Current Issue

2020 Vol.5 No.2 Published:20 February 2020

Guidelines and Consensus

Expert consensus of radiological examination scheme and infection prevention of coronavirus disease 2019 (Trial version first） 2020, 5 (2):  65-73.  Abstract ( 306)    PDF (840KB) ( 239 )    At the end of December 2019, unidentified pneumonia cases were found in Wuhan disease prevention center of Hubei Province. On January 7, 2020, China Center for Disease Control and Prevention successfully isolated the first strain of 2019-nCoV, which was confirmed to be a new coronavirus. 2019-nCoV was named for the new coronavirus by the World Health Organization. This coronavirus is spreading across the whole China rapidly through droplet transmission and contact transmission, and the infected cases reveal a rising tendency. Standard X-ray and CT examination techniques are confirmed as effective methods for the screening and diagnosis of infected cases. To prevent the spread of 2019-nCoV, prepare standard imaging examinations, and effectively reduce the infection risk of radiologists and technologists, an Expert consensus of radiological examination scheme and infection prevention of coronavirus disease 2019 was summarized under the endeavor of many radiologists and technologists, aiming to standardize the imaging examinations and guide the prevention and control work in a radiology department.

Forum of Specialist

Coronavirus origin, receptor and recent advances in novel coronavirus detection and vaccine Hao Pengfei, Xu Wang, Du Shouwen, Jin Ningyi, Wu Shipin, Li Chang, Li Tiyuan 2020, 5 (2):  74-78.  Abstract ( 620)    PDF (903KB) ( 1228 )    Coronavirus has a long history. It was isolated and named in 1936. There are many types of coronavirus, and the infection spectrum is relatively wild. Some viruses have the characteristics of zoonosis, which seriously threaten human and animal health and public health safety. Especially, SARS virus in 2003, MERS virus in 2012, and the coronavirus in 2019. In this paper, the discovery of origin and receptor of coronavirus, as well as the latest progress in the detection methods and vaccine research of new coronavirus are briefly reviewed in order to better understand coronavirus and provide a reference for the prevention and control of new coronavirus and other coronaviruses.

Original Articles

Clinical and CT findings of 31 cases of coronavirus disease 2019 Lu Yibo, Zhou Jingru, Mo Yimei, Song Shulin, Liu Tiejun 2020, 5 (2):  79-82.  Abstract ( 276)    PDF (3144KB) ( 1371 )    Objective To investigate the clinical features and CT manifestations of pneumonia caused by novel coronavirus infection. Methods Retrospectively, clinical and imaging data of patients with pneumonia with 2019 new novel coronavirus infection confirmed in the Fourth People's Hospital and Liuzhou People's Hospital from January 24, 2020 to February 2, 2020 was analyzed. Chest CT scans were made in all the cases, the lung and mediastinum window were observed, the clinical data and chest CT imaging findings were analyzed.Results Most of the pneumonia patients infected by the new coronavirus had a fever as the primary symptom, which could be accompanied by muscle pain, cough, fatigue, dizziness, headache and pharyngeal itching. Laboratory tests showed normal or low white blood cell counts, normal or slightly lower eosinophil and lymphocyte counts and ratios, and elevated reactive proteins. Chest CT showed multiple patchy ground glass density shadows in the two lungs, distributed under the pleura, with or without consolidation. Thickened blood vessels and air bronchi could be seen in the lesions, and pleural involvement was less. Generally, however, there was no mediastinal lymph node enlargement, pleural effusion or extrapulmonary lesions. The lesion changes quickly in a short time. Conclusion There are of great significance in determining the lesion range and course of pneumonia infected by novel coronavirus through imaging findings, and important guiding significance for the early detection and treatment of pneumonia infected by novel coronavirus.

Imaging manifestations and differential diagnosis of novel coronavirus pneumonia Song Lu, Zeng Yingting, Gong Xiaoming, Zhang Xiaochun, Lu Zhiyan 2020, 5 (2):  83-86.  Abstract ( 298)    PDF (1465KB) ( 1237 )    Objective To investigate the early manifestations of the novel coronavirus pneumonia on chest CT, and to distinguish it from the clinical and imaging features of the previous outbreak of viral pneumonia. Methods Retrospective analysis was performed on 33 suspected cases of novel coronavirus pneumonia admitted to Zhongnan Hospital of Wuhan University, and their clinical and imaging data was analyzed. Review and summarize the literature of previous outbreak of viral pneumonia for differential diagnosis.Results Chest CT of the suspected cases of the novel coronavirus pneumonia mainly showed ground-glass opacity, mixed ground-glass opacity,latticed opacity, consolidation, and showing patchy or lump-like shape. The lesions were widely distributed, involving three lobes of two lungs and above. Patients with pleural effusion and mediastinal lymph node enlargement are rare. Conclusion The chest CT of the novel coronavirus pneumonia has certain characteristics, but it is difficult to distinguish from other viral pneumonia. Combining clinical epidemiological data, clinical manifestations and laboratory tests, viral pneumonia can be differentiated.

CT findings and outcome with family clustering coronavirus disease 2019 in 8 families Jiang Rui, Liu Jinxin, Zhang Lieguang, Huang Deyang, Chen Bihua, Qu Jing, Lin Lin, Yu Chengcheng, Ling Zhoukun 2020, 5 (2):  87-90.  Abstract ( 433)    PDF (1427KB) ( 800 )    Objective To investigate the chest CT manifestations and outcomes of 25 cases of family clustering coronavirus disease 2019 (COVID-19) in 8 families. Methods Retrospectively, clinical and CT imaging data of 8 groups of family clustering COVID-19 patients admitted to the Eighth People's Hospital of Guangzhou was collected.Results Seven patients (28.0%) had negative chest CT from onset, cured to discharged. Another 4 patients (16.0%) had a positive chest CT 6 days after admission. Two patients (8.0%) had scattered single lung lobe and 16 patients (64.0%) with a multiple lesion of both lungs, mainly manifested by ground glass shadow (16/25, 64.0%); while a few fibrous cord shadow and ground glass shadow coexist (2/25, 8.0%), and some are accompanied by bilateral pleural thickening (3/25,12.0%). On April 9, 2020, all groups of 5 families were discharged from the hospital, 1 group of 3 critically ill patients was still being treated, 1 group of 1 severely ill patient was transferred to hospital for treatment, and another 1 group of imported cases has reached the discharge standard, but still under isolation observation. The earliest and latest onset of 8 groups of families was (6.1 ± 4.3) d, time from onset to visit was (4.3 ± 3.9) d, nucleic acid negative time was (18.0 ± 8.6) d, CT progression time was (9.6 ± 3.3) d, CT absorption time was (15.0 ± 2.9) d, and the total course of disease was (20.2 ± 6.3) d. Conclusion COVID-19 and HBV family clustering pattern infections are the same. The two aggregation methods of sibling infection and parent-child infection are the most common. The CT performance of family members does have certain similarities, but because some family members have different onset times, there are some differences in the stage of the chest CT image, the early stage and the advanced stage, but the overall distribution characteristics of the lesions gradually progress toward the same when the disease progresses.

The summary analysis of a new type of familial aggregation cases in coronavirus disease 2019 Hong Lingling, Xu Xiaojing, Fu Xiaoyi 2020, 5 (2):  91-94.  Abstract ( 247)    PDF (1148KB) ( 941 )    Objective To analyze the clinical manifestations of a new type of familial aggregation cases named coronavirus 2019(COVID-19) and explore the influence of early psychological disturbance on the outcome of the disease in our hospital recently. Methods The clinical manifestations and imaging characteristics in the case of COVID-19 from January 22 to 29 were analyzed, and were surveyed to assess the psychological status for each patient.Results Among the three patients, the incubation period was the shortest 4 days and the longest 11 days. The clinical manifestations were fever and weakness, and all of them had anxiety symptoms. The condition was stable after treatment and psychological intervention. Conclusion With similar imaging manifestations, the patients' coordination degree was significantly increased after early psychological intervention, which was conducive to the outcome of the disease. It needs to be confirmed in a randomized clinical trial with a larger sample size.

Establishment of rapid qPCR method for detection of five respiratory viruses based on microfluidic chip technology Ren Qin, Zhang Xingyan, Du Shouwen, Wang Yuhang, Yang Guilin, Lin Linhua, Dai Shaobo, Li Tiyuan, Jin Ningyi, Li Chang, Wu Shipin 2020, 5 (2):  95-99.  Abstract ( 486)    PDF (1119KB) ( 1139 )    Objective To establish a rapid differential diagnostic method for five respiratory viruses (influenza A virus, influenza B virus, H1N1/H3N2 subtype influenza virus and measles virus). Methods We designed and synthesized specific probe primers for the five respiratory viruses respectively. Based on the latest microfluidic chip technology, the specificity, sensitivity and repeatability of the detection system of probe primers was evaluated by a rapid fluorescent quantitative PCR instrument with the rapid reaction system and innovative temperature control module, and the method was used to test some clinical samples.Results The probe primers of five viruses designed and synthesized have high specificity and sensitivity. Virus nucleic acid was extracted in 5 minutes, and the detection results were obtained in 30 minutes and had good repeatability. Conclusion A rapid and quantitative detection method for five respiratory viruses was established, which was expected to be used in the differential diagnosis and rapid detection of unknown respiratory virus infection.

Isolation, identification and phylogenetic analysis of a dengue virus I Wang Yuhang, Zhang Xingyan, Hua Qunyi, Ren Qin, Dai Shaobo, Li Tiyuan, Jin Ningyi, Zhou Boping, Wu Shipin, Li Chang, Du Shouwen 2020, 5 (2):  100-103.  Abstract ( 318)    PDF (1385KB) ( 1265 )    Objective To preliminarily understand the origin and evolution of the dengue virus isolated strain. Methods A dengue virus was isolated, and its serotyping and genome sequence was identified and analyzed. Especially, the phylogenetic analysis of envelope protein E was performed by bioinformatics methods, ResultsA serotype Ⅰof DENV isolated strain named as SZ905 was identified to be genotype Ⅰ. And the homology analysis of E gene showed that the nucleotide homology with Malaysia 0802atw strain, Singapore strain, Zhejiang 17-45 strain, YN176282 strain and BNJH 17108 strain were all above 99%, and the homology of E protein with the multiple strains such as NJX-14, Zhejiang 17-45, Malaysia 0802atw and 1208atw strains was all above 99.8% in amino acid level, indicating that these strains maybe originate from a same original strain. And the evolution of E protein sequence is stable and highly homologous with that of several strains isolated in Guangdong Province since 2002. Conclusion DENV-Ⅰ genotype Ⅰ in China has stable genetic evolution and high degree of conservation, which is conducive to the prevention and control of this serotype virus disease in recent years.

The effect of KMT2E knockdown with siRNA on the proliferation of dengue virus Ⅱ Lin Jihui, Du Shouwen, Li Chang, Hua Qunyi, Wu Shipin 2020, 5 (2):  104-106.  Abstract ( 348)    PDF (1073KB) ( 1275 )    Objective To explore the effect of lysine methyltransferase 2E (KMT2E) knockdown on DENV virus Ⅱ (DENVⅡ) proliferation and preliminarily analyze the role of KMT2E in DENVⅡ proliferation. MethodAccording to the coding sequence of the kmt2e gene, three siRNAs were designed. 293T cells were transfected with these siRNAs to select the one with the highest efficiency in knockdown of KMT2E. RT-qPCR was used to analyze the proliferation of DENVⅡ after knockdown of KMT2E. ResultThe siRNA numbered as siKMT2E-1 possesses the highest knockdown efficiency of KMT2E protein, and can significantly inhibit DENVⅡ proliferation once transfected to 293T cells. Conclusion KMT2E maybe plays a positive role in the proliferation of DENVⅡ.

Analysis of MRI imaging features with intracranial tuberculosis and changes of imaging during antituberculosis treatment Fang Weijun, Song Min, Han Yuanyuan, Liu Zhihui 2020, 5 (2):  107-112.  Abstract ( 336)    PDF (2189KB) ( 1082 )    Objective To explore the MRI imaging features of intracranial tuberculosis,including the anatomic location and pathological changes, and the patterns of MRI imaging changes during antituberculosis chemotherapy. Methods The clinical and MRI data of 255 cases with intracranial tuberculosis diagnosed in Guangzhou Chest Hospital from November 2017 to November 2019 was analyzed retrospectively for exploring the MRI features. Furthermore,the changes of MRI imaging during antituberculosis chemotherapy of 218 cases, of which treatment courses were normative and treatment records were complete,were collected for analyzing the MRI imaging change patterns.Results Firstly, there are 255 patients with intracranial tuberculosis including 70 cases of meningeal type, 77 cases of parenchymal type and 108 cases of mixed type, accounted for 27.45%, 30.20% and 42.35% respectively. Their pathological MRI included meningeal thickening, nodules of brain parenchymal tuberculosis, cerebral parenchymal tuberculosis,meningeal nodules, meningeal tuberculoma,tuberculous encephalitis and tuberculous abscess. Their number and percentage were 161, 143, 73, 54, 46, 18, 5 and 63.14%、56.07%、28.63%、21.18%、18.04%、7.06%, 1.96% respectively. Especially, 23 cases of tuberculoma, including 13 cases located at meninges and 10 cases located at brain parenchyma, presented cluster.Secondly, of the 218 cases observed during antituberculosis chemotherapy, MRI imaging of 116 cured patients presented “deterioration” signs during the 1 to 3 months of antituberculosis chemotherapy course, such as enlarged primary lesions, increased or new lesions.After 12 months and 18 months of treatment,the disappearance rates of MRI imaging of corresponding lesions(including brain parenchymal tuberculosis nodule, meningeal thickening, brain parenchymal tuberculosis, meningeal tuberculosis nodule, meningeal tuberculosis, parenchymal tuberculous abscess, meningeal or brain parenchymal tuberculosisandbrain parenchymal tuberculous encephalitis) were 89.58%, 77.03%, 75.00%, 67.74%, 37.04%, 20.00%, 0, 0 and 95.83%, 82.43%, 85.00%, 85.19%, 55.56%, 20.00%, 0, 0 respectively. Conclusion Various parts of the meninges and brain parenchyma may be involved with intracranial tuberculosis . The MRI imaging presents mainly meningeal thickening, tuberculous nodules, and tuberculomas,and most of the pathological MRI imaging can disappear after antituberculosis chemotherapy for these cases.But,the vast majority of the pathological MRI imaging after antituberculosis chemotherapy have not improved much for cases such as brain parenchymal tuberculous abscess, meningeal or brain parenchymal tuberculosis and brain parenchymal tuberculous encephalitis.It is suggested that comprehensive treatment involving multidisciplinary must be considered at the beginning of treatment for these cases.

Comparative analysis of CT findings between non-tuberculous mycobacterial pulmonary disease and secondary pulmonary tuberculosis Xu Jinwei, Zhang Xin, Chen Zhen 2020, 5 (2):  113-117.  Abstract ( 297)    PDF (2071KB) ( 1010 )    Objective To analyze the CT features of non-tuberculous mycobacterial pulmonary disease and improve the cognition about it. Methods 42 cases of Non-tuberculous Mycobacteria infected patients diagnosed by sputum, bronchial washings fluid or pathological tissue culture and species identification were identified as observation group, and 42 patients with mycobacterium tuberculosis culture positive were selected as control group. The distribution, location, morphology and nature of the lesions in the two groups were compared.Results Lesions were widely distributed in the observation group, and the rate of lesion involvement in one lung lobe was 21.43%, lower than 45.24% in the tuberculosis group, with statistically significant differences (χ2=5.36, P<0.05). The rate of lesions involving 3 or more pulmonary lobes in the observation group (50.00%) was higher than that in the tuberculosis group (26.19%), and the difference between the two groups was statistically significant (χ2=5.05, P<0.05). In the non-tuberculous mycobacterial pulmonary disease group, the detection rate of lesions in the middle lobe and tongue segment was 78.57%, which was higher than 30.9% in the tuberculosis group, and the difference between the two groups was statistically significant (χ2=19.2, P<0.05). The incidence of bronchiectasis, thin-walled cavities, and emphysema bullous blisters in non-tuberculous mycobacterial pulmonary disease group was 54.76%, 23.81%, and 28.57%, which were higher than those of tuberculosis group (19.05%, 7.14%, and 9.52%, respectively). The difference between the two groups was statistically significant (χ2=11.50, 4.46 and 4.94, all P<0.05). The incidence of bronchial diffusion, calcification, glassed shadow, pleural effusion and mediastinal lymph node enlargement in non-tuberculous Mycobacterial pulmonary disease group was 9.52%, 16.67%, 9.52%, 11.90% and 16.67%, which were lower than that of the tuberculosis group (40.48%, 40.48%, 33.33%, 30.95% and 35.71%, respectively), and the differences were statistically significant (χ2=10.73, 5.83, 7.07, 4.53 and 3.94, all P<0.05). There was no statistically significant difference in the incidence of thick-walled cavities, infiltrating lesions, proliferating nodules and fibrous cords between the two groups (P>0.05). Conclusion The chest CT findings of non-tuberculous mycobacteria pulmonary disease are characterized by a wide distribution, two lungs scattered in columnar dilated bronchi, obvious lesions in the middle lobe of the right lung and the tongue segment of the left lung, subpleural thin-wall cavity and surrounding cavity with columnar bronchodilation, common emphysema and pulmonary bullae, etc.

Evaluation of Mycobacterium tuberculosis 16Sr RNA+DNA and 23S DNA detection in diagnosis and treatment of pulmonary tuberculosis Wu Yumei, Luo Ziyi, Peng Jinfu 2020, 5 (2):  118-121.  Abstract ( 375)    PDF (897KB) ( 1397 )    Objective To detect 16Sr RNA+DNA and 23S DNA in clinical samples of Mycobacterium tuberculosis simultaneously in the same system by fluorescence quantitative PCR, and detect tuberculosis DNA in samples by other tuberculosis DNA-PCR reagents, as well as culture Mycobacterium tuberculosis. And to explore its different clinical significance. Methods Multicenter double-blinded fluorescence quantitative polymerase chain reaction (16Sr RNA+DNA/23S DNA) was used to detect sputum samples from patients with tuberculosis in three hospitals. Chi-square test and t-test were used for statistical analysis.Results The coincidence rate of 16Sr RNA+DNA/23S DNA detection reagent and tuberculosis DNA-PCR contrast reagent was 95.76%, of which the positive coincidence rate was 95.08%, and the negative coincidence rate was 96.1%. Comparing to the culture of tuberculosis bacteria, the positive coincidence rate was 81.35%, the negative coincidence rate was 87.90%, the total consistent rate was 85.92%, and the coincidence rate was 86%. There were 87 samples detected positive by our kit and sputum culture negative in this study, of which 71 were detected positive by KaiJie Kit and negative in sputum culture samples.There were 58 samples with positive sputum culture test and negative detected by our kit ,of which 52 were negative detected by KaiJie Kit. In this study, the differences of CT values between 23S DNA and 16Sr RNA+DNA of 75 positive and 34 negative sputum cultures samples were analyzed (the CT value was over 30), P<0.01. The differences were statistically significant. Conclusion 16Sr RNA + DNA detection is more sensitive than Mycobacterium tuberculosis DNA detection. 16Sr RNA+DNA/23S DNA tests has a certain role in judging the bacterial activity of Mycobacterium tuberculosis infection which is a great tool to evaluate the efficacy and infectivity of Mycobacterium tuberculosis patients.

Review

Research on antiviral progress of interferon-induced transmembrane protein Li Haomin, Wu Shipin 2020, 5 (2):  122-125.  Abstract ( 516)    PDF (897KB) ( 1854 )    Interferon (IFN),binding to celluar interferon receptor specifically after stimulation, can promote the expression of hundreds of interferon stimulated genes (ISGs) that encodes many antiviral innate immune effectors,thus stimulating or regulating the host's immune response. And interferon-induced transmembrane protein (IFITM) , an important immune molecule, is just one of ISGs expression products. IFITM have multiple biological functions, such as antiviral infection, involving in tumor formation ,regulating bone metabolism, adjusting cell adhesion, affecting cell differentiation, and even having a role in cell signal transduction.However,The antiviral effect of IFITM is one of hot spots in current research.Not only can IFITM prevent the invasion of the virus through a variety of ways, but also the genetic polymorphism of IFITM has a certain correlation with the susceptibility and severity of the virus.Here we reviewed the antiviral progress of IFITM.

Human immunodeficiency virus-associated cryptococcal immune reconstitution inflammatory syndrome Hu Zhiliang, Xu Chuanjun 2020, 5 (2):  126-130.  Abstract ( 717)    PDF (2383KB) ( 941 )    Cryptococcal immune reconstitution inflammatory syndrome(C-IRIS) in human immunodeficiency virus (HIV)- infected patients manifests as a clinical worsening or new presentation of cryptococcal disease after initiating anti-retroviral therapy (ART). This review will discuss the clinical features, immunopathogenesis and management of this syndrome.

Prevention and treatment progress of congenital human cytomegalovirus infection Yang Lin, Wu Shipin 2020, 5 (2):  131-135.  Abstract ( 919)    PDF (904KB) ( 1079 )    Congenital cytomegalovirus infection is one of the most common causes of fetal malformation and delayed sensorineural hearing loss. The paper reviews the prospect of congenital CMV infection from the aspects of epidemiology, prognosis, prevention and treatment of different types of infection. We hope to bring new ideas on the treatment of congenital human cytomegalovirus（HCMV） infection through in-depth discussion on the treatment of CMV infection in pregnancy and neonatal CMV infection.

Research progress on antiviral effects of chemical constituents of Lonicera japonica flos Li Songtao, Ge Lanlan, Xiao Lingyun, Wu Shipin 2020, 5 (2):  136-139.  Abstract ( 1017)    PDF (918KB) ( 2457 )    Lonicera japonica flos has a wide range of medicinal value as traditional Chinese medicine, which has also aroused the research interest of scholars. In recent years, Lonicera japonica has been found to have a variety of antiviral activities, however, the chemical constituents of its antiviral effect have not been summarized in detail. In order to fully understand the material basis for Lonicera japonica flos, and to provide a research basis for the antiviral effect of later scholars, this review summarizes the antiviral effect of the chemical constituents of Lonicera japonica flos through the investigation of literature in the past 20 years.

Education Fields

Advances in clinical and imaging studies of novel coronavirus pneumonia Zheng Qiuting, Lu Yibo, Tan Lilian, Lu Puxuan 2020, 5 (2):  140-144.  Abstract ( 669)    PDF (1735KB) ( 1049 )    A new type of infectious coronavirus pneumonia 2019 (COVID-19) which caused by 2019-nCoV causes a wide range of spread. Now COVID-19 has attracted worldwide attention. Reverse tyranscription-polymerase chain reaction (RT-PCR) or/and "next-generation" sequencing technology(NGS) are the gold standards for the diagnosis of COVID-19, and chest imaging examination is used for cross-validation. Currently, CT and DR are mainly used. The chest CT examination is highly recommended as COVID-19 preferred imaging examination method because of its high density resolution and spatial resolution. There were different CT findings in different stages of COVID-19, including early stage, progression stage and absorption stage. It was characterized by the distribution of patchy ground-glass opacity（GGO）and lung consolidation. CT examination plays an important role in diagnosis, especially in screening and efficacy evaluation of nucleic acid negative cases.