Effectiveness of a booster dose of COVID-19 vaccines during an outbreak of SARS-CoV-2 Omicron BA.2.2 in China: A case-control study.

Real-world evidence on the effectiveness of COVID-19 vaccines marketed in China against the Omicron BA.2.2 variant remains scarce. A case-control study was conducted to estimate the vaccine effectiveness (VE) of COVID-19 vaccines marketed in China (inactivated vaccines, an Ad5-nCoV vaccine, and a recombinant protein vaccine). There were 414 cases infected with SARS-CoV-2 and 828 close contacts whose test results were consecutively negative as controls during the outbreak of the Omicron variant in Lu'an City, Anhui Province, China, in April 2022. The overall adjusted VE against Omicron BA.2.2 variant infection in the vaccinated group with any COVID-19 vaccine was 35.0% (95% CI: -9.1-61.3%), whereas the adjusted VE for booster vaccination was 51.6% (95% CI: 15.2-72.4%). Subgroup analysis showed that the overall adjusted VE of the Ad5-nCoV vaccine (65.8%, 95% CI: 12.8-86.6%) during the outbreak while any dose of inactivated vaccines and recombinant protein vaccine offered no protection. The adjusted VE of three-dose inactivated vaccines was 48.0% (95% CI: 8.0-70.6%), and the two-dose Ad5-nCoV vaccine was 62.9% (95% CI: 1.8-86%). There is no protection from a three-dose recombinant protein vaccine. COVID-19 vaccines offered 46.8% (95% CI: 9.5-68.7%) protection from infection within six months. There were statistically significant differences between the VEs of heterologous booster (VE = 76.4%, 95% CI: 14.3-93.5%) and homologous booster vaccination (VE = 51.8%, 95% CI: 9.6-74.3%) (P = .036). Booster vaccination of COVID-19 vaccines offered more protection than full vaccination. A booster vaccination campaign for a booster dose after three doses of a recombinant protein vaccine must be urgently conducted.

Use of Clinical Pathways Integrated into the Electronic Health Record to Address the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)-integrated Clinical Pathways (E-ICPs), easily-understood care algorithms accessible at the point-of-care. OBJECTIVE: To describe the institution's creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools. SETTING: Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices. METHODS: Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19 specific E-ICPs along with a process for frequent re-assessment and updating. We examined the development and use of our COVID-19 specific pathways for a six-month period (March 1 to September 1, 2020), and describe their impact using case studies. RESULTS: Forty-five COVID-19 specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders placed. Case studies describe the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting. CONCLUSION: E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and non-urgent clinical conditions.

Highly Time-Resolved and Nontargeted Characterization of Volatile Organic Compound Emissions from Face Masks

Face covering by masks has become a lifeline for humans to prevent the airborne transmission of highly infectious SARS-CoV-2. One of the side effects, however, is the release of volatile organic compounds (VOCs), which can hardly be fully understood based on traditional offline measurements. Here, for the first time, we performed highly time-resolved and nontargeted measurements of VOCs emitted from face masks using an ultrasensitive proton transfer-reaction quadrupole-interface time-of-flight mass spectrometer. We found diverse VOC species, some of which are toxic. The chemical structures of the major VOC species were identified to be from the chemicals and processes involved in mask production. High concentrations of VOCs emitted from surgical masks (predominant mask type) were all concentrated in the initial 1 h and then dropped rapidly to an acceptable level after a process of naturally airing out. Higher emissions from a surgical mask for children are likely due to their colorful cartoon patterns. Despite the lowest emissions, the N95 respirator with an active carbon layer required 6 h to remove the toxic methanol. We support mask wearing to curtail the COVID-19 pandemic, but our results highlight the importance of naturally airing out masks to reduce zero-distance inhalation of mask-emitted VOCs.

The acceptance to heterologous booster vaccination of COVID-19 vaccine among HCWs and targeted population: A cross-sectional study in central China

Background There are few studies reported on the acceptance of heterologous booster vaccination for the COVID-19 vaccine among healthcare workers (HCWs) and the general population. We aimed to address that gap and explore determinant factors of acceptance of the heterologous booster vaccination. Methods We conducted a cross-sectional study to examine the prevalence and determinant factors of the acceptance of heterologous booster vaccination for the COVID-19 vaccine among HCWs and the targeted population. Results A total of 364 HCWs and 1,898 targeted populations were investigated in our study. 76.4% HCWs would recommend heterologous booster vaccination to their patients and 59.8% targeted population endorsed a clear willingness to receive this strategy. Compared with the adenoviral vector vaccine (AD5-nCOV), recombinant protein vaccine (ZF2001) was more preferred by HCWs (79.1%) and the targeted population (72.0%) as a heterologous booster vaccine. HCWs who did not work in the vaccination clinics were more likely to recommend heterologous booster vaccination (OR = 3.3, CI: 1.5–7.3). The targeted population aged 18–59 years (OR = 1.5, 95% CI:1.1–2.3), had a positive attitude toward COVID-19 vaccination (OR = 3.8, 95% CI: 1.7–8.6), had confidence in the safety of COVID-19 vaccines (OR = 6.6, 95% CI: 4.2–10.2), followed the recommendation of HCWs (OR = 33.6, 95% CI: 22.0–51.2), took initiative in collecting booster shots information (OR = 2.1, 95% CI: 1.5–3.0), and were familiar with the heterologous strategy (OR = 1.9, 95% CI: 1.1–3.1) were more likely to choose heterologous booster vaccination. The history of side effects of inactivated COVID-19 vaccine was a negative factor in choosing heterologous booster vaccination (OR = 0.4, 95% CI: 0.4–1.0). Conclusions The heterologous booster vaccination strategy on the COVID-19 vaccine could be widely accepted among HCWs, whereas its acceptance among targeted population was only moderate. Public authorities should make efforts to communicate the public about the effectiveness and safety of the heterologous booster vaccination which could help increase their willingness to get vaccinated.

PET imaging to assess fibroblast activation protein inhibitor biodistribution: A training program adapted to pharmacology education.

In the process of pharmacology education, practical teaching is an important complement to theoretical teaching. These activities include the use of experimental animals to obtain certain pharmacological parameters or to help students understand certain classical concepts. However, the growing interest in laboratory animal welfare, the rapid development of pharmacology research and the challenges of cultivating innovative pharmacy talent create a need for innovative and flexible in vitro experiments for teaching purposes. Here, we report the application of positron emission tomography (PET) imaging of 18 F-labeled fibroblast activation protein inhibitor (18 F-FAPi) to practical pharmacology teaching, enabling dynamic visualization of the distribution and excretion process of FAPi in mice. Students can quantitatively analyze the distribution of FAPi in various tissues and organs without sacrificing the mice. Furthermore, the newly implemented method resulted in highly reproducible results and was generally appreciated by the students. Additionally, the application of PET imaging in pharmacokinetic teaching can not only greatly reduce the use of experimental animals but also need not sacrificing animals. Of note is that dynamic scanning data from this project can be used for online practical teaching during COVID-19 pandemic.

Book review

The main goal (and scope) of this collection is associated with the importance to understand the effects of cloud computing in society as well as the new legal issues in private life. Authors draw an interesting comparison between the USA and Europe arguing convincingly that in Europe, data protection is a protected right properly legalized by the different states. Applying concepts such as social justice and control, the chapter gives a snapshot of the interaction of cloud service providers (CSPs), consumers, governmental institutions and justice.

Effects of Wearing Face Masks on Exercise Capacity and Ventilatory Anaerobic Threshold in Healthy Subjects During the COVID-19 Epidemic.

BACKGROUND Face masks have become an important part of the COVID-19 prevention approach. This study aimed to explore the effect of wearing masks on exercise ability and ventilatory anaerobic threshold (VAT). MATERIAL AND METHODS Thirty-four young, healthy volunteers were included in this study, consisting of 18 men and 16 women. The subjects were randomized to perform 2 cardiopulmonary exercise tests (CPET) on a cycle ergometer with gas exchange analysis, one with and another without wearing a face mask (cross-over design). The general data for all subjects and indicators from the 2 exercise tests performed with and without wearing a face mask were collected. RESULTS In cardiopulmonary exercise tests, wearing a mask significantly (P<0.05) decreased peak indexes (eg, work rate (WR), oxygen consumption per kg body weight (VO2/kg), heart rate (HR), ventilation per minute (VE) and carbon dioxide ventilation equivalent (VE/VCO2)) and anaerobic threshold indexes (eg, WR, HR, VE, breath frequency (BF), dead space ratio (VD/VT), and VE/VCO2). However, the PETCO2 at peak was significantly higher. There was a positive linear correlation between WR difference and VO2 difference at VAT (abbreviated as deltaWR@VAT and deltaVO2@VAT, respectively) (r=0.495, P=0.003). Subgroup analysis of the VAT indexes showed that WR, VO2/kg, and VE were significantly decreased in the advanced VAT group with mask compared with the stable VAT group with mask (P<0.05). Logistic regression showed that deltaVE, deltaBF, and deltaVE/VCO2 had independent influences on VAT. CONCLUSIONS Wearing masks advances VAT in healthy young subjects during CPET. The advanced VAT was associated with changes in VE, BF, and VE/VCO2 while wearing masks.

Adequacy of Hemodialysis Serves as an Independent Predictor of Humoral Response to ChAdOx1 Prime-Boost Vaccination in Hemodialysis Patients.

BACKGROUND: Immune response assessed by the quantification of neutralizing antibodies (nAbs) and predictors associated with immunogenicity after the prime-boost ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccine in hemodialysis (HD) patients remains unclear. METHODS: This prospective study enrolled 174 HD patients and 67 healthy subjects to evaluate antibodies against the spike protein 1 and receptor-binding domain of severe acute respiratory syndrome coronavirus type 2 after prime-booster vaccination, by using enzyme-linked immunosorbent assay and applied spline-based generalized additive model regression analysis to predict 50% neutralization titer (NT50). The correlation between HD parameters and NT50 was analyzed. RESULTS: NT50 was lower in HD patients compared with healthy controls after the prime-boost dose (p < 0.001). The geometric mean titer ratios were higher in first-dose seronegative than in the seropositive subgroup in HD patients and healthy controls (6.96 vs. 2.36, p = 0.002, and 9.28 vs. 1.26, p = 0.011, respectively). After two doses of ChAdOx1, one-way ANOVA showed that Ca × P was positively associated with NT50 (p trend = 0.043) and multiple linear regression showed the similar results (p = 0.021). Kt/V (a quantification of dialysis adequacy) (OR = 20.295, p = 0.005) could independently predict seroconversion (NT50 ≥ 35.13 IU/mL). CONCLUSION: Adequacy of hemodialysis could independently predict seroconversion in HD subjects vaccinated with prime-boost doses of ChAdOx1.

Emotion Self-Regulation in Neurotic Students: A Pilot Mindfulness-Based Intervention to Assess Its Effectiveness through Brain Signals and Behavioral Data.

Neuroticism has recently received increased attention in the psychology field due to the finding of high implications of neuroticism on an individual's life and broader public health. This study aims to investigate the effect of a brief 6-week breathing-based mindfulness intervention (BMI) on undergraduate neurotic students' emotion regulation. We acquired data of their psychological states, physiological changes, and electroencephalogram (EEG), before and after BMI, in resting states and tasks. Through behavioral analysis, we found the students' anxiety and stress levels significantly reduced after BMI, with p-values of 0.013 and 0.027, respectively. Furthermore, a significant difference between students in emotion regulation strategy, that is, suppression, was also shown. The EEG analysis demonstrated significant differences between students before and after MI in resting states and tasks. Fp1 and O2 channels were identified as the most significant channels in evaluating the effect of BMI. The potential of these channels for classifying (single-channel-based) before and after BMI conditions during eyes-opened and eyes-closed baseline trials were displayed by a good performance in terms of accuracy (~77%), sensitivity (76-80%), specificity (73-77%), and area-under-the-curve (AUC) (0.66-0.8) obtained by k-nearest neighbor (KNN) and support vector machine (SVM) algorithms. Mindfulness can thus improve the self-regulation of the emotional state of neurotic students based on the psychometric and electrophysiological analyses conducted in this study.

Identification of a recombinant equine coronavirus in donkey, China.

Equine coronavirus (ECoV) was first identified in the USA and has been previously described in several countries. In order to test the presence of ECoV in China, we collected 51 small intestinal samples from donkey foals with diarrhoea from a donkey farm in Shandong Province, China between August 2020 and April 2021. Two samples tested positive for ECoV and full-length genome sequences were successfully obtained using next-generation sequencing, one of which was further confirmed by Sanger sequencing. The two strains shared 100% sequence identity at the scale of whole genome. Bioinformatics analyses further showed that the two Chinese strains represent a novel genetic variant of ECoV and shared the highest sequence identity of 97.05% with the first identified ECoV strain - NC99. In addition, it may be a recombinant, with the recombination region around the NS2 gene. To our knowledge, this is the first documented report of ECoV in China, highlighting its risk to horse/donkey breeding. In addition, its potential risk to public health also warrants further investigation.

Elucidating the responses of highly time-resolved PM2.5 related elements to extreme emission reductions.

China's unprecedented lockdown to contain the spread of the novel coronavirus disease (COVID-19) in early 2020, provided a tragic natural experiment to investigate the responses of atmospheric pollution to emission reduction at regional scale. Primarily driven by primary emissions, particulate trace elements is vitally important due to their disproportionally adverse impacts on human health and ecosystem. Here 14 trace elements in PM2.5 were selected for continuous measurement hourly in urban representative site of Shanghai, for three different phases: pre-control period (1-23 January 2020), control period (24 January-10 February 2020; overlapped with Chinese Lunar New Year holiday) and post control period (11-26 February 2020) the city's lockdown measures. The results show that all meteorological parameters (including temperature, RH, mixing layer height et al.) were generally consistent among different periods. Throughout the study period, the concentrations of most species displayed a "V-shaped" trend, suggesting significant effects by the restriction measures imposed during the lockdown period. While this is not the case for species like K, Cu and Ba, indicating their unusual origins. As a case study, the geographical origins of Cu were explored. Seven major sources, i.e., Vehicle-related emission (including road dust; indicative of Ca, Fe, Ba, Mn, Zn, Cu; accounting for 30.1%), shipping (Ni; 5.0%), coal combustion (As, Pb; 4.2%), Se and Cr industry (24.9%), nonferrous metal smelting (Au, Hg; 7.5%) and fireworks burning (K, Cu, Ba; 28.3%) were successfully pinpointed based on positive matrix factorization (PMF) analysis. Our source apportionment results also highlight fireworks burning was one of the dominant source of trace elements during the Chinese Lunar New Year holiday. It is worth noting that 56% of the total mass vehicular emissions are affiliated with non-exhaust sources (tire wear, brake wear, and road surface abrasion).

Impacts of p97 on Proteome Changes in Human Cells during Coronaviral Replication.

Human coronavirus (HCoV) similar to other viruses rely on host cell machinery for both replication and to spread. The p97/VCP ATPase is associated with diverse pathways that may favor HCoV replication. In this study, we assessed the role of p97 and associated host responses in human lung cell line H1299 after HCoV-229E or HCoV-OC43 infection. Inhibition of p97 function by small molecule inhibitors shows antiviral activity, particularly at early stages of the virus life cycle, during virus uncoating and viral RNA replication. Importantly, p97 activity inhibition protects human cells against HCoV-induced cytopathic effects. The p97 knockdown also inhibits viral production in infected cells. Unbiased quantitative proteomics analyses reveal that HCoV-OC43 infection resulted in proteome changes enriched in cellular senescence and DNA repair during virus replication. Further analysis of protein changes between infected cells with control and p97 shRNA identifies cell cycle pathways for both HCoV-229E and HCoV-OC43 infection. Together, our data indicate a role for the essential host protein p97 in supporting HCoV replication, suggesting that p97 is a therapeutic target to treat HCoV infection.

Effective Preventive Strategies to Prevent Secondary Transmission of COVID-19 in Hemodialysis Unit: The First Month of Community Outbreak in Taiwan.

BACKGROUND: Dialyzed patients are vulnerable to coronavirus infection disease 2019 (COVID-19). The incidence and outcome of COVID-19 in hemodialysis (HD) patients in Taiwan remain unclear. A series of preventive measures were executed to combat COVID-19 transmission among HD patients. METHODS: We carried out a series of forward-looking and practical preventive strategies of COVID-19 control in our HD center. Incidences of COVID-19 of our HD unit were compared with those of national and local estimates from a community outbreak from 15 May to 30 June 2021. Prognostic factors associated with mortality were analyzed. RESULTS: The national incidence of COVID-19 was 0.062%; being highest in Taipei City (0.173%), followed by New Taipei City (0.161%) and Keelung (0.083%). The overall incidence in Keelung HD patients was 0.666%. One patient of our HD center contracted COVID-19 from the household; however, we have contained secondary transmission in our HD center by implementing strict preventive measures. The mortality rate of HD patients in Keelung was 66.6%. The median Ct value of HD patients was 17.53 (11.75-27.90) upon diagnosis. The deceased patients had a higher cardiac/thoracic ratio than alive (0.61 vs. 0.55, p = 0.036). CONCLUSIONS: Taking aggressive and proactive infection preventive measures impedes the secondary transmission of COVID-19 in HD facilities. COVID-19-associated mortality was high in HD patients, being the high cardiac-thoracic ratio, an important prognostic factor for clinical outcome of infected HD patients.

[High-frequency Responses to the COVID-19 Shutdown of Heavy Metal Elements in PM2.5 in Shanghai].

To study the evolution and sources of heavy metal elements in the urban atmosphere before, during (overlapped with Chinese Lunar New Year), and after China's COVID-19 shutdown, a multi-metal online analyzer was deployed to determine the trace elements in PM2.5 in Shanghai from January 1 to February 26, 2020. Meanwhile, source apportionment of the hourly measured heavy metal concentrations was performed using a PMF model, in which eight sources were identified. The results show that the concentrations of most elements presented a "V-shaped" trend, which was mainly influenced by emissions from fireworks (K, Cu, Ba as indicative elements), Se-related industry, road dust (Ca, Fe, Ba), and motor vehicles (Mn, Zn, Fe, Cu). However, during the COVID-19 shutdown period, the concentrations of K, Ba, and Cu were high. Case-specific analysis suggested that prior to the shutdown period, the high concentrations of Cu were significantly influenced by long-range transport, which shifted to a dominant contribution from local fireworks during the shutdown period.

Etanercept Ameliorates Cardiac Fibrosis in Rats with Diet-Induced Obesity.

Diet-induced obesity (DIO) is considered the main risk factor for cardiovascular diseases. Increases in the plasma levels of tumor necrosis factor alpha (TNF-α) is associated with DIO. Etanercept, a TNF-α inhibitor, has been shown to alleviate cardiac hypertrophy. To investigate the effect of etanercept on cardiac fibrosis in DIO model, rats on high fat diet (HFD) were subdivided into two groups: the etanercept group and vehicle group. Cardiac injury was identified by classic methods, while fibrosis was characterized by histological analysis of the hearts. Etanercept treatment at 0.8 mg/kg/week twice weekly by subcutaneous injection effectively alleviates the cardiac fibrosis in HFD-fed rats. STAT3 activation seems to be induced in parallel with fibrosis-related gene expression in the hearts of HFD-fed rats. Decreased STAT3 activation plays a role in the etanercept-treated animals. Moreover, fibrosis-related genes are activated by palmitate in parallel with STAT3 activation in H9c2 cells. Etanercept may inhibit the effects of palmitate, but it is less effective than a direct inhibitor of STAT3. Direct inhibition of STAT3 activation by etanercept seems unlikely. Etanercept has the ability to ameliorate cardiac fibrosis through reduction of STAT3 activation after the inhibition of TNF-α and/or its receptor.

Simulation Based Ambulance and Crew Decontamination Advise During COVID-19 Pandemic.

This study involved a simulation of transportation and basic life support on ambulances carrying coronavirus disease 2019 (COVID-19) patients, using a specially modified mannequin. The mannequin used can spew a fluorescent solution from its mouth to simulate the droplets or vomitus made by the patient and can be detected using ultraviolet light illumination. We determined that the most frequently contaminated areas of an ambulance in the driver's cabin are the left front door's outer handle, driver's handler, gear lever, and mat. The most frequently contaminated area in the rear patient's cabin is the rear door, rear door lining, and handle over the roof. The most frequently contaminated areas before the removal of personal protective equipment (PPE) are the lower chest to the belly area, bilateral hands, lower rim of the gown, and shoes. After the removal of PPE, traces of fluorescence were observed over the neck, hands, and legs. We therefore suggest taking a bath immediately after PPE removal.

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients.

Hemodialysis (HD) patients are highly susceptible to COVID-19 infection. However, comprehensive assessments of current evidence regarding COVID-19 in HD patients remain incomplete. We systematically searched PUBMED and EMBASE for articles published on incidence or mortality of COVID-19 infection in HD patients until September 2020. Two independent researchers extracted data and study-level risk of bias across studies. We conducted meta-analysis of proportions for incidence and mortality rate. Study heterogeneity and publication bias were assessed. A total of 29 articles with 3261 confirmed COVID-19 cases from a pool of 396,062 HD patients were identified. Incidence of COVID-19 in these HD patients was 7.7% (95% CI: 5.0-10.9%; study heterogeneity: I2 = 99.7%, p < 0.001; risk of publication bias, Egger's test, p < 0.001). Overall mortality rate was 22.4% (95% CI: 17.9-27.1%; study heterogeneity: I2 = 87.1%, p < 0.001; risk of publication bias, Egger's test: p = 0.197) in HD patients with COVID-19. Reported estimates were higher in non-Asian than Asian countries. Quality of study may affect the reported incidence but not the mortality among studies. Both incidence and mortality of COVID-19 infection were higher in HD patients. Available data may underestimate the real incidence of infection. International collaboration and standardized reporting of epidemiological data should be needed for further studies.

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients (preprint)

Background: Better understanding of incidence and clinical outcomes of COVID-19 infection in hemodialysis (HD) patients could assist healthcare providers to develop proper preventive strategies and optimal management. However, no published systematic review summarizes current epidemiological evidence regarding COVID-19 infection in HD patients.Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched PUBMED and EMBASE for articles published on incidence or mortality of COVID-19 infection in maintenance HD patients until September 2020, and conducted meta-analysis of proportions for incidence and mortality rate. Heterogeneity was measured by Cochran’s Q and I2 statistic. Publication bias was evaluated by Egger’s test. The study protocol was registered in the PROSPERO database (CRD42020209134).Results: In total, 29 articles with 3,261 confirmed COVID-19 cases from pooled 396,062 HD patients were identified. Overall COVID-19 incidence in these HD patients was 7.7% (95% CI: 5.0-10.9%), with significant heterogeneity among the studies (I2 = 99.7%, p<0.001) and risk of publication bias (Egger’s test, p<0.001). Overall mortality rate was 22.4% (95% CI: 17.9-27.1%) in HD patients with COVID-19, with significant heterogeneity among the studies (I2 = 87.1%, p<0.001). Reported incidence and mortality varied by geographic area, being higher in non-Asian- than Asian countries.Conclusions: Both incidence and mortality of COVID-19 infection were higher in HD patients. Available data may underestimate the real incidence of infection because screening and diagnosis differ between countries. International collaboration and standardized reporting of future epidemiologic studies is encouraged to improve clinical outcomes of COVID-19 infection in HD patients.