Yellow Nail Syndrome (YNS) is a rare disorder characterized by the classic triad of yellow nails, lymphedema, and chronic respiratory involvement. We report a 42-year-old male with YNS and childhood-onset symptoms lasting for over three decades. He presented with refractory, recurrent chylothorax that progressed to organized pleural effusion and pleural calcification, complicated by respiratory failure and pericardial effusion. Systemic lymphangiography confirmed severe lymphatic reflux and obstruction. This case highlights the diagnostic and therapeutic challenges of YNS, which often leads to underdiagnosis. Clinicians should screen for extrapulmonary signs, including yellow nails and lymphedema, in patients with unexplained pleural effusion to facilitate early diagnosis and intervention and prevent irreversible disease progression.

Background:To analyze the effect of sequential mechanical ventilation and the risk factors of treatment failure in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with expiratory failure. Methods:This study retrospectively analyzed the clinical data of 125 patients with AECOPD and respiratory failure admitted to the Respiratory and Critical Care Medicine Department of the Central Theater Command General Hospital from January 2021 to December 2023 and observed the changes in arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), and heart rate (HR), respiration (RR), spirometry (FVC), as well as the changes in peak expiratory flow rate (PEF) before and after treatment. As well as the differences in the indexes of the first exertion expiratory volume (FEV1). Combined with the treatment outcome was divided into the treatment failure group the success group, and the logistic regression equation to determine the main factors of the failure of sequential ventilation treatment. Using ROC curve analysis to evaluate the predictive performance of logistic regression models, calculate the area under the curve (AUC) and its 95% confidence interval (CI). Results:PaO2, FVC, PEF, and FEV1 levels of the patients after treatment were increased compared with those before treatment, and the levels of PaCO2, HR, and RR were decreased (p < 0.05). Thirty cases were included in the failure group, and the remaining 95 cases were included in the success group. There were statistical differences in age, presence of medical diseases, acute physiology and chronic health evaluation II (APACHE II) score, PaO2, and PaCO2 levels between the two groups (p < 0.05). The ROC curve showed good discriminative ability, with an AUC of 0.864 (95% CI: 0.803-0.925, p < 0.05). Conclusion:Sequential ventilation therapy can improve blood gas indexes and lung function and stabilize vital signs in patients with AECOPD with expiratory failure. Moreover, age ≥60 years, presence of medical diseases, APACHE II score ≥19, PaO2 <55 mmHg, and PaCO2 ≥75 mmHg are risk factors for treatment failure.

BACKGROUND:The Hem-O-Lok clip is frequently used as a surgical consumable for the occlusion of blood vessels and bronchi during Video-Assisted Thoracoscopic Surgery (VATS). However, there is limited available literature addressing the potential complications associated with its clinical application. CASE PRESENTATION:This article reports a patient with bronchiectasis who underwent VATS for treatment of hemoptysis on August 12, 2021. During the postoperative follow-up, chest CT scan accidentally revealed a displaced Hem-O-Lok clip located within the tracheal lumem on April 12, 2024. After the Hem-O-Lok clip successfully retrieved via bronchoscopy, the patient's condition significantly improved. CONCLUSION:This case suggests a potential risk of Hem-O-Lok clip detachment after VATS, underscoring the importance of maintaining clinical vigilance and controlling chronic infection in postoperative patient management.

Immunocompromised patients with Lower Respiratory Tract Infections (LRTI) frequently encounter a diverse range of pathogenic infections, characterized by rapid disease progression and significant mortality rates due to reckless or excessive utilization of antibiotics. Therefore, it is crucial to promptly and accurately identify the causative microorganisms for pathogen diagnosis and clinical decision-making. The objective of this study is to evaluate the clinical applicability of metagenomic next-generation sequencing (mNGS) in the diagnosis and management of LRTI, as well as its impact on empirical antibacterial therapy for patients with varying immune statuses. We conducted a comparative analysis of positivity rate, detection accuracy, pathogen spectrum, duration of treatment (DOT), and antibiotic management in a cohort of 283 patients diagnosed with lower respiratory tract infections. The positive detection rate was higher in mNGS compared to conventional culture in both immunocompetent group (89.92

Nur77 is a member of the NR4A subfamily of orphan nuclear receptors that is expressed and has a function within the immune system. This study aimed to investigate the role of Nur77 in hypoxic pulmonary hypertension. SPF male SD rats were exposed in hypobaric chamber simulating 5000 m high altitude for 0, 3, 7, 14, 21 or 28 days. Rat pulmonary artery smooth muscle cells (RPASMCs) were cultured under normoxic conditions (5% CO2-95% ambient air) or hypoxic conditions (5% O2 for 6 h, 12 h, 24 h, 48 h). Hypoxic rats developed pulmonary arterial remodeling and right ventricular hypertrophy with significantly increased pulmonary arterial pressure. The levels of Nur77, HIF-1α and PNCA were upregulated in pulmonary arterial smooth muscle from hypoxic rats. Silencing of either Nur77 or HIF-1α attenuated hypoxia-induced proliferation. Silencing of HIF-1α down-regulated Nur77 protein level, but Nur77 silence did not reduce HIF-1α. Nur77 was not con-immunoprecipitated with HIF-1α. This study demonstrated that Nur77 acted as a downstream regulator of HIF-1α under hypoxia, and plays a critical role in the hypoxia-induced pulmonary vascular remodeling, which is regulated by HIF-1α. Nur77 maybe a novel target of HPH therapy.

BackgroundStreptococcus pneumoniae (S. pneumoniae) is the most common pathogen in community-acquired pneumonia (CAP) and takes the form of lobar pneumonia as typical computed tomography (CT) findings. Various patterns of radiological manifestation have also been reported in patients with S. pneumoniae pneumonia; however, the appearance of diffuse centrilobular nodules in both lungs is rarely reported.Case presentationWe report the case of a patient with a history of chronic lymphocytic leukemia (CLL) for 9 years who presented with new-onset fever, cough, excess sputum, and shortness of breath for 1 week. He was given intravenous antibacterial (cephalosporin) treatment for 4 days, but his condition did not improve and dyspnea became more serious. The chest CT indicated diffuse centrilobular nodules in both lungs at admission. Patient’s bronchoalveolar (BAL) fluid was sent for metagenomic next-generation sequencing, which only supported a diagnosis of S. pneumoniae infection. His condition improved gradually after antimicrobial treatment (moxifloxacin) and a follow-up CT showed that the diffuse centrilobular nodules in both lungs were absorbed completely.ConclusionThis case highlights a rare CT presentation of S. pneumoniae pneumonia that should alert clinicians, so as to avoid taking unnecessary treatment measures.

Coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been associated with cardiovascular features, which may be deteriorated in patients with cancer. However, cardiac outcomes of cancer patients with COVID-19 have not been closely examined. We retrospectively assessed 1,244 patients with COVID-19 from February 1 to August 31, 2020 (140 cancer and 1,104 noncancer patients). Demographic and clinical data were obtained and compared between cancer and noncancer groups. Including the cardiac biomarkers, we also analyzed laboratory findings between these two groups. Risk factors for in-hospital mortality were identified by multivariable Cox regression models. For cancer group, 56% were in severe and critical status with more diabetes and immune deficiency, whereas the proportion was 10% for noncancer group. Patients with cancer had increased levels of leukocyte, neutrophil count, and blood urea nitrogen (BUN) (all P < 0.01), whereas lymphocyte count was significantly lower (P < 0.001). The most common solid tumor types were gastrointestinal cancer (26%), lung cancer (21%), and breast and reproductive cancer (both 19%). There is a rising for cardiac biomarkers, including pro-B-type natriuretic peptide (Pro-BNP), sensitive troponin I (cTnI), myoglobin (MYO), creatine kinase-MB (CK-MB), as well as D-Dimer in COVID-19 cancer population, especially in deceased subjects with cancer. The 30-day in-hospital mortality in cancer group was dramatically raised than that in noncancer group (12.9% vs. 4.0%, P < 0.01). In multivariable Cox regression models, fever, disease severity status, and underlying diseases were risk factors for mortality. COVID-19 patients with cancer relate to deteriorating conditions and poor cardiac outcomes accompanied by a high in-hospital mortality, which warrants more aggressive treatment.NEW & NOTEWORTHY Our study indicates that the 30-day mortality is higher in COVID-19 patients with cancer; more COVID-19 patients with cancer are in severe and critical status; age, respiratory rate, neutrophil count, AST, BUN, MYO, Pro-BNP, disease severity status, underlying diseases, and fever are risk factors for in-hospital mortality among COVID-19 cancer cases; COVID-19 patients with cancer display severely impaired myocardium, damaged heart function, and imbalanced homeostasis of coagulation; what is more, those with both cancer and CVD have more significantly increased Pro-BNP and D-Dimer level.

成人社区获得性肺炎(community-acquired pneu-monia ,CAP)是常见的呼吸系统疾病,也是基层卫生医疗机构诊治的重点疾病之一.在CAP的诊治过程中,不同级别医院承担不同的分级诊疗任务.初始经验性抗菌药物的合理应用是降低CA P患者死亡率的重要途径[1].为了提高基层医生诊治CAP的水平和能力,获得同质化的分级诊疗任务,我国制定了《成人社区获得性肺炎基层诊疗指南2018》[2 ] (以下简称《基层指南》).为了更好地理解并应用《基层指南》,本文对该指南重点内容进行解读,并主要从药物分类的角度解析其中抗菌素的应用原则及选择要点.

Abstract Background We previously reported that lymphocytopenia and T cell exhaustion is notable in acute COVID19 patients, especially in aged and severe cases. Thymosin alpha 1 (Tα1) had been used in the treatment of viral infections as an immune response modifier for many years. However, clinical benefits and mechanism of Tα1 supplement to COVID-19 are still unclear. Methods We retrospectively reviewed the clinical outcomes of 76 severe cases with COVID-19 admitted into two hospitals in Wuhan from December 2019 to March 2020. The thymus output in peripheral blood mononuclear cells (PBMCs) from COVID-19 patients was measured by T cell receptor excision circles (TREC). The levels of T cell exhaustion markers PD-1 and Tim-3 on CD8+ T cells were detected by flow cytometry. Results Compared with untreated group, Tα1 treatment significantly reduces mortality of severe COVID-19 patients (11.11% vs. 30.00%, p=0.044). Tα1 timely enhances blood T cell numbers in COVID-19 patients with severe lymphocytopenia (the counts of CD8+ T cells or CD4+ T cells in circulation lower than 400/μL or 650/μL, respectively). Under such conditions, Tα1 also successfully restores CD8+ and CD4+ T cell numbers in aged patients. Meanwhile, Tα1 reduces PD-1 and Tim-3 expression on CD8+ T cells from severe COVID-19 patients in comparison with untreated cases. It is of note that restoration of lymphocytopenia and acute exhaustion of T cells are roughly parallel to the rise of TRECs. Conclusions Tα1 supplement significantly reduce mortality of severe COVID-19 patients. COVID-19 patients with the counts of CD8+ T cells or CD4+ T cells in circulation lower than 400/μL or 650/μL, respectively, gain more benefits from Tα1. Tα1 reverses T cell exhaustion and recovers immune reconstitution through promoting thymus output during SARS-CoV-2 infection.

目的 探讨新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者外周血淋巴细胞亚群、炎症因子的变化及临床意义.方法 收集2020-01-04/2020-03-12日中部战区总医院收治确诊的60例COVID-19患者的病历资料,其中普通型、重型、危重型各20例,危重型患者中存活10例,死亡10例.回顾性分析各组患者的临床信息及疾病不同阶段(入院时、疾病进展期)外周血CD3+、CD4+、CD8+T淋巴细胞计数及白细胞介素6、D-二聚体、C反应蛋白(C-reactive protein,CRP)、乳酸的表达水平,比较和分析各组患者上述指标变化的规律及其与疾病严重程度的关系.结果 3组患者年龄、性别、临床表现之间差异无统计学意义(P＞0.05).46例(76.7％,46/60)患者合并有基础疾病,其中合并高血压者最多,达28例(46.7％).合并两种以上基础疾病的患者,危重型组明显高于其他两组(P＜0.01).3组患者入院时外周血CD3+、CD4+、CD8+T淋巴细胞计数均低于正常值,在疾病进展期进一步下降,且病情越重下降越明显,其中危重型患者死亡病例的外周血CD3+、CD4+、CD8+T淋巴细胞计数明显低于存活病例(P＜0.01).3组患者在疾病进展期白细胞介素6、D-二聚体、CRP、乳酸水平均高于入院时,且危重型组＞重型组＞普通型组,组间比较差异均有统计学意义(P＜0.01).危重型患者死亡病例在疾病进展期D-二聚体、白细胞介素6、CRP、乳酸水平均明显高于存活患者(P＜0.01).结论 COVID-19患者在疾病过程中存在细胞免疫损伤和炎症因子过度表达,监测其外周血淋巴细胞亚群计数及白细胞介素6、D-二聚体、CRP、乳酸水平可能有助于预测COVID-19患者的严重程度和预后.

Objective　To investigate the clinical features of 13 fatal cases of corona virus disease 2019 (COVID-19). Methods　The clinical data of 13 patients who died of COVID-19 in Central Theater General Hospital, China, between January 4, 2020, and February 24, 2020, were analyzed retrospectively. The data reviewed included clinical manifestations, laboratory test results, radiographic features and dinical treatment plan. The cellular immune function, the expression of inflammatory factors, and lactate level in deceased patients at different stages of the disease were analyzed. Results　Of those who died, the patients consisted of 10 men and 3 women. The age of those who died was (74±19) years, and 10(76.9%) patients were over 70 years old. For the patients who died, 9 presented with underlying diseases, 6(46.2%) of whom had more than 2 diseases. On admission, the chest computed tomography (CT) for 8 patients (61.5%) mainly showed multiple patchy ground-glass opacities. When the disease progressed, the ground-glass opacities rapidly developed into diffuse lesions in both lungs. The lymphocyte and CD3+, CD4+, and CD8+ T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P<0.01). Additionally, the interleukin (IL)-6, D-dimer, C-reactive protein (CRP), lactic acid levels gradually increased, and most peaked before death. The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure. Three patients eventually developed multiorgan deficiency syndrome (MODS). Conclusions　The risk factors of death for COVID-19 patients included older men, more underlying diseases, poor cellular immune function and over-expression of inflammatory factors. The main cause of death in patients with COVID-19 was ARDS, which led to respiratory failure and MODS. DOI: 10.11855/j.issn.0577-7402.2020.05.03

BACKGROUND: Thymosin alpha 1 (T&#945;1) had been used in the treatment of viral infections as an immune response modifier for many years. However, clinical benefits and the mechanism of T&#945;1 treatment for COVID-19 patients are still unclear. METHODS: We retrospectively reviewed the clinical outcomes of 76 severe COVID-19 cases admitted to 2 hospitals in Wuhan, China, from December 2019 to March 2020. The thymus output in peripheral blood mononuclear cells from COVID-19 patients was measured by T-cell receptor excision circles (TRECs). The levels of T-cell exhaustion markers programmed death-1 (PD-1) and T-cell immunoglobulin and mucin domain protein 3 (Tim-3) on CD8+ T cells were detected by flow cytometry. RESULTS: Compared with the untreated group, T&#945;1 treatment significantly reduced the mortality of severe COVID-19 patients (11.11% vs 30.00%, P = .044). T&#945;1 enhanced blood T-cell numbers in COVID-19 patients with severe lymphocytopenia. Under such conditions, T&#945;1 also successfully restored CD8+ and CD4+ T-cell numbers in elderly patients. Meanwhile, T&#945;1 reduced PD-1 and Tim-3 expression on CD8+ T cells from severe COVID-19 patients compared with untreated cases. It is of note that restoration of lymphocytopenia and acute exhaustion of T cells were roughly parallel to the rise of TRECs. CONCLUSIONS: T&#945;1 treatment significantly reduced mortality of severe COVID-19 patients. COVID-19 patients with counts of CD8+ T cells or CD4+ T cells in circulation less than 400/µL or 650/µL, respectively, gained more benefits from T&#945;1. T&#945;1 reversed T-cell exhaustion and recovered immune reconstitution through promoting thymus output during severe acute respiratory syndrome-coronavirus 2 infection.

运动训练是综合性肺康复方案的基石,不仅是改善慢性阻塞性肺疾病(慢阻肺)患者肌肉功能和运动耐力最好的方法,而且能间接缓解劳力性呼吸困难,减少情绪紊乱,改善心血管功能等[1].慢阻肺常合并其他的疾病,包括心血管疾病、营养不良、骨质疏松、焦虑与抑郁症和代谢综合征等,合并症会进一步降低患者运动能力,运动能力下降是慢阻肺患者病死率的关键预测因子[2-3].慢阻肺运动受限可能与肺通气功能障碍、肺换气功能障碍、外周肌肉功能障碍、呼吸肌功能障碍、心功能不全或以上多方面功能障碍有关.相比同龄健康成年人,慢阻肺患者不愿意进行运动的原因主要包括:缺乏基础设施、意志力薄弱以及社会影响等.慢阻肺运动训练总的原则和健康人一致,但慢阻肺患者在运动训练前需要专业治疗师通过心肺运动试验评估患者的运动能力以制定个体化的运动处方,并帮助排除相关心血管疾病以确保干预措施的安全性,心肺运动试验在一定程度上有助于揭示部分隐藏的与运动相关的问题,如低氧血症、心律失常、心肌缺血及肌肉骨骼问题等[4].为提高有氧运动能力,加强肌肉强度,总运动负荷必须超出日常负荷,当患者有氧运动能力和肌肉强度得到改善后,总运动负荷必须继续加强.为实现运动训练效果最大化,需要多种训练模式相结合.而运动训练模式的选择取决于患者自身的生理需求、训练目的以及可用的康复设备.

Penicillium marneffei (P. marneffei) is a thermally dimorphic fungus pathogen that causes fatal infection. Alveolar macrophages are innate immune cells that have critical roles in protection against pulmonary fungal pathogens and the macrophage polarization state has the potential to be a deciding factor in disease progression or resolution. The aim of this study was to investigate mouse alveolar macrophage polarization states during P. marneffei infection.

Nuclear receptor subfamily 4 group A (NR4A) receptors are activated by many extracellular stimuli and involved in multiple biological processes,such as metabolism,proliferation,differentiation and apoptosis.Because of their atypical structure,they are believed to be regulated in a ligand-independent manner,thus they are regulated largely by post-translationnal modifications.A lot of studies have demonstrated that NR4A receptors could induce both proliferation and apoptosis in the same cells,and vary with the stimuli,type of tumor,stage of tumor,and subcellular localizations.Studies demonstrate that all the NR4A receptors play roles in inducing lung cancer and anti-cancer mechanism.Therefore,the present paper reviews NR4A receptors and their relationship with lung cancer.

多发性肌炎(polymyositis,PM)是一种系统性横纹肌炎性肌病,常合并肺间质病变(interstitial lung disease,ILD),严重影响患者预后,呼吸系统受累是PM患者住院及死亡的主要原因.肺间质病变可以是PM的首发症状,作者医院收治1例以肺间质病变为首发症状的PM患者,现将诊疗经验报道如下.

目的 应用环介导等温扩增(LAMP)技术建立马尔尼菲青霉菌(PM)快速检测方法,探讨该方法的特异性、敏感性等,评价其临床应用价值.方法 针对马尔尼菲青霉菌的特异性基因MP1基因设计4条特异引物,反应前加入钙黄绿素荧光试剂,63℃恒温反应60 min,结束后通过目视检测荧光及浊度仪检测产物浊度值判断结果;评价所建立LAMP方法的特异性和敏感性,建立标准曲线,并用LAMP法及PCR法检测样本,比较样本检出情况.结果 该方法特异性良好,PM出现特异性LAMP扩增反应,而烟曲霉菌、腐皮镰刀菌、棘状外瓶酶菌、大肠埃希菌、嗜水气单胞菌、哈氏孤菌、创伤孤菌、水等均未出现扩增;检测限约为1.7×10-7 ng/μl,为PCR检测方法的10倍;以LAMP反应时间X轴,浓度的负次方数为Y轴,构建的标准曲线方程为y=0.4145x-8.9968,相关系数R2 =0.9963,呈良好的线性关系;样本检测结果显示,LAMP法较PCR法获得更高的敏感性.结论 LAMP检测方法具有特异性高、敏感性高、反应时间短的特点,简便易行,适合于基层对PM的快速检测.

OBJECTIVE:To observe changes of inflammatory mediators, histone deacetylase 2 (HDAC2) and nuclear factor κB (NF-κB) in murine C2C12 skeletal muscle myocytes after exposed to cigarette smoke.METHODS:Murine C2C12 skeletal muscle myocytes were cultured and treated with cigarette smoke extract (CSE). MTT assay was used to detect the effect of CSE on cell proliferation to determine appropriate concentration of CSE. The C2C12 cells cultured for 6-7 days were planted in six-well plates, and divided into control group, (6.25, 12.50, 25.0) mL/L CSE groups. The cells were cultured for 24 hours. The levels of interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in the supernatant were measured by ELISA. The mRNA level of HDAC2 was determined by real-time quantitative PCR. The protein level of HDAC2 was detected by Western blotting. HDAC2/NF-κB compound was determined by the method of co-immunoprecipitation.RESULTS:MTT assay showed that CSE at the concentration of 50 mL/L inhibited proliferation of C2C12 cells. After 24-hour treatment with CSE, IL-8 and TNF-α releasing from C2C12 cells increased and the level of HDAC2 mRNA and protein were reduced, which were CSE dose-dependent. Co-immunoprecipitation confirmed that HDAC2/NF-κB compound existed in the CSE-exposed C2C12 cells.CONCLUSION:CSE can down-regulate the expression of HDAC2 and increase inflammatory cytokines releasing from C2C12 cells.

马尔尼菲青霉病（Penicilliosis marneffei，PSM）是由马尔尼菲青霉菌（Penicillium marneffei，PM）感染所引起的一种深部真菌感染性疾病。本病常见于获得性免疫缺陷综合征（acquired immunodeficiency syndrome，AIDS）患者及合并免疫受损的人免疫缺陷病毒（human immunodeficiency virus，HIV）阴性患者。