Acinetobacter baumannii infection. (2) Methods: All studies were included if they reported one or more of the following outcomes: clinical improvement, complete microbiological response, 14-day mortality, hospital mortality, or nephrotoxicity. (3) Results: Three randomized controlled trials and seven retrospective studies were included in the meta-analysis. Colistin monotherapy has similar rates of clinical improvement, 14-day mortality, hospital mortality, and nephrotoxicity as colistin plus meropenem combination therapy. Regarding complete microbiological response, the colistin plus meropenem combination was better than colistin monotherapy. (4) Discussion: Previous meta-analyses demonstrated heterogeneity in study quality and a lack of evidence supporting the use of colistin-based combination therapy. Our meta-analysis clearly showed that colistin combined with meropenem was not superior to colistin monotherapy for the treatment of Acinetobacter baumannii infection. (5) Conclusions: The efficacy and safety of treatment with colistin monotherapy and that of colistin plus meropenem combination therapy in patients with drug-resistant Acinetobacter baumannii infection were comparable. The majority of the evidence was obtained from nonrandomized studies, and high-quality randomized controlled trials are needed to confirm the role of colistin plus meropenem combination therapy in the treatment of multidrug-resistant Acinetobacter baumannii infection.(1) Introduction: Colistin combination therapy with other antibiotics is a way to enhance colistin activity. The purpose of this meta-analysis was to compare the efficacy and safety of treatment with colistin monotherapy versus colistin plus meropenem combination therapy in patients with drug-resistant  Acinetobacter baumannii is an aerobic Gram-negative opportunistic bacterium that is an important pathogen of nosocomial infections worldwide. Carbapenems have been considered to be appropriate agents to treat Acinetobacter baumannii infection. Acinetobacter baumannii has the ability to acquire resistance to multiple classes of antimicrobial agents, and a worldwide surge in carbapenem resistance has been reported [Acinetobacter baumannii has increased the prevalence of Acinetobacter baumannii infection. MDR Acinetobacter baumannii, which is resistant to all standard antimicrobial agents, makes the choice of appropriate antimicrobial treatment difficult. Colistin is used extensively to treat MDR Acinetobacter baumannii infection and remains an important active antibiotic to treat MDR Acinetobacter baumannii [https://en.wikipedia.org/wiki/Hydrophile, accessed on 27 May 2022) and lipophilic moieties . The cationic region interacts with the negatively charged outer membrane of GNB and competitively displaces calcium (Ca2+) and magnesium (Mg2+) ions from the phosphate groups found in membrane lipids. Therefore, the lipopolysaccharide becomes destabilized, which consequently increases the permeability of the bacterial membrane and leads to leakage of the cytoplasmic content and the disruption of the outer membrane [Acinetobacter baumannii is a complex and important issue. In a study by Nowak et al., 45.5% of 65 clinically isolated Acinetobacter baumannii isolates recovered from respiratory tract samples from patients with pneumonia were resistant to colistin [Acinetobacter baumannii. For example, the synergistic killing of Acinetobacter baumannii was recently demonstrated in many in vitro studies. Various colistin combinations have been explored, including those containing carbapenems, tigecycline, sulbactam, aminoglycosides, rifampicin, and fosfomycin. The mechanisms underlying the synergistic activity achieved by these combinations are not fully understood. This effect is considered to be mediated by the permeabilizing effect of colistin on the bacterial outer membrane, which permits the entry of large hydrophobic molecules. This disruption of the membrane may have a positive impact on the functions of several antibiotics and may result in improvements in their activities [Acinetobacter baumannii infection [Acinetobacter baumannii [Acinetobacter baumannii infection patients. The heterogeneous combinations of antibacterial agents included carbapenems, sulbactam, tigecycline, rifampicin, fosfomycin, aminoglycosides, and vancomycin. In 2018, Papst et al. conducted an international cross-sectional, internet-based questionnaire survey to explore the contemporary antibiotic management of infections caused by carbapenem-resistant GNB in hospitals. The study showed that combination therapy was occasionally prescribed in hospitals. Respondents were likely to consider combination therapy for infections caused by Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii. The combination of a polymyxin with a carbapenem was used in most cases. The author concluded that combination therapy was the preferred treatment strategy for infections caused by carbapenem-resistant GNB among hospital representatives even though high-quality evidence of the efficacy of carbapenem-based combination therapy is lacking [Acinetobacter baumannii and whether this leads to improved clinical outcomes are unclear. Which combination regimens are safe and effective in clinical settings is still controversial, and the optimal agent for combinations with colistin for the treatment of MDR Acinetobacter baumannii infection is undefined. Previous meta-analyses evaluated the efficacy and safety of colistin as a monotherapy or in combination with other antibacterial agents to treat MDR GNB infections. Carbapenems combined with polymyxins had better synergy in their effect on Acinetobacter baumannii than on other bacteria and better synergy with meropenem than with imipenem [Acinetobacter baumannii infection.reported ,2. The paumannii ,4,5. Themembrane  However,tivities ,9,10,11.nfection . The useaumannii . Clinica lacking . WhetherAcinetobacter baumannii infection, were included. The search terms included “colistin or polymyxin”, “Acinetobacter baumannii”, and “combination therapy” and were used to identify relevant clinical studies, including randomized controlled trials (RCTs) and retrospective and prospective cohort studies. Articles containing relevant terms in each database were identified and imported into Endnote Library for the deletion of duplicate records. After excluding duplicates, all studies were reviewed by reading the title and/or abstract to identify irrelevant studies. To determine the eligibility of the identified trial reports, two of the authors independently screened the titles and abstracts. After excluding irrelevant studies, all of the relevant articles were reviewed by reading the full text to determine eligible trial reports.All clinical studies were identified by a comprehensive literature search in the PubMed, Web of Science, and Cochrane Library databases between 1 January 2000 and 28 February 2022, and those that examined treatment options, including colistin monotherapy and colistin combined with another antibacterial agent for the treatment of Acinetobacter baumannii infection. Data were manually extracted from the eligible full-text articles. Author, year of publication, region, study type, infection site, resistance pattern of Acinetobacter baumannii, total number of monotherapy group patients, total number of combination group patients, and antibiotic dosage were extracted. Colistin was administered as a 9 million units (MU) loading dose, followed by 4.5 MU maintenance doses administered every 12 h, adjusted for renal function in patients with creatinine clearance. A loading dose for colistin that was not recommended in the studies was included also. Meropenem was given as 1–2 gm every 8 h, adjusted for renal function. The duration of antibiotic treatment was not limited in this study. All studies were included if they reported one or more of the following outcomes: clinical improvement, complete microbiological response, 14-day mortality, hospital mortality or 28-day mortality, or nephrotoxicity.We included the findings of observational studies to help offset the limitations of data analysis because a limited number of RCTs were available. The studies were considered eligible for inclusion only if they directly compared the clinical effectiveness of colistin monotherapy and colistin-based combination therapies involving meropenem in the treatment of adult patients with We did not include studies that evaluated inhaled colistin therapy or studies that focused on in vitro activity or pharmacokinetic-pharmacodynamic assessment. We excluded studies that were primarily reviews, meta-analyses, guidelines, case reports, editorials, and animal studies, and those in which treatment regimens that did not include carbapenem and colistin. Studies with a population <18 years old were excluded. Studies reporting no more than five patients per treatment group were excluded. Articles published in all languages were included.MDR refers to nonsusceptibility to ≥1 agent in ≥3 antimicrobial categories. Extensive drug resistance (XDR) refers to nonsusceptibility to ≥1 agent in all but ≤2 antimicrobial categories. Nonsusceptibility to all antimicrobial agents tested was defined as pandrug resistance (PDR) .We assessed the risk of bias in each study using the Cochrane Risk-of-Bias Tool 2.0 for RCTs. The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used to evaluate observational studies . We condp value less than 0.05 was considered statistically significant. The I2 test was used to assess the proportion of statistical heterogeneity, and the Q-statistic test was used to define the degree of heterogeneity. A p value less than 0.10 for the Q-test and I2 more than 50% were considered significant among the studies. The fixed-effects model was used when the effects were assumed to be homogenous, while the random-effects model was used when they were heterogeneous. Publication bias was assessed by examining the funnel plot.Data were entered into the Cochrane Review Manager software RevMan 5. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. The significance of the pooled ratios was determined by the Z test, and a Acinetobacter baumannii infection. Three articles were excluded because the monotherapy group and/or combination therapy group did not include more than five patients per treatment group [The numbers of initial search results from PubMed, Web of Science, and the Cochrane Library were 417, 468, and 80, respectively. There were 487 duplicate articles. A total of 404 irrelevant studies were identified by reading the title and/or abstract. After excluding duplicates and irrelevant studies, 74 potentially relevant articles remained. After full-text article review, 60 articles were excluded because they lacked results of comparisons between colistin monotherapy and combination therapy with colistin and meropenem in patients with nt group ,20,21. Ant group . Finallynt group ,30,31,32p = 0.19, I2 = 7%)  reported clinical improvement. There was no statistically significant difference in clinical improvement between patients treated with colistin monotherapy and colistin plus meropenem combination therapy  .p = 0.04, I2 = 36%). The combination therapy patient group had a better microbiological response than the monotherapy patient group  reported the microbiological response. The overall microbiological response was significantly different between the two groups   reported 14-day mortality. There was no statistically significant difference in 14-day mortality between patients treated with colistin monotherapy and colistin plus meropenem combination therapy  .p = 0.59, I2 = 59%)  reported hospital mortality or 28-day mortality. There was no statistically significant difference in hospital mortality or 28-day mortality between patients treated with colistin monotherapy and colistin plus meropenem combination therapy  .p = 0.13, I2 = 0%) . There was no statistically significant difference in nephrotoxicity between patients treated with colistin monotherapy and colistin plus meropenem combination therapy  .Acinetobacter baumannii, XDR Acinetobacter baumannii, and carbapenem resistant (CR) Acinetobacter baumannii infections. In terms of complete microbiological response, the colistin plus meropenem combination patient group showed better results than the colistin monotherapy patient group. The microbiological response was the only statistically significant difference between the two groups.The current meta-analysis of 10 studies  provides evidence that colistin monotherapy is as effective as colistin plus meropenem combination therapy for the treatment of MDR Acinetobacter baumannii infection. However, colistin-based combination therapy was shown to increase the microbiological response [Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa). [Acinetobacter baumannii and XDR Acinetobacter baumannii infections. However, colistin in combination with sulbactam was associated with a significantly higher microbiological cure rate than colistin monotherapy [Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa) [Acinetobacter baumannii,Enterobacteriaceae, and Pseudomonas aeruginosa), especially for Acinetobacter baumannii infection [Acinetobacter baumannii infection showed no statistically significant difference in clinical response or 28-day mortality from those achieved with colistin monotherapy, and only exhibited a microbiological benefit [Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa). The subgroup analysis showed no differences in the clinical cure rates and mortality rate between patients treated with monotherapy and those treated with combination therapy with other antibiotics targeting MDR Acinetobacter baumannii/XRD Acinetobacter baumannii [Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The studies revealed no statistically significant difference in mortality between the two groups. However, there was a trend toward mortality benefits with combination therapy containing carbapenem [There were eight meta-analyses reported in the literature which explored the issue of intravenous colistin versus colistin-based combination therapy against multidrug-resistant GNB infections . In the response . In the ginosa). . In the otherapy . In the uginosa) . In the nfection . In the  benefit . In the aumannii . The metrbapenem .Acinetobacter baumannii infection [Regarding clinical improvement, four of the eight meta-analyses reported no statistically significant difference between the effects of colistin monotherapy and colistin combination therapy again nfection ,35,38,39Acinetobacter baumannii [Acinetobacter baumannii [Acinetobacter baumannii infection and not in those treated with therapies targeting all of the GNB infections that were assessed. The results of the analysis of microbiological response were consistent between the previous and the current meta-analyses.Regarding microbiological response, two of the eight meta-analyses reported a statistically significant difference between patients administered colistin monotherapy and those treated with colistin combination therapy targeting aumannii ,38. One aumannii . One metaumannii . Three oRegarding hospital mortality , all of the eight meta-analyses reported no statistically significant difference between patients treated with colistin monotherapy and those administered colistin combination therapy targeting GNB infections. The results of the analysis of hospital mortality in the current meta-analysis were consistent with the results of previous meta-analyses.Regarding nephrotoxicity, three of the eight meta-analyses reported no statistically significant difference between patients treated with colistin monotherapy and those receiving colistin combination therapy ,37,38. FAcinetobacter baumannii infection [Acinetobacter baumannii infection in clinical improvement and hospital mortality. The findings were the same as those of our current meta-analysis. In the eight meta-analyses, four meta-analyses focused on colistin versus colistin in combination with other antibiotics to treat nfection ,35,38,39Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli). Previous meta-analyses included heterogeneous populations with different GNB infections and nonstandardized administration of heterogeneous combination treatment regimens. Therefore, these meta-analyses demonstrated heterogeneity in their study quality, variable study results, and lack of evidence supporting the superiority of colistin-based combination therapy. Our meta-analysis focused on colistin monotherapy versus colistin in combination with meropenem to treat drug-resistant Acinetobacter baumannii infection. This meta-analysis also included three newly published studies that were not included in the previous meta-analyses [Acinetobacter baumannii infection except with regard to microbiological response.Previous meta-analyses focused on colistin monotherapy versus colistin-based combination therapy with various antibacterial agents  to treat drug-resistant GNB infections (analyses ,31,32. OAcinetobacter baumannii infection. There were no statistically significant differences in clinical improvement, 14-day mortality, or 28-day mortality between the colistin monotherapy patient group and the colistin plus meropenem combination therapy patient group [Acinetobacter baumannii infection [Acinetobacter baumannii infection [Acinetobacter baumannii.There were three RCTs in our meta-analysis. Paul et al. showed that colistin plus carbapenem combination therapy was not superior to colistin monotherapy in the treatment of carbapenem-resistant nt group . Dickstenfection . In the nfection . We summThis meta-analysis has major strengths. The combination therapy antibiotic was meropenem, and the infectious pathogen included only Acinetobacter baumannii. Only one combination antibiotic and only one infectious pathogen were included in this meta-analysis. Thus, we can make a definite conclusion that colistin plus meropenem combination therapy for the treatment of Acinetobacter baumannii infection is not superior to colistin monotherapy. It is difficult to perform prospective RCTs to explore this issue. The majority of studies incorporated in this meta-analysis were retrospective observational studies, and only three RCTs were included in this meta-analysis. Selection bias and confounding were impossible to eliminate owing to the inherent nature of nonrandomized studies. Thus, our findings should be interpreted with caution. However, the conclusions of this meta-analysis are similar to the conclusions of the three RCTs and previous meta-analyses in the literature. In addition, the number of included studies for a certain comparison was small, which was a limitation of this meta-analysis.Acinetobacterbaumannii infection. However, the majority of evidence was from nonrandomized studies, and high-quality RCTs are still needed to confirm the role of colistin plus meropenem combination therapy in the treatment of drug-resistant Acinetobacter baumannii infection.The current meta-analysis found that colistin monotherapy was associated with similar rates of clinical improvement, 14-day mortality, hospital mortality, and nephrotoxicity to colistin plus meropenem combination therapy. There was low quality evidence that colistin plus meropenem combination therapy demonstrated a microbiological benefit. Therefore, colistin plus meropenem combination therapy was not superior to colistin monotherapy in the treatment of drug-resistant


The increasing concern for decarbonization and sustainability in construction materials is calling for green binders to partially replace cement since its production is responsible for approximately 8% of global anthropogenic greenhouse gas emissions. Supplementary cementitious materials (SCMs), including fly ash, slag, silica fume, etc., can be used as a partial replacement for ordinary Portland cement (OPC) owing to reduced carbon dioxide emissions associated with OPC production. This study aims to investigate the sustainable use of waste oyster shell powder (OSP)-lithium slag (LS)-ground granulated blast furnace slag (GGBFS) ternary SCM system in green concrete. The effect of ternary SCMs to OPC ratio  on compressive strength and permeability of the green concrete were studied. The reaction products of the concrete containing OSP-LS-GGBFS SCM system were characterized by SEM and thermogravimetric analyses. The results obtained from this study revealed that the compressive strength of concrete mixed with ternary SCMs are improved compared with the reference specimens. The OSP-LS-GGBFS ternary SCMs-based mortars exhibited a lower porosity and permeability compared to the control specimens. However, when the substitution rate was 30%, the two parameters showed a decline. In addition, the samples incorporating ternary SCMs had a more refined pore structure and lower permeability than that of specimens adding OSP alone. This work expands the possibility of valorization of OSP for sustainable construction materials.  Carbon neutrality, as a new commitment to environmental protection and sustainability, has been adopted by more and more countries . To limiThe recycling of shellfish wastes  generateHowever, the low volcanic ash activity still limits the application of OSP. While OSPs as SCM have been a topic of intensive research, very few studies have addressed the properties of a multi-SCM system containing OSPs . Ground Although the efficacy of OSPs in concrete has been well-documented and understood, there remains doubts and ongoing controversy regarding whether a multi-SCM system containing OSPs are applicable. As such, systematic research is needed to acquire a better understanding of OSPs in SCM system implemented in concrete and to elucidate the performance, thereby recycling resources and reducing carbon dioxide emissions for sustainable construction. In this study, OSP combined with LS and GGBFS as a ternary SCM system were incorporated into mortars. The present paper attempted to study the use of the OSP-LS-GGBFS ternary system as a partial replacement of cement with different effect substitution ratios by weight. The compressive strength and permeability of the mortars with the OSP-LS-GGBFS ternary system were studied. In addition, the hydration degree, pore structure, and microstructure were also explored. This study provides a new understanding of OSP in developing sustainable construction materials and demonstrates the compatibility of the three types of SCMs in green concrete.The raw materials include OSP, GGBFS, LS, Portland cement (PO.42.5), standard sand, and water. PO.42.5 grade cement from Shenyang Shanshui Park Cement Co., Ltd.  Was used as a primary binder in this study. Oyster shells were provided by Rongcheng Xingyang Fish Flour Factory in Rongcheng, Shandong Province, China. The shells were cleaned with water to remove any residues  that mayCompression tests were performed via GYE-300B universal testing machine . A loading rate of 2.4 kN/s, as stipulated by GB/T17671-1999, was conducted during the loading. TGA was conducted using TA instruments  in a nitrogen gas flow with a 70 mL/min flow rate. Each testing sample was about 15 mg. The TGA was exposed to the temperature from room temperature to 800 °C with a rate of 20 °C/min.(1)Water absorptionW = hygroscopic rate; wW = weight of wet sample; dW = weight of dry sample.The test was carried out according to the British standard. The cylinder sample (U75 mm × 75 mm) was solidified and demoulded. The standard curing times were 7 days and 28 days. The sample was dried in an oven (100 °C) for 3 days and cooled for 1 day. The sample was weighed, immersed in water for 24 h, and weighed again after 24 h. The average value of the two samples was the final result of each sample. The hygroscopic rate was calculated according to Equation (1):(2)Rapid chloride penetration test (RCPT)The chloride ion penetration test was carried out according to ASTM C1202 , and theThe pore size distribution of all specimens at the ages of 28 days was investigated using Mercury intrusion porosimetry (MIP) . The sample was dried in a 60 °C oven and tested three days later. The relationship between the applied pressure and the cylindrical aperture was described by the Washburn equation .The microstructure of the hydration products of the paste samples at 28 days was analyzed via SEM. SEM test was conducted using QUANTA 200 FEG SCANNING electron microscope produced by FEI Company of Holland , and the acceleration voltage was 0.2–30 kV. All specimens were immersed in anhydrous ethanol for 3 days before the SEM test to prevent water and reaction, and then the samples were dried in the oven to remove anhydrous ethanol. 2O3. SiO2 is the main oxide in GGBFS. LS and GGBFS both have volcanic ash properties. When CaO in calcined OSP becomes CH, it further reacts with Al2O3 in LS and SiO2 in GGBFS for the coming secondary hydration [ydration ,38, accoAs can be seen in 3 in the slurry with carbonation begins to decompose at a temperature of 600–800 °C [During the TG test of hardened cement-based materials, different types of hydration products will dehydrate or decompose at different temperatures . The bin0–800 °C . Therefo3 formed by the carbonization of CH [on of CH .2O is the sample’s relative water content; The mass loss of calcium carbonate caused by the removal of water by TG is denoted by WLCH, %; WLCaCO3 denotes the mass loss of calcium carbonate due to water removal by TG; The mass loss of calcium carbonate caused by the removal of water by TG is denoted by WLC-S-H; The molar mass of calcium hydroxide is denoted by mCH; The molar mass of water is denoted by mH2O; mCaCO3 is the molar mass of calcium carbonate; mCO2 is the molar mass of carbon dioxide.In order to obtain the hydration process and hydration product content of the ternary system clearly, the C-S-H and CH content of each group at 28 days were calculated by Equations (4) and (5) .(4)CH=WSubstitute the data from TG images of the ternary system into 2O and CH content in each experimental group. Gu et al. [3. Part of CH was not sourced from cement hydration but from OSP. Therefore, the chemical-bound water content in this test cannot represent the hydration degree of the system. However, the changing trend of compressive strength of each group can be confirmed by the decomposition of C-S-H. As can be seen in u et al.  found th(1)There is a coupling effect between OSP, LS, and GGBFS. This coupling effect is based on the self-consistent secondary hydration reaction between calcium hydroxide produced by OSP hydration and LS and GGBFS. The activity index was higher when the substitution rate was 30%.(2)OSP-LS-GGBFS ternary SCMs system has low porosity and permeability was significantly improved. With the increase of SCMs replacement rate, permeability gradually deteriorated.(3)There is a weak transition zone between C-S-H gel produced by secondary hydration and C-S-H gel produced by cement hydration. The gel in this interval is discontinuous and has lots of pores.(4)OSP particles can be activated to provide CH while having good filling effect. Therefore, OSP is a good cement-assisted cementing material, but the single introduction of OSP will cause the problem of too high basicity. Therefore, the multi-cementing system containing OSP will be the direction of future research.In this paper, a ternary system concrete admixture containing OSP was proposed, and the compressive strength, permeability, hydration process, hydration products, and porosity were tested. The hydration hardening mechanism and strength variation law of the ternary system containing OSP were revealed. Based on the experimental results, conclusions can be drawn up as follows:


Litchi seed starches from six varieties, as compared with maize starch, were studied for their multilevel structures, thermal and digestion properties to understand the distinct feather of each variety and provide guidance for their utilization in multi-industries. The results showed different varieties of litchi seed starch shared similar appearances with granules in oval shape and with a smooth surface. Starch granules of all the varieties exhibited typical bimodal size distributions consisting of small (<40 μm) and large granules (40–110 μm), although their relative proportions were largely dependent on variety. Huaizhi had the largest D50 value, whilst Guiwei showed the lowest. All the litchi seed starches had A-type crystalline with relative crystallinity varying from 20.67% (Huaizhi) to 26.76% (Guiwei). Similarly, the semi-crystalline structure varied apparently with variety. As to the chain-length distribution, only slight differences were observed among varieties, except Huaizhi displayed apparently higher amylose content (34.3%) and Guiwei showed the lowest (23.6%). Significant differences were also present in the gelatinization properties. Huaizhi seed starch showed significantly higher gelatinization temperatures and lower enthalpy change than the others. The digestibility of cooked litchi seed starches was only slightly different among varieties, suggesting variety is not the most critical factor regulating the digestibility of cooked litchi seed starch. Litchi chinensis Sonn.), belonging to the Sapindaceae family, is widely distributed in tropical and subtropical areas of the world. Litchi fruit is one of the most favored subtropical fruits worldwide, due to its nutritional value and excellent taste [Litchi  of starch . TherefoStarch is a high molecular weight carbohydrate polymer comprised of condensed glucose subunits. It provides half of the energy for human activity; therefore, is an important ingredient for many foods. Starch has also been widely used in non-food industries, for example, as fillers, disintegrants and glidants because it is low-cost, easily available and non-toxic ,11. TypiIn the present study, six litchi varieties distributed in South China were selected. Starch was extracted from litchi seeds, after which the multilevel structures of starch were characterized by scanning electron microscopy (SEM), laser particle size analyzer, small-angle X-ray scattering (SAXS), X-ray diffraction (XRD) and size exclusion chromatography (SEC), and the gelatinization and digestibility of starch were investigated using a differential scanning calorimeter (DSC) and an in vitro digestion model, respectively. These structural and property features of commercial maize starch were also studied for comparison. The results would provide detailed information for revealing the complex structure, physiochemical and nutritional properties of litchi seed starch from different varieties, which would give guidance for the utilization of litchi seed starch in various industries.Litchi fruits from six litchi varieties, including Guiwei (GW), Jingganghongnuo (JGHN), Lizhihuang (LZH), Jizuili (JZL), Huaizhi (HZ) and Shuangjianyuhebao (SJYHB) were collected after full maturity from orchards in Guangdong, China. Maize starch (amylose content ~29%) was purchased from Qinhuangdao Lihua Starch Co., Ltd. .α-Amylase from porcine pancreas was purchased from Sigma-Aldrich Pty. Ltd. . Isoamylase (from Pseudomonas sp.) was purchased from Megazyme International, Ltd. . Pullulan standards were purchased from Polymer Standards Service (PSS) GmbH . Chemical reagents including sodium chloride, sodium metabisulfite, sodium carbonate and sodium hydroxide were used as received.w/v) overnight. The mixture was then ground into a slurry using a homogenizer , and then filtered through a sieve with openings of 106 μm. The residues were homogenized again with sodium metabisulfite solution until the amount of residue on the sieve remained constant. The filtrate was combined, and then sodium chloride  and toluene (at a ratio of 9:1) were used to remove proteins and lipids. After constantly stirring the mixture for about 1.5 h, it was kept still until the upper toluene layer and NaCl layer could be easily removed. This step was repeated until the toluene layer became clear. The starch sample precipitated at the bottom was collected, and washed with water and ethanol prior to being dried at 40 °C.Isolation of starch from litchi seeds was carried out following the method described by Wang et al. . Litchi Morphological characteristics of starch samples were observed using a scanning electron microscope . The dried starch samples were fixed on aluminum stubs with double-sided adhesive tape. Additionally, the mounted samples were coated with a film of platinum using a sputtering coater . Images were captured under an accelerating voltage of 10 kV at 4000× magnification .The particle size distribution of starch samples was measured using a Mastersizer 3000 laser particle size analyzer . The refractive index of starch granules and distilled water in the system were 1.54 and 1.33, respectively .The crystalline structure of starch samples was analyzed using an X-ray diffractometer . The radiation source of the XRD was Cu-Kα, operating at 40 kV and 40 mA. The scanning speed of the instrument was set at 2°/min. A diffraction pattern with a scanning range of 4° (2θ) to 35° (2θ) was obtained, and the relative crystallinity was calculated by the ratio of the peak area of the crystal to the total diffraction area using PeakFit software  .−1. A series of SAXS parameters, including peak intensity (Imax), peak position (Smax) and peak full width at half maximum (ΔS) were extracted from SAXS patterns using a graphical method [max according to D = 2π/Smax [The semi-crystalline of starch was analyzed using a small angle X-ray scattering (SAXS) instrument operated at 50 mA and 40 kV fitted with a pinhole collimation system. The X-ray source was a copper rotating anode, equipped with cross-coupled Göbel mirrors, and the Cu-Kα radiation wavelength was 1.54 Å. The samples were stored in a sealed cell to prevent dehydration and processed in X-ray monochromatic light for 1 min. Scatter detection was performed within the range of q value of 0.03–0.15 nml method . The ave 2π/Smax .v/v) LiBr as eluent, and molecules were separated using pre-, Gram 100 and Gram 1000 columns  at 80 °C [The chain length distribution (CLD) of litchi seed samples was characterized using a size exclusion chromatography system  with a refractive index detector  after debranching of starch using isoamylase. Starch solution (0.6 mL/min) was injected into the SEC system using DMSO containing 0.5% (at 80 °C .o), peak (Tp) and conclusion (Tc) temperatures were calculated using Pyris software .The thermal properties of starch samples were analyzed using a differential scanning calorimeter . The starch sample  was mixed with water (9–12 μg) and sealed in an aluminum pan . After et is the concentration of starch at digestion time t and C∞ is the corresponding concentration of starch at the end of digestion.Starch digestion was performed in vitro following a previously published method . Each tup < 0.05.The results were expressed as the average and standard deviation of at least duplicated measurements calculated by one-way analysis of variance (ANOVA), and Duncan’s multiple range tests were used to analyze data in SPSS statistical software . Significant differences in the mean values were determined at The SEM images of litchi seed starches in comparison with maize starch are exhibited in The particle size distribution of starch samples was analyzed using a laser particle size analyzer, and the results are displayed in The D50, representing the size at which 50% of the sample is smaller and 50% is larger , was alsThe crystalline structure of starch was analyzed using XRD, and the resulting patterns and relative crystallinity of various litchi seed starches, in comparison with maize starch, are shown in In terms of the crystallinity, apparent differences were present among litchi seed starches from different varieties, varying from 20.67% to 26.76%. Guiwei and Lizhihuang showed the highest crystallinity values (26.76% and 26.41%), followed by Jizuili (24.32%) and Jingganghongnuo (23.70%). In contrast, Huaizhi and Shuangjianyuhebao exhibited the lowest crystallinity values . These suggest there are apparent differences in the crystalline structure of litchi seed starches from different varieties.−1 to allow direct comparisons. Parameters including peak intensity (Imax), peak position (Smax), peak full width at half maximum (ΔS) and average thickness of semi-crystal (D) were obtained from SAXS spectrum and summarized in The semi-crystalline structure, composed of alternating amorphous and crystalline regions, was characterized using SAXS with results exhibited in −1, and the peak position Smax values are as shown in max) is inversely proportional to the average total thickness  of the periodic arrangement lamellar architecture [The SAXS patterns of all starch samples showed obvious scattering peaks at about q = 0.06 nmitecture , which iitecture ,34,35. Tmax value of maize starch (174.25) was 1.2 to 2.6 times of that of litchi seed starches, among which Huaizhi had the lowest Imax value (68.28) and Lizhihuang had the highest (144.78). As previously reported, Imax is related to the amount of ordered semi-crystalline structures and the differences in electron density between crystalline and amorphous lamellae [The ΔS values of litchi seed starches from different varieties were ranging from 0.013 to 0.017, which is slightly lower than that of maize starch (0.019). The Ilamellae . These rThe chain length distribution of debranched litchi seed starches and maize starch, after being normalized to the same global maximum to allow comparison among samples, are exhibited in Typical chain length distribution profiles were observed for all the starch samples, with two amylopectin peaks at around DP 17 and 47, respectively, and a broad amylose peak at approximately DP > 100. This is similar to previously published results of starch from various botanical sources . And as The amylose content was also calculated based on the ratio of area under amylose curve (DP < 100) to that under the whole distribution curve. As summarized in o, Peak temperature Tp and conclusion temperature Tc) and the enthalpy change (ΔH), of litchi seed starches and maize starch were analyzed using DSC, with results being summarized in The thermal properties, including the gelatinization temperatures (onset temperature To) and 75.60 °C (Tc), and the ΔH was 6.12 J/g. In comparison, all the litchi seed starches showed higher gelatinization temperatures  and lower ΔH. Among the litchi varieties, Shuangjianyuhebao showed the lowest onset (68.86 °C) and peak (75.87 °C) temperatures, whilst Huaizhi showed the highest . The other four litchi varieties showed similar gelatinization temperatures, with no significant differences. A different trend was observed in the ΔH of litchi seed starches, with Guiwei displaying a significantly higher ΔH value (9.41 J/g) than the other varieties. The gelatinization temperatures reflect the heat stability of crystallites, while ΔH reflects the energy needed to disrupt the molecular order of the starch [It was observed that for maize starch, the temperature range of the gelatinization process of starch samples was between 64.03 °C  than others, while Shuangjianyuhebao showed the highest digestion rate (0.044 min−1). Maize starch had a k value of 0.041 min−1, which is not statistically different from most of the litchi seed starches. These suggest that the digestion rate of gelatinized starch from different varieties of litchi seeds are generally similar to each other, and it is not related to the structural differences among varieties.In order to make quantitative comparisons among samples, the digestion curves were fitted with first-order kinetics, and the resulting digestion rate coefficient (k) are exhibited in This is in accordance with previously published results reporting no dramatic differences in the digestibility of starch from different botanical sources . The reaIn this study, starch was isolated from litchi seeds of six varieties. The structural characteristics of these starches were analyzed, and gelatinization and digestibility were studied. The results showed litchi seed starches were mainly in round to oval shape with smooth surfaces, and no apparent differences were observed among varieties, implying these are common features for litchi seed starch. Typical bimodal granule size distribution patterns were exhibited for all the varieties, indicating litchi seed starches consist of both small and large granules with size <40 μm and 40–110 μm, respectively. The D50 and relative proportions of the small and large particles were dramatically different among varieties: Huaizhi had more large granules (72.69%), while Guiwei had the lowest (94%). All the starches were with A-type crystalline structure, whereas the relative crystallinity apparently vary with variety. Guiwei had the highest crystallinity (26.76%) and Huaizhi had the lowest (20.67%). The semi-crystalline structure was also different among varieties. In terms of the molecular structure, only slight differences were present in the CLDs among varieties, with Huaizhi exhibiting apparently different CLD pattern and significantly higher amylose content (34.3%).Regarding thermal properties, Huaizhi showed significantly higher gelatinization temperatures and lower ΔH than the others, while Guiwei had the highest ΔH. The digestion properties of gelatinized starch samples suggest only slight differences among varieties, and it does not seem associated with variety. These results would be beneficial for better understanding the characteristics of litchi seed starches, and provide guidance for their utilization as a novel source of starch in multiple industries.


Additionally, the significance of CXCL1 is described in vascular physiology, such as the effects of CXCL1 on angiogenesis and arteriogenesis.In this paper, we present a literature review of the role of CXC motif chemokine ligand 1 (CXCL1) in physiology, and in selected major non-cancer diseases of the cardiovascular system, respiratory system and skin. CXCL1, a cytokine belonging to the CXC sub-family of chemokines with CXC motif chemokine receptor 2 (CXCR2) as its main receptor, causes the migration and infiltration of neutrophils to the sites of high expression. This implicates CXCL1 in many adverse conditions associated with inflammation and the accumulation of neutrophils. The aim of this study was to describe the significance of CXCL1 in selected diseases of the cardiovascular system , the respiratory system , chronic rhinosinusitis, coronavirus disease 2019 (COVID-19), influenza, lung transplantation and ischemic-reperfusion injury and tuberculosis) and the skin (wound healing, psoriasis, sunburn and  Intercellular communication is an essential function in a multicellular organism and involves the cellular secretion of a variety of factors into the extracellular space. This communication is the basis for the functioning of the immune system, in which a significant role is played by cytokines . This gr+ CXC chemokine, i.e., one of the seven CXC chemokines that are ligands of CXCR2, the main receptor for CXCL1.One of the CXCL1. One of its first described properties was its ability to stimulate melanoma proliferation, hence, leading to one of its first names, i.e., melanoma growth stimulating activity (MGSA) . CXCL1 wCXCL1 gene expression. Another factor is interleukin-17 (IL-17), which increases the stability of CXCL1 mRNA and thus the expression of CXCL1 ..52].Finally, CXCL1 may also participate in atherosclerosis regression . It is r+ monocytes in their blood . A. A202]. The areas in the skin with high CXCL1 expression experience neutrophil infiltration ,210. As Neutrophils produce and secrete ROS and other reactive low molecular weight compounds that damage macromolecules in the skin ,212. In Upon entering the skin, neutrophils form NETs , structuNeutrophils also secrete proteases that are involved in the development of psoriasis lesions . These eStudies in mice have shown that CXCL1 may also be important in the development of psoriatic arthritis. In psoriatic arthritis, γδ T cells play a significant role in the response to the disease . These iSunburn is the result of excessive skin exposure to ultraviolet (UV) light. It mainly occurs under the influence of too much sunbathing and staying in the sun. This is followed by an increase in the expression of chemokines responsible for recruiting neutrophil, monocyte and dendritic cells to the skin. In particular, there is an increase in the expression of CCL2, CCL20, CXCL1 and CXCL8/IL-8 . StudiesXeroderma pigmentosum is an autosomal recessive disease [xeroderma pigmentosum is estimated to range from 1 per 100,000 in the United States to 35 per 100,000 in Japan. It is characterized by defects in DNA repair enzymes, specifically the nucleotide excision repair (NER) pathway [xeroderma pigmentosum. This leads to skin lesions in which a certain role is played by CXCL1. During skin exposure to UV light, xeroderma pigmentosum group A (XPA) protein-deficient mice show an increase in CXCL1/KC expression [ disease . The inc pathway . Becausepression , a paralpression . HoweverCXCR2 ligands can also cause itchy skin, as confirmed by studies in rats. However, further research is required on the relationship between itchy skin and CXCL1 in humans.An increase in CXCR2 ligands in the skin leads to the activation of transient receptor potential vanilloid type 1 (TRPV1) located on dorsal root ganglia neurons ,230. TheThe importance of CXCL1 in physiology and in diseases has been very well understood. Nevertheless, the greatest difficulty in understanding the action of CXCL1 is the lack of an animal model to study human CXCL1, as the CXCR2 ligand system differs between humans and rodents. This is related to the nature of evolution ,30. The Very often, either in physiology or in diseases, a pair of CXCR2 ligands complement each other. However, most experimental work examines only one CXCR2 ligand without analyzing other chemokines. For this reason, future work should focus on a more extensive examination of either physiological or disease mechanisms, and in particular should examine the significance of a given CXCR2 ligand in the context of other chemokines.Another direction of research into the significance of CXCL1 in diseases should be the development of therapeutic approaches that target this chemokine. An example of such a therapy could be the use of anti-CXCL1 antibodies . As CXCLThe main conclusions of this paper are as follows: knowledge on the role of CXCL1 in the non-cancerous diseases discussed in this paper is incomplete due to the lack of an animal model of the human CXCR2 ligand system; the currently applied therapies do not target CXCL1 or its receptor, CXCR2.


IntroductionWith the advent of fixed- and variable-loop suspensory fixation devices for arthroscopic anterior cruciate ligament (ACL) reconstruction, a maximum number of grafts can be placed within the femoral tunnel. Although several biomechanical studies have been conducted comparing these two devices, only a few comparative clinical studies are available. This study was conducted to compare the functional outcomes of arthroscopic ACL reconstruction using fixed-loop devices with those of variable-loop devices by determining their effect on graft laxity clinical assessment and patient-reported outcome scores.MethodologyOut of 32 patients  who underwent primary ACL reconstruction using tripled hamstring autograft, fixed- and variable-loop devices were used for 13 and 19 patients, respectively. Thirteen patients in each group were evaluated over a period of one year using the Lysholm knee score. Six patients in the variable-loop group had only six months of follow-up. Anterior drawer and Lachman tests were performed at six-month and one-year follow-ups, respectively.Resultsp<0.05). All the other parameters were comparable between the two groups. One patient in each group had ligament laxity at six-month and one-year follow-up, respectively.The mean ages of patients in the fixed- and variable-loop groups were 34.5ConclusionThis study showed no statistically significant difference in graft laxity or functional outcomes of arthroscopic ACL reconstruction with fixed- and variable-loop devices, except for a better patient-reported outcome score in the variable-loop group at six weeks of follow-up. Hence, there is a need for more comparative studies in this direction. This article was previously presented as a poster at the 64th Annual Conference of Indian Orthopaedic Association (IOACON 2019) on 22 November 2019 and as a scientific paper at the 44th State Conference of Karnataka Orthopaedic Association (KOACON 2020) on 1 February 2020.An anterior cruciate ligament (ACL) injury is the commonest knee injury seen by orthopaedic surgeons all over the world. Of all the factors contributing to a successful ACL reconstruction, graft fixation and tunnel incorporation are the most important determinants of post-operative knee stability .A short femoral tunnel effectively reduces the length of the graft in it, thereby compromising on strength of the graft-bone tunnel construct . ReducedIn fixed-loop systems, the length of the graft tunnel and the size of the loop have a significant impact on the outcome of ACL reconstruction. When the graft tunnel is short, closed-loop systems may not function effectively. A long loop may result in insufficient graft within the femoral tunnel.In variable-loop systems, pulling a series of sutures reduces the length of the loop and advances the graft to the femoral tunnel exit. This results in a larger contact area for bone-tendon healing, which in turn leads to better graft uptake. Hence, short tunnels do not preclude their usage. However, in biomechanical studies, these devices have exhibited more displacement than fixed-loop devices under lower loads than those occurring during early ACL rehabilitation . The relThe primary objective of this study was to compare the functional outcomes of arthroscopic ACL reconstruction using fixed-loop devices with that of variable-loop devices by determining their effect on clinically assessed graft laxity and functional outcome scores (the Lysholm knee score). The secondary objective was to evaluate the demographic distribution, mode, and MRI grading of ACL injuries and assess the pattern of associated injuries.This was a prospective study involving 32 patients with an ACL tear who visited the outpatient department and later underwent arthroscopic ACL reconstruction in the Orthopaedics Department of JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, between September 2017 and March 2019.The inclusion criteria were as follows: (1) age: 18 years or older; (2) no other illnesses preventing them from ambulating normally; (3) clinical and MRI proved ACL insufficiency of grades 3 and 4 ; (4) no The exclusion criteria were as follows: (1) ACL rupture associated with tibial or femoral condyle fractures and tibial spine avulsion fractures; (2) ACL reconstruction with other modes of fixation on the femoral side; (3) posterior cruciate ligament injury; (4) evidence of osteoarthritis on plain radiograph.Written informed consent for inclusion in the study was taken from all the patients. The treatment protocol was explained to them and they were briefed regarding their rights during the study. The treatment process had no adverse effects on the health of the participants, and the study was approved by the Institutional Ethical Committee of JSS Medical College, Mysuru .All the patients were subjected to detailed history taking and clinical examination. Lachman and anterior drawer tests were performed on all the patients before getting an MRI done. If MRI revealed significant femoral or tibial condyle contusion, surgery was delayed by three weeks. Functional limitations of all the patients were assessed preoperatively using the Lysholm knee scoring scale. Post-anaesthesia pivot shift test was done for further confirmation of ACL tear. All the surgeries were performed by an experienced team of orthopaedic surgeons trained in arthroscopy.Diagnostic arthroscopy was first done. Hamstring graft was then harvested, tripled, and pre-tensioned. The final graft size was 8 mm in all cases. The graft was then inserted through drill holes, assisted arthroscopically, and fixation was done with a fixed- or variable-loop device. The final femoral bone-tendon overlap length was 20 mm in all cases. The decision regarding the device to be used was made on-table based on the femoral tunnel length. If the tunnel length was less than 40 mm, variable-loop button fixation was done as a graft length of 20 mm had to be ensured within the tunnel (a 15-mm fixed-loop device is not available in our institute).o and full passive extension. Thereafter, progression to full knee flexion was encouraged by the end of six weeks. The active terminal extension was permitted only after six weeks. As and when patients demonstrated good quadriceps control, they were weaned off the brace and crutches. Patients were followed up at two weeks, four weeks, six weeks, three months, six months, nine months and 12 months. The objective and subjective evaluations were done with the Lysholm knee scoring scale. Graft laxity was assessed by a single individual, using Lachman and anterior drawer tests. These tests were performed on the affected as well as contralateral normal knees of patients, at six months and one year.After the surgery, all the patients underwent physiotherapy according to the institutional ACL rehabilitation protocol. Patients were encouraged to bear weight as tolerated with crutches and range of motion (ROM) knee brace locked in extension, second postoperative day onwards. In the first two weeks, emphasis was placed on patella mobilization, flexion up to 90t-test was used to compare the age distribution and knee ROM between the groups. The number of days after the injury at which the patients in both groups underwent surgery was compared using the Mann-Whitney U-test. A p-value of <0.05 was considered statistically significant for all tests.Data analysis was done using IBM SPSS Statistics for Windows, Version 21.0 . Chi-square analysis was used for comparing the sex distribution, mode of injury, MRI grading of an ACL tear, associated meniscal injuries, Lachman and anterior drawer tests for graft laxity at six months and one year and the Lysholm knee score grades of the two groups . An independent Of 32 patients  who underwent arthroscopic ACL reconstruction, the fixed-loop device was used in 13 patients and the variable-loop device in 19 patients. Six patients in the variable-loop group were lost to follow-up after six months. All the others were followed up over a period of one year. Baseline patient characteristics are mentioned in Table The distribution of patients with associated medial and lateral meniscus tears in each group is shown in Figure p=0.009) . Hagino et al. diagnosed an associated meniscal tear in 437 out of 552 knees with an ACL injury, on arthroscopic examination. The overall incidence of associated meniscal tear was thus found to be 79.2% [Lanzetti et al. noted Lysholm knee scores of 92.8 and 93.2 in the fixed- and variable-loop groups, respectively, at the end of 12 months [Wise et al. compared functional outcomes of the fixed- and variable-loop groups based on the Tegner scale and 12-Item Short-Form Health Survey, apart from the Lysholm questionnaire . Sharma The Lysholm knee score is one of the oldest knee-specific scoring systems used to assess patient-reported outcomes after ACL reconstruction . A studyWise et al. assessed graft laxity using a KT-1000 arthrometer. Clinical laxity of knees, as defined by KT-1000 >3 mm -18, was Apart from graft laxity, the only other complication encountered was knee stiffness. Persistent extensor lag was noticed at six months in one patient in the variable-loop group and incomplete flexion was observed in one patient each in both the groups. Knee stiffness could be because of improper tunnel placement or non-compliance with the rehabilitation protocol ,22. A tiLanzetti et al. found no difference in femoral tunnel enlargement on CT evaluation of knees in which ACL reconstruction was performed using fixed- and variable-loop constructs, 12 months after the surgery . Hoher eGraft healing is the most important factor influencing the outcome of ACL reconstruction. The factors influencing graft healing include the graft type, tunnel length and orientation, length of graft inside the tunnel, disparity between the diameters of the tunnel and the graft, graft tension, graft motion in the tunnel and type of fixation . We haveSeveral biomechanical studies have purported that variable-loop designs lengthen or slip, thereby delaying graft incorporation and causing knee instability ,28. PetrOur results were consistent with the findings of Boyle et al., who conducted a retrospective comparative study to ascertain whether adjustable-loop devices loosen after ACL reconstruction. They concluded that there was no statistically significant variation in the graft failure rate between fixed- and variable-loop designs up to two years post-ACL reconstruction .The fact that clinical studies like ours have not been demonstrating increased graft slippage in variable-loop designs as opposed to fixed-loop designs, as claimed by numerous biomechanical studies, could lead us to the fair assumption that biomechanical studies do not accurately represent clinical scenarios.Our study has a few limitations. Assessment of graft laxity might be biased due to the subjective nature of clinical assessment. Moreover, postoperative CT and MRI evaluations could not be done to assess the comparative femoral tunnel widening and the relative amount of graft in the femoral tunnel, respectively. Furthermore, the problem of relatively small sample size was compounded by the fact that six patients in the variable-loop group were lost to follow-up after six months.Our study showed no statistically significant difference in laxity of the graft or functional outcomes of arthroscopic ACL reconstruction with fixed- and variable-loop devices, except for a better patient-reported outcome score in the variable-loop group at six weeks of follow-up. Although many biomechanical studies have shown variable-loop designs to exhibit more displacement than fixed-loop designs, there was no significant difference in the displacement of the device between the two groups in our study. Hence, there is a need for more comparative clinical studies in this direction.


Numerou= 0.003) , 3. Undo= 0.003) , 3. A me= 0.008) . In the = 0.008) . Another We thank Dr. Honore and colleagues for their comments to our study on extracorporeal membrane oxygenation (ECMO) support for COVID-19 and H1N1 patients with ARDS . Ultrapr


The failure or success of an enterprise depends upon its working capital management practices (WCMP) along with effective corporate social responsibilities (CSR) and social entrepreneurship (SE). These factors ensure not only the soundness of financial indicators but also the profitability of an enterprise. Therefore, the objective of this study was to determine the impact of CSR, SE, and WCMP on the performance of small–medium enterprises (SMEs) of tourism sector, during the lockdown period in Malaysia. The goals also include the investigation of moderating role of employee behavior (EB) among the nexus of CSR, SE, WCMP, and performance of SMEs. The survey was performed to find out the practices adopted by the SMEs during corona days. A quantitative research method has been adopted to get data with convenient sampling technique, and PLS-SEM has been exploited to find out the significant nexus among CSR, SE, WCMP, and the performance of SMEs. The results indicate that CSR, SE, and WCMP have a positive association with the performance of SMEs in Malaysia. The results also indicate that EB positively moderates among the nexus of CSR, SE, WCMP, and the performance of SMEs in Malaysia. Stock review strategies by the SMEs during the corona days also exhibit significant differences except for no stock review. Significant differences between the enterprises show a lack of adaptation of the financial indicators that determine enterprise soundness. The study not only provides guidelines for entrepreneurs of SMEs but also helps in maintaining standards for the evaluation of the enterprises. Organizountries . A varieountries . Therefoountries .The objective of the ongoing research was to examine the impact of CSR, SE, and working capital management practices (WCMP) on the performance of SMEs along with the investigation of moderating role of employee behavior (EB) among the nexus of CSR, SE, WCMP, and performance of SMEs during the lockdown period in Malaysia. The survey was performed to find out the practices adopted by the SMEs during corona days.There is an inclusion of corporate social responsibility in the organizational structure. This benefits the organizations through variant means which includes performance in most of the organizations during COVID-19. The COVID-19 affects the safety and health of the people  along wiIt is though profitable for the SMEs but also helps to establish governing structure for the higher performance of SMEs. Although the high growth is depicted by some financial decisions during COVID-19 which are mostly relied on the governing bodies, the effectiveness of some dominant elements induces a positive rise among Malaysian SMEs performance. The indulging attribute of working capital management depicts higher growth among the emerging firms in many countries . With thComplete lockdown during the corona days has changed the working patterns of the enterprises. WCMP are the main factors that determine the survival of an enterprise these days. An organization of current resources and liabilities of entrepreneurship depicts the WCMP. The success of these practices results in decreasing real cash conversion cycles. These practices not only result in improvement in profitability but also provide standards to the investors for evaluation. Subtraction of current liabilities from current assets of an enterprise provides its working capital. It is mostly associated with receivable accounts, cash, delayed accounts, inventory, and payable accounts. The firms have bankruptcy problem due to lack of management practices. A significant level of current resources may decrease the danger of cash by leasing or renting immovable property. But the comparable strategy cannot be followed for the parts of working capital. Nonetheless, assessing working capital needs is an overwhelming job as it varies from business to business, cash flow cycles, and stock accessibility. Application of standards and practices of working capital reduces the danger and improves execution. The concept of entrepreneurship is mostly associated with SMEs by many researchers and policymakers. Unemployment can be decreased by getting benefits from the potential of SMEs. These are considered as an important source of stable economic growth along with new ways of working. The researchers describe various kinds of financial, environmental, and managerial problems associated with SMEs ,b.Most of the researchers link these problems with poor business and working capital management. Working capital management determines the financial soundness of a firm. It also determines the firm profitability. It also points out the firm ability to handle some uneven financial crisis. The keeping up of satisfactory working capital could not be simply addressed. The progression of assets for a business is as important as blood is necessary to keep our bodies alive. Cash and cash flows were the king and queen of the financial management of any firm. The firm’s short-term assets and liabilities describe the working capital. It is necessary to run an everyday business and considered paying employees’ wages before the collection of the revenues. Working capital is considered positive when a company can pay its transient liabilities, while it is considered negative when a company cannot pay its transient liabilities within its current resources. Accordingly, the inability to get ready for expanding working capital needs can prompt genuine income issues. Considering the need for the project, the study aims to find out WCMP by small–medium enterprises (SMEs) during the corona days.The services in SMEs have recorded significant growth of about 7.4% while inducing the growth of 8.1% in 2018. There is a probable momentum in the SMEs businesses indulged in retail, wholesale, and other sub-sectors that have been grown by 7.6% during 2018. Besides this, the business services have also been grown by 7.7% during 2018 where the products have attained a growth of 4.3% with a considerable rise of 5.9%. Some other sub-sectors which are associated with SMEs have depicted a slower rise of 4.9 and 3.2%, respectively, where the different values are added. SMEs indulged in the mining sector have been enhanced by 4.7% with the relevance of construction by 4.0%. While using the approach of EB, the performance of SMEs could not be omitted. This emergence of the behavioral approach helps to counter a variety of challenges prevailing in the competitive environment during COVID-19. However, the ethical practices of EB are important and the impacts of organizational justice and ethical leadership also fit in the organizational structure .This ethics of business involves a variety of comparing elements that belong to the organizational performance. Therefore, participation is always required to contribute a significant portion to organizational growth . CertainThe study based on social learning theory that was introduced by Albert Bandura suggests the social behaviors are learned by observing the others’ behaviors. Furthermore, people can learn the new behaviors and information by observing the other individuals in environmental and social circle. This theory supported the phenomena of this study.Some aftermaths of SE are dominant with reference to some exclusionary practices during COVID-19. These practices are widely associated with businesses and the events of the great recession which emphasizes the approach of SE. It focuses on the growing emergence of SE, which inserts capable measures to enhance the performance of SMEs. Many Malaysian firms have attained considerable growth with the reflection of SE during COVID-19. This renders the driving change in institutions where SE widely dominates with a variety of capabilities . The divDifferent dramatic situations are prominent in the organizational culture. This is due to the changing market environments and wide adaptation of technological approaches. This adaptation provides a variety of opportunities and also states wide challenges mostly for SMEs. This is strategically important for larger organizations and SMEs due to the guided approach of different market combinations during COVID-19. A comprehensive conceptualizing orientation states the supportive aspects of SME’s performance by the emergence of the digital economy . While cH1: Social entrepreneurship significantly and positively influences SME’s performance in Malaysia.Many factors have an important role in the organizational hierarchy, and CSR is one of them . This enThe indulging attitude of lining firm competitiveness and corporate social responsibility is described through a variety of dimensions . This exThe dimensions of corporate social responsibility state the structures which could bring significant performance. These dimensions are positively stated by the relativeness of financial capacity and the demanding needs of consumers in COVID-19 . TherefoH2: Corporate social responsibilities significantly and positively influence SME’s performance in Malaysia.Working capital is mostly linked with financial decision making, but the emergence of CSR among SMEs’ performance sustained the benefits. These benefits are probably associated with the working capital management in most of the corporate sectors, especially during COVID-19. These benefits are availed for the companies’ higher profits and the sake of the company’s performance. Therefore, the impact of capital expenditure is also vital among emerging economies with slight financial constraints . These cCertain determinants of working capital management place external effects on SMEs’ performance. Usually, in Malaysia, the elements of the socio-economic structure are most relying on factorial effects on the performance of organizations during the peak of COVID-19. This could state various influences whether they belong to the short-term effects or long-term impacts but carries the indicators which are prominent in organizations. Many determinants prevail in the organization that is relative to the SME’s performance and have a significant impact . This adH3: Working capital management practices significantly and positively influence SME’s performance in Malaysia.Employee behavior is the moral ownership that is induced by the employee toward companies. This is the sole contribution of employees which asserts its dominance among the SMEs performance. SMEs of Malaysia state the contribution of EB which enlarges the support and ethical context toward performance during COVID-19 . HoweverManagement controls are significant measures for the increment in SME’s performance during COVID-19. Therefore, effective incorporations among the EB are dominantly related to the innovations and harnessing creativities. This states the variety of convergence and evolution impacts of quality management on the performance of organizations . EB signH4: Employee behavior significantly moderates the relationship between SE and SMEs’ performance in Malaysia.H5: Employee behavior significantly moderates the relationship between CSR and SMEs performance in Malaysia.H6: Employee behavior significantly and positively moderates the relationship between WCMP and SMEs performance in Malaysia. The objective of the ongoing research was to examine the impact of CSR, SE, and WCMP on the performance of SMEs along with the investigation of moderating role of EB among the nexus of CSR, SE, WCMP, and performance of SMEs during the lockdown period in Malaysia. The survey was performed to find out the practices adopted by the SMEs during corona days. The quantitative research method was adopted to get data from the respondents under positivism philosophy and deductive approach. The data were collected through convenient sampling technique. The employees of SMEs in tourism sector that are currently operating in Malaysia are the respondents and send the surveys by mail and personal visit. A total of 580 surveys were sent by mail and personal visit, and out of them, only 410 were returned, representing a response rate of 70.69 percent.Moreover, PLS-SEM was used to find out the significant nexus among CSR, SE, WCMP, and the performance of SMEs. The smart-PLS was used because the complexity of the framework along with testing of the hypotheses is the main goal of the study . MeasureThis study has adopted three predictors named SE that has ten items, CSR that have five items, and WCMP that have eight items . In addiThe present study has examined the convergent validity first to check the measurement model assessment. The convergent validity is related to the relationships among the items, and the outcomes have exposed that the values of composite reliability (CR) along with alpha are higher than 0.70. In addition, the values of loadings along with AVE are more than 0.50. These outcomes have shown valid convergent validity and high correlation among items. These values are highlighted in The present study has also examined the discriminant validity in order to check the measurement model assessment. First, cross-loadings along with Fornell–Larcker have been executed. The discriminant validity is related to the relationships among the variables, and the outcomes have exposed that the values that exposed the nexus with the variable itself are higher than the values that exposed the nexus with other variables. These outcomes have shown valid discriminant validity and low correlation among variables. These values are highlighted in Second, the heterotrait–monotrait ratio has been executed and the outcomes have exposed that the values are lower than 0.85. These outcomes have shown valid discriminant validity and low correlation among variables. These values are highlighted in Finally, the structural model assessment has been executed that shows the nexus among the variables. The results indicate that CSR, social entrepreneurship, and WCMP have a positive association with the performance of SMEs in Malaysia and accept H1, H2, and H3. Moreover, the results also indicate that EB positively moderates among the nexus of CSR, social entrepreneurship, WCMP, and performance of SMEs in Malaysia and accept H4, H5, and H6. These relationships are highlighted in The outcomes of the present research have indicated that CSR has played a positive role in the performance of SMEs in Malaysia and these outcomes are in line with the outcomes of the A study by The results also expose that the EB has positive moderating among the nexus of CSR and performance of SMEs and this outcome is similar to the results of Finally, the study has concluded that the SMEs of Malaysia have implemented effective CSR practices in the organization along with effective social entrepreneurship and effective management of working capital, that is, the reason for the high performance of SMEs in the country. In addition, the EB of SMEs has also played a positive role in the performance of SMEs in accordance with effective CSR practices, effective social entrepreneurship, and effective management of working capital. The main target of the project was to analyze WCMP by SMEs during corona days. The results show that SMEs have variations in their account maintenance. SMEs have less use of computer for their record keeping. On average, SMEs have stock review strategies along with stock insurance. This study has provided the guidelines to the policymakers that they should focus on developing the regulation related to CSR along with WCMP and EB that could increase the performance of SMEs. The present study has also provided the guidelines to the upcoming researcher while examining this area in future. This study contributes to the literature of SMEs’ performance in accordance with CSR, social entrepreneurship, and WCMP along with EB.Finally, the present study has some limitations that guide future studies to be incorporated in their studies. The present study has taken EB as moderating variable and ignored the mediating impact on the model and suggested that future studies should incorporate this aspect in their studies. In addition, the ongoing study has also taken only three predictors such as CSR, social entrepreneurship, and WCMP and ignores the other factors that also affect the SMEs performance and recommended that future studies should also include the factors other than used by the present study in their analysis to predict the SMEs performance. Moreover, the current study has also examined the SMEs of Malaysia, ignored the other sector and countries, and suggested that future studies should add more sectors and countries in their studies. Finally, the present study has ignored the cross-country analysis and suggested to the upcoming studies that they should incorporate this point in their studies.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.YL contributed to funding acquisition and data collection. IA contributed to the literature review. HR contributed to the conceptual development and proposition of hypotheses and introduction. AS contributed to proofreading and language editing. ER-A contributed to methodology and data analysis. EA-S contributed to the discussion, conclusion, and limitations. All authors contributed to the article and approved the submitted version. All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Clinics and Practice, and started its development. The indicated aims of the journal are many, probably too many, because the title is extremely wide. In any case, it is especially devoted to the clinical aspects of medicine, not disregarding the basic and translational research.Recently, MDPI has acquired a new journal, https://www.mdpi.com/journal/clinpract/about (accessed on 15 November 2022). Publications on clinical medicine, including pain medicine, are certainly the main scope of the journal. The interest is also on infectious diseases, oncology, sport medicine and reproductive medicine, including pediatrics. Moreover, it is open to dentistry, psychology and psychiatry, public health, and healthcare, and lastly, but not of a minor interest, to intensive care. Of course, publications on basic and clinical pharmacology represent another important aspect of this evolving journal. The readers may find more detailed information at the link: The Editorial Management of the journal has kindly invited me as Editor in Chief. After an attentive analysis of contents, recent publications, and the website, and taking into consideration several other personal aspects, I decided to accept the challenging and intriguing adventure.https://www.mdpi.com/topics?query=&journal=clinpract&status=all&category=all (accessed on 15 November 2022)). This is a part of the website whose aim is to invite anyone to a transversal interaction on a specific topic in the scientific discussion. Those interested may easily find a common arena to have an open and stimulating confrontation. This is an interesting potentiality, providing the possibility to compare our point of view with many others having our same objective: the growth of science via research and interaction with peers.A new journal is always an intriguing adventure. In this case, the main attractive point was the great rapidity and proactivity of the publisher, and its expanded and growing offer of communication tools in science. The interactivity and potentiality have a clear example in what they call “Topics” (Clinics and Practice, and looking at its evolution in the last 2 years (Going back to  2 years , it seemThe contents of the journal are definitely interesting. In the last two years, there have been important papers already cited several times. The most important between them is a narrative review on the interferences between COVID and hypoxia, with over 200 citations . Then, tClinics and Practice has a peculiar column “Editor’s Choice Articles” listing all the recent articles preferred by the editorial team. This is appealing, considering that also indicates how many times the article has been viewed on the website and cited. Between them, the best ranked have over 5000 views [00 views ,2, but t00 views ,10. Now,Ad maiora.A wise and professional management will certainly provide an organic and progressive evolution of the journal. It will be my pleasure to give most of my energies and enthusiasm to help in the process. I count on the support of all my colleagues, the members of the Editorial Board, to make sure that the quantitative and qualitative growth will continue and increase as much as possible.


SARS-CoV-2 genetic sequence results collected from native COVID-19 cases who waited or saw relatives off at Xi’an Xianyang International Airport were highly consistent with the imported cases. In order to explore the routes of transmission and influencing factors that may cause the transmission of SARS-CoV-2 at the airport, a field simulation experiment of aerosol diffusion was adopted based on epidemiological survey data and a detailed field investigation of airport structure and ventilation. The results showed that the inbound passengers waited for approximately 3 h in the rest area on the first level of the international arrival area (Zone E). During the period, masks were removed for eating and drinking, resulting in the viral aerosols rising from the first level to the second level with hot air. After deplaning, the inbound passengers handled the relevant procedures and passed through the corridor on the second floor. The local side wall of the corridor adopted fan coil air conditioning, combined with fresh air supply and personnel walking, resulting in airflow flowing to Zone E. After merging with diffused air containing virus aerosol from the first floor, it continued to spread upward to the connected third-layer area. There was a local suspended ceiling on the top of the third floor, but it was approximately 4 m high and connected to the corridor from Terminal 2 to Terminal 3. When the virus aerosol diffused above the Terminal 2–Terminal 3 corridor, where the temperature was low and the air diffused downward, it could cause an infection risk for people passing through the corridor. In addition, the investigation found that the exhaust pipes of the nucleic acid sampling rooms at the international arrival corridor were directly discharged outdoors without treatment. Only one exhaust pipe and poor ventilation in the bathroom in Zone E had a risk of viral aerosol diffusion. Therefore, the international arrival area should be set up alone or separated from the other areas by hard isolation to avoid the existence of communication between different areas that could cause viral aerosols to diffuse with airflow. The toilet ventilation should be increased to avoid the accumulation of viral aerosols at high concentrations. The exhaust pipes of the toilet and the nucleic acid sampling rooms should be equipped with disinfection and efficient filtration devices, and high-altitude emission should be adopted to reduce the risk of virus aerosol diffusion. With the deepening understanding of SARS-CoV-2, aerosol transmission has been considered another transmission route of SARS-CoV-2 besides droplet transmission and contact transmission ,2,3,4. HAlthough the airport has taken many prevention and control measures to prevent the transmission of viral aerosols, there were still cases associated with inbound passengers at Xi’an Xianyang International Airport. In December 2021, the most serious local COVID-19 epidemic occurred in Xi’an , China, How did domestic personnel at the airport become infected, and what was the virus transmission path? It was necessary to understand the physical structure of the airport, the operation mode of the air conditioning system, the airflow layout and other possible factors to explore the reasons for the transmission of SARS-CoV-2 at the airport. Field measurement and investigation and field respiration simulation experiments to generate virus aerosol were adopted on 23 December 2021, and suggestions on improvement measures against risks that existed in airports were put forward.There were three floors in the international arrival area, each of which was approximately 5 m high, and the overall height of the building was 19.2 m. Zone E (first floor) was the hall for inbound passengers’ rest and waiting for their baggage to transfer. The second floor was the international arrival corridor. The third floor was the international departure corridor and the international airport terminal. The three floors were connected by rolling elevators. As the airport staff found, there was always airflow from the exit of the lounge bridge to the staircase at the international arrival area on the second floor. If inbound passengers did not wear a mask standardly, the virus aerosol generated by their respiration would move and diffuse with the airflow. Therefore, people’s walking around and respiration to generate virus aerosol were simulated on the second floor, and monitoring point B was set 12 m away from the occurrence point on the second-floor staircase, and monitoring point C was set on the third floor above the occurrence point. Inbound passengers were concentrated during the period of waiting for transportation to the centralized isolation hotel in the rest area on the first floor (Zone E). They had a behavior of removing their masks for drinking water and eating food. The positive cases could exhale aerosols containing viruses. In order to investigate the infection pathway of local cases, monitoring point D was set at the nearest location to the third floor above the vertical direction of Zone E in the action routes of domestic persons a and b in the T2–T3 corridor; monitoring point E was set 38 m away from point D in the T2–T3 corridor. There were negative-pressure nucleic acid sampling rooms on the second floor of the international arrival corridor. It was stated that the viral aerosol from the positive cases removing their masks for throat swabs discharged from the nucleic acid sampling rooms may spread to the third floor and infect domestic personnel c. Therefore, point F was set at the check-in counter in the T3 hall, where the domestic personnel c stayed (the distance between points D and F was approximately 168 m ).11–1012). According to the epidemiological investigation information, the inbound passengers stayed in Zone E for approximately 3 h, so the experimental duration was set to 3 h. During the experiment, the wind speed was monitored to observe the direction and speed of the airflow, PM2.5 and PM10 detectors and particle size spectrometries were used for monitoring the concentration changes of particles of different sizes, PM2.5 samplers  and biological aerosol samplers  were used for collecting aerosol samples at different sites and the samples were observed by a fluorescence microscope  to determine the existence of simulants in different regions. Meanwhile, temperature and humidity were monitored. The field direct reading data were statistically analyzed by Origin 9.Fluorescent polystyrene microspheres of different sizes were prepared by the Beijing Institute of Metrology. They did not exist in nature and were consistent with the similar aerodynamic characteristics of the SARS-CoV-2 spike pseudovirus. Therefore, they were selected to simulate particles generated by human respiration ,12. The During the epidemic, the airport reconstructed the international arrival area and set up an international arrival corridor on the second floor and Zone E for inbound passengers to go through emigration formalities, and rest and so on, which were separated by an empty, closed area of 15–20 m in length with the T2–T3 corridor. The third floor, where passengers were prohibited from entering, was separated from T3 by hard isolation. After investigation, it was found that the top of the third floor had hollow ceilings, which were approximately 3.6 m from the roof and communicated with the top of the T2–T3 corridor. Airflow was an important factor affecting viral aerosol transmission, and air-conditioning systems played a key role in the airflow layout ,14. The There were 16 nucleic acid sampling rooms set up in the international arrival corridor on the second floor. The nearest distance to point D, where personnel a and b stayed, was approximately 229 m, and the nearest outdoor straight-line distance to point F, where personnel c stayed, was approximately 277 m. There was some risk that the virus aerosols from the infectors removing the masks for throat swabs in the sampling rooms would be discharged through the exhaust pipe directly into the outdoors without any treatment. However, the outdoor distance was too far, though there were open windows on the glass curtain wall of the T3 hall, the possibility of viral aerosol spreading to the T3 hall was small, so the outdoor field simulation experiment of the virus aerosol discharged from the nucleic acid sampling room was not carried out. After inbound passengers arrived, they would go through a health declaration, temperature measurement and so on. During the survey, it was found that the person entered the epidemiological survey area for the special passenger whose temperature was abnormal and then continued to move forward with other passengers for nucleic acid detection and was sent to the first floor through a farther jet bridge and transferred. There was a risk of infecting other passengers. In addition, because the international arrival area only opened a bathroom with only one vent in Zone E for inbound passengers, there was a risk that the aerosol produced by toilet flushing after defecation and urination in positive cases was not discharged in time.To explore the transmission path of the virus aerosol, virus aerosols were generated by simulating the respiration of COVID-19 cases in the international arrival area. During the experiment, it was found that the wind speed at the international arrival corridor on the second floor was greater than that of Zone E and the third floor. This corridor adopted fan coil air conditioning for temperature regulation. In open indoor spaces, such as the wholesale market , differeThe airport only opened the first and second floors to provide international arrivals with formalities, rest and so on, and the third floor was vacant and inbound passengers were not allowed to enter. The outdoor temperature in Xi’an was low in December. In order to improve the comfort of passengers, the air conditioning system was opened at the airport. The air conditioning system on the third floor was not open due to no passengers, resulting in a low temperature. Inbound passengers completed the relevant formalities, waited for baggage and transfer in Zone E, and they were more concentrated. Usually, in order to maintain the constant temperature characteristics of the body, the human body will dissipate heat to the environment to achieve thermal balance, which becomes the main heat source of the environment ,17. In tThe virus aerosol generated by the respiration of inbound passengers while gathering and waiting in Zone E was transmitted upward under the temperature difference, and the use of the fan coil air conditioning and one-way flow of personnel on the international arrival corridor of the second floor promoted the flow of the airflow from the international arrival corridor to the stairway of the same floor and accelerated the diffusion of the virus aerosol. The chimney effect of the vertical penetration of the upper and lower spaces from the first floor to the third floor increased the pull-out effect, which led to the spread of the virus aerosol to the third floor. With the increase in the concentration of aerosols, they would continue to diffuse to the suspended ceiling of the third floor and the connected T2–T3 corridor. There were multiple windows in the corridor, and because the temperature was lower, the upper air contaminated by viral aerosol would diffuse downward. Infection may occur if the mask was not worn or was worn irregularly when the person passed by. Since there was an empty closed area of 15–20 m between the international arrival area and the T2–T3 corridor, the concentration of viral aerosol gradually decreased with the extension of the propagation distance in the transmission process. Therefore, no viral aerosol was detected at the farther point E and the farther point F in the T2–T3 corridor. However, with the extension of the residence time of people in Zone E, the concentration of viral aerosol increased, and there was still the risk of the spread of viral aerosol over a distance due to the airflow change caused by the walking of people in the T2–T3 corridor. The results of field simulation experiments confirmed that the simulated virus aerosol generated by simulated respiration could spread to the second and third floors 12 m away from the occurrence point of Zone E, and spread from the international arrival area to point D of the T2–T3 corridor, but it did not continue to spread to point E of the T2–T3 corridor and farther point F.During the SARS epidemic in 2002, it was reported that the virus aerosol spread between buildings in the outdoor environment , but itsIt has been reported in the literature that the viral aerosol produced by toilet flushing after defecation and urination can also cause the risk of personal exposure and aerosol transmission ,23,24. IThe airport was an important place for inbound passengers to stay longer after returning. In addition to inbound passengers entering the airport every day, there were also a large number of domestic passengers waiting, sending and leaving the airport, and people were more concentrated. Many airports have established GTC (Ground Transportation Center) as a diversified transportation center that undertakes all kinds of traffic facilities and increases the airport population. Although the airport had taken relevant measures to separate inbound passengers from domestic persons, cross-infection risks still persisted in different regions and personnels.Airflow layout was the main factor that led to the indoor transmission of virus aerosols. Building layout, the use of an air conditioning ventilation system and personnel movement all affected the indoor airflow layout. Therefore, the following should be practiced in the airport area: (1) The region for inbound passengers to go through formalities and so on should be strictly separated from other regions of the airport and should be set individually or separately by hard isolation means, and the existence of the connection of different regions should be strictly prohibited. (2) The returned air should be closed, and the full fresh air should be used when using a full air conditioning system. (3) The fan coil air conditioning should be avoided in the international arrival corridor to prevent airflow to the connected area. (4) The exhaust pipes set in the indoor nucleic acid sampling rooms need to be equipped with efficient filtration and disinfection devices before discharge and adopt high altitude discharge. (5) It is necessary to increase the exhaust air of the bathroom, install efficient filtration and disinfection devices and discharge at high altitude in areas where inbound passengers of international flights wait to be transferred. (6) After the arrival of international flights, personnel transfer channels should be set up at the corridor bridge nearest to the first temperature measuring point to transfer passengers with abnormal temperatures for the first time as soon as possible.In this study, the transmission route and influencing factors of SARS-CoV-2 transmission in airports were determined through a field investigation and simulation experiments. The virus aerosol generated by the respiration of the positive cases in the international arrival area can spread from Zone E (the first floor) with a high temperature to the upper area  with a low temperature. The use of the fan coil air conditioning and one-way flow of personnel in the international arrival corridor of the second floor promoted airflow to the stairway connecting Zone E. The chimney effect of the vertically connected space made the airflow continue to flow upward, resulting in the spread of the virus aerosol to the upper space of the third floor and the third-floor ceilings, and then continues to spread to the upper ceiling of the T2–T3 corridor with the increase in the concentration of aerosol. The virus aerosol flowed to the area below the T2–T3 corridor, where people passed by because of the lower temperature, resulting in human infection. In addition, there were some risks in the untreated exhaust pipes of the nucleic acid sampling rooms: the toilet with only one exhaust vent in the international arrival Zone E and the delayed transfer of the inbound passengers with abnormal temperatures, but they were not the cause of this transmission.We used fluorescent polystyrene microspheres consistent with similar aerodynamic characteristics to the SARS-CoV-2 spike pseudovirus to simulate the respiration of infected people to produce viral aerosols, which can verify the transmission pathway and influencing factors of viral aerosols, understand the risk and propose prevention and control measures. Virus infection is a complex process that is related to factors such as virus toxicity, load, activity and the immune status of susceptible individuals and so on. The experiment of the transmission of living viruses cannot be carried out in public places, and the propagation path can be confirmed by using fluorescent microspheres that do not exist in nature. However, fluorescent microspheres are not viruses, and the amount does not indicate the probability of infection.