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Objective:To investigate and summarize the chest CT imaging features of patients with novel coronavirus pneumonia (COVID-19), bacterial pneumonia and other viral pneumonia.Methods:Chest CT data of 102 patients with pulmonary infection due to different etiologies were retrospectively analyzed, including 36 patients with COVID-19 admitted to Hainan Provincial People's Hospital and the Second Affiliated Hospital of Hainan Medical University from December 2019 to March 2020, 16 patients with other viral pneumonia admitted to Hainan Provincial People's Hospital from January 2018 to February 2020, and 50 patients with bacterial pneumonia admitted to Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from April 2018 to May 2020. Two senior radiologists and two senior intensive care physicians were participated to evaluated the extent of lesions involvement and imaging features of the first chest CT after the onset of the disease.Results:Bilateral pulmonary lesions were more common in patients with COVID-19 and other viral pneumonia, and the incidence was significantly higher than that of bacterial pneumonia (91.6%, 75.0% vs. 26.0%, P < 0.05). Compared with other viral pneumonia and COVID-19, bacterial pneumonia was mainly characterized by single-lung and multi-lobed lesion (62.0% vs. 18.8%, 5.6%, P < 0.05), accompanied by pleural effusion and lymph node enlargement. The proportion of ground-glass opacity in the lung tissues of patients with COVID-19 was 97.2%, that of patients with other viral pneumonia was 56.2%, and that of patients with bacterial pneumonia was only 2.0% ( P < 0.05). The incidence rate of lung tissue consolidation (25.0%, 12.5%), air bronchial sign (13.9%, 6.2%) and pleural effusion (16.7%, 37.5%) in patients with COVID-19 and other viral pneumonia were significantly lower than those in patients with bacterial pneumonia (62.0%, 32.0%, 60.0%, all P < 0.05), paving stone sign (22.2%, 37.5%), fine mesh sign (38.9%, 31.2%), halo sign(11.1%, 25.0%), ground-glass opacity with interlobular septal thickening (30.6%, 37.5%), bilateral patchy pattern/rope shadow (80.6%, 50.0%) etc. were significantly higher than those of bacterial pneumonia (2.0%, 4.0%, 2.0%, 0%, 22.0%, all P < 0.05). The incidence of local patchy shadow in patients with COVID-19 was only 8.3%, significantly lower than that in patients with other viral pneumonia and bacterial pneumonia (8.3% vs. 68.8%, 50.0%, P < 0.05). There was no significant difference in the incidence of peripheral vascular shadow thickening in patients with COVID-19, other viral pneumonia and bacterial pneumonia (27.8%, 12.5%, 30.0%, P > 0.05). Conclusions:The probability of ground-glass opacity, paving stone and grid shadow in chest CT of patients with COVID-19 was significantly higher than those of bacterial pneumonia, and it was more common in the lower lungs and lateral dorsal segment. In other patients with viral pneumonia, ground-glass opacity was distributed in both upper and lower lungs. Bacterial pneumonia is usually characterized by single lung consolidation, distributed in lobules or large lobes and accompanied by pleural effusion.
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Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.
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Objective To describe the clinical features,diagnosis and treatment of osteomyelitis caused by Burkholderia pseudomallei.Methods Three cases of osteomyelitis caused by B.pseudomallei were treated in Haikou People's Hospital affiliated to Xiangya Medical College of Central South University from April 2007 to April 2017.The clinical data were reviewed and analyzed retrospectively.Relevant reports of osteomyelitis due to B.pseudomallei in China and abroad from 2007 to 2017 were comprehensively reviewed.Results The clinical manifestations included hot feeling,redness,swelling,and pain at site of infection.The infection usually occurred in tibia,femur,and skull bone.There were usually multiple lesions,frequently involving spleen,soft tissue and joints.The main imaging finding was osteomyelitis.The diagnosis was confirmed by bacterial culture in all patients.Antimicrobial therapy combined with surgical intervention was the most common approach in the stage of intensive treatment.Ceftazidime,trimethoprim-sulfamethoxazole and carbapenems were the mostly used antibiotics.However,in the stage of bacterial eradication,trimethoprim-sulfamethoxazole and doxycycline were used.The duration of treatment was very long in both stages.The recurrence was low after standard treatment.Conclusions The osteomyelitis caused by B.pseudomallei lacks specific clinical manifestation.Imaging techniques can identify the site of infection,and bacterial culture helps confirm the diagnosis.Timely and effective antimicrobial therapy combined with surgical intervention can reduce mortality.Full course and standard anti-infective therapy may prevent recurrence.
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Objective To investigate the expression of nuclear factor-κB in alveolar macrophages of paraquat-induced rats and the effect of diallyl sulfide on it.Methods Forty five male wistar rats were randomly divided into three groups,namely control group,model group,and DAS treatment group (n =15 in each).The model of paraquat poisoning was reproduced by single does of 70 mg/kg given by intra-gastric administration,while the equal volume of normal saline (NS) was given to the rats in control group instead.The dose of 100 mg/kg of DAS was given to rats by intra-peritoneal injection in DAS treatment group.The equal volume of NS was given to the rats by intra-peritoneal injection in model group and control group instead.The rats of model group and DSA treatment group were exposed to paraquat once a day for 14 days.Five rats in each group were sacrificed at 3,7,14 days.Alveolar maerophages were harvested by bronchalveolar lavage (BAL).The protein content of BAL fluid were examined.The exprossion of NF-κB was measured with immunocytochemistry technique.Results Alveolar macrophage cultures were carried out by using differential adherence of isolated and purified alveolar macrophages,and after 30 minutes culture,more adherent macrophages can be seen.Compared with model group,the protein content of BAL fluid at dfferent intervals in the control group were obviously lower,especially on the 3 rd day (261.6 ± 17.16) μg/mL vs.(673.4 ± 151.9) μg/mL;7 d (265.6 ± 18.37) μg/mL vs.(581.3 ± 134.58) μg/mL;14 d (253.8 ± 11.43) μg/mL vs.(589.07 ± 33.85) μg/mL,P ＜ 0.05.Comparisons of protein content in BLA fluid between PQ group and DAS treatment group were on the 3 rd day (673.4 ± 151.9) μg/mL vs.(342.9 ±39.03) μg/mL;on the 7 th day (581.3 ± 134.58) μg/mL vs.(383.7 ±7.37) μg/mL,P＜0.05;on the 14 th day (589.07±33.85) μg/mL vs.(282.9±15.59) μg/mL,P＜0.05.The immunocytochemistry analysis revealed minimal NF-κBp65 expression in the cell cytoplasm in the control group,while high NF-κBp65 expression was found in nuclear in the model group.Minimal NF-κBp65 expression was found in the cell cytoplasm in the DAS treatment group,and integral A value was significantly lower in the DAS treatment groups than that in the model group (P ＜ 0.05).Conclusions Treatment with an intra-peritoneal injection of DAS is capable of attenuating the extent of PQ-induced ALI in rats by lowering BLA fluid protein content,inhibiting the expression of NF-κB in alveolar maerophages.
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OBJECTIVE To investigate the effect of diallyl sulfide (DAS) in protection against acute lung injury in rats induced by paraquat(PQ). METHODS A total of 100 male Wistar rats were randomly divided into normal control group,PQ 70 mg·kg-1 model group,and DAS 25,50 and 100 mg·kg-1 treatment groups,with 20 rats in each group. A poisoning model was estalolished after administration ig at a single dose of PQ 70 mg·kg-1,while the normal control group was ip given the same volume of normal saline. DAS 25,50 and 100 mg · kg-1 was intraperitoneally injected 30 min before and after PQ exposure. Five rats in each group were sacrificed at 1,3,6 and 12 h,respectively. The inferior lobe of the right lung was observed by HE staining under an optical microscope. Tissue of the upper lobe of the right lung was used to detect the content of nitric oxide (NO). Alveolar macrophages (AMs) were collected and cultured for 24 h,and the content of nitric oxide synthase(iNOS)in the supernatant was detected. AMs were cultured for 72 h and the expression of iNOS protein in AMs was detected by immunocytochemistry method. RESULTS Compared with normal control group,the alveolar structure of PQ group was severely damaged and the pathological score was significantly increased(P<0.01). The NO content of PQ group was significantly higher than in normal control group(P<0.01). The content and protein expression of iNOS were significantly increased in PQ group(P<0.01). Compared with PQ group,the lung injury score of rats in DAS 50 mg·kg-1 group at 3,6 and 12 h and in the DAS 100 mg·kg-1 group at each time point was decreased(P<0.05). Compared with PQ group,the NO content of DAS 25 and 50 mg · kg-1 group was decreased(P<0.05),and the NO content of DAS 100 mg · kg-1 group was significantly reduced(P<0.01). The content of iNOS was reduced in DAS 100 mg · kg-1 group(P<0.05). Compared with PQ group,the expression of iNOS protein in DAS groups was decreased(P<0.05). CONCLUSION DAS can inhibit the oxidative damage in rats induced by PQ.
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ObjectiveTo investigate the mechanism of anti-inflammatory effect of diallyl sulfide (DAS) in protection against acute lung injury (ALI) in rats with paraquat poisoning.Methods Eighty male Wistar rats were randomly divided into four groups, namely: control group, model group, dexamethasone (DXM) treatment group, and DAS treatment group, with 20 rats in each group. The model of paraquat poisoning was reproduced by single does of 70 mg/kg given by gavage, while the same volume of normal saline (NS) was given in same manner in control group. 100 mg/kg of DAS, the same volume of NS, or 1 mg/kg DXM injection were given respectively in DAS treatment group, model group, or DXM treatment group intraperitoneally after exposure to paraquat, once a day for 14 days. Five rats in each group were sacrificed at 1, 3, 7, 14 days, respectively. The inferior lobe of right lung was harvested, and the degree of lung injury was observed with hematoxylin and eosin (HE) staining under optical microscope; the upper lobe of right lung was used to determine the lung wet/dry weight (W/D) ratio and for evaluation of the degree of pulmonary edema. The expression of nuclear factor -κB (NF-κB) in the middle lobe of right lung was assessed with immunohistochemistry. The expression of tumor necrosis factor -α (TNF-α) mRNA in the left lung was determined with the reverse transcription-polymerase chain reaction (RT-PCR).Results① The pulmonary structure in control group was found to be intact. However, in the model group there were progressive pathological changes in lung, including marked edema and thickening of alveolar walls, collapse of alveoli, infiltration of inflammatory cells, alveolar wall, and obvious bleeding in the local lung tissue, and formation of transparent membrane in alveolar space. Less infiltration of inflammatory cells and no obvious destruction were found in alveolar structure in the DAS and DXM treatment groups.② Lung W/D ratio: lung W/D ratio of model group was apparently higher than that in control group at every time point, and peaking on the 3rd day (6.15±0.54 vs. 4.15±2.10,P< 0.05), and the ratio of lung W/D of DAS and DXM treatment groups was obviously lower than that in model group at every time point, especially on the 3rd day (3.99±1.26, 4.30±0.70 vs. 6.15±0.54, bothP< 0.05), but there was no significant difference between DAS and DXM treatment groups in this regard.③ The immunocytochemistry analysis revealed minimal NF-κBp65 expression in the cell nuclei of the control group, while extensive NF-κBp65 expression was found in model group. Minimal NF-κBp65 positive expression in the cytoplasm and even less positive expression in the nucleus was found in the DAS and DXM treatment groups, and integralA value was significantly lower in the DAS and DXM treatment groups than that of the model group, especially on the 3rd day [(17.98±0.06)×107, (18.53±0.04)×107 vs. (28.85±0.61)×107, bothP< 0.01], but there was no significant difference between DAS and DXM treatment groups.④ It was shown by RT-PCR that the expression of TNF-α mRNA in lung tissue of the model group was significantly higher than that in the control group on the 3rd day (gray value: 3.63±0.62 vs. 0.51±0.13, P< 0.05). The expression of TNF-α mRNA in lung tissue was significantly decreased in DAS and DXM treatment groups compared with model group (gray value: 2.49±0.57, 2.02±0.26 vs. 3.63±0.62, bothP< 0.05), but there was no significant difference between DAS and DXM treated groups.ConclusionTreatment with an intraperitoneally injection of DAS is capable of attenuate the extent of PQ-induced ALI in rats by alleviating pulmonary edema, inhibiting the expression of NF-κB and TNF-α in lung tissue, and ameliorating pathological changes in lung tissue.
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ObjectiveTo compare the effectiveness of ω-3 fatty acids and middle/light fatty acids in the intervention of rats model of bleomycin-induced pulmonary fibrosis.MethodsTotally 120 rats were randomly divided into 4 groups: normal saline (NS) group,bleomycin-induced pulmonary fibrosis without treatment group ( BLM group),middle/light fatty acids group,ω-3 fatty acids group.Lung tissues were obtained on the 7th,14th,and 21st day after modeling.The left lung were measured by using immunohistochemical methods for transforming growth factor β1 (TGF-β1) and interferon garmma ( IFN-γ).The lower lobe of the right lung underwent HE staining.Serum TGF-β1,IFN-γ,and interleukin-4 (IL-4) were measured using double-antibody sandwich ELISA.ResultsThe pulmonary alveolitis and fibrosis in the ω-3 fatty acids group was significantly milder than in middle/light fatty acids group and BLM group.On the 7th,14th,and 21st day after modeling,stronger TGF-β1 protein expression was detected in the bronehiolar epithelia of middle/light fatty acids group and BLM group and poorer IFN-γexpression in both groups.However,the opposite results were found in the ω-3 fatty acids group: on the 7th,14th,and 21st day after modeling,TGF-β1 protein expression ( 13.60 ± 5.90,10.53 ± 4.21,and 7.23 ± 2.21 )was lower ( P =0.047) and IFN-γ ( 13.85 ± 7.48,15.32 ± 2.12,and 18.74 ± 2.65 ) was stronger in ω-3 fatty acids group (P =0.041).On the 7 ,14,and 21st day after modeling,the serum IL-4 levels in the middle/light fatty acids group and BLM group became significantly higher,while the IFN-γ level in both groups was significantly lower than in ω-3 fatty acids group ( P =0.008 ) ; meanwhile,in the ω-3 fatty acids group,the serum IL-4 levels [ (8.73 ± 1.20),(5.73 ±2.03),and (4.98 ± 1.89) pg/ml] were significantly lower (P =0.044) and serum IFN-γlevels [ (5.67 ± 0.13 ),( 6.58 ± 0.64 ),and ( 7.05 ± 0.52 ) pg/ml ] were significantly higher ( P =0.048 ) on the 72,14th,and 21st day after modeling.Conclusionsω-3 fatty acids can lower TGF-β1 protein expression in rat lung tissue and reduce the surum TGF-β1 and IL-4 levels.Compared with the middle/light fatty acids,it can more effectively upregulate the expression of IFN-γ in lung tissue and increase its serum level,and thus alleviate pulmonary fibrosis in rats.
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ObjectTo study the accumulation and distribution of dioscin in the different part of rhizome of Dioscorea zingiberensis C. H. Wright and the differences of its diosgenin. Methods Histochemistry has been used to study the accumulation and distribution of dioscin in the different part of rhizome and diosgenin was determined by HPLC. Results Dioscin distributed mainly in ground tissue. The amount of dioscin accumulated in the plant part from the region distributed with small vascular bundle (SVB) is the most abundant, and the diosgenin is also the highest in the same region; both of them in the region with no vascular bundle (NVB) are next to that of SVB; the amount of dioscin accumulated in the region distributed with big vascular bundle (BVB) is the lowest, and the diosgenin is the lowest in the same region too. Conclusion Diosgenin in every region of the three of male rhizome is higher than that of female rhizome and diosgenin in every region of the three of monoecism is between those of male and female rhizome.