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To our knowledge, ours is the first study to investigate the annual fluxes, environmental fate, and ecological risks of five categories of antibiotics from the Wuhan section of the Yangtze River (China). All the 24 antibiotics we tested for were detected in water, with total concentrations of 17.11–867.2 ng/L (mean: 63.69 ng/L), and 19 antibiotics were detected in sediment, at 0.02–287.7 ng/g (mean: 16.54 ng/g). Sulfonamides, amphenicols, and macrolides were the three most prominent antibiotic classes in water, and fluoroquinolones were the most prominent in sediment. Farming activities (animal husbandry and aquaculture) are proposed as the largest contributors to antibiotic pollution in the Wuhan section of the Yangtze River according to the Unmix model, followed by municipal wastewater and mixed sources. Higher pollution levels were observed downstream (combined discharge of these sources). Monthly monitoring data (12 months) were used to estimate antibiotic annual fluxes, with 101.5 t (uncertainty: 5.6%) in the Wuhan section of the Yangtze River. Risk assessments showed that erythromycin, clarithromycin, and azithromycin posed medium and high ecological risks and were found in 9%–35% and 1.8%–3.7% of all water samples, respectively; enrofloxacin, clarithromycin, azithromycin, florfenicol, and thiamphenicol posed medium resistance risks in 1.9%–16.7% of waters in the Wuhan section of the Yangtze River. Our results have filled data gaps on antibiotic sources, annual fluxes, and resistance risk in the Wuhan section of the Yangtze River and demonstrated the importance of further management of antibiotic use in the studied areas. Environ Toxicol Chem 2023;42:605–619. © 2022 SETAC [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) has posed a great threat to global public health. There remains an urgent need to address the clinical significance of laboratory finding changes in predicting disease progression in COVID-19 patients. We aimed to analyze the clinical and immunological features of severe and critically severe patients with COVID-19 in comparison with non-severe patients and identify risk factors for disease severity and clinical outcome in COVID-19 patients. Methods: The consecutive records of 211 patients with COVID-19 who were admitted to Zhongnan Hospital of Wuhan University from December 2019 to February 2020 were retrospectively reviewed. Results: Of the 211 patients with COVID-19 recruited, 111 patients were classified as non-severe, 59 as severe, and 41 as critically severe cases. The median age was obviously higher in severe and critically severe cases than in non-severe cases. Severe and critically severe patients showed more underlying comorbidities than non-severe patients. Fever was the predominant presenting symptom in COVID-19 patients, and the duration of fever was longer in critically severe patients. Moreover, patients with increased levels of serum aminotransferases and creatinine (CREA) were at a higher risk for severe and critical COVID-19 presentations. The serum levels of IL-6 in severe and critically severe patients were remarkably higher than in non-severe patients. Lymphopenia was more pronounced in severe and critically severe patients compared with non-severe patients. Lymphocyte subset analysis indicated that severe and critically severe patients had significantly decreased count of lymphocyte subpopulations, such as CD4+ T cells, CD8+ T cells and B cells. A multivariate logistic analysis indicated that older age, male sex, the length of hospital stay, body temperature before admission, comorbidities, higher white blood cell (WBC) counts, lower lymphocyte counts, and increased levels of IL-6 were significantly associated with predicting the progression to severe stage of COVID-19. Conclusion: Older age, male sex, underlying illness, sustained fever status, abnormal liver and renal functions, excessive expression of IL-6, lymphopenia, and selective loss of peripheral lymphocyte subsets were related to disease deterioration and clinical outcome in COVID-19 patients. This study would provide clinicians with valuable information for risk evaluation and effective interventions for COVID-19. [ABSTRACT FROM AUTHOR]