Chest Computed Tomography Results Research Articles

Prognosis Predictive Markers in Patients with Chronic Obstructive Pulmonary Disease and COVID-19.

Some studies have reported that chronic respiratory illnesses in patients with COVID-19 result in an increase in hospitalization and death rates, while other studies reported to the contrary. The present research aims to determine if a predictive model (developed by combing different clinical, imaging, or blood markers) could be established for patients with both chronic obstructive pulmonary disease (COPD) and COVID-19, in order to be able to foresee the outcomes of these patients. A prospective observational cohort of 165 patients with both diseases was analyzed in terms of clinical characteristics, blood tests, and chest computed tomography results. The beta-coefficients from the logistic regression were used to create a score based on the significant identified markers for poor outcomes (transfers to an intensive care unit (ICU) for mechanical ventilation, or death). The severity of COVID-19, renal failure, diabetes, smoking status (current or previous), the requirement for oxygen therapy upon admission, high lactate dehydrogenase (LDH) and C-reactive protein level (CRP readings), and low eosinophil and lymphocyte counts were all identified as being indicators of a poor prognosis. Higher mortality was linked to the occurrence of renal failure, the number of affected lobes, the need for oxygen therapy upon hospital admission, high LDH, and low lymphocyte levels. Patients had an 86.4% chance of dying if their mortality scores were -2.80 or lower, based on the predictive model. The factors that were linked to a poor prognosis in patients who had both COPD and COVID-19 were the same as those that were linked to a poor prognosis in patients who had only COVID-19.

Chest X-rays and CT Results from Tuberculosis Screening in Healthcare Workers Using Interferon- Gamma Release Assay (IGRA)

Background: To examine the prevalence of tuberculosis (TB) in healthcare workers (HCWs) with positive chest X-ray (CXR) and computed tomography (CT) findings and to ascertain the function of imaging in the diagnosis of TB. Aims & Objectives: This study’s objectives included determining the prevalence of TB based on CXR and CT findings in healthcare professionals with positive IGRA results as well as the function of imaging in the diagnosis and management of pulmonary TB. Materials and Methods: Retrospective investigations were conducted on IGRA positive people among 1976 hospital staff who had been TB-screened using the test. CXR was positive for clustered nodular and/or linear streaky opacities in the upper lung zone. The CT results were categorised. as being active, uncertain, inactive, or typical. The class was regarded as CT-positive if it was active or undetermined. Results: In 195 patients, the IGRA was positive. 190 participants (98.95%) and 90 subjects (46.87%) had CXR and CT, respectively. There were 6 of 190 and 14 of 90 patients with CXR- and CT-positive findings, respectively. 9 and 5 of the 14 CT-positive individuals had active and indeterminate TB results, respectively. All 14 CT-positive participants had negative microbiological reactions for TB. Nine CT-positive people were given empirical anti-TB drugs, and 5 of these 14 subjects tested negative for pulmonary TB on the CXR. Conclusion: CT helped diagnose asymptomatic TB in IGRA-positive HCWs.

Long-term outcomes and prognostic factors of patients with lung metastases from differentiated thyroid cancer after radioiodine therapy in Japan.

Long-term survival in patients with differentiated thyroid cancer (DTC) and lung metastasis remains unexplored in Japan. This study aimed to investigate the long-term survival and prognostic factors of radioiodine therapy (RIT) in a University Hospital setting. This retrospective study included 62 patients with lung metastases from DTC who received RIT between March 2005 and December 2016. According to the 131I whole-body scan and chest computed tomography results, lung metastases were classified as 131I-avid or non-131I-avid, and miliary, micronodular, or macronodular metastases. The 5- and 10-year overall survival (OS) rates from the initial RIT were calculated by the Kaplan-Meier method, and a proportional hazard fit analysis was performed to determine prognostic factors. With a median follow-up of 7.9 years, the 5- and 10-year OS rates from the initial RIT were 93% and 72%, respectively. Univariable and multivariable analyses of patient subgroups revealed that macronodular lung metastases (defined as nodules >1 cm), older age at initial RIT, and high thyroglobulin values (>400 ng/mL) at initial RIT predicted low OS. The 5- and 10-year OS rates of DTC patients with lung metastases were similar to those in previous Japanese reports, which included a smaller sample size compared with ours. Patients with ≤1 cm lung metastases, aged ≤55 years, and a thyroglobulin level of ≤400 ng/mL at the initial RIT had favorable outcomes.

"Day 25": a temporal indicator of stabilization of mortality risk among COVID-19 patients with high viral load.

The relationship between SARS-CoV-2 viral load and hospitalization and mortality among COVID-19 patients has been established. However, the estimation of the duration of time after which the risk of mortality of these patients stops escalating was not extensively discussed earlier. Stratifying patients according to their risk of mortality would optimize healthcare services and costs and reduce mortality. In this retrospective observational study, hospital records were used to collect data of 519 COVID-19 patients from May through November 2020. Data included the clinical condition of patients, their viral loads, their admission chest computed tomography results (CO-RAD scale), and the duration of their hospitalization. A Kaplan-Meier analysis was constructed to estimate mortality risk concerning viral load. By the end of the study, 20.42% of patients were deceased. The cumulative mortality was: 36.1% (75/208) among patients with high viral load, 12.6% (28/222) in those with moderate viral load, and 3.4% (3/89) among those with low viral load. Predictors of mortality were: older age [adjusted hazard ratio (aHR) = 1.02, 95% CI: [1.00-1.03], (p = 0.05)], "being female" [aHR = 1.53 with 95% CI: [1.03-2.26], (p = 0.031), "high CO-RAD scale" [aHR = 1.32 (1.06-1.64), p = 0.013], "high viral load" [aHR = 4.59 (2.38-20.92), p = 0.017, ICU admission [aHR = 15.95; 95%CI:7.22-35.20, p < 0.001] and lymphocytosis [aHR = 1.89 45;95%CI:1.04-3.45, p = 0.036]. In the ICU-admitted patients, the median survival was 19days and mortality stabilized at "day 25". For patients with high viral load, mortality rates stabilized at "day 25 post-admission" after which the risks of mortality did not change until day 40, while patients with low and moderate viral loads reached the peak and stabilized at day "20 post-admission". Initial high SARS-CoV-2 viral load might be used as an indicator of a delayed stabilization of mortality risk among COVID-19 patients.

Treatment of COVID-19 in Hemodialysis Patients Using Traditional Chinese Medicine: A Single-Center, Retrospective Study.

Background: To explore the effect of combining traditional Chinese medicine (TCM) and Western medicine in hemodialysis patients with coronavirus disease 2019 (COVID-19). Methods: This study was conducted from 27 January 2020 to 17 March 2020 in Wuhan Third Hospital Guanggu Branch, Wuhan, China. Fifty-three patients were included and divided into a control group (CG), which received Western medicine and a combined treatment group, which received TCM and Western medicine (TG). Clinical and laboratory data, TCM symptom scores, and chest computed tomography results were extracted and compared between the two groups. Results: The TG included 21 (67.7%) men and 10 (32.3%) women with a mean age of 61.02 (standard deviation [SD] 15.07, range 26–89) years. The mean dialysis duration in the TG was 49 (SD 31) months. Of all patients in the TG, 27 (87.1%) had fatigue, 18 (58.1%) had dry cough, 16 (51.6%) had anorexia, 11 (35.5%) had dyspnea, and 11 (35.5%) had fever. The CG included 14 (63.6%) men and 8 (36.4%) women with a mean age of 61.45 (SD 13.78, range 36–84) years. The mean dialysis duration in the CG was 63 (SD 46) months. Of all patients in the CG, 21 (95.5%) had fatigue, 12 (54.5%) had dry cough, 17 (77.3%) had anorexia, 12 (54.5%) had dyspnea, and 7 (31.8%) had fever. After treatment, the TCM symptom scores of the two groups decreased; the anorexia scores were lower in the TG than in the CG (p < 0.05). After treatment, albumin increased and D-dimer, C-reactive protein, and lactate dehydrogenase levels decreased in the TG. The d-dimer levels were lower and the albumin level was higher in the TG than in the CG after treatment (p < 0.05). The cure rate was higher, and the mortality rate was lower in the TG than in the CG (p < 0.05). Conclusion: A combination of TCM and Western medicine in hemodialysis patients with COVID-19 could relieve symptoms and help recovery. Further evidence from larger randomized controlled trials is needed to confirm our results.

Asynchronous changes of normal lung lobes during respiration based on quantitative computed tomography (CT).

This study aimed to explore the coordinated and independent actions of lung lobes during respiration using quantitative computed tomography (CT) in order to increase our in vivo understanding of pulmonary anatomy. Cases for whom test results showed normal pulmonary function tests (PFTs) results, and normal paired inspiratory-expiratory chest CT findings, as assessed by 2 radiologists, were retrospectively included in this study. From the chest CT results, we measured quantitative indices of lung volume (LV) and mean lung density (MLD) for the total lung (TL), left lung (LL), right lung (RL), and 5 lobes in inspiratory and expiratory phases. The differences of these measures between bilateral lungs and among the lobes were evaluated to study whether they were consistent or different during respiration. A total of 70 cases were included {median age of 49.5 [interquartile range (IQR), 38.0 to 60.3] years; 32 males; 38 females}. Overall, the inspiratory and expiratory volumes of the LL were smaller than those of the RL (both P<0.001). For the ventilation workload (λ, which indicates the ratio of lobar volume to total LV), the end-expiratory volume ratio (λex ) of the LL was 0.44 (IQR, 0.43 to 0.46), while the end-inspiratory volume ratio (λin ) had risen to 0.46 (IQR, 0.45 to 0.47) (P<0.001). Comparing the 5 lobes, not all lobes shared the same LV. However, the left lower lobe (LLL) and right lower lobe (RLL) showed some similarities. The λin-LLL and λin-RLL was higher than λex-LLL and λex-RLL , respectively (both P<0.001), while the ratios of the other lobes reduced. The pairwise mean absolute difference (PMAD) on λin and λex of the bilateral lower lobes was low in inspiration (0.0288) and expiration (0.0346). The MLD of bilateral lower lobes showed consistency in inspiration or in expiration (inspiration: P>0.999; expiration: P=0.975). In addition, the PMADs between the right middle lobe (RML) and other lobes were significantly larger than the PMAD between other pairs of lobes in both inspiration and expiration. Beyond that, the expiratory MLD of RML [-789.6 (IQR, -814 to -762.05) HU] was the lowest among the 5 lobes. We found that the LL assumes a higher workload during ventilation than it does during respiration. The 5 normal lobes were non-synchronous during respiration and contributed differently to ventilation. The bilateral lower lobes showed similarities and had a high-ventilation function, while and the LV and MLD of the RML showed the least changes within a respiration cycle.

Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report

BackgroundPulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to the presence of microscopic tumor emboli of the peripheral pulmonary arteries. Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer that was identified postmortem through pathological autopsy.Case presentationA 52-year-old Asian woman who experienced anterior chest pain while coughing visited the orthopedic department of the Gifu University Hospital. She was diagnosed as having multiple osteolytic bone metastases throughout her body and was subsequently scheduled to undergo combined positron emission tomography and computed tomography (CT) to search for a primary lesion. However, 4 days after her visit to the orthopedic department, she was unable to stand up and thus visited the emergency department. At the time of admission, physical examination results revealed that she had a percutaneous oxygen saturation level of 90% (on room air) and cyanosis and that she was in a state of hemodynamic shock. Laboratory test results revealed elevated levels of fibrin degradation products and D-dimer in her blood. Chest CT results were normal. She was admitted to the hospital’s general ward for follow-up but soon entered a gradually worsening state of shock and respiratory failure. Electrocardiography revealed findings associated with right heart strain; however, contrast-enhanced CT did not reveal the presence of pulmonary embolism. She was admitted to the intensive care unit and was treated for pulmonary hypertension; however, 45 h after her arrival at the hospital, she died of respiratory failure. A pathological autopsy revealed the presence of gastric cancer, tumor microemboli, and fibrous intimal thickening of the peripheral arteries of both lungs; thus, a diagnosis of PTTM was made.ConclusionsIn patients with carcinoma of unknown primary site and pulmonary hypertension with pulmonary embolism ruled out by CT, emergency physicians and intensivists must consider the possibility of PTTM, which represents an oncologic emergency, and initiate chemotherapy administration as soon as possible.

Evaluation of rapid antibody test and chest computed tomography results of COVID-19 patients: A retrospective study.

The purpose of this study was to evaluate the SARS‐CoV‐2 immunoglobulin M/immunoglobulin G (IgM/IgG) rapid antibody test results in symptomatic patients with COVID‐19 and their chest computed tomography (CT) data. A total of 320 patients admitted to our hospital for different durations due to COVID‐19 were included in the study. Serum samples were obtained within 0–7 days from COVID‐19 patients confirmed by reverse‐transcription polymerase chain reaction (RT‐PCR) and chest CT scan. According to the SARS‐CoV‐2 RT‐PCR results, the patients included in the study were divided into two groups: PCR positive group (n = 46) and PCR negative group (n = 274). The relationship between chest CT and rapid antibody test results were compared statistically. Of the 320 COVID‐19 serum samples, IgM, IgG, and IgM/IgG were detected in 8.4%, 0.3%, and 11.6% within 1 week, respectively. IgG/IgM antibodies were not detected in 79.7% of the patients. In the study, 249 (77.8%) of 320 patients had positive chest CT scans. Four (5.6%) of 71 patients with negative chest CT scans had IgM and two (2.8%) were both IgM/IgG positive. IgM was detected in 23 (9.2%), IgG in one (0.4%), and IgM/IgG in 35 (14%) of chest CT scan positive patients. The rate of CT findings in patients with antibody positivity was found to be significantly higher than those with antibody negativity. The results of the present study show the accurate and equivalent performance of serological antibody assays and chest CT in detecting SARS‐CoV‐2 within 0–7 days from the onset of COVID19 symptoms. When RT‐PCR is not available, we believe that the combination of immunochromatographic test and chest CT scan can increase diagnostic sensitivity for COVID‐19.

Literature Review: Effectiveness of Chest CT for Triage in the Emergency Departmet (ED) in Patients with Suspected COVID-19

Background: COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus. The spread of this virus is very fast, so patients come to the Emergency Department (ED) for examination. The initial examination was carried out by triage the patient using the RT-PCR method. Then, there are recent studies that Computed Tomography (CT) can be used as a triage tool and help in the early diagnosis of patients with suspected COVID-19.&#x0D; Objectives: To determine chest CT for triage in the Emergency Department (ED) in patients with suspected COVID-19.&#x0D; Method:Search for articles was conducted electronically using Google Scholar, Sience Direct, and PubMed databases. Article used from March 2020 to January 2021. Keywords in this article search used the keywords "chest CT" for "triage" and "emergency department" for "COVID-19" and "chest x-ray" for "triage" and "emergency department" for "COVID-19", thus getting 5 research articles reviewed.&#x0D; Results: A chest CT that can be used as a triage tool based on the speed at which the chest CT results can be released depicting a confirmed COVID-19 patient in 60 minutes. Second, based on the sensitivity of chest CT there was 90.2% and according to chest CT instructions there was 89%.&#x0D; Conclusion: Chest CT examination is very effective as the first triage in diagnosing patients with suspected COVID-19.

Analysis of pulmonary nodules caused by nontuberculous mycobacteriosis in 101 resected cases: multi-center retrospective study.

BackgroundSolitary pulmonary nodules caused by nontuberculous mycobacteriosis are included as a category of pulmonary nontuberculous mycobacterium disease. Clinical characteristics, treatments and prognosis are not fully known because there are a few related reports.MethodsThis was a multi-center retrospective study of 101 cases diagnosed as solitary nodular type of nontuberculous mycobacteriosis from January 2000 to March 2017 that underwent resection at 9 related facilities belonging to the Thoracic Surgery Study Group of Osaka.ResultsThe most common pathogen was Mycobacterium avium complex (n=77, 87.5%), followed by Mycobacterium kansasii (n=8, 9.1%). Chest computed tomography results showed subpleural locations that were difficult to distinguish from lung cancer. Fluorodeoxyglucose positron emission tomography/computed tomography was performed in 58 cases and positive results were obtained in 35 (60.3%), with an average maximum standardized uptake value of 3.87. The purpose of resection in most cases was for diagnosis. The surgical procedure was wedge resection in 87, segmentectomy in 3, and lobectomy in 11, while 77 underwent thoracoscopic surgery. Postoperative complications occurred in 7 cases, though no infections caused by nontuberculous mycobacteriosis were noted. The median observation period was 27 months. A worsened condition occurred in 10 (9.9%) with Mycobacterium avium complex, though none had local recurrence.ConclusionsSolitary pulmonary nodules due to nontuberculous mycobacteriosis is difficult to diagnose based on preoperative examination results or distinguish from lung cancer. Among the present cases, none had local complications or recurrence, even in those that underwent a wedge resection, thus postoperative chemotherapy was not considered necessary if a complete resection was performed. On the other hand, some cases showed reinfection after a long period following resection, thus patients should be informed of that future possibility.

The method of coding and quantitative evaluation of tuberculosis lesions in the lungs

To evaluate the degree of tuberculous lesions of the lungs, the method has been developed for coding and quantitative assessment of chest computed tomography results (chest CT) based on the presence of the following signs in each lobe of the lung: infiltrative and/or small focal changes – +1 point, focal formations (tuberculomas) – +2 points, cavitary changes (cavities) – +4 points. If there are all elements in the lobe, the maximum score is given – 7. The X-ray signs of tuberculous changes in the lungs are recorded in the form of a five-digit code "* * * | * *", where * corresponds to the lung lobe and is replaced by a figure corresponding to the total score calculated for this lobe. The arithmetic mean of the numbers in the code allows estimating the dissemination of tuberculosis: the higher the value, the more severe pathological changes in the lungs. The authors experimentally found that in the treatment of multiple and extensive drug resistant pulmonary tuberculosis with, the timing of sputum conversion (r s = 0.442; p &lt; 0.01) and healing of cavities (r s = 0.575; p &lt; 0.05) directly depended on the severity of tuberculous changes in the lungs, revealed by chest CT and evaluated using the proposed method.

Chest CT-scan findings in COVID-19 patients: Relationship between the duration of symptoms and correlation with the oxygen saturation level

"Abstract: Purpose: This study is carried out to evaluate the diagnostic value of using common features of computed tomography (CT) imaging in COVID-19 disease, and to assess the relationship between blood oxygen saturation level and severity of CT findings. Materials and Methods: In this retrospective study, the chest CT of 173 test-confirmed COVID-19 patients have been evaluated to determine the patterns of involvement in multiple phases of illness. Then, the correlation between the severity of lung involvement and oxygen saturation levels has been assessed. Results: The chest CT results show that 87.6% of patients had GGO, which was the most common pattern in our findings. 83.8% of patients had bilateral lung involvement with the dominant multifocal and peripheral distribution. peribronchovascular involvement was also a common finding in our study (47.2 %). we found predominantly peribronchovascular view in 3 patients (1.7%), pleural effusion in 4 patients (2.3%), lymphadenopathy in 10 patients (5.8%), the tree in the bud in one patient (0.6%), and nodules in 4 patients (2.3%). We also found that GGO is the most common pattern during the early phase of the disease (97.4% of early phase cases). However, in the intermediate and late phases, consolidation and crazy paving patterns are more common. Moreover, our findings indicate that there is a significant relationship between oxygen saturation level and Total Severity Score, with the exclusion of the young adult patients (20-40 years). Conclusion: Relying on chest CT-scan findings apart from the oxygen saturation level is sufficient for the diagnosis and management of patients with COVID-19 pneumonia. Keywords: COVID-19, pneumonia, spiral CT, diagnosis, treatment, Real-Time RTPCR"

The Diagnostic Value of Lung Ultrasonography in Children Community-Acquired Pneumonia

To explore the diagnostic value of lung ultrasonography in children community-acquired pneumonia is the objective of the study. A total of 126 children who were diagnosed with community-acquired pneumonia and underwent lung ultrasonography examination during the course of the disease were selected. All patients underwent lung ultrasonography and chest X-ray examination within 24 h of admission. The clinical characteristics of lung ultrasonography examination of community-acquired pneumonia were analyzed and the sensitivity, specificity, correct index and diagnostic coincidence rate of lung consolidation with lung ultrasonography and chest X-ray were compared. The lung ultrasonography imaging features of severe community-acquired pneumonia in children are the disappearance of A-line, increase of B-line, waterfall sign, lung consolidation, bronchial inflation sign, pleural effusion, etc. 53 cases of patients chest computed tomography results were used as the gold standard. The sensitivity, correct index and diagnostic coincidence rate of lung ultrasonography in the diagnosis of lung consolidation were all higher than those of X-ray diagnosis and the differences were statistically significant (p<0.05). Lung ultrasonography determined abnormal changes in the lungs of 124 children and chest X-ray determined abnormal changes in the lungs of 122 children. The chest X-rays of 2 children showed normal, while the lung ultrasonography showed a large number of B-line and lung consolidation in both lungs. A total of 17 cases of pleural effusion were determined by lung ultrasonography and 1 case of pleural effusion was determined by chest X-ray. The difference between the two groups was statistically significant (p<0.05). Lung ultrasonography in children community-acquired pneumonia is superior to chest X-ray in lung consolidation and pleural effusion and can be used for diagnosis of children community-acquired pneumonia.

COVID-19 Pneumonia and Idiopathic Pulmonary Fibrosis: A Novel Combination.

Coronavirus disease 2019 (COVID-19) has become a game changer in many aspects of clinical practice. Acute exacerbations of idiopathic pulmonary fibrosis (IPF) are known as serious events, which can reach a mortality rate of 50%, where viral infections may play a role. We describe the case of a 64-year-old male patient with a diagnosis of IPF under antifibrotic treatment for 1 year; the patient tested positive for COVID-19 with polymerase chain reaction test of the nasopharyngeal swab, and his chest computed tomography results were compatible with COVID-19 pneumonia described in the literature as well as the findings compatible with interstitial lung disease. The patient was successfully treated in the pulmonology ward according to official guidelines about COVID-19 along with antifibrotic treatment and required only a short course of oxygen therapy. We experienced no drug interactions, serious side effects, or complications during treatment. The patient was discharged after 1 week, and he is still in a good condition after 3 weeks. COVID-19 pneumonia in a patient with IPF who survived under antifibrotic treatment without serious deterioration is a new experience. Such cases will probably change our perspective in treating patients with IPF.

Epidemiological and clinical characteristics analysis of 11 children with 2019 novel coronavirus infection in Chongqing: a single-center retrospective study.

BackgroundThe global epidemic of the 2019 novel coronavirus (2019-nCoV) is still going on. This article shares information about the infected children from a treatment center in Chongqing, China.MethodsA retrospective analysis of the epidemiology, clinical symptoms, signs, laboratory examinations, chest computed tomography results, treatment effect of 11 children infected by 2019-nCoV was performed. Children were diagnosed from January 25 to February 29, 2020 in Chongqing University Three Gorges Hospital.ResultsThe mean age of the 11 children with 2019-nCoV infection was 11 years and 5 months. Two cases (18%) were imported cases from Wuhan. The 9 cases (82%) were family cluster cases. There were 5 asymptomatic type cases (45%), 2 mild cases (18%), and 4 common type cases (37%). The most common symptom was fever (5 cases), cough (3 cases), sore throat (1 case) and diarrhea (1 case). There were abnormal chest CT changes in 6 cases, including 4 cases with patchy ground-glass opacities and 2 cases with thickened lung texture. Laboratory tests showed that procalcitonin increased in 4 cases (36%), and C-reactive protein (CRP) increased in 1 case (9%). In lymphocyte subgroup examination, lymphocyte count increased in 2 cases (18%) and decreased in 1 case (9%); T%, cluster of differentiation 8 (CD8)+ T%, and natural killer (NK) cell% were normal in 11 cases; CD4+ T% was increased in 2 cases (18%), and CD4+ T%/CD8+ T% was decreased in 1 case (9%); B% was increased in 1 case (9%). The interleukin 4 (IL-4), IL-10, and IL-17 in 11 cases were normal; IL-6 was increased in 7 cases (64%); tumor necrosis factor-alpha (TNF-α) was increased in 1 case (9%); and interferon gamma (IFN-γ) was increased in 6 cases (55%). All patients had been discharged from the hospital.ConclusionsChildren are generally susceptible to 2019-nCoV, and the main way of infection is close contact with an infected person in the family. Clinical symptoms are mild. Laboratory and chest CT examinations are not as typical as those of adults. The prognosis is generally good. The unique immune function of children may help fight the new coronavirus.

Novel dynein axonemal assembly factor 1 mutations identified using whole‑exome sequencing in patients with primary ciliary dyskinesia.

Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disorder caused by dysfunction of the cilia and flagella; however, causative genetic defects have not been detected in all patients with PCD. Seven Chinese Han patients with Kartagener syndrome were enrolled onto the present study. Transmission electron microscopy (TEM) was performed to evaluate the cilial defects and whole-exome sequencing was used to analyze relevant genetic variations in all patients. In two of the seven patients with PCD, four novel dynein axonemal assembly factor 1 (DNAAF1) mutations were identified (NM_178452.6:c.3G>A, c.124+1G>C, c.509delG and c.943A>T) in three alleles. Both of these patients had long-standing infertility. Their chest computed tomography results showed bronchiectasis, lung infections and situs inversus, and paranasal computed tomography revealed sinusitis. Semen analysis of the male patient showed poor sperm motility. TEM showed defects in the inner and outer dynein arms in both patients. The DNAAF1 sequences of family members were then analyzed. Bioinformatics analysis indicated that these mutations may be the cause of the cilial defects in these two probands. Thus, the present study identified novel PCD-causing mutations in DNAAF1 in two patients with PCD. These genetic variations were predicted to alter DNAAF1 amino acid residues and lead to loss of function, thereby inhibiting cilia-mediated motility. Accordingly, the two probands had PCD symptoms, and one of them died due to PCD-associated complications.

Epidemiological and initial clinical characteristics of patients with family aggregation of COVID-19

BackgroundSince December 2019, a new outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan (Hubei, China) and rapidly spread throughout China, however, confirmed cases are still increasing worldwide. ObjectivesTo investigate the epidemiological history and initial clinical characteristics of 10 patients with family aggregation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Western Chongqing, China. Study designTen patients positive for SARS-CoV-2 nucleic acid detection by real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR), were collected from The People's Hospital of Dazu District, Chongqing. Epidemiological data and laboratory and imaging results were collected on the first day of admission, and analyzed based on the Diagnosis and Treatment Guideline for COVID-19 (5th edition, China). ResultsOf the 10 cases, case A had a history of a temporary stay in Wuhan and transmitted the virus to the others through family gathering, living together, and sharing vehicles. The average age was 56.5 years (± 11.16), six patients were males, and the incubation period was 2–14 days. Dry cough was the main symptom, followed by fever and fatigue. Most patients were clinically classified as ordinary-type, with three cases being severe-type. Chest computed tomography results were nonspecific, mainly with ground-glass attenuation and/or shadow images. Extensive lesion distribution was seen in severe cases. CD4+ lymphocyte counts were 61, 180, and 348 cells/uL in severe-type patients, respectively. Notably, viral nucleic acid values in nasopharyngeal swabs were lower (19, 25, and 26) than those of ordinary-type patients, suggesting a higher viral load. Neutrophil-lymphocyte ratio (NLR) was also higher in severe-type patients ConclusionsInitial examination results of lower CD4+ lymphocyte counts and RT-PCR-CT values coupled with higher NLR may indicate the severity of COVID-19 infection for these family clusters.

Impact of Model-Based Iterative Reconstruction on the Correlation between Computed Tomography Quantification of a Low Lung Attenuation Area and Airway Measurements and Pulmonary Function Test Results in Normal Subjects.

ObjectiveTo compare correlations between pulmonary function test (PFT) results and different reconstruction algorithms and to suggest the optimal reconstruction protocol for computed tomography (CT) quantification of low lung attenuation areas and airways in healthy individuals.Materials and MethodsA total of 259 subjects with normal PFT and chest CT results were included. CT scans were reconstructed using filtered back projection, hybrid-iterative reconstruction, and model–based IR (MIR). For quantitative analysis, the emphysema index (EI) and wall area percentage (WA%) were determined. Subgroup analysis according to smoking history was also performed.ResultsThe EIs of all the reconstruction algorithms correlated significantly with the forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) (all p < 0.001). The EI of MIR showed the strongest correlation with FEV1/FVC (r = −0.437). WA% showed a significant correlation with FEV1 in all the reconstruction algorithms (all p < 0.05) correlated significantly with FEV1/FVC for MIR only (p < 0.001). The WA% of MIR showed the strongest correlations with FEV1 (r = −0.205) and FEV1/FVC (r = −0.250). In subgroup analysis, the EI of MIR had the strongest correlation with PFT in both ever-smoker and never-smoker subgroups, although there was no significant difference in the EI between the reconstruction algorithms. WA% of MIR showed a significantly thinner airway thickness than the other algorithms (49.7 ± 7.6 in ever-smokers and 49.5 ± 7.5 in never-smokers, all p < 0.001), and also showed the strongest correlation with PFT in both ever-smoker and never-smoker subgroups.ConclusionCT quantification of low lung attenuation areas and airways by means of MIR showed the strongest correlation with PFT results among the algorithms used, in normal subjects.

Lung Abscess due to Clostridium baratii Infection in a Patient with Invasive Pulmonary Aspergillosis

Clostridial pleuropulmonary infections are rare; most of these infections are attributed to Clostridium perfringens (1), and none involving C. baratii have been reported. We describe here a fatal case of C. baratii lung abscess superimposed on invasive pulmonary aspergillosis. A 47-year-old man was diagnosed with myelodysplastic syndrome with refractory anemia and excess blasts in December 2005. The disease course was complicated by disseminated Mycobacterium avium complex infection and invasive pulmonary aspergillosis. The patient underwent allogeneic hematopoietic stem cell transplantation in May 2006. One year later, he was admitted for leukemia relapse associated with febrile neutropenia. Chest radiography and computed tomography (CT) displayed multiple small opacities on the right upper and lower and left upper lung fields. Compared with chest CT results seen 1 year before, only the lesion on the left upper lung had increased in size (Fig. ​(Fig.1A).1A). Low-grade fever persisted despite treatment with imipenem and voriconazole. Serum Aspergillus antigen results (Platelia Aspergillus enzyme immunoassay; Bio-Rad Laboratories) were negative. The lesion on the left lung progressed rapidly within 1 month (Fig. ​(Fig.1B).1B). Follow-up chest CT results showed an abscess with a thick wall (Fig. 1C and D). In August 2007, the patient was admitted to an intensive care unit (ICU) because of acute respiratory failure. A sonography-guided transthoracic lung biopsy was performed on the second ICU day. Pathology examination of the lung biopsy sample disclosed narrow, dichotomous, and septated hyphae compatible with Aspergillus spp. Cultures of the lung biopsy sample and aspirates of the lung abscess as well as blood cultures all yielded C. baratii that was susceptible to penicillin, chloramphenicol, metronidazole, and cefmetazole but was resistant to clindamycin by a disk diffusion test. The patient's hemodynamics deteriorated, and the patient died of multiple organ failure on the twelfth ICU day. FIG. 1. (A) CT scan of the chest on admission, showing a small faint patch at the left upper lung field (LULF) and old fibrotic changes at the right upper lung field. (B to D) Follow-up chest radiography 1 month later disclosed a mass lesion at the LULF (B), ... The genus Clostridium has more than 150 species, but fewer than 20 are associated with human diseases (5, 7). Members of the genus are mainly natural inhabitants of the human intestinal tract, and their disease spectra in humans are broad (7). C. baratii has attracted limited attention because of its lack of overt pathogenesis and failure to produce lethal toxin. Its most striking clinical feature is its neurotoxogenesis, type F botulism in infants (4) and in adults (3, 4). However, C. baratii pulmonary infection in adults has never been previously reported in the literature. We speculate that the development of a lung abscess caused by C. baratii in this case may be closely related to the patient's leukemia relapse with persistent neutropenia and invasive pulmonary aspergillosis. The hyphae of Aspergillus species tend to invade blood vessels, which in turn leads to local thrombosis and tissue infarction (2, 6). Simultaneously, clostridial bacteremia originating from the disruption of the gastrointestinal mucosa results in seeding into the lung, with subsequent formation of lung abscess. The infection is refractory to antimicrobials in the face of tissue infarction despite the use of antimicrobial agents with in vitro activity against C. barati. In conclusion, among high-risk hosts, the rapid progression of fungal pneumonia into lung abscesses may suggest the presence of a superimposed infection due to an anaerobic bacterial species such as C. barati.

Cystic adenomatoid malformation in children: CT histopathological correlation

This study was performed to assess the accuracy of computed tomography (CT) in classifying the various types of cystic adenomatoid malformation (CAM) of the lung, as described by Stocker et al., taking histopathology as the gold standard. We retrospectively reviewed six cases of histologically proven CAM. Chest radiography, chest CT and histopathology results were available for all patients. The CT images were reviewed blinded to the histological findings, and attention was paid to the number and size of cysts so as to classify the lesions into the three groups described by Stocker et al. The classification of lesions based on the CT images was then correlated to the histopathological findings. Areas with small-sized cysts (<2 cm) were detected by CT in two patients (33.3%), areas with large cysts (>2 cm) were seen in three cases (50%) whereas in the remaining case, the diagnosis was mixed type I and type II CAM. In one patient with type I CAM, an area of low-density consolidation around the cysts was interpreted as CAM in a context of pulmonary sequestration. The CT classification based on Stocker et al.'s categories was in agreement with the histopathological findings in four cases, whereas in the remaining two cases, the lesions were classed as type I or II on CT and as mixed (type I and II) lesions at histopathology. In one case, the CT classification was correct, but the histopathology revealed the coexistence of pulmonary sequestration. In our study, there was concordance between CT and histopathology in 66.7% of cases, whereas in 33.3% histopathology revealed areas with mixed grade lesions. CT proved to be accurate in identifying and characterising CAM and provided important information on lesion site and extension.