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BackgroundThe stage of CT images was rarely studied and the relationship between the severity of Coronavirus Disease 2019 (COVID-19) and CT images has not been studied based on systematic quantitative analysis currently. PurposeTo investigate the staging duration and classification of CT images of patients with COVID-19 based on quantitative analysis. Materials and MethodsThis is an ambispective observational cohort study based on 125 patients with COVID-19 from Jan 23 to Feb 28, 2020. The stage of CT and pulmonary lesion size were quantitatively analyzed. The categorical regression analysis based on optimal scale (CATREG) was performed to evaluate the association of CT score, age, and gender with the clinical type. ResultsThe CT images of 125 patients with COVID-19 (50.13 {+/-} 16.91 years, 66 women) were analyzed in this study. Except for pre-early stage, the duration of early, progression-consolidation, and dissipation stage of CT images was 3.40 {+/-} 2.31, 10.07 {+/-} 4.91, and 20.60 {+/-} 7.64 days, respectively. The median CT score was 5.00 (2.00-8.50) during the first 30 days, which reached a peak on the 11th day. Significant differences were found between the median CT scores of different clinical types (P<0.05). Besides, the age was correlated with the clinical type (P<0.001), the CT scores of 0.00-11.50, 11.50-16.00, and 16.00-20.00 were separately correlated with the moderate, severe, and critical type with the output accuracy 69.60%. ConclusionThe four-stage staging method based on quantitative analysis is consistent with the change rules of staging features and COVID-19. Quantitative study by scoring pulmonary lesion sizes accurately revealed the evolvement of pulmonary lesions and differences between different clinical types. SummaryQuantitative study of the stage duration and classification of chest CT images can objectively reveal the relationship between Coronavirus Disease 2019 (COVID-19) and chest CT images. Key Results1. A four-stage staging method was proposed. Except for pre-early stage, the duration of early, progression-consolidation, and dissipation stage of CT images was 3.40 {+/-} 2.31, 10.07 {+/-} 4.91, and 20.60 {+/-} 7.64 days, respectively. 2. The severer the disease, the higher the median CT scores and their peak value. 3. The CT scores of 0.00-11.50, 11.50-16.00, and 16.00-20.00 were separately correlated with the moderate, severe, and critical type.
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BackgroundThe pandemic of coronavirus disease 2019 (COVID-19) has become the first concern in international affairs as the novel coronavirus (SARS-CoV-2) is spreading all over the world at a terrific speed. The accuracy of early diagnosis is critical in the control of the spread of the virus. Although the real-time RT-PCR detection of the virus nucleic acid is the current golden diagnostic standard, it has high false negative rate when only apply single test. ObjectiveSummarize the baseline characteristics and laboratory examination results of hospitalized COVID-19 patients. Analyze the factors that could interfere with the early diagnosis quantitatively to support the timely confirmation of the disease. MethodsAll suspected patients with COVID-19 were included in our study until Feb 9th, 2020. The last day of follow-up was Mar 20th, 2020. Throat swab real-time RT-PCR test was used to confirm SARS-CoV-2 infection. The difference between the epidemiological profile and first laboratory examination results of COVID-19 patients and non-COVID-19 patients were compared and analyzed by multiple logistic regression. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to assess the potential diagnostic value in factors, which had statistical differences in regression analysis. ResultsIn total, 315 hospitalized patients were included. Among them, 108 were confirmed as COVID-19 patients and 207 were non-COVID-19 patients. Two groups of patients have significance in comparing age, contact history, leukocyte count, lymphocyte count, C-reactive protein, erythrocyte sedimentation rate (p<0.10). Multiple logistic regression analysis showed age, contact history and decreasing lymphocyte count could be used as individual factor that has diagnostic value (p<0.05). The AUC of first RT-PCR test was 0.84 (95% CI 0.73-0.89), AUC of cumulative two times of RT-PCR tests was 0.92 (95% CI 0.88-0.96) and 0.96 (95% CI 0.93-0.99) for cumulative three times of RT-PCR tests. Ninety-six patients showed typical pneumonia radiological features in first CT scan, AUC was 0.74 (95% CI 0.60-0.73). The AUC of patients age, contact history with confirmed people and the decreased lymphocytes were 0.66 (95% CI 0.60-0.73), 0.67 (95% CI 0.61-0.73), 0.62 (95% CI 0.56-0.69), respectively. Taking chest CT scan diagnosis together with patients age and decreasing lymphocytes, AUC would be 0.86 (95% CI 0.82-0.90). The age threshold to predict COVID-19 was 41.5 years, with a diagnostic sensitivity of 0.70 (95% CI 0.61-0.79) and a specificity of 0.59 (95% CI 0.52-0.66). Positive and negative likelihood ratios were 1.71 and 0.50, respectively. Threshold of lymphocyte count to diagnose COVID-19 was 1.53x109/L, with a diagnostic sensitivity of 0.82 (95% CI 0.73-0.88) and a specificity of 0.50 (95% CI 0.43-0.57). Positive and negative likelihood ratios were 1.64 and 0.37, respectively. ConclusionSingle RT-PCR test has relatively high false negative rate. When first RT-PCR test show negative result in suspected patients, the chest CT scan, contact history, age and lymphocyte count should be used combinedly to assess the possibility of SARS-CoV-2 infection.
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ObjectiveTo describe the epidemiological and clinical characteristics of the Coronavirus Disease 2019 (COVID-19) hospitalized patients and to offer suggestions to the urgent needs of COVID-19 prevention, diagnosis and treatment. MethodsWe included 102 confirmed COVID-19 cases hospitalized in Xiangyang No.1 peoples hospital, Hubei, China until Feb 9th, 2020. Demographic data, laboratory findings and chest computed tomographic (CT) images were obtained and analyzed. FindingsAll cases were confirmed by real-time RT-PCR, including 52 males and 50 females with a mean age of 50.38 years (SD 16.86). Incubation time ranged from one to twenty days with a mean period of 8.09 days (SD 4.99). Fever (86[84.3%] of 102 patients), cough (58[57%]), fatigue (28[27%]), shortness of breath (24[23%]), diarrhea (15[15%]), expectoration (13[12%]), inappetence (11[10%]) were common clinical manifestations. We observed a decreased blood leukocyte count and lymphopenia in 21 (20.6%) and 56 (54.9%) patients, respectively. There were 66 (68%) of 97 patients with elevated C-reactive protein levels and 49 (57.6%) of 85 with increased erythrocytes sedimentation rate. Higher levels of procalcitonin and ferritin were observed in 19 (25.3%) of 75 and 12 (92.3%) of 13 patients, respectively. Eight patients were admitted to intensive care unit (ICU), six developed respiratory failure, three had multiple organ failure and three died. The cumulative positivity rate over three rounds of real-time RT-PCR was 96%. One-hundred patients were found with typical radiological abnormalities in two rounds of chest CT scans, indicating a 98% consistency with real-time RT-PCR results. InterpretationMost COVID-19 patients in Xiangyang were secondary cases without sex difference, and the rate of severe case and death was low. Middle-to-old-age individuals were more susceptible to the virus infection and the subsequent development of severe/fatal consequences. The average incubation period was longer among our patients. We recommend prolonging the quarantine period to three weeks. Three times real-time RT-PCR plus two times CT scans is a practical clinical diagnosis strategy at present and should be used to increase the accuracy of diagnosis, thereby controlling the source of infection more effectively.
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BACKGROUND:Autologous bone marrow mesenchymal stem cels (BMSCs) transplantation has been used for clinical treatment of dilated cardiomyopathy. But the efficacy and safety of autologous BMSCs transplantation remains controversial. OBJECTIVE: To systematicaly assess the efficacy and safety of autologous BMSCs transplantation for treatment of dilated cardiomyopathy by using meta-analysis approach. METHODS:PubMed, Cochrane Library (Issue 2, 2016), Embase, CNKI, CBM, VIP, WanFang were systemicaly searched for relevant randomized controled trials (RCTs) about autologous BMSCs transplantation and conventional drugs for the treatment of dilated cardiomyopathy. After information extracting and quality assessing, Meta-analysis of left ventricular ejection fraction, left ventricular end-diastolic diameter, 6-minute walking distance, percentage of myocardial perfusion defect, mortality, incidence of malignant arrhythmia events and heart transplantation rate during treatment and folow-up was performed using R3.1.0 software. RESULTS AND CONCLUSION:A total of 7 RCTs involving 341 patients were included. Meta-analysis results showed that for efficacy, compared with the conventional drugs, BMSCs can increase the left ventricular ejection fraction [1 month post-treatment: mean difference (MD)=3.02, 95% confidence interval (CI) (1.55, 4.49); 3 months post-treatment:MD=4.38, 95%CI(3.55, 5.52); 6 months post-treatment:MD=6.47, 95%CI(4.78, 8.15);≥ 12 months post-treatment:MD=8.23, 95%CI(5.15, 9.19)]; decrease the left ventricular end-diastolic diameter after 3 months [3 months post-treatment:MD=-0.65, 95%CI(-0.72,-0.59); 6 months post-treatment:MD=-0.12, 95%CI(-0.21,-0.03);≥ 12 months post-treatment:MD=-0.19, 95%CI(-0.24,-0.13)]; increase 6-minute walking distance after 6 months [6 months post-treatment:MD=87.70, 95%CI(51.55, 123.85);≥ 12 months post-treatment:MD=143.83, 95%CI(122.73, 164.93)]; and decrease percentage of myocardial perfusion defect at 3 months [MD=-3.56, 95%CI(-5.57,-1.55)]. For safety, BMSCs can decrease the mortality [risk ratio=0.46, 95%CI(0.24, 0.89)], but there is no significant difference in the incidence of malignant arrhythmia events and heart transplantation rate between two treatment groups. To conclude, these results indicate that BMSCs transplantation for dilated cardiomyopathy is one of effective and safe treatments.
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BACKGROUND: Patients with hip instability due to cerebral palsy, hemiplegia, infantile paralysis and extensive damage in gluteus medius, appear with high dislocation rate after arthroplasty, which is a great challenge for clinicians.OBJECTIVE: To investigate the reconstruction of the hip joint stability with the dual-mobility acetabular cup, and to prevent the dislocation after replacement in patients with hip neuromuscular lesions.METHODS: Twelve cases of hemiplegia, infantile paralysis, developmental dysplasia of the hip and recurrent dislocation after hip arthroplasty admitted in the Orthopedic Treatment Center, the Second Affiliated Hospital of Henan University of Chinese Medicine from January 2010 to July 2014 were enrolled, then underwent joint replacement or revision with dual-mobility cup, and the dynamic stability of the hip was achieved by adjusting the abductor lever arm.RESULTS AND CONCLUSION: (1) The followed-up time was from 20 to 60 months. (2) One year later, one case suffered Vancouver A right femoral fracture and received conservative treatment at 1 year postoperatively; one case of dislocation at postoperative 1 week, and dislocation, infection and loosening occurred in none cases. (3) These results manifest that those patients with neuromuscular disease and hip instability treated with hip joint arthroplasty using dual-mobility acetabular cup can reconstruct the stability of the hip joint and prevent the occurrence of postoperative dislocation.
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Objective To compare the safety and effectiveness between ozone (O3) and hyaluronic acid (HA) in treating knee osteoarthritis(KOA) by using the meta analysis method.Methods The relevant randomized controlled trials(RCTs) in PubMed,Cochrane Library (issue 1,2016),Embase,CNKI,CBM,VIP,and Wan-Fang databases were retrieved from their establishment to January 23,2016.Two reviewers independently screened the literatures,extracted the data and evaluated the quality of the included RCTs.The results were performed the statistical analysis by using the RevMan5.3 and Stata13.0 software.Results Twenty RCTs involving 2 136 KOA patients were included.Compared with the HA treatment of KOA,the O3 treatment had higher treatment effective rate[odds ratio(OR) =2.78,P＜0.01],and better pain relief effect[at 1,3,6 month after treatment:mean difference(MD) =-0.25,-0.71,-1.70,P＜0.01].There were no statistically significant differences in complications between the two treatment methods[OR=0.84,P=0.56].Conclusion Current evidences indicate that the short-term therapeutic effect of O3 for KOA is superior to HA,and the safety is similar.
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BACKGROUND:Comparative study results between the efficacies of traditional Chinese medicine (TCM) therapy with Western medicine therapy in the treatment of knee osteoarthritis remain controversial. Currently, meta-analysis studies mainly focuson comparison of the efficacy between TCM and Western medicine,butlack investigations among TCM therapies. Itmakes usdifficult tofulyunderstand the efficacy of TCM therapy for knee osteoarthritis. OBJECTIVE:To compare the efficacies of TCM therapy with intra-articular injection of hyaluronic acid for knee osteoarthritis using a networkMeta-analysis method. METHODS:PubMed, The Cochrane Library (tissue 10, 2015), EMbase, CNKI, CBM, VIP, Wangfang databaseswere searchedup to October 20, 2015forrelevantrandomized controled trialsaddressingthe efficacies of TCM therapyversusintra-articular injection of hyaluronic acid for knee osteoarthritis. Two reviewers independently selected the studies, extracted information, and assessed the quality of included trials. Data extraction from eligible studies was pooled and meta-analyzed using Stata12.0 and WinBUGS1.4.3softwares. Odd ratios with their 95% confidence interval were estimated as effect size between treatments. RESULTS AND CONCLUSION:A total of 59 randomized controled trials involving 6 155 patients with knee osteoarthritis and 12 treatment strategies were included. The results of network meta-analysis showed that TCM comprehensive therapy wassuperior to the TCM monotherapy and intra-articular injection of hyaluronic acid. Among thesetherapies, the efficacy of needle scalpel combined with acupuncture is optimal. TCM comprehensive therapies may be the best choice to treat patients with knee osteoarthritisofKelgren-LawrenceII-III. Morelarge-scaleand wel-designedrandomized controled trials are stil warranted due to the limitation of the present study.
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Thirteen cases of developmental dysplasia hip underwent total hip arthroplasty with cementless biocon cup and femoral stem at the Department of Orthopedics,Second Hospital Affiliated to Henan College of Traditional Chinese Medicine from January to 2004 to December 2006 were selected.They consisted of 5 male with 5 hips and 8 female with 8 hips with the average age of 51 years(range,28-62 years) and 9 cases of Crowe-Ⅲ and 4 cases of Crowe-Ⅳ.Before operation,the lower limbs were shortened from 3 to 6 cm.13 patients were followed up for 24 months(range,12-36 months),the lower limbs were lengthened from 2 to 6 cm,and both lower limbs basically recovered the balance.There were no complication appeared such as dislocation,femoral fracture,femoral nerve or sciatic nerve injury,as well as prosthetic loosening.The hip pain and dysfunction in all the patients were obvious relieved after operation.
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BACKGROUND: Tendon injury and dysfunction often occurs in military training, but the exactly epidemiological, pathological, physiological, healing and remodeling mechanisms of tendonopathy is still unclear, even the pain due to chronic tendon dysfunction should be further studied.OBJECTIVE: To evaluate the effect of forced training on the muscular strength of ankle joint and the cross-sectional area (CSA) of achilles tendon of infantry soldiers, and look for effective training methods.DESIGN: One-sample contrasting study.SETTING: Fourth Military Medical University of Chinese PLA; InStitute of Military Training-related Medical Sciences, the 150 Hospital of Chinese PLA.PARTICIPANTS: The study was carried out in the Institute of Military Training-related Medical Sciences, the 150 Hospital of Chinese PLA from March to June 2004. Thirty male light infantry recruits and thirty one-year-trained male soldiers were regarded as recruit group and one-year soldier group. The enlisted age ranged from 17 to 18 years. Recruits did not have the history of special training and injury of ankle joints. All of them were able to undertake routinely physical training.METHODS: The recruits participated in routinely physical trainings, such as grenade throwing and 5 km cross-country race, and forced trainings, such as dorsiflexors and plantarflexors on ankle joint, twice a day for each training item for 8 successive weeks. The forced training included calf raise for 50 times and sit-ups for 50 times on 45° arched board.Moreover, one-year soldiers were undertaken routinely physical trainings. Eight weeks later, the isokinetic testing of ankle joint and CSA of achilles tendon were measured before and after trainings.MAIN OUTCOME MEASURES: Comparisons of CSA of achilles tendon and changes of muscular strength of ankle joint between recruits before routine training and after 8-week forced training and one-year soldiers after routine training.RESULTS: All 60 soldiers were involved in the final analysis. Partial correlation was showed between CSA and body weight (r =0.446, P=0.015), and there was no difference in CSA before and after training. The relative peak torque, endurance and torque acceleration energy of plantarflexors, dorsiflexors and evertors were distinctively higher in recruit group and one-year soldier group after training than those in recruit group before training (P ＜ 0.05); however, there was no difference between recruit group and one-year soldier group after training.CONCLUSION: Forced training method can improve physical readiness in a short time. No changes of CSA of achilles tendon after training show that the improvement of ankle muscular strength may be through the rebuilding of its inner-structure rather than through the hypertrophy of the tendon.
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[Objective] To evaluate the treatment with total hip arthroplasty(THA)using Zweym?ller system for short females with Crowe-Ⅲ and Ⅳ developmental dysplasia hip(DDH).[Method]From January 2004 to December 2006,thirteen THA procedures were performed in 12 female patients with 13 hips.The age of the patients was from 28 to 62 years old(average 51 years).The height was from 1.48 to 1.55 meters.Based on Crowe classification,8 patients with 9 hips were type-Ⅲ,and 4 patients with 4 hips were type-Ⅳ.before surgery,the discrepancy of lower limbs was from 3 cm to 5 cm.All patieds had severe hip pain and dysfunction.The Harris hip score ranged from 35 to 64 points with 40 points on the average.In all procedures the soft tissue was released entirely,the acetabular component was placed in the true acetabulum without femoral osteotomy.[Result]After operation,the legs lengthened from 2 to 5 cm.During the follow-up of 12 to 36 months(average 24 months),no femoral fracture,femoral or sciatic nerve palsy or loosening was detected except one dislocation according to clinical outcomes and X-ray findings.The Harris score was improved from 60 to 95.There was significant difference between before and after operation(P
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Objective To investigate the changes of collagen and proteoglycan of Guinea pig’s Achilles tendon suffering from different loads of training. Methods Achilles’ tendons of Guinea pigs were harvested after training, stained by picrosirius and toluidine blue respectively. Collagen Ⅰ, Ⅲ and proteoglycan were observed by polarization microscopy and atomic force microscopy (AFM) and analyzed semiquantitatively. Results After enforced training, the relative content of collagen Ⅲ was(16.71?1.37)% in Group A and (13.43?3.16)% in Group B, that were significantly increased compared with (9.57?1.90)% in control group (P
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Objective The purpose of this study was to evaluate the effects of intensified training on muscular strength of soldiers' ankles and Achilles tendon, and to search for effective training methods through the kinetic study of the ankle joint and cross-sectional area (CSA) measurements of the Achilles tendon. Methods 30 recruits and 30 soldiers enlisted over one year were selected randomly. The recruits underwent an intensified training for eight weeks, and the enlisted soldiers underwent only routine training. The muscular strength of the ankle was tested by CYBEX-6000 isokinetic test system and the cross-sectional area (CSA) of the Achilles tendon was measured in the recruits and the enlisted soldiers before and after the intensified training. Results No difference of CSA of Achilles tendon was found among the recruits before and after the intensified training and the soldiers enlisted over one year (0.64?0.05cm~2、0.67?0.07cm~2、0.65?0.07cm~2) (P=0.698, F=0.361), while the CSA showed a positive correlation with body weight (r=0.446). The isokinetic test results indicated that the muscular strength of the ankle of the recruits was built up obviously after intensified training (P0.05). Conclusion The effects of 8-week intensified training were almost similar to one-year routine training. Enforced training seemed to be able to improve training outcomes in a shorter time. The results that no change in CSA of the Achilles tendon after intensified training indicated that the improvement in ankle muscular strength might be attributed to the moulding reconstruction of tendon function rather than by the enlargement of the tendon.
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Objective The purpose of this study was to investigate the effects of short-term and high-intensity training on the biomechanics characteristic of guinea pig's Achilles tendon, and thus to propose a new training mode for quickly enhancing the ability of withstand stress and anti-injury. Method Guinea pigs were assigned to different groups according to the training intensity they would undergo, i.e. high intensity group, medium intensity training for 8-weeks group and control group. The bilateral Achilles tendons were excised after different strength training. The variety of biomechanics characteristic of different intensity and different period were observed and compared respectively. Result Compared with the control group (8.19?0.60, 30.54?5.71), both the high intensity group (group C, 11.51?2.49,35.64?5.28, group D, 14.92?2.75, 44.29?4.09) and the medium intensity group (12.37?2.15, 36.36?4.94) show significant differences (P
