A CARE-compliant article: A case report and literature review of IgG4-related lung disease.

RATIONALE: IgG4-related lung disease (IgG4-RLD) is an unusual disease, with various clinical manifestations and various chest imaging findings. The patients may have no respiratory symptoms. Therefore, diagnosis is challenging. This can easily cause misdiagnosis and mistreatment. PATIENT CONCERNS: A 71-year-old male presented with chest pain, cough, and shortness of breath. Plain chest computed tomography scans showed multi-locus nodes at the center of the hilum. DIAGNOSIS: Percutaneous lung biopsy was performed, and IgG4-RLD was diagnosed. INTERVENTIONS: Prednisone was orally administered daily. OUTCOMES: The case's symptoms improved. The patient was discharged from the hospital. After 2 months of reexamination, his symptoms were relieved. Reexamination of the chest computed tomography showed that multi-locus nodes of the lung were obviously absorbed compared with those before. LESSONS: IgG4-RLD is a rare respiratory disease. It has atypical clinical manifestations and chest images. We report the first case of IgG4-RLD showing multi-locus nodes centered on the hilar, hypertrophic mucosa; as well as a narrow and even occluded lumen.

Foreign Object Detection in Railway Images Based on an Efficient Two-Stage Convolutional Neural Network.

Foreign object intrusion is one of the main causes of train accidents that threaten human life and public property. Thus, the real-time detection of foreign objects intruding on the railway is important to prevent the train from colliding with foreign objects. Currently, the detection of railway foreign objects is mainly performed manually, which is prone to negligence and inefficient. In this study, an efficient two-stage framework is proposed for foreign object detection in railway images. In the first stage, a lightweight railway image classification network is established to classify any input railway images into one of two classes: normal or intruded. To enable real-time and accurate classification, we propose an improved inverted residual unit by introducing two improvements to the original inverted residual unit. First, the selective kernel convolution is used to dynamically select kernel size and learn multiscale features from railway images. Second, we employ a lightweight attention mechanism, called the convolutional block attention module, to exploit both spatial and channel-wise relationships between feature maps. In the second stage of our framework, the intruded image is fed to the foreign object detection network to further detect the location and class of the objects in the image. Experimental results confirm that the performance of our classification network is comparable to the widely used baselines, and it obtains outperforming efficiency. Moreover, the performances of the second-stage object detection are satisfying.

Endobronchial Therapy With Gentamicin and Dexamethasone After Airway Clearance by Bronchoscopy in Exacerbation of Non-Cystic Fibrosis Bronchiectasis: A Real-World Observational Study.

Background: The exacerbation of non-cystic fibrosis bronchiectasis (NCFB) may lead to poor prognosis. The objective of this study was to retrospectively analyze the clinical efficacy and safety of endobronchial therapy with gentamicin and dexamethasone after airway clearance by bronchoscopy in the exacerbation of NCFB. Methods: We retrospectively reviewed 2,156 patients with NCFB between January 2015 and June 2016 and 367 consecutive patients with exacerbation of bronchiectasis who had complete data and underwent airway clearance (AC) by bronchoscopy. The final cohort included 181 cases of intratracheal instillation with gentamicin and dexamethasone after AC (a group with airway drugs named the drug group) and 186 cases of AC only (a group without airway drugs named the control group). The last follow-up was on June 30, 2017. Results: The total cough score and the total symptom score in the drug group were improved compared to those in the control group during 3 months after discharge (p < 0.001). Re-examination of chest HRCT within 4-6 months after discharge revealed that the improvements of peribronchial thickening, the extent of mucous plugging, and the Bhalla score were all significantly improved in the drug group. Moreover, the re-exacerbations in the drug group were significantly decreased within 1 year after discharge. Univariate analysis showed a highly significant prolongation of the time to first re-exacerbation in bronchiectasis due to treatment with airway drugs compared with that of the control group. Multivariate Cox regression analysis showed that the risk of first re-exacerbation in the drug group decreased by 29.7% compared with that of the control group. Conclusion: Endobronchial therapy with gentamicin and dexamethasone after AC by bronchoscopy is a safe and effective method for treating NCFB.

Association of Admission Blood Glucose Level with All-Cause Mortality According to Age in Patients with Community Acquired Pneumonia.

OBJECTIVE: To assess the impact of blood glucose levels on the prognosis of patients with community-acquired pneumonia (CAP) who were elderly or middle-aged. METHODS: From January 1, 2018, to December 31, 2020, patients with CAP (≥45 years) were retrospectively enrolled in this observational study. They were stratified by age (45-64 or ≥65 years) and blood glucose level (≥11.1 or <11.1 mmol/l). The effect of admission blood glucose on 28-day mortality was assessed with the Cox proportional hazards model, adjusted for demographic factors and comorbidity. RESULTS: Among 1656 patients with CAP, increased blood glucose (HR=2.08, 95% CI: 1.38-3.49; P<0.01) and advanced age (HR=2.76, 95% CI: 1.65-3.77; P<0.01) were significantly associated with a higher risk of 28-day mortality, after controlling for potential confounding factors. The strength of the association of blood glucose level with 28-day mortality decreased with age (P=0.01 for the interaction) as the adjusted HRs for death were 4.48 (95% CI: 1.40-13.65; P<0.01) for middle-age patients 45-64 years and 1.52 (95% CI: 1.09-2.17; P=0.05) for elderly patients ≥65 years. CONCLUSION: The association of blood glucose level upon admission for CAP with all-cause mortality was stronger at younger ages.