Neutrophil Elastase Inhibitor (Sivelestat) in the Treatment of Acute Respiratory Distress Syndrome Induced by COVID- 19: A Multicenter Retrospective Cohort Study (preprint)

Background Recent studies suggest that neutrophil elastase inhibitor (Sivelestat) may improve pulmonary function and reduce mortality in patients with acute respiratory distress syndrome. We examined the association between receipt of sivelestat and improvement in oxygenation among patients with acute respiratory distress syndrome (ARDS) induced by COVID-19.Methods A large multicentre cohort study of patients with ARDS induced by COVID-19 who had been admitted to intensive care units (ICUs). We used propensity score matching to compare the outcomes of patients treated with sivelestat to those who were not. The differences in continuous outcomes were assessed with the Wilcoxon signed-rank test. Kaplan-Meier method was used to show the 28-day survival curves in the matched cohorts. A log-rank P-test stratified on the matched pairs was used to test the equality of the estimated survival curves. A Cox proportional hazards model that incorporated a robust sandwich-type variance estimator to account for the matched nature of the data was used to estimate hazard ratios (HR). All statistical analyses were performed with SPSS 26.0 and R 4.2.3. A two-sided p-value of < 0.05 was considered statistically significant.Results A total of 387 patients met inclusion criteria, including 259 patients (66.9%) who were treated with sivelestat. In 158 patients matched on the propensity for treatment, receipt of sivelestat was associated with improved oxygenation, decreased Murray lung injury score, increased non-mechanical ventilation time within 28 days, increased alive and ICU-free days within 28 days (HR, 1.85; 95% CI, 1.29 to 2.64; log-rank p < 0.001), shortened ICU stay and ultimately improved survival (HR, 2.78; 95% CI, 1.32 to 5.88; log-rank p = 0.0074).Conclusions Among patients with ARDS induce by COVID-19, sivelestat administration is associated with improved clinical outcomes.

Risk factors for severe COVID-19 infection and the impact of COVID-19 infection on disease progression among patients with AAV (preprint)

Objective To identify risk factors for COVID-19 infection and investigate the impact of COVID-19 infection on chronic kidney disease (CKD) progression and vasculitis flare in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods This cohort study retrospectively analyzed the prevalence and severity of COVID-19 infection in 276 patients with AAV who were followed up. Logistic regression was employed to estimate the risk of COVID-19 infection as well as CKD progression and vasculitis flare upon COVID-19 infection.Results During the 6-month observation period, 213 (77.2%) of 276 patients had a diagnosis of COVID-19 infection. Of these 213 patients, 49 (23.0%) had a COVID-19-related inpatient admission, including 17 patients who died of COVID-19 infection. AAV patients with severe COVID-19 infection were more likely to be male (OR 1.921 [95% CI 1.020–3.619], P = 0.043), suffered from worse kidney function (serum creatinine [Scr], OR 1.901 [95% CI 1.345–2.687], P < 0.001), had higher C-reactive protein (CRP) (OR 1.054 [95% CI 1.010–1.101], P = 0.017) and less likely to have evidence of initial vaccination (OR 0.469 [95% CI 0.231–0.951], P = 0.036), and Scr and COVID-19 vaccination were proven to be significantly associated with severe COVID-19 infection even after multivariable adjustment. Severe COVID-19 infection was significantly associated with subsequent CKD progression (OR 7.929 [95% CI 2.030-30.961], P = 0.003) and vasculitis flare (OR 11.842 [95% CI 1.048-133.835], P = 0.046) among patients with AAV.Conclusion AAV patients who were male, and with worse kidney function were more susceptible to severe COVID-19 infection, which subsequently increased the risk of CKD progression and vasculitis flare.

LSR is a cell-intrinsic defence factor against SARS-CoV-2 infection in small intestine (preprint)

The identification of host factors with antiviral potential is important for developing effective prevention as well as therapeutic strategies against SARS-CoV-2. Here, we have identified the lipolysis-stimulated lipoprotein receptor (LSR) as a crucial host-defense factor against SARS-CoV-2 infection in small intestine using immortalized cell lines, intestinal organoids, ex vivo intestinal tissues, and humanized ACE2 mouse model as proof-of-principle systems. Loss of endogenous LSR enhances ACE2-dependent infection by pseudotyped virus and authentic SARS-CoV-2 virus, and exogenous administration of LSR protect against viral infection. Mechanistically, LSR interacts with ACE2 both in cis and in trans, preventing its binding to Spike protein, and thus blocking viral entry and restricting Spike-mediated cell-cell fusion. These results identify both a previously unknown function for LSR and an associated antiviral host defense mechanism against SARS-CoV-2. The capacity of a small LSR-derived peptide to block Spike binding to the ACE2 receptor holds promise for pan-variant therapeutic interventions.

First uterine transplant case at the Royal Prince Alfred Hospital.

Uterine transplantation (UT) is an emerging medical treatment for women affected by absolute uterine factor infertility (AUFI). To date there have been over 90 documented cases of UT performed worldwide, with over 50 live births. UT allows women affected by AUFI the opportunity to carry and deliver a childd. The Royal Prince Alfred Hospital (RPAH) introduced a UT study in 2019; however, due to the impacts of the COVID pandemic the study was placed on hold for two years. In February 2023, RPAH performed the centre's first UT from a living unrelated donor to a 25-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome. The donor and recipient surgeries were uncomplicated and both are recovering well in the early post-operative period.

Molecular epidemiology of Mycoplasma pneumoniae pneumonia in children, Wuhan, 2020-2022 (preprint)

Background Mycoplasma pneumoniae (M. pneumoniae) is an important pathogen of community-acquired pneumonia in children. However, prior to this study, there was a lack of research on the genotypes and macrolide resistance monitoring of M. pneumoniae in Wuhan. The factors contributing to the severity of illness caused by M. pneumoniaeinfection are still under investigation. We aimed to evaluate the clinical manifestations, genotypes, macrolide resistance, respiratory microenvironment, and their relationship with the severity of illness in children with M. pneumoniaepneumonia in Wuhan. Results Among 1,259 clinical samples, 461 samples were positive for M. pneumoniae via qPCR. We successfully identified the P1 genotypes of 127 samples based on metagenomic and Sanger sequencing, with P1-type 1 (113/127, 88.98%) being the dominant genotype. In addition, we identified the MLST genotypes of 67 samples, with ST-3 being the most common (60/67, 89.6%), followed by ST-14 (5/67, 7.4%) and ST-7 (2/67, 3%). No significant difference in pathogenicity was observed among different genotypes. The macrolide resistance rate of M. pneumoniaeisolates was 96% (48/50) and all mutations were A2063G in domain V of 23S rRNA gene. There was no significant difference between the upper respiratory microbiome of patients with mild and severe symptoms. The pan-genome analysis revealed that the genome of M. pneumoniae is highly conserved, with the core genome comprising 79% of the total genome length. In addition, the initial serological test cannot accurately diagnose M. pneumoniae infection. qPCR is suitable for detecting M. pneumoniaeinfection, while IgM titers greater than 1:160 can be used as a predictor of severity. Conclusions This study is the first to characterize the epidemic and genomic features of M. pneumoniae in Wuhan after the COVID-19 outbreak in 2020, which provides a scientific data basis for monitoring and infection prevention and control of M. pneumoniae in the post-pandemic era.

A multistage multimodal deep learning model for disease severity assessment and early warnings of high-risk patients of COVID-19

The outbreak of coronavirus disease 2019 (COVID-19) has caused massive infections and large death tolls worldwide. Despite many studies on the clinical characteristics and the treatment plans of COVID-19, they rarely conduct in-depth prognostic research on leveraging consecutive rounds of multimodal clinical examination and laboratory test data to facilitate clinical decision-making for the treatment of COVID-19. To address this issue, we propose a multistage multimodal deep learning (MMDL) model to (1) first assess the patient's current condition (i.e., the mild and severe symptoms), then (2) give early warnings to patients with mild symptoms who are at high risk to develop severe illness. In MMDL, we build a sequential stage-wise learning architecture whose design philosophy embodies the model's predicted outcome and does not only depend on the current situation but also the history. Concretely, we meticulously combine the latest round of multimodal clinical data and the decayed past information to make assessments and predictions. In each round (stage), we design a two-layer multimodal feature extractor to extract the latent feature representation across different modalities of clinical data, including patient demographics, clinical manifestation, and 11 modalities of laboratory test results. We conduct experiments on a clinical dataset consisting of 216 COVID-19 patients that have passed the ethical review of the medical ethics committee. Experimental results validate our assumption that sequential stage-wise learning outperforms single-stage learning, but history long ago has little influence on the learning outcome. Also, comparison tests show the advantage of multimodal learning. MMDL with multimodal inputs can beat any reduced model with single-modal inputs only. In addition, we have deployed the prototype of MMDL in a hospital for clinical comparison tests and to assist doctors in clinical diagnosis.

Immune response of primary and booster immunity of SARS-CoV-2 vaccination among patients with chronic liver disease: a real-world study (preprint)

Aim: The present study discussed the humoral immune response and antibody dynamics after primary and booster immunity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines among patients with chronic liver disease (CLD) in the real world. Thus, it provided data to develop SARS-CoV-2 vaccination strategy. Methods: Patients with confirmed CLD and completed primary or booster immunity of SARS-CoV-2 vaccines were enrolled. Serological specimens were collected after primary or booster immunity of SARS-CoV-2 vaccines to detect novel coronavirus neutralizing antibody (nCoV NTAb) and novel coronavirus spike receptor-binding domain antibody (nCoV S-RBD). Thus, we could evaluate the humoral immune response and antibody dynamics after primary and booster immunity of SARS-CoV-2 vaccines among patients with CLD. Simultaneously, baseline demographics, liver disease-related situations, comorbidity-related situations, SARS-CoV-2 vaccination information, and laboratory examination-related indicators of patients were collected. Results: A total of 315 patients received SARS-CoV-2 vaccines, including 223 patients who completed the primary immunity of SARS-CoV-2 vaccines, 114 patients who completed booster immunity of SARS-CoV-2 vaccines, and 22 patients who underwent the antibody detection of SARS-CoV-2 vaccines after both primary and booster immunities. The positive rate of nCoV NTAb was 59.64% in Primary and 87.72% in Booster (P<0.001). The median level of nCoV NTAb was 11.53 AU/mL in Primary and 31.98 AU/mL in Booster (P<0.001). The positive rate of nCoV S-RBD was 69.06% in Primary and 91.23% in Booster (P<0.001). The median level of nCoV S-RBD was 21.60AU/mL in Primary and 112.65 AU/mL in Booster (P<0.001). After booster immunity of SARS-CoV-2 vaccines in 22 patients, the positive rate of nCoV NTAb increased from 59.09% to 86.36%, and that of nCoV S-RBD increased from 68.18% to 90.91%. The median level of nCoV NTAb increased from 11.24 AU /mL to 59.14 AU /mL after booster immunity. The median level of nCoV S-RBD increased from 27.28 AU/mL to 219.10 AU/mL. Compared to the antibody level of primary immunity, the median level of nCoV NTAb and nCoV S-RBD in 22 patients was increased by 5.26 and 8.03 times, respectively. Among 22 patients, 9 were negative for nCoV NTAb after primary immunity, while 6 were transformed positive after booster immunity, and the positive conversion rate of nCoV NTAb was 66.7%. On the other hand, 7 patients were negative for nCoV S-RBD after primary immunity, while 5 were transformed positive after booster immunity, and the positive conversion rate of nCoV S-RBD was 71.4%. Conclusion: Patients with CLD show improved humoral immune response after completing primary and booster immunity of SARS-CoV-2 vaccines, while booster immunity further improves the positive rate and antibody level of patients with CLD. Finally, the positive conversion rate among patients with primary immunity failure also can be improved after booster immunity. Keywords: immune response; primary and booster immunity; SARS-CoV-2 vaccination; chronic liver disease

Effect of community practical training on community residents’ health during the COVID-19 epidemic: A prospective study (preprint)

Background Community practice training is an important part of education in medicine, public health, social medicine, and other disciplines. The objective of this study is to explore the effect and importance of the community practice of Master of Public Health graduates on community residents’ health during the Coronavirus Disease 2019 epidemic.Methods This study used a prospective study design. A total of 152 participants with age ≥ 60 years were selected using a multistage sampling method from Hangzhou in China. Baseline and endline data were collected using structured questionnaires by face-to-face interviews. All psychological and behavioral measurements were performed using standardized instruments and showed good reliability and validity. A total of 147 participants were included in the analysis. The chi-square and rank sum tests were used to compare the difference between baseline and endline for categorical variables. Binary logistic regression analysis was used to evaluate the association between community practice training and changes in psychology and behavior.Results The result of chi-square test showed that the eating habits of participants were different at endline and baseline (p = 0.001). Participants reported that the self-perceived health status from “very good” to “not good” was different between endline and baseline by the rank sum test (p = 0.036). The results of logistic regression analysis showed that community practice training was significantly associated with increased self-efficacy scores and cognitive function, with odd ratios (ORs) of 1.08 (95% CI, 1.04–1.13, p < 0.001) and 0.90 (95% CI, 0.83–0.98, p < 0.013), respectively. The change in eating habits was also statistically significant at endline (p = 0.009).Conclusions Community practice training was associated with changes in health behavior and psychology of community residents. Our results suggested enhanced community practice training for students under the Master of Public Health program.

Role of OAS gene family in COVID-19 induced heart failure (preprint)

Background COVID-19, the current global pandemic caused by SARS-CoV-2 infection, can damage the heart and lead to heart failure (HF) and even cardiac death. The 2',5'-oligoadenylate synthetase (OAS) gene family encode interferon (IFN)-induced antiviral proteins which is associated with the antiviral immune responses of COVID-19. While the potential association of OAS family with cardiac injury and failure in COVID-19 has not been determined.Methods The expression levels and biological functions of OAS gene family in SARS-CoV-2 infected cardiomyocytes dataset (GSE150392) and HF dataset (GSE120852) were determined by comprehensive bioinformatic analysis and experimental validation. The associated microRNAs (miRNAs) were explored from Targetscan and GSE104150 databases. The potential OAS gene family-regulatory chemicals or ingredients were predicted using Comparative Toxicogenomics Database (CTD) and SymMap database.Results The OAS genes were highly expressed in both SARS-CoV-2 infected cardiomyocytes and in the failing hearts. The differentially expression genes (DEGs) in the two datasets were enriched in cardiovascular disease and COVID-19 related pathways, respectively. The miRNAs-target analysis indicated that 9 miRNAs could increase the expression of OAS genes. A variety of chemicals or ingredients were predicted regulating the expression of OAS gene family especially estradiol.Conclusion OAS gene family is an important mediator of HF in COVID-19 and may serve as a potential therapeutic target for cardiac injury and HF in COVID-19.

Serum antibody levels in COVID-19 patients six months after hospital discharge

Objective: To investigate the level of serum antibodies in COVID-19 patients six months after discharge, and to provide data to evaluate the duration of IgM, IgG and neutralizing antibody titers in the patients.

Preparation of the luciferase-labeled antibody for improving the detection sensitivity of viral antigen

Viral antigen detection test is the most common method used to detect viruses in the field rapidly. However, due to the low sensitivity, it can only be used as an auxiliary diagnosis method for virus infection. Improving sensitivity is crucial for developing more accurate viral antigen tests. Nano luciferase (Nluc) is a sensitive reporter that has not been used in virus detection. In this study, we produced an intracellularly Nluc labeled detection antibody (Nluc-ch2C5) and evaluated its ability to improve the detection sensitivity of respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens. Compared with the traditional horse-radish peroxidase (HRP) labeled antibody (HRP-ch2C5), Nluc-ch2C5 was 41 times more sensitive for inactivated SARS-CoV-2 virus by sandwich chemiluminescence ELISA. Then we applied Nluc-ch2C5 to establish an automatic magnet chemiluminescence immune assay (AMCA) for the SARS-CoV-2 viral spike protein, the limit of detection was 68 pfu/reaction. The clinical sensitivity and specificity reached 75% (24/32) and 100% (48/48) using 32 PCR-positive and 48 PCR-negative swab samples for clinical evaluation, which is more sensitive than the commercial ELSA kit and colloid gold strip kit. Here, monoclonal antibody ch2C5 served as a model antibody and the SARS-CoV-2 served as a model pathogen. The Nluc labeled detecting antibody (Nluc-ch2C5) significantly improved the detection sensitivity of SARS-CoV-2 antigen. This labeling principle applies to other viral infections, so this labeling and test format could be expected to play an important role in detecting other virus antigens.

The Sense of Safety and Active Leisure in Gated Enclaves: Evidence from Fuzhou University Campus

Scientific interest in how residential patterns affect both people’s subjective sense of safety and their behavior is increasing. The surge of gated communities in the world has changed the way we live to a great extent. Research on the gated development trend in postmodern cities is still limited;therefore, the purpose of this study was to analyze the relationship between residents’ attitudes toward gated enclaves and their sense of safety. At the same time, the relationship between a sense of security and active leisure behavior was also investigated. Using data collected from 350 college students in Fuzhou University Town, this study introduces a conceptual model to test the relationship between closed enclaves, campus security, and active leisure behavior while controlling population and community characteristics. The results of structural equation model analysis show that gated enclaves positively correlate with campus safety and positively correlate with active leisure behavior, and a safe campus positively correlates with active leisure behavior. The results of this study focus on the importance of gated enclaves as a living environment, and the discovery of functional characteristics of gated enclaves supports future interventions. In other words, when promoting active leisure behavior and increasing the sense of safety in the neighborhood environment, attention must be paid to the characteristics of these gated enclaves. In addition, the simultaneous measurement of these structures provides a dynamic observation of the existing environment, as well as information for future research and construction. Decision makers and urban planners can use these results to promote interaction and healthy behavior in the community under the multi-angle development of the existing access control, thereby improving residents’ sense of security, and increasing leisure participation.

Applications of Robotic Process Automation in Smart Governance to Empower COVID-19 Prevention

This paper explores how the robotic process automation (RPA) can benefit financial applications. To fully exploit RPA technologies potential will empower higher education and finance, which makes a better future together. The mechanism of RPA to mimic the process of human thinking in solving financial problems was discussed. Important technologies, challenges from cooperativeness, responsiveness and interconnectedness were explored. Exploration of automation technologies for COVID-19 prevention will reduce virus transmission, which empowers society governance, higher education and finance.

Compound Lidocaine cream combined with tetracaine prevents cough reaction of patients with general anesthesia caused by extubation: a randomised controlled trial (preprint)

Background: Coughing response caused by tracheal extubation is the most common in general anesthesia patients with tracheal intubation during recovery from anesthesia. However, high aerosol production by coughing during recovery from general anesthesia in patients with respiratory infections (especially COVID-19) is one of the highest risk factors for infection among healthcare workers. Application of local anesthetics to the endotracheal tube is an effective method to reduce the choking reaction. The most commonly used anaesthetics are compound Lidocaine cream and tetracaine injection. However, there is still a certain number of choking reactions in the clinic when the two anaesthetics are used alone. We speculate that the combined application of compound Lidocaine cream and tetracaine will play a better role in prevent coughing response caused by tracheal extubation.Methods: A total of 211 patients, who had undergone laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anesthesia, were randomly assigned to Group C (saline injection, 53 cases), Group L(compound lidocaine cream, 52 cases), Group T (tetracaine, 52 cases) and Group F (compound lidocaine cream combined tetracaine, 54 cases). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), levels of epinephrine and levels of norepinephrine were recorded or measured immediately before extubation and one minute after extubation. In addition, endotracheal tube tolerance, the incidence of bucking, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were analyzed. Results: Blood pressure and heart rate as well as blood concentrations of epinephrine and norepinephrine were significantly higher in the group C compared with the every other group at the time of extubation as well as 1 min after extubation (P < 0.001). And group F significantly reduced the Blood pressure and heart rate as well as blood concentrations of epinephrine and norepinephrine compared group L or group T (P < 0.05, P < 0.01 or P < 0.001). When the patients emerged from general anesthesia, 96% of the group C had cough caused by sputum aspiration and extubation, which was significantly reduced by group L (61.5%, P < 0.001), group T (75%, P < 0.05) and group F (22.2%, P < 0.001), furthermore, group F significantly reduced the incidence of cough compared group L or group T (P < 0.01). Assessment of endotracheal tube tolerance, the score in the group C ((1, 3) 4, P < 0.001) is higher than group L ((0, 1) 2), group T ((0, 1.25) 3) and group F ((0, 0) 1), furthermore, group F significantly reduced the score compared group L or group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in group C (96.2%, 71.7%, respectively, P < 0.001) than group L (48.1%, 15.4%, respectively), group T (61.5%, 26.9%，respectively) and group F (17.3%, 7.7%，respectively), furthermore，group F significantly reduced the incidence of cough compared group L or group T (P < 0.05 or P < 0.01). In addition, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were no statistical difference between every groupConclusions: Compound Lidocaine cream combined tetracaine may be a more advantageous approach for preventing choking and stabilizing circulation during extubation in emergence from general anesthesia, which may play an important role in preventing medical staff from contracting respiratory infectious diseases. Trial registration: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2020) “retrospectively registered”. 

Effects of temperature, humidity, and air saturation state on the transmission risk prediction of COVID-19 in typical scenarios (preprint)

Environmental parameters have a significant impact on the spread of respiratory viral diseases. Temperature and relative humidity are correlated with viral inactivation in the air, whereas supersaturated air can promote viral deposition in the respiratory tract. This study introduces a new concept, the dynamic virus deposition ratio (α), that reflects the dynamic changes in particle size and viral deposition under varying ambient environments. Moreover, a non-steady-state modified Wells-Riley model is established to predict the infection risk of shared air space under varying environmental parameters, including temperature, relative humidity, and air saturation state. The quanta emission rate of an asymptomatic infector during different respiratory activities (breath, voice, and cough) are explored, and the differences in the infection risk under saturated and unsaturated air conditions are also compared. Finally, six typical exposure scenarios from daily life are also explored, highlighting scenarios of higher risk. The results show that the highest infection risk (R max =5.2%) and the longest risk duration (T terminal =6.8h) are both reached in cold and damp conditions. This study quantitatively reflects how environmental parameters are linked to viral inactivation and particle deposition, affecting transmission risk.

Keeping Things Normal During an Uncommon Time: A Lesson from National Taiwan University

The COVID-19 pandemic impacts the learning and teaching experiences of faculty, students, and school staff in all levels of education around the world. While most schools face the challenges of closing down campuses, moving courses online, and relying on technology tools to deliver instructional activities, as one of the few countries with a regular semester schedule, universities in Taiwan have different experiences handling the current situation. This reflective essay aims to share our experiences and learned lessons at National Taiwan University (NTU) about keeping everything going commonly during the uncommon time. This essay will focus on the countermeasures the Center of Teaching and Learning Development (CTLD) and Digital Learning Center (DLC) at NTU had taken on in responding to the change versus unchanged environment. The pandemic impact were discussed from the interrelationships of the university policy, course, and instructor. And our reflections provide five suggestions regarding future precautions to other educational institutions.

An iTSC-derived placental model of SARS-CoV-2 infection unveils ACE2-dependent susceptibility in syncytiotrophoblasts (preprint)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing coronavirus disease 2019 (COVID-19) has caused a global health crisis. The primary site of infection is in the respiratory tract but the virus has been associated with a variety of complications involving the gastrointestinal and cardiovascular systems. Since the virus affects a variety of tissue types, there has been interest in understanding SARS-CoV-2 infection in early development and the placenta. The expression of ACE2 or TMPRSS2, both genes critical for viral entry, is present in placental-specific cell types such as extravillous trophoblasts (EVTs) and, especially, syncytiotrophoblasts (STs). The potential of SARS-CoV-2 to infect these placental cells and its effect on placental development and function is still unclear. Furthermore, it is crucial to understand the possible mechanism of vertical transmission of SARS-CoV-2 through the placenta. Here, we developed an in vitro model of SARS-CoV-2 infection of placental cell types using induced trophoblast stem cells (iTSCs). This model allowed us to show that STs but not EVTs are infected. Importantly, infected STs lack the expression of key differentiation genes, lack typically observed differentiated morphology and produce significantly lower human chorionic gonadotropin (HCG) compared to non-infected controls. We also show that an anti-ACE2 antibody prevents SARS-CoV-2 infection and restores normal ST differentiation and function. We highlight the establishment of a platform to study SARS-CoV-2 infection in early placental cell types, which will facilitate investigation of antiviral therapy to protect the placenta during early pregnancy and development.

Guiding value of dynamic lung ultrasound score in the respiratory support treatment of severe COVID-19

Objective: To explore the guiding value of dynamic changes of lung ultrasound score (LUS) for respiratory support therapy in patients with severe coronavirus disease 2019(COVID-19).

Genomic evidence for divergent co-infections of SARS-CoV-2 lineages (preprint)

Recently, patients co-infected by two SARS-CoV-2 lineages have been sporadically reported. Concerns are raised because previous studies have demonstrated co-infection may contribute to the recombination of RNA viruses and cause severe clinic symptoms. In this study, we have estimated the compositional lineage(s), tendentiousness, and frequency of co-infection events in population from a large-scale genomic analysis for SARS-CoV-2 patients. SARS-CoV-2 lineage(s) infected in each sample have been recognized from the assignment of within-host site variations into lineage-defined feature variations by introducing a hypergeometric distribution method. Of all the 29,993 samples, 53 (~0.18%) co-infection events have been identified. Apart from 52 co-infections with two SARS-CoV-2 lineages, one sample with co-infections of three SARS-CoV-2 lineages was firstly identified. As expected, the co-infection events mainly happened in the regions where have co-existed more than two dominant SARS-CoV-2 lineages. However, co-infection of two sub-lineages in Delta lineage were detected as well. Our results provide a useful reference framework for the high throughput detecting of SARS-CoV-2 co-infection events in the Next Generation Sequencing (NGS) data. Although low in average rate, the co-infection events showed an increasing tendency with the increased diversity of SARS-CoV-2. And considering the large base of SARS-CoV-2 infections globally, co-infected patients would be a nonnegligible population. Thus, more clinical research is urgently needed on these patients.

Emergency Remote Learning in Nursing Education During the COVID-19 Pandemic.

Due to the corona (COVID-19) pandemic, several countries are currently conducting non-face-to-face education. Therefore, teachers of nursing colleges have been carrying out emergency remote education. This study developed a questionnaire to understand the status of Emergency Remote Learning (ERL) in nursing education internationally, translated it into 7 languages, and distributed it to 18 countries. A total of 328 nursing educators responded, and the most often used online methods were Social networking technology such as Facebook, Google+ and Video sharing platform such as YouTube. The ERL applied to nursing education was positively evaluated as 3.59 out of 5. The results of the study show that during the two semesters nursing college professors have well adapted to this unprecedent crisis of teaching. The world after COVID-19 has become a completely different place, and nursing education should be prepared for 'untact' education.