Regional Cerebellar Volume Loss Predicts Future Disability in Multiple Sclerosis Patients

Cerebellar symptoms in multiple sclerosis (MS) are well described; however, the exact contribution of cerebellar damage to MS disability has not been fully explored. Longer-term observational periods are necessary to better understand the dynamics of pathological changes within the cerebellum and their clinical consequences. Cerebellar lobe and single lobule volumes were automatically segmented on 664 3D-T1-weighted MPRAGE scans (acquired at a single 1.5 T scanner) of 163 MS patients (111 women; mean age: 47.1 years; 125 relapsing–remitting (RR) and 38 secondary progressive (SP) MS, median EDSS: 3.0) imaged annually over 4 years. Clinical scores (EDSS, 9HPT, 25FWT, PASAT, SDMT) were determined per patient per year with a maximum clinical follow-up of 11 years. Linear mixed-effect models were applied to assess the association between cerebellar volumes and clinical scores and whether cerebellar atrophy measures may predict future disability progression. SPMS patients exhibited faster posterior superior lobe volume loss over time compared to RRMS, which was related to increase of EDSS over time. In RRMS, cerebellar volumes were significant predictors of motor scores (e.g. average EDSS, T25FWT and 9HPT) and SDMT. Atrophy of motor-associated lobules (IV-VI + VIII) was a significant predictor of future deterioration of the 9HPT of the non-dominant hand. In SPMS, the atrophy rate of the posterior superior lobe (VI + Crus I) was a significant predictor of future PASAT performance deterioration. Regional cerebellar volume reduction is associated with motor and cognitive disability in MS and may serve as a predictor for future disease progression, especially of dexterity and impaired processing speed.

Early Warning Information for Severe and Critical Patients With COVID-19 Based on Quantitative CT Analysis of Lung Segments

Background: The coronavirus disease 2019 (COVID-19) outbreak is spreading rapidly around the world.Purpose: We aimed to explore early warning information for patients with severe/critical COVID-19 based on quantitative analysis of chest CT images at the lung segment level.Materials and Methods: A dataset of 81 patients with coronavirus disease 2019 (COVID-19) treated at Wuhan Wuchang hospital in Wuhan city from 21 January 2020 to 14 February 2020 was retrospectively analyzed, including ordinary and severe/critical cases. The time course of all subjects was divided into four stages. The differences in each lobe and lung segment between the two groups at each stage were quantitatively analyzed using the percentage of lung involvement (PLI) in order to investigate the most important segment of lung involvement in the severe/critical group and its corresponding time point.Results: Lung involvement in the ordinary and severe/critical groups reached a peak on the 18th and 14th day, respectively. In the first stage, PLIs in the right middle lobe and the left superior lobe between the two groups were significantly different. In the second stage and the fourth stage, there were statistically significant differences between the two groups in the whole lung, right superior lobe, right inferior lobe and left superior lobe. The rapid progress of the lateral segment of the right middle lobe on the second day and the anterior segment of the right upper lobe on the 13th day may be a warning sign for severe/critical patients. Age was the most important demographic characteristic of the severe/critical group.Conclusion: Quantitative assessment based on the lung segments of chest CT images provides early warning information for potentially severe/critical patients.

CT Manifestations of Coronavirus Disease 2019 and the Semi-Quantitative Evaluation of Its Clinical Classification

Purpose: To improve the understanding of the manifestations associated with computed tomography (CT) in the context of coronavirus disease 2019 (COVID-19). Methods: An analysis of a retrospective nature was carried out on clinically-based data as well as CT manifestations in 102 patients with a COVID-19 diagnosis who were admitted to our hospital between the 24th of January, 2020 and the 5th of February, 2020. Scoring of CT manifestations was accomplished, and the total score was used to determine the severity of lung injury. Results: Of the 102 patients, 10 had mild COVID-19, 72 had COVID-19 that was classed as moderate, 16 had COVID-19 that was severe, and 4 had COVID-19 that was critically severe. In all, 92 patients developed lung lesions, among whom 85 showed bilateral lung involvement. Superior lobe lesions and lesions in the middle-inner zone of the lung less frequently affected patients who developed moderate COVID-19 as compared to patients who developed severe/critically severe COVID-19 (all P < 0.05). The lesion manifestations included ground-glass opacity shadows (98.9%) and mixed-density shadows with consolidation (45.7%). Lamellar lesions and interlobular septal thickening less frequently affected patients with COVID-19 that was moderate than in patients with COVID-19 that was severe or critically severe (P < 0.05). In terms of COVID-19 that was moderate, severe or critically severe, the average scores associated with CT were 10.68 ± 6.32, 22.31 ± 8.07, and 30.75 ± 1.89 points respectively. A cumulative CT score of ≤ 20 points was the critical point for distinguishing moderate COVID-19 from severe/critically severe COVID-19. Conclusion: With regards to CT manifestations that were associated with COVID-19, certain characteristics were demonstrated and these varied in relation to different classifications of COVID-19. Cumulative CT score could be used to evaluate the clinical classification and degree of lung damage in patients who develop COVID-19.

Lung Adenocarcinoma Complicated with a Carcinoid Microtumor: A Case Report and Literature Review

Background: Adenocarcinoma is the most common primary lung malignant tumor. However, pulmonary carcinoid tumorlets are rare neuroendocrine tumors, and the coexistence of adenocarcinoma and pulmonary carcinoid tumorlets is extremely rare. Herein, we describe a case of lung adenocarcinoma complicated with carcinoid tumorlets.Case presentation: A 71-year-old female patient was admitted to the hospital after physical examination, multiple micronodules were in the inferior lobe of the left lung and right lung for 2 years, and a tumor was in the superior lobe of the left lung for 1 month. The patient underwent resection of the superior lobe of the left lung and wedge resection of the inferior lobe of the left lung by Video-assisted Thoracoscopic Surgery(VATS). The pathology of the superior lobe of the left lung was adenocarcinoma (pathological stage pT1cN0M0, IA3 stage), and the pathology of the inferior lobe of the left lung was carcinoid tumorlets. The patient was discharged from the hospital one week after the operation and recovered well after follow-up without recurrence.Conclusions: The lack of understanding of carcinoid tumorlets in the clinic causes their misdiagnosis or missed diagnosis. At the same time, the lack of understand also suggests that we should pay attention not only to mass-type lung tumors but also to pulmonary micronodules.

Multimodality imaging of a rare pulmonary artery sessile mass: a case report

Background Primary pulmonary artery masses are unusual entities that mimic pulmonary embolism (PE) in clinical presentation and on imaging studies. It is necessary to perform advanced diagnostic exams, such as transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (MRI), to determine the proper diagnosis. In unclear cases, laboratory findings, morphological follow-up, and response to anticoagulant therapy can help to clarify the diagnosis. Case summary A 47-year-old previously healthy man with worsening effort dyspnoea underwent chest computed tomography (CT) for suspicion of PE, which showed a pedunculated eccentric mass at the origin of the pulmonary artery causing severe stenosis. The patient was started on anticoagulation therapy, but, after TEE and cardiac MRI, a neoplastic fibroelastic mass was suspected. Unexpectedly, 18fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT revealed a unique area of glucose uptake in the superior lobe of the left lung and not in the pulmonary artery. The biopsy was consistent with pleomorphic high-grade lung sarcoma. After 3 months of chemotherapy, a CT scan showed progression of the lung disease with no change in the arterial mass, which was therefore confirmed as pulmonary fibroelastoma. Discussion Due to the rarity of pulmonary artery tumours, they can be initially misdiagnosed as PE or a metastasis of a lung sarcoma. Three-dimensional TEE and cardiac MRI are particularly useful in differentiating tumours from PE.

New data on the genus Cheilosia Meigen (Diptera, Syrphidae) from Central Asia, with descriptions of two new species and a key to the ‘group C’

New information is given on the distribution of Cheilosia Meigen species (Diptera, Syrphidae) in Central Asia, together with a description of two new species. The new species, Cheilosia teneripilosa sp. nov. and Cheilosia vadimi sp. nov., belong to the subgenus Montanocheila Barkalov. Cheilosia teneripilosa differs from its close allies by a set of the following characters: eyes with long black hairs, legs of male completely black, abdomen predominantly with light hairs, superior lobe of hypandrium with a very small left process. Cheilosia vadimi is close to C. kirgizorum Peck, but differs by shorter hairs on the eyes and scutum, and a completely different shape of the superior lobe of the hypandrium. A revised key is given to the ‘group C’ species of Cheilosia from Central Asia (those with haired eyes, bare face and absence of strong bristles on scutellar hind margin). The descriptions of the new species are accompanied by drawings of the head and male genitalia.

Problem Terapeutik pada Empiema Terlokulasi karena Tuberkulosis

Background: Pleural effusion is the most common complication of pulmonary tuberculosis (TB). Some coexist with secondary infection could worsen clinical presentation as empyema. The incidence of pleural effusion in the early stage of empyema due to TB infection is about 31%. Somehow, untreated empyema increased in-hospital mortality. Case: A woman with unregulated diabetes mellitus was referred with organized empyema. The etiology of empyema is based on a specific process of TB infection with the ADA value of empyema fluid was 128 mg/dl. We decided to perform decortication with the result loculated empyema and bronchopleural fistula 2 cm in the inferior lobe of the right lung. The patient did not recover well. Unfortunately, fluidopneumothorax was found on a chest CT scan with contrast. Thoracotomy was performed and another bronchopleural fistula was found which length was about 1 cm in superior lobe of the right lung. Discussion: The worsening condition of the patient was caused by the occurrence of postoperative bronchopleural fistula. It was visualized as pulmonary TB with perforation of cavity nessessity. On the other hand, the condition could be worsened by the hyperglycemic state in an immunocompromised individual. Summary: Loculated empyema is a condition caused by bronchopleural fistula, the presence of a connecting cavity between pleural and bronchus which occurred less than 48 hours. Local and systemic factors might explain the development of bronchopleural fistula. Well management of the loculated empyema by knowing the etiology could improve the life survival of the patient.