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Background: Few studies have explored the correlation between asthma medication and features on HRCT images. We aim to analyse the differences and temporal changes of lung function and airway resistance in asthma with diverse HRCT phenotypes in a short period after inhalation of budesonide/formoterol. Method: This observational study recruited 55 adult patients with varying severities of asthma. We performed detailed airway metrics measurements of chest CT scans, such as airway wall thickness (WT), wall area percentage (WA%), wall thickness percentage (T/OR), and airways with an inner perimeter of 10 mm (Pi10). The effect of lung structural features on asthma medication response was explored according to the WA% and T/OR twelve hours post-drug administration. Using multivariable regression models, we then assessed the influence of WA% on lung function. Results: WA% (p < 0.001) and T/OR (p < 0.001) significantly increased in asthma than in healthy control subjects. Compared to mild asthma, airway walls were further thickened (WA%, p = 0.023; T/OR: p = 0.029) and associated with lumen narrowing (Pi10, p = 0.055) in moderate to severe asthma. WA% and T/OR correlated well with lung function (FEV1, FVC, MMEF, and PEF) and airway resistance (R5, R20, Rp, and Fres). Regression analysis showed that MEF25 decreased with increasing age and WA% (R2 = 0.58, p < 0.001). Patients with thickened airway walls experienced a maximal increase in FVC, FEV1, and PEF at 2 h (p < 0.001) and a maximal decrease of R5, Z5, and Rp at 2 h (p < 0.001) in those with a thickened airway pattern. Conclusions: Asthma patients with different bronchial wall thicknesses exhibited variable lung function changes. Specifically, patients with thick airway wall patterns were more sensitive to inhaled budesonide in the short term.

The outbreak of SARS-CoV-2 lead to a worldwide pandemic which poses substantial challenges to public health.We enrolled 102 consecutive recovered patients with laboratory-confirmed SARS-CoV-2 infection. Epidemiological and demographic characteristics, temporal dynamic profiles of laboratory tests and findings on chest CT radiography, and clinical outcomes were collected and analyzed.Independent risk factors for prolonged fever, viral RNA shedding or radiologic recovery included age of more than 44 years, female gender, having symptoms of cough and fever, a delay from the symptom onset to hospitalization of more than 3 days, a lower CD4 count of less than 500/μL on admission, and severe or critical illness in hospitalization. The estimated median time from symptom onset was 6.4 (5.5 - 7.4) days to peak viral load, 9.1 (7.9 - 10.4) days to afebrile, 8 (6.7 - 9.4) days to worst radiologic finding, 12.7 (11.2 - 14.3) days to viral RNA negativity, and 26.7 (23.8 - 29.9) days to radiologic resolution. This study included the entire cross-section of patients seen in our clinical practice and reflected the real-world situation.These findings provide the rationale for strategies of active symptom monitoring, timing of quarantine and antiviral interventions, and duration of radiologic follow-up in patients with COVID-19.

BackgroundImpulse oscillometry (IOS) can be used to evaluateairway impedance in patients with obstructive airway diseases. Previous studies have demonstrated that IOS parameters differ betweenbronchiectasis patients and healthy controls. This study aims to explore the usefulness of IOS in assessing disease severity and airway reversibility in bronchiectasis.MethodSeventy-four patients with non-cystic fibrosis bronchiectasis who visited our Respiratory Medicine outpatient clinic were consecutively recruited. Spirometry, plethysmography and IOS tests were performed. Patients were stratified into mild, moderate and severe disease according to Reiff, Bhalla, BSI, FACED, and BRICS scores. Airway reversibility was measured by bronchodilation test (BDT) and the result was classified as positive or negative.. ROC curves of IOS parameters was used to assess the usefulness of IOS parameters in predicting airway reversibility. Correlations between the IOS, spirometric lung function and bronchiectasis severity parameters were analysed.ResultsMany IOS parameters, such as airway resistance at 5Hz (R5), small airways resistance (R5–R20), total airway reactance (X5), resonance frequency (Fres), total airway impedance at 5Hz (Z5), and peripheral resistance (Rp) increased with increased bronchiectasis severity according to the FACED, BSI and Reiff scores. Large airway resistance (R20) and central resistance (Rc) were not significantly different among groups with differentbronchiectasis severity. The difference between R5 and R20 (R5-R20) showed 81.0% sensitivity, and 69.8%specificity in predicting the airway reversibility in bronchiectasis with AUC of 0.794 (95%CI, 0.672-0.915).ConclusionIOS measurements are useful indicators of bronchiectasis severity and may be useful for predicting the airway reversibility.

Background To illustrate the extent of transmission, identify affecting risk factors and estimate epidemiological modeling parameters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in household setting. Methods We enrolled 35 confirmed index cases and their 148 household contacts, January 2020–February 2020, in Zhuhai, China. All participants were interviewed and asked to complete questionnaires. Household contacts were then prospectively followed active symptom monitoring through the 21-day period and nasopharyngeal and/or oropharyngeal swabs were collected at 3–7 days intervals. Epidemiological, demographic, and clinical data (when available) were collected. Results Assuming that all these secondary cases were infected by their index cases, the second infection rate in household context is 32.4% (95% confidence interval [CI]: 22.4%–44.4%), with 10.4% of secondary cases being asymptomatic. Multivariate analysis showed that household contacts with underlying medical conditions, a history of direct exposure to Wuhan and its surrounding areas, and shared vehicle with an index patient were associated with higher susceptibility. Household members without protective measures after illness onset of the index patient seem to increase the risk for SARS-CoV-2 infection. The median incubation period and serial interval within household were estimated to be 4.3 days (95% CI: 3.4–5.3 days) and 5.1 days (95% CI: 4.3–6.2 days), respectively. Conclusion Early isolation of patients with coronavirus disease 2019 and prioritizing rapid contact investigation, followed by active symptom monitoring and periodic laboratory evaluation, should be initiated immediately after confirming patients to address the underlying determinants driving the continuing pandemic.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the leading cause of a public health emergency in the world, accompanying with high mortality in severe corona virus disease 2019(COVID-19 ), thereby early detection and stopping the progress to severe COVID-19 is important. Our aim is to establish a clinical nomogram model to calculate and predict the progress to severe COVID-19 timely and efficiently.Methods: In this study, 65 patients with COVID-19 had been included retrospectively in the Fifth Affiliated Hospital of Sun Yat-sen University from January 17, to February 11, 2020. Patients were randomly assigned to train dataset (n=51 with 15 progressing to severe COVID-19) and test dataset (n=14 with 4 progressing to severe COVID-19). Lasso algorithm was applied to filter the most classification relevant clinical factors. Based on selected factors, logistic regression model was fit to predict the severe from mild/common. Meanwhile in nomogram sensitivity, specificity, AUC (Area under Curve), and calibration curve were depicted and calculated by R language, to evaluate the prediction performance to severe COVID-19.Results:High ratio of sever COVID-19 patients (26.5%) had been found in our retrospective study, and 84% of these cases progress to severe or critical after 5 days from their first clinical examination. In these 65 patients with COVID-19, 77 clinical characteristics in first examination were collected and analyzed, and 37 ones had been found different between non-severe and severe COVID-19. But when all these factors were analyzed in establishment of prediction model, six factors are crucial for predicting progress of severe COVID-19 via Lasso algorithm. Based on these six factors, including increased fibrinogen, hyponatremia, decreased PaO2,multiple lung lobes involved, down-regulated CD3（+）T-lymphocyte and fever, a logistic regression model was fit to discriminate severe and common COVID-19 patients. The sensitivity, specificity and AUC were 0.93, 0.86, 0.96 in the train dataset and 0.9, 1.0, 1.0 in test dataset respectively. Nomogram-predicted probability was more consistent with actual probability by R language.Conclusions:In summary, an efficient and reliable clinical nomogram model had been established, which indicate increased fibrinogen, hyponatremia, decreased PaO2, multiple lung lobes involved, down-regulated CD3（+）T-lymphocyte and fever at the first clinical examination, could predict progress of patients to severe COVID-19.

Background Asthma is a serious global health problem, severely affecting the lives of sufferers and their families. An exceptionally hygienic home and reduced microbial exposure can aggravate the incidence of childhood asthma. Methods Specific-pathogen-free BALB/c mice were pre-treated with bacterial lysate (BL; 1 mg/kg) as a high microbial load maternal mouse model, and then, the offspring mice were established as an allergic airway disease (AAD) model. The expression levels of TLR2, TLR4, and HDAC9 in the mother's intestine and the offspring's lungs were detected. Relevant indicators of regulatory T cells (Tregs) were identified in the mother and offspring mice. The changes in the expression of Th1-, Th2-, Th9-, and Th17-related cytokines in the offspring mice were evaluated among different pre-treated groups. Results After augmenting the mothers' intestinal microbiota through oral BL gavage, the expression of TLR2 and TLR4 in the colon mucosa and colon lymphoid tissues was enhanced and that of HDAC9 in the colon mucosa was decreased, and the proportion of spleen Tregs was increased. The offspring showed similar changes in the AAD model compared with the offspring of the control-group mothers: TLR2 and TLR4 expression in the lungs and the proportion of spleen Tregs increased, HDAC9 expression in the lungs decreased, and AAD-induced airway pathologic characteristics were reversed; additionally, Th1/Th2 and Th9 imbalances were rectified. Conclusions This study presents a new framework for the prevention of childhood asthma, elucidating the mechanism of regulating the mother's intestinal microbiome to protect the offspring's early asthma via animal experiments.

Background Although it is widely accepted that the “hygiene hypothesis” explains the increased incidence of asthma, the lack of suitable animal models hinders further in-depth studies of the underlying molecular immune mechanisms. Therefore, we aimed to develop a robust mouse asthma model to investigate the role of bacteria in preventing asthma. Methods BALB/c female mice were fed a mixture of eight common bacterial lysates (BL; Broncho-Vaxom®) and a commercial probiotic (Bifidobacterium tetravaccine tablets) at different concentrations before and during pregnancy to simulate different microbial load levels. Faeces from the mother mice were subjected to bacterial 16S rRNA sequencing to quantify the maternal microbial load. TLR2/4 expression and the proportion of regulatory T cells (Tregs) in the intestinal tract of female mice were determined, and the safety of the microbial load was evaluated. An asthma model was established in the offspring mice after weaning, and the extent of pulmonary pathological changes and Treg proportion were evaluated. Results A BL concentration of 1 mg/kg enriched the intestinal flora, increased the proportion of Tregs, and increased the expression of TLR2/4 in the maternal mice. The proportion of peripheral blood Tregs was increased, whereas the risk of asthma decreased only in the offspring from mothers with a high microbial load relative to control mice. Conclusion This study established a safe and stable high microbial load maternal-offspring mouse asthma model, laying the foundation for a study on the molecular mechanism underlying the protective effects of a high microbial load against asthma.

This study was performed to evaluate the possibility of using reverse facial artery pedicled submandibular gland transfer for treating keratoconjunctivitis sicca. A reverse facial artery pedicled submandibular gland, including the duct, from a beagle dog was transplanted into the temporal region in the same animal. 99mTc pertechnetate scintigraphy was used to monitor graft viability, and the grafted glands were examined histologically 12 weeks after transplantation. Postoperative 99mTc pertechnetate scintigraphy demonstrated viable salivary gland tissue in the transplanted region. Histologically, some of the acinar cells in the graft had atrophied. The transplantation of a reverse facial artery pedicled submandibular gland was successful and may be a simple, reliable treatment for patients with keratoconjunctivitis sicca.