Wuhan Pulmonary Hospital

Various neurological diseases can cause rapidly progressive dementia, which is a clinical syndrome characterized by a rapid decline in cognitive function over a short period, typically less than 1 or 2years. It can be caused by various neurological diseases, including neurodegenerative, inflammatory, vascular, metabolic, and neoplastic central nervous system diseases. Rapidly progressive dementia is particularly associated with Creutzfeldt-Jakob disease, but other conditions such as immune-mediated encephalitis, rapidly progressive subtypes of Alzheimer's disease, and various other mimics of prion diseases must also be considered. Multiple cerebral microbleeds are typical imaging features of cerebral small vessel diseases, but can also appear in other rare conditions. We describe the case of a 45-year-old Asian female patient with lung adenocarcinoma who exhibited rapidly progressive dementia and multiple cerebral microbleeds. The patient was a 45-year-old woman who experienced rapid cognitive decline without obvious triggers, accompanied by disorganized speech, difficulty in expression, and short-term memory loss. Brain magnetic resonance imaging revealed widely distributed microhemorrhages, while computed tomography and pathological examination further confirmed the diagnosis of lung adenocarcinoma. The patient did not undergo a brain biopsy because of the rapid deterioration of her illness. Her condition deteriorated rapidly, leading to death in the fourth month. Herein, we discuss the presence of the apolipoprotein ε4 allele risk gene and the role of the tumor in causing multiple nodular lesions in the patient's brain, as well as multiple microbleeds. The role of the apolipoprotein ε4 allele risk gene in multiple nodular lesions of the brain and CMB requires further study, as it may be responsible for the rapid cognitive decline and imaging findings observed in patients. The role of the tumor in causing these brain lesions and cerebral microbleeds is also of interest as it may help to provide insight into the pathophysiological mechanisms of rapidly progressive dementia in the context of cancer. This case highlights the need for a comprehensive diagnosis, including magnetic resonance imaging, blood and cerebrospinal fluid analyses, and brain biopsy, to identify treatable causes of rapidly progressive dementia.

Abstract Background The rarity of tuberculous-infected native aortic aneurysms (INAA) limits clinical expertise in its diagnosis and management. This study was conducted to investigate the clinical characteristics of tuberculous INAAs and assess the risk factors for poor outcomes following endovascular aneurysm repair (EVAR). Materials and Methods Cases of tuberculous INAAs were retrospectively reviewed at three Chinese centers (2010–2022) after approval by the institutional review board. Patients with INAAs on thoracic aortas or abdominal aortas were included. ALL included patients underwent EVARs and received preoperative anti-tuberculosis (anti-TB) treatment. Primary outcomes were mortality and infection-related complications (IRCs), analyzed using Cox regression and logistic regression analysis. Results Among the 62 patients included (65.84 ± 10.91 years; 61.3% male), the rupture rate was 22.6%. Logistic regression analysis revealed irregular morphology (Odds Ratio [OR] 10.71; 95% CI 1.43–56.73, p = 0.021) and aneurysm diameter (OR 4.58; 95% CI 1.34–15.75, p = 0.016) as independent predictors of rupture. Postoperative IRCs occurred in 16 patients, of whom 81.25% (13/16) patients died during the 24-month follow-up. Logistic regression analysis revealed that perioperative anti-TB treatment (OR44.87, 95%CI 6.64–303.10; p = 0.002) and an elevated ESR (OR 8.79, 95%CI 1.50-51.45; p = 0.016) were risk factors for IRCs. Kaplan–Meier analysis revealed that the perioperative survival and 6-month, 12-month, and 24-month survival rates were 93.4%, 91.8%, 83.6% and 65.6%, respectively. Cox regression analysis revealed that rupture (HR 2.88, 95% CI 1.11–7.50; p = 0.030) and perioperative anti-TB treatment (HR 4.77, 95% CI 1.78–12.78; p = 0.002) were significant predictors of mortality. Conclusions Tuberculous INAAs are fatal disease with a high rupture rate. Irregular morphology and aneurysm diameter ≥ 5.2 cm predict rupture, warranting prompt surgical interventions. The therapeutic algorithm should be based on serum ESR, aneurysm diameter and morphology, and duration of preoperative anti-TB treatment.

This paper discusses a comprehensive analysis of the pricing of two typed of options and early exercise premiums under the binomial tree model. We find the differences between European and American options, with particular emphasis on the conditions governing optimal early exercise strategies.We verify that early exercise is never the best option for American call options on stocks that pay no dividends, making their pricing the same as their European counterparts.Moreover, in the single-period model, the exercise of American put options depends on K = uq r+q S0, while in contrast, the relative positioning of the strike price and the ultimate stock value influences the exercise decisions in the two-period model.Our analysis indicates that the early exercise premium primarily manifests in multiperiodwhere holders can determine their own exercise timingcreating additional value relative to European put options.

High mobility group box 1 is a dynamic nuclear protein that acts as a damage-associated molecular pattern when released from cells and plays key roles in neurodegenerative diseases. This review comprehensively analyzes the related post-translational modifications that affect the dual functions of high mobility group box 1 in neuroinflammation and neuronal survival, including acetylation, phosphorylation, oxidation, S-nitrosylation, lactylation, and ubiquitination. Post-translational modifications play critical regulatory roles in high mobility group box 1 subcellular localization, release processes and the specificity of receptor binding. In Alzheimer's disease, high mobility group box 1 exacerbates the disease through the Toll-like receptor 4/nuclear factor kappa B signaling pathway. Inhibition of high mobility group box 1 acetylation can alleviate neuroinflammation. Parkinson's disease models indicate that the S-nitrosylation of Cys106 is essential for the secretion of high mobility group box 1, which contributes to dopaminergic degeneration through the activation of microglia. In multiple sclerosis, high mobility group box 1 obstructs remyelination by inhibiting the maturation of oligodendrocytes and activating pro-inflammatory pathways. In contrast, high mobility group box 1 can maintain autophagy and DNA repair functions, suggesting its protective role. Therapeutic strategies targeting high mobility group box 1 show potential benefits. Glycyrrhizic acid inhibits disulfide-linked high mobility group box 1, SIRT activators suppress acetylation, and anti-high mobility group box 1 antibodies neutralize extracellular isoforms, thereby improving the results of preclinical studies. However, the diverse functions of high mobility group box 1 and the lack of post-translational modification-specific biomarkers present challenges for clinical translation. Future research should aim to create selective inhibitors that can cross the blood-brain barrier to target harmful forms of high mobility group box 1, and establish post-translational modification-based biomarkers for early detection. This review emphasizes that accurately targeting of high mobility group box 1 post-translational modifications in neurodegenerative diseases could be a new approach that can interrupt neuroinflammatory cascades while maintaining neuroprotective functions.

BackgroundMental health disorders and metabolic dysfunction-associated steatotic liver disease (MASLD) represent substantial global public health challenges. The precise relationship between mental health parameters and MASLD development remains poorly characterized.MethodsUsing data from the UK Biobank cohort, we conducted a prospective cohort study to evaluate participants’ anxiety, depression, mania, and trauma exposure scores using standardized psychometric instruments. Metabolic signatures were derived through elastic net regularization coupled with Cox proportional hazards modeling. Mediation analyses quantified the proportion of mental health-MASLD associations attributable to metabolic pathway alterations.ResultsThe analytical cohort comprises 55,012 participants with trauma assessments, 15,318 with mania evaluations, 30,798 with depression metrics, and 17,596 with anxiety profiles. Multivariable-adjusted analyses reveal significant dose-response relationships between mental health burden and MASLD incidence: anxiety (HR = 1.13, 95%CI 1.08–1.18, P < 0.05), depression (HR = 1.06, 95%CI 1.03–1.10, P < 0.05), mania (HR = 1.15, 95%CI 1.06–1.24, P < 0.05), and trauma (HR = 1.22, 95%CI 1.11–1.34, P < 0.05). Metabolic analyses indicate that creatinine, glutamine, and the triglyceride fraction of very low-density lipoprotein (VLDL-triglyceride%) serve as key mediators in the pathway through which mental health influences MASLD incidence. The derived metabolic signature demonstrates significant mediation effects across all psychological domains (anxiety: 12.7%, depression: 15.7%, mania: 11.5%, trauma: 11.2%).ConclusionsThis large-scale cohort study establishes clinically significant mental health conditions as risk factors for MASLD development, with metabolic dysregulation serving as a partial mediator of this association. The identified metabolite panel, particularly perturbations in nitrogen metabolism and lipid partitioning, provides mechanistic insights into psychosomatic pathways influencing hepatic steatosis, suggesting potential targets for interdisciplinary intervention strategies.

ObjectiveThe recurrence rate of post-tuberculosis chronic pulmonary aspergillosis (post-TB CPA) is alarmingly high. This study aims to establish a risk prediction model utilizing machine learning algorithms to forecast the one-year recurrence risk of post-TB CPA.MethodsThis retrospective study included all patients diagnosed with pulmonary tuberculosis complicated by chronic pulmonary aspergillosis at Wuhan Pulmonary Hospital in 2022. Ultimately, 220 patients were included for the significance analysis.The Least Absolute Shrinkage and Selection Operator LASSO regression analysis was utilized to select 8 variables associated with the recurrence of tuberculosis complicated by chronic pulmonary aspergillosis. Four machine learning algorithms were compared to predict the recurrence risk in patients with this complication, with their performance evaluated using the receiver operating characteristic curve, area under the curve (AUC), calibration curve analysis, and decision curve analysis.ResultsLASSO regression analysis identified chronic obstructive pulmonary disease (COPD), chronic fibrotic pulmonary aspergillosis (CFPA), progressive pleural hypertrophy, fungal culture results, age, disease duration, emphysema and treatment duration as factors related to the recurrence risk of tuberculosis complicated by chronic pulmonary aspergillosis. The logistic regression model demonstrated the best performance, it outperformed the other three models by achieving the highest AUC of 0.779 on the internal validation set and 0.819 in the test cohort. The calibration curve indicated a strong correlation between the actual and predicted probabilities, while the decision curve analysis revealed significant clinical benefits.DiscussionIn this study, we developed a disease recurrence prediction model using machine learning techniques. This model aims to assist clinicians in identifying the most relevant risk factors associated with the recurrence of tuberculosis complicated by chronic pulmonary aspergillus. It facilitates the formulation of targeted and effective re-examination plans for discharged patients, ultimately reducing the recurrence rate after discharge and enhancing the quality of life for these patients.

Cat scratch disease (CSD), caused by Bartonella henselae (B. henselae), typically presents as localized swelling of lymph nodes following a scratch or bite from a cat. It is crucial to differentiate CSD from tuberculosis (TB), particularly in regions where TB is prevalent. This report describes a 56-year-old man who exhibited bilateral swelling of the cervical lymph nodes. Initially, he was suspected to have tuberculous lymphadenitis due to the granulomatous changes observed in a biopsy of the lymph nodes, typical signs of TB on a chest CT scan, and a positive result from an interferon-gamma release assay (IGRA). He was subsequently referred to our hospital for TB treatment. Testing of bronchoalveolar lavage fluid confirmed the presence of TB-DNA, indicating active pulmonary tuberculosis (PTB). However, further investigation revealed recent cat contact. This led to the identification of a B. henselae infection using metagenomic pathogen detection workflow (MetaPath™) on formalin-fixed paraffin-embedded (FFPE) histopathological sections from a cervical lymph node specimen obtained at an external hospital, which confirmed the diagnosis of CSD and ruled out TB. Through a review of the literature, we found that this represents the first documented case of concurrent active PTB and CSD-related lymphadenitis in an immunocompetent individual. It highlights the diagnostic challenges in distinguishing CSD from TB in cases of granulomatous lymphadenitis and emphasizes the need to consider CSD in patients with a history of cat exposure, showcasing the pivotal role of advanced metagenomic diagnostics in accurately diagnosing CSD.

BackgroundTuberculosis (TB) is recognized as a serious public health concern in many developing countries. As the new main force and inheritors of national health construction, college students bear important social responsibilities and missions of practicing TB prevention and control, volunteer mobilization, and health concept dissemination. Improving college students' health literacy is crucial to preventing and treating infectious diseases. This study aims to assess college students' knowledge, attitudes, and practices (KAP) about TB prevention and treatment in Wuhan, China.MethodsA descriptive cross-sectional study survey among college students was conducted from May to June 2022 at 22 colleges using the judgment sampling method in Wuhan. KAP regarding TB was recorded and assessed using an online questionnaire platform. The status quo of KAP regarding TB prevention and treatment was statistically described, and the formation of students' TB prevention and treatment behavior was analyzed using single-factor and multifactor logistic regression.ResultsA total of 15,290 college students completed the questionnaire, and 15,272 valid questionnaires were collected. The total awareness rate of knowledge, attitudes, and practices of TB prevention and treatment was 79.69%. Among them, the awareness rate of key knowledge was 79.28%, and the passing rate was 92.46%. The holding rate of correct attitudes was 89.69%, and the passing rate was 90.56%. The formation rate of correct behaviors was 72.11%, and the passing rate was 96.62%. A single-factor analysis showed that gender, grade, parents' education level, contact history of TB patients, and passing rate of key knowledge were statistically different in the formation of prevention and treatment behaviors. Multivariate logistic regression analysis showed that for females (odds ratio [OR] = 1.86, 95% CI [1.50, 2.30], p &amp;lt; 0.01), students with father's educational background of primary school (OR = 2.94, 95%CI [1.62, 5.33], p &amp;lt; 0.01), junior school and equivalent (OR = 2.94, 95%CI [1.62, 5.33], p &amp;lt; 0.01), high school and equivalent (OR = 3.05, 95%CI [1.70, 5.46], p &amp;lt; 0.01), and diploma or undergraduate (OR = 3.24, 95% CI [1.73, 6.09], p &amp;lt; 0.01); no history of TB (OR = 3.32, 95% CI [1.49, 7.41], p &amp;lt; 0.01); a passing key knowledge score (OR = 9.91, 95% CI [8.11, 12.11], p &amp;lt; 0.01); and a passing attitude score (OR = 7.35, 95% CI [6.01, 8.99], p &amp;lt; 0.01) were likely to form TB prevention and treatment behaviors.ConclusionSchool health promotion should not only focus on improving students' personal knowledge and skills of TB prevention and treatment but also emphasize the level of family participation, strengthen the comprehensive mobilization action of schools, formulate policies to support health action, create a supportive social environment, and radiate the health education effect of students to the whole society.