Effect of the COVID-19 on Patients with Systemic Lupus Erythematosus during the First Pandemic Wave in China (preprint)

Objective: This study aimed to investigate the prevalence and clinical manifestations of coronavirus disease (COVID-19) in patients with systemic lupus erythematosus (SLE) during the first wave of the pandemic in China and to evaluate the effects of COVID-19 on the disease activity and treatment of SLE.  Methods: A telephone survey was conducted on patients diagnosed with SLE in our hospital between October 2017 and October 2022. Through the survey, we investigated whether the patients had COVID-19, the clinical manifestations of the infection, whether the patients were vaccinated, the effects of the infection on the disease activity of SLE, and whether the treatment regimen for SLE was adjusted due to the infection.  Results: A total of 351 patients participated in this study, of whom 261 (74.4%) had COVID-19. Regarding organ involvement, the circulatory system was more commonly affected than the other organs in patients with SLE without COVID-19 (P = 0.002). Regarding concomitant medications, the daily dose of glucocorticoids was higher than that of other medication in SLE patients without COVID-19 (P = 0.000). No differences were observed in age, disease duration, disease activity, of other concomitant medications. While infected with COVID-19, 46 patients (17.6%) discontinued parts of their treatment without experiencing any episodes of SLE.  Conclusion: Most SLE patients with COVID-19 had a good prognosis, and all the patients in our study recovered from COVID-19 infection. Abrupt dose reduction and discontinuation of medications by the patients themselves may lead to elevated disease activity or even episodes of SLE. As such, it is recommended that the patients adjust their treatment regimens following the guidance of their specialists after careful evaluation of their condition and SLE disease activity by specialists.

Research on Supply Chain Financial Risk Prevention Based on Machine Learning.

Artificial intelligence (AI) proves decisive in today's rapidly developing society and is a motive force for the evolution of financial technology. As a subdivision of artificial intelligence research, machine learning (ML) algorithm is extensively used in all aspects of the daily operation and development of the supply chain. Using data mining, deductive reasoning, and other characteristics of machine learning algorithms can effectively help decision-makers of enterprises to make more scientific and reasonable decisions by using the existing financial index data. At present, globalization uncertainties such as COVID-19 are intensifying, and supply chain enterprises are facing bankruptcy risk. In the operation process, practical tools are needed to identify and opportunely respond to the threat in the supply chain operation promptly, predict the probability of business failure of enterprises, and take scientific and feasible measures to prevent a financial crisis in good season. Artificial intelligence decision-making technology can help traditional supply chains to transform into intelligent supply chains, realize smart management, and promote supply chain transformation and upgrading. By applying machine learning algorithms, the supply chain can not only identify potential risks in time and adopt scientific and feasible measures to deal with the crisis but also strengthen the connection and cooperation between different enterprises with the advantage of advanced technology to provide overall operation efficiency. On account of this, the paper puts forward an artificial intelligence-based corporate financial-risk-prevention (FRP) model, which includes four stages: data preprocessing, feature selection, feature classification, and parameter adjustment. Firstly, relevant financial index data are collected, and the quality of the selected data is raised through preprocessing; secondly, the chaotic grasshopper optimization algorithm (CGOA) is used to simulate the behavior of grasshoppers in nature to build a mathematical model, and the selected data sets are selected and optimized for features. Then, the support vector machine (SVM) performs classification processing on the quantitative data with reduced features. Empirical risk is calculated using the hinge loss function, and a regular operation is added to optimize the risk structure. Finally, slime mould algorithm (SMA) can optimize the process to improve the efficiency of SVM, making the algorithm more accurate and effective. In this study, Python is used to simulate the function of the corporate business finance risk prevention model. The experimental results show that the CGOA-SVM-SMA algorithm proposed in this paper achieves good results. After calculation, it is found that the prediction and decision-making capabilities are good and better than other comparative models, which can effectively help supply chain enterprises to prevent financial risks.

Poor immune response to inactivated COVID-19 vaccine in patients with hypertension (preprint)

Purpose: The safety and efficacy of vaccination in people with hypertension (HTN) is important. There are currently just a few data on the immunogenicity and safety of inactivated SARS-CoV-2 vaccinations in hypertension patients.  Methods: After receiving a two-dose immunization, 94 hypertension patients and 74 healthy controls(HCs) in this study, the evaluation included looking at antibodies(Abs) against receptor binding domain (RBD) IgG, neutralizing antibodies(NAbs), RBD-specific B cells and memory B cells(MBCs).  Results: There was no discernible difference in the overall adverse events(AEs) over the course of seven or thirty days between HTN patients and HCs. HTN patients had lower frequencies of RBD-specific memory B cells and the seropositivity rates and titers of Abs compared to HCs(all, p < 0.05). HTN patients may exhibit comparable immunological responses in with or without concomitant cardiovascular and cerebrovascular conditions(CCVD). We again discovered a correlation between a weak Ab response and the interval time following a two-dose immunization.  Conclusion: Inactivated COVID-19 vaccinations were safe in hypertension patients, however humoral immune was limited.

Impact of COVID-19 pandemic on the etiology and characteristics of community-acquired pneumonia among children requiring bronchoalveolar lavage in northern China (preprint)

Background: To investigate the etiology and clinical characteristics of community-acquired pneumonia (CAP) among children requiring bronchoalveolar lavage (BAL) and analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on the pathogen spectrum and clinical manifestations. Methods: Children <14 years old hospitalized with CAP requiring BLA were enrolled between February 2019 to January 2020 and August 2021 to July 2022. Multiplex reverse transcription polymerase chain reaction (mRT-PCR) was used for pathogen detection. The demographic and clinical characteristics were compared between different pathogen-type infection groups, and before and during the COVID-19 pandemic. Results: Pathogen was detected in 91.66% (1363/1487) children. Mycoplasma pneumoniae, adenovirus and human rhinovirus were the most frequently detected pathogens. The frequency of detection of virus infections and co-infections was decreased during the pandemic, but the detection of atypical bacterial infections was increased. The clinical manifestations and the results of CT scans and fiberoptic bronchoscopy showed a significant difference between different types of pathogen infection, and lung inflammation was reduced during the COVID-19 pandemic compared with before the pandemic. Conclusions: M. pneumoniae infection might be the greatest pediatric disease burden leading to CAP in northern China. Wearing masks and social distancing in public places during the COVID-19 pandemic effectively reduced the transmission of respiratory viruses, but it did not reduce the infection rate of M. pneumoniae. In addition, these interventions significantly reduced lung inflammation in children compared with before the pandemic.

Patient Preferences for Cardiac Rehabilitation - A Systematic Review.

Background: Although a large number of studies have demonstrated the effectiveness of cardiac rehabilitation(CR), patient preferences for CR remain unclear. Knowing patient preferences may contribute to increasing patient participation and adherence, thus improving patient prognosis. Methods: A systematic search was carried out using electronic databases and manual reference checks from inception until 15th June 2022. Quantitative studies, qualitative studies and mixed methods studies assessing patient preferences for CR were included. Two researchers independently conducted study selectionand data extraction. CR preferences were divided into three categories: CR settings, CR components, and CR contents. A narrative synthesis was applied to integrate the results of the included studies. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. Results: Ultimately, 17 publications were included in this study. Regarding CR settings, most patients preferred the hospital to home, some considered both, and a few were willing to accept the local CR club as an alternative setting to the hospital. For CR components, regardless of age and gender, patients considered exercise training and nutrition counseling to be the most important and smoking cessation to be the least important. In exercise intervention of CR contents, progress discussion and encouragement were rated as most critical, and non-conflicting with other activities was rated as least critical. In psychological intervention of CR contents, most patients were willing to accept psychological intervention, and a few patients wanted to heal the trauma with the passage of time. Conclusion: This systematic review provides important insights into patient preferences for CR, clarifying patient preferences for CR settings, components, and contents, along with possible influencing factors. Patient preferences may change due to the COVID-19 epidemic, and there is still a need to focus on patient preferences for CR and conduct more relevant primary research to validate the findings of this paper in the future.

Immunity against Delta and Omicron variants elicited by homologous inactivated vaccine booster in kidney transplant recipients

Background A third mRNA vaccine booster is recommended to improve immunity against SARS-CoV-2 in kidney transplant recipients (KTRs). However, the immunity against SARS-CoV-2 Ancestral strain and Delta and Omicron variants elicited by the third dose of inactivated booster vaccine in KTRs remains unknown. Methods The blood parameters related to blood cells count, hepatic function, kidney function, heart injury and immunity were explored clinically from laboratory examinations. SARS-CoV-2 specific antibody IgG titer was detected using an enzyme-linked immunosorbent assay. Cellular immunity was analyzed using interferon-γ enzyme-linked immunospot assay. Results The results showed that there were no severe adverse effects and apparent changes of clinical laboratory biomarkers in KTRs and healthy volunteers (HVs) after homologous inactivated vaccine booster. A third dose of inactivated vaccine booster significantly increased anti-Ancestral-spike-trimer-IgG and anti-Ancestral-receptor binding domain (RBD)-IgG titers in KTRs and HVs compared with the second vaccination. However, the anti-Delta-RBD-IgG and anti-Omicron-RBD-IgG titers were significantly lower than anti-Ancestral-RBD-IgG titer in KTRs and HVs after the third dose. Notably, only 25.6% (10/39) and 10.3% (4/39) of KTRs had seropositivity for anti-Delta-RBD-IgG and anti-Omicron-RBD-IgG after booster, which were significantly lower than HVs (anti-Delta-RBD-IgG: 100%, anti-Omicron-RBD-IgG: 77.8%). Ancestral strain nucleocapsid protein and spike specific T cell frequency after booster was not significantly increased in KTRs compared with the second dose, significantly lower than that in HVs. Moreover, 33.3% (12/36), 14.3% (3/21) and 14.3% (3/21) of KTRs were positive for the Ancestral strain and Delta and Omicron spike-specific T cells, which were significantly lower than HVs (Ancestral: 80.8%, Delta: 53.8%, and Omicron: 57.7%). Conclusions A third dose of inactivated booster vaccine may significantly increase humoral immunity against the Ancestral strain in KTRs, while humoral and cellular immunity against the Delta and Omicron variants were still poor in KTRs.

Relationship between negative coping style and fear of COVID-19 among Wuhan college students during the post-pandemic period: A moderated chain mediation model

Objectives After a long-term lockdown, particularly one in which human life is at risk, negative psychological consequences are expected. In this study, we aimed to explore the cause of stress and fear of coronavirus-19 (COVID-19) among Chinese college students in Wuhan during the latest strictest lockdown. Methods During the COVID-19 outbreak, 1,070 college students from Wuhan, aged 18–29 years, took part in an online survey. We used correlations, bootstrap tests, and other statistical analysis methods to analyze the data. Results Negative coping style significantly positively predicted fear of COVID-19, and stress had a significant mediating effect on the relationship between negative coping style and fear of COVID-19. In addition, rumination and stress had a chain-mediating effect on the relationship between negative coping style and fear of COVID-19. Perceived social support moderated the three paths of this serial mediation model. Conclusion Negative emotions, such as stress and fear of COVID-19, in college students are caused by both behavior (e.g., negative coping style) and cognition (e.g., rumination). Importantly, negative cognitive thinking (i.e., rumination) is often a malign consequence of a negative coping style. Thus, to improve students' mental health, students should be encouraged to engage in more positive behaviors and seek social support during periods of adherence to regular prevention and control measures.

Quantifying the rebound of influenza epidemics after relaxing nonpharmaceutical interventions during the coronavirus disease 2019 pandemic in China (preprint)

Abstract The co-existence of coronavirus disease 2019 (COVID-19) and seasonal influenza epidemics has become a potential threat to human health, particularly in China in the oncoming season. However, with the relaxation of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic, the rebound extent of the influenza activities is still poorly understood. In this study, we constructed a susceptible-vaccinated-infectious-recovered-susceptible (SVIRS) model to simulate influenza transmission and calibrated it using influenza surveillance data from 2018 to 2022. We projected the influenza transmission over the next 3 years using the SVIRS model. We observed that, in epidemiological year 2021-2022, the reproduction numbers of influenza in southern and northern China were reduced by 38.6% and 30.2%, respectively, compared with those before the pandemic. The percentage of people susceptible to influenza virus increased by 138.6% and 57.3% in southern and northern China by October 1, 2022, respectively. After relaxing NPIs, the potential accumulation of susceptibility to influenza infection may lead to a large-scale and early influenza outbreak in the year 2022-2023, the scale of which may be affected by the intensity of the NPIs. And later relaxation of NPIs in the year 2023 would not lead to much larger rebound of influenza activities in the year 2023-2024. To control the influenza epidemic to the pre-pandemic level after relaxing NPIs, the influenza vaccination rates in southern and northern China should increase to 56.2% and 47.3%, respectively. Vaccination for influenza should be advocated to reduce the potential reemergence of the influenza epidemic in the next few years.

Case Report: A case of advanced duodenal adenocarcinoma in complete remission after chemotherapy combined with targeted therapy and radiotherapy.

Duodenal adenocarcinoma (DA) is an extremely rare and highly aggressive malignant tumor of the digestive system. Due to the lack of specific clinical characteristics, it is easy to misdiagnosis and miss diagnosis, and the lack of specific consensus and recommendation for treatment, so it often refers to stomach cancer and colorectal cancer. Now, we report a case of a patient with advanced DA who achieved complete remission (CR) after undergoing chemoradiotherapy combined with targeted therapy. The patient was pathologically diagnosed with DA after radical surgery in October 2020, and he failed to undergo adjuvant chemotherapy on time due to the COVID-19 outbreak. The patient found multiple lymph node liver and abdominal metastases 6 months after the operation. Considering the progression of the disease, XELOX regimen (oxaliplatin + capecitabine) chemotherapy was given for 1 cycle. After 1 cycle of treatment, the tumor markers remained elevated; the carcinoembryonic antigen (CEA) was 5.03 ng/ml (0-5 ng/ml), and the carbohydrate antigen 19-9 (CA19-9) was 747.30 U/ml (0-37 U/ml). The patient also developed intolerable capecitabine-related treatment-related adverse events (TRAEs), namely, hand-foot syndrome. For the above reasons, capecitabine was replaced as S-1 at cycle 2, and the chemotherapy regimen became SOX (oxaliplatin + S-1); bevacizumab injection was also added to the SOX regimen, and it was further treated regularly for 7 cycles with the regimen of SOX plus bevacizumab. Liver metastases showed a continuous narrowing trend throughout the treatment period; tumor markers also showed a downward trend. Finally, the patient achieved complete remission (CR) at cycle 7. After completion of chemotherapy, radiotherapy was administered to the resistant metastatic lymph nodes present in the patient's abdominal cavity for a total of 10 times. However, the patient developed severe bone marrow suppression and obstructive jaundice during the course of radiotherapy and finally failed to complete the radiotherapy plan. Currently, the patient continued maintenance therapy with bevacizumab and S-1 and showed no recurrence or metastasis after review. In this case of advanced DA, we referred to both CRC and gastric cancer in the treatment regimen of the patient. At the same time, targeted drugs and radiotherapy were also added to the basis of chemotherapy, which has no clear consensus recommendation or case for reference in the treatment of advanced DA. Thankfully, the patient's disease was controlled and remained stable after treatment with this regimen. Therefore, for patients with advanced DA who lack standardized treatment regimens and guidelines, the combination of chemotherapy with targeted therapy and radiotherapy may be one of the effective treatment modalities.

Synthetic Biology-Powered Biosensors Based on CRISPR/Cas Mediated Cascade Signal Amplification for Precise RNA Detection

Synthetic biology enabling technologies have been harnessed to create new diagnostic technologies. However, most strategies involve error-prone amplification steps and limitations of accuracy in RNA detection. Here, a cell-free synthetic biology-powered biosensing strategy, termed as SHARK (Synthetic Enzyme Shift RNA Signal Amplifier Related Cas13a Knockdown Reaction), could efficiently and accurately amplify RNA signal by leveraging the collateral cleavage of activated Cas13a to regulate cell-free enzyme synthesis. Based on cascade amplification and tailored enzyme output, SHARK behaves broad compatibility in different scenarios. The portable device based on SHARK was successfully used as SARS-CoV-2 biosensors with high sensitivity and selectivity, and the results were highly consistent with Ct values of qRT-PCR. In addition, when combined with machine learning, SHARK performs bio-computations and thus for cancer diagnosis and staging based on 64 clinical samples. SHARK shows characteristics of precise recognition, cascade amplification and tailored signal outputting comparisons with established assays, presenting significant potential in developing next-generation RNA detection technology.

The Pet Exposure Effect: Exploring the Differential Impact of Dogs Versus Cats on Consumer Mindsets

Despite the ubiquity of pets in consumers? lives, scant research has examined how exposure to them (e.g., recalling past interactions with dogs and cats, viewing ads featuring a dog or a cat) influences consumer behavior. The authors demonstrate that exposure to dogs (cats) reminds consumers of the stereotypical temperaments and behaviors of the pet species, which activates a promotion- (prevention-) focused motivational mindset among consumers. Using secondary data, Study 1 shows that people in states with a higher percentage of dog (cat) owners Google more promotion- (prevention-) focused words and report a higher COVID-19 transmission rate. Using multiple products, Studies 2 and 3 demonstrate that these regulatory mindsets, when activated by pet exposure, carry over to influence downstream consumer judgments, purchase intentions, and behaviors, even in pet-unrelated consumption contexts. Study 4 shows that pet stereotypicality moderates the proposed effect such that the relationship between pet exposure and regulatory orientations persists to the extent consumers are reminded of the stereotypical temperaments and behaviors of the pet species. Studies 5?7 examine the role of regulatory fit and evince that exposure to dogs (cats) leads to more favorable responses toward advertising messages featuring promotion- (prevention-) focused appeals.

Establishment of a rapid diagnosis assay for SARS-CoV-2 infection based on MALDI-TOF MS

Objective: To establish a rapid, high-throughput detection assay of serum peptidome profiling for the diagnosis of SARS-CoV-2 infection based on matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS).

SARS-CoV-2 Viral Genes Compromise Survival and Functions of Human Pluripotent Stem Cell-derived Cardiomyocytes via Reducing Cellular ATP Level (preprint)

Cardiac manifestations are commonly observed in COVID-19 patients and prominently contributed to overall mortality. Human myocardium could be infected by SARS-CoV-2, and human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) are susceptible to SARS-CoV-2 infection. However, molecular mechanisms of SARS-CoV-2 gene-induced injury and dysfunction of human CMs remain elusive. Here, we find overexpression of three SARS-CoV-2 coding genes, Nsp6, Nsp8 and M, could globally compromise transcriptome of hPSC-CMs. Integrated transcriptomic analyses of hPSC-CMs infected by SARS-CoV-2 with hPSC-CMs of Nsp6, Nsp8 or M overexpression identified concordantly activated genes enriched into apoptosis and immune/inflammation responses, whereas reduced genes related to heart contraction and functions. Further, Nsp6, Nsp8 or M overexpression induce prominent apoptosis and electrical dysfunctions of hPSC-CMs. Global interactome analysis find Nsp6, Nsp8 and M all interact with ATPase subunits, leading to significantly reduced cellular ATP level of hPSC-CMs. Finally, we find two FDA-approved drugs, ivermectin and meclizine, could enhance the ATP level, and ameliorate cell death and dysfunctions of hPSC-CMs overexpressing Nsp6, Nsp8 or M. Overall, we uncover the global detrimental impacts of SARS-CoV-2 genes Nsp6, Nsp8 and M on the whole transcriptome and interactome of hPSC-CMs, define the crucial role of ATP level reduced by SARS-CoV-2 genes in CM death and functional abnormalities, and explore the potentially pharmaceutical approaches to ameliorate SARS-CoV-2 genes-induced CM injury and abnormalities.

Impact of the COVID-19 Pandemic on Career Intention Among Undergraduate Medical Students: A Single-center Cross-Sectional Study in Hubei Province (preprint)

Background: ：Undergraduate medical (UM) students faced the realities of the difficulties inherent in medical careers due to the coronavirus 2019 (COVID-19) outbreak. Thus imperative containment measures could affect UM students’ career intentions. There is limited information regarding the factors potentially associated with these students’ career change intentions.Methods：we conducted a cross-sectional survey to investigate the impact of the COVID-19 pandemic on career intention and the associated factors in UM students in August 2020. Univariate analyses and logistic regression analysis were used to identify the factors that contributed to any change of career intention. Results: A total of 2,040 medical students were contained from Hubei University of Medicine. The change of career intention was related to grade, attitude towards being a health worker and the impact of the COVID-19 pandemic. Conclusions: Changes in career intentions were particularly influenced by grade, attitude towards being a health worker, and the degree of COVID-19’s impact on the participants’ lives. Treating large-scale public health emergencies in rational way, setting up correct views of occupation choice and building reasonable career planning may reduce the loss of medical talents.

Simultaneous detection of the spike and nucleocapsid proteins from SARS-CoV-2 based on ultrasensitive single molecule assays.

Nucleic acid detection technology based on polymerase chain reaction (PCR) and antibody detection based on immunochromatography still have many problems such as false negatives for the diagnosis of coronavirus disease 2019 (COVID-19). Therefore, it is of great importance to develop new techniques to improve the diagnostic accuracy of COVID-19. We herein developed an ultrasensitive, rapid, and duplex digital enzyme-linked immunosorbent assay (dELISA) for simultaneous detection of spike (S-RBD) and nucleocapsid (N) proteins of SARS-CoV-2 based on a single molecule array. This assay effectively combines magnetic bead encoding technology and the ultrasensitive detection capability of a single molecule array. The detection strategies of S-RBD protein and N-protein exhibited wide response ranges of 0.34-1065 pg/mL and 0.183-338 pg/mL with detection limits of 20.6 fg/mL and 69.8 fg/mL, respectively. It is a highly specific method for the simultaneous detection of S-RBD protein and N-protein and has minimal interference from other blood proteins. Moreover, the spike assay showed a satisfactory and reproducible recovery rate for the detection of S-RBD protein and N-protein in serum samples. Overall, this work provides a highly sensitive method for the simultaneous detection of S-RBD protein and N-protein, which shows ultrasensitivity and high signal-to-noise ratio and contributes to improve the diagnosis accuracy of COVID-19.

Updated SARS-CoV-2 Single Nucleotide Variants and Mortality Association (preprint)

Since its outbreak in December 2019, COVID-19 has caused 100,5844,555 cases and 2,167,313 deaths as of Jan 27, 2021. Comparing our previous study of SARS-CoV-2 single nucleotide variants (SNVs) before June 2020, we found out that the SNV clustering had changed considerably since June 2020. Apart from that the group SNVs represented by two non-synonymous mutations A23403G (S: D614G) and C14408T (ORF1ab: P4715L) became dominant and carried by over 95% genomes, a few emerging groups of SNVs were recognized with sharply increased monthly occurrence ratios up to 70% in November 2020. Further investigation revealed that several SNVs were strongly associated with the mortality, but they presented distinct distribution in specific countries, e.g., Brazil, USA, Saudi Arabia, India, and Italy. SNVs including G25088T, T25A, G29861T and G29864A were adopted in a regularized logistic regression model to predict the mortality status in Brazil with the AUC of 0.84. Protein structure analysis showed that the emerging subgroups of non-synonymous SNVs and those mortality-related ones in Brazil were located on protein surface area. The clashes in protein structure introduced by these mutations might in turn affect virus pathogenesis through conformation changes, leading to the difference in transmission and virulence. Particularly, we found that SNVs tended to occur in intrinsic disordered regions (IDRs) of Spike (S) and ORF1ab, suggesting a critical role of SNVs in protein IDRs to determine protein folding and immune evasion.

Rapid lateral flow immunoassay for the fluorescence detection of SARS-CoV-2 RNA.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for rapid and accurate nucleic acid detection at the point of care. Here, we report an amplification-free nucleic acid immunoassay, implemented on a lateral flow strip, for the fluorescence detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in less than one hour. The assay uses DNA probes that are designed to bind to the conserved open reading frame 1ab (ORF1ab), envelope protein (E) and the nucleocapsid (N) regions of the SARS-CoV-2 genome, and a fluorescent-nanoparticle-labelled monoclonal antibody that binds to double-stranded DNA-RNA hybrids. In a multi-hospital randomized double-blind trial involving 734 samples (593 throat swabs and 141 sputum) provided by 670 individuals, the assay achieved sensitivities of 100% and specificities of 99% for both types of sample (ground truth was determined using quantitative PCR with reverse transcription). The inexpensive amplification-free detection of SARS-CoV-2 RNA should facilitate the rapid diagnosis of COVID-19 at the point of care.

Association Between Cystatin C, Cystatin C Rangeability and Mortality of COVID-19 Patients With or Without Type 2 Diabetes Mellitus: An Opportunistic Retrospective Analysis (preprint)

Background: Since December of 2019, novel coronavirus (SARS-CoV-2)-induced pneumonia (COVID-19) exploded in Wuhan, and rapidly spread throughout China. Patients with COVID-19 demonstrated quite different appearances and outcomes in clinical manifestations. We aimed to figure out whether risk factors of the cystatin C (CysC) and the CysC rangeability are influencing the prognosis of COVID-19 patients with or without type 2 diabetes mellitus (T2DM).Methods: 675 T2DM patients and 602 non-T2DM patients were divided into low CysC group, high CysC group and low CysC rangeability group, high CysC rangeability group according to the serum CysC level and the change range of CysC. Demographic characteristics, clinical data and laboratory results of the four groups were collected and analyzed.Results: Our data showed that COVID-19 patients with high CysC level and CysC rangeability had more organic damage and higher mortality rate compared to those with low level or low rangeability of CysC. Furthermore, patients with higher CysC level and CysC rangeability also demonstrated higher blood lymphocytes (lymph), C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) which may greatly influence disease progression and poor prognosis of COVID-19. After adjusting for possible confounders, multivariate analysis revealed that CysC≤0.93mg/dl as a reference, CysC＞0.93mg/dl were significantly associated with the risk of heart failure (OR=2.401, 95% CI: 1.118–5.156) and all-cause death (OR=2.734, 95% CI: 1.098-6.811); referring to CysC rangeability≤0, CysC rangeability＞0 significantly associated with all-cause death (OR=4.029, 95% CI: 1.864-8.706). Further grouped by T2DM, these associations were stronger in T2DM than in non-T2DM.Conclusions: It suggests that CysC level and CysC rangeability contribute to clinical manifestations and may influence the prognosis of COVID-19. The CysC is considered as a potential risk factor of the prognosis of COVID-19. Special medical care and appropriate intervention should be performed in COVID-19 patients with elevated CysC during hospitalization and later clinical follow-up, especially for those with T2DM.

Distinct genetic spectrums and evolution patterns of SARS-CoV-2 (preprint)

Four signature groups of frequently occurred single-nucleotide variants (SNVs) were identified in over twenty-eight thousand high-quality and high-coverage SARS-CoV-2 complete genome sequences, representing different viral strains. Some SNVs predominated but were mutually exclusively presented in patients from different countries and areas. These major SNV signatures exhibited distinguishable evolution patterns over time. A few hundred patients were detected with multiple viral strain-representing mutations simultaneously, which may stand for possible co-infection or potential homogenous recombination of SARS-CoV-2 in environment or within the viral host. Interestingly nucleotide substitutions among SARS-CoV-2 genomes tended to switch between bat RaTG13 coronavirus sequence and Wuhan-Hu-1 genome, indicating the higher genetic instability or tolerance of mutations on those sites or suggesting that major viral strains might exist between Wuhan-Hu-1 and RaTG13 coronavirus.

Preprint of "COVID-19 Increases Online Emotional and Health-Related Searches" (preprint)

Objective: The COVID-19 pandemic has powerfully shaped people’s lives. The current work investigated the emotional and behavioral reactions people experience in response to COVID-19 through their internet searches. We hypothesized that when the prevalence rates of COVID-19 increase, people would experience more fear, which in turn would predict greater rates of protective behaviors, seeking health-related knowledge, and panic buying. Methods: Prevalence rates of COVID-19 in the United States, the United Kingdom, Canada, and Australia, were used as predictors. Fear-related emotions, protective behaviors, seeking health-related knowledge, and panic buying were indicated by internet search volumes in Google Trends. Cross-temporal analyses were conducted. Results: We found that increased prevalence rates of COVID-19 were associated with more searches for protective behaviors, health knowledge, and panic buying. This pattern was consistent across four countries, the United States, the United Kingdom, Canada, and Australia. Fear-related emotions explained the associations between COVID-19 and the content of their information searches. Conclusion: Findings suggest that exposure to prevalence rates of COVID-19 and fear-related emotions may motivate people to search for relevant health-related information so as to protect themselves from the pandemic.