Résumé
Mental stress has been recognized as an essential risk factor for hypertension. Therefore, experts specializing in cardiology, psychiatry, and Traditional Chinese Medicine organized by the Psycho-cardiology Group, College of Cardiovascular Physicians of Chinese Medical Doctor Association, and Hypertension Group of the Chinese Society of Cardiology proposed the expert consensus on the diagnosis and treatment of adult mental stress-induced hypertension in March 2021, which includes the epidemiology, etiology, diagnosis, and treatment of the mental stress-induced hypertension. This consensus will hopefully facilitate the clinical practice of this disorder. In addition, the COVID-19 pandemic has become one of the primary global sources of psychosocial stressors since the beginning of 2020, and the revision of this expert consensus in 2022 has increased the relevant content. This consensus consists of two parts. The sections of Part A include (I) Background and epidemiological characteristics, (II) Pathogenesis, and (III) Diagnosis. The sections of Part B contain (IV) Treatment recommendations, and (V) Prospects. This article presents Part B of the consensus. © 2022 Heart and Mind ;Published by Wolters Kluwer - Medknow.
Résumé
Mental stress has been recognized as an essential risk factor for hypertension. Therefore, experts specializing in cardiology, psychiatry, and Traditional Chinese Medicine organized by the Psycho-Cardiology Group of College of Cardiovascular Physicians of Chinese Medical Doctor Association and Hypertension Group of Chinese Society of Cardiology proposed the expert consensus on the diagnosis and treatment of adult mental stress-induced hypertension in March 2021, which includes the epidemiology, etiology, diagnosis, and treatment of the mental stress-induced hypertension. This consensus will hopefully facilitate the clinical practice of this disorder. In addition, the COVID-19 pandemic has become one of the primary global sources of psychosocial stressors since the beginning of 2020, and the revision of this expert consensus in 2022 has increased the relevant content. This consensus consists of Part A and Part B. Part A includes (I) Background and epidemiological characteristics, (II) Pathogenesis, and (III) Diagnosis and Part B includes (IV) Treatment recommendations and (V) Prospects. This part presents the content of Part A. © 2022 Heart and Mind ;Published by Wolters Kluwer - Medknow.
Résumé
SARS-CoV-2, the pathogen of the COVID-19 pandemic, causes serious damage to human health and social stability.In severe COVID-19 cases, the infection triggers cytokine storm, resulting in multi-organ excessive inflammatory responses and even failure, which eventually leads to death.Recent studies have shown the activation of nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 (NLRP3) inflammasome plays an essential role in the pathogenesis of COVID-19.SARS-CoV-2 can activate NLRP3 inflammasome through several pathways, thereby inducing the release of a large number of pro-inflammatory cytokines.This article reviews the activation of NLRP3 inflammasome caused by SARS-CoV-2 infection and the possible molecular mechanisms, and summarizes the progress in targeted inhibition of NLRP3 inflammation aiming to provide a new strategy for the treatment of SARS-CoV-2 infection.
Résumé
Objective: To investigate the management strategies for lung transplant patients in Wuhan areas during the COVID-19 epidemic period (from January 1, 2020 to April 8, 2020). Methods: During the epidemic period in Renmin Hospital of Wuhan University, three potential lung transplant patients on the waiting list were suspended for operation, one who underwent lung transplantation was carefully quarantined and the surrounding environment was disinfected, nine patients after lung transplantation received epidemic prevention instructions and were followed up through phone call or online communication. The clinical and follow-up data of these patients were collected and analyzed. Results: The patient with lung transplantation performed in the early stage of the epidemic was survived and didn't infected with SARS-CoV-2. Of the postoperative cases, only one was infected with SARS-CoV-2 which eventually caused death during the epidemic. Conclusion: During the COVID-19 epidemic, effective management strategies adopted in affected areas could reduce the incidence of SARS-CoV-2 infection in lung transplant patients. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
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Objective: To explore the risk factors and control methods of surgical operation during the outbreak of coronavirus disease 2019 (COVID-19), and to summarize the experience of prevention and treatment methods of COVID-19 under surgical conditions from a single center during the epidemic. Methods: The clinical data of 17 patients diagnosed as COVID-19 postoperatively in Renmin Hospital of Wuhan University from January 3 to January 22, 2020 were collected and analyzed. The diseases were classified according to the Chinese Diagnosis and Treatment of Novel Coronavirus Infected Pneumonia (5th trial edition). The mild and moderate type patients were incorporated into the non-severe group, while the severe and critical ones were categerized into the severe group. Then we compared the general information, clinical symptoms, laboratory test results, and outcomes between the two groups. Results: The clinical data of 3 339 patients underwent surgical operation were reviewed, and 17 patients were diagnosed as COVID-19 after operation, with a 0.51% incidence rate. Among them, 7 cases (41.2%) were severe, and 2 cases (11.8%) died of respiratory failure. The clinical manifestations were mainly fever (76.47%) and cough (58.82%). Laboratory examination results showed that in most patients, the leukocyte count was normal (70.59%), lymphocyte count was lower (88.24%), and C-reactive protein level was higher (88.24%). Immune function tests showed that cellular immune function was significantly impaired in some patients. Among them, 62.5%, 62.5% and 75% of the patients had decreased CD3 count, CD4 count and CD8 count. The percentage of severe COVID-19 cases in open surgery patients was significantly higher than that in minimally invasive surgery ones (71.43% vs 20%, P=0.034). Conclusion: The proportion of severe cases and mortality in COVID-19 patients undergone surgery are higher than those who haven't;and the severity rate of them receiving open surgery is higher than those performed minimally invasive surgery. During the epidemic, elective or confine surgery should be postponed and the indications for emergency surgery should be strictly accorded with;If an emergency surgery is inevitable, minimally invasive surgery should be selected as a priority. Postoperative screening of COVID-19 should be strengthened, while early, detection, early reporting, early isolation and early treatment should be applied to the infected patients. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
Résumé
Objective: To investigate the clinical characteristics in relation to the immune classification in patients with Coronavirus Disease 2019 (COVID-19). Methods: We retrospectively studied the clinical data, cellular and humoral immune function tests results of 101 cases of COVID-19 confirmed by our hospital. The patients were classified according to the Chinese guideline for COVID-19 diagnosis and treatment and divided into two groups as non-severe group and severe group, and the results of cellular and humoral immune function tests were compared. Results: The patients in the severe group were older on average, and the proportion of patients with underlying disease was higher. The counts of CD3, CD4, CD8, CD19, and CD16+CD56 T cells were significantly less in the severe group than in the non-severe group (P0.05). Levels of IgG, IgM, IgA, IgE, complement C3, and complement C4 were determined by mmunoassay, and no difference was found between the two groups. The diagnostic value of the cellular immune cells counts was analyzed by ROC curve. The area under the curve (AUC) of CD3, CD4, CD8, CD19, and CD16+CD56 T cells was 0.987 3, 0.969 3, 0.965 8, 0.817 4, and 0.658 7, respectively (P0.05), and the cut-off values for CD3, CD4, CD8, CD19, and CD16+CD56 T cells were 575.5, 390.0, 214.5, 111.0, and 127.5 cells/μL. Conclusion: Elderly COVID-19 patients with basic diseases are more likely to develop into severe patients. The depletion of each immune cells are more obvious in severe patients. Cellular immune function is helpful to determine the condition of COVID-19 pneumonia patients. © 2020, Editorial Board of Medical Journal of Wuhan University. All right reserved.