Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
At present, there are few studies on patients with epilepsy (PWE) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the results of many studies are inconsistent. SARS-CoV-2 may cause new seizures through a variety of mechanisms, and the susceptibility and mortality of PWE to SARS-CoV-2 remains controversial. During the SARS-CoV-2 pandemic, anxiety, depression and other psychological problems were common among epileptic patients. Clinicians providing telemedicine, telephone chat and video call can effectively reduce the risk of psychological disorders in PWE patients. At the same time, there are many interactions between antiepileptic drugs and various antiviral drugs, which should be carefully considered when using. Considering that the research results are few and many studies contradict each other, PWE and SARS-CoV-2 deserve further exploration in future studies.
Objective To investigate the status of frailty in patients with coronavirus disease 2019 (COVID-19), and to analyze the influence of COVID-19 disease on the prevalence of frailty. Methods This study was conducted using a cross-sectional survey method. COVID-19 patients admitted to a centralized isolation point in Guangzhou were selected for an questionnaire survey by “questionnaire star”, between November and December 2022. The questionnaire included the general information questionnaire, Tilburg Frailty Indicator (TFI), the COVID-19 symptom scale and Mental Resilience Scale (RS-11). Multi-model logistic regression analysis was used to explore the influence of COVID-19 on the occurrence of debilitation. Results A total of 667 questionnaires were distributed, of which 594 were valid, with an effective rate of 89.1%. There were 150 patients (25.3%) were frail, 444 patients (74.7%) were non-frail, and 51 patients (8.6%) were newly frail after infected COVID-19. The median TFI score before COVID-19 was 3 (2, 4) points, 16.7% (99/594) were in a weak state. The median TFI score after COVID-19 was 3 (2, 5) points, 25.3% (150/594) were in a weak state. There were statistically significant differences in TFI scores (Z=−6.596, P＜0.001) and the incidence of debilitation (χ2=351.648, P＜0.001) before and after COVID-19. The results of multivariate logistic regression analysis showed that after controlling disease factors, demographic factors and psychosocial factors, the score of the COVID-19 symptom score was always the influencing factor of COVID-19 patients. The overall change trend of COVID-19 symptom score was statistically significant (P<0.001). Conclusions The COVID-19 symptom score is an important risk factor or predictor of frailty in patients with COVID-19. As the level of COVID-19 symptom score increases, the risk of frailty in COVID-19 patients increases.
Since the first case of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019, the virus has spread rapidly around the world and has become a global public health problem. In the process of this virus epidemic, compared with the general population, cancer patients are considered to be highly susceptible people, especially the lung cancer patients. Some studies have shown that angiotensin converting enzyme 2 (ACE2) may be the pathway for SARS-CoV-2 to infect the host. At the same time, ACE2 is often abnormally expressed in non-small cell lung cancer. Therefore, understanding the respective mechanisms of ACE2 in COVID-19 and non-small cell lung cancer has extremely important reference value for the study of vaccines and therapeutic drugs, and also provides meaningful guidance for the protection of patients with lung cancer during the epidemic. This article reviews the possible invasive mechanism of ACE2 in SARS-CoV-2 and its abnormal expression in non-small cell lung cancer.
At the end of December 2019, some hospitals in Wuhan, Hubei, China found unexplained pneumonia cases one after another. On January 12, 2020, World Health Organization officially named the new coronavirus that caused the outbreak as “2019 new coronavirus”. The National Health Committee of China has organized experts to compile a “pneumonia diagnosis and treatment program for new coronavirus infection” to guide the prevention, control, diagnosis and treatment of the disease. However, due to the limited knowledge of the disease, there are still many problems to be solved in the diagnosis and treatment of the disease. We reviewed the researches on coronavirus infections related to severe acute respiratory syndrome and Middle East respiratory syndrome, combined with our own experience in diagnosis and treatment, and proposed some thoughts on several unclear hot issues such as the mode of disease transmission, the incubation period, the practical application of diagnostic standards, and the choice of treatment drugs in the diagnosis and treatment plan.
ObjectiveTo investigate the antibody concentration and immune status of intensive care medical staff after vaccination against COVID-19. Methods From October 1, 2021 to February 28, 2022, the serial numbers of 47 hospitals were randomly selected by cluster stratified random sampling method. Blood samples were collected from 192 medical staff in intensive care department who had received inactivated novel coronavirus vaccine in 7 hospitals. The antibody concentration was determined by chemiluminescence method to find the antibody rule. Logistic regression analysis was used to determine the related factors affecting the production of antibodies. ResultsTotal antibody concentration of 192 blood samples was 23.25 (5.09, 270.22), IgG concentration was 0.94 (0.15, 4.48), IgM concentration was 0.05 (0.03, 0.12). Logistic regression analysis showed that the total antibody concentration might be related to gender and age, and the IgG concentration was significantly related to whether the third injection was administered. One hundred and twenty-seven people received 2 doses of inactivated vaccine, and the positive rate of IgG was the highest within 1 to 2 months, and decreased significantly after 3 months. The positive rate of IgG antibody was 95.4% within 60 days after receiving 3 doses of vaccine, 70% within 1 month after receiving the third dose of vaccine, and 100.0% within 1 to 2 months (P<0.05). The total antibody positive rate was 96.3% in people aged 17 to 35 years and 73.3% in people aged 36 to 58 years, showing statistical difference (P<0.05). The total antibody production rate of those who received the third dose of vaccine was 100.0%, and no severe case of COVID-19 occurred during the sampling period. Conclusions After the first, second, and third doses of COVID-19 vaccine, the total antibody concentration of the virus gradually increases to 100.0%, indicating initial immunity. However, the antibody concentration decreased gradually after 3 months of inoculation. The concentration of IgG in women is higher than that in men, and the concentration of antibody in young people is higher than that in middle-aged and elderly people during the same period.
There was a male novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) patient after pulmonary surgery at age of 61 years. The patient had no clear history of contact COVID-19 patient before surgery. He developed transient fever on the 4th day after surgery. The body temperature returned to normal on the 5th day after antibiotic adjustment. The patient developed fever and fatigue again on the 6th day after surgery. A chest CT scan revealed postoperative pneumonia. The patient was treated by ganciclovir and moxifloxacin hydrochloride. The patient's temperature gradually decreased on the 7th to 9th days after the operation. CT scan on the 10th day after surgery showed viral pneumonia, so we immediately raised the level of protection. The novel coronavirus nucleic acid test was positive. The patient was immediately transferred to the designated hospital for treatment. The patient was treated by arbidol, moxifloxacin, human immunoglobulin (PH4), ambroxol and other nutritional symptomatic and supportive treatment. The patient's condition is currently stable. Ten people in close contact with the patient developed symptoms, and their CT scans showed viral pneumonia. Six of them were positive in nucleic acid tests, and the others were still under quarantine observation. This shows that it is easy to confuse the imaging manifestations of pneumonia with novel coronavirus pneumonia after lung surgery. We should perform nucleic acid detection as soon as possible in the early diagnosis of CT and reformulate the treatment protocol.
ObjectiveTo compare the mortality in lung cancer patients infected with coronavirus disease 2019 (COVID-19) versus other cancer patients infected with COVID-19. MethodsA computer search of PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI database was conducted to compare the mortality of lung cancer and other cancers patients infected with COVID-19 from the inception to December 2021. Two thoracic surgeons independently screened the literature, extracted data, and then cross-checked the literature. After evaluating the quality of the included literature, a meta-analysis was performed on the literature using Review Manager 5.4 software. ResultsA total of 12 retrospective cohort studies were included, covering 3 065 patients infected with COVID-19, among whom 340 patients suffered from lung cancer and the remaining 2 725 patients suffered from other cancers. Meta-analysis results showed that the lung cancer patients infected with COVID-19 had a higher mortality (OR=1.58, 95%CI 1.24 to 2.02, P<0.001). Subgroup analysis results showed that the mortality of two groups of patients in our country was not statistically different (OR=0.90, 95%CI 0.49 to 1.65, P=0.72). Whereas, patients with lung cancer had a higher mortality than those with other cancers in other countries (Brazil, Spain, USA, France, Italy, UK, Netherlands) (OR=1.78, 95%CI 1.37 to 2.32, P<0.001). ConclusionThere is a negligible difference in mortality between lung cancer and other cancers patients who are infected with COVID-19 in our country; while a higher mortality rate is found in lung cancer patients in other countries. Consequently, appropriate and positive prevention methods should be taken to reduce the risk of infecting COVID-19 in cancer patients and to optimize the management of the infected population.
ObjectiveTo construct a rapid screening tool for the donor of heart dead organ donation (donation after circulatory death, DCD) in the background of novel coronavirus (SARS-CoV-2) infection.MethodsBased on literature analysis and core group discussion, two rounds of expert consultation were carried out by Delphi method to establish dimension and index.ResultsThe screening tool included 3 dimensions, including epidemiological history, hospital exposure history, and clinical manifestations, with 15 entries. The mean of the two rounds of expert authority coefficient was 0.757 and 0.768, and the effective recovery rate of the expert consultation questionnaire was 88% and 100%, respectively. The second round dimension and index coordination coefficients was 0.417 and 0.319, respectively. The content validity of the questionnaire was 0.91.ConclusionsThe DCD liver transplant donor's new rapid screening tool for SARS-CoV-2 infection is scientific and reliable. During the epidemic period, the DCD liver transplant donor risk screening tool is of great significance to the prevention and control of liver transplantation risk.
Objective To discuss the epidemiological characteristics of young and middle-aged people infected with COVID-19 in Gansu province under the new epidemic policy. Methods A total of 1800 people were collected from two tertiary hospitals in Gansu province from November 8, 2022 to January 28, 2023. The vaccination status, nucleic acid antigen detection, the specific time of infection, main symptoms and severity of the disease were investigated. Results Among 1800 participants, 1685 (93.6%) were vaccinated and 1565 (86.9%) were infected with COVID-19. Among the 1565 infected persons, 523 (33.4%) completed both nucleic acid and antigen testing, 382 (24.4%) completed nucleic acid testing, 490 (31.3%) completed antigen testing, 170 (10.9%) received IgG testing. 1490 (95.2%) were slight ill, 75 (4.8%) were critical ill, and 96 (6.1%) were hospitalized, and no one died. In 2022, 92 cases (5.9%) were infected in the first half of November, 141 cases (9.1%) in the second half of November, 630 cases (40.3%) in the first half of December, and 553 cases (35.4%) in the second half of December. 109 cases (7.0%) were infected in the first half of January, 38 cases (2.2%) in the second half of January, and 2 cases (0.1%) in the first half of February of 2023. and no cases in the second half of February. Among the 1565 infected persons, 825 (52.7%) had respiratory symptoms, 293 (18.7%) had gastrointestinal symptoms, 257 (16.4%) had autonomic disorders, 140 (8.9%) had other symptoms such as decreased smell and taste, and 48 (3.3%) had no symptoms after infection. Conclusions The vaccination rate of young and middle-aged people in Lanzhou city of Gansu Province is high. Since the new policy, the infection rate of the novel coronavirus among young and middle-aged people is high, the number of antigen tests is more than nucleic acid tests, most of the infected patients are slight, with fewer critical patients, and the hospitalization rate is low. The peak of infection occurred in early December 2022, and the infection rate was basically zero by February 2023. The main symptoms of COVID-19 infection are mainly respiratory tract, followed by digestive tract and autonomic nervous system disorders, and few patients are completely asymptomatic.