Artificial intelligence (AI) adopting deep learning technology has been widely used in the med-ical imaging domain in recent years. It realized the automatic judgment of benign and malig-nant solitary pulmonary nodules (SPNs) and even replaced the work of doctors to some extent. However, misdiagnoses can occur in certain cases. Only by determining the causes can AI play a larger role. A total of 21 Coronavirus disease 2019 (COVID-19) patients were diagnosed with SPN by CT imaging. Their Clinical data, including general condition, imaging features, AI re-ports, and outcomes were included in this retrospective study. Although they were confirmed COVID-19 by testing reverse transcription-polymerase chain reaction (RT-PCR) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), their CT imaging data were misjudged by AI to be high-risk nodules for lung cancer. Imaging characteristics included burr sign (76.2%), lobulated sign (61.9%), pleural indentation (42.9%), smooth edges (23.8%), and cavity (14.3%). The accuracy of AI was different from that of radiologists in judging the nature of be-nign SPNs (p < 0.001, κ = 0.036 < 0.4, means the two diagnosis methods poor fit). COVID-19 patients with SPN might have been misdiagnosed using the AI system, suggesting that the AI system needs to be further optimized, especially in the event of a new disease outbreak.
Except for the traditional chemotherapy, few treatments strategy about miliary intrapulmonary carcinomatosis (MIPC) have been reported in the existing literature. In this report, we primarily discussed the possible etiology and the potentially effective treatment options for a patient with MIPC who benefited from combined treatment. A nonsmoking woman was diagnosed with MIPC at an advanced stage. Gene detection showed an EGFR negative status. She accepted first-line chemotherapy with pemetrexed and cisplatin, and the tumor progressed. Next, PD-1 inhibitors plus pemetrexed and cisplatin were administered, and the tumor remained uncontrolled. After two cycles of recombinant human endostatin plus second-line chemotherapy, the numerous pulmonary nodules had all nearly completely disappeared, while an accentuated decrease in the primary tumor volume was observed. Moreover, biochemical markers, including the patient's tumor markers, also trended toward normal. This report describes the first case of a MIPC patient who significantly responded to antiangiogenic therapy combined with chemotherapy. Anti-angiogenic therapy may be a possible strategy for the EGFR-negative lung adenocarcinoma population.
There have been almost no reports on the technique of dynamic volume computed tomography angiography (DVCTA) in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Twelve children with ALCAPA, aged 5 months to 15 years, were enrolled in this retrospective study to explore the clinical value of DVCTA in the diagnosis of ALCAPA in children. All patients underwent low-dose prospective ECG-gated 320-slice DVCTA and transthoracic echocardiography. Two radiologists evaluated the image quality of the DVCTA and recorded the radiation dose at the same time. The accuracy of DVCTA in the diagnosis of ALCAPA was 100%, with the left coronary artery (LCA) opening in the left wall of the pulmonary artery in 4 cases (33.3%), the right wall in 2 cases (16.7%), and the posterior wall in 6 cases (50.0%). All children completed 320-slice DVCTA at a single timepoint; all of the images were diagnosable, and the subjective score was 3.3±0.6, with good consistency between the evaluations performed by the two radiologists (k=0.79). From the echocardiographs of these cases, 4 cases (33.3%) of ALCAPA were diagnosed correctly, 4 cases (33.3%) were misdiagnosed as LCA-pulmonary artery fistula, and 4 cases (33.3%) were missed, including a small LCA that was not displayed in 2 cases. The average CT radiation dose was 0.83±0.57 mSv. Low-dose DVCTA clearly showed the origin, course, and collateral vessels of ALCAPA and could be used reliably for noninvasive diagnosis of ALCAPA in children.
The aim of this study was to evaluate factors affecting the recurrence of positive RT-PCR results. By performing a retrospective analysis, we evaluated the clinical data of recurrent positive coronavirus disease 2019 (COVID-19) patients in multiple medical institutions in Wuhan. We recruited COVID-19 patients who were hospitalized from January 1 to March 10, 2020, in three tertiary hospitals in Wuhan, met the discharge criteria and received at least one additional nucleic acid test before leaving the hospital. According to the RT-PCR results, patients were split into a recurrent positive group (RPos group) and a nonrecurrent positive group (non-RPos group). Clinical characteristics, therapeutic schedules and antibody titers were compared between the two groups. AI-assisted chest high-resolution computed tomography (HRCT) technology was applied to investigate pulmonary inflammatory exudation and compare the extent of lung areas with different densities. This study involved 122 COVID-19 patients. There were no significant differences in age, sex, preexisting diseases, clinical symptoms, clinical classification, course of disease, therapeutic schedules or serum-specific antibodies between the two groups. A higher proportion of patients who showed pulmonary inflammatory exudation on HRCT scans were recurrent positive at the time of discharge than other patients (81.6% vs 13.7%, P < 0.01). In addition, the degree of pulmonary fibrosis was higher in the RPos group than in the non-RPos group (P < 0.05). Subpleural exudation at the peripheral edge of the lung and extensive pulmonary fibrosis at the time of discharge represent risk factors for the recurrence of COVID-19.
The characteristics and evolution of pulmonary fibrosis in patients with coronavirus disease 2019 (COVID-19) have not been adequately studied. AI-assisted chest high-resolution computed tomography (HRCT) was used to investigate the proportion of COVID-19 patients with pulmonary fibrosis, the relationship between the degree of fibrosis and the clinical classification of COVID-19, the characteristics of and risk factors for pulmonary fibrosis, and the evolution of pulmonary fibrosis after discharge. The incidence of pulmonary fibrosis in patients with severe or critical COVID-19 was significantly higher than that in patients with moderate COVID-19. There were significant differences in the degree of pulmonary inflammation and the extent of the affected area among patients with mild, moderate and severe pulmonary fibrosis. The IL-6 level in the acute stage and albumin level were independent risk factors for pulmonary fibrosis. Ground-glass opacities, linear opacities, interlobular septal thickening, reticulation, honeycombing, bronchiectasis and the extent of the affected area were significantly improved 30, 60 and 90 days after discharge compared with at discharge. The more severe the clinical classification of COVID-19, the more severe the residual pulmonary fibrosis was; however, in most patients, pulmonary fibrosis was improved or even resolved within 90 days after discharge.
Artificial Intelligence , COVID-19/pathology , Pulmonary Fibrosis/diagnosis , Thorax/diagnostic imaging , COVID-19/complications , COVID-19/virology , Female , Humans , Image Processing, Computer-Assisted , Interleukin-6/metabolism , Male , Middle Aged , Patient Discharge , Pulmonary Fibrosis/etiology , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index , Tomography, X-Ray Computed
BACKGROUND: COVID-19 patients showed certain characteristic features of multiple signs in bilateral lungs. Some patients only had a single pulmonary lobe lesion, which has not been reported previously. Single pulmonary lobe lesions are easily missed or misdiagnosed if they do not receive enough attention. OBJECTIVE: To study the imaging manifestations, clinical features and outcomes of patients with COVID-19 with only one single pulmonary lobe lesion. METHODS: Patient clinical data were collected only from patients with confirmed SARS-CoV-2 infection by RT-PCR, which was confined to only single lobe lesions on chest CT imaging findings at the onset. Which lobe was frequently involved, the imaging manifestations, clinical features and outcomes were also analyzed. RESULT: From January 1, 2020, to March 14, 2020, a total of 367 inpatients were diagnosed with COVID-19, in which 50 (13.6%) patients were confirmed with only one single pulmonary lobe lesion. The most frequently involved lobe was the right lower lobe (18 patients, 36%, highest). Lesions in the lower lobe easily spread to all lobes of the bilateral lungs (P<0.001, χ2=10.264), especially the left lower lobe, and were less frequent in the right upper lobe. During hospitalization, 2 (4%) patients were admitted to the ICU, 2 (4%) patients died, and 28 (56%) patients developed lesions in other lobes within 6.32±3.71 days. CONCLUSIONS: The general pattern of COVID-19 imaging with localized nodules may also cause severe respiratory symptoms of bilateral lung disease, serious complications, or even death in patients with multiple lobe lesions or bilateral lung lesions, which should not be underestimated.
To explore the possibility of predicting the clinical types of Corona-Virus-Disease-2019 (COVID-19) pneumonia by analyzing the non-focus area of the lung in the first chest CT image of patients with COVID-19 by using automatic machine learning (Auto-ML). 136 moderate and 83 severe patients were selected from the patients with COVID-19 pneumonia. The clinical and laboratory data were collected for statistical analysis. The texture features of the Non-focus area of the first chest CT of patients with COVID-19 pneumonia were extracted, and then the classification model of the first chest CT of COVID-19 pneumonia was constructed by using these texture features based on the Auto-ML method of radiomics, The area under curve(AUC), true positive rate(TPR), true negative rate (TNR), positive predictive value(PPV) and negative predictive value (NPV) of the operating characteristic curve (ROC) were used to evaluate the accuracy of the first chest CT image classification model in patients with COVID-19 pneumonia. The TPR, TNR, PPV, NPV and AUC of the training cohort and test cohort of the moderate group and the control group, the severe group and the control group, the moderate group and the severe group were all greater than 95% and 0.95 respectively. The non-focus area of the first CT image of COVID-19 pneumonia has obvious difference in different clinical types. The AUTO-ML classification model of Radiomics based on this difference can be used to predict the clinical types of COVID-19 pneumonia.
Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Machine Learning , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , COVID-19 , Coronavirus Infections/pathology , Female , Humans , Lung/pathology , Male , Middle Aged , Pandemics , Pneumonia, Viral/pathology
A new catalytic system based on the readily available Zn, (i)PrI, H8BINOL, and Ti(O(i)Pr)4 has been developed which avoids the use of pyrophoric ZnEt2. It can effectively catalyze the reaction of various terminal alkynes with aromatic, aliphatic, and vinyl aldehydes to generate chiral propargylic alcohols at room temperature with up to 98% yield and 98% enantiomeric excess. This new system signifciantly expands the substrate scope of the previously reported system using Zn, EtI, BINOL, and Ti(O(i)Pr)4.
In the title compound, C(14)H(10)Cl(2)INO(3)S, the dihedral angle between the benzene rings is 52.13â (10)°. In the crystal, the components are linked by pairs of N-Hâ¯O(sulfon-yl) hydrogen bonds into centrosymmetric dimers.
OBJECTIVE: To investigate the value of high b value diffusion-weighted (DW) imaging in differentiating between pancreatic carcinoma and mass-forming chronic pancreatitis (MFCP). METHODS: Fifty-one consecutive patients with pathology-proven pancreatic carcinoma (n = 37) or MFCP (n = 14) were evaluated with DW imaging (b value, 0 and 1000 s/mm(2)) at a 3-T MR system. Overall 20 healthy volunteers were evaluated as the control group. The apparent diffusion coefficient (ADC) values of normal pancreas, pancreatic carcinoma, MFCP, and mass-associated obstructive pancreatitis were measured. RESULTS: On high b value (1000 s/mm(2) ) DW images, both pancreatic carcinoma and MFCP were hyperintense focal lesions; mass-associated obstructive pancreatitis occurred in 17 of 37 (45.9%) pancreatic carcinoma and 8 of 14 (57.1%) MFCP. The ADC (×10(-3) mm(2) /s) of the pancreatic carcinomas (1.06 ± 0.15) was significantly lower than that of normal pancreas (1.47 ± 0.18; P < 0.01), MFCP (1.35 ± 0.14; P < 0.01) and mass-associated chronic pancreatitis (1.44 ± 0.17; P < 0.01). The ADC of MFCP was also lower than that in the normal pancreas (P = 0.025), whereas the ADC of mass-associated obstructive pancreatitis was not different from those of the MFCP (P = 0.113) and normal pancreas (P = 0.544). When 1.195 was used as the optimal cut-off value, ADC quantification obtained a sensitivity of 85.7% and a specificity of 86.5% for differentiating pancreatic carcinomas from MFCP. CONCLUSION: High b value DW imaging in combination with ADC quantification at a 3-T MR system is useful in differentiating between pancreatic carcinoma and MFCP.
Diffusion Magnetic Resonance Imaging/methods , Pancreatic Neoplasms/diagnosis , Pancreatitis, Chronic/diagnosis , Adult , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged
In a cell-based screen of novel antiproliferative agents, the hit compound 1a, which bears a benzofuransulfonamide scaffold, exhibited broad-spectrum antiproliferative activities against a panel of tumor cell lines. The promising in vitro antiproliferative activity and structural novelty of 1a prompted us to investigate the synthesis of five analogs of 1a and test their antiproliferative activities. The most potent analogue, 1h, exhibited enhanced antiproliferative activities compared with the parent 1a, and exhibited an IC(50) value against NCI-H460 cells of 4.13 µM compared with 4.52 µM for the positive control cisplatin. Flow cytometric analysis revealed that 1h induces significant levels of apoptosis in NCI-H460 cells in vitro at low micromolar concentrations. These results suggest that 1a and analogs based on its benzofuransulfonamide scaffold may constitute a novel class of antiproliferative agents, which deserve further study.
Antineoplastic Agents/chemical synthesis , Antineoplastic Agents/pharmacology , Benzofurans/pharmacology , Sulfonamides/pharmacology , Antineoplastic Agents/chemistry , Benzofurans/chemical synthesis , Benzofurans/chemistry , Cell Line, Tumor , Cell Proliferation/drug effects , Chemistry Techniques, Synthetic , Crystallography, X-Ray , Dose-Response Relationship, Drug , Drug Screening Assays, Antitumor , HeLa Cells , Humans , Inhibitory Concentration 50 , Models, Molecular , Molecular Structure , Stereoisomerism , Structure-Activity Relationship , Sulfonamides/chemical synthesis , Sulfonamides/chemistry
Cyanoimidation of aldehydes using cyanamide as a nitrogen source and using NBS as an oxidant was achieved in high yields without the addition of a catalyst. The method has several advantages, including mild conditions, simple workflow, and inexpensive reagents. The reaction proceeds in a one-pot manner, giving rise to the formation of intermolecular C-N and C-O bonds. Subsequently, the substituted N-cyanobenimidate products may also undergo a cyclization reaction to give l,2,4-triazole derivatives in high yields.
Aldehydes/chemistry , Triazoles/chemical synthesis , Catalysis , Combinatorial Chemistry Techniques , Cyclization , Molecular Structure , Nitriles/chemistry , Oxidants/chemistry , Triazoles/chemistry
In the mol-ecule of the title compound, C(15)H(15)NO(4)S, the two six-membered rings are almost parallel to each other [dihedral angle = 1.87â (9)°] and perpendicular to the mean plane through the five-membered ring [dihedral angles of 89.98â (10) and 89.04â (10)°]. The crystal structure is stabilized by inter-molecular C-Hâ¯O hydrogen-bonding inter-actions.
The title compound, C(16)H(18)N(2)O(2)S, was obtained as an unexpected product while attempting to form carbon-nitro-gen bonds by catalytic amidation. The mol-ecule displays an E conformation about the C=N double bond. The planes of the two aromatic rings in the mol-ecule form a dihedral angle of 47.06â (9)°.
The mol-ecule of the title compound, C(9)H(6)Cl(2)N(2)O, displays an E conformation about the C=N double bond. The N-cyano-imidate fragment is substanti-ally planar [maximum deviation 0.010â (4)â Å] and perpendicular to the benzene ring [dihedral angle = 88.50â (14)°]. In the crystal packing, inter-molecular Clâ¯Cl inter-actions [3.490â (2)â Å] are observed.
The title compound, C(21)H(23)NO(7)S, is an important inter-mediate in the synthesis of poly(amido-amine) dendrimers. The cyclo-hexane ring adopts a chair conformation. The dihedral angle between the two aromatic rings is 69.5â (2)°. The mol-ecules are linked into a zigzag chain along the b axis by C-Hâ¯O hydrogen bonds.
The title compound, C(15)H(20)O(5)S, is an inter-mediate in the synthesis of a new type of poly(amido-amine) (PAMAM) dendrimer. The cyclo-hexane ring exhibits a chair conformation, with C-C bond lengths in the range 1.518â (3)-1.531â (3)â Å and C-C-C angles in the range 110.45â (19)-112.09â (19)°; these agree well with the values in other cyclo-hexane derivatives described in the literature. In the crystal structure, adjacent mol-ecules are linked by O-H⯷O hydrogen bonds. The H atoms of the methyl group are disordered equally over two positions.
The title compound, C(14)H(18)O(3), is an important model compound in the synthesis of phenolic ethers. The cyclo-hexane ring adopts a chair conformation. In the crystal structure, adjacent mol-ecules are linked by O-Hâ¯O hydrogen bonds.
The title compound, C(16)H(22)O(3), is a useful inter-mediate in the synthesis of poly(amido-amine) dendrimers. The cyclo-hexane ring adopts a chair conformation. In the crystal structure, mol-ecules are linked into centrosymmetric dimers by pairs of O-Hâ¯O hydrogen bonds.
