Guidance on the use of biologic agents in psoriatic patients during COVID-19 outbreak.

The COVID-19 outbreak may have some impact on the use of biologics in psoriatic patients because immunosuppressive effects of biologics may potentially alter the susceptibility of patients to the virus, deteriorate the condition of infected patients or even change the prognosis of infection. According to currently available recommendations from international psoriasis academic organizations and specialists, as well as specific situation in China, the authors provide some guidance on the use of biologics for psoriatic patients undergoing or planning to undergo treatment with biologics, those with low or high risk of infection, and for those with or without COVID-19 infection, so as to provide references for clinical practice.Copyright © 2020 by the Chinese Medical Association.

From Darkest to Finest Hour: Recovery Strategies and Organizational Resilience in China's Hotel Industry During the COVID-19 Pandemic

In 2020, the COVID-19 pandemic adversely affected the global tourism industry and continues to impact the Chinese hotel sector today. Using a multiple cases study method, we analyzed the response strategies of four Chinese hotel groups - Jinling, Jinjiang, New Century Hotels & Resorts, and Huazhu Group Ltd.-across four successive periods: (1) outbreak;(2) first recovery;(3) struggle;and (4) a predicted finest moment. We identified four internal recovery strategies: (a) rapid response, (b) recovery exploration, (c) optimization and upgrading, and (d) rejuvenation. Hotel groups' resilience proceeded through all four stages include (re)activation, consolidation, extension, and ecosystem. Each stage demonstrated the companies' movement from reliance on internal resources to interdependence across the supply chain with on the help of digital services such as contactless check-in, robot delivery and cloud-based PMS. We additionally identified a close link between stakeholders including online travel agencies, government and hotel chains. The analysis in the present study is premised on resource utilization, product and service development, organizational management and operation, leadership, digitalization, and social responsibility. Suggestions to cope with a long-duration crisis like COVID-19 are also provided.

Resource integration capabilities to enable platform complementarity in healthcare service ecosystem co-creation

Purpose Covid has increased the usage of multisided digital platforms. For companies, this has become a business opportunity. Data usage on platforms requires that platform companies co-create services for common customers. In this case, the target is not to make the same value proposition but rather to use the resources such as data, knowledge, technology, or institutions in a complementary manner. Platforms are characterized as a combination of hardware and software including standards, interfaces, and rules making it possible for different ecosystem players to complement and interact in the ecosystem. Current ecosystems include several platforms that do not work without resource integration. The purpose of this study is to increase understanding what do we mean by resource complementarity in service ecosystems. Design/methodology/approach This study was done via an in-depth qualitative case study in which a health service ecosystem co-creating technological surgery innovation was used as a unit of analysis. Findings The authors' findings suggest that key resource capabilities, to enable complementarity in service ecosystems, are motivation, knowledge, skills, data and complementary designed technology components. Research limitations/implications The authors' study increases theoretical understanding of what does one mean by construct of resource complementarity. Practical implications From a managerial perspective, it is shown that organizations need to develop adaptive capabilities to utilize internal and external competencies and resources and enable co-creative processes within the service ecosystem. Originality/value Very few empirical studies in the marketing literature have focused on multi-sided digital platforms and their resource complementarity in the data-driven healthcare ecosystem settings.

The safety and efficacy of surufatinib for the treatment of advanced neuroendocrine tumors: A prospective, multicenter, real-world study

Background: Surufatinib (a small-molecule inhibitor of VEGFR1-3, FGFR1, and CSF-1R) has exhibited encouraging antitumor activity for the treatment of advanced neuroendocrine tumors (including NEN and NEC) in multiple registration studies. Here, we report the preliminary results of advanced neuroendocrine tumors of an ongoing, multicenter, real-world study of surufatinib + MDT (ChiCTR2100049999). Challenges in tumor clinical trials management in the face of the COVID-19 resurgence period in Shanghai. Methods: In this multicenter, single-arm real-world study, adults (18-80) with advanced neuroendocrine tumors (including NEN and NEC) were eligible and received surufatinib (300mg orally, QD) with MDT（multidisciplinary collaborative diagnosis and treatment). The primary endpoint was progression-free survival (PFS) per RECIST 1.1. We minimized the interruptions caused by the pandemic using telemedicine platforms for all patients. This included online consultations, follow-up drug distributions, and health management services. Results: Twenty-three pts were enrolled, with 20 NEN and 3 NEC. At the data cutoff date (April 10, 2022), 15 pts had at least one post-baseline tumor assessment;of them, the confirmed ORR (95%CI) was 20% (4.3-48.1), and DCR (95%CI) was 93.33% (68.1-99.8). Median PFS (mPFS) (95%CI): 10.640 mo (3.796-17.484);median OS: not reached and median duration of follow up was 6.870 mo (6.797-6.943). A pNET patient (NO. 010007) was interrupted by asymptomatic COVID-19 infection 9 mo after enrollment. There are no interruptions caused by COVID-19 for other patients. An NEC patient treated with single agent had a 5.85 mo PFS, evaluated as NE, in whom target lesion resected after baseline. In overall pts (n=23), most commonly (≥3 pts) with hemorrhage, anemia, hypertension, proteinuria, and abdominal pain. Three pts had TRAEs that led to treatment discontinuation. Conclusions: Surufatinib + MDT exhibited promising efficacy and manageable toxicity in pts with advanced neuroendocrine tumors. Now and in the future, it is necessary to design regulatory changes in telehealth adoption for clinical trial design in the pandemic era. Clinical trial identification: ChiCTR2100049999. Legal entity responsible for the study: The authors. Funding: Hutchison MediPharma Limited. Disclosure: All authors have declared no conflicts of interest.

Chinese EdTech Economy in the COVID-19 era

This chapter discusses the Chinese EdTech economy in the COVID-19 era. After studying the characteristics of the Chinese online education market and its market size, this research focuses on the differences in business strategies and market responses among online education applications during the COVID-19 era and the subsequent institutional changes, as well as analyzing the factors that cause such differences. For the analysis, a few cases of successful online education companies in China are selected, and their business models and technology applications are discussed. The authors conclude this chapter by addressing the challenges that China's online education faces and providing corresponding suggestions. © 2022, IGI Global. All rights reserved.

COMPARISON OF MOVEMENT PATTERN TRAINING AND JOINT MOBILIZATION FOR CHRONIC PREARTHRITIC HIP DISORDERS: A PILOT RANDOMIZED CLINICAL TRIAL

Purpose: A clear need exists to rigorously assess treatment strategies for chronic prearthritic hip disorders (PAHD). We assessed the preliminary effects of two physical therapist-led interventions that target two distinct mechanisms, abnormal movement patterns and sensory disturbances. Abnormal movement patterns, such as excessive hip adduction, may create altered mechanical stresses on hip joint structures, resulting in subsequent injury, pain and activity limitations. Movement pattern training (MoveTrain) may improve movement patterns and patient-reported outcomes, however further investigation is needed to be definitive. Sensory disturbances such as peripheral sensitization and central sensitization (aka nociplastic pain) may also contribute to pain persistence long after an initial injury. Joint mobilization (JtMob) is proposed to impart a neurophysiological response within the peripheral and central nervous system that results in pain reduction and improved mobility, yet the investigation of JtMob for the treatment of PAHD is limited. Methods: Patients, 18-40 years, with chronic PAHD were recruited. Baseline assessment included self-report questionnaire completion, clinical examination and quantitative sensory testing. The primary outcome was the Hip disability and Osteoarthritis Outcome Score (HOOS), a hip-specific, patient-reported outcome measure. Secondary outcomes included movement evoked pain assessed with a repetitive step down task and a repetitive deep squat task, and pain pressure threshold assessed at the anterior groin of the most bothersome hip (local pressure hypersensitivity) and the dominant thenar eminence (generalized pressure hypersensitivity). After baseline assessment, patients were randomized into 1 of 2 treatment groups, MoveTrain or JtMob. Randomization was stratified by sex and HOOS Symptoms quartile, as determined from data collected during previous study. Treatment was provided by 4 experienced physical therapists (2 in each treatment arm) who were trained in standardized procedures. Treatment for both groups included 10 supervised sessions over 12 weeks and incorporated assessment of patient goals, patient education and instruction in a home program. Patient education focused on patient-specific tasks, such as work or fitness activities, identified by each patient to be symptom-producing. The goal of MoveTrain was to reduce stresses on the hip joint by optimizing the biomechanics of daily and patient-specific tasks. The key element of MoveTrain was task-specific instruction to correct abnormal movement patterns demonstrated during daily tasks and patient-specific tasks. For example, hip adduction and femoral internal rotation were minimized during step-down tasks. The home program included repeated practice of the modified tasks. Difficulty of the tasks were progressed based on each patient’s performance. The goal of JtMob was to reduce pain and improve pain-free motion of the hip. The key element of JtMob was manual techniques provided by the physical therapist. Specific criteria were used to determine the joint mobilization techniques and parameters used for each patient. The patient’s symptom report to each technique was monitored and if indicated, the technique modified according to our outlined procedures. The home program included flexibility exercises. Immediately after treatment completion, patients returned for follow up assessment. Data collected at baseline and post-treatment were analyzed with analysis of covariance (ANCOVA) using a generalized linear model where change is the dependent variable and baseline is the covariate. The adjusted immediate treatment effect was calculated by subtracting the least squares mean change between baseline and post for MoveTrain minus JtMob from the ANCOVA, and assesses the between-group difference in change after adjusting for baseline. Results: Thirty-three patients with PAHD were randomized. Demographics are provided in Table 1. Four patients did not complete treatment or post-treatment testing (3 due to COVID pandemic, 1 lost t follow up);7 patients did not complete post-treatment laboratory testing (due to COVID), but did complete post-treatment questionnaires. Both groups demonstrated clinically important within-group improvements in the HOOS subscales and movement evoked pain ratings after treatment (Table 2). No changes were noted in pain pressure threshold for either group. After adjusting for baseline, there were no between-group differences in change in outcomes when comparing MoveTrain and JtMob. Conclusions: Our preliminary findings suggest that 12 weeks of physical therapist-led intervention, including either MoveTrain or JtMob, may result in improvements in patient-reported pain and activities limitations. Further investigation is needed to determine the sustained effects of each treatment and to determine if specific patient factors are associated with treatment prognosis. [Formula presented] [Formula presented]

First-phase ejection fraction, a measure of pre-clinical heart failure, is strongly associated with increased mortality in patients with COVID-19

Introduction: Presence of heart failure is associated with a poor prognosis in patients with COVID-19. The aim of the present study was to examine whether first-phase ejection fraction (EF1), the ejection fraction measured in early systole up to the time of peak aortic velocity, a sensitive measure of pre-clinical heart failure, is associated with survival in patients hospitalised with COVID-19. Methods: A retrospective outcome study was performed in patients hospitalised with COVID-19 who underwent echocardiography (n=380) at the West Branch of the Union Hospital, Wuhan, China and in patients admitted to King's Health Partners in South London UK. Association of EF1 with survival was performed using Cox proportional hazards regression. EF1 was compared in patients with COVID-19 and in historical controls with similar co-morbidities (n=266) who had undergone echocardiography before the COVID-19 pandemic. Results: In patients with COVID-19, EF1 was a strong predictor of survival in each patient group (Wuhan and London). In the combined group, EF1 was a stronger predictor of survival than other clinical, laboratory and echocardiographic characteristics including age, co-morbidities and biochemical markers (figure 1). A cut-off value of 25% for EF1 gave a hazard ratio of 5.23 (95% CI: 2.85-9.60, p<0.001) unadjusted and 4.83 (95% CI: 2.35-9.95, p<0.001) when adjusted for demographics, co-morbidities, hs-cTnI and CRP (figure 2). EF1 was similar in patients with and without COVID-19 (23.2±7.3 vs 22.0±7.6%, p=0.092, adjusted for prevalence of risk factors and co-morbidities). Conclusion: Impaired first-phase ejection fraction is strongly associated with mortality in COVID-19 and probably reflects pre-existing, pre-clinical heart failure.

Experts Opinion on the Use of Biologic Agents in Psoriatic Patients during COVID-19 Outbreak#

The coronavirus disease 2019 (COVID-19) outbreak affects the use of biologics for psoriatic patients, in the way that the consequential immunosuppression potentially alters a patient's susceptibility to the virus or deteriorate the condition if the patient is infected or even change the prognosis of infection. Therefore, authors reviewed currently available recommendations from international psoriasis academic organizations and specialists, and summarized them with the specific situation in China. We are trying to provide guidance to the use of biologics for psoriatic patients in the following contexts: patients on biologic therapy, patients being considered for biologic therapy initiation, patients with low-risk or high-risk of SARS-CoV-2 coronavirus infection, patients tested negative or positive for the nucleic acid testing of virus. © 2021 Lippincott Williams and Wilkins. All rights reserved.

Virtual Screening of Chinese Medicine Small Molecule Compounds Targeting SARS-CoV-2 3CL Protease (3CL pro)

Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has attracted worldwide attention due to its high infectivity and pathogenicity. Objective: The purpose of this study is to develop drugs with therapeutic potentials for COVID-19. Methods: we selected the crystal structure of 3CL pm to perform virtual screening against natural products in the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). Then, molecular dynamics (MD) simulation was carried out to explore the binding mode between compounds and 3CL pro. Results and Discussion: A total of 6 candidates with good theoretical binding affinity to 3CL pm were identified. The binding mode after MD shows that hydrogen bonding and hydrophobic interaction play an important role in the binding process. Finally, based on the free binding energy analysis, the candidate natural product Gypenoside LXXV may bind to 3CL pm with high binding affinity. Conclusion: The natural product Gypenoside LXXV may have good potential anti-SARS-COV-2 activity.

Impact of COVID-19 outbreak on the quality of care and outcomes for in-hospital patients with acute ischemic stroke in china

Background: It is unclear the impact of the COVID-19 pandemic on the health care and outcomes for in-hospital patients with acute ischemic stroke (AIS). We aimed to evaluate the influence of COVID-19 on the quality of care for in-hospital patients with AIS. Methods: This is an observational registry study between November 23rd, 2019 and March 22nd, 2020. 408 hospital from 29 provinces in China were enrolled from Chinese Stroke Center Alliance (CSCA). Patients with AIS were extracted with demographic, clinical and previous history information. We focus on the time period before and after January 23rd, 2020, when the public health interventions were carried out in China. The primary outcome was adherence to 11 performance measures, with co-primary outcomes of a composite of percentage of performance measures adhered to. Secondary outcomes included were time measures and in-hospital outcomes. Results: 42056 patients with AIS was enrolled (mean age 66.5±12.1, male 61.3%). The overall inhospital patients decreased slightly from 14323 to 14204 before the COVID-19 outbreak and went down sharply by 31.4% and 61.1% after the outbreak and the public conducted interventions in China. A remarkable reduction was shown in patients with NIHSS score ≤ 3 from 57.7% to 55.7% after the outbreak (p<.001). Adherence to performance kept steady and grew slightly overall, for the composite measure (0.78±0.19 vs. 0.79±0.18, p<.001) increased after the COVID-19 outbreak. Discharged against medical advice increased from 5.9% to 7.3% after the outbreak (p<.001). The length of stay fell as expected after the public health interventions (10.0 (7.0-13.0) vs. 9.0 (7.0-13.0), p<.001). Conclusions: The admission number of patients with AIS declined significantly after the COVID-19outbreak, but the quality of care and outcomes kept stable. Hospitals should admit AIS patients tothe fullest extent of ability and provide tailored treatment strategies under the premise of no thecross-infection of COVID-19.

SARS-CoV-2 Superspread in Fitness Center, Hong Kong, China, March 2021

To investigate a superspreading event at a fitness center in Hong Kong, China, we used genomic sequencing to analyze 102 reverse transcription PCR-confirmed cases of severe acute respiratory syndrome coronavirus 2 infection. Our finding highlights the risk for virus transmission in confined spaces with poor ventilation and limited public health interventions.

Multivariate analyses of codon usage of SARS-CoV-2 and other betacoronaviruses

Coronavirus disease 2019 (COVID-19) is a global health concern as it continues to spread within China and beyond. The causative agent of this disease, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), belongs to the genus Betacoronavirus, which also includes severe acute respiratory syndrome-related coronavirus (SARSr-CoV) and Middle East respiratory syndrome-related coronavirus (MERSr-CoV). Codon usage of viral genes are believed to be subjected to different selection pressures in different host environments. Previous studies on codon usage of influenza A viruses helped identify viral host origins and evolution trends, however, similar studies on coronaviruses are lacking. In this study, we compared the codon usage bias using global correspondence analysis (CA), within-group CA and between-group CA. We found that the bat RaTG13 virus best matched the overall codon usage pattern of SARS-CoV-2 in orf1ab, spike and nucleocapsid genes, while the pangolin P1E virus had a more similar codon usage in membrane gene. The amino acid usage pattern of SARS-CoV-2 was generally found similar to bat and human SARSr-CoVs. However, we found greater synonymous codon usage differences between SARS-CoV-2 and its phylogenetic relatives on spike and membrane genes, suggesting these two genes of SARS-CoV-2 are subjected to different evolutionary pressures.

Impacts of the COVID-19 pandemic on vegetable production and countermeasures from an agricultural insurance perspective

In the face of the corona virus disease 2019 (COVID-19) pandemic, it is essential to stabilize the security of urban "shopping baskets". Through a survey and interviews with 46 agricultural cooperatives in Shanghai, this paper analyzes the impact of the pandemic on vegetable production and offers suggestions on agricultural insurance. The research results show that: (1) the pandemic has impacted almost all stages of the vegetable supply chain but has had a greater impact on the sales stage;(2) the market risks of vegetable production have increased significantly, and the gap between the field price and the market price has widened. The sales price difference between traditional channels and e-commerce is notable;(3) farmers' incomes have generally declined due to the COVID-19 pandemic, and traditional small-scale farmers have suffered more losses;and (4) agricultural insurance plays an important role in stabilizing the supply of vegetables to the city. To minimize the impact of the pandemic on vegetable production and to stabilize both urban "shopping baskets" and farmers' incomes, it is necessary to further improve agricultural insurance, especially to provide insurance against market risks.

A preliminary study on the dynamic imaging of chest high resolution CT in patients with mild COVID-19

Objective: To explore the evolution of imaging findings on dynamic chest high resolution CT(HRCT) in patients with mild COVID-19. Methods: The data of epidemiology, clinical data and continuous dynamic chest high-resolution CT images of the patients with mild COVID-19 were analyzed retrospectively. Twenty-five patients (including 24 common type and 1 mild) were enrolled in the group, including 14 males and 11 females, with age of (42±12) years and hospital stay of (19±5) days. The basic images and dynamic images of HRCT were analyzed and compared by the radiologists. Results: The clinical manifestations were fever (22 cases), cough (18 cases), expectoration (8 cases), pharyngeal pain (6 cases). Most laboratory tests lacked specificity. There were no significant abnormalities on chest CT of one mild patient. HRCT findings of the common type were as follows: (1) the distribution of the lesions: most of the multiple lesions involved both lungs (19 cases), with average of 3 (3±1) lobes, located in the peripheral pulmonary zone near the pleura (22 cases);(2) the morphology and density of the lesions: most of the lesions were ground glass density foci (22 cases), which were patchy and massive (18 cases), nodular (10 cases) and arc broadband (7 cases);with the development of the disease, the density of some lesions increased with localized pulmonary consolidation (10 cases), accompanied by air bronchus sign (5 cases) and halo sign (5 cases). Dynamic changes of HRCT images in the chest: the positive manifestations were found on the 5th (5, 6) day after the onset of the disease, the progressive time of CT lesions was 5 (5, 7) days, the peak time of CT lesions was 11 (10, 13) days, and the turning time of CT lesions was 9 (8, 11) days. Conclusions: Dynamic chest HRCT can monitor the basic evolution process of the disease in patients with mild COVID-19, and provide a more intuitive basis for clinical early diagnosis and treatment.