Targeting the SARS-CoV-2 main protease: Vaccines are an important tool in the fight against COVID-19, but developing antiviral drugs is also a high priority, especially with the rise of variants that may partially evade vaccines. The viral protein main protease is required for cleaving precursor polyproteins into functional viral proteins. This essential function makes it a key drug target. Qiao et al. designed 32 inhibitors based on either boceprevir or telaprevir, both of which are protease inhibitors approved to treat hepatitis C virus. Six compounds protected cells from viral infection with high potency, and two of these were selected for in vivo studies based on pharmokinetic experiments. Both showed strong antiviral activity in a mouse model. Science , this issue p. 1374

Interpreting an electrocardiogram (ECG) is not only one of the most important parts of clinical diagnostics but also one of the most difficult topics to teach and learn. In order to enable medical students to master ECG interpretation skills in a limited teaching period, the flipped teaching method has been recommended by previous research to improve teaching effect on undergraduate ECG learning. A randomized controlled trial for ECG learning was conducted, involving 181 junior-year medical undergraduates using a flipped classroom as an experimental intervention, compared with Lecture-Based Learning (LBL) as a control group. All participants took an examination one week after the intervention by analysing 20 ECGs from actual clinical cases and submitting their ECG reports. A self-administered questionnaire was also used to evaluate the students’ attitudes, total learning time, and conditions under each teaching method. The students in the experimental group scored significantly higher than the control group (8.72 ± 1.01 vs 8.03 ± 1.01, t = 4.549, P = 0.000) on ECG interpretation. The vast majority of the students in the flipped classroom group held positive attitudes toward the flipped classroom method and also supported LBL. There was no significant difference (4.07 ± 0.96 vs 4.16 ± 0.89, Z = − 0.948, P = 0.343) between the groups. Prior to class, the students in the flipped class group devoted significantly more time than those in the control group (42.33 ± 22.19 vs 30.55 ± 10.15, t = 4.586, P = 0.000), whereas after class, the time spent by the two groups were not significantly different (56.50 ± 46.80 vs 54.62 ± 31.77, t = 0.317, P = 0.752). Flipped classroom teaching can improve medical students’ interest in learning and their self-learning abilities. It is an effective teaching model that needs to be further studied and promoted.

A series of novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since the end of 2019 is ongoing and triggering a global public health crisis. The estimated case fatality rate is approximately 3.4% in China. However, some patients experience dyspnea within 1 week and develop rapidly to organ injury and even death within 2 weeks after dyspnea. 1 In addition, early organ injury could lead to higher risks of mortality. Thus, early identification of patients at risk of organ injury and death is crucial, which saves the patients from classified and invasive treatment, improving clinical outcome and prognosis. The human immune system plays significant roles in the resistance of foreign pathogens and the progress of pneumonia. Recent studies have mentioned that T cells were decreased in COVID-19 patients, excessive activated immune response was caused by pathogenic Th1 cells, and inflammatory CD14 + CD16 + monocytes may connect to pulmonary immunopathology, leading to deleterious clinical manifestations and even acute mortality after SARS-CoV-2 infections. 2 SARS-CoV-2 might damage lymphocytes, especially T lymphocytes, and the immune system was impaired during the period of disease to cause tissue injury. 2,3 Therefore, immune dysfunction is very likely to be a risk factor for patients with COVID-19, and immunological profiling may assist in the prediction of organ injury and prognosis in COVID-19 patients. However, few studies have systematically reported immunological characteristics and their relationship with organ injury and mortality in patients with COVID-19. In this multicenter retrospective cohort study, we analyzed data from the Early Risk Stratification of Novel Coronavirus Pneumonia (ERS-COVID-19) study. The study was registered at www.chictr.org.cn (Identifier: ChiCTR2000030494). The study complied with the Declaration of Helsinki, and the Human Ethical Committee of West China Hospital of Sichuan University approved the study protocol. From January 31, 2020 to February 18, 2020, 509 patients retrospectively enrolled in the ERS-COVID-19 study. The COVID-19 was confirmed according to the National Health Commission of the People's Republic of China and the National Administration of Traditional Chinese Medicine. 4 The inclusion criteria were age >18 years old and first diagnosis of COVID-19. The exclusion criteria were examination without immune-related indicators before treatment, pregnancy, taking immunosuppressive drugs or corticosteroids, a history of chronic organ dysfunction or immunological disease, operation history within 3 months, and simultaneous infection with other diseases. Finally, a total of 163

Background: The Barthel index (BI) is a widely used assessment tool for evaluating physical performance in activities of daily living (ADL). The association between BI scores and mortality in hospital and during follow-up of acute coronary syndrome (ACS) patients remains unclear. The present study investigated whether the BI score could be used as a predictor for mortality of ACS. Methods: We investigated ACS patients from the multi-center Retrospective Evaluation of Acute Chest Pain (REACP) study. The association between BI scores and all-cause mortality of patients with ACS was analyzed by Cox proportional hazards models. The primary endpoint was all-cause death and the secondary endpoint was cardiac death during follow-up. Results: Among 2908 patients with ACS enrolled, 277 (9.5%) patients died within a median follow-up time of 10.6 months. Patients with lower BI had higher risks of mortality, compared with those with higher BI in ACS patients. Kaplan–Meier analysis revealed that patients with lower BI had worse survival rates than patients with higher BI (P < 0.001). After adjustment for potential influencing factors, multivariate Cox regression analysis showed that the BI was independently associated with all-cause mortality and cardiac mortality, respectively. Conclusion: The BI at admission has the powerful potential to provide useful prognostic information of early risk stratification, and routine recording of the BI at the ED visit may help in decision-making and health care planning for patients with ACS.

Considering the adverse clinical consequences of pathologic tachycardia and the potential anxiety caused by physiological tachycardia in some heathy individuals, it is imperative to disseminate health information related to tachycardia for promotion in early diagnosis and appropriate management. YouTube has been increasingly used to access health care information. The aim of this study is to assess the quality and reliability of English YouTube videos focusing on tachycardia and further delve into strategies to enhance the quality of online health resources. We conducted a search using the specific key words “tachycardia” in YouTube online library on December 2, 2023. The first 150 videos, ranked by “relevance”, were initially recorded. After exclusions, a total of 113 videos were included. All videos were extracted for characteristics and categorized based on different topics, sources or contents. Two independent raters assessed the videos using Journal of American Medical Association (JAMA) benchmark criteria, Modified DISCERN (mDISCERN) tool, Global Quality Scale (GQS) and Tachycardia-Specific Scale (TSS), followed by statistical analyses. All continuous data in the study were presented as median (interquartile range). The videos had a median JAMA score of 2.00 (1.00), mDISCERN of 3.00 (1.00), GQS of 2.00 (1.00), and TSS of 6.00 (4.50). There were significant differences in JAMA (P < 0.001), mDISCERN (P = 0.004), GQS (P = 0.001) and TSS (P < 0.001) scores among different sources. mDISCERN (P = 0.002), GQS (P < 0.001) and TSS (P = 0.030) scores significantly differed among various contents. No significant differences were observed in any of the scores among video topics. Spearman correlation analysis revealed that VPI exhibited significant correlations with quality and reliability. Multiple linear regression analysis suggested that longer video duration, sources of academics and healthcare professionals were independent predictors of higher reliability and quality, while content of ECG-specific information was an independent predictor of lower quality. The reliability and educational quality of current tachycardia-related videos on YouTube are low. Longer video duration, sources of academics and healthcare professionals were closely associated with higher video reliability and quality. Improving the quality of internet medical information and optimizing online patient education necessitates collaborative efforts.