Background The ongoing pandemic of novel coronavirus disease 2019 (COVID-19) is challenging global public health system. Sex-differences in infectious diseases are a common but neglected problem. Methods We used the national surveillance database of COVID-19 in mainland China to compared gender differences in attack rate (AR), proportion of severe and critical cases (PSCC) and case fatality rate (CFR) in relation to age, affected province, and onset-to-diagnosis interval. Results The overall AR was significantly higher in female population than in males (63.9 versus 60.5 per million persons; P ˂ .001). By contrast, PSCC and CFR were significantly lower among female patients (16.9% and 4.0%) than among males (19.5% and 7.2%), with ORs of 0.87 and 0.57, respectively (both P ˂ .001). The female-to-male differences were age-dependent, which were significant among people aged 50–69 years for AR, and in the patients of 30-years or older for both PSCC and CFR (all P ≤ .001). The AR, PSCC and CFR varied greatly from province to province. However, female-to-male differences in AR, PSCC and CFR were significant in the epicenter, Hubei province, where 82.2% confirmed cases and 97.4% deaths occurred. After adjusting for age, affected province and onset-to-diagnosis interval, the female-to-male difference in AR, PSCC and CFR remained significant in multivariate logistic regression analyses. Conclusions We elucidate an age-dependent gender dimorphism for COVID-19, in which the females have higher susceptibility but lower severity and fatality. Further epidemiological and biological investigations are required to better understand the sex-specific differences for effective interventions.

The ongoing pandemic of 2019 novel coronavirus disease (COVID-19) is challenging global public health response system. We aim to identify the risk factors for the transmission of COVID-19 using data on mainland China. We estimated attack rate (AR) at county level. Logistic regression was used to explore the role of transportation in the nationwide spread. Generalized additive model and stratified linear mixed-effects model were developed to identify the effects of multiple meteorological factors on local transmission. The ARs in affected counties ranged from 0.6 to 9750.4 per million persons, with a median of 8.8. The counties being intersected by railways, freeways, national highways or having airports had significantly higher risk for COVID-19 with adjusted odds ratios (ORs) of 1.40 (p = 0.001), 2.07 (p < 0.001), 1.31 (p = 0.04), and 1.70 (p < 0.001), respectively. The higher AR of COVID-19 was significantly associated with lower average temperature, moderate cumulative precipitation and higher wind speed. Significant pairwise interactions were found among above three meteorological factors with higher risk of COVID-19 under low temperature and moderate precipitation. Warm areas can also be in higher risk of the disease with the increasing wind speed. In conclusion, transportation and meteorological factors may play important roles in the transmission of COVID-19 in mainland China, and could be integrated in consideration by public health alarm systems to better prevent the disease.

How government insurance coverage changed the utilization and affordability of expensive targeted anti-cancer medicines in China: an interrupted time-series study Background Evidence is lacking about the impact of emerging government health insurance coverage inclusion on patient utilization and affordability of expensive anti-cancer medicines and insurance sustainability in China. Methods Using an interrupted time series design, we conducted segmented regression analyses of utilization changes of targeted anti-cancer medicines covered by the provincial government health insurance program during 2013 to 2016 in 69 hospitals with more than 100 beds in Hangzhou, the capital city of Zhejiang province of China. The WHO/ Health Action International Project on Medicine Prices and Availability methodology was used to measure patient affordability of the study medicines. Results In March 2015, the utilization of all study medicines increased by 15.58 (95% CI = 3.86, 27.30, P = 0.01) to 439.14 standard units (95% CI = 311.79, 566.49, P < 0.001). Before covered by government health insurance, the estimated out-of-pocket payment by patient ranged from 3.0 to 13.1 times of the provincial average disposable annual income per capita for urban residents, and 6.2 to 27.3 times for rural residents. Such payments were reduced to 0.6 to 2.1 times for urban residents and 1.8 to 4.4 times for rural residents after government health insurance coverage inclusion. During 2015 to 2016, the per capita contribution to Hangzhou catastrophic health insurance program was CNY15 (US$ 2.3), and the reimbursement rate was 70% in Hangzhou city. The cumulative total insurance expenses on six study targeted anticancer medicines accounted for an estimated 53% of the total amount of premiums of the government catastrophic health insurance fund. Sensitivity analyses indicated that this proportion would have changed to 46%, 61% and 69% when changing the per capita contribution to CNY25 (US$ 3.8) and CNY40 (US$ 6.2), and changing the insurance reimbursement rate to 60%, 80 and 90%. Conclusion Government health insurance coverage inclusion significantly increased utilization of the expensive targeted anti-cancer medicines, and improved patient affordability. However, the financial burden of patients is still high, especially for the rural low-income population. Rising utilization and expenditures call for careful monitoring of anti-cancer medicines use, and for strategies to decrease prices to facilitate medicines access and keep the insurance system sustainable.

The pandemic of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has caused a large number of deaths, and there is still no effective treatment. COVID-19 can induce a systemic inflammatory response, and its clinical manifestations are diverse. Recently, it has been reported that COVID-19 patients may develop myositis and interstitial pulmonary disease similar to dermatomyositis (DM). This condition is similar to the rapidly progressive interstitial lung disease associated with MDA5+ DM that has a poor prognosis and high mortality, and this poses a challenge for an early identification. Suppression of the immune system can protect COVID-19 patients by preventing the production of inflammatory cytokines. This article attempts to explore the possibility of a relationship between COVID-19 and DM in terms of the potential pathogenesis and clinical features and to analyze the therapeutic effect of the immunosuppressive drugs that are commonly used for the treatment of both DM and COVID-19.

A portable linear ion trap mass spectrometer featuring a compact three-stage vacuum system, a continuous atmospheric pressure interface (CAPI), and a miniature ion funnel was developed and characterized.

Objective Interstitial lung disease (ILD) is a common extramuscular complication contributing to significant morbidity and mortality in anti-melanoma differentiation associated gene 5 positive dermatomyositis (anti-MDA5+ DM). We conducted this study to investigate the association of anti-Ro52 antibodies with clinical characteristics and prognosis in anti-MDA5+ DM patients. Methods We assessed a cohort of 246 patients with anti-MDA5+ DM. To calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for RP-ILD and death while controlling for potential confounders, variables selected by univariate COX regression analysis were included in a multivariate COX regression model with the stepwise forward selection method. A 2-tailed p value <0.05 was considered to indicate statistical significance. Results 246 anti-MDA5+ DM patients were enrolled, 70 cases male, with an average age of 53.10±12.35 years. Anti-Ro52 coexisted in 64.22% (158/246) patients. Anti- Ro52 autoantibodies positive anti-MDA5+ DM patients had a higher rate of RP-ILD (log-rank p<0.001) and a higher mortality rate (log-rankp=0.010). For anti-MDA5+ DM patients with positive anti-Ro52 antibodies, patients with a short disease course, and high inflammation are at increased risk of RP-ILD and death. The appearance of the active rash is an independent protective factor of death. Conclusion Anti-Ro52 antibodies are highly prevalent in anti-MDA5+ DM patients and their coexistence correlates with a higher rate of RP-ILD and mortality. Patients with a short disease course, increased inflammation and without rash are more likely to have a poor prognosis.

Abstract. A novel linear ion trap mass analyzer featuring half round rod electrodes (HreLIT) has been built. It is mainly composed of two pairs of stainless steel electrodes which have a cross-section of half round rod and a pair of end electrodes. The HreLIT has a simple structure and so it could be assembled by hand with relatively high mechanical accuracy. The external dimension of HreLIT is 50 mm×29.5 mm× 28 mm (length×width×height) and its internal volume is about 3.8 cm 3 . A home-made HreLIT mass spectrometer with three-stage vacuum system was built and the performance of HreLIT was characterized using reserpine solution and PPG standard solution. When the scan rate was 254 u/s, mass peak with FWHM of 0.14 u was achieved for ions with m/z 609, which corresponds to a mass resolution of 4350. The HreLIT was also operated at a low q value of 0.28 to extend its mass range. The experiment result showed a mass range of over 2800 u and the amplitude of radio frequency (rf) signal was only 1560 V (0-p). Three-stage tandem mass spectrometry was successfully performed in the HreLIT, and the collision-induced dissociation (CID) efficiencies of MS 2 (CID of ions with m/z 609) and MS 3 (CID of ions with m/z 448) were 78% and 59%, respectively.

Coxsackievirus A16 (CA16) is one of the major pathogens associated with human hand, foot, and mouth disease (HFMD) in the Asia-pacific region. Although CA16 infections are generally mild, severe neurological manifestations or even death has been reported. Studies on CA16 pathogenesis and vaccine development are severely hampered because the small animal models that are currently available show major limitations. In this study, gerbils (Meriones unguiculatus) were investigated for their suitability as an animal model to study CA16 pathogenesis and vaccine development. Our results showed that gerbils up to the age of 21 days were fully susceptible to CA16 and all died within five days post-infection. CA16 showed a tropism towards the skeletal muscle, spinal cord and brainstem of gerbils, and severe lesions, including necrosis, were observed. In addition, an inactivated CA16 whole-virus vaccine administrated to gerbils was able to provide full protection to the gerbils against lethal doses of CA16 strains. These results demonstrate that gerbils are a suitable animal model to study CA16 infection and vaccine development.