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Aim: To explore the risk factors of prolonged viral shedding time (VST) in critical/non-critical COVID-19 patients during hospitalization. Methods: In this retrospective study, we enrolled 363 patients with SARS-CoV-2 infection admitted in a designated hospital during the COVID-19 outbreak in Nanjing Lukou International Airport. Patients were divided into critical (n = 54) and non-critical (n = 309) groups. We analyzed the relationship between the VST and demographics, clinical characteristics, medications, and vaccination histories, respectively. Results: The median duration of VST was 24 d (IQR, 20–29) of all patients. The VST of critical cases was longer than non-critical cases (27 d, IQR, 22.0–30.0 vs. 23 d, IQR 20–28, P

ObjectivesTo summarize the clinical characteristics of patients infected by SARS-CoV-2 omicron variant and explore the risk factors affecting the progression in a Fangcang hospital, Shanghai, China.MethodsA total of 25,207 patients were retrospectively enrolled. We described the clinical characteristics and performed univariate and multivariate logistic regression analysis to identify the risk factors for non-severe to severe COVID-19 or death.ResultsAccording to the outcomes, there were 39 severe patients (including 1 death) and 25,168 non-severe patients enrolled in this study. Among the 25,207 cases, the median age was 45 years (IQR 33-54), and 65% patients were male. Cough (44.5%) and expectoration (38.4%) were the most two common symptoms. Hypertension (10.4%) and diabetes (3.5%) were most two common comorbidities. Most patients (81.1%) were fully vaccinated. The unvaccinated and partially vaccinated patients were 15.1% and 3.9%, respectively. The length of viral shedding time was six days (IQR 4-9) in non-severe patients. Multivariate logistic regression analysis suggested that age (OR=1.062, 95%CI 1.034-1.090, p

We aim to investigate whether a popular hand exercise could be used to improve the action of eating in patients with Alzheimer's disease (AD). A 6-month intervention was conducted in 60 patients with AD who live in a nursing home. They were divided into hand exercise and control groups. Patients of the control group maintained their daily routine. The improvement of Edinburgh Feeding Evaluation in Dementia scale in hand exercise group was significantly greater than in the control group (P = .003). Significant differences in time of autonomous eating and time of simulated eating between patients in the hand exercise and control groups (P < .05) were noted. The improvements in accuracy of eating action and coordination of eating action from baseline were significant in hand exercise group compared to the control group (P = .020 and .014, respectively). Hand exercise is a safe and effective intervention to improve the feeding and eating of people with AD. [ABSTRACT FROM AUTHOR]

Objective: To observe the therapeutic effect of electroacupuncture (EA) at Zusanli (ST 36) and Neiguan (PC 6) on stress responses of patients undergoing gastrointestinal surgery., Methods: A total of 40 patients undergoing gastrointestinal surgery were randomized into conventional treatment group (control) and EA group ( n ＝20 in each group). Patients of the EA group received conventional treatment (pre- and post-surgical fasting, measures for gastrointestinal decompression, parenteral nutrition support, and patient controlled analgesia pump, etc.) and EA stimulation (2 Hz, 30 min) of bilateral ST 36 and PC 6 (twice after surgery, at an interval of 6 h), and patients of the control group received conventional treatment only. The visual analogue scale (VAS) score was used to assess the patients' pain severity and the blood glucose levels were detected once every 4－6 h within 24 h after operation. Serum cortisol (Cort) and adrenocorticotropic hormone (ACTH) levels were detected by chemiluminescence method, and serum D-lactic acid level (for assessing gastrointestinal mucosal injury) was assayed by ELISA., Results: After the treatment, the levels of serum Cort, ACTH, D-lactate acid and the highest blood glucose were significantly lower in the EA group than those in the control group ( P <0.05, P <0.01), suggesting a reduction of stress reactions after EA. But no significant difference was found between the control and EA groups in the VAS score ( P >0.05)., Conclusion: EA at ST 36 and PC 6 can alleviate stress responses and reduce intestinal mucosal damage in patients undergoing gastrointestinal surgery.

Objective: To evaluate the effects of positive end-expiratory pressure (PEEP) targeting optimal oxygenation on local gas distribution and inflammation in dogs with acute respiratory distress syndrome (ARDS)., Methods: ARDS was induced by saline alveoli-lavage and oleic acid intravenous. The animals were mechanical ventilated 4 h at optimal PEEP titrated by oxygenation. Computed tomography (CT) scans were performed before and after induction of ARDS and at the end the study. NF-κB was measured by electrophoretic mobility shift assay (EMSA), IL-6 and IL-10 were assessed by ELISA. Myeloperoxidase (MPO) and malondialdehyde (MDA) were measured. Pathological changes were examined under optical microscope., Results: (1) Compared to baseline, total lung volumes decreased and nonaerated areas increased significantly after the induction of ARDS in both groups (P < 0.05). Compared with ARDS models, PEEP titrated to achieve optimal oxygenation resulted in greater lung recruitment but was accompanied with hyperinflation, hyperinflation occurred in non-dependent lung. Compared with oleic acid-injured ARDS, the changing of hyperinflated lung areas was increased markedly in saline lavage-injured ARDS (P < 0.05). (2) Compared with right lung ventral lower lobe, lung injury score was lower in right lung upper lobe. Histological injury in right lung dorsal lower lobe was severer than that in right lung upper lobe and right lung ventral lower lobe. NF-κB activation of right lung dorsal lower lobe was markedly higher than right lung upper lobe (P < 0.05). MPO and MDA were much higher with right lung dorsal lower lobe than right lung upper lobe and right lung ventral lower lobe (P < 0.05). Compared with right lung upper lobe and right lung ventral lower lobe, IL-6 and IL-10 increased markedly in right lung dorsal lower lobe (P < 0.05)., Conclusions: Alveolar hyperinflation and aggravated lung injury in non-dependent region were occurred at PEEP targeting optimal oxygenation. Hyperinflation was more common in saline lavage-injured ARDS.

Objective: To observe the effects of different fluids on alveolar epithelium barrier in rats with acute lung injury (ALI)., Methods: Thirty-six Sprague-Dawley (SD) rats were randomly assigned into six groups with 6 rats in each group. ALI was induced by intravenous injection of lipopolysaccharide(LPS). Rats in all treatment groups were given different fluids and sacrificed after 4 hours. Evans blue dye (EBD) was injected via the femoral vein 30 minutes before death. Tracheobronchial tree was washed with normal saline (NS) after death, and broncho-alveolar lavage fluid (BALF) was collected. Leakage of EBD from blood into BALF (alveolar epithelial permeability) and wet/dry (W/D) ratio were measured. The mRNA expression of surfactant protein-C (SP-C) was assessed by reverse transcription-polymerase chain reaction (RT-PCR). Alveolar epithelium apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP biotin nick end labeling (TUNEL). Lung injury was evaluated by Smith lung injury score., Results: (1) Lung injury scores in LPS and NS groups were significantly higher than in control group (both P < 0.05). Compared with NS group, lung injury scores were significantly lower in 5% albumin (ALB) and 6% hydroxyethyl starch 130/0.4 (HES) groups (both P < 0.05), and there was no significant difference in 4% succinylated gelatin (GEL) group (P > 0.05). No significant difference was found among the latter three groups. (2) W/D ratio in LPS and NS groups were significantly higher than that in control group (both P < 0.05). Compared with NS group, W/D ratios were lower in ALB, HES and GEL groups (all P < 0.05). But it showed no significant difference among the latter three groups. (3) Alveolar epithelial permeability in LPS and NS groups were remarkably higher than that in control group (both P < 0.05). Compared with NS group, the alveolar epithelial permeability were significantly lower in ALB, HES and GEL groups (all P < 0.05). The alveolar epithelial permeability in the latter two groups were significant lower than that in ALB group (both P < 0.05) but higher than that of control group. (4) The SP-C mRNA expression in LPS, NS, ALB and GEL groups were lower than that in control and HES groups (all P < 0.05), but there was no difference between control and HES groups (P > 0.05). (5) Apoptosis index (AI) of alveolar epithelial cell in all the treatment groups were significantly higher than that in control group (all P < 0.05). Compared with NS group, AI were noticeably lower in ALB and HES groups (both P < 0.05)., Conclusion: Compared with NS, colloid can probably improve the alveolar epithelial permeability and protect the barrier function.

Objective: To study the effect of angiotensin II (Ang II) and losartan, which is an angiotensin II type 1 receptor (AT1R) antagonist, on expression of AT2R in rat lung and the relationship between AT2R with acute lung injury (ALI)., Methods: Twenty-four Sprague-Dawley (SD) rats were randomly divided into normal group, Ang II group, Ang II + losartan group and losartan group, with 6 rats in each group. Normal group and Ang II group were treated with continuous subcutaneous injection of normal saline (NS, 1 microg.kg(-1).min(-1)) or Ang II (1 microg.kg(-1).min(-1)) for 72 hours respectively. Ang II + losartan group was gavaged with losartan (10 mg.kg(-1) .d(-1)) 24 hours before and during the 72 hours' continuous subcutaneous injection of Ang II for a duration of 4 days. In losartan group rats were gavaged with losartan (10 mg.kg(-1).d(-1)) for 4 days only. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were employed to measure AT2R mRNA and protein. The pathology of the rat pulmonary was scored., Results: Smith's score of pathology in Ang II group [(3.33+/-1.14) scores] was significantly higher than that of the normal group [(0.73+/-0.09) scores], while it was significantly lower in Ang II + losartan group [(1.98+/-0.30) scores] than that of Ang II group. Smith's score of pathology in losartan group was [(0.95+/-0.20) scores]. The differences among four groups showed significant statistical difference (P<0.05 or P<0.01). AT2R mRNA in Ang II group [(47.90+/-9.88)%] was significantly lower than that of normal group [(86.33+/-5.90)%], while it was significantly higher in Ang II + losartan group [(90.63+/-19.66)%] than Ang II group . AT2R mRNA of losartan group was (68.65+/-4.88)% . The differences among four groups had significant statistical difference (P<0.05 or P<0.01). While on protein level showed no statistically significant difference among the four groups. The values of AT2R were (78.80+/- 41.26)%, (68.98+/-23.93)%, (68.13+/-23.23)% and (70.15+/-17.16)%, respectively., Conclusion: Ang II could induce ALI and downregulate AT2R mRNA expression in the lung of ALI rats, whereas losartan acts as a positive regulator. AT2R seems to present lung protection in ALI.

Objective: To evaluate the effect of recruitment maneuvers in prone positioning on hemodynamic in dogs with acute respiratory distress syndrome (ARDS) of pulmonary or extra pulmonary origin., Methods: Forty-eight mongrel dogs were randomly divided into 8 groups with six dogs in each group. Hydrochloric acid was instilled into trachea to reproduce pulmonary ARDS (ARDSp) and oleic acid was intravenously injected to produce extra-pulmonary ARDS (ARDSe). ARDSp and ARDSe dogs were divided into conventional mechanical ventilation group (group A), prone-position ventilation group (group B), sustained inflation (SI) group (group C) and prone-position ventilation + SI group (group D) respectively. Hemodynamic parameters were monitored before injury and 0, 2 and 5 hours after ARDS was reproduced., Results: (1) In group A and group C, central venous pressure (CVP) increased significantly at 5 hours after ARDSp. Five hours after the establishment of ARDSp, pulmonary arterial wedge pressure (PAWP) increased in group C and group D. Mean pulmonary arterial pressure (MPAP) increased remarkably in group A, group C and group D at 2 hours and 5 hours after onset of ARDSp. In group C, intrathoracic blood volume index (ITBI) decreased at 5 hours after the onset of ARDSp. In all the four groups, extravascular lung water index (EVLWI) increased sharply at 0, 2 and 5 hours after onset of ARDSp. In group B and group C, cardiac index (CI) decreased to a greater extent at 2 and 5 hours after onset of ARDSp. CI decreased at 2 hours after onset of ARDSp in group D with statistically significant difference at different time points (all P<0.05). (2) In all four groups, EVLWI increased sharply at 0, 2 and 5 hours after onset of ARDSe. In ARDSe model, there was no significant difference in other hemodynamic parameters between groups (all P>0.05)., Conclusion: There are less influence on hemodynamics when SI is performed in prone position, and it is even more significantly so in ARDS dogs.