Corticosteroids for hospitalized patients with severe/critical COVID-19: a retrospective study in Chongqing, China (preprint)

Background To estimate the association between the administration of corticosteroids and all-cause mortality of hospitalized patients with severe/critical Corona Virus Disease 2019 (COVID-19).Methods We conducted this study at six tertiary hospitals in the area of Chongqing, China. Clinical records from all consecutive adult subjects admitted with SARS-CoV-2 infection from 1 November 2022 to 20 January 2023 were retrospectively reviewed. In-hospital and 28-day mortality were analyzed before and after propensity score matching (PSM). Logistic regression model and cox regression model was used to further examine the relationship between corticosteroid treatment and the risk of mortality.Results A total of 406 severe and critically ill COVID-19 patients were included in this study. They were divided into the corticosteroids group (231, 56.9%) and non-corticosteroids group (175, 43.1%) according to corticosteroids use (0.5-1mg/kg/d methylprednisolone or any corticosteroid at equivalent dose, no more than 10 days). Corticosteroid treatment did not reduce in-hospital mortality in overall cohorts (36.4% vs.28.0%) and matched cohorts (32.5% vs.34.5%). Univariate analysis showed that the 28-day mortality in the corticosteroids group was significantly higher than that in the non-corticosteroids group [hazard ratio (HR), 0.706; 95% CI, 0.507–0.983; p = 0.039] in the overall population. When the multivariate analysis was further used to control confounders, the results showed that corticosteroids were not associated with improved 28-day mortality (HR, 1.121; 95% CI, 0.641–1.959; p = 0.689). With PSM, similar results were obtained with univariate and multivariate analysis.Conclusions Corticosteroids in hospitalized patients with severe/critical COVID-19 did not reduce mortality in the overall population.

Potential Mechanism of Curcumin and Resveratrol against SARS-CoV-2 (preprint)

Recently, World Health Organization predicted a near end of COVID-19 pandemic. However, the prediction should be interpreted cautiously. Due to SARS-CoV-2 continuous mutation-evolve, limited durability of infection-acquired protection in individuals with hybrid immunity, and the effects of long COVID-19 or Post-COVID-19 syndrome, COVID-19 may continue to be a worldwide threat. Alternative therapeutics are incorporated into some countries’ health guidelines for COVID-19. Qiannan herbal, an ancient medical book of Yi Nationality in China, recorded that grapes and turmeric were often used to treat respiratory diseases. Curcumin and resveratrol are the primary bioactive compounds in turmeric and grapes, respectively. The clinical trials confirmed that curcumin or resveratrol supplementation could cause moderate or marked improvements in COVID-19 patients. Exploring the potential mechanisms is of great significance. This study found that curcumin and resveratrol could effectively inhibit SARS-CoV-23CLpro activity and spike protein-mediated cell entry. Curcumin and resveratrol could significantly alleviate spike protein-mediated cytokine storm via inhibiting over-activation of NFKB, and effectively ameliorate spike protein-mediated oxidative stress through scavenging ROS and enhancing function of antioxidation system. The combined treatment showed a better effect than alone treatment. Therefore, curcumin and resveratrol could inhibit SARS-CoV-23C-like proteinase activity and Spike protein-mediated cell entry, cytokine storm, and oxidative stress.

Longitudinal wastewater surveillance addressed public health priorities during the transition from "dynamic COVID-zero" to "opening up" in China: a population-based study (preprint)

Background Wastewater surveillance provides real-time, cost-effective monitoring of SARS-CoV-2 transmission. We developed the first city-level wastewater warning system in mainland China, located in Shenzhen. Our study aimed to reveal cryptic transmissions under the "dynamic COVID-zero" policy and characterize the dynamics of the infected population and variant prevalence, and then guide the allocation of medical resources during the transition to "opening up" in China. Methods In this population-based study, a total of 1,204 COVID-19 cases were enrolled to evaluate the contribution of Omicron variant-specific faecal shedding rates in wastewater. After that, wastewater samples from up to 334 sites distributed in communities and port areas in two districts of Shenzhen covering 1.74 million people were tested daily to evaluate the sensitivity and specificity of this approach and were validated against daily SARS-CoV-2 screening. After the public health policy was switched to "opening up" in December 7, 2022, we conducted wastewater surveillance at wastewater treatment plants and pump stations covering 3.55 million people to estimate infected populations using model prediction and detect the relative abundance of SARS-CoV-2 lineages using wastewater sequencing. Findings In total, 82.4% of SARS-CoV-2 Omicron cases tested positive for faecal viral RNA within the first four days after the diagnosis, which was far more than the proportion of the ancestral variant. A total of 27,759 wastewater samples were detected from July 26 to November 30 in 2022, showing a sensitivity of 73.8% and a specificity of 99.8%. We further found that wastewater surveillance played roles in providing early warnings and revealing cryptic transmissions in two communities. Based on the above results, we employed a prediction model to monitor the daily number of infected individuals in Shenzhen during the transition to "opening up" in China, with over 80% of the population infected in both Futian District and Nanshan District. Notably, the prediction of the daily number of hospital admission was consistent with the actual number. Further sequencing revealed that the Omicron subvariant BA.5.2.48 accounted for the most abundant SARS-CoV-2 RNA in wastewater, and BF.7.14 and BA.5.2.49 ranked second and third, respectively, which was consistent with the clinical sequencing. Interpretation This study provides a scalable solution for wastewater surveillance of SARS-CoV-2 to provide real-time monitoring of the new variants, infected populations and facilitate the precise prediction of hospital admission. This novel framework could be a One Health system for the surveillance of other infectious and emerging pathogens with faecal shedding and antibiotic resistance genes in the future. Funding Sanming Project of Medicine in Shenzhen, Shenzhen Key Medical Discipline Construction Fund.

Inhibition mechanism and antiviral activity of an α-ketoamide based SARS-CoV-2 main protease inhibitor (preprint)

SARS-CoV-2 has demonstrated extraordinary ability to evade antibody immunity by antigenic drift. Small molecule drugs may provide effective therapy while being part of a solution to circumvent SARS-CoV-2 immune escape. In this study we report an alpha-ketoamide based peptidomimetic inhibitor of SARS-CoV-2 main protease (Mpro), RAY1216. Enzyme inhibition kinetic analysis established that RAY1216 is a slow-tight inhibitor with a Ki of 8.6 nM; RAY1216 has a drug-target residence time of 104 min compared to 9 min of PF-07321332 (nirmatrelvir), the antiviral component in Paxlovid, suggesting that RAY1216 is approximately 12 times slower to dissociate from the protease-inhibitor complex compared to PF-07321332. Crystal structure of SARS-CoV-2 Mpro:RAY1216 complex demonstrates that RAY1216 is covalently attached to the catalytic Cys145 through the alpha-ketoamide warhead; more extensive interactions are identified between bound RAY1216 and Mpro active site compared to PF-07321332, consistent with a more stable acyl-enzyme inhibition complex for RAY1216. In cell culture and human ACE2 transgenic mouse models, RAY1216 demonstrates comparable antiviral activities towards different SARS-CoV-2 virus variants compared to PF-07321332. Improvement in pharmacokinetics has been observed for RAY1216 over PF-07321332 in various animal models, which may allow RAY1216 to be used without ritonavir. RAY1216 is currently undergoing phase III clinical trials (https://clinicaltrials.gov/ct2/show/NCT05620160) to test real-world therapeutic efficacy against COVID-19.

Atomically Dispersed d10 s-block Au Boosts Photocatalytic 1e- Water Oxidation for Self-Cleaning, Sanitation and Safe Drinkable Water­­ (preprint)

Providing affordable safe drinking water and universal sanitation poses a grand challenge especially after the global COVID-19 pandemic. In this work, we developed atomically dispersed Au on potassium-incorporated polymeric carbon nitride (AuKPCN) that could simultaneously boost photocatalytic generation of ·OH and H2O2 with an apparent quantum efficiency over 90% at 400–420 nm. The introduction of potassium into the poly(heptazine imide) matrix formed strong K-N bonds, preventing Au from forming strong interactions with N. Instead, Au formed a bond with C, only having weak interactions with N on KPCN, which rendered Au with an oxidation number close to 0. The results of in-situ vibrational spectroscopy, isotopic experiments, transient absorption spectroscopy and time-dependent density functional theory (TDDFT) simulations revealed that the low-valent Au could append its 6s orbital into the band diagram of AuKPCN that formed a trapping level for generating highly localized holes under photoexcitation. These highly localized holes could boost the 1e− water oxidation reaction to form highly oxidative ·OH and simultaneously unbind the hydrogen atom in H2O molecule, which greatly promoted the hydrogenation process during the 2e− oxygen reduction reaction (ORR) to produce H2O2. The photogenerated ·OH on AuKPCN led to a more than 120-fold efficiency enhancement for visible-light-response superhydrophilicity as compared to that of the commercial TiO2. The onsite fixed-bed reactor under photo-illumination achieved a remarkable 132.5 LH2O m− 2 day− 1 water disinfection rate (lg6), which is about 30 times superior than the TiO2 photocatalytic advanced oxidation process in the most ideal case (< 4 LH2O m− 2 day− 1; lg4).

Prevalence of and relevant factors for depression and anxiety symptoms among pregnant women on the eastern seaboard of China in the post-COVID-19 era (preprint)

Background Antenatal depression and anxiety symptoms may have negative consequences for both mothers and offspring, and upward trends in the prevalence of these symptoms were especially apparent during the COVID-19 epidemic. The purpose of this study was to evaluate the prevalence of and relevant factors influencing depressive and anxiety symptoms in Chinese pregnant women in the post-COVID-19 era.Methods We conducted an online survey of 1,963 pregnant women in Jiangsu Province, using a cross-sectional design, and collected their general demographic data. The nine-item Patient Health Questionnaire 9 (PHQ-9) was used to evaluate depression symptoms, and the seven-item Generalized Anxiety Disorder 7 (GAD-7) was used to measure anxiety symptoms.Results The prevalence of reported antenatal depressive symptoms, anxiety symptoms, and depression combined with anxiety symptoms was 25.2%, 27.9%, and 18.6%, respectively. Of the respondents, prevalence of moderate to severe depression, anxiety, and combined symptoms was 7.9%, 7.7%, and 4.7%, respectively. Binary logistic regression analysis demonstrated that age, low level of education, rural area, unemployment, pregnancy complications, poor marital relationship, and fair household income were positively association with both depressive and anxiety symptoms (all P < 0.05). The proportion of women reporting anxiety symptoms in the third trimester was 1.895-fold higher than in first trimester. Parity was not a relevant factor for depression and anxiety symptoms (all P > 0.05).Conclusions In the post-COVID-19 era, the prevalence of depression and anxiety symptoms in pregnant women was higher than expected, and it is vital to establish hospital, community, and family psychological health screening systems based on relevant factors and enhance early preventive measures.

Iontophoresis-Driven Microneedles Patch for Active Transdermal Delivery of Vaccine Macromolecules (preprint)

COVID-19 has seriously threatened public health and transdermal vaccination is an effective way to prevent pathogen infection. Microneedles (MN) can damage the stratum corneum for passive diffusion of vaccine macromolecules but the delivery efficiency is low, while iontophoresis can actively promote transdermal delivery but fails to transport vaccine macromolecules due to the barrier of stratum corneum. Herein, we developed a wearable iontophoresis-driven MN patch and its iontophoresis-driven device for active and efficient transdermal vaccine macromolecules delivery. Polyacrylamide/chitosan hydrogels with good biocompatibility, excellent conductivity, high elasticity and large loading capacity were prepared as the key component for vaccine storage and active iontophoresis. The transdermal vaccine delivery strategy of the iontophoresis-driven MN patch is: “press and poke, iontophoresis-driven delivery, and immune response”. We demonstrated that the synergistic effect of MN puncture and iontophoresis could significantly promote the transdermal vaccine delivery efficiency. In vitro experiments showed that the transdermal delivery amount of ovalbumin using iontophoresis-driven MN patch could be controlled by the iontophoresis current. In vivo immunization studies of Balb/c mice demonstrated that transdermal inoculation of ovalbumin using iontophoresis-driven MN patch induced an effective immune response, which was even stronger than that traditional intramuscular injection. Moreover, the iontophoresis-driven MN patch had little biosafety concern. This delivery system is low-cost, user-friendly, and active delivery that shows a great potential in vaccine self-administration at home.

Comparison of epidemiological characteristics and transmissibility of different strains of COVID-19 based on the incidence data of all local outbreaks in China as of March 1, 2022

Background The epidemiological characteristics and transmissibility of Coronavirus Disease 2019 (COVID-19) may undergo changes due to the mutation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) strains. The purpose of this study is to compare the differences in the outbreaks of the different strains with regards to aspects such as epidemiological characteristics, transmissibility, and difficulties in prevention and control. Methods COVID-19 data from outbreaks of pre-Delta strains, the Delta variant and Omicron variant, were obtained from the Chinese Center for Disease Control and Prevention (CDC). Case data were collected from China's direct-reporting system, and the data concerning outbreaks were collected by on-site epidemiological investigators and collated by the authors of this paper. Indicators such as the effective reproduction number (Reff), time-dependent reproduction number (Rt), rate of decrease in transmissibility (RDT), and duration from the illness onset date to the diagnosed date (DID)/reported date (DIR) were used to compare differences in transmissibility between pre-Delta strains, Delta variants and Omicron variants. Non-parametric tests (namely the Kruskal-Wallis H and Mean-Whitney U tests) were used to compare differences in epidemiological characteristics and transmissibility between outbreaks of different strains. P < 0.05 indicated that the difference was statistically significant. Results Mainland China has maintained a “dynamic zero-out strategy” since the first case was reported, and clusters of outbreaks have occurred intermittently. The strains causing outbreaks in mainland China have gone through three stages: the outbreak of pre-Delta strains, the outbreak of the Delta variant, and outbreaks involving the superposition of Delta and Omicron variant strains. Each outbreak of pre-Delta strains went through two stages: a rising stage and a falling stage, Each outbreak of the Delta variant and Omicron variant went through three stages: a rising stage, a platform stage and a falling stage. The maximum Reff value of Omicron variant outbreaks was highest (median: 6.7;ranged from 5.3 to 8.0) and the differences were statistically significant. The RDT value of outbreaks involving pre-Delta strains was smallest (median: 91.4%;[IQR]: 87.30–94.27%), and the differences were statistically significant. The DID and DIR for all strains was mostly in a range of 0–2 days, with more than 75%. The range of duration for outbreaks of pre-Delta strains was the largest (median: 20 days, ranging from 1 to 61 days), and the differences were statistically significant. Conclusion With the evolution of the virus, the transmissibility of the variants has increased. The transmissibility of the Omicron variant is higher than that of both the pre-Delta strains and the Delta variant, and is more difficult to suppress. These findings provide us with get a more clear and precise picture of the transmissibility of the different variants in the real world, in accordance with the findings of previous studies. Reff is more suitable than Rt for assessing the transmissibility of the disease during an epidemic outbreak.

Perceived Benefits and Forest Tourists Consumption Intention: Environmental Protection Attitude and Resource Utilization Attitude as Mediators

Establishing a relationship model between environmental protection and resource utilization attitude and consumption intention is the key to promoting the sustainable development of forest tourism. From the standpoint of the Stimulus–Organism–Response (SOR) framework, the purpose of this study is to explore the complex causal relationships between perceived benefits, attitudes toward environmental protection, resource utilization attitudes, and consumption intentions in the context of forest tourism. The research data have been collected using a questionnaire survey of 436 tourists at Siming Mountain in the suburbs of Ningbo city, China. Furthermore, it is analyzed by structural equation modeling. The results indicate a positive correlation between the perceived benefits and tourists’ consumption intention that is mediated by the tourists’ attitude toward resource utilization. Although the independent mediating effect of environmental protection attitude is not supported in this study, both attitudes have played a chain-mediating role between perceived benefit and consumption intention. This study contributes to the existing knowledge by measuring the impact of perceived benefits and environmental attitudes of forest tourists on consumption intentions.

The impact of cross-border knowledge management on internationalizing Renminbi: lessons from the belt and road initiative

PurposeIn the process of Renminbi (RMB) internationalization, the heterogeneity and complexity in knowledge under the multicultural contexts have been considered as important factors that can have profound impacts on the cross-border flow of the RMB currency. Moreover, COVID-19, an exogenous shock, also triggers more in-depth reflection on the relationship between cross-border knowledge management and the financial risk governance. In addition, the needs to effectively respond to global risks and crises prompt the necessity in systematically establishing an effective cross-border knowledge management mechanism and innovatively solidifying the knowledge bases needed for the further internationalization of the RMB.Design/methodology/approachBased on the analysis on the current status of the RMB internationalization, this paper qualitatively explores some major challenges and difficulties encountered in the process of RMB internationalization from the perspectives of knowledge management and cross-cultural theories. To effectively mitigate these challenges and difficulties, discussions and recommendations centered on three main aspects: cross-cultural management;cognition;and innovation for the further development of the RMB internationalization are also presented in this paper.FindingsBased on the analysis on the cross-border knowledge management and cross-cultural perspectives, this paper identifies three major challenges and difficulties that the RMB internationalization is encountering, including: cultural heterogeneity and its adverse impacts on the communication amongst economic entities;the existence of knowledge iceberg;and the difficulty it presents to cognition and financial innovation. Meanwhile, the authors also present recommendations on the development of the cross-border knowledge management mechanism for furthering the progress of internationalizing the RMB currency.Research limitations/implicationsFrom the perspective of cross-border knowledge management, this study not only elaborates on the recommendations aimed at further promoting the RMB internationalization but also provides reference and guidance for the state, central banks and commercial banks to play better roles in furthering the RMB internationalization.Originality/valueThis paper creatively integrates the micro knowledge management into the macro process of RMB internationalization, thoroughly discusses two main challenges and difficulties encountered in the process of RMB internationalization from the unique perspective of cross-border knowledge management under the multicultural contexts and provides relevant recommendations for RMB’s further internationalization. This study also enriches the exploration of knowledge management outcome variables and further expands the research field of knowledge management.

Let’s get on the same page: Conceptual clarification of individual-level information and communication technology use

[...]the authors theoretically separated technology experiences from technology-use behaviors, which in our opinion will constrain our understanding of ICT-related constructs. [...]although the authors draw on a work design perspective to discuss the literature, they overlook the more powerful role of work design theory for understanding ICT-related phenomena in the workplace. [...]the effects of non-work-related ICT use on performance and well-being are jointly influenced by use intensity and functions of ICT use. [...]the widespread use of advanced ICTs in communication makes the invasion of work-related issues into personal life possible, resulting in the demand for constant availability (Mazmanian, 2013). [...]as a consequence of workplace ICT use, constant availability is conceptually different from other long-existing constructs, such as work demands (e.g., workload).

TET1 controls Cxcl1 induction by DNA demethylation and promotes neutrophil recruitment during acute lung injury (preprint)

Neutrophils are rapidly recruited from the peripheral blood to the inflammatory site to initiate inflammatory response against pathogenic infections. The process to recruit neutrophils must be properly regulated since the abnormal accumulation of neutrophils can cause organ damage and dysfunction. The acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) is a common cause of respiratory failure that is characterized by the infiltration of neutrophils and epithelial integrity disruption. Indeed, recent studies suggest a pathogenic role of neutrophils in the clinic severity of the coronavirus disease 2019 (COVID-19) ARDS. The chemokine CXCL1, which is rapidly induced by inflammatory stimuli, plays a key role in neutrophil influx during lung inflammation. The molecular basis of Cxcl1 induction is not fully understood. Here we report that TET1, a member of the ten eleven translocation (TET) methylcytosine dioxygenase protein family, displays a striking specificity in the regulation of gene expression in macrophages. RNA sequencing (RNA-seq) analysis showed that Tet1 disruption significantly altered the expression of only 48 genes that include Cxcl1 and several other genes known to be important for cell migration and trafficking in bone marrow derived macrophages (BMDMs) in response to LPS stimulation. TET1 regulates the induction of Cxcl1 by facilitating the DNA demethylation of the Cxcl1 promoter. In Tet1 −/− mice, the induction of Cxcl1 was suppressed, resulting in defective neutrophil recruitment to the lung during LPS-induced acute lung injury. Our results identify a novel epigenetic mechanism that selectively controls Cxcl1 induction and neutrophil recruitment during acute lung injury. Key Points TET1 has a striking specificity in macrophage gene regulation and controls Cxcl1 induction by inflammatory stimuli via DNA demethylation Neutrophil recruitment is defective in Tet1 deficient mice during acute lung injury

Patients With A High-Risk Common Type COVID-19 Pneumonia May Be the Optimal Time for Methylprednisolone Therapy: A Retrospective Cohort Study (preprint)

Background: The optimal timing of corticosteroid treatment for coronavirus disease 2019(COVID-19) pneumonia is uncertain. We evaluated the clinical outcomes of methylprednisolone therapy (MPT) for patients with a high-risk common type(HRCT) COVID-19 pneumonia. Methods: We conducted a multi-centre retrospective cohort study in northeast China. A comparison was performed between the standard treatment (SDT) group and the SDT+MPT group to determine the efficacy of methylprednisolone in treating HRCT COVID-19 pneumonia. Results: We collected the medical records of 403 patients with HRCT COVID-19 pneumonia (127 in the SDT+MPT group and 276 in the SDT group). None of the patients had received mechanical ventilation or died. Further, there had been no side-effects associated with of MPT. Patients in the SDT+MPT group treated with methylprednisolone received an intravenous injection for a median interval of five days (interquartile range of three to seven days). The trends in lymphocyte count, C-reactive protein, interleukin 6, lactic acid dehydrogenase, respiratory rate, SpO2, PaO2, D-dimer and body temperature were similar between the SDT+MPT and SDT groups. The results for the SDT+MPT group seems to be faster improved than the SDT group; however, the results were not statistically significant. Clinical outcomes revealed that the average hospitalisation days and the rate of progression to severe type COVID-19 pneumonia in both the SDT+MPT group and the SDT group were present in 14.56±0.57days vs 16.55±0.3days(p=0.0009) and 21.26%(27/127) vs 32.4%(89/276)(p=0.0254), respectively. The 16-day nucleic acid negative rate was higher in the SDT+MPT group than the SDT group, 81.73% (104/127) vs 65.27% (180/276) (p = 0.0014). Conclusions: MPT effectively prevents patients with HRCT COVID-19 pneumonia from progressing to the severe stage. Therefore, patients with HRCT may be the optimal timing for MPT.Funding Statement: 1.The National Key Laboratory of Sponsored by Open Project of State Key Laboratory of Respiratory Disease (Project Funding Number：SKLRD-OP-201902)” 2.The National Key Laboratory of Urban Water Resources and Water Environment Full Funds. (Project Funding Number：ESK201602.)Declaration of Interests: We have not any conflict of interests to declare.Ethics Approval Statement: Ethical approval by the institutional ethics board of the Qun'li branch of the First Affiliated Hospital of Harbin Medical University and Kang'an Hospital of Mudanjiang was obtained for the analysis and summary of clinical data from COVID-19-infected inpatients.

Early Treatment Effect of Chinese Herbal Medicine Formula Huashibaidu Granule on Mild COVID-19 Patients in Fangcang Hospital: An Unblinded, Cluster-Randomized Clinical Trial (preprint)

BACKGROUND: Previous study suggested that Chinese Herbal Medicine (CHM) Formula Huashibaidu granule might shorten disease course of Corona Virus Disease 2019 (COVID-19) patients. Our research aims to investigate the early treatment effect of Huashibaidu granule in mild COVID-19 patients under well clinical management.METHODS: An unblended cluster-randomized clinical trial was conducted at the Dongxihu FangCang hospital. 2 cabins were randomly allocated to CHM or control group, with 204 randomly sampled mild COVID-19 patients in each cabin. All participants received a 7-day conventional treatment, and CHM group cabin used additional Huashibaidu granule 10g twice daily. Participants were followed up until they met clinical endpoint. The primary outcome was patient become worsening before clinical endpoint occurred. The secondary outcomes was discharge with cure before clinical endpoint occurred and relief of composite symptoms after 7 days treatment.FINDINGS: All 408 participants were followed up to meet clinical endpoint and included in statistical analysis. The baseline characteristics were comparable between 2 groups. The number of worsening patients in the CHM group was 5 (2.5%), and that in the control group was 16 (7.8%). There was a significant difference between groups (P=0.014). 8 foreseeable mild adverse events occurred without statistical difference between groups.INTERPRETATION: 7-day early treatment with Huashibaidu granule reduced worsening conversion of mild COVID-19 patients. Our study supports Huashibaidu Granule as an active option for early treatment of mild COVID-19 in similar medical locations with well management.TRIAL REGISTRATION: The Chinese Clinical Trial Registry: ChiCTR2000029763.FUNDING: This study was supported by “National Key R&D Program of China” (No.2020YFC0841500).DECLARATION OF INTERESTS: The authors guaranteed that there existed no competing interest in this paper.ETHICS APPROVAL STATEMENT: Ethics Review Committee of Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Approval of Ethical Review Acceptance Number: S2020-001; Approval Number: P20001/PJ01.

Multi-attribute group decision-making for online education live platform selection based on linguistic intuitionistic cubic fuzzy aggregation operators

The purpose of this study is to propose a multi-attribute group decision-making (MAGDM) method for online education live platform selection based on proposed novel aggregation operators (AOs) under linguistic intuitionistic cubic fuzzy set (LICFS). First, the Archimedean copula and co-copula are extended to handle linguistic intuitionistic cubic fuzzy information (LICFI) and the operational law of linguistic intuitionistic cubic fuzzy variables (LICFVs) based on extended copula (EC) and extended co-copula (ECC) are given. In addition, linguistic intuitionistic cubic fuzzy copula weighted average (LICFCWA) operator and linguistic intuitionistic cubic fuzzy copula weighted geometric (LICFCWG) operator are proposed based on EC and ECC under LICFI;meanwhile, some special forms of LICFCWA and LICFCWG have been obtained by different types generators of ECs and ECCs. Third, a novel MAGDM approach based on proposed LICFCWA (LICFCWG) is constructed to solve the selection problem of the online education live platform in the period of the COVID-19, and a detailed parameter analysis was carried out. Fourthly, LICFS will degenerate into linguistic intuitionistic fuzzy set and intuitionistic cubic fuzzy set, respectively, in different cases. Finally, some comparisons are carried out with other existing proposed MAGDM approaches. By comparing different types of experiments, the effectiveness and flexibility of the proposed approach are also showed.

Maximum chest CT score is associated with progression to severe illness in patients with COVID-19: A retrospective study from Wuhan, China (preprint)

Background: The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms. Methods: : This study, a retrospective single-center study at the Central Hospital of Wuhan, enrolled 243 patients with confirmed COVID­19 pneumonia. Forty of these patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between moderate- and severe/critical-type symptoms. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression. Results: : Patients with severe/critical symptoms were older (p<0.001) and more often male (p=0.046). A combination of chronic obstructive pulmonary disease (COPD) and high maximum chest computed tomography (CT) score was associated with disease progression. Maximum CT score (>11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve was 0.861 ( 95% confidence interval: 0.811-0.902). Conclusions: : Maximum CT score and COPD were associated with patient deterioration. Maximum CT score (>11) was associated with severe illness.

Clinical characteristics of 44 patients with coronavirus disease 2019 in Yongzhou

Objective: To analyze the general situation and clinical characteristics of coronavirus disease 2019 (COVID-2019)in Yongzhou city and provide reference for COVID-2019 control. Methods: 44 patients with COVID-2019 admitted in Yongzhou central hospital were included in the study. According to the clinical classification, the patients were divided into two groups: mild and moderate group (MM group, 32 cases), severe and critical group (SC group, 12 cases). The general situation, epidemiology, clinical symptoms, medical history and complications, laboratory examination, imaging characteristics and treatment plan of the two groups were compared and analyzed, and the clinical characteristics, treatment process and prognosis were summarized. Results: There was no significant difference between mild and moderate group and severe and critical group in age, gender, definite incubation period or definite infection transmission generations (P=0.072, 0.543, 0.108, 0.067). Compared with MM group, SC group needs longer hospitalization time(16.5±6.0 vs 12.4±4.5, P=0.019). There was no significant difference between the two groups in clinical symptoms of fever, cough, fatigue, pharyngeal pain, nasal obstruction, runny nose, diarrhea, history of hypertension or diabetes (each P> 0.05), Compared with MM group, SC group had higher proportion of hypokalemia and AST increase (58.3％ vs 15.6％, P=0.014;41.7％ vs 9.4％, P=0.042). There was no significant difference in hypoproteinemia, elevated ALT, respiratory failure or heart failure (each P > 0.05). Compared with MM group, SC group had higher WBC count, higher neutrophil count, lower lymphocyte count and more multileaf lesions in the laboratory and CT results (91.7％ vs 37.5％, P=0.010;91.7％ vs 46.9％, P=0.019;91.7％ vs 18.8％, P=0.000;100.00％ vs 59.4％, P=0.024). There was no significant difference between the two groups in decrease of leukocyte count, neutrophil count, eosinophil count, increase of C-reactive protein, ESR, LDH, ground glass or subpleural or extrapulmonary zone were the main pathological changes of CT (each P > 0.05). Compared with MM group, SC group were different in the use rate of antibiotics, glucocorticoids, immunoglobulin and noninvasive ventilator in the treatment plan (91.7％ vs 53.1％, P=0.044;100.00％ vs 59.4％, P=0.024;83.3％ vs 28.1％, P=0.001;41.7％ vs 0, P=0.001). 44 cases (100％) were cured without death. Conclusion: Compared with MM group, SC group is more likely to have increased leukocyte count, increased neutrophil count, decreased lymphocyte count and CT lesions with multileaf focus, more likely to have hypokalemia and increased AST, more likely to use antibiotics, glucocorticoids, immunoglobulins and non-invasive ventilator.

Two Color Single Molecule Sequencing on GenoCare 1600 Platform to Facilitate Clinical Applications (preprint)

With the rapid development of precision medicine industry, DNA sequencing becomes increasingly important as a research and diagnosis tool. For clinical applications, medical professionals require a platform which is fast, easy to use, and presents clear information relevant to definitive diagnosis. We have developed a single molecule desktop sequencing platform, GenoCare 1600. Fast library preparation (without amplification) and simple instrument operation make it friendlier for clinical use. Here we presented sequencing data of E. coli sample from GenoCare 1600 with consensus accuracy reaches 99.99%. We also demonstrated sequencing of microbial mixtures and COVID-19 samples from throat swabs. Our data show accurate quantitation of microbial, sensitive identification of SARS-CoV-2 virus and detection of variants confirmed by Sanger sequencing.