Clinical manifestations of pulmonary cryptococcosis: an analysis of 113 cases / 中华全科医师杂志

Objective:To analysis of clinical and imaging characteristics of pulmonary cryptococcosis.Methods:The clinical and imaging characteristics of 113 patients with pulmonary cryptococcosis who were admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to March 2019, were retrospectively analyzed.Results:Among 113 patients, 74 cases (65.5%) were males, and 71 cases (62.8%) were at a age of 40-60 years. The imaging manifestations showed a nodular-infiltrating patchy mixed type ( n=44,38.9%), accompanied by halo sign ( n=48, 42.5%) and bronchial air sign ( n=48, 42.5%). All patients were treated with fluconazole and the follow-up at 3 months after discharge showed their conditions were all improved. Subgroup analysis showed that patients with complications had older average age [(54.28±10.64)y vs. (46.52±12.12)y, t=-5.05, P<0.001], longer hospital stay [(10.42±6.11)d vs. (7.09±5.63)d, t=-4.28, P=0.007], lower white blood cell count [(6.02±2.16)×10 9/L vs. (6.96±2.29)×10 9/L, t=2.44, P=0.027]. The symptomatic group had fewer male patients [56.2% (45/80) vs. 87.9% (29/33), χ 2=19.54, P<0.001], and imaging was more likely to show infiltrative patchy [32.5%(26/80) vs. 9.1%(3/33), χ 2=18.25, P=0.031]. There was no significant difference in clinical and imaging manifestations between antigen positive group and antigen negative group(all P>0.05). Conclusions:Most of the patients with pulmonary cryptococcosis are middle-aged men, and have nodular-infiltrating patchy mixed type in imaging; the complications would prolong the length of hospital stay.

Spread and control of COVID-19 in China and their associations with population movement, public health emergency measures, and medical resources

BACKGROUNDThe COVID-19 epidemic, first emerged in Wuhan during December 2019, has spread globally. While the mass population movement for Chinese New Year has significantly influenced spreading the disease, little direct evidence exists about the relevance to epidemic and its control of population movement from Wuhan, local emergency response, and medical resources in China. METHODSSpearmans correlation analysis was performed between official data of confirmed COVID-19 cases from Jan 20th to Feb 19th, 2020 and real-time travel data and health resources data. RESULTSThere were 74,675 confirmed COVID-19 cases in China by Feb 19th, 2020. The overall fatality rate was 2.84%, much higher in Hubei than in other regions (3.27% vs 0.73%). The index of population inflow from Hubei was positively correlated with total (Provincial r=0.9159, p<0.001; City r=0.6311, p<0.001) and primary cases (Provincial r=0.8702, p<0.001; City r=0.6358, p<0.001). The local health emergency measures (eg, city lockdown and traffic control) were associated with reduced infections nationwide. Moreover, the number of public health employees per capita was inversely correlated with total cases (r=-0.6295, p <0.001) and infection rates (r =-0.4912, p <0.01). Similarly, cities with less medical resources had higher fatality (r =-0.4791, p<0.01) and lower cure rates (r = 0.5286, p<0.01) among the confirmed cases. CONCLUSIONSThe spread of the COVID-19 in China in its early phase was attributed primarily to population movement from Hubei, and effective governmental health emergency measures and adequate medical resources played important roles in subsequent control of epidemic and improved prognosis of affected individuals.

Interpretation of / 浙江大学学报·医学版

The revision inincludes both the diagnosis of asthma and the control-based asthma management. It points out that asthma is a heterogeneous disease, and the diagnosis of asthma should be based on the characteristic pattern of symptoms and evidence of variable airflow limitation, emphasizing the diagnosis of atypical asthma. Besides, the epidemiology of asthma, assessment of asthma, management severe asthma, special type of asthma and asthma in special populations have been added in this version. The revised guideline provides an important reference for the standardized management of asthma.

The evaluation of early lactate clearance rate in respect of prognosis in patients with severe COPD / 中华急诊医学杂志

Objective To investigate the clinical significance of early lactate clearance rate in respect of the prognosis of patients with severe chronic obstructive pulmonary disease (COPD) . Methods A total of 108 COPD patients with respiratory failure were studied prospectively. The patients were divided into survival group ( n = 82) and the death group ( n = 26) , and the survival group further divided into the conventional treatment subgroup ( n = 55 ) and the invasive ventilation subgroup ( n = 27 ) . Arterial blood lactate, arterial gas analysis, APACHE Ⅱ score and the 6-hour clearance rate were measured before and 6 hours after treatment in 3 groups. The high lactate clearance rate group (n =71 ) was defined as a lactate clearance rate ＞ 10% , and the low lactate clearance rate group (n = 37) with a lactate clearance rate ＜ 10%. The correlation between 6-hour lactate clearance rate and prognosis in patients was analyzed. Results Compared the survival patients in invasive ventilation group with the death group, there were no statistical differences in arterial blood lactate, pH value, PaCO2, PaO2, oxygenation index and APACHE Ⅱ score before the treatment. The 6-hour lactate clearance rate in survival patients in conventional treatment group or invasive ventilation group was significantly higher than that in the death group (t =31.2, P＜0. 01; t =34.6, P＜0. 01, respectively), while there were no statistical differences in APACHE Ⅱ score and pH value between these 3 groups. Between the conventional ventilation treatment group and the invasive ventilation treatment group, there was no statistical difference in 6-hour lactate clearance rate ( P ＞ 0. 05 ) . There was no statistical difference in APACHE Ⅱ score between before treatment and after treatment in 3 groups. Mortality in high lactate clearance rate group (4. 2% ) was significantly lower than that in low lactate clearance rate group (62. 2% ) (x2 = 121.9, P ＜ 0. 01 ) .Conclusions The early (6h) lactate clearance rate could be used as a marker for evaluating the severity,therapeutic efficacy and prognosis of patients with severe COPD.

Primary tracheobronchial amyloidosis in China: Analysis of 64 cases and a review of literature / 华中科技大学学报（医学）（英德文版）

Primary tracheobronchial amyloidosis (TBA) is a rare pulmonary disease. A systematic review was performed on 64 cases of primary TBA in China and progress in the diagnosis and treatment of this disease is discussed. The Chinese biological and medical databases from 1970 to 2010 were searched and 75 cases of complete clinical and pathological data were identified. The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time. The results showed that the morbidity associated with primary TBA has increased over recent years. The clinical manifestations were non-specific. Progressive dyspnea, cough and sputum were the most common symptoms. The percentage of patients undergoing computed tomography (CT) scan has increased over the years. The bronchoscopy and transbrochial lung biopsy (TBLB) were usually sufficient to establish the diagnosis. Treatment was reported for a total of 44 cases. Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration such as steroids and colchicines were reported to be effective in some patients. It is concluded that the demographic characteristics and clinical manifestations of primary TBA patients in China are largely consistent with findings reported in other countries. Dramatically more cases were reported in recent years, mainly due to the extensive application of bronchoscopy since 1990s. Chest CT scan provides important clues for the diagnosis of the disease. The definite diagnosis was confirmed by bronchoscopic findings and Congo red staining of biopsy specimen. Bronchoscopic Nd:YAG laser irradiation, argon plasma coagulation (APC) and drugs administration, such as steroids and colchicines were reported to be effective in some patients.

Diagnostic value of the soluble triggering receptor expressed on myeloid cells-1 in bacterial infection: a meta-analysis.

OBJECTIVE: To evaluate the accuracy of the soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic test for bacterial infection. DESIGN: Meta-analysis of 13 diagnostic studies. DATA SOURCE: Medline; Embase; Web of Science (from January 1966 to January, update to August 2008); and Cochrane Controlled Clinical Trials Register Database (through first quarter 2008). MEASUREMENTS AND RESULTS: A meta-analysis of all 73 studies was performed. Thirteen studies fulfilled the inclusion criteria (980 patients, 557 patients with bacterial infection, 423 with non-bacterial infection); global prevalence was 56.8%. The global sensitivity was 0.82 (95% confidence interval CI, 0.68-0.90), the specificity was 0.86 (95% CI, 0.77-0.91), the positive likelihood ratio (PLR) was 5.66 (95% CI, 3.41-9.38), the negative likelihood ratio (NLR) was 0.21 (95% CI, 0.12-0.40), and the diagnostic odds ratio (DOR) was 26.35 (95% CI, 10.32-67.28). The area under the curve of the summary receiver operator characteristic (SROC) was 0.86 (95% CI, 0.77-0.91), with a Q point value of 0.84. The sensitivity of the sTREM-1 assay for diagnosis of urinary tract infection was low (0.18, 95% CI, 0.05-0.51). CONCLUSIONS: sTREM-1 represents a reliable biological marker of bacterial infection, but it may be not a sufficient biological marker for infection of the urinary tract as a result of its low sensitivity. Whether sTREM-1 guidance can reduce antibiotic use as well as the measurement of sTREM-1 in different types of infection will require additional prospective studies.

Nontypeable Haemophilus influenzae up-regulate MUCSAC mucin expression / 中华传染病杂志

Objective To investigate the signaling mechanisms underlying up-regulation of nontypeable Haemophilus influenzae(NTHi)-induced MUC5AC mucin expression. Methods The expression of MUC 5AC at mRNA level was measured by reverse transcriptase-polymerase chain reaction (RT-PCR)and real-time fluorescent quantitative PCR.Immunoprecipitation and Western blot were performed tO examine the phosphorylation of p38 mitogen-activated protein kinase(p38MAPK)and epidermal growth factor receptor(EGFR)or the effect of dominant negative mutant of EGFR on the phosphorylation of p38MAPK in HM3 cells treated with NTHi.Luciferase assay was also performed to examine the effect of p38MAPK and EGFR inhibitors or dominant negative mutant of EGFR on NTHi-induced MUC5AC expression at transcription level.Results NTHi induced MUC5AC mucin expression at both mRNA and transcription levels.Phosphorylation of p38MAPK and EGFR were observed in HM3 cells treated with NTHi.Either SB203580,a specific inhibitor for p38MAPK or AGl478,a specific inhibitor for EGFR.inhibited NTHi-induced MUC5AC up-regulation at transcription level. Furthermore,Overexpressing dominant negative mutant of EGFR also inhibited NTHi-induced MUC5AC upregulation at transcription 1evel in a dos-dependent manner.EGFR inhibitor reduced NTHi-induced p38MAPK phosphorylation in HM3 cells.Conclusion Bacterium NTHi up-regulates MUC5AC mucin transcription via EGFR-p38MAPK signaling pathway.

Anti-IL-5 monoclony antibody inhibits the migration of eosinophil in a murine model of asthma / 基础医学与临床

Objective To study the effect of anti-IL-5 monoclony antibody (TRFK-5) on migration of Eos from BM to the airways in sensitized mice. Methods Male C57BL/6 (6-8wk of age) murine model of Asthma and control group were estabolished with routine method. The outcome measurements include white blood cell (WBC) total count, differential count of bronchoalveolar lavage fluid (BALF) and peripheral blood (PB), nuclear cell count and eosinophil percentage of BM. These parameters were collected 12 h after the final allergen challenge. To cheek Eos infiltration, the histology of lung tissues was also observed. Further, the effects of intranasal TRFK-5 on above changes were investigated. Results Eosinophil numbers of BALF, PB, BM and the infiltration of Eos in pulmovnary tissues were increased considerably 12 h after final OVA challenge compared with negative group(P

NOD proteins and lung diseases / 中国病理生理杂志

The nucleotide-binding oligomerization domain(NOD)proteins are recently identified as cytosolic pattern recognition receptors located on innate immune and epithelial cells,and recognize pathogen-associated molecular patterns.The NOD1 and NOD2,the two members of NOD protein family,have important roles in innate immunity as sensors of microbial components derived from bacterial peptidoglycan.Besides,NOD proteins have been established as key regulators of cell death and cytokine production,they also have been shown to participate in the pathogeny of allergic disease such as asthma.This review will focus on the identification and functional characterization of NOD proteins,as well as their role in lung diseases.

Effects of ganmao shuangjie heji on the inflammatory damage in the lungs of mice infected by IV FM1 / 中国病理生理杂志

AIM: To establish the influenza infected mouse model and study the anti-inflammatory effect of ganmao shuangjie heji. METHODS: IV FM1 infected mice were used as the animal model. The changes of pathology and the cytokine TNF-?, IFN-? and IL-10 in the lung were observed by HE staining and ELISA (double antibody sandwich enzyme linked immunosorbent assay) after ganmao shuangjie heji treatment. RESULTS: After infected by influenza virus, severe interstitial pneumonia was induced in the model group. Mild interstitial pneumonia was observed in ganmao shuangjie heji treated group. The protein expressions of cytokine TNF-?, IFN-? and IL-10 were higher in model group than those in the control group. The protein expressions of TNF-? and IFN-? in ganmao shuangjie heji treated group decreased and IL-10 expression increased significantly compared with model group. CONCLUSION: Ganmao shuangjie heji decreases the expressions of TNF-? and IFN-?, and increases the expression of IL-10, thus, alleviates inflammatory injury. The clinical application of this medicine can shorten the course of disease.

Nontypeable haemophilus influenzae induces IL-8 expression in alveolar epithelial cells in a p38MAPK and NF-?B dependent manner / 中国病理生理杂志

AIM: To investigate the key molecular mechanism of inflammatory response in alveolar epithelial cells induced by nontypeable haemophilus influenzae(NTHi).METHODS: A549 cells were co-cultured with NTHi(multiplicity of infection,MOI: 10) and harvested 15 min and 30 min after stimulation.The phosphorylation of p38 mitogen activated protein kinase(p38 MAPK) in A549 cells was detected by Western blotting.The intracellular expression of nuclear factor-?B(NF-?B) p65 was examined by flow cytometry 4 h after stimulation.A549 cells were preincubated with p38 inhibitor(SB203580) or NF-?B inhibitor(PDTC) for 1 h and then stimulated with NTHi for 24 h.The level of interleukin 8(IL-8) in the supernatants was determined by enzyme-linked immunosorbent assay(ELISA).RESULTS: The phosphorylation of p38 MAPK was rapidly induced by NTHi stimulation.The expression of NF-?B p65 in A549 cells after NTHi stimulation was significantly up-regulated compared with control group(P