Objectives: Here, we retrospectively described the diagnosis and treatment of 32 cases diagnosed with Chlamydia psittaci pneumonia during the COVID-19 pandemic. Methods: Clinical information was collected from all the patients. Reverse transcription–PCR and ELISAs were conducted for the detection of COVID-19 using nasal swabs and bronchoalveolar lavage fluid (BALF) samples. Metagenomic next-generation sequencing (mNGS) was performed for the identification of causative pathogens using BALF, peripheral blood and sputum samples. End-point PCR was performed to confirm the mNGS results. Results: All 32 patients showed atypical pneumonia and had infection-like symptoms that were similar to COVID-19. Results of reverse transcription–PCR and ELISAs ruled out COVID-19 infection. mNGS identified C. psittaci as the suspected pathogen in these patients within 48 hours, which was validated by PCR, except for three blood samples. The sequence reads that covered fragments of C. psittaci genome were detected more often in BALF than in sputum or blood samples. All patients received doxycycline-based treatment regimens and showed favorable outcomes. Conclusion: This retrospective study, with the highest number of C. psittaci pneumonia enrolled cases in China so far, suggests that human psittacosis may be underdiagnosed and misdiagnosed clinically, especially in the midst of the COVID-19 pandemic.

Early determination of coronavirus disease 2019 (COVID-19) pneumonia from numerous suspected cases is critical for the early isolation and treatment of patients. The purpose of the study was to develop and validate a rapid screening model to predict early COVID-19 pneumonia from suspected cases using a random forest algorithm in China. A total of 914 initially suspected COVID-19 pneumonia in multiple centers were prospectively included. The computer-assisted embedding method was used to screen the variables. The random forest algorithm was adopted to build a rapid screening model based on the training set. The screening model was evaluated by the confusion matrix and receiver operating characteristic (ROC) analysis in the validation. The rapid screening model was set up based on 4 epidemiological features, 3 clinical manifestations, decreased white blood cell count and lymphocytes, and imaging changes on chest X-ray or computed tomography. The area under the ROC curve was 0.956, and the model had a sensitivity of 83.82% and a specificity of 89.57%. The confusion matrix revealed that the prospective screening model had an accuracy of 87.0% for predicting early COVID-19 pneumonia. Here, we developed and validated a rapid screening model that could predict early COVID-19 pneumonia with high sensitivity and specificity. The use of this model to screen for COVID-19 pneumonia have epidemiological and clinical significance.

The aim of this study was to investigate the correlation between single-nucleotide polymorphisms (SNPs) in the 3 primer of untranslated region (3'UTR) of the Pentraxin 3 (PTX3) gene and the risk of essential hypertension (EHT). PTX3 genotypes, rs2614, rs111451363, and rs73158510 locus, were found in 260 patients with EHT and 260 healthy controls. Quantitative real-time polymerase chain reaction was used to detect plasma hsa-miR-4766-5p levels. Enzyme-linked immunosorbent assay was used to detect plasma PTX3 levels. The dual-luciferase reporter assay was used to identify the binding site of hsa-miR-4766-5p to the PTX3. PTX3 rs2614 locus T allele was a high risk factor for EHT (odds ratio [OR] = 2.76, 95% confidence interval [CI]: 1.86-4.09, P < .01). Sex and diabetes history affected the correlation between PTX3 gene rs2614 locus SNP and EHT risk. The CCG haplotype was a protective factor for EHT (OR = 0.40, 95% CI: 0.28-0.57, P < .01), whereas the TCG haplotype was a risk factor for EHT (OR = 2.35, 95% CI: 1.51-3.66, P < .01). The plasma PTX3 level of patients with EHT was significantly higher than that of the control group, and the difference was statistically significant (P < .01). The area under the curve for EHT diagnosis in plasma PTX3 levels was 0.62 (95% CI: 0.57-0.66, P < .01). The plasma hsa-miR-4766-5p level in patients with EHT was significantly lower than that in the control group (P < .01). The area under the curve for the diagnosis of EHT according to the plasma hsa-miR-4766-5p level was 0.88 (95% CI: 0.85-0.91, P < .01). Plasma PTX3 levels were significantly negatively correlated with hsa-miR-4766-5p levels in patients with EHT and the control group (r = -0.87, -0.85, P < .01, P < .01). The PTX3 gene rs2614 locus C allele was the target gene of hsa-miR-4766-5p. The PTX3 rs2614 locus SNP is significantly associated with EHT risk.

Nontuberculous mycobacteria infections present mostly pulmonary characteris-tics. However, the incidence of skin and soft tissue infections caused by nontuberculous mycobacteria has increased in part due to the increased popularity of cosmetic and plastic surgery. Here, we report a case of Mycobacterium agri infection. The patient underwent a one-year course of anti-infection therapy. To the best of our knowledge, this is the first report of a previously healthy patient presenting a skin and soft tissue infection caused by Mycobacterium agri. Clinical personnel should be aware of possible causes of persistent skin and soft tissue infection after cosmetic and plastic surgery.

Objective To analyze the clinical and pathological features of chronic hepatitis B (CHB) patients with hepatic steatosis.Methods Clinical and pathological data of 841 patients with CHB who underwent liver biopsy in Zhejiang Provincial People’s Hospital during September 2015 to September 2018 were retrospectively reviewed.One hundred and thirty five gender and age-matched pairs of steatosis and non-steatosis patients entered the analysis.Multivariable Logistic regression and rank sum test were used to analyze the clinical features and risk factors of hepatic steatosis in CHB patients .Spearman correlation test was used to analyze the correlation between hepatic steatosis and HBV DNA , hepatic inflammation and fibrosis status.Results Logistic regression analysis showed that overweight ／obesity ( χ2 ＝3.947, OR ＝1.436, 95%CI 1.005-2.051, P＜0.05) and hyperlipidemia (χ2 ＝4.277,OR＝1.803,95%CI 1.031-3.151, P＜0.05) were the risk factors for hepatic steatosis in CHB patients.There was no correlation of hepatic steatosis with serum HBeAg and HBV DNA levels (Z＝-1.762,r＝-0.011, both P＞0.05). However, hepatic steatosis was negatively correlated with inflammatory grade and fibrosis grade of the liver (r＝-0.146 and -0.192, both P＜0.05).Conclusions Overweight／obesity and hyperlipidemia are associated with steatosis in CHB patients.Hepatic steatosis may not aggravate the degree of liver inflammation and fibrosis in CHB patients.

Objective To assess the clinical characteristics and prognostic factors of bacterial liver abscess in patients with or without diabetes mellitus,and to provide clinical guides for the diagnosis and treatment.Methods A total of 208 patients with bacterial liver abscess were enrolled during January 2014 and January 2018 in Zhejiang Provincial People's Hospital,including 67 patients with diabetes mellitus and 141 patients without diabetes mellitus.Clinical characteristics,laboratory examinntion,imaging findings,etiology results,treatment and prognosis were analyzed.Multiple logistic regression analysis was performed to analyze the prognosis between patients with and without diabetes.Results The majority of patients were male,and the fever was the most common symptom.The incidence of fight upper abdominal pain in diabetic group was lower than that in non-diabetic group(32.84％ vs 47.5％,x2=3.999,P＜0.05).Compared with non-diabetic group,the neutrophil percentage and hemoglobin A1c were (84.0-±-6.8)％and (9.8±2.6)％,which were higher (t=2.263,13.716,P＜0.05),while the albumin and hemoglobin were lower in diabetic group (t=-2.862,-2.034,P＜0.05).Klebsiella pneumonia was the most common pathogens and the positive ratewashigher in diabetic group (x2=3.893,P＜0.05).Multivariate logistic regression analysis showed that multiple abscesses (OR=8.761,95％CI:1.364-56.259) and abscess size≥10 cm (OR=9.648,95％CI:1.496-62.232) were independent risk factors for poor prognosis in diabetic patients.Hypoalbuminemia (OR=2.794,95％CI:1.062-7.349)and abscess size ≥ 10 cm (OR=3.777,95％CI:1.402-10.178) were independent risk factors for poor prognosis in non-diabetic patients.Conclusions Diabetic patients with liver abscess have atypical clinical characteristics and ware commonly caused by Klebsiella pneumonia.The size and number of abscesses may be associated with its prognosis.

Objective To compare the efficacy of telbivudine(LdT) and entecavir (ETV) in treatment of hepatitis B virus e antigen (HBeAg)-positive chronic hepatitis B (CHB) patients with high viral load (HBV DNA ≥ 107copies/mL).Methods Eighty-one HBeAg-positive CHB patients with high viral load were divided into LdT group (n=41) and ETV group (n=40).All patients received a 144-consecutive-week treatment.HBV DNA level,HBV serological markers,biochemical index,related complications,and drug resistance were observed and compared at the same time points between two groups.Results Baseline data of two groups were comparable.At 4,8 and 12 weeks,HBV DNA negative rates of LdT group were 24.4％,63.4％ and 80.5％,higher than 12.5％,27.5％ and 70.0％ of ETV group with significant differences (x2=5.102,P＜0.05); but no significant difference in HBV DNA negative rates at 144 weeks was noted between two groups (97.6％ vs 100.0％,x2=3.374,P＞0.05).After 144-week treatment,HBeAg seroconversion rate of LdT group was 63.4％,higher than 25.0％ of ETV group with a significant difference (x2=12.183,P＜0.01).In LdT group,2 cases (4.9％) had HBsAg seroconversion,5 cases (12.2％) developed drug resistance,and 8 cases (19.5％) had an elevation of creatine kinase.The total cost of LdT treatment was lower than that of ETV.Conclusions HBeAg-positive CHB patients with high viral load can obtain complete viral suppression after long-term (144 weeks) treatment with LdT or ETV.ETV has the advantage of low drug resistance and no adverse reaction,while LdT has higher rate of early viral suppression and seroconversion,and low cost.

Objective To evaluate the influence to detect ascites bacteria with 16S rRNA PCR-microarray in patients with spontaneous bacterial peritonitis( SBP) after treated with antibiotics.Methods Compared to ascites bacterial culture,ascites bacterial 16S rRNA genes were detected by PCR-microarray in 76 cases of suspected SBP with chronic liver diseases,and the difference of ascites bacteria positive rates between two groups with and without antibiotics were analyzed.Results Of the 76 ascites samples in SBP patients,there were 17(22.37％ ) ascites bacteria positive detected by PCR-microarray,and 6(7.89％ ) ascites bacteria positive detected by bacterial culture.The positive rates of former were much higher(x2 =18.05,P ＜0.01).In groups with and without antibiotics,the positive rates of bacterial detection with PCR-microarray were 19.35％ and 24.44％ respectirely,there was no statistical difference between the two groups( x2 =0.274,P ＞ 0.05) ; and the positive rates of bacterial detection with bacterial culture were 0(0/31 ) and 13.33％(6/45) respectively,there was statistical difference between the two groups(x2 =4.488,P ＜ 0.05).Conclusions Compared to the ascites bacterial culture,less influence is found in ascites bacteria detection with 16S rRNA PCR-microarray in patients with SBP after treatment with antibiotics.

Objective To compare the efficacy of combination therapy with lamivudine(LAM) and adefovir dipivoxil(ADV) for LAM-poorly responsed and LAM-resistant to those de novo combination therapy for chronic hepatitis B (CHB).Methods Twenty CHB patients with poorly response to LAM were selected as group A,20 LAM-resistant patients as group B,other 20 CHB patients received combination therapy for the first time as group C.All the patients were given LAM ( 100 mg/d) and ADV (10 mg/d) for 48 weeks,the level of HBV DNA,ALT and HBeAg in patients were detected and HBV mutation was detected for whose HBV DNA were still positive after treatment.Results The negative rate of HBV DNA in group A,B and C were 85％,80％,90％ ( F =0.784,P ＞ 0.05),and the negative rate of HBeAg were 31.3 ％,30.8 ％,33.3 ％ ( F =0.025,P ＞ 0.05) in group A,B,C,respectively.The level of HBV DNA and ALT decreased remarkably after 48 combination treatment in group A,B,C ( t =9.706,10.871,11.807,P ＜ 0.01 ;t =2.157,2.109,2.653,P ＜ 0.05).HBV DNA in 9 patients were still positive after treatment,but no HBV mutations were detected in three groups.Concusions The combination therapy of LAM and ADV can effectively inhibit HBV replication,improve ALT level in CHB patients,but the efficacy in HBeAg seroconversion rate are not obvious.The efficacy of combination therapy in three groups are similar.No HBV mutations are detected for three groups.