Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study.
中国武汉 81 例新型冠状病毒肺炎肺炎患者的影像学表现: 一项描述性研究。
- 作者列表："Shi H","Han X","Jiang N","Cao Y","Alwalid O","Gu J","Fan Y","Zheng C
BACKGROUND:A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were successively reported in Wuhan, China. We aimed to describe the CT findings across different timepoints throughout the disease course. METHODS:Patients with COVID-19 pneumonia (confirmed by next-generation sequencing or RT-PCR) who were admitted to one of two hospitals in Wuhan and who underwent serial chest CT scans were retrospectively enrolled. Patients were grouped on the basis of the interval between symptom onset and the first CT scan: group 1 (subclinical patients; scans done before symptom onset), group 2 (scans done ≤1 week after symptom onset), group 3 (>1 week to 2 weeks), and group 4 (>2 weeks to 3 weeks). Imaging features and their distribution were analysed and compared across the four groups. FINDINGS:81 patients admitted to hospital between Dec 20, 2019, and Jan 23, 2020, were retrospectively enrolled. The cohort included 42 (52%) men and 39 (48%) women, and the mean age was 49·5 years (SD 11·0). The mean number of involved lung segments was 10·5 (SD 6·4) overall, 2·8 (3·3) in group 1, 11·1 (5·4) in group 2, 13·0 (5·7) in group 3, and 12·1 (5·9) in group 4. The predominant pattern of abnormality observed was bilateral (64 [79%] patients), peripheral (44 [54%]), ill-defined (66 [81%]), and ground-glass opacification (53 [65%]), mainly involving the right lower lobes (225 [27%] of 849 affected segments). In group 1 (n=15), the predominant pattern was unilateral (nine [60%]) and multifocal (eight [53%]) ground-glass opacities (14 [93%]). Lesions quickly evolved to bilateral (19 [90%]), diffuse (11 [52%]) ground-glass opacity predominance (17 [81%]) in group 2 (n=21). Thereafter, the prevalence of ground-glass opacities continued to decrease (17 [57%] of 30 patients in group 3, and five [33%] of 15 in group 4), and consolidation and mixed patterns became more frequent (12 [40%] in group 3, eight [53%] in group 4). INTERPRETATION:COVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1-3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia. FUNDING:None.
背景: 在中国武汉相继报告了由新型冠状病毒肺炎冠状病毒 2 型 (新型冠状病毒) 感染引起的 2019 (SARS-CoV-2) 冠状病毒肺炎患者群。我们旨在描述整个病程中不同时间点的CT表现。 方法: 回顾性纳入在武汉两家医院之一接受连续胸部ct扫描的新型冠状病毒肺炎例肺炎患者 (经新一代测序或rt-pcr证实)。患者根据症状发作和第一次ct扫描之间的间隔进行分组: 第 1 组 (亚临床患者; 症状发作前进行的扫描)，第 2 组 (症状发作后 ≤ 1 周进行扫描) 、第 3 组 (>1 周至 2 周) 和第 4 组 (>2 周至 3 周)。分析并比较四组的影像学特征及其分布。 结果: 回顾性纳入 2019 年 12 月 20 日至 20 年 1 月 23 日期间入院的 81 例患者。队列包括 42 名 (52%) 男性和 39 名 (48%) 女性，平均年龄为 49 · 5 岁 (SD 11 · 0)。总的肺段受累数平均为 10 · 5 (SD 6 · 4)，组 1 为 2 · 8 (3 · 3)，组 11 · 1 (5 · 4) 第 2 组，第 3 组 13 · 0 (5 · 7)，第 4 组 12 · 1 (5 · 9)。观察到的异常的主要模式是双侧 (64 [79%]患者)，外周 (44 [54%])，定义不清 (66 [81%]) 和磨玻璃浑浊 (53 [65%])，主要累及右下叶 (225 个受累节段中 27% 个 )。在组 1 (n = 15) 中，主要模式是单侧 (9 [60%]) 和多焦 (8 [53%]) 磨玻璃混浊 (14 [93%])。在组 2 (n = 21) 中，病变迅速演变为双侧 (19 [90%])，弥漫性 (11 [52%]) 磨玻璃影占优势 (17 [81%])。此后，磨玻璃混浊的患病率继续下降 (组 3 中 30 名患者中有 17 名 [57%]，组 4 中 15 名患者中有 5 名 [33%])，巩固和混合模式变得更加频繁 (组 3 为 12 [40%]，组 4 为 8 [53%])。 解读: 新型冠状病毒肺炎肺炎表现为胸部CT影像学异常，即使无症状患者，从局灶性单侧到弥漫性双侧磨玻璃混浊的快速演变，在 1-3 周内进展到或与固结共存。将影像学特征与临床和实验室检查结果相结合，有助于新型冠状病毒肺炎肺炎的早期诊断。 经费: 无。
METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.
METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.
METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.