Continuous evolution and emerging lineage of seasonal human coronaviruses: A multicenter surveillance study.

The seasonal human coronaviruses (HCoVs) have zoonotic origins, repeated infections, and global transmission. The objectives of this study are to elaborate the epidemiological and evolutionary characteristics of HCoVs from patients with acute respiratory illness. We conducted a multicenter surveillance at 36 sentinel hospitals of Beijing Metropolis, China, during 2016-2019. Patients with influenza-like illness (ILI) and severe acute respiratory infection (SARI) were included, and submitted respiratory samples for screening HCoVs by multiplex real-time reverse transcription-polymerase chain reaction assays. All the positive samples were used for metatranscriptomic sequencing to get whole genomes of HCoVs for genetical and evolutionary analyses. Totally, 321 of 15 677 patients with ILI or SARI were found to be positive for HCoVs, with an infection rate of 2.0% (95% confidence interval, 1.8%-2.3%). HCoV-229E, HCoV-NL63, HCoV-OC43, and HCoV-HKU1 infections accounted for 18.7%, 38.3%, 40.5%, and 2.5%, respectively. In comparison to ILI cases, SARI cases were significantly older, more likely caused by HCoV-229E and HCoV-OC43, and more often co-infected with other respiratory pathogens. A total of 179 full genome sequences of HCoVs were obtained from 321 positive patients. The phylogenetical analyses revealed that HCoV-229E, HCoV-NL63 and HCoV-OC43 continuously yielded novel lineages, respectively. The nonsynonymous to synonymous ratio of all key genes in each HCoV was less than one, indicating that all four HCoVs were under negative selection pressure. Multiple substitution modes were observed in spike glycoprotein among the four HCoVs. Our findings highlight the importance of enhancing surveillance on HCoVs, and imply that more variants might occur in the future.

Nursing workforce allocation in the intensive care units of COVID-19-designated hospitals: A nationwide cross-sectional survey in China.

AIM: To explore the nursing workforce allocation in intensive care units (ICUs) of COVID-19-designated hospitals during the epidemic peak in China. DESIGN: A nationwide cross-sectional online survey. METHODS: A total of 37 head nurses and 262 frontline nurses in 37 ICUs of COVID-19-designated tertiary hospitals located in 22 cities of China were surveyed. The self-reported human resource allocation questionnaire was used to assess the nursing workforce allocation. RESULTS: The average patient-to-nurse ratio was 1.89 ± 1.14, and the median working hours per shift was 5 h. The top four majors of front-line nurses in ICUs were respiratory (31.30%), lemology (27.86%), intensive care (21.76%) and emergency (17.18%). We also found that a smaller average patient-to-nurse ratio (odds ratio [OR]: 0.328, 95% CI: 0.108, 1.000), longer average weekly rest time per person (OR: 0.193, 95% CI: 0.051, 0.729) and larger proportion of 6-9 working years (OR: 0.002, 95% CI: 0.001, 1.121) decreased the occurrence of nursing adverse events.

Prevalence and factors associated with insomnia among medical students in China during the COVID-19 pandemic: characterization and associated factors.

BACKGROUND: Insomnia has become an important issue in recent years. Insomnia is affected by many factors. Previous research has shown that during the COVID-19 pandemic, there would be a long-term negative effect on the mental health of medical college students. The state of medical college students' insomnia directly determines the results of medical education and the career development prospects of the medical students themselves. Therefore, it is very important to understand the insomnia situation of medical students in the post-epidemic era. METHODS: This study was conducted 2 years after the global COVID-19 pandemic (April 1-April 23, 2022). The study used an online questionnaire, administered through a web-based survey platform. The Athens Insomnia Scale (AIS), Fear of COVID-19 Scale (FCV-19S), GAD-2, PHQ-2, and socio-demographic information were surveyed by the Questionnaire Star platform. RESULTS: The prevalence of insomnia was 27.80% (636/2289). Grade(P < 0.05), age(P < 0.001), loneliness(P < 0.001), depression(P < 0.001), anxiety(P < 0.001), fear of COVID-19 was highly correlated with insomnia (P < 0.001). Adapting to online class(P < 0.001) was a protective factor of smartphone addiction. CONCLUSIONS: This survey shows that Insomnia was highly prevalent among the Chinese medical college students during the COVID-19 pandemic. Governments and schools should through psychological interventions to address the current situation of insomnia among medical students, and formulate targeted programs and strategies to reduce their psychological problems.

Prevalence and Associated Factors of Depression Among Frontline Nurses in Wuhan 6 Months After the Outbreak of COVID-19: A Cross-Sectional Study.

BACKGROUND Due to the COVID-19 pandemic, frontline nurses have experienced psychological problems. However, the depression of frontline nurses in Wuhan 6 months after the outbreak of COVID-19 has not been studied adequately. The purpose of this study was to investigate the depression of frontline nurses in Wuhan 6 months after the COVID-19 outbreak and to analyze possible risk and protective factors. MATERIAL AND METHODS Data were collected through Wenjuanxing from 612 frontline nurses in Wuhan national COVID-19-designated hospitals between July 27, 2020, and August 12, 2020. The levels of depression, family functioning, and psychological resilience were assessed among frontline nurses in Wuhan with a depression scale, family function scale, and 10-item psychological resilience scale, respectively. The factors associated with depressive symptoms were identified using the chi-square test and binary logistic regression analysis. RESULTS A total of 126 respondents were included in the study. The overall prevalence of depression was 25.2%. The need for mental health services was a potential risk factor for depressive symptoms, while family functioning and psychological resilience were potential protective factors. The COVID-19 pandemic poses a major challenge to the depressive symptoms of frontline nursing in Wuhan, highlighting the need for all frontline nurses in Wuhan to be screened for depression regularly for timely intervention. CONCLUSIONS To mitigate the impact of the pandemic on depression, psychological interventions for frontline nurses need to be implemented to preserve their mental health.

Online experimental research on the psychological capital development of new venture entrepreneur under the COVID-19 pneumonia epidemic.

The global economy has been severely traumatized by the COVID-19 pandemic, and new ventures are under tremendous pressure to survive. This paper explores whether structured reading materials and mindfulness intervention can develop entrepreneurs' psychological capital and whether there are different effects on different development methods. We recruited 112 new venture entrepreneurs and carried out an online experiment using the experimental group, the control group, and the pre-test and post-test design; at last, 83 of whom participated in the process can be assessed for psychological capital development effect. The research findings indicated that structured reading materials could effectively improve the overall psychological capital of the subjects (t = -5.574，p < 0.01) and impact in every dimension, including self-efficacy (Z = -2.858, p < 0.01), hope (t = -3.560, p < 0.01), resilience (t = -4.368, p < 0.01) and optimism (Z = -3.300, p < 0.01). In comparison, mindfulness intervention can improve the subjects' overall psychological capital (Z = -3.293, p < 0.01) and improve levels of self-efficacy (Z = -2.285, p < 0.01), hope (t = -4.244, p < 0.01), resilience (t = -3.167, p < 0.01), but limited effect on the optimism (t = -1.955, p > 0.05); In addition, there is no significant difference between structured reading materials and mindfulness intervention according to the statistical analysis.

Prevalence and Associated Factors of Depression Among Frontline Nurses in Wuhan 6 Months After the Outbreak of COVID-19: A Cross-Sectional Study

Background Due to the COVID-19 pandemic, frontline nurses have experienced psychological problems. However, the depression of frontline nurses in Wuhan 6 months after the outbreak of COVID-19 has not been studied adequately. The purpose of this study was to investigate the depression of frontline nurses in Wuhan 6 months after the COVID-19 outbreak and to analyze possible risk and protective factors. Material/Methods Data were collected through Wenjuanxing from 612 frontline nurses in Wuhan national COVID-19-designated hospitals between July 27, 2020, and August 12, 2020. The levels of depression, family functioning, and psychological resilience were assessed among frontline nurses in Wuhan with a depression scale, family function scale, and 10-item psychological resilience scale, respectively. The factors associated with depressive symptoms were identified using the chi-square test and binary logistic regression analysis. Results A total of 126 respondents were included in the study. The overall prevalence of depression was 25.2%. The need for mental health services was a potential risk factor for depressive symptoms, while family functioning and psychological resilience were potential protective factors. The COVID-19 pandemic poses a major challenge to the depressive symptoms of frontline nursing in Wuhan, highlighting the need for all frontline nurses in Wuhan to be screened for depression regularly for timely intervention. Conclusions To mitigate the impact of the pandemic on depression, psychological interventions for frontline nurses need to be implemented to preserve their mental health.

The role of intangible assets in promoting the sustainability of agri-food enterprises: Evidence from China

Considerable research has explored the relationship between intangible assets and firm performance in manufacturing and tertiary industries, but such studies remain scarce for the agri-food industry. In fact, numerous stresses, including the COVID-19 pandemic, have disrupted many activities along agri-food production chains in developing countries, resulting in huge pressure on sustainable agri-food production. Based on a sample of 94 A-share listed agri-food firms in China from 2008 to 2017, this study examines the impact of intangible assets on agri-food enterprises' productivity using generalized method of moments estimation. The results reveal differences between private and state-owned enterprises, indicating that the promotional productivity effect of intangible assets held by private agri-food enterprises was insignificant in the current period, but will be manifested three periods later, in contrast to state-owned enterprises. Due to the soft budget constraints and incentive mechanism of state-owned agri-food enterprises, intangible assets will not promote productivity. In addition, by pursuing the financialization profit model, agri-food enterprises will sacrifice productivity improvement, which can further lead to selective abandonment in the use of intangible assets. Simultaneously, there is a crowding-out effect between intangible and fixed assets in promoting agri-food enterprises' total factor productivity. The findings highlight the importance of the quality and conversion rate of intangible assets, particularly for agri-food enterprises, which are closely related to food security and stability.

Using search trends before and after the COVID-19 outbreak in China to analyze digestive symptoms: medical informatics study of the Baidu Index data.

Background: From the beginning of 2020, the world was plunged into a pandemic caused by the novel coronavirus disease-19 (COVID-19). People increasingly searched for information related to COVID-19 on internet websites. The Baidu Index is a data sharing platform. The main data provided is the search index (SI), which represents the frequency that keywords are used in searches. Methods: January 9, 2020 is an important date for the outbreak of COVID-19 in China. We compared the changes of SI before and after for 7 keywords, including "fever", "cough", "nausea", "vomiting", "abdominal pain", "diarrhea", "constipation". The slope and peak values of SI change curves are compared. Ten provinces in China were selected for a separate analysis, including Beijing, Gansu, Guangdong, Guangxi, Heilongjiang, Hubei, Sichuan, Shanghai, Xinjiang, Tibet. The change of SI was analyzed separately, and the correlation between SI and demographic and economic data was analyzed. Results: During period I, from January 9 to January 25, 2020, the average daily increase (ADI) of the SI for "diarrhea" was lower than that for "cough" (889.47 vs. 1,799.12, F=11.43, P=0.002). In period II, from January 25 to April 8, 2020, the average daily decrease (ADD) of the SI for "diarrhea" was significantly lower than that for "cough", with statistical significance (cough, 191.40 vs. 441.44, F=68.66, P<0.001). The mean SI after January 9, 2020 (pre-SI) was lower than that before January 9, 2020 (post-SI) (fever, 2,616.41±116.92 vs. 3,724.51±867.81, P<0.001; cough, 3,260.04±308.43 vs. 5,590.66±874.25, P<0.001; diarrhea, 4,128.80±200.82 vs. 4,423.55±1,058.01, P<0.001). The pre-SI mean was correlated with population (P=0.004, R=0.813) and gross domestic product (GDP) (P<0.001, R=0.966). The post-SI peak was correlated with population (P=0.007, R=0.789), GDP (P=0.005, R=0.804), and previously confirmed cases (PCC) (P=0.03, R=0.670). The growth rate of the SI was correlated with the post-SI peak (P=0.04, R=0.649), PCC (P=0.003, R=0.835). Conclusions: Diarrhea was of widespread concern in all provinces before and after the COVID-19 outbreak and may be associated with novel coronavirus infection. Internet big data can reflect the public's concern about diseases, which is of great significance for the study of the epidemiological characteristics of diseases.

Impact of the eHealth literacy, knowledge and attitudes on COVID-19 prevention behavior among residents in the second year of the COVID-19 pandemic: A cross-sectional study in Anhui Province, China.

Objective: The pandemic of COVID-19 continues to challenge people's health worldwide. In the second year of the pandemic, adherence to COVID-19 preventive behavior is key to continuing efforts to overcome the epidemic. This study aims to assess the COVID-19-related knowledge, attitude, and prevention behavior (KAP) and electronic health literacy (eHealth literacy) among Anhui residents in China. Methods: From January 30 to March 27, 2021, the cross-sectional study was performed among Anhui residents in China, including 16 cities. An online survey was adopted to assess KAP regarding COVID-19, and eHealth, involving a total of 2,122 citizens. Following informed consent, residents were recruited by convenience sampling. Frequencies and proportions were calculated. Additionally, Mann-Whitney U tests were used to analyze the variables. Independent predictors of preventive behavior of COVID-19 were ascertained using a multivariable logistic regression model. Result: Residents demonstrated good knowledge, positive attitudes, acceptable practices, and good eHealth literacy. Online news and WeChat are the main health information resources. Citizens who had good knowledge, a positive attitude, good eHealth, and did not participate in the online lectures or training COVID-19 were more likely to take preventive measures. Those with poor health, who were male, did not have family members working in health care facilities, and did not work in a face-to-face environment were less likely to take precautions. Compared with a master's degree and above, participants with middle school education level and below took preventive behavior sometimes. Residents who browse the COVID-19 webpage <15 min weekly seldom took preventive actions. Conclusion: The study showed that in the second year of the COVID-19 pandemic, Chinese residents had adequate knowledge of COVID-19, positive attitudes, appropriate preventive practices, and basic eHealth literacy. To prevent the rebound of the COVID-19 epidemic, the government and health agencies should inform citizens concerning which information channels or websites to use and assist the underprivileged population who lacks basic infrastructure. In addition, increasing the level of knowledge and attitude, enhancing eHealth literacy and the Health Belief Model (HBM), and implementing the Health Code were seen as ways to reinforce adherence to preventive behavior. Targeting men, implementing public awareness campaigns, community engagement strategies, and health education programs are recommended.

Recent Advances in the Molecular Design and Delivery Technology of mRNA for Vaccination Against Infectious Diseases.

Vaccines can prevent many millions of illnesses against infectious diseases and save numerous lives every year. However, traditional vaccines such as inactivated viral and live attenuated vaccines cannot adapt to emerging pandemics due to their time-consuming development. With the global outbreak of the COVID-19 epidemic, the virus continues to evolve and mutate, producing mutants with enhanced transmissibility and virulence; the rapid development of vaccines against such emerging global pandemics becomes more and more critical. In recent years, mRNA vaccines have been of significant interest in combating emerging infectious diseases due to their rapid development and large-scale production advantages. However, their development still suffers from many hurdles such as their safety, cellular delivery, uptake, and response to their manufacturing, logistics, and storage. More efforts are still required to optimize the molecular designs of mRNA molecules with increased protein expression and enhanced structural stability. In addition, a variety of delivery systems are also needed to achieve effective delivery of vaccines. In this review, we highlight the advances in mRNA vaccines against various infectious diseases and discuss the molecular design principles and delivery systems of associated mRNA vaccines. The current state of the clinical application of mRNA vaccine pipelines against various infectious diseases and the challenge, safety, and protective effect of associated vaccines are also discussed.

Impact of Zinc, Vitamins C and D on Disease Prognosis among Patients with COVID-19 in Bangladesh: A Cross-Sectional Study.

Vitamin C, (ascorbic acid), vitamin D (cholecalciferol) and zinc (zinc sulfate monohydrate) supplements are important in immunity against coronavirus disease-2019 (COVID-19). However, a limited number of studies have been conducted on the association of vitamins and supplements with the reduced risks of COVID-19 infection. This study aims to evaluate the association of vitamins and supplements as treatment options to reduce the severity of COVID-19. Data were collected from 962 participants from 13 December 2020 to 4 February 2021. The presence of COVID-19 was confirmed by qRT-PCR. The Chi-square test and multivariate regression analyses were conducted. The ratio of uptake of vitamin C:vitamin D:zinc was 1:1:0.95. Uptake of vitamin C, vitamin D and zinc were significantly associated with the reduced risk of infection and severity of COVID-19 (OR: 0.006 (95% CI: 0.03-0.11) (p = 0.004)) and (OR: 0.03 (95% CI: 0.01-0.22) (p = 0.005)). The tendency of taking supplements was associated with the presence of infection of COVID-19 (p = 0.001), age (p = 0.02), sex (p = 0.05) and residence (p = 0.04). The duration of supplementation and medication was significantly associated with reduced hospitalization (p = 0.0001). Vitamins C, D and zinc were not significantly (p = 0.9) associated with a reduced risk of severity when taken through the diet. Hospitalization (p = 0.000001) and access to health facilities (p = 0.0097) were significantly associated with the survival period of the participants. Participants with better access to health facilities recovered early (OR: 6.21, 95% CI 1.56-24.7). This study will add knowledge in the field of treatment of COVID-19 by using vitamins and zinc supplements.

Using search trends before and after the COVID-19 outbreak in China to analyze digestive symptoms: medical informatics study of the Baidu Index data

Background From the beginning of 2020, the world was plunged into a pandemic caused by the novel coronavirus disease-19 (COVID-19). People increasingly searched for information related to COVID-19 on internet websites. The Baidu Index is a data sharing platform. The main data provided is the search index (SI), which represents the frequency that keywords are used in searches. Methods January 9, 2020 is an important date for the outbreak of COVID-19 in China. We compared the changes of SI before and after for 7 keywords, including “fever”, “cough”, “nausea”, “vomiting”, “abdominal pain”, “diarrhea”, “constipation”. The slope and peak values of SI change curves are compared. Ten provinces in China were selected for a separate analysis, including Beijing, Gansu, Guangdong, Guangxi, Heilongjiang, Hubei, Sichuan, Shanghai, Xinjiang, Tibet. The change of SI was analyzed separately, and the correlation between SI and demographic and economic data was analyzed. Results During period I, from January 9 to January 25, 2020, the average daily increase (ADI) of the SI for “diarrhea” was lower than that for “cough” (889.47 vs. 1,799.12, F=11.43, P=0.002). In period II, from January 25 to April 8, 2020, the average daily decrease (ADD) of the SI for “diarrhea” was significantly lower than that for “cough”, with statistical significance (cough, 191.40 vs. 441.44, F=68.66, P<0.001). The mean SI after January 9, 2020 (pre-SI) was lower than that before January 9, 2020 (post-SI) (fever, 2,616.41±116.92 vs. 3,724.51±867.81, P<0.001;cough, 3,260.04±308.43 vs. 5,590.66±874.25, P<0.001;diarrhea, 4,128.80±200.82 vs. 4,423.55±1,058.01, P<0.001). The pre-SI mean was correlated with population (P=0.004, R=0.813) and gross domestic product (GDP) (P<0.001, R=0.966). The post-SI peak was correlated with population (P=0.007, R=0.789), GDP (P=0.005, R=0.804), and previously confirmed cases (PCC) (P=0.03, R=0.670). The growth rate of the SI was correlated with the post-SI peak (P=0.04, R=0.649), PCC (P=0.003, R=0.835). Conclusions Diarrhea was of widespread concern in all provinces before and after the COVID-19 outbreak and may be associated with novel coronavirus infection. Internet big data can reflect the public’s concern about diseases, which is of great significance for the study of the epidemiological characteristics of diseases.

Nab-paclitaxel plus S-1 versus oxaliplatin plus S-1 as first-line treatment in advanced gastric cancer: results of a multicenter, randomized, phase III trial (GAPSO study).

Background: This study aimed to investigate the superiority of nab-paclitaxel plus S-1 (AS) over oxaliplatin plus S-1 (SOX) in patients with advanced gastric cancer (AGC). Methods: In this multicenter, randomized, phase III superiority trial, eligible patients with unresectable, locally advanced gastric adenocarcinoma were recruited and randomly assigned (1:1) to receive AS (nab-paclitaxel 260 mg/m2 on day 1 or 130 mg/m2 on days 1 and 8; oral S-1 40-60 mg twice daily for 14 days) or SOX (130 mg/m2 oxaliplatin on day 1; oral S-1 40-60 mg twice daily for 14 days) every 3 weeks for up to six cycles. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were overall survival, objective response rate, and safety. Results: Owing to slow enrolment, an unplanned interim analysis was performed, resulting in the early termination of the study on 31 December 2021 (data cutoff). Between March 2019 and March 2021, 97 patients (AS, n = 48; SOX, n = 49) were treated and evaluated for efficacy and safety of AS and SOX. As of the data cutoff, the median follow-up was 23.13 months [95% confidence interval (CI), 13.39-32.87]. The median PFS was 9.03 months (95% CI, 6.50-11.56) in the AS group and 5.07 months (95% CI, 4.33-5.81) in the SOX group, demonstrating a better PFS tendency following AS treatment than SOX treatment (hazard ratio = 0.59; 95% CI, 0.37-0.94; p = 0.03). The most common grade 3 or worse adverse events were anemia, neutropenia, and leukopenia in both groups, with a higher incidence of thrombocytopenia in the SOX group. Conclusion: Although this study was terminated early, the results demonstrated a better PFS tendency in patients with AGC who were treated with AS than in those treated with SOX, with controllable toxicities. Trial registration: Clinical Trials.gov identifiers: NCT03801668. Registered January 11, 2019.

Aerosol Characteristics during the COVID-19 Lockdown in China: Optical Properties, Vertical Distribution, and Potential Source

The concentration changes of aerosols have attracted wide-ranging attention during the COVID-19 lockdown (CLD) period, but the studies involving aerosol optical properties (AOPs) are relatively insufficient, mainly AOD (fine-mode AOD (AODf) and coarse-mode AOD (AODc)), aerosol absorption optical depth (AAOD), and aerosol extinction coefficient (AEC). Here, the remote-sensing observations, Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2) products, backward-trajectory, and potential-source-contribution models are used to assess the impact of AOPs, vertical distribution, and possible sources on the atmosphere environment in North China Plain (NCP), Central China (CC), Yangtze River Delta (YRD), Pearl River Delta (PRD), and Sichuan Basin (SB) during the CLD period. The results demonstrate that both AOD (MODIS) and near-surface AEC (CALIPSO, <2 km) decreased in most areas of China. Compared with previous years (average 2017–2019), the AOD (AEC) of NCP, CC, YRD, PRD, and SB reduced by 3.33% (10.76%), 14.36% (32.48%), 10.80% (29.64%), 31.44% (22.68%), and 15.50% (8.44%), respectively. In addition, MODIS (AODc) and MERRA-2 (AODc) decreased in the five study areas compared with previous years, so the reduction in dust activities also contributed to improving regional air quality during the epidemic. Despite the reduction of anthropogenic emissions (AODf) in most areas of China during the CLD periods, severe haze events (AODf > 0.6) still occurred in some areas. Compared to previous years, there were increases in BC, OC (MERRA-2), and national raw coal consumption during CLD. Therefore, emissions from some key sectors (raw coal heating, thermal power generation, and residential coal) did not decrease, and this may have increased AODf during the CLD. Based on backward -rajectory and potential source contribution models, the study area was mainly influenced by local anthropogenic emissions, but some areas were also influenced by northwestern dust, Southeast Asian biomass burning, and marine aerosol transport. This paper underscores the importance of emissions from the residential sector and thermal power plants for atmospheric pollution in China and suggests that these sources must be taken into account in developing pollution-mitigation plans. [ FROM AUTHOR] Copyright of Remote Sensing is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Recent Advances in the Molecular Design and Delivery Technology of mRNA for Vaccination Against Infectious Diseases

Vaccines can prevent many millions of illnesses against infectious diseases and save numerous lives every year. However, traditional vaccines such as inactivated viral and live attenuated vaccines cannot adapt to emerging pandemics due to their time-consuming development. With the global outbreak of the COVID-19 epidemic, the virus continues to evolve and mutate, producing mutants with enhanced transmissibility and virulence;the rapid development of vaccines against such emerging global pandemics becomes more and more critical. In recent years, mRNA vaccines have been of significant interest in combating emerging infectious diseases due to their rapid development and large-scale production advantages. However, their development still suffers from many hurdles such as their safety, cellular delivery, uptake, and response to their manufacturing, logistics, and storage. More efforts are still required to optimize the molecular designs of mRNA molecules with increased protein expression and enhanced structural stability. In addition, a variety of delivery systems are also needed to achieve effective delivery of vaccines. In this review, we highlight the advances in mRNA vaccines against various infectious diseases and discuss the molecular design principles and delivery systems of associated mRNA vaccines. The current state of the clinical application of mRNA vaccine pipelines against various infectious diseases and the challenge, safety, and protective effect of associated vaccines are also discussed.

Association Between Clinical Competencies and Mental Health Symptoms Among Frontline Medical Staff During the COVID-19 Outbreak: A Cross-Sectional Study.

Background: In China, mental health of frontline medical staff might be influenced by clinicians' ability to handle the outbreak of coronavirus disease 2019 (COVID-19). Few studies to-date have addressed the association between clinicians' competencies and mental health in this context. This cross-sectional study was to examine the prevalence of mental health symptoms among frontline medical staff that fought against the COVID-19 outbreak, and explore the associations between their competencies, and separate and concurrent depressive and anxiety symptoms. Methods: A total of 623 frontline medical staff was included in this study. Competencies, depressive symptoms, and anxiety symptoms were assessed using a self-reported short form of the Chinese clinical physicians' competency model, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 questionnaire, respectively. Logistic regression models were used to evaluate the associations between one SD increase in competency scores and the prevalence of mental health problems. Results: The prevalence of depressive, anxiety, and comorbid depressive and anxiety symptoms was 40.93, 31.78, and 26.00%, respectively. Among the medical staff with higher total competency scores, the prevalence of depressive [odds ratios (ORs) = 0.67, 95% confidence intervals (CIs): 0.55-0.81], anxiety (OR = 0.68, 95% CI: 0.56-0.83), and comorbid anxiety and depressive symptoms (OR = 0.69, 95% CI: 0.55-0.83) was lower than among their lower-scoring counterparts. Subgroup analyses stratified by core competency scores revealed similar associations as the main analyses. Conclusion: The present findings highlight the association between high core competency scores and lower prevalence of depressive, anxiety, and comorbid anxiety and depressive symptoms.

Analysis of blood samples from 42 patients with varying degrees of infection during the epidemic of COVID-19: a retrospective study.

BACKGROUND: Blood samples from 42 patients with coronavirus disease 2019 (COVID-19) with varying degrees of infection were examined to further explore the relationship between clinical features, immune factors and COVID-19, as well as the diagnostic and predictive values of clinical features and immune factors in severe disease progression. METHODS: This study included 42 nucleic acid-positive COVID-19 patients admitted to the First Hospital of Jiaxing from January 26, 2020 to February 21, 2020, who were divided into mild-moderate group and severe group based on respiratory rate, resting oxygen saturation and alveolar oxygen partial pressure/O2 inhalation. On February 21, 2020, clinical data including sex, age, body mass index (BMI), past medical history, clinical symptoms, hematology indexes [white blood cell (WBC); neutrophil (NEUT); lymphocyte (LYM); C-reactive protein (CRP)] were collected. The chi-square test was used to compare the clinical data differences between the two groups, so as to perform comparative analysis in the context of serious disease development. RESULTS: There were 8 cases of severe disease, and 34 cases of mild and moderate symptoms. Comparative analysis showed that patients with advanced age (≥60 years, OR =5.800, P=0.0286), history of hypertension (OR =5.800, P=0.0286) and pulmonary lobe lesions (≥4, OR =6.273, P=0.0270) were more likely to develop serious diseases. In addition, according to clinical symptoms, chest pain was more prominent in patients with severe disease. Laboratory tests showed that levels of WBC (severe 4.96±1.76 vs. mild-moderate 5.45±2.01, P=0.5300), NEUT (severe 3.56±1.44 vs. mild-moderate 3.94±1.87, P=0.5945) and LYM (severe 0.91±0.25 vs. mild-moderate 1.11±0.51, P=0.2903) were normal or decreased, but CRP level (severe 31.03±9.38 vs. mild-moderate 12.53±15.73, P=0.0029) was obviously increased, especially in patients with severe disease, with statistically significant difference between groups. CONCLUSIONS: Patients with hypertension and advanced age are more likely to develop deteriorate with COVID-19, and the number of lung lobes with lesions and chest pain may indicate disease progression. Notably, CRP level is significantly elevated in severe disease and it may be closely related to COVID-19 progression.

Heart-targeted amelioration of sepsis-induced myocardial dysfunction by microenvironment responsive nitric oxide nanogenerators in situ.

BACKGROUND: A balanced endogenous level of bioavailable nitric oxide (NO) plays a key role in maintaining cardiovascular homeostasis. The bioactive NO level in the cardiomyocytes was much reduced during sepsis. However, it is clinically challenging for the NO gas therapy due to the lack of spatial and temporal release system with precise control. The purpose of this study is to design a NO-releasing biomaterial with heart-targeted capability responsive to the infectious microenvironment, thus ameliorating lipopolysaccharide (LPS)-induced cardiac dysfunction. RESULTS: The heart-targeted NO delivery and in situ releasing system, PCM-MSN@LA, was synthesized using hollow mesoporous silica nanoparticles (MSN) as the carrier, and L-arginine (LA) as the NO donor. The myocardial delivery was successfully directed to heart by specific peptide (PCM) combined with low-intensity focused ultrasound (LIFU) guidance. The myocardial system synthesized NO from the LA released from PCM-MSN@LA in the presence of increased endogenous nitric oxide synthase (NOS) activity induced by LPS. This targeted NO release in situ achieved extraordinary protective effects against LPS-challenged myocardial injury by reducing the recruitment of inflammatory cells, inhibiting oxidative stress and maintaining the mitochondria integrity. In particular, this protection was not compromised by simultaneous circulation collapse as an adverse event in the context. CONCLUSIONS: PCM-MSN@LA + LIFU exhibited extraordinary cardioprotective effects against severe sepsis in the hearts of LPS-treated animals without the side effect of NO diffusion. This technology has great potential to be served as a novel therapeutic strategy for sepsis-induced myocardial injury.

Willingness and Influencing Factors to Receive COVID-19 Vaccination Among Chinese Medical Students.

Objectives: The aim of this study is to evaluate the desire of medical students in China to get vaccinated or not get vaccinated and the reasons for either decision. Methods: A cross-sectional survey was conducted from 11 March and 12 March 2021, by administering an online questionnaire to the Chinese medical students. Data entry and analysis were conducted using IBM SPSS ver. 26.0. Results: Of 3,047 students who completed the survey, 37.9% (1,154) of participants indicated that they would be vaccinated against COVID-19, while 62.1% (1,893) declared that they would not. Attitudes to the COVID-19 vaccine (p = 0.000), levels of eHealth Literacy (p = 0.000), the impact of COVID19 (p = 0.000), concerns about the COVID-19 vaccine (p = 0.000) and gender (p = 0.000) strong associations with willingness to receive the COVID-19 vaccine. Conclusion: The willingness to receive COVID-19 vaccination was sub-optimal among medical students in China. Educational interventions to improve medical students' perceptions and acceptance toward the COVID-19 vaccine are needed.

Poly(I:C) exposure during in vitro fertilization disrupts first cleavage of mouse embryos and subsequent blastocyst development.

The reproductive system can be infected by a variety of double-stranded RNA viruses, which disrupt ovary function and pregnancy. However, whether viral infection directly affects early embryonic development remains unknown. Here we show that Poly(I:C), which mimics a double-stranded RNA virus, significantly impaired mouse early embryonic development in vitro, and up-regulated TLR3 and IFNα at the two cells embryo stage. Further studies indicated that Poly(I:C)-treatment caused DNA damage and abnormal spindle morphology at the first cleavage. Moreover, CDX2 and SOX2 expression was decreased while blastocyst cell apoptosis was increased. Altogether, Poly(I:C) decreased the rate of successful in vitro fertilization via DNA damage and abnormal spindle morphology at the first cleavage and inhibited early embryonic development by inducing immune response and promoting blastocyst cell apoptosis. This study provides an implication for exploring the causes of reproductive disorders in mammals and humans caused by infection of double-stranded RNA virus.