Health progression for Covid-19 survivors hospitalized in geriatric clinics in Sweden.

OBJECTIVE: To analyse if the health progression of geriatric Covid-19 survivors three months after an acute Covid-19 infection was worse than in other geriatric patients. Specifically, we wanted to see if we could see distinct health profiles in the flow of re-admitted Covid-19 patients compared to re-admitted non-Covid-19 controls. DESIGN: Matched cohort study. SETTING AND PARTICIPANTS: Electronic medical records of geriatric patients hospitalised in geriatric clinics in Stockholm, Sweden, between March 2020 and January 2022. Patients readmitted three months after initial admission were selected for the analysis and Covid-19 survivors (n = 895) were compared to age-sex-Charlson comorbidity index (CCI)-matched non-Covid-19 controls (n = 2685). METHODS: We assessed using binary logistic and Cox regression if a previous Covid-19 infection could be a risk factor for worse health progression indicated by the CCI, hospital frailty risk score (HFRS), mortality and specific comorbidities. RESULTS: The patients were mostly older than 75 years and, already at baseline, had typically multiple comorbidities. The Covid-19 patients with readmission had mostly had their acute-phase infection in the 1st or 2nd pandemic waves before the vaccinations. The Covid-19 patients did not have worse health after three months compared to the matched controls according to the CCI (odds ratio, OR[95% confidence interval, CI] = 1.12[0.94-1.34]), HFRS (OR[95%CI] = 1.05[0.87-1.26]), 6-months (hazard ratio, HR[95%CI] = 1.04[0.70-1.52]) and 1-year-mortality risk (HR[95%CI] = 0.89[0.71-1.10]), adjusted for age, sex and health at baseline (the CCI and HFRS). CONCLUSIONS AND IMPLICATIONS: The overall health progression of re-hospitalized geriatric Covid-19 survivors did not differ dramatically from other re-hospitalized geriatric patients with similar age, sex and health at baseline. Our results emphasize that Covid-19 was especially detrimental for geriatric patients in the acute-phase, but not in the later phase. Further studies including post-vaccination samples are needed.

Identification and assessment of TCR-T cells targeting an epitope conserved in SARS-CoV-2 variants for the treatment of COVID-19

Background Coronavirus disease 2019 (COVID-19) continues to be a major global public health challenge, with the emergence of variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Current vaccines or monoclonal antibodies may not well be protect against infection with new SARS-CoV-2 variants. Unlike antibody-based treatment, T cell-based therapies such as TCR-T cells can target epitopes that are highly conserved across different SARS-CoV-2 variants. Reportedly, T cell-based immunity alone can restrict SARS-CoV-2 replication. Methods In this study, we identified two TCRs targeting the RNA-dependent RNA polymerase (RdRp) protein in CD8+ T cells. Functional evaluation by transducing these TCRs into CD8+ or CD4+ T cells confirmed their specificity. Results Combinations of inflammatory and anti-inflammatory cytokines secreted by CD8+ and CD4+ T cells can help control COVID-19 in patients. Moreover, the targeted epitope is highly conserved in all emerged SARS-CoV-2 variants, including the Omicron. It is also conserved in the seven coronaviruses that infect humans and more broadly in the subfamily Coronavirinae. Conclusions The pan-genera coverage of mutant epitopes from the Coronavirinae subfamily by the two TCRs highlights the unique strengths of TCR-T cell therapies in controlling the ongoing pandemic and in preparing for the next coronavirus outbreak.

The lending risk predicting of the folk informal financial organization from big data using the deep learning hybrid model

ABSTACT This article is first to predict and earlier warning folk lending risk used deep learning hybrid model, we find that the LSTM hybrid model has a higher predict accuracy on lending risk forecasting and earlier warning of the FIFO, with an obviously improvement of the average value of forecasting accuracy. The predict accuracy of LSTM-GRU and LSTM-CNN models on lending risk forecasting of the FIFO is higher than others during COVID-19 pandemic. Therefore, we believe that the LSTM hybrid model, especially the LSTM-GRU model can better predict and early warn lending risk of the FIFO on big data.

Predictive value of lactate dehydrogenase to albumin ratio (LAR) in patients with coronavirus Disease 2019 (COVID-19) (preprint)

Coronavirus Disease-2019 (COVID-19) is an emerging acute infectious disease around the world. Therefore, it is crucial to identify the risk factors of in-hospital mortality and disease severity for COVID-19 patients. We firstly proposed a biomarker ratio, lactate dehydrogenase to albumin ratio (LAR) may be more reliable to assess the predictive value of LAR for in-hospital mortality and early identification of critical COVID-19 patients. A retrospective study was conducted including patients (≥18 years old) with laboratory-confirmed COVID-19 infection who had been discharged or had died from 1 February to 29 February, 2020. The study included 321 patients and the median age of the 321 patients was 63.0 (IQR 51.0-70.0), ranging from 19 to 95 years old and 180 (56.1%) patients were male. 142 (44.2%) patients had 1 or more coexisting comorbidity. The most common symptoms on admission were fever(289[90%]) and cough(258[80.4%]). In multivariable logistic regression, only older age (OR, 1.11; 95% CI, 1.05-1.16), WBC count (OR, 1.26; 95% CI, 1.11-1.44), lymphocyte count (OR, 0.78; 95% CI, 0.62-0.99) and LAR (OR, 1.29; 95% CI, 1.18-1.40) were found to be significantly associated with in-hospital death. ROC analysis showed that LAR had a higher AUC (0.917) and the highest specificity(84.0%) and sensitivity(84.6%). Furthermore, the results showed that LAR had a higher AUC (0.931) to differentiate critical from mild patients and had a sensitivity of 87.7% and a specificity of 82.1%. Besides, LAR had an AUC (0.861) to differentiate critical from severe patients and had a sensitivity of 86.0% and a specificity of 73.8% and the role of LAR to distinguish severe from mild patients was the worst. To the best of our knowledge, a high LAR appears to predict higher odds of mortality and differentiate critical patients from mild or severe COVID-19 patients.

Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021 (preprint)

Importance: Previous reports have suggested reductions in mortality risk from COVID-19 throughout the first wave of the COVID-19 pandemic. Mortality changes later in the pandemic and pandemic effects on other types of geriatric hospitalizations are less studied. Objectives: To describe the changes in hospitalizations and 30-day mortality in Stockholm for patients 70+ receiving inpatient geriatric care for COVID-19 and other causes. Design: Observational study. For patients 70 or older, we present the incidence of 30-day mortality from COVID-19 in the Stockholm region, in relationship to geriatric hospitalizations and 30-day mortality after admission for COVID-19 and other causes. Setting: Hospitalizations for patients 70+ from geriatric clinics in Stockholm, Sweden hospitalized for COVID-19 or other causes between March 2020 and July 31, 2021, were included. Participants: The total number of geriatric hospitalizations for patients 70+ was 5,320 for COVID-19 and 32,243 for non-COVID-19 causes, corresponding to 4,565 individual COVID-19 patients and 19,308 non-COVID-19 patients. Exposure(s): The date of hospital admission to a geriatric clinic. Main Outcome(s) and Measure(s): 30-day mortality after admission. Results: In patients with COVID-19, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), decreased as the first wave subsided (7% July-August), increased again in the second wave (17% November-December), but failed to increase as much in the third wave (11-13% March-July 2021). In non-COVID-19 geriatric patients during the same period, the 30-day mortality presented a similar trend, but with a smaller magnitude of variation (5 to 10%). The number of persons 70 or older testing positive for COVID-19 in Stockholm reached two peaks in 2020 (April and December), fell in January 2021 and then increased again in March-April 2021. Conclusions and Relevance: During the first and second waves, hospital admissions and 30-day mortality after geriatric hospitalization for COVID-19 increased in periods of high community transmission, although the mortality peak was lower in wave 2 than in wave 1. The mortality for non-COVID geriatric cases was lower and more stable but also showed an increase with the pandemic peaks.

Separation, identification and quantification of associated impurities in cobratide using sheathless CE-MS and CE-UV.

Cobratide is a peptide drug extracted from the venom of Chinese cobra, and has been widely used in the clinical treatment of chronic, intractable and persistent pain. In a recent study, it was reported that it has the potential to treat COVID-19. In order to control the quality of commercial cobratide drugs, a protocol was established for the separation, identification and quantification of cobratide and its associated impurities, in which sheathless capillary electrophoresis-mass spectrometry (CE-MS) was used for identification and a rapid capillary electrophoresis-ultraviolet-visible detector (CE-UV) method was developed for accurate quantification. Separation conditions that affect the resolution and MS intensities of cobratide and its associated impurities were investigated, including pH value, concentration of background electrolyte (BGE), ratio of organic additive and sample solution. The optimized CE conditions (BGE: 50 mM NH4Ac, pH 4.0; sample solution: deionized water) were used for both sheathless CE-MS and CE-UV methods. Three associated impurities were separated and identified for the first time by sheathless CE-MS. Then, a rapid CE-UV method was validated and used for accurate quantification of cobratide and its associated impurities. The CE-UV method showed good linearity between concentration and corrected peak area of cobratide in the concentration range of 5.36-536.30 µg mL-1. The limit of quantification of the CE-UV method was 4.16 µg mL-1. The relative standard deviations of migration time were less than 1% for both intra-day and inter-day experiments, and those of corrected peak area were less than 5%. Finally, different cobratide drugs were analyzed to evaluate the batch-to-batch consistency. This established protocol combining sheathless CE-MS and CE-UV methods would provide useful information for both quality control and process analysis of peptide drugs.

Children of parents with mental illness in the COVID-19pandemic: A cross-sectional survey in China.

OBJECTIVE: Children of parents with mental illness (COPMI) are vulnerable during the COVID-19 pandemic. The study aimed to assess the psychosocial impacts of the pandemic and identify potential factors influencing their mental health. METHOD: 665 COPMI from six sites including Wuhan in China were enrolled. COPMI's mental health and the impacts of COVID-19 were assessed by an online survey. Univariate and multivariate analyses were performed to examine the association between impact factors and participants' mental health. RESULTS: 16.1 % of participants were in abnormal range of mental health, with interpersonal relationship being the most common problem. 48.6 % of participants reported quite worried about the epidemic. All aspects of adverse effects of COVID-19 were more prevalent among COPMI in Wuhan than in other sites. Concerns about COVID-19 (OR = 1.7, p = 0.02), decreased family income (OR = 2.0, p = 0.02), being physically abused (OR = 2.1, p = 0.04), witnessing family members being physically abused (OR = 2.0, p = 0.03), and needs for promoting family members' mental health (OR = 2.2, p < 0.01) were independent risk factors for participants' mental health. CONCLUSION: The findings raise our awareness of the impacts of COVID-19 pandemic on the wellbeing of COPMI. Multifaceted psychosocial support for COPMI is urgently needed to support them live through the pandemic.

Predictive Value of Lactate Dehydrogenase to Albumin Ratio (LAR) in Patients With Coronavirus Disease 2019 (COVID-19) (preprint)

BackgroundCoronavirus Disease-2019 (COVID-19) is an emerging acute infectious disease that was first discovered in Wuhan, Hubei Province, China. Since then, it has quickly spread to over one hundred cities around the world. Therefore, it is crucial to identify the risk factors of in-hospital mortality and disease severity for COVID-19 patients. MethodsWe firstly proposed a biomarker ratio, lactate dehydrogenase(LDH) to albumin ratio (LAR) may be more reliable to assess the predictive value of LAR for in-hospital mortality and early identification of critical COVID-19 patients. A retrospective study was conducted including patients (≥18 years old) with laboratory-confirmed COVID-19 infection who had been discharged or had died from 1 February to 29 February, 2020. ResultsThe study included 321 patients with COVID-19. The median age of the 321 patients was 63.0 (IQR 51.0-70.0), ranging from 19 to 95 years old and 180 (56.1%) patients were male. 142 (44.2%) patients had 1 or more coexisting comorbidity. The most common symptoms on admission were fever(289[90%]) and cough(258[80.4%]). In multivariable logistic regression, only older age (OR, 1.11; 95% CI, 1.05-1.16), WBC count (OR, 1.26; 95% CI, 1.11-1.44), lymphocyte count (OR, 0.78; 95% CI, 0.62-0.99) and LAR (OR, 1.29; 95% CI, 1.18-1.40) were found to be significantly associated with in-hospital death. ROC analysis showed that LAR had a higher AUC (0.917) and the highest specificity(84.0%) and sensitivity(84.6%). Furthermore, the results showed that LAR had a higher AUC (0.931) to differentiate critical from mild patients and had a sensitivity of 87.7% and a specificity of 82.1%. Besides, LAR had an AUC (0.861) to differentiate critical from severe patients and had a sensitivity of 86.0% and a specificity of 73.8% and the role of LAR to distinguish severe from mild patients was the worst. ConclusionsTo the best of our knowledge, this study is the first for us to explore the predictive value of LAR for in-hospital mortality and disease severity. A high LAR appears to predict higher odds of mortality and differentiate critical patients from mild or severe COVID-19 patients. 

Cancer Patient Management Strategy in a Cancer Center of Zhejiang, China During the COVID-19 Pandemic (preprint)

Background: Due to the increased risk of viral infection and the severe shortage of medical resources during the pandemic of COVID-19, most hospitals in the epidemic areas significantly reduced non-emergency admissions and services, if not closed. As a result, it has been difficult to treat cancer patients on time, which adversely affects their prognosis. To address this problem, cancer centers must develop a strategic plan to manage both inpatients and outpatients during the pandemic, provide them with the necessary treatment, and at the same time prevent the spread of the virus among patients, visitors and medical staff. Methods: : Based upon the epidemic situation in Zhejiang Province, China, the number of running non-emergency medical wards in the Zhejiang Cancer Hospital was gradually increased in a controlled manner. All staff of the hospital received COVID-19 preventive training and was provided with three different levels of protection according to the risks of their services. Only patients without a known history of SARS-CoV-2 contact were eligible to schedule an appointment. Body temperature was measured on all patients upon their arrival at the hospital. Chest CT image, blood cell counting and travel/contact history were investigated in patients with fever. Respiratory tract samples, such as sputum and throat swabs, from all patients, including those clinically suspected of SARS-CoV-2 infection, were collected for nucleic acid detection of SARS-CoV-2 before treatment. Results: : A total of 3697 inpatients and 416 outpatients seeking cancer treatment were enrolled from February 1 to April 3, 2020, in compliance with the hospital’s infection-control interventions. The clinicopathological parameters of the patients were summarized herein. 4237 samples from 4101 patients produced negative RNA testing results. Four clinically suspected patients all presented negative RNA test results and were excluded from the SARS-CoV-2 infection through follow-up retesting and monitoring. Seven patients with only N-gene positive results were retested, followed by CT scan and SARS-CoV-2 contact history investigation. All of them were finally diagnosed as non-infected patients. There was one outpatient who was confirmed positive by virus RNA test and then followed up. She might be an asymptomatic laboratory-confirmed case. During the study period, there was no SARS-CoV-2 infection among staff, patients and escorts of patients in the Zhejiang Cancer Hospital. Conclusion: This study suggested our infection-control interventions, including viral nucleic acid test, could be used as a reliable method to screen cancer patients in the area with moderate COVID-19 prevalence. Cancer may not be a high-risk factor of SARS-CoV-2 infection.

Perceptions and Behavioral Adoptions of the Preventive Strategies from Person-to-Person Transmission of COVID-19 Among the Public in China: An Online Cross-Sectional Survey (preprint)

Background: The strategies adopted to prevent spreading of COVID-19 are quarantine, social distancing and isolation of infected cases. This study investigates perceptions and behavioral adoptions of COVID-19 prevention strategies among the Chinese public and identified factors predicting individual health behavior.Methods: We conducted a cross-sectional online survey between 22 February and 5 March, 2020. We approached to urban residents aged over 18 years through snowball sampling method using the Chinese social media. The Health Belief Model was adopted to guide the analysis. Bivariate and multivariate logistic regressions were used to examine impacts of modifying factors (including demographic and socio-economic characteristics) and individual beliefs on individual health behavior.Results: of 5675 valid questionnaires, 95.8% of the respondents well understood the preventive measures from COVID-19 transmission, while 79.9% of the respondents adopted the behavior advised. 45.7% of the respondents perceived severity of the disease, 75.6% of the respondents perceived benefits of social constraints measures and 62.7% reported anxiety during the epidemic. After adjusting for modifying factors and individual beliefs, those who were female, had better income and good knowledge on preventive measures, perceived benefits on social constraint measures and did not feel anxiety were more likely to adopt behaviors advised.Conclusions: The Chinese public highly accepted and adopted behaviors advised to slow down the COVID-19 epidemic. People with low income or feeling anxiety were less likely to adopt the behavior advised. The policy support should target on the social vulnerable groups. The psychological support should be disseminated through different means, and the consultation should be provided to those who are in need.

Perceptions and Behavioral Adoptions of the Preventive Strategies from Person-to-Person Transmission of COVID-19 among the Public in China: An Online Cross-Sectional Survey (preprint)

Background: The strategies adopted to prevent spreading of COVID-19 are quarantine, social distancing and isolation of infected cases. This study investigates perceptions and behavioral adoptions of COVID-19 prevention strategies among the Chinese public and identified factors predicting individual health behavior.Methods: We conducted a cross-sectional online survey between 22 February and 5 March, 2020. We approached to urban residents aged over 18 years through snowball sampling method using the Chinese social media. The Health Belief Model was adopted to guide the analysis. Bivariate and multivariate logistic regressions were used to examine impacts of modifying factors (including demographic and socio-economic characteristics) and individual beliefs on individual health behavior.Results: of 5675 valid questionnaires, 95.8% of the respondents well understood the preventive measures from COVID-19 transmission, while 79.9% of the respondents adopted the behavior advised. 45.7% of the respondents perceived severity of the disease, 75.6% of the respondents perceived benefits of social constraints measures and 62.7% reported anxiety during the epidemic. After adjusting for modifying factors and individual beliefs, those who were female, had better income and good knowledge on preventive measures, perceived benefits on social constraint measures and did not feel anxiety were more likely to adopt behaviors advised.Conclusions: The Chinese public highly accepted and adopted behaviors advised to slow down the COVID-19 epidemic. People with low income or feeling anxiety were less likely to adopt the behavior advised. The policy support should target on the social vulnerable groups. The psychological support should be disseminated through different means, and the consultation should be provided to those who are in need.

Characteristics of Renal Function in Patients Diagnosed With COVID-19: An Observational Study.

Objective: The aim of the study was to analyze the characteristics of renal function in patients diagnosed with COVID-19. Methods: In this retrospective, single-center study, we included all confirmed cases of COVID-19 in a tertiary hospital in Guangdong, China from January 20, 2020 to March 20, 2020. Blood and urine laboratory findings related to renal function were summarized, and the estimated glomerular filtration rate (eGFR) and endogenous creatinine clearance (Ccr) were also calculated to assess the renal function. Results: A total of 12 admitted hospital patients were diagnosed with COVID-19, included 3 severe cases, and 9 common cases. Serum creatinine (Scr) was not abnormally elevated in all of the patients, and blood urea nitrogen (BUN) was abnormally elevated in only 25.0% of the patients. However, compared with the recovery period, the patient's Scr and BUN increased significantly in peak of disease (p-scr = 0.002 & p-bun < 0.001). By observing the fluctuations in Scr and BUN from admission to recovery, it was found that the peak of Scr and BUN appeared within the first 14 day of the course of the disease. Urinary microprotein detection indicated that the abnormally elevated rates of urine microalbumin (UMA), α1-microglobulin (A1M), urine immunoglobulin-G (IGU), and urine transferring (TRU) standardized by urinary creatinine in peak of disease were 41.7, 41.7, 50.0, and 16.7%, respectively. The abnormal rates of the calculated eGFR and Ccr were 66.7 and 41.7%. Conclusion: Scr and BUN were generally increased during the course of COVID-19. Detection of urinary microproteins and application of multiple indicators assessment could be helpful for discovering abnormal renal function in patients with COVID-19. However, the evidence is limited due to the small sample size and observational nature. Additional studies, especially large prospective cohort studies, are required to confirm these findings.

Severity detection for the coronavirus disease 2019 (COVID-19) patients using a machine learning model based on the blood and urine tests (preprint)

The recent outbreak of the coronavirus disease-2019 (COVID-19) caused serious challenges to the human society in China and across the world. COVID-19 induced pneumonia in human hosts and carried a highly inter-person contagiousness. The COVID-19 patients may carry severe symptoms, and some of them may even die of major organ failures. This study utilized the machine learning algorithms to build the COVID-19 severeness detection model. Support vector machine (SVM) demonstrated a promising detection accuracy after 32 features were detected to be significantly associated with the COVID-19 severeness. These 32 features were further screened for inter-feature redundancies. The final SVM model was trained using 28 features and achieved the overall accuracy 0.8148. This work may facilitate the risk estimation of whether the COVID-19 patients would develop the severe symptoms. The 28 COVID-19 severeness associated biomarkers may also be investigated for their underlining mechanisms how they were involved in the COVID-19 infections.

The Relationship Between COVID-19 Infection and Risk Perception, Knowledge, Attitude As Well As Four Non-pharmaceutical Interventions (NPIs) During the Late Period Of The COVID-19 Epidemic In China An Online Cross-sectional Survey of 8158 Adults (preprint)

BackgroundSo far, there has been no published population study on the relationship between COVID-19 infection and publics risk perception, information source, knowledge, attitude and four non-pharmaceutical interventions(NPI: hand washing, proper coughing habits, social distancing and mask wearing) during the COVID-19 outbreak in China. MethodsAn online survey of 8158 Chinese adults between 22 February to 5 March 2020 was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. ResultsOf 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (99.2%), positive risk perception (99.9%) and high knowledge levels that were among the strongest predictors of four highly adopted NPIs (hand washing:96.8%; proper coughing: 93.1%; social distancing:87.1%; mask wearing:97.9%). There was an increased risk of COVID-19 infection for those who not washing hands (2.28% vs 0.65%; RR=3.53: 95%CI: 1.53-8.15; P<0.009); not practicing proper coughing (1.79% vs 0.73%; RR=2.44: 95%CI: 1.15-5.15;P=0.026); not practicing social distancing (1.52% vs 0.58%; RR=2.63:95%CI:1.48 - 4.67; P=0.002); and not wearing a mask (7.41% vs 0.6%; RR=12.38:95%CI:5.81-26.36; P<0.001). For those who did practice all other three NPIs, wearing mask was associated with significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; p=0.035). Similarly, for those who did not practice all or part of the other three NPIs, wearing mask was also associated with significantly reduced risk of infection. In a penalised logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among four NPIs (OR=7.20; 95%CI:2.24-23.11; p<0.001). ConclusionsWe found high levels of risk perception, positive attitude, desirable knowledge as well as a high level of adopting four NPIs. The relevant knowledge, risk perception and attitude were strong predictors of adapting the four NPIs. Mask wearing, among four personal NPIs, was the most effective protective measure against COVID-19 infection with added preventive effect among those who practised all or part of the other three NPIs.

Point-of-care training program on COVID-19 infection prevention and control for pediatric healthcare workers (preprint)

Background: To evaluate the effectiveness of training on knowledge and practices of infection prevention and control (IPC) among pediatric health care workers (HCW) in Shanghai, China, in the context of COVID-19 pandemic. Methods: An online training program was designed by the Shanghai Pediatric Clinical Quality Control Center (SPQCC) during the early phase of COVID-19 pandemic on disease knowledge and practice of IPC. Training took place in the 81 partner hospitals affiliated with SPQCC. A 25-item self-administered questionnaire was used to evaluate knowledge gained from the training. Stratified-random sampling was used to select HCW according to three professionals (i.e., pediatricians, nurses and administrators) within each partner hospital. Awareness and knowledge of COVID-19 and its related infection control and practice was assessed by comparing survey results between different types of hospitals, professionals and professional ranks. A higher survey score meant that the respondent was more prepared and knowledgeable about COVID-19 and its infection control measures. Results: Completed questionnaires were returned from 1,062 subjects (385 pediatricians, 410 nurses, and 267 administrators), giving a response rate of 96.5%. Overall, awareness of clinical information related to COVID-19, importance of personal hygiene and isolation policy was high among the respondents. No statistical difference of scores on knowledge of COVID-19, IPC and relevant practice between the tertiary and peripheral hospitals. Among all respondents, middle-ranked health care personnel were most knowledgeable and achieved the highest score. Conclusions: Majority of pediatric HCW showed good recognition and practice in infection protection and control measures. The online training was able to achieve its aim to enhance knowledge and awareness and could have contributed to the zero infection rate among HCW caring for confirmed COVID-19 cases in Shanghai.

Association between Clinical, Laboratory and CT Characteristics and RT-PCR Results in the Follow-up of COVID-19 patients (preprint)

Abstract Background: Since December 2019, more than 100,000 coronavirus disease 2019 (COVID-19) patients have been confirmed globally based on positive viral nucleic acids with real-time reverse transcriptase-polymerase chain reaction (RT-PCR). However, the association between clinical, laboratory and CT characteristics and RT-PCR results is still unclear. We sought to examine this association in detail, especially in recovered patients. Methods: We analysed data from 52 confirmed patients who had been discharged with COVID-19. The clinical, laboratory, and radiological data were dynamically recorded and compared with the admission and follow-up RT-PCR results. Results: In this cohort, 52 admitted COVID-19 patients who had confirmed positive RT-PCR results were discharged after 2 rounds of consecutively negative RT-PCR results. Compared with admission levels, CRP levels (median 4.93 mg/L [IQR: 1.78-10.20]) decreased significantly (p<0.001). and lymphocyte counts (median 1.50x109/L [IQR: 1.11-1.88]) increased obviously after obtaining negative RT-PCR results (p<0.001). Additionally, substantially improved inflammatory exudation was observed on chest CT except for 2 progressed patients. At the two-week follow-up after discharge, 7 patients had re-positive RT-PCR results, including the abovementioned 2 progressed patients. Among the 7 patients, new GGO was demonstrated in 2 patients. There were no significant differences in CPR levels or lymphocyte counts when comparing the negative and re-positive PCT results (all p >0.05). Conclusion: Heterogeneity between CT features and RT-PCR results was found in COVID-19, especially in some recovered patients with negative RT-PCR results. Our study highlights that both RT-PCR and chest CT should be considered as the key determinants for the diagnosis and management of COVID-19 patients.

Single-cell transcriptome profiling of an adult human cell atlas of 15 major organs (preprint)

ABSTRACT Background As core units of organ tissues, cells of various types play their harmonious rhythms to maintain the homeostasis of the human body. It is essential to identify the characteristics of cells in human organs and their regulatory networks for understanding the biological mechanisms related to health and disease. However, a systematic and comprehensive single-cell transcriptional profile across multiple organs of a normal human adult is missing. Results We perform single-cell transcriptomes of 84,363 cells derived from 15 tissue organs of one adult donor and generate an adult human cell atlas. The adult human cell atlas depicts 252 subtypes of cells, including major cell types such as T, B, myeloid, epithelial, and stromal cells, as well as novel COCH + fibroblasts and FibSmo cells, each of which is distinguished by multiple marker genes and transcriptional profiles. These collectively contribute to the heterogeneity of major human organs. Moreover, T cell and B cell receptor repertoire comparisons and trajectory analyses reveal direct clonal sharing of T and B cells with various developmental states among different tissues. Furthermore, novel cell markers, transcription factors and ligand-receptor pairs are identified with potential functional regulations in maintaining the homeostasis of human cells among tissues. Conclusions The adult human cell atlas reveals the inter- and intra-organ heterogeneity of cell characteristics and provides a useful resource in uncovering key events during the development of human diseases in the context of the heterogeneity of cells and organs.

Acute Myocardial Injury of Patients with Coronavirus Disease 2019 (preprint)

Background: Since the outbreak of the Coronavirus Disease 2019 (COVID-19) in China, respiratory manifestations of the disease have been observed. However, as a fatal comorbidity, acute myocardial injury (AMI) in COVID-19 patients has not been previously investigated in detail. We investigated the clinical characteristics of COVID-19 patients with AMI and determined the risk factors for AMI in them. Methods: We analyzed data from 53 consecutive laboratory-confirmed and hospitalized COVID-19 patients (28 men, 25 women; age, 19-81 years). We collected information on epidemiological and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury biomarkers), echocardiography, electrocardiography, imaging findings, management methods, and clinical outcomes. Results: Cardiac complications were found in 42 of the 53 (79.25%) patients: tachycardia (n=15), electrocardiography abnormities (n=11), diastolic dysfunction (n=20), elevated myocardial enzymes (n=30), and AMI (n=6). All the six AMI patients were aged >60 years; five of them had two or more underlying comorbidities (hypertension, diabetes, cardiovascular diseases, and chronic obstructive pulmonary disease). Novel coronavirus pneumonia (NCP) severity was higher in the AMI patients than in patients with non-definite AMI (p<0.001). All the AMI patients required care in intensive care unit; of them, three died, two remain hospitalized. Multivariate analyses showed that C-reactive protein (CRP) levels, NCP severity, and underlying comorbidities were the risk factors for cardiac abnormalities in COVID-19 patients. Conclusions: Cardiac complications are common in COVID-19 patients. Elevated CRP levels, underlying comorbidities, and NCP severity are the main risk factors for cardiac complications in COVID-19 patients.