Diagnostic Imaging of Novel Coronavirus Pneumonia

This book presents radiological findings in patients with 2019 Novel Coronavirus Pneumonia (COVID-19). It starts with a general review of COVID-19 Pneumonia discovery, including etiology characteristics, transmission routes and pathogenic mechanisms. In the following chapters, details in clinical classification, imaging manifestations in different groups, and imaging features of family aggregated coronavirus pneumonia are introduced. In addition, key points in differential diagnosis of COVID-19 Pneumonia are summarized in the last chapter. The book provides a valuable reference source for radiologists and doctors working in the area of COVID-19 Pneumonia. © Henan Science and Technology Press 2020.

Data Mining and Network Pharmacology on Tibetan Medicine Prescriptions for the Prevention and Treatment of COVID-19

In this paper, the compatibility rules and drug combinations of Tibetan medicine prescriptions are explored, and the possible anti-epidemic mechanism is analyzed from the perspectives of biological network and signaling pathway, so as to provide reference for scientifically elaborating the potential value of ancient Tibetan medicine in preventing epidemic diseases. Association rules and clustering analysis are used for Tibetan drug mining. A total of 18 prescriptions involving 113 Tibetan medicinal materials were included, and 26 high-frequency Tibetan medicinal materials with the statistical frequency ≥3 are included, most of which are medicinal materials for clearing heat, detoxicating, eliminating plague. Thirteen potential drug combinations are obtained through association rule analysis. The KMean clustering and hierarchical clustering were used for clustering analysis to obtain five drug clusters, and the "Bamusaeconcretiosilicea - Carthami Flos"combination was selected for network pharmacology research by comparing the two methods. After drug target and pathway analysis, "Bamusaeconcretiosilicea - Carthami Flos"through MAPK cascade, response to oxygen level, reactive oxygen species metabolism process, PI3K-Akt signaling pathway, NF- κ B signaling pathway, cytokine-cytokine Receptor interaction and calcium signaling pathways have certain feasibility for the treatment of immune disease fever in three aspects: immune response, inflammatory response, and oxidative stress. © 2022 IEEE.

A preliminary study on the anxiety and depression situation and psychological intervention of the first-line medical staff in our hospital during the COVID-19 epidemic.

To assess the anxiety and depression situation and psychological intervention effect of the first-line medical staff in our hospital during the COVID-19 epidemic. A total of 384 front-line medical staff in our hospital from January 25 to March 8, 2020 were selected as subjects, which were divided into group A and group B respectively. PHQ-9 depression scale and GAD-7 self-rating anxiety scale questionnaire were used to investigate their anxiety and depression. After 1 month, all subjects were re-self-assessed for anxiety and depression, which were named as A1 and B1 group respectively. The GAD-7 anxiety scale had mild, moderate, and severe anxiety scores before group A, which were significantly higher than those in group B (P < 0.05); after psychological intervention, group A1 had significantly reduced anxiety scores (P < 0.05). And there were no markedly difference of PHQ-9 scale scores before and after psychological intervention between groups A and B, A and A1, and B and B1 (P > 0.05). The first-line medical staff in our hospital have different degree of anxiety and depression during COVID-19. Early positive psychological intervention has an effect on ameliorating the anxiety.

Clinical Characteristics of Patients With Re-admitted of Novel Coronavirus 2019 (nCOVID-19) in Wenzhou, China.

Background: During the COVID-19 pandemic, many patients admitted to hospital for treatment have recovered and been discharged; however, in some instances, these same patients are re-admitted due to a second fever or a positive COVID-19 PCR test result. To ascertain whether it is necessary to treat these patients in hospitals, especially in asymptomatic cases, we summarize and analyze the clinical and treatment characteristics of patients re-admitted to hospital with a second COVID-19 infection. Methods: Of the 141 COVID-19 cases admitted to the Wenzhou Central Hospital between January 17, 2020, to March 5, 2020, which were followed until March 30, 2020, 12 patients were re-admitted with a second COVID-19 infection. Data was collected and analyzed from their clinical records, lab indexes, commuted tomography (CT), and treatment strategies. Results: Most of the 141 patients had positive outcomes from treatment, with only 12 (8.5%) being re-admitted. In this sub-group: one (8.3%) had a fever, a high white blood cell count (WBC), and progressive CT changes; and one (8.3%) had increased transaminase. The PCR tests of these two patients returned negative results. Another 10 patients were admitted due to a positive PCR test result, seven of which were clinically asymptomatic. Compared to the CT imaging following their initial discharge, the CT imaging of all patients was significantly improved, and none required additional oxygen or mechanical ventilation during their second course of treatment. Conclusions: The prognoses of the re-admitted patients were good with no serious cases. We conclude that home treatment with concentrated medical observation is a safe and feasible course of treatment if the patient returns a positive PCR test result but does not display serious clinical symptoms. During medical observation, patients with underlying conditions should remain a primary focus, but most do not need to be re-admitted to the hospital.

Effects of WeChat-based psychological interventions on the mental health of patients with suspected new coronavirus pneumonia: A pilot study.

OBJECTIVE: Suspected patients with new coronavirus pneumonia (NCP) may suffer from unique mental health problems. However, the shortage of medical personnel and the infectiousness of the disease have challenged traditional psychological interventions. This study investigated the effects of a new WeChat-based psychological intervention on the mental health of suspected NCP patients. METHODS: This study included 48 participants (control group = 24 vs. intervention group = 24). The control group received conventional NCP nursing, and the intervention group received conventional NCP nursing and the WeChat psychological interventions. Participants completed the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Acute Stress Disorder Scale (ASDS) on the day of, and the 14th day after, admission. RESULTS: There were no significant differences between the two groups (p > .05) regarding demographic characteristics, education, work status, anxiety, depression, or acute stress disorder on the day of admission (p > .05). On the 14th day after admission, the intervention group showed an improvement in anxiety (p < .05) and a significant improvement in depression and acute stress disorder compared with the control group (p < .01). CONCLUSION: The WeChat-based psychological interventions can have a positive effect on the mental health problems of suspected NCP patients.

The clinical value of high-density lipoprotein in the evaluation of new coronavirus pneumonia.

BACKGROUND: The new coronavirus pneumonia (NCP, COVID-19) outbreak began in Wuhan in December 2019. The new coronavirus (2019 novel coronavirus (2019-nCoV)) can cause multiple organ damage, mainly to lung tissue, and induce inflammation in the body. OBJECTIVES: To investigate the changes of high-density lipoprotein (HDL) level in patients with COVID-19 and assess its value in the evaluation and prognosis of this disease. MATERIAL AND METHODS: This paper is a cross-sectional retrospective study. Eighty-six severe COVID-19 patients, 132 non-severe COVID-19 patients and 76 healthy individuals (control group) were recruited to measure triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) using enzyme-coupled colorimetry. RESULTS: The serum HDL-C level in COVID-19 group was 1.02 ±0.28 mmol/L which was significantly lower than in control group (1.52 ±0.55 mmol/L) (p < 0.05). In addition, the serum HDL-C level in severe COVID-19 group was 0.83 ±1.67 mmol/L, which was significantly lower than that in non-severe COVID-19 group (1.15 ±0.27 mmol/L) (p < 0.05). CONCLUSIONS: Changes in HDL levels in patients with COVID-19 can reflect the severity of the disease and have a clinical significance in establishing the prognosis.

Potential compound from herbal food of Rhizoma Polygonati for treatment of COVID-19 analyzed by network pharmacology: Viral and cancer signaling mechanisms.

Rhizoma Polygonati (huangjing in Chinese, ) is a medicine food homology herb used as a component of traditional Chinese medicine treating COVID-19 in the current pandemic emergency in China but the mechanisms remain elusive. Here using TCMSP and Swiss Target Prediction databases to sort out the potential targets of the main chemical components and GenCLiP3, NCBI, and GeneCard databases to search for COVID-19 related targets, the chemical compound-target-pathway network was analyzed. Each component was molecularly docked with host cell target angiotensin converting enzyme II, SARS-CoV-2 targets Spike protein, RNA-dependent RNA polymerase, or 3CL hydrolase. Our results showed a higher affinity of the compound diosgenin and (+)-Syringaresinol-O-beta-D-glucoside binding to the three SARS-CoV-2 proteins compared to the other compounds tested. Thus, our data suggest that potential compounds in Rhizoma Polygonati may act on different targets with viral and cancer related signaling and have a great potential in treatment of COVID-19.

Emotional "inflection point" in public health emergencies with the 2019 new coronavirus pneumonia (NCP) in China.

BACKGROUND: The outbreak of the new coronavirus pneumonia (NCP) in Wuhan, Hubei, has caused very serious consequences and severely affected people's lives and mental health. The outbreak will cause bad emotions such as tension, anxiety, fear, and so on. College students who have returned home from school face infection, isolation, and delay in starting school, and thus, their emotional stress should be observed. METHODS: This study used self-designed questionnaires and artificial intelligence (AI) to assess and analyze the emotional state of over 30,000 college students during the outbreak period in January (T1) and home quarantine in February (T2). This survey used online questionnaire (www.wjx.cn) to investigate the emotion information of college students. RESULTS: In the T1 survey, the "Typhoon Eye Effect" appeared. College students in Hubei are calmer than those outside Hubei in T1. However, in T2, an emotional "infection point" appeared, there was an "Exposure Effect", the negative emotions of students in Hubei largely increased and became higher than students outside Hubei. CONCLUSION: This survey found that there is an emotional "infection point" in February among college students, especially in the Hubei area. College students in Hubei are calmer than those outside Hubei in T1. In contrast, college students in Hubei were more nervous and scared than those outside Hubei in T2. This epidemic has caused the students to experience significant pressure and negative emotions. Therefore, universities and society should pay attention to their emotional adjustment, there are some suggestions such as establish the mental health organizations, test students' emotion status regularly.

Case analysis of novel coronavirus pneumonia in the Second Hospital of Wuhan Iron and Steel Company, Qingshan District, Wuhan, China.

BACKGROUND: To analyze the clinical and infectious characteristics of new coronavirus pneumonia with diagnosed and suspected cases in the Second Hospital of WISCO(Wuhan Iron and Steel Company) of Qingshan District, Wuhan City, and further enhance the understanding of new coronavirus pneumonia. METHODS: According to the fifth and sixth editions of the new coronavirus pneumonia diagnosis and treatment plan issued by the National Health Commission of the People's Republic of China and National Administration of Traditional Chinese Medicine, we carried out the case analysis and infectious disease investigation and research on the confirmed and suspected cases of new coronavirus pneumonia admitted to the second-floor ward of the hospital from January 28th, 2020, to February 26th, 2020. RESULTS: From January 28th, 2020 to February 26th, 2020, 83 patients were admitted, 40 were cured, and 7 died. Before February 13th, 69 patients were admitted, including 22 confirmed patients and 47 suspected patients. After February 13th, the data of newly hospitalized suspected patients decreased to 2 people. The average time from onset to diagnosis was 5.38 days. About 57.1% of the confirmed patients were isolated at home before admission, and 53.2% of the suspected patients were isolated by hospital observation before admission. The proportion of fever and other clinical symptoms was 81.8%, 65.5% of the patients had the fastest heart rate of 90-120 rpm, and 11 of the patients had severe/critical illness, accounting for 20%. The count of leukocytes, neutrophils, and C-reactive proteins (CRPs) in severe patients was higher than those in light patients (P<0.05), and the count of lymphocytes was lower than that in mild patients (P=0.016). CONCLUSIONS: The novel coronavirus pneumonia in Qingshan District of Wuhan in February was diagnosed promptly, controlled,and treated effectively. The combination of traditional Chinese and western medicine in the treatment of new coronavirus pneumonia might help patients.

Systematic review of the registered clinical trials for coronavirus disease 2019 (COVID-19).

BACKGROUND: Since the outbreak of coronavirus disease 2019 (COVID-19), many researchers in China have performed related clinical research. However, systematic reviews of the registered clinical trials are still lacking. Therefore, we conducted a systematic review of clinical trials for COVID-19 to summarize their characteristics. METHODS: This study is based on the PRISMA recommendations in the Cochrane handbook. The Chinese Clinical Registration Center and the ClinicalTrials.gov databases were searched to identify registered clinical trials related to COVID-19. The retrieval inception date was February 9, 2020. Two researchers independently selected the literature based on the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias. RESULTS: A total of 75 registered clinical trials (63 interventional studies and 12 observational studies) for COVID-19 were identified. The majority of clinical trials were sponsored by Chinese hospitals. Only 11 trials have begun to recruit patients, and none of the registered clinical trials have been completed; 34 trials were early clinical exploratory trials or in the pre-experiment stage, 13 trials were phase III, and four trials were phase IV. The intervention methods included traditional Chinese medicine in 26 trials, Western medicine in 30 trials, and integrated traditional Chinese medicine and Western medicine in 19 trials. The subjects were primarily non-critical adult patients (≥ 18 years old). The median sample size of the trials was 100 (IQR: 60-200), and the median length of the trial periods was 179 d (IQR: 94-366 d). The main outcomes were clinical observation and examinations. Overall, the methodological quality of both the interventional trials and observational studies was low. CONCLUSIONS: Intensive clinical trials on the treatment of COVID-19 using traditional Chinese medicine and Western medicine are ongoing or will be performed in China. However, based on the uncertain methodological quality, small sample size, and long trial duration, we will not be able to obtain reliable, high-quality clinical evidence regarding the treatment of COVID-19 in the near future. Improving the quality of study design, prioritizing promising drugs, and using different designs and statistical methods are worth advocating and recommending for clinical trials of COVID-19 in the future.

A retrospective analysis of the epidemiology, clinical manifestations, and imaging characteristics of familial cluster-onset COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) virus has a high incidence rate and strong infectivity. The diagnosis and evaluation of familial outbreaks requires a collective consideration of epidemiological history, molecular detection methods, chest computed tomography (CT), and clinical symptoms. METHODS: A group of family patients with COVID-19 diagnosed in Guizhou, China, in February 2020, was retrospectively analyzed. As of March 1, all patients in the group have been discharged from hospital. This study tracked all patients in the group. We report the epidemiology, radiological characteristics, treatment, and clinical outcomes of these patients. RESULTS: We collected a group of 8 clustered cases (3 men and 5 women) from a family with confirmed COVID-19 infection. In the first admission diagnosis, according to the degree of clinical symptoms, the 8 patients were defined as mild type (4/8) or moderate type (4/8). They were also divided according to the CT findings into early period (1/8), progressive period (3/8), and negative on CT scan (4/8); for the first 4 patients, the corresponding CT image scores were 1, 4, 5, and 5 respectively. In this group of COVID-19 patients, half of the patients showed occult clinical manifestations and negative CT performance. We defined these patients as COVID-19-infected patients, or asymptomatic carriers. CONCLUSIONS: The family cluster analysis indicated that COVID-19-infected patients (asymptomatic carriers) and symptomatic COVID-19 patients are distinct but coexistent. This may indicate that the infectivity and virulence of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has decreased. In order to block the transmission pathway of this virus before it spreads, we need to identify the presence of asymptomatic carriers as early as possible.

Standardize the management procedures for breast cancer patients during the outbreak of COVID-19 in Wuhan, China.

PURPOSE: The outbreak of the coronavirus disease 2019 (COVID-19) has led to interruption or delay in treatment of breast cancer patient. This commentary aims to standardize the management procedures and ensure complete or relatively complete treatment for breast cancer patients during the outbreak of COVID-19. METHODS: Provide detailed online diagnosis, online treatment recommendations, and face-to-face consultation suggestions. RESULTS: Breast cancer patients who are at high risk of COVID-19 are advised to consult online first. For patients who have undergone online consultation and need face-to-face consultation, try to go to the clinic alone and take necessary precautions. Medical staff should be provided with necessary training about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and knowledge of standard precautions and personal protective equipment. CONCLUSIONS: This commentary focused on breast cancer patients and provided suggestions to avoid the spread of COVID-19. Some of these suggestions are also suitable for cancer patients in other lesions. We hope our suggestions are useful to oncologists in other countries and help them to overcome this challenge.

The first case of COVID-19 occurring as community-acquired pneumonia in Hokkaido, Japan and our preventive measures against nosocomial infection.

We report a case of a 59-year-old man with coronavirus disease 2019 (COVID-19). He had visited a hospital for fever and cough and been treated with antibiotics for pneumonia in the right upper lobe. However, he gradually progressed to dyspnea and consulted our hospital. His chest radiographs showed bilateral pneumonia shadows and his CT showed ground glass opacities and consolidation. Although we treated him with broad-spectrum antibiotics, the pneumonia shadow rapidly progressed and mechanical ventilation was administered. We collected sputum from the bronchus using bronchoscopy to detect microorganisms, and RT-PCR tests confirmed COVID-19 pneumonia. He was transferred to a designated hospital. In order to prevent the occurrence of nosocomial infections, close contacts within the hospital and medical staff were suspended from their work for two weeks. No secondary infection with COVID-19 appeared. This was the first case of COVID-19 occurring as community-acquired pneumonia in Hokkaido, Japan.

Clinical trial analysis of 2019-nCoV therapy registered in China.

So far, there is a lack of effective drugs for the new coronavirus pneumonia. With more and more patients diagnosed, China has carried out more than 100 clinical studies of new coronavirus infection, including antiviral drugs, antimalarial drugs, glucocorticoids, plasma therapy, virus vaccine, and other Western drugs, while Chinese medicine research accounted for half of the studies. Most of the trials were initiated by investigators and the study period would last for 1 to 11 months. The primary endpoints included symptom improvement and virus nucleic acid turning negative, but the optimal endpoint has not been determined. Although the final results of studies will take a long time to complete, the interim research data may provide some help for the current urgent demand for drug treatment. Compared with that of during SARS period in 2003, China has the stronger capability to carry out clinical trials of new drugs in emergency period.

Management strategies of neonatal jaundice during the coronavirus disease 2019 outbreak.

The outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV) has become a most challenging health emergency. Owing to rigorous quarantine and control measures taken in China, routine neonatal health surveillance and follow-up have become challenging. Without follow-up surveillance, some rapid and progressive newborn diseases, such as bilirubin encephalopathy, may be ignored. The characteristics of onset age of kernicterus suggest that monitoring of bilirubin level at home provides a useful way to alert hospital visits and to prevent the development of extremely hyperbilirubinemia. Therefore, we developed an online follow-up program for convenient monitoring of bilirubin level of newborns that is based on our practical experiences. The aim is to make our management strategies of neonatal jaundice tailored to the infection prevention and control during the COVID-19 epidemic.

Psychological crisis intervention during the outbreak period of new coronavirus pneumonia from experience in Shanghai.

Since the middle of December 2019, human-to-human transmission of novel coronavirus pneumonia (NCP) has occurred among close contacts. At the same time, greater attention should be paid to psychological crisis intervention (PCI) among affected populations, for the timely prevention of inestimable damage from a secondary psychological crisis. PCI has been initiated via remote (telephone and internet) and onsite medical services to help medical workers, patients, and others affected to overcome any psychological difficulties. This paper outlines experiences based on the work of the Shanghai Medical Team.

Analysis of clinical characteristics of new coronavirus pneumonia patients in secondary epidemic areas / 中华危重病急救医学

Objective@#Understand the clinical characteristics of confirmed pneumonia patients infected with new corona virus in secondary epidemic areas and guide the diagnosis and treatment of novel pneumonia in secondary epidemic areas and provide a reference for clinical prevention and control of the epidemic situation.@*Methods@#The clinical data of 33 patients admitted with pneumonia caused by a novel coronavirus in the Second Affiliated Hospital of Wenzhou Medical University from January 15 to February 1, 2020, were retrospectively reviewed. At the onset of the disease, we analyzed the primary symptoms such as fever, cough, fatigue, chest tightness, chest pain and also a significant blood test results of the patients. According to the patient's contact history, it was divided into the direct infection group of the main epidemic area and the indirect contact infection group of the main epidemic areas. The difference between clinical manifestations among the two groups was analyzed.@*Results@#The main clinical symptoms of patients with novel coronavirus pneumonia in the secondary epidemic area were respiratory tract and systemic symptoms. After grouping according to the presence and absence of direct contact in the main epidemic area, there was no significant difference in baseline data between the two groups, and there was no significant difference in symptoms and signs between the two groups (P < 0.05). Some patients had serum amyloid protein (SAP) increased abnormall.@*Conclusions@#The respiratory tract and systemic symptoms are the primary symptoms of the patients with the new type of coronavirus pneumonia in the secondary epidemic area, which are not typical. The abnormal increase of serum amyloid protein (SAA) may be used as an auxiliary index for diagnosis and treatment.

[Pharmacotherapeutics for the New Coronavirus Pneumonia].

The New Coronavirus Pneumonia (NCP, also named as COVID-19 by WHO on Feb 11 2020, is now causing a severe public health emergency in China since. The number of diagnosed cases is more than 40,000 until the submission of this manuscript. Coronavirus has caused several epidemic situations world widely, but the present contagious disease caused by 2019 new Coronavirus is unprecedentedly fulminating. The published cohorts of 2019 new Coronavirus (n-Cov) are single-center studies, or retrospective studies. We here share the therapeutic experiences of NCP treatment with literature review. Combination of Ribavirin and Interferon-α is recommended by the 5(th) edition National Health Commission's Regimen (Revised Edition) because of the effect on MERS (Middle East Respiratory Syndrome), and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial (RCT), given the situation of no specific antivirus drug on NCP is unavailable. Systemic glucocorticosteroid is recommended as a short term use (1~2 mg.kg(-1).d(-1), 3~5d ) by the 5(th) edition National Health Commission's Regimen (Revised Edition) yet RCTs are expected to confirm the effectiveness. Inappropriate application of antibiotics should be avoided, especially the combination of broad-spectrum antibiotics, for the NCP is not often complicated with bacterial infection.