Pulmonary reversed halo cycles and consolidations after immunotherapy: A case report.

BACKGROUND: Immune checkpoint inhibitor-associated interstitial lung disease (ICI-ILD) and opportunistic pneumonias are the main pulmonary complications during immunotherapy for malignancies. The organizing pneumonia (OP) pattern is one of the common radiological manifestations of ICI-ILD, and OP is the most common cause of reversed halo cycles and consolidations. However, opportunistic pneumonias should be excluded. CASE SUMMARY: In this report, we described a case of a 44-year-old man with esophageal cancer who showed multiple reversed-halo cycles and consolidations on chest computed tomography (CT) after he had a cold during immunotherapy. He was diagnosed with esophageal squamous-cell cancer (T2NIM0) after surgery. Then, he was successfully treated with 6 cycles of chemotherapy plus tislelizumab, one cycle of radiotherapy and 9 cycles of tislelizumab. Two months later, he complained of low-grade fever and cough with nonpurulent sputum after he had a cold. Community-acquired pneumonia was considered, but moxifloxacin was ineffective. Chest CT showed multiple reversed-halo cycles and consolidations. Mycobacterium tuberculosis was identified with next-generation sequence analysis of bronchoalveolar lavage fluid (BALF). Two months later, he improved with standard anti-tuberculosis medications. Both the cycles and consolidations disappeared in the repeat CT after 6 mo of medications. CONCLUSION: When chest CT shows reversed-halo cycles and consolidations in patients during anticancer immunotherapy, both ICI-ILD and infectious pneumonia should be considered. BALF microbiological analysis was helpful to differentiate them.

Prediction of Re-positivity for Coronavirus Nucleic Acid Among COVID-19 Patients in the Recovery Phase.

Background and Objectives: Although the pathogenesis and treatment of coronavirus disease 2019 (COVID-19) have been gradually revealed, the risk for re-emergence of coronavirus nucleic acids in recovered patients remains poorly understood. Hence, this study evaluated the risk predictors associated with re-positivity for virus nucleic acid. Methods: Between February 1 and March 20, 2020, we retrospectively reviewed the clinical epidemiological data of 129 COVID-19 patients who were treated at Zhongxiang People's Hospital of Hubei Province in China. Subsequently, a risk prediction model for the re-positivity of virus nucleic acid was developed, and a receiver operating characteristic (ROC) curve was drawn for further validation. Results: In this study, the rate of re-positivity for virus nucleic acid was 17.8% (23/129) where all re-positivity cases were asymptomatic. The median time interval from discharge to nucleic acid re-positivity to discharge after being cured again was 11.5 days (range: 7-23 days). Multivariate logistic regression analysis showed that leukocytopenia [odds ratio (OR) 7.316, 95% confidence interval (CI) 2.319-23.080, p = 0.001], prealbumin < 150 mg/L (OR 4.199, 95% CI 1.461-12.071, p = 0.008), and hyperpyrexia (body temperature >39°C, OR 4.643, 95% CI 1.426-15.117, p = 0.011) were independent risk factors associated with re-positivity. The area under the ROC curve was 0.815 (95% CI, 0.729-0.902). Conclusion: COVID-19 patients with leukocytopenia, low prealbumin level, and hyperpyrexia are more likely to test positive for virus nucleic acid after discharge. Timely and effective treatment and appropriate extension of hospital stays and quarantine periods may be feasible strategies for managing such patients.

Association of ADAM33 gene polymorphisms with asthma in Mongolian and Han groups in Inner Mongolia.

Polymorphisms in the gene encoding for A disintegrin and metalloprotease 33 (ADAM33) are closely associated with the risk of bronchial asthma attacks in different populations. We collected blood samples from 248 asthma patients - 130 of the Han ethnic group and 118 of the Mongolian ethnic group - living in the Inner Mongolia region of China, and analyzed the single nuclear polymorphisms (SNPs) of the T1, T2 and V4 loci of the ADAM33 gene using PCR-RFLP (restriction fragment length polymorphism). In addition, we also tested 256 healthy controls (134 and 122 from the Han and Mongolian ethnic groups respectively) for the same SNPs. Three genotypes of the T1, T2 and V4 loci were predominantly detected: while polymorphisms in the T1 locus were significantly associated with asthma risk in both Mongolian and Han ethnicities (P < 0.05, ∗P < 0.05), that in the V4 locus were relevant only in the Mongolian patients (P < 0.05, ∗P > 0.05). In contrast, polymorphisms in the T2 locus showed no significant association with asthma risk in either ethnic group (P > 0.05, ∗P > 0.05).

A Comparison of the Image Quality and Radiation Dose With Routine Computed Tomography and the Latest Gemstone Spectral Imaging Combination of Different Scanning Protocols in Computed Tomography Angiography of the Kidney.

OBJECTIVE: The objective of our study was to compare the image quality and radiation dose of computed tomography angiography (CTA) of the kidney in patients with different body mass indexes using routine CT and the latest gemstone spectral imaging (GSI) combination of different scanning protocols with the adaptive statistical iterative reconstruction 2.0 algorithm. METHODS: A total of 90 patients who had undergone a CTA of the kidney were divided into 3 groups (A, B, and C), with 30 patients in each group. Group A underwent a routine CT examination, whereas groups B and C underwent GSI with different scanning protocols. All images were restructured using the adaptive statistical iterative reconstruction 2.0. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of all images were calculated when the kidney CTA was completed. Each subjective image evaluation used a 5-point scoring method and was conducted by 2 independent radiologists. The CT dose index of volume and the dose-length product were recorded, and the mean value was calculated. The dose-length product was converted to the effective dose. All data were compared with a 1-way analysis of variance. RESULTS: The SNR, CNR, and subjective image quality in group A were significantly lower than those in groups B and C (P < 0.01). There were no significant differences in SNR, CNR, and subjective image quality between groups B and C. The effective dose of group C decreased by 46.05% and 15.03% relative to those of groups A and B, respectively (P < 0.01). CONCLUSIONS: The latest GSI with different scanning protocols can more effectively reduce the radiation dose than can the routine CT scan mode for a kidney CTA while still maintaining diagnostic image quality.

CT Pulmonary Angiography Using Automatic Tube Current Modulation Combination with Different Noise Index with Iterative Reconstruction Algorithm in Different Body Mass Index: Image Quality and Radiation Dose.

RATIONALE AND OBJECTIVES: This study aimed to determine the appropriate body mass index (BMI)-dependent noise index (NI) setting in computed tomography pulmonary angiography (CTPA) with automatic tube current modulation with adaptive statistical iterative reconstruction (ASiR). MATERIALS AND METHODS: A total of 480 patients who had a CTPA were divided into group A (18.5 kg/m2 ≤ BMI < 25 kg/m2), group B (25 kg/m2 ≤ BMI < 30 kg/m2), and group C (BMI ≥ 30 kg/m2), according to their BMI values; each group had 160 patients. The three groups were further randomly divided into four subgroups: A1, A2, A3, A4; B1, B2, B3, B4; and C1, C2, C3, C4, with corresponding NI values of 26, 36, 40, and 46, respectively. All images were restructured with the ASiR algorithm, and the images with the lowest NI (26 Hounsfield units) in each group were used as reference standard. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for the pulmonary artery of each group were calculated. Subjective image quality was evaluated using a five-score method by two independent radiologists. The CT dose index of volume and dose-length product were recorded and were converted to effective dose (ED). SNR and CNR in the group A, B, and C subgroups were compared to repeated measures analysis of variance, and the subjective score, Volumetric CT dose index of volume, dose-length product, and ED were compared to one-way analysis of variance. RESULTS: For groups A and B, the SNR, CNR, and subjective scores of the images in their subgroups showed no statistical differences (P >.05). The ED in subgroups A4 and B4 was significantly lower than that in subgroups A1 (by 33.24%) and B1 (by 34.47%) (P <.01). For group C, there was no significant difference in the SNR, CNR, and the subjective image scores between subgroups C3 and C1 (P >.05). The ED in subgroup C3 was significantly lower than the ED in subgroup C1 (by 47.75%) (P <.01) CONCLUSIONS: Patient BMI-dependent NI settings that are higher than the recommended value may be used in CTPA with automatic tube current modulation and ASiR to effectively reduce radiation dose while maintaining diagnostic image quality.

A Comparison of the Image Quality and Radiation Dose Using 100-kVp Combination of Different Noise Index and 120-kVp in Computed Tomography Pulmonary Angiography.

OBJECTIVE: The objective of our study was to compare the image quality and radiation dose of computed tomography pulmonary angiography (CTPA) in patients with different body mass indexes using 100-kVp combination of different noise indexes (NIs) and 120-kVp scan protocol with the adaptive statistical iterative reconstruction 2.0 algorithm (ASiR 2.0). METHODS: A total of 120 patients who had undergone a CTPA were divided into 4 groups (A, B, C, and D), with 30 patients in each group. Group A underwent 120-kVp CT scan protocol in combination with NI = 25, while groups B, C, and D underwent 100-kVp CT scan protocol in combination with NI = 30, 35, and 40, respectively. All images were restructured using ASiR 2.0. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of all images were calculated when the CTPA was completed. Each subjective image evaluation used a 5-point scoring method and was conducted by 2 independent radiologists. The CT dose index of volume and dose-length product were recorded, and the mean value was calculated. The dose-length product was converted to the effective dose. RESULTS: There were no significant differences in SNR, CNR, and subjective image quality among the groups A, B, C, and D. The effective dose of group D decreased by 48.33% and 27.27% relative to groups A and B, respectively (P < 0.01). CONCLUSIONS: The 100-kVp CT scan protocol in combination with NI = 40 can more effectively reduce the radiation dose than can the 120-kVp CT scan protocol in combination with NI = 25 for a CTPA while still maintaining diagnostic image quality.

Characterization and distribution of polycyclic aromatic hydrocarbon in sediments of Haihe River, Tianjin, China.

In this study sediment samples were collected from 13 sites of Haihe River in Tianjin City, China, sixteen of priority polycyclic aromatic hydrocarbons (PAHs) listed in USEPA were analyzed by means of GC-MS. The total concentrations of PAH ranged from 774.81 to 255371.91 ng/g dw, and two to four rings of PAHs were dominant in sediment samples. Molecular ratios, such as phenanthrene/anthracene, fluoranthene/pyrene and low-molecular-weight PAH /high-molecular-weight PAH, were used to study the possible sources of pollution. It indicated a mixed pattern of parolytic and petrogenic inputs of PAHs in sediments in Haihe River. The petrogenic PAHs may be mainly derived from the leakage of refined products, e.g., gasoline, diesel fuel and fuel oil vehicle traffics or gas stations from urban area. The pyrolytic PAHs might be from the discharge of industrial wastewater and the emission of atmospheric particles from petrochemical factories. In addition, the levels of PAHs in the urban and industrial areas are far beyond the values reported from other rivers and marine systems reported. This situation may be due to polluted discharging from some petrochemical industrial manufactories and worse traffic conditions in Tianjin.