This study reports the surgical treatment of a female patient at age of 64 years with novel coronavirus (SARS-CoV-2) latent infection complicated with esophageal foreign body perforation with no significant changes in the lung CT. The patient was confirmed as SARS-CoV-2 infection on the 4th day after surgery and then was transferred into the Department of Infectious Disease in our hospital for treatment. This case has guiding value for the operation of thoracic surgery during the outbreak of novel coronavirus pneumonia.
ObjectivesTo estimate the basic reproduction number of the novel coronavirus (2019-nCoV) and to provide support to epidemic preparedness and response.MethodsBased on the susceptible–exposed–infected–removed (SEIR) compartment model and the assumption that the infection cases with symptoms occurred before January 26, 2020 were resulted from free propagation without intervention, we estimated the basic reproduction number of 2019-nCoV according to the reported confirmed cases and suspected cases, as well as theoretical estimated number of infected cases by other research teams, together with some epidemiological determinants learned from the severe acute respiratory syndrome.ResultsThe basic reproduction number fall between 2.8 to 3.3 by using the real-time reports on the number of 2019-nCoV infected cases from People’s Daily in China, and fall between 3.2 and 3.9 on the basis of the predicted number of infected cases from international colleagues.ConclusionsThe early transmission capability of 2019-nCoV is close to or slightly higher than SARS. It is a controllable disease with moderate-high transmissibility. Timely and effective control measures are capable to quickly reduce further transmission.
Since December 2019, a novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) outbreak has occurred in Wuhan, Hubei Province, and the epidemic situation has continued to spread. Such cases have also been found in other parts of the country. The spread of the novel coronavirus pneumonia epidemic has brought great challenges to the clinical practice of thoracic surgery. Outpatient clinics need to strengthen the differential diagnosis of ground glass opacity and pulmonary plaque shadows. During the epidemic, surgical indications are strictly controlled, and selective surgery is postponed. Patients planning to undergo a limited period of surgery should be quarantined for 2 weeks and have a nucleic acid test when necessary before surgery. For patients who are planning to undergo emergency surgery, nucleic acid testing should be carried out before surgery, and three-level protection should be performed during surgery. Patients who are planning to undergo emergency surgery in the epidemic area should be confirmed with or without novel coronavirus pneumonia before operation, and perform nucleic acid test if necessary. Surgical disinfection and isolation measures should be strictly carried out. Among postoperative patients, cases with new coronavirus infection were actively investigated. For the rescue of patients with novel coronavirus infection, attention needs to be paid to prevention and treatment and related complications, including mechanical ventilation-related pneumothorax or mediastinal emphysema, and injury after tracheal intubation.
At the end of December 2019, some hospitals in Wuhan, Hubei, China found unexplained pneumonia cases one after another. On January 12, 2020, World Health Organization officially named the new coronavirus that caused the outbreak as “2019 new coronavirus”. The National Health Committee of China has organized experts to compile a “pneumonia diagnosis and treatment program for new coronavirus infection” to guide the prevention, control, diagnosis and treatment of the disease. However, due to the limited knowledge of the disease, there are still many problems to be solved in the diagnosis and treatment of the disease. We reviewed the researches on coronavirus infections related to severe acute respiratory syndrome and Middle East respiratory syndrome, combined with our own experience in diagnosis and treatment, and proposed some thoughts on several unclear hot issues such as the mode of disease transmission, the incubation period, the practical application of diagnostic standards, and the choice of treatment drugs in the diagnosis and treatment plan.
ObjectiveTo investigate CT image features of ground glass opacity (GGO)-like 2019 novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) and early-stage lung carcinoma for control and therapy of this acute severe respiratory disease.MethodsWe retrospectively analyzed the clinical data of 71 GGO-like COVID-19 patients who received therapy in Tongji Hospital of Huazhong University of Science and Technology between January 17th and February 13th, 2020. These 71 GGO-like COVID-19 patients were as a COVID-19 group. And 80 GGO-like early-stage lung carcinoma patients who underwent resection were as a lung carcinoma group. Clinical features such as sex, age, symptoms including fever, cough, fatigue, myalgia and dyspnea, detailed exposure history, confirmatory test (SARS-CoV-2 quantitative RT-PCR) and pathologic diagnosis were analyzed.ResultsSignificantly different symptoms and exposure history between the two groups were detected (P<0.001). More lesions (61 patients at percentage of 85.92%, P<0.001), relative peripheral locations (69 patients at percentage of 97.18%, P<0.001) and larger opacities (65 patients at percentage of 91.55%, P<0.001) were found in chest radiographs of GGO-like COVID-19 compared with GGO-like early-stage lung carcinoma. Similar features appeared in early-stage of COVID-19 and lung carcinoma, while pneumonia developed into more extensive and basal predominant lung consolidation. Coexistence of GGO-like COVID-19 and early-stage lung carcinoma might occur.ConclusionConsidering these similar and unique features of GGO-like COVID-19 and early-stage lung carcinoma, it is necessary to understand short time re-examination of chest radiographs and other diagnostic methods of these two diseases. We believe that the findings reported here are important for diagnosis and control of COVID-19 in China.
A 49-year-old male patient with compartment syndrome of the right leg caused by acute carbon monoxide poisoning was admitted on December 30, 2019. The patient had a 10-year history of chronic nephritis and began dialysis treatment due to renal failure 1 month ago. Emergency surgical decompression for compartment syndrome was performed after admission. Two weeks later, the patient was diagnosed as the novel coronavirus pneumonia caused by 2019 novel coronavirus (2019-nCoV) infection. Then, the patient was transferred to the isolation ward, where he was given anti-infection, anti-virus, expectorant, heat-clearing and detoxifying drugs, bedside dialysis, and nutrition support symptomatic treatment. After 2 weeks of treatment, the patient is getting better, with no fever, cough, wheezing, and other discomfort. Meanwhile, the sensory and motor functions of right lower limb recovered gradually. This case is rare, severe, and difficult to diagnose and treat. It is the first reported case of novel coronavirus pneumonia after orthopedic surgery.
ObjectiveTo detect the 2019 novel coronavirus (2019-nCoV) in various biological specimens of novel coronavirus pneumonia (NCP), and preliminarily observe the status of 2019-nCoV in different systems of the body and its clinical significance.MethodsThe study design was a small-scale cross-sectional observational study. All the confirmed NCP cases being treated in the Second People’s Hospital of Yibin · West China Yibin Hospital, Sichuan University on February 2nd, 2020 were enrolled in this study. Two sets of primers were designed for 2019-nCoV-1ab and N regions using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay. The 2019-nCoV in upper respiratory specimens, blood, feces and urine specimens of the NCP cases were detected on the single day.ResultsA total of 7 imported NCP cases (mild type) were included. The 7 patients were confirmed by the positive results of 2019-nCoV nucleic acid tests of upper or lower respiratory specimens between the 3rd day and the 7th day after fever onset, while 2 patients were found positive on the 3rd day after onset. The 2019-nCoV nucleic acid tests of the 7 patients were detected again on a single day between the 7th day and the 15th day after onset, and the results showed: the upper respiratory specimens of 5 patients were found negative (1 case was on the 7th day after onset); 2019-nCoV was not detected in the blood, feces or urine specimens of the 7 patients.ConclusionsFor mild type NCP patients, real-time RT-PCR test could detect 2019-nCoV between the 3rd day and the 7th day after onset, while 2019-nCoV might become negative since the 7th day after onset. 2019-nCoV was not detected in the blood, feces or urine of mild type NCP patients on the single day between the 7th day and the 15th day after onset. This study was only a preliminary observational study, which needed high-qualified studies to obtain more definitive conclusions.
There was a male novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) patient after pulmonary surgery at age of 61 years. The patient had no clear history of contact COVID-19 patient before surgery. He developed transient fever on the 4th day after surgery. The body temperature returned to normal on the 5th day after antibiotic adjustment. The patient developed fever and fatigue again on the 6th day after surgery. A chest CT scan revealed postoperative pneumonia. The patient was treated by ganciclovir and moxifloxacin hydrochloride. The patient's temperature gradually decreased on the 7th to 9th days after the operation. CT scan on the 10th day after surgery showed viral pneumonia, so we immediately raised the level of protection. The novel coronavirus nucleic acid test was positive. The patient was immediately transferred to the designated hospital for treatment. The patient was treated by arbidol, moxifloxacin, human immunoglobulin (PH4), ambroxol and other nutritional symptomatic and supportive treatment. The patient's condition is currently stable. Ten people in close contact with the patient developed symptoms, and their CT scans showed viral pneumonia. Six of them were positive in nucleic acid tests, and the others were still under quarantine observation. This shows that it is easy to confuse the imaging manifestations of pneumonia with novel coronavirus pneumonia after lung surgery. We should perform nucleic acid detection as soon as possible in the early diagnosis of CT and reformulate the treatment protocol.
ObjectiveTo summarize the clinical experience in the prevention and treatment of novel coronavirus (2019-nCoV, SARS-CoV-2) disease (COVID-19) in the department of thoracic surgery of large grade A tertiary hospitals in Wuhan, and to provide feasible clinical practice strategies.MethodsThe clinical data of 41 COVID-19 patients in the department of thoracic surgery of 7 large grade A tertiary hospitals in Wuhan from December 15, 2019 to February 15, 2020 were analyzed retrospectively. There were 20 surgical patients (10 males and 10 females at an average age of 54.35±10.80 years) and 21 medical personnel (7 males and 14 females at an average age of 30.38±6.23 years).ResultsThe main clinical manifestations of COVID-19 patients were fever (70.73%) and cough (53.66%). Normal or reduced peripheral white blood cells and reduced lymphocyte counts were found in the COVID-19 patients, and some patients may have increased C-reactive protein. COVID-19 patients showed limited ground-glass opacities in early chest CT, which was evident in the edge band of lung. The disease could further develop into multiple pulmonary infiltrations, and pulmonary consolidation was found in severe cases. At the time of confirmed diagnosis, most of the medical personnel were ground-glass shadows and unilateral lesions, and even no obvious abnormalities were found in the lungs. The diagnosed COVID-19 patients were transferred to the isolation ward immediately and treated according to the "Diagnosis and Treatment Program of Novel Coronavirus Pneumonia", which was released by the National Health Commission of the People's Republic of China. At the end of follow-up on February 20, 2020, seven surgical patients (35.00%) were discharged and seven (35.00%) were dead, 13 (61.90%) medical personnel were discharged and no death was found.ConclusionsOf all COVID-19 patients in the department of thoracic surgery of hospitals in Wuhan, the proportion of severe degree and mortality in surgical patients are significantly higher than that of the general population, and medical personnel are prone to nosocomial infections. Early oxygen therapy and respiratory support may improve prognosis. During the epidemic period of COVID-19, elective or limited surgery is suggested to be postponed and the indications for emergency operation should be strictly controlled. Emergency operation is suggested to be treated in accordance with tertiary prevention. On the consideration of specialty in the department of thoracic surgery, all people of the ward should be carefully investigated for infection once one case is confirmed with COVID-19. Early detection, isolation, diagnosis, and treatment are the best preventive measures to improve the prognosis of COVID-19.
ObjectiveTo construct a rapid screening tool for the donor of heart dead organ donation (donation after circulatory death, DCD) in the background of novel coronavirus (SARS-CoV-2) infection.MethodsBased on literature analysis and core group discussion, two rounds of expert consultation were carried out by Delphi method to establish dimension and index.ResultsThe screening tool included 3 dimensions, including epidemiological history, hospital exposure history, and clinical manifestations, with 15 entries. The mean of the two rounds of expert authority coefficient was 0.757 and 0.768, and the effective recovery rate of the expert consultation questionnaire was 88% and 100%, respectively. The second round dimension and index coordination coefficients was 0.417 and 0.319, respectively. The content validity of the questionnaire was 0.91.ConclusionsThe DCD liver transplant donor's new rapid screening tool for SARS-CoV-2 infection is scientific and reliable. During the epidemic period, the DCD liver transplant donor risk screening tool is of great significance to the prevention and control of liver transplantation risk.