Comparison of attitudes toward the medical student-led community health education service to support chronic disease self-management among students, faculty and patients.

BACKGROUND: Shortage of health professionals is one of the most important barriers for community health centers to provide quality primary care for chronic disease patients especially after the outbreak of COVID-19. Under such condition, medical students have been well-accepted as a force multiplier for community-based health service. Community service learning (CSL) based on medical student-led community health education service to support chronic disease self-management might be a valuable interactive learning tool in medical education. This study compared the attitudes toward medical student-led community health education service to support chronic disease self-management among three stakeholder roles in CSL, including medical students, faculty and patients. METHODS: This cross-sectional comparative survey was conducted using a self-developed questionnaire among the convenience samples of undergraduate students and faculty members from the Medical College, Wuhan University of Science and Technology, as well as patient volunteers with chronic diseases recruited from a free on-site clinic offered by a community health center. Attitudes toward medical student-led community health education service to support chronic disease self-management were compared among students, faculty and patients. RESULTS: A total of 515 valid questionnaires were obtained (342 were collected from medical students, 54 from faculty respondents, and 119 from patients). Overall positive attitudes toward medical student-led community health education service to support chronic disease self-management were positive. Among the three stakeholder roles, faculty and patients were more supportive of the current inadequate level of primary care provision within the community. However, patient respondents showed more negative attitudes towards using resources in higher medical education system to provide support for primary care practice, and participating in the medical student-led community health education service to support chronic disease self-management, and were most skeptical about the medical students' competency in supporting chronic disease self-management with their professional knowledge and skills. The educational value of CSL for medical undergraduates and the role of faculty instructors were most appreciated by faculty respondents. Additionally, > 62 years old and > 2 kinds of chronic diseases per patient exhibited significant correlations with positive patients' attitudes. CONCLUSIONS: Medical students, faculty and patients had overall positive attitudes towards CSL based on medical student-led community health education service to support chronic disease self-management. However, more should be done to create higher expectations and enthusiasm of patients about CSL.

Vaccination practices, knowledge and attitudes regarding COVID-19 vaccines among Chinese university students: a cross-sectional study from a comprehensive university in Wuhan.

OBJECTIVE: In China, a free national COVID-19 vaccination programme has been launched in spring 2021 and is ongoing across the country. This study aimed to preliminarily understand the current COVID-19 vaccination practices and the associated knowledge/attitude factors among Chinese university students. DESIGN AND SETTING: A single-centre cross-sectional questionnaire-based study was conducted between 1 and 20 May 2021 among a convenience sample of Chinese university students recruited from a comprehensive university in Wuhan. A total of 359 valid questionnaires were obtained. RESULTS: Just 1 month after the commencement of the university vaccination process, 75% of responding students had received the COVID-19 vaccination. Students without experience of COVID-19 infection were more likely to get vaccinated than those who had been infected. Most (57%) received information about COVID-19 vaccination through official announcements released by the university, and 67% were vaccinated at vaccination place arranged by the university. An interesting finding is that, although the overall vaccine uptake rate was 75%, nearly one-third of vaccinees did not know or incorrectly stated the type of COVID-19 vaccines that they had received. Mean knowledge test score was 3.05 out of 6, suggesting poor knowledge regarding COVID-19 vaccines. The vaccinated showed more positive attitudes towards the importance of establishing herd immunity through the COVID-19 vaccination programme for pandemic control than the non-vaccinated did. 'Effectiveness in preventing COVID-19' was perceived by 76% respondents as the most important factor contributing to COVID-19 vaccination. A total of 76% were worried about safety-related issues, including 'unknown long-term safety', 'vaccine allergy' and 'vaccine-caused COVID-19 infection'. CONCLUSIONS: Data suggested a rapid and effective progress of the national COVID-19 vaccination programme in China among university students. Taking effective official actions, as well as enhancing the belief in vaccines' effectiveness, might be necessary for the good implementation of COVID-19 vaccination programmes.

The effectiveness of travel restriction measures in alleviating the COVID-19 epidemic: evidence from Shenzhen, China.

With the expansion of the global novel coronavirus disease (COVID-19) pandemic, unprecedented interventions have been widely implemented in many countries, including China. In view of this scenario, this research aims to explore the effectiveness of population mobility restriction in alleviating epidemic transmission during different stages of the outbreak. Taking Shenzhen, a city with a large immigrant population in China, as a case study, the real-time reproduction number of COVID-19 is estimated by statistical methods to represent the dynamic spatiotemporal transmission pattern of COVID-19. Furthermore, migration data between Shenzhen and other provinces are collected to investigate the impact of nationwide population flow on near-real-time dynamic reproductive numbers. The results show that traffic flow control between populated cities has an inhibitory effect on urban transmission, but this effect is not significant in the late stage of the epidemic spread in China. This finding implies that the government should limit international and domestic population movement starting from the very early stage of the outbreak. This work confirms the effectiveness of travel restriction measures in the face of COVID-19 in China and provides new insight for densely populated cities in imposing intervention measures at various stages of the transmission cycle.

Geriatric Nutritional Risk Index is related to the risk of stroke-associated pneumonia.

BACKGROUND: Stroke-associated pneumonia (SAP) occurs frequently after a stroke. Geriatric Nutritional Risk Index (GNRI) is a valuable indicator of elderly individuals' nutritional status. This research was designed to obtain insight into the link between GNRI and SAP. METHODS: Patients with acute ischemic stroke (AIS) were categorized into the SAP and non-SAP groups. GNRI scores were divided into four layers: Q1, GNRI < 82; Q2, 82≤ GNRI < 92; Q3, 92≤ GNRI ≤98; Q4, GNRI > 98. To identify the independent risk and protective factors of developing SAP, logistic regression analyses were conducted. Additionally, we utilized the restricted cubic spline (RCS) analysis to test the effect of GNRI on the SAP risk. RESULTS: The SAP group showed lower GNRI scores than the non-SAP group (96.88 ± 9.36 vs. 100.88 ± 8.25, p  <  0.001). According to the logistic regression model, the Q1 and Q2 layers showed a higher risk of SAP than the Q3 layer, while the Q4 layer showed a lower SAP risk (all p < 0.05). Besides, the RCS model found that the risk of SAP dropped dramatically as GNRI scores increased, which got stable when the GNRI score was more significant than 100. CONCLUSION: Lower GNRI scores were linked to a higher prevalence of SAP. In clinical practice, GNRI showed predictive value for SAP, which could be helpful in early SAP intervention and therapy.

Exosomal Vaccine Loading T Cell Epitope Peptides of SARS-CoV-2 Induces Robust CD8+ T Cell Response in HLA-A Transgenic Mice.

Purpose: Current vaccines for the SARS-CoV-2 virus mainly induce neutralizing antibodies but overlook the T cell responses. This study aims to generate an exosomal vaccine carrying T cell epitope peptides of SARS-CoV-2 for the induction of CD8+ T cell response. Methods: Thirty-one peptides presented by HLA-A0201 molecule were conjugated to the DMPE-PEG-NHS molecules, and mixed with DSPE-PEG to form the peptide-PEG-lipid micelles, then fused with exosomes to generate the exosomal vaccine, followed by purification using size-exclusion chromatography and validation by Western blotting, liquid nuclear magnetic resonance (NMR) test and transmission electron microscopy. Furthermore, the exosomal vaccine was mixed with Poly (I:C) adjuvant and subcutaneously administered for three times into the hybrid mice of HLA-A0201/DR1 transgenic mice with wild-type mice. Then, the epitope-specific T cell responses were detected by ex vivo ELISPOT assay and intracellular cytokine staining. Results: The exosomal vaccine was purified from the Peak 2 fraction of FPLC and injected into the hybrid mice for three times. The IFN-γ spot forming units and the frequencies of IFN-γ+/CD8+ T cells were 10-82-fold and 13-65-fold, respectively, higher in the exosomal vaccine group compared to the Poly (I:C) control group, without visible organ toxicity. In comparison with the peptides cocktail vaccine generated in our recent work, the exosomal vaccine induced significantly stronger T cell response. Conclusion: Exosomal vaccine loading T cell epitope peptides of SARS-CoV-2 virus was initially generated without pre-modification for both peptides and exosomes, and elicited robust CD8+ T cell response in HLA-A transgenic mice.

Efficacy and Safety of MSC Cell Therapies for Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis.

MSC (a.k.a. mesenchymal stem cell or medicinal signaling cell) cell therapies show promise in decreasing mortality in acute respiratory distress syndrome (ARDS) and suggest benefits in treatment of COVID-19-related ARDS. We performed a meta-analysis of published trials assessing the efficacy and adverse events (AE) rates of MSC cell therapy in individuals hospitalized for COVID-19. Systematic searches were performed in multiple databases through November 3, 2021. Reports in all languages, including randomized clinical trials (RCTs), non-randomized interventional trials, and uncontrolled trials, were included. Random effects model was used to pool outcomes from RCTs and non-randomized interventional trials. Outcome measures included all-cause mortality, serious adverse events (SAEs), AEs, pulmonary function, laboratory, and imaging findings. A total of 736 patients were identified from 34 studies, which included 5 RCTs (n = 235), 7 non-randomized interventional trials (n = 370), and 22 uncontrolled comparative trials (n = 131). Patients aged on average 59.4 years and 32.2% were women. When compared with the control group, MSC cell therapy was associated with a reduction in all-cause mortality (RR = 0.54, 95% CI: 0.35-0.85, I  2 = 0.0%), reduction in SAEs (IRR = 0.36, 95% CI: 0.14-0.90, I  2 = 0.0%) and no significant difference in AE rate. A sub-group with pulmonary function studies suggested improvement in patients receiving MSC. These findings support the potential for MSC cell therapy to decrease all-cause mortality, reduce SAEs, and improve pulmonary function compared with conventional care. Large-scale double-blinded, well-powered RCTs should be conducted to further explore these results.

Global Trends in Urban Agriculture Research: A Pathway toward Urban Resilience and Sustainability

Urban agriculture has been proposed as an important urban element to deal with the challenges of food insecurity and environmental deterioration. In order to track current popular topics and global research trends in urban agriculture, we used bibliometric analysis and visualization mapping to evaluate and analyze the developments in the knowledge of urban agriculture based on 605 papers from the core collection database Web of Science from 2001–2021. The results were as follows. (1) The number of urban agriculture publications increased substantially year by year, indicating that the field is attracting increasing attention. The University of Kassel, Chinese Academy of Sciences, and University of Freiburg are the most productive research institutions in the field of urban agriculture. The top-five most influential countries are the Unites States, Germany, the United Kingdom, Italy, and China, of which the Unites States plays a central role in the cooperative linkage between countries. (2) Research on urban agriculture focuses not only on food production and different styles but also on how to realize the various functions of urban agriculture. In addition, UA-related sustainability and the water-energy-food nexus have become two emerging research topics. (3) Urban agriculture does not necessarily mean a resource-conserving and environmentally friendly food system. To achieve sustainable development, a transition based on technological innovation is needed. How to improve the sustainable development level of the food system while fully considering the resilience, sustainability, and versatility of urban agriculture is the main direction of future research.

Impact of the COVID-19 pandemic on household disinfectant consumption behaviors and related environmental concerns: A questionnaire-based survey in China.

Considering the potential hazardous effects of disinfectant residues on environment, organisms and biodiversity, the sharp rise in use of disinfectants during COVID-19 pandemic has been considered highly likely to cause worldwide secondary disasters in ecosystems and human health. This questionnaire-based survey investigated the impact of COVID-19 outbreak on household disinfectant product consumption levels and behavior of 3667 Chinese residents. In particular, in the context that no strategy is currently available to minimize the disinfectant pollution, based on the similarities between disinfectants and pharmaceuticals, we proposed a perspective of ecopharmacovigilance (EPV), which is an effective measure to minimize the environmental risks posed by pharmaceuticals using drug administration protocols, for disinfectant environmental risk management. The public's environmental perceptions, attitudes and the related practices regarding household disinfectant consumption from an EPV perspective were also included in the study. The results showed that the COVID-19 outbreak caused a tremendous rise in the public's household disinfectant consumption and usage levels in China. After the COVID-19 outbreak, the chlorine-based and alcohol-based disinfectants were considered as the most preferred products for household disinfection and hand sanitization, respectively. Importantly, the Chinese public's environmental perceptions and practice on disinfectants were poor. Less than half respondents had positive attitudes toward the source control of disinfectant pollution. The population groups including females, the middle aged adults, those having healthcare professional background, as well as the higher-educated could be focused on to develop targeted efforts for the future control of disinfectant pollution in environment.

Liver Chemistries in Patients With COVID-19 Who Were Discharged Alive or Died: A Meta-analysis.

Although abnormal liver chemistries are linked to a higher risk of coronavirus disease 2019 (COVID-19)-related death, liver manifestations may be diverse and even confusing. Thus, we performed a meta-analysis of published liver manifestations and described the liver damage in patients with COVID-19 who died or discharged alive. We searched PubMed, Google Scholar, medRxiv, bioRxiv, the Cochrane Library, Embase, and three Chinese electronic databases through April 22, 2020. We analyzed pooled data on liver chemistries stratified by the main clinical outcome of COVID-19, using a fixed or random-effects model. In our meta-analysis of 19 studies, which included a total of 4,103 patients, the pooled mean alanine aminotransferase and aspartate aminotransferase levels were, respectively, 31.7 IU/L and 51.0 IU/L in the patients with COVID-19 who died and 27.7 IU/L and 32.9 IU/L in those discharged alive (both P < 0.0001). Compared with the patients discharged alive, those who died tended to have lower albumin levels but longer prothrombin time and higher international normalized ratio. Conclusion: In this meta-analysis, according to the main clinical outcome of COVID-19, we comprehensively describe three patterns of liver impairment related to COVID-19: hepatocellular injury, cholestasis, and hepatocellular disfunction. The patients who died from COVID-19 tended to have different liver chemistries from those discharged alive. Special caution should be given to the patients with a relatively higher index of liver chemistries.

Potential Role of Gut Microbiota in Traditional Chinese Medicine against COVID-19.

The coronavirus disease 2019 (COVID-19) spreads and rages around the world and threatens human life. It is disappointing that there are no specific drugs until now. The combination of traditional Chinese medicine (TCM) and western medication seems to be the current more effective treatment strategy for COVID-19 patients in China. In this review, we mainly discussed the relationship between COVID-19 and gut microbiota (GM), as well as the possible impact of TCM combined with western medication on GM in the treatment of COVID-19 patients, aiming to provide references for the possible role of GM in TCM against COVID-19. The available data suggest that GM dysbiosis did occur in COVID-19 patients, and the intervention of GM could ameliorate the clinical condition of COVID-19 patients. In addition, TCMs (e.g., Jinhua Qinggan granule, Lianhua Qingwen capsule, Qingfei Paidu decoction, Shufeng Jiedu capsule, Qingjin Jianghuo decoction, Toujie Quwen granules, and MaxingShigan) have been proven to be safe and effective for the treatment of COVID-19 in Chinese clinic. Among them, Ephedra sinica, Glycyrrhiza uralensis, Bupleurum chinense, Lonicera japonica,Scutellaria baicalensi, and Astragalus membranaceus are common herbs and have a certain regulation on GM, immunity, and angiotensin converting enzyme 2 (ACE2). Notably, Qingfei Paidu decoction and MaxingShigan have been demonstrated to modulate GM. Finally, the hypothesis of GM-mediated TCM treatment of COVID-19 is proposed, and more clinical trials and basic experiments need to be initiated to confirm this hypothesis.

Liver Chemistries in COVID-19 Patients with Survival or Death: A Meta-Analysis (preprint)

Background and Aims: Although abnormal liver chemistries are linked to higher risk of death related to coronavirus disease (COVID-19), liver manifestations may be diverse and even confused. Thus, we performed a meta-analysis of published liver manifestations and described the liver damage in COVID-19 patients with death or survival. Methods: We searched PubMed, Google Scholar, medRxiv, bioRxiv, Cochrane Library, Embase, and three Chinese electronic databases through April 22, 2020. We analyzed pooled data on liver chemistries stratified by the main clinical outcome of COVID-19 using a fixed or random-effects model. Results: In the meta-analysis of 18 studies, which included a total of 2,862 patients, the pooled mean alanine aminotransferase (ALT) was 30.9 IU/L in the COVID-19 patients with death and 26.3 IU/L in the COVID-19 patients discharged alive (p < 0.0001). The pooled mean aspartate aminotransferase (AST) level was 45.3 IU/L in the COVID-19 patients with death while 30.1 IU/L in the patients discharged alive (p < 0.0001). Compared with the discharged alive cases, the dead cases tended to have lower albumin levels but longer prothrombin time, and international standardized ratio. Conclusions: In this meta-analysis, according to the main clinical outcome of COVID-19, we comprehensively described three patterns of liver impairment related to COVID-19, hepatocellular injury, cholestasis, and hepatocellular disfunction. Patients died from COVID-19 tend to have different liver chemistries from those are discharged alive. Close monitoring of liver chemistries provides an early warning against COVID-19 related death.

Liver Chemistries in Patients with Severe or Non-Severe COVID-19: a Meta-Analysis (preprint)

Background & Aims: Cumulating observations have indicated that COVID-19 patients undergo different patterns of abnormal liver chemistries. We performed a meta-analysis of published liver manifestations and tried to describe the liver damage. Methods: We searched PubMed, google scholar, Embase, Cochrane Library, medRxiv, bioRxiv, and three Chinese electronic databases through April 18, 2020 according to the Preferred Reporting Items for Meta-Analyses. We analyzed pooled data on liver chemistries stratified by the severity of COVID-19 using a fixed or random effects model. Results: In a meta-analysis of 37 studies, comprising 6,235 patients, the pooled mean of ALT was 36.4 IU/L in the severe cases of COVID-19 while 27.8 IU/L in the non-severe cases (95% CI: -9.4- -5.1, p<0.0001). Pooled average of AST was 46.8 IU/L in the severe cases while 30.4 IU/L in the non-severe cases (95% CI: -15.1- -10.4, p<0.0001). Compared with the non-severe cases, the severe cases tended to have higher {gamma}-Glutamyltransferase while lower albumin. Conclusions: In this meta-analysis, we comprehensively described three patterns of liver impairment related to COVID-19, including hepatocellular injury, cholestasis, and synthetic disfunction, according to the severity of the COVID-19. Patients with abnormal liver tests are at higher risks of progressing to severe disease. Close monitoring on liver chemistries helps to early warn against disease progression.

Deep Learning-Based Recognizing COVID-19 and other Common Infectious Diseases of the Lung by Chest CT Scan Images (preprint)

Purpose: COVID-19 has become global threaten. CT acts as an important method of diagnosis. However, human-based interpretation of CT imaging is time consuming. More than that, substantial inter-observer-variation cannot be ignored. We aim at developing a diagnostic tool for artificial intelligence (AI)-based classification of CT images for recognizing COVID-19 and other common infectious diseases of the lung. Experimental Design: In this study, images were retrospectively collected and prospectively analyzed using machine learning. CT scan images of the lung that show or do not show COVID-19 were used to train and validate a classification framework based on convolutional neural network. Five conditions including COVID-19 pneumonia, non-COVID-19 viral pneumonia, bacterial pneumonia, pulmonary tuberculosis, and normal lung were evaluated. Training and validation set of images were collected from Wuhan Jin Yin-Tan Hospital whereas test set of images were collected from Zhongshan Hospital Xiamen University and the fifth Hospital of Wuhan. Results: Accuracy, sensitivity, and specificity of the AI framework were reported. For test dataset, accuracies for recognizing normal lung, COVID-19 pneumonia, non-COVID-19 viral pneumonia, bacterial pneumonia, and pulmonary tuberculosis were 99.4%, 98.8%, 98.5%, 98.3%, and 98.6%, respectively. For the test dataset, accuracy, sensitivity, specificity, PPV, and NPV of recognizing COVID-19 were 98.8%, 98.2%, 98.9%, 94.5%, and 99.7%, respectively. Conclusions: The performance of the proposed AI framework has excellent performance of recognizing COVID-19 and other common infectious diseases of the lung, which also has balanced sensitivity and specificity.

Factors associated with prolonged viral shedding and impact of Lopinavir/Ritonavir treatment in hospitalised non-critically ill patients with SARS-CoV-2 infection

BACKGROUND: The duration of viral shedding is central to guide the decisions of isolation precautions and antiviral treatment. However, studies regarding the risk factors associated with prolonged SARS-CoV-2 shedding and the impact of Lopinavir/Ritonavir (LPV/r) treatment on viral shedding remain scarce. METHODS: Data were collected from all SARS-CoV-2 infected patients who were admitted to isolation wards and had reverse transcription polymerase chain-reaction conversion at the No.3 People's Hospital of Hubei province between 31 January and 09 March 2020. We compared clinical characteristics and SARS-CoV-2 RNA shedding between patients initiated with LPV/r treatment and those without. Logistic regression analysis was employed to evaluate the risk factors associated with prolonged viral shedding. RESULTS: Of 120 patients, the median age was 52 years, 54 (45%) were male and 78 (65%) received LPV/r treatment. The median duration of SARS-CoV-2 RNA detection from symptom onset was 23 days (IQR, 18-32 days). Older age (odd ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05, p=0.03) and the lack of LPV/r treatment (OR 2.42, 95% CI 1.10-5.36, p=0.029) were independent risk factors of prolonged SARS-CoV-2 RNA shedding. Patients who initiated LPV/r treatment within 10 days from symptom onset, but not initiated from day 11 onwards, had significantly shorter viral shedding duration compared with those without LPV/r treatment (median 19 days versus 28.5 days, Log-rank p<0.001). CONCLUSION: Older age and the lack of LPV/r treatment were independently associated with prolonged SARS-CoV-2 RNA shedding in patients with COVID-19. Earlier administration of LPV/r treatment could shorten viral shedding duration.