Dip in Daily New Deaths; Research on Natural Killer Cells & COVID-19 (Lecture 50)
关注每日新死亡；自然杀手细胞与COVID-19的研究（第50讲）
Welcome to another MedCram Covid-19 update and I’m so glad to be back with you. I’ve completed my week of being in the Intensive Care Unit and I just wanted to give a shout out to all of the nurses and respiratory therapists, hospitalists and the other specialists that I work with throughout the week and I especially want to thank all of the donning and doffing buddies that I had.
欢迎收听MedCram Covid-19的最新课程，很高兴又和大家在一起。我已经完成了在加护病房的一周工作，我要向这一周与我合作的所有护士和呼吸治疗师，医院工作人员及其他专家大声说感谢，我要特别感谢所有我的防护穿脱伙伴。
So basically when you go into an isolated room, there’s somebody watching you to make sure that you’re doing everything correctly step by step, so you don’t infect yourself. And I’ll tell you those are lifesavers to have to remind you what to do.
当你进入隔离房间时，会有人看着你，以确保你一步一步正确地进行了所有操作，以免感染自己。我要说那些人是救生员，他们提醒你该怎么做。
If this is a war against the virus then the Intensive Care Unit and the emergency room are literally the trenches in that warfare. And more than anything else those respiratory therapists and nurses go into that room several times every couple of hours risking their lives to help save other lives and it’s important to have that body armor in place.
如果这是一场针对病毒的战争，那么重症监护室和急诊室实际上就是这场战争的战壕。而且，这些呼吸治疗师和护士每隔几个小时要几次进入那个房间，冒着生命危险来挽救其他生命，因此必须配备适当的防弹衣。
There have been so many developments since we last talked and we will get to those things as the week progresses.
自从我们上次课程，已经有了很多进展，随着一周的进行，我们将掌握这些事情。
Interestingly, Finland continues to be leading the pack in the Nordic countries in terms of the least amount of deaths per 1 million population and the number of new deaths. And we’ve talked about this before in terms of their practices with Finnish saunas. We showed some scientific evidence that heat followed by cold could be beneficial for boosting your innate immunity specifically monocytes and natural killer cells.
有趣的是，就每100万人中最少的死亡人数和新的死亡人数而言，芬兰继续在北欧国家中领先最低。我们之前已经在芬兰桑拿浴的实践方面谈论过这一点。我们显示了一些科学证据，即先热后冷的疗法有助于增强先天免疫力，特别是单核细胞和自然杀手细胞
And that led me to this article on NPR, which featured Dr. Corey Casper and this institute in Seattle, known as the Infectious Disease Research Institute, launches Covid-19 immunotherapy trial. They’re aware of the studies coming out of Asia looking at these patients that had deficiencies in their immune system particularly while it was being infected by the Covid-19 disease and the SARS-CoV2 virus.
这使我想到了NPR上的这篇文章，该文章的重点是Corey Casper医生和位于西雅图的这家名为传染病研究所的研究所启动了Covid-19免疫疗法试验。他们知道来自亚洲的研究正在针对这些免疫系统不足的患者进行研究，尤其是当这些患者被Covid-19和SARS-CoV2病毒感染时。
The interviewer asks, I understand that you’re looking particularly at a group of patients who are seriously ill, hospitalized, but not yet quite on a ventilator. Why are you looking at that group in particular?
面试官问，我了解你特别关注的是一群病情严重，已住院但尚未使用呼吸机的患者。你为什么特别关注这个群体？
And that’s an interesting question because, as we’ve talked about before, there are three phases of intervention in this disease. And we showed it here. When you become infected at day 0, you’ve got about a five day period where you don’t know that you’re infected and you’re asymptomatic, and then at day 5 you develop symptoms of cough and perhaps even fever until finally shortness of breath ensues by day number 12, which is about seven or eight days later and then you go to the hospital where there is a quick downturn.
这是一个有趣的问题，因为正如我们之前所讨论的，对这种疾病的干预分为三个阶段。我们在这里展示了它。当你在第0天感染时，大约有五天的时间，你不知道自己已被感染且没有症状，然后在第5天出现咳嗽甚至发烧的症状，直到最后呼吸急促会在第12天发生，这大约是在七八天后，然后你去医院，很快就好转。
And I’ll tell you by experience in the hospital in the Intensive Care last week talking to my colleagues. It was not unusual to see some of these patients coming in with shortness of breath and literally within 12 hours coding, basically their heart stopping. So you go from shortness of breath to being ventilated intubated, having blood pressure fall and then heart-stopping. That wasn’t the story for all of the patients, but for a certain subset that was definitely a grim reality.
根据我上周在医院加护病房的经验，我跟大家说看到一些呼吸急促并在12小时基本上心脏停止跳动的患者已经不陌生了。因此，你会从呼吸急促变为插管通气，血压下降，然后心跳停止。虽然不是所有患者都这样，但对于某些患者来说绝对是一个严峻的现实。
So that may leave just a small amount of room here for when they come in maybe perhaps even a day or so and we did see that data coming out of the articles in the New England Journal of Medicine at the very beginning of this outbreak showing that there was maybe about a day or so between when they were admitted and when they went to the Intensive Care Unit. So yes, there is a small window here, but let’s not overlook this large period before hospitalization.
因此，当它们进入医院，也许大约一天之内，可能只剩下一小部分空间，而我们确实在该疾病爆发的开始就看到《新英格兰医学杂志》上的文章中的数据表明从他们被收到重症监护室之间可能大约需要一天左右的时间。所以，是的，这有一小段窗口期，但在住院之前不要让我们忽略这么长时间。
I think that’s one of the key things. And that’s the second phase, third phase in the hospital, and of course here in the first phase, which is before infection. And that would be the purpose of isolation trying to prevent people from becoming infected.
我认为这是关键因素之一。这是医院的第二阶段，第三阶段，当然这是第一阶段，即感染之前。那将是隔离的目的，试图防止人们被感染。
So, let’s see what the good doctor in Seattle answers with. He says here “there’s a critical moment in the treatment of patients with Covid-19. It is where they have already been hospitalized, but not yet sick enough to require the support of an intensive care unit or a ventilator, where we think we can make the most impact.
那么，让我们看看西雅图的这位医生的回答。他在这里说：“在治疗Covid-19患者时，有一个关键期。这是他们住院的地方，但是还没有病到需要重症监护病房或呼吸机的支持，我们认为在这个阶段我们可以发挥最大的作用。
At that time, there are very few available therapies, but being able to provide a therapy that can both destroy the virus and help regulate the immune response to the virus, we think will be an enormous benefit to clinicians.”
那时，可用的疗法很少，但是如果能够提供既可以破坏病毒又可以调节对病毒的免疫反应的疗法，我们认为这将为临床医生带来巨大的好处。”
And the interviewer asks “tell me a little bit more about how this works.” And he goes on to talk about “the natural killer cell.“ This is the cells that were all born with. This is the innate system and these natural killer cells go around and eat up parts of the virus in addition to killing the virus, cells that are infected with the virus.
采访者问：“告诉我更多有关它是如何工作的”。然后他继续说“自然杀手细胞”。这是我们与生俱来的细胞。这是先天系统，这些自然杀手细胞会四处觅食，除了杀死病毒外，还可以吃掉一些病毒，即感染病毒的细胞。
They also go around secreting cytokines in a way that they as they put it “orchestrate the effective immune response.“ So going on the interviewer asks, “is there something about Covid-19 in particular that you think this might be a really great match?” Well, he also points out the observation that we talked about last week when we talked about innate immunity and that’s that these natural killer cells and monocytes part of the innate immune system are found to be very low.
这些细胞还以他们所说的“协调有效的免疫反应”的方式四处活动并分泌细胞因子。采访者继续问：“你认为Covid-19有什么特别之处与这些细胞很好地匹配？”他还指出了我们在上周谈到先天免疫时所谈到的观察结果，那就是先天免疫系统中的这些自然杀手细胞和单核细胞被发现非常低。
You can see in this article that we’ve already referenced before in update 46. The monocytes are very very low here in comparison to where they should be in healthy subjects.
大家可以在本文中看到，我们之前在第46讲中已经提到过。与健康受试者中的单核细胞相比，这里的单核细胞非常非常低。
And so going back to that interview they talked about what they could do about that. They say here. “It’s one of the reasons we think that because these patients with low numbers of natural killer cells progressed to severe disease. We think that if we can provide effective supplements of natural killer cells, these will allow these patients to control this disease more effectively.”
回到采访中，他们谈到了他们可以做些什么。他们在这里说“我们认为这是为什么缺少自然杀手细胞数量的患者发展为严重疾病的原因之一。我们认为，如果我们能够提供有效的自然杀手细胞补充剂，这将使这些患者更有效地控制这种疾病。”
The interviewer points out that they just got approval from the FDA to start trials. And what’s the timeline look like to make that more widely available for people who are sick. And they say here that “within the month of April“, they’re looking to see if they can get patients treated with this new therapy.
采访者指出，他们刚刚获得FDA的批准开始试验。什么时候才能使之更广泛地用于患者。他们在这里说，“在4月份之内”，他们正在寻找是否可以使患者接受这种新疗法的治疗。
Now the reason why I think this paper is very important is because many people, they look at these studies that we presented in update 46 and 47, and say okay while you’re looking at these certain treatments and all they’re doing is increasing the number of cells or maybe even the function of cells, but those cells and the presence of those cells and even the function of those cells are simply surrogates. In other words, they are markers maybe of immunity.
现在，我之所以认为这篇论文非常重要，是因为许多人都看了我们在第46讲和第47讲中介绍的这些研究，这些特定的治疗方法就是增加细胞的数量，甚至可能是细胞的功能，但是这些细胞，这些细胞的存在以及这些细胞的功能只是替代物。换句话说，它们可能是免疫力的标志。
Clearly here though, you can see that there is at least a subsection of research which is going on in this case in Seattle that believes that simply increasing the numbers may have a benefit improving the chances relatively early on in the infection of changing the course of that infection.
显然，在这里大家可以看到，在西雅图，至少有这方面的研究，研究人员认为，仅仅增加数量可能会在感染相对较早的阶段提高改变感染进程的机会。
Remember back in update 46 we showed this paper that was published in 1999 out at the University of Toronto that in subjects that were exposed to cold water after being in warm water there was also a similar effect in terms of leukocytes, granulocytes, lymphocytes and monocytes, but more specifically in natural killer cells as you can see here. So in sitting at 38 degrees Centigrade, after sitting in a cold bath, there was a significant increase in the number of lytic units in natural killer cells.
请记住，在46讲中，我们展示了发表于1999年多伦多大学的这篇论文，在接触热水后又接触冷水的受试者中，在白细胞，粒细胞，淋巴细胞和单核细胞方面也有类似的作用，但更具体地讲就是在自然杀手细胞中，如大家在此处看到的。因此，坐在38摄氏度的冷浴中后，自然杀手细胞中裂解单位的数量显着增加。
In fact, it led the authors of this paper to say the following “the parameters evaluated were those components of the immune system that we hypothesized would be the most responsive to such a challenge,” referring to going into the cold, “natural killer cell activity was included because natural killer cells represent one of the first lines of defense against virally infected cells, tumor cells, and certain microorganisms.”
事实上，它使本文的作者说出以下：“被评估的参数是免疫系统中我们认为对此类挑战最敏感的那些组成部分，”就是进入低温状态，“自然杀手细胞活动被包括在内，这是因为自然杀手细胞代表了抵御病毒感染的细胞、肿瘤细胞和某些微生物的第一道防线之一。
“Our findings that the selected aspects of immune function measured in this study were not adversely affected by a moderate exposure to cold air are reassuring. Indeed, we have demonstrated that exposing subjects to a cold environment chamber at 5 degrees Centigrade for two hours in this case can be immunoenhancing and that moderate exercise can further augment the response of certain parameters to subsequent cold exposure.”
“我们的研究结果表明，适度暴露于冷空气不会对免疫功能产生不利影响，这一点令人放心。确实，我们已经证明，在此过程中，将受试者暴露于5摄氏度的寒冷环境中两小时可能增强免疫力，适度的运动可以进一步增强某些参数对随后的冷暴露的反应。”
So I want to emphasize once again here they were looking in Seattle at increasing the amount of natural killer cells at this point in the hospital stay. I’m wondering what would happen if we were able to increase the number of natural killer cells here as soon as the subject feels the symptoms of a virus coming on, especially in this current Covid-19 environment. Is it possible that implementing that kind of a strategy might augment the immune system, thereby reducing the number of people that would require hospitalization?
因此，我想在此再次强调，他们在西雅图研究住院期间增加自然杀手细胞数量。我想知道，一旦受试者感觉到病毒的症状，特别是在当前的Covid-19环境中，如果我们能够增加自然杀手细胞的数量，将会发生什么。实施这种策略是否有可能增强免疫系统，从而减少需要住院的人数？
And we’ll have more on that the rest of the week and the week to come. Okay, we’ll see you for the next update. Thanks for joining us.
在接下来几天以及下一周，我们还会有更多内容。好的，我们下次再见。感谢加入我们。
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