Immune characteristics of kidney transplant recipients with acute respiratory distress syndrome induced by COVID-19 at single-cell resolution.

BACKGROUND: COVID-19-induced acute respiratory distress syndrome (ARDS) can result in tissue damage and multiple organ dysfunction, especially in kidney transplant recipients (KTRs) receiving immunosuppressive drugs. Presently, single-cell research on COVID-19-induced ARDS is considerably advanced, yet knowledge about ARDS in KTRs is still constrained. METHODS: Single-cell RNA sequencing (scRNA-seq) analysis was performed to construct a comprehensive single-cell immune landscape of the peripheral blood mononuclear cells (PBMCs) of eight patients with COVID-19-induced ARDS, five KTRs with COVID-19-induced ARDS, and five healthy individuals. Subsequently, we conducted a comprehensive bioinformatics analysis, including cell clustering, enrichment analysis, trajectory analysis, gene regulatory network analysis, and cell-cell interaction analysis, to investigate the heterogeneity of the immune microenvironment in KTRs with ARDS. RESULT: Our study revealed that KTRs exhibit significant heterogeneity with COVID-19-induced ARDS compared with those of other individuals, with significant reductions in T cells, as well as an abnormal proliferation of B cells and monocytes. In the context of dual influences from immunosuppression and viral infection, KTRs exhibited more specific plasma cells, along with significant enrichment of dysfunctional GZMB and XAF1 double-positive effector T cells and IFI27-positive monocytes. Additionally, robust communication existed among T cells and monocytes in cytokine signaling. These effects impede the process of immune reconstitution in KTR patients. CONCLUSION: Our findings suggest that KTRs with COVID-19-induced ARDS show elevated antibody levels, impaired T cell differentiation, and dysregulation of innate immunity. In summary, this study provides a theoretical foundation for a comprehensive understanding of COVID-19-induced ARDS in KTRs.

NIR triggered polydopamine coated cerium dioxide nanozyme for ameliorating acute lung injury via enhanced ROS scavenging.

Acute lung injury (ALI) is a life threatening disease in critically ill patients, and characterized by excessive reactive oxygen species (ROS) and inflammatory factors levels in the lung. Multiple evidences suggest that nanozyme with diversified catalytic capabilities plays a vital role in this fatal lung injury. At present, we developed a novel class of polydopamine (PDA) coated cerium dioxide (CeO2) nanozyme (Ce@P) that acts as the potent ROS scavenger for scavenging intracellular ROS and suppressing inflammatory responses against ALI. Herein, we aimed to identify that Ce@P combining with NIR irradiation could further strengthen its ROS scavenging capacity. Specifically, NIR triggered Ce@P exhibited the most potent antioxidant and anti-inflammatory behaviors in lipopolysaccharide (LPS) induced macrophages through decreasing the intracellular ROS levels, down-regulating the levels of TNF-α, IL-1ß and IL-6, up-regulating the level of antioxidant cytokine (SOD-2), inducing M2 directional polarization (CD206 up-regulation), and increasing the expression level of HSP70. Besides, we performed intravenous (IV) injection of Ce@P in LPS induced ALI rat model, and found that it significantly accumulated in the lung tissue for 6 h after injection. It was also observed that Ce@P + NIR presented the superior behaviors of decreasing lung inflammation, alleviating diffuse alveolar damage, as well as promoting lung tissue repair. All in all, it has developed the strategy of using Ce@P combining with NIR irradiation for the synergistic enhanced treatment of ALI, which can serve as a promising therapeutic strategy for the clinical treatment of ROS derived diseases as well.

Performance of ChatGPT on Chinese national medical licensing examinations: a five-year examination evaluation study for physicians, pharmacists and nurses.

BACKGROUND: Large language models like ChatGPT have revolutionized the field of natural language processing with their capability to comprehend and generate textual content, showing great potential to play a role in medical education. This study aimed to quantitatively evaluate and comprehensively analysis the performance of ChatGPT on three types of national medical examinations in China, including National Medical Licensing Examination (NMLE), National Pharmacist Licensing Examination (NPLE), and National Nurse Licensing Examination (NNLE). METHODS: We collected questions from Chinese NMLE, NPLE and NNLE from year 2017 to 2021. In NMLE and NPLE, each exam consists of 4 units, while in NNLE, each exam consists of 2 units. The questions with figures, tables or chemical structure were manually identified and excluded by clinician. We applied direct instruction strategy via multiple prompts to force ChatGPT to generate the clear answer with the capability to distinguish between single-choice and multiple-choice questions. RESULTS: ChatGPT failed to pass the accuracy threshold of 0.6 in any of the three types of examinations over the five years. Specifically, in the NMLE, the highest recorded accuracy was 0.5467, which was attained in both 2018 and 2021. In the NPLE, the highest accuracy was 0.5599 in 2017. In the NNLE, the most impressive result was shown in 2017, with an accuracy of 0.5897, which is also the highest accuracy in our entire evaluation. ChatGPT's performance showed no significant difference in different units, but significant difference in different question types. ChatGPT performed well in a range of subject areas, including clinical epidemiology, human parasitology, and dermatology, as well as in various medical topics such as molecules, health management and prevention, diagnosis and screening. CONCLUSIONS: These results indicate ChatGPT failed the NMLE, NPLE and NNLE in China, spanning from year 2017 to 2021. but show great potential of large language models in medical education. In the future high-quality medical data will be required to improve the performance.

Hydrogen improves exercise endurance in rats by promoting mitochondrial biogenesis.

BACKGROUND: Previous studies have shown that hydrogen water has antioxidant and anti-inflammatory effects on exercise-induced fatigue; however, its molecular mechanism remains unclear. METHODS: Adult male Sprague-Dawley rats were randomly divided into a pure water drinking group (NC) and a hydrogen water drinking group (HW) (n = 7), and 2-week treadmill training was used to establish a sports model. Gut bacterial community profiling was performed using 16S rRNA gene sequencing analysis. The expression levels of mitochondrial energy metabolism-related genes and the levels of sugar metabolites and enzymes were measured. RESULTS: The exercise tolerance of rats in the HW group significantly improved, and the distribution and diversity of intestinal microbes were altered. Hydrogen significantly upregulated genes related to mitochondrial biogenesis, possibly via the Pparγ/Pgc-1α/Tfam pathway. In addition, hydrogen effectively mediated the reprogramming of skeletal muscle glucose metabolism. CONCLUSION: Our findings establish a critical role for hydrogen in improving endurance exercise performance by promoting mitochondrial biogenesis via the Pparγ/Pgc-1α/Tfam pathway.

Carbon deficit checks in high resolution and compensation under regional inequity.

Carbon compensation is an effective way of reducing carbon emissions. However, previous studies in this field have been limited and have not examined high-precision scientific carbon compensation under regional inequity. The present study examined initial carbon compensation in the grid and developed a new equitable carbon compensation model. Additionally, it modified the carbon compensation value for each province and analysed how land-use change affected carbon compensation. The results show that, after the modification, the entire carbon deficit reached 17.34 × 108 t C in 2015, representing a decrease of 14% compared with the initial carbon deficit. The area with negative carbon deficit values accounted for 36% of the whole area, concentrated mainly in the south, southwest and northwest. Without modification, the initial carbon compensation reached 537 × 108 USD, and only Yunnan, Sichuan and Hainan provinces being eligible to receive compensation. The final modified carbon compensation was approximately 20% of the initial values, and 11 provinces were eligible to obtain compensation. The other provinces responsible for paying the carbon compensation costs were typically concentrated in Central and Eastern China. Land-use changes in 2015 led to increases in the initial carbon compensation and modified carbon compensation of 3.74 × 108 and 0.13 × 108 USD, respectively. The per-unit land-use change caused greater increases in carbon emissions in China's big cities and the provinces in Central and East China. Some policies, such as macro-control by the central government, diversified forms and patterns of compensation, and auxiliary measures should be formulated/proposed.

M2c Macrophages Protect Mice from Adriamycin-Induced Nephropathy by Upregulating CD62L in Tregs.

Regulatory T cells (Tregs) and M2c macrophages have been shown to exert potentially synergistic therapeutic effects in animals with adriamycin-induced nephropathy (AN), a model chronic proteinuric renal disease. M2c macrophages may protect against renal injury by promoting an increase in the number of Tregs in the renal draining lymph nodes of AN mice, but how they do so is unclear. In this study, we used an AN mouse model to analyze how M2c macrophages induce the migration of Tregs. Using flow cytometry, we found that M2c macrophages promoted the migration of Tregs from the peripheral blood to the spleen, thymus, kidney, and renal draining lymph nodes. At the same time, M2c macrophages significantly upregulated chemokine receptors and adhesion molecule in Tregs, including CCR4, CCR5, CCR7, CXCR5, and CD62L. Treating AN mice with monoclonal anti-CD62L antibody inhibited the migration of M2c macrophages and Tregs to the spleen, thymus, kidney, and renal draining lymph nodes. Taken together, our results suggest that M2c macrophages upregulate CD62L in Tregs and thereby promote their migration to inflammatory sites, where they exert renoprotective effects. These insights may aid the development of treatments against chronic kidney disease.

Spatiotemporal trend of carbon storage in China's bamboo industry, 1993-2018.

To alleviate the greenhouse effect, increasing the carbon storage of forest and harvested wood products is an effective way. As one of the most important components of forest resources, bamboo plays an important role in carbon sequestration. China possesses the richest bamboo resources in the world. In this study, we developed a comprehensive carbon model including the supply chain from bamboo forest to final products to estimate the carbon pool for China's bamboo industry from 1993 to 2018. To examine the changes in carbon storage, we conducted a spatiotemporal analysis for 15 provinces employing a simple linear regression model. Additionally, a stochastic simulation was employed to test the parameter uncertainty in carbon estimation. Results show the carbon storage of China's bamboo industry has steadily improved, including both bamboo forest and products. In 2018, the carbon storage of bamboo vegetation, soil, and ground layer reached 448.30 TgC, 396.75 TgC, and 11.20 TgC, respectively. The carbon storage of bamboo products also increased gradually, with the storage and emission being 55.33 TgC and 1.70 TgC, respectively. The total carbon storage of China's bamboo industry in 2018 is 909.88 TgC. Moreover, the spatiotemporal analysis quantifies the annual change of the carbon storage for each province. It reveals the spatiotemporal change pattern of total bamboo carbon storage as similar to the bamboo forest. The provinces with more carbon storage tend to increase more rapidly per year. The bamboo industry is immensely significant for both the economy and the environment.

A meta-analysis of agricultural conservation intentions, behaviors, and practices: Insights from 35 years of quantitative literature in the United States.

Conservation practices (CPs) are integral to maintaining the long-term viability of agro-ecological systems. Because farming systems and farmers' values and attitudes are heterogeneous, factors that consistently predict conservation behaviors remain elusive. Moreover, heterogeneity is present among studies regarding the type of CPs examined, and whether behavioral intentions or actual behaviors were measured. This study considers the characteristics of each CP, and whether a given study measured behavioral intention or actual behavior, to better understand farmers' adoption of CPs. We reviewed and analyzed 35 years (1982-2017) of quantitative conservation adoption literature in the United States. We categorized CPs based on their primary purpose, the type of benefit they provide, and whether they are operational or structural. We also examined the following five CPs: conservation tillage, buffers or borders, soil testing, grassed waterways, and cover crops. In our behavioral intention and actual behavior analysis, we found that attitudinal factors predicted both conservation intention and action (actual behavior), whereas current or previous use of practices only influenced actions, not stated conservation intentions. In our analysis focusing on CP characteristics, we found that having specific knowledge about and positive attitudes toward the CP, adoption of other CPs, seeking and using information, larger farm size, and vulnerable land predicted actual adoption across nearly all CP categorizations. Nuances emerge when comparing predictors of CPs that share a particular characteristic. For example, we found farm characteristics to be comparatively more important in predicting adoption of soil management CPs than nutrient and livestock management CPs, and farmers' stewardship identity to be more important for permanent practices than operational practices.

Coagulation dysfunction is associated with severity of COVID-19: A meta-analysis.

To systematically analyze the blood coagulation features of coronavirus disease 2019 (COVID-19) patients to provide a reference for clinical practice. An electronic search in PubMed, EMbase, Web of Science, Scopus, CNKI, WanFang Data, and VIP databases to identify studies describing the blood coagulation features of COVID-19 patients from 1 January 2020 to 21 April 2020. Three reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies, then, the meta-analysis was performed by using Stata 12.0 software. Thirty-four studies involving 6492 COVID-19 patients were included. Meta-analysis showed that patients with severe disease showed significantly lower platelet count (weighted mean differences [WMD]: -16.29 × 109 /L; 95% confidence interval [CI]: -25.34 to -7.23) and shorter activated partial thromboplastin time (WMD: -0.81 seconds; 95% CI: -1.94 to 0.33) but higher D-dimer levels (WMD: 0.44 µg/mL; 95% CI: 0.29-0.58), higher fibrinogen levels (WMD: 0.51 g/L; 95% CI: 0.33-0.69) and longer prothrombin time (PT; WMD: 0.65 seconds; 95% CI: 0.44-0.86). Patients who died showed significantly higher D-dimer levels (WMD: 6.58 µg/mL; 95% CI: 3.59-9.57), longer PT (WMD: 1.27 seconds; 95% CI: 0.49-2.06) and lower platelet count (WMD: -39.73 × 109 /L; 95% CI: -61.99 to -17.45) than patients who survived. Coagulation dysfunction is common in severe COVID-19 patients and it is associated with severity of COVID-19.

Explaining the use of online agricultural decision support tools with weather or climate information in the Midwestern United States.

Agricultural decision support tools (DSTs) with weather or climate information can provide useful information to help stakeholders make operational farming decisions and adapt to increasingly variable weather or climate in the context of climate change. However, many of these DSTs are still not fully utilized. Understanding the use of DSTs can help identify strategies to promote their usage to more end-users. This study surveyed farmers (n = 2,633) and advisors (n = 2,719) across 12 states in the Midwest to draw comparisons on their usage of DSTs and factors influencing the usage. The advisors are more likely to take advantage of free and publicly available sources than farmers. Advisors are also more likely to agree on the usefulness of DSTs, feel social pressure to use DSTs, be concerned and perceive risks from variable weather, believe in climate change, and show positive attitudes towards climate change adaptation than farmers. Concerns about weather or climate, descriptive social norms, greater farm size, and general propensity to adopt a new technology are positively associated with higher adoption rate of DSTs for both farmers and advisors. Higher level of perceived behavioral control to deal with weather-related risks, injunctive social norms, gender (male), and age are positively associated with higher adoption rate of DSTs for only advisors. Positive adaptation attitude towards climate change and higher education level are positively associated with higher adoption rate of DSTs for only farmers. Unlike advisors, age is negatively associated with higher adoption rate of DSTs for farmers. Implications of our findings include DST educators leveraging social networks and reinforcing social norms to promote usage among current non-users, building up both farmers' and advisors' confidence and knowledge in using DSTs, understanding the role of advisors as "change agents" to promote DST usage among farmers, and connecting networks of "innovators" and "early adopters." With more and more DSTs developed, future scholarship can draw upon our findings to understand how to encourage DSTs adoption among current non-users and extend to other regions.

Crop insurance: A barrier to conservation adoption?

Midwest corn producers face inherent risks in their daily operations and incorporate risk-management strategies to reduce uncertainty; among these, crop insurance has dominated the agricultural landscape for decades. Previous research on conservation adoption has primarily examined the impact of individual-level characteristics on adoption, yet little is known about the impact of external factors, such as crop insurance. Using a mixed-methods approach, we conducted semi-structured interviews and a multi-state survey to determine if crop insurance requirements limit cover crops and/or conservation tillage adoption for Midwest corn producers. Our findings indicate that crop insurance requirements are not a barrier to adoption. Rather, crop insurance and conservation practices serve unique - not contradictory - roles in Midwest producers' operations and are used simultaneously. Future research should continue to identify and seek solutions for external barriers to broadly increase adoption rates.

Erythropoietin-Derived Peptide Protects Against Acute Lung Injury After Rat Traumatic Brain Injury.

BACKGROUND: Traumatic brain injury (TBI) can be complicated by TBI-triggered acute lung injury (ALI), in which inflammation plays a central role. It has been reported that an Erythropoietin-derived peptide (pHBSP) was able to ameliorate TBI; however, its function in TBI-caused ALI has not been reported yet. METHODS: In this study, we studied the effect of pHBSP on TBI-caused ALI by using a weight-drop induced TBI model. At 8 h and 24 h post-TBI, pulmonary edema (PE) and bronchoalveolar lavage fluid (BALF) proteins were measured, and haematoxylin and eosin (H&E) staining of lung sections was carried out. At 24 h following TBI, the lungs were harvested for immunofluorescence staining and qRT-PCR analysis. RESULTS: At 8 h and 24 h post-TBI, pHBSP treatment significantly decreased wet/dry ratios, decreased total BALF protein, and attenuated the histological signs of pulmonary injury. At 24 h post-TBI, pHBSP treatment decreased the accumulation of CD68+ macrophages in the lung and reduced the mRNA levels of TNF-α, IL-6, IL-1ß and iNOS in the lung. CONCLUSIONS: We identified the protective role that pHBSP played in TBI-caused ALI, suggesting that pHBSP is a potent candidate for systemic therapy in TBI patients.

Ionic-liquid-modified magnetic nanoparticles as a solid-phase extraction adsorbent coupled with high-performance liquid chromatography for the determination of linear alkylbenzene sulfonates in water samples.

Novel ionic-liquid-functionalized Fe3 O4 magnetic nanoparticles were synthesized by the thiol-ene click reaction. The prepared functionalized Fe3 O4 nanoparticles possessed multiple interactions, such as electrostatic, hydrophobic, and π-π interactions. The functionalized Fe3 O4 nanoparticles were characterized by using Fourier transform infrared spectroscopy, X-ray diffraction, vibrating sample magnetometry, and transmission electron microscopy. Four kinds of linear alkylbenzene sulfonates, namely, sodium decylbenzenesulfonate, sodium undecylbenzene sulfonate, sodium dodecylbenzenesulfonate, and sodium tridecylbenzenesulfonate, were selected as model compounds to evaluate the applicability of adsorbents for extraction and subjected to high-performance liquid chromatography analysis. In addition, the effects of various parameters, such as sorbent amount, pH value, ionic strength, sample volume, extraction time, and elution conditions on extraction efficiency were studied in detail. Under the optimum conditions, good linearities were attained, with correlation coefficients between 0.9912 and 0.9968. The proposed method exhibited limits of detection ranging from 0.061 to 0.099 µg/L for all the target analytes. The spiked recoveries of the target analytes in real water samples ranged from 86.3 to 107.5%, with relative standard deviations lower than 7.96%. The enrichment factors of the analytes ranged from 364 to 391, indicating that the obtained functionalized Fe3 O4 nanoparticles can effectively extract trace target analytes from environmental water samples.

CD103+ Dendritic Cells Elicit CD8+ T Cell Responses to Accelerate Kidney Injury in Adriamycin Nephropathy.

CD103(+) dendritic cells (DCs) in nonlymphoid organs exhibit two main functions: maintaining tolerance by induction of regulatory T cells and protecting against tissue infection through cross-presentation of foreign antigens to CD8(+) T cells. However, the role of CD103(+) DCs in kidney disease is unknown. In this study, we show that CD103(+) DCs are one of four subpopulations of renal mononuclear phagocytes in normal kidneys. CD103(+) DCs expressed DC-specific surface markers, transcription factors, and growth factor receptors and were found in the kidney cortex but not in the medulla. The number of kidney CD103(+) DCs was significantly higher in mice with adriamycin nephropathy (AN) than in normal mice, and depletion of CD103(+) DCs attenuated kidney injury in AN mice. In vitro, kidney CD103(+) DCs preferentially primed CD8(+) T cells and did not directly induce tubular epithelial cell apoptosis. Adoptive transfer of CD8(+) T cells significantly exacerbated kidney injury in AN SCID mice, whereas depletion of CD103(+) DCs in these mice impaired activation and proliferation of transfused CD8(+) T cells and prevented the exacerbation of kidney injury associated with this transfusion. In conclusion, kidney CD103(+) DCs display a pathogenic role in murine CKD via activation of CD8(+) T cells.

Renal F4/80+ CD11c+ mononuclear phagocytes display phenotypic and functional characteristics of macrophages in health and in adriamycin nephropathy.

Conventional markers of macrophages (Mфs) and dendritic cells (DCs) lack specificity and often overlap, leading to confusion and controversy regarding the precise function of these cells in kidney and other diseases. This study aimed to identify the phenotype and function of renal mononuclear phagocytes (rMPs) expressing key markers of both Mфs and DCs. F4/80(+)CD11c(+) cells accounted for 45% of total rMPs in normal kidneys and in those from mice with Adriamycin nephropathy (AN). Despite expression of the DC marker CD11c, these double-positive rMPs displayed the features of Mфs, including Mф-like morphology, high expression of CD68, CD204, and CD206, and high phagocytic ability but low antigen-presenting ability. F4/80(+)CD11c(+) cells were found in the cortex but not in the medulla of the kidney. In AN, F4/80(+)CD11c(+) cells displayed an M1 Mф phenotype with high expression of inflammatory mediators and costimulatory factors. Adoptive transfer of F4/80(+)CD11c(+) cells separated from diseased kidney aggravated renal injury in AN mice. Furthermore, adoptive transfer of common progenitors revealed that kidney F4/80(+)CD11c(+) cells were derived predominantly from monocytes, but not from pre-DCs. In conclusion, renal F4/80(+)CD11c(+) cells are a major subset of rMPs and display Mф-like phenotypic and functional characteristics in health and in AN.

Chloroquine prevents progression of experimental pulmonary hypertension via inhibition of autophagy and lysosomal bone morphogenetic protein type II receptor degradation.

RATIONALE: Pulmonary arterial hypertension (PAH) is characterized by excessive proliferation and apoptosis resistance in pulmonary artery smooth muscle cells (PASMCs). OBJECTIVE: We reasoned that chloroquine, based on its ability to inhibit autophagy and block lysosomal degradation of the bone morphogenetic protein type II receptor (BMPR-II), might exert beneficial effects in this disease. METHODS AND RESULTS: PAH was induced in male Sprague-Dawley rats by administering monocrotaline. The induction of PAH was associated with changes in lung expression of LC3B-II, ATG5, and p62, consistent with increased autophagy, and decreased BMPR-II protein expression. Administration of chloroquine prevented the development of PAH, right ventricular hypertrophy, and vascular remodelling after monocrotaline, and prevented progression of established PAH in this model. Similar results were obtained with hydroxychloroquine. Chloroquine treatment increased whole lung and PASMC p62 protein levels consistent with inhibition of autophagy, and increased levels of BMPR-II protein. Chloroquine inhibited proliferation and increased apoptosis of PASMCs in vivo. In cultured rat PASMCs we confirmed that chloroquine both inhibited autophagy pathways and increased expression of BMPR-II protein via lysosomal inhibition. Consistent with the in vivo findings, chloroquine inhibited the proliferation and stimulated apoptosis of rat PASMCs in vitro, with no effect on endothelial cell proliferation or survival. Moreover, direct inhibition of autophagy pathways by ATG5 small interfering RNA knockdown inhibited proliferation of rat PASMCs. CONCLUSIONS: Chloroquine and hydroxychloroquine exert beneficial effects in experimental PAH. The mechanism of action includes inhibition of autophagy pathways and inhibition of lysosomal degradation of BMPR-II.

Spatiotemporal Changes of Built-Up Land Expansion and Carbon Emissions Caused by the Chinese Construction Industry.

China is undergoing rapid urbanization, enlarging the construction industry, greatly expanding built-up land, and generating substantial carbon emissions. We calculated both the direct and indirect carbon emissions from energy consumption (anthropogenic emissions) in the construction sector and analyzed built-up land expansion and carbon storage losses from the terrestrial ecosystem. According to our study, the total anthropogenic carbon emissions from the construction sector increased from 3,905×10(4) to 103,721.17×10(4) t from 1995 to 2010, representing 27.87%-34.31% of the total carbon emissions from energy consumption in China. Indirect carbon emissions from other industrial sectors induced by the construction sector represented approximately 97% of the total anthropogenic carbon emissions of the sector. These emissions were mainly concentrated in seven upstream industry sectors. Based on our assumptions, built-up land expansion caused 3704.84×10(4) t of carbon storage loss from vegetation between 1995 and 2010. Cropland was the main built-up land expansion type across all regions. The study shows great regional differences. Coastal regions showed dramatic built-up land expansion, greater carbon storage losses from vegetation, and greater anthropogenic carbon emissions. These regional differences were the most obvious in East China followed by Midsouth China. These regions are under pressure for strong carbon emissions reduction.

[Study of reason of "the older, the better" of Pericarpium Citri Reticulatae (PCR) which contributed increase of flavonoids].

This study is to explore the reason of "the older, the better" of PCR and itsincrease of flavonoids. We identified the fun- gus isolated from the PCR using microscopic and molecular identification. HPLC method was used to determine the content of 4 fla- vonoids and to clarifythe regularity of them; UV spectrophotometry method was used to determine the total content of flavonoids; reverse thinking was applied to screen the fungus that have close relation to the change of flavonoids. Finally, we have isolated and identified 25 fungusfrom the PCR, which belong to 2 genus and 4 species, including pencillium commune, P. minioluteeum, P. citrinum, Aspergillus flavus and A. niger. The content of flavonoids was increased in the mildew PCR due to A. niger and other fungus. Therefore, "the ol- der, the better" of PCR had its scientific reason that the increase of flavonoids had a close relation of the metabolic activity of A. niger and other fungus.

Lung carcinoma with diffuse cysts repeatedly misdiagnosed as pulmonary infections and lymphoid interstitial pneumonia: A case report.

INTRODUCTION: Diffuse cystic lung diseases comprise a heterogeneous group of pulmonary disorders, with most cases being benign and malignant instances being rare. CASE REPORT: We present an unusual case of lung adenocarcinoma characterized by the progressive diffusion of cystic lesions. The patient, initially diagnosed with a pulmonary infection and lymphoid interstitial pneumonia, underwent repeated misdiagnoses. Ultimately, the diagnosis was confirmed using radial endobronchial ultrasound-guided-transbronchial cryobiopsy (rEBUS-TBCB). A 44-year-old male was admitted to the hospital with a persistent cough and expectoration of bloody sputum for over 6 months. Thoracic computed tomography revealed widespread cystic lesions and nodules. Despite multiple misdiagnoses, rEBUS-TBCB successfully confirmed the presence of lung adenocarcinoma and identified an echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) E13:A20 gene rearrangement. The patient was subsequently transferred to a local hospital for oral targeted drug therapy, which resulted in a favorable response. CONCLUSION: In conclusions, transbronchial lung biopsies often provide inadequate specimens for confirming diffuse cystic lung diseases. In contrast, the utilization of rEBUS-guided TBCB offers superior diagnostic capabilities, as it enables the collection of larger lung biopsies with higher diagnostic yields and fewer complications compared to surgical lung biopsy.

Whipple's disease of the respiratory system: A case report.

Whipple's disease (WD) is a multiple-system chronic disease caused by Tropheryma whipplei (T. whipplei) infection. The present study describes 3 cases of WD with clinical manifestations of cough, chest pain, headache, dyspnea, sputum, joint pain, abdominal pain, diarrhea and weight loss. Chest computed tomography (CT) showed signs of plaques, nodules and pleural thickening; and bronchoscopic alveolar lavage fluid metagenomic-sequencing indicated that it was T. whipplei. One patient was treated with meropenem as the starting regimen and two patients were treated with ceftriaxone as the starting regimen. Furthermore, two patients were provided with a maintenance regimen of cotrimoxazole and one was given a maintenance regimen of minocycline, which was combined with meropenem and ceftriaxone in order to improve their cough, chest pain, headache and dyspnea symptoms. To the best of our knowledge, there are few reports on WD of the respiratory system caused by T. whipplei, and differential diagnosis is the key to clinical diagnosis. When WD of the respiratory system is difficult to diagnose, metagenomic second-generation sequencing (mNGS) may be a better choice, which can achieve early diagnosis and early treatment. However, its clinical value is still limited; therefore, more research needs to be conducted in the future.