以合理用药为核心的中药临床药师参与新型冠状病毒肺炎（NCP）防治的基本切入点及必要性分析＊

新型冠状病毒肺炎爆发以来，我国以最快的响应速度发布了《新型冠状病毒感染的肺炎诊疗方案》，并明确指示在新型冠状病毒肺炎防治工作中建立健全中西医协作机制，使中医药尽早、尽快参与其中，积极发挥其作用。本研究从中药临床药学的角度，以国家及各省区发布的新型冠状病毒肺炎的预防及诊疗方案为切入点，分析中药临床药师参与新型冠状病毒肺炎防治的可行性及必要性，提出中药临床药师参与新型冠状病毒肺炎的防治及公共卫生突发事件的观点，以期能为壮大中医药参与传染性疾病队伍，完善中医药多力量参与公共卫生突发事的体制提供参考。     

新型冠状病毒肺炎疫情下早期乳腺癌治疗延期若干问题探讨

早期乳腺癌病人在接受既定方案治疗过程中因特殊原因导致治疗延期时有发生。但是，鉴于当前新型冠状病毒肺炎疫情防控的原因，多数乳腺癌病人既定的治疗方案出现延期。其中包括：初诊早期乳腺癌病人的手术时间延期；拟行新辅助化疗的病人开始实施化疗的时间延期；以及完成新辅助化疗后实施手术时间延期等问题。在降低感染风险和不影响病人预后前提下，针对不同情况提出具体应对意见。     

2019-nCoV重症患者气管切开防喷溅装置的设计与初步应用

目的 对2019-nCoV高传染性重症患者进行气管插管、气管切开等高危程序操作,是一线医务人员发生感染的重要危险因素,急需降低操作者的感染风险。方法 本团队发明一种手术防喷溅隔离装置,在操作者与患者之间建立可视化防喷溅隔离区域,术者可将手伸进隔离装置的操作口进行手术操作,在不影响正常手术程序的同时,降低了自身感染风险。结果 本装置经申请专利后已初步试用于临床,在7例重症新型冠状病毒肺炎患者的气管切开术中得以成功应用,目前已批量生产,发往武汉抗疫一线。结论 本隔离装置在救治2019-nCoV患者的临床应用中得到良好反馈,为抗击疫情的一线医务工作者提供了有效防护措施,降低了感染风险。     

新型冠状病毒感染防控时期口腔外科门诊诊疗的专家建议

随着新型冠状病毒肺炎的爆发及蔓延,口腔诊疗过程中带来的感染风险也迅速被人重视。在可择期的口腔诊治项目按照疫情防控相关要求全面暂停的当下,口腔外科医护人员仍坚守一线,担负着口腔颌面部外伤、感染及造成患者极大痛苦且无法保留的患牙拔除等必须急诊处置的工作。本文围绕口腔外科急诊处置的原则、适应证、风险评估、患者准备、医护防护等方面提出建议,以期为疫情期间开展口腔外科诊疗的医护人员提供参考。     

应对新型冠状病毒肺炎,我们能从SARS中得到哪些借鉴

目前对于新型冠状病毒肺炎(简称:新冠肺炎)的病程机制和治疗方法的选择等方面仍有许多未知之处。由于2019-nCoV和SARS-CoV之间的高度相似性,从严重急性呼吸综合征(severe acute respiratory syndrome,SARS)中获得的一些知识经验,尤其是患者肺部病毒复制和免疫应答的时间规律和病程的演变特征,或许能对我们深入了解和应对新冠肺炎提供重要的借鉴。     

疫情防控策略优化后上海市新型冠状病毒感染疫情的预测和估计

目的 量化预测在不同场景下上海市新型冠状病毒（新冠病毒）感染疫情的发展规模和医疗卫生资源需求，模拟评估新冠病毒疫苗接种情况、非药物干预措施（NPIs）、居家隔离意愿和入境情况等因素对新冠病毒感染疫情发展规模的影响。方法 基于新冠病毒的自然史、上海市新冠病毒疫苗接种情况和NPIs情况构建具有年龄结构的SEIR传染病动力学模型（SEIR模型），以2022年12月1日作为模型模拟起点的当日实际情况，对疫情发展规模和床位需求情况进行模拟估计。结果 上海市在新冠病毒疫苗接种的实际情况下，100 d的模拟期内累计有住院需求的感染人数为18.02万。相比于新冠病毒疫苗接种的实际情况，当人群加强针接种率达到理想情况时，累计有住院需求的感染人数下降73.20%，与不实施NPIs相比，仅关闭学校、关闭学校和工作场所的措施对普通床位需求数的峰值分别降低24.04%、37.73%，感染者居家隔离意愿的提高可降低每日新增感染人数并推迟峰值出现时间，入境人数的变化对于疫情发展规模的影响较小。结论 上海市在新冠病毒感染的流行特征和新冠病毒疫苗接种的实际情况下，可通过提高新冠病毒疫苗接种率、尽早实施NPIs以降低新冠病毒感染人数、普通床位和重症加强护理病房床位需求数，从而缓解卫生资源需求。     

新型冠状病毒感染者航班同乘风险人员排查效果分析

目的 分析新型冠状病毒（新冠病毒）感染者航班同乘人员新冠病毒核酸阳性检出情况，为有效确定风险人员排查范围提供依据。方法 回顾性收集我国2020年4月1日至2022年4月30日本土新冠病毒感染者航班同乘人员信息，采用χ²检验分析比较指示病例发病前不同时间、不同座位距离和不同新冠病毒变异株流行期的同乘人员核酸阳性检出率。结果 研究期间，新冠病毒感染者共涉及370架次航班和23 548名同乘人员，累计判定指示病例433名。指示病例的同乘人员中，核酸检测阳性人员72名，其中，与指示病例同行人员57名，非同行人员15名。对15名非同行的阳性同乘人员进一步分析显示，86.67%在指示病例诊断后3 d内发病或检测阳性，乘机时间均在指示病例发病前4 d内，指示病例前后三排内的阳性检出率为0.15%（95%CI：0.08%~0.27%），显著高于前后三排外的阳性检出率［0.04%（95%CI：0.02%~0.10%），P=0.007］，前后三排内各排的阳性检出率差异无统计学意义（P=0.577）。不同类型变异株流行期间，非同行的同乘人员阳性检出率差异无统计学意义（P=0.565）。Omicron变异株流行期中，非同行人员阳性检出集中在指示病例发病前3 d内。结论 指示病例航班同乘人员的风险排查时间可设定为指示病例发病前4 d内。指示病例前后三排内的同乘人员应作为优先排查人员，并作为密切接触者进行管理，座位距离在指示病例前后三排外的同乘人员可作为一般风险人员进行排查和管理。     

Recomendaciones sobre el manejo clínico de la infección por el «nuevo coronavirus» SARS-CoV2. Grupo de trabajo de la Asociación Española de Pediatría (AEP)

On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19).The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them.     

Clinical characteristics of coronavirus disease 2019 in patients aged 80 years and older

ObjectiveCoronavirus disease 2019 (COVID-19) has raised concern around the world as an epidemic or pandemic. As data on COVID-19 has grown, it has become clear that older adults have a disproportionately high rate of death from COVID-19. This study describes the early clinical characteristics of COVID-19 in patients with more than 80 years of age.MethodsEpidemiological, clinical, laboratory, radiological, and treatment data from 17 patients diagnosed with COVID-19 between January 20 and February 20, 2020 were collected and analyzed retrospectively. Treatment outcomes among subgroups of patients with non-severe and severe symptoms of COVID-19 were compared.ResultsOf the 17 hospitalized patients with COVID-19, the median age was 88.0 years (interquartile range, 86.6–90.0 years; range, 80.0–100.0 years) and 12 (70.6%) were men. The age distribution of patients was not significantly different between non-severe group and severe group. All patients had chronic pre-existing conditions. Hypertension and cardiovascular diseases were the most common chronic conditions in both subgroups. The most common symptoms at the onset of COVID-19 were fever (n = 13; 76.5%), fatigue (n = 11; 64.7%), and cough (n = 5; 29.4%). Lymphopenia was observed in all patients, and lymphopenia was significantly more severe in the severe group than that in non-severe group (0.4 × 10⁹/L vs 1.2 × 10⁹/L, P = 0.014). The level of serum creatinine was higher in the severe group than in the non-severe group (99.0 μmol/L vs 62.5 μmol/L, P = 0.038). The most common features of chest computed tomography images were nodular foci in 10 (58.8%) patients and pleural thickening in 7 (41.2%) patients. All patients received antiviral therapy, while some patients also received intravenous antibiotics therapy (76.5%), Chinese medicinal preparation therapy (Lianhuaqingwen capsule, 64.7%), corticosteroids (35.3%) or immunoglobin (29.4%). Eight patients (47.1%) were transferred to the intensive care unit because of complications. Ten patients (58.8%) received intranasal oxygen, while 3 (17.6%) received non-invasive mechanical ventilation, and 4 (23.5%) received high-flow oxygen. As of June 20, 7 (41.2%) patients had been discharged and 10 (58.8% of this cohort, 77.8% of severe patients) had died.ConclusionThe mortality of patients aged 80 years and older with severe COVID-19 symptoms was high. Lymphopenia was a characteristic laboratory result in these patients, and the severity of lymphopenia was indicative of the severity of COVID-19. However, the majority of patients with COVID-19 in this age cohort had atypical symptoms, and early diagnosis depends on prompt use of a viral nucleic acid test.     

新型冠状病毒感染者末次核酸阴性前后的传染性分析

目的研究新型冠状病毒(新冠病毒)感染者末次核酸阴性前后密切接触者(密接)的感染率, 评估动态核酸检测结果在判断新冠病毒感染者传染性中的作用。方法采用回顾性队列研究的方法, 收集新冠病毒感染者的动态核酸检测结果。选择新冠病毒感染者在首次核酸检测阳性前有核酸阴性结果者为研究对象, 对感染者的密接以及密接的密接(次密接)进行持续隔离医学观察, 评估密接和次密接的发病风险。结果共纳入宁波市2起本土疫情的89例新冠病毒感染者, 均为确诊病例。追踪调查了5 609名密接, 密接的总感染率为0.20%。感染者末次核酸阴性前的密接无感染, 末次核酸阴性后的密接感染率为1.33%, 且均为与指示病例共同居住生活者。感染者涉及的所有次密接均未感染。结论新冠病毒感染者末次核酸阴性前无传染性, 末次核酸阴性后开始具有传染性。