Background: Long term respiratory symptoms are reported following recovery of acute COVID-19 infection and residual lung abnormalities (RLA) on follow-up thoracic computed tomography (CT) after COVID-19 hospitalisation have been observed. It is unknown whether RLA are associated with epithelial lung injury. Methods: Plasma was sampled from the Post HOSPitalisation-COVID cohort at five months post-hospitalisation. Epithelial injury biomarkers Krebs von den Lungen-6 (KL-6), matrix metalloproteinase 7 (MMP-7), surfactant protein-D (SP-D) and surfactant protein-A (SP-A) were assayed. In those without follow-up CT, RLA at-risk was defined by percent predicted DLCO <80% and/or abnormal chest X-ray, otherwise they were considered low-risk. Follow-up CT RLA was defined as combined involvement of ground glass opacity and reticulation ≥10%. Findings: A total of 957 people were included, 846 people with no CT (at-risk n=103; 12.2%), 111 people with follow-up CT (RLA ≥10% n=85; 76.6%). All epithelial injury biomarkers were significantly elevated in people at-risk of RLA compared with low-risk. KL-6 and MMP-7 were significantly higher in people with ≥10% RLA than those with <10%, SP-D and SP-A did not reach significance. SP-D and SP-A were associated with percent involvement of reticulation (3.22%, 95%CI 1.19 to 5.24; 3.03%, 95%CI 0.76 to 5.30, respectively). Interpretation: RLA after acute COVID-19 infection were consistent with elevated epithelial injury biomarkers and pro-fibrotic signalling. Future studies should address the temporal association between fibrotic biomarkers and resolution or progression of radiological involvement. Funding: PHOSP-COVID is jointly funded by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19 (grant references: MR/V027859/1 and COV0319). Declaration of Interest: JJ reports fees from Boehringer Ingelheim, F. Hoffmann-La Roche, GlaxoSmithKline, NHSX, Takeda and patent: UK patent application number 2113765.8 all unrelated to the submitted work. PMG reports honoraria from Boehringer Ingelheim, Roche, AstraZeneca, Cipla, Brainomix. JCP reports grants from LifeArc, NIHR, Breathing Matters, consulting fees from Carrick Therapeutics, AstraZeneca and honoraria from The Limbic. RAE reports speaker fees from Boehringer Ingelheim and membership positions on European Respiratory Society and American Thoracic Society committees. PM reports consulting fees from EUSA pharma and SOBI, and honoraria from SOBI, UCB, Lilly, and Abbvie. MGS reports grants from NIHR, MRC, board positions on Pfizer External Data Monitoring Committee and Integrum Scientific LLC Infectious Disease Scientific Advisory Board, member positions of HMG UK SAGE and MHG UK NERVTAG, stocks in Integrum Scientific LLC and MedEx Solutions Ltd, gifts from Chiesi Farmaceutici S.p.A. AART reports grants and travel support from Janssen-Cilag Ltd. CEB reports consultancy fees paid to institution from GSK, AstraZeneca, Sanofi, Boehringer Ingelheim, Chiesi, Novartis, Roche, Genentech, Mologic, 4DPharma, TEVA. LVW reports recent and current research funding from GSK and Orion, and consultancy from Galapagos. RGJ reports honoraria from Chiesi, Roche, PatientMPower, AstraZeneca, GSK, Boehringer Ingelheim, and consulting fees from Bristol Myers Squibb, Daewoong, Veracyte, Resolution Therapeutics, RedX, Pliant, Chiesi. AM, AS, MP and SY are employees of Sysmex. All remaining authors declare no competing interests. Ethical Approval: The study cohort included participants of the PHOSP–COVID study, a prospective longitudinal cohort study of adults discharged from National Health Service hospitals across the United Kingdom after admission for confirmed or clinically diagnosed COVID-19, previously described in detail (Ethics Approval Ref: 20/YH/0225).

Background: COVID-19 outbreaks in acute care settings can have severe consequences for patients due to their underlying vulnerabilities, and can be costly due to additional patient bed days and the need to replace isolating staff. This study assessed the cost-effectiveness of clinical staff N95 masks and admission screening testing of patients to reduce COVID-19 hospital-acquired infections. Methods: An agent-based model was calibrated to data on 178 outbreaks in acute care settings in Victoria, Australia between October 2021 and July 2023. Outbreaks were simulated under different combinations of staff masking (surgical, N95) and patient admission screening testing (none, RAT, PCR). For each scenario, average diagnoses, COVID-19 deaths, quality-adjusted life years (QALYs) from discharged patients, and costs (masks, testing, patient COVID-19 bed days, staff replacement costs while isolating) from acute COVID-19 were estimated over a 12-month period. Findings: Compared to no admission screening testing and staff surgical masks, all scenarios were cost saving with health gains. Staff N95s + RAT admission screening of patients was the cheapest, saving A$78.4M [95%UI 44.4M-135.3M] and preventing 1,543 [1,070-2,146] deaths state-wide per annum. Both interventions were individually beneficial: staff N95s in isolation saved A$54.7M and 854 deaths state-wide per annum, while RAT admission screening of patients in isolation saved A$57.6M and 1,176 deaths state-wide per annum. Interpretation: In acute care settings, staff N95 mask use and admission screening testing of patients can reduce hospital-acquired COVID-19 infections, COVID-19 deaths, and are cost-saving because of reduced patient bed days and staff replacement needs. Funding: Victorian Department of Health. SM and NS are the recipients of National Health and Medical Research Council fellowships. Declaration of Interest: The authors declare that there are no competing interests. Ethical Approval: Approval from a Human Research Ethics Committee was not required as only aggregated values were used to inform model input parameters, which were routinely collected by the Victorian Department of Health as part of its public health function pursuant to the Public Health and Wellbeing Act 2008 (Vic) and the Health Records Act 2001 (Vic).

The COVID-19 pandemic has disrupted urban lifestyles and systems, creating planning policy challenges but also opportunities to deliver healthier and more resilient cities. For example, improving public open spaces, and supporting active transport and well-designed higher-density housing can have co-benefits for prevention of infectious and non-communicable diseases. This paper examines the implications of COVID-19 for planning healthy, resilient cities. We reviewed the international academic literature to explore best-practice city planning responses to COVID-19. Using Melbourne, Australia as a case study, we analysed City of Melbourne and state government city planning policy responses to COVID-19, and their implications for health and longer-term resilience. Policy changes included public space adjustments, supporting walking and cycling, and addressing housing affordability and homelessness. While most policy actions were consistent with evidence on planning healthy, resilient cities in response to COVID-19, they did not represent a major shift in city planning approaches, and some innovations were short lived. Melbourne’s city planning responses to COVID-19 prioritised ‘bouncing back’ to pre-pandemic conditions, rather than ‘evolutionary’ urban resilience, which aims for positive transformation of cities in response to disruption. We develop recommendations for city planning that prepares for future pandemics and builds resilience to other shocks and stresses.

Objective: To determine the epidemiologic change in Kawasaki disease (KD) during the post-acute phase of the coronavirus disease 2019 (COVID-19) pandemic compared with the pre- and acute phases. Study design: A follow-up epidemiological study was conducted using data obtained from hospitalized patients with KD in Shiga Prefecture, Japan. The study period was divided into three phases: pre-pandemic (January 2015 to March 2020), acute pandemic (April 2020 to December 2020), and post-acute pandemic (January 2021 to December 2022). The incidence of KD was compared among these phases, focusing on monthly variation, patient age, and regional population density. Results: A total of 1,598 patients with KD were analyzed. The incidence of KD (per 100,000 person-years) was 105.6 [95% confidence interval 99.8–111.8], 69.9 [57.9–84.5], and 76.1 [68.1–85.2] in the pre-, acute, and post-acute phases, respectively. Monthly variation during the post-acute phase dramatically differed from that observed in the pre- and acute phases, with the highest incidence in August and the lowest in April. The reduction in KD incidence was larger in older age groups during the post-acute phase. During the post-acute phase, an association between population density and decrease in KD incidence was no longer observed, contrary to the result during the acute phase. Conclusions: The reduction in KD incidence in Shiga Prefecture remained after the acute phase of the COVID-19 pandemic, although seasonal variation dramatically differed in the post-acute phase from the traditional pattern. Our data indicate that for older children, minimal infection control measures might reduce KD development.

BACKGROUND: Monogenic autoinflammatory disorders result in a diverse range of neurological symptoms in adults, often leading to diagnostic delays. Despite the significance of early detection for effective treatment, the neurological manifestations of these disorders remain inadequately recognized. METHODS: We conducted a systematic review searching Pubmed, Embase and Scopus for case reports and case series related to neurological manifestations in adult-onset monogenic autoinflammatory diseases. Selection criteria focused on the four most relevant adult-onset autoinflammatory diseases-deficiency of deaminase 2 (DADA2), tumor necrosis factor receptor associated periodic fever syndrome (TRAPS), cryopyrin associated periodic fever syndrome (CAPS), and familial mediterranean fever (FMF). We extracted clinical, laboratory and radiological features to propose the most common neurological phenotypes. RESULTS: From 276 records, 28 articles were included. The median patient age was 38, with neurological symptoms appearing after a median disease duration of 5 years. Headaches, cranial nerve dysfunction, seizures, and focal neurological deficits were prevalent. Predominant phenotypes included stroke for DADA2 patients, demyelinating lesions and meningitis for FMF, and meningitis for CAPS. TRAPS had insufficient data for adequate phenotype characterization. CONCLUSION: Neurologists should be proactive in diagnosing monogenic autoinflammatory diseases in young adults showcasing clinical and laboratory indications of inflammation, especially when symptoms align with recurrent or chronic meningitis, small vessel disease strokes, and demyelinating lesions.

BACKGROUND: The emergence of artificial intelligence-based chatbot has revolutionized the field of clinical psychology and psychotherapy, granting individuals unprecedented access to professional assistance, overcoming time constraints and geographical limitations with cost-effective convenience. However, despite its potential, there has been a noticeable gap in the literature regarding their effectiveness in addressing common mental health issues like depression and anxiety. This meta-analysis aims to evaluate the efficacy of AI-based chatbots in treating these conditions. METHODS: A systematic search was executed across multiple databases, including PubMed, Cochrane Library, Web of Science, PsycINFO, and Embase on April 4th, 2024. The effect size of treatment efficacy was calculated using the standardized mean difference (Hedge's g). Quality assessment measures were implemented to ensure trial's quality. RESULTS: In our analysis of 18 randomized controlled trials involving 3477 participants, we observed noteworthy improvements in depression (g = -0.26, 95 % CI = -0.34, -0.17) and anxiety (g = -0.19, 95 % CI = -0.29, -0.09) symptoms. The most significant benefits were evident after 8 weeks of treatment. However, at the three-month follow-up, no substantial effects were detected for either condition. LIMITATIONS: Several limitations should be considered. These include the lack of diversity in the study populations, variations in chatbot design, and the use of different psychotherapeutic approaches. These factors may limit the generalizability of our findings. CONCLUSION: This meta-analysis highlights the promising role of AI-based chatbot interventions in alleviating depressive and anxiety symptoms among adults. Our results indicate that these interventions can yield substantial improvements over a relatively brief treatment period.

INTRODUCTION: Breast cancer stands as the most prevalent type of cancer affecting women globally, and chemotherapy plays a pivotal role in its treatment by diminishing tumour recurrence and enhancing the survival rates of patients. However, chemotherapy-related cognitive impairment (CRCI) often occurs in patients undergoing treatment. Although multiple clinical trials have indicated that exercise therapy can improve CRCI in patients with breast cancer, there are variations in the types of exercise interventions and their effectiveness. We aim to perform a pioneering network meta-analysis (NMA) to assess and prioritise the effectiveness of various exercise interventions in enhancing cognitive function in patients with breast cancer undergoing chemotherapy. METHODS AND ANALYSIS: We will search multiple databases, including PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Wanfang and Sinomed databases, from their inception to May 2023. The main outcome is the cognitive function changes in patients with breast cancer, including subjective and objective results. We will specifically include randomised controlled trials reported in English and Chinese languages, whose primary outcome consists of an assessment of the cognitive function of patients with breast cancer using standardised and validated assessment tools, encompassing both subjective and objective outcomes. The quality of all the trials included will be evaluated based on 'Version 2 of the Cochrane tool for assessing the risk of bias in randomized controlled trials (RoB2)'. We will conduct a Bayesian NMA to thoroughly evaluate and compare the effectiveness of different exercise interventions. We will use cumulative ranking probability plots to estimate the ranking of the best interventions for various exercises. Network plots and funnel plots will be employed to display the study sizes and participants of each exercise intervention, as well as potential publication biases. ETHICS AND DISSEMINATION: The study findings will be shared via peer-reviewed journals to ensure the highest quality and credibility of the research. As the reporting will not include any private patient data, there are no ethical considerations associated with this protocol. PROSPERO REGISTRATION NUMBER: CRD42023406597.

BACKGROUND: This study investigates the associations between air pollution and colorectal cancer (CRC) risk and survival from an epigenomic perspective. METHODS: Using a newly developed Air Pollutants Exposure Score (APES), we utilized a prospective cohort study (UK Biobank) to investigate the associations of individual and combined air pollution exposures with CRC incidence and survival, followed by an up-to-date systematic review with meta-analysis to verify the associations. In epigenetic two-sample Mendelian randomization analyses, we examine the associations between genetically predicted DNA methylation related to air pollution and CRC risk. Further genetic colocalization and gene-environment interaction analyses provided different insights to disentangle pathogenic effects of air pollution via epigenetic modification. FINDINGS: During a median 12.97-year follow-up, 5767 incident CRC cases among 428,632 participants free of baseline CRC and 533 deaths in 2401 patients with CRC were documented in the UK Biobank. A higher APES score was associated with an increased CRC risk (HR, 1.03, 95% CI = 1.01-1.06; P = 0.016) and poorer survival (HR, 1.13, 95% CI = 1.03-1.23; P = 0.010), particularly among participants with insufficient physical activity and ever smokers (Pinteraction > 0.05). A subsequent meta-analysis of seven observational studies, including UK Biobank data, corroborated the association between PM2.5 exposure (per 10 μg/m3 increment) and elevated CRC risk (RR,1.42, 95% CI = 1.12-1.79; P = 0.004; I2 = 90.8%). Genetically predicted methylation at PM2.5-related CpG site cg13835894 near TMBIM1/PNKD and cg16235962 near CXCR5, and NO2-related cg16947394 near TMEM110 were associated with an increased CRC risk. Gene-environment interaction analysis confirmed the epigenetic modification of aforementioned CpG sites with CRC risk and survival. INTERPRETATION: Our study suggests the association between air pollution and CRC incidence and survival, underscoring the possible modifying roles of epigenomic factors. Methylation may partly mediate pathogenic effects of air pollution on CRC, with annotation to epigenetic alterations in protein-coding genes TMBIM1/PNKD, CXCR5 and TMEM110. FUNDING: Xue Li is supported by the Natural Science Fund for Distinguished Young Scholars of Zhejiang Province (LR22H260001), the National Nature Science Foundation of China (No. 82204019) and Healthy Zhejiang One Million People Cohort (K-20230085). ET is supported by a Cancer Research UK Career Development Fellowship (C31250/A22804). MGD is supported by the MRC Human Genetics Unit Centre Grant (U127527198).

Heart failure can lead to cognitive impairment that is estimated to be present in over a quarter of patients. It is important to intervene at a cognitive level to promote brain plasticity through cognitive training programs. Interventions transformed by technology offer the promise of improved cognitive health for heart failure patients. This review was conducted on studies evaluating the role of cognitive rehabilitation in patients with heart failure. We examined clinical trials involving patients with heart failure. Our search was performed on Pubmed, Web of Science and Cochrane library databases. Of the initial 256 studies, 10 studies met the inclusion criteria. Cognitive rehabilitation training has important implications for the treatment and prevention of cognitive decline in heart failure patients with significant recovery for delayed recall memory and a significant time effect for total recall memory and delayed, psychomotor speed and IADL performance. It is important to include the assessment of cognitive functioning in the routine clinical examinations of patients with heart failure, discover the relationship between cognitive function and heart failure, and target cognitive rehabilitation programs that promote brain plasticity.

BACKGROUND: Cancer-related fatigue is associated with spiritual distress. Spiritual well-being, characterized by the presence of factors such as meaning in life or purpose in life, seems to play an important role in the management of symptoms of cancer. Currently, the number of studies evaluating the association between cancer-related fatigue and spiritual well-being is increasing and no systematic review has been conducted. AIM: To summarize the association between cancer-related fatigue and spiritual well-being, faith, meaning in life, peace, and purpose in life. DESIGN: A systematic review with meta-analysis. DATA SOURCES: The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to 9 October 2023. We considered studies evaluating the cross-sectional or longitudinal association between cancer-related fatigue and the spiritual factors above mentioned. The Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and the Quality in Prognosis Studies tool assessed the methodological quality of cross-sectional and longitudinal studies, respectively. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system rated the certainty of evidence. Meta-analyses, meta-regressions, subgroup meta-analyses, and sensitivity analyses were conducted. RESULTS: A total of 13 studies were included and no longitudinal findings were found. One meta-analysis showed that cancer-related fatigue may be negatively correlated with spiritual well-being (r =  - 0.37 (95%CI - 0.44 to - 0.28) p < 0.01). In addition, another meta-analysis found the correlation between cancer-related fatigue and faith was not statistically significant (r =  - 0.25 (95%CI - 0.66 to 0.28) p = 0.36). CONCLUSIONS: Cancer-related fatigue may be correlated with spiritual well-being. However, the certainty of evidence was very low across the meta-analyzed outcomes. IMPLICATIONS FOR CANCER SURVIVORS: A negative correlation was observed between spiritual well-being and cancer-related fatigue.