Auricular vagus nerve acupressure for patients with emotional distress under the COVID-19 pandemic:A smartphone-based,randomized controlled trial

Objective: To confirm whether self-administered AVNA treatment is effective in improving emotional distressunder the COVID-19 pandemic.Methods: A smartphone-based online, randomized, controlled trial was designed from 26 February 2020 to 28April 2020 in four study sites, including Wuhan, Beijing, Shenyang, and Guangzhou of China. Local residentswho had considerable emotional distress with a score of the Hospital Anxiety and Depression Scale (HADS) ≥9 were recruited. Participants were randomly assigned to three times of AVNA (n = 191) per day, in morning,around noon, and in evening or usual care (UC, n = 215) once daily for 14 days. The primary outcome was theresponse rate, which was the proportion of participants whose Hospital Anxiety and Depression Scale (HADS)score reduced from baseline by ≥ 50%. The assessment was conducted at baseline, 3 days, and 14 days.Results: The AVNA group had a markedly higher response rate than the UC group at 3 days (35.6% vs. 24.9%,P = 0.02) and at 14 days (70.7% vs. 60.6%, P = 0.02). The AVNA group showed significantly greater reductionin scores of HADS at the two measurement points and BAI at 3 days (P ≤ 0.03), with average respective effectsize of 0.217 and 0.195. Participants with AVNA spent less time falling asleep and rated their sleep qualitybeing remarkably higher than those with UC at endpoint.Conclusion: During COVID-19 pandemic period, treatment with self-administrated AVNA was more effectivethan UC in reducing emotional distress of isolated populations. These findings support self-administered AVNAas a treatment option for patients with emotional distress under the COVID-19 pandemic or other emergentevents.

Promising of Multidrug-resistant Tuberculosis Screening among New Tuberculosis Patients in China

Peng et al.[1] reported that the MDR-TB burden among the new tuberculosis （TB） patients accounted for more than 1/4th of all multidrug-resistant TB （MDR-TB） cases in the past 5 years in Zhejiang province,although the identified rate of MDR-TB among 9830 new TB cases was only 2.0%.Drug-resistant TB,especially MDR-TB,is a major threat to the control of TB worldwide.However,due to high cost and limited budget,screening on MDR-TB has not been implemented among all TB cases by now.

Multidrug-resistant Tuberculosis Burden among the New Tuberculosis Patients in Zhejiang Province： An Observational Study, 2009-2013

Background：Screening on multidrug-resistant tuberculosis （MDR-TB） has been limited to the serious TB subpopulations excluding the new TB patients.This study aimed to examine MDR-TB burden among the new TB patients.Methods：We conducted a study in Zhejiang Province during 2009-2013 to screen for MDR-TB patients among the low MDR-TB risk patients and five subpopulations of high MDR-TB risk patients.The number,prevalence,and trend of MDR-TB were compared while the logistic regression model was used to examine risk factors related to MDR-TB.Results：A total of 200 and 791 MDR-TB cases were,respectively,identified from the 9830 new TB cases and 2372 high-risk suspects who took MDR-TB screening from 2009 to 2013.The MDR-TB rates went down in both of the new TB patients and five MDR-TB high-risk groups over the study time,but the percentage of MDR-TB patients identified from the new TB patients in all diagnosed MDR-TB cases kept stable from 28.3% in 2011 to 27.0% in 2012 to 26.0% in 2013.Conclusions：The study indicated that MDR-TB burden among new TB patients was high,thus screening for MDR-TB among the new TB patients should be recommended in China as well as in the similar situation worldwide.

Heterosexual risk of HIV infection in China： systematic review and meta-analysis

Background Heterosexual sex has become the dominant transmission route in China. Recently studies reported high heterogeneity in heterosexual transmission risk in resource-limited countries. The aim of this study was to summarize the risk of HIV transmission among Chinese serodiscordant couples. Methods A systematic review and meta-analysis of observational studies of heterosexual HIV transmission among serodiscordant couples in China was conducted. Two reviewers conducted a literature search using the China National Knowledge Infrastructure （CNKI）, Chinese Medical Current Contents （CMCC）, and Medline databases. Pooled transmission estimates per 100 person-years （PY） were calculated using a random-effects model. Meta-regression analysis and subgroup analysis stratified by study design, transmission direction and period of antiretroviral therapy （ART） availability were conducted to assess the factors associated with transmission. Results Eleven eligible studies were identified reporting on 11 984 couples and 405 HIV transmission events. HIV transmission risk from HIV-positive individuals to heterosexual partners was 1.68 （95% Cl 0.74-2.62） per 100 PY. Study design did not reach statistical significance in meta-regression analysis. The pooled female-to-male transmission estimate was 1.11 （95% CI 0.09-2.14） per 100 PY and male-to-female transmission estimate was 1.43 （95% Cl 0.19-2.68） per 100 PY. The pooled estimate for those before the availability of the Chinese National Free Antiretroviral Therapy Program （2.13 （95% Cl 0.00-4.63） per 100 PY） was higher than that for those after the implementation of this program （1.44 （95% CI 0.62-2.26） per 100 PY）. Conclusions Transmission estimates in China were lower than other developing countries, but higher than developed countries. Research that better defines HIV secondary transmission rates and the associated behavioral, treatment adherence, and health-related risk factors among heterosexual serodiscordant couples in China is needed.

Notification Rate of Tuberculosis among Migrants in China 2005-2014： A Systematic Review and Meta-analysis

Background： Migrations have been reported to be associated with the high risk of tuberculosis （TB）, but there is no systematic analysis of the available data for TB among migrant in China. The aim of this study was to examine the notification rate of active and sputum smear-positive TB by a systematic review and meta-analysis. Methods： A systematic review and meta-analysis were performed to examine the notification rate of active and sputum smear-positive TB among migrants in China. Two reviewers searched the cross-sectional studies published in PubMed, EMBASE, SciFinder, and Web of Science in English and in CNKI and Wanfang databases in Chinese. Pooled estimates of notification rate of TB among migrants were calculated using a random effects model. Meta-regression analysis and subgroup analysis stratified by year, region were also performed. Results： Seventy eligible studies met the inclusion criteria for the final analysis. The overall notification rate of active TB and sputum smear-positive cases among migrants were 53.12 （95% confidence interval [CI]： 47.32 59.63） and 24.53 （95% Cl： 22.01-27.34） per 100,000 populations, respectively. The notification rate of active TB significantly increased from 50.95 （95% CI： 41.11 -63.14） per 100,000 populations in 2005 to 84.62 （95% CI： 78.00-91.80） per 100,000 populations in 2014 while that of smear-positive TB was constant during the study time （P = 0.79）. The geographic difference was identified both for active and sputum smear-positive TB, with the higher notification rates mainly distributing along the eastern coastal areas. Conclusions： The pooled estimate of active TB and sputum smear-positive TB among migrants was lower than the national notification rate among general population, but the gap between our data and national notification rate among general population is narrowed down during 2005-2014.

Role of big data in reducing the bias of a cohort study

Validity in research is referred to the closeness of the observed results to the truth or the degree to which an inference drawn from a study.1 Guarantee and pursuit of validity is always a challenge through the whole course of a research.What blocks research to reach validity？-Bias.Generally speaking,the more complicate the study is,the larger the bias and the lower the validity are.The cohort study,especially for a prospective cohort study,is a kind of epidemiological study which can provide strong evidences for medical practices and policy-making.

Orexin Receptor Antagonists as Emerging Treatments for Psychiatric Disorders

Orexins comprise two neuropeptides produced by orexin neurons in the lateral hypothalamus and are released by extensive projections of these neurons throughout the central nervous system. Orexins bind and activate their associated G protein-coupled orexin type 1 receptors(OX1Rs) and OX2Rs and act on numerous physiological processes, such as sleep-wake regulation, feeding, reward,emotion, and motivation. Research on the development of orexin receptor antagonists has dramatically increased with the approval of suvorexant for the treatment of primary insomnia. In the present review, we discuss recent findings on the involvement of the orexin system in the pathophysiology of psychiatric disorders, including sleep disorders,depression, anxiety, and drug addiction. We discuss the actions of orexin receptor antagonists, including selective OX1R antagonists (SORA1s), selective OX2R antagonists(SORA2s), and dual OX1/2R antagonists (DORAs), in the treatment of these disorders based on both preclinical and clinical evidence. SORA2s and DORAs have more pronounced efficacy in the treatment of sleep disorders,whereas SORA1s may be promising for the treatment of anxiety and drug addiction. We also discuss potential challenges and opportunities for the application of orexin receptor antagonists to clinical interventions.