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Exacerbations are crucial events during bronchiectasis progression.To explore the associations between bacterial, viral, and bacterial plus viral isolations and bronchiectasis exacerbations.In this prospective study, we enrolled 108 patients who were followed up every 3-6 months and at onset of exacerbations between March 2017 and November 2018. Spontaneous sputum was split for detection of bacteria (routine culture) and viruses (quantitative polymerase chain reaction). Symptoms and lung function were assessed during exacerbations.The median exacerbation rate was 2.0 (interquartile range: 1.0-2.5) per patient-year. At any visit, viral isolations (V+) occurred more frequently during onset of exacerbations [odds ratio (OR): 3.28, 95% confidence interval (95%CI): 1.76-6.12], as did isolation of new bacteria (NB+) (OR: 2.52, 95%CI: 1.35-4.71) and bacterial plus viral isolations (OR: 2.24, 95%CI: 1.11-4.55). Whilst coryza appeared more common in exacerbations with V+ than in exacerbations with no pathogen isolations and those with NB+, lower airway symptoms were more severe in exacerbations with NB+ (Viral isolations, isolation of new bacteria and bacterial plus viral isolation are associated with bronchiectasis exacerbations. Symptoms at exacerbations might inform clinicians the possible culprit pathogens.Las exacerbaciones son eventos cruciales durante la progresión de la bronquiectasia.Analizar las asociaciones entre el aislamiento de bacterias, virus y virus y bacterias juntas y las exacerbaciones de las bronquiectasias.En este estudio prospectivo se incluyó a 108 pacientes a los que se siguió cada 3-6 meses y al comienzo de las exacerbaciones entre marzo de 2017 y noviembre de 2018. La muestra de esputo espontáneo se dividió para la detección de bacterias (cultivo de rutina) y virus (reacción en cadena de la polimerasa cuantitativa). Se evaluaron los síntomas y la función pulmonar durante las exacerbaciones.La mediana de la tasa de exacerbación fue de 2,0 (rango intercuartil: 1,0-2,5) por paciente/año. En cualquier visita, los aislamientos de virus (V+) tuvieron lugar con mayor frecuencia durante el inicio de las exacerbaciones (Los aislamientos de virus, el aislamiento de nuevas bacterias y el aislamiento de bacterias y virus juntos están asociados a las exacerbaciones de las bronquiectasias. Los síntomas de las exacerbaciones pueden proporcionar información a los médicos sobre los posibles patógenos responsables.

Background Pseudomonas aeruginosa (PA) colonization confers poor prognosis in bronchiectasis. However, the biomarkers and biological pathways underlying these associations are unclear. Objective To identify the roles of PA colonization in bronchiectasis by exploring for sputum exosomal microRNA profiles. Methods We enrolled 98 patients with clinically stable bronchiectasis and 17 healthy subjects. Sputum was split for bacterial culture and exosomal microRNA sequencing, followed by validation with quantitative polymerase chain reaction. Bronchiectasis patients were stratified into PA and non-PA colonization groups based on sputum culture findings. We applied Gene Ontology and Kyoto Encyclopedia of Genes and Genome pathway enrichment analysis to explore biological pathways corresponding to the differentially expressed microRNAs (DEMs) associated with PA colonization. Results Eighty-two bronchiectasis patients and 9 healthy subjects yielded sufficient sputum that passed quality control. We identified 10 overlap DEMs for the comparison between bronchiectasis patients and healthy subjects, and between PA and non-PA colonization group. Both miR-92b-5p and miR-223-3p could discriminate PA colonization (C-statistic >0.60) and independently correlated with PA colonization in multiple linear regression analysis. The differential expression of miR-92b-5p was validated by quantitative polymerase chain reaction (P

Background Epstein-Barr virus (EBV) is implicated in the progression of chronic obstructive pulmonary disease. We aimed to determine whether EBV correlates with bronchiectasis severity, exacerbations, and progression. Methods We collected induced sputum in healthy controls and spontaneous sputum at 3–6-month intervals and onset of exacerbations in bronchiectasis patients between March 2017 and October 2018. EBV DNA was detected with quantitative polymerase chain reaction. Results We collected 442 sputum samples from 108 bronchiectasis patients and 50 induced sputum samples from 50 healthy controls. When stable, bronchiectasis patients yielded higher detection rates of EBV DNA (48.1% vs 20.0%; P = .001), but not viral loads (mean log10 load, 4.45 vs 4.76; P = .266), compared with controls; 64.9% of patients yielded consistent detection status between 2 consecutive stable visits. Neither detection rate (40.8% vs 48.1%; P = .393) nor load (mean log10 load, 4.34 vs 4.45; P = .580) differed between the onset of exacerbations and stable visits, nor between exacerbations and convalescence. Neither detection status nor viral loads correlated with bronchiectasis severity. EBV loads correlated negatively with sputum interleukin-1β (P = .002), CXC motif chemokine-8 (P = .008), and tumor necrosis factor–α levels (P = .005). Patients initially detected with, or repeatedly detected with, EBV DNA had significantly faster lung function decline and shorter time to next exacerbations (both P < .05) than those without. Detection of EBV DNA was unrelated to influenza virus and opportunistic bacteria (all P > .05). The EBV strains detected in bronchiectasis patients were phylogenetically homologous. Conclusions Patients with detection of EBV DNA have a shorter time to bronchiectasis exacerbations. EBV may contribute to bronchiectasis progression., The role of chronic viral infections in bronchiectasis is unclear. In this prospective study, we summarize the association between viral loads or detection rate and the clinical status as well as inflammatory response of bronchiectasis.

Background: Epstein-Barr virus (EBV) is prevalent and has been implicated in chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis. However, the roles of EBV in adults with bronchiectasis are unclear. We aimed to delineate the association between EBV infection and bronchiectasis. Methods: We recruited 108 bronchiectasis patients and 18 healthy controls. We collected sputum for EBV detection during follow-up, with an interval of every 3 to 6 months, and at bronchiectasis exacerbation. Results: We collected 442 sputum specimens from 108 patients. The Bronchiectasis patients yielded significantly higher detection rate of EBV when remaining clinically stable (48.1% vs. 22.2%, P=0.040), but not the load (mean Log10load: 4.47 vs. 5.00, P=0.270), compared with controls. EBV was consistently detected in bronchiectasis, with 71.5% of patients having identical detection status in two consecutive stable visits. There was no substantial difference in detection rate (40.8% vs. 48.1%, P=0.393) and load (mean Log10load: 4.34 vs. 4.47, P=0.270) at exacerbation compared with stable visits. Both EBV detection rate and load varied slightly at different time points throughout the course of exacerbation. Neither the infection status nor the viral load correlated with bronchiectasis severity. EBV load correlated negatively with sputum inflammatory biomarker levels (all P Conclusion: EBV might have partially contributed to the progression of bronchiectasis.

Mammary ductoscopy (MD) is commonly used to detect intraductal lesions associated with nipple discharge. This study investigated the relationships between ductoscopic image-based indicators and breast cancer risk, and developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge. A total of 879 consecutive inpatients (916 breasts) with nipple discharge who underwent selective duct excision for intraductal neoplasms detected by MD from June 2008 to April 2014 were analyzed retrospectively. A nomogram was developed using a multivariate logistic regression model based on data from a training set (687 cases) and validated in an independent validation set (229 cases). A Youden-derived cut-off value was assigned to the nomogram for the diagnosis of breast cancer. Color of discharge, location, appearance, and surface of neoplasm, and morphology of ductal wall were independent predictors for breast cancer in multivariate logistic regression analysis. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.36. Area under the curve values of 0.812 (95 % confidence interval (CI) 0.763-0.860) and 0.738 (95 % CI 0.635-0.841) was obtained in the training and validation sets, respectively. The accuracies of the nomogram for breast cancer diagnosis were 71.2 % in the training set and 75.5 % in the validation set. We developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge based on MD image findings. This model may aid individual risk assessment and guide treatment in clinical practice.

Background Exacerbations are crucial events in the progression of bronchiectasis. Previous studies have documented associations between viral or bacterial infection and bronchiectasis exacerbations, but assays for viral or bacterial infection were conducted separately. No study has yet revealed an association between bacteria and viruses in bronchiectasis exacerbations. Moreover, the clinical correlates of bacterial with or without viral detections are unclear. We sought to explore associations between bacterial infection, viral infection and co-infection, and exacerbation of bronchiectasis. Methods In this prospective cohort study, we enrolled 108 patients from the outpatient clinics of The First Affiliated Hospital of Guangzhou Medical University (Guangzhou, China). The participants were followed up every 3–6 months and at exacerbation episodes, between March, 2017, and November, 2018. Each sputum sample was split into two for detection of bacteria (routine culture) and viruses (quantitative PCR). Clinical characteristics were assessed during exacerbation episodes. Findings The median exacerbation rate was 2·0 (interquartile range 1·0–2·5) per patient per year. Viral infection was correlated with significantly higher risks of exacerbation (29% [22 of 76] of exacerbation episodes; OR 3·28, 95% CI 1·76–6·12) than non-viral infection. Similarly, new occurrence of bacterial infection was correlated with significantly higher risks of exacerbation (eg, Haemophilus influenza was associated with 11% [eight of 26] of exacerbation episodes; 2·52, 1·35–4·71) than no new occurrence of bacterial infection, and likewise co-infection (2·24, 1·11–4·55) than all of the other groups combined. A positive bacterial culture alone was not correlated with exacerbations (p>0·778). Although coryza seemed to be more common in viral exacerbation than in unexplained and new bacterial exacerbation (p=0·053), lower airway symptoms were more severe in new bacterial exacerbation (visual analogue scale for cough, p=0·030; sputum volume, p=0·006; sputum purulence, p=0·025). Airway interleukin-1β levels were consistently higher in new bacterial exacerbation than in unexplained and viral exacerbation (p=0·007). A significantly greater number of coryza was correlated with co-infection at exacerbation (p=0·019). However, co-infection did not differ from bacterial or viral infection alone in lower airway symptoms (p=0·063), lung function decline (forced expiratory volume in one second, p=0·278; forced vital capacity, p=0·230), and sputum cytokine levels (interleukin-1β, p=0·445; CXC motif chmokine-8, p=0·279; tumour necrosis factor-α, p=0·055; and interferon-γ, p=0·555). Interpretation Viral infection, new occurrence of bacterial infection and co-infection are associated with exacerbation of bronchiectasis. The clinical characteristics of bronchiectasis exacerbation might inform clinicians of the possible underlying pathogens. Funding This work was supported by the National Natural Science Foundation (no. 81870003 ), Pearl River S&T Nova Program of Guangzhou (no. 201710010097 ) and Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme 2017 (to W-JG), and the Impact and Mechanisms of Physical, Chemical and Biological Interventions on the Development and Outcome of Acute Lung Injury (no. 81490534 , to N-SZ).

Bronchiectasis confers a considerable economic burden on healthcare services worldwidehttp://ow.ly/mTkF30nbEu7

Supplemental Digital Content is available in the text, Background: Compassionate care is essential for better clinical and patient outcomes, but during healthcare provision it can be compromised by several factors. This study evaluates factors affecting compassion satisfaction, compassion fatigue and burnout in nursing. Methods: Literature search in electronic databases was followed by data extraction, conversion, and meta-analyses under random effect model. Correlation coefficients (r) reported by individual studies were first converted to z-scores for meta-analyses and the overall effect sizes were then back-transformed into r. Results: Eleven studies (4054 respondents; 64.34 [95% confidence interval: 38.82, 89.86] % response rate; age 39.81 [31.36, 48.27] years; 87.11 [79.48, 94.73] % females) were used for meta-analysis. There was a strong positive correlation between compassion fatigue and burnout (r = 0.59), whereas compassion satisfaction had weak negative correlation with compassion fatigue (r = −0.226) but moderate with burnout (r = −0.446). Stress and negative affect were moderately positively associated with compassion fatigue (r = 0.405) but weakly correlated with burnout (r = 0.119). Positive affect and personal/social factors had weak inverse relationship with burnout (r = −0.197). Positive affect also had a moderately positive relationship with compassion satisfaction (r = 0.396). Demographic or professional factors were not significantly related to compassion satisfaction, compassion fatigue, or burnout. Conclusion: In nursing, a variety of stressful factors and negative affect promote compassion fatigue and burnout whereas positive affect is helpful in achieving compassion satisfaction.

The aim of this study was to investigate the efficacy and safety of bronchoscopic cryotherapy for pediatric poor ventilation.A total of 156 pediatric patients with airway stenosis and obstruction as well as pulmonary atelectasis received bronchoscopic cryotherapy. Treatment efficacy was evaluated on bronchoscopy Before cryotherapy and after the last cryotherapy treatment. Pulmonary atelectasis was assessed according to range of atelectasis on chest computed tomography (CT), and tracheobronchial stenosis according to pulmonary function, tidal volume analysis and dyspnea index.The 154 patients with effective treatment had patent airway, smooth mucosa and resolved atelectasis. In the two patients with ineffective treatment, however, the airway was not smooth and the range of pulmonary atelectasis was reduced by30%. Among the 156 patients, 136 had markedly effective treatment, with CT pulmonary atelectasis recovery70%. The width of the main airway significantly increased approximately 50% and the tidal volume or capacity increased 100%. Effective treatment was identified in 18 patients (18/156), with CT pulmonary atelectasis area reduced 30-70%. Ineffective treatment was noted in two patients, with CT pulmonary atelectasis area reduced by30%. No complications were noted in any patients during or after operation. No recurrence was noted on follow up of 2-24 months.Bronchoscopic cryotherapy is effective and safe for dyspnea caused by airway obstruction, and wide application in clinic is recommended.

To analyze the effect and safety of bronchoscopic cryosurgery in children with lower airway stenosis caused by granulation and fiber hyperplasia.Twenty-two patients had undergone bronchoscopic examination and cryosurgery, 18 patients with atelectasis caused by Mycoplasma pneumoniae pneumonia, 2 patients with endobronchial tuberculosis (EBTB), 1 patient with atelectasis caused by granulation tissue after bronchial foreign body, and 1 case who had severe dyspnea, with tracheal stenosis after long-term endotracheal intubation during surgery for heart disease. All the patients under went bronchoscopic cryosurgery for several times, 1 case with severe tracheal stenosis was operated by electric coagulation before cryosurgery. Before and after the treatment, all the patients were evaluated based on clinical symptoms, tracheal lumen by bronchoscopy, chest CT for atelectasis and pulmonary function for tracheal stenosis.The patients were treated with cryosurgery for 1-4 times. Sixteen cases were markedly improved, clinical symptoms disappeared completely, no granulation and fiber hyperplasia were found during bronchoscopy, and all the atelectasis were cured. After the treatment, the bronchial lumen diameter of the patient with tracheal stenosis was increased from 2 mm to about 5 mm, the tidal volume increased from 3.0 ml/kg to 8.8 ml/kg. Five cases were effectively improved, the clinical symptoms also disappeared, during bronchoscopy and bronchial alveolar lavage (BAL), no granulation and fiber hyperplasia were found, but some distal bronchial tubes were atresia or narrowed, the lumen was patent, the atelectasis recovered partially. In 1 case the treatment was ineffective, as the clinical symptoms and granulation disappeared, but because almost all distal bronchi were atresia or narrow, the lumen was not patent during BAL, there was no change on chest CT. The total effective rate was 21/22 (95.5%). No severe complications occurred during and after the procedures. All the patient were followed up for 1 - 12 months, no case had recurrence.Treatment with bronchoscopic cryosurgery is a safe and effective methods to tracheal stenosis caused by granulation tissue and fiber hyperplasia in children.

To evaluate the effect of bronchoalveolar lavage (BAL) through bronchoscopy in diagnosis and treatment of accidental inhalation of liquid and powdery foreign bodies in children.Twenty-one cases of accidental inhalation were classified into the following 4 groups according to the materials inhaled: 3 cases inhaled the lipidic material; 2 cases inhaled chemical material; 15 cases inhaled hydrosoluble materials; 1 case inhaled powdery material. Eighteen cases were hospitalized within 3 days after the accidents, which included 16 cases treated within 1 day in hospital. And 3 cases were hospitalized 3 days after the accident. After hospitalization, all patients were immediately treated with direct aspiration and lavage clearance method through bronchoscopy. The inhaled foreign materials were cleared as soon as possible, which reduced the absorption, stimulation and infection of respiratory mucosa. The therapeutic effect was evaluated by endoscopic findings, clinical manifestation, laboratory examination and chest imaging. At the same time, decision was made on the second BAL and the prognosis was estimated.Twenty-one cases had dyspnea of certain degree. The bronchial mucous membrane of all the 21 cases showed hyperemia, edema and exudate attached. Lavage fluid looked like broth and contained much of the inhaled material. After two to five times treatment, 18 cases were cured (86%), but 3 cases died (14%). One of these 3 cases fell into an oil well, 1 into mosquito repellent solution, another into manure pit. The patients who could not survive had severe airway obstruction, which was difficult to clean and made the problem deteriorated progressively. One of the patients was sent to a hospital 3 days after the accident and another case developed fungal infection, pneumothorax and finally respiratory failure.BAL through bronchoscopy is necessary for children who accidentally inhaled liquid and powdery materials. This treatment is safe and effective in diagnosis and treatment of such problems in children. The effect of treatment is influenced by types of inhaled material, the time of lavage clearance through bronchoscopy, and certain complications, such as infection etc.

To assess the efficacy and safety of balloon dilatation through flexible bronchoscopy in the management of inflammatory stenosis of grade 4-5 bronchus.Thirty patients with inflammatory bronchial stenosis caused by mycoplasmal pneumonia complicated with pulmonary atelectasis were treated with balloon dilatation through fiberoptic bronchoscopy. Before the procedure and after the last operation, therapeutic effect on pulmonary atelectasis were evaluated with CT and all of the patients were followed-up for 1 - 6 months.One to three operations were required to achieve satisfactory dilatation. After balloon dilatation, the average airway diameter increased obviously and the farther airways were opened after the therapy with irrigation. In 25 of 30 cases satisfactory immediate effects were obtained, a narrow airway diameter above expansion significantly increased as compared with preoperative diameter. In 5 children treated with balloon dilatation, the stenosis could not be improved significantly. In 3 patients with hyperplasia of granulation tissue, cryotherapy had to be applied. The operations were ineffective in the other two patients whose course of disease exceeded 3 months. After follow-up periods of 1 - 6 months, chest CT manifestation of expanded sites was improved in 28 patients and atelectasis disappeared. No severe complication was found in any patients.Bronchoplasty by balloon dilatation through flexible fiberoptic bronchoscopy is a simple, effective and safe method to treat childhood tracheobronchial stenosis after pulmonary infections.