Identification and quantitative analysis of bioactive components from Potentilla kleiniana Wight et Arn with anti HIV-1 proteases activity.

Potentilla kleiniana Wight et Arn（PK, 'Wu Pi Feng' in Chinese） was recorded as Miao ethnic medicine for treatment of fever, cough, ulcer, and erysipelas for thousands years. This study aimed to evaluate the antiviral activity of four PK extracts and seven compounds by using HIV-1 protease (HIV-1 PR). In addition, Ultra-High Performance Liquid Chromatography and High Resolution Mass Spectrometry (UPLC-HRMS) was employed to identify the bioactive components. The toxicity assessment of the extracts was done before antiviral screening using a highly specific human aspartyl protease, renin protease by fluorimetric method. As a result, seven compounds and four extracts of PK inhibited HIV-1 PR with IC50 range from 0.009 to 0.36 mg/mL, and did not appreciably inhibit the general human protease renin. This study first demonstrated that four PK extracts, ellagic acid and ursolic acid potent inhibit HIV-1 protease, could be used as an efficacious drug candidate to treat SARS-CoV-2 infection.

Analysis of the Influencing Factors of Seeking Intention on COVID-19 Risk Information: A Cross-Sectional Study.

Background: Information seeking, as an important part of the prevention and control of infectious diseases, can lead to positive outcomes by reducing uncertainty and alleviating panic. However, most previous studies have limited their analysis to individual-level psychosocial factors, and little is known about how social-level factors influence individuals' information-seeking intentions. Methods: The cross-sectional survey was conducted from July 30, 2020 to August 15, 2020 in China. We used a convenience sampling strategy to recruit participants from among the Internet users. The structural equation model was used to identify the incentives associated with coronavirus disease 2019 (COVID-19) risk information-seeking intention. Results: In this study, the responses of 871 Internet users who reflected a response rate of 85% were analyzed. Information-seeking intention was found to be directed by informational subjective norms (ISNs), perceived information need, risk knowledge, the sense of community (SOC), and negative affective responses, and ISNs were found to be the strongest driving factor. Individuals with a stronger SOC, which was associated with greater pressure and expectations, show negative affective responses. COVID-19 risk knowledge can affect the information-seeking intention of Internet users not only directly but also indirectly through their perceived information need. In addition, more risk knowledge was associated with a lower perceived risk likelihood. Conclusion: When formulating risk communication strategies, governments and health institutions should take targeted measures to improve the public's SOC and knowledge. This will provide an opportunity to explore the role of individual cognition and environmental risk information in public health.

The Effect of Regional Factors on the Mental Health Status of Frontline Nurses and Patients With COVID-19 During COVID-19: The Role of Depression and Anxiety.

At the end of 2019, Wuhan, Hubei Province, China, experienced the ravages of Coronavirus disease 2019 (COVID-19). In a few months, infected people rose to tens of thousands. This study aimed to explore the mental health status of military nurse personnel assisting (non-Hubei area) in the fight against COVID-19 and local nurse personnel (in the Wuhan area), as well as the differences in mental health status between nurses and COVID-19 patients that provide a reference basis for psychological crisis intervention. A convenience sampling method was used to select frontline nurses and COVID-19 patients (sample size 1,000+) from two mobile cabin hospitals from January to March 2020. The questionnaire consists of socio-demographic information, Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), General Mental Health Service Questionnaire and Work Intensity and Physical Status Questionnaire. The results showed that depression was present in 117 nurses (19.73%) and 101 patients (23.33%) with PHQ-9 scores >10; anxiety was present in 60 nurses (10.12%) and 54 patients (12.47%) with GAD-7 >10. The anxiety and depression levels of nurses in Wuhan area were higher than those in non-Hubei area. The differences in PHQ-9 and GAD-7 scores were also statistically significant (p < 0.001) when comparing patients from different regions, with anxiety and depression rates of 30.19 and 16.04% in local patients and 16.74 and 9.50% in foreign patients. The comparison between nurses and patients showed that the nurses were more depressed than the patients, while the patients were more anxious. Local nurses in Wuhan had a higher workload intensity than aid nurses (77.72 vs. 57.29%). Over 95% of frontline nurses and patients reported that they had not received any form of psychological counseling before the COVID-19 outbreak. 12.87% (26/194) of frontline nurses in Wuhan had a history of taking hypnotic drugs. However, fewer patients (16/212, 7.55%) took medication than frontline nurses. Anxiety and depression levels were far higher among local nurses and patients in Wuhan than in non-Hubei areas. The nurses had higher levels of depression, while the patients had higher anxiety levels. Providing targeted mental health services to healthcare professionals and patients is necessary when experiencing the impact of a major event.

The Effect of Regional Factors on the Mental Health Status of Frontline Nurses and Patients With COVID-19 During COVID-19: The Role of Depression and Anxiety

At the end of 2019, Wuhan, Hubei Province, China, experienced the ravages of Coronavirus disease 2019 (COVID-19). In a few months, infected people rose to tens of thousands. This study aimed to explore the mental health status of military nurse personnel assisting (non-Hubei area) in the fight against COVID-19 and local nurse personnel (in the Wuhan area), as well as the differences in mental health status between nurses and COVID-19 patients that provide a reference basis for psychological crisis intervention. A convenience sampling method was used to select frontline nurses and COVID-19 patients (sample size 1,000+) from two mobile cabin hospitals from January to March 2020. The questionnaire consists of socio-demographic information, Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), General Mental Health Service Questionnaire and Work Intensity and Physical Status Questionnaire. The results showed that depression was present in 117 nurses (19.73%) and 101 patients (23.33%) with PHQ-9 scores >10;anxiety was present in 60 nurses (10.12%) and 54 patients (12.47%) with GAD-7 >10. The anxiety and depression levels of nurses in Wuhan area were higher than those in non-Hubei area. The differences in PHQ-9 and GAD-7 scores were also statistically significant (p < 0.001) when comparing patients from different regions, with anxiety and depression rates of 30.19 and 16.04% in local patients and 16.74 and 9.50% in foreign patients. The comparison between nurses and patients showed that the nurses were more depressed than the patients, while the patients were more anxious. Local nurses in Wuhan had a higher workload intensity than aid nurses (77.72 vs. 57.29%). Over 95% of frontline nurses and patients reported that they had not received any form of psychological counseling before the COVID-19 outbreak. 12.87% (26/194) of frontline nurses in Wuhan had a history of taking hypnotic drugs. However, fewer patients (16/212, 7.55%) took medication than frontline nurses. Anxiety and depression levels were far higher among local nurses and patients in Wuhan than in non-Hubei areas. The nurses had higher levels of depression, while the patients had higher anxiety levels. Providing targeted mental health services to healthcare professionals and patients is necessary when experiencing the impact of a major event.

Takotsubo syndrome and respiratory diseases: a systematic review

Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction and a presentation resembling that of acute myocardial infarction. An increasing number of studies has shown the association of respiratory diseases with TTS. Here, we comprehensively reviewed the literature and examined the available evidence for this association. After searching PubMed, EMBASE, and Cochrane Library databases, two investigators independently reviewed 3117 studies published through May 2021. Of these studies, 99 met the inclusion criteria (n = 108 patients). In patients with coexisting respiratory disease and TTS, the most common TTS symptom was dyspnoea (70.48%), followed by chest pain (24.76%) and syncope (2.86%). The most common type of TTS was apical, accounting for 81.13% of cases, followed by the midventricular (8.49%), basal (8.49%), and biventricular (1.89%) types. Among the TTS cases, 39.82% were associated with obstructive lung disease and 38.89% were associated with pneumonia. Coronavirus disease 2019 (COVID-19), which has been increasingly reported in patients with TTS, was identified in 29 of 42 (69.05%) patients with pneumonia. The overall mortality rate for patients admitted for respiratory disease complicated by TTS was 12.50%. Obstructive lung disease and pneumonia are the most frequently identified respiratory triggers of TTS. Medications and invasive procedures utilized in managing respiratory diseases may also contribute to the development of TTS. Furthermore, the diagnosis of TTS triggered by these conditions can be challenging due to its atypical presentation. Future prospective studies are needed to establish appropriate guidelines for managing respiratory disease with concurrent TTS. Graphical Graphical

How platform-based internet hospital innovation affects doctors’ active stress coping efforts: The conservation of resource theory perspective

Doctor's effort of active stress coping is a key factor for keeping stability of healthcare system in the COVID pandemic. The Internet hospital breaks through the boundaries and expands external resources of the physical hospital, but brings doctors stress and challenges. However, it is not clear how Internet hospital innovation affects doctors' active stress coping effort. To address this question, based on conservation of resource theory (COR), we explore the issue and examine the model through a face-to-face situational investigation of 174 doctors from 66 Internet hospitals with complete online service functions in China. The results show that the personal characteristics and energy resources provided by platform-based hospital will promote doctors to actively respond to stress. The increase in object and condition resources will lead to doctors' avoidance of coping with stress in the short term, but help doctors to actively cope with stress in the long term. We extend the COR theory by considering platform-based feature of Internet hospital and suggest that hospital should continue to promote technological innovation for its long-term benefits. This study contributes to the growing literature on platform-based healthcare innovation and its non-economic benefits for healthcare professionals.

QoE oriented intelligent online learning evaluation technology in B5G scenario

Students' demand for online learning has exploded during the post-COVID-19 pandemic era. However, due to their poor learning experience, students' dropout rate and learning performance of online learning are not always satisfactory. The technical advantages of Beyond Fifth Generation (B5G) can guarantee a good multimedia Quality of Experience (QoE). As a special case of multimedia services, online learning takes into account both the usability of the service and the cognitive development of the users. Factors that affect the Quality of Online Learning Experience (OL-QoE) become more complicated. To get over this dilemma, we propose a systematic scheme by integrating big data, Machine Learning (ML) technologies, and educational psychology theory. Specifically, we first formulate a general definition of OL-QoE by data analysis and experimental verification. This formula considers both the subjective and objective factors (i.e., video watching ratio and test scores) that most affect OL-QoE. Then, we induce an extended layer to the classic Broad Learning System (BLS) to construct an Extended Broad Learning System (EBLS) for the students' OL-QoE prediction. Since the extended layer can increase the width of the BLS model and reduce the redundant nodes of BLS, the proposed EBLS can achieve a trade-off between the prediction accuracy and computation complexity. Finally, we provide a series of early intervention suggestions for different types of students according to their predicted OL-QoE values. Through timely interventions, their OL-QoE and learning performance can be improved. Experimental results verify the effectiveness of the proposed scheme.

Red blood cell distribution width: A severity indicator in patients with COVID-19.

Red blood cell distribution width (RDW) was frequently assessed in COVID-19 infection and reported to be associated with adverse outcomes. However, there was no consensus regarding the optimal cutoff value for RDW. Records of 98 patients with COVID-19 from the First People's Hospital of Jingzhou were reviewed. They were divided into two groups according to the cutoff value for RDW on admission by receiver operator characteristic curve analysis: ≤11.5% (n = 50) and >11.5% (n = 48). The association of RDW with the severity and outcomes of COVID-19 was analyzed. The receiver operating characteristic curve indicated that the RDW was a good discrimination factor for identifying COVID-19 severity (area under the curve = 0.728, 95% CI: 0.626-0.830, p < 0.001). Patients with RDW > 11.5% more frequently suffered from critical COVID-19 than those with RDW ≤ 11.5% (62.5% vs. 26.0%, p < 0.001). Multivariate logistic regression analysis showed RDW to be an independent predictor for critical illness due to COVID-19 (OR = 2.40, 95% CI: 1.27-4.55, p = 0.007). A similar result was obtained when we included RDW > 11.5% into another model instead of RDW as a continuous variable (OR = 5.41, 95% CI: 1.53-19.10, p = 0.009). RDW, as an inexpensive and routinely measured parameter, showed promise as a predictor for critical illness in patients with COVID-19 infection. RDW > 11.5% could be the optimal cutoff to discriminate critical COVID-19 infection.

Inhibition of SARS-CoV-2 replication in the lung with siRNA/VIPER polyplexes.

SARS-CoV-2 has been the cause of a global pandemic since 2019 and remains a medical urgency. siRNA-based therapies are a promising strategy to fight viral infections. By targeting a specific region of the viral genome, siRNAs can efficiently downregulate viral replication and suppress viral infection. However, to achieve the desired therapeutic activity, siRNA requires a suitable delivery system. The VIPER (virus-inspired polymer for endosomal release) block copolymer has been reported as promising delivery system for both plasmid DNA and siRNA in the past years. It is composed of a hydrophilic block for condensation of nucleic acids as well as a hydrophobic, pH-sensitive block that, at acidic pH, exposes the membrane lytic peptide melittin, which enhances endosomal escape. In this study, we aimed at developing a formulation for pulmonary administration of siRNA to suppress SARS-CoV-2 replication in lung epithelial cells. After characterizing siRNA/VIPER polyplexes, the activity and safety profile were confirmed in a lung epithelial cell line. To further investigate the activity of the polyplexes in a more sophisticated cell culture system, an air-liquid interface (ALI) culture was established. siRNA/VIPER polyplexes reached the cell monolayer and penetrated through the mucus layer secreted by the cells. Additionally, the activity against wild-type SARS-CoV-2 in the ALI model was confirmed by qRT-PCR. To investigate translatability of our findings, the activity against SARS-CoV-2 was tested ex vivo in human lung explants. Here, siRNA/VIPER polyplexes efficiently inhibited SARS-CoV-2 replication. Finally, we verified the delivery of siRNA/VIPER polyplexes to lung epithelial cells in vivo, which represent the main cellular target of viral infection in the lung. In conclusion, siRNA/VIPER polyplexes efficiently delivered siRNA to lung epithelial cells and mediated robust downregulation of viral replication both in vitro and ex vivo without toxic or immunogenic side effects in vivo, demonstrating the potential of local siRNA delivery as a promising antiviral therapy in the lung.

Genetically Predicted Higher Educational Attainment Decreases the Risk of COVID-19 Susceptibility and Severity: A Mendelian Randomization Study

Background: Prior observational studies indicated that lower educational attainment (EA) is associated with higher COVID-19 risk, while these findings were vulnerable to bias from confounding factors. We aimed to clarify the causal effect of EA on COVID-19 susceptibility, hospitalization, and severity using Mendelian randomization (MR). Methods: We identified genetic instruments for EA from a large genome-wide association study (GWAS) (n = 1,131,881). Summary statistics for COVID-19 susceptibility (112,612 cases and 2,474,079 controls), hospitalization (24,274 cases and 2,061,529 controls), and severity (8,779 cases and 1,001,875 controls) were obtained from the COVID-19 Host Genetics Initiative. We used the single-variable MR (SVMR) and the multivariable MR (MVMR) controlling intelligence, income, body mass index, vigorous physical activity, sedentary behavior, smoking, and alcohol consumption to estimate the total and direct effects of EA on COVID-19 outcomes. Inverse variance weighted was the primary analysis method. All the statistical analyses were performed using R software. Results: Results from the SVMR showed that genetically predicted higher EA was correlated with a lower risk of COVID-19 susceptibility [odds ratio (OR) 0.86, 95% CI 0.84–0.89], hospitalization (OR 0.67, 95% CI 0.62–0.73), and severity (OR 0.67, 95% CI 0.58–0.79). EA still maintained its effects in most of the MVMR. Conclusion: Educational attainment is a predictor for susceptibility, hospitalization, and severity of COVID-19 disease. Population with lower EA should be provided with a higher prioritization to public health resources to decrease the morbidity and mortality of COVID-19.

Targeting genomic SARS-CoV-2 RNA with siRNAs allows efficient inhibition of viral replication and spread.

A promising approach to tackle the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) could be small interfering (si)RNAs. So far it is unclear, which viral replication steps can be efficiently inhibited with siRNAs. Here, we report that siRNAs can target genomic RNA (gRNA) of SARS-CoV-2 after cell entry, and thereby terminate replication before start of transcription and prevent virus-induced cell death. Coronaviruses replicate via negative sense RNA intermediates using a unique discontinuous transcription process. As a result, each viral RNA contains identical sequences at the 5' and 3' end. Surprisingly, siRNAs were not active against intermediate negative sense transcripts. Targeting common sequences shared by all viral transcripts allowed simultaneous suppression of gRNA and subgenomic (sg)RNAs by a single siRNA. The most effective suppression of viral replication and spread, however, was achieved by siRNAs that targeted open reading frame 1 (ORF1) which only exists in gRNA. In contrast, siRNAs that targeted the common regions of transcripts were outcompeted by the highly abundant sgRNAs leading to an impaired antiviral efficacy. Verifying the translational relevance of these findings, we show that a chemically modified siRNA that targets a highly conserved region of ORF1, inhibited SARS-CoV-2 replication ex vivo in explants of the human lung. Our work encourages the development of siRNA-based therapies for COVID-19 and suggests that early therapy start, or prophylactic application, together with specifically targeting gRNA, might be key for high antiviral efficacy.

Status of Humoral and Cellular Immune Responses within 12 Months Following CoronaVac Vaccination Against COVID-19 (preprint)

Background: Understanding immune memory to COVID-19 vaccines is critical for the design and optimal vaccination schedule for curbing the COVID-19 pandemic. Here, we assessed the persistence of humoral and cellular immune responses for 12 months after two-dose CoronaVac.Methods: Participants aged 18–59 years received two doses of 3 μg CoronaVac 14 days apart, and blood samples were collected before vaccination (baseline) and at 1, 3, 6, and 12 months after the second shot. Humoral responses of specific antibodies and neutralising antibodies were measured by using chemiluminescent immunoassay and wild-type SARS-CoV-2 microneutralisation assay, respectively. Cellular responses were measured by immunospot-based and intracellular cytokine staining assays. This trial is registered with ClinicalTrials.gov, NCT05072496.Findings: Total 150 participants were enrolled, and 136 of them completed the study through the 12-month endpoint. At 1 month after vaccination, binding and neutralising antibodies emerged rapidly, the seropositive rate of binding antibodies and seroconversion rate of neutralizing antibodies was 99% and 50%, respectively. From 3 to 12 months, the binding and neutralizing antibodies declined slightly overtime. At 12 months, the binding and neutralizing antibodies were still detectable and significantly higher than the baseline. IFN-γ and IL-2 secretion specifically induced by RBD persisted at high levels until 6 months, and could be observed at 12 months, while the levels of IL-5 and Granzyme B were hardly detected, demonstrating a Th1-biased response. Besides, specific CD4+TCM, CD4+TEMM, CD8+ TEMand CD8+TE cells were all detectable and functional up to 12 months after the second dose, as the cells produced IFN-γ, IL-2, and GzmB in response to stimulation of SARS-CoV-2 RBD.Interpretation: CoronaVac not only induced durable binding and neutralising antibody responses, but also SARS-CoV-2-specific CD4+ and CD8+ memory T cells for up to 12 months.Trial Registration: This study is registered with ClinicalTrials.gov, NCT05072496.Funding: Beijing Municipal Science & Technology CommissionDeclaration of Interest: None to declare. Ethical Approval: The trial protocol was approved by the Ethics Committee of Beijing CDC (2020-28)

Computer Vision Syndrome During SARS-CoV-2 Outbreak in University Students: A Comparison Between Online Courses and Classroom Lectures.

Purpose: To compare the prevalence of computer vision syndrome in university students of different teaching modes during the SARS-CoV-2 outbreak period. Methods: A cross-sectional survey study using the validated Computer Vision Syndrome Questionnaire in Chinese medical students of Sichuan University who took classroom lectures and the same-grade foreign students from a Bachelor of Medicine and Bachelor of Surgery (MBBS) program who took online lectures with similar schedules. Results: A total of 137 responses from 63 Chinese students and 74 MBBS students were obtained. The highest frequency of digital screen time was 7-9 h (43.24%, 32/74) for MBBS students and 2-4 h (46.03%, 29/63) for Chinese students. The prevalence of computer vision syndrome among Chinese students and MBBS students were 50.79% and 74.32%, respectively (P = 0.004). The average numbers of reported symptoms were 5.00 ± 2.17 in Chinese students and 5.91 ± 1.90 in MBBS students (P = 0.01). The three most highly reported symptoms were "heavy eyelids" (53.97%), "dryness" (50.79%), and "feeling of a foreign body" (46.03%) in Chinese students and "dryness" (72.97%), "feeling of a foreign body" (62.16%), and "heavy eyelids" (58.11%) in MBBS students. The sum grades of computer vision syndrome had a moderate positive correlation with screen time (Spearman's correlation coefficient = 0.386, P < 0.001). The grades of symptoms of "feeling of a foreign body," "heavy eyelids," and "dryness" showed a weak positive correlation with screen time (Spearman's correlation coefficients were 0.220, 0.205, and 0.230, respectively). Conclusion: Online study may contribute to the prevalence of computer vision syndrome among university students.

ECMO combined with prone positioning strategies in COVID-19 respiratory distress syndrome.

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has already become a global pandemic as a public health emergency of international concern. Previous evidence from similar patient populations proved that carefully selected patients with severe ARDS who did not benefit from conventional treatment might be successfully supported with Veno-Venous extracorporeal membrane oxygenation (V-V ECMO). We now share the case reports of COVID-19 patients with ECMO combined prone position strategies.

Dynamic changes in monocytes subsets in COVID-19 patients.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is affecting the whole world and threatening human health. We aim to investigate the immunological characteristics of monocytes in critical patients with COVID-19. METHODS: The number and immune status of monocytes were detected by flow cytometry in 32 COVID-19 patients and 18 healthy individuals. RESULTS: In critical patients with COVID-19, the absolute number of total monocytes and CD16- monocytes was significantly decreased but CD16+ pro-inflammatory monocytes was increased compared to healthy controls. Antigen presentation potential of monocytes, as measured by HLA-DR expression, was suppressed, while their inflammatory phenotype (CD38 expression) was enhanced. Cytokine levels showed sustained increases in critical patients. And the levels of IL-6 were positively correlated with CD16+ monocytes number. IL-6 and IL-10 levels were negatively correlated with HLA-DR expression of monocytes. During the recovery of COVID-19 patients, the count and immune status of monocyte subsets were restored by degrees. HLA-DR+ monocytes possessed good sensitivity and specificity for predicting the incidence of critical patients with COVID-19. CONCLUSIONS: In critical patients with COVID-19, decline in number and HLA-DR expression of monocytes might lead to decreased antigen presentation potential and thus immunosuppression, while increased CD16+ pro-inflammatory monocytes might mediate hyperinflammation. HLA-DR+ monocytes might be a meaningful assisted indicator to predict the incidence of critical patients with COVID-19.

Liver function recovery of COVID-19 patients after discharge, a follow-up study.

Objective: The aim of this study was to observe the liver function recovery of COVID-19 patients after discharge. Patients and Methods: A total of 253 discharged COVID-19 patients in Shenzhen city, China were selected. The clinical characteristics of these patients were assessed. A 2-month follow-up and laboratory hematology test were performed to examine the status of patients' liver function. Results: Patients combined with liver diseases, especially fatty liver, are more likely to progress to severe condition (P<0.05). Patients in severe condition and those with liver diseases have higher rates of liver injuries during hospitalization, characterized by a significant increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST, P<0.01). The ALT, AST/ALT, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total protein (TP), albumin (ALB), and A/G levels showed significant differences in comparison with the control group (P<0.05, and P<0.001); and the outlier ratio of A/G, ALT, GGT and ALP of patients remained abnormal higher within 14 days after discharge (P<0.001). Liver injuries of COVID-19 patients may be related to the epidemiological characteristics, clinical indexes, basic diseases, symptoms, drug treatment during hospitalization and the complications. Indicators of liver function were correlated with cardiac function, renal function, thyroid function, lipid metabolism, glucose metabolism, immune index, leukocyte, erythrocyte, hemoglobin and platelet related indexes. The outlier ratio of TP, ALB and GLB remained extremely low throughout the follow-up period; the outlier ratio of ALT, AST and GGT decreased below 10% from a high level at 40 days after discharged. However, the outlier ratio of A/G, AST/ALT and ALP remained high during the follow-up period. Conclusions: Abnormal liver function might indicate worse recovery of COVID-19 patients. Changes in liver function should be emphasized during long-term follow-up of COVID-19 patients after hospital discharge; the necessity of employing appropriate interventions for liver function repair should be emphasized.

COVID-19 pneumonia: CD8+ T and NK cells are decreased in number but compensatory increased in cytotoxic potential.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is posing a huge threat to human health worldwide. We aim to investigate the immune status of CD8+ T and NK cells in COVID-19 patients. METHODS: The count and immune status of lymphocytes were detected by flow cytometry in 32 COVID-19 patients and 18 healthy individuals. RESULTS: As the disease progression in COVID-19 patients, CD8+ T and NK cells were significantly decreased in absolute number but highly activated. After patients' condition improved, the count and immune status of CD8+ T and NK cells restored to some extent. GrA+CD8+ T and perforin+ NK cells had good sensitivity and specificity for assisting diagnosis of COVID-19. CONCLUSIONS: As the disease progression, the declined lymphocytes in COVID-19 patients might lead to compensatory activation of CD8+ T and NK cells. GrA+CD8+ T and perforin+ NK cells might be used as meaningful indicators for assisting diagnosis of COVID-19.

Clinical characteristics and follow-up analysis of 324 discharged COVID-19 patients in Shenzhen during the recovery period.

Objectives: Research on recovering COVID-19 patients could be helpful for containing the pandemic and developing vaccines, but we still do not know much about the clinical features, recovery process, and antibody reactions during the recovery period. Methods: We retrospectively analysed the epidemiological information, discharge summaries, and laboratory results of 324 patients. Results: In all, 15 (8.62%) patients experienced chest distress/breath shortness, where 8 of the 15 were severely ill. This means severely ill patients need an extended amount of time to recover after discharge; next, 20 (11.49%) patients experienced anxiety and 21 (12.07%) had headache/insomnia and a small fraction of them complained of anosmia/ageusia, indicating that these patients need treatment for mental and psychological health issues. Regarding the re-positive patients, their CT and laboratory test results showed no obvious evidence of illness progress or infectivity but a high anti-SARS-CoV-2 antibody expression. Conclusion: Recovered COVID-19 patients need psychological and physiological care and treatment, re-positivity can occur in any person, but juveniles, females, and patients with mild/moderate existing symptoms have higher rates of re-positivity, While there is no evidence that turning re-positive has an impact on their infectivity, but it still alerted us that we need differentiate them in the following managements.

Cardiovascular Manifestations and Mechanisms in Patients with COVID-19.

Coronavirus disease 2019 (COVID-19) patients with pre-existing cardiovascular disease (CVD) or with cardiovascular complications have a higher risk of mortality. The main cardiovascular complications of COVID-19 include acute cardiac injury, acute myocardial infarction (AMI), myocarditis, arrhythmia, heart failure, shock, and venous thromboembolism (VTE)/pulmonary embolism (PE). COVID-19 can cause cardiovascular complications or deterioration of coexisting CVD through direct or indirect mechanisms, including viral toxicity, dysregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial cell damage and thromboinflammation, cytokine storm, and oxygen supply-demand mismatch. We systematically review cardiovascular manifestations, histopathology, and mechanisms of COVID-19, to help to formulate future research goals and facilitate the development of therapeutic management strategies.