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Background and aim: Two oral antivirals (Nirmatrelvir- ritonavir and Azvudine) are widely used in China practice during the Omicron wave of the pandemic. However, little evidence regarding the real-world effectiveness of these two oral antivirals in in-hospital patients. We aimed to evaluate the clinical effectiveness of nirmatrelvir-ritonavir versus azvudine among adult hospitalized patients with COVID-19. Methods: This retrospective cohort study used data from three Chinese PLA General Hospital medical centres. Hospitalized patients with COVID-19 treated with azvudine or nirmatrelvir-ritonavir from Dec 10, 2022, to February 20, 2023, and did not require invasive ventilation support on admission were eligible for inclusion. Results: After exclusions and propensity-score matching, the final analysis included 486 azvudine recipients and 486 nirmatrelvir-ritonavir recipients. By 28 days of initiation of the antivirus treatment, the crude incidence rate of all-cause death was similar in both types of antivirus treatment (nirmatrelvir-ritonavir group 2.8 events 1000 person-days [95% CI, 2.1–3.6] vs azvudine group 3.4 events/1000 person-days [95% CI, 2.6–4.3], P = 0.38). Landmark analysis showed that all-cause death was lower in the nirmatrelvir-ritonavir (3.5%) group than the azvudine (6.8%, P = 0.029) within the initial 10-day admission period, while no significant difference was observed for results between 10 and 28 days follow-up. There was no significant difference between the nirmatrelvir-ritonavir group and the azvudine group in cumulative incidence of the composite disease progression event (8.6% with nirmatrelvir-ritonavir vs. 10.1% with azvudine, HR, 1.22; 95% CI 0.80–1.86, P = 0.43). Conclusion: Among patients hospitalized with COVID-19 during the omicron wave in Beijing, similar in-hospital clinical outcomes on 28 days were observed between patients receiving nirmatrelvir-ritonavir and azvudine. However, it is worth noticing that nirmatrelvir-ritonavir appears to hold an advantage over azvudine in reducing early mortality. Further randomized controlled trials are needed to verify the efficacy of those two antivirus medications especially in early treatment. [ABSTRACT FROM AUTHOR]

Background: Preoperative carbohydrates (CHO) supplement has been widely investigated in nondiabetic patients undergoing a variety of surgeries. It has been proved that preoperative CHO could alleviate postoperative insulin resistance (IR) and improve patients' well-being in nondiabetic patients. However, it remains controversial whether preoperative CHO could yield similar effects in diabetic patients. Till now, seldom has the administration of preoperative CHO been investigated in diabetic patients and there are limited studies reporting IR and postoperative recovery of diabetic patients undergoing cardiac surgery. Methods and analysis: We present a prospective, single-center, single-blind, randomized, no-treatment controlled trial of preoperative CHO on diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB). A total of 62 patients will be enrolled and randomized to either Group CHO or Group control (CTRL). Patients in Group CHO will consume CHO fluid containing 50 g carbohydrates orally the evening before surgery (20:00–24:00) while their counterparts in Group CTRL will be fasted after 20:00 the evening before surgery. The primary endpoint is postoperative IR assessed via homeostasis model assessment (HOMA). The secondary endpoints are postoperative levels of potential mediators relating to IR including inflammatory factors and stress reaction characterized by serum cortisol. Exploratory endpoints are in-hospital clinical endpoints. Continuous variables will be compared by Student's t-test or Mann-Whitney U test. Categorical variables will be compared with χ2 test or Fisher's exact test. All tests in the present study are two-tailed and P<0.05 is considered statistically significant. All analyses will be performed with R 4.0.4. Discussion: This is the first prospective randomized controlled trial of preoperative CHO in diabetic patients undergoing cardiac surgery, with the hypothesis that preoperative CHO could improve postoperative IR and promote postoperative recovery. The research may assist in improving the clinical outcomes of diabetic patients undergoing OPCAB. Trial registration: The trial has been prospectively registered with ClinicalTrials.gov (https://register.clinicaltrials.gov) and Chinese Clinical Trial Registry (http://www.chictr.org.cn). Registry number is NCT05540249 and ChiCTR2000029664 respectively. Registered on Sept. 14, 2022. Clinical trials unit: Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. [ABSTRACT FROM AUTHOR]

This study investigates a cross-variable ozone data assimilation (DA) method based on an ensemble Kalman filter (EnKF) that has been used in the companion study to improve ozone forecasts over Beijing and surrounding areas. The main purpose is to delve into the impacts of the crossvariable adjustment of nitrogen oxide (NOx) emissions on the nitrogen dioxide (NO2) forecasts over this region during the 2008 Beijing Olympic Games. A mixed effect on the NO2 forecasts was observed through application of the cross-variable assimilation approach in the real-data assimilation (RDA) experiments. The method improved the NO2 forecasts over almost half of the urban sites with reductions of the root mean square errors (RMSEs) by 15-36% in contrast to big increases of the RMSEs over other urban stations by 56-239 %. Over the urban stations with negative DA impacts, improvement of the NO2 forecasts (with 7% reduction of the RMSEs) was noticed at night and in the morning versus significant deterioration during daytime (with 190% increase of the RMSEs), suggesting that the negative data assimilation impacts mainly occurred during daytime. Idealdata assimilation (IDA) experiments with a box model and the same cross-variable assimilation method confirmed the mixed effects found in the RDA experiments. In the same way, NOx emission estimation was improved at night and in the morning even under large biases in the prior emission, while it deteriorated during daytime (except for the case of minor errors in the prior emission). The mixed effects observed in the cross-variable data assimilation, i.e., positive data assimilation impacts on NO2 forecasts over some urban sites, negative data assimilation impacts over the other urban sites, and weak data assimilation impacts over suburban sites, highlighted the limitations of the EnKF under strong nonlinear relationships between chemical variables. Under strong nonlinearity between daytime ozone concentrations and NOx emissions uncertainties (with large biases in the a priori emission), the EnKF may come up with inefficient or wrong adjustments to NOx emissions. The present findings reveal that bias correction is essential for the application of the EnKF in dealing with the data assimilation problem over strong nonlinear system. [ABSTRACT FROM AUTHOR]

Presents the case of Beijing, China in terms of transportation growth and preservation of historic sites. Land use policy; Automobile industry; Private car; Public transport; Bicycles.