A document by Wen-Hung Chung. Click on the document to view its contents.

Background Based on previous reports of disparities in financial burden following cancer, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support. Methods Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity and income change. Results Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH 57% v. 21% v. 19%, p<0.001; financial toxicity 73% v. 52% v. 53%, p=0.07). Low and middle income caregivers were more likely to experience HMH and financial toxicity compared to high income (HMH: 68% low v. 38% middle v 8.7% high, p<0.001; financial toxicity: 81% v. 68% v. 44%, p<0.001). All income categories demonstrated significant increases in HMH one year after diagnosis. Seventeen percent reported >40% income loss, more of whom were low income than high income (27% v. 12%, p=0.20). Work flexibility and social support were associated with income and financial toxicity. Conclusion HMH, financial toxicity, and income loss are prevalent after a child’s cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low income and Hispanic caregivers. Further research is underway to understand how safety net services are utilized by families, how best to support families with HMH, and how the financial burden of cancer has been impacted by COVID-19.

Evaluating the IgG titers targeting the S protein of SARS-CoV-2 by ELISA assays have been used in the development of several anti-SARS-CoV-2 vaccines in China. It is unclear whether the IgG levels against S protein tested by ELISA can monitor immune evasion against different Omicron variants. In the study, 88 recipients immunized with three doses of a COVID-19-inactivated vaccine were enrolled, whose serum samples were collected within 2 months after the third immunization. The IgG antibody levels were detected by using three commercial ELISA kits, which coated the S protein of the prototype, Omicron BA.1 and BA.5 variants respectively. The neutralizing activities of sera against the pseudotyped Omicron variant, prototype was determined. We also analyzed the correlation between the IgG titers with the neutralizing antibodies. The results showed that, after the third dose of the homologous inactivated vaccine, the neutralizing activity against the Omicron variant BA.1(GMT, 60) and BA. 5(GMT, 42) were decreased significantly compared with the prototype (GMT, 331) respectively ( P<0.05). However, the IgG titers against the S of Omicron BA.1(GMT, 2334) and BA.5(GMT, 2447) variants showed no significant difference with the prototype (GMT, 2797). Our results showed different correlation levels between anti-Spike protein of SARS-CoV-2 IgG titers and neutralizing antibodies, against SARS-CoV-2 prototype, Omicron variant BA.1 and BA.5 In summary, our result highlight that the Omicron variant BA.1 and BA.5 escape vaccine-induced immunity by neutralization activity test, and IgG titers against the SARS-CoV-2 Spike protein can not predict the viral immune evasion against different Omicron variants.

Since May 2022, Monkeypox virus (MPXV) cases have dramatically increased worldwide. In this comprehensive review, we describe the basic characteristics, transmission routes, and susceptible individuals of MPXV as well as discuss the main causes of the current outbreak. The history, clades, genetic evolution, and transmission tendency of MPXV are depicted. Regarding viral transmission analysis in several geographical spots, we would like to point out that men who have sex with men (MSM) could play important roles in the process of transmission that eventually causes viral outbreaks. Susceptible populations at high risk of infection alert society to raise awareness on the protection of these special individuals. We also highlight that airline traveling is a driving force in causing international MPXV transmission. Further summarization of the clinical implications, the prevention of MPXV, and clinical measures of viral detection can enable the rapid diagnosis of MPXV.

Mechanical forces play a crucial role in biological processes at the molecular and cellular levels. Recent advancements in dynamic force spectroscopies (DFS) have enabled the application and measurement of forces and displacements with high resolutions, providing insights into the mechanical pathways involved in various diseases, including cancer, cardiovascular disease, and COVID-19. Among the various DFS techniques, biomembrane force probe (BFP) advancements have improved our ability to measure bond kinetics and cellular mechanosensing with pico-newton and nano-meter resolutions. In this review, we provide a comprehensive overview of the classical BFP-DFS setup and highlight key advancements, including the development of dual biomembrane force probe (dBFP) and fluorescence biomembrane force probe (fBFP). BFP-DFS not only enables the investigation of dynamic bond behaviors on living cells, but also contributed significantly to our understanding of the specific ligand–receptor axes mediated cell mechanosensing. Besides, we explore the contribution of discoveries made possible by BFP-DFS in cancer biology, thrombosis, and inflammation, as well as predict future BFP upgrades to improve output and feasibility. Although BFP-DFS is still a niche research modality, its contribution to the growing field of cell mechanobiology is unparalleled, and its potential to elucidate novel therapeutic discoveries is significant.

SARS-CoV-2 causes COVID-19 pandemic and continues to pose a threat to global public health through genetic mutation. In this study, we have found that an ACE2-specific monoclonal antibody at low concentration was able to greatly enhance SARS-CoV-2 infection and growth in cell culture. Strikingly, it promotes SARS-CoV-2 plaque formation, resulting in accurate titration of different SARS-CoV-2 variants, particularly the newly emerged Omicron variants, which otherwise cannot be determined by standard plaque assays. Quantification of infectious titers of the newly emerged variants will facilitate the development and evaluation of vaccines and antiviral drugs against SARS-CoV-2.

The high prevalence of dialysis-related symptoms in maintenance hemodialysis (MHD) patients severely affect quality of life. Therefore, in this study, we assessed the dialysis symptom index (DSI) of MHD patients during the second wave of COVID-19, which triggered a health crisis, resulting in many cities in China opting for social isolation. A total of 106 MHD patients from our center were screened. DSI, sleep quality, and fatigue scales were investigated separately before and during lockdown. Demographic and laboratory data of MHD patients were collected. A nomogram was used to predict high DSI by combining multiple indicators. Additionally, internal validation was performed to reduce overfitting bias. The mean age of patients was 56.0 years (SD 13.1). The prevalence and severity of DSI were significantly higher during lockdown than pre-lockdown. Notably, itching, trouble staying asleep, bone or joint pain, muscle cramps, feeling irritability, difficulty concentrating, headache, constipation, and feeling nervous were observed ( P<0.05). Multivariate logistic regression analysis identified longer dialysis vintage, lower albumin level, and lower Kt/V as predictors of high DSI. Additionally, the nomogram showed good accuracy in estimating high DSI with a C-index and bootstrap-corrected index of 0.875 and 0.863, respectively. Moreover, calibration plots showed optimal consistency with the actual presence of high DSI. We found a higher prevalence of DSI in MHD patients during the COVID-19 lockdown. Furthermore, patients with longer dialysis vintage, lower albumin levels and Kt/V had a risk of developing high DSI. Further studies should identify targeted therapies for improving the symptom burden of MHD patients.

A recent quantitative study showed volunteering to be an important protective factor against the negative psychological impact of the COVID-19 pandemic. This study aimed to further explore this area of research by analysing the experiences of those volunteering during the pandemic using qualitative methodology. Semi-structured interviews of six individuals volunteering in various roles throughout the pandemic have been analysed using Interpretative Phenomenological Analysis. There emerged three superordinate themes; Staying Connected, Doing Something Useful and Having a Choice. The results suggest that volunteering can help individuals to overcome the negative effects of social isolation and strengthen their sense of connectedness, to find meaning by engaging in interesting and useful activities, and, finally, to experience autonomy in the autonomy-frustrating lockdown context. The findings broaden understanding of the protective impact of volunteering which could be used to inform public health interventions following infectious outbreaks.

Perceived stress has increased due to the COVID-19 pandemic. In addition, those with diagnosed emotional disturbances note higher perceived stress ratings than those without these conditions. Emotion-focused coping can be a practical adjunctive component with problem-based solutions during elevated stress. However, it is unknown if there are differences in perceived stress levels and emotional affect in adults with and without emotional disturbances using a novel emotion-focused coping strategy. A cross-sectional study of 97 adults using the novel strategy completed an online survey of the Perceived Stress Scale (PSS-10) and Positive and Negative Affect Schedule (PANAS). Group one (NEDG) included 34 individuals without a history of emotional disturbance. Group two (EDG) included 63 individuals reporting an emotional disturbance (Anxiety; N= 58 & Depression; N=5). There was no significant difference in perceived stress between the NEDG (17.6 + 5.3) and EDG (17.0 + 5.5) groups. Moreover, there were no significant differences in PANAS between groups. Positive affect was in the 51st percentile (95 % CI: 45.7-56.6%), and negative affect was in the 74th percentile (95% CI: 70.4-78.9%) of normative data. Individuals with or without emotional disturbance may experience similar perceived stress levels and emotional affect while using a novel coping strategy. Additional research investigating this novel strategy is warranted.

Objective Little has been published about maternity outcomes from New Zealand’s unique handling of the COVID-19 pandemic. Objectives were to determine obstetric outcomes between the variants, identify risk factors, and whether the changes to healthcare delivery affected pregnancy outcomes. Design This was a case control study comparing singleton pregnancies affected by the Delta and Omicron strains of COVID-19. The COVID 19-free controls were from 2019. Setting & Population The largest tertiary maternity unit in New Zealand providing taxpayer funded healthcare to a multi-ethnic, high deprivation index population with complex health needs. Methods Data were extracted from electronic record systems and further verified by reviewing patient’s notes. The risk of an event was modelled with logistic regression. The multivariate analyses adjusted for known clinical risk factors and other significant differences between the groups. Main Outcome Measures Outcomes of interest included admission for COVID-19, adverse pregnancy outcomes, including placentally-mediated ones. Results In the study population of > 8,000 pregnancies, Delta variant was associated with significantly worse maternal and obstetric outcomes. Fetal anomalies and most placentally-mediated adverse outcomes of pregnancy in the COVID-19 affected cohort did not persist once adjusted for underlying maternal risk factors, except for a 4-fold increased risk of stillbirth. Vaccination was protective against admissions and severe disease (OR 0.19;95%CI 0.11-0.32). Conclusions While the Delta variant has been associated with poorer outcomes, modifications to the delivery of maternity care during the pandemic could have unintended consequences on how patients utilised healthcare; this may have contributed to poorer outcomes.

A document by Deyang Liu. Click on the document to view its contents.

Background: Here we conducted this study to find the changes in the hematological parameters of healthy individuals that can predict their immune status, also this study aims to find out whether herd immunity against COVID-19 is developing or not in the Pakistani population. Methods: A comparative cross-sectional study of 210 healthy individuals was conducted. All individuals were divided into three groups i.e IgG positive, IgG negative, and IgG and IgM both positive based on ELISA results. Data analysis was done by SPSS version 25 for windows. Results: A statistically significant effect was found among the three groups in terms of mean hemoglobin level, mean hematocrit, mean corpuscular hemoglobin concentration, mean red blood cells count, RDW-CV, mean lymphocyte, mean neutrophil, mean eosinophils, and mean basophil. The study also showed that 52.8% (n=74) had neither taken vaccination nor had any history of previous covid infection but still their antibodies were positive. Conclusion: There was a statistically significant difference among hematological parameters between immune and nonimmune groups and can predict the covid immune status also the study predicted that herd immunity against COVID-19 is developing in Pakistan.

In response to the COVID-19 pandemic shut-down of in-person research laboratories, remote data collection became mainstream in developmental psychology research. The aim of this study was to test the feasibility of two remote data collection methods for studying sleep and motor development in infancy and the relationship between the two. We asked 1,371 parents of infants aged 4 to 17 months who used the Nanit baby monitor to take the on-line Survey of Well-being of Young Children (SWYC) about their infants’ motor experience. Nanit uses auto-videosomnography and computer vision algorithms to calculate and report summary statistics of infants’ sleep. Nanit replicated all expected developmental trends in sleep, while the SWYC only replicated some, appearing to underestimate infants at the transition between motor milestones. However, we replicated some well-established findings regarding the relationship between sleep and motor development using both measures, suggesting that both Nanit and the SWYC can feasibly be used for remote data collection, especially if some modifications were made to how researchers explained using the SWYC to caregivers. Researchers should consider alternatives to traditional research methods not only when in-person participation is difficult or impossible, but also when large samples are needed and/or simple measurement tools are sufficient.

Introduction: Severe Acute Respiratory Syndrome SARS-Cov-2 coronavirus is a member of the coronavirus family. Fever, shortness of breath, and pneumonic infiltrates in both lungs were among the disease’s clinical signs. Along with severe respiratory infections, Covid-19 may also encounter thrombosis complications, and other complications like coronary syndrome, myocardial dysfunction and arrhythmia, acute kidney injury, coronary syndrome, liver cell injury, gastrointestinal symptoms, hyperglycaemia, ocular symptoms, neurological diseases, and dermatological problems. The way in which ophthalmic services were provided changed significantly during this time. Many people, particularly those who suffer from dry eye, are spending a lot of time at home due to continuous spread of coronavirus disease (COVID-19) pandemic. The difficulty for regular follow-up meetings impacting the continuance of glaucoma therapy, cataract surgery, and other eye diseases had been considerably much worse by establishment of strict social distancing and restrictions in travelling during COVID 19 pandemic. Methods: The PubMed, Google Scholar, ResearchGate and healthcare system evidences were searched from 2019 to 2022 for systemic review that were published in English language. Results: Both ocular disease and the overall health care system have been impacted by the result of Covid 19 pandemic. Like other professions, ophthalmology profession has experienced varied degrees of pandemic impact. Ocular problems could develop as a direct result of the SARS infection. The most frequent ocular symptom is viral conjunctivitis, dry-eye problems. During lockdown, the overall symptoms of dry eyes were worse than those who were under normal circumstances. Keywords: COVID-19, Dry-Eye Disease , Eye Diseases, SARS-CoV-2

Effective vaccines have reduced SARS-CoV-2 morbidity and mortality; however, the elderly remain the most at risk. Understanding how vaccines generate protective immunity, and how these mechanisms change with age is key for informing future vaccine design. Cytotoxic CD8+ T cells are important for killing virally infected cells, and vaccines that induce antigen specific CD8+ T cells in addition to humoral immunity provide an extra layer of immune protection. This is particularly important in cases where antibody titres are sub-optimal, as can occur in older individuals. Here, we show that in aged mice, spike-epitope specific CD8+ T cells are generated in comparable numbers to younger animals after ChAdOx1 nCoV-19 vaccination, although phenotypic differences exist. This demonstrates that ChAdOx1 nCoV-19 elicits a good CD8+ T cell response in older bodies, but that typical age-associated features are evident on these vaccine reactive T cells.

Depression and anxiety are common emotional responses among infertility patients, with research showing that they can negatively impact the mental well-being and quality of life of individuals struggling with infertility. This study aimed to conduct a bibliometric analysis of the existing literature on depression and anxiety in infertility patients, in order to shed light on the current state of research and identify potential areas for future study. The majority of research on depression and anxiety in infertility patients has been conducted in recent years, with a growing interest in the topic. Numerous investigations have assessed the effect of infertility treatments on patients' psychological health, with some examinations delving into the application of cognitive behavioral therapy and mindfulness-based stress reduction as potential methods for mitigating symptoms of depression and anxiety. Polycystic ovary syndrome, fertility preservation of cancer patients, COVID-19 pandemic, and assisted reproductive technology are also hot spots in this field. The findings of this bibliometric analysis highlight the importance of addressing depression and anxiety in infertility patients, and imply that further investigation is required to fully comprehend the intricate connections between infertility, depression, and anxiety.

Azvudine was included into the Guidelines for the Diagnosis and Treatment of Coronavirus Disease 2019 (version ninth) issued by the National Health Commission and National Administration of Traditional Chinese Medicine announced on August 9, 2022. Numerous domestic public hospitals introduced Azvudine to copy with the current omicron wave of the COVID-19 pandemic by the end of 2022. In the study, we comprehensively evaluated the efficacy and safety of Azvudine using the clinical data from four phase Ⅲ clinical trials.

Considering the efficacy of monoclonal antibodies (mAbs) directed against the Spike (S) protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in reducing disease severity, the aim of this study was to investigate the innate immune response before and after mAbs treatment in 72 vaccinated and 31 unvaccinated SARS-CoV-2 patients. Type I interferon (IFN-I) signature and cytokines genes were evaluated by real time RT-PCR. The vaccinated patients had increased negative rate of SARS-CoV-2 RT/real-time PCR tests as compared to unvaccinated ones after mAbs treatment. Unvaccinated patients but also those that resulted negative for serum anti-S antibodies despite vaccination had lower IFN-I and higher IFN-I related genes and cytokines mRNAs levels as compared to vaccinated individuals before mAbs. In addition, patients with low anti-S antibody titer showed immune genes expression levels between those found in negative and patients with high titer of anti-S antibodies. Changes in IFN-I pathway and cytokines levels were observed in unvaccinated patients after mAbs treatment, while the expression of most of the type I IFN genes and cytokines analysed, except for ISGs and IL-10 mRNAs, remained unchanged vaccinated patients. These data suggest that mAbs treatment is associated to a different virological and immunological response in SARS-CoV-2 infected patients according to their vaccination status and related anti-S antibodies titers.

SARS-CoV-2 infection in already-vaccinated individuals is still possible and may require hospitalization. The aim of the present study was to evaluate the clinical evolution of patients with COVID-19 admitted in a public hospital. The outcomes were assessed in relation to the predominant viral variant and the vaccination status. This retrospective study was performed on 1,295 COVID-19-positive patients who attended a 352-bed university hospital between 2021 and 2022. Clinical variables and vaccination status were recorded. Of the patients, 799 had not been vaccinated (NV, 61.7%), 449 were partially vaccinated (PV, 34.7%) and 47 were completely vaccinated (CV, 3.6%). The mean age of the CV patients was significantly higher than that of PV and NV. Also, they had higher percentages of chronic diseases. The outcomes depended on age but not on vaccination status. There were 209 patients admitted during the Omicron-infection period, from which 70 (33.5%) were NV, 135 (64.6%) PV, and 4 (1.9%) CV. In conclusion: Correct vaccination greatly reduces the risk of acquiring severe COVID-19. Partial vaccination does not guarantee protection of the population. This highlights the need for continuous vaccination promotion with all recommended doses, while investigating alternative treatments for those patients who do not respond to the vaccines.

Objectives: Despite its low sensitivity for the interstitial syndrome, chests X-Ray (XR) have been used on COVID-19 patients to exclude alternative diagnoses. Computed tomography (CT) scans can both exclude other pathological conditions and display a high level of sensitivity for the COVID-19 pneumonia. We therefore decided to compare the performance of lung ultrasonography (LUS) with that of lung CT scans in suspect or confirmed COVID-19 patients for the presence of interstitial pneumonia and the degree of lung injury. Methods: In a cross-sectional clinical study, LUS an CT were compared for the presence of interstitial pneumonia and the degree of lung injury in COVID-19 patients. Pearson’s and Spearman correlations analysis were performed to measure the degree of association between two methods. Bland–Altman plot was generated to provide a graphical visualization of the agreement between the two measurement methods. All statistical tests in this study were two-sided and p-values ≤ 0.05 were considered as statistically significant. Results: A good correlation between LUS and CT scan was obtained for estimates of lung injury in pneumonia in a group of COVID-19 suspect and diagnosed patients (R 2= 0.7613; p <0.01). Agreement between LUS and CT values is assessed by constructing Bland-Altman plot. Conclusions: LUS, as compared to CT scans, is an effective method to estimate degrees of lung injury in COVID-19 patients in the emergency department.

Objectives This study aims to investigate the readiness and resilience of health system against COVID-19 and the impact of the pandemic on economy and foreign trade in the Middle East and North Africa (MENA) region with Turkey. Methods By descriptive analysis, we evaluated the readiness and resilience of the health system and the impact of the pandemic on economy and foreign trade in the MENA region with Turkey. We tested the normality of the indicators by Jarque-Bera (JB), Shapiro-Wilk (SW) and Kolmogorov-Smirnov (KS) tests. We ranked the countries by min-max standardization method. Results As of the end of July 2021, the number of COVID-19 related cases was more than 12.4 million in MENA and 5.7 million in Turkey and deaths were more than 212 thousand in MENA and 51 thousand in Turkey. After the analysis in order, we have found Israel, Saudi Arabia, United Arab Emirates, Turkey and Qatar as the most resilient countries and Yemen, Syria, Palestine, Iraq and Libya as the most vulnerable countries against pandemic. Conclusion The pandemic has affected the life and the economies in the region negatively and the health system for some of them was not sufficient to fight with it.

A 43 year old male presented to a community hospital emergency department for evaluation of sudden onset shortness of breath, tachycardia, and hypertension. Initial evaluation showed an adrenal mass on chest computed tomography. There was biochemical evidence of multi organ damage. Patient had elevated plasma metanephrine and normametanephrine levels.

We have read the article entitled ”Prone Positioning in intubated and mechanically ventilated patients with SARS-CoV-2” by Chen et al., published in the Journal of Clinical Anesthesia (2021 August) \cite{Chen_2021}[1]. We congratulate the authors for this successful publication and make some contributions.In the article, it has been mentioned in the conclusion that a prolonged prone position is a safe and feasible option to extend survival in patients with COVID-19. It was reported that among the patients that died within 14 days of intensive care admission, 11.8% received prolonged prone positioning, while 52.2% did not. The authors mentioned some study limitations, but it is incomplete.We have the following concerns regarding the methodology of the study. The authors clearly stated that patients who did not tolerate prolonged prone positioning were excluded from the study. The author should have mentioned how many patients were excluded, which could have affected the sample size distribution. Also, what was the definition of a prolonged prone position? What was the definition of intolerance to the prolonged prone position? Is it worsening oxygenation, hemodynamic stability, or other criteria? If exclusion were based on worsening oxygenation, hence prone position would have affected the outcomes and mortality. The authors did not mention if the patients excluded had an absolute or a relative contraindication to prone positioning. There are various terms used for proning in the study, prolonged proning, long-term proning, and persistent proning.During the early phase of the COVID-19 pandemic, with limited evidence of this novel disease. Many journals accepted borderline publications. Some journals didn't pay attention to major methodological concerns in published articles. We addressed our concerns in the published article addressing a similar topic \cite{Fayed_2022}. Our published meta-analysis on this topic showed no mortality benefit of prone ventilation. The study, as mentioned earlier by Chen et al., results were skewed compared to other published ones \cite{Fayed_2022a}.In conclusion, the excluded patients might have worse outcomes in the prone position. Hence, excluding these patients from the study might show results favoring the prone position, and hence there are favorable outcomes in the prone position. This should have been mentioned as a significant limitation of this study, and the conclusion should be cautiously drawn and rephrased.

Observational studies have reported that COVID-19 is associated with alterations in retinal layer thickness, including changes in the ganglion cell inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL). However, observational studies are susceptible to confounding factors and reverse causality. Therefore, we assessed the direction and strength of the causal relationship between COVID-19 patient phenotypes (susceptibility, hospitalization, and severity) and GCIPL and RNFL thicknesses using a bidirectional two-sample Mendelian randomization (MR) design. The inverse-variance weighted (IVW) method is the primary approach used to estimate causal effects. MR Egger, weighted median, weighted mode, MR Egger (bootstrap), and penalized weighted median methods were applied. In addition, we performed sensitivity analyses using RadialMR, MRPRESSO, MR Egger regression, Cochran’s Q statistic, and Leave-one-out analysis. Forward MR analysis revealed that genetically identified COVID-19 susceptibility significantly increased the risk of GCIPL thickness (OR: 2.428, 95% confidence interval[CI]:1.493-3.947, PIVW=3.579 ×10 -4) and RNFL thickness (OR: 1.735,95%CI:1.198-2.513, PIVW=3.580×10 -3). The results after excluding MRPRESSO and RadialMR to identify outliers and SNPs associated with confounding factors showed RNFL thickness(OR:1.800,95%CI: 1.192-2.717, PIVW=5.147×10 -3).Reverse MR analysis did not indicate a significant causal association between GCIPL and RNFL thicknesses and COVID-19 phenotypes. In conclusion, the host genetic liability to COVID-19 susceptibility was causally associated with increased GCIPL and RNFL thicknesses. Documenting this association increases our understanding of the pathophysiological mechanisms underlying COVID-19 susceptibility in retinopathy.