Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients.

OBJECTIVES: To compare clinical, laboratory, and chest computed tomography (CT) findings in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19) who survived and who died. METHODS: This retrospective study reviewed 60 critically ill patients (43 males and 17 females, mean age 64.4 ± 11.0 years) with COVID-19 pneumonia who were admitted to two different clinical centers. Their clinical and medical records were analyzed, and the chest CT images were assessed to determine the involvement of lobes and the distribution of lesions in the lungs between the patients who recovered from the illness and those who died. RESULTS: Compared with recovered patients (50/60, 83%), deceased patients (10/60, 17%) were older (mean age, 70.6 vs. 62.6 years, p = 0.044). C-reactive protein (CRP) (110.8 ± 26.3 mg/L vs 63.0 ± 50.4 mg/L, p < 0.001) and neutrophil-to-lymphocyte ratio (NLR) (18.7 ± 16.6 vs 8.4 ± 7.5, p = 0.030) were significantly elevated in the deceased as opposed to the recovered. Medial or parahilar area involvement was observed in all the deceased patients (10/10, 100%), when compared to only 54% (27/50) in the recovered. Ground-glass opacities (97%), crazy-paving pattern (92%), and air bronchogram (93%) were the most common radiological findings. There was significant difference in diabetes (p = 0.025) and emphysema (p = 0.013), and the odds ratio on a deceased patient having diabetes and emphysema was 6 times and 21 times the odds ratio on a recovered patient having diabetes and emphysema, respectively. CONCLUSIONS: Older patients with comorbidities such as diabetes and emphysema, and higher CRP and NLRs with diffuse lung involvement were more likely to die of COVID-19. KEY POINTS: • Almost all patients critically ill with COVID-19 pneumonia had five lung lobes involved. • Medial or parahilar area involvement and degree of lung involvement were more serious in the deceased patients when compared with those who recovered from treatment. • Chronic lung disease, e.g., emphysema, diabetes, and higher serum CRP and NLR characterized patients who died of COVID-19.

Interpretation of CT signs of 2019 novel coronavirus (COVID-19) pneumonia.

OBJECTIVES: To characterize and interpret the CT imaging signs of the 2019 novel coronavirus (COVID-19) pneumonia in China. MATERIALS AND METHODS: The CT images of 130 patients diagnosed as COVID-19 pneumonia from several hospitals in China were collected and their imaging features were analyzed and interpreted in detail. RESULTS: Among the 130 patients, we can see (1) distribution: 14 cases with unilateral lung disease and 116 cases with bilateral disease, the distribution was mainly lobular core (99 cases) and subpleural (102 cases); (2) number: 9 cases with single lesion, 113 cases with multiple lesions, and 8 cases with diffuse distribution; (3) density: 70 cases of pure ground glass opacity (GGO), and 60 cases of GGO with consolidation; (4) accompanying signs: vascular thickening (100 cases), "parallel pleura sign" (98 cases), "paving stone sign" (100 cases), "halo sign" (18 cases), "reversed halo sign" (6 cases), pleural effusion (2 cases), and pneumonocele (2 cases). After follow-up CT examination on 35 patients, 21 cases turned better and 14 became worse. There were signs of consolidation with marginal contraction, bronchiectasis, subpleural line, or fibrous streak. CONCLUSION: GGO and consolidation are the most common CT signs of COVID-19 pneumonia, mainly with lobular distribution and subpleural distribution. The main manifestations were tissue organization and fibrosis at late stage. The most valuable features are the parallel pleura sign and the paving stone sign. KEY POINTS: • The CT signs of the COVID-19 pneumonia are mainly distributed in the lobular core, subpleural and diffused bilaterally. • The CT signs include the "parallel pleura sign," "paving stone sign," "halo sign," and "reversed halo sign." • During the follow-up, the distribution of lobular core, the fusion of lesions, and the organization changes at late stage will appear.

Application of CareDose 4D combined with Karl 3D technology in the low dose computed tomography for the follow-up of COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the new coronavirus. Previous studies have shown that the chest CT examination plays an important role in the diagnosis and monitoring of COVID-19. However, some patients with COVID-19 had low white blood cell counts and reduced lymphocyte ratios. Multiple CT examinations may cause radiation damages as well as increase the apoptosis of peripheral blood lymphocytes. A new low-dose CT method should be developed because the regular CT may aggravate the disease. METHOD: Sixty cases were randomly divided into the study group (n = 30) and control group (n = 30). The lung window was reconstructed by Karl 3D iterative technique in the study group. The image quality was subjectively evaluated by two senior chest group diagnostic physicians using a 5-point double-blind method. The value of CT measurement and its standard deviation (SD) was used as an objective evaluation criteria. The volume of CT dose index (CTDIvol), dose length product (DLP) and effective dose (ED) from the two groups were compared and analyzed statistically. RESULT: There was no significant difference in the occurrence rates of ground glass opacities, consolidation, crazy-paving pattern, fiber cable shadow and axial interstitial thickening between the study group and control group (p > 0.05). In addition, no significant difference was found for the subjective score of overall image quality and image noise level (SD) between the two groups (p > 0.05). However, significant differences was found in CTDIvol, DLP, and ED between the study group and the control group (p < 0.05). The effective dose of the study group was reduced by 76% compared to the control group. CONCLUSION: CareDose 4D low-dose scanning combined with Karl 3D iterative reconstruction technology can not only greatly reduce the radiation dose, but also provide images that meet the diagnostic criteria of COVID-19, which can be used as a routine method for the follow-up of COVID-19 patients.

Case Report: Fainting During Acupuncture Treatment.

CONTEXT: The first issue to be considered in acupuncture is the safety of and adverse effects from treatment. Fainting is an uncommon adverse reaction. Some researchers believe that fainting is related to the mechanism underlying acupuncture treatment, but due to moral and technical issues, studies involving fainting during the acupuncture process haven't been conducted. OBJECTIVE: The study intended to determine if specific risk factors are associated with fainting during acupuncture treatment. DESIGN: The research team performed 2 case studies involving fainting during acupuncture. SETTING: The study took place in the Physiotherapy Departments of the Leribe Motebang Hospital and the Mamohau Hospital in the Kingdom of Lesotho. PARTICIPANTS: Participants were 2 out of 2050 patients who received acupuncture treatment between October 2017 and April 2018 at one of the hospitals. They had fainted, with different clinical manifestations, during acupuncture treatment. Their main symptoms were dizziness, general weakness associated forehead sweating, palpitations, dyspnea, and nausea. RESULTS: In both cases, the patient had complained of hunger before treatment. Both claimed that they had never experienced such a situation previously. CONCLUSIONS: The research team suggests that the fainting occurred for the patients in the two case studies secondary to the hungry state. Hunger may be one of the most important causes of fainting connected to acupuncture. The failure of a practitioner to perform treatment for fainting in a timely and effective manner, or his or her improper handling of it, can lead to serious consequences. Therefore, factors that may cause fainting should be minimized to avoid their occurrence during acupuncture.

Challenging anticoagulation therapy for multiple primary malignant tumors combined with thrombosis: A case report and review of literature.

BACKGROUND: Venous thromboembolism significantly contributes to patient deterioration and mortality. Management of its etiology and anticoagulation treatment is intricate, necessitating a comprehensive consideration of various factors, including the bleeding risk, dosage, specific anticoagulant medications, and duration of therapy. Herein, a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience. CASE SUMMARY: An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d. Considering her medical history and relevant post-admission investigations, it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors, including multiple primary malignant tumors, iliac venous compression syndrome, previous novel coronavirus infection, and inadequate treatment for prior thrombotic events. However, the selection of appropriate anticoagulant medications, determination of optimal drug dosages, and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia, decreased quantitative fibrinogen levels, and renal insufficiency. CONCLUSION: Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis. Individualized anticoagulation therapy is required for complex thrombosis.

Rare Case of Cystic Lymphangioma Transforming Into Lymphangiosarcoma: A Case Report.

Cystic lymphangioma (CL) is a rare benign tumor that mainly occurs in the neck and axilla and usually occurs in children, whereas lymphangiosarcoma (LAS) is a rare invasive tumor, usually secondary to chronic lymphedema caused by various causes, with a rare malignant transformation from CL. We presented the case of a 63-year-old woman who underwent four surgical excisions for multiple recurrence of CL in the right groin. The changes of imaging and pathological examination revealed the unusual process of its gradual malignant transformation into LAS. We followed up the patient for 16 years, and she eventually died of LAS complications.

Effectiveness and Safety of Saccharomyces Boulardii for the Treatment of Acute Gastroenteritis in the Pediatric Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective: To explore the efficacy and safety of Saccharomyces boulardii for the treatment of acute gastroenteritis in children aged under 5. Methods: Two independent researchers retrieved literature from PubMed, OVID, Embase, ScienceDirect, and other databases, followed by extracting indicators of the primary endpoints. Cochrane Q test and I 2 statistics were used to evaluate interstudy heterogeneity. The relative risk (RR) and mean difference (MD) of related indicators were calculated and combined using the random- or fixed-effect model, as appropriate. Furthermore, the funnel plot and Egger's test were used to evaluate the publication bias. A two-sided P < 0.05 denoted statistical significance. Results: 10 articles were included in this meta-analysis, with a total of 1282 children having acute gastroenteritis. The use of Saccharomyces boulardii in children with acute gastroenteritis could effectively shorten diarrhea duration (MD = 19.70, 95% CI: -24.87, 14.52) and reduce the length of hospital stay (MD = -0.91, 95% CI: -1.28, -0.54). Compared with the control group, the RR of continued diarrhea was significantly lower in the treatment group after 1 day treatment (RR = -0.31, 95% CI: 0.59, 0.03) and 3 days treatment (RR = 0.52, 95% CI: 0.41, 0.66). In addition, treatment with Saccharomyces boulardii reduced the average number of diarrhea after 3 days of treatment by about 1.03 (MD = -1.03, 95% CI: -1.53, -0.53). There were no adverse drug reactions in both groups. Conclusion: The use of probiotic Saccharomyces boulardii can significantly improve the symptoms of diarrhea in children with acute gastroenteritis and reduce the duration of diarrhea symptoms and the time of hospitalization. Meanwhile, the RR of continued diarrhea in children after 1 and 3 days of Saccharomyces boulardii treatment and the frequency of diarrhea after 3 days of Saccharomyces boulardii treatment were decreased. It is also safe and does not increase the incidence of adverse drug reactions.

Dynamic changes on chest CT of COVID-19 patients with solitary pulmonary lesion in initial CT.

PURPOSE: To investigate the dynamic evolution of image features of COVID-19 patients appearing as a solitary lesion at initial chest CT scan. MATERIALS AND METHODS: Twenty-two COVID-19 patients with solitary pulmonary lesion from three hospitals in China were enrolled from January 18, 2020 to March 18, 2020. The clinical feature and laboratory findings at first visit, as well as characteristics and dynamic evolution of chest CT images were analyzed. Among them, the CT score evaluation was the sum of the lung involvement in five lobes (0-5 points for each lobe, with a total score ranging from 0 to 25). RESULTS: 22 COVID-19 patients (11 males and 11 females, with an average age of 40.7 ± 10.3) developed a solitary pulmonary lesion within 4 days after the onset of symptoms, the peak time of CT score was about 11 days (with a median CT score of 6), and was discharged about 19 days. The peak of CT score was positively correlated with the peak time and the discharge time (p < 0.001, r = 0.793; p < 0.001, r = 0.715). Scan-1 (first visit): 22 cases (100%) showed GGO and one lobe was involved, CT score was 1.0/1.0 (median/IQR). Scan-2 (peak): 15 cases (68%) showed crazy-paving pattern, 19 cases (86%) showed consolidation, and 2.5 lobes were involved, CT score was 6.0/12.0. Scan-3 (before discharge): ten cases (45%) showed linear opacities, none had crazy-paving pattern, and 2.5 lobes were involved, CT score was 6.0/11.0. Scan-4 (after discharge): three cases (19%) showed linear opacities and one lobe was involved, CT score was 2.0/5.0. CONCLUSION: The chest CT features are related to the course of COVID-19 disease, and dynamic chest CT scan are helpful to monitor disease progress and patients' condition. In recovered patients with COVID-19, the positive CT manifestations were found within 4 days, lung involvement peaking at approximately 11 days, and discharged at about 19 days. The patients with more severe the lung injury was, the later the peak time appeared and the longer the recovery time was. Although the lesion was resolved over time, isolation and reexamination were required after discharge.

Small Solitary Ground-Glass Nodule on CT as an Initial Manifestation of Coronavirus Disease 2019 (COVID-19) Pneumonia.

The 2019 novel coronavirus (2019-nCoV) outbreak in Wuhan, Hubei Province, China in 2019 led to large numbers of people being infected and developing atypical pneumonia (coronavirus disease 2019, COVID-19). Typical imaging manifestations of patients infected with 2019-nCoV has been reported, but we encountered an atypical radiological manifestation on baseline computed tomography (CT) images in three patients from Wuhan, China infected with the 2019-nCoV. Surprisingly, the only similar CT finding was a solitary sub-centimeter ground-glass nodule adjacent to bronchovascular bundles, which could be easily overlooked. In addition, the follow-up images in these patients showed how COVID-19 pneumonia evolved from these small nodules. The radiologic manifestation of the three cases will expand contemporary understanding of COVID-19.

A systematic review of chest imaging findings in COVID-19.

Chest computed tomography (CT) is frequently used in diagnosing coronavirus disease 2019 (COVID-19) for detecting abnormal changes in the lungs and monitoring disease progression during the treatment process. Furthermore, CT imaging appearances are correlated with patients presenting with different clinical scenarios, such as early versus advanced stages, asymptomatic versus symptomatic patients, and severe versus nonsevere situations. However, its role as a screening and diagnostic tool in COVID-19 remains to be clarified. This article provides a systematic review and meta-analysis of the current literature on chest CT imaging findings with the aim of highlighting the contribution and judicious use of CT in the diagnosis of COVID-19. A search of PubMed/Medline, Web of Science, ScienceDirect, Google Scholar and Scopus was performed to identify studies reporting chest imaging findings in COVID-19. Chest imaging abnormalities associated with COVID-19 were extracted from the eligible studies and diagnostic value of CT in detecting these abnormal changes was compared between studies consisting of both COVID-19 and non-COVID-19 patients. A random-effects model was used to perform meta-analysis for calculation of pooled mean values and 95% confidence intervals (95% CI) of abnormal imaging findings. Fifty-five studies met the selection criteria and were included in the analysis. Pulmonary lesions more often involved bilateral lungs (78%, 95% CI: 45-100%) and were more likely to have a peripheral (65.35%, 95% CI: 25.93-100%) and peripheral plus central distribution (31.12%, 95% CI: 1.96-74.07%), but less likely to have a central distribution (3.57%, 95% CI: 0.99-9.80%). Ground glass opacities (GGO) (58.05%, 95% CI: 16.67-100%), consolidation (44.18%, 95% CI: 1.61-71.46%) and GGO plus consolidation (52.99%, 95% CI: 19.05-76.79%) were the most common findings reported in 94.5% (52/55) of the studies, followed by air bronchogram (42.50%, 95% CI: 7.78-80.39%), linear opacities (41.29%, 95% CI: 7.44-65.06%), crazy-paving pattern (23.57%, 95% CI: 3.13-91.67%) and interlobular septal thickening (22.91%, 95% CI: 0.90-80.49%). CT has low specificity in differentiating pneumonia-related lung changes due to significant overlap between COVID-19 and non-COVID-19 patients with no significant differences in most of the imaging findings between these two groups (P>0.05). Furthermore, normal CT (13.31%, 95% CI: 0.74-38.36%) was reported in 26 (47.3%) studies. Despite widespread use of CT in the diagnosis of COVID-19 patients based on the current literature, CT findings are not pathognomonic as it lacks specificity in differentiating imaging appearances caused by different types of pneumonia. Further, there is a relatively high percentage of normal CT scans. Use of CT as a first-line diagnostic or screening tool in COVID-19 is not recommended.

Medullary and papillary thyroid carcinomas in a patient with a C634Y mutation in the RET proto-oncogene: A case report.

A 41 year old man presented with a familial history of multiple endocrine neoplasia type 2A (MEN2A) and severe hypertension. Rearranged during transfection (RET) gene sequencing confirmed a Cys634Tyr mutation of TGC to TAC. Total thyroidectomy and bilateral neck dissection were performed and the pathological assessment revealed a medullary thyroid carcinoma (MTC), 0.6 cm in size on the right side (number of lymph nodes: 0/2, 0/15, 0/12, and 0/8 in areas VI, II, III, and IV, respectively) and a papillary thyroid carcinoma (PTC), 0.2 cm in size on the left side (numbers of lymph nodes: 2/6, 0/3, 0/10, and 0/6 in areas VI, II, III, and IV, respectively). There were no pathological changes in the MTC observed in the thyroid tissues on the left side. We believe that the follow-up of patients with both MTC and PTC should utilize a combination of the respective principles for rational disease reassessment.

[Computed tomographic analysis of frontal recess region].

OBJECTIVE: The purpose of the study was to observe the CT imaging features of the frontal recess regional. METHOD: Eighty-two patients were undergone spiral computed tomography (CT). Then multiplanar reconstruction images were made using standard triplanar reconstruction protocol on a computer workstation. RESULT: The prevalence of agger nasi cell was 87.8% (144/164). One hundred and forty-five (89%, 145/164) uncinate processes had one superior attachment for each uncinate process. The others had two superior attachments for each uncinate process. The uncinate process' single superior attachment of into the surrounding structures was identified to have the following distribution: 90/164 (54.9%): to the lamina papyracea, 50/164 (30.5%) to the middle turbinate, and 5/164 (3.0%) to the skull base. Of all the frontal cells were identified in 144 (87.8%) sides of frontal recesses, the prevalence of type I II, type III IV, were 30.5% and 9.8% respectively. CONCLUSION: T Agger nasi cell and uncinate process play an important role in endoscopic frontal sinus surgery.