Chest CT Changes Research Articles

Escalated complement activation during hospitalization is associated with higher risk of 60-day mortality in SARS-CoV-2-infected patients.

The complement system, an upstream recognition system of innate immunity, is activated upon SARS-CoV-2 infection. To gain a deeper understanding of the extent and duration of this activation, we investigated complement activation profiles during the acute phase of COVID-19, its persistence post-recovery and dynamic changes in relation to disease severity. Serial blood samples were obtained from two cohorts of hospitalized COVID-19 patients (n=457). Systemic complement activation products reflecting classical/lectin (C4d), alternative (C3bBbP), common (C3bc) and terminal pathway (TCC and C5a) were measured during hospitalization (admission, days 3-5 and days 7-10), at 3 months and after 1 year. Levels of activation and temporal profiles during hospitalization were related to disease severity defined as respiratory failure (PO2/FiO2 ratio <26.6kPa) and/or admission to intensive care unit, 60-day total mortality and pulmonary pathology after 3 months. During hospitalization, TCC, C4d, C3bc, C3bBbP and C5a were significantly elevated compared to healthy controls. Severely ill patients had significantly higher levels of TCC and C4d (p<0.001), compared to patients with moderate COVID-19. Escalated levels of TCC and C4d during hospitalization were associated with a higher risk of 60-day mortality (p<0.001), and C4d levels were additionally associated with chest CT changes at 3 months (p<0.001). At 3 months and 1 year, we observed consistently elevated levels of most complement activation products compared to controls. Hospitalized COVID-19 patients display prominent and long-lasting systemic complement activation. Optimal targeting of the system may be achieved through enhanced risk stratification and closer monitoring of in-hospital changes of complement activation products.

Effect of azithromycin sequential therapy combined with budesonide nebulization on chest CT changes in children with mycoplasma pneumonia.

Effect of azithromycin sequential therapy combined with budesonide nebulization on chest CT changes in children with mycoplasma pneumonia.

Federated Learning Approach with Pre-Trained Deep Learning Models for COVID-19 Detection from Unsegmented CT images.

(1) Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Reverse transcription polymerase chain reaction (RT-PCR) remains the current gold standard for detecting SARS-CoV-2 infections in nasopharyngeal swabs. In Romania, the first reported patient to have contracted COVID-19 was officially declared on 26 February 2020. (2) Methods: This study proposes a federated learning approach with pre-trained deep learning models for COVID-19 detection. Three clients were locally deployed with their own dataset. The goal of the clients was to collaborate in order to obtain a global model without sharing samples from the dataset. The algorithm we developed was connected to our internal picture archiving and communication system and, after running backwards, it encountered chest CT changes suggestive for COVID-19 in a patient investigated in our medical imaging department on the 28 January 2020. (4) Conclusions: Based on our results, we recommend using an automated AI-assisted software in order to detect COVID-19 based on the lung imaging changes as an adjuvant diagnostic method to the current gold standard (RT-PCR) in order to greatly enhance the management of these patients and also limit the spread of the disease, not only to the general population but also to healthcare professionals.

Influence of Fasting Plasma Glucose Level on Admission of COVID-19 Patients: A Retrospective Study.

Background The coronavirus disease 2019 (COVID-19) is a serious global health threat and has spread dramatically worldwide. Prolonged viral shedding is associated with a more severe disease course and inflammatory reaction. Blood glucose levels were significantly associated with an increased hazard ratio (HR) for poor outcomes in COVID-19 patients. Objective Previous studies focused primarily on the relationship between blood glucose and mortality or severe outcomes, but there were few research studies on the relationship between fasting plasma glucose (FPG) and duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA positive status. To explore the relationship between FPG levels and prolonged duration of SARS-CoV-2 viral positivity, the clinical data of COVID-19 patients were analyzed. Method In this retrospective study, 99 cases of COVID-19 patients in Beijing Ditan Hospital were recruited, and their clinical and laboratory findings at admission were collected and analyzed. Furthermore, the risk factors for prolonged duration of SARS-CoV-2 RNA shedding were identified, and the relationship between FPG levels and the prolonged presence of SARS-CoV-2 RNA was evaluated. Result We found that elevated FPG levels were correlated with longer duration of SARS-CoV-2 RNA positivity, classification of COVID-19, imaging changes of chest CT, inflammation-related biomarkers, and CD8+ T cell number in COVID-19 patients. In a logistic regression model, after adjusting for gender and age, COVID-19 patients with elevated FPG were more likely to had longer duration of SARS-CoV-2 RNA positivity than those with normal FPG levels (OR 3.053 [95% CI 1.343, 6.936]). Conclusion Higher FPG levels (≥6.1 mmol/l) at admission was an independent predictor for prolonged SARS-CoV-2 shedding, regardless of a known history of diabetes. It suggests that intensive monitoring and control of blood glucose are important for all COVID-19 patients.

Clinical Characteristics of Pediatric Cases of COVID-19 in Hunan, China: A Retrospective, Multi-Center Case Series.

Objective: Aimed to investigate the epidemiological characteristics, clinical features, treatment, and short-term prognosis of COVID-19 in children.Methods: Retrospective analysis was conducted in 48 children with COVID-19 admitted to 12 hospitals in eight cities in Hunan province, China, from January 26, 2020 to June 30, 2020.Results: Of the 48 cases, Familial clusters were confirmed for 46 children (96%). 16 (33%) were imported from other provinces. There were 11 (23%) asymptomatic cases. only 2 cases (4%) were severe. The most common symptom was fever (n = 20, 42%). Other symptoms included cough (n = 19, 40%), fatigue (n = 8, 17%), and diarrhea (n = 5, 10%). In the early stage, the total peripheral blood leukocytes count increased in 3(6%) cases and the lymphocytes count decreased in 5 (10%) cases. C-reactive protein and procalcitonin were elevated respectively in 3 (6%) cases and 2 (4%) cases. There were abnormal chest CT changes in 22 (46%) children, including 15 (68%) with patchy ground glass opacity, 5 (22%) with consolidation, and 2 (10%) with mixed shadowing. In addition to supportive treatment, antiviral therapy was received by 41 (85%) children, 11 (23%) patients were treated with antibiotics, and 2 (4%) were treated with methylprednisolone and intravenous immunoglobulin. Compared to 2 weeks follow-up, one child developed low fever and headache during the 4 weeks follow-up, 3 (6%) children had runny noses, one of them got mild cough, and 4 (12%) children had elevated white blood cells and lymphocytes. However, LDH and CK increased at 2 weeks and 4 weeks follow-up. 2 weeks follow-up identified normal chest radiographs in 33 (69%) pediatric patients. RT-PCR detection of SARS-CoV-2 was negative in all follow-up patients at 2 and 4 weeks follow-up. All 48 pediatric patients were visited by calling after 1 year of discharge.Conclusions: Most cases of COVID-19 in children in Hunan province were asymptomatic, mild, or moderate. Close family contact was the main route of infection. It appeared that the younger the patient, the less obvious their symptoms. Epidemiological history, nucleic acid test, and chest imaging were important tools for diagnosis in children.

Chest CT Features from 58 Patients with COVID-19 Pneumonia from the Perspective of ACE2.

Chest CT is important for the diagnosis of Corona Virus Disease 2019, which is caused by SARS-CoV-2 via the receptor angiotensin-converting enzyme 2. This study aimed to present special chest CT changes in the detection and management of COVID-19. From February 20 to March 6, 2020, clinical data and chest CT of patients with COVID-19 being treated by the Hubei Medical Team were retrospectively analyzed with a time-interval of 2 weeks. In addition, the expressions of ACE2 in different parts of the respiratory system were detected by immunohistochemical staining to explain the special chest CT features of COVID-19 by ACE2 expression. Of 58 patients, the main respiratory manifestations were fever and cough. Spherical or patchy GGO was the initial CT manifestation of COVID-19 pneumonia. CT findings manifested as rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities (GGO) that progressed to or co-existed with consolidations in chest CT scans. Lung consolidation increased as the disease progressed, accounting for 63.2%, 76.3%, and 87.5% in group 1 (disease course with 0 - 2 weeks), group 2 (2 - 4 weeks), and group 3 (> 4 weeks). Fibrous lesions (72.3%), high density vascular shadow (69.2%), reticular pattern (63.1%), and subpleural parallel sign (61.5%) were common signs of chest CT of COVID-19. IHC results showed that ACE2-expression in the pulmonary alveoli was significantly higher than that in the bronchial mucosa and pleura (p < 0.001). The special change of CT features in the lung of COVID-19 pneumonia patients have a connection with ACE2 expression patterns in the respiratory system.

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.

Pre- and post-treatment chest CT changes in a patient with COVID-19

Pre- and post-treatment chest CT changes in a patient with COVID-19

Pre- and post-treatment chest CT changes in a patient with COVID-19

Pre- and post-treatment chest CT changes in a patient with COVID-19

Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China

Objective: To analyze the epidemiological history, clinical manifestations, treatment and the short-term prognosis of 31 cases of 2019 novel coronavirus (2019-nCoV) infection in children from six provinces (autonomous region) in northern China. Methods: A retrospective analysis of the epidemiological history, clinical symptoms, signs, laboratory examinations, chest imaging, treatment and the short-term prognosis of 31 cases of 2019-nCoV was conducted. The patients were diagnosed between January 25th, 2020 and February 21st, 2020 in 21 hospitals in 17 cities of six provinces (autonomous region) of Shaanxi, Gansu, Ningxia, Hebei, Henan and Shandong. Results: The age of the 31 children with 2019-nCoV infection was 7 years and 1 month (6 months-17 years). Nine cases (29%) were imported cases. Other 21 cases (68%) had contact with confirmed infected adults. One case (3%) had contact with asymptomatic returnees from Wuhan. Among the 31 children, 28 patients (90%) were family cluster cases. The clinical types were asymptomatic type in 4 cases (13%), mild type in 13 cases (42%), and common type in 14 cases (45%). No severe or critical type existed. The most common symptom was fever (n=20, 65%), including 1 case of high fever, 9 cases of moderate fever, 10 cases of low fever. Fever lasted from 1 day to 9 days. The fever of fifteen cases lasted for ≤3 d, while in other 5 cases lasted >3 d. Other symptoms included cough (n=14, 45%), fatigue (n=3, 10%) and diarrhea (n=3, 10%). Pharyngalgia, runny nose, dizziness, headache and vomiting were rare. In the early stage, the total leukocytes count in peripheral blood decreased in 2 cases (6%), the lymphocytes count decreased in 2 cases (6%), and the platelet count increased in 2 cases (6%).Elevation of C-reactive protein (10%, 3/30), erythrocyte sedimentation rate (19%, 4/21), procalcitonin (4%,1/28), liver enzyme (22%, 6/27) and muscle enzyme (15%, 4/27) occurred in different proportions. Renal function and blood glucose were normal. There were abnormal chest CT changes in 14 cases, including 9 cases with patchy ground glass opacities and nodules, mostly located in the lower lobe of both lungs near the pleural area. After receiving supportive treatment, the viral nucleic acid turned negative in 25 cases within 7-23 days. Among them, 24 children (77%) recovered and were discharged from hospital. No death occurred. Conclusions: In this case series, 2019-nCoV infection in children from six provinces (autonomous region) in northern China are mainly caused by close family contact. Clinical types are asymptomatic, mild and common types. Clinical manifestations and laboratory examination results are nonspecific. Close contact history of epidemiology, nucleic acid detection and chest imaging are important bases for diagnosis of 2019-nCoV infection. After general treatment, the short-term prognosis is good.

Correlation between pulmonary function and chest CT changes in children with refractory mycoplasma pneumonia

目的 探讨难治性肺炎支原体肺炎的儿童，其肺通气功能与胸部CT改变类型的相关性。 方法 收集2014年1月至2017年12月在我院儿科住院的患有难治性肺炎支原体肺炎的患儿90例。对于大于5周岁以上的60例患儿评估其常规肺通气功能指标的差异，对于5周岁以下的30例患儿评估潮气呼吸指标的差异。根据胸部CT的检查结果，将患儿分为磨玻璃样改变组(磨玻璃样改变组)、肺实变患儿(实变组)、斑片影改变的患儿(斑片组)。 结果 对于大于5周岁的60例患儿中，CT的检查结果提示磨玻璃样改变组有14例，实变组有26例，斑片组有20例。磨玻璃样改变组、实变组以及斑片组患儿常规肺功能的FVC占预计值分别为(65.23±12.41)%、(75.86±19.08)%和(88.29±19.41)%，FEV1占预计值分别为(63.05±13.21)%、(69.02±19.46)%和(88.54±19.52)%，FEV1/FVC分别为(93.49±11.28)%、(86.55±14.13)%和(97.20±13.01)%，PEF占预计值分别为(52.31±16.25)%、(57.12±15.03)%和(64.30±18.64)%，MMEF25～75分别为(52.41±21.29)%、(43.90±23.10)%和(70.58±26.87)%，上述组间数据之间的差异具有统计学的意义(P<0.05)。对于5周岁以下的30例患儿中，CT的检查结果提示磨玻璃样改变组有8例，实变组有9例，斑片组有13例。磨玻璃样改变组、实变组以及斑片组患儿的潮气呼吸肺功能的TPTEF/TE分别为%(23.16±7.69)、(25.12±8.42)%和(27.56±8.63)%，VPEF/VE分别为(27.59±5.13)%、(29.63±5.68)%和(31.42±6.21)%，Ti/Te分别为(0.76±0.13)、(0.71±0.15)和(0.79±0.21)，VT分别为(12.10±2.34)ml/kg、(12.25±2.63)ml/kg和(13.52±2.61)ml/kg。上述组间数据之间的差异具有统计学的意义(P<0.05)。 结论 难治性肺炎支原体肺炎患儿不同的胸部CT改变与肺功能之间的改变有着多样性以及特异性，胸部CT显示磨玻璃样改变的患儿多存在限制性及阻塞性通气功能的障碍，肺实变的患儿多数存在大小气道阻塞的障碍，斑片样改变的患儿仅存在轻度大气道阻塞性病变。

Effect of hospital follow-up nursing on disease control and life quality of pulmonary tuberculosis patients

Objective To explore the application effect of hospital follow- up nursing of pulmonary tuberculosis patients. Methods A total of 100 cases of pulmonary tuberculosis patients were randomly divided into the observation group and the control group, the control group was only given guidance in hospital, the observation group was given followed- up nursing based on the control group, two groups were compared with compliance, disease control and quality life. Results After 3 months, the compliance of medication, diet, exercise, regular inspection in the observation were higher than those in the control group, the sputum negative conversion rate was higher than that in the control group, chest CT changes was better than that in the control group, with statistically significant(P<0.05). Life quality in the aspect of role limitations, bodily pain, general health, vitality in the observation group were higher than those in the control group, with statistically significant(P< 0.05). Conclusions Hospital follow- up nursing can improve the compliance behavior of pulmonary tuberculosis patients. It is conducive to the control the disease and improves the life quality of patients. Key words: Hospital follow-up nursing; Pulmonary tuberculosis; Disease control; Life quality

Potential risk of TNF inhibitors on the progression of interstitial lung disease in patients with rheumatoid arthritis

ObjectivesBiological therapy represents important advances in alleviating rheumatoid arthritis (RA), but the effect on interstitial lung disease (ILD) has been controversial. The objective of this study was to assess the...

The relationship between chest CT findings and viral load in patients with novel influenza A (H1N1)

To evaluate the value of chest CT findings and dynamic changes of viral load in patients with novel influenza A (H1N1) infection in clinical diagnosis, differential diagnosis and treatment. Fifty-one patients with confirmed novel influenza A (H1N1) according to the diagnostic criteria of the Ministry of Health, received chest X-ray, CT scans (HRCT) and viral load tests in our hospital from May to December of 2009. Based on whether there were signs of pneumonia in CT imaging, the patients were divided into a pneumonia group (n = 31) and a non-pneumonia group (n = 20). The relationship between chest CT changes and viral load was observed and analyzed statistically using SPSS 10.5 software. Patchy consolidations of lungs were the main findings in pneumonia group with influenza A (H1N1) infection, and ground-glass opacities were the main CT findings at acute and convalescent phases. Lobular and segmental shadows of the lungs were diffusely distributed, mostly found in lower lungs, especially the left lung. In some cases, the lung diseases were accompanied with mediastinal lymphadenopathy. Co-existence of pulmonary parenchymal, interstitial and pleural diseases was observed. Peak viral load occurred at the early phase of illness, with the mean initial viral load being 7.7 copies/ml and 4.2 copies/ml in the pneumonia and the non-pneumonia groups respectively. The viral nucleic acid became negative 4 days after antiviral treatment (course of 6 days). Dynamic observation of 3 patients with novel influenza A (H1N1) pneumonia showed that, the viral clearance period preceded the absorption of lung lesions in 2 cases, but viral clearance period of a young patient was significantly prolonged. In patients with the novel influenza A (H1N1) infection, the viral load in the pneumonia group was significantly higher than that in the group with normal chest imaging. Dynamic observation on chest imaging and viral load may be beneficial for clinicians to start prompt and effective treatment.