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Objective: To analyze the clinical features of COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. Methods: A single-center retrospective observational study was conducted on 213 inpatients diagnosed with COVID-19 in the Peking University People's Hospital between December 2022 and October 2023. They were divided into an immunocompromised group (102 patients, 47.9%) and an immunocompetent group(111 patients, 52.1%), and clinical data were compared between the two groups. The immunocompromised group was further divided into death group (18 cases, 17.6%) and non-death group (84 cases, 82.4%). The differences in laboratory examination findings were compared. Further analysis was performed on the lymphocyte subset differences between the death group(10 patients, 9.8%) and the non-death group (36 patients, 35.3%) with complete data. Results: The proportion of severe and critical cases and the mortality rate, were significantly higher in the immunocompromised group than the immunocompetent group (47.1% vs . 40.5%, 18.6% vs . 9.0%, 17.6% vs . 9.0%, P< 0.05). The immunocompromised group had lower vaccination rate (26.5% vs . 44.1%, P <0.05). Hypertension, kidney disease and infections were more common in the immunocompromised group (63.7% vs . 48.6%, 30.4% vs . 9.0%, 49.0% vs . 19.8%, all P <0.05). CT findings of consolidation (40.2% vs . 18.9%), rate of antiviral treatment (48.0% vs . 30.6%) and the positive duration of viral nucleic acid [median 14(7.0, 19.3) days vs . 9(7.0, 18.0) days] were higher in the immunocomprised group (all P <0.05). Lactate dehydrogenase (LDH), procalcitonin (PCT), interleukin-6 (IL-6) and ferritin were higher in the immunocompromised group than those in the immunocompetent group (all P <0.05). In the death group, neutrophils (NEU), C-reactive protein (CRP), PCT, IL-6, ferritin and D-dimer were higher, while lymphocytes (LY), CD4 + T-cells, CD8 + T-cells, B-cell counts and hemoglobin (HGB) were significantly lower than those in the non-death group (all P <0.05). Conclusions: More than 60% of patients in the immunocompromised group were classified as severe or critical type, with a higher mortality rate and decreased ability to clear severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Decreases in total lymphocytes, CD4 + T lymphocytes, CD8 + T lymphocytes, and B lymphocytes, along with elevated levels of procalcitonin, ferritin, and D-dimer, indicated poor prognosis.

We retrospectively analyzed a rare case of giant pleural tuberculoma. The patient was a female, 62 years old, admitted to hospital for intermittent fever and hemoptysis. The CT scan of the chest and abdomen showed a mass in the right thoracic cavity, and the uneven surface of the bilateral fallopian tubes. Routine blood tests showed a decrease in platelets, white blood cells, and hemoglobin. The mass in the chest was finally confirmed as a tuberculoma by biopsy. The patient was diagnosed with tuberculosis more than 9 years ago and had been treated with anti-tuberculosis drugs for more than 9 years, which caused damage to the liver, bone marrow and other organs, and led to the drug-resistant tuberculosis, making diagnosis and treatment more complex.

Cryptococcus gattii often causes meningitis, but rarely causes pulmonary infections. Here, we reported a patient with asymptomatic pulmonary cryptococcosis caused by Cryptococcus gattii . The patient presented to the thoracic surgery department with an isolated pulmonary nodule that had been present for three years and underwent a thoracoscopic pulmonary wedge resection. Postoperative pathology was consistent with Cryptococcus gattii infection. Although the incidence of Cryptococcus gattii infection is lower than that of Cryptococcus neoformans , the neurological involvement is common and has severe complications. In this report, the risk factors, symptoms, diagnosis, treatment, and prognosis of Cryptococcus gattii pneumonia were discussed to improve clinical awareness of this disease.

Objective: To investigate the clinical features and pathogenesis of spontaneous regression of lymphoma involving the respiratory system. Methods: Two cases of pulmonary lymphoma which regressed spontaneously were reported. Literatures with"spontaneous regression, lymphoma""spontaneous remission, lymphoma"published before February 2020 were searched in Wanfang, CNKI and Pubmed database. And cases with respiratory system involvement of lymphoma which regressed spontaneously were analyzed. A total of 22 cases were finally retrieved. There were 6 males and 16 females, with an average age of (62.5±16.8) years. Results: Common symptoms included dyspnea, cough, expectoration, fever and weakness. Imaging examination showed that any parts in respiratory system could be involved. The proportion of invasive and indolent lymphomas was approximately similar. The time interval between diagnosis of lymphoma and first sign of spontaneous regression of the disease was from 2 weeks to 1 year. Spontaneous regression of the disease could sustain from 50 days to 60 months. Moreover, 78.6% of patients achieved complete remission in their courses of treatment, and some patients showed wax and wane phenomena. Conclusions: Spontaneous regression of lymphoma may occur in any part of the respiratory system. When a patient exhibits spontaneous regression of pulmonary lesions, lymphoma should be considered in the differential diagnoses. Pathology study is needed to achieve a definitive diagnosis. Misdiagnosis and delayed diagnosis related to empirical treatment of antibiotics and corticosteroid should be avoided.

Objective: To explore the epidemiological and clinical characteristics of COVID-19 reinfection cases. Methods: The published COVID-19 reinfection cases were reviewed and the relevant data were extracted, including the baseline characteristics of patients, the results of antibody tests, and the whole-genome sequencing results of the viral strains. Results: We reviewed 29 reinfection cases in 20 reports from 14 countries. The age of re-infected patients ranged from 21 to 90 years (median 53 years), and there was no significant difference in gender distribution. Among the 29 patients, 11 were health care workers, 6 received immunosuppressive drugs (including glucocorticoids), 17 presented more severe symptoms than their primary infections and 5 (all aged over 80 years) died. The interval of the two infections was usually less than 60 days when the patients were infected by the same viral strain,while the interval was much longer (median 78.5 days) when the patients were infected by different viral strains. Nine patients had negative antibody test results or low antibody titers when the reinfections were confirmed, and 5 of them had negative antibody test results even during the initial infection. Conclusions: Virus-specific antibodies had a protective effect against COVID-19 reinfection for the majority of the population, however, this effect may decrease over time. Occupational exposure, low levels of antibodies, or an inability to produce antibodies may be the main risk factors for reinfection. Advanced age was a major risk factor for a poor prognosis. Effective personal prevention and social distancing were still essential for the prevention of reinfection.

At the end of 2019, sporadic and clustered case with "pneumonia of unknown origin" emerged in Wuhan, Hubei province. The causative pathogen was quickly confirmed as "2019-nCoV" . The epidemic soon spread throughout the country and became a pandemic in over a month. Government and medical institutions across the country mobilized all kinds of resources and took a variety of measures to actively treat patients and stop the epidemic. Based on current studies, the author summarized the clinical characteristics and evolution of the novel viral pneumonia, and proposed the key points of diagnosis and treatment, the scientific management of both confirmed and suspected cases, and the scientific management of disease prevention and control.

At the end of 2019, sporadic and clustered case with "pneumonia of unknown origin" emerged in Wuhan, Hubei province. The causative pathogen was quickly confirmed as "2019-nCoV" . The epidemic soon spread throughout the country and became a pandemic in over a month. Government and medical institutions across the country mobilized all kinds of resources and took a variety of measures to actively treat patients and stop the epidemic. Based on current studies, the author summarized the clinical characteristics and evolution of the novel viral pneumonia, and proposed the key points of diagnosis and treatment, the scientific management of both confirmed and suspected cases, and the scientific management of disease prevention and control.

Objective: To better understand the clinical features of human adenovirus type 7 (hAdV7) pneumonia and to identify whether there is a variation in the genome of the strain (CHN/BeiJing/2018) isolated during the small-scale epidemic. Method: Forty-two patients were diagnosed with hAdV7 pneumonia between October 27th, 2017 and February 28th, 2018. They were all males with an average age of (21±2) years. Demographic and clinical data were reviewed and analyzed in detail. The nucleic acid of the epidemic strain was extracted from a bronchoalveolar lavage fluid sample. Whole genome sequencing (WGS) was then performed and sequences were compared with other hAdV7 strains distributed globally. Phylogenetic tree analysis was conducted based on whole genome sequences of the epidemic strain. Results: Thirty-eight cases with hAdV7 pneumonia presented with influenza-like symptoms (90.5%) at the onset and 36 cases developed fever (85.7%), followed by cough (97.6%), expectoration (90.5%) and chest pain (28.6%). Five cases presented with tonsillitis(11.9%) and 4 had transient hemoptysis (9.5%), while 3 patients reported dyspnea (7.1%). Moist rales were only heard in 3 patients (7.1%). Notably elevated creatine kinase (CK) concentrations were observed in 8 patients (19.1%), but all returned to normal after treatment. Four cases developed hypoxemia (9.5%), but none of them progressed to respiratory failure or acute respiratory distress syndrome (ARDS). Chest CT imaging showed bilateral patchy parenchymal opacities with a random distribution with or without consolidation. Ten patients were co-infected with influenza virus (23.8%), while 32 patients developed atypical pneumonia (76.2%). Genomic analysis revealed that the strain isolated during this epidemic was 99% similar to the known hAdV7 strains (19BOVLB/Volgograd/Rus/2014 and 0901HZ/ShX/CHN/2009). Phylogenetic tree analysis suggested that the strain was closely related to the hAdV7 strain isolated in Jingmen China in 2012. Conclusions: Cases with hAdV7 pneumonia were generally mild. Symptomatic treatment was sufficient for a favorable prognosis. A good genome stability of the hAdV7 strain was observed, indicating that hAdV7 could remain stable for a long period and cause continuing sporadic cases and clusters.

Objectives: To summarize the computed tomography angiography(CTA) features of Dieulafoy disease of the bronchus. Methods: The clinical, imaging and pathological data of Dieulafoy disease of the bronchus diagnosed in our hospital from July 4, 2010 to June 20, 2016 were retrospectively analyzed, and the CTA imaging features of the abnormal bronchial arteries were summarized. Results: There were 6 cases of bronchial Dieulafoy disease, 5 males and 1 female, with an average age of (55±15) years. Three cases had smoking history, and 2 cases had underlying diseases such as tuberculosis and acute myeloid leukemia. The common manifestations were hemoptysis, fever and pneumonia. Three patients got CTA examination, and bronchial arteries of Dieulafoy disease of the bronchus were circuitous and dilated, with the vascular diameter lager than 2 mm, no gradual narrowing but sudden truncation. Some circuitous vessels went into bronchial lumen as nodules. The bronchoscopy biopsy of 2 cases of bronchial nodules led to severe hemorrhage, with one death and one survival by successful management. Conclusions: Bronchial arteries of Dieulafoy disease of the bronchus were circuitous and dilated, and some circuitous vessels went into bronchial lumen as nodules, this demonstration can be used to diagnose Dieulafoy disease of the bronchus. For patients with hemoptysis, bronchial biopsy should only be performed after CTA examination if this disease is suspected.

Objective: To investigate the differential diagnosis between pulmonary metastases from soft-tissue angiosarcoma and primary pulmonary angiosarcoma. Methods: A case of soft-tissue angiosarcoma with pulmonary metastases was reported and related literatures were reviewed. Results: A 39 year-old man complaining of hemoptysis, cough, and sputum for 10 months was admitted to our hospital in September 2013. He was initially diagnosed as having primary pulmonary angiosarcoma after wedge-resection biopsy of the lung. After 22 months since onset, he felt discomfort in his leg, which led to the confirmative diagnosis of soft-tissue angiosarcoma of the leg with multiple pulmonary metastases by a full-body PET/CT scan and core needle biopsy of the leg. Twenty-three articles concerning primary pulmonary angiosarcoma with complete records of history, treatment and follow-up of patients were included in the literature review. A total of 26 patients were reported in these articles, including 18 males, 8 females, age 19-85 years, average (52±18) years. Primary pulmonary angiosarcoma was mainly manifested as single or multiple pulmonary nodules or masses, with or without ground glass opacity. In our case, chest CT showed multiple thin-wall cysts and ground glass opacities, and recurrent spontaneous pneumothorax, which had never been reported in literatures on primary pulmonary angiosarcoma. Conclusions: Pulmonary metastases from soft-tissue angiosarcoma differed from primary pulmonary lesions in terms of chest imaging, with the former usually showing thin-wall cysts and pneumothorax. A full-body PET-CT was essential for differential diagnosis between primary and metastatic pulmonary angiosarcoma.

Objective: To seek risk factors of VTE in patients with lung cancer through analysis of clinical features of patients with lung cancer complicated with venous thromboembolism (VTE)., Methods: Retrospective investigation was performed on patients diagnosed with lung cancer and with complete clinical data who were hospitalized in Peking University People's Hospital from January 1, 2010 to December 31, 2014. According to the presence of symptomatic VTE, patients were distributed into two groups, VTE group and control group. Patients' clinical data and laboratory parameters were collected. Single factor analysis was applied to compare the differences between the two groups. t test or nonparametric test was applied for intragroup comparison of measurement data, and chi-square test was applied for the comparison of counting information. Logistic regression analysis was applied to explore risk factors of venous thromboembolism. For VTE patients with this diagnosis when they were hospitalized, D-dimer and PT were obtained after the occurrence of VTE, so D-dimer and PT were eliminated in the multiple factors analysis. SPSS 13.0 statistical software was applied for statistical management and analysis., Results: 548 patients with lung cancer were include in the investigation, with male 357, female 191, average age of (63.8±10.9) years old, 46 patients in VTE group and 502 patinets in control group. According to the results of single factor analysis in gender, age, tumor pathologic type, tumor stage, WBC, Hb, PLT, CEA, ALT, FIB, D-dimer, PT, APTT, PT-INR, the tumor stage (χ(2)=14.177), CEA (t=2.129) and Hb (t=-2.424) were risk factors for lung cancer patients complicated with venous thromboembolism. Logistic regression analysis showed that tumor stage was the independent risk factor of lung cancer complicated with venous thromboembolism (OR 2.058, 95%CI 1.307-3.238, P=0.002) , and CEA (r=0.395, P<0.001) and Hb (r=-0.144, P=0.001) were associated with lung cancer stage. The area under the curve formed by D-dimer predicting VTE was 0.825 (95%CI 0.751-0.900, P<0.001)., Conclusion: Tumor stage is the only risk factor for lung cancer patients complicated with venous thromboembolism in the study. However, because this study is a retrospective study, other potential high risk factors causing VTE cannot be excluded.

Objective: To analyze the characteristics of pulmonary function and the clinical significance of non-specific pattern (NSP)., Methods: A total of 1933 pulmonary function tests of adult patients were analyzed, and those with NSP were selected. The pulmonary function test results, clinical diagnosis and radiological manifestations were analyzed. Normal distribution data were compared by t test, while non-normal distribution data were compared by Mann-Whitney U test, and χ(2) test was used to compare ratios., Results: There were 61 patients in the NSP group and 1017 in the control group. The BMI of the 2 groups was (24.5 ± 4.6) and (24.5 ± 3.8) kg/m(2), respectively, being not significantly different (t = 0.008, P > 0.05). The age was 64 (49-74) years and 56 (42-70) years, and the smoking index was 0.4 (0-20) and 0 (0-10), respectively, showing no significant differences (Z values were -2.209 and -2.571, respectively, all P < 0.05). In the NSP group, FEV1 was 69% (66%-73%) predicted, FVC 75% (70%-77%) predicted, FEV1/FVC 75% (73%-78%), RV 118% (105%-145%) predicted, and TLC 86% (82%- 93%) predicted, which were significantly different as compared to those of the control group [95% (87%-104%), 98% (90%-106%), 79% (76%-84%), 101% (88%-114%) and 94% (88%-102%), respectively],(Z values are -13.059--5.185, all P < 0.05). RV/TLC was (52 ± 11)% in the NSP group and (39 ± 9)% in the control group, the difference being significant (t = -10.351, P < 0.05). The decreased TLC indicated restricted ventilation, while the increased RV and RV/TLC indicated air trapping. The clinical diagnosis of NSP included obstructive and restrictive diseases, some of which showed severe radiological abnormalities, but there were 31 patients without pulmonary lesions., Conclusions: Age and smoking, but not obesity, may play a role in NSP.NSP has characteristics of obstructive and restrictive ventilation defects, but does not associate with particular diseases, thus having limited clinical significance.

Objective: To validate the authenticity of the cases diagnosed as pulmonary Lophomonas blattarum infection in literatures and Lophomonas blattarum as a kind of pathogen resulting in pulmonary infection., Methods: From June 2012 to May 2013, mobile cells with cilia at the anterior end of the cells were observed in BALF from 6 patients with pulmonary disease in our hospital. Morphological feature and ultrastructure of the cells were further investigated by optical microscope and electron microscope to determine the type of the cells referring to literature-published photos of Lophomonas blattarum. Literatures about Lophomonas blattarum infection were searched with keyword Lophomonas blattarum from Wanfang Data, China National Knowledge Infrastructure (CNKI) and PubMed. Diagnostic methods and figures provided by the literature were carefully reviewed, and the accuracy of diagnosis of pulmonary Lophomonas blattarum was identified., Results: Mobile cells found in BALF from the 6 patients in our hospital had the morphological features of bronchial ciliate epithelial cells. A nucleus far from the cilia was observed in the middle or at the bottom of the cytoplasm, and these cells did not display the characteristic cytological structures of Lophomonas blattarum: calyx, perinuclear tubules and axial filament. Diagnosis of pulmonary Lophomonas blattarum reported in literatures so far were all based on the morphological features of mobile cells with a cluster of flagellate at anterior end of the cell by optical microscopy. None of the authors did further exploration on the ultrastructure of such a kind of cells and compared with features of Lophomonas blattarum described in the literature. All the active cells reported in literatures had the identical morphological features to those found in our investigation., Conclusion: In the past 20 years, all the diagnosed cases as pulmonary Lophomonas blattarum infection reported in our country were misdiagnosed. Currently, there is no evidence to show Lophomonas blattarum as a pathogen resulting in pulmonary infection.

Objectives: To improve the understanding of bronchial Dieulafoy disease by summarizing the clinical and literature reported cases., Methods: The clinical data of 3 patients with bronchial Dieulafoy disease diagnosed by pathology from January 1, 2007 to May 31, 2012 in our hospital was collected and summarized. The data of 19 cases from literature case report regarding bronchial Dieulafoy disease both in Chinese and English were also reviewed through databases including Wanfang Data, National Knowledge Infrastructure, National Center for Biotechnology Information and Ovid Technologics from January 1, 2005 to May 31, 2012. The clinical characteristics, diagnosis and treatment of all the 22 cases were summarized and analyzed., Results: The average age of the 22 cases with bronchial Dieulafoy disease was (47 ± 15) years, and the preponderance was in male adults (16/22). Right lung (16/22) was more commonly involved than the left lung (4/22), and rarely in both lungs (2/22). Eight cases had smoking history, and 10 cases had underlying diseases such as tuberculosis.Sudden onset of massive hemoptysis was a common manifestation. Massive or lethal hemorrhage was often caused by biopsy injury. The abnormality of bronchial Dieulafoy disease was usually demonstrated as nodular lesions within the lumen of the bronchus.However, It was unable to determine their originating of the anomalous arteries in half of the cases(11/22). Most anomalous arteries confirmed by pathology were branched from bronchial artery (9/22), and rarely from pulmonary artery (2/22). The definitive diagnosis was made by pathological examination.Selective bronchial artery embolization and pulmonary lobectomy were the major therapeutic strategies, but bleeding may relapse after bronchial artery embolization, and lobectomy of the lung was a cure approach., Conclusions: Bronchial Dieulafoy disease should be differentiated in patients with massive and unexplained hemoptysis.It takes a very high risk for biopsy, which rarely needs to be implemented. Bronchial arteriography and selective bronchial artery embolization should be promptly carried out to avoid life-threatening hemoptysis.Lobectomy could be an alternative choice for a cure.

Objective: To evaluate the diagnostic value of granulocyte-macrophage colony stimulating factor (GM-CSF) antibody in serum for pulmonary alveolar proteinosis (PAP)., Methods: Twelve PAP patients visiting Peking University People's Hospital or Fujian Provincial Hospital from January 1, 2002 to December 31, 2012, 25 patients with other pulmonary diseases (disease control), and 25 healthy volunteers (healthy control) were recruited in the study. The titer level of GM-CSF antibody in serum was determined with enzyme-linked immunosorbent assay (ELISA), and the clinical characteristics were collected in the PAP patients., Results: The geometric mean titers of GM-CSF antibody in the PAP patients, the disease controls and the healthy controls were 1: 25 349, 1: 311 and 1: 256, respectively. The differences between the disease controls and the healthy controls were of no statistic significance (t = -1.14, P = 0.261) . With 3 times standard error (3s) above the mean value as the higher limit of X value(X = lgT, T standing for the reciprocal of the titer), the upper limit for T was 1698. With the T value ≥ 1698 as the diagnostic threshold for PAP, both the sensitivity and the specificity were 100%. The diagnostic value of GM-CSF antibody was similar to that of surgical lung biopsy and higher than that of transbronchial lung biopsy., Conclusion: The detection of serum GM-CSF is non-invasive, convenient and efficient for the diagnosis of PAP with high sensitivity and specificity.

Objective: To assess the clinical characteristics of heart failure and respiratory failure in patients with sleep disordered breathing (SDB)., Methods: Symptoms, signs, laboratory tests, clinical courses, blood gases responses to voluntary hyperventilation test and non-invasive ventilation treatment were analyzed in 29 patients with SDB. All patients were diagnosed as right and left heart failure and respiratory failure from 1994 to 2009 in Peking University People's Hospital., Results: Among the 29 patients recruited, 13 were male and 16 female. The mean age was 62 ± 13 yrs, and BMI was (34 ± 4) kg/m(2). Fourteen (48.3%) were diagnosed as obstructive sleep apnea syndrome at first visit. Chief complains includes dyspnea, edema, cough, snoring, hypersomnolence, oliguria, and altered mental status. Common signs include obesity, narrow upper airway, cyanosis, moist rales at the base of lungs, enlarged border of cardiac dullness, edema. Polycythemia was seen in 13 patients (44.80%), among the 26 patients who had underwent pulmonary function tests, 14 had FEV(1)/FVC ≥ 70%, the others were FEV(1)/FVC < 70%, with 6 patients had 50% predict value ≤ FEV(1) < 80% predict value and 6 patients had 30% predict value ≤ FEV(1) < 50% predict value. After positive airway pressure (BiPAP and CPAP) treatment, symptoms and arterial blood gases test results improved. Chest X-ray, CT scan and UCG show pulmonary vascular congestion and edema with cardiomegaly and possible pleural effusion, pulmonary hypertension, left ventricular diastolic dysfunction. Five patients underwent 24 h blood pressure monitoring showed non-dipping pattern or morning risen pattern of BP. In 11 patients who undertaken the test, voluntary hyperventilation induced significant improvement of SpO(2), PaCO(2) and PaO(2), and most of the parameters returned from type II respiratory failure to normal level., Conclusion: The morbidity of SDB remained to be recognized. This cases report indicated that obese patients complaining of severe dyspnea and edema may have respiratory failure and bilateral heart failure secondary to SDB. The respiratory failure can be completely reversed by voluntary hyperventilation, and noninvasive treatments only could achieve good outcomes in most of the patients.

Objective: To investigate the current status of atypical pathogen associated infections in community-acquired pneumonia (CAP) in adults, and their clinical attributes., Methods: Clinical data, sputum specimens from acute phase, and paired sera from acute- and convalescent-phases of CAP in 153 adult patients were collected from May 2005 to May 2008 in multiple medical centers. Chlamydia pneumoniae (Cpn) IgG antibody, and Legionella pneumophila (LP) mixed IgG, IgA and IgM antibodies were determined by indirect immuno-fluorescent assay. Mycoplasma pneumoniae (Mpn) mixed IgG, IgA and IgM antibodies were determined by passive agglutination assay. All the sputum specimens were routinely cultured for bacterial isolation., Results: Fifty-two (34%) out of the 153 cases were diagnosed as atypical CAP per the paired serum-antibody assay. Forty-seven of the 52 atypical CAP cases were infected by one atypical pathogen, 38 with Cpn, 4 with Mpn, and 5 with LP, while 5 out of the 52 atypical CAP cases were infected by 2 pathogens, Cpn and Mpnin 2, Cpn and LP in 3 cases. Eleven cases (21.2%) out of the 52 patients with atypical pneumonia were complicated with bacterial infection. Except peripheral white blood count was significant increased in the group of typical (bacterial only) pneumonia (WBC > 10 × 10⁹)/L, P = 0.03), all the other clinical parameters did not show statistically significant difference between the typical and the atypical pneumonia groups., Conclusions: Our data suggest that Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila are common pathogens of adult CAP. Chlamydia pneumoniae might be the most frequent atypical pathogen associated with atypical CAP.

Objective: Food-dependent exercise-induced anaphylaxis (FDEIA) is a kind of food allergic disorder induced by physical exercise. Some FDEIA patients presented severe symptoms which were threat to life. The aim of the article was to improve the recognition of FDEIA among physicians., Methods: The clinical data of a patient with FDEIA in our hospital was collected and analyzed, and current related literatures were reviewed., Results: An eighteen year-old male was admitted to our hospital because of repeated episodes of urticaria, dyspnea and loss of consciousness for eight months. Each episode was induced by exercise after ingestion of wheat-made food. Symptoms were relieved rapidly by treatment with adrenaline, antihistamines, and/or dexamethasone. Assay of food-specific IgE in serum of the patient showed positive result for shrimp and crab. However, no anaphylaxis was related to the suspected food. Wheat-exercise challenge test showed positive result in the patient, which confirmed the diagnosis of FDEIA. Since then, the patient had avoided wheat food for more than one year, during which period no episode of anaphylaxis was observed, until one day the patient exercised after a diet of wheat food., Conclusions: The incidence of FDEIA was rare. Wheat is the common causative food. Food-exercise challenge test is a reliable method for diagnosis of FDEIA. Avoidance of exercise for 4h after eating causative food might be helpful to prevent the occurrence of symptoms in many FDEIA cases. Dietary elimination of causative food ingredients was a reliable method for prophylaxis of FDEIA.

Objective: To investigate the relationship between clinical features of patients with A/H5N1 infection and their prognosis in mainland China., Methods: This study included 28 human cases with A/H5N1 infection in mainland China from October 2005 to May 2008. Data were collected and reviewed from hospital medical records and publishied papers. A database was built by EPIDATA 3.02 and statistical analyses were performed with SPSS 13.0., Results: The median age of the 28 cases was 29 years (range 6-62), and 15 were females. Ten patients survived, and 18 died. The typically clinical manifestations of human influenza A/H5N1 infection included fever and lower respiratory infection. The numbers of peripheral white blood cells, lymphocytes and platelets in the survival and non-survival groups were (4.01 +/- 1.86) x 10(9)/L vs (5.1 +/- 2.9) x 10(9)/L, (1.09 +/- 0.49) x 10(9)/L vs (0.98 +/- 0.44) x 10(9)/L, and (116 +/- 39) x 10(9)/L vs (101 +/- 40) x 10(9)/L, respectively; the differences were not statistically significant between the 2 groups (P>0.05). There was also no statistically significant difference in the increased serum enzymes, such as aspartate aminotransferase [(173 +/- 246) U/L vs (272 +/- 263) U/L], lactate dehydrogenase [(1016 +/- 568) U/L vs (1512 +/- 1052) U/L], creatine kinase [(1099 +/- 1590) U/L vs (2534 +/- 4281) U/L] and MB isoenzyme of creatine kinase [(28 +/- 30) U/L vs (125 +/- 197) U/L] (P>0.05) between the survival and the non-survival groups. However, there was a statistically significant difference in the number of patients with an initial LDH level more than 8 fold of the normal value between the survival and the non-survival groups (none vs 6, P<0.05). All of the 28 cases developed bilateral multiple infiltrates and consolidation in chest radiographs. Acute respiratory distress syndrome occurred in 22 cases, 17 of them died. All the 9 patients with acute kidney injury died. Ten patients received antiviral treatment with oseltamivir, and 6 of them survived. There was a statistical difference in the time of initiating oseltamivir treatment between the survival and the non-survival cases [(6.5 +/- 3.0) d vs (11.8 +/- 3.3) d, Z = 3.70, P<0.05]. Broad spectrum antibiotics and corticosteroids were administered in all of the 28 cases. There was no statistical difference between the survival and the non-survival groups regarding to the corticosteroid treatment (P>0.05)., Conclusions: Initial LDH level reaching more than 8 fold of the normal value suggests a poor prognosis for human H5N1 infection. Patients complicated with either ARDS or acute kidney injury had a higher risk of death. Early administration of effective antiviral agents might improve the prognosis and decrease case fatality.

Objective: To explore the optimized clinical management and therapeutic strategies for the survived human case infected by influenza A (A/H5N1)., Methods: All the data of the first human case infected by A/H5N1 in Guizhou province was collected and analyzed., Results: The first case infected by A/H5N1 in Guizhou Province was confirmed by laboratory findings with reverse-transcription polymerase chain reaction (RT-PCR) and A/H5N1 isolation. Patient was healthy in the past and exposed in the environment of living poultry. The initial symptoms was high fever without influenza-like presentation, but with extremity hyperspasmia and conscious disturbance sometimes. A productive cough with a large mount of pink foaming sputum then appeared. The clinical situation was rapidly deteriorated with dyspnea, acute respiratory distress syndrome and atrial fibrillation. Multiple infiltration in bilateral lungs was progressively developed with moderate bilateral pleural effusion. Invasive ventilation was intervened since ARDS on day 8 after sickness. Oseltamivir was kicked off since day 9 after sickness. However, the clinical condition was still exacerbated. High titering antibody of A/H5N1 vaccinated plasma was administrated on day 10 after sickness. The clinical condition (including oxygen saturation, respiratory symptoms, etc.) was improved rapidly. The weaning of ventilation was carried out in two days. Atrial fibrillation was back to normal. The patient was clinical recovery and was discharged from hospital on day 23 after sickness., Conclusions: The prognosis was poor if A/H5N1 infected human cases developed as acute respiratory distress syndrome with heart injury. However, it could be ameliorated if the plasma of A/H5N1 vaccinated neutralizing antibody was administrated in time or within two weeks after sickness.

Objective: To describe the clinical, laboratory and radiological presentation of a human case infected by influenza A (H5N1), and to understand its management and prognosis., Methods: The clinical and autopsy data of the first human case infected by influenza A (H5N1) in Jiangxi Province were collected and analyzed., Results: The first case infected by influenza A (H5N1) in Jiangxi Province was confirmed by laboratory findings with reverse transcription-polymerase chain reaction (RT-PCR) and influenza A (H5N1) isolation. The patient had been healthy in the past and exposed to the environment of bird flu before illness. The initial symptoms included high fever with influenza-like symptoms, and then cough and purulent sputum mixed with blood appeared. The clinical situation deteriorated progressively with occurrence of diarrhea and dyspnea. Laboratory abnormalities included decrease of peripheral white blood cells and lymphocytes, urine protein, dramatic increase of enzymes associated with hepatic injury and myocarditis and decrease of serum albumin. Six days later, penicillin-resistant streptococcus pneumoniae was isolated from multiple sputum cultures. With the deterioration of clinical situation, several other bacteria and fungi were found in sputum culture. Pulmonary infiltrates were evident in right middle and lower lobe at day 5 after illness, and rapidly progressed to involve bilateral lungs as acute respiratory distress syndrome (ARDS)-like changes. The patient was treated with antiviral, antibacterial, and antifungal reagents, and corticosteroids and invasive mechanical ventilation were also administered, but without any improvement. The patient died 27 days after the onset of symptoms and an autopsy was performed. Pathologically, the lungs exhibited diffuse alveolar damage. The lymphocytes in the spleen, the lymph nodes and the tonsils were depleted prominently with histiocytic hyperplasia and hemophagocytic phenomena. Edema and degeneration of myocytes in the heart and extensive acute tubular necrosis in the kidney were observed., Conclusion: The prognosis was very poor if influenza A (H5N1) infected human cases was developed as ARDS with multiple organ damage or failure.

Objective: To investigate adenoviral vector mediated murine interferon-gamma (mIFN-gamma) transgene expression and its effect on allergen-induced airway inflammation and multiple interleukin (IL) cytokines (IL-4, IL-5, IL-6, IL-10, IL-12, IL-13 and IL-18) expression in a murine allergic model., Methods: Forty-eight mice were divided into 7 groups by random digits table: a negative control group (A), allergic model groups I, II, III (B, D, F), gene therapy groups I, II, III (C, E, G). Except for group A, mice of the other groups were peritoneally sensitized with ovalbumin (OVA, 15 microg/mouse) twice on day 0 and day 5, and challenged by inhalation of 0.5% OVA (20 ml per time) twice per day from day 12 to 14. On day 15, AdCMVmIFN-gamma (5 x 10(9) PFU/mouse) solution 50 microl was administrated by nasal drip in groups C, E and G. For groups A, B, D and F, 0.9% NaCl 50 microl was administrated by nasal drip. Groups A, B and C were sacrificed on day 18. Groups D and E were sacrificed on day 21. Groups F and G were sacrificed on day 25. The concentration of mIFN-gamma in bronchioalveolar lavage (BALF) was measured by enzyme-linked immunosorbant assay. Accumulation of inflammatory cells and eosinophils (EOS) were quantified by cell count and histopathological analysis. Multi-cytokine expression was tested by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR)., Results: (1) mIFN-gamma was efficiently expressed after gene therapy. The concentration of mIFN-gamma in BALF was (729.0 +/- 104.7) pg/ml 3 days after gene therapy (group C); it was (984.5 +/- 119.1) pg/ml after 6 days (group E); and (310.6 +/- 59.7) pg/ml after 10 days (group G). (2) The total cell number in BALF of group B and C was (318 +/- 41) x 10(3)/ml and (137 +/- 12) x 10(3)/ml, respectively (P < 0.01); the constituent ratio of EOS in BALF was 0.715 +/- 0.054 and 0.452 +/- 0.016, respectively (P < 0.01). The total cell number in BALF of group D and E was (183 +/- 23) x 10(3)/ml and (92 +/- 6) x 10(3)/ml, respectively (P < 0.01); the constituent ratio of EOS was 0.393 +/- 0.065 and 0.083 +/- 0.038, respectively (P < 0.01). The total cell number in BALF of groups F and G was (196 +/- 7) x 10(3)/ml and (98 +/- 15) x 10(3)/ml, respectively (P < 0.01); the constituent ratio of EOS was 0.253 +/- 0.035 and 0.068 +/- 0.025, respectively (P < 0.01). (3) The histopathological results showed that in the gene therapy groups, the infiltration of inflammatory cells was markedly reduced and the damage of airway epithelium was alleviated. (4) For group D and E, the ratio of IL-10 mRNA abundance to that of home gene was 0.14 +/- 0.10 and 0.49 +/- 0.27, respectively (P < 0.01); that of IL-12 was 0.15 +/- 0.05 and 0.63 +/- 0.17, respectively (P < 0.01); that of IL-13 was 0.76 +/- 0.17 and 0.37 +/- 0.10, respectively (P < 0.01). For group F and G, the ratio of IL-10 mRNA abundance to that of home gene was 0.13 +/- 0.04 and 0.27 +/- 0.17, respectively (P = 0.019); that of IL-12 was 0.14 +/- 0.05 and 0.35 +/- 0.21, respectively (P = 0.006); that of IL-13 was 0.57 +/- 0.24 and 0.30 +/- 0.09, respectively (P = 0.003). However, there were no statistically significant changes in IL-4, IL-5, IL-6, and IL-18 in lung tissue between allergic model groups (B, D, F) and gene therapy groups (C, E, G, P > 0.05)., Conclusions: (1) mIFN-gamma gene transferred via adenoviral vector could abrogate the infiltration of EOS in OVA-induced allergic model. (2) The molecular mechanisms for effect by AdCMVmIFN-gamma transgenic therapy on murine allergic model involve the indirect action by the upregulation of IL-10 and IL-12 expression and the downregulation of IL-13 expression locally in the lungs, in addition to the direct effects of locally overexpressed mIFN-gamma.

Objective: To summarize and analyze the clinical manifestation of the first case of severe acute respiratory syndrome (SARS) in Beijing in 2004, and therefore providing clues of differential diagnosis for physicians to diagnose SARS cases in a timely manner and find out its transmission., Methods: The clinical data of an out-hospital-imported SARS case and its clinical features were analyzed., Results: (1) The delay in diagnosis of this SARS case was largely associated with unclear epidemiologic history; (2) The SARS patient showed characteristics of typical pneumonia in the early stage. The numbers of peripheral white blood cells and lymphocytes were in the normal range without any specific changes typical of SARS., Conclusion: It is very important for physicians to be alert to the epidemiological data for an early diagnosis of SARS, and therefore early isolation and initiation of appropriate treatment.

Objective: To describe the blood gas features and short-term outcomes of noninvasive positive pressure ventilation (NPPV) treatment for acute respiratory failure (ARF) in patients with severe acute respiratory syndrome (SARS) in this retrospective case series study sought., Methods: Between April 22 and May 1, 2003, 120 clinically compatible SARS patients were admitted to a special hospital for infectious diseases in Beijing. All patients' records were reviewed. The outcome variables of NPPV therapy were analyzed., Results: At 6 weeks of SARS onset, 25% (30/120) patients had respiratory failure with ALI/ARDS. 16 (53%) had hypercapnia (PaCO(2) > 45 mm Hg) during the course of SARS. 28 of them received NPPV therapy. One was intolerable to NPPV treatment. In the remaining 27 patients, NPPV was initiated 1.2 +/- 1.6 (0 - 10) days after onset of respiratory failure. One hour of NPPV therapy led to significant increases in PaO(2), SpO(2) and PaO(2)/FiO(2), and decrease in respiratory rate (all P < 0.01). 18 of the 27 patients were weaned successfully from NPPV. The mean duration of NPPV use was 10 +/- 6 (5 - 30) days. In addition to one patient who was intolerable to NPPV treatment, intubation was required in other 9 patients who initially had a favorable response to NPPV. Remarkable pulmonary barotrauma was noted in 7 of the 120 (5.8%) patients with SARS, among which 1 developed 2 days after intubation, and 6 occurred while the patients were on NPPV, the incidence being 22% (6/27) in patients using NPPV. The fatality rate at 13 weeks of SARS onset was 6.7% (8/120) in the patient cohort, and 26.7% (8/30) in the ALI/ARDS patients. No SARS occurred in medical staff taking care of NPPV patients., Conclusions: Some of the SARS patients with ALI/ARDS could experience CO(2) retention, which might be related to the impairment of respiratory muscles. It is proved to be feasible and appropriate for NPPV treatment of respiratory failure in SARS patients who were at high risk of intubation related complications. As there was a high incidence of remarkable barotrauma, a careful lung protective strategy is necessary during the administration of NPPV as well as invasive mechanical ventilation.

Objective: To investigate the diagnostic value of interferon-gamma (IFN-gamma), interleukin-12 (IL-12) and adenosine deaminase isoenzymes (ADA(2)) in tuberculous pleural effusions., Methods: One hundred and ninety specimens of pleural effusion were collected from 190 patients with pleural effusion in Peking University People's Hospital, Beijing Chest Hospital, and Beijing Tuberculosis and Thoracic Tumor Institute, from March 2002 to February 2003. Of them 141 pleural specimens were diagnosed as tuberculous, and 49 as malignant. IFN-gamma and IL-12 concentrations and ADA isoenzyme activity in all the specimens were determined by ELISA and enzyme kinetic analytical method respectively., Results: (1) ADA(2) activity (47.9 +/- 6.9) U/L in tuberculous effusions was significantly higher than that in malignant effusion (13.2 +/- 3.2) U/L (P < 0.01). The IFN-gamma level (112.1 +/- 45.8) ng/L in tuberculous effusion was significantly higher than that in malignant diseases (24.8 +/- 5.9) ng/L (P < 0.01). The IL-12 level (104.3 +/- 32.3) ng/L in tuberculous effusions was significantly higher than that in malignant diseases (61.8 +/- 10.8) ng/L (P < 0.05). (2) By analysis of ROC curves, the cut-off values for IFN-gamma, IL-12 and ADA(2) were defined. The sensitivity and specificity of IFN-gamma for tuberculous effusion were 84.4% and 95.9% respectively. Those of IL-12 for tuberculous effusion were 85.1% and 65.3% respectively, while those of ADA(2) were 84.4% and 91.8%., Conclusions: IFN-gamma and IL-12 could be used as valuable parameters for the differentiation of tuberculous effusion from malignant, and IFN-gamma was more sensitive and specific for tuberculous effusion than IL-12 and ADA(2).

Objective: To investigate the effect of murine interferon-gamma (IFN-gamma) transgene expression on bleomycin-induced pulmonary fibrosis in mice., Methods: 6 - 8 week aged pathogen-free male ICR mice were treated with bleomycin (3 mg/kg weight in 70 micro l) by intranasal instillation on day 0 in the model group. Adenoviral vector with murine IFN-gamma cDNA (AdCMVmIFN-gamma) 5 x 10(8) plague forming unit (pfu) was administrated via nastril instillation 48 h before bleomycin treatment in the preventive therapeutic group, but 72 h after bleomycin treatment in the therapeutic group. Mice treated with a same volume of normal saline (NS) and a same dosage of sham recombinant adenoviruses (AdCMVNull) served as controls. The animals were weighted on day 0, 7, 14, and sacrificed on day 14. Bronchial alveolar lavage fluid (BALF) and lungs were recovered. The right lung was stained with either hematoxylin-eosin or masson. The left lung was weighted, and its content of hydroxyproline (HYP) was measured by HCl acid hydrosis method. The IFN-gamma concentration in BALF was determined with enzyme-linked immunosorbent assay., Results: The concentrations of IFN-gamma in BALF from the AdCMVmIFN-gamma treated groups were remarkably increased, (21,250 +/- 6,497) pg/ml and (21,000 +/- 5,451) pg/ml in the IFN-gamma transgenetic preventive therapeutic group and the therapeutic group respectively. IFN-gamma was undetectable in BALF from other groups. Mice in the two groups treated with AdCMVmIFN-gamma had statistically significant weight loss (P < 0.05), higher HYP content (P < 0.05), and tended to have more severe alveolitis and pulmonary fibrosis (P = 0.07) as compared with those in other groups., Conclusions: (1) mIFN-gamma could be overexpressed in airway and alveolar epithelium by locally administrated AdCMVmIFN-gamma. (2) Early mIFN-gamma transgene expression via adenoviral vector in this bleomycin model aggravated alveolitis and fibrosis to some degree.