A retrospective analysis of first-line PD-1 monoclonal antibodies treatment in patients with leptomeningeal metastasis from solid tumors.

INTRODUCTION: Patients whose solid tumors (ST) show leptomeningeal metastasis (LM) have very poor prognosis and short overall survival. The aim of this study was to evaluate the efficacy of first-line programed death-1(PD-1) monoclonal antibody (mAb) treatment in these patients. METHODS: We retrospectively evaluated patients diagnosed with LM from ST who were treated with first-line PD-1 mAb at our hospital between April 1 and November 30, 2019. We analyzed their clinicopathological characteristics and response to the treatment. RESULTS: We collected and analyzed data from 6 patients with different primary ST. 5 patients received PD-1 mAb combined with chemotherapy and/or anti-angiogenic drugs, while one received only PD-1 mAb. The median (range) number of treatment cycles was 5.5 (1-21). PD-1 mAb treatment did not cause neurotoxicity. The time period of first assessment varied from 21 to 65 days after treatment. Among 5 patients who got obvious symptoms relief, 4 patients persisted for > 3 months and even showed a reduction in the number of tumor cells in cerebrosprinal fluid. Ventriculoperitoneal (VP) shunt was used to treat hydrocephalus observed beneficial in 3 patients: 2 before and 1 after PD-1 mAb treatment. The median (range) follow-up time was 214 (57-460) days. 4 patients died. The overall survival ranged from 57 days to at least 460 days. 1 of the two alive patients continued to show no worsening of symptoms after 457 days. CONCLUSIONS: Patients with LM from ST can benefit from first-line PD-1 mAb combined treatment without additional neurotoxicity. Further research is required to validate the safety and efficacy.

Characteristics and sources of carbonaceous aerosols in a semi-arid city: Quantifying anthropogenic and meteorological impacts.

Carbonaceous aerosols have great adverse impacts on air quality, human health, and climate. However, there is a limited understanding of carbonaceous aerosols in semi-arid areas. The correlation between carbonaceous aerosols and control measures is still unclear owing to the insufficient information regarding meteorological contribution. To reveal the complex relationship between control measures and carbonaceous aerosols, offline and online observations of carbonaceous aerosols were conducted from October 8, 2019 to October 7, 2020 in Hohhot, a semi-arid city. The characteristics and sources of carbonaceous aerosols and impacts of anthropogenic emissions and meteorological conditions were studied. The annual mean concentrations (± standard deviation) of fine particulate matter (PM2.5), organic carbon (OC), and elemental carbon (EC) were 42.81 (±40.13), 7.57 (±6.43), and 2.25 (±1.39) µg m-3, respectively. The highest PM2.5 and carbonaceous aerosol concentrations were observed in winter, whereas the lowest was observed in summer. The result indicated that coal combustion for heating had a critical role in air quality degradation in Hohhot. A boost regression tree model was applied to quantify the impacts of anthropogenic emissions and meteorological conditions on carbonaceous aerosols. The results suggested that the anthropogenic contributions of PM2.5, OC, and EC during the COVID-19 lockdown period were 53.0, 15.0, and 2.36 µg m-3, respectively, while the meteorological contributions were 5.38, 2.49, and -0.62 µg m-3, respectively. Secondary formation caused by unfavorable meteorological conditions offset the emission reduction during the COVID-19 lockdown period. Coal combustion (46.4% for OC and 35.4% for EC) and vehicular emissions (32.0% for OC and 50.4% for EC) were the predominant contributors of carbonaceous aerosols. The result indicated that Hohhot must regulate coal use and vehicle emissions to reduce carbonaceous aerosol pollution. This study provides new insights and a comprehensive understanding of the complex relationships between control strategies, meteorological conditions, and air quality.

Effectiveness of COVID-19 Vaccination Against SARS-CoV-2 Omicron Variant Infection and Symptoms - China, December 2022-February 2023.

What is already known about this topic?: A considerable percentage of the population has received both primary and booster vaccinations, which could potentially provide protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron infections and related symptoms. What is added by this report?: The self-reported infection rate, as determined from an online survey, reached its peak (15.5%) between December 19 and 21, 2022, with an estimated 82.4% of individuals in China being infected as of February 7, 2023. During the epidemic, the effectiveness of booster vaccinations against SARS-CoV-2 Omicron infection was found to be 49.0% within three months of vaccination and 37.9% between 3 and 6 months following vaccination. Furthermore, the vaccine effectiveness of the booster vaccination in relation to symptom prevention varied from 48.7% to 83.2% within three months and from 25.9% to 69.0% between 3 and 6 months post-booster vaccination. What are the implications for public health practice?: The development and production of efficacious vaccines, together with prompt vaccinations or emergency vaccinations, have the potential to mitigate the epidemic's impact and safeguard public health.

Asian American mental health amidst COVID-19 anti-Asian racism: Internalized racism and generational status as moderators

In a national sample of 565 Asian Americans, this study investigates whether direct experiences of coronavirus disease (COVID-19) racism or vicarious exposure (e.g., witnessing, news reports, videos, and stories) of others experiencing COVID-19 racism lead to adverse mental health outcomes above and beyond the impact of general COVID-19 stressors. We used moderated moderation models to test our hypotheses of main effects and three-way interaction effects using the PROCESS Macro in SPSS (Hayes, 2017). Our results showed that both direct and vicarious experience of COVID-related racism significantly and positively predicted depressive, anxiety, and somatic symptoms, above and beyond the impact of general COVID-related stressors. In addition, the three-way interaction of COVID-related racism, internalized racism, and generational status was significant in three out of four models. There was a significant interaction effect such that higher levels of internalized racism mitigated the strength of the relation of COVID-related direct and vicarious racism on depression and anxiety symptoms for 1.5 and 2nd+ generation Asian Americans. For 1st generation Asian Americans, internalized racism exacerbated the impact of vicarious COVID-related racism on somatic symptoms. Our findings revealed the nature of how immigration generational status and internalized racism moderated the relations between COVID-related racism and psychological wellbeing for Asian Americans during a public health crisis. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement What is the public significance of this article?-The study shows that direct and vicarious COVID-19-related racism was detrimental to Asian Americans' mental health. Additionally, the study revealed that the risk for adverse mental health outcomes depends on internalized racism beliefs and generational status, jointly. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

In Silico Discovery of Small Molecule Modulators Targeting the Achilles' Heel of SARS-CoV-2 Spike Protein.

The spike protein of SARS-CoV-2 has been a promising target for developing vaccines and therapeutics due to its crucial role in the viral entry process. Previously reported cryogenic electron microscopy (cryo-EM) structures have revealed that free fatty acids (FFA) bind with SARS-CoV-2 spike protein, stabilizing its closed conformation and reducing its interaction with the host cell target in vitro. Inspired by these, we utilized a structure-based virtual screening approach against the conserved FFA-binding pocket to identify small molecule modulators of SARS-CoV-2 spike protein, which helped us identify six hits with micromolar binding affinities. Further evaluation of their commercially available and synthesized analogs enabled us to discover a series of compounds with better binding affinities and solubilities. Notably, our identified compounds exhibited similar binding affinities against the spike proteins of the prototypic SARS-CoV-2 and a currently circulating Omicron BA.4 variant. Furthermore, the cryo-EM structure of the compound SPC-14 bound spike revealed that SPC-14 could shift the conformational equilibrium of the spike protein toward the closed conformation, which is human ACE2 (hACE2) inaccessible. Our identified small molecule modulators targeting the conserved FFA-binding pocket could serve as the starting point for the future development of broad-spectrum COVID-19 intervention treatments.

Working from Home in Urban China during the COVID-19 Pandemic: Assemblages of Work-Family Interference.

During the COVID-19 pandemic, millions of workers globally have been forced to work from home. Empirical data from Chinese cities in the Hubei province reveal work productivity decreased among many respondents working from home in 2020, primarily due to family interference with work. Such interference stems not only from the domain of daily life but also from other family members' e-working and e-learning. Conversely, respondents' work interferes with family; thus, interference operates bi-directionally. This article proposes an analytical framework of work-family interference along three dimensions: work-daily life, work-work, work-study, and each dimension can be understood through four distinct aspects: temporality, physicality, vocality, digitality. Remote workers encounter 'assemblages of work-family interference', consisting of a heterogeneous mixture of these dimensions and aspects. Furthermore, some factors (e.g., living patterns, work culture, digital infrastructure) constrain effective work-family boundary management among urban households.

In Silico Discovery of Small Molecule Modulators Targeting the Achilles' Heel of SARS-CoV-2 Spike Protein

The spike protein of SARS-CoV-2 has been a promising target for developing vaccines and therapeutics due to its crucial role in the viral entry process. Previously reported cryogenic electron microscopy (cryo-EM) structures have revealed that free fatty acids (FFA) bind with SARS-CoV-2 spike protein, stabilizing its closed conformation and reducing its interaction with the host cell target in vitro. Inspired by these, we utilized a structure-based virtual screening approach against the conserved FFA-binding pocket to identify small molecule modulators of SARS-CoV-2 spike protein, which helped us identify six hits with micromolar binding affinities. Further evaluation of their commercially available and synthesized analogs enabled us to discover a series of compounds with better binding affinities and solubilities. Notably, our identified compounds exhibited similar binding affinities against the spike proteins of the prototypic SARS-CoV-2 and a currently circulating Omicron BA.4 variant. Furthermore, the cryo-EM structure of the compound SPC-14 bound spike revealed that SPC-14 could shift the conformational equilibrium of the spike protein toward the closed conformation, which is human ACE2 (hACE2) inaccessible. Our identified small molecule modulators targeting the conserved FFA-binding pocket could serve as the starting point for the future development of broad-spectrum COVID-19 intervention treatments. Computationally identified compound SPC-14 stabilizes the ACE2-inaccessible closed conformation of the SARS-CoV-2 spike protein by targeting a less mutation-prone free fatty acids-binding pocket.

Spatiotemporal Evolution of Carbon Emissions According to Major Function-Oriented Zones: A Case Study of Guangdong Province, China.

Studying the spatiotemporal evolution of carbon emissions from the perspective of major function-oriented zones (MFOZs) is crucial for making a carbon reduction policy. However, most previous research has ignored the spatial characteristics and MFOZ influence. Using statistical and spatial analysis tools, we explored the spatiotemporal characteristics of carbon emissions in Guangdong Province from 2001 to 2021. The following results were obtained: (1) Carbon emissions fluctuated from 2020 to 2021 because of COVID-19. (2) Over the last 20 years, the proportion of carbon emissions from urbanization development zones (UDZs) has gradually decreased, whereas those of the main agricultural production zones (MAPZs) and key ecological function zones (KEFZs) have increased. (3) Carbon emissions efficiency differed significantly among the three MFOZs. (4) Carbon emissions from coastal UDZs were increasingly apparent; however, the directional characteristics of MAPZ and KEFZ emissions were not remarkable. (5) Carbon transfer existed among the three kinds of MFOZs, resulting in the economy and carbon emissions being considerably misaligned across Guangdong Province. These results indicated that the MFOZ is noteworthy in revealing how carbon emissions evolved. Furthermore, spatiotemporal characteristics, especially spatial characteristics, can help formulate carbon reduction policies for realizing carbon peak and neutrality goals in Guangdong Province.

Chinese Economic Growth Projections Based on Mixed Data of Carbon Emissions under the COVID-19 Pandemic

Current research on carbon emissions and economic development has tended to apply more homogeneous low-frequency data to construct VAR models with impulse responses, ignoring some of the sample information in high-frequency data. This study constructs a MIDAS model to forecast GDP growth rate based on monthly carbon emission data and quarterly GDP data in the context of the COVID-19 pandemic. The results show that: (1) The MIDAS model has smaller RMSE than the VAR model in short-term forecasting, and provides more stable real-time forecasts and short-term forecasts of quarterly GDP growth rates, which can provide more accurate reference intervals;(2) China's future macroeconomic growth rate has recently declined due to the impact of the sudden epidemic, but the trend is generally optimistic. By improving urban planning and other methods, the authorities can achieve the two-carbon goal of carbon capping and carbon neutrality at an early date. In the context of the impact of COVID-19 on China's economic development, we need to strike a balance between ensuring stable economic growth and ecological protection, and build environmentally friendly cities, so as to achieve sustainable economic and ecological development and enhance human well-being.

Impact of the COVID-19 on electricity consumption of open university campus buildings - The case of Twente University in the Netherlands.

Since the COVID-19 outbreak, the restrictive policies enacted by countries in response to the epidemic have led to changes in the movement of people in public places, which has had a direct impact on the use and energy consumption of various public buildings. This study was based on electricity consumption data for 25 on-campus public buildings at 1-hour intervals between January 2020 and June 2022 at Tewnte University in the Netherlands, and after the data were climate-corrected by multiple regression analysis, the changes in EU and EUI for various types of buildings were compared for different restriction periods using ANOVA, LSD and t-tests. And additionally, further analyzed the changes and reasons for the electricity consumption of various public buildings on campus and customers' electricity consumption behavior in a period of time after the lifting of the epidemic restriction policy. The results of ANOVA analysis show that the restriction policy has a significant effect on teaching, sports, and cultural buildings, and the electricity intensity of the three types of buildings is reduced by 0.28, 0.09, and 0.07 kwh/m2/day respectively under the strict restriction policy; The t-test results show that during the restriction period, all building types, except for living and academic buildings, show a significant decreasing trend, with the teaching buildings having the greatest energy saving potential, with an average daily EU reduction of 1088kwh/day and an EUI reduction of 0.075kwh/ m2/day. The above findings provide a case study of a complete cycle of energy consumption changes in university buildings under similar epidemic restriction policies before and after the epidemic restriction, and inform the electricity allocation policies of university and government energy management authorities.

Serum Proteomic Analysis for New Types of Long-Term Persistent COVID-19 Patients in Wuhan.

The emergence of a new type of COVID-19 patients, who were retested positive after hospital discharge with long-term persistent SARS-CoV-2 infection but without COVID-19 clinical symptoms (hereinafter, LTPPs), poses novel challenges to COVID-19 treatment and prevention. Why was there such a contradictory phenomenon in LTPPs? To explore the mechanism underlying this phenomenon, we performed quantitative proteomic analyses using the sera of 12 LTPPs (Wuhan Pulmonary Hospital), with the longest carrying history of 132 days, and mainly focused on 7 LTPPs without hypertension (LTPPs-NH). The results showed differential serum protein profiles between LTPPs/LTPPs-NH and health controls. Further analysis identified 174 differentially-expressed-proteins (DEPs) for LTPPs, and 165 DEPs for LTPPs-NH, most of which were shared. GO and KEGG analyses for these DEPs revealed significant enrichment of "coagulation" and "immune response" in both LTPPs and LTPPs-NH. A unity of contradictory genotypes in the 2 aspects were then observed: some DEPs showed the same dysregulated expressed trend as that previously reported for patients in the acute phase of COVID-19, which might be caused by long-term stimulation of persistent SARS-CoV-2 infection in LTPPs, further preventing them from complete elimination; in contrast, some DEPs showed the opposite expression trend in expression, so as to retain control of COVID-19 clinical symptoms in LTPPs. Overall, the contrary effects of these DEPs worked together to maintain the balance of LTPPs, further endowing their contradictory steady-state with long-term persistent SARS-CoV-2 infection but without symptoms. Additionally, our study revealed some potential therapeutic targets of COVID-19. Further studies on these are warranted. IMPORTANCE This study reported a new type of COVID-19 patients and explored the underlying molecular mechanism by quantitative proteomic analyses. DEPs were significantly enriched in "coagulation" and "immune response". Importantly, we identified 7 "coagulation system"- and 9 "immune response"-related DEPs, the expression levels of which were consistent with those previously reported for patients in the acute phase of COVID-19, which appeared to play a role in avoiding the complete elimination of SARS-CoV-2 in LTPPs. On the contrary, 6 "coagulation system"- and 5 "immune response"-related DEPs showed the opposite trend in expression. The 11 inconsistent serum proteins seem to play a key role in the fight against long-term persistent SARS-CoV-2 infection, further retaining control of COVID-19 clinical symptom of LTPPs. The 26 proteins can serve as potential therapeutic targets and are thus valuable for the treatment of LTPPs; further studies on them are warranted.

Effect of Green Plants on Individuals' Mental Stress during the COVID-19 Pandemic: A Preliminary Study.

The COVID-19 pandemic has not only jeopardized people's physical health, but also put additional strain on their mental health. This study explored the role of indoor natural elements (i.e., green plants) in relieving individuals' mental stress during a prolonged stressful period. A pilot and three formal studies examined the effect of indoor green plants placed in living and working environments on people's perceived stress during the pandemic and further uncovered its underlying mechanism emphasizing a mediating role of emotion. The pilot study confirmed that the severity of the pandemic positively correlated with individuals' level of stress. Study 1 then demonstrated that indoor green plants in people's living environments might reduce their perceived stress during the pandemic, which is referred to as the "plant effect". Study 2 repeated the plant effect in a field experiment conducted in a working environment and Study 3 revealed a mediating role of positive emotion. This study provides preliminary evidence for the mitigating effect of indoor green plants on individuals' mental stress during the COVID-19 pandemic period. The indoor green plants placed in living and working environments may elicit positive emotion, which in turn reduce people's mental stress. In addition, our results reveal that growth status of the indoor green plants affected the plant effect as well.

Chemical characteristics and sources of PM2.5 in Hohhot, a semi-arid city in northern China: insight from the COVID-19 lockdown

A knowledge gap exists concerning how chemical composition and sources respond to implemented policy control measures for aerosols, particularly in a semi-arid region. To address this, a single year's offline measurement was conducted in Hohhot, a semi-arid city in northern China, to reveal the driving factors of severe air pollution in a semi-arid region and assess the impact of the COVID-19 lockdown measures on chemical characteristics and sources of PM2.5. Organic matter, mineral dust, sulfate and nitrate accounted for 31.5 %, 14.2 %, 13.4 % and 12.3 % of the total PM2.5 mass, respectively. Coal combustion, vehicular emission, crustal source and secondary inorganic aerosols were the main sources of PM2.5 in Hohhot, at 38.3 %, 35.0 %, 13.5 %, and 11.4 %, respectively. Due to the coupling effect of emission reduction and improved atmospheric conditions, the concentration of secondary inorganic components, organic matter and elemental carbon declined substantially from the pre-lockdown (pre-LD) period to the lockdown (LD) and post-lockdown (post-LD) periods. The source contribution of secondary inorganic aerosols increased (from 21.1 % to 37.8 %), whereas the contribution of vehicular emission reduced (from 35.5 % to 4.4 %) due to lockdown measures. The rapid generation of secondary inorganic components caused by unfavorable meteorological conditions during lockdown led to serious pollution. This study elucidates the complex relationship between air quality and environmental policy.

Density-based detection of cell transition states to construct disparate and bifurcating trajectories.

Tree- and linear-shaped cell differentiation trajectories have been widely observed in developmental biologies and can be also inferred through computational methods from single-cell RNA-sequencing datasets. However, trajectories with complicated topologies such as loops, disparate lineages and bifurcating hierarchy remain difficult to infer accurately. Here, we introduce a density-based trajectory inference method capable of constructing diverse shapes of topological patterns including the most intriguing bifurcations. The novelty of our method is a step to exploit overlapping probability distributions to identify transition states of cells for determining connectability between cell clusters, and another step to infer a stable trajectory through a base-topology guided iterative fitting. Our method precisely re-constructed various benchmark reference trajectories. As a case study to demonstrate practical usefulness, our method was tested on single-cell RNA sequencing profiles of blood cells of SARS-CoV-2-infected patients. We not only re-discovered the linear trajectory bridging the transition from IgM plasmablast cells to developing neutrophils, and also found a previously-undiscovered lineage which can be rigorously supported by differentially expressed gene analysis.

Periodic Optimization of Bus Dispatching Times and Vehicle Schedules Considering the COVID-19 Capacity Limits: A Dutch Case Study

The COVID-19 pandemic has had serious adverse impacts on public transport service providers. Most public transport lines exhibit reduced ridership levels while, at the same time, some of them may exhibit passenger demand levels beyond the pandemic-imposed capacity limitations. This study models the problem of bus dispatching time optimization within a periodic rolling horizon optimization framework that reacts to travel time and passenger demand variations. This model allows public transport service providers to adjust their bus schedules periodically to avoid in-vehicle crowding beyond the pandemic-imposed capacity limit. The proposed model is a mixed-integer linear program that considers the possible changes to vehicle schedules and tries to minimize the number of vehicles required to perform the service while adhering to the COVID-19 capacity restrictions. Case study results from the implementation of our model on bus Line 2 in the Twente region in the Netherlands are provided demonstrating the potential gains when rescheduling the trip dispatching times and vehicle schedules.

Scalable Printing of Prussian Blue Analogue@Au Edge-Rich Microcubes as Flexible Biosensing Microchips Performing Ultrasensitive Sucrose Fermentation Monitoring.

Sucrose is one of the most applied carbon sources in the fermentation process, and it directly determines the microbial metabolism with its concentration fluctuation. Meanwhile, sucrose also plays a key role of a protective agent in the production of biological vaccines, especially in the new mRNA vaccines for curing COVID-19. However, rapid and precise detection of sucrose is always desired but unrealized in industrial fermentation and synthetic biology research. In order to address the above issue, we proposed an ultrasensitive biosensor microchip achieving accurate sucrose recognition within only 12 s, relying on the construction of a Prussian blue analogue@Au edge-rich (PBA@AuER) microarchitecture. This special geometric structure was formed through exactly inducing the oriented PBA crystallization toward a certain plane to create more regular and continuous edge features. This composite was further transformed to a screen-printed ink to directly and large-scale fabricate an enzymatic biosensor microchip showing ultrahigh sensitivity, a wide detection range, and a low detection limit to the accurate sucrose recognition. As confirmed in a real alcohol fermentation reaction, the as-prepared microchip enabled us to accurately detect the sucrose and glucose concentrations with outstanding reusability (more than 300 times) during the whole process through proposing a novel analytical strategy for the binary mixture substrate system.

Unequal impact of the COVID-19 pandemic on mental health: Role of the neighborhood environment.

The COVID-19 pandemic has taken a significant toll on people's mental wellbeing. Few studies have investigated how the neighborhood environment might help to moderate the mental health impact in a natural disaster context. We aim to investigate the unequal impact of the pandemic on mental health between different population groups, and the role of the neighborhood environment in alleviating this impact. We collected survey data (n=2,741) on mental health, neighborhood environment, and pandemic-related behaviors in Beijing metropolitan region between July 10 and 28, 2020, and then applied the partial proportional odds model. Overall, we found that the pandemic has disproportionately affected the lower-income people. The lower-income residents experienced a greater psychological impact than the higher-income residents. We further found that distance to an urban park was a key built environment variable that moderates mental health impact. Residents who lived near urban parks were 4.2 to 4.6% less likely to report an increase in negative emotions, and therefore are more resilient to the mental health impact. In addition to the built environment, a cohesive neighborhood environment may have also helped to mitigate the negative mental health impacts. These findings can inform planning policies that aim to promote healthy and resilient communities.

Frailty is an independent determinant of COVID-19 vaccine hesitancy in the elderly: a cross-sectional study.

COVID-19 vaccines have become an important hope for slowing down or stopping the pandemic. As the population ages, older adults will comprise a greater proportion of the vaccinated population. We aimed to assess influencing factors of COVID-19 vaccine hesitancy in older adults. For this aim, We conducted a cross-sectional study on a questionnaire survey of the elderly over 65 years living in the community of Haikou City from August 1st to September 30th, 2021. Univariate and multivariate Logistic regression analyses were performed to identify factors related to vaccine hesitancy. We analyzed completed questionnaires from 225 respondents (42.2% women, mean age 73.4±6.2 years). There were 99 people in the vaccine hesitation group and 126 people in the vaccine acceptance group, the incidence of vaccine hesitation in the elderly population is about44%（99/225）. The incidence of frailty in the vaccine hesitation group was much higher than that in the vaccine trust group (62.63 vs. 30.95%, P＜0.001). The risk factors of vaccine hesitancy in the elderly aged 70-75years and over 75 years were 2.987 times and 3.587 times higher than that in the population aged 65-70 years (OR=2.987,95%CI: 1.424-6.265, P＜0.001; OR=3.587,95% CI:1.804-7.131, P＜0.001). Frailty is also an independent risk factor of vaccine hesitancy in the elderly population (OR=2.624,95%CI: 1.447-4.757, P＜0.001). Then the vaccination rate of the COVID-19 vaccine is far from reaching the requirements of herd immunity, and more flexible and comprehensive efforts are needed to increase the vaccination willingness of the frail elderly.

Setting up a three-stage pre-endoscopy triage during the coronavirus disease 2019 pandemic: A multicenter observational study

Objectives Between May and July 2021, the coronavirus disease 2019 (COVID-19) pandemic led to a sharp surge in community transmission in Taiwan. We present a three-stage restructuring process of pre-endoscopy triage at the beginning of the pandemic, which can support urgent endoscopic procedures while protecting endoscopy staff. Methods The pre-endoscopy triage framework was set up with three checkpoints at the hospital entrance, outpatient department, and endoscopy unit, with a specific target patient population and screening methods. Relevant data included the number of endoscopic procedures performed, outpatient department visits, and performing screening methods such as temperature measurement, travel, occupation, contact, and clustering history checking, polymerase chain reaction assay, and rapid antigen test. Results Forehead temperature measurement and verification of travel, occupation, contact, and clustering history provided rapid, easy, and early mass screening of symptomatic patients at the hospital entrance. During the pandemic, outpatient department visits and endoscopic procedures decreased by 37% and 64%, respectively. The pre-endoscopy screening methods used displayed regional variations in COVID-19 prevalence. Among 16 endoscopy units with a community prevalence of ≥ 31.04 cases per 100,000 residents, 12 (75%) used polymerase chain reaction assay and four (25%) used rapid antigen test to identify asymptomatic patients before endoscopy. Of 6540 pre-endoscopy screening patients, 15 (0.23%) tested positive by laboratory testing. No endoscopy-related nosocomial COVID-19 infections were reported during the pandemic. Conclusions We present a three-stage pre-endoscopy triage based on the local laboratory capacity, medical resources, and community prevalence. These measures could be useful during the COVID-19 pandemic.