Government-Enterprise Collusion and the Effectiveness of Environmental Regulations: Implications for Public Health.

Effective environmental management will create a win-win situation for building an ecological civilization with the potential to control the COVID-19 pandemic. From the perspective of government-enterprise collusion (GEC), this study analyzes the moderating effects of the officials' promotion incentives and turnover on the effectiveness of environmental regulations utilizing a panel dataset on 276 cities in China from 2003 to 2019. The study reveals the following empirical results: First, promotion incentives positively moderate the relationship between environmental regulations and environmental pollution, mainly air pollution; results for water pollution are not significant. Compared with general cities, the positive moderating effect of promotion incentives in high-level cities is weaker and the negative moderating effect is more potent. Additionally, the moderating effect of promotion incentives is predominantly positive in the new developmental stage from 2013 to 2019. Second, the negative moderating effect of officials' turnover on the effectiveness of environmental regulations is mainly observed for water pollution but not evident for air pollution. Compared with high-level cities, officials' turnover in general cities is more conducive to the effectiveness of environmental regulations. These findings provide beneficial insights for promoting green growth by improving official governance and destroying GEC.

One-Step Formation of Targeted Liposomes in a Versatile Microfluidic Mixing Device.

Targeted liposomes, as a promising carrier, have received tremendous attention in COVID-19 vaccines, molecular imaging, and cancer treatment, due to their enhanced cellular uptake and payload accumulation at target sites. However, the conventional methods for preparing targeted liposomes still suffer from limitations, including complex operation, time-consuming, and poor reproducibility. Herein, a facile and scalable strategy is developed for one-step construction of targeted liposomes using a versatile microfluidic mixing device (MMD). The engineered MMD provides an advanced synthesis platform for multifunctional liposome with high production rate and controllability. To validate the method, a programmed death-ligand 1 (PD-L1)-targeting aptamer modified indocyanine green (ICG)-liposome (Apt-ICG@Lip) is successfully constructed via the MMD. ICG and the PD-L1-targeting aptamer are used as model drug and targeting moiety, respectively. The Apt-ICG@Lip has high encapsulation efficiency (89.9 ± 1.4%) and small mean diameter (129.16 ± 5.48 nm). In vivo studies (PD-L1-expressing tumor models) show that Apt-ICG@Lip can realize PD-L1 targeted photoacoustic imaging, fluorescence imaging, and photothermal therapy. To verify the versatility of this approach, various targeted liposomes with different functions are further prepared and investigated. These experimental results demonstrate that this method is concise, efficient, and scalable to prepare multifunctional targeted liposomal nanoplatforms for molecular imaging and disease theranostics.

Exploring the driving factors of haze events in Beijing during Chinese New Year holidays in 2020 and 2021 under the influence of COVID-19 pandemic.

Unexpected outbreak of the 2019 novel coronavirus (COVID-19) has profoundly altered the way of human life and production activity, which posed visible impacts on PM2.5 and its chemical species. The abruptly emergency reduction in human activities provided an opportunity to explore the synergetic impacts of multi-factors on shaping PM2.5 pollution. Here, we conducted two comprehensive observation measurements of PM2.5 and its chemical species from 1 January to 16 February in Beijing 2020 and the same lunar date in 2021, to investigate temporal variations and reveal the driving factors of haze before and after Chinese New Year (CNY). Results show that mean PM2.5 concentrations during the whole observation were 63.83 and 66.86 µg/m3 in 2020 and 2021, respectively. Higher secondary inorganic species were observed after CNY, and K+, Cl- showed three prominent peaks which associated closely with fireworks burnings from suburb Beijing and surroundings, verifying that they could be used as two representative tracers of fireworks. Further, we explored the impacts of meteorological conditions, regional transportation as well as chemical reactions on PM2.5. We found that unfavorable meteorological conditions accounted for 11.0 % and 16.9 % of PM2.5 during CNY holidays in 2020 and 2021, respectively. Regional transport from southwest and southeast (south) played an important role on PM2.5 during the two observation periods. Higher ratio of NO3-/SO42- were observed under high OX and low RH conditions, suggesting the major pathway of NO3- and SO42- formation could be photochemical process and aqueous-phase reaction. Additionally, nocturnal chemistry facilitated the formation of secondary components of both inorganic and organic. This study promotes understandings of PM2.5 pollution in winter under the influence of COVID-19 pandemic and provides a well reference for haze and PM2.5 control in future.

Impact of the COVID-19 pandemic on cardiac implantable electronic device implantation in China: Insights from 2 years of changing pandemic conditions.

Background: A substantial reduction in the number of cardiac implantable electronic device (CIED) implantation was reported in the early stages of the COVID-19 pandemic. None of the studies have yet explored changes in CIED implantation during the following pandemic. Objective: To explore changes in CIED implantation during the COVID-19 pandemic from 2020 to 2021. Methods: From 2019 to 2021, 177,263 patients undergone CIED implantation from 1,227 hospitals in China were included in the analysis. Generalized linear models measured the differences in CIED implantation in different periods. The relationship between changes in CIED implantation and COVID-19 cases was assessed by simple linear regression models. Results: Compared with the pre-COVID-19 period, the monthly CIED implantation decreased by 17.67% (95% CI: 16.62-18.72%, p < 0.001) in 2020. In 2021, the monthly number of CIED implantation increased by 15.60% (95% CI: 14.34-16.85%, p < 0.001) compared with 2020. For every 10-fold increase in the number of COVID-19 cases, the monthly number of pacemaker implantation decreased by 429 in 2021, while it decreased by 676 in 2020. The proportion of CIED implantation in secondary medical centers increased from 52.84% in 2019 to 56.77% in 2021 (p < 0.001). For every 10-fold increase in regional accumulated COVID-19 cases, the proportion of CIED implantation in secondary centers increased by 6.43% (95% CI: 0.47-12.39%, p = 0.036). Conclusion: The impact of the COVID-19 pandemic on the number of CIED implantation is diminishing in China. Improving the ability of secondary medical centers to undertake more operations may be a critical way to relieve the strain on healthcare resources during the epidemic.

Impact of COVID-19 pandemic on catheter ablation in China: A spatiotemporal analysis.

Background: The COVID-19 pandemic has significantly impacted routine cardiovascular health assessments and services. We aim to depict the temporal trend of catheter ablation (CA) and provide experience in dealing with the negative impact of the COVID-19 pandemic. Methods: Data on CA between January 2019, and December 2021, were extracted from the National Center for Cardiovascular Quality Improvement platform. CA alterations from 2019 to 2021 were assessed with a generalized estimation equation. Results: A total of 347,924 patients undergoing CA were included in the final analysis. The CA decreased remarkably from 122,839 in 2019 to 100,019 (-18.58%, 95% CI: -33.40% to -3.75%, p = 0.02) in 2020, and increased slightly to 125,006 (1.81%, 95% CI: -7.01% to 3.38%, p = 0.49) in 2021. The CA experienced the maximal reduction in February 2020 (-88.78%) corresponding with the peak of monthly new COVID-19 cases and decreased by 54.32% (95%CI: -71.27% to -37.37%, p < 0.001) during the 3-month lockdown and increased firstly in June 2020 relative to 2019. Since then, the CA in 2020 remained unchanged relative to 2019 (-0.06%, 95% CI: -7.01% to 3.38%, p = 0.98). Notably, the recovery of CA in 2021 to pre-COVID-19 levels was mainly driven by the growth of CA in secondary hospitals. Although there is a slight increase (2167) in CA in 2021 relative to 2019, both the absolute number and proportion of CA in the top 50 hospitals nationwide [53,887 (43.09%) vs. 63,811 (51.95%), p < 0.001] and top three hospitals in each province [66,152 (52.73%) vs. 72,392 (59.28%), p < 0.001] still declined significantly. Conclusions: The CA experienced a substantial decline during the early phase of the COVID-19 pandemic, and then gradually returned to pre-COVID-19 levels. Notably, the growth of CA in secondary hospitals plays an important role in the overall resumption, which implies that systematic guidance of secondary hospitals with CA experience may aid in mitigating the negative impact of the COVID-19 pandemic.

Impact of the COVID-19 pandemic on cardiac implantable electronic device implantation in China: Insights from 2 years of changing pandemic conditions

Background A substantial reduction in the number of cardiac implantable electronic device (CIED) implantation was reported in the early stages of the COVID-19 pandemic. None of the studies have yet explored changes in CIED implantation during the following pandemic. Objective To explore changes in CIED implantation during the COVID-19 pandemic from 2020 to 2021. Methods From 2019 to 2021, 177,263 patients undergone CIED implantation from 1,227 hospitals in China were included in the analysis. Generalized linear models measured the differences in CIED implantation in different periods. The relationship between changes in CIED implantation and COVID-19 cases was assessed by simple linear regression models. Results Compared with the pre-COVID-19 period, the monthly CIED implantation decreased by 17.67% (95% CI: 16.62–18.72%, p < 0.001) in 2020. In 2021, the monthly number of CIED implantation increased by 15.60% (95% CI: 14.34–16.85%, p < 0.001) compared with 2020. For every 10-fold increase in the number of COVID-19 cases, the monthly number of pacemaker implantation decreased by 429 in 2021, while it decreased by 676 in 2020. The proportion of CIED implantation in secondary medical centers increased from 52.84% in 2019 to 56.77% in 2021 (p < 0.001). For every 10-fold increase in regional accumulated COVID-19 cases, the proportion of CIED implantation in secondary centers increased by 6.43% (95% CI: 0.47–12.39%, p = 0.036). Conclusion The impact of the COVID-19 pandemic on the number of CIED implantation is diminishing in China. Improving the ability of secondary medical centers to undertake more operations may be a critical way to relieve the strain on healthcare resources during the epidemic.

Understanding and revealing the intrinsic impacts of the COVID-19 lockdown on air quality and public health in North China using machine learning.

To avoid the spread of COVID-19, China implemented strict prevention and control measures, resulting in dramatic variations in urban and regional air quality. With the complex effect from long-term emission mitigation and meteorology variation, an accurate evaluation of the net effect from lockdown on air quality changes has not been fully quantified. Here, we combined machine learning algorithm and Theil-Sen regression technique to eliminate meteorological and long-term trends effects on air pollutant concentrations and precisely detect concentrations changes those ascribed to lockdown measures in North China. Our results showed that, compared to the same period in 2015-2019, the adverse meteorology during the lockdown period (January 25th to March 15th) in early 2020 increased PM2.5 concentration in North China by 9.8 %, while the reduction of anthropogenic emissions led to a 32.2 % drop. Stagnant meteorological conditions have a more significant impact on the ground-level air quality in the Beijing-Tianjin-Hebei Region than that in Shanxi and Shandong provinces. After further striping out the effect of long-term emission reduction trend, the lockdown-derived NO2, PM2.5, and O3 shown variety change trend, and at -30.8 %, -27.6 %, and +10.0 %, respectively. Air pollutant changes during the lockdown could be overestimated up to 2-fold without accounting for the influences of meteorology and long-term trends. Further, with pollution reduction during the lockdown period, it would avoid 15,807 premature deaths in 40 cities. If with no deteriorate meteorological condition, the total avoided premature should increase by 1146.

Spatiotemporal evolution of online attention to vaccines since 2011: An empirical study in China.

Since the outbreak of Coronavirus Disease 2019 (COVID-19), the Chinese government has taken a number of measures to effectively control the pandemic. By the end of 2021, China achieved a full vaccination rate higher than 85%. The Chinese Plan provides an important model for the global fight against COVID-19. Internet search reflects the public's attention toward and potential demand for a particular thing. Research on the spatiotemporal characteristics of online attention to vaccines can determine the spatiotemporal distribution of vaccine demand in China and provides a basis for global public health policy making. This study analyzes the spatiotemporal characteristics of online attention to vaccines and their influencing factors in 31 provinces/municipalities in mainland China with Baidu Index as the data source by using geographic concentration index, coefficient of variation, GeoDetector, and other methods. The following findings are presented. First, online attention to vaccines showed an overall upward trend in China since 2011, especially after 2016. Significant seasonal differences and an unbalanced monthly distribution were observed. Second, there was an obvious geographical imbalance in online attention to vaccines among the provinces/municipalities, generally exhibiting a spatial pattern of "high in the east and low in the west." Low aggregation and obvious spatial dispersion among the provinces/municipalities were also observed. The geographic distribution of hot and cold spots of online attention to vaccines has clear boundaries. The hot spots are mainly distributed in the central-eastern provinces and the cold spots are in the western provinces. Third, the spatiotemporal differences in online attention to vaccines are the combined result of socioeconomic level, socio-demographic characteristics, and disease control level.

Impact of COVID 19 Pandemic and Big Data on China's International Trade: Challenges and Countermeasures.

Early 2020 witnessed the coronavirus disease 2019 (COVID-19) pandemic followed by a nationwide lockdown in the whole history for the first time. In this raising dilemma, multiple countries had a serious impact on their international trade, especially during the lockdown. It is also widely accepted that the lives of individuals had been changing ever since the spread of COVID-19. Several other sectors were badly affected during the pandemic. For the above reasons, service industries had a significant impact before and after the pandemic. Based on the data collected, it was identified that the pandemic affected the service industries, enterprises, and other organizations that contribute to the economic growth of the nation. It was also found that the pandemic has adversely impacted private and public enterprises. In addition, the study examined the impact of COVID-19 on China's international trade using artificial intelligence and blockchain technology. Another objective of the article is to examine the impact of big data on China's international trade. The study suggests upgrading the trading policies of China to deal with the challenges being faced in the trading industry.

Distribution, Biotransformation, Pharmacological Effects, Metabolic Mechanism and Safety Evaluation of Platycodin D: A Comprehensive Review.

Platycodonis Radix (Jiegeng), the dried root of Platycodon grandiflorum, is a traditional herb used as both medicine and food. Its clinical application for the treatment of cough, phlegm, sore throat, pulmonary and respiratory diseases has been thousands of years in China. Platycodin D is the main active ingredient in Platycodonis Radix, which belongs to the family of pentacyclic triterpenoid saponins because it contains an oleanolane type aglycone linked with double sugar chains. Modern pharmacology has demonstrated that Platycodin D displays various biological activities, such as analgesics, expectoration and cough suppression, promoting weight loss, anti-tumor and immune regulation, suggesting that Platycodin D has the potential to be a drug candidate and an interesting target as a natural product for clinical research. In this review, the distribution and biotransformation, pharmacological effects, metabolic mechanism and safety evaluation of Platycodin D are summarized to lay the foundation for further studies.

Meteorology-normalized variations of air quality during the COVID-19 lockdown in three Chinese megacities.

To avoid the spread of COVID-19, China implemented strict prevention and control measures, resulting in dramatic variations in air quality. Here, we applied a machine learning algorithm (random forest model) to eliminate meteorological effects and characterize the high-resolution variation characteristics of air quality induced by COVID-19 in Beijing, Wuhan, and Urumqi. Our RF model estimates showed that the highest decrease in deweathered PM2.5 in Wuhan (-43.6%) and Beijing (-14.0%) was at traffic stations during lockdown period (February 1- March 15, 2020), while it was at industry stations in Urumqi (-54.2%). Deweathered NO2 decreased significantly in each city (∼30%-50%), whereas accompanied by a notable increase in O3. The diurnal patterns show that the morning peaks of traffic-related NO2 and CO almost disappeared. Additionally, our results suggested that meteorological effects offset some of the reduction in pollutant concentrations. Adverse meteorological conditions played a leading role in the variation in PM2.5 concentration in Beijing, which contributed to +33.5%. The true effect of lockdown reduced the PM2.5 concentrations in Wuhan, Beijing, and Urumqi by approximately 14.6%, 17.0%, and 34.0%, respectively. In summary, lockdown is the most important driver of the decline in pollutant concentrations, but the reduction of SO2 and CO is limited and they are mainly influenced by changing trends. This study provides insights into quantifying variations in air quality due to the lockdown by considering meteorological variability, which varies greatly from city to city, and provides a reference for changes in city scale pollutant concentrations during the lockdown.

COVID-19 vaccines in patients with decompensated cirrhosis: a retrospective cohort on safety data and risk factors associated with unvaccinated status.

BACKGROUND: Safety data reported from the large-scale clinical trials of the coronavirus disease 2019 (COVID-19) vaccine are extremely limited in patients with decompensated cirrhosis. The vaccination campaign in this specific population could be difficult due to uncertainty about the adverse events following vaccination. We aimed to assessed the COVID-19 vaccination rate, factors associated with unvaccinated status, and the adverse events following vaccination in patients with decompensated cirrhosis. METHODS: This is a retrospective study from Ruijin Hospial (Shanghai, China) on an ongoing prospective cohort designed for long-term survival analysis of decompensated cirrhotic patients who recovered from decompensating events or acute-on-chronic liver failure (ACLF) between 2016 and 2018. We assessed the COVID-19 vaccination rate, the number of doses, type of vaccine, safety data, patient-reported reasons for remaining unvaccinated, factors associated with unvaccinated status, and the adverse events of COVID-19 vaccine. Binary logistic regression was used for identifying factors associated with unvaccinated status. RESULTS: A total of 229 patients with decompensated cirrhosis without previous SARS-CoV-2 infection participated (mean age, 56 ± 12.2 years, 75% male, 65% viral-related cirrhosis). Mode of decompensation were grade II‒III ascites (82.5%), gastroesophageal varices bleeding (7.9%), hepatic encephalopathy (7.9%). Eighty-five participants (37.1%) received at least one dose of vaccination (1 dose: n = 1, 2 doses: n = 65, 3 doses: n = 19) while 62.9% remained unvaccinated. Patient-reported reasons for remaining unvaccinated were mainly fear of adverse events (37.5%) and lack of positive advice from healthcare providers (52.1%). The experience of hepatic encephalopathy (OR = 5.61, 95% CI: 1.24-25.4) or ACLF (OR = 3.13, 95% CI: 1.12-8.69) and post-liver transplantation status (OR = 2.47, 95% CI: 1.06-5.76) were risk factors of remaining unvaccinated independent of residential areas. The safety analysis demonstrated that 75.3% had no adverse events, 23.6% had non-severe reactions (20% injection-site pain, 1.2% fatigue, 2.4% rash) and 1.2% had a severe event (development of acute decompensation requiring hospitalization). CONCLUSIONS: Patients with decompensated cirrhosis in eastern China are largely remained at unvaccinated status, particularly those with previous episodes of ACLF or hepatic encephalopathy and liver transplantation recipients. Vaccination against COVID-19 in this population is safe.

Socioeconomic Determinants of Melanoma-Related Health Literacy and Attitudes Among College Students in China: A Population-Based Cross-Sectional Study.

Objectives: To investigate the association of gender, ethnicity, living region, and socioeconomic status (SES) with health literacy and attitudes toward nevi and melanoma in Chinese adolescents and to examine whether health literacy mediates the association of SES with attitudes. Study Design: A multicenter cross-sectional study was conducted among newly enrolled college students. First-year students were recruited from five universities in different regions of China in 2018 using the cluster sampling method. The observers were blinded to the participants. Methods: Health literacy and attitudes were measured using a previously validated tool (Nevus and Melanoma Health Literacy and attitudes Test). SES was measured by annual family income and parental highest educational level. Nonparametric test was used to examine the association of participants' characteristics with health literacy and attitudes. Two-level generalized linear model with logarithm link function and Gamma distribution was used individually for SES. The mediation effect model was used to examine the mediation effect of health literacy. Results: A total of 21,086 questionnaires were completed by college students with a mean age of 18.0 ± 0.8 years. The mean scores of health literacy and attitudes were 9.83 ± 7.46 (maximum score: 28) and 16.98 ± 2.92 (maximum score: 20), respectively. Female, Han nationality, annual family income, and parental educational levels were positively associated with health literacy and attitudes. Regional differences showed different effects on health literacy and attitudes. A mediation model showed that literacy mediated the association of SES with attitudes toward nevi and melanoma. Health literacy mediated ~30-50% of the association of SES with attitudes. Conclusions: Melanoma-related health literacy among Chinese college students is generally insufficient and needs to be improved. Targeted and personalized health education for improving health literacy related to nevi and melanoma may improve the general population's attitudes and further promote health-related behavior to prevent and identify early-stage melanoma.

Exploring the Online EFL Classroom Ecology of Middle Schools During the COVID-19 Lockdown

The outbreak of COVID-19 has induced an abrupt shift from face-to-face instruction to online delivery mode for academic continuity. This research aims to explore the ecology of the pandemic-induced online English as foreign language (EFL) classrooms in Chinese middle schools and perceptions held by the English teachers, students, and parents. By analyzing data collected from 10, 576 questionnaires and eleven interviews, this study revealed how these participants played their respective parts in online EFL classroom ecology. Also, it was found that teachers' evaluations of students' learning performance (le arning engagement and outcomes) and teacher-student interactions (in-class interaction, after-class interaction, and teachers' feedback about homework) and their overall satisfaction of the online EFL classrooms were lower than that of the other two groups. In addition, major concerns of the participants about online EFL teaching and learning were identified, such as students' vision damage and inadequate self-discipline, lack of face-to-face communication, and unstable Internet connection. Through presenting and discussing the research findings, this study is expected to provide implications and insights for foreign language educators, learners, and parents worldwide in adapting to online classrooms during public crises.

Combining initial chest CT with clinical variables in differentiating coronavirus disease 2019 (COVID-19) pneumonia from influenza pneumonia.

Coronavirus disease 2019 (COVID-19) has spread in more than 100 countries and regions around the world, raising grave global concerns. COVID-19 has a similar pattern of infection, clinical symptoms, and chest imaging findings to influenza pneumonia. In this retrospective study, we analysed clinical and chest CT data of 24 patients with COVID-19 and 79 patients with influenza pneumonia. Univariate analysis demonstrated that the temperature, systolic pressure, cough and sputum production could distinguish COVID-19 from influenza pneumonia. The diagnostic sensitivity and specificity for the clinical features are 0.783 and 0.747, and the AUC value is 0.819. Univariate analysis demonstrates that nine CT features, central-peripheral distribution, superior-inferior distribution, anterior-posterior distribution, patches of GGO, GGO nodule, vascular enlargement in GGO, air bronchogram, bronchiectasis within focus, interlobular septal thickening, could distinguish COVID-19 from influenza pneumonia. The diagnostic sensitivity and specificity for the CT features are 0.750 and 0.962, and the AUC value is 0.927. Finally, a multivariate logistic regression model combined the variables from the clinical variables and CT features models was made. The combined model contained six features: systolic blood pressure, sputum production, vascular enlargement in the GGO, GGO nodule, central-peripheral distribution and bronchiectasis within focus. The diagnostic sensitivity and specificity for the combined features are 0.87 and 0.96, and the AUC value is 0.961. In conclusion, some CT features or clinical variables can differentiate COVID-19 from influenza pneumonia. Moreover, CT features combined with clinical variables had higher diagnostic performance.

Unemployment and Health-Related Quality of Life in Melanoma Patients During the COVID-19 Pandemic.

The outbreak of coronavirus disease-2019 (COVID-19) ineluctably caused social distancing and unemployment, which may bring additional health risks for patients with cancer. To investigate the association of the pandemic-related impacts with the health-related quality of life (HRQoL) among patients with melanoma during the COVID-19 pandemic, we conducted a cross-sectional study among Chinese patients with melanoma. A self-administered online questionnaire was distributed to melanoma patients through social media. Demographic and clinical data, and pandemic-related impacts (unemployment and income loss) were collected. HRQoL was determined by the Functional Assessment of Cancer Therapy-General (FACT-G) and its disease-specific module (the melanoma subscale, MS). A total of 135 patients with melanoma completed the study. The mean age of the patients was 55.8 ± 14.2 years, 48.1% (65/135) were male, and 17.04% (34/135) were unemployed since the epidemic. Unemployment of the patients and their family members and income loss were significantly associated with a lower FACT-G score, while the MS score was associated with the unemployment of the patients' family members. Our findings suggested that unemployment is associated with impaired HRQoL in melanoma patients during the COVID-19 epidemic.

Container CT scanner: a solution for modular emergency radiology department during the COVID-19 pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic period, container computed tomography (CT) scanners were developed and used for the first time in China to perform CT examinations for patients with clinically mild to moderate COVID-19 who did not need to be hospitalized for comprehensive treatment, but needed to be isolated in Fangcang shelter hospitals (also known as makeshift hospitals) to receive some supportive treatment. The container CT is a multidetector CT scanner installed within a radiation-protected stand-alone container (a detachable lead shielding room) that is deployed outside the makeshift hospital buildings. The container CT approach provided various medical institutions with the solution not only for rapid CT installation and high adaptability to site environments, but also for significantly minimizing the risk of cross-infection between radiological personnel and patients during CT examination in the pandemic. In this article, we described the typical setup of a container CT and how it worked for chest CT examinations in Wuhan city, the epicenter of COVID-19 outbreak.

Association of Socioeconomic Changes due to the COVID-19 Pandemic With Health Outcomes in Patients With Skin Diseases: Cross-Sectional Survey Study.

BACKGROUND: The outbreak of COVID-19 has profoundly influenced people's lifestyles; these impacts have varied across subgroups of people. The pandemic-related impacts on the health outcomes of people with dermatological conditions are unknown. OBJECTIVE: The aim of this paper was to study the association of COVID-19 pandemic-related impacts with health-related quality of life in patients with skin diseases. METHODS: This was a cross-sectional study among Chinese patients with skin diseases. A self-administered web-based questionnaire was distributed through social media. Demographic and clinical data and pandemic-related impacts (isolation status, income changes, and employment status) were collected. The main outcomes included perceived stress (Visual Analog Scale), symptoms of anxiety (Generalized Anxiety Disorder-7) and depression (9-Item Patient Health Questionnaire), quality of life (Dermatology Life Quality Index), and health utility mapping based on the EQ-5D-3L descriptive system. Multivariable logistic regression was used to investigate the associations. RESULTS: A total of 506 patients with skin diseases completed the survey. The mean age of the patients was 33.5 years (SD 14.0), and 217/506 patients (42.9%) were male. Among the 506 respondents, 128 (25.3%) were quarantined, 102 (20.2%) reported unemployment, and 317 (62.6%) reported decrease or loss of income since the pandemic. The pandemic-related impacts were significantly associated with impaired mental well-being and quality of life with different effects. Unemployment and complete loss of income were associated with the highest risks of adverse outcomes, with increases of 110% to 162% in the prevalence of anxiety, depression, and impaired quality of life. CONCLUSIONS: Isolation, income loss, and unemployment are associated with impaired health-related quality of life in patients with skin diseases during the COVID-19 pandemic.

A Quantitative and Radiomics approach to monitoring ARDS in COVID-19 patients based on chest CT: a retrospective cohort study.

Rationale: Acute respiratory distress syndrome (ARDS) is one of the major reasons for ventilation and intubation management of COVID-19 patients but there is no noninvasive imaging monitoring protocol for ARDS. In this study, we aimed to develop a noninvasive ARDS monitoring protocol based on traditional quantitative and radiomics approaches from chest CT. Methods: Patients diagnosed with COVID-19 from Jan 20, 2020 to Mar 31, 2020 were enrolled in this study. Quantitative and radiomics data were extracted from automatically segmented regions of interest (ROIs) of infection regions in the lungs. ARDS existence was measured by Pa02/Fi02 <300 in artery blood samples. Three different models were constructed by using the traditional quantitative imaging metrics, radiomics features and their combinations, respectively. Receiver operating characteristic (ROC) curve analysis was used to assess the effectiveness of the models. Decision curve analysis (DCA) was used to test the clinical value of the proposed model. Results: The proposed models were constructed using 352 CT images from 86 patients. The median age was 49, and the male proportion was 61.9%. The training dataset and the validation dataset were generated by randomly sampling the patients with a 2:1 ratio. Chi-squared test showed that there was no significant difference in baseline of the enrolled patients between the training and validation datasets. The areas under the ROC curve (AUCs) of the traditional quantitative model, radiomics model and combined model in the validation dataset was 0.91, 0.91 and 0.94, respectively. Accordingly, the sensitivities were 0.55, 0.82 and 0.58, while the specificities were 0.97, 0.86 and 0.98. The DCA curve showed that when threshold probability for a doctor or patients is within a range of 0 to 0.83, the combined model adds more net benefit than "treat all" or "treat none" strategies, while the traditional quantitative model and radiomics model could add benefit in all threshold probability. Conclusions: It is feasible to monitor ARDS from CT images using radiomics or traditional quantitative analysis in COVID-19. The radiomics model seems to be the most practical one for possible clinical use. Multi-center validation with a larger number of samples is recommended in the future.