Lymphopenia is common and correlates with poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19).
To determine whether a therapy that increases peripheral blood leukocyte and ...lymphocyte cell counts leads to clinical improvement in patients with COVID-19.
Between February 18 and April 10, 2020, we conducted an open-label, multicenter, randomized clinical trial at 3 participating centers in China. The main eligibility criteria were pneumonia, a blood lymphocyte cell count of 800 per μL (to convert to ×109/L, multiply by 0.001) or lower, and no comorbidities. Severe acute respiratory syndrome coronavirus 2 infection was confirmed with reverse-transcription polymerase chain reaction testing.
Usual care alone, or usual care plus 3 doses of recombinant human granulocyte colony-stimulating factor (rhG-CSF, 5 μg/kg, subcutaneously at days 0-2).
The primary end point was the time from randomization to improvement of at least 1 point on a 7-category disease severity score.
Of 200 participants, 112 (56%) were men and the median (interquartile range IQR) age was 45 (40-55) years. There was random assignment of 100 patients (50%) to the rhG-CSF group and 100 (50%) to the usual care group. Time to clinical improvement was similar between groups (rhG-CSF group median of 12 days (IQR, 10-16 days) vs usual care group median of 13 days (IQR, 11-17 days); hazard ratio, 1.28; 95% CI, 0.95-1.71; P = .06). For secondary end points, the proportion of patients progressing to acute respiratory distress syndrome, sepsis, or septic shock was lower in the rhG-CSF group (rhG-CSF group, 2% vs usual care group, 15%; difference, -13%; 95%CI, -21.4% to -5.4%). At 21 days, 2 patients (2%) had died in the rhG-CSF group compared with 10 patients (10%) in the usual care group (hazard ratio, 0.19; 95%CI, 0.04-0.88). At day 5, the lymphocyte cell count was higher in the rhG-CSF group (rhG-CSF group median of 1050/μL vs usual care group median of 620/μL; Hodges-Lehmann estimate of the difference in medians, 440; 95% CI, 380-490). Serious adverse events, such as sepsis or septic shock, respiratory failure, and acute respiratory distress syndrome, occurred in 29 patients (14.5%) in the rhG-CSF group and 42 patients (21%) in the usual care group.
In preliminary findings from a randomized clinical trial, rhG-CSF treatment for patients with COVID-19 with lymphopenia but no comorbidities did not accelerate clinical improvement, but the number of patients developing critical illness or dying may have been reduced. Larger studies that include a broader range of patients with COVID-19 should be conducted.
Chinese Clinical Trial Registry: ChiCTR2000030007.
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•HPDAlR&ZA (a new zinc alginate hydrogel embedded with hollow dopamine nanoparticles (HPDA) loaded with potent pro-healing peptide RL-QN15) promotes cells proliferation, as well as ...migration and angiogenesis and accelerates the healing rate of chronic skin wounds in diabetes mice.•HPDAlR&ZA modulates the expression of cytokines from macrophages.•HPDAlR&ZA resists the inflammatory response by rapidly polarizing M1 macrophages to M2 macrophages, thereby reconstructing blood supply, increasing collagen deposition, and accelerating diabetic wound repair and skin regeneration.
Chronic wound healing remains a considerable clinical challenge worldwide. We previously identified a pro-regenerative agent, i.e., hollow dopamine nanoparticles (HPDA) loaded with potent pro-healing peptide RL-QN15 (HPDAlR), with significant skin wound healing activity. In the current study, in consideration of clinical application, we successfully prepared a new zinc alginate hydrogel embedded with HPDAlR (HPDAlR&ZA) to treat diabetic wounds. HPDAlR&ZA exhibited no obvious toxicity against keratinocytes, human umbilical vein endothelial cells (HUVECs), human skin fibroblasts (HSFs), and mice. HPDAlR&ZA significantly promoted keratinocyte, HUVEC, and HSF proliferation, as well as HUVEC migration and angiogenesis. HPDAlR&ZA also modulated the expression of cytokines from macrophages. Diabetic mouse full-thickness skin wound and diabetic patient in vitro skin wound models showed that HPDAlR&ZA resisted the inflammatory response by rapidly polarizing M1 macrophages to M2 macrophages, thereby reconstructing blood supply, increasing collagen deposition, and accelerating diabetic wound repair and skin regeneration. In summary, HPDAlR&ZA is a biodegradable hydrogel wound dressing and an efficient treatment strategy for diabetic wound repair, with strong anti-oxidant, anti-inflammatory, and pro-angiogenic features.
The rare-earth nickelates (RENiO
3
) exhibit an exceptional complex electronic phase diagram and multiple electronic phase transitions that enrich promising applications in correlated electronic ...devices beyond conventional semiconductors. Nevertheless, the practical applications of RENiO
3
are challenged by their intrinsic thermodynamic metastability in material synthesis and high material cost. Therefore, developing an economical strategy to achieve the batch synthesis of RENiO
3
is of vital importance. In this work, we enlarged the synthesis amount of RENiO
3
up to 20 g per batch using chloride (KCl) assisted molten salt reaction. By optimizing the reaction conditions, the powder of RENiO
3
with the cubic shape and average size of ~ 2 μm was effectively synthesized, while their phase purity exceeded 95%. In addition, the cost to synthesize RENiO
3
was further reduced by using rare-earth extraction intermediate products as the raw materials, instead of using the pure rare-earth precursors. It also achieved wide adjustments in the metal-to-insulator-transition temperature from 160 to 420 K without significantly reducing the transition sharpness. By enlarging the synthesis amount and the reducing the cost, it paves the way to the device application of RENiO
3
.
Graphical abstract
To establish an optical coherence tomography (OCT)-based method for imaging peripheral pulmonary arteries.
We recruited eight patients (five men; average age, 48±12 years; peripheral pulmonary artery ...thrombosis, three patients; idiopathic pulmonary hypertension, three patients; interstitial lung disease, two patients) who underwent OCT of the peripheral pulmonary arteries in the First Affiliated Hospital of Guangzhou Medical University and Guangzhou Institute of Respiratory Diseases, between September 2009 and September 2010. OCT was performed using both the conventional OCT imaging method (COI) and the improved pulmonary artery imaging method (IPI). In the IPI, contrast agent was used as an indicator of balloon inflation meanwhile increases in flushing speed of the replacement fluid. The percentage of optimal images, inflation pressure, flushing speeds and complications were compared between the two methods.
We performed OCT of 33 vessel segments by both methods. IPI produced more optimal images than COI (88%
24%). Mean inflation pressure and flushing speed were higher during IPI than COI (0.62±0.15
0.43±0.08 atm; 1 atm =101.3 kPa; 0.82±0.10
0.42±0.06 mL/s; both P<0.01). Decreased blood oxygen saturation (SaO2) was associated with 9% and 30% segments (P<0.01) in the COI (mean decrease, 8.4%±3.6%) and IPI groups (mean decrease, 12.1%±5.3%; P<0.05) respectively. SaO2 recovered to pre-imaging levels after oxygen inhalation.
IPI is safe and effective for OCT of peripheral pulmonary arteries.
Optical coherence tomography (OCT) is a new imaging technique capable of obtaining high-resolution intravascular images and has been used in interventional cardiology. However, an application of OCT ...in pulmonary arteries had seldom been documented. In this case, OCT imaging is performed in peripheral pulmonary arteries and shows mural red thrombi. Subsequently, the red thrombi are aspirated and confirmed by a histological examination. These findings suggest that OCT may be a useful tool to depict peripheral pulmonary artery thrombi.
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•Cotton@ODMX is fabricated using a straightforward and effective approach.•Cotton@ODMX exhibits capabilities in thermal management, self-cleaning, bio-protection and strain ...sensor.•Cotton@ODMX can be a wearable electronic device.
Textile-based wearable electronic devices have gained significant attention due to their promising applications in personal thermal management, human healthcare monitoring, and human motion detection. Herein, a multifunctional MXene-decorated textile has been fabricated as a promising wearable electronic textile for thermal management, durable self-cleaning, bio-protection and wearable strain sensor. In this study, Ti3C2Tx MXene nanosheets, which are followed by surface engineering with mussel-inspired polydopamine coatings and hydrophobic octadecyl trimethoxysilane, are chosen as active materials for constructing multifunctional MXene-decorated textile. Thus, the multifunctional MXene-decorated textile (Cotton@ODMX) is fabricated by spray-coating the hydrophobic MXene-based composites (ODMX) onto the surface of the cotton textile. Such a Cotton@ODMX epitomizes a highly innovative electronic textile that not only retains the flexibility of the original textile, but also possesses remarkable superhydrophobic properties, outstanding photothermal conversion performance, photothermal self-healing capabilities, environmental stability and exceptional photothermal sterilization capabilities. More importantly, Cotton@ODMX is demonstrated to serve as a wearable strain sensor to monitor fundamental human movements, thus highlighting its impressive sensing capabilities. This work offers valuable insights for the development of multifunctional, flexible and wearable electronic devices with promising potential in personal thermal management, human healthcare monitoring, and human motion detection.
To analyze the clinical features of 1 case of bronchoesophageal fistula (BEF) secondary to mediastinal lymph node tuberculosis.
The clinical, auxiliary examinational and pathological data of 1 case ...with BEF were presented, and the literatures were reviewed.
The patient was a 19 year old female, who was admitted to hospital because of fever and cough associated with liquid intake. It was diagnosed by chest CT scan, endobronchial ultrasound biopsy of mediastinal lymph nodes, and clinical testing (methylene blue). The BEF was closed after anti-tuberculosis therapy and preventing contamination of the fistula by indwelling stomach tube.
Bronchoesophageal fistula secondary to mediastinal lymph node tuberculosis is rare. Chest CT scan, fiberoptic bronchoscopy, and clinical testing (methylene blue) are useful diagnostic tools for BEF.
During the outbreak of coronavirus disease 2019 (COVID-19), consistent and considerable differences in disease severity and mortality rate of patients treated in Hubei province compared to those in ...other parts of China have been observed. We sought to compare the clinical characteristics and outcomes of patients being treated inside and outside Hubei province, and explore the factors underlying these differences.
Collaborating with the National Health Commission, we established a retrospective cohort to study hospitalised COVID-19 cases in China. Clinical characteristics, the rate of severe events and deaths, and the time to critical illness (invasive ventilation or intensive care unit admission or death) were compared between patients within and outside Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicentre as well the administrative centre of Hubei province) and the duration between symptom onset and admission on prognosis were also determined.
At the data cut-off (31 January 2020), 1590 cases from 575 hospitals in 31 provincial administrative regions were collected (core cohort). The overall rate of severe cases and mortality was 16.0% and 3.2%, respectively. Patients in Hubei (predominantly with Wuhan-related exposure, 597 (92.3%) out of 647) were older (mean age 49.7
44.9 years), had more cases with comorbidity (32.9%
19.7%), higher symptomatic burden, abnormal radiologic manifestations and, especially, a longer waiting time between symptom onset and admission (5.7
4.5 days) compared with patients outside Hubei. Patients in Hubei (severe event rate 23.0%
11.1%, death rate 7.3%
0.3%, HR (95% CI) for critical illness 1.59 (1.05-2.41)) have a poorer prognosis compared with patients outside Hubei after adjusting for age and comorbidity. However, among patients outside Hubei, the duration from symptom onset to hospitalisation (mean 4.4
4.7 days) and prognosis (HR (95%) 0.84 (0.40-1.80)) were similar between patients with or without Wuhan-related exposure. In the overall population, the waiting time, but neither treated in Hubei nor Wuhan-related exposure, remained an independent prognostic factor (HR (95%) 1.05 (1.01-1.08)).
There were more severe cases and poorer outcomes for COVID-19 patients treated in Hubei, which might be attributed to the prolonged duration of symptom onset to hospitalisation in the epicentre. Future studies to determine the reason for delaying hospitalisation are warranted.
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