COVID‐19 and spinal cord injuries: The viewpoint from an emergency department resident with quadriplegia

Spinal cord injuries (SCIs) present distinct physiological and social considerations for the emergency physician. During the COVID‐19 pandemic, these considerations may generate unique challenges for emergency physicians managing patients with SCIs. Physiological disruptions may alter the way SCI patients present with COVID‐19. The same disruptions can affect management of this vulnerable patient group, perhaps warranting early aggressive treatment. The medical picture will often be complicated by unique social characteristics. The reliance on caregivers for activities of daily living can, as an example, increase the human resource requirement of an ED. Considering the vulnerabilities and complexities of patients with SCI, the community should prioritise prevention of COVID‐19 infections in this group. In the event that they do present to an ED, planning for and understanding their complexities will facilitate optimal management.     

新型冠状病毒肺炎药物治疗的研究进展

2019年12月,中国以湖北省武汉市为中心暴发了一场新型冠状病毒导致的肺炎疫情,称为新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)疫情。截至2020年3月1日24时,据我国31个省(自治区、直辖市)和新疆生产建设兵团报告,累计确诊病例80 026例,中国港澳台地区确诊148例。目前,COVID-19无特效抗病毒药物或疫苗,治疗药物的选择主要是基于既往严重急性呼吸综合征、中东呼吸综合征及其他一些流感病毒的治疗经验。瑞德西韦、氯喹、法匹拉韦、恢复期血浆在临床上初见疗效,但其安全性和疗效,还须要大样本量进一步验证。利巴韦林、洛匹那韦/利托那韦、干扰素-α、阿比多尔联合应用,应注意其不良反应,慎重选择。达鲁那韦目前还停留在体外实验阶段,中医辩证治疗还须进一步验证。本文围绕目前临床上治疗COVID-19药物的研究进展进行综述,为COVID-19治疗提供参考。     

基于网络药理学的连花清瘟方抗冠状病毒的物质基础及机制探讨

目的探寻连花清瘟方抗冠状病毒的物质基础及作用机制,为新型冠状病毒肺炎(COVID-19)的中医药治疗提供参考。方法借助TCMSP、Batman、Swiss Target Prediction等数据库检索连花清瘟方中药味的化学成分和作用靶点。通过Gene Cards筛选出冠状病毒的疾病靶点。使用Cytoscape软件构建"药物-成分-靶点-疾病"网络和潜在靶点的相互作用关系,通过富集分析预测作用机制,并将连花清瘟方的主要活性成分与新型冠状病毒(SARS-Co V-2)3CL水解酶(Mpro)、血管紧张素转化酶Ⅱ(ACE2)进行分子对接验证。结果挖掘出连花清瘟方中100种活性成分、636个药物靶点,冠状病毒347个疾病靶点,得到药物-疾病共同靶点67个,关键靶点涉及PTGS2、IL6、CASP3、MAPK1、EGFR、ACE2等。GO富集分析共得到条目1 946个,主要涉及T细胞活化、病毒受体、炎症反应等。KEGG通路富集筛选出166条信号通路,包括肾素-血管紧张素系统、Toll样受体信号通路、JAK-STAT信号通路、T细胞受体信号通路、TNF信号通路等。分子对接结果显示山柰酚、槲皮素、木犀草素与Mpro有较好的结合能力;甘草次酸、豆甾醇、靛蓝与ACE2有较好的结合能力。结论连花清瘟方可通过多成分、多靶点、多通路作用于冠状病毒,其主要成分与Mpro、ACE2有较好的结合能力,从而可能对COVID-19有治疗作用。     

2020年1月全球传染病疫情概要

2020年1月全球共监测到传染病65种,涉及52个国家和地区。除流感外,涉及国家和地区数量位于前5位的传染病分别为登革热(22个)、麻疹(19个)、疟疾(8个)、军团菌病(8个)和流行性脑脊髓膜炎(8个)。病死率位于前3位的传染病分别为埃博拉病毒病(65.5%)、中东呼吸综合征(34.3%)和拉沙热(15.9%)。死亡病例数位于前5位的传染病分别为新型冠状病毒肺炎、麻疹、拉沙热、登革热和埃博拉病毒病。非洲主要流行埃博拉病毒病、霍乱、黄热病、拉沙热和麻疹;亚洲主要流行新型冠状病毒肺炎、中东呼吸综合征和登革热;美洲主要流行登革热。     

Effect of persistent mouse hepatitis virus infection on MHC Class I expression in murine astrocytes

Neurotropic strains of mouse hepatitis virus (MHV) have been used extensively for the study of viral pathogenesis in the central nervous system (CNS), serving as models for human neurological diseases such as multiple sclerosis (MS). MHV strains A59 and JHMV both cause acute and chronic encephalomyelitis and demyelination in susceptible strains of mice and rats. In acute disease, CNS damage is most likely the result of lytic infection in neurons and oligodendrocytes, and death can be prevented by the adoptive transfer of Class I-restricted CD8+ T cells. However, in later stages of the disease induced by some MHV strains, virus tends to be restricted to astrocytes in a nonlytic infection, and the immune response appears to contribute to CNS damage. These data lead us to suggest that the astrocyte may play a central role in the neuropathogenesis of MHV infection. Consistent with this possibility, A59 has been reported to induce the expression of Class I molecules of the major histocompatibility complex (MHC) in glial cells following infection in vivo and in vitro. In this communication, we have examined the influence of persistent infection by both A59 and JHMV on MHC Class I expression in primary murine astrocytes. Persistence was characterized by the presence of intracellular viral antigen and mRNA in the absence of detectable infectious virus particles. Under these conditions, JHMV, but not A59, inhibited constitutive expression of the H-2 K^b molecule, with the magnitude of inhibition increasing with postinfection time. A59 was not able to induce Class I during persistence, presumably due to the lack of infectious virus particles. Class I expression was restored by the addition of gamma-interferon (IFN-γ) to astrocytes persistently infected with either A59 or JHMV. Thus, Class I inhibition is not a permanent consequence of JHMV persistence, and persistence does not interfere with normal signalling pathways for Class I induction. © 1995 Wiley-Liss, Inc.     

32例新型冠状病毒肺炎患者流行病学和临床特征分析

 目的 探讨武汉外新型冠状病毒肺炎（简称为新冠肺炎）患者流行病学和主要临床特征。方法 收集2020年1月22日—2月28日在某院收治的新冠肺炎确诊病例资料,详细询问患者接触史,比较输入病例与本地病例的临床特征以及实验室检测、影像学检查结果。结果 共纳入32例新冠肺炎确诊患者,包括14例（43.75%）输入病例和18例（56.25%）本地病例。27例（84.38%）患者具有明确的接触史,5例（15.62%）患者接触史不明。家庭聚集（66.67%）为主要传播途径。患者年龄中位数为42（32.5,50.5）岁,女性19例（59.37%）。首发症状主要为干咳（23例,71.88%）、发热（16例,50.00%）和咳痰（13例,40.63%）。潜伏期中位数为6.5（0,9）d,首发症状到确诊中位数为7（4.5,9）d,确诊到出院中位数为12（9,16）d。实验室异常指标包括白细胞计数、淋巴细胞绝对计数、清蛋白、CD4⁺和CD8⁺T淋巴细胞计数降低,C反应蛋白、D-二聚体和纤维蛋白原增高。81.25%（26例）患者肺部双侧受累。输入病例和本地病例的淋巴细胞绝对计数差异具有统计学意义（P=0.044）,其他实验室检查结果无差异（均P>0.05）。32例患者均已治愈出院。结论 该市新冠肺炎疫情处于低流行,主要表现为家庭聚集性传播,输入病例和本地病例的临床特征差异不明显。     

WHO关于新型冠状病毒(2019-nCoV)感染预防与控制十问十答

正1.医护人员在治疗和护理新型冠状病毒(2019-nCoV)感染疑似或确诊患者时,是否需要穿防护靴、医用围裙或连体防护服等常规个人防护设备?不需要。目前,世界卫生组织(WHO)对2019-nCoV急性呼吸道疾病疑似或确诊患者的医护人员的指导意见是,除了所有医护人员对所有患者应始终采取标准防护措施之外,还建议采用接触预防和飞沫预防措施。关于个人防护装备,接触传播、飞沫传播的预防措施包括,在进入收治2019-nCoV急性呼吸道疾病疑似或确诊患者病房之前,应佩戴一次性手套保护双手,穿戴清洁、非无菌的长袖袍服保护     

某大型综合医院发热门诊1 770例发热患者临床资料分析

 

目的 分析发热门诊患者新型冠状病毒感染的流行病学临床特征,及时了解发热门诊患者的发热原因及临床表现,为疾病的预防与治疗提供依据。方法 对某大型综合医院2020年1月17日-2月2日发热门诊就诊患者的病历资料进行分析,包括一般资料、流行病学史、新型冠状病毒核酸检测及其他实验室检查结果。结果 共有1 770例患者,男性888例,女性882例,其中21~40岁患者占61.24%。实验室检查结果显示：15例新型冠状病毒核酸检测阳性的患者,主要以白细胞计数正常或减少,淋巴细胞计数减少为主,分别占100.00%、40.00%。857份胸部CT普通扫描检查报告中,阳性822份,阳性率为95.92%。结论 发热门诊的设立有利于对发热患者进行快速、有效的筛检,就诊患者中以病毒感染最为常见,以中青年为主,新型冠状病毒核酸检测阳性的患者行胸部CT检查阳性率较高。