Expert consensus on antiviral therapy of COVID-19 / 中华临床感染病杂志

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.

Epidemiological, Clinical Characteristics and Risk Factors for Severe Condition and ICU Admission of COVID-19 Patients of Early Stage in China: A review

ObjectiveSome retrospective studies reporting epidemiological, clinical characteristics of COVID-19 patients of early stage were published. We aim to provide an overview of epidemiological and clinical characteristics of the COVID-19 patients, and identification, treatment of early stage, especially for the patients with poor prognosis. Data SourcesPubMed, CNKI and Google Scholar. Study SelectionWe searched for published retrospective studies that described epidemiological and clinical characteristics of confirmed COVID-19 patients in China by April 14th, 2020 with search terms. Some studies were excluded according to criteria. Finally, 53 studies were included. Data ExtractionCharacteristics of the COVID-19 patients available from included articles were extracted, reorganized and recorded into electronic data forms. Data SynthesisCharacteristics of patients in the included studies were summarized and analyzed for median-interquartile ranges and univariable odds ratio. ConclusionThis study summarized, analyzed and compared epidemiological, clinical characteristics and estimated univariable risk factors among confirmed COVID-19 patients either in former epicenter, in severe condition, with ICU admission or not of early stage. Higher proportions of patients were found to have older age and more comorbidities, typical characteristics on admission and complications either in former epicenter, with severe condition or ICU admission. No evidence showed that patients who were male or had smoking history had higher susceptibility, but they were significant risk factors for severe condition. Some self-implementable traditional Chinese medicine therapies conducted for immunity improvement, control of comorbidities and reduction of some medicine intake. Limited evidence revealed that some characteristics of the disease might be changing with human-to-human transmission, and more research, especially international collaboration, is needed. Copyright form disclosureThe authors have disclosed that they do not have any potential conflicts of interest.

Broad phenotypic alterations and potential dysfunctions of lymphocytes in COVID-19 recovered individuals

BackgroundLymphopenia is a typical symptom in the COVID-19 patients. While millions of patients are clinical recovered, little is known about the immune status of lymphocytes in these individuals. MethodsA clinical recovered cohort (CR) of 55 COVID-19 individuals (discharged from hospital 4 to 11 weeks), and 55 age and sex matched healthy donors cohort (HD) were recruited. Detailed analysis on phenotype of the lymphocytes in peripheral blood mononuclear cells (PBMCs) was performed by flow cytometry. FindingsCompared with cohort HD, the CD8+ T cells in cohort CR had higher Teff and Tem, but lower Tc1 (IFN-{gamma}+), Tc2 (IL-4+) and Tc17 (IL-17A+) frequencies. The CD4+ T cells of CR had decreased frequency, especially on the Tcm subset. Moreover, CD4+ T cells of CR expressed lower PD-1 and had lower frequencies of Th1 (IFN-{gamma}+), Th2 (IL-4+), Th17 (IL-17A+) as well as circulating Tfh (CXCR5+PD-1+). Accordingly, isotype-switched memory B cell (IgM-CD20hi) in CR had significantly lower proportion in B cells, though level of activation marker CD71 elevated. For CD3-HLA-DRlo lymphocytes of CR, besides levels of IFN-{gamma}, Granzyme B and T-bet were lower, the correlation between T-bet and IFN-{gamma} became irrelevant. In addition, taken into account of discharged days, all the lowered function associated phenotypes showed no recovery tendency within whole observation period. InterpretationThe CR COVID-19 individuals still showed remarkable phenotypic alterations in lymphocytes after clinical recovery 4 to 11 weeks. This suggests SARS-CoV-2 infection imprints profoundly on lymphocytes and results in long-lasting potential dysfunctions. FundingKunming Science and Technology Department (2020-1-N-037)

Impaired T cell functions along with elevated activated Tregs at the early stage of asymptomatic SARS-CoV-2 infection

BackgroundLimited data are available on the T cell responses for the asymptomatic SARS-CoV-2 infection case. MethodsAn imported SARS-CoV-2 infection case in Wuhan was admitted in hospital for quarantine and observation. The T cell responses were followed up by flow cytometry analysis of the peripheral blood nonnuclear cells (PBMCs) at days 7, 13, 22, and 28 after admission. FindingsWe found the imported SARS-CoV-2 infection in Wuhan is an asymptomatic case. His T cell differentiation, proliferation and activation matched the classical kinetics of T cell responses induced by viral infection, but the activation maintained at a relatively low level. Function analysis indicated frequencies of IFN-{gamma} producing CD4+ and CD8+ T cells were notably lower than that of the healthy controls (HC) at day 7, and then rebound gradually. But IFN-{gamma}+CD8+ T cells were detained at a significant lower level even at day 28, when the SARS-CoV-2 virus had already become undetectable for 3 weeks. Moreover, percentage of IL-17 producing CD4+ T cells was also detained constantly at a much lower level compared to HC. At day 7, although percentage of Tregs was in normal range, the frequency of activated Treg (aTreg) was remarkably as high as 4{middle dot}4-fold of that in HC. InterpretationThe T cell activation in the asymptomatic SARS-CoV-2 infection experienced a significant suppression and presented impairment of Th1/Th17 and CD8+ T cell functions. Early elevation of the aTregs might play role in the activation and function of T cells in the asymptomatic SARS-CoV-2 infection.

Validating the surgical indication value of the LTB-S classification system for drug resistant tuberculosis.

BACKGROUND: Currently there is no guideline based on preoperative clinical parameters for assessing the prognosis of the adjunctive surgery for drug-resistant tuberculosis. METHODS: We retrospectively analyzed 138 patients who had undergone surgical resection as a treatment for drug- resistant tuberculosis after 24 months. Four clinical parameters on lesion type, treatment history, body physiological status, and surgery approach were evaluated. Categorical preoperative clinical parameters were analyzed by ordinal logistic regression model when considering postoperative complications as outcomes ordered in terms of severity. Statistically significant parameters were then combined in a single classification system for predicting the outcomes of the adjunctive surgery. FINDINGS: Diffused, progressive bilateral lesions, or active/progressive extra pulmonary tuberculosis (L3), and history of less than 2 months treatment before surgery (T3) were the strongest predicative parameters for postoperative complications and for surgery failure. Classification systems based on the four parameters were found to have a statistically significant effect on postoperative complications and postoperative efficacy. 24- month follow up indicated a high cure rate (above 95.5%) among patients without T3, L3, or severe physiological complications (B3). INTERPRETATION: A classification system based on objective clinical parameters showed predicative value for the prognosis of the adjunctive surgery and could guide management of drug-resistant Tuberculosis.

The clinical value of HbA1c,CRP,IL-6 and IMA in patients with type 2 diabetes nephropathy / 国际检验医学杂志

Objective To explore the clinical value of glycosylated hemoglobin A1(HbA1c) ,C-reactive protein(CRP) ,interleu-kin-6(IL-6) and ischemia modified albumin(IMA) in patients with type 2 diabetes nephropathy .Methods 64 patients with type 2 diabetes mellitus were divided into simple diabetic mellitus group(34 patients) and diabetic nephropathy group(30 patients) .In ad-dition ,40 healthy subjects were chosen as control group .The levels of HbA1c ,CRP ,IL-6 and IMA were detected .Results The lev-els of HbA1c ,CRP ,IL-6 and IMA in simple diabetic mellitus group were all significantly higher than those in control group(P<0 .05) .The levels of HbA1c ,CRP ,IL-6 and IMA in diabetic nephropathy group were all significantly higher than those in simple di-abetic mellitus group(P<0 .05) .There were a positive correlations between the HbA1c level and the levels of CRP ,IL-6 ,IMA(P<0 .05) .The positive rate of combined detection of HbA1c ,CRP ,IL-6 and IMA was significantly higher than separate index detection (P<0 .05) .Conclusion The combined detection of HbA1c ,CRP ,IL-6 and IMA may be beneficial to the early diagnosis of diabetic nephropathy ,which will delay the progress of diabetic nephropathy .

The Value of fPSA/tPSA Ratio in Differential Diagnosis of Prostate Cancer / 中国慢性病预防与控制

0.05),but the ratio of fPSA/tPSA in PC group was very lower than that in BPH group(P20.0 ?g/L,the sensitivity and the specificity was 91.6%(22/24) and 87.5%(21/24).Conclusion It can improve the differential diagnosis between PC and BPH to use the ratio of fPSA/tPSA combining with the serum tPSA.It is important for the observation of the differential diagnosis and the therapeutic effects of PC and the preparation of the high risk persons and etc.