OBJECTIVES:Systematic evaluations of targeted next-generation sequencing (tNGS) for lower respiratory tract infections (LRTIs) remain limited. This study assesses tNGS diagnostic performance and clinical utility. METHODS:We prospectively analyzed bronchoalveolar lavage fluid (BALF) from 1251 patients with LRTIs, comparing tNGS results against conventional culture and galactomannan (GM) testing. RESULTS:tNGS achieved a significantly higher pathogen positivity rate than culture (95.6% vs 25.7%, p < 0.0001), with an agreement of 25.2%; stratified agreement was 50.9% for bacteria and 63.5% for fungi. For bacterial targets, tNGS showed 92% positive percent agreement (PPA) and 92% negative percent agreement (NPA); fungal targets showed 74% PPA and 95% NPA. For AMR determinants, the PPA and NPA relative to phenotypic resistance were 72% and 79%, respectively; PPA was 71% for carbapenem resistance and 100% for mecA/C. Higher semiquantitative tNGS levels were significantly associated with culture positivity overall and for bacterial and fungal targets. Clinically adjudicated PPV was 80.3% for tNGS-positive findings, with higher PPV for bacterial than fungal targets (77.3% vs 18.2%). Overall concordance between tNGS and GM for Aspergillus was 84.2%. tNGS positively influenced clinical outcomes in 69.6% of patients and prompted antibiotic adjustments in 42.7%. CONCLUSIONS:In LRTIs, tNGS is significantly more sensitive than culture with high qualitative accuracy. Although it effectively guides clinical decision-making, caution is warranted when using tNGS to predict carbapenem resistance or to initiate antifungal therapy.

During the coronavirus disease 2019 (COVID-19) pandemic, the exploration of microecology has been essential for elucidating the intricacies of infection mechanisms and the recovery of afflicted individuals. To decipher the interplay of microorganisms between the intestinal and respiratory tracts, we collected sputum and throat swabs and feces from COVID-19 patients and explored the mutual migration among intestinal and respiratory microorganisms. Using next-generation sequencing (NGS) technology, we investigated intestinal and respiratory microorganism intermigration in two patients with severe COVID-19 during their hospitalization. Notably, we observed an expedited recovery of microecological equilibrium in one patient harboring Mycobacterium avium. Comparative analyses between 32 healthy controls and 110 COVID-19 patients with different disease severities revealed alterations in predominant microorganisms inhabiting the respiratory and intestinal tracts of COVID-19 patients. Among the alterations, intestinal Bacteroides vulgatus (BV) was identified as a noteworthy microorganism that exhibited marked enrichment in patients with severe COVID-19. BV, when highly abundant, may inhibit the transitional growth of Escherichia coli/Enterococcus, indirectly prevent the overgrowth of salivary streptococci, and maintain lung/intestinal microecology stability. In summary, this study elucidates the bidirectional microbial intermigration between the intestinal and respiratory tracts in COVID-19 patients. These findings are expected to provide new ideas for the treatment and management of COVID-19, underscoring the essential role of microecology in infectious diseases. Nevertheless, a systematic study of the roles of BV in recovery from infection is required to gain a deeper understanding of the mechanisms of microbial migration.

BACKGROUND:Existing panels for lower respiratory tract infections (LRTIs) are slow and lack quantification of important pathogens and antimicrobial resistance, which are not solely responsible for their complex etiology and antibiotic resistance. BioFire FilmArray Pneumonia (PN) panels may provide rapid information on their etiology.METHODS:The bronchoalveolar lavage fluid of 187 patients with LRTIs was simultaneously analyzed using a PN panel and cultivation, and the impact of the PN panel on clinical practice was assessed. The primary endpoint was to compare the consistency between the PN panel and conventional microbiology in terms of etiology and drug resistance, as well as to explore the clinical significance of the PN panel. The secondary endpoint was pathogen detection using the PN panel in patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).RESULTS:Fifty-seven patients with HAP and 130 with CAP were included. The most common pathogens of HAP were Acinetobacter baumannii and Klebsiella pneumoniae, with the most prevalent antimicrobial resistance (AMR) genes being CTX-M and KPC. For CAP, the most common pathogens were Haemophilus influenzae and Staphylococcus aureus, with the most frequent AMR genes being CTX-M and VIM. Compared with routine bacterial culture, the PN panel demonstrated an 85% combined positive percent agreement (PPA) and 92% negative percent agreement (NPA) for the qualitative identification of 13 bacterial targets. PN detection of bacteria with higher levels of semi-quantitative bacteria was associated with more positive bacterial cultures. Positive concordance between phenotypic resistance and the presence of corresponding AMR determinants was 85%, with 90% positive agreement between CTX-M-type extended-spectrum beta-lactamase gene type and phenotype and 100% agreement for mecA/C and MREJ. The clinical benefit of the PN panel increased by 25.97% compared with traditional cultural tests.CONCLUSION:The bacterial pathogens and AMR identified by the PN panel were in good agreement with conventional cultivation, and the clinical benefit of the PN panel increased by 25.97% compared with traditional detection. Therefore, the PN panel is recommended for patients with CAP or HAP who require prompt pathogen diagnosis and resistance identification.

The clinical features, laboratory tests, imaging findings, treatment and outcomes of 26 non-HIV infection patients with Pneumocystis jirovecii pneumonia (PJP) diagnosed in our hospital from January 2017 to February 2022 were retrospectively analyzed. There were 19 males and 7 females, with an average age of 44(30, 51)years. All patients had underlying diseases of immunosuppression. The main symptoms included fever in 18 cases (69.2%), cough in 15 cases (57.7%), shortness of breath in 11 cases(42.3%). The laboratory test results showed elevated levels of CRP in 22 cases (95.7%), PCT in 18 cases (78.3%), lactate dehydrogenase in 17 cases (17/19), G test in 14 cases (14/20), and decreased CD4 +T cell count in 14 cases (14/19). Pneumocystis jirovecii pathogen was detected in bronchoalveolar lavage fluid in 16 cases (61.5%), in blood samples in 10 cases (38.5%). Pneumocystis jirovecii was not detected in sputum or bronchoalveolar lavage fluid using smear microscopy. Chest CT showed ground-glass opacity in 25 cases (96.1%). All patients received compound sulfamethoxazole tablet, 21 patients (80.8%) were also treated with other anti-fungal drugs. Among the 26 patients, 1 case (3.9%) received extra-corporeal membrane oxygenation (ECMO), 5 cases (19.2%) received non-invasive ventilation, 7 cases (27.0%) received invasive ventilation, and 13 cases (50.0%) received nasal cannula oxygen therapy. Of the 26 cases, 19 cases(73.1%)developed severe pneumonia. Finally, 21 patients (80.8%) improved and discharged, and 5 patients (19.2%) died. In conclusion, non-HIV infection patients with Pneumocystis jirovecii pneumonia were mainly middle-aged or elderly people with underlying diseases of immunosuppression. The clinical symptoms are mainly fever, cough, and shortness of breath. The imaging manifestations are mainly ground-glass opacity and consolidation opacity. Laboratory tests show elevated CRP, PCT, LDH, and G tests, and decreased CD4 +T cells. Compound sulfamethoxazole-based comprehensive treatment is effective for PJP. The disease is characterized by high proportion of severe pneumonia, fast remission and high risk of mortality.

Enhanced invasion and migration of non-small cell lung cancer (NSCLC) cells is the major cause of metastasis and poor prognosis in NSCLC. This study was conducted to investigate the role and mechanism of lncRNA KCNQ1OT1 in the proliferation, invasion, and migration of NSCLC cells. The expression of KCNQ1OT1 in NSCLC was analyzed in the StarBase database, and the target miRNA of KCNQ1OT1 as well as the target genes of the miRNA was predicted. Then, the mRNA expression levels of KCNQ1OT1, miR-496, and HMGB1 were detected in clinical tissue samples and cells by qRT-PCR assay. Besides, the protein levels of HMGB1 were detected by Western blot. MTT assay, transwell assay, and scratch assay were used to determine the proliferation, invasion, and migration ability of NSCLC cells, respectively. Correlation analysis was performed to assess the correlation between the expression of KCNQ1OT1, miR-496, and HMGB1 in clinical NSCLC samples. Dual-luciferase reporter gene assay was conducted to analyze the interaction between KCNQ1OT1 and miR-496 and between miR-496 and HMGB1. The database results showed that KCNQ1OT1 was highly expressed in NSCLC. Similarly, we found that the expression level of KCNQ1OT1 was significantly higher in NSCLC tissues and cells than that in the corresponding normal tissues and cells. The results of MTT assay, transwell assay, and scratch assay demonstrated that KCNQ1OT1 significantly enhanced the proliferation, invasion, and migration of NSCLC cells. Further mechanism exploration revealed that KCNQ1OT1 could sponge miR-496, and miR-496 directly targeted and regulated the expression of HMGB1. The expression of miR-496 and either KCNQ1OT1 or HMGB1 were negatively correlated in NSCLC, while the expression of KCNQ1OT1 and HMGB1 were positively correlated. Compared with normal paracancer tissues, miR-496 was much lower and HMGB1 was much higher expressed in NSCLC tissues. The results of cotransfection also further demonstrated that miR-496 inhibitor or sh-HMGB1 cotransfected with sh-KCNQ1OT1 could significantly decrease or increase the ability of sh-KCNQ1OT1 to inhibit the proliferation, invasion, and migration of H1299 cells, respectively. In conclusion, lncRNA KCNQ1OT1 promotes the invasion and migration of NSCLC cells through miR-496/HMGB1 signaling axis.

UPVA (Unilateral pulmonary vein atresia) is the failure of connection between the common pulmonary vein and the left atrium. UPVA is a rare malformation of common pulmonary vein caused by embryonic development defects. Isolated UPVA is uncommon, the diagnosis commonly occurs during early childhood because of asthma, recurrent pneumonia or hemoptysis, but diagnosis in adults is unusual. Some patients can be asymptomatic until adulthood. In this report, we describe a case about UPVA presenting with recurrent hydrothorax in an adult. We gradually carried out routine diagnostic methods and eventually confirmed the rare UPVA according to the two common clinical manifestations of repeated pleural effusion and hilar soft tissue shadow.

Obstructive sleep apnea (OSA) is a serious breathing disorder, leading to myocardial infarction, high blood pressure, and stroke. Brain morphological changes have been widely reported in patients with OSA. The pathophysiological mechanisms of cerebral blood flow (CBF) changes associated with OSA are not clear. In this study, 20 patients with OSA and 36 healthy controls (HCs) were recruited, and then pseudo-continuous arterial spin labeling (pCASL) and voxel-based morphometry (VBM) methods were utilized to explore blood perfusion and morphological changes in the patients with OSA. Compared with the HC group, the OSA group showed increased CBF values in the right medial prefrontal cortex (mPFC), left precentral gyrus, and right insula and showed decreased CBF values in the right temporal pole (TP) and the right cerebellum_Crus2. Compared with the HC group, the patients with OSA showed decreased gray matter volume (GMV) in the right dorsal lateral prefrontal cortex (DLPFC), the right occipital pole, and the vermis. There were no significantly increased GMV brain regions found in patients with OSA. Pearson correlation analysis showed that the reduced GMV in the right DLPFC and the right occipital pole was both positively correlated with Mini-Mental State Examination (MMSE) (r = 0.755, p < 0.001; r = 0.686, p = 0.002) and Montreal Cognitive Assessment (MoCA) scores (r = 0.716, p = 0.001; r = 0.601, p = 0.008), and the reduced GMV in the right occipital pole was negatively correlated with duration of illness (r = -0.497, p = 0.036). Patients with OSA have abnormal blood perfusion metabolism and morphological changes in brain regions including the frontal lobe and the cerebellum and were closely related to abnormal behavior, psychology, and cognitive function, which play an important role in the pathophysiological mechanism of OSA.

Sepsis is a highly heterogeneous disease and a major factor in increasing mortality from infection. N7-Methylguanosine (m7G) is a widely RNA modification in eukaryotes, which involved in regulation of different biological processes. Researchers have found that m7G methylation contributes to a variety of human diseases, but its research in sepsis is still limited. Here, we aim to establish the molecular classification of m7G gene-related sepsis, reveal its heterogeneity and explore the underlying mechanism. We first identified eight m7G related prognostic genes, and identified two different molecular subtypes of sepsis through Consensus Clustering. Among them, the prognosis of C2 subtype is worse than that of C1 subtype. The signal pathways enriched by the two subtypes were analyzed by ssGSEA, and the results showed that the amino acid metabolism activity of C2 subtype was more active than that of C1 subtype. In addition, the difference of immune microenvironment among different subtypes was explored through CIBERSORT algorithm, and the results showed that the contents of macrophages M0 and NK cells activated were significantly increased in C2 subtype, while the content of NK cells resting decreased significantly in C2 subtype. We further explored the relationship between immune regulatory genes and inflammation related genes between C2 subtype and C1 subtype, and found that C2 subtype showed higher expression of immune regulatory genes and inflammation related genes. Finally, we screened the key genes in sepsis by WGCNA analysis, namely NUDT4 and PARN, and verified their expression patterns in sepsis in the datasets GSE131761 and GSE65682. The RT-PCR test further confirmed the increased expression of NUDTA4 in sepsis patients. In conclusion, sepsis clustering based on eight m7G-related genes can well distinguish the heterogeneity of sepsis patients and help guide the personalized treatment of sepsis patients.

目的 探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼出气一氧化氮(FeNO)及其与涎液化糖链抗原(KL-6)的相关性.方法 选取2017年1月-2018年12月广东省第二人民医院收治的70例重度OSAHS患者作为试验组,选择同期70例健康者作为对照组.比较两组体重指数(BMI)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、KL-6和FeNO水平,分析FeNO与BMI、AHI、LSaO2、KL-6的相关性.结果 试验组的BMI和AHI水平高于对照组,LSaO2低于对照组,差异有统计学意义(P如.05);试验组的KL-6和FeNO水平高于对照组,差异有统计学意义(P＜0.05).FeNO水平与BMI、AHI、KL-6呈正相关(r=0.43,0.57,0.37,P＜0.05);FeNO水平与LSaO2呈负相关(r=-0.49,P＜0.05).结论 重度OSAHS患者血清中KL-6和FeNO水平升高,并且FeNO水平与KL-6、AHI呈正相关,与LSaO2呈负相关,提示FeNO与疾病严重程度相关,可作为评估病情的指标之一.

Objective:To evaluate the detection performance of Luminex NxTAG TM RPP on 17 respiratory pathogens. Methods:The detection performance of the Luminex NxTAG TM RPP kit was evaluated by comparing the detection results of clinical specimens with those by the sanger sequencing. Results:The results of Luminex NxTAG TM RPP kit for influenza virus type A (FluA), influenza A virus (H1N1) pdm09, influenza A virus subtype H3N2 (H3N2), influenza B virus (FluB), parainfluenza virus type 2 (PIV 2), parainfluenza type 3 (PIV 3), parainfluenza type 4 (PIV 4), Chlamydia pneumonia (CP) and coronavirus HKU1 (CoV HKU1) were highly consistent to the results by the Sanger sequencing. The results of adenovirus (ADV), coronavirus 229E (CoV 229E), coronavirus OC43 (CoV OC43), respiratory syncytial virus (RSV), rhinovirus (RV) and Bokavirus (BoV) were moderately consistent to the results of the Sanger sequencing while the consistency of reuslts for parainfluenza virus type 1 (PIV 1) and metapneumovirus (MPV) by the methods was poor. Conclusions:Luminex NxTAG TM RPP kit was characterized by accurate detection, high throughput and short operation time with good performance in the detection of most respiratory pathogens.

With the rapid development of AI techniques, Computer-aided Diagnosis has attracted much attention and has been successfully deployed in many applications of health care and medical diagnosis. For some specific tasks, the learning-based system can compare with or even outperform human experts' performance. The impressive performance owes to the excellent expressiveness and scalability of the neural networks, although the models' intuition usually cannot be represented explicitly. Interpretability is, however, very important, even the same as the diagnosis precision, for computer-aided diagnosis. To fill this gap, our approach is intuitive to detect pneumonia interpretably. We first build a large dataset of community-acquired pneumonia consisting of 35389 cases (distinguished from nosocomial pneumonia) based on actual medical records. Second, we train a prediction model with the chest X-ray images in our dataset, capable of precisely detecting pneumonia. Third, we propose an intuitive approach to combine neural networks with an explainable model such as the Bayesian Network. The experiment result shows that our proposal further improves the performance by using multi-source data and provides intuitive explanations for the diagnosis results.

Prolonged viral RNA shedding and recurrence of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) in coronavirus disease 2019(COVID-19) patients have been reported. However, the clinical outcome and pathogenesis remain unclear. In this study, we recruited 43 laboratory-confirmed COVID-19 patients. We found that prolonged viral RNA shedding or recurrence mainly occurred in severe/critical patients(P<0.05). The average viral shedding time in severe/critical patients was more than 50 days, and up to 100 days in some patients, after symptom onset. However, chest computed tomography gradually improved and complete absorption occurred when SARS-CoV-2RT-PCR was still positive, but specific antibodies appeared. Furthermore, the viral shedding time significantly decreased when the A1,430G or C12,473T mutation occurred(P<0.01 and FDR<0.01) and increased when G227A occurred(P<0.05 and FDR<0.05). High IL1 R1, IL1 R2, and TNFRSF21 expression in the host positively correlated with viral shedding time(P<0.05 and false discovery rate <0.05). Prolonged viral RNA shedding often occurs but may not increase disease damage. Prolonged viral RNA shedding is associated with viral mutations and host factors.

目的:总结慢性阻塞性肺疾病急性加重期(AECOPD)患者合并细菌感染与降钙素原(PCT)、超敏C反应蛋白(Hs-CRP)、中性粒细胞CD64、白细胞(WBC)等感染指标变化,探讨其诊疗价值.方法:回顾性分析广东省第二人民医院2017年1月-年2018年12月106例AECOPD患者(观察组)合并肺感染的病原菌、PCT、CD64、Hs-CRP、WBC等感染指标,并与AECOPD患者无感染68例(对照组)进行比较.结果:AECOPD患者感染的主要病原菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌等.AECOPD患者肺部细菌感染同时伴有PCT、CD64、Hs-CRP、WBC等指标均有不同程度升高,治疗3天和7天后,四项指标均明显下降(P＜0.05)至逐渐趋于正常.结论:AECOPD患者合并细菌感染的病原菌中主要为革兰阴性杆菌,PCT、CD64、Hs-CRP、WBC可作为AECOPD细菌感染鉴别及诊断指标,综合考虑基础病情及身体情况,同时加强监测病原菌及耐药性,确定感染病原菌并治疗,对改善预后和降低病死率有重要意义.

为探讨miR-496对肺癌A549细胞的增殖和凋亡调控作用及分子机制,本研究通过荧光定量PCR检测miR-496在肺癌和癌旁组织中的表达,记A549细胞转染miR-496 mimics及对照miR-NC;通过CCK8检测miR-496对肺癌A549细胞增殖的影响,采用流式细胞术检测miR-496对A549细胞凋亡的影响,并通过双荧光素酶报告基因检测miR-496的靶基因;采用Western blotting检测miR-496对靶基因CDK1蛋白表达的影响.荧光定量PCR结果显示,肺癌组中的miR-496的相对表达量较癌旁组比较表达显著下调(p＜0.01).CCK8结果显示,miR-496 mimics组细胞在培养24 h和48 h后细胞增值率(A450值)较miR-NC对照组显著降低.流式细胞术检测结果显示,miR-496 mimics组细胞凋亡率较miR-NC对照组显著增加.双荧光素酶报告基因实验结果显示,miR-496 mimics与CDK1 3'UTR WT载体共转染组荧光强度明显低于对照miR-NC与WT载体共转染组.Western blotting检测结果显示,miR-496 mimics组细胞的CDK1蛋白表达量与miR-NC对照组比较显著降低(p＜0.01),miR-496 mimics+CDK1组细胞CDK1蛋白表达量与miR-496mimics组比较显著升高(p＜0.01).miR-496能够通过抑制靶基因CDK1的表达,抑制肺癌细胞A549的增殖,促进肺癌A549细胞凋亡.本研究结果有助于了解miR-496和CDK1在肺癌中的作用,为肺癌的治疗提供理论依据和实验基础.

Abstract The outbreak of the novel coronavirus disease (COVID‐19) quickly spread all over China and to more than 20 other countries. Although the virus (severe acute respiratory syndrome coronavirus [SARS‐Cov‐2]) nucleic acid real‐time polymerase chain reaction (PCR) test has become the standard method for diagnosis of SARS‐CoV‐2 infection, these real‐time PCR test kits have many limitations. In addition, high false‐negative rates were reported. There is an urgent need for an accurate and rapid test method to quickly identify a large number of infected patients and asymptomatic carriers to prevent virus transmission and assure timely treatment of patients. We have developed a rapid and simple point‐of‐care lateral flow immunoassay that can detect immunoglobulin M (IgM) and IgG antibodies simultaneously against SARS‐CoV‐2 virus in human blood within 15 minutes which can detect patients at different infection stages. With this test kit, we carried out clinical studies to validate its clinical efficacy uses. The clinical detection sensitivity and specificity of this test were measured using blood samples collected from 397 PCR confirmed COVID‐19 patients and 128 negative patients at eight different clinical sites. The overall testing sensitivity was 88.66% and specificity was 90.63%. In addition, we evaluated clinical diagnosis results obtained from different types of venous and fingerstick blood samples. The results indicated great detection consistency among samples from fingerstick blood, serum and plasma of venous blood. The IgM‐IgG combined assay has better utility and sensitivity compared with a single IgM or IgG test. It can be used for the rapid screening of SARS‐CoV‐2 carriers, symptomatic or asymptomatic, in hospitals, clinics, and test laboratories.

目的 探讨血清淀粉样蛋白A(Serum Amyloid A Protein SAA)、超敏C-反应蛋白(hs-CRP)和血清降钙素原(PCT)对原发性肺癌患者肺部感染病原菌的诊断效果.方法 选取2015年7月-2018年7月于广东省第二人民医院接受治疗的314例原发性肺癌患者为研究对象,按照患者住院过程中是否发生感染分为细菌感染组、病毒感染组、真菌感染组、非感染组.检测各组患者血清SAA、hs-CRP、PCT指标水平.并采用受试者工作曲线(ROC)对细菌感染患者、病毒感染患者血清SAA、hs-CRP、PCT指标诊断价值进行评价.结果 原发性肺癌患者细菌感染组血清SAA、hs-CRP、PCT指标水平明显高于病毒感染组、真菌感染组和非感染组(P<0.05),非感染组血清SAA、hs-CRP、PCT指标水平最低.SAA诊断原发性肺癌患者细菌感染的敏感度、特异度、阳性似然值分别为0.837、0.973、0.168,诊断病毒感染的敏感度、特异度、阳性似然值分别为0.532、0.940、0.494,均优于hs-CRP和PCT.结论 原发性肺癌患者发生肺部感染后血清SAA、hs-CRP、PCT指标水平变化明显,血清SAA、hs-CRP、PCT诊断细菌感染患者较病毒感染患者准确性高,临床医师可以根据血清SAA、hs-CRP、PCT检测结果对患者肺部感染情况进行初步判断.

Objective:Luminex NxTAG? RPP kit was used to detect respiratory tract infection samples in Guangzhou, and the pathogen spectrum of respiratory tract infection in Guangzhou in the past year was summarized to provide reference for clinical diagnosis, treatment and disease prevention and control of respiratory tract infection.Methods:A total of 484 respiratory infection samples were collected from December 2018 to November 2019 from Guangdong Maternal and Child Health Hospital and The Second People's Hospital of Guangdong Province. QIAamp MinElute Virus Spin Kit(50) was used to extract total nucleic acid, and Luminex NxTAG? RPP Kit was used to detect pathogens in the samples. Excel 2016 was used to draw the data and SPSS19.0 software was used for statistical analysis.Results:Among the 484 samples, 397 were found to be positive, with A total positive rate of 79.96%. Infection included Influenza A H1N1pdm09 virus (H1N1 2009), rhinoviruses (RhV), Metapneumovirus (MPV). In the age distribution, the positive rates of H1N1 2009, Respiratory syncytial virus (RSV), Parainfluenza virus (PIV), MPV, RhV and Bocavirus (BoV) were relatively high in the children group. The positive rate of Influenza B virus (FLuB) in adult group was relatively high. The positive rates of H1N1 2009, RSV, MPV and BoV were higher in outpatients. The positive rate of FLuB was relatively high in hospitalized patients. In the pathogen detection of patients with different symptoms, the RSV positive rate of samples from patients with cough and sputum symptoms was higher. The positive rates of Coronaviruses (CoV), MPV and RhV samples from patients with nasal obstruction were higher. The detection rate of most pathogens is high in winter and spring.Conclusions:H1N1 2009, RhV and MPV are the important pathogens of respiratory tract infections in Guangzhou in 2019. Strengthening the research and monitoring of these pathogens can be the focus of the prevention and control of respiratory tract infectious diseases in Guangzhou.

目的 分析我院收治52例疑似新型冠状病毒肺炎(COVID-19)的流行病学及临床特点,探讨定点医院收治疑似病例的重要性.方法 回顾分析2020年1月31日至2020年2月15日广东省第二人民医院收治的52例疑似COVID-19病例的流行病学和临床表现、实验室检查和影像学检查特点,总结收治疑似病例的临床工作经验,以及疑似病例管理对传染病防控的重要作用.结果 52例患者中,男24例,女28例;年龄范围为15～65岁,中位年龄为36.5岁.其中有疫区旅行史或居住史的占28.8％,有确诊病例接触史的占26.9％,有确诊区域发热或呼吸道症状患者接触史的占7.7％,无明确流行病学史的占34.6％.临床主要表现为发热39例(75.0％),咳嗽23例(44.2％)和乏力6例(11.5％).血常规白细胞计数下降7例(13.5％),正常34例(65.4％),升高11例(21.2％);淋巴细胞计数下降19例(36.5％),正常33例(63.5％).CD3+T淋巴细胞绝对值下降13例(28.9％);CD4+T淋巴细胞绝对值下降15例(33.3％).CD8+T淋巴细胞绝对值下降12例(26.7％).C反应蛋白(CRP)值升高30例(57.7％);降钙素原(PCT)升高11例(21.1％).44例行甲型流感、乙型流感、H7N9抗原检测,全阴性.22例行呼吸道13项常见病原体核酸检测,其中流感嗜血杆菌12例最多(54.5％).影像学出现异常42例(80.8％),其中磨玻璃影29例(55.8％)、斑片影24例(46.2％),具有多重异常特征的16例(30.8％).结论 疑似病例的收治对于疫情防控具有重要意义,其与确诊病例存在诸多相似之处,在收治的同时我们需要做好自身防护以及及时对其鉴别和诊治.

目的 探讨二氧化碳(CO2)激光与放疗治疗前联合受侵T1b声门型喉癌患者对其吞咽功能和呼吸功能的影响.方法 76例前联合受侵T1b声门型喉癌患者,根据治疗方法 的不同分为A组(41例)与B组(35例).A组选择单纯放疗治疗,B组选择CO2激光切除术治疗.分析比较两组治疗后吞咽功能、呼吸功能检测结果 .结果 B组吞咽功能优于A组,差异具有统计学意义(P<0.05).治疗后,A组肺功能检查值正常比例为24.39％,B组肺功能检查值正常比例为42.86％,比较差异无统计学意义(χ2=2.917,P>0.05);A组流量容积曲线(F-V曲线)出现特征性平台样改变27例(65.85％),B组F-V曲线出现特征性平台样改变13例(37.14％),比较差异具有统计学意义(χ2=6.243,P<0.05).治疗前,两组用力肺活量占预计值百分比(FVC％pred)、第1秒用力呼气容积占预计值百分比(FEV1％pred)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、每分钟最大通气量占预计值百分比(MVV％pred)水平比较,差异无统计学意义(P>0.05);治疗后,两组FVC％pred、FEV1％pred、FEV1/FVC、MVV％pred水平均较治疗前下降,但B组FVC％pred、FEV1％pred、FEV1/FVC、MVV％pred水平分别为(78.41±10.42)％、(70.01±4.52)％、(65.71±6.03)％、(62.82±10.56)％,均高于A组的(72.21±8.32)％、(63.32±4.51)％、(60.51±5.63)％、(45.45±11.25)％,差异具有统计学意义(P<0.05).结论 相比放疗,CO2激光治疗前联合受侵T1b声门型喉癌患者对其吞咽功能、呼吸功能影响更小,患者生存质量更高.

BACKGROUND The coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Suspected cases accounted for a large proportion in the early stage of the COVID-19 outbreak. The deviation of the nucleic acid test by throat swab (the current gold standard of COVID-19) caused by variation in sampling techniques and reagent kits and coupled with nonspecific clinical manifestations make confirmation of the suspected cases difficult. Proper management of the suspected cases of COVID-19 is crucial for disease control. CASE SUMMARY A 65-year-old male presented with fever, lymphopenia, and chest computed tomography (CT) images similar to COVID-19 after percutaneous coronary intervention. The patient was diagnosed as having bacterial pneumonia with cardiogenic pulmonary edema instead of COVID-19. This was based on four negative results for throat swab detection of SARS-CoV-2 nucleic acid using reverse transcriptase-polymerase chain reaction assay and one negative result for serological antibody of SARS-CoV-2 with the serological assay. Additionally, the distribution of ground-glass opacities and thickened blood vessels from the CT images differed from COVID-19 features, which further supported the exclusion of COVID-19. CONCLUSION Distinguishing COVID-19 patients from those with bacterial pneumonia with cardiogenic pulmonary edema can be difficult. Therefore, it requires serious identification.