Relationship between rumination and post-traumatic growth in mobile cabin hospital nurses: The mediating role of psychological resilience.

Psychological resilience helps individuals to actively respond to various emergencies, but its mediating role between the rumination and post-traumatic growth (PTG) of nurses remains unknown. Our study aimed to explore the extent to which psychological resilience mediates the association between rumination and PTG among nurses working in mobile cabin hospitals. This cross-sectional survey was conducted on 449 medical team members working in mobile cabin hospitals to support the prevention and control of coronavirus disease 2019 in Shanghai, China in 2022. Pearson correlation analysis was applied to assess the correlation between rumination, psychological resilience, and PTG. Structural equation models were used to examine the mediating role of psychological resilience between rumination and PTG. Our study results showed that deliberate rumination directly promoted psychological resilience and PTG and had positive effects on PTG through the mediating effect of psychological resilience. Invasive rumination had no direct effect on PTG. However, it had a negative effect on PTG through the mediating effect of psychological resilience. Together the results of this study indicate that the mediating effect of psychological resilience was significant in the association of rumination and PTG among mobile cabin hospital nurses, with a higher individual psychological resilience level helping nurses to achieve PTG. Therefore, targeted interventions should be implemented to improve nurses' psychological resilience and guide their rapid growth.

Investigation of Adverse Events Experienced by Healthcare Workers following Immunization with Homologous orHeterologous COVID-19 Booster Vaccinations.

OBJECTIVE: A comparative analysis was performed to investigate the potential risk factors of Adverse Events Following Immunization (AEFI) after receiving different booster vaccines. METHODS: From 18 January 2021 to 21 January 2022, the Health Care Workers (HCWs) of Guizhou Provincial Staff Hospital (Guizhou Province, China) who received a third Booster vaccine, that was either homologous (i.e., (i) a total of three doses of Vero cell vaccine or (ii) three doses of CHO cell vaccine) or (iii) heterologous with two first doses of Vero cell vaccine, being either CHO cell vaccine or adenovirus type-5 (Ad5) vectored COVID-19 vaccine, were asked to complete a self-report questionnaire form to provide information on any AEFI that may have occurred in the first 3 days after vaccination with the booster. The frequency of AEFI corresponding to the three different booster vaccines was compared, and the risk factors for predicting AEFI were determined by multivariate logistic regression analysis. RESULTS: Of the 904 HCWs who completed the survey, 792 met the inclusion criteria. The rates of AEFI were 9.8% (62/635) in the homologous Vero cell booster group, 17.3% (13/75) in the homologous CHO cell booster group, and 20.7% (17/82) in the heterologous mixed vaccines booster group, and the rates were significantly different (c2 = 11.5, p = 0.004) between the three groups of vaccines. Multivariate logistic regression analysis showed that: (1) compared to the homologous Vero cell booster group, the risk of AEFI was about 2.1 times higher (OR = 2.095, 95% CI: 1.056-4.157, p = 0.034) in the CHO cell booster group and 2.5 times higher (OR = 2.476, 95% CI: 1.352-4.533, p = 0.003) in the mixed vaccines group; (2) the odds for women experiencing AEFI were about 2.8 times higher (OR = 2.792, 95% CI: 1.407-5.543, p = 0.003) than men; and (3) compared to the non-frontline HCWs, the risk of AEFI was about 2.6 times higher (OR = 2.648, 95% CI: 1.473-4.760, p = 0.001) in the doctors. CONCLUSION: The AEFI in all three booster groups are acceptable, and serious adverse events are rare. The risk of AEFI was higher in doctors, which may be related to the high stress during the COVID-19 epidemic. Support from government and non-governmental agencies is important for ensuring the physical and mental health of HCWs.

Preparation of antibodies against the spike glycoprotein of SARS -CoV- 2 and establishment of a double antibody sandwich ELISA for detection of the spike glycoprotein

The coronavirus disease 2019 (COVID-19) pandemic poses a serious threat to human life and health. To establish a method for quantitative detection of detection of the spike glycoprotein of severe acute respiratory syndrome coronavirus'Z (SARS-CoV-Z) in vaccines. Goat anti-SARS-CoV-Z polyclonal antibody and mouse anti -SARS -CoV-Z spike glycoprotein monoclonal antibody were prepared to establish a double antibody sandwich enzymerlinked immunosorbent assay (ELISA) for detection of the spike glycoprotein. The ELISA system was optimized and the linear range, sensitivity, specificity, repeatability and coincidence rate were tested. The linear range was 1-64 U and correlation coefficient (R2) > 0.99. There was no reaction with the nucleocapsid protein, Vero-cell debris or influenza Viruses, etc, indicating the high specificity of our method. The sensitivity was 92.1% and the variations in intra- and inter' assay repeatability were 2.5%-11.7% and 1.3% -14.8%, respectively. The samples showed a coincidence rate Of 96.7% with known background. Our method had high specificity, sensitivity, stability and accuracy, and could be used for determination of spike - glycoprotein antigen content in vaccine.

[Identifying SARS-CoV-2 main protease inhibitors by a novel sandwich-like fluorescence polarization screening assay].

SARS-CoV-2 main protease (Mpro) is responsible for polyprotein cleavage to release non-structural proteins (nsps) for viral genomic RNA replication, and its homologues are absent in human cells. Therefore, Mpro has been regarded as one of the ideal drug targets for the treatment of coronavirus disease 2019 (COVID-19). In this study, we first combined the fluorescence polarization (FP) technique with biotin-avidin system (BAS) to develop a novel sandwich-like FP screening assay for quick discovery of SARS-CoV-2 Mpro inhibitors from a natural product library. With this screening assay, anacardic acid (AA) and 1, 2, 3, 4, 6-O-pentagalloylglucose (PGG) were found to be the competitive inhibitor and mixed-type inhibitor targeting Mpro, respectively. Importantly, our results showed that the majority of the reported Mpro inhibitors are promiscuous cysteine inhibitors that are not specific to Mpro. In summary, this novel sandwich-like FP screening assay is simple, sensitive, and robust, which is ideal for large-scale screening. Natural products AA and PGG will be the promising lead compounds for generating more potent antiviral agents targeting Mpro, and the stringent hit validation at the early stage of drug discovery is urgently needed.

Association among sleep, depression, and health-related quality of life in patients with non-dialysis chronic kidney disease during the coronavirus disease 2019 pandemic.

BACKGROUND: Sleep disturbance is well documented as a crucial element that impairs health. Depression and health-related quality of life (HRQOL), which on behalf of a patient's overall perception of emotional, physical and social well-being, are increasingly emphasized self-reported health outcomes especially during the coronavirus disease 2019 (COVID-19) pandemic. Among dialysis patients, sleep disturbance is associated with depression and poorer HRQOL. The study was designed to depict the prevalence of sleep disturbance, and to explore the association among sleep, depression, and HRQOL in patients with non-dialysis chronic kidney disease (CKD) during the COVID-19 pandemic. METHODS: A total of 172 non-dialysis CKD patients enrolled in this cross-sectional study, with sociodemographic and clinical data recorded. Sleep, HRQOL, and depression were evaluated via the Pittsburgh Sleep Quality Index (PSQI), the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36), and the 9-item Patient Health Questionnaire (PHQ-9), respectively. RESULTS: A total of 100 (58%) met the criteria for poor sleep. Good sleepers had strikingly disparate HRQOL and depression scores compared to poor sleepers. Sleep disorders were significantly associated with decreased HRQOL and increased depression in regression models adjusted or unadjusted for sociodemographic and clinical characteristics. Mediation analysis indicated depression was a significant mediator explaining 51% of the relationship between sleep status with physical component summary (PCS) and played a fully mediating role in the association between sleep and mental component summary (MCS). CONCLUSIONS: Our study suggested the high incidence of sleep disorders in patients with non-dialysis CKD during the COVID-19 pandemic, as well as the tight associations among sleep, depression, and HRQOL. Considering the negative influences of sleep and depression on HRQOL, appropriate screening and treatment for these treatable health-related domains are necessary for patients with non-dialysis CKD.

Iron oxide nanoparticles augment the intercellular mitochondrial transfer-mediated therapy.

The transfer of mitochondria between cells has recently been revealed as a spontaneous way to protect the injured cells. However, the utilization of this natural transfer process for disease treatment is so far limited by its unsatisfactory transfer efficiency and selectivity. Here, we demonstrate that iron oxide nanoparticles (IONPs) can augment the intercellular mitochondrial transfer from human mesenchymal stem cells (hMSCs) selectively to diseased cells, owing to the enhanced formation of connexin 43­containing gap junctional channels triggered by ionized IONPs. In a mouse model of pulmonary fibrosis, the IONP-engineered hMSCs achieve a remarkable mitigation of fibrotic progression because of the promoted intercellular mitochondrial transfer, with no serious safety issues identified. The present study reports a potential method of using IONPs to enable hMSCs for efficient and safe transfer of mitochondria to diseased cells to restore mitochondrial bioenergetics.

Redefining NT-proBNP in predicting mortality of adult inpatients with COVID-19 (preprint)

NT-proBNP was much lower than the recommended threshold for heart failure in some adult COVID-19 inpatients with poor prognosis. NT-proBNP has different ranges of normal values for different age groups. NT-proBNP levels specific to age, defined as NT-proBNP ratio, were divided into quartiles and measured the hazard ratios (and 95% confidence intervals) for in-hospital death of COVID-19 patients. Higher NT-proBNP ratio was directly associated, in a dose-response manner, with a higher risk of all causes in-hospital death in the COVID-19 patients. Our study shows that NT-proBNP ratio is an independent predictor of the risk of in-hospital death of the adult patients with COVID-19. This implies that NT-proBNP levels specific to age in the COVID-19 patietns requires attention of healthcare workers.

Clinical outcomes of dialysis patients with COVID-19 in the initial phase of the COVID-19 outbreak in Wuhan, China.

PURPOSE: Since the end of 2019, dialysis patients have been at risk of coronavirus disease 2019 (COVID-19) as well as other potential complications. Hence, we sought to describe the clinical characteristics of dialysis patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: We reviewed clinical outcomes, which consisted of clinical data extracted from the medical records of 695 registered dialysis patients at the Dialysis Center of Central Hospital of Wuhan from January 13th, 2020, to February 29th, 2020, and performed statistical analysis. According to the results, there were 447, 227 and 21 hemodialysis (HD), peritoneal dialysis (PD) and combined HD and PD (HD&PD) cases, respectively. RESULTS: During the outbreak of COVID-19, 36 dialysis patients were infected by SARS-CoV-2. Among those 36 patients, 32 (7.2%) were on HD, and 4 (1.8%) were on PD. When comparing SARS-CoV-2 infection between HD and PD, the relative risk was 4.07 (RR = 4.07, 95% CI 1.46-11.35). We noted a median age of 66 years during the observation period, and the number of male patients was 23 (63.9%). There were 15 fatal cases tested positive for SARS-CoV-2 (13 cases on HD and 2 cases on PD). By comparing mortality in the same period of 2018, 2019 and 2020, the all-cause mortality of hemodialysis patients was significantly higher in 2020 (4.89%) than in either 2018 (2.55%) or 2019 (1.97%). There was no significant difference in mortality from all causes excluding COVID-19, during the same period among the 3-year period. However, during the COVID-19 outbreak, the mortality from all causes excluding COVID-19 was 2.73%, which was slightly higher than that from COVID-19 (2.16%). CONCLUSIONS: Although COVID-19 seriously threatens the health of people with uremia, deaths from all causes excluding COVID-19 during the epidemic cannot be ignored.

ACE2 and energy metabolism: the connection between COVID-19 and chronic metabolic disorders.

The renin-angiotensin system (RAS) has currently attracted increasing attention due to its potential function in regulating energy homeostasis, other than the actions on cellular growth, blood pressure, fluid, and electrolyte balance. The existence of RAS is well established in metabolic organs, including pancreas, liver, skeletal muscle, and adipose tissue, where activation of angiotensin-converting enzyme (ACE) - angiotensin II pathway contributes to the impairment of insulin secretion, glucose transport, fat distribution, and adipokines production. However, the activation of angiotensin-converting enzyme 2 (ACE2) - angiotensin (1-7) pathway, a novel branch of the RAS, plays an opposite role in the ACE pathway, which could reverse these consequences by improving local microcirculation, inflammation, stress state, structure remolding, and insulin signaling pathway. In addition, new studies indicate the protective RAS arm possesses extraordinary ability to enhance brown adipose tissue (BAT) activity and induces browning of white adipose tissue, and consequently, it leads to increased energy expenditure in the form of heat instead of ATP synthesis. Interestingly, ACE2 is the receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is threating public health worldwide. The main complications of SARS-CoV-2 infected death patients include many energy metabolism-related chronic diseases, such as diabetes. The specific mechanism leading to this phenomenon is largely unknown. Here, we summarize the latest pharmacological and genetic tools on regulating ACE/ACE2 balance and highlight the beneficial effects of the ACE2 pathway axis hyperactivity on glycolipid metabolism, as well as the thermogenic modulation.

The effects of novel coronavirus (SARS-CoV-2) infection on cardiovascular diseases and cardiopulmonary injuries.

COVID-19 caused by a novel coronavirus named SARS-CoV-2, can elites severe acute respiratory syndrome, severe lung injury, cardiac injury, and even death and became a worldwide pandemic. SARS-CoV-2 infection may result in cardiac injury via several mechanisms, including the expression of angiotensin-converting enzyme 2 (ACE2) receptor and leading to a cytokine storm, can elicit an exaggerated host immune response. This response contributes to multi-organ dysfunction. As an emerging infectious disease, there are limited data on the effects of this infection on patients with underlying cardiovascular comorbidities. In this review, we summarize the early-stage clinical experiences with COVID-19, with particular focus on patients with cardiovascular diseases and cardiopulmonary injuries, and explores potential available evidence regarding the association between COVID-19, and cardiovascular complications.

Current situation and trends of online academic activities for oncologists during the COVID-19 pandemic: a multicenter survey.

BACKGROUND: The present study aimed to investigate the current situation and future trends of online academic activities for oncologists during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: From April 22 to May 5, 2020, a multicenter survey was conducted using an online questionnaire platform. To compare categorical variables, χ2-test, the kappa consistency analysis, and Wilcoxon rank sum test were applied. For all statistical hypotheses, P<0.05 was considered significant. RESULTS: In the present study, 2,120 oncologists participated in the survey. Of these, 2,035 respondents participated in online academic activities. During the pandemic, online academic activities significantly increased [oncologists who participated in online academic activities ≥60%: 64.58% (during the pandemic) vs. 10.90% (before the pandemic), Cohen's kappa coefficient =0.0499, P<0.001]. The findings indicated that 90.6% of respondents considered that the online academic activities would become a future trend. The main reason for the increase in online academic activities was due to in-person academic conferences and diagnoses/treatment being affected by the pandemic. Both speakers/chairs and audiences agreed that online academic activities resulted in reduced stress (61.15% vs. 67.26%, respectively; χ2=7.009, P=0.03). In the present study, 62.21% of audiences considered that the recording function of online activities was very important (score 5), while only 53.86% of the speakers had the same opinion (Z=-3.5340, P<0.001). Compared with provincial capital cities and other cities, the participants from first-tier cities thought that online academic activities required significant physical energy (χ2=6.41, P=0.040), and were more reluctant for the playback of activity contents (χ2=9.33, P=0.002) and the screenshot of activity contents (χ2=41.99, P<0.001). CONCLUSIONS: During the COVID-19 pandemic, online academic activities have become the main form of academic exchanges for oncologists. Taking full advantage of online academic activities and paying adequate attention to the participants' requirements with different roles and titles, and from different cities, are key to improving the quality of and involvement in online academic activities.

condLSTM-Q: A novel deep learning model for predicting Covid-19 mortality in fine geographical Scale (preprint)

Predictive models with a focus on different spatial-temporal scales benefit governments and healthcare systems to combat the COVID-19 pandemic. Here we present the conditional Long Short-Term Memory networks with Quantile output (condLSTM-Q), a well-performing model for making quantile predictions on COVID-19 death tolls at the county level with a two-week forecast window. This fine geographical scale is a rare but useful feature in publicly available predictive models, which would especially benefit state-level officials to coordinate resources within the state. The quantile predictions from condLSTM-Q inform people about the distribution of the predicted death tolls, allowing better evaluation of possible trajectories of the severity. Given the scalability and generalizability of neural network models, this model could incorporate additional data sources with ease, and could be further developed to generate other useful predictions such as new cases or hospitalizations intuitively.

Outcomes and risk factors for the survival of COVID-19 related ARDS patients treated with extracorporeal membrane oxygenation (preprint)

Background: In current pandemic of COVID-19, approximately 15% to 30% of critically ill COVID-19 patients developed acute respiratory distress syndrome (ARDS) with a high mortality. Extracorporeal membrane of oxygenation (ECMO) provides direct support for both lung and heart in ARDS. However, the role of ECMO in COVID-19 related ARDS was still controversial. The aim of this study was to provide insights into the mortality, intensive care unit (ICU) management, risk factors for mortality, 180-day short term prognosis of the COVID-19 related severe ARDS patients receiving ECMO treatment. Methods: From Feb 2nd, 2020 to April 27th, 2020, we included adult COVID-19 related ARDS patients admitted to intensive care unit in Tongji Hospital. Totally, 53 patients were retrospectively analyzed. They were divided into ECMO (mechanical ventilation with ECMO, n=16) and non-ECMO group (mechanical ventilation, n=37). The primary outcome was all-cause 60-day mortality. The secondary outcomes were complications on ECMO, successful weaning from ECMO, and all-cause 180-day mortality. Results: The all-cause 60-day mortality was 37.5% (6/16) in ECMO group and 86.5% (32/37) in non-ECMO group (HR, 0.196; 95% CI, 0.053-0.721; p=0.014). 10 (62.5%) patients were successfully weaned from ECMO. The all-cause 180-day mortality was 56.3% (9/16) in ECMO group and 33 (89.2%, 33/37) in non-ECMO group (HR, 0.298; 95% CI, 0.130-0.680; p=0.004). All the patients in ECMO group suffered from at least one device-related complication with coagulopathy (81.3%) being most frequently seen. Up to 180-day follow up after disease onset, the ECMO-treated survivors maintained good quality of life without severe complications or disabilities. Hypercapnia, thrombopenia, myocardial injury and elevation of IL-8 and IL-10 during ECMO treatment were strongly associated with death.Conclusion: This study showed the COVID-19 patients significantly benefited from ECMO treatment during severe ARDS, which supported the application of ECMO as an indicated strategy in the management of COVID-19 related ARDS.

Pathogenesis clue from early clinical presentation of 300 hospitalized COVID-19 patients (preprint)

The global spread of COVID-19 has been lasted more than half a year. Except for the gene sequence and virus structure of SARS-CoV-2, its clinical characteristics, pathological mechanism and corresponding measures have not been fully revealed. Objective: To speculate the possible pathological mechanism from the early clinical manifestations of the patients with COVID-19. Methods: The onset symptoms, laboratory examination and CT findings on admission of 300 cases in two wards of Wuhan Third Hospital from January 28 to March 15 were analyzed retrospectively. Results: There was no difference in incidence between men and women, but women were hospitalized later after onset. Upper respiratory symptoms and sputum were seldom. The incidence of fever was 71%. Blood lymphocytes count decreased significantly on admission, which was related to the severity of the disease. In the moderate type of patients, who without hypoxia, thrombocytopenia occurred in 12.37%, CRP rose in 64.43 %, BUN elevated in 20.62 %, creatinine rose in 17.53 %, D-dimer elevated in 74.74%, creatine kinase and α-hydroxybutyrate dehydrogenase elevated in 45.36% and 54.12% patients respectively. The early CT showed a small amount of infiltration in the subpleural, the lateral zone of the lung and thickening of the interlobular septum. About 5 days later, infiltration had been worse in a part of the patients, and the affected lung was negatively correlated with the lymphocyte count. Conclusion: There was no gender difference in patients with SARS-CoV-2 invasion. Alveolar cells and T lymphocytes maybe main targets of the virus and apoptosis maybe primary pathogenesis. The virus entering the lung maybe transmitted through lymph or blood channels, rather than direct diffused in the respiratory tract. Early damage of multiple organs maybe caused by immune response. 

Pathogenesis Clues from the Early Clinical Presentation of 300 Hospitalized COVID-19 Patients (preprint)

Background: The global spread of the 2019 coronavirus disease (COVID-19) has lasted more than half a year. Except for the gene sequence and viral structure of SARS-CoV-2, its clinical characteristics, pathological mechanisms and corresponding measures have not been fully revealed. We aimed to speculate about the possible pathological mechanism from the early clinical manifestations of patients with COVID-19. Methods: The onset symptoms, laboratory examinations and CT findings on admission of 300 patients in two wards of Wuhan Third Hospital from January 28 to March 15 were analyzed retrospectively. Results: There was no difference in incidence between men and women, but women were hospitalized later after onset. Upper respiratory symptoms and sputum were rare. The incidence of fever was 71%. Blood lymphocyte counts were decreased significantly on admission and were related to the severity of the disease. In moderate patients without hypoxia, thrombocytopenia occurred in 12.37%, CRP rose in 64.43%, BUN was elevated in 20.62%, creatinine rose in 17.53%, D-dimer was elevated in 74.74%, and creatine kinase and α-hydroxybutyrate dehydrogenase were elevated in 45.36% and 54.12% of patients, respectively. Early CT showed a small amount of infiltration in the subpleural and lateral zones of the lung and thickening of the interlobular septum. Approximately 5 days later, infiltration was worse in some of the patients, and the proportion of involvement of the affected lung was negatively correlated with the lymphocyte count. Conclusions: There was no sex difference in patients with SARS-CoV-2 infection. Alveolar cells and T lymphocytes may be the main targets of the virus, and apoptosis may be the primary mechanism of pathogenesis. The virus entering the lung may be transmitted through lymph or blood vessels rather than directly dispersing through the respiratory tract. Early damage to multiple organs may be caused by the immune response.