Lower-dose Intravenous Immunoglobulin Therapy for Geriatric Inflammatory Bowel Disease Accompanied by COVID-19 Multisystem Inflammatory Syndrome: a Case Report (preprint)

Background this article presents a noteworthy case of SARS-CoV-2-associated inflammatory bowel disease (IBD) in an elderly individual who endured three hospitalizations without favorable response to conventional treatment. Ultimately, the patient's symptoms subsided following the administration of intravenous immunoglobulin (IVIg).Case presentation : the patient, an elderly individual, experienced short-term fever and sore throat after encountering the COVID-19 pandemic. Despite receiving a three-dose inactivated COVID-19 vaccine, the patient tested positive for SARS-CoV-2 antigen and developed worsening symptoms, including diarrhea and recurrent fever. Initial antibiotic treatment for bacterial enteritis proved ineffective. Further evaluation, including endoscopy and pathology, confirmed the diagnosis of IBD with concurrent multisystem inflammatory syndrome (MIS) in adults. Following lower-dose IVIg administration, the patient's symptoms improved, with resolution of fever, diarrhea, and inflammation.Conclusions the case highlights the complexity of diagnosis and treatment in geriatric with IBD and MIS, emphasizing the importance of early intervention with IVIg. Further research is needed to explore the relationship between COVID-19 infection, MIS, and acute autoimmune diseases, as well as the efficacy of IVIg in these conditions.

Evaluating the Landscape Quality of Residential Communities: A Case Study of the Chinese City Yangling

Due to continuous urbanization and an increasing need to improve living quality, citizens' pursuit of landscape quality in residential communities is constantly improving in developing countries, e.g., China. This is especially true in the period when citizens were locked down in their home cities or communities in the context of the COVID-19 pandemic. Studying whether the current landscape in residential communities still meets citizens' needs is of significance as it is crucial for city planners, landscape architects, and city managers. In this study, we used the analytic hierarchy process method to evaluate the landscape quality of five residential communities, using the case city of Yangling, China. In total, 516 valid questionnaires were collected in May 2022. The results showed that good organization of residential roads and pedestrian systems, the rationality of rest facilities, and the hierarchical richness of plants were the most important aspects for residents. Based on these, optimization design strategies were summarized. We hope to provide a reference for future landscape optimization of existing residential communities, especially in developing countries.

Computed tomography findings and clinical manifestations in different clinical types of coronavirus disease 2019

OBJECTIVE: Since the coronavirus disease 2019 (COVID-19) outbreak in Wuhan in 2019, the virus has spread rapidly. We investigated the clinical and computed tomography (CT) characteristics of different clinical types of COVID-19. MATERIALS AND METHODS: We retrospectively analyzed clinical and chest CT findings of 89 reverse transcription polymerase chain reaction confirmed cases from five medical centers in China. All the patients were classified into the common (n = 65), severe (n = 18), or fatal (n = 6) type. CT features included lesion distribution, location, size, shape, edge, density, and the ratio of lung lesions to extra-pulmonary lesions. A COVID-19 chest CT analysis tool (uAI-discover-COVID-19) was used to calculate the number of infections from the chest CT images. RESULTS: Fatal type COVID-19 is more common in older men, with a median age of 65 years. Fever was more common in the severe and fatal type COVID-19 patients than in the common type patients. Patients with fatal type COVID-19 were more likely to have underlying diseases. On CT examination, common type COVID-19 showed bilateral (68%), patchy (83%), ground-glass opacity (48%), or mixed (46%) lesions. Severe and fatal type COVID-19 showed bilateral multiple mixed density lesions (56%). The infection ratio (IR) increased in the common type (2.4 [4.3]), severe type (15.7 [14.3]), and fatal type (36.9 [14.2]). The IR in the inferior lobe of both lungs was statistically different from that of other lobes in common and severe type patients (P < 0.05). However, in the fatal type group, only the IR in the right inferior lung (RIL) was statistically different from that in the right superior lung(RUL), right middle lung (RML), and the left superior lung (LSL) (P < 0.05). CONCLUSION: The CT findings and clinical features of the various clinical types of COVID-19 pneumonia are different. Chest CT findings have unique characteristics in the different clinical types, which can facilitate an early diagnosis and evaluate the clinical course and severity of COVID-19.

Mechanisms and strategies for operation of fever clinics in a general hospital during prevention and control of COVID-19

OBJECTIVE: To explore the mechanisms and strategies for operation of fever clinics of a general hospital during prevention and control of COVID-19. METHODS: The working characteristics and management modes of the fever clinic of the First Medical Center of Chinese PLA General Hospital were analyzed and summarized during the period of normalized prevention and control without cases and the period with local outbreak. RESULTS: During the period of normalized prevention and control, strict pre-job admission was carried out, the new recruits must pass the qualification test for special positions, the daily training was intensified, the treatment procedures were optimized, the step of identification of infectious diseases was moved forward to the triage;the closed-loop management of information was improved, the links such as identification of infectious diseases, treatment warning, prewarning and reporting have been achieved, and the standard prevention measures were taken. During the period of local outbreak, the application for demand of personnel and prevention supplies was put forward, fever clinic was designed and expanded, supporting personnel was trained, shifts were reasonably arranged, supervisors were added, and 24-hour logistic shifts wee also added. Zero infection of health care workers and zero case of nosocomial infection were achieved during the prevention and control of epidemic. CONCLUSION: The fever clinic is an outpost of prevention and control of infectious diseases. Combined with the characteristics, it is recommended that the construction of departments, personnel management and hardware configuration should be solidified and promoted.

An IgM-like Inhalable ACE2 fusion protein broadly neutralizes SARS-CoV-2 (preprint)

Many of the currently available COVID-19 vaccines and therapeutics are not effective against newly emerged SARS-CoV-2 variants. Here, we developed the metallo-enzyme domain of angiotensin converting enzyme 2 (ACE2)—the cellular receptor of SARS-CoV-2—into an IgM-like inhalable molecule (HH-120). HH-120 binds to the SARS-CoV-2 Spike (S) protein with exceptionally high avidity and confers potent and broad-spectrum neutralization activity against all known SARS-CoV-2 variants of concern. HH-120 was successfully developed as an inhaled formulation that achieves appropriate aerodynamic properties for respiratory system delivery, and we found that aerosol inhalation of HH-120 significantly reduced viral loads and lung pathology scores in golden Syrian hamsters infected by the SARS-CoV-2 wild-type strain and the Delta variant. Our study presents a breakthrough for the inhalation delivery of large biologics like HH-120 (molecular weight ~ 1000kDa) and demonstrates that HH-120 can serve as a highly efficacious, safe, and convenient agent against all SARS-CoV-2 variants. Finally, given the known role of ACE2 in viral reception, it is conceivable that HH-120 will be efficacious against additional emergent coronaviruses.

Sustainable development-oriented location-transportation integrated optimization problem regarding multi-period multi-type disaster medical waste during COVID-19 pandemic

After the outbreak of COVID-19 pandemic, devising an effective reverse logistics supply chain to clean up disaster medical waste is conducive to controlling and containing novel coronavirus transmission. Thus, the focus of this paper concentrates on multi-period multi-type disaster medical waste location-transportation integrated optimization problem with the concern of sustainability, which is formulated as a tri-objective mixed-integer programming model with the goals of maximizing total economic benefits, minimizing total carbon emissions and total potential social risks. Then, a real-world case from Wuhan using CPLEX solver is used to validate the developed model. Results indicate that constructing DMWTTSs with flexible capacity in different periods is encouraged to handle the sharply increasing disaster medical waste. The multi-period decision model outperforms the single-period one in disaster medical waste supply chains because the former has the capability of handling the uncertainties in the future periods. Increasingly, since the increase of budget doesn’t always work well and social resources are limited, the estimation of minimum budget to obtain optimum overall performance is of great importance.

Epidemiological characteristics of 123 confirmed COVID-19 cases in Shangrao City, Jiangxi

Objective: To describe the epidemiological characteristics of confirmed COVID-19 cases in Shangrao City, and provide scientific evidence for the development of prevention and control strategies.

Response and Duration of Serum Anti-SARS-CoV-2 Antibodies After Inactivated Vaccination Within 160 Days

Background A vaccine against coronavirus disease 2019 (COVID-19) with highly effective protection is urgently needed. The anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody response and duration after vaccination are crucial predictive indicators. Objectives To evaluate the response and duration for 5 subsets of anti-SARS-CoV-2 antibodies after vaccination and their predictive value for protection. Methods We determined the response and duration for 5 subsets of anti-SARS-CoV-2 antibodies (neutralizing antibody, anti-RBD total antibody, anti-Spike IgG, anti-Spike IgM, and anti-Spike IgA) in 61 volunteers within 160 days after the CoronaVac vaccine. A logistic regression model was used to determine the predictors of the persistence of neutralizing antibody persistence. Results The seropositivity rates of neutralizing antibody, anti-RBD total antibody, anti-Spike IgG, anti-Spike IgM, and anti-Spike IgA were only 4.92%, 27.87%, 21.31%, 3.28% and 0.00%, respectively, at the end of the first dose (28 days). After the second dose, the seropositivity rates reached peaks of 95.08%, 100.00%, 100.00%, 59.02% and 31.15% in two weeks (42 days). Their decay was obvious and the seropositivity rate remained at 19.67%, 54.10%, 50.82%, 3.28% and 0.00% on day 160, respectively. The level of neutralizing antibody reached a peak of 149.40 (101.00–244.60) IU/mL two weeks after the second dose (42 days) and dropped to 14.23 (7.62–30.73) IU/mL at 160 days, with a half-life of 35.61(95% CI, 32.68 to 39.12) days. Younger participants (≤31 years) had 6.179 times more persistent neutralizing antibodies than older participants (>31 years) (P<0.05). Participants with anti-Spike IgA seropositivity had 4.314 times greater persistence of neutralizing antibodies than participants without anti-Spike IgA seroconversion (P<0.05). Conclusions Antibody response for the CoronaVac vaccine was intense and comprehensive with 95.08% neutralizing seropositivity rate, while decay was also obvious after 160 days. Therefore, booster doses should be considered in the vaccine strategies.

The Impact of Social Isolation on Cognition and Quality of Life Among Stroke Patients in China

This study examined the impactof social isolation on cognitive function and Quality of Life (QoL) among acute ischemic stroke (AIS) patients in China. We conducted in-person interviews among 206 AIS patients during the acute stage and at 3-month after onset in three cities between May 2020 and February 2021. The data was collected during and post-COVID-19 period in China. We conducted bivariate and multipleregression analyses.Results show that over time, average level of social isolation decreased, and cognitive function and QoL increased.After controllingfor covariates, social isolation was negatively associated with cognitive function (β=-0.438, p<0.01) and QoL (β=-2.521, p<0.01). These findings suggest that addressing the issue of social isolation could potentially impact patients’ cognitive function and QoL.Future studies are needed to further examine the linkages between long-term social isolation and changes in cognitive function and QoL among AIS patients.

SARS-CoV-2 Seroprevalence and Risk Factors among Convalescents in Sichuan Province, China: a retrospective cohort study (preprint)

Objectives: To understand SARS-CoV-2 seroprevalence of convalescents and assess their the immunity. Furthermore, we intend to explore the association between antibody levels and with demographic factors. Methods: 177 COVID-19 convalescents in Sichuan Province were voluntarily participated in our study. 363 serum samples were collected from June, 2020 to November, 2020. Duration of seroprevelance in these convalescents and their demographic characteristics were described, and the risk factors to antibody levels were analysed. Results: Men had more than twice the odds of having IgM antibody positive compared with women (OR=2.419, 95% CI:[1.232, 4.751]). Participants without symptoms were nearly 0.5 times IgG seropositive than those with symptoms (OR=0.455, 95% CI: [0.220, 0.940]). People aged[≥]60 years were nearly 3 times IgG seropositive than those who aged < 20 years (OR=2.986, 95% CI: [1.058, 8.432]). Seroprevalence in asymptomatic declined quicker than symptomatic. Conclusions: Age and gender may affect the antibody levels and seroprevalence. Asymptomatic appeared more easier to turn to seronegative than symptomatic. Keywords: Seroprevalence; SARS-CoV-2; Risk Factors

Post-Infection Cognitive Impairments in Elderly Patients with COVID-19 (preprint)

Background: Understanding the long-term effects of coronavirus disease 2019 (COVID-19) on cognitive function is essential for the prevention of cognitive decline in elderly population. This study aims to assess cognitive status and longitudinal decline at 6 months post-infection in elderly patients recovered from COVID-19.Methods: This cross-sectional study recruited 1013 COVID-19 inpatients aged over 60 years who were discharged from three COVID-19-designated hospitals in Wuhan, China, from February 10 to March 13, 2020. In total, 262 uninfected living spouses of COVID-19 patients were selected as controls. Subjects were examined for their current cognitive status using a Chinese version of the Telephone Interview of Cognitive Status-40 (TICS-40) and longitudinal cognitive decline using an Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Cognitive assessments were performed 6 months after patient discharge.Findings: COVID-19 patients had significantly lower TICS-40 scores (patients: 29.73±6.13; controls: 30.74±5.95, p=0.016) and higher IQCODE scores (patients: 3.40±0.81; controls: 3.15±0.39, p<0.001) than the controls. Severe COVID-19 patients had lower TICS-40 scores and higher IQCODE scores than non-severe COVID-19 patients (TICS-40: 22.98±7.12 vs. 30.46±5.53, p<0.001; IQCODE: 4.06±1.39 vs. 3.33±0.68, p<0.001) and controls (TICS-40: 22.98±7.12 vs. 30.74±5.95, p<0.001; IQCODE: 4.06±1.39 vs. 3.15±0.39, p<0.001). Severe COVID-19 patients had a higher proportion of cases with a current cognitive impairment and longitudinal cognitive decline than non-severe COVID-19 patients and controls. COVID-19 severity (OR: 8.142, 95% CI: 5.007-13.239) was associated with worse current cognitive function. Older age (OR: 1.024, 95% CI: 1.003 to 1.046), COVID-19 severity (OR: 2.277, 95% CI: 1.308 to 3.964), mechanical ventilation (OR: 5.388, 95% CI: 3.007 to 9.656), and hypertension (OR: 1.866, 95% CI: 1.376 to 2.531) were associated with an increased risk of longitudinal cognitive decline.Interpretation: SARS-CoV-2 infection is associated with delayed cognitive decline in elderly population. COVID-19 patients with risk factors, including severe disease, older age, mechanical ventilation, and hypertension, should be intensively monitored for delayed cognitive decline. Funding: National Natural Science Foundation of China.Conflict of Interest: We declared no conflict of interests.Ethical Approval: The study protocols were approved by the institutional review boards of the hospitals. Verbal informed consent was obtained from all participants prior to the survey.

An Early Study on Intelligent Analysis of Speech under COVID-19: Severity, Sleep Quality, Fatigue, and Anxiety (preprint)

The COVID-19 outbreak was announced as a global pandemic by the World Health Organisation in March 2020 and has affected a growing number of people in the past few weeks. In this context, advanced artificial intelligence techniques are brought to the fore in responding to fight against and reduce the impact of this global health crisis. In this study, we focus on developing some potential use-cases of intelligent speech analysis for COVID-19 diagnosed patients. In particular, by analysing speech recordings from these patients, we construct audio-only-based models to automatically categorise the health state of patients from four aspects, including the severity of illness, sleep quality, fatigue, and anxiety. For this purpose, two established acoustic feature sets and support vector machines are utilised. Our experiments show that an average accuracy of .69 obtained estimating the severity of illness, which is derived from the number of days in hospitalisation. We hope that this study can foster an extremely fast, low-cost, and convenient way to automatically detect the COVID-19 disease.

Characteristics and evaluation of the effectiveness of monitoring and control measures for the first 69 Patients with COVID-19 from 18 January 2020 to 2 March in Wuxi, China (preprint)

Background: The novel coronavirus disease 2019(COVID-19) outbreak and has caused has caused 82,830 confirmed cases and 4,633 deaths in China by 26 April 2020. We analyzed data on 69 infections in Wuxi to describe the epidemiologic characteristics and evaluate the control measures.Methods: The demographic characteristics, exposure history, and illness timelines of COVID-19 cases in Wuxi were collected.Results: Among the 69 positive infections with COVID-19, mild and normal types accounted for 75.36% (52/69), adolescents and children are mainly mild and asymptomatic. The basic reproductive number was estimated to be 1.12 (95% CI, 0.71 to 1.69). The mean incubation period was estimated to be 4.77 days (95% CI, 3.61 to 5.94), with a mean serial interval of 6.31 days (95%CI, 5.12 to 7.50). We also found that age (RR=1.57, 95%CI: 1.11-2.21) and fever (RR=4.09, 95%CI: 1.10-15.19) were risk factors for COVID-19 disease severity.Conclusions: The incidence of COVID-19 in Wuxi has turned into a lower level, suggesting that the early prevention and control measures have achieved effectiveness. The community transmission can be effectively prevented through isolation and virus detection of all the people who were exposed together and close contact with the infected people. Aging and fever are risk factors for clinical outcome, which might be useful for preventing severe transition.

The characteristics of laboratory tests at admission and the risk factors for adverse clinical outcomes of severe and critical COVID-19 patients (preprint)

Background  Coronavirus disease 2019(COVID-19) is a worldwide pandemic.In this study, we aimed to evaluate the risk factors of death from severe and critical COVID-19 patients.Method  A retrospective study of patients diagnosed with severe and critical COVID-19 from four hospitals in Wuhan, China, describing the clinical characteristics and laboratory results, and using Cox regression to study the risk factors was conducted.Results  Four hundred and forty-six patients with COVID-19 showed a high case fatality rate(CFR)(20.2%). All patients required oxygen therapy, and 52(12%) patients required invasive mechanical ventilation,of which 50(96%) patients died.The univariate Cox proportional hazard model showed a white blood cell count of more than 10 × 10⁹/L(HR3.903,95%CI 2.413 to 6.313),patients’ risk of death significantly increased.The multivariate Cox proportional hazard model demonstrated that older age (HR 1.074, 95% CI 1.050 to 1.098) was an independent risk factor and high white blood cell count(HR 1.119, 95% CI 1.056 to 1.186)was a predictive factor for COVID-19 on admission.Conclusions  COVID-19 is a new disease entity that carries significant risk of morbidity and CFR.Older age was an independent risk factor and high white blood cell was a predictive factor for COVID-19.

COVID-19 and Computer Audition: An Overview on What Speech & Sound Analysis Could Contribute in the SARS-CoV-2 Corona Crisis (preprint)

At the time of writing, the world population is suffering from more than 10,000 registered COVID-19 disease epidemic induced deaths since the outbreak of the Corona virus more than three months ago now officially known as SARS-CoV-2. Since, tremendous efforts have been made worldwide to counter-steer and control the epidemic by now labelled as pandemic. In this contribution, we provide an overview on the potential for computer audition (CA), i.e., the usage of speech and sound analysis by artificial intelligence to help in this scenario. We first survey which types of related or contextually significant phenomena can be automatically assessed from speech or sound. These include the automatic recognition and monitoring of breathing, dry and wet coughing or sneezing sounds, speech under cold, eating behaviour, sleepiness, or pain to name but a few. Then, we consider potential use-cases for exploitation. These include risk assessment and diagnosis based on symptom histograms and their development over time, as well as monitoring of spread, social distancing and its effects, treatment and recovery, and patient wellbeing. We quickly guide further through challenges that need to be faced for real-life usage. We come to the conclusion that CA appears ready for implementation of (pre-)diagnosis and monitoring tools, and more generally provides rich and significant, yet so far untapped potential in the fight against COVID-19 spread.

Myocardial injury is associated with in-hospital mortality of confirmed or suspected COVID-19 in Wuhan, China: A single center retrospective cohort study (preprint)

[Background] Since December 2019, a cluster of coronavirus disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China and spread rapidly from China to other countries. In-hospital mortality are high in severe cases and cardiac injury characterized by elevated cardiac troponin are common among them. The mechanism of cardiac injury and the relationship between cardiac injury and in-hospital mortality remained unclear. Studies focused on cardiac injury in COVID-19 patients are scarce. [Objectives] To investigate the association between cardiac injury and in-hospital mortality of patients with confirmed or suspected COVID-19. [Methods] Demographic, clinical, treatment, and laboratory data of consecutive confirmed or suspected COVID-19 patients admitted in Wuhan No.1 Hospital from 25th December, 2019 to 15th February, 2020 were extracted from electronic medical records and were retrospectively reviewed and analyzed. Univariate and multivariate Cox regression analysis were used to explore the risk factors associated with in-hospital death. [Results] A total of 110 patients with confirmed (n=80) or suspected (n=30) COVID-19 were screened and 48 patients (female 31.3%, mean age 70.58{+/-}13.38 year old) among them with high-sensitivity cardiac troponin I (hs-cTnI) test within 48 hours after admission were included, of whom 17 (17/48, 35.4%) died in hospital while 31 (31/48, 64.6%) were discharged or transferred to other hospital. High-sensitivity cardiac troponin I was levated in 13 (13/48, 27.1%) patents. Multivariate Cox regression analysis showed pulse oximetry of oxygen saturation (SpO2) on admission (HR 0.704, 95% CI 0.546-0.909, per 1% decrease, p=0.007), elevated hs-cTnI (HR 10.902, 95% 1.279-92.927, p=0.029) and elevated d-dimer (HR 1.103, 95%CI 1.034-1.176, per 1mg/L increase, p=0.003) on admission were independently associated with in-hospital mortality. [Conclusions] Cardiac injury defined by hs-cTnI elevation and elevated d-dimer on admission were risk factors for in-hospital death, while higher SpO2 could be seen as a protective factor, which could help clinicians to identify patients with adverse outcome at the early stage of COVID-19.

Transmission of corona virus disease 2019 during the incubation period may lead to a quarantine loophole (preprint)

Background: The ongoing outbreak of novel corona virus disease 2019 (COVID-19) in Wuhan, China, is arousing international concern. This study evaluated whether and when the infected but asymptomatic cases during the incubation period could infect others. Methods: We collected data on demographic characteristics, exposure history, and symptom onset day of the confirmed cases, which had been announced by the Chinese local authorities. We evaluated the potential of transmission during the incubation period in 50 infection clusters, including 124 cases. All the secondary cases had a history of contact with their first-generation cases prior to symptom onset. Results: The estimated mean incubation period for COVID-19 was 4.9 days (95% confidence interval [CI], 4.4 to 5.4) days, ranging from 0.8 to 11.1 days (2.5th to 97.5th percentile). The observed mean and standard deviation (SD) of serial interval was 4.1{+/-}3.3 days, with the 2.5th and 97.5th percentiles at -1 and 13 days. The infectious curve showed that in 73.0% of the secondary cases, their date of getting infected was before symptom onset of the first-generation cases, particularly in the last three days of the incubation period. Conclusions: The results indicated the transmission of COVID-9 occurs among close contacts during the incubation period, which may lead to a quarantine loophole. Strong and effective countermeasures should be implemented to prevent or mitigate asymptomatic transmission during the incubation period in populations at high risk.