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Guidelines for the Prevention, Diagnosis, Care and Treatment for People with Chronic Hepatitis B Infection (Text Extract): Executive Summary. 慢性乙型肝炎感染者的预防、诊断、护理和治疗指南(文本摘录):执行摘要。
Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1097/ID9.0000000000000128
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引用次数: 0
Clinical Epidemiology, Illness Profiles, and the Implication of COVID-19 Before and After the Nationwide Omicron Outbreak During the Winter of 2022 2022 年冬季全国范围内爆发欧米茄疫情前后的临床流行病学、疾病概况以及 COVID-19 的影响
Pub Date : 2023-10-01 DOI: 10.1097/ID9.0000000000000101
Yuming Guo, Zhe Xu, Wen-Xin Wang, C. Zhen, Jinhua Hu, Jinsong Mu, Chengcheng Ji, Xin Yuan, R. Xu, Lei Huang, Lei Shi, F. Meng, Jun‐liang Fu, Shuangnan Zhou, Siyu Wang, Fengyi Li, B. Tu, Dawei Zhang, Hui‐huang Huang, Yufeng Mao, Wenxin Xu, Chao Zhang, X. Mu, Jun Zhao, B. Jin, Haibin Su, Yinying Lu, Yongqian Cheng, Dong Ji, Shaoli You, Jing-hui Dong, Changchun Liu, Mengmeng Zhang, Yuan-yuan Li, T. Jiang, Yonggang Li, Furang Wang
Abstract Background The outbreak and prevalence of the Omicron variant have threatened human health since March 2022 in mainland China. In this study, we aimed to investigate the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) in the Beijing region. Methods In this retrospective study, we enrolled inpatients admitted for COVID-19 in the Fifth Medical Center of Chinese PLA General Hospital in Beijing between November 10, 2022, and January 30, 2023. Demographic and clinical features and treatment outcomes were comprehensively analyzed. We used logistic regression and linear regression analyses to explore the risk factors associated with disease severity and time of nucleic acid conversion, respectively. Results A total of 1010 hospitalized patients with COVID-19 were enrolled. The median age was 43.0 years (interquartile range, 28.0–63.0), and patients aged <60 years and ≥60 years comprised 71.2% and 28.8% of total included patients, respectively. The clinical classification of mild (74.6%, 753/1010), moderate (21.0%, 212/1010), severe (2.7%, 27/1010), and unidentified (1.8%, 18/1010) was separately recorded; 1005 patients were discharged, and 5 patients died in the hospital. The outbreak of the emerging epidemic witnessed an evident increase in the proportion of moderate (42.9% vs. 16.4%) and severe (10.3% vs. 1.1%) cases after December 7, 2022. Patients with a moderate/severe classification had higher levels of procalcitonin, IL-6, serum ferritin, C-reactive protein, lactic dehydrogenase, serum urea nitrogen, and d-dimer and lower counts of CD4+ T, CD8+ T, and B cells (all P < 0.001). Multivariable regression analysis revealed that increased odds of disease severity were associated with the following factors: age ≥60 years, IL-6 > 7 pg/mL, lactic dehydrogenase level >245 U/L, cough, and fever at admission. Age ≥80 years and chronic lung disease were independent risk factors in the nonmild group in elderly patients. In addition, the duration for nucleic acid to turn negative was approximately 5.0 d (interquartile range, 3.0–7.0). Prolonged time of nucleic acid conversion was associated with age ≥60 years, serum urea nitrogen level >8.2 mmol/L, neutrophil count >7 ×109/L, and the presence of a chronic lung disease or carcinoma. Finally, unvaccinated patients accounted for 37.3% of enrolled patients; children and the elder people accounted for approximately half of that. The univariable analysis found that booster doses reduced disease severity and shortened the time of nucleic acid conversion in elderly patients. Conclusions The outbreak of Omicron rapidly increased the number of patients with COVID-19 in Beijing. In elderly patients, booster doses may reduce disease severity and shorten the time of nucleic acid conversion. Healthcare systems should be optimized before an emerging epidemic outbreak.
摘要 背景 2022年3月以来,奥米克变异株在中国大陆的爆发和流行威胁着人类健康。本研究旨在调查北京地区冠状病毒病 2019(COVID-19)患者的临床特征和预后。方法 在这项回顾性研究中,我们纳入了2022年11月10日至2023年1月30日期间在北京中国人民解放军总医院第五医学中心收治的COVID-19住院患者。我们对患者的人口统计学特征、临床特征和治疗结果进行了全面分析。我们采用逻辑回归和线性回归分析分别探讨了与疾病严重程度和核酸转换时间相关的风险因素。结果 共纳入了 1010 名 COVID-19 住院患者。中位年龄为 43.0 岁(四分位距为 28.0-63.0),入院时年龄为 7 pg/mL、乳酸脱氢酶水平 >245 U/L、咳嗽和发烧。年龄≥80 岁和慢性肺部疾病是非轻度组老年患者的独立风险因素。此外,核酸转阴的时间约为 5.0 d(四分位数间距,3.0-7.0)。核酸转阴时间延长与年龄≥60岁、血清尿素氮水平>8.2 mmol/L、中性粒细胞计数>7 ×109/L、患有慢性肺部疾病或癌症有关。最后,未接种疫苗的患者占登记患者的 37.3%;儿童和老年人约占一半。单变量分析发现,加强剂量可减轻老年患者的疾病严重程度并缩短核酸转换时间。结论 Omicron 的爆发使北京的 COVID-19 患者人数迅速增加。在老年患者中,加强剂量可减轻疾病的严重程度并缩短核酸转换时间。在新的流行病爆发之前,应优化医疗保健系统。
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引用次数: 0
Survey on Changes in the Willingness to Receive the COVID-19 Vaccine Among Patients with Breast Cancer in the Postpandemic Era 后大流行时代乳腺癌患者COVID-19疫苗接种意愿变化调查
Pub Date : 2023-09-12 DOI: 10.1097/id9.0000000000000097
Lixiao Bai, Jianbin Li, Ailing Yang, Cuicui Ding, Jiayi Li, Yan Wang, Liangying Li, Shaohua Zhang, Zefei Jiang
Abstract This study aimed to investigate the status of and changes in the vaccination willingness of patients with breast cancer to increase the coronavirus disease 2019 (COVID-19) vaccination rate among these patients. The first survey included patients from the Fifth Medical Center of the PLA General Hospital who participated in the Society of Clinical Oncology Breast Cancer Committee NCP-02 study conducted from September 16 to December 31, 2021. The second survey was conducted from December 9 to December 26, 2022, for those who had not received vaccines previously. In total, 266 patients completed two questionnaires. A total of 143 patients (53.8%) changed their willingness to receive the vaccination. Among them, 45, who were initially unwilling to be vaccinated, changed their stance to become hesitant and 15 changed to become willing. Among those with hesitant attitudes toward vaccines, 45 changed their stance to become willing, and 28 changed to become unwilling; 10 patients with willing attitudes toward vaccines changed to become hesitant. Those who received surgery (odds ratio (OR), 4.24; 95% confidence interval (CI), 1.45–12.42; P = 0.01) and who lived with older adults or children (OR, 2.03; 95% CI, 1.13–3.62; P = 0.02) were more likely to change their attitudes toward COVID-19 vaccines. This finding suggested that patients with breast cancer were cautious about receiving the COVID-19 vaccine. Multiple methods should be used to promote vaccination and reduce vaccine hesitancy.
摘要本研究旨在了解乳腺癌患者疫苗接种意愿的现状及变化,以提高乳腺癌患者2019冠状病毒病(COVID-19)疫苗接种率。第一次调查对象为解放军总医院第五医学中心参加临床肿瘤学会乳腺癌委员会NCP-02研究的患者,该研究于2021年9月16日至12月31日进行。第二次调查于2022年12月9日至12月26日进行,针对之前未接种疫苗的人。共有266名患者完成了两份问卷。143例(53.8%)患者改变接种意愿。其中,最初不愿意接种疫苗的45人转变为犹豫,15人转变为愿意接种。在对疫苗持犹豫态度的人中,45人转变为愿意,28人转变为不愿意;10名患者对疫苗的态度从愿意转变为犹豫。接受手术者(优势比(OR), 4.24;95%置信区间(CI), 1.45-12.42;P = 0.01),与老年人或儿童一起生活(or, 2.03;95% ci, 1.13-3.62;P = 0.02)更有可能改变对COVID-19疫苗的态度。这一发现表明,乳腺癌患者对接种COVID-19疫苗持谨慎态度。应采用多种方法促进疫苗接种,减少疫苗犹豫。
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引用次数: 0
Immune Profile of COVID-19 Survivors and Contacts During 9 Months: A Cohort Study COVID-19 存活者和接触者 9 个月的免疫概况:队列研究
Pub Date : 2023-08-15 DOI: 10.1097/ID9.0000000000000100
Valentina V. Tatarnikova, N. O. Kiseleva, V. .. Dubrovina, V. A. Vishnyakov, D. D. Bryukhova, A. B. Pyatidesyatnikova, K. Korytov, M. B. Sharakshanov, S. Balakhonov
Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a multi-organ systemic damage that can lead to long-term consequences. Little is known about the possible long-term effects of COVID-19 on circulating leukocyte kinetics and functional T-cell activity after recovery. To investigate immune system changes, we designed a cohort study. Methods Volunteer screening and sample collection were performed at the Irkutsk Research Anti-Plague Institute of Rospotrebnadzor. Sixty-four volunteers who have had COVID-19 (recovered volunteers (RVs)) between May 2020 and May 2021, 33 volunteers who had been in contact with COVID-19 patients (contact volunteers (CVs)) within the family setting but had not become ill, and 47 healthy volunteers (HVs) participated in the study. We performed immunophenotyping of peripheral blood cells using flow cytometry. Serum was tested for SARS-CoV-2 anti-nucleocapsid immunoglobulin G antibodies by enzyme-linked immunosorbent assay (Ab(+), people with specific anti-N antibodies to SARS-CoV-2; Ab(−), people without specific antibodies). Results There were no serious disturbances in the internal environment of the body in RVs and CVs. In the evaluation of the general state of the immune system, the most informative indicator was the index of the ratio of neutrophils to blood monocytes – decreased on the 1st terms of observation (1 and 3 months post-symptom onset (PSO)/post-contact onset (PCO)), on average, 1.3 times compared with HVs (8.6% (7.5%–10.5%), P < 0.05), which recovered by the 6th month of observation. Redistribution of the cells responsible for the development of the adaptive immune response was noted only in RVs – increased B-lymphocyte content (HVs, 9.1% (6.4%–10.2%)) and immunoregulatory index ratio (HVs, 1.6% (1.2%–2.1%)) due to redistribution of T-helper and cytotoxic T cells throughout the follow-up period by an average of 1.2-fold compared with HVs (P < 0.05). However, CVs with specific antibodies to SARS-CoV-2 N-protein also had an increased proportion of CD3−CD19+ cells after 1 month PCO (Ab(+), 11.4% (10.2%–15.1%); Ab(−), 8.6% (5.7%–9.7%); P = 0.006). A significant difference between RVs and CVs is that the RVs showed significant activation of circulating T cells, which persisted up to the 6th month of the study, whereas in CVs, it persisted for 3 months PCO. The highest proportion of HLA-DR+ T-lymphocytes was recorded after 1 month PSO/PCO in Ab(+) RVs and CVs: Ab(+) volunteers, 8.1% (6.0%–11.2%) and 4.4% (2.7%–6.4%), respectively; Ab(−) volunteers, 4.2% (2.6%–5.4%) and 5.1% (3.7%–5.6%); and HVs, 3.5% (2.5%–4.7%) (P < 0.01). In CVs, natural killer cells also played a major role in preventing manifest infection (CVs, 10.8% ± 4.3%; HVs, 15.9% ± 7.6%; P < 0.05). Conclusion In this study, we demonstrated the dynamics of returning to the initial state of health in RVs and CVs. In CVs, we observed changes in the studied immunological parameters similar to those of RVs, but which are
摘要 背景 严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)会造成多器官系统性损伤,从而导致长期后果。COVID-19对康复后循环白细胞动力学和功能性T细胞活性可能产生的长期影响知之甚少。为了调查免疫系统的变化,我们设计了一项队列研究。方法 在 Rospotrebnadzor 的伊尔库茨克抗鼠疫研究所进行志愿者筛选和样本采集。64 名在 2020 年 5 月至 2021 年 5 月期间感染过 COVID-19 的志愿者(康复志愿者 (RV))、33 名在家庭环境中接触过 COVID-19 患者但未患病的志愿者(接触志愿者 (CV))以及 47 名健康志愿者 (HV) 参与了研究。我们使用流式细胞术对外周血细胞进行了免疫分型。用酶联免疫吸附试验检测血清中的 SARS-CoV-2 抗核头壳免疫球蛋白 G 抗体(Ab(+)表示有 SARS-CoV-2 特异性抗 N 抗体;Ab(-)表示无特异性抗体)。结果 RV 和 CV 的机体内环境未出现严重紊乱。在对免疫系统总体状况的评估中,最有参考价值的指标是中性粒细胞与血单核细胞的比率指数--在观察的第一阶段(症状出现后 1 个月和 3 个月(PSO)/接触后发病(PCO)),中性粒细胞与血单核细胞的比率指数平均下降了 1.3 倍,而 HVs 则下降了 8.6% (7.5%-10.5%),P < 0.05。在整个随访期间,由于 T 辅助细胞和细胞毒性 T 细胞的重新分布,B 淋巴细胞含量(HVs,9.1%(6.4%-10.2%))和免疫调节指数比(HVs,1.6%(1.2%-2.1%))增加,平均比 HVs 增加了 1.2 倍(P < 0.05)。然而,在 PCO 1 个月后,具有 SARS-CoV-2 N 蛋白特异性抗体的 CVs 的 CD3-CD19+ 细胞比例也有所增加(Ab(+),11.4% (10.2%-15.1%);Ab(-),8.6% (5.7%-9.7%);P = 0.006)。RV和CV之间的一个明显差异是,RV显示循环T细胞明显活化,这种活化持续到研究的第6个月,而在CV中,这种活化持续到PCO的3个月。1 个月 PSO/PCO 后,Ab(+)RV 和 CV 中 HLA-DR+ T 淋巴细胞的比例最高:Ab(+)志愿者分别为 8.1%(6.0%-11.2%)和 4.4%(2.7%-6.4%);Ab(-)志愿者分别为 4.2%(2.6%-5.4%)和 5.1%(3.7%-5.6%);HVs 为 3.5%(2.5%-4.7%)(P < 0.01)。在 CVs 中,自然杀伤细胞在预防显性感染方面也发挥了重要作用(CVs,10.8% ± 4.3%;HVs,15.9% ± 7.6%;P < 0.05)。结论 在这项研究中,我们展示了 RV 和 CV 恢复到初始健康状态的动态过程。在 CV 中,我们观察到所研究的免疫参数发生了与 RV 相似的变化,但这种变化的强度和持续时间较短。所研究的免疫参数在 6 个月内完全恢复。
{"title":"Immune Profile of COVID-19 Survivors and Contacts During 9 Months: A Cohort Study","authors":"Valentina V. Tatarnikova, N. O. Kiseleva, V. .. Dubrovina, V. A. Vishnyakov, D. D. Bryukhova, A. B. Pyatidesyatnikova, K. Korytov, M. B. Sharakshanov, S. Balakhonov","doi":"10.1097/ID9.0000000000000100","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000100","url":null,"abstract":"Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a multi-organ systemic damage that can lead to long-term consequences. Little is known about the possible long-term effects of COVID-19 on circulating leukocyte kinetics and functional T-cell activity after recovery. To investigate immune system changes, we designed a cohort study. Methods Volunteer screening and sample collection were performed at the Irkutsk Research Anti-Plague Institute of Rospotrebnadzor. Sixty-four volunteers who have had COVID-19 (recovered volunteers (RVs)) between May 2020 and May 2021, 33 volunteers who had been in contact with COVID-19 patients (contact volunteers (CVs)) within the family setting but had not become ill, and 47 healthy volunteers (HVs) participated in the study. We performed immunophenotyping of peripheral blood cells using flow cytometry. Serum was tested for SARS-CoV-2 anti-nucleocapsid immunoglobulin G antibodies by enzyme-linked immunosorbent assay (Ab(+), people with specific anti-N antibodies to SARS-CoV-2; Ab(−), people without specific antibodies). Results There were no serious disturbances in the internal environment of the body in RVs and CVs. In the evaluation of the general state of the immune system, the most informative indicator was the index of the ratio of neutrophils to blood monocytes – decreased on the 1st terms of observation (1 and 3 months post-symptom onset (PSO)/post-contact onset (PCO)), on average, 1.3 times compared with HVs (8.6% (7.5%–10.5%), P < 0.05), which recovered by the 6th month of observation. Redistribution of the cells responsible for the development of the adaptive immune response was noted only in RVs – increased B-lymphocyte content (HVs, 9.1% (6.4%–10.2%)) and immunoregulatory index ratio (HVs, 1.6% (1.2%–2.1%)) due to redistribution of T-helper and cytotoxic T cells throughout the follow-up period by an average of 1.2-fold compared with HVs (P < 0.05). However, CVs with specific antibodies to SARS-CoV-2 N-protein also had an increased proportion of CD3−CD19+ cells after 1 month PCO (Ab(+), 11.4% (10.2%–15.1%); Ab(−), 8.6% (5.7%–9.7%); P = 0.006). A significant difference between RVs and CVs is that the RVs showed significant activation of circulating T cells, which persisted up to the 6th month of the study, whereas in CVs, it persisted for 3 months PCO. The highest proportion of HLA-DR+ T-lymphocytes was recorded after 1 month PSO/PCO in Ab(+) RVs and CVs: Ab(+) volunteers, 8.1% (6.0%–11.2%) and 4.4% (2.7%–6.4%), respectively; Ab(−) volunteers, 4.2% (2.6%–5.4%) and 5.1% (3.7%–5.6%); and HVs, 3.5% (2.5%–4.7%) (P < 0.01). In CVs, natural killer cells also played a major role in preventing manifest infection (CVs, 10.8% ± 4.3%; HVs, 15.9% ± 7.6%; P < 0.05). Conclusion In this study, we demonstrated the dynamics of returning to the initial state of health in RVs and CVs. In CVs, we observed changes in the studied immunological parameters similar to those of RVs, but which are","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":"91 1","pages":"163 - 175"},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139350494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of Methylprednisolone on Mortality and Clinical Courses in Patients with Severe COVID-19: A Propensity Score Matching Analysis. 甲基强的松龙对重症 COVID-19 患者死亡率和临床病程的影响:倾向得分匹配分析
Pub Date : 2023-01-01 Epub Date: 2022-10-21 DOI: 10.1097/ID9.0000000000000076
Xiaoyan Li, Xin Yuan, Zhe Xu, Lei Shi, Lei Huang, Xuechun Lu, Junliang Fu
<p><strong>Background: </strong>Whether methylprednisolone therapy can reduce the mortality rate of patients with severe coronavirus disease 2019 (COVID-19) remains controversial, and its effects on the length of hospital stay and virus shedding time are also unknown. This retrospective study investigates the previous issues to provide more evidence for methylprednisolone treatment in severe COVID-19.</p><p><strong>Methods: </strong>This retrospective study included 563 of 4827 patients with confirmed COVID-19 admitted to Wuhan Huoshenshan Hospital or Wuhan Guanggu Hospital between February 3, 2020 and March 30, 2020 who met the screening criteria. The participants' epidemiological and demographic data, comorbidities, laboratory test results, treatments, outcomes, and vital clinical time points were extracted from electronic medical records. The primary outcome was in-hospital death, and the secondary outcomes were 2 clinical courses: length from admission to viral clearance and discharge. Univariate and multivariate logistic or linear regression analyses were used to assess the role of methylprednisolone in different outcomes. Propensity score matching was performed to control for confounding factors.</p><p><strong>Results: </strong>Of the 563 patients who met the screening criteria and were included in the subsequent analysis, 138 were included in the methylprednisolone group and 425 in the nonmethylprednisolone group. The in-hospital death rate between the methylprednisolone and nonmethylprednisolone groups showed a significant difference (23.91% <i>vs.</i> 1.65%, <i>P</i> < 0.001), which was maintained after propensity score matching (13.98% <i>vs.</i> 5.38%, <i>P</i> = 0.048). However, univariate logistic analysis in the matched groups showed that methylprednisolone treatment (odds ratio [OR], 5.242; 95% confidence interval [CI], 0.802 to 34.246; <i>P</i> = 0.084) was not a risk factor for in-hospital death in severe patients. Further multivariate logistic regression analysis found comorbidities (OR, 3.327; 95% CI, 1.702 to 6.501; <i>P</i> < 0.001), lower lymphocyte count (OR, 0.076; 95% CI, 0.012 to 0.461; <i>P</i> = 0.005), higher lactate dehydrogenase (LDH) levels (OR, 1.008; 95% CI, 1.003 to 1.013; <i>P</i> = 0.002), and anticoagulation therapy (OR, 11.187; 95% CI, 2.459 to 50.900; <i>P</i> = 0.002) were associated with in-hospital mortality. Multivariate linear regression analysis in the matched groups showed that methylprednisolone treatment was not a risk factor for a prolonged duration from admission to viral clearance (β Value 0.081; 95% CI, -1.012 to 3.657; <i>P</i> = 0.265) or discharge (β Value 0.114; 95% CI, -0.723 to 6.408; <i>P</i> = 0.117). d-dimer (β Value, 0.144; 95% CI, 0.012 to 0.817; <i>P</i> = 0.044), LDH (β Value 0.260; 95% CI, 0.010 to 0.034; <i>P</i> < 0.001), and antiviral therapy (β Value 0.220; 95% CI, 1.373 to 6.263; <i>P</i> = 0.002) were associated with a longer length from admission to viral clearance. The lym
背景:甲基强的松龙治疗能否降低重症冠状病毒病2019(COVID-19)患者的死亡率仍存在争议,其对住院时间和病毒脱落时间的影响也尚不清楚。本回顾性研究对之前的问题进行了调查,为甲基强的松龙治疗重症COVID-19提供更多证据:这项回顾性研究纳入了2020年2月3日至2020年3月30日期间武汉市霍山医院或武汉市光谷医院收治的4827例确诊COVID-19患者中符合筛查标准的563例。参与者的流行病学和人口统计学数据、合并症、实验室检查结果、治疗、结果和重要临床时间点均从电子病历中提取。主要结果是院内死亡,次要结果是两个临床过程:从入院到病毒清除和出院的时间。采用单变量和多变量逻辑或线性回归分析来评估甲基强的松龙在不同结果中的作用。为控制混杂因素,进行了倾向评分匹配:在符合筛选标准并纳入后续分析的563名患者中,甲基强的松龙组有138人,非甲基强的松龙组有425人。甲基强的松龙组和非甲基强的松龙组的院内死亡率存在显著差异(23.91% vs. 1.65%,P < 0.001),倾向评分匹配后仍保持这一差异(13.98% vs. 5.38%,P = 0.048)。然而,对匹配组进行的单变量逻辑分析表明,甲基强的松龙治疗(几率比 [OR],5.242;95% 置信区间 [CI],0.802 至 34.246;P = 0.084)不是重症患者院内死亡的危险因素。进一步的多变量逻辑回归分析发现,合并症(OR,3.327;95% CI,1.702 至 6.501;P < 0.001)、较低的淋巴细胞计数(OR,0.076;95% CI,0.012 至 0.461;P = 0.005)、较高的乳酸脱氢酶(LDH)水平(OR,1.008;95% CI,1.003 至 1.013;P = 0.002)和抗凝治疗(OR,11.187;95% CI,2.459 至 50.900;P = 0.002)与院内死亡率相关。匹配组的多变量线性回归分析表明,甲基强的松龙治疗不是入院到病毒清除(β值 0.081;95% CI,-1.012 至 3.657;P = 0.265)或出院(β值 0.114;95% CI,-0.723 至 6.d-二聚体(β值,0.144;95% CI,0.012 至 0.817;P = 0.044)、LDH(β值,0.260;95% CI,0.010 至 0.034;P <0.001)和抗病毒治疗(β值,0.220;95% CI,1.373 至 6.263;P = 0.002)与从入院到病毒清除的时间较长有关。淋巴细胞计数(β 值 -0.206;95% CI,-6.248 至 -1.197;P = 0.004)、LDH(β 值 0.231;95% CI,0.012 至 0.048;P = 0.001)、抗病毒治疗(β 值 0.143;95% CI,0.058 to 7.497; P = 0.047)和抗菌治疗(β 值 0.152; 95% CI, 0.133 to 8.154; P = 0.043)与从入院到出院的住院时间较长有关。进一步的分层分析显示,低日剂量组(≤60 mg/d)和低总剂量组(≤200 mg)从入院到病毒清除的持续时间较短(Z=-2.362,P=0.018;Z=-2.010,P=0.044),住院时间较短(Z=-2.735,P=0.006;Z=-3.858,P<0.001):对于重症 COVID-19 患者,甲基强的松龙是安全的,不会延长患者从入院到病毒清除或出院的时间。小剂量、短期甲基强的松龙治疗可能更有利于缩短病程。
{"title":"Effect of Methylprednisolone on Mortality and Clinical Courses in Patients with Severe COVID-19: A Propensity Score Matching Analysis.","authors":"Xiaoyan Li, Xin Yuan, Zhe Xu, Lei Shi, Lei Huang, Xuechun Lu, Junliang Fu","doi":"10.1097/ID9.0000000000000076","DOIUrl":"10.1097/ID9.0000000000000076","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Whether methylprednisolone therapy can reduce the mortality rate of patients with severe coronavirus disease 2019 (COVID-19) remains controversial, and its effects on the length of hospital stay and virus shedding time are also unknown. This retrospective study investigates the previous issues to provide more evidence for methylprednisolone treatment in severe COVID-19.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included 563 of 4827 patients with confirmed COVID-19 admitted to Wuhan Huoshenshan Hospital or Wuhan Guanggu Hospital between February 3, 2020 and March 30, 2020 who met the screening criteria. The participants' epidemiological and demographic data, comorbidities, laboratory test results, treatments, outcomes, and vital clinical time points were extracted from electronic medical records. The primary outcome was in-hospital death, and the secondary outcomes were 2 clinical courses: length from admission to viral clearance and discharge. Univariate and multivariate logistic or linear regression analyses were used to assess the role of methylprednisolone in different outcomes. Propensity score matching was performed to control for confounding factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 563 patients who met the screening criteria and were included in the subsequent analysis, 138 were included in the methylprednisolone group and 425 in the nonmethylprednisolone group. The in-hospital death rate between the methylprednisolone and nonmethylprednisolone groups showed a significant difference (23.91% &lt;i&gt;vs.&lt;/i&gt; 1.65%, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), which was maintained after propensity score matching (13.98% &lt;i&gt;vs.&lt;/i&gt; 5.38%, &lt;i&gt;P&lt;/i&gt; = 0.048). However, univariate logistic analysis in the matched groups showed that methylprednisolone treatment (odds ratio [OR], 5.242; 95% confidence interval [CI], 0.802 to 34.246; &lt;i&gt;P&lt;/i&gt; = 0.084) was not a risk factor for in-hospital death in severe patients. Further multivariate logistic regression analysis found comorbidities (OR, 3.327; 95% CI, 1.702 to 6.501; &lt;i&gt;P&lt;/i&gt; &lt; 0.001), lower lymphocyte count (OR, 0.076; 95% CI, 0.012 to 0.461; &lt;i&gt;P&lt;/i&gt; = 0.005), higher lactate dehydrogenase (LDH) levels (OR, 1.008; 95% CI, 1.003 to 1.013; &lt;i&gt;P&lt;/i&gt; = 0.002), and anticoagulation therapy (OR, 11.187; 95% CI, 2.459 to 50.900; &lt;i&gt;P&lt;/i&gt; = 0.002) were associated with in-hospital mortality. Multivariate linear regression analysis in the matched groups showed that methylprednisolone treatment was not a risk factor for a prolonged duration from admission to viral clearance (β Value 0.081; 95% CI, -1.012 to 3.657; &lt;i&gt;P&lt;/i&gt; = 0.265) or discharge (β Value 0.114; 95% CI, -0.723 to 6.408; &lt;i&gt;P&lt;/i&gt; = 0.117). d-dimer (β Value, 0.144; 95% CI, 0.012 to 0.817; &lt;i&gt;P&lt;/i&gt; = 0.044), LDH (β Value 0.260; 95% CI, 0.010 to 0.034; &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and antiviral therapy (β Value 0.220; 95% CI, 1.373 to 6.263; &lt;i&gt;P&lt;/i&gt; = 0.002) were associated with a longer length from admission to viral clearance. The lym","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":"3 1","pages":"20-28"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/84/idi-3-20.PMC9912987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10737780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lipid-Based Poly(I:C) Adjuvants Strongly Enhance the Immunogenicity of SARS-CoV-2 Receptor-Binding Domain Vaccine 脂质基聚(I:C)佐剂增强严重急性呼吸系统综合征冠状病毒2型受体结合域疫苗的免疫原性
Pub Date : 2023-01-01 DOI: 10.1097/ID9.0000000000000074
Yixin Wu, Liuxian Meng, Huicong Zhang, Shun-guang Hu, Fusheng Li, Yingjie Yu
Abstract Background The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has greatly threatened public health. Recent studies have revealed that the spike receptor-binding domain (RBD) of SARS-CoV-2 is a potent target for vaccine development. However, adjuvants are usually required to strengthen the immunogenicity of recombinant antigens. Different types of adjuvants can elicit different immune responses. Methods We developed an RBD recombinant protein vaccine with a polyriboinosinic acid–polyribocytidylic acid [poly(I:C)] adjuvant to evoke a strong immune response. The delivery of poly(I:C) was optimized in two steps. First, poly(I:C) was complexed with a cationic polymer, poly-l-lysine (PLL), to form poly(I:C)–PLL, a polyplex core. Thereafter, it was loaded into five different lipid shells (group II, III-1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC], III-1,2-dioleoyl-sn-glycero-3-phosphoethanolamine [DOPE], IV-DOPE, and IV-DSPC). We performed an enzyme-linked immunosorbent assay and enzyme-linked immunosorbent spot assay to compare the ability of the five lipopolyplex adjuvants to enhance the immunogenicity of the SARS-CoV-2 RBD protein, including humoral and cellular immune responses. Finally, the adjuvant with the highest immunogenicity was selected to verify the protective immunity of the vaccine through animal challenge experiments. Results Recombinant RBD protein has low immunogenicity. The different adjuvants we developed enhanced the immunogenicity of the RBD protein in different ways. Among the lipopolyplexes, those containing DOPE (III-DOPE and IV-DOPE) elicited RBD-specific immunoglobulin G antibody responses, and adjuvants with four components elicited better RBD-specific immunoglobulin G antibody responses than those containing three components (P < 0.05). The IC50 and IC90 titers indicated that the IV-DOPE lipopolyplex had the greatest neutralization ability, with IC50 titers of 1/117,490. Furthermore, in the challenge study, IV-DOPE lipopolyplex protected mice from SARS-CoV-2 infection. On the fourth day after infection, the average animal body weights were reduced by 18.56% (24.164 ± 0.665 g vs. 19.678 ± 0.455 g) and 0.06% (24.249 ± 0.683 g vs. 24.235 ± 0.681 g) in the MOCK and vaccine groups, respectively. In addition, the relative expression of viral RNA in the vaccinated group was significantly lower than that in the MOCK group (P < 0.05). Interstitial inflammatory cell infiltration was observed in the MOCK group, whereas no obvious damage was observed in the vaccinated group. Conclusions The IV-DOPE–adjuvanted SARS-CoV-2 recombinant RBD protein vaccine efficiently protected mice from SARS-CoV-2 in the animal challenge study. Therefore, IV-DOPE is considered an exceptional adjuvant for SARS-CoV-2 recombinant RBD protein-based vaccines and has the potential to be further developed into a SARS-CoV-2 recombinant RBD protein-based vaccine.
摘要背景严重急性呼吸系统综合征冠状病毒2型的爆发严重威胁着公众健康。最近的研究表明,严重急性呼吸系统综合征冠状病毒2型的刺突受体结合域(RBD)是疫苗开发的有力靶点。然而,通常需要佐剂来增强重组抗原的免疫原性。不同类型的佐剂可以引发不同的免疫反应。方法我们开发了一种含有聚核糖肌苷酸-聚核糖胞苷酸[聚(I:C)]佐剂的RBD重组蛋白疫苗,以引起强烈的免疫反应。聚(I:C)的递送分两步进行优化。首先,将poly(I:C)与阳离子聚合物聚赖氨酸(PLL)络合,形成poly(1:C)–PLL,一种多聚物核。此后,将其装载到五种不同的脂质壳中(第II组,III-1,2-二硬脂酰基-sn-甘油-3-磷酸胆碱[DPC]、III-1,2-二醇酰基-sn-葡萄糖-3-磷酸乙醇胺[DOPE]、IV-DOPE和IV-DSPC)。我们进行了酶联免疫吸附试验和酶联免疫斑点试验,以比较五种脂多糖佐剂增强严重急性呼吸系统综合征冠状病毒2型RBD蛋白免疫原性的能力,包括体液和细胞免疫反应。最后,选择免疫原性最高的佐剂,通过动物攻击实验验证疫苗的保护性免疫。结果重组RBD蛋白具有较低的免疫原性。我们开发的不同佐剂以不同的方式增强RBD蛋白的免疫原性。在脂溶性复合物中,含有DOPE的(III-DOPE和IV-DOPE)能引发RBD特异性免疫球蛋白G抗体反应,而含有四种成分的佐剂比含有三种成分的辅料能引发更好的RBD特异性免疫球蛋白G抗体反应(P<0.05),IC50滴度为1/117490。此外,在挑战性研究中,IV-DOPE脂多糖保护小鼠免受严重急性呼吸系统综合征冠状病毒2型感染。感染后第4天,MOCK组和疫苗组的平均动物体重分别减少了18.56%(24.164±0.665 g vs.19.678±0.455 g)和0.06%(24.249±0.683 g vs.24.235±0.681 g)。此外,接种组病毒RNA的相对表达显著低于对照组(P<0.05)。对照组间质炎症细胞浸润,而接种组未观察到明显损伤。结论在动物攻击研究中,IV-DOPE佐剂的严重急性呼吸系统综合征冠状病毒2型重组RBD蛋白疫苗有效地保护小鼠免受严重急性呼吸综合征冠状病毒的感染。因此,IV-DOPE被认为是基于严重急性呼吸系统综合征冠状病毒2型重组RBD蛋白的疫苗的一种特殊佐剂,并有可能进一步发展成为基于严重急性呼吸道综合征冠状病毒2中重组RBD蛋白质的疫苗。
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引用次数: 0
Inflammasomes in Human Immunodeficiency Virus Type 1 Infection. 人类免疫缺陷病毒1型感染中的炎性小体。
Pub Date : 2022-10-01 DOI: 10.1097/ID9.0000000000000070
Qiankun Wang, Liang Shan

Innate immune responses are the host's first line of defense against human immunodeficiency virus type 1 (HIV-1) infection, with pattern recognition receptors detecting viral specific pathogen-associated molecular patterns and initiating antiviral responses. In response to HIV-1 nucleic acids or proteins, some pattern recognition receptors have the ability to assemble a large multiprotein complex called the inflammasome, which triggers pro-inflammatory cytokine release and a form of lytic programmed cell death called pyroptosis. Here, we review our current understanding of the mechanism of the inflammasome in sensing HIV-1 infection. Furthermore, we discuss the contribution of inflammasome activation in HIV-1 pathogenesis as well as potential strategies of targeting inflammasome activation for the treatment of HIV-1 infection.

先天免疫反应是宿主抵御人类免疫缺陷病毒1型(HIV-1)感染的第一道防线,模式识别受体检测病毒特异性病原体相关的分子模式并启动抗病毒反应。在对HIV-1核酸或蛋白质的反应中,一些模式识别受体有能力组装一个称为炎性小体的大型多蛋白复合物,从而触发促炎细胞因子释放和一种称为焦亡的溶解性程序性细胞死亡形式。在这里,我们回顾了我们目前对炎症小体感知HIV-1感染的机制的理解。此外,我们讨论了炎症小体激活在HIV-1发病机制中的作用,以及靶向炎症小体激活治疗HIV-1感染的潜在策略。
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引用次数: 1
Prolonged Viral Shedding in Three Young Adult Cases of COVID-19. 三例 COVID-19 青壮年病例的病毒长期脱落。
Pub Date : 2022-10-01 Epub Date: 2022-08-12 DOI: 10.1097/ID9.0000000000000041
Wen-Yi Dong, Ming-Ju Zhou, Lei Huang, Chao Zhang, Fu-Sheng Wang, Zhou-Hua Xie

Severe acute respiratory syndrome coronavirus-2 infection is usually self-limited, with a short duration for viral shedding within several weeks. However, prolonged viral shedding has been observed in severe or immune-compromised coronavirus disease 2019 (COVID-19) cases. Here, we reported that three young adult cases of COVID-19 patients, who were either immunosuppressed nor severe, showed prolonged viral RNA shedding from the upper respiratory tract for 58, 81, and 137 days since initial diagnosis. To our knowledge, this is the longest duration of viral shedding reported to date in young adult patients. Further studies on factors relevant to prolonged viral positivity, as well as the correlation between viral positivity and transmission risk are needed for the optimal management of COVID-19 patients with prolonged nucleic acid positive.

严重急性呼吸系统综合征冠状病毒-2感染通常是自限性的,病毒脱落的持续时间很短,只有几周。然而,在重症或免疫力低下的冠状病毒病 2019(COVID-19)病例中却观察到了长时间的病毒脱落。在此,我们报告了三例年轻的COVID-19成年患者,他们既不是免疫抑制患者,也不是重症患者,自初次诊断以来,上呼吸道病毒RNA脱落时间分别为58天、81天和137天。据我们所知,这是迄今为止在年轻成人患者中报告的最长病毒脱落持续时间。需要进一步研究与病毒长期阳性相关的因素,以及病毒阳性与传播风险之间的相关性,以便对核酸长期阳性的 COVID-19 患者进行最佳管理。
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引用次数: 0
Advances in Research on COVID-19 Vaccination for People Living with HIV. 艾滋病毒感染者COVID-19疫苗接种研究进展
Pub Date : 2022-10-01 Epub Date: 2022-09-01 DOI: 10.1097/ID9.0000000000000065
Junyan Jin, Xiuwen Wang, Raphael Carapito, Christiane Moog, Bin Su
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引用次数: 0
Examination of Homologies between COVID-19 Vaccines and Common Allergens: The Potential for T Cell-mediated Responses for Allergic Rhinitis and Asthma. COVID-19疫苗与常见过敏原的同源性检测:T细胞介导的过敏性鼻炎和哮喘反应的潜力
Pub Date : 2022-10-01 DOI: 10.1097/ID9.0000000000000056
Micah Hartwell, Benjamin H Greiner, Savannah Nicks

As the SARS-CoV-2 virus shares relatively large protein sequences homologous to grass pollens, dust mites, and molds, our objective was to assess the potential overlap between the COVID-19 mRNA vaccines from Pfizer-BioNtech and Moderna and known allergens. We found 7 common allergens with potential for cross-reactivity with the Pfizer vaccine and 19 with the Moderna vaccine, including common grasses, molds, and dust mites. T-cell mediated antigen cross-reactivity between viruses and allergens is a relatively new area of study in clinical immunology; a discipline that may be particularly useful regarding the SARS-CoV-2 virus and the allergic response in humans. These results suggest that vaccination with the Pfizer-BioNtech and Moderna COVID-19 vaccines may contribute to T-cell cross-reactivity with allergens that impact allergic asthma and allergic rhinitis. Further research should assess the clinical implications of COVID-19 vaccination on the severity and symptomatology of the allergic disease, in addition to natural viral infection.

由于SARS-CoV-2病毒具有相对较大的与草花粉、尘螨和霉菌同源的蛋白质序列,因此我们的目标是评估辉瑞- biontech和Moderna公司的COVID-19 mRNA疫苗与已知过敏原之间的潜在重叠。我们发现7种常见的过敏原与辉瑞疫苗有潜在的交叉反应,19种与Moderna疫苗有潜在的交叉反应,包括常见的草、霉菌和尘螨。在临床免疫学中,t细胞介导的病毒与过敏原之间的抗原交叉反应是一个相对较新的研究领域。这一学科可能对SARS-CoV-2病毒和人类过敏反应特别有用。这些结果表明,接种辉瑞biontech和Moderna COVID-19疫苗可能有助于t细胞与过敏原的交叉反应,从而影响过敏性哮喘和变应性鼻炎。进一步的研究应评估COVID-19疫苗接种对变应性疾病严重程度和症状的临床意义,以及自然病毒感染。
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引用次数: 0
期刊
Infectious diseases & immunity
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