Comparison of the Clinical Implications among Two Different Nutritional Indices in Hospitalized Patients with COVID-19

BackgroundCoronavirus disease 2019 (COVID-19) is an emerging infectious disease.It was first reported in Wuhan, China, and then broke out on a large scale around the world.This study aimed to assess the clinical significance of two different nutritional indices in 245 patients with COVID-19. MethodsIn this retrospective single-center study, we finally included 245 consecutive patients who confirmed COVID-19 in Wuhan University Zhongnan Hospital from January 1 to February 29. Cases were classified as either discharged or dead. Demographic, clinical and laboratory datas were registered, two different nutritional indices were calculated: (i)the Controlling nutritional status (CONUT) score; (ii) prognostic nutritional index (PNI). We used univariate and multivariate logistic regression analysis to explore the relationship between nutritional indices and hospital death. Results212 of them were discharged and 33 of them died. In-hospital mortality was signifcantly higher in the severe group of PNI than in the moderate and normal groups. It was also significantly worse in the severe-CONUT group than in the moderate-, mild-, and normal-CONUT groups. Multivariate logistic regression analysis showed the CONUT score (odds ratio3.371,95%CI (1.124-10.106), p = 0.030) and PNI(odds ratio 0.721,95% CI (0.581-0.896), P=0.003) were independent predictors of all-cause death at an early stage; Multivariate logistic regression analysis also showed that the severe group of PNI was the independent risk predictor of in-hospital death(odds ratio 24.225, 95% CI(2.147-273.327), p=0.010).The CONUT score cutoff value was 5.5 (56.00 and 80.81%; AUC 0.753; 95% CI (0.644-0.862); respectively). The PNI cutoff value was 40.58 (81.80 and 66.20%; AUC 0.778; 95% CI (0.686-0.809); respectively). We use PNI and the COUNT score to assess malnutrition, which can have a prognosis effect of COVID-19patients. ConclusionThe CONUT score and PNI could be a reliable prognostic marker of all-cause deathin patients with COVID-19.

Persistent SARS-CoV-2 presence is companied with defects in adaptive immune system in non-severe COVID-19 patients

BackgroundCOVID-19 has been widely spreading. We aim to examine adaptive immune cells in non-severe patients with persistent SARS-CoV-2 shedding. Methods37 non-severe patients with persistent SARS-CoV-2 presence transferred to Zhongnan hospital of Wuhan University were retrospectively recruited to PP (persistently positive) group, which was further allocated to PPP group (n=19) and PPN group (n=18), according to their testing results after 7 days (N=negative). Epidemiological, demographic, clinical and laboratory data were collected and analyzed. Data from age- and sex-matched non-severe patients at disease onset (PA [positive on admission] patients, n=37), and lymphocyte subpopulation measurements from matched 54 healthy subjects were extracted for comparison. ResultsCompared with PA patients, PP patients had much improved laboratory findings, including WBCs, neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio, albumin, AST, CRP, SAA, and IL-6. The absolute numbers of CD3+ T cells, CD4+ T cells, and NK cells were significantly higher in PP group than that in PA group, and were comparable to that in healthy controls. PPP subgroup had markedly reduced B cells and T cells compared to PPN group and healthy subjects. Finally, paired results of these lymphocyte subpopulations from 10 PPN patients demonstrated that the number of T cells and B cells significantly increased when the SARS-CoV-2 tests turned negative. ConclusionPersistent SARS-CoV-2 presence in non-severe COVID-19 patients is associated with reduced numbers of adaptive immune cells. Monitoring lymphocyte subpopulations could be clinically meaningful in identifying fully recovered COVID-19 patients. SummaryDefects in adaptive immune system, including reduced T cells and B cells, were frequently observed in non-severe COVID-19 patients with persistent SARS-CoV-2 shedding. Assessment of immune system could be clinically relevant for discharge management.

Favipiravir versus Arbidol for COVID-19: A Randomized Clinical Trial

BackgroundNo clinically proven effective antiviral strategy exists for the epidemic Coronavirus Disease 2019 (COVID-19). MethodsWe conducted a prospective, randomized, controlled, open-label multicenter trial involving adult patients with COVID-19. Patients were randomly assigned in a 1:1 ratio to receive conventional therapy plus Umifenovir (Arbidol) (200mg*3/day) or Favipiravir (1600mg*2/first day followed by 600mg*2/day) for 10 days. The primary outcome was clinical recovery rate of Day 7. Latency to relief for pyrexia and cough, the rate of auxiliary oxygen therapy (AOT) or noninvasive mechanical ventilation (NMV) were the secondary outcomes. Safety data were collected for 17 days. Results240 enrolled COVID-19 patients underwent randomization; 120 patients were assigned to receive Favipiravir (116 assessed), and 120 to receive Arbidol (120 assessed). Clinical recovery rate of Day 7 does not significantly differ between Favipiravir group (71/116) and Arbidol group (62/120) (P=0.1396, difference of recovery rate: 0.0954; 95% CI: -0.0305 to 0.2213). Favipiravir led to shorter latencies to relief for both pyrexia (difference: 1.70 days, P<0.0001) and cough (difference: 1.75 days, P<0.0001). No difference was observed of AOT or NMV rate (both P>0.05). The most frequently observed Favipiravir-associated adverse event was raised serum uric acid (16/116, OR: 5.52, P=0.0014). ConclusionsAmong patients with COVID-19, Favipiravir, compared to Arbidol, did not significantly improve the clinically recovery rate at Day 7. Favipiravir significantly improved the latency to relief for pyrexia and cough. Adverse effects caused Favipiravir are mild and manageable. This trial is registered with Chictr.org.cn (ChiCTR2000030254).

Association between 2019-nCoV transmission and N95 respirator use

2019-nCoV had caused pneumonia outbreak in Wuhan. Existing evidence have confirmed the human-to-human transmission of 2019-nCoV. We retrospectively collected infection data from 2 January to 22 January at six departments from Zhongnan Hospital of Wuhan University. In our study, we found N95 respirators, disinfection and hand washing can help to reduce the risk of 2019-nCoV infection in medical staffs. Our results call for re-emphasizing strict occupational protection code in battling this novel contagious disease. The risk of 2019-nCoV infection was higher in the open area than in the quarantined area. N95 may be more effective for 2019-nCoV infections.

[Transforming growth factor-ß1 induces epithelial-mesenchymal transition in A549 cells by up-regulating expression of calpain].

OBJECTIVE: To investigate the effect of transforming growth factor-ß1 (TGF-ß1) on epithelial-mesenchymal transition in type II alveolar epithelial cells and the relationship with Calpain. METHODS: The type II alveolar epithelial cell line-A549 cells cultured in vitro were divided into 4 groups: the control group, the TGF-ßl group, the TGF-ß1 + PD150606 group, the PD150606 group. Given the corresponding processing,Western-blot and RT-PCR were utilized to evaluate the expression of Calpain- 1,E-cad and α-SMA. RESULTS: Compared with the control group, the protein and mRNA expression of Calpain-1 and α-SMA in the TGF-ß1 group was markedly increased, but the protein and mRNA expression of E-cad was significantly decreased. While, after calpain inhibitor PD150606 was added, the protein and mRNA expression of Calpain-1 and α-SMA was markedly decreased and the protein and mRNA expression of E-cad was significantly increased in the TGF-ßl + PD150606 group, but there was no difference between TGF-ß1 + PD150606 group and control group. But with Calpain inhibitor PD150606 alone, the expression of Calpain-1,E-cad and α-SMA was no difference with the control group. CONCLUSIONS: TGF-ßl could induce epithelial-mesenchymal transition in A549 cells by up-regulating expression of calpain which could be inhibited by calpain inhibitor PD150606.

MiR-152 suppresses the proliferation and invasion of NSCLC cells by inhibiting FGF2

MicroRNAs (miRNAs) regulate the proliferation and metastasis of cancer cells. Here, we showed that miR-152 was downregulated in non-small-cell lung cancer (NSCLC) tissues and cell lines. Overexpression of miR-152 suppressed cell proliferation and colony formation and also limited migration and invasion. Fibroblast growth factor 2 (FGF2) was confirmed as a direct target of miR-152. FGF2 knockdown suppressed cell proliferation, colony formation, migration and invasion, whereas FGF2 overexpression partially reversed the suppressive effect of miR-152. Furthermore, the presence of miR-152 was inversely correlated with FGF2 in NSCLC tissues. Overall, this study demonstrated that miR-152 suppressed the proliferation and invasion of NSCLC cells by downregulating FGF2. These findings provide novel insights with potential therapeutic applications for the treatment of NSCLC.

Therapeutic value of early bronchoscopy in aspiration pneumonia patients after nasopharyngeal carcinoma radiotherapy / 中华全科医师杂志

A total of 41 patients with aspiration pneumonia after nasopharyngeal carcinoma radiotherapy were retrospectively selected from January 2005 to December 2010.They were divided into early bronchoscopy group (n =24) and conventional therapy group (n =17) to analyze the therapeutic effects of early bronchoscopy on temperature,white blood cell (WBC),absorption of chest radiography and mortality rates.The temperature and WBC were at the same level between both groups at pre-treatment [(38.7 ±0.7)℃ vs.(38.5 ±0.7)℃,P=0.633; (15.8 ±4.2) × 109/L vs.(16.2 ±3.4) × 109/L,P =0.430]while the temperature declined obviously after a 3-day treatment [(37.3 ±0.9)℃ vs.(38.4 ± 1.4)℃,P =0.015] and also WBC after a 5-day treatment[(10.6±4.2) × 109/L vs.(15.3 ±6.9) × 109/L,P=0.045].The bronchoscopy group had a faster absorption of chest radiography (Z =-3.515,P =0.00).The mortality rate showed no statistically significant difference between both groups.

Cryptogenic organizing pneumonia: a case report and literature review / 中华全科医师杂志

We reported a case of cryptogenic organizing pneumonia ( COP) who was admitted to the hospital in July 2008 and reviewed the Chinese literature of COP from 2003 to 2008. The most common symptoms of COP are fever, cough and exertional dyspnea. The imaging characteristics of COP are similar to those of pneumonia, therefore is often misdiagnosed as pneumonia with a high misdiagnosis rate. Lung biopsy is the main method for pathological diagnosis; polypoid growth of granulation tissue was noted within respiratory bronchioles, small airways and alveolar spaces.

Analysis of clinical features and current therapy for aspiration pneumonia in the elderly / 中华全科医师杂志

Totally, 125 elderly inpatients with aspiration pneumonia (AP) were enrolled from departments of respiratory medicine and neurology at Zhongnan Hospital, Wuhan during June 2005 to October 2009 for analysis. Results showed that listlessness was manifested in 70 cases (56%), primary neurological illness in 80 cases (64%), 57 of them (46%) complicated with respiratory failure and 26 died with case-fatality of 21%. Main pathogen for them was Gram-negative bacillus, accounting for 57% of the total. Two kinds or more of antibiotics had ever been administered in 98 cases (78%), with an average length of antibiotics use for 28 days, ranging from one day to 128 days. Nasal feeding was instituted for those with choking over their feeding and coughing, and their inspired feeding was aspirated from the trachea or bronchi and lavished with bronchoscopy, with 38 cases by tracheal intubation, 26 by tracheotomy and 42 with artificial ventilation. Their average duration of hospital stay spanned 28 days with an average cost of 25 000 RMB yuan per capita, significantly higher than that for those with common pneumonia. In conclusion, clinical features of these elderly patients with AP were not so typical, most of them manifest severe, with lots of medical cost and bad prognosis.

Percutaneous transthoracic biopsy in pathologic diagnosis of stage Ⅰ～Ⅱ lung cancer / 中华全科医师杂志

Fifty-six patients diagnosed as early stage lung cancer by spiral CT scan,underwent CTguided percutaneous transthoracic biopsy with a successful rate of 100%.Forty nice cases were confirmed pathologically including adenocarcinoma in 30 cases,squamous carcinoma in 14,alveolar cell carcinoma in 2 and small cell lung cancer in 3.Three cases were diagnosed as chronic inflammatory lesion,2 cases as tuberculosis and the diagnosis was not confirmed in 2 cases.The results suggest that CT-guided percutaneous transthoracic biopsy is an effective diagnostic measure for patients with stage Ⅰ-Ⅱ lung cancer.

Application of percutaneous transthoracic automated biopsy instrument in diagnosis for pulmonary lesions / 中华全科医师杂志

Objective To study clinical application of Bard automated disposable instrument for percutaneous transtheracic biopsy guided by CT in diagnosis of pulmonary lesions. Methods Percutaneons transthoracic biopsy was performed with CT-guided Bard automated disposable instrument for 95 patients with pulmonary lesions but without established diagnosis by clinical and imaging procedures in order to obtain pathological diagnosis. Results Tissue specimens were obtained from all the 95 patients by Bard automated disposable instrument for percutaneous transthoracis biopsy, with a hundred percent of success. After the procedure, 68 of 95 were pathologically diagnosed as lung cancer (including adenocarcinoma in 44,squamous carcinoma in 19, alveolar cell carcinoma in three and small cell carcinoma in two), 10 as chronic inflammatory lesions, eight as tuberculosis, two as inflammatory pseudotumor, one as metastatic cancer, two as fungal infection, and four without an established diagnosis, with an overall diagnosis rate of 95.8%.Pneumothorax occurred in eight and mild haemoptysis in six of 95 patients, respectively, by the procedure.Conclusion Percutaneons transthoracic biopsy with Bard automated disposable instrument is an effective diagnostic procedure for patients with pulmonary lesions but their diagnoses were not established by routine examinations.

The effect of endobronchial decimeter wave therapy on pulmonary function of patients with constrictive endo-bronchial tuberculosis / 中华物理医学与康复杂志

Objective To observe the effects of endobronchial decimeter wave therapy on ventilation func-tion of patients with the constrictive endobronehial tuberculosis (EBTB). Methods Forty-four EBTB patients weredivided into an experiment group and a control group. All the patients of the two groups were treated with generalchemotherapy, the patients of experiment group accepted endobronehial decimeter wave therapy at the same time. Thepurulent secretion or caseous necrosis of the diseased region was drawn-off from the bronchi lumina by bronchoseope,then the antenna of the decimeter wave irradiator was inserted into the diseased region through the biopsy pore to per-form the radiation. The vital capacity, forced expiratory volume in the 1st second and maximal voluntary ventilationwere tested before and 60 days after the operation. Results Endobronehial decimeter wave therapy significantly re-duced the constriction of bronchi, improved the lung ventilation function, and relieved the anhelation symptom of pa-tients in the experiment group to a significantly larger extent than those in the controls group (P< 0. 01 ). Moreover,the therapeutic effects of endobronchial decimeter wave therapy were more significant for the endomembrane tuberculo-sis with pulmonary closure due to ulcerous necrosis or granulation hyperplasy ( P < 0. 05 ) , but ineffective for the atro-phy due to fibrous constriction. Conclusion Endobronchial decimeter wave therapy could reduce the incidence oflung closure in endomembrane tuberculosis and improve lung function.