Background: Pulmonary mucoepidermoid carcinoma (PMEC) is often misdiagnosed due to the lack of specificity of clinical symptoms. The ratio of neutrophil/lymphocyte ratio (NLR) and the ratio of platelet/lymphocyte ratio (PLR) are used in the diagnosis and prognostic assessment of a variety of diseases. This paper aims to verify the auxiliary diagnostic value of NLR and PLR in the peripheral blood of PMEC, and calculate several indices to confirm the reliability of the hypothesis. Methods: A total of 26 patients with PMEC were enrolled as the case group, and 156 healthy patients were selected as the control group in this study according to the inclusion criteria and exclusion criteria. All clinical data were collected, and all subjects took blood from their fasting veins. The correlation analysis of NLR, PLR and tumour indicators was consistent with the normal distribution using Pearson analysis. The receiver operating characteristic (ROC) curve was used to calculate the diagnostic value of NLR and PLR. Results: NLR and PLR levels were significantly increased in patients with PMEC compared with healthy controls. PLR was positively correlated with the patient's stage, and NLR was independent of the patient's stage in PMEC patients. NLR was positively correlated with the patient's tumour size, and PLR was independent of the patient's tumour size. ROC curve analysis showed that NLR and PLR could be used as diagnostic indicators to distinguish patients with PMEC from normal people. Conclusions: NLR and PLR tests are simple, non-invasive, inexpensive, and have high patient compliance. As potential markers for screening PMEC patients, NLR and PLR have auxiliary value for further exploration and research, and are worth promoting in the clinical setting.

Treatment choices for metastatic non-small-cell lung cancer (NSCLC) after first-line targeted therapy progression are heterogeneous. This study aimed to characterize real-world treatment patterns and outcomes of advanced NSCLC harboring actionable genomic alterations (AGAs) in second- (2 L) or third-line (3 L) settings. This retrospective cohort study across six Chinese centers included stage IV NSCLC patients with confirmed AGAs. Therapies were divided into six categories: targeted monotherapy (T), targeted combinations (T+), chemotherapy monotherapy (C), chemotherapy combinations (C+), anti-angiogenic monotherapy (A), and other regimens (O). The primary outcome was the treatment pattern. Secondary outcomes included biomarker testing and effectiveness. A total of 658 patients were enrolled, with the majority harboring EGFR mutations (n = 590, 89.7

Background:The current status of nutritional support for patients in Respiratory ICU across mainland China remains inadequately characterized. This multi-center study, conducted in RICUs, was designed to investigate nutritional practices in this specific patient population, focusing on initiation timing, energy/protein adequacy, and associations with clinical outcomes. Methods:A prospective, observational study enrolled 1,026 patients (ICU stay >48 h) across 68 Chinese RICUs. We analyzed EN initiation rates (24 h/48 h), caloric/protein intake adequacy during the first 7 days, and outcomes via multivariable Cox regression. Results:EN initiation occurred in 36.8% (24 h) and 43.4% (48 h) of patients. Excluding patients who could take oral food, the proportion of patients who started EN within 24 and 48 h increased to 86.9 and 95.3%. Among 499 EN-fed patients, 26.1% developed EN complications. Caloric analysis (n = 317) identified three trajectories: underfeeding (<70% targets, 32.5%), adequate feeding (70-110, 43.2%), and overfeeding (>110, 24.3%). Overfeeding independently predicted higher non-social infections and significantly increased mortality risk in patients >50 years (HR = 1.83, 95% CI 1.02-3.28; p = 0.04). Mean protein intake was 0.9 g/kg/day, with no 28-day mortality benefit at higher thresholds (≥1.2 g/kg: p = 0.31; ≥1.3 g/kg: p = 0.42). Conclusion:This multicenter study demonstrates optimal early EN initiation rates in Chinese RICUs. Energy overfeeding was associated with increased mortality risk only in patients >50 years and non-social infections risk, whereas protein adequacy showed no outcome associations. Protocolized EN delivery balancing adequacy and overfeeding risks is urgently needed in RICUs. Clinical trial registration:Identifier, NCT04958447.

BackgroundSecondary organizing pneumonia (SOP) may develop following infections. Psittacosis, caused by Chlamydia psittaci (C. psittaci), is a zoonotic disease transmitted from birds to humans. It can present with a wide spectrum of symptoms, ranging from mild flu-like illness to life-threatening severe pneumonia. Cases of C. psittaci infection complicated by organizing pneumonia (OP) are rarely reported, and delayed treatment may pose a life-threatening risk.MethodsWe report a case of C. psittaci pneumonia complicated by OP. To identify additional cases and clarify the clinical features of this condition, a literature search was conducted using the PubMed and Embase databases for the period from January 1995 to May 2025. The search included the following keywords: “psittacosis,” “Chlamydia psittaci,” “chlamydia,” “organizing pneumonia,” and “bronchiolitis obliterans with organizing pneumonia.”ResultsA 66-year-old male with a history of poultry farming presented with fever, cough, sputum production, and hemoptysis. Empirical antimicrobial therapy with ceftizoxime was ineffective. To identify the etiology of the pulmonary lesions, bronchoscopy was performed, and C. psittaci infection was confirmed by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). Although the lesions partially resolved after moxifloxacin therapy, the patient experienced recurrent episodes. Chest CT revealed migratory lesions, which are uncommon in C. psittaci pneumonia. Further pathological examination of the specimen confirmed the diagnosis of OP. The patient's condition improved following corticosteroid therapy. A review of the literature indicated that none of the three previously reported cases were definitively diagnosed at initial admission; all presented primarily with fever and cough. One case progressed to severe pneumonia and resulted in death.ConclusionOP caused by C. psittaci pneumonia presents with non-specific symptoms and signs, making early diagnosis challenging. During treatment of C. psittaci pneumonia, if empirical anti-infective therapy shows no response after three days, or if imaging reveals features such as consolidation, migratory lesions, or a reverse halo sign, the possibility of concurrent OP should be considered. Pathological examination is recommended in such cases to avoid missed diagnosis and to ensure timely intervention.

BackgroundImmunotherapies targeting the programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) have shown great promise for a subset of patients with non-small cell lung cancer (NSCLC). However, safe and robust combination therapies are still needed to bring the benefit to broader patient populations.Methodswe performed in vivo treatment with PD-L1 antibody in Lewis lung carcinoma (LLC)-derived murine NSCLC model. Expression of B and T lymphocyte attenuator (BTLA) was detected during treatment. We evaluated the effects of the combination of anti-BTLA and anti-PD-L1 mAbs on tumor growth and overall survival of mice. In addition, distribution and function of immune cells were analyzed by flow cytometry. The role of BTLA in human and murine CD8+ T cells and its impact on reversing exhausted phenotype of PD-1+CD8+ T cell by PD-L1 blockade were analyzed. Furthermore, we investigated expression and distribution of BTLA on lymphocytes in tumor microenvironment of different specimens from NSCLC patients.ResultsThere was no significant difference overall survival between anti-PD-L1 therapy and IgG in LLC-bearing mice, and BTLA expression was increased on CD8+ T cells after PD-L1 antibody treatment. LLC-bearing mice treated with combination of anti-BTLA and anti-PD-L1 therapy had an improved overall survival than anti-BTLA or anti-PD-L1 alone. Compared to monotherapy with anti-BTLA or anti-PD-L1, mice treated with combination therapy demonstrated increased infiltration of CD8+ and CD4+ T cells, as well as increased expression of IFN-γ, TNF-α and Ki-67 in CD8+ T cells. In addition, CD8+ T cells co-expressing BTLA and PD-1 exhibited the most exhausted phenotype to resist PD-L1 blockade therapy. Furthermore, BTLA+CD8+ T cells were abnormally increased in different specimens from NSCLC patients, and CD8+ T cells expressing BTLA in NSCLC microenvironment were correlated with clinical response to anti-PD-1 therapy in NSCLC patients.ConclusionOur results show that BTLA and PD-1 cooperatively inhibit the activity of CD8+ T cells and are associated with resistance to PD-1/PD-L1 pathway blockade in NSCLC patients. Anti-BTLA blockade enhances the antitumor efficacy of anti-PD-L1 therapy. Dual BTLA and PD-1/PD-L1 blockade should be further explored to elicit potent antitumor CD8+ T-cell responses in NSCLC patients.

Abstract Background Cough variant asthma (CVA) is a specific type of asthma characterized by chronic cough as the sole or predominant symptom. Accurate diagnosis is crucial for effective treatment, yet bronchial provocation test is not always feasible in clinical settings. To identify independent predictors of CVA diagnosis, we developed a nomogram for predicting CVA. Univariate and multivariate logistic regression analyses were employed to construct the model, and the accuracy and consistency of the prediction model were subsequently validated. Methods We conducted a retrospective review of clinical data from 241 outpatients with chronic cough (≥ 8 weeks) who underwent bronchial provocation test at our hospital between January 2018 and December 2021. Patients were categorized into CVA group and Non-CVA group based on diagnostic criteria. Univariate analysis (chi-square and t-tests) was performed, followed by multivariate logistic regression to identify independent predictors. A nomogram was constructed using these predictors and validated using Bootstrap resampling (B = 200) to calculate the C-index. Additionally, receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were employed to assess the model's accuracy. Results Of the 241 outpatients, 156 (64.7%) were diagnosed with CVA. Multivariate analysis identified several independent predictors of CVA, including cough triggered by cold air (OR = 12.493, P = 0.019), exposure to pungent odors (OR = 3.969, P = 0.002), cough phasing (OR = 4.515, P < 0.001), history of allergic rhinitis (OR = 3.231, P = 0.018), and the percentage of the predicted value of maximum mid-expiratory flow (MMEF%pred) (OR = 0.981, P = 0.039) were independent predictors of CVA. The nomogram demonstrated good discrimination (AUC = 0.829) and calibration, with a sensitivity of 75.3% and specificity of 77.6% at the optimal cutoff. The C-index was 0.920, indicating excellent model performance. Conclusions We successfully developed and validated a user-friendly nomogram that accurately predicted CVA diagnosis based on clinical characteristics and pulmonary function test. This nomogram model could assist clinicians in diagnosing CVA, especially in patients without bronchial provocation test or with contraindications to bronchial provocation test.

To compare the effectiveness and safety of two antiviral drugs, azvudine and nirmatrelvir/ritonavir, in treating hospitalized patients with COVID-19. We conducted a retrospective analysis of patients who were admitted to the First Affiliated Hospital of Soochow University and diagnosed with SARS-CoV-2 infection between December 2022 and February 2023. These patients were treated with either azvudine or nirmatrelvir/ritonavir. The study initially included a total of 1097 patients. After applying a 1:3 propensity score matching, we ultimately included 728 patients, comprising 521 recipients of azvudine and 207 recipients of nirmatrelvir/ritonavir. Among them, 463 patients (88.9

The role of circular RNAs (circRNAs) in sepsis-induced lung injury is not clear. This study investigated the role and molecular mechanism of a novel circRNA in sepsis-induced lung injury and explored its prognostic value in patients with sepsis. In this study, aberrant circRNA expression profiling in lung tissues from mice with sepsis-induced lung injury was analyzed using high-throughput sequencing. circRNA-Cacna1d was verified by qRT-PCR, and its biological function in sepsis-induced lung injury was validated in vitro and in vivo. The interactions among circRNA-Cacna1d, microRNAs (miRNAs), and their downstream genes were verified. Furthermore, the clinical value of circRNA-Cacna1d in peripheral blood from patients with sepsis was also evaluated. We found that circRNA-Cacna1d expression was significantly increased in lung tissues of mice with sepsis and in microvascular endothelial cells after LPS challenge. circRNA-Cacna1d knockdown alleviated inflammatory response and ameliorated the permeability of vascular endothelium, thereby mitigating sepsis-induced lung injury and significantly improving the survival rate of mice with sepsis. Mechanistically, circRNA-Cacna1d directly interacted with miRNA-185-5p and functioned as a miRNA sponge to regulate the RhoA/ROCK1 signaling pathway. The expression level of circRNA-Cacna1d in patients with early sepsis was significantly higher than that in the healthy control subjects. Higher levels of circRNA-Cacna1d in patients with sepsis were associated with increased disease severity and poorer outcomes. In conclusions, circRNA-Cacna1d may play a role in sepsis-induced lung injury by regulating the RhoA/ROCK1 axis by acting as a miRNA-185-5p sponge. circRNA-Cacna1d is a potential therapeutic target for sepsis-induced lung injury and a prognostic biomarker in sepsis.

Tension pneumothorax (TP) is a clinical emergency that requires immediate treatment. However, there are specific cases that may be misdiagnosed as TP in clinical settings, potentially leading to iatrogenic injury. The goal of this study was to analyse and summarize instances of misdiagnosis in order to improve the clinician's ability to recognize and distinguish pseudotension pneumothorax (PTP). Cases misdiagnosed as TP were retrospectively analysed by literature retrieval, and the related clinical characteristics were summarized. A total of 45 cases were misdiagnosed as TP, including 27 (60.0%) cases of diaphragmatic hernia (DH), 9 cases of giant pulmonary bullae, 8 cases of cystic lung lesions and 1 case of pulmonary hydatid cyst. A total of 77.8% cases occurred in emergency and paediatric departments. Among patients with DH, 92.6% had the condition on the left with a younger onset age, and 85.2% presented with a history of digestive system diseases, surgery, trauma or digestive system manifestations. The onset of giant pulmonary bullae was mild, without haemodynamic abnormalities, and 66.7% of the patients were males. Cystic lung lesions occurred mainly in infants. Among 45 cases, 93.3% were misdiagnosed by chest X-ray, which showed 'pseudo-pneumothorax line', with compressed lung displaced centrifugally away from hilum. In DH, the diaphragm appeared indistinct without gastric bubbles, whereas the air-fluid level might be noted. Finally, 66.7% of patients were definitely diagnosed from computed tomography scans and others by thoracotomy, thoracic drainage, X-ray after gastric tube insertion, and so forth. Thoracic tube drainage was performed in 91.1% of patients, with 24.4% of patients draining fluid, and 9.8% of patients deteriorated after drainage. A total of 41.5% of patients suffered complications, including gastric perforation, haemopneumothorax and subcutaneous emphysema. Except for 1 patient who did not report the treatment and prognosis, all other patients recovered and were discharged after treatment. Distinguishing PTP from TP is clinically challenging. A thorough medical history, detailed clinical features, chest X-ray, ultrasound, computed tomography and strategic gastric tube insertion can provide important information of value for differential diagnosis. Clinicians need to think twice before placing a thoracic drainage tube to prevent additional iatrogenic injury.

This study investigated the correlation between epidemiological and clinical characteristics of patients infected with omicron variants and the cycle threshold (Ct value) for RT-PCR detection. The study population consisted of 115 patients with Omicron infection and the most common symptoms included fever (43.5 %), cough (38.3 %) and sore throat (29.6 %). Laboratory abnormalities were mainly lymphopenia, elevated globulins and elevated blood glucose. Univariate analysis found that older age (P < 0.001) and unvaccinated (P = 0.003) were associated with low Ct values (high viral load). Multivariate analysis showed that an elevated monocyte count (OR: 3.556; 95 % CI: 1.330-9.503) was associated with low Ct values, whereas being vaccinated (OR: 0.209; 95 % CI: 0.051-0.854) and lower serum sodium (OR: 0.137; 95 % CI: 0.051-0.367) were negatively associated with low Ct values. Studies have shown that factors such as monocyte count, vaccination status and serum sodium correlate with Ct values, suggesting the potential of Ct values as a clinical predictor, which could also provide a valuable reference for clinical decision-making.

Abstract Background Understanding of the early immune response in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) breakthrough infections is limited. Methods Ninety‐eight patients with coronavirus disease 2019 (COVID‐19) breakthrough infections were divided into two groups, with intervals from receiving the second dose of inactivated vaccine to the onset of illness <60 or ≥60 days. Results The median lymphocyte count and the median anti‐SARS‐CoV‐2 spike immunoglobulin G (IgG) and immunoglobulin M (IgM) titers were higher in the <60‐day interval group compared with the corresponding medians in the ≥60‐day interval group (p = 0.005, p = 0.001, and p = 0.001, respectively). The median interleukin‐6 (IL‐6) level in the <60‐day interval group was significantly lower than the median IL‐6 level in the ≥60‐day interval group (p < 0.001). Conclusions Our results highlight the different anti‐SARS‐CoV‐2 spike IgG and IgM antibody titers among patients with different intervals from receiving the second dose of inactivated vaccine to the onset of illness.

We retrospectively analyzed 3 cases of pulmonary nocardiosis. Patients were identified by metagenomic next generation sequencing (mNGS) in the First Affiliated Hospital of Soochow University, from January 2019 to April 2022. All patients had underlying diseases, and were in immunocompromised state, with membranous nephropathy, acute lymphoblastic leukemia (ALL), and systemic lupus erythematosus (SLE), respectively. Symptoms common to all cases included fever, cough and expectoration. Chest computed tomography (CT) presented patchy shadows or nodules, with or without cavitation lesions, or pleural effusion. mNGS detected Nocardia spp. via bronchoalveolar lavage fluid (BALF) or blood samples from patients. All the patients were discharged with recovery after using the trimethoprim-sulfamethoxazole (TMP-SMX) and remained without evidence of disease during regular follow-ups. mNGS may be a tool for rapid and accurate detection and identification of pulmonary nocardiosis, but interpreting the mNGS results should be more cautious because the mNGS assay can also detect colonization.

We examined the efficacy and safety of Liushen pill combined with basic treatment for patients with COVID-19. In total, 181 patients hospitalized with COVID-19, classified as asymptomatic mild type, were randomly divided into the experimental (n = 91) and control (n = 90) groups and were administered placebo (Maizao decoction) and Maizao decoction and Liushen pill, in addition to standard care, respectively. The negative conversion rate of nucleic acid (Day 7), hospital discharge rate (Days 8, 10, and 14), symptom disappearance rate (Days 3, 5, and 7), inflammatory cytokine levels, and adverse events were compared between the groups. The negative viral conversion rate was significantly higher in the experimental than in the control group (48.35 vs. 31.11%, p < 0.05). Subgroup analysis showed a similar significant trend when the Ct value was <= 30 at baseline. After 10 days, the hospital discharge rate was significantly higher in the experimental than in the control group (69.23 vs. 53.33%, p < 0.05). After 3-day medication, the headache symptoms significantly disappeared in the experimental (88.57%) compared to the control group (63.33%) (p < 0.05). After 5 days, the symptom disappearance rates of headache and cough were significantly higher in the experimental (97.14%) than in the control group (97.14 vs. 80.00, p < 0.05; 82.65 vs. 58.93%, p < 0.01, respectively). Posttreatment, the procalcitonin level was significantly lower in the experimental than in the control group (0.09 +/- 0.00 vs. 0.14 +/- 0.05 ng/L; p < 0.05). There were no significant between-group differences in clinical safety test indices. Early intervention with Liushen pill improved cough and headache and increased negative viral conversion and discharge rate.

Abstract Purpose The diagnosis of pulmonary hamartoma (PH) based on computed tomography (CT) is a challenge, especially in patients with atypical imaging characteristics. This study was aimed at summarizing the imaging characteristic of 18F-Fluoro-d-glucose positron emission tomography-computed tomography (18F-FDG PET-CT) in PH and exploring the application value of PET-CT in the diagnosis of PH. Data and methods Patients diagnosed with PH who had undergone PET-CT from literature pertaining were retrospectively analyzed, which were cases of publications from the Cochrane Library, PubMed, Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI) and Wanfang databases, from 2008 to June 2022. The other 20 cases of the collection were patients from our hospital from 2008 to June 2022. Patients’ symptoms, imaging characteristics of chest CT, PET-CT characteristics, the reason for PET-CT and the complications were analyzed. Results In this retrospective study, a total of 216 patients were diagnosed with PH and had been examined by PET-CT. 20 of the cases were patients of our hospital from January 2008 to June 2022. The other cases were collected from the literature. The mean diameter of most PH lesions is 1.7 ± 1.0 cm. The mean maximum standardized uptake value (SUVmax) of the PH lesions was 1.2 ± 1.1. Most of their SUVmax were lower than internationally recognized cut-off value (SUVmax = 2.5). PET-CT was superior to CT in the diagnosis of PH but there was a correlation of between CT diagnosis and PET-CT diagnosis for the PH lesions. In order to draw the Receiver operating characteristic (ROC), we selected 29 patients with a clear SUVmax value of their PH lesion, and 29 lung cancer patients with clear SUVmax value in our hospital were collected as a control group. ROC curve analysis showed that the area under curve (AUC) of SUVmax was 0.899, and the optimal diagnostic threshold was SUVmax > 2.65. PET-CT could distinguish PH from malignant lesions with a sensitivity of 89.66% by applying a SUVmax of 2.65 as a cut-off in this study. Conclusion PET-CT might be a useful tool to diagnose PH, which shows a better diagnostic sensitivity than CT. But PET-CT can not be used as a single diagnostic approach, which should be combined with other methods and the patients’ history to make the most correct diagnosis.

慢性阻塞性肺疾病是一种常见的肺部状态,以持续性气流受限及相应慢性呼吸道症状为特征.在全国流行病学调查中,我国20岁及以上成人慢性阻塞性肺疾病患病率为8.6%,40岁以上人群患病率高达13.7%,但仅有少数患者认识到病情,且仅有小部分患者接受过常规肺功能检查.这可能是因为对慢性阻塞性肺疾病认识不足、肺功能检查普及率低等原因.肺功能检查在慢性阻塞性肺疾病诊断的应用仍有较大普及和发展空间.

Severe Pneumocystis pneumonia (PCP) has a poor prognosis, and its early and precise diagnosis is difficult in immunocompromised individuals. Therefore, this study explored the diagnostic value of metagenomic next-generation sequencing (mNGS) of peripheral blood in diagnosing severe PCP in patients with hematological diseases. This prospective study analyzed the clinical manifestations, mNGS results (from the peripheral blood), traditional pathogen detection results, laboratory test results, chest computed tomography (CT) images, treatments, and outcomes of severe PCP in hematological patients who were hospitalized in the 2 centers of the Affiliated Hospital of Soochow University between September 2019 and October 2021. A total of 31 cases of hematological diseases complicated with pulmonary infections, including 7 cases of severe PCP diagnosed by mNGS performed on peripheral blood samples, were analyzed. Traditional pathogen detection methods for PCP cannot be used. In contrast, the laboratory readings for Pneumocystis jirovecii (Pj) detected within 48 hours of symptom onset by mNGS on the 7 blood samples ranged from 12 to 5873, with a median value of 43. Under the guidance of the mNGS results, preemptive antimicrobial therapy with trimethoprim/sulfamethoxazole alone or in combination with caspofungin was administered to treat Pj. After treatment, 4 patients recovered, and 3 patients died of acute respiratory failure and acute respiratory distress syndrome (ARDS). MNGS performed on peripheral blood samples is optional but can provide early recognition of severe PCP and help guide empirical treatment in critical hematological patients.

The diagnostic methods of conventional microbiological tests (CMTs) for severe community-acquired pneumonia (SCAP) may be too complicated or impossible to use in polymicrobial infections, and it may be difficult to identify unexpected pathogens. CMTs are also limited due to the early application of broad-spectrum or prophylactic antimicrobial drugs and the fastidious or slow-growing pathogenic microorganisms. The present study aimed to investigate the value of mNGS compared with CMTs in the clinical diagnosis of SCAP in immunocompromised individuals. Therefore, 37 patients diagnosed with SCAP in immunocompromised adult patients were enrolled from the Respiratory Intensive Care Unit of the First Affiliated Hospital of Soochow University (Soochow, China) between May 1, 2019, and March 30, 2022. A bronchoalveolar lavage fluid sample from each individual was divided in half. Half was sent to the microbiology laboratory directly for examination, and the other one was sent for DNA extraction and sequencing. In addition, other relevant specimens (such as blood) were sent for CMTs, including culture or smear, T-spot, acid-fast stain, antigen detection, multiplex PCR and direct microscopic examination. Based on a composite reference standard, the diagnostic outcomes were compared between CMTs and mNGS. Among the enrolled patients, 31 patients were diagnosed with microbiologically confirmed pneumonia, with 16 (43.2%) having monomicrobial infections, while 15 (40.5%) had polymicrobial infections. Fungi were the most common etiologic pathogens in immunosuppressive individuals. Pneumocystis jirovecii (45.9%) and Aspergillus spp. (18.9%) were the most common etiologic pathogens. Initial screening test validity of mNGS [sensitivity=96.8%; specificity=33.3%; positive predictive value (PPV)=88.2%; negative predictive value (NPV)=66.6%; likelihood ratio (LR)+, 1.45; LR-, 0.10) was higher compared with that of CMTs (sensitivity=38.7%; specificity=82.3; PPV=92.3%; NPV=20.8%; LR+, 2.3; LR-, 0.74). The total diagnostic accuracy of mNGS was superior to CMTs and it was statistically significantly different [86.5% (32/37) vs. 45.9% (17/37); P<0.001]. In conclusion, the total diagnostic accuracy of mNGS was superior to CMTs for SCAP in immunocompromised patients as an important diagnostic method.

Abstract Objective To analyze the efficacy and safety of Liushen Pill combined with basic treatment on patients with COVID-19.Methods One-hundred-eighty-one patients hospitalized with COVID-19, classified as asymptomatic, mild type, were randomly separated into the experimental (n=91) and control (n=90) groups. The control group was given placebo (Maizao decoction), while the experimental group was given Maizao decoction and Liushen pill, in addition to standard care. The negative conversion rate of nucleic acid (Day 7), hospital discharge rate (Day 8, 10, 14), symptom disappearance rate (Day 3, 5, 7), inflammatory cytokines and adverse events between the two groups were compared. Results The negative viral conversion rate in the experimental group was significantly higher than that in the control group (48.35% vs 31.11%, P＜0.05). Subgroup analysis showed a similar significant trend when the Ct value was ≤ 30 at baseline. After 10 days, the hospital discharge rate was significantly higher in the experimental than the control group (69.23% vs 53.33%, P＜0.05). After 3 days of medication, the headache symptoms significantly disappeared in the experimental group (88.57%) compared to the control group (63.33%) (P＜0.05). After 5 days, symptom disappearance rate of headache in the experimental group (97.14%) was still significantly higher than that in the control group (80.00%) (P＜0.05), as was the symptom disappearance rate of cough (82.65% vs 58.93%, P＜0.01). After treatment, the PCT level was significantly lower in the experimental than the control group (0.09±0.00 ng/L vs 0.14±0.05 ng/L) (P＜0.05). There were no significant between-groups differences in clinical safety test indexes.Conclusion Early intervention with Liushen Pill could improve the symptoms of cough and headache, and increase negative viral conversion and discharge rate.Trial registration Chinese Clinical Trial Registry, No. ChiCTR2200058859. Registered on April 18, 2022. https://www.chictr.org.cn/edit.aspx?pid=166975&htm=4

目的 探讨重症肺结核的临床特征及诊治要点.方法 总结苏州大学附属第一医院呼吸与危重症医学科1例肺结核死亡病例的临床特征、诊治经过及转归,同时检索Pubmed数据库2012年1月-2022年3月发表的对肺结核死亡病例进行分析、研究的相关文章.结果 患者女,25岁,因"间断咳嗽咳痰1年余,加重伴胸闷气短5 d"入院.既往无基础疾病.经结核菌涂片及肺泡灌洗液高通量测序技术诊断为肺结核,入院时处于休克代偿期,入院后迅速出现急性呼吸窘迫综合征,经积极抗结核、有创机械通气、主动脉内球囊反搏、连续肾脏替代治疗后,病情仍持续恶化,入院后第3天死亡.从数据库中检索到肺结核死亡病例269例.对其中244例患者的既往疾病史分析发现,年轻人以人类免疫缺陷病毒混合感染居首位,老年人以各种慢性病为主.269例患者均因感染性休克、呼吸衰竭及多器官功能障碍综合征最终死亡,其中低钠血症是不可忽视的并发症之一.患者从入院到死亡发生时间最短7 d,最长的平均时间仅为35 d.结论 肺结核可发展为感染性休克、多器官功能障碍综合征,重症肺结核预后不良,死亡率高.应加强结核病的健康宣教.

Background High-flow nasal cannula (HFNC) can improve ventilatory function in patients with acute COPD exacerbation. However, its effect on clinical outcomes remains uncertain. Methods This randomized controlled trial was conducted from July 2017 to December 2020 in 16 tertiary hospitals in China. Patients with acute COPD exacerbation with mild hypercapnia (pH ≥ 7.35 and arterial partial pressure of carbon dioxide > 45 mmHg) were randomly assigned to either HFNC or conventional oxygen therapy. The primary outcome was the proportion of patients who met the criteria for intubation during hospitalization. Secondary outcomes included treatment failure (intolerance and need for non-invasive or invasive ventilation), length of hospital stay, hospital cost, mortality, and readmission at day 90. Results Among 337 randomized patients (median age, 70.0 years; 280 men [83.1%]; median pH 7.399; arterial partial pressure of carbon dioxide 51 mmHg), 330 completed the trial. 4/158 patients on HFNC and 1/172 patient on conventional oxygen therapy met the criteria for intubation ( P = 0.198). Patients progressed to NPPV in both groups were comparable (15 [9.5%] in the HFNC group vs. 22 [12.8%] in the conventional oxygen therapy group; P = 0.343). Compared with conventional oxygen therapy, HFNC yielded a significantly longer median length of hospital stay (9.0 [interquartile range, 7.0–13.0] vs. 8.0 [interquartile range, 7.0–11.0] days) and a higher median hospital cost (approximately $2298 [interquartile range, $1613–$3782] vs. $2005 [interquartile range, $1439–$2968]). There were no significant differences in other secondary outcomes between groups. Conclusions In this multi-center randomized controlled study, HFNC compared to conventional oxygen therapy did not reduce need for intubation among acute COPD exacerbation patients with mild hypercapnia. The future studies should focus on patients with acute COPD exacerbation with respiratory acidosis (pH < 7.35). However, because the primary outcome rate was well below expected, the study was underpowered to show a meaningful difference between the two treatment groups. Trial registration : NCT03003559 . Registered on December 28, 2016.