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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322630

ABSTRACT

Background: Computed tomography (CT) and reverse-transcription polymerase chain reaction (RT-PCR) are the recommended tools for the diagnosis of coronavirus disease 2019 (COVID-19). The present study aimed to investigate the correlation between chest CT and RT-PCR while describing the atypical CT imaging features of COVID-19. Methods: In this study, 418 patients in Jiangsu, China, clinically diagnosed with COVID-19 from January 10 to February 17, 2020, were included. Patients who fulfilled the following conditions were evaluated further: (1) Patients had positive RT-PCR and negative CT;(2) Patients had initial negative RT-PCR and positive CT, and follow-up PT-PCR tests were positive;(3) Patients had atypical CT findings. Results: Of the 418 initial chest CT scans, 30 (7.2%) patients had normal CT presentation, and 6 (1.4%) patients had initial negative RT-PCR results and positive CT scans. Next, 10 (2.4%) cases of patients showed atypical CT findings, including 2 case of solid nodule, 4 cases of halo sign (solid nodule or mass surrounded by ground glass opacity), and 4 cases of predominant fibrous stripes. Conclusions: False-negative results can be found on both chest CT and RT-PCR;hence, the diagnosis of COVID-19 should consider both CT and RT-PCR. CT manifestations, such as solitary nodule, halo sign, and pulmonary fibrous stripes, might indicate the possibility of COVID-19 to the radiologists.

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-321371

ABSTRACT

Background The long-term consequences of human umbilical cord-derived mesenchymal stem cell (UC-MSC) treatment for COVID-19 patients are yet to be reported. This study assessed the 1-year outcomes in patients with severe COVID-19, who were recruited in our previous UC-MSC clinical trial.Methods: In this prospective, longitudinal, cohort study, 100 patients enrolled in our phase 2 trial were prospectively followed up at 3-month intervals for 1 year to evaluate the long-term safety and effectiveness of UC-MSC treatment. The primary endpoint was an altered proportion of whole-lung lesion volumes measured by high-resolution CT. Other imaging outcomes, 6-minute walking distance (6-MWD), lung function, plasma biomarkers, and adverse events were also recorded and analyzed. This trial was registered with ClinicalTrials.gov (NCT04288102).Findings: Within 3 months, MSC administration exerted numerical improvement in whole-lung lesion volume compared with the placebo, leading to a significant difference of −10.82% (95% CI: −20.69%, −1.46%, P=0.030) on day 10. MSC also reduced the proportion of solid component lesion volume compared with the placebo at each follow-up point, with a significant difference of − 9.02% (95%CI: − 17.44%, − 0.10%, P=0.045) at month 9. More interestingly, 17.86% (10/56) of patients in the MSC group had normal CT images at month 12 ( P= 0.013), but none in the placebo group. The incidence of symptoms was lower in the MSC group than in the placebo group at each follow-up time, particularly sleep difficulties at month 3 (OR 0.19, 95% CI 0.07,0.50;P=0.001), and usual activity at month 12 (OR 0.15, 95% CI 0.03,0.79;P=0.018). Neutralizing antibodies were all positive, with a similar median inhibition rate (61.6% vs. 67.55%) in both groups at month 12. No difference in adverse events at the 1-year follow-up and tumor markers at month 12 were observed between the two groups.Interpretation: UC-MSC administration achieves a long-term benefit in the recovery of lung lesions and symptoms in COVID-19 patients.Trial Registration: This trial was registered with ClinicalTrials.gov (NCT04288102).Funding The National Key R&D Program of China, the Innovation Groups of the National Natural Science Foundation of China, and the National Science and Technology Major Project.Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Ethics Committee of the Fifth Medical Center, Chinese PLA General Hospital (2020-013-D).

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-309018

ABSTRACT

Background: Coronavirus Disease 2019 (COVID-19) is currently a global pandemic. Information about the death predicting of severe COVID-19 is not clear. Methods: : 151 in-patients from January 23th to March 8th 2020 were divided into severe and critically severe group, as well as survival and death group. The analysis of differences of clinical and imaging data were performed between groups. The logistic regression analysis of factors associated with death in COVID-19 were conducted, and the prediction model of death risk was developed. Results: : Many clinical and imaging indices were significantly different between groups, including the age, the epidemic history, the past medical history, the duration of symptoms prior to admission, blood routine, inflammatory related factors, Na + , myocardial zymogram, liver and renal function, coagulation function, fraction of inspired oxygen and complications. The proportion of patients in imaging stage III and comprehensive CT scores was increased significantly in death group. The area under receiver operating characteristic curve of the prediction model was 0.9593. Conclusions: : The clinical and imaging data reflect the severity of COVID-19 pneumonia. The prediction model of death risk might be a promising method to help clinicians to quickly identify and screen potential individuals who had a high-risk of death.

4.
Curr Med Imaging ; 18(7): 780-786, 2022.
Article in English | MEDLINE | ID: covidwho-1599092

ABSTRACT

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) pneumonia remains a matter of concern. Chest CT findings of COVID-19 pneumonia have been reported widely, while there is relatively rare research on chest X-ray (CXR). OBJECTIVE: The study was aimed to compare the CXR and chest CT findings of patients with confirmed COVID-19 infection and to explore their respective clinical values. METHODS: 28 inpatients with COVID-19 pneumonia who underwent both CXR and CT were included. The pulmonary manifestations of the lesions were recorded. Ground-glass opacity (GGO), consolidation, and fibrosis were quantified in CXR and chest CT separately. Consistency was analyzed using Fleiss' kappa and intraclass correlation coefficient. The stages of the disease in CXR and chest CT were evaluated. RESULTS: Approximately 67.9% (19/28) of subjects had abnormal findings on CXR. The common manifestations in CXR were ground-glass opacities (GGO) (100%, 19/19) and consolidation (68.4%, 13/19). 92.9% (26/28) of patients had abnormal manifestations on CT. The common manifestations in CT were GGO (88.5%, 23/26), consolidation (69.2%, 18/26), reticular opacity (69.2%, 18/26) and nodule (46.2%, 12/26). Among the abnormalities between CXR and CT, only consolidation was consistent (κ=0.510). GGO (ICC=0.501) and consolidation (ICC=0.431) scores were consistent in CXR and chest CT. The results of staging were the same in 14 cases, most of them were in stage I and stage II. While in other cases with inconsistent results, CT was more advanced in the disease stage than CXR, mainly stage III and stage IV. CONCLUSION: CXR is helpful to observe the change of the pulmonary lesions in patients with confirmed COVID-19 pneumonia. CT can be used for early diagnosis and staging of lesions.


Subject(s)
COVID-19 , COVID-19/diagnostic imaging , Humans , Lung/diagnostic imaging , Tomography, X-Ray Computed/methods
5.
EBioMedicine ; 75: 103789, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1587925

ABSTRACT

BACKGROUND: The long-term consequences of human umbilical cord-derived mesenchymal stem cell (UC-MSC) treatment for COVID-19 patients are yet to be reported. This study assessed the 1-year outcomes in patients with severe COVID-19, who were recruited in our previous UC-MSC clinical trial. METHODS: In this prospective, longitudinal, cohort study, 100 patients enrolled in our phase 2 trial were prospectively followed up at 3-month intervals for 1 year to evaluate the long-term safety and effectiveness of UC-MSC treatment. The primary endpoint was an altered proportion of whole-lung lesion volumes measured by high-resolution CT. Other imaging outcomes, 6 min walking distance (6-MWD), lung function, plasma biomarkers, and adverse events were also recorded and analyzed. This trial was registered with ClinicalTrials.gov (NCT04288102). FINDINGS: MSC administration improved in whole-lung lesion volume compared with the placebo with a difference of -10.8% (95% CI: -20.7%, -1.5%, p = 0.030) on day 10. MSC also reduced the proportion of solid component lesion volume compared with the placebo at each follow-up point. More interestingly, 17.9% (10/56) of patients in the MSC group had normal CT images at month 12, but none in the placebo group (p = 0.013). The incidence of symptoms was lower in the MSC group than in the placebo group at each follow-up time. Neutralizing antibodies were all positive, with a similar median inhibition rate (61.6% vs. 67.6%) in both groups at month 12. No difference in adverse events at the 1-year follow-up and tumor markers at month 12 were observed between the two groups. INTERPRETATION: UC-MSC administration achieves a long-term benefit in the recovery of lung lesions and symptoms in COVID-19 patients. FUNDING: The National Key R&D Program of China, the Innovation Groups of the National Natural Science Foundation of China, and the National Science and Technology Major Project.


Subject(s)
COVID-19/therapy , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells , Aged , Allografts , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Acuity
6.
Curr Med Imaging ; 17(11): 1299-1307, 2021.
Article in English | MEDLINE | ID: covidwho-1574576

ABSTRACT

BACKGROUND: An outbreak of coronavirus disease 2019 (COVID-19) has occurred worldwide. However, the small-airway disease in patients with COVID-19 has not been explored. AIM: This study aimed to explore the small-airway disease in patients with COVID-19 using inspiratory and expiratory chest high-resolution computed tomography (CT). METHODS: This multicenter study included 108 patients with COVID-19. The patients were classified into five stages (0-IV) based on the CT images. The clinical and imaging data were compared among CT images in different stages. Patients were divided into three groups according to the time interval from the initial CT scan, and the clinical and air trapping data were compared among these groups. The correlation between clinical parameters and CT scores was evaluated. RESULTS: The clinical data, including age, frequency of breath shortness and dyspnea, neutrophil percentage, lymphocyte count, PaO2, PaCO2, SaO2, and time interval between the onset of illness and initial CT, showed significant differences among CT images in different stages. A significant difference in the CT score of air trapping was observed between stage I and stage III. A low negative correlation was found between the CT score of air trapping and the time interval between the onset of symptoms and initial CT. No significant difference was noted in the frequency and CT score of air trapping among different groups. CONCLUSION: Some patients with COVID-19 developed small-airway disease. Air trapping was more distinguished in the early stage of the disease and persisted during the 2-month follow-up. Longer-term follow-up studies are needed to confirm the findings.


Subject(s)
COVID-19 , Tomography, X-Ray Computed , COVID-19/diagnosis , Humans
7.
International Journal of Infectious Diseases ; 95:106-112, 2020.
Article in English | CAB Abstracts | ID: covidwho-1409634

ABSTRACT

Background: A pneumonia associated with the coronavirus disease 2019 (COVID-19) recently emerged in China. It was recognized as a global health hazard.

8.
Fundamental Research ; 2021.
Article in English | ScienceDirect | ID: covidwho-1051638

ABSTRACT

The present study aimed to establish a prognostic nomogram to stratify high-risk patients with Coronavirus Disease 2019 (COVID-19) who progressed from the nonsevere condition on admission to severe during hospitalization. This multicenter retrospective study included patients with nonsevere COVID-19 on admission from Jan 10, 2020 to Feb 7, 2020. In the training cohort, independent risk factors associated with disease progression were identified by univariate and multivariate analyses. The prognostic nomogram was established and then validated externally using C-index. The study included 351 patients (293 and 58 in the training and validation cohorts, respectively), with 27 (9.2%) and 5 (8.6%) patients progressed, respectively. In the training cohort, older age (OR 1.036, 95% CI 1.000-1.073), more lobes involved on chest CT (OR 1.841, 95% CI 1.117-3.035), comorbidity present (OR 2.478, 95% CI 1.020-6.018), and lower lymphocyte count (OR 0.081, 95% CI 0.019-0.349) were identified as independent risk factors. The prognostic nomogram was established in the training cohort with satisfied external prognostic performance (C-index 0.906, 95% CI 0.806-1.000). In conclusion, older age, comorbidity present, more lobes involved on chest CT, and lower lymphocyte count are independent risk factors associated with disease progression during hospitalization for patients with nonsevere COVID-19.

9.
Curr Med Imaging ; 17(11): 1299-1307, 2021.
Article in English | MEDLINE | ID: covidwho-1028856

ABSTRACT

BACKGROUND: An outbreak of coronavirus disease 2019 (COVID-19) has occurred worldwide. However, the small-airway disease in patients with COVID-19 has not been explored. AIM: This study aimed to explore the small-airway disease in patients with COVID-19 using inspiratory and expiratory chest high-resolution computed tomography (CT). METHODS: This multicenter study included 108 patients with COVID-19. The patients were classified into five stages (0-IV) based on the CT images. The clinical and imaging data were compared among CT images in different stages. Patients were divided into three groups according to the time interval from the initial CT scan, and the clinical and air trapping data were compared among these groups. The correlation between clinical parameters and CT scores was evaluated. RESULTS: The clinical data, including age, frequency of breath shortness and dyspnea, neutrophil percentage, lymphocyte count, PaO2, PaCO2, SaO2, and time interval between the onset of illness and initial CT, showed significant differences among CT images in different stages. A significant difference in the CT score of air trapping was observed between stage I and stage III. A low negative correlation was found between the CT score of air trapping and the time interval between the onset of symptoms and initial CT. No significant difference was noted in the frequency and CT score of air trapping among different groups. CONCLUSION: Some patients with COVID-19 developed small-airway disease. Air trapping was more distinguished in the early stage of the disease and persisted during the 2-month follow-up. Longer-term follow-up studies are needed to confirm the findings.


Subject(s)
COVID-19 , Tomography, X-Ray Computed , COVID-19/diagnosis , Humans
10.
Int J Infect Dis ; 96: 157-162, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-644799

ABSTRACT

OBJECTIVE: The study was aimed to describe the clinical characteristics and evaluate the dynamic changes of chest CT features in the first three weeks in the common type fo COVID-19 pneumonia patients in Jiangsu Province. METHODS: 307 patients infected SARS-CoV-2 classified as common type were enrolled in the study. 628 chest CT scans were divided into three groups based on the time interval between symptoms and chest CT scan. The clinical characteristics were descriptively analyzed.The chest CT features were quantitatively evaluated. Mann-Whitney U test was used to test the differences in three groups and between men and women. Spearman rank correlation was used to test the association between the arterial blood gas(ABG) analysis results and chest CT scores. RESULTS: Fever (69.1%) and cough (62.8%) were common symptoms. 111(36.2%) patients were anorexia. GGO was the most common manifestation of COVID-19 pneumonia, which could be followed by consolidation and fibrosis. Lower lobe or subpleural region was the most common distribution form of lesion. More lung lobes were involved in the third week. Total chest CT scores in the second week were higher than the first week. Fibrosis Scores increased in the second and third week. Total CT score, GGO score and fibrosis score of male patients were significantly higher than female in the second week. Male patients had higher consolidation score and fibrosis score than female in the third week. Total CT score and GGO score had weak to moderate correlation with arterial blood gas indices. CONCLUSION: Changes in chest CT were difficult to assess quantitatively in the first third weeks. Male patients recovered slower than female in the second week. Although CT score had correlations with arterial blood gas indices, long-term follow-up of pulmonary function test is needed to determine the recovery of lung.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Adult , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
11.
Int J Infect Dis ; 95: 106-112, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-35010

ABSTRACT

BACKGROUND: A pneumonia associated with the coronavirus disease 2019 (COVID-19) recently emerged in China. It was recognized as a global health hazard. METHODS: 234 inpatients with COVID-19 were included. Detailed clinical data, chest HRCT basic performances and certain signs were recorded Ground-glass opacity (GGO), consolidation, fibrosis and air trapping were quantified. Both clinical types and CT stages were evaluated. RESULTS: Most patients (approximately 90%) were classified as common type and with epidemiologic history. Fever and cough were main symptoms. Chest CT showed abnormal attenuation in bilateral multiple lung lobes, distributed in the lower and/or periphery of the lungs (94.98%), with multiple shapes. GGO and vascular enhancement sign were most frequent seen, followed by interlobular septal thickening and air bronchus sign as well as consolidation, fibrosis and air trapping. There were significant differences in most of CT signs between different stage groups. The SpO2 and OI were decreased in stage IV, and the CT score of consolidation, fibrosis and air trapping was significantly lower in stage I (P<0.05). A weak relevance was between the fibrosis score and the value of PaO2 and SpO2 (P<0.05). CONCLUSIONS: Clinical performances of patients with COVID-19, mostly with epidemiologic history and typical symptoms, were critical valuable in the diagnosis of the COVID-19. While chest HRCT provided the distribution, shape, attenuation and extent of lung lesions, as well as some typical CT signs of COVID-19 pneumonia.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , SARS-CoV-2 , Young Adult
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