ABSTRACT
Objective The cholinergic anti-inflammatory pathway (CAP) has been shown to modulate cytokine release by activating alpha-7 nicotinic acetylcholine receptors (α7nAChR) in monocytes/macrophages. However, their association with proinflammatory factors and prognosis in patients with acute respiratory distress syndrome (ARDS) has not been clarified. Here, we explored the correlation between CAP activity, proinflammatory factors, and the prognosis of ARDS patients. Methods The data of patients with ARDS (n = 65;underwent treatment) and healthy individuals (the control group;n = 65;underwent routine physical examination) at the Chongqing People's Hospital were investigated. Based on the survival status, ARDS patients were divided into a death ARDS group (n = 22) and a survival ARDS group (n = 43), and based on the diagnostic criteria of ARDS, the patients were also divided into a severe ARDS group (n = 30) and a mild-to-moderate ARDS group (n = 35). The levels of acetylcholine (ACh), acetylcholinesterase (AChE), and α7nAChR mRNA in peripheral blood monocytes were assessed. The levels of TNF-α and IL-6 in peripheral serum and peripheral monocytes were detected by ELISA and Western blot tests. The association between α7nAChR and inflammatory factors and prognosis was analyzed. The receiver-operating characteristic (ROC) curve was used to evaluate the reliability of CAP-related factors in predicting the survival status of ARDS patients. Results Compared with the control group, the levels of ACh, AChE, and α7nAChR mRNA of the ARDS group were significantly decreased. And, the ACh, AChE, and α7nAChR mRNA levels in the death/severe ARDS group were significantly lower than in the survival/mild-to-moderate ARDS group. However, the levels of TNF-α and IL-6 were significantly higher in the severe/death ARDS group. Furthermore, we observed that CAP-related factors were negatively correlated with the levels of IL-6 and TNF-α in peripheral serum in the ARDS group. The ROC curve showed that CAP-related factors were reliable markers for predicting the survival status of ARDS patients. Conclusion The related factors of the cholinergic anti-inflammatory pathway were significantly decreased in patients with ARDS, suggesting the ACh, AChE, and α7nAChR levels as potential indicators to evaluate the severity and prognosis status of ARDS patients.
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Objective: To investigate the prevalence of anxiety and depression in graduating university students during the COVID-19 pandemic and determine the associated factors. Methods: A total of 681 graduating university students and 620 juniors enrolled in the first stage. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to measure anxiety and depression. In the second stage, 578 of the 681 graduating students completed the SAS and SDS questionnaires after graduation. Results: The average SAS score of the graduating university students was significantly higher than that of the juniors (47.66±12.86 vs. 43.97±10.42, P<0.001). Depression was more prevalent among the graduating university students than in the control groups (39.06% vs. 9.19%, P<0.01). The percentages of anxiety and depression significantly decreased after graduation (t=8.602, P<0.001). The anxiety of graduating university students was associated with gender (OR=1.62, 95% CI: 1.10-2.37), monthly family income (OR=0.05, 95% CI: 0.02-0.11), and weekly exercise time (OR=0.53, 95% CI: 0.35-0.08). Their depression was related to their family’s monthly income (OR=0.09, 95% CI: 0.05-0.16) and father’s educational status (OR=2.24, 95% CI: 1.17-4.30). Conclusion: Anxiety and depression were rife within the graduating Chinese university students during the period of the COVID-19 pandemic and were both associated with monthly family income. Treatments tailored to specific targets are needed for graduating university students with mental problems.
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During the pandemic of COVID-19, the public is encouraged to take stairs or escalators instead of elevators. However, the dispersion of respiratory droplets in these places, featured by slopes and human motion, is not well understood yet. It is consequently unclear whether the commonly recommended social-distancing guidelines are still appropriate in these scenarios. In this work, we analyze the dispersion of cough-generated droplets from a passenger riding an escalator with numerical simulations, focusing on the effects of the slope and speed of the escalator on the droplet dispersion. In the simulations, a one-way coupled Eulerian-Lagrangian approach is adopted, with the air-flow solved using the Reynolds-averaged Navier-Stokes method and the droplets modeled as passive Lagrangian particles. It is found that the slope alters the vertical concentration of the droplets in the passenger's wake significantly. The deflection of cough-generated jet and the wake flow behind the passenger drive the cough-generated droplets upwards when descending an escalator and downwards when ascending, resulting in both higher suspension height and larger spreading range of the viral droplets on a descending escalator than on an ascending one. These findings suggest that the present social-distancing guidelines may be inadequate on descending escalators and need further investigation.
ABSTRACT
The dispersion of viral droplets plays a key role in the transmission of COVID-19. In this work, we analyze the dispersion of cough-generated droplets in the wake of a walking person for different space sizes. The air flow is simulated by solving the Reynolds-averaged Navier-Stokes equations, and the droplets are modeled as passive Lagrangian particles. Simulation results show that the cloud of droplets locates around and below the waist height of the manikin after 2 s from coughing, which indicates that kids walking behind an infectious patient are exposed to higher transmission risk than adults. More importantly, two distinct droplet dispersion modes occupying significantly different contamination regions are discovered. A slight change of space size is found being able to trigger the transition of dispersion modes even though the flow patterns are still similar. This shows the importance of accurately simulating the air flow in predicting the dispersion of viral droplets and implies the necessity to set different safe-distancing guidelines for different environments.
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INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has spread globally since it outbroke in December 2019. The urgent pandemic presents an unprecedented challenge to develop and identify effective medication therapy strategies to combat the COVID-19. AREAS COVERED: Here, we summarized and evaluated the current treatment drugs and regimens, and put forward the treatment recommendations, including using the potential repurposed or experimental drugs against COVID-19, e.g. chloroquine (CQ), hydroxychloroquine (HCQ), lopinavir/ritonavir (LPV/r), remdesivir (RDV), and favipiravir (FPV). We also analyzed the specific drugs and vaccines against SARS-CoV-2 ongoing development and formulated the comprehensive treatment regimens based on condition of patients, diseases and drugs as well as concomitant medications. EXPERT OPINION: No drugs and vaccines have been proven to be particularly effective against SARS-CoV-2 up to now. The recommended comprehensive medication therapy strategies have already displayed favorable effect in the fight against COVID-19. Research should be focused on the development of anti-SARS-CoV-2 drugs and vaccines based on high-quality clinical trial evidence, treatment guidelines and expert consensus.