Rong-Chang Chen's research while affiliated with Shenzhen Second People's Hospital and other places

Purpose The study aimed to identify potential risk factors for family transmission and to provide precautionary guidelines for the general public during novel Coronavirus disease 2019 (COVID-19) waves. Methods A retrospective cohort study with numerous COVID-19 patients recruited was conducted in Shanghai. Epidemiological data including transmission details, demographics, vaccination status, symptoms, comorbidities, antigen test, living environment, residential ventilation, disinfection and medical treatment of each participant were collected and risk factors for family transmission were determined. Results A total of 2,334 COVID-19 patients participated. Compared with non-cohabitation infected patients, cohabitated ones were younger (p = 0.019), more commonly unvaccinated (p = 0.048) or exposed to infections (p < 0.001), and had higher rates of symptoms (p = 0.003) or shared living room (p < 0.001). Risk factors analysis showed that the 2019-nCov antigen positive (OR = 1.86, 95%CI 1.40–2.48, p < 0.001), symptoms development (OR = 1.86, 95%CI 1.34–2.58, p < 0.001), direct contact exposure (OR = 1.47, 95%CI 1.09–1.96, p = 0.010) were independent risk factors for the cohabitant transmission of COVID-19, and a separate room with a separate toilet could reduce the risk of family transmission (OR = 0.62, 95%CI 0.41–0.92, p = 0.018). Conclusion Patients showing negative 2019-nCov antigen tests, being asymptomatic, living in a separate room with a separate toilet, or actively avoiding direct contact with cohabitants were at low risk of family transmission, and the study recommended that avoiding direct contact and residential disinfection could reduce the risk of all cohabitants within the same house being infected with COVID-19.

Abstract Background The effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on mortality was preliminarily explored through the comparison of ACEIs/ARBs with non-ACEIs/ARBs in patients with coronavirus disease 2019 (COVID-19). Reaching a conclusion on whether previous ACEI/ARB treatment should be continued in view of the different ACE2 levels in the comparison groups was not unimpeachable. Therefore, this study aimed to further elucidate the effect of ACEI/ARB continuation on hospital mortality, intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV) in the same patient population. Methods We searched PubMed, the Cochrane Library, Ovid, and Embase for relevant articles published between December 1, 2019 and April 30, 2022. Continuation of ACEI/ARB use after hospitalization due to COVID-19 was considered as an exposure and discontinuation of ACEI/ARB considered as a control. The primary outcome was hospital mortality, and the secondary outcomes included 30-day mortality, rate of ICU admission, IMV, and other clinical outcomes. Results Seven observational studies and four randomized controlled trials involving 2823 patients were included. The pooled hospital mortality in the continuation group (13.04%, 158/1212) was significantly lower than that (22.15%, 278/1255) in the discontinuation group (risk ratio [RR] = 0.45; 95% confidence interval [CI], 0.28–0.72; P = 0.001). Continuation of ACEI/ARB use was associated with lower rates of ICU admission (10.5% versus 16.2%, RR = 0.63; 95% CI 0.5–0.79; P

Background Bronchiectasis is a highly heterogeneous chronic airway disease with marked geographic and ethnic variations. Most influential cohort studies to date have been performed in Europe and USA, which serve as the examples for developing a cohort study in China where there is a high burden of bronchiectasis. The Establishment of China Bronchiectasis Registry and Research Collaboration (BE-China) is designed to: (1) describe the clinical characteristics and natural history of bronchiectasis in China and identify the differences of bronchiectasis between the western countries and China; (2) identify the risk factors associated with disease progression in Chinese population; (3) elucidate the phenotype and endotype of bronchiectasis by integrating the genome, microbiome, proteome, and transcriptome with detailed clinical data; (4) facilitate large randomized controlled trials in China. Methods The BE-China is an ongoing prospective, longitudinal, multi-center, observational cohort study aiming to recruit a minimum of 10,000 patients, which was initiated in January 2020 in China. Comprehensive data, including medical history, aetiological testing, lung function, microbiological profiles, radiological scores, comorbidities, mental status, and quality of life (QoL), will be collected at baseline. Patients will be followed up annually for up to 10 years to record longitudinal data on outcomes, treatment patterns and QoL. Biospecimens, if possible, will be collected and stored at − 80 °C for further research. Up to October 2021, the BE-China has enrolled 3758 patients, and collected 666 blood samples and 196 sputum samples from 91 medical centers. The study protocol has been approved by the Shanghai Pulmonary Hospital ethics committee, and all collaborating centers have received approvals from their local ethics committee. All patients will be required to provide written informed consent to their participation. Conclusions Findings of the BE-China will be crucial to reveal the clinical characteristics and natural history of bronchiectasis and facilitate evidence-based clinical practice in China. Trial registration Registration Number in ClinicalTrials.gov: NCT03643653

Background Bronchiectasis is a highly heterogeneous chronic airway disease with marked geographic and ethnic variations. Most influential cohort studies to date have been performed in Europe and USA, which serve as the examples for developing a cohort study in China where there is a high burden of bronchiectasis. The Establishment of China Bronchiectasis Registry and Research Collaboration (BE-China) is designed to: (1) describe the clinical characteristics and natural history of bronchiectasis in China and identify the differences of bronchiectasis between the western countries and China; (2) identify the risk factors associated with disease progression in Chinese population; (3) elucidate the phenotype and endotype of bronchiectasis by integrating the genome, microbiome, proteome, and transcriptome with detailed clinical data; (4) facilitate large randomized controlled trials in China.Methods and design:The BE-China is an ongoing prospective, longitudinal, multi-center, observational cohort study which aims to recruit a minimum of 10,000 patients, which was initiated in January 2020 in China. Comprehensive data, including medical history, aetiological testing, lung function, microbiological profiles, radiological scores, comorbidities, mental status, and quality of life (QoL), will be collected at baseline. Patients will be followed up annually for up to 10 years to record longitudinal data on outcomes, treatment patterns and QoL. Biospecimens, if possible, will be collected and stored at -80℃ for further research. Up to October 2021, the BE-China has enrolled 3758 patients from 91 medical centers. The study protocol has been approved by the Shanghai Pulmonary Hospital ethics committee, and all collaborating centers received approvals from their local ethics committee. All patients provided written informed consent to their participation.Conclusions Findings of the BE-China will be crucial to reveal the clinical characteristics and natural history of bronchiectasis and facilitate evidence-based clinical practice in China. Registration Number in ClinicalTrials.gov: NCT03643653

Background: Accurate identification of pathogens is essential for the diagnosis and control of infections. We aimed to compare the diagnostic performance of metagenomic next-generation sequencing (mNGS) and conventional detection methods (CDM) in lung transplant recipients (LTRs). Methods: We retrospectively analyzed 107 LTRs with suspected infection of pulmonary, blood, central nervous system or chest wall between March 2018 and November 2020. Bronchoalveolar lavage fluid and other body fluids were subject to pathogen detection by both mNGS and CDM. Results: Of the 163 specimens, 84 (51.5%) tested positive for both mNGS and culture, 19 (11.7%) of which were completely consistent, 44 (27.0%) were partially congruent, and 21 (12.9%) were discordant (kappa = .215; p = .001). Compared with CDM, mNGS detected a higher diversity of pathogens. Moreover, the turn-around time was significantly shorter for mNGS compared with culture (2.7 ± .4 vs. 5.5 ± 1.6 days, p < .001). As an auxiliary method, treatment strategies were adjusted according to mNGS findings in 31 cases (29.0%), including eight patients with non-infectious diseases, who were finally cured. Conclusion: mNGS can identify pathogens with a shorter turn-around time and therefore provide a more accurate and timely diagnostic information to ascertaining pulmonary infections. mNGS might have a role in differentiating infectious from non-infectious lung diseases in LTRs.

Recently identified plasmid-borne tet (X) genes have greatly challenged the efficiency of tigecycline, a last-resort antibiotic for severe infection, while the dissemination pattern of the plasmid-borne tet (X) genes remains unclear. In this study, we identified a clonal dissemination of tet (X3)-positive A. towneri isolates on a swine farm, while the tet (X6)-positive A. towneri strains mainly disseminated sporadically on the same farm.

The emergence of plasmid-borne tet (X) genes mediated high-level resistance of tigecycline largely threatening its clinical effectiveness. Currently, the dissemination pattern of plasmid-borne tet (X) genes remains unclear. In this study, 684 fecal and environmental samples were collected at six livestock farms, and 15 tet (X)-positive Acinetobacter isolates were recovered, mainly including 9 tet (X3)- and 5 tet (X6)-positive A. towneri strains. A clonal dissemination of tet (X3)-positive A. towneri was detected in a swine farm, while the tet (X6)-positive A. towneri strains mainly sporadically disseminated in the same farm. A tet (X3)-carrying plasmid (pAT181) was self-transmissible from a tigecycline-susceptible A. towneri strain to A. baumannii ATCC17978, causing a 128-fold and 64-512-fold increase in the MIC values of tigecycline and the other tetracyclines, respectively. Worrisomely, pAT181 was stably maintained and increased the growth rate of ATCC17978. Further identification of tet (X)s in 10,680 Acinetobacter genomes retrieved from GenBank revealed that, tet (X3) (n=249) followed by tet (X5)-like (n=61) and tet (X6) (n=53) are the prevalent alleles mainly carried by four species, and most of them are livestock associated. Phylogenetic analysis showed that most of tet (X3)- and tet (X6)-positive isolates disseminate sporadically. The structures of tet (X3) and tet (X6) plasmidomes are highly diverse and no epidemic plasmids have emerged yet. However, cross-species and cross-region transmissions of tet (X3) might have been mediated by several plasmids in a small proportion of strains. Our study evidence that tet (X3) and tet (X6) currently disseminate sporadically in Acinetobacter . Continuous surveillance for tet (X)s in the context of One Health is necessary to prevent them from transmitting to humans. Importance Recently identified plasmid-borne tet (X) genes highly challenged the efficiency of tigecycline, a last resort antibiotic for severe infection. Currently, the dissemination pattern of plasmid-borne tet (X) genes remains unclear. In this study, we first identified plasmid-borne tet (X)-positive Acinetobacter spp. strains from fecal and environmental samples collected at six livestock farms. A clonal dissemination of tet (X3)-positive A. towneri was detected in a swine farm, while the tet (X6)-positive A. towneri strains mainly disseminated sporadically in the same farm. A tet (X3)-carrying plasmid was found self-transmissible resulting in enhanced tigecycline resistance and growth rate. Further exploring a global dataset of tet (X)-positive Acinetobacter genomes retried from GenBank revealed that most of tet (X3) and tet (X6)-positive isolates share highly distant relationship, and the structures of tet (X3) and tet (X6) plasmidomes are highly diverse. Our study evidence that tet (X3) and tet (X6) disseminate sporadically in Acinetobacter and continuous surveillance for tet (X)s in the context of One Health is necessary.

Viral infectious diseases remain a major challenge for human health. Following the emergence of a new coronavirus pneumonia, more than 10,000 species of wild viruses have been mentioned by mass media, but only a few are well recognized. In recent decades, human beings have constantly faced the challenge of bacterial and viral infections. The most common pathogens of new infectious diseases are viruses, the latest being COVID-19. Therefore, we should pay close attention to the severity of respiratory virus infection. There are many common viruses that can cause respiratory infections, including influenza-related viruses, human metapneumovirus, measles virus, rhinovirus, enterovirus, coronavirus, respiratory tract syncytial virus, adenovirus, cytomegalovirus, herpes simplex virus, etc. In particular, there are more than 100 species of coronaviruses.

Combined with clinical manifestations and chest imaging features, such as dry cough and abnormal coagulation function, chest imaging mainly showed multiple small patches and interstitial changes at the early stage, with obvious extravasation and less exudative lesions, which developed into multiple ground-glass opacity and infiltrating shadows in the lungs. In critically ill patients receiving tracheal intubation, infiltration fluid is rare in the trachea, which is different from influenza and avian influenza. We assume that pathogenesis of COVID-19 lung injury could mainly be impairment of the lung interstitium and vascular endothelium. Although ARDS can be found in some patients, exudative lesions are relatively less.