Infection Control Precautions and Care Delivery in Hemodialysis Unit during Coronavirus Disease 2019 Outbreak: A Case Series.

BACKGROUND: With an estimated basic reproductive number of 3.77, the Coronavirus Disease 2019 (COVID-19) continues to spread. It is urgent to exert adequate efforts for the management of dialysis patients, caregivers, and healthcare personnel (HCP). This study aimed at reporting practical workflow, identification of high-risk or suspected cases of CO-VID-19, and subsequent response measures. METHODS: At the time of the COVID-19 outbreak, precautions and practice protocols were applied in our dialysis units (DUs). This single-center study retrospectively reviewed all high-risk/suspected cases from January 23, 2020, to February 10, 2020. Epidemiological, clinical feature, and detailed data on all cases were recorded. RESULTS: Practical workflow for the clinical management of dialysis patients, caregivers, and HCP was initiated. A total of 6 high-risk/suspected cases were identified. Female gender, older age, presence of cardiovascular disease, diabetes, anuresis, immunocompromised status, hypoalbuminemia, and underweight were noticeable features in these cases. Direct evidence of infection or epidemiological risk was detected in five cases. Close monitoring for temperature and oxygen saturation during hemodialysis sessions may be reasonable. No confirmed COVID-19 cases were reported in our DU, but certain cases showed rapid deterioration due to other critically severe condition needing hospitalization. Portable dialysis machines are of great need to ensure dialysis care provision. CONCLUSIONS: Our study described a practical workflow for patient-centered management during COVID-19 outbreak. Potential risk factors and underlying clinical patterns were reported. Further studies regarding the efficacy of infection control precautions and practice protocols tailored for dialysis settings are warranted.

Automated detection and quantification of COVID-19 pneumonia: CT imaging analysis by a deep learning-based software.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) is an emerging worldwide threat to public health. While chest computed tomography (CT) plays an indispensable role in its diagnosis, the quantification and localization of lesions cannot be accurately assessed manually. We employed deep learning-based software to aid in detection, localization and quantification of COVID-19 pneumonia. METHODS: A total of 2460 RT-PCR tested SARS-CoV-2-positive patients (1250 men and 1210 women; mean age, 57.7 ± 14.0 years (age range, 11-93 years) were retrospectively identified from Huoshenshan Hospital in Wuhan from February 11 to March 16, 2020. Basic clinical characteristics were reviewed. The uAI Intelligent Assistant Analysis System was used to assess the CT scans. RESULTS: CT scans of 2215 patients (90%) showed multiple lesions of which 36 (1%) and 50 patients (2%) had left and right lung infections, respectively (> 50% of each affected lung's volume), while 27 (1%) had total lung infection (> 50% of the total volume of both lungs). Overall, 298 (12%), 778 (32%) and 1300 (53%) patients exhibited pure ground glass opacities (GGOs), GGOs with sub-solid lesions and GGOs with both sub-solid and solid lesions, respectively. Moreover, 2305 (94%) and 71 (3%) patients presented primarily with GGOs and sub-solid lesions, respectively. Elderly patients (≥ 60 years) were more likely to exhibit sub-solid lesions. The generalized linear mixed model showed that the dorsal segment of the right lower lobe was the favoured site of COVID-19 pneumonia. CONCLUSION: Chest CT combined with analysis by the uAI Intelligent Assistant Analysis System can accurately evaluate pneumonia in COVID-19 patients.

MiR-23a-5p modulates mycobacterial survival and autophagy during mycobacterium tuberculosis infection through TLR2/MyD88/NF-κB pathway by targeting TLR2.

Autophagy plays a pivotal role in activating the antimicrobial host defense against Mycobacterium tuberculosis (M.tb.). The emerging roles of microRNAs (miRNAs) in regulating immune responses have attracted increasing attention in recent years. Appreciating the potential of host-directed therapies designed to control autophagy during mycobacterial infection, we focused on the influence of miR-23a-5p on the activation of macrophage autophagy during M.tb. infection in bone marrow-derived macrophages (BMDMs) and murine RAW264.7 cells. Here, we demonstrated that M.tb.-infection of macrophages lead to markedly enhanced expression of miR-23a-5p in a time- and dose-dependent manner. Furthermore, forced expression of miR-23a-5p accelerated the survival rate of intracellular mycobacteria, while transfection with miR-23a-5p inhibitors attenuated mycobacterial survival. More importantly, overexpression of miR-23a-5p dramatically prevented M.tb.-induced activation of autophagy in macrophages, whereas inhibitors of miR-23a-5p remarkably accelerated M.tb.-induced autophagy. Mechanistically, miR-23a-5p is able to modulate TLR2/MyD88/NF-κB signaling activity by targeting TLR2 in RAW264.7 cells in response to M.tb.-infection. Collectively, these findings demonstrated that miR-23a-5p modulated the innate host defense by promoting mycobacteria survival and inhibiting the activation of autophagy against M.tb. through TLR2/MyD88/NF-κB pathway by targeting TLR2, which may provide a promising therapeutic target for tuberculosis.

ZC3H12D attenuated inflammation responses by reducing mRNA stability of proinflammatory genes.

Infection in airspaces and lung parenchyma may cause acute lung injury and multiple organ dysfunction syndrome due to acute inflammatory response, leading to organ failure and high mortality. ZC3H12D has been shown to modulate Toll-like receptor signaling. This study aimed to investigate the change of ZC3H12D during acute lung injury and its role in inflammation processes. Mice were challenged with lipopolysaccharides (LPS) intratracheally. The expression levels of Zc3h12d, NF-κB, and cytokines were analyzed by quantitative real-time PCR (qPCR), ELISA, and Western blot. The mRNA stability was assessed by qPCR after cells were treated with actinomycin D for specified times. The 3' untranslated region (3'-UTR) of c-fos was cloned immediately downstream of the luciferase coding sequence driven by CMV promoter and luciferase activity was measured with a Luciferase Assay kit. Upon LPS treatment, ZC3H12D levels were reduced in mouse immune cells, whereas levels of NF-κB, IL-6, and TNF-α were significantly increased. Knockdown Zc3h12d in THP1 cells resulted in the upregulation of NF-κB while overexpression of Zc3h12d inhibited NF-κB expression. Ectopic Zc3h12d significantly reduced the mRNA stability of c-fos, NF-κB, TNF-α, IL-1ß, and IL-6. Attachment of the c-fos 3'-UTR made luciferase expression levels sensitive to levels of ZC3H12D. The data indicated that ZC3H12D could suppress both the initial inflammation storm and chronic inflammation by targeting the mRNA of cytokines as well as NF-κB and c-fos.

Novel bronchoscopic balloon dilation for patients with bronchostenosis caused by bronchial tuberculosis: a case report.

INTRODUCTION: Bronchoscopic balloon dilation is a common method in the treatment of bronchostenosis but it is not an effective treatment due to its short dilating time (3 minutes) and low pressure (<3atm). Until recently, the reported highest dilating pressure was ≤6atm; however, this is not enough pressure to dilate a bronchostenosis because of the resistance of the bronchus. We hypothesized that higher dilating pressure (up to 14atm) with longer dilating time (40 minutes) may make bronchoscopic balloon dilation treatment more effective according to the blood vessel dilating method. Therefore, we designed this new bronchoscopic balloon dilation method for treating bronchostenosis, particularly in cases caused by bronchial tuberculosis. CASE PRESENTATION: A 23-year-old Chinese woman presented with right middle segmental bronchostenosis caused by bronchial tuberculosis. She was informed of the surgical procedure and she provided informed consent. After taking anti-bronchial tuberculosis drugs for 2 months, she underwent our new bronchoscopic balloon dilation treatment (dilating time, 40 minutes; pressure, 14atm). After anti-bronchial tuberculosis treatment for 13 months, her intermediate bronchus was observed with videobronchoscopy again and no re-stenosis was seen. Furthermore, a computed tomography scan revealed that her right lower lobe and right middle lobe had reopened. No complications occurred in the patient. CONCLUSION: The novel high-handed videobronchoscopic balloon dilation method was safe and effective for treating this patient with bronchostenosis caused by bronchial tuberculosis.

Therapeutic effects of sequential therapy by electric coagulation, cryotherapy and balloon dilation with an electronic video bronchoscope.

The aim of the current study was to retrospectively analyze clinical data concerning bronchostenosis or bronchial obstruction caused by endobronchial tuberculosis. Fifty-six cases were subjected to bronchoscopy and chest computed tomography to assess the prognosis of bronchostenosis and bronchial obstruction. Based on reliable and effective anti-pulmonary tuberculosis therapy, these conditions were treated sequentially by electric coagulation, cryotherapy and balloon dilation with an electronic video bronchoscope during outpatient consultation or inpatient hospitalization. Fifty-three subjects with bronchostenosis recovered to varying degrees, a recovery rate of 94.6%. Thirteen of the 15 cases with bronchial obstruction reopened (86.7%). The clinical symptoms of these cases appeared to be in remission. Bronchostenosis or bronchial obstruction resulting from endobronchial tuberculosis may be treated by electric coagulation, cryotherapy and balloon dilation with an electronic video bronchoscope.

Overexpression of STAT3 potentiates growth, survival, and radioresistance of non-small-cell lung cancer (NSCLC) cells.

OBJECTIVE: Activation of signal transducer and activator of transcription 3 (STAT3) play important roles in tumorigenesis and tumor progression. The overexpression of STAT3 has been found in various malignancies including non-small-cell lung carcinoma (NSCLC). The purpose of this study was to explore the correlation between overexpression of STAT3 gene and growth, survival, and radiosensitivity of NSCLC cells. METHODS: Subclones using vector-based short hairpin RNA (shRNA) were established. RT-PCR and Western blot assays were performed to detect the expression of STAT3 mRNA and protein in untransfected or stably transfected NSCLC cells. Then, MTT and soft agar colony assays were performed to determine the effect of STAT3 inhibition on in vitro growth of NSCLC cells. Hoechst staining assay was performed to analyze the effect of STAT3 inhibition on apoptosis of NSCLC cells. Additionally, clonogenic survival assays were performed to detect the effect of STAT3 inhibition on in vitro radiosensitivity of NSCLC cells. Finally, to examine the effect of pSUPER-shSTAT3 on proliferation and radiosensitivity in vivo, a subcutaneous (s.c.) tumor formation assay in nude mice was performed. RESULTS: We successfully established two stable transfected cell lines (A549/shSTAT3 and SK-MES-1/shSTAT3) in which the expression of STAT3 mRNA and protein was down-regulated. Those two stable subclones showed a significantly dramatic reduction in colony-forming ability and proliferation not only in vitro but also in vivo. The apoptotic rates of A549/shSTAT3 and SK-MES-1/shSTAT3 cells increased to 19.2% and 16.4%, respectively. Moreover, shRNA-mediated STAT3 inhibition could also significantly enhance radiosensitivity of NSCLC cells both in vitro and in vivo. CONCLUSION: Together, the overexpression of STAT3 is correlated with growth, survival, and radioresistance of NSCLC cells, and STAT3 might be a molecular therapeutic target for gene therapy or radiosensitization of NSCLC.

[The application of combined interventional procedures for the management of intractable central airway stenosis].

OBJECTIVE: to evaluate the application of combined five interventional procedures in the management of intractable central airway stenosis. METHODS: clinical manifestations and pulmonary functions of 138 patients with intractable central airway stenosis were evaluated. Five interventional procedures, including high-frequency electrotome, argon plasma coagulation (APC), cryotherapy, stent placement and high-pressure balloon dilatation, were used in this study. Among them, two or more procedures were combined to manage complicated airway stenosis according to stenosis causes, types, position, degree and duration, or functions of distal lung tissue and airway. Forty-two cases were treated with high-frequency electrotome and APC, 54 cases with high-frequency electrotome, cryotherapy and APC, 29 cases with high-frequency electrotome, cryotherapy, APC and stent placement, and 13 cases with cryotherapy, APC and high-pressure balloon dilatation. Airways opening, short-term therapeutic effects and improvement of pulmonary functions were evaluated when ideal curative effects were achieved in the first month after intervention. RESULTS: the total short-term effective rate in the 138 patients was 100%. The airway diameter was increased from (2.6 ± 1.5) mm before operation to (6.2 ± 1.7) mm after operation (P < 0.05). Dyspnea score was decreased from (2.4 ± 0.8) before operation to (0.7 ± 0.6) after operation (P < 0.05). FEV(1) was increased from (1.8 ± 0.6) L before operation to (3.1 ± 0.7) L after operation (P < 0.05). Among 23 cases benign disease, including 4 benign tumor, 15 tuberculosis and 4 other granulomatosis, 5 cases with various degrees of restenosis needed further interventional therapy after 3 months of follow up and effective rate was 78.3% (18/23). After 6 months of follow-up, 3 cases with restenosis needed re-intervention, and the effective rate was 86.9% (20/23). All of the 23 cases did not experience stenosis after 12 months of follow-up. Patients with malignant tumor were not followed up for long term. CONCLUSION: combination of five interventional procedures, including high-frequency electrotome, APC, cryotherapy, stent placement and high-pressure balloon dilatation, has fewer complications and favorable clinical effects in management of intractable central airway stenosis.

[Joint application of 7 interventional pulmonology methods in early diagnosis of lung cancer].

OBJECTIVE: To evaluate the combination of 7 interventional pulmonology methods in early diagnosis of lung cancer. METHODS: A total of 467 patients with thoracic and pulmonary lesions (include hilum pulmonis lymphadenectasis, mediastinal lymphadenectasis, pulmonary scobination, lump, lamellar infiltration, small amount of pleural fluid and pleural scobination) had negative results via exfoliative cytology, bacteriology and routine bronchoscopy. All these patients had ultrathin bronchoscopy with biopsy and brushing. For those 155 cases whose foci were located at porta pulmonis, inner zone or median zone, the authors applied ultrathin bronchoscopy with biopsy and brushing guided by X-ray. For those 95 cases whose foci were located at median zone or outer zone and unconnected with chest wall, per cutem lung puncture needle aspiration was employed under the guidance of X-ray. For those 102 cases whose foci were tightly connected with pleural membrane, per cutem lung puncture biopsy was employed under the guidance of type-B ultrasonic. For those 59 cases with suspected central airway foci, auto-fluorescence bronchoscopic biopsy and brushing were employed. For those 67 cases with hilum pulmonis or mediastinal lymphadenectasis, endobronchial ultrasonic transbronchial needle aspiration (EBUS-TBNA) was employed. For those 23 cases with small amount of pleural fluid or pleural scobination, electronic thoracoscopic biopsy and brushing were employed. RESULTS: It was found that 118 cases were diagnosed by ultrathin bronchoscopic biopsy and brushing with a positive rate of 25.3% (118/467), 105 cases by ultrathin bronchoscopy with biopsy and brushing guided by X-ray with a positive rate of 67.7% (105/155), 63 cases by per cutem lung puncture needle aspiration under the guidance of X-ray with a positive rate of 66.3% (63/95), 69 cases by per cutem lung puncture biopsy under the guidance of type-B ultrasound with a positive rate of 67.6% (69/102), 18 cases by auto-fluorescence bronchoscopic biopsy and brushing with a positive rate of 35.3% (18/51), 52 cases by EBUS-TBNA with a positive rate of 77.6% (52/67), 12 cases by electronic thoracoscopic biopsy and brushing with a positive rate of 52.2% (12/23). The total positive diagnostic rate was 93.6% (437/467). And the diagnostic rate of < or = stage II lung cancer (3 cases carcinoma in situ, 84 stage I a, 63 stage Ib, 65 stage IIa and 44 stage IIb) was 82.7% (259/313). CONCLUSION: Joint application of these 7 interventional bronchoscopic techniques can significantly boost the rate of early diagnosis of lung cancer.

[Efficacy and safety of argon plasma coagulation in the treatment of obstructive tracheobronchial stenosis].

OBJECTIVE: To evaluate the efficacy and safety of argon plasma coagulation (APC) in the treatment of large airway obstruction. METHODS: Totally 389 patients with treacheobronchial stenosis were treated with APC (ARCO3000 type) by bronchoscopy. The stenoses were caused by carcinomas (203 cases, 52.2%), metastatic tumors (67 cases, 17.2%), benign tumors (18 cases, 4.6%), granulomas (93 cases, 23.9%) and other lesions (8 cases, 2.1%). The rate of recanalization, relief of the symptoms, and complications were analyzed. RESULTS: 1121 times of APC treatment were performed in the 389 patients. Complete recanalization was achieved in 138 cases (35.5%), partial in 143 (36.8%), mild in 55 (14.1%) and none in 53 (13.6%). The major complications included: super-ventricular tachycardia in 136 cases (34.9%), bleeding in 51 (13.1%), decrease in blood oxygen saturation in 48 (12.3%), asphyxia in 33 (8.5%), ventricular or super-ventricular arrhythmia in 24 (6.2%), short-term aggravation of airway obstruction in 18 (4.6%), and tracheal perforation in 3 (0.78%). All those complications were treated with various measures and no patient died of the complications during the procedure. CONCLUSION: Argon plasma coagulation is effective and relatively safe in relieving the obstruction and dyspnea in patients with large airway obstruction caused by various reasons. However, for the patients with severe airway obstruction, argon plasma coagulation sometimes may cause severe or even lethal complications. Critical consideration of the indication, operators' skill and taking more precautions during the procedure are required to ensure the safety of argon plasma coagulation treatment.

Effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients infected with hepatitis B virus.

AIM: To observe the effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients with hepatitis B virus (HBV) infection, and to compare the differences of liver function by two treatments of anti-tuberculosis. METHODS: Forty-seven TB patients with HBV infection and 170 TB patients without HBV infection were divided into HPBE(S) and HLAMKO treatment groups. Liver function tests before and after the treatments were performed once in 2 wk or monthly, and their clinical manifestations were recorded. RESULTS: The rate of hepatotoxicity occurred in 26 (59%) TB patients with HBV during anti-TB treatment, higher than that in 40 (24%) TB patients without HBV. Hepatotoxicity occurred in 66 out of 217 patients, and the incidence of liver dysfunction was 46.1% in HPBE(S) group, significantly higher than that in HLAMKO group (12.7%) (P<0.01). CONCLUSION: TB patients with HBV should choose HLAMKO treatment because of fewer hepatotoxicity.