Journal articles on the topic 'Blood cholesterol China Hong Kong'

ObjectivesTo investigate potential geographical and socioeconomic patterning of allostatic load (AL) in China.DesignMultilevel longitudinal study of the 2010 Chronic Disease Risk Factor Surveillance linked to the National Death Surveillance up to 31 December 2015.SettingAll 31 provinces in China, not including Hong Kong, Macao or Taiwan.Participants96 466 ≥ 18 years old (women=54.3%).ExposuresPerson-level educational attainment and mean years of education in counties.OutcomeAL was measured using clinical guidelines for nine biomarkers: body mass index; waist circumference; systolic blood pressure; diastolic blood pressure; fasting blood glucose; total cholesterol; triglycerides; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol.ResultsMultilevel logistic regressions adjusted for sex, age, marital status, person-level education, county mean years of education and urban/rural reported ORs of 1.22 (95% CI 1.08 to 1.38) for 5-year all-cause mortality (n=3284) and 1.20 (1.04–1.37) for deaths from non-communicable diseases (n=2891) among people in AL quintile 5 (high) compared with quintile 1 (low). The median rate ratio estimated from unadjusted multilevel negative binomial regression showed AL clustered geographically (province=1.14; county=1.12; town=1.11; village=1.14). After adjusting for aforementioned confounders, AL remained higher with age (rate ratio 1.02, 95% CI 1.02 to 1.02), higher in women compared with men (1.17, 1.15 to 1.19), lower among singletons (0.83, 0.81 to 0.85) and widowers (0.96, 0.94 to 0.98). AL was lower among people with university-level compared with no education (0.92, 0.89 to 0.96), but higher in counties with higher mean education years (1.03, 1.01 to 1.05). A two-way interaction suggested AL was higher (1.04, 1.02 to 1.06) among those with university-level compared with no education within counties with higher mean years of education. Similar results were observed for alternative constructions of AL using 75th and 80th percentile cut-points.ConclusionsAL in China is patterned geographically. The degree of association between AL and person-level education seems to be dependent on area-level education, which may be a proxy for other contextual factors that warrant investigation.

Purpose As far as governments are concerned, it is the nationality of a person, usually reflected in a passport, that shows whether the government has a duty to protect that individual and whether the person owes obligations to the state. Hong Kong is unusual in that for many people there, passports are primarily seen as documents that offer safety and security. It is not unusual for people to possess two or more passports. The purpose of this paper is to examine attitudes toward passports on the part of Hong Kong people, formed by their unique experience. Design/methodology/approach This paper analyzes key documents, such as China’s Nationality Law and a little known document, “Explanations of Some Questions by the Standing Committee of the National People’s Congress Concerning the Implementation of the Nationality Law of the People’s Republic of China in the Hong Kong Special Administrative Region.” The paper also looks at the Loh case of August 2016, involving a Canadian man who wanted a Hong Kong passport for his 11-year-old Canadian-born son, and the Patrick Tse case, where Hong Kong tried to strip a teenager who possessed German nationality of his Hong Kong passport. Findings The convenience of travel to China with a Home Return Permit seems to outweigh any sense of loyalty to an adopted country in the west, or the realization that the use of a document identifying its holder as a Chinese national means that she/he would not have any consular protection. It is also ironical that the Hong Kong Government should maintain the difference between nationality and ethnicity at a time when the Chinese Government is doing the very opposite, playing down the status of nationality while magnifying the importance of so-called “Chinese blood.” Originality/value This paper examines a topic that has not been widely studied but is likely to become more important in the years to come as China’s impact on the rest of the world increases. The nationality status of ethnic Chinese will increasingly become an issue as the flow of travel between China and other countries rises and Chinese immigrants continue to take up foreign nationality. While this issue is of special importance to Hong Kong, its impact will extend to countries around the world, in fact, to wherever Chinese persons are to be found.

LANGUAGE NOTE | Document text in Chinese; abstract in English only.The study consisted of two phases: Phase I was designed to investigate the health status and physical fitness levels of office workers and phase II was conducted to examine the training effects of a circuit training on health and physical fitness of the workers. In phase I, health and stress inventories (Pace of Life Index, General Well-Being Scale, and Bacek Sports Questionnaire), health indices (blood total cholesterol, blood pressure, lung capacity, and resting heart rate), and physical fitness assessment (bicycle ergometer test; skinfold measurement, sit-ups test; grip strength test; and sit and reach test) were conducted to 171 (112 males & 59 females, aged 30-49) office workers from 22 local corporations. From Descriptive Statistics analyses, it was found that the overall health status and stress level of the office workers were at acceptable levels. However, the lung capacity of the workers was in the category of "fair". The total cholesterol level of the male 40-year old group was found higher than the optimal level. Most of the fitness indices of the workers were in categories of "average" or "fair" when comparing with that of the general population of U.S.A. The Correlation analyses shown that the female workers, with higher regular physical activity hours, had fewer incidents of low-back pain and lower resting heart rates. It was also found that the lower the percent body fat, the lower the systolic blood pressure and the better the cardiorespiratory endurance. Similar correlations were found in the male workers: the better the cardiorespiratory endurance, the lower the resting heart rate and systolic blood pressure for the workers. Researchers indicated that workers with higher levels of physical fitness would have higher working ability and productivity, it was suggested that local office workers should give priority to regular physical activity. Activities such as aerobic exercises, calisthenics, stretching, and muscular training should be included in the exercise programmes so that a total fitness can be developed.

Perfluorinated chemicals (PFCs) can be absorbed on fine particulate matter (PM2.5) and used as stain, water and grease repellent in a wide range of consumer products. Among the PFCs, perfluorooctane sulfonate (PFOS) and perfluoro octanoic acid (PFOA) are widely detected in human blood and serum and are of concern due to their potential toxicity. In the present experiment, fine particulate matter (PM2.5) from some northern (Beijing, Xian) and southern (Hong Kong, Guangzhou and Xiamen) cities of China were collected and analyzed for perfluoro butanoic acid (PFBA), perfluoro hexanoic acid (PFHxA), perfluoro octanoic acid (PFOA), perfluoro nonanoic acid (PFNA), perfluoro decanoic acid (PFDA), perfluoro undecanoic acid (PFUdA), perfluoro dodecanoic acid (PFDoA), perfluoro hexanesulfonate (PFHxS) and perfluoro octanesulfonate (PFOS) using liquid chromatography mass spectrometry (LC-MS/MS). The total PFCs ranged from 121.2 to 192.2pg/m3, leading by Guangzhou followed by Xian, Beijing, Xiamen and Hong Koung. Among the nine measured PFCs compounds, the level of PFHxS was below the limit of detection in all the sampling cities. The other eight PFCs (PFOS, PFDoA, PFUdA, PFDA, PFNA, PFOA, PFHxA and PFBA) were detected in all the sampling locations except PFDoA in Hong Kong samples. Human exposure estimated to PFCs for adults showed PFOS as the dominant inhaled compound representing 1.59, 1.15, 1.0 and 1.0 ng/day exposure for Hong Kong, Guangzhou, Xiamen, Beijing and Xian respectively. Results from this study contribute to our understanding of exposure pathways of PFCs to humans.Jahangirnagar University J. Biol. Sci. 5(1): 21-27, 2016 (June)

ObjectiveTo explore the association between cardiometabolic dysregulation, an integral component of allostatic load, and health risk behaviours (HRBs) of the Hong Kong healthy adult population.DesignSecondary analysis of cross-sectional anonymous data.SettingData on sociodemographics, self-reported health status, HRBs and biomarkers were extracted from the Hong Kong Population Health Survey 2014/2015.ParticipantsOne thousand five hundred and fifty-one participants aged 18–64 years without self-reported diagnoses of hypertension, diabetes mellitus, hyperlipidaemia, cardiovascular disease, cognitive impairment or cancer.Primary outcome measuresCardiometabolic dysregulation index (CMDI), ranging from 0 to 6, was calculated by counting the number of biomarkers including systolic blood pressure, diastolic blood pressure, waist to hip ratio, glycated haemoglobin, total cholesterol to high-density lipoprotein cholesterol ratio, and triglycerides that were above the respective normal level suggested by international guidelines and literature. HRBs including smoking, dietary habits and sleeping hours were collected by self-report questionnaire. Alcohol consumption was assessed by the 10-item Alcohol Use Disorders Identification Test, while physical activity level was measured using the Global Physical Activity Questionnaire. A composite HRB score, ranging from 0 to 5, was calculated as the cumulative number of HRBs. The effect of HRB on CMDI was evaluated by negative binomial regression with adjustment for socioeconomic status, health awareness and comorbidities of the participants.ResultsThe mean CMDI of the studied population was 1.6; 29.5% had a CMDI of 0, whereas 1.5% had a CMDI of 6. Significant difference was observed in mean CMDI between gender and different age groups. Sleeping less than 6 hours (incidence rate ratio (IRR)=1.26, p<0.001), smoking (IRR=1.15, p=0.027), insufficient physical activity (IRR=1.12, p=0.007) and higher composite HRB score (IRR=1.12, 95% CI 1.06 to 1.18) were significantly associated with higher CMDI.ConclusionSmoking, physical inactivity and inadequate sleep—an essential yet often overlooked health behaviour—were associated with higher CMDI in the Hong Kong healthy adult population.

Several studies have suggested that viral oncogenesis is one of the etiologic factors of breast cancer, while others are provocative, however, their association remains controversial. The purpose of this study was to investigate whether the human papillomavirus (HPV) DNA is present in the blood and tissue samples of breast cancer patients in Hong Kong. A total of 102 patients with breast tumour tissues and adjacent normal tissues were available and recruited unselectively. Both DNA and RNA were extracted from those samples, and real-time quantitative PCR was performed to detect HPV-16, with 18 sequences targeting the E6 and L1 regions. Results showed that HPV DNA sequences were absent in all the blood and breast tissues. These data argue against the role of oncogenic HPV in the pathogenesis of breast cancer. Additional lines of evidence need to be obtained in order to assess the possibility of breast cancer prevention using HPV vaccines.

Objective To guide clinical decision making, race-, age- and gender-specific reference ranges for lymphocytes and CD4+ T-cell subsets are required. Methods Single platform flow cytometry to determine reference intervals for lymphocyte subpopulations and CD4+ T-cell subsets in 196 healthy Han Chinese adults. Results The frequencies and absolute numbers of B cells were slightly lower in Han Chinese individuals of the Shanxi region than in individuals from Hong Kong, Germany and Singapore, while percentages and absolute numbers of NK cells were slightly higher compared with individuals from Hong Kong. CD4+/CD8+ T-cell ratios, CD4+ T cell percentages and Th2 cell counts were higher, while frequencies and numbers of CD8+ T cells, numbers of NK cells and percentages of Th1 cells were lower, in females compared with males. CD4+ T cell percentages, CD4+/CD8+ T-cell ratios, numbers of CD8+ T cells and Treg cells, and Th17/Treg cell ratios differed by age. Conclusion We established lymphocyte and CD4+ T-cell subset reference intervals for healthy Han Chinese adults of the Shanxi region. Ethnicity, gender and age affected lymphocyte subset composition.

IntroductionPatients with diabetes mellitus are risk of premature death. In this study, we developed a machine learning-driven predictive risk model for all-cause mortality among patients with type 2 diabetes mellitus using multiparametric approach with data from different domains.Research design and methodsThis study used territory-wide data of patients with type 2 diabetes attending public hospitals or their associated ambulatory/outpatient facilities in Hong Kong between January 1, 2009 and December 31, 2009. The primary outcome is all-cause mortality. The association of risk variables and all-cause mortality was assessed using Cox proportional hazards models. Machine and deep learning approaches were used to improve overall survival prediction and were evaluated with fivefold cross validation method.ResultsA total of 273 678 patients (mean age: 65.4±12.7 years, male: 48.2%, median follow-up: 142 (IQR=106–142) months) were included, with 91 155 deaths occurring on follow-up (33.3%; annualized mortality rate: 3.4%/year; 2.7 million patient-years). Multivariate Cox regression found the following significant predictors of all-cause mortality: age, male gender, baseline comorbidities, anemia, mean values of neutrophil-to-lymphocyte ratio, high-density lipoprotein-cholesterol, total cholesterol, triglyceride, HbA1c and fasting blood glucose (FBG), measures of variability of both HbA1c and FBG. The above parameters were incorporated into a score-based predictive risk model that had a c-statistic of 0.73 (95% CI 0.66 to 0.77), which was improved to 0.86 (0.81 to 0.90) and 0.87 (0.84 to 0.91) using random survival forests and deep survival learning models, respectively.ConclusionsA multiparametric model incorporating variables from different domains predicted all-cause mortality accurately in type 2 diabetes mellitus. The predictive and modeling capabilities of machine/deep learning survival analysis achieved more accurate predictions.

AbstractObjectiveIn our previous study, the prevalence of childhood masked hypertension was 11%. This study aims to assess the left ventricular mass index of persistent masked hypertension and determine the factors of elevated left ventricular mass index in Hong Kong Chinese adolescents from a community cohort.DesignCommunity prospective cohort study, follow-up of a case-control study in community.SubjectsPatients with masked hypertension at baseline were invited to recheck ambulatory blood pressure for the persistence of masked hypertension.ResultsA total of 144 out of 165 patients with masked hypertension in the 2011/2012 ambulatory blood pressure survey consented to participate in the study. In all, 48 patients were found to have persistent masked hypertension by ambulatory blood pressure rechecking and were matched with normotensive controls by sex, age, and body height. The left ventricular mass (117.3±39.9 g versus 87.0±28.2 g versus 102.0±28.2 g) and left ventricular mass index (30.1±8.4 g/m2.7 versus 23.9±6.3 g/m2.7 versus 25.1±5.7 g/m2.7) were significantly higher in the persistent masked hypertension group (p<0.0001) compared with the patients without persistent masked hypertension and controls. In multivariate linear regression analysis, left ventricular mass index was found to be higher in male gender (β=4.874, p<0.0001) and the patients with persistent masked hypertension (β=2.796, p=0.003). In addition, left ventricular mass index was positively associated with body mass index z-score (β=3.045, p<0.0001) and low-density lipoprotein cholesterol concentration (β=1.634, p=0.015).ConclusionsPersistent masked hypertension in adolescents is associated with elevated left ventricular mass index.

LANGUAGE NOTE | Document text in Chinese; abstract in English only.The study consisted of two phases: Phase I was designed to investigate the health and physical fitness status of office workers and phase II was conducted to examine the training effects of a circuit training program on health and physical fitness of the workers. In phase II，100 subjects (50 males & 50 females), randomly selected from the participants (112 males & 59 females, aged 30-49) of phase I, were randomly assigned to experimental groups and control groups (25 subjects per group). Subjects in experimental group received a 8-week, 2 times a week with 1 hour per session circuit training program while subjects in control group were not receiving any physical training. The ANCOVA analyses revealed that subjects in both gender of the experimental groups had significant (p < .05) improvement on the health and fitness indices which included grip strength, abdominal muscular strength and endurance, trunk flexibility, cardiorespiratory endurance, resting heart rate, and forced vital capacity. Body fat and stress levels (Pace of Life Index) were also significantly (p < . 05 ) reduced for both sexes after the 8-week circuit training. However, there were no training effects on general health concerns (General Well-Being Scale), cholesterol levels, and blood pressure in this study. As the related research indicated that workers with higher levels of physical fitness would have higher working ability and productivity, it was suggested that local office workers should give priority to regular physical activity. Circuit training, which consists of aerobic exercises, calisthenics, stretching, and muscular training in a workout period, is time saving and highly desirable for local office workers to promote their health and fitness.

The disease caused by Influenza viruses has been well known for a very long time. In the recent period there has been noted an occurrence of pandemics caused by Influenza viruses type A with a high rate of mortality. The ongoing pandemic caused by avian influenza virus serotype H9N9 began in Hong Kong in 1992, and another pandemic caused by serotype H5N1 began in China (Hong Kong) in 1999. The world wide spreading of these viruses occurred due to migratory birds. Avian influenza was confirmed in Serbia in 2007. The goal of this study was to examine whether the avian influenza viruses type A circulate in the region of the Obedska bara marsh, which is a famous resort for many birds in Serbia, as well as many birds migrating from Europe to Africa and vice versa. The samples of blood sera of many animal species (123 samples from fowl, 64 samples from donkeys, 40 samples from horses) were tested by serologic reaction of inhibition of haemmaglutination (IHA) for the presence of antibodies to influenza A subtypes H5N1, H5N2, H5N3, H7N1 and H7N2. Also, the samples of blood sera of experimental chicken exposed to wild life in Obedska bara (sentinel species) were tested. Antibodies to subtypes H5N1, H5N2, H5N3, H7N1 and H7N2 were found in chicken from Dec, Boljevci, Petrovcic and Kupinovo villages but no antibodies were found in blood sera from hams from Dobanovci, Jakovo, Becmen and Surcin villages. From 23 samples from ducks antibodies were detected in 3 samples, and from 22 geese blood sera antibodies were found in 4 samples. From a total of 40 horse blood sera tested one was tested positive, and from 64 donkey sera 17 were positive for the presence of antibodies for avian influenza type A. In blood sera of experimental chicken antibodies were found by subtype H5N1 with corrections with H5N2 and H7N1.

Cardiovascular disease (CVD) is a major contributor to the global burden of disease. Berberine, a long-standing, widely used, traditional Chinese medicine, is thought to have beneficial effects on CVD risk factors and in women with polycystic ovary syndrome. The mechanisms and effects, specifically in men, possibly via testosterone, have not been examined previously. To assess the effect of berberine on CVD risk factors and any potential pathway via testosterone in men, we conducted a randomized, double-blind, placebo-controlled, parallel trial in Hong Kong. In total, 84 eligible Chinese men with hyperlipidemia were randomized to berberine (500 mg orally, twice a day) or placebo for 12 weeks. CVD risk factors (lipids, thromboxane A2, blood pressure, body mass index and waist–hip ratio) and testosterone were assessed at baseline, and 8 and 12 weeks after intervention. We compared changes in CVD risk factors and testosterone after 12 weeks of intervention using analysis of variance, and after 8 and 12 weeks using generalized estimating equations (GEE). Of the 84 men randomized, 80 men completed the trial. Men randomized to berberine had larger reductions in total cholesterol (−0.39 mmol/L, 95% confidence interval (CI) −0.70 to −0.08) and high-density lipoprotein cholesterol (−0.07 mmol/L, 95% CI −0.13 to −0.01) after 12 weeks. Considering changes after 8 and 12 weeks together, berberine lowered total cholesterol and possibly low-density lipoprotein-cholesterol (LDL-c), and possibly increased testosterone. Changes in triglycerides, thromboxane A2, blood pressure, body mass index and waist–hip ratio after the intervention did not differ between the berberine and placebo groups. No serious adverse event was reported. Berberine is a promising treatment for lowering cholesterol. Berberine did not lower testosterone but instead may increase testosterone in men, suggesting sex-specific effects of berberine. Exploring other pathways and assessing sex differences would be worthwhile, with relevance to drug repositioning and healthcare.

Tai Chi and walking are both moderate-intensity physical activity (PA) that can be easily practiced in daily life. The objective of the study was to determine the effects of these two PAs on weight loss, metabolic syndrome parameters, and bone mineral density (BMD) in Chinese adults. We randomized 374 middle-aged subjects (45.8 ± 5.3 years) into 12-week training (45 minutes per day, 5 days per week) of Tai Chi(n=124)or self-paced walking(n=121)or control group(n=129). On average, Tai Chi and walking groups lost 0.50 and 0.76 kg of body weight and 0.47 and 0.59 kg of fat mass after intervention, respectively. The between-group difference of waist circumference (WC) and fasting blood glucose (FBG) was −3.7 cm and −0.18 mmol/L for Tai Chi versus control and −4.1 cm and −0.22 mmol/L for walking versus control. No significant differences were observed regarding lean mass, blood pressure, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, and BMD compared to control. Change in lean mass, not fat mass or total weight loss, was significantly correlated to the change in BMD. Our results suggest that both of these two PAs can produce moderate weight loss and significantly improve the WC and FBG in Hong Kong Chinese adults, with no additional effects on BMD.

Background Hypertension is a leading preventable risk factor of chronic disease and all-cause mortality. Housing is a fundamental social determinant of health. Yet, little is known about the impacts of liveable residential space and density on hypertension. Methods and findings This retrospective observational study (median follow-up of 2.2 years) leveraged the FAMILY Cohort, a large territory-wide cohort in Hong Kong, Special Administrative Region, People’s Republic of China to quantify associations of objectively measured liveable space and residential density with blood pressure outcomes among adults aged ≥16 years. Blood pressure outcomes comprised diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), and hypertension. Liveable space was measured as residential floor area, and density was assessed using the number of residential units per building block and neighborhood residential unit density within predefined catchments. Multivariable regression models examined associations of liveable floor area and residential density with prevalent and incident hypertension. We investigated effect modifications by age, sex, income, employment status, and housing type. Propensity score matching was further employed to match a subset of participants who moved to smaller residences at follow-up with equivalent controls who did not move, and generalized linear models examined the impact of moving to smaller residences upon blood pressure outcomes. Our fully adjusted models of prevalent hypertension outcomes comprised 30,439 participants at baseline, while 13,895 participants were available for incident models at follow-up. We found that each interquartile range (IQR) increment in liveable floor area was associated with lower DBP (beta [β] = −0.269 mm Hg, 95% confidence interval [CI]: −0.419 to −0.118, p < 0.001), SBP (β = −0.317 mm Hg, −0.551 to −0.084, p = 0.008), MAP (β = −0.285 mm Hg, −0.451 to −0.119 with p < 0.001), and prevalent hypertension (odds ratio [OR] = 0.955, 0.918 to 0.993, p = 0.022) at baseline. Each IQR increment in residential units per building block was associated with higher DBP (β = 0.477 mm Hg, 0.212 to 0.742, p = <0.001), SBP (β = 0.750 mm Hg, 0.322 to 1.177, p = <0.001), MAP (β = 0.568 mm Hg, 0.269 to 0.866, p < 0.001), and prevalent hypertension (OR = 1.091, 1.024 to 1.162, p = 0.007). Each IQR increase in neighborhood residential density within 0.5-mi street catchment was associated with lower DBP (β = −0.289 mm Hg, −0.441 to −0.137, p = <0.001), SBP (β = −0.411 mm Hg, −0.655 to −0.168, p < 0.001), MAP (β = −0.330 mm Hg, −0.501 to −0.159, p = <0.001), and lower prevalent hypertension (OR = 0.933, 0.899 to 0.969, p < 0.001). In the longitudinal analyses, each IQR increment in liveable floor area was associated with lower DBP (β = −0.237 mm Hg, −0.431 to −0.043, p = 0.016), MAP (β = −0.244 mm Hg, −0.444 to −0.043, p = 0.017), and incident hypertension (adjusted OR = 0.909, 0.836 to 0.988, p = 0.025). The inverse associations between larger liveable area and blood pressure outcomes were more pronounced among women and those residing in public housing. In the propensity-matched analysis, participants moving to residences of lower liveable floor area were associated with higher odds of incident hypertension in reference to those who did not move (OR = 1.623, 1.173 to 2.199, p = 0.002). The major limitations of the study are unmeasured residual confounding and loss to follow-up. Conclusions We disentangled the association of micro-, meso-, and macrolevel residential densities with hypertension and found that higher liveable floor area and neighborhood scale residential density were associated with lower odds of hypertension. These findings suggest adequate housing in the form of provisioning of sufficient liveable space and optimizing residential density at the building block, and neighborhood levels should be investigated as a potential population-wide preventive strategy for lowering hypertension and associated chronic diseases.

Abstract Introduction: Non-transfusion dependent thalassemia (NTDT) includes HbH disease, β-thalassemia intermedia (β-TI) and HbE/β-thalassemia. The transfusion requirements of patients with NTDT are variable and they are all at risk of developing iron overload and other complications. The prevalent genetic changes in thalassemia are different across geographical territories, accounting largely for the diverse clinical outcomes. The complication profile of NTDT in Southern China is less well studied than other areas. Data on age-related complications is sparse. The present study aims to describe the clinical-pathological features of adult NTDT patients in Hong Kong, and to evaluate the risk factors associated with complications. Method: A single-center observational study was performed during Jan 2017 to Jun 2018. Data collection included review of medical records for demographics; globin genotypes; hepatitis B and C status; transfusion requirement; splenectomy; iron chelation therapy; complications including gallstone disease, hypothyroidism or hypogonadism, diabetes mellitus (DM), extramedullary hematopoiesis (EMH), leg ulcer, venous thrombosis and cerebral ischemia. During the study period, steady state hemoglobin (Hb) and serum ferritin levels in the recent year were obtained; organ iron deposition assessed using liver and cardiac T2* at 1.5T MRI; liver stiffness measured by Fibroscan; and presence of pulmonary arterial hypertension (PAH) evaluated by echocardiography. The disease profile and prevalence of complications were described with descriptive statistics. Factors impacting clinical parameters and development of complication were studied with univariate regressions. Age and sex adjusted β-coefficients or odd ratios were then determined with multivariable regression analysis. Results: A total of 96 Chinese patients were recruited (mean age 50±15 years; 31% patients >60 years; females 66%). There were 63 (65%) patients having deletional HbH disease, 20 (21%) with non-deletional HbH disease (ND-HbHD), and 13 (14%) with β-TI. The mean Hb was 8.9±1.1 g/dL. Transfusion requirement was never in 39 (41%), occasional in 50 (52%), and regular in 7 (7%) patients. Ten (10%) patients were splenectomized. Iron chelation was given to 21 (21%) patients and the median duration of therapy was 3 (range 1-21) years. Respectively 4 (4%) and 2 (2%) patients were hepatitis B and C carriers. The median serum ferritin was 473 [IQR 217-1029] ng/mL. The median liver iron concentration (LIC) estimated by MRI T2* was 3.6 [IQR 1.7-7.1] mg Fe/g with 26% of patients having moderate to severe liver iron overload (≥7.1 Fe mg/g). In the study population, the prevalence of liver fibrosis (liver stiffness ≥7.1kPa) was 26%, gallstones 50%, hypo-thyroidism/-gonadism 8%, DM 16%, EMH 5%, leg ulcer 1%, thrombotic events 2%, cardiac iron overload 1%. No patients had PAH (Table 1). In multivariable regression, advanced age (>60 years) was associated with lower Hb (p=0.03), higher risk of liver fibrosis (p=0.04) and DM (p<0.01). β-TI was associated with higher transfusion requirement (p<0.01), higher serum ferritin (p<0.01) and higher risk of hypo-thyroidism/-gonadism(p=0.01). Both ND-HbHD and β-TI were associated with higher LIC (p<0.01). Patients requiring regular transfusions had higher serum ferritin (p<0.01) and LIC (p<0.01). Occasionally transfused (p=0.01) and female patients (p=0.01) had higher risk of developing gallstones. Splenectomy was associated with higher serum ferritin level (p=0.03). Patients with moderate to severe liver iron overload had increased risk of liver fibrosis (p=0.01) (Table 2). Conclusions: The present study including 1/3 of elderly patients illustrates the heterogeneous clinical features of NTDT in Hong Kong in terms of transfusion requirement and body iron store. HbH disease is the most frequent type of NTDT. Liver iron overload, liver fibrosis, gallstones and DM were the most common complications. Advancing age, β-TI, ND-HbHD were associated with higher risk of developing complications. A low prevalence of EMH, cardiac iron overload, PAH, thrombosis and leg ulcer was observed. Larger prospective study is needed to confirm the prevalence of complications in NTDT in Chinese, which may be different from other ethnic groups, and at the same time to provide more insight to the pathophysiology of NTDT and facilitate establishment of future local management strategies. Disclosures No relevant conflicts of interest to declare.

BackgroundThe Sichuan earthquake on 12 May 2008 with a magnitude of 8.0 killed > 87,000 people. The response of the Hong Kong Red Cross (HKRC) included a basic healthcare team to a small rural town called Yanmen three weeks after the earthquake. The objective of this study was to review HKRC's medical records to identify the disease pattern in the Chinese rural setting post earthquake.MethodsA cross-sectional, record-based study of all patients treated by the HKRC basic healthcare team from 01 June to 19 June 2008. This retrospective study studied the medical records collected during the clinical consultations, and descriptive analysis was performed for the demographic and clinical information. Blood pressure measurement was classified according to the JNC-7 classification, and the age- and gender-specific prevalence of hypertension was sought.ResultsA total of 2,034 cases were seen during the 19-day period with daily attendance ranging from 73 to 153 cases. Musculoskeletal, respiratory, and gastrointestinal problems were the top three categories and accounted for 30.4, 17.4, and 12.7% respectively. Trauma accounted for 5.4% of the cases attended, and 26.0% of the injuries were related to the earthquake. A total of 38.7% of the consultations were for medical problems that existed before the earthquake. A total of 43.4% patients with blood pressure measurements were above the recognized cutoff for hypertension.ConclusionsDue to the impact and time phase post disaster, trauma, and injuries directly resulting from the earthquake did not contribute to a large number of cases. However, the management of chronic illness was an important issue, especially with the excessive prevalence of high blood pressure found in this study. Further studies to investigate the relationship between chronic diseases including hypertension and post-earthquake conditions are needed.

IntroductionDiabetic kidney disease (DKD) is a prevalent and costly complication of diabetes with limited therapeutic options, being the leading cause of end-stage kidney disease in most developed regions. Recent big data studies showed that add-on Chinese medicine (CM) led to a reduced risk of end-stage kidney disease and mortality among patients with chronic kidney disease (CKD) and diabetes. Astragalus, commonly known as huang-qi, is the most prescribed CM or used dietary herb in China for diabetes and DKD. In vivo and in vitro studies showed that astragalus ameliorated podocyte apoptosis, foot process effacement, mesangial expansion, glomerulosclerosis and interstitial fibrosis. Nevertheless, the clinical effect of astragalus remains uncharacterised. This pragmatic clinical trial aims to evaluate the effectiveness of add-on astragalus in patients with type 2 diabetes, stage 2–3 CKD and macroalbuminuria, and to identify related response predictors.Methods and analysisThis is an add-on, assessor-blind, parallel, pragmatic randomised controlled clinical trial. 118 patients diagnosed with DKD will be recruited and randomised 1:1 to receive 48 weeks of add-on astragalus or standard medical care. Primary endpoints are the changes in estimated glomerular filtration rate and urine albumin-to-creatinine ratio between baseline and treatment endpoint. Secondary endpoints include adverse events, fasting blood glucose, glycated haemoglobin, lipids and other biomarkers. Adverse events are monitored through self-complete questionnaire and clinical visits. Outcomes will be analysed by regression models. Subgroup and sensitivity analyses will be conducted for different epidemiological subgroups and statistical analyses. Enrolment started in July 2018.Ethics and disseminationThis study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West/East/Kowloon Central clusters (UW 16-553/HKEC-2019-026/REC (KC/KE)-19-0049/ER-4). We will report the findings in medical journals and conferences. The dataset will be available on reasonable request.Trial registration numberNCT03535935

ObjectivesThis study is aimed to develop and validate a prediction model for multistate transitions across different stages of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus under primary care.SettingWe retrieved the anonymised electronic health records of a population-based retrospective cohort in Hong Kong.ParticipantsA total of 26 197 patients were included in the analysis.Primary and secondary outcome measuresThe new-onset, progression and regression of CKD were defined by the transitions of four stages that were classified by combining glomerular filtration rate and urine albumin-to-creatinine ratio. We applied a multiscale multistate Poisson regression model to estimate the rates of the stage transitions by integrating the baseline demographic characteristics, routine laboratory test results and clinical data from electronic health records.ResultsDuring the mean follow-up time of 1.8 years, there were 2632 patients newly diagnosed with CKD, 1746 progressed to the next stage and 1971 regressed into an earlier stage. The models achieved the best performance in predicting the new-onset and progression with the predictors of sex, age, body mass index, systolic blood pressure, diastolic blood pressure, serum creatinine, haemoglobin A1c, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides and drug prescriptions.ConclusionsThis study demonstrated that individual risks of new-onset and progression of CKD can be predicted from the routine physical and laboratory test results. The individualised prediction curves developed from this study could potentially be applied to routine clinical practices, to facilitate clinical decision making, risk communications with patients and early interventions.

Abstract Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal blood disorder, resulting from severe deficiency of plasma ADAMTS13 activity. Plasma infusion or exchange is the mainstay of treatment. However, complications associated with the administration of blood products and with the placement of a central venous line remain to be a major concern. To address the unmet clinical need, we test hypothesis that anfibatide, a novel snake venom-derived glycoprotein (GP) Ib antagonist, may be efficacious in treating TTP. Here, we show that purified anfibatide from snake venom inhibited murine platelet agglutination induced by botrocetin in the presence of recombinant murine VWF in a concentration-dependent manner. At 6-9 micro grams per ml (final concentrations), anfibatide nearly completely abolished botrocetin-induced murine platelet agglutination (Fig. 1A). As expected, anfibatide at the same concentrations showed little or no inhibitory effect on the protease-activating receptor 4 (PAR4) agonist (AYPGKF)-induced murine platelet aggregation. In vivo, an intravenously infused radiolabeled anfibatide exhibited a half-life of 5-7 hours depending on the initial loading dose. This information provided pharmacokinetic basis for therapeutic strategy for TTP in the murine model. An infusion of purified anfibatide at the dose of 60-90 ng per gram of body weight twice daily significantly reduced the rate of thrombocytopenia in Adamts13-/- mice triggered by intravenous infusion of a bacterial toxin, i.e. shigatoxin-2 (Stx2) (250 pg per gram body weight). As shown, 5/5 (100%) Adamts13-/- mice after being challenged with Stx2 and but treated with normal saline (control) exhibited severe thrombocytopenia (defined by 50% reduction of platelet counts from the baseline). Similarly, treatment of Adamts13-/- mice with anfibatide at the dose of 30 ng per gram body weight twice daily had little or no effect in preventing thrombocytopenia. However, treatment of the same mice with anfibatide at doses of 60-90 ng per gram body weight twice daily resulted in significantly reduced rate of severe thrombocytopenia to 11%-37.5% (Fig. 1B). Our ongoing effort is to determine the efficacy of anfibatide in treatment of acquired TTP associated with inhibitors. We conclude that anfibatide when given at the optimal doses and interval can efficiently prevent Stx2-induced TTP syndrome in the murine model. These findings support a rationale for further development of anfibatide as a novel therapeutic for TTP in humans. Disclosures Li: 3Lee's Pharmaceutical Holdings Limited, Shatin, Hong Kong: Employment. Dai:4Zhaoke Pharmaceutical Co. Limited, Hefei, Anhui, China: Employment. Li:3Lee's Pharmaceutical Holdings Limited, Shatin, Hong Kong, China: Employment.

ObjectiveTo determine physicians’ knowledge, awareness and preferences regarding the care of familial hypercholesterolaemia (FH) in the Asia-Pacific region.SettingA formal questionnaire was anonymously completed by physicians from different countries/regions in the Asia-Pacific. The survey sought responses relating to general familiarity, awareness of management guidelines, identification (clinical characteristics and lipid profile), prevalence and inheritance, extent of elevation in risk of cardiovascular disease (CVD) and practice on screening and treatment.ParticipantsPractising community physicians from Australia, Japan, Malaysia, South Korea, Philippines, Hong Kong, China, Vietnam and Taiwan were recruited to complete the questionnaire, with the UK as the international benchmark.Primary outcomeAn assessment and comparison of the knowledge, awareness and preferences of FH among physicians in 10 different countries/regions.Results1078 physicians completed the questionnaire from the Asia-Pacific region; only 34% considered themselves to be familiar with FH. 72% correctly described FH and 65% identified the typical lipid profile, with a higher proportion of physicians from Japan and China selecting the correct FH definition and lipid profile compared with those from Vietnam and Philippines. However, less than half of the physician were aware of national or international management guidelines; this was significantly worse than physicians from the UK (35% vs 61%, p<0.001). Knowledge of prevalence (24%), inheritability (41%) and CVD risk (9%) of FH were also suboptimal. The majority of the physicians considered laboratory interpretative commenting as being useful (81%) and statin therapy as an appropriate cholesterol-lowering therapy (89%) for FH management.ConclusionsThe study identified important gaps, which are readily addressable, in the awareness and knowledge of FH among physicians in the region. Implementation of country-specific guidelines and extensive work in FH education and awareness programmes are imperative to improve the care of FH in the region.

Abstract Background Low-density lipoprotein cholesterol (LDL-C) is suggested to play a role in osteoporosis but its association with bone metabolism remains unclear. Effects of LDL-C-lowering drugs on bone are also controversial. We aim to determine whether LDL-C is linked causally to bone mineral density (BMD) and assess the effects of LDL-C-lowering drugs on BMD. Methods Association between blood lipid levels and BMD was examined by epidemiological observation analyses in a US representative cohort NHANES III (n = 3638) and the Hong Kong Osteoporosis Study (HKOS; n = 1128). Two-sample Mendelian randomization (MR), employing genetic data from a large-scale genome-wide association study (GWAS) of blood lipids (n = 188 577), total body BMD (TB-BMD) (n = 66 628) and estimated BMD (eBMD) (n= 142 487), was performed to infer causality between LDL-C and BMD. Genetic proxies for LDL-C-lowering drugs were used to examine the drugs’ effects on BMD. Results In the NHANES III cohort, each standard deviation (SD) decrease in LDL-C was associated with a 0.045 SD increase in femoral neck BMD (95% CI: 0.009 − 0.081; P = 0.015). A similar increase in BMD was observed in the HKOS at femoral neck and lumbar spine. In MR analysis, a decrease in genetically predicted LDL-C was associated with an increase in TB-BMD {estimate per SD decrease, 0.038 [95% confidence interval (CI): 0.002 − 0.074]; P = 0.038} and eBMD [0.076 (0.042 − 0.111); P = 1.20x10−5]. Reduction in TB-BMD was causally associated with increased LDL-C [0.035 (0.033 − 0.066); P = 0.034]. Statins’ LDL-C-lowering proxies were associated with increased TB-BMD [0.18 (0.044 − 0.316); P = 9.600x10−3] and eBMD [0.143 (0.062 − 0.223); P = 5.165x10−4]. Conclusions Negative causal association exists between LDL-C level and BMD. Statins’ LDL-C-lowering effect increases BMD, suggesting their protective effect on bone.

Patients with prediabetes who are at a high risk of progressing to diabetes are recommended early-stage intervention, according to guidelines. Non-pharmacological interventions are effective and cost-effective for glycemic control compared with medicines. We aim to explore which non-pharmacological interventions have the greatest potential effectiveness, cost-effectiveness, and feasibility in community-based diabetes management in China. We will perform a systematic review and network meta-analysis to compare the effectiveness of included non-pharmacological interventions, then use Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) to model the yearly incidence of complications, costs, and health utility for the lifetime. Published studies (only randomized controlled trials (RCTs) and cluster RCTs with at least one study arm of any non-pharmacological intervention) will be retrieved and screened using several databases. Primary outcomes included blood glucose, glycated hemoglobin, incidence of type 2 diabetes mellitus, and achievement of normoglycemia. Health utilities and cost parameters are to be calculated using a societal perspective and integrated into the modified CHIME model to achieve quality-adjusted life-year (QALY) estimates and lifetime costs. QALYs and incremental cost-effectiveness ratio will then be used to determine effectiveness and cost-effectiveness, respectively. Our study findings can inform improved diabetes management in countries with no intervention programs for these patients.

Context: Zinc-α2-glycoprotein (ZAG) is a 40-kDa circulating glycoprotein secreted from the liver and adipose tissues. Animal studies have demonstrated the role of ZAG as a lipid-mobilizing factor involved in regulating lipid metabolism and adiposity. However, the clinical relevance of these findings remains to be established. Objective: This study aimed to address the relationship of serum ZAG levels with adiposity and cardiometabolic risk factors in humans. Design and Setting: A total of 258 Chinese subjects [aged 55.1 ± 12.5 yr; 120 males, 138 females; body mass index (BMI), 25.4 ± 4.1 kg/m2] were randomly selected from the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study, based on their BMI. Serum ZAG levels were determined with ELISA. The relationship between serum ZAG levels and cardiometabolic parameters was assessed. Results: Serum ZAG levels were higher in men (P &lt; 0.001 vs. women). Serum ZAG correlated positively with age, parameters of adiposity (waist circumference and BMI), fasting insulin, insulin resistance indices, serum triglycerides, adipocyte-fatty acid-binding protein, and C-reactive protein, and diastolic blood pressure (all P &lt; 0.005, age- and sex-adjusted), and inversely with high-density lipoprotein-cholesterol levels (P = 0.008, age- and sex-adjusted). It was also elevated progressively with an increasing number of components of the metabolic syndrome (P for trend &lt; 0.001). On multivariate analysis, serum ZAG was independently associated with male sex, the metabolic syndrome (or type 2 diabetes and serum triglycerides), and C-reactive protein (all P ≤ 0.002). Conclusions: ZAG might be involved in the pathogenesis of obesity-related metabolic disorders in humans and thus warrants further investigation.

Vitamin D is essential for human health. However, it is not clear if vitamin D supplementation is necessary for all pregnant women. This study examines the relative importance of dietary patterns and vitamin D supplementation frequency in determining serum 25-hydroxyvitamin D (25(OH)D) and ferritin concentrations among pregnant women in Hong Kong, China. A total of 572 healthy women were recruited from antenatal clinics at 25–35 weeks pregnant. Participants completed an electronic version of the food frequency questionnaire and a web questionnaire on supplement use. Their blood samples were tested for serum 25(OH)D and ferritin. The associations of dietary patterns and vitamin D supplementation frequency with serum 25(OH)D and ferritin concentrations were analyzed using moderated hierarchical regression. Two dietary patterns were identified. The adequate dietary intake was characterized by the high probability of meeting recommended daily food group servings, whereas the inadequate dietary intake was characterized by inadequate consumption of vegetables, fruits, meat, fish, and eggs, or alternatives. The association between adequate dietary intake and serum ferritin concentrations was independent of vitamin D supplementation frequency (β = 0.05, p = 0.035), but dietary patterns interacted with vitamin D supplementation frequency to determine serum 25(OH)D concentrations (β = −13.22, p = 0.014). The current study presents evidence on the relative importance of dietary patterns and vitamin D supplementation in maintaining sufficient vitamin D and iron in pregnancy. Antenatal nutrition counselling services should be provided to pregnant women who show signs of inadequate dietary intake.

ABSTRACT Among 125 clinical isolates of Mycobacterium tuberculosis collected in Hong Kong and Shanghai, China, between 2002 and 2004, IS6110 typing revealed that 71 strains (57%) belonged to the Beijing family. The intracellular growth of the strains in human peripheral blood monocyte-derived macrophages was measured ex vivo on days 0, 3, 6, and 10. Among all tested strains, three hypervirulent strains showed significant increases in intracellular growth after 10 days of incubation. With an initial bacterial load of 104 CFU, most of the clinical isolates and H37Ra (an avirulent strain) exhibited no intracellular survival on day 10, while the three hypervirulent strains together with H37Rv (a virulent strain) showed on average a two- to fourfold rise in CFU count. These three hypervirulent strains belonging to a non-Beijing family were isolated from patients suffering from tuberculosis meningitis. Cytokines secreted by gamma interferon-activated macrophages were measured daily after challenge with selected strains of M. tuberculosis. The levels of tumor necrosis factor alpha were elevated after 24 h of infection among all strains, but the levels were significantly lower among the three hypervirulent strains, whereas interleukin 10 (IL-10) and IL-12 were not detected. Results were concordant with the differential expression of the corresponding cytokine genes in activated macrophages, as monitored by real-time PCR. Our findings highlighted that these three hypervirulent strains may possess an innate mechanism for escaping host immunity, which accounts for their characteristic virulence in patients presenting with a more severe form of disease.

Abstract Introduction: Central hypothyroidism results from pituitary or hypothalamic dysfunction. The evaluation of the adequacy of thyroxine replacement is difficult, due to the loss of thyrotropin (TSH) as an accurate feedback marker. This study aim to explore the potential metabolic and clinical effects of different free T4 (fT4) replacement targets in patients with central hypothyroidism. Method: This was a single center, prospective open-label crossover-like trial of 51 patients (mean age 56±12.9 years, 27 male) with hypopituitarism with multiple hormonal deficiencies including central hypothyroidism after excluding those with primary thyroid diseases, high risk for cardiovascular diseases (CVD) and known CVD. Dosage of levothyroxine (L-T4) was titrated to a targeted lower, middle and upper fT4 tertile and maintained for 24 weeks before assessment. Anthropometric and physiological measurements, metabolic and peripheral tissue markers, cognitive and quality of life assessments (SF-36 and Hong Kong Montreal Cognitive Assessment-5 [HK-MoCA-5]) were compared before and after each fT4 tertile change. This was followed by another 24-week cycle of L-T4 dosage adjustment to achieve fT4 in another tertile, with the same assessment as above. Results: We demonstrated that raising fT4 target from lower to upper tertile within the normal reference range resulted in significant decrease in body mass index (27.1±6.0 vs 25.7±5.6 kg/m2, P&lt;0.01), waist circumference (89.5±12.7 vs 86.4±12.1 cm, p&lt;0.01), diastolic blood pressure (79.1±12.9 vs 74.5±12.9 mmHg, p&lt;0.05) and low density lipoprotein cholesterol (3.94±0.88 vs 2.90±0.71 mmol/L, p&lt;0.01), apart from expected significant effect on tissue markers such as increased sex-hormone binding globulin (SHBG), increased ferritin and reduced creatinine kinase (CPK). The occurrence of metabolic syndrome (48.2% vs 29.0%, p &lt;0.05) was significantly reduced with increasing fT4 from middle to upper tertile, without significant effect on glycemic indexes, heart rate, SF-36 and HK-MoCA-5. Conclusion: In this study, we demonstrated that raising fT4 target to the upper tertile of normal resulted in a favourable improvement in various metabolic indexes without a significant increase in adverse effects over a period of 48 weeks.

Background Gestational diabetes mellitus (GDM) can cause adverse consequences to both mothers and their newborns. However, pregnant women living in low- and middle-income areas or countries often fail to receive early clinical interventions at local medical facilities due to restricted availability of GDM diagnosis. The outstanding performance of artificial intelligence (AI) in disease diagnosis in previous studies demonstrates its promising applications in GDM diagnosis. Objective This study aims to investigate the implementation of a well-performing AI algorithm in GDM diagnosis in a setting, which requires fewer medical equipment and staff and to establish an app based on the AI algorithm. This study also explores possible progress if our app is widely used. Methods An AI model that included 9 algorithms was trained on 12,304 pregnant outpatients with their consent who received a test for GDM in the obstetrics and gynecology department of the First Affiliated Hospital of Jinan University, a local hospital in South China, between November 2010 and October 2017. GDM was diagnosed according to American Diabetes Association (ADA) 2011 diagnostic criteria. Age and fasting blood glucose were chosen as critical parameters. For validation, we performed k-fold cross-validation (k=5) for the internal dataset and an external validation dataset that included 1655 cases from the Prince of Wales Hospital, the affiliated teaching hospital of the Chinese University of Hong Kong, a non-local hospital. Accuracy, sensitivity, and other criteria were calculated for each algorithm. Results The areas under the receiver operating characteristic curve (AUROC) of external validation dataset for support vector machine (SVM), random forest, AdaBoost, k-nearest neighbors (kNN), naive Bayes (NB), decision tree, logistic regression (LR), eXtreme gradient boosting (XGBoost), and gradient boosting decision tree (GBDT) were 0.780, 0.657, 0.736, 0.669, 0.774, 0.614, 0.769, 0.742, and 0.757, respectively. SVM also retained high performance in other criteria. The specificity for SVM retained 100% in the external validation set with an accuracy of 88.7%. Conclusions Our prospective and multicenter study is the first clinical study that supports the GDM diagnosis for pregnant women in resource-limited areas, using only fasting blood glucose value, patients’ age, and a smartphone connected to the internet. Our study proved that SVM can achieve accurate diagnosis with less operation cost and higher efficacy. Our study (referred to as GDM-AI study, ie, the study of AI-based diagnosis of GDM) also shows our app has a promising future in improving the quality of maternal health for pregnant women, precision medicine, and long-distance medical care. We recommend future work should expand the dataset scope and replicate the process to validate the performance of the AI algorithms.

Abstract Introduction: Human epidermal growth factor receptor 2 (HER2) amplification is commonly detected in breast cancer tissue samples by immunohistochemistry (IHC) and/or fluorescent in situ hybridization (FISH) tests in clinical practice. It has been reported that cell-free DNA (cfDNA) may better capture the heterogeneity of acquired resistance than tumor biopsy. This study aims to develop a noninvasive digital polymerase chain reaction (PCR) assay for the detection of HER2 amplification in the plasma cfDNA of breast cancer patients. We further examine the concordance rate of HER2 amplification detected by blood-based digital PCR with tissue-based IHC/FISH tests. Materials and Methods: Plasma samples from 32 breast cancer patients were prospectively collected at Queen Elizabeth Hospital (Hong Kong SAR, China). According to previous IHC/FISH records, 15 patients were scored as HER2 amplified (IHC score 3 and/or FISH positive) and 17 patients as HER2 non-amplified. The detection of plasma cfDNA was performed by droplet digital PCR (ddPCR). The EFTUD2 gene was used as a reference and HER2:EFTUD2 ratio was assessed by ddPCR on the plasma DNA from cancer samples. Results: A median of 1.47 (range 0.92-3.83) was detected in the HER2 amplified patients and a median of 1.03 (range 0.76-1.23) was detected in the HER2 non-amplified patients by ddPCR. Our results showed that using 1.30 as the cutoff, ddPCR assay could well detect HER2 amplification. Receiver operating characteristic analysis was used to evaluate the diagnostic ability of this ddPCR assay and it returned an area under the curve of 0.898. A diagnostic test was used to evaluate the concordance of this ddPCR assay with the IHC/FISH tests and determine the sensitivity (73.33%), specificity (100%), accuracy (87.5%), positive predictive value (100%), and negative predictive value (81%) of the ddPCR assay. Conclusion: Accurate reporting of HER2 amplification status is a prerequisite for the appropriate choice of targeted therapy. We have obtained a high level of concordance in comparison to tissue-based IHC/FISH when cfDNA ddPCR assay was used to determine HER2 amplification in breast cancer patients. Most importantly, we have established a great accuracy of the ddPCR assay. Increasing studies have reported that HER2 levels may change during targeted therapy, but there are additional risks of patients by the invasive nature of IHC/FISH tests. Our results support the potential application of blood-based ddPCR assay to monitor the changes of HER2 amplification status in breast cancer patients during targeted therapy. Citation Format: William C. Cho, Eunice Y. Lau, Jeffrey C. Chan, Anna Y. Tai, Alex K. Leung, Anthony K. Leung, Michelle O. Szeto, Elizabeth Y. Chuk, Tony Y. Yuen, Molly W. Fung, Roger K. Ngan. Noninvasive detection of HER2 amplification in breast cancer with plasma DNA digital PCR [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5155.

Abstract Background: Essential thrombocythemia (ET) is a subtype of chronic myeloproliferative neoplasms (MPN) characterized by thrombocytosis and disease-related symptoms, which may be difficult to manage. Patients with ET are also at higher risk of thrombosis and hemorrhage. Ideal therapeutic approaches should achieve adequate cytoreduction, reduce the risk of thrombo-hemorrhagic complications, and prevent progression to post-ET myelofibrosis (PET-MF) or secondary acute myeloid leukemia (AML). Low-dose aspirin with hydroxyurea (HU) is typically given as first-line therapy in high-risk patients. However, approximately 20-40% of ET patients become HU-intolerant or -resistant. In ET, resistance and/or intolerance portend an increased risk of thrombosis, hemorrhage, disease transformation and death. There is a paucity of prospective clinical trial data to guide management of ET patients who are HU resistant or intolerant. P1101 is a next generation monopegylated interferon (IFN) alfa-2b, developed specifically to treat MPNs, including ET. Study Design and Methods: The SURPASS-ET trial (NCT04285086) is a Phase 3, open-label, multicenter, randomized, active-controlled study to assess the efficacy, safety, tolerability, and pharmacokinetics (PK) of P1101 after 12 months of treatment compared with anagrelide as second line therapy for subjects with ET who have shown resistance or intolerance to HU. The primary endpoint is durable modified ELN composite response at 9 and 12 months from dosing. Cochran-Mantel-Haenszel test will be used for comparing the primary endpoint in the two treatment arms. The PK parameters of P1101, including (but not limited to) C min, T max, C max, and area-under-curve (AUC) will be derived using PPK analysis and the relationship between exposure and efficacy and safety endpoints will be examined using E-R analysis. Evaluation of efficacy will include clinical laboratory assessments, allelic burden measurements of CALR, JAK2, and MPL, spleen size measurements, bone marrow sampling (optional), EQ-5D-3L, and MPN Symptom Assessment Form Total Symptom Score (MPN-SAF TSS) assessments. A total of 130 randomized subjects is planned to detect a difference of 40% (P1101) versus 15% (anagrelide) in durable ELN response rate with 90% power at alpha level = 0.05 using the chi-square test. To account for possible non-evaluability (e.g., no follow-up data), approximately 160 subjects will be randomized in this study to get 130 completed patients. Because of uncertainty in the assumptions on which the calculation of the sample size is based, an interim analysis for sample size adjustment will be implemented. Major inclusion criteria include subjects diagnosed with high-risk ET (either older than 60 years and JAK2V617F-positive at screening or having disease-related thrombosis or hemorrhage in the past), diagnosed according to the World Health Organization (WHO) 2016 criteria, documented resistance/intolerance to HU and IFN naïve or anti-P1101 binding antibody negative. Key exclusion criteria include pregnant females, significant cardiovascular disease, documented autoimmune disease and a history or presence of clinically significant depression or neurological disease. The study involves approximately 65 sites across the US, Taiwan, Japan, China, Hong Kong, Singapore, S. Korea, Canada, and Europe. To-date 55 patients (54 Asians, 1 Caucasian) have been randomized. The mean and median age at recruitment was 58.9 years (SD: 14.34) and 63 years (range 21 to 80 years) respectively. Twenty-seven men (49.1%) and twenty-eight women (50.9%) were recruited. Forty-two subjects (76.4%) had a TSS &lt; 20. The study is being overseen by a Data Safety Monitoring Board (DSMB). Figure 1 Figure 1. Disclosures Mesa: Gilead: Research Funding; Promedior: Research Funding; AOP: Consultancy; Incyte Corporation: Consultancy, Research Funding; Abbvie: Research Funding; Genentech: Research Funding; La Jolla Pharma: Consultancy; Novartis: Consultancy; Sierra Oncology: Consultancy, Research Funding; Samus: Research Funding; Pharma: Consultancy; CTI: Research Funding; Celgene: Research Funding; Constellation Pharmaceuticals: Consultancy, Research Funding; CTI: Research Funding. Komatsu: Fujifilm Wako Pure Chemical Corporation: Research Funding; Fuso Pharmaceutical Industries, Ltd.: Research Funding; Japan Tobacco Inc.: Consultancy; Otsuka Pharmaceutical Co. Ltd: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis Pharma KK: Consultancy, Research Funding, Speakers Bureau; Shire Japan KK: Consultancy, Research Funding, Speakers Bureau; PharmaEssentia Japan KK: Consultancy, Current Employment, Research Funding; Chugai Pharmaceutical Co., Ltd.: Research Funding; Kyowa Hakko Kirin Co., Ltd.: Research Funding. Sato: PharmaEssentia Japan KK: Current Employment. Qin: PharmaEssentia Corp.: Current Employment. Urbanski: PharmaEssentia Corporation: Current Employment. Shih: PharmaEssentia Corporation: Consultancy. Zagrijtschuk: PharmaEssentia U.S.A. Corp.: Current Employment. Zimmerman: PharmaEssentia Corporation: Current Employment. Verstovsek: Gilead: Research Funding; Protagonist Therapeutics: Research Funding; NS Pharma: Research Funding; Incyte Corporation: Consultancy, Research Funding; PharmaEssentia: Research Funding; Ital Pharma: Research Funding; CTI BioPharma: Research Funding; Blueprint Medicines Corp: Research Funding; AstraZeneca: Research Funding; Promedior: Research Funding; Genentech: Research Funding; Celgene: Consultancy, Research Funding; Roche: Research Funding; Novartis: Consultancy, Research Funding; Sierra Oncology: Consultancy, Research Funding; Constellation: Consultancy; Pragmatist: Consultancy.

Introduction: Recent studies suggest that incidence of multiple myeloma (MM) is increasing in Asian countries. Prevalence is also expected to rise due to ageing populations and advances in treatment. Therapeutic options continue to expand as new, targeted agents enter the market. However, despite advances in therapy and supportive care, MM remains incurable. Most patients receive care outside the setting of clinical trials. Therefore, the generation of Real-World Evidence (RWE) on practice, including long-term monitoring and evaluation of current and future treatment strategies, is important in informing optimal therapies for MM and enable benchmarking to improve outcomes, quality of life (QoL), and cost-effectiveness of care for patients. Some country-specific data are available in Asia, but few at regional level. We established the Asia-Pacific (APAC) Myeloma and Related Diseases Registry (MRDR) in 2018, as a regional collaboration and sister registry to the Australian and New Zealand MRDR (ACTRN12618000659202). The aims are collection of a standardised APAC dataset for analysis and benchmarking. Key opinion leaders from the participating countries were invited to form the steering committee to provide local clinical context and oversight of the registry. Early in the process, ethics committees and legal counsel were consulted to assist with challenges presented by the diversity in data privacy and ethical regulations across the APAC region. Participating hospitals are responsible for obtaining local ethics approval, patient recruitment, and data collection. Participants provide written informed consent before data collection. Methods: The APAC MRDR prospectively collects observational data on patient characteristics, diagnosis, medical history, treatment (including supportive therapies), and outcomes (overall and progression-free survival, and QoL using the EQ-5D-5L) on newly diagnosed MM (NDMM), plasma cell leukaemia, plasmacytoma, and MGUS patients via a secure, country-specific web-based database. Whilst the core dataset is standardised across countries to ensure comparability, regional differences such as units of measurements and local privacy laws were accommodated in the design of each country's database. Participants are reviewed 4-monthly for a minimum of 2 years. Longer-term outcomes will be collected through linkage with local cancer and death registries. Six-monthly hospital reports, providing de-identified, risk-adjusted outcome data at hospital- and country-level, will be provided to contributing hospitals. Preliminary APAC MRDR data from October 2018 to June 2019 were analysed. Results: Eleven hospitals now have Institutional Review Board approval to participate and patient recruitment has commenced at 6 hospitals in Korea and Singapore. Sites in Taiwan, Hong Kong, China, and Malaysia are in progress. To date, 182 patients have been enrolled and data collection on these patients is in progress. At the time of analysis, 85% (96/113) were NDMM. Median age was 66 years (IQR: 59-73) and 54% were male. Median EQ5D VAS Health State score at diagnosis was 70 (IQR: 50-80; self-report: 100=best health imaginable, 0=the worst). Comorbidities were present in 47%. Proportion of patients with main paraprotein type IgG: 64%, IgA: 17%, light chain only Kappa: 13%, light chain only Lambda: 6%. Median number of days from diagnosis to chemotherapy was 9.5 (IQR: 3-15). The top two most frequently used first-line regimens for NDMM patients in Korea and Singapore were: Korea: 1. bortezomib/thalidomide/dexamethasone (VTd: 39%), 2. lenalidomide/dexamethasone (Rd: 27%), and Singapore: 1. VTd: 41%, 2. bortezomib/cyclophosphamide/dexamethasone (VCD): 25%. Overall response rate to first-line chemotherapy (≥PR) was 86% (44/51). Conclusion: The APAC MRDR database is expanding and, as data mature and feedback is provided to participating sites, will provide RWE that will contribute to our understanding on current myeloma treatment strategies and patient outcomes in the Asia-Pacific region. Future plans include expansion to additional sites and countries, and linkage with local cancer and death registries. The registry can also serve as a regional resource by providing infrastructure and identifying eligible participants for clinical trials and other research. Disclosures Aoki: Janssen Asia-Pacific: Research Funding. Moore:Takeda: Research Funding; Gilead: Research Funding. Wood:Bristol-Myers Squibb: Research Funding; Novartis: Research Funding; Alexion: Research Funding; Roche: Research Funding; Takeda: Research Funding; Gilead: Research Funding; Janssen-Cilag: Research Funding; Amgen: Research Funding; CSL Behring: Research Funding; Sanofi: Research Funding; Celgene: Research Funding; Abbvie: Research Funding. McQuilten:Gilead Sciences: Research Funding; CSL Biotherapies: Research Funding; Celgene: Research Funding; AbbVie: Research Funding; Takeda Pharmaceuticals: Research Funding; Janssen-Cilag: Research Funding. Spencer:Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Haemalogix: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen Oncology: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Specialised Therapeutics Australia: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Secura Bio: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Servier: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.

Abstract Acute myeloid leukemia (AML) is a heterogeneous group of diseases characterized by an abnormal increase of myeloblasts in bone marrow (BM) and peripheral blood (PB). Conventional approach of treatment with standard induction chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT) has reached an impasse with a cure rate of only 30%. A gain-of-function internal tandem duplication (ITD) of fms-like tyrosine kinase 3 (FLT3) was found in 30% of AML and was associated with an inferior treatment response and clinical prognosis. Despite much interests in FLT3 inhibitors in clinical trials, the response was at best transient, limiting their clinical application. Homoharringtonine (HHT) is a natural alkaloid widely used in Mainland China for the treatment of AML. It is a protein translation inhibitor and affects primarily proteins with short half-lives, including many of the downstream effectors of FLT3 signaling. In this study, we evaluated if HHT can be used in combination with sorafenib in the treatment of FLT3-ITD+ AML and examined the mechanistic basis of their synergism. The anti-leukemia effects of drugs on AML cell lines with or without FLT3-ITD mutation were evaluated by a high throughput PrestoBlue® fluorometric assay (a measure of viable cell number) after 3-day culture. Synergism between drugs in combination treatment was evaluated based on Excess Over Bliss Additivism (EOBA). The drug effects on leukemia initiating cells (LIC) activity were examined by xenotransplantation using NOD/SCID/IL2Rg-/- NSG mice and engraftment was enumerated by the presence of human CD45+/mouse CD45.1- cells 6 weeks after transplantation. The effects of HHT and FLT3 inhibitors on FLT3 signaling were examined by Western Blot and Phospho-flow analysis by flow cytometry. HHT exhibited more potent growth inhibitory effect on FLT3-ITD+ AML cell lines, MV4-11 and MOLM-13 (IC50: 3.65 and 3.67 nM) than other AML cell lines (IC50: 7.7 - 32.3 nM). Combination of HHT and sorafenib (H+S) showed pronounced synergism in growth inhibition based on EOBA (29.7% ± 5%) at 3.65 nM (HHT) and 3.85 nM (S). H+S also induced significant increase in apoptosis in MV4-11 based on Annexin V+ population (H+S: 21.3% ± 2.3%; HHT: 11.7% ± 1.9%; S: 8.4% ± 1.0%). Synergism with HHT could also be demonstrated with other FLT3 inhibitors, quizartinib (EOBA: 16% ± 8%) and ponatinib (EOBA: 24% ± 6%) on MV4-11 cell lines. There was no synergism between sorafenib and conventional chemotherapy as exemplified by cytarabine. H+S in vitro significantly reduced engraftment of MV4-11 cells (Vehicle: 65.0% ± 9.7%; H+S: 21.8% ± 8.7%, p<0.01, n=6). HHT alone also inhibited leukemia growth of primary AML samples (IC50: 38.4 ± 7.2 nM, n=88), that was below the peak plasma concentration of HHT (66 nM) in patients receiving treatment. Synergism between H+S was also seen in primary AML samples. Mechanistically, HHT treatment for 6 hours reduced total FLT3 and p-FLT3 protein levels in MV4-11 and MOLM-13. Protein levels of downstream effectors of FLT3 pathway including total Stat5, pStat5, pStat3, pErk were also reduced. A phase II clinical trial of sorafenib (200-400 mg twice daily continuous) and HHT (1.5 mg/m2 for 7 days every 28 days for the first cycle and for 4 days in subsequent cycles, until leukemia progression) combination treatment in patients with chemo-refractory FLT3-ITD+ AML has begun in Hong Kong since January 2014. Bone marrow was performed before and on day 21 after treatment and repeated every two cycles thereafter. Five patients have been treated, including two patients who were primarily refractory to sorafenib monotherapy. Complete remission (CR) was achieved in 1 patient and CR with incomplete hematological recovery (CRi) in four others after 1 cycle. The FLT3-ITD allelic burdens before treatment and at CR/CRi were 77.7 ± 9.6% and 20.0 ± 9.6% (p=0.007). As of 5th August 2014, the two primary sorafenib refractory patients had leukemia progression at 65 and 95 days after treatment. The other three patients remained in remission at 113, 134 and 150 days after treatment. In conclusion, HHT and sorafenib demonstrated significant synergistic effect in suppressing the growth of FLT3-ITD+ AML cells both in vitro and in vivo. It provides a promising strategy in improving treatment outcome of FLT3-ITD+ AML patients. Disclosures No relevant conflicts of interest to declare.

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. Available at: https://covid19.who.int/ [Accessed on 23 August 2020] Sim K, Chua HC. The psychological impact of SARS: a matter of heart and mind. CMAJ. 2004; 170:811e2. https://doi.org/10.1503/cmaj.1032003. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatr. 2009; 54:302e11. https://doi.org/10.1177/070674370905400504. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395:912e20. https://doi.org/10.1016/S0140-6736(20)30460-8. Robertson E, Hershenfield K, Grace SL, Stewart DE. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. Can J Psychiatr. 2004; 49:403e7. https://doi.org/10.1177/070674370404900612. Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep. 2015; 9:547e53. https://doi.org/10.1017/dmp.2015.38. Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38: e2016048. https://doi.org/10.4178/epih.e2016048. Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatr. 2012; 53:15e23. https://doi.org/10.1016/j.comppsych.2011.02.003 Chadda RK, Deb KS. Indian family systems, collectivistic society and psychotherapy. Indian J Psychiatry. 2013;55: S299‑ https://dx.doi.org/10.4103%2F0019-5545.105555. Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, et al. Psychological impact of COVID‑19 lockdown: An online survey from India. Indian J Psychiatry. 2020; 62:354-62. https://doi.org/ 10.4103/psychiatry.IndianJPsychiatry _427_20. Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 2010; 40: 218–27. https://dx.doi.org/10.1007%2Fs12160-010-9210-8. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7. Bhandari S, Sharma R, Singh Shaktawat A, Banerjee S, Patel B, Tak A, et al. COVID-19 related mortality profile at a tertiary care centre: a descriptive study. Scr Med. 2020;51(2):69-73. https://doi.org/10.5937/scriptamed51-27126. Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995; 117: 497–529. https://doi.org/10.1037/0033-2909.117.3.497. Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R. Socially isolated children 20 years later: risk of cardiovascular disease. Arch Pediatr Adolesc Med. 2006; 160(8):805-11. https://doi.org/10.1001/archpedi.160.8.805. Eaker ED, Pinsky J, Castelli WP. Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol. 1992; 135(8):854-64. https://doi.org/10.1093/oxfordjournals.aje.a116381. Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012 Mar; 74(6):907-14. https://dx.doi.org/10.1016%2Fj.socscimed.2011.11.028. Olsen RB, Olsen J, Gunner-Svensson F, Waldstrøm B. Social networks and longevity. A 14-year follow-up study among elderly in Denmark. Soc Sci Med. 1991; 33(10):1189-95. https://doi.org/10.1016/0277-9536(91)90235-5. Patterson AC, Veenstra G. Loneliness and risk of mortality: a longitudinal investigation in Alameda County, California. Soc Sci Med. 2010; 71(1):181-6. https://doi.org/10.1016/j.socscimed.2010.03.024. Savikko N, Routassalo P, Tilvis RS, Strandberg TE, Pitkalla KH. Predictors and subjective causes of loneliness in an aged population. Arch Gerontol Geriatrics. 2005; 41:3;223-33. https://doi.org/10.1016/j.archger.2005.03.002. Health Advisory for Elderly Population of India during COVID19. Available at: https://www.mohfw.gov.in/pdf/AdvisoryforElderlyPopulation.pdf [Accessed on 13 August 2020]. Dicks D, Myers R, Kling A. Uncus and amygdala lesions: effects on social behavior in the free-ranging rhesus monkey. Science. 1969; 165:69–71. https://doi.org/10.1126/science.165.3888.69. Kanai R, Bahrami B, Duchaine B, Janik A, Banissy MJ, Rees G. Brain structure links loneliness to social perception. Curr Biol. 2012; 22(20):1975-9. https://dx.doi.org/10.1016%2Fj.cub.2012.08.045. Bender AR, Daugherty A, Raz N. Vascular risk moderates associations between hippocampal subfield volumes and memory. J Cogn Neurosci. 2013; 25:1851–62. https://doi.org/10.1162/jocn_a_00435. Raz N. Diabetes: brain, mind, insulin–what is normal and do we need to know? Nat Rev Endocrinol. 2011; 7:636–7. https://doi.org/10.1038/nrendo.2011.149. Colcombe SJ, Erickson KI, Naftali R, Andrew GW, Cohen NJ, McAuley E, et al. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci. 2003; 58:176–80. https://doi.org/10.1093/gerona/58.2.m176. Maass A, Düzel S, Goerke M, Becke A, Sobieray U, Neumann K, et al. Vascular hippocampal plasticity after aerobic exercise in older adults. Mol Psychiatry. 2015; 20, 585–93. https://doi.org/10.1038/mp.2014.114. Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, et al. Loneliness and Risk of Alzheimer Disease. Arch Gen Psychiatry. 2007;64(2):234–240. https://doi.org/10.1001/archpsyc.64.2.234. Kogan JH, Frankland PW, Silva AJ. Long-term memory underlying hippocampus-dependent social recognition in mice. Hippocampus. 2000;10(1):47-56. https://doi.org/10.1002/(sici)1098-1063(2000)10:1%3C47::aid-hipo5%3E3.0.co;2-6. Yorgason JT, España RA, Konstantopoulos JK, Weiner JL, Jones SR. Enduring increases in anxiety-like behavior and rapid nucleus accumbens dopamine signaling in socially isolated rats. Eur J Neurosci. 2013;37(6):1022-31. https://doi.org/10.1111/ejn.12113. Bledsoe AC, Oliver KM, Scholl JL, Forster GL. Anxiety states induced by post-weaning social isolation are mediated by CRF receptors in the dorsal raphe nucleus. Brain Res Bull. 2011;85(3-4):117-22. https://dx.doi.org/10.1016%2Fj.brainresbull.2011.03.003. Lukkes JL, Engelman GH, Zelin NS, Hale MW, Lowry CA. Post-weaning social isolation of female rats, anxiety-related behavior, and serotonergic systems. Brain Res. 2012; 1443:1-17. https://dx.doi.org/10.1016%2Fj.brainres.2012.01.005. Ago Y, Araki R, Tanaka T, Sasaga A, Nishiyama S, Takuma K, et al. Role of social encounter-induced activation of prefrontal serotonergic systems in the abnormal behaviors of isolation-reared mice. Neuropsychopharmacology. 2013; 38(8):1535-47. https://doi.org/10.1038/npp.2013.52. Veenema AH. Early life stress, the development of aggression and neuroendocrine and neurobiological correlates: what can we learn from animal models? Front Neuroendocrinol. 2009;30(4):497-518. https://doi.org/10.1016/j.yfrne.2009.03.003. Zhao X, Sun L, Jia H, Meng Q, Wu S, Li N, et al. Isolation rearing induces social and emotional function abnormalities and alters glutamate and neurodevelopment-related gene expression in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(7):1173-1177. https://doi.org/10.1016/j.pnpbp.2009.06.016. Sciolino NR, Bortolato M, Eisenstein SA, Fu J, Oveisi F, Hohmann AG, et al. Social isolation and chronic handling alter endocannabinoid signaling and behavioral reactivity to context in adult rats. Neuroscience. 2010;168(2):371-86. https://dx.doi.org/10.1016%2Fj.neuroscience.2010.04.007. Ghasemi M, Phillips C, Trillo L, De Miguel Z, Das D, Salehi A. The role of NMDA receptors in the pathophysiology and treatment of mood disorders. Neurosci Biobehav Rev. 2014; 47:336-358. https://doi.org/10.1016/j.neubiorev.2014.08.017. Olivenza R, Moro MA, Lizasoain I, Lorenzo P, Fernández AP, Rodrigo J, et al. Chronic stress induces the expression of inducible nitric oxide synthase in rat brain cortex. J Neurochem. 2000;74(2):785-791. https://doi.org/10.1046/j.1471-4159.2000.740785.x. Maeng S, Zarate CA Jr, Du J, Schloesser RJ, McCammon J, Chen G, et al. Cellular mechanisms underlying the antidepressant effects of ketamine: role of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptors. Biol Psychiatry. 2008;63(4):349-352. https://doi.org/10.1016/j.biopsych.2007.05.028. Kalia LV, Kalia SK, Salter MW. NMDA receptors in clinical neurology: excitatory times ahead. Lancet Neurol. 2008;7(8):742-755. https://dx.doi.org/10.1016%2FS1474-4422(08)70165-0. Waxman EA, Lynch DR. N-methyl-D-aspartate Receptor Subtypes: Multiple Roles in Excitotoxicity and Neurological Disease. The Neuroscientist. 2005; 11(1), 37–49. https://doi.org/10.1177/1073858404269012. Hermes G, Li N, Duman C, Duman R. Post-weaning chronic social isolation produces profound behavioral dysregulation with decreases in prefrontal cortex synaptic-associated protein expression in female rats. Physiol Behav. 2011;104(2):354-9. https://dx.doi.org/10.1016%2Fj.physbeh.2010.12.019. Sestito RS, Trindade LB, de Souza RG, Kerbauy LN, Iyomasa MM, Rosa ML. Effect of isolation rearing on the expression of AMPA glutamate receptors in the hippocampal formation. J Psychopharmacol. 2011;25(12):1720-1729. https://doi.org/10.1177/0269881110385595. Toua C, Brand L, Möller M, Emsley RA, Harvey BH. The effects of sub-chronic clozapine and haloperidol administration on isolation rearing induced changes in frontal cortical N-methyl-D-aspartate and D1 receptor binding in rats. Neuroscience. 2010;165(2):492-499. https://doi.org/10.1016/j.neuroscience.2009.10.039. Alò R, Avolio E, Mele M, Storino F, Canonaco A, Carelli A et al. Excitatory/inhibitory equilibrium of the central amygdala nucleus gates anti-depressive and anxiolytic states in the hamster. Pharmacol Biochem Behav. 2014; 118:79-86. https://doi.org/10.1016/j.pbb.2014.01.007. St JP, Petkov VV. Changes in 5-HT1 receptors in different brain structures of rats with isolation syndrome. General pharmacology. 1990;21(2):223-5. https://doi.org/10.1016/0306-3623(90)90905-2. Miachon S, Rochet T, Mathian B, Barbagli B, Claustrat B. Long-term isolation of Wistar rats alters brain monoamine turnover, blood corticosterone, and ACTH. Brain Res Bull. 1993;32(6):611-614. https://doi.org/10.1016/0361-9230(93)90162-5. Van den Berg CL, Van Ree JM, Spruijt BM, Kitchen I. Effects of juvenile isolation and morphine treatment on social interactions and opioid receptors in adult rats: behavioural and autoradiographic studies. Eur J Neurosci. 1999;11(9):3023-3032. https://doi.org/10.1046/j.1460-9568.1999.00717.x. Vanderschuren LJ, Stein EA, Wiegant VM, Van Ree JM. Social play alters regional brain opioid receptor binding in juvenile rats. Brain Res. 1995;680(1-2):148-156. https://doi.org/10.1016/0006-8993(95)00256-p. Moles A, Kieffer BL, D'Amato FR. Deficit in attachment behavior in mice lacking the mu-opioid receptor gene. Science. 2004;304(5679):1983-1986. https://doi.org/10.1126/science.1095943. Panksepp J, Herman BH, Vilberg T, Bishop P, DeEskinazi FG. Endogenous opioids and social behavior. Neurosci Biobehav Rev. 1980;4(4):473-487. https://doi.org/10.1016/0149-7634(80)90036-6. Gong JP, Onaivi ES, Ishiguro H, Liu Q, Tagliaferro PA, Brusco A, et al. Cannabinoid CB2 receptors: immunohistochemical localization in rat brain. Brain Res. 2006;1071(1):10-23. https://doi.org/10.1016/j.brainres.2005.11.035. Breivogel CS, Sim-Selley LJ. Basic neuroanatomy and neuropharmacology of cannabinoids. Int Rev Psychiatry 2009; 21:2:113-121. https://doi.org/10.1080/09540260902782760. Haj-Mirzaian A, Amini-Khoei H, Haj-Mirzaian A, Amiri S, Ghesmati M, Zahir M, et al. Activation of cannabinoid receptors elicits antidepressant-like effects in a mouse model of social isolation stress. Brain Res Bull. 2017; 130:200-210. https://doi.org/10.1016/j.brainresbull.2017.01.018. Banach M, Piskorska B, Czuczwar SJ, Borowicz KK. Nitric Oxide, Epileptic Seizures, and Action of Antiepileptic Drugs. CNS & Neurological Disorders - Drug Targets 2011;10: 808. https://doi.org/10.2174/187152711798072347. Förstermann U, Sessa WC. Nitric oxide synthases: regulation and function. Eur Heart J. 2012;33(7):829-37, 837a-837d. https://dx.doi.org/10.1093%2Feurheartj%2Fehr304. Hu Y, Wu D, Luo C, Zhu L, Zhang J, Wu H, et al. Hippocampal nitric oxide contributes to sex difference in affective behaviors. PNAS. 2012, 109 (35) 14224-14229. https://doi.org/10.1073/pnas.1207461109. Khan MI, Ostadhadi S, Zolfaghari S, Mehr SE, Hassanzadeh G, Dehpour, A et al. The involvement of NMDA receptor/NO/cGMP pathway in the antidepressant like effects of baclofen in mouse force swimming test. Neuroscience Letters. 2016; 612:52-61. https://doi.org/10.1016/j.neulet.2015.12.006. Matsumoto K, Puia G, Dong E, Pinna G. GABAA receptor neurotransmission dysfunction in a mouse model of social isolation-induced stress: Possible insights into a non-serotonergic mechanism of action of SSRIs in mood and anxiety disorders. Stress. 2007; 10:1:3-12. https://doi.org/10.1080/10253890701200997. Zlatković J, Filipović D. Chronic social isolation induces NF-κB activation and upregulation of iNOS protein expression in rat prefrontal cortex. Neurochem Int. 2013;63(3):172-179. https://doi.org/10.1016/j.neuint.2013.06.002. Haj-Mirzaian A, Amiri S, Kordjazy N, Momeny M, Razmi A, Balaei MR, et al. Lithium attenuated the depressant and anxiogenic effect of juvenile social stress through mitigating the negative impact of interlukin-1β and nitric oxide on hypothalamic-pituitary-adrenal axis function. Neuroscience. 2016; 315:271-285. https://doi.org/10.1016/j.neuroscience.2015.12.024. Larson HJ. The biggest pandemic risk? Viral misinformation. Nature 2018; 562:309. https://doi.org/10.1038/d41586-018-07034-4. Zarocostas J. How to fight an infodemic. Lancet 2020; 395:676. https://doi.org/10.1016/S0140-6736(20)30461-X. World Health Organization, 2019. Ebola Virus Disease – Democratic Republic of the Congo. Geneva, Switzerland: WHO. Available at: https://www.who.int/csr/don/28-november-2019-ebola-drc/en/ [Accessed on August 8, 2020] Times of India. Covid-19: doctors gone to collect samples attacked in Indore. Available at: https://timesofindia.indiatimes.com/videos/news/covid-19-doctors-goneto- collect-samples-attacked-in-indore/videoshow/74942153.cms; 2020 [Accessed on August 8, 2020]. Withnall A. Coronavirus: why India has had to pass new law against attacks on healthcare workers. The Independent. April 23, 2020. Semple K. “Afraid to be a nurse”: health workers under attack. The New York Times. 2020 Apr 27. The Economist. Health workers become unexpected targets during COVID-19. The Economist. May 11, 2020. Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav. 2017; 21: 283–291. https://doi.org/10.1007/s10461-016-1451-5. James PB, Wardle J, Steel A, Adams J. An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross sectional study. BMC Public Health. 2020; 20: 182. https://doi.org/10.1186/s12889-020-8279-7. Aljazeera, 2020. Iran: Over 700 Dead after Drinking Alcohol to Cure Coronavirus. Aljazeera. Available at: https://www.aljazeera.com/ news/2020/04/iran-700-dead-drinking-alcohol-cure-coronavirus200427163529629.html. (Accessed June 4, 2020) Delirrad M, Mohammadi AB, 2020. New methanol poisoning outbreaks in Iran following COVID-19 pandemic. Alcohol Alcohol. 55: 347–348. https://doi.org/10.1093/alcalc/agaa036. Hassanian-Moghaddam H, Zamani N, Kolahi A-A, McDonald R, Hovda KE. Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran-a cross-sectional assessment. Crit Care. 2020; 24: 402. https://doi.org/10.1186/s13054-020-03140-w. Soltaninejad K. Methanol Mass Poisoning Outbreak: A Consequence of COVID-19 Pandemic and Misleading Messages on Social Media. Int J Occup Environ Med. 2020;11(3):148-150. https://dx.doi.org/10.34172%2Fijoem.2020.1983. Islam MS, Sarkar T, Khan SH, Kamal AM, Hasan SMM, Kabir A, et al. COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis. Am J Trop Med Hyg. 2020; 00(0):1–9. https://doi.org/10.4269/ajtmh.20-0812. Hawryluck L, Gold W, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206–1212. https://dx.doi.org/10.3201%2Feid1007.030703. Lee S, Chan LYY, Chau AAM, Kwok KPS, Kleinman A. The experience of SARS-related stigma at Amoy Gardens. Soc Sci Med. 2005; 61(9): 2038-2046. https://doi.org/10.1016/j.socscimed.2005.04.010. Yoon MK Kim SY Ko HS Lee MS. System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. Int J Ment Health Syst. 2016; 10: 51. https://doi.org/10.1186/s13033-016-0083-5. Reynolds DL, Garay JR, Deamond SL, Moran MK, Gold W, Styra R. Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiol Infect. 2008; 136: 997-1007. https://dx.doi.org/10.1017%2FS0950268807009156. Marjanovic Z, Greenglass ER, Coffey S. The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: an online questionnaire survey. Int J Nurs Stud. 2007; 44(6): 991-998. https://doi.org/10.1016/j.ijnurstu.2006.02.012. Bai Y, Lin C-C, Lin C-Y, Chen J-Y, Chue C-M, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004; 55: 1055-1057. https://doi.org/10.1176/appi.ps.55.9.1055. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf [Accessed on 25 August 2020]. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofverymildpresymptomaticCOVID19cases10May2020.pdf [Accessed on 25 August 2020]. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/AdvisoryformanagingHealthcareworkersworkinginCOVIDandNonCOVIDareasofthehospital.pdf (Accessed on 25 August 2020). Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforInternationalArrivals02082020.pdf [Accessed on 25 August 2020]. Cost of the lockdown? Over 10% of GDP loss for 18 states. Available at: https://timesofindia.indiatimes.com/india/cost-of-the-lockdown-over-10-of-gdp-loss-for-18-states/articleshow/76028826.cms [Accessed on 21 August 2020]. Jorda O, Singh SR, Taylor AM. Longer-Run Economic Consequences of Pandemics. Federal Reserve Bank of San Francisco Working Paper. 2020-09. https://doi.org/10.24148/wp2020-09. Firdaus G. Mental well‑being of migrants in urban center of India: Analyzing the role of social environment. Indian J Psychiatry. 2017; 59:164‑ https://doi.org/10.4103/psychiatry.indianjpsychiatry_272_15. National Crime Record Bureau. Annual Crime in India Report. New Delhi, India: Ministry of Home Affairs; 2018. 198 migrant workers killed in road accidents during lockdown: Report. Available at: https://www.hindustantimes.com/india-news/198-migrant-workers-killed-in-road-accidents-during-lockdown-report/story-hTWzAWMYn0kyycKw1dyKqL.html [Accessed on 25 August 2020]. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; 20:689-96. https://doi.org/10.1016/S1473-3099(20)30198-5. Dalton L, Rapa E, Stein A. Protecting the psychological health of through effective communication about COVID-19. Lancet Child Adolesc Health. 2020;4(5):346-347. https://doi.org/10.1016/S2352-4642(20)30097-3. Centre for Disease Control. Helping Children Cope with Emergencies. Available at: https://www.cdc.gov/childrenindisasters/helping-children-cope.html [Accessed on 25 August 2020]. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child & Adolesc Health. 2020; 4(5):347-349. https://doi.org/10.1016/S2352-4642(20)30096-1. Sprang G, Silman M. Posttraumatic Stress Disorder in Parents and Youth After Health-Related Disasters. Disaster Med Public Health Prep. 2013;7(1):105-110. https://doi.org/10.1017/dmp.2013.22. Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, Anxiety and Stress Among Indians in Times of Covid-19 Lockdown. Community Ment Health J. 2020:1-7. https://doi.org/10.1007/s10597-020-00664-x. Cao W, Fang Z, Hou, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research. 2020; 287:112934. https://doi.org/10.1016/j.psychres.2020.112934. Wang C, Zhao H. The Impact of COVID-19 on Anxiety in Chinese University Students. Front Psychol. 2020; 11:1168. https://dx.doi.org/10.3389%2Ffpsyg.2020.01168. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7(3): e14. https://doi.org/10.1016/s2215-0366(20)30047-x. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3(3): e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976. Lancee WJ, Maunder RG, Goldbloom DS, Coauthors for the Impact of SARS Study. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. 2008;59(1):91-95. https://dx.doi.org/10.1176%2Fps.2008.59.1.91. Tam CWC, Pang EPF, Lam LCW, Chiu HFK. Severe acute respiratory syndrome (SARS) in Hongkong in 2003: Stress and psychological impact among frontline healthcare workers. Psychol Med. 2004;34 (7):1197-1204. https://doi.org/10.1017/s0033291704002247. Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018; 87:123-127. https://dx.doi.org/10.1016%2Fj.comppsych.2018.10.003. Koh D, Meng KL, Chia SE, Ko SM, Qian F, Ng V, et al. Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare workers in Singapore: What can we learn? Med Care. 2005;43(7):676-682. https://doi.org/10.1097/01.mlr.0000167181.36730.cc. Verma S, Mythily S, Chan YH, Deslypere JP, Teo EK, Chong SA. Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore. Ann Acad Med Singap. 2004; 33(6):743e8. Yeung J, Gupta S. Doctors evicted from their homes in India as fear spreads amid coronavirus lockdown. CNN World. 2020. Available at: https://edition.cnn.com/2020/03/25/asia/india-coronavirus-doctors-discrimination-intl-hnk/index.html. [Accessed on 24 August 2020] Violence Against Women and Girls: the Shadow Pandemic. UN Women. 2020. May 3, 2020. Available at: https://www.unwomen.org/en/news/stories/2020/4/statement-ed-phumzile-violence-against-women-during-pandemic. [Accessed on 24 August 2020]. Gearhart S, Patron MP, Hammond TA, Goldberg DW, Klein A, Horney JA. The impact of natural disasters on domestic violence: an analysis of reports of simple assault in Florida (1999–2007). Violence Gend. 2018;5(2):87–92. https://doi.org/10.1089/vio.2017.0077. Sahoo S, Rani S, Parveen S, Pal Singh A, Mehra A, Chakrabarti S, et al. Self-harm and COVID-19 pandemic: An emerging concern – A report of 2 cases from India. Asian J Psychiatr 2020; 51:102104. https://dx.doi.org/10.1016%2Fj.ajp.2020.102104. Ghosh A, Khitiz MT, Pandiyan S, Roub F, Grover S. Multiple suicide attempts in an individual with opioid dependence: Unintended harm of lockdown during the COVID-19 outbreak? Indian J Psychiatry 2020; [In Press]. The Economic Times. 11 Coronavirus suspects flee from a hospital in Maharashtra. March 16 2020. Available at: https://economictimes.indiatimes.com/news/politics-and-nation/11-coronavirus-suspects-flee-from-a-hospital-in-maharashtra/videoshow/74644936.cms?from=mdr. [Accessed on 23 August 2020]. Xiang Y, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry 2020;(3):228–229. https://doi.org/10.1016/S2215-0366(20)30046-8. Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma A, Muana A, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ. 2016;94(3):210–214. https://dx.doi.org/10.2471%2FBLT.15.158543. Kumar A, Nayar KR. COVID 19 and its mental health consequences. Journal of Mental Health. 2020; ahead of print:1-2. https://doi.org/10.1080/09638237.2020.1757052. Gupta R, Grover S, Basu A, Krishnan V, Tripathi A, Subramanyam A, et al. Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatry. 2020; 62(4):370-8. https://doi.org/10.4103/psychiatry.indianjpsychiatry_523_20. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4): P300-302. https://doi.org/10.1016/S2215-0366(20)30073-0. Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020; 14(5): 779–788. https://dx.doi.org/10.1016%2Fj.dsx.2020.05.035. Wright R. The world's largest coronavirus lockdown is having a dramatic impact on pollution in India. CNN World; 2020. Available at: https://edition.cnn.com/2020/03/31/asia/coronavirus-lockdown-impact-pollution-india-intl-hnk/index.html. [Accessed on 23 August 2020] Foster O. ‘Lockdown made me Realise What’s Important’: Meet the Families Reconnecting Remotely. The Guardian; 2020. Available at: https://www.theguardian.com/keep-connected/2020/apr/23/lockdown-made-me-realise-whats-important-meet-the-families-reconnecting-remotely. (Accessed on 23 August 2020) Bilefsky D, Yeginsu C. Of ‘Covidivorces’ and ‘Coronababies’: Life During a Lockdown. N. Y. Times; 2020. Available at: https://www.nytimes.com/2020/03/27/world/coronavirus-lockdown-relationships.html [Accessed on 23 August 2020]

Background and Purpose— Carotid atherosclerosis is not neglectable as a cause for stroke in China, despite of low prevalence. This study was performed to evaluate the association between its ultrasonographic markers with metabolic syndrome (MetS). Methods— This was a community-based cross-sectional study. Demographics, common vascular risk factors, and results of fasting blood analysis were collected at baseline. MetS was defined as ≥3 following conditions or receiving specific treatment: abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension and impaired fasting blood glucose. All subjects underwent carotid duplex ultrasonography. Mean carotid intima-media thickness (CIMT) of bilateral common carotid arteries was used as the CIMT value for a single subject. CIMT within the 4th quartile was regarded as increased CIMT. Carotid plaque was defined as a focal CIMT of >1.5 mm. Results— A total of 653 subjects (mean age 55.1±10.4; 47.2% male) were recruited. MetS was found in 188 (28.8%) subjects (30.8% in male and 27.0% in female). Mean CIMT was 0.74±0.12 mm. Increased CIMT and carotid plaques were detected in 163 (25.0%) and 95 (14.5%) subjects, respectively. In multivariate linear regression, CIMT significantly increased with increasing numbers of MetS components (P<0.001). In multivariate logistic regression, MetS was independently associated with increased CIMT (OR 1.17; 95% CI 1.11-2.64; P=0.014) but not presence of carotid plaque (OR 1.50; 95% CI 0.92-2.46; P=0.108). Conclusion— MetS may be independently associated with early stage but not later and advanced stages of carotid atherosclerosis in community residents in China.

Abstract Background Air pollution has been associated with an increase in cardiovascular diseases incidence. To evaluate whether air pollution can accelerate atherogenic processes, we assessed the effects of air pollution on important surrogate markers of atherosclerosis [brachial flow-mediated dilation (FMD) and carotid intima-media thickness (IMT)]. Methods A total of 1656 Han Chinese (mean age 46.0 + 11.2 years; male 47%) in Hong Kong, Macau, Pun Yu, Yu County and the 3-Gorges Territories (Yangtze River) were studied between 1996 and 2007 [Chinese Atherosclerosis in the Aged and Young Project (the CATHAY Study)]. Cardiovascular risk profiles were evaluated. Particulate matter with an aerodynamic diameter &lt;2.5 µm (PM2.5) parameters were computed from satellite sensors. Brachial FMD and carotid IMT were measured by ultrasound. Results Health parameters [age, gender, body mass index, waist : hip ratio (WHR) and glucose)] were similar in lowest and highest PM2.5 exposure tertiles, systolic and diastolic blood pressures and triglycerides were higher (P &lt; 0.001) and low-density cholesterol (LDL-C) was lower in the top PM2.5 tertile (P &lt; 0.001). Brachial FMD [7.84 ± 1.77, 95% confidence interval (CI) 7.59–8.10%, vs 8.50 ± 2.52, 95% CI 8.23–8.77%, P &lt; 0.0001) was significantly lower and carotid IMT (0.68 ± 0.13 mm, 95% CI 0.67–0.69 mm vs 0.63 mm ± 0.15 mm 95% CI 0.62–0.64 mm; P &lt; 0.0001) was significantly thicker in the top PM2.5 tertile compared with the lowest tertile. On multiple regression, FMD was inversely related to PM2.5 (beta = 0.134, P = 0.015) independent of gender, age and blood pressure (model R2 = 0.156, F-value = 7.6, P &lt; 0.0001). Carotid IMT was significantly correlated with PM2.5 exposure (beta = 0.381, P &lt; 0.0001) independent of age, location, gender, WHR, blood pressure and LDL-C (model R2 = 0.408, F-value = 51.4, P-value &lt;0.0001). Conclusions Air pollution is strongly associated with markers of early atherosclerosis, suggesting a potential target for preventive intervention.

Challenges for Australia's Biotechnology Sector. Website on Poisonous Creatures and Plants Launched. Pharmaceutical Giants to Set up Research Centers in China. MedPharmaWorld Conference to be Held in Hong Kong. Hong Kong Science Park Unveiled. Yogurt's on a Roll in Japan. Controlling Korea's Foot-and-mouth Disease Outbreaks. Sugar Cane Extract Available for Treating Cholesterol. Increase in Premature Births Perhaps Due to Work. NZ's Opportunity in Bio-pharmaceuticals. Study on Rice Structural Genomics to be Completed By 2002. Filipino Farmers Urged to Adopt Biotechnology. Singapore Varsity Students to Study at US Biotech Firms. Taiwan to Build R&D Center as Showcase for Enterprises.

AUSTRALIA — UWA Researchers Link New Gene to Osteoporosis. AUSTRALIA — Australian Surgeons Save Unborn Baby's Leg. CHINA — China Honors IRRI for Contributions to Food Security and Science. CHINA — Chinese Red Yeast Rice Extract Reduces Repeat Heart Attacks/Mortality Rates. CHINA — Cholesterol Absorbing Mechanism Unveiled. CHINA — Academia Sinica and BASF to Develop Rice Strains. HONG KONG — Hong Kong Scientists Make New Bird Flu Breakthrough. INDIA — Mirrus Opens India R&D center. INDIA — United States Launches Rs 580 million Health Initiative in India. INDIA — IBSD to Analyze Herb with Cancer Curing Property. INDIA — Rare Heart Surgery at Delhi Hospital. JAPAN — First Optical Pacemaker: Laser Controls Beating Of Heart Muscle Cells in Cell Culture. SINGAPORE — Singapore-led Team Starts S$3.5 Million Liver Cancer Clinical Trial. SINGAPORE — Wealth of Genomic Hotspots Discovered in Embryonic Stem Cells. SINGAPORE — Scientists Identify Genetic Regulator of Colon Cancer and Develop a Novel Therapeutic Strategy for Colon Cancer Treatment. SINGAPORE — First Confirmed Common Genetic Risk Factors for Breast Cancer Uncovered by Genome Institute of Singapore and Partners in international Breast Cancer Association Collaboration.

Mab-Venture Biopharma & Thermo Fisher Establish Asia Pacific’s First “SmartFactory” for Antibody Drugs. Venus Medtech’s TAVR Device Is Approved By CFDA, Creating A New Era of Interventional Cardiology in China. Key Diabetes Receptor Structure Determined by International Collaboration. China Sets Up National Lab Developing Brain-Like AI Technology. Chinese Scientists Realize On-site Drug Detection. Scientists Map Single-Copy HIV-1 Provirus Loci in Human Chromosomes in Live Host Cells. Gene Variant Explains Differences in Blood Fatty Acid Levels. Scientists Illustrate How Host Cell Responds to Zika Virus Infection. Hong Kong News – Uni-Bio Science Launches Best-in-Class Oral Anti-Diabetic Drug Mitiglinide Branded “博康泰®”(Bokangtai).

Australia — Australia Ends Ban on Embryo Cloning for Research. Australia — Australia Government Allocates A$500 million for Science. Australia — Gardasil Immunization Program in Australia from Next Year. China — AIDS Patients to be Compensated for Blood Infection. China — New AIDS Therapy More Effective. China — Changzhou National Hi-Tech District Creates Alliance with Samara Province in Russia For Joint Construction Of Science & Technology Park. Hong Kong — New CRO in Hong Kong to Feed China. Hong Kong — Botanical Medicine Company Chi-Med Collaborates with Merck. India — Indian Pharmaceuticals Agree to Supply Cheaper Drugs for Children with AIDS. India — British Pharmacopoeia Officials to Hold Talks with Indian officials. India — Indian Government to Set Up Five Institutes to Boost Pharma R&D. South Korea — South Korea Reports on its Second Outbreak of Bird Flu. Singapore — Scientists will Perform Research Work on New Stem Cell Bank. Singapore — Scientists Discover New Path for Malaria Drug. Singapore — Singapore's Fusionopolis Phase 2A Sells Out. Singapore — Singapore Ministries to Tackle Rise in AIDS Number. Singapore — A*STAR-Karolinska Symposium on Immunology. Singapore — Singapore to Set Up Two Biomed R&D Centers. Singapore — Human Embroynic Stem Cells Research in Singapore. Thailand — Thai Health Ministry To Issue Compulsory License For Merck's HIV/AIDS Drug Efavirenz. Others — Gardisil Research in Britain. Others — World Bank Says More Funding Needed to Fight Bird Flu.

Abstract Background Residual dried blood spots (rDBS) from newborn screening programmes represent a valuable resource for medical research, from basic sciences, through clinical to public health. In Hong Kong, there is no legislation for biobanking. Parents’ view on the retention and use of residual newborn blood samples could be cultural-specific and is important to consider for biobanking of rDBS. Objective To study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents. Methods A mixed-method approach was used to study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents of children 0–3 years or expecting parents through focus groups (8 groups; 33 participants) and a survey (n = 1012, 85% mothers) designed with insights obtained from the focus groups. We used framework analysis to summarise the themes as supportive factors, concerns and critical arguments for retention and secondary use of rDBS from focus group discussion. We used multiple logistic regression to assess factors associated with support for retention and secondary use of rDBS in the survey. Results Both in focus groups and survey, majority of parents were not aware of the potential secondary use of rDBS. Overall secondary use of rDBS in medical research was well accepted by a large proportion of Hong Kong parents, even if all potential future research could not be specified in a broad consent. However parents were concerned about potential risks of biobanking rDBS including leaking of data and mis-use of genetic information. Parents wanted to be asked for permission before rDBS are stored and mainly did not accept an “opt-out” approach. The survey showed that parents born in mainland China, compared to Hong Kong born parents, had lower awareness of newborn screening but higher support in biobanking rDBS. Higher education was associated with support in rDBS biobanking only among fathers. Conclusion Long-term storage and secondary use of rDBS from newborn screening for biomedical research and a broad consent for biobanking of rDBS are generally acceptable to Hong Kong parents given their autonomy is respected and their privacy is protected, highlighting the importance of an accountable governance and a transparent access policy for rDBS biobanks.

AUSTRALIA — Australia Launches New Online Service to Explain Laboratory Tests. AUSTRALIA — Australia Government Pledges US$86 Million to Indonesia to Fight HIV/AIDS. CHINA — New Test Improves Detection of Liver Cancer. CHINA — CAS Scientists Discover New Mechanism for Neural Stem Cell Maintenance. CHINA — Price of Herbs to Increase in China. HONG KONG — Scientists from Chinese University of Hong Kong Discover New Treatment for Chronic Hepatitis C with Less Side Effects. INDIA — AKCDA to Set Up Drug Information Center at Trichur in Kerala. INDIA — India Invests in Nanotech Park in Bangalore. INDIA — Serum Institute of India Launches Low-cost HIB Vaccine in India. INDIA — Indian Government Launches Campaign to Curb Mother-to-Child HIV Transmissions. INDONESIA — WHO Urges Indonesia to Share Live H5N1 Virus Samples. NEW ZEALAND — New Zealand Minister Rejects GM Corn. SINGAPORE — Singaporean Scientists Make Medical Breakthrough Findings in Crab Blood. SINGAPORE — IBN and Caltech to Tie Up in Nanomedicine. SOUTH KOREA — South Korean Scientist Created World's First "Virgin Birth" by Accident. TAIWAN — Leukemia Drug Used as a Treatment for Alzheimer's Disease. VIETNAM — Vietnam Finds Bird Flu Poultry Near China Border.

Introduction: Tai Chi and walking are both moderate-intensity physical activity (PA) that can be easily practiced in daily life. The purpose of this study was to better understand that after practicing these two types of PAs in a relative short term and keeping the stable dietary intake in this period, how much body weight would be reduced and what extent the metabolic syndrome parameters would be improved; and if a significant weight loss was observed, whether this exercise-induced weight loss had adverse effect on bone mineral density (BMD). Methods: Three-hundred seventy-four healthy and physically inactive adults (45.8±5.3 years) from 9 geographic areas in Hong Kong were randomized to 12 weeks training (45 minutes per day, 5 days per week) of Tai Chi (n=124) or self-paced walking (n=121), or control group (n=129) at area level. Body weight, fat and lean mass, waist circumference, blood pressure and regional BMD, as well as the fasting blood samples were obtained at the beginning and end of trial. Fasting blood glucose (FBG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides were analyzed. Results: On average, Tai Chi and walking groups lost 0.50 and 0.76 kg of body weight, 0.47 and 0.59 kg of fat mass, respectively (all p<0.001). No significant changes were observed for lean mass and BMD. Two intervention groups had significant improvements in waist circumference and FBG. The between-group difference of waist circumference and FBG was -3.7 cm and -0.18 mmol/L for Tai Chi vs. control; and -4.1 cm and -0.22 mmol/L for walking vs. control (all p<0.001). No significant differences were observed regarding blood pressure, total cholesterol, HDL-C, LDL-C and triglycerides compared to control (all p>0.05). The effects on all outcomes between Tai Chi and walking were similar (all p>0.05). Among intervention groups, change in lean mass, not fat mass or total weight loss, was significantly correlated to the change in BMD. Conclusions: 12-week Tai Chi and walking exercises can produce moderate weight loss and improve the waist circumference and FBG in middle-aged Hong Kong Chinese people, with no additional effects on BMD.

AUSTRALIA – Degenerative Disease Breakthrough. AUSTRALIA – New Genetic Cancer Risk Found. AUSTRALIA – Experts Find Way to Make Mosquitoes Dengue-free. CHINA – Virus May Cause High Blood Pressure. CHINA – Eleven Die from Suspected Tainted Vinegar in China. HONG KONG – HK Study Finds Molecule that Offers Fertility Hope. INDIA – Hyderabad Hospital Performs Rare Kidney Transplant. INDIA – 20-minute Treatment for Blood Pressure. INDIA – New Experimental Vaccine against Chikungunya. JAPAN – ES Cells Turn Into Sperm. JAPAN – Leading Japanese Pharmaceutical Scientists Advance Drug Discovery & Development with Mass Spectrometry and Chip LC Technology from AB SCIEX. SINGAPORE – One Hundred and Twenty Aspiring Scientists Awarded Scholarships. SINGAPORE – Pacific Healthcare Launches Pacific Surgical and Colorectal Centre in Singapore. SINGAPORE – NTU Achieves Bacterium Breakthrough. OTHER REGIONS — Killer T-cells Wipe Out Leukemia.

AbstractSwine dysentery (SD) is an important endemic disease of pigs throughout the world. The most common aetiological agent is the anaerobic intestinal spirochaete Brachyspira hyodysenteriae. The related spirochaete Brachyspira pilosicoli causes a milder form of colitis. We report the first isolation of B. hyodysenteriae and B. pilosicoli from a pig farm in Hong Kong. Faecal samples containing mucus or fresh blood were collected from the ground where finisher pigs had just been loaded into a truck for transport to the abattoir. The samples were subjected to selective anaerobic culture and PCR for B. hyodysenteriae and B. pilosicoli, and two isolates of both species were obtained. The B. hyodysenteriae isolates showed clinical resistance to tylosin and lincomycin, whilst the B. pilosicoli isolates were resistant to tylosin and showed intermediate susceptibility to lincomycin. The B. hyodysenteriae isolates were subjected to multilocus sequence typing and a single previously undescribed sequence type (ST250) was identified. Disease was not recorded in other pigs on the farm, but it may have been masked by the use of antimicrobials. Further work is required to examine the distribution of these two pathogens in this and other farms in Hong Kong and in adjoining mainland China.

AUSTRALIA – Minimizing Spread of Deadly Hendra Virus. AUSTRALIA – Breakthrough High Blood Pressure Treatment Trial Down Under. AUSTRALIA – Australia Sees Rise in Newborn Withdrawal Syndrome. CHINA – CAS, Hong Kong University Set Up Joint Lab of Natural Medicine. CHINA – Chinese Researchers Discover 20 Essential Genes in Polyoxin. CHINA – China Aims to Lead Asia's Stem Cell R&D. CHINA – China Rural Areas on High Alert for Hand, Foot and Mouth Disease. CHINA – Hepatitis Infects 64 at China Hospital. CHINA – China's Colorectal Cancer Drug Market will More Than Double by 2012. CHINA – Critical Gene for Enhancing China's Super Rice Yield Identified. CHINA – Chinese Scientists say New Discovery May Yield Clue to Cure Human Infertility. HONG KONG – Compound to Fight Bird Flu Identified. INDIA – Yashoda Cancer Institute Treats First Patient In India Using RapidArc Radiotherapy Technology. INDIA – Indian Pharma Industry May Gain $18.4 bn from Global Market. INDIA – Philips to Make India Hub for Medical Equipment Manufacturing. JAPAN – Herbal Medicines to Treat Gastrointestinal Disease. SINGAPORE – Tetravalent Dengue Vaccine Trial in Singapore. SINGAPORE – Minimally Invasive Robot-Assisted Surgeries for Heart Patients. SINGAPORE – US-Based Company Launches Singapore Doctor Search Site for Medical Travelers. SINGAPORE – Genetic Research: Time for a rethink? SINGAPORE – Test Kits to be Licensed. SINGAPORE – Local Team Develops Method to Predict Heart Disease. SINGAPORE – Consumer Genetic Tests – A Cause for Worry? SINGAPORE – S'pore Firm's Test Kit Joins the Fight. SINGAPORE – Singapore Gives New Hope To The Blind. SINGAPORE – Singapore and Korea Research Institutes Embark on Landmark Collaboration for Breakthroughs in Micro and Nanotechnology. SOUTH KOREA – Institute Develops Cheap Cholera Vaccine. TAIWAN – Herbal Substance Developed for Cardiovascular Disease. TAIWAN – Prototype of Household Breast Cancer Detector Unveiled. TAIWAN – Breakthrough in New Diabetes Drug.

ASIA-PACIFIC — Entries open for the USD170,000 Ryman Prize. ASIA-PACIFIC — Singapore scientists discover new ways to help us understand how the body fights cancer. ASIA-PACIFIC — New discovery reveals acne, acne scarring and osteoporosis may be related to collagen issues. ASIA-PACIFIC — Making the switch: Potent anticancer liposomal drugs. ASIA-PACIFIC — Blood vessel-forming cells involved in aggressive brain tumour. ASIA-PACIFIC — New medical device for safe growth of neural stem cells using nanotechnology. ASIA-PACIFIC — HKU to collaborate on biomedical innovation with Institut Pasteur and Hong Kong Science and Technology Parks Corporation. REST OF THE WORLD — Could the eye be the window to brain degeneration? REST OF THE WORLD — High vitamin D levels linked to lower cholesterol in children.

Background: Migraine has been found to be a risk marker for several cardiovascular diseases (CVDs). Some studies have shown that migraineurs had unfavorable cardiovascular risk profile, which might partially explain the mechanisms that link migraine to CVD. But the results are still controversial. The relevant study in Chinese population was lacking. The aim of this study was to evaluate the cardiovascular risk profile in a sample of Hong Kong Chinese women with and without migraine. Methods: Three rounds of mail surveys were conducted among Chinese female nurses aged 35 to 65 years in Hong Kong. In total 1253 nurses were enrolled in analysis. Information on traditional CVD risk factors, including body mass index (BMI), blood pressure (BP), hypercholesterolemia, diabetes mellitus (DM), smoking, alcohol drinking, physical activity, and family history of CVD, together with the physician-diagnosed migraine, was collected by a self-administered questionnaire. The self-reported anthropometric variables and BP have been validated in a pilot study. Results: The overall prevalence of physician-diagnosed migraine was 7.9%. Women with migraine had higher systolic and diastolic BP than those without migraine (118.2 mmHg vs. 113.1 mmHg, 73.8 mmHg vs. 70.0 mmHg; both P<0.001). More than half of the migraineurs (57.3%) had the family history of CVD, which was higher than non-migraineurs (33.0%, P<0.001). Compared with non-migraineurs, the migraineurs were more likely to have hypertension (OR: 2.00, 95% CI: 1.14-3.51), high cholesterol (OR: 1.70, 95% CI: 1.02-2.85), and family history of CVD (OR: 2.72, 95% CI: 1.78-4.15). There were no statistically significant differences regarding obesity, smoking, alcohol drinking, physical activity, and DM between migraineurs and non-migraineurs (all P>0.05). In the logistic regression analysis, after adjustment for age and BMI, the odds of having hypertension in migraineurs were 105% greater than in non-migraineurs (OR: 2.05, 95% CI: 1.08-3.91; P<0.05), and strengthened in those with family history of CVD (OR: 2.81, 95% CI: 1.27-6.21; P<0.05); however, the association between migraine and high cholesterol were eliminated (P>0.05). Conclusion: We did not find an overall worse cardiovascular risk profile among Chinese women with migraine. While family history of CVD and hypertension were significantly associated with migraine. Further prospective studies with larger sample size are needed in Chinese population.

Background: Air Pollution (AP) and metabolic syndrome (MS) are important global health hazards of the 21st century, in mainland China in particular, and AP has been associated with increased prevalence of cardiovascular diseases, and stroke. Methods: To evaluate the impact of metabolic syndrome on AP-related atherogenesis, 1557 Han Chinese adults (mean age 47.2±11.8 years, male 47%) in Hong Kong, Macau, Pun Yu, Yu County (Shanxi coalmine) and 3-Gorges (Yangtze River) were studied. Cardiovascular risk profiles and metabolic syndrome (IDF criteria) were evaluated. PM2.5 (satellite sensor modeling), and atherosclerotic surrogates, brachial reactivity (FMD) and carotid Intima-media thickness (IMT) (ultrasound), were measured. Results: The yearly PM2.5 concentration ranged from 34.0μg/m³ in Hong Kong to 93.8μg/m³ in 3-Gorges Territories. MS was diagnosed in 340 subjects (21.8%). Smoking status, gender and PM2.5 were similar in the MS cohort versus those without MS. Blood pressures (SBP and DBP), waist circumference, triglycerides and glucose were higher, but high-density lipidcholesterol was lower in the MS cohort, compared to the other subjects. Brachial FMD was significantly lower and carotid IMT significantly higher (0.70±0.13 mm, 95% CI 0.68-0.71 mm vs. 0.63mm±0.14mm, 95% CI 0.62-0.64 mm) in the MS cohort than those without (P<0.0001). On multivariate regression, PM2.5 was not related to MS development, but was significantly related to carotid IMT in both no MS (beta=0.234, P<0.0001) and MS cohorts (beta=0.245, p<0.0001), independent of age, SBP, and waist circumference. There was no direct interaction between PM2.5 and MS. Conclusions: Both AP and MS have independent impacts on atherogenic processes in China, with significant implications for atherosclerosis prevention.

Background: Patients with transient ischemic attacks(TIAs) are at risk of developing ischemic stroke and therefore early management is of paramount importance. An alternative to the conventional physician-led assessment is nurse-led TIA clinic which can provide rapid access to evaluation and diagnostic investigations of TIA. Objective: To evaluate the efficacy of nurse-led TIA clinic in cardiovascular risk factors control and prevention of ischemic stroke Methods: A prospective study was conducted in a nurse-led TIA clinic in the United Christian Hospital of Hong Kong between January and July 2013. The referral sources included emergency room, medical wards and outpatient clinics. TIA patients were first screened by stroke nurse upon receiving the referrals, and then protocol-driven investigations and treatment were initiated quickly before further assessment by stroke physician. The efficacy endpoints were measured by healthcare utilization, changes in biomedical parameters, lifestyle modification and patients’ satisfaction score at 3 months. Results: A total of 213 patients were referred to stroke nurse for screening.95 patients were recruited and managed first in the nurse-led TIA clinic. 85 patients were diagnosed to be TIA after review by stroke physician. At 3 months(n=33), there were 3 patients hospitalized for non-vascular events,1 patient for recurrent TIA and none for non-stroke vascular events. The 3-month mortality was 0%. For biomedical parameters,significant reduction in mean total cholesterol(p=0.001), mean low-density lipoprotein(p<0.001), mean systolic blood pressure(p=0.011) and mean diastolic blood pressure(p=0.002). 3(38%) out of 8 active smokers ceased smoking. There was no change in the mean BMI. The mean patients’ satisfaction score was 9.1 out of 10(range 8 to 10) Conclusion: Nurse-led TIA clinic is efficient in triaging TIA referrals and providing early access to initial evaluation and diagnostic workup. Combined with physician’s treatment, TIA patients can achieve significant improvement in cardiovascular risk factors control and low incidence rate of ischemic stroke at 3 months. Our TIA patients are satisfied with this modality of assessment pathway and this can serve as a model of care for future TIA services