Objective:To explore the predictive value of low-dose biphasic (inspiratory and expiratory) CT air trapping sign and semi-quantitative score in predicting abnormal blood gas parameters and progression to severe disease in COVID-19 patients.Methods:Patients with non-severe COVID-19 who were diagnosed by nucleic acid testing and hospitalized in designated hospitals in Wuxi City from January 23 to February 29, 2020 were prospectively and consecutively recruited. All patients received low-dose biphasic CT examination on admission and repeated CT examination at regular intervals during the course. On the inspiratory phase admission of the bipolar CT, the scope of the lesion was evaluated by semi-quantitative score, and the air trapping sign on bipolar CT was assessed. The differences of semi-quantitative score, the presence of the air trapping sign and other clinical factors were compared between the patients with abnormal and the normal blood gas index, as well as between the cases progressed to severe disease and cases without disease progression using the independent sample t-test or χ 2 test. The area under the curve (AUC) of receiver operating characteristic (ROC) and the comprehensive discriminant improvement index (IDI) were used to evaluate the predictive effectiveness of the semi-quantitative scores, air trapping sign, and combination of two factors in differentiating cases with abnormal and normal blood gas indexes, as well as in differentiating cases with and without disease progression to severe COVID-19 cases. Results:In total 51 non-severe COVID-19 cases were included, with 16 cases showed air trapping sign during the first biphasic CT examination on admission. During the course of the disease, there were 13 patients with abnormal blood gas index, and 9 cases displaying air trapping sign (9/13). All 7 cases with progression to severe cases showed air trapping sign (7/7). Patients with advanced age, air trapping sign and higher semi-quantitative score were found more likely to have abnormal blood gas index ( t=3.10, χ 2=9.38, t=3.34, P<0.05); patients with advanced age, underlying diseases, air trapping sign and higher semi-quantitative score were more likely to develop into severe disease ( t=2.68, χ 2=6.65, χ 2=4.25, t=4.33, P<0.05). The AUC of semi-quantitative score, air trapping sign and combination of two factors in distinguishing abnormal blood gas index from normal blood gas index was 0.803, 0.754 and 0.794 respectively. The AUC of semi-quantitative score, air trapping sign and combination of two factors in distinguishing cases with progression to severe cases from non-progression was 0.881, 0.898 and 0.932, respectively. Air trapping sign combined with semi-quantitative score significantly improved the prediction effectiveness of disease progression, compared with semi-quantitative score or air trapping sign (IDI=0.271, 0.117). Conclusion:Air trapping sign and semi-quantitative score might be used as effective indicators to predict the progression of COVID-19 cases, and the combination of these two factors might be more helpful to predict the disease progression.

BACKGROUND:An outbreak of coronavirus disease 2019 (COVID-19) has occurred worldwide. However, the small-airway disease in patients with COVID-19 has not been explored.AIM:This study aimed to explore the small-airway disease in patients with COVID-19 using inspiratory and expiratory chest high-resolution computed tomography (CT).METHODS:This multicenter study included 108 patients with COVID-19. The patients were classified into five stages (0-IV) based on the CT images. The clinical and imaging data were compared among CT images in different stages. Patients were divided into three groups according to the time interval from the initial CT scan, and the clinical and air trapping data were compared among these groups. The correlation between clinical parameters and CT scores was evaluated.RESULTS:The clinical data, including age, frequency of breath shortness and dyspnea, neutrophil percentage, lymphocyte count, PaO2, PaCO2, SaO2, and time interval between the onset of illness and initial CT, showed significant differences among CT images in different stages. A significant difference in the CT score of air trapping was observed between stage I and stage III. A low negative correlation was found between the CT score of air trapping and the time interval between the onset of symptoms and initial CT. No significant difference was noted in the frequency and CT score of air trapping among different groups.CONCLUSION:Some patients with COVID-19 developed small-airway disease. Air trapping was more distinguished in the early stage of the disease and persisted during the 2-month follow-up. Longer-term follow-up studies are needed to confirm the findings.

目的 探讨基于初诊的临床和CT特征的诺模图在早期识别重症新型冠状病毒肺炎(COVID-19)中的应用价值.方法 回顾性分析108例COVID-19患者的临床和CT资料.所有患者按照病程中严重程度分为轻症组(76例)和重症组(32例),并分析其临床特征和CT特征.对两组间差异有统计学意义的临床和CT特征进行多因素Logistic回归分析,确定重症COVID-19相关的独立危险因素.将独立危险因素引入R软件,构建预测重症COV-ID-19的诺模图,并进行ROC曲线分析,通过绘制校准曲线及进行Hosmer-Lemeshow拟合优度检验进行模型验证.结果 重症组的年龄(55.78±14.45)岁明显大于轻症组(43.46±14.84)岁(P＜0.05).重症患者的CT严重性评分[8(5.2～10.0)]高于轻症患者[4(2.0～5.0)],差异有统计学意义(P＜0.001).两组患者的糖尿病、冠心病、白细胞计数、中性粒细胞计数、C反应蛋白、位置、分布、形态、密度、血管束增粗、空气支气管征、铺路石征、马赛克灌注征的差异均有统计学意义(P＜0.05).多因素Logistic回归结果显示年龄、白细胞计数、空气支气管征和CT严重性评分是重症COVID-19的独立危险因素.诺模图的曲线下面积为0.939(95％置信区间:0.895～0.983),敏感性和特异性分别为96.9％和84.2％.标准曲线显示预测概率与实际概率符合度良好.Hosmer-Lemeshow拟合优度检验(X2=10.136,P=0.256)显示诺模图预测重症COVID-19具有较好准确性.结论 基于初诊的临床和CT特征构建的诺模图在早期识别重症COVID-19有较大的应用价值,可为临床个体化评估COVID-19患者病情提供一定的帮助.

Background: To develop and validate a nomogram for early identification of severe coronavirus disease 2019 (COVID-19) based on initial clinical and CT characteristics.Methods: The initial clinical and CT imaging data of 217 patients with COVID-19 were analyzed retrospectively from January to March 2020. 217 patients with 146 mild cases and 71 severe cases were randomly divided into training and validation cohorts. Independent risk factors were selected to construct the nomogram for predicting severe COVID-19. Nomogram performance in terms of discrimination and calibration ability was evaluated using the area under the curve (AUC), calibration curve, decision curve, clinical impact curve and risk chart.Results: In the training cohort, the severity score of lung in the severe group (7, interquartile range [IQR]:5-9) was significantly higher than that of the mild group (4, IQR:2-5) (P < 0.001). Age, density, mosaic perfusion sign and severity score of lung were independent risk factors for severe COVID-19. The nomogram had a AUC of 0.929 (95% CI, 0.889-0.969), sensitivity of 84.0% and specificity of 86.3%, in the training cohort, and a AUC of 0.936 (95% CI, 0.867-1.000), sensitivity of 90.5% and specificity of 88.6% in the validation cohort. The calibration curve, decision curve, clinical impact curve and risk chart showed that nomogram had high accuracy and superior net benefit in predicting severe COVID-19.Conclusion: The nomogram incorporating initial clinical and CT characteristics may help to identify the severe patients with COVID-19 in the early stage.

Objective To evaluate the value of a novel laser navigation system (LNS) designed for a SPECT/ CT platform in improving efficiency of molecular imaging-guided percutaneous transthoracic needle biopsy (PTNB). Methods From January 2017 to October 2017, a total of 25 patients (17 males, 8 fe-males, age (58.9±10.8) years) with thoracic lesions suspicious for malignancy underwent 99 Tcm-methoxy-isobutylisonitrile (MIBI) SPECT/ CT-guided PTNB, and the hyperactivity areas were chosen as the sam-pling areas. Thirteen patients underwent traditional free hand puncture (control group), and 12 patients had LNS-assisted puncture (LNS group). The operation time, CT-guided times, average effective radiation dose of the two methods were compared. Two-sample t test was used to analyze the data. Results Comparing to control group, LNS-assisted PTNB puncture significantly reduced operation time ((7.6±2.2) vs (24. 2± 9. 8) min; t= 5.693, P<0.001), CT-guided times (1.9±0.9 vs 4.0±1.5; t= 4.108, P<0.001) and average effective radiation dose ((7.7±0.9) vs (10.5±2.1) mSv; t= 4.306, P<0.01). Conclusion The novel LNS is helpful in improving efficiency of molecular imaging-guided PTNB based on a SPECT/ CT platform.

Introduction: The neutrophil-to-lymphocyte ratio (NLR) is a readily available biomarker associated with recurrence and survival in various diseases. The objective of this study was to investigate the relationship between NLR and pulmonary tuberculosis (PTB) retreatment. Material and methods : This was a case-control study that included 306 newly diagnosed cases of PTB in the clinical database of the Infectious Hospital of Wuxi from December 2009 to December 2011. Of the 306 patients, a total of 68 cases were followed up with TB retreatment. The remaining 238 PTB patients who completed anti-TB treatment and were cured without retreatment were selected as controls. Results : According to the ROC curve, the best cut-off value of NLR was 2.53, with a sensitivity of 70.6% and a specificity of 45.4%. The NLR ≥ 2.53 before anti-TB treatment was associated with PTB retreatment (OR = 1.994, 95% CI: 1.116–3.564; adjusted OR (AOR) = 2.409, 95% CI: 1.212–4.788). The retreatment rates with NLR ≥ 2.53 and NLR < 2.53 were 27.1% and 15.5%, respectively, with a significant difference (log-rank test; p = 0.010). Additionally, cavitation on chest X-ray (OR = 2.922, 95% CI: 1.654–5.411; AOR = 2.482, 95% CI: 1.230–5.007), history of smoking (OR = 2.202, 95% CI: 1.158–3.493; AOR = 2.321, 95% CI: 1.135–4.745) and age ≥ 60 (OR = 3.828, 95% CI: 1.626–9.015; AOR = 2.931, 95% CI: 1.122–7.653) were also associated with PTB retreatment. Conclusions : NLR ≥ 2.53 is predictive of PTB retreatment. Otherwise, initial cavitation on chest X-ray, history of smoking, and age of ≥ 60 are also risk factors for PTB retreatment.

Pulmonary cavitation is the classic hallmark of pulmonary tuberculosis (PTB) and is the site of very high mycobacterial burden associated with antimycobacterial drug resistance and treatment failure. The objective of this study was to investigate the relationship between re-treatment PTB and initial pulmonary cavitation coordinated with other clinical factors.

Recently, a series of studies explored the correlation between the neutrophil to lymphocyte ratio and the prognosis of lung cancer. However, the current opinion regarding the prognostic role of the neutrophil to lymphocyte ratio in lung cancer is inconsistent.We performed a meta-analysis of published articles to investigate the prognostic value of the neutrophil to lymphocyte ratio in lung cancer. The hazard ratio (HR) and its 95% confidence interval (CI) were calculated.An elevated neutrophil to lymphocyte ratio predicted worse overall survival, with a pooled HR of 1.243 (95% CI: 1.106-1.397; P-heterogeneity=0.001) from multivariate studies and 1.867 (95% CI: 1.487-2.344; P-heterogeneity=0.047) from univariate studies. Subgroup analysis showed that a high neutrophil to lymphocyte ratio yielded worse overall survival in non-small cell lung cancer (NSCLC) (HR=1.192, 95% CI: 1.061-1.399; P-heterogeneity=0.003) as well as small cell lung cancer (SCLC) (HR=1.550, 95% CI: 1.156-2.077; P-heterogeneity=0.625) in multivariate studies.The synthesized evidence from this meta-analysis of published articles demonstrated that an elevated neutrophil to lymphocyte ratio was a predictor of poor overall survival in patients with lung cancer.

Objective: The ratio of monocytes to lymphocytes in peripheral blood could reflect an individual's immunity to Mycobacterium tuberculosis. The objective of this study was to evaluate the relationship between ratio of monocytes to lymphocytes and clinical status of patients with active tuberculosis.Methods: This was a retrospective review of data collected from the clinical database of The Fifth People's Hospital of Wuxi, Medical College of Jiangnan University. A total of 419 patients who had newly diagnosed active tuberculosis and 108 cases from 419 patients with tuberculosis therapy either near completion or completed were selected. Controls were 327 healthy donors.Results: Median ratio of monocytes to lymphocytes was 0.36 (IQR, 0.22-0.54) in patients before treatment, and 0.16 (IQR, 0.12-0.20) in controls (p < 0.001). Ratio of monocytes to lymphocytes <9% or >25% was significant predictors for active tuberculosis (OR = 114.73, 95% CI, 39.80-330.71; OR = 89.81, 95% CI, 53.18-151.68, respectively). After treatment, the median ratio of monocytes to lymphocytes recovered to be nearly normal. Compared to other patients, patients with extrapulmonary tuberculosis and of age >60 years were more likely to have extreme ratio of monocytes to lymphocytes (AOR = 2.57, 95% CI, 1.08-6.09; AOR = 4.36, 95% CI, 1.43-13.29, respectively).Conclusions: Ratio of monocytes to lymphocytes <9% or >25% is predictive of active tuberculosis. (C) 2014 Elsevier Editora Ltda. All rights reserved.