Thecoronavirusdisease2019(COVID-19)pandemic continues to pose a global threat to the human population. Identifying animal species susceptible to infection with the SARS-CoV-2/HCoV-19 pathogen is essential for controll...Thecoronavirusdisease2019(COVID-19)pandemic continues to pose a global threat to the human population. Identifying animal species susceptible to infection with the SARS-CoV-2/HCoV-19 pathogen is essential for controlling the outbreak and for testing valid prophylactics or therapeutics based on animal model studies. Here,different aged Chinese tree shrews(adult group, 1 year old;old group, 5–6 years old), which are close relatives to primates, were infected with SARS-CoV-2. X-ray, viral shedding, laboratory, and histological analyses were performed on different days postinoculation(dpi). Results showed that Chinese tree shrews could be infected by SARS-CoV-2. Lung infiltrates were visible in X-ray radiographs in most infected animals. Viral RNA was consistently detected in lung tissues from infected animals at 3,5, and 7 dpi, along with alterations in related parameters from routine blood tests and serum biochemistry, including increased levels of aspartate aminotransferase(AST) and blood urea nitrogen(BUN). Histological analysis of lung tissues from animals at 3 dpi(adult group) and 7 dpi(old group) showed thickened alveolar septa and interstitial hemorrhage. Several differences were found between the two different aged groups in regard to viral shedding peak. Our results indicate that Chinese tree shrews have the potential to be used as animal models for SARS-CoV-2 infection.展开更多
As of June 2020, Coronavirus Disease 2019(COVID-19) has killed an estimated 440 000 people worldwide, 74% of whom were aged ≥65 years,making age the most significant risk factor for death caused by severe acute respi...As of June 2020, Coronavirus Disease 2019(COVID-19) has killed an estimated 440 000 people worldwide, 74% of whom were aged ≥65 years,making age the most significant risk factor for death caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection. To examine the effect of age on death, we established a SARSCoV-2 infection model in Chinese rhesus macaques(Macaca mulatta) of varied ages. Results indicated that infected young macaques manifested impaired respiratory function, active viral replication, severe lung damage, and infiltration of CD11b^+ and CD8^+ cells in lungs at one-week post infection(wpi), but also recovered rapidly at 2 wpi. In contrast, aged macaques demonstrated delayed immune responses with a more severe cytokine storm, increased infiltration of CD11b^+ cells, and persistent infiltration of CD8^+ cells in the lungs at 2 wpi. In addition,peripheral blood T cells from aged macaques showed greater inflammation and chemotaxis, but weaker antiviral functions than that in cells from young macaques. Thus, the delayed but more severe cytokine storm and higher immune cell infiltration may explain the poorer prognosis of older aged patients suffering SARS-CoV-2 infection.展开更多
Coronavirus disease 2019(COVID-19),which is caused by severe acute respiratory syndrome coronavirus(SARS-CoV-2),has become an unprecedented global health emergency.At present,SARS-CoV-2-infected nonhuman primates are ...Coronavirus disease 2019(COVID-19),which is caused by severe acute respiratory syndrome coronavirus(SARS-CoV-2),has become an unprecedented global health emergency.At present,SARS-CoV-2-infected nonhuman primates are considered the gold standard animal model for COVID-19 research.Here,we showed that northern pig-tailed macaques(Macaca leonina,NPMs)supported SARS-CoV-2 replication.Furthermore,compared with rhesus macaques,NPMs showed rapid viral clearance in lung tissues,nose swabs,throat swabs,and rectal swabs,which may be due to higher expression of interferon(IFN)-αin lung tissue.However,the rapid viral clearance was not associated with good outcome.In the second week post infection,NPMs developed persistent or even more severe inflammation and body injury compared with rhesus macaques.These results suggest that viral clearance may have no relationship with COVID-19 progression and SARS-CoV-2-infected NPMs could be considered as a critically ill animal model in COVID-19 research.展开更多
Background： Acute fibrinous and organizing pneumonia （AFOP） is a unique pathological entity with intra-alveolar fibrin in the form of ＂fibrin balls＂ and organizing pneumonia. It was divided into rare idiopathic i...Background： Acute fibrinous and organizing pneumonia （AFOP） is a unique pathological entity with intra-alveolar fibrin in the form of ＂fibrin balls＂ and organizing pneumonia. It was divided into rare idiopathic interstitial pneumonia according to the classification notified by American Thoracic Society/European Respiratory Society in 2013. As a rare pathological entity, it is still not well known and recognized by clinicians. We reviewed the clinical features of 20 patients with AFOP diagnosed in a teaching hospital. Methods： The medical records of 20 patients with biopsy-proven diagnosis of AFOP were retrospectively reviewed. The patients＇ symptoms, duration of the disease, comorbidities, clinical laboratory data, pulmonary function testing, radiographic studies, and the response to treatment were extracted and analyzed. Results： Fever was the most common symptom and was manifested in 90% of AFOP patients. For clinical laboratory findings, systematic inflammatory indicators, including C-reactive protein and erythrocyte sedimentation rate, were significantly higher than normal ill AFOP patients. In accordance with this increased indicators, injured liver functions were common in AFOP patients. Inversely, AFOP patients had worse clinical conditions including anemia and hypoalbuminemia. For pulmonary function testing, AFOP patients showed the pattern of restrictive mixed with obstructive ventilation dysfunction. For high-resolution computerized tomography （HRCT） findings, the most common pattern for AFOP patients was lobar consolidation which was very similar to pneumonia. However, unlike pneumonia, AFOP patients responded well to glucocorticoids. Conclusion： Patients with AFOP manifest as acute inflammatory-like clinical laboratory parameters and lobar consolidation on HRCT, but respond well to steroid.展开更多
INTRODUCTIONCryptogenic organizing pneumonia （COP） is a distinct type of idiopathic interstitial pneumonia with a response rate of 65 85% on corticosteroid therapy. The difficulty of COP diagnosis is that the clinic...INTRODUCTIONCryptogenic organizing pneumonia （COP） is a distinct type of idiopathic interstitial pneumonia with a response rate of 65 85% on corticosteroid therapy. The difficulty of COP diagnosis is that the clinical features and the radiological findings are nonspecific. The pathological hallmark of organizing pneumonia （OP） needs to be confirmed. It can also occur in a variety of other interstitial pneumonia, infectious diseases, vasculitis, and so on. To increase the pathological reliability, larger and more tissue samples are required. According to the current classification of interstitial lung disease and guidelines, the surgical lung biopsy is recommended and is considered to be the best way of obtaining a representative lung specimen However, the invasive diagnostic procedures require general anesthesia and also increase the morbidity and mortality risks; therefore, only few patients undergo such biopsy. Thus, safer and more acceptable methods for identifying COP are urgently needed.展开更多
Backgrounds:Hypersensitivity pneumonitis(HP)is an immune-mediated interstitial lung disease(ILD)that develops in response to the inhalation of various antigens.The clinical pathologies are very complex and undetermine...Backgrounds:Hypersensitivity pneumonitis(HP)is an immune-mediated interstitial lung disease(ILD)that develops in response to the inhalation of various antigens.The clinical pathologies are very complex and undetermined.The clinical features and outcomes of HP have not been fully elucidated.The aim of this study was to analyze the incidence,clinical features,and outcomes of HP patients and construct a simple clinical model for diagnosing chronic HP(CHP).Methods:The cohort study included 101 patients with HP admitted to the Nanjing Drum Tower Hospital from January 2009 to December 2017.The patients were categorized into acute HP(AHP,n=72)and CHP(n=29)groups according to the updated international criteria.The clinical,imaging,treatment,and follow-up data were retrospectively reviewed.All patients were followed up until December 31,2017.Statistical analysis was performed,and a clinical scoring system for CHP was constructed by SPSS 20.0 software.Results:The incidence of HP was 2.4%in ILD inpatients in our center.Patients in the CHP group were older=-2.212,(P=0.029),had more smokers(x^(2)=8.428,P=0.004),and longer duration of symptoms(t=-4.852,P<0.001)than those in the AHP group.Weight loss,crackles,digital clubbing,and cyanosis were more common in the CHP group than those in the AHP group(x^(2)=5.862,P<0.001;x^(2)=8.997,P=0.003;x^(2)=11-939,P=0.001;and x^(2)=4.025,P=0.045,respectively).On chest high-resolution computed tomography(HRCT),reticular patterns,traction bronchiectasis,and accompanying honeycombing were more common in CHP cases than those in AHP cases(x^(2)=101.000,P<0.001;x^(2)=32.048,P<0.001;a n d/2=36.568,P<0.001,respectively).The clinical scoring system for CHP was established based on the clinical variables(age[A],duration of symptoms[D],smoking history[S],unidentified exposure[U],and chest HRCT[C];ADSUC)(area under the curve 0.935,95%confidence interval:0.883-0.987,P<0.001).Eleven patients(15.3%)in the AHP group developed CHP,and unidentified exposure was an independent risk factor for the progression of disease(P=0.038).The survival of patients with CHP,smoking history,unidentified antigens and fibrosis on Chest HRCT were significantly worse(P=0.011,P=0.001,F=0.005,and P=0.011,respectively)by Kaplan-Meier analysis.Cox multivariate regression analysis revealed that unidentified exposure and total lung volume(TLC pred%)were independent prognostic predictors for HP patients(P=0.017 and P=0.017,respectively).Conclusions:The clinical features and outcomes of the CHP patients differ from those of the AHP patients.ADSUC is a simple and feasible clinical model for CHP.Unidentified exposure is an independent risk factor for the progression of AHP to CHP.Unidentified exposure and a low baseline TLC pred%are independent predictors for survival in HP patients.展开更多
Chest computed tomography （CT） screening is becoming more popular in China. Therefore, more and more rare diseases and early stages of lung diseases were found. Here, we reported a case who presented as multiple gro...Chest computed tomography （CT） screening is becoming more popular in China. Therefore, more and more rare diseases and early stages of lung diseases were found. Here, we reported a case who presented as multiple ground glass nodules incidentally found in chest CT scan who had been suspected as synchronous multiple primary lung cancer （SMPLC） and/or metastatic cancer. She was finally diagnosed as tuberous sclerosis complex （TSC）, an autosomal-dominant disorder characterized by the fort-nation of hanaartomatous lesions in the skin, eyes, kidney, and central nervous system. Tuberous sclerosis complex 1 （TSC1） gene mutation （c.1030-1G〉A） was found in her and her family members. This is a very rare report in China.展开更多
Endobronchial ultrasound with transbronchial needle aspiration （EBUS-TBNA） is a minimally invasive and safe technique which is universally accepted for the mediastinum and/or hilum lymph node biopsy.Severe infectiou...Endobronchial ultrasound with transbronchial needle aspiration （EBUS-TBNA） is a minimally invasive and safe technique which is universally accepted for the mediastinum and/or hilum lymph node biopsy.Severe infectious complications following EBUS-TBNA were occasional,but sometimes life-threatening. Two patients with severe mediastinal abscess after EBUS-TBNA were treated successfully with surgical drainage in our department,and we reported here to improve our clinical vigilance to this disease.展开更多
To the Editor： Pulmonary Langerhans cell histiocytosis （PLCH） in adults is a rare disease occurring almost exclusively in smokers. The characteristic high-resolution computed tomography （HRCT） manifestation of PL...To the Editor： Pulmonary Langerhans cell histiocytosis （PLCH） in adults is a rare disease occurring almost exclusively in smokers. The characteristic high-resolution computed tomography （HRCT） manifestation of PLCH is a combination of cysts （or cavities） and nodules mainly in the upper lung zone. However, not all HRCT patterns of PLCH are typical. Few treatments are effective in current practice regarding PLCH. Targeted therapy with an inhibitor of mutated BRAF （vemurafenib） has been proved effective in Langerhans cell histiocytosis （LCH） harboring BRAF valine at position 600 （V600E） mutation.MAP2K1 mutations are mutually exclusive with BRAF mutations and might have implications for the use of BRAF targeted therapy. Here, we reported a case of PLCH proven by lung biopsy.展开更多
Background:The prognosis of acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF)is very poor with a high mortality.The aim of this study was to describe the clinical features and survival of patients with AE-IP...Background:The prognosis of acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF)is very poor with a high mortality.The aim of this study was to describe the clinical features and survival of patients with AE-IPF with usual pulmonary fibrosis(UIP)and possible UIP(P-UIP)pattern on chest high resolution computed tomography(HRCT).Methods:This retrospective study included 107 patients with AE-IPF admitted to Nanjing Drum Tower Hospital from January 2010 to December 2016.The subjects were divided into UIP(n=86)and P-UIP group(n=21)based on chest HRCT.Continuous variables were analyzed using Student's t test or Mann-Whimey U test.Categorical variables were analyzed using x2 test.Log-rank test was used for the survival analysis.Cox proportional models evaluated the risk factors for AE occurrence and survival.Results:The male,older patients,previous N-acetylcysteine use,elevated white blood cell(WBC)counts,and microbiology infection were more common in the UIP group than the P-UIP group(X2=13.567,P<0.001;z=-2.936,P=0.003;X2=5.901,P=0.015;t=2.048,P=0.043;x2=10.297,P=0.036,respectively).The percentage of AE with UIP pattern in idiopathic interstitial pneumonia(ⅡP)was significantly higher than P-UIP pattern(X2=40.011,P<0.001).Smoking was the risk factor for AE within 6 months after IPF diagnosis in the UIP group.The cumulative proportion survival of 30-days was significantly higher in the UIP group compared with the P-UIP group(x2=5.489,P=0.019)despite of the similar overall survival in the two groups.Multivariate Cox regression analysis indicated WBC count,partial pressure of oxygen in artery(PaO2)/ffactional concentration of inspired oxygen(FiOz),and computed tomography(CT)score were the independent predictors for survival in the UIP group(hazard ratio[HR]:1.070,95%confidential interval[CI]:1.027-1.114,P=0.001;HR:0.992,95%CI:0.986-0.997,P=0.002;and HR:1.649,95%CI:1.253-2.171,P<0.001,respectively).Conclusions:AE occurrence of UIP patients in IIP was significantly more than P-UIP cases.The short-term survival was better in the UIP group despite of the similar overall survival in the two groups.WBC count,PaO2/FiO2,and CT score were the independent predictors for survival in UIP subjects.展开更多
Reference 1.Wang LJ,Cai HR,Xiao YL,Wang Y,Cao MS.Clinical characteristics and outcomes of hypersensitivity pneumonitis:a population-based study in China.Chin Med J 2019;132:1283–1292.doi:10.1097/CM9.0000000000000256.
基金partly supported by the National Key R&D Program of China(2020YFC0842000 to Y.T.Z.)National Natural Science Foundation of China(U1902215 to Y.G.Y.)+2 种基金National Science and Technology Major Projects of Infectious Disease Funds(2017ZX10304402 to Y.T.Z.)Yunnan Province(2018FB046 to D.D.Y.)CAS“Light of West China”Program(xbzg-zdsys-201909to Y.G.Y.and Y.T.Z.)。
文摘Thecoronavirusdisease2019(COVID-19)pandemic continues to pose a global threat to the human population. Identifying animal species susceptible to infection with the SARS-CoV-2/HCoV-19 pathogen is essential for controlling the outbreak and for testing valid prophylactics or therapeutics based on animal model studies. Here,different aged Chinese tree shrews(adult group, 1 year old;old group, 5–6 years old), which are close relatives to primates, were infected with SARS-CoV-2. X-ray, viral shedding, laboratory, and histological analyses were performed on different days postinoculation(dpi). Results showed that Chinese tree shrews could be infected by SARS-CoV-2. Lung infiltrates were visible in X-ray radiographs in most infected animals. Viral RNA was consistently detected in lung tissues from infected animals at 3,5, and 7 dpi, along with alterations in related parameters from routine blood tests and serum biochemistry, including increased levels of aspartate aminotransferase(AST) and blood urea nitrogen(BUN). Histological analysis of lung tissues from animals at 3 dpi(adult group) and 7 dpi(old group) showed thickened alveolar septa and interstitial hemorrhage. Several differences were found between the two different aged groups in regard to viral shedding peak. Our results indicate that Chinese tree shrews have the potential to be used as animal models for SARS-CoV-2 infection.
基金This work was supported by the National Key Research and Development Program of China(2020YFC0842000)。
文摘As of June 2020, Coronavirus Disease 2019(COVID-19) has killed an estimated 440 000 people worldwide, 74% of whom were aged ≥65 years,making age the most significant risk factor for death caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection. To examine the effect of age on death, we established a SARSCoV-2 infection model in Chinese rhesus macaques(Macaca mulatta) of varied ages. Results indicated that infected young macaques manifested impaired respiratory function, active viral replication, severe lung damage, and infiltration of CD11b^+ and CD8^+ cells in lungs at one-week post infection(wpi), but also recovered rapidly at 2 wpi. In contrast, aged macaques demonstrated delayed immune responses with a more severe cytokine storm, increased infiltration of CD11b^+ cells, and persistent infiltration of CD8^+ cells in the lungs at 2 wpi. In addition,peripheral blood T cells from aged macaques showed greater inflammation and chemotaxis, but weaker antiviral functions than that in cells from young macaques. Thus, the delayed but more severe cytokine storm and higher immune cell infiltration may explain the poorer prognosis of older aged patients suffering SARS-CoV-2 infection.
基金This work was partly supported by the National Key R&D Program of China(2020YFC0842000)National Science and Technology Major Projects of Infectious Disease Funds(2017ZX10304402,2018ZX10301406-003)+1 种基金the National Natural Science Foundation of China(U1802284,U1902210)National Resource Center for Non-Human Primates。
文摘Coronavirus disease 2019(COVID-19),which is caused by severe acute respiratory syndrome coronavirus(SARS-CoV-2),has become an unprecedented global health emergency.At present,SARS-CoV-2-infected nonhuman primates are considered the gold standard animal model for COVID-19 research.Here,we showed that northern pig-tailed macaques(Macaca leonina,NPMs)supported SARS-CoV-2 replication.Furthermore,compared with rhesus macaques,NPMs showed rapid viral clearance in lung tissues,nose swabs,throat swabs,and rectal swabs,which may be due to higher expression of interferon(IFN)-αin lung tissue.However,the rapid viral clearance was not associated with good outcome.In the second week post infection,NPMs developed persistent or even more severe inflammation and body injury compared with rhesus macaques.These results suggest that viral clearance may have no relationship with COVID-19 progression and SARS-CoV-2-infected NPMs could be considered as a critically ill animal model in COVID-19 research.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 81470253）.
文摘Background： Acute fibrinous and organizing pneumonia （AFOP） is a unique pathological entity with intra-alveolar fibrin in the form of ＂fibrin balls＂ and organizing pneumonia. It was divided into rare idiopathic interstitial pneumonia according to the classification notified by American Thoracic Society/European Respiratory Society in 2013. As a rare pathological entity, it is still not well known and recognized by clinicians. We reviewed the clinical features of 20 patients with AFOP diagnosed in a teaching hospital. Methods： The medical records of 20 patients with biopsy-proven diagnosis of AFOP were retrospectively reviewed. The patients＇ symptoms, duration of the disease, comorbidities, clinical laboratory data, pulmonary function testing, radiographic studies, and the response to treatment were extracted and analyzed. Results： Fever was the most common symptom and was manifested in 90% of AFOP patients. For clinical laboratory findings, systematic inflammatory indicators, including C-reactive protein and erythrocyte sedimentation rate, were significantly higher than normal ill AFOP patients. In accordance with this increased indicators, injured liver functions were common in AFOP patients. Inversely, AFOP patients had worse clinical conditions including anemia and hypoalbuminemia. For pulmonary function testing, AFOP patients showed the pattern of restrictive mixed with obstructive ventilation dysfunction. For high-resolution computerized tomography （HRCT） findings, the most common pattern for AFOP patients was lobar consolidation which was very similar to pneumonia. However, unlike pneumonia, AFOP patients responded well to glucocorticoids. Conclusion： Patients with AFOP manifest as acute inflammatory-like clinical laboratory parameters and lobar consolidation on HRCT, but respond well to steroid.
文摘INTRODUCTIONCryptogenic organizing pneumonia （COP） is a distinct type of idiopathic interstitial pneumonia with a response rate of 65 85% on corticosteroid therapy. The difficulty of COP diagnosis is that the clinical features and the radiological findings are nonspecific. The pathological hallmark of organizing pneumonia （OP） needs to be confirmed. It can also occur in a variety of other interstitial pneumonia, infectious diseases, vasculitis, and so on. To increase the pathological reliability, larger and more tissue samples are required. According to the current classification of interstitial lung disease and guidelines, the surgical lung biopsy is recommended and is considered to be the best way of obtaining a representative lung specimen However, the invasive diagnostic procedures require general anesthesia and also increase the morbidity and mortality risks; therefore, only few patients undergo such biopsy. Thus, safer and more acceptable methods for identifying COP are urgently needed.
基金National Natural Science Foundation of China(No.81200049 andNo.81670059)Nanjing Medical Science and Technique Development Foundation(No.QRX17005).
文摘Backgrounds:Hypersensitivity pneumonitis(HP)is an immune-mediated interstitial lung disease(ILD)that develops in response to the inhalation of various antigens.The clinical pathologies are very complex and undetermined.The clinical features and outcomes of HP have not been fully elucidated.The aim of this study was to analyze the incidence,clinical features,and outcomes of HP patients and construct a simple clinical model for diagnosing chronic HP(CHP).Methods:The cohort study included 101 patients with HP admitted to the Nanjing Drum Tower Hospital from January 2009 to December 2017.The patients were categorized into acute HP(AHP,n=72)and CHP(n=29)groups according to the updated international criteria.The clinical,imaging,treatment,and follow-up data were retrospectively reviewed.All patients were followed up until December 31,2017.Statistical analysis was performed,and a clinical scoring system for CHP was constructed by SPSS 20.0 software.Results:The incidence of HP was 2.4%in ILD inpatients in our center.Patients in the CHP group were older=-2.212,(P=0.029),had more smokers(x^(2)=8.428,P=0.004),and longer duration of symptoms(t=-4.852,P<0.001)than those in the AHP group.Weight loss,crackles,digital clubbing,and cyanosis were more common in the CHP group than those in the AHP group(x^(2)=5.862,P<0.001;x^(2)=8.997,P=0.003;x^(2)=11-939,P=0.001;and x^(2)=4.025,P=0.045,respectively).On chest high-resolution computed tomography(HRCT),reticular patterns,traction bronchiectasis,and accompanying honeycombing were more common in CHP cases than those in AHP cases(x^(2)=101.000,P<0.001;x^(2)=32.048,P<0.001;a n d/2=36.568,P<0.001,respectively).The clinical scoring system for CHP was established based on the clinical variables(age[A],duration of symptoms[D],smoking history[S],unidentified exposure[U],and chest HRCT[C];ADSUC)(area under the curve 0.935,95%confidence interval:0.883-0.987,P<0.001).Eleven patients(15.3%)in the AHP group developed CHP,and unidentified exposure was an independent risk factor for the progression of disease(P=0.038).The survival of patients with CHP,smoking history,unidentified antigens and fibrosis on Chest HRCT were significantly worse(P=0.011,P=0.001,F=0.005,and P=0.011,respectively)by Kaplan-Meier analysis.Cox multivariate regression analysis revealed that unidentified exposure and total lung volume(TLC pred%)were independent prognostic predictors for HP patients(P=0.017 and P=0.017,respectively).Conclusions:The clinical features and outcomes of the CHP patients differ from those of the AHP patients.ADSUC is a simple and feasible clinical model for CHP.Unidentified exposure is an independent risk factor for the progression of AHP to CHP.Unidentified exposure and a low baseline TLC pred%are independent predictors for survival in HP patients.
文摘Chest computed tomography （CT） screening is becoming more popular in China. Therefore, more and more rare diseases and early stages of lung diseases were found. Here, we reported a case who presented as multiple ground glass nodules incidentally found in chest CT scan who had been suspected as synchronous multiple primary lung cancer （SMPLC） and/or metastatic cancer. She was finally diagnosed as tuberous sclerosis complex （TSC）, an autosomal-dominant disorder characterized by the fort-nation of hanaartomatous lesions in the skin, eyes, kidney, and central nervous system. Tuberous sclerosis complex 1 （TSC1） gene mutation （c.1030-1G〉A） was found in her and her family members. This is a very rare report in China.
基金The study was supported by the National Natural Science Foundation of China （81570058）, Jiangsu Provincial Medical Talent, Jiangsu Social Development Project （BE2017604, ZDRCA2016058）.
文摘Endobronchial ultrasound with transbronchial needle aspiration （EBUS-TBNA） is a minimally invasive and safe technique which is universally accepted for the mediastinum and/or hilum lymph node biopsy.Severe infectious complications following EBUS-TBNA were occasional,but sometimes life-threatening. Two patients with severe mediastinal abscess after EBUS-TBNA were treated successfully with surgical drainage in our department,and we reported here to improve our clinical vigilance to this disease.
文摘To the Editor： Pulmonary Langerhans cell histiocytosis （PLCH） in adults is a rare disease occurring almost exclusively in smokers. The characteristic high-resolution computed tomography （HRCT） manifestation of PLCH is a combination of cysts （or cavities） and nodules mainly in the upper lung zone. However, not all HRCT patterns of PLCH are typical. Few treatments are effective in current practice regarding PLCH. Targeted therapy with an inhibitor of mutated BRAF （vemurafenib） has been proved effective in Langerhans cell histiocytosis （LCH） harboring BRAF valine at position 600 （V600E） mutation.MAP2K1 mutations are mutually exclusive with BRAF mutations and might have implications for the use of BRAF targeted therapy. Here, we reported a case of PLCH proven by lung biopsy.
基金partially supported by the grants from the National Natural Science Foundation of China(No.81200049 and No.81670059)the Nanjing Medical Science and Technique Development Foundation(No.ORX17005).
文摘Background:The prognosis of acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF)is very poor with a high mortality.The aim of this study was to describe the clinical features and survival of patients with AE-IPF with usual pulmonary fibrosis(UIP)and possible UIP(P-UIP)pattern on chest high resolution computed tomography(HRCT).Methods:This retrospective study included 107 patients with AE-IPF admitted to Nanjing Drum Tower Hospital from January 2010 to December 2016.The subjects were divided into UIP(n=86)and P-UIP group(n=21)based on chest HRCT.Continuous variables were analyzed using Student's t test or Mann-Whimey U test.Categorical variables were analyzed using x2 test.Log-rank test was used for the survival analysis.Cox proportional models evaluated the risk factors for AE occurrence and survival.Results:The male,older patients,previous N-acetylcysteine use,elevated white blood cell(WBC)counts,and microbiology infection were more common in the UIP group than the P-UIP group(X2=13.567,P<0.001;z=-2.936,P=0.003;X2=5.901,P=0.015;t=2.048,P=0.043;x2=10.297,P=0.036,respectively).The percentage of AE with UIP pattern in idiopathic interstitial pneumonia(ⅡP)was significantly higher than P-UIP pattern(X2=40.011,P<0.001).Smoking was the risk factor for AE within 6 months after IPF diagnosis in the UIP group.The cumulative proportion survival of 30-days was significantly higher in the UIP group compared with the P-UIP group(x2=5.489,P=0.019)despite of the similar overall survival in the two groups.Multivariate Cox regression analysis indicated WBC count,partial pressure of oxygen in artery(PaO2)/ffactional concentration of inspired oxygen(FiOz),and computed tomography(CT)score were the independent predictors for survival in the UIP group(hazard ratio[HR]:1.070,95%confidential interval[CI]:1.027-1.114,P=0.001;HR:0.992,95%CI:0.986-0.997,P=0.002;and HR:1.649,95%CI:1.253-2.171,P<0.001,respectively).Conclusions:AE occurrence of UIP patients in IIP was significantly more than P-UIP cases.The short-term survival was better in the UIP group despite of the similar overall survival in the two groups.WBC count,PaO2/FiO2,and CT score were the independent predictors for survival in UIP subjects.
文摘Reference 1.Wang LJ,Cai HR,Xiao YL,Wang Y,Cao MS.Clinical characteristics and outcomes of hypersensitivity pneumonitis:a population-based study in China.Chin Med J 2019;132:1283–1292.doi:10.1097/CM9.0000000000000256.
