目的 比较伴和不伴肺炎旁胸腔积液的社区获得性肺炎(community acquired pneumonia,CAP)患者的基础疾病因素、实验室检查、影像学资料、疾病严重程度,分析影响CAP合并肺炎旁胸腔积液患者的临床因素.方法 回顾性分析2018 年1 月1 日至 2022 年3 月31 日期间苏州大学附属第一医院呼吸与危重症医学科CAP患者临床数据,将患者分成合并胸腔积液组(CAP-PE 组)和不合并胸腔积液组(CAP组),采用多因素方法分析CAP患者发生肺炎旁胸腔积液的独立影响因素,建立其ROC曲线预测模型.结果 共343 例CAP患者纳入分析,其中CAP-PE组176 例(51.3%),与CAP组相比,CAP-PE组以男性和年龄≥65 岁居多,合并基础疾病比例较高,且感染生物标志物和凝血功能明显异常.Logistic回归分析显示,外周血淋巴细胞、白蛋白和D-二聚体是影响CAP合并肺炎旁胸腔积液形成的独立影响因素.ROC曲线显示,将上述三个参数联合应用于肺炎旁胸腔积液形成的预测优于单个变量,其曲线下面积为 0.815.结论 CAP-PE组的临床指标明显异常于CAP组.经过多因素分析,外周血淋巴细胞、白蛋白和D-二聚体能预测肺炎旁胸腔积液的形成,将以上三个参数其联合分析时具有更优的预测价值.
急性肺损伤(acute lung injury,ALI)是以炎性细胞浸润、肺泡毛细血管屏障通透性增加和急性弥漫性肺泡水肿为特征的急性进行性肺部炎症,是一种危及生命的低氧性呼吸系统疾病.
Objective To explore the correlation between CT lung density and emphysema volume on post-operative lung function and pulmonary complications in lung cancer patients.Methods 77 lung cancer patients who underwent surgical treatment from April 2022 to April 2023 were selected.The preoperative CT chest scan was used to calculate the volume and density of emphysema,collect postoperative lung function parameters and complications,analyze the correlation between preoperative CT parameters and postoperative lung function and complications,test the effectiveness of CT parameters in predicting postoperative lung complications,and analyze the influencing factors of lung complications through logistic regression.Results Postoperative FEV1％predicted value,DLCO％predicted value,FEV1/FVC,MMEF75-25％predicted value,MEF50％predicted value and DLCO/VA％predicted value were positively correlated with preoperative lung density,and negatively correlated with preoperative emphysema volume.The ROC curve showed that the AUC of lung density for predicting postoperative pulmonary complications was 0.898,with a critical value of-787.5 HU,sensitivity and specificity of 86.96％and 81.48％,respectively.The AUC of emphysema volume for predicting pulmonary complications was 0.878,with a critical value of 5.41％,sensitivity and specificity of 84.00％and 80.00％,respectively.Logistic regression showed that preoperative emphysema volume＞5.41％and lung density＜-787.5HU were independent risk factors for postoperative pulmonary complications.Conclusion Preoperative CT lung density and emphysema volume are correlated with postoperative lung function in lung cancer patients.Emphysema volume＞5.41％and lung density＜-787.5 HU are independent risk factors for postoperative pulmonary complications.
Objective To explore the relationship between the Notch signaling pathway regulating the polari-zation direction of macrophages and the lungs of rat fibrotic pigeon feeders.Methods Normal SD rats(the control group)were selected,and a fibrotic allergic pneumonia rat model(the M group)was constructed by observing pa-thology,CT,and detecting fibrotic markers.γ secretory enzymes(DAPT)inhibiting the Notch signaling pathway was taken as the M+DAPT group.It used fluorescence quantitative PCR technology to detect the effect of blocking the Notch pathway on the polarization direction of macrophages.Results 20 weeks after intratracheal instillation of allergen freeze-dried powder in normal rats,fibrosis formation was observed in pathology and CT,and the levels of α-SMA and TGF-β1 increased,which confirmed the successful modeling.The protein expression levels of the key pro-tein ligands DLL1,DLL4,JAG1,JAG2 in the Notch signaling pathway and the receptors Notch1 and Notch2 in the lung tissue of rats with fibrotic allergic pneumonia increased.The application of DAPT to inhibit the Ntoch signaling pathway resulted in a decrease in DLL4,JAG1,JAG2,and receptor Notch1(P＜0.05).Compared with the control group,the expression levels of M1 type macrophage marker genes TNF-a and iNOS mRNA decreased in the M group.The mRNA expression levels of M2 macrophage marker genes Mrc2 and Arg-1 increased(P＜0.05),and the relative expression levels of TNF-α and iNOS gene mRNA increased after the use of DAPT inhibitors,while the relative ex-pression levels of Mrc2 and Arg-1 gene mRNA decreased(P＜0.05).Conclusion The Notch signaling pathway regulates the polarization direction of macrophages,and administration of DAPT inhibitors inhibits macrophage polari-zation towards M2 type,effectively delaying fibrosis formation.
支气管哮喘(简称哮喘)是一种以气道慢性炎症、气道高反应性及气道重塑为主要特征的异质性疾病,需要长期用药来控制发病.吸入性糖皮质激素(inhaled corticosteroids,ICS)和长效 β2 激动剂分别用于长期控制气道炎症和支气管收缩.
Objective To explore the application value and safety of the Tubeless technique in minimally in-vasive surgery for early malignant pulmonary nodules based on the concept of rapid rehabilitation surgery.Methods A total of 80 patients with early malignant pulmonary nodules admitted to Nanjing Chest Hospital from December 2018 to August 2020 were selected as the study objects and the patients were randomly divided into the Tubeless group and intubation group according to simple randomization method,with 40 cases in each group.Patients in both groups un-derwent single-hole video-assisted thoracoscopic cuneiform resection of pulmonary nodules.Patients in the Tubeless group did not undergo intraoperative tracheal intubation,catheter placement,and postoperative thoracic drainage catheter indentation.Patients in the intubation group were intubated intraoperatively,and the catheter and thoracic drainage tube were retained after the operation.The clinical data of the two groups were compared,the postoperative pain scores of the two groups were compared,and the differences in the occurrence of adverse reactions and the satis-faction of the two groups of patients with postoperative analgesia were observed.Results All 80 patients completed the operation.The VAS scores of the Tubeless group were 0.94±0.92,2.20±1.16 and 1.62±0.91 on the 1st,2nd,and 4th day after the operation,and the VAS scores of the intubation group were 2.14±1.12,3.52±1.11 and 2.45±0.86,respectively.The difference between the two groups was statistically significant(P＜0.05).The time of surgical access was(36.67±3.20)min in the Tubeless group and(52.33±3.39)min in the intubation group,and the difference between the two groups was statistically significant(P＜0.001).Intraoperative blood loss was(5.00±4.47)mL in the Tubeless group and(13.33±5.16)mL in the intubation group,and the difference be-tween the two was also statistically significant(P=0.014).Postoperative nausea and vomiting occurred in 6 patients in the Tubeless group,dizziness in 8 patients,and hypotension in 2 patients.In the intubation group,nausea and vomiting occurred in 8 cases,dizziness in 9 cases,and hypotension in 3 cases.No postoperative complications such as lung infection and hoarseness occurred in both groups.There was no significant difference in the incidence of nau-sea,vomiting,dizziness,and hypotension(x2=0.718,3.872,2.832,P＞0.05).In the Tubeless group,34 pa-tients were satisfied with postoperative analgesia,5 were acceptable and 1 was not satisfied.In the intubation group,22 patients were satisfied with postoperative analgesia,14 were acceptable,and 4 were dissatisfied.The satisfaction of postoperative analgesia in the Tubeless group was significantly higher than that in the intubation group(x2=10.546,P＜0.05).Conclusion The treatment of early malignant pulmonary nodules by single-hole tubeless tech-nique can significantly reduce postoperative pain,improve patient comfort,shorten patient hospitalization time,re-duce hospitalization cost,and not increase postoperative complications.
Objective To explore the clinical value of serum microRNA-134-5p(miR-134-5p),miR-34a,and chemokine(C-X-C)ligand 20(CCL20)in predicting postoperative recurrence in lung cancer patients after de-finitive surgery.Methods A total of 90 non-small cell lung cancer(NSCLC)patients were selected as the research subjects.All patients underwent thoracoscopic lung cancer resection surgery under the guidance of the Hebei Central Petroleum Hospital.After 24 months of follow-up telephone or outpatient examination,61 patients(the recurrence group)and 29 patients(the control group)showed recurrence.The levels of miR-134-5p,miR-34a,and CCL20 be-fore surgery were compared between the two groups.The receiver operating characteristic(ROC)curve analysis was used to compare the predictive value of the three indicators for postoperative recurrence.Logistic regression model was used to analyze the relationship between the three indicators and the risk of postoperative recurrence in NSCLC pa-tients after surgery.Results The levels of serum miR-134-5p and miR-34a before surgery were significantly lower in the recurrence group than those in the control group,and the levels of serum miR-34a and CCL20 were significantly higher in the recurrence group than those in the control group,with statistically significant differences(P＜0.05).The proportion of patients with stage≥Ⅱ in the recurrence group was 75.41％,higher than that in the control group(51.72％).The proportion of non-keratinization neoplastic forms and metastases was 42.62％in the recurrence group,higher than in the control group(17.24％).The proportion of positive margin was 45.90％higher in the re-currence group than in the control group(20.69％).The above indicators showed statistically significant differences(P＜0.05)for all groups.Logistic results showed that preoperative decrease of miR-134-5p,increase of miR-34a,increase of CCL20,staging ≥Ⅱ stage,lymph node metastasis positive were independent risk factors for postoperative recurrence of NSCLC(P＜0.05).Conclusion Preoperative serum miR-134-5p,miR-34a,and CCL20 have a cer-tain value in predicting postoperative recurrence of NSCLC patients,and miR-134-5p has a higher value and is closely related to postoperative recurrence.
Objective To explore the clinical value of lung ultrasound(LUS)application in evaluating the severity of pneumonia in children.Methods 114 children with pneumonia from January 2020 to June 2022 were se-lected,and they were divided into the severe group(n=41,CPIS＞6 points)and the general group(n=73,CPIS≤ 6 points)based on the Clinical Pulmonary Infection Score(CPIS).Their clinical data between the severe group and the general group was compared,the correlation between LUS score and CPIS,serum CRP,and IL-6 levels in children with pneumonia were analyzed,and the independent risk factors that affected the condition of children with pneumonia were screened through multivariate logistic regression.The predictive efficacy of LUS score,CPIS,CRP,IL-6,and the combination of various indicators for severe pneumonia were analyzed.Results The proportion of dyspnea,weakened respiratory sounds,neutrophil count,serum CRP,serum IL-6 levels,CPIS,and LUS scores of the severe group were higher than those of the general group(P＜0.05),while the lymphocyte count was lower than that of the general group(P＜0.05).Pearson correlation analysis showed that the LUS score of children with pneu-monia was positively correlated with serum CRP,IL-6 levels,and CPIS(r=0.518,0.469,0.565,P=0.009,0.013,0.006).Multivariate logistic regression analysis showed that CRP,IL-6,CPIS,and LUS scores were inde-pendent risk factors affecting the severity of pneumonia in children.ROC curve analysis showed that the area under the curve(AUC)of LUS score for predicting severe pneumonia was 0.783(95％CI,0.688～0.896),and the sensitivity and specificity were 68.3％and 86.7％respectively.The AUC of the combination of CRP,IL-6,and CPIS was 0.892(95％CI,0.804～0.961),and the sensitivity and specificity were 79.8％and 88.5％respective-ly.Conclusion LUS score can reflect the severity of pneumonia in children,and it is an independent risk factor that affects the severity of pneumonia in children.It has high clinical value in predicting severe pneumonia,and it can further improve the predictive value combined with CRP,IL-6,and CPIS.
Objective To analyze the epidemiological analysis of respiratory pathogens in patients in Baos-han area,Shanghai from 2017 to 2023.Methods A total of 449890 outpatients and inpatients with respiratory dis-eases from January 2017 to July 2023 were enrolled,and 11 common respiratory pathogens were detected,including Influenza virus A(FluA),Influenza virus B,FluB,Mycoplasma pneumoniae(MP),respiratory syncytial virus(RSV),adenovirus(ADV),Coxsackievirus A(CVA),Coxsackievirus B(CVB),human parvovirus B19(HPV B19),mumps virus(MV),and Mycobacterium tuberculosis.The correlation of year,age,sex and season with re-spiratory infection rate was investigated,and the statistical difference in positive rate and sex between the observation group and the control group was analyzed.In order to analyze the impact of the new crown epidemic on respiratory in-fections,the patients with pathogens detected from January 2017 to December 2019 were taken as the control group,and the patients with pathogens detected from January 2020 to July 2023 were taken as the observation group.The correlation of 2023 influenza A outbreak with age,sex and department of visit was explored.Results The respiratory infection rate was the highest in 2019(6.06％),and the infection rate decreased by half(3.51％)in 2020 when the epidemic just began,and gradually decreased in 2021 and 2022,to 1.81％and 1.65％,respectively.Chi-square test found that except for respiratory syncytial virus,coxsackievirus type B and tuberculosis IgM,the infection rate of the control group was higher than that in the observation group,and there were statistical differences.The re-spiratory infection rate of people under or equal to 18 years old was higher at 6.74％(11772/174728),and the re-spiratory infection rate in people over 18 years old was lower at 2.75％(7565/275162).The prevalence of respirato-ry infections in male was higher than in female,but only influenza A,B,respiratory syncytial virus,coxsackievirus type B,and tuberculosis IgG antibody infection rates were statistically different between male and female.Influenza A,B and respiratory syncytial virus were mainly detected in winter and spring,adenovirus was mainly detected in winter(2.1％),and the infection rate of Mycoplasma pneumoniae was higher in all seasons and the highest in winter(10.73％).Coxsackievirus A,B and human parvovirus B19 were the highest in spring,mumps virus was most sus-ceptible to infection in winter(0.6％),and tuberculosis IgG and IgM antibodies were mainly detected in winter.In the second week of March,both the number of tests for influenza A(n=5682)and the number of positive cases for influenza A(n=977)reached their peak,with the positive rate peaking at 22.63％in the first week of March.The main causes of respiratory tract infection reached 49.61％,and the main departments were pediatrics(43.05％).Conclusion Respiratory tract infection is seasonal,with the highest infection rate in winter,and prevention is the main measure to reduce respiratory infection.
Objective To explore the effect of TGR5 on inflammation and bronchopulmonary dysplasia(BPD)in neonatal mice with hyperoxia(HO)lung injury.Methods Neonatal mice were placed in a sealed plexi-glas chamber containing 75％oxygen for 14 days to establish a bronchopulmonary dysplasia(BPD)model,and then they were divided into six experimental groups:the control group(the normoxic group),the hyperoxia group(the HO group),the HO+LV-NCgroup,the HO+LV-TGR5 group,the HO+si-NC group and the HO+si-TGR5 group.The lung tissue,serum,and bronchoalveolar fluid(BALF)were collected for histological examination.The wet/dry(W/D)weight ratio,myeloperoxidase(MPO)activity,cytokines,oxidative stress,and protein expression were ana-lyzed until postnatal Day 14.Results Compared with the control group,the expression of TGR5 in the lung tissue of newborn mice in the HO group was significantly increased(P＜0.05).Newborn mice exhibited pulmonary inflamma-tion accompanied by alveolar capillary leakage,neutrophil infiltration,increased MPO activity,release of inflammato-ry mediators and occurrence of oxidative stress.The expression of TRAF6 and p65 proteins was elevated(P＜0.05).Compared with the HO group,the over-expression of TGR5 alleviated the pathological damage of lung tissue,and sig-nificantly reduced neutrophil infiltration and MPO activity(P＜0.05).The over-expression of TGR5 inhibited the re-lease of inflammatory mediators and oxidative stress(P＜0.05).The over-expression of TGR5 reduced the TRAF6 protein expression and p65 phosphorylation level(P＜0.05).On the contrary,TGR5 interference further exacerba-ted the effect of HO on lung development in newborn mice.Conclusion The over-expression of TGR5 ameliorates HO-induced lung injury in mice by inhibiting the activation of TRAF6/NF-κB signaling pathway,which can be used as a new strategy for the prevention and treatment of neonatal lung dysplasia in clinical trials.
碰撞癌是一种特殊、少见的肿瘤类型,其发病机制、治疗方式、预后尚不明确,临床上易误诊、漏诊,多于术后病理诊断明确.本文报道1例罕见的原发性肺腺癌碰撞原发性肺黏膜相关淋巴组织淋巴瘤(mucosa-associated lymphoid tissue lymphoma,MALT淋巴瘤).旨在提高对于此类疾病的认识以及分享疾病的相关信息,探讨该类疾病的发病机制与治疗方法,重视临床病理对于疾病诊治的意义.
Objective To investigate the difference of intestinal flora in patients with primary treatment of pulmonary tuberculosis before and after anti-tuberculosis treatment and the changes of intestinal flora when drug-relat-ed liver injury occurs,and to analyze the correlation between intestinal flora and anti-tuberculosis drug-related liver injury(ATLI).Methods Stool specimens were collected before and after anti-tuberculosis treatment of patients with primary tuberculosis diagnosed at The Fifth People's Hospital of Suzhou from January 2020 to January 2021,and they were divided into the liver damage group(the ATLI group)and the control group(the non-ATLI group)accord-ing to whether the patients had abnormal liver function within 4 weeks of receiving anti-tuberculosis drug treatment,and stool specimens were collected at the time of occurrence of liver damage.The liver function-related indexes were detected using a laboratory biochemical analyzer.The changes in diversity,species composition and component abun-dance of intestinal flora before and after anti-tuberculosis were compared by bacterial 16S rDNA high-throughput se-quencing,and the relationship between differential intestinal genera and serum liver function indexes was analyzed by Spearman's correlation coefficient.Results The differences in the abundance,flora composition and relative abun-dance of intestinal flora before and after anti-tuberculosis treatment were statistically significant in both groups(P＜0.05).There was no significant difference in the beta diversity of intestinal flora between the ATLI and Non-ATLI groups during the same time period(P＞0.05).17 taxa with significant differences were found between the two groups by LEfSe analysis(P＜0.05).Further analysis of the relationship between intestinal differential bacteria and liver function indicators revealed Lactobacillus,Herbinix,Anaerosporobacter,[Eubacterium]brachy group,Pro-teus,Prevotella 9,Enterobacter,and Phascolarctobacterium were correlated with liver function indicators AST and ALT.Conclusion The dynamic changes of intestinal flora in patients with pulmonary tuberculosis before and after anti-tuberculosis treatment show significant differences,and the intestinal differential bacteria are correlated with the occurrence of anti-tuberculosis drug-induced liver injury.
Objective To investigate the expression and clinical significance of soluble triggering receptor expressed on myeloid cells-1(sTREM1)and adenosine deaminase(ADA)in serum of children with adenovirus pneumonia.Methods A total of 97 children with adenovirus pneumonia admitted to Cangzhou City Central Hospital from October 2021 to December 2022 were regarded as the adenovirus group,and 97 children with non adenovirus pneumonia were regarded as the non adenovirus group.According to the severity of the condition,patients in the ade-novirus group were divided into the mild adenovirus pneumonia group of 65 cases and the severe adenovirus pneumonia group of 32 cases,and another 97 healthy children who underwent physical examination in our hospital during the same period and whose general data matched the two groups were taken as the control group.Pearson method was applied to analyze the correlation between serum sTREM1 and ADA expression levels in children with ad-enovirus pneumonia.It used logistic regression analysis to investigate relevant factors affecting the severity of adenovi-rus pneumonia,and receiver operating characteristic(ROC)curve to analyze the diagnostic value of sTREM1 and ADA in severe adenovirus pneumonia.The expression levels of serum sTREM1 and ADA in the adenovirus group were significantly higher than those in the control group(P＜0.05).The expression levels of sTREM1 and ADA in serum of children with adenovirus pneumonia were positively correlated(r=0.743,P＜0.001).The expression lev-els of serum sTREM1 and ADA in children with severe adenovirus pneumonia were significantly higher than those in the mild adenovirus pneumonia group(P＜0.05).There was a significant difference in the history of lung disease and PLT between the mild and severe adenovirus pneumonia groups(P＜0.05).Previous history of lung disease,PLT≥300 × 109/L,sTREM1,and ADA were all risk factors for the development of severe adenovirus pneumonia(P＜0.05).The AUC of serum sTREM1 and ADA,as well as their combined detection for the diagnosis of severe adenovirus pneumonia,were 0.599,0.790,and 0.930,respectively.The combined detection of the two was superi-or to the individual detection of serum sTREM1 and ADA(Z combined sTREM1=5.566,Z combined ADA=4.860,P＜0.001).Conclusion The elevated expression levels of sTREM1 and ADA in serum are closely related to the occurrence of severe adenovirus pneumonia,and the combined detection of them has high diagnostic value for adenovirus pneumonia.
Objective To evaluate the clinical application value of an artificial intelligence-aided diagnosis system for qualitative diagnosis of lung nodules and predicting the invasive pulmonary adenocarcinomas.Methods Patients with surgically pathologically confirmed pulmonary nodules from January 2021 to January 2022 in our hospital were retrospectively analyzed.Lung nodules were divided into the malignant tumor group and the benign lesion group,among which lung adenocarcinoma was divided into the infiltrative adenocarcinoma group and the non-invasive adeno-carcinoma group.The imaging data of lung nodules in each group were imported into the AI-aided diagnosis system,and the quantitative parameters,malignancy probability,and predicted pathological subtypes were recorded.The clinical value of the AI-aided diagnosis system in identifying benign and malignant lung nodules and predicting the in-vasive degree of lung adenocarcinoma was evaluated using the working characteristic curve of subjects.Results The Kappa value of the agreement test between AI diagnosis and pathological findings was 0.676(P＜0.001).The area under the ROC curve for identifying benign and malignant lung nodules in the artificial intelligence group was 0.91,with a sensitivity of 94.3％and specificity of 70.2％.The area under the ROC curve in the physician-reading group was 0.767,with a sensitivity of 80.5％and specificity of 63.3％.While comparing the clinical data of the two groups,there were significant differences in age,gender,malignancy probability,mean CT value,and maximum CT value(P＜0.05).The area under the ROC curve for automatic prediction of lung adenocarcinoma invasiveness by artificial intelligence was 0.808,with a sensitivity of 71.0％and specificity of 89.7％.Conclusion The artificial intelligence system has a good agreement between the qualitative diagnosis of lung nodules and the pathological results of lung nodules,which is important for the diagnosis of early lung cancer and can automatically predict the degree of early lung adenocarcinoma infiltration,and can be widely used in clinical practice.
根据2020年世界卫生组织国际癌症研究机构(IARC)发布的GLOBOCAN数据库:全世界估计新增恶性肿瘤约1930万例,其中新发肺癌占11.4％,死亡995万例,肺癌死亡人数占18％,肺癌成为全世界发病率排名第二和死亡率最高的恶性肿瘤[1-2].
Objective To explore the predictive value of Padua prediction score combined with D-dimer in venous thromboembolism with COVID-19.Methods 441 patients with COVID-19 who were hospitalized in the Inter-nal Department of the Affiliated Hospital of Chengde Medical University admitted from December 2022 to February 2023,including 195 cases in the VTE group and 246 cases in the non-VTE group.The basic data of the two groups were analyzed.The receiver operating characteristic curve(ROC curve)of Padua Prediction Score,D-dimer,and the combination of predicting VTE in COVID-19 patients was drawn to compare the area under the curve of the 3 methods.A Logistic regression analysis was used to investigate the risk stratification of Padua Prediction Score(≥4 points of Padua prediction score)and D-dimer level with the risk of VTE.Results Compared with the non-VTE group,the VTE group had higher Padua prediction score and D-dimer.The optimal cut-off value for Padua prediction score and D-dimer prediction of COVID-19 VTE were 4.5 points and 1.485 μg/mL respectively.The Youden index was 0.446 and 0.484,the sensitivity was 0.641 and 0.744,the specificity was 0.805 and 0.740,and the AUC was 0.789 and 0.804.There was no significant difference between the two AUC comparison(Z=0.512,P=0.609).In COVID-19 patients,the risk of VTE increased with increasing score(≥4 points of Padua prediction score)and in-creased with increasing D-dimer levels,with statistically significant differences(P＜0.05).The maximum Yoden index for Padua prediction score combined with D-dimer prediction of VTE was 0.575,with the sensitivity and speci-ficity of 0.795 and 0.780,respectively,and an AUC of 0.863.Compared with Padua prediction score and D-dimer alone,the AUC of the combination was higher and the difference was statistically significant(Z=4.655,P＜0.001 and Z=3.606,P＜0.001).Conclusion Padua prediction score and D-dimer level may be associated with the risk of VTE in COVID-19 patients.Padua prediction score combined with D-dimer may be having a good predictive value for the VTE in COVID-19 patients.
Objective To compare the merits and demerits of metagenomic Next-Generation Sequencing(mNGS)with traditional etiological diagnostic methods in the etiological diagnosis of pulmonary infection in patients with type 2 diabetes,and to provide reference for clinical diagnosis and treatment.Methods A retrospective analy-sis was conducted on 103 patients with type 2 diabetes mellitus and pulmonary infection treated in Fuyang People's Hospital from November 2021 to March 2023.All of them were tested by traditional culture and mNGS.The positive rate of pathogen detection,etiological distribution and consistency of detection results of two different detection meth-ods were compared.The sensitivity and diagnostic efficacy of two different detection methods were compared.The positive detection rate of mNGS in different groups was compared.Results The positive rate and diagnostic sensitivi-ty of mNGS were significantly higher than those of traditional detection methods(81.55％vs 42.72％,P＜0.001;92.68％vs 51.21％,P＜0.001),but the consistency was poor(Kappa=0.179＜0.4).In comparison of the posi-tive rate of mNGS in all subgroups,the positive rate of mNGS in patients with pulmonary underlying diseases was higher(93.02％vs 73.33％,P＜0.05).Conclusion mNGS detection can improve the detection rate of pathogens in patients with type 2 diabetes mellitus complicated with pulmonary infection,especially in the aspect of fungi,viru-ses and special pathogens.
静脉血栓栓塞症(venous thromboembolism,VTE)是恶性肿瘤患者的常见并发症,其分为深静脉血栓形成(deep venous thrombosis,DVT)、肺栓塞(pulmonary embolism,PE)两部分,是全球第三大常见的死亡原因[1].有研究显示肿瘤患者并发VTE的风险比普通人群增加了 9倍[2].
Objective To explore the efficacy of bronchial artery embolization in treatment of benign lung le-sions with massive hemoptysis and analyze the recurrence factors.Methods The clinical data of 55 patients with be-nign pulmonary disease treated with massive hemoptysis by bronchial artery embolization from September 2016 to Sep-tember 2019 in Suqian First People's Hospital Affiliated with Nanjing Medical University were retrospectively ana-lyzed.Log-rank univariate and Cox multivariate analyses were performed to analyze the factors influencing the recur-rence of hemoptysis.The hemostasis rate was calculated by the Kaplan-Meier method.Results All 55 patients were successfully embolized.9 patients had chest pain,6 patients had fever,and 1 suffered abdominal pain after the oper-ation.These complications improved after symptomatic treatment,and no serious procedure-related complications such as spinal cord injury occurred after the operation.The cumulative hemostasis rates for 1 month,6 months,1 year,2 years,and 3 years were 96.4％,94.5％,89.1％,72.7％,69.1％respectively.The mean survival time of no hemoptysis patients was 30.1(28.33～33.49)months.Univariate analysis showed that non-bronchial body artery(NBSA),body pulmonary circulation shunt(SPS),pulmonary destruction,and embolization materials were associ-ated with recurrence after hemoptysis intervention(P＜0.05).Multivariate regression analysis revealed that NBS and embolization materials were the independent factors influencing the recurrence after interventional embolization of he-moptysis.Conclusion BAE is safe and effective for the control of massive hemoptysis with benign pulmonary dis-ease.The cumulative recurrence rate gradually increases with the extension of postoperative time.Embolization mate-rials and NBSA blood supply are independent influencing factors for postoperative recurrence.Therefore,NBSA blood supply embolization should be emphasized and permanent embolization agents such as PVA should be selected.
