Volume 101 ·  Issue 08 ·  2021

Series of the studies and consensus on the basic research on seasonal and animal influenza virus, clinical characteristics of patients with pneumonia caused by influenza A (H1N1) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), disease burden of influenza, and promotion of influenza vaccination for the elderly were published in this special issue, aiming to describe the feature of influenza virological and clinical characteristics, health and economic burden, and vaccination. These researches emphasized the importance of the integration between basic medicine, clinical medicine, public health and preventive medicine in the prevention and control of infectious diseases. Based on the concept of population medicine, promoting the integration of multidisciplinary and strengthening prevention, control and pandemic preparedness on influenza, corona virus disease 2019 and other infectious diseases, could consolidate the foundation of surveillance and early warning, prevention and control, diagnosis and treatment of emerging infectious diseases, as well as improve the ability of emergency preparedness for public health events.

Seasonal influenza (influenza for short) is an acute respiratory infectious disease caused by influenza viruses. Compared with other age groups, older adults have a higher risk of severe illness and death after contracting influenza, with heavier health impacts and financial burdens. Influenza vaccination is the most effective intervention to prevent influenza. WHO and the Chinese Center for Disease Control and Prevention both recommend the elderly as one of the priority populations for influenza vaccine. However, influenza vaccine is a non-immunization program vaccine in China. Most areas of China are voluntary and self-funded vaccination, and the vaccination rate of the elderly is low. Although influenza vaccines are less effective in the elderly than in younger adults, vaccination is still the most effective means of protecting the elderly from the flu. It is suggested that China should take a series of comprehensive measures (such as strengthening government financial support, promoting multi-party financing mode, improving adult vaccination service, etc.) to actively promote the existing influenza vaccination work of the elderly population and improve the vaccination rate. In addition, aiming at the problem that the existing standard antigen content inactivated influenza vaccine in China is inferior to that of other healthy adults in the immune protection induced by the elderly, it is suggested to actively explore the model of promoting the introduction of new influenza vaccines (high antigen content inactivated influenza vaccine, recombinant influenza vaccine and adjuvant vaccine) that have been marketed abroad and can produce better protection in the elderly, and encourage and support the research and development of new influenza vaccine in China, so that the elderly in China can enjoy the new vaccine synchronized with the world as soon as possible.

Malnutrition is a common complication of chronic kidney disease and a risk factor for the development of chronic kidney disease and increased patient mortality. China's "Consensus on Protein Nutrition Therapy for Chronic Kidney Disease" formulated in 2005 has promoted the progress of nutritional therapy and clinical research of chronic kidney disease in China. In recent years, the evidence-based medical evidence of nutritional therapy for chronic kidney disease published by nephrologists internationally and in China has emerged continuously. Therefore, a new version of the guidelines needs to be formulated and updated. The expert group developed this guideline to provide guidance for clinical practice on the characteristics of malnutrition in hemodialysis and peritoneal dialysis and renal transplant recipients in early, pre-dialysis and end-stage renal disease of chronic kidney disease.

To estimate the health impact and economic burden of seasonal influenza in mainland China.

From systematic literature reviews, we collected the influenza-associated excess influenza-like-illness (ILI) outpatient consultation rates, hospitalization rates of severe acute respiratory infections (SARI) and respiratory excess mortality, 2006-2017. Using these data, as well as demographic data (2019), the number of influenza-associated excess ILI outpatient consultations, SARI hospitalizations and respiratory excess deaths were estimated. Then using per capita economic burden of influenza-associated outpatient consultations and hospitalizations, as well as the productivity loss of influenza-related premature deaths, the annual influenza-associated total economic burden was estimated. All costs were adjusted to 2019 using the consumer price index.

The annual influenza-associated excess ILI outpatient consultations, SARI hospitalizations and excess respiratory deaths were 3 million, 2.34 million, 0.09 million, respectively. The total economic burden was 26.38 billion CNY, accounting for 0.266‰ GDP in 2019, of which the hospitalization-related economic burden accounted for the highest proportion (86.4%, 22.79 billion CNY), followed by the outpatient-related economic burden (11.3%, 2.97 billion CNY), and the indirect economic burden of productivity loss of premature deaths was the lowest (2.4%, 0.62 billion CNY). Largest economic burden was observed in East China (10.51 billion CNY) and smallest observed in Northeast China (0.38 billion CNY).

The health burden of influenza-related outpatient visits and hospitalizations were substantial. The economic burden of influenza-related SARI hospitalization was higher than that of influenza-related outpatients and pre-mature deaths. The highest economic burden of influenza occurred in the East China.

To evaluate the cross-reaction of seasonal influenza vaccine immune serum against Eurasian avian-like H1N1 swine influenza virus.

Nine human infected Eurasian avian-like H1N1 swine influenza virus strains were obtained from national influenza surveillance network laboratories in Jiangsu, Hebei, Shandong, Yunnan, Hunan, Fujian and Tianjin provinces, and their genetic characteristics of hemagglutinin were analyzed by deep sequencing. 30 volunteers were recruited respectively from children (2-5 years old), adults (24-57 years old) and elderly (60-84 years old) who received 2019-2020 seasonal influenza vaccine in Anning city, Yunnan Province in October 2019, and serum samples were collected before and 1 month after vaccination. The hemagglutination inhibition test was used to evaluate the cross-reaction of serum before and after immunization against 4 strains of human infection with Eurasian avian-like H1N1 swine influenza virus isolated since 2015.

The homology of hemagglutinin genes of 9 Eurasian avian-like H1N1 swine influenza viruses was similar, but the difference of hemagglutinin heavy chain and light chain amino acid genes with A (H1N1) pdm09 (vaccine strain) were 90-101 and 24-30 amino acids respectively. The antibody titer of vaccine strain antiserum to vaccine strain was 2 560; the antibody titers of the vaccine strain antiserum to Eurasian avian-like H1N1 swine influenza virus and the Eurasian avian-like H1N1 swine influenza virus antiserum to vaccine strain were same as 640. The proportion of children, adults and elderly vaccinated with seasonal influenza vaccine with antibody titer ≥40 against vaccine strain was 90.0%, 70.0% and 73.3%, respectively; while the proportion merely were 46.7%, 36.7% and 33.3%-43.3% to 4 strains of Eurasian avian-like H1N1 swine influenza virus, respectively.

Seasonal influenza vaccination does not provide effective cross-protection against Eurasian avian-like H1N1 swine influenza virus.

To explore the difference in the expression profile of circular RNA in peripheral blood mononuclear cells between patients with mild and severe influenza pneumonia.

From December 2018 to March 2019, 10 inpatients with mild and 10 inpatients with severe influenza pneumonia admitted to the Department of Infection and Clinical Microbiology of Beijing Chaoyang Hospital were included. Clariom™ D gene chip was used to explore the circRNA expression profiles of peripheral blood mononuclear cells (PBMC) isolated from the patients. The absolute value of the fold change (FC value)>2 andP<0.05 were used as the criteria to screen the differentially expressed circRNA, and the gene ontology (GO) enrichment analysis and the Kyoto Encyclopedia of Gene and Genome database (Kyoto Encyclopedia of Genes and Genomes, KEGG) signal pathway enrichment analysis were also performed.

The age of mild patients [M (P₂₅, P₇₅)] was 62.0 (34.5, 69.8) years old, including 4 males; the age of severe patients [M (P₂₅, P₇₅)] was 50.0 (37.0, 60.0) years old, all were males. A total of 137 differentially expressed circRNAs in PBMCs of mild and severe patients were screened. The numbers of up-regulated and down-regulated circRNAs in mild patients were 101 and 36, respectively. Among them, hsa_circ_0091073 (FC value=160.898, P<0.05) was the most significantly up-regulated circRNA and hsa_circ_0092219 (FC value =-17.630,P<0.05) was the most significantly down-regulated circRNA. GO enrichment analysis showed that a total of 111 secondary GO items were significantly associated with related differential expression of circRNA (P<0.05). The GO terms associated with upregulated circRNAs included DNA-templated transcription, regulation of DNA-templated transcription, regulation of transcription from RNA polymerase Ⅱ promoter, etc.; The GO terms associated with downregulated circRNAs included neutrophil degranulation, killing of cells of other organism, defense response to fungus, etc. KEGG signaling pathway analysis showed that there were 37 metabolic pathways related to differentially expressed circRNAs (P<0.05). Signaling pathways related to up-regulated circRNAs included nuclear factor-κB (NF-κB) signaling pathway, mitogen-activated protein kinase (MAPK) signaling pathway, tumor necrosis factor (TNF) signaling pathway, etc. Signaling pathways related to down-regulation of circRNAs included cancer transcription disorders, folate carbon pool, and other types of O-glycan biosynthesis.

The expression of circRNA in PBMC of mild and severe influenza pneumonia patients is significantly different, and it may play a role in the pathogenic mechanism of influenza pneumonia through multiple signal pathways.

To compare the clinical characteristics and prognosis of critical patients with COVID-19 and novel influenza A (H1N1) virus pneumonia (influenza pneumonia) applied with extracorporeal membrane oxygenation (ECMO).

A total of 24 patients with influenza pneumonia treated with ECMO in respiratory intensive-care unit (ICU) of Beijing Chaoyang Hospital from March 2016 to December 2019 and 12 patients with COVID-19 hospitalized from February 1, 2020 to March 31, 2020 in 5 government designated infectious hospitals of Beijing and Hebei Province that applied with ECMO were enrolled. The demographic data, clinical manifestations, and ECMO related information were described and analyzed and all numerical variables are described as M (P₂₅, P₇₅).

The age of COVID-19 patients was 77 (66, 79) years old, which was older than influenza pneumonia patients [46 (32, 62) years old], P<0.05; acute lung injury score and respiratory ECMO survival prediction (RESP) score before ECMO application were 3.3 (3.0, 3.5) and 1 (0, 2), respectively, which were lower than influenza pneumonia patients [3.8 (3.5, 4.0) and 4 (2, 6), respectively], allP values<0.05. Thrombotic complications, bleeding complications, and ventilator-associated pneumonia occurred in ECMO applied COVID-19 patients were 4, 10 and 5 cases, respectively, which were more than that among influenza pneumonia patients (1, 9, and 2 cases, respectively), allP values<0.05. The length of ICU stay of COVID-19 patients was 31 (28, 75) d, which was longer than that of influenza pneumonia patients [27 (18, 39) d],P<0.05. The cases with successful decannulation of ECMO among COVID-19 and influenza pneumonia patients were 6 and 14 cases, respectively and mortality during ICU stay were 8 cases and 11 cases, respectively, and the difference were not statistically significant (allP values>0.05).

COVID-19 patients applied with ECMO have more ECMO-related complications and a longer stay in the ICU than patients with influenza pneumonia.

To analyze the effects of hemocoagulase agkistrodon (HCA) on the coagulation status of healthy people and traumatic brain injury (TBI) patients in vitro.

A total of 10 TBI patients were enrolled from December 2018 to June 2019,and 24 age and sex matched healthy controls were also enrolled. Clinical and pathological data, blood samples of all subjects were collected. Different gradient concentrations of HCA were added to the blood samples which were detected by thromboelastography, and the R value, K value, α angle and MA value of thromboelastography parameters between the two groups were analyzed to explore the effect of HCA on the coagulation status of patients with TBI.

With the increase of HCA concentration in blood samples, the R and K values gradually increased, and the α angles and MA values gradually decreased in both TBI patients group which included 7 males and 3 females, with an median age of 33 (28-39) years old and healthy control group which included 11 males and 13 females, with an median age of 33 (23-49) years old. The differences in the R values, K values, α angles, and MA values of different concentration gradients were statistically significant in both healthy control group and TBI patients group (χ² were 109.80, 131.28, 185.47, 165.97 and 54.92, 75.60, 80.12, 59.25, respectively, all P<0.001). The differences between R values after adding HCA of 0-0.105 U/ml in the healthy group were statistically significant (P=0.025), but K values, α angles and MA values were not statistically significant (P values were 0.275, 0.206 and 0.330, respectively); the R values of the TBI patients group were not statistically significant after adding HCA of 0 to 0.105 U/ml (P=0.976), and the K values, α angles, and MA values were statistically significant (P values were 0.047, 0.041, and 0.034, respectively).The R values of the healthy control group, the TBI patients group, and the overall data were significantly positively correlated with the HCA dose (r values were 0.552、0.700、0.420, respectively, P<0.001), the K values were significantly positively correlated with the HCA dose (r values were 0.726、0.861、0.750, respectively, P<0.001), the α angles were significantly negatively correlated with the HCA dose (r values were -0.815、-0.876、-0.807, respectively, P<0.001) and the MA values were significantly negatively correlated with the HCA dose (r values were -0.757、-0.710、-0.729, respectively, P<0.001).

HCA does not aggravate the procoagulant state of blood in healthy people and TBI patients, and with the increase of HCA concentration in blood, the blood samples of both groups show a tendency to decrease the coagulation ability.

To investigate the efficacy and clinical outcomes of intracytoplasmic sperm injection (ICSI) with micro amount frozen-thawed diagnostic sperm obtained by microdissection testicular sperm extraction (microTESE), percutaneous epididymal sperm as-piration (PESA) and testicularsperm extraction (TESA) in the treatment of azoospermia.

A retrospective analysis was performed on 736 ICSI cycles of azoospermia patients.In Reprocluctive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2019. Including 199 ICSI cycles (microTESE 47cycles, PESA 75cycles and TESA 77 cycles) with micro amount frozen-thawed diagnostic sperm and 537 ICSI cycles (microTESE 23 cycles, PESA 111 cycles and TESA 403 cycles) with fresh micro amount sperm. The general conditions, embryo development conditions and clinical outcomes of patients were compared between and within the two groups.

The recovery rate of PESA group was significantly lower than that of TESA group (89.3% vs 98.7%), P<0.05. The rate of 2PN in the fresh control group was significantly higher than that in the experiment group (75.5% vs 71.3%) and the rate of 2PN in the fresh microTESE and PESA groups were also significantly higher than those of the frozen-thawed microTESE and PESA groups (74.2% vs 64.6%) and (78.5% vs 72.4%), P<0.05. Both the rate of D5 blastocyst formation and high quality blastocyst in the fresh group were significantly lower than that in the experiment group (26.9% vs 32.9%) and (15.1% vs 18.0%),P<0.05; both the rate of early cleavage and blastocyst formation in the fresh microTESE group were significantly lower than that in the frozen-thawed microTESE group (55.1% vs 68.3%) (27.3% vs 39.3%),P<0.05. Both the rate of 8 cells embryos and blastocyst formation in the fresh TESA group were significantly lower than those of the TESA frozen-thawed group (41.3% vs 46.0%) (26.5% vs 32.4%),P<0.05. There was no significant difference in pregnancy rate and planting rate between or within the groups(P>0.05). The abortion rate in the frozen-thawed group was significantly higher than the fresh group (12.0% vs 4.0%), P<0.05, especially the abortion rate in the PESA frozen-thawed group was significantly higher than the fresh group (18.0% vs 1.7%),P<0.05. There was no significant difference in gender, weight and body length between the fresh group and the frozen-thawed group (P>0.05), but there were two malformed babies born in the frozen-thawed group.

Frozen-thawed microinjection of diagnostic microspermatozoa is a feasible method for the treatment of asthenospermia.There was on significonty difference in pregnancy rate and planting rate between of with in the groups. However, significantly higher than the fresh PESA group of the influence on offspring needs to be further studied.

To investigate the clinical efficacy and safety of Nimotuzumab combined with concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer.

A total of 65 patients with locally advanced cervical cancer treated with Nimotuzumab combined with concurrent chemoradiotherapy in Tianjin Medical University Cancer Institute and Hospital were selected from January 2015 to November 2018. Intensity-modulated radiotherapy and intracavitary post-packaging were used for radiation therapy. Platinum and paclitaxel were used for chemotherapy. Nimotuzumab were 400 mg/week. The clinical efficacy, the changes of serum tumor markers and the occurrence of adverse events were observed for 2 years, and the evaluation was performed once for every 3 months.

Sixty-one cases could be evaluated by imaging during the follow-up. The best curative effect evaluation showed that complete remission (CR) was 43 (70.5%), partial remission (PR) was 9 (14.8%), stable disease (SD) was 6 (9.8%) and objective response rate (CR+PR) was 85.3%, disease control rate (CR+PR+SD) was 95.1%. Survival analysis showed that one-year overall survival rate was 93.9% and two-year overall survival rate was 79.6%. After 3 months of treatment, the serum tumor markers SCC, CA125, CEA, and HE4 were significantly lower than those before treatment (P<0.05). Safety assessments showed that the main adverse events were hematochezia, abdominal pain, diarrhea, fever and dizziness, and 37 cases of them were grades Ⅰ-Ⅱ.

Nimotuzumab combined with concurrent chemoradiotherapy has a good clinical effect in the treatment of locally advanced cervical cancer, significantly reduces serum tumor marker levels after treatment, and is safe and tolerable in clinical use.

Listeria monocytogenes (LM) is an important foodborne bacterium. LM meningoencephalitis is rare in clinic, and the prognosis of severe patients is poor. This paper reports two special cases of severe LM meningoencephalitis, one of which was complicated with renal failure, Guillain-Barre syndrome; Another case was complicated with sepsis, infectious endocarditis, skin and soft tissue infection.

Appendix intussusception is relatively rare in clinical practice and can be divided into two types: appendix-appendix type and appendix-cecum type. Among them, appendix-appendix type is rarer, and most of them onset before the age of 20 (especially in children). It is rare to occur in adults. This paper reports a case of blind intussusception of the appendix and acute gangrenous perforated appendicitis.

Vocal cord dysfunction (VCD) is a disease caused by many factors, and its clinical manifestations are diverse, mainly manifested by recurrent episodes of dyspnea. Contradictory vocal cord movement under laryngoscope is the gold standard for diagnosis, and pulmonary function test, provocation test and dynamic laryngeal CT can help judgment. Treatment emphasizes relieving fear and anxiety during acute attack, while attaching importance to the role of behavioral intervention therapy, strengthening individualized management and multidisciplinary combination therapy. Recently, there is still a lack of systematic description of VCD in China. In order to deepen the understanding of this disease and its progression, the latest research on VCD is reviewed.

Studies have confirmed that compared with the standard antigen content influenza vaccine, the elderly ≥65 years old vaccinated with high antigen content influenza vaccine has higher relative vaccine effectiveness (RVE) in most influenza seasons. Studies have shown that the relative vaccine effect of cell culture vaccine is slightly higher than that of chicken embryo culture vaccine in the 2017-2018 influenza season with influenza A (H3N2) virus as the dominant circulating strain. This study aimed to analyze the relative vaccine efficacy of influenza vaccination in retirement health insurance-enrolled seniors ≥65 years of age in the United States during the 2018-2019 influenza season. Inverse probability processing weighted and Poisson regression methods were used to evaluate the relative vaccine effect of influenza vaccination on preventing influenza hospitalization or emergency medical treatment, including people aged ≥65 years who participated in Medicare and received influenza vaccine from August 5, 2018 to January 31, 2019. Among 12 777,214 insured beneficiaries, adjuvanted influenza vaccines cultured in chicken embryos (RVE 7.7%; 95%CI: 3.9% to 11.4%) and influenza vaccines with high antigen content cultured in chicken embryos (RVE: 4.9%; 95%CI: 1.7% ~8.1%) was slightly higher than that of tetravalent influenza vaccine cultured with chicken embryos. There was no statistically significant difference in efficacy between cell-cultured quadrivalent influenza vaccine and chicken embryo-cultured quadrivalent influenza vaccine (RVE 2.5%; 95%CI：-2.4%~7.3%）。 Studies suggest that there is no significant difference in the effectiveness of influenza vaccines for the elderly that have been approved for marketing in the United States in the 2018-2019 flu season. Consistent with previous studies, this study further confirmed that the efficacy of adjuvant-containing influenza vaccine and high antigen-content influenza vaccine cultured in chicken embryos in the elderly is slightly higher than that of tetravalent influenza vaccine cultured in chicken embryos.

Seasonal influenza can cause an annual burden of severe lower respiratory tract infections (LRTIs) and other respiratory diseases (such as chronic obstructive pulmonary disease). Clarification of the disease burden pyramid of influenza-related LRTIs (including LRTI incidence, hospitalizations, and deaths) is essential for a comprehensive understanding of the disease spectrum and the development of influenza surveillance and prevention measures. The 2017 Global Burden of Disease Study (GBD) used Bayesian predictive models and counterfactual methods to estimate influenza-related LRTI incidence, hospitalizations, and death Burden by age, sex, year, and country (region). The results showed that in 2017, the global number of deaths caused by influenza-related LRTI across all ages was 145,000 (95%UI: 99,000 to 200,000). Mortality from influenza-related LRTI was highest among older adults ≥70 years of age [16.4/100,000 (95%UI: 11.6/100,000 to 21.9/100,000)]; The region with the highest rate of all-age mortality is Eastern Europe [5.2/100,000 (95%UI: 3.5/100,000~7.2/100,000)]. Influenza-related LRTI caused 9.459 million cases (95%UI: 3.709 million to 22.935 million) hospitalizations and 81.536 million hospital days (95%UI: 24,330 million to 259,851 million). 11.5%（95%UI: 10.0%-12.9%) of LRTI incidence was attributable to influenza, including 54.481 million (95%UI: 38.465 million to 73.864 million) and 8.172 million (95%UI: 5 million to 13.296 million) severe cases. The study suggests that the annual health damage caused by influenza-related LRTI to the world cannot be ignored, and influenza vaccination should be considered, and influenza prevention measures should be improved.

The use of mechanical circulation assistance in influenza virus-associated myocarditis complicated with refractory cardiogenic shock (rCS) is still lacking in evidence. This study is a single-center, prospective, observational study based on the last two influenza epidemic seasons. Objective to observe the effect of venous-arterial extracorporeal membrane oxygenation (V-A ECMO) and ventricular assist system combined with mechanical circulation assistance in patients with influenza-related myocarditis complicated with rCS. Patients diagnosed with influenza-related myocarditis combined with rCS and undergoing MCS in the intensive care unit of Hannover Medical School, Germany, were studied. Subsequently, propensity score matching analysis was performed in patients with acute myocardial infarction with rCS and non-ischemic cardiomyopathy with rCS. Seven patients with influenza-related myocarditis complicated with rCS were aged (56 ± 10) years, 4 male, 2 influenza A and 5 influenza B. All patients were not vaccinated against influenza. Mechanical circulation assistance is the combined application of V-AECMO and Impella ventricular assistance system. Two patients experienced out-of-hospital cardiac arrest, V-A ECMO was established during extracorporeal cardiopulmonary resuscitation (ECPR), and all patients died within 18 days of admission. After propensity score matching analysis, the 30-day mortality rate of patients with influenza-related rCS was significantly higher than that of patients with acute myocardial infarction or non-ischemic cardiomyopathy-related rCS receiving combined mechanical circulation assistance. Although patients with influenza-associated myocarditis complicated with rCS were initially stabilized after receiving combined mechanical circulatory assistance, the worsening process of shock was not prevented, so that all patients died. Influenza virus infections can have severe effects on organs other than the heart, resulting in mechanical circulatory assistance also failing to reverse end organ damage, with devastating consequences.

Extracorporeal membrane oxygenation (ECMO) is recommended by most international health organizations for saving patients with acute hypoxic respiratory failure caused by novel coronavirus pneumonia (COVID-19). However, up to now, the preliminary reports of ECMO application to COVID-19 have all shown high case fatality rates, and there is still a lack of large-scale international cohort studies. This study was derived from the in vitro life support organization (ELSO) registration study and included epidemiological, hospitalization course and prognosis data of patients aged ≥16 years old who received ECMO support due to confirmed COVID-19 from January 16, 2020 to May 1, 2020 in 213 hospitals in 36 countries. The primary study endpoint was to analyze in-hospital mortality within ECMO establishment 90 by time to event. A multivariate Cox regression model was applied to analyze whether patient and hospitalization factors were associated with hospital mortality. Data were included for a total of 1 035 COVID-19 patients receiving ECMO support, of which 67 (6%) were still hospitalized at the time of publication, 311 (30%) were discharged home or transferred to rehabilitation centers for continued treatment, 101 (10%) were discharged to long-term care centers or unspecified facilities, 176 (17%) were transferred to other hospitals, and 380 (37%) died. After data propensity processing analysis by death or discharge, the in-hospital mortality rate was 39% (380/968). Circulatory support with ECMO was an independent risk factor for increased in-hospital mortality (HR=1.89，95%CI：1.20~2.97）。 Subgroup analysis of patients with COVID-19 with acute respiratory distress syndrome supported by intravenous-intravenous ECMO revealed an estimated cumulative case fatality rate of 38.0% (95%CI：34.6~41.5）。 For ECMO-supported COVID-19 patients, the estimated cumulative mortality rate within 90 days of ECMO establishment and the in-hospital mortality rate after data propensity processing by death or discharge were less than 40%. These data from 213 hospitals worldwide provide a broad estimate of case fatality among COVID-19 patients receiving ECMO support.