CT Imaging Features and Clinical Characteristics of 2019 Novel Coronavirus Pneumonia (COVID-19) During Rehabilitation.

This study aims to explore the clinical characteristics of the patients with novel coronavirus pneumonia (COVID-19) during rehabilitation. One hundred and twelve confirmed patients were enrolled, while 72 were females (64.3%) and 40 were males (35.7%). The age of the patients was 51.63 ± 4.07 years old. Those patients were divided into mild group, moderate group and severe group based on lesion volume and proportion of total lesion on CT images. The age, gender, past medical history, finger pulse oxygen (SPO2), heart rate (HR) and body temperature and other clinical characteristics of patients were collected. Lesion volume was measured by CT. Compared with mild group, age, lesion volume and total lesion proportion in moderate group were significantly higher. Age, lesion volume and total lesion proportion in severe group were also higher than those in moderate group. Age and past medical history were the risk factors for the lesion volume of COVID-19. Older the patient has larger CT lesion range (R = 0.232, P = 0.045). Without past medical history or combination of post-medical history, the COVID-19 patients had smaller CT lesion ranges, and the history of previous cardiovascular disease and pulmonary disease was important risk factors for the larger CT lesion ranges. The patients who were older or combined with chronic diseases, especially cardiovascular diseases, respiratory disease and diabetes, tended to have the larger lesions. Age and past medical history of patients with COVID-19 period are significantly related to the lesion volume and total lesion proportion on CT images.

Epidemiological and clinical characteristics of 40 cases of COVID-19 outside Hubei

To explore characteristics of patients with pneumonia infected by 2019 Novel Coronavirus (COVID-19) in 2019 outside Hubei Province, China. 40 patients with pneumonia infected by COVID-19 which were confirmed by COVID-19 nucleic acid test were included. Procalcitonin (PCT), serum amyloid A (SAA), C-reactive protein (CRP) and computed tomography (CT) manifestations were analyzed. 40% of patients had clear contact history with Wuhan or other areas of Hubei Province. 60% of patients were clustered diseases and 40% were imported cases. 75% of patients had initial fever, 7.5% had cough, 5% had sore throat at first. 45% had decreased lymphocyte count, 72.5% and 55% patients had increased levels of SAA and CRP. 72.5% of the patients showed multiple ground glass lesions in one or two lungs on chest CT. 90% of the patients with pneumonia are of the common type, and alpha-interferon atomization inhalation combined with Lopinavir/Ritonavir tablets were given to patients during treatment. 62.5% of the patients were treated with antibiotics, and 15% with hormone. All patients improved after treatment, and 14 patients were cured and discharged. Family cluster infection and asymptomatic infection may be the main way of spreading of COVID-19 pneumonia outside Hubei Province in China.

The study of relationship between acute myocardial injury and coagulation function in patients with COVID-19 / 医学研究生学报

ObjectiveTo study the relationship between acute myocardial injury（AMI） and coagulation function in patients with COVID-19.MethodsA retrospective study was carried out to record the general and laboratory data of 133 patients diagnosed with COVID-19 who were hospitalized in Wuhan TongJi Guanggu Hospital, Wuhan, Hubei Province from February 10 to February 29, 2020. The laboratory data includes blood routine, liver and renal function, myocardial infarction tests, coagulation function, inflammatory factors, hypersensitive C-reactive protein, procalcitonin etc. The patients were divided into two groups according to cardiac troponin I（TNI）34.2 ug/L. The differences of general conditions and laboratory data between the two groups were compared. Besides, the correlation between coagulation function and coagulation function, and the ROC curve of D-dimer in AMI were conducted .ResultsAmong the 133 patients, 9 (6.77%) had cTnI greater than 34.2 μg/L, and 124 (93.23%) had normal cTnI. There were significant differences between the two groups in age, COPD history, blood routine (neutrophil count, lymphocyte count, platelet count), myoglobin, liver function (direct bilirubin, indirect bilirubin), cytokines (IL-2 receptor, IL-6, IL-8, IL-10, TNF-α), coagulation function (PT, PTA, D-dimer). D-dimer level was positively correlated with TnI, CK-MB and myoglobin levels. The cut off value of D-dimer was 2.35 μg/ml in acute myocardial injury.ConclusionAcute myocardial injury in COVID-19 patients may be related to coagulation dysfunction. Therefore, monitoring of coagulation function dynamically, screening of thrombus and starting anticoagulant and antiplatelet therapy timely help to reduce acute myocardial injury.

Clinical characteristics of 2019 novel coronavirus pneumonia in Zhejiang province, China.

Since December 2019, an increasing number of cases associated with the 2019 novel coronavirus (2019­nCoV) have emerged in Wuhan, China, which has resulted in a rapid outbreak in China and worldwide. The present study aimed to describe the clinical, laboratory and radiological characteristics of 2019­nCoV pneumonia (NCP) in Zhejiang province, outside of Wuhan. A total of 74 patients with 2019­nCoV were continuously enrolled between January 22 and March 2, 2020 at Zhejiang Hospital. Diagnosis was confirmed at Zhejiang Hospital by reverse transcription­PCR (RT­PCR), which was approved by the Chinese government. Subsequently, the clinical features between positive­ and negative­NCP patients in Zhejiang were compared. Among the 74 hospitalized patients with suspected 2019­NCP, six patients (one male and five female patients) were confirmed to be infected with 2019­nCoV by RT­PCR. The average age of the confirmed patients was 40±13 years. There were three family clusters among the confirmed cases, one patient from each of these families had travel history or contact with patients from Wuhan within 2 weeks. Compared with non­NCP patients, the most common symptoms at onset for patients with NCP were fever (5/6; 83.3%) and cough (5/6; 83.3%), followed by dyspnea/pharyngalgia (2/6; 33.3%), whereas myalgia (1/6; 16.7%) and fatigue (1/6; 16.7%) were less common. All 74 patients with suspected NCP exhibited abnormal computerized tomography (CT) images. In total, 2/6 (33.3%) patients with confirmed NCP presented with bilateral pneumonia, and 21/68 (30.9%) non­NCP patients exhibited bilateral pneumonia, with bilateral distribution of patchy shadows or ground glass opacity. The present study revealed that epidemiological history was critical to the diagnosis of 2019­nCoV in low epidemic regions outside Hubei province. It was also identified that chest CT could not replace nucleic acid testing due to similar radiological manifestations.

Typical radiological progression and clinical features of patients with coronavirus disease 2019.

We aimed to describe typical radiological features and progression of Coronavirus disease 2019 (COVID-19) patients. We reviewed the chest CT scans, laboratory findings, and clinical records of 66 COVID-19 patients who were admitted to affiliated hospitals of Nanchang university, Nanchang, China, from Jan 21 to Feb 2, 2020. CT was used to evaluate the radiological characteristics of COVID-19 patients. Only 4 patients (4/66, 6%) claimed their exposure to COVID-19 pneumonia patients. The major symptoms were fever (60/66, 91%) and cough (37/66, 56%). The predominant features of lesion were scattered (43/66, 65%), bilateral (50/66, 76%), ground-glass opacity (64/66, 97%), and air bronchogram sign (47/66, 71%). Forty-eight patients (48/66, 73%) had more than two lobes involved. Right lower lobe (58/66, 88%) and left lower lobe (49/66, 74%) were most likely invaded. Twelve patients (12/66, 18%) had at least one comorbid condition. Pleural traction (29/66, 44%), crazy paving (15/66, 23%), interlobular septal thickening (11/66, 17%), and consolidation (7/66, 11%) were also observed. The typical radiology features of COVID-19 patients are scattered ground-glass opacity in the bilateral lobes. Fever and cough are the major symptoms. Evaluating chest CT, clinical symptoms, and laboratory results could facilitate the early diagnosis of COVID-19, and judge disease progression.

Transient appearance of EDTA dependent pseudothrombocytopenia in a patient with 2019 novel coronavirus pneumonia.

EDTA dependent pseudothrombocytopenia (EDTA-PCTP) is a phenomenon that characterized by a spurious decrease of platelets in vitro due to the aggregation of platelets in EDTA anticoagulant blood samples. We report the first case of a transient appearance of EDTA-PCTP in a patient with 2019 novel coronavirus pneumonia (COVID-19). A 59-year-old woman was admitted to the isolated ward for severe type of 2019 novel coronavirus pneumonia. At the time of admission, her platelet count was in a normal range. Two days later, her platelet count decreased gradually without any signs or symptoms of bleeding. Since the peripheral blood smear showed a platelet aggregation, a blood sample anticoagulanted with citrate was tested and the number of platelet was normal. The phenomenon disappeared after 17 days when the patient was cured. This case emphasized the importance of peripheral blood smear and clinical manifestation, especially in the differential diagnosis of thrombocytopenia.

[Clinical features and outcome of treatment for novel coronavirus pneumonia: a meta-analysis].

Objective: To investigate the clinical features and outcome of treatment for novel coronavirus pneumonia. Methods: Literature on novel coronavirus pneumonia was retrieved from PubMed and EMBASE databases. The relevant data was extracted and a meta-analysis was performed using StatsDirect statistical software V.2.8.0 to calculate the combined odds ratio. Results: Seven studies were included, consisting of 1594 cases. The meta-analysis result showed that the most common clinical symptoms of the novel coronavirus pneumonia were fever (91.6%) and cough (64.5%), followed by dyspnea (32.8%) and sputum (28.1%). Headache (10.5%), sore throat (11.2%), hemoptysis (3.2%), diarrhea (6.6%) and the other symptoms were relatively rare. Aspartate aminotransferase (29%), alanine transaminase (22.7%), and total bilirubin (11.7%) levels were elevated, except for serum albumin levels (80.4%). The common therapeutic agents used were antibiotics (87.7%), antiviral drugs (75.5%), and glucocorticoids (26.6%), while antifungal agents (7.7%) were used in few. Mechanical ventilation (13.4%), extracorporeal membrane oxygenation (1.9%), and continuous renal replacement therapy (3.8%) were used in severe cases. The rate of mortality in hospital was 7.7%, respectively. Heterogeneity between studies was significant; however, subgroup and sensitivity analysis had failed to identify clear sources of heterogeneity. Conclusion: Fever, cough and liver dysfunction are the main clinical manifestations of this disease and the mortality rate is low.

The profile of peripheral blood lymphocyte subsets and serum cytokines in children with 2019 novel coronavirus pneumonia.

OBJECTIVES: The study was aimed at investigating the characteristics of peripheral blood lymphocyte subsets and serum cytokines in children with 2019 novel coronavirus (2019-nCoV) pneumonia. METHODS: Children with 2019-nCoV pneumonia or with respiratory syncytial virus (RSV) pneumonia were included. Data including lymphocyte subsets and serum cytokines were collected and analyzed. RESULTS: 56 patients were included in the study, 40 children with 2019-nCoV pneumonia and 16 children with RSV pneumonia. Compared with children with RSV pneumonia, patients with 2019-nCoV pneumonia had higher count of CD3+8+ lymphocyte, higher percentages of CD3+, CD3+8+ lymphocytes and a lower percentage of CD19+ lymphocyte. The serum IL-10 level was significantly higher in children with RSV pneumonia. One 2019-nCoV pneumonia child who was with an obvious increase of IL-10 developed severe pneumonia. CONCLUSIONS: Immune response played a very important role in the development of 2019-nCoV pneumonia. The effective CD8+ T cell response might influence the severity of 2019-nCoV pneumonia. The adaptable change in IL-10 level might contribute to the relatively mild pneumonia symptoms in children with 2019-nCoV pneumonia and bacterial co-infection might be a risk factor of severe 2019-nCoV pneumonia.

Current status and progress of 2019 novel coronavirus pneumonia / 中华危重病急救医学

Recently, the 2019 novel coronavirus (2019-nCoV) pneumonia outbroke in Wuhan and rapidly spread to all over China and even the world. Because of the strong infectivity and various clinical symptoms, it has brought certain difficulties to the epidemic prevention and control. Currently there is no specific drug for 2019-nCoV. Previous drugs used to treat other coronaviruses may be effective, but further clinical trials remain needed. We reviewed literature on the epidemiology, etiology, clinical manifestations, imaging manifestations, laboratory examination, diagnosis, complications, treatment and outcome of 2019-nCoV pneumonia.

Dynamic Chest CT Evaluation in Three Cases of 2019 Novel Coronavirus Pneumonia.

A recent outbreak of pneumonia in Wuhan, China, was caused by the 2019 novel coronavirus (2019-nCoV). There have been some reports of imaging findings regarding the disease's characteristic features. Here, we report three cases of coronavirus disease 2019 (COVID-19) with dynamic pulmonary CT evaluation. The CT scan showed multiple regions of ground-glass opacities and patchy consolidation in COVID-19 patients and the CT scan was useful in tracking the progression or regression of COVID-19.

Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: A systematic review and meta-analysis.

BACKGROUND: Currently, the epidemic of coronavirus disease 2019 (COVID-19) has begun to spread worldwide. We aim to explore reliable evidence for the diagnosis and treatment of the COVID-19 by analyzing all the published studies by Chinese scholars on the clinical and imaging features in novel coronavirus pneumonia caused by SARS-CoV-2. METHODS: We searched five medical databases including two Chinese and three English databases for all published articles on COVID-19 since the outbreak. A random-effects model was designed, and the imaging and clinical data from all studies were collected for meta-analysis. RESULTS: Overall, 31 articles and 46 959 patients were included, including 10 English articles and 21 Chinese articles. The results of meta-analysis showed that the most common clinical manifestations were fever (87.3%; 0.838-0.909), cough (58.1%; 0.502-0.660), dyspnea (38.3%; 0.246-0.520), muscle soreness or fatigue (35.5%; 0.253-0.456), and chest distress (31.2%; -0.024 to 0.648). The main imaging findings were bilateral pneumonia (75.7%; 0.639-0.871) and ground-glass opacification (69.9%; 0.602-0.796). Among the patients, the incidence that required intensive care unit (ICU) was (29.3%; 0.190-0.395), the incidence with acute respiratory distress syndrome was (28.8%; 0.147-0.429), the incidence with multiple organ dysfunction syndrome was (8.5%; -0.008 to 0.179), and the case fatality rate of patients with COVID-19 was (6.8%; 0.044-0.093). CONCLUSION: COVID-19 is a new clinical infectious disease that mainly causes bilateral pneumonia and lung function deteriorates rapidly. Nearly a third of patients need to be admitted to the ICU, and patients are likely to present respiratory failure or even death.

Asymptomatic novel coronavirus pneumonia presenting as acute cerebral infarction:case report and review of the literature / 中华急诊医学杂志

An outbreak of novel coronavirus pneumonia that began in Wuhan, China, has spread rapidly in December 2019, with cases now confirmed in multiple countries. As the number of cases increases, we pay more and more attention to asymptomatic novel coronavirus pneumonia,We report the first case of Asymptomatic novel coronavirus pneumonia presenting as acute cerebral infarction and describe the identification, diagnosis, clinical course, and emergency treatment, including. This case highlights the the importance of emergency medical teams in initial assessment of emergency public health emergencies, as well as the necessary of the emergency chest CT for screening asymptomatic novel coronavirus pneumonia.

Comparison of different samples for 2019 novel coronavirus detection by nucleic acid amplification tests.

An ongoing outbreak of severe respiratory pneumonia associated with the 2019 novel coronavirus has recently emerged in China. Here we report the epidemiological, clinical, laboratory and radiological characteristics of 19 suspect cases. We compared the positive ratio of 2019-nCoV nucleic acid amplification test results from different samples including oropharyngeal swab, blood, urine and stool with 3 different fluorescent RT-PCR kits. Nine out of the 19 patients had 2019-nCoV infection detected using oropharyngeal swab samples, and the virus nucleic acid was also detected in eight of these nine patients using stool samples. None of positive results was identified in the blood and urine samples. These three different kits got the same result for each sample and the positive ratio of nucleic acid detection for 2019-nCoV was only 47.4% in the suspect patients. Therefore, it is possible that infected patients have been missed by using nucleic acid detection only. It might be better to make a diagnosis combining the computed tomography scans and nucleic acid detection.

Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2.

BACKGROUND: The pneumonia caused by the 2019 novel coronavirus (SARS-CoV-2, also called 2019-nCoV) recently break out in Wuhan, China, and was named as COVID-19. With the spread of the disease, similar cases have also been confirmed in other regions of China. We aimed to report the imaging and clinical characteristics of these patients infected with SARS-CoV-2 in Guangzhou, China. METHODS: All patients with laboratory-identified SARS-CoV-2 infection by real-time polymerase chain reaction (PCR) were collected between January 23, 2020, and February 4, 2020, in a designated hospital (Guangzhou Eighth People's Hospital). This analysis included 90 patients (39 men and 51 women; median age, 50 years (age range, 18-86 years). All the included SARS-CoV-2-infected patients underwent non-contrast enhanced chest computed tomography (CT). We analyzed the clinical characteristics of the patients, as well as the distribution characteristics, pattern, morphology, and accompanying manifestations of lung lesions. In addition, after 1-6 days (mean 3.5 days), follow-up chest CT images were evaluated to assess radiological evolution. FINDINGS: The majority of infected patients had a history of exposure in Wuhan or to infected patients and mostly presented with fever and cough. More than half of the patients presented bilateral, multifocal lung lesions, with peripheral distribution, and 53 (59%) patients had more than two lobes involved. Of all included patients, COVID-19 pneumonia presented with ground glass opacities in 65 (72%), consolidation in 12 (13%), crazy paving pattern in 11 (12%), interlobular thickening in 33 (37%), adjacent pleura thickening in 50 (56%), and linear opacities combined in 55 (61%). Pleural effusion, pericardial effusion, and lymphadenopathy were uncommon findings. In addition, baseline chest CT did not show any abnormalities in 21 patients (23%), but 3 patients presented bilateral ground glass opacities on the second CT after 3-4 days. CONCLUSION: SARS-CoV-2 infection can be confirmed based on the patient's history, clinical manifestations, imaging characteristics, and laboratory tests. Chest CT examination plays an important role in the initial diagnosis of the novel coronavirus pneumonia. Multiple patchy ground glass opacities in bilateral multiple lobular with periphery distribution are typical chest CT imaging features of the COVID-19 pneumonia.

Experience of treating severe cases of 2019 novel coronavirus pneumonia in Changde area / 中华危重病急救医学

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.

Treatment of 2019 novel coronavirus pneumonia based on the theory of 'three syndromes and three methods' / 中华危重病急救医学

The latest diagnosis and treatment plan (4th edition) of 2019 novel coronavirus pneumonia has been issued. The diagnosis and treatment plan highlights the concept of integrated traditional Chinese and Western medicine, and Xuebijing injection was referred for three times. Xuebijing injection was successfully developed based on the theory of 'three syndromes and three methods'. The theory of 'three syndromes and three methods' is a theoretical system of integrated traditional Chinese and Western medicine on critical diseases proposed by Professor Wang Jinda and his team in the 1970s, and it is one of the main contents of Wang Jinda's academic thought. The theory of 'three syndromes and three methods' has a deep foundation of traditional Chinese medicine theory, and it is still being continuously enriched and improved. It is also supported by multiple evidence-based data. Therefore, 'three syndromes and three methods' has rich theoretical connotation and tenacious vitality.

[Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia].

Objective: To analyze the clinical characteristics of 2019 novel coronavirus (2019-nCoV) pneumonia and to investigate the correlation between serum inflammatory cytokines and severity of the disease. Methods: 29 patients with 2019-ncov admitted to the isolation ward of Tongji hospital affiliated to Tongji medical college of Huazhong University of Science and Technology in January 2020 were selected as the study subjects. Clinical data were collected and the general information, clinical symptoms, blood test and CT imaging characteristics were analyzed. According to the relevant diagnostic criteria, the patients were divided into three groups: mild (15 cases), severe (9 cases) and critical (5 cases). The expression levels of inflammatory cytokines and other markers in the serum of each group were detected, and the changes of these indicators of the three groups were compared and analyzed, as well as their relationship with the clinical classification of the disease. Results: (1) The main symptoms of 2019-nCoV pneumonia was fever (28/29) with or without respiratory and other systemic symptoms. Two patients died with underlying disease and co-bacterial infection, respectively. (2) The blood test of the patients showed normal or decreased white blood cell count (23/29), decreased lymphocyte count (20/29), increased hypersensitive C reactive protein (hs-CRP) (27/29), and normal procalcitonin. In most patients,serum lactate dehydrogenase (LDH) was significantly increased (20/29), while albumin was decreased(15/29). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbil), serum creatinine (Scr) and other items showed no significant changes. (3) CT findings of typical cases were single or multiple patchy ground glass shadows accompanied by septal thickening. When the disease progresses, the lesion increases and the scope expands, and the ground glass shadow coexists with the solid shadow or the stripe shadow. (4) There were statistically significant differences in the expression levels of interleukin-2 receptor (IL-2R) and IL-6 in the serum of the three groups (P<0.05), among which the critical group was higher than the severe group and the severe group was higher than the mildgroup. However, there were no statistically significant differences in serum levels of tumor necrosis factor-alpha (TNF-α), IL-1, IL-8, IL-10, hs-CRP, lymphocyte count and LDH among the three groups (P>0.05). Conclusion: The clinical characteristics of 2019-nCoV pneumonia are similar to those of common viral pneumonia. High resolution CT is of great value in the differential diagnosis of this disease. The increased expression of IL-2R and IL-6 in serum is expected to predict the severity of the 2019-nCoV pneumonia and the prognosis of patients.