Patients without Increased Lymphocyte Counts and Decreased CT Scores During the Early 2nd Week of Illness Onset may Develop to Severe COVID-19.

BACKGROUND: Lymphopenia and high CT score is associated with COVID-19 severity. Herein we describe the change pattern in lymphocyte count and CT score during hospitalization and explore a possible association with the severity of COVID-19. METHODS: In this retrospective study, 13 non-severe COVID-19 patients diagnosed at admission were enrolled. One patient progressed to severe disease. Change patterns in lymphocyte counts and CT scores of all patients were analyzed. RESULTS: Lymphocyte count increased gradually from day 5 post-illness onset (day 5 vs. day 15, p = 0.001). Lymphocyte count of the severe patient fluctuated at low levels throughout the 15-day period. Chest CT scores of non-severe patients increased significantly during the first 5 days of illness onset, but decreased gradually beginning day 9 (illness onset vs. day 5, p = 0.002, day 9 vs. day 15, p = 0.015). In the severe patient, CT score continued to increase over the 11 days post-illness onset period. CONCLUSIONS: Non-severe COVID-19 patients had significantly increased lymphocyte counts and decreased CT scores beginning day 5 and day 9 of illness onset, respectively. The patients without increased lymphocyte counts and decreased CT scores during the early 2nd week of illness onset may develop to severe COVID-19.

Elevated INR in a COVID-19 patient after concomitant administration of azvudine and anticoagulants.

Background: Azvudine (FNC) is a promising treatment candidate for managing coronavirus disease 2019 (COVID-19). However, drug interactions with azvudine have been poorly studied, especially with no reported cases of azvudine with anticoagulants such as warfarin and rivaroxaban. Case summary: The patient was diagnosed with lower limb venous thrombosis and took warfarin regularly. The international normalized ratio (INR) was stable (2.0-3.0). However, the INR increased to 7.52 after administering azvudine. The patient had no other factors justifying this change. This increase in INR occurred again with the administration of azvudine in combination with rivaroxaban, and the INR increased to 18.91. After azvudine administration was stopped, the INR did not increase when rivaroxaban was used alone. Conclusion: Azvudine, warfarin, and rivaroxaban might have previously unidentified drug interactions that increased the INR. Therefore, the INR must be closely monitored when they are concomitantly administered in COVID-19 patients.

Severe/critical COVID-19 early warning system based on machine learning algorithms using novel imaging scores.

BACKGROUND: Early identification of severe/critical coronavirus disease 2019 (COVID-19) is crucial for timely treatment and intervention. Chest computed tomography (CT) score has been shown to be a significant factor in the diagnosis and treatment of pneumonia, however, there is currently a lack of effective early warning systems for severe/critical COVID-19 based on dynamic CT evolution. AIM: To develop a severe/critical COVID-19 prediction model using a combination of imaging scores, clinical features, and biomarker levels. METHODS: This study used an improved scoring system to extract and describe the chest CT characteristics of COVID-19 patients. The study also took into consideration the general clinical indicators such as dyspnea, oxygen saturation, alternative lengthening of telomeres (ALT), and androgen suppression treatment (AST), which are commonly associated with severe/critical COVID-19 cases. The study employed lasso regression to evaluate and rank the significance of different disease characteristics. RESULTS: The results showed that blood oxygen saturation, ALT, IL-6/IL-10, combined score, ground glass opacity score, age, crazy paving mode score, qsofa, AST, and overall lung involvement score were key factors in predicting severe/critical COVID-19 cases. The study established a COVID-19 severe/critical early warning system using various machine learning algorithms, including XGBClassifier, Logistic Regression, MLPClassifier, RandomForestClassifier, and AdaBoost Classifier. The study concluded that the prediction model based on the improved CT score and machine learning algorithms is a feasible method for early detection of severe/critical COVID-19 evolution. CONCLUSION: The findings of this study suggest that a prediction model based on improved CT scores and machine learning algorithms is effective in detecting the early warning signals of severe/critical COVID-19.

Factors influencing effective prevention behavior among medical care workers during epidemic

Objective: To identify the influencing factors of effective prevention behaviors among medical staff during the COVID-19 pandemic in China. Methods: A total of 863 medical care workers were recruited from hospitals of some regions in China from February to March, 2020. Depression, anxiety and stress scale (DASS), the perceived social support scale (PSSS), simplified coping style questionnaire (SCSQ) and some self-developed scales were used to collect information of the study participants. Pearson correlation analysis was used to test the correlation between variables;Mplus was used to build a structural equation model to analyze the direct and indirect factors affecting the effective prevention behavior of these medical personnel. Results: The score of effective preventive behavior of 863 medical staff was (50.18 +or- 4.99). Anxiety was weakly negatively correlated with effective prevention behavior (r = - 0.139, P < 0.05), and positive coping style, attitude, perceived severity, behavior skills and perceived social support were weakly positively correlated with effective prevention behavior (r = 0.258, 0.104, 0.131, 0.302, 0.276, P < 0.05, respectively). The fitting degree of the established structural equation model was good (X 2/df = 2.829, CFI = 0.931, TLI = 0.920, RMSEA = 0.046, SRMR = 0.045). The perceived social support had an impact on effective prevention behavior, and its total effect(beta = 0.270) and direct effect(beta = 0.134) were statistically significant (P < 0.05). Positive coping style could play a part of intermediary role between understanding social support and effective prevention behavior(beta = 0.049, P = 0.019), behavioral skills could play a partial intermediary role between understanding social support and effective prevention of behavior(beta = 0.061, P = 0.002), anxiety, attitude and behavior skills could play a chain intermediary role between understanding social support and effectively preventing behavior(beta = 0.002, P = 0.012), and anxiety, perceived severity, and behavioral skills can play a chain intermediary role between understanding social support and effectively preventing behavior(beta = - 0.001, P = 0.028), with the ratio of intermediary effect to total effect 0.181, 0.226, 0.007, - 0.004 (P < 0.05), respectively. Conclusions: By improving the understanding of social support, positive attitude and coping strategies, and improving the behavior skills can promote medical staff to take effective preventive behavior.

The coverage of SARS-CoV-2 vaccination and the willingness to receive the SARS-CoV-2 variant vaccine among employees in China.

BACKGROUND: COVID-19, which is caused by SARS-CoV-2, is a major global health threat. The dominant variant of SARS-CoV-2 has changed over time due to continuous evolution. We aimed to evaluate the coverage of SARS-CoV-2 vaccination among employees in China, explore their willingness to receive the SARS-CoV-2 variant vaccine and examine the potential factors influencing vaccination coverage and willingness. METHODS: A cross-sectional epidemiological survey was conducted online from January 1, 2022, to January 30, 2022. The information collected in the survey included sociodemographic characteristics, lifestyle habits, vaccination coverage, willingness to be vaccinated against SARS-CoV-2 variants and the reasons for vaccination and willingness. Multivariable logistic regression models were used to assess the associations of potential factors with the rate of vaccination and the willingness to be vaccinated. RESULTS: Among 62,395 eligible participants, the coverage of SARS-CoV-2 vaccination was 98.9% for at least one dose and 70.1% for a booster. The great majority of vaccinated individuals (94.4%) voluntarily received the vaccine. A total of 60,694 respondents (97.7%) were willing to be vaccinated against SARS-CoV-2 variants, mainly due to confidence in the effectiveness of vaccines (92.8%). A total of 1431 respondents were unwilling to be vaccinated, mainly because of concerns about the adverse effects of vaccines (77.6%). Longer education duration was associated with a higher rate of SARS-CoV-2 vaccination and willingness to be vaccinated. General or poor health status and having no history of influenza vaccination were associated with a lower rate of SARS-CoV-2 vaccination and willingness to be vaccinated. Additionally, we observed a significant positive association of abuse experience with the willingness to be vaccinated. CONCLUSION: Although the rate of SARS-CoV-2 vaccination and the willingness to be vaccinated were relatively high in the study population, there were still some respondents with vaccine hesitancy. Relevant strategies based on significant related factors should be developed and implemented to encourage vaccination.

Analysis of the anxiety level and influencing factors during the coronavirus disease 2019 epidemic among the parents of students in China.

Background: Due to the outbreak of Coronavirus Disease 2019, there has been a significant impact on the mental health of parents. However, no detailed study on the mental health status of parents has been conducted to date. Methods: This study was a cross-sectional used a whole-group random sampling method to conduct an online questionnaire survey with 102,883 parents in Guangdong Province, China, April 25, 2020 and May 14, 2020. Anxiety was assessed by using the Generalized Anxiety Disorder tool (GAD-7). Potential factors of anxiety were estimated using univariate analysis and multivariate logistic regression analysis by SPSS 22.0 statistical software. Results: Among the total 94,705 parents who have completed the questionnaire survey (92.05% response rate). The incidence of anxiety was 23.77%. Parents' anxiety symptoms are more likely to be caused by female family roles, higher levels of education, unemployed or jobless employment status, children not being an only child, and children having negative attitudes toward online courses. Conclusions: Our research shows that most parents experienced mild anxiety during the Coronavirus Disease 2019 epidemic. Our findings provide strong evidence for investigating and focusing on the mental health of this population during the COVID-19 epidemic. Therefore, governments and healthcare departments at all levels should actively provide psychological counseling services to relieve their anxiety symptoms.

Hematopoietic stem cell transplantation activity in China 2020-2021 during the SARS-CoV-2 pandemic: a report from the Chinese Blood and Marrow Transplantation Registry Group.

Between 2020 and 2021, 31,525 hematopoietic stem cell transplantations (HSCTs) were reported to the Chinese Blood and Marrow Transplantation Registry Group (CBMTRG) throughout mainland China. In this report, we describe the activity and current trends for HSCT in China during the SARS-CoV-2 pandemic. In 2020, a total of 13,415 cases of HSCT were reported from 166 transplant teams, and 75% (10,042 cases) were allogeneic HSCTs. In 2021, a total of 18,110 cases of HSCT were reported from 174 transplant teams, and 70% (12,744 cases) were allogeneic HSCTs. Haploidentical donor (HID) transplantation accounted for 63% (7977 cases) of allogeneic HSCTs in 2021. The most common indications for allogeneic HSCT for malignant disease were acute myeloid leukemia (AML) (37%) and acute lymphoblastic leukemia (ALL) (23%), and the largest proportion of nonmalignant disease comprised aplastic anemia (AA) (13%). The PB stem cell source accounted for 41% of HIDs and 75% of MSDs. The BuCy-based regimen (57%) was the most popular conditioning regimen for allogeneic HSCT, followed by the BuFlu-based regimen (28%) and TBI-based regimen (11%). This survey provides comprehensive information about the current activities and might benefit clinical physicians' decision planning for HSCT.

Combining PCA-AHP Combination Weighting to Prioritize Design Elements of Intelligent Wearable Masks

Intelligent wearable masks are gaining increasing interest due to COVID-19 and the problems and limitations of existing masks. This paper prioritizes the design elements of personal protective equipment-intelligent wearable masks from the perspective of the product design domain. Using principal component analysis (PCA), the principal components of the design elements were selected first in this paper. Using the combined weights (PCA-AHP) method, the intelligent wearable masks' prioritized design elements at each level were determined. The highest priority among the primary elements is comfort (0.3422), with the adjustable ear strap (0.1870) receiving the highest priority among the primary elements of comfort. The highest priority in functionality (0.2733) is anti-respiratory droplets/air purification (0.1097), the highest priority in usability (0.1686) is the easy removal and replacement of filters (0.0761), the highest priority in the aesthetic design (0.1192) is styling (0.0509), and the highest priority in material (0.0967) is flexible fabric material (0.0355). Finally, the six prioritized design elements were evaluated using fuzzy comprehensive evaluation (FCE), and overall, 76% of the experts considered them 'appropriate';or 'very appropriate';and 18% considered them 'fair.';Therefore, this study's six most prioritized design elements proposed for intelligent wearable masks can satisfy users' needs.

Recent advances in double-lumen tube malposition in thoracic surgery: A bibliometric analysis and narrative literature review.

Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine "passive" chest computed tomography (CT) screening of inpatients detects some pulmonary diseases requiring thoracic surgeries timely. As an essential device for thoracic anesthesia, the double-lumen tube (DLT) is particularly important for anesthesia and surgery. With the continuous upgrading of the DLTs and the widespread use of fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, DLT malposition still occurs during transferring patients from a supine to the lateral position in thoracic surgery, which leads to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently, some innovative DLTs or improved intervention methods have shown good results in reducing the incidence of DLT malposition. This review aims to summarize the recent studies of the incidence of left-sided DLT malposition, the reasons and effects of malposition, and summarize current methods for reducing DLT malposition and prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.

Identifying Traffic Congestion Patterns of Urban Road Network Based on Traffic Performance Index

Urban congestion has become a global problem with urbanization and motorization. The analysis of time-varying traffic congestion patterns is necessary to formulate effective management strategies. The existing studies have focused on traffic flow patterns developed by the volume, speed and density of road sections in a limited district, while the long-time analysis of congestion patterns of the macro road network at the city level is inadequate. This paper aims to recognize traffic congestion patterns of the urban road network based on the traffic performance index (TPI) of 699 days in 2018, 2019 and 2021 in Beijing. The self-organizing maps (SOM) method improved by an automatic clustering number determination algorithm is proposed to cluster congestion patterns based on time-varying TPI. The traffic congestion of the macro road network is clustered into Mondays, Fridays, ordinary weekdays, congested weekdays, weekdays of winter and summer vacation, Saturdays, Sundays and festivals patterns. Patterns of Mondays and congested weekdays have a prominent morning peak, while patterns of Fridays, ordinary weekdays, and weekdays of winter and summer vacation have a prominent evening peak. Saturdays, Sundays and festivals are less congested than weekday patterns. It is verified that the SOM method proposed in this paper clusters traffic congestion into more detailed and accurate patterns, and it is applicable to TPI clustering in different years. The degree of congestion in 2021 increases by 7.15% in peak hours and decreases by 7.50% in off-peak hours compared with that in 2019 due to COVID-19. This method is helpful for traffic management in terms of making decisions according to different congestion patterns.

Clinical and immune response characteristics among vaccinated persons infected with SARS-CoV-2 delta variant: a retrospective study.

OBJECTIVES: This study aimed to observe the clinical and immune response characteristics of vaccinated persons infected with the delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Yangzhou, China. METHODS: We extracted the medical data of 129 patients with delta-variant infection who were admitted to Northern Jiangsu People's Hospital (Yangzhou, China) between August and September, 2021. The patients were grouped according to the number of vaccine doses received into an unvaccinated group: a one-dose group and a two-dose group. The vaccine used was SARS-CoV-2-inactivated vaccine developed by Sinovac. We retrospectively analyzed the patients' epidemiological, clinical, laboratory, and imaging data. RESULTS: Almost all patients with delta-variant infection in Yangzhou were elderly, and patients with severe/critical illness were over 70 years of age. The rates of severe/critical illness (P=0.006), fever (P=0.025), and dyspnea (P=0.045) were lower in the two-dose group than in the unvaccinated group. Compared to the unvaccinated group, the two-dose group showed significantly higher lymphocyte counts and significantly lower levels of C-reactive protein (CRP), interleukin-6 (IL-6), and D-dimer during hospitalization and a significantly higher positive rate of immunoglobulin G (IgG) antibodies at admission (all P<0.05). The cumulative probabilities of hospital discharge and negative virus conversion were also higher in the two-dose group than in the unvaccinated group (P<0.05). CONCLUSIONS: Two doses of the SARS-CoV-2-inactivated vaccine were highly effective at limiting symptomatic disease and reducing immune response, while a single dose did not seem to be effective.

How rumors diffuse in the infodemic: Evidence from the healthy online social change in China

Infodemic is defined as ‘an overabundance of information-some accurate and some not-that makes it hard for people to find trustworthy sources and reliable guidance when they need it’ by the World Health Organization. As unverified information, rumors can widely spread in online society, further diffusing infodemic. Existed studies mainly focused on rumor detection and prediction from the statement itself and give the probability that it will evolve into a rumor in the future. However, the detection and prediction from rumors production perspective is lack. This research explores the production mechanism from the uncertainty perspective using the data from Weibo and public rumor data set. Specifically, we identify the public uncertainty through user-generated content on social media based on systemic functional linguistics theory. Then we empirically verify the promoting effect of uncertainty on rumor production and constructed a model for rumor prediction. The fitting effect of the empirical model with the public uncertainty is significantly better than that with only control variables, indicating that our framework identifies public uncertainty well and uncertainty has a significantly predictive effect on rumors. Our study contributes to the research of rumor prediction and uncertainty identification, providing implications for healthy online social change in the post-epidemic era.

Current status and prospects of hematopoietic stem cell transplantation in China.

ABSTRACT: Hematopoietic stem cell transplantation (HSCT) is a highly effective and unique medical procedure for the treatment of most hematological malignancies. The first allogeneic transplantation was performed by E. Donnall Thomas in 1957. Since then, the field has evolved and expanded worldwide. The first successful allogenic HSCT (allo-HSCT) in China was conducted in 1981. Although the development of allo-HSCT in China lagged, China has since made considerable contributions to the process of HSCT worldwide, with more than 10,000 HSCTs performed annually. In particular, haploid HSCT (haplo-HSCT) technology represented in the Beijing Protocol has demonstrated similar efficacy to human leukocyte antigen-matched HSCT and has gradually become the pre-dominant choice for allo-HSCT in China. Currently, the number of haplo-HSCT procedures exceeds 5000 per year, and the Beijing Protocol has been greatly improved by implementing updated individualized strategies for controlling complications, relapse, and infection management. In addition, innovative haplo-HSCT technologies developed by different medical transplantation centers, such as Soochow, Zhejiang, Fujian, Chongqing, and Anhui, have emerged, providing inspiration for the refinement of global practice. This review will focus on the current activity in this field and highlight important trends that are vital in China's allo-HSCT process, examining the current viewpoint and future directions.

A Multi-Center Study on the Negative Psychological Impact and Associated Factors in Chinese Healthcare Workers 1 Year After the COVID-19 Initial Outbreak.

Objectives: The study aimed at analyzing the prevalence of five psychological outcomes (depression, anxiety, stress, post-traumatic stress disorder (PTSD), and suicidal ideation) among Chinese healthcare workers (HCWs), and measured the total possible negative psychological impact 1 year after the COVID-19 initial outbreak. Methods: A cross-sectional nationwide multi-center study was performed between November 2020 and March 2021 in China. A self-report questionnaire was applied, and three psychological scales were used. Binary logistic regression was performed to analyze the risk factors associated with each psychological outcome. Results: The findings demonstrated that the COVID-19 pandemic had a negative psychological impact on HCWs, which was still evident 1 year after the initial outbreak. Nurses showed higher depression and anxiety than other HCWs. Female gender, passive coping, long working hours, having a chronic disease, and experiencing violence, among other factors, were all risk factors for psychological impairment. Conclusion: Developing and promoting programs to improve mental health among HCWs, and identifying those who might need psychological support is still relevant 1 year after the initial outbreak.

Clinical characteristics in immune thrombocytopenia patients after COVID-19 vaccination.

It is well documented that COVID-19 vaccines greatly reduce the severity and complications of SARS-CoV-2 infection. However, it has been reported that COVID-19 related vaccines may induce or exacerbate autoimmune hematological disorders, for example, a decrease in platelet numbers characteristic of immune thrombocytopenia (ITP). To investigate this, we retrospectively reported, for the first time, the clinical characteristics of 42 ITP patients after COVID-19 vaccination in southwest China. Of the 42 patients, 28 patients were historically diagnosed ITP, and their platelet counts (PC) decrease mainly occurred after the first-dose vaccinations. The average PC after vaccination was 39.5 × 109/L and recovered to an average of 80.6 × 109/L after treatment. Efficacy of treatment was 90%, and only 10% maintained low PC at the third month of treatment. More interestingly, of the 42 patients, 14 were newly diagnosed ITP following vaccination. Of these 14 patients, 6 patients (43%) were found PC deterioration after the first vaccine dose, and 7 patients (50%) after the second dose. Fortunately, the peripheral PC of all 14 patients recovered significantly after treatment, and the average PC was 139.4 × 109/L, including 8 CRs (complete response) and 6 PRs (partial response). Notably, 9 of the 14 cases were found to have abnormal immune indices when thrombocytopenia diagnosed. No severe organ hemorrhage was found in either subgroup. These results are reassuring the vaccine safety for ITP patients, in that the risks of aggravating thrombocytopenia by COVID-19 vaccination do exist, but it was transient and can be effectively controlled through intensive clinical monitoring and management.

Institutional, therapeutic, and individual factors associated with 30-day mortality after COVID-19 diagnosis in Canadian long-term care facilities.

BACKGROUND: Canadian long-term care facility (LTCF) residents experienced higher death rates compared to other countries during the first wave of the COVID-19 pandemic. This cohort study analyzes the individual, therapeutic, and institutional factors associated with death in LTCFs. METHODS: Institutional data for 17 LTCFs in Montreal, Canada were obtained from local administrative registries. Individual data for 1197 residents infected by SARS-CoV-2 between February 23 and July 11, 2020 were obtained through chart reviews. A multivariable modified Poisson regression model, which accounted for LTCF clustering, was used to identify resident and facility covariates associated with 30-day mortality after COVID-19 diagnosis. RESULTS: Severe shortage of licensed practical nurses (RR 2.60 95% CI 1.20-5.61) and medium-sized facilities compared to smaller-sized facilities (RR 2.73 95% CI 1.23-6.07) were associated with 30-day mortality. Later COVID-19 diagnosis (RR 0.98 95% CI 0.97-0.99 per additional day) was associated with survival. Individual risk factors for death included age (RR 1.33 95% CI 1.23-1.45 per additional 10 years), male sex (RR 1.46 95% CI 1.24-1.71), functional impairment (RR 1.08 95% CI 1.04-1.12 per unit increase of SMAF), as well as a diagnosis of congestive heart failure (RR 1.31 95% CI 1.04-1.66) and neurocognitive disorder (RR 1.31 95% CI 1.01-1.70). Among severe cases, anticoagulation was associated with survival (RR 0.70 95% CI 0.51-0.96). CONCLUSIONS: This study identified practical nurse shortages and facility size as institutional risk factors for COVID-19 death. Anticoagulation was associated with survival among severe cases.

The Eudemonic Wellbeing of Volunteers in a Public Health Emergency: COVID-19 in China.

With improvements in the public awareness regarding volunteer opportunities, more people are participating in social work, particularly during emergency events. The mental health of volunteers has been attracting more academic attention due to its increasing social significance. Drawing on the Theory of Planned Behavior, a qualitative interview was conducted to identify important attitudes, subjective norms, and perceived control factors guiding people's volunteering behaviors in an emergency context. Then, a sequential quantitative survey was implemented based on the results of the qualitative study to explore the impact of the aforementioned factors and job involvement on eudemonic well-being. The moderating role of empathy in these relationships was also investigated in this nested design. The results indicate that behavioral attitudes, perceived control, and job involvement have significant positive effects on volunteers' eudemonic well-being. A high perspective taking (cognitive empathy) of volunteers positively moderates the relationship between job involvement and eudemonic well-being, while high personal distress (affective empathy) buffers this relationship. The theoretical and practical implications of these findings are discussed in relation to emergency volunteer activities.

How platform-based internet hospital innovation affects doctors’ active stress coping efforts: The conservation of resource theory perspective

Doctor's effort of active stress coping is a key factor for keeping stability of healthcare system in the COVID pandemic. The Internet hospital breaks through the boundaries and expands external resources of the physical hospital, but brings doctors stress and challenges. However, it is not clear how Internet hospital innovation affects doctors' active stress coping effort. To address this question, based on conservation of resource theory (COR), we explore the issue and examine the model through a face-to-face situational investigation of 174 doctors from 66 Internet hospitals with complete online service functions in China. The results show that the personal characteristics and energy resources provided by platform-based hospital will promote doctors to actively respond to stress. The increase in object and condition resources will lead to doctors' avoidance of coping with stress in the short term, but help doctors to actively cope with stress in the long term. We extend the COR theory by considering platform-based feature of Internet hospital and suggest that hospital should continue to promote technological innovation for its long-term benefits. This study contributes to the growing literature on platform-based healthcare innovation and its non-economic benefits for healthcare professionals.