The clinical warning index of severe COVID-19: discussion based on the clinical features and outcomes of 4 patients.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is spreading worldwide. The onset of severe COVID-19 could lead to multiple organ damage and even death. It is worth paying attention to the warning index of the onset for severe COVID-19 so that patients can be identified and monitored carefully. PATIENTS AND METHODS: The report is a retrospective study that describes and analyzes the clinical features during the treatment of COVID-19. Four patients with COVID-19 were involved in this study, who were father-and-son pairs from two families. All patients were treated with the same combination of anti-microbial and anti-viral agents for 10-14 days, adjusting for the disease status. The primary outcome measure was SARS-CoV-2 detection using RT-qPCR with oropharyngeal swabs. Chest CT imaging served as a secondary outcome measure. RESULTS: One of the four patients progressed to severe disease, while the remaining patients recovered with the same treatment. A persistent decrease in the lymphocyte ratio and increase in the C-reactive protein (CRP) level were observed in the severe patient, along with other typical symptoms of COVID-19. CONCLUSIONS: The cases we described indicate that blood cell and CRP tests could be useful risk warnings of severe onset of COVID-19.

Anesthetic effect and safety of sevoflurane combined with propofol in removing tracheobronchial foreign bodies in children.

OBJECTIVE: To systematically evaluate the anesthetic effect and safety of sevoflurane combined with propofol in removing tracheal foreign bodies in children. MATERIALS AND METHODS: PubMed, EMbase, The Cochrane Library, China Biomedicine Database, China National Knowledge Internet, WanFang Data, and VIP databases were searched. Randomized controlled trials (RCTs) of sevoflurane combined with propofol for anesthesia during tracheal foreign body extraction in children were collected. The retrieval time was from the establishment of the database to April 10, 2019. RevMan 5.3 software was used for meta-analysis after two researchers independently screened the literature, extracted data, and evaluated the risk bias included in the study. RESULTS: Seven RCTs involving 473 patients were included. Meta-analysis showed that the time of loss of consciousness significantly reduced (MD=-38.27, 95% CI (-41.77, -34.77), p < 0.00001) and the recovery time significantly reduced (MD=-12.29, 95% CI (-2.77, -1.80), p < 0.00001) in the sevoflurane combined with propofol group compared with the control group. In terms of safety, the heart rate was slower [MD=-11.00, 95% CI (-21.64, -0.36), p=0.04 < 0.05] and the incidence of cough and breath holding was lower [MD=0.38, 95% CI (0.19, 0.78), p=0.008] in the sevoflurane combined with propofol group than in the control group. However, no significant difference in respiratory rate and SPO 2 < 90% was found between the two groups (p > 0.05). CONCLUSIONS: Sevoflurane combined with propofol is worth popularizing because of its high anesthetic effect and safety in the removal of tracheal foreign bodies in children. However, given the limited quantity and quality of the included studies, the above conclusions need to be verified by high-quality studies.

Clinical features of 17 patients with 2019-nCoV.

OBJECTIVE: This study aims to discuss the unique clinical features of patients with 2019-nCoV in Zhengzhou City to provide references for clinical diagnosis and treatment. PATIENTS AND METHODS: Seventeen patients with 2019-nCoV in Zhengzhou People's Hospital from February to March 2020 were collected. Their epidemiology, clinical symptoms, laboratory examinations, and chest CT images were reviewed. All 17 patients were aged between 12-83 years, with an average age of 47 years, and consisted of 10 males (58.8%) and 7 females (41.2%). Two patients had histories of living or traveling in Wuhan, and 9 patients were attacked locally. The 6 remaining patients were unknown about incidence reasons. RESULTS: The average incubation period was 10 days, and the average time of the course of the disease was 9 days. Among the participants, 12 patients had fever as the first symptoms and 5 patients had normal body temperature. One patient was symptom-free carrier, and one patient had serious symptoms. One patient developed from mild symptoms to severe symptoms, and 14 patients had mild symptoms. Moreover, 7 patients had complications of cardiovascular and cerebrovascular diseases and hypertension, 1 patient was in the advanced stage of squamous cell lung carcinoma, and 1 patient had diabetes mellitus, renal failure, and late-stage uremia. According to novel coronavirus nucleic acid test, 8 patients were positive, accounting for 47.1%. All patients were negative in the novel coronavirus IgM antibody test and negative in other common respiratory pathogen detection. All 17 patients had ground glass-like high-density shadow or stripped high-density shadow on lung CT images, accompanied with many affected lesions on two lungs. The average stay in hospital was 10 days, and the average time of the course of the disease was 9 days. After hospitalization, 15 patients were discharged from the hospital upon recovery, 1 patient was transferred to superior hospital for continuous treatment, and 1 patient died. Patients with 2019-nCoV in Zhengzhou People's Hospital were mainly attacked in local areas, and most of them had mild symptoms. The positive rate of the nucleic acid test was 47.1%. CONCLUSIONS: The main clinical characteristics are increased neutrophil granulocytes, increased C-reactive proteins, decreased lymphocytes, ground glass-like or stripped lesions on lung CT image, common complications of cardiovascular and cerebrovascular diseases, and favorable prognosis.

Effects of reed straw, zeolite, and superphosphate amendments on ammonia and greenhouse gas emissions from stored duck manure.

Stored poultry manure can be a significant source of ammonia (NH) and greenhouse gases (GHGs), including nitrous oxide (NO), methane (CH), and carbon dioxide (CO) emissions. Amendments can be used to modify physiochemical properties of manure, thus having the potential to reduce gas emissions. Here, we lab-tested the single and combined effects of addition of reed straw, zeolite, and superphosphate on gas emissions from stored duck manure. We showed that, over a period of 46 d, cumulative NH emissions were reduced by 61 to 70% with superphosphate additions, whereas cumulative NO emissions were increased by up to 23% compared with the control treatment. Reed straw addition reduced cumulative NH, NO, and CH emissions relative to the control by 12, 27, and 47%, respectively, and zeolite addition reduced cumulative NH and NO emissions by 36 and 20%, respectively. Total GHG emissions (as CO-equivalents) were reduced by up to 27% with the additions of reed straw and/or zeolite. Our results indicate that reed straw or zeolite can be recommended as amendments to reduce GHG emissions from duck manure; however, superphosphate is more effective in reducing NH emissions.

The fluxes of CO2 from grazed and fenced temperate steppe during two drought years on the Inner Mongolia Plateau, China.

The CO(2) flux was measured by the eddy covariance method on a temperate Leymus chinensis steppe over a period of 17 months spanning two consecutive growing seasons. The amount of precipitation was nearly normal, but it was low in the early and high in the late growing period in 2006. In the 2007 growing season, the amount of precipitation was about 45% less than the multi-year average and more evenly distributed. Comparisons were made between a moderately grazed site and a 28-year-old fenced site. The maximum instantaneous CO(2) release and uptake rates were 0.12 (May) and -0.11mg CO(2)m(-2)s(-1) (July) at the fenced site, and 0.11 and -0.16mg CO(2)m(-2)s(-1) (both in July) at the grazed site. In both growing seasons, the grazed site always had a higher daily uptake rate or lower release rate than the fenced site. The grazed site was a CO(2) sink during the growing season of 2007 and a CO(2) source in the growing season of 2006, whereas the fenced site was a CO(2) source in both seasons. Lower precipitation decreased CO(2) loss during the growing season more in the grazed site than in the fenced site, mainly because of depression of total ecosystem respiration (R(e)) in the former and stimulation in the latter. During the dormant season (from October to April), the fenced and grazed sites released 60.0 and 32.4g of C per m(2), respectively. Path analysis showed that temperature had the greatest effect on daily variation of ecosystem CO(2) exchange during the growing seasons at the two study sites. The results suggest that decrease of precipitation and/or increase of temperature will likely promote C loss from L. chinensis steppes, whether fenced or grazed, and that a grazed site is more sensitive.

Protective effects of nitroglycerin-induced preconditioning mediated by calcitonin gene-related peptide in rat small intestine.

Previous studies of myocardium have shown that ischemic preconditioning could be mimicked by nitroglycerin through stimulating the release of calcitonin gene-related peptide (CGRP). The present study examined whether nitroglycerin could also provide a preconditioning stimulus in the peripheral vascular bed (the anse intestinalis of rat), and whether endogenous CGRP is involved in this process. The model of in situ perfusion was prepared with rat small intestine. One hour of ischemia and 15 min of reperfusion caused a significant impairment of intestinal morphology and an increase in the release of both lactate dehydrogenase and malondialdehyde. Pretreatment with nitroglycerin, 10(-7), 3 x 10(-7), 10(-6) M for 5 min produced a significant improvement of intestinal tissue morphology and a decrease in the release of both lactate dehydrogenase and malondialdehyde. However, the protection afforded by nitroglycerin was abolished by CGRP-(8-37), a selective CGRP acceptor antagonist. Pretreatment with capsaicin, which specifically depletes the transmitter content of sensory nerves, also abolished the protection by nitroglycerin. In addition, the content of CGRP-like immunoreactivity in the effluent was increased during nitroglycerin perfusion. On the other hand, the results from the in vivo experiment showed that nitroglycerin (i.v. 0.13 mg/kg) injected 5 min before prolonged ischemia could provide significant protection against the injury caused by 30-min ischemia and 1-h reperfusion in the rat small intestine, but would also cause a significant increase in the levels of CGRP in the plasma. All these findings suggest that nitroglycerin-induced preconditioning is related to stimulation of CGRP release in the rat small intestine.

Role of endogenous opioid peptides in protection of ischemic preconditioning in rat small intestine.

This study investigated the protective effects of ischemic preconditioning on intestinal ischemic injury and the role of endogenous opioid peptides (EOP) in these effects. Ischemia-reperfusion (I/R) induced by 30-min of ischemia and 60-min of reperfusion significantly increased the levels of malondialdehyde (MDA) and lactate dehydrogenase (LDH) and resulted in serious intestinal edema (wet weight/dry weight). The ischemic preconditioning (PC) elicited by three 8-min occlusion periods interspersed with 10-min reperfusion markedly attenuated intestinal injury caused by ischemia-reperfusion. Pretreatment with morphine (300 microg x kg(-1), i.v.) 10-min before ischemia and reperfusion mimicked the protection produced by PC. Naloxone (3 mg x kg(-1), i.v.) abolished the protection of morphine-induced preconditioning and ischemic preconditioning in rat intestine. However, there were no changes between naloxone alone and control groups. Treatment with naloxone before ischemia-reperfusion had no effect on animals compared with the I/R group. In addition, we also measured the content of endogenous opioid peptides (Leu-enkephalin) in the effluent which was collected before and during preconditioning. It was shown that the release of leu-enkephalin was markedly increased during preconditioning. These results suggested that EOP might play an important role in PC in rat small intestine.

Ischemic preconditioning mediated by activation of KATP channels in rat small intestine.

AIM: To study whether the protective effects of ischemic preconditioning against rat small intestine ischemia/reperfusion injury could be mediated by KATP channel opener. METHODS: Preconditioning (Pc) was induced by 3 cycles of 8-min superior mesenteric artery (SMA) occlusion and 10-min reperfusion before prolonged ischemia. Cromakalim (Cro 75 micrograms.kg-1) and glibenclamide (Gli 8 mg.kg-1) were injected i.v. 10 min before prolonged ischemia and Pc, respectively. RESULTS: Compared with ischemic reperfusion (IR) group, Pc before prolonged ischemia (Pc + IR) decreased LDH release [(380 +/- 55) vs (559 +/- 49) U.L-1, P < 0.05], attenuated intestinal edema [wet weight/dry weight (WW/DW), 5.6 +/- 0.6 vs 6.34 +/- 0.29, P < 0.05], ameliorated intestinal histological damage (grading scale, 3.4 vs 5.7, P < 0.01), and improved reperfusion-induced hypotension. These effects of Pc were mimicked by Cro [LDH, (298 +/- 40) vs (559 +/- 49) U.L-1, P < 0.05; WW/DW, 5.6 +/- 0.4 vs 6.34 +/- 0.29, P < 0.05; grading scale, 3.6 vs 5.7, P < 0.01] and abolished in the presence of Gli [LDH, (624 +/- 44) vs (559 +/- 49) U.L-1; WW/DW, 6.6 +/- 0.6 vs 6.34 +/- 0.29; grading scale, 5.7 vs 5.7; P > 0.05] compared with IR group, respectively. CONCLUSION: Ischemic preconditioning on the rat small intestine is mediated by activation of KATP channels.

[Studies on hypoglycemic effect of xuetangping].

Effects of xuetangping (XTP) on serum sugar liver glycongen in diabetic rats induced by alloxan were studied. The result showed that XTP (1.5 g/kg qd 14 d) lowered serum sugar near normal level in diabetic rats. While at 14d, XTP also increased the content of liver glycogen in diabetic rats and reduced the mortality of it XTP (0.75 g/kg ig qd 7d) prevented the alloxan induced elevation of serum sugar level in rats.

[Effects of methylflavonolamine on TXA2 and PGI2 plasma levels in rabbits with myocardial infarction].

Effects of methylflavonolamine (MFA) on TXA2 and PGI2 plasma levels in rabbits of myocardial infarction were investigated. It was found that TXB2 levels were inhibited by MFA 2.5 or 5.0 mg.kg-1 i.v. while 6-keto-PGF1 alpha levels were only slightly inhibited after repeated doses of 5.0 mg.kg-1 i.v. within 6 h. This result indicates that MFA exhibit stronger inhibition on cyclo-oxygenase in platelets than in endothelial cells. In addition, the myocardial injury and the size of myocardial infarction were much less in the MFA treated groups than in the control.