Sera from Breakthrough Infections with SARS-CoV-2 BA.5 or BF.7 Showed Lower Neutralization Activity against XBB.1.5 and CH.1.1.

From December 2022 to January 2023, SARS-CoV-2 infections caused by BA.5 and BF.7 subvariants of B.1.1.529 (Omicron) spread in China. It is urgently needed to evaluate the protective immune responses in the infected individuals against the current circulating variants to predict the future potential infection waves, such as the BQ.1.1, XBB.1.5, and CH1.1 variants. In this study, we constructed a panel of pseudotyped viruses for SARS-CoV-2 for the past and current circulating variants, including D614G, Delta, BA.1, BA.5, BF.7, BQ.1.1, XBB.1.5 and CH.1.1. We investigated the neutralization sensitivity of these pseudotyped viruses to sera from individuals who had BA.5 or BF.7 breakthrough infections in the infection wave of last December in China. The mean neutralization ID50 against infected variants BA.5 and BF.7 are 533 and 444, respectively. The highest neutralizing antibody level was observed when tested against the D614G strain, with the ID50 of 742, which is about 1.52-folds higher than that against the BA.5/BF.7 variant. The ID50 for BA.1, Delta and BQ.1.1 pseudotyped viruses were about 2-3 folds lower when compared to BA.5/BF.7. The neutralization activities of these serum samples against XBB.1.5 and CH.1.1 decreased 7.39-folds and 15.25-folds when compared to that against BA.5/BF.7. The immune escape capacity of these two variants might predict new infection waves in future when the neutralizing antibody levels decrease furtherly.

Imported malaria from land bordering countries in China: A challenge in preventing the reestablishment of malaria transmission.

OBJECTIVE: No indigenous malaria cases have been reported since 2017 in China, but a large number of imported cases are still reported every year, including those from the land bordering countries. To characterize their epidemiological profiles will provide evidence for the development of appropriate strategies to effectively address the challenges of border malaria in the post-elimination phase. METHODS: Individual-level data of imported malaria cases from the land bordering countries were collected from 2017 to 2021 in China via the web-based surveillance systems, and analyzed by SPSS, ArcGIS and WPS software, to explore their epidemiological profiles. RESULTS: A total of 1170 malaria cases imported into China from six of the fourteen land bordering countries were reported between 2017 and 2021 with a decline trend. Overall, cases were widely distributed in 31-97 counties from 11 to 21 provinces but mainly in Yunnan. Moreover, these imported cases were mainly infected with P. vivax (94.8%), and a total of 68 recurrent cases were reported in 6-14 counties from 4 to 8 provinces. In addition, nearly 57.1% of the total reported cases could seek healthcare within 2 days of getting sick, and 71.3% of the reported cases could be confirmed as malaria on the day they sought medical care. CONCLUSIONS: China still needs to attach great importance to the risk and challenge of the imported malaria from bordering countries particularly from Myanmar in preventing reestablishment of malaria transmission in the post-elimination phase. It is necessary not only to strengthen collaboration and cooperation with the bordering countries, but also coordinate multiple departments at home to improve malaria surveillance and response system and prevent the reestablishment of malaria transmission in China.

Nurses' preparedness to respond to COVID-19 and associated factors after the outbreak in China.

AIM: Nurses are key staff in the response to the COVID-19 epidemic. The aim of present study was to assess Chinese clinical nurses' preparedness levels for COVID-19 after the outbreak, as well as the associated demographic factors. DESIGN: The design was a cross-sectional survey. METHODS: We distributed an online questionnaire to nurses from five eastern coastal area hospitals. The questionnaire collected demographic information, and included the nurses' preparedness to respond to COVID-19 questionnaire (NPR COVID-19). RESULTS: The total mean NPR COVID-19 score was 200.99 (standard deviation = 33.60), and the psychological approaches subscale had the lowest mean score. Education and training were positively associated with the NPR COVID-19 score. Nurses' characteristics, such as seniority, job category and educational level, were entered into the NPR COVID-19 regression model, and seniority (≤5 years) showed the strongest negative association with NPR COVID-19 scores (standard coefficient = -0.20). CONCLUSIONS: Chinese nurse's preparedness to respond to COVID-19 was adequate. Nurses with less than 5 years of work experience, nursing researchers and diploma-educated nurses reported feeling a low preparedness to respond to COVID-19. These nurses should receive specific training.

Risk factors associated with indoor transmission during home quarantine of COVID-19 patients.

Purpose: The study aimed to identify potential risk factors for family transmission and to provide precautionary guidelines for the general public during novel Coronavirus disease 2019 (COVID-19) waves. Methods: A retrospective cohort study with numerous COVID-19 patients recruited was conducted in Shanghai. Epidemiological data including transmission details, demographics, vaccination status, symptoms, comorbidities, antigen test, living environment, residential ventilation, disinfection and medical treatment of each participant were collected and risk factors for family transmission were determined. Results: A total of 2,334 COVID-19 patients participated. Compared with non-cohabitation infected patients, cohabitated ones were younger (p = 0.019), more commonly unvaccinated (p = 0.048) or exposed to infections (p < 0.001), and had higher rates of symptoms (p = 0.003) or shared living room (p < 0.001). Risk factors analysis showed that the 2019-nCov antigen positive (OR = 1.86, 95%CI 1.40-2.48, p < 0.001), symptoms development (OR = 1.86, 95%CI 1.34-2.58, p < 0.001), direct contact exposure (OR = 1.47, 95%CI 1.09-1.96, p = 0.010) were independent risk factors for the cohabitant transmission of COVID-19, and a separate room with a separate toilet could reduce the risk of family transmission (OR = 0.62, 95%CI 0.41-0.92, p = 0.018). Conclusion: Patients showing negative 2019-nCov antigen tests, being asymptomatic, living in a separate room with a separate toilet, or actively avoiding direct contact with cohabitants were at low risk of family transmission, and the study recommended that avoiding direct contact and residential disinfection could reduce the risk of all cohabitants within the same house being infected with COVID-19.

Serological evaluation of immune effect of inactivated COVID-19 vaccine in adult population in deqing county, Huzhou city, Zhejiang Province

ObjectiveTo investigate the specific anti-SARS-CoV-2 antibody in adults and above after initial vaccination with inactivated COVID-19 vaccine, and determine the influencing factors. MethodsIn this study, residents aged 18 and above who had completed two doses of inactivated COVID-19 vaccine in Deqing County, Huzhou City, Zhejiang Province were included. Information such as gender, age, type of vaccine and vaccination time were collected, and serum specimens were sampled. Anti-SARS-CoV-2 receptor binding domain (RBD) antibody was quantitatively examined by enzyma-linked immunosorbent assay (ELISA) and influencing factors were determined. ResultsThe median concentration of anti-SARS-CoV-2 IgG antibody in the residents vaccinated with an inactivated booster vaccine was higher than that in those vaccinated with only two doses of COVID-19 vaccine or single dose (P<0.05). The median concentration of IgG antibody in males was 9.73 (4.01-23.70) RUmL-1, lower than 17.76 (7.07-49.23) RUmL-1 in females (P<0.05). The median concentration in the residents vaccinated with BBIBP-CorV (Sinopharm) was 6.53 (0.97-13.69) RUmL-1, which was lower than that in those vaccinated with CoronaVac (Sinovac) that was 17.29 (8.54-43.73) RUmL-1 (P<0.05). The median concentration in those with BBIBP-CorV was also lower than 12 (5.45-40.06) RUmL-1 in those with heterologous booster vaccine (P<0.05). The median concentration was 9.73 (3.83-23.63) RUmL-1 in the residents with an interval of more than 6 months from the second dose, which was lower than 14.66 (6.36-35.98) RUmL-1 in those with an interval of 3-6 months (P<0.05). Moreover, immune effect was better in females (X2=16.464, P<0.05), 18-45 years (X2=7.158, P<0.05), and those vaccinated with CornaVac (X2=49.637, P<0.05), while decreased in those with an interval of more than 6 months from the second dose (X2=8.447, P<0.05). ConclusionGender, age, and type of vaccine may affect the effect of immunization. The COVID-19 vaccination shows an acceptable immunogenicity in adults;however, it declines in 6 months after vaccination. It warrants strengthening the booster vaccination to maintain the immune response.

Etiological identification and genetic source tracking of a cluster of cases with fever during the period of regular prevention and control of COVID-19 epidemic

Objective To identify the pathogen and track the genetic source of a cluster of cases with fever in a kindergarten in Fengtai district during the normalization of COVID-19 prevention and control in Beijing.Methods A descriptive analysis method was used to investigate this cluster of cases with fever in April 2021.Pharyngeal swabs were collected and viral nucleic acid was extracted, real-time PCR was performed to identify SARS-CoV-2 and other common respiratory virus. G gene of human metapneumovirus（hMPV） was amplified by RT-PCR and was then sequenced. BioEdit was used for G gene sequence analysis and the Neighbor-Joining model in MEGA 5. 0 software was used to construct the phylogenic tree of G gene. Results A total of 16 cases were reported in one class with the incidence of 53. 3%（16/30） during 8 days of a cluster outbreak. All pharyngeal swabs collected from 12 cases were tested SARS-CoV-2 negative, six were found to be hMPV positive by multiplex-PCR, and one was positive for both human adenovirus and hMPV. Full-length sequences of G genes were obtained from 2 strains of hMPV. Sequence analysis showed that both strains were hMPV B2 and the nucleic acid homology of G gene was 96. 73%-98. 01% with strains from Japan（LC337940, LC337935, LC1922349） in 2016 and over 98. 40%with strains from Shandong（OL625642, OL625644） in 2019, Henan MN944096 in 2019.Compared with the amino acid sequence of hMPV-B2 reference strain（AY297748）, six amino acid insertions containing EKEKEK were identified between 161-166 amino acid location and N-glycosylation of G protein analysis showed that the two strains had four N-glycosylation sites. Conclusions The leading pathogen for this cluster outbreak is found to be hMPV-B2, which are highly homologous with strains from Japan, Shandong and Henan. Therefore, a non-stop surveillance of hMPV is necessary during the normalization control and prevention period for COVID-19.

Biodegradable Microrobots for DNA Vaccine Delivery.

The delivery of nucleic acid vaccine to stimulate host immune responses against Coronavirus disease 2019 shows promise. However, nucleic acid vaccines have drawbacks, including rapid clearance and poor cellular uptake, that limit their therapeutic potential. Microrobots can be engineered to sustain vaccine release and further control the interactions with immune cells that are vital for robust vaccination. Here, the 3D fabrication of biocompatible and biodegradable microrobots via the two-photon polymerization of gelatin methacryloyl (GelMA) and their proof-of-concept application for DNA vaccine delivery is reported. Programmed degradation and drug release by varying the local exposure dose in 3D laser lithography and further functionalized the GelMA microspheres with polyethyleneimine for DNA vaccine delivery to dendritic cell and primary cells is demonstrated. In mice, the DNA vaccine delivered by functionalized microspheres elicited fast, enhanced, and durable antigen expression, which may lead to prolonged protection. Furthermore, we demonstrated the maneuverability of microrobots by fabricating GelMA microspheres on magnetic skeletons. In conclusion, GelMA microrobots may provide an efficient vaccination strategy by controlling the expression duration of DNA vaccines.

1-3-7 surveillance and response approach in malaria elimination: China's practice and global adaptions.

There has been a significant reduction in malaria morbidity and mortality worldwide from 2000 to 2019. However, the incidence and mortality increased again in 2020 due to the disruption to services during the COVID-19 pandemic. Surveillance to reduce the burden of malaria, eliminate the disease and prevent its retransmission is, therefore, crucial. The 1-3-7 approach proposed by China has played an important role in eliminating malaria, which has been internationally popularized and adopted in some countries to help eliminate malaria. This review summarizes the experience and lessons of 1-3-7 approach in China and its application in other malaria-endemic countries, so as to provide references for its role in eliminating malaria and preventing retransmission. This approach needs to be tailored and adapted according to the region condition, considering the completion, timeliness and limitation of case-based reactive surveillance and response. It is very important to popularize malaria knowledge, train staff, improve the capacity of health centres and monitor high-risk groups to improve the performance in eliminating settings. After all, remaining vigilance in detecting malaria cases and optimizing surveillance and response systems are critical to achieving and sustaining malaria elimination.

An electrochemical sensor based on Ce-MOF-derived Ce-doped poly(3,4-ethylenedioxythiophene) composite for efficient determination of rutin in food.

As a common antioxidant and nutritional fortifier in food chemistry, rutin has positive therapeutic effects against novel coronaviruses. Here, Ce-doped poly(3,4-ethylenedioxythiophene) (Ce-PEDOT) nanocomposites derived through cerium-based metal-organic framework (Ce-MOF) as a sacrificial template have been synthesized and successfully applied to electrochemical sensors. Due to the outstanding electrical conductivity of PEDOT and the high catalytic activity of Ce, the nanocomposites were used for the detection of rutin. The Ce-PEDOT/GCE sensor detects rutin over a linear range of 0.02-9 µM with the limit of detection of 14.7 nM (S/N = 3). Satisfactory results were obtained in the determination of rutin in natural food samples (buckwheat tea and orange). Moreover, the redox mechanism and electrochemical reaction sites of rutin were investigated by the CV curves of scan rate and density functional theory. This work is the first to demonstrate the combined PEDOT and Ce-MOF-derived materials as an electrochemical sensor to detect rutin, thus opening a new window for the application of the material in detection.

Impact of the COVID-19 kindergarten closure on overweight and obesity among 3- to 7-year-old children.

BACKGROUND: Knowledge on the impact of the temporary kindergarten closure policy under COVID-19 in 2020 on childhood overweight and obesity is inadequate. We aimed to examine differences in rates of overweight and obesity from 2018 to 2021 among kindergarten children aged 3-7 years. METHODS: Overweight was defined as body mass index (BMI) > 1 standard deviation (SD) for age and sex, and obesity was defined as BMI > 2 SD for age and sex. Generalized linear mixed modeling was used for analysis. RESULTS: A total of 44,884 children and 71,216 growth data points from all 57 public kindergartens in Jiading District, Shanghai, China were analyzed. The rates of obesity from 2018 to 2021 were 6.9%, 6.6%, 9.5%, and 7.3% in boys and 2.8%, 2.8%, 4.5%, and 3.1% in girls, respectively. The rates of overweight from 2018 to 2021 were 14.3%, 14.3%, 18.2%, and 15.3% in boys and 10.6%, 10.9%, 13.9%, and 11.6% in girls. The rates of obesity and overweight among kindergarten children in 2020 were significantly higher than those in 2018, 2019, and 2021. Compared to 2020, the odds ratios of the obesity rate in 2018, 2019, and 2021 were 0.67 [95% confidence interval (CI) = 0.58-0.77, P < 0.001], 0.72 (95% CI = 0.64-0.80, P < 0.001) and 0.81 (95% CI = 0.72-0.92, P = 0.001), respectively. The odds ratios of the overweight rate in 2018, 2019, and 2021 were 0.75 (95% CI = 0.69-0.82, P < 0.001), 0.78 (95% CI = 0.72-0.84, P < 0.001), and 0.89 (95% CI = 0.81-0.97, P = 0.008), respectively, compared to 2020. CONCLUSIONS: The rates of overweight and obesity significantly increased among kindergarten children in 2020 after the 5-month kindergarten closure. It was critical to provide guidance to caregivers on fostering a healthy lifestyle for children at home under public health emergencies.

Association between nitrogen dioxide concentration and hypertension hospitalization: A multicenter time-series analysis in Xinxiang, China

Hypertension is a common chronic disease, and air pollution is strongly associated with hypertension hospitalization. However, the association between nitrogen dioxide (NO2)1 concentration and hypertension hospitalization has rarely been studied. We collected daily data on hypertension hospitalizations, air pollutants, and meteorology from January 1, 2016 to October 31, 2021. After controlling for the effects of seasonal and long-term trends, weather conditions, weekdays, holidays, and during the novel coronavirus crown epidemic, a generalized additive model with over discrete Poisson regression was used to simulate the association between NO2 concentration and hypertension hospitalizations while quantifying hypertension hospitalizations, hospital stays, and hospital costs attributable to NO2. The results showed that each 10 μg/m3 increase in NO2 concentration was significantly associated with the relative risk (RR) of hypertension admission in Xinxiang, with the greatest effect at lag04 (RR = 1.107;95% confidence interval, 1.046–1.172). Hypertension hospitalizations attributed to NO2 during the study period accounted for 9.70% (484) of the total hypertension hospitalizations, equivalent to 4202 hospital days and 338.55 thousand United States dollars (USD). Increased NO2 concentration increases the risk of hypertension hospitalization in Xinxiang, which poses a significant health and economic burden to society and patients. The findings of this study provide a basis for developing stricter environmental pollutant standards.

Porcine Epidemic Diarrhea Virus Replication in Human Intestinal Cells Reveals Potential Susceptibility to Cross-Species Infection.

Various coronaviruses have emerged as a result of cross-species transmission among humans and domestic animals. Porcine epidemic diarrhea virus (PEDV; family Coronaviridae, genus Alphacoronavirus) causes acute diarrhea, vomiting, dehydration, and high mortality in neonatal piglets. Porcine small intestinal epithelial cells (IPEC-J2 cells) can be used as target cells for PEDV infection. However, the origin of PEDV in pigs, the host range, and cross-species infection of PEDV remain unclear. To determine whether PEDV has the ability to infect human cells in vitro, human small intestinal epithelial cells (FHs 74 Int cells) were inoculated with PEDV LJX and PEDV CV777 strains. The results indicated that PEDV LJX, but not PEDV CV777, could infect FHs 74 Int cells. Furthermore, we observed M gene mRNA transcripts and N protein expression in infected FHs 74 Int cells. A one-step growth curve showed that the highest viral titer of PEDV occurred at 12 h post infection. Viral particles in vacuoles were observed in FHs 74 Int cells at 24 h post infection. The results proved that human small intestinal epithelial cells are susceptible to PEDV infection, suggesting the possibility of cross-species transmission of PEDV.

"Should I change myself or not?”: Examining (Re)constructed language teacher identity during the COVID-19 pandemic through text-mining☆

On the basis of interviews with 20 Chinese EFL teachers and text-mining analysis, this study investigates the reconstruction of language teacher identity during the COVID-19 pandemic in terms of context, agency, and practice. The word co-occurrence analysis and collocation statistics with modal verbs coded by KH Coder 3.0 demonstrate that English teachers face two types of identity reconstruction processes: (a) situational context related to various changes, and, (b) interactional context that causes communication difficulties with students. How teachers enact agency is influenced by their teaching experience. Through practice, teachers reconstruct their identity as solution seekers, positive learners, and confident professionals.

An investigation on information quality, media richness, and social media fatigue during the disruptions of COVID-19 pandemic.

Mobile social platforms have become a valuable information source by which users gain information about the COVID-19 pandemic. However, little is known about whether users have experienced increased daily fatigue as a result of the disruptions caused by pandemic. Drawing on the cognitive activation theory of stress (CATS), this study proposed that two typical characteristics of social media platforms (SMP), information quality and media richness, are associated with event disruptions of the COVID-19 pandemic (EDC), and then induce social media fatigue. To address this, this study used the experience sampling method (ESM), collecting 550 matched cases from 110 users of the WeChat application in mainland China over five consecutive days. Through multilevel structural equation modeling (MSEM), this study discovered three main findings: (1) daily information quality is negatively related to event disruptions of the COVID-19 pandemic, which in turn decreases daily social media fatigue; (2) daily media richness is positively associated with such event disruptions, which ultimately increases daily social media fatigue; (3) these effects were stronger for users who reported higher (vs. lower) levels of health consciousness. The implications of these results for the COVID-19 pandemic and beyond are discussed.

Using an influenza surveillance system to estimate the number of SARS-CoV-2 infections in Beijing, China, weeks 2 to 6 2023.

With COVID-19 public health control measures downgraded in China in January 2023, reported COVID-19 case numbers may underestimate the true numbers after the SARS-CoV-2 Omicron wave. Using a multiplier model based on our influenza surveillance system, we estimated that the overall incidence of SARS-CoV-2 infections was 392/100,000 population in Beijing during the 5 weeks following policy adjustment. No notable change occurred after the Spring Festival in early February. The multiplier model provides an opportunity for assessing the actual COVID-19 situation.

Psychosocial crisis intervention for coronavirus disease 2019 patients and healthcare workers. / æ–°åž‹å† çŠ¶ç— æ¯’è‚ºç‚Žæ‚£è€ å’ŒåŒ»åŠ¡äººå‘˜çš„å¿ƒç†ç¤¾ä¼šå±æœºå¹²é¢„ï¼ˆè‹±æ–‡ï¼‰.

OBJECTIVES: Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model. METHODS: The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention. RESULTS: The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful. CONCLUSIONS: Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.

"Should I change myself or not?": Examining (Re)constructed language teacher identity during the COVID-19 pandemic through text-mining.

On the basis of interviews with 20 Chinese EFL teachers and text-mining analysis, this study investigates the reconstruction of language teacher identity during the COVID-19 pandemic in terms of context, agency, and practice. The word co-occurrence analysis and collocation statistics with modal verbs coded by KH Coder 3.0 demonstrate that English teachers face two types of identity reconstruction processes: (a) situational context related to various changes, and, (b) interactional context that causes communication difficulties with students. How teachers enact agency is influenced by their teaching experience. Through practice, teachers reconstruct their identity as solution seekers, positive learners, and confident professionals.

Concurrence of immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura: a case report and review of the literature.

BACKGROUND: Immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura are both causes of thrombocytopenia. Recognizing thrombotic thrombocytopenic purpura is crucial for subsequent treatment and prognosis. In clinical practice, corticosteroids and rituximab can be used to treat both immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura; plasma exchange therapy is the first-line treatment in thrombotic thrombocytopenic purpura, while corticosteroids are strongly recommended as first-line treatment in immune thrombocytopenic purpura. The differential diagnosis of immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura is essential in clinical practice. However, case reports have suggested that immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura can occur concurrently. CASE PRESENTATION: We report the case of a 32-year-old Asian female without previous disease who presented with pancytopenia, concurrent with immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura. The morphology of the megakaryocytes in the bone marrow indicated immune-mediated thrombocytopenia. The patient received glucocorticoid treatment, and her platelet count increased; however, schistocytes remained high during the course of the therapy. Further investigations revealed ADAMTS13 activity deficiency and positive ADAMTS13 antibodies. The high titer of antinuclear antibody and positive anti-U1-ribonucleoprotein/Smith antibody indicated a potential autoimmune disease. However, the patient did not fulfill the current criteria for systemic lupus erythematosus or mixed connective tissue disease. The patient responded well to plasma exchange therapy, and her platelet count remained normal on further follow-up. CONCLUSIONS: Concurrence of immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura is rare, but clinicians should be aware of this entity to ensure prompt medical intervention. Most of the reported cases involve young women. Human immunodeficiency virus infection, pregnancy, and autoimmune disease are the most common underlying conditions.

Impact of the COVID-19 pandemic on acute stroke care: An analysis of the 24-month data from a comprehensive stroke center in Shanghai, China.

INTRODUCTION: Whether the coronavirus disease-2019 (COVID-19) pandemic is associated with a long-term negative impact on acute stroke care remains uncertain. This study aims to compare the timing of key aspects of stroke codes between patients before and after the COVID-19 pandemic. METHODS: This retrospective cohort study was conducted at an academic hospital in Shanghai, China and included all adult patients with acute ischemic stroke hospitalized via the emergency department (ED) stroke pathway during the 24 months since the COVID-19 outbreak (COVID-19: January 1, 2020-December 31, 2021). The comparison cohort included patients with ED stroke pathway visits and hospitalizations during the same period (pre-COVID-19: January 1, 2018-December 31, 2019). We compared critical time points of prehospital and intrahospital acute stroke care between patients during the COVID-19 era and patients during the pre-COVID-19 era using t test, χ2 , and Mann-Whitney U test where appropriate. RESULTS: A total of 1194 acute ischemic stroke cases were enrolled, including 606 patients in COVID-19 and 588 patients in pre-COVID-19. During the COVID-19 pandemic, the median onset-to-hospital time was about 108 min longer compared with the same period of pre-COVID-19 (300 vs 192 min, p = 0.01). Accordingly, the median onset-to-needle time was 169 min in COVID-19 and 113 min in pre-COVID-19 (p = 0.0001), and the proportion of patients with onset-to-hospital time within 4.5 h was lower (292/606 [48.2%] vs 328/558 [58.8%], p = 0.0003) during the pandemic period. Furthermore, the median door-to-inpatient admission and door-to-inpatient rehabilitation times increased from 28 to 37 h and from 3 to 4 days (p = 0.014 and 0.0001). CONCLUSIONS: During the 24 months of COVID-19, a prolongation of stroke onset to hospital arrival and to intravenous rt-PA administration times were noted. Meanwhile, acute stroke patients needed to stay in the ED for a longer time before hospitalization. Educational system support and process optimization should be pursued in order to acquire timely delivery of stroke care during the pandemic.