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Objective:To explore the incidence of secondary hemophagocytic lymphohistiocytosis (sHLH) in elderly patients with severe SARS-CoV-2 infection, and to analyze and summarize its clinical features and risk factors for early identification of high-risk groups.Methods:A retrospective cohort study was conducted. From January to May 2020, No. 960 Hospital of People's Liberation Army, the Second Hospital Affiliated to Cheeloo College of Medicine of Shandong Province, the First Rehabilitation Hospital of Shandong Province, the Public Health Clinical Center Affiliated to Shandong University, and Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine received 248 patients over 60 years old who were diagnosed with severe SARS-CoV-2 infection during their assistance to Hubei or support for diagnosis and treatment of SARS-CoV-2 infection in Shandong Province. The clinical data of patients were collected. According to the hemophagocytic lymphohistiocytosis diagnosis scoring (HScore) criteria, the patients were divided into sHLH group (HScore > 169) and non-sHLH group (HScore < 98). The demographic data, clinical features, laboratory results, the proportion of organ failure and 60-day mortality of patients were collected and compared between the two groups. The risk factors of sHLH and 60-day death were evaluated through binary multivariate Logistic regression analysis in elderly patients with severe SARS-CoV-2 infection. The receiver operator characteristic curve (ROC curve) was plotted to analyze the diagnostic value of indicators only or combined for sHLH.Results:Among 248 elderly patients with severe SARS-CoV-2 infection, 82 patients with incomplete data and untraceable clinical outcomes, and 35 patients with HScore of 98-169 were excluded. Finally, 131 patients were enrolled in the final follow-up and statistics, including 25 patients in the sHLH group and 106 patients in the non-sHLH group. Compared with the non-sHLH group, plasma albumin (ALB), hemoglobin (Hb), lymphocyte count (LYM), platelet count (PLT), fibrinogen (Fib) and prealbumin (PAB) in the sHLH group were significantly reduced, while alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), MB isoenzyme of creatine kinase (CK-MB), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ferritin (Fer), lactate dehydrogenase (LDH), procalcitonin (PCT), cardiac troponin I (cTnI), triglycerides (TG), interleukin-6 (IL-6), total bilirubin (TBil) were significantly higher. The fever and fatigue in the sHLH group were more severe than those in the non-sHLH group, and the patients in the sHLH group had higher rates of shock, acute kidney injury, liver dysfunction, and cardiac injury than the non-sHLH group. The 60-day mortality of patient in the sHLH group was significantly higher than that in the non-sHLH group [84.0% (21/25) vs. 40.6% (43/106), P < 0.01]. Binary multivariate Logistic regression analysis showed that high Fer [odds ratio ( OR) = 0.997, 95% confidence interval (95% CI) was 0.996-0.998], D-dimer ( OR = 0.960, 95% CI was 0.944-0.977), LDH ( OR = 0.998, 95% CI was 0.997-0.999) and TG ( OR = 0.706, 95% CI was 0.579-0.860) were independent risk factors for sHLH in elderly patients with severe SARS-CoV-2 infection (all P < 0.01), while elevated Fer ( OR = 1.001, 95% CI was 1.001-1.002), LDH ( OR = 1.004, 95% CI was 1.002-1.005) and D-dimer ( OR = 1.036, 95% CI was 1.018-1.055) were independent risk factors for 60-day death of patients (all P < 0.01). The death risk of the sHLH patients was 7.692 times higher than that of the non-sHLH patients ( OR = 7.692, 95% CI was 2.466-23.987, P = 0.000). ROC curve analysis showed that a three-composite-index composed of LDH, D-dimer and TG had good diagnostic value for sHLH in elderly patients with severe SARS-CoV-2 infection [area under the ROC curve (AUC) = 0.920, 95% CI was 0.866-0.973, P = 0.000]. Conclusions:Elderly patients with severe SARS-CoV-2 infection complicated by sHLH tend to be critically ill and have refractory status and worse prognosis. High Fer, LDH, D-dimer and TG are independent risk factors for sHLH, and are highly suggestive of poor outcome. The comprehensive index composed of LDH, D-dimer and TG has good diagnostic value, and can be used as an early screening tool for sHLH in elderly patients with severe SARS-CoV-2 infection.
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The global emergency caused by the SARS-CoV-2 pandemics can only be solved with adequate preventive and therapeutic strategies, both currently missing. The electropositive Receptor Binding Domain (RBD) of SARS-CoV-2 spike protein with abundant {beta}-sheet structure serves as target for COVID-19 therapeutic drug design. Here, we discovered that ultrathin 2D CuInP2S6 (CIPS) nanosheets as a new agent against SARS-CoV-2 infection, which also able to promote viral host elimination. CIPS exhibits extremely high and selective binding capacity with the RBD of SARS-CoV-2 spike protein, with consequent inhibition of virus entry and infection in ACE2-bearing cells and human airway epithelial organoids. CIPS displays nano-viscous properties in selectively binding with spike protein (KD < 1 pM) with negligible toxicity in vitro and in vivo. Further, the CIPS-bound SARS-CoV-2 was quickly phagocytosed and eliminated by macrophages, suggesting CIPS could be successfully used to capture and facilitate the virus host elimination with possibility of triggering anti-viral immunization. Thus, we propose CIPS as a promising nanodrug for future safe and effective anti-SARS-CoV-2 therapy, as well as for use as disinfection agent and surface coating material to constrain the SARS-CoV-2 spreading.
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Objective To discuss effect of compound Xueshuantong capsule in in treatment patients of cataract with proliferative diabetic retinopathy.Methods 60 cases of cataract patients with proliferative diabetic retinopathy from February 2015 to February 2016 in our hospital were selected,according to random number table method divided into observation group (n=30) and control group (n=30).The patients in both groups were given basic medical treatment of diabetes,the patients in observation group were treated with Xueshuantong capsule before cataract surgery,continue treatment for three months.The total effective rate of treatment was compared between the two groups,the results of fundus fluorescein angiography and macular thickness before and after treatment were compared,comparison the levels of VEGF in the aqueous humor of the two groups after the treatment. Results The total effective rate of treatment in observation group was significantly higher than control group (P<0.05).After treatment, the number of hemangiomas in the observation group was significantly less than that in the control group (P<0.05),the area of exudation was significantly smaller than that of the control group (P<0.05),the macular thickness of the observation group was significantly lower than the control group (P<0.05),the VEGF content in aqueous humor was significantly lower than that in control group (P<0.05).Conclusion Compound Xueshuantong capsule can significantly improve the retinopathy of cataract patients with proliferative diabetic retinopathy,has a significant effect on decreasing VEGF concentration in aqueous humor and reducing macular edema .
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Objective The optimal community nursing intervention methods for community patients with primary hypertension was discussed in order to promote their health. Methods System management and community intervention were applied to 140 community patients with primary hypertension for 2 years, including strengthing community communication, popularizing health knowledge, improving cognition of danger of hypertension, hypertensive disease project management, tracking and monitoring the patients with primary hypertension and medication supervision.The cognition rate of prevention and control knowledge for hypertension, hypertension-related cardiovascular complication and formation rote of hypertension control behavior were compared before and after intervention. Results The prevalence rate of the knowledge on hypertension was increased, accompanied with promoting regular medication in patients with hypertension, decreasing cardiovascular complication caused by hypertension and heightening formation rate of controlling behavior in hypertension patients.Conclusions Applying community nursing intervention is practically effective in prevention and treatment of primary hypertension, deserving promotion and application in community medical institute.
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Clinical manifestations thoracoscopy findings,and pathological findings of 54 patients with tuberculous pleural effusion were reported.The gross appearance of pleural lesions under direct vision with thoracoscope can be divided into three types:(A) tuberculous nodules in 34 cases,all of them were proved by pathological examination;(B) Inflammatory reaction type in 14 cases,in whom rate of positive pathology was 78.5% (11/14);(C) pleural hyperplasia and adhesion type in 6 cases,and rate for positive pathology was 66.7% (4/6).Of these 54 patients,the overall rate for positive pathoiogy was 00.75% (49/54).The diagnosis and pathogenesis of tuberculous effusion were discussed.The presence of characteristic tuberculous nodules on the pleura with specific pathological finbings suggets that direct invasion of pleura by tubercle bacilli may play a more important role than pleural allergic reaction in the pathogenesis of tuberculous pleural effusion.
