Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial.

Importance: Myopia is a global concern, but effective prevention measures remain limited. Premyopia is a refractive state in which children are at higher risk of myopia, meriting preventive interventions. Objective: To assess the efficacy and safety of a repeated low-level red-light (RLRL) intervention in preventing incident myopia among children with premyopia. Design, Setting, and Participants: This was a 12-month, parallel-group, school-based randomized clinical trial conducted in 10 primary schools in Shanghai, China. A total of 139 children with premyopia (defined as cycloplegic spherical equivalence refraction [SER] of -0.50 to 0.50 diopter [D] in the more myopic eye and having at least 1 parent with SER ≤-3.00 D) in grades 1 to 4 were enrolled between April 1, 2021, and June 30, 2021; the trial was completed August 31, 2022. Interventions: Children were randomly assigned to 2 groups after grade stratification. Children in the intervention group received RLRL therapy twice per day, 5 days per week, with each session lasting 3 minutes. The intervention was conducted at school during semesters and at home during winter and summer vacations. Children in the control group continued usual activities. Main Outcomes and Measures: The primary outcome was the 12-month incidence rate of myopia (defined as SER ≤-0.50 D). Secondary outcomes included the changes in SER, axial length, vision function, and optical coherence tomography scan results over 12 months. Data from the more myopic eyes were analyzed. Outcomes were analyzed by means of an intention-to-treat method and per-protocol method. The intention-to-treat analysis included participants in both groups at baseline, while the per-protocol analysis included participants in the control group and those in the intervention group who were able to continue the intervention without interruption by the COVID-19 pandemic. Results: There were 139 children (mean [SD] age, 8.3 [1.1] years; 71 boys [51.1%]) in the intervention group and 139 children (mean [SD] age, 8.3 [1.1] years; 68 boys [48.9%]) in the control group. The 12-month incidence of myopia was 40.8% (49 of 120) in the intervention group and 61.3% (68 of 111) in the control group, a relative 33.4% reduction in incidence. For children in the intervention group who did not have treatment interruption secondary to the COVID-19 pandemic, the incidence was 28.1% (9 of 32), a relative 54.1% reduction in incidence. The RLRL intervention significantly reduced the myopic shifts in terms of axial length and SER compared with the control group (mean [SD] axial length, 0.30 [0.27] mm vs 0.47 [0.25] mm; difference, 0.17 mm [95% CI, 0.11-0.23 mm]; mean [SD] SER, -0.35 [0.54] D vs -0.76 [0.60] D; difference, -0.41 D [95% CI, -0.56 to -0.26 D]). No visual acuity or structural damage was noted on optical coherence tomography scans in the intervention group. Conclusions and Relevance: In this randomized clinical trial, RLRL therapy was a novel and effective intervention for myopia prevention, with good user acceptability and up to 54.1% reduction in incident myopia within 12 months among children with premyopia. Trial Registration: ClinicalTrials.gov Identifier: NCT04825769.

Spatiotemporal impact of non-pharmaceutical interventions against COVID-19 on the incidence of infectious diarrhea in Xi'an, China.

Background: Non-pharmaceutical interventions (NPIs) against COVID-19 may prevent the spread of other infectious diseases. Our purpose was to assess the effects of NPIs against COVID-19 on infectious diarrhea in Xi'an, China. Methods: Based on the surveillance data of infectious diarrhea, and the different periods of emergence responses for COVID-19 in Xi'an from 2011 to 2021, we applied Bayesian structural time series model and interrupted time series model to evaluate the effects of NPIs against COVID-19 on the epidemiological characteristics and the causative pathogens of infectious diarrhea. Findings: A total of 102,051 cases of infectious diarrhea were reported in Xi'an from 2011 to 2021. The Bayesian structural time series model results demonstrated that the cases of infectious diarrhea during the emergency response period was 40.38% lower than predicted, corresponding to 3,211 fewer cases, during the COVID-19 epidemic period of 2020-2021. The reduction exhibited significant variations in the demography, temporal and geographical distribution. The decline in incidence was especially evident in children under 5-years-old, with decreases of 34.09% in 2020 and 33.99% in 2021, relative to the 2017-2019 average. Meanwhile, the incidence decreased more significantly in industrial areas. Interpretation: NPIs against COVID-19 were associated with short- and long-term reductions in the incidence of infectious diarrhea, and this effect exhibited significant variations in epidemiological characteristics.

Bibliometric analysis and system review of vehicle routing optimization for emergency material distribution

Determining the optimal vehicle routing of emergency material distribution (VREMD) is one of the core issues of emergency management, which is strategically important to improve the effectiveness of emergency response and thus reduce the negative impact of large-scale emergency events. To summarize the latest research progress, we collected 511 VREMD-related articles published from 2010 to the present from the Scopus database and conducted a bibliometric analysis using VOSviewer software. Subsequently, we cautiously selected 49 articles from these publications for system review;sorted out the latest research progress in model construction and solution algorithms;and summarized the evolution trend of keywords, research gaps, and future works. The results show that domestic scholars and research organizations held an unqualified advantage regarding the number of published papers. However, these organizations with the most publications performed poorly regarding the number of literature citations. China and the US have contributed the vast majority of the literature, and there are close collaborations between researchers from both countries. The optimization model of VREMD can be divided into single-, multi-, and joint-objective models. The shortest travel time is the most common optimization objective in the single-objective optimization model. Several scholars focus on multiobjective optimization models to consider conflicting objectives simultaneously. In recent literature, scholars have focused on the impact of uncertainty and special events (e.g., COVID-19) on VREMD. Moreover, some scholars focus on joint optimization models to optimize vehicle routes and central locations (or material allocation) simultaneously. Solution algorithms can be divided into two primary categories, i.e., mathematical planning methods and intelligent evolutionary algorithms. The branch and bound algorithm is the most dominant mathematical planning algorithm, while genetic algorithms and their enhancements are the most commonly used intelligent evolutionary algorithms. It is shown that the nondominated sorting genetic algorithm II (NSGA-II) can effectively solve the multiobjective model of VREMD. To further improve the algorithm's performance, researchers have proposed improved hybrid intelligent algorithms that combine the advantages of NSGA-II and certain other algorithms. Scholars have also proposed a series of optimization algorithms for specific scenarios. With the development of new technologies and computation methods, it will be exciting to construct optimization models that consider uncertainty, heterogeneity, and temporality for large-scale real-world issues and develop generalized solution approaches rather than those applicable to specific scenarios.

Uncovering the Effects of Ammonium Sulfate on Neomycin B Biosynthesis in Streptomyces fradiae SF-2

The aminoglycoside antibiotic neomycin has broad antibacterial properties and is widely used in medicine and agriculture. With the discovery of neomycin's potential applications in treating tumors and SARS-CoV-2, it is necessary to accelerate the biosynthesis of neomycin. In the present study, we investigated the effects of various inorganic salts on neomycin B (the main active neomycin) biosynthesis in Streptomyces fradiae SF-2. We found that 60 mM (NH4)2SO4 could promote neomycin B biosynthesis and cell growth most effectively. Further comparative transcriptomic analyses revealed that 60 mM (NH4)2SO4 inhibited the EMP and TCA cycles and enhanced the expression of neo genes involved in the neomycin B biosynthesis pathway. Finally, a neomycin B potency of 17,399 U/mL in shaking flasks was achieved by overexpressing neoE and adding 60 mM (NH4)2SO4, corresponding to a 51.2% increase compared with the control S. fradiae SF-2. In the present study, the mechanism by which (NH4)2SO4 affects neomycin biosynthesis was revealed through transcriptomics, providing a reference for the further metabolic engineering of S. fradiae SF-2 for neomycin B production.

Thickness-Sensing Sandwiched Plasmonic Biosensors Enable Label-Free Naked-Eye Antibody Quantification.

Clinical serology assays for detecting the antibodies of the virus are time-consuming, are less sensitive/selective, or rely on sophisticated detection instruments. Here, we develop a sandwiched plasmonic biosensor (SPB) for supersensitive thickness-sensing via utilizing the distance-dependent electromagnetic coupling in sandwiched plasmonic nanostructures. SPBs quantitatively amplify the thickness changes on the nanoscale range (sensitivity: ∼2% nm-1) into macroscopically visible signals, thereby enabling the rapid, label-free, and naked-eye detection of targeted biomolecular species (via the thickness change caused by immunobinding events). As a proof of concept, this assay affords a broad dynamic range (7 orders of magnitude) and a low LOD (∼0.3 pM), allowing for the extremely accurate SARS-CoV-2 antibody quantification (sensitivity/specificity: 100%/∼99%, with a portable optical fiber device). This strategy is suitable for high-throughput multiplexed detection and smartphone-based sensing at the point-of-care, which can be expanded for various sensing applications beyond the fields of viral infections and vaccination.

Ecology of Middle East respiratory syndrome coronavirus, 2012-2020: A machine learning modelling analysis.

The ongoing enzootic circulation of the Middle East respiratory syndrome coronavirus (MERS-CoV) in the Middle East and North Africa is increasingly raising the concern about the possibility of its recombination with other human-adapted coronaviruses, particularly the pandemic SARS-CoV-2. We aim to provide an updated picture about ecological niches of MERS-CoV and associated socio-environmental drivers. Based on 356 confirmed MERS cases with animal contact reported to the WHO and 63 records of animal infections collected from the literature as of 30 May 2020, we assessed ecological niches of MERS-CoV using an ensemble model integrating three machine learning algorithms. With a high predictive accuracy (area under receiver operating characteristic curve = 91.66% in test data), the ensemble model estimated that ecologically suitable areas span over the Middle East, South Asia and the whole North Africa, much wider than the range of reported locally infected MERS cases and test-positive animal samples. Ecological suitability for MERS-CoV was significantly associated with high levels of bareland coverage (relative contribution = 30.06%), population density (7.28%), average temperature (6.48%) and camel density (6.20%). Future surveillance and intervention programs should target the high-risk populations and regions informed by updated quantitative analyses.

Application of geographic information system in the control of COVID-19 epidemic. (Special Issue: Spatio-temporal dynamics analysis, risk assessment and emergency management for COVID-19 epidemic.) [Chinese]

Since the outbreak of coronavirus disease 2019 (COVID-19) epidemic, the geographic information system (GIS) has played an important role in explaining the epidemic distribution, characteristics of regional transmission, risk assessment, and early prediction and warning, which greatly helped the disease control and prevention. In this study, the application of GIS in COVID-19 prevention and control was reviewed, hoping to provide reference for future improvement in the prevention and control measures.

Investigation of a family cluster outbreak of coronavirus disease 2019 in Xi-an. (Special Issue: Spatio-temporal dynamics analysis, risk assessment and emergency management for COVID-19 epidemic.) [Chinese]

Objective: To investigate the transmission characteristics of a family cluster outbreak of coronavirus disease 2019 (COVID-19) in Xi-an, in order to provide reference for prevention and control efforts.

Nursing Methods and Experience of Local Anesthesia Patients under Arthroscope.

In order to solve the nursing problems of local anesthesia patients under arthroscopy, a nursing method and experience based on local anesthesia patients under arthroscopy was proposed. From June 2019 to May 2021, 478 patients who underwent knee arthroscopy under spinal anesthesia or local anesthesia were retrospectively investigated, including 186 cases (38.9%) under local anesthesia and 292 cases (61.1%) under spinal anesthesia. 2% lidocaine plus epinephrine was injected locally and intra-articular in patients with local anesthesia, and 0.75% bupivacaine in patients with spinal anesthesia. It was found that in the local anesthesia group and spinal anesthesia group, 94.1% (175/186) and 98.3% (287/292) patients did not feel pain during operation. 93.0% (173/186 cases) and 96.2% (281/292 cases) of patients in the two groups were satisfied or very satisfied with the effect of anesthesia, respectively. The experimental results showed that local anesthesia was a simple and effective anesthesia method for knee arthroscopy, which was more reliable and safer than spinal anesthesia. Local anesthesia could be used for knee arthroscopy or cleaning and rinsing, free body removal, or even common meniscinoplasty.

Vaccination and Government Stringent Control as Effective Strategies in Preventing SARS-CoV-2 Infections: A Global Perspective.

With the rapid implementation of global vaccination against the coronavirus disease 2019 (COVID-19), the threat posed by the disease has been mitigated, yet it remains a major global public health concern. Few studies have estimated the effects of vaccination and government stringent control measures on the disease transmission from a global perspective. To address this, we collected 216 countries' data on COVID-19 daily reported cases, daily vaccinations, daily government stringency indexes (GSIs), and the human development index (HDI) from the dataset of the World Health Organization (WHO) and the Our World in Data COVID-19 (OWID). We utilized the interrupted time series (ITS) model to examine how the incidence was affected by the vaccination and GSI at continental and country levels from 22 January 2020 to 13 February 2022. We found that the effectiveness of vaccination was better in Europe, North America, and Africa than in Asia, South America, and Oceania. The long-term effects outperformed the short-term effects in most cases. Countries with a high HDI usually had a high vaccination coverage, resulting in better vaccination effects. Nonetheless, some countries with high vaccination coverage did not receive a relatively low incidence due to the weaker GSI. The results suggest that in addition to increasing population vaccination coverage, it is crucial to maintain a certain level of government stringent measures to prevent and control the disease. The strategy is particularly appropriate for countries with low vaccination coverage at present.

Using Crowdsourced Big Data to Unravel Urban Green Space Utilization during COVID-19 in Guangzhou, China

Urban green spaces (UGSs) can meet the spiritual and cultural needs of citizens and provide various ecosystem services. In the context of the COVID-19 pandemic, the utilization of UGSs has been affected in various countries worldwide. This study considered 13 UGSs in Guangzhou, China, as examples. It obtained user check-in data by sampling the check-in pages of Sina Weibo locations using a Python-based web crawler program. The study was conducted for 731 days from 1 October 2019 to 30 September 2021, during different phases of the pandemic. Based on automated Chinese corpus recognition technology, statistical results were obtained after periodization and sentiment calculation. The study assessed the pandemic's impact on the use of UGSs by analyzing the time, frequency, and emotions of residents visiting UGSs. The study concluded that the emotions of UGS users during COVID-19 tended to be positive. They tended to choose UGSs with low expected population density and visited UGSs on weekdays. Additionally, the religious attributes of UGSs also influenced their utilization.

Toxoplasma gondii infection as a risk factor for osteoporosis: a case-control study.

BACKGROUND: More than one-third of the total world population is infected by Toxoplasma gondii (T. gondii). T. gondii has been linked to various diseases, such as cancer, mental disorders, type 2 diabetes mellitus (T2DM), etc. However, the effects of T. gondii infection on the risk of osteoporosis are unclear. Our study aimed to uncover evidence to determine whether patients exposed to T. gondii have an increased or decreased risk of osteoporosis in people with abnormal bone mineral density (BMD) by using case-control study. METHODS: A total of 729 patients, including 316 osteopenia and 413 osteoporosis patients of Han Chinese ancestry were selected in the study. Their blood samples were collected and the levels of specific IgG antibodies against T. gondii were measured using ELISA assay. We obtained some information about the patients from the medical record that included demographic indexes and clinical data. A logistic regression analysis was used to evaluate the effects of T. gondii infection on femur osteoporosis, lumbar osteoporosis and compound osteoporosis. Potential interaction was analyzed using multifactor dimensionality reduction software 1.0.0 (MDR 1.0.0). RESULTS: 113 positive patients with T. gondii infections have been detected, including 80 cases of osteoporosis and 33 cases of osteopenia, the infection rates of T. gondii were 19.37% (80/413) and 10.44% (33/316), respectively. The patients with T.gondii infections were at a 2.60 times higher risk of suffering from compound osteoporosis than those without T. gondii infections (OR = 2.60, 95% CI 1.54-4.39, P < 0.001), but not associated with femur osteoporosis (OR = 1.01, 95% CI 0.43-2.34, P = 0.989) and lumbar osteoporosis (OR = 0.84, 95% CI 0.34-2.07, P = 0.705) after adjusting for the covariates. Moreover, a significantly higher risk of compound osteoporosis in the individuals with all two factors (T. gondii infection, Female) was observed compared with reference group (without T. gondii infection, male) under the interaction model (OR = 11.44, 95%CI = 5.44-24.05, P < 0.001). And the individuals with all two factors (T. gondii infection, over 70 years) exhibited a 8.14-fold higher possibility of developing compound osteoporosis compared with reference group (without T. gondii infection, under 70 years) (OR = 8.14, 95% CI 3.91-16.93, P < 0.001). We further stratified by age and sex, and found that women with T. gondii infection was more likely to develop compound osteoporosis than those without infection(OR = 3.12, 95% CI 1.67-5.81, P < 0.001), but we not found the association between T. gondii infection and compound osteoporosis in males (OR = 1.36, 95% CI 0.37-4.94, P = 0.645). CONCLUSIONS: T. gondii infection is a risk factor for osteoporosis, especially compound osteoporosis. Meanwhile, it is very necessary for patients with osteoporosis to further diagnose and treat T. gondii infection, especially women.

From Outbreak to Near Disappearance: How Did Non-pharmaceutical Interventions Against COVID-19 Affect the Transmission of Influenza Virus?

Influenza shares the same putative transmission pathway with coronavirus disease 2019 (COVID-19), and causes tremendous morbidity and mortality annually globally. Since the transmission of COVID-19 in China, a series of non-pharmaceutical interventions (NPIs) against to the disease have been implemented to contain its transmission. Based on the surveillance data of influenza, Search Engine Index, and meteorological factors from 2011 to 2021 in Xi'an, and the different level of emergence responses for COVID-19 from 2020 to 2021, Bayesian Structural Time Series model and interrupted time series analysis were applied to quantitatively assess the impact of NPIs in sequent phases with different intensities, and to estimate the reduction of influenza infections. From 2011 to 2021, a total of 197,528 confirmed cases of influenza were reported in Xi'an, and the incidence of influenza continuously increased from 2011 to 2019, especially, in 2019–2020, when the incidence was up to 975.90 per 100,000 persons;however, it showed a sharp reduction of 97.68% in 2020–2021, and of 87.22% in 2021, comparing with 2019–2020. The highest impact on reduction of influenza was observed in the phase of strict implementation of NPIs with an inclusion probability of 0.54. The weekly influenza incidence was reduced by 95.45%, and an approximate reduction of 210,100 (95% CI: 125,100–329,500) influenza infections was found during the post-COVID-19 period. The reduction exhibited significant variations in the geographical, population, and temporal distribution. Our findings demonstrated that NPIs against COVID-19 had a long-term impact on the reduction of influenza transmission.

Numerical evaluation of face masks for prevention of COVID-19 airborne transmission.

The COVID-19 pandemic has forced governments around the globe to apply various preventive measures for public health. One of the most effective measures is wearing face masks, which plays a vital role in blocking the transmission of droplets and aerosols. To understand the protective mechanism of face masks, especially in indoor environments, we apply a computational fluid dynamics technique to predict the lifetime of cough droplets. Therefore, we can assess the exposure risk in a ventilated room where an infected individual wears a face mask or not. We focus on the dynamic evaporation and diffusion of droplets in a human-cough process, which is a major cause for the spread of the virus. We find that wearing a face mask can effectively reduce the total mass and Sauter mean diameter of the residual droplets after a single cough. The mass concentration of virus-carrying droplets in the ventilated room decreases by 201, 43,786, and 307,060 times, corresponding to wearing cotton face masks, surgical face masks, and N95 face masks, respectively. However, the maximum travel distance of 80% droplets is insensitive to wearing a face mask or not. Therefore, the residual droplets are widely distributed due to the influence of indoor airflow. Furthermore, we study aerosol exposure risks in different areas of the room and find that high concentrations of aerosols occur in the streamline through an infected individual, especially next to the individual within 1.5 m. This strongly suggests a social distance despite the fact that the majority of droplets are filtered by face masks. This study explains the impact of face masks and airflow on indoor exposure risks and further inspires potential measures for public health, for example, no individuals should sit near the air supply opening.

Patterns of mental health problems before and after easing COVID-19 restrictions: Evidence from a 105248-subject survey in general population in China.

BACKGROUND: The COVID-19 pandemic has alarming implications for individual and population level mental health. Although the future of COVID-19 is unknown at present, more countries or regions start to ease restrictions. The findings from this study have provided the empirical evidence of prevalence and patterns of mental disorders in Chinese general population before and after easing most COVID-19 restrictions, and information of the factors associated with these patterns. METHODS: A cross-sectional population-based online survey was carried out from February to March 2020 in the general population across all provinces in China. The 12-item General Health Questionnaire (GHQ-12) was incorporated in the survey. Latent class analyses were performed to investigate the patterns of mental disorders and multinomial logistic regressions were used to examine how individual and regional risk factors can predict mental disorder patterns. RESULTS: Four distinctive patterns of mental health were revealed in the general population. After the ease of most COVID-19 restrictions, the prevalence of high risk of mental disorders decreased from 25.8% to 20.9% and prevalence of being high risk of unhappiness and loss of confidence decreased from 10.1% to 8.1%. However, the prevalence of stressed, social dysfunction and unhappy were consistently high before and after easing restrictions. Several regional factors, such as case mortality rate and healthcare resources, were associated with mental health status. Of note, healthcare workers were less likely to have mental disorders, compared to other professionals and students. CONCLUSIONS: The dynamic management of mental health and psychosocial well-being is as important as that of physical health both before and after the ease of COVID-19 restrictions. Our findings may help in mental health interventions in other countries and regions while easing COVID-19 restrictions.

A Cluster Transmission of Coronavirus Disease 2019 and the Prevention and Control Measures in the Early Stage of the Epidemic in Xi'an, China, 2020.

BACKGROUND At the beginning of the COVID-19 pandemic, a cluster outbreak caused by an imported case from Hubei Province was reported in Xi'an City, Shaanxi Province, China. Ten patients from 2 families and 1 hospital were involved in the transmission. MATERIAL AND METHODS We conducted an epidemiological investigation to identify the cluster transmission of COVID-19. The demographic, epidemiological, clinical, laboratory, and cluster characteristics were described and analyzed. RESULTS From January 27 to February 13, 2020, a total of 10 individuals were confirmed to be infected with SARS-CoV-2 by the nucleic acid testing of nasopharyngeal swabs from 2 families and 1 hospital. Among the confirmed cases, 7 had atypical clinical symptoms and 3 were asymptomatic. The median times from onset to diagnosis and to discharge were 3.5 days (range, 1-5 days) and 19.5 days (range, 16-38 days), respectively. There were 4 patients whose exposure dates were 1, 3, 3, and 2 days earlier than the onset dates of their previous-generation cases, respectively. Four prevention and control measures were effectively used to interrupt the disease transmission. CONCLUSIONS SARS-CoV-2 can be easily transmitted within families and in hospitals, and asymptomatic patients could act as a source of disease transmission. The results of this outbreak at the early epidemic stage support the recommendation that individuals with confirmed COVID-19 and all their close contacts should be subjected to medical quarantined observation and nucleic acid screening as early as possible, even if they do not have any symptoms. Meanwhile, people in high-risk areas should improve their protective measures.

Fast detection of harmful trace elements in glycyrrhiza using standard addition and internal standard method - laser-induced breakdown spectroscopy (SAIS-LIBS)

Glycyrrhiza is traditional Chinese medicine, whose active compounds have great potential in treating COVID-19. Detecting harmful trace elements of glycyrrhiza has become essential. However, it is not easy to detect trace elements due to the complex matrix of nonstandard glycyrrhiza. Calibration-free laser-induced breakdown spectroscopy (CF-LIBS) can be used in quantitive of nonstandard, but its stability and accuracy are low. To detect trace elements of glycyrrhiza quickly and accurately, this work introduced the standard addition method and internal standard method into LIBS, namely SAIS-LIBS. SAIS-LIBS was applied to determine trace copper and manganese in glycyrrhiza. The results showed that SAIS-LIBS had higher efficiency (<0.3 h), and could be up to 3-25 times more accuracy and stability than CF-LIBS. Furthermore, SAIS-LIBS results and inductively coupled plasma-optical emission spectroscopy (ICP-OES) were very similar (p-values > 0.05). This research provided a foundation for the rapid and accurate detection of harmful trace elements in glycyrrhiza.

Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012-2020.

BACKGROUND: The ongoing transmission of the Middle East respiratory syndrome coronavirus (MERS-CoV) in the Middle East and its expansion to other regions are raising concerns of a potential pandemic. An in-depth analysis about both population and molecular epidemiology of this pathogen is needed. METHODS: MERS cases reported globally as of June 2020 were collected mainly from World Health Organization official reports, supplemented by other reliable sources. Determinants for case fatality and spatial diffusion of MERS were assessed with Logistic regressions and Cox proportional hazard models, respectively. Phylogenetic and phylogeographic analyses were performed to examine the evolution and migration history of MERS-CoV. RESULTS: A total of 2562 confirmed MERS cases with 150 case clusters were reported with a case fatality rate of 32.7% (95% CI: 30.9‒34.6%). Saudi Arabia accounted for 83.6% of the cases. Age of ≥ 65 years old, underlying conditions and ≥ 5 days delay in diagnosis were independent risk factors for death. However, a history of animal contact was associated with a higher risk (adjusted OR = 2.97, 95% CI: 1.10-7.98) among female cases < 65 years but with a lower risk (adjusted OR = 0.31, 95% CI: 0.18-0.51) among male cases ≥ 65 years old. Diffusion of the disease was fastest from its origin in Saudi Arabia to the east, and was primarily driven by the transportation network. The most recent sub-clade C5.1 (since 2013) was associated with non-synonymous mutations and a higher mortality rate. Phylogeographic analyses pointed to Riyadh of Saudi Arabia and Abu Dhabi of the United Arab Emirates as the hubs for both local and international spread of MERS-CoV. CONCLUSIONS: MERS-CoV remains primarily locally transmitted in the Middle East, with opportunistic exportation to other continents and a potential of causing transmission clusters of human cases. Animal contact is associated with a higher risk of death, but the association differs by age and sex. Transportation network is the leading driver for the spatial diffusion of the disease. These findings how this pathogen spread are helpful for targeting public health surveillance and interventions to control endemics and to prevent a potential pandemic.

[Observation of therapeutic effect on coronavirus disease 2019 with insomnia in treatment with baduanjin and auricular point sticking therapy].

OBJECTIVE: To compare the clinical therapeutic effect on coronavirus disease 2019 (COVID-19) with insomnia between the combined treatment of baduanjin and auricular point sticking therapy and the medication with oral estazolam on the base of the conventional treatment. METHODS: A total of 90 patients with COVID-19 accompanied with insomnia were randomly divided into an observation group (45 cases, 3 cases dropped off) and a control group (45 cases). In the observation group, baduanjin, a traditional Chinese fitness activity, was practiced everyday. Besides, auricular point sticking therapy was exerted at ear-shenmen (TF 4), subcortex (AT 4), heart (CO 15), occiput (AT 3), etc. These auricular points were pressed and kneaded three times a day, 30 s at each point each time, consecutively for 12 days. In the control group, estazolam tablets were prescribed for oral administration, 1 mg, once daily, consecutively for 12 days. Before and after treatment, the score of Pittsburgh sleep quality index (PSQI), the score of self-rating anxiety scale (SAS), the score of self-rating depression scale (SDS) and the score of symptoms in traditional Chinese medicine (TCM) were observed in the two groups and the clinical therapeutic effect was evaluated. RESULTS: After treatment, the scores of every item and the total scores in PSQI were all reduced as compared with those before treatment in the two groups (P<0.01). The scores of sleep time and sleep efficiency in the observation group were lower than those in the control group after treatment (P<0.05). SAS scores and SDS scores in the observation group and SAS score in the control group after treatment were all reduced as compared with those before treatment (P<0.01), and SDS score in the observation group was lower than that in the control group (P<0.01). After treatment, in the observation group, the score of each of the symptoms of TCM, i.e. unsound sleep, irritability and hot temper, profuse sputum and sticky feeling in the mouth, bitter taste in the mouth and foul breath, abdominal distention and poor appetite, as well as lassitude was reduced as compared with that before treatment successively (P<0.01), and the scores aforementioned (excepted for the unsound sleep) in the observation group were all lower than the control group (P<0.05). The total effective rates were 83.3% (35/42) in the observation group and 84.4% (38/45) in the control group, without statistical difference in comparison (P>0.05). CONCLUSION: The combined treatment of baduanjin and auricular point sticking therapy improves sleep quality, the conditions of anxiety and depression and the symptoms in TCM for patients of COVID-19 with insomnia. The therapeutic effect of this combined treatment is better than the oral administration of estazolam.