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Inter-facility transfer of patients with type A aortic dissection (AD) requires timely and efficient medical care. However, the quality of care provided during the transfer remains largely unknown. This study aimed to evaluate the quality of care of patients with type A AD who underwent inter-facility transfer at a single medical center in Taiwan. This retrospective cohort study enrolled all patients with type A AD who underwent interfacility transfer between January 2017 and December 2019. Patients with complete transfer records and electronic medical charts in the emergency department (ED) were included. Patients who experienced a cardiac arrest episode before transfer were excluded due to poor outcomes. Patients were divided into two groups based on their hemodynamic status: the ideal group with values within the desirable range heart rate (HR) <60 bpm and systolic blood pressure (SBP): 100-120 mmHg and the control group with values out of range (HR >60 bpm or SBP <100 or >120 mmHg) before the transfer. We conducted an analysis of variations of hemodynamic status after the transfer. Among the 378 patients transferred with type A AD, 36 (31.9%) in the ideal group and 255 (96.2%) in the control group experienced hemodynamic deterioration after the transfer. In the ideal group and control group, the presence of nurses and emergency physicians assisting in the transfer accounted for only 6.2% and 7.95%, respectively. The ideal group had a significantly better survival outcome (adjusted OR (aOR): 1.25, 95% confidence interval (CI): 1.12-2.45) compared to the control group. The quality of interfacility transfer in patients with type A AD is inadequate. Hemodynamic deterioration should be managed by ambulance crews during the transfer. [ABSTRACT FROM AUTHOR]

Enterovirus A71 (EV-A71) can induce severe neurological complications and even fatal encephalitis in children, and it has caused several large outbreaks in Taiwan since 1998. We previously generated VP1 codon-deoptimized (VP1-CD) reverse genetics (rg) EV-A71 viruses (rgEV-A71s) that harbor a high-fidelity (HF) 3D polymerase. These VP1-CD-HF rgEV-A71s showed lower replication kinetics in vitro and decreased virulence in an Institute of Cancer Research (ICR) mouse model of EV-A71 infection, while still retaining their antigenicity in comparison to the wild-type virus. In this study, we aimed to further investigate the humoral and cellular immune responses elicited by VP1-CD-HF rgEV-A71s to assess the potential efficacy of these EV-A71 vaccine candidates. Following intraperitoneal (i.p.) injection of VP1-CD-HF rgEV-A71s in mice, we observed a robust induction of EV-A71-specific neutralizing IgG antibodies in the antisera after 21 days. Splenocytes isolated from VP1-CD-HF rgEV-A71s-immunized mice exhibited enhanced proliferative activities and cytokine production (IL-2, IFN-, IL-4, IL-6, and TNF-a) upon re-stimulation with VP1-CD-HF rgEV-A71, as compared to control mice treated with adjuvant only. Importantly, administration of antisera from VP1-CD-HF rgEV-A71s-immunized mice protected against lethal EV-A71 challenge in neonatal mice. These findings highlight that our generated VP1-CD-HF rgEV-A71 viruses are capable of inducing both cellular and humoral immune responses, supporting their potential as next-generation EV-A71 vaccines for combating EV-A71 infection. IMPORTANCE EV-A71 can cause severe neurological diseases and cause death in young children. Here, we report the development of synthetic rgEV-A71s with the combination of codon deoptimization and high-fidelity (HF) substitutions that generate genetically stable reverse genetics (rg) viruses as potential attenuated vaccine candidates. Our work provides insight into the development of low-virulence candidate vaccines through a series of viral genetic editing for maintaining antigenicity and genome stability and suggests a strategy for the development of an innovative next-generation vaccine against EV-A71. [ABSTRACT FROM AUTHOR]