Structural and Functional Pulmonary Assessment in Severe COVID-19 Survivors at 12 Months after Discharge.

Long-term pulmonary sequelae in COVID-19 patients are currently under investigation worldwide. Potential relationships between blood sampling and functional and radiological findings are crucial to guide the follow-up. In this study, we collected and evaluated clinical status, namely symptoms and patients' reported outcome, pulmonary function tests (PFT), laboratory tests, and radiological findings at 3- and 12-months post-discharge in patients admitted between 25 February and 2 May 2020, and who survived severe COVID-19 pneumonia. A history of chronic pulmonary disease or COVID-19-unrelated complications were used as exclusion criteria. Unenhanced CTs were analyzed quantitatively (compromising lung volume %) and qualitatively, with main patterns of: ground-glass opacity (GGO), consolidation, and reticular configuration. Patients were subsequently divided into groups based on their radiological trends and according to the evolution in the percentage of compromised lung volume. At 12 months post-discharge, seventy-one patients showed significantly improved laboratory tests and PFT. Among them, 63 patients also underwent CT examination: all patients with negative CT findings at three months (n = 14) had negative CT also at 12 months; among the 49/63 patients presenting CT alterations at three months, 1/49 (2%) normalized, 40/49 (82%) improved, 7/49 (14%) remained stably abnormal, and 1/49 (2%) worsened. D-dimer values were low in patients with normal CT and higher in cases with improved or stably abnormal CT (median values 213 vs. 329 vs. 1000 ng/mL, respectively). The overall compromised lung volume was reduced compared with three months post-discharge (12.3 vs. 14.4%, p < 0.001). In stably abnormal CT, the main pulmonary pattern changed, showing a reduction in GGO and an increase in reticular configuration. To summarize, PFT are normal in most COVID-19 survivors 12 months post-discharge, but CT structural abnormalities persist (although sensibly improved over time) and are associated with higher D-dimer values.

Influence of the volume of restorative material on the concentration of stresses in the restorative interface.

BACKGROUND: To evaluate the microtensile strength in the adhesive interface depending on the volume of the composite resin used to restore class I cavities. MATERIAL AND METHODS: Forty-eight human third molars received a standardized class I cavity preparation and they were separated into six experimental groups: G1 - single-bottle adhesive system; G2 - bonding system with load; G3 - single-bottle adhesive associated with low-viscosity composite resin; G4 - loaded adhesive associated with low-viscosity composite; G5 - resin-modified glass ionomer associated with single-bottle adhesive; and G6 - resin-modified glass ionomer associated with loaded adhesive. All cavities were restored with a universal restorative composite. After completing the restorations, the samples were stored for seven days in a stove (37°C) and the microtensile bond strength was evaluated by producing slices and applying axial loading in an Instron universal testing machine at a speed of 0.5 mm/min. The thickness of the intermediate layer formed on the cavity floor to verify the relationship between the volume of restorative composite and the concentration of stresses in the buccal wall. With the data obtained in the microtensile strength test, an Analysis of Variance (ANOVA) was performed entirely at random. RESULTS: Duncan's test showed that group 4 (Filtek Flow/Optibond Solo Plus) obtained the highest mean of microtensile strength with no statistically significant difference to groups 3 (Filtek Flow/Single Bond), 5 (Vitremer/Single Bond), and 6 (Vitremer/Optibond Solo Plus). It also showed a statistically significant difference to groups 2 (Optibond Solo Plus) and 1 (Single Bond), with no statistical difference between the other groups studied. CONCLUSIONS: The highest mean of microtensile strength was obtained when the volume of the restorative material decreased through the interposition between the material and the adhesive system of a base with low elasticity modulus. Key words:Adhesion, microtensile, composite resin.

Imaging of liver fusion and vascular intra-hepatic shunts in omphalopagus conjoined twins: The role of a double CT study.

Omphalopagus twins are joined ventrally in the umbilical region. In omphalopagus twins, liver's fusion is very frequent, being present in about 80% of cases. Two conjoined twins born in our Hospital were evaluated using plain x-rays, ultrasound (US), gastrointestinal xrays, Tc-99 hepatobiliary scintigraphy (SC) and contrast enhanced computed tomography (CT). There was no bony connection on conventional xrays, neither bowel communication on GI x-rays study. US demonstrated the fusion of left hepatic lobes and a not-quantifiable vascular shunt. Normal biliary function was demonstrated by Tc-99 SC. The first CT scan (twin A) showed irregular lobules in the site of hepatic fusion, a portoportal shunt and a venous vessel to the inferior vena cava of twin B. Only the second CT scan (twin B) showed an arterio-arterial partiallyextrahepatic shunts. The double CT scan allows to increase the probability of a correct individuation and description of vascular shunts for an effective preoperatory assessment. The omphalopagus twins in our case underwent planned surgical separation at 5 months of age. The surgery lasted 5 h and was not affected by any intraoperative complications.

Tracheal diverticula: A retrospective analysis of patients referred for thoracic CT.

To assess the prevalence of tracheal diverticula (TD) in patients referred for thoracic Computed Tomography (CT).1679 consecutive patients subjected to thoracic CT examination for different causes, from January to June 2017, were included in this cohort study. CT was performed with a 64 slice CT, using a standard protocol and Multiplanar Reformat Images (MPR). A TD was defined as a thin-walled air sac at the paratracheal wall with a communication with the tracheal lumen. Congenital or acquired nature of TD was determined by the anatomical location, being usually the congenital ones located 4 to 5 cm below the vocal cords or a few centimeters above the carina in the right paratracheal area, whereas acquired ones were located at the level of the thoracic inlet, in the posterolateral tracheal wall. Presence of TD was assessed and their number and size recorded based on 2 axial diameters and size of neck.One or more TD were found in 96 patients (5.7% of sample), with a slight preponderance (65%) in male gender. Globally, 124 TD were detected; they were solitary in 75% of cases, double in 20.8%, and in about 4.2% they were triple. Average size of the TD was 1.3×4.9 mm with a mean width of the neck of 1.9 mm. The peak of prevalence (9%) was in patients belonging to the fourth-decade group (see ). According to their anatomical location, the majority (97.6%) of TD were acquired in nature and devoided of specific symptoms (see below).(Table is included in full-text article.)Acquired TD were detected in about 1 out of 20 of thoracic CTs and were usually incidentally. Our findings show a slightly higher frequency than previously reported. The most frequent presentation was in male and as a single entity. Clinically, TD was not associated with specific symptoms, in particular with chronic cough or Chronic Obstructive Pulmonary Disease (COPD).

The proton pump inhibitor test and the diagnosis of gastroesophageal reflux disease.

There continues to be significant controversy related to diagnostic testing for gastroesophageal reflux disease (GERD). Symptoms of GERD may be associated with physiologic esophageal acid exposure measured by intraesophageal pH monitoring or pH-impedance monitoring, and a significant percentage of patients with abnormal esophageal acid (or weak acid) exposure have no or minimal clinical symptoms of reflux. On the other hand, endoscopic lesions are only present in a minority of GERD patients. In clinical practice, presumptive diagnosis of GERD is reasonably assumed by the substantial reduction or elimination of suspected reflux symptoms during the therapeutic trial of acid reduction therapy, the so-called proton pump inhibitor (PPI) test. We aimed to assess the optimal cutoff value and duration of this test in GERD patients with and without esophagitis. We conducted a prospective study of 544 patients, endoscopically investigated and treated for 2 weeks with PPIs at double dose, and for an additional 3 months at standard dose. The status of the patient at the end of the study was used as an independent diagnostic standard. We found esophagitis present in 55.8% and absent in 44.2% of patients (corresponding to a diagnosis of nonerosive reflux disease [NERD]). The test was positive in 89.7-97.8% of the patients according to the cutoff or duration of the test used. The sensitivity of the PPI test was excellent, ranging from 95.5 to 98.8%, whereas the specificity was poor, not exceeding 36.3%. Erosive esophagitis patients responded more favorably to the PPI test and subsequent PPI therapy compared with NERD patients. In conclusion, the PPI test is a sensitive but less specific test. Its optimal duration is 1 week, and the optimal cutoff value is a decrease of heartburn score of more than 75%. NERD patients respond less satisfactorily to PPIs, even when functional heartburn patients are excluded and only 'true' NERD patients are considered.

Is it possible to clinically differentiate erosive from nonerosive reflux disease patients? A study using an artificial neural networks-assisted algorithm.

BACKGROUND: The use of either symptom questionnaires or artificial neural networks (ANNs) has proven to improve the accuracy in diagnosing gastroesophageal reflux disease (GERD). However, the differentiation between the erosive and nonerosive reflux disease based upon symptoms at presentation still remains inconclusive. AIM: To assess the capability of a combined approach, that is, the use of a novel GERD questionnaire - the QUestionario Italiano Diagnostico (QUID) questionnaire - and of an ANNs-assisted algorithm, to discriminate between nonerosive gastroesophageal reflux disease (NERD) and erosive esophagitis (EE) patients. METHODS: Five hundred and fifty-seven adult outpatients with typical GERD symptoms and 94 asymptomatic adult patients, were submitted to the QUID questionnaire. GERD patients were then submitted to upper gastrointestinal endoscopy to differentiate them between EE and NERD patients. RESULTS: The QUID score resulted significantly (P<0.001) higher in GERD patients versus controls, but it was not statistically significantly different between EE and NERD patients. ANNs assisted diagnosis had greater specificity, sensitivity and accuracy compared with the linear discriminant analysis only to differentiate GERD patients from controls. However, no single technique was able to satisfactorily discriminate between EE and NERD patients. CONCLUSION: Our study suggests that the combination between QUID questionnaire and an ANNs-assisted algorithm is useful only to differentiate GERD patients from healthy individuals but fails to further discriminate erosive from nonerosive patients.