Effects of Tai Chi practice on postural sway for older people during COVID-19 pandemic (preprint)

Tai Chi has been promoted for older people to prevent falls and may be seen as a priority exercise during coronavirus (COVID-19) pandemic. The purpose of this study was to investigate the effects of Tai Chi practice on standing balance for older people in a nursing home. Thirty-eight older people recruited during COVID-19 extended restrictions, a Tai Chi group who were regularly performed Tai Chi during the periods (n = 18, more than five-year experience) and Control group (n = 20, no Tai Chi experience). Postural sway during standing balance was quantified under four different conditions:1) eyes open (EO); 2) eyes closed (EC); 3) eyes open and cross step with right leg forward (ER) and 4) with left leg forward (EL). Significantly less postural sway was observed in the Tai Chi group, particularly during EO and EL conditions. The findings of this study support the positive effects of Tai Chi practice on balance control. During COVID-19, although older people living in the nursing home limited their outdoor mobility, Tai Chi practice may maintain their physical function on a standing balance.

Integration of a hybrid scan approach and in-house high-resolution MS2 spectral database for charactering the multicomponents of Xuebijing Injection

Xuebijing (XBJ) Injection is a reputable patent Chinese medicine widely used to cure sepsis, among the Chinese ″Three Medicines and Three Prescriptions″ solution to fight against COVID-19. We were aimed to achieve the comprehensive multicomponent characterization from the single drugs to traditional Chinese medicine (TCM) formula, by integrating powerful data acquisition and the in-house MS2 spectral database searching. By ultra-high performance liquid chromatography/ion mobility-quadrupole time-of-flight mass spectrometry (UHPLC/IM-QTOF-MS), a hybrid scan approach (HDMSE-HDDDA) was developed, while the HDMSE data for five component drugs and 56 reference compounds were acquired and processed to establish an in-house MS2 spectral database of XBJ. Good resolution of the XBJ components was accomplished on a Zorbax Eclipse Plus C18 column within 24 min, while a fit-for-purpose HDMSE-HDDDA approach was elaborated in two ionization modes for enhanced MS2 data acquisition. XBJ MS2 spectral library was thus established on the UNIFITM platform involving rich structure-related information for the chemicals from five component drugs. We could identify or tentatively characterize 294 components from XBJ, involving 81 flavonoids, 51 terpenoids, 42 phthalides, 40 organic acids, 13 phenylpropanoids, seven phenanthrenequinones, six alkaloids, and 54 others. In contrast to the application of conventional MS1 library, this newly established strategy could demonstrate superiority in the accuracy of identification results and the characterization of isomers, due to the more restricted filtering/matching criteria. Conclusively, the integration of the HDMSE-HDDDA hybrid scan approach and the in-house MS2 spectral database can favor the efficient and more reliable multicomponent characterization from single drugs to the TCM formula.

Expression of ACE2, TMPRSS2, and Furin in Mouse Ear Tissue, and the Implications for SARS-CoV-2 Infection.

OBJECTIVES/HYPOTHESIS: Intracellular entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on the interaction between its spike protein with the cellular receptor angiotensin-converting enzyme 2 (ACE2) and depends on Furin-mediated spike protein cleavage and spike protein priming by host cell proteases, including transmembrane protease serine 2 (TMPRSS2). As the expression of ACE2, TMPRSS2, and Furin in the middle and inner ear remain unclear, we analyzed the expression of these proteins in mouse ear tissues. STUDY DESIGN: Animal Research. METHODS: We performed immunohistochemical analysis to examine the distribution of ACE2, TMPRSS2, and Furin in the Eustachian tube, middle ear spaces, and cochlea of mice. RESULTS: ACE2 was present in the nucleus of the epithelium of the middle ear and Eustachian tube, as well as in some nuclei of the hair cells in the organ of Corti, in the stria vascularis, and the spiral ganglion cells. ACE2 was also expressed in the cytoplasm of the stria vascularis. TMPRSS2 was expressed in both the nucleus and cytoplasm in the middle spaces, with the expression being stronger in the nucleus in the mucosal epithelium of the middle ear spaces and Eustachian tube. TMPRSS2 was present in the cytoplasm in the organ of Corti and stria vascularis and in the nucleus and cytoplasm in the spiral ganglion. Furin was expressed in the cytoplasm in the middle ear spaces, Eustachian tube, and cochlea. CONCLUSIONS: ACE2, TMPRSS2, and Furin are diffusely present in the Eustachian tube, middle ear spaces, and cochlea, suggesting that these tissues are susceptible to SARS-CoV-2 infection. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E2013-E2017, 2021.

Practical considerations for Ultraviolet-C radiation mediated decontamination of N95 respirator against SARS-CoV-2 virus (preprint)

Decontaminating N95 respirators for reuse could mitigate shortages during the COVID-19 pandemic. We tested a portable UV-C light-emitting diode disinfection chamber and found that decontamination efficacy depends on mask model, material and location on the mask. This emphasizes the need for caution when interpreting efficacy data of UV-C decontamination methods.

Prognostic value of bedside lung ultrasound score in patients with COVID-19 (preprint)

Background: Bedside lung ultrasound (LUS) has emerged as a useful and noninvasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19. Methods: : The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated. Results: : The median time from admission to LUS examinations was 7 days (interquartile range [IQR] 3-10). Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI]: 1.02～1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75～42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC =286; C-index = 0.866). An LUS score cut-off >12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively. Conclusions: : The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.

Relative Energy Deficiency in an Elite Professional non-Endurance Male Caused by Short Period of Overtraining and Caloric Restriction: A Case Report (preprint)

Background: Relative energy deficiency in sports (RED-S) is well-recognized in women competing in endurance sports; however, it is less common in males competing in non-endurance sports. Here, we report a case of hypogonadotropic hypogonadism associated with RED-S in an elite male non-endurance skill athlete caused by a change in workout over a short time frame.Case presentation: An 18-year-old elite male non-endurance skill athlete complained of fatigue, depression, and inattention. Blood tests showed low total testosterone levels and a physical examination revealed Tanner stage phase IV-V. A gonadotropin-releasing hormone (GnRH) stimulation test revealed that the luteinizing hormone (LH) level was 10 times above normal, suggesting hypothalamic hypogonadism. However, magnetic resonance imagings (MRI) of pituitary gland, brain, and adrenal glands were normal. Due to COVID-19 pandemic, he was quarantined for 2 weeks. During that time, he only performed a basic workout. At the end of quarantine, his coach made him follow a new training program that was >50% more intense than the one before quarantine. He also had to restrict calorie intake for snowboarding. He was diagnosed as relative energy deficiency in sport (RED-S). The condition resolved after lifestyle and training modifications.Conclusions: RED-S is not restricted to endurance athletes. Elite athletes performing non-endurance sports can also suffer from it after a significant modification of training. Sports scientists/trainers should monitor caloric intake and training intensity to avoid RED-S, protect the health and improve the performance of all athletes.

Prognostic value of bedside lung ultrasound-score in patients with COVID-19 (preprint)

Background: Bedside lung ultrasound (LUS) has emerged as a useful and non-invasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019(COVID-19). While the clinical significance of LUS-score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of LUS-score in patients with COVID-19.MethodsLUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. LUS-score based on B-lines, pleural line abnormalities and lung consolidation was evaluated. The primary outcome was a combination of severe acute respiratory distress syndrome (ARDS), and mortality.ResultsCompared with patients in the lowest LUS-score group, those in the highest LUS-score group were more likely to have a lower lymphocyte%, higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain, more invasive mechanical ventilation therapy, higher incidence of ARDS, and higher mortality. After a median follow-up of 14 days, 37 patients progressed to the poor outcome. Compared with event-free survivors, patients with adverse event presented higher rate of bilateral involved, more involved zones and B-lines, pleural lines abnormalities and consolidation, and higher LUS-score. The Cox models adding LUS-score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI]: 1.02~1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75~42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcome more accurately than the basic model (AIC =286; C-index = 0.866). LUS-score cutoff >12 would predict adverse events with specificity and sensitivity of 90.5% and 91.9%, respectively.ConclusionsLUS-score is a powerful predictor of adverse events in patients with COVID-19, and is important for risk stratification in COVID-19 patients.

Expression of Ace2, Tmprss2, and Furin in mouse ear tissue (preprint)

ObjectivesIntracellular entry of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on the interaction between its spike protein to a cellular receptor named angiotensin-converting enzyme 2 (ACE2) and depends on Furin-mediated spike 23 protein cleavage and spike protein priming by host cell proteases including 24 transmembrane protease serine 2 (TMPRSS2). Tmprss1, Tmprss3, and Tmprss5 are expressed in the spiral ganglion neurons and the organ of Corti in the inner ear; however, Ace2, Tmprss2, and Furin expression profiles in the middle ear remain unclear. Therefore, this study aimed to analyze Ace2, Tmprss2, and Furin expression in the middle and inner ear of mice. Study DesignAnimal research. SettingDepartment of Otolaryngology and Head and Neck Surgery, University of Tokyo. MethodsWe performed immunohistochemical analysis to examine the distribution of Ace2, Tmprss2, and Furin in the eustachian tube, middle ear space, and cochlea of mice. ResultsAce2 was expressed in the cytoplasm in the middle ear epithelium, eustachian tube epithelium, stria vascularis, and spiral ganglion. Tmprss2 and Furin were widely expressed in the middle ear spaces and the cochlea. ConclusionCo-expression of Ace2, Tmprss2, and Furin in the middle ear indicates that the middle ear is susceptible to SARS-CoV-2 infections, thus warranting the use of personal protective equipment during mastoidectomy for coronavirus disease (COVID-19) patients.

Characteristics of online medical care consultation for pregnant women during the COVID-19 outbreak: a cross-sectional study (preprint)

Background During the Coronavirus Disease 2019 (COVID-19) outbreak, emergency traffic bans limited accessibility of some medical resource for pregnant women. Fear of viral transmission also prevented pregnant women from seeking routine antenatal care (ANC). This study described the needs of pregnant women and the contents of online obstetric consultation in representative areas with various severity of the epidemic in China. Methods From February 10 th to 23 rd , we collected data on online obstetric consultations and women’s satisfaction in mild, moderate and severe epidemic areas through an e-health provider’s platform. Information on women’s needs, contents of the consultation and satisfaction were collected and compared by epidemic areas. Results A total of 2599 pregnant women participated in this study, of whom 448, 1322 and 819 women were from the mild, moderate and severe epidemic areas, respectively. The distributions of the amount of online consultation were significantly different not only in different areas, but also in different trimesters. The more severe the epidemic was and the more advanced the pregnancy was, the higher the amount of second category (changed their schedules of ANC and/or delivery as well as method of delivery) was. 957 participants completed a satisfaction survey. For most of the participants, it’s their first time to use the e-health, and nearly 90% participants were completely or mostly satisfied with the online consultation. Conclusions Our study found that during the outbreak, many pregnant women had changed their scheduled ANC visits without authorization, and the more serious the epidemic was, the more common it occurred. The needs for online consultation was substantial. In order to prevent irreversible obstetric adverse events, an appropriate ANC contingency plan with e-health services is highly recommended during the Public Health Emergency of International Concern (PHEIC).