Quality-of-Life Bronchiectasis Respiratory Symptom Scale Predicts the Risk of Exacerbations in Adults with Bronchiectasis: A Prospective Observational Study.

Rationale: The relationship between symptoms, measured using a validated disease-specific questionnaire, and longitudinal exacerbation risk has not been demonstrated in bronchiectasis. Objectives: The aim of this study is to investigate whether baseline symptoms, assessed using the Quality-of-Life Bronchiectasis Respiratory Symptom Scale (QoL-B-RSS) and its individual component scores, could predict future exacerbation risk in patients with bronchiectasis. Methods: The study included 436 adults with bronchiectasis from three tertiary hospitals. Symptoms were measured using the QoL-B-RSS, with scores ranging from 0 to 100, where lower scores indicated more severe symptoms. We examined whether symptoms as continuous measures were associated with the risk of exacerbation over 12 months. The analysis was also repeated for individual components of the QoL-B-RSS score. Results: The baseline QoL-B-RSS score was associated with an increased risk of exacerbations (rate ratio, 1.25 for each 10-point decrease; 95% confidence interval [CI], 1.15-1.35; P < 0.001), hospitalizations (rate ratio, 1.24; 95% CI, 1.05-1.43; P = 0.02), and reduced time to the first exacerbation (hazard ratio, 1.12; 95% CI, 1.03-1.21; P = 0.01) over 12 months, even after adjusting for relevant confounders, including exacerbation history. The QoL-B-RSS score was comparable to exacerbation history in its association with future frequent exacerbations (defined as three or more exacerbations per year) and hospitalization (area under the curve, 0.86 vs. 0.84; P = 0.46; and area under the curve, 0.81 vs. 0.83; P = 0.41, respectively). Moreover, patients with more severe symptoms in the majority of individual components of the QoL-B-RSS were more likely to experience exacerbations. Conclusions: Symptoms can serve as useful indicators for identifying patients at increased risk of exacerbation in bronchiectasis. Beyond relying solely on exacerbation history, a comprehensive assessment of symptoms could facilitate timely and cost-effective implementation of interventions for exacerbation prevention.

Updated severity and prognosis score of pulmonary alveolar proteinosis: A multi-center cohort study in China.

Background: The high-resolution computed tomography (HRCT) score is an important component of the severity and prognosis score of pulmonary alveolar proteinosis (SPSP). However, the HRCT score in SPSP only considers the extent of opacity, which is insufficient. Methods: We retrospectively evaluated HRCT scores for 231 patients with autoimmune pulmonary alveolar proteinosis (APAP) from three centers of the China Alliance for Rare Diseases. The SPSPII was created based on the overall density and extent, incorporating the SPSP. The severity of APAP patients was assessed using disease severity scores (DSS), SPSP, and SPSPII to determine the strengths and weaknesses of the different assessment methods. We then prospectively applied the SPSPII to patients before treatment, and the curative effect was assessed after 3 months. Results: The HRCT overall density and extent scores in our retrospective analysis were higher than the extent scores in all patients and every original extent score severity group, as well as higher related to arterial partial oxygen pressure (PaO2) than extent scores. The mild patients accounted for 61.9% based on DSS 1-2, 20.3% based on SPSP 1-3, and 20.8% based on SPSPII 1-3. Based on SPSP or SPSPII, the number of severe patients deteriorating was higher in the mild and moderate groups. When applied prospectively, arterial PaO2 differed between any two SPSPII severity groups. The alveolar-arterial gradient in PaO2 (P[A-a]O2), % predicted carbon monoxide diffusing capacity of the lung (DLCO), and HRCT score were higher in the severe group than in the mild and moderate groups. After diagnosis, mild patients received symptomatic treatment, moderate patients received pure whole lung lavage (WLL) or granulocyte-macrophage colony-stimulating factor (GM-CSF) therapy, and severe patients received WLL and GM-CSF therapy. Importantly, the SPSPII in mild and severe groups were lower than baseline after 3 months. Conclusion: The HRCT density and extent scores of patients with APAP were better than the extent score. The SPSPII score system based on smoking status, symptoms, PaO2, predicted DLCO, and overall HRCT score was better than DSS and SPSP for assessing the severity and efficacy and predicting the prognosis. Trial registration: ClinicalTrial.gov, identifier: NCT04516577.

Meniscal allograft transplantation in isolated and combined surgery.

PURPOSE: The purpose of this study was to report the initial results of meniscus allograft transplantation after a 2-year follow-up period with second-look arthroscopy of 18 patients. METHODS: Seven medial and 11 lateral meniscus allografts were evaluated with a median follow-up of 24.9 months (range, 18-41 months). The clinical outcome and failure rate were evaluated by use of second-look arthroscopy in all patients, magnetic resonance imaging (MRI) analysis in 17 patients, and standardized outcome scores assessment, including Lysholm score, Knee Injury, and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) on pain and satisfaction and International Knee Documentation Committee (IKDC) objective ratings in all patients. Patients were grouped into medial and lateral subgroups as well as those with isolated or combined procedures. RESULTS: For the second-look arthroscopic findings, 6 meniscus transplants (33%) had normal characteristics, 10 (56%) had altered characteristics, and 2 (11%) failed. On MRI, two grafts had grade III signals and 11 showed partially extruded. Patients demonstrated statistically significant improvements in standardized outcome scores and VAS pain scales. Overall, 67% of the patients reported that they were completely or mostly satisfied with the procedure. There were no significant differences in the medial and lateral subgroups and no significant differences were noted in the isolated and combined subgroups. CONCLUSIONS: Arthroscopic meniscus transplantation can achieve satisfying subjective and objective clinical outcomes, with a failure rate of 11% after 1-3 years of follow-up, as documented by second-look arthroscopy.

Femoral peel-off lesions in acute posterolateral corner injuries: incidence, classification, and clinical characteristics.

PURPOSE: The purpose of this study was to determine the incidence of acute avulsions of the popliteus tendon (PT) and lateral collateral ligament (LCL) of the femur (peel-off lesions) in knees with multiple injured ligaments. This study also describes the tear patterns and associations based on preoperative magnetic resonance imaging (MRI), physical examination, and arthroscopic inspection with injury patterns. METHODS: This was a retrospective review of a consecutive series of 48 acute grade III posterolateral knee repairs and reconstructions. All office evaluations were reviewed to determine the preoperative MRI examination results, the findings on physical examination with the patient under anesthesia, and the intraoperative arthroscopic findings. RESULTS: In total, 19 patients (40%) were surgically verified as having peel-off lesions. Tears were typically categorized into 3 patterns: isolated PT tear (pattern 1) (4 of 19 [21%]), combined PT and LCL tears (pattern 2) (8 of 19 [42%]), and complex tears (associated intrasubstance- and/or fibula-based injuries) (pattern 3) (7 of 19 [37%]). Of the patients, 82% (14 of 17) showed conclusive MRI signs of femoral insertion separation and discontinuity. Examination with the patient under anesthesia showed tibial external rotation of greater than 10° in 84% of patients (16 of 19) and positive varus instability in 73% (11 of 15). Arthroscopic findings of acute avulsion and a positive lateral gutter drive-through sign were found in 94% (16 of 17). CONCLUSIONS: In a series of 48 grade III, consecutive, acute posterolateral corner surgery cases, we found that 19 patients (40%) had peel-off lesions. For adequate clinical identification, we recommend a comprehensive diagnostic protocol, including MRI, physical examination, and arthroscopic inspection, to avoid underdiagnosis of the lesion in multiple ligament-injured knees. The lateral gutter arthroscopic evaluation is particularly sensitive for detecting the lesion. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Associations of serum cryptococcal antigen with different of clinical characteristics: a comprehensive analysis of 378 pulmonary cryptococcosis patients.

BACKGROUND: Pulmonary cryptococcosis (PC) is an infection typically diagnosed in immunocompromised or immunocompetent patients, which can lead to severe disease if not treated appropriately. We aimed to determine the association between clinical manifestations, computed tomography (CT) findings, and host immune status with the serum cryptococcal antigen (CRAG) test results of PC patients. METHODS: The clinical data of 378 PC patients over a 12-year period were retrospectively reviewed at Shanghai Pulmonary Hospital (Shanghai, China). Serum CRAG was detected by a latex agglutination (LA) test using CryptoTrol (Immuno-Mycologics Inc., Norman, OK, USA). Patients were categorized according to their serum LA results, and their clinical characteristics were analyzed: 244 of 378 patients showed positive serum LA results and 134 had negative results. RESULTS: Immunocompromised hosts (ICH) were more likely to present positive LA results. The ICH group had higher titers of LA test than the non-immunocompromised host (NICH) group. Patients with negative LA results often had no symptoms and their CT findings presented a solitary nodule or mass, while LA-positive patients had variable symptoms such as cough, expectoration, fever, etc. A large diversity of CT manifestations were observed in the LA-positive patients, such as multiple nodules, patchy shadows, interstitial infiltrates, and diffuse granular shadows. Patients with a solitary nodule or mass had lower titers than did the patients with other manifestations. The clinical characteristics of LA-positive patients were different from those of LA-negative patients. CONCLUSIONS: Serum CRAG test results were found to be associated with the clinical manifestations, CT findings, and host immune status of PC patients.

A randomized trial in the investigation of anxiety and depression in patients with coronavirus disease 2019 (COVID-19).

BACKGROUND: In March 2020, the World Health Organization (WHO) declared COVID-19 a public health emergency of international concern. A small proportion of patients infected with COVID-19 go on to develop pneumonia. We speculated that COVID-19 may be likely to result in psychological disorders such as anxiety and depression. In this study, we conducted an investigation of anxiety and depression in patients with COVID-19. METHODS: Sixty-five COVID-19 patients were randomly enrolled into this study. Anxiety and depression among participants were measured through the completion of anonymous Chinese-language Zung self-rating anxiety scale and self-rating depression scale questionnaires. Data were analyzed using independent samples t-tests, Mann-Whitney U-tests, and χ2 tests. RESULTS: The questionnaire results showed that 26.15% and 41.54% of participants suffered from anxiety and depression, respectively, although there was no significantly statistical difference between the proportions of COVID-19 patients with anxiety and depression. Statistically significant differences in employment status, partial pressure of oxygen, and corticosteroid application existed between moderate- and severe COVID-19 patients (P<0.05). In particular, the partial pressure of oxygen was significantly lower in severe COVID-19 patients than in their moderate counter parts (71.31±23.54 vs. 101.06±34.43, U=156, P=0.006). Total lymphocytes was lower in severe group than in moderate group [1.659±0.643 vs. 0.745 (0.645, 0.928), U=109, P=0.000]. Also, a higher proportion of female than male patients had anxiety (χ2=5.388, P=0.02). COVID-19 patients who received antiviral medications also displayed a higher rate of anxiety (χ2=4.481, P=0.034). Total lymphocytes between the non-anxiety and anxiety had statistical difference (U=321, P=0.019). Meanwhile, total lymphocytes between the non-depression and depression also had statistical difference (U=389.5, P=0.01). CONCLUSIONS: Among patients with COVID-19, females and those treated with antiviral medications were more likely to experience anxiety. In addition, our findings reflected the effect of anxiety and depression on immune system.

The clinical characteristics and prognosis of ABPA are closely related to the mucus plugs in central bronchiectasis.

INTRODUCTION: The characteristics of Allergic Bronchopulmonary Aspergillosis (ABPA) based on its radiological classification is still unclear. OBJECTIVES: To investigate the clinical significances of ABPA patients with central bronchiectasis (ABPA-CB) by different radiological classifications of mucus plugs. METHODS: ABPA-CB patients from a pulmonary hospital between 2008 and 2015 were retrospectively included and analysed. According to the chest imaging in their first visit to physician, the ABPA-CB patients were divided into two groups based on the presence of high-attenuation mucus (HAM) or low-attenuation mucus (LAM). The primary endpoint was ABPA relapse within 1 year since the glucocorticoid withdrawal. The relationship between the imaging findings and the clinical prognosis was illuminated. RESULTS: A total of 125 ABPA patients were analysed in this study. Compared to the LAM group, the HAM group presented higher blood eosinophil cells counts, higher rates of Aspergillus detection isolated in sputum and expectoration of brownish-black mucus plugs, more affected lobes and segments, poorer pulmonary function and higher rate of relapse. CONCLUSIONS: The clinical characteristics and prognosis of ABPA-CB patients are closely related to its radiological phenotype of mucus plugs in the central bronchiectasis. Clinicians should promote a diversity of personalized treatments for different patients with different radiological characteristics.

The spatial differences in bone mineral density and hip structure between low-energy femoral neck and trochanteric fractures in elderly Chinese using quantitative computed tomography.

The purpose of this study was to investigate the differences in bone mineral density (BMD) and hip structure between femoral neck and trochanteric fractures in elderly Chinese individuals using quantitative computed tomography (QCT). A total of 625 Chinese patients (mean age 75.8 years) who sustained low-energy hip fractures (female: 293 femoral neck, 175 trochanteric; male: 82 femoral neck, 75 trochanteric) were recruited. Each patient underwent a hip QCT scan. The areal BMD (aBMD) of the contralateral normal hip was obtained using a computed tomography X-ray absorptiometry module. Using the bone investigation toolkit (BIT) module, the femoral neck was divided into four quadrants: supero-anterior (SA), infero-anterior (IA), infero-posterior (IP), and supero-posterior (SP). Estimated cortical thickness, cortical BMD, and trabecular BMD were measured in each quadrant. Using the hip structure analysis (HSA) function, several parameters were calculated. Stratified by sex, covariance analyses were applied to compare the femoral neck fractures group with trochanteric fractures group after adjustments for age, height, and weight. In women, trochanteric fractures exhibited lower trabecular BMD and estimated cortical thickness at three quadrants of the femoral neck (IA: P = 0.02, P < 0.01; IP: P < 0.01, P = 0.01; SP: P = 0.01, P < 0.01), and lower aBMD at the trochanter area (P < 0.01); femoral neck fractures exhibited lower cortical BMD and estimated cortical thickness at the SA quadrant (P = 0.04, P = 0.01). Differences in HSA parameters were not statistically significant. Among all parameters, the most valuable ones to discrimination of hip fracture type are estimated cortical thickness of the SA quadrant of femoral neck and the aBMD of the trochanter area. In men, only lower cortical BMD at the SP quadrant and aBMD at the trochanter were found in the trochanteric fractures (P = 0.02, P < 0.01). QCT outcomes indicate that spatial differences are helpful to explore the pathogenesis of different type of hip fractures. In women, trochanteric fractures are related to severer osteoporosis, whereas cortical fragility in the SA region of the femoral neck predominates in cases of femoral neck fractures. In men, trochanteric fractures are related to more bone loss of trochanter.

Clinical characteristics and validation of bronchiectasis severity score systems for post-tuberculosis bronchiectasis.

INTRODUCTION: Lung damage related to tuberculosis is a major contributor to the etiology of bronchiectasis in China. It is unknown whether bronchiectasis severity score systems are applicable in these cases. OBJECTIVES: To evaluate the clinical characteristics and validation of bronchiectasis severity score systems for post-tuberculosis bronchiectasis. METHODS: The study enrolled 596 bronchiectasis patients in Shanghai Pulmonary Hospital between January 2011 and December 2012. The data for calculating FACED and bronchiectasis severity index (BSI) scores along with mortality, readmission, and exacerbation outcomes were collected and analyzed within a follow-up period with a median length of 48 months (interquartile range 43-54 months). RESULTS: The study enrolled 101 post-tuberculosis bronchiectasis patients and 495 non-tuberculosis bronchiectasis patients. Compared with non-post-tuberculosis bronchiectasis, post-tuberculosis bronchiectasis patients experienced less bilateral bronchiectasis (P = .004), a higher frequency of right upper lobe involvement (P < .001) and showed the cylindrical type more often (P < .001). Follow-up data indicated that both scoring systems were able to predict 48(43-54) month mortality in post-tuberculosis patients as assessed by the area under the receiver operator characteristic curve (AUC) (FACED AUC = 0.81, BSI AUC = 0.70), but they did not predict readmission (FACED and BSI = 0.56) or exacerbation (FACED and BSI = 0.52) well. CONCLUSIONS: There are apparent differences on radiologic features between bronchiectasis patients with and without history of pulmonary tuberculosis. Both FACED and BSI can predict mortality in post-tuberculosis bronchiectasis.

[An study on screening the gene clusters associated with pulmonary embolism-deep venous thrombosis by oligo microarray].

OBJECTIVE: To find out the gene clusters associated with pulmonary embolism-deep venous thrombosis (PE-DVT) and elucidate the molecular genetic mechanism of PE. METHODS: Peripheral venous blood samples were collected from 9 PE patients and 33 normal controls. The total RNA was extracted and purified. Nine PE cRNA probes labeled with cyanine 3 were constructed, and one standard cRNA probe labeled with cyanine 5 was synthesized based on the total RNA mixture of the controls. Hybridization with Agilent Whole Human Genome Oligo Microarray was performed. Eleven of the genes screened were randomly selected to be amplified by fluorescence quantitative PCR (FQ-PCR). RESULTS: 434 differential expression genes were screened from the 9 microarrays, including 36 gene transcripts. Associated with blood coagulation, 20 with immune or inflammatory response, 29 with metabolism, 26 with cell differentiation and apoptosis, 25 with cell growth/maintenance, 22 with cell-cell signaling or signal transduction, 14 with cytoskeleton or motility, 15 with ion channel or ion transport, 14 with transcription, and 6 with DNA/RNA binding. These 11 of these genes were randomly selected to be amplified by FQ-PCR. The differential expression of the 11 selected genes was consistent with the microarray. CONCLUSION: The differential expression of a lot of genes in the body may play a role in the process of initiation and development of PE-DVT.

Pulmonary sparganosis mansoni: a case report from a non-endemic region.

Sparganosis mansoni is a parasitic disease caused by the larva of Spirometra mansoni. It occurs worldwide, but only a few patients show pulmonary involvement. Here, we present a case of pulmonary sparganosis mansoni in a non-endemic region. A 32-year-old Chinese woman presented with intermittent bloody phlegm, peripheral blood eosinophilia, and migratory patch shadows in both lungs. She had been misdiagnosed with eosinophilic pneumonia. She had a history of eating raw frogs, and the sparganum mansoni antibody was positive in both her blood and bronchoalveolar lavage fluid. Several sparganum mansoni were found in a frog sample that the patient provided. Consequently, she was diagnosed with pulmonary sparganosis mansoni. After two oral courses of praziquantel were administered, her symptoms and radiological lesions improved significantly. To our knowledge, this is the first case of pulmonary sparganosis mansoni occuring in Shanghai. Oral praziquantel is effective for the treatment of sparganosis mansoni, although its course of therapy may need to be repeated.

Evaluation of PCR in bronchoalveolar lavage fluid for diagnosis of Pneumocystis jirovecii pneumonia: a bivariate meta-analysis and systematic review.

BACKGROUND: As a promising tool, PCR in bronchoalveolar lavage fluid (BALF) has not been accepted as a diagnostic criterion for PJP. OBJECTIVE: We undertook a systematic review of published studies to evaluate the diagnostic accuracy of PCR assays in BALF for PJP. METHODS: Eligible studies from PubMed, Embase and Web of Science reporting PCR assays in BALF for diagnosing PJP were identified. A bivariate meta-analysis of the method's sensitivity, specificity, and positive and negative likelihood ratios with a 95% confidence interval (CI) were analyzed. The post-test probability was performed to evaluate clinical usefulness. A summary receiver operating characteristics (SROC) curve was used to evaluate overall performance. Subgroup analyses were carried out to analysis the potential heterogeneity. RESULTS: Sixteen studies published between 1994 and 2012 were included. The summary sensitivity and specificity values (95% CI) of PCR in BALF for diagnosis of PJP were 98.3% (91.3%-99.7%) and 91.0% (82.7%-95.5%), respectively. The positive and negative likelihood ratios were 10.894 (5.569-21.309) and 0.018 (0.003-0.099), respectively. In a setting of 20% prevalence of PJP, the probability of PJP would be over 3-fold if the BALF-PCR test was positive, and the probability of PJP would be less than 0.5% if it was negative. The area under the SROC curve was 0.98 (0.97-0.99). CONCLUSIONS: The method of PCR in BALF shows high sensitivity and good specificity for the diagnosis of PJP. However, clinical practice for the diagnosis of PJP should consider the consistent respiratory symptoms, radiographic changes and laboratory findings of the suspected patients.

Protein C polymorphism and susceptibility to PTE in China.

Pulmonary thromboembolism (PTE) is a common clinical problem that is associated with substantial morbidity and mortality. We investigated the role of protein C polymorphism in patients with PTE in order to find out the correlation between its polymorphism and the susceptibility of the Chinese population to develop PTE. We used a case-control study design. Sixty-three consecutive patients with PTE were enrolled as the investigated group and 86 healthy people as the control group. Two novel polymorphisms, C/T at the position of 2405 and A/G at the position of 2418in the protein C gene promoter region were detected through PCR-restriction fragment length polymorphism analysis. The results suggested that the genotype frequencies of the two single-nucleotide polymorphisms (SNPs) when combined together were not significantly different between the case and control group (P > 0.05). However, the allele frequency of the C2405T SNP was significantly different between the case and control group. The frequency of T allele in the PTE group was higher when compared to the control, whereas the frequency of C allele was lower (P < 0.05). These results suggested that there were six different kinds of genotype distribution (TA-TA, TA-CA, TA-CG, CG-CG, CA-CG, CA-CA) and three different kinds of haplotype (TA, CG, CA). Our result showed that the frequency of the TA haplotype was significantly higher in the patients suffering from PTE (P < 0.05). These results suggest that the two polymorphisms present in the control region of the protein C gene are associated with an increased susceptibility to PTE in the Chinese population. The 2405T allele may be a possible risk factor for the development of PTE, whereas the C allele may probably be a protective factor of PTE Moreover, the TA haplotype may also be associated with an increased risk for developing PTE.