Mối liên quan giữa một số đặc điểm lâm sàng, tổn thương phổi trên X-quang và kết cục lâm sàng ở bệnh nhân Covid-19

TÓM TẮT Đặt vấn đề: Bệnh COVID-19 gây ra bởi vi rút SARS-CoV-2 hiện nay là một đại dịch toàn cầu gây ảnh hưởng lớn đến hơn 200 quốc gia trên thế giới. Mức độ nặng của bệnh lý nhu mô phổi được coi là một yếu tố nguy cơ liên quan đến kết cục tử vong, bác sĩ nhận biết được điều này sẽ cải thiện sự phân tầng nguy cơ và điều chỉnh cường độ chăm sóc, đặc biệt là những bệnh nhân có nguy cơ cao. Phương pháp: Nghiên cứu hồi cứu 220 bệnh nhân COVID-19 được cách ly và điều trị tại Trung tâm hồi sức tích cực người bệnh COVID-19 trực thuộc Bệnh viện Trung ương Huế tại TP HCM Kết quả: Chúng tôi đã lấy ngẫu nhiên 110 bệnh nhân sống và 110 bệnh nhân tử vong (TV). Tổn thương trên X-quang ở nhóm tử vong trung vị TSS là 8 (8 - 8) và gặp gần như hoàn toàn mức độ nặng 109 (49,5%), nhóm sống trung vị TSS là 6 (4 - 7), và gặp phần lớn là mức độ vừa 68 (30,9%), sự khác biệt rất có ý nghĩa thống kê với p < 0,000001 và p < 0,0001. Tổn thương trên X-quang thường phối hợp và gặp theo thứ tự sau: tổn thương kẽ 212 (96,4%), kính mờ 205 (93,2%), nốt mờ 140 (63,6%), đông đặc 103 (46,8%), tổn thương dạng nốt mờ ở nhóm TV 96 (43,6%) cao hơn hẳn nhóm sống 44 (20%) với p < 0.0001. Vị trí tổn thương gặp ở nhóm TV là lan tỏa 2 phế trường bệnh nhân, trong khi ở nhóm sống gặp ở cả ở ngoại vi 58 (26,4%) và lan tỏa 52 (23,6%), không gặp tổn thương ở quanh rốn phổi ở cả hai nhóm với p < 0,0001. Kết luận: Nghiên cứu đầu tiên ở Việt Nam chỉ ra rằng điểm TSS cao, tổn thương lan tỏa trên X-quang và tuổi cao tăng nguy cơ tử vong do COVID-19. ABSTRACT RELATIONSHIP BETWEEN CLINICAL SYMPTOMS, CHEST X-RAY ABNORMALITIES AND OUTCOME IN PATIENTS WITH COVID-19 Background: COVID-19 caused by SARS-CoV-2 virus is an unprecedented global pandemic affecting more than 200 countries worldwide. The severity of parenchymal lung disease is considered as a major risk factor for mortality. Therefore, it is important to improve its recognition by clinicians, henceits risk stratification and intensity adjustment of care, especially in high - risk patients. Methods: A retrospective study was conducted on 220 COVID-19 patients who were treated at the COVID-19 Intensive Care Center Unit run by Hue Central Hospital in Ho Chi Minh City. Results: We randomly selected 110 patients who had recovered (R) and 110 who died (D) from COVID-19. The radiographic lesion in the D group median TSS was 8 (8 - 8) and had almost complete severity 109 (49.5%) and median recovery group TSS was 6 (4 - 7), and most of them were moderate 68 (30.9%) with p < 0.00001 and p < 0.0001. Lesions on X - ray are often combined and occurred in the following order: interstitial lesions 212 (96.4%), ground - glass opacity 205 (93.2%), blurred nodules 140 (63.6%), consolidation 103 (46.8%), nodular lesions in the D group 96 (43.6%) were significantly higher than in the recovery group 44 (20%) with p < 0.0001. The location of the lesions seen in the D group was diffuse to 2 lung fields patients, while in the recovery group it was found in both peripheral 58 (26.4%) and diffuse 52 (23.6%), not found lesions around the hilum in both groups with p < 0.0001. Conclusions: This study demonstrates for the first time in Vietnam that a high TSS score, diffuse radiographic involvement, and elderly age increase the risk of death in patients with COVID-19. Keywords: Clinical symptoms, chest X-ray, TSS, outcome, COVID-19

Multimodal Imaging Biomarker-Based Model Using Stratification Strategies for Predicting Upper Extremity Motor Recovery in Severe Stroke Patients

Background. Various prognostic biomarkers for upper extremity (UE) motor recovery after stroke have been reported. However, most have relatively low predictive accuracy in severe stroke patients. Objective. This study suggests an imaging biomarker-based model for effectively predicting UE recovery in severe stroke patients. Methods. Of 104 ischemic stroke patients screened, 42 with severe motor impairment were included. All patients underwent structural, diffusion, and functional magnetic resonance imaging at 2 weeks and underwent motor function assessments at 2 weeks and 3 months after stroke onset. According to motor function recovery at 3 months, patients were divided into good and poor subgroups. The value of multimodal imaging biomarkers of lesion load, lesion volume, white matter integrity, and cortical functional connectivity for motor recovery prediction was investigated in each subgroup. Results. Imaging biomarkers varied depending on recovery pattern. The integrity of the cerebellar tract ( P = .005, R 2 = .432) was the primary biomarker in the good recovery group. In contrast, the sensory-related corpus callosum tract ( P = .026, R 2 = .332) and sensory-related functional connectivity ( P = .001, R 2 = .531) were primary biomarkers in the poor recovery group. A prediction model was proposed by applying each biomarker in the subgroup to patients with different motor evoked potential responses ( P < .001, R 2 = .853, root mean square error = 5.28). Conclusions. Our results suggest an optimized imaging biomarker model for predicting UE motor recovery after stroke. This model can contribute to individualized management of severe stroke in a clinical setting.

Circulating Chromogranin B Is Associated With Left Ventricular Functional Recovery After Successful Recanalization of Chronic Total Occlusion

Background: Chromogranin B (CgB) is increased in heart failure and proportionate to disease severity. We investigated whether circulating CgB level is associated with left ventricular (LV) functional recovery potential after successful recanalization of chronic total occlusion (CTO).Methods: Serum levels of CgB were assayed in 53 patients with stable angina with LV functional recovery [an absolute increase in LV ejection fraction (EF) of ≥5%] and 53 age- and sex-matched non-recovery controls after successful recanalization of CTO during 12-month follow-up.Results: We found that CgB level was significantly lower in the recovery group than in the non-recovery group (593 [IQR 454–934] vs. 1,108 [IQR 696–2020] pg/ml, P &lt; 0.001), and that it was inversely correlated with changes in LVEF (Spearman's r = −0.31, P = 0.001). Receiver operating characteristic (ROC) analysis showed that the area under the curve of CgB for predicting LVEF improvement was 0.76 (95% CI 0.664–0.856), and that the optimal cutoff value was 972.5 pg/ml. In multivariate analyses, after adjusting for confounding factors, high CgB level remained an independent determinant of impaired LV functional recovery after CTO recanalization. LV functional improvement appeared to be more responsive to CgB in patients with poor than with good coronary collaterals.Conclusions: Elevated circulating CgB level confers an increased risk of impaired LV functional recovery after successful recanalization of CTO in patients with stable coronary artery disease.

Effect Mechanism of Electroacupuncture at ST36 on the Injured Extensor Digitorum Longus in the Jumping Rat Model Based on mRNA-Seq Analysis

The key target and regulatory mechanism of electroacupuncture of Zusanli (ST36) on extensor longus muscle injury in a jumping rat model were investigated. To this end, 24 female SD rats were randomly divided into the following four groups: no-treatment control group (NON), 6-week jumping group (J6O), electroacupuncture group after 6-week jumping (J6A), and natural recovery group after 6-week jumping (J6N). After 6 weeks of jumping, in the electroacupuncture group (J6A), electroacupuncture stimulation was applied at Zusanli(ST36) for 20 min per day over the course of 5 days. In the natural recovery group (J6N), rats were fastened with a special apparatus without electroacupuncture stimulation for 20 min at the same time. Transmission electron microscopy, transcriptome sequencing and analysis, Western blotting assay and immunofluorescence staining were performed at the end of our experiment. The recovery effect of J6A rats was more obvious than that of J6N rats and J6O rats as indicated by changes of infiltration of inflammatory cells and morphological structure. Notably, the morphological structure of J6A rats was closer to NON rats in the observation of transmission electron microscopy. CISH/STAT3 regulation was identified by mRNA-seq. The pro-inflammatory response to STAT3 activation was alleviated through up-regulating the expression of CISH protein in J6A rats relative to J6O rats. The level of BAX was decreased and the level of Bcl-2 level was increased in J6A rats relative to J6O rats. Moreover, when compared to J6N rats, the level of Bcl-2 was significantly up-regulated in J6A rats. Increased caspase-3 expression but decreased CDKN2α expression was shown in J6A rats relative to NON rats. These results indicate that the potential mechanism underlying electroacupuncture stimulation of Zusanli (ST36) in repairing the injured extensor digitorum longus following overused jumping may be attributed to CISH/STAT3 regulation of proteins associated with inflammation, apoptosis, and proliferation.

Transcriptome Analysis of Gills Provides Insights Into Translation Changes Under Hypoxic Stress and Reoxygenation in Golden Pompano, Trachinotus ovatus (Linnaeus 1758)

Golden pompano (Trachinotus ovatus) is one of the most economically critical marine fish in South China. Low oxygen stress has resulted in substantial economic losses to the aquaculture of T. ovatus. However, the molecular responses of fish gills to hypoxia challenge remain unclear. To understand the mechanism underlying adaption to hypoxia, we analyzed the transcriptome of T. ovatus gills in response to hypoxic stress in the normal oxygen group, hypoxic group, and hypoxia treatment after oxygen recovery group. This study found that hypoxia for 8 h was the critical time of hypoxic stress and corresponded to the largest number of differentially expressed genes. After hypoxic stress, genes for chemokines, chemokine receptors, interleukins, complement factors, and other cytokines were significantly downregulated, which may be why fish are vulnerable to pathogen infection in a hypoxic environment. According to a Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, many downregulated genes were significantly enriched in the steroid biosynthesis, focal adhesion, and the extracellular matrix (ECM)-receptor interaction signal pathways, which affected cell signal transduction, adhesion, and apoptosis. Compared with the hypoxic group, the amounts of upregulated genes related to phagocytosis and protein degradation were upregulated in the dissolved oxygen recovery group. These results indicated that after the recovery of dissolved oxygen, the fish body repaired the stress-induced damage by rapidly removing misfolded proteins. These findings provide a better understanding of the hypoxia response mechanism of fish and represent a useful resource for the genetic breeding of T. ovatus.

Muscle Damage Indicated by Maximal Voluntary Contraction Strength Changes From Immediately to 1 Day After Eccentric Exercise of the Knee Extensors

The present study examined if the magnitude of changes in indirect muscle damage markers could be predicted by maximal voluntary isometric contraction (MVIC) torque changes from immediately to 1 day after eccentric exercise. Twenty-eight young men performed 100 maximal isokinetic (60°/s) eccentric contractions of the knee extensors. MVIC torque, potentiated doublet torque, voluntary activation (VA) during MVIC, shear modulus of rectus femoris (RF), vastus medialis and lateralis, and muscle soreness of these muscles were measured before, immediately after, and 1–3 days post-exercise. Based on the recovery rate of the MVIC torque from immediately to 1-day post-exercise, the participants were placed to a recovery group that showed an increase in the MVIC torque (11.3–79.9%, n = 15) or a no-recovery group that showed no recovery (−71.9 to 0%, n = 13). No significant difference in MVIC torque decrease immediately post-exercise was found between the recovery (−33 ± 12%) and no-recovery (−32 ± 9%) groups. At 1–3 days, changes in MVIC torque (−40 to −26% vs. −22 to −12%), potentiated doublet torque (−37 to −22% vs. −20 to −9%), and proximal RF shear modulus (29–34% vs. 8–15%) were greater (p &lt; 0.05) for the no-recovery than recovery group. No significant group differences were found for muscle soreness. The recovery rate of MVIC torque was correlated (p &lt; 0.05) with the change in MVIC torque from baseline to 2 (r = 0.624) or 3 days post-exercise (r = 0.526), or peak change in potentiated doublet torque at 1–3 days post-exercise from baseline (r = 0.691), but not correlated with the changes in other dependent variables. These results suggest that the recovery rate of MVIC torque predicts changes in neuromuscular function but not muscle soreness and stiffness following eccentric exercise of the knee extensors.

Sustainability evaluation of the solid waste management system in Makassar City

The many impacts of improper solid waste management have made every region run a solid waste management system (SWMS) in a sustainable manner. It is necessary to evaluate it using the appropriate indicators to assess the sustainability of a SWMS. This study uses a sustainability indicator consisting of 27 indicators divided into six groups, which are suitable for assessing the sustainability of SWMS. This study found that the SWMS condition in Makassar City was still far from being sustainable. The results found that SWMS in Makassar City scored 58% in the general group, 95% in the collection and sorting group, 57% in the recycling group, 20% in the composting group, 20% in the energy recovery group, and 24% in the landfill group.

Chest radiographic score and lactate dehydrogenase are independent risk factors linked to mortality in Middle East Respiratory Syndrome Coronavirus (MERS-CoV) patients

Background Despite the dominance of Covid-19 in the current situation, MERS-CoV is found infrequently in the Middle East. When coupled with the chest radiographic score, serum biochemical parameters may be utilized to assess serum biochemical changes in individuals with different degrees of MERS-CoV infection and to predict death. The purpose of this study was to examine the association between increased LDH levels and severe MERS-CoV outcomes utilizing ventilation days and an elevated chest radiographic score. Results Fifty-seven patients were included in the retrospective cohort. The mean age was 44.9 ± 13.5 years, while the range was between 12 and 73 years. With an average age of 53.3 ± 16.5 years, 18 of 57 (31.6%) patients were classified as deceased. The deceased group showed a substantially greater amount of LDH than the recovery group (280.18 ± 150.79 vs. 1241.72 ± 1327.77, p = 0.007). A cut-off value of > 512 LDH was established with a C-statistic of 0.96 (95% CI 0.92–1.00) and was 94% sensitive and 93% specific for mortality. Multivariate cox regression analysis revealed that loge (LDH) (adjusted HR: 9.91, 95% CI: 2.44–40.3, p = 0.001) and chest radiographic score (adjusted HR: 1.24, 95% CI: 1.05–1.47, p = 0.01) were risk factors for mortality, whereas ventilation days were a protective factor (adjusted HR: 0.84, 95% CI: 0.76–0.93, p = 0.001). Conclusion According to our results, blood LDH levels of > 512 had a 94% sensitivity and 93% specificity for predicting in-hospital mortality in patients infected with MERS-CoV. The chest radiographic score of 11.34 ± 5.4 was the risk factor for the mortality (adjusted Hazard ratio HR: 1.24, 95% CI: 1.05–1.47, p = 0.01). Thus, threshold may aid in the identification of individuals with MERS-CoV infection who die in hospital.

The possible protective role of Vitamin C versus Mesna against effect of Cyclophosphamide on the Urinary Bladder of Adult Male Albino Rats (A Histological and Immunohistochemical Study)

Background Cyclophosphamide (CYP) is considered one of the most successful chemotherapeutic drugs involved in anticancer regimens. However, it has multiple side effects. Mesna has an antiinflammatory effect and usually used in the treatment of cystitis. Vitamin C is a water-soluble vitamin which has a potent anti –oxidant effect that might protect cells against the oxidative damage caused by cyclophosphamide. Aim of the study The aim of the present study was comparing between the possible protective effect of vitamin C versus mesna and their combined therapy against the histological and immunohistochemical changes induced by cyclophosphamide on the urinary bladder of adult male albino rats. Material and methods Thirty adult male albino rats were divided into 5 groups, 6 rats each; (control(?), CYP-treated group (Пa), recovery group(Пb), mesna-treated group(???), vitamin C- treated group(?V) and the combined group (V). Histological examination of the H&Eand toluidine blue stained sections was done by light microscopy to assess the changes in the architecture of the urinary bladder. Avidin Biotin staining was performed for demonstration of iNOS immunoreactivity and histomorphometric analysis was done. Results Examination of H&E stained sections of cyclophosphamide- treated group (Пa) showed variable degrees of urothelial affection. Wide areas of urothelial cell degeneration with evident basal cytoplasmic vacoulatins, surface erosions and sloughed urothelial debris. Other Areas showed surface ulceration, completely denuded urothelium or the presence of multiple cysts replacing the urothelium and resting on the basement membrane. Semithin sections showed that the cytoplasmic microvesicles of umbrella cells were hardly detected. The Avidin Bioton stained sections showed intense positive immune reaction to iNOS in all layers of the urothelium. Scanning electron microscopy showed loss of the normal polygonal shape of the superficial epithelial cells, erosions, or deep ulcerations. Moreover, examination of the lamina propria by light microscopy showed multiple mononuclear inflammatory cells were detected, mast cells were seen in the lamina propria and some of them were invading the basement membrane of the urothelium. Dilated blood vessels and wide areas of extravasted blood (hemorrhage) were also observed. In addition, multiple epithelial cell nests of irregular shapes and sizes were deeply located in the lamina propria and exhibited pale esinophilic colloid discharge in their lumen. Scanning electron microscopy showed dense deposition of collagen fibers in both superficial and deep fibers of the lamina propria. Minimal improvement was observed in the recovery group (subgroup Пb). Mild to moderate improvement of the previous findings of CYP treated group was observed with each of mesna and vitamin C. Combined treatment of CYP with both of mesna and vitamin C induced apparent restoration of almost of the normal architecture of the urinary bladder. Conclusion CYP consumption developed morphologic and morphometric changes in the urinary bladder. The recovery group showed minimal improvement of the bladder architecture and increasing the period of recovery might produce better results. Each of vitamin C and mesna- treated groups induced mild to moderate improvement on the bladder architecture but treatment with combination of both of them offered remarkable improvement. Combined mesna and vitamin C induced significant protection via their combined anti-inflammatory and anti-oxidant proprieties.

Machine Learning-Based Radiomics of the Optic Chiasm Predict Visual Outcome Following Pituitary Adenoma Surgery

Preoperative prediction of visual recovery after pituitary adenoma surgery remains a challenge. We aimed to investigate the value of MRI-based radiomics of the optic chiasm in predicting postoperative visual field outcome using machine learning technology. A total of 131 pituitary adenoma patients were retrospectively enrolled and divided into the recovery group (N = 79) and the non-recovery group (N = 52) according to visual field outcome following surgical chiasmal decompression. Radiomic features were extracted from the optic chiasm on preoperative coronal T2-weighted imaging. Least absolute shrinkage and selection operator regression were first used to select optimal features. Then, three machine learning algorithms were employed to develop radiomic models to predict visual recovery, including support vector machine (SVM), random forest and linear discriminant analysis. The prognostic performances of models were evaluated via five-fold cross-validation. The results showed that radiomic models using different machine learning algorithms all achieved area under the curve (AUC) over 0.750. The SVM-based model represented the best predictive performance for visual field recovery, with the highest AUC of 0.824. In conclusion, machine learning-based radiomics of the optic chiasm on routine MR imaging could potentially serve as a novel approach to preoperatively predict visual recovery and allow personalized counseling for individual pituitary adenoma patients.