Effects of behaviors and surrounding environment on myopia before and during the COVID-19 pandemic: a longitudinal analysis of children and adolescents in China.

Aim: To investigate the relationship between related factors and visual acuity of Chinese school students before and during the COVID-19 pandemic. Subject and methods: Chinese students from primary and secondary schools were included from the Chinese National Surveys on Students' Constitution and Health CNSSCH (2019). A total of 1496 participants completed follow-ups in June and December 2020, respectively. Generalized estimating equations were used to test the differences in visual environment. Logistic regression models were utilized to examine the roles of behaviors and surrounding environment changes associated with myopia before and during the pandemic. Results: The prevalence of myopia was 47.7%, 55.6%, and 57.2% in baseline and two follow-ups, respectively. Significant differences existed for gender, learning level, and region (all P < 0.05). The proportion of new myopia and myopia torsion was the highest in the primary schools. Multivariate logistic regression analysis found that screen time ≥ 4h/d (OR = 2.717), poor eye habits (OR = 1.477), insufficient lighting for studying at night (OR = 1.779), desk or roof lamps only (OR = 1.388), and poor sleep quality (OR = 4.512) were the risk factors for myopia (all P < 0.05), and eye exercises (OR = 0.417), milk intake (OR = 0.758), and eggs intake (OR = 0.735) were the protective factors for myopia (all P < 0.05). Conclusion: Prevalence of myopia increased among Chinese students before and during the COVID-19. It is necessary to pay more attention to the pupils' visual acuity, especially in primary school students, in the future. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01900-w.

Worry and fear during the COVID-19 epidemic normalization: Analyzing prevalence and risk factors among 182,991 high school students in China.

It is worth paying attention to the level of worry and fear of students during the normalization of the epidemic. We conducted the cross-sectional study that included 182,991 high school students using an online survey to assess worry and fear levels and its influencing factors in three cities in Henan Province, China, from May 21 to May 27, 2021. Worry and fear levels were measured using a five-item Likert-type scale. Multinomial logistic regression was used to analyze the risk factors. Approximately 65.42% of students reported being high worry about the coronavirus disease 2019 (COVID-19) epidemic, and about 41.44% of students reported being high fear about the COVID-19 epidemic. In addition, compared with female, male had lower odds of suffering from a high worry, and compared with senior high school students, junior high school students were more likely to suffer from a high worry. Students lived in rural had highest odds increased likelihood of high worry. Similar results in fear levels. During the normalization period of the COVID-19 epidemic, many students have high levels of worry and fear. This study has implications for potential influencers of worry and fear levels in follow-up work.

Association between attitudes toward the COVID-19 vaccines and mental health among 140,259 college students in China.

Background: With the launch of the COVID-19 vaccines, the vaccination rate has become a hot issue of concern. However, the evidence for the relationship between college students' attitudes toward vaccines and anxiety and depressive symptoms has been limited. Methods: In total, 140,259 college students were recruited using a cluster sampling method in Zhengzhou, Xinxiang, Xinyang city of Henan Province, China, May 21-27, 2021. Anxiety symptoms were determined by the Generalized Anxiety Disorder tool (GAD-7) and depressive symptoms were determined by the Patient Health Questionnaire (PHQ-9). Multiple logistic regression was performed to estimate the association between students' attitudes toward the vaccines and anxiety and depressive symptoms. Results: The results indicate that 22.45% of students are unclear whether the vaccine can protect them from infection and 45.57% are unclear whether the vaccine is safe and has no side effects. In addition, after adjusting, the model showed that students who think vaccines can protect them and are safe had 0.128 (95%CI 0.110-0.150; Ptrend < 0.001) times lower risk of anxiety compared to their counterparts who think vaccines can neither protect them nor are safe. Similar ORs were found in depression (aOR = 0.157; 95%CI 0.137-0.180). Conclusion: This large-scale study has shown an association between symptoms of anxiety and depression and reluctance to obtain vaccination. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01830-7.

Infectivity of pseudotyped SARS-CoV-2 variants of concern in different human cell types and inhibitory effects of recombinant spike protein and entry-related cellular factors.

Since the report of the first COVID-19 case in 2019, SARS-CoV-2 variants of concern (VOCs) have continued to emerge, manifesting diverse infectivity, evasion of host immunity and pathology. While ACE2 is the predominant receptor of SARS-CoV-2, TMPRSS2, Kim-1, NRP-1, CD147, furin, CD209L, and CD26 have also been implicated as viral entry-related cofactors. To understand the variations in infectivity and pathogenesis of VOCs, we conducted infection analysis in human cells from different organ systems using pseudoviruses of VOCs including Alpha, Beta, Gamma, and Delta. Recombinant spike S1, RBD, ACE2, Kim-1, and NRP-1 proteins were tested for their ability to block infection to dissect their roles in SARS-CoV-2 entry into cells. Compared with wild type SARS-CoV-2 (WT), numerous VOCs had significant increases of infectivity across a wide spectrum of cell types. Recombinant ACE2 protein more effectively inhibited the infection of VOCs including Delta and Omicron (BA.1 and BA.2) than that of WT. Interestingly, recombinant S1, RBD, Kim-1, and NRP-1 proteins inhibited the infection of all pseudoviruses in a manner dependent on the levels of ACE2 expression in different cell types. These results provide insights into the diverse infectivity of SARS-CoV-2 VOCs, which might be helpful for managing the emergence of new VOCs.

Discussion on the advantages of acupuncture and moxibustion in the prevention and treatment of COVID-19

COVID-19 belongs to the plague category of Traditional Chinese Medicine. It has been confirmed in many ancient books and modern clinical studies that the acupuncture and moxibustion can cure the plague. Containing COVID-19, National Health Commission of the People's Republic of China and National Administration of Traditional Chinese Medicine Jointly issued the Diagnosis and Treatment of Corona Virus Disease-19(7th edition). It mentions the treatment program of acupuncture and moxibustion participating in the prevention and treatment of COVID-19. Liu Baoyan's team analyzed the ideas of acupuncture and moxibustion treatment for COVID-19. However, the clinical advantages of acupuncture and moxibustion still need to be further clarified. In the treatment of many clinical symptoms of COVID-19, acupuncture therapy has a good clinical effect, so the purpose of our discussion on the advantages is to improve the clinical accuracy and efficacy of COVID-19.

Multidimensional self-rating biological rhythm disorder and its association with depression and anxiety symptoms among adolescents aged 11-23 years: a school-based cross-sectional study from China.

BACKGROUND: Depression and anxiety are topical concerns worldwide, especially among adolescents. Besides, biological rhythm disorder as a candidate mechanism for mood disorders is highly prevalent, but relevant research among adolescents in China is presently limited. We conducted the present study to investigate the distribution of multi-dimensional self-rating biological rhythm disorder and the association of self-rating biological rhythm disorders with depression and anxiety symptoms among Chinese adolescents in different academic stages. METHODS: In the cross-sectional study, 3693 students aged 11-23 from Zhengzhou City, Henan Province, China were included. The Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) were used to evaluate symptoms of depression and anxiety, respectively. Additionally, the Self-Rating of Biological Rhythm Disorder for Adolescents (SBRDA) was used to assess status of biological rhythm disorders. Multivariate logistic regression was developed to explore factors potentially associated with symptoms of depression and anxiety stratified by academic stages. RESULTS: Among all participants, 44.14 and 36.15% suffered from depression and anxiety symptoms, respectively. On average, participants scored 74.66 ± 19.37 on the measure of total biological rhythm disorder. Adjusted for demographic confounding factors, the logistic regression analysis showed higher scores of total biological rhythm disorder were associated with more severe depression (OR = 14.38, 95%CI: 11.38-18.16) and anxiety symptoms (OR = 11.63, 95%CI: 9.14-14.81). The similar results were also found in the stratified analysis by academic stages. CONCLUSIONS: Self-rating biological rhythm disorders are significantly associated with depression and anxiety symptoms among adolescents. Discrepancy across academic stages should also be taken into account in establishing public health strategies.

The Impact of COVID-19 on Maternal Mental Health during Pregnancy: A Comparison between Canada and China within the CONCEPTION Cohort.

The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and China but no study has compared the two countries using the same standardized and validated instruments. In this study, we aimed to evaluate and compare the impact of COVID-19 public health policies on maternal mental health between Canada and China, as we hypothesize that geographical factors and different COVID-19 policies are likely to influence maternal mental health. Pregnant persons >18 years old were recruited in Canada and China using a web-based strategy. All participants recruited between 26 June 2020 and 16 February 2021 were analyzed. Self-reported data included sociodemographic variables, COVID-19 experience and maternal mental health assessments (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7) scale, stress and satisfaction with life). Analyses were stratified by recruitment cohort, namely: Canada 1 (26 June 2020-10 October 2020), Canada 2 and China (11 October 2020-16 February 2021). Overall, 2423 participants were recruited, with 1804 participants within Canada 1, 135 within Canada 2 and 484 in China. The mean EDPS scores were 8.1 (SD, 5.1) in Canada 1, 8.1 (SD, 5.2) in Canada 2 and 7.7 (SD, 4.9) in China (p-value Canada 2/China: p = 0.005). The mean GAD-7 scores were 2.6 (SD, 2.9) in China, 4.3 (SD, 3.8) in Canada 1 (p < 0.001) and 5.8 (SD, 5.2) in Canada 2 (p < 0.001). When adjusting for stress and anxiety, being part of the Chinese cohort significantly increased the chances of having maternal depression by over threefold (adjusted OR 3.20, 95%CI 1.77-5.78). Canadian and Chinese participants reported depressive scores nearly double those of other crises and non-pandemic periods. Lockdowns and reopening periods have an important impact on levels of depression and anxiety among pregnant persons.

Review of action mechanisms of acupuncture on post-traumatic stress disorder

Post-traumatic stress disorder(PTSD) is a kind of mental disorder caused by severe traumatic events. It has a high incidence, a serious of impacts on the physical and mental health of patients. Especially in the current situation of COVID-19, the researches on PTSD are particularly important, but the choice of drugs available for PTSD is limited and it is often accompanied by adverse reactions. In the field of acupuncture, there are many clinical research evidences suggested that PTSD is a predominant disease of acupuncture. However, its action mechanisms have not been fully elucidated, so the possible mechanisms of acupuncture in treating PTSD were discussed.

Prevalence and risk factors of depressive symptoms among 140,259 college students during the COVID-19 epidemic normalization in China: A cross-sectional survey.

Objective: College students are one of the most vulnerable populations to the COVID-19 pandemic's mental health effects. During the coronavirus disease 2019 (COVID-19) outbreak, we wanted to see how common depressive symptoms were among college students and what factors contributed to that. Methods: Between 21 and 27 May 2021, 140,259 college students from three cities in Henan Province, China, were involved. The Patient Health Questionnaire-9 was used to determine depressive symptoms (PHQ-9). Multiple logistic regression analysis was used to calculate odds ratios (ORs) and 95% CIs for potential depressive symptom factors. Results: Mild depressive symptoms and above are present in 21.12% of college students. Women had a higher prevalence of mild depressive symptoms than men (61.38 vs. 59.75%), and depressive symptoms were most prevalent among rural students and least prevalent among city students (21.44 vs. 20.29%). Participants with depressive symptoms are also more likely to have a poor-behavioral status. From none-to-severe depressive symptoms, 78.88, 15.78, 2.80, 1.67, and 0.88% had them. Gender, residential location, and behavioral status were found to be associated with depressive symptoms after adjusting for potential confounders. Conclusion: This cross-sectional study identified the factors that influence the prevalence of depression in college students. It found that the government should pay more attention to mental health issues affecting college students in combating the COVID-19 epidemic normalization.

Attitude toward COVID-19 vaccines and its association with depressive symptoms in 386,924 Chinese primary school students during COVID-19 epidemic normalization.

AIM: Before Chinese primary school students were generally vaccinated against the COVID-19 vaccine, this study evaluated the willingness of this population and its influencing factors before vaccination, and evaluate its association between attitudes toward the vaccine and depressive symptoms. METHODS: A cross-sectional study involved 386,924 primary school students using a cluster sampling method during May 21-27, 2021. The Chinese version of the Children Depression Inventory (CDI) was used to assess depressive symptoms. Multiple logistic regression analysis models were used to estimate the relationship between attitudes toward COVID-19 vaccines and depressive symptoms. RESULTS: Among the participants, the prevalence of depressive symptoms was higher in higher grades. The prevalence was higher in fifth and sixth grade students than third and fourth grade students and first and second grades (10.22% vs. 6.07% vs. 3.04%). In addition, 20.79% of students do not know whether the vaccine can protect him from the COVID-19 infection, and 40.60% of students do not know whether the vaccine is safe. Of note, in terms of attitudes toward COVID-19 vaccines, students with more positive attitudes have a lower risk of depressive symptoms (adjusted odds ratio (aOR) = 0.151; 95% confidence interval (CI): 0.140-0.164). CONCLUSION: Based on these findings, it is necessary for the government and schools to promote vaccine safety and reliability information in a timely manner to increase vaccination uptake.

RNA-based therapeutics: an overview and prospectus.

The growing understanding of RNA functions and their crucial roles in diseases promotes the application of various RNAs to selectively function on hitherto "undruggable" proteins, transcripts and genes, thus potentially broadening the therapeutic targets. Several RNA-based medications have been approved for clinical use, while others are still under investigation or preclinical trials. Various techniques have been explored to promote RNA intracellular trafficking and metabolic stability, despite significant challenges in developing RNA-based therapeutics. In this review, the mechanisms of action, challenges, solutions, and clinical application of RNA-based therapeutics have been comprehensively summarized.

Hydrophilic rhodamine B-loaded / boronic acid-modified graphene oxide nanocomposite as a substitute of enzyme-labeled second antibody for ultrasensitive detection of antibodies.

Enzyme-labeled secondary antibody is often used to amplify the output signal in the process of antibody detection. However, its preparation process is complex and time-consuming. Herein, we fabricated an innovative hydrophilic rhodamine B-loaded / boronic acid-modified graphene oxide (HRBGO) nanocomposite, used as a substitute of enzyme-labeled second antibody. The synthetic HRBGO was loaded with generous rhodamine B and modified with boronic acid. Therefore, the HRBGO could selectively label the carbohydrate chains of Fc fragment of primary antibody through specific boronate affinity recognition, and then perform signal output and amplification by releasing rhodamine B. To verify the practicability of HRBGO, trastuzumab as a humanized monoclonal antibody targeting human epidermal growth factor receptor-2 (HER2) was selected as model antibody. A glycosylation site-blocked / HER2-immobilized magnetic nanoparticles (GHMN) was also prepared for selectively capturing trastuzumab from complex samples via specific immunoaffinity. Because the glycosylation sites of HER2 can also be labeled with the HRBGO by boronate affinity recognition, these sites were blocked by a masking agent to minimize the background signal. For specific and ultrasensitive detection of trastuzumab, the integration of GHMN and HRBGO was proposed and optimized in detail. Trastuzumab detection based on HRBGO consisted of three steps: specific capture, selective labeling, and output signal. The proposed strategy provided ultrahigh sensitivity with limit of detection of 0.35 fg mL-1 and was successfully applied in the detection of trastuzumab in spiked serum sample with recovery and relative standard deviation in the range of 98.7-103.8% and 3.8-6.0%, respectively. To assess universal applicability, the HRBGO was also successfully used for the determination of anti-SARS-COV2 RBD antibody in human serum sample.

Research on NTP Nonlinear Reflection Attack Identification Based on AHP Multidimensional Matrix in Global COVID-19 Environment

Under the influence of the global epidemic, various businesses have moved online one after another. With the rise of emerging industries such as online medical treatment, online education, and online conference, the proportion of attacks in the network service industry has increased year by year. UDP-FLOOD is still the primary scenario of DDoS attacks. Among them, with a large number of attack resources and most of them are high configuration servers, NTP (Network Time Protocol) reflection has become the most common UDP reflection attack method, accounting for 59% of the overall distribution. Therefore, establishing an efficient NTP attack detection system is a very important content to prevent network malicious attacks. At present, NTP-attacking based defensed methods mainly include IP filtering, hop mapping, and response packet detection, but they all have obvious weaknesses. Among them, the IP detection scheme can only detect historical attack IP, the implementation of hop mapping scheme is complex, and the resource overhead of response packet detection scheme is too large. Therefore, this paper proposes a nonlinear detection algorithm based on AHP multidimensional matrix quad information entropy. Through simulation experiments, the change of quad information entropy of attack intensity from 10% to 100% is counted. The detection rate based on the traditional target IP and target port algorithm is only 50% and 60%, which is significantly lower than this algorithm. Experiments show that the detection rate of this algorithm is higher.

Flavonoids for Treating Viral Acute Respiratory Tract Infections: A Systematic Review and Meta-Analysis of 30 Randomized Controlled Trials.

BACKGROUND: This meta-analysis aimed to investigate the efficacy and safety of flavonoids in treating viral acute respiratory tract infections (ARTIs). METHODS: Randomized controlled trials (RCTs) were entered into meta-analyses performed separately for each indication. Efficacy analyses were based on changes in disease-specific symptom scores. Safety was analyzed based on the pooled data from all eligible trials, by comparing the incidence of adverse events between flavonoids and the control. RESULTS: In this study, thirty RCTs (n = 5,166) were included. In common cold, results showed that the flavonoids group decreased total cold intensity score (CIS), the sum of sum of symptom intensity differences (SSID) of CIS, and duration of inability to work vs. the control group. In influenza, the flavonoids group improved the visual analog scores for symptoms. In COVID-19, the flavonoids group decreased the time taken for alleviation of symptoms, time taken for SARS-CoV-2 RT-PCR clearance, the RT-PCR positive subjects at day 7, time to achievement of the normal status of symptoms, patients needed oxygen, patients hospitalized and requiring mechanical ventilation, patients in ICU, days of hospitalization, and mortality vs. the control group. In acute non-streptococcal tonsillopharyngitis, the flavonoids group decreased the tonsillitis severity score (TSS) on day 7. In acute rhinosinusitis, the flavonoids group decreased the sinusitis severity score (SSS) on day 7, days off work, and duration of illness. In acute bronchitis, the flavonoids group decreased the bronchitis severity score (BSS) on day 7, days off work, and duration of illness. In bronchial pneumonia, the flavonoids group decreased the time to symptoms disappearance, the level of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α). In upper respiratory tract infections, the flavonoids group decreased total CIS on day 7 and increased the improvement rate of symptoms. Furthermore, the results of the incidence of adverse reactions did not differ between the flavonoids and the control group. CONCLUSION: Results from this systematic review and meta-analysis suggested that flavonoids were efficacious and safe in treating viral ARTIs including the common cold, influenza, COVID-19, acute non-streptococcal tonsillopharyngitis, acute rhinosinusitis, acute bronchitis, bronchial pneumonia, and upper respiratory tract infections. However, uncertainty remains because there were few RCTs per type of ARTI and many of the RCTs were small and of low quality with a substantial risk of bias. Given the limitations, we suggest that the conclusions need to be confirmed on a larger scale with more detailed instructions in future studies.Systematic Review Registration: inplasy.com/inplasy-2021-8-0107/, identifier: INPLASY20218010.

Clinical Applicable AI System Based on Deep Learning Algorithm for Differentiation of Pulmonary Infectious Disease.

Objective: To assess the performance of a novel deep learning (DL)-based artificial intelligence (AI) system in classifying computed tomography (CT) scans of pneumonia patients into different groups, as well as to present an effective clinically relevant machine learning (ML) system based on medical image identification and clinical feature interpretation to assist radiologists in triage and diagnosis. Methods: The 3,463 CT images of pneumonia used in this multi-center retrospective study were divided into four categories: bacterial pneumonia (n = 507), fungal pneumonia (n = 126), common viral pneumonia (n = 777), and COVID-19 (n = 2,053). We used DL methods based on images to distinguish pulmonary infections. A machine learning (ML) model for risk interpretation was developed using key imaging (learned from the DL methods) and clinical features. The algorithms were evaluated using the areas under the receiver operating characteristic curves (AUCs). Results: The median AUC of DL models for differentiating pulmonary infection was 99.5% (COVID-19), 98.6% (viral pneumonia), 98.4% (bacterial pneumonia), 99.1% (fungal pneumonia), respectively. By combining chest CT results and clinical symptoms, the ML model performed well, with an AUC of 99.7% for SARS-CoV-2, 99.4% for common virus, 98.9% for bacteria, and 99.6% for fungus. Regarding clinical features interpreting, the model revealed distinctive CT characteristics associated with specific pneumonia: in COVID-19, ground-glass opacity (GGO) [92.5%; odds ratio (OR), 1.76; 95% confidence interval (CI): 1.71-1.86]; larger lesions in the right upper lung (75.0%; OR, 1.12; 95% CI: 1.03-1.25) with viral pneumonia; older age (57.0 years ± 14.2, OR, 1.84; 95% CI: 1.73-1.99) with bacterial pneumonia; and consolidation (95.8%, OR, 1.29; 95% CI: 1.05-1.40) with fungal pneumonia. Conclusion: For classifying common types of pneumonia and assessing the influential factors for triage, our AI system has shown promising results. Our ultimate goal is to assist clinicians in making quick and accurate diagnoses, resulting in the potential for early therapeutic intervention.

Severe Type of COVID-19: Pathogenesis, Warning Indicators and Treatment.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is a major public health issue. The epidemic is unlikely to be contained until the global launch of safe and effective vaccines that could prevent serious illnesses and provide herd immunity. Although most patients have mild flu-like symptoms, some develop severe illnesses accompanied by multiple organ dysfunction. The identification of pathophysiology and early warning biomarkers of a severe type of COVID-19 contribute to the treatment and prevention of serious complications. Here, we review the pathophysiology, early warning indicators, and effective treatment of Chinese and Western Medicine for patients with a severe type of COVID-19.

Association between mask wearing and anxiety symptoms during the outbreak of COVID 19: A large survey among 386,432 junior and senior high school students in China.

AIM: To evaluate the association between mask wearing practice and the risk of anxiety symptoms during the COVID-19 epidemic among Chinese students aged 12-18 years old. METHODS: Totally, 386,432 junior and senior high school students were recruited using a cluster sampling method across three cities of Henan Province in China during February 4-12, 2020. Mask wearing practice was defined according to its type and the behavior exhibited in relation to wearing a mask. Presence of anxiety symptoms was determined by Generalized Anxiety Disorder tool (GAD-7). Multiple logistic regression was performed to estimate the association between mask wearing and anxiety symptoms. RESULTS: Among the participants, compared with students who completely adhered to the all the mask wearing practice, students who did not adhere to all the mask wearing practice had 1.97 times more likely to suffer from anxiety symptoms (adjusted odds ratio (aOR) = 1.97; 95% confidence interval (CI): 1.74-2.22). Furthermore, compared with students who did not know the proper type of mask, students who knew the proper type of mask had a lower risk of anxiety symptoms (aOR = 0.78; 95%CI: 0.76-0.80). Students who adhered to proper behavior of mask wearing was associated with 34% decreased odds for anxiety symptoms (aOR = 0.68; 95%CI: 0.62-0.74). CONCLUSIONS: To conclude, proper mask wearing may be an important attribute that play a significant role in reducing the risk of anxiety symptoms among junior and senior school student. However, since this study is a cross-sectional study, prospective studies are needed to further verify.

Prevalence and associated factors of anxiety among 538,500 Chinese students during the outbreak of COVID-19: A web-based cross-sectional study.

This study was conducted on elementary school students in Henan Province, China, from February 4th to 11th, 2020, during the coronavirus disease 2019 (COVID-19) epidemic. The purpose of the study was to examine the prevalence of anxiety among students and identify the related risk factors contributing to anxiety. Demographic information and psychological status were assessed by using self-reported measures. The generalized anxiety disorder tool (GAD-7) and a multiple logistic regression model were used to assess anxiety and identify potential influencing factors. Cross-sectional data indicated that the overall anxiety prevalence was 13.4%. The prevalence of anxiety symptoms was highest among rural primary school students and lowest among city students. Three groups of students in different regions were surveyed, and the prevalence of anxiety symptoms was significantly higher among students with poor knowledge of COVID-19 than among students with good knowledge of COVID-19. After adjusting for potential confounding factors, it was found that location, knowledge, and practice were related to anxiety. This study showed that the prevalence of anxiety symptoms was higher among Chinese primary school students. The influencing factors found in this study may help relevant staff improve the mental health of children during the epidemic.

Common mtDNA variations at C5178a and A249d/T6392C/G10310A decrease the risk of severe COVID-19 in a Han Chinese population from Central China.

BACKGROUND: Mitochondria have been shown to play vital roles during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) development. Currently, it is unclear whether mitochondrial DNA (mtDNA) variants, which define mtDNA haplogroups and determine oxidative phosphorylation performance and reactive oxygen species production, are associated with COVID-19 risk. METHODS: A population-based case-control study was conducted to compare the distribution of mtDNA variations defining mtDNA haplogroups between healthy controls (n = 615) and COVID-19 patients (n = 536). COVID-19 patients were diagnosed based on molecular diagnostics of the viral genome by qPCR and chest X-ray or computed tomography scanning. The exclusion criteria for the healthy controls were any history of disease in the month preceding the study assessment. MtDNA variants defining mtDNA haplogroups were identified by PCR-RFLPs and HVS-I sequencing and determined based on mtDNA phylogenetic analysis using Mitomap Phylogeny. Student's t-test was used for continuous variables, and Pearson's chi-squared test or Fisher's exact test was used for categorical variables. To assess the independent effect of each mtDNA variant defining mtDNA haplogroups, multivariate logistic regression analyses were performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) with adjustments for possible confounding factors of age, sex, smoking and diseases (including cardiopulmonary diseases, diabetes, obesity and hypertension) as determined through clinical and radiographic examinations. RESULTS: Multivariate logistic regression analyses revealed that the most common investigated mtDNA variations (> 10% in the control population) at C5178a (in NADH dehydrogenase subunit 2 gene, ND2) and A249d (in the displacement loop region, D-loop)/T6392C (in cytochrome c oxidase I gene, CO1)/G10310A (in ND3) were associated with a reduced risk of severe COVID-19 (OR = 0.590, 95% CI 0.428-0.814, P = 0.001; and OR = 0.654, 95% CI 0.457-0.936, P = 0.020, respectively), while A4833G (ND2), A4715G (ND2), T3394C (ND1) and G5417A (ND2)/C16257a (D-loop)/C16261T (D-loop) were related to an increased risk of severe COVID-19 (OR = 2.336, 95% CI 1.179-4.608, P = 0.015; OR = 2.033, 95% CI 1.242-3.322, P = 0.005; OR = 3.040, 95% CI 1.522-6.061, P = 0.002; and OR = 2.890, 95% CI 1.199-6.993, P = 0.018, respectively). CONCLUSIONS: This is the first study to explore the association of mtDNA variants with individual's risk of developing severe COVID-19. Based on the case-control study, we concluded that the common mtDNA variants at C5178a and A249d/T6392C/G10310A might contribute to an individual's resistance to developing severe COVID-19, whereas A4833G, A4715G, T3394C and G5417A/C16257a/C16261T might increase an individual's risk of developing severe COVID-19.