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Both COVID-19 mRNA or recombinant Adenovirus vector (rAdVV) based vaccines have shown a great efficacy in generating humoral and cellular immune responses. Two doses of the COVID-19 vaccines generate enough antibodies and generate spike-specific T cell responses. However, after 6-8 months there is a decline in antibody production and T cell responses. Due to the rise of new SARS-CoV-2 variants of concern, a third or even fourth dose of vaccine was recommended for the elderly, immune comprised and frontline medical health care workers. However, despite additional booster doses given, those who were infected with either delta or omicron (during December 2021 - March 2022) had symptoms of illness. By what means these COVID-19 vaccines provide immunity against the SARS-CoV-2 virus at the molecular level is not explored extensively yet and, it is an emerging research field as to how the SARS-CoV-2 virus is able to evade the host immunity. Most of the infected people had mild symptoms whilst some were asymptomatic. Many of the people had developed nucleocapsid antibodies against the SARS-CoV-2 delta/omicron variants confirming a humoral immune response against viral infection. Furthermore, cellular analysis shows that post-vaccinated recovered COVID-19 individuals have significantly reduced NK cells and increased T naive CD4+, TEM CD8+ and B cells. This decrease in cellular immunity corresponds to individuals who recovered from alpha variants infection and had mild symptoms. Our results highlight that booster doses clearly reduce the severity of infection against delta/omicron infection. Furthermore, our cellular and humoral immune system is trained by vaccines and ready to deal with breakthrough infections in the future.
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ObjectivesTo describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with co-morbid neurological symptoms. DesignRetrospective case series. SettingHuoshenshan Hospital in Wuhan, China. ParticipantsFrom 4 February to 14 April 2020, 106 patients with neurological diseases were enrolled from all patients in the hospital with confirmed COVID-19 and divided into a severe group and a non-severe group according to their COVID-19 diagnosis. Main outcome measuresClinical characteristics, laboratory results, imaging findings, and treatment methods were all retrieved through an electronic medical records system and recorded in spreadsheets. ResultsThe mean (standard deviation, SD) age of patients was 72.7 (11.8) years, and 64 patients were male (60.4%). Among patients with co-morbid neurological diseases, 81 had a previous cerebral infarction (76.4%), 20 had dementia (18.9%), 10 had acute cerebral infarction (9.4%), 5 had sequelae of cerebral haemorrhage (4.7%), 4 had intracranial mass lesions (3.8%), 3 had epilepsy (2.8%), 2 had Parkinsons disease (1.9%), and 1 had myelopathy (0.9%). Fever (n = 62, 58.5%) was the most common symptom. The most common neurological symptoms were myalgia (n = 26, 24.5%), followed by extremity paralysis (n = 20, 18.9%), impaired consciousness (n = 17, 16%), and positive focal neurological signs (n = 42, 39.6%). Eight patients (7.5%) died. There were more patients with altered mental status in the severe group than in the non-severe group (6 [10.2%] vs. 0, P = 0.033). The inflammatory response in the severe group was more significant than that in the non-severe group. There were more patients taking anticoagulant drugs (25 [42.4%] vs. 4 [8.5%], P < 0.001) and sedative drugs (22 [37.3%] vs. 9 [19.1%], P = 0.041) in the severe group than in the non-severe group. Amid all 93 patients with cerebrovascular diseases, only 32 (34.4%) were taking aspirin, 13 (14%) taking clopidogrel, and 33 (35.5%) taking statins. ConclusionsPatients with COVID-19 with co-morbid neurological diseases had an advanced age, a high rate of severe illness, and a high mortality rate. Among the neurological symptoms, altered mental status was more common in patients with severe COVID-19 with co-morbid neurological diseases.
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PurposeTo identify differences in CT imaging and clinical features between COVID-19 and influenza pneumonia in the early stage, and to identify the most valuable features in the differential diagnosis. Materials and MethodA consecutive cohort of 73 COVID-19 and 48 influenza pneumonia patients were retrospectively recruited from five independent institutions. The courses of both diseases were confirmed to be in the early stages (2.66 {+/-} 2.62 days for COVID-19 and 2.19 {+/-} 2.10 days for influenza pneumonia after onset). The chi-square test, students t-test, and Kruskal-Wallis H-test were performed to compare CT imaging and clinical features between the two groups. Spearman or Kendall correlation tests between feature metrics and diagnosis outcomes were also assessed. The diagnostic performance of each feature in differentiating COVID-19 from influenza pneumonia was evaluated with univariate analysis. The corresponding area under the curve (AUC), accuracy, specificity, sensitivity and threshold were reported. ResultsThe ground-glass opacification (GGO) was the most common imaging feature in COVID-19, including pure-GGO (75.3%) and mixed-GGO (78.1%), mainly in peripheral distribution. For clinical features, most COVID-19 patients presented normal white blood cell (WBC) count (89.04%) and neutrophil count (84.93%). Twenty imaging features and 6 clinical features were identified to be significantly different between the two diseases. The diagnosis outcomes correlated significantly with the WBC count (r=-0.526, P<0.001) and neutrophil count (r=-0.500, P<0.001). Four CT imaging features had absolute correlations coefficients higher than 0.300 (P<0.001), including crazy-paving pattern, mixed-GGO in peripheral area, pleural effusions, and consolidation. ConclusionsAmong a total of 1537 lesions and 62 imaging and clinical features, 26 features were demonstrated to be significantly different between COVID-19 and influenza pneumonia. The crazy-paving pattern was recognized as the most powerful imaging feature for the differential diagnosis in the early stage, while WBC count yielded the highest diagnostic efficacy in clinical manifestations.
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Objective ToinvestigatethefeasibilityofspectralvirtualnonGcontrast(VNC)takingtheplaceoftruenonGcontrast (TNC)inthyroiddiseases.Methods CTimagesof30patientswiththyroiddiseasewerecollected,includingTNC,spectraldualGphase contrastandconventionaldelayedcontrastimaging.36lesionswithcorrespondingsurgeryandpathologicalconditionswereselected forretrospectiveanalysis.Theradiationdose,imagequality,meanCTvalues,SNRanddiagnosticefficacybetweenTNCand VNC werecompared.Results Theeffectivedose(ED)andtotaldoseGlengthproduct(DLP)ofthespectraldualGphasecontrastscanswere bothsignificantlylowerthanthoseofTNCincombinationwithconventionaldualGphasecontrast(P＜0.05).Thesubjectivequality scoreofVNCwasslightlylowerthanthatofTNC (P＜0.05),howeveritwasacceptableforradiologistwithascoreabove3.The SNRofVNCimageswassignificantlylowerthanthatofTNC (P＜0.05).The meanCTvaluesofVNCimageswerelowerthan thoseofTNCimagesbutwithoutasignificantdifference(P＞0.05).TheabilityofVNCtodelineatenecrosis,calcification,andlymph nodemetastasisinthelesionwasconsistentwithTNC (k＞0.75).Conclusion TheimagequalityofVNCissatisfiedinthediagnosis ofthyroiddiseases.VNChassimilardiagnosticefficacytoTNCwitheffectivelyreducdingradiationdose,whichisapromisingclinical application.
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Objective ToinvestigatethecorrelationandthediagnosticefficiencyofquantitativeDCE-MRIparametersandADC valueinhistopathologicalgradeinpatients withinvasiveductalbreastcancer.Methods The DCE-MRIquantitativeparameters (Ktrans,KepandVe),semiquantitativeparameters(W-in,W-outandTTP)andtheADCvaluewereanalyzedandcomparedaccording bydifferenthistopathologicalgradein90invasiveductalbreastcancerpatients.Results ThemeanvalueofKtrans washigheringradeⅢgroupthanthatingradeⅡgroup,andthemeanvalueofADCwasloweringradeⅢgroupthanthatingradeⅡgroup.Thedifferenceswere statisticallysignificant(P<0.05),butthecorrelationswereweak(|r|<0.30).TherewerenostatisticallysignificantdifferencesamongKep, Ve,W-in,W-out,TTPingradeⅡandgradeⅢ (P>0.05).TheAUCofKtrans,ADCandKtranscombinedwithADCwere0.647,0.685 and0.749,respectively.Conclusion TheDCE-MRIquantitativeparametersKtransandADCvaluehavecorrelationswithhistopathologicalgradeof invasiveductalbreastcancer.HigherKtransandlowerADCvalueindicatehigherhistologicalgrade,andKtranscombinedwithADCcould improvethediagnosticefficiency.
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Objective@#To explore the value of dynamic contrast-enhanced MRI (DCE-MRI) based radiomics model in predicting the pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) of breast cancer.@*Methods@#In this retrospective study, 91 patients who had received NAC and had pathological response results were collected in Meizhou people′s hospital from January 2016 to August 2018. A primary cohort consisted of 63 patients and an independent validation cohort consisted of 28 patients. The patients were divided into pCR group of 23 cases and non-pathological complete response (Non-pCR) group of 68 cases. All the patients underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) before NAC. A list of radiomics features were extracted using the A.K software and the corresponding radiomics signature was constructed. Logistic regression was used to develop the prediction model. The predictive ability of the model was tested by using the area under the curve (AUC) of ROC analysis.@*Results@#The discrimination performance of radiomics signature yielded a AUC of 0.750 in the primary dataset and a AUC of 0.789 in the validation dataset. The model that incorporated estrogen receptor (ER), progesterone receptor (PR) and radiomics features was developed, and had an AUC of 0.859 in the primary dataset and an AUC of 0.905 in the validation dataset.@*Conclusion@#The radiomics predictive model, which integrated with the DCE-MRI based radiomics signature, ER and PR, can be used as a promising and applicable adjunct approach for predicting the pCR to NAC of breast cancer.
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Objective To explore the value of dynamic contrast-enhanced MRI (DCE-MRI) based radiomics model in predicting the pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) of breast cancer. Methods In this retrospective study, 91 patients who had received NAC and had pathological response results were collected in Meizhou people′s hospital from January 2016 to August 2018. A primary cohort consisted of 63 patients and an independent validation cohort consisted of 28 patients. The patients were divided into pCR group of 23 cases and non-pathological complete response (Non-pCR) group of 68 cases. All the patients underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) before NAC. A list of radiomics features were extracted using the A. K software and the corresponding radiomics signature was constructed. Logistic regression was used to develop the prediction model. The predictive ability of the model was tested by using the area under the curve (AUC) of ROC analysis. Results The discrimination performance of radiomics signature yielded a AUC of 0.750 in the primary dataset and a AUC of 0.789 in the validation dataset. The model that incorporated estrogen receptor (ER), progesterone receptor (PR) and radiomics features was developed, and had an AUC of 0.859 in the primary dataset and an AUC of 0.905 in the validation dataset. Conclusion The radiomics predictive model, which integrated with the DCE-MRI based radiomics signature, ER and PR, can be used as a promising and applicable adjunct approach for predicting the pCR to NAC of breast cancer.
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Objective To study the characteristics,operative timing,repair methods for iatrogenic bile duct injury caused by laparoscopic cholecystectomy.Methods Clinical data of 30 cases of iatrogenic bile duct injury found during or after laparoscopic cholecystectomy were studied retrospectively.Results There were type Ⅱ 1 bile duct injury in 9 patients,type Ⅱ 2 in 4 patients,type Ⅱ 3 in 2 patients,and type Ⅱ 4 in 15 patient.17 cases underwent immediate repair,13 cases did early repair.All cases followed up from 5 months to 10 years,the follow-up rate was 83.3％.1 case with end-to-end anastomosis and biliary stent underwent Roux-en-Y choledochojejunostomy for biliary stenosis 13 months postoperatively,4 cases underwent secondary Roux-en-Y choledochojejunostomy because of obstructive jaundice and the cicatricial anastomotic orifice stenosis one to one and half years after primary repairs.The remaining cases were doing well up to the end of the follow-up.Conclusion Most iatrogenic bile duct injury after laparoscopic cholecystectomy were high in position,while Roux-en-Y choledochojejunostomy is the mainstay of repair.
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Objective To evaluate the significance of laparoscopy in the diagnosis and treatment of unexplained acute right lower abdominal pain in women. Methods Clinical data of 52 women with unexplained acute right lower abdominal pain from April 1999 to April 2004 were retrospectively analyzed. Results Diagnosis was clarified under laparoscope in all the 52 patients, including 28 cases of acute appendicitis, 18 cases of acute pelvic inflammatory disease, 3 cases of ovarian cyst pediculotorsion, 2 cases of right tubal pregnancy, and 1 case of Crohn’s disease with iliac perforation. With exception of a conversion to open surgery in 3 patients, laparoscopic treatment was successfully completed in the remaining 49 patients. No surgical complications occurred. The patients were discharged from the hospital 2~6 days postoperatively. Conclusions Laparoscopy is a timely, safe and effective alternative for the diagnosis and treatment of unexplained acute lower right abdominal pain in women.
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<p><b>OBJECTIVE</b>To study the immunogenicity and safety of recombinant yeast-derived hepatitis B vaccine (YDV) in adults.</p><p><b>METHODS</b>One hundred and twenty-four healthy teachers aged 22 approximately 58 years with serum negative HBsAg, anti-HBs, anti-HBc and with normal temperature were randomly selected from Beipiao city, Liaoning province. All the subjects were immunized with 5 microg/0.5 ml of YDV made by Beijing Institute of Biologic Products, for three doses at an interval of one and six months, respectively.</p><p><b>RESULTS</b>The positivity of serum anti-HBs was 35.0%, 83.3%, 65.5% and 32.7% with a geometric mean titre (GMT) of 12.6 mIU/ml, 402.0 mIU/ml, 70.3 mIU/ml and 20.3 mIU/ml, respectively, three, seven, 12 and 24 months after immunization. The positivity and GMT of serum anti-HBs appeared the highest seven months after immunization, then began to decrease sharply. The positivity and GMT of serum anti-HBs in women was higher than that in men either three, or seven, or 12, or 24 months after immunization. The positivity of serum anti-HBs in those of 35 years or over was lower than that less than 35 years, seven months after immunization, but no age difference could be found 12 months after immunization. No local or systematic adverse reactions were found in all the subjects within three days after immunization.</p><p><b>CONCLUSION</b>The recombinant yeast-derived hepatitis B vaccine (YDV) is immunogenic and safe for adults, but the persistency of serum anti-HBs in after immunization should be followed-up further.</p>
