[Impact of the Timing of Traditional Chinese Medicine Therapy on the Therapeutic Effect and Prognosis of Severe Coronavirus Disease 2019].

Objective To explore the optimal therapy time for the treatment of severe coronavirus disease 2019(COVID-19)by traditional Chinese medicine(TCM)and its influence on the therapeutic effect and prognosis. Methods The clinical data,laboratory findings,and outcomes of 64 patients with severe COVID-19 treated with TCM and western medicine in Chongqing from January 20,2020, to March 11,2020 were retrospectively analyzed.Patients were divided into early intervention group[TCM was initiated within 3 days (including day 3) after the first diagnosis of severe type/critical type COVID-19]and late intervention group[TCM was initiated after 7 days (including day 7) after the first diagnosis of severe type /critical type COVID-19].The changes in clinical parameters during the course of disease were compared between the two groups. Results On day 14,the oxygenation index was 292.5(252.0,351.0)mmHg in the early intervention group,which was significantly higher than that in the late intervention group [246.0(170.0,292.5)mmHg](P=0.005).The length of hospital stay [(18.56±1.11)d vs.(24.87±1.64)d,P=0.001],duration of ICU stay [(14.12±0.91)d vs.(20.00±1.53)d,P=0.000] and time to negativity [(16.77±1.04)d vs.(22.48±1.66)d,P=0.001] in the early intervention group were significantly shorter than those in the late intervention group.The intubation rate(7.3%)in the early intervention group was significantly lower than that in the late intervention group(30.4%)(P=0.028). Conclusion Early TCM therapy within three days after a diagnosis of severe COVID-19 can shorten the length of hospital stay,duration of ICU stay,and time to negativity and decrease intubation rate.

A transendocardial delivery and intracardiac ultrasound irradiation treatment catheter.

OBJECTIVES: This study introduces the structural design, working principles, performance testing and treatment effects of a newly developed ultrasonic irradiation delivery and treatment catheter system that integrates interventional catheterization technology. BACKGROUND: Systemic administration method needs a high dose of gene and induces side effect of non-target organ delivery. Direct intramyocardial injection of a low-dose angiogenic gene followed by insonation treatment can enhance gene expression. So, a novel transendocardial gene delivery and intracardiac ultrasound irradiation strategy was tested. METHODS: The medical interventional ultrasonic therapeutic apparatus is comprised of an ultrasonic irradiation catheter and a host. The ultrasonic irradiation catheter, which is equipped with an advance-and-retreat convenient miniature syringe needle and a miniature piezoelectric transducer on the tip, was used. Twelve dogs were divided into three groups: (1) EGFP and US (EGFP + US), (2) EGFP alone and (3) control group. In the EGFP + US group, EGFP plasmid DNA (500 µg) was injected and followed by intracardiac insonation. In the EGFP alone group, EGFP plasmid DNA (500 µg) was injected without insonation. In the control group, saline was injected. RESULTS: The catheter can enter the heart through percutaneous intervention to realize intramyocardial injection, directly irradiate cardiac muscular tissues at close range and correctly control the ultrasonic irradiation energy delivered to cardiac muscular tissues. Compared with the EGFP gene group, an average sixfold enhancement in gene expression was achieved in the EGFP EGFP + US group (p < 0.05). CONCLUSIONS: The experimental results confirmed that the treatment catheter was safe and reliable, which can realize transendocardial intramyocardial gene injection in the left ventricular chamber, and the ultrasonic parameter can increase gene expression after intracardiac ultrasonic irradiation. The intracardiac ultrasound irradiation treatment catheter may be a useful delivery and therapy tool in the future.