2019冠状病毒病待排患者临床特征分析及鉴别诊断体会

目的 总结2019冠状病毒病(coronavirus disease 2019,COVID-19)待排患者的临床特征和鉴别诊断体会,提高COVID-19的诊断技能.方法 回顾性分析53例COVID-19待排患者的临床资料,包括流行病学史,以及白细胞计数、淋巴细胞计数、PLT、CRP、LDH、胸部高分辨CT(high resolution CT,HRCT)等检查结果.结果 本研究的53例COVID-19待排患者中,男32例,女21例;年龄15～79岁,平均年龄(53.5±8.4)岁.首诊时病程为1～12 d不等,病程中位数4 d.所有患者均否认COVID-19流行病学史.21例患者具有慢性基础病.首发症状主要为发热、乏力、咳嗽、咳痰、咽痛等.实验室检查外周血白细胞计数多为正常或减少;部分患者LDH、ALT、CK升高.胸部HRCT均呈现多发小斑片影、磨玻璃影及间质改变,以肺外带明显.53例患者均经间隔至少24 h的2次新冠病毒核酸检测为阴性,排除COVID-19,诊断为轻症社区获得性肺炎(community acquired pneumonia,CAP),经治疗后患者无发热及呼吸道症状.结论 COVID-19待排患者的临床表现以及肺部影像学与COVID-19相似,与CAP鉴别亦缺乏特异性;结合流行病学史以及新型冠状病毒核酸检测可以提高COVID-19诊断准确率.     

57例新型冠状病毒肺炎患者临床特点分析

目的　分析南宁市第四人民医院收治的新型冠状病毒肺炎（coronavirus disease-2019, COVID-19）患者临床特征及流行病学特点，为COVID-19疫情防控提供借鉴。方法　选取2020年1月22日—2月17日在南宁市第四人民医院隔离病房收治的57例COVID-19患者为研究对象，收集患者的临床资料，分析其一般情况、流行病学、临床症状、实验室检查结果及CT影像学特征。根据《新型冠状病毒感染的肺炎诊疗方案（试行第五版）》的临床分型方法，对比分析轻型/普通型与重型/危重型患者的临床特征。结果　57例确诊COVID-19患者中，男28例（49%），女29例（51%），平均年龄45岁，武汉相关病例36例（63.16%）。37例患者来自聚集性感染（64.91%），有10起家庭聚集性感染。临床症状以发热（52.63%）、咳嗽（42.10%）、咽喉不适（22.81%）、乏力（19.30%）为主，7例无症状。轻型/普通型50例（87.72%），重型/危重型7例（12.28%）。17例（29.82%）合并基础疾病，1例合并乙型流感病毒感染，1例合并肺部支原体感染。17例粪便核酸检测阳性，且咽拭子核酸转阴快于粪便核酸检测，13例（32.50%）咽拭子核酸检测转阴后粪便核酸检测仍为阳性。典型病例CT表现为多发斑片状磨玻璃影，外周胸膜下分布为主，下肺多见，重症患者病灶广泛。病灶吸收好转表现形式可不一致。结论　南宁市COVID-19病例以输入性及轻型/普通型病例为主，有粪便传播途径可能；临床特征与病毒性肺炎类似，高分辨率CT有助于诊断。     

新型冠状病毒肺炎疫情期间79例心脏大血管外科急诊手术的围术期管理

摘 要 目的：总结突发重大传染病时心脏大血管外科急诊手术的围术期管理经验。 方法：对我院1月23日武汉封城至3月31日新型冠状病毒肺炎（corona virus disease-19,COVID-19）疫情期间,79例心脏大血管急诊外科患者进行回顾分析,其中男性63例,女性16例,年龄0-77岁,平均49.91±7.21岁;武汉市内患者26例,市外53例;急性主动脉综合征（AAS）55例,急性冠脉综合征(ACS)合并机械并发症8例,心脏瓣膜病合并心内膜炎8例、难治性心衰5例,左房粘液瘤2例,婴幼儿高度房室传导阻滞1例。所有患者有120转运,市内患者在急诊科明确诊断,市外患者转运前均通过网络会诊明确诊断和确定急诊手术指征后再转运,在急诊完善肺部CT平扫初步排除COVID-19后收治隔离病区,紧急核酸检测和完善术前检查后行急诊手术,术后转运至监护室单间隔离直至排除COVID-19,住院期间出现发热时即行核酸检测和复查肺部CT。所有参与手术和围术期管理的医护人员均采取三级防护和医学观察。结果：行急诊手术大血管外科手术29例,主动脉腔内隔绝手术24例,大血管杂交手术2例,单纯冠脉旁路移植3例,冠脉旁路移植联合瓣膜手术3例,急性心梗室间隔穿孔封堵2例,瓣膜置换11例,瓣膜修复2例,左房粘液瘤摘除2例,心外膜永久起搏器植入1例,同期房颤射频消融术3例。术前首次核酸检测均为阴性,肺部CT有COVID-19影像学表现12例,4例确诊为COVID-19,疑似病例5例。全组患者中因COVID-19危重型死亡1例,因合并肾功能不全和重症感染放弃出院1例,其余患者均康复出院。所有参与手术和围术期管理的医护人员无感染COVID-19。 结论：在重大传染病期间,规范心脏急危重症患者收治流程,加强院内感染的控制,做好防护,急诊手术是救治心脏大血管急危重症的有效手段,医护人员的个人安全是有保证的。     

蚌埠地区79例新型冠状病毒肺炎患者临床特征

目的 提高对新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者临床特征及早期转归的认识.方法 回顾性分析2020年1月25日—3月4日蚌埠医学院第一附属医院收治经新型冠状病毒核酸检测确诊的79例资料完整的COVID-19出院患者病例资料及出院后3个月43例患者的随访资料.结果 7...     

新型冠状病毒肺炎特异性IgM抗体假阳性患者的临床特点分析

目的:分析我院新型冠状病毒肺炎(COVID-19)特异性IgM抗体假阳性患者的临床特点及预后,为疫情防控提供参考。方法:回顾分析2020年1月至2020年12月,首都医科大学附属北京安贞医院的COVID-19特异性IgM抗体假阳性的17例门、急诊及住院患者的流行病学病史、临床表现、辅助检查结果及预后,并与我院6例确诊的COVID-19感染患者相关临床资料进行对比。结果:17例COVID-19 IgM抗体假阳性患者均住院或居家隔离观察,间隔至少24 h的2次COVID-19核酸检测均为阴性,间隔至少1周的3次IgM抗体检测结果均阳性。COVID-19 IgM抗体结果采用胶体金和化学发光两种方法核验均为阳性。其中16例患者为IgM阳性IgG阴性,1例为IgM阳性IgG阳性,5例有自身抗体阳性,7例合并慢性炎症。均否认COVID-19流行病学病史(P0.001),2例有发热表现,平均体温低于COVID-19的确诊患者(P0.001)。17例胸部CT均无新冠肺炎影像学特征(P=0.002),17例均预后良好。结论:COVID-19特异性IgM抗体假阳性可能与慢性炎症、自身免疫因素相关,此类患者无COVID-19的流行病学病史、典型临床及影像学表现。     

老年人新型冠状病毒病临床特点及胸部CT表现

目的探讨老年人新型冠状病毒病(COVID-19)的临床特点及胸部CT表现。方法回顾性分析深圳市第三人民医院经核酸检测确诊为COVID-19的104例住院老年患者的临床资料、实验室检查及胸部CT表现。结果 104例患者中临床表现以发热(77.9%)和咳嗽(49.0%)为主;其他临床表现为淋巴细胞减少(41.3%),白细胞减少(19.2%),血钠降低(26.0%)、血钾降低(26.9%)、C反应蛋白升高(74.0%),D-二聚体升高(50.0%);胸部CT显示肺部磨玻璃影(100.00%)、小叶间隔增厚(59.6%)、索条灶(54.8%)及实变(19.2%),双肺分布多见(85.6%),多分布在胸膜下(63.5%)。结论老年人COVID-19胸部CT表现较典型,结合流行病学史、临床特点和实验室检查有助于COVID-19早期诊断。     

一例疑似重症新冠肺炎患者救治经验

正2019年12月突然爆发新型冠状病毒(SARS-CoV-2)肺炎~([1-2])。SARS-CoV-2是一种高度传染性且可能致命的病毒,比流感更具传染性,更致命~([3])。2020年2月11日WHO将新冠病毒引发的疾病正式命名为冠状病毒病(corona virus disease 2019,COVID-19)。我国已将该病纳入《中国人民共和国传染病法》规定的乙类传染病,采取甲类传染病预防控制措施~([4-6])。疫情期间,若有不确切的流行病学史,每一个有呼吸道感染证据的危重病患者,均应该考虑存在COVID-19的可能性,需要在单人间隔离治疗,尽快釆集标本进行新型冠状病毒核酸检测,同时在确保转运安全前提下立即将疑似病例转运至定点医院。若因病情严重存在转运风险,则需要     

全国新型冠状病毒肺炎空间分布及空间聚集性浅析

目的探索新型冠状病毒肺炎(COVID-19)在地级行政区层面的空间分布、空间聚集性及在不同时期的分布特征。方法收集全国地级行政区(直辖市、特别行政区)COVID-19确诊的相关信息和数据,运用空间自相关方法对COVID-19确诊情况进行空间统计分析。结果1月24日、1月29日和2月8日COVID-19累计确诊病例与2月8日COVID-19新增确诊病例具有全局空间正相关性,局部空间自相关结果显示不同时间点的COVID-19累计确诊病例与新增确诊病例空间分布有所不同。结论COVID-19累计确诊病例与新增确诊病例全国分布具有空间聚集性,确定COVID-19的高值聚集地区,将为进一步采取防控措施提供参考。     

52例疑似COVID-19的防控及临床特点分析

目的分析我院收治52例疑似新型冠状病毒肺炎(COVID-19)的流行病学及临床特点，探讨定点医院收治疑似病例的重要性。 方法回顾分析2020年1月31日至2020年2月15日广东省第二人民医院收治的52例疑似COVID-19病例的流行病学和临床表现、实验室检查和影像学检查特点，总结收治疑似病例的临床工作经验，以及疑似病例管理对传染病防控的重要作用。 结果52例患者中，男24例，女28例；年龄范围为15～65岁，中位年龄为36.5岁。其中有疫区旅行史或居住史的占28.8%，有确诊病例接触史的占26.9%，有确诊区域发热或呼吸道症状患者接触史的占7.7%，无明确流行病学史的占34.6%。临床主要表现为发热39例(75.0%)，咳嗽23例(44.2%)和乏力6例(11.5%)。血常规白细胞计数下降7例(13.5%)，正常34例(65.4%)，升高11例(21.2%)；淋巴细胞计数下降19例(36.5%)，正常33例(63.5%)。CD3⁺ T淋巴细胞绝对值下降13例(28.9%)；CD4⁺ T淋巴细胞绝对值下降15例(33.3%)。CD8⁺ T淋巴细胞绝对值下降12例(26.7%)。C反应蛋白(CRP)值升高30例(57.7%)；降钙素原(PCT)升高11例(21.1%)。44例行甲型流感、乙型流感、H7N9抗原检测，全阴性。22例行呼吸道13项常见病原体核酸检测，其中流感嗜血杆菌12例最多(54.5%)。影像学出现异常42例(80.8%)，其中磨玻璃影29例(55.8%)、斑片影24例(46.2%)，具有多重异常特征的16例(30.8%)。 结论疑似病例的收治对于疫情防控具有重要意义，其与确诊病例存在诸多相似之处，在收治的同时我们需要做好自身防护以及及时对其鉴别和诊治。     

石家庄地区45例COVID-19患者临床特征分析

目的　分析石家庄地区45例新型冠状病毒肺炎（coronavirus diseases-2019, COVID-19）患者的流行病学特征、临床表现、治疗及预后情况，为COVID-19的防治提供参考。方法　收集2020年1月21 日—5月31日在石家庄市第五医院就诊的45例COVID-19患者临床信息，根据临床表现将患者分为无症状/轻型组，普通型组，重/危重型组，对比分析不同组间临床症状、实验室与影像学检查、治疗及预后情况。结果　45例患者中，聚集性感染病例占57.78%；临床症状以发热、咳嗽/咳痰为主，重/危重型组患者发热比例更高；此外，患者年龄方面，重/危重型组明显高于其他2组（P＜0.05）；部分患者出现WBC、淋巴细胞计数下降，CRP升高及肝功能异常。其中3组之间淋巴细胞计数比较差异有统计学意义，两两比较，重/危重型组患者淋巴细胞计数显著低于无症状/轻型组（P＜0.05）。3组之间CRP比较差异亦有统计学意义，两两比较，差异均有统计学意义（P均＜0.05）。肺CT病变主要以双肺多发为主，多表现为磨玻璃样渗出。出院患者2周后复查核酸，7例患者核酸检测阳性。结论　石家庄地区COVID-19患者临床特征与其他地区相似，但病例以聚集性为主，当地COVID-19疫情防控工作须持续加强，同时应重点强化中老年患者的防护与救治，并注意出院患者的随访观察。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.