Background Varicella-zoster virus (VZV) can cause acute brain infection manifesting as meningitis or encephalitis, which more likely occurs in winter and population with immunocompromised conditions[1]. During the enterovirus epidemic season, VZV meningitis is easy to be ignored and misdiagnosed, especially when the typical dermatomal rash is absent. Case presentation Here, we present an atypical case of a young immunocompetent male with VZV meningitis and encephalitis during summer. The patient presented with fever, headache and vomiting, but without dermatomal rash. Metagenomic Next-generation Sequencing (mNGS) of cerebrospinal fluid (CSF) revealed VZV infection. He was treated successfully with acyclovir and recovered without any neurological sign. Conclusions This case report describes a patient with mild diabetes but no immunocompromised condition who developed meningitis and encephalitis resulting from VZV infection in summer. Additionally, there is no dermatomal rash in the patient. It can broaden the understanding of the disease, and keep VZV infection in differential diagnoses of viral meningitis.

BACKGROUND:Airway microbiome has been linked to asthma heterogeneity, yet little is known about the associations between airway microbiota and type 2 (T2) asthma phenotype and severity. OBJECTIVE:To determine the relationship of nasopharyngeal (NP) and induced sputum (IS) microbiota to the phenotypic features of T2 asthma. METHODS:NP and IS samples from subjects with T2 mild-to-moderate asthma (n = 23), subjects with severe asthma (n = 21), and healthy controls (n = 16) were analyzed. Bacterial microbiota and functional profiles were compared. The correlation between microbial communities and clinical and inflammatory features was evaluated in individuals with asthma of 2 statuses. RESULTS:Differences in NP and IS microbiota were associated with T2 asthma phenotype. Alterations in NP microbiota were more reflective of T2 inflammation and severity, with additional stratification of a subgroup characterized by significant elevations in T2 inflammatory biomarkers and reductions in bacterial richness and diversity (P < .05). Burkholderia-Caballeronia-Paraburkholderia, Ralstonia, and Rhodococcus were identified as hub taxa within NP microbial network in T2 severe asthma, which were prevalent in the entire airway and involved in bacterial functions including inflammatory and steroid responses (P < .05). The composition and diversity of IS microbiota were complex, with Veillonella as the most altered genus, having an increase with increasing asthma severity. CONCLUSION:Our work revealed the significant associations of microbiota perturbations throughout the entire respiratory tract to the extent of T2 inflammation, phenotype and severity in T2 asthma. The specific taxa identified invite further mechanistic investigations to unravel their possibility as biomarkers and therapeutic targets for T2 severe asthma.

Background: There are no guidelines in China or worldwide that clearly recommend indicators for the early diagnosis of sepsis in the emergency department. Simple and unified joint diagnostic criteria are also scarce. We compare the Quick Sequential Organ Failure Assessment (qSOFA) score and inflammatory mediator concen-trations in patients with normal infection, sepsis, and sepsis death.Methods: This study used a prospective and consecutive manner, including 79 patients with sepsis in the Emergency Department of Shenzhen People's Hospital from December 2020 to June 2021, and 79 patients with common infections (non-sepsis) matched by age and sex during the same period. The sepsis patients were then divided into a sepsis survival group (n = 67) and a sepsis death group (n = 12) based on whether they survived within 28 days. The baseline characteristics, qSOFA scores, the concentrations of tumor necrosis factor-alpha(TNF-alpha), interleukin (IL)-6, IL-1b, IL-8, IL-10, procalcitonin (PCT), high-sensitivity C-reactive protein (HSCRP) and other indicators were collected in all subjects.Results: PCT and qSOFA were independent risk factors for predicting sepsis in the emergency department. The AUC value of PCT was the largest (0.819) among all diagnostic indicators of sepsis, with a cut-off value of 0.775 ng/ml and sensitivity and specificity of 0.785 and 0.709, respectively. The AUC of qSOFA combined PCT was the largest (0.842) in the combination of the 2 indicators, and the sensitivity and specificity were 0.722 and 0.848, respectively. IL-6 was an independent risk factor for predicting death within 28 days. IL-8 had the largest AUC value (0.826) among all indicators predicting sepsis death, with a cut-off value of 215 pg/ml and sensitivity and specificity of 0.667 and 0.895, respectively. Among the combination of two indicators, qSOFA combined with IL -8 had the largest AUC value (0.782) and sensitivity and specificity of 0.833 and 0.612, respectively.Conclusions: QSOFA and PCT are independent risk factors for sepsis, and qSOFA combined with PCT may be an ideal combination for early diagnosis of sepsis in the emergency department. IL-6 is an independent risk factor for death within 28 days of sepsis, and qSOFA combined with IL-8 may be an ideal combination for early pre-diction of death within 28 days in sepsis patients in the emergency department.

Objective:To assess the effect of exercise prescription on patients with chronic obstructive pulmonary disease (COPD) and respiratory failure through meta-analysis.Methods:A comprehensive search was conducted in PubMed, The Cochrane Library, EMbase, CNKI, Wanfang, VIP, and China National Knowledge Infrastructure from the database establishment date to February 1, 2023. The search included randomized controlled trials that involved exercise prescription for patients with COPD and respiratory failure. Two independent researchers conducted literature searches, data extraction, and methodological quality evaluation. Meta-analysis was performed using Review Manager 5.3.Results:A total of 11 studies with 862 patients were included in the analysis. The meta-analysis revealed that the exercise prescription was beneficial in improving lung function [forced expiratory volume in one second (FEV 1): standardized mean difference ( SMD)=1.53(95% CI: 1.28, 1.78), P<0.001; forced vital capacity (FVC): SMD=1.55(95% CI: 0.25, 2.84), P=0.020; FEV 1/FVC: SMD=1.68(95% CI: 0.81, 2.55), P<0.001], gas exchange ability [arterial partial pressure of oxygen (PaO 2): SMD=1.13(95% CI: 0.92, 1.34), P<0.001; arterial partial pressure of carbon dioxide (PaCO 2): SMD=-1.23(95% CI:-1.60, -0.85), P<0.001], improving 6 minutes walking distance test (6MWT) [ SMD=2.20(95% CI: 1.13, 3.27), P<0.001], relieving dyspnea [Borg score: SMD=-1.74(95% CI:-3.26, -0.22), P=0.020; St George′ respiratory questionnaire (SGRQ) score: SMD=-1.10(95% CI:-1.53, 0.66), P<0.001], and reducing mechanical ventilation time [ SMD=-2.08(95% CI:-3.33, -0.83), P=0.001]. Conclusion:Exercise prescription can improve the pulmonary function, gas exchange ability, cardiorespiratory endurance, quality of life, dyspnea and reduce the duration of mechanical ventilation and negative outcomes for patients with COPD and respiratory failure.

Background Leptospirosis is a zoonosis caused by spirochete “genus” leptospira. The clinical presentations of leptospirosis range from an influenza-like presentation of fever and myalgia, to severe forms. Leptospirosis can potentially lead to a misdiagnosis or delay in diagnosis when clinical similarities exist. Case presentation A 63-year-old man presented with fever, shock and thrombocytopenia followed by diffuse pulmonary hemorrhage. Peripheral blood Metagenomic Next-generation Sequencing (mNGS) reported Leptospira interrogans. The patient was treated with piperacillin-tazobactam (TZP) plus doxycycline and improved dramatically after 7 days. Conclusion We conclude that leptospirosis can potentially lead to a misdiagnosis or delay in diagnosis. Correctly evaluation of thrombocytopenia in acute febrile illnesses facilitates the differential diagnosis of leptospirosis. mNGS can accurately detect Leptospira DNA during the early stage of the infection.

Background Acute exposures to high levels of air pollutants are thought to be associated with hospitalization of patients with lung infection, while relatively little is known about the association between air pollutants and HOSPITAL ADMISSIONS FOR pulmonary sepsis. Objectives To assess the correlation between low-level exposure to air pollutants and the hospitalizations for pulmonary sepsis in elderly patients. Methods A total of 249 elderly patients with pulmonary sepsis from January 2018 to December 2020 in Shenzhen people’s hospital were included. The data regarding hospitalizations for pulmonary sepsis, meteorological factors, and daily average levels of air pollutants on single-day lags (Lag0 to Lag7) in Shenzhen were collected. Low-level exposure was defined as the annual means of air pollutants below the levels of the Ambient Air Quality Standard (AAQS) in China (NO. GB3095-2012) and/or Global Air Quality Guidelines (AQG). A time-stratified case-crossover study design approach was used to evaluate the associations between exposure to air pollutants and incidence of the disease, univariate and multivariate logistic regression analysis to analyze the association between levels of air pollutants and hospitalizations for pulmonary sepsis in elderly patients. Results Exposure to PM 1 ( P = 0.007, Lag 2 day; P = 0.038, Lag6 day), PM 2.5 ( P = 0.046, Lag2 day), PM 10 ( P = 0.048, Lag4 day), and O 3 ( P = 0.044, Lag6 day) was positively correlated with elevated risk of hospitalizations for pulmonary sepsis. In addition, logistic regression analysis revealed that exposure to PM 1 (OR = 1.833, 95%CI:1.032 ~ 3.256, Lag6 day) and O 3 (OR = 2.091, 95%CI:1.019 ~ 4.289, Lag6 day) were the independent risk factors of pulmonary sepsis in elderly patients. Conclusion Our results demonstrate that short-term low-level exposure to PM 1 and O 3 could elevate the risk of hospitalizations for pulmonary sepsis in elderly patients in Shenzhen, providing evidence for developing early warning and screening systems for pulmonary sepsis.

气道重塑是导致哮喘患者持续性气流受限及肺功能受损的主要病理基础.越来越多的学者致力于哮喘气道重塑的分子干预研究,并已取得了一定的进展,有望为改善哮喘患者的临床预后带来希望.本文就分子靶向药物在哮喘气道重塑治疗中的进展作一综述,探讨哮喘气道重塑靶向治疗的可行性.