Bleeding after endobronchial biopsy: sometimes frightening, often safe, always careful.

We explain to Dr. Govindasaami's several comments on our published article "Association between blood pressure and the risk of biopsy-induced endobronchial hemorrhage during bronchoscopy".

Association between urine uranium and asthma prevalence.

Background: Previous studies showed that urine uranium (U) is associated with asthma prevalence in adults. However, the association between them among the general population is unclear. Therefore, this study aimed to explore this unclear association. Methods: The data of the participants were collected from the 2007-2016 National Health and Nutrition Examination Survey (NHANES) performed in the United States. Continuous variables with a skewed distribution were analyzed using Ln-transformation. The association between urine U and asthma prevalence was analyzed by multiple regression analysis, and the linear association between them was evaluated by smoothed curve fitting. The subgroup analysis was performed using the hierarchical multivariate regression analysis. Results: A total of 13,581 participants were included in our analysis. The multivariate regression analysis showed that LnU was independently and positively correlated with asthma prevalence in the general population (OR = 1.12; 95% CI: 1.04-1.20; p = 0.002). The subgroup analysis revealed that college graduate or above showed a stronger association between LnU and asthma prevalence (<9th grade: OR = 0.84; 95% CI: 0.61-1.14; 9-11th grade: OR = 1.23; 95% CI: 0.99-1.52; high school grade: OR = 1.00; 95% CI: 0.84-1.19; college: OR = 1.04; 95% CI: 0.91-1.19; ≥college graduate: OR = 1.32; 95% CI: 1.11-1.57; P for interaction = 0.0389). Conclusion: Our research suggested that urinary U levels are positively associated with asthma prevalence among the general population of the United States, and the association is especially strong among people with high levels of education.

Jinlian Xiaodu Decoction Protects against Bleomycin-Induced Pulmonary Fibrosis in Rats.

Background: Jinlian Xiaodu Decoction (JXD) was reported to have anti-inflammatory and lung protection effects. This study aimed to explore the role and mechanism of JXD on bleomycin (BLM)-induced pulmonary fibrosis (PF). Methods: The UHPLC-Q/TOF-MS system was applied to analyze JXD composition. The PF model was established by BLM intratracheal administration in Wistar rats. Subsequently, BLM-treated rats were intragastrically administered with dexamethasone (DXM, 1 g/kg/d) or JXD (3.5, 7 or 14 g/kg/d). Next, the lung coefficient was calculated; H&E, Masson, and TUNEL staining were used for lung morphological analysis and apoptosis assessment. Bronchoalveolar lavage fluid (BALF) biochemical analysis was conducted to count the inflammatory cell number. The expression of inflammatory factors mRNA in the lung tissue and BALF were measured by qRT-PCR. The content and activity of oxidative stress-related proteins were detected. The expression of PF-related, apoptosis-related, and TGF-ß1 pathway-related protein were assessed by immunohistochemistry or Western blot. Results: Twenty-six compounds were identified from JXD in both negative and positive ion modes. In BLM-induced rats, JXD reduced the lung coefficient and alleviated PF injury. JXD decreased inflammatory cell count and TNF-α, IL-1ß, IL-6, and MCP-1 content. Meanwhile, JXD blunted BLM-induced oxidative stress and a high level of HYP. Furthermore, TUNEL analysis found that JXD inhibited cell apoptosis and increased Bcl-2/Bax ratio in BLM-induced lung. Moreover, JXD relieved the role of BLM on α-SMA, TGF-ß1, collagen I, fibronectin, E-cadherin protein expression, and the phosphorylation of Smad2/3 in PF rat. Conclusion: This study revealed the protective effect and possible element of JXD on BLM-caused PF.

Hyperuricemia is associated with an increased prevalence of ventricular tachycardia and fibrillation in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention.

BACKGROUND: Little is known about the association between hyperuricemia and ventricular tachycardia and fibrillation (VT/VF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS: The data from a cohort of STEMI patients undergoing PPCI at our center from January 2013 to December 2018 were retrospectively analyzed. The endpoint of the study was the occurrence of VT/VF, including (1) non-sustained ventricular tachycardia (nsVT) on Holter monitoring; (2) sustained ventricular tachycardia (SVT)/VF on cardiac monitoring. RESULTS: Of the 634 patients included in the study, 147 (23.2%) of them had hyperuricemia. The occurrence of VT/VF after PPCI was significantly higher in patients with hyperuricemia (19.0 vs. 9.4%, p = 0.001) compared with those without hyperuricemia. Hyperuricemia was associated with a significantly higher risk of VF/VT (odds ratio (OR) 2.11; 95% CI 1.11-4.03; p = 0.024). The strength of this association remained statistically after adjustments for age, sex, history of hypertension, estimated glomerular filtration rate, hypersensitive C reactive protein, plasma natrium, peak troponin I, fasting glucose, B-type natriuretic peptides and VT/VF in PPCI (adjusted odds ratio 2.73; 95% CI 1.19-6.27; p = 0.018). CONCLUSIONS: There is a significant association between hyperuricemia and increased prevalence of VT/VF in STEMI patients after PPCI, independently of multiple risk factors and potential confounders.

Association between blood pressure and the risk of biopsy-induced endobronchial hemorrhage during bronchoscopy.

BACKGROUND: Hemorrhage is one of the most common complications of bronchoscopy. Although several hemorrhage risk factors have been proposed, it remains unclear whether blood pressure affects the onset of biopsy-induced endobronchial hemorrhage. METHODS: We conducted a retrospective cohort study of 643 consecutive adults with lung cancer over an approximately 4-year period (from January 2014 to February 2018) at a large tertiary care hospital. Patients were divided into the hemorrhage group and the non-hemorrhage group based on endobronchial biopsy (EBB) findings. The association between systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), pulse pressure (PP), PP to DP ratio (PP/DP) and the risk of EBB-induced hemorrhage was evaluated using multivariate regression analysis and smooth curve fitting adjusted for potential confounding factors. RESULTS: The EBB-induced bleeding incidence was 37.8% (243/643) in our cohort. An independent association was found between PP/PD and the EBB-induced hemorrhage risk (per 1 SD, adjusted odds ratio, 0.788; 95% confidence interval, 0.653-0.951). The multivariate regression analysis performed using quartiles of PP/DP revealed that lower level of PP/DP ratio was related to a higher risk of EBB-induced hemorrhage (P for trend <0.05) after adjustment for potential confounders. However, no association was observed between SP, DP, MAP, PP and EBB-induced hemorrhage. CONCLUSIONS: Low PP/DP was the independent risk factor for biopsy-induced endobronchial hemorrhage during bronchoscopy in patients with lung cancer.

Association Between the Anti-Aging Protein Klotho and Sleep Duration in General Population.

PURPOSE: Sleep duration is associated with aging. However, the relationship between sleep duration and the concentration of the protein klotho in the serum remains unknown in the general population of the United States. Hence, this study aimed at exploring the association between them. METHODS: Participants whose data included klotho protein and sleep duration variables in the National Health and Nutrition Examination Survey data from 2007 to 2016 were utilized for this analysis. RESULTS: Sleep duration was non-linearly associated with the level of klotho protein in the serum, with a negative association between sleep duration and serum klotho concentration after adjusting for confounding variables (ß = -7.6; 95% CI: -11.3, -4.0; P < 0.001). The conversion of the sleep duration from a continuous variable to a categorical variable (tertile: T1: <5.5 hours; T2: 5.5-7.5 hours; T3: >7.5 hours) revealed that the serum klotho of the participants in the highest tertile (>7.5 hours) was 21.9 pg/mL lower (95% CI: -38.6, -5.2; P = 0.01) than those in the lowest tertile (<5.5 hours). CONCLUSION: Our results revealed that people who sleep more than 7.5 hours per night have decreased levels of the anti-aging protein klotho in their serum, thus being more at risk of aging-related syndromes.

The association of blood urea nitrogen levels upon emergency admission with mortality in acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND AND PURPOSE: High blood urea nitrogen (BUN) is associated with an elevated risk of mortality in various diseases, such as heart failure and pneumonia. Heart failure and pneumonia are common comorbidities of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, data on the relationship of BUN levels with mortality in patients with AECOPD are sparse. The purpose of this study was to evaluate the correlation between BUN level and in-hospital mortality in a cohort of patients with AECOPD who presented at the emergency department (ED). METHODS: A total of 842 patients with AECOPD were enrolled in the retrospective observational study from January 2018 to September 2020. The outcome was all-cause in-hospital mortality. Receiver operating characteristic (ROC) curve analysis and logistic regression models were performed to evaluate the association of BUN levels with in-hospital mortality in patients with AECOPD. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics, and logistic regression models were also performed in the propensity score matching cohort. RESULTS: During hospitalization, 26 patients (3.09%) died from all causes, 142 patients (16.86%) needed invasive ventilation, and 190 patients (22.57%) were admitted to the ICU. The mean level of blood urea nitrogen was 7.5 ± 4.5 mmol/L. Patients in the hospital non-survivor group had higher BUN levels (13.48 ± 9.62 mmol/L vs. 7.35 ± 4.14 mmol/L, p < 0.001) than those in the survivor group. The area under the curve (AUC) was 0.76 (95% CI 0.73-0.79, p < 0.001), and the optimal BUN level cutoff was 7.63 mmol/L for hospital mortality. As a continuous variable, BUN level was associated with hospital mortality after adjusting respiratory rate, level of consciousness, pH, PCO2, lactic acid, albumin, glucose, CRP, hemoglobin, platelet distribution width, D-dimer, and pro-B-type natriuretic peptide (OR 1.10, 95% CI 1.03-1.17, p=0.005). The OR of hospital mortality was significantly higher in the BUN level ≥7.63 mmol/L group than in the BUN level <7.63 mmol/L group in adjusted model (OR 3.29, 95% CI 1.05-10.29, p=0.041). Similar results were found after multiple imputation and in the propensity score matching cohort. CONCLUSIONS: Increased BUN level at ED admission is associated with hospital mortality in patients with AECOPD who present at the ED. The level of 7.63 mmol/L can be used as a cutoff value for critical stratification.

Association of the location and initial degree of malignant central airway stenosis with the risk of severe restenosis after interventional bronchoscopy.

BACKGROUND: Therapeutic bronchoscopy is one of the effective methods in the treatment and management of malignant central airway stenosis (MCAS). However, restenosis after therapeutic bronchoscopy frequently occurs and severe restenosis (SR) can be life-threatening. Therefore, this study aimed at investigating the risk factors for SR after therapeutic bronchoscopy. METHODS: The data of 233 consecutive cases with MCAS who were subjected to therapeutic bronchoscopy between 2015 and 2020 at a tertiary hospital were collected. Patients were divided into SR group and non-SR during 6 months after therapeutic bronchoscopy. Multiple logistic regression analysis was performed to determine the risk factors for SR. RESULTS: SR during 6 months after therapeutic bronchoscopy occurred in 39.5% (92/233) of patients. The location and the initial degree of MCAS were associated with SR, as assessed by multiple logistic regression analysis (P < 0.05). The risk of SR after therapeutic bronchoscopy in the left main bronchus, right main bronchus, and right intermediate bronchus increased, compared to the risk when of MCAS was located in the trachea (OR (95% CI) of 8.821 (1.850-25.148), 6.583 (1.791-24.189), and 3.350 (0.831-13.511), respectively). In addition, the initial degree of MCAS was positively associated with an increased risk of SR (OR 1.020; 95% CI 1.006-1.035). CONCLUSIONS: MCAS located in the left main bronchus, right main bronchus and right intermediate bronchus, as well as the higher initial degree of MCAS were independent risk factors for SR during 6 months after therapeutic bronchoscopy.

Development of a nomogram for predicting treatment default under facility-based directly observed therapy short-course in a region with a high tuberculosis burden.

BACKGROUND: Poor adherence to tuberculosis (TB) treatment is a substantial barrier to global TB control. The aim of this study was to construct a nomogram for predicting the probability of TB treatment default. METHODS: A total of 1185 TB patients who had received treatment between 2010 and 2011 in Peru were analyzed in this study. Patient demographics, social, and medical information were recorded. Predictors were selected by least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram for predicting TB treatment default was constructed by using multivariable logistic regression analysis. Bootstrapping method was applied for internal validation. Calibration and clinical utility of the nomogram was also evaluated. RESULTS: The incidence of TB treatment default among the study patients was 11.6% (138/1185). Six predictors (secondary education status, alcohol use, illegal drug use, body mass index, multidrug-resistant tuberculosis, and human immunodeficiency virus serostatus) were selected through the LASSO regression analysis. A nomogram was developed based on the six predictors and it yielded an area under the curve (AUC) value of 0.797 [95% confidence interval (CI), 0.755-0.839]. In the internal validation, the AUC achieved 0.805 (95% CI, 0.759-0.844). Additionally, the nomogram was well-calibrated, and it showed clinical utility in decision curve analysis. CONCLUSION: A nomogram was constructed that incorporates six characteristics of the TB patients, which provides a good reference for predicting TB treatment default.

Emergency admission parameters for predicting in-hospital mortality in patients with acute exacerbations of chronic obstructive pulmonary disease with hypercapnic respiratory failure.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation in emergency departments (ED) that can be fatal. This study aimed to develop a mortality risk assessment model for patients presenting to the ED with AECOPD and hypercapnic respiratory failure. METHODS: We analysed 601 participants who were presented to an ED of a tertiary hospital with AECOPD between 2018 and 2020. Patient demographics, vital signs, and altered mental status were assessed on admission; moreover, the initial laboratory findings and major comorbidities were assessed. We used least absolute shrinkage and selection operator (LASSO) regression to identify predictors for establishing a nomogram for in-hospital mortality. Predictive ability was assessed using the area under the receiver operating curve (AUC). A 500 bootstrap method was applied for internal validation; moreover, the model's clinical utility was evaluated using decision curve analysis (DCA). Additionally, the nomogram was compared with other prognostic models, including CRB65, CURB65, BAP65, and NEWS. RESULTS: Among the 601 patients, 19 (3.16%) died during hospitalization. LASSO regression analysis identified 7 variables, including respiratory rate, PCO2, lactic acid, blood urea nitrogen, haemoglobin, platelet distribution width, and platelet count. These 7 variables and the variable of concomitant pneumonia were used to establish a predictive model. The nomogram showed good calibration and discrimination for mortality (AUC 0.940; 95% CI 0.895-0.985), which was higher than that of previous models. The DCA showed that our nomogram had clinical utility. CONCLUSIONS: Our nomogram, which is based on clinical variables that can be easily obtained at presentation, showed favourable predictive accuracy for mortality in patients with AECOPD with hypercapnic respiratory failure.

National Early Warning Score in Predicting Severe Adverse Outcomes of Emergency Medicine Patients: A Retrospective Cohort Study.

BACKGROUND: For emergency triage, it is very important to identify patient severity according to their vital signs and chief complaint. Several studies have examined the predictive value of the National Early Warning Score (NEWS) for specific emergency patients and have shown it to be effective. However, few have studied the utility of NEWS in emergency triage for general emergency medicine patients. The aim of this research was to investigate the performance of NEWS in emergency triage with regard to predicting adverse outcomes. METHODS: This was a retrospective cohort study carried out at a tertiary care center hospital in Jinhua, China. A total of 62,403 patients attending the emergency department (ED) from January to December 2018 were included. The NEWS, Modified Early Warning Score (MEWS), and quick Sepsis Related Organ Failure Assessment (qSOFA) score were obtained from emergency triage. Multivariate logistic regression analysis was performed to evaluate the associations between the NEWS, MEWS, and qSOFA, as well as those between other parameters with ED mortality. The predictive performances for emergency observation, death, and intensive care unit (ICU) admission of NEWS, MEWS and qSOFA were compared to the area under the receiver operating characteristic curve (AUROC). RESULTS: Of the total participants, 6502 were placed under emergency observation, 106 died in the ED, 638 were admitted to the ICU, and 324 died in-hospital. The NEWS, qSOFA, age, and gender were significantly associated with ED mortality. NEWS was significantly better at discriminating all outcomes, and the area under the curve and 95% confidence intervals for ED mortality, observation in ED, composite of ED mortality and ICU admission, and in-hospital mortality were 0.862 (0.859-0.865), 0.691 (0.687-0.695), 0.859 (0.856-0.861), and 0.805 (0.802-0.808), respectively. CONCLUSION: NEWS shows good performance in discriminating critical emergency patients in ED triage for emergency medicine patients.

Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study.

BACKGROUND: Upper gastrointestinal bleeding is a common presentation in emergency departments and carries significant morbidity worldwide. It is paramount that treating physicians have access to tools that can effectively evaluate the patient risk, allowing quick and effective treatments to ultimately improve their prognosis. This study aims to establish a mortality risk assessment model for patients with acute upper gastrointestinal bleeding at an emergency department. METHODS: A total of 991 patients presenting with acute upper gastrointestinal bleeding between July 2016 and June 2019 were enrolled in this retrospective single-center cohort study. Patient demographics, parameters assessed at admission, laboratory test, and clinical interventions were extracted. We used the least absolute shrinkage and selection operator regression to identify predictors for establishing a nomogram for death in the emergency department or within 24 h after leaving the emergency department and a corresponding nomogram. The area under the curve of the model was calculated. A bootstrap resampling method was used to internal validation, and decision curve analysis was applied for evaluate the clinical utility of the model. We also compared our predictive model with other prognostic models, such as AIMS65, Glasgow-Blatchford bleeding score, modified Glasgow-Blatchford bleeding score, and Pre-Endoscopic Rockall Score. RESULTS: Among 991 patients, 41 (4.14%) died in the emergency department or within 24 h after leaving the emergency department. Five non-zero coefficient variables (transfusion of plasma, D-dimer, albumin, potassium, age) were filtered by the least absolute shrinkage and selection operator regression analysis and used to establish a predictive model. The area under the curve for the model was 0.847 (95% confidence interval [0.794-0.900]), which is higher than that of previous models for mortality of patients with acute upper gastrointestinal bleeding. The decision curve analysis indicated the clinical usefulness of the model. CONCLUSIONS: The nomogram based on transfusion of plasma, D-dimer, albumin, potassium, and age effectively assessed the prognosis of patients with acute upper gastrointestinal bleeding presenting at the emergency department.

Association between serum low-density lipoprotein cholesterol and metabolic syndrome in a working population.

BACKGROUND: The studies, investigating the association of low-density lipoprotein cholesterol (LDL-C) with metabolic syndrome (MetS) are limited with controversial conclusions. Therefore, this study aimed at revealing the specific relationship between the serum LDL-C levels and MetS prevalence in a large working population. METHODS: Secondary data analysis of a cross-sectional study, conducted between 2012 and 2016 in Spain on participants aged within the range of 20-70 years, involved 60,799 workers. Logistic regression analysis was applied to evaluate the association between the levels of serum LDL-C and MetS prevalence. RESULTS: Among the 60,799 workers, the prevalence of MetS was 9.0%. The odds ratios (95% confidence intervals) of MetS prevalence were 1.27 (1.16-1.39) and 1.53 (1.41-1.65) for the individuals with the LDL-C levels in lower (< 103.8 mg/dL) and upper (> 135.8 mg/dL) tertiles as compared to those with the LDL-C levels in middle tertile (103.8-135.8 mg/dL) in the studied population. Similarly, a U-shaped relationship was also observed in male cohort. The serum LDL-C levels associated with the lowest risk of current MetS were 113.6 mg/dL and 117.6 mg/dL in the overall studied population and male cohort, respectively. The female workers with the levels of LDL-C higher than 135.0 mg/dL had an increased prevalence of MetS (P < 0.05). CONCLUSIONS: The low and high levels of serum LDL-C were associated with an increased prevalence of MetS in the working population and in male workers. Only the high (> 135.0 mg/dL) levels of LDL-C increased MetS prevalence in female workers.

Association between peripheral lymphocyte count and the mortality risk of COVID-19 inpatients.

BACKGROUND: To explore the relationship between peripheral lymphocyte counts (PLCs) and the mortality risk of coronavirus disease 2019 (COVID-19), as well as the potential of PLC for predicting COVID-19 hospitalized patients death. METHODS: Baseline characteristics, laboratory tests, imaging examinations, and outcomes of 134 consecutive COVID-19 hospitalized patients were collected from a tertiary hospital in Wuhan city from January 25 to February 24, 2020. Multiple regression analysis was used to analyze the relationship between the PLC at admission and mortality risk in COVID-19 patients and to establish a model for predicting death in COVID-19 hospitalized patients based on PLC. RESULTS: After adjusting for potential confounding factors, we found a non-linear relationship and threshold saturation effect between PLC and mortality risk in COVID-19 patients (infection point of PLC: 0.95 × 109/L). Multiple regression analysis showed that when PLCs of COVID-19 patients were lower than 0.95 × 109/L, the patients had a significantly higher mortality risk as compared to COVID-19 patient with PLCs > 0.95 × 109/L (OR 7.27; 95% CI 1.10-48.25). The predictive power of PLC for death in COVID-19 patients (presented as area under the curve) was 0.78. The decision curve analysis showed that PLC had clinical utility for the prediction of death in COVID-19 inpatients. CONCLUSIONS: PLC had a non-linear relationship with mortality risk in COVID-19 inpatients. Reduced PLCs (< 0.95 × 109/L) were associated with an increased mortality risk in COVID-19 inpatients. PLCs also had a potential predictive value for the death of COVID-19 inpatients.

Progressive Renal Impairment in an Older Patient with Coronavirus Disease 2019: A Case Report and Literature Review.

Advanced age is a high-risk factor for exacerbation of coronavirus disease 2019 (COVID-19), which causes a high rate of mortality. Therefore, it is important to strengthen the warning and monitoring of severe patients, and early identify the severe and critically severe types in time in the clinical treatment of COVID-19. Moreover, it is necessary to pay attention to the adverse reactions and damage to vital target organs caused by treatment drugs. This study reports the successful experience of diagnosis and treatment of an older patient with COVID-19 accompanied by progressive renal impairment, and pertinent literature was reviewed to help clinicians raise awareness of the disease.

Development of a hemoptysis risk prediction model for patients following CT-guided transthoracic lung biopsy.

BACKGROUND: Computed tomography-guided transthoracic needle biopsy (CT-TNB) is a widely used method for diagnosis of lung diseases; however, CT-TNB-induced bleeding is usually unexpected and this complication can be life-threatening. The aim of this study was to develop and validate a predictive model for hemoptysis following CT-TNB. METHODS: A total of 436 consecutive patients who underwent CT-TNB from June 2016 to December 2017 at a tertiary hospital in China were divided into derivation (n = 307) and validation (n = 129) cohorts. We used LASSO regression to reduce the data dimension, select variables and determine which predictors were entered into the model. Multivariate logistic regression was used to develop the predictive model. The discrimination capacity of the model was evaluated by the area under the receiver operating characteristic curve (AUROC), the calibration curve was used to test the goodness-of-fit of the model, and decision curve analysis was conducted to assess its clinical utility. RESULTS: Five predictive factors (diagnosis of the lesion, lesion characteristics, lesion diameter, procedure time, and puncture distance) selected by LASSO regression analysis were applied to construct the predictive model. The AUC was 0.850 (95% confidence interval [CI], 0.808-0.893) in the derivation, and 0.767 (95% CI, 0.684-0.851) in the validation. The model showed good calibration consistency (p > 0.05). Moreover, decision curve analysis indicated its clinical usefulness. CONCLUSION: We established a predictive model that incorporates lesion features and puncture parameters, which may facilitate the individualized preoperative prediction of hemoptysis following CT-TNB.

Nomogram to predict multidrug-resistant tuberculosis.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is burgeoning globally, and has been a serious challenge in TB management. Clinically, the ability to identify MDR-TB is still limited, especially in smear-negative TB. The aim of this study was to develop a nomogram for predicting MDR-TB. METHODS: Demographics and clinical characteristics of both MDR-TB and drug-susceptible TB patients were utilized to develop a nomogram for predicting MDR-TB. The LASSO regression method was applied to filter variables and select predictors, and multivariate logistic regression was used to construct a nomogram. The discriminatory ability of the model was determined by calculating the area under the curve (AUC). Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed. This study involved a second analysis of a completed prospective cohort study conducted in a country with a high TB burden. RESULTS: Five variables of TB patients were selected through the LASSO regression method, and a nomogram was built based on these variables. The predictive model yielded an AUC of 0.759 (95% CI, 0.719-0.799), and in the internal validation, the AUC was 0.757 (95% CI, 0.715-0.793). The predictive model was well-calibrated, and DCA showed that if the threshold probability of MDR-TB was between 70 and 90%, using the proposed nomogram to predict MDR-TB would obtain a net benefit. CONCLUSIONS: In this study, a nomogram was constructed that incorporated five demographic and clinical characteristics of TB patients. The nomogram may be of great value for the prediction of MDR-TB in patients with sputum-free or smear-negative TB.

Fecal specimen diagnosis 2019 novel coronavirus-infected pneumonia.

The emergence and spread of 2019 novel coronavirus-infected pneumonia (COVID-19) from Wuhan, China, it has spread globally. We extracted the data on 14 patients with laboratory-confirmed COVID-19 from Jinhua Municipal Central hospital through 27 January 2020. We found that compared to pharyngeal swab specimens, nucleic acid detection of COVID-19 in fecal specimens was equally accurate. And we found that patients with a positive stool test did not experience gastrointestinal symptoms and had nothing to do with the severity of the lung infection. These results may help to understand the clinical diagnosis and the changes in clinical parameters of COVID-19.