关键词： 危重疾病   肺炎患者   临床有效性   治疗应答   地塞米松   人的生命   新型冠状病毒   无应答  

摘要： 地塞米松(Dexamethasone)是治疗重度新型冠状病毒肺炎(COVID-19)最重要的药物之一I。其在COV-ID-19大流行期间挽救了数百万人的生命。尽管地塞米松的临床有效性已得到证实,但仍有大量患者对地塞米松的治疗应答极少或无应答,最终进展为危重疾病并死亡。总体而言,COVID-19患者对地塞米松疗法的反应存在较大差异。

关键词： 血液透析   新型冠状病毒   免疫性血小板减少  

摘要： 病例介绍患者,女,71岁,因“维持性血液透析24年,发现血小板减少3 d”于2023年1月15日就诊于四川大学华西医院(以下简称“我院”)。患者30+年前诊断丙型病毒性肝炎,自述经专科治疗已痊愈;24年前发现血肌酐升高,诊断为尿毒症,开始规律血液透析治疗至今;5+年前因心房颤动及病态窦房结综合征行射频消融及心脏起搏器植入术。入院前20 d患者因咳嗽、咳痰,于外院行新型冠状病毒[严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)]核酸检测,结果阳性(循环阈值27.4);胸部CT示双肺散在感染,考虑病毒性感染可能;血红蛋白92 g/L,血小板计数186×10^(9)/L,白细胞介素-693.86 pg/mL,降钙素原1.02 ng/mL;血气分析:氧分压89 mm Hg(1 mm Hg=0.133 kPa),血氧饱和度97%(氧合指数401.7)。外院予抗感染、止咳化痰、血液透析等治疗。入我院前7 d查血红蛋白82 g/L,血小板计数115×10^(9)/L。入我院前3 d患者出现口腔出血,查血红蛋白94 g/L,血小板计数10×10^(9)/L,外院予以输注2个治疗量血小板后复查血红蛋白85 g/L,血小板计数2×10^(9)/L。患者为进一步诊治入我院。

关键词： 新型冠状病毒感染   咳嗽   国医名师   蔡宛如  

摘要： 介绍浙江省国医名师蔡宛如教授治疗新型冠状病毒感染咳嗽的临床经验。蔡宛如教授认为,新型冠状病毒感染咳嗽属于外感邪气,首先上犯,必先犯肺,肺失宣降,肺气壅滞,上逆而咳,病位在肺,肺经受损,易传至脾,亦可逆传至肾。治疗上应注重辨证施治,主张从祛风止咳、宣肺平喘、益气养阴三方面治疗。

关键词： 新型冠状病毒感染   中医学   阿育吠陀   对比分析  

摘要： 目的:通过文献计量学方法分析并比较中医学与印度阿育吠陀防治新型冠状病毒(新冠病毒)感染的研究主题和热点,为中医药创新发展提供参考。方法:计算机检索Web of Science核心合集数据库,获得中医学及阿育吠陀防治新冠病毒感染研究文献,利用CiteSpace 6.2.R7可视化软件,采用引文分析、共现分析及聚类分析等文献计量学分析方法,分析并对比2020-2023年新冠病毒感染中医学与阿育吠陀研究论文的分布情况及研究热点。结果:中医药防治新冠病毒感染研究相较于阿育吠陀相关研究发文数量更多(1177/259)、参与国家更多(74/31)、参与机构更广(610/327)。中医药防治新冠病毒感染研究主题涉及网络药理学、系统综述、血必净注射液、荟萃分析、人参皂苷、模拟研究、网络分子对接等,研究热点包括网络药理学、分子对接、植物药、系统评价、抗病毒、急性肺损伤、天然产物等。阿育吠陀防治新冠病毒感染研究主题涉及腺苷-磷酸、病毒感受态、阿育吠陀-64、植物提取物、药代动力学、瑜伽等,研究热点包括提取物、分子对接、睡茄、心叶青牛胆、药用植物、抗病毒活性、水提取物、临床试验、免疫调节活性等。结论:中医学与阿育吠陀均基于各自固有优势开展新冠病毒感染相关研究,研究重点均在防治而非诊断上。相较于阿育吠陀,中医学更擅长引进与吸收新技术方法以筛选具有活性成分的中药,且关注患者的免疫调节。阿育吠陀似乎更重视利用传统方法对患心理健康及创伤后应激的干预。

关键词： 新型冠状病毒   Omicron变异株   肾移植   血肌酐   合并症  

摘要： 目的 报道和分析肾移植受者(KTRs)合并新型冠状病毒(SARS-CoV-2)Omicron变异株感染患者的临床特征并探究影响血肌酐变化的可能因素。方法 回顾性观察2022年10月至2023年12月于该院行同种异体肾移植术且合并Omicron变异株感染的患者,收集并分析其临床资料、基础合并症及预后情况等,分析影响血肌酐变化的可能因素。结果 本研究纳入的114例KTRs合并Omicron变异株感染的患者中,居家管理组(A组)90例(78.9%)、非重症隔离病房组(B组)18例(15.8%)、ICU组(C组)6例(5.3%),出现最多的症状依次是发热(90.4%)、乏力(65.8%)和咳嗽(61.4%),临床表现以上呼吸道感染症状为主,整体病死率为2.6%(3/114),且死亡患者均为C组患者。C组基础合并症数量较B组及A组更高(P<0.05)。患者再分为肌酐升高组(D组)33例(28.9%),肌酐不变组(E组)71例(62.3%),肌酐下降组(F组)10例(8.8%),F组均为Omicron变异株感染轻型和中型的A组患者,D组和F组较E组都有更大比例的患者停用或减量钙调神经磷酸酶抑制剂类药物。结论 Omicron变异株对KTRs的危害性较前其他变异株已大幅下降,实现抗感染与抗排斥间的免疫平衡是预防KTRs肾功能损害的有效措施。

关键词： 新冠肺炎   疫情   基层公共卫生   应急管理   传染病   流行病学调查  

摘要： 本文以山东省乳山市为例,回顾了在突发重大传染病疫情背景下,构建基层突发公共卫生事件应急管理体系的主要做法,包括应急完成山东省第二例新型冠状病毒肺炎确诊病例的临床救治工作、精准进行流行病学调查、建设高效综合防控体系、推进多部门综合协调能力、针对地域特点加强输入性冷链管理等有效做法,探讨了在协同联动机制、专业应急能力、信息传递、防控措施实施等方面存在的短板。提出了建立健全基层突发公共卫生事件应急管理体系、提升卫生专业队伍的公共卫生应急能力、强化部门间信息沟通效率等方面的对策与建议,进而构建响应迅速、高效运行的基层公共卫生体系,为完善重大突发公共卫生事件应急体系提供依据。

关键词： 2019-nCoV nucleic acid detection kit   Ion Proton   MGI Tech (DNBSEQ-G99)   Next-generation sequencing   Performance evaluation  

摘要： Purpose: To evaluate the performance of a newly developed 2019-nCoV nucleic acid detection kit based on Ion Proton sequencing platform and make comparation with MGI Tech (DNBSEQ-G99) platform. Methods: References and clinical samples were used to evaluate the precision, agreement rate, limit of detection (LOD), anti-interference ability and analytical specificity. Twenty-seven clinical specimens were used to make comparison between two platforms. Results: The kit showed good intra-assay, inter-assay, inter-day precision between different operators and laboratories, fine agreement rate with references, a relatively low LOD of 1 x 10 3 copies/ml, anti-interference capability of 5 % whole blood and 1mg/ml mucin and no cross reaction with twenty-nine common clinical pathogens. Consistency of variant classification was observed between two platforms. The WGS from Ion Proton tended to have higher coverage and less missing data. Conclusions: The newly developed kit has shown satisfactory performances and excellent consistency with DNBSEQ-G99, making it a good alternative choice clinically.

关键词： 冠状病毒感染   抗病毒治疗   小分子药物   早期   专家共识  

摘要： 新型冠状病毒(新冠病毒)感染虽已不再构成"国际关注的突发公共卫生事件",但仍在全球范围内处于低水平流行.小分子口服药物是我国目前推荐的针对新冠病毒感染的主要抗病毒治疗方案.虽然国内已上市多种抗新冠病毒小分子药物,但目前尚无针对特殊人群的具体用药推荐.中华医学会细菌感染与耐药防治分会联合国家呼吸医学中心、国家呼吸系统疾病临床医学研究中心组织国内呼吸、病毒学、感染、重症、急诊、药学等各领域专家制订了本共识.本共识的主要内容包括7种抗新冠病毒小分子药物介绍,重点阐述了老年人群、合并慢性疾病人群、肿瘤患者、孕妇、儿童等14种特殊人群用药推荐,为临床医师规范用药提供建议.

关键词： All Hazards Approach   COVID-19   crisis management   disaster management   Israel   local governance   local government  

摘要： Local governments were instrumental in managing the COVID-19 crisis in countries worldwide. This study examines the methods that local governments in Israel used to successfully manage the COVID-19 crisis. We explored the structural characteristics of the localities that excelled at managing the pandemic. Furthermore, we used measures of the spread of the virus and vaccination rates to identify a group of localities that managed the crisis with relative success. We conducted interviews with officials from these localities to determine the methods, policies, and conditions that led to success. We found that ethnicity, distance from urban centers, and socioeconomic status were associated with effective COVID-19 management. We also identified several intraorganizational and interorganizational policies and practices that were successful: crisis-adjusted management, a unified organizational atmosphere, digitalization, information management, autonomous decision making, and the fostering of collaborative relationships. Implications of the findings for the All Hazards Approach to disaster management are discussed.

摘要： The ChAdOx1 nCoV-19 (COVISHIELD) vaccine has emerged as a pivotal tool in the global fight against the COVID-19 pandemic. In our previous study eligible subjects were supplemented with calcifediol, a direct precursor to the biologically active form of vitamin D, calcitriol with an objective to enhance the immunogenicity of the COVISHIELD vaccine. Herein we investigated the effects of calcifediol supplementation on gene expression profiles in individuals who received the COVISHIELD vaccine. Peripheral blood mononuclear cells were isolated from vaccinated individuals with and without calcifediol supplementation at baseline, 3rd and 6th month, and the gene expression profiles were analyzed using high-throughput sequencing. The results revealed distinct patterns of gene expression associated with calcifediol supplementation, suggesting potential molecular mechanisms underlying the beneficial effects of calcifediol in improving the efficacy of COVISHIELD vaccine via augmentation of T cell activation, proliferation and T cell memory responses. Additionally, there was upregulation of NOD like receptor, JAK/STAT and TGF beta signaling pathways. Calcifediol supplementation in vaccinated individuals also downregulated the pathways related to the Coronavirus disease. Taken together, our findings provide valuable insights into the interplay between vitamin D receptor (VDR) signaling and vaccine-induced immune responses and offer another approach in improving vaccination induced antiviral responses.