Radiographic Opacities Research Articles

Sinus irrigation as an adjunctive therapy for odontogenic maxillary sinusitis — an in-depth analysis

BackgroundOdontogenic maxillary sinusitis (OMS) is widely acknowledged in both the dentistry and otolaryngology fields. Recently, iatrogenic odontogenic maxillary sinusitis cases can be encountered frequently. The purpose of this study was to evaluate the effect of intraoral sinus irrigation using the small lateral window approach in patients with odontogenic maxillary sinusitis by comparing pre- and postoperative volumetric measurement of CBCT and symptoms.We surveyed 21 patients who visited the Oral and Maxillofacial Surgery Department at PNUDH from 2016 to 2022. All the patients’ information was extracted from an electronic database. The patients with a follow-up period of 2 months or more were included. The three-dimensional volumetric measurement was performed using the ImageJ program (National Institute of Health, University of Wisconsin).ResultsAmong 21 patients, 16 (76.1%) were male, and 5 (23%) were female. The most common type of surgery was general anesthesia (16 cases) in which oroantral fistula was present in 7 cases. In the causes of maxillary sinusitis, there were seven implant-related patients, five patients of tooth extraction, seven patients of bone grafting, and two patients in other groups. Radiographic opacity decreased by 40.15% after sinus irrigation especially in bone graft and tooth extraction cases. Clinically, symptoms improved in 17 patients (80.9%).ConclusionBy this study, it can be concluded that maxillary sinus irrigation using the small lateral window approach is a clinically and radiologically effective treatment method for odontogenic maxillary sinusitis.

Hypoxemia secondary to thymoma excision with 1-lung ventilation: A case report.

Acute respiratory distress syndrome (ARDS) is an acute respiratory illness characterized by bilateral chest radiographic opacities and severe hypoxemia due to noncardiogenic pulmonary edema. However, ARDS due to sing lung injury is rare. In this article, we describe a case of a female patient who developed ARDS during surgery and 1-lung mechanical ventilation. A 53-year-old woman developed hypoxemia 2 days after undergoing thymoma excision. Antibiotics, diuretics, expectorants, and supportive treatment strategies (noninvasive positive-pressure breathing, high-flow nasal oxygen) were used for approximately 3 days after admission to the intensive care unit (ICU), but the patient's oxygen index continued to deteriorate. Considering the possibility of ARDS being induced by 1-lung mechanical ventilation, prone positioning, methylprednisolone, nintedanib, and acetylcysteine were administered. Oxygenation improves greatly after 23 days admitted to ICU. Chest computed tomography shows a real reversal of the disease. The patient was discharged from ICU 29 days after admission to the ICU and was discharged from the hospital after 36 days admitted to ICU. In this report, we describe a rare case of ARDS involved 1 lung, in which we successfully used noninvasive positive-pressure breathing, high-flow nasal oxygen, and prone positioning to succeed improvement of clinical outcomes. The use of the prone position has benefits in nonintubated patient with ARDS even involved 1 lung.

Quantitative evaluation of middle ear radiopacity in French bulldogs using X-ray imaging.

Radiographic examination of the middle ear in French bulldogs can be challenging due to their small ear cavity and thick walls. Quantifying opacity on radiographic images is required to determine normal or abnormal results. To quantify the radiographic opacity of the middle ear in French bulldogs and create a threshold for objective diagnosis. A study was conducted on 32 French Bulldogs using radiographic images. Significant difference tests were performed on the ears of patients with unilateral and bilateral middle ear filling on computed tomography. A threshold was established for detecting left-right asymmetry in the same individuals. In addition, comparisons were made between the filling and nonfilling middle ear groups to establish a threshold of pixel values that could determine single middle ear filling and nonfilling for different patient images. Significant differences were observed in the left-right difference in max, left-right difference in max-ave, and left-right ratio of max-ave between unilateral and bilateral filling groups. The max-ave left-right ratio had the highest area under the curve value with a cutoff of 1.077% and 92.3% sensitivity. The item that showed a significant difference between middle ear groups with and without filling was corrected for nasopharyngeal pixel values with a cutoff of 1.028% and 85% sensitivity. Pixel value ratios in the middle ear region can detect asymmetries in ear densities. The max value in the region compared to the same image's nasopharyngeal region can determine the filling. Combining individual ear evaluations and symmetry improves accuracy.

Visualization of radiographic mineral opacities in guinea pigs in the location of the bulbourethral glands may be underdiagnosed

BackgroundPathology of male guinea pig accessory sex glands is minimally described. Mineral opacities caudal to the pelvis were identified during evaluation of two index cases presenting with urinary signs. The objective of this study was to identify the prevalence of this radiographic finding, suspected to be bulbourethral glands, and to describe associated clinical signs. MethodsA retrospective review of medical records from a single academic institution was performed identifying male guinea pigs with abdominal radiographs, abdominal computed tomography, and/or necropsy. Available imaging studies were evaluated for mineral opacities caudal to the pelvis and necropsy reports were reviewed. Medical case histories meeting the inclusion criteria were summarized. ResultsSix cases met the inclusion criteria, with a prevalence of 5.17% (6/116) amongst male guinea pigs with abdominal imaging that included the soft tissues caudal to the pelvis. Collimation of 25% (28/112) of radiographic studies and 50% (4/8) of computed tomographic studies excluded this region. One necropsy report (3.23%, 1/31) during the study period evaluated the accessory sex glands. The most common clinical signs in identified cases were hematuria (66.7%, 4/6) and stranguria (50%, 3/6). Conclusions and clinical relevanceThe clinical significance of radiographic mineralization in the vicinity of the bulbourethral glands is unknown. This radiographic finding may be underreported due to collimation practices which may exclude the soft tissues caudal to the pelvis. Purposeful evaluation of these organs should be performed during imaging and necropsy evaluation to screen and develop better understanding of the clinical significance of this radiographic finding.

Use of Lung Ultrasound in the New Definitions of Acute Respiratory Distress Syndrome Increases the Occurrence Rate of Acute Respiratory Distress Syndrome.

To assess the effect of incorporating bilateral abnormalities as detected by lung ultrasound (LUS) in the Kigali modification and the New Global definition of acute respiratory distress syndrome (ARDS) on the occurrence rate of ARDS. Post hoc analysis of a previously published prospective cohort study. An academic mixed medical-surgical ICU. The original study included critically ill adults with any opacity on chest radiography in whom subsequent LUS was performed. Patients with ARDS according to the Berlin definition, COVID-19 patients and patients with major thorax trauma were excluded. None. LUS was performed within 24 hours of chest radiography and the presence of unilateral and bilateral abnormalities on LUS and chest radiograph (opacities) was scored. Subsequently, the Kigali modification and the New Global definition of ARDS were applied by two independent researchers on the patients with newly found bilateral opacities. Of 120 patients, 116 were included in this post hoc analysis. Thirty-three patients had bilateral opacities on LUS and unilateral opacities on chest radiograph. Fourteen of these patients had ARDS according to the Kigali modification and 12 had ARDS according to the New Global definition. The detected LUS patterns were significantly different between patients with and without ARDS ( p = 0.004). An A-profile with a positive PosteroLateral Alveolar and/or Pleural Syndrome was most prevalent in patients without ARDS, whereas heterogeneous and mixed A, B, and C patterns were most prevalent in patients with ARDS. The addition of bilateral abnormalities as detected by LUS to the Kigali modification and the New Global definition increases the occurrence rate of the ARDS. The nomenclature for LUS needs to be better defined as LUS patterns differ between patients with and without ARDS. Incorporating well-defined LUS criteria can increase specificity and sensitivity of new ARDS definitions.

Intrapleural tissue plasminogen activator and deoxyribonuclease administered concurrently and once daily for complex parapneumonic pleural effusion and empyema.

Pleural infection is life-threatening and increasingly prevalent. In addition to usual care, twice-daily, separate administration of tissue plasminogen activator and deoxyribonuclease (tPA-DNase) reduces radiological pleural opacity with lower surgical referral rates. This retrospective cohort study examines the use of once-daily, concurrent administration of tPA-DNase for complex parapneumonic pleural effusion and empyema. Patients with pleural infection who received intrapleural tPA-DNase between October 2014 and July 2020 at Logan Hospital, where it is given concurrently and once-daily as salvage therapy, were retrospectively identified. Radiographic opacification, inflammatory markers, clinical response and complications were examined. Thirty-one patients were identified. Mean age was 48.8 years (standard deviation [SD], 17.2). Median tPA-DNase administration was 3 (interquartile range [IQR], 2-3). Chest x-ray pleural opacity decreased significantly (P = 0.047) from a median of 39.6% (IQR, 28.8-65.7%) to 9.7% (IQR, 2.5-23.2%), a median relative reduction of 75.5% (IQR, 47.7-93.9%). White cell count and C-reactive protein improved significantly (P = 0.002 and P = 0.032, respectively) from a median of 16.3 × 109 /L (IQR, 11.8-20.6 × 109 /L) to 9.9 × 109 /L (IQR, 8.0-12.3 × 109 /L) and 311.0 mg/L (IQR, 218.8-374.0 mg/L) to 69.0 mg/L (IQR, 36.0-118.0 mg/L), respectively. No patients experienced significant bleeding or died. Five patients (16.1%) were referred for surgery. This is pilot evidence that a practical regimen of concurrent, once-daily intrapleural tPA-DNase improved pleural opacification and inflammatory markers without bleeding or mortality. The surgical referral rate was higher than in studies assessing twice-daily administration, though the validity of this outcome as a measure of treatment success is limited, and further studies are needed to assess the optimal dose and frequency of intrapleural therapy and indications for surgical referral.

Increased radiographic opacity in the region of the gallbladder can be identified in dogs with large amounts of gallbladder sediment, sludge balls, and gallbladder mucocele.

Increased soft-tissue opacity in the region of the canine gallbladder is incidentally detected on radiographs. We hypothesized that there is a difference in the detection of gallbladder sediment on radiographs depending on the amount or mobility of the sediment. In this retrospective and analytical study, we aimed to assess the ultrasonographic features of gallbladder sediment that were detected radiographically. We also aimed to assess the differences in the detection of increased opacity of the gallbladder between radiographic views. We included 223 dogs that underwent thoracic radiography, abdominal radiography, and gallbladder ultrasonography. Ultrasonographic images of the gallbladder were divided into five groups: group 1, gravity-dependent sediment occupying<50% of the gallbladder; group 2, gravity-dependent sediment occupying ≥50%; group 3, sediment attached to the gallbladder wall; group 4, sludge ball; and group 5, gallbladder mucocele. Dogs showing increased opacity on subjective assessment of any radiographic view were recorded, and the sensitivity of radiographic views for detecting gallbladder sediment was analyzed. Of 168 dogs with gallbladder sediment, 37 had increased opacity on at least one radiographic projection. The frequency was compared as a percentage within each category, and Group 4 was the highest percentage with increased radiographic gallbladder opacity, followed by Groups 2 and 5. The sensitivity for detecting increased opacity was highest in the thoracic ventrodorsal view. Thus, in dogs with increased gallbladder opacity on radiographs, large amounts of gallbladder sediment, sludge balls, and gallbladder mucocele should be considered differential diagnoses. In addition, the thoracic ventrodorsal view is recommended to evaluate gallbladder opacity.

1076. The Role of Bronchoalveolar Lavage in COVID-19 Diagnoses and Management

Abstract Background In the diagnosis of SARS-COV-2, upper respiratory tract specimens are primarily used for PCR testing. This study aims to evaluate the clinical and diagnostic role of bronchoalveolar lavage (BAL) in diagnosing and managing COVID-19. Methods Patients admitted to Keck Medical Center (Los Angeles, CA) during March 2020-May 2021 who had SARS-CoV-2 PCR tested on both nasopharyngeal swab (NPS) and BAL specimens (QIAGEN QIAstat-Dx RP) were included. Four patient groups were designated by PCR results: (A) NPS+/BAL+ (n=34), (B) NPS+/BAL- (n=26), (C) NPS-/BAL+ (n=5), (D) NPS-/BAL- (n=89). Clinical and laboratory data were retrospectively reviewed. Statistical analysis included the use of one-way ANOVA with Tukey HSD and Fisher’s exact test. Results 154 inpatients had NPS and BAL tested for SARS-CoV-2 RNA (mean age 55.1 y, 59.6% male). BAL was performed mainly to further assess abnormal respiratory function (n=43) or chest imaging findings (n=27), or for COVID-19 work-up (n=17). Mean turnaround time for BAL PCR was 4 h 5 min. Ct values, available on 28 BAL+ samples, did not significantly differ between patients who died (mean Ct 29.9, n=18) vs. survived (mean Ct 28.7, n=10). Time from symptom onset to BAL was significantly longer in Group B (34.2 d) vs. D (13.7 d, p&amp;lt; 0.01) or C (12.8 d, p&amp;lt; 0.05) but not vs. A (23.9 d). Groups did not differ significantly in patient comorbidities, mortality, length of hospital stay, or immunosuppressive status. SARS-CoV-2 NPS+/BAL+ patients were more likely to have diffuse or bilateral chest radiographic opacities (p&amp;lt; 0.01), respiratory culture with Aspergillus spp. (p&amp;lt; 0.05), and ARDS diagnosis than those who were NPS+/BAL- (p&amp;lt; 0.01). Conclusion BALs were an important specimen source for the detection of SARS-CoV-2 in the lower respiratory tract particularly when NPS at admission was PCR-negative and for ruling out COVID-19 pneumonia as a cause of abnormal pulmonary findings or declining respiratory status. BAL positivity for SARS-CoV-2 RNA was associated with higher frequency of diffuse or bilateral opacities on CXR, culture recovery of Aspergillus spp., and ARDS. Ct values of BAL+ samples did not predict mortality though sample size was limited. Further studies on the role of viral detection in BALs in patient management and prognosis are warranted. Disclosures All Authors: No reported disclosures.

Deep learning-based classification for lung opacities in chest x-ray radiographs through batch control and sensitivity regulation

In this study, we implemented a system to classify lung opacities from frontal chest x-ray radiographs. We also proposed a training method to address the class imbalance problem presented in the dataset. We participated in the Radiological Society of America (RSNA) 2018 Pneumonia Detection Challenge and used the datasets provided by the RSNA for further research. Using convolutional neural networks, we implemented a training procedure termed batch control to manipulate the data distribution of positive and negative cases in each training batch. The batch control method regulated and stabilized the performance of the deep-learning models, allowing the adaptive sensitivity of the network models to meet the specific application. The convolutional neural network is practical for classifying lung opacities on chest x-ray radiographs. The batch control method is advantageous for sensitivity regulation and optimization for class-unbalanced datasets.

PROLONGED COLONIZATION AND COISOLATION OF SARS-COV-2 IN UNVACCINATED RECIPIENTS OF LUNG TRANSPLANTS

PROLONGED COLONIZATION AND COISOLATION OF SARS-COV-2 IN UNVACCINATED RECIPIENTS OF LUNG TRANSPLANTS

ENAMPT Neutralization Preserves Lung Fluid Balance and Reduces Acute Renal Injury in Porcine Sepsis/VILI-Induced Inflammatory Lung Injury.

Background: Numerous potential ARDS therapeutics, based upon preclinical successful rodent studies that utilized LPS challenge without mechanical ventilation, have failed in Phase 2/3 clinical trials. Recently, ALT-100 mAb, a novel biologic that neutralizes the TLR4 ligand and DAMP, eNAMPT (extracellular nicotinamide phosphoribosyltransferase), was shown to reduce septic shock/VILI-induced porcine lung injury when delivered 2 h after injury onset. We now examine the ALT-100 mAb efficacy on acute kidney injury (AKI) and lung fluid balance in a porcine ARDS/VILI model when delivered 6 h post injury. Methods/Results: Compared to control PBS-treated pigs, exposure of ALT-100 mAb-treated pigs (0.4 mg/kg, 2 h or 6 h after injury initiation) to LPS-induced pneumonia/septic shock and VILI (12 h), demonstrated significantly diminished lung injury severity (histology, BAL PMNs, plasma cytokines), biochemical/genomic evidence of NF-kB/MAP kinase/cytokine receptor signaling, and AKI (histology, plasma lipocalin). ALT-100 mAb treatment effectively preserved lung fluid balance reflected by reduced BAL protein/tissue albumin levels, lung wet/dry tissue ratios, ultrasound-derived B lines, and chest radiograph opacities. Delayed ALT-100 mAb at 2 h was significantly more protective than 6 h delivery only for plasma eNAMPT while trending toward greater protection for remaining inflammatory indices. Delayed ALT-100 treatment also decreased lung/renal injury indices in LPS/VILI-exposed rats when delivered up to 12 h after LPS. Conclusions: These studies indicate the delayed delivery of the eNAMPT-neutralizing ALT-100 mAb reduces inflammatory lung injury, preserves lung fluid balance, and reduces multi-organ dysfunction, and may potentially address the unmet need for novel therapeutics that reduce ARDS/VILI mortality.

Deep Learning-Based Four-Region Lung Segmentation in Chest Radiography for COVID-19 Diagnosis.

Imaging plays an important role in assessing the severity of COVID-19 pneumonia. Recent COVID-19 research indicates that the disease progress propagates from the bottom of the lungs to the top. However, chest radiography (CXR) cannot directly provide a quantitative metric of radiographic opacities, and existing AI-assisted CXR analysis methods do not quantify the regional severity. In this paper, to assist the regional analysis, we developed a fully automated framework using deep learning-based four-region segmentation and detection models to assist the quantification of COVID-19 pneumonia. Specifically, a segmentation model is first applied to separate left and right lungs, and then a detection network of the carina and left hilum is used to separate upper and lower lungs. To improve the segmentation performance, an ensemble strategy with five models is exploited. We evaluated the clinical relevance of the proposed method compared with the radiographic assessment of the quality of lung edema (RALE) annotated by physicians. Mean intensities of segmented four regions indicate a positive correlation to the regional extent and density scores of pulmonary opacities based on the RALE. Therefore, the proposed method can accurately assist the quantification of regional pulmonary opacities of COVID-19 pneumonia patients.

45 Experience of 5 years of balloon pulmonary angioplasty in a single centre: safety and short-term results

Abstract Aims Balloon pulmonary angioplasty (BPA) has recently been developed as a treatment strategy for chronic thromboembolic pulmonary hypertension (CTEPH) but efficacy and technical safety have to be established. We examine the effects of BPA on patients with inoperable disease or residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). Methods and results From 2015 to 2020 we enrolled symptomatic inoperable CTEPH patients and patients with residual PH after PEA. At baseline and 3 months after last BPA session patients underwent clinical evaluation, 6-min walking distance (6MWD), and right heart catheterization. Friedman test with Bonferroni post-hoc pairwise analysis was used. Fifty patients [male 42%, median age 68 (51–74) years, 42 inoperable, and 8 with residual PH after PEA] were treated for a total of 156 sessions (median 2 sessions/patient); during each session we treated 2.3 (2.2–2.7) vessels. Results are shown in the Table. Forty-nine patients were treated with medical therapy before BPA (19 with combination therapy). Five pulmonary artery dissection and two haemoptysis with clinical impairment were documented during the procedures; 37 patients had lung injury (radiographic opacity with/without haemoptysis and/or hypoxaemia), none had renal dysfunction, 7 patients had access site complications. Seven patients died during follow-up (none within 30 days from the procedure) because of sepsis (1), heart failure (1), cancer (2), arrhythmic storm (2), and sudden death in patients with severe coronary atherosclerosis (1). Conclusions BPA is a safe and effective treatment able to improve symptoms and haemodynamic profile. 45 Table 16MWD, six minute walking distanceCI, cardiac index; mPAP, mean pulmonary arterial pressure; PAC, pulmonary arterial compliance; PVR, pulmonary vascular resistance; RAP, right atrial pressure; SvO2, mixed venous oxygen saturation; WHO-FC, World Health Organization functional class.

Prognostic Impact of the Histologic Lepidic Component in Pathologic Stage IA Adenocarcinoma

IntroductionBecause several articles have reported a prognostic association with the radiologic features of ground-glass opacity, we explored whether the histologic presence of a lepidic component had similar significance. MethodsWe retrospectively evaluated 380 consecutive surgically resected lung adenocarcinomas (ADCs) of pathologic (p)stage IA. The tumors were classified into lepidic-positive and lepidic-negative ADCs. Clinicopathologic characteristics, radiographic ground-glass opacity status, and disease-free survival were compared between lepidic-positive and lepidic-negative ADCs and between part-solid and solid nodules on computed tomography images. ResultsOf the 380 cases, 176 (46.3%) were lepidic-positive ADCs. Of the overall patients with pT1, lepidic-positive ADCs were found to have significantly better recurrence-free survival (5 y, 95.4% versus 87.0%, p = 0.005), but this significance was not reproduced in pT1 subcategories (pT1a, pT1b, and pT1c). Furthermore, the presence of the lepidic component was not an independent prognostic factor in the multivariate analysis (hazard ratio = 0.46 [95% confidence interval: 0.19–1.14], p = 0.09). We also analyzed the extent of the lepidic component with 10% incremental valuables. Although we found that a 10% or greater extent of lepidic component made the recurrence-free survival difference the largest, a clear prognostic impact was not obtained with this cutoff point. ConclusionsAlthough lepidic-positive ADCs tended to have a favorable outcome, the lepidic component was not a clear independent prognostic factor in pstage I ADC.

Targeting Systemic Inflammatory Response Syndrome As Initial Therapy and Oral Arsenic Based Consolidation Regimen for Acute Promyelocytic Leukemia

Early life-threatening complications are a hindrance towards the cure of acute promyelocytic leukemia (APL). Some patients could indicate symptoms in line with systemic inflammatory response syndrome (SIRS) at admission or along with induction therapy. Here we designed this multicenter, single-arm APL-SIRS prospective study and enrolled 140 patients to test the efficacy and safety of the early intervention through targeting SIRS as initial therapy. The diagnostic of SIRS based on previous reported criteria. Other systematic manifestations include: weight gain (from capillary leak and soft tissue edema), respiratory distress, radiographic opacities, pleural or pericardial effusion, hypotension, renal failure, abnormal coagulation manifestation, and disseminated intravascular coagulation (DIC) may also be present. We stratified patients with SIRS based on the presence or absence of systematic symptoms, and tailored treatment accordingly. The risk groups were defined as (i) low-risk (LR): Patient diagnosed with SIRS but without systematic manifestations of SIRS or underlying diseases; (ii) medium-risk (MR): Patient diagnosed with SIRS with 1-2 of systematic presentations; (iii) high-risk (HR): Patients diagnosed with SIRS plus with ≥ 3 of the systematic presentations. We used stratified glucocorticoid therapy in addition to ATRA, anthracycline, and ATO in induction. The consolidation regimen consisted of two additional cycles of ATRA and oral tetra-arsenic tetra-sulfide formula, Realgar-Indigo Naturalis Formula (RIF), followed by maintenance therapy with ATRA, oral methotrexate (MTX), and 6-mercaptopurine (6MP). Our results indicated that increased SIRS risk levels are associated with higher WBC counts (P 0.05). This result suggests that though elevated WBCs could reflect an ongoing inflammation cascade initiated by cytokine secretion, appropriate stratified glucocorticoid therapy in addition to standard induction therapy appear to mitigate any potential differences in outcome. We monitored the levels of both pro-inflammatory (TNFα, IL-1β, IL2, IL-6, IL-8) and anti-inflammatory (IL-4, IL-10, IL-13) cytokines on day 1, 8, 15, 22, and 28 and evaluated their prognostic value in different SIRS risk groups. Interestingly, we see differences in cytokine expression level within different SIRS risk groups. However, following glucocorticoid treatment the increased cytokine levels decline by the end of induction, and differences in cytokine levels between groups disappeared. Further statistical analysis indicated there is no difference among different SIRS risk groups at the end of induction in both pro- and anti–inflammatory cytokine levels. We also found that the change of cytokine level happens prior to clinical symptom changes, which make it possible that cytokines may be a sensitive prognostic marker tailoring for APL treatment. In total 126 cases attained CR and all survived throughout the follow-up period. The estimated 10 years overall survival for the whole cohort was 92.14±2.27%. There are 11 people died in SIRS-LR (2/44), -MR (3/44), -HR (6/50), respectively. The overall survival of SIRS-LR, -MR, and -HR group was 95.46±3.14%; 93.48±3.64%; and 88.00±4.60%. During follow up, 15 cases has events (SIRS-LR: 3/44, SIRS-MR: 5/46, SIRS-HR: 7/50) and all of them are in remission again after intervention. No patients received hematopoietic stem cell transplantation. The EFS for SIRS-LR, SIRS-MR, SIRS-HR are 88.64±4.79%, 82.61%±5.59%, 74.00±6.20%, respectively. In short, early diagnosis and intervention of SIRS is likely a key to decreasing the early mortality of APL. The dynamic change of cytokine value could be potentially used as prognostic makers to detect early disease progression of APL. Disclosures No relevant conflicts of interest to declare.

Predicting Prolonged Hospitalization and Supplemental Oxygenation in Patients with COVID-19 Infection from Ambulatory Chest Radiographs using Deep Learning

Rationale and ObjectivesThe clinical prognosis of outpatients with coronavirus disease 2019 (COVID-19) remains difficult to predict, with outcomes including asymptomatic, hospitalization, intubation, and death. Here we determined the prognostic value of an outpatient chest radiograph, together with an ensemble of deep learning algorithms predicting comorbidities and airspace disease to identify patients at a higher risk of hospitalization from COVID-19 infection.Materials and MethodsThis retrospective study included outpatients with COVID-19 confirmed by reverse transcription-polymerase chain reaction testing who received an ambulatory chest radiography between March 17, 2020 and October 24, 2020. In this study, full admission was defined as hospitalization within 14 days of the COVID-19 test for > 2 days with supplemental oxygen. Univariate analysis and machine learning algorithms were used to evaluate the relationship between the deep learning model predictions and hospitalization for > 2 days.ResultsThe study included 413 patients, 222 men (54%), with a median age of 51 years (interquartile range, 39–62 years). Fifty-one patients (12.3%) required full admission. A boosted decision tree model produced the best prediction. Variables included patient age, frontal chest radiograph predictions of morbid obesity, congestive heart failure and cardiac arrhythmias, and radiographic opacity, with an internally validated area under the curve (AUC) of 0.837 (95% CI: 0.791–0.883) on a test cohort.ConclusionDeep learning analysis of single frontal chest radiographs was used to generate combined comorbidity and pneumonia scores that predict the need for supplemental oxygen and hospitalization for > 2 days in patients with COVID-19 infection with an AUC of 0.837 (95% confidence interval: 0.791–0.883). Comorbidity scoring may prove useful in other clinical scenarios.

Digital Analysis of Subtrochlear Sclerosis in Elbows Submitted for Dysplasia Screening.

Ulnar trochlear notch (UTN) subchondral bone sclerosis is observed in elbow dysplasia (ED) associated with the medial coronoid disease. However, its evaluation is based on a simple visual examiner assessment of bone radio-opacity level and is considered subjective. The purpose of this study was to objectively characterize the radiographic opacity of the ulnar trochlear notch (UTN) subchondral bone in mediolateral elbow projections classified, using the International Elbow Working Group guidelines. Records and mediolateral flexed elbow images from the Danish Kennel Club database for the ED screening scheme between 2012 and 2018 were available. Of the dogs in the database, those with an ED-negative status in the left limb were identified. From these, 20 dogs each having a status free from ED, or with Grade 1, 2, or 3 in the right limb, were randomly chosen. Joints with primary ununited anconeal process were excluded from the sample. A template was developed using the ImageJ software, for computer UTN sclerosis analysis. It was overlaid onto each image to define five regions of interest (ROIs): ROI-1, distal UTN; ROI-2, middle UTN; ROI-3, caudal UTN; ROI-4, cortical bone; and ROI-5, bone marrow. Mean pixel intensity for each UTN ROI was divided by the mean pixel intensity of ROI-4 to normalize the data. The mean ± standard deviation (SD) of the normalized pixel intensity in the disease joints (ED Grades 1, 2, and 3) was 1.18 ± 0.17, 1.03 ± 0.12, and 0.92 ± 0.09 for ROIs 1, 2, and 3, respectively. The corresponding values for the contralateral normal left joints were 1.16 ± 0.17, 1.01 ± 0.1, and 0.91 ± 0.08. There was a significant difference (P < 0.05) in the normalized mean pixel intensity in dysplastic vs. non-dysplastic elbow joints for ROIs 1 and 2. The raw mean pixel intensity from right and left cortical and marrow bone ROIs sometimes showed relatively large differences. Digital radiography is associated with exposure and post-processing variabilities. Differences in apparent radio-opacity (as indicated by pixel intensity) though statistically significant in dysplastic joints compared with contralateral normal joints are slight and are thus problematic for computer-aided assessments of UTN sclerosis.

Prevalence and Pattern of Non-Trauma Induced Bone Disorders Among Young Dogs Presented At The Veterinary Teaching Hospital, University Of Ibadan, Nigeria

The study evaluated the prevalence and pattern of orthopaedic conditions in young dogs below one year presented at the Veterinary Teaching Hospital, University of Ibadan Nigeria from January 2015 to April 2019. Out of two hundred and thirty-eight (238) patients presented for surgical management, fifty-one cases (21%) were orthopaedic in nature, and thirty-two cases (62.7%) involved young dogs below 1-year-old. Seventy-five percent (75 %) were males while 25 % were female. Fifty percent of young dogs presenting with fracture had no apparent bone disorders. Some (15.6%) had Legg-Calve Perthes disease (LCPD) with or without fracture. While 12.5% had Osteopenia with or without fracture. Other observed bone disorders included: hypertrophic osteodystrophy with or without fracture (6.3%), osteochondrosis (6.3%), and hyperostosis (3.1%). Fifty percent of fractures occurred on the tibia and fibula, 31% occurred on the femur, 13% were on the radius and ulna, and 6% were on the humerus. The bones of most of the patients were low in radiographic opacity, presenting with thin cortical margins and enlarged medullary cavity, with resultant low cortical bone index. The mean cortical bone index for the femur was 0.107±0.04, and tibia was 0.09 ± 0.04. Those of humerus and radio-ulna were not included for low case numbers. We therefore conclude that bones disorders, with or without fracture, are common in young dogs presenting lameness in Ibadan, Nigeria, and should be noted during patient routine examination, and pet-owners counselling on pets’ care for proper bone health.&#x0D; Key words: Non-traumatic, Bone disease, Fracture, Young dogs

Dual-energy CT evidence of pulmonary microvascular occlusion in patients with sickle cell disease experiencing acute chest syndrome

PurposeAcute chest syndrome (ACS), defined by the presence of a chest radiographic opacity in sickle cell disease patients experiencing respiratory symptoms is a leading cause of death in these patients. The etiology is ACS is not well understood however pulmonary microvascular occlusion has been postulated to be a major pathophysiologic driver. Our study aims to assess the value of dual-energy CT (DECT) as a marker of pulmonary microvascular occlusion. Materials/methodsA search tool was used to identify CT angiography studies from 1/1/2017 to 9/15/2019 with any variation of the phrases “Acute chest syndrome” and “Sickle cell”. These studies were manually reviewed for the use of DECT technique. An age-matched control group was created. DECT pulmonary blood volume (PBV) maps were reviewed semi-quantitatively for the presence of iodine defects and the number of involved bronchopulmonary segments were scored. Other recorded values included type of parenchymal opacities, diameter of main pulmonary artery (MPA) and presence of right ventricular dilatation. Mean values between cases and controls were compared using a two-sample t-test. ResultsNine sickle cell DECT cases with PBV maps and nine age-matched controls were evaluated. Bronchopulmonary segments with iodine defects were significantly higher in cases vs controls (mean: 4.7 vs 0.3, p < 0.003). PBV defects were more extensive than parenchymal findings. MPA diameter was higher in cases (2.9 cm) vs control (2.4 cm), P < 0.03. ConclusionsDECT demonstrates abnormal PBV in sickle cell patients, often the predominant abnormality identified early, and likely reflects the presence of pulmonary microvascular occlusion.

Multisystem outcomes and predictors of mortality in critically ill patients with COVID-19: Demographics and disease acuity matter more than comorbidities or treatment modalities.

We sought to describe characteristics, multisystem outcomes, and predictors of mortality of the critically ill COVID-19 patients in the largest hospital in Massachusetts. This is a prospective cohort study. All patients admitted to the intensive care unit (ICU) with reverse-transcriptase-polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection between March 14, 2020, and April 28, 2020, were included; hospital and multisystem outcomes were evaluated. Data were collected from electronic records. Acute respiratory distress syndrome (ARDS) was defined as PaO2/FiO2 ratio of ≤300 during admission and bilateral radiographic pulmonary opacities. Multivariable logistic regression analyses adjusting for available confounders were performed to identify predictors of mortality. A total of 235 patients were included. The median (interquartile range [IQR]) Sequential Organ Failure Assessment score was 5 (3-8), and the median (IQR) PaO2/FiO2 was 208 (146-300) with 86.4% of patients meeting criteria for ARDS. The median (IQR) follow-up was 92 (86-99) days, and the median ICU length of stay was 16 (8-25) days; 62.1% of patients were proned, 49.8% required neuromuscular blockade, and 3.4% required extracorporeal membrane oxygenation. The most common complications were shock (88.9%), acute kidney injury (AKI) (69.8%), secondary bacterial pneumonia (70.6%), and pressure ulcers (51.1%). As of July 8, 2020, 175 patients (74.5%) were discharged alive (61.7% to skilled nursing or rehabilitation facility), 58 (24.7%) died in the hospital, and only 2 patients were still hospitalized, but out of the ICU. Age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12), higher median Sequential Organ Failure Assessment score at ICU admission (OR, 1.24; 95% CI, 1.06-1.43), elevated creatine kinase of ≥1,000 U/L at hospital admission (OR, 6.64; 95% CI, 1.51-29.17), and severe ARDS (OR, 5.24; 95% CI, 1.18-23.29) independently predicted hospital mortality.Comorbidities, steroids, and hydroxychloroquine treatment did not predict mortality. We present here the outcomes of critically ill patients with COVID-19. Age, acuity of disease, and severe ARDS predicted mortality rather than comorbidities. Prognostic, level III.