Objective: The aim of this study was to investigate the clinical and computed tomography (CT) features associated with severe and critical coronavirus disease 2019 pneumonia. Materials and Methods: Eighty-three patients with COVID-19 pneumonia including 25 severe/critical cases and 58 ordinary cases were enrolled. The chest CT images and clinical data of them were reviewed and compared. The risk factors associated with disease severity were analyzed. Results: Compared with the ordinary patients, the severe/critical patients had older ages, higher incidence of comorbidities, cough, expectoration, chest pain, and dyspnea. The incidences of consolidation, linear opacities, crazy-paving pattern, and bronchial wall thickening in severe/critical patients were significantly higher than those of the ordinary patients. Besides, severe/critical patients showed higher incidences of lymph node enlargement, pericardial effusion, and pleural effusion than the ordinary patients. The CT scores of severe/critical patients were significantly higher than those of the ordinary patients (P < 0.001). Receiver operating characteristic curve showed that the sensitivity and specificity of CT score were 80.0% and 82.8%, respectively, for the discrimination of the 2 types. The clinical factors of age older than 50 years, comorbidities, dyspnea, chest pain, cough, expectoration, decreased lymphocytes, and increased inflammation indicators were risk factors for severe/critical COVID-19 pneumonia. Computed tomography findings of consolidation, linear opacities, crazy-paving pattern, bronchial wall thickening, high CT scores, and extrapulmonary lesions were features of severe/critical COVID-19 pneumonia. Conclusions: There are significant differences in clinical symptoms, laboratory examinations, and CT manifestations between the ordinary patients and the severe/ critical patients. Many factors are related to the severity of the disease, which can help clinicians to judge the severity of the patient and evaluate the prognosis.
Objectives: The aim of this study was to investigate the chest computed tomography (CT) findings in patients with confirmed coronavirus disease 2019 and to evaluate its relationship with clinical features. Materials and Methods: Study sample consisted of 80 patients diagnosed as COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, and the relationship between them was analyzed. Results: Totally, 80 patients diagnosed with COVID-19 were included. With regards to the clinical manifestations, 58 (73%) of the 80 patients had cough, and 61 (76%) of the 80 patients had high temperature levels. The most frequent CT abnormalities observed were ground glass opacity (73/80 cases, 91%), consolidation (50/80 cases, 63%), and interlobular septal thickening (47/80, 59%). Most of the lesions were multiple, with an average of 12 ± 6 lung segments involved. The most common involved lung segments were the dorsal segment of the right lower lobe (69/80, 86%), the posterior basal segment of the right lower lobe (68/80, 85%), the lateral basal segment of the right lower lobe (64/80, 80%), the dorsal segment of the left lower lobe (61/80, 76%), and the posterior basal segment of the left lower lobe (65/80, 81%). The average pulmonary inflammation index value was (34% ± 20%) for all the patients. Correlation analysis showed that the pulmonary inflammation index value was significantly correlated with the values of lymphocyte count, monocyte count, C-reactive protein, procalcitonin, days from illness onset, and body temperature (P < 0.05). Conclusions: The common chest CT findings of COVID-19 are multiple ground glass opacity, consolidation, and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. There are significant correlations between the degree of pulmonary inflammation and the main clinical symptoms and laboratory results. Computed tomography plays an important role in the diagnosis and evaluation of this emerging global health emergency.
Near-infrared spectroscopy seems to be a highly suitable candidate for postoperative flap monitoring. Larger-scale, randomized, multicentric clinical trials are needed in the future.
Extended systemic antibiotic prophylaxis should be considered to decrease SSI risk in breast implant surgery, especially in breast reconstruction. Topical antibiotic irrigation would decrease CC risk. Risk factors such as chest irradiation and diabetes should be taken into consideration when prescribing antibiotic prophylaxis.
Aim Proctology is one of the surgical specialties that has suffered the most during COVID‐19 pandemic. Using a cross‐sectional non‐incentivised World Wide Web survey, we aimed to snapshot the current status of proctological practice in six world regions. Method Surgeons affiliated to renowned scientific societies with an interest in coloproctology were invited to join the survey. Members of the ProctoLock Working Group enhanced recruitment by direct invitation. The predictive power of respondents’ and hospitals’ demographics on the change of status of surgical and outpatient activities was calculated. Results Respondents ( n = 1050) were mostly men (79%), with a mean age of 46.9 years, at consultant level (79%), practising in academic hospitals (53%) offering a dedicated proctology service (68%). A total of 119 (11%) tested positive for SARS‐CoV‐2. The majority (54%) came from Europe. Participants from Asia reported a higher proportion of unaltered practice (17%), while those from Europe had the highest proportion of fully stopped practice (20%). The likelihood of ongoing surgical practice was higher in men (OR 1.54, 95% CI 1.13–2.09; P = 0.006), in those reporting readily availability of personal protective equipment (PPE) (OR 1.40, 1.08–1.42; P = 0.012) and in centres that were partially or not at all involved in COVID‐19 care (OR 2.95, 2.14–4.09; P < 0.001). This chance decreased by 2% per year of respondent’s age ( P = 0.001). Conclusion Several factors including different screening policies and resource capacity affected the current status of proctological practice. This information may help health authorities to formulate effective preventive strategies to limit curtailment of care of these patients during the pandemic.
• ILPCI-CT can detect fibrous material even in the early stage of liver fibrosis. • MVD, L/V, P/V, and the distribution of vascular diameter reflect pathological angiogenesis. • 3D reconstruction could be a promising approach for detecting liver fibrosis.
Background: Pyrotinib (an irreversible pan-ErbB inhibitor) plus capecitabine have shown clinically and statistically meaningful progression free survival and overall survival benefits and acceptable tolerability in patients with HER2-positive metastatic breast cancer in phase 3 study. We compared the efficacy and safety of adding pyrotinib to trastuzumab and docetaxel vs placebo, trastuzumab and docetaxel as neoadjuvant treatment in women with HER2-positive early or locally advanced breast cancer (ABC) in this randomized, double-blind, multicenter, phase 3 study. Methods: Treatment naive patients with HER2-positive early or locally ABC (T2-3, N0-3, M0) were randomly assigned (1:1) to pyrotinib arm receiving 4 neoadjuvant cycles of pyrotinib (400 mg po qd, d1-21, q3w), trastuzumab (8 mg/kg iv, cycle 1 d1, then 6 mg/kg d1 q3w) and placebo arm with docetaxel (100 mg/m2 iv d1, q3w) or placebo, trastuzumab and docetaxel. Randomization was done via a centralized interactive web-response system and stratified by primary tumor size (>2 cm and ≤5cm, or >5cm) and hormone receptor status (ER positive and/or PR positive, or negative for both). After surgery, patients received 3 cycles of intravenous fluorouracil, epirubicin, and cyclophosphamide followed by anti-cancer treatment (anti-HER2 therapy, radiotherapy, or endocrine therapy) at physicians’ discretion in accordance with clinical practice guidelines. The primary endpoint was total pCR rate (tpCR; defined as absence of any residual invasive cancer in the breast and lymph nodes [ypT0/is, ypN0]), assessed by an independent review committee (IRC). This study is registered with ClinicalTrials.gov, number NCT03588091. The data cutoff date was April 30, 2021. Results: Between July 23, 2018 and January 8, 2021, a total of 355 patients were randomized (pyrotinib arm, n=178; and placebo arm, n=177; mean [SD] age, 48.8 [9.4] years). Baseline demographics and disease characteristics were well balanced. In the full analysis set, IRC-assessed tpCR rates were 41.0% (73 of 178) in the pyrotinib arm and 22.0% (39 of 177) in the placebo arm (difference, 19.0% [95% CI, 9.5%-28.4%]; one-sided P<0.0001). The local pathologist-assessed tpCR rates were 44.4% (79 of 178) and 24.3% (43 of 177) in the pyrotinib arm and the placebo arm, respectively. Incidence of grade ≥3 adverse events (AEs) was 71.3% (127 of 178) in the pyrotinib arm and 37.3% (66 of 177) in the placebo arm. Of the most-common grade ≥3 AEs (≥5% of patients in either arm), the incidences of diarrhea (79 of 178 [44.4%] vs 9 of 177 [5.1%]), decreased WBC count (29 of 178 [16.3%] vs 24 of 177 [13.6%]), vomiting (23 of 178 [12.9%] vs 2 of 177 [1.1%]), anemia (11 of 178 [6.2%] vs 2 of 177 [1.1%]), and hypokalemia (9 of 178 [5.1%] vs 0) were higher in the pyrotinib arm compared with the placebo arm. Grade 3 diarrhea occurred mainly during the first treatment cycle and decreased in the second cycle and thereafter. No grade 4 or 5 diarrheas occurred. The median duration per grade 3 episode was 2.0 days and median cumulative duration of grade 3 episodes was 4.0 days. Only 1 patient (1 of 178 [0.6%]) in the pyrotinb arm experienced diarrhea-related discontinuation. Serious AEs were reported in 14.6% of patients (26 of 178) in the pyrotinib arm and 6.8% of patients (12 of 177) in the placebo arm. Conclusions: Pyrotinib, trastuzumab, and docetaxel as neoadjuvant treatment achieved a statistically significant and clinically meaningful improvement in IRC-assessed tpCR rate for patients with HER2-positive early or locally ABC compared with placebo, trastuzumab, and docetaxel, with an acceptable and manageable safety profile. These findings support pyrotinib, trastuzumab, and docetaxel as a new neoadjuvant treatment option in this patient population. Citation Format: Jiong Wu, Zhenzhen Liu, Hongjian Yang, Jinhai Tang, Kun Wang, Yunjiang Liu, Haibo Wang, Peifen Fu, Shuqun Zhang, Qiang Liu, Zefei Jiang, Shusen Wang, Jian Huang, Chuan Wang, Shu Wang, Yongsheng Wang, Linlin Zhen, Xiaoyu Zhu, Fei Wu, Tao Zhang, Jianjun Zou. Pyrotinib in combination with trastuzumab and docetaxel as neoadjuvant treatment for HER2-positive early or locally advanced breast cancer (PHEDRA): A randomized, double-blind, multicenter, phase 3 study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD8-08.
Proctology is one of the surgical specialties that suffered the most during COVID-19 pandemic. Using data from a crosssectional worldwide web survey, we aimed to snapshot the current status of proctologic practice in Italy with differences between three macro areas (North, Centre, South). Specialists affiliated to renowned scientific societies with an interest in coloproctology were invited to join a 27-item survey. Predictive power of respondents' and hospitals' demographics on the change of status of surgical activities was calculated. The study was registered at ClinicalTrials.gov (NCT 04392245). Of 299 respondents from Italy, 94 (40%) practiced in the North, 60 (25%) in the Centrer and 82 (35%) in the South and Islands. The majority were men (79%), at consultant level (70%), with a mean age of 46.5 years, practicing in academic hospitals (39%), where a dedicated proctologist was readily available (68%). Southern respondents were more at risk of infection compared to those from the Center (OR, 3.30; 95%CI 1.46; 7.47, P = 0.004), as were males (OR, 2.64; 95%CI 1.09; 6.37, P = 0.031) and those who routinely tested patients prior to surgery (OR, 3.02; 95%CI 1.39; 6.53, P = 0.005). The likelihood of ongoing surgical practice was higher in the South (OR 1.36, 95%CI 0.75; 2.46, P = 0.304) and in centers that were not fully dedicated to COVID-19 care (OR 4.00, 95%CI 1.88; 8.50, P < 0.001). The results of this survey highlight important factors contributing to the deadlock of proctologic practice in Italy and may inform the development of future management strategies.
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