No abstract

In comparison to severe acute respiratory syndrome coronavirus (SARS-CoV), SARS-CoV-2 appears to be more contagious [1], and coronavirus disease 2019 (COVID-19) patients demonstrate varied clinical manifestations distinct from those seen in patients with SARS-CoV and Middle East respiratory syndrome coronavirus infections [2]. Collective results from the clinical and epidemiological observations suggest a distinct viral-host interaction in COVID-19 patients. Profiling of the antibody response during SARS-CoV-2 infection may help improve our understanding of the viral-host interaction and the immunopathological mechanisms of the disease. Studies on humoral responses to infections have been mainly geared toward the production of high-affinity IgG antibodies that efficiently resolve an infection. It has been well recognised, however, that humoral immune response to infection can be a double-edged sword that either serves as a protective mechanism to resolve the infection or aggravates the tissue injury, e.g. the IgG response causes fatal acute lung injury by skewing the inflammation-resolving response in SARS-CoV [3]. In the case of respiratory infection, while IgM and IgG isotypes have been the primary emphasis in characterising immunity, mucosal and systemic IgA responses that may play a critical role in the disease pathogenesis have received much less attention. This study was designed to better understand the timing and patterns of humoral immune responses to SARS-CoV-2 in a cohort of COVID-19 patients and evaluate their relationship with the disease course and severity. 37 patients with COVID-19, with a mean±SD age of 52.3±16.3 years, were enrolled in this study. The enrolled COVID-19 patients consisted of 25 (67.6%) males and 12 (32.4%) females. All patients tested positive for viral nucleic acid of SARS-CoV-2 (Real-Time Fluorescent RT-PCR Kit; BGI, Shenzhen, China). According to the "Guidelines for the Diagnosis and Treatment of Novel Coronavirus (2019-nCoV) Infection" published by the National Health Commission of China, the enrolled COVID-19 patients were categorised into two groups: 20 (54.1%) severe cases and 17 (46.0%) nonsevere cases [4]. The nonsevere group included patients with mild and moderate symptoms who were also required to be admitted to hospital by the COVID-19 control policy in China. The severe group included severe and critically ill patients. Mild patients did not demonstrate abnormal computed tomography (CT) imaging. Moderate patients had fever and/or classical respiratory symptoms, and typical CT images of viral pneumonia. Severe patients met at least one of following additional conditions: 1) shortness of breath with a respiratory rate ⩾30 times•min −1 ; 2) oxygen saturation measured by pulse oximetry (resting state) of ⩽93%; or 3) arterial oxygen tension/inspiratory oxygen tension of ⩽300 mmHg. Critically ill patients met at least one of the extra following conditions in addition to the COVID-19 diagnosis: 1) respiratory failure that required mechanical ventilation; 2) shock; or 3) mu...

Fast-track surgery can lessen postoperative stress reactions and accelerate rehabilitation for patients with gastric cancer.

Background Effective therapies are urgently needed for the SARS-CoV-2 pandemic. Chloroquine has been proved to have antiviral effect against coronavirus in vitro. In this study, we aimed to assess the efficacy and safety of chloroquine with different doses in COVID-19. Method In this multicenter prospective observational study, we enrolled patients older than 18 years old with confirmed SARS-CoV-2 infection excluding critical cases from 12 hospitals in Guangdong and Hubei Provinces. Eligible patients received chloroquine phosphate 500 mg, orally, once (half dose) or twice (full dose) daily. Patients treated with non-chloroquine therapy were included as historical controls. The primary endpoint is the time to undetectable viral RNA. Secondary outcomes include the proportion of patients with undetectable viral RNA by day 10 and 14, hospitalization time, duration of fever, and adverse events. Results A total of 197 patients completed chloroquine treatment, and 176 patients were included as historical controls. The median time to achieve an undetectable viral RNA was shorter in chloroquine than in non-chloroquine (absolute difference in medians -6.0 days; 95% CI -6.0 to -4.0). The duration of fever is shorter in chloroquine (geometric mean ratio 0.6; 95% CI 0.5 to 0.8). No serious adverse events were observed in the chloroquine group. Patients treated with half dose experienced lower rate of adverse events than with full dose. Conclusions Although randomised trials are needed for further evaluation, this study provides evidence for safety and efficacy of chloroquine in COVID-19 and suggests that chloroquine can be a cost-effective therapy for combating the COVID-19 pandemic.