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Objective: To study the effect of low-to-moderate dose glucocorticoid therapy on viral clearance in patients with COVID-19. Methods: A total of 72 patients diagnosed with COVID-19 from January 19 to February 17, 2020 at the First Affiliated Hospital, Zhejiang University School of Medicine were recruited. All patients received oral arbidol and combination of lopinavir/ritonavir or darunavir/cobistitat for antiviral therapy, and symptomatic supportive care. Among them, 51 patients received methylprednisolone (0.75-1.50 mg.kg-1.d-1) (glucocorticoid treatment group), and 21 patients did not use glucocorticoid (control group). The time of virologic negative conversion in sputum and the time of radiologic recovery in lung since onset were compared between the two groups. The Kruskal-Wallis test or Fisher exact test was used to compare the difference between groups. Results: The median ages of the glucocorticoid group and the control group were 52 (45, 62) and 46 (32, 56) years (chi2=4.365, P<0.05). The clinical conditions at hospital admission were different between the two groups (P<0.01). The severe cases accounted for 52.0%, while moderate cases in the control group accounted for 71.4%. The median times from the onset to virologic negative conversion in the two groups were 15 (13, 20) and 14 (12, 20) days (P>0.05). The median times from onset to radiologic recovery were 13 (11, 15) and 13 (12, 17) days in the two groups (P>0.05). In moderate cases, the median times from the onset to virologic conversion in sputum were 13 (11, 18) days in the glucocorticoid group and 13 (12, 15) days in the control group (P>0.05). The median times from onset to radiologic recovery in lung were 12 (10, 15) and 13 (12, 17) days, respectively (P>0.05). Conclusion(s): Low-to-moderate glucocorticoid treatment has no effect on the time of virus clearance in patients with different clinical types of COVID-19, and also no effect on accelerating radiologic recovery in lung, so it is not recommended.Copyright © 2020 by the Chinese Medical Association.
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Objective: To study the effect of low-to-moderate dose glucocorticoid therapy on viral clearance in patients with COVID-19. Methods: A total of 72 patients diagnosed with COVID-19 from January 19 to February 17, 2020 at the First Affiliated Hospital, Zhejiang University School of Medicine were recruited. All patients received oral arbidol and combination of lopinavir/ritonavir or darunavir/cobistitat for antiviral therapy, and symptomatic supportive care. Among them, 51 patients received methylprednisolone (0.75-1.50 mg.kg-1.d-1) (glucocorticoid treatment group), and 21 patients did not use glucocorticoid (control group). The time of virologic negative conversion in sputum and the time of radiologic recovery in lung since onset were compared between the two groups. The Kruskal-Wallis test or Fisher exact test was used to compare the difference between groups. Results: The median ages of the glucocorticoid group and the control group were 52 (45, 62) and 46 (32, 56) years (chi2=4.365, P<0.05). The clinical conditions at hospital admission were different between the two groups (P<0.01). The severe cases accounted for 52.0%, while moderate cases in the control group accounted for 71.4%. The median times from the onset to virologic negative conversion in the two groups were 15 (13, 20) and 14 (12, 20) days (P>0.05). The median times from onset to radiologic recovery were 13 (11, 15) and 13 (12, 17) days in the two groups (P>0.05). In moderate cases, the median times from the onset to virologic conversion in sputum were 13 (11, 18) days in the glucocorticoid group and 13 (12, 15) days in the control group (P>0.05). The median times from onset to radiologic recovery in lung were 12 (10, 15) and 13 (12, 17) days, respectively (P>0.05). Conclusion(s): Low-to-moderate glucocorticoid treatment has no effect on the time of virus clearance in patients with different clinical types of COVID-19, and also no effect on accelerating radiologic recovery in lung, so it is not recommended.Copyright © 2020 by the Chinese Medical Association.
ABSTRACT
Objective: To study the effect of low-to-moderate dose glucocorticoid therapy on viral clearance in patients with COVID-19. Methods: A total of 72 patients diagnosed with COVID-19 from January 19 to February 17, 2020 at the First Affiliated Hospital, Zhejiang University School of Medicine were recruited. All patients received oral arbidol and combination of lopinavir/ritonavir or darunavir/cobistitat for antiviral therapy, and symptomatic supportive care. Among them, 51 patients received methylprednisolone (0.75-1.50 mg.kg-1.d-1) (glucocorticoid treatment group), and 21 patients did not use glucocorticoid (control group). The time of virologic negative conversion in sputum and the time of radiologic recovery in lung since onset were compared between the two groups. The Kruskal-Wallis test or Fisher exact test was used to compare the difference between groups. Results: The median ages of the glucocorticoid group and the control group were 52 (45, 62) and 46 (32, 56) years (chi2=4.365, P<0.05). The clinical conditions at hospital admission were different between the two groups (P<0.01). The severe cases accounted for 52.0%, while moderate cases in the control group accounted for 71.4%. The median times from the onset to virologic negative conversion in the two groups were 15 (13, 20) and 14 (12, 20) days (P>0.05). The median times from onset to radiologic recovery were 13 (11, 15) and 13 (12, 17) days in the two groups (P>0.05). In moderate cases, the median times from the onset to virologic conversion in sputum were 13 (11, 18) days in the glucocorticoid group and 13 (12, 15) days in the control group (P>0.05). The median times from onset to radiologic recovery in lung were 12 (10, 15) and 13 (12, 17) days, respectively (P>0.05). Conclusion(s): Low-to-moderate glucocorticoid treatment has no effect on the time of virus clearance in patients with different clinical types of COVID-19, and also no effect on accelerating radiologic recovery in lung, so it is not recommended.Copyright © 2020 by the Chinese Medical Association.
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Global shipping alliances have become an important institution in international seaborne trade. Their raison d'être is higher efficiency and lower costs, to the benefit of the consumer. However, experiences from GSA operations during the COVID-19 supply chain crisis show that GSAs may have considerable market power, not quite aligned with the spirit of the lawmaker who has exempted them from antitrust laws. This raises many questions this paper attempts to answer: What drives the formation, stability and dissolution of GSAs? And have external and internal factors, such as government policies, ship sizes and freight rates, had always the same effect on GSAs over time? We decompose industry concentration (HHI) into seven components. This is done based on the Variational Mode Decomposition model. The components are subsequently reconstructed through gray correlation. Next, a Generalized Additive Model is specified, to analyze the relationships between influencing factors and the evolution of GSAs. We look both at the development (trend) of industry concentration, as well as its fluctuations (cyclicality) over time. We show that effects vary over time, with the same factors having different impacts on GSAs at different times. The paper can assist policymakers in their efforts to regulate and supervise container shipping. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Objectives: Lab-based polysomnography (PSG), for diagnosing obstructive sleep apnoea (OSA), is a subsidised inpatient service in Singapore’s public healthcare institutions (PHIs). The alternative, home sleep test (HST), is cheaper and can be prescribed in the outpatient setting. Following health technology assessment performed by Agency for Care Effectiveness, HST was listed as a subsidised service in PHIs in May 2019. This study aims to assess the impact of the subsidy decision on sleep tests utilisation. Methods: We conducted an interrupted time series (ITS) analysis using sleep tests utilisation data submitted by PHIs from January 2018 to June 2021. Segmented regression models were used to assess the degree of level change (LC) and trend change (TC) of HST and PSG. Data points during Singapore’s most stringent COVID-19 restrictions were modelled as “wild” points to account for drastic reduction of elective procedures. Autocorrelation was tested and corrected by including an autoregressive or moving average term in the models. Results: Subsidy implementation increased the use of HST, from 12% of all sleep tests pre-subsidy to 26% post-subsidy. Despite multiple periods of interruptions, associated with COVID-19 restrictions, ITS showed subsidy implementation led to significant level change in HST utilisation [LC 36.1 (95% CI: 15.1 - 57.2);TC -0.5 (95% CI: -2.3 - 1.4)]. There was also a trend towards reduction in PSG, though this did not reach statistical significance [LC -44.3 (95% CI: -126.6 - 38.2);TC -2.0 (95% CI: -11.6 - 7.7)]. As HST is much cheaper than PSG, total charge avoided by the healthcare system in 10 years is projected to be in the range of SGD9 million to SGD14 million. Conclusion: Extension of subsidy to HST appeared to have improved accessibility of sleep tests for OSA diagnosis and resulted in cost saving to Singapore’s healthcare system.
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BACKGROUND: Cardiovascular disease had a global prevalence of 523 million cases and 18.6 million deaths in 2019. The current standard for diagnosing coronary artery disease (CAD) is coronary angiography. Surprisingly, despite well-established clinical indications, up to 40% of the one million invasive cardiac catheterizations return a result of 'no blockage'. The present studies employed RNA sequencing of whole blood to identify an RNA signature in patients with angiographically confirmed CAD. METHODS: Whole blood RNA was depleted of ribosomal RNA (rRNA) and analyzed by single-molecule sequencing of RNA (RNAseq) to identify transcripts associated with CAD (TRACs) in a discovery group of 96 patients presenting for elective coronary catheterization. The resulting transcript counts were compared between groups to identify differentially expressed genes (DEGs). RESULTS: Surprisingly, 98% of DEGs/TRACs were down-regulated ~ 1.7-fold in patients with mild to severe CAD (> 20% stenosis). The TRACs were independent of comorbid risk factors for CAD, such as sex, hypertension, and smoking. Bioinformatic analysis identified an enrichment in transcripts such as FoxP1, ICOSLG, IKZF4/Eos, SMYD3, TRIM28, and TCF3/E2A that are likely markers of regulatory T cells (Treg), consistent with known reductions in Tregs in CAD. A validation cohort of 80 patients confirmed the overall pattern (92% down-regulation) and supported many of the Treg-related changes. TRACs were enriched for transcripts associated with stress granules, which sequester RNAs, and ciliary and synaptic transcripts, possibly consistent with changes in the immune synapse of developing T cells. CONCLUSIONS: These studies identify a novel mRNA signature of a Treg-like defect in CAD patients and provides a blueprint for a diagnostic test for CAD. The pattern of changes is consistent with stress-related changes in the maturation of T and Treg cells, possibly due to changes in the immune synapse.
Subject(s)
T-Lymphocytes, RegulatoryABSTRACT
The Center for Air Quality &Control at the Seoul Research Institute of Public Health and the Environment (SIHE) has monitored changes in the concentration of fine dust in Seoul over the past 10 years and investigated meteorological factors as well as fine particulate matter (PM2.5), sulfur dioxide (SO2), and nitrogen dioxide (NO2) concentrations in northeastern China and its contribution to the PM2.5 concentration in Seoul. The concentration of fine dust in Seoul in 2020 was 21 µg/m3, which is down 16% from 2019 and the lowest since 2010. In 2020, China’s emissions of pollutants such as NO2 have decreased significantly due to regional blockades, social distancing, and factory shutdowns caused by COVID-19. As a results, the concentration of precursors such as SO2 and NO2, and PM2.5 in northeastern China are also decreased, which contributed to the reduction in PM2.5 concentration in Seoul caused by westerly winds blowing. In addition, the ratio of east and south winds that usually contain low concentrations of pollutants was more than 30% of the total air currents into Seoul, which is the highest in the last three years. Moreover, the mean wind velocity and the amount of precipitation were also the highest recorded values of 2.4 m/s and 1651.0 mm, respectively. Calculations using Comprehensive Air quality Model with eXtensions (CAMx)-Particulate Source Apportionment Technology (PSAT) show that the contribution of external inflows to the PM2.5 concentration in Seoul was 65%. We believe that the reasons for the low PM2.5 concentration in 2020 are due to meteorological factors and a decrease in air pollution in northeastern China. Meanwhile, the major contribution of emissions in Seoul (resuspended road dust and non-exhaust dust) was high. When the concentration of PM2.5 was high, the contribution of resuspended road dust was reduced due to an increase of secondary generating materials. Currently, data on emission reduction due to the COVID-19 cannot be assessed, which we believe will enable more accurate contribution calculations in the future. © 2021