Reducedhumoral response against variants of concern in childhood solid cancer patients compared to adult patients and healthy children after SARS-CoV-2 vaccination.

Introduction: Although there is extended research on the response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in adult cancer patients (ACP), the immunogenicity to the variants of concern (VOCs) in childhood cancer patients (CCP) and safety profiles are now little known. Methods: A prospective, multi-center cohort study was performed by recruiting children with a solid cancer diagnosis and childhood healthy control (CHC) to receive standard two-dose SARS-CoV-2 vaccines. An independent ACP group was included to match CCP in treatment history. Humoral response to six variants was performed and adverse events were followed up 3 months after vaccination. Responses to variants were compared with ACP and CHC by means of propensity score-matched (PSM) analysis. Results: The analysis included 111 CCP (27.2%, median age of 8, quartile 5.5-15 years), 134 CHC (32.8%), and 163 ACP (40.0%), for a total 408 patients. Pathology included carcinoma, neural tumors, sarcoma, and germ cell tumors. Median chemotherapy time was 7 (quartile, 5-11) months. In PSM sample pairs, the humoral response of CCP against variants was significantly decreased, and serology titers (281.8 ± 315.5 U/ml) were reduced, as compared to ACP (p< 0.01 for the rate of neutralization rate against each variant) and CHC (p< 0.01 for the rate of neutralization against each variant) groups. Chemotherapy time and age (Pearson r ≥ 0.8 for all variants) were associated with the humoral response against VOCs of the CHC group. In the CCP group, less than grade II adverse events were observed, including 32 patients with local reactions, and 29 patients had systemic adverse events, including fever (n = 9), rash (n = 20), headache (n = 3), fatigue (n = 11), and myalgia (n = 15). All reactions were well-managed medically. Conclusions: The humoral response against VOCs after the CoronaVac vaccination in CCP was moderately impaired although the vaccine was safe. Age and chemotherapy time seem to be the primary reason for poor response and low serology levels.

The effect of prolonged closed-loop management on athletes' sleep and mood during COVID-19 pandemic: Evidence from the 2022 Shanghai Omicron Wave.

Closed-loop management of athletes at the training base is a compromise approach that balanced epidemic prevention and sports training during the COVID-19 pandemic. This study investigated the impact of prolonged closed-loop management on athletes' sleep and mood during the 2022 Shanghai Omicron wave. The Pittsburgh Sleep Quality Index and the Profile of Mood States were used to assess the sleep and mood states of 110 professional athletes in "closed-loop management" at the training base after 1 and 2 months of closed-loop management, respectively, to characterize changes in sleep and mood with prolonged closed-loop management. After two months of control, the sleep and mood of 69 athletes and students of the same age were measured using the Pittsburgh Sleep Quality Index and Perceptual Stress Scale, as well as the Warwick-Edinburgh Mental Well-being Scale, to compare the differences in sleep and mood between athletes undergoing closed-loop management and the general population who were managed in the community. Paired sample t-tests and independent sample t-tests were used for comparisons across different time intervals and different management approaches. Results showed that with the time of closed-loop management increased, athletes woke up earlier (p = 0.002), slept less (p = 0.024), and became angrier (p = 0.014); athletes had poorer overall sleep quality (p < 0.001) but lower stress level (p = 0.004) than those who were outside the base. In closed-loop management, the athletes were able to maintain a stable sleep and mood state. Sports team administrators must be aware of the need to improve athletes' sleep quality and help athletes to agree with this approach of management.

Parent Acceptance toward Inactivated COVID-19 Vaccination in Children with Acute Lymphoblastic Leukemia: The Power of Oncologist and Alliance.

Objectives: The current study aims to survey the willingness of parents to vaccinate their children, who are childhood acute lymphoblastic leukemia survivors (CALLS), and identify factors associated with vaccine acceptance. Methods: Parents of CALLS on/off treatment, with the general condition of being amendable to vaccination, were recruited for interviews with attending oncologists about COVID-19 vaccination acceptance from July to November 2021 in China. After controlling for socioeconomic factors, the Association of Oncologists' recommendations and parent−oncologist alliance with acceptance status were investigated. For validation, propensity score-matched (PSM) analysis was used. Results: A total of 424 families were included in the study, with CALLS mean remission age of 5.99 ± 3.40 years. Among them, 91 (21.4%) agreed, 168 (39.6%) hesitated, and 165 (38.9%) parents disagreed with the vaccination. The most common reason that kept parents from vaccinating their children was lack of recommendations from professional personnel (84/165, 50.9%), and massive amounts of internet information (78/175, 44.6%) was the main nonhealthcare resource against vaccination. Logistic regression analysis showed that only the recommendation from the oncologist was associated with parents' vaccine acceptance (OR = 3.17, 95% CI = 1.93−5.20), as demonstrated by PSM comparison (42 in recommendation group vs. 18 in nonrecommendation group among 114 pairs, p < 0.001). An exploratory analysis revealed that parents with a better patient−oncologist alliance had a significantly higher level of acceptance (65.6% in alliance group vs. 15.6% in nonalliance group among 32 pairs, p < 0.001). Conclusions: Due to a lack of professional recommendation resources and the potential for serious consequences, parents were generally reluctant to vaccinate their CALLS. The recommendation of oncologists, which was influenced by the parent−oncologist alliance, significantly increased acceptance. This study emphasizes the critical role of oncologists in vaccinating cancer survivors and can be used to promote COVID-19 vaccines among vulnerable populations.

The interaction between black carbon and planetary boundary layer in the Yangtze River Delta from 2015 to 2020: Why O3 didn't decline so significantly as PM2.5.

Since the Air Pollution Prevention and Control Action Plan (air clean plan) issued in 2013, air quality has been in continuous improvement. The second stage of air clean plan since 2018 was focused on O3 controlling, but it still didn't decline so significantly as PM2.5. This study conducted a long-term observation on black carbon (BC) and utilized the observational data of other air pollutants (PM2.5, PM10, NO2, SO2, CO and O3), the meteorological elements and the vertical sounding data of PBL in Nanjing. In the daytime (08:00-20:00), PM2.5 kept decreasing from 2015 to 2020 at the rate of 4.8 µg⋅m-3⋅a-1, however, BC increased at the rate of 0.6 µg⋅m-3⋅a-1, which has led to the continuous growth of BC/PM2.5 (0.9%⋅a-1). However, during this period, O3 was relatively stable and, in 2020, it returned below its value in 2015 after slight increases in 2017 and 2018. Meanwhile, the average surface temperature had increased by around 1.0 °C during 2015-2019 at the rate of 0.3 °C⋅a-1. Also, the average height of the inversion layer had increased significantly by 494.0 and 176.7 m at 20:00 and 08:00, whose growth ratio was up to 57% and 25%, respectively. The above observation results have formed a set of chain reactions as follows. The growth of the surface BC caused the surface temperature to rise due to the increasing heating effect of BC. The continuous growth of the surface temperature made it easier for the PBL height to develop, which led to the lift of the inversion layer in the PBL and the larger atmospheric environment capacity. Ultimately, it is conducive to the diffusion of the near surface pollutants, thus helping reduce their concentrations, which offsets the increasing tendency of O3 and add to the decreasing trend of PM2.5. This phenomenon is the most remarkable in summer, with the fastest increasing rate of temperature (0.8 °C⋅a-1) and O3 (3.9 µg⋅m-3⋅a-1) during 2015-2019 (excluding 2020 to erase the great effect of COVID-19 lockdown on emissions).

Serial negative response after standard and third (Booster) dose of COVID-19 inactivated vaccine is associated with low vitamin D levels in patients with solid cancers.

Introduction: The response is poorly understood to the third dose in patients with cancer who failed the standard dose of inactivated SARS-CoV-2 vaccines (CoronaVac). We aim to assess the immune response to the third dose and identify whether vitamin D deficiency is associated with serial serologic failure in patients with cancer. Methods: Solid cancer patients (SCP-N) and healthy controls (HCs) who were seronegative after the standard-dose vaccines in our previous study were prospectively recruited, from October 2021 to February 2022, to receive the third dose vaccines and anti-SARS-CoV-2S antibodies were measured. SCP-N who failed the third dose (serial seronegative group, SSG) were matched by propensity scores with the historical standard-dose positive cancer patient group (robust response group, RRG). An exploratory analysis was carried out to validate the role of vitamin D on the serology response. Results: The multi-center study recruited 97 SCP-N with 279 positive controls as RRG and 82 negative controls as HC group. The seroconversion rate after third-dose vaccination was higher in SCP-N than in HC (70.6% vs. 29.4%, p < 0.01). The matched comparison showed that patients in SSG had a significantly lower level of vitamin D and consumption rate than RRG or RRG-B (RRG with third-dose positive) (all p < 0.01). None had serious (over grade II) adverse events after the third dose. Conclusion: Solid cancer patients with second-dose vaccine failure may have a relatively poor humoral response to the third dose of COVID-19 vaccines as compared with the seronegative HC group. The consecutively poor humoral response could be associated with poor vitamin D levels and intake. Vitamin D status and cancer-related immune compromise may jointly affect the humoral response following booster vaccination.

Psychometric Properties of the Chinese Version of the Primary Care Post-Traumatic Stress Disorder Screen-5 for Medical Staff Exposed to the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic may increase the development of psychiatric disorders, such as posttraumatic stress disorder (PTSD) among medical staff. A brief validated screening tool is essential for the early diagnosis of PTSD. The purpose of the present study was to evaluate the validation of a Chinese version of the Primary Care-PTSD-5 (C-PC-PTSD-5) and determine an appropriate cutoff score with optimal sensitivity and specificity for medical staff in China during the COVID-19 pandemic. PARTICIPANTS AND METHODS: An online cross-sectional survey was conducted on medical staff (n = 1104) from 17 medical institutions in Shanghai. Questionnaires comprising general information, medical-related traumatic event experiences, the PTSD Checklist (PCL-5), and C-PC-PTSD-5 were distributed to participants using the online Questionnaire Star electronic system. Internal consistency, convergent validity, and test-retest reliability were calculated. Receiver operating characteristic (ROC) analysis was performed to determine diagnostic accuracy and the optimal cutoff score of the C-PC-PTSD-5 for medical staff. RESULTS: We included 1062 valid questionnaires for the analysis. Data of 838 traumatic experiences were analyzed. Internal consistency of the C-PC-PTSD-5 was satisfied (Cronbach's α = 0.756). The total score of the C-PC-PTSD-5 showed good test-retest reliability (r = 0.746). We found a strong correlation between the C-PC-PTSD-5 score and PCL-5 total score (r = 0.669, p < 0.001), which indicated good convergent validity. The ROC analysis showed an area under the curve of 0.81 ± 0.016. A cutoff score of 2 provided optimal sensitivity and specificity for the C-PC-PTSD-5 (sensitivity = 0.632, specificity = 0.871, Youden index = 0.503, and overall efficiency = 0.768). CONCLUSION: Our results indicated that the C-PC-PTSD-5 can be employed as a brief and efficient screening instrument for medical staff exposed to the COVID-19 pandemic. A score of 2 was identified as the optimal threshold for probable clinical PTSD symptoms.

Predictors for Fear of Cancer Recurrence in Breast Cancer Patients Referred to Radiation Therapy During the COVID-19 Pandemic: A Multi-Center Cross-Section Survey.

OBJECTIVE: The outbreak of COVID-19 pandemic has greatly impacted on radiotherapy (RT) strategy for breast cancer patients, which might lead to increased distressing psychological symptoms. We performed a multi-center cross-section survey to investigate prevalence of fear of cancer recurrence (FCR) and predictors for FCR in patients referred to RT during pandemic. METHODS: 542 patients were consecutively enrolled from three regions in China including Yangtze Delta River Region, Guangdong and Shanxi province. Patients' characteristics were collected using an information sheet, Fear of progression questionnaire-short form, Hospital Anxiety/Depression Scale and EORTC QLQ-C30. The hierarchical multiple regression models were performed. RESULTS: 488 patients with complete data were eligible. The RT strategy was affected in 265 (54.3%) patients, including 143 with delayed RT initiation, 66 believing to have delayed RT initiation but actually not, 24 with RT interruptions, 19 shifting to local hospitals for RT and the remaining 13 influenced on both RT schedule and hospital level. The model explained 59.7% of observed variances in FCR (p<0.001) and showed that influence of RT strategy had significantly impacted on FCR (△R2 = 0.01, △F=2.966, p=0.019). Hospitals in Shanxi province (ß=-0.117, p=0.001), emotional function (ß=-0.19, p<0.001), social function (ß=-0.111, p=0.006), anxiety (ß=0.434, p<0.001) and RT interruption (ß=0.071, p=0.035) were independent predictors. CONCLUSIONS: RT strategy for breast cancer patients was greatly influenced during pandemic. RT interruption is an independent predictor for high FCR. Our findings emphasize the necessity to ensure continuum of RT, and efforts should be taken to alleviate FCR through psychological interventions.

Weakened Aerosol-PBL Interaction During COVID-19 Lockdown in Northern China.

Anthropogenic emissions were greatly constrained during COVID-19 lockdown in China. Nevertheless, observations still showed high loadings of fine particles (PM2.5) over northern China with secondary aerosols increasing by 15 µg/m3 yet a ∼10% drop in light-absorbing black carbon (BC). Such a chemical transition in aerosol composition tended to make the atmosphere more scattering, indicated by satellite-retrieved aerosol absorption optical depth falling by 60%. Comparison between weather forecast and radiosonde observations illustrated that, without upper-level heating induced by BC, the stabilized stratification diminished, which was conducive for planetary boundary layer (PBL) mixing and thus near-surface pollution dispersion. Furthermore, coupled dynamic-chemistry simulations estimated that emission reduction during the lockdown weakened aerosol-PBL interaction and thus a reduction of 25 µg/m3 (∼50%) in PM2.5 enhancement. Based on the unique natural experiment, this work observationally confirmed and numerically quantified the importance of BC-induced meteorological feedback, further highlighting the priority of BC control in haze mitigation.

Health-related quality of life of COVID-19 patients after discharge: A multicenter follow-up study.

AIMS AND OBJECTIVES: To determine the health-related quality of life (HRQoL) of COVID-19 patients after discharge and its predicting factors. BACKGROUND: COVID-19 has caused a worldwide pandemic and led a huge impact on the health of human and daily life. It has been demonstrated that physical and psychological conditions of hospitalised COVID-19 patients are impaired, but the studies focus on physical and psychological conditions of COVID-19 patients after discharge from hospital are rare. DESIGN: A multicentre follow-up study. METHODS: This was a multicentre follow-up study of COVID-19 patients who had discharged from six designated hospitals. Physical symptoms and HRQoL were surveyed at first follow-up (the third month after discharge). The latest multiple laboratory findings were collected through medical examination records. This study was performed and reported in accordance with STROBE checklist. RESULTS: Three hundred eleven patients (57.6%) were reported with one or more physical symptoms. The scores of HRQoL of COVID-19 patients at third month after discharge, except for the dimension of general health, were significantly lower than Chinese population norm (p < .001). Results of logistic regression showed that female (odds ratio (OR): 1.79, 95% confidence interval (CI): 1.04-3.06), older age (≥60 years) (OR: 2.44, 95% CI: 1.33-4.47) and the physical symptom after discharge (OR: 40.15, 95% CI: 9.68-166.49) were risk factors for poor physical component summary; the physical symptom after discharge (OR: 6.68, 95% CI: 4.21-10.59) was a risk factor for poor mental component summary. CONCLUSIONS: Health-related quality of life of discharged COVID-19 patients did not come back to normal at third month after discharge and affected by age, sex and the physical symptom after discharge. RELEVANCE TO CLINICAL PRACTICE: Healthcare workers should pay more attention to the physical and psychological rehabilitation of discharged COVID-19 patients. Long-term follow-up on COVID-19 patients after discharge is needed to determine the long-term impact of COVID-19.