中国冠状病毒病 2019 的临床特征。
- 作者列表："Guan WJ","Ni ZY","Hu Y","Liang WH","Ou CQ","He JX","Liu L","Shan H","Lei CL","Hui DSC","Du B","Li LJ","Zeng G","Yuen KY","Chen RC","Tang CL","Wang T","Chen PY","Xiang J","Li SY","Wang JL","Liang ZJ","Peng YX","Wei L","Liu Y","Hu YH","Peng P","Wang JM","Liu JY","Chen Z","Li G","Zheng ZJ","Qiu SQ","Luo J","Ye CJ","Zhu SY","Zhong NS","China Medical Treatment Expert Group for Covid-19.
BACKGROUND:Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. METHODS:We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. RESULTS:The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. CONCLUSIONS:During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).
背景: 自 2019 年 12 月，冠状病毒疾病 2019 (新型冠状病毒肺炎) 在武汉市出现并在中国迅速蔓延以来，一直需要有关受影响患者临床特征的数据。 方法: 我们从中国大陆 30 个省、自治区和直辖市的 1099 家医院提取了截至 2020 年 1 月 29 日的新型冠状病毒肺炎 552 例实验室确诊患者的数据。主要复合终点是进入重症监护病房 (ICU) 、使用机械通气或死亡。 结果: 患者的中位年龄为 47 岁; 41.9% 的患者为女性。主要复合终点发生在 67 例患者 (6.1%) 中，包括 5.0% 例入住ICU，2.3% 例接受有创机械通气，1.4% 例死亡.只有 1.9% 的患者与野生动物有直接接触史。在武汉市非居民中，与武汉市居民有过接触的占 72.3%，其中去过武汉市的占 31.3%。最常见的症状是发热 (入院时 43.8%，住院期间 88.7%) 和咳嗽 (67.8%)。腹泻不常见 (3.8%)。中位潜伏期为 4 天 (四分位距，2 ~ 7).入院时，毛玻璃样混浊是胸部计算机断层扫描 (CT) 最常见的放射学发现 (56.4%)。157 例非重症患者中的 877 例 (17.9%) 和 173 例重症患者中的 5 例 (2.9%) 未发现影像学或CT异常。83.2% 的患者在入院时出现淋巴细胞减少。 结论: 在本次疫情的前 2 个月，新型冠状病毒肺炎在中国迅速蔓延并引起不同程度的疾病。患者通常无发热，许多患者没有异常的影像学表现。(中国国家卫生健康委员会等资助)。
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.
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.
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.