Volume 105 · Issue 02 · 2025

The prevalence and evolution of respiratory pathogens are changing, and issues related to drug-resistance are becoming increasingly prominent in the post-COVID era. The urgency of controlling respiratory pathogens has intensified. This issue organizes expert discussions to address the resurgence of various respiratory pathogens, summarizing current status of pathogen surveillance, drug-resistance research and vaccine development, while suggesting countermeasures. It emphasizes the need to integrate of medical and preventive measures, conduct multi-pathogen surveillance and management, enhance the response capacity of respiratory infectious diseases, optimize vaccine policy and immunization services, improve the level of diagnosis and treatment, and strengthen protection for vulnerable populations, so as to reduce the burden of respiratory infectious diseases.

The core technologies proposed in surgery have boosted the innovation transformation and disciplinary development. However, the core technologies in anesthesiology remain undefined both domestically and internationally. Through collaborative discussions among Chinese anesthesiologists, the core technologies of anesthesiology can be succinctly summarized as Relief of pain, Regulation of life, Resuscitation, and Restoration of organ function, and collectively referred to as the 4R technologies. Their primary components include: (1) Technology for sedation, analgesia and muscle relaxation; (2) Technology for the monitoring and regulation of life; (3) Technology for resuscitation and restoration of organ function; (4) Technology for diagnosis and therapy for acute and chronic pain, as well as functional regulation. Up to now, there is still a significant gap between the current situation of anesthesiology and the requirements of core technologic content. Exclusive innovation transformation can remodel the new future of anesthesiology.

Pneumococcal disease (PD) caused by Streptococcus pneumoniae (Sp) is a global public health concern. Children younger than 5 years and elderly over 60 years, due to immature development of the immune system early in life or the gradual decline of immune function with age, are high-risk groups for pneumococcal infections, which makes the disease burden particularly serious and the situation of prevention and control grim. Vaccination is the most effective measure to prevent PD and reduce pneumococcal antimicrobial resistance. Improving health consciousness and vaccination rates are particularly necessary and urgent for the prevention and control of PD. Based on the disease burden, this article discusses the problems and challenges of PD in China regarding surveillance, laboratory testing, antimicrobial resistance, and vaccination. Recommended strategies concerning the surveillance system, clinical diagnosis and treatment, vaccination, and health promotion were made to increase the vaccination rate of pneumococcal vaccine among the elderly and young and to improve the level of PD prevention and control.

Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia in children in China, and it is often prevalent in the autumn and winter seasons. In the autumn and winter of 2023, a large-scale epidemic outbreak of MP pneumonia occurred nationwide in the pediatric population, which brought harm to child health, caused a heavy disease burden, imposed a challenge to the pediatric medical service system, and aroused great attention from medical administration and public health fields. The widespread prevalence of macrolide-resistant MP (MRMP) in China has become a prominent problem in pediatric clinical practice. This article reviewed the epidemiology of MP pneumonia and made evidence-based suggestions for the prevention and treatment of seasonal MP pneumonia in children in terms of the current clinical practice issues and public health concerns.

Pertussis is an important public health and clinical issue in China currently. Macrolide resistance in Bordetella pertussis is a serious challenge to prevent and manage pertussis in China. Early, timely and effective antimicrobial therapy plays an important role in alleviating disease, reducing complications and severe diseases, eliminating carriers and reducing secondary transmission, and implementing post-exposure chemoprophylaxis in special scenarios is also necessary to protect individuals at high risk of severe diseases. In view of the current situation of antimicrobial resistance to Bordetella pertussis in China, combining with the practical needs of clinical treatment and prevention and control of pertussis, this article puts forward evidence-based suggestions on antibiotic treatment and post-exposure chemoprophylaxis strategies for pertussis.

In recent years, particularly since the outbreaks of scarlet fever and invasive group A streptococcal diseases/infections (iGAS) in several European countries in 2022, iGAS has garnered widespread attention. Recently, Japan experienced an outbreak of a specific type of iGAS, streptococcal toxic shock syndrome (STSS). The outbreak was reported under the label"flesh-eating bacteria,"emphasizing the pathogenic potential of group A streptococcus (GAS). Although GAS is not a newly emerging pathogen and remains susceptible to antibiotics, and guidelines exist for the diagnosis and treatment of various clinical manifestations of iGAS, systematic surveillance and research on iGAS are lacking in China. The high mortality rate associated with the STSS outbreak in Japan highlights the need for continued attention to GAS-related diseases, with a focus on emerging trends in iGAS epidemiology, as well as changes in bacterial virulence and transmission dynamics. There is a pressing need to conduct research based on domestic clinical practice to enhance iGAS diagnosis, treatment, and prevention, ultimately to safeguard public health.

The elderly population in China faces a significant burden of influenza, but the influenza vaccination rate among this group remains far below international recommended standards due to factors such as the underdeveloped adult immunization service system, high vaccination costs, and insufficient awareness among both the elderly and healthcare professionals. It is recommended that China implement a free or reimbursement policy influenza vaccination for elderly in border regions, improve the adult immunization service system, enhance the awareness of healthcare professionals and the elderly, and strengthen the research and post-vaccination monitoring of vaccines tailored to the elderly population to increase the influenza vaccination rate among the elderly.

Perioperative fluid therapy is a pivotal component of surgical patient management, as appropriate fluid administration can significantly enhance postoperative recovery. To standardize perioperative fluid therapy for adult patients in China, the Geriatric Anesthesia and Perioperative Management Group of the Chinese Society of Anesthesiology has developed the "Clinical Practice Guidelines for Perioperative Fluid Therapy in Chinese Adult Patients". Based on current clinical status in China, this guideline addressed 11 key areas based on clinical evidence, more than 30% of which is from China researchers, including principles for the selection of common fluid types, preoperative fasting and hydration following enhanced recovery after surgery (ERAS) protocols, intraoperative fluid requirements for adult patients, perioperative volume assessment, perioperative evaluation of volume overload/insufficiency, goal-directed fluid therapy, restrictive fluid therapy, perioperative fluid therapy strategies for high-risk patients, fluid resuscitation for massive blood loss, the relationship between perioperative fluid therapy and postoperative complications, and the relationship between perioperative fluid therapy and ERAS. The guideline included 51 evidence-based recommendations aimed at optimizing perioperative fluid management and improving patient outcomes after surgery.

To investigate the characteristics of type 2 inflammation in patients with nocturnal asthma, and analyze the improvement of asthma symptoms after the use of inhaled corticosteroids (ICS) combined with different long-acting bronchodilators.

Data of 231 asthma patients who first visited the Respiratory and Critical Care Medical Clinic of Nanfang Hospital of Southern Medical University from January 2020 to June 2023 and had positive bronchodilator tests (BDT), were retrospectively analyzed. These patients were divided into nocturnal asthma group and non-nocturnal asthma group based on the presence or absence of nocturnal symptoms. According to fractional exhaled nitric oxide (FeNO) levels, patients were divided into type 2 inflammatory group [FeNO≥20 ppb (×10^-12)] and non-type 2 inflammatory group (FeNO<20 ppb). Patients were further divided into ICS+long-actingβ2 agonist (LABA) group and ICS+LABA+long-acting anticholinergic agent (LAMA) group based on medication regimens. Patients were followed-up at the 3rd, 6th, and 12th months after enrollment to evaluate the patient′s asthma control test (ACT) questionnaire, actual medication status and number of acute attacks. The clinical characteristics, treatment and prognosis of different groups were compared.

A total of 231 asthma patients were included, including 152 males and 79 females, with a age[M (Q₁, Q₃)] of 52 (42, 60) years. There were 144 cases (62.3%) in the nocturnal asthma group and 87 cases (37.7%) in the non-nocturnal asthma group. Among the 144 patients with nocturnal asthma, 133 patients completed FeNO testing, of which 95 were classified into the type 2 inflammation group and 38 to the non-type 2 inflammation group. The eosinophil (EOS) count and FeNO level in the nocturnal asthma group were both higher than those in the non-nocturnal asthma group [(0.45±0.40) ×10⁹/L vs (0.25±0.20)×10⁹/L, 38 (18, 82) vs 29 (15, 48) ppb, both P<0.05]. Baseline ACT score was lower in nocturnal asthma group than in non-nocturnal asthma group [16 (14, 18) vs 21 (19, 23) scores, P<0.001]. There was no significant difference in the forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and peak expiratory flow (PEF) in the two groups (both P>0.05). During the follow-up at the 3rd, 6th, and 12th months, the improvement values of ACT scores (ΔACT) in the nocturnal asthma group were higher than the non-nocturnal asthma group [5 (3, 7) vs 2 (1, 3), 7 (4, 9) vs 3 (1, 4) and 7 (6, 9) vs 3 (1, 5) scores, all P<0.05]. The EOS count [0.40 (0.29, 0.80)×10⁹/L vs 0.20 (0.12, 0.29)×10⁹/L] and percentage [5.10% (3.55%, 9.10%) vs 2.20% (1.65%, 3.85%)] of the type 2 inflammation group were both higher than the non-type 2 inflammation group (both P<0.05). In the nocturnal asthma group, there was no significant difference in ΔACT between ICS+LABA and ICS+LABA+LAMA groups (both P>0.05).

Patients with nocturnal asthma have more pronounced type 2 inflammation and the symptoms are often not well controlled or even worse. After one year of combined therapy with ICS, significant improvements in asthma symptoms can be observed. But there is no significant difference in symptom improvement among different medication regimens in the nocturnal asthma group.

To investigate anticoagulation effects of nafamostat mesylate(NM) in sustained low-efficiency dialysis (SLED) and its relevant factors.

Critically ill patients with kidney disease who were admitted to Zhongshan Hospital Affiliated to Fudan University and underwent SLED treatment from May to August 2024 were retrospectively included. Baseline clinical data were collected, and the activated partial thromboplastin time (APTT) and activated clotting time (ACT) were measured at the arterial end, before the filter, and at the venous end two hours post-NM anticoagulation treatment. Patients were categorized into two groups: the anticoagulation achievement group and the anticoagulation non-achievement group, based on the observed clotting status of the filter and venous reservoir following treatment completion. Multivariate logistic regression analysis was employed to identify risk factors influencing the efficacy of NM anticoagulation. Additionally, the receiver operating characteristic (ROC) curve was utilized to ascertain optimal monitoring indicators for NM anticoagulation.

A total of 96 patients (64 males and 32 females) aged (60±18) years undergoing SLED were included in the study, with 75 patients in the anticoagulation achievement group and 21 patients in the anticoagulation non-achievement group. No statistically significant differences were observed in baseline characteristics such as age, gender, body weight, baseline liver and kidney function, and platelet count between the two groups (all P>0.05). The proportion of patients with a baseline hematocrit (HCT)>30% was higher in the anticoagulation non-achievement group than that in the achievement group [57.1% (12/21) vs 22.7% (17/75), P=0.009]. The proportion of patients with fibrinogen (Fib)>4 g/L was also higher in the anticoagulation non-achievement group [90.5% (19/21) vs 49.3% (37/75), P<0.001]. The ultrafiltration rate in the anticoagulation achievement group was lower than that in the non-achievement group [232 (182, 353) ml/h vs 478 (289, 691) ml/h, P<0.001], and the NM dose was higher in the achievement group [35 (30, 40) mg/h vs 30 (25, 35) mg/h, P<0.001]. Multivariate logistic regression analysis revealed that high ultrafiltration rate (OR=1.489, 95%CI: 1.007-2.145, P<0.001), HCT>30% (OR=6.907, 95%CI: 1.523-18.342, P=0.009), and low albumin level (OR=0.821, 95%CI: 0.709-0.951, P=0.002) were relevant factors for poor NM efficacy. After 2 hours of NM treatment, the ratio of ACT at the venous/baseline ACT and the ratio of APTT at the venous/baseline APTT in the anticoagulation achievement group were both higher than those in the non-achievement group (both P<0.05). There was a positive correlation between APTT and ACT measured at the venous end 2 hours after NM treatment (r=0.763, P<0.001). The ROC curve analysis results showed that the area under the curve (AUC) for determining the effectiveness of NM anticoagulation using the ratio of APTT at the venous end to baseline APTT at 2 hours was 0.845 (95%CI: 0.762-0.928, P<0.001), with a cut-off value of 1.78 (sensitivity: 89.8%; specificity: 68.6%).

Higher filtration rate, HCT>30% and lower albumin levels are identified as relevant factors for poor NM efficacy. Additionally, the ratio of venous/baseline APTT at 2 h after NM treatment may serve as a predictive indicator for assessing of NM anticoagulation.

This paper reports a case of tuberous sclerosis type 2/polycystic kidney disease type 1 (TSC2/PKD1) adjacent gene syndrome treated with maintenance hemodialysis. A 27-year-old male with systemic papules, intermittent seizures, hematuria and renal insufficiency onset. The patient was born without abnormalities, and his parents were not close relatives and both were in good health. Whole exome sequencing results showed that there were heterozygous deletion variants in TSC2 and PKD1 genes, and the patient did not receive targeted treatment, and slowly progressed to the uremic stage of renal failure. At present, there is a lack of effective treatment for this disease. Mammalian rapamycin target protein (mTOR) inhibitors can delay the progression of the disease, and targeted treatment after early diagnosis by molecular genetic testing may benefit patients.

To report the management of anesthesia in a patient with Coffin-Siris syndrome type 1 undergoing tethered cord release. The patient, an 8-year-old female, visited Xuanwu Hospital of Capital Medical University on August 12, 2024 due to poor urinary control, and underwent head + spine MRI to diagnose "Chiari deformity, tethered cord syndrome". The patient was diagnosed with Coffin-Siris syndrome type 1, growth retardation, and transthoracic echocardiography revealed patent foramen ovale (left-to-right shunt), approximately 2.1 mm in diameter. Tethered cord release was proposed under general anesthesia. Patients with Coffin-Siris syndrome type 1 are rare, and no consensus anesthesia protocol has been proposed at present. General anesthesia with tracheal intubation can be considered for such patients, and the intraoperative circulatory function and internal environment stability can be actively maintained.

Chimeric antigen receptor T cell (CAR-T) therapy is a novel strategy for tumor treatment, which has shown significant efficacy in the treatment of hematological malignancies and some solid tumors. However, there are some adverse reactions of CAR-T therapy, such as cytokine release syndrome (CRS), neurotoxic syndrome (ICANS) and infection. In recent years, CAR-T related acute kidney injury (AKI) has been paid more and more attention. The mechanism and prevention of AKI after CAR-T treatment are reviewed in this paper.

The patient, a 27-year-old female, was admitted to the Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital on March 11, 2024 due to "intermittent cough and fever for 2 months". In the past 2 months, he has developed fever, accompanied by irritating cough, fatigue, night sweats, gradual swelling of neck lymph nodes, and weight loss of 5 kg. Past physical fitness. Laboratory tests showed high-sensitivity C-reactive protein of 191.14 mg/L and erythrocyte sedimentation rate of 96 mm/1 h; Tumor markers, angiotensin converting enzyme, tuberculosis T lymphocyte detection, autoantibody screening were all negative. Chest CT showed multiple asymmetric enlarged lymph nodes in the mediastinum and both pulmonary hilums (shown by arrows in Figure A), and the enhancement scan showed mild uniform enhancement (shown by arrows in Figure B). Positron emission computed tomography (PET-CT) indicated that many lymph nodes and many extranodal organs in the whole body were metabolically increased to varying degrees, and lymph node infiltration was possible. Under bronchoscopy, multiple white nodules were seen in the mucosa of the airway and left and right main bronchial openings (Figure C), partially fused into pieces, and the texture was tough. Bronchial mucosal biopsy of right upper lobe showed chronic inflammation of bronchial mucosa, focal mucosal erosion with granulation tissue formation, and special staining was negative. Endoscopic ultrasound lymph node biopsy showed pathological indication of atypical cell infiltration (shown by arrow in Figure D, hematoxylin-eosin staining ×40), immunohistochemistry: CD30 (+), CD15 (+), CD20 (-), CD3 (-), pairing box gene 5 (PAX5) (weak +), octamer-binding transcription factor 2 (OCT2) (+), B lymphocyte-specific activation of OCT-binding protein 1 (BOB.1) (-), consistent with Hodgkin's lymphoma (HL). Clinical HL diagnosis is clear. After 4 cycles of chemotherapy, the Deauville score was 4, and the symptoms such as cough, fever and night sweats were significantly relieved. After adjusting the chemotherapy regimen for 4 cycles of chemotherapy, the Deauville score was 2; The consolidation treatment was continued, the clinical symptoms disappeared, and no recurrence was observed at follow-up. The typical clinical manifestation of HL is painless lymphadenopathy with continuous lymph node involvement. Airway involvement is rare, with an incidence rate of about 1.9%, among which obstructive polypoid lesions are the most common, and may also be manifested as superficial mucosal ulcer formation. Pathology is the gold standard for diagnosing HL airway involvement. HL airway involvement is not a determinant of HL staging and prognosis. In addition to systemic treatment, interventional or surgical intervention is feasible for patients with severe airway obstruction caused by HL airway involvement.

The patient, a 59-year-old female, underwent extensive hysterectomy + pelvic lymph node dissection in the Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Soochow University in June 2022 due to the diagnosis of "cervical squamous cell carcinoma stage IIA1 (FIGO 2018)". Postoperative pathology showed that poorly differentiated squamous cell carcinoma of the cervix infiltrated 1/3 of the cervical muscle layer without involving the internal cervical orifice; No clear nerve or vascular invasion was detected; Cancer involvement was seen at the vaginal margin; No cancer involvement was seen in bilateral parauterine and bilateral adnexes; No cancer metastasis was found in the pelvic lymph nodes submitted for examination. A total of three times of high-dose brachyloading adjuvant radiotherapy of vaginal stump were performed after surgery. The process was smooth, and the Karnofsky functional status score was 80 points. In September 2023, he went to the Department of Orthopedics, the Second Affiliated Hospital of Soochow University due to "right hip pain for more than 10 days". He denied a history of trauma and hormone application, and had no long-term single-action skeletal stress; Specialist examination showed positive bilateral "4" sign and negative straight leg elevation test; Detection of bone metabolic markers showed osteocalcin 8.82 μ g/L, amino-terminal propeptide of type I collagen 16.80 μ g/L, carboxy-terminal peptide of type I collagen 138.00 ng/L, 25-hydroxyvitamin D 40.47 μ g/L, and parathyroid hormone 31.77 ng/L. Pelvic MRI showed that the sacral bone was not continuous, T1W1 showed linear low signal (shown by arrows in Figure 1, which is the fracture line), and T2 lipid pressure image showed flaky high signal foci (shown by dotted circles in Figure 2, which is the bone marrow edema area); The bone of the right pubic bone was interrupted, and a flaky T2 lipid pressure like a hyperintensity focus was seen in it. Dual-energy X-ray bone mineral density measurement (DXA) showed that lumbar spine (L_1~4) Bone density was 0.789 g/cm² with a t-value of-2.7, suggesting osteoporosis. The clinical diagnosis was pelvic failure fracture after radiotherapy for cervical cancer. Failure fracture refers to stress fracture caused by decreased bone mineral content or elasticity, resulting in decreased bone strength. It is more common in patients with postmenopausal osteoporosis, post-radiotherapy osteoporosis and long-term hormone therapy; It is often manifested as a fracture line with callus formation, accompanied by local bone density reduction and other osteoporotic manifestations. It is common in sacrum, pubic bone, ischial bone, etc., and can be single or multiple. Pelvic failure fractures after cervical cancer radiotherapy tend to occur in unilateral or bilateral sacral ears. The fracture line is serpentine or creeping, parallel to the sacroiliac joint, and the bilateral shape is "H", which needs to be distinguished from traumatic fractures, pathological fractures caused by bone metastases and osteoporotic fractures. For the detection of pelvic failure fractures, the sensitivity and specificity of pelvic X-ray examination are low; In the early stage of fracture, the detection rate of occult fracture by MRI was higher than that of CT. The fracture lines were T1WI and T2WI low signal, and the peripheral bone marrow edema showed diffuse T1WI low signal and T2WI high signal. The edema area of bone marrow in enhanced scan showed uneven enhancement, but the fracture line was not enhanced. Reasonable radiation dose, three-dimensional conformal radiotherapy and intensity modulated radiotherapy were adopted to reduce the damage to normal tissues by radiotherapy, and appropriate imaging methods were selected to improve the detection rate of cervical cancer fracture after radiotherapy. Regular monitoring of bone mineral density after radiotherapy for cervical cancer and appropriate intervention measures for patients with osteoporosis will help to reduce the incidence of pelvic failure and fracture and improve the quality of life of patients.

The patient, a 29-year-old female, went to the thoracic surgery clinic of Shanghai Ruijin Hospital for "chest tightness and shortness of breath for 3 days". History of recurrent pneumothorax and uterine fibroid surgery in the past. Physical examination showed multiple small nodules on the skin of the waist. Chest CT showed the left chest gas density shadow, left lung tissue compression and expansion were incomplete, and both lungs were scattered in cystic shape without lung texture and translucent shadow (Figures 1 and 2). The clinical diagnosis was "left pneumothorax (recurrent), multiple cystic lesions in both lungs". After admission, "thoracoscopic lung biopsy" was performed to obtain a piece of lung tissue with a size of 5.0 cm ×2.0 cm ×1.0 cm, and the section surface was gray-white, gray-red and spongy. Pathology showed that there were multiple cyst cavities in the lung tissue, and fat spindle cells with mild morphology showed fascicular or nodular proliferation on the cyst wall, and the cytoplasm was eosinophilic (shown by arrows in Figure 3, hematoxylin-eosin staining ×100). Immunohistochemistry showed that spindle cell smooth muscle actin (SMA), estrogen receptor (ER), progesterone receptor (PR) were positive, microphthalmia transcription factor (MiTF) was partially positive, and anti-melanin specific monoclonal antibody (HMB45) was a small amount positive. The diagnosis of LAM was confirmed according to the fifth edition of the diagnostic criteria for WHO classification of thoracic tumors lymphangioleiomyomatosis (LAM). LAM was classified as sporadic and LAM associated with tuberous sclerosis. This patient had a history of surgery for lumbar skin nodules and uterine fibroids, suggesting the possibility of tuberous sclerosis-related LAM. Further second-generation sequencing of diseased tissues and peripheral blood showed that heterozygous variation of TSC1 was found, which was consistent with tuberous sclerosis-related LAM. Tuberous sclerosis is an autosomal dominant hereditary disease caused by the abnormal activation of the rapamycin target protein (mTOR) signal transduction pathway caused by TSC1 or TSC2 gene mutation. It is manifested as systemic multisystem damage mainly with neurological and skin lesions, different types of epilepsy, renal cysts and angiomyolipomas, and eye, heart and lung involvement are less common. LAM mostly progresses slowly, and mTOR inhibitors sirolimus or everolimus improve patient prognosis, requiring lung transplantation in the end stage.