Clinical analysis of 132 cases COVID-19 from Wuhan.

Numerous cases of pneumonia from a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China during December 2019.We determined the correlations of patient parameters with disease severity in patients with COVID-19.A total of 132 patients from Wuhan Fourth Hospital who had COVID-19 from February 1 to February 29 in 2020 were retrospectively analyzed.Ninety patients had mild disease, 32 had severe disease, and 10 had critical disease. The severe/critical group was older (P < .05), had a higher proportion of males (P < .05), and had a greater mortality rate (0% vs 61.9%, P < .05). The main symptoms were fever (n = 112, 84.8%) and cough (n = 96, 72.7%). Patients were treated with antiviral agents (n = 94, 71.2%), antibiotics (n = 92, 69.7%), glucocorticoids (n = 46, 34.8%), intravenous immunoglobulin (n = 38, 27.3%), and/or traditional Chinese medicine (n = 40, 30.3%). Patients in the severe/critical group received mechanical ventilation (n = 22, 16.7%) or high-flow nasal can-nula oxygen therapy (n = 6, 4.5%). Chest computed tomography (CT) indicated bilateral pneumonia in all patients. Relative to the mild group, the severe/critical group had higher levels of leukocytes, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, B-type natriuretic peptide (BNP), liver enzymes, and myocardial enzymes (P < .05), and decreased levels of lymphocytes and blood oxygen partial pressure (P < .05).The main clinical symptoms of patients from Wuhan who had COVID-19 were fever and cough. Patients with severe/critical disease were more likely to be male and elderly. Disease severity correlated with increased leukocytes, CRP, PCT, BNP, D-dimer, liver enzymes, and myocardial enzymes, and with decreased lymphocytes and blood oxygen partial pressure.

Analysis of psychological resilience and influencing factors of medical staff participating in nucleic acid sampling outside hospital in a tertiary hospital of Guangzhou

Objective: To investigate the psychological resilience of medical staff participating in nucleic acid sampling outside hospital during the COVID-19 epidemic and its influence factors. Methods: A total of 197 medical staff in a general tertiary hospital in Guangzhou, Guangdong were selected by convenience sampling method and survey with the general data questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the General Self-Efficacy Scale (GSES) and the Simplified Coping Style Questionnaire (SCSQ). Statistical analysis was performed using multiple linear regression analysis. Results: The total score of resilience of these staff was (69.95 +or- 12.85) points. Correlation analysis showed that there was a positive correlation between psychological resilience and positive response, self-efficacy(P < 0.01). The multiple linear regression analysis showed that: compared with medical staff without professional titles, medical staff with intermediate professional title or above had a high level of psychological flexibility (beta = 0.150, 0.145, P < 0.05);compared with medical staff with sampling time less than 4 h, the psychological resilience level of those with sampling time longer than 4 h was lower (beta = -0.143, P < 0.05);the medical staff who can respond positively had higher psychological resilience (beta = 0.422, P < 0.01);and the medical staff with higher levels of self-efficacy had higher psychological resilience (beta = 0.296, P < 0.01). Conclusions: Medical staff participating in nucleic acid sampling during the COVID-19 epidemic had low psychological resilience. Managers should improve the emergency management mechanism, strengthen the relevant knowledge training and timely psychological counseling to promote their physical and mental health.

COVID-19 Vaccine Hesitancy Among Medical Students: The Next COVID-19 Challenge in Wuhan, China.

OBJECTIVE: The purpose of this study was to explore the level of coronavirus disease 2019 (COVID-19) vaccine hesitancy among medical students in Wuhan, China, and to identify the factors and barriers associated with their vaccination decision. METHODS: A cross-sectional survey was launched with 612 medical students recruited by convenience sampling from 6 universities. Data collection measures mainly included a demographic questionnaire, COVID-19 vaccine knowledge questionnaire, and the vaccine hesitancy scale. RESULTS: A total of 58.2% of medical students reported vaccine hesitancy. The most common reasons for this were worrying about the side effects of vaccines (44.4%), uncertainty about vaccine safety (40.4%), and underestimating the risk of exposure to COVID-19 (27.9%). The main factors associated with COVID-19 vaccine hesitancy among participants were their knowledge about COVID-19 vaccine, training related to COVID-19 vaccines, family address, and education level (P < 0.05). CONCLUSIONS: The government, health department and universities in China need to work together and actively communicate with vaccine-hesitant students, establish a standardized COVID-19 vaccine course, and provide on-campus vaccination services.

Impact of internet plus health education on urinary stoma caregivers in coping with care burden and stress in the era of COVID-19.

Objective: To explore the impact of "Internet Plus Health Education" on coping with care burden and pressure in urinary stoma caregivers in the era of COVID-19. Materials and methods: Eighty caregivers of patients with urinary ostomy were equally randomized to experimental and control groups. Caregivers in the experimental group received digital nursing education intervention, which involved nursing intervention of Internet Plus Health Education (IPHE), and those in the control group received conventional care instructions. Six months later, care burden and emotional pressure were assessed in all caregivers using the Zarit Caregiver Burden Interview (ZBI) and the Simplified Coping Style Questionnaire (SCSQ). Results: Before the intervention, the ZBI and SCSQ scores were comparable between both groups (p > 0.05). After the intervention, the ZBI scores in the experimental group were significantly higher than in the control group and vice versa for SCSQ scores (p < 0.01). Furthermore, after the intervention, the family care satisfaction scale (FCSS) of the experimental group was significantly higher than the control group. Conclusion: Providing "Internet Plus Health Education" to urinary stoma caregivers can reduce their care burden and enhance their pressure-coping ability in the COVID-19 era.

Merely Folklore? The Role of a Growth Mindset in the Taking and Timing of Entrepreneurial Actions

Why do some potential entrepreneurs promptly engage in entrepreneurial behavior while others do not pursue their entrepreneurial intentions or delay acting? This study investigated whether potential entrepreneurs' mindset shapes engaging in entrepreneurial behavior and the time until they do so. Over a 16-month period, holding more of a growth (vs. fixed) mindset positively predicted taking various entrepreneurial actions and doing so sooner. Interestingly, these effects vanished when individuals faced a less challenging context for entrepreneurship. Post-hoc exploratory analyses revealed that the COVID-19 pandemic magnified the impact of mindsets on entrepreneurial behavior. These findings pave the way for preliminary research on the viability of growth mindset interventions for fostering entrepreneurial behavior.

Learning from errors? The impact of erroneous example elaboration on learning outcomes of medical statistics in Chinese medical students.

BACKGROUND: Constructivism theory has suggested that constructing students' own meaning is essential to successful learning. The erroneous example can easily trigger learners' confusion and metacognition, which may "force" students to process the learning material and construct meaning deeply. However, some learners exhibit a low level of elaboration activity and spend little time on each example. Providing instructional scaffolding and elaboration training may be an efficient method for addressing this issue. The current study conducted a randomized controlled trial to examine the effectiveness of erroneous example elaboration training on learning outcomes and the mediating effects of metacognitive load for Chinese students in medical statistics during the COVID-19 pandemic. METHODS: Ninety-one third-year undergraduate medical students were randomly assigned to the training group (n = 47) and the control group (n = 44). Prerequisite course performance and learning motivation were collected as covariates. The mid-term exam and final exam were viewed as posttest and delayed-test to make sure the robustness of the training effect. The metacognitive load was measured as a mediating variable to explain the relationship between the training and academic performance. RESULTS: The training significantly improved both posttest and delayed-test performance compared with no training (Fposttest = 26.65, p < 0.001, Partial η2 = 0.23; Fdelayed test = 38.03, p < 0.001, Partial η2 = 0.30). The variation trend in metacognitive load in the two groups was significantly different (F = 2.24, p < 0.05, partial η2 = 0.20), but metacognitive load could not explain the positive association between the treatment and academic performance (ß = - 0.06, se = 0.24, 95% CI - 0.57 to 0.43). CONCLUSIONS: Erroneous example learning and metacognitive demonstrations are effective for academic performance in the domain of medical statistics, but their underlying mechanism merits further study.

Modeling and Preliminary Analysis of the Impact of Meteorological Conditions on the COVID-19 Epidemic.

Since the COVID-19 epidemic outbreak at the end of 2019, many studies regarding the impact of meteorological factors on the attack have been carried out, and inconsistent conclusions have been reached, indicating the issue's complexity. To more accurately identify the effects and patterns of meteorological factors on the epidemic, we used a combination of logistic regression (LgR) and partial least squares regression (PLSR) modeling to investigate the possible effects of common meteorological factors, including air temperature, relative humidity, wind speed, and surface pressure, on the transmission of the COVID-19 epidemic. Our analysis shows that: (1) Different countries and regions show spatial heterogeneity in the number of diagnosed patients of the epidemic, but this can be roughly classified into three types: "continuous growth", "staged shock", and "finished"; (2) Air temperature is the most significant meteorological factor influencing the transmission of the COVID-19 epidemic. Except for a few areas, regional air temperature changes and the transmission of the epidemic show a significant positive correlation, i.e., an increase in air temperature is conducive to the spread of the epidemic; (3) In different countries and regions studied, wind speed, relative humidity, and surface pressure show inconsistent correlation (and significance) with the number of diagnosed cases but show some regularity.

Understanding Safety Performance of Prefabricated Construction Based on Complex Network Theory

With the rapid expansion of prefabricated construction in China, significant changes in safety performance are still unapparent for numerous prefabricated constructions, and safety accidents are constantly exposed in public. The ignorance of interactions among safety risks impedes efficacious improvement, which instructs the need for a thorough analysis of these interactions based on complex network theory. This paper starts with the identification of 37 safety risks refined through literature review and expert interviews, and 90 interrelationships among them verified by virtue of the questionnaire survey, laying a foundation for the establishment of a prefabricated construction safety risk network (PCSRN). The topological analysis results prove that PCSRN is a scale-free as well as a small-world network, which indicates the high-efficiency propagation and diffusion among safety risks in prefabricated constructions. Moreover, eight critical nodes are identified with four different ranking criteria, and corresponding safety strategies are proposed to address them. The developed method not only provides a novel insight to interpret the safety risks of prefabricated construction but also has the potential to advance safety performance of this sector.

The olfactory route is a potential way for SARS-CoV-2 to invade the central nervous system of rhesus monkeys.

Neurological manifestations are frequently reported in the COVID-19 patients. Neuromechanism of SARS-CoV-2 remains to be elucidated. In this study, we explored the mechanisms of SARS-CoV-2 neurotropism via our established non-human primate model of COVID-19. In rhesus monkey, SARS-CoV-2 invades the CNS primarily via the olfactory bulb. Thereafter, viruses rapidly spread to functional areas of the central nervous system, such as hippocampus, thalamus, and medulla oblongata. The infection of SARS-CoV-2 induces the inflammation possibly by targeting neurons, microglia, and astrocytes in the CNS. Consistently, SARS-CoV-2 infects neuro-derived SK-N-SH, glial-derived U251, and brain microvascular endothelial cells in vitro. To our knowledge, this is the first experimental evidence of SARS-CoV-2 neuroinvasion in the NHP model, which provides important insights into the CNS-related pathogenesis of SARS-CoV-2.

Development of a Physiologically Based Pharmacokinetic Model for Hydroxychloroquine and Its Application in Dose Optimization in Specific COVID-19 Patients.

In Feb 2020, we developed a physiologically-based pharmacokinetic (PBPK) model of hydroxychloroquine (HCQ) and integrated in vitro anti-viral effect to support dosing design of HCQ in the treatment of COVID-19 patients in China. This, along with emerging research and clinical findings, supported broader uptake of HCQ as a potential treatment for COVID-19 globally at the beginning of the pandemics. Therefore, many COVID-19 patients have been or will be exposed to HCQ, including specific populations with underlying intrinsic and/or extrinsic characteristics that may affect the disposition and drug actions of HCQ. It is critical to update our PBPK model of HCQ with adequate drug absorption and disposition mechanisms to support optimal dosing of HCQ in these specific populations. We conducted relevant in vitro and in vivo experiments to support HCQ PBPK model update. Different aspects of this model are validated using PK study from 11 published references. With parameterization informed by results from monkeys, a permeability-limited lung model is employed to describe HCQ distribution in the lung tissues. The updated model is applied to optimize HCQ dosing regimens for specific populations, including those taking concomitant medications. In order to meet predefined HCQ exposure target, HCQ dose may need to be reduced in young children, elderly subjects with organ impairment and/or coadministration with a strong CYP2C8/CYP2D6/CYP3A4 inhibitor, and be increased in pregnant women. The updated HCQ PBPK model informed by new metabolism and distribution data can be used to effectively support dosing recommendations for clinical trials in specific COVID-19 patients and treatment of patients with malaria or autoimmune diseases.

The Impact of the Economic Corridor on Economic Stability: A Double Mediating Role of Environmental Sustainability and Sustainable Development Under the Exceptional Circumstances of COVID-19.

This study discusses the impact of different economic indicators on economic stability, including honest leadership, improved infrastructure, revenue generation, and CPEC taking into account the double mediating role of environmental sustainability and sustainable development, while considering the latest COVID-19 situation. This study adopted primary data collection methods and obtained data from the employees of CPEC by using questionnaires and smart-PLS for analysis purposes. The results revealed that honest leadership, improved infrastructure, revenue generation, and CPEC have a positive nexus with economic stability. Despite the severe impact of COVID-19 on the country's economy, the economic corridor plays a vital role in stabilizing the state's economy and supports all those related to this phenomenal project either directly or indirectly.

Combating COVID-19 as a designated hospital: Experience from Shanghai, China.

Many large international cities, such as Shanghai, are facing the threat of more imported cases of COVID-19 because of the frequent flow of people and objects at home and abroad. In the face of the complex and changing disease status of the international community, dealing with this disease effectively is a great challenge to the city's existing public health emergency response capacity and also a major test of designated COVID-19 hospitals. Here, we share our experience as a designated COVID-19 hospital in Shanghai, China in terms of i) A Professional Multi-disciplinary Team, ii) Personalized Treatment Plans for Patients in Severe or Critically Ill Condition, iii) Well-organized Classification of Patients, iv) Establishment of Transitional Wards, v) Nosocomial Infection Prevention and Control, and vi) Identification and Reporting of the Asymptomatic in the hopes that these approaches can serve as a reference for healthcare providers and medical staff who are fighting the pandemic.

The Gastrointestinal Tract Is an Alternative Route for SARS-CoV-2 Infection in a Nonhuman Primate Model.

BACKGROUND & AIMS: Gastrointestinal (GI) manifestations have been increasingly reported in patients with coronavirus disease 2019 (COVID-19). However, the roles of the GI tract in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not fully understood. We investigated how the GI tract is involved in SARS-CoV-2 infection to elucidate the pathogenesis of COVID-19. METHODS: Our previously established nonhuman primate (NHP) model of COVID-19 was modified in this study to test our hypothesis. Rhesus monkeys were infected with an intragastric or intranasal challenge with SARS-CoV-2. Clinical signs were recorded after infection. Viral genomic RNA was quantified by quantitative reverse transcription polymerase chain reaction. Host responses to SARS-CoV-2 infection were evaluated by examining inflammatory cytokines, macrophages, histopathology, and mucin barrier integrity. RESULTS: Intranasal inoculation with SARS-CoV-2 led to infections and pathologic changes not only in respiratory tissues but also in digestive tissues. Expectedly, intragastric inoculation with SARS-CoV-2 resulted in the productive infection of digestive tissues and inflammation in both the lung and digestive tissues. Inflammatory cytokines were induced by both types of inoculation with SARS-CoV-2, consistent with the increased expression of CD68. Immunohistochemistry and Alcian blue/periodic acid-Schiff staining showed decreased Ki67, increased cleaved caspase 3, and decreased numbers of mucin-containing goblet cells, suggesting that the inflammation induced by these 2 types of inoculation with SARS-CoV-2 impaired the GI barrier and caused severe infections. CONCLUSIONS: Both intranasal and intragastric inoculation with SARS-CoV-2 caused pneumonia and GI dysfunction in our rhesus monkey model. Inflammatory cytokines are possible connections for the pathogenesis of SARS-CoV-2 between the respiratory and digestive systems.

Cytotoxicity Evaluation of Chloroquine and Hydroxychloroquine in Multiple Cell Lines and Tissues by Dynamic Imaging System and Physiologically Based Pharmacokinetic Model.

Chloroquine (CQ) and hydroxychloroquine (HCQ) have been challenged in treating COVID-19 patients and still under debate due to the uncertainty regarding the effectiveness and safety, and there is still lack of the systematic study on the toxicity of these two drugs. To further uncover the toxicity profile of CQ and HCQ in different tissues, we evaluated the cytotoxicity of them in eight cell lines and further adopted the physiologically based pharmacokinetic models to predict the tissue risk, respectively. Retina, myocardium, lung, liver, kidney, vascular endothelium, and intestinal epithelium originated cells were included in the toxicity evaluation of CQ and HCQ, respectively. The proliferation pattern was monitored in 0-72 h by IncuCyte S3. CC50 and the ratio of tissue trough concentrations to CC50 (RTTCC) were brought into predicted toxicity profiles. Compared to CQ, HCQ was found to be less toxic in six cell types except Hep3B and Vero cells. In addition, RTTCC was significantly higher in CQ treatment group compared to HCQ group, which indicates relative safety of HCQ. To further simulate the situation of the COVID-19 patients who suffered the dyspnea and hypoxemia, we also tested the cytotoxicity upon hypoxia and normoxia (1, 5 vs. 21% O2). It was found that the cytotoxicity of CQ was more sensitive to hypoxia compared with that of HCQ, particularly in liver originated cells. Both CQ and HCQ showed cytotoxicity in time-dependent manner which indicates the necessity of short period administration clinically.

Population-based meta-analysis of chloroquine: informing chloroquine pharmacokinetics in COVID-19 patients.

AIMS: Chloroquine (CQ) has been repurposed to treat coronavirus disease 2019 (COVID-19). Understanding the pharmacokinetics (PK) in COVID-19 patients is essential to study its exposure-efficacy/safety relationship and provide a basis for a possible dosing regimen optimization. SUBJECT AND METHODS: In this study, we used a population-based meta-analysis approach to develop a population PK model to characterize the CQ PK in COVID-19 patients. An open-label, single-center study (ethical review approval number: PJ-NBEY-KY-2020-063-01) was conducted to assess the safety, efficacy, and pharmacokinetics of CQ in patients with COVID-19. The sparse PK data from 50 COVID-19 patients, receiving 500 mg CQ phosphate twice daily for 7 days, were combined with additional CQ PK data from 18 publications. RESULTS: A two-compartment model with first-order oral absorption and first-order elimination and an absorption lag best described the data. Absorption rate (ka) was estimated to be 0.559 h-1, and a lag time of absorption (ALAG) was estimated to be 0.149 h. Apparent clearance (CL/F) and apparent central volume of distribution (V2/F) was 33.3 l/h and 3630 l. Apparent distribution clearance (Q/F) and volume of distribution of peripheral compartment (Q3/F) were 58.7 l/h and 5120 l. The simulated CQ concentration under five dosing regimens of CQ phosphate were within the safety margin (400 ng/ml). CONCLUSION: Model-based simulation using PK parameters from the COVID-19 patients shows that the concentrations under the currently recommended dosing regimen are below the safety margin for side-effects, which suggests that these dosing regimens are generally safe. The derived population PK model should allow for the assessment of pharmacokinetics-pharmacodynamics (PK-PD) relationships for CQ when given alone or in combination with other agents to treat COVID-19.

Effects and safety of herbal medicines among community-dwelling residents during COVID-19 pandemic: A large prospective, randomized controlled trial (RCT).

BACKGROUND: Since the declaration of COVID-19 as a global pandemic by the World Health Organization, countries are struggling with a shortage of medical capacities. It would be essential if the risk for preventable comorbidities, such as the common cold, can be reduced or prevented, so that the scarce medical resources and facilities can be focused on COVID-19. PURPOSE: To evaluate the effects of two herbal medicines (Jinhaoartemisia antipyretic granules and Huoxiangzhengqi oral liquids) in reducing the risk of the common cold in community-dwelling residents in China during the COVID-19 outbreak. STUDY DESIGN: A prospective open-label, parallel-group, cluster-randomized controlled trial (RCT), was conducted in Chengdu, China. METHODS: A total of 22,065 participants from 11 communities were recruited during a period of one month. The trial started on 30 January and participants were followed up till 29 February 2020. Participants were randomly assigned to receive either a five-day herbal medicine therapy plus a reference manual or a reference manual only if they were allocated to the control group. The primary endpoint was the occurrence of patient-reported common cold symptoms. The secondary endpoint was the time in days from the receipt of herbal drugs/reference manual and the occurrence of the common cold symptoms. RESULTS: Use of herbal medicine reduced the risk of the common cold by 89.6% (95% CI, 52.9% to 97.7%) in all community-dwelling residents, and by 94.0% (95% CI, 52.1% to 99.2%) in residents aged between 16 and 59 years old. Sensitivity analyses showed similar results. CONCLUSION: This community-based RCT found that the use of a herbal medicine therapy (Jinhaoartemisia antipyretic granules and Huoxiangzhengqi oral liquids) could significantly reduce the risks of the common cold among community-dwelling residents, suggesting that herbal medicine may be a useful approach for public health intervention to minimize preventable morbidity during COVID-19 outbreak.