Weathering the storm: COVID-19 infection in patients with hematological malignancies

The coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within a matter of months, this highly contagious novel virus has led to a global outbreak and is still spreading rapidly across continents. In patients with COVID-19, underlying chronic diseases and comorbidities are associated with dismal treatment outcomes. Owing to their immunosuppressive status, patients with hematological malignancies (HMs) are at an increased risk of infection and have a worse prognosis than patients without HMs. Accordingly, intensive attention should be paid to this cohort. In this review, we summarize and analyze specific clinical manifestations for patients with coexisting COVID-19 and HMs. Furthermore, we briefly describe customized management strategies and interventions for this susceptible cohort. This review is intended to guide clinical practice.     

Clinical characteristics and plasma antibody titer of patients with COVID-19 in Zhejiang,China

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first affected humans in China on December 31, 2019 (Shi et al., 2020). Coronaviruses generally cause mild, self-limiting upper respiratory tract infections in humans, such as the common cold, pneumonia, and gastroenteritis (To et al., 2013; Berry et al., 2015; Chan et al., 2015). According to the Report of the World Health Organization (WHO)-China Joint Mission on COVID-19 (WHO, 2020), the case fatality rate of COVID-19 increases with age, while the rate among males is higher than that among females (4.7% and 2.8%, respectively). Since an effective vaccine and specific anti-viral drugs are still under development, passive immunization using the convalescent plasma (CP) of recovered COVID-19 donors may offer a suitable therapeutic strategy for severely ill patients in the meantime. So far, several studies have shown therapeutic efficacy of CP transfusion in treating COVID-19 cases. A pilot study first reported that transfusion of CP with neutralizing antibody titers above 1:640 was well tolerated and could potentially improve clinical outcomes through neutralizing viremia in severe COVID-19 cases (Chen et al., 2020). Immunoglobulin G (IgG) and IgM are the most abundant and important antibodies in protecting the human body from viral attack (Arabi et al., 2015; Marano et al., 2016). Our study aimed to understand the aspects of plasma antibody titer levels in convalescent patients, as well as assessing the clinical characteristics of normal, severely ill, and critically ill patients, and thus provide a basis for guiding CP therapy. We also hoped to find indicators which could serve as a reference in predicting the progression of the disease.     

Structural and physiological changes of the human body upon SARS-CoV-2 infection

Since December 2019, the novel coronavirus(severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)) has spread to many countries around the world, developing into a global pandemic with increasing numbers of deaths reported worldwide. To data, although some vaccines have been developed, there are no ideal drugs to treat novel coronavirus pneumonia(coronavirus disease 2019(COVID-19)). By examining the structure of the coronavirus and briefly describing its possible pathogenesis based on recent autopsy reports conducted by various teams worldwide, this review analyzes the possible structural and functional changes of the human body upon infection with SARS-CoV-2. We observed that the most prominent pathological changes in COVID-19 patients are diffuse alveolar damage(DAD) of the lungs and microthrombus formation,resulting in an imbalance of the ventilation/perfusion ratio and respiratory failure. Although direct evidence of viral infection can also be found in other organs and tissues, the viral load is relatively small. The conclusion that the injuries of the extrapulmonary organs are directly caused by the virus needs further investigation.     

Effects of antiepileptic drugs on bone mineral density and bone metabolism in children: a meta-analysis

Objective: The aim of our meta-analysis was to assess the effects of antiepileptic drugs on bone mineral density and bone metabolism in epileptic children. Methods: Searches of PubMed and Web of Science were undertaken to identify studies evaluating the association between antiepileptic drugs and bone mineral density and bone metabolism. Results: A total of 22 studies with 1492 subjects were included in our research. We identified: (1) a reduction in bone mineral density at lumbar spine (standardized mean difference (SMD)=−0.30, 95% confidence interval (CI) [−0.61, −0.05]), trochanter (mean difference (MD)=−0.07, 95% CI [−0.10, −0.05]), femoral neck (MD=−0.05, 95% CI [−0.09, −0.02]), and total body bone mineral density (MD=−0.33, 95% CI [−0.51, −0.15]); (2) a reduction in 25-hydroxyvitamin D (MD=−3.37, 95% CI [−5.94, −0.80]) and an increase in serum alkaline phosphatase (SMD=0.71, 95% CI [0.38, 1.05]); (3) no significant changes in serum parathyroid hormone, calcium, or phosphorus. Conclusions: Our meta-analysis suggests that treatment with antiepileptic drugs may be associated with decreased bone mineral density in epileptic children.     

Application of extracorporeal therapies in critically ill COVID-19 patients

The coronavirus disease 2019 (COVID-19) pandemic is a major public health event caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has spread widely all over the world. A high proportion of patients become severely or critically ill, and suffer high mortality due to respiratory failure and multiple organ dysfunction. Therefore, providing timely and effective treatment for critically ill patients is essential to reduce overall mortality. Convalescent plasma therapy and pharmacological treatments, such as aerosol inhalation of interferon-α (IFN-α), corticosteroids, and tocilizumab, have all been applied in clinical practice; however, their effects remain controversial. Recent studies have shown that extracorporeal therapies might have a potential role in treating critically ill COVID-19 patients. In this review, we examine the application of continuous renal replacement therapy (CRRT), therapeutic plasma exchange (TPE), hemoadsorption (HA), extracorporeal membrane oxygenation (ECMO), and extracorporeal carbon dioxide removal (ECCO₂R) in critically ill COVID-19 patients to provide support for the further diagnosis and treatment of COVID-19.

     

Seasonal coronaviruses and SARS-CoV-2: effects of preexisting immunity during the COVID-19 pandemic

Although the coronavirus disease 2019 (COVID-19) epidemic is still ongoing, vaccination rates are rising slowly and related treatments and drugs are being developed. At the same time, there is increasing evidence of preexisting immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in humans, mainly consisting of preexisting antibodies and immune cells (including T cells and B cells). The presence of these antibodies is mainly due to the seasonal prevalence of four common coronavirus types, especially OC43 and HKU1. The accumulated relevant evidence has suggested that the target of antibodies is mainly the S2 subunit of S protein, followed by evolutionary conservative regions such as the nucleocapsid (N) protein. Additionally, preexisting memory T and B cells are also present in the population. Preexisting antibodies can help the body protect against SARS-CoV-2 infection, reduce the severity of COVID-19, and rapidly increase the immune response post-infection. These multiple effects can directly affect disease progression and even the likelihood of death in certain individuals. Besides the positive effects, preexisting immunity may also have negative consequences, such as antibody-dependent enhancement (ADE) and original antigenic sin (OAS), the prevalence of which needs to be further established. In the future, more research should be focused on evaluating the role of preexisting immunity in COVID-19 outcomes, adopting appropriate policies and strategies for fighting the pandemic, and vaccine development that considers preexisting immunity.     

Safety of protease inhibitors and Arbidol for SARS-CoV-2 pneumonia in Zhejiang Province,China

The aim of this study was to evaluate the safety of an antiviral regimen of protease inhibitors combined with Arbidol (umifenovir) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia patients. The genomic sequence of SARS-CoV-2 is highly homologous to that of SARS-CoV (Zhou et al., 2020). Previously published basic and clinical research on anti-SARS-CoV treatment found that lopinavir/ritonavir (LPV/r) could improve the prognosis of SARS patients (Chan et al., 2003; Chu et al., 2004). Darunavir (DRV) is another protease inhibitor that blocks the binding of SARS-CoV-2 to human angiotensin-converting enzyme 2 (Omotuyi et al., 2020). The broad-spectrum antiviral drug Arbidol (umifenovir) also shows in vitro anti-SARS-CoV activity (Khamitov et al., 2008).     

Comparison of COVID-19 and influenza characteristics

The emergence of coronavirus disease 2019(COVID-19) not only poses a serious threat to the health of people worldwide but also affects the global economy. The outbreak of COVID-19 began in December 2019, at the same time as the influenza season. However, as the treatments and prognoses of COVID-19 and influenza are different, it is important to accurately differentiate these two different respiratory tract infections on the basis of their respective early-stage characteristics. We reviewed official documents and news released by the National Health Commission of the People's Republic of China, the Chinese Center for Disease Control and Prevention(China CDC), the United States CDC, and the World Health Organization(WHO), and we also searched the PubMed, Web of Science, Excerpta Medica database(Embase), China National Knowledge Infrastructure(CNKI), Wanfang, preprinted bioRxiv and medRxiv databases for documents and guidelines from earliest available date up until October 3 rd, 2020. We obtained the latest information about COVID-19 and influenza and summarized and compared their biological characteristics, epidemiology, clinical manifestations, pathological mechanisms, treatments, and prognostic factors. We show that although COVID-19 and influenza are different in many ways, there are numerous similarities;thus, in addition to using nucleic acid-based polymerase chain reaction(PCR) and antibody-based approaches, clinicians and epidemiologists should distinguish between the two using their respective characteristics in early stages. We should utilize experiences from other epidemics to provide additional guidance for the treatment and prevention of COVID-19.     

ADP-ribosylhydrolases: from DNA damage repair to COVID-19

Adenosine diphosphate(ADP)-ribosylation is a unique post-translational modification that regulates many biological processes,such as DNA damage repair.During DNA repair,ADP-ribosylation needs to be reversed by ADP-ribosylhydrolases.A group of ADP-ribosylhydrolases have a catalytic domain,namely the macrodomain,which is conserved in evolution from prokaryotes to humans.Not all macrodomains remove ADP-ribosylation.One set of macrodomains loses enzymatic activity and only binds to ADP-ribose(ADPR).Here,we summarize the biological functions of these macrodomains in DNA damage repair and compare the structure of enzymatically active and inactive macrodomains.Moreover,small molecular inhibitors have been developed that target macrodomains to suppress DNA damage repair and tumor growth.Macrodomain proteins are also expressed in pathogens,such as severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).However,these domains may not be directly involved in DNA damage repair in the hosts or pathogens.Instead,they play key roles in pathogen replication.Thus,by targeting macrodomains it may be possible to treat pathogen-induced diseases,such as coronavirus disease 2019(COVID-19).     

Development and validation of an individualized nomogram for early prediction of the duration of SARS-CoV-2 shedding in COVID-19 patients with non-severe disease

With the number of cases of coronavirus disease-2019(COVID-19) increasing rapidly, the World Health Organization(WHO) has recommended that patients with mild or moderate symptoms could be released from quarantine without nucleic acid retesting, and self-isolate in the community. This may pose a potential virus transmission risk. We aimed to develop a nomogram to predict the duration of viral shedding for individual COVID-19 patients. This retrospective multicentric study enrolled 135 patients as a training cohort and 102 patients as a validation cohort. Significant factors associated with the duration of viral shedding were identified by multivariate Cox modeling in the training cohort and combined to develop a nomogram to predict the probability of viral shedding at 9, 13, 17, and 21 d after admission. The nomogram was validated in the validation cohort and evaluated by concordance index(C-index), area under the curve(AUC), and calibration curve. A higher absolute lymphocyte count(P=0.001) and lymphocyte-to-monocyte ratio(P=0.013) were correlated with a shorter duration of viral shedding, while a longer activated partial thromboplastin time(P=0.007) prolonged the viral shedding duration. The C-indices of the nomogram were 0.732(95% confidence interval(CI): 0.685-0.777) in the training cohort and 0.703(95% CI: 0.642-0.764) in the validation cohort. The AUC showed a good discriminative ability(training cohort: 0.879, 0.762, 0.738, and 0.715 for 9, 13, 17, and 21 d; validation cohort: 0.855, 0.758, 0.728, and 0.706 for 9, 13, 17, and 21 d), and calibration curves were consistent between outcomes and predictions in both cohorts. A predictive nomogram for viral shedding duration based on three easily accessible factors was developed to help estimate appropriate self-isolation time for patients with mild or moderate symptoms, and to control virus transmission.     

Molecular hydrogen is a promising therapeutic agent for pulmonary disease

Molecular hydrogen exerts biological effects on nearly all organs. It has anti-oxidative, anti-inflammatory, and anti-aging effects and contributes to the regulation of autophagy and cell death. As the primary organ for gas exchange, the lungs are constantly exposed to various harmful environmental irritants. Short- or long-term exposure to these harmful substances often results in lung injury, causing respiratory and lung diseases. Acute and chronic respiratory diseases have high rates of morbidity and mortality and have become a major public health concern worldwide. For example, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. An increasing number of studies have revealed that hydrogen may protect the lungs from diverse diseases, including acute lung injury, chronic obstructive pulmonary disease, asthma, lung cancer, pulmonary arterial hypertension, and pulmonary fibrosis. In this review, we highlight the multiple functions of hydrogen and the mechanisms underlying its protective effects in various lung diseases, with a focus on its roles in disease pathogenesis and clinical significance.     

Psychological Flexibility,Coronavirus Anxiety,Humor and Social Media Addiction During COVID-19 Pandemic in Turkey

Psychological flexibility is associated with psychological health and affected by various factors. The aim of the present study is to examine the role of coronavirus anxiety, humor and social media addiction on psychological flexibility during the COVID-19 pandemic in Turkey. Variables were measured with online self-report surveys and data were gathered from December 2020 to January 2021 in Turkey. The sample consisted of 376 people (295 female, M?=?29.88, SD?=?11.05). The relationships between the variables were tested with path analysis using structural equation modelling (SEM). According to results, the constructed model showed that COVID-19 anxiety significantly and directly increased social media addiction (β?=?.17, p?<?.01), decreased coping humor (β?=?-.11, p?<?.05) and decreased psychological flexibility indirectly through social media addictions (β?=?-.08, p?<?.01). Humor coping significantly and directly increased psychological flexibility (β?=?.25, p?<?.01), and social media addiction significantly and directly decreased psychological flexibility (β?=?-.31, p?<?.01). Findings indicated that psychological flexibility is influenced by coronavirus anxiety, social media addiction and humor coping.  Supporting humor coping and reducing anxiety and problematic social media use would be helpful to enhance psychological flexibility of individuals during the pandemic.

     

Association between serum vitamin D and severity of liver fibrosis in chronic hepatitis C patients: a systematic meta-analysis

To conduct a systematic review of group studies assessing the association of serum vitamin D status with the severity of liver fibrosis in chronic hepatitis C patients using meta-analysis. The relevant research literatures were identified by searching PubMed and EMBASE databases prior to October 2013 with no restrictions. We included group studies that reported odds ratio (OR) estimates with 95% confidence intervals (CIs) or a mean with standard deviation (SD) for the association between serum vitamin D status and the severity of liver fibrosis in chronic hepatitis C patients. Approximately 8321 participants from several countries were included in this analysis. Six studies on serum vitamin D status and the severity of liver fibrosis were included in this meta-analysis. ORs with 95% CIs were extracted from four studies and the pooled ORs were 0.866 (95% CI, 0.649 to 1.157). The means with SDs were extracted from three studies and the pooled means were −0.487 (95% CI, −0.659 to −0.315). There was statistically significant heterogeneity among the mean data extracted studies (P=0.029; I ²=71.8%) but not among the OR data extracted studies (P=0.061; I ²=55.6%). Finally, results from the mean data extracted studies suggest that lower serum vitamin D is a risk factor for the severity of liver fibrosis in chronic hepatitis C patients. However, there is no conclusive evidence on this association because of inconsistencies between the OR data extracted studies and the mean data extracted studies.     

Attachment security predicts adolescents’ prosocial and health protective responses to the COVID-19 pandemic

Prosocial and health protective behaviors are critical to contain the COVID-19 pandemic, yet adolescents have been difficult to engage. Attachment security promotes adolescents’ capacities to navigate stress, and influences prosocial and health behaviors. Drawing on a diverse sample of 202 adolescents (48% female; 47.5% Latinx) this study evaluated relations among attachment, mental health, and prosocial and health protective responses to the COVID-19 pandemic. Attachment security (age 12) predicted adolescents’ (age 15) COVID-19 prosocial (f² = .201) and health protective behaviors (f² = .274) during the pandemic via smaller-than-expected increases in mental health symptoms above pre-pandemic levels (age 14). Findings highlight the importance of attachment for supporting adolescents’ mental health responses to life stressors and promoting prosocial and health protective behaviors.     

抗击COVID-19疫情一线护士压力知觉现状调查及分析

目的了解参加抗击新型冠状病毒肺炎疫情临床一线护士的压力知觉现状,并分析其影响因素,为制定缓解疫情抗击一线护士压力感知相关措施提供理论依据。方法采用中文版压力知觉量表(CPSS)、领悟社会支持量表(PSSS)对盐城市区参加支援湖北COVID-19疫情抗击的95名一线护士进行问卷调查,并对现状进行分析。结果95名参与COVID-19疫情抗击的临床一线护士CPSS总分为(38.11±6.88)分,PSSS总分为(38.11±6.88)分,压力感知与社会支持呈负相关(r=-0.462)。多元回归分析显示,性别、是否独生子女、社会支持水平是影响疫情抗击一线护士压力感知的主要因素。结论COVID-19疫情抗击一线护士压力知觉得分总体较高,压力较大,医疗机构管理者应采取适当的激励制度等积极有效措施,缓解其压力,改善其身心健康。     

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Objective

The study compared laparoscopy-assisted gastrectomy (LAG) with open gastrectomy (OG) in the management of advanced gastric cancer (AGC).

Methods

Literature search was performed in the Medline, Embase, and Cochrane Library databases to identify control studies that compared LAG and OG for AGC. A meta-analysis was conducted to examine the surgical safety and oncologic adequacy, using the random-effect model.

Results

Seven eligible studies including 815 patients were analyzed. LAG was associated with less blood loss, less use of analgesics, shorter time of flatus and periods of hospital stay, but longer time of operation. The incidence of most complications was similar between the two groups. However, LAG was associated with a lower rate of pulmonary infection (odds ratio (OR) 0.19; 95% confidence interval (CI) 0.05 to 0.68; P<0.05). No significant differences were noted in terms of the number of harvested lymph nodes (weighted mean difference (WMD) 1.165; 95% CI–2.000 to 4.311; P>0.05), overall mortality (OR 0.65; 95% CI 0.39 to 1.10; P>0.05), cancer-related mortality (OR 0.64; 95% CI 0.32 to 1.25; P>0.05), or recurrence (OR 0.62; 95% CI 0.33 to 1.16; P>0.05).

Conclusions

LAG could be performed safely for AGC with adequate lymphadenectomy and has several short-term advantages compared with conventional OG. No differences were found in long-term outcomes. However, these results should be validated in large randomized controlled studies (RCTs) with sufficient follow-up.     

Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study

Objective: To compare the peri-operative outcomes for laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign or premalignant pancreatic neoplasms in two institutions. Methods: This prospective comparative study included 91 consecutive patients who underwent LDP (n=45) or ODP (n=46) from Jan. 2010 to Dec. 2012. Demographics, intra-operative characteristics, and post-operative outcomes were compared. Results: The median operating time in the LDP group was (158.7±38.3) min compared with (92.2±24.1) min in the ODP group (P<0.001). Patients had lower blood loss in LDP than in the ODP (122.6±61.1) ml vs. (203.1±84.8) ml, P<0.001). The rates of splenic conservation between the LDP and ODP groups were similar (53.3% vs. 47.8%, P=0.35). All spleen-preserving distal pancreatectomies were conducted with vessel preservation. LDP also demonstrated better post-operative outcomes. The time to oral intake and normal daily activities was faster in the LDP group than in the ODP group (1.6±0.5) d vs. (3.2±0.7) d, P<0.01; (1.8±0.4) d vs. (2.1±0.6) d, P=0.02, respectively), and the postoperative length of hospital stay in LDP was shorter than that in ODP (7.9±3.8) d vs. (11.9±5.8) d, P=0.006). No difference in tumor size (4.7±3.2) cm vs. (4.5±1.8) cm, P=0.77) or overall pancreatic fistula rate (15.6% vs. 19.6%, P=0.62) was found between the groups, while the overall post-operative complication rate was lower in the LDP group (26.7% vs. 47.8%, P=0.04). Conclusions: LDP is safe and effective for benign or premalignant pancreatic neoplasms, featuring lower blood loss and substantially faster recovery.     

Young children’s ability to make predictions about novel illnesses

Understanding disease transmission is a complex problem highlighted by the COVID-19 pandemic. These studies test whether 3- to 6-year-old children in the United States use information about social interactions to predict disease transmission. Before and during COVID-19, children predicted illness would spread through close interactions. Older children outperformed younger children with no associations between task performance and pandemic experience. Children did not predict that being hungry or tired would similarly spread through close interactions. Participants include 196 three- to six-year-olds (53% girls, 47% boys; 68% White, 9% Black, 7% Asian, 6% Hispanic or Latinx), with medium-sized effects (d = .6,  = .3). These findings suggest that thinking about social interaction supports young children's predictions about illness, with noted limitations regarding children's real-world avoidance of disease-spreading behaviors.     

新型冠状病毒肺炎患者血液中红细胞体积参数的变化

目的观察新型冠状病毒肺炎患者血液中RDW-SD、RDW-CV和MCV三种红细胞体积参数的变化。方法以确诊为新型冠状病毒肺炎患者17例作为病例组,64例普通肺部感染患者作为对照组,比较两组患者的RDW-SD、RDW-CV和MCV均值。结果新型冠状病毒肺炎组的RDW-SD、RDW-CV和MCV均值分别为39.7、12.3和88.5;普通肺部感染组的RDW-SD、RDW-CV和MCV均值分别为43.7、13.7和88.4;病例组与对照组比较RDW-SD(t=3.168,P=0.002),RDW-CV(t=3.990,P<0.001)有统计学差异,MCV(t=0.038,P=0.970)无统计学差异;RDW-SD、RDW-CV和三种红细胞体积参数联合检测的ROC曲线下面积分别为0.674、0.677和0.712。结论新型冠状病毒肺炎患者血液中红细胞体积参数RDW-SD和RDW-CV在发病过程中有明显变化,而普通肺部感染患者血液中红细胞体积参数在发病过程中变化不明显;RDW-SD、RDW-CV和MCV这三种红细胞体积参数联合检测可以辅助鉴别诊断新型冠状病毒肺炎与普通肺部感染。