Background Interstitial lung disease (ILD) is a major pulmonary complication of idiopathic inflammatory myopathy (IIM), where early diagnosis improves outcomes. While high-resolution CT (HRCT) remains the gold standard, its radiation exposure poses concerns. Serum Krebs von den Lungen-6 (KL-6) and lung ultrasound (LUS) B-lines offer non-invasive alternatives, though their optimal diagnostic cut-offs and combined utility for IIM-ILD remain undefined. This study aimed to establish these cut-offs, evaluate diagnostic performance and develop a clinical prediction model.Methods In this single-centre observational study, 162 patients diagnosed with IIM between 2020 and 2024 were enrolled. All underwent serum KL-6 testing, and 120 received systematic 50-point LUS examinations. Using HRCT as the reference standard for ILD diagnosis, receiver operating characteristics (ROC) curve analysis was used to determine optimal cut-offs and construct a combined nomogram.Results KL-6 levels were significantly elevated in the ILD group (n=113) compared with non-ILD (n=49). The optimal KL-6 cut-off was 553 U/mL (area under the curve (AUC)=0.895, sensitivity 69%, specificity 95.9%). For LUS B-lines number, 25 was recommended as the clinical threshold (sensitivity 98.8%). Their combination enhanced diagnostic performance (AUC=0.984). An online prediction model demonstrated strong clinical applicability. In an exploratory analysis of the rapid-progressive ILD subgroups, KL-6 and B-lines showed only modest predictive value (AUC ≈ 0.65).Conclusion KL-6 ≥553 U/mL and B-lines ≥25 are effective screening thresholds, with combined use significantly improving diagnostic accuracy. The prediction model provides a practical tool for early identification in similar clinical settings. To optimise and generalise its use, external validation in multicentre cohorts is warranted.

Background Lung cancer incidence and mortality continue to rise in China, highlighting the need for a deeper understanding of its epidemiology and optimal screening targets. Methods A total of 10,560 participants with 5–30 mm pulmonary nodules incidentally detected via low-dose computed tomography (LDCT)/CT were enrolled from 23 hospitals (October 2018–May 2021) and followed for 2–3 years for evaluation of circulating tumor DNA (ctDNA) biomarkers to distinguish malignant and benign nodules. Demographic, clinical, and imaging data were collected and analyzed. Lung cancer risk factors were assessed using stepwise single and multiple-factor binary logistic regression. This study reports only the baseline epidemiological characteristics of the population and the associated risk factors of lung cancer. Results A higher proportion of females (56.56%) were present across all age groups, with a median age of 53 years (45–62), younger than males (55 years [46–63], P < 0.001). While 97.1% of females and 37.8% of males were non-smokers, and 68.65% of participants had no occupational exposure, 71.10% had a history of second-hand smoke exposure. Most nodules were solitary (81.24%), sub-centimeter (78.22%), and non-solid (62.49%). Malignancy was identified in 17.33% of nodules, with 97.32% classified as early-stage lung adenocarcinoma (AJCC stage 0–I: 90.35%). The malignant rate increased with age and nodule size and was also associated with multiple nodules, ground-glass nodules (GGNs), upper lobe location, and female sex. Proportion of patients with malignant nodules was similar between non-high-risk (21.04%) and high-risk (17.92%) groups based on current Chinese screening guidelines, while proportions of benign nodules were notably high for solid nodules (37.21%) and small nodules (20.15%). Conclusion Our large-scale investigation provides updated data to guide future precise clinical management of pulmonary nodules, with a particular focus on younger females and reducing overtreatment.

Background: Following the 2021 first International Consensus on Severe Lung Cancer, global attention to patients with PS 2-4 has grown significantly. Recent advances in novel therapies, interventional techniques, and supportive care, along with emerging real world data, have expanded treatment opportunities for this population. To incorporate these advances, we have updated the consensus. Methods: A multidisciplinary panel comprising experts from oncology, radiation oncology, thoracic surgery, radiology, interventional medicine, respiratory medicine, critical care medicine, and nursing. After being presented with a comprehensive review of the current evidence pertaining to severe lung cancer and thorough discussions, the panel reached a consensus on 11 recommendations, each with over 70% expert agreement. Results: The 11 consensus points focused on definition and causes (n=2), assessment and general strategies (n=4), and specific treatment modalities (n=5) were updated or newly developed. This updated consensus emphasizes dynamic and precise detection, robust life support, flexible application of novel therapies, and MDT guided treatment adjustment based on PS dynamics. Early rehabilitation and comprehensive supportive care are integral to disease management. Conclusions: This consensus updates the definition, diagnostic evaluation, and treatment strategies, providing a practical framework for clinicians based on current evidence and multidisciplinary expert consensus. Prospective trials focusing specifically on patients with severe lung cancer are urgently needed.

OBJECTIVES:To develop a user-friendly nomogram-based predictive model for interstitial lung disease (ILD) in patients with idiopathic inflammatory myositis (IIM). METHODS:A retrospective study was conducted at Shantou Central Hospital, encompassing 205 IIM patients diagnosed between January 2013 and December 2022. We used the LASSO regression method in the discovery set to select features for model construction, followed by efficacy verification through AUC of ROC. Afterwards, KL-6 values and LUS B-lines number were added into this model to evaluate whether these 2 factors added to the model efficiency. Finally, a web version was constructed to make it more available. RESULTS:Among the 205 IIM patients, 115 (56.1%) patients were diagnosed with ILD, and 90 (43.9%) did not. The predictive model, derived from the training set, comprised four independent risk factors, including age, presence of respiratory symptoms, anti-melanoma differentiation-associated gene 5 (MDA-5) antibody positivity, and anti-aminoacyl transfer RNA synthetase (anti-ARS) antibodies positivity. Notably, anti-TIF1-γ antibody positivity emerged as a protective factor. The AUC of the ROC based on these 5 factors was 0.876 in the training set and 0.861 in the validation set. The AUC of the ROC based on the 5 factors plus KL-6 was 0.922, 5 factors plus B-line number was 0.949 and 5 factors plus both KL-6 and B-line number was 0.951. Accordingly, a nomogram and a web version were developed. CONCLUSIONS:This predictive model demonstrates robust capability to assess ILD risk in IIM patients, particularly when augmented with serum KL-6 level or/and LUS B-line number.

Review question / Objective: To conduct a meta-analysis and systematic review on the association between anticholinergic medication uses and the risk of pneumonia in elderly adults. Condition being studied: Because of the widespread use of anticholinergic medication, several epidemiological studies have investigated the association between anticholinergic medication uses and the risk of pneumonia. These studies had been heterogeneous with regard to study design, methodologies, countries and the results were inconsistent. Overall, all of the previous investigations were observational cohort of case-control studies which lacked powerful statistical evidence to assess the relationship between the risk of pneumonia and anticholinergic medication. In the absence of randomized clinical trials, we therefore carried out present meta-analysis and systemic review to summarize the results of all existing studies and to ascertain the risk of pneumonia associated with exposure to anticholinergic medication uses.

Background:Malignant mesothelioma (MM) is a rare cancer with poor prognosis. It is less common that two serosal cavities are involved when the patient seeks medical attention firstly. The current first-line chemotherapy for advanced MM is a combination with cisplatin and pemetrexed. However, nedaplatin, a second-generation platinum-based antitumor agent, has the similar therapeutic effects as cisplatin but lower toxicity and higher water solubility. To our knowledge, this is the first case of co-existing pericardial and pleural MM treated with nedaplatin and pemetrexed and responding well.Case Description:A 33-year-old woman, who had worked in a kiln for more than 10 years, suffered from dyspnea and chest tightness for 6 days. Chest computed tomography (CT) showed a massive pericardial effusion. She was diagnosed tuberculous pericarditis and received 6 months antituberculosis treatment (rifampicin, isoniazide, pyrazinamide, ethambutol). But it was ineffective and she was re hospitalized again due to massive pleural effusion and pericardial effusion. She was diagnosed with co-existing pericardial and pleural MM finally based on pleural biopsy and cytology of pericardial effusion. She was responding well excitedly to chemotherapy with nedaplatin and pemetrexed with high tolerance. Bone marrow toxicity or recurrent massive pericardial or pleural effusion were not observed during chemotherapy. However, she gave up chemotherapy and has survived for 22 months, from the onset symptoms.Conclusions:In terms of clinical tolerance and less adverse reactions, we suggest that chemotherapy of nedaplatin with pemetrexed may be a more appropriate treatment in advanced MM. Further clinical trials are warrant.

Objective:To explore the effect of case management of chronic obstructive pulmonary disease (COPD) in the nurse-led clinics.Methods:A total of 50 patients with COPD who met the selection criteria in the outpatient department of the respiratory department of Shantou Central Hospital were enrolled from March 2019 to March 2020. Case management was carried out by specialist nurses in the outpatient department. Body Mass Index (BMI), the forced expiratory volume in one second/predicted value ratio (FEV 1%pred), modified British medical research council (mMRC), 6-min walking distance (6MWD), COPD assessment test (CAT), and St.George Respiratory Questionnaire (SGRQ), basic activities of daily living (BADL) were compared before and after 6 months′ case management. The difference of medication compliance after case management was also analyzed. Results:There were statistically significant differences in the mMRC[(1.9±1.2) vs (1.4±1.1) points], 6MWD[(238.1±84.9) vs (284.1±113.8) m] and CAT scores [(19.7±6.6) vs (17.1±5.9) points], which suggested the improvement of dyspnea, self-conscious symptoms and exercise performance in these patients (all P<0.05). The BADL scores [(87.8±5.4) vs (90.00±7.5) points] and the total score of SGRQ [(48.0±7.3) vs (45.0±6.9) points] were significantly different (both P<0.01). These indicators were improved after the implementation of case management. Patients were followed up for 1 month, 3 months and 6 months, and the improvement of medication compliance score was statistically significant [(7.1±0.8) vs (7.4±0.8) vs (7.7±0.5) points] ( P<0.01). Conclusion:The implementation of respiratory nursing clinic can effectively manage COPD patients, improve medication compliance of patients, so as to improve the degree of dyspnea, self-conscious symptoms, self-care ability and exercise endurance of patients.

Molecularly-targeted agents are still urgently needed for better non-small cell lung cancer (NSCLC) therapy. CC-115 is a potent DNA-dependent protein kinase (DNA-PK) and mammalian target of rapamycin (mTOR) dual blocker. We evaluated its activity in different human NSCLC cells. In various primary human NSCLC cells and A549 cells, CC-115 potently inhibited viability, cell proliferation, cell cycle progression, and hindered cell migration/invasion. Apoptosis was provoked in CC-115-stimulated NSCLC cells. The dual inhibitor, however, was unable to induce significant cytotoxic and pro-apoptotic activity in the lung epithelial cells. In primary NSCLC cells, CC-115 blocked activation of mTORC1/2 and DNA-PK. Yet, CC-115-induced primary NSCLC cell death was more potent than combined inhibition of DNA-PK plus mTOR. Further studies found that CC-115 provoked robust oxidative injury in primary NSCLC cells, which appeared independent of mTOR-DNA-PK dual blockage. In vivo studies showed that CC-115 oral administration in nude mice remarkably suppressed primary NSCLC cell xenograft growth. In CC-115-treated NSCLC xenograft tissues, mTOR-DNA-PK dual inhibition and oxidative injury were detected. Together, CC-115 potently inhibits NSCLC cell growth.

目的 分析汕头地区成人血流感染(loodstream infection,BSI)患者的临床特点、病原菌分布和耐药情况,为本地区临床正确使用抗菌药治疗BSI提供依据.方法 选取汕头市中心医院2017年1月-2019年12月急诊和住院成人血培养阳性并确诊为BSI的患者,回顾性分析BSI患者的临床特点、病原菌分布及耐药性.结果 共有成人BSI患者2040例,其中男1032例,女1008例,年龄18～98岁,平均年龄(62.23±15.91)岁,其中60岁以上占61.13％.绝大多数患者存在1种或以上基础疾病,以2型糖尿病最为常见.总共分离出BSI非重复病原菌2166株,其中,67例患者存在混合感染.病原菌分离数量最多的前3位科室依次为急诊科、血液科和肾内科.分离菌株中,革兰阴性菌1397株,占64.50％,革兰阳性菌726株,占33.52％,真菌43株,占1.98％.居前8位病原菌依次为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌、草绿色链球菌、鲍曼不动杆菌、肠球菌属和铜绿假单胞菌.有44.09％的大肠埃希菌和15.65％的肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs);耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)和金黄色葡萄球菌(MRSA)的检出率分别为72.53％和43.92％.大肠埃希菌和肺炎克雷伯菌对阿米卡星、头孢西丁、β-内酰胺类/β-内酰胺酶抑制剂复方制剂、替加环素和碳青霉烯类具有较高敏感性.鲍曼不动杆菌具有较严重的多重耐药性,而铜绿假单胞菌对多种抗菌药均具有较高的敏感性.未发现耐万古霉素的葡萄球菌和肠球菌属.草绿色链球菌对头孢曲松、喹诺酮类、万古霉素和利奈唑胺具有高度敏感性.结论 本地区成人BSI以老年患者居多,绝大多数患者存在1种或以上基础疾病,病原菌以革兰阴性菌为主,不同病原菌耐药性不同,定期开展BSI病原学监测,可为临床正确使用抗菌药提供帮助.

Background: Bisphenol A (BPA) is a plasticizer with high production and ubiquitous usage in polycarbonate plastics and epoxy resins. The association between prenatal or postnatal exposure to BPA and childhood wheeze/asthma has not been well established. Our study aimed to provide further justification for the current studies. Methods: Studies were searched from PubMed, Web of Science, Scopus and Embase from inception until Sep 15, 2020. Meta-analysis was performed to calculate pooled adjusted odds ratios (aOR). The methodological quality of included studies was assessed by using the Newcastle Ottawa Scale (NOS). Results: Of 2,814 screened articles, 9 studies with 3,885 participants were included in the final analysis. When all studies were pooled, postnatal exposure to BPA was associated with a higher risk of childhood asthma (aOR = 1.43; 95% CI: 1.28-1.59) or childhood wheeze (aOR =1.38; 95% CI: 1.18-1.62). Prenatal exposure to BPA had a small but significant increased risk of childhood asthma (aOR = 1.17; 95% CI: 1.011.34). An increased risk of childhood wheeze was related to prenatal exposure to BPA at 16 weeks' gestation (aOR = 1.29; 95% CI: 1.07-1.55), but not at 26 weeks' gestation (aOR = 1.07; 95% CI: 0.88-1.29) nor at random-time gestation (aOR = 1.02; 95% CI: 0.89-1.16). Conclusions: Prenatal and postnatal exposure to BPA was related to an increased risk of childhood asthma. However, only postnatal and early gestational exposure (at 16 weeks) to BPA could induce the risk of childhood wheeze, but not late gestational exposure (at 26 weeks).

AbstractObjectivesThe aim of the study was to analyze the incidence of COVID-19 with early renal injury, and to explore the value of multi-index combined detection in diagnosis of early renal injury in COVID-19.DesignThe study was an observational, descriptive study.SettingThis study was carried out in a tertiary hospital in Guangdong, China.Participants12 patients diagnosed with COVID-19 from January 20, 2020 to February 20, 2020.Primary and secondary outcome measuresThe primary outcome was to evaluate the incidence of early renal injury in COVID-19. In this study, the estimated glomerular filtration rate (eGFR), endogenous creatinine clearance (Ccr) and urine microalbumin / urinary creatinine ratio (UACR) were calculated to assess the incidence of early renal injury. Secondary outcomes were the diagnostic value of urine microalbumin (UMA), α1-microglobulin (A1M), urine immunoglobulin-G (IGU), urine transferring (TRU) alone and in combination in diagnosis of COVID-19 with early renal injury.ResultsWhile all patients had no significant abnormalities in serum creatinine (Scr) and blood urea nitrogen (BUN), the abnormal rates of eGFR, Ccr, and UACR were 66.7%, 41.7%, and 41.7%, respectively. Urinary microprotein detection indicated that the area under curve (AUC) of multi-index combined to diagnose early renal injury in COVID-19 was 0.875, which was higher than UMA (0,813), A1M (0.813), IGU (0.750) and TRU (0.750) alone. Spearman analysis showed that the degree of early renal injury was significantly related to C-reactive protein (CRP) and neutrophil ratio (NER), suggesting that the more severe the infection, the more obvious the early renal injury. Hypokalemia and hyponatremia were common in patients with COVID-19, and there was a correlation with the degree of renal injury.ConclusionsEarly renal injury was common in patients with COVID-19. Combined detection of UMA, A1M, IGU, and TRU was helpful for the diagnosis of early renal injury in COVID-19.

目的 探讨慢性阻塞性肺疾病(COPD)并痰结核分枝杆菌阴性肺结核患者多种无创辅助检查对疾病诊断的临床价值.方法 选取诊断为COPD并肺结核患者376例,以痰结核分枝杆菌涂片为分组依据,比较两组间血常规、血沉、C-反应蛋白、降钙素原、T-SPOT.TB、TST等常见无创辅助检查方法,分析对疾病的诊断效能.结果 入选患者337例,其中菌阳组59例、菌阴组278例,菌阴组C-反应蛋白、降钙素原、血沉水平均高于菌阳组(P<0.05);菌阴组TST阳性率高于菌阳组(70.6％vs 15.1％,P<0.05).菌阴组TST敏感度85.61％,T-SPOT.TB敏感度95.68％.结论 C-反应蛋白、降钙素原、血沉水平升高和TST阳性结局与T-SPOT.TB检验结果可为临床诊断COPD并肺结核提供参考依据.

OBJECTIVE:As a result of the pandemic of COVID-19, the public have been experiencing psychological distress. However, the prevalence of psychological distress during the COVID-19 pandemic remains unknown. Our objective was to evaluate the prevalence of psychological distress during COVID-19 outbreak and their risk factors, especially their internal paths and causality. METHODS:A nationwide cross-sectional survey of the prevalence of mental disorders was conducted. We used Hospital Anxiety and Depression Scale (HADS) to estimate the prevalence of anxiety and depression. The internal paths and the causality of the psychological health were analyzed using a structural equation modeling (SEM) approach. RESULTS:A total of 24,789 respondents completed the survey. We found that the overall prevalence of anxiety, depression, combination of anxiety, and depression were 51.6% (95% CI: 51.0-52.2), 47.5% (95% CI: 46.9-48.1), and 24.5% (95% CI: 24.0-25.0), respectively. The risk of psychological disorders in men was higher than that in women. The status of psychological health was different across different age groups, education levels, occupations, and income levels. The SEM analysis revealed that inadequate material supplies, low income, low education, lack of knowledge or confidence of the epidemic, and lack of exercise are major risk factors for psychological distress. CONCLUSIONS:The evidence from this survey poses serious challenges related to the high prevalence of psychological distress, but also offers strategies to deal with the mental health problems caused by the COVID-19 pandemic.

目的 探讨血清25-羟维生素D(25-OH-D)水平与慢性阻塞性肺疾病(COPD)急性加重期患者免疫炎症指标、COPD评估测试(CAT)评分的相关性.方法 于2018年1月至2020年3月,选择汕头市中心医院呼吸内科住院的COPD急性加重期患者(急性加重期组)、门诊随访的COPD稳定期患者(稳定期组)和健康体检者(对照组)各30例.对各组研究对象的血清25-OH-D、T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)、IgA、IgG、IgM、C反应蛋白(CRP)和降钙素原(PCT)水平进行测定和比较;对急性加重期组和稳定期组患者进行CAT评分和比较;同时分析急性加重期组患者血清25-OH-D水平与免疫炎症指标和CAT评分的相关性.结果 ①急性加重期组血清25-OH-D水平低于稳定期组和对照组(P<0.05);其25-OH-D缺乏的患病率高于后两组(P<0.05);稳定期组和对照组比较,这两项指标差异均无统计学意义(P>0.05).②急性加重期组血清CD3+、CD4+、CD4+/CD8+水平低于稳定期组和对照组(P<0.05),CD8+高于后两组(P<0.05);稳定期组和对照组比较,这些指标虽然有差异,但无统计学意义(P>0.05).3组间血清IgA、IgG、IgM水平差异无统计学意义(P>0.05).③急性加重期组血清CRP和PCT水平高于稳定期组和对照组(P<0.05),稳定期组高于对照组(P<0.05).④急性加重期组患者的CAT评分高于稳定期组患者(P<0.05);⑤急性加重期组患者的血清25-OH-D水平与CD4+/CD8+呈正相关(r=0.524,P<0.05),与CRP、PCT和CAT评分呈负相关(r=-0.221、-0.368、-0.323,P均<0.05).结论 COPD急性加重期患者普遍存在维生素D缺乏、细胞免疫功能下降、炎症反应加剧和生活质量下降,且血清25-OH-D水平与免疫炎症指标和CAT评分存在一定相关性.

目的 分析经鼻高流量氧疗在慢性阻塞性肺疾病(COPD)急性加重期并II型呼吸衰竭患者中的应用.方法 研究选取2019年3月～2020年1月院内收治的60例COPD急性加重期合并II型呼吸衰竭患者作为研究对象,随机分为治疗组和对照组后,分别接受经鼻高流量氧疗和无创正压通气(NIPPV)治疗,对比两组患者的临床治疗效果.结果 两组患者的的总有效率相比并无明显差异(P>0.05);两组患者治疗前后的血气指标相比无明显差异(P>0.05),但两组患者治疗后的血气指标均优于治疗前(P<0.05);治疗组的耐受良好率为93.33％,高于对照组的70.00％(P<0.05).结论 经鼻高流量氧疗在COPD急性加重期合并II型呼吸衰竭患者中发挥出了确切的疗效,可以有效改善患者的血气指标,且患者耐受性较好,宜广泛应用与推广.

目的 探讨肺诺卡菌病的特点,为临床诊治提供帮助.方法 收集汕头市中心医院2017年1月-2019年7月确诊为肺诺卡菌病患者的临床资料进行回顾性分析.结果 12例肺诺卡菌病患者中,男5例,女7例,年龄26～89岁,平均(65.0±17.8)岁;均伴有多种基础疾病,其中,支气管扩张6例,肺结核3例,慢性阻塞性肺疾病2例,血液系统恶性肿瘤2例,糖尿病1例,自身免疫性疾病1例.临床表现主要有咳嗽、咯痰、发热、气促、咯血等.胸部影像学可同时出现多种表现,其中阴影呈斑片状8例,团块状6例,结节状4例,肺实变1例,空洞形成1例.实验室检查均有白细胞和中性粒细胞升高.确诊通过痰培养11例,支气管肺泡灌洗液培养1例,确诊时间为5～21 d,平均(10.6±4.4)d.药敏试验结果显示对甲氧苄啶-磺胺甲唑、利奈唑胺、米诺环素、亚胺培南和头孢曲松具有较高的敏感率.应用甲氧苄啶-磺胺甲唑联合β内酰胺类或喹诺酮类治疗的5例患者,病情均好转;7例应用β内酰胺类或喹诺酮类,其中5例好转,2例病情恶化.结论 肺诺卡菌病易发生在患有结构性肺病和免疫功能低下的入群,临床症状、胸部影像学和实验室检查均缺乏特异性,标本培养诺卡菌阳性是诊断该病的关键,但报告时间较长.治疗应以甲氧苄啶-磺胺甲唑为主的联合治疗,改善预后.

BACKGROUND:Lung nodules are a diagnostic challenge. Current clinical management of lung nodule patients is inefficient and therefore causes patient misclassification, which increases healthcare expenses. However, a precise and robust lung nodule classifier to minimize discomfort for patients and healthcare costs is still lacking. The aim of the present protocol is to evaluate the effectiveness of using a liquid biopsy classifier to diagnose nodules compared to physician estimates and whether the classifier can reduce the number of unnecessary biopsies in benign cases.METHODS:A prospective cohort of 10,560 patients enrolled at 23 clinical centers in China with non-calcified pulmonary nodules, ranging from 0.5 to 3 cm in diameter, indicated by LDCT or CT will be included. After signed consent forms, the participants' pulmonary nodules will be assessed using three evaluation tools: (I) physician cancer probability estimates (II) validated lung nodule risk models, including Mayo Clinic and Veteran's Affairs models (III) ctDNA methylation classifier previously established. Each patient will undergo LDCT/CT follow-ups for 2 to 3 years and their information and one blood sample will be collected at baseline, 3, 6, 12, 24 and 36 months. The primary study outcomes will be the diagnostic accuracy of the methylation classifier in the cohort. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) will be used to compare the diagnostic value of each testing tool in differentiating benign and malignant pulmonary nodules.DISCUSSION:We are conducting an observational study to explore the accuracy of using a ctDNA methylation classifier for incidental lung nodules diagnosis.TRIAL REGISTRATION:Clinicaltrials.gov NCT03651986.

Objective: The aim of the study was to analyze the characteristics of renal function in patients diagnosed with COVID-19. Methods: In this retrospective, single-center study, we included all confirmed cases of COVID-19 in a tertiary hospital in Guangdong, China from January 20, 2020 to March 20, 2020. Blood and urine laboratory findings related to renal function were summarized, and the estimated glomerular filtration rate (eGFR) and endogenous creatinine clearance (Ccr) were also calculated to assess the renal function. Results: A total of 12 admitted hospital patients were diagnosed with COVID-19, included 3 severe cases, and 9 common cases. Serum creatinine (Scr) was not abnormally elevated in all of the patients, and blood urea nitrogen (BUN) was abnormally elevated in only 25.0% of the patients. However, compared with the recovery period, the patient's Scr and BUN increased significantly in peak of disease (p-scr = 0.002 & p-bun < 0.001). By observing the fluctuations in Scr and BUN from admission to recovery, it was found that the peak of Scr and BUN appeared within the first 14 day of the course of the disease. Urinary microprotein detection indicated that the abnormally elevated rates of urine microalbumin (UMA), α1-microglobulin (A1M), urine immunoglobulin-G (IGU), and urine transferring (TRU) standardized by urinary creatinine in peak of disease were 41.7, 41.7, 50.0, and 16.7%, respectively. The abnormal rates of the calculated eGFR and Ccr were 66.7 and 41.7%. Conclusion: Scr and BUN were generally increased during the course of COVID-19. Detection of urinary microproteins and application of multiple indicators assessment could be helpful for discovering abnormal renal function in patients with COVID-19. However, the evidence is limited due to the small sample size and observational nature. Additional studies, especially large prospective cohort studies, are required to confirm these findings.

Objective To investigate the diagnostic value of Wells score combined with age-adjusted D-dimer (AADD) standard in acute pulmonary embolism (APE) in inpatients.Methods A total of 555 inpatients (over 50 years old) with suspected APE from Shantou Central Hospital during October 2010 and November 2018 were divided into low risk groups (Wells score ＜ 2),intermediate risk groups (Wells score 2-6) and high risk groups (Wells score＞ 6)according to Wells criteria,with spiral CT pulmonary angiography (CTPA) as the diagnostic mehtod of APE.Meanwhile,the plasma concentration of D-dimer was detected and analyzed by immunoturbidimetry in all patients.The AADD cut-off value was (a patint's age× 10) μg/L.Then the sensitivity,specificity,positive predictive value (PPV) and negative predictive value(NPV) of Wells criteria,AADD and their combination for APE diagnosis were calculated and compared respectively.Results Out of 555 cases,213 cases were diagnosed as APE by the CTPA.There were 290,224 and 41 suspected cases which had low,medium and high Wells score respectively.The sensitivity,specificity,PPV and NPV of APE diagnosis for low,medium and high Wells score were 24.41％,57.28％ and 18.31％,30.41％,70.18％ and 99.42％,17.93％,54.46％ and 95.12％,82.07％,45.54％ and 4.88％,respectively.The sensitivity,specificity,PPV and NPV of AADD were 89.20％,40.06％,48.10％ and 85.63％ respectively.Combinning a low risk Wells score with a negative AADD improved the NPV to 93.04％.Conclusions Patients with low Wells score and negative AADD may have higher clinical value in eliminating suspected APE.

目的 对比经鼻高流量氧疗(HFNC)和无创通气(NIV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)的疗效,探讨HFNC治疗AECOPD的可行性.方法 回顾性分析82例中度(Ⅱ级)AECOPD患者,其中43例使用HFNC呼吸支持治疗,39例使用NIV呼吸支持治疗,观察两组治疗临床缓解率及动脉血二氧化碳分压(PaCO2)、氧合指数等指标.结果 全组患者治疗前与治疗后72 h PaCO2[(58.6±10.6) mmHg vs(46.1±9.4) mmHg,P=0.016]及氧合指数[(149.3±20.8)mmHg vs(200.8±20.6)mmHg,P=0.024]均有改善,差异有统计学意义;而分组治疗,HFNC组与NIV组患者治疗后24h的PaCO2和氧合指数,72 h的PaCO2和氧合指数,两组间差异无统计学意义(P＞0.05).HFNC组治疗第3、5、7天临床缓解率分别6.98％、34.88％及62.79％,NIV组则分别为10.25％、46.15％及76.92％,但两组差异无统计学意义(P=0.36).结论 HFNC对中度AECOPD患者的呼吸支持治疗,与NIV具有类似的效果.