Pulmonary sequestration (PS) is a rare congenital malformation. This study presents the characteristics of PS in adult patients, including pulmonary function and concurrent infection, which have not been well documented previously. Patients ≥16 years old with a discharge diagnosis of PS from Peking Union Medical College Hospital between January 1990 and December 2013 were retrospectively analysed. Age, sex, clinical symptoms, chest computed tomography (CT) results, results of pulmonary function tests, diagnostic methods, type and localization of sequestration, origin of arterial supply, complications due to infection and treatment information were retrieved from hospital records and analysed. Seventy-two patients were included in this study (mean age 36.6 ± 11.8 years). Clinical symptoms included cough, expectoration, haemoptysis, intermittent fever and chest pain. The most common CT findings were soft tissue opacity, cystic lesion, cavitary lesion and bronchiectasis. Intralobar and extralobar sequestrations were present in 92.8 and 7.2% of the patients, respectively. PS located in the left lower lobe was 2.1 times more frequent than that in the right lower lobe. PS was diagnosed by computed tomography angiography (CTA) in only 37.5% of patients; the remaining patients were undiagnosed before surgery. Obstructive ventilation dysfunction was found in 8.8% of patients. Pulmonary aspergillosis was detected in 9.7% of patients, and Pseudomonas aeruginosa was the leading pathogen (as determined by tissue cultures). PS was resected via thoracotomy in 87.0% of patients and via video-assisted thoracoscopic surgery (VATS) in 13.0%. PS is a rare disease, and missed diagnosis and misdiagnosis are very common in PS patients. CTA and other angiography techniques should be used when there is suspicion of PS. Some PS patients have mild to moderate derangement of pulmonary ventilation, and PS might be associated with concurrent aspergillosis. VATS and posterolateral thoracotomy are both feasible methods for PS resection.

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) is underdiagnosed. Screening patients at high risk of OSAHS is extremely important. Using the standard questionnaire to screen OSAHS is a practical method. This study aimed to evaluate the value of the STOP-Bang questionnaire (SBQ) in screening OSAHS in sleep-disordered breathing clinic by comparing it with the Epworth sleepiness scales (ESS), Berlin questionnaire, and STOP questionnaire. Methods: In this study, 212 patients at the sleep-disordered breathing clinic of the Peking Union Medical College Hospital between May 2011 and January 2012 were prospectively included. They were asked to fill in the SBQ, ESS, Berlin questionnaire, and STOP questionnaire before overnight polysomnography (PSG). Using PSG as gold standard, the sensitivities and specificities of SBQ were compared with those of ESS, Berlin questionnaire, and STOP questionnaire. Results: There was no significance in applying ESS score ≥11 to screen OSAHS and detect moderate and severe OSAHS (P >0.05). SBQ was superior to Berlin questionnaire and STOP questionnaire in screening OSAHS and detecting the severity of OSAHS patients. The sensitivities of SBQ score ≥3 with apnea hypopnea index (AHI) ≥5/h, AHI ≥15/h, and AHI ≥30/h as gold standards were 94.9%, 96.5%, and 97.7%, respectively. The specificities were 50.0%, 28.6%, and 17.9%, respectively. The area upper curves were 0.815 (0.706–0.925, P <0.01), 0.746 (0.665–0.828, P <0.01), and 0.751 (0.686–0.817, P <0.01), respectively. According to SBQ, the population was classified into high-risk group and low-risk group. The gender, BMI, neck circumference, AHI, LSpO₂, and number of subjects of AHI ≥5/h, AHI ≥15/h, and AHI ≥30/h of these two groups were significantly different. Conclusions: The SBQ has superior predictive value compared with ESS, Berlin questionnaire, and STOP questionnaire. It should be used further in screening for OSAHS in the general population.

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent, progressive respiratory disease, and acute exacerbations of COPD (AECOPD) can accelerate the deterioration of the disease. Increasing evidence suggests that airway bacterial dysbiosis is associated with AECOPD. However, the exact relationship between changes in the sputum microbiome during AECOPD and clinical indices remains unclear. Methods: In this study, a total of 76 sputum samples were collected from patients with AECOPD (n = 28), stable COPD (n = 23), recovery (n = 15) and healthy controls (HCs; n = 10). The sputum microbiome profile was analysed by sequencing the V3‑V4 amplicon of the 16S rRNA (ribosomal RNA) gene. Results: The bacterial diversity (Shannon and Simpson’s index) was found to be significantly decreased in the AECOPD and recovery groups when compared to that in the stable COPD and HC groups. The most dominant phylum identified in the sputum samples of AECOPD patients was Proteobacteria, accounting for 30% of the microbiome. Compared to the stable COPD groups, the relative abundances of Firmicutes and Bacteroidetes were decreased, whereas those of Proteobacteria and Actinobacteria were increased in AECOPD patients. Furthermore, discriminative bacteria, such as Haemophilus, were identified as being specific taxa in AECOPD patients. Functional analysis showed that genes involved in membrane transport and signal transduction metabolism were enriched in the AECOPD group. Importantly, the proportions of Veillonella were positively correlated with lung function, and Staphylococcus was positively correlated with inflammatory indices. Conclusion: Our study revealed variations in the sputum microbiome of AECOPD (based on composition and function) in a Chinese cohort and highlighted its correlation to clinical indices. These results indicated that microbial dysbiosis may contribute to disease progression and provide microbial biomarkers for the diagnosis of AECOPD.

Obstructive sleep apnea (OSA) is a common and heterogeneous disease characterized by episodic collapse within the upper airways, which leads to reduced ventilation and adverse consequences, including hypoxia, hypercapnia, sleep fragmentation, and long-term effects such as cardiovascular comorbidities. The clinical diagnosis of OSA and its severity classification are often determined based on the apnea–hypopnea index (AHI), defining the number of apneic and hypopnea events per hour of sleep. However, the limitations of the AHI to assess disease severity have necessitated the exploration of other metrics for additional information to reflect the complexity of OSA. Novel parameters such as the hypoxic burden have the potential to better capture the main features of OSA by maximizing the information available from the polysomnogram. These emerging measures have described multidimensional qualities of sleep-disordered breathing events and breathing irregularity and will ultimately result in better management of OSA.

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) is the most common sleep-disordered breathing and is still underdiagnosed. This study was designed to evaluate the value of the STOP-Bang questionnaire (SBQ) in screening OSAHS in sleep-disordered breathing clinics in order to extend it into the general Chinese population. Methods: Two hundred and twelve patients undergoing overnight polysomnography (PSG) in the sleep-disordered breathing clinic of Pecking Union Medical College Hospital between May 2011 and January 2012 were prospectively included and were asked to fill in the SBQ. A score of 3 or more of the SBQ indicated a high risk of OSAHS. We analyzed the sensitivities and specificities of SBQ in screening OSAHS. Logistic regression analysis was used to evaluate the probabilities of the severity of OSAHS based upon the apnea hypopnea index (AHI). Results: The patients at high risk of OSAHS had higher AHI, higher oxygen desaturation index (ODI), lower pulse oxygen saturation (LSpO₂) during sleep time and less sleep time in stage N3. SBQ scores were positively correlated with AHI, ODI and the ratio of SpO₂ lower than 90%, and negatively correlated with LSpO₂ during sleep. The sensitivities of the SBQ with AHI ≥5/h, AHI ≥15/h, AHI ≥30/h as cut-offs were 94.9%, 96.5%, and 97.7%, respectively, and the specificities were 50.0%, 28.6%, and 17.9%, respectively. The Logistic regression analysis showed the probability of severe OSAHS increased and the probability of normal subjects decreased with increasing SBQ score. Conclusions: The STOP-Bang questionnaire has excellent sensitivity in screening OSAHS patients and can predict the severity of OSAHS. More studies will be required to determine the value of SBQ in the general Chinese population.

Thorax is the common place to develop Castleman disease (CD), but there is no systemic clinical analysis for intrathoracic CD. We conducted a retrospective analysis of 48 intrathoracic CD patients with definite pathological diagnosis who were hospitalized between 1992 and 2012 in a Chinese tertiary referral hospital. The study included 16 cases with unicentric CD (UCD) and 32 cases with multicentric CD (MCD). UCD were younger than MCD (30.5y vs 41.6ys, P < 0.05). MCD were more symptomatic (50% vs 96.9%, P < 0.001) and sicker than UCD, including more fever, hepatomegaly and/or splenomegaly and hypoalbuminemia. All of UCD showed solitary mass in various sites and two of them were complicated by small pleural effusion. In the MCD group, their chest CT showed obvious lymphadenopathy in the hilum and/or mediastinum (100%), diffuse parenchymal lung shadows (43.75%), pleural effusion (40.6%), mass in the mediastinum (6.25%) or hilum (3.12%) and bronchiolitis obliterans (BO) (3.12%). Besides LIP-like images, multiple nodules of different size and sites, patchy, ground-glass opacities and consolidation were showed in their chest CT. Surgery were arranged for all UCD for diagnosis and treatment and all were alive. In MCD group, superficial lymph nodes biopsies (21 cases), surgery biopsy (9 cases) and CT-guided percutaneous lung biopsy (2 cases) were performed. Hyaline vascular (HV) variant were more common in the UCD group (75% vs 37.5%, P < 0.05). In MCD group, 28 cases were prescribed with chemotherapy, one refused to receive therapy and the rest three were arranged for regular follow-up. Among MCD, 18 cases was improved, 7 cases was stable, 4 cases lost follow-up and 3 cases died. Intrathoracic MCD was more common than UCD in our hospital. MCD was older, more symptomic and sicker than UCD. HV variant were more common in UCD. All of UCD showed mass in various intrathoracic locations and surgery resection was performed for all and all were alive. Mass, pleural effusion, BO and diffuse pulmonary shadows, including LIP-like images, multiple nodules of different size and sites, patchy, GGO and consolidations were showed in our MCD. Most of MCD cases were arranged with chemotherapy and their prognosis were worse than UCD’s.