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  1. Fulltext Conceptualizing a Sustainable Food System in an Automated World: Toward a "Eudaimonian" Future
    Shepon A, Henriksson PJG, Wu T
    Front Nutr, 2018;5:104.
    PMID: 30456214 DOI: 10.3389/fnut.2018.00104
    The industrialized world has entered a new era of widespread automation, and although this may create long-term gains in economic productivity and wealth accumulation, many professions are expected to disappear during the ensuing shift, leading to potentially significant disruptions in labor markets and associated socioeconomic difficulties. Food production, like many other industrial sectors, has also undergone a century of mechanization, having moved toward increasingly large-scale monoculture production-especially in developed economies-with higher yields but detrimental environmental impacts on a global scale. Certain characteristics of the food sector and its products cast doubts on whether future automation will influence it in the same ways as in other sectors. We conceptualize a model of future food production within the socioeconomic conditions created by widespread automation. We ideate that despite immediate shocks to the economy, in the long run higher productivity can free up human activity to be channeled toward more interactive, skill-intensive food production systems, where communal efforts can reduce industrial reliance, diversify farming, and reconnect people to the biosphere-a realization of human well-being that resembles the classical philosophical ideal of Eudaimonia. We explore food production concepts, such as communal gardens and polyculture, and the economic conditions and institutions needed to underwrite them [e.g., a universal basic income (UBI)]. However, arguments can be raised as to why social-ecological systems would benefit from more labor-intensive food production. In this paper we: (1) discuss the current state of the food system and the need to reform it in light of its environmental and social impacts; (2) present automation as a lever that could move society toward more sustainable food production; (3) highlight the beneficial attributes of a Eudaimonian model; and (4) discuss the potential challenges to its implementation. Our purpose is to highlight a possible outcome that future research will need to refine and expand based on evidence and successful case studies. The ultimate aim is to promote a food system that can provide food security while staying within the safe operating space of planetary boundaries, produce more nutritious diets, enhance social capital, and reconnect communities with the biosphere.
  2. Reaction-diffusion model to quantify and visualize mass transfer and deactivation within core-shell polymeric microreactors
    Goh KB, Li Z, Chen X, Liu Q, Wu T
    J Colloid Interface Sci, 2022 Feb 15;608(Pt 2):1999-2008.
    PMID: 34749148 DOI: 10.1016/j.jcis.2021.10.092
    HYPOTHESIS: The performance of a polymeric core-shell microreactor depends critically on (i) mass transfer, (ii) catalyzed chemical reaction, and (iii) deactivation within the nonuniform core-shell microstructure environment. As such, these three basic working principles control the active catalytic phase density in the reactor.

    THEORY: We present a high-fidelity, image-based nonequilibrium computational model to quantify and visualize the mass transport as well as the deactivation process of a core-shell polymeric microreactor. In stark contrast with other published works, our microstructure-based computer simulation can provide a single-particle visualization with a micrometer spatial accuracy.

    FINDINGS: We show how the interplay of kinetics and thermodynamics controls the product-induced deactivation process. The model predicts and visualizes the non-trivial, spatially resolved active catalyst phase patterns within a core-shell system. Moreover, we also show how the microstructure influences the formation of foulant within a core-shell structure; that is, begins from the core and grows radially onto the shell section. Our results suggest that the deactivation process is highly governed by the porosity/microstructure of the microreactor as well as the affinity of the products towards the solid phase of the reactor.

  3. Perampanel, an AMPA receptor antagonist: From clinical research to practice in clinical settings
    Tsai JJ, Wu T, Leung H, Desudchit T, Tiamkao S, Lim KS, et al.
    Acta Neurol. Scand., 2018 Apr;137(4):378-391.
    PMID: 29214650 DOI: 10.1111/ane.12879
    Epileptic seizures are refractory to treatment in approximately one-third of patients despite the recent introduction of many newer antiepileptic drugs (AEDs). Development of novel AEDs therefore remains a high priority. Perampanel is a first-in-class non-competitive selective AMPA receptor antagonist with a unique mechanism of action. Clinical efficacy and safety of perampanel as adjunctive treatment for focal seizures with/without secondary generalization (±SG) and primary generalized tonic-clonic (PGTC) seizures have been established in five phase 3 randomized controlled trials (RCTs), and a long-term extension study, and perampanel is approved as monotherapy for focal seizures ±SG in the USA. In patients with focal seizures ±SG, add-on perampanel resulted in median percent reduction in seizure frequency 23.3%-34.5% and ≥50% responder rate 28.5%-37.6%; in PGTC seizures, these results were 76.5% and 64.2%, respectively. Efficacy among adolescents (reduction in seizure frequency 34.8%-35.6%; ≥50% responder rate 40.9%-45.0%) and elderly people (reduction in seizure frequency 12.5%-16.9%; ≥50% responder rate 22.2%-42.9%) is similar to those in adults, and results remain comparable between Asian (reduction in seizure frequency 17.3%-38.0%) and global populations. Perampanel has been extensively studied in real-world clinical practice, with similar efficacy and safety results to the RCTs (≥50% responder rate 12.8%-75.0%; adverse events of somnolence/sedation, dizziness, ataxia, and behavioral changes). Real-world observational studies suggest that perampanel tolerability can be improved by slow titration (2 mg every 2-4 weeks), and bedtime administration can mitigate somnolence and dizziness. Counseling about the potential for behavioral changes and close monitoring are recommended.
  4. Fulltext Ultrasonic liquid exfoliation for producing graphene materials from rice stem: Investigating cellular components and functionalities
    Wu X, Sivakumar M, Lim SS, Wu T, Heng PC
    Ultrason Sonochem, 2024 Feb;103:106782.
    PMID: 38309050 DOI: 10.1016/j.ultsonch.2024.106782
    This study investigates a prospective and straightforward method for producing graphene material derived from biomass, examining the influence of plant cell composition and functions. The experimental outcomes highlight ultrasound's crucial role in synthesizing graphene material sourced from biomass. Ultrasound, a pivotal element in the experiment, significantly affects graphene production from biomass by working synergistically with the liquid components in the solvent system. Notably, the ethanol content reduces the solution's surface tension, facilitating the effective dispersion of biochar and graphene oxide sheets throughout the process. Simultaneously, the water content maintains the solution's polarity, enhancing the cavitation effect induced by ultrasound. Biomass-derived graphene is exfoliated utilizing an ultrasonic bath system (134.4 W, 40 kHz, 0.5 W/cm2) from biochar. The as-synthesized graphene oxide exhibits a structure comprising a few layers while remaining intact, featuring abundant functional groups. Interestingly, the resulting product displays nanopores with an approximate diameter of 100 nm. These nanopores are attributed to preserving specific cell structures, particularly those with specialized cell wall structures or secondary metabolite deposits from biomass resources. The study's findings shed light on the impact of cellular structure on synthesizing graphene material sourced from biomass, emphasizing the potential application of ultrasound as a promising approach in graphene production.
  5. Fulltext Draft Genome Sequence of Clostridium sp. Strain Ade.TY, a New Biohydrogen- and Biochemical-Producing Bacterium Isolated from Landfill Leachate Sludge
    Wong YM, Juan JC, Ting A, Wu TY, Gan HM, Austin CM
    Genome Announc, 2014;2(2).
    PMID: 24604640 DOI: 10.1128/genomeA.00078-14
    Clostridium sp. strain Ade.TY is potentially a new biohydrogen-producing species isolated from landfill leachate sludge. Here we present the assembly and annotation of its genome, which may provide further insights into its gene interactions for efficient biohydrogen production.
  6. NES-REBS: A novel nuclear export signal prediction method using regular expressions and biochemical properties
    Wu T, Wang X, Zhang Z, Gong F, Song T, Chen Z, et al.
    J Bioinform Comput Biol, 2016 06;14(3):1650013.
    PMID: 27225342 DOI: 10.1142/S021972001650013X
    A nuclear export signal (NES) is a protein localization signal, which is involved in binding of cargo proteins to nuclear export receptor, thus contributes to regulate localization of cellular proteins. Consensus sequences of NES have been used to detect NES from protein sequences, but suffer from poor predictive power. Some recent peering works were proposed to use biochemical properties of experimental verified NES to refine NES candidates. Those methods can achieve high prediction rates, but their execution time will become unacceptable for large-scale NES searching if too much properties are involved. In this work, we developed a novel computational approach, named NES-REBS, to search NES from protein sequences, where biochemical properties of experimental verified NES, including secondary structure and surface accessibility, are utilized to refine NES candidates obtained by matching popular consensus sequences. We test our method by searching 262 experimental verified NES from 221 NES-containing protein sequences. It is obtained that NES-REBS runs in 2-3[Formula: see text]mins and performs well by achieving precision rate 47.2% and sensitivity 54.6%.
  7. The role of digestive factors in determining glycemic response in a multiethnic Asian population
    Tan VM, Ooi DS, Kapur J, Wu T, Chan YH, Henry CJ, et al.
    Eur J Nutr, 2016 Jun;55(4):1573-81.
    PMID: 26160548 DOI: 10.1007/s00394-015-0976-0
    PURPOSE: There are wide inter-individual differences in glycemic response (GR). We aimed to examine key digestive parameters that influence inter-individual and ethnic differences in GR in healthy Asian individuals.
    METHODS: Seventy-five healthy male subjects (25 Chinese, 25 Malays, and 25 Asian-Indians) were served equivalent available carbohydrate amounts (50 g) of jasmine rice (JR) and basmati rice (BR) on separate occasions. Postprandial blood glucose concentrations were measured at fasting (-5 and 0 min) and at 15- to 30-min interval over 180 min. Mastication parameters (number of chews per mouth and chewing time per mouthful), saliva α-amylase activity, AMY1 gene copy numbers and gastric emptying rate were measured to investigate their relationships with GR.
    RESULTS: The GR for jasmine rice was significantly higher than for basmati rice (P 0.05).
    CONCLUSION: Mastication parameters contribute significantly to GR. Eating slowly and having larger food boluses before swallowing (less chewing), both potentially modifiable, may be beneficial in glycemic control.
  8. Fulltext The First 75 Days of Novel Coronavirus (SARS-CoV-2) Outbreak: Recent Advances, Prevention, and Treatment
    Yan Y, Shin WI, Pang YX, Meng Y, Lai J, You C, et al.
    Int J Environ Res Public Health, 2020 03 30;17(7).
    PMID: 32235575 DOI: 10.3390/ijerph17072323
    The recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, previously known as 2019-nCoV) outbreak has engulfed an unprepared world amidst a festive season. The zoonotic SARS-CoV-2, believed to have originated from infected bats, is the seventh member of enveloped RNA coronavirus. Specifically, the overall genome sequence of the SARS-CoV-2 is 96.2% identical to that of bat coronavirus termed BatCoV RaTG13. Although the current mortality rate of 2% is significantly lower than that of SARS (9.6%) and Middle East respiratory syndrome (MERS) (35%), SARS-CoV-2 is highly contagious and transmissible from human to human with an incubation period of up to 24 days. Some statistical studies have shown that, on average, one infected patient may lead to a subsequent 5.7 confirmed cases. Since the first reported case of coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 on December 1, 2019, in Wuhan, China, there has been a total of 60,412 confirmed cases with 1370 fatalities reported in 25 different countries as of February 13, 2020. The outbreak has led to severe impacts on social health and the economy at various levels. This paper is a review of the significant, continuous global effort that was made to respond to the outbreak in the first 75 days. Although no vaccines have been discovered yet, a series of containment measures have been implemented by various governments, especially in China, in the effort to prevent further outbreak, whilst various medical treatment approaches have been used to successfully treat infected patients. On the basis of current studies, it would appear that the combined antiviral treatment has shown the highest success rate. This review aims to critically summarize the most recent advances in understanding the coronavirus, as well as the strategies in prevention and treatment.
  9. Nest site selection for five common birds and their coexistence in an urban habitat
    Han Y, Bai J, Zhang Z, Wu T, Chen P, Sun G, et al.
    Sci Total Environ, 2019 Nov 10;690:748-759.
    PMID: 31302540 DOI: 10.1016/j.scitotenv.2019.06.508
    Many species of birds gradually adapt to urbanization and colonize cities successfully. However, their nest site selection and competitive relationship in an urban community remain little known. Understanding the impact of urbanization on birds and the competitive relationship has important implications for the conservation and management of wildlife in urban ecosystems. Here, we undertook a systematic study to quantify nests in all species of birds in an urbanizing area of Nanchang, China. A total of 363 nests were detected in surveys including 340 nests of 16 bird species and 23 unidentified species nests. We mainly analyzed 5 dominant breeding birds with a sample size of >10 during the two breeding seasons (From April to July in 2016 and 2017), which included the light-vented bulbul, Chinese blackbird, scaly-breasted munia, spotted dove and grey-capped greenfinch. Most birds (93.66%) nested in the tree of artificial green belts, which seems to be the best breeding habitat for urban birds. Our results suggested that birds' breeding success relies on the trade-off between the benefit and the expense of specific stresses from habitats. The nest site selection of birds is also affected by the life habit of urban predators. Furthermore, competition among species can influence their distributions and utilization of environmental resources when birds nest in cities. We confirmed that the niche differentiation of five bird species in an urban environment makes them coexist successfully by utilizing various resources.
  10. The study of seroprevalence of hepatitis E virus and an investigation into the lifestyle behaviours of the aborigines in Malaysia
    Wong LP, Alias H, Choy SH, Goh XT, Lee SC, Lim YAL, et al.
    Zoonoses Public Health, 2020 05;67(3):263-270.
    PMID: 31927794 DOI: 10.1111/zph.12681
    Malaysia is a non-endemic country for hepatitis E virus (HEV) infection. However, seroprevalence as high as 50% among samples of aboriginal people were reported over two decades ago. A total of 207 samples collected from seven aboriginal villages in rural settlements across two states in Malaysia were analysed for anti-HEV IgG and IgM by an enzyme-linked immunoassay. Following the detection of anti-HEV seroprevalence, we organized health outreach to inform and educate the community. Qualitative interviews were conducted with individuals tested positive for anti-HEV antibodies. Data derived from interviews and observations were used to investigate possible lifestyle behaviours associated with HEV infection. Anti-HEV IgG was detected in six samples (5.9%) from the village of Dusun Kubur. Qualitative inquiry and observation study revealed poor dietary and household hygiene, contaminated food and water, contact with animal faeces, unsanitary and domestic waste disposal, and wildlife reservoirs could be the contributing factors for transmission and acquisition of HEV infection. Investigation during health outreach is important to provide insights for future empirical research and implementation for improvement of lifestyle behaviours among the aborigines. Managing the risk of HEV infection in the aborigines may reduce the risk of HEV transmission to the local communities.
  11. Fulltext Human iPS-derived pre-epicardial cells direct cardiomyocyte aggregation expansion and organization in vitro
    Tan JJ, Guyette JP, Miki K, Xiao L, Kaur G, Wu T, et al.
    Nat Commun, 2021 08 17;12(1):4997.
    PMID: 34404774 DOI: 10.1038/s41467-021-24921-z
    Epicardial formation is necessary for normal myocardial morphogenesis. Here, we show that differentiating hiPSC-derived lateral plate mesoderm with BMP4, RA and VEGF (BVR) can generate a premature form of epicardial cells (termed pre-epicardial cells, PECs) expressing WT1, TBX18, SEMA3D, and SCX within 7 days. BVR stimulation after Wnt inhibition of LPM demonstrates co-differentiation and spatial organization of PECs and cardiomyocytes (CMs) in a single 2D culture. Co-culture consolidates CMs into dense aggregates, which then form a connected beating syncytium with enhanced contractility and calcium handling; while PECs become more mature with significant upregulation of UPK1B, ITGA4, and ALDH1A2 expressions. Our study also demonstrates that PECs secrete IGF2 and stimulate CM proliferation in co-culture. Three-dimensional PEC-CM spheroid co-cultures form outer smooth muscle cell layers on cardiac micro-tissues with organized internal luminal structures. These characteristics suggest PECs could play a key role in enhancing tissue organization within engineered cardiac constructs in vitro.
  12. Fulltext The Risk of Transfusion-Transmitted Hepatitis E Virus: Evidence from Seroprevalence Screening of Blood Donations
    Wong LP, Lee HY, Khor CS, Abdul-Jamil J, Alias H, Abu-Amin N, et al.
    Indian J Hematol Blood Transfus, 2021 Apr 16.
    PMID: 33879981 DOI: 10.1007/s12288-021-01428-7
    Throughout the world, there has been growing concern over the risk of hepatitis E virus (HEV) transmission via blood transfusion. The present study screened blood donor samples for anti-HEV immunoglobulin M (IgM) and immunoglobulin G (IgG). The prevalence of HEV infection was assessed on a total of 1,003 archived serum samples obtained from the National Blood Centre, Malaysia. The samples were collected from healthy blood donor from Klang Valley between 2017 and 2018. All samples were tested for IgM and IgG antibodies to HEV using enzyme-linked immunosorbent assays (ELISA). HEV-specific IgG antibodies were detected in 31/1003 (3.1%; 95% confidence interval [CI] 2.1%-4.4%) and IgM in 9/1003 (0.9%; 95% CI 0.4%-1.7%) samples. In bivariate analysis, there was no significant difference in the prevalence of anti-HEV IgG with respect to gender and district of origin. Although not statistically significant, males had higher odds of having anti-HEV IgG than females (odds ratio [OR] = 2.86; 95% CI 0.95-8.64). All anti-HEV IgG positive individuals were people of Chinese descent. Anti-HEV IgG increased significantly with age, from 0.6% (95% CI 0.1%-2.6%) of 18-30-year-old donors to 7.4% (95% CI 2.7%-17.0%) of donors older than 50 years and was highest among non-professional workers (5.3%; 95% CI 2.5%-10.5%). Increasing age and a non-professional occupation remained significant predictors for anti-HEV IgG in the multivariable analysis. Screening of blood donations for HEV in Malaysia is important to safeguard the health of transfusion recipients. The higher rates of HEV infection in blood from older donors and donors who are non-professional workers may provide insights into targeted groups for blood screening.
  13. Metabolic glycan labeling and chemoselective functionalization of native biomaterials
    Ren X, Evangelista-Leite D, Wu T, Rajab TK, Moser PT, Kitano K, et al.
    Biomaterials, 2018 11;182:127-134.
    PMID: 30118980 DOI: 10.1016/j.biomaterials.2018.08.012
    Decellularized native extracellular matrix (ECM) biomaterials are widely used in tissue engineering and have reached clinical application as biomesh implants. To enhance their regenerative properties and postimplantation performance, ECM biomaterials could be functionalized via immobilization of bioactive molecules. To facilitate ECM functionalization, we developed a metabolic glycan labeling approach using physiologic pathways to covalently incorporate click-reactive azide ligands into the native ECM of a wide variety of rodent tissues and organs in vivo, and into the ECM of isolated rodent and porcine lungs cultured ex vivo. The incorporated azides within the ECM were preserved after decellularization and served as chemoselective ligands for subsequent bioconjugation via click chemistry. As proof of principle, we generated alkyne-modified heparin, immobilized it onto azide-incorporated acellular lungs, and demonstrated its bioactivity by Antithrombin III immobilization and Factor Xa inhibition. The herein reported metabolic glycan labeling approach represents a novel platform technology for manufacturing click-reactive native ECM biomaterials, thereby enabling efficient and chemoselective functionalization of these materials to facilitate tissue regeneration and repair.
  14. Fulltext Advances in hematopoietic stem cell transplantation in the Asia-Pacific region: the second report from APBMT 2005-2015
    Iida M, Kodera Y, Dodds A, Ho AYL, Nivison-Smith I, Akter MR, et al.
    Bone Marrow Transplant, 2019 Dec;54(12):1973-1986.
    PMID: 31089289 DOI: 10.1038/s41409-019-0554-9
    Between 2005 and 2015, 138,165 hematopoietic stem cell transplantation (HSCT) were reported in 18 countries/regions in the Asia-Pacific region. In this report, we describe current trends in HSCT throughout the Asia-Pacific region and differences among nations in this region and various global registries. Since 2008, more than 10,000 HSCTs have been recorded each year by the Asia-Pacific Blood and Marrow Transplantation Group Data Center. Between 2005 and 2015, the greatest increase in the number of HSCTs was observed in Vietnam. Allogeneic HSCT was performed more frequently than autologous HSCT, and a majority of cases involved related donors. Regarding allogeneic HSCT, the use of cord blood has remained steady, especially in Japan, and the number of cases involving related HLA non-identical donors has increased rapidly, particularly in China. The incidence of hemoglobinopathy, a main indication for allogeneic HSCT in India, China, Iran, and Pakistan, increased nearly six-fold over the last decade. Among the 18 participating countries/regions, the transplant rate per population varied widely according to the absolute number of HSCTs and the national/regional population size. We believe that this report will not only benefit the AP region but will also provide information about HSCT to other regions worldwide.
  15. Genetic variants associated with phenytoin-related severe cutaneous adverse reactions
    Chung WH, Chang WC, Lee YS, Wu YY, Yang CH, Ho HC, et al.
    JAMA, 2014 Aug 6;312(5):525-34.
    PMID: 25096692 DOI: 10.1001/jama.2014.7859
    The antiepileptic drug phenytoin can cause cutaneous adverse reactions, ranging from maculopapular exanthema to severe cutaneous adverse reactions, which include drug reactions with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis. The pharmacogenomic basis of phenytoin-related severe cutaneous adverse reactions remains unknown.
  16. Fulltext The Tsinghua-Lancet Commission on Healthy Cities in China: unlocking the power of cities for a healthy China
    Yang J, Siri JG, Remais JV, Cheng Q, Zhang H, Chan KKY, et al.
    Lancet, 2018 05 26;391(10135):2140-2184.
    PMID: 29678340 DOI: 10.1016/S0140-6736(18)30486-0
  17. IDRiD: Diabetic Retinopathy - Segmentation and Grading Challenge
    Porwal P, Pachade S, Kokare M, Deshmukh G, Son J, Bae W, et al.
    Med Image Anal, 2020 01;59:101561.
    PMID: 31671320 DOI: 10.1016/j.media.2019.101561
    Diabetic Retinopathy (DR) is the most common cause of avoidable vision loss, predominantly affecting the working-age population across the globe. Screening for DR, coupled with timely consultation and treatment, is a globally trusted policy to avoid vision loss. However, implementation of DR screening programs is challenging due to the scarcity of medical professionals able to screen a growing global diabetic population at risk for DR. Computer-aided disease diagnosis in retinal image analysis could provide a sustainable approach for such large-scale screening effort. The recent scientific advances in computing capacity and machine learning approaches provide an avenue for biomedical scientists to reach this goal. Aiming to advance the state-of-the-art in automatic DR diagnosis, a grand challenge on "Diabetic Retinopathy - Segmentation and Grading" was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI - 2018). In this paper, we report the set-up and results of this challenge that is primarily based on Indian Diabetic Retinopathy Image Dataset (IDRiD). There were three principal sub-challenges: lesion segmentation, disease severity grading, and localization of retinal landmarks and segmentation. These multiple tasks in this challenge allow to test the generalizability of algorithms, and this is what makes it different from existing ones. It received a positive response from the scientific community with 148 submissions from 495 registrations effectively entered in this challenge. This paper outlines the challenge, its organization, the dataset used, evaluation methods and results of top-performing participating solutions. The top-performing approaches utilized a blend of clinical information, data augmentation, and an ensemble of models. These findings have the potential to enable new developments in retinal image analysis and image-based DR screening in particular.
  18. Fulltext Female chromosome X mosaicism is age-related and preferentially affects the inactivated X chromosome
    Machiela MJ, Zhou W, Karlins E, Sampson JN, Freedman ND, Yang Q, et al.
    Nat Commun, 2016 06 13;7:11843.
    PMID: 27291797 DOI: 10.1038/ncomms11843
    To investigate large structural clonal mosaicism of chromosome X, we analysed the SNP microarray intensity data of 38,303 women from cancer genome-wide association studies (20,878 cases and 17,425 controls) and detected 124 mosaic X events >2 Mb in 97 (0.25%) women. Here we show rates for X-chromosome mosaicism are four times higher than mean autosomal rates; X mosaic events more often include the entire chromosome and participants with X events more likely harbour autosomal mosaic events. X mosaicism frequency increases with age (0.11% in 50-year olds; 0.45% in 75-year olds), as reported for Y and autosomes. Methylation array analyses of 33 women with X mosaicism indicate events preferentially involve the inactive X chromosome. Our results provide further evidence that the sex chromosomes undergo mosaic events more frequently than autosomes, which could have implications for understanding the underlying mechanisms of mosaic events and their possible contribution to risk for chronic diseases.
  19. Fulltext Global Impact of COVID-19 on Stroke Care and IV Thrombolysis
    Nogueira RG, Qureshi MM, Abdalkader M, Martins SO, Yamagami H, Qiu Z, et al.
    Neurology, 2021 Jun 08;96(23):e2824-e2838.
    PMID: 33766997 DOI: 10.1212/WNL.0000000000011885
    OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.

    METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.

    RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions.

    CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

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