SARS-CoV-2 Omicron infection augments the magnitude and durability of systemic and mucosal immunity in triple-dose CoronaVac recipients (preprint)

Background: The inactivated whole-virion vaccine, CoronaVac, is one of the most widely used coronavirus disease 2019 (COVID-19) vaccines worldwide. There is a paucity of data indicating the durability of the immune response and the impact of immune imprinting induced by CoronaVac upon Omicron breakthrough infection. Methods: In this prospective cohort study, 41 recipients of triple-dose CoronaVac and 14 unvaccinated individuals were recruited. We comprehensively profiled adaptive immune parameters in both groups, including spike-specific immunoglobulin (Ig) G and IgA titers, neutralizing activity, B cells, follicular helper T (Tfh) cells, CD4+ and CD8+ T cells, and their memory subpopulations at 12 months after the third booster dose and at 4 weeks and 20 weeks after Omicron BA.5 infection. Results: Twelve months after the third CoronaVac vaccination, spike-specific antibody and cellular responses were detectable in most vaccinated individuals. BA.5 infection significantly augmented the magnitude, cross-reactivity and durability of serum neutralization activities, Fc-mediated phagocytosis, and nasal spike-specific IgA responses, memory B cells, activated Tfh cells memory CD4+ T cells, and memory CD8+ T cells for both the ancestral strain and Omicron subvariants, compared to unvaccinated individuals. Notably, the increase in BA.5-specific immunity after breakthrough infection was consistently higher than for the ancestral strain, suggesting no evidence of immune imprinting. Immune landscape analyses showed vaccinated individuals have better synchronization of multiple immune components than unvaccinated individuals upon heterologous SARS-CoV-2 infection. Conclusion: Our data provides detailed insight into the protective role of inactivated COVID-19 vaccine in shaping humoral and cellular immune responses to heterologous Omicron infection.

Therapists' practical implementation and preparation of online counseling in the post-pandemic era.

In recent years, COVID-19 has led to a blossoming of online counseling (OC) as an important and alternative way to help people in need. In this regard, the present study aims to explore and clarify therapists' practical implementation and preparation of OC in the post-pandemic era by developing scales. In total, 306 Taiwanese licensed therapists participated in this study and filled out the developed scales (75 males and 231 females, 246 of whom have provided OC to clients). The psychometric analysis revealed that the two scales developed in this study, the implementation of OC scale and the preparation of OC scale, have positive reliability and validity. The former consists of three factors: standardized process, presence of infrastructure, and similarity in practice, and the latter comprises two factors: intent to conduct OC and perceived benefits for clients. In addition, the results indicated that therapists who are elder, more experienced, or working in community mental health facilities showed better practical implementation and preparation of OC. Findings from this study carry useful reference for strengthening therapists' preparation for and the effectiveness of OC.

Quality of care in the course of subcutaneous versus intravenous trastuzumab administration in patients with breast cancer: an integrated time-motion study with mixed-methods research.

OBJECTIVES: This study aimed to compare the time required and concerns raised by various perspectives of participants regarding administering subcutaneous and intravenous trastuzumab for patients with breast cancer (BC). DESIGN: This observational time-motion study design with mixed-methods research (cross-sectional surveys and semistructured interviews) was conducted. The time spent on preparing or administering trastuzumab by different healthcare professionals (HCPs) was recorded. The data were analysed by descriptive/inferential statistical analyses, followed by thematic analyses. SETTING: Outpatient and inpatient administration units of a single medical centre in Taiwan. PARTICIPANTS: The study included patients with early-stage BC who received subcutaneous or intravenous trastuzumab (n=93), and HCPs including two attending physicians, a nurse practitioner, two pharmacists and two nurses. RESULT: Based on the perspectives of patients and HCPs, the subcutaneous form of trastuzumab was more efficient, less expensive and produced less discomfort in outpatient units than inpatient units. More participants preferred the subcutaneous form over the intravenous form in both outpatient and inpatient units. Pharmacists and nurse practitioners spent threefold more time on patients when preparing and administering the intravenous form in both outpatient and inpatient units. The concerns raised by patients and HCPs varied in certain aspects, including the injection skills, speed, mental distress (eg, needle phobia) and pain associated with the subcutaneous form. Almost all patients preferred receiving the subcutaneous form in outpatient units after the initial COVID-19 outbreak. CONCLUSION: Patients with early-stage BC preferred receiving subcutaneous trastuzumab in outpatient units rather than inpatient units or the intravenous form before and after the COVID-19 outbreak. Such findings may serve as real-world evidence to facilitate better quality of care regarding administration of subcutaneous or intravenous trastuzumab in medical settings, and its feasible resolutions to balance the quality, concerns and efficiency of anticancer administration during the COVID-19 pandemic.

Efficacy and Safety of Baricitinib in Patients with Severe Alopecia Areata over 52 Weeks of Continuous Therapy in Two Phase III Trials (BRAVE-AA1 and BRAVE-AA2).

BACKGROUND: The oral Janus kinase (JAK) inhibitor baricitinib has demonstrated efficacy for severe alopecia areata (AA) over 36 weeks. There are limited data on the longer-term treatment of AA. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of baricitinib for AA in adults with ≥50% scalp hair loss through 52 weeks of continuous therapy in two phase III trials (BRAVE-AA1 and BRAVE-AA2). METHODS: Patients randomized to baricitinib at baseline in BRAVE-AA1 (N = 465) and BRAVE-AA2 (N = 390) retained their treatment allocation through Week 52. Efficacy outcomes included the proportion of patients achieving a Severity of Alopecia Tool (SALT) score ≤ 20 (≤ 20% scalp hair loss). Data were censored after permanent treatment discontinuation or if collected remotely due to the coronavirus disease 2019 (COVID-19) pandemic. RESULTS: Response rates for hair regrowth increased over the 52-week period. Of patients treated with baricitinib 4 mg and 2 mg, respectively, 40.9% and 21.2% in BRAVE-AA1 and 36.8% and 24.4% in BRAVE-AA2 achieved a SALT score ≤ 20 at Week 52. The most frequent treatment-emergent adverse events included upper respiratory tract infection, headache, nasopharyngitis, acne, urinary tract infection, creatine phosphokinase elevation, and COVID-19 infection. LIMITATION: There were no comparisons with placebo. CONCLUSION: Efficacy of baricitinib for adults with severe AA continuously improved over 52 weeks, indicating that long-term treatment may be necessary to observe maximum clinical benefit. There were no new safety signals. CLINICALTRIALS REGISTRATION: ClinicalTrials.gov NCT03570749 and NCT03899259. Efficacy and Safety of Baricitinib in Patients with Severe Alopecia Areata: Week-52 Results from BRAVE-AA1 and BRAVE-AA2.

Alopecia areata (AA) is an autoimmune disease that causes patchy hair loss on the scalp, face, and body. Baricitinib is a Janus kinase inhibitor that is approved to treat AA in several countries, based on results from two studies, BRAVE-AA1 and BRAVE-AA2. In these studies, adults with at least 50% scalp hair loss were treated with baricitinib for 36 weeks. Long-term therapy is important in AA, and hair regrowth can take longer in some patients with severe disease. Therefore, we assessed outcomes from a longer course of therapy. In this study, we report the results after 52 weeks of continuous treatment with baricitinib 4 mg or 2 mg in 465 patients in BRAVE-AA1 and 390 patients BRAVE-AA2. The goal was to reduce scalp hair loss to 20% or less by Week 52. In BRAVE-AA1, 40.9% of patients who took baricitinib 4 mg and 21.2% of patients who took baricitinib 2 mg had 20% or less missing scalp hair by Week 52. Similarly, in BRAVE-AA2, 36.8% of patients who took baricitinib 4 mg and 24.4% of patients who took baricitinib 2 mg had 20% or less missing scalp hair by Week 52. The most common adverse effects that were reported during the study period were upper respiratory tract infection, headache, nasopharyngitis, acne, urinary tract infection, creatine phosphokinase elevation, and coronavirus disease 2019 (COVID-19) infection. The results of longer-term treatment indicate that hair regrowth continues to improve without any new safety concerns for adults with severe AA taking baricitinib.

Rapid response nursing triage outcomes for COVID-19: factors associated with patient's participation in triage recommendations.

BACKGROUND: COVID-19 is an ongoing global health crisis with prevention and treatment recommendations rapidly changing. Rapid response telephone triage and advice services are critical in providing timely care during pandemics. Understanding patient participation with triage recommendations and factors associated with patient participation can assist in developing sensitive and timely interventions for receiving the treatment to prevent adverse health effects of COVID-19. METHODS: This cohort study aimed to assess patient participation (percentage of patients who followed nursing triage suggestions from the COVID hotline) and identify factors associated with patient participation in four quarterly electronic health records from March 2020 to March 2021 (Phase 1: 14 March 2020-6 June 2020; Phase 2: 17 June 2020-16 September 2020; Phase 3: 17 September 2020-16 December 2020; Phase 4: 17 December 2020-16 March 2021). All callers who provided their symptoms (including asymptomatic with exposure to COVID) and received nursing triage were included in the study. Factors associated with patient participation were identified using multivariable logistic regression analyses, including demographic variables, comorbidity variables, health behaviors, and COVID-19-related symptoms. RESULTS: The aggregated data included 9849 encounters/calls from 9021 unique participants. Results indicated: (1) 72.5% of patient participation rate; (2) participants advised to seek emergency department care had the lowest patient participation rate (43.4%); (3) patient participation was associated with older age, a lower comorbidity index, a lack of unexplained muscle aches, and respiratory symptoms. The absence of respiratory symptoms was the only factor significantly associated with patient participation in all four phases (OR = 0.75, 0.60, 0.64, 0.52, respectively). Older age was associated with higher patient participation in three out of four phases (OR = 1.01-1.02), and a lower Charlson comorbidity index was associated with higher patient participation in phase 3 and phase 4 (OR = 0.83, 0.88). CONCLUSION: Public participation in nursing triage during the COVID pandemic requires attention. This study supports using a nurse-led telehealth intervention and reveals crucial factors associated with patient participation. It highlighted the importance of timely follow-up in high-risk groups and the benefit of a telehealth intervention led by nurses serving as healthcare navigators during the COVID-19 pandemic.

Analysis on mosquito control effect in quarantine hotels for COVID-19 medical observation in Pudong District in 2020

Objective To analyze the mosquito density and larvae breeding of quarantine hotels for COVID-19 medical observation in Pudong District of Shanghai in 2020, assess mosquito control effect in outdoor environment of the hotels, and provide suggestions for the prevention and control of mosquito-borne diseases in these hotels. Methods CO2 traps were used for the investigation of mosquito density outside the quarantine hotels in the middle of every month from May to November in 2020, Breteau index and mosq-ovitrap method were adopted to monitor Aedes albopictus laval density in the middle of every month from May to October. Those investigation were also carried out in residential areas around the quarantine hotels. Mosquito control was conducted once a month in the town where the quarantine hotels located from May to November. Results The peak of mosquito density, Breteau index and mosq-ovitrap index in quarantine hotels for medical observation all appeared in June, being 1.85, 10.49 and 7.99 insects per trap per hour, respectively. The peak of mosquito density, Breteau index and mosq-ovitrap index in residential areas appeared in different month, being 2.00, 9.08 and 12.40 insects per trap per hour, respectively. The peaks of mosquito density and mosq-ovitrap index in quarantine hotels were earlier than those in residential areas. Statistical analysis showed that there was significant difference in the positive rate of mosq-ovitrap between quarantine hotels and residential areas (P < 0.001). The mosquito density in quarantine hotels reached the control standard, but the control effect of Aedes albopictus breeding sites was poor. Conclusion There was a risk of mosquito-borne diseases in quarantine hotels, so attention should be paid to mosquito control in such places and the construction of anti-mosquito facilities.

Mechanisms and strategies for operation of fever clinics in a general hospital during prevention and control of COVID-19

OBJECTIVE: To explore the mechanisms and strategies for operation of fever clinics of a general hospital during prevention and control of COVID-19. METHODS: The working characteristics and management modes of the fever clinic of the First Medical Center of Chinese PLA General Hospital were analyzed and summarized during the period of normalized prevention and control without cases and the period with local outbreak. RESULTS: During the period of normalized prevention and control, strict pre-job admission was carried out, the new recruits must pass the qualification test for special positions, the daily training was intensified, the treatment procedures were optimized, the step of identification of infectious diseases was moved forward to the triage;the closed-loop management of information was improved, the links such as identification of infectious diseases, treatment warning, prewarning and reporting have been achieved, and the standard prevention measures were taken. During the period of local outbreak, the application for demand of personnel and prevention supplies was put forward, fever clinic was designed and expanded, supporting personnel was trained, shifts were reasonably arranged, supervisors were added, and 24-hour logistic shifts wee also added. Zero infection of health care workers and zero case of nosocomial infection were achieved during the prevention and control of epidemic. CONCLUSION: The fever clinic is an outpost of prevention and control of infectious diseases. Combined with the characteristics, it is recommended that the construction of departments, personnel management and hardware configuration should be solidified and promoted.

Microfluidic nanodevices for drug sensing and screening applications

The outbreak of pandemics (e.g., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 in 2019), influenza A viruses (H1N1 in 2009), etc.), and worldwide spike in the aging population have created unprecedented urgency for developing new drugs to improve disease treatment. As a result, extensive efforts have been made to design novel techniques for efficient drug monitoring and screening, which form the backbone of drug development. Compared to traditional techniques, microfluidics-based platforms have emerged as promising alternatives for high-throughput drug screening due to their inherent miniaturization characteristics, low sample consumption, integration, and compatibility with diverse analytical strategies. Moreover, the microfluidic-based models utilizing human cells to produce in-vitro biomimetics of the human body pave new ways to predict more accurate drug effects in humans. This review provides a comprehensive summary of different microfluidics-based drug sensing and screening strategies and briefly discusses their advantages. Most importantly, an in-depth outlook of the commonly used detection techniques integrated with microfluidic chips for highly sensitive drug screening is provided. Then, the influence of critical parameters such as sensing materials and microfluidic platform geometries on screening performance is summarized. This review also outlines the recent applications of microfluidic approaches for screening therapeutic and illicit drugs. Moreover, the current challenges and the future perspective of this research field is elaborately highlighted, which we believe will contribute immensely towards significant achievements in all aspects of drug development.

Identification of Applicable YouTubers for Hotels: A Case Study of Integrated Hybrid MCDM Model

The coronavirus disease 2019 (COVID-19) pandemic has caused a serious business recession in various walks of life, particularly in the full-service hotel industry. YouTube has one billion active users and is undoubtedly a social media platform that companies use to build relationships with customers and create value for brands. Marketers should be aware of YouTubers' significant influence on complex decision-making processes. Given the above reasons, identifying a YouTuber attracts the concerns of various industries;thus, this important issue is focused on and offered the study's rationality. This study proposes an integrated hybrid MCDM model to organize the four key techniques of FDM, DEMATEL, ANP, and TOPSIS to identify YouTubers for hotels. Consequently, 12 key criteria and four core dimensions were identified to improve the decision of optimal YouTubers for promoting sustainable development and increasing the efficiency of decision-making. From the limited literature review, the proposed hybrid model was not observed regarding YouTuber identification of hotels;thus, this study provides a superior application contribution to address this important and interesting topic for academicians and practitioners.

Targeting spike protein-induced TLR/NET axis by COVID-19 therapeutic NRICM102 ameliorates pulmonary embolism and fibrosis.

The global COVID-19 pandemic remains a critical public health threat, as existing vaccines and drugs appear insufficient to halt the rapid transmission. During an outbreak from May to August 2021 in Taiwan, patients with severe COVID-19 were administered NRICM102, which was a traditional Chinese medicine (TCM) formula developed based on its predecessor NRICM101 approved for treating mild cases. This study aimed to explore the mechanism of NRICM102 in ameliorating severe COVID-19-related embolic and fibrotic pulmonary injury. NRICM102 was found to disrupt spike protein/ACE2 interaction, 3CL protease activity, reduce activation of neutrophils, monocytes and expression of cytokines (TNF-α, IL-1ß, IL-6, IL-8), chemokines (MCP-1, MIP-1, RANTES) and proinflammatory receptor (TLR4). NRICM102 also inhibited the spread of virus and progression to embolic and fibrotic pulmonary injury through reducing prothrombotic (vWF, PAI-1, NET) and fibrotic (c-Kit, SCF) factors, and reducing alveolar type I (AT1) and type II (AT2) cell apoptosis. NRICM102 may exhibit its protective capability via regulation of TLRs, JAK/STAT, PI3K/AKT, and NET signaling pathways. The study demonstrates the ability of NRICM102 to ameliorate severe COVID-19-related embolic and fibrotic pulmonary injury in vitro and in vivo and elucidates the underlying mechanisms.

covSampler: A Subsampling Method with Balanced Genetic Diversity for Large-Scale SARS-CoV-2 Genome Data Sets

Phylogenetic analysis has been widely used to describe, display and infer the evolutionary patterns of viruses. The unprecedented accumulation of SARS-CoV-2 genomes has provided valuable materials for the real-time study of SARS-CoV-2 evolution. However, the large number of SARS-CoV-2 genome sequences also poses great challenges for data analysis. Several methods for subsampling these large data sets have been introduced. However, current methods mainly focus on the spatiotemporal distribution of genomes without considering their genetic diversity, which might lead to postsubsampling bias. In this study, a subsampling method named covSampler was developed for the subsampling of SARS-CoV-2 genomes with consideration of both their spatiotemporal distribution and their genetic diversity. First, covSampler clusters all genomes according to their spatiotemporal distribution and genetic variation into groups that we call divergent pathways. Then, based on these divergent pathways, two kinds of subsampling strategies, representative subsampling and comprehensive subsampling, were provided with adjustable parameters to meet different users’ requirements. Our performance and validation tests indicate that covSampler is efficient and stable, with an abundance of options for user customization. Overall, our work has developed an easy-to-use tool and a webserver (https://www.covsampler.net) for the subsampling of SARS-CoV-2 genome sequences.

Curbing COVID-19 progression and mortality with traditional Chinese medicine among hospitalized patients with COVID-19: A propensity score-matched analysis.

BACKGROUND: Viral- and host-targeted traditional Chinese medicine (TCM) formulae NRICM101 and NRICM102 were administered to hospitalized patients with COVID-19 during the mid-2021 outbreak in Taiwan. We report the outcomes by measuring the risks of intubation or admission to intensive care unit (ICU) for patients requiring no oxygen support, and death for those requiring oxygen therapy. METHODS: This multicenter retrospective study retrieved data of 840 patients admitted to 9 hospitals between May 1 and July 26, 2021. After propensity score matching, 302 patients (151 received NRICM101 and 151 did not) and 246 patients (123 received NRICM102 and 123 did not) were included in the analysis to assess relative risks. RESULTS: During the 30-day observation period, no endpoint occurred in the patients receiving NRICM101 plus usual care while 14 (9.27%) in the group receiving only usual care were intubated or admitted to ICU. The numbers of deceased patients were 7 (5.69%) in the group receiving NRICM102 plus usual care and 27 (21.95%) in the usual care group. No patients receiving NRICM101 transitioned to a more severe status; NRICM102 users were 74.07% less likely to die than non-users (relative risk= 25.93%, 95% confidence interval 11.73%-57.29%). CONCLUSION: NRICM101 and NRICM102 were significantly associated with a lower risk of intubation/ICU admission or death among patients with mild-to-severe COVID-19. This study provides real-world evidence of adopting broad-spectrum oral therapeutics and shortening the gap between outbreak and effective response. It offers a new vision in our preparation for future pandemics.

Epidemiological monitoring to ascertain if SARS-CoV-2 infects dogs and cats

2019 novel coronavirus (SARS-CoV-2) is a new strain of coronavirus that has never been found in humans. SARS-CoV-2 is a beta coronavirus. whereas the coronaviruses infecting pet dogs and cats arise mainly from a-coronaviruses. Whether SARS-CoV-2 infects cats, dogs and other pets is an important public-health issue during this time. In the present study, respiratory-tract symptoms in 20 pet cats and 4 pet dogs (especially with obvious fever and cough symptoms) in Beijing, China, were detected by fluorescence quantitative polymerase chain reaction (PCR) of SARS-CoV-2 and established diagnostic methods. Throat swabs were collected to detect the nucleic acids of SARS-CoV-2 using fluorescence quantitative PCR and to detect other pathogens. The nucleic acids of SARS-CoV-2 were not present in the 24 pets that we evaluated.

Spatiotemporal Feature Learning Based on Two-Step LSTM and Transformer for CT Scans (preprint)

Computed tomography (CT) imaging could be very practical for diagnosing various diseases. However, the nature of the CT images is even more diverse since the resolution and number of the slices of a CT scan are determined by the machine and its settings. Conventional deep learning models are hard to tickle such diverse data since the essential requirement of the deep neural network is the consistent shape of the input data. In this paper, we propose a novel, effective, two-step-wise approach to tickle this issue for COVID-19 symptom classification thoroughly. First, the semantic feature embedding of each slice for a CT scan is extracted by conventional backbone networks. Then, we proposed a long short-term memory (LSTM) and Transformer-based sub-network to deal with temporal feature learning, leading to spatiotemporal feature representation learning. In this fashion, the proposed two-step LSTM model could prevent overfitting, as well as increase performance. Comprehensive experiments reveal that the proposed two-step method not only shows excellent performance but also could be compensated for each other. More specifically, the two-step LSTM model has a lower false-negative rate, while the 2-step Swin model has a lower false-positive rate. In summary, it is suggested that the model ensemble could be adopted for more stable and promising performance in real-world applications.

Factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic: a cross-sectional study in 12 Asian countries

IntroductionRegardless of having effective vaccines against COVID-19, containment measures such as enhanced physical distancing and good practice of personal hygiene remain the mainstay of controlling the COVID-19 pandemic. Countries across Asia have imposed these containment measures to varying extents. However, residents in different countries would have a differing degree of compliance to these containment measures potentially due to differences in the level of awareness and motivation in the early phase of pandemic.ObjectivesIn our study, we aimed to describe and correlate the level of knowledge and attitude with the level of compliance with personal hygiene and physical distancing practices among Asian countries in the early phase of pandemic.MethodsA multinational cross-sectional study was carried out using electronic surveys between May and June 2020 across 14 geographical areas. Subjects aged 21 years and above were invited to participate through social media, word of mouth and electronic mail.ResultsAmong the 2574 responses obtained, 762 (29.6%) participants were from East Asia and 1812 (70.4%) were from Southeast Asia (SEA). A greater proportion of participants from SEA will practise physical distancing as long as it takes (72.8% vs 60.6%). Having safe distancing practices such as standing more than 1 or 2 m apart (AdjOR 5.09 95% CI (1.08 to 24.01)) or more than 3 or 4 m apart (AdjOR 7.05 95% CI (1.32 to 37.67)), wearing a mask when they had influenza-like symptoms before the COVID-19 pandemic, preferring online news channels such as online news websites/applications (AdjOR 1.73 95% CI (1.21 to 2.49)) and social media (AdjOR 1.68 95% CI (1.13 to 2.50) as sources of obtaining information about COVID-19 and high psychological well-being (AdjOR 1.39 95% CI (1.04 to 1.87)) were independent factors associated with high compliance.ConclusionsWe found factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic and it will be useful to consider them in risk assessment, communication and pandemic preparedness.

The Willingness of Elderly Taiwanese Individuals to Accept COVID-19 Vaccines after the First Local Outbreak.

Vaccination is the most effective intervention to prevent infection and subsequent complications from SARS-CoV-2. Because of their multiple comorbidities, the elderly population experienced the highest number of deaths from the COVID-19 pandemic. Although in most countries, older people have top priority for COVID-19 vaccines, their actual willingness and attitudes regarding vaccination are still unclear. Thus, we conducted a cross-sectional study to investigate their willingness, attitudes, awareness, and knowledge of COVID-19 through a web-based questionnaire after the first local outbreak of COVID-19 in Taiwan. A total of 957 questionnaires were completed, and 74.9% of elderly individuals were likely to receive COVID-19 vaccines. The results from a multiple logistic regression demonstrated that older people who need to visit the outpatient department and have a high level of concern about the safety of COVID-19 vaccines are prone to having a negative willingness to accept COVID-19 vaccines. The following items related to awareness of the COVID-19 pandemic were attributed to the acceptance of COVID-19 vaccines: "understanding the risk of being infected by SARS-CoV-2", "understanding the effectiveness of COVID-19 vaccines", "willingness to accept the COVID-19 vaccine for protecting others", and "safety of COVID-19 vaccines is a key factor for you to accept them". Furthermore, a positive association between COVID-19 vaccination and attitudes toward accepting booster doses of the COVID-19 vaccine was observed. Our results show that these factors could affect the willingness of older people to accept COVID-19 vaccines and that they are important for policymakers and medical staff to develop vaccination plans during the COVID-19 pandemic.

Directed stimulation of the dentato-rubro-thalamic tract for deep brain stimulation in essential tremor: a blinded clinical trial.

OBJECTIVE: Observational studies utilising diffusion tractography have suggested a common mechanism for tremor alleviation in deep brain stimulation for essential tremor: the decussating portion of the dentato-rubro-thalamic tract. We hypothesised that directional stimulation of the dentato-rubro-thalamic tract would result in greater tremor improvement compared to sham programming, as well as comparable improvement as more tedious standard-of-care programming. METHODS: A prospective, blinded crossover trial was performed to assess the feasibility, safety and outcomes of programming based solely on dentato-rubro-thalamic tract anatomy. Using magnetic resonance imaging diffusion-tractography, the dentato-rubro-thalamic tract was identified and a connectivity-based treatment setting was derived by modelling a volume of tissue activated using directional current steering oriented towards the dentato-rubro-thalamic tract centre. A sham setting was created at approximately 180° opposite the connectivity-based treatment. Standard-of-care programming at 3 months was compared to connectivity-based treatment and sham settings that were blinded to the programmer. The primary outcome measure was percentage improvement in the Fahn-Tolosa-Marín tremor rating score compared to the preoperative baseline. RESULTS: Among the six patients, tremor rating scores differed significantly among the three experimental conditions (P=0.030). The mean tremor rating score improvement was greater with the connectivity-based treatment settings (64.6% ± 14.3%) than with sham (44.8% ± 18.6%; P=0.031) and standard-of-care programming (50.7% ± 19.2%; P=0.062). The distance between the centre of the dentato-rubro-thalamic tract and the volume of tissue activated inversely correlated with the percentage improvement in the tremor rating score (R2=0.24; P=0.04). No significant adverse events were encountered. CONCLUSIONS: Using a blinded, crossover trial design, we have shown the technical feasibility, safety and potential efficacy of connectivity-based stimulation settings in deep brain stimulation for treatment of essential tremor.

T cell response in patients with COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was the third zoonotic coronavirus to have an outbreak in the first two decades of the 21st century. Human-to-human transmission of this virus has threatened thousands of lives around the world. SARS-CoV-2 shares 79% and 50% sequence homology with severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), respectively. Like SARS-CoV and MERS-CoV infection, evidence has shown that SARS-CoV-2 infection also causes acute tissue damage due to a pathological immune response, particularly in severe cases. T cells play an important role in virus clearance and prevention, and in this paper, we summarize dynamic changes in the T cell count, subsets, phenotype, and function in Coronavirus Disease 2019 (COVID-19) patients based on current clinical reports. This review may help to better understand the pathological immune response of T cells and facilitate making better therapeutic strategies for patients with SARS-CoV-2 infection.