Impact of COVID-19 pandemic on specialty training in Obstetrics and Gynaecology in Hong Kong: what is the future prospect? (preprint)

Introduction The COVID-19 pandemic in the past few years have led to major adjustments in the provision of healthcare. This study aimed to investigate the impact of the pandemic on specialty training in Obstetrics & Gynaecology (O&G) in Hong Kong.Methods A cross-sectional questionnaire survey was performed on all the O&G trainees and the young fellows of the Hong Kong College of Obstetricians and Gynaecologists (HKCOG). The questionnaires included 5 parts: demographic data, impact on clinical activities, redeployment, educational activities and career progression.Results A total of 104 questionnaires (92.9%) were received for final analysis. The majority of the participants had reductions in elective and emergency operations, as well as exposure to in-patient admissions and out-patient clinics in both obstetrics and gynaecology. The reduction was most significant in elective gynaecology operations. One-third (34.6%) of the participants had been redeployed to other departments, and educational activities were reduced during the pandemic. Around 58% of the trainees were concerned with the reduction in clinical exposure, and 78% worried they would not be able to log sufficient number of surgical procedures. Basic trainees were significantly more worried than higher trainees. Around half of the trainees had doubts or regrets about choosing to undergo O&G specialty training.Conclusion The COVID-19 pandemic had significant negative impacts on O&G training in Hong Kong. Many trainees were worried they would not be able to attain the required level of competence when they complete their specialist training.

Long-Term Cross Immune Response in Mice following Heterologous Prime-Boost COVID-19 Vaccination with Full-Length Spike mRNA and Recombinant S1 Protein.

(1) Background: As the COVID-19 pandemic enters its fourth year, it continues to cause significant morbidity and mortality worldwide. Although various vaccines have been approved and the use of homologous or heterologous boost doses is widely promoted, the impact of vaccine antigen basis, forms, dosages, and administration routes on the duration and spectrum of vaccine-induced immunity against variants remains incompletely understood. (2) Methods: In this study, we investigated the effects of combining a full-length spike mRNA vaccine with a recombinant S1 protein vaccine, using intradermal/intramuscular, homologous/heterologous, and high/low dosage immunization strategies. (3) Results: Over a period of seven months, vaccination with a mutant recombinant S1 protein vaccine based on the full-length spike mRNA vaccine maintained a broadly stable humoral immunity against the wild-type strain, a partially attenuated but broader-spectrum immunity against variant strains, and a comparable level of cellular immunity across all tested strains. Furthermore, intradermal vaccination enhanced the heterologous boosting of the protein vaccine based on the mRNA vaccine. (4) Conclusions: This study provides valuable insights into optimizing vaccination strategies to address the ongoing challenges posed by emerging SARS-CoV-2 variants.

A universal CRISPR/Cas12a-powered intelligent point-of-care testing platform for multiple small molecules in the healthcare, environment, and food.

Growing studies focusing on nuclear acid detection via the emerging CRISPR technique demonstrate its promising application. However, limited works solve the identification of non-nucleic acid targets, especially multiple small molecules. To address challenges for point-of-care testing (POCT) in complex matrices for healthcare, environment, and food safety, we developed CRISPR Cas12a-powered highly sensitive, high throughput, intelligent POCT (iPOCT) for multiple small molecules based on a smartphone-controlled reader. As a proof of concept, aflatoxin B1 (AFB1), benzo[a]pyrene (BaP), and capsaicin (CAP) were chosen as multiple targets. First, three antigens were preloaded in independent microwells. Then, the antibody/antigen-induced fluorescent signals were consecutively transferred from the biotin-streptavidin to CRISPR/Cas12a system. Third, the fluorescent signals were recorded by a smartphone-controlled handheld dark-box readout. Under optimization, detection limits in AFB1, BaP, and CAP were 0.00257, 4.971, and 794.6 fg/mL with wide linear ranges up to four orders of magnitude. Using urine, water, soybean oil, wheat, and peanuts as the complex matrix, we recorded high selectivity, considerable recovery, repeatability, and high consistency comparison to HPLC-MS/MS methods. This work promises a practical intelligent POCT platform for multiple targets in lipid-soluble and water-soluble matrices and could be extensively applied for healthcare, environment, and food safety.

Multiple detection of 13 kinds of viruses in 500 children with acute respiratory tract infection in Hami of Xinjiang province

OBJECTIVE: To investigate and analyze multiple detection of 13 kinds of viruses in 500 children with acute respiratory tract infection in Hami of Xinjiang. METHODS: A total of 500 children with acute respiratory tract infection treated in the hospital between Jan 2018 and Jan 2021 were enrolled. Thirteen kinds of respiratory infection viruses including human respiratory syncytial virus(RSV), human rhinovirus(hRV), respiratory adenovirus(AdV), influenza A and B viruses(Inf A, Inf B), parainfluenza virus(PIV 1/2/3), human enterovirus(hEV), human metapneumovirus(hMPV), human coronavirus(hCoV 229E/OC43) and human Boca virus(hBoV) were detected by multiple reverse transcription polymerase chain reaction(RT-PCR) amplification and capillary electrophoresis. And the results were compared with those by direct sequencing method. RESULTS: Of the 500 samples, 379 samples were positive(75.80%), and the top three detection rates were RSV(19.40%), hRV(16.00%) and Inf B(12.60%). The differences in positive rates of the respiratory virus among <1 year group, 1-3 years group and >3 years group were significant(84.97%, 77.47%, 65.45%)(P<0.05). The detection rate of RSV was the highest in <1 year group, and the detection rates of Inf A and Inf B were the highest in >3 years group. The differences in positive rates of respiratory viruses among the spring group, summer group, autumn group and winter group were significant(74.05%, 63.73%, 77.24%, 84.03%)(P<0.05). The detection rates of RSV, PIV 3, and hMPV were the highest in the winter group, and detection rate of AdV was the highest in spring group. CONCLUSION: RSV is the main infection virus in children with acute respiratory infection in Hami of Xinjiang. The distribution of respiratory viruses is related to age and onset season in children.

Preclinical safety evaluation of intradermal SARS-CoV-2 inactivated vaccine (Vero cells) administration in macaques

Coronavirus disease 2019 (COVID-19) is an acute and highly pathogenic infectious disease in humans caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Six months after immunization with the SARS-CoV-2 vaccine, however, antibodies are almost depleted. Intradermal immunization could be a new way to solve the problem of nondurable antibody responses against SARS-CoV-2 or the poor immune protection against variant strains. We evaluated the preclinical safety of a SARS-CoV-2 vaccine for intradermal immunization in rhesus monkeys. The results showed that there were no obvious abnormalities in the general clinical condition, food intake, body weight or ophthalmologic examination except for a reaction at the local vaccination site. In the hematology examination, bone marrow imaging, serum biochemistry, and routine urine testing, the related indexes of each group fluctuated to different degrees after administration, but there was no dose-response or time-response correlation. The neutralization antibody and ELISpot results also showed that strong humoral and cellular immunity could be induced after vaccination, and the levels of neutralizing antibodies increased with certain dose- and time-response trends. The results of a repeated-administration toxicity test in rhesus monkeys intradermally inoculated with a SARS-CoV-2 inactivated vaccine showed good safety and immunogenicity.

Study of the Effects of Several SARS-CoV-2 Structural Proteins on Antiviral Immunity.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike (S) protein is a critical viral antigenic protein that enables the production of neutralizing antibodies, while other structural proteins, including the membrane (M), nucleocapsid (N) and envelope (E) proteins, have unclear roles in antiviral immunity. In this study, S1, S2, M, N and E proteins were expressed in 16HBE cells to explore the characteristics of the resultant innate immune response. Furthermore, peripheral blood mononuclear cells (PBMCs) from mice immunized with two doses of inactivated SARS-CoV-2 vaccine or two doses of mRNA vaccine were isolated and stimulated by these five proteins to evaluate the corresponding specific T-cell immune response. In addition, the levels of humoral immunity induced by two-dose inactivated vaccine priming followed by mRNA vaccine boosting, two homologous inactivated vaccine doses and two homologous mRNA vaccine doses in immunized mice were compared. Our results suggested that viral structural proteins can activate the innate immune response and elicit a specific T-cell response in mice immunized with the inactivated vaccine. However, the existence of the specific T-cell response against M, N and E is seemingly insufficient to improve the level of humoral immunity.

Preclinical safety evaluation of intradermal SARS-CoV-2 inactivated vaccine (Vero cells) administration in macaques.

Coronavirus disease 2019 (COVID-19) is an acute and highly pathogenic infectious disease in humans caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Six months after immunization with the SARS-CoV-2 vaccine, however, antibodies are almost depleted. Intradermal immunization could be a new way to solve the problem of nondurable antibody responses against SARS-CoV-2 or the poor immune protection against variant strains. We evaluated the preclinical safety of a SARS-CoV-2 vaccine for intradermal immunization in rhesus monkeys. The results showed that there were no obvious abnormalities in the general clinical condition, food intake, body weight or ophthalmologic examination except for a reaction at the local vaccination site. In the hematology examination, bone marrow imaging, serum biochemistry, and routine urine testing, the related indexes of each group fluctuated to different degrees after administration, but there was no dose-response or time-response correlation. The neutralization antibody and ELISpot results also showed that strong humoral and cellular immunity could be induced after vaccination, and the levels of neutralizing antibodies increased with certain dose- and time-response trends. The results of a repeated-administration toxicity test in rhesus monkeys intradermally inoculated with a SARS-CoV-2 inactivated vaccine showed good safety and immunogenicity.

Three Amino Acid Substitutions in the Spike Protein Enable the Coronavirus Porcine Epidemic Diarrhea Virus To Infect Vero Cells.

Porcine epidemic diarrhea virus (PEDV), a continuously evolving pathogen, causes severe diarrhea in piglets, with high mortality rates. To prevent or mitigate the disease, it is common practice to develop live or inactivated PEDV vaccines based on cell-adapted viral variants. Propagating wild-type PEDV in cultured cells is, however, often challenging due to the lack of knowledge about the requirements for the cell adaptation of PEDV. In the present study, by using the RNA-targeted reverse genetic system for PEDV to apply S protein swapping followed by the rescue of the recombinant viruses, three key amino acid mutations in the S protein, A605E, E633Q, and R891G, were identified, which enable attenuated PEDV strain DR13 (DR13att) to efficiently and productively infect Vero cells, in contrast to the parental DR13 strain (DR13par). The former two key mutations reside inside and in the vicinity of the receptor binding domain (RBD), respectively, while the latter occurs at the N-terminal end of the fusion peptide (FP). Besides the three key mutations, other mutations in the S protein further enhanced the infection efficiency of the recombinant viruses. We hypothesize that the three mutations changed PEDV tropism by altering the S2' cleavage site and the RBD structure. This study provides basic molecular insight into cell adaptation by PEDV, which is also relevant for vaccine design. IMPORTANCE Porcine epidemic diarrhea virus (PEDV) is a lethal pathogen for newborn piglets, and an efficient vaccine is needed urgently. However, propagating wild-type PEDV in cultured cells for vaccine development is still challenging due to the lack of knowledge about the mechanism of the cell adaptation of PEDV. In this study, we found that three amino acid mutations, A605E, E633Q, and R891G, in the spike protein of the Vero cell-adapted PEDV strain DR13att were critical for its cell adaptation. After analyzing the mutation sites in the spike protein, we hypothesize that the cell adaptation of DR13att was achieved by altering the S2' cleavage site and the RBD structure. This study provides new molecular insight into the mechanism of PEDV culture adaptation and new strategies for PEDV vaccine design.

Effects of Stressors of COVID-19 on Chinese College Students' Problematic Social Media Use: A Mediated Moderation Model.

Purpose: Isolation policies are long-term and strictly enforced in China during the COVID-19 outbreak. Social media might be widely used for communication, work, understanding the development of the epidemic, etc. However, these behaviors might lead to problematic social media use. The present study investigated the effect of stressors of COVID-19 on problematic social media use, as well as the internal mechanisms involved. Methods: One thousand three hundred seventy-three Chinese college students (M age = 19.53, SD age = 1.09) were recruited randomly from four grades who completed Coronavirus Stress Scale, Fear of Missing Out Scale, Problematic Mobile Social Media Usage Assessment Questionnaire, and Regulatory Emotional Self-Efficacy Scale. Results: Stressors of COVID-19 were positively related to problematic social media use. The link between stressors of COVID-19 and problematic social media use was mediated by fear of missing out. Additionally, the association between fear of missing out and problematic social media use, as well as the association between stressors of COVID-19 and problematic social media use were moderated by regulatory emotional self-efficacy. Conclusion: The current findings reveal the mechanism that may be used to reduce the likelihood of problematic social media use in the context of the COVID-19 outbreak. To prevent and intervene in problematic social media use during the COVID-19 pandemic, this study stressed the importance of decreasing the fear of missing out and enhancing regulatory emotional self-efficacy.

Risk Factors Surrounding an Increase in Burnout and Depression Among Health Care Professionals in Taiwan During the COVID-19 Pandemic.

OBJECTIVES: This study aimed to investigate the risk factors surrounding an increase in both burnout levels and depression among health care professionals in Taiwan through use of a longitudinal study design. DESIGN: This is a 2-year observational study that took place from January 2019 to December 2020. SETTING AND PARTICIPANTS: Data among health care professionals were extracted from the Overload Health Control System of a tertiary medical center in central Taiwan. METHODS: Burnout was measured through use of the Chinese version of the Copenhagen Burnout Inventory (C-CBI), whereas depression was ascertained by the Taiwanese Depression Questionnaire. Each participant provided both burnout and depression measurements during a nonpandemic period (2019) as well as during the COVID pandemic era (2020). Risk factors surrounding an increase in burnout levels and depression were analyzed through a multivariate logistic regression model with adjusting confounding factors. RESULTS: Two thousand nineteen participants completed the questionnaire over 2 consecutive years, including 132 visiting doctors, 105 resident doctors, 1371 nurses, and 411 medical technicians. After adjustments, sleeplessness, daily working hours >8, and stress due to one's workload were all found to be risk factors for an increase in depression levels, whereas sleeplessness, lack of exercise, and stress due to one's workload were all found to be risk factors for an increase in personal burnout level. Being a member of the nursing staff, a younger age, sleeplessness, and lack of exercise were all risk factors for an increase in work-related burnout levels. CONCLUSIONS AND IMPLICATIONS: Poor sleep, lack of exercise, long working hours, and being a member of the nursing staff were risk factors regarding an increase in personal burnout, work-related burnout levels and depression among health care professionals. Leaders within the hospital should investigate the working conditions and personal habits of all medical staff regularly and systematically during the COVID-19 pandemic and take any necessary preventive measures, such as improving resilience for nursing staff, in order to best care for their employees.

How do digital technologies improve supply chain resilience in the COVID-19 pandemic? Evidence from Chinese manufacturing firms

Digital technologies (DTs) can assist businesses in coping with supply chain (SC) disruptions caused by unpredictability, such as pandemics. However, the current knowledge of the relationship between DTs and supply chain resilience (SCR) is insufficient. This study draws on information processing theory to develop a serial mediation model to address this deficiency. We analyze a sample set consisting of 264 Chinese manufacturers. The empirical results reveal that digital supply chain platforms (DSCPs), as well as supply chain traceability (SCT) and supply chain agility (SCA), fully mediate the favorable association between DTs and SCR. Specifically, the four significant indirect paths indicated that firms can improve SCR only if they use DTs to directly or indirectly improve SCT and SCA (through DSCPs). Our study contributes to the literature on resilience by examining the possible mechanism of mediation through which DTs influence SCR. The findings also offer essential insights for firms to modify their digital strategies and thrive in a turbulent environment.

Chinese expert consensus on intestinal microecology and management of digestive tract complications related to tumor treatment (version 2022).

The human gut microbiota represents a complex ecosystem that is composed of bacteria, fungi, viruses, and archaea. It affects many physiological functions including metabolism, inflammation, and the immune response. The gut microbiota also plays a role in preventing infection. Chemotherapy disrupts an organism's microbiome, increasing the risk of microbial invasive infection; therefore, restoring the gut microbiota composition is one potential strategy to reduce this risk. The gut microbiome can develop colonization resistance, in which pathogenic bacteria and other competing microorganisms are destroyed through attacks on bacterial cell walls by bacteriocins, antimicrobial peptides, and other proteins produced by symbiotic bacteria. There is also a direct way. For example, Escherichia coli colonized in the human body competes with pathogenic Escherichia coli 0157 for proline, which shows that symbiotic bacteria compete with pathogens for resources and niches, thus improving the host's ability to resist pathogenic bacteria. Increased attention has been given to the impact of microecological changes in the digestive tract on tumor treatment. After 2019, the global pandemic of novel coronavirus disease 2019 (COVID-19), the development of novel tumor-targeting drugs, immune checkpoint inhibitors, and the increased prevalence of antimicrobial resistance have posed serious challenges and threats to public health. Currently, it is becoming increasingly important to manage the adverse effects and complications after chemotherapy. Gastrointestinal reactions are a common clinical presentation in patients with solid and hematologic tumors after chemotherapy, which increases the treatment risks of patients and affects treatment efficacy and prognosis. Gastrointestinal symptoms after chemotherapy range from nausea, vomiting, and anorexia to severe oral and intestinal mucositis, abdominal pain, diarrhea, and constipation, which are often closely associated with the dose and toxicity of chemotherapeutic drugs. It is particularly important to profile the gastrointestinal microecological flora and monitor the impact of antibiotics in older patients, low immune function, neutropenia, and bone marrow suppression, especially in complex clinical situations involving special pathogenic microbial infections (such as clostridioides difficile, multidrug-resistant Escherichia coli, carbapenem-resistant bacteria, and norovirus).

Anti-inflammatory and antiviral activities of flavone C-glycosides of Lophatherum gracile for COVID-19.

Lophatherum gracile (L. gracile) has long been used as a functional food and herbal medicine. Previous studies have demonstrated that extracts of L. gracile attenuate inflammatory response and inhibit SARS-CoV-2 replication; however, the underlying active constituents have yet to be identified. This study investigated the bioactive components of L. gracile. Flavone C-glycosides of L. gracile were found to dominate both anti-inflammatory and antiviral effects. A simple chromatography-based method was developed to obtain flavone C-glycoside-enriched extract (FlavoLG) from L. gracile. FlavoLG and its major flavone C-glycoside isoorientin were shown to restrict respiratory bursts and the formation of neutrophil extracellular traps in activated human neutrophils. FlavoLG and isoorientin were also shown to inhibit SARS-CoV-2 pseudovirus infection by interfering with the binding of the SARS-CoV-2 spike on ACE2. These results provide scientific evidence indicating the efficacy of L. gracile as a potential supplement for treating neutrophil-associated COVID-19.

A Multipopulation Multiobjective Ant Colony System Considering Travel and Prevention Costs for Vehicle Routing in COVID-19-Like Epidemics

As transportation system plays a vastly important role in combatting newly-emerging and severe epidemics like the coronavirus disease 2019 (COVID-19), the vehicle routing problem (VRP) in epidemics has become an emerging topic that has attracted increasing attention worldwide. However, most existing VRP models are not suitable for epidemic situations, because they do not consider the prevention cost caused by issues such as viral tests and quarantine during the traveling. Therefore, this paper proposes a multi-objective VRP model for epidemic situations, named VRP4E, which considers not only the traditional travel cost but also the prevention cost of the VRP in epidemic situations. To efficiently solve the VRP4E, this paper further proposes a novel algorithm named multi-objective ant colony system algorithm for epidemic situations, termed MOACS4E, together with three novel designs. First, by extending the efficient “multiple populations for multiple objectives” framework, the MOACS4E adopts two ant colonies to optimize the travel and prevention costs respectively, so as to improve the search efficiency. Second, a pheromone fusion-based solution generation method is proposed to fuse the pheromones from different colonies to increase solution diversity effectively. Third, a solution quality improvement method is further proposed to improve the solutions for the prevention cost objective. The effectiveness of the MOACS4E is verified in experiments on 25 generated benchmarks by comparison with six state-of-the-art and modern algorithms. Moreover, the VRP4E in different epidemic situations and a real-world case in the Beijing-Tianjin-Hebei region, China, are further studied to provide helpful insights for combatting COVID-19-like epidemics.

Telehealth care system for chronic disease management of middle-aged and older adults in remote areas.

BACKGROUND: With the global spread of the coronavirus disease pandemic, governments have become more interested in applying telehealth technology in 2020. OBJECTIVE: This study integrates the technology acceptance model and information system success model to explore the influence of satisfaction, attitudes, and continued use of telehealth systems among middle-aged and older people in remote areas. METHODS: The study participants were patients over 40 years (inclusive) who lived in remote townships in eastern Taiwan, were diagnosed with diabetes or hypertension, and used the telehealth care system. In total, 545 questionnaires were returned, resulting in a recovery rate of 99%. RESULTS: Accepting the hypothesized structural equation model, this study found that information, system, and service quality were influenced by the mediating effect of perceived ease of use and the perceived usefulness of the technology acceptance model. The use of telehealth care systems among chronic patients increased significantly.

Evaluation of Immunogenicity and Clinical Protection of SARS-CoV-2 S1 and N Antigens in Syrian Golden Hamster.

The novel coronavirus (SARS-CoV-2) epidemic continues to be a global public crisis affecting human health. Many research groups are developing different types of vaccines to suppress the spread of SARS-CoV-2, and some vaccines have entered phase III clinical trials and have been rapidly implemented. Whether multiple antigen matches are necessary to induce a better immune response remains unclear. To address this question, this study tested the immunogenicity and protective effects of a SARS-CoV-2 recombinant S and N peptide vaccine in the Syrian golden hamster model. This experiment was based on two immunization methods: intradermal and intramuscular administration. Immunized hamsters were challenged with live SARS-CoV-2 14 days after booster immunization. Clinical symptoms were observed daily, and the antibody titer and viral load in each tissue were detected. The results showed that immunization of golden hamsters with the SARS-CoV-2 structural protein S alone or in combination with the N protein through different routes induced antibody responses, whereas immunization with the N protein alone did not. However, although the immunized hamsters exhibited partial alleviation of clinical symptoms when challenged with the virus, neither vaccine effectively inhibited the proliferation and replication of the challenging virus. In addition, the pathological damage in the immunized hamsters was similar to that in the control hamsters. Interestingly, the neutralizing antibody levels of all groups including immunized and nonimmunized animals increased significantly after viral challenge. In conclusion, the immune response induced by the experimental S and N polypeptide vaccines had no significant ability to prevent viral infection and pathogenicity in golden hamsters.

Interpretation of Guidelines for medical observation management of close contacts with COVID-19 cases Part 3: home-based medical observation

Effectively blocking the transmission route of coronavirus and protecting the susceptible population play significant roles in the control of COVID-19 pandemic.Strengthening home-based medical observation is one of the key points in preventing the spread of SARS-CoV-2 virus in families and communities.Therefore, in order to meet the needs for COVID-19 prevention and control in Beijing, a group of experts organized by Beijing Association of Preventive Medicine developed the Guidelines for medical observation management of close contacts with COVID-19 cases Part 3: home-based medical observation（T/BPMA007.3-2020）, which offers the specific provisions for close contacts of COVID-19 cases who need home-based medical observation as well as home environmental condition, prevention and control requirements, waste disposal, disinfection, community prevention and control work requirements, basic requirements for training and education and management guidelines.It provides standard support for home-based medical observation of close contacts with COVID-19 cases.

Household Physical Activity for Adults in the Context of the Pandemic: A Systematic Review

Background: People were isolated at home during the COVID-19 pandemic and were restricted from going outside, leaving them with the option of physical activity at home. The purpose of this paper is to examine how home isolation during an epidemic changes adult lifestyle and health behaviors and the role of physical activity during home isolation in improving adult dysphoria. Methods: Four major databases were searched and the 21 final included papers on home physical activity during the epidemic were evaluated. The literature was analyzed and evaluated using generalization, summarization, analysis, and evaluation methods. The findings revealed that home isolation during the epidemic changed the lifestyle and physical activity behavior of adults. Participation in physical activity varied among different levels of the population during home isolation for the epidemic. In addition, physical activity in home isolation during the epidemic helped improve adults' poor mood. The negative impact of prolonged home isolation on the health of the global population cannot be ignored, and more encouragement should be given to diversified indoor physical activities to maintain physical and mental health. In addition, there is a need to develop more personalized technology tools for physical activity supervision regarding use.

Research hotspots and trends of cardiopulmonary exercise test: Visualization analysis based on citespace

The study aims to grasp the hot spots and trends of global cardiopulmonary exercise research.Web of Science (WoS) core collection and Derwent Innovation Index database were retrieved to collect literature from 2002 to 2022 with Cardiopulmonary Exercise Test (CPET) as the retrieval theme. CiteSpace was used to conduct bibliometrics and visual analysis of 6679 pieces of literature in the web of science core collection database and 251 patent data in the Derwent Innovation Index database. The results show that: (1) the number of CPET theme research papers is increasing year by year, and the main research fields are cardiology, respiratory system, sports science, etc.;(2) The main research hot spots of CPET include exercise prescription, exercise and heart failure, COVID-19 cardiopulmonary rehabilitation and evaluation, etc.;(3) The development trend of CPET technology is majorly in the direction of intelligence, portability, individualization and the integration of Virtual Reality (VR) technology and evidence-based research of CPET guiding clinical decision-making.