROUND Recently,two naval pilots in a two-seat trainer jet were forced to eject urgently due to sudden mechanical failure during night-time training.They were both successfully rescued and sent to the hospital for emergency treatment.In this study,we investigate their ejection injuries and recovery process.CASE SUMMARY We analyzed the clinical data of the traumatic condition and recovery process from ejection injuries of two pilots who ejected from a failed trainer jet and survived.After being successfully rescued and sent to the hospital,they were diagnosed with multiple ejection injuries,including eye trauma,limb bone and joint injury,rib and spine injury,and so on.Both cases underwent fluid replacement,acid suppression,nutritional support,hemostasis,bone metabolism improvement,phlegm elimination,psychological measurement,blood circulation promotion and detumescence,physical therapy,and external fixation with braces for 1 mo before being discharged from hospital.They then recuperated in a sanatorium for 2 mo,and the related laboratory tests and supplementary examinations show that they recovered from all the above injuries.After successfully passing the psychological test and physical examination,they returned to flight duty 3 mo after ejection.CONCLUSION The causes and conditions of ejection injury in the pilots were very complex.Although they finally recovered quickly and were released,it also serves as a reminder that attention should be paid to pilots’ejection and parachute training in order to significantly reduce ejection injury and improve the ejection success rate.In addition,air defense support personnel should strengthen search and rescue and on-site emergency measures,and locate and rescue pilots in distress as early as possible to reduce subsequent injuries.

Retrospective analysis of influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients

BACKGROUND The novel coronavirus disease 2019(COVID-19)has spread widely around the world with strong infectivity,rapid mutation and a high mortality rate.Mechanical ventilation has been included in the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia(Trial Version 8)as an important treatment for severe and critical COVID-19 patients,but its clinical efficacy in COVID-19 patients is various.Therefore,it is necessary to study the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.AIM The aim of this study was to determine the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.METHODS A total of 27 severe and critical COVID-19 patients were enrolled in this study and treated with mechanical ventilation at the Optical Valley Campus of Hubei Maternal and Child Health Care Hospital(Wuhan,Hubei Province)from February 20,2020 to April 5,2020.According to the final treatment outcomes,the patients were divided into the“effective group”and“death group.”The clinical data of the two groups,such as the treatment process and final outcome,were retrospectively analyzed in order to determine the specific curative effects on the two groups and the reasons for the differences in such curative effects,as well as to explore the factors related to death.RESULTS This study enrolled 27 severe and critical COVID-19 patients,including 17 males(63.0%)and 10 females(37.0%).Their ages were 74.41±11.73-years-old,and 19 patients(70.4%)were over 70-years-old.Severe COVID-19 patients over 70-yearsold who were treated with mechanical ventilation died in 14 cases(82.4%);thus,this was the peak age.A total of 17 patients died of basic disease,16 of whom had more than two basic diseases.The basic diseases were hypertension,diabetes,and cardiovascular and cerebrovascular diseases.At the same time,13 patients(76.5%)died from an abnormal increase in blood glucose.Among them,eight had diabetes before contracting COVID-19 and five had a stress-induced increase in blood glucose after contracting COVID-19.Diabetic ketoacidosis occurred in one case.The use of tocilizumab may be a double-edged sword that carries a certain risk in clinical usage.Among the patients who died,16(94.1%)went into septic shock at the end.There were significant differences in the degree of infection,cardiac and renal function,and blood glucose between the death group and effective group.CONCLUSION Age,blood glucose,cardiac and renal function,and inflammatory reaction are important indicators of poor prognosis for mechanical ventilation in severe and critical COVID-19 patients.

Must pilots permanently quit flying career after treatment for colorectal cancer?-Medical waiver for Air Force pilots with colorectal cancer: Three case reports

BACKGROUND Colorectal cancer(CRC)could seriously threaten the physical and mental health of pilots.Shall they end their flying after treatment of CRC?With this study,we investigated the possibility of a gradual medical waiver for such pilots to fly aircrafts again after treatment of CRC.CASE SUMMARY We analyzed the medical waiver and clinical data of 3 pilots with CRC,who had accepted the treatment at the Department of General Surgery,Air Force Medical Center(formerly,Air Force General Hospital)between 2013 and 2018.All 3 cases underwent a series of comprehensive treatment courses,including radical resection of CRC,sequential radiotherapy,and chemotherapy.The follow-up results were satisfactory.After passing through the high-risk period of recurrence and metastasis of CRC,they all were given a medical waiver for flying again.Medical observation showed that their flying operations were safe.CONCLUSION The CRC treatment shall follow the guidelines for diagnosis and treatment and should simultaneously protect the combating capabilities of pilots as much as possible.It is safe for pilots with CRC,who are continuously monitored under medical observation after passing through the high-risk period of recurrence and metastasis,to undertake military flight missions again.