新型冠状病毒肺炎患者血清SARS-CoV-2 抗体的检测分析

目的 分析新型冠状病毒肺炎（corona virus disease 2019,COVID-19） 患者血清新型冠状病毒（severeacute respiratory syndrome coronavirus 2,SARS-CoV-2）IgM 和IgG 抗体的变化规律及临床应用。方法 收集2020 年1 ～ 2 月初温州医科大学附属乐清医院收治的28 例SARS-CoV-2 核酸检测阳性的COVID-19 患者作为病例组,排除COVID-19 的30 例其他疾病患者作为对照组。利用全自动化学发光免疫分析技术检测所有研究对象的血清SARS-CoV-2IgM 和IgG,分析SARS-CoV-2 抗体的变化规律。结果 SARS-CoV-2 IgM,发病第1 ～ 6 天均阴性,发病第7 ～ 10 天,2 例患者阳性,发病第18 天后均转阳性,一个月左右达峰值,2 例患者分别在第49 天和第55 天出现9.80AU/ml（阴性）和10.79AU/ml（弱阳性）。SARS-CoV-2 IgG,发病第1 ～ 6 天均阴性,发病第8 天后均阳性。结论 发病10 天内SARS-CoV-2 IgM 阴性的患者不能排除SARS-CoV-2 感染,发病超过一周或多次核酸检测阴性的疑似患者检测SARSCoV-2 IgM 和IgG 具有重要意义。     

新型冠状病毒肺炎临床实验室相关检测现状

正近来,由新型冠状病毒(SARS-CoV-2)引起的新型冠状病毒肺炎(COVID-19)仍全球持续蔓延,形势极其严峻,影响不容小觑~([1-3])。对COVID-19的实验室相关检测已有了诸多报道,已知COVID-19患者发病早期外周血白细胞总数正常或减低,淋巴细胞计数减少,部分患者出现肌酸激酶(CK)、乳酸脱氢酶     

新型冠状病毒疫苗的研究进展

<正>新型冠状病毒严重危害全球公众健康。2019年12月发现多例新型冠状病毒肺炎（COVID-19）病例,此后疫情迅速蔓延至全球,造成大量的感染和死亡病例,对全球公共卫生安全造成巨大的威胁。COVID-19在全球范围内大流行,它以指数速率蔓延,目前尚无有效的药物治疗这种疾病,新型冠状病毒的疫苗对于遏制COVID-19的传播,改善全球健康至关重要。在中国新型冠状病毒传播的基本再生数（R0）为2.40,疫苗接种率达到83.3%可形成群体免疫。     

补充维生素D在新型冠状病毒肺炎辅助治疗中的作用研究进展

新型冠状病毒肺炎（COVID-19）引起的大流行给全球公共卫生健康带来了严峻的挑战。维生素D作为免疫调节剂,在增强免疫、抗呼吸道病毒感染方面具有重要作用。研究表明维生素D可通过影响血管紧张素转换酶2/血管紧张素（1~7）/Mas受体轴信号通路,抑制肾素-血管紧张素系统信号的过度激活而抗严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染和抑制炎症因子风暴产生,从而减少COVID-19患者ARDS、心源性梗阻的发生和血栓的形成。该文对维生素D在SARS-CoV-2感染及临床表现中的作用机制进行综述,推测维生素D在预防或辅助治疗COVID-19、减轻COVID-19患者临床症状方面发挥重要作用。     

新型冠状病毒气溶胶传播及实验室检测的最新研究进展

自新型冠状病毒肺炎（corona virus disease 2019,COVID-19）疫情暴发以来,气溶胶传播新型冠状病毒（2019novel coronavirus,SARS-CoV-2）的案例相继被报道。SARS-CoV-2气溶胶作为一种存在于空气中能够进行短期和远程运输的细小颗粒,具有很强的传播能力。提前预测或者实时监测气溶胶中的SARS-CoV-2是控制COVID-19疫情大流行的有效措施。该文通过对SARS-CoV-2气溶胶的特点、构建数学模型预测、采集检测的研究进展进行综述,为疫情理论研究和实际防控提供有效的帮助。     

2021年宁夏回族自治区聚集性新型冠状病毒肺炎疫情分子流行病学分析

目的 分析2021年10月宁夏回族自治区（宁夏）新型冠状病毒肺炎（COVID-19）疫情的分子流行病学特征,为完善防控措施提供科学依据。方法 收集2021年10月17日至11月6日宁夏COVID-19确诊病例的发病时间、病例分布、人群特征、基因测序结果等信息,进行描述性分析。结果 宁夏2021年10月聚集性疫情共确诊COVID-19病例44例,本轮疫情有2个独立的传播链,平均代间距约4 d,潜伏期中位数为5.3 d(1.1～8.0 d),最多已传代至3代;获得43例COVID-19病例的全基因组序列,结果表明本起疫情是由VOC/Delta变异株（B.1.617.2进化分支）感染,同武汉参考株（NC＿045512）序列相比,43例病例新型冠状病毒（SARS-CoV-2）基因组序列存在45～50个核苷酸突变位点;SARS-CoV-2刺突（S）蛋白存在12个氨基酸突变位点。结论 Delta毒株导致的疫情呈现出病毒载量高,潜伏期短,传播能力强的特点,境外输入的SARS-CoV-2变异株存在引起本地暴发与流行的风险,需持续对境外输入的SARS-CoV-2毒株进行分子监测。     

SARS-CoV-2病原学特点、实验室检测及实验室生物安全防护

2019年12月,武汉市首次发现多起新型冠状病毒肺炎(COVID-19)病例,目前COVID-19已成全球蔓延趋势。COVID-19具有极强的传染性及较高的病死率,快速、准确的实验室检测对其诊疗至关重要。但COVID-19患者的临床样本具有潜在致病性和高传染性,为降低实验室人员感染风险,文章就新型冠状病毒(SARS-CoV-2)的病原学特点、实验室检测及生物安全防护相关措施作一综述。     

北京市海淀区新型冠状病毒肺炎患者及其家庭成员呼吸道病原谱研究

目的 分析北京市海淀区新型冠状病毒肺炎(COVID-19)患者及其家庭成员中常见呼吸道病原体的流行情况,比较混合感染患者与只感染新型冠状病毒(SARS-CoV-2)患者的疾病严重程度差异.方法 使用多重荧光定量PCR方法对2020年1-6月北京市海淀区疾病预防控制中心检测的所有COVID-19患者及其家庭成员同期采集的...     

COVID-19患者外周血淋巴细胞的变化及临床意义

2019年末以来,新型冠状病毒(SARS-CoV-2)凭借强传染性快速在人群中广泛传播,并诱发新型冠状病毒肺炎(COVID-19),严重危害人类健康,给全球公共卫生带来了巨大冲击[1-5].COVID-19患者外周血淋巴细胞常会发生变化,对于病情监测等有一定的临床意义[6].本文基于目前SARS-CoV-2的研究成果,探讨COVID-19患者中是否存在相应淋巴细胞的变化,并根据对淋巴细胞的认识阐述其变化具有的临床意义.     

新型冠状病毒肺炎患者肝功能异常的相关临床分析

目的　探讨新型冠状病毒肺炎（COVID-19）患者肝功能异常的相关性因素。方法　回顾性分析湖南省岳阳市 第一人民医院2020 年1~3 月收治的新型冠状病毒（SARS-CoV-2）感染患者80 例，根据肝功能情况分为肝功能异常 组45 例，对照组35 例，对其进行病例对照研究，选择与肝损伤有关指标进行单因素及多因素分析，探讨COVID-19 患者肝功能异常的发生机制。结果　研究显示肺炎严重程度是COVID-19 患者发生肝损伤的主要危险因素（P=0.009， OR=3.826，95%CI 1.388~10.544），而基础疾病、炎症因子水平与COVID-19 患者出现肝损伤无统计学相关性（P>0.05）。 结论　COVID-19 患者发生肝功能损害与病情进展密切相关，临床医生诊治患者时，应当遵从早发现、早治疗的原则， 避免造成肝脏进一步损伤，改善患者预后。     

Medical research during the COVID-19 pandemic

The current pandemic of coronavirus disease 2019 (COVID-19) which was first detected in Wuhan, China in December 2019 is caused by the novel coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The virus has quickly spread to a large number of countries leading to a great number of deaths. Unfortunately, till today there is no specific treatment or vaccination for SARS-CoV-2. Most of the suggested treatment medications are based on in vitro laboratory investigations, experimental animal models, or previous clinical experience in treating similar viruses such as SARS-CoV-1 or other retroviral infections. The running of any clinical trial during a pandemic is affected at multiple levels. Reasons for this include patient hesitancy or inability to continue investigative treatments due to self-isolation/quarantine, or limited access to public places (including hospitals). Additional barriers relate to health care professionals being committed to other critical tasks or quarantining themselves due to contact with COVID-19 positive patients. The best research approaches are those that adapt to such external unplanned obstacles. Ongoing clinical trials before COVID-19 pandemic have the potential for identifying important therapies in the long-term if they can be completed as planned. However, these clinical trials may require modifications due a pandemic such as this one to ensure the rights, safety, and wellbeing of participants as well as medical staff involved in the conduction of clinical trials. Clinical trials initiated during the pandemic must be time-efficient and flexible due to high contagiousness of severe acute respiratory syndrome coronavirus 2, the significant number of reported deaths, and time constraints needed to perform high quality clinical trials, enrolling adequate sample sizes. Collaboration between different countries as well as implementation of innovative clinical trial designs are essential to successfully complete such initiatives during the current pandemic. Studies looking at the long term sequalae of COVID-19 are also of importance as recent publications describe multi-organ involvement. Long term follow-up of COVID-19 survivors is thus also important to identify possible physical and mental health sequellae.     

Distinctive features of severe SARS-CoV-2 pneumonia

The coronavirus disease 2019 (COVID-19) pandemic is among the most important public health crises of our generation. Despite the promise of prevention offered by effective vaccines, patients with severe COVID-19 will continue to populate hospitals and intensive care units for the foreseeable future. The most common clinical presentation of severe COVID-19 is hypoxemia and respiratory failure, typical of the acute respiratory distress syndrome (ARDS). Whether the clinical features and pathobiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia differ from those of pneumonia secondary to other pathogens is unclear. This uncertainty has created variability in the application of historically proven therapies for ARDS to patients with COVID-19. We review the available literature and find many similarities between patients with ARDS from pneumonia attributable to SARS-CoV-2 versus other respiratory pathogens. A notable exception is the long duration of illness among patients with COVID-19, which could result from its unique pathobiology. Available data support the use of care pathways and therapies proven effective for patients with ARDS, while pointing to unique features that might be therapeutically targeted for patients with severe SARS-CoV-2 pneumonia.     

Surgical intervention for acute pancreatitis in the COVID-19 era

Approximately 15%-19% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. Acute pancreatitis (AP) has been reported in 0.1% of patients with coronavirus disease 2019 (COVID-19). Biliary AP was most common (78.4%) before the COVID-19 pandemic; idiopathic AP is most common in patients with COVID-19 (up to 57.1%). The number of emergency department presentations decreased by 23.3% during the pandemic and many governments made national recommendations to delay nonurgent endoscopic procedures, leading to decrements of 22% in combined esophagogastroduodenoscopy (EGD) and colonoscopy and 20% in EGD after the COVID-19 pandemic. The symptoms and signs of COVID-19-related AP are fever (63%), abdominal pain (58%), respiratory symptoms (40%), nausea and vomiting (39%), and headache (4%). Approximately 5-10% of patients develop necrotizing or hemorrhagic AP, and patients who required surgical intervention had a higher mortality risk. Compared to 2019, the rates of elective surgery decreased by 41.8% in 2020; including cholecystectomy (40.1% decrease) and pancreas (111.1% decrease). Surgical volumes also decreased by 18.7% in 2020; device-assisted laparoscopic and robot-assisted procedures reduced by 45.4% and 61.9% during the COVID-19 Lockdown in 2020.     

COVID-19 and liver diseases,what we know so far

Coronavirus disease 2019 (COVID-19) pneumonia outbreak started in December 2019. On March 12, 2020, the World Health Organization (WHO) declared that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a pandemic, and as of May 2021, SARS-CoV-2 has infected over 167.3 million patients, including 3.4 million deaths, reported to WHO. In this review, we will focus on the relationship between SARS-CoV-2 infection and the liver. We will discuss how chronic liver diseases affect the COVID-19 disease course and outcomes. We will also discuss the SARS-CoV-2 effects on the liver, mechanisms of acute liver injury, and potential management plans.     

Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand

Coronavirus disease 2019 (COVID-19) results from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical features and subsequent medical treatment, combined with the impact of a global pandemic, require specific nutritional therapy in hospitalised adults. This document aims to provide Australian and New Zealand clinicians with guidance on managing critically and acutely unwell adult patients hospitalised with COVID-19. These recommendations were developed using expert consensus, incorporating the documented clinical signs and metabolic processes associated with COVID-19, the literature from other respiratory illnesses, in particular acute respiratory distress syndrome, and published guidelines for medical management of COVID-19 and general nutrition and intensive care. Patients hospitalised with COVID-19 are likely to have preexisting comorbidities, and the ensuing inflammatory response may result in increased metabolic demands, protein catabolism, and poor glycaemic control. Common medical interventions, including deep sedation, early mechanical ventilation, fluid restriction, and management in the prone position, may exacerbate gastrointestinal dysfunction and affect nutritional intake. Nutrition care should be tailored to pandemic capacity, with early gastric feeding commenced using an algorithm to provide nutrition for the first 5–7 days in lower-nutritional-risk patients and individualised care for high-nutritional-risk patients where capacity allows. Indirect calorimetry should be avoided owing to potential aerosole exposure and therefore infection risk to healthcare providers. Use of a volume-controlled, higher-protein enteral formula and gastric residual volume monitoring should be initiated. Careful monitoring, particularly after intensive care unit stay, is required to ensure appropriate nutrition delivery to prevent muscle deconditioning and aid recovery. The infectious nature of SARS-CoV-2 and the expected high volume of patient admissions will require contingency planning to optimise staffing resources including upskilling, ensure adequate nutrition supplies, facilitate remote consultations, and optimise food service management. These guidelines provide recommendations on how to manage the aforementioned aspects when providing nutrition support to patients during the SARS-CoV-2 pandemic.     

Nonalcoholic fatty liver disease and COVID-19: An epidemic that begets pandemic

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic, affecting all the individuals across the planet. COVID-19 has gained significant attention due to its high prevalence among individuals with diabetes, nonalcoholic fatty liver disease (NAFLD), and metabolic syndrome. NAFLD is the hepatic manifestation of metabolic syndrome and can be associated with a high risk of developing type 2 diabetes. The association of COVID-19 and NAFLD has also gained more attention because NAFLD is highly associated with the epidemic of obesity. NAFLD is a potential risk factor for SARS-CoV-2 infection and severe COVID-19, independent of metabolic syndrome. Importantly, it is not yet clear whether the epidemics of obesity and NAFLD have perpetuated the current pandemic of COVID-19. Further research is urgently needed to assess the following: (1) Whether NAFLD is a high risk factor for SARS-CoV-2 infection; (2) Whether NAFLD is associated with the severe form of COVID-19; and (3) Whether the presence of NAFLD can explain the racial variation in the morbidity and mortality associated with COVID-19. This review summarizes the interactions between COVID-19 and NAFLD, mechanism of liver injury by COVID-19, and effect of lockdown due to COVID- 19 on patients with NAFLD.     

Implications of COVID-19 for inflammatory bowel disease: Opportunities and challenges amidst the pandemic

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic various measures have been taken to mitigate the effects of the global health crisis in this unprecedented time. According to the World Health Organization, more than 5 million people have been infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and with more than 300000 deaths attributed to COVID-19 worldwide. There is emerging evidence that SARS-CoV-2 utilizes angiotensin-converting enzyme 2 receptors to enter human cells which are found in abundance in the alveoli and intestines. In addition, the infection is noted to be more severe in patients with co-morbid conditions, those who are malnourished, immunosuppressed and immunocompromised. Inflammatory bowel disease (IBD) which includes ulcerative colitis and Crohn’s disease is chronic remitting and relapsing disorders with intestinal and extraintestinal manifestation. IBD patients are often malnourished and on immunosuppressive medications and there is a hypothetical concern that IBD patients are at substantial risk of COVID-19 infection. The management of IBD patients is often complex and poses unique challenges for gastroenterologists during the pandemic. The purpose of this review article is to summarize the growing level of evidence and understanding of the management of IBD during the COVID-19 pandemic, in the light of international and national gastroenterology society guidelines. We performed a thorough literature search on IBD, SARS-CoV-2 and COVID-19 on PubMed, EMBASE, OVID Medline and Google Scholar and pertaining literature was critically examined and summarized. Per national and international society guidelines and recommendations, IBD is not a risk factor for SARS-CoV-2 infection. IBD patients should continue with their medications and they should follow universal precautions i.e. masks, hand and respiratory hygiene and avoidance of health care facilities and public toilets as general population. Among IBD patients older age, having active disease, and co-morbid conditions are risk factors for a severe SARS-CoV-2 infection. Furthermore, elective endoscopic and surgical procedures can be delayed or deferred until discussing the risks and benefits with patients.     

Contemporary use of cardiac imaging for COVID-19 patients: a three center experience defining a potential role for cardiac MRI

The pandemic of coronavirus disease 2019 (COVID-19) secondary to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has bestowed an unprecedented challenge upon us, resulting in an international public health emergency. COVID-19 has already resulted in >?1,600,000 deaths worldwide and the fear of a global economic collapse. SARS-CoV-2 is notorious for causing acute respiratory distress syndrome, however emerging literature suggests various dreaded cardiac manifestations associated with high mortality. The mechanism of myocardial damage in COVID-19 is unclear but thought to be multifactorial and mainly driven by the host’s immune response (cytokine storm), hypoxemia and direct myocardial injury by the virus. Cardiac manifestations from COVID-19 include but are not limited to, acute myocardial injury, cardiac arrhythmias, congestive heart failure and acute coronary syndrome. Cardiac imaging is paramount to appropriately diagnose and manage the cardiac manifestations of COVID-19. Herein, we present cardiac imaging findings of COVID-19 patients with biomarker and imaging confirmed myocarditis to provide insight regarding the variable manifestations of COVID-19 myocarditis via Cardiac MRI (CMR) coupled with CMR-edema education along with recommendations on how to incorporate advanced CMR into the clinicians’ COVID-19 armamentarium.

     

Role of monoclonal antibody drugs in the treatment of COVID-19

Currently clinicians all around the world are experiencing a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical presentation of this pathology includes fever, dry cough, fatigue and acute respiratory distress syndrome that can lead to death infected patients. Current studies on coronavirus disease 2019 (COVID-19) continue to highlight the urgent need for an effective therapy. Numerous therapeutic strategies have been used until now but, to date, there is no specific effective treatment for SARS-CoV-2 infection. Elevated inflammatory cytokines have been reported in patients with COVID-19. Evidence suggests that elevated cytokine levels, reflecting a hyperinflammatory response secondary to SARS-CoV-2 infection, are responsible for multi-organ damage in patients with COVID-19. For these reason, numerous randomized clinical trials are currently underway to explore the effectiveness of biopharmaceutical drugs, such as, interleukin-1 blockers, interleukin-6 inhibitors, Janus kinase inhibitors, in COVID-19. The aim of the present paper is to briefly summarize the pathogenetic rationale and the state of the art of therapeutic strategy blocking hyperinflammation.     

Veno-venous extracorporeal membrane oxygenation allocation in the COVID-19 pandemic

Rapid global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resultant clinical illness, coronavirus disease 2019 (COVID-19), drove the World Health Organization to declare COVID-19 a pandemic. Veno-venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) is an established therapy for management of patients demonstrating the most severe forms of hypoxemic respiratory failure from COVID-19. However, features of COVID-19 pathophysiology and necessary length of treatment present distinct challenges for utilization of VV-ECMO within the current healthcare emergency. In addition, growing allocation concerns due to capacity and cost present significant challenges. Ethical and legal aspects pertinent to triage of this resource-intensive, but potentially life-saving, therapy in the setting of the COVID-19 pandemic are reviewed here. Given considerations relevant to VV-ECMO use, additional emphasis has been placed on emerging hospital resource scarcity and disproportionate representation of healthcare workers among the ill. Considerations are also discussed surrounding withdrawal of VV-ECMO and the role for early communication as well as consultation from palliative care teams and local ethics committees. In discussing how to best manage these issues in the COVID-19 pandemic at present, we identify gaps in the literature and policy important to clinicians as this crisis continues.