Ground-Based MAX-DOAS Observation of Trace Gases from 2019 to 2021 in Huaibei, China

With the spread of the COVID-19 pandemic and the implementation of closure measures in 2020, population mobility and human activities have decreased, which has seriously impacted atmospheric quality. Huaibei City is an important coal and chemical production base in East China, which faces increasing environmental problems. The impact of anthropogenic activities on air quality in this area was investigated by comparing the COVID-19 lockdown in 2020 with the normal situation in 2021. Tropospheric NO2, HCHO and SO2 column densities were observed by ground-based multiple axis differential optical absorption spectroscopy (MAX-DOAS). In situ measurements for PM2.5, NO2, SO2 and O3 were also taken. The observation period was divided into four phases, the pre-lockdown period, phase 1 lockdown, phase 2 lockdown and the post-lockdown period. Ground-based MAX-DOAS results showed that tropospheric NO2, HCHO and SO2 column densities increased by 41, 14 and 14%, respectively, during phase 1 in 2021 vs. 2020. In situ results showed that NO2 and SO2 increased by 59 and 11%, respectively, during phase 1 in 2021 vs. 2020, but PM2.5 and O3 decreased by 15 and 17%, respectively. In the phase 2 period, due to the partial lifting of control measures, the concentration of pollutants did not significantly change. The weekly MAX-DOAS results showed that there was no obvious weekend effect of pollutants in the Huaibei area, and NO2, HCHO and SO2 had obvious diurnal variation characteristics. In addition, the relationship between the column densities and wind speed and direction in 2020 and 2021 was studied. The results showed that, in the absence of traffic control in 2021, elevated sources in the Eastern part of the city emitted large amounts of NO2. The observed ratios of HCHO to NO2 suggested that tropospheric ozone production involved NOX-limited scenarios. The correlation analysis between HCHO and different gases showed that HCHO mainly originated from primary emission sources related to SO2. © 2023 by the authors.

A Framework for Infectious Disease Monitoring With Automated Contact Tracing-A Case Study of COVID-19

Throughout human history, deadly infectious diseases emerged occasionally. Even with the present-day advanced healthcare systems, the COVID-19 has caused more than six million deaths worldwide (as of 27 July 2022). Currently, researchers are working to develop tools for better and effective management of the pandemic. "Contact tracing " is one such tool to monitor and control the spread of the disease. However, manual contact tracing is labor-intensive and time-consuming. Therefore, manually tracking all potentially infected individuals is a great challenge, especially for an infectious disease like COVID-19. To date, many digital contact tracing applications were developed and used globally to restrain the spread of COVID-19. In this work, we perform a detailed review of the current digital contact tracing technologies. We mention some of their key limitations and propose a fully integrated system for contact tracing of infectious diseases using COVID-19 as a case study. Our system has four main modules-1) case maps;2) exposure detection;3) screening;and 4) health indicators that take multiple inputs like users' self-reported information, measurement of physiological parameters, and information of the confirmed cases from the public health, and keeps a record of contact histories using Bluetooth technology. The system can potentially evaluate the users' risk of getting infected and generate notifications to alert them about the exposure events, risk of infection, or abnormal health indicators. The system further integrates the Web-based information on confirmed COVID-19 cases and screening tools, which potentially increases the adoption rate of the system.

Shared and Specific Systemic Cytokine Responses in Infants Hospitalized with SARS-CoV-2 versus RSV Infection

Background. Cytokines play a major role in the immune response to viral infections, contributing to viral clearance but also mediating immunopathology following infection. We sought to define and compare systemic cytokine responses in infants hospitalized with COVID-19 versus RSV infection (RSVi). Methods. Prospective study of convenience cohort of infants hospitalized with PCR confirmed SARS-CoV-2 or RSVi, as well as pre-pandemic healthy controls (HC). Blood samples were obtained at enrollment and cytokine analysis performed using a 92-cytokine inflammation panel (Olink platform). Statistical analyses were performed in R environment. Results. We enrolled 26 infants with COVID-19, 77 with RSVi, and 18 healthy infants as a comparator control group. Oxygen requirement was significantly more frequent in infants with RSVi (p=0.02), while presence of comorbidities was significantly more common in infants with COVID-19 (p=0.01). No statistical differences were identified in terms of length of stay, admission to pediatric intensive care unit, need for mechanical ventilation, and lymphocyte counts (Table 1). Principal component analysis (PCA) revealed clustering of the global cytokine profiles differentiating HC from infants with COVID-19 and RSVi (Figure 1A). Multiple comparison analysis among the three groups yielded 49 significantly different cytokines clustered in three groups. A first cluster that included cytokines such as CCL11, CCL19 and TNFSF12 were lower in both COVID-19 and RSVi compared to HC;a second cluster with CCL8, CXCL8 and CASP8 that were mildly increased in both COVID-19 and RSVi;and a third cluster that included IL6, IL17C and IFN-gamma were markedly increased in both viral groups compared with HC (ANOVA padj< 0.05) (Figure 1B). Direct comparison between COVID-19 and RSVi (padj< 0.05 and FC >1.5) identified 7 statistically different cytokines. CCL8, CXCL1, CCL20 concentrations were increased in COVID-19, while SIRT2, STAMBP, MMP10 and EIF4EBP1 concentrations were increased in RSVi (Figure 1C-D). Conclusion. Analysis of systemic cytokine profiles identified shared but also distinct cytokine responses in infants with SARS-CoV-2 and RSVi suggesting important differences in the pathogenesis of these viral infections. (Figure Presented).

Mucosal Antiviral Cytokine Responses Are Impaired in Children and Adolescents with Severe COVID-19

Background. The factors associated with severe COVID-19 in pediatric patients remain poorly understood. We sought to determine whether mucosal innate immunity cytokines were associated with disease severity in children and adolescents with acute COVID-19. Methods. Single-center, prospective study including children and adolescents < 21 years of age hospitalized because of symptomatic COVID-19 from 3/2020 to 1/ 2021, and age, sex and race matched pre-pandemic (2016-2019) healthy controls. Nasopharyngeal (NP) samples were obtained at enrollment for measurement of SARS-CoV-2 viral loads by rt-PCR and cytokine concentrations using a 92-plex inflammation/ antiviral panel (Olink). Disease severity was assessed by the need for supplemental oxygen or PICU admission, and patients classified as severe and non-severe based on these two parameters. Statistical analyses were performed in R studio and Benjamini-Hochberg applied to adjust for multiple comparisons. Results. Of the 75 children with acute COVID-19 (median IQR age: 3.4 [0.2-15.3] years), 28 (37%) were classified as severe COVID-19 (19 PICU;25 supplemental oxygen) and 47 (63%) were non-severe. Children with severe COVID-19 were predominantly male and had an underlying condition more frequently than those with non-severe disease (79% vs 49% respectively;p< 0.01, Table 1). SARS-CoV-2 viral loads were comparable between groups, yet patients with severe COVID-19 had significantly higher concentrations of C-reactive protein (p=0.04), more frequent lymphopenia (p=0.03) and cardiac involvement (p=0.04), and received COVID-19 directed therapies more commonly (p< 0.001). Comparative analyses identified 24 cytokines that were significantly different between children with acute COVID-19 versus 45 healthy controls. Of those, concentrations of IFN-gamma (p=0.004), CXCL10 (p=0.01), CXCL11 (p=0.02) and CCL19 (p=0.02) were significantly lower in children with severe versus those with non-severe COVID-19 (Fig 1). Conclusion. Mucosal concentrations of antiviral/regulatory cytokines were decreased in children with severe COVID-19. These findings suggest that impaired mucosal innate immune responses might favor SARS-CoV-2 disease progression and severity in children. (Figure Presented).

A Framework for Infectious Disease Monitoring with Automated Contact Tracing - A Case Study of COVID-19

Throughout human history, deadly infectious diseases emerged occasionally. Even with the present-day advanced healthcare systems, the COVID-19 has caused more than six million deaths worldwide (as of 27 July 2022). Currently, researchers are working to develop tools for better and effective management of the pandemic. ’Contact tracing’is one such tool to monitor and control the spread of the disease. However, manual contact tracing is labor-intensive and time-consuming. Therefore, manually tracking all potentially infected individuals is a great challenge, especially for an infectious disease like COIVD-19. To date, many digital contact tracing applications were developed and used globally to restrain the spread of COVID-19. In this work, we perform a detailed review of the current digital contact tracing technologies. We mention some of their key limitations and propose a fully integrated system for contact tracing of infectious diseases using COVID-19 as a case study. Our system has four main modules -Case Maps, Exposure Detection, Screening, and Health Indicators that takes multiple inputs like users’self-reported information, measurement of physiological parameters, and information of the confirmed cases from the public health, and keeps a record of contact histories using Bluetooth technology. The system can potentially evaluate the users’risk of getting infected and generate notifications to alert them about the exposure events, risk of infection, or abnormal health indicators. The system further integrates the web-based information on confirmed Covid-19 cases and screening tools, which potentially increases the adoption rate of the system. IEEE

Study on specific antibodies in patients infected with SARS-CoV-2 and recipients of inactivated vaccine

Objective To detect the serum levels of SARS-CoV-2-specific IgM and IgG antibodies in patients infected with SARS-CoV-2 and recipients of inactivated vaccine in different periods for understanding their variation patterns in vivo. Methods Chemiluminescence immunoassay was used to detect the levels of SARS-CoV-2-specific IgM and IgG antibodies in 144 serum samples of 44 COVID-19 patients, 381 serum samples of 118 asymptomatic infected cases and 398 serum samples of 273 inactivated vaccine recipients collected at different periods. The results were statistically analyzed together with basic characteristics and vaccination status. Results The positive rates of IgM antibody in COVID-19 patients, asymptomatic infected cases and inactivated vaccine recipients were 52. 27% (23 / 44), 23. 73% (28 / 118) and 14. 29% (39 / 273). The positive rate of IgM antibody was higher in COVID-19 patients than in asymptomatic infected cases and vaccine recipients (χ2 = 12. 106, P = 0. 001;χ2 = 34. 755, P<0. 001). The positive rates of IgG antibody in the three populations were 100. 00% (44 / 44), 97. 46% (115 / 118) and 98. 81% (166 / 168), and the differences were not statistically significant (χ2 = 2. 944, P = 0. 229). In COVID-19 patients, the concentration of IgM antibody in <40 years old group was lower than that in ≥40 years old group (Waldχ2 = 6. 609, P = 0. 010), and the concentration of IgG antibody in patients with vaccination was higher than that in patients without vaccination (Waldχ2 = 12. 402,P<0. 001). In asymptomatic infected cases, the concentration of IgG antibody was higher in people with vaccination than in those without vaccination (Waldχ2 = 4. 530, P = 0. 033). In SARS-CoV-2 vaccine recipients, the concentration of IgG antibody in <40 years old group was higher than that in ≥40 years old group (Waldχ2 = 9. 565, P = 0. 002). Dynamic analysis of antibody levels showed that from week 1 to week 9, the concentrations of IgM and IgG antibodies in COVID-19 patients were higher than those in asymptomatic infected cases and vaccine recipients. Conclusions The concentrations of IgM and IgG antibodies in COVID-19 patients were higher than those in asymptomatic infected cases and inactivated vaccine recipients. COVID-19 patients aged ≥40 years had higher level of IgM antibody. COVID-19 patients and asymptomatic infected cases who had received vaccination had higher concentration of IgG antibody. Inactivated vaccine showed good immunogenicity after whole course of immunization, and the IgG antibody level in <40 years old group was higher.

A NOVEL CONVOLUTIONAL NEURAL NETWORK BASED ON ADAPTIVE MULTI-SCALE AGGREGATION AND BOUNDARY-AWARE FOR LATERAL VENTRICLE SEGMENTATION ON MR IMAGES

In this paper, we propose a novel convolutional neural network based on adaptive multi-scale feature aggregation and boundary-aware for lateral ventricle segmentation (MB-Net), which mainly includes three parts, i.e., an adaptive multi-scale feature aggregation module (AMSFM), an embedded boundary refinement module (EBRM), and a local feature extraction module (LFM). Specifically, the AMSFM is used to extract multi-scale features through the different receptive fields to effectively solve the problem of distinct target regions on magnetic resonance (MR) images. The EBRM is intended to extract boundary information to effectively solve blurred boundary problems. The LFM can make the extraction of local information based on spatial and channel attention mechanisms to solve the problem of irregular shapes. Finally, extensive experiments are conducted from different perspectives to evaluate the performance of the proposed MB-Net. Furthermore, we also verify the robustness of the model on other public datasets, i.e., COVID-SemiSeg and CHASE DB1. The results show that our MB-Net can achieve competitive results when compared with state-of-the-art methods. © 2022 IEEE

Evaluation of Long-Term Modeling Fine Particulate Matter and Ozone in China During 2013-2019

Air quality in China has been undergoing significant changes due to the implementation of extensive emission control measures since 2013. Many observational and modeling studies investigated the formation mechanisms of fine particulate matter (PM2.5) and ozone (O-3) pollution in the major regions of China. To improve understanding of the driving forces for the changes in PM2.5 and O-3 in China, a nationwide air quality modeling study was conducted from 2013 to 2019 using the Weather Research and Forecasting/Community Multiscale Air Quality (WRF/CMAQ) modeling system. In this study, the model predictions were evaluated using the observation data for the key pollutants including O-3, sulfur dioxide (SO2), nitrogen dioxide (NO2), and PM2.5 and its major components. The evaluation mainly focused on five major regions, that is , the North China Plain (NCP), the Yangtze River Delta (YRD), the Pearl River Delta (PRD), the Chengyu Basin (CY), and the Fenwei Plain (FW). The CMAQ model successfully reproduced the air pollutants in all the regions with model performance indices meeting the suggested benchmarks. However, over-prediction of PM2.5 was noted in CY. NO2, O-3,O- and PM2.5 were well simulated in the north compared to the south. Nitrate (NO3-) and ammonium (NH4+) were the most important PM2.5 components in heavily polluted regions. For the performance on different pollution levels, the model generally over-predicted the clean days but underpredicted the polluted days. O-3 was found increasing each year, while other pollutants gradually reduced during 2013-2019 across the five regions. In all of the regions except PRD (all seasons) and YRD (spring and summer), the correlations between PM2.5 and O-3 were negative during all four seasons. Low-to-medium correlations were noted between the simulated PM2.5 and NO2, while strong and positive correlations were established between PM2.5 and SO2 during all four seasons across the five regions. This study validates the ability of the CMAQ model in simulating air pollution in China over a long period and provides insights for designing effective emission control strategies across China.

Mucosal Cytokine Profiles in Children with COVID-19

Background. The mechanisms associated with COVID-19 in children are not well understood. We sought to define the differences in nasopharyngeal (NP) cytokine profiles according to clinical presentation in children with COVID-19. Methods. Single-center, prospective study in 137 children and adolescents < 21 years of age hospitalized with COVID-19, and 35 age, sex and race matched pre-pandemic (2016-2019) healthy controls. Children with COVID-19 were categorized according to their clinical presentation in: COVID-19-symptomatic;COVID-19-screening, and multisystem inflammatory syndrome (MIS-C). NP swabs were obtained within 24 hours of admission to measure SARS-CoV-2 loads by rt-PCR, and a 92-cytokine panel. Unsupervised and supervised analysis adjusted for multiple comparisons were performed. Results. From 3/2020 to 1/2021, we enrolled 76 COVID-19-symptomatic children (3.5 [0.2-15.75] years);45 COVID-19-screening (11.1 [4.2-16.1] years), and 16 MIS-C (11.2 [5.9-14.6] years). Median NP SARS-CoV-2 loads were higher in COVID-19-symptomatic versus screening and MIS-C (6.8 vs 3.5 vs 2.82 log10 copies/mL;p< 0.001). Statistical group comparisons identified 15 cytokines that consistently differed between groups and were clustered in three functional categories: (1) antiviral/regulatory, (2) pro-inflammatory/chemotactic, and (3) a combination of (1) and (2);(Fig 1). All 15 cytokines were higher in COVID-19-symptomatic versus controls (p< 0.05). Similarly, and except for TNF, CCL3, CCL4 and CCL23, which were comparable in COVID-19-symptomatic and screening patients, the remaining cytokines were higher in symptomatic children (p< 0.05). PDL-1 (p=0.01) and CCL3 (p=0.03) were the only cytokines significantly decreased in children with MIS-C versus symptomatic COVID-19 children. The 15 cytokines identified by multiple comparisons were correlated using Person's in R software. Red reflects a positive correlation and blue a negative correlation with the intensity of the color indicating the strength of the association. Conclusion. Children with symptomatic COVID-19 demonstrated higher viral loads and greater mucosal cytokines concentrations than those identified via screening, whereas in MIS-C concentrations of regulatory cytokines were decreased. Simultaneous evaluation of viral loads and mucosal immune responses using non-invasive sampling could aid with the stratification of children and adolescents with COVID-19 in the clinical setting.

Children with COVID-19 Demonstrate Distinct Serum Cytokines Profiles According to Clinical Presentations

Background. Almost 4 million children have tested positive for Coronavirus Disease 2019 (COVID-19) as of June 3 2021, representing 14% of all cases in USA. Children present with diverse clinical findings including the multisystem inflammatory syndrome in children (MIS-C). In this study, we measured serum cytokine concentrations in children with COVID-19 to identify differences in immune profiles according to clinical presentations. Methods. A total of 133 children 0-21 years of age with COVID-19 were enrolled at Nationwide Children's Hospital, in Columbus, Ohio. Nasopharyngeal swab RT-PCR testing was used for SARS-CoV-2 detection and quantification. Clinical and laboratory information were obtained, and blood samples were collected for measurement of cytokines with a 92-plex inflammation assay (Olink). Normalized cytokine expression levels in patients were compared with serum samples from 66 pre-pandemic agematched healthy controls. Results. COVID-19 children included: 1) those identified by universal screening (n=47);2) moderate disease (ward;n=48);3) severe disease (PICU;n=20);4) MIS-C (n=18). Children identified by universal screening were hospitalized for trauma, appendicitis or new onset diabetes among others. Children with symptomatic COVID-19 had significantly higher SARS-CoV-2 viral loads than children with MIS-C or those identified via universal screening. Concentrations of interferon (IFN) related cytokines (IFNg, CXCL9, CXCL10, CXCL11), interleukins (IL6, IL8, IL10, IL17A, IL18, IL24) and other inflammatory cytokines (TGF, TNF, VEGF, MCP, CD40) were significantly increased in children with acute COVID-19 and MIS-C compared with children identified by universal screening and healthy controls. These cytokines were positively correlated with C-reactive protein, D-dimer and disease severity in COVID-19, but negatively correlated with viral loads (Fig 1). MIS-C showed stronger inflammatory response than acute COVID-19 (Fig 2). Correlation of Age-adjusted cytokine expression values with viral load, disease severity, CRP and D-dimer. Pearson correlation coefficient is shown for each pair. Red: positive correlation;blue: negative correlation Cytokines that differentiate MIS-C from acute COVID-19 Heatmap shows the differential expressed cytokines between MIS-C and acute severe COVID-19 (padj<0.05, FC>2). The age-adjusted expression values are normalized the median of healthy controls. Red: up-regulation, blue: down-regulation. Conclusion. We identified three cytokine clusters in children with COVID-19 according to clinical presentations. Correlations of serum cytokines with clinical/laboratory parameters could be used to identify potential biomarkers associated with disease severity in COVID-19.

SARS-CoV-2 RNAemia and Disease Severity in Pediatric Coronavirus Disease 2019 (COVID-19)

Background. Children with COVID-19 may develop severe disease. In hospitalized adults, detection of plasma SARS-CoV-2 RNAemia ranges from 19% to 42% and has been associated with worse clinical outcomes. A similar association in children remains unexplored. We determined the frequency of SARS-CoV-2 RNAemia in children hospitalized with COVID-19 and evaluated its potential association with severe disease. Methods. Single center prospective study that enrolled hospitalized children and adolescents ≤21 years old with COVID-19 from March 2020-April 2021 at Nationwide Children's Hospital, Columbus, OH. Nasopharyngeal (NP) and blood samples were obtained and SARS-CoV-2 RNA was quantified using a real time PCR assay targeting the N1 gene. Pertinent demographic, clinical, laboratory, and outcome data were evaluated. Results. We enrolled a convenience sample of 103 hospitalized children (median age, 9 years;range, 3 days-21 years) who had confirmed SARS-CoV-2 infection and both NP and blood samples obtained (Table 1). Overall, 27 (26%) patients with COVID-19 had SARS-CoV-2 RNAemia. Compared with patients who had undetectable RNAemia, those with SARS-CoV-2 RNAemia had significantly higher nasopharyngeal RNA loads (8.1 vs. 4.9 log10 copies/mL;p=0.0006), fever (78 vs 54%;p=0.02), receipt of supplemental oxygen (37% vs 14%;p=0.02), and treatment with anti-COVID-19 medications (30% vs 12%;p=0.04). In addition, patients with SARSCoV-2 RNAemia were more likely to require intensive care (40%% vs. 20%, p= 0.04) and had longer hospitalization (2.56 vs 2.15 days;p=0.03). There were no COVID-19 related deaths. Table 1. Demographic, clinical, laboratory and virology characteristics of study patients Conclusion. The frequency of SARS-CoV-2 RNAemia in pediatric patients was 26% and its finding was associated with worse clinical in-hospital outcomes, similar to that reported in adults. Testing for SARS-CoV-2 RNAemia in children may help identify those who could benefit from more intensive supportive care as well as antiviral and anti-inflammatory medications.

Variation of trace gases in Kannur Town, a coastal South Indian city

This paper describes diurnal and seasonal variations of trace air pollutants include surface ozone (O3), oxides of nitrogen (NOx), carbon monoxide (CO), volatile organic compounds (Benzene, Toluene, Ethyl Benzene, Xylenes which are classified as BTEX)), ammonia (NH3), sulphur dioxide (SO2), and meteorological parameters observed at Kannur town (11.87° N, 75.37° E, 2 m msl) for a period of one year from September 2019. Seasonal variations of trace air pollutants exhibit a daytime maximum during winter due to the enhanced local emission and long-range transport, and minimum during the monsoon period. Surprisingly, air pollutants except O3 show a reduction in concentration in the months of April 2020 due to countrywide lockdown in the wake of restricting the spread of COVID 19. Weekday/weekend variations of air pollutants reveal that high concentrations of O3 are found on weekends compared to weekdays, unlike the concentrations of all other pollutants are found low during weekends. From the analysis of the chemical coupling between NO, NO2, NOx, O3, and OX (=O3+NO2), it is found that OX has both regional and local contributions on NOx. Intercorrelations between trace pollutants showed a strong positive correlation between O3 and CO, a negative correlation between O3 and NOx. © 2021 The Authors

Development of PRO-PMs assessing symptoms following completion of curative-intent chemotherapy

Background: Few patient-reported outcome performance measures (PRO-PMs) have been validated for the cancer population. The testing that has occurred mostly focuses on advanced cancers despite the fact that the majority of people with cancer are diagnosed with earlier stage disease. We developed and tested PROPMs to assess quality of life, pain and fatigue in adult patients completing curative-intent chemotherapy for breast, colon and non-small cell lung cancers. Our goal is to develop measures that target symptoms that impact entry into the survivorship phase. Methods: We recruited 20 diverse test sites from the Michigan Oncology Quality Collaborative (MOQC) and the Alliance of Dedicated Cancer Centers (ADCC). Test sites enrolled patients, administered surveys, and collected clinical and demographic data. A Technical Expert Panel and the Patient and Caregiver Council selected PROMs and provided testing guidance. We assessed data collection feasibility and clinician/staff/patient burden throughout the testing process. Results: PROMIS instruments were selected due to psychometric testing in the target population, public availability and acceptability to patients and test sites. 1,753 patients were enrolled between 10/1/19-3/31/21. The COVID public health emergency disrupted testing and resulted in lower than expected enrolled patients/completed surveys;however, adaptations led to expansions in survey administration methods. Preliminary practicelevel performance results from 10 sites show variation across sites for pain interference (mean = 50.5, SD = 2.8, with a range of 44.6-54.6) and fatigue (mean 49.2, SD = 2.8, with a range of 44.6-54.3). Some test sites reported PRO implementation to be burdensome;however, most patients evaluated did not find survey completion to be burdensome. Conclusions: Next steps include testing risk adjustment variables/model, creating adjusted performance scores, reliability and validity testing. Despite the consensus goal of PRO-PMs in oncology, barriers to implementation persist and important methodologic barriers exist (e.g., ability to achieve sufficient sample size in an oncology practice;defining the most appropriate numerator calculation that reports the desired quality concept and is appropriate for the PROM being used;analytic best practices for PRO-PM adjustment/testing). This project is contributing to the knowledge base as we seek to ensure that PRO-PMs provide meaningful, actionable, patient-centered quality data with benefits that outweigh the burden of implementation.

The impact of the COVID-19 pandemic on nighttime room entries and sleep disruptions for pediatric patients

Introduction: Sleep is critical to children's health and recovery, but pediatric inpatient sleep is often disrupted by nonessential overnight interruptions. The COVID-19 pandemic necessitated social distancing policies which minimized contact with low-risk patients. These policies have the potential to decrease overnight disruptions and improve sleep for hospitalized patients. Methods: This cohort study compared sleep disruptions for pediatric inpatients admitted prior to (Sep 2018 - Feb 2020) and during (Apr 2020 - Aug 2020) the COVID-19 pandemic at a single site, urban academic medical center. Objective disruptions were measured as room entries detected by hand hygiene sensors for occupied rooms pre-pandemic (n-average=56) and during the pandemic (n-average=48) for 69 and 154 nights, respectively. Subjective reports of overnight disruptions, sleep quantity, and caregiver mood were measured by surveys adopted from validated tools: the Karolinska Sleep Log, Potential Hospital Sleep Disruptions and Noises Questionnaire, and Visual Analog Mood Scale. Caregivers of a convenience sample of pediatric general medicine inpatients completed surveys. Caregivers pre-pandemic were surveyed in person, and during the pandemic, surveys were conducted over the phone. Results: 293 pre-pandemic (age-patients=4.1±4.4 years) and 154 pandemic (age-patients=8.7±5.6 years) surveys were collected from caregivers. The majority (71% pre-pandemic and 52% pandemic) of the study population identified as Black/African American. Nighttime room entries initially decreased 36% (95% CI: 30%, 42%, p<0.001), then returned towards pre-pandemic levels as the COVID-19 hospital caseload decreased. Despite this, caregivers reported more disrupted patient sleep (p<0.001) due to tests (21% vs. 38%) as well as stress (30% vs. 49%), anxiety (23% vs. 41%), and pain (23% vs. 48%). Caregivers also reported children slept 61 minutes less (95% CI: 12 min, 110 min, p<0.001) and had more awakenings. Caregivers self-reported feeling more sad and weary, less calm, and worse overall (p<0.001 for all). Conclusion: Despite fewer objective room entries, caregivers reported increased sleep disruptions and an hour less nighttime sleep with more awakenings during the pandemic for pediatric patients. Caregivers also self-reported worse mood. This highlights the importance of addressing subjective perceptions and experiences of hospitalized children and their caregivers during hospitalization.

Dynamic changes of lymphocytes and the disease progression in patients with coronavirus disease 2019 in Xi'an

Objective: To analyze the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) in Xi'an so as to investigate the relationship between the dynamic changes of lymphocytes and the disease progression. Methods: We retrospectively analyzed the clinical data of 15 patients with COVID-19 in The First Affiliated Hospital of Xi'an Jiaotong University from January 22 to February 16, 2020. Results: Among the 15 patients with COVID-19, 8 were males and 7 were females, aged from 22 to 89 years. There were 12 ordinary cases (80%), 1 severe case (6.67%), and 2 critical cases(13.33%). There were 6 groups of family clusters.Most of the patients (14/15, 93.3%) had fever of different degrees. The average time from illness onset to admission was 2.80±1.66 days, and the average time from illness onset to diagnosis was 2.83±2.29 days. The main accompanying symptoms were dry cough (8/15, 53.33%) and shortness of breath (4/15, 26.67%). Nine patients (60%) who had low lymphocyte counts at admission, including of all of the critically ill patients (1 severe case and 2 critical cases) and 6 (6/12, 50%) ordinary patients. Lymphocyte counts in the ordinary cases increased gradually, but fluctuated in the severely ill patients. They were always at low level, or even decreased overall in critical cases. Conclusion: In Xi'an City, COVID-19 mostly occurred in family clusters. Lymphocyte counts were reduced in most patients, especially in critically ill (severe and critical) ones. The lymphocyte count at admission and its kinetics during therapy may be an important predictor for the severity and prognosis of the disease.

[Discussion on diagnosis and treatment of hepatobiliary malignancies during the outbreak of COVID-19].

Objective: From December 2019, the new coronavirus pneumonia (COVID-19) broke out in Wuhan, Hubei, and spread rapidly to the nationwide. On January 20, 2020, the National Health Committee classified COVID-19 pneumonia as one of B class infectious diseases and treated it as class A infectious disease. During the epidemic period, the routine diagnosis and treatment of tumor patients was affected with varying degrees. In this special period, we performed the superiority of the multi-disciplinary team of diagnosis and treatment, achieved accurate diagnosis and treatment of patients with hepatobiliary malignant tumors, provided support for these patients with limited medical resources, and helped them to survive during the epidemic period.On the basis of fully understanding the new coronavirus pneumonia, the treatment strategy should be changed timely during the epidemic, and more appropriate treatment methods should be adopted to minimize the adverse effect of the epidemic on tumor treatment.