The corona virus disease 2019 (COVID-19) pandemic has created a global health and economic crisis. Our studies uncovered that in addition to respiratory symptoms, liver damage is also common in COVID-19 patients; however, the cause of liver damage has not been fully elucidated. In this article, we summarize the clinical manifestations and pathological features of COVID-19 reported in published relevant studies and delineate the etiology and pathogenesis of COVID-19-related liver injury. We speculate that cold stimulation may be associated with COVID-19-related liver injury, which should be considered in clinical decision-making and treatment of COVID-19 in cold regions.
The management of chronic kidney disease (CKD) patients in cold areas is an important task in the daily practice of primary medical and health institutions. An important way to reduce the burden of CKD is to achieve early identification of and implement timely intervention on the relevant risk factors. Studies have shown that diet, alcohol, tobacco, air, sedentary and other factors in cold areas have negative impacts on human kidneys; yet, our current understanding of the effect of cold stimulation on CKD remains blurry. This paper introduces the research progress of risk factors related to CKD in cold areas and analytically summarizes the pathogenesis of CKD caused by cold stimulation, aiming to provide a reference work for the prevention, screening, evaluation, and management of CKD in cold areas.
With the global population aging, especially in China, the prevention and management of osteoporotic fragility fractures has become increasingly important. Bone mineral density (BMD) is an important index of osteoporotic fracture risk, which has become aroutine measurement inclinical practice and thus formed the cornerstone in monitoring treatment efficacy of osteoporosis. In the past 30 years, several pharmacologic therapies have been developed to increase BMD and reduce osteoporotic fractures, especially vertebral fractures. However, the management of nonvertebral fractures and hip fractures remains challenging as low BMD is only one of the multi-factors for these conditions. Hip fractures mainly result from a fall and its incidence is higher in the frigid zone due to low temperature affecting neuromuscular function and high latitude with less sunlight, the conditions rendering less active vitamin D conversion, apart from increased falling. In this paper, we focus on two therapeutic strategies targeting both skeletal and non-skeletal factors, that is, Tai Chi (TC) exercise for improving balance and "kidney-tonifying" traditional Chinese medicine (TCM) against muscle atrophy. TC is a mind-body exercise that has the potential as an effective and safe intervention for preventing fall-related fractures in the elderly. This makes it a promising and feasible physical activity for the elderly in frigid zone to prevent osteoporotic fractures. Several TCM formula popular in northeast of China within frigid zone are also introduced. They are reportedly effective in maintaining or improving BMD and muscle strength with the potential of reducing osteoporotic fracture. However, more rationally designed vigorous basic investigations and prospective clinical trials are highly desired to validate and consolidate the preliminary observations in the future.
Diabetes mellitus (DM) is a progressive metabolic disease characterized by chronic hyperglycemia and caused by different degree of pancreatic islet dysfunction and/or insulin resistance (IR). Long course DM can lead to a variety of macrovascular and microvascular complications which involve artery vessels, heart, kidney, retina, nervous system, etc. In recent years, DM has attracted more and more attention due to its high morbidity and mortality. In addition to achieve effective glycemic control, prevention of complications has also been considered a priority for type 2 diabetes mellitus (T2DM) management. Herein, we provide a comprehensive overview on the pharmacotherapeutics for T2DM and perspectives on the future directions of basic and translational research on anti-diabetic therapy and pharmatheutical development of new drugs.
Objective: To evaluate the inflammatory pattern and the interferon (IFN) -γ in the bronchial secretion of asthma patients in response to acute cold bronchoprovocation. Material and methods: We enrolled 42 patients with asthma. We assessed asthma by Asthma Control Test, the lung function by spirometry before and after the bronchodilator test, followed by collecting induced sputum. The next day, we collected exhaled breath condensate (EBC) and conducted a 3-minute isocapnic hyperventilation with cold air (IHCA), followed by collecting spontaneously produced sputum. Results: Group 1 included 20 patients with cold airway hyperresponsiveness (CAHR), and group 2 included 22 patients without CAHR. In both groups, a high level of neutrophils in bronchial secretion was observed before and after IHCA. In response to IHCA, the number of epitheliocytes in the sputum decreased to a greater extent in patients of group 1.The baseline epitheliocytes and the concentration of IFN-γ after IHCA had an inverse relationship (r = -0.60; P = 0.017). The baseline IFN-γ in EBC before and after IHCA was lower in group 1. Airway response to cold exposure directly correlated with IFN-γ levels after IHCA (Rs = 0.42; P = 0.014). Conclusion: In asthma patients with CAHR, there is a relationship between the persistence of mixed inflammation and the level of IFN-γ in the bronchi. IFN-γ in response to IHCA is decreased with increased cytokine utilization during cold bronchospasm, which is accompanied by the mobilization of neutrophils and the shift in the cytokine spectrum of the respiratory tract towards the T helper cells (Th) 1 immune response.
Background: Patients with coronavirus disease 2019 (COVID-19) have high resource utilization. Identifying the causes of severe COVID-19 is helpful for early intervention to reduce the consumption of medical resources. Methods: We included 103 patients with COVID-19 in this single-center observational study. To evaluate the incidence, predictors, and effects of COVID-19, we analyzed demographic information, laboratory results, comorbidities, and vital signs as factors for association with severe COVID-19. Results: The incidence of severe COVID-19 was 16.5% and the percent poor outcome (including mortality, entering in ICU or transferred to a superior hospital) was 6.8%. The majority of severe COVID-19 patients had abnormal electrocardiogram (ECG) (82.35%), hypertension (76.47%) and other cardiac diseases (58.82%). Multivariate logistic regression was used to determine the predictors of severe illness. Abnormal body mass index (BMI) and ECG (P < 0.05) were independent predictors of severe COVID-19. ECG abnormality was associated with increased odds of poor outcome (area under the receiver operating characteristic curves [AUC], 0.793; P = 0.010) and severe COVID-19 (AUC, 0.807; P < 0.0001). Overweight was also associated with increased odds of poor outcome (AUC, 0.728; P = 0.045) and severe illness COVID-19 (AUC, 0.816; P < 0.0001). Conclusion: Overweight and electrophysiological disorders on admission are important predictors of prognosis of patients with COVID-19.