A retrospective analysis of clinical efficacy of ribavirin in adults hospitalized with severe COVID-19.

INTRODUCTION: Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swept rapidly throughout the world. So far, no therapeutics have yet proven to be effective. Ribavirin was recommended for the treatment of COVID-19 in China because of its in vitro activity. However, evidence supporting its clinical use with good efficacy is still lacking. METHODS: A total of 208 confirmed severe COVID-19 patients who were hospitalized in Wuhan Union West Campus between 1 February 2020 and 10 March 2020 were enrolled in the retrospective study. Patients were divided into two groups based on the use of ribavirin. The primary endpoint was the time to clinical improvement. The secondary endpoints included mortality, survival time, time to throat swab SARS-CoV-2 nucleic acid negative conversion, and the length of hospital stay. RESULTS: 68 patients were treated with ribavirin while 140 not. There were no significant between-group differences in demographic characteristics, baseline laboratory test results, treatment, and distribution of ordinal scale scores at enrollment, except for coexisting diseases especially cancer (ribavirin group vs no ribavirin group, P = 0.01). Treatment with ribavirin was not associated with a difference in the time to clinical improvement (P = 0.48, HR = 0.88, 95% CI = 0.63-1.25). There were also no significant differences between-group in SARS-CoV-2 nucleic acid negative conversion, mortality, survival time, and the length of hospital stay. CONCLUSIONS: In hospitalized adult patients with severe COVID-19, no significant benefit was observed with ribavirin treatment.

Full-Endoscopic Approach Forchronic Low Back Pain from Baastrup's Disease: Interspinous Plasty.

The objective was to introduce a new endoscopic technique-interspinous plasty for low back pain from Baastrup's disease; based on clinical manifestations, imaging findings and diagnostic test, to discuss a detailed diagnostic procedure for Baastrup's disease; and to explore the mechanism of interspinous plasty in pain relief. To our knowledge, there is no report about the results of endoscopic lumbar technique for Baastrup's disease. This study described the successful full-endoscopic surgical treatment for Baastrup's disease, providing a brand-new therapeutic method for patients. Clinical manifestations, imaging findings, including X-ray, computed tomography (CT) and magnetic resonance imaging, and a "positive" diagnostic test with local anesthetic were used to confirm Baastrup's disease in the three included patients. The interspinous plasty procedure, which aimed to recover a physiological gap between the adjacent spinous processes, was performed by full-endoscopic resection of marginal osteophytes. The removal of local inflamed tissue and reducing inflammation via intraoperative saline irrigation also lead to pain relief. Clinical outcomes included visual analog scale (VAS) for low back pain and the Oswestry Disability Index (ODI). The distance between the adjacent spinous processes was measured from the preoperative and postoperative CT scan. We calculated and recorded the difference between preoperative and postoperative measurements. Technical procedures and advantages of interspinous plasty are introduced. The three patients showed improvement in terms of the postoperative VAS of low back pain (from 8 to 2, from 7 to 1 and from 8 to 2) and ODI (from 68.9% to 33.3%, from 77.8% to 28.9% and from 71.1% to 28.9%, respectively) at the 12-month follow-up. Compared postoperative ODI index, the ODI index increased from 26.7% to 33.3% and from 24.4% to 28.9% in two of the cases at the 12-month follow-up. At 1 week, CT confirmed an obvious reduction in the marginal osteophytes between the adjacent spinous processes. Compared with those on preoperative CT images, the distance between adjacent spinous processes on postoperative CT was enlarged from 1 to 4 mm, and a repeated CT scan 3 months later reconfirmed little recrudescent osteoproliferation. In selected cases, full-endoscopic surgical treatment for chronic mechanical back pain as part of the phenomena of Baastrup's disease may be beneficial. The operations in this study were performed under local anesthesia, with satisfactory early clinical outcomes and a low incidence of complications or adverse events. This may be a feasible therapeutic method or an alternative option for patients who cannot tolerate general anesthesia surgery.

[Experimental treatment of chronic pelvic inflammatory disease in rats with acupoint injection of Astragalus parenteral solution].

OBJECTIVE: To observe the effect of acupoint injection with astragalus parenteral solution in rat chronic pelvic inflammatory disease (CPID). METHODS: Fifty female Wistar rats were randomly divided into 6 groups: CPID model was induced in 4 groups, in addition to control group and false surgery group. The rats were given acupoint (Guanyuan and Zusanli) injection with astragalus parenteral solution and saline. The drug group was fed with Qianjinpian solutions. The histopathologic changes of uterus were observed and serum IL-2 and TNF-alpha levels detected. RESULT: The rats in the model group showed chronic inflammatory changes, the animals in astragalus parenteral injection group and Qianjinpian group showed little histopathological changes. The serum TNF-alpha levels in the model group were significantly higher than those in the normal group and the astragalus parenteral injection group; while the IL-2 levels in model group were significantly lower than those of other 5 groups. The TNF-alpha and IL-2 levels in astragalus parenteral injection group were similar to those of normal group. CONCLUSION: The treatment of chronic pelvic inflammatory disease with acupoint injection of astragalus parenteral solution might be effective.