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Id Subject Object Predicate Lexical cue
T1 0-118 Sentence denotes The unsynchronized changes of CT image and nucleic acid detection in COVID-19: reports the two cases from Gansu, China
T2 120-128 Sentence denotes Abstract
T3 129-292 Sentence denotes The novel coronavirus disease (COVID-19) outbreak started in December 2019 in Wuhan, China, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
T4 293-503 Sentence denotes The CT image is used to assess the disease progress, whereas the continued two times of negative results from SARS-CoV-2 nucleic acid detection had been considered as a criterion for ending antiviral treatment.
T5 504-612 Sentence denotes We compared the two COVID-19 cases with similar backgrounds and CT image repeated intervals under treatment.
T6 613-816 Sentence denotes Our report highlighted the unsynchronized expression in the changes of CT image and nucleic acid detection in COVID-19, and lasting positive nucleic acid test result in patients recovered from pneumonia.
T7 817-887 Sentence denotes It may be contributed to recognize the disease and improve prevention.
T8 889-901 Sentence denotes Introduction
T9 902-1072 Sentence denotes The novel coronavirus disease (COVID-19) outbreak started in December 2019 in Wuhan, China, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2].
T10 1073-1181 Sentence denotes The Huanan seafood wholesale market in Wuhan, where is highly suspected as the source place of COVID-19 [3].
T11 1182-1249 Sentence denotes It has spread rapidly in China and multiple other countries [1, 4].
T12 1250-1309 Sentence denotes Over 70,000 COVID-19 cases had been confirmed until Feb 18.
T13 1310-1319 Sentence denotes 2020 [5].
T14 1320-1530 Sentence denotes The CT image is used to assess the disease progress, whereas the continued two times of negative results from SARS-CoV-2 nucleic acid detection had been considered as a criterion for ending antiviral treatment.
T15 1531-1639 Sentence denotes We compared the two COVID-19 cases with similar backgrounds and CT image repeated intervals under treatment.
T16 1640-1804 Sentence denotes Our report highlighted the unsynchronized expression in the changes of CT image and nucleic acid detection in COVID-19, and showed the suspected SARS-CoV-2 carrier.
T17 1805-1875 Sentence denotes It may be contributed to recognize the disease and improve prevention.
T18 1877-1895 Sentence denotes Case 1 description
T19 1896-1958 Sentence denotes A 24-year-old man enrolled in his hometown hospital on Jan 22.
T20 1959-2083 Sentence denotes 2020 (about 1260 km far from Wuhan), China, due to a 7-day history of mild fever, dry coughs, and weakness of unknown cause.
T21 2084-2127 Sentence denotes He had been lived in Wuhan since July 2019.
T22 2128-2233 Sentence denotes Fourteen days before his clinical symptom appeared, he had visited the seafood wholesale market in Wuhan.
T23 2234-2322 Sentence denotes Also, he reported that he contacted with other respiratory patients with fever in Wuhan.
T24 2323-2399 Sentence denotes He traveled home from Wuhan, 2 days before his presentation to the hospital.
T25 2400-2588 Sentence denotes At admission (day 1), the patient reported his symptom was very mild, and his body temperature was 37.6 °C (99.7 °F), whereas coarse breath sounds of both lungs were heard at auscultation.
T26 2589-2661 Sentence denotes The results of laboratory tests indicated normal white blood cell count:
T27 2662-2675 Sentence denotes 5.24 × 109/L.
T28 2676-2770 Sentence denotes The neutrophils count declined to 46.7%, whereas C-reactive protein (CRP) was up to 11.8 mg/L.
T29 2771-2885 Sentence denotes Unenhanced chest computed tomography (CT) showed multiple patchy shadows in the lower lobe of both lungs (Fig. 1).
T30 2886-2975 Sentence denotes The SARS-CoV-2 nucleic acid detection of the patient’s throat swab was positive (Fig. 1).
T31 2976-3020 Sentence denotes Thus, the patient was diagnosed as COVID-19.
T32 3021-3196 Sentence denotes After received a day treatment with interferon inhalation (1,000,000 IU, 3/day) and azithromycin (0.5 g, 1/day), his body temperature was declined to normal 36.7 °C (98.1 °F).
T33 3197-3406 Sentence denotes On day 3 from admission (day 3), the 1st repeated chest CT showed the infection range was slightly reduced in the medial segment of the right middle lobe and the dorsal segment of the left lower lobe (Fig. 1).
T34 3407-3571 Sentence denotes On day 8, the 2nd repeated chest CT image showed the infection range was reduced when compared to the previous one (Fig. 1), and CRP levels was reduced to 1.3 mg/L.
T35 3572-3746 Sentence denotes On day 10, the patient had less cough, and body temperature has slighter increased, but still in normal range, whereas the 2nd nucleic acid in throat swab was still positive.
T36 3747-3917 Sentence denotes Thus, it’s added another antiviral medicine as lopinavir (50 mg)/ritonavir (200 mg) (2 tablets, 2 times/day) and stopped to use azithromycin from day 10 in the treatment.
T37 3918-4044 Sentence denotes On day 12, the patient reported no clinical symptom, and the repeated chest CT image showed no infection in the lung (Fig. 1).
T38 4045-4155 Sentence denotes On day 15, patients received the 3rd detection of nucleic acid in throat swab, it was still positive (Fig. 1).
T39 4156-4368 Sentence denotes On day 16, the 4th result of nucleic acid in throat swab changed to negative, whereas it was positive in sputum (Fig. 1), thus continued the antiviral treatment with interferon inhalation and lopinavir/ritonavir.
T40 4369-4449 Sentence denotes On day 19, the 5th result of nucleic acid in sputum was still positive (Fig. 1).
T41 4450-4564 Sentence denotes On day 22, the nucleic acid in sputum changed to negative, whereas the result back to positive on day 24 (Fig. 1).
T42 4565-4589 Sentence denotes The treatment continued.
T43 4590-4687 Sentence denotes Finally, the nucleic acid detection result was changed to negative on day 29 and day 31 (Fig. 1).
T44 4688-4739 Sentence denotes The patient was discharged from hospital on day 32.
T45 4740-4780 Sentence denotes Fig. 1 The summary of two COVID-19 cases
T46 4782-4800 Sentence denotes Case 2 description
T47 4801-4970 Sentence denotes A 29-year-old man enrolled in his hometown hospital on Jan 22, 2020 (about 1250 km far from Wuhan), due to a 3-day history of very mild fever and cough of unknown cause.
T48 4971-5072 Sentence denotes He had been lived in Wuhan since March 2019, and contacted to the other patients with fever in Wuhan.
T49 5073-5148 Sentence denotes He traveled home from Wuhan, 1 day before his presentation to the hospital.
T50 5149-5318 Sentence denotes The patient reported mild symptoms at admission, since his body temperature was 37.4 °C (99.3 °F), whereas coarse breath sounds of both lungs were heard at auscultation.
T51 5319-5412 Sentence denotes Laboratory tests indicated leucopenia as white blood cell count was declined to 3.38 × 109/L.
T52 5413-5586 Sentence denotes The white blood cell differential count showed 72.8% as neutrophils, whereas CRP and erythrocyte sedimentation rate (ESR) was elevated to 9.8 mg/L and 15 mm/h, respectively.
T53 5587-5685 Sentence denotes The unenhanced chest CT image showed multiple patchy shadows in lower lobe of both lungs (Fig. 1).
T54 5686-5754 Sentence denotes The SARS-CoV-2 nucleic acid in throat swab was detected as positive.
T55 5755-5812 Sentence denotes Thus, the patient was diagnosed as of COVID-19 pneumonia.
T56 5813-6144 Sentence denotes Since admission (day 1), the patients received the antiviral treatment with interferon inhalation (5,000,000 IU, 2 times/day) and lopinavir (50 mg)/ritonavir (200 mg) (2 tablets, 2 times/day), the antibacterial treatment with ceftazidime (2.0 g, 2 times/day), and the anti-inflammation treatment with prednisone (30 mg, 1time/day).
T57 6145-6226 Sentence denotes On day 3, the body temperature declined to normal 36.3 °C (97.3 °F) and no cough.
T58 6227-6421 Sentence denotes On day 8 and day 10, SARS-CoV-2 nucleic acid in throat swab were shown the negative at that two time, and the repeated chest CT image showed that the infection range was declined a lot (Fig. 1).
T59 6422-6552 Sentence denotes On day 12, the infection still showed in peripheral lung, but very little (Fig. 1), thus the patient was discharged from hospital.
T60 6553-6640 Sentence denotes At Feb 18, the CT image of 1st follow-up showed that no infection in his lung (Fig. 1).
T61 6642-6652 Sentence denotes Discussion
T62 6653-6789 Sentence denotes The main finding is the unsynchronized changes in the CT image and SARS-CoV-2 nucleic acid detection in the two imported COVID-19 cases.
T63 6790-6976 Sentence denotes Importantly, we highlight the need for evaluating the suspected virus carriers even after the recovery from pneumonia, who may be asymptomatic with no positive result in laboratory test.
T64 6977-7169 Sentence denotes The PCR positive result in the 1st young male patient lasted nearly 20 days after his pneumonia recovery, suggested a proportion of recovered patients still may be asymptomatic virus carriers.
T65 7170-7302 Sentence denotes When SARS-CoV-2 enters humans, the interplay between virus and host antiviral defence is a governed factor for outcome of infection.
T66 7303-7547 Sentence denotes Asymptomatic carriers might arise when host antiviral defence is either strong or decoupled, thus asymptomatic shedding might occur when the immune response effectively limits but could not enough to completely block SARS-CoV-2 replication [6].
T67 7548-7655 Sentence denotes Thus, the continued treatment and isolated is needed, since the risk of transmitting to others still exist.
T68 7656-7847 Sentence denotes On the other hand, it is the need to evaluation the effect of the long-time antiviral treatment and side effect, especially for positive SARS-CoV-2 nucleic acid patient without any pneumonia.
T69 7848-7976 Sentence denotes The unsynchronized result of nucleic acid detection between throat and sputum sample were shown in the 1st patient in our study.
T70 7977-8115 Sentence denotes First patient showed the virus PCR-negative throat swab on day 16, whereas the result in sputum was continued to be positive until day 24.
T71 8116-8231 Sentence denotes Thus, we supposed that the different viral load shown between lower respiratory tract than upper respiratory tract.
T72 8232-8374 Sentence denotes Hase. et al. study reported that a COVID-19 case diagnosed by PCR-positive lower respiratory specimen, but with PCR-negative throat swabs [7].
T73 8375-8608 Sentence denotes Although the knowledge of viral loads in COVID-19 is limited, the high viral loads of lower respiratory tract specimens had been reported in severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) [8, 9].
T74 8609-8795 Sentence denotes Our results not only confirmed the necessary of multiple times test in COVID-19, but also highly recommended to use multitype samples for the disease evaluation, especially lower airway.
T75 8796-8891 Sentence denotes To collect the induced sputum may be recommended for the patients with dry cough or no symptom.
T76 8892-8982 Sentence denotes We also noticed that the unsynchronized expression could also show in the diagnosis stage.
T77 8983-9080 Sentence denotes In our cases, the patient had very less symptom, whereas the CT image showed a clearly infection.
T78 9081-9194 Sentence denotes This unsynchronized expression may help clinician to arrange the examination plan for suspected COVID-19 patient.
T79 9195-9326 Sentence denotes The choice of antiviral medicine for COVID-19 is still controversial, especially no specific anti-SARS-CoV-2 medicine is available.
T80 9327-9491 Sentence denotes However, we noticed that the 2nd patient got quicker recovery compared to the 1st patient, which may relate to the use of double antiviral medicines at early stage.
T81 9492-9654 Sentence denotes Olfactory disturbance or taste disorder was reported in COVID-19 patients [10], and these symptoms did not been reported by our patients at hospital or follow-up.
T82 9655-9782 Sentence denotes The study was limited to a small number of patients, which could not identify the representative and generalizable in COVID-19.
T83 9784-9794 Sentence denotes Conclusion
T84 9795-9911 Sentence denotes The unsynchronized changes in the CT image and SARS-CoV-2 nucleic acid detection in the two imported COVID-19 cases.
T85 9912-9996 Sentence denotes Lasting positive nucleic acid test result shown in patients recovered from COVID-19.
T86 9997-10081 Sentence denotes Our report would be contributed to aid clinicians in a more personalized management.
T87 10083-10096 Sentence denotes Abbreviations
T88 10097-10131 Sentence denotes COVID-19 Novel coronavirus disease
T89 10132-10190 Sentence denotes SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2
T90 10191-10233 Sentence denotes RT-PCR Real-time polymerase chain reaction
T91 10234-10256 Sentence denotes CT Computed tomography
T92 10257-10279 Sentence denotes CRP C-reactive protein
T93 10280-10314 Sentence denotes ESR Erythrocyte sedimentation rate
T94 10315-10353 Sentence denotes SARS Severe acute respiratory syndrome
T95 10354-10391 Sentence denotes MERS Middle East respiratory syndrome
T96 10392-10408 Sentence denotes Publisher’s Note
T97 10409-10527 Sentence denotes Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
T98 10528-10602 Sentence denotes Jing Gao, Jun-Qiang Liu and Heng-Jun Wen contributed equally to this work.
T99 10604-10620 Sentence denotes Acknowledgements
T100 10621-10940 Sentence denotes We thank the patients; the nurses and clinical staff who are providing care for the patients in Huining People’s Hospital and Longxi People’s Hospital; Centers for Disease Control and Prevention (CDC) Division of Viral Disease Laboratory in Gansu Province; and staff at the Gansu Province and nation health departments.
T101 10942-10964 Sentence denotes Authors’ contributions
T102 10965-11025 Sentence denotes This study was planned by J Gao, JQ Liu, HJ Wen and XJ Wang.
T103 11026-11104 Sentence denotes T The cases were evaluated by J Gao, JQ Liu, HJ Wen, H Liu, WD Hu and XJ Wang.
T104 11105-11202 Sentence denotes The manuscript was written by J Gao, X Han, CX Li and XJ Wang, and approved by J Gao and XJ Wang.
T105 11203-11259 Sentence denotes J Gao and XJ Wang contributed equally as senior authors.
T106 11260-11320 Sentence denotes XJ Wang is responsible for the overall content as guarantor.
T107 11322-11329 Sentence denotes Funding
T108 11330-11549 Sentence denotes This study was supported by the Science-Technology Foundation for Young Scientist of Gansu Province of China (Grant no.18JR3RA059) and the Young Scientists Fund of Gansu Provincial Hospital of China (Grant no.17GSS7–1).
T109 11550-11747 Sentence denotes J Gao was supported by the Sigrid Jusélius Foundation, the Finnish Anti-Tuberculosis Association Foundation, the Jalmari and Rauha Ahokas Foundationm, and the Swedish Asthma and Allergy Foundation.
T110 11748-11837 Sentence denotes CX Li was supported by the Mats Klebergs Stiftelse and the Swedish Heart-lung foundation.
T111 11839-11873 Sentence denotes Availability of data and materials
T112 11874-11876 Sentence denotes No
T113 11878-11920 Sentence denotes Ethics approval and consent to participate
T114 11921-12020 Sentence denotes The study was approved by the Ethics Committee of the Gansu Provincial Hospital (3rd Feb, 2020, No.
T115 12021-12087 Sentence denotes 2020–009), and all participants provided written informed consent.
T116 12089-12112 Sentence denotes Consent for publication
T117 12113-12116 Sentence denotes Yes
T118 12118-12137 Sentence denotes Competing interests
T119 12138-12152 Sentence denotes None reported.