Management of centralized transition ward in a large general hospital in Shanghai during the epidemic caused by severe acute respiratory syndrome coronavirus 2 omicron variant infection.

The epidemic of coronavirus disease 2019 (COVID-19) has seriously affected people's normal work, life, and medical treatment. Since Mar. 2022, there has been a pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant in Shanghai. In order to meet the needs of hospitalization for patients, and at the same time for better control of epidemic and nosocomial infections, a large hospital in Shanghai innovatively set up a centralized transition ward in the hospital, and established scientific rules of medical work, regulations for prevention of nosocomial infections and efficient norms for patient admission. During the operation of the ward, a total of 211 patients were treated and one of the patients was confirmed of COVID-19 recurrence. All work was carried out methodically, and neither hospitalized patients nor medical staff had nosocomial infection of COVID-19. The preparation, operation and management of the central transition ward in our hospital are summarized here to provide guidance and reference for general hospitals to carry out similar work under the epidemic.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Exploration of college students' psychological problems based on online education under COVID-19

As a result of the COVID-19 pandemic, many college students have been isolated at home and unable to walk into class as usual. This series of protective measures to avoid the spread of the disease may have an additional psychological impact on the lives of college students. The purpose of this study was to propose a strategy for using an intelligent online learning system based on content recommendations and electronic questionnaires in the educational domain. We invited 3000 isolated university students (47.6% male and 52.4% female) to an online trial. It proved to be effective in helping us intervene in students' psychological problems quickly, objectively, efficiently, and in real-time. In addition, our analysis of the data collected from the intelligent online learning system showed that the degree to which college students' psychological problems were affected by isolation was closely related to students' grade level, family background, major category, and computer proficiency. The current study suggests that the mental health of college students should be well monitored during segregation. Targeted psychological counseling is more necessary for students in upper grades, low-income families, liberal arts majors, and those with weak computer proficiency to reduce the emotional impact of segregation on students.

The effects of COVID-19 on Chinese commuting patterns in early 2020

We build mobility networks from Chinese commuting data and track network metrics for the two months before the WHO pandemic announcement. The Wuhan travel ban on 23 January imposed changes to the level of importance of some central cities in the commuting patterns. While Beijing was the most important city in both the inflows and outflows, Wuhan and other cities became more relevant after the transition. © 2022 National Institute for Space Research, INPE. All rights reserved.

Management of centralized transition ward in a large general hospital in Shanghai during the epidemic caused by severe acute respiratory syndrome coronavirus 2 omicron variant infection

The epidemic of coronavirus disease 2019 (COVID-19) has seriously affected people's normal work, life, and medical treatment. Since Mar. 2022, there has been a pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant in Shanghai. In order to meet the needs of hospitalization for patients, and at the same time for better control of epidemic and nosocomial infections, a large hospital in Shanghai innovatively set up a centralized transition ward in the hospital, and established scientific rules of medical work, regulations for prevention of nosocomial infections and efficient norms for patient admission. During the operation of the ward, a total of 211 patients were treated and one of the patients was confirmed of COVID-19 recurrence. All work was carried out methodically, and neither hospitalized patients nor medical staff had nosocomial infection of COVID-19. The preparation, operation and management of the central transition ward in our hospital are summarized here to provide guidance and reference for general hospitals to carry out similar work under the epidemic.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Real-time Cheating Detection System Based on Sight Detection

Due to the COVID-19 pandemic, many exams, written tests and interviews are conducted online and remotely, which raises a series of questions such as how to prevent cheating. In this project, the methods commonly used in the existing cheating monitoring system are fully investigated and their shortcomings are improved one by one. Finally, a line of sight detection algorithm based on computer vision technology is designed, and a prototype of auxiliary cheating detection system that can get good results only with a small number of samples is developed. © 2022 SPIE.

Multicentral Agent-Based Model of Four Waves of COVID-19 Spreading in Nizhny Novgorod Region of Russian Federation

To study the characteristics of the spread of the COVID-19 pandemic and introduce timely and effective measures, there is a need for models that can predict the impact of various restrictive factors on COVID-19 disease dynamics. In this regard, it seems expedient to employ agent-based models that can take into account various characteristics of the population (for example, age distribution and social activity) and restrictive measures, testing, etc., as well as random factors that are usually omitted in traditionally used modifications of Susceptible-Infected-Recovered (SIR) type models. This paper presents the development of the previously proposed agent model for numerical simulation of the spread of COVID-19, namely, the transition from a single-center model, in which all agents interact within one common pool, to a multi-center model, in which the agents under consideration are distributed over several centers of interactions, and are also redistributed over time to other pools. This model allows us to more accurately simulate the epidemic dynamic within one region, when the patient zero usually arrives at the regional center, after which the distribution chains capture the periphery of the region due to pendulum migration. This paper demonstrates the application of the developed model to analyze the epidemic spread in the Nizhny Novgorod region of Russian Federation. Simulated dynamics of the daily number of newly detected cases and COVID-19-associated deaths is in good agreement with official statistics. Modeling results suggest that the actual number of COVID-19 cases is 1.5–3 times higher than the number of reported cases. The developed model also takes into account the process of vaccination. It is shown that with the same modeling parameters, but without vaccination, the third and fourth waves of the pandemic would be characterized by a significant increase in the incidence and the formation of natural immunity, but the number of deaths would exceed the real one by about 9 times. © 2023 Journal of Biomedical Photonics & Engineering.

Why Zoom Is Not Doomed Yet: Privacy and Security Crisis Response in the COVID-19 Pandemic

The COVID-19 pandemic not only fueled the explosive growth of Zoom but also led to a major privacy and security crisis in March 2020. This research examines Zoom's response to this privacy and security crisis with the aid of a producer's perspective that aims to direct attention to institutional and organizational actors and draws on theories of privacy management and organizational crisis communication. We primarily use data from 14 weekly Ask Eric Anything webinars from April 8 to July 15, 2020, to illustrate the strategies of Zoom's crisis response, especially organizational representation, the contours of its analytic account acknowledging and minimizing responsibility, and patterns of corrective and preventive action for user education and product improvement. Results demonstrate the usefulness of the producer's perspective that sheds light on how Zoom navigated the privacy and security crisis. Special attention is paid to the mobilization of networks of executives, advisors, consultants, and clients for expertise, endorsement, and collaboration. It is argued that Zoom's response strategies have contributed to Zoom's organizational mission and culture and reframed the crisis from a growing pain to a growth opportunity relating to privacy and security. Zoom's nimble, reasonable, collaborative, interactive yet curated organizational response to the privacy and security crisis can be seen as an unintended consequence of its sudden rise amid a global pandemic. It offers a useful model for tech firms' crisis response at a crucial moment for the tech industry around the world. © 2023 SAGE Publications.

Multi-party Secure Comparison of Strings Based on Outsourced Computation

Data is an important production factor in the era of digital economy. Privacy computing can ensure that data providers do not disclose sensitive data, carry out multi-party joint analysis and computation, securely and privately complete the full excavation of data value in the process of circulation, sharing, fusion, and calculation, which has become a popular research topic. String comparison is one of the common operations in data processing. To address the string comparison problem in multi-party scenarios, we propose an algorithm for secure string comparison based on outsourced computation. The algorithm encodes the strings with one hot encoding scheme and encrypts the encoded strings using an XOR homomorphic encryption scheme. The proposed algorithm achieves efficient and secure string comparison and counts the number of different characters with the help of a cloud-assisted server. The proposed scheme is implemented and verified using the new coronavirus gene sequence as the comparison string, and the performance is compared with that of a state-of-the-art security framework. Experiments show that the proposed algorithm can effectively improve the string comparison speed and obtain correct comparison results without compromising data privacy. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Travel route planning method to avoid epidemic hot-spots in the post-epidemic era

The Chinese government adhered to the "dynamic clearance” epidemic prevention strategy from August 2021 to December 7, 2022, during the post-epidemic era (this study started in March 2022 and ended in September 2022). People are gradually resuming their daily routines, and demand for travel is rising again. Nonetheless, the epidemic occasionally breaks out on a smaller scale, causing social concern. As a social reaction, the essential issue is how to avoid COVID-19 hot-spots effectively by offering secure travel options for local residents who tend to travel privately. Two travel route planning models are proposed to avoid COVID-19 hot-spots based on the invalid road sections which are affected by epidemic. Specifically, the static model aims at generating the shortest travel distance after detours, with the constraint of avoiding COVID-19 hot-spots;the dynamic model takes real-time data into account, which includes epidemic risk levels, road grades, and real-time traffic information on road selection. Shenzhen, China, is illustrated as an example of the research area in this paper. To assess the effectiveness and efficiency of the suggested approaches, data regarding the road network, the prevalence of epidemics, and traffic congestion are collected. The experimental results demonstrate that 1) the proposed two route planning models can effectively bypass areas with high levels of epidemic risk. 2) The static route planning model increases the travel distance by 12.24% and 13.03%, while the dynamic route planning model increases the travel distance by 24.33% and 27.69% compared with the conventional shortest route, given the same origin and destination and the same impact radii of the COVID-19 hot-spots (300 and 500 m respectively). When taking detour routes to avoid COVID-19 hot-spots, the average increase in trip distance does not surpass 50%, which is acceptable psychologically for travelers. 3) The static travel route planning model is suitable for the severe epidemic situation for it can strictly avoid the epidemic hot-spots;The dynamic travel route planning model is applicable to the situation where the epidemic situation is relatively mild. Ultimately, the route planning models can be utilized to develop a framework to provide travelers with detour options, which would make a practical difference to ensure travelers' safety during traveling and contribute to preventing the spread of the epidemic. © 2023 The Author(s)

Mechanism of Cold-Dampness Epidemic Prescription in Treatment of Novel Coronavirus Pneumonia Based on Network Pharmacology

Background:The emergence of novel coronavirus pneumonia has seriously affected people's normal life and health. Cold-dampness epidemic prescription has a good effect in the prevention and treatment of novel coronavirus pneumonia. Methods:TCMSP, PubChem, Swiss Target Prediction, PharmMapper database and related literatures were used to retrieve and predict the main chemical components and corresponding targets of Traditional Chinese Medicine (TCM)TCM. GeneCard, OMIM, NCBI and TTD databases were used to collect disease targets. Uniprot disease database was used to standardize target names. Cytoscape3.8.2 software was used to establish the 'active components-action target' network. Protein interaction (PPI) network was established by using protein interaction database (STRING), and core genes were screened by CytoNCA plug-in of Cytoscape3.8.2 software.GO enrichment analysis and KEGG pathway enrichment analysis were carried out through DAVID network database, and Hiplot network platform was used for visualization. Molecular docking technology was used to verify the docking between core components and targets. Results:After preliminary screening, 102 effective components, 255 potential targets and 2230 COVID-19 disease targets were obtained, and it was speculated that the mechanism might be related to 177 pathways such as TNF signaling pathway, IL-17 signaling pathway and AGE-RAGE signaling pathway in diabetic complications. The absolute values of docking binding energy between active components such as quercetin, luteolin and wogonin and targets such as PTGS2, AR, TP53 and CASP3 were greater than 5.0 Kcal/mol, and the docking results were good. Conclusion:Cold-dampness epidemic prescription has the characteristics of multiple components, multiple targets and multiple pathways in the prevention and treatment of COVID-19, and may play a therapeutic role through anti-inflammatory, antiviral and immune regulation. © 2022 IEEE.

Research on ship tracking and control for COVID-19 epidemic prevention based on multi-source information fusion

With the normalization of COVID-19 epidemic prevention and control, big data analysis technology has become an important support for scientific and accurate prevention and control. As a transportation means for water traffic, ship management plays an important role in the whole COVID-19 epidemic prevention system. It is the key to improve the efficiency of water traffic epidemic prevention to identify and track the key ships. To improve the efficiency and accuracy of key ships identification and tracking in epidemic prevention and control, a real-time ship tracking and control platform for epidemic prevention is proposed. By fusing the multi-source information, the platform changes the epidemic prevention way of water traffic from the manual query method to the data analysis method. The platform has been applied in the local maritime regulatory department, and it improves the identifying, tracking and control efficiency of key ships. © 2022 IEEE.

Specificity of 2019-nCoV nucleic acid detection kit (fluorescence PCR)

Objective To evaluate the specificity of three consecutive batches of 2019-nCoV nucleic acid detection kit (fluorescence PCR) manufactured by Shanghai GeneoDx Biotech Co., LTD. Methods A total of 55 common respiratory pathogens, including endemic human coronaviruses (HKU1, OC43, NL63 and 229E), severe acute respiratory syndrome conronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS), seasonal influenza virus, rhinovirus, adenovirus, Klebsiella pneumonia and Mycobacterium tuberculosis, were grouped and used for verification of cross reactivity of the detection kit. According to the requirements in the Key Points of Technical Review for Registration of 2019 New Coronavirus Nucleic Acid Detection Reagents issued by Center for Medical Device Evaluation, National Medical Products Administration (NMPA), human mucoprotein, human blood, phenylephrine, oxymetazoline, sodium chloride (including those as preservatives) and other 29 interfering substances were selected to verify the anti-interference substances of this kit. Results In the verification for cross reactivity, the test results of mixed positive samples by the three consecutive batches of kit were positive, while those of negative samples were negative, indicating a coincidence rate of accuracy of 100%. The cross-reactive substances showed no effect on the test result by the kit. All the test results of positive and borderline positive samples were positive, while those of negative samples were negative, indicating a coincidence rate of accuracy of 100%. All the 29 kinds of endogenous / exogenous interfering substances showed no influence on the test results by this kit. Conclusion Hie new coronavirus 2019-nCoV nucleic acid detection kit (fluorescence PCR method) manufactured by Shanghai GeneoDx Biotech Co., LTD. showed no cross-reactivity with 55 common respiratory pathogens, while showed anti-interference properties against endogenous and exogenous interfering substances such as host tissue, common respiratory pathogen and common drugs for respiratory diseases in clinic. The specificity test result of the kit met the requirements for registration of 2019 new coronavirus nucleic acid detection reagents. The test results of three consecutive batches of kits were highly stable. Copyright © 2021 Changchun Institute of Biological Products. All rights reserved.

[Analysis of the stressors and mental status of civil aviation pilots under the background of the major infectious disease].

Objective: To study the stressors and mental status of civil aviation pilots under the background of major infectious disease. Methods: From January to March 2021, a cluster sampling method was used to select 143 airline pilots in service as the research objects. The self-made emotion and stress source questionnaire, Chinese version of stress perception scale (CPSS) , self rating Anxiety Scale (SAS) and self rating Depression Scale (SDS) were used to investigate the airline pilot population. 136 valid questionnaires were collected, with an effective recovery rate of 95.1%. The measurement data conform to the normal distribution and are expressed by (x±s) . T-test and analysis of variance are used for comparison between groups, and Pearson correlation is used for correlation analysis. The data that do not conform to the normal distribution are expressed by the median and quartile [M (Q(1), Q(3)) ], and the non parametric test is used for the comparison between groups. Multiple linear stepwise regression was used to analyze the influencing factors of pressure perception. In addition, Amos 23.0 software was used to construct structural equation models of stress perception and negative emotions. Results: Under the background of the epidemic, the main sources of stress for civil aviation pilots are: the risk of possible reduction in income, the risk of contracting COVID-19, the pressure at work, and the risk of possible slow progress of upgrading. Among them, the first co pilot was more worried about the possible reduction of income than the instructor (P=0.009) ; The first co pilot and the captain of the airline were more worried about the possible slowdown of the upgrade progress than the instructor (P<0.001, P=0.014) . The mean pressure perception of pilots was higher than that of Chinese norm (t=3.11, P=0.002) . The standard scores of anxiety and depression were slightly higher than the standard scores of the Chinese norm under the non epidemic situation (t=7.00, 4.07, all P<0.001) . The results of multiple linear stepwise regression analysis showed that stress perception was negatively correlated with good family relations (t=-8.50, P=0.000) , and positively correlated with worries about slow progress of upgrading, COVID-19 infection, lack of interpersonal communication and income reduction (t=3.31、3.86、2.88、2.06, P<0.05) . Pressure perception was positively correlated with negative emotion (all P<0.001) . The results of structural equation model show that stress perception affects pilots' negative emotions directly or indirectly, and its standardized total effects on anxiety, depression, hypochondriac, fear, compulsion and irritability are 0.719, 0.811, 0.403, 0.355, 0.295 and 0.244 respectively. Conclusion: Public health emergencies have an impact on the mental status of pilots. Should pay attention to the stressors and psychological conditions of pilots in time, and consider formulating measures to relieve the stress of pilots.

CLINICAL FEATURES AND CHARACTERISTIC OF CHOLANGIOPATHY AFTER SEVERE COVID-19

Introduction Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2), can commonly lead to abnormal liver tests, mostly transaminase elevation. Recently, a novel entity of cholangiopathy was discovered in patients who recovered from critical COVID-19 infection. However, understanding of this disease is limited due to its rarity. Methods We reviewed Pubmed, Embase, and Web of Science Core Collection databases from inception to Nov 30th, 2021, to identify studies reporting cholangiopathy after severe COVID-19 infection. “SARS-CoV-2” or “COVID-19” with “cholangiopathy” were used as keywords to search. Our study is to summarize the clinical features and characteristics of cholangiopathy after severe COVID-19 illness. Results Literature review identified 15 articles including 33 patients for reviews. Most studies were performed in the United States. The mean age of participants from all studies is 52.17 ± 13.98 years old. Among the 33 included patients, the majority are male (29, 88%) and the common medical histories include hypertension (n=11), obesity (n=8), and diabetes mellitus (n=8). The length of stay (LOS) during hospitalization was prolonged with a mean of 80.23 ± 33.14 days. All patients were intubated and put on mechanical ventilation during medical intensive care stay with 12 patients having a history of endotracheal cardiac output monitoring. The mean peak of serum alkaline phosphatase, aspartate aminotransferase, alanine transaminase and total bilirubin were 2106.96 (U/l) ± 784.04, 1456.09 (U/l) ± 2325.10, 983.57 (U/l) ± 1244.44 and 14.04 (mg/dl) ± 8.41, respectively. Cholangiopathy after severe COVID illness mimics secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography studies with ductal beading but the presence of unique severe cholangiocyte injury and intrahepatic microangiopathy is suggestive of direct hepatic injury due to COVID-19. In terms of outcome, 7 patients were documented as deceased. Eight patients underwent liver transplantation (Table 1). Discussion Cholangiopathy is a late complication of severe COVID-19 after prolonged ICU stay with potential for long-term liver morbidity and liver failure needing liver transplantation. Further studies are warranted to understand pathogenesis, natural history, therapeutic interventions, and prognostic indicators. (Table Presented)

[Clinical characteristics and vaccination status of SARS-CoV-2 Omicron variant infected children].

Objective: To investigate the clinical characteristics and vaccination status of SARS-CoV-2 Omicron variant infected children. Methods: A total of 105 children infected with Omicron variant admitted to Tianjin Haihe Hospital (designated referral hospital for SARS-CoV-2 infection in Tianjin) from January 8, 2022 to February 3 were included for a retrospective study. The cases were divided into pneumonia group and non-pneumonia group according to chest imaging. Based on the doses of inactivated SARS-CoV-2 vaccine, the children who completed SARS-CoV-2 antibody test within 3 days after hospitalization were divided into 2 dose group and<2 dose group.Rank sum test and Chi-square test were used for the comparison between the groups. Results: The age of these 105 children was 10 (8, 11) years on admission, 53 children were males and 52 were females. Eighty-seven cases (82.9%) had mild symptoms, 13 cases (12.4%) had common symptoms and 5 cases (4.8%) were asymptomatic. Ninety-one cases (86.7%) completed 2 doses vaccination. The clinical symptoms were characterized by cough (74 cases, 70.5%), fever (58 cases, 55.2%), sore or dry throat (34 cases, 32.4%), nasal congestion (28 cases, 26.7%), rhinorrhea (23 cases, 21.9%). None of the children received antivirals, steroids, immunosuppressant or oxygen therapy. Seventy-six cases(72.4%) received traditional Chinese medicine treatment. The pneumonia group had a higher rate of positive SARS-CoV-2 IgG within 1 day after admission (13/13 vs. 87.0% (80/92), χ2=42.81, P<0.001) than the non-pneumonia group. Among the 62 children who had serial SARS-CoV-2 antibody tests within 3 days after hospitalization, Compared to the<2 dose group, the 2 dose group had a higher rate of nucleic acid conversion within 16 days after onset and a higher rate of positive SARS-CoV-2 IgG 1 day after admission and 3 days after hospitalization (96.4% (54/56) vs. 4/6, 100.0% (56/56) vs. 2/6, 100.0% (56/56) vs. 3/6, all P<0.05). Conclusions: Most children infected with Omicron variant have mild symptoms, mainly respiratory infection symptoms. The proportion of SARS-CoV-2 antibody IgG positive in children who have received 2 doses of inactivated SARS-CoV-2 vaccines is higher,and the time of whose nucleic acid conversion may be shortened.

Specificity of 2019-nCoV nucleic acid detection kit (fluorescence PCR)

Objective To evaluate the specificity of three consecutive batches of 2019-nCoV nucleic acid detection kit (fluorescence PCR) manufactured by Shanghai GeneoDx Biotech Co., LTD. Methods A total of 55 common respiratory pathogens, including endemic human coronaviruses (HKU1, OC43, NL63 and 229E), severe acute respiratory syndrome conronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS), seasonal influenza virus, rhinovirus, adenovirus, Klebsiella pneumonia and Mycobacterium tuberculosis, were grouped and used for verification of cross reactivity of the detection kit. According to the requirements in the Key Points of Technical Review for Registration of 2019 New Coronavirus Nucleic Acid Detection Reagents issued by Center for Medical Device Evaluation, National Medical Products Administration (NMPA), human mucoprotein, human blood, phenylephrine, oxymetazoline, sodium chloride (including those as preservatives) and other 29 interfering substances were selected to verify the anti-interference substances of this kit. Results In the verification for cross reactivity, the test results of mixed positive samples by the three consecutive batches of kit were positive, while those of negative samples were negative, indicating a coincidence rate of accuracy of 100%. The cross-reactive substances showed no effect on the test result by the kit. All the test results of positive and borderline positive samples were positive, while those of negative samples were negative, indicating a coincidence rate of accuracy of 100%. All the 29 kinds of endogenous / exogenous interfering substances showed no influence on the test results by this kit. Conclusion Hie new coronavirus 2019-nCoV nucleic acid detection kit (fluo¬rescence PCR method) manufactured by Shanghai GeneoDx Biotech Co., LTD. showed no cross-reactivity with 55 common respiratory pathogens, while showed anti-interference properties against endogenous and exogenous interfering substances such as host tissue, common respiratory pathogen and common drugs for respiratory diseases in clinic. The specificity test result of the kit met the requirements for registration of 2019 new coronavirus nucleic acid detection reagents. The test results of three consecutive batches of kits were highly stable.

COVID-19 associated aortitis

Case report-IntroductionSince the emergence of Coronavirus disease 2019 (COVID-19) there has been increasing recognition of the potential associated cardio-vascular manifestations. There have been reports of Kawasaki like disease in children. However, in adults there are very few reports of non-cutaneous vasculitis. Here we report the case of an adult male presenting with an inflammatory aortitis associated with COVID-19 infection.Case report-Case descriptionA 71-year-old Caucasian male with a background of cholecystectomy and rotator cuff repair presented to hospital in May 2020 with a 3-month history of feeling generally unwell, weight loss and worsening thoraco-lumbar back pain. Prior to the onset of these symptoms he had had a 2-week illness in March 2020 clinically consistent with COVID-19 infection comprising fevers, hot sweats, dry cough, and chest tightness for which he had not sought medical attention. He had no recent travel history. Physical examination was unremarkable.On admission, COVID-19 tests revealed evidence of prior infection with negative SARS-CoV-2 polymerase chain reaction test but positive SARS-CoV-2 antibodies. Blood tests revealed a marked inflammatory state with a C-reactive protein of 122mg/L, plasmas viscosity of 2.76, Ferritin 777ug/L, Interleukin-6 of 25 ng/L and normocytic anaemia with a Haemoglobin of 77g/L. Immunology tests were negative for anti-neutrophil cytoplasmic antibody, anti-glomerular basement antibodies, HLA-B27, anti-citrullinated protein antibody, rheumatoid factor, and nuclear antibodies, with normal IgG 4 subclasses. Microbiology workup showed negative blood cultures, syphilis screen and Hepatitis B and C serology. Temporal artery ultrasound was unremarkable. Troponin-T, pro-B-type natriuretic peptide, electrocardiogram and echocardiogram were normal. CT thorax abdomen pelvis revealed inflammatory change surrounding the aortic arch extending all the way down the aorta in keeping with a florid inflammatory aortitis with no aneurysms seen.Rapid resolution of symptoms was seen with commencement of Prednisolone 40mg once daily, with normalisation of CRP one week later and subsequent normalisation of haemoglobin and plasma viscosity. A repeat CT aorta 2 weeks after commencement of prednisolone demonstrated a reduction in the thickness of the inflammatory rind over the aorta from 6mm to 2mm. The patient now continues a reducing regime of prednisolone and remains in clinical remission.Case report-DiscussionIn children, Kawasaki like disease associated with COVID-19 is well described and can result in coronary artery inflammation and aneurysm. In adults, COVID-19 associated cutaneous vasculitis is well recognised however there are only a small number of case reports of organ specific vasculitis including the central nervous system, retina, and small bowel. To our knowledge this is the first reported case of aortitis associated with COVID-19 infection in an adult patient.The mechanisms underlying the development of COVID-19 associated vasculitis are not established but may be secondary to endothelial inflammation. Findings from a histological case series suggest that SARS-CoV-2 can infect endothelial cells directly, possibly via endothelial ACE2 receptors, leading to inflammation in the endothelium. Another postulated mechanism is that endothelial cell dysfunction and inflammation is caused by the cytokine storm that can be seen in some patients with COVID-19 infection.Our patient responded very well to corticosteroid treatment. However, in case of a relapse his cytokine profile could be helpful in directing further therapeutic options. IL-6 levels were elevated in our patient. Studies show that IL-6 appears to play a dominant role in the cytokine storm. In a report of 150 patients IL-6 was found to be significantly higher in the group with severe disease and possibly predictive of mortality. The IL-6 antagonist, Tocilizumab, has also been used with promising results. The first report of its use was in China in 21 critically ill COVID-19 patients with significant improvements Since this first report, further clinical trials are underway investigating the efficacy and tolerability of IL-6 antagonists in patients with COVID-19 disease. Expanding our understanding of the pathogenesis of COVID-19 associated vasculitis is a critical area for future research to identify other immune targets for novel/existing therapeutic agents.Case report-Key learning points Vasculitis including aortitis can be a complication of COVID-19 infection.Endothelial cell inflammation is likely to play key role in the pathogenesis of COVID-19 associated vasculitis.In addition to corticosteroids, other immune-modulating drugs presently used in rheumatology may be effective therapeutic agents.

Factors affecting recurrent positive RT-PCR results in clinically cured COVID-19 patients: a multicenter study

The aim of this study was to evaluate factors affecting the recurrence of positive RT-PCR results. By performing a retrospective analysis, we evaluated the clinical data of recurrent positive coronavirus disease 2019 (COVID-19) patients in multiple medical institutions in Wuhan. We recruited COVID-19 patients who were hospitalized from January 1 to March 10, 2020, in three tertiary hospitals in Wuhan, met the discharge criteria and received at least one additional nucleic acid test before leaving the hospital. According to the RT-PCR results, patients were split into a recurrent positive group (RPos group) and a nonrecurrent positive group (non-RPos group). Clinical characteristics, therapeutic schedules and antibody titers were compared between the two groups. AI-assisted chest high-resolution computed tomography (HRCT) technology was applied to investigate pulmonary inflammatory exudation and compare the extent of lung areas with different densities. This study involved 122 COVID-19 patients. There were no significant differences in age, sex, preexisting diseases, clinical symptoms, clinical classification, course of disease, therapeutic schedules or serum-specific antibodies between the two groups. A higher proportion of patients who showed pulmonary inflammatory exudation on HRCT scans were recurrent positive at the time of discharge than other patients (81.6% vs 13.7%, P < 0.01). In addition, the degree of pulmonary fibrosis was higher in the RPos group than in the non-RPos group (P < 0.05). Subpleural exudation at the peripheral edge of the lung and extensive pulmonary fibrosis at the time of discharge represent risk factors for the recurrence of COVID-19.