Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China.
武汉市COVID-19 108例住院患者胸部CT评分与临床特征的关系 [j].
- 作者列表："Zhang J","Meng G","Li W","Shi B","Dong H","Su Z","Huang Q","Gao P
BACKGROUND:In December 2019, the outbreak of a disease subsequently termed COVID-19 occurred in Wuhan, China. The number of cases increased rapidly and spread to six continents. However, there is limited information on the chest computed tomography (CT) results of affected patients. Chest CT can assess the severity of COVID-19 and has sufficient sensitivity to assess changes in response to glucocorticoid therapy. OBJECTIVE:Analyze COVID-19 patients to determine the relationships of clinical characteristics, chest CT score, and levels of inflammatory mediators. METHODS:This retrospective, single-center case series of 108 consecutive hospitalized patients with confirmed COVID-19 at Tongji Hospital, Tongji Medical College of HUST (Wuhan, China) examined patients admitted from January 28 to February 20, 2020. Patient demographics, comorbidities, clinical findings, chest CT results, and CT scores of affected lung parenchyma were recorded. The relationships between chest CT score with levels of systemic inflammatory mediators were determined. RESULTS:All patients exhibited signs of significant systemic inflammation, including increased levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, chest CT score, and a decreased lymphocyte (LY) count. Chest CT score had positive associations with white blood cell (WBC) count, CRP, ESR, procalcitonin, and abnormal coagulation function, and a negative association with LY count. Treatment with a glucocorticoid increased the LY count, reduced the CT score and CRP level, and improved coagulation function. CONCLUSIONS:COVID-19 infection is characterized by a systemic inflammatory response that affects the lungs, blood, digestive system, and circulatory systems. The chest CT score is a good indicator of the extent of systemic inflammation. Glucocorticoid treatment appears to reduce systemic inflammation in these patients.
背景: 2019年12月，在中国武汉爆发了一种后来称为COVID-19的疾病。病例数迅速增加，并蔓延至六大洲。然而，关于受影响患者的胸部计算机断层扫描 (CT) 结果的信息有限。胸部CT可以评估COVID-19的严重程度，并且具有足够的灵敏度来评估对糖皮质激素治疗的反应变化。 目的: 分析COVID-19例患者临床特征、胸部CT评分与炎症介质水平的关系。 方法: 回顾性、单中心病例系列研究了COVID-19在华中科技大学同济医学院附属同济医院 (中国武汉) 确诊的108例连续住院患者，检查了2020年1月28日至2月20日收治的患者。记录患者人口统计学、合并症、临床发现、胸部CT结果和受累肺实质的CT评分。测定胸部CT评分与全身炎症介质水平之间的关系。 结果: 所有患者均表现出明显的全身性炎症体征，包括C反应蛋白 (CRP) 、红细胞沉降率 (ESR) 、降钙素原、胸部CT评分和淋巴细胞 (LY) 计数水平升高。胸部CT评分与白细胞 (WBC) 计数、CRP、ESR、降钙素原和凝血功能异常呈正相关，与LY计数呈负相关。糖皮质激素治疗增加了LY计数，降低了CT评分和CRP水平，改善了凝血功能。 结论: COVID-19感染以影响肺、血液、消化系统和循环系统的全身性炎症反应为特征。胸部CT评分是反映全身炎症程度的良好指标。糖皮质激素治疗似乎减少了这些患者的全身性炎症。
METHODS:BACKGROUND:There is a commonly held belief that overweight women are more likely to offer contaminated urine samples (UAs) in the emergency department (ED) than women with normal body mass index (BMI). However, there is a paucity of research evaluating this potential concern. OBJECTIVE:We hypothesized that patients with higher BMI would be more likely to provide contaminated urine samples than women with low BMI. METHODS:This was a prospective, observational, cohort study evaluating consenting, adult, women that provided a clean catch, mid-stream sample at an inner-city ED. UAs were ordered at the discretion of the caring physician, cultures based on standardized parameters. The primary outcome parameter was the presence of UA contamination as defined by our microbiology lab. Demographic/historical data and BMI were recorded on a structured data sheet. Categorical data were analyzed by chi-square; continuous data by t-tests. Multivariable logistic regression was performed to control for confounding. RESULTS:There were 350 patients in the study group; 22% overweight, 35% obese, 17% morbidly obese, mean BMI 31. 5, and 60% provided contaminated specimens. The mean BMIs of the subjects with contaminated vs. uncontaminated UAs were significantly different (32.7 ± 10.2 vs 29.7 ± 8.8, p < 0.01). Within our multiple variable logistic regression model, obese and morbidly obese patients were more likely to provide contaminated UAs, while there were no significant associations for contamination with other variables except for hypertension (OR = 1.85, p = 0.02). CONCLUSION:Obesity was significantly associated with contamination of clean catch mid-stream samples in our population.
METHODS:OBJECTIVE:To determine whether the performance of a new quantum dots-based point-of-care test (POCT) devices is qualified for procalcitonin testing. METHODS:Finger-prick and venous blood specimens from 153 patients were measured with a quantum dots-based POCT device; the results were compared with those from the reference method. RESULTS:The quantum dots-based POCT device correlated well with the reference method in measuring plasma, venous whole blood, and finger-prick blood. No significant bias was observed (-0.08 ng/mL). At 0.5 ng per mL cutoff value, the concordances were 96.6%, 94.6%, and 90.5% for plasma, venous whole blood, and finger-prick blood, respectively. And at 2 ng per mL cutoff value, the concordances were 98.0%, 96.6%, and 95.3%, respectively. CONCLUSIONS:The quantum dots-based POCT device measured procalcitonin with multiple specimen types, high sensitivity, wide detection range, and short turnaround time. It would allow a more widespread use of procalcitonin and help lessen the burden of overcrowding in healthcare facilities in China.
METHODS:CONTEXT.—:The Paris System for Reporting Urinary Cytology has been disseminated since its inception in 2013; however, the daily practice patterns of urinary tract cytopathology are not well known. OBJECTIVE.—:To assess urinary tract cytopathology practice patterns across a variety of pathology laboratories to aid in the implementation and future update of the Paris System for Reporting Urinary Cytology. DESIGN.—:A questionnaire was designed to gather information about urinary tract cytopathology practices and mailed in July 2014 to 2116 laboratories participating in the College of American Pathologists interlaboratory comparison program. The participating laboratories' answers were summarized. RESULTS.—:Of the 879 of 2116 laboratories (41%) that participated, 745 (84.8%) reported processing urinary tract specimens in house. The laboratories reported processing various specimen types: voided urine, 735 of 738 (99.6%); bladder washing/barbotage, 639 of 738 (86.6%); and catheterized urine specimens, 653 of 738 (88.5%). Some laboratories used multiple preparation methods, but the most commonly used preparation techniques for urinary tract specimens were ThinPrep (57.4%) and Cytospin (45.5%). Eighty-eight of 197 laboratories (44.7%) reported preparing a cell block, but with a low frequency. Adequacy criteria were used by 295 of 707 laboratories (41.7%) for voided urine, and 244 of 707 (34.5%) assessed adequacy for bladder washing/barbotage. More than 95% of the laboratories reported the use of general categories: negative, atypical, suspicious, and positive. Polyomavirus was classified as negative in 408 of 642 laboratories (63.6%) and atypical in 189 of 642 (29.4%). One hundred twenty-eight of 708 laboratories (18.1%) performed ancillary testing, and of these, 102 of 122 (83.6%) reported performing UroVysion. CONCLUSIONS.—:Most laboratories use the ThinPrep method followed by the Cytospin technique; therefore, the criteria published in The Paris System for Reporting Urinary Cytology, based mostly on ThinPrep and SurePath, should be validated for Cytospin, and relevant information should be included in the revised edition of The Paris System for Reporting Urinary Cytology.