Comparison of anthropometric parameters and laboratory test results before and after the COVID-19 outbreak among Chinese children aged 3-18 years.

Objective: To compare the physiological health of Chinese children around the COVID-19 lockdown. Methods: We extracted data on children's anthropometric and laboratory parameters from May to November in both 2019 and 2020 from the Health Checkup Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China. Overall, 2162 children aged 3~18 years without comorbidities in 2019 and 2646 in 2020 were assessed. Mann Whitney U tests were used to compare differences between the above health indicators before and after COVID-19 outbreak. Quantile regression analyses adjusted for age, sex and body mass index (BMI) were also used in analysis. Chi-square tests and Fisher's exact tests were used for comparing differences of categorical variables. Results: Compared with children examined in 2019 before the outbreak, children in 2020 had a higher median z score of BMI for age (-0.16 vs. -0.31), total cholesterol (TC, 4.34 vs. 4.16 mmol/L), low density lipoprotein cholesterol (LDL-C, 2.48 vs. 2.15 mmol/L), high density lipoprotein cholesterol (HDL-C, 1.45 vs. 1.43 mmol/L) and serum uric acid (290 vs. 282 µmol/L), and a lower hemoglobin (Hb, 134 vs. 133 g/L), triglycerides (TG, 0.70 vs. 0.78 mmol/L) and 25(OH)D (45.8 vs. 52.2 nmol/L), all P < 0.05. No differences were identified for waist height ratio, blood pressure and fasting glucose (both P > 0.05). However, in regression models after adjusting, BMI, TC, LDL-C, blood glucose and sUA were positively correlated with year; while Hb, TG and 25(OH)D were negatively correlated with year (all P < 0.05). Accordingly, children in 2020 had a higher prevalence of overweight/obesity (20.6 vs. 16.7%, P < 0.001), hypercholesterol (16.2%vs. 10.2%, P < 0.001), high LDL-C (10 vs. 2.9%, P < 0.001), hyperuricemia (18.9 vs.15.1%, P = 0.002), vitamin D deficiency (22.6 vs. 8.1%, P < 0.001) and a lower prevalence of high TG (4.3 vs. 2.8%, P = 0.018) compared with children in 2019. Conclusion: In this real-world study, we found that long-term lockdown due to COVID-19 outbreak might cause adverse impact on children's metabolic health, which might increase their future risk of cardiovascular diseases. Thus, parents, health professionals, educationists, and caregivers should pay more attention to children's dietary pattern and lifestyle, especially in this new normal against COVID-19.

Evolution of the PB1 gene of human influenza A (H3N2) viruses circulating between 1968 and 2019.

One avian H3N2 influenza virus, providing its PB1 and HA segments, reassorted with one human H2N2 virus and caused a pandemic outbreak in 1968, killing over 1 million people. After its introduction to humanity, the pandemic H3N2 virus continued adapting to humans and has resulted in epidemic outbreaks every influenza season. To understand the functional roles of the originally avian PB1 gene in the circulating strains of human H3N2 influenza viruses, we analyzed the evolution of the PB1 gene in all human H3N2 isolates from 1968 to 2019. We found several specific residues dramatically changed around 2002-2009 and remained stable through to 2019. Then, we verified the functions of these PB1 mutations in the genetic background of the early pandemic virus, A/Hong Kong/1/1968(HK/68), as well as a recent seasonal strain, A/Jiangsu/34/2016 (JS/16). The PB1 V709I or PB1 V113A/K586R/D619N/V709I induced higher polymerase activity of HK/68 in human cells. And the four mutations acted cooperatively that had an increased replication capacity in vitro and in vivo at an early stage of infection. In contrast, the backward mutant, A113V/R586K/N619D/I709V, reduced polymerase activity in human cells. The PB1 I709V decreased viral replication in vitro, but this mutant only showed less effect on mice infection experiment, which suggested influenza A virus evolved in human host was not always consisted with highly replication efficiency and pathogenicity in other mammalian host. Overall, our results demonstrated that the identified PB1 mutations contributed to the viral evolution of human influenza A (H3N2) viruses.

Chinese contribution to NEJM, Lancet, JAMA, and BMJ from 2011 to 2020: a 10-year bibliometric study

Background New England Journal of Medicine (NEJM), Lancet, Journal of the American Medical Association (JAMA), and British Medical Journal (BMJ) are collectively known as “the Top Four Medical Journals (TFMJ)” in China. Through the analysis of Chinese scholars’ publications in the TFMJ in the recent 10 years, this study aimed to clarify the current situation of high-quality medical research conducted by Chinese scholars and institutions. Methods Data were retrieved and downloaded manually from PubMed (2011–2020). Information on the publication year, journal, author, affiliation, and citation, etc. were extracted and analyzed using R software. Results A total of 761 articles were involved in the final analysis. The number of articles published by Chinese scholars in the TFMJ was 135/29,942 (0.45%) in BMJ, 124/14,033 (0.88%) in JAMA, 314/16,117 (1.94%) in Lancet, and 188/15,242 (1.23%) in NEJM (P<0.001). Besides, the letter was the main research type, which was up to 44.54%, and the original research only accounted for 17.47%. The most popular subspecialty and subject were infectious diseases and COVID-19, respectively. The most productive researcher was Chen Wang, and Bin Cao was the most cited Chinese scholar. The most productive institute was Chinese Academy of Medical Sciences and Peking Union Medical College. The most cited study was “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Conclusions The presence of Chinese scholars in the TFMJ has grown, but there is still much room to improve. A Matthew effect in China's high-level scientific research was demonstrated.

Chinese contribution to NEJM, Lancet, JAMA, and BMJ from 2011 to 2020: a 10-year bibliometric study.

Background: New England Journal of Medicine (NEJM), Lancet, Journal of the American Medical Association (JAMA), and British Medical Journal (BMJ) are collectively known as "the Top Four Medical Journals (TFMJ)" in China. Through the analysis of Chinese scholars' publications in the TFMJ in the recent 10 years, this study aimed to clarify the current situation of high-quality medical research conducted by Chinese scholars and institutions. Methods: Data were retrieved and downloaded manually from PubMed (2011-2020). Information on the publication year, journal, author, affiliation, and citation, etc. were extracted and analyzed using R software. Results: A total of 761 articles were involved in the final analysis. The number of articles published by Chinese scholars in the TFMJ was 135/29,942 (0.45%) in BMJ, 124/14,033 (0.88%) in JAMA, 314/16,117 (1.94%) in Lancet, and 188/15,242 (1.23%) in NEJM (P<0.001). Besides, the letter was the main research type, which was up to 44.54%, and the original research only accounted for 17.47%. The most popular subspecialty and subject were infectious diseases and COVID-19, respectively. The most productive researcher was Chen Wang, and Bin Cao was the most cited Chinese scholar. The most productive institute was Chinese Academy of Medical Sciences and Peking Union Medical College. The most cited study was "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". Conclusions: The presence of Chinese scholars in the TFMJ has grown, but there is still much room to improve. A Matthew effect in China's high-level scientific research was demonstrated.

Efficacy and Safety of Zuojin Pill for the Treatment of Chronic Nonatrophic Gastritis: A Randomized Active-Controlled Clinical Trial.

Objective: Zuojin pill (ZJP) is used as the classical prescription for a wide variety of digestive diseases. However, there is a lack of direct evidence for its use in the treatment of chronic nonatrophic gastritis (CNG). In particular, there is a lack of rigorous trials of randomized controlled designs. In this study, a randomized active-controlled clinical trial was performed to verify the efficacy and safety of ZJP in detail. Methods: Patients with CNG were divided into the ZJP group and the Marzulene-S granule group. Patients were enrolled from September 2019 to February 2021 (ChiCTR2000040549). Endoscopy and histology scores were evaluated as the primary outcome measure. The Helicobacter pylori positive rate and the disappearance rate of symptoms were also measured to reflect the outcomes. Finally, adverse events were also calculated as the index of safety. Results: A total of 68 eligible patients were enrolled in this trial and randomly divided into two groups with baseline comparability. ZJP was able to improve the red plaques as well as bile reflux scores compared with Marzulene-S granule (P=0.043 and P=0.019, respectively). Moreover, it also remarkably alleviated the active chronic inflammation score (P=0.043). However, there was no difference between the Helicobacter pylori positivity rate (P=0.752). The symptom scores of abdominal distension (P=0.004), belching (P=0.010), and loss of appetite (P=0.019) were alleviated by ZJP, but nausea and vomiting were not (P=0.616). ZJP can also be considered safe with no obvious adverse effects. Conclusion: ZJP might decrease mucosal injury and alleviate symptoms in CNG. In addition, more large-scale clinical trials should be carried out to further confirm its clinical efficacy and safety.

Application of pseudovirus system in the development of vaccine, antiviral-drugs, and neutralizing antibodies.

Pseudoviruses are viral particles coated with a heterologous envelope protein, which mediates the entry of pseudoviruses as efficiently as that of the live viruses possessing high pathogenicity and infectivity. Due to the deletion of the envelope protein gene and the absence of pathogenic genes, pseudoviruses have no autonomous replication ability and can infect host cells for only a single cycle. In addition, pseudoviruses have the desired characteristics of high safety, strong operability, and can be easily used to perform rapid throughput detection. Therefore, pseudoviruses are widely employed in the mechanistic investigation of viral infection, the screening and evaluation of monoclonal antibodies and antiviral drugs, and the detection of neutralizing antibody titers in serum after vaccination. In this review, we will discuss the construction of pseudoviruses based on different packaging systems, their current applications especially in the research of SARS-CoV-2, limitations, and further directions.