Value of CT findings in predicting transformation of clinical types of COVID-19 / 中华放射学杂志

Objective:To investigate the value of CT findings in predicting thetransformation of clinical types of COVID-19.Methods:From January 24 to February 6, 2020, the clinical and chest CT data of patients with common COVID-19 were analyzed retrospectively. A total of 64 patients were enrolled, including 32 males and 32 females, aged 18-76 (45±15) years. Based on the fact whether patients’ conditions had deteriorated into severe type, all the cases were divided into common type group (51 cases) and deteriorated type group (13 cases). Differences of CT findings in the two groups of patients were analyzed, and visual semi-quantitative scores were introduced to evaluate the pneumonia.Results:Compared with the common type group, the deteriorated type group was more likely to involve the left upper lobe, the right middle lobe and the lung far away from the pleura. The differences between the two groups were statistically significant (χ2= 5.897, P=0.027; χ2=8.549, P=0.005; χ2=10.169, P=0.002). The median of the involved lobes were 2 (1,5) in the common type group and 5 (4,5) in the deteriorated type group. The difference between the two groups was statistically significant (Z =-3.303, P=0.001). Taking the involved lobes ( n=4) as the threshold, the sensitivity and specificity of the diagnosis of the common type to the deteriorated type patients were the highest, 76.9% and 74.5% respectively, and the area under the ROC curve was 0.787. Pneumonia score of the deteriorated group was 10 (4,16), higher than that of the common group [4 (1,13)], and the difference was statistically significant ( Z=-4.040, P<0.001). Pneumonia score 8 as the threshold, the sensitivity and specificity of the general severe group were the highest, 69.2% and 86.3% respectively, and the area under ROC curve was 0.863. Conclusions:CT imaging has a profound value in the early prediction of deterioration in clinical type of COVID-19. It can help evaluate the severity of pneumonia in early stage. Range of lesions might be an important indicator for prognosis of common type COVID-19.

The sodium fluorescein-guided microsurgical resection of glioblastoma / 中华外科杂志

Objective@#To investigate the clinic effect of the sodium fluorescein-guided microsurgical resection of glioblastoma.@*Methods@#In a retrospective clinical study, 82 patients with glioblastoma confirmed by post-operative pathologic inspection in the Department of Neurosurgery of Tianjin Huanhu Hospital from January 2016 to June 2017 were randomly divided into sodium fluorescein (FL) group (42 cases) and traditional microsurgical (TM) group (40 cases). The tumors were removed by the sodium fluorescein-guided surgical procedure in the FL group. The tissues which displayed different intensity of fluorescent staining were taken for the pathologic inspection. The resection of tumors were completed under common microscope in the TM group. The two groups of patients underwent MRI enhanced scan at 48 hours after operation to determine the degree of tumor resection. The rate of gross total resection, postoperative complication, recurrent rate of two groups were compared by χ2 test or Fisher exact test.@*Results@#Totally 135 fluorescent staining samples were obtained in the FL group. Forty-two samples were showed strong fluorescent staining, and all samples were proved to be tumor tissue by pathologic inspection, the sensitivity of FL was 100%. Thirty-seven gliomas were detected from 45 samples of faintly fluorescent staining, sensitivity of FL was 82.3%. Eight gliomas were found from 48 samples of non-fluorescent staining, the specificity of FL was 83.3%. The total resection rate of sodium fluorescein group was 85.7% (36/42), higher than that of traditional microsurgical group (62.5% (25/40)) (χ2=5.795, P=0.016). Two groups of patients were followed up to 6 months after the operation, and 6 cases (14.3%, 6/42) were recurred in the FL group. Among them, 1 case died and the average Karnofsky performance score was 82.2±15.2. There were 12 recurrent cases (33.3%, 12/36) in the TM group, of which 2 cases were died and the average Karnofsky performance score was 76.9±20.3. There was significantly statistical difference in recurrent rate (χ2=3.962, P=0.047).@*Conclusions@#The sensitivity and specificity of fluorescein staining in glioblastoma tissue are high. And the application of sodium fluorescein-guided microsurgical resection of glioblastoma is safe and simple. Therefore, it is helpful to improve the total resection rate of glioblastoma patients and reduce the recurrence rate.

Therapy of the neurosurgical postoperative culture negative meningitis by using external lumbar drainage combined with empirical antibiotics treatment / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the curative effect of external lumbar drainage combined with empirical antibiotics treatment on the postoperative culture negative meningitis.</p><p><b>METHODS</b>The clinical data of eighty post-operative meningitis patients with cerebrospinal fluid culture negative were retrospectively analyzed according to inclusive and exclusive criteria from January 2013 to December 2014 in Department of Neurosurgery, Tianjin Huanhu Hospital. All patients were composed of 45 male cases and 35 female cases, aging from 9 to 72 years. All patients were divided into two groups according to receiving the different treatment: one group only receiving a intravenously empirical antibiotics treatment (n=40), another group receiving a combined therapy of external lumbar drainage and intravenously empirical antibiotics treatment (n=40). The volume of drainage of cerebrospinal fluid (CSF) were set up from 200 to 300 ml per day. There was no difference in the dosage and interval of the same antibiotics between two groups. The antibiotics usage and therapeutic effect of two groups of patients were observed and analyzed by t-test, Wilcoxon rank test or χ(2) test.</p><p><b>RESULTS</b>The rate of CSF bacterial culture negative was 62.9% (88/140) in the same period. In group of empirical antibiotics treatment, the time of antibiotics treatment was (12.6±3.1) days, the rate of combined with other antibiotics treatment was 40.0% (16/40), the rate of mortality was 15.0% (6/40). However, in group of external lumbar drainage combined with empirical antibiotics treatment, the 3 data were (5.3±1.2) days, 10.0% (4/40), 7.5% (3/40), respectively. The time of antibiotics of the group of empirical antibiotics was longer (t=3.605, P=0.017), while the rate of combined antibiotics and the rate of mortality were lower (χ(2)=3.971, P=0.035; χ(2)=4.136, P=0.027, respectively). The average drainage time was (5.8±1.5) days, 32 patients gained a complete healing only by their first placement, 5 cases need replacement because of occlusion or drainage time more than 14 days. There were no recurrence cases after 3 months' follow-up.</p><p><b>CONCLUSIONS</b>The method of external lumbar drainage combined with empirical antibiotics treatment can significantly reduce the dosage and course of antibiotics treatment. It is a simple, safe, efficacious method for the treatment of neurosurgical postoperative bacterial culture negative meningitis.</p>

Relationship between pathological features and 64-MSCT findings of pulmonary nodules in patients with coal workers' pneumoconiosis / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To analyze the relationship between the pathological features and 64-multislice spiral computed tomography (64-MSCT) findings of pulmonary nodules in autopsies from patients with coal workers' pneumoconiosis (CWP), to investigate the optimal imaging method for the distribution of pulmonary nodules, and to provide data for the establishment of CT diagnostic criteria for CWP.</p><p><b>METHODS</b>Cadaveric lung specimens were collected from 7 CWP patients. All of them were men, aged 42∼77 years (mean, 60.00±13.00 years), and their dust exposure time was 5∼30 years (mean, 15.4±8.01 years). The cadaveric lung specimens were treated by aeration, sectioning, and immobilization and were then examined by coronary 64-MSCT. The primitive images were reconstructed into the maximumintensity projection (MIP) images (slice thickness: 3 mm, 5 mm, and 8 mm). The sensitivities of imaging methods with different slice thickness were evaluated based on the pathology and anatomy of local pulmonary nodules, and the correlation between pathological results and radiological findings was analyzed.</p><p><b>RESULTS</b>There were significant differences between the stages determined by pathological examination and high-kV chest radiography (before death) (χ(2) = 4.667, P < 0.05; kappa value = 0.167, P < 0.05). A total of 271 nodules were found in all pathological sections, including peribronchovascular nodules (27, 9.9%), centrilobular nodules (67, 24.6%), interlobular nodules (65, 24.3%), nodules within 5 mm from the pleura (45, 16.5%), pleural plaque-like nodules on the lateral chest wall (45, 16.5%), and nodules on the interlobar pleura (22, 8.1%). The likelihood ratio was the highest (0.981) between 5-mm MIP images and pathological results according to the chi-square test.</p><p><b>CONCLUSION</b>The stage of pulmonary nodules determined by pathological examination is significantly different from that determined by high-kV chest radiography. The 5-mm MIP images of 64-MSCT provide a good reflection of the local pathology and anatomy of pulmonary nodules in CWP patients.</p>

Morphological analysis and pathological basis of the fine pulmonary reticulation at high-resolution CT / 中华放射学杂志

Objective To study the morphological appearance and pathological basis of the fine pulmonary reticulation at HRCT.Methods One hundred and seven patients were analyzed about the morphology findings and dynamic changes on pulmonary HRCT.Twenty-four coal worker's pneumoconiosis(CWP)specimens were examined to make comparison between CT and pathology.The data was analyzed by using the Chi-square test.Results The reticular gap was less than 3 mm in diameter.The morphology of reticulation was round or irregular.Pulmonary parenchyma was seen between the gaps.The reticular wall was smooth or coarse.The thickness was less than 1 mm.One hundred and seven patients had accompanying signs including ground-glass opacity(68.2%,73 patients),crazy paving(23.4%,25 patients),interlobular septal thickening(84.1%,90 patients),emphysema(32.7%,35 patients),interface sign(58.9%,63 patients),traction bronchiolectasis(41.1%,44 patients)and honeycombing(26.2%,28 patients).The differences of the honeycomb,traction bronchiolectosis,interbobular septal thickening,interface sign and paving were statistically significant between the fibrotic group and pneunonia(P＜0.01).Pneumonia showed extensive area of ground-glass opacity(GGO)with fine reticulation.Fine reticulation with both interlobular septal thickening and small nodules were observed more frequently in lmphangitic carcinomatosis.Idiopathic pulmonary fibrosis(IPF)showed fine reticulation among the honeycombing.Connective tissue disease (CTD)showed fine reticulation with rarely honeycombing and it could be partly absorbed.Fine reticulation with emphysema was seen in chronic bronchitis.In the 58 follow-up patients,the fine reticulation increased in 26 patients,decreased or disappeared in 22 patients and showed no change in 10 patients.The major pathological basis of the fine reticulation was intralobular interstitial thickening,including fibrosis hyperplasia,inflammatory cells and tumor cells infiltration,effusion filling,smut deposition and so on.Conclusions The fine reticulation was caused by intralobular interstitial thickening including inflammation,interstitial hyperplasia,pulmonary fibrosis and tumor.The fine reticulation is helpful to prompt the diagnosis of these diseases,but the diagnosis need its combination with the other CT findings and dynamic changes.

Discrimination method of large log-likelihood study in differential diagnosis of pulmonary diffuse mild micronodule / 中华放射学杂志

Objective To analyze HRCT and thin-slice CT scan findings in 150 patients with pulmonary diffuse mild micronodule, and to find the features with the purpose of identifying random micronodule, peri-lymphatic micronodule, and centrilobular micronodule. Methods The useful features in 150 patients with pulmonary diffuse mild micronodule were translated into scores by means of discrimination method of large log-likelihood to identify the micronodular category. Results The accuracy of diagnosis was 94.0% for random micronodule, 76.0% for peri-lymphatic micronodule, and 90.0% for centrilobular micronodule. Conclusion HRCT and thin-slice CT scans were helpful in differential diagnosis of pulmonary diffuse mild micronodule. The discrimination method of large log-likelihood was propitious to diagnosis and differential diagnosis.