A case with prolonged headache after COVID-19 vaccination and later developed Bell's palsy.

PURPOSE: During COVID-19 pandemic, the authorization of emergent usage of new vaccine has raised suspicions and doubts about potential adverse events related to vaccination. Among the reported adverse events related to ChAdOx1/nCoV-19 vaccine, facial paralysis did not have an incident rate higher than natural occurrence like mRNA vaccines. However, temporal association between vaccination and facial palsy have been documented in several studies. Here, we report a case of an otherwise healthy 23-year-old Taiwanese female who experienced prolonged headache since the second day postvaccination and developed facial palsy on the tenth day. CASE REPORT: A 23-year-old Taiwanese female who was previously healthy experienced intermittent right side throbbing headache, general malaise, myalgia and fever. Headache, transient ear pain and right scalp numbness developed in the next few days but quickly resolved. On day ten after vaccination, signs of facial palsy on the right side of her face was noticed. The results of brain Magnetic Resonance Imaging (MRI) with contrast displayed no abnormality. Facial stimulation and blink reflex tests were compatible with right facial neuropathy. CONCLUSION: Reactivation of latent herpes virus has been suggested as one of the possible mechanisms underlying the phenomenon, but the causal pathophysiology related to the symptom needs further validation. Moreover, in the event of facial palsy post-vaccination, alternative diagnoses such as Guillain-Barre syndrome (GBS), Ramsey-Hunt syndrome, Lyme disease, trauma, central nervous system infection (CNS) infection, or stroke should also be considered.

Identification of priority pathogens for aetiological diagnosis in adults with community-acquired pneumonia in China: a multicentre prospective study.

BACKGROUND: Community-acquired pneumonia (CAP) is a major public health challenge worldwide. However, the aetiological and disease severity-related pathogens associated with CAP in adults in China are not well established based on the detection of both viral and bacterial agents. METHODS: A multicentre, prospective study was conducted involving 10 hospitals located in nine geographical regions in China from 2014 to 2019. Sputum or bronchoalveolar lavage fluid (BALF) samples were collected from each recruited CAP patient. Multiplex real-time PCR and bacteria culture methods were used to detect respiratory pathogens. The association between detected pathogens and CAP severity was evaluated. RESULTS: Among the 3,403 recruited eligible patients, 462 (13.58%) had severe CAP, and the in-hospital mortality rate was 1.94% (66/3,403). At least one pathogen was detected in 2,054 (60.36%) patients, with two or more pathogens were co-detected in 725 patients. The ten major pathogens detected were Mycoplasma pneumoniae (11.05%), Haemophilus influenzae (10.67%), Klebsiella pneumoniae (10.43%), influenza A virus (9.49%), human rhinovirus (9.02%), Streptococcus pneumoniae (7.43%), Staphylococcus aureus (4.50%), adenovirus (2.94%), respiratory syncytial viruses (2.35%), and Legionella pneumophila (1.03%), which accounted for 76.06-92.52% of all positive detection results across sampling sites. Klebsiella pneumoniae (p < 0.001) and influenza viruses (p = 0.005) were more frequently detected in older patients, whereas Mycoplasma pneumoniae was more frequently detected in younger patients (p < 0.001). Infections with Klebsiella pneumoniae, Staphylococcus aureus, influenza viruses and respiratory syncytial viruses were risk factors for severe CAP. CONCLUSIONS: The major respiratory pathogens causing CAP in adults in China were different from those in USA and European countries, which were consistent across different geographical regions over study years. Given the detection rate of pathogens and their association with severe CAP, we propose to include the ten major pathogens as priorities for clinical pathogen screening in China.

Effect of EIT-guided PEEP titration on prognosis of patients with moderate to severe ARDS: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Acute respiratory syndrome distress (ARDS) is a clinical common syndrome with high mortality. Electrical impedance tomography (EIT)-guided positive end-expiratory pressure (PEEP) titration can achieve the compromise between lung overdistension and collapse which may minimize ventilator-induced lung injury in these patients. However, the effect of EIT-guided PEEP titration on the clinical outcomes remains unknown. The objective of this trial is to investigate the effects of EIT-guided PEEP titration on the clinical outcomes for moderate or severe ARDS, compared to the low fraction of inspired oxygen (FiO2)-PEEP table. METHODS: This is a prospective, multicenter, single-blind, parallel-group, adaptive designed, randomized controlled trial (RCT) with intention-to-treat analysis. Adult patients with moderate to severe ARDS less than 72 h after diagnosis will be included in this study. Participants in the intervention group will receive PEEP titrated by EIT with a stepwise decrease PEEP trial, whereas participants in the control group will select PEEP based on the low FiO2-PEEP table. Other ventilator parameters will be set according to the ARDSNet strategy. Participants will be followed up until 28 days after enrollment. Three hundred seventy-six participants will be recruited based on a 15% decrease of 28-day mortality in the intervention group, with an interim analysis for sample size re-estimation and futility assessment being undertaken once 188 participants have been recruited. The primary outcome is 28-day mortality. The secondary outcomes include ventilator-free days and shock-free days at day 28, length of ICU and hospital stay, the rate of successful weaning, proportion requiring rescue therapies, compilations, respiratory variables, and Sequential Organ Failure Assessment (SOFA). DISCUSSION: As a heterogeneous syndrome, ARDS has different responses to treatment and further results in different clinical outcomes. PEEP selection will depend on the properties of patients and can be individually achieved by EIT. This study will be the largest randomized trial to investigate thoroughly the effect of individual PEEP titrated by EIT in moderate to severe ARDS patients to date. TRIAL REGISTRATION: ClinicalTrial.gov NCT05207202. First published on January 26, 2022.

Extended Multicriteria Group Decision Making with a Novel Aggregation Operator for Emergency Material Supplier Selection.

How to ensure the normal production of industries in an uncertain emergency environment has aroused a lot of concern in society. Selecting the best emergency material suppliers using the multicriteria group decision making (MCGDM) method will ensure the normal production of industries in this environment. However, there are few studies in emergency environments that consider the impact of the decision order of decision makers (DMs) on the decision results. Therefore, in order to fill the research gap, we propose an extended MCGDM method, whose main steps include the following: Firstly, the DMs give their assessment of all alternatives. Secondly, we take the AHP method and entropy weight method to weight the criteria and the DMs. Thirdly, we take the intuitionistic fuzzy hybrid priority weight average (IFHPWA) operator we proposed to aggregate evaluation information and take the TOPSIS method to rank all the alternatives. Finally, the proposed method is applied in a case to prove its practicability and effectiveness. The proposed method considers the influence of the decision order of the DMs on the decision results, which improves the accuracy and efficiency of decision-making results.

High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review.

OBJECTIVE: This study aimed to investigate the effect of high-flow nasal cannula therapy (HFNC) versus conventional oxygen therapy (COT) on intubation rate, 28-day intensive care unit (ICU) mortality, 28-day ventilator-free days (VFDs) and ICU length of stay (ICU LOS) in adult patients with acute respiratory failure (ARF) associated with COVID-19. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Web of Science, Cochrane Library and Embase up to June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Only randomised controlled trials or cohort studies comparing HFNC with COT in patients with COVID-19 were included up to June 2022. Studies conducted on children or pregnant women, and those not published in English were excluded. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened the titles, abstracts and full texts. Relevant information was extracted and curated in the tables. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to assess the quality of randomised controlled trials or cohort studies. Meta-analysis was conducted using RevMan V.5.4 computer software using a random effects model with a 95% CI. Heterogeneity was assessed using Cochran's Q test (χ2) and Higgins I2 statistics, with subgroup analyses to account for sources of heterogeneity. RESULTS: Nine studies involving 3370 (1480 received HFNC) were included. HFNC reduced the intubation rate compared with COT (OR 0.44, 95% CI 0.28 to 0.71, p=0.0007), decreased 28-day ICU mortality (OR 0.54, 95% CI 0.30 to 0.97, p=0.04) and improved 28-day VFDs (mean difference (MD) 2.58, 95% CI 1.70 to 3.45, p<0.00001). However, HFNC had no effect on ICU LOS versus COT (MD 0.52, 95% CI -1.01 to 2.06, p=0.50). CONCLUSIONS: Our study indicates that HFNC may reduce intubation rate and 28-day ICU mortality, and improve 28-day VFDs in patients with ARF due to COVID-19 compared with COT. Large-scale randomised controlled trials are necessary to validate our findings. PROSPERO REGISTRATION NUMBER: CRD42022345713.

An expanded definition of acute respiratory distress syndrome: Challenging the status quo.

Although the Berlin definition of acute respiratory distress syndrome (ARDS), 2012 has been widely used in clinical practice, issues have occasionally been raised regarding various criteria since it was proposed. High-flow nasal oxygen (HFNO) is widely used for effective respiratory support in acute respiratory failure. As patients who do not require ventilation but meet the Berlin criteria have similar characteristics to those with ARDS, the definition of ARDS may be broadened to include patients receiving HFNO. As the PaO2/FiO2 under-recognizes the diagnosis of ARDS, a SpO2/FiO2 value of ≤315 may be considered instead of a PaO2/FiO2 value of ≤300 for diagnosing the condition in resource-constrained settings. In this context, patients with severe COVID-19 always meet other criteria for ARDS except for 7-day acute onset. Therefore, the timeframe for the onset of ARDS may be extended to up to 14 days. An expanded definition of ARDS may allow early identification of patients with less severe diseases and facilitate testing and application of new therapies in patients with a high risk of poor outcomes. Here, we discuss the major controversies regarding the extension of the ARDS definition with a view to improving clinical implementation and patient outcomes.

How does interactive virtual reality enhance learning outcomes via emotional experiences? A structural equation modeling approach.

Introduction: Interest in interactive virtual reality (IVR) is increasing due to its potential for embodied learning and group-led teaching. However, few studies have investigated the internal mechanism by which IVR technology features and learning experiences affect learning outcomes in terms of psychological and emotional value. Based on media technology models and the control value theory of achievement emotions (CVTAE), this study uses structural equation modeling (SEM) to investigate the correlations among the internal elements of IVR technology features, learning experiences, and learning outcomes. It also emphasizes the role played by emotional experience in this context. Methods: The sample referenced by this study consisted of 480 college students (193 males) who were simultaneously engaged in guided inquiry and learning in an IVR-based COVID-19 pandemic science museum in groups of 10. Results: The findings suggest that presence and perceived enjoyment have a key mediating effect on the relationship between virtual reality (VR) features and perceived learning outcomes in an IVR-based learning simulation. In addition, the results indicate that presence is more strongly correlated with perceived learning effects, while enjoyment is more strongly correlated with learning satisfaction. Discussion: These findings provide intellectual support and theoretical backing for VR-based instructional design and environmental development. Moreover, this study has practical value with regard to the future large-scale application of IVR to experiential teaching, group-led teaching, and the promotion of the digital transformation and intelligence upgrading in education.

It is time to update the ARDS definition: It starts with COVID-19-induced respiratory failure.

Coronavirus disease 2019 (COVID-19) may rapidly worsen respiratory failure, thereby leading to death. COVID-19-induced respiratory failure exhibits some atypical characteristics, silent hypoxemia, and high lung compliance. Some histopathological changes associated with COVID-19-induced respiratory failure differ from those of classic acute respiratory distress syndrome (ARDS). However, compared with classical ARDS, COVID-19-induced respiratory failure has a similar timing of onset, clinical syndromes, radiological profile, and mortality rate in the intensive care unit (ICU). Respiratory failure induced by COVID-19 is a type of ARDS and is currently underdiagnosed. This condition stretches the definition of classic ARDS; therefore, an updated definition is warranted.

Precise Detection on Cell-Cell Fusion by a Facile Molecular Beacon-Based Method.

Cell-cell fusion studies provide an experimental platform for evaluating disease progression and investigating cell infection. However, to realize sensitive and quantitative detection on cell-cell fusion is still a challenge. Herein, we report a facile molecular beacon (MB)-based method for precise detection on cell-cell fusion. By transfection of the spike protein (S protein) and enhanced green fluorescent protein (EGFP) in HEK 293 cells, the virus-mimicking fusogenic effector cells 293-S-EGFP cells were constructed to interact with target cells. Before mixing the effector cells with the target cells, the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) expression in 293-S-EGFP cells was silenced, and the MB for GAPDH mRNA detection was delivered into the GAPDH silenced 293-S-EGFP cells. Once cell-cell fusion occurred, MB migrated from the GAPDH silenced effector cells to the target cells and hybridized with GAPDH mRNA in the target cells to induce fluorescence emission. The cell-cell fusion can be easily visualized and quantitated by fluorescence microscopy and flow cytometry. The fluorescence intensity is strongly dependent on the number of fused target cells. This MB-based method can easily identify the differences in the cell fusions for various target cells with different angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) expression levels, resulting in dramatically different fluorescence intensities in fused target cells. Our study provides a convenient and efficient quantitative detection approach to study cell-cell fusion.

Bioinformatics analysis on structure and function of the spike glycoprotein of SARS-CoV-2 and its prokaryotic expression

Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV -2) is a highly pathogenic and rapidly spreading pathogen. It can invade and infect cells by recognizing receptors on the surface of host cells with spike (5) glycoprotein. Systematic bioinformatics analysis and prokaryotic expression of the S protein can aid understanding of its function and clarify the molecular mechanism of viral infection mediated by this protein. The physicochemical properties, subcellular localization, post - translational modifications and protein - interaction network of the S protein were analyzed systematically using Protparam. Pfam, TMHMM ExPASy - ProtScale, PSORT II, SignalP, UniProt, NetPhos 3.1. NetNGlyc 1.0, NetOGlyc 4.0. BLAST and other bioinformatics software and databases. In addition. Clustal X2 and MEGA7.0 were used to analyze the homology and phylogeny of S glycoproteins based on amino-acid sequences. Finally, recombinant expression vector of the S glycoprotein was constructed by molecular cloning technology and expressed in Escherichia call. Results showed that the S glycoprotein is composed of 1,273 amino acids, with a molecular weight of 141.2 kD and an isoelectric point of 6.24. It had two coiled helical structures and one transmembrane helix region. It was a hydrophobic protein, contained a spike receptor-binding domain and 52 glycoprotein domain. This protein was distributed mainly in the endoplasmic-reticulum membrane (39.1%) and cell membrane (21.7%) of host cells. and contained 136 potential phosphorylation sites and 20 possible glycosylation sites. SARS-CoV, SARS-Coy WI-120 and bat coronavirus HKU3 showed the highest sequence identity with the spike-glycoprotein sequence of SARS-CoV-2 (76%). SARS-CoV-2, SARS-CoV and bat coronavirus clustered into a large branch. suggesting that they may have a common ancestor. The S protein was expressed mainly in the precipitate after centrifugation of bacterial lysates, which lays a foundation for future structural analysis and vaccine development. The S glycoprotein was highly conserved between SARS-CoV and bat coronavirus, suggesting that this glycoprotein has a vital role in viral invasion into host cells. SARS-CoV-2 may have a common ancestor with SARS-CoV and bat coronavirus. Our study provides an important data basis for expression. purification. structural and functional analysis of the S glycoprotein of SARS-CoV-2. Our data may help to reveal the biological functions of the S glycoprotein, and provide a scientific basis for the design and screening of new antiviral drugs targeting this protein.

Immune persistence induced by two-dose BBIBP-CorV vaccine with different intervals, and immunogenicity and safety of a homologous booster dose in high-risk occupational population.

BACKGROUND: The immune persistence of neutralizing antibodies elicited by BBIBP-CorV vaccines on day 0-14, 0-21 and 0-28 schedule, and the immunogenicity and safety of a homologous booster dose after different priming vaccination regimens is scarcely reported. METHODS: : Responders (GMT≥16) at day 28, after priming with the two-dose vaccine, were followed up at 3, 6, and 10 months. Eligible participants received a homologous booster dose at month 10 and were followed-up 28 days post-booster. RESULTS: The GMT of neutralizing antibodies in 0-28d-10 m and 0-21d-10 m group were significantly higher than 0-14d-10 m group from month 3 (71.6 & 64.2 vs 46.4, p < 0.001) to month 10 (32.4 & 28.8 vs 20.3, p < 0.001) after the second dose. On day 28 post-booster, a remarkable rebound in neutralizing antibodies (246.2, 277.5, and 288.6, respectively) was observed in the three groups. All adverse reactions were mild after booster injection. CONCLUSIONS: The priming two-dose BBIBP-CorV vaccine with 0-28 days and 0-21 days schedule could lead to a longer persistence of neutralizing antibody than the 0-14 days schedule. Regardless of the priming vaccination regimens, a homologous booster dose led to a strong rebound in neutralizing antibodies and might persist for at least 18 months.

Bioinformatics analysis of the structure, function and prokaryotic expression of SARS-CoV-2 nonstructural protein

The Nsp1 protein, the main virulence factor of the virus of SARS-CoV-2, mediates viral immune escape in host cells and expands the viral infection range. Systematic bioinformatics analysis and prokaryotic expression of Nsp1 protein were performed to aid the understanding of the molecular mechanism of SARS-CoV-2 infection in host cells. Pfam, TMHMM, ProtScale, ExPASy, SignalP 4.0 and other tools were used to systematically analyze the post-translational modifications, physicochemical properties, transmembrane helix, interaction network, homology and evolutionary characteristics of Nsp1 protein. The recombinant expression vector pET-22b-Nsp1 was constructed through molecular cloning technology and expressed in a prokaryotic system. Nsp1 is composed of 180 amino acids, with a molecular weight of 19.78 kDa, an isoelectric point of 5.36 and an instability index of 28.83. It has a half-life of 30 h in mammalian reticulocytes and more than 10 h in E. coli. It has 12 potential phosphorylation sites, three potential O-glycosylation sites and no signal peptide. It is a hydrophilic protein without a transmembrane helix. Secondary structure analysis indicated that the highest proportion of structural components comprised random coils (45.00%), followed by a-helices (25.56%) and extended chains (20.56%);the lowest proportion comprised ss-turns (8.89%). Multiple sequence alignment and evolutionary analysis revealed that Bat SARS-like coronavirus WIV1 had the highest sequence identity (85.00%) with the Nsp1 protein of SARS-CoV-2. After prokaryotic expression, Nsp1 protein was found to be mainly expressed in the precipitate after centrifugation of bacterial lysate. The target protein was further identified as Nsp1 by mass spectrometry. This study provides an important reference for the expression, purification and functional analysis of SARS-CoV-2 Nsp1 protein, and further reveals the biological functions of Nsp1, thus providing a reference for research and development of related inhibitors and antiviral drugs.

Aerogel-Functionalized Thermoplastic Polyurethane as Waterproof, Breathable Freestanding Films and Coatings for Passive Daytime Radiative Cooling.

Passive daytime radiative cooling (PDRC) is an emerging sustainable technology that can spontaneously radiate heat to outer space through an atmospheric transparency window to achieve self-cooling. PDRC has attracted considerable attention and shows great potential for personal thermal management (PTM). However, PDRC polymers are limited to polyethylene, polyvinylidene fluoride, and their derivatives. In this study, a series of polymer films based on thermoplastic polyurethane (TPU) and their composite films with silica aerogels (aerogel-functionalized TPU (AFTPU)) are prepared using a simple and scalable non-solvent-phase-separation strategy. The TPU and AFTPU films are freestanding, mechanically strong, show high solar reflection up to 94%, and emit strongly in the atmospheric transparency window, thereby achieving subambient cooling of 10.0 and 7.7 °C on a hot summer day for the TPU and AFTPU film (10 wt%), respectively. The AFTPU films can be used as waterproof and moisture permeable coatings for traditional textiles, such as cotton, polyester, and nylon, and the highest temperature drop of 17.6 °C is achieved with respect to pristine nylon fabric, in which both the cooling performance and waterproof properties are highly desirable for the PTM applications. This study opens up a promising route for designing common polymers for highly efficient PDRC.

A novel hybrid multi-criteria group decision-making approach with intuitionistic fuzzy sets to design reverse supply chains for COVID-19 medical waste recycling channels.

The COVID-19 pandemic has led to exponential growth in COVID-19 medical waste (CMW) generation worldwide. This tremendous growth in CMW is a major transmission medium for COVID-19 virus and thus brings serious challenges to medical waste (MW) management. Designing an efficient and reliable CMW reverse supply chain in this situation can help to prevent epidemic spread. Nowadays, the assessment of CMW recycling channels has become a challenging mission for health-care institutions, especially in developing countries. It can be seen as a complex multi-criteria group decision-making (MCGDM) problem that requires the consideration of multiple conflicting tangible and intangible criteria. Nevertheless, few academics have been concerned about this issue. Moreover, current MCGDM methods have limited support for CMW recycling channel evaluation and they do not consider hospitals' reverse supply chain strategy when evaluating. Thus, this study presents a novel MCGDM approach based on intuitionistic fuzzy sets (IFSs) and the VIKOR method for assessing the capacity of CWM recycling channels. According to the characteristics of CMW, processing flow and the TOE (Technology, Organization and Environment) theoretical framework, we established a new CMW recycling channel capacity evaluation index system which makes our proposed method more targeted and efficient. In the decision-making process, we integrate the best-worst method (BWM) and entropy to determine the decision makers (DMs) weighting in a more comprehensive way, considering both subjective and objective criteria, which was ignored by many MCGDM methods. A new aggregation operator called IFWA is proposed by us, considering the priority of DMs. Based on both the ranking of capacity and disposal charges, we then position the alternatives in the recycling channel priority index (RCPI) matrix constructed by us. According to this PCPI matrix and the reverse supply chain strategy of hospitals, a more reasonable CMW allocation strategy is determined and a more efficient CMW reverse supply chain is designed. Finally, a real case study from Wuhan was examined to illustrate the validation of our approach.

The Moderating Effect of Compassionate Mindfulness on the Psychological Needs and Emotions of Generation Y in the 21st Century in Taiwan.

During the 2020 COVID-19 pandemic in Taiwan, 6.5% of Generation Y required medical treatment for emotional and stress-related mental disorders. This study explores the moderating effect of mindfulness training on psychological needs and emotions to propose effective measures to promote the mental health of Generation Y. This study was carried out by questionnaire, using the data of respondents born in 1980-1999, collected in three different periods for quantitative analysis with compassionate mindfulness as the main variable. The results show that the compassionate mindfulness effect on emotion regulation varies greatly among different educational levels. However, it still plays a positive role in the psychological needs of Generation Y. Most members of Generation Y who receive compassionate mindfulness training have fewer basic needs and more interpersonal trust. They pay more attention to individual-oriented self-realization. Compassionate mindfulness has a greater positive moderating effect on the mental health of women aged 30-39 and those who are highly educated. Compassionate mindfulness has a more positive moderating effect on the psychological needs of members of Generation Y who were born more recently. During the COVID-19 pandemic, providing compassionate mindfulness has a significant positive effect on the prevention of mental disorders of Generation Y in Taiwan.

Safety and immunogenicity of inactivated SARS-CoV-2 vaccine in high-risk occupational population: a randomized, parallel, controlled clinical trial.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (COVID-19) have a substantial burden on health-care systems around the world. This is a randomized parallel controlled trial for assessment of the immunogenicity and safety of an inactivated SARS-CoV-2 vaccine, aiming to determine an appropriate vaccination interval of the vaccine for high-risk occupational population. METHODS: In an ongoing randomized, parallel, controlled phase IV trial between January and May 2021 in Taiyuan City, Shanxi Province, China, we randomly assigned the airport ground staff and public security officers aged 18 to 59 years to receive two doses of inactivated SARS-CoV-2 vaccine at 14 days, 21 days, or 28 days. The serum neutralizing antibody to live SARS-CoV-2 was performed at baseline and 28 days after immunization. Long-term data are being collected. The primary immunogenicity endpoints were neutralization antibody seroconversion and geometric mean titer (GMT) at 28 days after the second dose. Analysis of variance (ANOVA), chi-square, and logistic regression analysis were used for data analysis. RESULTS: A total of 809 participants underwent randomization and received two doses of injections: 270, 270, 269 in the 0-14, 0-21, and 0-28 vaccination group, respectively. By day 28 after the second injection, SARS-CoV-2 neutralizing antibody of GMT was 98.4 (95% CI: 88.4-108.4) in the 0-14 group, which was significantly lower compared with 134.4 (95% CI: 123.1-145.7) in the 0-21 group (P < 0.001 vs 0-14 group) and 145.5 (95% CI: 131.3-159.6) in the 0-28 group (P < 0.001 vs 0-14 group), resulting in the seroconversion rates to neutralizing antibodies (GMT ≥ 16) of 100.0% for all three groups, respectively. The intention-to-treat (ITT) analysis yielded similar results. All reported adverse reactions were mild. CONCLUSIONS: Both a two-dose of inactivated SARS-CoV-2 vaccine at 0-21 days and 0-28 days regimens significantly improved SARS-CoV-2 neutralizing antibody level compared to the 0-14 days regimen in high-risk occupational population, with seroconversion rates of 100.0%. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2100041705, ChiCTR2100041706. Registered 1 January 2021, www.chictr.org.cn .