Long-term Consequences of COVID-19: Chemosensory Disorders.

PURPOSE OF REVIEW: A number of sequelae after acute coronavirus disease 2019 (COVID-19) significantly affect the quality of life of patients. The chemosensory disorders including olfactory dysfunction (OD) and gustatory dysfunction (GD) are two of the commonest symptoms complained by patients with COVID-19. Although chemosensory function has been reported improved in over 60% of COVID-19 patients in a short time after acute infection, it may last as a major symptom for patients with long COVID-19. This narrative review discussed current literatures on OD and GD in long COVID-19 including the prevalence, risk factors, possible mechanisms, and potential therapies. RECENT FINDINGS: Although the prevalence of OD and GD has declined continuously after acute COVID-19, a considerable number of patients had persistent chemosensory disorders 3 months to 2 years after symptom onset. Female gender, initial severity of dysfunction, nasal congestion, emotional distress and depression, and SARS-CoV-2 variants have been identified as risk factors for persistent OD and GD in long COVID-19. The pathogenesis of OD and GD in long COVID-19 remains unknown, but may be analogous to the persistent OD and GD post common respiratory viral infection. Corticosteroids and olfactory training might be a potential choice regarding the treatment of lasting OD and GD after SARS-CoV-2 infection; however, more studies are needed to prove it. OD and GD are common long-term consequences of COVID-19 and influenced by gender, initial severity of dysfunction, emotional distress and depression, and SARS-CoV-2 variants. More studies are needed to illustrate their pathogenesis and to establish therapeutic strategies.

The role transition of radiotherapy for the treatment of liver cancer in the COVID-19 era.

The uncontrollable COVID-19 crises in the SARS-CoV-2 high-prevalence areas have greatly disrupted the routine treatment of liver cancer and triggered a role transformation of radiotherapy for liver cancer. The weight of radiotherapy in the treatment algorithm for liver cancer has been enlarged by the COVID-19 pandemic, which is helpful for the optimal risk-benefit profile.

The role transition of radiotherapy for the treatment of liver cancer in the COVID-19 era

The uncontrollable COVID-19 crises in the SARS-CoV-2 high-prevalence areas have greatly disrupted the routine treatment of liver cancer and triggered a role transformation of radiotherapy for liver cancer. The weight of radiotherapy in the treatment algorithm for liver cancer has been enlarged by the COVID-19 pandemic, which is helpful for the optimal risk-benefit profile.

Resumption of school after lockdown in COVID-19 pandemic: Three case reports.

BACKGROUND: Students in the 9th grade of junior high school in Changsha were under a 75 d lockdown due to the coronavirus disease 2019 (COVID-19) pandemic. After the resumption of school post-lockdown, the 9th grade students in Changsha faced the entrance physical examination test for senior high school. CASE SUMMARY: We report on 3 cases of occult fracture on the same site in adolescents of the same grade since resumption of school after the lockdown from the COVID-19 pandemic. Three students in the 9th grade of junior high school who were facing the physical examination in 2 wk were diagnosed with an occult fracture of the distal femur. CONCLUSION: It is recommended that the students, parents, education providers and policy makers should all pay attention to the physical exercise of students when the resumption of school after lockdown occurs and they should be aware of occult fractures when the adolescents have pain after physical exercise.

Has COVID-19 Changed China's Digital Trade?-Implications for Health Economics.

Digital technologies have played a significant role in the defense against the COVID-19 pandemic. This development raises the question of whether digital technologies have helped Chinese exports recover quickly and even grow. To answer this question, we study monthly data on Chinese exports to 40 countries/regions from January 2019 to June 2020 and covering 97 product categories. The study takes the COVID-19 outbreak as a natural experiment and treats digital trade products as the treatment group. Using a generalized difference-in-differences (DID) approach, we empirically investigate how this major global public health crisis and digital trade have influenced Chinese exports. Our empirical analysis reveals that the COVID-19 pandemic has inhibited China's export trade overall, digital trade has significantly promoted trade, and the supply mechanism has played a significant role in promoting the recovery of exports. Heterogeneity tests on destination countries/regions reveal that digital trade has significantly promoted exports to countries/regions with different income levels, with a more significant effect on low-risk destinations than on high-risk destinations. The sector heterogeneity test demonstrates that digital trade has enhanced the export recovery of sectors dealing in necessities for pandemic prevention. Other robustness tests, including parallel trend and placebo tests, support the above conclusions. Finally, we extend the research conclusions and discuss their implication for health economics and the practice of fighting COVID-19.

Has COVID-19 Changed China's Digital Trade?—Implications for Health Economics

Digital technologies have played a significant role in the defense against the COVID-19 pandemic. This development raises the question of whether digital technologies have helped Chinese exports recover quickly and even grow. To answer this question, we study monthly data on Chinese exports to 40 countries/regions from January 2019 to June 2020 and covering 97 product categories. The study takes the COVID-19 outbreak as a natural experiment and treats digital trade products as the treatment group. Using a generalized difference-in-differences (DID) approach, we empirically investigate how this major global public health crisis and digital trade have influenced Chinese exports. Our empirical analysis reveals that the COVID-19 pandemic has inhibited China's export trade overall, digital trade has significantly promoted trade, and the supply mechanism has played a significant role in promoting the recovery of exports. Heterogeneity tests on destination countries/regions reveal that digital trade has significantly promoted exports to countries/regions with different income levels, with a more significant effect on low-risk destinations than on high-risk destinations. The sector heterogeneity test demonstrates that digital trade has enhanced the export recovery of sectors dealing in necessities for pandemic prevention. Other robustness tests, including parallel trend and placebo tests, support the above conclusions. Finally, we extend the research conclusions and discuss their implication for health economics and the practice of fighting COVID-19.

Biosynthesis of Self-Assembled Proteinaceous Nanoparticles for Vaccination.

Recent years have seen enormous advances in nanovaccines for both prophylactic and therapeutic applications, but most of these technologies employ chemical or hybrid semi-biosynthetic production methods. Thus, production of nanovaccines has to date failed to exploit biology-only processes like complex sequential post-translational biochemical modifications and scalability, limiting the realization of the initial promise for offering major performance advantages and improved therapeutic outcomes over conventional vaccines. A Nano-B5 platform for in vivo production of fully protein-based, self-assembling, stable nanovaccines bearing diverse antigens including peptides and polysaccharides is presented here. Combined with the self-assembly capacities of pentamer domains from the bacterial AB5 toxin and unnatural trimer peptides, diverse nanovaccine structures can be produced in common Escherichia coli strains and in attenuated pathogenic strains. Notably, the chassis of these nanovaccines functions as an immunostimulant. After showing excellent lymph node targeting and immunoresponse elicitation and safety performance in both mouse and monkey models, the strong prophylactic effects of these nanovaccines against infection, as well as their efficient therapeutic effects against tumors are further demonstrated. Thus, the Nano-B5 platform can efficiently combine diverse modular components and antigen cargos to efficiently generate a potentially very large diversity of nanovaccine structures using many bacterial species.

Distinct effects of asthma and COPD comorbidity on disease expression and outcome in patients with COVID-19.

BACKGROUND: The impacts of chronic airway diseases on coronavirus disease 2019 (COVID-19) are far from understood. OBJECTIVE: To explore the influence of asthma and chronic obstructive pulmonary disease (COPD) comorbidity on disease expression and outcomes, and the potential underlying mechanisms in COVID-19 patients. METHODS: A total of 961 hospitalized COVID-19 patients with a definite clinical outcome (death or discharge) were retrospectively enrolled. Demographic and clinical information were extracted from the medical records. Lung tissue sections from patients suffering from lung cancer were used for immunohistochemistry study of angiotensin-converting enzyme II (ACE2) expression. BEAS-2B cell line was stimulated with various cytokines. RESULTS: In this cohort, 21 subjects (2.2%) had COPD and 22 (2.3%) had asthma. After adjusting for confounding factors, COPD patients had higher risk of developing severe illness (OR: 23.433; 95% CI 1.525-360.135; P < .01) and acute respiratory distress syndrome (OR: 19.762; 95% CI 1.461-267.369; P = .025) than asthmatics. COPD patients, particularly those with severe COVID-19, had lower counts of CD4+ T and CD8+ T cells and B cells and higher levels of TNF-α, IL-2 receptor, IL-10, IL-8, and IL-6 than asthmatics. COPD patients had increased, whereas asthmatics had decreased ACE2 protein expression in lower airways, compared with that in control subjects without asthma and COPD. IL-4 and IL-13 downregulated, but TNF-α, IL-12, and IL-17A upregulated ACE2 expression in BEAS-2B cells. CONCLUSION: Patients with asthma and COPD likely have different risk of severe COVID-19, which may be associated with different ACE2 expression.

Self-reported Taste and Smell Disorders in Patients with COVID-19: Distinct Features in China.

Last December 2019, a cluster of viral pneumonia cases identified as coronavirus disease 2019 (COVID-19) was reported in Wuhan, China. We aimed to explore the frequencies of nasal symptoms in patients with COVID-19, including loss of smell and taste, as well as their presentation as the first symptom of the disease and their association with the severity of COVID-19. In this retrospective study, 1206 laboratory-confirmed COVID-19 patients were included and followed up by telephone one month after discharged from Tongji Hospital, Wuhan. Demographic data, laboratory values, comorbidities, symptoms, and numerical rating scale scores (0-10) of nasal symptoms were extracted from the hospital medical records, and confirmed or reevaluated by the telephone follow-up. From patients (n=1172) completing follow-up, 199 (17%) subjects had severe COVID-19 and 342 (29.2%) reported nasal symptoms. 20.6% COVID-19 patients had loss of taste (median score=6), while 11.4% had loss of smell (median score=5). Loss of taste scores, but not loss of smell scores, were significantly increased in severe vs. non-severe COVID-19 patients. Interleukin (IL)-6 and lactose dehydrogenase (LDH) serum levels were positively correlated with loss of taste scores. About 80% of COVID-19 patients recovered from smell and taste dysfunction in 2 weeks. In this cohort, only 1 out of 10 hospital admitted patients had loss of smell while 1 out of 5 reported loss of taste which was associated to severity of COVID-19. Most patients recovered smell and taste dysfunctions in 2 weeks.

Chemosensory Dysfunction in Patients with COVID-19: What Do We Learn from the Global Outbreak?

PURPOSE OF REVIEW: Chemosensory dysfunction in the patients with COVID-19 has been reported frequently in the studies from different regions of the world. However, the prevalence of smell and/or taste disorders presents significant ethnic and geographic variability. In addition, the pathogenesis of chemosensory dysfunction remains unclarified. RECENT FINDINGS: This is a narrative review on the recent state of the prevalence, mechanism, and diagnostic and therapeutic strategy of chemosensory dysfunction in COVID-19 patients during the global pandemic. The chemosensory dysfunction was analysis based on recent studies, which either used questionnaires, Likert scales (0-10), or smell tests to estimate the smell and taste dysfunction. The ethnic and geographic difference of the prevalence of smell and/or taste disorders and the potential underlying mechanisms have been discussed. Several suggestions on the diagnosis and treatment of COVID-19 patients with smell and taste disorders were summarized for the physicians. This review provides a comprehensive overview of the current studies regarding the chemosensory dysfunction during the COVID-19 worldwide outbreak.

A CT-based radiomics nomogram for predicting prognosis of coronavirus disease 2019 (COVID-19) radiomics nomogram predicting COVID-19.

OBJECTIVES: To identify the value of radiomics method derived from CT images to predict prognosis in patients with COVID-19. METHODS: A total of 40 patients with COVID-19 were enrolled in the study. Baseline clinical data, CT images, and laboratory testing results were collected from all patients. We defined that ROIs in the absorption group decreased in the density and scope in GGO, and ROIs in the progress group progressed to consolidation. A total of 180 ROIs from absorption group (n = 118) and consolidation group (n = 62) were randomly divided into a training set (n = 145) and a validation set (n = 35) (8:2). Radiomics features were extracted from CT images, and the radiomics-based models were built with three classifiers. A radiomics score (Rad-score) was calculated by a linear combination of selected features. The Rad-score and clinical factors were incorporated into the radiomics nomogram construction. The prediction performance of the clinical factors model and the radiomics nomogram for prognosis was estimated. RESULTS: A total of 15 radiomics features with respective coefficients were calculated. The AUC values of radiomics models (kNN, SVM, and LR) were 0.88, 0.88, and 0.84, respectively, showing a good performance. The C-index of the clinical factors model was 0.82 [95% CI (0.75-0.88)] in the training set and 0.77 [95% CI (0.59-0.90)] in the validation set. The radiomics nomogram showed optimal prediction performance. In the training set, the C-index was 0.91 [95% CI (0.85-0.95)], and in the validation set, the C-index was 0.85 [95% CI (0.69-0.95)]. For the training set, the C-index of the radiomics nomogram was significantly higher than the clinical factors model (p = 0.0021). Decision curve analysis showed that radiomics nomogram outperformed the clinical model in terms of clinical usefulness. CONCLUSIONS: The radiomics nomogram based on CT images showed favorable prediction performance in the prognosis of COVID-19. The radiomics nomogram could be used as a potential biomarker for more accurate categorization of patients into different stages for clinical decision-making process. ADVANCES IN KNOWLEDGE: Radiomics features based on chest CT images help clinicians to categorize the patients of COVID-19 into different stages. Radiomics nomogram based on CT images has favorable predictive performance in the prognosis of COVID-19. Radiomics act as a potential modality to supplement conventional medical examinations.

Psychological Behavior of Frontline Medical Staff in the Use of Preventive Medication for COVID-19: A Cross-Sectional Study.

PURPOSE: To understand the current pandemic, levels of anxiety in frontline staff, and whether they have been using medication to prevent COVID-19. METHODS: Between January 10 and March 10, 2020, 290 frontline staff completed a questionnaire incorporating the Generalized Anxiety Disorder Scale 7 (GAD-7) to indicate their psychological behavior in the use of preventive medication. RESULTS: Of those who participated in the study, 77.6% used preventive medication, with 47.5, 40.9, and 11.6% using these as part of routine preventive treatment, to fight infection after it was contracted, and after occupational exposure, respectively. There was a statistically significant relationship between the anxiety scale scores and the frequency of medication use (P < 0.05). Comparative analyses revealed that the scores of those in the group taking medication after occupational exposure (to respiratory and blood-borne pathogens) were significantly different from other groups. The proportion of participants choosing Western medicine, traditional Chinese medicine, and integrated Chinese and Western medicine was 24.4, 28.0, and 47.6%, respectively. Additionally, the relationship between the anxiety scale scores and the three types of medication was statistically significant (P < 0.05), as was the difference between Western medicine and other groups. According to Multinomial logistic regression based on the adjustment to gender, age, educational level, marital status, current workplace, and profession, participants with moderate to severe anxiety, had higher odds (OR = 10.331, 95%CI:1.453-73.429) of using Western medicine than participants with no anxiety. Participants with moderate anxiety were 6.399 times more likely to use an integrated combination of traditional Chinese and Western medicine compared to those with no anxiety (OR = 6.399, 95%CI:1.007-40.658). Furthermore, those with mild anxiety were 2.656 times more likely to use integrated traditional Chinese and Western medicine than those with no anxiety (OR = 2.657, 95%CI:1.075-6.570). The probability that frontline medical staff with moderate anxiety took preventive medication after occupational exposure to COVID-19 was 8.066 times (OR = 8.066, 95%CI:1.043-62.353) higher than that of staff without anxiety. DISCUSSION: This study revealed that there was more anxiety among frontline medical staff who took medication after unexpected occupational exposure. There was less anxiety among those using an integrated course of Chinese and Western medicine than Western medicine alone. It was also observed that anxiety affects the types and frequency of the preventive medication taken. Frontline medical staff who suffer from anxiety are also more likely to use medication to prevent COVID-19.

Challenges for a Cancer Center in the Novel Coronavirus Pneumonia Epidemic.

INTRODUCTION: The novel Coronavirus disease 2019 pandemic is sweeping through China, posing the greatest ever threat to its public health and economy. As a tertiary cancer center in Southwest China, we formulated and implemented an anti-infection protocol to prevent the spread of Coronavirus disease 2019 in our department. METHODS: The anti-infection protocol divided patients into 3 categories, namely outpatients, inpatients, and patients receiving radiation therapy at our cancer center, and each category had a distinct anti-infection protocol to minimize the risk of Coronavirus disease 2019 transmission. In each category, the patients were classified into high-, intermediate-, and low-risk groups. Each risk group was managed differently. A survey of patient volume changes prior to and during the Coronavirus disease 2019 outbreak was performed. RESULTS: We carried out the anti-infection protocol at our cancer center during the Coronavirus disease 2019 outbreak. We found that the total volume of both outpatient visits and inpatient treatment declined significantly depending on the conditions of each group. Radiation therapy and palliative service had the lowest and highest volume reductions at 58.3% and 100%, respectively. The decline in outpatient volumes was higher than the decline in inpatient treatment services (78.8% vs 71.8%). There was no Coronavirus disease 2019 cross-infection at our center, or Coronavirus disease 2019-related injury or death. The anti-infection protocol measures continue to be taken at the hospital even today but they have been modified depending on the prevalent local conditions. CONCLUSIONS: Challenges from the Coronavirus disease 2019 pandemic remain in our community. The anti-infection protocol implemented at our cancer center has been effective in preventing cross-infection. Whether our anti-infection protocol experience can be applied to curb the spread of the infection in other parts of the world remains to be tested.

Acute myocardial injury is common in patients with COVID-19 and impairs their prognosis.

OBJECTIVE: We sought to explore the prevalence and immediate clinical implications of acute myocardial injury in a cohort of patients with COVID-19 in a region of China where medical resources are less stressed than in Wuhan (the epicentre of the pandemic). METHODS: We prospectively assessed the medical records, laboratory results, chest CT images and use of medication in a cohort of patients presenting to two designated covid-19 treatment centres in Sichuan, China. Outcomes of interest included death, admission to an intensive care unit (ICU), need for mechanical ventilation, treatment with vasoactive agents and classification of disease severity. Acute myocardial injury was defined by a value of high-sensitivity troponin T (hs-TnT) greater than the normal upper limit. RESULTS: A total of 101 cases were enrolled from January to 10 March 2020 (average age 49 years, IQR 34-62 years). Acute myocardial injury was present in 15.8% of patients, nearly half of whom had a hs-TnT value fivefold greater than the normal upper limit. Patients with acute myocardial injury were older, with a higher prevalence of pre-existing cardiovascular disease and more likely to require ICU admission (62.5% vs 24.7%, p=0.003), mechanical ventilation (43.5% vs 4.7%, p<0.001) and treatment with vasoactive agents (31.2% vs 0%, p<0.001). Log hs-TnT was associated with disease severity (OR 6.63, 95% CI 2.24 to 19.65), and all of the three deaths occurred in patients with acute myocardial injury. CONCLUSION: Acute myocardial injury is common in patients with COVID-19 and is associated with adverse prognosis.