The coronavirus disease 2019 (COVID-19) has been spreading worldwide. Severe cases quickly progressed with unfavorable outcomes. We aim to investigate the clinical features of COVID-19 and identify the risk factors associated with its progression. Data of confirmed SARS-CoV-2-infected patients and healthy participants were collected. Thirty-seven healthy people and 79 confirmed patients, which include 48 severe patients and 31 mild patients, were recruited. COVID-19 patients presented with dysregulated immune response (decreased T, B, and NK cells and increased inflammatory cytokines). Also, they were found to have increased levels of white blood cell, neutrophil count, and D-dimer in severe cases. Moreover, lymphocyte, CD4+ T cell, CD8+ T cell, NK cell, and B cell counts were lower in the severe group. Multivariate logistic regression analysis showed that CD4+ cell count, neutrophil-to-lymphocyte ratio (NLR) and D-dimer were risk factors for severe cases. Both CT score and clinical pulmonary infection score (CPIS) were associated with disease severity. The receiver operating characteristic (ROC) curve analysis has shown that all these parameters and scores had quite a high predictive value. Immune dysfunction plays critical roles in disease progression. Early and constant surveillance of complete blood cell count, T lymphocyte subsets, coagulation function, CT scan and CPIS was recommended for early screening of severe cases.

Patients with diabetes are more susceptible to severe acute respiratory syndrome-associated coronavirus (SARS-CoV)-2 infection, but vaccine hesitancy is a problem in this population. We investigated the prevalence of SARS-CoV-2 vaccine hesitancy among diabetes patients in China through a cross-sectional survey from April and August 2021 using a questionnaire administered to patients at two hospitals affiliated with Changzhi Medical College (Shanxi, China). The health belief model (HBM) is used examining factors influencing vaccine hesitancy. After adjusting for potential confounders, a multivariate logistic regression model was used to analyze correlations between vaccine hesitancy and associated factors. Of the 483 participants, 56.4% (273/483) had vaccine hesitancy, including 58.2% (159/273) who were unsure of being vaccinated and 41.8% (114/273) who were unwilling. Although patients considered SARS-CoV-2 infection to be serious (adjusted odds ratio [aOR] = 3.90, 95% confidence interval [CI]: 2.36–6.42; p < 0.001), they had concerns about vaccine safety (aOR = 3.05, 95% CI: 1.89–4.91; p < 0.001). Relatives’ vaccination status did not influence participants’ willingness to be vaccinated (aOR = 2.43, 95% CI: 1.39–4.25; p < 0.001). Disagreement with physicians’ view that vaccination can reduce SARS-CoV-2 infection risk was independently correlated with vaccine hesitancy (aOR = 2.25, 95% CI: 1.28–3.95; p < 0.001). Diabetes patients in China need to be educated on SARS-CoV-2 vaccine safety and protective effects to increase the vaccination rate in this population.

Background: Myeloid derived suppressor cells (MDSCs) have been reported to keep elevating during sepsis. The current study was performed to investigate the immunosuppressive effect of MDSCs and their subsets with the underlying mechanisms. Methods: The immunosuppressive status was manifested by the apoptosis of splenocytes, quantity of T cells and PD-1 expression. The dynamics of quantity and PD-L1 level of MDSCs and the subsets were determined over time. The subset of MDSCs with high PD-L1 level was co-cultured with T cells to observe the suppressive effect. Results: Abdominal abscess was observed after 7 days post-sepsis. Five biomarkers related to organ functions were all significantly higher in the CLP group. The survival rate was consistent with the middle grade severity of sepsis model. Apoptosis of splenocytes increased over time during sepsis; CD4 + T cell decreased from day 1 post-sepsis; CD8+ T cells significantly reduced at day 7. The PD-1 expression in spleen was upregulated from an early stage of sepsis, and negatively related with the quantity of T cells. MDSCs were low at day 1 post-sepsis, but increased to a high level later; the dynamics of PMN-MDSC was similar to MDSCs. PD-L1 on MDSCs was highest at day 1 post-sepsis; PMN-MDSC was the main subset expressing PD-L1. The PMN-MDSC with high PD-L1 expression level extracted on day 1 after surgery from CLP mice significantly inhibited the proliferation of T cells. Conclusions: Sepsis-induced immunosuppression is initiated from a very early stage, a high expression level of PD-L1 on MDSCs and the main subset, PMN-MDSC might play a critical role suppressive role on T cells through PD-L1/PD-1 axis.

Tripterygium wilfordii Hook F has significant anti-inflammatory and immunosuppressive properties and is widely used for treating autoimmune and inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, and kidney disease, especially in traditional Chinese medicine. The mechanisms underlying its effects may be diverse but they remain unclear, and its toxicity and side effects limit its wider clinical application. This review summarizes the clinical application of Tripterygium wilfordii Hook F in recent years, as well as the results of studies into its mechanisms and toxicity, to provide a reference for its future clinical application.

The population with diabetes is more susceptible to severe acute respiratory syndrome-associated coronavirus (SARS-CoV)-2, and have a significantly higher coronavirus disease-2019 (COVID-19) mortality rate. Previous studies have shown low willingness for the COVID-19 vaccination, and there are limited reports on the behavior and relevance of the COVID-19 vaccination. This study aimed to determine the uptake behavior and associated factors of the COVID-19 vaccine. In our cross-sectional questionnaire-based clinical study, 645 diabetes patients affiliated with two affiliated hospitals of Changzhi Medical College completed the questionnaire between June to October 2021. The health belief model (HBM) was used in examining factors influencing vaccination behavior. After adjusting for covariates with significant differences in social background characteristics, a multivariable logistic regression was used to determine predictors related to uptake in COVID-19 vaccination. A total of 162 vaccinated and 483 unvaccinated eligible diabetic patients were recruited. Patients who believed that the COVID-19 syndrome is severe (aOR3.67, 95%CI 1.88–7.17; p < 0.001), believe that vaccination can significantly reduce the risk of SARS-Cov-2 infection (aOR3.48, 95%CI 1.80–6.73; p < 0.001), believe that vaccination is beneficial to themselves and others (aOR 4.53, 95%CI 1.71–11.99; p = 0.002), think that relatives’ vaccination status has a positive impact on their vaccination behavior (aOR 5.68, 95%CI 2.83–11.39; p < 0.001), and were more likely to be vaccinated; worrying about the adverse health effects of COVID-19 vaccination (aOR 0.18, 95%CI 0.09–0.35; p < 0.001) was negatively correlated with COVID-19 vaccination behavior. Health care workers should provide targeted informative interventions based on the safety and protective effects theory of HBM to improve vaccination behavior in patients with diabetes.