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BackgroundWith the spread of COVID-19 from Wuhan, Hubei Province to other areas of the country, medical staff in Fever Clinics faced the challenge of identifying suspected cases among febrile patients with acute respiratory infections. We aimed to describe the prevalence and clinical features of COVID-19 as compared to pneumonias of other etiologies in a Fever Clinic in Beijing. MethodsIn this single-center, retrospective study, 342 cases of pneumonia were diagnosed in Fever Clinic in Peking University Third Hospital between January 21 to February 15, 2020. From these patients, 88 were reviewed by panel discussion as possible or probable cases of COVID-19, and received 2019-nCoV detection by RT-PCR. COVID-19 was confirmed by positive 2019-nCoV in 19 cases, and by epidemiological, clinical and CT features in 2 cases (the COVID-19 Group, n=21), while the remaining 67 cases served as the non-COVID-19 group. Demographic and epidemiological data, symptoms, laboratory and lung CT findings were collected, and compared between the two groups. FindingsThe prevalence of COVID-19 in all pneumonia patients during the study period was 6.14% (21/342). Compared with the non-COVID-19 group, more patients with COVID-19 had an identified epidemiological history (90.5% versus 32.8%, P<0.001). The COVID-19 group had lower WBC [5.19x109/L ({+/-}1.47) versus 7.21x109/L ({+/-}2.94), P<0.001] and neutrophil counts [3.39x109/L ({+/-}1.48) versus 5.38x109/L ({+/-}2.85), P<0.001] in peripheral blood. However, the count of lymphocytes was not different. On lung CT scans, involvement of 4 or more lobes was more common in the COVID-19 group (45% versus 16.4%, P=0.008). InterpretationIn the period of COVID-19 epidemic outside Hubei Province, the prevalence of COVID-19 in patients with pneumonia visiting our Fever Clinic in Beijing was 6.14%. Epidemiological evidence was important for prompt case finding, and lower blood WBC and neutrophil counts may be useful for differentiation from pneumonia of other etiologies. FundingNone.
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Objective To study the relationship between single subcortical small infarction (SSSI) in middle cerebral artery (MCA) and large artery atheromatous sclerosis (LAAS).Methods One hundred and sixty patients with acute SSSI in MCA admitted to our hospital from January 2014 to December 2015 were divided into proximal infarction group (n=98) and distal infarction group (n=62).Their demographic,clinical,imaging data and National Institutes of Health Stroke Scale (NIHSS) score were recorded on admision.Results The incidence of coronary heart disease,NIHSS score,and contralateral intracranial artery stenosis were significantly higher while the incidence of proximal infarction,old lacunar infarction,and periventricular leukoaraiosis was significantly lower in proximal infarction group than in distal infarction group (21.4％ vs 3.2％,P=0.001;3 vs 2,P=0.030;19.4％ vs 1.6％,P=0.002;10.2％ vs 29.0％,P=0.002;16.3％ vs 33.9％,P=0.010).Logistic regression analysis showed that proximal infarction was independently related with old lacunar infarction,contralateral intracranial artery stenosis and periventricular leukoaraiosis (OR=0.270,95％CI:0.100-0.726,P=0.009;OR=4.500,95％CI:1.541-15.012,P=0.018;OR=0.325,95％CI:0.127-0.834,P=0.019).Conclusion Distal SSSI in MCA is related with small vessel disease while proximal SSSI in MCA is related with LAAS.
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Objective To clarify the clinical and imaging features of the small centrum ovale infarcts by comparing with the small basal ganglia infarcts. Methods Forty-six consecutive patients with small centrum ovale infarct showed on the axial MR diffusion weighted imaging admitted to hospital within one week after onset were enrolled retrospectively. One hundred fifty-seven patients with small basal ganglia infarct were used as a control group. The differences of demography,vascular risk factors,clinical features, and imaging data in patients with small centrum ovale infarct and small basal ganglia infarct were compared and analyzed. Results The mean age of small centrum ovale infarct was 69 ± 12 years,among them, 27 patients were male. The mean age of small basal ganglia infarct was 66 ± 11 years,among them,98 were male. The vascular risk factors,clinical features and imaging data of the small centrum ovale infarct and the small basal ganglia infarct were compared. There were significant differences in hypertension (63. 0% [n =29]vs. 43. 3% [n = 68],P = 0. 018),coronary heart disease (4. 3% [n = 2]vs. 17. 8% [n = 28],P =0. 042),atrial fibrillation (15. 2% [n = 7]vs. 5. 7% [n = 9],P = 0. 036),single limb weakness (17. 4% [n = 8]vs. 6. 4% [n = 10],P = 0. 021),National Institutes of Health Stroke Scale score (2 [1,3]vs. 3 [2,5],P = 0. 002),infarct diameter (6 ± 3 mm vs. 10 ± 3 mm,P < 0. 01),ipsilateral middle cerebral artery(MCA)stenosis (4. 3% [n =2]vs. 24. 2% [n =38],P = 0. 006),and accompanied with contralateral intracranial artery stenosis (ICAS)(4. 3% [n = 2]vs. 17. 8% [n = 28 ],P = 0. 042). Conclusions Compared with the small basal ganglia infarcts,the prevalence of atrial fibrillation of the small centrum ovale infarcts was higher. The degree of neurological deficits on admission was milder,the diameter of the infarct was smaller,and the incidences of ipsilateral MCA stenosis and contralateral ICAS were lower.
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Objective To investigate the clinical and radiographic features of rheumatoid arthritis (RA) patients with cervical subluxations.Methods The clinical, laboratory and imaging data of 68 RA patients who were hospitalized to our hospital because of cervical syndrome were retrospectively reviewed.The patients were divided into two groups depend based on whether cervical spine subluxations presented or not.Mann-Whitney U test, t test and Person correlation, x2 test were used for statistical analysis.Results This study confirmed the high frequency (11.6％, 39/335) of radiological cervical subluxations in RA patients.The nNeck pain was a common symptom, accounting for 87％ (34/39).Other symptoms included limb numbness 59％ (23/39).The rate of positive C-reactive protein (CRP) in the subluxation group was both significantly higher than that of the non-subluxation group [89％(24/27) vs 59％(16/27),x2=6.17, P＜0.01].Anterior atlantoaxial subluxation (AAS) was the most common form, accounting for 95％(37/39) of all cervical subluxations,followed by vertical subluxation (VS), accounting for 18％ (7/39).Subaxial subluxation (SAS) of the lower cervical vertebrae was less common (5.1％).The ratio of bone destruction, spinal stenosis, spinal cord compression in image findings of the subluxation group was significantly higher than that of the non-subluxation group (x2=7.96, x2=6.12, x2=4.89, P＜0.05).But more hyperostosis and osteosclerosis feature of the non-subluxation group could be observed more hyperostosis and osteosclerosis feature (x2=6.21, P＜0.05).PADI correlated with ADI (r=-0.588, P=0.015).Conclusion This study confirms the high frequency of radiological cervical involvement in patients with RA.AAS is the most common form of cervical involvement and may occur either independently or concomitantly with cranial settling and subaxial subluxation.
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Objective Toinvestigatetherelationshipbetweendifferenttypesofinternalwatershed infarctionandtandemstenosesofinternalcarotidartery(ICA).Methods Atotalof55patientswith internal watershed infarction confirmed by head MRI and diffusion-weighted imaging (DWI )examination were enrolled. They all underwent the extracranial internal carotid artery (ICA ) ultrasonography and intracranial cerebral artery MR angiography (MRA)examinations. According to the findings of imaging,the 55 patients with internal watershed infarction were divided into a simple internal watershed infarction (IWSI)group and an internal watershed infarction accompanied with ipsilateral cortical watershed infarction (C-IWSI)group. The relationship between the two types of internal watershed infarction and tandem stenoses of ICA was analyzed. Results (1 ) Of the 55 patients with internal watershed infarction,24 cases (43. 6%)were in the internal watershed infarction group and 31 cases (56. 4%)were in the C-IWSI group. The ipsilateral vascular stenosis were ICA 20 cases (36. 4%,including extracranial segment 11 cases and intracranial segment 17 cases),middle cerebral artery (MCA)44 cases (80. 0%), and tandem stenoses of ICA 15 cases (27. 3%). (2)Ipsilateral tandem stenoses of ICA:2 cases were in the IWSI group (intracranial ICA+MCA 2 cases);13 cases were in the C-IWSI group (extracranial ICA+intracranial ICA +MCA 4 cases,extracranial ICA + intracranial ICA 1 case,extracranial ICA + MCA 2 cases,and intracranial ICA+MCA 6 cases). (3)Compared with the IWSI group,the incidences of ipsilateral ICA stenosis and tandem stenoses of ICA in patients of the C-IWSI group were higher (54. 8%[n=17]vs. 12. 5%[n=3],41. 9%[n=13]vs. 8. 3%[n =2]),and there were significant differences(P =0. 001, 0.006]). The incidences of extracranial and intercranial ICA stenosis were higher than those of the IWSI group (35. 5%[n=11]vs. 0,45. 2%[n=14]vs. 12. 5%[n=3]),and there were significant differences (P=0.003,0.009).Conclusion Inthedifferenttypesofinternalwatershedinfarction,theincidenceof tandem stenoses of ICA is different. The IWSI patients with ipsilateral cortical watershed infarction often accompany by tandem stenoses of ICA.
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Objective To analyze the efficacy of the combination of MALDI-TOF and immunoadsorption to detect new biomarkers for lupus. Methods Twenty lupus patients at active stage (SLE group), 10 SLE patients in remission (SLE control group), 10 RA patients and 10 PSS patients (other rheumatic disease control group) and 20 healthy volunteers (healthy control group) were enrolled. The serum samples before and after immunoadsorption from SLE group and those from the control groups were co-incubated with activated chitosan copper derivative nano material. The adsorbed nano material was spotted onto the matrix used in MALDI-TOF for analysis by the Axima-CFR plus MALDI-TOF mass spectrometer. T-test was used for statistical analysis. Results MALDI-TOF MS screening showed that three potential protein biomarkers of mass-to-charge (m/z) ratio 3136, 3264, 3326 were found to be very specific for lupus patients: All of them were expressed before immunoadsorption in high quantity and none of them could be detected both after immunoadsorption and in all the three control groups. None of them (<10 000) were in the molecular weight range of the biomarkers used nowadays such as auto antibodies and complement (>50 000). Conclusion The combination of MALDI-TOF and immunoadsorption is effective in the detection of new serum protein biomarkers for lupus and it may be helpful in the screening of SLE patients at active stage from healthy people.
