Preliminary evidence from a multicenter prospective observational study of the safety and efficacy of chloroquine for the treatment of COVID-19

BackgroundEffective therapies are urgently needed for the SARS-CoV-2 pandemic. Chloroquine has been proved to have antiviral effect against coronavirus in vitro. In this study, we aimed to assess the efficacy and safety of chloroquine with different doses in COVID-19. MethodIn this multicenter prospective observational study, we enrolled patients older than 18 years old with confirmed SARS-CoV-2 infection excluding critical cases from 12 hospitals in Guangdong and Hubei Provinces. Eligible patients received chloroquine phosphate 500mg, orally, once (half dose) or twice (full dose) daily. Patients treated with non-chloroquine therapy were included as historical controls. The primary endpoint is the time to undetectable viral RNA. Secondary outcomes include the proportion of patients with undetectable viral RNA by day 10 and 14, hospitalization time, duration of fever, and adverse events. ResultsA total of 197 patients completed chloroquine treatment, and 176 patients were included as historical controls. The median time to achieve an undetectable viral RNA was shorter in chloroquine than in non-chloroquine (absolute difference in medians -6.0 days; 95% CI -6.0 to -4.0). The duration of fever is shorter in chloroquine (geometric mean ratio 0.6; 95% CI 0.5 to 0.8). No serious adverse events were observed in the chloroquine group. Patients treated with half dose experienced lower rate of adverse events than with full dose. ConclusionsAlthough randomised trials are needed for further evaluation, this study provides evidence for safety and efficacy of chloroquine in COVID-19 and suggests that chloroquine can be a cost-effective therapy for combating 102 the COVID-19 pandemic.

Imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation / 器官移植

Objective To investigate the imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation.Methods Imaging data of 4 patients with rare tumors or tumor-like lesions in the liver grafts of patients after liver transplantation from December 2006 to August 2013 in the Third Affiliated Hospital of Sun Yat-sen University were reviewed.Findings of computerized tomography ( CT ) and ( or ) magnetic resonance imaging ( MRI) plain scan and dynamic enhanced MRI of liver lesions in these patients were analyzed specially.Results In the 4 patients, 3 cases were misdiagnosed , including undifferentiated liver sarcoma , secondary lymphoma and eosinophilic granuloma.One case was diagnosed correctly with hepatic metastases of gallbladder carcinoma.The undifferentiated liver sarcomas appeared as cystic and solid space occupying masses with significant and persistent enhancement in the surrounding solid and separating parts .No enhancement was observed in the cystic parts , which increased rapidly in a short term.No edema area around the lesions was observed , but many calcifications were detected.The secondary hepatic lymphoma appeared as intrahepatic multiple nodules , most of which presented uniform signal intensity with moderate enhancement in every phase.No intrahepatic vascular invasion was observed but extrahepatic lymphadenectasis was detected .Bleeding was observed in a few lesions.The liver eosinophilic granuloma appeared as multiple liver lesions with variable signal intensity and enhancement modes , which suggested that the lesions were consisted of variety of elements and in the different disease stages.Most of the lesions were observed with progressive circled enhancement.The recurrence of gallbladder carcinoma and hepatic metastasis after liver transplantation appeared as a intrahepatic hypodensity lesion with slight enhancement in arterial phase and slight hypodensity in portal phase.Retroperitoneal lymph nodes were observed swelled and fused.Conclusions Rare tumors or tumor-like lesions in liver grafts have distinctive imaging features.Imaging examinations are useful for the early detection of these rare tumors or tumor-like lesions in liver grafts.Imaging findings combining with disease history and clinical manifestations can help to make correct diagnosis.

Comparative analysis on detection results of HBV preS1-Ag,HBV-DNA and HBeAg / 国际检验医学杂志

Objective To study the clinical significance of HBV preS1-Ag,HBV-DNA and HBeAg in main groups of HBV infection.Methods HBV preS1-Ag and hepatitis B serum markers individually were detected by ELISA,and HBV-DNA by fluorescence quantitative PCR, then the detection results of the 308 cases were analysed.Results The serum markers of the 308 cases infected by HBV presented four modes which were "HBsAg,HBeAg,HBcAb","HBsAg,HBeAb,HBcAb","HBsAg,HBeAg","HBsAg,HBcAb".The total positive rate of preS1-Ag was 62.34%(192/308),and HBV-DNA was 78.90%(243/308).Compared HBeAg(+) groups with HBeAg(-)/anti-HBe(+) groups, the corresponding positive rates of preS1-Ag were 71.65%(139/194) and 46.49%(53/114),respectively.The difference of the two groups was significant (?~2=18.30;P