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Background: The risk factors for adverse events of Coronavirus Disease-19 (COVID-19) have not been well described. We aimed to explore the predictive value of clinical, laboratory and CT imaging characteristics on admission for short-term outcomes of COVID-19 patients. Methods: This multicenter, retrospective, observation study enrolled 703 laboratory-confirmed COVID-19 patients admitted to 16 tertiary hospitals from 8 provinces in China between January 10, 2020 and March 13, 2020. Demographic, clinical, laboratory data, CT imaging findings on admission and clinical outcomes were collected and compared. The primary endpoint was in-hospital death, the secondary endpoints were composite clinical adverse outcomes including in-hospital death, admission to intensive care unit (ICU) and requiring invasive mechanical ventilation support (IMV). Multivariable Cox regression, Kaplan-Meier plots and log-rank test were used to explore risk factors related to in-hospital death and in-hospital adverse outcomes. Results: Of 703 patients, 55 (8%) developed adverse outcomes (including 33 deceased), 648 (92%) discharged without any adverse outcome. Multivariable regression analysis showed risk factors associated with in-hospital death included ≥ 2 comorbidities (hazard ratio [HR], 6.734; 95% CI; 3.239-14.003, p < 0.001), leukocytosis (HR, 9.639; 95% CI, 4.572-20.321, p < 0.001), lymphopenia (HR, 4.579; 95% CI, 1.334-15.715, p = 0.016) and CT severity score > 14 (HR, 2.915; 95% CI, 1.376-6.177, p = 0.005) on admission, while older age (HR, 2.231; 95% CI, 1.124-4.427, p = 0.022), ≥ 2 comorbidities (HR, 4.778; 95% CI; 2.451-9.315, p < 0.001), leukocytosis (HR, 6.349; 95% CI; 3.330-12.108, p < 0.001), lymphopenia (HR, 3.014; 95% CI; 1.356-6.697, p = 0.007) and CT severity score > 14 (HR, 1.946; 95% CI; 1.095-3.459, p = 0.023) were associated with increased odds of composite adverse outcomes. Conclusion: The risk factors of older age, multiple comorbidities, leukocytosis, lymphopenia and higher CT severity score could help clinicians identify patients with potential adverse events.

Atypical triplication anterior cerebral artery is a rare entity and the variation is an important factor leading to aneurysm. A patient with aneurysm that arises from the bifurcation of the distal anterior cerebral arteries is presented. The contralateral anterior cerebral artery is also presented, and there is no communication between the left and the right anterior cerebral artery. The findings from multiple slice CT angiography in this case are illustrated and discussed. The recognition of this variant is important for the therapy planning.

Objectives We sought to evaluate a moderate-potassium cardioplegic solution using adenosine and lidocaine as the arresting and protecting cardioprotective combination in pediatric cardiac surgery. Methods One hundred thirty-four patients with congenital heart disease were randomly allocated to one of 3 groups according to the cardioplegia formula used: the high-potassium (HP) group (K + , 20 mmol/L), 46 patients; the high-potassium adenosine–lidocaine (HPAL) group (K + , 20 mmol/L; adenosine, 0.7 mmol/L; and lidocaine, 0.7 mmol/L), 44 patients; and the moderate-potassium adenosine–lidocaine (MPAL) group (K + , 10 mmol/L; adenosine, 0.7 mmol/L; and lidocaine, 0.7 mmol/L), 44 patients. Hemodynamic data during the operation and postoperative data were recorded. Serum cardiac troponin I concentrations were examined at the time points of before cardiopulmonary bypass and 1, 3, 6, 12, and 24 hours after aortic crossclamp removal. Results At the end of cardiopulmonary bypass and modified ultrafiltration, the systolic and pulse pressures of the MPAL group were significantly increased compared with the respective values of the HP group. At the time points of 1 to 12 hours after reperfusion, the levels of serum cardiac troponin I were significantly decreased in the MPAL group compared with those in the HP and HPAL groups. Conclusions The MPAL cardioplegia formula was associated with better myocardial protective effects.

To study the clinical application of dual-energy CT (DECT) in the knee ligaments.Twelve cases (24 knees) were scanned using dual-energy CT for the knee. Two- and three-dimensional images were used for display in all cases by means of multi-planar reformation (MPR) and volume rendering technique (VRT). All images were ranked by two radiologists according to the grade of knee ligament displayed, the definition of edge and attachment points of the knee ligament.The partial ligaments of 24 knees, such as the patellar ligament, fibular collateral ligament, anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were clearly displayed; the tibial collateral ligament was not satisfactorily displayed. The transversal ligaments, such as lateral patellar retinaculum and medial patellar retinaculum, and the posterior ligament, such as oblique popliteal ligament could not be shown clearly.The dual-energy CT is a new and valuable tool to qualitatively display the main ligaments of the knee.

The effect of adenosine postconditioning on myocardial protection in cardiac surgery remains uncertain. The present study evaluated the safety, feasibility, and beneficial effect of adenosine postconditioning as an adjunct to predominantly used cold-blood cardioplegic myocardial protection method in the setting of heart valve replacement operations.Sixty patients with rheumatic heart valve disease undergoing heart valve replacement operations were randomized to an adenosine (1.5 mg/kg) or saline (as control) bolus injection through an arterial catheter immediately after the aorta cross-clamp was removed. The surgical indications were similar in both groups, and heart valve replacement was successful in all patients.The extubation time and postoperative hospital time were similar in both groups. Compared with the control group, however, the inotrope scores in the intensive care unit (ICU) were much lower (p0.01), and the ICU time was significantly shorter (p0.05) in adenosine group. More important, cardiac troponin I release was less in the adenosine group, especially at 12 and 24 hours after reperfusion (p0.01), and total cardiac troponin I release estimated with the area under curve was also significantly reduced during the first 24 hours after reperfusion (p0.01).A 1.5-mg/kg bolus administration of adenosine through an arterial catheter immediately after the aorta cross-clamp is removed is feasible and well tolerated in patients undergoing heart valve replacement. An adenosine postconditioning adjunct to high potassium cold blood myocardial protection is related to less troponin I release, less inotropic drug use, and shorter ICU stay.

The objective of this study was to investigate the value of low-dose whole pancreatic computed tomography (CT) perfusion integrated with individualized dual-energy CT (DECT) scanning in the diagnosis of pancreatic adenocarcinoma.Twenty patients with pancreatic adenocarcinoma underwent pancreatic CT perfusion as well as individualized dual-phase DECT pancreatic scans. Perfusion characteristics of non-tumourous pancreatic parenchyma and pancreatic adenocarcinoma were analysed. Weighted-average 120 kVp images and the optimal monoenergetic images in dual phase were reconstructed and the contrast noise ratio (CNR) of pancreas-to-tumour were compared.There were significant difference on blood flow as well as blood volume between pancreatic adenocarcinoma and the non-tumourous pancreatic parenchyma (P 0.05), whereas no difference on permeability (P 0.05). CNRs of pancreas-to-tumour in individualized pancreatic phase were significantly higher than those in venous phase (P 0.05), and CNRs of optimal monoenergetic images were higher than those on weighted-average 120 kVp images (P 0.05) in both phase. Total effective radiation dose of CT examination was around 9.32-13.75 mSv.Low-dose whole pancreatic CT perfusion can provide functional information, and the individualized pancreatic phase DECT scan is the optimal method for detecting pancreatic adenocarcinomas. The integration of the two techniques has great value in clinical application.

Accurate evaluation of coronary artery, aortic valve annulus diameter (AVAD), and cardiac function in patients with aortic valve disease is of great significance for surgical strategy. In this study, we explored the preoperative evaluation of low-dose sequence (MinDose sequence) scan of dual-source CT (DSCT) for those patients.Forty patients suspected for aortic valve disease (the experimental group) underwent MinDose sequence of DSCT to observe coronary artery, AVAD, and left ventricular ejection fraction (LVEF). Another 33 subjects suspected for coronary artery disease (the control group) underwent conventional retrospective electrocardiographically-gated sequence of DSCT. Two-dimensional transthoracic echocardiography (2D-TTE) and four-dimensional transthoracic echocardiography (4D-TTE) were applied in the experimental group to measure AVAD and LVEF and compared with MinDose-DSCT.There was a strong correlation between LVEFs measured by 2D-TTE and MinDose-DSCT (r = 0.87, P0.01), as well as between 4D-TTE and MinDose-DSCT (r = 0.90, P0.01). AVAD measured by MinDose-DSCT was in good agreement with corresponding measurements by 2D-TTE (r = 0.90, P0.01). The effective dose in the experimental group was 63.54% lower than that in the control group.MinDose sequence of DSCT with a low radiation dose serving as a one-stop preoperative evaluation makes effective assessment of the coronary artery, AVAD, and LVEF for patients with aortic valve disease.

The role of the cerebral venous system (CVS) in intracranial pressure (ICP) regulation remains largely unclear. In the present study, the interaction between ICP and the cerebral venous system and its possible mechanism were investigated with respect to the biological characteristics of the cerebral venous system and its hemodynamic response under increased ICP.We created intracranial hypertension animal model, measured and calculated the venous flow velocity and diameter of the outflow terminal of the CVS with color ultrasonic system and recorded the vascular morphology by 3-dimensional anatomical microscopy. Patients who suffered from raised ICP underwent MRI and digital subtraction angiography (DSA) examination to show the length in the vertical direction of the wall of the bridging vein representing the diameter value. Pathological autopsy was performed from bodies of patients who had died from non-cerebral causes to observe the juncture part between the venous sinuses and tributary vertical brain veins.Under increased ICP conditions, venous drainage through the outlet cuff segment, a unique structure between the bridge vein and sinus, was obstructed and in turn venous blood became congested. Therefore, the increased blood volume worsened the pre-existing ICP according to the well-accepted theory regarding volume-pressure relationship. This phenomenon was described as concurrent "venogenic intracranial hypertension", which is characterized by intracranial venous blood stasis responsive to and together with the original increased ICP.The existence of this special pathophysiological process is prevalent, rather than rare, in various intracranial disorders. This finding would definitely provide new insight into the area of cerebral venous system research.

To explore the application of prospective ECG-triggering dual-source CT (DSCT) angiography in infants and children with complex congenital heart disease (CHD) compared with transthoracic echocardiography (TTE).Eighty-seven patients (mean age: 28 months, range 3 months to 6 years; male 46; mean weight: 15 kg) underwent prospective ECG-triggering DSCT angiography and TTE. Surgery was performed in 54 patients. The overall imaging quality was evaluated on a four-point scale. Inter-observer agreement in subjective image quality grading was assessed by kappa statistics. The accuracy of DSCT angiography and TTE was calculated based on the surgery findings in the 54 patients who were performed with surgery.A total of 267 cardiovascular deformities were diagnosed by DSCT angiography, and 231 deformities were diagnosed by TTE. There was a good agreement on overall image quality (kappa = 0.78). A total of 173 cardiovascular deformities were confirmed by surgery findings in 54 patients. The accuracy of DSCT angiography and TTE was 97.69% (169/173) and 82.08% (142/173). The mean effective dose was (0.40 ± 0.08) mSv.Prospective ECG-triggering DSCT angiography with a very low effective radiation dose allows the accurate diagnosis of anomalies in infants and children with complex CHD compared with TTE. It has great value for preoperative assessment of CHD.

To perform a meta-analysis to compare (18)FDG PET, CT, MRI and bone scintigraphy (BS) for the diagnosis of bone metastases.Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 1995 to January 2010. Software was used to obtain pooled estimates of sensitivity, specificity and summary receiver operating characteristic curves (SROC).67 articles consisting of 145 studies fulfilled all inclusion criteria. On per-patient basis, the pooled sensitivity estimates for PET, CT, MRI and BS were 89.7%, 72.9%, 90.6% and 86.0% respectively. PET=MRIBSCT. ("="indicated no significant difference, P 0.05; "" indicated significantly higher, P 0.05). The pooled specificity estimates for PET, CT, MRI and BS were 96.8%, 94.8%, 95.4% and 81.4% respectively. PET = CT = MRIBS. On per-lesion basis, the pooled sensitivity estimates for PET, CT, MRI and BS were 86.9%, 77.1%, 90.4% and 75.1% respectively. PET = MRIBSCT. The pooled specificity estimates for PET, CT, MRI and BS were 97.0%, 83.2%, 96.0% and 93.6% respectively. PETMRIBSCT.PET and MRI were found to be comparable and both significantly more accurate than CT and BS for the diagnosis of bone metastases.

Accurate views of the head and neck vessels, tumor angiogenesis and the relationship of tumor and the surrounding blood vessels are especially crucial to carotid body tumor (CBT) patients. The aim of this study was to explore the value of dual-source CT (DSCT) cerebral and carotid angiography in CBT diagnosis.DSCT cerebral and carotid angiography was performed on nine patients with CBT. Two-dimensional and three-dimensional reconstruction images were obtained by means of multiple planar reconstructions (MPR), maximum intensity projection (MIP) and volume rendering (VR). All patients were subjected to color Doppler flow imaging (CDFI) examination. Two kinds of examinations were performed in 3 days, and all patients were confirmed by surgery.DSCT angiography was successful in all patients. CBTs were diagnosed in 9 patients with 10 lesions (1 case had multiple bilateral CBTs). The largest lesion was 12 cm in diameter, and the smallest one was 1.6 cm in diameter. All patients had clearly demonstrated head and neck vessels, tumor angiogenesis, and tumor relationship with the surrounding blood vessels. The internal and external carotid artery (ICA, ECA) were involved in 2 cases. There were 7 cases with basilar artery ring integrity, and 1 case had the posterior communicating artery absent; 1 case had middle cerebral artery stenosis; 4 cases (4 tumors) showed arterial phase homogeneous enhancement; 5 cases (6 tumors) had obvious heterogeneous enhancement where irregular low-density necrosis could be seen in the tumors. CDFI could demonstrate the nearby blood vessels and tumor structure, instead of tumor angiogenesis. However, DSCT can display both the tumor and the peripheral vascular tumor angiogenesis consistent with surgical findings.DSCT cerebral and carotid angiography can provide reliable information for the operation. It might be a valuable CBT diagnostic method by showing accurate views of the CBT along with the bilateral neck and brain blood vessels.

Doppler color echocardiography is a common method for detecting coronary artery lesions in patients with Kawasaki disease (KD). However, the diagnostic accuracy for the whole coronary artery lesions is limited. The purpose of this study was to compare the diagnostic value of dual-source computed tomography (DSCT) and Doppler color echocardiography for the assessment of coronary artery lesions caused by KD.Sixteen patients, 12 with typical KD and 4 with atypical KD, underwent DSCT and Doppler color echocardiography. The position and internal diameter of each coronary artery lesion was measured. Correlation analysis was used to compare the diagnostic value of the two imaging modalities.In the typical KD group, seven patients did not have any coronary artery lesion as confirmed by both DSCT scans and Doppler color echocardiography; in four patients proximal coronary artery injuries were identified by both modalities; in one patient an aneurysm in the middle and distal segments of the coronary artery was detected by DSCT but was negative in Doppler color echocardiography. In the atypical KD group, three cases showed the same results with both modalities, while one case with coronary artery stenosis in the middle segment was identified by DSCT but not detected by Doppler color echocardiography. There was a good correlation between the two imaging modalities (Kappa value, 0.768 (or= 0.75)).DSCT coronary artery angiography is an accurate, non-invasive, and valuable technique for detecting and following up coronary artery lesions in patients with KD.

Objective To investigate the correlation between the degree of systolic compression of mural coronary artery (MCA) and the length and depth of myocardial bridging (MB) with dual-source computed tomography (DSCT). Methods The length and depth of MB were measured from diastolic phase. All datasets were reconstructed in 5% steps of R-R interval. The optimum phases were chosen where the maximal and minimal diameters were shown. The degree of systolic compression of MCA was calculated. The correlation between length and depth of MB and the degree of systolic compression of MCA were analyzed by Pearson test. Results The minimal diameters were found in 27 sites (90.0%) from 30% to 35% R-R interval, and the maximal diameters were found in 27 sites (90.0%) from 70% to 80% R-R interval. The correlation between systolic compression of MCA and length of MB was not significant ( r =0.096, P =.613); however, the correlation between systolic compression of MCA and the depth of MB was significant ( r =0.675, P Conclusion The minimal and maximal diameters of MCA are usually demonstrated in 30–35% and 70–80% R-R reconstruction interval, respectively. The degree of systolic compression of MCA correlates well with the depth of MB.

To discuss the value of multi-slice CT dynamic enhancement scan in the diagnosis and treatment of colonic lymphomas.16 patients with colonic lymphomas underwent multi-slice CT dynamic enhancement scans, images of axial and reconstructive images of VR, MPR and CTVE were analyzed, patients were respectively diagnosed.Appearances of primary colorectal lymphomas were categorized into focal and diffuse lesions. Focal and diffuse lesions were 6 and 10 patients, respectively. The accuracy rate of diagnosis was 87.5%.MSCT dynamic scan has distinctive superiority in diagnosis and treatment of colonic lymphomas.

Objective To explore the clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. Methods Eighteen patients with diagnosed Tetralogy of Fallot underwent cardiac CT angiography with 64-slice CT (CTA). Two- and three-dimensional images were used for diagnosing in all cases by means of MPR (coronal, sagital and oblique), cMPR, MIP and VRT. Results All patients had ventricular septal defect, pulmonary stenosis and hypertrophy of right ventricle. The morphologic features of Tetralogy of Fallot were equal to echocardiography. Patent ductus arteriosus (PDA) were detected on eight patients. Main coronary artery branches and partial sub-branches were visualized in all patients. Abnormal coronary arteries were found in seven cases: both left and right main coronary artery arising from the right aortic sinus one case, right main coronary artery and circumflex (CX) arising from the right aortic sinus one case, left anterior descending (LAD) and CX arising from left aortic sinus directly one case, left and right coronary artery arising from back and front of the aortic sinus, respectively, three cases. Pulmonary artery branch stenosis was found in 12 cases and branch pulmonary artery dilation noticed in 1 case. Double superior vena cava was also found in one case. According to the surgery the diagnostic accuracy of CT and Echocardiography was 95.45 and 83.33%, respectively. Conclusion Two- and three-dimensional 64-slice CTA not only show the overall anatomical structure of the heart, but also show coronary and pulmonary arteries. With these results, evaluation of coronary anomalies and pulmonary artery stenosis with 64-MSCT is extremely valuable for planning the operative procedure on the patients with Tetralogy of Fallot.

It has been shown that melatonin has a direct inhibitory effect on the proliferation of H22 mouse hepatoma cells in our research. This study was designed to investigate its molecular mechanism.(1) Animal models were established by transplanting H22 cells and treated with melatonin, and then the p53 and cyclin E of the tumor tissue were determined by immunohistochemical analysis. (2) After treatment of H22 cells with melatonin in vitro, the percentage of cells in each cell cycle phase and apoptosis rate were analyzed by flow cytometry. p53 and cyclin E were determined again by immunohistochemical analysis. The level of Fas mRNA was examined by real time polymerase chain reaction (RT-PCR).(1) After treated with melatonin (1 x 10(-6) mol/L), the number of the H22 cells in phase G(0)/G(1) were elevated from 75.24% to 85.46%, while which in phase S almost decreased from 10.32% to 0, and at the same time, the number of apoptotic cells increased from 5.07% to 12.77%. (2) Compared with the control, the level of p53 elevated 42.5% (in vitro) and 19.5% (in vivo), however, the level of cyclin E decreased 31.7% (in vitro) and 39.9% (in vivo). (3) Fas mRNA increased about 44.2% after melatonin treatment (P0.01).Melatonin inhibits the proliferation of H22 cells by arrest and apoptosis, and the mechanism perhaps interferes with increasing p53 that results in down-regulation of cyclin E indirectly and stimulates the expression of Fas gene.