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Combination of chest CT and clinical features for diagnosis of 2019 novel coronavirus pneumonia

  • Xin Wang , Peng Wen , Zhi-Gang Sun EMAIL logo , Chun-Yan Xing EMAIL logo and Yun Li
Published/Copyright: July 28, 2020
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Open Medicine
From the journal Open Medicine Volume 15 Issue 1

Abstract

In December 2019, novel coronavirus pneumonia-19 (COVID-19) was discovered in the viral pneumonia cases that occurred in Wuhan, China, and then quickly spread around the world. This report described the clinical course of two COVID-19 patients and the purpose of the study was to discuss the combination of chest CT and clinical features for diagnosis of COVID-19. The first case was a typical COVID-19 case. A 66-year-old female presented to our hospital with a 3-day history of fever. She had contact with a COVID-19 patient. Chest CT showed a typical COVID-19 appearance. She was diagnosed with COVID-19 by a positive nucleic acid test. The second case was a 50-year-old male with a 2-day history of fever. He denied having been to Wuhan. Chest CT also showed typical features of COVID-19 pneumonia. COVID-19 nucleic acid tests were repeated up to seven times and the results remained controversial. Eventually, he was diagnosed with COVID-19. Our study shows that chest CT has high sensitivity for diagnosis of COVID-19 in clinical practice, particularly when the nucleic acid test is negative. The chest CT should be considered as a diagnostic tool for the COVID-19 screening, comprehensive evaluation, and follow-up and patients would benefit from effective treatments in time.

Keywords: coronavirus pneumonia; COVID-19; CT; nucleic acid test

1 Introduction

In December 2019, a succession of pneumonia cases, which were later proven to be caused by a novel coronavirus (named as novel coronavirus pneumonia-19 [COVID-19] by the World Health Organization [WHO] on January 12, 2020), emerged in Wuhan City, Hubei Province, China. In the following days, COVID-19 had quickly spread inside of Hubei Province, throughout China and other countries. A global health emergency was declared by the WHO on January 30, 2020 [1,2]. As of March 23, 2020, a total of 3,49,828 COVID-19 cases had been reported in at least 172 countries. Among them, 81,691 cases came from China and 2,68,137 cases came from the other countries. A total of 15,336 patients have died of COVID-19. Regarding the virus itself, the International Committee on Taxonomy of Viruses has renamed the previously provisionally named COVID-19 as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [3]. In the absence of specific therapeutic drugs or vaccines for COVID-19, it is critical to diagnose the disease at an early stage and immediately isolate the infected cases from the healthy population. Chest computed tomography (CT) is used for diagnosis of COVID-19, as an important complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests [4]. Here, we reported two cases and the purpose of the study was to discuss the combination of chest CT and clinical features for diagnosis of COVID-19.

2 Case presentations

2.1 Case one

A 66-year-old female presented to our hospital with a 3-day history of fever with coughing, white sputum, runny nose, and dizziness. Two days before, her daughter-in-law was diagnosed with COVID-19. Her body temperature was elevated to 38.6°C. She was examined for complete blood count, C-reactive protein, and chest CT. The white cell count was 3.88  ×  109/L (reducing, range 4–11  ×  109/L), with low lymphocytes at 1.24 ×  109/L and normal neutrophils. The C-reactive protein was 10 mg/L (slightly elevated, normal  <  3 mg/L). Chest CT showed multiple peripheral solid and ground-glass opacities in both lungs (Figure 1). She was diagnosed with COVID-19, based on the positive nucleic acid test using swabbed samples from her throat and sputum.

Figure 1 Case 1: CT chest result showed multiple peripheral solid and ground-glass images on bilateral lungs.
Figure 1

Case 1: CT chest result showed multiple peripheral solid and ground-glass images on bilateral lungs.

2.2 Case two

A 50-year-old male presented to our hospital with a 2-day history of fever and dry cough. He denied having been to Wuhan. His body temperature was elevated to 38.5°C. The examination of complete blood count was normal but the C-reactive protein was slightly elevated (6.39 mg/L, normal <  3 mg/L). The chest CT result showed multiple peripheral ground-glass opacities on bilateral lungs (Figure 2). COVID-19 nucleic acid tests were repeated up to seven times using the patient’s throat samples and the test results remained controversial. The results from our hospital showed negative, positive, negative, and positive and the results from Jinan Center for Disease Control and Prevention (CDC) showed negative, negative, and positive. Eventually, he was diagnosed with COVID-19 pneumonia five days after initial symptoms.

Figure 2 Case 2: CT chest result showed multiple peripheral ground-glass images on bilateral lungs.
Figure 2

Case 2: CT chest result showed multiple peripheral ground-glass images on bilateral lungs.

  1. Ethical approval: Jinan Central Hospital Institutional Review Board approved this study and written informed consent was given by the patient. The images are published under agreement of the patient.

  2. Consent for publication: All the authors gave consent for publication.

3 Discussion

The epidemiological history is essential and very important to a kind of contagion, especially to diagnosis in early stage. Most patients outside Wuhan had been to Wuhan or had close contact with individuals from Wuhan. Guan et al. reported 1,099 COVID-19 cases from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020. They found that 43.9% of patients lived in Wuhan. Among the cases who lived outside Wuhan, 72.3% had contact with residents of Wuhan [5]. The epidemiological history from Wuhan is essential to diagnose the disease. According to WHO Interim Guidance, the epidemiological history of COVID-19 included: within 14 days before the onset of the disease, (1) the case had a travel history to Wuhan or its surrounding areas, or other communities with confirmed patients; (2) the case had contact with confirmed COVID-19 patients; (3) the case had contact with suspected COVID-19 patients (fever or respiratory symptoms) from Wuhan or its surrounding areas, or other communities with COVID-19 patients [6]. The Chinese government has taken several effective measures to stop the spread of the disease from Wuhan to the entire country. New cases are gradually decreasing in China.

Fever, dry cough, and fatigue are the most common presenting clinical symptoms of the COVID-19 infection. Some cases also have nasal congestion, runny nose, or other upper respiratory symptoms. About 20% of patients had severe dyspnea, and the death rate for COVID-19 in China is nearly 3% [5,7]. WHO Interim Guidance also described COVID-19 clinical features included: (1) Fever and/or respiratory symptoms; (2) bilateral ground-glass opacity, infiltrates, or lung consolidation on CT images; (3) early onset of normal/decreased white blood cell count or decreased lymphocyte count following a sign of pneumonia on chest images [6,8].

Chest CT is a very important method to diagnose COVID-19. Typical CT imaging manifestations include: (1) quantity (often more lesions); (2) dominant distribution (mainly subpleural); (3) density (mostly uneven, a paving stone-like change mixed with ground-glass density and interlobular septal thickening, etc.); (4) shape (large block, patchy, lumpy, nodular, honeycomb-like or grid-like, cord-like, etc). Among them, multiple, patchy, segmental, or sub-segmental ground-glass density shadows in bilateral lungs are the most common COVID-19 CT images. Some are accompanied by fine-grid or small honeycomb-like interlobular septal thickening. The high-resolution computed tomography shows a slight high-density and ground-glass change with fuzzy edge in the fine-grid or small honeycomb-like thickening of interlobular septa. The thinner the chest CT scan layers, the clearer the above imaging manifestations are displayed [4]. The differential diagnosis of COVID-19 is facing challenges since many other lung diseases can have manifestations of multiple ground-glass opacities, such as interstitial lung diseases, drug-related lung injury, and other lung influenza infections. Accurate detection of COVID-19 RNA is a diagnostic method close to the gold standard and could be strongly recommended.

In our study, the first case had a 3-day history of fever with coughing, white sputum, runny nose, and dizziness. The patient had contact with a confirmed case of COVID-19. Her white cell count and lymphocytes were low. The chest CT showed multiple peripheral solid and ground-glass opacities in both lungs, which is a typical COVID-19 CT imaging manifestation. She was diagnosed with COVID-19 by a positive nucleic acid test. The first case was a typical COVID-19 case and the diagnosis was relatively easy to make on the basis of typical epidemiologic characteristics, clinical manifestations, chest images, and the nucleic acid test result.

The nucleic acid test is very important to control the spread of the disease, especially for the patients with mild symptoms. They may have negative chest CT findings but with positive nucleic acid test results. However, the detection of COVID-19 nucleic acid using RT-PCR has some shortcomings: (1) immature development of nucleic acid detection technology; (2) the patient’s viral load is low (an undetectable viral load in the patient); (3) different manufacturers may lead to different detection rates; or (4) clinical sampling is improper. Fang et al. reported that the diagnosis sensitivity using chest CT image was greater than that using nucleic acid test (98% vs 71%, p < 0.001) in 51 confirmed COVID-19 cases [9]. Ai et al. summarized 1,014 COVID-19 patients, and their study showed 59% (601/1,014) of the cases had positive RT-PCR results, whereas 88% (888/1,014) had positive chest CT results. The sensitivity of CT in suggesting that COVID-19 was 97% was based on positive RT-PCR results [10]. It is necessary to enhance the sensitivity of the nucleic acid test. Recently, for some hard-to-diagnose cases, COVID-19 antibody is another reliable method to make diagnosis.

It is important to detect COVID-19 at an early stage, and immediately isolate the infected cases from the healthy people due to a lack of specific therapeutic drugs or vaccines. It was reported that the total positive rate of RT-PCR for throat swab samples was about 30%–60% at initial presentation [11] with limitations of sample collection and transportation, and kit performance. In the current emergency, the low sensitivity of the nucleic acid test can lead to missed or delayed diagnosis and treatment of COVID-19 cases. Moreover, underdiagnosis of the infected cases can accelerate the spread of the virus due to its highly contagious nature. Chest CT is an easy, fast, and reliable diagnostic tool for a routine pneumonia diagnosis. It was reported that chest CT demonstrated pulmonary abnormalities consistent with COVID-19 in cases with initial negative RT-PCR results [12]. In our study, the second case had a 2-day history of fever and dry coughing. The chest CT result showed multiple peripheral ground-glass images on bilateral lungs, which is a typical COVID-19 CT imaging manifestation. He received COVID-19 nucleic acid tests up to 7 times with mixed results. The diagnosis of COVID-19 was delayed by five days. It is important to enhance the sensitivity of the nucleic acid test. Method of sample taking, quality control of the kits, and adequacy of the skills, all might affect the reliability of the nucleic acid test. On February 12, 2020, COVID-19 was first diagnosed clinically using chest CT in Hubei province according to “diagnosis and treatment of novel coronavirus pneumonia in China (The Fifth Edition, passed on February 5, 2020)”. A total of 13,332 new cases in Hubei province were clinically confirmed using chest CT without nucleic acid test in one day and timely treatments were provided. These infected cases were isolated immediately and more healthy people were protected (Figure 3).

Figure 3 On February 12, 2020, a total of 15,152 new cases in China were confirmed COVID-19 on one day. Among of them, a total of 13,332 new cases in Hubei Province were clinically confirmed using chest CT without nucleic acid test.
Figure 3

On February 12, 2020, a total of 15,152 new cases in China were confirmed COVID-19 on one day. Among of them, a total of 13,332 new cases in Hubei Province were clinically confirmed using chest CT without nucleic acid test.

4 Conclusion

In conclusion, our study shows that chest CT examination has high sensitivity for clinical diagnosis of COVID-19, particularly when the nucleic acid test result is negative. Chest CT should be considered as a useful tool for the screening, comprehensive evaluation, and follow-up of the COVID-19 cases, especially for determining the disease severity and monitoring the patient outcomes, therefore patients can benefit from effective treatment in time.

Abbreviations

COVID-19

novel coronavirus disease-19

CT

computed tomography

RT-PCR

reverse-transcription polymerase chain reaction

SARS-CoV-2

severe acute respiratory syndrome coronavirus-2

WHO

World Health Organization

tel: +86-133-7058-2825, tel: +86-133-7055-3510

Acknowledgments

We are deeply saddened by the passing of Dr Li Wenliang. We all need to celebrate the work that he did on COVID-19.

  1. Funding: No funding was supported in the study.

  2. Author contributions: WX wrote the case report and collected the data. LY contributed data, provided clinical information, and helped revise the case report. WP provided the radiological images, radiological expertise, and helped revise the case report. CP provided the radiological images and radiological expertise and helped revise the case report. S-ZG and X-CY contributed to the idea, conception of the case report, and radiological expertise, and helped revise the case report. All authors read and approved the final manuscript.

  3. Availability of data and materials: All relevant data are included in the manuscript.

  4. Conflict of interest: The authors have no potential conflict of interest to disclose.

References

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Received: 2020-03-24
Revised: 2020-06-22
Accepted: 2020-06-23
Published Online: 2020-07-28

© 2020 Xin Wang et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/med-2020-0107
Keywords for this article
coronavirus pneumonia; COVID-19; CT; nucleic acid test
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  8. Optimization of the Convolutional Neural Networks for Automatic Detection of Skin Cancer
  9. NEAT1 promotes LPS-induced inflammatory injury in macrophages by regulating miR-17-5p/TLR4
  10. Plasma matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 as prognostic biomarkers in critically ill patients
  11. Effects of extracorporeal magnetic stimulation in fecal incontinence
  12. Case Report
  13. Mixed germ cell tumor of the endometrium: a case report and literature review
  14. Bowel perforation after ventriculoperitoneal-shunt placement: case report and review of the literature
  15. Research Article
  16. Prognostic value of lncRNA HOTAIR in colorectal cancer : a meta-analysis
  17. Case Report
  18. Treatment of insulinomas by laparoscopic radiofrequency ablation: case reports and literature review
  19. Research Article
  20. The characteristics and nomogram for primary lung papillary adenocarcinoma
  21. Undiagnosed pheochromocytoma presenting as a pancreatic tumor: A case report
  22. Bioinformatics Analysis of the Expression of ATP binding cassette subfamily C member 3 (ABCC3) in Human Glioma
  23. Diagnostic value of recombinant heparin-binding hemagglutinin adhesin protein in spinal tuberculosis
  24. Primary cutaneous DLBCL non-GCB type: challenges of a rare case
  25. LINC00152 knock-down suppresses esophageal cancer by EGFR signaling pathway
  26. Case Report
  27. Life-threatening anaemia in patient with hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome)
  28. Research Article
  29. QTc interval predicts disturbed circadian blood pressure variation
  30. Shoulder ultrasound in the diagnosis of the suprascapular neuropathy in athletes
  31. The number of negative lymph nodes is positively associated with survival in esophageal squamous cell carcinoma patients in China
  32. Differentiation of pontine infarction by size
  33. RAF1 expression is correlated with HAF, a parameter of liver computed tomographic perfusion, and may predict the early therapeutic response to sorafenib in advanced hepatocellular carcinoma patients
  34. LncRNA ZEB1-AS1 regulates colorectal cancer cells by miR-205/YAP1 axis
  35. Tissue coagulation in laser hemorrhoidoplasty – an experimental study
  36. Classification of pathological types of lung cancer from CT images by deep residual neural networks with transfer learning strategy
  37. Enhanced Recovery after Surgery for Lung Cancer Patients
  38. Case Report
  39. Streptococcus pneumoniae-associated thrombotic microangiopathy in an immunosuppressed adult
  40. Research Article
  41. The characterization of Enterococcus genus: resistance mechanisms and inflammatory bowel disease
  42. Case Report
  43. Inflammatory fibroid polyp: an unusual cause of abdominal pain in the upper gastrointestinal tract A case report
  44. Research Article
  45. microRNA-204-5p participates in atherosclerosis via targeting MMP-9
  46. LncRNA LINC00152 promotes laryngeal cancer progression by sponging miR-613
  47. Can keratin scaffolds be used for creating three-dimensional cell cultures?
  48. miRNA-186 improves sepsis induced renal injury via PTEN/PI3K/AKT/P53 pathway
  49. Case Report
  50. Delayed bowel perforation after routine distal loopogram prior to ileostomy closure
  51. Research Article
  52. Diagnostic accuracy of MALDI-TOF mass spectrometry for the direct identification of clinical pathogens from urine
  53. The R219K polymorphism of the ATP binding cassette subfamily A member 1 gene and susceptibility to ischemic stroke in Chinese population
  54. miR-92 regulates the proliferation, migration, invasion and apoptosis of glioma cells by targeting neogenin
  55. Clinicopathological features of programmed cell death-ligand 1 expression in patients with oral squamous cell carcinoma
  56. NF2 inhibits proliferation and cancer stemness in breast cancer
  57. Body composition indices and cardiovascular risk in type 2 diabetes. CV biomarkers are not related to body composition
  58. S100A6 promotes proliferation and migration of HepG2 cells via increased ubiquitin-dependent degradation of p53
  59. Review Article
  60. Focus on localized laryngeal amyloidosis: management of five cases
  61. Research Article
  62. NEAT1 aggravates sepsis-induced acute kidney injury by sponging miR-22-3p
  63. Pericentric inversion in chromosome 1 and male infertility
  64. Increased atherogenic index in the general hearing loss population
  65. Prognostic role of SIRT6 in gastrointestinal cancers: a meta-analysis
  66. The complexity of molecular processes in osteoarthritis of the knee joint
  67. Interleukin-6 gene −572 G > C polymorphism and myocardial infarction risk
  68. Case Report
  69. Severe anaphylactic reaction to cisatracurium during anesthesia with cross-reactivity to atracurium
  70. Research Article
  71. Rehabilitation training improves nerve injuries by affecting Notch1 and SYN
  72. Case Report
  73. Myocardial amyloidosis following multiple myeloma in a 38-year-old female patient: A case report
  74. Research Article
  75. Identification of the hub genes RUNX2 and FN1 in gastric cancer
  76. miR-101-3p sensitizes non-small cell lung cancer cells to irradiation
  77. Distinct functions and prognostic values of RORs in gastric cancer
  78. Clinical impact of post-mortem genetic testing in cardiac death and cardiomyopathy
  79. Efficacy of pembrolizumab for advanced/metastatic melanoma: a meta-analysis
  80. Review Article
  81. The role of osteoprotegerin in the development, progression and management of abdominal aortic aneurysms
  82. Research Article
  83. Identification of key microRNAs of plasma extracellular vesicles and their diagnostic and prognostic significance in melanoma
  84. miR-30a-3p participates in the development of asthma by targeting CCR3
  85. microRNA-491-5p protects against atherosclerosis by targeting matrix metallopeptidase-9
  86. Bladder-embedded ectopic intrauterine device with calculus
  87. Case Report
  88. Mycobacterial identification on homogenised biopsy facilitates the early diagnosis and treatment of laryngeal tuberculosis
  89. Research Article
  90. The will of young minors in the terminal stage of sickness: A case report
  91. Extended perfusion protocol for MS lesion quantification
  92. Identification of four genes associated with cutaneous metastatic melanoma
  93. Case Report
  94. Thalidomide-induced serious RR interval prolongation (longest interval >5.0 s) in multiple myeloma patient with rectal cancer: A case report
  95. Research Article
  96. Voluntary exercise and cardiac remodeling in a myocardial infarction model
  97. Electromyography as an intraoperative test to assess the quality of nerve anastomosis – experimental study on rats
  98. Case Report
  99. CT findings of severe novel coronavirus disease (COVID-19): A case report of Heilongjiang Province, China
  100. Commentary
  101. Directed differentiation into insulin-producing cells using microRNA manipulation
  102. Research Article
  103. Culture-negative infective endocarditis (CNIE): impact on postoperative mortality
  104. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome
  105. Plasma microRNAs in human left ventricular reverse remodelling
  106. Bevacizumab for non-small cell lung cancer patients with brain metastasis: A meta-analysis
  107. Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage
  108. Problems and solutions of personal protective equipment doffing in COVID-19
  109. Evaluation of COVID-19 based on ACE2 expression in normal and cancer patients
  110. Review Article
  111. Gastroenterological complications in kidney transplant patients
  112. Research Article
  113. CXCL13 concentration in latent syphilis patients with treatment failure
  114. A novel age-biomarker-clinical history prognostic index for heart failure with reduced left ventricular ejection fraction
  115. Case Report
  116. Clinicopathological analysis of composite lymphoma: A two-case report and literature review
  117. Trastuzumab-induced thrombocytopenia after eight cycles of trastuzumab treatment
  118. Research Article
  119. Inhibition of vitamin D analog eldecalcitol on hepatoma in vitro and in vivo
  120. CCTs as new biomarkers for the prognosis of head and neck squamous cancer
  121. Effect of glucagon-like peptide-1 receptor agonists on adipokine level of nonalcoholic fatty liver disease in rats fed high-fat diet
  122. 72 hour Holter monitoring, 7 day Holter monitoring, and 30 day intermittent patient-activated heart rhythm recording in detecting arrhythmias in cryptogenic stroke patients free from arrhythmia in a screening 24 h Holter
  123. FOXK2 downregulation suppresses EMT in hepatocellular carcinoma
  124. Case Report
  125. Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  126. Research Article
  127. Clinical prediction for outcomes of patients with acute-on-chronic liver failure associated with HBV infection: A new model establishment
  128. Case Report
  129. Combination of chest CT and clinical features for diagnosis of 2019 novel coronavirus pneumonia
  130. Research Article
  131. Clinical significance and potential mechanisms of miR-223-3p and miR-204-5p in squamous cell carcinoma of head and neck: a study based on TCGA and GEO
  132. Review Article
  133. Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma in noncirrhotic liver. A case report and systematic review
  134. Research Article
  135. Voltage-dependent anion channels mediated apoptosis in refractory epilepsy
  136. Prognostic factors in stage I gastric cancer: A retrospective analysis
  137. Circulating irisin is linked to bone mineral density in geriatric Chinese men
  138. Case Report
  139. A family study of congenital dysfibrinogenemia caused by a novel mutation in the FGA gene: A case report
  140. Research Article
  141. CBCT for estimation of the cemento-enamel junction and crestal bone of anterior teeth
  142. Case Report
  143. Successful de-escalation antibiotic therapy using cephamycins for sepsis caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia: A sequential 25-case series
  144. Research Article
  145. Influence factors of extra-articular manifestations in rheumatoid arthritis
  146. Assessment of knowledge of use of electronic cigarette and its harmful effects among young adults
  147. Predictive factors of progression to severe COVID-19
  148. Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts
  149. Acute chemoradiotherapy toxicity in cervical cancer patients
  150. IGF-1 regulates the growth of fibroblasts and extracellular matrix deposition in pelvic organ prolapse
  151. NANOG regulates the proliferation of PCSCs via the TGF-β1/SMAD pathway
  152. An immune-relevant signature of nine genes as a prognostic biomarker in patients with gastric carcinoma
  153. Computer-aided diagnosis of skin cancer based on soft computing techniques
  154. MiR-1225-5p acts as tumor suppressor in glioblastoma via targeting FNDC3B
  155. miR-300/FA2H affects gastric cancer cell proliferation and apoptosis
  156. Hybrid treatment of fibroadipose vascular anomaly: A case report
  157. Surgical treatment for common hepatic aneurysm. Original one-step technique
  158. Neuropsychiatric symptoms, quality of life and caregivers’ burden in dementia
  159. Predictor of postoperative dyspnea for Pierre Robin Sequence infants
  160. Long non-coding RNA FOXD2-AS1 promotes cell proliferation, metastasis and EMT in glioma by sponging miR-506-5p
  161. Analysis of expression and prognosis of KLK7 in ovarian cancer
  162. Circular RNA circ_SETD2 represses breast cancer progression via modulating the miR-155-5p/SCUBE2 axis
  163. Glial cell induced neural differentiation of bone marrow stromal cells
  164. Case Report
  165. Moraxella lacunata infection accompanied by acute glomerulonephritis
  166. Research Article
  167. Diagnosis of complication in lung transplantation by TBLB + ROSE + mNGS
  168. Case Report
  169. Endometrial cancer in a renal transplant recipient: A case report
  170. Research Article
  171. Downregulation of lncRNA FGF12-AS2 suppresses the tumorigenesis of NSCLC via sponging miR-188-3p
  172. Case Report
  173. Splenic abscess caused by Streptococcus anginosus bacteremia secondary to urinary tract infection: a case report and literature review
  174. Research Article
  175. Advances in the role of miRNAs in the occurrence and development of osteosarcoma
  176. Rheumatoid arthritis increases the risk of pleural empyema
  177. Effect of miRNA-200b on the proliferation and apoptosis of cervical cancer cells by targeting RhoA
  178. LncRNA NEAT1 promotes gastric cancer progression via miR-1294/AKT1 axis
  179. Key pathways in prostate cancer with SPOP mutation identified by bioinformatic analysis
  180. Comparison of low-molecular-weight heparins in thromboprophylaxis of major orthopaedic surgery – randomized, prospective pilot study
  181. Case Report
  182. A case of SLE with COVID-19 and multiple infections
  183. Research Article
  184. Circular RNA hsa_circ_0007121 regulates proliferation, migration, invasion, and epithelial–mesenchymal transition of trophoblast cells by miR-182-5p/PGF axis in preeclampsia
  185. SRPX2 boosts pancreatic cancer chemoresistance by activating PI3K/AKT axis
  186. Case Report
  187. A case report of cervical pregnancy after in vitro fertilization complicated by tuberculosis and a literature review
  188. Review Article
  189. Serrated lesions of the colon and rectum: Emergent epidemiological data and molecular pathways
  190. Research Article
  191. Biological properties and therapeutic effects of plant-derived nanovesicles
  192. Case Report
  193. Clinical characterization of chromosome 5q21.1–21.3 microduplication: A case report
  194. Research Article
  195. Serum calcium levels correlates with coronary artery disease outcomes
  196. Rapunzel syndrome with cholangitis and pancreatitis – A rare case report
  197. Review Article
  198. A review of current progress in triple-negative breast cancer therapy
  199. Case Report
  200. Peritoneal-cutaneous fistula successfully treated at home: A case report and literature review
  201. Research Article
  202. Trim24 prompts tumor progression via inducing EMT in renal cell carcinoma
  203. Degradation of connexin 50 protein causes waterclefts in human lens
  204. GABRD promotes progression and predicts poor prognosis in colorectal cancer
  205. The lncRNA UBE2R2-AS1 suppresses cervical cancer cell growth in vitro
  206. LncRNA FOXD3-AS1/miR-135a-5p function in nasopharyngeal carcinoma cells
  207. MicroRNA-182-5p relieves murine allergic rhinitis via TLR4/NF-κB pathway
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