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Pingping Z, Yanyu Z, Xuri S, Qiming H, Yi W, Guoliang T. Comparison between original SARS-CoV-2 strain and omicron variant on thin-section chest CT imaging of COVID-19 pneumonia. Radiologie (Heidelb) 2023; 63:55-63. [PMID: 37280418 PMCID: PMC10243278 DOI: 10.1007/s00117-023-01147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We investigated different computed tomography (CT) features between Omicron-variant and original-strain SARS-CoV‑2 pneumonia to facilitate the clinical management. MATERIALS AND METHODS Medical records were retrospectively reviewed to select patients with original-strain SARS-CoV‑2 pneumonia from February 22 to April 22, 2020, or Omicron-variant SARS-CoV‑2 pneumonia from March 26 to May 31, 2022. Data on the demographics, comorbidities, symptoms, clinical types, and CT features were compared between the two groups. RESULTS There were 62 and 78 patients with original-strain or Omicron-variant SARS-CoV‑2 pneumonia, respectively. There were no differences between the two groups in terms of age, sex, clinical types, symptoms, and comorbidities. The main CT features differed between the two groups (p = 0.003). There were 37 (59.7%) and 20 (25.6%) patients with ground-glass opacities (GGO) in the original-strain and Omicron-variant pneumonia, respectively. A consolidation pattern was more frequently observed in the Omicron-variant than original-strain pneumonia (62.8% vs. 24.2%). There was no difference in crazy-paving pattern between the original-strain and Omicron-variant pneumonia (16.1% vs. 11.6%). Pleural effusion was observed more often in Omicron-variant pneumonia, while subpleural lesions were more common in the original-strain pneumonia. The CT score in the Omicron-variant group was higher than that in the original-strain group for critical-type (17.00, 16.00-18.00 vs. 16.00, 14.00-17.00, p = 0.031) and for severe-type (13.00, 12.00-14.00 vs 12.00, 10.75-13.00, p = 0.027) pneumonia. CONCLUSION The main CT finding of the Omicron-variant SARS-CoV‑2 pneumonia included consolidations and pleural effusion. By contrast, CT findings of original-strain SARS-CoV‑2 pneumonia showed frequent GGO and subpleural lesions, but without pleural effusion. The CT scores were also higher in the critical and severe types of Omicron-variant than original-strain pneumonia.
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Affiliation(s)
- Zeng Pingping
- Department ICU of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Zhou Yanyu
- Department ICU of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Sun Xuri
- Department ICU of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Huang Qiming
- Department of Medical Imaging of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Wang Yi
- Department of Medical Imaging of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Tan Guoliang
- Department ICU of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China.
- Wuhan Jinyintan Hospital, Wuhan City, China.
- The Fourth People's Hospital of Shanghai, Shanghai City, China.
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Chen J, Ding Z. Advances in natural product anti-coronavirus research (2002-2022). Chin Med 2023; 18:13. [PMID: 36782317 PMCID: PMC9924896 DOI: 10.1186/s13020-023-00715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
COVID-19 is a severe acute respiratory syndrome caused by coronavirus that has triggered acute respiratory infections in countries around the world. In the last 20 years, there have been several outbreaks of coronaviruses, which have had a tremendous impact on productive life and globalization. Since coronaviruses are mutagenic and highly susceptible to mutation, there are no specific drugs against coronaviruses. Medicines made from natural products gains worldwide attention, and the mechanism and effectiveness of natural products for the treatment of coronavirus-related diseases have received much attention after the global pandemic of COVID-19 in 2020. The vitro research results and clinical data from various countries have shown protective effects of good effects against coronaviruses. This review summarizes representative natural products for the treatment of coronavirus-related diseases in the past 20 years, and demonstrates the promising prospects of natural products against coronavirus-related diseases by listing herbal formulas, Chinese patent medicines and natural small molecule compounds and their therapeutic mechanisms, providing references for subsequent related studies.
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Affiliation(s)
- Jiaxin Chen
- grid.254147.10000 0000 9776 7793School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu China
| | - Zuoqi Ding
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China. .,Editorial Board of Chinese Journal of Natural Medicines, Nanjing, Jiangsu, China.
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Alhares H, Tanha J, Balafar MA. AMTLDC: a new adversarial multi-source transfer learning framework to diagnosis of COVID-19. Evol Syst (Berl) 2023; 14:1-15. [PMID: 38625255 PMCID: PMC9838404 DOI: 10.1007/s12530-023-09484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
In recent years, deep learning techniques have been widely used to diagnose diseases. However, in some tasks, such as the diagnosis of COVID-19 disease, due to insufficient data, the model is not properly trained and as a result, the generalizability of the model decreases. For example, if the model is trained on a CT scan dataset and tested on another CT scan dataset, it predicts near-random results. To address this, data from several different sources can be combined using transfer learning, taking into account the intrinsic and natural differences in existing datasets obtained with different medical imaging tools and approaches. In this paper, to improve the transfer learning technique and better generalizability between multiple data sources, we propose a multi-source adversarial transfer learning model, namely AMTLDC. In AMTLDC, representations are learned that are similar among the sources. In other words, extracted representations are general and not dependent on the particular dataset domain. We apply the AMTLDC to predict Covid-19 from medical images using a convolutional neural network. We show that accuracy can be improved using the AMTLDC framework, and surpass the results of current successful transfer learning approaches. In particular, we show that the AMTLDC works well when using different dataset domains, or when there is insufficient data.
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Affiliation(s)
- Hadi Alhares
- Department of Computer Engineering, Faculty of Electrical and Computer Engineering, University of Tabriz, 29th Bahman Blvd, Tabriz, 5166616471 Iran
| | - Jafar Tanha
- Department of Computer Engineering, Faculty of Electrical and Computer Engineering, University of Tabriz, 29th Bahman Blvd, Tabriz, 5166616471 Iran
| | - Mohammad Ali Balafar
- Department of Computer Engineering, Faculty of Electrical and Computer Engineering, University of Tabriz, 29th Bahman Blvd, Tabriz, 5166616471 Iran
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Montalbo FJ. Truncating fined-tuned vision-based models to lightweight deployable diagnostic tools for SARS-CoV-2 infected chest X-rays and CT-scans. Multimed Tools Appl 2022; 81:16411-16439. [PMID: 35261555 PMCID: PMC8893243 DOI: 10.1007/s11042-022-12484-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/05/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
In such a brief period, the recent coronavirus (COVID-19) already infected large populations worldwide. Diagnosing an infected individual requires a Real-Time Polymerase Chain Reaction (RT-PCR) test, which can become expensive and limited in most developing countries, making them rely on alternatives like Chest X-Rays (CXR) or Computerized Tomography (CT) scans. However, results from these imaging approaches radiated confusion for medical experts due to their similarities with other diseases like pneumonia. Other solutions based on Deep Convolutional Neural Network (DCNN) recently improved and automated the diagnosis of COVID-19 from CXRs and CT scans. However, upon examination, most proposed studies focused primarily on accuracy rather than deployment and reproduction, which may cause them to become difficult to reproduce and implement in locations with inadequate computing resources. Therefore, instead of focusing only on accuracy, this work investigated the effects of parameter reduction through a proposed truncation method and analyzed its effects. Various DCNNs had their architectures truncated, which retained only their initial core block, reducing their parameter sizes to <1 M. Once trained and validated, findings have shown that a DCNN with robust layer aggregations like the InceptionResNetV2 had less vulnerability to the adverse effects of the proposed truncation. The results also showed that from its full-length size of 55 M with 98.67% accuracy, the proposed truncation reduced its parameters to only 441 K and still attained an accuracy of 97.41%, outperforming other studies based on its size to performance ratio.
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Affiliation(s)
- Francis Jesmar Montalbo
- College of Informatics and Computing Sciences, Batangas State University, Rizal Avenue Extension, Batangas, Batangas City, Philippines
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Alipour Z, Samadi P, Eskandari N, Ghaedrahmati M, Vahedian M, Khalajinia Z, Mastanijahroodi A. Relationship between coronavirus disease 2019 in pregnancy and maternal and fetal outcomes: Retrospective analytical cohort study. Midwifery 2021; 102:103128. [PMID: 34474247 PMCID: PMC8384487 DOI: 10.1016/j.midw.2021.103128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/08/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has caused many deaths and complications worldwide. However, limited data are available about COVID-19 during pregnancy. This study aimed to assess the epidemiological and clinical features of COVID-19, and the adverse maternal and fetal outcomes. DESIGN This retrospective analytical cohort study was conducted on all pregnant women with confirmed COVID-19 at Nekouei-Hedayati-Forghani Hospital in Qom, Iran from 15 March 2020 to 15 November 2020. For the same period, 165 pregnant women who did not have COVID-19 were selected at random and included in this study. All epidemiological and clinical features were collected from the medical records of the participants. A logistic regression model was used to determine associations between COVID-19 in pregnancy and maternal and fetal outcomes. FINDINGS The most common symptoms reported by pregnant women with COVID-19 were shortness of breath (60.9%), dry cough (59%) and fever (42.9%). After adjustment for potential confounding factors, COVID-19 in pregnancy was associated with a significantly higher risk of admission to the intensive care unit (ICU) [odds ratio (OR) 6.16, 95% confidence interval (CI) 1.23-31], caesarean section (OR 0.45, 95 CI 0.25-1.03), preterm birth (OR 3.01, 95% CI 1.4-6.54), fetal distress (OR 5.7, 95% CI 2.13-15.59) and admission to the neonatal intensive care unit (NICU) (OR 3.04, 95% CI 1.21-7.70). KEY CONCLUSIONS COVID-19 is associated with adverse maternal and fetal outcomes, including ICU admission, caesarean section, fetal distress, preterm birth and NICU admission.
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Affiliation(s)
- Zahra Alipour
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Parisa Samadi
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Narges Eskandari
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | | | - Mostafa Vahedian
- Faculty of Medical Sciences, Qom University of Medical Sciences, Qom, Iran
| | - Zohre Khalajinia
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Ali Mastanijahroodi
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
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Blagova OV, Varionchik NV, Zaidenov VA, Savina PO, Sarkisova ND. Previous and First Detected Cardiovascular Diseases in Patients with New Coronavirus Pneumonia: Possible Mechanisms and Place in a Unified Prognostic Model. Int Arch Allergy Immunol 2021; 182:765-774. [PMID: 34010841 DOI: 10.1159/000515253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the frequency of cardiac involvement in patients with coronavirus disease 2019 (COVID-19), possible immune mechanisms of myocardial injury, and the place of cardiovascular pathology among other prognostic factors. METHODS The study included 86 patients (48 male, 60.2 ± 16.6 years) with COVID-19. In addition to common investigation, examination of troponin T (n = 18) and anti-heart antibodies (AHA, n = 34) were used. The average hospital period was 14 [12; 18] days. RESULTS The incidence of cardiovascular disease and symptoms was 45.3%. Arrhythmias, heart failure, low-QRS voltage, repolarization disorders, and pericardial effusion were the typical for coronavirus cardiac injury. The level of AHA was increased in 73.5%. Significant (p < 0.05) correlations of AHA level with inflammatory activity, pneumonia, respiratory failure, cardiac symptoms, and death were found. D-dimer >0.5 μg/mL had a sensitivity of 79.2% and specificity of 60% in the prediction of cardiovascular manifestations. Cardiac failure was one of the causes of death in 3/8 patients (37.5%). Lethality in the presence of cardiovascular pathology was 17.9 versus 2.2% without it, p < 0.05. The most powerful prognostic model includes age, diabetes, oxygen therapy volume, maximum leukocyte level, C-reactive protein, and D-dimer (correlation coefficient 0.871, p < 0.001). The model with only age, diabetes, and cardiovascular disease included also had predictive power (correlation coefficient 0.568, p < 0.001). CONCLUSIONS The cardiovascular pathology is frequent in patients with COVID-19 and strong correlates with the D-dimer. It indicates the high significance of prothrombotic and ischemic mechanisms. High AHA levels may reflect an inflammatory heart injury. The cardiovascular pathology is associated with higher lethality.
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Affiliation(s)
- Olga V Blagova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Nadezhda V Varionchik
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - Polina O Savina
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Natalia D Sarkisova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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7
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Coppadoro A, Benini A, Fruscio R, Verga L, Mazzola P, Bellelli G, Carbone M, Mulinacci G, Soria A, Noè B, Beck E, Di Sciacca R, Ippolito D, Citerio G, Valsecchi MG, Biondi A, Pesci A, Bonfanti P, Gaudesi D, Bellani G, Foti G. Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak. Crit Care 2021; 25:80. [PMID: 33627169 PMCID: PMC7903369 DOI: 10.1186/s13054-021-03502-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/10/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI). METHODS In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients' data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death. RESULTS A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards. CONCLUSIONS Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival. TRIAL REGISTRATION NCT04424992.
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Affiliation(s)
- Andrea Coppadoro
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Annalisa Benini
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Robert Fruscio
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Luisa Verga
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Paolo Mazzola
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Giuseppe Bellelli
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Marco Carbone
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Giacomo Mulinacci
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Alessandro Soria
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Beatrice Noè
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Eduardo Beck
- grid.413643.70000 0004 1760 8047ASST Monza, Desio Hospital, Desio, Italy
| | - Riccardo Di Sciacca
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Davide Ippolito
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Citerio
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Maria Grazia Valsecchi
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Andrea Biondi
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Alberto Pesci
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Paolo Bonfanti
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Davide Gaudesi
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Giacomo Bellani
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Giuseppe Foti
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
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Ticinesi A, Cerundolo N, Parise A, Nouvenne A, Prati B, Guerra A, Lauretani F, Maggio M, Meschi T. Delirium in COVID-19: epidemiology and clinical correlations in a large group of patients admitted to an academic hospital. Aging Clin Exp Res 2020; 32:2159-2166. [PMID: 32946031 PMCID: PMC7498987 DOI: 10.1007/s40520-020-01699-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/26/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Delirium incidence and clinical correlates in coronavirus disease-19 (COVID-19) pneumonia are still poorly investigated. AIM To describe the epidemiology of delirium in patients hospitalized for suspect COVID-19 pneumonia during the pandemic peak in an academic hospital of Northern Italy, identify its clinical correlations and evaluate the association with mortality. METHODS The clinical records of 852 patients admitted for suspect COVID-19 pneumonia, defined as respiratory symptoms or fever or certain history of contact with COVID-19 patients, plus chest CT imaging compatible with alveolar-interstitial pneumonia, were retrospectively analyzed. Delirium was defined after careful revision of daily clinical reports in accordance with the Confusion Assessment Method criteria. Data on age, clinical presentation, comorbidities, drugs, baseline lab tests and outcome were collected. The factors associated with delirium, and the association of delirium with mortality, were evaluated through binary logistic regression models. RESULTS Ninety-four patients (11%) developed delirium during stay. They were older (median age 82, interquartile range, IQR 78-89, vs 75, IQR 63-84, p < 0.001), had more neuropsychiatric comorbidities and worse respiratory exchanges at baseline. At multivariate models, delirium was independently and positively associated with age [odds ratio (OR) 1.093, 95% confidence interval (CI) 1.046-1.143, p < 0.001], use of antipsychotic drugs (OR 4.529, 95% CI 1.204-17.027, p = 0.025), serum urea and lactate-dehydrogenase at admission. Despite a higher mortality in patients with delirium (57% vs 30%), this association was not independent of age and respiratory parameters. CONCLUSIONS Delirium represents a common complication of COVID-19 and a marker of severe disease course, especially in older patients with neuropsychiatric comorbidity.
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Affiliation(s)
- Andrea Ticinesi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy.
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fulvio Lauretani
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Maggio
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tiziana Meschi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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9
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Shu L, Niu C, Li R, Huang T, Wang Y, Huang M, Ji N, Zheng Y, Chen X, Shi L, Wu M, Deng K, Wei J, Wang X, Cao Y, Yan J, Feng G. Treatment of severe COVID-19 with human umbilical cord mesenchymal stem cells. Stem Cell Res Ther 2020; 11:361. [PMID: 32811531 PMCID: PMC7432540 DOI: 10.1186/s13287-020-01875-5] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 is a highly infectious respiratory disease. No therapeutics have yet been proven effective for treating severe COVID-19. Objectives To determine whether human umbilical cord mesenchymal stem cell infusion may be effective and safe for the treatment of severe COVID-19. Methods Patients with severe COVID-19 were randomly divided into 2 groups: the standard treatment group and the standard treatment plus hUC-MSC infusion group. The incidence of progression from severe to critical illness, 28-day mortality, clinical symptom improvement, time to clinical symptom improvement, hematologic indicators including C-reactive protein, lymphocyte number, and interleukin 6, and imaging changes were observed and compared between the two groups. Measurements and main results The incidence of progression from severe to critical illness and the 28-day mortality rate were 0 in the hUC-MSC treatment group, while 4 patients in the control group deteriorated to critical condition and received invasive ventilation; 3 of them died, and the 28-day mortality rate was 10.34%. In the hUC-MSC treatment group, the time to clinical improvement was shorter than that in the control group. Clinical symptoms of weakness and fatigue, shortness of breath, and low oxygen saturation obviously improved beginning on the third day of stem cell infusion and reached a significant difference on day 7. CRP and IL-6 levels were significantly lower from day 3 of infusion, the time for the lymphocyte count to return to the normal range was significantly faster, and lung inflammation absorption was significantly shorter on CT imaging in the hUC-MSC group than in the control group. Conclusions Intravenous transplantation of hUC-MSCs is a safe and effective method that can be considered a salvage and priority treatment option for severe COVID-19. Trial registration Chinese Clinical Trial Registration; ChiCTR2000031494; Registered on 2 April 2020; http://www.medresman.org
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Affiliation(s)
- Lei Shu
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.,Department of Respiratory Medicine, the Second Clinical Medical School of Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Changming Niu
- Department of Critical Care Medicine, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Ruyou Li
- Department of Respiratory Medicine, Huangshi Central Hospital, Hangshi, 435000, Hubei, China
| | - Tingrong Huang
- Department of Nephrology, Huangshi Hospital of Traditional Chinese Medicine, Hangshi, 435000, Hubei, China
| | - Yan Wang
- Jiangsu Cell Tech Medical Research Institute, Nanjing, 211166, Jiangsu, China
| | - Mao Huang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ningfei Ji
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - You Zheng
- Department of Nephrology, Huangshi Hospital of Traditional Chinese Medicine, Hangshi, 435000, Hubei, China
| | - Xiaolin Chen
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Lei Shi
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Mingjing Wu
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Kaili Deng
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Jing Wei
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Xueli Wang
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Yang Cao
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Jiaxin Yan
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Ganzhu Feng
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Nanjing Medical University, Address: No. 121 Jiangjiayuan Rd, Gulou District, Nanjing, 210011, Jiangsu, China.
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10
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Zheng Z, Yao Z, Wu K, Zheng J. The diagnosis of pandemic coronavirus pneumonia: A review of radiology examination and laboratory test. J Clin Virol 2020; 128:104396. [PMID: 32438256 PMCID: PMC7189856 DOI: 10.1016/j.jcv.2020.104396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
Since the outbreak of novel coronavirus disease 2019 (COVID-19), epidemic prevention strategies have been implemented worldwide. For the sake of controlling the infectious coronavirus pneumonia, early diagnosis and quarantine play an imperative role. Currently, the mainstream diagnostic methods are imaging and laboratory diagnosis, which differ in their efficacy of diagnosis. To compare the detection rate, we reviewed numerous literature on pneumonia caused by coronaviruses (SARS, MERS, and SARS-CoV-2) and analyzed two different ways of diagnosis. The results showed that the detection rate of computed tomography (CT) diagnosis was significantly higher than that of real-time quantitative polymerase chain reaction (qPCR) (P = 0.00697). Still, clinicians should combine radiology and laboratory methods to achieve a higher detection rate, so that instant isolation and treatment could be effectively conducted to curb the rampant spread of the epidemic.
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Affiliation(s)
- Zhong Zheng
- Department of Evidence-based Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; Shanghai Medical Aid Team in Wuhan, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zhixian Yao
- Department of Evidence-based Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; Shanghai Medical Aid Team in Wuhan, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ke Wu
- Department of Evidence-based Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; Shanghai Medical Aid Team in Wuhan, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
| | - Junhua Zheng
- Department of Evidence-based Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; Shanghai Medical Aid Team in Wuhan, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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11
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Nouvenne A, Zani MD, Milanese G, Parise A, Baciarello M, Bignami EG, Odone A, Sverzellati N, Meschi T, Ticinesi A. Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission. Respiration 2020; 99:617-624. [PMID: 32570265 PMCID: PMC7360505 DOI: 10.1159/000509223] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background Lung ultrasound (LUS) is an accurate, safe, and cheap tool assisting in the diagnosis of several acute respiratory diseases. The diagnostic value of LUS in the workup of coronavirus disease-19 (COVID-19) in the hospital setting is still uncertain. Objectives The aim of this observational study was to explore correlations of the LUS appearance of COVID-19-related pneumonia with CT findings. Methods Twenty-six patients (14 males, age 64 ± 16 years) urgently hospitalized for COVID-19 pneumonia, who underwent chest CT and bedside LUS on the day of admission, were enrolled in this observational study. CT images were reviewed by expert chest radiologists, who calculated a visual CT score based on extension and distribution of ground-glass opacities and consolidations. LUS was performed by clinicians with certified competency in thoracic ultrasonography, blind to CT findings, following a systematic approach recommended by ultrasound guidelines. LUS score was calculated according to presence, distribution, and severity of abnormalities. Results All participants had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 43 ± 24%. LUS identified 4 different possible abnormalities, with bilateral distribution (average LUS score 15 ± 5): focal areas of nonconfluent B lines, diffuse confluent B lines, small subpleural microconsolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (r = 0.65, p < 0.001) and oxygen saturation in room air (r = −0.66, p < 0.001). Conclusion When integrated with clinical data, LUS could represent a valid diagnostic aid in patients with suspect COVID-19 pneumonia, which reflects CT findings.
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Affiliation(s)
- Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marco Davìd Zani
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gianluca Milanese
- Diagnostic Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marco Baciarello
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,General and Specialized Surgical Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elena Giovanna Bignami
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,General and Specialized Surgical Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Anna Odone
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Diagnostic Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziana Meschi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Ticinesi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy,
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12
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Carotti M, Salaffi F, Sarzi-Puttini P, Agostini A, Borgheresi A, Minorati D, Galli M, Marotto D, Giovagnoni A. Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: key points for radiologists. Radiol Med 2020; 125:636-646. [PMID: 32500509 PMCID: PMC7270744 DOI: 10.1007/s11547-020-01237-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022]
Abstract
COVID-19 is an emerging infection caused by a novel coronavirus that is moving so rapidly that on 30 January 2020 the World Health Organization declared the outbreak a Public Health Emergency of International Concern and on 11 March 2020 as a pandemic. An early diagnosis of COVID-19 is crucial for disease treatment and control of the disease spread. Real-time reverse-transcription polymerase chain reaction (RT-PCR) demonstrated a low sensibility; therefore chest computed tomography (CT) plays a pivotal role not only in the early detection and diagnosis, especially for false negative RT-PCR tests, but also in monitoring the clinical course and in evaluating the disease severity. This paper reports the CT findings with some hints on the temporal changes over the course of the disease: the CT hallmarks of COVID-19 are bilateral distribution of ground glass opacities with or without consolidation in the posterior and peripheral lung, but the predominant findings in later phases include consolidations, linear opacities, “crazy-paving” pattern, “reversed halo” sign and vascular enlargement. The CT findings of COVID-19 overlap with the CT findings of other diseases, in particular the viral pneumonia including influenza viruses, parainfluenza virus, adenovirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, etc. There are differences as well as similarities in the CT features of COVID-19 compared with those of the severe acute respiratory syndrome. The aim of this article is to review the typical and atypical CT findings in COVID-19 patients in order to help radiologists and clinicians to become more familiar with the disease.
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Affiliation(s)
- Marina Carotti
- Dipartimento di Scienze Radiologiche S. O. D. Radiologia Pediatrica e Specialistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Via Conca 71, 60030, Ancona, AN, Italy. .,Dipartimento di Scienze Cliniche Specialistiche e Odontostomatologiche, University Politecnica delle Marche, Ancona, AN, Italy.
| | - Fausto Salaffi
- Clinica Reumatologica, Ospedale "Carlo Urbani", Jesi, AN, Italy.,Dipartimento di Scienze Cliniche e Molecolari, University Politecnica delle Marche, Ancona, AN, Italy
| | - Piercarlo Sarzi-Puttini
- Divisione di Reumatologia, Dipartimento di Medicina Interna, ASST Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
| | - Andrea Agostini
- Dipartimento di Scienze Radiologiche S. O. D. Radiologia Pediatrica e Specialistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Via Conca 71, 60030, Ancona, AN, Italy.,Dipartimento di Scienze Cliniche Specialistiche e Odontostomatologiche, University Politecnica delle Marche, Ancona, AN, Italy
| | - Alessandra Borgheresi
- Dipartimento di Scienze Radiologiche S. O. D. Radiologia Pediatrica e Specialistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Via Conca 71, 60030, Ancona, AN, Italy
| | - Davide Minorati
- Dipartimento di Radiologia. ASST Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
| | - Massimo Galli
- Divisione di Malattie Infettive, Department di Scienze Cliniche e Biomolecolari, ASST Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
| | - Daniela Marotto
- Divisione di Reumatologia, Dipartimento di Medicina Interna, ASST Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
| | - Andrea Giovagnoni
- Dipartimento di Scienze Radiologiche S. O. D. Radiologia Pediatrica e Specialistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Via Conca 71, 60030, Ancona, AN, Italy.,Dipartimento di Scienze Cliniche Specialistiche e Odontostomatologiche, University Politecnica delle Marche, Ancona, AN, Italy
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13
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Abstract
The pandemic of 2019 coronavirus disease (COVID-19) has burdened an unprecedented psychological stress on people around the world, especially the medical workforce. The study focuses on assess the psychological status of them. The authors conducted a single-center, cross-sectional survey via online questionnaires. Occurrence of fear, anxiety and depression were measured by the numeric rating scale (NRS) on fear, Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD), respectively. A total of 2299 eligible participants were enrolled from the authors' institution, including 2042 medical staff and 257 administrative staff. The severity of fear, anxiety and depression were significantly different between two groups. Furthermore, as compared to the non-clinical staff, front line medical staff with close contact with infected patients, including working in the departments of respiratory, emergency, infectious disease, and ICU, showed higher scores on fear scale, HAMA and HAMD, and they were 1.4 times more likely to feel fear, twice more likely to suffer anxiety and depression. The medical staff especially working in above-mentioned departments made them more susceptible to psychological disorders. Effective strategies toward to improving the mental health should be provided to these individuals.
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Affiliation(s)
- Wen Lu
- Department of healthcare and disease control and prevention, Fujian Provincial Hospital, Fuzhou, Fujian, China.
| | - Hang Wang
- Department of healthcare and disease control and prevention, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China
| | - Yuxing Lin
- Department of health examination center, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Li Li
- Department of healthcare and disease control and prevention, Fujian Provincial Hospital, Fuzhou, Fujian, China.
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14
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Hu XH, Niu WB, Zhang JF, Li BK, Yu B, Zhang ZY, Zhou CX, Zhang XN, Gao Y, Wang GY. [Thinking of treatment strategies for colorectal cancer patients in tumor hospitals under the background of coronavirus pneumonia]. Zhonghua Wei Chang Wai Ke Za Zhi 2020; 23:E002. [PMID: 32084675 DOI: 10.3760/cma.j.cn441530-20200217-00058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In December 2019, a new outbreak of coronavirus pneumonia began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies(including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.
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Affiliation(s)
- X H Hu
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - W B Niu
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - J F Zhang
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - B K Li
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - B Yu
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - Z Y Zhang
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - C X Zhou
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - X N Zhang
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - Y Gao
- The Second Department of General Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050000, China
| | - G Y Wang
- Department of Surgery, The Third Hospital, Hebei Medical University, Shijiazhuang 050051, China
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