Early autoimmunity and outcome in virus encephalitis: a retrospective study based on tissue-based assay.

To explore the autoimmune response and outcome in the central nervous system (CNS) at the onset of viral infection and correlation between autoantibodies and viruses. METHODS: A retrospective observational study was conducted in 121 patients (2016-2021) with a CNS viral infection confirmed via cerebrospinal fluid (CSF) next-generation sequencing (cohort A). Their clinical information was analysed and CSF samples were screened for autoantibodies against monkey cerebellum by tissue-based assay. In situ hybridisation was used to detect Epstein-Barr virus (EBV) in brain tissue of 8 patients with glial fibrillar acidic protein (GFAP)-IgG and nasopharyngeal carcinoma tissue of 2 patients with GFAP-IgG as control (cohort B). RESULTS: Among cohort A (male:female=79:42; median age: 42 (14-78) years old), 61 (50.4%) participants had detectable autoantibodies in CSF. Compared with other viruses, EBV increased the odds of having GFAP-IgG (OR 18.22, 95% CI 6.54 to 50.77, p<0.001). In cohort B, EBV was found in the brain tissue from two of eight (25.0%) patients with GFAP-IgG. Autoantibody-positive patients had a higher CSF protein level (median: 1126.00 (281.00-5352.00) vs 700.00 (76.70-2899.00), p<0.001), lower CSF chloride level (mean: 119.80±6.24 vs 122.84±5.26, p=0.005), lower ratios of CSF-glucose/serum-glucose (median: 0.50[0.13-0.94] vs 0.60[0.26-1.23], p=0.003), more meningitis (26/61 (42.6%) vs 12/60 (20.0%), p=0.007) and higher follow-up modified Rankin Scale scores (1 (0-6) vs 0 (0-3), p=0.037) compared with antibody-negative patients. A Kaplan-Meier analysis revealed that autoantibody-positive patients experienced significantly worse outcomes (p=0.031). CONCLUSIONS: Autoimmune responses are found at the onset of viral encephalitis. EBV in the CNS increases the risk for autoimmunity to GFAP.

Infectious Complications After Tocilizumab in Patients with COVID: A Real-World Experience.

Introduction: Controversies remain regarding the safety of tocilizumab in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this study, we seek to describe the infectious complications after tocilizumab in COVID patients and determine the related risk factors. Methods: A single-center retrospective observational study was conducted among adult patients with SARS-CoV-2 infection admitted between 06/01/2020 and 12/31/2021 who received tocilizumab at our institution. Baseline demographics and laboratory values are obtained through reviewing electronic medical records. Risk factors of infectious complications after tocilizumab are identified through regression analysis. Statistics are performed using SPSS. P-value <0.05 is considered statistically significant. Results: Out of the 52 patients identified, infectious complications after tocilizumab were documented in 30 patients (57.7%). The most common infections include pneumonia, urinary tract infections, and bacteremia of unknown sources. Overall mortality was 42.3%. Through multivariate regression analysis, age more than 65, hyperglycemia on admission, and tocilizumab administration more than 2 days after hospital admission are independent risk factors associated with developing infections. Conclusions: In real-world experience, infectious complications are not uncommon in COVID patients who receive tocilizumab. Early use of tocilizumab may be of benefit. More rigorous patient selection and monitoring should be explored in future studies.

Attitude and Performance for Online Learning during COVID-19 Pandemic: A Meta-Analytic Evidence.

The COVID-19 pandemic prominently hit almost all the aspects of our life, especially in routine education. For public health security, online learning has to be enforced to replace classroom learning. Thus, it is a priority to clarify how these changes impacted students. We built a random-effect model of a meta-analysis to pool individual effect sizes for published articles concerning the attitudes and performance towards online learning. Databases included Google Scholar, PubMed and (Chinese) CNKI repository. Further, a moderated analysis and meta-regression were further used to clarify potential heterogenous factors impacting this pooled effect. Forty published papers (n = 98,558) were screened that were eligible for formal analysis. Meta-analytic results demonstrated that 13.3% (95% CI: 10.0-17.5) of students possessed negative attitudes towards online learning during the COVID-19 pandemic. A total of 12.7% (95% CI: 9.6-16.8) students were found to report poor performance in online learning. Moderated analysis revealed poor performance in online learning in the early pandemic (p = 0.006). Results for the meta-regression analysis showed that negative attitudes could predict poor learning performance significantly (p = 0.026). In conclusion, online learning that is caused by COVID-19 pandemic may have brought about negative learning attitudes and poorer learning performance compared to classroom learning, especially in the early pandemic.

Positive Epstein-Barr virus detection in coronavirus disease 2019 (COVID-19) patients.

The objective of this study was to detect the Epstein-Barr virus (EBV) coinfection in coronavirus disease 2019 (COVID-19). In this retrospective single-center study, we included 67 COVID-19 patients with onset time within 2 weeks in Renmin Hospital of Wuhan University from January 9 to February 29, 2020. Patients were divided into EBV/SARS-CoV-2 coinfection group and SARS-CoV-2 infection alone group according to the serological results of EBV, and the characteristics differences between the two groups were compared. The median age was 37 years, with 35 (52.2%) females. Among these COVID-19 patients, thirty-seven (55.2%) patients were seropositive for EBV viral capsid antigen (VCA) IgM antibody. EBV/SARS-CoV-2 coinfection patients had a 3.09-fold risk of having a fever symptom than SARS-CoV-2 infection alone patients (95% CI 1.11-8.56; P = 0.03). C-reactive protein (CRP) (P = 0.02) and the aspartate aminotransferase (AST) (P = 0.04) in EBV/SARS-CoV-2 coinfection patients were higher than that in SARS-CoV-2 infection alone patients. EBV/SARS-CoV-2 coinfection patients had a higher portion of corticosteroid use than the SARS-CoV-2 infection alone patients (P = 0.03). We find a high incidence of EBV coinfection in COVID-19 patients. EBV/SARS-CoV-2 coinfection was associated with fever and increased inflammation. EBV reactivation may associated with the severity of COVID-19.

Clinical characteristics of 132 healthcare worker cases with COVID-19: A retrospective study from a single center in Wuhan, China.

Many healthcare workers (HCWs) have been confirmed to be infected with SARS-CoV-2 in China. A retrospective, single-center study was conducted. The median age of the 132 HCWs with COVID-19 was 32 years, with 92 (69.7%) being females. There were 47 (35.6%) doctors, 72 (54.6%) nurses, and 13 (9.9%) other HCWs. Ten of the 132 patients (7.6%) had underlying diseases. The most common symptoms of illness onset were fever (70, 53.0%), cough (66, 50.0%), and fatigue (58, 43.9%). All patients were categorized into mild or moderate COVID-19 type on admission to hospital, and five (3.8%) progressed to the severe COVID-19 type. Sixty-six HCWs patients were included in both the early and later discharged group. In the logistic analysis, the later discharged patients had a longer time for illness onset to hospital admission (per 1 day; OR, 1.10; 95% CI, 1.03-1.18; p = .006), a higher proportion of >3 onset symptoms clustering (OR, 3.11; 95% CI, 1.27-7.62; p = .01), and a higher percentage of other HCWs (OR, 6.20; 95% CI, 1.49-25.80; p = .01). HCW patients were young female nurses with fewer comorbidities, and most were mild or moderate COVID-19 type. The later discharged patients exhibited characteristics of longer time for illness onset to hospitalization and clustering of onset symptoms.

Study on the variation of air pollutant concentration and its formation mechanism during the COVID-19 period in Wuhan.

To prevent the spread of COVID-19 (2019 novel coronavirus), from January 23 to April 8 in 2020, the highest Class 1 Response was ordered in Wuhan, requiring all residents to stay at home unless absolutely necessary. This action was implemented to cut down all unnecessary human activities, including industry, agriculture and transportation. Reducing these activities to a very low level during these hard times meant that some unprecedented naturally occurring measures of controlling emissions were executed. Ironically, however, after these measures were implemented, ozone levels increased by 43.9%. Also worthy of note, PM2.5 decreased 31.7%, which was found by comparing the observation data in Wuhan during the epidemic from 8th Feb. to 8th Apr. in 2020 with the same periods in 2019. Utilizing CMAQ (The Community Multiscale Air Quality modeling system), this article investigated the reason for these phenomena based on four sets of numerical simulations with different schemes of emission reduction. Comparing the four sets of simulations with observation, it was deduced that the emissions should decrease to approximately 20% from the typical industrial output, and 10% from agriculture and transportation sources, attributed to the COVID-19 lockdown in Wuhan. More importantly, through the CMAQ process analysis, this study quantitatively analyzed differences of the physical and chemical processes that were affected by the COVID-19 lockdown. It then examined the differences of the COVID-19 lockdown impact and determined the physical and chemical processes between when the pollution increased and decreased, determining the most affected period of the day. As a result, this paper found that (1) PM2.5 decreased mainly due to the reduction of emission and the contrary contribution of aerosol processes. The North-East wind was also in favor of the decreasing of PM2.5. (2) O3 increased mainly due to the slowing down of chemical consumption processes, which made the concentration change of O3 pollution higher at about 4 p.m.-7 p.m. of the day, while increasing the concentration of O3 at night during the COVID-19 lockdown in Wuhan. The higher O3 concentration in the North-East of the main urban area also contributed to the increasing of O3 with unfavorable wind direction.

Development of management strategies for pregnancy with SARS-CoV-2 infection

Objective: To develop .scientific and practical management strategies for pregnancy with novel coronavirus infection, so as to provide reference for clinical treatment of pregnancy with SARS-CoV-2 infection. Methods: Management strategies for pregnancy with SARS-CoV-2 infection were initially compiled, which was based on the literature researching and clinical treatment experience analysis. Then management strategies were modified by using Delphi method. Results: Management strategies for pregnancy with SARS-CoV-2 infection were compiled. There were totally 24 entries, involving 8 dimensions. Both of positive coefficients in two rounds of expert consultations were 100%. And both authoritative coefficients were 0. 91. And coordination coefficients ranged from 0. 24 to 0. 39. After two rounds of expert consultations, the importance values of each dimension varied from 4. 73 to 4. 89. Coefficients of variation(CV) of each dimension ranged from 0. 06 to 0. 14. And importance values of each item were different from 4. 71 to 4. 90. And CV of each item varied from 0. 05 to 0. 18. Conclusion: On the basis of Delphi method, compiled management strategies for pregnancy with SARS-CoV-2 infection are scientific and practical. And it can provide a reference for clinical fight against pregnancy with novel coronavirus infection.