Review and Prospect of Pathological Features of Corona Virus Disease / 法医学杂志

Since 2003, coronavirus has caused multiple major public health events that resulted in global epidemics, such as severe acute respiratory syndrome （SARS）, Middle East respiratory syndrome （MERS） and corona virus disease 2019 （COVID-19）. Especially since COVID-19 outbroke in Wuhan, Hubei, in December 2019, coronavirus has had a significant impact on people's health and lives. But so far, the pathological diagnosis of COVID-19 has been relatively deficient： it is still confined to the pathological findings of punctured organs, and the majority of medical workers have poor awareness of its pathological characteristics. The COVID-19, as same as SARS and MERS, is caused by coronaviruses and can cause viral pneumonia. They have certain similarities. This article comprehensively reviews the pathological features observed in the autopsies of the aforementioned three diseases, in order to provide reference to the analysis of pathological changes of COVID-19.

Expression of SARS-CoV nucleocapsid protein in Bac-to-Bac Baculovirus System and antigenic analysis / 中国免疫学杂志

Objective:To express SARS-CoV nucleocapsid protein in Bac-to-Bac Baculovirus Expression System and analyze the antigenicity of the recombinant protein.Methods: The SARS-CoV nucleocapsid gene was amplified by PCR.The PCR product digested with BamHⅠand SalⅠrestriction endonucleases was cloned into vector pFastBac HTC of Bac-to-Bac Baculovirus expression system.Recombinant plasmid was transformed DH 10Bac cells to obtain the recombinant Bacmid DNA.Recombinant Bacmid DNA was transferred into Sf9 cells which were inducted to express the recombinant protein in High Five cells.After purified by Ni affinity chroma-tography ,the antigenicity of the recombinant protein was analyzed by Western blot and ELISA.Results:Recombinant plasmid was con-structed successfully.The recombinant protein with the relative molecular mass of 48 kD was efficiently expressed in High Five cells and purified successfully by Ni affinity chromatography.Western blot and ELISA analysis showed that the recombinant protein could be spe -cifically recognized by the monoclonal antibody to SARS-CoV N protein and immune serum from rabbits ,respectively.The recombinant protein can specifically reacted with serum from SARS patients ,not with serum from healthy persons and patients infected with hCoV-229 E and hCoV-OC43.Conclusion: SARS-CoV nucleocapsid protein has been expressed successfully in the Bac-to-Bac Baculovirus Expression System ,and obtained good antigenicity.It is preliminary deemed that it can't reacted with serum from patients infected with hCoV-229E and hCoV-OC43.

Expression of Prothrombinase/fibroleukin Gene fg12 in Lung Impairment in a Murine Severe Acute Respiratory Syndrome Model / 中国病毒学

To evaluate the role of murine fibrinogen like protein 2 (mfgl2) /fibroleukin in lung impairment in Severe acute respiratory syndrome (SARS), a murine SARS model induced by Murine hepatitis virus strain 3 (MHV-3) through trachea was established. Impressively, all the animals developed interstitial pneumonia with extensive hyaline membranes formation within alveoli, and presence of micro-vascular thrombosis in the pulmonary vessels. MHV-3 nucleocapsid gene transcripts were identified in multiple organs including lungs, spleen etc. As a representative proinflammatory gene, mfgl2 prothrombinase expression was evident in terminal and respiratory bronchioles, alveolar epithelia and infiltrated cells in the lungs associated with fibrin deposition and micro-vascular thrombosis. In summary, the established murine SARS model could mimic the pathologic characteristics of lungs in patients with SARS. Besides the physical damages due to virus replication in organs, the up-regulation of novel gene mfgl2 in lungs may play a vital role in the development of SARS associated lung damage.

Follow-up study on mental symptoms of SARS patients / 中华行为医学与脑科学杂志

Objective To investigate mental symptoms of SARS patients and its related factors for three period-admission, discharge and three months after SARS crisis and to carry out mental intervention and effect evaluation.Methods The mental problems of SARS patients in three periods of admission, discharger and three months after discharger were continuously investigated.114 SARS patients came from seven designated hospitals in Taiyuan of Shanxi. The participants were assessed by self- compiled stressor Questionnaire, PSSS, SCSQ, SES, SCL-90 and EPQ.Results 1.Change tendency of factor score: The SCL-90 total and factors scores including obsessive-compulsion, phobic anxiety went up during discharge compared with admission. After that,these factors scores went down. The factors scores of somatization and depression descended continuously for three period. 2.Change tendency of the incidence:The incidence on factors of obsessive-compulsive, interpersonal sensitivity, phobic anxiety ascended during discharge compared with admission. Then,these factors scores descended. The other factors went down continually for three periods.3. The self-esteem was influencing factor on mental symptoms of SARS patients for three periods.Conscientious condition severity was influencing factor in admission and discharge.Negative coping was influencing factor in discharge and three months after SARS crisis. Education was influencing factor in three months after SARS crisis.4.After intervention ,the most mental symptoms of 35 SARS patients had mental problems were improved. Dissimilarly, a part of mental symptoms got severity.Conclusions 1.SARS patients exist severe mood disorders and have different influencing factors for three periods. They should be evaluated continuously and be intervened in time.2.The effect of mental intervention by telephone is not uncertainty.

A study on Knowledge, Attitude, and Behavior toward Severe Acute Respiratory Syndrome (SARS) among College-prep Students at Japanese Language Schools in Tokyo / 国際保健医療

<b>Introduction:</b> The outbreak of severe acute respiratory syndrome (SARS) began in Guangdong, China in November 2002 and spread to Hong Kong around March 2003. It stopped spreading in July of the same year. However, a sense of crisis toward potential new infections may exist in epidemic areas. “College-prep students” are regarded as a high-risk group as a source of infection because of certain factors, such as the differences in linguistic capabilities and their customs. The purpose of this study was to clarify the knowledge, attitude, and behavior toward SARS, and also to collect the information as baseline data for the control of emerging infectious diseases toward them.<br><b>Methods:</b> We conducted a self-administered questionnaire to 303 “college-prep students” from June 27 to July13, 2003. For statistical analyses, the chi-square test, t-test and factor analysis were used.<br><b>Results:</b> The average age of subjects was 22.8 years for males, and 22.6 years for females. The majority of subjects was from China (76.8%, n= 218), and had only stayed in Japan less than one year (70.9%, n= 205). Most subjects were knowledgeable of the symptoms of and preventative measures for SARS. There were no significant differences in knowledge, attitude, and behavior items between students from epidemic areas and those from non-epidemic areas. However, we observed a statistically significant difference in the proportion of subjects in the two groups stratified by information source: radio (p<0.01) and family (p<0.05), where the proportion was higher in epidemic areas than in non-epidemic areas. Three factors were extracted by factor analysis on information sources, which suggested an inverse correlation for language and frequency of communication.<br><b>Conclusions:</b> This study clarified the knowledge, attitude, and behavior toward SARS for “college-prep students”. These findings must be useful for the control against emerging infectious diseases.

Severe Acute Respiratory Syndrome, SARS / 대한임상미생물학회지

An international outbreak of severe acute respiratory syndrome (SARS), a recently recognized syndrome caused by the newly identified severe acute respiratory syndrome-associated coronavirus (SARS-CoV), began in November 2002 and ended in July 2003. Coronavirus is a family of enveloped, single stranded-RNA viruses causing disease in humans and animals, but the other known coronaviruses that affect humans cause only the common cold. The number of SARS cases in 2003 was approximately 8000 across the world. Many recent studies have reinforced initial impressions that SARS-CoV is primarily transported via contact and/or droplets and that the combination of standard, contact, and droplet precautions is generally effective for its control. Active surveillance for clusters of cases of severe respiratory disease must be a first priority, especially among health care workers. Such surveillance should include the rapid diagnosis and prevention of other respiratory viruses that cause outbreaks of febrile respiratory disease-notably, influenza. Surveillance on the part of clinicians is the key to the early detection of any reemergence before it regains a foothold in the community. During the outbreak of SARS, ribavirin, steroids, interferon, convalescent plasma, and lopinavir/itonavir were used in varying doses and combinations in different regions of the world. At present no definitive conclusions regarding the efficacy of any of these treatments can be drawn. New findings regarding SARS are continuing to be discovered at an unprecedented pace, permitting a better understanding of the disease and enabling better preparation for its possible returns.

Effects and adverse drug reactions of mtrisone in the treatment of patients with severe acute respiratory syndrome / 中国临床药理学与治疗学

AIM: To study effects and adverse drug reactions of mtrisone in the treatment of patients with severe acute respiratory syndrome. METHODS: The information of the medications in 680 patients with severe acute respiratory syndrome (SARS) in Xiaotangshan Hospital was collected by HIS system and the effects and ADRs of metrisone were staiated. RESULTS: The kinds of drugs of SARS patients who had been cured by metrisone were more than those which were not cured by metrisone. Condition of SARS patients who had been cured by metrisone was more serious than those which were not cured by metrisone. The ADRs rate, blood glucose and leukocyte of SARS patients who had been cured by metrisone are higher than those which were not cured by metrisone while blood K+ is lower. CONCLUSION: The utilization of metrison to SRAS patient should be more cautious to balance the effects and ADRs of metrisone.

National Questionnaire Survey on Managing Patients with Severe Acute Respiratory Syndrome, 2003 / 감염과화학요법

BACKGROUND: There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. RESULTS:Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. RESULTS: The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. CONCLUSIONS: The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

National Questionnaire Survey on Managing Patients with Severe Acute Respiratory Syndrome, 2003 / 감염과화학요법

BACKGROUND: There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. RESULTS:Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. RESULTS: The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. CONCLUSIONS: The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

Some remarks on the Severe Acute Respiratory Syndrome (SARS) in Hanoi from 23 February to 23 March 2003

By monitoring the clinical and epidemiological development and prevention of SARS outbreak, the author initially informed some remarks: 1 month after outbreak, SARS just occurred in individuals who were close related with the initial sources of infection from hospitals. Not detect outbreak in community

SARS quarantining hospital employees's knowledge about SARS and attitude to SARS control / 결핵

BACKGROUND: In Korea, the effort to control the spread of severe acute respiratory syndrome (SARS) has succeeded, but we have to maintain vigilance against SARS and other infectious diseases, because many experts warn that SARS may return or that other infectious agents could spread globally. The purpose of this study is to describe the degree of knowledge of hospital employees, assuming full responsibility for treating and attending to SARS suspected case, and to elucidate the attitude to SARS using questionnaires. METHOD: All employees of Kangwon university hospital were eligible for this study. We used validated questionnaires to survey demographic characteristics, the degree of knowledge of SARS, intention of treating and attending suspected cases, influence and effects of SARS on the community, and acquisition of information about SARS. RESULT: Based on the 251 completed surveys, out of 280 returned the score for knowledge about SARS was 72.0+/-13.7, 50.6% responded positively about joining a SARS team, and 23.1% were opposed to the designation for quarantining. There was no relationship between the degree of knowledge of SARS and the attitudes to it. Most employees wanted to know how to manage SARS patients and how to prevent SARS. CONCLUSION: The attitudes to SARS were not affected by the level of knowledge of SARS. We suggest that national policies about SARS and other infectious diseases should be promulgated using the mass media and internet to provide information on rapidly spreading infectious agents, especially about the proper protocol for treating suspected cases and the appropriate steps to prevent or reduce the risk.

Measurement of Serum INF-2? in Patients with SARS and Its Clinical Significance / 中国医师杂志

Objective To observe the level of serum IFN-2? in patients with severe acute respiratory syndrome(SARS). Methods The level of serum IFN-2? in 66 patients with SARS were measured by RIA, and healthy subjects served as control. Results The results showed that level of serum IFN-2? in patients with SARS in active period were significantly higher than that in control, and level of serum IFN-2? in severe type of patients with SARS either rose or fell. Conclusions The change of serum IFN-2? level indicated that cellular immunity participated in immunoreaction to SARS virus. The change of IFN-2? level in severe type of patients with SARS reflected the difference of immunoreaction in the patients.

Clinical features of severe acute respiratory syndrome patients complicated with underlying diseases / 中国实用内科杂志

Objective To investigate the clinical and laborat ory characteristics of SARS patients complicated with underlying diseases.Methods 1 291 patients clinically diagnosed as SARS defined by Chinese Ministry of Health reported in Beijing area were analyzed retrospect ively in our study.Results In 1 291 cases,there were 27.5% patients with unde rlying diseases,in which,65.6% cases were 40 years or older.There were 72.5% p atients without underlying diseases,in which,74.6% cases were 40 years or young er.Hypertension,diabetes mellitus and coronary heart disease were the most commo n underlying diseases of SARS.Clinical symptoms and signs of SARS in underlying diseases group were more than that in without underlying diseases group (P

Conderation over the status of lemology triggered by epidemics of severe acute respiratory syndrome / 解放军医学杂志

Severe acute respiratory syndrome (SARS) is a newly discovered infectious disease that greatly threatens human health in the 21st centry. In this article the author elucidates the current status and problems and difficulties encountered in the specialty of lemology as experienced in personal practices in an epidemic of SARS in China, and ventures to present several personal opinions in this regard.

Analysis of the effect of glucocorticoid treatment on severe acute respiratory syndrome / 解放军医学杂志

0 05). Conclusions The administration of glucocorticoid in early phase of SARS in small dosage and short term regimen could shorten the course of the disease and accelerate resolution of inflammation in the lung

Content of serum SARS-CoV IgG antibody, lung function and lung radiographic changes in SARS patients six months after convalescence / 解放军医学杂志

Objective To study the changes in serum SARS coronavirus (SARS CoV) IgG antibody, and lung function and radiographic image of the lung six months after being discharged from the hospital. The incidence of femoral head necrosis in some of them was also evaluated. Methods 293 patients who were convalescent from SARS regularly received SARS CoV IgG antibody assay, lung function test and chest X ray and/or high resolution computerized tomography (HRCT) examination in the General Hospital of PLA 6 months after being discharge. In the patients who were found to have lung diffusion abnormity (D L CO

Clinical manifestation and outcome of severe acute respiratory syndrome / 中国实用内科杂志

Objective To investigate the clinical manifestation and outcome of severe acute respiratory syndrome (SARS).Methods The clinical data of 233 patients with SARS admitted to China-Japan Friendship Hospital from April 2003 to June 2003 were analyzed,including clinical manifestations,laboratory findings,chest radiograph,outcome and mortality of SARS.Results There were 115 male and 118 female patients in this cohort,aged 13-86 (mean 42 8?18 5yr);43 3%of the patients had one or two kinds of underlying diseases;73 0% of the patients had a history of SARS close contact. Incubation period was 1-21 days (mean 4 9?4 1d).The initial symptoms were fever in 86 3% of the patients.The respiratory symptoms were found after the onset of 1-2 weeks.The laboratory abnormalities were decreased in WBC (56 7%) and lymphocytes (78 5%).Corticosteriod was used in 69 5% of the patients.There were 10 deaths (4 3%).The elder age,underlying diseases,continued high fever, thrombocytopenia,leucocytosis and bilateral lung involvement were the risk factors.Conclusion SARS is a new and strongly contagious disease,which mainly affects youth and people in their prime life.It has its own characteristic clinical manifestations.There is high mortality in severe cases.The prognosis is poor in patients complicated with diabetes,leucocytosis,lymphocytopenia,thrombocytopenia and elevated serum LDH and CPK.

CLINICAL ANALYSIS OF SEVERE ACUTE RESPIRATORY SYNDROME / 解放军医学杂志

Objective To explore the clinical features of severe acute respiratory syndrome (SARS). Methods Clinical data of 70 patients with SARS were retrospectively analyzed. Results The age of the patients ranged from 10 to 74 years old (mean age 33.81?12.73 years). Severe type of SARS was diagnosed in 38 patients and 32 as common type of SARS. The most common symptoms included fever(98.57%), malaise(80.00%), cough(74.28%), shortness of breath (55.71%), headache(38.57%). The fever lasted for 7.20?4.57d. Based on the symptoms and chest X-ray examination, the disease was classified into early stage, progressive stage, and recovery stage with a mean duration of 3.19?2.32d, 8.18?4.36d, and 8.82?7.01d, respectively. It was found that the incidence of severe type of SARS was higher with the increase of age. Compared with common type of SARS, the fever in patients with severe type of SARS was more difficult to control (the mean highest fever 38.74?0.97℃, 38.02?0.14℃, respectively). The duration of fever after treatment (4.12?3.19d, 2.37?1.75d, respectively) was longer in the illness course (27.78?9.99d, 14.93?5.80d, respectively). The ALT, LDH and HBDH in patients with severe type of SARS were higher than those in patients with common type of SARS (ALT:78.95%,50.00%, respectively; LDH, HBDH:42.11%, 18.75%, respectively). Advanced age, pre-existing chronic disease, and elevation of LDH and HBDH were the factors of poor prognosis. Combination therapy was the first choice for the treatment of SARS. Empirical use of glucocorticoid was useful in preventing progression of the disease. Conclusion Although severe type of SARS had a high mortality, combination therapy could be very effective in the treatment of the majority of patients.

A STUDY OF PATHOLOGY AND ULTRAMICROSTRUCTURE OF NEEDLE-BIOPSY SPECIMENS OF MULTIPLE ORGANS OF SARS PATIENTS / 解放军医学杂志

Objective To study the pathological and ultramicrostructural characteristics of organ tissues in relation to the clinical course of severe acute respiratory syndrome (SARS). Methods Post-mortem tissue samples of organs (lungs, heart, liver, spleen, kidneys, pancreas, stomach ) were obtained by needle biopsy from four SARS patients who died in middle and late stages 3-5 weeks after the onset of the disease. The pathological samples were studied by light and electron microscope, immunohistochemistry, histochemistry and indirect immuno-fluorescent antibody test. Results The main pathological features were early interstitial pulmonary fibrosis or organizing pneumonia. Fibroblasts were increased in the interalveoli septa and young connective tissue was found to fill the alveoli. Diffuse alveolar damage (DAD) with alveolar pneumocytes proliferation and an increase in macrophages were found. Desquamative alveolitis also existed at the same time. Squamous metaplasia and syncytial giant cells with multinuclei could be seen. CD3 + and CD20 + lymphocytes were markedly decreased and CD68 + macrophages and S-100 + dendritic cells increased in spleen. Proliferation of bone marrow cells became restrained . Hepatocytes were vacuolated with fatty degeneration. Electron microscopy showed the presence of coronavirus-like particles 80-60nm in diameter enveloped in the cytoplasm of the type Ⅱ pneumocytes, endothelial cells and lymphocytes. Conclusions A novel coronavirus is the cause of the newly recognized severe acute respiratory syndrom (SARS). The main target organs are lung and immune system. Different pulmonary pathological features were found in patients dying from the disease in different stages. All of specimens showed positive reaction of SARS-fluorescence antibody.

The Level Change of Serum Superoxide Dismutase in Patients with Severe Acute Respiratory Syndrome / 中国医师杂志

Objective To observe the level change of serum SOD in patients with severe acute respiratory syndrome (SARS). Methods The levels of serum SOD in 66 patients with SARS were measured by RIA, and compared with controls. Results The levels of serum SOD in patients with SARS were significantly lower than those in controls, and in severe type of SARS patients were lower than those in the other types. The levels of serum SOD in the recovery stage of SARS patients increased, but still was lower than those in controls. Conclusion Excessive free radicals were produced in patients with SARS, and SOD was depleted. The level change of SOD in patients with SARS may reflect state of disease. Dynamic detection of serum SOD level is helpful for monitoring state of SARS. It may be an important therapeutic measure that excessive free radicals were eliminated from SARS patient body.