Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Impact of SARS-CoV-2 on Aerobic and Anaerobic Capacity in Professional Ice Hockey Players

Background/Objectives: COVID-19 poses significant physiological challenges for athletes, particularly those engaged in high-intensity intermittent sports such as ice hockey. This study aimed to evaluate the impact of SARS-CoV-2 infection-especially symptomatic cases-on aerobic and anaerobic performance in professional ice hockey players. Methods: Fifty athletes from the Polish Hockey League were assigned to three groups: control (CG, n = 13), asymptomatic COVID-19 (NSG, n = 28), and symptomatic COVID-19 with post-infection SpO2 < 90% (WSG, n = 9). Each underwent assessments at three time points-pre-preparatory period 2020/2021, post-preparatory period 2020/2021, and pre-preparatory period 2021/2022. Aerobic capacity was measured via a progressive cycle ergometer test (VO2max, VO2 at lactate threshold [VO2Lt], minute ventilation [V'E], breathing frequency [BF], and lactate clearance rate [ΔLa]), and anaerobic capacity via a 30 s Wingate test (relative mean power). Results: Compared with CG and NSG, symptomatic athletes exhibited significant post-infection declines in VO2max (48.2 ± 2.9 vs. 56.2 ± 6.2 and 54.6 ± 3.9 mL/kg/min; p = 0.006, d = 1.56 vs. CG; p < 0.024, d = 1.79 vs. NSG) and VO2Lt (p < 0.05). Relative mean power also decreased in WSG (p < 0.05). In contrast, CG and NSG improved or maintained these metrics over the same period. Symptomatic players showed elevated BF post infection (p = 0.022, d = 1.72) and reduced V'E (p = 0.035; d = 0.83), while ΔLa was markedly lower (p = 0.0004; d = 2.86). Conclusions: SARS-CoV-2 infection, particularly symptomatic cases, can significantly impair both aerobic and anaerobic capacity in elite hockey players. Targeted recovery protocols are essential for restoring performance in affected athletes.

Glutamine Administration Attenuates Poly(I:C)-Induced Lung Injury by Reducing Neutrophil Infiltration and Activating the TLR-3 Antiviral Pathway

Objectives: In this study, we investigated the effects of intravenous glutamine (GLN) administration on the Toll-like receptor 3 (TLR3) antiviral pathway and leukocyte migration in mice with poly(I:C)-induced acute lung injury (ALI). Methods: There were four groups in this study: the NC group, mice without an intratracheal injection; the SH group, mice intratracheally injected with endotoxin-free saline; the PS group, intratracheally instilled with 3 mg poly(I:C)/kg body weight (BW), followed by an intravenous (IV) injection of saline; and the PG group, intratracheally injected with poly(I:C) followed by the IV administration of 0.75 g GLN/kg BW. Mice in the SH, PS, and PG groups were sacrificed at 4, 12, and 24 h after intratracheal instillation. Results: The results showed that poly(I:C) stimulation decreased the plasma GLN concentration and increased inflammatory cytokine levels. In bronchoalveolar lavage fluid, concentrations of interferon λ3 and percentages of macrophages and M1 macrophages decreased, while neutrophils increased along with significantly elevated myeloperoxidase activity in lung tissues. The gene expressions of molecules related to leukocyte migration increased, whereas tight/adherens junction expressions in endothelial and epithelial cells were reduced. GLN supplementation upregulated the mRNA and/or protein expressions of TLR3 antiviral pathway-related factors and tight/adherens junctions while reducing inflammatory cytokines and the expressions of leukocyte migration molecules. Histological results also showed that lung injury was attenuated. Conclusions: These findings indicated that intravenous GLN administration after poly(I:C) instillation restored plasma GLN levels and alleviated ALI by activating the TLR3 antiviral pathway, suppressing leukocyte migration and neutrophil infiltration, mitigating inflammation, and improving the integrity of the alveolar-capillary barrier.

Astrocytes-derived LCN2 triggers EV-A71-induced muscle soreness via accumulating lactate

Viral muscle soreness (VMS) is a common feature during acute viral infections, including those caused by enteroviruses, and it substantially diminishes patients' quality of life. At present, we aim to establish the "brain-muscle" axis to explore the underlying mechanisms of VMS. We initially observed that diminished pain threshold occurred in enterovirus A71 (EV-A71)-infected C57BL/6J and AG6 mice. Subsequently, RNA sequencing data showed that lipocalin 2 (LCN2) was up-regulated during multiple viral infections, including EV-A71, Japanese encephalitis virus, vesicular stomatitis virus, and West Nile virus, which all caused VMS. As expected, Lcn2-deficient C57BL/6 J (Lcn2-/-) mice exhibited greater pain tolerance, as shown by stronger grip force and stable motor function after EV-A71 infection. Mechanistically, EV-A71-induced high-mobility group 1 (HMGB1) stimulated astrocyte-derived LCN2 secreted into the circulatory system, which enhanced glycolysis and induced lactate buildup in muscle through increasing pyruvate dehydrogenase kinase 1 (PDK1) expression and decreasing pyruvate dehydrogenase (PDH) activity. Together, HMGB1/LCN2/PDK1/lactate pathway in the brain-muscle axis promoted VMS development.

Sex differences in adenosine deaminase activity associate with disparities in SARS-CoV-2 innate immunity

Females demonstrate elevated type-I interferon production and a stronger antiviral immune response; however, the mechanisms underlying sex-based differences in antiviral immunity are incompletely understood. We previously reported that low adenosine deaminase (ADA) activity perturbs the methylation-based transcriptional silencing of endogenous retroviral elements (hERV), which stimulates IFN-Stimulated Genes (ISG) and primes antiviral immunity. Here we demonstrate lower ADA activity in females compared to their male counterparts, which correlated with higher hERV and ISG expression in female lungs. Sex differences in ADA2 were linked to the number and expression profiles of blood and lung-derived monocyte populations. Single-cell RNA sequencing of respiratory cells from patients with COVID-19 showed a significant female bias in hERV-ISG signatures, and implicated IL-18 as a driver of sex-specific ADA2 expression. Observations in healthy and COVID-19 cohorts indicate that higher ADA activity is associated with suppressed antiviral innate immunity in the male respiratory tract, which may drive adverse COVID-19 outcomes.

Neutrophil green inclusions combined with hemophagocytosis in peripheral blood after bee sting a case report and literature review

RATIONALE

Neutrophils green inclusions serve as sensitive biomarkers for acute liver failure and lactic acidosis, demonstrating a strong correlation with short-term mortality, commonly referred to as "death inclusions." The combination of macrophage phagocytosis with neutrophil green inclusion is rarely reported, and this article discusses the clinical association and prognostic value of these 2 critical phenomena.

PATIENT CONCERNS

A 76-year-old female patient and an 82-year-old male patient both developed acute hepatic and renal failure, lactic acidosis, and multiple organ dysfunction syndrome following bee stings. Green inclusions in the cytoplasm of neutrophils and hemophagocytosis were detected in peripheral blood smears during hospitalization in both cases. Notably, both patients were elderly and had a poor prognosis.

DIAGNOSES

Multiple organ dysfunction syndrome due to bee sting.

INTERVENTIONS

Give endotracheal intubation ventilator-assisted respiration, perform plasma exchange to remove poison, perform continuous renal replacement therapy for blood purification to correct acidosis, use hormone anti-inflammation to stabilize cell membranes and the internal environment, implement fluid resuscitation and blood product transfusion, replenishment of albumin and parenteral nutritional support, and other therapies.

OUTCOMES

The conditions of both patients deteriorated rapidly following the discovery of neutrophils green inclusions, and resuscitation efforts were eventually abandoned by their families, leading to their discharge from the hospital.

LESSONS

The co-occurrence of neutrophils green inclusions and macrophage phagocytosis in peripheral blood smears indicates systemic cytokine storm and hepatic dysfunction, serving as an early prognostic marker for multiorgan dysfunction syndrome. Enhanced detection of these morphological abnormalities and their prompt clinical reporting are critical for assessing disease severity and outcomes. We propose integrating dynamic peripheral blood smear monitoring into the standard diagnostic protocol for critical cases of bee venom envenomation.

Multi-omics analysis reveals that Bacillus spp. enhance mucosal antiviral immunity in teleost fish by mediating diglyceride production through lipid metabolism

BACKGROUND

Symbiotic microbiota in vertebrates play critical roles in establishing and enhancing host resistance to pathogenic infections as well as maintaining host homeostasis. The interactions and mechanisms of commensal microbiota-mediated mucosal immune systems have been extensively studied in mammals and, to a lesser extent, in birds. However, despite several studies emphasizing the role of mucosal microbiota in controlling pathogen infections in teleost fish, limited knowledge exists regarding the core microbiota and the mechanisms by which they contribute to resistance against viral infections.

RESULTS

Our findings suggest that viral infections shape clinical manifestations of varying severity in infected fish. An increased abundance of Bacillus spp. in the mild phenotype indicates its crucial role in influencing fish immunity during viral infections. To confirm that Bacillus spp. act as a core contributor against viral infection in fish, we isolated a representative strain of Bacillus spp. from largemouth bass (Micropterus salmoides), which was identified as Bacillus velezensis (Bv), and subsequently conducted feeding trials. Our study demonstrated that dietary supplementation with Bv significantly reduced mortality from largemouth bass virus (LMBV) infection in bass by enhancing host immunity and metabolism as well as by regulating the microbial community. Furthermore, multi-omics analysis elucidated the mechanism by which Bacillus spp. confer resistance to viral infections by regulating the production of diglyceride (DG) during lipid metabolism.

CONCLUSIONS

Our study provides the first evidence that Bacillus spp. are a core microbiota for combating viral infections in teleost fish, shedding light on the conserved functions of probiotics as a core microbiota in regulating microbial homeostasis and mucosal immunity across the vertebrate lineage.

SARS-CoV-2 induced immune perturbations in infants vary with disease severity and differ from adults' responses

Differences in immune profiles of children and adults with COVID-19 have been previously described. However, no systematic studies have been reported from infants hospitalized with severe disease. We applied a multidimensional approach to decipher the immune responses of SARS-CoV-2 infected infants (n = 26; 10 subacute, 11 moderate and 5 severe disease; median age = 1.6 months) and matched controls (n = 14; median age = 2 months). Single cell (scRNA-seq) profiling of PBMCs revealed substantial alterations in cell composition in SARS-CoV-2 infected infants; with most cell-types switching to an interferon-stimulated gene (ISGhi) state including: (i) CD14+ monocytes co-expressing ISGs and inflammasome-related molecules, (ii) ISGhi naive CD4+ T cells, (iii) ISGhi proliferating cytotoxic CD8+ T cells, and (iv) ISGhi naive and transitional B cells. We observe increased serum concentrations of both interferons and inflammatory cytokines in infected infants. Antibody responses to SARS-CoV-2 are also consistently detected in the absence of anti-IFN autoantibodies. Compared with infected adults, infants display a similar ISG signature in monocytes but a markedly enhanced ISG signature in T and B cells. These findings provide insights into the distinct immune responses to SARS-CoV-2 in the first year of life and underscore the importance of further defining the unique features of early life immunity.

Integrating multiplex PCR in fever clinics for acute respiratory pathogen-specific diagnosis

The epidemiological patterns of respiratory tract infections (RTIs) have experienced substantial changes due to the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with a particular focus on acute respiratory infections (ARIs). Challenges in early diagnosis, inadequate triage strategies, and the inappropriate use of antimicrobials or antivirals have compounded the difficulties in accurately diagnosing and managing ARIs in the post-pandemic context. This study aimed to investigate the efficacy of fever clinics equipped with nucleic acid testing capabilities in the precise triage of ARIs. In a cohort of 604 individuals presenting with symptoms of ARIs, we utilized real-time reverse transcription polymerase chain reaction (RT-PCR) technology available in the fever clinic to perform nucleic acid testing for SARS-CoV-2, influenza A virus (Flu A), influenza B virus (Flu B), respiratory syncytial virus, adenovirus, human rhinovirus, and Mycoplasma pneumoniae. Subsequently, statistical methods were employed to analyze the distribution and types of ARIs associated with these pathogens. In fever clinics, most patients presenting with respiratory pathogen infections were diagnosed with non-SARS-CoV-2 respiratory pathogens, with a higher incidence noted among pediatric patients compared to adults. In contrast, SARS-CoV-2 primarily affected the adult population and was linked to more severe clinical outcomes. Consequently, the swift triage of patients exhibiting ARI symptoms in a fever clinic equipped with nucleic acid testing enables the rapid identification and precise treatment of pathogens. This approach alleviates patient discomfort and enhances the efficiency of healthcare resource utilization.

High-Lethality Precision-Guided Nanomissile for Broad-Spectrum Virucidal and Anti-Inflammatory Therapy

Viral infection, especially the past SARS-CoV-2 pandemic, has posed severe threat toward globalized healthcare, whereas vaccine and drug development can hardly keep up with the rate of virus mutation and resistance. In severe COVID-19 patients, the virus triggers a cytokine storm marked by excessive pro-inflammatory cytokine release, resulting in acute respiratory distress syndrome (ARDS). Therefore, a comprehensive strategy for viral neutralization and inflammation suppression is highly demanded. Herein, we designed a high-lethality precision-guided nanomissile for broad-spectrum virucidal and anti-inflammatory therapy. The nanomissile was a nanoscale molecularly imprinted polymer (nanoMIP) harboring hypervalent mannose-binding cavities and loaded with a magnetocaloric core and photothermal dye ICG. It demonstrated an ultrafast heating rate, increasing from 25.2 to 55.9 °C within 60 s under alternating magnetic field (AMF) and near-infrared (NIR) laser irradiation. In addition, the nanomissile exhibited a unique double-punch mechanism, being capable of targeting not only the conserved high-mannose glycans of SARS-CoV-2, HIV-1, LASV, and PDCoV with Kd values reaching 10-10 M but also heat-inactivating the virions right away. Beyond this, it also exhibited significant anti-inflammatory and immunomodulatory properties. In the mouse model, the nanomissile exerted outstanding therapeutic and prophylactic effects while inhibiting virus replication and protecting lung injury. Thus, this potently broad-spectrum virucidal strategy opens a new access to eradicating viral infectivity and inflammatory storm suspension.

Immune modulation: the key to combat SARS-CoV-2 induced myocardial injury

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which caused the Coronavirus disease 2019 (COVID-19) pandemic, has posed significant healthcare challenges. In addition to respiratory complications, it has led to severe damage in other organs, particularly the cardiovascular system. Of which, myocardial injury is increasingly recognized as a most significant complication, contributing to the high mortality. Recent research indicates the pivotal role of immune dysregulation in mediating myocardial injury in patients infected with SARS-CoV-2. In this review, we provide a comprehensive analysis of the immune mechanisms involved in SARS-CoV-2-induced myocardial damage, focusing on the roles of key immune cells and molecules that contribute to this pathological process. Aiming at mitigating the myocardial injury of COVID-19, we review immune-based treatments under evaluation in preclinical and clinical trials. Along with talking about the similarities and differences in myocardial injury resulting from SARS-CoV-2, the Middle East respiratory syndrome coronavirus (MERS-CoV) and the severe acute respiratory syndrome coronavirus (SARS-CoV). This article provides a unique perspective on using past experiences to prevent myocardial injury in the face of ongoing virus mutations.

Prognostic Accuracy of Nutritional Assessment Tools in Critically-Ill COVID-19 Patients

Objectives: Critically ill COVID-19 patients are at high risk of malnutrition; however, no study has directly compared the prognostic accuracy of different nutritional assessment tools. This study aimed to determine the optimal cutoff values for the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score, Nutritional Risk Screening 2002 (NRS 2002), and Malnutrition Universal Screening Tool (MUST) and to evaluate their predictive value for ICU mortality. Method: A retrospective analysis was conducted on patients with laboratory-confirmed COVID-19 admitted to our ICU between 20 March 2020 and 15 June 2021. Clinical and laboratory data, as well as patient outcomes, were retrieved from electronic medical records and patient charts. The mNUTRIC, NRS 2002, and MUST scores were calculated at ICU admission. Results: The study included 397 patients, with 273 survivors and 124 non-survivors. The median age was 65 (55-76) years, and the median BMI was 26.1 (24.0-29.4). Non-survivors had significantly higher median scores in all three nutritional assessment tools compared to survivors (mNUTRIC: 5 vs. 3, NRS 2002: 4 vs. 3, MUST: 2 vs. 2; p < 0.01). At the optimal cutoff values, mNUTRIC ≥ 4 demonstrated the highest prognostic accuracy (sensitivity: 0.77, specificity: 0.74; AUC = 0.75, CI = 0.70-0.81), followed by NRS 2002 ≥ 4 (sensitivity: 0.63, specificity: 0.60; AUC = 0.62, CI = 0.56-0.67) and MUST ≥ 3 (sensitivity: 0.21, specificity: 0.91; AUC = 0.56, CI = 0.50-0.68). Higher scores were associated with increased disease severity, poorer patient performance, prolonged hospital stays, and elevated ICU, 28-day, and overall hospital mortality rates. Among the three assessment tools, only an mNUTRIC score of ≥ 4 was independently associated with ICU mortality (OR = 1.54, CI = 1.21-1.96, p < 0.01). Conclusions: At ICU admission, mNUTRIC ≥ 4, NRS 2002 ≥ 4, and MUST ≥ 3 were identified as the most accurate predictors of mortality in critically ill COVID-19 patients. However, only the mNUTRIC score was an independent predictor of ICU mortality.

Effects of coronavirus disease 2019 on the incidence, mortality, and prognosis of ischemic stroke: a systematic review and meta-analysis

Objective

The objective of this study was to conduct a systematic review on the effect of coronavirus disease 2019 (COVID-19) on the incidence, mortality, and prognosis of ischemic stroke. The systematic review also ascertained the relationship between COVID-19 and the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) typing of ischemic stroke, as well as the risk factors for ischemic stroke in patients with COVID-19.

Methods

The relevant literature between COVID-19 and ischemic stroke incidence, mortality, and prognosis up to January 2024 were systematically reviewed. Searches were carried out PubMed, Embase, Web of Science, and Cochrane databases. Utilizing the Meta-analysis of observational studies in epidemiology (MOOSE) declaration list, a systematic review and meta-analysis were carried out. Heterogeneity and publication bias were assessed.

Results

Twenty-one studies encompassed 505,864 participants across 13 countries. In total, 1.1% of patients with COVID-19 infection had an ischemic stroke (odds ratio [OR], 0.011; 95% confidence interval [CI], 0.007-0.017; p < 0.001). COVID-19 was related to in-hospital mortality (OR, 2.76; 95% CI, 1.90-4.02; p < 0.001), mortality 3 months following the beginning of an ischemic stroke (OR, 2.54; 95% CI, 1.80-3.58; p < 0.001), and modified Rankin scale (mRS) score ≤2 at hospital discharge (OR, 0.62; 95% CI, 0.54-0.72; p < 0.001). mRS ≤ 2 at 3 months after the onset of ischemic stroke did not show any correlation significantly with COVID-19 (OR, 0.67; 95% CI, 0.43-1.06; p = 0.086). Longer hospital stays (OR, 0.13; 95% CI, 0.06-0.20; p < 0.001) and increased incidence of large-artery atherosclerosis and small-vessel disease phenotypes of ischemic stroke were observed in patients with both COVID-19 and ischemic stroke (p < 0.05). In patients with COVID-19, ischemic stroke was substantially linked with hypertension, diabetes, hyperlipidemia, smoking, atrial fibrillation, coronary artery disease, chronic kidney disease, and chronic obstructive pulmonary disease (p < 0.05).

Conclusion

COVID-19 is linked with increased incidence and mortality rates for ischemic stroke, as well as a worsening prognosis for the condition. With the data obtained from this study, targeted strategies to prevent and treat ischemic stroke in the context of the COVID-19 can be developed.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524016, identifier: CRD42024524016.

The NSP6-L260F substitution in SARS-CoV-2 BQ.1.1 and XBB.1.16 lineages compensates for the reduced viral polymerase activity caused by mutations in NSP13 and NSP14

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants emerged at the end of 2021, and their subvariants are still circulating worldwide. While changes in the S protein of these variants have been extensively studied, the roles of amino acid substitutions in non-structural proteins have not been fully revealed. In this study, we found that SARS-CoV-2 bearing the NSP6-L260F substitution emerged repeatedly when we generated several SARS-CoV-2 variants by reverse genetics or when we passaged SARS-CoV-2 isolated from clinical samples and that it was selected under cell culture conditions. Although this substitution has been detected in BQ.1.1 and XBB.1.16 that circulated in nature, its effect on viral properties is unclear. Here, we generated SARS-CoV-2 with or without the NSP6-L260F by reverse genetics and found that NSP6-L260F promotes virus replication in vitro and in vivo by increasing viral polymerase activity and enhancing virus pathogenicity in hamsters. We also identified disadvantageous substitutions, NSP13-M233I and NSP14-D222Y, that reduced BQ.1.1 and XBB.1.16 replication, respectively. These adverse effects were compensated for by NSP6-L260F. Our findings suggest the importance of NSP6-L260F for virus replication and pathogenicity and reveal part of the evolutionary process of Omicron variants.IMPORTANCEAlthough the properties of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants continue to change through the acquisition of various amino acid substitutions, the roles of the amino acid substitutions in the non-structural proteins have not been fully explored. In this study, we found that the NSP6-L260F substitution enhances viral polymerase activity and is important for viral replication and pathogenicity. In addition, we found that the NSP13-M233I substitution in the BQ.1.1 lineage and the NSP14-D222Y substitution in the XBB.1.16 lineage reduce viral polymerase activity, and this adverse effect is compensated for by the NSP6-L260F substitution. Our results provide insight into the evolutionary process of SARS-CoV-2.

Impact of nurse staffing coverage and care complexity factors on health outcomes in hospitalized COVID-19 patients: a cross-sectional study

BACKGROUND

Few studies have captured the impact of inadequate nurse staffing levels and broader health patient conditions in admitted patients during the COVID-19 pandemic. We aimed to determine the association between nurse staffing coverage, care complexity individual factors (CCIFs) and adverse events (AEs) in patients admitted with COVID-19.

METHODS

A multicentre cross-sectional study was conducted from March 1, 2020 to March 31, 2022 at eight public health hospitals in Spain. All patients with COVID-19 who were admitted to these hospitals were included. The main variables included AEs, nurse staffing coverage (as measured using the ATIC patient classification system) and CCIFs to evaluate broader patient health conditions. Adjusted logistic models were performed to identify associations with AEs, stratified by patients admitted to wards and hospitalized patients who required admission to intensive care units (ICUs).

RESULTS

A total of 11,968 hospitalized patients, 2,824 (23.6%) experienced AEs. Multivariate analysis showed that higher levels of nurse staffing coverage protected against AEs. Among patients admitted to acute wards, the independent risk factors for AEs included old age, haemodynamic instability, chronic disease, uncontrolled pain, urinary or faecal incontinence and mental status impairments. In addition to these factors, extreme weight, position impairment and communication disorders were factors associated with AEs in patients who required ICU admission.

CONCLUSIONS

Nurse staffing coverage was a protective factor for AEs. Several CCIFs related to comorbidity/complications, developmental, and mental-cognitive domains were strongly associated with AEs. Therefore, ensuring safe nurse staffing levels could be improve patient outcomes.

Distinct immunity dynamics of natural killer cells in mild and moderate COVID-19 cases during the Omicron variant phase

Background

The SARS-CoV-2 Omicron variant is associated with milder COVID-19 symptoms than previous strains. This study analyzed alterations in natural killer (NK) cell-associated immunity dynamics in mild and moderate COVID-19 cases during the Omicron phase of the COVID-19 pandemic.

Methods

We conducted a retrospective observational cohort study of patients aged ≥16 with confirmed SARS-CoV-2 infection who were hospitalized at Tottori University Hospital between January 2022 and May 2022. A total of 27 patients were included in the analysis. Of these, 11 and 16 were diagnosed with mild and moderate COVID-19, respectively, based on the Japanese COVID-19 clinical practice guideline. Peripheral blood NK cell subsets and surface markers, including the activating receptor NKG2D and the inhibitory receptor TIGIT, as well as serum levels of 24 immunoregulatory markers, such as cytokines and cytotoxic mediators, were measured at admission and recovery. In addition, to explore immune patterns associated with disease severity, differences in 24 serum markers and soluble UL16-binding protein 2 (sULBP2) at the clinically most symptomatic time point during hospitalization were visualized using a volcano plot and analyzed with Spearman's rank correlation analysis and principal component analysis (PCA).

Results

Patients with mild COVID-19 exhibited expanded subsets of unconventional CD56dimCD16- NK cells with elevated NKG2D expression and lower levels of cytotoxic mediators (granzyme A, granzyme B, and granulysin). In contrast, patients with moderate disease exhibited NK cell exhaustion, characterized by upregulation of TIGIT, along with increased levels of NK cell-associated cytokines and cytotoxic mediators. The volcano plot identified that the patients with moderate COVID-19 exhibited significantly elevated IL-6 and sULBP2 levels. Spearman's rank correlation analysis revealed that IL-6, IFN-γ, soluble Fas, and CXCL8 were correlated with increased sULBP2. The PCA identified distinct clusters based on disease severity.

Conclusions

The results of study highlight the differences in NK cell-associated immune alterations between mild and moderate COVID-19 cases. Elevated IL-6 and sULBP2 levels, along with their correlations with inflammatory mediators, reflects differences in immune response based on disease severity. These findings provide insight into the immune response to infection caused by the Omicron variant of SARS-CoV-2 and improve our understanding of its immunological features.

Inhibition of RACK1-Mediated NLRP3 Oligomerization (Active Conformation) Ameliorates Acute Respiratory Distress Syndrome

Aberrant activation of the NACHT, LRR, and PYD domain-containing protein 3 (NLRP3) inflammasome contributes to the pathogenesis of fatal and perplexing pulmonary diseases. Although pharmacological inhibition of the NLRP3 inflammasome brings potent therapeutic effects in clinical trials and preclinical models, the molecular chaperones and transition governing its transformation from an auto-suppressed state to an active oligomer remain controversial. Here, this work shows that sesquiterpene bigelovin inhibited NLRP3 inflammasome activation and downstream pro-inflammatory cytokines release via canonical, noncanonical, and alternative pathways at nanomolar ranges. Chemoproteomic target identification discloses that bigelovin covalently bound to Cys168 of RACK1, disrupting the interaction between RACK1 and NLRP3 monomer and thereby suppressing NLRP3 inflammasome oligomerization in vitro and in vivo. Bigelovin treatment significantly alleviates the severity of NLRP3-related pulmonary disorders in murine models, such as LPS-induced ARDS and silicosis. These results consolidated the intricate role of RACK1 in transiting the NLRP3 state and provided a new anti-inflammatory lead and therapy for NLRP3-driven diseases.

A Rare Case of Small Bowel Ulceration Induced by COVID-19

Background

COVID-19 can affect multiple organ systems beyond the respiratory tract, including the gastrointestinal tract, where gastrointestinal symptoms include nausea, vomiting, diarrhea, abdominal pain, and even serious manifestations such as ulcers, perforation, or gastrointestinal bleeding.

Case Presentation

We report a case of a 45-year-old male patient with small bowel ulcers caused by chronic COVID-19 infection. Initially presenting with fever and transient unconsciousness, he developed ischemic necrosis and required a mid-thigh amputation. Despite treatment with anti-infection therapy, extracorporeal membrane oxygenation, and continuous renal replacement therapy, he experienced persistent abdominal pain and gastrointestinal bleeding. Imaging and colonoscopy confirmed partial small bowel obstruction and inflammation. After treatment with methylprednisolone and enteral nutrition, his symptoms improved. However, he suffered a gastrointestinal perforation requiring emergency surgery and later underwent a successful stoma reversal. The patient was subsequently discharged with improvement and was discharged with a primary diagnosis of "enterostomal status, perforation of small intestinal ulcer, viral myocarditis, COVID-19 infection, and post right lower extremity amputation". During the past year of follow-up, the patient has not experienced any recurrence of abdominal pain or rectal bleeding.

Conclusion

Although coronavirus pneumonia combined with small bowel ulcers is rare, it requires emergency treatment and has a high mortality rate. This case highlighted the severe gastrointestinal complications induced by COVID-19 infection and the effectiveness of comprehensive management strategies.

SARS-CoV-2 damages cardiomyocyte mitochondria and implicates long COVID-associated cardiovascular manifestations

INTRODUCTION

With the COVID-19 pandemic becoming endemic, vigilance for Long COVID-related cardiovascular issues remains essential, though their specific pathophysiology is largely unexplored.

OBJECTIVES

Our study investigates the persistent cardiovascular symptoms observed in individuals long after contracting SARS-CoV-2, a condition commonly referred to as "Long COVID", which has significantly affected millions globally.

METHODS

We meticulously describe the cardiovascular outcomes in five patients, encompassing a range of severe conditions such as sudden cardiac death during exercise, coronary atherosclerotic heart disease, palpitation, chest tightness, and acute myocarditis.

RESULTS

All five patients were diagnosed with myocarditis, confirmed through endomyocardial biopsy and histochemical staining, which identified inflammatory cell infiltration in their heart tissue. Crucially, electron microscopy revealed widespread mitochondrial vacuolations and the presence of myofilament degradation within the cardiomyocytes of these patients. These findings were mirrored in SARS-CoV-2-infected mice, suggesting a potential underlying cellular mechanism for the cardiac effects associated with Long COVID.

CONCLUSION

Our findings demonstrate a profound impact of SARS-CoV-2 on mitochondrial integrity, shedding light on the cardiovascular implications of Long COVID.

Association of Vitamin D Supplementation with Glutathione Peroxidase (GPx) Activity, Interleukine-6 (IL-6) Levels, and Anxiety and Depression Scores in Patients with Post-COVID-19 Condition

Coronavirus disease 2019 (COVID-19) presents with various symptoms, and some patients develop post-COVID-19 condition (PCC). Vitamin D has shown therapeutic potential in COVID-19 and may offer benefits for PCC. The aim of this study was to evaluate the differences associated with two supplementation strategies (bolus and daily) on interleukin-6 (IL-6) levels, glutathione peroxidase (GPx) activity, and clinical outcomes in PCC patients, regardless of whether target 25 (OH) D levels reached the ideal range. We conducted a self-controlled study in which 54 participants with PCC were supplemented with vitamin D3 (n = 28 bolus and n = 26 daily) for 2 months. Blood samples were collected to measure IL-6 levels and GPx activity using spectrophotometric methods. The Hospital Anxiety and Depression Scale (HADS) was used to assess mental function. Both bolus and daily vitamin D supplementation were significantly associated with increased GPx activity and decreased IL-6 levels. Daily supplementation was additionally associated with a significant reduction in anxiety and depression scores. However, neither regimen was associated with improvements in cough, dyspnea, or fatigue. These findings suggest a potential association between vitamin D supplementation and improvements in antioxidant and neuropsychiatric parameters in PCC, possibly mediated by its immunomodulatory and antioxidant properties. Further placebo-controlled trials are warranted to determine whether these observed associations reflect causal relationships.

Early Immunological and Inflammation Proteomic Changes in Elderly COVID-19 Patients Predict Severe Disease Progression

Background: Elderly patients infected with SARS-CoV-2 are at higher risk of developing cytokine storm and severe outcomes; however, specific immunological and proteomic biomarkers for early prediction remain unclear in this vulnerable group. Methods: We enrolled 182 elderly COVID-19 patients from the Chinese PLA General Hospital between November 2022 and April 2023, categorizing them based on progression to respiratory failure requiring mechanical ventilation (defined as severe progression). Olink proteomic analysis was performed on admission serum from 40 propensity score-matched samples, with differentially expressed proteins (DEPs) validated by cytometric bead array (CBA) in 178 patients. To predict severe progression, a model was developed using a 70% training set and validated on a 30% validation set. LASSO regression screened features followed by logistic regression and receiver operating characteristic (ROC) analysis to optimize the model by incrementally incorporating features ranked by random forest importance. Results: Elderly patients progressing to severe COVID-19 exhibited early immune dysregulation, including neutrophilia, lymphopenia, monocytopenia, elevated procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII), as well as coagulation dysfunction and multi-organ injury. Proteomics identified a set of biomarkers, including tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), and revealed disruptions in signaling pathways, including the mTOR and VEGF signaling pathways. The optimal predictive model, which incorporated PCT, IL-6, monocyte percentage, lymphocyte count, and TRAIL, achieved an area under curve (AUC) of 0.870 (0.729-1.000) during validation. TRAIL levels negatively correlated with fibrinogen (p < 0.05). Conclusions: Elderly COVID-19 patients with severe progression demonstrate early immune dysregulation, hyperinflammation, coagulation dysfunction, and multi-organ injury. The model we proposed effectively predicts disease progression in elderly COVID-19 patients, providing potential biomarkers for early clinical risk stratification in this vulnerable population.

Impact of long COVID on the health-related quality of life of Japanese patients: A prospective nationwide cohort study

BACKGROUND

Various prolonged systemic symptoms, forming the long coronavirus disease (COVID), have been observed in patients who have recovered from the acute phase of COVID-19. Although previous studies have reported that COVID-19 impacts health-related quality of life (HRQoL), the associations of long COVID symptoms and clinical characteristics with HRQoL remain unclear. This study aimed to clarify these associations using nationwide Japanese epidemiological data.

METHODS

A prospective nationwide cohort study was conducted on patients with COVID-19 between January 2020 and February 2021 at 26 participating medical institutions in Japan. Various long COVID symptoms and HRQoL scores at 3, 6, and 12 months following diagnosis were collected from 986 participants. Generalized estimating equations (GEE) were used to explore the association between HRQoL scores evaluated using the short form-8 (SF-8), long COVID symptoms, and baseline clinical characteristics.

RESULTS

Patients who had one long COVID symptom showed a significantly lower physical component summary score (PCS) and mental component summary score (MCS) compared with those without any symptoms at all time points after diagnosis. GEE revealed that long COVID symptoms, including dyspnea, fatigue, headache, and muscle weakness, were significantly associated with worse PCS, whereas poor concentration, sleep disorders, fatigue, and headache were significantly associated with worse MCS. Severity-related baseline parameters for patients with COVID-19 were significantly associated with worse PCS scores, although these factors were not significantly associated with worse MCS scores.

CONCLUSIONS

Long COVID symptoms were associated with lower physical and mental HRQoL. Severe outcomes of COVID-19 impacted PCS but not MCS.

Risk perceptions, knowledge and protection practices related to COVID-19 in Dessie City Administration, Northeast Ethiopia: a community-based study

Background

COVID-19 is a global concern due to its high transmission and mortality rates. Despite governments' efforts worldwide to control its spread, many people were hesitant to adopt preventive measures. The effectiveness of these measures largely depends on public willingness, which is influenced by their knowledge and perception of risk. Therefore, this study aimed to examine the knowledge, risk perceptions, protection practices, and related factors concerning COVID-19 in the Dessie City Administration, Northeast Ethiopia.

Methodology

This study employed a cross-sectional design. We selected seven hundred ninety participants using a systematic sampling technique. Data was collected face-to-face using an interviewer-administered questionnaire. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to summarise the sample characteristics. Multivariable logistic regression analysis was conducted using SPSS (version 23), and the results were presented in the form of text, tables, and graphs.

Results

Of the study participants, 498 (63%) had good knowledge of the pandemic, while 457 (58%) had a low-risk perception. Only 305 (39%) demonstrated good protection practices. The most trusted sources of information were healthcare personnel (686 participants, 86.8%), followed by the Ministry of Health websites (654 participants, 82.8%). Monthly income (>10,000 ETB), knowledge, and risk perceptions with AORs of 3.05 (CI: 1.51-6.14), 4.45 (CI: 2.81-7.04), 2.06 (CI: 1.38-3.08) were significantly associated with protection practices against the COVID-19 pandemic.

Conclusion

More than two-thirds of the participants demonstrated good knowledge about COVID-19. However, over half perceived themselves to be at low risk and engaged in poor preventive practices. Control efforts will be challenging, especially among younger and less educated groups who consider themselves at low risk, requiring focused attention. Understanding people's risk perceptions and beliefs about the effectiveness of COVID-19 prevention measures is essential for improving protective behaviours. Health education and active community engagement are key strategies in combating the spread of the virus.

COVIVA: Effect of transcutaneous auricular vagal nerve stimulation on fatigue-syndrome in patients with Long Covid - A placebo-controlled pilot study protocol

BACKGROUND

Up to 80% of patients who develop coronavirus disease-2019 (Covid-19) infection subsequently experience long covid/post-covid syndrome. The World Health Organization (WHO) has estimated that >770 million patients have been infected with Covid-19 globally. Even if only 10% of these patients develop long covid, > 75 million patients will suffer for a long period. Among the various symptoms of post-covid syndrome, fatigue is common, affecting up to 60% of the patients. As observed in other viral infections, elevated levels of inflammatory cytokines may play a role. Transcutaneous auricular vagal nerve stimulation (taVNS) is a noninvasive method that modulates the immune system via the central nervous system and has shown promising effects in autoimmune diseases and improving fatigue. In this pilot study, we investigated the feasibility of daily taVNS in patients with long covid-related fatigue. Additionally, the effects of taVNS on fatigue and quality of life will be analyzed.

METHODS

A total of 45 adult patients with long covid associated fatigue syndrome will be enrolled in this study, and will be randomized to the above-threshold-stimulation, below-threshold-stimulation, or sham-stimulation arms, after being informed that they will feel the stimulation. The above-threshold-group will receive a 4-week-long left-sided cymba conchae taVNS with 25 Hz, 250 µs pulse width 28s/32s on/off paradigm for 4 h throughout the day. The below-threshold group will receive stimulation below the sensational threshold, whereas the sham group will receive no stimulation following application of a non-functional electrode. The daily stimulation protocol will be recorded either manually or using the provided app. Three well-established questionnaires, the Multidimensional-Fatigue-Inventory-20, Short-Form-36, and Beck-Depression-Inventory, and the newly established Post-Covid-Syndrome-Score will be completed both before and after 4 weeks of stimulation.

DISCUSSION

The primary endpoint has been set as the patients' average daily stimulation time after 4 weeks, while secondary endpoints include the effects of taVNS on fatigue and Quality of Live (QoL). As a non-invasive treatment option, taVNS may be a notable alternative for patients with post-covid related fatigue.

TRIAL REGISTRATION

This study was approved by the local ethics committee (23/7798) and registered (DRKS00031974) (see supporting information files).

ETHICS & DISSEMINATION

The ethical justifiability of this study was supported by prior research demonstrating the safety of taVNS. Patients will be recruited by general practitioners, and written informed consent will be obtained. All data will be pseudonymized for collection and storage. The study results will be published in peer-reviewed journals with the aim of providing evidence of the potential of taVNS in long covid management. The study will be conducted in accordance with the principles of the Declaration of Helsinki.

Molecular Evidence of SARS-CoV-2 Virus in Dogs and Cats from Grenada

SARS-CoV-2 is a highly contagious virus that infects humans, wildlife, domesticated and farmed animals. An increase in SARS-CoV-2 variants and human-animal interactions could have implications for the global maintenance and perpetuation of the virus. This study aimed to detect SARS-CoV-2 infection in dogs and cats living in households with and without SARS-CoV-2-positive owners by real-time reverse transcription polymerase chain reaction (qRT-PCR) in Grenada. This cross-sectional study was conducted from August 2020 to April 2022 from dogs (139) and cats (22) in households (96) in Grenada. Nasopharyngeal and oropharyngeal swabs were taken from the dogs and cats to detect SARS-CoV-2. qRT-PCR tests were performed targeting the E and RdRP genes, respectively. Notably, 12% (17/139) of dogs and 23% (5/22) of cats tested positive for SARS-CoV-2. The positive animals were found in 17 (18%) households, all with at least one positive individual. No positive cases of pets were detected in households without infected humans. A statistically significant association (p < 0.0001) was observed between humans with SARS-CoV2 and their pets. Phylogenetic tree analysis showed evidence of a relationship between the Grenadian SARS-CoV-2 E gene and other SARS-CoV-2 E gene sequences available in the NCBI database. This study confirmed the concurrent SARS-CoV-2 human/companion animal infection from households in Grenada. Humans and pet animals were positive synchronously; however, the direction of transmission from pets to humans or vice versa remains unknown. This study suggests that pets could play a role in the maintenance, transmission, and prolongation of infection of human-adapted pathogens such as SARS-CoV-2.

Evaluation of Retinal and Optic Nerve Parameters in Recovered COVID-19 Patients: Potential Neurodegenerative Impact on the Ganglion Cell Layer

Background/Objectives: This study aimed to analyze optic nerve parameters, retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), and subfoveal choroidal thickness (ChT) in patients who have recovered from coronavirus disease 2019 (COVID-19). Methods: This comparative study included 78 recovered COVID-19 patients (16 men, 62 women) and 56 age- and sex-matched healthy controls (18 men, 38 women). COVID-19 was confirmed in all patients, either through the detection of viral RNA in nasopharyngeal swabs via reverse transcriptase polymerase chain reaction or by serological testing for SARS-CoV-2 antibodies. Spectral-domain optical coherence tomography (SD-OCT) was used to assess optic nerve parameters, RNFLT, GCLT, and ChT. Results: The mean age was 35.0 ± 8.3 years in the COVID-19 group and 31.5 ± 8.3 years in the control group, with no statistically significant differences in age or sex distribution between groups (p = 0.41 and p = 0.16, respectively). Optic nerve parameters and RNFLT (overall and across the four peripapillary quadrants) did not differ significantly between the COVID-19 and control groups. However, the mean ganglion cell-inner plexiform layer (GC-IPL) thickness was significantly reduced in all quadrants in the COVID-19 group compared to the controls. No significant difference was observed in mean subfoveal ChT between groups. Conclusions: A significant reduction in ganglion GCLT was observed in recovered COVID-19 patients compared to healthy controls, suggesting a potential neurodegenerative effect of the disease on the optic nerve.

NLRP3 inflammasome: From drug target to drug discovery

The immune system employs innate and adaptive immunity to combat pathogens and stress stimuli. Innate immunity rapidly detects pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) via pattern recognition receptors (PRRs), whereas adaptive immunity mediates antigen-specific T/B cell responses. The NLRP3 inflammasome, a key cytoplasmic PRR, consists of leucine-rich repeat, nucleotide-binding, and pyrin domains. Its activation requires priming (signal 1: Toll-like receptors/NOD-like receptors/cytokine receptors) and activation (signal 2: PAMPs/DAMPs/particulates). NLRP3 triggers cytokine storms and neuroinflammation, contributing to inflammatory diseases. Emerging therapies target NLRP3 via nuclear receptors (transcriptional regulation), adeno-associated virus (AAV) vectors (gene delivery), and microRNAs (post-transcriptional modulation). This review highlights NLRP3's signaling cascade, pathological roles, and combinatorial treatments leveraging nuclear receptors, AAVs, and microRNAs for immunomodulation.

Impact of SARS-CoV-2 P.1 Variant Infection on the Nasopharyngeal Commensal Bacterial Microbiome of Individuals from the Brazilian Amazon

It is important to understand which bacterial taxa are most abundant during SARS-CoV-2 infection and to promote mitigation strategies for conditions subsequent to infection. Nasopharyngeal swab samples were collected from patients infected with SARS-CoV-2 and their family contacts (uninfected and asymptomatic) during the outbreak of the P.1 variant of SARS-CoV-2 in Parintins, Amazonas-Brazil, in March 2021. The samples were investigated by a shotgun sequencing metagenomic approach using the NextSeq 500 Illumina® system. The samples were stratified according to the presence or absence of SARS-CoV-2, household group, sex, and age. Of the total of 63 individuals, 37 (58.73%) were positive for SARS-CoV-2 and 26 (41.27%) were negative for SARS-CoV-2 and other respiratory viruses (FLU, AdV, HBoV, HCoV, HMPV, RSV, PIV, HRV). The alpha diversity indexes Chao1, species observed, Simpson, and Inv Simpson demonstrated a significant difference (p < 0.05) in both the diversity of observed species and the abundance of some taxa between positive and negative individuals. We also observed an abundance of opportunists such as Klebsiella pneumoniae, Staphylococcus spp, and Shigella sonnei, previously associated with the severity of COVID-19. Our results suggest that SARS-CoV-2 infection causes changes in the microenvironment of the nasopharyngeal region, allowing greater proliferation of opportunistic bacteria and decreased abundance of commensal bacteria.

A pilot study of coughing into the shirt to disrupt respiratory pathogen transmission

BACKGROUND

Scientific evidence is lacking for the respiratory etiquette maneuver of coughing into the elbow. This pilot study introduces and evaluates a novel maneuver " coughing into the shirt" comparing effectiveness of containing respiratory plumes to existing respiratory etiquette strategies.

METHODS

In this open-bench, observational respiratory etiquette pilot study, five healthcare workers performed four respiratory etiquette maneuvers including: unobstructed, into the elbow, into a mask, and into the shirt. Observational data for the cough maximal plume area, an area calculation, were collected using slow-motion video recording. The various respiratory plume areas of the participants were compared to the unobstructed maneuver, assessing the percent reduction of the maximal plume area.

RESULTS

All respiratory etiquette maneuvers significantly reduced the maximal plume area as compared to the unobstructed condition (F(3,12) = 18.56, P < 0.005). Comparing the maximal plume area of the unobstructed maneuver to the "into the shirt" maneuver, we found a 95.4% decrease for the "into the shirt" respiratory etiquette maneuver (P < 0.005). There was no statistically significant difference when comparing the obstructive maneuvers to each other. Additionally, the maximal plume area from the "into the shirt" maneuver was 35.75% less than the "into the elbow" maneuver (P = 0.15). Comparing the maximal plume area of the "into the shirt" maneuver to the "into the mask" maneuver, results were inconclusive, with an average difference of 2.24% (P = 0.66).

CONCLUSIONS

Coughing into the shirt may offer superior containment of the respiratory plume than coughing into the elbow. Larger studies are warranted to validate these findings and guide future public health recommendations.

STUDY DESIGN

Open bench, observational, cough etiquette pilot study comparing the into the shirt respiratory etiquette maneuver to other respiratory etiquette maneuvers.

Longitudinal lipoprotein and inflammatory mediators analysis uncover persisting inflammation and hyperlipidemia following SARS-CoV-2 infection in long COVID-19

INTRODUCTION

Individuals suffering from acute COVID-19 (AC) often develop long COVID-19 (LC) syndrome that is associated with aberrant levels of lipoproteins and inflammatory mediators. Yet, these dysregulations are heterogenous due to the uncertain prevalence and require a more extensive characterization.

OBJECTIVES

This study aimed to investigate LC-associated dysregulations in inflammatory mediators and lipids by longitudinal Nuclear Magnetic Resonance (NMR) lipoprotein analysis and cytokine profiling in human blood.

METHODS

We quantitatively profiled lipoproteins and inflammatory parameters in LC patients at 5 (n = 95), 9 (n = 73), 12 (n = 95), 16 (n = 78), and 20 (n = 85) months post AC by in vitro diagnostics research (IVDr)-based NMR spectroscopy. Simultaneously, we assessed inflammatory meditators with a 13-plex cytokine panel by flow cytometry. We then compared the lipoprotein profiles with historical data from AC (N = 307) and healthy cohorts collected before the COVID-19 pandemic (N = 305), whereas the cytokine profiles were correlated with that of the AC cohort.

RESULTS

We identified 31 main and 80 significantly altered subclass lipoproteins, respectively. LC was associated with higher serum levels of very low-density, intermediate-density, low-density, high-density lipoproteins, along with triglycerides, cholesterols, and apolipoprotein a-I & a-II lipoproteins compared to the healthy cohort. We also observed significantly lower concentrations of NMR-based inflammatory parameters in LC than in AC cohort, whilst proinflammatory mediators IFN-α2, IFN-γ, TNF-α, CXCL8/IL-8, IL-12p70, IL-17 A, and IL-23 displayed significantly higher concentrations in LC compared with the AC cohort. Conversely, CCL2/MCP-1, IL-6, and IL-18 were significantly higher in the AC cohort than in LC.

CONCLUSION

Our findings demonstrate a persistent hyperlipidemic phenotype in LC alongside signs of chronic inflammation and lipoprotein metabolism that vary in states of acute and chronic inflammation.

Gender dependent modulation of opioid dependance genes and signaling pathways in HIV-1 Transgenic rats at morphine tolerance

Misuse of opioids is a major comorbidity in people with HIV (PWH). Neurological abnormalities and opioid addiction seen in PWH involve the interplay among signaling pathways. However, the impact of HIV proteins on morphine dependence is understudied. We aimed to understand the modulation of the opioid dependence genes and signaling pathways in the striatum (Str) and prefrontal cortex (PFC) of PWH. HIV-1 transgenic (HIV-1Tg) rats and F344 control animals were given 2 and 4 pellets of morphine (75-mg/pellet)/placebo on Days 1 and 2, respectively, via subcutaneous implantation. On Day 5, at morphine tolerance the rats were sacrificed, Str and PFC were collected for RNA isolation and cDNA preparation. A PCR-array was used to examine the expression of the 65 opioid dependance genes. Varying numbers of genes were significantly upregulated in the Str and PFC of morphine treated rats. Fold change values were uploaded to QIAGEN Ingenuity Pathway Analysis, to study the signaling pathways associated with the treatment conditions. CREB signaling in neurons and Neuroinflammation signaling pathway were highly activated in the Str of both male and female HIV-1Tg rats given morphine. Gαq signaling and S100 family signaling were activated in female HIV-1Tg rats received morphine. Similarly, in the PFC, synthesis of IP3, CREB Signaling in neurons, Gαq signaling in males and CREB Signaling in neuron, and Gαq signaling in females were activated. Using bioinformatic analysis, we identified key signaling pathways and gender dependent changes in the opioid dependent gene expression and pathway enrichment of HIV-1Tg rats at morphine tolerance.

Genome-wide association study of post COVID-19 syndrome in a population-based cohort in Germany

If health impairments due to coronavirus disease 2019 (COVID-19) persist for 12 weeks or longer, patients are diagnosed with Post-COVID Syndrome (PCS), or Long-COVID. Although the COVID-19 pandemic has largely subsided in 2024, PCS is still a major health burden worldwide, and identifying potential genetic modifiers of PCS remains of great clinical and scientific interest. We therefore performed a case-control type genome-wide association study (GWAS) of three recently developed PCS (severity) scores in 2,247 participants of COVIDOM, a prospective, multi-centre, population-based cohort study of SARS-CoV-2-infected individuals in Germany. Each PCS score originally represented the weighted sum of the binary indicators of all, or a subset, of 12 PCS symptom complexes, assessed six months or later after the PCR test-confirmed SARS-CoV-2 infection of a participant. For various methodical reasons, however, the PCS scores were dichotomized along their respective median values in the present study, prior to the GWAS. Of the 6,383,167 single nucleotide polymorphisms included, various variants were found to be associated with at least one of the PCS scores, although not at the stringent genome-wide statistical significance level of 5 × 10- 8. With p = 6.6 × 10- 8, however, the genotype-phenotype association of SNP rs9792535 at position chr9:127,166,653 narrowly missed this threshold. The SNP is located in a region including the NEK6, PSMB7 and ADGRD2 genes which, however, does not immediately suggest an etiological connection to PCS. As regards functional plausibility, variants of a possible effect mapped to the olfactory receptor gene region (lead SNP rs10893121 at position chr11:123,854,744; p = 2.5 × 10- 6). Impairment of smell and taste is a pathognomonic feature of both, acute COVID-19 and PCS, and our results suggest that this connection may have a genetic basis. Three other genotype-phenotype associations pointed towards a possible etiological role in PCS of cellular virus repression (CHD6 gene region), activation of macrophages (SLC7A2) and the release of virus particles from infected cells (ARHGAP44). All other gene regions highlighted by our GWAS did not relate to pathophysiological processes currently discussed for PCS. Therefore, and because the genotype-phenotype associations observed in our GWAS were generally not very strong, the complexity of the genetic background of PCS appears to be as high as that of most other multifactorial traits in humans.

Incidence of major adverse kidney events after ICU admission in COVID-19 and non-COVID-19 ARDS patients

OBJECTIVES

To compare the incidence and drivers of major adverse kidney events (MAKEs) between COVID-19 and non-COVID-19 acute respiratory distress syndrome (ARDS) patients, with a focus on long-term kidney outcomes.

DESIGN

Retrospective cohort study.

SETTING

Single-centre intensive care unit in the Midlands, UK.

PARTICIPANTS

708 ARDS patients (458 COVID-19, 250 non-COVID-19).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was MAKE at 365 days (MAKE-365), defined as new renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) <75% of baseline or all-cause mortality. Secondary analyses examined non-mortality MAKE components.

RESULTS

The incidence of MAKE-365 was significantly higher in the non-COVID-19 group compared with the COVID-19 group (66% vs 39%, p<0.001), primarily driven by increased RRT initiation, followed by mortality and eGFR decline (p=0.055). Independent predictors of MAKE-365 included lower eGFR and elevated bilirubin in both groups. Age (p<0.001) and diabetes (p=0.041) were additional predictors in the COVID-19 cohort, while lower albumin (p=0.002) was significant in the non-COVID-19 group. Excluding mortality, RRT and eGFR decline remained significant drivers of MAKE outcomes in the non-COVID-19 cohort.

CONCLUSIONS

Non-COVID-19 ARDS patients face a greater risk of MAKE-365 and adverse kidney outcomes due to higher RRT requirements and mortality rates. These findings underscore the importance of tailored interventions and long-term nephrology follow-up, particularly for patients with reduced eGFR, elevated bilirubin and comorbidities like diabetes and hypoalbuminaemia.

The common genetic variant rs1278960 determining expression of Interferon-lambda predicts inflammatory response in critically ill COVID-19 patients

The single nucleotide polymorphism rs12979860 is associated with the production of IFNλ4, a type III interferon, which offers protection from viral infection via its proinflammatory properties. We investigated if a genetically determined increase in IFNλ4 affects disease progression in SARS-CoV-2. This prospective, single-center study involved critically ill SARS-CoV-2 patients admitted to the intensive care unit. We performed genotyping for rs12979860 and analyzed daily laboratory data. Genotype frequencies were compared with an external validation cohort. Critically ill individuals with COVID-19 (n = 184; 29.3% women) were included. Median age was 63 years. The TT genotype was present in 11%, CT in 48% and CC in 41%. At baseline, CRP, ferritin, transferrin and neopterin did not differ significantly between groups. Longitudinal analysis revealed significant genotype-dependent differences in CRP, ferritin and neopterin with the highest peak in TT patients after 10-15 days. A higher need for renal replacement therapy (31.6% vs. 11.7%, p = 0.044) and mechanical ventilation (22 days vs. 15 days, p = 0.018) was observed in the TT group. The SNP rs12979860 near IFNL4 is associated with distinct inflammatory trajectories in critically ill COVID-19 patients. Genetic determinants of the immune response influence the severity of inflammation and clinical outcomes in severe COVID-19.

PEBL, a component-based Chinese medicine, reduces virus-induced acute lung injury by targeting FXR to decrease ACE2 levels

INTRODUCTION

Despite the growing clinical need, the therapeutic efficacy of drugs for acute lung injury (ALI) remains inadequate. Traditional Chinese Medicine (TCM) holds potential in managing ALI due to its unique therapeutic properties. However, the intricate nature of TCM formulations hinders global adoption. Component-based Chinese medicine (CCM) offers a promising pathway for TCM's internationalization. Phillyrin-Emodin-Baicalin-Liquiritin (PEBL), a CCM with significant anti-inflammatory activity, is derived from the well-established TCM formula Liang-Ge-San. Whether PEBL effectively addresses viral ALI, however, remains unclear.

OBJECTIVES

This study aims to investigate the therapeutic effects and underlying mechanisms of PEBL on viral ALI.

METHODS

The efficacy of PEBL against Poly(I:C)-induced ALI was assessed by analyzing cytokine production, macrophage infiltration, pulmonary damage, and mortality. Bioinformatics and network pharmacology were employed to identify key targets and signaling pathways. The molecular mechanisms were further validated using Poly(I:C)-treated RAW264.7 cells, Tg(coro1α: GFP) zebrafish, BALB/c mice, and models of Influenza A/Puerto Rico/8/1934 (H1N1) virus strain (PR8)-induced ALI in BALB/c mice and SARS-CoV-2 Omicron XBB.1.16 subvariant (XBB)-induced ALI in hACE2-transgenic C57BL/6 mice.

RESULTS

PEBL mitigated Poly(I:C)-induced ALI, as evidenced by reduced cytokine levels, diminished macrophage infiltration, alleviated lung damage, and decreased mortality. Virtual screening identified the farnesyl X receptor (FXR) and angiotensin-converting enzyme 2 (ACE2) as key therapeutic targets for viral pneumonia. Mechanistically, PEBL downregulated FXR expression, inhibiting FXR binding to ACE2 promoters, which subsequently suppressed NF-κB-p65 nuclear translocation and cytokine production. In vivo, PEBL attenuated cytokine production by inhibiting ACE2 transcription through FXR downregulation, leading to alleviation of Poly(I:C)-induced ALI in both zebrafish and mice. Additionally, PEBL significantly improved symptoms of ALI caused by PR8 and XBB infections, by disrupting the FXR/ACE2 signaling axis, resulting in reduced weight loss, lower lung indices, diminished viral load and titer, fewer pulmonary lesions, and suppressed NF-κB-p65 nuclear translocation, along with decreased cytokine storm.

CONCLUSIONS

This study provides the first evidence that PEBL offers protective effects against ALI induced by acute respiratory viruses. PEBL prevents FXR from binding to ACE2 by inhibiting FXR transcription, which reduces macrophage infiltration, cytokine storm formation, and inflammatory injury, thereby ameliorating viral ALI. These findings underscore the potential of PEBL as a candidate for further exploration in the treatment of viral ALI.

Rhabdomyolysis in patients with COVID-19: A cause or consequence of acute kidney injury or mortality?

Rhabdomyolysis can occur due to many traumatic and nontraumatic causes. Rhabdomyolysis has been reported in new type of coronavirus disease (COVID-19) cases. The aim of our study was to examine the effects of rhabdomyolysis on mortality and renal outcomes in patients hospitalized in our hospital's COVID-19 wards. In our single-center and retrospective study, we included patients who were admitted with a diagnosis of COVID-19 by a thorax-computed tomography finding who were older than 18 years of age and with a measured creatinine kinase (CK) > 1000 U/L on any day of hospitalization. The same number of patients hospitalized in COVID-19 services with CK < 1000 U/L and with similar gender and age were determined as the control group. We analyzed the data of 2065 patients, and compared 154 patients in the rhabdomyolysis group (group 1) and 154 patients in the control group (group 2). Acute kidney injury (AKI) (44.2% vs 21.4%; P < .001), intensive care unit (ICU) admissions (53.2% vs 13.6%; P < .001), intubation (75.6% vs 23.8%; P < .001), mortality (36.4% vs 3.2%; P < .001) and the need for dialysis (3.9% vs 0.6%; P = .005) were seen more in the rhabdomyolysis group. When that group was divided into the early rhabdomyolysis group (group 1a), where the CK value reached its highest value in ≤3 days, and the late rhabdomyolysis group (group 1b), where it was ≥ 4 days, AKI (29.7% vs 65.1%; P < .001), ICU (35.2% vs 79.4%; P < .001), intubation (56.2% vs 88%; P = .001), mortality (18% vs 61.9%; P < .001), and dialysis (1.1% vs 7.9%; P = .031), the results were higher in the group 1b. The available data suggest that rhabdomyolysis seen in COVID-19 patients is not a direct predictor of mortality and poor renal outcomes, but is a secondary outcome to multiple-organ failure caused by worsening clinical status.

Comparison of N- and O-Glycosylation on Spike Glycoprotein 1 of SARS-CoV-1 and MERS-CoV

SARS-CoV-1 and MERS-CoV were the infective agents of the 2002 and 2012 coronavirus outbreaks, respectively. Here, we report a comparative liquid chromatography/mass spectrometry (LC/MS) Orbitrap N- and O-glycosylation glycoproteomics study of the recombinant S1 spike derived from these two viruses. The former was produced in HEK293 cells and the latter in both HEK293 and insect cells. Both proteins were highly glycosylated, with SARS-CoV-1 S1 having 13 and MERS-CoV S1 having 12 N-glycosites. Nearly all were occupied at 85% or more. Between 2 and 113 unique N-glycan compositions were detected at each N-glycosite across the three proteins. Complex N-glycans dominated in HEK293 cell-derived spike S1 proteins. While glycosylation differs between HEK293 and insect cells, the extent of glycan processing at glycosites was similar for the two MERS-CoV S1 forms. The HEK293-derived SARS-CoV-1 S1 N-glycans were more highly sialylated and fucosylated compared to MERS S1, while the latter had more high-mannose glycosides, particularly in the N-terminus and near the RBD. Seven and 8 O-glycosites were identified in SARS-CoV-1 S1 and MERS-CoV S1, respectively. Mapping of predicted antigenic and glycosylation sites reveals colocalization consistent with a role for glycosylation in immune system avoidance. Glycosylation patterns of these S1 proteins differ from those of other SARS-CoV-1 and MERS-CoV spike reported forms such as recombinant trimeric and virus-propagated forms, which has implications for virus research, including vaccine development, as glycosylation plays a role in spike function and epitope structure.

Cytokine, chemokine, and acute-phase protein profiles in plasma as correlative biomarkers of clinical outcomes for patients with COVID-19

Coronavirus disease identified in 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2, had a global impact on human health and the economy. The aim of this study was to quantify cytokines, chemokines, and acute phase proteins in the plasma of patients with COVID-19 to elucidate potential biomarkers to inform prognostic and treatment decisions. Clustering analysis using the K-prototypes method identified underlying biological patterns in patients with COVID-19. The penalized multinomial logistic regression analysis identified two comorbidities (hypertension, congestive heart failure) and thirteen analytes as potential risk factors for COVID-19 progression with 88.2% accuracy. Based on a patient's age, high concentrations of interleukin (IL)-6, monocyte chemoattractant protein-1, and pentraxin 3 were important biomarkers for lethal COVID-19. Decreased concentrations of interferon gamma-induced protein-10, IL-10, and soluble tumor necrosis factor receptor I were found to be associated with mild COVID-19, while increasing concentrations of these analytes could be used to predict COVID-19 severity.

Alterations in Semen Quality and Immune-Related Factors in Men with Infertility who Recovered from COVID-19

The emergence of coronavirus disease 2019 (COVID-19) has triggered research into its impact on male reproductive health. However, studies exploring the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on semen quality in infertile men remain limited. Herein, we enrolled 781 male infertile patients who recovered from COVID-19 and analyzed their semen and blood samples collected at different time points. We found that SARS-CoV-2 RNA was undetectable in semen samples. Compared with pre-COVID-19 status, total sperm count, sperm concentration, vitality, motility, and percentage of sperm cells with normal morphology decreased significantly in the first month post-COVID-19. However, these alterations were reversed in the third month. Furthermore, seminal plasma samples exhibited reduced proinflammatory cytokine levels and notable changes in amino acid, nucleic acid, and carbohydrate metabolism by the third month compared with those in the first month. By contrast, no significant alterations in reproductive hormone levels were found. Vitality, progressive motility, and total motility negatively correlated with body temperature when it was above 38°C. In conclusion, semen quality initially decreases post-COVID-19 but reverses after approximately 3 months, with a decline related to inflammatory and fever. These findings may provide guidance to infertile male patients who need assisted reproductive technology.

[Clinical nursing assessment of Covid-19 patients: a comparison of home-hospital practices]

This study examines the impact of clinical assessment training on nurses' practices in Geneva during the Covid-19 pandemic. The results reveal that trained professionals, mainly in hospital settings, adopted more advanced techniques, such as auscultation and palpation. Practices varied significantly according to practice location and training received, underlining the importance of ongoing training to improve quality of care.

Socioecology and Prevalence of SARS-CoV-2 Infection in Quilombolas Living in the Brazilian Amazon

OBJECTIVES

This cross-sectional study presents socioecological, epidemiological aspects, and the seroprevalence of immunoglobulin G (IgG) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a group of quilombola (afro-derived) communities in the states of Pará and Tocantins, in the Brazilian Amazon, to evaluate the impact of SARS-CoV-2 prevalence among them.

METHODS

A total of 551 individuals participated. The detection of anti-SARS-CoV-2 antibodies was performed using an enzyme immunoassay. Socioeconomic and ecological data was collected from all participants 7 years of age or older who were not previously vaccinated.

RESULTS

The seroprevalence of antibodies in both states was 40.7% and was associated with factors such as age group, contact with infected individuals, and being in lockdown inside the quilombos. In Pará, a statistically significant association was observed between seroprevalence and females, and the age group of 12-18 years. In addition, seroprevalence in Pará was higher than in Tocantins, and the reported use of masks was a protective factor, while in Tocantins, the reported use of masks was associated with the presence of antibodies. There was no association between the prevalence of antibodies and the presence of COVID-19 symptoms in Pará. However, in Tocantins, diarrhea and loss of taste were associated with infection.

CONCLUSIONS

Quilombola are highly vulnerable groups due to the long history of enslavement in Brazil. This is the first investigation of SARS-CoV-2 seroprevalence and its impact in these groups in the Amazon. The study helps us to understand the relationship of socioecological differences, behavioral characteristics, and the dynamics of viral transmission associated with the risk of infection by SARS-CoV-2 among traditional populations, and can be useful to the planning of more culturally adequate public health policies for future epidemics.

Characteristics and Outcomes of Children Hospitalized With COVID-19 During Early Pandemic and Delta Variant

Background: Children were less affected by severe illness as compared to adults at the start of the COVID-19 pandemic. As the pandemic progressed and variants emerged, pediatric hospitalizations increased, and some previously healthy children developed multisystem inflammatory disorder. The aim of this study was to describe the characteristics and outcomes of children hospitalized with COVID-19 from the beginning of the pandemic through the Delta variant. Methods: Data were collected retrospectively for children hospitalized during March 2020-November 2021 with a diagnosis of COVID-19. Admissions were classified as early pandemic or during the Delta variant, and outcomes were compared between the time periods. Primary outcome measures were hospital length of stay and use of respiratory support. The number of admissions/month was the secondary outcome. Results: There were 784 hospital admissions: 400 during early pandemic and 378 during the Delta period. Forty-four percent had an underlying medical condition, and 78% were not eligible for COVID-19 vaccination. Oxygen was the most common respiratory support modality and was required more often during Delta (P < .001). Hospital stay was longer during the Delta period (P < .001), and the number of monthly admissions was higher. A statistically significant but low correlation was identified between body mass index (BMI) Z score and stay (P < .001, r = 0.19). Conclusions: The Delta variant was associated with increased hospital length of stay and use of respiratory support compared to the early pandemic period. Children with preexisting medical conditions were more likely to require respiratory support and have longer hospitalization than others. Higher BMI Z score was also weakly associated with longer length of stay. The reason for admission was attributed to causes other than COVID-19 for the majority of admissions except during the Delta period.

Liang-Ge-San attenuates virus-induced acute lung injury by targeting FXR-mediated ACE2 downregulation to modulate the formation of the cytokine storm

BACKGROUND

Traditional Chinese medicine has been recognized for its significant role in treating acute lung injury (ALI) due to its distinct therapeutic advantages. Liang-Ge-San (LGS), a formulation from the ancient "Taiping Huimin Hejiju Fang", is believed to possess beneficial effects for treating ALI. However, LGS's precise mechanisms and efficacy in addressing viral ALI remain inadequately explored.

PURPOSE

To evaluate LGS's therapeutic effects and underlying mechanisms in treating viral-induced ALI.

METHODS

The protective effects of LGS were examined in a Polyinosinic-polycytidylic acid [Poly(I:C)]-induced ALI model using real-time quantitative PCR, enzyme-linked immunosorbent assay, and histopathological analysis. A bioinformatics approach combined with network pharmacology was utilized to ascertain the key targets of LGS in viral pneumonia. The pharmacodynamic mechanisms of LGS in viral ALI were further validated through immunofluorescence, overexpression, short hairpin RNA, chromatin immunoprecipitation, and target agonist assays.

RESULTS

LGS administration resulted in a reduction of IL-1β, IL-6, and TNF-α levels, along with a decrease in macrophage infiltration, pulmonary damage, and pneumonedema following the Poly(I:C) challenge. Bioinformatics and network pharmacology analyses suggested that Farnesyl X receptor (FXR) and angiotensin converting enzyme 2 (ACE2) are potential therapeutic targets for LGS in viral pneumonia. Further experiments revealed that LGS suppressed the expression of FXR, ACE2, and NF-κB-p65 in Poly(I:C)-infected cells. Notably, overexpression of FXR counteracted the repressive effects of LGS, while ACE2 expression remained unchanged in FXR-knockdown RAW264.7 cells upon treatment with Poly(I:C) or LGS. Additionally, LGS inhibited the interaction between FXR and ACE2 transcriptional promoters. In vivo, LGS attenuated the Poly(I:C)-induced upregulation of FXR, ACE2, IL-1β, IL-6, and TNF-α in ALI zebrafish and mice models, effects that could be reversed by chenodeoxycholic acid (CDCA), an FXR agonist. Moreover, LGS markedly alleviated weight loss, improved survival rates, reduced lung index, diminished viral load, and inhibited lung pathological changes in H1N1-PR8-induced ALI mice. IL-1β, IL-6, TNF-α, INF-γ, FXR, ACE2, small heterodimer partner, and NF-κB-p65 levels were markedly reduced by LGS, with these effects being reversed by CDCA.

CONCLUSION

This investigation provides the first evidence that FXR/ACE2 signaling is pivotal in acute respiratory viral infections, while LGS demonstrates antiviral activity against viral-induced ALI. LGS inhibits ACE2 expression induced by viral infection via FXR inhibition and modulates the cytokine storm, thus alleviating viral ALI. These findings suggest that LGS may be a promising treatment strategy for treating viral ALI.

The Sociology of Suicide After COVID-19: Assessment of the Spanish Case

The phenomenon of suicide has become a significant global concern, claiming over 800,000 lives annually and resulting in millions of suicide attempts worldwide. In the aftermath of the COVID-19 pandemic, these troubling statistics have worsened, with notable increases in suicidal behavior, especially among vulnerable populations such as the youth, the elderly, and those in socioeconomically disadvantaged groups. This paper aims to explore the impact of the COVID-19 pandemic on suicide rates in Spain, using a theoretical ex post facto analysis. Spain has witnessed an alarming rise in suicide rates, particularly among young people, and a disturbing trend of increased suicidal ideation and self-harm behaviors. While some studies report no significant change in suicide rates during the pandemic, others point to the exacerbating effects of social isolation, economic instability, and public health measures. This study provides an in-depth examination of the psychosocial consequences of the pandemic on mental health in Spain, emphasizing the urgency of the need to address pre-existing inequalities and implement effective suicide prevention measures. Furthermore, it highlights the importance of gender-sensitive strategies and the need for systemic reforms to ensure better mental healthcare access for all segments of society. To achieve this goal, this paper uses a narrative literature review combined with a theoretical ex post facto analysis to assess the influence of the COVID-19 pandemic on suicide patterns in Spain.

Imaging the microvasculature using nailfold capillaroscopy in patients with coronavirus disease-2019; A cross-sectional study

OBJECTIVES

It is understood that microvascular dysfunction plays a key role in the pathogenesis of SARS-CoV-2 coronavirus disease (COVID-19). The aim of this study was to evaluate the usefulness of an automated, quantitative nailfold capillaroscopy system in identifying microvascular changes in those confirmed with or having had COVID-19.

METHODS

Ninety-seven participants were enrolled into this study and grouped as follows: 52 participants with acute COVID-19 (further grouped by disease severity) and 45 participants with convalescent COVID-19 (further grouped into long COVID i.e. symptoms beyond 12 weeks, and fully recovered). Nailfold capillaroscopy images were obtained from the bilateral ring fingers using a Dino-Lite CapillaryScope 200 Pro, a small USB handheld microscope. Images were assessed quantitatively using bespoke automated measurement software and the number of haemorrhages noted for each participant.

RESULTS

Capillaries were predominantly 'normal' in appearance with narrow capillary loops and evenly distributed, but with an increased number of haemorrhages (40 % in the convalescent group and 17 % in the acute group, p = 0.007). There was no statistically significant difference in the mean width of capillaries (20.9-21.8 μm) or vessel density (9.6-9.9 caps/mm; acute and convalescent group, respectively).

CONCLUSIONS

This study has demonstrated the feasibility of nailfold capillaroscopy at the critical care bedside. Capillary structure appeared normal across all groups of individuals affected by COVID-19. Although the small differences in the microvasculature in recovered patients compared to in acutely unwell patients may suggest delayed structural change due to COVID-19, these differences are unlikely to be clinically relevant. Longitudinal studies would be required to explore this in more detail.

Cross-Domain Invariant Feature Absorption and Domain-Specific Feature Retention for Domain Incremental Chest X-Ray Classification

Chest X-ray (CXR) images have been widely adopted in clinical care and pathological diagnosis in recent years. Some advanced methods on CXR classification task achieve impressive performance by training the model statically. However, in the real clinical environment, the model needs to learn continually and this can be viewed as a domain incremental learning (DIL) problem. Due to large domain gaps, DIL is faced with catastrophic forgetting. Therefore, in this paper, we propose a Cross-domain invariant feature absorption and Domain-specific feature retention (CaD) framework. To be specific, we adopt a Cross-domain Invariant Feature Absorption (CIFA) module to learn the domain invariant knowledge and a Domain-Specific Feature Retention (DSFR) module to learn the domain-specific knowledge. The CIFA module contains the C(lass)-adapter and an absorbing strategy is used to fuse the common features among different domains. The DSFR module contains the D(omain)-adapter for each domain and it connects to the network in parallel independently to prevent forgetting. A multi-label contrastive loss (MLCL) is used in the training process and improves the class distinctiveness within each domain. We leverage publicly available large-scale datasets to simulate domain incremental learning scenarios, extensive experimental results substantiate the effectiveness of our proposed methods and it has reached state-of-the-art performance.

Impact of COVID-19 infection on genitourinary cancer management. SOGUG-COVID-19: A spanish, multicenter, observational study

INTRODUCTION

The COVID-19 pandemic is a great burden worldwide, but its impact on patients with genitourinary cancer (GUC) is poorly characterized. This study aimed to characterize the clinical features and evolution of GUC patients affected by COVID-19 in Spain.

PATIENTS AND METHODS

SOGUG-COVID-19 was an observational ambispective non-interventional study that recruited patients with SARS-CoV-2 infection who had been treated for GUC in 32 Spanish hospitals. Data were collected from patients' medical records in a short period of time, coinciding with the first waves of COVID-19, when the mortality was also higher in the general population.

RESULTS

From November 2020 to April 2021, 408 patients were enrolled in the study. The median age was 70 years, and 357 patients (87.5%) were male. Most frequent Cancer Origin was: prostate (40.7%), urothelial (31.4%) and kidney (22.1%). Most patients (71.3%) were diagnosed at the metastatic stage, and 33.3% had poorly differentiated histology. Anticancer treatment during the infection was reported in 58.3% of patients, and 21.3% had received immunotherapy prior to or concurrent with the infection. The most frequent COVID-19 symptoms were pyrexia (49.0%), cough (38.2%) and dyspnea (31.9%). Median age was higher for patients with pneumonia (p < 0.001), patchy infiltrates (p = 0.005), ICU admission (p < 0.001) and death (p < 0.001). Tumor stage was associated with complications (p = 0.006). The fatality rate was 19.9% and the 6-month COVID-19-specific survival rate was 79.7%.

CONCLUSION

Patients with genitourinary cancers seem exceptionally vulnerable to COVID-19 regardless of tumor type or anticancer therapy. Age and tumor stage were the only identified risk factors for severe COVID-19.

Translational research on pandemic virus infection using nonhuman primate models

After the COVID-19 pandemic, nonhuman primate (NHP) models, which are necessary for the rapid development of vaccines and new medical therapies, have become important in studies on infectious diseases because of their genetic, metabolic, and immunological similarities to humans. Our group has long been using NHP models in studies on infectious diseases including H1N1 influenza pandemic and COVID-19. Despite limitations such as the limited number of animals and the husbandry requirements, NHP models have contributed to the prediction of the pathogenicity of emerging viruses and the evaluation of the efficacy of vaccines and therapeutics due to the similarity of NHP models to humans before starting clinical trials to select good candidates of vaccines and drugs. In this review, the findings obtained in NHP infectious disease models of influenza and COVID-19 are summarized to clarify the benefits of NHP models for studies on infectious diseases. We believe that this review will support future research in exploring new perspectives for the development of vaccines and therapies targeting influenza, COVID-19, and infectious diseases in future pandemics.

Liang-Ge-San drives macrophages toward M2 polarization for alleviating lipopolysaccharide-induced acute lung injury via activating the miR-21/PTEN axis

Acute lung injury (ALI) has high clinical mortality currently and no specific drugs available for its treatment. Although Liang-Ge-San (LGS), a traditional Chinese medicine formula, is known to promote inflammation resolution and shorten hospitalization duration of ALI, the mechanism is still unclear. Our results demonstrated that LGS regulated the dynamic balance of macrophage polarization as reflected by up-regulating the expression of anti-inflammatory factors (CD206, Arg-1 and IL-10) in advance to counteract the high expression of pro-inflammatory factors (CD86, iNOS, IL-6 and TNF-α) in vitro. MiR-21 concentration was elevated in LPS-challenged RAW264.7 cells and ALI mice. Moreover, the overexpression of miR-21 mimicked the anti-inflammatory effects of LGS, whereas a miR-21 inhibitor abolished the protective effects of LGS in vitro. Most importantly, LGS protected ALI mice from LPS which could be counteracted by the treatment of miR-21 antagomir. Furthermore, LGS could inhibit the transcriptional activity and protein expression of PTEN by up-regulating miR-21. In summary, LGS functions by regulating the miR-21/PTEN axis to induce a shift in macrophages from a pro-inflammatory phenotype to an anti-inflammatory phenotype, thereby alleviating LPS-induced ALI. This study supports the clinical evidence of LGS in the treatment of ALI.

Evaluating the evidence for GM-CSF as a host-directed therapy in respiratory infections

Novel therapeutic approaches are needed to treat respiratory infections due to the rising antimicrobial resistance and the lack of effective antiviral therapies. A promising avenue to overcome treatment failure is to develop strategies that target the host immune response rather than the pathogen itself. Granulocyte-macrophage colony-stimulating factor (GM-CSF) plays a critical role in controlling homeostasis in lungs, alveolar macrophages being the most sensitive cells to GM-CSF signaling. In this review, we discuss the importance of GM-CSF secretion for lung homeostasis and its alteration during respiratory infections. We also present the pre-clinical evidence and clinical investigations evaluating GM-CSF-based treatments (administration or inhibition) as a therapeutic strategy for treating respiratory infections, highlighting both supporting and contradictory findings.