Reply to Chan, et al.

We appreciate the comments from Chan et al. for our study, and have carefully responded to the comments of Chan et al. and are very grateful for their praise of our research. We agree that smoking might be a risk factor of the severity of COVID-19 as mentioned by Chan et al., but in our study, smoking was not so robust compared with our conclusion. Also, we strongly agreed with the opinion of Chan, et al. that COVID-19 patients with diabetes or other chronic diseases might worsen the situation of the disease. But these factors were out of the scope of our study and we had published other research on this topic related to diabetes. Because of the limited sample size and original medical records, our study could not cover many factors suggested as Chan, et al. But we wish our study will be a useful and meaningful pilot study for the future studies. This article is protected by copyright. All rights reserved.

Management and Scheduling of Spine Surgery in a Level 1 Trauma Center in the Setting of the COVID-19 Pandemic: Feasibility and Considerations for Reimplementation of Elective Spine Surgery.

Introduction: Determination of what constitutes necessary surgery in the setting of acute hospital resource strain during the COVID-19 pandemic is an unprecedented challenge for healthcare systems. Over the past two years during the COVID-19 pandemic, there have been many changes in reviews of medically necessary spine surgery. There continues to be no clear guidelines on recommendations and further discussion is necessary to continue to provide appropriate and high-level care during future pandemics. Significance: This review critically appraises and evaluates current barriers to medically necessary spine surgery during the COVID-19 pandemic and evaluates future decision making to maintain spine surgery during future pandemics or limitations in medical care. Results: Multiple studies included in this review have shown that while various orthopaedic surgeries may be considered elective, medically necessary spine surgery will need to continue during settings of limited medical care. This review discussed multiple methods and recommendations to limit transmission of virus from patients to providers and providers to patients. Conclusion: Continued medically necessary spine surgery in the setting of the COVID-19 pandemic and future pandemics should continue while limiting risk of transmission to continue providing high-level medical care and allowing hospitals to maintain financial responsibility.

Virome analysis provides new insights into the association between viruses and Parkinson's disease.

Parkinson's disease (PD) is a kind of neurodegenerative disease that causes a huge burden to society. Previous studies have suggested the association between PD and multiple viruses. However, there is still a lack of a virome study about PD. This study systematically identified viruses from the public RNA-sequencing data of more than 700 samples from both PD patients and the control group (most were healthy people). Only nine viruses such as human betaherpesvirus 5 and Merkel cell polyomavirus have been detected in several human brain tissues of the central nervous system, the appendix, and blood of PD patients, and all of these viruses were also detected in the control group. Most viruses were observed to have low abundance in no more than three tissues. No statistically significant differences were observed between the virus abundance in the PD patients and the control group for all viruses. The positive rates of most viruses in PD patients were higher or similar to that in the control group, although those were less than 5% for most viruses. Overall, this is the first study to systematically investigate the virome in PD patients, and provides new insights into the association between viruses and PD.

Beyond the Digital Competencies of Medical Students: Concerns over Integrating Data Science Basics into the Medical Curriculum.

Introduction. Data science is becoming increasingly prominent in the medical profession, in the face of the COVID-19 pandemic, presenting additional challenges and opportunities for medical education. We retrospectively appraised the existing biomedical informatics (BMI) and biostatistics courses taught to students enrolled in a six-year medical program. Methods. An anonymous cross-sectional survey was conducted among 121 students in their fourth year, with regard to the courses they previously attended, in contrast with the ongoing emergency medicine (EM) course during the first semester of the academic year 2020−2021, when all activities went online. The questionnaire included opinion items about courses and self-assessed knowledge, and questions probing into the respondents' familiarity with the basics of data science. Results. Appreciation of the EM course was high, with a median (IQR) score of 9 (7−10) on a scale from 1 to 10. The overall scores for the BMI and biostatistics were 7 (5−9) and 8 (5−9), respectively. These latter scores were strongly correlated (Spearman correlation coefficient R = 0.869, p < 0.001). We found no correlation between measured and self-assessed knowledge of data science (R = 0.107, p = 0.246), but the latter was fairly and significantly correlated with the perceived usefulness of the courses. Conclusions. The keystone of this different perception of EM versus data science was the courses' apparent value to the medical profession. The following conclusions could be drawn: (a) objective assessments of residual knowledge of the basics of data science do not necessarily correlate with the students' subjective appraisal and opinion of the field or courses; (b) medical students need to see the explicit connection between interdisciplinary or complementary courses and the medical profession; and (c) courses on information technology and data science would better suit a distributed approach across the medical curriculum.

What's best, online or on-site? The write a scientific paper course.

Background: The ability to publish is a career-critical skill but requires the acquisition of a wide and disparate skill set. The Write a Scientific Paper (WASP) course was created in Malta in 2010, an intensive, three-day event. WASP is an accredited event held in Malta, London, and Bahrain. The COVID pandemic forced WASP to go online. This study compared satisfaction with WASP online as opposed to in-person by analyzing course feedback pre- and post-pandemic. Methods: Google forms are used to collect anonymous feedback on a Likert scale for various aspects of each WASP. The period 2017 to 2022 was used to compare four courses on-site and five courses online. Feedback on: Rate lectures, handouts, WASP overall and how likely are you to recommend WASP was compared. Results: Response rates were >60% and almost all Cronbach's Alpha values were >0.7. High satisfaction scores were achieved in all four questions (>4/5). There were no significant differences except in lectures, which scored well but fared slightly worse overall online. Conclusions: Migrating online does not necessarily lead to change/s in presentation contents but transforms delivery. Our results indicate that WASP is accepted online but the slightly lower lectures score implies that WASP might be better delivered in-person than online. However, students remained happy to recommend WASP and this accords with other studies that overall, student satisfaction with online education is common. It is hoped that as the pandemic recedes, webinars complement and not continue to totally replace traditional in-person meetings.

Inter-arm blood pressure difference as a tool for predicting coronary artery disease severity.

BACKGROUND: Patients with severe atherosclerosis have been found to exhibit considerable changes in blood pressure (BP) between arms. The objective of our study was to investigate the predictive value of interarm blood pressure difference (IABPD) for coronary artery disease (CAD) severity. METHODS: It was a cross-sectional study conducted in the Department of Cardiology, Chittagong Medical College Hospital, Chattogram from May 2020 to November 2020. The study conveniently selected 110 individuals who visited the department for a coronary angiography during the study period. The BP of both arms were synchronously measured 1-2 days before the coronary angiography and IABPD were calculated. After coronary angiography, two blinded interventional cardiologists visually estimated the amount of coronary artery obstruction and determined the Gensini score. RESULTS: Among the participants, more than three-fourths of the patients were above 50 years of age (64.66%), and the majority were male (86.67%). 14.7% of participants had no occlusion in their coronary artery, 38.0% of participants had insignificant occlusion, 26.7% participants had mild occlusion, 10.3% participants had moderate occlusion, 3.3% participants had significant occlusion and 6.0% participants had total occlusion. Corrected pulse IABPD (cIABPDpulse) showed the greatest area under the receiver operating characteristic curve (0.73) for predicting a high Gensini score (>median). Multiple regression analysis revealed a significant relationship between corrected systolic IABPD (cIABPDsys) and the Gensini score (B=0.057, p<0.001). CONCLUSION: The differences in BP between the arms were found to be having a strong positive correlation with CAD severity.

The clinical and bioinformatics analysis for the role of antihypertension drugs on mortality among patients with hypertension hospitalized with COVID-19.

Comorbidities such as hypertension could exacerbate symptoms of coronaviral disease 2019 (COVID)-19 infection. Patients with hypertension may receive both anti-COVID-19 and antihypertension therapies when infected with COVID-19. However, it is not clear how different classes of anti-hypertension drugs impact the outcome of COVID-19 treatment. Herein, we explore the association between the inpatient use of different classes of anti-hypertension drugs and mortality among patients with hypertension hospitalized with COVID-19. We totally collected data from 278 patients with hypertension diagnosed with COVID-19 admitted to hospitals in Wuhan from February 1 to April 1, 2020. A retrospective study was conducted and single-cell RNA-sequencing (RNA-Seq) analysis of treatment-related genes was performed. The results showed that Angiotensin II receptor blocker (ARB) and calcium channel blocker (CCB) drugs significantly increased the survival rate but the use of angiotensin-converting enzyme inhibitor/ß-block/diuretic drugs did not affect the mortality caused by COVID-19. Based on the analysis of four public data sets of single-cell RNA-Seq on COVID-19 patients, we concluded that JUN, LST1 genes may play a role in the effect of ARB on COVID-19-related mortality, whereas CALM1 gene may contribute to the effect of CCB on COVID-19-related mortality. Our results provide guidance on the selection of antihypertension drugs for hypertensive patients infected with COVID-19.

Evaluation of diagnostic test procedures for SARS-CoV-2 using latent class models.

Polymerase chain reaction (PCR) and antigen tests have been used extensively for screening during the severe acute respiratory syndrome coronavirus 2 pandemics. However, the real-world sensitivity and specificity of the two testing procedures in the field have not yet been estimated without assuming that the PCR constitutes a gold standard test. We use latent class models to estimate the in situ performance of both tests using data from the Danish national registries. We find that the specificity of both tests is very high (>99.7%), while the sensitivities are 95.7% (95% confidence interval [CI]: 92.8%-98.4%) and 53.8% (95% CI: 49.8%-57.9%) for the PCR and antigen tests, respectively. These findings have implications for the use of confirmatory PCR tests following a positive antigen test result: we estimate that serial testing is counterproductive at higher prevalence levels.

Tackling brain drain at Chinese CDCs: understanding job preferences of public health doctoral students using a discrete choice experiment survey.

BACKGROUND: Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China. METHODS: A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children's education opportunities, working environment, career promotion speed and bianzhi (formally established post). RESULTS: A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed). CONCLUSION: Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.

Survival of SARS-CoV-2 in artificial seawater and on the surface of inanimate materials.

There is a potential risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread through human contact with seafood and the inanimate materials contaminated by the virus. In this study, we examined the stability of the virus in artificial seawater (ASW) and on the surface of selected materials. SARS-CoV-2 (3.75 log10 TCID50 ) in ASW at 22℃ maintained infectious about 3 days and at 4℃ the virus survived more than 7 days. It should be noticed that viable virus at high titer (5.50 log10 TCID50 ) may survive more than 20 days in ASW at 4℃ and for 7 days at 22℃. SARS-CoV-2 on stainless steel and plastic bag maintained infectious for 3 days, and on nonwoven fabric for 1 day at 22℃. In addition, the virus remained infectious for 9 days on stainless steel and non-woven fabric, and on plastic bag for 12 days at 4℃. It is important to highlight the role of inanimate material surfaces as a source of infection and the necessity for surface decontamination and disinfection.

The SARS-CoV-2 Mu variant should not be left aside: It warrants attention for its immuno-escaping ability.

The COVID-19 pandemic continues to have a threatening impact on a global scale, largely due to the emergence of newly SARS-CoV-2 variants. The Mu (PANGO lineage B.1.621), was first identified in Colombia in January 2021 and was classified as a variant of interest (VOI) in August 2021, due to a constellation of mutations that likely-mediate an unexpectedly enhanced immune resistance to inactivated vaccine-elicited antibodies. Despite recent studies suggesting that the Mu variant appears to have less infectivity than the Delta variant, here we examined the structural effect of the Mu spike protein mutations and predicted the potential impact on infectivity of the Mu variant compared with the Delta and Delta plus spike protein.

Statistical recomendations for the authors of manuscripts submitted to the Journal of Cancer Research and Clinical Oncology.

In recent years, a negative picture of statistical analyses carried out in medicine has been observed around the world. Unfortunately, as it turns out, this also applies to COVID-19. The most important guidelines for the members of the readers and authors of articles submitted to the Journal of Cancer Research and Clinical Oncology, i.e., on numerous factors related to the statistical analysis, are presented.

COVID-19 Management Missteps.

In December 2019, the first case of a novel coronavirus infectious disease, coronavirus disease 2019 (COVID-19), was identified in the province of Wuhan, China. Since the initial identification on March 11, 2020, by the World Health Organization (WHO), COVID-19 had rapidly spread all over the world, leading to the declaration of COVID-19 as a pandemic. In response to the exponential trend of reported confirmed cases, national governments worked quickly to devise plans to combat the spread and to soften the consequences which were to follow. Two primary approaches included limiting the spread of the virus and increasing hospital capacity. The implementation of these strategies, however, varied greatly among different governments and their respective populations. Countries developed similar guidelines in response to COVID-19, but with a variation. Many of these guidelines were similar in that they fell under the same general topics such as the use of facial masks, social distancing, and online learning. The effect of COVID-19 on public health was more reliant on the implementation of these recommendations rather than the recommendations themselves.  The medical therapies used to treat the widespread COVID-19 disease are flourishing and evolving rapidly. Ongoing research shows that the spectrum of treatment for COVID-19 varies from pharmacological and non-pharmacological therapeutic interventions. Some of the treatments that are being used in clinical practice include supportive care, antiviral drugs, immunomodulatory agents, convalescent plasma transfusion, and monoclonal antibody treatments. In addition, the most promising approach thus far is the COVID-19 vaccine developed by Pfizer-BioNTech, Moderna, and most recently Johnson & Johnson. Overall, as various treatment approaches are being explored and administered to people globally, it is important to acknowledge that there is currently no definite cure or any evidence-based treatment for COVID-19.  COVID-19 infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have brought devastating consequences to the lives of millions of people through their health effects and the failure of global initiatives to contain it. A review of many missteps that potentially could have altered the landscape for this virus to affect the lives of many is discussed with hope for a better approach going forward.

Finding Metabolomic Signatures in Pregnancy that Predict Breast Cancer: 60-Year Prospective Study in the Child Health and Development Studies Pregnancy Cohort

We propose to study 2nd and 3rd trimester archival serum samples of women in the Child Health and Development Studies (CHDS) pregnancy cohort who subsequently developed breast cancer, compared to 2nd and 3rd trimester archival serum samples from women who did not develop breast cancer, to identify predictive gestational biomarkers which could lead to new approaches to prevent breast cancer. For this, we will apply powerful high-resolution metabolomics (HRM) with advanced computational tools to identify chemicals and biochemical metabolic networks in pregnancy which are linked to subsequent breast cancer occurrence. There were minor delays caused by staff and offices transitioning to remote work due to the COVID-19 pandemic. We still accomplished all major tasks specified in the first year (obtaining all human subjects approvals, sample selection, preparation and order of archived pregnancy serum for delivery to Site 2).