Nursing ethics for prevention and control of major infectious disease outbreaks:Chinese expert consensus

Background Major infectious disease has become a serious threat to people’s health worldwide.As the world’s largest healthcare workforce and the core forces fighting against the epidemic,nurses are on the frontline of this battle.A number of ethical issues have given rise to numerous concerns that have largely affected nurses in different ways as they respond to the epidemic.In addition,excessive expectations from people can exert undue pressure,which can easily lead to burnout in nurses.Methods In this consensus,the expert panel method was used to develop and reach a consensus.The members involved in the formation of the consensus included an expert discussion panel and a consensus writing expert group,a methodologist,and four secretaries.After 16 rounds of online expert consultation and two rounds of expert panel meetings,the writing team analyzed and reviewed the 78 amendments suggested by the experts to develop a consensus on nursing ethics for prevention and control of major infectious disease outbreaks based on the ethical vision of life care.Results This expert consensus focuses on five essential domains:the responsibilities and rights of nurses,the nurse-patient relationship,the doctor-nurse relationship,and the relationship between society and nurses throughout the epidemic.Conclusions We hope this consensus can help nurses better understand and respond to the ethical issues and challenges in public health emergencies,and raise reasonable public expectations of the roles and responsibilities of nurses in these situations.

Causal effects of circulating vitamin levels on the risk of heart failure:a Mendelian randomization study

BACKGROUND Observational studies suggest inverse associations between serum vitamin levels and the risk of heart failure(HF). However, the causal effects of vitamins on HF have not been fully elucidated. Here, we conducted a Mendelian randomization(MR) study to investigate the causal associations between genetically determined vitamin levels and HF.METHODS Genetic instrumental variables for circulating vitamin levels, including vitamins A, B, C, D, and E, which were assessed as either absolute or metabolite levels were obtained from public genome-wide association studies. Summary statistics for single-nucleotide-polymorphisms and HF associations were retrieved from the HERMES Consortium(47,309 cases and 930,014controls) and FinnGen Study(30,098 cases and 229,612 controls). Two-sample MR analyses were implemented to assess the causality between vitamin levels and HF per outcome database, and the results were subsequently combined by meta-analysis.RESULTS Our MR study did not find significant associations between genetically determined circulating vitamin levels and HF risk. For absolute vitamin levels, the odds ratio for HF ranged from 0.97(95% confidence interval [CI]: 0.85–1.09, P = 0.41) for vitamin C to 1.05(95% CI: 0.61–1.82, P = 0.85) for vitamin A. For vitamin metabolites, the odds ratio ranged between 0.94(95% CI:0.75–1.19, P = 0.62) for α-tocopherol and 1.11(95% CI: 0.98–1.26, P = 0.09) for γ-tocopherol.CONCLUSION Evidence from our study does not support the causal effects of circulating vitamin levels on HF. Therefore,there may be no direct beneficial effects of vitamin intake on the prevention of primary HF.

The experiences of menstrual symptom changes among international students studying in China during the acculturation period: A phenomenology study

Objectives Menstruation is a normal physiological phenomenon among female which could be influenced by the process of acculturation.Few studies have explored the experience of menstrual symptom changes among international female students studying in China.Therefore,this paper aims to summarize international female students’experiences of menstrual symptom changes when they were studying in China and interpret these changes through considering the influence of acculturation on their social and academic lives.Methods We used a descriptive phenomenology approach.Structured in-depth face-to-face interviews were conducted between May and November 2019 among ten international female students studying in one Province located in south central China.Participants were those who reported having experienced menstrual symptom changes during the acculturation period,which was defined as the first six months of living in China.All interviews were audio-recorded,transcribed verbatim,and analyzed using NVivo 11.0 with the guidance of Colaizzi's seven-step method.Results The international female students’experiences of menstrual symptom changes were summarized and grouped into five main categories and 13 subcategories.The main categories include:1)demonstration of menstrual symptom changes,2)challenges of maintaining menstrual function in the new setting,3)coping styles to take care of menstrual health,4)consequences of the menstrual symptom changes,and 5)culture-based attitude toward menstruation.Conclusions International female students reported experiences of menstrual symptom changes,including somatic and psychological symptoms during the acculturation period.Culture barriers,academic stress,and sleep patterns are common factors influencing their menstrual symptom changes.More culturally-tailored interventions should be explored to improve the menstrual health of international female students in China.

Global trends and knowledge-relationship of symptom clusters in cancer research:a bibliometric analysis over the past 20 years

Objective:To use Cite Space and VOSviewer to investigate the scientific production in the field of symptom clusters in cancer research.Methods:The search was performed using the terms“symptom clusters,”“cancer,”and“oncology”on the Web of Science Core Collection database.The retrieval time was from 2001 to 2021,which covers the last 2 decades.Based on the production theory of scientific knowledge and the data mining of citations,data pertaining to the annual publications,journals,countries,organizations,authors,and keywords that produce symptom clusters in cancer research,as well as their cooperation(collaboration network),were extracted,and then both were clarified by the software tools VOSviewer(version 1.6.16)and Cite Space(version 6.1.R2).Results:A total of 1796 publications were retrieved between 2001 and 2021,and 473 relevant publications were included after screening.The results showed an increasing trend in published articles.The United States had the largest number of publications(261/473,55.18%),followed by China and Canada.The University of California,San Francisco,was the most productive institution.Current research hotspots included the analysis of symptom clusters and symptom management in patients with breast cancer and lung cancer,as well as any advanced cancer and cancer cachexia;fatigue-related symptom clusters and depression-anxiety symptom cluster;and the impacts of symptom clusters on quality of life.The research frontiers included analysis between health-related quality of life and symptom clusters,data mining in symptom clusters,research on the mental health status of cancer patients,and study of the mechanism and biological pathways of symptom clusters.Conclusions:The study provides insight into the global research perspective for the scientific progress on cancer symptom clusters,which suggests a growing scientific interest in this field,and more studies are warranted to guide symptom management.

护士参与抗菌药物管理现状及影响因素研究

目的基于能力、机会、动机和行为(capability, opportunity, motivation, and behavior, COM-B )理论,调查我国护士抗菌药物管理(antimicrobial stewardship, AMS)参 与水平及其影响因素,为制订有效策略提高AMS护理质量提供参考依据。方法采用横断面调查法。于2021年11月至2022年1月,选取湖南省的17所三级医院的4514名护士进行调查。在COM-B理论指导下,自行编制护士参与抗菌药物管理问卷(the NurseAMS Engagement Que stionnaire ,NAEQ)。该问卷包括能力(14个条目)、机会(7个条目)、动机(6个条目)和行为(12个条目)4个维度,共39个条目。结果护士NAEQ总分为( 155.08±±27.12)分,得分率为79.5% ,表明护士参与AMS处于中等水平。其中,能力维度得分为(52.33±13.48 )分,机会维度得分为(28.64±5.76)分,动机维度得分为(24.57±4.57)分,行为维度得分为(4953±8.83)分。不同职称、是否兼职感染控制护士、是否知晓AMS团队、是否知晓抗菌药物限定日剂量、科室类型、科室是否配备临床药师、参与抗菌药物培训和医师-护士联合查房的频率等特征不同的护士NAEQ得分比较,差异有统计学意义(P<0.05)。其中初级职称护士的NAEQ得分高于中级职称护士(P<0.05);担任兼职感染控制护士、知晓AMS团队、知晓抗菌药物限定日剂量的护士NAEQ得分高于其他护士(P<0.01);重症监护室和传染病科护士NAEQ得分低于五官科等其他科室的护士(P<0.01);科室配备临床药师的护士NAEQ得分高于未配备或不清楚是否配备临床药师的护士(P<0.01);参与抗菌药物培训和医师-护士联合查房次数较多的护士NAEQ得分高于其他护士(P<0.01)。结论加强教育和培训及改善多学科沟通与协作等多种策略有望提高护士参与AMS的水平。此外,应更多关注中级职称、感染控制经验较少以及特定科室工作的护士。

重症监护室智慧化管理措施减少临床虚假警报效果的整合性综述

目的医疗设备的频繁虚假警报可能导致护土警报疲劳,这可能导致反应行动延迟或错过警报,增加患者不良事件的风险。本综述旨在探讨重症监护室临床警报智慧化管理措施对减少临床虚假警报的应用效果。方法根据Whitmore 和Knaf的方法学框架,对6个数据库进行系统检索: PubMed, EMBASE,CINAHL,OVID,CochraneLibrary,Scopus,检索从每个数据库建库到2022年12月以英文或中文发表的临床警报的智慧化管理相关文章。采用乔安娜布里格斯研究所的评价工具(JBI-MAStARI)评估研究的质量,并对文献进行数据提取和分析。该研究已在PROSPERO完成注册(CRD42023411552)。结果共纳入7项研究。不同的警报智慧化管理措施有利于减少虚假警报数量和警报的持续时间,缩短护士对重要警报的应答时间,减轻护士的警报疲劳程度。在实践中,应用新的警报管理方式后取得了积极的效果。结论智慧化管理措施可能是警报减少的有效途径,医院迫切需要进行临床警报的智慧化管理。为确保更有效的患者监测、减少警报给护士带来的困扰,未来需要更多与人工智能相结合的警报管理手段,以实现关键警报的准确识别,确保护士对警报准确响应,并真正改善警报频繁的临床医疗环境。

Multidimensional health literacy profiles and health-related behaviors in the elderly:A cross-sectional survey

Objectives:To investigate health literacy profiles using a multidimensional tool in the elderly,analyze the factors related to health literacy,and explore the relationships between health literacy and health-related behaviors.Methods:A cross-sectional survey including 440 participants was conducted at a community health center and a village health center in Changsha,Hunan Province,between June 2020 and August 2020.We used the Health Literacy Questionnaire(HLQ)to assess the elderly’s health literacy.Sociodemographic data and health-related behaviors of them were surveyed with a self-designed questionnaire.Latent profile analysis,Pearson’s chi-squared and ordinal logistic regression were used to analyze the data.Results:The median age of the 440 respondents was 68 years.The participants had the lowest scores in the“appraisal of health information”subscale(2.22±0.52),followed by“navigating the healthcare system”subscale(2.89±0.81)of HLQ.Based on the analysis of three profiles,respondents who were 60 e74 years(OR=2.06,95%CI:1.23e3.42,P=0.006),living in urban areas(OR=3.28,95%CI:2.17e4.94,P<0.001),with secondary education or above(OR=2.86,95%CI:1.92e4.27,P<0.001),and having health insurance(OR=1.89,95%CI:1.02e3.51,P=0.042)were significantly associated with health literacy.Statistically significant associations were found between health literacy level and health-related behaviors,including medical service-seeking behavior(χ^(2)=25.14,P<0.001),exercising regularly(χ^(2)=34.08,P<0.001),and taking a medical examination in the past 12 months(χ^(2)=24.76,P<0.001).Conclusion:The multidimensional health literacy survey has identified the low health literacy level among the elderly in community settings.It revealed the relationships of sociodemographic character-istics,including age,education level and residence,with health literacy.These findings emphasized the importance of health literacy in promoting health behaviors,guiding a profound understanding of the Chinese elderly’s health needs and health literacy to develop community-based health promotion interventions.

Self reported adherence to antiretroviral treatment and correlates in Hunan province,the Peoples Republic of China

Aims:This study aimed to describe the adherence level to antiretroviral therapy and its associated factors among people living with HIV in Hunan province,China.Methods:Across-sectional survey study was done at two major HIV treatment sites within Hunan province in China from July 2011 to Oct 2012 through face-to-face interviews.Adherence measures were captured using a 30-day visual analog scale(VAS).Results:A total of 418 participants consented and completed the questionnaires with the mean age being 38 years old.Based on VAS,28%of the participants had lower than 90%ART adherence level.The main reasons for missing drugs were;forgetting,being away from home,being busy and feeling worse after taking drugs.Logistic regression results showed that drug use(B=0.68,OR=2.11),time on ART(B=0.31,OR=0.72)and side effects(B=0.64,OR=1.82)were significantly associated with adherence to ART.Conclusion:Patients on ARVs in Hunan province are faced with adherence challenges notably drug abuse,drug regime scheduling challenges at the initial stages of therapy and drug side effects.It is therefore necessary to institute specific adherence interventions that target those who abuse drugs,ART naïve patients,and those experiencing side effects in order to achieve optimal ART adherence.

A qualitative study of childbirth fear and preparation among primigravid women:The blind spot of antenatal care in Lilongwe,Malawi

Objectives:This study aimed to explore childbirth fear and childbirth preparation among primigravid women in the late pregnancy from 36 to 40 weeks gestation.Methods:We purposively recruited 18 primigravid women into in-depth interviews,21 birth companions,and 13 health workers into focus group discussions.Participants were recruited from two community hospitals'maternity waiting homes in Lilongwe,Malawi.Semi-structured interview guides were used to collect data that were analyzed using content analysis.NVivo11 computer software was used to organize the data.Results:The four categories developed were:"ambivalent pregnancy feelings","dependence on traditional childbirth counseling","inadequate prenatal childbirth instruction"and"inconsistent roles of a birth companion".The findings suggest that primigravid women who were mainly exposed to traditional childbirth mentoring rather than professional care providers,experienced childbirth fear,and lacked proper psychosocial childbirth preparation.Conclusions:Childbirth fear among primigravid women emanate from personal;family;ineffective traditional counseling;and inadequate antenatal childbirth instruction.Birth companions may increase childbirth stress.However,our findings highlight birth companions as readily available psychosocial support resources among primigravid women.We recommend that professional childbirth instruction during antenatal care should be strengthened to surpass traditional childbirth counseling.Appropriateness and effectiveness of birth companions need to be carefully assessed.

The relationship between acceptance of illness and quality of life among men who have sex with men living with human immunodeficiency virus:A cross-sectional study

Objectives To explore the relationship between acceptance of illness and quality of life(QOL),and factors associated with acceptance of illness among men who have sex with men(MSM)living with human immunodeficiency virus(HIV).Methods Three hundred and one MSM were recruited from an HIV clinic between August and December 2018.The battery of measurements consisted of the Acceptance of Illness Scale,World Health Organization Quality of Life Questionnaire for HIV brief version,HIV Cognitive Appraisal Scale and a self-designed questionnaire used to collect general information.Pearson correlation test was used to examine the relationship between acceptance of illness and QOL.Univariate and multivariate ordinal logistic regression analyses were used to examine whether the general data(demographic and HIV-related clinical data)and HIV cognitive appraisal were associated with acceptance of illness levels.Results Descriptive analysis showed the acceptance level among MSM living with HIV was moderate(Mean=26.29,SD=5.28).Those with a better acceptance of illness had a better QOL(r=0.69,P<0.01).In the multivariate ordinal logistic regression model,education level,threat appraisals(OR:1.09;95%CI[1.06–1.13]),and controllability appraisals(OR:0.82;95%CI[0.71–0.94])were significantly associated with acceptance of illness.Conclusions Results showed acceptance level was moderate and had a positive correlation with QOL.High level of education,low threat appraisals and high controllability appraisals were related to high illness acceptance.This finding highlights the importance of focusing on HIV-infected MSM with low education and on their perceptions of threat and controllability about HIV-related issues when designing interventions to promote illness acceptance in this vulnerable population.

Improve nursing in evidence-based practice:How Chinese nurses'read and comprehend scientific literature

Objectives:To examine Chinese nurses'practice of reading and understanding scientific literature and elucidate the motivating and deterring factors.Methods:This is a cross-sectional study conducted between March and June 2015.A random sample of 853 full-time registered nurses from three tertiary and two secondary hospitals in China filled out a set of self-administered questionnaires,including literature habit questionnaire(41 items),the situational motivation scale and the socio-demographic and professional characteristics questionnaire(15 items).Results:Significant majority(89.2%)of the respondents reported perception of barriers to keeping up to date with literature.The language barrier was the most prominent,followed by poor presentation and readability of articles.Using simpler language when writing articles,improving ones'foreign language proficiency and getting education or training on nursing research were raised as the top facilitators.Additionally,reading and understanding literature was significantly associated with the nurses'educational background,motivation,genders and work settings.Conclusions:The survey of the current status of literature education among Chinese nurses suggests that providing protected time,training for critical thinking,and incentive mechanisms will help improve nurses'engagement in literature and create a culture of academic inquiry.

Hospital ethical climate associated with the professional quality of life among nurses during the early stage of COVID-19 pandemic inWuhan,China:A cross-sectional study

Objectives:To describe the professional quality of life and explore its associated factors among nurses coming from other areas of China to assist with the anti-epidemic fight inWuhan and especially examine whether the hospital ethical climate was independently associated with nurses’professional quality of life.Methods:A cross-sectional online survey was conducted from March 2020 to April 2020.The nurses working in Wuhan from the other parts of China were the target population.The Professional Quality of Life Scale version 5,the Hospital Ethical Climate Survey,and a basic information sheet were used to collect data.Descriptive statistics,t-test,ANOVA,Pearson correlation,and multiple linear regression analysis were used to analyze the data.Results:In total,236 nurses participated in this study,and 219 valid questionnaires were analyzed.The average age of the participants was 31.2±5.0 years.Most nurses were female(176/219;80.4%)and married(145/219;66.2%).In term of professional quality of life,nurses reported moderate(129/219;58.9%)to high(90/219;41.1%)levels of compassion satisfaction,low(119/219;54.3%)to moderate(100/219;45.7%)levels of burnout,and low(67/219;36.0%)to high(10/219;4.6%)levels of secondary traumatic stress.Regarding hospital ethical climate,nurses reported moderately high hospital ethical climates with an average score of 4.46.After controlling for socio-demographic characteristics,the multiple linear regression models showed that the hospital ethical climate subscale of“relationship with physicians”was independently associated with the compassion satisfaction(b=0.533,P<0.01)and burnout(b=0.237,P<0.05);the hospital ethical climate subscale of“relationship with peers”(b=0.191,P<0.01)was independently associated with the secondary traumatic stress.Conclusions:During the early stage of the pandemic,nurses demonstrated moderate to high level of compassion satisfaction,low to moderate level of burnout,and all nurses experienced secondary traumatic stress.Nurses perceived a high level of hospital ethical climate,and the perceived hospital ethical climate played an important role in promoting nurses’professional quality of life during a lifethreatening infectious disease pandemic.

女性艾滋病风险感知及安全套使用相关因素的调查研究

目的全球范围内中老年女性人类免疫缺陷病毒(human immunodeficiency virus,HIV)阳性病例有明显增加趋势。本研究旨调查湖南省40岁及以上女性对HIV感染风险的感知、艾滋病相关知识和态度、安全套使用情况及关联因素。方法2019年7月至2020年8月,对湖南省4个地区的958名40岁及以上女性进行横断面调查。收集其社会人口学特征、HIV感染风险感知、艾滋病知识和态度、安全套使用和其他安全性行为的相关资料。使用单因素和多因素logistic回归分析来确定安全套使用的关联因素。结果在958名调查对象中,60.6%认为自己没有感染艾滋病毒的风险,46.8%报告他们在过去的性生活中从未使用过安全套。年龄较大、家庭月收入较低、在过去1年没有接受过艾滋病相关教育、不愿意使用避孕套或无法在性行为时决定安全套的使用、对艾滋病态度更消极的女性在性行为过程中使用安全套的可能性较小。结论调查显示多数40岁及以上的女性认为自己感染HIV的风险很低,性行为过程中安全套使用率也很低。未来应针对这一群体加强艾滋病预防和控制相关知识教育。

HIV Counseling and Testing Uptake,Knowledge and Attitude and Influencing Factors among Student Nurses and Midwives in The Gambia:An Institutional-based Cross-sectional Study

HIV counseling and testing(HCT)has become paramount in the prevention and control of HIV/AIDS worldwide.However,the uptake of HCT has been very slow globally,especially in sub-Saharan Africa.Student nurses formed the largest group undergoing health care training in the country compared to doctors and other health cadres.According to WHO,they are part of the most vulnerable group to HIV infection,judging by the fact that they interact more with patients/clients than other healthcare professionals.This study aimed to determine the prevalence of HCT uptake,knowledge,and attitude and evaluate influencing factors among student nurses and midwives in public nursing schools.An institutional-based cross-sectional study design was employed to collect data from 305 randomly selected nursing students and midwives using a validated and reliable self-administered questionnaire.Descriptive statistics(percentages,mean and standard deviation)and inferential statistics(chi square,logistics regression,one-way ANOVA and independent samples t-test)were used for data analysis using SPSS version 25.0.A p-value<0.05 was considered for statistical significance.Out of the 305 students recruited for the study,60.98%were females,with a mean age of 25.5 years old.About 58.4%of the participants had tested for HIV in the past.About 95.7%acknowledged the importance of HCT in the prevention and control of HIV/AIDS.HCT uptake among student nurses and midwives was influenced by factors ranging from an individual that are interpersonal challenges(such as concerns of friends),perceived susceptibility to the disease,lack of confidentiality,stigma and discrimination from health service providers.Therefore,these barriers can be addressed through an organized targeted health education intervention and advocacy programs across health training institutions in the Gambia and beyond.

Extracellular vesicles from human urine-derived stem cells delay aging through the transfer of PLAU and TIMP1

Aging increases the risks of various diseases and the vulnerability to death.Cellular senescence is a hallmark of aging that contributes greatly to aging and aging-related diseases.This study demonstrates that extracellular vesicles from human urine-derived stem cells(USC-EVs)efficiently inhibit cellular senescence in vitro and in vivo.The intravenous injection of USC-EVs improves cognitive function,increases physical fitness and bone quality,and alleviates aging-related structural changes in different organs of senescence-accelerated mice and natural aging mice.The anti-aging effects of USC-EVs are not obviously affected by the USC donors’ages,genders,or health status.Proteomic analysis reveals that USC-EVs are enriched with plasminogen activator urokinase(PLAU)and tissue inhibitor of metalloproteinases 1(TIMP1).These two proteins contribute importantly to the anti-senescent effects of USC-EVs associated with the inhibition of matrix metalloproteinases,cyclin-dependent kinase inhibitor 2A(P16INK4a),and cyclin-dependent kinase inhibitor 1A(P21cip1).These findings suggest a great potential of autologous USC-EVs as a promising anti-aging agent by transferring PLAU and TIMP1 proteins.

Extracellular vesicles from human urine-derived stem cells prevent osteoporosis by transferring CTHRC1 and OPG

Osteoporosis is a debilitating bone disease affecting millions of people. Here, we used human urine-derived stem cells(USCs),which were noninvasively harvested from unlimited and easily available urine, as a "factory" to obtain extracellular vesicles(USCEVs) and demonstrated that the systemic injection of USC-EVs effectively alleviates bone loss and maintains bone strength in osteoporotic mice by enhancing osteoblastic bone formation and suppressing osteoclastic bone resorption. More importantly, the anti-osteoporotic properties of USC-EVs are not notably disrupted by the age, gender, or health condition(with or without osteoporosis) of the USC donor. Mechanistic studies determined that collagen triple-helix repeat containing 1(CTHRC1) and osteoprotegerin(OPG) proteins are enriched in USC-EVs and required for USC-EV-induced pro-osteogenic and anti-osteoclastic effects. Our results suggest that autologous USC-EVs represent a promising novel therapeutic agent for osteoporosis by promoting osteogenesis and inhibiting osteoclastogenesis by transferring CTHRC1 and OPG.

Antiretroviral therapy improves neurocognitive impairment in people living with HIV? A meta-analysis

Objectives:Although effective antiretroviral therapy(ART)has been used for more than two decades,HIV-associated neurocognitive disorder remains prevalent.Thus,whether ART can improve neurocognitive impairment is controversial.This review aims to explore the effects of ART on cognitive impairment in people living with HIV(PLWH).Methods:A systematic literature search was conducted in eight databases(PubMed,Embase,Web of Science,Cochrane Library,CNKI,VIP,China Biology Medicine disc,and WanFang)to identify studies that compare cognitive function between study groups who are administered and not administered ART.We searched for articles published up to April 2019.Article evaluation and data extraction were independently conducted by two reviewers.Results:Sixteen articles(6,694 participants)-14 cross-sectional studies and 2 cohort studies—were included in this meta-analysis.The cross-sectional studies demonstrated that ART group did not perform better than the non-ART group(OR=1.16;95%CI,1.03-1.30).However,the cohort studies reported a significant improvement in cognitive function at three months(OR=4.01;95%CI,2.35-6.85)and six months(OR=9.24;95%CI,1.71-49.96)after ART initiation compared with the baseline data.No significant cognitive improvement was found in participants younger than 55 years old,but the two crosssectional studies showed that ART may improve cognitive function in PLWH under 65 years old with poor physical condition and immune status.Conclusions:ART could improve cognitive function in PLWH with poor physical condition and immune status,but it does not considerably improve cognition in the entire PLWH population.

Transmission risk of asymptomatic SARS-CoV-2 infection:a systematic review and meta-analysis

Background:Global evidence on the transmission of asymptomatic SARS-CoV-2 infection needs to be synthesized.Methods:A search of 4 electronic databases(PubMed,EMBASE,Cochrane Library,and Web of Science databases)as of January 24,2021 was performed.Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines were followed.Studies which reported the transmission rate among close contacts with asymptomatic SARS-CoV-2 cases were included,and transmission activities occurred were considered.The trans-mission rates were pooled by zero-inflated beta distribution.The risk ratios(RRs)were calculated using random-effects models.Results:Of 4923 records retrieved and reviewed,15 studies including 3917 close contacts with asymptomatic indexes were eligible.The pooled transmission rates were 1.79 per 100 person-days(or 1.79%,95%confidence interval[CI]0.41%-3.16%)by asymptomatic index,which is significantly lower than by presymptomatic(5.02%,95%CI 2.37%-7.66%;p<0.001),and by symptomatic(5.27%,95%CI 2.40%-8.15%;p<0.001).Subgroup anal-yses showed that the household transmission rate of asymptomatic index was(4.22%,95%CI 0.91%-7.52%),four times significantly higher than non-household transmission(1.03%,95%CI 0.73%-1.33%;p=0.03),and the asymptomatic transmission rate in China(1.82%,95%CI 0.11%-3.53%)was lower than in other countries(2.22%,95%CI 0.67%-3.77%;p=0.01).Conclusions:People with asymptomatic SARS-CoV-2 infection are at risk of transmitting the virus to their close contacts,particularly in household settings.The transmission potential of asymptomatic infection is lower than symptomatic and presymptomatic infections.This meta-analysis provides evidence for predict-ing the epidemic trend and promulgating vaccination and other control measures.Registered with PROS-PERO International Prospective Register of Systematic Reviews,CRD42021269446;https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269446.

Increased 5-hydroxymethylcytosine and Ten-eleven Translocation Protein Expression in Ultraviolet B-irradiated HaCaT Cells

Background： DNA hydroxymethylation refers to a chemical modification process in which 5-methylcytosine （5mC） is catalyzed to 5-hydroxymethylcytosine （5hmC） by ten-eleven translocation （TET） family proteins. Recent studies have revealed that aberrant TETs expression or 5hmC level may play important roles in the occurrence and development of various pathological and physiological processes including cancer and aging. This study aimed to explore the relation between aberrant DNA hydroxymethylation with skin photoaging and to investigate the levels of TETs, 5mC, and 5hmC expression 24 h after 40 mJ/cm^2 and 80 mJ/cm^2 doses of ultraviolet B （UVB） irradiation to HaCaT cells. Methods： To explore whether aberrant DNA hydroxymethylation is also related to skin photoaging, 40 mJ/cm^2 and 80 mJ/cm^2 doses of UVB were chosen to treat keratinocytes （HaCaT cells）. After 24 h of UVB irradiation, 5mC and 5hmC levels were determined by immunohistochemistry （IHC） and immunofluorescence （IF）, and at the same time, the expression levels of matrix metalloproteinase 1 （MMP-1） and TETs were assessed by reverse transcription-polymerase chain reaction or Western blot analysis. Results： After 40 mJ/cm^2 and 80 mJ/cm^2 doses of UVB exposure, both IHC and IF results showed that 5hmC levels increased significantly, while the 5mC levels did not exhibit significant changes in HaCaT cells, compared with HaCat cells without UVB exposure. Moreover, compared with HaCat cells without UVB exposure, the levels ofTET1, TET2, and TET3 mRNA and protein expression were significantly upregulated （mRNA： P = 0.0022 and 0.0043 for TET1; all P 〈 0.0001 for TET2; all P = 0.0006 for TET3; protein： P = 0.0012 and 0.0006 tbr TET 1 ; all P = 0.0022 for TET2; and all P = 0.0002 for TET3）, and the levels of MMP- 1 mRNA expression increased dose dependently in 40 mJ/cm^2 and 80 mJ/cm^2 UVB-irradiated groups. Conclusion： UVB radiation could cause increased 5hmC and TET expression, which might become a novel biomarker in UVB-related skin aging.