Invasive Mechanical Ventilation in COVID-19

Patients with severe COVID-19 pneumonia present with severe hypoxemic respiratory failure, typically meet the clinical criteria for acute respiratory distress syndrome (ARDS) and often require invasive mechanical ventilation. While peculiar pathophysiological aspects deserve discussion to better tailor the mechanical ventilation settings in these patients, most recommendations on the ventilatory management of these patients are derived from studies in patients with ARDS from causes other than COVID-19. Protective ventilation is recommended in most COVID-19 patients, tidal volume should be kept around 6 mL per kg of predicted body weight, positive end-expiratory pressure (PEEP) should be titrated individually considering that in many patients with COVID-19 improvement of oxygenation at higher PEEP is often accompanied by worsening of respiratory system compliance. Therefore, attention should be paid in limiting plateau and driving pressures to avoid excessive strain potentially resulting in ventilator-induced lung injury. Prone positioning has been used extensively in COVID-19 patients, but its impact on mortality is uncertain. Inhaled nitric oxide, extracorporeal CO2 removal (ECCO2R), and extracorporeal membrane oxygenation (ECMO) should be considered in selected patients as rescue measures. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Myopia progression and associated factors of refractive status in children and adolescents in Tibet and Chongqing during the COVID-19 pandemic.

Objectives: To investigate myopia progression and associated factors of refractive status among children and adolescents in Tibet and Chongqing in China during the COVID-19 pandemic. Methods: A population-based cross-sectional study was conducted to compare rates of myopia and high myopia, axial length (AL), spherical equivalent (SE), outdoor activity time, digital device use, and frequency of visual examinations for children and adolescents affected by myopia in Chongqing and Tibet in 2021. Results: A total of 2,303 students from Chongqing and 1,687 students from Tibet were examined. The overall prevalence of myopia and high myopia in these two groups were 53.80 and 7.04% vs. 43.86 and 1.30%, respectively in each case. The Chongqing students had a longer AL than the group from Tibet (23.95 vs. 23.40 mm, respectively; p < 0.001). The mean SE of the students with myopic parents in Tibet was lower than that of the students in Chongqing with myopic parents (-2.57 ± 2.38 diopters (D) vs. -2.30 ± 2.34 D, respectively) (p < 0.001). Conversely, the mean SE of the students from urban areas in Chongqing was lower than that of the students in Tibet (-2.26 ± 2.25 D vs. -1.75 ± 1.96 D, respectively; p < 0.001). The Chongqing students exhibited lower SE (-2.44 ± 2.22 D) than their Tibetan counterparts (mean SE: -1.78 ± 1.65 D (p = 0.0001) when spending more than 2.5 h outdoors. For example, 61.35% of the students in Tibet spent more than 2.5 h outdoors daily, compared with 43.04% of the students in Chongqing. Correspondingly, the proportion of students using digital devices in Tibet (64.43%) was lower than that in Chongqing (100%). For the latter, 38.62% of the students in Chongqing spent more than 2.5 h online using digital devices compared to 10.49% of the students in Tibet. Greater monitoring of visual status was observed for the Chongqing students (mean SE: -1.90 ± 1.98 D) compared with students in Tibet (mean SE: -2.68 ± 1.85 D) (p = 0.0448), with the frequency of optimal examinations being every 6 months. Outdoor activity time was identified as a common risk factor for myopia in both of the populations examined, with odds ratios (ORs) of 1.84 (95% CI: 1.79-1.90) in Chongqing and 0.84 (95% CI: 0.73-0.96) in Tibet. Digital screen time was associated with myopia and high myopia in Chongqing, with ORs of 1.15 (95% CI: 1.08-1.22) and 1.06 (95% CI: 0.94-1.77), respectively. Digital screen time was also found to be a risk factor for high myopia in Tibet (OR: 1.21, 95% CI: 0.77-1.61). The type of digital devices used was also associated with myopia and high myopia in Tibet (OR: 1.33, 95% CI: 1.06-1.68 and OR: 1.49, 95% CI: 0.84-2.58, respectively). Finally, examination frequency was found to correlate with high myopia in the Tibet group (OR: 1.79, 95% CI: 0.66-2.71). Conclusion: Based on our data, we observed that the prevalence of refractive errors in children and adolescents was significantly lower in Tibet than in Chongqing. These results are potentially due to prolonged outdoor activity time, and the type and time of use for digital devices that characterize the group of children and adolescents from Tibet. It is recommended that parents and children in Chongqing would benefit from increased awareness regarding myopia progression and its prevention.

Spatiotemporal evolution and suitability of apple production in China from climate change and land use transfer perspectives

Apple production in China, the world's largest apple producer and consumer, is challenged by a huge and growing population coupled with rapid industrialisation and urbanisation. China's apple output has increased continuously over the past 42 years with distinctive spatial differences. Herein, changes in the spatial patterns of apple production increases, and their potential impact factors in China are described at the provincial level. Between 1978 and 2019, the centre‐of‐gravity of apple production shifted southwest towards the upper reaches of the Yellow River, the main water source for agricultural irrigation in North China. Analysis of absolute and relative growth of apple output reveals that the Loess Plateau, characterised by fragile habitat and low land productivity, has gradually become a major contributor to apple production. Despite annual increases in apple output, apple production system has become more fragile and unstable overtime, especially in the Shaanxi‐Gansu region where apple cultivation is prevalent. With continuous changes in policy, the amount of forest transfer (i.e. the area of other land use types converted to forest) has significantly affected the impact of standardised precipitation evapotranspiration index on apple production increases in China. Thus, to prevent the degradation of new forests, a differentiated management and protection system should be implemented for apple planting sub‐regions. This should include altering subsidy policies on apple production, enhancing soil erosion control in the Loess Plateau and strengthening ecological management of forests and grassland.

Spatial Distribution Characteristics of the Rural Tourism Villages in the Qinghai-Tibetan Plateau and Its Influencing Factors.

The development of rural tourism (RT) has great significance in reducing poverty and achieving rural vitalization. Qinghai-Tibetan Plateau (QTP) is a depressed area with rich RT resources due to its unspoiled nature and diverse culture. For future sustainable development of RT in QTP, this paper analyzes the spatial distribution characteristics and its influencing factors of RT villages using various spatial analysis methods, such as nearest neighbor index, kernel density estimation, vector buffer analysis, and geographic detectors. The results show the following. First, the RT villages present an agglomeration distribution tendency dense in the southeast and spare in the northwest. The inter-county imbalance distribution feature is obvious and four relatively high-density zones have been formed. Second, the RT villages have significant positive spatial autocorrelation, and the area of cold spots is larger and of hot spots is smaller. Third, the RT villages are mainly distributed with favorable topographic and climate conditions, near the road and water, around the city, and close to tourism resources. Fourth, the spatial distribution is the result of multifactor interactions. Socio-economic and tourism resource are the dominant factor in the mechanism network. Fifth, based on the above conclusions this study provides scientific suggestions for the sustainable development of the RT industry.

Has the United States Reached a Plateau in Overdoses Caused by Synthetic Opioids After the Onset of the COVID-19 Pandemic? Examination of Centers for Disease Control and Prevention Data to November 2021.

Background: Overdoses caused by synthetic mu-opioid receptor (MOR) agonists such as fentanyl are causing increasing mortality in the United States. The COVID-19 pandemic continues to have complex effects on public health, including opioid use disorders (OUD). It is unclear whether recent increases in mortality caused by synthetic opioids have reached a plateau (i.e., a stable period), after the onset of the COVID-19 pandemic. Method: This study examined provisional overdose mortality data from the Centers for Disease Control and Prevention, for synthetic opioids excluding methadone (code T40.4; monthly data available from 39 States, plus New York City and Washington DC), for June 2019-November 2021. Data were first examined as crude mortality rates. The presence of a maximum plateau was analyzed for the last 4 months of available data. For authorities in which a plateau in mortality was detected, sigmoidal Boltzmann equations were used to model parameters of this phenomenon (e.g., level of the plateau). Results: At the end of the study period, all but one authority (New Hampshire) reported increases in mortality rates for synthetic opioids, compared to the baseline month of June 2019 (range: 111-745% of baseline). A plateau was observed over the last 4 months of the study period (Aug 2021-Nov 2021) in 29 of the authorities. Ten other authorities had not reached a stable plateau at the end of the study period. For the authorities where a plateau was detected, a sigmoidal Boltzmann model revealed a fitted maximum of 262% rise in mortality over the study period, from the baseline month. The midpoint in the rise in mortality was fitted in September 2020. After separation of data into census regions, the highest plateau was observed in the West region, followed by South, Midwest, and Northeast (fitted plateau values were 409, 262, 204, and 149% of baseline, respectively). Discussion: There were increases in overdose mortality due to synthetic opioids across most states, ranging considerably in magnitude. A plateau in overdose mortality was detected at the end of the study period in most of these authorities. The reasons for these plateaus should be explored, in order to develop optimized public health interventions.

The Impact of Active Screening and Management on COVID-19 in Plateau Region of Sichuan, China.

Background: In December 2019, the cases of pneumonia of unknown etiology emerged in Wuhan, China, and rapidly spread throughout the country. The disease was later designated by the World Health Organization (WHO) as Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Few studies have assessed the clinical characteristics of COVID-19 and control strategies used to mitigate disease spread in high-altitude plateau regions of China. Study Objective: To assess the impact of real-world strategies to control COVID-19 spread in remote plateau regions. Methods: A retrospective study was performed to assess the epidemiology of COVID-19 and strategies used to control disease spread in the high-altitude plateau of Sichuan, China from 24 January 2020 to 19 March 2020. Results: COVID-19 spread and outbreaks in Sichuan were attributed to mass gatherings. A total of 70 patients and 20 asymptomatic individuals were found in the hypoxic plateau region of Sichuan. Twelve patients were admitted after the onset of symptoms, while 58 patients and 20 asymptomatic individuals were found by active screening. The symptomatic patients included those with uncomplicated illness (16/70, 22.9%), mild pneumonia (44/70, 62.9%), and severe pneumonia (10/70, 14.3%). Most patients in the study area showed relatively mild and atypical symptoms such as low or no fever and dyspnea. The incidence of severe pneumonia, fever, dyspnea, and interstitial abnormalities identified by chest CT were all significantly lower in screened patients than those admitted after symptom onset (P < 0.05). Severe pneumonia was noted in patients with chronic conditions like hypertension, diabetes etc. as compared to less severe pneumonia in healthy subjects (P <0.05). No patients died and all were eventually discharged. Conclusion: Mass gatherings increased risk of spread of SARS-CoV-2 responsible for COVID-19. Active screening and early management have collectively contributed to reduced incidence of severe pneumonia and satisfactory prognoses of infections with COVID-19 in this hypoxic plateau region.

Why does segregation prevent conflict in some regions but not others? Interrogating social distance amid ethnic conflicts in Jos, Nigeria

This paper revisits the longstanding question of why segregation douses ethnic tensions in some places but exacerbates them in others. Anchored on the concept of social distance and drawing on empirical evidence from Jos, Nigeria’s hotbed of ethnoterritorial conflict, this article provides a nuanced analysis of why segregation mediates both the emergence and the prevention of ethnic conflict. In the examined case study, the role of social distance in conflict mitigation varies according to neighbourhood type. Animosity was already deep-seated across the region when social distancing–the effect of partition and segregation–was cemented following the outbreak of conflict in some communities in 2001. Yet the conflict spread to some ethnically unmixed neighbourhoods but not others. In conflict-affected areas, social distance did not avert future conflicts compared to neighbourhoods where the initial conflict was avoided. However, past conflict is not a predictor of future outbreaks in socially distanced neighbourhoods given that in the areas that avoided future conflicts, social distance occurred simultaneously with extensive informal bi-communal leadership engagements. Therefore, the paper shows that even imperfect unmixing can dampen violence when combined with observable leadership engagement. © 2022 Global South Ltd.

High Altitude as a Risk Factor for Venous Thromboembolism in Tibial Plateau Fractures

Background: Tibial plateau fractures are often significant injuries that can require complex surgical interventions with prolonged perioperative immobilization, thereby increasing the risk of developing venous thromboembolic (VTE) events, specifically, deep vein thrombosis (DVT) and pulmonary embolism (PE). Risk stratification is paramount for guiding VTE prophylaxis. Although high altitude has been suggested to create a prothrombotic state, virtually no studies have explored its clinical effects in lower extremity trauma. The purpose of this study was to compare surgical fixation of tibial plateau fractures at high and low altitudes and its effects on post-operative VTE development.Methods: The Truven MarketScan claims database was used to retrospectively identify patients who underwent surgical fixation of isolated and closed tibial plateau fractures using Current Procedural Terminology (CPT) codes over a 10-year period. Extraneous injuries were excluded using the International Classification of Diseases, 10th edition (ICD-10), and CPT codes. Patient demographics, comorbidities, and DVT chemoprophylaxis prescriptions were obtained. Patients were partitioned into high altitude (>4000 feet) or low altitude (<100 feet) cohorts based on the zip codes of their surgery locations. One-to-one matching and univariate analysis were used to assess and control any baseline discrepancies between cohorts;multivariate regression was then performed between cohorts to determine the odds ratios (OR) for developing VTEs post-operatively.Results: There were 7,832 patients included for analysis. There was no statistical difference between high and low altitude cohorts in developing VTEs within 30 days post-operatively. Higher altitudes were associated with increased odds of developing DVT (OR 1.21, p = 0.043) and PE (OR 1.27, p = 0.037) within 90 days post-operatively.Conclusions: Surgical fixation of tibial plateau fractures is associated with an increased risk of developing VTEs at high altitudes within 90 days post-operatively. Understanding such risk factors in specific orthopaedic patient populations is essential for optimizing DVT prophylaxis protocols. Further studies should investigate this relationship and the role of DVT prophylaxis regimens in this population. 

Evaluation of Potential for Nature-Based Recreation in the Qinghai-Tibet Plateau: A Spatial-Temporal Perspective

Nature-based recreation (NBR) is an important cultural ecosystem service providing human well-being from natural environments. As the most concentrated and high-quality wilderness in China, the Qinghai-Tibet Plateau (QTP) has unique advantages for NBR. In this study, we designed an integrated nature-based recreation potential index (INRPI) based on four aspects: nature-based recreation resources, landscape attractiveness, recreation comfort and opportunity, and recreation reception ability. A combination of the analytic hierarchy process (AHP) and entropy evaluation method was adopted to assess the NBR potential in the QTP from 2000 to 2020. The research shows that: (i) The INRPI for the QTP decreases gradually from southeast to northwest and increases slightly from 2000 to 2020. (ii) The INRPI displays a pronounced difference on either side of the Qilian-Gyirong line. The areas with very high and high potentials mainly distributed in the southeast of the line, while areas with very low and low potentials distributed in the northwest. (iii) The construction of protected areas effectively improves NBR potential. Areas of INRPI at diverse levels within protected areas obviously increased in 2020. (iv) Increasing altitude has a notable effect on INRPI, and 3000 m is a critical dividing line for the NBR in the QTP. These findings can contribute to decision-makers in guiding rational use and spatial planning of natural land and promoting sustainable recreational development.

What Affects the Livelihood Risk Coping Preferences of Smallholder Farmers? A Case Study from the Eastern Margin of the Qinghai-Tibet Plateau, China

As the smallest livelihood unit in rural areas, farmers often face multiple risks. Rational responses to livelihood risks not only prevent households from falling into poverty, but also improve the sustainability of family livelihoods. This is essential to the sustainable development of rural areas. This paper takes the region located in the eastern margin of the Qinghai-Tibet Plateau in China as an example, using household survey data to analyze farmers’ livelihood risk coping strategies and their key factors through a binary logistic model. The results show that 92.80% of farmers face the shock of multiple livelihood risks. The main livelihood risks of farmers are family capacity building risk, health risk and social risk. When faced with multiple livelihood risks, farmers have the strongest preference to give priority to health risks, followed by family capacity building risks and social risks. Among them, farmers’ health risk coping preferences are stronger in farming areas than those in purely pastoral and farming-pastoral areas. There are differences in the factors for farmers’ preferences for coping with different livelihood risks. Human capital is a key factor for health risk coping preferences. Human capital and social capital are key factors for social risk coping preferences. Social capital is a key factor for family capacity building risk coping preferences. Finally, this paper puts forward countermeasures and suggestions to provide reference for farmers rationally coping with livelihood risks.

Applicability of Grassland Production Estimation Using Remote Sensing for the Mongolian Plateau by Comparing Typical Regions in China and Mongolia

Grasslands on the Mongolian Plateau are critical for supporting local sustainable development. Sufficient measured sample information is the basis of remote sensing modeling and estimation of grassland production. Limited by field inventory costs, it is difficult to collect sufficient and widely distributed samples in the Mongolian Plateau, especially in transboundary areas, which affects the results of grassland production estimation. Here, considering that the measured sample points are sparse, this study took Xilingol League of Inner Mongolia Autonomous Region in China and Dornogovi Province in Mongolia as the study areas, introduced multiple interpolation methods for interpolation experiments, established a statistical regression model based on the above measured and interpolated samples combined with the normalized differential vegetation index, and discussed the applicability of grassland production estimation. The comparison results revealed that the point estimation biased sample hospital-based area disease estimation method and radial basis function showed the best interpolation results for grassland production in Xilingol League and Dornogovi Province, respectively. The power function model was suitable for grassland production estimation in both regions. By inversion, we obtained annual grassland production for 2010–2021 and the uneven spatial distribution of grassland production in both regions. In these two regions, the spatial change in grassland production showed a decreasing trend from northeast to southwest, and the interannual change generally showed a dynamic upward trend. The growth rate of grassland output was faster in Xilingol League than in Dornogovi Province with similar physical geography and climate conditions, indicating that the animal husbandry regulation policies play important roles beyond the influence of climate change. The study recommended grassland estimation methods for an area with sparse samples and the results can be used to support decision making for sustainable animal husbandry and grassland succession management.

Moving up without moving forward! Managing career plateau in COVID-19: a dual serial mediations: MRN

Purpose>Although the research stream in the area of career plateau acknowledges its ramifications, yet investigation on how this phenomenon can be reduced is sparse. This study aims to address this gap by illuminating the role of proactive personality (PP) as a factor of minimizing plateau via playful work design (PWD), career adaptability (CA) and perceived work-life balance (PWLB).Design/methodology/approach>A cross-sectional study design was applied and structural equation modelling was used to assess the hypothesized relationships among PP, CA, PWD, perceived work design and career plateau. A total of 338 employees from public and private universities were sampled from February 2020 to July 2020.Findings>The results highlighted that CA mediated the relationship between PP and PWLB, as well as, PWD mediated the association between PP and PWLB. Further, the authors got support for both serial mediation paths i.e. PP, CA, PWLB and career plateau and PP, PWD, PWLB and career plateau.Originality/value>The findings of this study provide much needed ways to overcome career plateau in the academic sector. Moreover, the use of multiple serial paths has enhanced the underlying factors of PP and career plateau nexus.

The Impact of Career Plateau on Job Burnout in the COVID-19 Pandemic: A Moderating Role of Regulatory Focus.

This study reviewed the mental health problems experienced by office workers exposed to new kinds of work stress, career plateau, and job burnout, due to no-contact teleworking during the COVID-19 pandemic. Human beings tend to evaluate their own qualities to determine their own superiority by comparing themselves with others. Appropriate social comparison helps to promote self-understanding and boost self-esteem. However, in the case of no-contact remote working, where the amount of time spent alone is drastically increased, the information obtained from such social comparisons is naturally insufficient, resulting in the perception of reaching a career plateau. Prolonged anxiety and a sense of helplessness have been shown to cause job burnout; however, so far, few studies have examined career plateau as an antecedent factor for job burnout. This study also considered the moderating effect of regulatory focus in order to closely examine the effect of career plateau on job burnout. According to the regulatory focus theory, differences appear in various psychological processes, such as human choices, judgments, motivations, and attitudes, determined by whether individuals adopt a promotion focus or a prevention focus. This study aimed to verify whether regulatory focus operates in a conditional context, in the process of job burnout following career plateau, to change the magnitude and direction of the influence of career plateau. To this end, a hierarchical regression analysis was performed by collecting data from 202 people working for three Korean companies. As a result of the analysis, it was found that the career plateau had a significant effect on job burnout. This direct effect was still significant even after considering the interaction with regulatory focus. In addition, promotion focus was found to have a negative moderating effect, while prevention focus had no effect on the influence of career plateau on job burnout. This study demonstrated that the negative effects of career plateau, which have been presented in various ways in academia, lead to job burnout under the non-face-to-face teleworking systems implemented due to the COVID-19 pandemic, and suggested that promotion focus can play a positive role in alleviating this dynamic.

Brucellosis prevalence in yaks in China in 1980-2019: A systematic review and meta-analysis.

In the Qinghai-Tibet Plateau of China, the yak is an animal of particular economic interest, which provides protein and income for herders in daily life. Brucellosis is a bacterial disease that can infect humans and animals, including yaks. It can damage the yak reproductive system, causing miscarriage and orchitis. At the same time, brucellosis threatens the health of herders. We performed this meta-analysis using R software to explore the combined prevalence and risk factors of brucellosis in yak in China. Variability was assessed by the I2 statistic and Cochran Q statistic. We identified 52 publications of related research from four databases (Wanfang Data, VIP Chinese Journal Database, China National Knowledge Infrastructure, and of PubMed). The pooled prevalence of yak brucellosis was 8.39 %. Prevalence was highest in Southwestern China (11.1 %). The point estimate of brucellosis in yak from 2012 to 2016 was the highest (11.47 %). The point estimate of age ≤ 12 months (1.44 %) was lower than that of age > 12 months (15.6 %). This study shows that yak brucellosis is serious, and its incidence is higher than before 2012. We recommend carrying out large-scale yak brucellosis investigations in Western China and conducting comprehensive testing planning. The detection of brucellosis in adult animals should be strengthened to reduce the economic loss caused by brucellosis to herders and to improve public health.

Respiratory Pathophysiology of Mechanically Ventilated COVID-19 Patients.

Background and objectives Coronavirus disease 2019 (COVID-19) is mainly a disease of the respiratory system that can lead to acute respiratory distress syndrome (ARDS). The pathophysiology of COVID-19 ARDS and consequently its management is a disputable subject. Early COVID-19 investigators hypothesized that the pathogenesis of COVID-19 ARDS is different from the usual ARDS. The aim of this study was to describe the lung mechanics in mechanically ventilated COVID-19 patients with ARDS. Methodology An observational retrospective cohort study was conducted on adult COVID-19 patients with ARDS who needed mechanical ventilation in the ICU of Ohoud Hospital, Madinah, KSA, from June to September 2020. Data were collected from the patients' medical charts and electronic medical records and analyzed using Statistical Package for the Social Sciences (SPSS) software package version 22 (IBM Corp., Armonk, NY) for descriptive statistical analysis. Measurements and main results A total of 52 patients were analyzed: on intubation, the median positive end-expiratory pressure (PEEP) was 10 cm H2O (IQR, 2.3-16), the median plateau pressure was 27 cm H2O (IQR, 12-40), and the median driving pressure was 17 cm H2O (IQR, 3-30). The median static compliance of the respiratory system was 24.7 mL/cm H2O (IQR, 12.8-153.3). 59.5% had severe ARDS (the PaO2/FiO2 ratio was less than 100 mmHg), and 33% had moderate ARDS (the PaO2/FiO2 ratio ranged from 100 to 200 mmHg). Conclusion Our results suggest that the lung mechanics in COVID-19 ARDS patients who need mechanical ventilation do not differ from non-COVID-19 patients.

Discovery and Evolution of a Divergent Coronavirus in the Plateau Pika From China That Extends the Host Range of Alphacoronaviruses.

Although plateau pikas are the keystone species in the plateau ecosystem of the Qinghai Province of China, little is known about their role in the evolution and transmission of viral pathogens, especially coronaviruses. Here, we describe the characterization and evolution of a novel alphacoronavirus, termed plateau pika coronavirus (PPCoV) P83, which has a prevalence of 4.5% in plateau pika fecal samples. In addition to classical gene order, the complete viral genome contains a unique nonstructural protein (NS2), several variable transcription regulatory sequences and a highly divergent spike protein. Phylogenetic analysis indicates that the newly discovered PPCoV falls into the genus Alphacoronavirus and is most closely related to rodent alphacoronaviruses. The co-speciation analysis shows that the phylogenetic trees of the alphacoronaviruses and their hosts are not always matched, suggesting inter-species transmission is common in alphacoronaviruses. And, PPCoV origin was estimated by molecular clock based on membrane and RNA-dependent RNA polymerase encoding genes, respectively, which revealed an apparent discrepancy with that of co-speciation analysis. PPCoV was detected mainly in intestinal samples, indicating a potential enteric tropism for the virus. Overall, this study extends the host range of alphacoronaviruses to a new order (Lagomorpha), indicating that plateau pikas may be the natural reservoir of PPCoV and play an important and long-term role in alphacoronavirus evolution.

Do ventilatory parameters influence outcome in patients with severe acute respiratory infection? Secondary analysis of an international, multicentre14-day inception cohort study.

PURPOSE: To investigate the possible association between ventilatory settings on the first day of invasive mechanical ventilation (IMV) and mortality in patients admitted to the intensive care unit (ICU) with severe acute respiratory infection (SARI). MATERIALS AND METHODS: In this pre-planned sub-study of a prospective, multicentre observational study, 441 patients with SARI who received controlled IMV during the ICU stay were included in the analysis. RESULTS: ICU and hospital mortality rates were 23.1 and 28.1%, respectively. In multivariable analysis, tidal volume and respiratory rate on the first day of IMV were not associated with an increased risk of death; however, higher driving pressure (DP: odds ratio (OR) 1.05; 95% confidence interval (CI): 1.01-1.1, p = 0.011), plateau pressure (Pplat) (OR 1.08; 95% CI: 1.04-1.13, p < 0.001) and positive end-expiratory pressure (PEEP) (OR 1.13; 95% CI: 1.03-1.24, p = 0.006) were independently associated with in-hospital mortality. In subgroup analysis, in hypoxemic patients and in patients with acute respiratory distress syndrome (ARDS), higher DP, Pplat, and PEEP were associated with increased risk of in-hospital death. CONCLUSIONS: In patients with SARI receiving IMV, higher DP, Pplat and PEEP, and not tidal volume, were associated with a higher risk of in-hospital death, especially in those with hypoxemia or ARDS.

Case series of COVID-19 patients from the Qinghai-Tibetan Plateau Area in China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a serious infection caused by the new coronavirus severe acute respiratory syndrome coronavirus 2. The disease was first identified in December 2019 and has caused significant morbidity and mortality worldwide. AIM: To explore the clinical characteristics and treatments for COVID-19 in the Qinghai-Tibetan Plateau Area in China. METHODS: We retrospectively analyzed the blood cell counts (neutrophils and lymphocytes), blood gas analysis, and thoracic computed tomography changes of patients from Qinghai Province before, during, and after treatment (January 23, 2020 to February 21, 2020). In addition, we summarized and analyzed the information of critical patients. All data were analyzed using SPSS 17.0 (SPSS Inc., Chicago, IL, United States). The quantitative and count variables are represented as the mean ± SD and n (%), respectively. RESULTS: The main symptoms and signs of patients with COVID-19 were fever, dry cough, cough with phlegm, difficulty breathing, and respiratory distress with a respiration rate ≥ 30 times/min, finger oxygen saturation ≤ 93% in the resting state, and oxygenation index less than 200 but greater than 100 (after altitude correction). Eighteen patients with COVID-19, of whom three were critical, and the others were in a mild condition, were included. The main manifestations included fever, dry cough, and fatigue. Three patients developed difficulty breathing and had a fever. They were eventually cured and discharged. Adjuvant examinations showed one case with reduced white cell count (6%) (< 4 × 109/L), six with reduced count of lymphocytes (33%) (< 0.8 × 109/L), and one with abnormal blood glucose level. All 18 patients were discharged, and no death occurred. CONCLUSION: Our findings provide critical insight into assessing the clinical diagnosis and treatment for COVID-19 in the Tibetan plateau area.

Beta- and Novel Delta-Coronaviruses Are Identified from Wild Animals in the Qinghai-Tibetan Plateau, China.

Outbreaks of severe virus infections with the potential to cause global pandemics are increasingly concerning. One type of those commonly emerging and re-emerging pathogens are coronaviruses (SARS-CoV, MERS-CoV and SARS-CoV-2). Wild animals are hosts of different coronaviruses with the potential risk of cross-species transmission. However, little is known about the reservoir and host of coronaviruses in wild animals in Qinghai Province, where has the greatest biodiversity among the world's high-altitude regions. Here, from the next-generation sequencing data, we obtained a known beta-coronavirus (beta-CoV) genome and a novel delta-coronavirus (delta-CoV) genome from faecal samples of 29 marmots, 50 rats and 25 birds in Yushu Tibetan Autonomous Prefecture, Qinghai Province, China in July 2019. According to the phylogenetic analysis, the beta-CoV shared high nucleotide identity with Coronavirus HKU24. Although the novel delta-CoV (MtCoV) was closely related to Sparrow deltacoronavirus ISU42824, the protein spike of the novel delta-CoV showed highest amino acid identity to Sparrow coronavirus HKU17 (73.1%). Interestingly, our results identified a novel host (Montifringilla taczanowskii) for the novel delta-CoV and the potential cross-species transmission. The most recent common ancestor (tMRCA) of MtCoVs along with other closest members of the species of Coronavirus HKU15 was estimated to be 289 years ago. Thus, this study increases our understanding of the genetic diversity of beta-CoVs and delta-CoVs, and also provides a new perspective of the coronavirus hosts.

The effect of driving pressures in COVID-19 ARDS: Lower may still be better as in classic ARDS.

BACKGROUND: The respiratory dynamics of coronavirus disease 2019 (COVID-19) patients under invasive ventilation are still not well known. In this prospective cohort, we aimed to assess the characteristics of the respiratory system in COVID-19 patients under invasive mechanical ventilation and evaluate their relationship with mortality. METHODS: Fifty-eight COVID-19 patients who underwent invasive mechanical ventilation between March 11, 2020 and September 1, 2020 were enrolled for the present study. Demographics and laboratory values at baseline were recorded. Respiratory variables such as tidal volume, plateau pressure, positive end expiratory pressure, static compliance, and driving pressure were recorded daily under passive conditions. Further, the median values were analyzed. RESULTS: Median age of the patients was 64 years (58-72). Mortality was 60% on day 28. Plateau pressure, driving pressure, and static compliance significantly differ between the survivors and non-survivors. When patients were categorized into two groups based on the median driving pressure (Pdrive) of ≤15 cmH2O or >15 cmH2O during their invasive mechanical ventilation period, there was significantly better survival on day 28 in patients having a Pdrive ≤ 15 cmH2O [28 days (95% CI = 19-28) vs 16 days (95% CI = 6-25), (log-rank p = 0.026). CONCLUSION: COVID-19 related acute respiratory distress syndrome (ARDS) seemed to have similar characteristics as other forms of ARDS. Lung protective ventilation with low plateau and driving pressures might be related to lower mortality.