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Epidemiology, pathogenesis, and management of coronavirus disease 2019-associated stroke

《医学前沿（英文）》 doi: 10.1007/s11684-023-1041-7

摘要： The coronavirus disease 2019 (COVID-19) epidemic has triggered a huge impact on healthcare, socioeconomics, and other aspects of the world over the past three years. An increasing number of studies have identified a complex relationship between COVID-19 and stroke, although active measures are being implemented to prevent disease transmission. Severe COVID-19 may be associated with an increased risk of stroke and increase the rates of disability and mortality, posing a serious challenge to acute stroke diagnosis, treatment, and care. This review aims to provide an update on the influence of COVID-19 itself or vaccines on stroke, including arterial stroke (ischemic stroke and hemorrhagic stroke) and venous stroke (cerebral venous thrombosis). Additionally, the neurovascular mechanisms involved in SARS-CoV-2 infection and the clinical characteristics of stroke in the COVID-19 setting are presented. Evidence on vaccinations, potential therapeutic approaches, and effective strategies for stroke management has been highlighted.

关键词： SARS-CoV-2 ischemic stroke stroke hemorrhagic stroke cerebral venous thrombosis vaccination

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Coronavirus disease 2019 (COVID-19): a clinical update

Min Zhou, Xinxin Zhang, Jieming Qu

《医学前沿（英文）》 2020年第14卷第2期页码 126-135 doi: 10.1007/s11684-020-0767-8

摘要： Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed a significant threat to global health. It caused a total of 80 868 confirmed cases and 3101 deaths in Chinese mainland until March 8, 2020. This novel virus spread mainly through respiratory droplets and close contact. As disease progressed, a series of complications tend to develop, especially in critically ill patients. Pathological findings showed representative features of acute respiratory distress syndrome and involvement of multiple organs. Apart from supportive care, no specific treatment has been established for COVID-19. The efficacy of some promising antivirals, convalescent plasma transfusion, and tocilizumab needs to be investigated by ongoing clinical trials.

关键词： coronavirus disease 2019 epidemiology pathology radiology clinical characteristics treatment

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Clinical characteristics of 19 neonates born to mothers with COVID-19

Wei Liu, Jing Wang, Wenbin Li, Zhaoxian Zhou, Siying Liu, Zhihui Rong

《医学前沿（英文）》 2020年第14卷第2期页码 193-198 doi: 10.1007/s11684-020-0772-y

摘要： The aim of this study was to investigate the clinical characteristics of neonates born to SARS-CoV-2 infected mothers and increase the current knowledge on the perinatal consequences of COVID-19. Nineteen neonates were admitted to Tongji Hospital from January 31 to February 29, 2020. Their mothers were clinically diagnosed or laboratory-confirmed with COVID-19. We prospectively collected and analyzed data of mothers and infants. There are 19 neonates included in the research. Among them, 10 mothers were confirmed COVID-19 by positive SARS-CoV-2 RT-PCR in throat swab, and 9 mothers were clinically diagnosed with COVID-19. Delivery occurred in an isolation room and neonates were immediately separated from the mothers and isolated for at least 14 days. No fetal distress was found. Gestational age of the neonates was 38.6±1.5 weeks, and average birth weight was 3293±425 g. SARS-CoV-2 RT-PCR in throat swab, urine, and feces of all neonates were negative. SARS-CoV-2 RT-PCR in breast milk and amniotic fluid was negative too. None of the neonates developed clinical, radiologic, hematologic, or biochemical evidence of COVID-19. No vertical transmission of SARS-CoV-2 and no perinatal complications in the third trimester were found in our study. The delivery should occur in isolation and neonates should be separated from the infected mothers and care givers.

关键词： coronavirus disease 2019 severe acute respiratory syndrome-associated coronavirus maternal-infant infection newborn

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间充质干细胞——新冠病毒肺炎相关急性呼吸窘迫综合征潜在的治疗选择

赵璇, 张毅

《工程（英文）》 2020年第6卷第10期页码 1073-1075 doi: 10.1016/j.eng.2020.05.015

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2019 novel coronavirus outbreak: a quiz or final exam?

Jiuyang Xu, Yijun Chen, Hao Chen, Bin Cao

《医学前沿（英文）》 2020年第14卷第2期页码 225-228 doi: 10.1007/s11684-020-0753-1

摘要： The 2019 novel coronavirus (2019-nCoV) is an emerging pathogen and is threatening the global health. Strikingly, more than 28 000 cases and 550 deaths have been reported within two months from disease emergence. Armed with experience from previous epidemics in the last two decades, clinicians, scientists, officials, and citizens in China are all contributing to the prevention of further 2019-nCoV transmission. Efficient preliminary work has enabled us to understand the basic characteristics of 2019-nCoV, but there are still many unanswered questions. It is too early now to judge our performance in this outbreak. Continuous and strengthened efforts should be made not only during the epidemic, but also afterwards in order to prepare for any incoming challenges.

关键词： 2019-nCoV novel coronavirus epidemic public response

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Organ function support in patients with coronavirus disease 2019: Tongji experience

Yong Li, Fan He, Ning Zhou, Jia Wei, Zeyang Ding, Luyun Wang, Peng Chen, Shuiming Guo, Binhao Zhang, Xiaoning Wan, Wei Zhu, on behalf of Multidisciplinary Team for COVID-19, Optical Valley Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China

《医学前沿（英文）》 2020年第14卷第2期页码 232-248 doi: 10.1007/s11684-020-0774-9

摘要： Coronavirus disease 2019 (COVID-19) is a highly contagious disease and a serious threat to human health. COVID-19 can cause multiple organ dysfunction, such as respiratory and circulatory failure, liver and kidney injury, gastrointestinal dysfunction, disseminated intravascular coagulation, and thromboembolism, and even death. The World Health Organization reports that the mortality rate of severe-type COVID-19 is over 50%. Currently, the number of severe cases worldwide has increased rapidly, but the experience in the treatment of infected patients is still limited. Given the lack of specific antiviral drugs, multi-organ function support treatment is important for patients with COVID-19. To improve the cure rate and reduce the mortality of patients with severe- and critical-type COVID-19, this paper summarizes the experience of organ function support in patients with severe- and critical-type COVID-19 in Optical Valley Branch of Tongji Hospital, Wuhan, China. This paper systematically summarizes the procedures of functional support therapies for multiple organs and systems, including respiratory, circulatory, renal, gastrointestinal, hepatic, and hematological systems, among patients with severe- and critical-type COVID-19. This paper provides a clinical reference and a new strategy for the optimal treatment of COVID-19 worldwide.

关键词： COVID-19 severe and critical type organ function support

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Clinical manifestations and pathogen characteristics in children admitted for suspected COVID-19

Xiaofang Cai, Hanlan Jiang, Simin Zhang, Shengying Xia, Wenhui Du, Yaoling Ma, Tao Yu, Wenbin Li

《医学前沿（英文）》 2020年第14卷第6期页码 776-785 doi: 10.1007/s11684-020-0820-7

摘要： Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread around the world. However, approaches to distinguish COVID-19 from pneumonia caused by other pathogens have not yet been reported. We retrospectively analyzed the clinical data of 97 children with probable COVID-19. A total of 13 (13.4%) patients were confirmed positive for SARS-CoV-2 infection by nucleic acid RT-PCR testing, and 41 (42.3%) patients were found to be infected with other pathogens. Notably, no pathogen was detected in 43 (44.3%) patients. Among all patients, 25 (25.8%) had familial cluster exposure history, and 52 (53.6%) had one or more coexisting conditions. Fifteen (15.5%) patients were admitted or transferred to the PICU. In the 11 confirmed COVID-19 cases, 5 (45.5%) and 7 (63.6%) were positive for IgM and IgG against SARS-CoV-2, respectively. In 22 patients with suspected COVID-19, 1 (4.5%) was positive for IgG but negative for IgM. The most frequently detected pathogen was (29, 29.9%). One patient with confirmed COVID 19 died. Our results strongly indicated that the detection of asymptomatic COVID 19 or coexisting conditions must be strengthened in pediatric patients. These cases may be difficult to diagnose as COVID-19 unless etiologic analysis is conducted. A serologic test can be a useful adjunctive diagnostic tool in cases where SARS-CoV-2 infection is highly suspected but the nucleic acid test is negative.

关键词： coronavirus disease 2019 pediatrics emergency retrospective investigation severe acute respiratory syndrome coronavirus 2

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Chinese herbal medicine reduces mortality in patients with severe and critical coronavirus disease 2019

Guohua Chen, Wen Su, Jiayao Yang, Dan Luo, Ping Xia, Wen Jia, Xiuyang Li, Chuan Wang, Suping Lang, Qingbin Meng, Ying Zhang, Yuhe Ke, An Fan, Shuo Yang, Yujiao Zheng, Xuepeng Fan, Jie Qiao, Fengmei Lian, Li Wei, Xiaolin Tong

《医学前沿（英文）》 2020年第14卷第6期页码 752-759 doi: 10.1007/s11684-020-0813-6

摘要： This study aimed to evaluate the efficacy of Chinese herbal medicine (CHM) in patients with severe/critical coronavirus disease 2019 (COVID-19). In this retrospective study, data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20, 2020. All patients were divided into an exposed group (CHM users) and a control group (non-users). After propensity score matching in a 1:1 ratio, 156 CHM users were matched by propensity score to 156 non-users. No significant differences in seven baseline clinical variables were found between the two groups of patients. All-cause mortality was reported in 13 CHM users who died and 36 non-users who died. After multivariate adjustment, the mortality risk of CHM users was reduced by 82.2% (odds ratio 0.178, 95% CI 0.076–0.418; <0.001) compared with the non-users. Secondly, age (odds ratio 1.053, 95% CI 1.023–1.084; <0.001) and the proportion of severe/critical patients (odds ratio 0.063, 95% CI 0.028–0.143; <0.001) were the risk factors of mortality. These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.

关键词： COVID-19 CHM mortality a retrospective cohort study

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应对新冠病毒肺炎疫情的东西方分异 Article

Dean T Jamison, Kin Bing Wu

《工程（英文）》 2021年第7卷第7期页码 936-947 doi: 10.1016/j.eng.2021.05.008

摘要：

截至2021年5月，西方国家每百万人口中新冠病毒肺炎（简称新冠肺炎）死亡人数往往超过东方国家的100倍。本文中提及的西方国家是以美国和西欧地区5个人口最多的国家（法国、德国、意大利、西班牙和英国）为代表，东方国家是以作为《区域全面经济伙伴关系协定》（RCEP）成员的东亚和大洋洲的15个国家（澳大利亚、文莱达鲁萨兰国、柬埔寨王国、中国、印度尼西亚、日本、韩国、老挝、马来西亚、缅甸、新西兰、菲律宾、新加坡、泰国和越南）为代表。本文认为，现有信息指明了造成东西方差异的最主要因素。到2020年1月初，中国武汉市发生非典型病毒性肺炎的预警促使东亚诸多司法管辖区迅速做出反应。2020年1月10日，病毒基因组的发布为进行诊断测试和开展疫苗研发提供了重要信息。2020年1月23日，中国武汉市封城，明确表明了这种新疾病的危险性。截至2020年3月下旬，中国新冠肺炎疫情已经得到全面控制，而其他的RCEP成员国也已提早采取了果断措施（包括限制出行），从而避免了严重的结局。在2020年2月这一关键时期，美国和其他一些西方国家的不作为导致新冠肺炎的肆虐和传播。东西方国家都广泛实施了严格的全民非药物干预措施，社会、经济和教育系统都付出了巨大的代价。如果没有采取这些措施，结局可能会更糟。大多数东方国家还实施了严格的集中政策，对感染者进行集中隔离。然而，即使在今天，大多数西方国家仍然允许感染者与其家人、同事和社区居民交往。东西方之间的差异在很大程度上是由于西方国家未能及早实施基本公共卫生政策。一些RCEP成员国及高收入国家进行广泛的免疫接种，疫情很快减轻。然而，低收入国家的疫苗推出缓慢，导致在结局上全球南北方差异正逐渐取代东西方差异。因此，南方国家正在取代西方国家，成为更危险病毒变种的滋生地。例如，具有高度传染性的德尔塔（Delta）变种，可能会削弱迄今为止在很多国家中取得成功的控制策略的效果。

关键词：新冠病毒肺炎隔离非药物干预措施大流行疫苗接种

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Phase- and epidemic region-adjusted estimation of the number of coronavirus disease 2019 cases in China

Ruijie Chang, Huwen Wang, Shuxian Zhang, Zezhou Wang, Yinqiao Dong, Lhakpa Tsamlag, Xiaoyue Yu, Chen Xu, Yuelin Yu, Rusi Long, Ning-Ning Liu, Qiao Chu, Ying Wang, Gang Xu, Tian Shen, Suping Wang, Xiaobei Deng, Jinyan Huang, Xinxin Zhang, Hui Wang, Yong Cai

《医学前沿（英文）》 2020年第14卷第2期页码 199-209 doi: 10.1007/s11684-020-0768-7

摘要： The outbreak of the coronavirus disease 2019 was first reported in Wuhan in December 2019 and gradually spread to other areas in China. After implementation of prevention and control measures, the estimation of the epidemic trend is needed. A phase- and region-adjusted SEIR model was applied for modeling and predicting the number of cases in Wuhan, Hubei Province and regions outside Hubei Province in China. The estimated number of infections could reach its peak in late February 2020 in Wuhan and Hubei Province, which is 55 303–84 520 and 83 944–129 312, respectively, while the epidemic peaks in regions outside Hubei Province in China could appear on February 13, 2020 with the estimated 13 035–19 108 cases. According to the estimation, the outbreak would abate in March and April all over China. Current estimation provided evidence for planned work resumption under stringent prevention and control in China to further support the fight against the epidemic. Nevertheless, there is still possibility of the second outbreak brought by the work resumption and population migration, especially from Hubei Province and high intensity cities outside Hubei Province. Strict prevention and control measures still need to be considered in the regions with high intensity of epidemic and densely-populated cities.

关键词： SEIR model COVID-19 estimate China

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利用深度学习系统筛查新冠病毒肺炎 Article

徐小微, 蒋贤高, 马春莲, 杜鹏, 李旭坤, 吕双志, 俞亮, 倪勤, 陈燕飞, 苏俊威, 郎观晶, 李永涛, 赵宏, 刘俊, 徐凯进, 阮凌翔, 盛吉芳, 裘云庆, 吴炜, 梁廷波, 李兰娟

《工程（英文）》 2020年第6卷第10期页码 1122-1129 doi: 10.1016/j.eng.2020.04.010

摘要：

实时逆转录聚合酶链反应（RT-PCR）检测早期新冠病毒肺炎（COVID-19）患者的痰液或鼻咽拭子中的病毒RNA阳性率较低。同时，COVID-19的计算机断层扫描（CT）影像学的临床表现有其自身的特点，不同于甲型流感病毒性肺炎（IAVP）等其他类型的病毒性肺炎。本研究旨在应用深度学习技术，建立COVID-19、IAVP及健康人群肺部CT的早期筛查模型。本研究共采集618份CT样本，其中219份样本来自110例COVID-19患者（平均年龄50岁，其中男性63例，占57.3%），224份样本来自224例IAVP患者（平均年龄61岁，其中男性156例，占69.6%），175份样本来自健康人群（平均年龄39岁，其中男性97例，占55.4%）。所有CT样本均来自浙江省三家COVID-19定点收治医院。我们首先利用胸部CT图像集的三维（3D）深度学习模型分割出候选感染区域，然后利用位置敏感机制深度学习网络将这些分离的图像归类为COVID-19、IAVP以及与感染无关（ITI）的图像，并且输出相应置信度得分。最后，用Noisy-OR贝叶斯函数计算每份CT病例的感染类型及总置信度。测试数据集的实验结果表明，从整体CT病例来看，本研究利用深度学习系统建立的COVID-19患者的早期筛查模型的总体准确率为86.7%。该模型有望成为一线临床医生诊断COVID-19的一种有效的辅助方法。

关键词： COVID-19 位置敏感机制深度学习网络计算机断层扫描

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中国抗击新型冠状病毒的策略与进展 Review

刘薇, 关伟杰, 钟南山

《工程（英文）》 2020年第6卷第10期页码 1076-1084 doi: 10.1016/j.eng.2020.10.003

摘要：

新型冠状病毒肺炎（COVID-19）是21世纪第三次由冠状病毒引发的流行病，并导致全球大规模感染和死亡，造成全球性公共卫生事件。基于在防控重症急性呼吸综合征（SARS）和中东呼吸综合征（MERS）两次疫情中积累的经验，中国迅速确定病毒传播途径，总结临床特点，提出治疗干预措施并开展疫苗研发，在科学界发挥了关键作用。尽管针对COVID-19的研究取得了快速进展，但在追溯病毒起源、明确传播途径和解析致病机制等方面仍有待进一步研究。目前仍需建立更具针对性的临床治疗方案以及研发特效药。本文总结了中国针对COVID-19防控的主要策略及研究进展，以期为全球疫情防控提供有用的信息。

关键词：新冠病毒肺炎血管紧张素转换酶免疫反应炎症临床特征治疗疫苗

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特力阿扎维林治疗新冠病毒肺炎的疗效和安全性——一项随机对照试验 Article

吴效科, 于凯江, 王永晨, 徐万海, 马红丽, 侯艳, 李悦, 蔡本志, 朱丽影, 张敏, 胡晓丽, 高敬书, 王宇, 秦慧超, 王文杰, 赵鸣雁, 吴霞, 张勇, 李璐, 李康, 杜智敏, Ben Willem J. Mol, 杨宝峰

《工程（英文）》 2020年第6卷第10期页码 1185-1191 doi: 10.1016/j.eng.2020.08.011

摘要：

目前，尚无有效疗法可治愈由新型冠状病毒（severe acute respiratory syndrome coronavirus 2, SARS-CoV-2）引起的新型冠状病毒肺炎（coronavirusdisease 2019, COVID-19）。

关键词：新型冠状病毒肺炎特力阿扎维林有效性安全性

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中药治疗新冠病毒肺炎的科学基础 Perspective

梁丽娴, 潘胡丹, 黄虞枫, 范星星, 王婉莹, 何芳, 蔡俊, 周华, 刘良

《工程（英文）》 2020年第6卷第10期页码 1099-1107 doi: 10.1016/j.eng.2020.08.009

摘要：

新近暴发的新冠病毒肺炎（COVID-19）已成为危害全球健康的紧急事件。现有证据表明，新冠病毒（SARS-CoV-2）与其他冠状病毒（如SARS-CoV和MERS-CoV）的基因序列具有相似性。因此，针对现存冠状病毒的引发疾病的机制研究和在治疗SARS时所取得的经验和教训，可咨今天对抗新冠病毒引发疾病的参考。COVID-19患者的临床病理特征提示患者在病情进展过程中通常会经历五个发展阶段：大量病毒感染、免疫系统抑制、细胞因子风暴、多器官损伤及后期的肺纤维化样改变，严重者常导致死亡。早期阻断疾病进展是取得治疗成功的关键。但是，目前尚无针对COVID-19的特效药物或疫苗，世界卫生组织（WHO）正敦促尽快建立新型预防和治疗策略。传统中医药（TCM）对于疫病的防治的实践已经积累了几千年的有用经验，它通过整体调节机体功能发挥疗效。在此次疫情中，中医药作为替代治疗或与西药联合使用，在疫情防控中发挥了重要的作用。本文总结了此次抗疫过程中中国国家和省级机构推荐使用的中药复方和中成药的潜在用途和治疗机制，以期发现其治疗COVID-19的潜在科学内涵。同时，整合应用多种组学及转化医学技术开展基础与临床研究有望进一步证实中药复方的治疗机制。

关键词： COVID-19 SARS-CoV-2 中药抗病毒细胞因子风暴肺纤维化

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COVID-19 containment: China provides important lessons for global response

Shuxian Zhang, Zezhou Wang, Ruijie Chang, Huwen Wang, Chen Xu, Xiaoyue Yu, Lhakpa Tsamlag, Yinqiao Dong, Hui Wang, Yong Cai

《医学前沿（英文）》 2020年第14卷第2期页码 215-219 doi: 10.1007/s11684-020-0766-9

摘要： The world must act fast to contain wider international spread of the epidemic of COVID-19 now. The unprecedented public health efforts in China have contained the spread of this new virus. Measures taken in China are currently proven to reduce human-to-human transmission successfully. We summarized the effective intervention and prevention measures in the fields of public health response, clinical management, and research development in China, which may provide vital lessons for the global response. It is really important to take collaborative actions now to save more lives from the pandemic of COVID-19.

关键词： coronavirus disease 2019 (COVID-19) control measure public health response