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Introduction: Advanced MZL is generally incurable, with periods of remission and relapse. Zanubrutinib (BGB-3111), a potent and highly specific next-generation Bruton tyrosine kinase (BTK) inhibitor, was approved in the US and Canada for R/R MZL based on the MAGNOLIA primary analysis (BGB- 3111-214;NCT03846427);here, the final MAGNOLIA analysis is presented. Method(s): This was a phase 2, multicenter, single-arm study of adult patients (pts) with R/R MZL (>=1 prior CD20-directed therapy). Zanubrutinib (160 mg twice daily) was given until disease progression or unacceptable toxicity. The primary endpoint was overall response rate (ORR) by independent review committee (IRC) per Lugano classification. Secondary endpoints were investigator-assessed ORR, duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. Efficacy was assessed by positron emission tomography (PET)-based Lugano criteria for IRC-confirmed fluorodeoxyglucose (FDG)-avid disease at baseline;non-avid disease was assessed by computed tomography (CT)-based criteria. Result(s): As of May 4, 2022, 68 pts were treated (median age=70 y [range 37-95];>=75 y=27.9%). MZL subtypes included extranodal (38.2%), nodal (38.2%), splenic (17.6%), and unknown (5.9%). The median number of prior therapies was 2 (range 1-6);32.4% of pts had disease refractory to last therapy, most (89.7%) had prior chemoimmunotherapy, and 7 (10.3%) had rituximab monotherapy as their only prior treatment. Sixty-one pts (89.7%) had FDG-avid disease. After a median follow-up of 28.0 mos (range 1.6-32.9) and a median treatment duration of 24.2 mos (range 0.9-32.9), 66 pts were efficacy- evaluable. IRC-assessed ORR (complete response [CR]+partial response [PR]) was 68.2% (CR=25.8%). By subtype, (Figure Presented)(Figure Presented)ORR/CR rates were 64.0%/40.0% (extranodal), 76.0%/20.0% (nodal), 66.7%/8.3% (splenic), and 50.0%/25.0% (unknown). Median DOR, PFS, and OS were not reached. Over 70.0% of pts were alive or progression-free after 2 years (Figure). Sensitivity analysis using only CT-based criteria (n=66) showed an ORR of 66.7% and CR of 24.2%. The most common treatment-emergent AEs were bruising (23.5%), diarrhea (22.1%), and constipation (17.6%). Neutropenia (8.8%) and COVID-19 pneumonia (5.9%) were the most common Grade >=3 AEs. Five pts (7.4%) died due to unrelated AEs: COVID-19 pneumonia=2, acute myeloid leukemia=1, myocardial infarction=1, septic encephalopathy=1. Hypertension occurred in 3 pts (4.4%), atrial fibrillation and atrial flutter in 1 pt (1.5%) each;none led to treatment withdrawal. One pt (1.5%) had a Grade 3 gastrointestinal hemorrhage while receiving rivaroxaban. None of the pts required dose reduction. Conclusion(s): In this final analysis with over 2 years of median follow-up, zanubrutinib continues to demonstrate durable disease control and was generally well tolerated, with no new safety signals observedCopyright © 2023 American Society for Transplantation and Cellular Therapy
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Context and aims. The purpose of the study was to examine the impact of environmental development in the seashore waters of Maluan Bay on the current situation of sustainable development of coastal villages. Methods. We used SPSS statistical software (ver. 26.0) to analyse the data with statistical verification, Student's t-test and ANOVA, the used the inverview method to solicit opinions on the questionnarie results, and, finally, conducted multivariate inspection and analysis to explore the results. Key results. The development of seashore waters can effectively enhance people's positive perceptions of the current economic, social, environmental and coastal ecological development, and increase their willingness to revisit and purchase property. Also, the insufficient number of security guards in villages can be improved, the environmental awareness of residents and their willingness to participate in decision-making can be enhanced. Conclusions and implications. Providing tourists with better tourism facilities, transportation, hotel and restaurant management and planning will increase leisure opportunities and solve environmental and waste problems such as in this scenic location. It will help achieve the goal of sustainable circular economy of water.
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Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2023 Report) (GOLD 2023) maintains the basic framework of GOLD 2022, but with major revisions in the definition, assessment, initial therapy and follow-up management of chronic obstructive lung disease (COPD) as follow: (1) Chapter 1: The definition and overview section was rewritten to propose a new definition of COPD, incorporating new background information, therapeutic strategies and classifications for COPD, with the addition of content on chronic bronchitis;(2) Chapter 2: Content on screening and case-finding of COPD has been included, the ABCD assessment tool has been revised to the ABE assessment tool (no further grouping of high-risk population of acute exacerbation of COPD based on symptom levels), information on imaging and computed tomography scans (CT) has been included in the diagnosis and assessment section;(3) Chapter 3: Recommendations for Streptococcus pneumoniae vaccination have been updated, information on therapeutic interventions to reduce COPD mortality has been included, issues related to inhalation delivery have been updated, content on inhaled medications adherence and remote rehabilitation has been included, information on interventional and surgical therapies of COPD has been expanded in the prevention and maintenance treatment section;(4) Chapter 4: Information on the selection of inhalation devices has been included, information on initial drug therapy and follow-up drug therapy has been updated in the management of stable COPD section;(5) Chapter 5: A new definition of and set of acute exacerbation of COPD assessment parameters have been proposed, information on differential diagnoses of acute exacerbation of COPD has been expanded in the acute exacerbation of COPD section management;(6) Chapter 6 and 7: Updating content on COPD and complications (Chapter 6), COPD (Chapter 7) and COVID-19 based on the latest evidence. The above updates will be an important guide to the clinical management of COPD. © 2023 Chinese General Practice. All rights reserved.
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Background Respiratory virus infection is an important trigger of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. China has adopted a series of containment measures assisting to curb COVID-19 transmission since the outbreak of the pandemic. Several studies showed a decrease in hospitalizations for AECOPD during the COVID-19 pandemic. However，there has been a relative lack of studies investigating the effects of preventive measures on the frequency and severity of exacerbations. Objective To explore the impact of the COVID-19 pandemic on the frequency of AECOPD with or without medical attention. Methods The subjects were from a prospective COPD cohort study conducted in the First Affiliated Hospital of Guangzhou Medical University，which began recruiting patients in early 2016，with visits every 3 months to collect demographic and clinical data，including those who were followed up during June to August 2017（group 1），June to August 2018（group 2），June to August 2019 （group 3），and June to August 2020（group 4）. Basic clinical data （including the frequency of AECOPD，sex，age，symptom score and so on） were collected from group 1 from October 2016 to May 2017，group 2 from October 2017 to May 2018，group 3 from October 2018 to May 2019，and group 4 from October 2019 to May 2020（during which the periods from October 2019 to January 2020，and from February to May 2020 were defined as preCOVID-19 period，and post-COVID-19 period，respectively）. The frequency of AECOPD during October to May next year in group 4 was compared with that of the other three groups. The changes in the frequency of AECOPD between pre- and postCOVID-19 periods were analyzed. Results There were 162 patients in group 1，157 in group 2，167 in group 3，and 159 in group 4. Group 1 had a higher frequency of AECOPD in February to May than in October to January next year（P=0.013），so did group 2（P=0.016）. In contrast，group 4 had a higher frequency of AECOPD in October to January next year than in February to May（P=0.001）. The frequency of AECOPD during October to December in group 4 was similar to that of the other three groups（P>0.05）. But the frequency of AECOPD from February to April in group 4 was lower than that in groups 1-3 （P<0.05）. There was no significant difference in the monthly frequency of AECOPD without medical attention in group 4 compared with that of groups 1-3（P>0.05）. The frequency of AECOPD with medical attention from October to December in group 4 was similar to that of groups 1-3（P>0.05）. but it from February to April in group 4 was lower than that in groups 1-3（P<0.05）. Conclusion Prevention and control measures targeting COVID-19 may be contributive to reducing the frequency of AECOPD. It is suggested that COPD patients should reduce gathering activities，maintain social distance，wear masks when going out，and wash hands frequently even after the COVID-19. © 2023 Chinese General Practice. All rights reserved.
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During the COVID-19 pandemic some organizations chose to restrict the number of people permitted to occupy a room simultaneously. People in these organizations often had difficulty finding an available room. In this study we designed, implemented, and evaluated a mobile app-based real-time room occupancy estimation system named AkiKomi. The system comprises a set of distributed Grid-EYE sensors, a Message Queueing Telemetry Transport broker hosted in the Amazon Web Service cloud platform, and a mobile app that runs on users' mobile devices. We conducted a pilot usability test using the System Usability Scale questionnaire. The results showed that the system achieved a total score of 73.4, above the cut-off threshold of good usability. © 2022 IEEE.
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Background Respiratory virus infection is an important trigger of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. China has adopted a series of containment measures assisting to curb COVID-19 transmission since the outbreak of the pandemic. Several studies showed a decrease in hospitalizations for AECOPD during the COVID-19 pandemic. However，there has been a relative lack of studies investigating the effects of preventive measures on the frequency and severity of exacerbations. Objective To explore the impact of the COVID-19 pandemic on the frequency of AECOPD with or without medical attention. Methods The subjects were from a prospective COPD cohort study conducted in the First Affiliated Hospital of Guangzhou Medical University，which began recruiting patients in early 2016，with visits every 3 months to collect demographic and clinical data，including those who were followed up during June to August 2017（group 1），June to August 2018（group 2），June to August 2019 （group 3），and June to August 2020（group 4）. Basic clinical data （including the frequency of AECOPD，sex，age，symptom score and so on） were collected from group 1 from October 2016 to May 2017，group 2 from October 2017 to May 2018，group 3 from October 2018 to May 2019，and group 4 from October 2019 to May 2020（during which the periods from October 2019 to January 2020，and from February to May 2020 were defined as preCOVID-19 period，and post-COVID-19 period，respectively）. The frequency of AECOPD during October to May next year in group 4 was compared with that of the other three groups. The changes in the frequency of AECOPD between pre- and postCOVID-19 periods were analyzed. Results There were 162 patients in group 1，157 in group 2，167 in group 3，and 159 in group 4. Group 1 had a higher frequency of AECOPD in February to May than in October to January next year（P=0.013），so did group 2（P=0.016）. In contrast，group 4 had a higher frequency of AECOPD in October to January next year than in February to May（P=0.001）. The frequency of AECOPD during October to December in group 4 was similar to that of the other three groups（P>0.05）. But the frequency of AECOPD from February to April in group 4 was lower than that in groups 1-3 （P<0.05）. There was no significant difference in the monthly frequency of AECOPD without medical attention in group 4 compared with that of groups 1-3（P>0.05）. The frequency of AECOPD with medical attention from October to December in group 4 was similar to that of groups 1-3（P>0.05）. but it from February to April in group 4 was lower than that in groups 1-3（P<0.05）. Conclusion Prevention and control measures targeting COVID-19 may be contributive to reducing the frequency of AECOPD. It is suggested that COPD patients should reduce gathering activities，maintain social distance，wear masks when going out，and wash hands frequently even after the COVID-19. © 2023 Chinese General Practice. All rights reserved.
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Background: MZL is the second most common lymphoma in older pts. Choosing an optimal treatment can be challenging because of patient-or disease-related risk factors and treatment-related toxicities (Curr Opin Oncol. 2019;31(5):386-393). Zanubrutinib is a potent, irreversible next-generation Bruton tyrosine kinase (BTK) inhibitor designed to maximize BTK occupancy and minimize off-target kinase inhibition, which may improve efficacy outcomes and minimize toxicities, such as cardiac arrythmias and bleeding events. Zanubrutinib received accelerated approval from the United States FDA for the treatment of pts with R/R MZL (Haematologica . 2022;107(1):35-43). Aims: We aim to present a subgroup analysis of efficacy and safety of zanubrutinib in pts aged ≥65 years with R/R MZL enrolled in MAGNOLIA (BGB-3111-214;NCT03846427). Methods: MAGNOLIA is a phase 2, multicenter, single-arm study of adults with R/R MZL who had received ≥1 line of therapy including ≥1 CD20-directed regimen. All were treated with zanubrutinib 160 mg twice daily until disease progression or unacceptable toxicity. Use of long-term antiplatelet and anticoagulation agents was permitted. The primary endpoint was overall response rate (ORR;complete response [CR] and partial response [PR]) determined by an independent review committee (IRC) in accordance with the Lugano classification. Secondary endpoints include ORR by investigator assessment (INV), duration of response (DOR), progression-free survival (PFS), and safety. All pts gave informed consent. Results: As of 18 January 2021, a total of 68 pts were enrolled (Table). Forty (61%) pts were ≥65 years old with a median age of 73 (range, 65-85);18 pts were ≥75 years old. Median number of prior therapies was 2 (range, 1-6) and 10 (25%) pts were refractory to last therapy. Most pts received prior rituximab + cyclophosphamide + vincristine + prednisone (48%) or bendamustine + rituximab (30%), while 5 (13%) pts received rituximab monotherapy. MZL subtypes included extranodal (n=17, 43%), nodal (n=14, 35%), and splenic (n=8, 20%). Median duration of treatment was 14.4 months (mo;range, 0.9-19.6). At a median follow-up of 15.8 mo (range, 2.8-21.8), ORR by IRC was 75% (CR 25%, PR 50%;Table). Responses were observed in all subtypes, with an ORR of 71%, 86%, and 75% in extranodal, nodal, and splenic subtypes, respectively (CR 41%, 21%, and 0%, respectively). Median DOR and PFS were not reached;15-month PFS was 87% and 12-month DOR was 93%. Most (63%) pts are continuing zanubrutinib. Treatment discontinuation due to disease progression was 28% by INV. Most common treatmentemergent adverse events (AEs) observed in ≥20% of pts include contusion (28%), diarrhea (25%), and constipation (20%). Grade ≥3 neutropenia occurred in 5% of pts. The most common infection was upper respiratory tract infection (10%). Two (5%) pts discontinued zanubrutinib due to unrelated fatal AEs (COVID-19 pneumonia and myocardial infarction in a patient with pre-existing coronary artery disease). Atrial fibrillation/flutter and hypertension occurred in 2 (5%) pts each and did not lead to treatment discontinuation. No pts required dose reductions, or experienced major or serious hemorrhage. Image: Summary/Conclusion: The safety profile of zanubrutinib observed in older pts was consistent with previously published results (Clin Cancer Res . 2021;27(23):6323-6332). Zanubrutinib was well tolerated and effective, as demonstrated by a high response rate and durable disease control in older pts with R/R MZL.
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Purpose: This study aims to examine the corporate donations in response to the intensive outbreak of the COVID-19 pandemic in China in 2020 and proposes that the local spread of COVID-19 is negatively associated with corporate donations due to the non-trivial costs, but meanwhile, strong institutional pressures based on institutional theory are put on firms to donate, which thus creates a dilemma for firms. This study further argues that the dilemma is heterogeneous across different institutional fields. Design/methodology/approach: Using a sample of Chinese listed companies during the intensive outbreak of this pandemic, a two-stage Heckman selection model is conducted to address the potential sample selection bias. Findings: This study reveals a negative relationship between the local spread of COVID-19 and corporate donations, confirms the driving effect of various types of institutional pressure and finds that the intensity of the COVID-19 pandemic strengthens the effect of coercive pressure and mimetic pressure on philanthropic giving but weakens the effect of normative pressure. Originality/value: This study extends the knowledge on firms’ philanthropic response to natural crises, as the COVID-19 pandemic has not only led to a public health crisis but also to a global economic crisis, and how the effects of institutional pressures are affected by a situational crisis. This work enriches the literature on corporate philanthropy and crisis management and has some implications for both policymakers and business practitioners. © 2022, Emerald Publishing Limited.
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The Covid-19 pandemic poses great challenges to the resilience of global agriculture in response to disasters or crises. The pandemic mitigation measures prevent the spread of coronavirus but bring disruptions to the agriculture sector. Smallholder farmers and small agricultural producer particularly showed their vulnerability to these disruptions amid the pandemic. Technology innovations can be adopted to develop resilient, flexible and inclusive agriculture. Blockchain enables autonomous and decentralized coordination of trust in a distributed network without any trusted third-party intermediaries that can vastly reduce the transaction costs of exchange and trade. This paper examines the viable applications of blockchain technology in enhancing the resilience of agriculture and the food supply chain, facilitating trades and financing, and driving value allocation from a perspective of institutional economics. © 2022 ACM.
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Computed tomography (CT) of COVID-19 manifests a relatively global effect through the whole lungs, like peripheral ground glass, consolidation, reticular pattern, nodules etc. This characteristic effect renders the difficulties in differentiating COVID-19 from the normal body or other lung diseases by CT. This work presents a novel method to relieve the difficulties by reducing the global effect through the 3D whole lung volume into 2D-like domain. The hypothesis is that the lung tissue shares the similar anatomic structure within a small lung sub-volume for normal subjects. Therefore, the anatomic land-markers along the z-axis, denoted as Lung Marks are used to eliminate axial variable. Our experiments indicated that 30 Lung Marks are sufficient to eliminate the axial variable. The method computes texture measures from each 2D-like volumetric data and maps the measures on to the corresponding Lung Mark, resulting in a profile along the z-axis. The difference of the profiles between two different abnormalities is the proposed sensitive merit to differentiate COVID-19 cases from others in CT images. 48 COVID-19 cases and 48 normal screening cases were used to test the effectiveness of the proposed sensitive merit. Intensity and gradient based texture descriptors were computed from each axial cross image at the corresponding Lung Mark along the z-axis. Euclidean, Jaccard and Dice distances are calculated to generate the profiles of the proposed sensitive merit. Consistent results are observed across texture descriptor types and distance types in the texture measure between the normal and COVID-19 subjects. Uneven Profiles demonstrate the variation along the z-axis. With Lung Mark, the variation of texture descriptor has been reduced prominently. The Gradient based descriptor is more sensitive. Individual Haralick features analysis shows the 2nd and 10th dimensions are most distinguishable. © 2020 IEEE
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OBJECTIVES: Cigarette smoking is an established risk factor for illness severity and adverse outcomes in patients with COVID-19. Alcohol drinking may also be a potential risk factor for disease severity. However, the combined and interactive effects of drinking and smoking on COVID-19 have not yet been reported. This study aimed to examine the combined and interactive effects of alcohol drinking and cigarette smoking on the risk of severe illness and poor outcomes in patients with COVID-19. STUDY DESIGN: This was a multicentre retrospective cohort study. METHODS: This study retrospectively reviewed the data of 1399 consecutive hospitalised COVID-19 patients from 43 designated hospitals. Patients were grouped according to different combinations of drinking and smoking status. Multivariate mixed-effects logistic regression models were used to estimate the combined and interactive effects of drinking and smoking on the risk of severe COVID-19 and poor clinical outcomes. RESULTS: In the study population, 7.3% were drinkers/smokers, 4.3% were drinkers/non-smokers and 4.9% were non-drinkers/smokers. After controlling for potential confounders, smokers or drinkers alone did not show a significant increase in the risk of severe COVID-19 or poor clinical outcomes compared with non-drinkers/non-smokers. Moreover, this study did not observe any interactive effects of drinking and smoking on COVID-19. Drinkers/smokers had a 62% increased risk (odds ratio = 1.62, 95% confidence interval: 1.01-2.60) of severe COVID-19 but did not have a significant increase in the risk for poor clinical outcomes compared with non-drinkers/non-smokers. CONCLUSIONS: Combined exposure to drinking and smoking increases the risk of severe COVID-19, but no direct effects of drinking or smoking, or interaction effects of drinking and smoking, were detected.
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COVID-19 , Cigarette Smoking , Alcohol Drinking/adverse effects , Alcohol Drinking/epidemiology , COVID-19/epidemiology , Humans , Odds Ratio , Retrospective StudiesABSTRACT
Federated Learning (FL) creates an ecosystem for multiple agents to collaborate on building models with data privacy consideration. The method for contribution measurement of each agent in the FL system is critical for fair credits allocation but few are proposed. In this paper, we develop a real-time contribution measurement method FedCM that is simple but powerful. The method defines the impact of each agent, comprehensively considers the current round and the previous round to obtain the contribution rate of each agent with attention aggregation. Moreover, FedCM updates contribution every round, which enable it to perform in real-time. Real-time is not considered by the existing approaches, but it is critical for FL systems to allocate computing power, communication resources, etc. Compared to the state-of-the-art method, the experimental results show that FedCM is more sensitive to data quantity and data quality under the premise of real-time. Furthermore, we developed federated learning open-source software based on FedCM. The software has been applied to identify COVID-19 based on medical images.
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The COVID-19 pandemic triggered unprecedented adoption of online education in universities and digital technologies are increasingly becoming an essential part of the learning and teaching experience. From within an ongoing pandemic 'lockdown', this study investigates the current landscape of online education with a focus on the learning and teaching experience in virtual classrooms compared to physical classrooms. We found that instructors typically combine multiple technologies to create a holistic learning experience for students. The benefits of virtual classrooms included self-paced learning, increased opportunities to gain procedural knowledge, diversified communication channels, and greater opportunities for learning analytics. Compared to physical classrooms, the drawbacks of virtual classrooms included the lack of both timely access to all information through a single interface and natural interpersonal interaction. Based on our findings we recommend instructors to remain flexible when selecting technologies and to adapt the level of offline learning to fit their students' learning styles and abilities. We also identified opportunities for virtual reality technology to mitigate the drawbacks of online education by helping to translate in-class experience to virtual spaces.
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The development of COVID-19 detection strategies with high sensitivity and selectivity are urgent for early diagnosis. Herein, we constructed an electrochemical dual-aptamer biosensor based on the metal organic frameworks MIL-53(Al) decorated with Au@Pt nanoparticles and enzymes to determine SARSCoV-2 nucleocapsid protein (2019-nCoV-NP) via co-catalysis of the nanomaterials, horseradish peroxidase (HRP) and G-quadruplex DNAzyme. First, the two thiol-modified aptamers (N48 and N61), as recognition elements, were immobilized on the surface of gold electrode (GE) to capture the biomarker 2019nCoV-NP. Then, the nanomaterial composites Au@Pt/MIL-53 (Al) were decorated by HRP and hemin/Gquadruplex DNAzyme as signal nanoprobe. The designed nanoprobe was applied to amplifying the aptasensor signal via co-catalyzing the oxidation of hydroquinone in the presence of hydrogen peroxide. Finally, the aptamer-protein-nanoprobe sandwich electrochemical detection system was fabricated on the GE surface. The results demonstrated that this aptasensor had a wide linear range from 0.025 to 50 ng mL -1 and the detection limit was 8.33 pg mL -1 for 2019-nCoV-NP. This aptasensor has great potential in the early diagnosis of COVID-19 with high sensitivity, selectivity and reliability. (c) 2021 Elsevier Ltd. All rights reserved.
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In this paper, a Markov decision process (MDP) model was established to study emergency medical material scheduling strategies for public health emergencies such as COVID-19.Within the constraints of dispatchable supplies, the priority of each medical node complicates the problem of deciding which hospital node supplies to respond to. The model assumes that the probability of events in the initial time period is in line with the Poisson distribution and that the location and priority of each hospital node is known when the material demand is initiated. The priority of hospital nodes is divided into four categories: critical, urgent, priority, and routine. There are several patients with different priorities in a hospital node: critical illness, severe illness, and mild illness. The priority of the hospital node is determined by the overall situation of the hospital patients. The MDP model established in this paper gives how to dispatch limited emergency medical supplies in the dispatching center to make the service rate of the whole system the best. The efficiency of the dispatching center in responding to the material needs of the hospital node depends on the constraints of the number and response time of different priority patients at the node. The maximum effect iterative dynamic model was simulated by simulation experiment and compared with the simulation effect under general conditions, so as to observe whether the model improved the system service rate. (C) 2021 The Authors. Published by Atlantis Press B.V.
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OBJECTIVE: To evaluate systematically the efficacy and safety of COVID-19 vaccines. METHODS: PubMed, Embase, Cochrane Library, Clinicaltrial.gov, CNKI, Wanfang Data, China Biomedical Literature Service System, and China Clinical Trial Registry were searched for randomized controlled trials of COVID-19 vaccines published up to December 31, 2020. The Cochrane bias risk assessment tool was used to assess the quality of studies. A qualitative analysis was performed on the results of clinical trials. RESULTS: Thirteen randomized, blinded, controlled trials, which involved the safety and efficacy of 11 COVID-19 vaccines, were included. In 10 studies, the 28-day seroconversion rate of subjects exceeded 80%. In two 10 000-scale clinical trials, the vaccines were effective in 95% and 70.4% of the subjects, respectively. The seroconversion rate was lower than 60% in only one study. In six studies, the proportion of subjects who had an adverse reaction within 28 days after vaccination was lower than 30%. This proportion was 30%-50% in two studies and > 50% in the other two studies. Most of the adverse reactions were mild to moderate and resolved within 24 hours after vaccination. The most common local adverse reaction was pain or tenderness at the injection site, and the most common systemic adverse reaction was fatigue, fever, or bodily pain. The immune response and incidence of adverse reactions to the vaccines were positively correlated with the dose given to the subjects. The immune response to the vaccines was worse in the elderly than in the younger population. In 6 studies that compared single-dose and double-dose vaccination, 4 studies showed that double-dose vaccination produced a stronger immune response than single-dose vaccination. CONCLUSIONS: Most of the COVID-19 vaccines appear to be effective and safe. Double-dose vaccination is recommended. However, more research is needed to investigate the long-term efficacy and safety of the vaccines and the influence of dose, age, and production process on the protective efficacy.
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The severe pneumonia induced by the infection of the SARS-CoV-2 virus causes massive death in the ongoing COVID-19 pandemic. The early detection of the SARS-CoV-2 induced pneumonia relies on the unique patterns of the chest XRay images. Deep learning is a data-greedy algorithm to achieve high performance when adequately trained. A common challenge for machine learning in the medical domain is the accessibility to properly annotated data. In this study, we apply a conditional adversarial network (cGAN) to perform image to image (Pix2Pix) translation from the non-COVID-19 chest X-Ray domain to the COVID-19 chest X-Ray domain. The objective is to learn a mapping from the normal chest X-Ray visual patterns to the COVID-19 pneumonia chest X-ray patterns. The original dataset has a typical imbalanced issue because it contains only 219 COVID-19 positive images but has 1,341 images for normal chest X-Ray and 1,345 images for viral pneumonia. A U-Net based architecture is applied for the image-to-image translation to generate synthesized COVID-19 X-Ray chest images from the normal chest X-ray images. A 50-convolutional-layer residual net (ResNet) architecture is applied for the final classification task. After training the GAN model for 100 epochs, we use the GAN generator to translate 1,100 COVID-19 images from the normal X-Ray to form a balanced training dataset (3,762 images) for the classification task. The ResNet based classifier trained by the enhanced dataset achieves the classification accuracy of 97.8% compared to 96.1% in the transfer learning mode. When trained with the original imbalanced dataset, the model achieves an accuracy of 96.1% compared to 95.6% in the training from trainby-scratch model. In addition, the classifier trained by the enhanced dataset has more stable measures in precision, recall, and F1 scores across different image classes. We conclude that the GAN-based data enhancement strategy is applicable to most medical image pattern recognition tasks, and it provides an effective way to solve the common expertise dependence issue in the medical domain. © 2020 IEEE.