Computed Tomography Scan Score Research Articles

Early Predictive Value of Laboratory Inflammatory Markers in Evaluating Both Lung Involvement and Progression in Hospitalized Patients With COVID-19

Background The new coronavirus known as SARS-CoV-2, first discovered in Wuhan, China, in December 2019, rapidly spread over the globe. It has created many challenges for the world's health and treatment systems. Due to the outspread of this virus and the limited treatment facilities, one of the important issues is the early diagnosis of patients who may continue to suffer from a severe type of disease. This study aims to determine the relationship between hospitalized COVID-19 patients' computed tomography (CT) scan results and laboratory results such as neutrophil-to-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). Methods We created this retrospective study to investigate the relationship between the CT scan results of COVID-19 patients and laboratory results such as NLR and PLR ratios. We randomly sampled individuals whose hospitalization records from Shahada Kargar Hospital in Yazd in 2021 showed a positive COVID-19 test diagnosis. Results During this investigation, 17% of patients were hospitalized in the intensive care unit, and around 7% of patients passed away. These prognostic values have had a significant relationship with the mean NLR and (P = 0.004). In addition, this NLR laboratory index indicated a considerable positive correlation coefficient with the CT scan score (P = 0.014). Conclusions Our results reflect the significant predictive ability of NLR and PLR ratios regarding the prognosis of hospitalized patients with COVID-19. Imaging findings use the CT scan score as an indicator to predict the amount of NLR. In this way, the results of preliminary laboratory tests and imaging can determine the affected patient's progress to a large extent.

NCOG-48. CT SCAN COMPOSITE SCORE CAN IDENTIFY GLIOBLASTOMA PATIENTS WITH WORSE OUTCOMES

Abstract OBJECTIVE Obesity is a risk factor for many cancer types including glioblastoma multiforme (GBM). We used CT body composition analyses to construct a sex-specific composite score that would optimally predict overall survival in GBM. METHODS Using a retrospective institutional cohort, we performed single slice (L3) and volumetric (L1-L5) automated body segmentation analyses on abdominal and pelvic computed tomography (CT) scans performed within 1 month of diagnosis of GBM. Multivariable Cox proportional hazards models were then used to identify variables that were independently associated with GBM overall survival. Lastly, a learning-tree algorithm was implemented to identify the relative importance of body composition metrics using a XGBoost-powered learning model. These weights were used to create sex-specific composite CT scan scores of protective and predisposing factor with relation to GBM survival. A log-rank pairwise t-test was used to compared GBM survival across patient groups stratified based on these CT composite scores. RESULTS Higher relative inter/intramuscular adipose tissue volume (HR(95%CI):1.9(1.01-3.06), p=0.02), visceral adipose tissue volume (HR(95%CI):2.1(1.04-4.1), p=0.04) and aortic calcification volume (HR(95%CI):2.6(1.2-5.5), p<0.001) were associated with lower GBM overall survival, while higher subcutaneous adipose tissue volume (HR(95%CI):0.4(0.2-0.8), p=0.02), iliopsoas muscle volume (HR(95%CI):0.4(0.2-0.9), p<0.001), and trabecular bone density (HR(95%CI):0.4(0.1-0.8), p=0.003) were predictive of higher GBM OS (p-value of all tests <0.05). Using quartiles of the CT scan composite predisposing and protective scores, we were able to stratify male and female participants with significantly different outcomes with regards to GBM OS (Figure). Male and female participants with higher burden of predisposing factors had significantly lower chances of survival compared to those with lower cumulative burden of these factors (Figure, p-value Q4 vs. Q1 males< 0.01 and 0.001 in females) CONCLUSION Using automated body segmentation analysis we optimized a CT scan composite score that was able to stratify GBM patients with worse overall survival.

Elexacaftor-Tezacaftor-Ivacaftor Therapy for Chronic Sinus Disease in Cystic Fibrosis

Cystic fibrosis (CF) is a multiorgan genetic disease with progressive upper and lower airway involvement. The effects of CF transmembrane conductance regulator (CFTR) modifier therapies on CF-related upper airway disease, specifically chronic rhinosinusitis (CRS), are not characterized. To determine the outcome of elexacaftor-tezacaftor-ivacaftor (ETI) on CRS as measured by changes in sinus computed tomography (CT) metrics and on clinical parameters in individuals with CF. This prospective longitudinal cohort study was conducted at the CF center of a tertiary care hospital between October 1, 2019, and July 31, 2021. A total of 64 participants with CF were included in the analysis. Sinus CT was obtained within 1 month of initiation of ETI therapy (baseline), and within 1 month of 1 year of ETI therapy. Images were independently analyzed by pulmonology, radiology, and otolaryngology physicians, using the Lund-Mackay and Sheikh-Lind scoring systems. Percent predicted forced expiratory volume in 1 second (ppFEV1), body mass index (BMI), and microbiologic data collected at initiation of ETI therapy and 3-month intervals for 1 year were also measured. The study hypothesis was that ETI therapy will improve CRS as measured by changes in sinus CT at initiation and 1 year after ETI therapy and clinical parameters in individuals with CF. Among the 64 participants (39 [60.9%] female; median age, 18.5 [IQR, 16.0-28.5] years; 64 [100%] White), improvement in CRS was noted by improvements in sinus CT scans using both sinus CT scoring systems after 1 year of ETI therapy. The reduction in the median total score using the Lund-Mackay sinus CT scoring system (from 5.8 [IQR, 5.0-7.0] to 3.3 [IQR, 2.6-4.2]) and the Sheikh-Lind scoring system (from 3.8 [IQR, 3.0-5.0] to 2.2 [IQR, 2.0-2.5]) was noted. Increases in ppFEV1 and BMI were also observed by 3 months of ETI therapy with persistent improvement through 1 year of treatment. Similarly, after 1 year of ETI therapy, participants with CF had reductions in positivity for Pseudomonas aeruginosa and Staphylococcus aureus in oropharyngeal cultures. This cohort study found that use of ETI therapy was associated with improved CRS outcomes in participants with CF as quantified by improved sinus CT scans measured by 2 radiographic scoring systems and was also associated with improved clinical outcomes. Despite improvement in CT scan scores, most people with CF continue to have scores that indicate severe sinus disease.

Sino-nasal outcome Test-22 and Lund-Mackay CT score to select endoscopic sinus surgery in chronic rhinosinusitis.

Chronic rhinosinusitis is one of the common diseases that cause morbidity and affects a person's quality of life. We tried to provide a more appropriate and effective approach to selecting patients for endoscopic sinus surgery. The study population is chronic rhinosinusitis children referred to the ear, nose, and throat clinic of two general hospitalsin Tehran, Iran, who have previously undergone sufficient drug treatment and have not recovered. The Lund-Mackay score is calculated by examining the computed tomography (CT) scan. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was provided to the patients before the operation, after the operation, and 3 and 6months later in the clinic. Before the operation, the most SNOT-22 score people were in the range of 40-59 points. The SNOT-22 score before the operation is significantly different from 3 and 6 months after the operation. The highest frequency of Lund-Mackay CT (LMCT) scan score was in the range of 18-23 points. The LMCT scan score did not show any significant relationship with the SNOT-22 score before surgery, 3 months, and 6 months after surgery. Sensitivity to aspirin had a significant relationship with SNOT-22 scores and the history of asthma and nasal polyps had a significant relationship with the preoperative LMCT scan score. The LMCT scan scoring system cannot be a good measure of chronic rhinosinusitis severity or the prognosis of patients after surgery. The SNOT-22 questionnaire can be used as a predictive tool to help the doctor and the patient in deciding to operate and the possibility of obtaining a relative recovery.

Wavelet Decomposition and Feedforward Neural Network for Classification of Acute Ischemic Stroke based on Electroencephalography

Stroke is one of the leading causes of death in Indonesia. From 2013 to 2018, the prevalence of stroke increased from 7% to 10.9%. There are two types of strokes, namely Hemorrhagic and Acutte Ischemic Stroke (AIS) with the majority of it being AIS. Early detection and diagnosis are essential in stroke as it is a life-threatening disease, and the stroke treatment is based on its type. Currently, the gold imaging standards in stroke diagnosis are Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI). However, the mentioned services for stroke diagnosis are primarily available in hospitals classified as “class A” (general hospitals with extensive facilities and medical services). Compared to CT scans and MRI, electroencephalography (EEG) is a cost-friendly, non-invasive device studied for various brain-related diseases. This study aimed to determine the optimal epoch length to classify four stroke classes (healthy, minor, moderate, and severe) during resting condition for a machine learning-based AIS computer-aided diagnostics system. 32-channel EEG, CT scan, and NIHSS Scores were the obtained data. The features were delta-theta to alpha-beta ratio (DTABR), delta to alpha ratio (DAR), relative power ratio (RPR), and asymmetry, which were extracted using wavelet decomposition technique. The epoch length was varied by 1s, 2s, 10s, 30s, 60s, and 120s. The severity of stroke were classified using a feedforward neural network. The best performance was obtained at the 60-second epoch length with 89% accuracy using 15 hidden layers. This EEG-based diagnostic system would be expected to be implemented in “class C” hospitals, where only essential medical services and facilities are available, usually in rural areas.

Correlation of Abdominal CT scan Score and Alpha-fetoprotein Levels in Hepatocellular Carcinoma

Objective: To assess the correlation between the Alpha-fetoprotein (AFP) level and characteristics of liver lesions listed in the abdominal computed tomography (CT) scan scores in hepatocellular carcinoma.Methods: This was a retrospective analytic observational study with a cross-sectional design conducted at Sanglah Hospital in January 2017–January 2021. Subjects were patients diagnosed with hepatocellular carcinoma based on clinical and laboratory features. Samples were taken by consecutive sampling. The results of the abdominal CT scan were read by two radiologists with a predetermined abdominal CT scan scoring system. The AFP level data were taken at a maximum of 5 days before an abdominal CT scan was performed.Results: A total of 64 subjects were included in this study. The mean serum AFP level was 1,000 IU/mL (range 0.54–61830 IU/mL). The mean abdominal CT scan score by examiner one was 10.093±5.59, while the examiner two provided a score of 10.281±5.45. The difference in mean CT scan scores between the two examiners was very low and insignificant (mean difference score -0.188; 95% CI -1.894–1.519). The rho Spearman value was 0.918 (p<0.001) between serum AFP levels and abdominal CT scan scores. In the partial correlation, the value of r=0.678 (p<0.001) was obtained after controlling for body mass index (BMI), age, and sex variables.Conclusions: There is a strong positive correlation between serum AFP levels and abdominal CT scan scores in hepatocellular carcinoma patients. Further research is needed with a prospective design to reduce research bias.

The relationship between computed tomography appearance of pulmonary tuberculosis and blood glucose levels in 763 diabetes mellitus patients with pulmonary tuberculosis: a comparative study

IntroductionGlucose tolerance is often impaired in pulmonary tuberculosis (TB) patients. We aimed to explore the relationship between computed tomography (CT) findings of TB and blood glucose levels in diabetes mellitus (DM) patients.Methods763 diabetes mellitus patients with pulmonary tuberculosis (DMTB) from March 2015 to March 2018 were selected and their clinical data were retrospectively evaluated. CT appearance of DMTB was reviewed and compared according to blood glucose levels and CT scores. TB scores were calculated according to the combination of typical and atypical CT appearance. The relationship between blood glucose levels and CT scores was analyzed via Pearson correlation coefficient.ResultsTB lesions mainly occurred in the left lung and the lower lobes in the DMTB patients. Nodules and cavities are the main typical complications in these DMTB patients, and especially the number and size of cavities predominantly contribute to CT scan scores. The size of cavities (diameters (cm), median (95% CI of median)) was 0.72 (0.66–0.77), 1.20 (1.09–1.28), and 3.45 (2.92–3.94) from the low-, middle- and high-CT-score groups, respectively. The patients with high CT scores had a higher level of fasting plasma glucose (mean 13.48 mM, 95% CI of median 12.56–14.44 mM) than the patients in the low-CT-score (mean 8.73 mM, 95% CI of median 8.49–9.36 mM) and middle-CT-score groups (mean 10.16 mM, 95% CI of median 9.89–10.49 mM) (P < 0.0001). CT scores have a consistent relationship with the levels of blood glucose (rho = 0.60, P < 0.0001).ConclusionsCT appearance stands for the severity of tuberculosis and is closely associated with blood glucose levels in diabetic TB patients.

Risk Factors for the Mortality in Hospitalized Patients with COVID-19: A Brief Report.

The cumulative rate of death of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has necessitated better recognizing the risk factors of the disease and the COVID-19-induced mortality. This cross-sectional study aimed to determine the potential risk factors that predict COVID-19-related mortality concentrating on the initial recorded laboratory tests. We extracted admission’s medical records of a total of 136 deaths related to COVID-19 and 272 discharged adult inpatients (≥18 years old) related to four referral centers from February 24th to April 12th, 2020, in Isfahan, Iran, to figure out the relationship between the laboratory findings and mortality beyond demographic and clinical findings. We applied the independent sample t test and a chichi square test with SPSS software to compare the differences between the survivor and non-survivor patients. A P value of less than 0.05 was considered significant. Our results showed that greater length of hospitalization (P≤0.001), pre-existing chronic obstructive pulmonary disease (P≤0.001), high pulse rate, hypoxia (P≤0.001), and high computed tomography scan score (P<0.001), in addition to high values of some laboratory parameters, increase the risk of mortality. Moreover, high neutrophil/lymphocyte ratio (OR, 1.890; 95% CI, 1.074-3.325, P=0.027), increased creatinine levels (OR, 15.488; 95% CI, 0.801-299.479, P=0.07), and elevated potassium levels (OR, 13.400; 95% CI, 1.084-165.618, P=0.043) independently predicted in-hospital death related to COVID-19 infection. These results emphasized the potential role of impaired laboratory parameters for the prognosis of fatal outcomes in adult inpatients.

Correlation between the Opacification Degree of Paranasal Sinuses on CT, Clinical Symptoms and Anatomical Variations of the Nose and Paranasal Sinuses in Patients with Chronic Rhinosinusitis.

Objectives: This study aimed to evaluate the correlation between the opacification degree of the paranasal sinuses on computed tomography (CT) with clinical symptoms, and anatomical variations of the nose and paranasal sinuses in patients with chronic rhinosinusitis (CRS). Materials and Methods: This descriptive prospective study evaluated 100 patients (60 males and 40 females), who were diagnosed with CRS by ENT specialists according to the clinical findings, and were scheduled for a CT scan. The patients were requested to express the severity of their symptoms using a visual analog scale. The CT scans of the paranasal sinuses were assessed for the presence of anatomical variations and scored using the modified Lund-Mackay scoring system for the opacification degree of each sinus. The correlations between the anatomical variations and sinusitis, and also between the severity of symptoms/disease severity and CT scores were statistically analyzed. P<0.05 was considered statistically significant. Results: The most common symptoms were purulent (discolored) nasal drainage and nasal obstruction. Septal deviation was the most common anatomical variation. The maxillary and anterior ethmoid sinuses were the most commonly involved areas. The Spearman’s correlation coefficient showed a significant correlation between the sinus involvement and some of the evaluated symptoms, as well as certain types of anatomical variations (P<0.05). Conclusion: Some specific anatomical variations of the paranasal sinuses may predispose them to sinusitis. The CT scan score can predict the severity of many symptoms such as purulent (discolored) nasal drainage, nasal obstruction, hyposmia/anosmia, halitosis, cough, and fatigue, among the other symptoms of CRS.

Convalescent plasma in Severe/ Critically Ill COVID-19 patients; impact of time and mechanical ventilation

Background: Convalescent plasma (CP) transfusion is one of the suggested treatments for Coronavirus disease 2019 (COVID-19) especially in critically ill patients. Methods: We investigated the efficacy and safety of CP transfusion in 50 consecutive COVID-19 patients with severe/ critically ill disease. Severe disease was defined as having at least one of the following: shortness of breath, respiratory frequency ≥ 20/min, blood oxygen saturation ≤ 93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio &lt; 300, lung infiltrates &gt; 50% within recent 24-48 hours. Critically ill disease was considered as intensive care unit admission, respiratory failure, septic shock, or multiple organ dysfunction or failure. Primary outcomes included the safety of CP transfusion, 14-day and 30-day survival rate, and change in lung computed tomography (CT) scan score. Several other clinical and laboratory features were evaluated as secondary outcome. Results: Of 50 consecutive patients, 21 were on mechanical ventilation at time of CP transfusion. Totally, 32 patients (64%) survived 30 days after CP transfusion. Survival rate was 74% and 44% in patients who received CP &lt;7 and ≥7 days of admission, respectively. While 92% of patients without mechanical ventilation survived, survival was 29% in patients on mechanical ventilation. CT scan score and some other clinical features were improved. No adverse effects were observed. Conclusion: CP transfusion is a safe and effective treatment in COVID-19 patients with severe/ critically ill disease. The best outcome can be achieved in patients who are not on mechanical ventilation especially early in the disease course.

Relationship between CT Severity Score and Capillary Blood Oxygen Saturation in Patients with COVID-19 Infection.

Background: COVID-19 pneumonia is responsible for the latest pandemic. Usage of pulmonary computed tomography (CT) scan is known to be an important method in the diagnosis of COVID-19. Here, we aimed to evaluate the relationship between CT severity score and capillary blood oxygen saturation in patients with COVID-19 infection.Methods and material: This is a cross-sectional study performed in 2020 on patients with COVID-19 infection. All patients underwent pulmonary CT scan and CT severity score was calculated. The initial capillary oxygen saturation by the time of admission was also collected. Data were collected and analyzed.Results: A total number of 270 patients diagnosed with COVID-19 infection entered the study. The initial mean capillary oxygen saturation was 89.65 ± 8.09%. The mean score in patients was 15.16 ± 8.08. We also indicated that 27 patients had hypoxia by the time of admission and these patients had significantly higher CT severity scores (p = 0.001). Diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic obstructive pulmonary disease (COPD) (p = 0.03) and totally having an underlying disease (p < 0.001) were significantly associated with decreased capillary oxygen saturation. Patients with hypertension (p = 0.001) and patients with the previous medical disease (p = 0.01) had significantly higher CT severity scores than others. There was a significant reverse relationship between CT severity score and capillary oxygen saturation (r = −0.44, p < 0.001).Conclusions: We showed that there was a significant reverse relationship between CT severity score and capillary oxygen saturation which has great clinical importance. Furthermore, we indicated that previous medical history could also play an important role in CT severity score.How to cite this article: Aalinezhad M, Alikhani F, Akbari P, Haji Rezaei M, Soleimani S, Hakamifard A. Relationship between CT Severity Score and Capillary Blood Oxygen Saturation in Patients with COVID-19 Infection. Indian J Crit Care Med 2021;25(3):279–283.

Dupilumab improves upper and lower airway disease control in chronic rhinosinusitis with nasal polyps and asthma

BackgroundChronic rhinosinusitis with nasal polyps (CRSwNP) and type 2 asthma share the same inflammatory pathophysiology and are frequent comorbidities. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin 4 and interleukin 13, which are key and central drivers of type 2 inflammation. ObjectiveWe report the effect of dupilumab vs placebo on outcome measures of the upper and lower airways and health-related quality of life (HRQoL) in the pooled population of patients with CRSwNP and comorbid asthma from the phase 3 SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) studies. MethodsIn these randomized, double-blind, placebo-controlled trials, patients received subcutaneous dupilumab 300 mg (n = 438) or placebo (n = 286) every 2 weeks on a background of mometasone furoate nasal spray. Changes from baseline at week 24 in the upper and lower airway outcome measures are reported. ResultsOf the 724 patients randomized, 428 (59.1%) had comorbid asthma. In patients with asthma at week 24, dupilumab vs placebo improved the nasal polyp score (−2.04), patient-reported nasal congestion score (−1.04), Lund-Mackay computed tomography scan score (−6.43), peak nasal inspiratory flow (46.15 L/min), and 22-item sinonasal outcome test score (−21.42; all P < .001). The forced expiratory volume in 1 second and 6-item asthma control questionnaire scores were also markedly improved with dupilumab vs placebo. The most common adverse events (nasopharyngitis, headache, injection-site erythema, worsening of nasal polyposis, and asthma) were more frequent with placebo than dupilumab. ConclusionDupilumab improved upper and lower airway outcome measures and HRQoL in patients with severe CRSwNP and comorbid asthma and was well tolerated. Trial RegistrationClinicalTrials.gov Identifiers: NCT02912468 (SINUS-24) and NCT02898454 (SINUS-52).

Evaluation of Serum Total Immunoglobulin E, Interleukin-17 and Pentraxin-3 as Biomarkers for Chronic Rhinosinusitis With Nasal Polyposis.

Different biomarkers are detectable in cases of chronic rhinosinusitis with nasal polyposis (CRSwNP) with need for evaluation of their diagnostic and prognostic roles. To assess the serum levels of total IgE, interleukin-17 and Pentraxin-3 in patients with CRSwNP and correlate them with the clinical evaluation using Sino-Nasal Outcome Test (SNOT-22), radiological evaluation using Lund - Mackay (LM) computed tomography scan score, and polyposis recurrence. This cross-sectional comparative study was carried out on fifty patients with CRSwNP and twenty-five age and gender matched healthy volunteers as control group. Patients were assessed clinically by SNOT-22 and radiologically by LM score. Blood samples of patients and controls were analyzed for serum levels of total immunoglobulin E (IgE), Interleukin-17 (IL-17) and Pentraxin-3 (PTX-3). The correlation between the serum levels of every two markers of the study markers was assessed. The levels of the three biomarkers were correlated with SNOT-22 and LM scores and polyp recurrence with assessment of their sensitivity and specificity to diagnose CRSwNP. This study showed significantly higher values of the three biomarkers in patients group compared with control group (p < 0.001 for all). There were significant positive correlations between the levels of the three markers and SNOT 22 and LM scores (p < 0.001 for all) and with recurrence of polyposis (p < 0.001, p = 0.005 and p = 0.032 respectively). Agreement (sensitivity and specificity) for these markers to diagnose patient group was statistically significant (p < 0.001 for all). There was a significant positive correlation between every two markers of the study markers. Serum levels of total IgE, IL-17 and PTX-3 are important biological markers for diagnosis and follow up of cases of CRSwNP with high sensitivity and specificity in detection of such cases. They should be included in the routine laboratory workup for cases of CRSwNP.

Corrigendum: Correlation of Bromodomain Protein BRD4 Expression With Epithelial–Mesenchymal Transition and Disease Severity in Chronic Rhinosinusitis With Nasal Polyps

[This corrects the article DOI: 10.3389/fmed.2020.00413.].

Correlation of Bromodomain Protein BRD4 Expression With Epithelial-Mesenchymal Transition and Disease Severity in Chronic Rhinosinusitis With Nasal Polyps.

Objectives: This study aimed to explore the relationship between bromodomain-containing protein 4 (BRD4), epithelial–mesenchymal transition (EMT), and disease severity in chronic rhinosinusitis with nasal polyps (CRSwNP).Methods: We performed immunofluorescent (IF) staining to evaluate the expression of BRD4 in the polyp tissues of CRSwNP and inferior turbinate mucosa of healthy controls. The relationship between BRD4 and EMT was evaluated by the BRD inhibitor JQ1 and BRD4 siRNA in primary human nasal polyp–derived epithelial cells. Disease severity was scored by using the Lund–Mackay scores of paranasal sinus computed tomography (CT) scans.Results: The expression of BRD4 in patients with CRSwNP was significantly higher than that in healthy controls. The loss of BRD4 function by the BRD inhibitor JQ1 and BRD4 siRNA resulted in the reduction of E-cadherin, increasing vimentin, and Snai1 mRNA expression. Moreover, the expression of BRD4 was related to the total CT scan scores (r = 0.4682, P = 0.0210).Conclusions: BRD4 had higher expression in CRSwNP than in healthy controls and might be associated with EMT in CRSwNP. BRD4 mRNA expression was associated with disease severity in CRSwNP.

Outcomes of the surgical management of encapsulating peritoneal sclerosis: A case series from a single center in Korea.

BackgroundEncapsulating peritoneal sclerosis (EPS) is a rare but near-fatal complication of peritoneal dialysis (PD). Despite the high mortality rate of EPS, the surgical treatment strategy of severe EPS is yet to be established.MethodsWe retrospectively analyzed outcomes of patients with EPS who underwent enterolysis for intractable EPS at Seoul National University Hospital between 2001 and 2018. EPS was diagnosed based on the clinical symptoms and radiological findings of abdominal computed tomography (CT). CT scans were scored according to an EPS scoring system that assessed peritoneal thickening and calcification as well as bowel thickening, tethering, loculation, and dilatation.ResultsThirteen patients (nine males and four females; age, 48 [29–63] years) underwent enterolysis for severe EPS. PD duration (11 [6–21] years) was not associated with survival. Two patients were newly diagnosed with EPS following kidney transplantation. Five patients died of infectious complications immediately after the surgery. Eight patients survived after the first surgery; however, five of them underwent reoperation but died of persistent infection, fistula formation, or adhesive bowel obstruction. Four young (< 60 years) male patients with relatively low CT scan scores (< 13) survived for > 2 years after the first surgery. Median survival duration from EPS diagnosis was 22 (1.3–184) months and that from the first surgery was 9 (0.3–153) months.ConclusionThe high mortality rate of EPS suggests the importance of appropriate surgical intervention in young symptomatic male EPS patients with relatively low CT scan scores.

OP 8 Arterial calcifications and arterial stiffness in women after preeclampsia

Question Preeclampsia is associated with long-term chronic hypertension and accelerated development of atherosclerosis, which may lead to premature arterial calcifications and arterial stiffness. However, the degree and distribution of these subclinical signs of atherosclerosis in women with a history of preeclampsia has not been previously addressed. In this study, we prospectively evaluate arterial calcifications by low-dose computed tomography (CT) and arterial stiffness by pulse wave velocity (PWV) in asymptomatic women with a history of preeclampsia. Methods Women with a history of preeclampsia ( N = 153) who participated in a prospective multicenter evaluation of cardiovascular health at age 45–55 years were screened for subclinical arterial disease using low-dose CT and pulse wave velocity (PWV) analysis. Coronary artery calcium score (CACS), thoracic aortic calcium score (TACS) excluding the aortic arch, and valvular calcium score (VCS) were assessed on a non-contrast cardiac CT scan and carotid siphon calcium score (CSCS) on a non-contrast carotid siphon scan. PWV was assessed as a measure of arterial stiffness (TensioMed Arteriograph). Correlations between vascular calcifications and the relationship between vascular calcifications and CVD risk factors were assessed. Results Study participants had a mean age at inclusion of 49.0 years (SD 3.9 years). Of these, 54.6% had hypertension and 35.3% fulfilled criteria for metabolic syndrome. Vascular calcifications were seen in 110 women (71.9%) on low-dose CT: 49 (32.0%) had CACS >0; 22 (14.9%) had TACS >0; 5 (3.3%) had VCS >0 and 95 (69.9%) had CSCS >0. CACS was strongly correlated with TACS ( R = 0.98, p 0 and hypertension (OR 2.50, 95%CI 1.22–5.13). The presence of calcifications (CACS >0) was not related to other cardiovascular risk factors including obesity, smoking, hyperlipidemia and increased PWV. Conclusions Coronary and vascular calcifications in general are common in women with a history of preeclampsia at age 45–55 years. Only CACS >0 appears to be associated with chronic hypertension, but not with increased arterial stiffness or other cardiovascular risk factors.

Surgical treatment of isolated zygomatic fracture: Outcome comparison between titanium plate and bioabsorbable plate

Zygoma fracture is of clinical importance because malar prominence plays an essential role in facial appearance. Traditionally, most maxillofacial surgeons perform osteosynthesis with titanium plates and screws for rigid fixation. However, this procedure has certain disadvantages that include the possibility of implant exposure, palpability or loosening of the screws, painful irritation, temperature sensitization, and radiographic artifacts. In this study, we compared the function and satisfaction outcome between Bonamates® bioabsorbable implant and Leibinger titanium implant. Consecutively 53 patients with isolated unilateral zygomatic fracture that were treated with the Bonamates® bioabsorbable plate system, n=53 were compared to patients with the titanium plate system, n=55 in the period between 2009 and 2013. All patients were followed-up at least 6 months. Preoperative and postoperative facial computed tomography (CT) scans were performed and scored from 0 to 2 in the 5 areas of zygoma. A score of 2 indicated the most severely displaced fracture in one of the areas. A visual analogue scale ranging from 0 to 10 was used to assess the postoperative aesthetic and functional satisfactions. The mean ages of the patients in the bioabsorbable and titanium plate groups were 33 years and 30 years, respectively. The male to female ratios were 1.2:1 (bioabsorbable plate group) and 1.1:1 (titanium plate group). The average preoperative CT scan scores of the bioabsorbable and titanium plate groups were 5.7 and 5.1, respectively. The postoperative CT scan scores of the bioabsorbable and titanium plate groups were 1.3 and 1.1, respectively. The implant cost of the bioabsorbable group was approximately 6-fold higher than that of the titanium plate group. The complication rate was similar in both groups and included complications such as palpable implant, skin irritation, and hypersensitive cheek. The patients in both groups attained similar mouth-opening function and a satisfactory score at 6 months after operation. This study revealed that the bioabsorbable plate outcome was similar to the titanium plate outcome for patients with isolated unilateral zygomatic fracture. The bioabsorbable implant system provides another option for internal fixation devices in the treatment of zygomatic fractures and avoids implant removal surgery; however, the implant cost of bioabsorbable plates is higher than that of titanium plates in Taiwan.

Programmed cell death‐1 expression correlates with disease severity and IL‐5 in chronic rhinosinusitis with nasal polyps

Programmed cell death-1 (PD-1) is a negative regulator of T-cell responses. Expression of PD-1 and its ligands PD-L1 and PD-L2 in chronic rhinosinusitis with nasal polyps (CRSwNP) is poorly studied. Expression of PD-1, PD-L1, PD-L2, TGF-β, IL-5, and IL-10 mRNA was measured by real-time quantitative PCR on tissue homogenates of patients with CRSwNP (n=21) and healthy controls (n=21) and on primary epithelial cells. Disease severity was scored using the Lund-Mackay scores of maxillofacial computed tomography (CT) scans. Expression of PD-1 and PD-L1/L2 was evaluated at the cellular and tissue levels (n=6) by flow cytometry and immunohistochemistry. Programmed cell death-1 mRNA expression was increased in tissue homogenates from patients with CRSwNP compared with controls, irrespective of the atopy status. Importantly, expression of PD-1 correlated with the total CT scan scores (r=0.5, P=0.02). Additionally, a significant association was found between PD-1 mRNA and expression of IL-5 mRNA in control nasal tissue (r=0.95, P<0.0001) and in CRSwNP (r=0.63, P=0.002). PD-1 was expressed on different subsets of T cells and CD11b- dendritic cells. Both PD-1 and its ligands were expressed on primary epithelial cells from control nasal tissue and nasal polyp tissue. Higher PD-1 expression was found in CRSwNP than in nasal tissue from controls. This was associated with disease severity and tissue IL-5 expression but unrelated to the patients' atopy status.

E-ASPECTS software is non-inferior to neuroradiologists in applying the ASPECT score to computed tomography scans of acute ischemic stroke patients.

Background The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an established 10-point quantitative topographic computed tomography scan score to assess early ischemic changes. We performed a non-inferiority trial between the e-ASPECTS software and neuroradiologists in scoring ASPECTS on non-contrast enhanced computed tomography images of acute ischemic stroke patients. Methods In this multicenter study, e-ASPECTS and three independent neuroradiologists retrospectively and blindly assessed baseline non-contrast enhanced computed tomography images of 132 patients with acute anterior circulation ischemic stroke. Follow-up scans served as ground truth to determine the definite area of infarction. Sensitivity, specificity, and accuracy for region- and score-based analysis, receiver-operating characteristic curves, Bland-Altman plots and Matthews correlation coefficients relative to the ground truth were calculated and comparisons were made between neuroradiologists and different pre-specified e-ASPECTS operating points. The non-inferiority margin was set to 10% for both sensitivity and specificity on region-based analysis. Results In total 2640 (132 patients × 20 regions per patient) ASPECTS regions were scored. Mean time from onset to baseline computed tomography was 146 ± 124 min and median NIH Stroke Scale (NIHSS) was 11 (6-17, interquartile range). Median ASPECTS for ground truth on follow-up imaging was 8 (6.5-9, interquartile range). In the region-based analysis, two e-ASPECTS operating points (sensitivity, specificity, and accuracy of 44%, 93%, 87% and 44%, 91%, 85%) were statistically non-inferior to all three neuroradiologists (all p-values <0.003). Both Matthews correlation coefficients for e-ASPECTS were higher (0.36 and 0.34) than those of all neuroradiologists (0.32, 0.31, and 0.3). Conclusions e-ASPECTS was non-inferior to three neuroradiologists in scoring ASPECTS on non-contrast enhanced computed tomography images of acute stroke patients.