Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractor...Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.展开更多
Background: Mycoplasma pneumoniae (MP) is the primary causative agent of community-acquired pneumonia, which has increasingly become resistant to macrolides, complicating treatment regimens, especially with the co-inf...Background: Mycoplasma pneumoniae (MP) is the primary causative agent of community-acquired pneumonia, which has increasingly become resistant to macrolides, complicating treatment regimens, especially with the co-infection factor. Its worldwide prevalence has fluctuated due to the influence of the COVID-19 pandemic. The study investigated co-infection patterns in children diagnosed with Mycoplasma pneumoniae pneumonia (MPP). Methods: From June 2022 to December 2023, we retrospectively analyzed the clinical data for hospitalized children with Mycoplasma pneumoniae pneumonia in Wuhan, China. We collected data on age, sex, clinical information, and pathogenic results. We also collected sputum or bronchoalveolar lavage fluid (BALF) samples to test respiratory pathogens and macrolide resistance using targeted microbial next-generation sequencing (tNGS). We analyzed the data using SPSS. Results: The study involved 417 patients diagnosed with MPP, of whom 86.33% had co-infections. Co-infections were notably linked to lobar pneumonia, prominent imaging shadows and higher macrolide resistance rate. Key bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, rhinoviruses, and human adenoviruses (HADV). In MPP cases, Candida albicans was the fungal pathogen related to co-infections. The co-infection with HADV and human bocavirus 1 (HBoV1) correlated with prolonged fever, whereas Bordetella pertussis was linked to prolonged cough. In contrast, Candida albicans exhibited a weaker association with diffuse large-area infiltration on chest imaging, and its co-infection was less likely to result in severe disease. Conclusion: These results offer valuable insight into Mycoplasma pneumoniae pneumonia in children, highlighting the impact of co-infections on the disease’s clinical outcomes.展开更多
BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatm...BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.展开更多
There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia.In other words,obese individuals with communityacquired pneumonia have a better prognosis.The study by Wang et al...There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia.In other words,obese individuals with communityacquired pneumonia have a better prognosis.The study by Wang et al supports this claim,but we believe that the obesity paradox should not be proposed hastily as it is influenced by numerous subjective and objective confounding factors.展开更多
Introduction: The misuse of antibiotics has driven the emergence of antimicrobial resistance, with certain bacterial species, including Klebsiella pneumoniae, initially susceptible to most antibiotics, now exhibiting ...Introduction: The misuse of antibiotics has driven the emergence of antimicrobial resistance, with certain bacterial species, including Klebsiella pneumoniae, initially susceptible to most antibiotics, now exhibiting resistance to multiple antimicrobial agents. The objective of this study was to investigate the distribution and antimicrobial resistance profiles of Klebsiella pneumoniae strains isolated at the Yaoundé Central Hospital. Methodology: The study was conducted over a period of 4 months (March 1st, 2023-July 1st, 2023) and involved 32 strains isolated from bacterial cultures performed on patients, regardless of sex. The different Klebsiella pneumoniae strains were isolated using conventional methods. Identification, antibiogram, and detection of resistance enzyme production were generated using the VITEK 2 system. The Carbapenem-resistant K.N.I.V.O. kit was used to detect carbapenemases. Data analysis was performed using EXCEL 2019 software. Results: Out of 196 samples collected from various biological products, 32 Klebsiella pneumoniae strains were isolated, representing 16.32% (196/32). Urine samples were most frequently affected, accounting for 53.125%. The emergency department was the most represented (40.63%) by these isolates. The mean age was 50 years, with a minimum of 20 years and a maximum of 80 years. The sex ratio was equal to 1. The identified strains were resistant to cefotaxime (78.13%), cefoxitin (62.50%), tobramycin (71.88%), gentamicin (56.25%), ofloxacin (81.25%), and cotrimoxazole (78.13%). 78.25% were ESBL producers. Three strains were resistant to carbapenems, accounting for 9.37%;one of which exhibited the NDM type. Conclusion: This study highlights the evolving bacterial resistance to antibiotics, which requires adequate measures through the strengthening of the Antimicrobial Resistance (AMR) program in Cameroon.展开更多
Sickle cell anemia (SCA) is a prevalent genetic disorder primarily affecting individuals of African descent and populations in malaria-endemic regions, with significant global public health implications. Sickle cell c...Sickle cell anemia (SCA) is a prevalent genetic disorder primarily affecting individuals of African descent and populations in malaria-endemic regions, with significant global public health implications. Sickle cell crises are their most common acute complication, characterized by episodes of intense pain and systemic manifestations that impair quality of life and impose a high healthcare burden. We present the case of a 19-year-old male diagnosed with SCA since the age of two, who developed a sickle cell crisis precipitated by right basal pneumonia. The patient exhibited sudden-onset, cyclic lumbar pain with progressive dyspnea. Initial management included multimodal pain control, volume optimization, and targeted antimicrobial therapy to achieve clinical stabilization. This case underscores the importance of a comprehensive approach to managing sickle cell crises, addressing both symptomatic relief and the prevention and treatment of complications. It also highlights the need for public health strategies promoting early diagnosis, access to disease-modifying therapies such as hydroxyurea, and interdisciplinary follow-up to mitigate the socioeconomic and clinical impact of SCA.展开更多
Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmo...Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmonary complications, such as pneumonia and pneumothorax, significantly contribute to increased morbidity in this population. Case Presentation: We report the case of a 28-year-old female who injects drugs, and presents with fever, bilateral hand edema, and respiratory symptoms. Clinical evaluation revealed erythema and edema of both hands, elevated inflammatory markers, and a left lower lobe infiltration that progressed to pneumothorax. A diagnosis of PHS and left lower lobe pneumonia complicated by pneumothorax was established. Management and Outcomes: The patient was treated with broad-spectrum antibiotics, including ceftriaxone, levofloxacin, dexamethasone, and oxygen supplementation, as well as antipyretics. She demonstrated partial clinical improvement and was referred to another hospital’s thoracic surgery department for specialized care. Conclusions: This case underscores the importance of early recognition and multidisciplinary management of rare but serious complications in IVDU patients. Further research is necessary to elucidate the interplay between lymphatic dysfunction and pulmonary pathophysiology in this demographic.展开更多
Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of pro...Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of procalcitonin(PCT)and C-reactive protein(CRP)as inflammatory markers is widely recognized,their relative diagnostic performance across different age groups remains debate.This meta-analysis was designed to assess the diagnostic accuracy of PCT and CRP in bacterial pneumonia.Methods:In this meta-analysis adhering to PRISMA guidelines,we searched PubMed,Web of Science,and the Cochrane Library for relevant diagnostic accuracy studies.From 19 included studies(n=2,603),data were extracted to construct tables.Study quality was assessed with the QUADAS-2 tool.The bivariate random-effects model was employed to derive pooled sensitivity,specificity,positive and negative likelihood ratios,and summary AUCs.To explore the substantial heterogeneity(I^(2)>80%),we performed pre-specified subgroup analyses based on age demographics.Results:Our findings indicate superior diagnostic performance for PCT,evidenced by a pooled sensitivity of 0.8841 and specificity of 0.8499,relative to CRP’s sensitivity of 0.8371 and specificity of 0.7185.The area under the ROC curve(AUC)for PCT was 0.992,a value significantly higher than that of CRP(0.987).Intriguingly,subgroup analyses revealed age-dependent variations:CRP demonstrated enhanced diagnostic utility in minors,while PCT proved substantially more effective in non-elderly adults.Conclusion:These results reinforce the clinical relevance of PCT as a more dependable biomarker for bacterial pneumonia,particularly in informing antibiotic treatment and mitigating misuse.This study uniquely includes age-stratified analyses based on predefined groups(minors and non-elderly adults),providing refined insights for individualized diagnostic approaches.We propose further multicenter research endeavors to confirm threshold optimization and explore combined biomarker strategies.展开更多
BACKGROUND Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pedia...BACKGROUND Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pediatric CCAP,and compare their etiology,clinical profile,and outcome in the post-pneumococcal vaccination era.METHODS This prospective observational study was conducted over a 2-year period.All details(demographics,clinical,management,and outcomes)were recorded.Continuous data were presented either as mean and SD,or as median and interquartile range.Categorical data were presented as frequencies and percentages(%).Data were analyzed by using the IBM SPSS Statistics for Windows,version 21(IBM Corp.,Armonk,NY,United States).RESULTS Of the 80 cases included(71%aged 4-8 years),the distribution was as follows:PPE(42%),empyema(39%),and NP(19%).Bacterial etiology was identified in 28%(empyema 63%,P=0.012).Staphylococcus aureus(45%)was most common followed by Escherichia coli(E.coli)(22.7%),and Streptococcus pneumoniae(13.6%).Patients with empyema,compared to PPE and NP,were less likely to receive prior antibiotics(32%vs 56%and 58%,respectively,P=0.03).Duration(days,mean±SD)of hospitalization was longer in children with NP compared to empyema and PPE(17.7±9.8,16.1±7.5,and 13.6±4.2,respectively).All children recovered with the medical management except 2 children requiring decortication.CONCLUSION Staphylococcus aureus and E.coli are the most common bacterial etiology in the post-pneumococcal vaccination era.Empyema might be related to a delay in antibiotics administration.NP is the most severe pediatric CCAP with prolonged hospitalization.展开更多
Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlo...Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlooked etiological agents.This review consolidates existing literature to delineate the clinical,radiological,and pathological features of exogenous lipoid pneumonia induced by nasal decongestants,highlight diagnostic challenges,and underscore the importance of thorough patient history in early diagnosis and management.This condition,while preventable,can result in serious pulmonary complications if not recog-nized early.It necessitates a multidisciplinary approach that incorporates careful history taking,high-resolution imaging,cytological assessment,and public health vigilance.展开更多
BACKGROUND:Community-acquired pneumonia(CAP)represents a significant public health concern due to its widespread prevalence and substantial healthcare costs.This study was to utilize an integrated proteomic and metabo...BACKGROUND:Community-acquired pneumonia(CAP)represents a significant public health concern due to its widespread prevalence and substantial healthcare costs.This study was to utilize an integrated proteomic and metabolomic approach to explore the mechanisms involved in severe CAP.METHODS:We integrated proteomics and metabolomics data to identify potential biomarkers for early diagnosis of severe CAP.Plasma samples were collected from 46 CAP patients(including27 with severe CAP and 19 with non-severe CAP)and 19 healthy controls upon admission.A comprehensive analysis of the combined proteomics and metabolomics data was then performed to elucidate the key pathological features associated with CAP severity.RESULTS:The proteomic and metabolic signature was markedly dif ferent between CAPs and healthy controls.Pathway analysis of changes revealed complement and coagulation cascades,ribosome,tumor necrosis factor(TNF)signaling pathway and lipid metabolic process as contributors to CAP.Furthermore,alterations in lipid metabolism,including sphingolipids and phosphatidylcholines(PCs),and dysregulation of cadherin binding were observed,potentially contributing to the development of severe CAP.Specifi cally,within the severe CAP group,sphingosine-1-phosphate(S1P)and apolipoproteins(APOC1 and APOA2)levels were downregulated,while S100P level was signifi cantly upregulated.CONCLUSION:The combined proteomic and metabolomic analysis may elucidate the complexity of CAP severity and inform the development of improved diagnostic tools.展开更多
This study explores the clinical efficacy of budesonide combined with ambroxol inhalation therapy for neonatal pneumonia.A total of 68 neonatal pneumonia patients treated at Li County Hospital from January 2023 to Dec...This study explores the clinical efficacy of budesonide combined with ambroxol inhalation therapy for neonatal pneumonia.A total of 68 neonatal pneumonia patients treated at Li County Hospital from January 2023 to December 2024 were randomly divided into a monotherapy group and a combination group,with 34 patients in each.The monotherapy group received ambroxol inhalation therapy,while the combination group received budesonide inhalation therapy in addition to ambroxol.The recovery progress,blood gas analysis indicators,inflammatory response improvement,and overall clinical efficacy were compared between the two groups.Results showed that the combination group experienced a significantly shorter time for body temperature normalization(3.36±0.58 days vs.4.59±0.45 days),oxygen inhalation duration(4.89±0.57min vs.6.96±0.79min),disappearance of shortness of breath and cough(4.56±0.29 days vs.6.63±0.75 days),and resolution of lung wet rales(5.62±1.46 days vs.7.92±1.28 days)compared to the monotherapy group(P<0.05).Additionally,the total effective rate was significantly higher in the combination group(97.06%)than in the monotherapy group(73.52%)(P<0.05).Post-treatment,the combination group exhibited significantly better blood gas analysis and inflammatory response indicators(P<0.05).These findings suggest that budesonide combined with ambroxol inhalation therapy can effectively improve blood oxygen saturation,reduce inflammation,promote faster recovery,and enhance overall clinical efficacy,making it a reliable treatment option for neonatal pneumonia.展开更多
BACKGROUND Mycoplasma pneumoniae(M.pneumoniae)is considered to be one of the causative agents of community acquired pneumonia in children with general or severe course of disease.Severe M.pneumoniae pneumonia(SMPP)has...BACKGROUND Mycoplasma pneumoniae(M.pneumoniae)is considered to be one of the causative agents of community acquired pneumonia in children with general or severe course of disease.Severe M.pneumoniae pneumonia(SMPP)has emerged as a crucial global health concern due to high mortality rate in children under 5 years,potentially life-threatening complications,and growing challenges in pediatric treatment associated with rising macrolide resistance.Additionally,MPP can be complicated by other bacterial and/or viral pathogens,which may exacerbate disease severity.After the lifting of strict non-pharmaceutical interventions(NPIs)worldwide,the dramatic rise of incidence of MPP in Asia and Europe was observed.AIM To perform the comprehensive study of community acquired MPP cases registered in 2023 in Baoding Hospital,China.METHODS A total of 1160 children from 1 month to 15 years old with confirmed MPP diagnosis were enrolled in the study.The blood and respiratory samples were collected within the 24 hours after admission.The hematological parameters,biochemical markers,cytokine profiles were assessed.The respiratory samples were tested for the presence of M.pneumoniae and other 23 bacterial/viral pathogens by multiplex polymerase chain reaction(PCR).The macrolide resistance mutations(A2063G,A2064G in the 23S rRNA gene of M.pneumoniae)were determined by PCR.RESULTS Number of MPP cases has dramatically increased starting August with peak in November.SMPP and general MPP(GMPP)were identified in 264 and 896 of 1160 hospitalized children.The binary logistic regression analysis identified six[C-reactive protein(CRP),lactate dehydrogenase,procalcitonin,erythrocyte sedimentation rate,fibrin and fibrinogen degradation products(FDPs),D-dimer]and four(neutrophils,CRP,FDPs,prothrombin time)predictors of SMPP in age groups 2-5 years and 6-15 years,respectively.Children with SMPP showed significantly higher levels of cytokine interleukin(IL)-17F(2-5 years),and cytokines interferon-gamma,tumor necrosis factoralpha,IL-10(6-13 years).Concomitant viral/bacterial pathogens were determined in 24.3%and 28.0%cases of SMPP and GMPP.Among them,Streptococcus pneumoniae(S.pneumoniae)and Haemophilus influenzae(H.influenzae)were predominant.93.2%cases of MPP were associated with macrolide resistant M.pneumoniae.CONCLUSION Specific MPP epidemiological pattern associated with lifting NPIs was revealed:Increase of hospitalized cases,prevalence of S.pneumoniae and H.influenzae among concomitant pathogens,93.2%of macrolide resistant M.pneumonia.展开更多
Bacterial pneumonia is one of the most common infectious diseases,a great threat to the health of children and the elderly.In the clinic,due to the extensive use of antibiotics,multi-drug-resistant bacteria have incre...Bacterial pneumonia is one of the most common infectious diseases,a great threat to the health of children and the elderly.In the clinic,due to the extensive use of antibiotics,multi-drug-resistant bacteria have increased in large numbers,seriously affects the treatment of patients with bacterial pneumonia.With the development of nanomedicine,it shows great potential in the treatment of bacterial pneumonia.In this review,it initially comprehensively describes the pathological process of bacterial pneumonia and the current status of its clinical treatment.Then it summarizes the strategies of nanomedicine for the treatment of bacterial pneumonia,including inorganic nanomaterials,polymer nanoparticles,natural source nanomaterials and artificial antimicrobial peptides,with a focus on novel nanomaterials for the treatment of bacterial pneumonia(biomimetic nanomaterials,nanovaccines and genetically engineered nanomaterials).Finally,the prospect of nanomedicine for bacterial pneumonia therapy is discussed in the hope of providing new ideas for the clinical treatment of bacterial pneumonia.展开更多
To solve the problems of complex lesion region morphology,blurred edges,and limited hardware resources for deploying the recognition model in pneumonia image recognition,an improved EfficientNetV2 pneumo-nia recogniti...To solve the problems of complex lesion region morphology,blurred edges,and limited hardware resources for deploying the recognition model in pneumonia image recognition,an improved EfficientNetV2 pneumo-nia recognition model based on multiscale attention is proposed.First,the number of main module stacks of the model is reduced to avoid overfitting,while the dilated convolution is introduced in the first convolutional layer to expand the receptive field of the model;second,a redesigned improved mobile inverted bottleneck convolution(IMBConv)module is proposed,in which GSConv is introduced to enhance the model’s attention to inter-channel information,and a SimAM module is introduced to reduce the number of model parameters while guaranteeing the model’s recognition performance;finally,an improved multi-scale efficient local attention(MELA)module is proposed to ensure the model’s recognition ability for pneumonia images with complex lesion regions.The experimental results show that the improved model has a computational complexity of 1.96 GFLOPs,which is reduced by 32%relative to the baseline model,and the number of model parameters is also reduced,and achieves an accuracy of 86.67%on the triple classification task of the public dataset Chest X-ray,representing an improvement of 2.74%compared to the baseline model.The recognition accuracies of ResNet50,Inception-V4,and Swin Transformer V2 on this dataset are 84.36%,85.98%,and 83.42%,respectively,and their computational complexities and model parameter counts are all higher than those of the proposed model.This indicates that the proposed model has very high feasibility for deployment in edge computing or mobile healthcare systems.In addition,the improved model achieved the highest accuracy of 90.98%on the four-classification public dataset compared to other models,indicating that the model has better recognition accuracy and generalization ability for pneumonia image recognition.展开更多
Streptococcus (S.) pyogenes is usually associated with mild infections of the pharynx and skin.However,in some cases,this microorganism can cause potentially lethal invasive infections,such as bacteremic pneumonia,ski...Streptococcus (S.) pyogenes is usually associated with mild infections of the pharynx and skin.However,in some cases,this microorganism can cause potentially lethal invasive infections,such as bacteremic pneumonia,skin and soft-tissue infections,sepsis,meningitis,necrotizing fasciitis,and streptococcal toxic shock syndrome.^([1,2])Although S.pyogenes is currently considered a rare cause of pneumonia,with most cases occurring in patients following influenza,the mortality rate for invasive infections is high.^([3,4])We present a case of S.pyogenes bacteremic pneumonia in a woman with no severe comorbidities,which led to a fatal outcome 9h after admission to the hospital on the third day of the disease onset.展开更多
Community-acquired pneumonia(CAP)in adults(≥18 years old)is the most common infectious disease encountered in emergency departments.Its clinical complexity and the need for prompt treatment decisions pose significant...Community-acquired pneumonia(CAP)in adults(≥18 years old)is the most common infectious disease encountered in emergency departments.Its clinical complexity and the need for prompt treatment decisions pose significant challenges for patient management.The physician-pharmacist collaborative management(PPCM)model,which optimizes drug therapy regimens through collaboration between physicians and clinical pharmacists,has demonstrated strong clinical value in practice.However,the lack of standardized national guidelines for the application of the PPCM model in emergency departments in China has hampered its widespread adoption.This guideline is developed based on evidence-based medicine and clinical practice experience,with a focus on the application of the PPCM model in the management of CAP in emergency settings.It outlines the significance of the PPCM model,its applicable scenarios,the respective roles of emergency physicians and clinical pharmacists,and its practical implementation in the antimicrobial treatment of CAP patients.In addition,the guideline proposes standardized implementation processes and clinical pathways.By promoting the PPCM model,the expert panel aims to standardize the use of antimicrobial agents in the emergency treatment of CAP,reduce the risk of antimicrobial resistance,and improve patient outcomes.展开更多
Background:In this research,we explored the operational principles of Huangqin Shegan decoction(HQSGD)for addressing acute pneumonia utilizing network pharmacology(NP)and transcriptomic analysis.Methods:Methods:A rat ...Background:In this research,we explored the operational principles of Huangqin Shegan decoction(HQSGD)for addressing acute pneumonia utilizing network pharmacology(NP)and transcriptomic analysis.Methods:Methods:A rat model of acute pneumonia was developed by treating rats with lipopolysaccharide(LPS)through a non-exposed tracheal drip.The pharmacological effects of HQSGD were evaluated via histopathological analysis of rat lung tissues,histological scoring of lung injury,assessment of lung index,serum inflammatory factors,oxidative stress levels,western blotting,and qRT-PCR.The active compounds of HQSGD were detected utilizing ultra-performance liquid chromatography coupled with tandem mass spectrometry(UPLC-MS/MS).NP and transcriptomic analysis were integrated to determine signaling pathways implicated in the pharmacological activity of HQSGD.The expression levels of mRNA and protein for factors implicated in these pathways were evaluated in rat lung tissues via qRT-PCR and western blotting,respectively.Results:HQSGD alleviated acute pneumonia in rats by reducing the lung index and the levels of TNF-α,IL-1β,CRP,and MDA while increasing the levels of SOD.The UPLC-MS/MS and NP techniques facilitated the identification of 28 bioactive constituents present in HQSGD.The principal 20 KEGG pathways were identified by intersecting the targets of HQSGD with pneumonia-related targets.These pathways were screened by comparing the transcriptomic data of the blank and model cohorts and those of the model and drug administration cohorts.GO and KEGG analyses indicated that the PI3K/AKT/NF-κB pathway was a potentially effective target of HQSGD.Conclusion:This investigation revealed the overall multi-component,multi-target,and multi-pathway interactions of HQSGD in the treatment of acute pneumonia.展开更多
Tacrolimus (TAC) is increasingly used for immunosuppression in organ transplantation,dermatomyositis/polymyositis,and myasthenia gravis(MG) patients.^([1]) TAC has a narrow therapeutic window with overexposure leading...Tacrolimus (TAC) is increasingly used for immunosuppression in organ transplantation,dermatomyositis/polymyositis,and myasthenia gravis(MG) patients.^([1]) TAC has a narrow therapeutic window with overexposure leading to acute and chronic forms of adverse reactions (ADRs).After oral administration,TAC is predominantly absorbed in the duodenum and jejunum and has highly variable pharmacokinetics,particularly when diarrhea occurs.^([2,3]) Few data has been published on TAC overexposure following mild diarrhea.Mild diarrhea is relatively common and often unreported,which can easily be overlooked by physicians,especially in the emergency department.Here,we report the occurrence of serious ADRs to TAC after mild diarrhea in a MG patient with community-acquired pneumonia(CAP),including nephrotoxicity,metabolic abnormalities and severe immunosuppression.展开更多
文摘Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.
文摘Background: Mycoplasma pneumoniae (MP) is the primary causative agent of community-acquired pneumonia, which has increasingly become resistant to macrolides, complicating treatment regimens, especially with the co-infection factor. Its worldwide prevalence has fluctuated due to the influence of the COVID-19 pandemic. The study investigated co-infection patterns in children diagnosed with Mycoplasma pneumoniae pneumonia (MPP). Methods: From June 2022 to December 2023, we retrospectively analyzed the clinical data for hospitalized children with Mycoplasma pneumoniae pneumonia in Wuhan, China. We collected data on age, sex, clinical information, and pathogenic results. We also collected sputum or bronchoalveolar lavage fluid (BALF) samples to test respiratory pathogens and macrolide resistance using targeted microbial next-generation sequencing (tNGS). We analyzed the data using SPSS. Results: The study involved 417 patients diagnosed with MPP, of whom 86.33% had co-infections. Co-infections were notably linked to lobar pneumonia, prominent imaging shadows and higher macrolide resistance rate. Key bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, rhinoviruses, and human adenoviruses (HADV). In MPP cases, Candida albicans was the fungal pathogen related to co-infections. The co-infection with HADV and human bocavirus 1 (HBoV1) correlated with prolonged fever, whereas Bordetella pertussis was linked to prolonged cough. In contrast, Candida albicans exhibited a weaker association with diffuse large-area infiltration on chest imaging, and its co-infection was less likely to result in severe disease. Conclusion: These results offer valuable insight into Mycoplasma pneumoniae pneumonia in children, highlighting the impact of co-infections on the disease’s clinical outcomes.
文摘BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
文摘BACKGROUND Liver transplant(LT)recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae(CRKP)infections.Comprehensive research addressing the incidence,timing,infection sites,resistance patterns,treatment options,and associated risk factors among LT recipients with CRKP is now lacking.AIM To assess the incidence,resistance,therapy,and risk factors of CRKP infections post-LT,and to evaluate the impact of them on prognosis.METHODS A retrospective study was conducted,including 430 consecutive patients who underwent LT between January 2015 and June 2023.This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.RESULTS Among the 430 patients who underwent LT,20(4.7%)experienced at least one documented CRKP infection within 3 months post-transplantation.The median time from LT to the onset of CRKP infections was 6.5 days.The lungs and bloodstream were the most common sites of CRKP infections.CRKP isolates were relatively susceptible to ceftazidime/avibactam(93.7%),polymyxin B(90.6%),and tigecycline(75.0%)treatment.However,all isolates were resistant to piperacillin/tazobactam,ceftazidime,cefepime,aztreonam,meropenem,and levofloxacin treatment.Recipients with CRKP infections had a mortality rate of 35%,the rate was 12.5%for those receiving ceftazidime/avibactam therapy.Multivariate analysis identified female sex[odds ratio(OR)=3.306;95%confidence interval(CI):1.239-8.822;P=0.017],intraoperative bleeding≥3000 mL(OR=3.269;95%CI:1.018-10.490;P=0.047),alanine aminotransferase on day 1 post-LT≥1500 U/L(OR=4.370;95%CI:1.686-11.326;P=0.002),and post-LT mechanical ventilation(OR=2.772;95%CI:1.077-7.135;P=0.035)as significant variables associated with CRKP.CRKP infections were related to an intensive care unit length(ICU)of stay≥7 days and 6-month all-cause mortality post-LT.CONCLUSION CRKP infections were frequent complications following LT,with poor associated outcomes.Risk factors for post-LT CRKP infections included female sex,significant intraoperative bleeding,elevated alanine aminotransferase levels,and the need for mechanical ventilation.CRKP infections negatively impacted survival and led to prolonged ICU stays.
文摘There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia.In other words,obese individuals with communityacquired pneumonia have a better prognosis.The study by Wang et al supports this claim,but we believe that the obesity paradox should not be proposed hastily as it is influenced by numerous subjective and objective confounding factors.
文摘Introduction: The misuse of antibiotics has driven the emergence of antimicrobial resistance, with certain bacterial species, including Klebsiella pneumoniae, initially susceptible to most antibiotics, now exhibiting resistance to multiple antimicrobial agents. The objective of this study was to investigate the distribution and antimicrobial resistance profiles of Klebsiella pneumoniae strains isolated at the Yaoundé Central Hospital. Methodology: The study was conducted over a period of 4 months (March 1st, 2023-July 1st, 2023) and involved 32 strains isolated from bacterial cultures performed on patients, regardless of sex. The different Klebsiella pneumoniae strains were isolated using conventional methods. Identification, antibiogram, and detection of resistance enzyme production were generated using the VITEK 2 system. The Carbapenem-resistant K.N.I.V.O. kit was used to detect carbapenemases. Data analysis was performed using EXCEL 2019 software. Results: Out of 196 samples collected from various biological products, 32 Klebsiella pneumoniae strains were isolated, representing 16.32% (196/32). Urine samples were most frequently affected, accounting for 53.125%. The emergency department was the most represented (40.63%) by these isolates. The mean age was 50 years, with a minimum of 20 years and a maximum of 80 years. The sex ratio was equal to 1. The identified strains were resistant to cefotaxime (78.13%), cefoxitin (62.50%), tobramycin (71.88%), gentamicin (56.25%), ofloxacin (81.25%), and cotrimoxazole (78.13%). 78.25% were ESBL producers. Three strains were resistant to carbapenems, accounting for 9.37%;one of which exhibited the NDM type. Conclusion: This study highlights the evolving bacterial resistance to antibiotics, which requires adequate measures through the strengthening of the Antimicrobial Resistance (AMR) program in Cameroon.
文摘Sickle cell anemia (SCA) is a prevalent genetic disorder primarily affecting individuals of African descent and populations in malaria-endemic regions, with significant global public health implications. Sickle cell crises are their most common acute complication, characterized by episodes of intense pain and systemic manifestations that impair quality of life and impose a high healthcare burden. We present the case of a 19-year-old male diagnosed with SCA since the age of two, who developed a sickle cell crisis precipitated by right basal pneumonia. The patient exhibited sudden-onset, cyclic lumbar pain with progressive dyspnea. Initial management included multimodal pain control, volume optimization, and targeted antimicrobial therapy to achieve clinical stabilization. This case underscores the importance of a comprehensive approach to managing sickle cell crises, addressing both symptomatic relief and the prevention and treatment of complications. It also highlights the need for public health strategies promoting early diagnosis, access to disease-modifying therapies such as hydroxyurea, and interdisciplinary follow-up to mitigate the socioeconomic and clinical impact of SCA.
文摘Background: Puffy hand syndrome (PHS) is a rare complication primarily associated with intravenous drug use (IVDU), characterized by chronic swelling and fibrosis of the hands due to lymphatic damage. Concurrent pulmonary complications, such as pneumonia and pneumothorax, significantly contribute to increased morbidity in this population. Case Presentation: We report the case of a 28-year-old female who injects drugs, and presents with fever, bilateral hand edema, and respiratory symptoms. Clinical evaluation revealed erythema and edema of both hands, elevated inflammatory markers, and a left lower lobe infiltration that progressed to pneumothorax. A diagnosis of PHS and left lower lobe pneumonia complicated by pneumothorax was established. Management and Outcomes: The patient was treated with broad-spectrum antibiotics, including ceftriaxone, levofloxacin, dexamethasone, and oxygen supplementation, as well as antipyretics. She demonstrated partial clinical improvement and was referred to another hospital’s thoracic surgery department for specialized care. Conclusions: This case underscores the importance of early recognition and multidisciplinary management of rare but serious complications in IVDU patients. Further research is necessary to elucidate the interplay between lymphatic dysfunction and pulmonary pathophysiology in this demographic.
基金supported by the National Natural Science Foundation of China(82360801,82460822)Natural Science Foundation of Inner Mongolia Autonomous Region(2022LHQN08001,2023QN08050,2025LHMS08061)+4 种基金the Scientific Research Project of Higher Education Institutions in Inner Mongolia Autonomous Region(NJZY23135)the Laboratory Open Fund of Inner Mongolia Medical University(2024ZN23)and the General Project of Inner Mongolia Medical University(YKD2025MS047Inner Mongolia Medical University Undergraduate Science and Technology Innovation"Talent Cultivation"Project(YCPY2025028,YCPY2025024)Inner Mongolia Medical University Undergraduate Innovation and Entrepreneurship Training Program Project(101322025034).
文摘Background:Bacterial pneumonia continues to be a significant global health concern,particularly among high-risk groups,necessitating the development of precise and early diagnostic biomarkers.While the efficacy of procalcitonin(PCT)and C-reactive protein(CRP)as inflammatory markers is widely recognized,their relative diagnostic performance across different age groups remains debate.This meta-analysis was designed to assess the diagnostic accuracy of PCT and CRP in bacterial pneumonia.Methods:In this meta-analysis adhering to PRISMA guidelines,we searched PubMed,Web of Science,and the Cochrane Library for relevant diagnostic accuracy studies.From 19 included studies(n=2,603),data were extracted to construct tables.Study quality was assessed with the QUADAS-2 tool.The bivariate random-effects model was employed to derive pooled sensitivity,specificity,positive and negative likelihood ratios,and summary AUCs.To explore the substantial heterogeneity(I^(2)>80%),we performed pre-specified subgroup analyses based on age demographics.Results:Our findings indicate superior diagnostic performance for PCT,evidenced by a pooled sensitivity of 0.8841 and specificity of 0.8499,relative to CRP’s sensitivity of 0.8371 and specificity of 0.7185.The area under the ROC curve(AUC)for PCT was 0.992,a value significantly higher than that of CRP(0.987).Intriguingly,subgroup analyses revealed age-dependent variations:CRP demonstrated enhanced diagnostic utility in minors,while PCT proved substantially more effective in non-elderly adults.Conclusion:These results reinforce the clinical relevance of PCT as a more dependable biomarker for bacterial pneumonia,particularly in informing antibiotic treatment and mitigating misuse.This study uniquely includes age-stratified analyses based on predefined groups(minors and non-elderly adults),providing refined insights for individualized diagnostic approaches.We propose further multicenter research endeavors to confirm threshold optimization and explore combined biomarker strategies.
文摘BACKGROUND Pediatric complicated community-acquired pneumonia(CCAP)is on the rise.The three subtypes include para-pneumonic effusion(PPE),necrotizing pneumonia(NP),and empyema.AIM To study different sub-types of pediatric CCAP,and compare their etiology,clinical profile,and outcome in the post-pneumococcal vaccination era.METHODS This prospective observational study was conducted over a 2-year period.All details(demographics,clinical,management,and outcomes)were recorded.Continuous data were presented either as mean and SD,or as median and interquartile range.Categorical data were presented as frequencies and percentages(%).Data were analyzed by using the IBM SPSS Statistics for Windows,version 21(IBM Corp.,Armonk,NY,United States).RESULTS Of the 80 cases included(71%aged 4-8 years),the distribution was as follows:PPE(42%),empyema(39%),and NP(19%).Bacterial etiology was identified in 28%(empyema 63%,P=0.012).Staphylococcus aureus(45%)was most common followed by Escherichia coli(E.coli)(22.7%),and Streptococcus pneumoniae(13.6%).Patients with empyema,compared to PPE and NP,were less likely to receive prior antibiotics(32%vs 56%and 58%,respectively,P=0.03).Duration(days,mean±SD)of hospitalization was longer in children with NP compared to empyema and PPE(17.7±9.8,16.1±7.5,and 13.6±4.2,respectively).All children recovered with the medical management except 2 children requiring decortication.CONCLUSION Staphylococcus aureus and E.coli are the most common bacterial etiology in the post-pneumococcal vaccination era.Empyema might be related to a delay in antibiotics administration.NP is the most severe pediatric CCAP with prolonged hospitalization.
文摘Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances.Nasal decongestants containing mineral oils or paraffin are emerging as overlooked etiological agents.This review consolidates existing literature to delineate the clinical,radiological,and pathological features of exogenous lipoid pneumonia induced by nasal decongestants,highlight diagnostic challenges,and underscore the importance of thorough patient history in early diagnosis and management.This condition,while preventable,can result in serious pulmonary complications if not recog-nized early.It necessitates a multidisciplinary approach that incorporates careful history taking,high-resolution imaging,cytological assessment,and public health vigilance.
基金supported by the National Key Research and Development Program of China(2021YFC2501800,2023YFC0872500 and 2024YFC3044600)the National Natural Science Foundation of China(82072214,82272198,82202373)+1 种基金the Science and Technology of Shanghai Committee(21MC1930400,22Y11900100 and 23Y31900100)the Shanghai Municipal Health Commission(2023ZDFC0101)。
文摘BACKGROUND:Community-acquired pneumonia(CAP)represents a significant public health concern due to its widespread prevalence and substantial healthcare costs.This study was to utilize an integrated proteomic and metabolomic approach to explore the mechanisms involved in severe CAP.METHODS:We integrated proteomics and metabolomics data to identify potential biomarkers for early diagnosis of severe CAP.Plasma samples were collected from 46 CAP patients(including27 with severe CAP and 19 with non-severe CAP)and 19 healthy controls upon admission.A comprehensive analysis of the combined proteomics and metabolomics data was then performed to elucidate the key pathological features associated with CAP severity.RESULTS:The proteomic and metabolic signature was markedly dif ferent between CAPs and healthy controls.Pathway analysis of changes revealed complement and coagulation cascades,ribosome,tumor necrosis factor(TNF)signaling pathway and lipid metabolic process as contributors to CAP.Furthermore,alterations in lipid metabolism,including sphingolipids and phosphatidylcholines(PCs),and dysregulation of cadherin binding were observed,potentially contributing to the development of severe CAP.Specifi cally,within the severe CAP group,sphingosine-1-phosphate(S1P)and apolipoproteins(APOC1 and APOA2)levels were downregulated,while S100P level was signifi cantly upregulated.CONCLUSION:The combined proteomic and metabolomic analysis may elucidate the complexity of CAP severity and inform the development of improved diagnostic tools.
文摘This study explores the clinical efficacy of budesonide combined with ambroxol inhalation therapy for neonatal pneumonia.A total of 68 neonatal pneumonia patients treated at Li County Hospital from January 2023 to December 2024 were randomly divided into a monotherapy group and a combination group,with 34 patients in each.The monotherapy group received ambroxol inhalation therapy,while the combination group received budesonide inhalation therapy in addition to ambroxol.The recovery progress,blood gas analysis indicators,inflammatory response improvement,and overall clinical efficacy were compared between the two groups.Results showed that the combination group experienced a significantly shorter time for body temperature normalization(3.36±0.58 days vs.4.59±0.45 days),oxygen inhalation duration(4.89±0.57min vs.6.96±0.79min),disappearance of shortness of breath and cough(4.56±0.29 days vs.6.63±0.75 days),and resolution of lung wet rales(5.62±1.46 days vs.7.92±1.28 days)compared to the monotherapy group(P<0.05).Additionally,the total effective rate was significantly higher in the combination group(97.06%)than in the monotherapy group(73.52%)(P<0.05).Post-treatment,the combination group exhibited significantly better blood gas analysis and inflammatory response indicators(P<0.05).These findings suggest that budesonide combined with ambroxol inhalation therapy can effectively improve blood oxygen saturation,reduce inflammation,promote faster recovery,and enhance overall clinical efficacy,making it a reliable treatment option for neonatal pneumonia.
基金Supported by Baoding Science and Technology Plan Project,No.2272P011Hebei Province Scientific Research Project,No.20241734Hebei Natural Science Foundation Project,No.H2024104011.
文摘BACKGROUND Mycoplasma pneumoniae(M.pneumoniae)is considered to be one of the causative agents of community acquired pneumonia in children with general or severe course of disease.Severe M.pneumoniae pneumonia(SMPP)has emerged as a crucial global health concern due to high mortality rate in children under 5 years,potentially life-threatening complications,and growing challenges in pediatric treatment associated with rising macrolide resistance.Additionally,MPP can be complicated by other bacterial and/or viral pathogens,which may exacerbate disease severity.After the lifting of strict non-pharmaceutical interventions(NPIs)worldwide,the dramatic rise of incidence of MPP in Asia and Europe was observed.AIM To perform the comprehensive study of community acquired MPP cases registered in 2023 in Baoding Hospital,China.METHODS A total of 1160 children from 1 month to 15 years old with confirmed MPP diagnosis were enrolled in the study.The blood and respiratory samples were collected within the 24 hours after admission.The hematological parameters,biochemical markers,cytokine profiles were assessed.The respiratory samples were tested for the presence of M.pneumoniae and other 23 bacterial/viral pathogens by multiplex polymerase chain reaction(PCR).The macrolide resistance mutations(A2063G,A2064G in the 23S rRNA gene of M.pneumoniae)were determined by PCR.RESULTS Number of MPP cases has dramatically increased starting August with peak in November.SMPP and general MPP(GMPP)were identified in 264 and 896 of 1160 hospitalized children.The binary logistic regression analysis identified six[C-reactive protein(CRP),lactate dehydrogenase,procalcitonin,erythrocyte sedimentation rate,fibrin and fibrinogen degradation products(FDPs),D-dimer]and four(neutrophils,CRP,FDPs,prothrombin time)predictors of SMPP in age groups 2-5 years and 6-15 years,respectively.Children with SMPP showed significantly higher levels of cytokine interleukin(IL)-17F(2-5 years),and cytokines interferon-gamma,tumor necrosis factoralpha,IL-10(6-13 years).Concomitant viral/bacterial pathogens were determined in 24.3%and 28.0%cases of SMPP and GMPP.Among them,Streptococcus pneumoniae(S.pneumoniae)and Haemophilus influenzae(H.influenzae)were predominant.93.2%cases of MPP were associated with macrolide resistant M.pneumoniae.CONCLUSION Specific MPP epidemiological pattern associated with lifting NPIs was revealed:Increase of hospitalized cases,prevalence of S.pneumoniae and H.influenzae among concomitant pathogens,93.2%of macrolide resistant M.pneumonia.
基金supported by the Joint Project on Regional High-Incidence Diseases Research of Guangxi Natural Science Foundation(Nos.2023GXNSFDA026023 and 2024GXNSFAA010089)the Key Research&Development Program of Guangxi(No.Gui Ke AB22080088)+2 种基金the National Natural Science Foundation of China(No.82360372)the First-class Discipline Innovation-driven Talent Program of Guangxi Medical Universitythe Major Talent Project of Guangxi Autonomous Region。
文摘Bacterial pneumonia is one of the most common infectious diseases,a great threat to the health of children and the elderly.In the clinic,due to the extensive use of antibiotics,multi-drug-resistant bacteria have increased in large numbers,seriously affects the treatment of patients with bacterial pneumonia.With the development of nanomedicine,it shows great potential in the treatment of bacterial pneumonia.In this review,it initially comprehensively describes the pathological process of bacterial pneumonia and the current status of its clinical treatment.Then it summarizes the strategies of nanomedicine for the treatment of bacterial pneumonia,including inorganic nanomaterials,polymer nanoparticles,natural source nanomaterials and artificial antimicrobial peptides,with a focus on novel nanomaterials for the treatment of bacterial pneumonia(biomimetic nanomaterials,nanovaccines and genetically engineered nanomaterials).Finally,the prospect of nanomedicine for bacterial pneumonia therapy is discussed in the hope of providing new ideas for the clinical treatment of bacterial pneumonia.
基金supported by the Scientific Research Fund of Hunan Provincial Education Department,China(Grant Nos.21C0439,22A0408).
文摘To solve the problems of complex lesion region morphology,blurred edges,and limited hardware resources for deploying the recognition model in pneumonia image recognition,an improved EfficientNetV2 pneumo-nia recognition model based on multiscale attention is proposed.First,the number of main module stacks of the model is reduced to avoid overfitting,while the dilated convolution is introduced in the first convolutional layer to expand the receptive field of the model;second,a redesigned improved mobile inverted bottleneck convolution(IMBConv)module is proposed,in which GSConv is introduced to enhance the model’s attention to inter-channel information,and a SimAM module is introduced to reduce the number of model parameters while guaranteeing the model’s recognition performance;finally,an improved multi-scale efficient local attention(MELA)module is proposed to ensure the model’s recognition ability for pneumonia images with complex lesion regions.The experimental results show that the improved model has a computational complexity of 1.96 GFLOPs,which is reduced by 32%relative to the baseline model,and the number of model parameters is also reduced,and achieves an accuracy of 86.67%on the triple classification task of the public dataset Chest X-ray,representing an improvement of 2.74%compared to the baseline model.The recognition accuracies of ResNet50,Inception-V4,and Swin Transformer V2 on this dataset are 84.36%,85.98%,and 83.42%,respectively,and their computational complexities and model parameter counts are all higher than those of the proposed model.This indicates that the proposed model has very high feasibility for deployment in edge computing or mobile healthcare systems.In addition,the improved model achieved the highest accuracy of 90.98%on the four-classification public dataset compared to other models,indicating that the model has better recognition accuracy and generalization ability for pneumonia image recognition.
文摘Streptococcus (S.) pyogenes is usually associated with mild infections of the pharynx and skin.However,in some cases,this microorganism can cause potentially lethal invasive infections,such as bacteremic pneumonia,skin and soft-tissue infections,sepsis,meningitis,necrotizing fasciitis,and streptococcal toxic shock syndrome.^([1,2])Although S.pyogenes is currently considered a rare cause of pneumonia,with most cases occurring in patients following influenza,the mortality rate for invasive infections is high.^([3,4])We present a case of S.pyogenes bacteremic pneumonia in a woman with no severe comorbidities,which led to a fatal outcome 9h after admission to the hospital on the third day of the disease onset.
基金supported by Sanming Project of Medicine in Shenzhen(No.SZZYSM202411012)Beijing Clinical Key Specialty Project(2023).
文摘Community-acquired pneumonia(CAP)in adults(≥18 years old)is the most common infectious disease encountered in emergency departments.Its clinical complexity and the need for prompt treatment decisions pose significant challenges for patient management.The physician-pharmacist collaborative management(PPCM)model,which optimizes drug therapy regimens through collaboration between physicians and clinical pharmacists,has demonstrated strong clinical value in practice.However,the lack of standardized national guidelines for the application of the PPCM model in emergency departments in China has hampered its widespread adoption.This guideline is developed based on evidence-based medicine and clinical practice experience,with a focus on the application of the PPCM model in the management of CAP in emergency settings.It outlines the significance of the PPCM model,its applicable scenarios,the respective roles of emergency physicians and clinical pharmacists,and its practical implementation in the antimicrobial treatment of CAP patients.In addition,the guideline proposes standardized implementation processes and clinical pathways.By promoting the PPCM model,the expert panel aims to standardize the use of antimicrobial agents in the emergency treatment of CAP,reduce the risk of antimicrobial resistance,and improve patient outcomes.
基金the"Qin Medicine"Quality Evaluation and Resource Development Discipline Innovation Team Project of Shaanxi University of Traditional Chinese Medicine(2019-QN01)Shaanxi University of Traditional Chinese Medicine School of Pharmacy/Shaanxi Engineering Research Centre for the Application and Development of Qinling Herbal Medicine,"Qin Medicine"Research and Development Key Laboratory(2019-QYPT-002)+2 种基金Shaanxi Provincial Administration of Traditional Chinese Medicine Province,Research and Development Key Laboratory(2019-QYPT-002)Shaanxi Provincial Administration of Traditional Chinese Medicine Province Chinese medicine province-wide earmarked special project:"Qin medicine planting and breeding guide research"(2021-QYZL-02)Shaanxi Provincial Science and Technology Department project:Chinese medicine Scutellaria baicalensis germplasm selection,seedling breeding and planting key technology research(2016KTTSSF01-01-01)and other projects.
文摘Background:In this research,we explored the operational principles of Huangqin Shegan decoction(HQSGD)for addressing acute pneumonia utilizing network pharmacology(NP)and transcriptomic analysis.Methods:Methods:A rat model of acute pneumonia was developed by treating rats with lipopolysaccharide(LPS)through a non-exposed tracheal drip.The pharmacological effects of HQSGD were evaluated via histopathological analysis of rat lung tissues,histological scoring of lung injury,assessment of lung index,serum inflammatory factors,oxidative stress levels,western blotting,and qRT-PCR.The active compounds of HQSGD were detected utilizing ultra-performance liquid chromatography coupled with tandem mass spectrometry(UPLC-MS/MS).NP and transcriptomic analysis were integrated to determine signaling pathways implicated in the pharmacological activity of HQSGD.The expression levels of mRNA and protein for factors implicated in these pathways were evaluated in rat lung tissues via qRT-PCR and western blotting,respectively.Results:HQSGD alleviated acute pneumonia in rats by reducing the lung index and the levels of TNF-α,IL-1β,CRP,and MDA while increasing the levels of SOD.The UPLC-MS/MS and NP techniques facilitated the identification of 28 bioactive constituents present in HQSGD.The principal 20 KEGG pathways were identified by intersecting the targets of HQSGD with pneumonia-related targets.These pathways were screened by comparing the transcriptomic data of the blank and model cohorts and those of the model and drug administration cohorts.GO and KEGG analyses indicated that the PI3K/AKT/NF-κB pathway was a potentially effective target of HQSGD.Conclusion:This investigation revealed the overall multi-component,multi-target,and multi-pathway interactions of HQSGD in the treatment of acute pneumonia.
基金supported by the Clinical Research Foundation of Zhejiang Provincial Medical Association (2020ZYC-A113)。
文摘Tacrolimus (TAC) is increasingly used for immunosuppression in organ transplantation,dermatomyositis/polymyositis,and myasthenia gravis(MG) patients.^([1]) TAC has a narrow therapeutic window with overexposure leading to acute and chronic forms of adverse reactions (ADRs).After oral administration,TAC is predominantly absorbed in the duodenum and jejunum and has highly variable pharmacokinetics,particularly when diarrhea occurs.^([2,3]) Few data has been published on TAC overexposure following mild diarrhea.Mild diarrhea is relatively common and often unreported,which can easily be overlooked by physicians,especially in the emergency department.Here,we report the occurrence of serious ADRs to TAC after mild diarrhea in a MG patient with community-acquired pneumonia(CAP),including nephrotoxicity,metabolic abnormalities and severe immunosuppression.
