关键词： 器官移植   实体器官移植   新型冠状病毒   抗病毒治疗   小分子药物   诊断  

摘要： 新型冠状病毒(以下简称新冠病毒)自发现以来,已历经多次变异。随着新冠病毒奥密克戎变异株的出现及其持续时间的延长,机体的免疫保护作用也随之下降。虽然普通人群二次感染的发生率相对较低,但实体器官移植受者(solid organ transplant recipient,SOTR)作为免疫抑制宿主,其新冠病毒二次感染甚至三次感染的发生率和重症率仍高于普通人群。而且SOTR也面临其它呼吸道病毒(如流行性感冒病毒、呼吸道合胞病毒等)和多种机会性病毒感染的高风险,需仔细甄别并给予精准化诊疗。多款小分子抗病毒药物的上市给新冠病毒的治疗方案带来更多新选择。本文从SOTR角度,简要述评新形势下新冠病毒变异株的特点、SOTR感染新冠病毒新变异株情况和防治策略、新型抗病毒药物的特点,探讨了SOTR新冠病毒再感染的特点、鉴别诊断和诊疗方案的优化选择。

关键词： 新型冠状病毒感染   耳鸣   不寐   咳嗽   少阳   柴胡剂   医案  

摘要： 新型冠状病毒(2019-nCoV,SARS-CoV-2)是以前从未在人体中发现的冠状病毒新毒株。人体感染2019-nCoV后多以呼吸系统症状较为突出。笔者临证发现部分患者在2019-nCoV核酸或抗原转阴后仍可遗留诸多症状。由于患者体质不同,病位不一,临床表现千奇百怪,如病在手少阳三焦经或足少阳胆经经络循行部位,或在半表半里,或呈阵发性发作,或见干呕,多为病在少阳,如伴舌质不红,脉弦者,属少阳风寒偏表证,治疗以柴胡剂为主,可取得良效。现介绍运用柴胡剂从少阳辨治新型冠状病毒感染后遗症医案3则。

关键词： 多发性硬化   新型冠状病毒   感染   疾病修正治疗   影响因素  

摘要： 目的探讨多发性硬化(MS)患者不同疾病修正治疗(DMT)药物与严重新型冠状病毒(简称新冠病毒)感染风险的相关性。方法选择截止2023年1月31日于泛长三角MS诊疗协作组各医疗中心接受治疗的MS患者,通过问卷形式收集2022年12月至2023年1月中国新冠病毒感染高峰期间患者的感染情况,进行回顾性和横断面分析。结果336例MS患者的平均年龄(34.14±10.21)岁,女性70.54%。治疗包括:特立氟胺86例,鞘氨醇-1-磷酸受体调节剂99例,CD20单抗37例,其他治疗43例,未接受任何治疗71例。接种过新冠病毒疫苗138例(41.07%),发生新冠病毒感染244例(72.62%)。最常见的感染症状有发热、咳嗽、疲劳;21例发生严重新冠病毒感染,其中15例经肺部CT诊断为肺炎,需急诊或住院治疗9例,1例入住ICU,2例使用呼吸机。6例在新冠病毒感染后发生MS复发。不同DMT药物对新冠病毒严重感染的风险差异无显著性(P=0.671)。未接种新冠病毒疫苗的MS患者发生严重新冠病毒感染的风险是接种疫苗的患者的2.37倍(P=0.034);无法独立行走的MS患者发生严重新冠病毒感染的风险是能独立行走患者的3.26倍,但差异无显著性(P=0.052)。结论MS患者感染新冠病毒后转化为严重感染及导致复发的风险较低;不同DMT药物在新冠病毒流行期间具有较高安全性;未接种新冠疫苗及无法自主行走的MS患者严重新冠病毒感染的风险增加,推荐MS患者及时接种新冠疫苗并接受规范治疗。

关键词： 流感   COVID-19   侵袭性肺曲霉菌病   诊断   治疗  

摘要： 流感病毒相关侵袭性肺曲霉病(influenza-associated pulmonary aspergillosis,IAPA)和新型冠状病毒相关侵袭性肺曲霉病(COVID-19-associated pulmonary aspergillosis,CAPA)均为重症病毒性肺炎并发侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA),在重症患者中发病率和病死率均较高。肺组织活检仍是诊断IAPA和CAPA的金标准,而传统生物标志物检测的诊断价值有限,需要新型诊断方法辅助临床诊断。在对IAPA和CAPA患者的抗真菌治疗中应关注药物相互作用和耐药性情况,预防真菌感染的研究和新型抗真菌药物的研究正在进行中。

关键词： COVID-19   pandemic   parents   well-being   children   anxiety  

摘要： The COVID-19 pandemic has impacted parents' and children's well-being. This study aimed to evaluate the impact of the COVID-19 pandemic and its preventive measures on children's well-being and their parents' anxiety level. Parents/caregivers were invited to respond to a self-administered survey. The primary outcome was to assess the rate and severity of parental anxiety during the pandemic/lockdown. Four hundred and thirty parents completed the survey. Ninety-two (21%) and 10 (2%) parents reported that their children gained or lost weight during the pandemic, respectively. Eighty-one (19%) parents reported a regression in their children's developmental milestones, particularly in toileting, speech, and social interaction. The GAD-7 mean scores increased by 2.9 points (95% CI [2.5, 3.25];P < .001) in comparison with prepandemic scores. Adjusted multivariable analysis showed that having children with psychological conditions and a maternal education level less than a university degree were significantly associated with higher parental anxiety.

关键词： COVID-19   Molecular dynamics simulations   Multi-mutant   Infection assay   Spike  

摘要： Background: The emerging mutants of the 2019-nCoV coronavirus are posing unprecedented challenges to the pandemic prevention. A thorough, understanding of the mutational characterization responsible for the pathogenic mechanisms of mutations in 2019-nCoV-Spike is indispensable for developing effective drugs and new ***: We employed computational methods and viral infection assays to examine the interaction pattern and binding affinity between ACE2 and both single-and multi-mutants of the Spike ***: Using data from the CNCB-NGDC databank and analysis of the 2019-nCoV-Spike/ACE2 interface crystal structure, we identified 31 amino acids that may significantly contribute to viral infectivity. Subsequently, we performed molecular dynamics simulations for 589 single-mutants that emerged from the nonsynonymous substitutions of the aforementioned 31 residues. Ultimately, we discovered 8 single-mutants that exhibited significantly higher binding affinities (<-65.00 kcal/mol) to ACE2 compared with the wild-type Spike protein (-55.07 kcal/mol). The random combination of these 8 single-mutants yielded 184 multi-mutants, of which 60 multi-mutants exhibit markedly enhanced binding affinities (<-65.00 kcal/mol). Moreover, the binding free energy analyses of all 773 mutants (including 589 single-and 184 multi-mutants) revealed that Y449R and S494R had a synergistic effect on the binding affinity with other mutants, which were confirmed by virus infection assays of six randomly selected multi-mutants. More importantly, the findings of virus infection assay further validated a strong association between the binding free energy of Spike/ACE2 complex and the viral ***: These findings will greatly contribute to the future surveillance of viruses and rational design of therapeutics.

摘要： Background Aerosolised Ad5-nCoV is one of the first licensed mucosal respiratory vaccine against SARS-CoV-2 in the world;however, the safety profile of this vaccine has not been reported in a large population yet. Methods This multicentre, open-label phase 3 trial, done in 15 centres in six provinces (Jiangsu, Hunan, Anhui, Chongqing, Yunnan, Shandong) in China, aimed to evaluate the safety and immunogenicity of aerosolised Ad5-nCoV in healthy adults (members of the general population with no acute febrile disorders, infectious disease, serious cardiovascular diseases, serious chronic diseases or progressive diseases that cannot be controlled) at least 18 years old, who had received two doses of inactivated COVID-19 vaccine as their primary regimen. This study contained a non-randomly assigned safety cohort and a centrally randomly assigned (1:1) immunogenicity subcohort. The patients in the immunogenicity subcohort received aerosolised Ad5-nCov (aerosolised Ad5-nCoV group) or inactivated vaccine (inactivated COVID-19 group) The primary endpoints were the incidence of adverse reactions within 28 days following the booster vaccination with aerosolised Ad5-nCoV in the safety population (collected through a daily record of any solicited or unsolicited adverse events filled by each participant) and the geometric mean titre of neutralising antibodies at day 28 after the booster dose in the immunogenicity subcohort (measured with a pseudovirus neutralisation test). This study was registered with ***, NCT05204589. Findings Between Jan 22, 2022, and March 12, 2022, we recruited 11 410 participants who were screened for eligibility, of whom 10 267 (99 center dot 8%) participants (5738 [55 center dot 9%] men, 4529 [44 center dot 1%] women;median age 53 years [18-92]) received the study drugs: 9847 (95 center dot 9%) participants in the open-label cohort to receive aerosolised Ad5-nCoV, and 420 (4 center dot 1%) in the immunogenicity subcohort (212 in the aeroso

关键词： 出游决策   影响因子   新冠肺炎疫情   旅游者  

摘要： 新冠肺炎疫情对旅游业造成了巨大冲击,人们整体呈现出规避人流、远离风险、注重安全的行为偏好特征,这些共性决定了旅游者在风险决策中某些共有的行为特征,而这些决策行为往往导致旅游者的出游决策产生偏差.因此,了解旅游者出游决策的影响因子在旅游决策中非常重要.文章从人口学特征、旅游方式的变迁、心理学因素等方面分析旅游者出游决策影响因子,研究新冠肺炎疫情对旅游者出游决策的影响.研究发现,在防疫政策放开前后,旅游者在出游频率、出游半径、出游目的、出游方式、出行方式、目的地选择、旅游信息获取途径方面均存在显著差异.

关键词： 新冠肺炎疫情   空间布局   企业韧性能力  

摘要： 企业韧性能力是企业应对外部危机的重要能力之一,拥有强大韧性能力的企业甚至能够在危机情境下做到转"危"为"机".本文基于企业韧性能力的视角,选取了沪深A股上市公司2017-2020年发布的重大合同作为研究样本,对于合同数据进行了实证检验,研究结果发现:在新冠肺炎疫情的背景下,母子公司之间的距离对于企业韧性能力有显著的负相关作用;企业子公司之间的距离对于企业韧性能力有显著的正相关作用;母公司所在地出行便利度对子公司之间距离和企业韧性能力之间有正向的调节作用.本文的研究结果为企业的地域多元化战略决策提供了借鉴和参考.