期刊,当代医学科学(英文) 2021年卷1期_国家学术搜索

Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan,China:A Retrospective Multicenter Cohort Study

Jing FANGRui LIYue CHENJuan-juan QIN...

1-13页

查看更多>>摘要：Currently,little in-depth evidence is known about the application of extracorporeal membrane oxygenation(ECMO)therapy in coronavirus disease 2019(COVID-19)patients.This retrospective multicenter cohort study included patients with COVID-19 at 7 designated hospitals in Wuhan,China.The patients were followed up until June 30,2020.Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning.Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation(IMV)-only therapy.Of 88 patients receiving ECMO therapy,27 and 61 patients were and were not successfully weaned from ECMO,respectively.Additionally,15,15,and 65 patients were further weaned from IMV,discharged from hospital,or died during hospitalization,respectively.In the multivariate logistic regression analysis,a lymphocyte count ≤0.5×109/L and D-dimer concentration ＞4x the upper limit of normal level at ICU admission,a peak PaCO2 ＞60 mmHg at 24 h before ECMO initiation,and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning.In the propensity score-matched analysis,a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group.The presence of lymphocytopenia,higher D-dimer concentrations at ICU admission and hypercapnia before ECMO initiation could help to identify patients with a poor prognosis.Tracheotomy could facilitate weaning from ECMO.ECMO relative to IMV-only therapy was associated with improved outcomes in critically ill COVID-19 patients.

原文链接:

NETL
NSTL
万方数据
维普

Self-reported Taste and Smell Disorders in Patients with COVID-19:Distinct Features in China

Jia SONGYi-ke DENGHai WANGZhi-chao WANG...

14-23页

查看更多>>摘要：Last December 2019,a cluster of viral pneumonia cases identified as coronavirus disease 2019(COVID-19)was reported in Wuhan,China.We aimed to explore the frequencies of nasal symptoms in patients with COVID-19,including loss of smell and taste,as well as their presentation as the first symptom of the disease and their association with the severity of COVID-19.In this retrospective study,1206 laboratory-confirmed COVID-19 patients were included and followed up by telephone one month after discharged from Tongji Hospital,Wuhan.Demographic data,laboratory values,comorbidities,symptoms,and numerical rating scale scores(0-10)of nasal symptoms were extracted from the hospital medical records,and confirmed or reevaluated by the telephone follow-up.From patients(n=1172)completing follow-up,199(17％)subjects had severe COVID-19 and 342(29.2％)reported nasal symptoms.20.6％COVID-19 patients had loss of taste(median score=6),while 11.4％had loss of smell(median score=5).Loss of taste scores,but not loss of smell scores,were significantly increased in severe vs.non-severe COVID-19 patients.Interleukin(IL)-6 and lactose dehydrogenase(LDH)serum levels were positively correlated with loss of taste scores.About 80％of COVID-19 patients recovered from smell and taste dysfunction in 2 weeks.In this cohort,only 1 out of 10 hospital admitted patients had loss of smell while 1 out of 5 reported loss of taste which was associated to severity of COVID-19.Most patients recovered smell and taste dysfunctions in 2 weeks.

原文链接:

NETL
NSTL
万方数据
维普

Self-reported Taste and Smell Disorders in Patients with COVID-19:Distinct Features in China

Jia SONGYi-ke DENGHai WANGZhi-chao WANG...

14-23页

查看更多>>摘要：Last December 2019,a cluster of viral pneumonia cases identified as coronavirus disease 2019(COVID-19)was reported in Wuhan,China.We aimed to explore the frequencies of nasal symptoms in patients with COVID-19,including loss of smell and taste,as well as their presentation as the first symptom of the disease and their association with the severity of COVID-19.In this retrospective study,1206 laboratory-confirmed COVID-19 patients were included and followed up by telephone one month after discharged from Tongji Hospital,Wuhan.Demographic data,laboratory values,comorbidities,symptoms,and numerical rating scale scores(0-10)of nasal symptoms were extracted from the hospital medical records,and confirmed or reevaluated by the telephone follow-up.From patients(n=1172)completing follow-up,199(17％)subjects had severe COVID-19 and 342(29.2％)reported nasal symptoms.20.6％COVID-19 patients had loss of taste(median score=6),while 11.4％had loss of smell(median score=5).Loss of taste scores,but not loss of smell scores,were significantly increased in severe vs.non-severe COVID-19 patients.Interleukin(IL)-6 and lactose dehydrogenase(LDH)serum levels were positively correlated with loss of taste scores.About 80％of COVID-19 patients recovered from smell and taste dysfunction in 2 weeks.In this cohort,only 1 out of 10 hospital admitted patients had loss of smell while 1 out of 5 reported loss of taste which was associated to severity of COVID-19.Most patients recovered smell and taste dysfunctions in 2 weeks.

原文链接:

NETL
NSTL
万方数据
维普

Corticosteroids Treatment of Patients with Coronavirus Disease 2019:A Propensity Score Matching Study

Meng-yuan LIANGPing CHENMiao HEJian TANG...

24-30页

查看更多>>摘要：The role of corticosteroids in the treatment of coronavirus disease 2019(COVID-19)is controversial.In the present study,we evaluated the effects of adjuvant corticosteroids treatment on the outcome of patients with COVID-19(n=966),using Propensity Score Matching to adjust for potential differences between the corticosteroids group(n=289)and the non-corticosteroids group(n=677).Analysis of data without adjusting differences in baseline characteristics indicated that the proportion of mechanical ventilation and the mortality was higher in the corticosteroids treatment group in total or severe/critical patients.The duration of viral shedding was longer in the non-corticosteroids treatment group in total or general/mild patients.After adjusting the difference between the corticosteroids and non-corticosteroids treatment group,the analysis revealed that the use of corticosteroids had no effect on the duration of viral shedding,in-hospital mortality or 28-day mortality.

原文链接:

NETL
NSTL
万方数据
维普

Corticosteroids Treatment of Patients with Coronavirus Disease 2019:A Propensity Score Matching Study

Meng-yuan LIANGPing CHENMiao HEJian TANG...

24-30页

查看更多>>摘要：The role of corticosteroids in the treatment of coronavirus disease 2019(COVID-19)is controversial.In the present study,we evaluated the effects of adjuvant corticosteroids treatment on the outcome of patients with COVID-19(n=966),using Propensity Score Matching to adjust for potential differences between the corticosteroids group(n=289)and the non-corticosteroids group(n=677).Analysis of data without adjusting differences in baseline characteristics indicated that the proportion of mechanical ventilation and the mortality was higher in the corticosteroids treatment group in total or severe/critical patients.The duration of viral shedding was longer in the non-corticosteroids treatment group in total or general/mild patients.After adjusting the difference between the corticosteroids and non-corticosteroids treatment group,the analysis revealed that the use of corticosteroids had no effect on the duration of viral shedding,in-hospital mortality or 28-day mortality.

原文链接:

NETL
NSTL
万方数据
维普

A Large Scale of Nurses Participated in Beating down COVID-19 in China:The Physical and Psychological Distress

Quan WANGJun-yao FANHui-min ZHAOYue-ting LIU...

31-38页

查看更多>>摘要：The outbreak of coronavirus disease 2019(COVID-19)posed an unprecedented threat to health care providers(HCPs)in Wuhan,China,especially for nurses who were frequently exposed to infected or suspected patients.Limited information was available about the working experience of nurses in fighting against the pandemic.To learn the physical and psychological responses of nurses during the pandemic and explore the potential determinants,we conducted a large-scale survey in Wuhan.This multicenter cross-sectional study enrolled 5521 nurses who worked in designated hospitals,mobile cabins,or shelters during the pandemic.A structured online questionnaire was distributed to assess the physical discomforts,emotional distress and cognitive reactions of nurses at work,and the log-binomial regression analysis was performed to explore potential determinants.A considerable proportion of nurses had symptoms of physical discomforts[3677(66.6％)]and emotional distress[4721(85.5％)].Nurses who were directly involved in the care of patients(i.e.,care for severe patients:RR,2.35;95％CI,1.95-2.84),with irregular work schedules(RR,2.36;95％CI,1.95-2.87),and working overtime(RR,1.34;95％CI,1.08-1.65)were at a higher risk for physical discomforts.Nurses who were directly involved in the care of patients(i.e.,care for severe patients:RR,1.78;95％CI,1.40-2.29),with irregular work schedules(RR,3.39;95％CI,2.43-4.73),and working overtime(RR,1.51;95％CI,1.12-2.04)were at a higher risk for emotional distress.Therefore,formulating reasonable work schedules and improving workforce systems are necessary to alleviate the physical and emotional distress of nurses during the pandemic.

原文链接:

NETL
NSTL
万方数据
维普

A Large Scale of Nurses Participated in Beating down COVID-19 in China:The Physical and Psychological Distress

Quan WANGJun-yao FANHui-min ZHAOYue-ting LIU...

31-38页

查看更多>>摘要：The outbreak of coronavirus disease 2019(COVID-19)posed an unprecedented threat to health care providers(HCPs)in Wuhan,China,especially for nurses who were frequently exposed to infected or suspected patients.Limited information was available about the working experience of nurses in fighting against the pandemic.To learn the physical and psychological responses of nurses during the pandemic and explore the potential determinants,we conducted a large-scale survey in Wuhan.This multicenter cross-sectional study enrolled 5521 nurses who worked in designated hospitals,mobile cabins,or shelters during the pandemic.A structured online questionnaire was distributed to assess the physical discomforts,emotional distress and cognitive reactions of nurses at work,and the log-binomial regression analysis was performed to explore potential determinants.A considerable proportion of nurses had symptoms of physical discomforts[3677(66.6％)]and emotional distress[4721(85.5％)].Nurses who were directly involved in the care of patients(i.e.,care for severe patients:RR,2.35;95％CI,1.95-2.84),with irregular work schedules(RR,2.36;95％CI,1.95-2.87),and working overtime(RR,1.34;95％CI,1.08-1.65)were at a higher risk for physical discomforts.Nurses who were directly involved in the care of patients(i.e.,care for severe patients:RR,1.78;95％CI,1.40-2.29),with irregular work schedules(RR,3.39;95％CI,2.43-4.73),and working overtime(RR,1.51;95％CI,1.12-2.04)were at a higher risk for emotional distress.Therefore,formulating reasonable work schedules and improving workforce systems are necessary to alleviate the physical and emotional distress of nurses during the pandemic.

原文链接:

NETL
NSTL
万方数据
维普

Infection-associated Hemophagocytic Syndrome in Critically Ill Patients with COVID-19

Kun YANGMing-you XINGLing-yu JIANGYan-ping CAI...

39-45页

查看更多>>摘要：Infection-associated hemophagocytic syndrome(IAHS),a severe complication of various infections,is potentially fatal.This study aims to determine whether IAHS occurs in critically ill patients with coronavirus disease 2019(COVID-19).We conducted a retrospective observational study on 268 critically ill patients with COVID-19 between February 1st,2020 and February 26th,2020.Demographics,clinical characteristics,laboratory results,information on concurrent treatments and outcomes were collected.A diagnosis of secondary hemophagocytic lymphohistiocytosis(sHLH)was made when the patients had an HScore greater than 169.Histopathological examinations were performed to confirm the presence of hemophagocytosis.Of 268 critically ill patients with confirmed SARS-CoV-2 infection,17(6.3％)patients had an HScore greater than 169.All the 17 patients with sHLH died.The interval from the onset of symptom of COVID-19 to the time of a diagnosis of sHLH made was 19 days and the interval from the diagnosis of sHLH to death was 4 days.Ten(59％)patients were infected with only SARS-CoV-2.Hemophagocytosis in the spleen and the liver,as well as lymphocyte infiltration in the liver on histopathological examinations,was found in 3 sHLH autopsy patients.Mortality in sHLH patients with COVID-19 is high.And SARS-CoV-2 is a potential trigger for sHLH.Prompt recognition of IAHS in critically ill patients with COVID-19 could be beneficial for improving clinical outcomes.

原文链接:

NETL
NSTL
万方数据
维普

Infection-associated Hemophagocytic Syndrome in Critically Ill Patients with COVID-19

Kun YANGMing-you XINGLing-yu JIANGYan-ping CAI...

39-45页

查看更多>>摘要：Infection-associated hemophagocytic syndrome(IAHS),a severe complication of various infections,is potentially fatal.This study aims to determine whether IAHS occurs in critically ill patients with coronavirus disease 2019(COVID-19).We conducted a retrospective observational study on 268 critically ill patients with COVID-19 between February 1st,2020 and February 26th,2020.Demographics,clinical characteristics,laboratory results,information on concurrent treatments and outcomes were collected.A diagnosis of secondary hemophagocytic lymphohistiocytosis(sHLH)was made when the patients had an HScore greater than 169.Histopathological examinations were performed to confirm the presence of hemophagocytosis.Of 268 critically ill patients with confirmed SARS-CoV-2 infection,17(6.3％)patients had an HScore greater than 169.All the 17 patients with sHLH died.The interval from the onset of symptom of COVID-19 to the time of a diagnosis of sHLH made was 19 days and the interval from the diagnosis of sHLH to death was 4 days.Ten(59％)patients were infected with only SARS-CoV-2.Hemophagocytosis in the spleen and the liver,as well as lymphocyte infiltration in the liver on histopathological examinations,was found in 3 sHLH autopsy patients.Mortality in sHLH patients with COVID-19 is high.And SARS-CoV-2 is a potential trigger for sHLH.Prompt recognition of IAHS in critically ill patients with COVID-19 could be beneficial for improving clinical outcomes.

原文链接:

NETL
NSTL
万方数据
维普

Characteristics of Viral Shedding in Respiratory Samples and Specific Antibodies Production in 564 COVID-19 Patients

Jing GONGHui DONGDing-kun WANGFu-er LU...

46-50页

查看更多>>摘要：Positive nucleic acid(NA)results have been found in recovered and discharged COVID-19 patients,but the proportion is unclear.This study was designed to analyze the recurrent positive rate of NA results after consecutively negative results,and the relationship between the specific antibody production and positive NA rate.According to Strengthening the Reporting of Observational Studies in Epidemiology guidelines,data of inpatients in Sino-French New City Branch of Tongji Hospital between Jan.28 and Mar.6,2020 were collected.A total of 564 COVID-19 patients over 14 years old who received the examinations of NA and antibodies against SARS-CoV-2 were included.Days of viral shedding and specific antibodies were recorded and assessed.Among NA tests in respiratory samples(throat swabs,nasopharyngeal swabs,sputum and flushing fluid in alveoli),the patients with all-negative NA results accounted for 17.20％,those with single-positive results for 46.63％,and those with multiple-positive results for 36.17％respectively.Besides,the recurrent positive NA results after consecutively negative results appeared in 66 patients(11.70％).For multiple-positive patients,median viral shedding duration was 20 days(range:1 to 57 days).Of the 205 patients who received 2 or more antibody tests,141(68.78％)had decreased IgG and IgM concentrations.IgM decreased to normal range in 24 patients,with a median of 44 days from symptom onset.Viral shedding duration was not significantly correlated with gender,age,disease severity,changes in pulmonary imaging,and antibody concentration.It is concluded that antibody level and antibody change had no significant correlation with the positive rate of NA tests and the conversion rate after continuous negative NA tests.In order to reduce the recurrent positive proportion after discharge,3 or more consecutive negative NA test results with test interval more than 24 h every time are suggested for the discharge or release from quarantine.

原文链接:

NETL
NSTL
万方数据
维普