Abstract Inoculation of COVID-19 vaccines is an important approach to preventing SARS-CoV-2 infections and reducing the severe disease and mortality of COVID-19. The elderly, children and adolescents, pregnant women, lactating women, patients with chronic diseases and immunocompromised individuals are considered to be susceptible to and at a high risk of COVID-19. Early, safe and effective inoculation of COVID-19 vaccines is critical for the successful building of the population immune barrier against COVID-19. This review, based on data from clinical trials, summarizes the safety and efficacy and safety of COVID-19 vaccines among special populations, so as to provide insights into COVID-19 vaccination among special populations.

Objective:To investigate the effect of insulin secretion index (HOMA-β) in the evaluation of the condition of patients with acute respiratory distress syndrome (ARDS), multiple organ failure (MOF) and prognosis prediction.Methods:A retrospective analysis of the clinical data of 96 patients with ARDS hospitalized in Hangzhou Hospital of Zhejiang Medical Health Group from January 2019 to February 2021 was divided into MOF group (38 cases) and non-MOF group (58 cases). The baseline HOMA-β, oxygenation index, acute physiology and chronic health score Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) and 28 d case fatality rate were collected and compared between the two groups. Compare the HOMA-β, oxygenation index, APACHE Ⅱ score, SOFA of ARDS patients with different survival prognosis. Logistic regression model analyzed the influence of HOMA-β, oxygenation index, APACHE Ⅱ, SOFA on the MOF and survival prognosis of ARDS patients. Pearson linear correlation method was used to analyze the relationship between HOMA-β and oxygenation index, APACHE Ⅱ, SOFA in ARDS patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive power of HOMA-β on MOF and prognosis of ARDS patients.Results:The incidence of MOF and 28 d case fatality rate in 96 patients with ARDS were 39.58% (38/96) and 31.25% (31/96), respectively. The HOMA-β and oxygenation index in the MOF group were significantly lower than those in non-MOF group: 126.37 ± 28.75 vs. 178.52 ± 32.66, (125.41 ± 18.77) mmHg (1 mmHg = 0.133 kPa) vs. (153.62 ± 26.42) mmHg, while the APACHE Ⅱ, SOFA and 28 d case fatality rate were significantly higher than those in non-MOF group: (23.61 ± 4.68) points vs. (10.96 ± 2.85) points, (11.24 ± 1.65) points vs. (5.62 ± 0.87) points and 65.79% (25/38) vs. 10.34% (6/58), and there were statistical differences ( P<0.05). The HOMA-β and oxygenation index in dead ARDS patients were significantly lower than those in surviving ARDS patients: 89.62 ± 21.17 vs. 195.43 ± 35.64 and (121.66 ± 21.06) mmHg vs. (158.87 ± 28.71) mmHg, the APACHE Ⅱ and SOFA were significantly higher than those in surviving ARDS patients: (25.78 ± 5.42) points vs. (8.84 ± 2.51) points, (12.38 ± 1.22) points vs. (4.88 ± 0.83) points, and there were statistical differences ( P<0.05). Logistic regression model analysis showed that HOMA-β, oxygenation index, APACHE Ⅱ, SOFA of ARDS patients were all influencing factors of MOF and survival prognosis ( P<0.05). The results of Pearson linear correlation analysis showed that HOMA-β in ARDS patients was positively correlated with its oxygenation index ( P<0.05), and its APACHE Ⅱ and SOFA were negatively correlated ( P<0.05). ROC curve analysis results show that HOMA-β in ARDS patients has a high predictive power for their MOF and prognosis. Conclusions:The level of HOMA-β in ARDS patients is low, and it is closely related to its condition, MOF occurrence and survival prognosis. It can be used as a reference index for disease assessment and MOF and prognosis prediction of ARDS patients.

Objective:To investigate the relationship between intestinal flora and acute respiratory distress syndrome in patients with severe acute pancreatitis.Methods:One hundred and six patients with severe acute pancreatitis admitted to a hospital from March 2019 to February 2021 were selected as the observation group for prospective analysis. They were divided into concurrent group (52 cases) and non-concurrent group (54 cases) according to whether they were complicated with acute respiratory distress syndrome. In addition, 100 healthy people in the same period were selected as the control group to analyze the relationship between intestinal flora and acute respiratory distress syndrome in patients with severe acute pancreatitis.Results:There were significant differences in the number of intestinal flora ( Lactobacillus, Bifidobacterium, Escherichia coli) between the observation group and the control group ( t = 49.69, 73.28 and 46.32; P<0.05). There were significant differences in the number of intestinal flora ( Lactobacillus, Bifidobacterium, Escherichia coli) between the concurrent group and the non-concurrent group ( t = 34.85, 39.71 and 23.47; P<0.05). The levels of serum endotoxin, diamine oxidase and D-lactic acid in the concurrent group were significantly higher than those in the non-concurrent group: (0.63 ± 0.16) EU/ml vs. (0.45 ± 0.08) EU/ml, (6.29 ± 1.18) U/ml vs. (4.89 ± 0.91) U/ml, (11.63 ± 2.84) mmol/L vs. (9.33 ± 2.61) mmol/L ( t = 7.37, 6.85 and 4.34, P<0.05). Spearman analysis showed that severe acute pancreatitis complicated with acute respiratory distress syndrome was negatively correlated with the number of intestinal Lactobacillus and Bifidobacterium ( r = - 0.342 and - 0.291, P = 0.011 and 0.021), which was positively correlated with the number of intestinal Escherichia coli flora ( r = 0.263, P = 0.033). Conclusions:Intestinal colony imbalance is common in patients with severe acute pancreatitis, and the imbalance of intestinal colony and the impairment of intestinal mucosal barrier function are more serious in patients with acute respiratory distress syndrome. There is a significant correlation between severe acute pancreatitis complicated with acute respiratory distress syndrome and its intestinal colony.