passengers on a flight from Singapore to Hangzhou in China. This study aimed to investigate the source of the outbreak and assess the risk of transmission of COVID-19 during the flight. Method: Using a standardized questionnaire, we collected information on the travelers' demographic characteristics and illness before, during, and after the flight. We also collected data on factors potentially associated with COVID-19 transmission during the flight. Results: A total of 16 COVID-19 patients were diagnosed among all passengers; the overall attack rate was 4.8%. The attack rate among passengers who had departed from Wuhan was significantly higher than that among those who had departed from other places. One passenger without an epidemiological history of exposure before boarding developed COVID-19. During the flight, he was seated near four infected passengers from Wuhan for approximately an hour and did not wear his facemask correctly during the flight. Conclusions: COVID-19 transmission may have occurred during the flight. However, the majority of the cases in the flight-associated outbreak could not be attributed to transmission on the flight but were associated with exposure to the virus in Wuhan or to infected members in a single tour group.

IMPORTANCE Much remains unknown about the transmission dynamics of COVID-19. How the severity of the index case and timing of exposure is associated with disease in close contacts of index patients with COVID-19 and clinical presentation in those developing disease is not well elucidated.OBJECTIVES To investigate the association between the timing of exposure and development of disease among close contacts of index patients with COVID-19 and to evaluate whether the severity of the index case is associated with clinical presentation in close contacts who develop COVID-19. DESIGN, SETTING, AND PARTICIPANTSThis study used a large, population-based cohort of 730 individuals (index patients) who received a diagnosis of COVID-19 in Zhejiang Province, China, from January 8 to July 30, 2020, along with a contact tracing surveillance program. Field workers visited 8852 close contacts of the index patients and evaluated them for COVID-19 through August 2020. A timeline was constructed to characterize different exposure periods between index patients and their contacts. MAIN OUTCOMES AND MEASURESThe primary outcome was the attack rate of COVID-19, defined as the total number of new COVID-19 cases diagnosed among contacts of index patients divided by the total number of exposed contacts. A secondary outcome was asymptomatic clinical presentation among infected contacts. Relative risks were calculated to investigate risk factors for COVID-19 among contacts and asymptomatic clinical presentation among infected contacts. RESULTS Among 8852 close contacts (4679 male contacts [52.9%]; median age, 41 years [interquartile range, 28-54 years]) of 730 index patients (374 male patients [51.2%]; median age, 46 years [interquartile range, 36-56 years]), contacts were at highest risk of COVID-19 if they were exposed between 2 days before and 3 days after the index patient's symptom onset, peaking at day 0 (adjusted relative risk [ARR], 1.3; 95% CI, 1.2-1.5). Compared with being exposed to an asymptomatic index patient, the risk of COVID-19 among contacts was higher when they were exposed to index patients with mild (ARR, 4.0; 95% CI, 1.8-9.1) and moderate (ARR, 4.3; 95% CI, 1.9-9.7) cases of COVID-19. As index case severity increased, infected contacts were less likely to be asymptomatic (exposed to patient with mild COVID-19: ARR, 0.3; 95% CI, 0.1-0.9; exposed to patient with moderate COVID-19: ARR, 0.3; 95% CI, 0.1-0.8).CONCLUSIONS AND RELEVANCE This cohort study found that individuals with COVID-19 were most infectious a few days before and after symptom onset. Infected contacts of asymptomatic index patients were less likely to present with COVID-19 symptoms, suggesting that quantity of exposure may be associated with clinical presentation in close contacts.

Lipoprotein (a) [Lp(a)], synthesized by the liver, is a cholesterol-laden LDL-like particle, consisting of a moiety of apo(a) covalently attached to one molecule of apoB100 via a disulfi de bond ( 1 ). The concentration of Lp(a) was found to a large extent genetically determined via variations in the LPA gene, especially the LPA kringle IV repeats, which encode apo(a) and exist in multiple copies ( 2 ). Both serum Lp(a) levels and LPA gene variants have been reported strongly associated with the risk of CVD ( 3-5 ).Because diabetes predisposes individuals toward CVD, a similar association between circulating Lp(a) levels and Abstract Lipoprotein (a) [Lp(a)], an LDL-like particle, has been proposed as a causal risk factor for CVD among general populations. Meanwhile, both serum Lp(a) and diabetes increase the risk of CVD. However, the relationship between serum Lp(a) and T2D is poorly characterized, especially in the Asian population. Therefore, we conducted a cross-sectional study in 10,122 participants aged 40 years or older in Jiading District, Shanghai, China. Our study found that the prevalence of T2D was decreased from 20.9% to 15.0% from the lowest quartile to the highest quartile of serum Lp(a) concentrations ( P for trend <0.0001). Logistic regression analyses showed that the odds ratios and 95% confi dence intervals of prevalent T2D for quartiles 2-4 versus quartile 1 were 0.86 (0.73-1.01), 0.88 (0.75-1.04), and 0.76 (0.64-0.90) ( P for trend = 0.0002), after adjustment for traditional confounding factors. Moreover, the risks for prevalent prediabetes, insulin resistance, and hyperinsulinemia were also decreased from the lowest to the top quartile. This inverse association between serum Lp(a) and T2D was not appreciably changed after we adjusted hypoglycemic medications or excluded the subjects with hypoglycemic and/or lipid-lowering agents and/or a history of self-reported CVD. (81321001, 81390350, 81222008, and 81130016), the Shanghai Municipal of Science and Technology (13495810200) 24 January 2015. Published, JLR Papers in Press, February 3, 2015 DOI 10.1194 Serum lipoprotein (a) concentrations are inversely associated with T2D, prediabetes, and insulin resistance in a middle-aged and elderly Chinese population Abbreviations: 2 hPG, 2 h 75 g oral glucose tolerance test plasma glucose; CCHS, Copenhagen City Heart Study; CI, confi dence interval; DBP, diastolic blood pressure; FPG, fasting plasma glucose; FSI, fasting serum insulin; HbA1C, hemoglobin A1C; HDL-C, high density lipoprotein cholesterol; HOMA-IR, homeostasis model assessment for insulin resistance; LDL-C, low density lipoprotein cholesterol; lg, logarithmically transformed; Lp(a), lipoprotein (a); MET-h/week, metabolic equivalent hours per week; OGTT, oral glucose tolerance test; OR, odds ratio; SBP, systolic blood pressure; TC, total cholesterol; WC, waist circumference; WHS , Women's Health Study. This work was supported by grants from the Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health (1994DP131044), the N...

Prolactin plays an important role in maintaining a normal glucose homeostasis during pregnancy and beyond. Studies investigating the association between prolactin and type 2 diabetes beyond pregnancy are rare and none is prospective. We aimed to examine whether prolactin associates with type 2 diabetes prospectively in a Chinese population. In 2009, 2,377 participants aged 40 years or older were enrolled from Shanghai, China. Among 1,596 diabetes-free participants at baseline, 1,510 completed the follow-up investigation in 2013. Participants who had a fasting plasma glucose ≥126 mg/dL and/or a 2-hour plasma glucose ≥200 mg/dL during a 75-g oral glucose tolerance test had a definite diagnosis of type 2 diabetes or received antidiabetic therapies during follow-up were classified as having type 2 diabetes. During a mean follow-up of 3.7 years, 189 new cases of type 2 diabetes were documented. After multivariate adjustment, women in the highest quartile of prolactin showed the lowest risk for diabetes compared with those in the lowest quartile (hazard ratio = 0.48, 95% confidence interval: 0.26, 0.90). However, such significant associations were not observed in men. Prolactin may be a mediator in the pathogenesis of type 2 diabetes in women; however, more studies are needed to elucidate the underlying sex-specific mechanism.