Modification of pea starch using ternary mixtures of natural crosslinking agents: Vanillin-chitosan-betaine and vanillin-gelatin-betaine.

Different methods of starch modification have been proposed to broaden its application. In this study, the effects of ternary mixtures of natural crosslinking agents: chitosan-betaine-vanillin and gelatin-betaine-vanillin on the properties of pea starch were explored. These combinations of substances were selected because they have complementary crosslinking mechanisms. The effects of the ternary crosslinker mixtures on the gelatinization, mechanical properties, thermal stability, and microstructure of pea starch were compared. Both combinations of crosslinkers enhanced the gelatinization viscosity, viscoelasticity, gel hardness, and thermal stability of the pea starch, by an amount that depended on the ratio of the different components in the ternary mixtures. In all cases, the crystal structure of the starch granules disappeared after gelatinization. The modified starch had a more compact and uniform microstructure than the non-modified version, especially when it was crosslinked by vanillin, gelatin, and betaine. The improvement in the gelation properties of the starch were primarily attributed to hydrogen bonding, electrostatic attraction, and Schiff base crosslinking of the various components present. Gelatin enhanced the gel strength more than chitosan, which was probably because of greater hydrogen bonding. Our findings suggest that the properties of starch can be enhanced by adding ternary mixtures of natural crosslinkers.

High water resistance starch based intelligent label for the freshness monitoring of beverages.

The traditional starch-based intelligent freshness labels struggle to maintain long-term structural stability when exposed to moisture. To solve this problem, we prepared composite crosslinked labels using phytic acid for double crosslinking of corn starch and soybean isolate proteins, with anthocyanin serving as the chromogenic dye. The mechanical properties, hydrophobic characteristics, and pH responsivity of these crosslinked labels were assessed in this study. The prepared double-crosslinked labels showed reduced moisture content (15.96%), diminished swelling (147.21%), decreased solubility (28.55%), and minimized water permeability, which suggested that they have enhanced hydrophobicity and densification. The crosslinked labels demonstrated the ability to maintain morphological stability when immersed in water for 12 h. Additionally, the mechanical properties of the crosslinked labels were enhanced without compromising their pH-sensing capabilities, demonstrated a color response visible to the naked eye for milk and coconut water freshness monitoring, suggesting great potential for application in beverages freshness monitoring.

[Intraspinal Metastasis of Thymic Carcinoma:Report of One Case].

Intraspinal metastasis from malignant carcinomas in other body parts is rarely reported.Intraspinal metastases are often epidural,with primary tumors mostly from the lung and prostate.The extramedullary subdural metastasis of thymic carcinoma is particularly rare and prone to misdiagnosis due to overlapping imaging features with primary intraspinal tumors.This article reports one case of intraspinal metastasis of thymic carcinoma,with the main diagnostic clues including a history of thymic carcinoma,fast growth rate,and irregular shape.

CT Quantitation and Prediction of the Risk of Type 2 Diabetes Mellitus in Non-Obese Patients with Pancreatic Fatty Infiltration.

Purpose: To examine the risk of type 2 diabetes mellitus in non-obese patients with pancreatic fatty infiltration through abdominal computed tomography (CT) quantitation. Patients and Methods: We carried out a retrospective analysis of abdominal CT and inpatient medical records of 238 inpatients from July 2019 to April 2021. The patients were divided into a normal non-obese group (BMI < 25, n = 135) and diabetic non-obese group (BMI < 25, n = 103). Abdominal CT-related parameters included body width; mean CT values of the pancreas, liver, and spleen; difference between pancreas and spleen CT values (P-S); pancreas-to-spleen attenuation ratio (P/S); and liver-to-spleen attenuation ratio (L/S). Logistic regression was used to estimate the risk factors for comorbid diabetes in a non-obese population. Results: The P-values of the pancreas CT value, P-S, P/S, body width, and L/S were all <0.05 and correlated to comorbid diabetes in non-obese patients. Worsening pancreatic fatty infiltration increased the risk of developing diabetes. Using a P/S of 1.0 as reference, every successive decrease in this ratio by 0.1 increases patient risk by 3.981, 4.452, 6.037, and 12.937 times. Conclusion: The risk of developing type 2 diabetes mellitus in non-obese patients increases with the degree of pancreatic fatty infiltration as assessed by CT.

Total Tumor ADC Histogram Analysis: A New Tool for Predicting High-Risk Cytogenetic Abnormalities in Multiple Myeloma Patients.

RATIONALE AND OBJECTIVES: We explored the feasibility of using total tumor apparent diffusion coefficient (ttADC) histogram parameters to predict high-risk cytogenetic abnormalities (HRCA) in patients with multiple myeloma (MM) and compared the performance of an image prediction model based on these parameters with that of a combined prediction model based on these parameters and clinical indicators. METHODS: We retrospectively analyzed the parameters of the ttADC histogram based on whole-body diffusion-weighted images(WB-DWI) and clinical indicators in 92 patients with MM. The patients were divided into HRCA and non-HRCA groups according to the results of the fluorescence in situ hybridization. Logistic regression analysis was used to construct the image prediction and combined prediction models. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to evaluate the performance of the models to identify HRCA. The DeLong test was used to compare the AUC differences of each prediction model. RESULTS: Logistic regression analysis results revealed that the ttADC histogram parameter, ttADC entropy < 7.959 (OR: 39.167; 95% confidence interval [CI]: 3.891-394.208; P < 0.05), was an independent risk factor for HRCA. The image prediction model consisted of ttADC entropy and ttADC SD. The combined prediction model included ttADC entropy along with patient clinical indicators such as biological sex and M protein percentage. The AUCs of the image prediction and combined prediction models were 0.739 and 0.811, respectively (P < .05). The image prediction model showed a sensitivity of 73.9% and a specificity of 68.1%. The combined prediction model showed 82.6% sensitivity and 72.5% specificity. CONCLUSIONS: Using ttADC histogram parameters based on WB-DWI images to predict HRCA in patients with MM is feasible, and combining ttADC parameters with clinical indicators can achieve better predictive performance.

Genome-wide identification and expression analysis of the BZR gene family in Zanthoxylum armatum DC and functional analysis of ZaBZR1 in drought tolerance.

MAIN CONCLUSION: In this study, six ZaBZRs were identified in Zanthoxylum armatum DC, and all the ZaBZRs were upregulated by abscisic acid (ABA) and drought. Overexpression of ZaBZR1 enhanced the drought tolerance of transgenic Nicotiana benthamian. Brassinosteroids (BRs) are a pivotal class of sterol hormones in plants that play a crucial role in plant growth and development. BZR (brassinazole resistant) is a crucial transcription factor in the signal transduction pathway of BRs. However, the BZR gene family members have not yet been identified in Zanthoxylum armatum DC. In this study, six members of the ZaBZR family were identified by bioinformatic methods. All six ZaBZRs exhibited multiple phosphorylation sites. Phylogenetic and collinearity analyses revealed a closest relationship between ZaBZRs and ZbBZRs located on the B subgenomes. Expression analysis revealed tissue-specific expression patterns of ZaBZRs in Z. armatum, and their promoter regions contained cis-acting elements associated with hormone response and stress induction. Additionally, all six ZaBZRs showed upregulation upon treatment after abscisic acid (ABA) and polyethylene glycol (PEG), indicating their participation in drought response. Subsequently, we conducted an extensive investigation of ZaBZR1. ZaBZR1 showed the highest expression in the root, followed by the stem and terminal bud. Subcellular localization analysis revealed that ZaBZR1 is present in the cytoplasm and nucleus. Overexpression of ZaBZR1 in transgenic Nicotiana benthamiana improved seed germination rate and root growth under drought conditions, reducing water loss rates compared to wild-type plants. Furthermore, ZaBZR1 increased proline content (PRO) and decreased malondialdehyde content (MDA), indicating improved tolerance to drought-induced oxidative stress. The transgenic plants also showed a reduced accumulation of reactive oxygen species. Importantly, ZaBZR1 up-regulated the expression of drought-related genes such as NbP5CS1, NbDREB2A, and NbWRKY44. These findings highlight the potential of ZaBZR1 as a candidate gene for enhancing drought resistance in transgenic N. benthamiana and provide insight into the function of ZaBZRs in Z. armatum.

Structural elucidation and functional characteristics of novel potential prebiotics produced from Limosilactobacillus reuteri N1 GtfB-treated maize starches.

The recently characterized Limosilactobacillus reuteri N1 GtfB (LrN1 GtfB) from glycoside hydrolase family 70 is a novel 4,6-α-glucanotransferase acting on starch/maltooligosaccharides with high enzyme activity and soluble protein yield (in heterogenous system). In this study, the influence of the treatment by LrN1 GtfB on the fine structure and functional characteristics of three maize starches were furtherly investigated and elucidated. Due to the treatment of LrN1 GtfB, the starch molecules were transformed into reuterans containing linear and branched (α1 â†’ 6) linkages with notably smaller molecular weight and shorter chain length. Moreover, the (α1 â†’ 6) linkage ratios in the GtfB-modified high-amylose maize starch (GHMS)/normal maize starch (GNMS)/waxy maize starch (GWMS) increased by 18.3 %/12.6 %/9.0 % as compared to their corresponding controls. In vitro digestibility experiment revealed that the resistant starch content of GHMS, GNMS and GWMS increased by 16 %, 18 % and 25 % as compared to the starch substrates. Furthermore, the butyric acid yielded from GHMS, GNMS and GWMS in the in vitro fermentation experiments were 1.4, 1.5 and 1.4 times higher than those of commercial galactose oligosaccharides. These results indicated that the highly-branched short-clustered reuteran synthesized by LrN1 GtfB might serve as novel potential prebiotics, and provide insights for the synthesis of promising prebiotic dietary fiber from starch.

Diagnostic performance of MRI in detecting prostate cancer in patients with prostate-specific antigen levels of 4-10 ng/mL: a systematic review and meta-analysis.

OBJECTIVE: To investigate the diagnostic performance of MRI in detecting clinically significant prostate cancer (csPCa) and prostate cancer (PCa) in patients with prostate-specific antigen (PSA) levels of 4-10 ng/mL. METHODS: A computerized search of PubMed, Embase, Cochrane Library, Medline, and Web of Science was conducted from inception until October 31, 2023. We included articles on the use of MRI to detect csPCa or PCa at 4-10 ng/mL PSA. The primary and secondary outcomes were MRI performance in csPCa and PCa detection, respectively; the estimates of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were pooled in a bivariate random-effects model. RESULTS: Among the 19 studies (3879 patients), there were 10 (2205 patients) and 13 studies (2965 patients) that reported MRI for detecting csPCa or PCa, respectively. The pooled sensitivity and specificity for csPCa detection were 0.84 (95% confidence interval [CI], 0.79-0.88) and 0.76 (95%CI, 0.65-0.84), respectively, for PCa detection were 0.82 (95%CI, 0.75-0.87) and 0.74 (95%CI, 0.65-0.82), respectively. The pooled NPV for csPCa detection was 0.91 (0.87-0.93). Biparametric magnetic resonance imaging also showed a significantly higher sensitivity and specificity relative to multiparametric magnetic resonance imaging (both p < 0.01). CONCLUSION: Prostate MRI enables the detection of csPCa and PCa with satisfactory performance in the PSA gray zone. The excellent NPV for csPCa detection indicates the possibility of biopsy decision-making in patients in the PSA gray zone, but substantial heterogeneity among the included studies should be taken into account. CLINICAL RELEVANCE STATEMENT: Prostate MRI can be considered a reliable and satisfactory tool for detecting csPCa and PCa in patients with PSA in the "gray zone", allowing for reducing unnecessary biopsy and optimizing the overall examination process. KEY POINTS: Prostate-specific antigen (PSA) is a common screening tool for prostate cancer but risks overdiagnosis. MRI demonstrated excellent negative predictive value for prostate cancer in the PSA gray zone. MRI can influence decision-making for these patients, and biparametric MRI should be further evaluated.

Influence of key component interactions in flour on the quality of fried flour products.

In the field of food, the interaction between various components in food is commonly used to regulate food quality. Starches, proteins, and lipids are ubiquitous in the food system and play a critical role in the food system. The interaction between proteins, starches, and lipids components in flour is the molecular basis for the formation of the classical texture of dough, and has a profound impact on the processing properties of dough and the quality of flour products. In this article, the composition of the key components of flour (starch, protein and lipid) and their functions in dough processing were reviewed, and the interaction mechanism of the three components in the dynamic processing of dough from mixing to rising to frying was emphatically discussed, and the effects of the components on the network structure of dough and then on the quality of fried flour products were introduced. The analysis of the relationship between dough component interaction, network structure and quality of fried flour products is helpful to reveal the common mechanism of quality change of fried flour products, and provide a reference for exploring the interaction of ingredients in starch food processing.

Effects of different polysaccharide colloids on the structure and physicochemical properties of peanut protein and wheat gluten composite system under extrusion.

The structure and physicochemical properties of the complex system of peanut protein and gluten with different concentrations (0 %, 0.5 %, 1 %, and 2 %) of carboxymethyl cellulose (CMC) or sodium alginate (SA) under high-moisture extrusion were studied. The water absorption index and low-field nuclear magnetic resonance showed that adding 0.5 % SA could significantly improve the water uniformity of peanut protein extrudates, while the increase in water absorption was not significant. The texture properties showed that adding CMC or SA increased the hardness, vertical shearing force, and parallel shearing force of the system. Furthermore, adding 0.5 % SA increased approximately 33 % and 75.2 % of the tensile distance and strength of the system, respectively. The secondary structure showed that CMC or SA decreased the proportion of α-helix, ß-turn, and random coil, while increased ß-sheet proportion. The results of hydrophobicity, unextractable protein, and endogenous fluorescence revealed that CMC and SA reduced the surface hydrophobicity of the system and caused fluorescence quenching in the system. Additionally, it was found that CMC generally increased the free sulfhydryl group content, while SA exhibited the opposite effect.

Effect of magnetic fields on the structure, properties, baking performance of frozen wheat dough at different frozen stage.

As an emerging physical technology, magnetic fields have been used to improve the quality of frozen and refrigerated foods. This study compared the effect of applying a static magnetic field (2 mT) at different stages of freezing and storage on the quality of frozen dough. Results suggested that the magnetic field significantly impacted frozen dough quality. It not only prevented the formation of ice crystals during the pre-freezing stage but also inhibited ice crystal growth during the following frozen storage. This effect helped to maintain the integrity of gluten proteins and their adhesion to starch granules by preventing the breakage of disulfide bonds and the depolymerization of gluten macromolecules. It was also observed that yeast inactivation and glutathione release were reduced, resulting in improved air retention and air production capacity of the dough. This, in turn, led to a more appealing volume and texture quality of the finished bread.

Dynamic Mechanism of Cerebral Venous Disruption: Longitudinal Evidence From a Community-Based Cohort.

BACKGROUND: This study aims to investigate the temporal and spatial patterns of structural brain injury related to deep medullary veins (DMVs) damage. METHODS AND RESULTS: This is a longitudinal analysis of the population-based Shunyi cohort study. Baseline DMVs numbers were identified on susceptibility-weighted imaging. We assessed vertex-wise cortex maps and diffusion maps at both baseline and follow-up using FSL software and the longitudinal FreeSurfer analysis suite. We performed statistical analysis of global measurements and voxel/vertex-wise analysis to explore the relationship between DMVs number and brain structural measurements. A total of 977 participants were included in the baseline, of whom 544 completed the follow-up magnetic resonance imaging (age 54.97±7.83 years, 32% men, mean interval 5.56±0.47 years). A lower number of DMVs was associated with a faster disruption of white matter microstructural integrity, presented by increased mean diffusivity and radial diffusion (ß=0.0001 and SE=0.0001 for both, P=0.04 and 0.03, respectively), in extensive deep white matter (threshold-free cluster enhancement P<0.05, adjusted for age and sex). Of particular interest, we found a bidirectional trend association between DMVs number and change in brain volumes. Specifically, participants with mild DMVs disruption showed greater cortical enlargement, whereas those with severe disruption exhibited more significant brain atrophy, primarily involving clusters in the frontal and parietal lobes (multiple comparison corrected P<0.05, adjusted for age, sex, and total intracranial volume). CONCLUSIONS: Our findings posed the dynamic pattern of brain parenchymal lesions related to DMVs injury, shedding light on the interactions and chronological roles of various pathological mechanisms.

Review of formation mechanisms and quality regulation of chewiness in staple foods: Rice, noodles, potatoes and bread.

Staple foods serve as vital nutrient sources for the human body, and chewiness is an essential aspect of food texture. Age, specific preferences, and diminished eating functions have broadened the chewiness requirements for staple foods. Therefore, comprehending the formation mechanism of chewiness in staple foods and exploring approaches to modulate it becomes imperative. This article reviewed the formation mechanisms and quality control methods for chewiness in several of the most common staple foods (rice, noodles, potatoes and bread). It initially summarized the chewiness formation mechanisms under three distinct thermal processing methods: water medium, oil medium, and air medium processing. Subsequently, proposed some effective approaches for regulating chewiness based on mechanistic changes. Optimizing raw material composition, controlling processing conditions, and adopting innovative processing techniques can be utilized. Nonetheless, the precise adjustment of staple foods' chewiness remains a challenge due to their diversity and technical study limitations. Hence, further in-depth exploration of chewiness across different staple foods is warranted.

Tailor-Made α-Glucans by Engineering the Processivity of α-Glucanotransferases via Tunnel-Cleft Active Center Interconversions.

The function of polysaccharides is intimately associated with their size, which is largely determined by the processivity of transferases responsible for their synthesis. A tunnel active center architecture has been recognized as a key factor that governs processivity of several glycoside hydrolases (GHs), e.g., cellulases and chitinases. Similar tunnel architecture is also observed in the Limosilactobacillus reuteri 121 GtfB (Lr121 GtfB) α-glucanotransferase from the GH70 family. The molecular element underpinning processivity of these transglucosylases remains underexplored. Here, we report the synthesis of the smallest (α1 → 4)-α-glucan interspersed with linear and branched (α1 → 6) linkages by a novel 4,6-α-glucanotransferase from L. reuteri N1 (LrN1 GtfB) with an open-clefted active center instead of the tunnel structure. Notably, the loop swapping engineering of LrN1 GtfB and Lr121 GtfB based on their crystal structures clarified the impact of the loop-mediated tunnel/cleft structure at the donor subsites -2 to -3 on processivity of these α-glucanotransferases, enabling the tailoring of both product sizes and substrate preferences. This study provides unprecedented insights into the processivity determinants and evolutionary diversification of GH70 α-glucanotransferases and offers a simple route for engineering starch-converting α-glucanotransferases to generate diverse α-glucans for different biotechnological applications.

Progress in using cross-linking technologies to increase the thermal stability of colloidal delivery systems.

In recent years, crosslinking technology has been found and widely used in food, textile, pharmaceutical, bioengineering and other fields. Crosslinking is a reaction in which two or more molecules bond to each other to form a stable three-dimensional network structure to improve the strength, heat resistance and other properties of substances. The researchers found that the cross-linking technology has a significant effect on improving the thermal stability of the colloidal delivery system. In this paper, crosslinking techniques that can be used to improve the thermal stability of colloidal delivery systems are reviewed, including enzyme-, ion-, chemical-, and combined cross-linking. Initially, the underlying mechanisms of these crosslinking technologies is reviewed. Then, the impacts of crosslinking on the heat-stability of colloidal delivery systems are discussed. Finally, the application of crosslinked delivery systems in improving the thermal stability of probiotics, polyphenols, pigments, and nutrients in foods and food packaging materials is introduced. The ability of proteins and polysaccharides to form heat-stable colloidal delivery systems can be improved by crosslinking. Nevertheless, more research is required to establish the impact of different crosslinking on the thermal stability of a broader range of different delivery systems, as well as to ensure their safety and efficacy.

Recent advances in enzymatic modification techniques to improve the quality of flour-based fried foods.

Flour-based fried foods are among the most commonly consumed foods worldwide. However, the sensory attributes and nutritional value of fried foods are inconsistent and unstable. Therefore, the creation of fried foods with desirable sensory attributes and good nutritional value remains a major challenge for the development of the fried food industry. The quality of flour-based fried foods can sometimes be improved by physical methods and the addition of chemical modifiers. However, enzyme modification is widely accepted by consumers due to its unique advantages of specificity, mild processing conditions and high safety. Therefore, it is important to elucidate the effects of enzyme treatments on the sensory attributes (color, flavor and texture), oil absorption and digestibility of flour-based fried foods. This paper reviews recent research progress in utilizing enzyme modification to improve the quality of flour-based fried foods. This paper begins with the effects of common enzymes on the physicochemical properties (rheological property, retrogradation property and specific volume) of dough. Based on the analysis of the mechanism of formation of sensory attributes and nutritional properties, it focuses on the application of amylase, protease, transglutaminase, and lipase in the regulation of sensory attributes and nutritional properties of flour-based fried foods.

Pea protein/carboxymethyl cellulose complexes prepared using a pH cycle strategy as stabilizers of high internal phase emulsions for 3D printing.

The development of food-grade high internal phase emulsions (HIPEs) for 3D printing and the replacement of animal fats have attracted considerable attention. In this study, in order to improve the rheological properties and stability of pea protein to prepare HIPE, pea protein/carboxymethyl cellulose (pH-PP/CMC) was prepared and subjected to pH cycle treatment to produce HIPEs. The results showed that pH cycle treatment and CMC significantly reduced the droplet size of HIPEs (from 143.33 to 12.10 µm). At higher CMC concentrations, the interfacial tension of the PP solution decreased from 12.84 to 11.71 mN/m without pH cycle treatment and to 10.79 mN/m with pH cycle treatment. The HIPEs with higher CMC concentrations subjected to pH cycle treatment showed shear thinning behavior and higher viscoelasticity and recovered their solid-like properties after being subjected to 50 % strain, indicating that they could be used for 3D printing. The 3D printing results showed that the pH-PP/CMC HIPE with 0.3 % CMC had the finest structure. Our work provides new insights into developing food-grade HIPEs and facilitating their use in 3D printing inks as nutrient delivery systems and animal fat substitutes.

Effect of different molecular weight ß-glucan hydrated with highland barley protein on the quality and in vitro starch digestibility of whole wheat bread.

Whole wheat bread has high nutritional value, but it has inferior baking quality and high glycemic index, which needs to be improved by methods such as adding protein and ß-glucan. This study investigated the effects of ß-glucan and highland barley protein of different molecular weights (2 × 104, 1 × 105, and 3 × 105 Da) and different hydrate methods (pre-hydrate and not pre-hydrate) on the characteristics of whole wheat dough and bread. The mixing properties and rheological properties demonstrated that ß-glucan pre-hydrated with highland barley protein were able to reduce the dough tan δ, reduce the dough viscoelasticity, while enhance the gluten network structure and dough deformation resistance. Compared to the control sample, the medium molecular weight pre-hydrate bread had a better specific volume of 3.21 mL/g, lower hardness of 527.28 g. In vitro starch digestion characteristics and ATR-FTIR showed that low and high molecular weight pre-hydrate increased the short-range ordered structure of starch and reduced the starch digestibility, while not pre-hydrated medium molecular weight hydrate had the lowest level of starch digestibility.

Time-dependent CT score-based model for identifying severe/critical COVID-19 at a fever clinic after the emergence of Omicron variant.

Rationale and objectives: The computed tomography (CT) score has been used to evaluate the severity of COVID-19 during the pandemic; however, most studies have overlooked the impact of infection duration on the CT score. This study aimed to determine the optimal cutoff CT score value for identifying severe/critical COVID-19 during different stages of infection and to construct corresponding predictive models using radiological characteristics and clinical factors. Materials and methods: This retrospective study collected consecutive baseline chest CT images of confirmed COVID-19 patients from a fever clinic at a tertiary referral hospital from November 28, 2022, to January 8, 2023. Cohorts were divided into three subcohorts according to the time interval from symptom onset to CT examination at the hospital: early phase (0-3 days), intermediate phase (4-7 days), and late phase (8-14 days). The binary endpoints were mild/moderate and severe/critical infection. The CT scores and qualitative CT features were manually evaluated. A logistic regression analysis was performed on the CT score as determined by a visual assessment to predict severe/critical infection. Receiver operating characteristic analysis was performed and the area under the curve (AUC) was calculated. The optimal cutoff value was determined by maximizing the Youden index in each subcohort. A radiology score and integrated models were then constructed by combining the qualitative CT features and clinical features, respectively, using multivariate logistic regression with stepwise elimination. Results: A total of 962 patients (aged, 61.7 ± 19.6 years; 490 men) were included; 179 (18.6%) were classified as severe/critical COVID-19, while 344 (35.8%) had a typical Radiological Society of North America (RSNA) COVID-19 appearance. The AUCs of the CT score models reached 0.91 (95% confidence interval (CI) 0.88-0.94), 0.82 (95% CI 0.76-0.87), and 0.83 (95% CI 0.77-0.89) during the early, intermediate, and late phases, respectively. The best cutoff values of the CT scores during each phase were 1.5, 4.5, and 5.5. The predictive accuracies associated with the time-dependent cutoff values reached 88% (vs.78%), 73% (vs. 63%), and 87% (vs. 57%), which were greater than those associated with universal cutoff value (all P < 0.001). The radiology score models reached AUCs of 0.96 (95% CI 0.94-0.98), 0.90 (95% CI 0.87-0.94), and 0.89 (95% CI 0.84-0.94) during the early, intermediate, and late phases, respectively. The integrated models including demographic and clinical risk factors greatly enhanced the AUC during the intermediate and late phases compared with the values obtained with the radiology score models; however, an improvement in accuracy was not observed. Conclusion: The time interval between symptom onset and CT examination should be tracked to determine the cutoff value for the CT score for identifying severe/critical COVID-19. The radiology score combining qualitative CT features and the CT score complements clinical factors for identifying severe/critical COVID-19 patients and facilitates timely hierarchical diagnoses and treatment.