新型冠状病毒肺炎多器官功能损伤机制的研究进展

新型冠状病毒肺炎(COVID-19)病原体为新型冠状病毒(2019-nCoV),该病毒属于β冠状病毒。与严重急性呼吸综合征冠状病毒一样,2019-nCoV的受体为血管紧张素转化酶2(ACE2),重症患者多为有基础疾病老年人的机制可能与人体内幼稚T细胞数量的减少有关。除肺部症状外,COVID-19还可引发多器官(肝脏、神...     

新型冠状病毒感染后急诊心血管手术预后分析北大核心CSCD

目的探讨新型冠状病毒感染对心血管急诊手术患者预后的影响。方法回顾性收集首都医科大学附属北京安贞医院2022年12月1日至2023年1月31日期间接受急诊心脏外科手术,术后返回心脏外科危重症中心治疗的43例患者的临床资料,根据是否感染新型冠状病毒将患者分为新型冠状感染组(22例)和非新型冠状感染组(21例)。记录两组患者术后常规实验室检查结果、并发症发生率及院内病死率。结果与非新型冠状感染组相比,新型冠状感染组患者术后的淋巴细胞计数显著降低(P<0.05),ALT、AST显著升高(P<0.05),术后新发房颤、肝功能异常、住ICU时间显著增加(P<0.05)。结论新型冠状病毒感染患者行心血管急诊手术,术后并发症发生率升高,患者ICU时间增加。     

淋巴瘤患者合并COVID-19的临床特征和管理研究进展

新型冠状病毒由于其极强的传染性和极高的突变性, 目前已在全球范围内出现多种变异株, 给各国的公共卫生系统带来了巨大的威胁和挑战, 反复多次感染新型冠状病毒或在全世界成为流行趋势。与非肿瘤患者相比, 淋巴瘤患者更易感染新型冠状病毒, 预后较差, 因此应高度重视对淋巴瘤患者合并新型冠状病毒感染(COVID-19)的临床管理。本文就淋巴瘤合并COVID-19患者的临床特征及目前临床管理策略进行综述, 为该类患者的临床治疗提供参考。     

新型冠状病毒肺炎疫情下腹膜透析患者的管理策略

在新型冠状病毒肺炎疫情防控背景下,腹膜透析患者普遍存在营养不良,免疫力低下,属于易感人群.为更好地指导腹膜透析患者认识新发传染病,做好居家防控,也为更好地指导腹膜透析中心医护人员在特殊时期开展随访管理工作,陆军军医大学新桥医院腹膜透析中心针对腹膜透析患者自身特点,参照国内外指南和新型冠状病毒肺炎疫情期间的防控指导意见,...     

新型冠状病毒感染患者择期手术相关的几个热点问题

在新型冠状病毒感染大流行不断演变的大背景下, 感染患者择期手术的需求将给医疗系统和临床麻醉工作带来严峻的考验。如何决定新型冠状病毒感染患者的择期手术时机及患者是否具有传染性、如何避免患者医院内感染将是广大医务工作者关注的热点问题。通过以上问题的探讨可以为新型冠状病毒感染患者手术麻醉相关指南的制定提供参考。     

妊娠期新型冠状病毒肺炎研究进展

新型冠状病毒肺炎(COVID-19)为新发急性呼吸道传染病,是严重的突发卫生公共事件.孕妇作为一类特殊群体,为新型冠状病毒(SARS-CoV-2)易感人群,因其特殊生理状态,病毒感染时会有与妊娠相关的临床特点,诊断和治疗也更为棘手.此外,妊娠期COVID-19对胎儿的影响亦是目前研究非常关注的问题.妊娠期COVID-1...     

密切接触疑似新型冠状病毒感染患者的一例断指再植手术的处理

2019年12月以来,新型冠状病毒肺炎(COVID-19)在中国武汉出现.我院在2020年1月下旬,为1例接触疑似新型冠状病毒肺炎的断指患者实行再植手术,获得成功.     

普通病区预防新型冠状病毒医院感染应急护理管理实践

目的探讨普通病区预防新型冠状病毒院内交叉感染的应急护理管理方案。方法在新型冠状病毒肺炎疫情期间对微创妇科病区进行应急管理,包括环境与物资准备,护理人员准备,患者管理,病区入口管理,日常工作管理。结果 2020年1月26日至2月14日,医护人员、护理员、保洁人员掌握新型冠状病毒肺炎知识、手卫生、口罩、帽子的正确使用、标准防护知识;顺利收治7例患者,完成平诊手术2台、急诊手术4台,10例患者好转出院,2月14日住院患者16例。科室未发现新型冠状病毒肺炎疑似病例,无患者及医护感染新冠肺炎,患者及家属情绪稳定,医疗护理工作正常运行。结论微创妇科病区采用的应急护理管理方案具有科学性、实用性,可有效预防新型冠状病毒的院内交叉感染。     

新型冠状病毒感染出院后的VTE的诊治与预防

新型冠状病毒感染后的住院患者，特别是入住重症监护室的患者，可能会发生一系列凝血功能障碍，可能会导致血栓形成，如肺栓塞、深静脉血栓形成或动脉血栓。尽管关于新型冠状病毒感染住院患者静脉血栓栓塞症（venous thromboembolism,VTE）的发病率、预防和治疗的文献较多，但新型冠状病毒感染出院后的症状性和亚临床VTE发病率的数据很少。因此，对于新型冠状病毒感染出院后VTE的预防尚无确切的建议或指南，目前的指南存在一些争议。笔者回顾和总结了有关新型冠状病毒感染患者VTE发病率、预防、诊断和治疗方法的现有文献，以求对新型冠状病毒感染出院后的患者给予VTE预防的指导。     

病毒感染相关的肾损伤

病毒感染在人类中普遍存在,可能通过多种机制导致不同程度的肾脏损伤,并且与患者的预后息息相关.近期在世界范围内流行的新型冠状病毒肺炎(coronavirus disease 2019,COVID-19),可能通过包括细胞因子炎症风暴内的多种机制引发患者急性肾损伤.常见的乙型、丙型肝炎病毒和人类免疫缺陷病毒(human i...     

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in Non-Diabetes patients”.     

A comprehensive narrative review of the cutaneous manifestations associated with COVID-19

The systemic and respiratory clinical manifestations of coronavirus disease 2019 (COVID-19) include fever, coughing, sneezing, sore throat, rhinitis, dyspnea, chest pain, malaise, fatigue, anorexia and headache. Moreover, cutaneous manifestations have been reported in 0.2% to 20.4% of cases. Early diagnosis of COVID-19 leads to a better prognosis; knowledge of its cutaneous manifestations is one way that may help fulfil this goal. In this review, PubMed and Medline were searched with the terms “dermatology”, “skin” and “cutaneous”, each in combination with “SARS-CoV-2” or “COVID-19”. All articles, including original articles, case reports, case series and review articles published from the emergence of the disease to the time of submission, were included. In this comprehensive narrative review, we tried to provide an analysis of the cutaneous manifestations associated with COVID-19, including maculopapular rash, urticaria, Chilblain-like, vesicular lesions, livedo reticularis and petechiae in asymptomatic/symptomatic COVID-19 patients that might be the first complication of infection after respiratory symptoms. Immune dysregulation, cytokine storms, side effects of antiviral drugs, environmental conditions and high-dose intravenous immunoglobulin (IVIG) therapy might be involved in the pathogenesis of the cutaneous manifestations in COVID-19 patients. Therefore, knowledge of cutaneous COVID-19 manifestations might be vital in achieving a quick diagnosis in some COVID-19 patients, which would help control the pandemic. Further research is very much warranted to clarify this issue.     

At the heart of COVID-19

Coronavirus disease (COVID-19) first presented in Wuhan, Hubei province, China in December 2019. Since then, it has rapidly spread across the world, and is now formally considered a pandemic. The disease does not discriminate but increasing age and the presence of comorbidities are associated with severe form of the disease and poor outcomes. Although the prevalence of COVID-19 in patients with cardiovascular disease is under-reported, there is evidence that pre-existing cardiac disease can render individuals vulnerable. It is thought that COVID-19 may have both a direct and indirect effect on the cardiovascular system; however, the primary mechanism of underlying cardiovascular involvement is still uncertain. Of particular interest is the role of angiotensin-converting enzyme 2, which is well known for its cardiovascular effects and is also considered to be important in the pathogenesis of COVID-19. With a range of different drug candidates being suggested, effective anti-virals and vaccines are an area of on-going research. While our knowledge of COVID-19 continues to rapidly expand, this review highlights recent advances in our understanding of the interaction between COVID-19 and the cardiovascular system.     

Diabetes and COVID-19: Role of insulin resistance as a risk factor for COVID-19 severity

Patients with diabetes are more susceptible to coronavirus disease 2019 (COVID-19), and as a consequence, develop more severe form of disease. This is partly due to a systemic inflammatory state and pro thrombotic milieu seen in metabolic syndrome. In this review, we attempt to explore the pathogenetic links between insulin resistance and COVID-19 disease severity. Insulin resistance is an underlying condition for metabolic syndromes, including type 2 diabetes, which impairs insulin signaling pathways affecting metabolic and cardiovascular homeostasis. A high concentration of circulating insulin shifts the balance to mitogen activated protein kinase (MAPK)-dependent signaling and causes endothelial cell damage. The phosphatidylinositol 3 kinase and MAPK dependent signaling pathways maintain a balance between nitric oxide-dependent vasodilator and endothelin-1 dependent vasoconstriction actions of insulin. Vascular smooth muscle cell dysfunction is responsible for inflammation and blood coagulation leading to microvascular and macrovascular complications in diabetes. Hyperactivity in renin-angiotensin system is implicated in development of islet oxidative stress and subsequent β-cell dysfunction, as it alters the islet blood flow. These deleterious effects of insulin resistance involving altered blood pressure, vascular dysfunction, and inflammation could be associated with increased severity in COVID-19 patients. We conclude that clinical and/or biochemical markers of insulin resistance should be included as prognostic markers in assessment of acute COVID-19 disease.     

Imaging of COVID-19: An update of current evidences

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been reported as a global emergency. As respiratory dysfunction is a major clinical presentation of COVID-19, chest computed tomography (CT) plays a central role in the diagnosis and management of patients with COVID-19. Recent advances in imaging approaches using artificial intelligence have been essential as a quantification and diagnostic tool to differentiate COVID-19 from other respiratory infectious diseases. Furthermore, cardiovascular involvement in patients with COVID-19 is not negligible and may result in rapid worsening of the disease and sudden death. Cardiac magnetic resonance imaging can accurately depict myocardial involvement in SARS-CoV-2 infection. This review summarizes the role of the radiology department in the management and the diagnosis of COVID-19, with a special emphasis on ultra-high-resolution CT findings, cardiovascular complications and the potential of artificial intelligence.     

Double Trouble—COVID-19 and the Widespread Use of Corticosteroids: Are We Staring at an Osteonecrosis Epidemic?

BackgroundA combination of immune-mediated vascular damage and routine use of systemic corticosteroid (CS) therapy in COVID-19 may significantly increase the risk and burden of osteonecrosis (ON) after COVID-19. This narrative review explores the pathogenesis, risk factors, and possible preventive and early treatment measures for ON in COVID-19.MethodsFor this narrative review, an extensive literature search was performed using the PubMed, Medline, and Science Direct databases from January 2000 to August 2021 for relevant articles on etiopathogenesis, epidemiology, clinical manifestations, and treatment of severe acute respiratory syndrome coronavirus (SARS-CoV) infection and steroid-induced ON (SION).ResultsPathogenesis of COVID-19, utility of corticosteroids in the treatment of COVID-19, pathogenesis of SION vis-a-vis SARS-CoV infection, associated risk factors, and early diagnosis and treatment of ON following CS therapy of SARS-CoV infection were discussed.ConclusionPreliminary data of COVID-19 and similar trends from the SARS 2003 epidemic indicate that the “angiocentric” pathogenesis of SARS-CoV-2 and treatment with high-dose CS may increase the risk of ON in COVID-19 patients. Risk stratification based on CS intake during COVID-19 treatment can help identify subjects at moderate to high-risk for ON where early preventive and follow-up plans can be initiated.     

From cellular function to global impact: the vascular perspective on COVID-19

Since COVID-19 was declared a pandemic a year ago, our understanding of its effects on the vascular system has slowly evolved. At the cellular level, SARS-CoV-2 — the virus that causes COVID-19 — accesses the vascular endothelium through the angiotensin-converting enzyme 2 (ACE-2) receptor and induces proinflammatory and prothrombotic responses. At the clinical level, these pathways lead to thromboembolic events that affect the pulmonary, extracranial, mesenteric, and lower extremity vessels. At the population level, the presence of vascular risk factors predisposes individuals to more severe forms of COVID-19, whereas the absence of vascular risk factors does not spare patients with COVID-19 from unprecedented rates of stroke, pulmonary embolism and acute limb ischemia. Finally, at the community and global level, the fear of COVID-19, measures taken to limit the spread of SARS-CoV-2 and reallocation of limited hospital resources have led to delayed presentations of severe forms of ischemia, surgery cancellations and missed opportunities for limb salvage. The purpose of this narrative review is to present some of the data on COVID-19, from cellular mechanisms to clinical manifestations, and discuss its impact on the local and global surgical communities from a vascular perspective.     

人工肝血液净化系统应用于重型、危重型新型冠状病毒肺炎治疗的专家共识

全国新型冠状病毒肺炎(COVID-19)的防治工作进入攻坚阶段,重型、危重型患者的有效救治是降低该疾病病死率的关键。人工肝血液净化系统能清除炎症因子,减轻炎症反应对机体的损伤,对重型、危重型患者的救治具有重要价值。由李兰娟院士领衔,基于全国各地的救治经验,整合全国各地专家意见,针对人工肝治疗重型、危重型COVID-19患者的基本原理、治疗适应证、相对禁忌证、治疗模式选择、监测指标及疗效评价等进行总结,制订了本专家共识,供各单位参考开展救治工作。     

新型冠状病毒肺炎期间的眼科诊疗建议

新型冠状病毒病(COVID-19)的临床症状和体征多样,其中少数患者可能以结膜炎为首发表现在眼科就诊,且已有研究发现不能排除通过眼表途径传播的可能。鉴于此,眼科医师在诊疗工作中的防护措施不可忽视。本文总结了新型冠状病毒与眼科的现有相关发现,并对疫情期间眼科医务人员在临床工作中的诊疗注意事项提出建议,以期对疫情期间的眼科门急诊管理、患者收治、病房管控、手术管理等方面提供借鉴和参考。