新冠肺炎治疗和药物临床试验以及甲型H1N1流感
Treatment and Medication Clinical Trials, & H1N1 Influenza A (Lecture 19)
Welcome to another MedCram lecture update from the road. I’m currently at a medical conference in Hawaii, but we’ll continue to try to do these updates as they come up. If we go to the WorldOmeter website, we can see that they’ve broken down the cases now into Active Cases versus Closed Cases, and you can see that they are still increasing. These numbers are under-represented. We will get into more of that later.
欢迎参加另一个MedCram讲座，今天我在车上做讲座。我目前正在夏威夷举行的一次医学会议上，但是我们会继续尝试进行这些更新。如果我们访问WorldOmeter网站，我们可以看到它们现在将案例分解为活动案例与已关闭案例，并且您还在看到它们还在增加。这些数字代表不足。我们稍后将进一步介绍。
Then we come to the graph that is looking at the total cases outside of China, and those are still continuing to grow. Although it doesn’t appear as though it’s logarithmic in nature. If we switch over to logarithmic, we can see that it’s less than linear.
然后，我们来看一下正在研究中国以外的总病例的图表，并且这些病例仍在继续增长。尽管它看起来似乎不是对数的。如果切换到对数，可以看到它小于线性。
If we look at daily cases excluding mainland China, it seems to be more sporadic with some days with up to 79 and the most recent at 22. And if we look at these total death cases here going from the beginning of the year until mid-February is quite obvious. They’re still continuing to grow. What’s unique about this virus is that it has infected not just another mammalian species, specifically humans, but it’s infected a species that can think, act and retaliate against this virus. And that’s where we come to today.
如果我们查看不包括中国大陆在内的日常病例，则似乎更为零星，有的日子最多有79天，最近的是22天。如果我们查看这些从今年年初到二月是相当明显的。他们仍在继续增长。这种病毒的独特之处在于，它不仅感染了另一种哺乳动物，特别是人类，还感染了能够对该病毒进行思考，行动和报复的物种。这就是我们今天要去的地方。
Some of you have asked us to talk about some of the medications that are being developed. There’s a nice article in Nature that was published just a few days ago. There are more than 80 clinical trials currently launching the test coronavirus treatments, and the big thrust of this article is that there are so many trials going on in China looking at every single thing that you could possibly imagine to see if it’s going to work that there’s no standardization. What exactly is a recovery? What is the definition of a recovery? And if things are not being blinded, but things are being looked at, is their nefarious work there either intentionally or unintentionally.
你们中的一些人要求我们谈论一些正在开发的药物。几天前发表的《自然》杂志上有一篇不错的文章。目前有80项临床试验正在启动冠状病毒测试疗法，本文的重点是在中国正在进行如此多的试验，着眼于您可能想像到的每件事，看看它们是否会奏效。没有标准化。恢复到底是什么？恢复的定义是什么？如果事情不是盲目的，而是正在观察的东西，那是他们有意或无意的XX工作。
So we’ll put a link to this article in the description below. But it talks about exactly what the WHO is doing to try to standardize these trials to make sure that they can be compared amongst each other, and that the outcomes are true in nature, and not just the push medications or favorite drugs onto this coronavirus.
因此，我们将在下面的描述中提供指向本文的链接。但是它确切地谈到了世界卫生组织正在努力使这些试验标准化，以确保它们之间可以进行比较，并且结果是真实的，而不仅仅是在这种冠状病毒上推入药物或最喜欢的药物。
There are a lot of medications and drugs, for instance, chloroquine phosphate, which has shown in vitro to have some pretty promising effects against the coronavirus. It inhibits coronavirus’s growth. And currently, this is being tested in about ten hospitals in 100 patients. Another drug that’s being looked at is Favipiravir, which is being looked at in a clinical trial of about 70 patients.
有许多药物和药物，例如磷酸氯喹，在体外已显示出对冠状病毒的某些相当有希望的作用。它抑制冠状病毒的生长。目前，这已在大约十家医院的100名患者中进行了测试。正在研究的另一种药物是Favipiravir，该药物正在约70名患者的临床试验中进行研究。
And of course the other one, Remdesivir, and that is currently being looked at in ten hospitals in Wuhan. Of course, this one was developed for Ebola, and it worked in vitro, but it doesn’t seem to be working in vivo for Ebola, but it’s being used as a potential source of a medication to be used against this coronavirus.
当然还有另一种，Remdesivir，目前正在武汉的十家医院进行检查。当然，这种药物是为埃博拉病毒开发的，它在体外起作用，但似乎在体内对埃博拉病毒没有作用，但是它被用作对抗这种冠状病毒的潜在药物来源。
Another thing that they’re looking at is something called convalescent plasma. This is basically the plasma of patients who had recovery from this coronavirus. So presumably there are antibodies that have already been developed against the virus, and if you take this plasma from these donors and put it into patients who have severe infections of the coronavirus, which all brings us to the big question to really do the right research on this.
他们正在寻找的另一件事是所谓的恢复血浆。这基本上是从这种冠状病毒中康复的患者的血浆。因此，大概已经有了针对这种病毒的抗体，如果您从这些供体中提取血浆，并将其放入患有严重冠状病毒感染的患者中，这将使我们面临一个重大问题，那就是要进行正确的研究在此。
There has to be blind Placebo randomized controlled trials. The question that I have, and a lot of people have, is if people are saying already that things are looking promising, that things are getting better, are they really conducting the right kind of studies? Which leads me to the next thing I want to talk about. That’s what I do.
必须有盲目的安慰剂随机对照试验。我和很多人所面临的问题是，如果人们已经在说事情看起来很有希望，事情变得越来越好，他们是否真的在进行正确的学习？这导致我想谈的下一件事。我就是做这个的。
I’m not an epidemiologist. I’m not an administrator. I don’t work for the WHO. I’m just a critical care doctor who takes care of patients. So when patients are coming into the Intensive Care Unit, and they’re crashing, I’m the one that puts the central line in. I’m the one that puts the arterial line in. We intubate the patient. We do the bronchoscopy. So this virus has been a real interest for me. So my full-time job is taking care of patients.
我不是流行病学家。我不是管理员。我不为世界卫生组织工作。我只是负责照顾患者的重症监护医生。因此，当患者进入重症监护病房时，当他们坠毁时，我是将中心线插入其中的人。我是将动脉线插入其中的人。我们为患者插管。我们做支气管镜检查。因此，这种病毒一直是我真正的兴趣所在。所以我的全职工作是照顾病人。
And I wanted to show you what’s been going on at least what I’ve noticed. In my practice in southern California in the last month or so, I’ve seen personally at least three or four cases of influenza A. Let’s come in, and these patients have not done well.
我想向您展示至少我注意到的情况。在过去一个月左右的时间里，我在南加州的实践中，我亲眼目睹了至少三，四例甲型流感。让我们进去吧，这些患者的状况并不理想。
Recently had a young person come in who went from just having reports of the flu to having severe pneumonia, requiring intubation within about two to three days, and she went on to actually require ECMO, or E-C-M-O, which is where they do heart-lung bypass.
最近有一个年轻人进来，从报告流感到严重的肺炎，需要在大约两到三天内进行插管，然后她实际上需要ECMO或E-C-M-O，这是他们做肺活的地方旁路。
And what you’re looking at here is a graph of the influenza-positive tests by the CDC, and you can see the vast majority of these cases are H1N1 from 2009, which was a very bad year. We’re noticing that these patients have particularly bad cardiac reactions to influenza. I’ve seen a patient code and go asystolic after being intubated. I had another one who had ST segment elevation from xxx Myocarditis.
您在这里看到的是疾病预防控制中心（CDC）进行的流感检测图表，您可以看到这些病例中绝大多数是2009年的H1N1流感，那是非常糟糕的一年。我们注意到这些患者对流感的心脏反应特别差。我已经看过病人的代码，并且在插管后进入了心脏收缩期。我还有一个人因xxx心肌炎而ST段抬高。
The bottom line being is that this strain H1N1 is covered in the annual vaccine. That’s been covered since 2009, and so because I’m seeing such a huge amount of this, this is kind of a callout to those who are susceptible. It’s not too late. As you can see here. The flu season still has some weeks to burn through here, to get vaccinated against this potentially deadly strain of the influenza A. Thank you for joining us!
底线是该菌株H1N1已被年度疫苗覆盖。自2009年以来就已经涵盖了这一点，因此，由于我看到了如此大量的信息，因此对于那些易感人群来说，这是一种呼声。不算太晚。如您所见。流感季节仍需花费数周的时间，才能针对这种可能致命的A型流感毒株进行疫苗接种。谢谢您加入我们！
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