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The global morbidity of invasive fungal diseases (IFD) tends to increase, especially in immunocompromised people.Due to the atypical symptoms, unclear etiological mechanism, and emerging antifungal resistance, IFD challenge current clinical diagnosis and treatment.The World Health Organization (WHO) developed the first WHO fungal priority pathogens list in 2022.The most concerning fungal pathogens were listed and summarized to promote further understanding of the epidemiology of IFD and antifungal drug resistance.It is hoped to provide a basis for the prevention and interventions of IFD.
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Objective:To investigate the clinical characteristics and risk factors of postinfectious bronchiolitis obliterans(PIBO)after severe adenovirus pneumonia(SAP).Methods:We retrospectivly analyzed 78 children who were hospitalized for SAP at Shenzhen Children′s Hospital from April 2015 to April 2020.The cases were divided into PIBO group( n=26) and non-PIBO group( n=52) based on the diagnosis results.The general conditions, clinical characteristics, and laboratory data from two groups were analyzed, and the risk factors for PIBO were explored. Results:A total of 78 children were included in this study.There were 18 (69.2%) males and eight (30.8%) females in PIBO group; the average age of onset in PIBO group was younger than that in non-PIBO group[(11.77±3.24)months vs.(15.08±6.48)months, P=0.027]. The cough duration[(11.35±7.35)days vs.(7.15±5.67)days, P=0.010], and heat duration[(13.12±6.78)days vs.(8.62±4.76)days, P=0.007] were longer in PIBO group than those in non-PIBO group.The white blood cell count[(12.46±7.23)×10 9/L vs.(9.17±3.66)×10 9/L), P<0.05], platelet count[(390.12±209.03)×10 9/L vs.(284.69±83.33)10 9/L, P<0.05], C-reactive protein[(37.04±32.16)mg/L vs.(18.14±18.33)mg/L, P<0.05], procalcitonin[(3.51±3.33)μg/L vs.(1.09±1.37)μg/L, P<0.05], lactate dehydrogenase(LDH)[(1 155.88±842.94)IU/L vs.(414.00±218.94)IU/L, P<0.01] were all higher in PIBO group than those in non-PIBO group; The roportion of patients with mycoplasma pneumoniae infection[5(19.2%) cases vs.4(7.7%) cases, P<0.05], admitted to PICU[18(69.2%) cases vs.8(15.4%) cases, P<0.01] , using invasive mechanical ventilation[10(38.5%) cases vs.5(9.6%) cases, P<0.01], using hormones[23(88.5%) cases vs.21(40.4%) cases, P<0.01], and using human immunoglobulin[20 (76.9%) cases vs.10(19.2%) cases, P<0.01] were higher in PIBO group than those in non-PIBO group.The multivariate Logistic regression using stepwise method showed that older age ( OR=0.942, 95% CI 0.890-0.997) was a protective factor for PIBO, while higher LDH levels ( OR=1.005, 95% CI 1.002-1.008), using intravenous corticosteroids ( OR=6.622, 95% CI 0.924-47.436), and using human immunoglobulin ( OR=9.681, 95% CI 1.742-53.802) were the risk factors for PIBO in SAP ( P<0.05). The receiver operating characteristic curve was constructed through the combination of age of onset, LDH level, using intravenous hormone, and using human immunoglobulin.The area under the curve reached 0.954.The overall best cut-off value of the prediction model was 0.272, the sensitivity was 92.3%, and the specificity was 86.5%.When LDH=462 IU/L, the area under the curve reached the maximum value of 0.882, the sensitivity was 100.0%, and the specificity was 61.5%. Conclusion:SAP children with characteristics such as younger age, long cough and fever duration, high inflammatory index, LDH level higher than 462 IU/L, admitted to PICU, mechanical ventilation and need hormones and human immunoglobulin, should be alert to the risk of PIBO.
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<p><b>OBJECTIVE</b>To explore the operative approach and method of internal fixation for the treatment of type-C thoracolumbar fractures.</p><p><b>METHODS</b>T wenty-eight patients (male 20, female 8, ranging in age from 20 to 54 years, with an average of 38.5 years) with type-C thoracolumbar fractures were invovled in the study. Distributed segments involved T11 in 2 patients, T12 in 3 patients, L1 in 11 patients, L2 in 8 patient, L3 in 3 patients and L4 in 1 patient. Twenty-six patients were followed up (range from 12 to 20 months). According to the analysis of X-ray and CT image,height of vertebral body, Cobb angle on sagittal and coronal plane and the percentage of occupancy of vertebral canal were measured. The recovery of nerve, happening of back pain and the failure of internal fixation were observed.</p><p><b>RESULTS</b>The preoperative averaging height-loss decreased from 37.4% to 6.8% and the deformation of coronal plane was completely rectified. The preoperative averaging Cobb angle on sagittal plane recovered from 22.3 degrees to 5.6 degrees and the preoperative occupancy of vertebral canal averaging recovered from 33.7% to 5.9%. The difference was statistically significant (P < 0.05). Moreover, after 1 year follow-up, the changes of the above-mentioned index was no statistically significant (P > 0.05). Except for 8 patients with complete nerve damage losing the possibility of recovery, the others with incomplete nerve damage obtained 1 to 3 degree's improvement. The ratio of back pain occurrence was 19.2%. There was no failure of internal fixation.</p><p><b>CONCLUSION</b>The treatment of thoracolumbar type-C fractures with simple posterior long-segment internal fixation or posterior long-segmental fixation added by anterior autograft fusion is a reliable and effective method. The short-term therapeutic effect is satisfactory and the long-term therapeutic effect is to be further observed.</p>