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Clinical course of 2019 novel coronavirus disease (COVID-19) in individuals present during the outbreak on the Diamond Princess cruise ship.

钻石公主游轮上爆发期间存在的个体的 2019 新型冠状病毒疾病 (新型冠状病毒肺炎) 的临床过程。

  • 影响因子:1.67
  • DOI:10.1016/j.jiac.2020.05.005
  • 作者列表:"Kato H","Shimizu H","Shibue Y","Hosoda T","Iwabuchi K","Nagamine K","Saito H","Sawada R","Oishi T","Tsukiji J","Fujita H","Furuya R","Masuda M","Akasaka O","Ikeda Y","Sakamoto M","Sakai K","Uchiyama M","Watanabe H","Yamaguchi N","Higa R","Sasaki A","Tanaka K","Toyoda Y","Hamanaka S","Miyazawa N","Shimizu A","Fukase F","Iwai S","Komase Y","Kawasaki T","Nagata I","Nakayama Y","Takei T","Kimura K","Kunisaki R","Kudo M","Takeuchi I","Nakajima H
  • 发表时间:2020-08-01
Abstract

:We investigated the clinical course of individuals with 2019 novel coronavirus disease (COVID-19) who were transferred from the Diamond Princess cruise ship to 12 local hospitals. The conditions and clinical courses of patients with pneumonia were compared with those of patients without pneumonia. Among 70 patients (median age: 67 years) analyzed, the major symptoms were fever (64.3%), cough (54.3%), and general fatigue (24.3%). Forty-three patients (61.4%) had pneumonia. Higher body temperature, heart rate, and respiratory rate as well as higher of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and C-reactive protein (CRP) levels and lower serum albumin level and lymphocyte count were associated with the presence of pneumonia. Ground-glass opacity was found in 97.7% of the patients with pneumonia. Patients were administered neuraminidase inhibitors (20%), lopinavir/ritonavir (32.9%), and ciclesonide inhalation (11.4%). Mechanical ventilation and veno-venous extracorporeal membrane oxygenation was performed on 14 (20%) and 2 (2.9%) patients, respectively; two patients died. The median duration of intubation was 12 days. The patients with COVID-19 transferred to local hospitals during the outbreak had severe conditions and needed close monitoring. The severity of COVID-19 depends on the presence of pneumonia. High serum LDH, AST and CRP levels and low serum albumin level and lymphocyte count were found to be predictors of pneumonia. It was challenging for local hospitals to admit and treat these patients during the outbreak of COVID-19. Assessment of severity was crucial to manage a large number of patients.

摘要

: 我们调查了从钻石公主号游轮转移到 12 家当地医院的 2019 名新型冠状病毒患者 (新型冠状病毒肺炎) 的临床过程。比较肺炎患者与非肺炎患者的病情和临床病程。在分析的 70 例患者 (中位年龄: 67 岁) 中,主要症状为发热 (64.3%) 、咳嗽 (54.3%) 和乏力 (24.3%)。43 例患者 (61.4%) 患有肺炎。较高的体温、心率和呼吸频率以及较高的乳酸脱氢酶 (LDH) 、天冬氨酸氨基转移酶 (AST) 和C-反应蛋白 (CRP)。血清白蛋白水平和淋巴细胞计数降低与肺炎的发生有关。在 97.7% 的肺炎患者中发现磨玻璃影。患者给予神经氨酸酶抑制剂 (20%),洛匹那韦/利托那韦 (32.9%) 和环索奈德吸入 (11.4%)。分别对 14 例 (20%) 和 2 例 (2.9%) 患者进行机械通气和静脉-静脉体外膜肺氧合; 2 例患者死亡。插管的中位持续时间为 12 天。疫情期间转入当地医院的新型冠状病毒肺炎患者病情较重,需要密切监测。新型冠状病毒肺炎的严重程度取决于肺炎的存在。发现高血清LDH、AST和CRP水平以及低血清白蛋白水平和淋巴细胞计数是肺炎的预测因子。在新型冠状病毒肺炎爆发期间,当地医院接纳和治疗这些患者是一项挑战。严重程度的评估对于管理大量患者至关重要。

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影响因子:14.71
发表时间:2020-02-01
来源期刊:Nature immunology
DOI:10.1038/s41590-019-0571-2
作者列表:["Adrover JM","Aroca-Crevillén A","Crainiciuc G","Ostos F","Rojas-Vega Y","Rubio-Ponce A","Cilloniz C","Bonzón-Kulichenko E","Calvo E","Rico D","Moro MA","Weber C","Lizasoaín I","Torres A","Ruiz-Cabello J","Vázquez J","Hidalgo A"]

METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.

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影响因子:2.81
发表时间:2020-01-05
DOI:10.3390/ijerph17010356
作者列表:["Yang LC","Suen YJ","Wang YH","Lin TC","Yu HC","Chang YC"]

METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.

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影响因子:2.89
发表时间:2020-04-01
DOI:10.1016/j.ijid.2020.01.038
作者列表:["Ngocho JS","Horumpende PG","de Jonge MI","Mmbaga BT"]

METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.

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肺炎方向

肺炎是指终末气道、肺泡和肺间质的炎症。可由细菌、病毒、真菌、寄生虫等致病微生物,以及放射线、吸入性异物等理化因素引起。临床主要症状为发热、咳嗽、咳痰、痰中带血,可伴胸痛或呼吸困难等。

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