Wearing N95 masks decreases the odor discrimination ability of healthcare workers: a self-controlled before-after study.

Objective: During the coronavirus disease 2019 (COVID-19) pandemic, the N95 mask is an essential piece of protective equipment for healthcare workers. However, the N95 mask may inhibit air exchange and odor penetration. Our study aimed to determine whether the use of N95 masks affects the odor discrimination ability of healthcare workers. Methods: In our study, all the participants were asked to complete three olfactory tests. Each test involved 12 different odors. The participants completed the test while wearing an N95 mask, a surgical mask, and no mask. The score for each olfactory test was documented. Results: The olfactory test score was significantly lower when the participants wore N95 masks than when they did not wear a mask (7 vs. 10, p < 0.01). The score was also lower when the participants wore N95 masks than surgical masks (7 vs. 8, p < 0.01). Conclusion: Wearing N95 masks decreases the odor discrimination ability of healthcare workers. Therefore, we suggest that healthcare workers seek other clues when diagnosing disease with a characteristic odor.

Endoplasmic Reticulum Stress Contributes to Ventilator-Induced Diaphragm Atrophy and Weakness in Rats.

Background: Accumulating evidence indicates that endoplasmic reticulum (ER) stress plays a critical role in the regulation of skeletal muscle mass. In recent years, much attention has been given to ventilator-induced diaphragm dysfunction (VIDD) because it strongly impacts the outcomes of critically ill patients. Current evidence suggests that the enhancement of oxidative stress is essential for the development of VIDD, but there are no data on the effects of ER stress on this pathological process. Methods: VIDD was induced by volume-controlled mechanical ventilation (MV) for 12 h; Spontaneous breathing (SB, for 12 h) rats were used as controls. The ER stress inhibitor 4-phenylbutyrate (4-PBA), the antioxidant N-acetylcysteine (NAC), and the ER stress inducer tunicamycin (TUN) were given before the onset of MV or SB. Diaphragm function, oxidative stress, and ER stress in the diaphragms were measured at the end of the experiments. Results: ER stress was markedly increased in diaphragms relative to that in SB after 12 h of MV (all p < 0.001). Inhibition of ER stress by 4-PBA downregulated the expression levels of proteolysis-related genes in skeletal muscle, including Atrogin-1 and MuRF-1, reduced myofiber atrophy, and improved diaphragm force-generating capacity in rats subjected to MV (all p < 0.01). In addition, mitochondrial reactive oxygen species (ROS) production and protein level of 4-HNE (4-hydroxynonenal) were decreased upon 4-PBA treatment in rats during MV (all p < 0.01). Interestingly, the 4-PBA treatment also markedly increased the expression of peroxisome proliferator-activated receptor-gamma co-activator-1alpha (PGC-1α) (p < 0.01), a master regulator for mitochondrial function and a strong antioxidant. However, the antioxidant NAC failed to reduce ER stress in the diaphragm during MV (p > 0.05). Finally, ER stress inducer TUN largely compromised diaphragm dysfunction in the absence of oxidative stress (all p < 0.01). Conclusion: ER stress is induced by MV and the inhibition of ER stress alleviates oxidative stress in the diaphragm during MV. In addition, ER stress is responsible for diaphragm dysfunction in the absence of oxidative stress. Therefore, the inhibition of ER stress may be another promising therapeutic approach for the treatment of VIDD.

Comparison of the anxiety level between the medical staff and the public during the early phase of the coronavirus disease 2019 pandemic.

Background: A sudden outbreak of the coronavirus disease 2019 (COVID-19) started in December 2019 in Wuhan, China. Up-to-date, there have been limited studies examining the anxiety status of Chinese individuals in the early phase of the pandemic period (January 30, 2020-February 15, 2020). This survey aimed to compare the level of anxiety of the medical staff with that of the public and to provide a theoretical basis for developing an effective psychological intervention. Method: Questionnaires were sent on the Internet (http://www.wjx.cn) during this period. The anxiety levels of Chinese people were investigated using the Self-Rating Anxiety Scale (SAS), and the demographic data were collected simultaneously. Results: A total of 1110 participants were enrolled in this study, with an effective response rate of 100%. A total of 482 respondents were medical staff (43.4%), while 628 were members of the general public (56.6%). The medical staff itself had a higher SAS score than the general public (48.36±13.40 vs. 45.74±11.79, P < 0.01), while the medical staff in Wuhan were more anxious than the public in Wuhan with a higher SAS score (54.17±14.08 vs. 48.53±11.92, P < 0.01). Conclusion: The COVID-19 pandemic has had a significant impact on the anxiety levels of the medical staff and the public, with the medical personnel showing a higher anxiety level than the public, especially female medical staff in Wuhan. Therefore, urgent intervention programs to reduce anxiety should be implemented.

Abrupt and unexpected stressful life events are followed with increased disease activity in spondyloarthritis: A two years web-based cohort study.

OBJECTIVE: The contribution of environmental factors to spondyloarthritis (SpA) course remains poorly characterized. We previously reported a possible triggering of disease flares by stressful life events and vaccination. The objective of the present study was to specify the types of vaccine and life event that may influence disease activity. METHODS: A prospective cohort of adult SpA was followed for two years. Patients logged on to a secured website every month to complete a standardized auto-questionnaire. They reported whether they had been exposed to stressful life events, vaccinations or other environmental factors. Patients were asked to rate the distress resulting from exposure to life events on a numerical rating scale (NRS: 0-10). Primary outcome variable was the variation of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) measured on two consecutive connections. Months where an event occurred were compared to months without events. The cut-off value of 1 is defined as the minimal clinically important variation for the BASDAI. RESULTS: The 272 enrolled SpA patients returned 3,388 questionnaires. Months where an abrupt and unexpected traumatic event occurred were associated with a significant increase of BASDAI of 0.57 [95%CI: 0.29; 0.85] (P<0.001). The higher the rating of distress, the larger the impact on BASDAI, reaching a clinically meaningful increase of 0.99 [0.17; 1.82] for a VNS≥9. The effect of stressful events on BASDAI persisted during a median of 3 months. No other environmental factor was significantly associated with BASDAI variations. CONCLUSION: Among stressful life events, abrupt and unexpected events were associated with transient worsening of disease activity in SpA, which reached a clinically meaningful increase for the highest rating of distress. Association between vaccines and disease flare was not confirmed.