The Use of Adjuvant Therapy in Preventing Progression to Severe Pneumonia in Patients with Coronavirus Disease 2019: A Multicenter Data Analysis

IMPORTANCECoronavirus disease 2019 (COVID-19) is a global pandemic associated with high mortality and effective treatment to prevent clinical deterioration to severe pneumonia has not yet been well clarified. OBJECTIVETo investigate the role of several adjuvant treatments in preventing severe pneumonia in patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTSMulticenter, retrospective cohort study of 564 consecutively hospitalized patients with confirmed COVID-19 at Third Xiangya Hospital of Central South University, Changsha Public Health Treatment Center, First Hospital of Yueyang, Junshan Peoples Hospital of Yueyang, Central Hospital of Shaoyang, Central Hospital of Xiangtan, Second Hospital of Changde, Central Hospital of Loudi, and First Affiliated Hospital of University of South China in Hunan province from January 17, 2020 to February 28, 2020; The final date of follow-up was March 15, 2020. EXPOSURESNonspecific antivirals (arbidol, lopinavir/ritonavir, and interferon ), antihypertensives, and chloroquine. MAIN OUTCOMES AND MEASURESThe development of severe COVID-19 pneumonia; Demographic, epidemiological, clinical, laboratory, radiological, and treatment data were collected and analyzed. RESULTSOf 564 patients, the median age was 47 years (interquartile range, 36-58 years), and 284 (50.4%) patients were men. Sixty-nine patients (12.2%) developed severe pneumonia. Patients who developed severe pneumonia were older (median age of 59 and 45 years, respectively), and more patients had comorbidities including hypertension (30.4% and 12.3%, respectively), diabetes (17.4% and 6.7%, respectively), and cardiovascular disease (8.7% and 3.2%, respectively) and presented with fever (84.1% and 60.4%, respectively) and shortness of breath (10.1% and 3.8%, respectively) compared with those who did not. Nonspecific antiviral therapy did not prevent clinical progression to severe pneumonia, although fewer hypertensive patients on angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEI/ARB) therapy developed severe pneumonia in contrast with those on non-ACEI/ARB antihypertensive therapy (1 of 16 [6.3%] patients and 16 of 49 [32.7%] patients, respectively [difference, 26.4%; 95% CI, 1.5% to 41.3%]). Multivariate logistic regression analysis showed that hypertension without receiving ACEI/ARB therapy was an independent risk factor (odds ratio [OR], 2.07; 95% CI, 1.07 to 4.00) for developing severe pneumonia irrespective of age. Besides, none of patients treated with chloroquine developed severe pneumonia, though without significance (difference, 12.0%; 95% CI, -3.5% to 30.0%) by propensity score matching. CONCLUSIONS AND RELEVANCEHypertensive patients on ACEI or ARB may be protective from severe pneumonia in COVID-19 and hence these therapies should not be ceased unless there is a strong indication or further epidemiological evidence. Though none of the current antiviral and immunoregulation therapy showed benefit in preventing COVID-19 progression, chloroquine deserved further investigation. KEYPOINTSO_ST_ABSQuestionC_ST_ABSDoes the use of adjuvant therapy reduce progression to severe pneumonia in patients with coronavirus disease 2019 (COVID-19)? FindingsIn this retrospective, observational cohort study involving 564 patients with confirmed COVID-19, hypertension was an independent risk factor for progression to severe pneumonia irrespective of age and those on angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy were less likely to develop severe COVID-19 pneumonia, while nonspecific antivirals or chloroquine did not have significant impact on clinical progression. MeaningHypertensive patients with COVID-19 should not have ACEI or ARB ceased, unless there is a strong indication or further epidemiological evidence, given its potential protective effects.

Early Prediction of Disease Progression in 2019 Novel Coronavirus Pneumonia Patients Outside Wuhan with CT and Clinical Characteristics

ObjectiveTo determine the predictive value of CT and clinical characteristics for short-term disease progression in patients with 2019 novel coronavirus pneumonia (NCP). Materials and Methods224 patients with confirmed 2019 novel coronavirus (COVID-19) infection outside Wuhan who had chest CT examinations were retrospectively screened. Clinical data were obtained from electronic medical records. CT images were reviewed and scored for lesion distribution, lobe and segment involvement, ground-glass opacities, consolidation, and interstitial thickening. All included patients with moderate NCP were observed for at least 14 days from admission to determine whether they exacerbated to severe NCP (progressive group) or not (stable group). CT and clinical characteristics between the two groups were compared, and multivariate logistic regression and sensitivity analyses were performed to identify the risk factors for developing severe NCP. ResultsA total of 141 patients with moderate NCP were included, of which 15 (10.6%) patients developed severe NCP during hospitalization and assigned to the progressive group. Multivariate logistic regression analysis showed that higher neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] and 95% confidence interval [CI], 1.26 [1.04-1.53]; P = 0.018) and CT severity score (OR and 95% CI, 1.25 [1.08-1.46]; P = 0.004) on admission were independent predictors for progression to severe NCP, and sensitivity analysis confirmed the consistent results in nonimported patients but not in imported patients. However, no significant difference in lung involvement was found on CT between imported and nonimported patients (all P > 0.05). Patients who were admitted more than 4 days from symptom onset tended to have more severe lung involvement. Spearman correlation analysis showed the close association between CT severity score and inflammatory indexes (r = 0.17[~]0.47, all P < 0.05). ConclusionCT severity score was associated with inflammatory levels and higher NLR and CT severity score on admission were independent risk factors for short-term progression in patients with NCP outside Wuhan. Furthermore, early admission and surveillance by CT should be recommended to improve clinical outcomes.

Chest CT findings and clinical features of coronavirus disease 2019 in children / 中南大学学报(医学版)

Objective: To describe the CT features and clinical characteristics of pediatric patients with coronavirus disease 2019 (COVID-19).Method: A total of 9 COVID-19 infected pediatric patients were included in this study.Clinical history,laboratory examination,and detailed CT imaging features were analyzed.All patients underwent the first CT scanning on the same day of being diagnosed by realtime reverse-transcription polymerase chain reaction (rRT-PCR).A low-dose CT scan was performed during follow-up.Results: All the child patients had positive results.Four patients had cough and one patient had fever.One patient presented both cough and fever.Two children presented other symptoms like sore throat and stuffy nose.One child showed no clinical symptom.Five patients had positive initial CT findings with subtle lesions like ground-glass opacity (GGO) or spot-like mixed consolidation.Three patients were reported with negative results in the initial and follow-up CT examination.One patient was reported with initial negative CT findings but turning positive during the first follow-up.All patients had absorbed lesions on follow-up CT images after treatment.Conclusion: Pediatric COVID-19 patients have certain imaging and clinical features as well as disease prognosis.Children with COVID-19 tend to have normal or subtle CT findings and relatively better outcome.

Analysis of MRI findings in HIV patients with secondary toxoplasmosis encephalitis / 实用放射学杂志

Objective To investigate the MRI manifestations of secondary toxoplasmosis encephalitis in HIV patients and summarize the characteristics of MRI changes.Methods MRI images of 3 5 HIV patients with secondary toxoplasmosis encephalitis were analyzed retrospectively.Results Of 35 patients,27 showed multiple lesions and 8 showed single lesion.Lesions mainly involved the brain gray matter j unction or basal ganglia.MRI showed lamellar,nodular or round lesions,which showed low signal on T1WI,and slightly higher and unevenly high signal on T2WI.Irregular liquid signal or nodular slightly lower signal was showed on T2WI in 14 cases,and short T1signal was showed in 15 cases.Circular lesions could be seen"cattle eye"in 18 cases.For 11 cases of enhanced scan of a single lesion,a ring enhancement was displayed,and coexistence of patchy,nodular and annular enhancement were showed in multiple lesions,in which parts of the multi-circular enhancemens were clustered.Conclusion MRI manifestations of HIV patients with secondary toxoplasmosis encephalitis show primarily multiple lesions on the gray matter j unction or basal ganglia.The lesions show high signal on T1WI and"cattle eye"on T2WI,and existence of flaky,nodular and ring enhanced lesion or clustered enhancement are showed on enhanced imaging,which is of a certain specificity.

Therapeutic Observation of Conjunctiva Valve Combined with Tarsorrhaphy and Standardized Drug Intervention Treating Refractory Kera-tohelcosis / 浙江中医药大学学报

[Objective] To discuss the cure effect of conjunctiva valve combined with tarsorrhaphy and standardized medication on refractory keratohelcosis. [Method] Choose 37 cases with 37 eyes of the disease above, divide them into control group, n=17, and observation group, n=20; the control one take conjunctiva valve combined with tarsorrhaphy and routine medicine intervention; other group, standardized drug intervention instead of routine medicine. Observe the therapeutic effect after 6m. [Result] In observation group, 18 cases were cured(90%), 2 better(10%); for other group, they were 9(52.9%) and 4(23.5%) respectively, and 4 cases had no effect(23.5%). Comparing both cure effects, the difference had statistical meaning. [Conclusion] The conjunctiva valve combined with tarsorrhaphy could markedly improve the cure effect if intervened with standardized drug.

The effect of laparoscopic excision vs open excision in children with choledochal cyst: a midterm follow-up study.

PURPOSE: Cyst excision with hepaticojejunostomy has been the classic procedure for treating choledochal cysts. Recently, laparoscopic treatment of the disease has gained popularity worldwide. The aim of this study is to evaluate whether laparoscopic management of choledochal cysts is as feasible and safe as conventional open surgery in children with this disease. METHODS: A retrospective study comparing the laparoscopic and the open procedures was performed in 77 consecutive patients with choledochal cyst in our hospital. Thirty-nine patients operated on between June 2001 and September 2003 were in the laparoscopic group, whereas 38 patients in the open group were operated on between February 1999 and May 2001. RESULTS: Patient demographics were similar between the 2 groups. The duration of operation was significantly longer in the laparoscopic group than in the open group (median, 230 vs 190 minutes; P < .001). In contrast, the durations of delayed oral feeding and hospital stay postoperatively were significantly shorter in the laparoscopic group (median, 4 vs 5 days [P < .01] and median, 5 vs 7 days [P < .01], respectively.) There were no differences in the early and late complication rates between the 2 groups. CONCLUSIONS: Laparoscopic treatment of choledochal cyst in children is feasible and safe. For experienced centers, this procedure can be recommended.

Laparoscopic choledochocele resection,report of 48 cases / 北京大学学报(医学版)

Objective: To summarize surgery experience and efficiency of laparoscopic excision of choledochal cyst and reconstruction of biliary tract and to analyze the treatments administered during intra and post-operation of the biliary reconstruction. Methods: We enrolled 48 cases of video-guided laparoscopic intraoperative cholangiography, cholecystectomy, choledochocele resection, Roux-en-Y hepaticojejunostomy with an anti-reflux valve from August, 2001 to October, 2003.Their operative procedures and aims were retrospectively analyzed. Results: Forty-four out of 48 patients successfully underwent laparoscopy and recovered soon. Only 4 cases were transformed to open operation. The post-operation complications were found in 4 cases. Conclusion: Video-guided laparoscopic excision of choledochal cyst, biliary tract reconstruction and Roux-en-Y hepaticojejunostomy are an effective method of treatment with advantages of minimal injury, less bleeding, and sooner recovery.

Primary laparoscopically assisted anorectal pull-through for high imperforate anus: A report of 4 cases / 中国微创外科杂志

Objective To investigate the feasibility of laparoscopically assisted anorectal pull-through in the repair of high imperforate anus. Methods Four infants (3 boys and 1 girl, age range, 1 d～90 d) with high imperforate anus entered this study. During operations, the rectum was exposed via laparoscope down to the rectourethral fistula, which was ligated and dissected out laparoscopically; and then, by way of a passage through the center of pelvic floor musculature, the rectum was exteriorized to the perineum to perform anorectal anastomosis. Results Laparoscopically assisted anorectal pull-through was successfully performed in all the 4 cases as a primary procedure. The mean duration of the laparoscopy was 71 8 min (range, 45 min～90 min) and the mean blood loss 8 3 ml (range, 5 ml～20 ml), no blood transfusion required and no intraoperative complications occurred. All patients recovered uneventfully. In 3～12 months of follow-up, 1 patient was found anal stenosis at 1 month after the operation and was cured with secondary anorectoplasty. No postoperative complications were seen in the other 3 cases. By now, all the 4 patients have normal fecal continence. Conclusions Laparoscopically assisted anorectal pull-through is an effective technique in the repair of high imperforate anus. Experience has shown that this approach offers minimally invasive wounds, excellent visualization of the rectal fistula and accurate identification of the center of pelvic floor musculature.

Laparoscopic operation of choledochal cyst / 中国微创外科杂志

Objective To study the feasibility and efficacy of laparoscopic operation for choledochal cyst. Methods Under laparoscopy,intraoperative cholangiography was performed.The dilated commom bile duct and the gallbladder were excised,a Roux-en-Y cholangio-jejunostomy was constructed outside the abdominal cavity. Results 5 babies underwent the total cyst excision and hepato-cholangio-jejunostomy successfully and quickly recovered.Only a girl transferred to open operation because of previous operative history. Conclusions Laparoscopic treatment of choledochal cyst is feasible and satisfied outcome.

Laparoscopic total cyst excision with Roux-Y hepatoenterostomy for choledochal cyst / 中国普通外科杂志

Objective The aim of this study was to discuss the technical details on laparoscopic total cyst excision with Roux Y hepatoenterostomy for the treatment of choledochal cyst in children.Methods Eight patients with type Ⅰ choledochal cyst (median age 3 6 years) underwent laparoscopic cyst excision with Roux Y hepatoenterostomy from July 2001 to April 2002.Under laparoscopic guidance, intraoperative cholangiogram was performed, the gallbladder and the dilated bile duct were completely excised. Roux en Y jejunojejunostomy was performed extracorporeally through umbilical incision (2 cm), and an end to side anastomosis was carried out intracorporeally.Results Median duration of operation was 4 8 hours (3 6 to 6 0 hours), intraoperative bleeding was between 10 to 50 ml. Hospital stay after the operation ranged from 3 to 8 days. There was no intra or postoperative complication.ConclusionLaparoscopic total cyst excision with Roux Y hepatoenterostomy was effective and safe procedure for children with choledochal cyst.

Analysis and Comparison of MRI Diagnosis of Spinal Cavernous Hemangioma with Its Clinical and Pathology Features / 实用放射学杂志

Objective To study the connection between MRI characteristics of spinal cavernous hemangioma(SCH)and its clinical and pathological features.Methods 20 cases of SCH confirmed by pathology were retrospectively analysed.The characteristics of MRI signal intensity were analysed in comparison with the clinical manifestations and pathology.Results Among the 20 cases,5 lesions located in the cervical segment of spinal cord,12 lesions in the thoracic segment,2 in the lumbar segment and 1 in the thoracic-lumbar segement.SCH could be devided into four patterns:intramedullary lesion,epidural lesion,intradural-extramedulary lesion and vertebral lesion.The typical MRI characteristics of SCH were mixed signal intersity on T_1 or T_2 weighted images,low signal intensity ring could be seen around the lesions and more pronounced on T_2 images.Spinal cord compression syndrome was the main clinical manifestation.Cavernous hemangiomas were red or purple mulberg-like lesions which were composed of dilated,thin-walled vessel with a simple endothelial lining and a variably thin fibrous adventitia under the microscope.Conclusion MRI is the most reliable method in diagnosing SCH,MRI characteristics of signal intensity of SCH are correspond with their clinical and pathological features.

Transanal pull-through plus internal sphincter myoctomy for the treatment of Hirschsprung's disease / 中国普通外科杂志

Objective To explore a new therapy for Hirschsprung's disease ( HD). Methods From Jul 2001 to Aug 2003,72 cases underwent transanal pull-through plus partial myoctomy of internal sphincter. Rectoanal manometry was done for 27 patients perioperatively. Forty-eight patients were followed-up and evaluated according Reding standard. Results Pre-and post-operative rest pressure was (38 ?8) mm Hg and (22?6 ) mm Hg respectively (P

The diagnosis and treatment of Currarino syndrome: report of 7 cases / 中国普通外科杂志

Objective To study the diagnosis and treatment of Currarino triad Methods A retrospective study was made on clinical features, diagnosis; treatment and prognosis of 7 cases with Currarino triad Results In 6 patients definite diagnosis was made only intraoperatively including reoperation in 3 cases All the 7 cases were cured Postoperative urinary retention and infection developed in one each Conclusion Correct preoperative diagnosis of Currarino triad has great influence on the treatment Total excision of presacral mass should be emphasized