COVID-19 and Acute Pulmonary Embolism: A Case Series and Brief Review

The SARS-CoV-2 virus, or COVID-19, is responsible for the current global pandemic and has resulted in the death of over 400,000 in the United States. Rates of venous thromboembolism have been noted to be much higher in those infected with COVID-19. Here we report a case-series of COVID-19 patients with diverse presentations of pulmonary embolism (PE). We also briefly describe the pathophysiology and mechanisms for pulmonary embolism in COVID-19. These cases indicate a need to maintain a high index of suspicion for PE in patients with COVID-19, as well as the need to consider occult COVID-19 infection in patients with PE in the right clinical circumstance.     

Metformin inhibition of mitochondrial ATP and DNA synthesis abrogates NLRP3 inflammasome activation and pulmonary inflammation

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多发伤患者的乳酸水平与急性呼吸窘迫综合征发生的相关性研究

目的:回顾性分析多发伤患者的乳酸水平与急性呼吸窘迫综合征(ARDS)发生率之间的相关性方法:选取多发伤患者45例,根据病程中是否发生ARDS分为两组,比较两组入院时和24 h后乳酸值及24 h乳酸清除率的差异。结果:ARDS组和非ARDS组在入院时的乳酸值,差异无统计学意义(P>0.05);24 h后的乳酸值和24 h乳酸清除率,差异有统计学意义(P<0.05)。结论:监测动脉血乳酸值及乳酸清除率对于多发伤患者的ARDS发生率具有重要的临床指导意义。     

辛伐他汀对急性呼吸窘迫综合征的治疗效果研究

目的 探讨辛伐他汀治疗急性呼吸窘迫综合征患者的临床疗效及安全性。方法 将2018 年1 月～2019 年7月至我院治疗的88 例高ARDS 患者纳入研究，随机均分为实验组与对照组，每组各44 例。两组患者在常规治疗之外，实验组接受每日80 mg 辛伐他汀给药，对照组接受每日80 mg 安慰剂给药。研究持续28 d，治疗前后使用Murray 肺损伤评分评估患者肺损伤程度，检测治疗后患者血浆IL-6、TNF-α 和hs-CRP 含量，统计研究期间两组患者不良反应率。并使用辛伐他汀处理EC 细胞，检测S1PR1 蛋白和KLF2 蛋白的表达。结果 治疗后，两组患者Murray 肺损伤评分均显著下降（P＜0.05），且实验组改善幅度大于对照组；治疗后，实验组患者Murray 肺损伤评分、血浆IL-6/TNF-α 和hs-CRP 均显著低于对照组（P＜0.05）；治疗期间，两组间总不良反应率比较，差异无统计学意义（P=0.534）。辛伐他汀处理后，EC 细胞中的S1PR1 和KLF2 的表达均显著提高。结论 辛伐他汀治疗能够显著改善ARDS 患者肺损伤和炎症反应，具有良好的安全性，可能是通过与KLF2 相关的机制，增加S1PR1 的表达来增强内皮屏障功能，从而降低血管通透性的增加。     

Calcineurin inhibitors revisited: A new paradigm for COVID-19?

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can cause mild, moderate or severe disease (COVID-19). In severe disease, there is hyperinflammation causing severe symptoms. Severe COVID-19 is an immunological phenomenon, rather than a direct viral damage disease. Therapies for COVID-19 are all investigational therapies. In case of severe disease, treatment with a calcineurin inhibitor could be promising. In this article we explain the mechanisms of calcineurin inhibitor treatment for COVID-19, based on experiences seen in solid organ transplant recipients who suffered from COVID-19.     

Not just a matter of weight: A case report of ECMO treatment in a severely obese patient

The ELSO Guidelines list a BMI ≥ 40 kg/m² among the relative contraindications to give ECMO treatment in SARS – COV2 patients. We describe a case of a 52-year-old with BMI 50.21 kg/m², admitted to the intensive care unit (ICU) with severe respiratory conditions and successfully treated with extracorporeal membrane oxygenation (ECMO). The application of veno-venous (VV) ECMO will evolve as far as we understand the pathophysiology of the COVID-19 disease and will probably have a determinant role in management of patient with refractory hypoxemia, whose ventilation management is difficult, even in case of severe obesity.