Palliative care for cancer patients during the COVID-19 pandemic: A narrative synthesis from 36 studies of 16 countries.

BACKGROUND: During the COVID-19 epidemic, palliative care has become even more indispensable for cancer patients. AIM: To identify the changes in palliative care for cancer patients and improvements in palliative care quality during the COVID-19 pandemic. DESIGN: A systematic review and narrative synthesis was conducted in PubMed, Embase and Web of Science. An evaluation tool using mixed methods was used to assess the quality of the study. The main relevant themes identified were used to group qualitative and quantitative findings. RESULTS: A total of 36 studies were identified, primarily from different countries, with a total of 14,427 patients, 238 caregivers and 354 health care providers. Cancer palliative care has been experiencing several difficulties following the COVID-19 pandemic, including increased mortality and infection rates as well as delays in patient treatment that have resulted in poorer prognoses. Treatment providers are seeking solutions such as electronic management of patients and integration of resources to care for the mental health of patients and staff. Telemedicine plays an important role in many ways but cannot completely replace traditional treatment. Clinicians strive to meet patients' palliative care needs during special times and improve their quality of life. CONCLUSIONS: Palliative care faces unique challenges during the COVID-19 epidemic. With adequate support to alleviate care-related challenges, patients in the home versus hospital setting will be able to receive better palliative care. In addition, this review highlights the importance of multiparty collaboration to achieve personal and societal benefits of palliative care. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Clinical outcomes of the severe acute respiratory syndrome coronavirus 2 Omicron and Delta variant: systematic review and meta-analysis of 33 studies covering 6 037 144 coronavirus disease 2019-positive patients.

BACKGROUND: Although the SARS-CoV-2 Omicron variant is considered to induce less severe disease, there have been no consistent results on the extent of the decrease in severity. OBJECTIVES: To compare the clinical outcomes of COVID-19-positive patients with Omicron and Delta variant infection. DATA SOURCES: Searches were implemented up to 8 November 2022 in PubMed, Web of Science, BioRvix, and MedRvix. STUDY ELIGIBILITY CRITERIA: Eligible studies were cohort studies reporting the clinical outcomes of COVID-19-positive patients with Omicron and Delta variant infection, including hospitalization, intensive care unit (ICU) admission, receiving invasive mechanical ventilation (IMV), and death. PARTICIPANTS: COVID-19-positive patients with Omicron and Delta variant infection. ASSESSMENT OF RISK OF BIAS: Risk of bias was assessed employing the Newcastle-Ottawa Scale. METHODS OF DATA SYNTHESIS: Random-effect models were employed to pool the ORs and 95% CIs to compare the risk of clinical outcome. I2 was employed to evaluate the heterogeneity between studies. RESULTS: A total of 33 studies with 6 037 144 COVID-19-positive patients were included in this meta-analysis. In the general population of COVID-19-positive patients, compared with Delta, Omicron variant infection resulted in a decreased risk of hospitalization (10.24% vs. 4.14%, OR = 2.91, 95% CI = 2.35-3.60), ICU admission (3.67% vs. 0.48%, OR = 3.64, 95% CI = 2.63-5.04), receiving IMV (3.93% vs. 0.34%, OR = 3.11, 95% CI = 1.76-5.50), and death (2.40% vs. 0.46%, OR = 2.97, 95% CI = 2.17-4.08). In the hospitalized patients with COVID-19, compared with Delta, Omicron variant infection resulted in a decreased risk of ICU admission (20.70% vs. 12.90%, OR = 1.63, 95% CI = 1.32-2.02), receiving IMV (10.90% vs. 5.80%, OR = 1.65, 95% CI = 1.28-2.14), and death (10.72% vs. 7.10%, OR = 1.44, 95% CI = 1.22-1.71). CONCLUSIONS: Compared with Delta, the severity of Omicron variant infection decreased.

COVID-19 pandemic increases the occurrence of nursing burnout syndrome: an interrupted time-series analysis of preliminary data from 38 countries.

AIM: To evaluate the trends in nursing burnout rates before and during the coronavirus 2019 restrictions. METHOD: Meta-analysis was used to extract the data on global nursing burnout from 1 Jan. 2010-15 Dec. 2022. An interrupted time-series analysis using segmented ordinary least squares (OLS) regression models was used to explore if the nursing burnout were affected by the epidemic. Newey-West standard error was used to adjust for autocorrelation and heteroskedasticity. RESULTS: Before the epidemic (April 2020), the nursing burnout rate rose with 0.0007497 (95% CI: 0.0000316, 0.0014677, t = 2.07, P = 0.041) per month. The trend of nursing burnout rate has increased by 0.0231042 (95 CI%:0.0086818, 0.0375266, t = 3.18, P = 0.002). The increasing trend of nursing burnout rate after the COVID-19 restrictions is 0.0007497 + 0.0231042 = 0.0238539 per month. CONCLUSION: The study indicated that the Covid-19 restrictions had an impact on nursing burnout, increasing the occurrence of nursing burnout syndrome.

Effect of vitamin D supplementation on COVID-19 patients: A systematic review and meta-analysis.

Objective: To systematically evaluate the impact of vitamin D supplementation on mortality, ICU admission, and the rates of mechanical ventilation or intubation among COVID-19 patients. Data sources and study selection: The PubMed, Embase, Cochrane Library, CBM, CNKI, VIP, and WanFang databases were searched from 1 December 2019 to 31 December 2022. The authors sought to identify randomized controlled trials and cohort studies that examined the relationship between vitamin D supplementation and mortality, ICU admission, and mechanical ventilation or intubation rates among COVID-19 patients. Data extraction and synthesis: Two investigators independently searched the literature, extracted the data, and assessed the quality of the included studies. The Grading of Recommendation, Assessment, Development, and Evaluation approach was used to evaluate the quality of the evidence. Meta-analysis was conducted using RevMan 5.3, STATA 15.1, and R 4.1.3 software. Results: Eight randomized controlled trials (RCTs) and eight cohort studies were included, involving 3359 COVID-19 patients. The pooled analysis of randomized controlled trials showed that vitamin D supplementation did not have a significant effect on reducing mortality (Relative Risk, RR = 0.94, 95% CI 0.69-1.29, P = 0.7), while the results of cohort studies indicated that vitamin D supplementation had a positive impact on reducing mortality among COVID-19 patients (RR = 0.33, 95% CI 0.23-0.47, P < 0.001). There was no statistically significant difference in the rates of ICU admission (RCTs: RR = 0.64, 95%CI 0.38-1.08, P = 0.10; cohort studies: RR = 0.32, 95% CI 0.08-1.29, P = 0.109) or rates of mechanical ventilation or intubation (RCTs: RR = 0.77, 95% CI 0.58-1.02, P = 0.07; cohort studies: RR = 0.93, 95% CI 0.55-1.58, P = 0.789). Conclusion: The results of this systematic review and meta-analysis suggest that vitamin D supplementation does not have a significant impact on reducing mortality, ICU admission, and the rates of mechanical ventilation or intubation among COVID-19 patients. However, due to the limited number and quality of the studies included, further high-quality studies are needed to confirm these findings. Systematic review registration: www.crd.york.ac.uk, identifier CRD42021299521.

Saliva - a new opportunity for fluid biopsy.

Saliva is a complex biological fluid with a variety of biomolecules, such as DNA, RNA, proteins, metabolites and microbiota, which can be used for the screening and diagnosis of many diseases. In addition, saliva has the characteristics of simple collection, non-invasive and convenient storage, which gives it the potential to replace blood as a new main body of fluid biopsy, and it is an excellent biological diagnostic fluid. This review integrates recent studies and summarizes the research contents of salivaomics and the research progress of saliva in early diagnosis of oral and systemic diseases. This review aims to explore the value and prospect of saliva diagnosis in clinical application.

The initial attempt at home hemodialysis in mainland China.

BACKGROUND: Observational studies have shown home hemodialysis (HHD) to be associated with better survival than facility hemodialysis (HD) and peritoneal dialysis (PD). Patients on HHD have reported higher quality of life and independence. HHD is considered to be an economical way to manage end-stage kidney disease (ESKD). The coronavirus disease 2019 pandemic has had a significant impact on patients with ESKD. Patients on HHD may have an advantage over in-center HD patients because of a lower risk of exposure to infection. PARTICIPANTS AND METHODS: We enrolled HD patients from our dialysis center. We first established the HHD training center. The training center was approved by the Chinese government. Doctors, nurses and engineers train and assess patients separately. There are three forms of patient monitoring: home visits, internet remote monitoring, and outpatient services. Demographic and medical data included age, sex, blood pressure, and dialysis-related data. Laboratory tests were conducted in our central testing laboratory, including hemoglobin (Hgb), serum creatinine (Cr), urea nitrogen (BUN), uric acid (UA), albumin (Alb), calcium (Ca), phosphorus (P), parathyroid hormone (PTH), and brain natriuretic peptide (BNP) levels. RESULTS: Six patients who underwent regular dialysis in the HD center of our hospital were selected for HHD training. We enrolled 6 patients, including 4 males and 2 females. The mean age of the patients was 47.5 (34.7-55.7) years, and the mean dialysis age was 33.5 (11.2-41.5) months. After an average of 16.0 (11.2-25.5) months of training, Alb, P and BNP levels were improved compared with the baseline values. After training, three patients returned home to begin independent HD. During the follow-up, there were no serious adverse events leading to hospitalization or death, but there were several adverse events. They were solved quickly by extra home visits of the technicians or online by remote monitoring. During the follow-up time, the laboratory indicators of all the patients, including Hgb, Alb, Ca, P, PTH, BNP, and ß2-MG levels, remained stable before and after HHD treatment. CONCLUSION: HHD is feasible and safe for ESKD in China, but larger-scale and longer-term studies are needed for further confirmation.

Research on the relationship between architectural features in northeast China and vertical aerosol transmission of COVID-19.

During the COVID-19 pandemic, many buildings in northeast China have had clusters of infected cases in the vertical layout. There is speculation that vertical aerosol transmission occurs. The houses in northeast China are airtight, and range hoods may be used for a long period of time when cooking. The pathway and factors influencing vertical aerosol transmission are worth studying. To elucidate a viral aerosol transmission pathway, we selected a multistory apartment and a high-rise building in Changchun city, Jilin province, China, to conduct an in-depth investigation and on-site simulation experiments. According to epidemiological investigation information on infected cases, building structures, drainage, ventilation, etc., we used fluorescent microspheres to simulate the behaviors of infected people, such as breathing and flushing the toilet after defecation, to discharge simulated viruses and track and monitor them. The field simulation experiment confirmed the transmission of fluorescent microsphere aerosols to other rooms in two types of buildings using a vertical aerosol transmission pathway of toilet flush-sewage pipe-floor drain without a water seal. Our study showed that, in the absence of a U-shaped trap or floor drain water seal whether in a multistory apartment or high-rise residential building, there is a transmission pathway of "excretion of virus through feces-toilet flushing-sewage pipe-floor drain without water seal," which will cause the vertical transmission of viral aerosol across floors during the COVID-19 pandemic. Moreover, the negative pressure generated by turning on the range hood when closing doors and windows increase aerosol transmission. Based on this negative pressure, prevention and control measures for residential buildings in northeast China during the COVID-19 pandemic were proposed.

Neglected Aspects of SARS-CoV-2 Aerosol Transmission in Bathrooms of Multistory and High-Rise Buildings - Beijing Municipality, China, October 2022.

What is already known about this topic?: There is a toilet flush-soil stack-floor drain pathway of aerosol transmission in multistory and high-rise buildings, but the influencing factors are not completely clear. What is added by this report?: The poor airtightness of the connecting parts of the floor drain, as well as pressure fluctuations in the sewage pipe during toilet flushing caused by blockage of the soil stack vent, may lead to the cross-floor transmission of viral aerosols through the soil stack and floor drains. What are the implications for public health practice?: In multistory and high-rise buildings, the bathroom floor drains should be kept sealed, and floor drain connecting parts should be airtight. Furthermore, the soil stack vent should not be blocked. In this way, the cross-floor transmission of viral aerosols can be effectively reduced.

Activation of a novel α2AAR-spinophilin-cofilin axis determines the effect of α2 adrenergic drugs on fear memory reconsolidation.

Posttraumatic stress disorder (PTSD) after the pandemic has emerged as a major neuropsychiatric component of post-acute COVID-19 syndrome, yet the current pharmacotherapy for PTSD is limited. The use of adrenergic drugs to treat PTSD has been suggested; however, it is hindered by conflicting clinical results and a lack of mechanistic understanding of drug actions. Our studies, using both genetically modified mice and human induced pluripotent stem cell-derived neurons, reveal a novel α2A adrenergic receptor (α2AAR)-spinophilin-cofilin axis in the hippocampus that is critical for regulation of contextual fear memory reconsolidation. In addition, we have found that two α2 ligands, clonidine and guanfacine, exhibit differential abilities in activating this signaling axis to disrupt fear memory reconsolidation. Stimulation of α2AAR with clonidine, but not guanfacine, promotes the interaction of the actin binding protein cofilin with the receptor and with the dendritic spine scaffolding protein spinophilin to induce cofilin activation at the synapse. Spinophilin-dependent regulation of cofilin is required for clonidine-induced disruption of contextual fear memory reconsolidation. Our results inform the interpretation of differential clinical observations of these two drugs on PTSD and suggest that clonidine could provide immediate treatment for PTSD symptoms related to the current pandemic. Furthermore, our study indicates that modulation of dendritic spine morphology may represent an effective strategy for the development of new pharmacotherapies for PTSD.

Discovery of Novel and Highly Potent Inhibitors of SARS CoV-2 Papain-Like Protease Through Structure-Based Pharmacophore Modeling, Virtual Screening, Molecular Docking, Molecular Dynamics Simulations, and Biological Evaluation.

Background and Objective: COVID-19 has struck our society as a great calamity, and the need for effective anti-viral drugs is more urgent than ever. Papain-like protease (PLpro) of SARS CoV-2 plays important roles in virus maturation, dysregulation of host inflammation, and antiviral immune responses, which is being regarded as a promising druggable target for the treatment of COVID-19. Here, we carried out a combined screening approach to identify novel and highly potent PLpro inhibitors for the treatment of COVID-19. Methods: We used a combined screening approach of structure-based pharmacophore modeling and molecular docking to screen an in-house database containing 35,000 compounds. SARS CoV-2 PLpro inhibition assay was used to carry out the biological evaluation of hit compounds. Molecular dynamics (MD) simulations were conducted to check the stability of the PLpro-hit complexes predicted by molecular docking. Results: We found that four hit compounds showed excellent inhibitory activities against PLpro with IC50 values ranging from 0.6 to 2.4 µM. Among them, the most promising compound, hit 2 is the best PLpro inhibitor and its inhibitory activity was about 4 times higher than that of the positive control (GRL0617). The study of MD simulations indicated that four hits could bind stably to the active site of PLpro. Further study of interaction analysis indicated that hit 2 could form hydrogen-bond interactions with the key amino acids such as Gln269 and Asp164 in the PLpro-active site. Conclusion: Hit 2 is a novel and highly potent PLpro inhibitor, which will open the way for the development of clinical PLpro inhibitors for the treatment of COVID-19.

A Network DEA Approach for Performance Evaluation of Safety Supervision and Rescue Capability in the Port Waters of Changjiang MSA

In recent years, the global economic situation and the development of the international shipping industry have been deeply affected by COVID-19. Since 2021, China has gradually recovered its international shipping supply chain industry with the help of government policy support, and its GDP has grown by 8.1% year by year. Under this favorable macroeconomic background, the Yangtze River waterway transportation, with its good waterway conditions, has led to the continuous increase in transportation demands. However, while pursuing rapid economic growth, ensuring the navigation safety and rescue of ships in the waterway has been one of the key issues of concern for maritime divisions along the Yangtze River. Therefore, combined with the network date envelopment data (DEA) model, this study intends to construct a new set of performance evaluation models in line with their safety supervision and rescue capability based on the daily work characteristics of the Changjiang Maritime Safety Administration (MSA). The occurrence of disasters in their port areas has been taken into consideration as the key undesirable variable. This study hopes to screen out worthy pacesetter representatives, and further suggests more targeted improvement options for inefficient maritime authorities to facilitate more effective safety supervision in the future.

CRISPR/Cas systems usher in a new era of disease treatment and diagnosis.

The discovery and development of the CRISPR/Cas system is a milestone in precise medicine. CRISPR/Cas nucleases, base-editing (BE) and prime-editing (PE) are three genome editing technologies derived from CRISPR/Cas. In recent years, CRISPR-based genome editing technologies have created immense therapeutic potential with safe and efficient viral or non-viral delivery systems. Significant progress has been made in applying genome editing strategies to modify T cells and hematopoietic stem cells (HSCs) ex vivo and to treat a wide variety of diseases and disorders in vivo. Nevertheless, the clinical translation of this unique technology still faces many challenges, especially targeting, safety and delivery issues, which require further improvement and optimization. In addition, with the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), CRISPR-based molecular diagnosis has attracted extensive attention. Growing from the specific set of molecular biological discoveries to several active clinical trials, CRISPR/Cas systems offer the opportunity to create a cost-effective, portable and point-of-care diagnosis through nucleic acid screening of diseases. In this review, we describe the development, mechanisms and delivery systems of CRISPR-based genome editing and focus on clinical and preclinical studies of therapeutic CRISPR genome editing in disease treatment as well as its application prospects in therapeutics and molecular detection.

Multiplex Target-Redundant RT-LAMP for Robust Detection of SARS-CoV-2 Using Fluorescent Universal Displacement Probes.

The increasing prevalence of variant lineages during the COVID-19 pandemic has the potential to disrupt molecular diagnostics due to mismatches between primers and variant templates. Point-of-care molecular diagnostics, which often lack the complete functionality of their high-throughput laboratory counterparts, are particularly susceptible to this type of disruption, which can result in false-negative results. To address this challenge, we have developed a robust Loop Mediated Isothermal Amplification assay with single tube multiplexed multitarget redundancy and an internal amplification control. A convenient and cost-effective target-specific fluorescence detection system allows amplifications to be grouped by signal using adaptable probes for pooled reporting of SARS-CoV-2 target amplifications or differentiation of the Internal Amplification Control. Over the course of the pandemic, primer coverage of viral lineages by the three redundant sub-assays has varied from assay to assay as they have diverged from the Wuhan-Hu-1 isolate sequence, but aggregate coverage has remained high for all variant sequences analyzed, with a minimum of 97.4% (Variant of Interest: Eta). In three instances (Delta, Gamma, Eta), a high-frequency mismatch with one of the three sub-assays was observed, but overall coverage remained high due to multitarget redundancy. When challenged with extracted human samples the multiplex assay showed 87% or better sensitivity (of 30 positive samples), with 100% sensitivity for samples containing greater than 30 copies of viral RNA per reaction (of 21 positive samples), and 100% specificity (of 60 negative samples). These results are further evidence that conventional laboratory methodologies can be leveraged at the point of care for robust performance and diagnostic stability over time. IMPORTANCE The COVID-19 pandemic has had tremendous impact, and the ability to perform molecular diagnostics in resource limited settings has emerged as a key resource for mitigating spread of the disease. One challenge in COVID-19 diagnosis, as well as other viruses, is ongoing mutation that can allow viruses to evade detection by diagnostic tests. We developed a test that detects multiple parts of the virus genome in a single test to reduce the chance of missing a virus due to mutation, and it is designed to be simpler and faster than typical laboratory tests while maintaining high sensitivity. This capability is enabled by a novel fluorescent probe technology that works with a simple constant temperature reaction condition.

SARS-CoV-2 Aerosol Transmission Through Vertical Sanitary Drains in High-Rise Buildings - Shenzhen, Guangdong Province, China, March 2022.

What is already known about this topic?: Aerosol transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via sanitary pipelines in high-rise buildings is possible, however, there is a lack of experimental evidence. What is added by this report?: The field simulation experiment confirmed the existence of a vertical aerosol transmission pathway from toilet flush-soil stack-floor drains without water seal. This report provided experimental evidence for vertical aerosol transmission of clustered outbreaks on 18 floors of a 33-story residential building. What are the implications for public health practice?: The water seal on floor drains is a necessary barrier to prevent the risk of vertical aerosol transmission of infectious disease pathogens in buildings. It is necessary not only to have a U-shaped trap in the drainage pipe, but also to be filled with water regularly.

Analysis of the Difference in College Students' Experience of Family Harmony before and after the COVID-19 Outbreak.

BACKGROUND: China implemented a home quarantine policy in the early days of the COVID-19 pandemic. At the same time, college students stayed at home for a long time, facing their parents and being directly exposed to family affairs every day. Thus, the effects of the COVID-19 pandemic and home quarantine on college students' experience of family harmony are worth discussing. OBJECTIVES: In this study, we aimed to explore whether there was any difference in college students' experience of family harmony before and after the COVID-19 outbreak. METHODS: Participants in this study were undergraduates from a university in Tianjin. They completed the college students' experience of family harmony questionnaire (CSEFHQ) before and after the COVID-19 outbreak (December 2019 and March 2020). A total of 215 participants (96 men and 119 women) completed the whole test. RESULTS: The paired sample t-tests showed that the scores on seven dimensions of CSEFHQ: getting along (t = 5.116, p < 0.001), conflict (t = 6.442, p < 0.001), sharing (t = 5.414, p < 0.001), self-isolation (t = 3.014, p < 0.01), help-seeking (t = 5.353, p < 0.001), avoidance (t = 6.010, p < 0.001), support-providing (t = 5.818, p < 0.001), and the total scores of CSEFHQ (t = 6.496, p < 0.001) were all significantly reduced after the COVID-19 outbreak, while the scores on the other two dimensions, undertaking housework (t = 1.379) and indifference (t = 1.765), did not change significantly. CONCLUSIONS: The college students' experience of family harmony was significantly worse after the COVID-19 outbreak. These results can be used to improve the level of family harmony of college students during the pandemic and improve their quality of life.

Analysis of the Difference in College Students' Experience of Family Harmony before and after the COVID-19 Outbreak

Background: China implemented a home quarantine policy in the early days of the COVID-19 pandemic. At the same time, college students stayed at home for a long time, facing their parents and being directly exposed to family affairs every day. Thus, the effects of the COVID-19 pandemic and home quarantine on college students' experience of family harmony are worth discussing. Objectives: In this study, we aimed to explore whether there was any difference in college students' experience of family harmony before and after the COVID-19 outbreak. Methods: Participants in this study were undergraduates from a university in Tianjin. They completed the college students' experience of family harmony questionnaire (CSEFHQ) before and after the COVID-19 outbreak (December 2019 and March 2020). A total of 215 participants (96 men and 119 women) completed the whole test. Results: The paired sample t-tests showed that the scores on seven dimensions of CSEFHQ: getting along (t = 5.116, p < 0.001), conflict (t = 6.442, p < 0.001), sharing (t = 5.414, p < 0.001), self-isolation (t = 3.014, p < 0.01), help-seeking (t = 5.353, p < 0.001), avoidance (t = 6.010, p < 0.001), support-providing (t = 5.818, p < 0.001), and the total scores of CSEFHQ (t = 6.496, p < 0.001) were all significantly reduced after the COVID-19 outbreak, while the scores on the other two dimensions, undertaking housework (t = 1.379) and indifference (t = 1.765), did not change significantly. Conclusions: The college students' experience of family harmony was significantly worse after the COVID-19 outbreak. These results can be used to improve the level of family harmony of college students during the pandemic and improve their quality of life.

Associations between body composition, fat distribution and metabolic consequences of excess adiposity with severe COVID-19 outcomes: observational study and Mendelian randomisation analysis.

BACKGROUND: Higher body mass index (BMI) and metabolic consequences of excess weight are associated with increased risk of severe COVID-19, though their mediating pathway is unclear. METHODS: A prospective cohort study included 435,504 UK Biobank participants. A two-sample Mendelian randomisation (MR) study used the COVID-19 Host Genetics Initiative in 1.6 million participants. We examined associations of total adiposity, body composition, fat distribution and metabolic consequences of excess weight, particularly type 2 diabetes, with incidence and severity of COVID-19, assessed by test positivity, hospital admission, intensive care unit (ICU) admission and death. RESULTS: BMI and body fat were associated with COVID-19 in the observational and MR analyses but muscle mass was not. The observational study suggested the association with central fat distribution was stronger than for BMI, but there was little evidence from the MR analyses than this was causal. There was evidence that strong associations of metabolic consequences with COVID-19 outcomes in observational but not MR analyses. Type 2 diabetes was strongly associated with COVID-19 in observational but not MR analyses. In adjusted models, the observational analysis showed that the association of BMI with COVID-19 diminished, while central fat distribution and metabolic consequences of excess weight remained strongly associated. In contrast, MR showed the reverse, with only BMI retaining a direct effect on COVID-19. CONCLUSIONS: Excess total adiposity is probably casually associated with severe COVID-19. Mendelian randomisation data do not support causality for the observed associations of central fat distribution or metabolic consequences of excess adiposity with COVID-19.

The Effects of BITs on Contract Execution in Developing Countries: Some Implications for the COVID-19 Crisis.

Bilateral investment agreements are bilateral treaties between capital exporting countries and host countries, which is specially used to protect international investment, and the contract execution is directly related to the daily operation of multinational enterprises. Based on the panel data of 73 developing countries from 2005 to 2019, this paper examines the improvement effect of BITs on the contract execution of host countries. The study found that both the overall bilateral investment agreements and the bilateral investment agreements in force can significantly improve the contract execution of the host country. Due to the differences between the civil law system and the common law system in many aspects, such as the source of evidence and trial mode, the effect of BITs on the improvement of contract execution in host countries of the common law system is more prominent. In terms of specific impact, the improvement effect of BITs on time is significantly better than cost. The core conclusion is still valid after changing the estimation method and eliminating abnormal samples.

Distribution and Drug Resistance of Bacterial Pathogens Associated with Lower Respiratory Tract Infection in Children and the Effect of COVID-19 on the Distribution of Pathogens.

By studying the distribution and drug resistance of bacterial pathogens associated with lower respiratory tract infection (LRTI) in children in Chengdu and the effect of the COVID-19 on the distribution of pathogens and by analyzing the epidemic trend and drug resistance changes of the main pathogens of LRTI, this research is supposed to provide a useful basis for the prevention of LRTI in children and the rational use of drugs in clinical practice. Hospitalized children clinically diagnosed with LRTI in Chengdu Women and Children's Central Hospital from 2011 to 2020 were selected as the study subjects. The pathogens of LRTI in children and the distribution of pathogens in different ages, genders, seasons, years, and departments and before and after the pandemic situation of COVID-19 were counted. The drug resistance distribution of the top six pathogens with the highest infection rate in the past three years and the trend of drug resistance in the past decade were analyzed. A total of 26,469 pathogens were isolated. Among them, 6240 strains (23.6%) were Gram-positive bacteria, 20152 strains (76.1%) were Gram-negative bacteria, and 73 strains (0.3%) were fungi. Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Staphylococcus aureus were highly isolated in the group of infants aged 0-1 (P < 0.01), Moraxella catarrhalis and Streptococcus pneumoniae were highly isolated in children aged 1-6 (P < 0.01), and Haemophilus influenzae was highly isolated in children over 1 (P < 0.01). The isolation rates of Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Staphylococcus aureus, and Candida albicans in the lower respiratory tract of 0-1 year-old male infants were higher than those of female infants (p < 0.05). Haemophilus influenzae was highly isolated in spring and summer, and Moraxella catarrhalis was highly isolated in autumn and winter, while the infection of Streptococcus pneumoniae was mainly concentrated in winter. This difference was statistically significant (P < 0.01). Affected by the COVID-19 pandemic, the isolation rates of Haemophilus influenzae and Streptococcus pneumoniae were significantly lower than those before the pandemic, and the isolation rate of Moraxella catarrhalis was significantly higher. The difference was statistically significant (P < 0.01). The proportion of isolated negative bacteria in NICU and PICU was higher than that in positive bacteria, and the infection rates of Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Acinetobacter baumannii were higher than those in other departments. The differences were statistically significant (P < 0.01). The results of drug sensitivity test showed that the drug resistance of Haemophilus influenzae and Moraxella catarrhalis was mainly concentrated in Ampicillin, First- and Second-generation cephalosporins, and Cotrimoxazole, with stable sensitivity to Third-generation cephalosporins, while the drug resistance of Streptococcus pneumoniae was concentrated in Macrolides, Sulfonamides, and Tetracyclines, with stable sensitivity to Penicillin. Staphylococcus aureus is highly resistant to penicillins and macrolides and susceptible to vancomycin. Enterobacteriaceae resistance is concentrated in cephalosporins, with a low rate of carbapenem resistance. From 2018 to 2020, 1557 strains of Staphylococcus aureus were isolated, of which 416 strains were MRSA, accounting for 27% of the isolates; 1064 strains of Escherichia coli were isolated, of which 423 strains were ESBL and 23 strains were CRE, accounting for 40% and 2% of the isolates, respectively; and 1400 strains of Klebsiella pneumoniae were isolated, of which 385 strains were ESBL and 402 strains were CRE, accounting for 28% and 29% of the isolates, respectively. Since 2011, the resistance of Escherichia coli and Klebsiella pneumoniae to Third-generation cephalosporins has increased, peaking in 2017, and has decreased after 2018, years after which carbapenem resistance has increased significantly, corresponding to an increase in the detection rate of Carbapenem-resistant Enterobacteriaceae CRE. Findings from this study revealed that there are significant differences in community-associated infectious pathogens before and after the COVID-19 pandemic, and there are significant age differences, seasonal epidemic trends, and high departmental correlation of pathogens related to lower respiratory tract disease infection in children. There was a significant gender difference in the isolation rate of pathogens associated with LRTI in infants under one year. Vaccination, implementation of isolation measures and social distance, strengthening of personal protective measures, aseptic operation of invasive medical treatment, hand hygiene, and environmental disinfection are beneficial to reducing community-associated pathogen infection, opportunistic pathogen infection, and an increase in resistant bacteria. The strengthening of bacterial culture of lower respiratory tract samples by pediatricians is conducive to the diagnosis of respiratory tract infections caused by different pathogens, contributing to the selection of effective drugs for treatment according to drug susceptibility results, which is important for the rational use of antibiotics and curbing bacterial resistance.

Reliability of Non-Contact Infrared Thermometers for Fever Screening Under COVID-19

Purpose Fever is one of the most typical clinical symptoms of coronavirus disease 2019 (COVID-19), and non-contact infrared thermometers (NCITs) are commonly used to screen for fever. However, there is a lack of authoritative data to define a “fever” when an NCIT is used and previous studies have shown that NCIT readings fluctuate widely depending on ambient temperatures and the body surface site screened. The aim of this study was to establish cut-off points for normal temperatures of different body sites (neck, forehead, temples, and wrist) and investigate the accuracy of NCITs at various ambient temperatures to improve the standardization and accuracy of fever screening. Patients and Methods A prospective investigation was conducted among 904 participants in the outpatient and emergency departments of Chengdu Women’s and Children’s Central Hospital. Body temperature was measured using NCITs and mercury axillary thermometers. A receiver operating characteristic curve was used to determine the accuracy of body temperature detection at the four body surface sites. Data on participant characteristics were also collected. Results Among the four surface sites, the neck temperature detection group had the highest accuracy. When the neck temperature was 37.35°C as the optimum fever diagnostic threshold, the sensitivity was 0.866. The optimum fever diagnostic thresholds for forehead, temporal, and wrist temperature were 36.65°C, 36.65°C, and 36.75°C, respectively. Moreover, triple neck temperature detection had the highest sensitivity, up to 0.998, whereas the sensitivity of triple wrist temperature detections was 0.949. Notably, the accuracy of NCITs significantly reduced when the temperature was lower than 18°C. Conclusion Neck temperature had the highest accuracy among the four NCIT temperature measurement sites, with an optimum fever diagnostic threshold of 37.35°C. Considering the findings reported in our study, we recommend triple neck temperature detection with NCITs as the fever screening standard for COVID-19.