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Background: The recent outbreak of coronavirus disease 2019 (COVID-19) has been rapidly spreading on a global scale and poses a great threat to human health. Acute respiratory distress syndrome, characterized by a rapid onset of generalized inflammation, is the leading cause of mortality in patients with COVID-19. We thus aimed to explore the effect of risk factors on the severity of the disease, focusing on immune-inflammatory parameters, which represent the immune status of patients. Methods: A comprehensive systematic search for relevant studies published up to April 2020 was performed by using the PubMed, Web of Science, EMBASE, and China National Knowledge Internet (CNKI) databases. After extracting all available data of immune-inflammatory indicators, we statistically analyzed the risk factors of severe and non-severe COVID-19 patients with a meta-analysis. Results: A total of 4,911 patients from 29 studies were included in the final meta-analysis. The results demonstrated that severe patients tend to present with increased white blood cell (WBC) and neutrophil counts, neutrophil-lymphocyte ratio (NLR), procalcitonin (PCT), C-reaction protein (CRP), erythrocyte sedimentation rate (ESR), and Interleukin-6 (IL-6) and a decreased number of total lymphocyte and lymphocyte subtypes, such as CD4+ T lymphocyte and CD8+ T lymphocyte, compared to the non-severe patients. In addition, the WBC count>10 × 10 9 /L, lymphocyte count<1 × 10 9 /L, PCT>0.5 ng/mL, and CRP>10 mg/L were risk factors for disease progression in patients with COVID-19 (WBC count>10 × 10 9 /L: OR = 2.92, 95% CI: 1.96-4.35; lymphocyte count<1 × 10 9 /L: OR = 4.97, 95% CI: 3.53-6.99; PCT>0.5 ng/mL: OR = 6.33, 95% CI: 3.97-10.10; CRP>10 mg/L: OR = 3.51, 95% CI: 2.38-5.16). Furthermore, we found that NLR, as a novel marker of systemic inflammatory response, can also help predict clinical severity in patients with COVID-19 (OR = 2.50, 95% CI: 2.04-3.06). Conclusions: Immune-inflammatory parameters, such as WBC, lymphocyte, PCT, CRP, and NLR, could imply the progression of COVID-19. NLR has taken both the levels Feng et al. Immune-Inflammatory Parameters in COVID-19 of neutrophil and lymphocyte into account, indicating a more complete, accurate, and reliable inspection efficiency; surveillance of NLR may help clinicians identify high-risk COVID-19 patients at an early stage.
The clinical value of plasma Epstein-Barr virus (EBV) DNA has not been evaluated in patients with early-stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) receiving primary radiotherapy. Fiftyeight patients with stage I disease and 11 with stage II disease were recruited. High pretreatment EBV-DNA concentrations were associated with B-symptoms, elevated lactate dehydrogenase levels, and a high International Prognostic Index score. EBV-DNA levels significantly decreased after treatment. The 3-year overall survival (OS) rate was 82.6% for all patients. Stage I or II patients with a pretreatment EBV-DNA level of < 500 copies/mL had 3-year OS and progressionfree survival (PFS) rates of 97.1% and 79.0%, respectively, compared with 66.3% (P ؍ .002) and 52.2% (P ؍ .045) in patients with EBV-DNA levels of > 500 copies/mL. The 3-year OS and PFS rates for patients with undetectable EBV-DNA after treatment was significantly higher than patients with detectable EBV-DNA (OS, 92.0% vs 69.8%, P ؍ .031; PFS, 77.5% vs 50.7%, P ؍ .028). Similar results were observed in stage I patients. EBV-DNA levels correlate with tumor load and a poorer prognosis in early-stage NKTCL. The circulating EBV-DNA level could serve both as a valuable biomarker of tumor load for the accurate classification of early-stage NKTCL and as a prognostic factor. (Blood.
The relationship between outdoor atmospheric pollution by particulate matter and the morbidity and mortality of coronavirus disease 2019 (COVID-19) infections was recently disclosed, yet the role of indoor aerosols is poorly known. Since people spend most of their time indoor, indoor aerosols are closer to human occupants than outdoors, thus favoring airborne transmission of COVID-19. Therefore, here we review the characteristics of aerosol particles emitted from indoor sources, and how exposure to particles affects human respiratory infections and transport of airborne pathogens. We found that tobacco smoking, cooking, vacuum cleaning, laser printing, burning candles, mosquito coils and incenses generate large quantities of particles, mostly in the ultrafine range below 100 nm. These tiny particles stay airborne, are deposited in the deeper regions of human airways and are difficult to be removed by the respiratory system. As a consequence, adverse effects can be induced by inhaled aerosol particles via oxidative stress and inflammation. Early epidemiological evidence and animal studies have revealed the adverse effects of particle exposure in respiratory infections. In particular, inhaled particles can impair human respiratory systems and immune functions, and induce the upregulation of angiotensin-converting enzyme 2, thus inducing higher vulnerability to COVID-19 infection. Moreover, co-production of inflammation mediators by COVID-19 infection and particle exposure magnifies the cytokine storm and aggravates symptoms in patients. We also discuss the role of indoor aerosol particles as virus carriers. Although many hypotheses were proposed, there is still few knowledge on interactions between aerosol articles and virus-laden droplets or droplet nuclei.
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