Objective To investigate the value of fibrinogen to albumin ratio (FAR) combined with pulmonary embolism severity index (PESI) in the assessment of severity and prognosis of patients with acute pulmonary thromboembolism (APTE). Methods A retrospective study of hospitalized patients with confirmed APTE admitted to the Affiliated Hospital of Southwest Medical University from September 2013 to August 2021, divided into low-risk, intermediate-risk, and high-risk groups according to the Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism, and divided into survival groups and death groups according to the 30-day prognosis. The general data of all patients and relevant blood laboratory tests within 2 hours after admission were collected to calculate PESI and FAR. FAR and PESI levels were compared in APTE patients with different severity of disease and different prognosis. Independent risk factors for 30-day mortality in APTE patients were analyzed using logistic regression. Subject working characteristic curves were drawn to assess the differences in sensitivity, specificity and area under the curve of FAR, PESI and FAR combined with PESI in predicting 30-day death. Results Total of 235 APTE patients were included, divided into 85 in the low-risk group, 110 in the intermediate-risk group, and 40 in the high-risk group; 192 in the survival group and 43 in the death group according to 30-day survival. The differences in age, albumin (ALB), high-sensitivity troponin, D-dimer, fibrinogen (FIB), FAR, and PESI of APTE patients with different disease severity were statistically significant (P<0.05). FAR increased progressively with increasing severity of disease (P<0.05), and correlation analysis showed a positive correlation between FAR and PESI (r=0.614, P<0.05). Elevated FIB, FAR, PESI and decreased ALB were independent risk factors for 30-day death in patients with APTE (P<0.05). FAR, PESI, and FAR combined with PESI all had predictive value for 30-day death in APTE patients, and FAR combined with PESI predicted the largest area under the 30-day death curve. Conclusions FAR correlated with the severity and prognosis of APTE patients. FAR combined with PESI was more valuable in assessing the 30-day prognosis of APTE patients than FAR alone or PESI alone.
ObjectiveTo investigate the protective effect and mechanism of arbutin on LPS induced Acute lung injury in mice. Methods SPF BCLB/C mice were randomly divided into control group, model group,arbutin group, and arbutin+PI3K inhibitor group.arbutin group and arbutin+PI3K group were intervened with corresponding drugs respectively; Constructing an ALI model by intranasal instillation of LPS into mice; After modeling for 6 hours, the mice were killed. After staining the lung tissue slices, observe the pathological changes of the lung tissue and evaluate the lung injury score, and calculate the wet to dry weight ratio (W/D); ELISA method was used to determine the levels of TNF-a and IL-6 in serum and bronchoalveolar lavage fluid (BALF); Measure the ROS content, MDA level,and MPO activity in the lungs; Western blot method was used to detect the expression of PI3K/Akt/mTOR pathway related proteins and autophagy related proteins Beclin-1 and LC3II/I. ResultsCompared with the control group, the pathological changes in the lung tissue of model group mice worsened, and the W/D and lung injury scores increased, The levels of IL-6 and TNF-a in BALF and serum was increased, The ROS content, MDA expression and MPO activity in the lungs was increased,the expression of Beclin-1 and LC3II/I in the lungs was increased. The expression of PI3K/Akt/mTOR pathway related proteins in the lungs decreased (P<0.05). Compared with the model group, the pathological changes in the lung tissue of arbutin group mice were alleviated, with a decrease in W/D and lung injury score, The levels of IL-6 and TNF-a in BALF and serum decrease,ROS content, MDA expression and MPO activity in lung were decreased.The expression of PI3K/Akt/mTOR pathway related proteins in the lung was increased, The expression of Beclin-1 and LC3II/I decreased. However, the appeal performance was partially blocked in the arbutin+PI3K group after the administration of LY294002.ConclusionsArbutin regulates autophagy through PI3K/Akt/mTOR pathway to inhibit inflammatory response and oxidative stress in LPS-induced ALI mice, and plays a protective role in LPS-induced ALI.
Objective To explore the application value of metagenomic next-generation sequencing (mNGS) based on human sequencing in the clinical early diagnosis of lung cancer. Methods Four patients hospitalized with suspected lung infection were retrospectively analyzed, and the test results of bronchoalveolar lavage fluid (BALF) on mNGS of tumor metagenome, the routine clinical test results, and their clinical diagnosis and treatment information in between August 26, 2021, and December 18, 2021. Results Patient 1 was preliminarily diagnosed with lung cancer by referring to chest computed tomography (CT) imaging. Chest radiograph or CT in the other three patients showed bilateral lung CT and lamellar hyperintensities (patient 2), bilateral lung mass-like and lamellar hyperintensities (patient 3), and lung masses (patient 4), respectively. BALF samples from all 4 patients were detected with mNGS based on human tumor sequences, indicating tumor. In addition, the result in patient 3 also indicated white pseudofilamentous yeast infection consistent with clinical culture, and the result in patient 4 also showed infection of rhinovirus type A. Conclusion The second generation genome sequencing technology based on human sequence can not only assist clinical diagnosis of infection, but also provide detection datUM support for tumor early warning.
The diagnosis of coronavirus disease 2019 should not only depend on nucleic acid test, but also be based on clinical information such as medical history and radiographic findings. It’s critical to identify patients with high risk of rapid progression. Treatment of coronavirus disease 2019 should be individualized according to the underlying diseases and progression manner. For severely ill patients, oxygen and nutrition supplementation need to be strengthened, and for some highly selected cases, administration of glucocorticoids might be beneficial.
ObjectiveTo investigate the clinical efficacy, side effects, influence on viral nucleic acid conversion and prognosis of glucocorticoid used in patients with coronavirus disease 2019.MethodsEighty-seven patients with severe and critical coronavirus disease 2019 were included to observe respiratory symptoms, blood oxygen saturation, pulmonary imaging absorption, weaning status, complicated bacterial infection and double infection, and prognosis after glucocorticoid use. Whether glucocorticoid use affects the patient's viral nucleic acid was analyzed.ResultsOf the 87 patients included, 55 were severe, 32 were critical, and 38 died, which included 30 critical patients. Seventy-seven patients accepted short-term glucocorticoid, and 10 patients accepted long-term glucocorticoid due to diffuse lung lesions and poor absorption. Eleven patients had bacterial infection and 4 cases had double infection. In 10 patients with long-term use of glucocorticoids, the lung lesions relieved, no double infection was found, but 1 patient maintained nucleic acid positive even after 5 weeks’ treatment.ConclusionsThe use of appropriate glucocorticoids is beneficial to the improvement of disease status and disease absorption in patients with coronavirus disease 2019. Long-term oral administration of glucocorticoids in patients with diffuse lung lesions may be beneficial to disease absorption.