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BackgroundSARS-CoV-2-caused coronavirus disease (COVID-19) is posing a large casualty. The features of COVID-19 patients with and without pneumonia, SARS-CoV-2 transmissibility in asymptomatic carriers, and factors predicting disease progression remain unknown. MethodsWe collected information on clinical characteristics, exposure history, and laboratory examinations of all laboratory-confirmed COVID-19 patients admitted to PLA General Hospital. Cox regression analysis was applied to identify prognostic factors. The last follow-up was February 18, 2020. ResultsWe characterized 55 consecutive COVID-19 patients. The mean incubation was 8.42 (95% confidence interval [CI], 6.55-10.29) days. The mean SARS-CoV-2-positive duration from first positive test to conversion was 9.71 (95%CI, 8.21-11.22) days. COVID-19 course was approximately 2 weeks. Asymptomatic carriers might transmit SARS-CoV-2. Compared to patients without pneumonia, those with pneumonia were 15 years older and had a higher rate of hypertension, higher frequencies of having a fever and cough, and higher levels of interleukin-6 (14.61 vs. 8.06pg/mL, P=0.040), B lymphocyte proportion (13.0% vs.10.0%, P=0.024), low account (<190/{micro}L) of CD8+ T cells (33.3% vs. 0, P=0.019). Multivariate Cox regression analysis indicated that circulating interleukin-6 and lactate independently predicted COVID-19 progression, with a hazard ratio (95%CI) of 1.052 (1.000-1.107) and 1.082 (1.013-1.155), respectively. During disease course, T lymphocytes were generally lower, neutrophils higher, in pneumonia patients than in pneumonia-free patients. CD8+ lymphocytes did not increase at the 20th days after illness onset. ConclusionThe epidemiological features are important for COVID-19 prophylaxis. Circulating interleukin-6 and lactate are independent prognostic factors. CD8+ T cell exhaustion might be critical in the development of COVID-19.
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Objective To explore the clinical treatment strategies of laparoscopic hepatocellular carcinoma ablation for patients with severe cirrhosis background.Methods We analyzed the clinical data of 430 patients and analyzed the indications,key techniques,efficacy and safety of laparoscopic hepatocellular carcinoma ablation for patients with severe cirrhosis background,and summarized the related experiences.Results The first complete ablation rate for the entire cohort was 94％,the 2-year local recurrence rate was 2.8％.No significant complications were found postoperatively.Conclusions Laparoscopic hepatocellular carcinoma ablation is a minimally invasive,safe and effective treatment strategy for patients with small cancer under severe cirrhosis background.Especially when the tumor is located in the " high-risk parts" for ablation,it could be a preferred method for pre-transplant treatment of these patients.
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Objective To evaluate the efficacy of intraopèrative ultrasonography (IOUS) on primary and repeated hepatectomies for hepatocellular carcinoma (HCC).Methods 430 patients underwent 555 operations for HCC.New tumors detected by IOUS at the primary and repeated hepatectomies were retrospectively analyzed.The long-term outcomes were also studied.Results IOUS had the highest sensitivity in the routinely used imaging examinations.The detection rate by each imaging modality decreased slightly but uniformly at the second hepatectomy.IOUS detected 56 new tumors in 30 patients (7.1％) at the primary hepatectomy and 13 new tumors in 8 (7.3％) at the second.The average size of tumor detected was 8.7±3.8 and 9.0±5.2 mm at the primary and second resections,respectively.The preoperative surgical plan was changed due to the IOUS findings alone in 24 patients (5.6％) at the primary hepatectomy,and in 7 (6.4％) at the second.Although recurrence was frequent in patients with new tumors detected at the primary hepatectomy,long-term survival after appropriate treatment for recurrence was similar to those patients without new tumors detected.Conlusions Despite recent progress in imaging modalities,IOUS is still the most sensitive examination.The same degree of precaution is necessary to detect new tumors using IOUS in repeated hepatectomy.Patients with new tumors detected by IOUS are at high risk for recurrence so that regular check-up is important to improve patient survival.