ABSTRACT
The present study aimed to identify useful biomarkers to predict deterioration in patients with coronavirus disease 2019 (COVID‑19). A total of 201 COVID‑19 patients were classified according to their disease severity into non‑severe (n=125) and severe (n=76) groups, and the behavior of laboratory biomarkers was examined according to the prognosis. Neutrophil count, aspartate aminotransferase (AST), alanine aminotransferase, lactate dehydrogenase (LDH), C‑reactive protein (CRP), sialylated carbohydrate antigen KL‑6 (KL‑6), procalcitonin (PCT), presepsin (PSP) and D‑dimer levels were significantly higher, and lymphocyte count and platelet count were significantly lower in the non‑severe group compared with the severe group. In the non‑severe group, ROC analysis demonstrated that only four biomarkers, CRP, PSP, AST and LDH were useful for differentiating the prognosis between improvement and deterioration subgroups. No strong correlation was revealed for any of the markers. Multivariate analysis identified CRP as a significant prognostic factor in non‑severe cases (odds ratio, 41.45;95% confidence interval, 4.91‑349.24;P<0.001). However, there were no blood biomarkers that could predict the outcome of patients in the severe group. Overall, several blood markers changed significantly according to disease severity in the course of COVID‑19 infection. Among them, CRP, PSP, LDH and AST were the most reliable markers for predicting the patient's prognosis in non‑severe COVID‑19 cases.
ABSTRACT
Background The COVID-19 pandemic highlighted the necessity of allocating limited healthcare resources both fairly and effectively. Like many other countries, Japan decided to set priorities for the distribution of COVID-19 vaccines. Prior to this, priority setting had not been common in the healthcare setting in Japan. Japan's vaccination programme was initiated in February 2021 and is carried out by local governments and social health insurers, following national guidelines which state that priority should be given to members of high-risk groups according to their age and clinical condition. We investigated how local governments in Japan apply this policy and how, through their websites, they describe it to local communities. Methods We reviewed and analysed the official websites of 47 prefectures and 20 municipalities in Japan. The contents were reviewed to see (1) what priority framework they applied (2) whether municipal governments explained how priority was set and (3) how they implemented their policy. We also investigated how the terms 'priority' and 'fairness' were used on their websites. Results Due to the limited supplies of vaccine provided by the central government, many local governments needed to set their own priorities within the framework provided by the government. Examples include Osaka City, which prioritised elderly people living in care homes. At least 40 prefectures decided to allocate vaccines first to their capital city. Kagawa prefecture decided not to announce which cities they allocated vaccines to, out of a sense of 'fairness'. Discussion Although Japan achieved high vaccination acceptance in the short term, the government's guidance on priority setting for vaccines lacked specificity and it was unclear how important it was to follow their guidance. The government left many decisions to local municipalities and did not clarify the concept of 'fair allocation', leading to geographical inequalities in the distribution of vaccines.
ABSTRACT
In this study, we propose a method to estimate oxygen saturation by selecting the best bands from video images captured by a multiband camera. Oxygen saturation is one of the most important bioindicators for measuring human health. For example, when a person contracts COVID-19, which is currently prevalent, oxygen uptake does not work properly and oxygen saturation drops without the person being aware of it, which may lead to severe symptoms. Monitoring oxygen saturation is very important so that the person receives treatment before such a situation occurs. The commonly used contact sensor is uncomfortable because of its pressure and it is difficult to wear on a daily basis, so non-contact estimation of oxygen saturation is desirable. To estimate oxygen saturation using a contact sensor, the difference in the absorption coefficients of oxidized hemoglobin and deoxidized hemoglobin is used. Using the same principle, it is possible to estimate oxygen saturation without contact using the signals from two channels obtained by an RGB camera. Currently, many smartphones are equipped with infrared cameras for face recognition, and increasingly more models are equipped with multi-camera systems consisting of RGB and infrared cameras. In such cases, it is difficult to take advantage of the multiple bands because the optimal combination of bands for oxygen saturation estimation varies depending on the imaging environment and the subject. In this study, to select the optimal combination of bands from multi-band video images, we used a Monte Carlo simulation of light scattering on the skin to simulate pulse waves during oxygen saturation changes while measuring the signals with a multi-band camera. We further propose a method to select the most accurate combination for estimating the oxygen saturation based on the features obtained from the pulse wave.
ABSTRACT
Objective: Use of frozen sperm in non-male factor infertility is often needed in donor cycles. Most studies to date examining outcomes of fresh vs frozen sperm are unable to control for oocyte quality. Studies examining sibling oocytes represent a unique model to control for oocyte quality. A recent small study using this model found worse outcomes in the frozen group. We sought to evaluate, in a large cohort, if fresh and frozen ejaculated sperm are associated with similar pregnancy outcomes by analyzing paired donor egg recipient (DER) cycles. Materials and Methods: Retrospective cohort study from 2016-2019 at a large fertility center. Patients who underwent DER cycles where oocytes were split between two couples and one couple used fresh sperm and the other used frozen sperm were included. All patients with uterine factor, male factor or surgically obtained sperm were excluded. Primary outcome was Ongoing pregnancy/Live birth rate (OPR). Secondary outcome included clinical pregnancy rate (CPR) and miscarriage rate. GEE analysis was performed to control for confounding factors and donors providing oocytes to both study cohorts. Results: 1255 donor oocytes cycles were screened. A total of 205 unique oocytes donors were identified with oocytes inseminated with discrepant sperm in different recipient cycles. There were 698 recipient transfer cycles, 405 fresh and 293 frozen. Cohorts were similar in baseline characteristics (table 1). There were no differences in OPR/LBR with fresh vs frozen sperm (53.6% vs 55.6%, p=0.7) or clinical pregnancies (66.4% vs 63.5%, p=0.4). Spontaneous miscarriage (<20 weeks) was significantly higher in the fresh cohort (12.3% vs 6.1%, p=0.01). Conclusions: In this large study uniquely controlling for oocyte quality, there are no differences in live birth rate when fresh or frozen sperm was utilized on the same donor oocytes. This type of comparison is important as it helps control as much as possible the oocyte, thus isolating the discrepant sperm state as a determinant of outcome. There was a significant increase in miscarriage rate when fresh sperm was used. Impact Statement: In this large study comparing paired sibling donor oocytes, no difference in live birth rate was seen when couples utilized fresh or frozen sperm. This is particularly important in large donor or international programs especially during the COVID19 pandemic in which it may be difficult for the partner to be present, and a frozen sample may be needed. [Formula presented]