Highlights d Human ACE2 knockin mice were generated by using CRISPR/Cas9 technology d SARS-CoV-2 leads to robust replication in lung, trachea, and brain d SARS-CoV-2 causes interstitial pneumonia and elevated cytokine in aged hACE2 mice d High dose of SARS-CoV-2 can establish infection via intragastric route in hACE2 mice

Aim: To investigate the prevalence of insomnia among front-line nurses fighting against COVID-19 in Wuhan, China, and analyse its influencing factors. Background: Insomnia is an important factor that can affect the health and work quality of nurses. However, there is a lack of big-sample studies exploring factors that affect the insomnia of nurses fighting against COVID-19. Method: This cross-sectional study using the Ascension Insomnia Scale, Fatigue Scale-14 and Perceived Stress Scale took place in March 2020. Participants were 1,794 front-line nurses from four tertiary-level general hospitals. Results: The prevalence of insomnia among participants was 52.8%. Insomnia was predicted by gender, working experience, chronic diseases, midday nap duration, direct participation in the rescue of patients with COVID-19, frequency of night shifts, professional psychological assistance during the pandemic, negative experiences (such as family, friends or colleagues being seriously ill or dying due to COVID-19), the degree of fear of COVID-19, fatigue and perceived stress. Conclusion: The level of insomnia among participants was higher than the normal level. Interventions based on influencing factors should be implemented to ensure nurses' sleep quality. Implications for Nursing Management: An in-depth understanding of the influencing factors of insomnia among front-line nurses can help nurse managers develop solutions to improve front-line nurses' sleep quality, which will enhance the physical and mental conditions of nurses and promote the quality of care.

Aims and Objectives To investigate the present status of anxiety among nurses fighting the spread of COVID‐19 and its association with perceived stress and insomnia. Background With the outbreak of COVID‐19, nurses have been caring for infected patients for a considerable length of time in Wuhan, China. Previous COVID‐19 studies generally focused on patients’ medical treatment, but few considered healthcare workers’ psychological needs while working with a pandemic involving an unfamiliar infectious disease. Numerous nurses have experienced mental health problems, such as anxiety. Design The STROBE guidelines for a cross‐sectional questionnaire were implemented. Methods An online survey of 643 frontline nurses working with COVID‐19 patients was conducted from March 3 to 10, 2020. Sociodemographic data were collected, and the Generalized Anxiety Disorder Scale, the Chinese Perceived Stress Scale, and the Athens Insomnia Scale were administered. Results One‐third (33.4%) of participants reported anxiety, which was associated with perceived stress and insomnia among Chinese frontline nurses in Wuhan during the COVID‐19 pandemic. Significant associations were found between anxiety, perceived stress, insomnia, working four‐night shifts per week, experience working during more than two epidemics, and fear of COVID‐19. Conclusions This study found that a substantial proportion of frontline nurses caring for COVID‐19 patients experienced anxiety. We recommend that nurse managers focus on working conditions and cultivate safe and satisfactory work environments. Meanwhile, frontline nurses should foster awareness of mental health and rely on online resources for psychological training to alleviate anxiety. Relevance to clinical practice The findings of this study could facilitate better understanding of anxiety among frontline nurses; more importantly, health care authorities and nursing managers need to pay more attention to ensuring intervention training to reduce anxiety for frontline nurses worldwide.

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Objectives The main objective of this study was to explore the associations of family relationships and negative life events with depressive symptoms among Chinese adolescents. Methods A cross-sectional study of 3081 middle school students was conducted in Ganzhou City, Jiangxi Province, China. Students were asked to complete questionnaires regarding family relationships, negative life events, and depressive symptoms. A mediation analysis was carried out using a multiple regression analysis and the PROCESS macro method. Results Of all participants, 19.9% reported experiencing depressive symptoms. The prevalence of depressive symptoms was 13.0% and 29.2% in participants with good and poor parental relationships, and the prevalence of depressive symptoms was 11.4% and 30.9% in participants with closed and alienated parental-child relationships, respectively. Parental relationships, parental-child relationships, and negative life events were positively correlated with depressive symptoms. The effect of parental relationships on depressive symptoms was fully mediated by negative life events (Effect = 0.052, 95% CI = [0.023, 0.082]), while the effect of parent-child relationships on adolescent depressive symptoms was partially mediated by negative life events (Effect = 0.075, 95% CI = [0.048, 0.104]). Conclusions Our results showed a high prevalence of depressive symptoms in Chinese adolescents. Poor family relationships may have the potential to increase the risk of depressive symptoms, and they could affect depressive symptoms through negative life events.

Background Limited published research has examined the relationships of negative life events and coping styles with sleep quality in Chinese junior high school students. We aimed to investigate the prevalence of poor sleep quality and to clarify the role of coping styles between negative life events and sleep quality. Methods A cross-sectional study of 3081 students was conducted in Ganzhou City, Jiangxi Province, Southeastern China. Adolescent Self-Rating Life Events Checklist, Simplified Coping Style Questionnaire, and Pittsburg Sleep Quality Index were applied to assess negative life events, coping styles, and sleep quality, respectively. Descriptive analyses, independent-samples t tests, one-way analyses of variance, Pearson correlation analyses, and structural equation modeling (SEM) were applied to analyze the data. Results The prevalence of poor sleep quality was 26.7%. Negative life events (B = 0.038, P < 0.001) and negative coping style (B = 0.049, P < 0.001) demonstrated a positive association with poor sleep quality, while positive coping style indicated a negative association with poor sleep quality (B = −0.029, P < 0.001). Interactions of negative life events and coping styles with sleep quality were not found (all P > 0.05). The association between negative life events and sleep quality was mediated by negative coping styles. Conclusions Our results indicated that poor sleep quality was common in these Chinese adolescents. Negative life events and negative coping style were associated with an increased prevalence of poor sleep quality, while the positive coping style was related to a decreased prevalence of poor sleep quality. A negative coping style mediated the association between negative life events and sleep quality.

Background Obsessive–compulsive and related disorders (OCRDs) are a group of intractable and chronic mental disorders. Trichotillomania (TTM) is a common type of OCRDs characterized by repetitive hair pulling, driven by escalating tension before the action and during the attempts to resist it. Binge eating disorder (BED) is a common type of eating disorder characterized by recurrent compulsive episodes of binge eating. Both have common psychological processes (tension or impulsion) and pathological manifestations (out of control), but the pathological mechanisms are still unclear and the current clinical treatments are often unsatisfactory for these two disorders. Case presentation A 25-year-old woman with TTM comorbid BED came to our hospital for treatment. She had accepted systematic cognitive behavioral therapy (CBT) and also monotherapy or multidrug therapy with sertraline, fluvoxamine, bupropion, risperidone in full dosage and duration for 2 years, but all of them did not work. We treated this case with N-acetylcysteine (NAC) as a synergist on the basis of recent treatment (fluvoxamine 150 mg/day and bupropion 300 mg/day). The pathological hair plucking behavior and binge eating symptoms were both significantly and rapidly improved, and the follow-up in next 14 weeks showed that the effect was still maintained. Conclusion To our knowledge, this may be the first case report of using NAC as a synergist to treat TTM comorbid BED successfully, which suggest that these two disorders may have a common pathophysiological mechanism. Moreover, NAC can be one choice as a synergistic treatment for OCRDs.

ObjectivesTo find out the genetic association between IL6 and autoimmune arthritis.MethodsWe performed a two-sample Mendelian randomization (MR) study using multiple genome-wide association studies (GWAS) datasets. Furthermore, a sex-stratified MR study was performed to identify sexual dimorphism in the association between IL6 and autoimmune arthritis. Then, LocusZoom plots were displayed based on the IL6R gene region to present evidence of genetic colocalization between diseases.ResultsThe MR result denoted a genetic association between the increased level of IL-6 signaling and risk of RA (β=0.325, 95%CI 0.088, 0.561, p=7.08E-03) and AS (β=1.240, 95%CI 0.495, 1.980, p=1.1E-03). Accordingly, sIL6R was found to have negatively correlation with the onset of RA (β=-0.020, 95%CI -0.0320, -0.008, p=1.18E-03) and AS (β=-0.125, 95%CI -0.177, -0.073, p=2.29E-06). However, no genetic association between IL6/sIL6R and PsA was detected. The gender-stratified MR analysis showed that IL6 was associated with AS in the male population, with RA in the female population, and with PsA in the male population. Additionally, ADAR, a gene identified by a sensitive test, could be the reason for the nonsignificant association between IL6 and PsA in a pooled population.ConclusionOur findings showed that the overactive IL6 signal pathway led to autoimmune arthritis, especially in RA and AS. Sexual difference was also observed in IL6-intermediate susceptibility to autoimmune arthritis.