Gut microbiota: A new insight into lung diseases.

The human gut microbiota is a complex ecosystem involved in the metabolism, immunity, and health of the host. The microbiome plays a key role in the development of the host's innate and adaptive immune system, while the immune system orchestrates the maintenance of host-microbe symbiosis. Lung diseases are usually accompanied by dysbiosis of the intestinal flora and an immune-inflammatory response. The intestinal flora and its metabolites are directly or indirectly involved in the immune regulation of the host in lung disease. However, the exact mechanism of action of the gut-lung axis crosstalk remains unclear. This review is aimed to summarize the latest advances in gut microbiota and their metabolites in typical lung diseases, such as pulmonary hypertension, COPD, and lung cancer. Especially COVID-19, a problem troubling the world, is also discussed in it. Moreover, it is concentrated on the action mechanisms between the identified gut microbiota or their metabolites and the specific lung diseases, and on the link among the gut microbiota, its metabolites, and immune regulation, which could be used as a breakthrough to find new mechanisms and targets for some diseases without specific therapeutic drugs in clinic. It is also discussed a new therapeutic tool "drug-bacterial interaction" and the potential of therapeutic applications in clinic. This review would provide a clear direction for future research on gut microbiota and lung diseases, and propose a new therapeutic strategy targeting "drug-bacterial interaction" in clinic.

Comparison of initial clinic characteristics of hospitalized patients in Suzhou City during the COVID-19 Omicron wave with ancestral variant wave.

BACKGROUND: Recently, the SARS-CoV-2 variant of concern, Omicron (B.1.1.529), was identified as responsible for a novel wave of COVID-19 worldwide. Here, we compared initial clinical features of hospitalized COVID-19 patients during recent wave (Omicron Variant) with those in ancestral variant wave (2020). METHODS: This is a cohort study of electronic health record (EHR) data from a signal center in the China. The clinical data of 116 cases of Omicron hospitalized in 2022 and 87 cases hospitalized in 2020 were collected. The comparisons were performed with the Mann-Whitney U test, Fisher exact test or the chi-square test, and multivariable logistic regression analysis. RESULTS: Clinically, compared with 2020-cohort, Omicron-cohort was more inclined to cluster in younger population and had more nonsymptomatic (25.0%) and nonsevere cases, as well as suffered from comparable extrapulmonary complication. Radiologically, although the major computed tomography (CT) findings of both cohorts were ground-glass opacities (GGOs), crazy-paving pattern was relatively less seen in the Omicron-cohort. Based on multiple logistic regression analysis, Omicron-cohort was associated with a lower risk of complaining with fever, the presence of lung opacity, and increased Sequential Organ Failure Assessment (SOFA) score. CONCLUSION: This study provided the data of different patterns of clinic characteristics and reduced severity from infections that occurred in Omicron variant as compared with the outbreak of the epidemic in 2020 wave (ancestral variant).

The burden and trend of gastric cancer and possible risk factors in five Asian countries from 1990 to 2019.

The burdens and trends of gastric cancer are poorly understood, especially in high-prevalence countries. Based on the Global Burden of Disease Study 2019, we analyzed the incidence, death, and possible risk factors of gastric cancer in five Asian countries, in relation to year, age, sex, and sociodemographic index. The annual percentage change was calculated to estimate the trends in age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR). The highest ASIR per 100,000 person-years in 2019 was in Mongolia [44 (95% uncertainty interval (UI), 34 to 55)], while the lowest was in the Democratic People's Republic of Korea (DPRK) [23 (95% UI, 19 to 29)]. The highest ASDR per 100,000 person-years was in Mongolia [46 (95% UI, 37 to 57)], while the lowest was in Japan [14 (95% UI, 12 to 15)]. Despite the increase in the absolute number of cases and deaths from 1990 to 2019, the ASIRs and ASDRs in all five countries decreased with time and improved sociodemographic index but increased with age. Smoking and a high-sodium diet were two possible risk factors for gastric cancer. In 2019, the proportion of age-standardized disability-adjusted life-years attributable to smoking was highest in Japan [23% (95% UI, 19 to 28%)], and the proportions attributable to a high-sodium diet were highest in China [8.8% (95% UI, 0.21 to 33%)], DPRK, and the Republic of Korea. There are substantial variations in the incidence and death of gastric cancer in the five studied Asian countries. This study may be crucial in helping policymakers to make better decisions and allocate appropriate resources.

Case series of COVID-19 patients from the Qinghai-Tibetan Plateau Area in China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a serious infection caused by the new coronavirus severe acute respiratory syndrome coronavirus 2. The disease was first identified in December 2019 and has caused significant morbidity and mortality worldwide. AIM: To explore the clinical characteristics and treatments for COVID-19 in the Qinghai-Tibetan Plateau Area in China. METHODS: We retrospectively analyzed the blood cell counts (neutrophils and lymphocytes), blood gas analysis, and thoracic computed tomography changes of patients from Qinghai Province before, during, and after treatment (January 23, 2020 to February 21, 2020). In addition, we summarized and analyzed the information of critical patients. All data were analyzed using SPSS 17.0 (SPSS Inc., Chicago, IL, United States). The quantitative and count variables are represented as the mean ± SD and n (%), respectively. RESULTS: The main symptoms and signs of patients with COVID-19 were fever, dry cough, cough with phlegm, difficulty breathing, and respiratory distress with a respiration rate ≥ 30 times/min, finger oxygen saturation ≤ 93% in the resting state, and oxygenation index less than 200 but greater than 100 (after altitude correction). Eighteen patients with COVID-19, of whom three were critical, and the others were in a mild condition, were included. The main manifestations included fever, dry cough, and fatigue. Three patients developed difficulty breathing and had a fever. They were eventually cured and discharged. Adjuvant examinations showed one case with reduced white cell count (6%) (< 4 × 109/L), six with reduced count of lymphocytes (33%) (< 0.8 × 109/L), and one with abnormal blood glucose level. All 18 patients were discharged, and no death occurred. CONCLUSION: Our findings provide critical insight into assessing the clinical diagnosis and treatment for COVID-19 in the Tibetan plateau area.

Microbial and metabolomic analysis of gingival crevicular fluid in general chronic periodontitis patients: lessons for a predictive, preventive, and personalized medical approach.

OBJECTIVES: General chronic periodontitis (GCP) is a bacterial inflammatory disease with complex pathology. Despite extensive studies published on the variation in the oral microbiota and metabolic profiles of GCP patients, information is lacking regarding the correlation between host-bacterial interactions and biochemical metabolism. This study aimed to analyze the oral microbiome, the oral metabolome, and the link between them and to identify potential molecules as useful biomarkers for predictive, preventive, and personalized medicine (PPPM) in GCP. METHODS: In this study, gingival crevicular fluid (GCF) samples were collected from patients with GCP (n = 30) and healthy controls (n = 28). The abundance of oral microbiota constituents was obtained by Illumina sequencing, and the relative level of metabolites was measured by gas chromatography-mass spectrometry. Full-mouth probing depth, clinical attachment loss, and bleeding on probing were recorded as indices of periodontal disease. RESULTS: The relative abundances of 7 phyla and 82 genera differed significantly between the GCP and healthy groups. Seventeen differential metabolites involved in different metabolism pathways were selected based on variable influence on projection values (VIP > 1) and P values (P < 0.05). Through Spearman's correlation analysis, microorganisms, metabolites in GCF, and clinical data together showed a clear trend, and clinical data regarding periodontitis can be reflected in the shift of the oral microbial community and the change in metabolites in GCF. A combination of citramalic acid and N-carbamylglutamate yielded satisfactory accuracy (AUC = 0.876) for the predictive diagnosis of GCP. CONCLUSIONS: Dysbiosis in the polymicrobial community structure and changes in metabolism could be mechanisms underlying periodontitis. The differential microorganisms and metabolites in GCF between periodontitis patients and healthy individuals are possibly biomarkers, pointing to a potential strategy for the prediction, diagnosis, prognosis, and management of personalized periodontal therapy.

Comparison of Hospitalized Patients with Severe Pneumonia Caused by COVID-19 and Highly Pathogenic Avian Influenza (H7N9): A Retrospective Study from A Designated Hospital (preprint)

Background: Considerable attention has been focused on clinical features of Coronavirus Disease 2019 (COVID-19), it is also important for clinicians to differentiate it from influenza virus infections.Methods: The clinical data of 23 cases of H7N9 and 23 cases of COVID-19 with severe pneumonia were collected. The comparisons were performed with the t test, Mann-Whitney U test, Fisher exact test or the chi-squared test, and multivariable logistic regression analysis.Results: All of the cases were under the circumstance of sufficient medical staff and medical supplies. Radiologically, severe COVID-19 patients had less consolidation and pleural effusion, but more crazy-paving pattern than severe H7N9 patients (p<0.05). Clinically, compared to severe H7N9, severe COVID-19 patients were more inclined to surfer to relative better disease severity score, less secondary bacterial infection, a shorter time to beginning absorption on CT, but a longer duration of viral shedding from the admission (p<0.05). Although more severe H7N9 patients needed non-invasive respiratory support, these two groups ultimately yielded comparable mortality. Based on multiple logistic regression analysis, severe COVID-19 infection was associated with a lower risk of the presence of severe ARDS (OR 0.964, 95% [CI] 0.931-0.998, p=0.040), but exhibited longer duration of viral shedding (OR 0.734, 95% [CI] 0.550-0.980, p=0.036) than severe H7N9 infection.Conclusion: Although the conditions of severe H7N9 patients seemed to be more critical than those of severe COVID-19 patients, the relatively lower mortality of these two severe cases is to be expected in context of sufficient medical supplies.

Clinical characteristics and laboratory indicator analysis of 67 COVID-19 pneumonia patients in Suzhou, China.

BACKGROUND: Sudden exacerbations and respiratory failure are major causes of death in patients with severe coronavirus disease 2019(COVID-19) pneumonia, but indicators for the prediction and treatment of severe patients are still lacking. METHODS: A retrospective analysis of 67 collected cases was conducted and included approximately 67 patients with COVID-19 pneumonia who were admitted to the Suzhou Fifth People's Hospital from January 1, 2020 to February 8, 2020. The epidemiological, clinical and imaging characteristics as well as laboratory data of the 67 patients were analyzed. RESULTS: The study found that fibrinogen (FIB) was increased in 45 (65.2%) patients, and when FIB reached a critical value of 4.805 g/L, the sensitivity and specificity、DA, helping to distinguish general and severe cases, were 100 and 14%、92.9%, respectively, which were significantly better than those for lymphocyte count and myoglobin. Chest CT images indicated that the cumulative number of lung lobes with lesions in severe patients was significantly higher than that in general patients (P < 0.05), and the cumulative number of lung lobes with lesions was negatively correlated with lymphocyte count and positively correlated with myoglobin and FIB. Our study also found that there was no obvious effect of hormone therapy in patients with severe COVID-19. CONCLUSIONS: Based on the retrospective analysis, FIB was found to be increased in severe patients and was better than lymphocyte count and myoglobin in distinguishing general and severe patients. The study also suggested that hormone treatment has no significant effect on COVID-19.

Clinical characteristics and laboratory indicator analysis of 67 COVID-19 pneumonia patients in Suzhou, China (preprint)

Background: Sudden exacerbations and respiratory failure are major causes of death in patients with severe coronavirus disease 2019(COVID-19) pneumonia, but indicators for the prediction and treatment of severe patients are still lacking.MethodsA retrospective analysis of 67 collected cases was conducted and included approximately 67 patients with COVID-19 pneumonia who were admitted to the Suzhou Fifth People’s Hospital from January 1, 2020 to February 8, 2020. The epidemiological, clinical and imaging characteristics as well as laboratory data of the 67 patients were analyzed.ResultsThe study found that fibrinogen(FIB) was increased in 45 (65.2%) patients, and when FIB reached a critical value of 4.805 g/L, the sensitivity and specificity、DA, helping to distinguish general and severe cases, were 100% and 14%、92.9%, respectively, which were significantly better than those for lymphocyte count and myoglobin. Chest CT images indicated that the cumulative number of lung lobes with lesions in severe patients was significantly higher than that in general patients (P<0.05), and the cumulative number of lung lobes with lesions was negatively correlated with lymphocyte count and positively correlated with myoglobin and FIB. Our study also found that there was no obvious effect of hormone therapy in patients with severe COVID-19.ConclusionsBased on the retrospective analysis, FIB was found to be increased in severe patients and was better than lymphocyte count and myoglobin in distinguishing general and severe patients. The study also suggested that hormone treatment has no significant effect on COVID-19.

Clinical evaluation of potential usefulness of serum lactate dehydrogenase (LDH) in 2019 novel coronavirus (COVID-19) pneumonia.

BACKGROUND: There was much evidence suggesting that the serum lactate dehydrogenase (LDH) levels reflect the extent of various pathophysiological processes. However, the current information about dynamic change of LDH in COVID-19 pneumonia has not been well investigated. METHODS: Study was performed in 87 cases confirmed by COVID-19 infection. The serum LDH levels were determined at diagnosis and follow-up visits. The evaluation of clinical response to therapy was based on chest CT scan. We selected the value of LDH around the data of chest CT scan (- 1 ~ + 1 day). RESULTS: At diagnosis, significant differences in LDH levels were found between non-severe and severe group (P < 0.05). It was demonstrated that increase or decrease of LDH was indicative of radiographic progress or improvement (P < 0.05). The time to LDH normalization (5.67 ± 0.55, days) was positively correlated with the time to radiographic absorption (5.57 ± 0.65 days, r = 0.53, P < 0.05). Applying the cut-off value of the increase in LDH has good specificity to predict disease progression. CONCLUSIONS: Serum LDH was validated for its potential usefulness as markers for evaluating clinical severity and monitoring treatment response in COVID-19 pneumonia.

Can corticosteroids improve the outcomes of patients with Covid-19? A retrospective cohort study of patients within and outside the epicentre (preprint)

Background The novel coronavirus disease 2019 (Covid-19) has been a worldwide pandemic with more than 300,000 deaths. Corticosteroids have been used in some patients with severe Covid-19 in order to control the systemic inflammation or cytokine storm, however, their effects and safety have not yet been elucidated.Methods Patients with confirmed Covid-19 were retrospectively included from both the epicentre and out of the epicentre. Patients were classified into two groups according to the use of systemic corticosteroids, and the mortality and the rate of virus clearance were compared between the two groups. In addition, independent factors associated with death after corticosteroids treatment were also identified.Results A total of 775 patients were included in our final analysis, of which 238 (30.7%) patients received systemic corticosteroids treatment. Compared with patients without corticosteroids treatment, patients with corticosteroids treatment had significantly higher mortality (19.3% vs. 3.7%, P < 0.001) and lower rate of virus clearance (43.2% vs. 66.7%, P < 0.001) although along with increase of SpO2/FiO2 and blood lymphocytes in patients with severe Covid-19. Corticosteroids treatment was associated with longer hospital length of stays and delayed virus clearance time. In patients with corticosteroids treatment, blood lymphocytes (odds ratio (OR) 0.792, 95% confidence interval (CI) 0.672–0.932, P = 0.005) and creatine kinase (CK) (OR 1.006, 95%CI 1.000-1.012, P = 0.038) were independent risk factors associated with death, with a sensitivity of 90.91% and 44.44% and a specificity of 70.75% and 94.05%, respectively.Conclusions In patients with Covid-19, corticosteroids treatment is associated with increased mortality and reduced rate of virus clearance.

Comparison of Hospitalized Patients with Severe Pneumonia Caused by COVID-19 and Highly Pathogenic Avian Influenza (H7N9): A Retrospective Study from A Designated Hospital (preprint)

Background Considerable attention has been focused on clinical features of Coronavirus Disease 2019 (COVID-19), it is also important for clinicians to differentiate it from influenza virus infections.Methods The clinical data of 23 cases of H7N9 and 23 cases of COVID-19 with severe pneumonia were collected. The comparisons were performed with the t test, Mann-Whitney U test, Fisher exact test or the chi-squared test, and multivariable logistic regression analysis.Results All of the cases were under the circumstance of sufficient medical staff and medical supplies. The rate of coexisting disease was lower in the severe COVID-19 group than in the severe H7N9 group (p < 0.05). Radiologically, severe COVID-19 patients had less consolidation and pleural effusion, but more crazy-paving pattern than severe H7N9 patients (p < 0.05). Clinically, compared to severe H7N9, severe COVID-19 patients were more inclined to surfer to relative better disease severity score, less secondary bacterial infection, a shorter time to beginning absorption on CT, but a longer duration of viral shedding from the admission (p < 0.05). Although more severe H7N9 patients needed non-invasive respiratory support, these two groups ultimately yielded comparable mortality. Based on multiple logistic regression analysis, severe COVID-19 infection was associated with a lower risk of the presence of severe ARDS (OR 0.964, 95% [CI] 0.931–0.998, p = 0.040), but exhibited longer duration of viral shedding (OR 0.734, 95% [CI] 0.550–0.980, p = 0.036) than severe H7N9 infection.Conclusion Although the conditions of severe H7N9 patients seemed to be more critical than those of severe COVID-19 patients, the relatively lower mortality of these two severe cases is to be expected in context of sufficient medical supplies.

Clinical characteristics and laboratory indicator analysis of 69 COVID-19 pneumonia patients in Suzhou, China (preprint)

Background Sudden exacerbations and respiratory failure are major causes for the death of severe COVID-19 pneumonia patient and but now the detection and treatment of severe patients is still lack. Methods A retrospective analysis is conducted on 69 collected cases, which are about 69 patients with COVID-19 pneumonia who were admitted to the Suzhou Fifth People’s Hospital from January 1, 2020 to February 8, 2020. Their epidemiological, clinical and imaging characteristics as well as laboratory data of the 69 patients were analyzed. Results The study found fibrinogen increased in 45 (65.2%) patients and when the fibrinogen takes a critical value of 4.805 g/L, the sensitivity and specificity, helping distinguish general and severe classification, are 100% and 14%, respectively, which are significantly better than lymphocyte and myoglobin. Chest CT images indicate that the cumulative number of lung lobes in severe patients were significantly higher than that in general patients (P＜0.05) and the cumulative number of lung lobes in the lesions was negatively correlated with lymphocyte, and positively correlated with myoglobin and fibrinogen. Our study also found that there is no obvious effect of hormone therapy in severe patients with COVID-19. Conclusions Based on the retrospective analysis, the fibrinogen were found increased in severe patients and were better than lymphocyte and myoglobin in respect of distinguishing general and severe patients. And the study also suggested hormone treatment has no significant effect on COVID-19.

A Social Network Model of the COVID-19 Pandemic (preprint)

In the COVID-19 coronavirus pandemic, currently vaccines and specific anti-viral treatment are not yet available. Thus, preventing viral transmission by case isolation, quarantine, and social distancing is essential to slowing its spread. Here we model social networks using weighted graphs, where vertices represent individuals and edges represent contact. As public health measures are implemented, connectivity in the graph decreases, resulting in lower effective reproductive numbers, and reduced viral transmission. For COVID-19, model parameters were derived from the coronavirus epidemic in China, validated by epidemic data in Italy, then applied to the United States. We calculate that, in the U.S., the public is able to contain viral transmission by limiting the average number of contacts per person to less than 7 unique individuals over each 5 day period. This increases the average social distance between individuals to 10 degrees of separation.