Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version).

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: an evidence-based clinical practice guideline (updated version)

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID19 patients

Effects of Tai Chi Yunshou on upper limb function and balance in stroke survivors: A protocol for systematic review and meta analysis.

BACKGROUND: Functional disability is the most common disorder that occurs after stroke and seriously affects the quality of life of stroke survivors. Tai Chi Yunshou (TCY), a fundamental form of Tai Chi, is a simple, convenient, and economical exercise therapy from ancient China. Some clinical trials have reported that it improves upper limb function and balance during stroke rehabilitation. Thus, we plan to conduct a systematic review to investigate the effects of TCY in stroke survivors. METHODS: This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We will search English and Chinese databases for randomized controlled trials on TCY for stroke survivors from the dates when the databases were established to 1 July 2020. The English databases will include MEDLINE (PubMed), EMBASE (embase.com), and the Cochrane Central Register of Controlled Trials (Cochrane Library). In addition, the Chinese databases will include the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Science and Technology Periodical Database, the Wanfang database, and the Chinese Dissertation Database. The primary outcomes will include upper limb function and balance function, as measured by the Fugl-Meyer assessment and Berg balance scale, respectively. Two reviewers will independently screen the studies on the basis of the inclusion criteria and extract data. Review Manager (v5.3) will be used for data synthesis, and Cochrane Collaboration's tool will be used to assess the risk of bias. A fixed effects model or a random effects model will be selected based on the level of heterogeneity. The grading of recommendations assessment, development, and evaluation system will be used to evaluate the quality of the outcomes. RESULTS: This systematic review results will be carried out after the completion of the protocol. CONCLUSIONS: This protocol aims to guide a systematic review and meta-analysis investigating the effects of JCY on upper limb function and body balance in stroke survivors, which will provide evidence for post-stroke rehabilitation training. PROSPERO REGISTRATION NUMBER: CRD42020169549.

Bioactive seco-Sativene Sesquiterpenoids from an Artemisia desertorum Endophytic Fungus, Cochliobolus sativus.

A series of seco-sativene sesquiterpenoids (1-11) including two new natural products (2 and 3), four new analogues (4-7), and six known analogues, helminthosporic acid (1), drechslerine A (8), drechslerine B (9), helminthosporol (10), helminthosporal acid (11), and isosativenediol (12), were purified from the endophytic fungus Cochliobolus sativus isolated from a desert plant, Artemisia desertorum. The stereochemistry of helminthosporic acid (1) was established for the first time by X-ray diffraction, and the structures including relative and absolute configurations of these new compounds were determined by NMR and CD spectra together with biosynthetic considerations. Compounds 5-7 are the first seco-sativene sesquiterpenoids possessing a glucose group on C-15, C-15, and C-14, respectively. Compounds 1, 7, 9, and 11 displayed strong phytotoxic effects on corn leaves by producing visible lesions, and helminthosporic acid (1) was shown to promote division of leaves and roots of Arabidopsis thaliana with a dose-dependent relationship.

Study on the Changes of Chemical Constituents in Different Compatibilities of Ginseng-Prepared Rehmannia Root and Their Effects on Bone Marrow Inhibition after Chemotherapy.

Ginseng (G) and Prepared Rehmannia Root (PRR) are commonly used in traditional Chinese medicine for blood supplementation. This study aimed to study G and PRR with different compatibility ratios changes in chemical composition and inhibition of cyclophosphamide-induced myelosuppression. HPLC was used to determine the chemical constituents of 13 ginsenosides, 5-hydroxymethylfurfural (5-HMF) and verbascoside in different proportions of G-PRR. Balb/c mice were injected intraperitoneally with cyclophosphamide (CTX) to induce bone marrow suppression. The effects of different proportions of G-PRR on peripheral blood, bone marrow nucleated cells, thymus and spleen index of myelosuppressed mice were analyzed. The results showed that the compatibility of G and PRR can promote the dissolution of ginsenosides, and the content of conventional ginsenosides decreased, and the content of rare ginsenosides increased. Different proportions of G-PRR increased the number of peripheral blood and bone marrow nucleated cells in cyclophosphamide-induced bone marrow suppression mice (p < 0.01), increased thymus index (p < 0.01), decreased spleen index (p < 0.01). Different proportions of G-PRR can improve the myelosuppression induced by cyclophosphamide in mice, and the combined effect of G-PRR is better than the single decoction of G and PRR. Among them, G-PRR 2 : 3 and G-PRR 1 : 2 were better than the other groups. These results indicate that different proportion of G-PRR can improve bone marrow suppression, and the combined decoction of G-PRR is better than the separate Decoction in improving bone marrow suppression. This improvement may be related to the changes of the substance basis and active ingredients of G-PRR.

Tanshinone II is a potent candidate for treatment of lipopolysaccharide-induced acute lung injury in rat model.

The present study aimed to investigate the effect of tanshinone II, isolated from Salvia miltiorrhiza Bunge, on lipopolysaccharide (LPS)-induced acute lung injury (ALI) in rats. Male Sprague-Dawley rats were divided into three groups: Control, LPS and tanshinone II. Animals in the tanshinone II and LPS groups were administered 10 mg/kg LPS, whereas those in the control group received an equal volume of normal saline. Tanshinone II treatment group were injected with 30 nm/kg tanshinone II at 1 h after LPS administration. The results revealed that LPS administration increased the bronchoalveolar lavage fluid protein concentration significantly compared with the control group. However, tanshinone II treatment significantly inhibited the LPS-induced increase in protein level. Treatment of the LPS-administered rats with tanshinone II prevented the formation of pulmonary edema, which was evidenced by low values for wet to dry lung weight ratio. The activity of myeloperoxidase and expression of malondialdehyde were significantly lower in lung homogenates from the tanshinone II group compared with the LPS group. Furthermore, tanshinone II treatment inhibited the expression of tumor necrosis factor-α and interleukin-6 in the blood plasma. Tissue sections of the tanshinone II group exhibited normal morphology and absence of neutrophil accumulation. However, in the LPS group, neutrophils accumulated and penetrated into the pulmonary tissues. These results suggested that tanshinone II protects the rats from LPS-induced ALI. Therefore tanshinone II may have clinical applications in the treatment of ALI.

[Effect of environmental factors on photosynthetic physiology and flavonoid constituent of Scutellaria baicalensis].

To discuss the effect of environmental factors and photosynthesis on the growing of plant and the content of active components in Scutellaria baicalensis, the photosynthetic physiology index and diurnal changes of flavonoid constituent of S. Baicalensis were observed and tested in flowering and fruiting stages, and in the meantime environmental parameters were recorded. The obtained data were analyzed data by using path analysis and gray correlation analysis. The results showed that PAR and SWC were important environmental factors impacting on photosynthesis of S. baicalensis. SWC, RH and Ca were important environmental factors impacting on baicalin content. PAR, Po and Ta were important environmental factors impacting on baicalein content.

[Study on preparation of matrine double-sensitive colon-specific pellets and in vitro release].

OBJECTIVE: To prepare matrine double-sensitive colon-specific pellets and study the factors affecting its quality and evaluateing the colon-specific effects of preparation. METHOD: Matrine enzyme-sensitive pellets core were prepared by carboxymethyl konjac glucomannan as the main carrier material, and coated the core by acrylic resin II and III to prepare matrine double-sensitive colon-specific pellets. The prescription and technology of the matrine colon-specific pellets were studied by the single factor investigation, through the in vitro release test and coating rate determination. RESULT: The optimized process conditions: FeCl3 concentration is 4.0 g x L(-1), chitosan concentration is 3.0 g x L(-1), carboxymethyl konjac glucomannan concentration is 20 g x L(-1), mixed gel solution pH value is 3. The release of matrine is less than 30% in the simulation of the upper gastrointestinal medium. The release of matrine is close to 100% in simulated full gastrointestinal medium, the coating weight is 7%. CONCLUSION: The prepared pellets have good colon positioning effect in vitro.

The effects of different hyperbaric oxygen manipulations in rats after traumatic brain injury.

The protective effects of hyperbaric oxygenation following traumatic brain injury have been widely investigated; however, few studies have made systematic comparisons between the different hyperbaric oxygenation manipulations and their corresponding effects. In this study, male Sprague-Dawley rats were observed at 4h, 15d and 75d after traumatic brain injury. The effects of the different hyperbaric oxygenation manipulations on the rats were compared based on morphological, molecular biological and behavioral tests. Our results showed that hyperbaric oxygenation inhibited cell apoptosis in the rat hippocampus and improved their physiological functions. The effects observed in the hyperbaric oxygen-early group were better than the hyperbaric oxygen-delayed group, and the hyperbaric oxygen-early-delayed group demonstrated the best effects among all the groups. Our results showed the hyperbaric oxygenation was recommended early and delayed post-traumatic brain injury and exposure to hyperbaric oxygenation should be prolonged. These findings provide new ideal therapeutic insight for the clinical treatment of traumatic brain injury.

[Physiological ecology responses of Scutellaria baicalensis to drought and rewatering].

To study the physiological ecology responses of Scutellaria baicalensis to drought and rewatering of short period, we tested and analyzed photosynthesis and chlorophyll fluorescence parameters of S. baicalensis leaves processed by different ways of water treatment in drought and rewatering period, characteristic indexes of physiology and biochemistry of root SOD, POD, PAL, C4H, etc. and accumulation dynamic change of root baicalin and baicalein. The result showed that along with the worsening drought, P(n), T(r), G(s) and F(v)/F(m) of S. baicalensis declined in different water supply, and F(o) increased. The response of SOD and POD's activity in S. baicalensis root to drought in I and II was earlier than it in III. The response time and increase range of baicalin accumulation existed differences in different water supply, and the indexes regained after rewatering. Therefore, photosynthesis of S. baicalensis changed and it destroyed the antioxidant metabolism balance when soil water content decreased resulting from drought. The synergistic effect of defence mechanism launched by S. baicalensis, SOD, POD, PAL, C4H, baicalin and baicalein reduced active oxygen's damage to the cell.

[Effects of Huangqi Guizhi Wuwu Decoction given by different administration methods on rats with frostbite and the mechanism].

OBJECTIVE: To establish a rat model of frostbite and to evaluate the effects of different administration methods of Huangqi Guizhi Wuwu Decoction (HGWD), a compound traditional Chinese herbal medicine for warming meridians to disperse cold, on rats with frostbite. METHODS: Frostbite in rats was induced by the method of soaking feet in hypothermia ethanol-water mixture. Levels of interleukin-6 (IL-6), tumor necrosis factor-beta (TNF-beta), thromboxane B(2) (TXB(2)) and 6-keto-prostaglandin F(1alpha) (6-keto-PGF(1alpha)) in serum of rats treated with different administration methods of HGWD, such as oral administration (Oral HGWD), soak (Soak HGWD), and oral administration plus soak (Oral-soak HGWD), were tested by enzyme-linked immunosorbent assay. RESULTS: IL-6, TNF-beta, TXB(2) levels were significantly higher (P<0.01) and 6-keto-PGFbeta level was lower (P<0.01) in serum of rats in the untreated group than in the normal control group. Compared with the untreated group, the level of IL-6 obviously decreased (P<0.05) in serum of the rats treated by oral HGWD, while no significant decrease (P>0.05) was observed in the soak HGWD group, and there was no interaction (P>0.05) between the two administration methods in regulating the level of IL-6. The levels of TNF-beta obviously decreased (P<0.01, P<0.05) in serum of the rats treated by oral and soak HGWD, and there was interaction between the two administration methods. The level of TNF-beta in the oral HGWD group was significantly lower than that in the soak HGWD group (P<0.01). Compared with the untreated group, level of TXB(2) in oral HGWD or soak HGWD group did not decrease significantly (P>0.05) and there was no interaction (P>0.05) between the two administration methods. The level of 6-keto-PGF(1alpha) was obviously increased (P<0.01) in serum of the rats treated by oral HGWD, while there was no significant decrease (P>0.05) in the soak HGWD group as compared with the untreated group, and there was interaction (P<0.05) between the two administration methods in regulating the level of 6-keto-PGF(1alpha). CONCLUSION: Rats with frostbite has immunologic dysfunction and a state of forming thrombus easily. The oral-soak HGWD can improve frostbite of local skin in rats. The therapeutic mechanism of HGWD may be to regulate the dysfunction of immune system and the imbalance of TXB(2)-PGF(1alpha).