Clinical study on the treatment of bronchiectasis in remission period by embedding thread combined with Jianpi Qushi Huayu plaster

Objective:To explore the clinical effect of embedding thread combined with Jianpi Qushi Huayu ointment in the treatment of bronchiectasis in remission period,and to observe the effect on the level of inflammatory cytokines.Methods:150 patients with bronchiectasis in remission period were divided into three groups(50 cases in each group),western medicine group(treated with salmeterol fluticasone and low dose erythromycin),combined group(treated with Jianpi Qushi Huayu plaster),observation group(treated with western medicine+Jianpi Qushi Huayu plaster+embedding thread),and the clinical treatment of the three groups were compared.Result:before and after treatment,the improvement of TCM syndrome score,the improvement of pulmonary ventilation index,the improvement of inflammatory cytokines,and the change of adverse reactions.Results:the treatment efficiency of the observation group and the combination group was significantly higher than that of the western medicine group P The peak level of expiratory flow velocity,the maximum expiratory flow,the forced expiratory volume in one second and the ratio of forced expiratory volume in one second to vital capacity in the observation group and the combined group were significantly better than those in the western medicine group and the pre-treatment level(P<0.05),and the improvement in the observation group was better than that in the combined group After treatment,the expression of IL-13,IL-10 and IL-4 in the combined group was significantly better than that in the western medicine group and before treatment(P<0.05),and the improvement in the observation group was better than that in the combined group;there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion:catgut embedding combined with Jianpi Qushi Huayu ointment can significantly alleviate the related clinical symptoms and signs,effectively control the further aggravation of the disease,improve the lung function of patients,regulate the level of inflammatory cytokines to reduce the degree of inflammatory reaction,and do not significantly aggravate the adverse reactions of drugs.

Role of vitamin D in cystic fibrosis and non-cystic fibrosis bronchiectasis

Bronchiectasis is usually classified as cystic fibrosis(CF) related or CF unrelated(non-CF); the latter is not considered an orphan disease any more, even in developed countries. Irrespective of the underlying etiology, bronchiectasis is the result of interaction between host, pathogens, and environment. Vitamin D is known to be involved in a wide spectrum of significant immunomodulatory effects such as down-regulation of pro-inflammatory cytokines and chemokines. Respiratory epithelial cells constitutively express 1α-hydroxylase leading to the local transformation of the inactive 25(OH)-vitamin D to the active 1,25(OH)_2-vitamin D. The latter through its autocrine and paracrine functions up-regulates vitamin D dependent genes with important consequences in the local immunity of lungs. Despite the scarcity of direct evidence on the involvement of vitamin D deficiency states in the development of bronchiectasis in either CF or non-CF patients, it is reasonable to postulate that vitamin D may play some role in the pathogenesis of lung diseases and especially bronchiectasis. The potential contribution of vitamin D deficiency in the process of bronchiectasis is of particular clinical importance, taking into consideration the increasing prevalence of vitamin D deficiency worldwide and the significant morbidity of bronchiectasis. Given the well-established association of vitamin D deficiency with increased inflammation, and the indicative evidence for harmful consequences in lungs, it is intriguing to speculate that the administration of vitamin D supplementation could be a reasonable and cost effective supplementary therapeutic approach for children with non-CF bronchiectasis. Regarding CF patients, maybe in the future as more data become available, we have to re-evaluate our policy on the most appropriate dosage scheme for vitamin D.

The Role of Vitamin D3 Therapy in Pediatric Bronchiectasis Severity (CF versus non-CF Patients)

Objective: To determine and compare the effect of vitamin D3 supplementation on modifying the disease severity in cystic fibrosis (CF) and non-CF bronchiectasis pediatric patients. Methods: A randomized clinical trial evaluating the role of oral vitamin D3 supplementation for six months, was performed in forty patients with CF and non-CF bronchiectasis under the age of 18 years with vitamin D deficiency or insufficiency. The primary outcome was to reach the sufficient Vitamin D level, the secondary outcome was to reevaluate bronchiectasis severity by following up the frequency, severity of pulmonary exacerbations and lung function after vitamin D3 supplementation. Results: Forty patients completed the trial. The percentage of improvement of vitamin D level after vitamin D3 supplementation for six months was significantly higher in CF (88.3%) than non-CF bronchiectasis patients (59.82%) (P = 0.03). Additionally, moderate to severe pulmonary exacerbations significantly decreased by more than 60%, 45% (P = 0.001, 0.005) and frequent exacerbations decreased by 15%, 10% (P = 0.327, 0.490), while the forced expiratory volume in 1 (FEV1) significantly increased by 17% and 15% in non CF bronchiectasis and CF patients respectively (p < 0.001). Conclusions: Vitamin D3 therapy was effective in decreasing the frequency and severity of pulmonary exacerbations and preserving lung function. Thereby, improving the disease severity even more in non-CF bronchiectasis than CF patients.

The Benefits of Pulmonary Rehabilitation Program on Post-Tuberculosis Bronchiectasis

Pulmonary rehabilitation has emerged as a recommended standard of care for patients with chronic lung disease. As in chronic obstructive pulmonary disease (COPD), persons with other forms of chronic respiratory disease commonly experience deconditioning and decreased quality of life. The aim of this prospective study is to determine the effect of a 4-week pulmonary rehabilitation program (PRP) on patients diagnosed with post-pulmonary tuberculosis bronchiectasis in the Philippines. The participants were above 18 years of age, diagnosed to have stable Post-Pulmonary tuberculosis bronchiectasis with chest computerized tomography (CT) scan or chest radiograph showing bronchiectatic changes, consented to attend the PRP sessions and be included in the study. The subjects underwent PRP for 4 weeks with a total of 8 sessions and determination of Forced expiratory volume at 1 second (FEV1), forced vital capacity (FVC), quality of life determination using the Saint George Respiratory Disease Questionnaire (SGRQ), and exercise endurance using the 6-minute walking test (6 MWT), before and after the PRP. A total of fourteen patients, six males and eight females, aged from 28 - 72 years old, completed the 4-week pulmonary rehabilitation program. There were four ex-smokers and ten non-smokers with concomitant asthma and COPD in some patients. There was significant improvement in the 6-minute walk test and quality of life after 4 weeks of rehabilitation program among the subjects with p value for 6 MWT at p = 0.0001 and p = 0.008 for SGRQ. Conclusion: Pulmonary rehabilitation program led to a significant improvement in exercise capacity and health related quality of life among patients with post-pulmonary tuberculosis bronchiectasis.

Impact of Immunoglobulin E and Airway Obstruction on Bronchiectasis

Introduction: Although an increased prevalence of airway obstruction, bronchial hyperreactivity and allergic diseases such as asthma has been associated with bronchiectasis, studies investigating role of atopy in bronchiectasis are few and controversial. We have therefore studied IgE level and reversible airways obstruction in bronchiectasis which have not previously been evaluated in bronchiectasis. Patients and Methods: This study was conducted at Department of Chest Diseases of Al-Azhar University, Assiut, Egypt from January 2012 to December 2013, all consecutive patients with bronchiectasis admitted to the department were enrolled to the study. Serum IgE, pulmonary function tests (PFT) and high resolution computerized tomography (HRCT) were done to all cases. Results: Patients with high IgE (32/50) had longer disease duration and frequent history of allergic diseases. They also had significantly worse FEV1 (49.38 ± 12.65;p = 0.041) and FEV1/FVC (60.89 ± 13.52, p = 0.015) values. Mean HRCT score was significantly higher in patients with high IgE than in patients with normal (18/50) IgE (23.6 ± 10.1 and 7.83 ± 2.43 respectively). IgE showed positive correlation (r = 0.266, p = 0.015) with HRCT scores. Furthermore, the mean increase in FEV1 after inhalation of salbutamol was significantly greater (p = 0.002) in high IgE patients. Conclusions: In conclusion, IgE level is significantly high in bronchiectasis and it may lead to worse pulmonary function and more HRCT extent. Appreciable reversible airways obstruction should be sought in all cases of bronchiectasis and treated appropriately.

Effect of bronchoscopic ambroxol lavage on inflammatory factors in lavage fluid of patients with bronchiectasis complicated by infection

Objective:To study the effect of bronchoscopic ambroxol lavage on inflammatory factors in lavage fluid of patients with bronchiectasis complicated by infection.Methods:100 patients with bronchiectasis complicated by infection who were treated in our hospital between May 2012 and January 2016 were divided into the control group (n=54) who received conventional treatment and the observation group (n=46) who received intravenous anti-infection combined with bronchoscopic ambroxol lavage after the therapies were reviewed. The contents of inflammatory factors, adhesion molecules and acute phase proteins in lavage fluid were compared between the two groups.Results: Before treatment, the differences in contents of inflammatory factors, adhesion molecules and acute phase proteins in lavage fluid were not statistically significant between two groups of patients. After treatment, inflammatory factors IL-4, IL-6, IL-10 and TNF-α contents in lavage fluid of observation group were lower than those of control group;adhesion molecules sICAM-1 and VCAM-1 contents in lavage fluid were lower than those of control group;acute phase proteins CRP, AAG, HPT and CER contents in lavage fluid were lower than those of control group.Conclusion:Bronchoscopic ambroxol lavage can reduce airway inflammation in patients with bronchiectasis complicated by infection.

Distribution of Major Pathogens from Sputum and Bronchoalveolar Lavage Fluid in Patients with Noncystic Fibrosis Bronchiectasis： A Systematic Review

Objective： Noncystic fibrosis （non-CF） bronchiectasis remains as a common health problem in Asia. Pathogens＇ distribution in airways of patients with non-CF bronchiectasis is important for doctors to make right decision. Data Sources： We performed this systematic review on the English language literatures from 1966 to July 2014, using various search terms included ＂pathogens＂ or ＂bacteria＂ or ＂microbiology＂ and ＂bronchiectasis＂ or ＂non-cystic fibrosis bronchiectasis＂ or ＂non-CF bronchiectasis＂ or ＂NCFB.＂ Study Selection： We included studies of patients with the confirmed non-CF bronchiectasis for which culture methods were required to sputum or bronchoalveolar lavage fluid （BALF）. Weighted mean isolation rates for Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Stapylococcus aureus, Moxarella catarrhails were compared according to different methodology. Results： The total mean bacterial culture positive rates were 63%. For studies using sputum samples, the mean positive culture rates were 74%. For studies using BALF alone or BALF and sputum, it was 48%. The distributions of main bacterial strains were 29% for 1-1. influenzae, 28% for P. aeruginosa, 11% for S. pneumoniae, 12% for S. aureus, and 8% for M. catarrhails with methodology of sputum. Meanwhile, the bacterial distributions were 37% for H. influenzae, 8% for P aeruginosa, 14% for S. pneumoniae, 5% for S. attretts, and 10% for M. catarrhails with methodology of BALF alone or BALF and sputum. Analysis of the effect of different methodology on the isolation rates revealed some statistically significant differences. Conclusions： H. influenzae accounted for the highest percentage in different methodology. Our results suggested that the total positive culture rates and the proportion of P. aeruginosa from sputum and BALF specimens had significant differences, which can be used in further appropriate recommendations for the treatment of non-CF bronchiectasis.

Completely thoracoscopic lobectomy for the surgical management of bronchiectasis

Background The feasibility of completing a Iobectomy by completely video-assisted thoracoscopic surgery （cVATS） in the management of bronchiectasis is unclear. By retrospectively comparing the outcomes from the Iobectomies that used thoracotomy vs. cVATS, we determined the appropriateness of the minimally invasive cVATS approach in the management of bronchiectasis. Methods Between June 2001 and October 2010, 60 patients with bronchiectasis underwent surgery, of which 56 Iobectomies were performed. All Iobectomies were carried out by either thoracotomy or cVATS approach. Pulmonary vessels and bronchi were manipulated by ligation or stapler in the thoracotomy group, while they were dissected by endo-cutters in the cVATS group. Results There were 21 patients in the thoracotomy group and 35 patients in the cVATS group. Two cVATS patients （5.7%） converted. The difference in operation time, chest tube duration, lengths of hospitalization, and morbidity were not significantly different between the two groups （P 〉0.05）. The blood loss was less in the cVATS group （P=0.015）. A total of 52.4% and 62.9% of patients were postoperatively asymptomatic in the thoracotomy and cVATS groups respectively, and symptomatic improvement was obtained in 38.1% patients by thoracotomy vs. 31.4% patients by cVATS. Conclusion cVATS Iobectomy is safe and effective for the management of bronchiectasis, especially for the patients with localized lesions.

Bronchiectasis as a Comorbidity of Chronic Obstructive Pulmonary Disease： Implications and Future Research

Chronic obstructive pulmonary disease （COPD） is a heterogeneous disease with high morbidity and mortality. With increasing use of computed tomography in the assessment of patients with COPD, the presence of previously unrecognized radiological bronchiectasis is being identified. Accumulating evidence shows that bronchiectasis has an important impact on the natural history of COPD. Moderate-severe COPD with eomorbid bronchiectasis has more severe symptoms, higher frequency of exacerbations, and increased mortality Given the prognostic implications of bronchiectasis in COPD, its detection could serve as a guide to better management and eventually improved survival. Therefore, bronchiectasis was proposed as a comorbidity of COPD by Global Initiative for Chronic Obstructive Lung Disease （GOLD） updated 2014.

Thoracoscopic management for bronchiectasis with non-tuberculous mycobacterial infection

Background Non-tuberculous mycobacteria （NTM） have emerged as important opportunistic pathogens of the human being in recent years. Patients with pre-existing bronchiectasis are susceptible to NTM. However, information about its occurrence among bronchiectatic patients in Shenzhen, China is lacking and its impact on the course of bronchiectasis following surgical intervention is unknown. This preliminary study aimed to investigate the prevalence of NTM in bronchiectasis that required surgery in our center, evaluate the role of intraoperative routine screening for NTM, and summarize our initial experience in thoracoscopic management for bronchiectatic patients with NTM. Methods A retrospective analysis of clinical, microbiological data of our bronchiectatic patients with NTM over 5 years was made and 40 patients with bronchiectasis were studied to determine the role of intraoperative routine screening for NTM. Results The prevalence of NTM in this population of patients with bronchiectasis in our center was 6.7% （7/105）. The diagnostic yield of the 40 intraoperative specimens was 7.5% （3/40）. Of the 7 patients with bronchiectasis and NTM, 3 patients developed postoperative wound infections. All were cured with chemotherapy for 8-12 months along with vigorous surgical debridement. Another patient had a slow growth of mycobacteria involving double lungs and the right thoracic cavity and recovered after chemotherapy for nearly 14 months and tube drainage. The affected tissue was completely resected in the remaining 3 patients with no operative mortality and postoperative morbidity, and routine intraoperative screening for NTM was initiated in these patients. Conclusions NTM is not uncommon in bronchiectatic patients which deserves surgeons＇ utmost attention. Routine intraoperative screening for NTM identified otherwise unsuspected patients has shown favorable outcomes. Thoracoscopic management for bronchiectasis with NTM is technically feasible although its role remains to be defined.

Bronchiectasis： still a problem

Objective The purpose of this descriptive review was to delineate the current knowledge of bronchiectasis in terms of prevalence,burden of disease,pathophysiology,and management.Data sources The National Library of Medicines MEDLINE and PubMed database （2005-2013） were used to conduct a search using the keyword term ＂bronchiectasis＂.The references for articles being considered for inclusion were searched from additional sources such as conference proceedings.Study selection Criteria for inclusion of articles included data outlining epidemiology,pathogenesis,diagnosis,and evidence-based guidelines for management of bronchiectasis.In assessing the quality of the articles,factors such as size of the population studied,clinical setting of the study,and whether or not the studies were prospective or retrospective were taken into consideration.Review articles were also included in our data collection.Results Despite many advances in modem medicine,bronchiectasis still remains a significant public health problem in developed countries and the developing world.It carries a significant burden worldwide in terms of morbidity and mortality,as well as financially to the affected population.In addition,bronchiectasis may associate with chronic airflow obstruction,regardless of smoking status.Conclusions Bronchiectasis is a debilitating illness responsible for significant morbidity with a poor health-related quality of life.The condition has a substantial socioeconomic cost because both primary and secondary healthcare resources are frequently used and periods of sick leave are common.

Bronchiectasis and COVID-19 infection:a two-way street

Bronchiectasis(BE)has been linked to past viral infections such as influenza,measles,or adenovirus.Two years ago,a new pandemic viral infection severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)broke out and it still persists today,and a significant proportion of surviving patients have radiological and clinical sequelae,including BE.Our aim was to thoroughly review the information available in the literature on the bidirectional relationship between SARS-CoV-2 infection and the development of BE,as well as the impact of this infection on patients already suffering from BE.Available information indicates that only a small percentage of patients in the acute phase of coronavirus disease 2019(COVID-19)pneumonia develop BE,although the latter is recognized as one of the radiological sequelae of COVID-19 pneumonia,especially when it is caused by traction.The severity of the initial pneumonia is the main risk factor for the development of future BE,but during the COVID-19 pandemic,exacerbations in BE patients were reduced by approximately 50%.Finally,the impact of BE on the prognosis of patients with COVID-19 pneumonia is not yet known.

Imaging evaluation of hemoptysis in children

Hemoptysis is an uncommon but distressing symptom in children. It poses a diagnostic challenge as it is difficult to elicit a clear history and perform thorough physical examination in a child. The cause of hemoptysis in children can vary with the child's age. It can range from infection, milk protein allergy and congenital heart disease in early childhood, to vasculitis, bronchial tumor and bronchiectasis in older children. Acute lower respiratory tract infections are the most common cause of pediatric hemoptysis. The objective of imaging is to identify the source of bleeding, underlying primary cause, and serve as a roadmap for invasive procedures. Hemoptysis originates primarily from the bronchial arteries. The imaging modalities available for the diagnostic evaluation of hemoptysis include chest radiography, multi-detector computed tomography(MDCT), magnetic resonance imaging(MRI) and catheter angiography. Chest radiography is the initial screening tool. It can help in lateralizing the bleeding with high degree of accuracy and can detect several parenchymal and pleural abnormalities. However, it may be normal in up to 30% cases. MDCT is a rapid, non-invasive multiplanar imaging modality. It aids in evaluation of hemoptysis by depiction of underlying disease, assessment of consequences of hemorrhage and provides panoramic view of the thoracic vasculature. The various structures which need to be assessed carefully include the pulmonary parenchyma, tracheobronchial tree, pulmonary arteries, bronchial arteries and non-bronchial systemic arteries. Since the use of MDCT entails radiation exposure, optimal low dose protocols should be used so as to keep radiation dose as low as reasonably achievable. MRI and catheter angiography have limited application.

Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review

Significant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been established. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.

High-resolution computed tomography findings in humoral primary immunodeficiencies and correlation with pulmonary function tests

AIM To compare high-resolution computed tomography(HRCT) findings between humoral primary immunodeficiencies(hPIDs) subtypes; to correlate these findings to pulmonary function tests(PFTs).METHODS We retrospectively identified 52 consecutive adult patients with hPIDs who underwent 64-row HRCT and PFTs at the time of diagnosis. On a per-patient basis, an experienced radiologist recorded airway abnormalities(bronchiectasis,airway wall thickening, mucus plugging, tree-in-bud, and air-trapping) and parenchymal-interstitial abnormalities(consolidations, ground-glass opacities,linear and/or irregular opacities, nodules, and bullae/cysts) found on HRCT.The chi-square test was performed to compare the prevalence of each abnormality among patients with different subtypes of hPIDs. Overall logistic regression analysis was performed to assess whether HRCT findings predicted obstructive and/or restrictive PFTs results(absent-to-mild vs moderate-tosevere).RESULTS Thirty-eight of the 52 patients with hPIDs showed common variable immunodeficiency disorders(CVID), while the remaining 14 had CVID-like conditions(i.e., 11 had isolated IgG subclass deficiencies and 3 had selective IgA deficiencies). The prevalence of most HRCT abnormalities was not significantly different between CVID and CVID-like patients(P > 0.05), except for linear and/or irregular opacities(prevalence of 31.6% in the CVID group and 0 in the CVID-like group; P = 0.0427). Airway wall thickening was the most frequent HRCT abnormality found in both CVID and CVID-like patients(71% of cases in both groups). The presence of tree-in-bud abnormalities was an independent predictor of moderate-to-severe obstructive defects at PFTs(Odds Ratio, OR, of 18.75, P < 0.05), while the presence of linear and/or irregular opacities was an independent predictor of restrictive defects at PFTs(OR = 13.00; P < 0.05).CONCLUSION CVID and CVID-like patients showed similar HRCT findings. Tree-in-bud and linear and/or irregular opacities predicted higher risks of, respectively,obstructive and restrictive defects at PFTs.

A rare complication of a rare disease: Amyloidosis in situs inversus

A 31-year-old female admitted with productive cough and progressively increasing edema in her legs. Four years ago she had the diagnosis of situs inversus (SI) totalis. She had6.5 g/day proteinuria in 24-hour urine analysis. High resolution computed tomography revealed bronchiectatic areas in the left lung. In renal biopsy, kongo and amyloid AA antibody positivity was detected in arteriolar walls and mesangial areas. The patient is currently being followed with ramipril and colchicine treatments. Primary ciliary dyskinesia (PCD) and resultant SI totalis are very rare anomalies characterized by the total inversion of all organs and chronic bronchiectasis. There are very few reports on the association of SI totalis with nephrotic syndrome. Patients with SI totalis and chronic bronchiectasis have increased risk of AA amyloidosis and possibly end stage renal disease and thus these patients should be regularly followed with proteinuria and serum creatinine levels.

Destroyed Lung Syndrome: A Review of 31 Published Cases

Background: Destroyed lung is a lung condition commonly caused by tuberculosis. Other causes include bronchiectasis, aspergilloma, emphysema, etc. It is characterized by extensive lung destruction and reduced lung function. Chest X-ray, chest CT, bronchography, and ventilation-perfusion ratio scan are the commonest radiologic diagnostic tools. Treatment of choice may include pneumonectomy. The study aims to highlight the common causes of destroyed lung and the major presenting complaints based on age, sex and affected lungs. Method: Published cases from English medical journals were evaluated and analyzed. Results: 31 published cases on destroyed lung were reviewed. 58.1% showed that the left lung was the most commonly affected lung. The condition was more common in males (71%). Based on our review, the commonest causes are pneumonia and tuberculosis at 25.9% and 22.8%, respectively. Conclusion: Pneumonia and Tuberculosis seem to be the commonest causes of destroyed lung based on our review, with left sided affectation being more predominant.

Lady Windermere Syndrome: An Interesting Clinical and Radiological Presentation

Lady Windermere Syndrome is an uncommon pulmonary disease characteristically observed in elderly white females with chronic cough suppression and dyspnea. It is classically associated with Mycobacterium avium complex (MAC) species. An 84-year-old female was evaluated for longstanding non-productive cough and intermittent dyspnea. A chest computed tomography scan revealed densities in the right upper lobe and scattered nodular-cystic bronchiectasis. Biopsy was negative for malignancy;however, bronchioalveolar lavage studies showed presence of MAC. Patient was treated with a 12-month course of azithromycin, rifampin and ethambutol resulting in resolution of her symptoms.

Computed tomography imaging and clinical significance of bacterium-positive pulmonary tuberculosis complicated with diabetes

BACKGROUND The increasing prevalence of tuberculosis(TB)and diabetes on a global scale poses a significant health challenge,particularly due to their co-occurrence,which amplifies the severity,recurrence and mortality rates associated with both conditions.This highlights the need for further investigation into their interrelationship.AIM To explore the computed tomography(CT)imaging and clinical significance of bacterium-positive pulmonary TB(PTB)combined with diabetes.METHODS There were 50 patients with bacterium-positive PTB and diabetes,and 50 with only bacterium-positive PTB.The latter were designated as the control group.The CT imaging of the two groups of patients was compared,including lesion range,shape,density and calcification.RESULTS No significant differences were observed in age,gender,smoking and drinking history,high blood pressure,hyperlipidemia and family genetic factors between the groups.However,compared to the patients diagnosed solely with simple bacterium-positive PTB,those with concurrent diabetes showed a wider range of lesions and more complex and diverse morphology on CT images.Among them,intrapulmonary tuberculosis lesions were often accompanied by manifestations of pulmonary infection,such as cavity formation and bronchiectasis.At the same time,diabetes-related signs were often seen on CT images,such as pulmonary infection combined with diabetic pulmonary lesions.Logistic regression analysis identified age and medical history as significant factors influencing the degree of pulmonary infection and CT imaging outcomes in patients with both TB and diabetes.This suggests that older age and specific medical histories may increase the risk or severity of pulmonary damage in these patients.CONCLUSION CT imaging reveals more complex lesions in PTB patients with diabetes,emphasizing the need for careful evaluation and comprehensive analysis to enhance diagnostic accuracy.

Fegeneration of functional alveoli by adult human SOX9^＋ airway basal cell transplantation

Irreversible destruction of bronchi and alveoli can lead to multiple incurable lung diseases. Identifying lung stem/progenitor cells with regenerative capacity and utilizing them to reconstruct functional tissue is one of the biggest hopes to reverse the damage and cure such diseases. Here we showed that a rare population of SOX9^＋ basal cells （BCs） located at airway epithelium rugae can regenerate adult human lung. Human SOX9^＋ BCs can be readily isolated by bronchoscopic brushing and indefinitely expanded in feeder-free condition. Expanded human SOX9^＋ BCs can give rise to alveolar and bronchiolar epithelium after being transplanted into injured mouse lung, with air-blood exchange system reconstructed and recipient＇s lung function improved. Manipulation of lung microenvironment with Pirfenidone to suppress TGF-β signaling could further boost the transplantation efficiency. Moreover, we conducted the first autologous SOX9^＋ BCs transplantation clinical trial in two bronchiectasis patients. Lung tissue repair and pulmonary function enhancement was observed in patients 3-12 months after cell transplantation. Alto- gether our current work indicated that functional adult human lung structure can be reconstituted by orthotopic transplantation of tissue-specific stem/progenitor cells, which could be translated into a mature regenerative therapeutic strategy in near future.