Timing and Depth Selection for Sedated Gastroscopy After SARS-CoV-2 Infection—A Retrospective Cohort Study (preprint)

Background Sedated gastroscopy is a crucial procedure for patients with upper respiratory infections. SARS-CoV-2-infected patients are more susceptible to anesthesia-related complications, such as edema, pharyngeal mucosa congestion, laryngospasm, and pulmonary infections.Methods We retrospectively analyzed a total of 386 patients who underwent sedated gastroscopy at the Affiliated Hospital of Qingdao University during the SARS-CoV-2 infection period. The patients were divided into three groups based on SARS-CoV-2 status: Negative (N), Two-week post-SARS-CoV-2 infection (T), and Three-week post-SARS-CoV-2 infection (Th) groups. Based on the anesthesia method, patients were divided into mild/moderate sedation and deep sedation/general anesthesia groups. Additionally, patients were categorized into groups based on COVID-19 severity and vaccination status. We recorded the laryngeal mucosal conditions, the occurrence rates of adverse reactions such as coughing, laryngospasm, and transient oxygen desaturation during the examination, as well as the satisfaction of patients and endoscopists were recorded.Results The T group displayed a significantly higher occurrence rate of adverse reactions when compared to the N and Th group, with decreased satisfaction levels of patients and endoscopists. In the T group, the occurrence rate of adverse reactions was higher in mild to moderate sedation than in deep sedation/general anesthesia methods, while patient and endoscopist satisfaction was lower. In the Th group, there was no statistically significant difference in the examination success rate or patient satisfaction between the mild/moderate sedation and deep sedation/general anesthesia methods; however, endoscopist satisfaction was lower with mild/moderate sedation method than deep sedation/general anesthesia method. There was a significant difference in the gastroscopy success rates of patients with different COVID-19 classifications. A significant difference was observed in the gastroscopy success rates among patients with different vaccination statuses.Conclusions Sedated gastroscopy post-three weeks of SARS-CoV-2 infection is safe. Moreover, using a deep sedation/general anesthesia method for sedated gastroscopy in SARS-CoV-2-infected patients within three weeks is significantly safer.

Timeliness of health science popularization in local media of Shanghai during the outbreak of Coronavirus disease 2019

Objective: To analyze the timeliness of health science popularization during the outbreak of coronavirus disease 2019 (COVID-19) and its correlation with the epidemic situation and policies.

The Synergy Green Innovation Effect of Green Innovation Subsidies and Carbon Taxes

The economic uncertainty caused by COVID-19 has led governments around the world to attach more importance to green innovation to accomplish their carbon reduction schemes. To improve the green innovation encouraging effect of an environmental policy system, this study introduces a unit progressive carbon tax on the basis of a green innovation subsidy to discuss the synergy green innovation effect between them. We set up a dynamic evolutionary game model to analyze the respective influences of green innovation subsidies and an environmental policy system containing a unit progressive carbon tax on Low Carbon Technology (LCT) heterogeneous enterprises' endogenous green innovation strategies. The Evolutionary Stable Strategy analysis of dynamic game models demonstrate that there does exist a synergy green innovation effect between green innovation subsidies and unit carbon taxes. The numerical simulation shows that the synergy green innovation effect of green innovation subsidies and carbon taxes contains both an overlapping policy effect and a more significant green innovation stimulating effect on enterprises with high LCT. Additionally, the introduction of a carbon tax will increase enterprises' affordability on the green innovation cost coefficient. Furthermore, introducing a unit progressive carbon tax would also create additional stimulation for enterprises to pursue a larger carbon reduction amount for the carbon emission cost-saving advantage. Based on the synergy green innovation effect mentioned above, we also investigate the policy implications of varying the tax rate and subsidy proportion in different situations.

Comparative analysis of single cell lung atlas of bat, cat, tiger and pangolin (preprint)

Horseshoe bats (Rhinolophus sinicus) might help maintain coronaviruses severely affecting human health, such as SARS-CoV and SARS-CoV-2. It has long been suggested that bats may be more tolerant of viral infection than other mammals due to their unique immune system, but the exact mechanism remains to be fully explored. During the COVID-19 pandemic, multiple animal species were diseased by SARS-CoV-2 infection, especially in the respiratory system. Herein, single-cell transcriptomic data of the lungs of a horseshoe bat, a cat, a tiger, and a pangolin were generated. The receptor distribution of twenty-eight respiratory viruses belonging to fourteen viral families were characterized for the four species. Comparison on the immune-related transcripts further revealed limited cytokine activations in bats, which might explain the reason why bats experienced only mild diseases or even no symptoms upon virus infection. Our findings might increase our understanding of the immune background of horseshoe bats and their insensitivity to virus infections.

How to Promote Sustainable Travel Behavior in the Post COVID-19 Period: A Perspective from Customized Bus Services

The Corona Virus Disease 2019 (COVID-19) has influenced the daily life of urban residents worldwide. In the post COVID-19 period, the proportion of public transport commuting trips decreased, whereas that of car commuting trips increased. As a sustainable travel mode, customized bus services have been promoted to ensure the public health security during commuting in this period in many cities in China and other countries. This study focused on the promotion of sustainable travel behavior in the post COVID-19 period from the perspective of customized bus services. A total of 664 respondents from Shanghai, China participated in this study to provide revealed preference (RP) and stated preference (SP) data related to the customized bus services in the post COVID-19 period. The mode choice model was established based on the hypothetical scenarios to estimate the commuters’ intention to shift to the customized bus services, determine the mode preference of different groups, and suggest potential policies. The results showed that the preference for customized buses decreased with the increasing fare for one journey, the travel time, and the availability of a one-way ticket, and middle-class commuters had a higher preference to commute by customized bus. The measures for the short and long term in the post COVID-19 period were proposed. The results of this study can help governments adopt policies to promote customized bus services not only in the post COVID-19 period but also during regular daily life.

Detection and Staging of Chronic Obstructive Pulmonary Disease Using a Computed Tomography-based Weakly Supervised Deep Learning Approach (preprint)

BackgroundChronic obstructive pulmonary disease (COPD) remains underdiagnosed globally. The coronavirus disease 2019 pandemic has also severely restricted spirometry, the primary tool used for COPD diagnosis and severity evaluation, due to concerns of virus transmission. Computed tomography (CT)-based deep learning (DL) approaches have been suggested as a cost-effective alternative for COPD identification within smokers. The present study aims to develop weakly supervised DL models that utilize CT image data for the automated detection and staging of spirometry-defined COPD among natural population.MethodsA large, highly heterogenous dataset was established comprising 1393 participants recruited from outpatient, inpatient and physical examination center settings of 4 large public hospitals in China. CT scans, spirometry data, demographic data, and clinical information of each participant were collected for the purpose of model development and evaluation. An attention-based multi-instance learning (MIL) model for COPD detection was trained using CT scans from 837 participants and evaluated using a test set comprised of data from 278 non-overlapping participants. External validation of the COPD detection was performed with 620 low-dose CT (LDCT) scans acquired from the National Lung Screening Trial (NLST) cohort. A multi-channel 3D residual network was further developed to categorize GOLD stages among confirmed COPD patients and evaluated using 5-fold cross validation. Spirometry tests were used to diagnose COPD, with stages defined according to the GOLD criteria.ResultsThe attention-based MIL model used for COPD detection achieved an area under the receiver operating characteristic curve (AUC) of 0.934 on the test set and 0.866 on the LDCT subset acquired from NLST. The model exhibited high generalizability across distinct scanning devices and slice thicknesses, with an AUC above 0.90. The multi-channel 3D residual network was able to correctly grade 76.4% of COPD patients in the test set (423/553) using the GOLD scale, with a Cohen’s weighted Kappa of 0.619 for the assessment of GOLD categorization .ConclusionThe proposed chest CT-DL approach can automatically identify spirometry-defined COPD and categorize patients according to the GOLD scale, with clinically acceptable performance. As such, this approach may be a powerful novel tool for COPD diagnosis and staging at the population level.

Single-cell screening of SARS-CoV-2 target cells in pets, livestock, poultry and wildlife (preprint)

A few animals have been suspected to be intermediate hosts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, a large-scale single-cell screening of SARS-CoV-2 target cells on a wide variety of animals is missing. Here, we constructed the single-cell atlas for 11 representative species in pets, livestock, poultry, and wildlife. Notably, the proportion of SARS-CoV-2 target cells in cat was found considerably higher than other species we investigated and SARS-CoV-2 target cells were detected in multiple cell types of domestic pig, implying the necessity to carefully evaluate the risk of cats during the current COVID-19 pandemic and keep pigs under surveillance for the possibility of becoming intermediate hosts in future coronavirus outbreak. Furthermore, we screened the expression patterns of receptors for 144 viruses, resulting in a comprehensive atlas of virus target cells. Taken together, our work provides a novel and fundamental strategy to screen virus target cells and susceptible species, based on single-cell transcriptomes we generated for domesticated animals and wildlife, which could function as a valuable resource for controlling current pandemics and serve as an early warning system for coping with future infectious disease threats.

Development and validation of an early warning score (EWAS) for predicting clinical deterioration in patients with coronavirus disease 2019 (preprint)

Background: Since the pandemic outbreak of coronavirus disease 2019 (COVID-19), the health system capacity in highly endemic areas has been overwhelmed. Approaches to efficient management are urgently needed. We aimed to develop and validate a score for early prediction of clinical deterioration of COVID-19 patients. Methods: In this retrospective multicenter cohort study, we included 1138 mild to moderate COVID-19 patients admitted to 33 hospitals in Guangdong Province from December 27, 2019 to March 4, 2020 (N =818; training cohort), as well as two hospitals in Hubei Province from January 21 to February 22, 2020 (N =320; validation cohort) in the analysis. Results: The 14-day cumulative incidences of clinical deterioration were 7.9% and 12.1% in the training and validation cohorts, respectively. An Early WArning Score (EWAS) (ranging from 0 to 4.5), comprising of age, underlying chronic disease, neutrophil to lymphocyte ratio, C-reactive protein, and D-dimer levels, was developed (AUROC: 0.857). By applying the EWAS, patients were categorized into low-, medium-, and high risk groups (cut-off values: two and three). The 14-day cumulative incidence of clinical deterioration in the low-risk group was 1.8%, which was significantly lower than the incidence rates in the medium- (14.4%) and high-risk (40.9%) groups (P

Establishment and clinical performance evaluation of 2019 novel coronavirus antibody colloidal gold detection method / 中华传染病杂志

Objective@#To establish a colloidal gold technique assay for the rapid detection of immunoglobulin(Ig) M and IgG antibodies against 2019 novel coronavirus (2019-nCoV) and to evaluate its clinical performance.@*Methods@#A total of 278 patients who were treated at Wuhan Hankou Hospital and the People's Hospital of Honghu from February 12, 2020 to February 20, 2020 were collected. According to the diagnostic criteria, 89 patients were confirmed with 2019-nCoV nucleic acid positive diagnosis, and 189 were 2019-nCoV nucleic acid-negative suspected patients. A total of 273 medical examiners from Nanfang Hospital, Southern Medical University from 2015 to 2018 were selected as controls. The serum samples of patients were collected. 2019-nCoV nucleic proteins were obtained from prokaryotic expression vectors. Indirect IgM and IgG colloidal gold techniques were established by using recombinant N protein. 2019-nCoV nucleic acid detection by reverse transcription-polymerase chain reaction (RT-PCR) was used as control. Serum specimens were tested for 2019-nCoV IgM and IgG. The specificity and sensitivity of colloidal gold assay were analyzed.@*Results@#The sensitivity and specificity of IgM detection reagents were 78.7% and 98.2%, respectively, those of IgG detection reagents were 73.0% and 99.3%, respectively, and those of IgM combined with IgG detection were 87.6% and 98.2%, respectively. For suspected patients with negative 2019-nCoV nucleic acid, the positive rates of IgM and IgG were 59.8% (113/189) and 52.9% (100/189), respectively, and the positive rate of IgM combined with IgG detection was 66.1% (125/189).@*Conclusion@#This reagent of 2019-nCoV antibodies detection (colloidal gold technique) fulfills the requirement for clinical application with high specificity and sensitivity, which can be served as a supplementary detection method for 2019-nCoV nucleic acid detection by RT-PCR.

ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan, China (preprint)

Background: Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) outbreaks in Wuhan, China, healthcare systems capacities in highly endemic areas have been overwhelmed. Approaches to efficient management are urgently needed and key to a quicker control of the outbreaks and casualties. We aimed to characterize the clinical features of hospitalized patients with confirmed or suspected COVID-19, and develop a mortality risk index for COVID-19 patients. Methods: In this retrospective one-centre cohort study, we included all the confirmed or suspected COVID-19 patients hospitalized in a COVID-19-designated hospital from January 21 to February 5, 2020. Demographic, clinical, laboratory, radiological and clinical outcome data were collected from the hospital information system, nursing records and laboratory reports. Results: Of 577 patients with at least one post-admission evaluation, the median age was 55 years (interquartile range [IQR], 39 - 66); 254 (44.0%) were men; 22.8% (100/438) were severe pneumonia on admission, and 37.7% (75/199) patients were SARS-CoV-2 positive. The clinical, laboratory and radiological data were comparable between positive and negative SARS-CoV-2 patients. During a median follow-up of 8.4 days (IQR, 5.8 - 12.0), 39 patients died with a 12-day cumulative mortality of 8.7% (95% CI, 5.9% to 11.5%). A simple mortality risk index (called ACP index), composed of Age and C-reactive Protein, was developed. By applying the ACP index, patients were categorized into three grades. The 12-day cumulative mortality in grade three (age [≥] 60 years and CRP [≥] 34 mg/L) was 33.2% (95% CI, 19.8% to 44.3%), which was significantly higher than those of grade two (age [≥] 60 years and CRP < 34 mg/L; age < 60 years and CRP [≥] 34 mg/L; 5.6% [95% CI, 0 to 11.3%]) and grade one (age < 60 years and CRP < 34 mg/L, 0%) (P <0.001), respectively. Conclusion: The ACP index can predict COVID-19 related short-term mortality, which may be a useful and convenient tool for quickly establishing a COVID-19 hierarchical management system that can greatly reduce the medical burden and therefore mortality in highly endemic areas.