NCP Patients Research Articles

573. DOES CHEST PAIN AFFECT THE LONG TERM OTCOME OF SURGERY FOR ESOPHAGEAL ACHALASIA?

Abstract Literature supporting the adoption of POEM in place of the standard Heller myotomy in the presence of significant chest pain associated with typical symptoms like in case of Achalasia Type III according to the Chicago classification, generally reports on outcome data collected after short follow up periods. We aimed to assess behaviors of chest pain in the long term in a case series of patients submitted to the Heller-Dor operation. Between 1978 and 2021,394 achalasia patients underwent the Heller-Dor operation. Chest pain was evaluated according to its frequency (0: absent; 1: occasional; 2: weekly; 3: daily): 81 preoperatively complained of chest pain (score 2-3) (CP group), 313 did not (score 0-1) (NCP group). Patients were followed up according to a timed protocol based on clinical assessment of dysphagia (D0 absent – D3 each meal), GERD symptoms (RS0 absent-RS3 each meal). Barium swallow and endoscopy (E0: normal, E1: mild esophagitis, E2-3: erosive/ulcerative esophagitis) were performed at each planned control. CP and NCP were compared. CP group had shorter duration of dysphagia (p=0.03), smaller esophageal diameter and lower barium column (p<0.05). At a median follow-up of 10 years for CP and 11 years for NCP (p=0.166), the frequency of dysphagia (p=0.05), GERD symptoms (p=0.3) and esophagitis (p=0.27) was similar in the two groups. Chest pain progressively attenuated in intensity and frequency.; median chest pain score preoperatively was 3, at follow-up it was 0 (p<0.01). Clinical results obtained in CP patients (satisfactory D0–2, RS0–2, and E1 in 95%) were not inferior to those obtained in NCP patients (satisfactory in 93%) (p=0.05). According to our single center case series, in the long term chest pain does not influence negatively HD outcome which is absolutely competitive with that generally reported for POEM and pneumatic dilation. Results presented in this study must be verified: as new randomized prospective studies would require a too long lag time, valid retrospective multi center studies should be performed.

The characteristics and clinical value of chest CT images of novel corona virus pneumonia: An update

Aim: To investigate the characteristics of chest Computed Tomography (CT) images of corona virus pneumonia in India. Materials and methods: Clinical data and CT images of 1000 cases of NCP were collected. Lesions were scored and characterized. The clinical manifestations and laboratory test results of the patients were analysed. Results: The main clinical manifestations were fever, dry cough, and fatigue. A total of 15000 scored lesions were found in the first chest CT images of patients. The lesions were located mainly in the subpleural area of the lungs (90%). Most of the lesions were ground-glass opacity. Pulmonary consolidation accounted for 40% of all of the lesions. Of the 1000 cases, 900 patients (90%) had bilateral lung disease, 100 (1%) patients had unilateral lung disease Conclusion: The chest CT of NCP patients is characterized by bilateral ground-glass lesions located in the subpleural area of the lung, and progressive consolidation with no migratory lesions. Pleural effusions and mediastinal lymphadenopathy are rare. As patients can have a negative early nucleic acid test, chest CT, in combination with epidemiological and laboratory tests, is a useful examination to evaluate the disease and curative effect.

Low-dose naltrexone is effective and well-tolerated for modulating symptoms in patients with neuropathic corneal pain

PurposeNeuropathic corneal pain (NCP) is caused by damage or disease of the somatosensory nervous system that innervates the cornea and presents with symptoms of pain or persistent unpleasant sensations, such as burning, dryness, or light sensitivity. This retrospective study aims to assess the efficacy and tolerability of low-dose naltrexone (LDN) in refractory NCP patients. MethodsFifty-nine NCP patients with a centralized component treated with oral LDN 4.5 mg at bedtime for at least four weeks were identified. Thirty out of 59 patients who had a baseline pain score ≥4 on the visual analogue scale had completed the ocular pain assessment survey (OPAS) and presented persistent pain, despite instillation of topical anesthetic drops, were included. Changes in pain scores, comorbidities, side effects, among others, were analyzed. Change in ocular pain scores (scale 0–10) and quality of life (QoL) scores (scale 0–100%) were the main endpoints. ResultsMean age (years ± SD) was 45.60 ± 19.30 with a white (80.00%) female (73.33%) predominance. Duration of LDN use was 14.87 ± 11.25 months, and the duration of NCP before treatment was 17.53 ± 17.29 months. Eight patients used LDN as a monotherapy, whereas the remaining used it as an adjunct therapy. LDN resulted in a 49.22% decrease in mean pain score from 6.13 ± 1.93 to 3.23 ± 2.60 (p < 0.001). Mean QoL scores by the OPAS were 5.84 ± 2.57 at the first visit and improved to 3.77 ± 2.91 at the last visit (p = 0.023). Common side effects were vivid dreams, headaches, and stomachache. ConclusionLDN was effective and well-tolerated for NCP treatment.

Efficacy and tolerability of nortriptyline in the management of neuropathic corneal pain

PurposeNeuropathic corneal pain (NCP) is a recently acknowledged disease entity. However, there is no consensus in potential treatment strategies, particularly in patients with a centralized component of pain. This study aims to assess the efficacy and tolerability of the tricyclic antidepressant, nortriptyline, among NCP patients. MethodsPatients with clinically diagnosed NCP and a centralized component of pain, treated with oral nortriptyline, who had recorded pain scores as assessed by the ocular pain assessment survey at the first and last visit were included. Patients were excluded if they had any other ocular pathology that might result in pain or had less than 4 weeks of nortriptyline use. Demographics, time between visits, concomitant medications, systemic and ocular co-morbidities, duration of NCP, side effects, ocular pain scores, and quality of life (QoL) assessment were recorded. ResultsThirty patients with a mean age of 53.1 ± 18.5 were included. Male to female ratio was 8:22. Mean ocular pain in the past 24 h improved from 5.7 ± 2.1 to 3.6 ± 2.1 after 10.5 ± 9.1 months (p < 0.0001). Twelve patients (40.0%) had equal to or more than 50% improvement, 6 patients (20.0%) had 30–49% improvement, 6 patients (20.0%) had 1–29% improvement, 4 patients (13.3%) did not improve, while 2 patients (6.7%) reported increase in pain levels. Mean QoL improved from 6.0 ± 2.5 to 4.3 ± 2.4 (p = 0.019). Eight patients (26.6%) discontinued treatment due to persistent side effects, despite improvement by 22.4%. ConclusionNortriptyline was effective in relieving NCP symptoms in patients with centralized component and insufficient response to other systemic and topical therapies who tolerated the drug for at least 4 weeks. Nortriptyline may be used in the management of patients with NCP.

Radiomics-based model for accurately distinguishing between severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) and influenza A infected pneumonia.

Clinicians have been faced with the challenge of differentiating between severe acute respiratory syndrome associated coronavirus 2 (SARS‐CoV‐2) infected pneumonia (NCP) and influenza A infected pneumonia (IAP), a seasonal disease that coincided with the outbreak. We aim to develop a machine‐learning algorithm based on radiomics to distinguish NCP from IAP by texture analysis based on computed tomography (CT) imaging. Forty‐one NCP and 37 IAP patients admitted from January to February 6, 2019 admitted to two hospitals in Wenzhou, China. All patients had undergone chest CT examination and blood routine tests prior to receiving medical treatment. NCP was diagnosed by real‐time RT‐PCR assays. Eight of 56 radiomic features extracted by LIFEx were selected by least absolute shrinkage and selection operator regression to develop a radiomics score and subsequently constructed into a nomogram to predict NCP with area under the operating characteristics curve of 0.87 (95% confidence interval: 0.77‐0.93). The nomogram also showed excellent calibration with Hosmer‐Lemeshow test yielding a nonsignificant statistic (P = .904). The novel nomogram may efficiently distinguish between NCP and IAP patients. The nomogram may be incorporated to existing diagnostic algorithm to effectively stratify suspected patients for SARS‐CoV‐2 pneumonia.

Difficulties and strategies of public hospitals in their participation in the prevention and control of novel coronavirus pneumonia

Outbreak of the novel coronavirus pneumonia (NC) across the country has seriously threatened people's lives and health, endangering smooth operation of the national economy and social stability. An all-out campaign to save the NCP patients and reduce their mortality is not only one of the key tasks to fight against the epidemic, but also a major responsibility and mission of public hospitals. In view of the field practice of Wuhan Union Hospital in the epicenter, the authors Described the challenges faced by such hospitals in the prevention and control, summarized its experiences and proposed improvement measures, for reference of other public hospitals and relevant authorities. Key words: Novel coronavirus pneumonia; Prevention and control; Public hospitals; Safeguard system

Exploring the mechanism of liver enzyme abnormalities in patients with novel coronavirus-infected pneumonia

Objective: To explore and analyze the possible mechanism of liver injury in patients with coronavirus disease 2019 (novel coronavirus pneumonia, NCP). Methods: The correlation between ALT, AST and other liver enzyme changes condition and NCP patients' disease status reported in the literature was comprehensively analyzed. ACE2 expression in liver tissue for novel coronavirus was analyzed based on single cell sequencing (GSE115469) data. RNA-Seq method was used to analyze Ace2 expression and transcription factors related to its expression in liver tissues at various time-points after hepatectomy in mouse model of acute liver injury with partial hepatectomy. t-test or Spearman rank correlation analysis was used for statistical analysis. Results: ALT and AST were abnormally elevated in some patients with novel coronavirus infection, and the rate and extent of ALT and AST elevation in severe NCP patients were higher than those in non-severe patients. Liver tissue results of single cell sequencing and immunohistochemistry showed that ACE2 was only expressed in bile duct epithelial cells of normal liver tissues, and very low in hepatocytes. In a mouse model of acute liver injury with partial hepatectomy, Ace2 expression was down-regulated on the first day, but it was elevated up to twice of the normal level on the third day, and returned to normal level on seventh day when the liver recovered and hepatocyte proliferation stopped. Whether this phenomenon suggests that the bile duct epithelial cells with positive expression of Ace2 participate in the process of liver regeneration after partial hepatectomy deserves further study. In RNA-Seq data, 77 transcription factors were positively correlated with the expression of Ace2 (r > 0.2, FDR < 0.05), which were mainly enriched in the development, differentiation, morphogenesis and cell proliferation of glandular epithelial cells. Conclusion: We assumed that in addition to the over activated inflammatory response in patients with NCP, the up-regulation of ACE2 expression in liver tissue caused by compensatory proliferation of hepatocytes derived from bile duct epithelial cells may also be the possible mechanism of liver tissue injury caused by 2019 novel coronavirus infection.

A correlation study ofCT and clinical features of different clinical types of 2019 novel coronavirus pneumonia/ 中华放射学杂志

Objective To investigate the CT and clinical features of 2019 novel coronavirus (NCP) pneumonia. Methods Chest CT and clinical data of confirmed 103 patients with 2019 novel coronavirus pneumonia in January 2020, retrospectively. According to diagnosis and treatment of NCP infected pneumonia (trial version 5), all the patients were classified into mild(n=58), severe (n=36) and very severe (n=9) type, and their clinical findings, laboratory examination and CT finding were analyzed. CT features included lesions’ distribution, location, size, shape, edge, number, density, percentage of pneumonia lesions of the whole lung and extra-pulmonary manifestations. The CT features of different clinical subtypes were compared using χ2test or Fisher's exact probability. Comparisons between the percentage of pneumonic lesions to total lung volume were computed by using analysis of variance (normal distribution) or Kruskal-Wallis rank sum test (non-normal distribution). Results In terms of clinical manifestations, the patients with severe NCP were more common in elderly men, with a median age of 65 years. Fever was the first symptom in 49 (84%) of 58 patients with NCP, and fever was the first symptom in both severe and critical NCP patients. The incidence of cough in severe (25 / 36, 69%) and critical (6 /9, 67%) NCP patients was higher than that in general (20 /58, 34%). All critical patients have dyspnea. In terms of CT findings, common NCP showed double lung (40/58,71%) multiple (40 / 58,69%) ground glass (31/58,52%) or mixed (25 / 58,43%) lesions (56 / 58,97%); severe and critical NCP showed double lung lesions, heavy NCP mainly showed multiple (34 / 36,96%) patches (33 / 36,92%) mixed density lesions (26 / 36,72%); 9 severe NCP lesions were more than 3 cm Mixed density lesions. The percentage of pneumonia focus in the whole lung volume: the common type (12.5% ± 6.1%) was significantly lower than the severe type (25.9% ± 10.7%) and the critical type (47.2% ± 19.2%) NCP, the difference was statistically significant (P values were < 0.001 and 0.002 respectively), and the severe type NCP was also significantly lower than the critical type (P = 0.032). Conclusions CT and clinical features of different clinical types of NCP pneumonia are different. Chest CT findings have unique characteristic, which can not only make early diagnosis, but also evaluate its clinical course and severity. Key words: Coronavirus infection; Pneumonia; Tomography, X-ray computed

Characteristics of in peripheral blood of 70 hospitalized patients and 8 diarrhea patients with COVID-19.

Objective: To analyze the blood test indicators of patients after infection of COVID-19 in Chongqing and analyze the clinical indicators of 8 patients with diarrhea.Materials and Methods: From January 26, 2019 to February 13, 2020, 70 patients diagnosed with 2019-nCoV according to the World Health Organization interim guidance for NCP and divided into diarrhea and non-diarrhea groups. The laboratory tests liver and kidney function, blood routine, coagulation function, and immune status.Results: The study population included 70 hospitalized patients with confirmed CONV-2019. NCP patients (43males and 27 females) with a mean age of 48.57±17.80 (9~82) years and only 4.3% of patients have lung-related diseases. The positive rate of ESR, CRP, PT, IL6, lymphocyte count, GGT, Prealbumin and CD4 was more than 50%. We further analyzed the differences between 8 diarrhea patients and 62 non-diarrhea patients. Among these indicators, only Lymphocyte, CRP, Prealbumin and Cystatin C positive rate is more than 50%. Although there is no statistical difference in GGT, 100% of the 7 patients tested decreased.Conclusion: Our data recommended that the ESR, CRP, PT, IL6, lymphocyte count, GGT, prealbumin and CD4 have important value in the diagnosis of COVID-19, and the decrease of GGT may be an important indicator for judging the intestinal dysfunction of patients.

MAP2K6 is associated with radiation resistance and adverse prognosis for locally advanced nasopharyngeal carcinoma patients.

BackgroundAlthough radiotherapy is the primary therapeutic option for nasopharyngeal carcinoma (NPC), local recurrence and distant metastasis caused by radioresistance are still the major barriers for some NPC patients who cannot benefit from radiotherapy. In this study, we analyzed the association between MAP2K6 expression and radioresistance in patients with locally advanced NPC.MethodsWe collected 120 NPC patients who received radiotherapy in the Xiangya Hospital of Central South University from August 2008 to July 2012. The clinical data and tissue samples of patients were collected. Detection of MAP2K6 was performed using immunohistochemical staining.ResultsThe rates of two groups were 19.4% and 4.2%, and significant difference was observed between MAP2K6 high expression group and low expression group (χ2=5.817, P=0.016). The Kaplan–Meier analysis suggested a significant difference in the survival rate between two groups (P<0.05). The results from multivariate Cox regression indicated that the MAP2K6 was independently related to adverse prognosis in NCP patients (HR =3.40, 95% CI =1.13–10.26, P=0.030).ConclusionThe present study indicated that MAP2K6 was correlated with radioresistance, and the elevated expression of MAP2K6 predicted poor prognosis in NPC patients. MAP2K6 may be a new therapy target for radioresistance of NPC.

Radiation Therapy for Nasopharyngeal Carcinoma: Predictability of Treatment Outcomes at Interim Re-assessment

As most prognostic factors of nasopharyngeal carcinoma (NPC) are based on pretreatment characteristics, individual radiosensitivity differences are not considered. We perform interim target volume re-assessments with CT and/or MRI at the end of elective nodal irradiation (ENI). We retrospectively investigated whether interim lymph node (LN) re-assessment is predictive of the treatment outcome in NPC patients. Between February 1996 and June 2007 we performed radiation therapy in 43 NCP patients. At pretreatment assessment, 9 and 34 patients were recorded as N0 and N+, respectively. Thirty-four patients received combination chemotherapy. ENI was with a median dose of 39.6 Gy. Thereafter, boost irradiation was delivered based on the interim re-assessment results; the primary tumor was irradiated with a median dose of 24 Gy, the cervical LN of 27 N+ patients with a median dose of 24 Gy. Planned neck dissection (ND) was performed in 7 patients. The patients with regional failure or residual carcinoma in the LN specimen were categorized as uncontrolled, and the remaining patients were categorized as controlled. The short axis of the largest cervical LN was measured by CT or MRI at pretreatment assessment and interim re-assessment, thereafter, receiver operating characteristic (ROC) analysis was used to compare the predictability of regional control using the LN size at both assessments. Median follow-up was 61 months (range 6-176 months); 60% of all patients had an overall survival (OS) of 5 years. Residual carcinoma in the LN specimens was confirmed in 4 patients with ND. Among 15 patients with treatment failure it was local in 6, regional in 1, and distant in 8. Of the 43 NCP, 5 were categorized as uncontrolled and 38 as controlled. The area under the ROC curve (AUC) at pretreatment assessment and interim re-assessment was 0.825 and 1.000, respectively. The optimal cut-off was 16 mm (Youden index = 0.6071) and 15 mm (Youden index = 1.0000) for the two assessments, respectively. None of the 16 patients without boost irradiation to the LN manifested regional failure; their LN measured 5-10 mm at interim re-assessment. All LN in controlled NPC were ≤ 15 mm at interim re-assessment, in uncontrolled NPC they measured 17-26 mm. An LN size ≤ 15 mm at interim re-assessment was a significant factor for 5-year OS (65% vs 20%, p = 0.03) while a pretreatment size of ≤ 16 mm was not (p = 0.78). Interim re-assessment yields better predictability of treatment outcomes in NPC patients than pretreatment assessment. LN measuring ≤10 mm at interim re-assessment need not undergo boost irradiation. Patients whose LN is > 15 mm are at high risk for regional failure and their prognosis is poor.

008 Circulating secreted phospholipase A2 activity: an early prognostic marker in unselected patients presenting to the emergency department with suspected acute coronary syndrome

sPLA2 and Lp-PLA2 are currently being evaluated as potential markers and therapeutic targets in coronary artery disease. We hypothesized that their measurement, in parallel with CRP, could correlate to the risk of death or myocardial infarction (MI) in patients with suspected acute coronary syndromes (ACS), providing thereby important prognostic information. We therefore analysed a cohort of 419 unselected consecutive patients (mean 61.1 years old ; 63.9% male) presenting in the emergency room of a large tertiary hospital, without ST-segment elevation (NSTE) on the baseline ECG, with chest pain (72%) or other clinical features considered indicative of ACS. Clinical history, basal troponin I (cTnI) and CRP measurements were obtained. Final discharge diagnoses were assigned to the following categories: NSTE-ACS including NSTE-MI and unstable angina (UA), other cardiac diseases (OCD) or non cardiac diseases (NCD). Follow-up was obtained in all patients at 40 days. sPLA2 mass, sPLA2 and Lp-PLA2 activities were measured on the serum samples collected at presentation. The median sPLA2 activity was significantly higher in NSTE-ACS patients (1.89), than in OCP and NCP patients (1.45 and 1.43 respectively; p< 0.001). A significant association between sPLA2 mass and diagnosis (p<0.02) was also found, while the Lp-PLA2 activity appeared not to be associated with the final diagnosis. Patients with sPLA2 activity or mass at presentation in the highest quartile had a statistically higher incidence of cardiac death and MI than those with sPLA2 activity or mass in the lowest quartile (37.5% versus 13.4%, p=0.0001 and 33.6% versus 16%; p=0.0047, respectively). On the other hand, no association was observed with Lp-PLA2 activity. Therefore, a single measurement of sPLA2 activity in unselected patients presenting with suspected ACS and no ST-segment elevation, provides better independent prognostic information than either CRP, sPLA2 mass or Lp-PLA2, on the risk of death or MI.

Relationships between homocysteine, factor VIIa, and thrombin generation in acute coronary syndromes.

It has been suggested by clinical, epidemiological, and experimental in vitro studies that homocysteine potentiates thrombin generation. This prothrombotic effect however has not previously been demonstrated in patients presenting with acute coronary syndromes (ACS). Patients with ACS (n =117) presenting with confirmed acute myocardial infarction (MI) (n =57) or unstable angina pectoris (UAP) (n =60) were consecutively recruited together with patients (n =18) in whom the presenting chest pain was not of cardiac origin (NCP), included as controls. Plasma samples were collected on admission and before clinical intervention. Homocysteine was assayed by high performance liquid chromatography, and both Factor VIIa and prothrombin fragment F1+2 were analyzed by ELISA. There were significant elevations in F1+2 in MI (P<0.001) and UAP (P=0.003), and modest elevations in Factor VIIa in UAP (P<0.05) compared with NCP but no differences in homocysteine levels among those groups. On dividing patients with ACS into quartiles of homocysteine, there was a stepwise increase in F1+2 (P<0.0001) and of Factor VIIa (P<0.05). There were significant correlations in ACS between homocysteine and F1+2 (r=0.46, P<0.0001), homocysteine and Factor VIIa (r=0.24, P<0.01), and F1+2 and Factor VIIa (r=0.41, P<0.0001). There was no correlation between homocysteine and either F1+2 (r=-0.15, P=0.57) or Factor VIIa (r=0. 22, P=0.37) in the NCP patients. Elevated plasma homocysteine is associated with and may cause elevated Factor VIIa and thrombin generation in patients presenting with ACS. These findings suggest an explanation for the prothrombotic effect of homocysteine in ACS.

Coronary bypass with substrate-enhanced cardioplegia versus non-cardioplegic technique for early revascularization in acute infarction

Nine patients chosen at random received substrate enhanced cardioplegia (SECP) for early (less than 4 h) revascularization in acute infarction. A control group of 9 patients with similar clinical characteristics was chosen from the larger group revascularized concurrently with a noncardioplegic technique (NCP). There were no significant differences between the NCP and SECP groups respectively in preoperative clinical parameters such as age (62.8 vs. 62.3 years), sex (7 men, 2 women in both groups), ejection fraction (50% vs. 56%) or number of diseased vessels (2.1 vs 2.3). Intraoperative aortic clamp times were significantly shorter in NCP patients (11 vs. 38 min), and 4 NCP patients had no clamping. The internal mammary artery (IMA) was used in 6 NCP patients and 1 SECP patient (to a nonoccluded branch vessel). Postoperatively, NCP patients had higher peak CPK-MB (284 vs. 190 IU/l), longer use of inotropes (10 vs. 2.7 h) and intraaortic balloon pump (15 vs. 8 h), and a higher ejection fraction before discharge from hospital, but none of these differences were significant. SECP appears to provide better myocardial performance early postoperatively, but lasting benefits were not apparent in this subset of patients with early revascularization. Because the IMA has a powerful effect on long term survival but is very difficult to use with antegrade SECP, we continue to favor the IMA without SECP in hemodynamically stable, young patients (less than 65 years) who are revascularized early after infarction.