We aimed to evaluate whether there is a linear relationship between neutrophil to lymphocyte ratio (NLR) and adverse outcomes in the older hospitalised patients with community-acquired pneumonia (CAP). The performance of adding NLR to current pneumonia severity scores, including CURB-65, CRB-65, A-DROP and SMART-COP, in predicting 30-day mortality was also investigated. This is a secondary analysis based on an existing dataset of an older cohort of CAP, including 812 patients. Clinical and laboratory results on admission were used to calculate the above scores. The primary outcome was 30-day mortality. Baseline characteristics and outcomes were presented grouped by quartile of NLR. Multivariable adjusted logistic regression and restricted cubic spline were used to evaluate the association between NLR and 30-day mortality. Updated systems were developed after adding NLR to the above four scoring systems. Model discrimination was evaluated by the area under receiver operating characteristic curve (AUCs). Compared with the lowest quartile NLR group, the higher quartile NLR group had an increased risk of 30-day mortality, with a rate of 18.3

Isavuconazole has been used to treat invasive fungal infections, however, it is unclear whether the efficacy of isavuconazole is superior to that of voriconazole. The purpose of this meta-analysis was to assess the efficacy and safety of isavuconazole compared to voriconazole in treating invasive fungal infections. Electronic databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, were searched to identify relevant studies. Studies evaluating the effect of isavuconazole in the treatment of patients with invasive fungal infections were included. Pooled rates of overall response, all-cause mortality, drug-related adverse events (AEs), and discontinuation due to drug-related AEs were calculated. Seven studies involving 890 patients were included. Meta-analysis showed that there was no significant difference between isavuconazole and voriconazole in overall response (risk ratio [RR]: 1.02, 95

The construction of a quality control system for respiratory medicine is of great significance for improving the quality and homogenization of the diagnosis and treatment of respiratory diseases. The national respiratory quality control work conducted by the China National Respiratory Medicine Quality Control Center was summarized.

Although persistent or recurrent COVID-19 infection is well described in some immunosuppressed patient cohort, to date, there have been no reports of this phenomenon in the context of repeatedly negative SARS-CoV-2 testing in the upper respiratory tract. We reported six patients with follicular lymphoma who developed recurrent symptomatic COVID-19 infection. They tested persistently negative for SARS-CoV-2 on pharyngeal swabs and ultimately confirmed by bronchoalveolar lavage fluid metagenomics next-generation sequencing. All six patients presented with lymphopenia and B-cell depletion, and five of them received the anti-cluster of differentiation 20 treatment in the last year. Persistent fever was the most common symptom and bilateral ground-glass opacities were the primary pattern on chest computed tomography. A relatively long course of unnecessary and ineffective antibacterial and/or antifungal treatments was administered until the definitive diagnosis. Persistent fever subsided rapidly with nirmatrelvir/ritonavir treatment. Our case highlighted that recurrent COVID-19 infection should be suspected in immunocompromised patients with persistent fever despite negative pharyngeal swabs, and urgent bronchoalveolar lavage fluid testing is necessary. Treatment with nirmatrelvir/ritonavir appeared to be very effective in these patients.

慢性阻塞性肺疾病(简称慢阻肺)是严重威胁人类健康的疾病,具有高患病率、高病死率、高致残率、高疾病负担的特点.慢阻肺质量控制(简称质控)指标的制定对慢阻肺诊疗的质量及均质化提升有着重大的意义.国际上英国、美国、澳大利亚的呼吸专科质控体系不同,并从不同侧重点制定了慢阻肺质控指标,对我国慢阻肺质控指标的修订有一定的借鉴作用.我国卫健委发布的慢阻肺质控指标注重慢阻肺检查和治疗的过程管理以及疾病预后.本文对国际主要国家及我国的慢阻肺质控指标进行解读,旨在为完善慢阻肺质控指标以及提高慢阻肺诊疗规范提供参考.

医疗质量是医疗安全的基石.医疗质量控制体系没有统一的模式.作者通过阐述医疗质量相关概念,概述国际呼吸专科医疗质量控制体系,提出中国呼吸专科医疗质量控制体系存在的问题及改进方向,以期不断健全和完善呼吸专科医疗质量控制体系.

An approach to a patient with suspected meat allergy due to underlying alpha-Gal syndrome in a resource-limited setting

Dupilumab, a human monoclonal antibody against interleukin (IL) 4 receptor α, inhibits the signaling of IL-4 and IL-13. It is an effective treatment for several conditions characterized by the recruitment of eosinophils to sites of inflammation, such as asthma, atopic dermatitis, chronic spontaneous urticaria, and eosinophilic esophagitis.1 Recently, dupilumab was reported to be markedly effective and well tolerated in a treatment-recalcitrant patient with hypereosinophilic syndrome (HES).2

Background: Asthma is a chronic airway disorder associated with aberrant inflammatory, remodeling and angiogenesis, indicating that the altered pulmonary microcirculatory may exist in the local and contribute to the pathogenesis. There are rare studies in vivo, which could directly prove the disorders of microcirculation in asthmatic lungs. This study aimed to establish Micro-in-One platform and set up the first profile of the integrated asthmatic pulmonary microcirculation. Methods: Using murine models of asthma induced by ovalbumin (OVA) and house dust mite (HDM), the raw data set of pulmonary microcirculation was collected and visualized by multimodal device and computer algorithm-based Micro-in-One platform. A three-dimensional framework was constructed, and changes of pulmonary microcirculatory oxygen, microhemodynamics were compared. The contributions of biological oscillators were revealed by wavelet transform analysis. Additionally, levels of microcirculation-associated proteins in serum were measured by antibody-pair-based assay. Results: Microcirculatory profile of the lungs in both OVA-induced and HDM-induced asthma groups exhibited a loss of microhemodynamic coherence compare to the control mice, including the decreased microvascular blood perfusion, decreased PO , and significantly increased index of pulmonary microcirculatory resistance (IMRp). In addition, amplitude regimens separated by (NO-dependent and NO-independent) endothelial components were related to the changes in pulmonary microcirculation in asthmatic models. Meanwhile, matrix-based hierarchical clustering analysis showed that IMRp positively correlated to amplitude in both asthmatic groups. Conclusions: Micro-in-One is a validated and reliable method to measure and visualize the integrated pulmonary microcirculation. Data suggest that there is the dysfunctional status of pulmonary microcirculation in asthma.

随着生活环境的变化,过敏性疾病的发病率迅速增长,已成为影响人们健康、生活的重要因素.由于起步较晚,中国的过敏疾病学科在诊治水平、专业协作以及公众认知等方面与国际水平仍有较大差距.现代医学认识过敏性疾病经历了较为漫长的历程,这起步于19世纪初对"枯草热"的描述,随后的半个世纪科学家通过实验的方法证明花粉是其直接诱因.20世纪至今,对过敏性疾病的认识经历了卓有成效的进步,这些研究成果构建了今天过敏性疾病的雏形并确立了治疗的基石.尽管如此,过敏性疾病仍然困扰着众多患者,影响着他们的健康并影响着整个社会的经济天平.通过观察和总结,科学家逐渐认识到多种过敏性疾病的发生和发展具有密切的关联并提出了过敏进程的定义,这为过敏性疾病未来的发展指明了道路.向内深入机制,向外推广规范的治疗,横向联合众多学科,纵向参透过敏的进程,将是未来过敏性疾病前进发展的目标和方向.

近年来,随着支气管哮喘发病机制相关信号通路研究的不断深入,基于其机制研发了一些新的靶向药物.这些药物正逐步进入临床研究阶段,部分药物已经通过临床试验,最终进入临床使用,给临床医师带来更多的精准治疗的选择.本文将从支气管哮喘的病理生理机制、不同信号通路的功能的角度,对靶向药物在支气管哮喘中的应用做一系统综述,以期加深对靶向药物作用机制的理解,并为临床工作中治疗方案的选择提供参考和依据.

Background: Invasive mycoses are serious infections with high mortality and increasing incidence. Voriconazole, an important drug to treat invasive mycosis, is metabolized mainly by the cytochrome P450 family 2 sub-family C member 19 enzyme ( CYP2C19) and is affected by the genotypes of CYP2C19. Objective: We reviewed studies on how genotypes affect the pharmacokinetics and pharmacodynamics of voriconazole, and attempted to determine a method to decide on dosage adjustments based on genotypes, after which, the main characteristic of voriconazole was clarified in details. The pharmacokinetics of voriconazole are influenced by various inter and intrapersonal factors, and for certain populations, such as geriatric patients and pediatric patients, these influences must be considered. CYP2C19 genotype represents the main part of the interpersonal variability related to voriconazole blood concentrations. Thus monitoring the concentration of voriconazole is needed in clinical scenarios to minimize the negative influences of inter and intrapersonal factors. Several studies provided evidence on the stable trough concentration range from 1-2 to 4-6 mg/L, which was combined to consider the efficacy and toxicity. However, the therapeutic drug concentration needs to be narrowed down and evaluated by large-scale clinical trials. Conclusion: Though there is insufficient evidence on the relationship between CYP2C19 genotypes and clinical outcomes, there is a great potential for the initial voriconazole dose selection to be guided by the CYP2C19 genotype. Finally, voriconazole therapeutic drug monitoring is essential to provide patient-specific dosing recommendations, leading to more effective anti-fungal regimens to increase clinical efficacy and reduce adverse drug reactions.