Background: Multiple nonpharmaceutical interventions (NPIs) had been introduced in Hong Kong during coronavirus disease 2019 (COVID-19) pandemic. The impact on asthma admission, which was closely related to viral infection, was of concern.Objective: The study aimed to identify the impact of NPIs on pediatric asthma admissions and their association with respiratory viruses. Methods:We conducted a retrospective observational study to compare the difference in pediatric asthma hospital admission rates between pre-COVID-19 and COVID-19 periods. Information on demographics, nasopharyngeal specimen results, ventilatory support, intensive care admission, hospital stay duration, asthma control therapy, and previous admission episodes was collected. Weather parameters including temperature, rainfall, humidity, and air quality data that was reflected by the air quality health index were recorded.Results: A total of 1808 pediatric asthma admissions were recorded during the pre-COVID-19 period while there were 62 admissions during COVID-19 period, among which 54 admissions from the pre-COVID-19 period and 4 admissions from COVID-19 period were excluded. Weekly pediatric asthma admissions per total pediatric admissions during COVID-19 was one-third of that during the pre-COVID-19 period (0.3% vs. 0.9%, p < 0.001). During COVID-19 period, a significantly lower percentage of respiratory virus isolates was noted (58.6% vs. 72.6%, p = 0.019). Poisson regression analysis showed that the COVID-19 period (odds ratio[OR] = 0.202, 95% confidence interval [CI,; p ≤ 0.001), summer vacation period (OR = 0.512, 95% CI [0.43-0.62]; p ≤ 0.001), and humidity (OR = 0.99, 95% CI [0.98-1.00]; p = 0.004) were independent protective factors for asthma admission.Conclusions: There was a significant reduction in pediatric asthma hospitalizations and respiratory virus isolates in the first year of COVID-19 pandemic in Hong Kong with the implementation of NPIs. Rhinovirus remained the key respiratory virus

Background: Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. Objective: To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents. Methods: A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with keywords “sleep problem” or “sleep disorder” and “child” or “adolescent”. Findings in the relevant articles and cross-references were compiled. Results: Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. A comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders such as obstructive sleep apnea and narcolepsy that need timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized. Conclusion: Screening for sleep problems shall be an integral part of each child health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.

Objective Premature infants are at risk of developing respiratory distress syndrome (RDS). Beractants and poractants are two commonly used natural surfactants. This retrospective cohort study aims to compare the incidence of pulmonary complications between beractant and poractant treatment groups. Study Design This study evaluated 29 patients treated with beractant and 49 patients treated with poractant. The primary outcome was the incidence of air leak syndrome (ALS) and pulmonary hemorrhage. Secondary outcomes included mortality and pulmonary outcomes, such as mechanical ventilation duration, oxygen dependence duration, fraction of inspired oxygen, and mean airway pressure requirement. Logistic regression analyses were conducted to identify independent risk factors for significant primary outcomes. Results No significant difference was found in the demographics between the two groups. A significantly higher incidence of pulmonary hemorrhage was observed in the poractant group (14.3% versus 0.0%, p = 0.038). The difference in the incidence of ALS between the groups was insignificant (p = 0.536). Logistic regression for the incidence of pulmonary hemorrhage identified coagulopathy as the only significant independent risk factor (odds ratio 39.855, 95% confidence interval [2.912–545.537]; p = 0.006). Secondary outcomes in both treatment groups were similar, except that patients in the poractant group had a higher mean airway pressure before surfactant therapy (9 cmH2O versus 8 cmH2O, p < 0.001). Conclusion This study showed a significantly higher incidence of pulmonary hemorrhage in the poractant group. Coagulopathy was identified as an independent risk factor for pulmonary hemorrhage. Future long-term prospective studies are essential to establish the temporal and causal relationships between coagulopathy and pulmonary hemorrhage in premature infants receiving surfactant therapy for RDS, hence the need for a screening protocol before surfactant administration. Key Words Poractant; Beractant; Respiratory distress syndrome; Pulmonary hemorrhage; Air leak syndrome

Advanced lung cancers frequently metastasize to the brain, where nutrient deprivation from tumour microenvironments at either primary, invading or metastatic sites may exert a selective pressure on tumour cells. Our lab has identified a rare brain metastasis cell line of lung cancer origin: A1115, that possessed heightened basal glycolytic activity. Characterization of the metabolic profiles of A1115 and 4 other lung adenocarcinoma cell lines revealed A1115 to have the highest dependence on glycolysis and the lowest utilization of mitochondrial oxidative phosphorylation (OXPHOS) for metabolism. Thus, we hypothesized that A1115 is hypersensitive to glucose starvation. A1115 relied heavily on glycolysis on survival and propagation, while inhibiting mitochondrial OXPHOS had less effect. Glucose deprivation induced the nutrient sensor AMP-activated protein kinase (AMPK) to be elevated in A1115, while the proliferative capacity of A1115 was drastically reduced by an AMPK activator, AICAR, suggesting AMPK to be detrimental to cell viability of A1115 under glucose deprivation. To understand how such metastatic cell line could survive the low glucose environment in blood circulation and during the invasion into the brain parenchyma, we established clonal A1115 sublines that could propagate under low glucose (LG) environment. LG sublines regained hypersensitivity to glucose deprivation upon exposure to normal glucose concentrations suggest an adaptive response. We hypothesised that tumour cells maintain cell viability under glycolytic stress conditions by undergoing metabolic reprogramming, this involves changes in metabolite utilization and transcriptional activity of key metabolic enzymes. A parallel metabolomics (targeted LC/MS) and transcriptomics (RNAseq) analysis was conducted comparing A1115 LG sublines with the parental control. Metabolomics analysis revealed that LG sublines under glucose deprivation harboured a significant metabolite increase in amino acids: glutamate, arginine, aspartic acid and pyrimidine: cytidine, whereas integrated pathway analysis of metabolomics and transcriptomics revealed upregulation in both pyrimidine metabolism and alanine, aspartate and glutamate metabolism. Moreover, increased carbamoyl phosphate synthetase 1 (CPS-1) expression was observed in LG sublines, an initiating enzyme for pyrimidine biosynthesis and urea cycle, silencing CPS-1 decreased cell viability on LG in normal conditioned media, suggesting that the disruption of pathway could impede survival. Overall, our results suggest that lung adenocarcinoma may undergo reprogramming towards a starkly different constituent of transcriptional activation leading to metabolite flux and signalling activation to allow viable adaption to glucose deprivation in the microenvironment. Citation Format: Kin Lok Wong, Andrew M. Chan. Adaptive upregulation of carbamoyl phosphate synthetase-1 (CPS-1) in glucose-deprived metastatic lung adenocarcinoma cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1841.