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To evaluate the analgesic efficacy and safety of paravertebral block (PVB) versus intercostal nerve block (INB) in thoracic surgery and breast surgery. The PubMed, Web of Science, Embase and the Cochrane Library were searched up to February 2020 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of PVB compared with INB after thoracic surgery and breast surgery. For binary variables, odds ratio (OR) and 95% confidence interval (CI) was used. For continuous variables, weighted mean difference (WMD) and 95% confidence interval (CI) were used. RevMan5. 3 and Stata/MP 14.0 were used for performing the meta-analysis. A total of 9 trials including 440 patients (PVB block:222 patients; INB: 218 patients) met the inclusion criteria. In the primary outcome, there was no significant differences between the two groups with respect to postoperative visual analogue scale (VAS) at 1h (Std. MD = -0. 20; 95% CI = -1. 11to 0. 71; P = 0. 66), 2h (Std. MD = -0. 71; 95% CI = -2. 32to 0. 91; P = 0. 39), 24h (Std. MD = -0. 36; 95% CI = -0. 73 to -0. 00; P = 0. 05) and 48h (Std. MD = -0. 04; 95% CI = -0. 20 to 0. 11; P = 0. 57). However, there was significant difference in VAS of non Chinese subgroup at 1h (Std. MD = 0. 33; 95% CI = 0. 25to 0. 41; P<0. 00001) and VAS of Chinese subgroup at 24h (Std. MD = -0.32; 95% CI = -0.49 to-0.14; P = 0.0003). In the secondary outcome, the analysis also showed no significant difference between the groups according to the rates of postoperative nausea and vomit (OR = 0. 63; 95% CI = 0. 38 to 1. 03; P = 0. 06) and the rates of postoperative additional analgesia (OR = 0. 57; 95% CI = 0. 21 to 1. 55; P = 0. 27). There was significant difference in postoperative consumption of morphine (Std. MD = -14. 57; 95% CI = -26. 63 to -0.25; P = 0. 02). Compared with INB, PVB can provide better analgesia efficacy and cause lower consumption of morphine after thoracic surgery and breast surgery.

Severely immunocompromised persons with HIV (PWH) are vulnerable to pulmonary mycobacterial infections (MBI), including Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM). This study aimed to assess the effectiveness of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) in aiding the diagnosis of pulmonary mycobacterial infections in PWH. This study encompassed 146 hospitalized PWH who had a CD4+ T cell count of less than 200 cells/μL. We employed BALF mNGS to pinpoint the causative pathogens of pulmonary infections, with particular focus on pulmonary mycobacterial infections. We evaluated the diagnostic performance of BALF mNGS, and interpreted its clinical significance in detecting mixed infections as appropriate. The median CD4+ T cell count of the participants was 22.5 (IQR: 7.0–63.0) cells/uL. BALF mNGS analysis of 146 severely immunocompromised PWH identified Mycobacterium tuberculosis (13.0%) and M. avium complex (7.5%) as the predominant mycobacterial species, with 9.3% (4/43) of mycobacterial infections showing mixed speciation including TB-NTM co-infections or interspecies NTM coinfections. Furthermore, mNGS demonstrated 78.8% sensitivity (95% CI: 62.2%−89.3%) for proven mycobacterial infections, outperforming conventional culture (68.4% vs. 42.1%, P < 0.01), though missing 7 proven MBI cases. Finally, among 158 co-detected pathogens, Pneumocystis jirovecii (67.1%) and cytomegalovirus (63.0%) were most prevalent, demonstrating co-occurrence rates of 53.5% and 55.8%, respectively in mycobacterial-infected patients. These rates were elevated to 81.2% ( P. jirovecii ) and 65.3% (CMV) in the subset of 101 patients with CD4+ counts <50 cells/μL. The presence of atypical clinical presentations, along with the coexistence of multiple opportunistic pathogens in BALF, complicates the management of pulmonary MBI in PWH. In this context, mNGS has emerged as a highly promising microbiological test that could revolutionize the management of pulmonary MBI in PWH.

What is already known about this topic? In China, patients with human immunodeficiency virus are diagnosed at the CDC and then referred to hospitals for antiretroviral therapy (ART), but treatment delays persist. Previous studies have reported overall delay in time from diagnosis to ART initiation without identifying where delays occur. What is added by this report? A Nanjing cohort study showed that hospital delays were almost eliminated with integrase strand transfer inhibitor (INSTI)-based regimens: 87.9% of patients initiated ART within 7 days of their first hospital visit. However, the main bottleneck remains CDC referral, as 49.8% of patients attended the hospital within 7 days of HIV confirmation. What are the implications for public health practice? Shortening the CDC-to-hospital interval via stronger linkage and equitable INSTI access is critical for achieving rapid ART.

Parkinson’s disease (PD) involves the loss of dopaminergic neurons, and prodromal PD exhibits elevated miR-214-3p, suggesting its role as a biomarker and pathogenic factor. This study investigated miR-214-3p’s effects on mitochondrial function in dopaminergic SH-SY5Y cells and mouse primary cortical neurons. In SH-SY5Y cells, proteomic/transcriptomic analyses and target prediction confirmed GFM1 as a direct target of miR-214-3p. miR-214-3p upregulation downregulated GFM1, causing severe mitochondrial bioenergetic impairment: increased reactive oxygen species (ROS), reduced oxygen consumption, diminished ATP production, and decreased respiratory chain complexes (RCC) I/IV expression. Critically, restoring GFM1 reversed these mitochondrial deficits and neuronal dysfunction. In mouse primary cortical neurons, miR-214-3p overexpression also impaired RCC I/IV but did not affect GFM1, revealing a cell type-dependent regulatory mechanism. These findings demonstrate that elevated miR-214-3p impairs mitochondrial function in a cell-specific manner. In dopaminergic cells, this damage is mediated by GFM1 downregulation, highlighting the miR-214-3p/GFM1 axis as a potential cell-type specific therapeutic target for PD and related dopaminergic neuronopathies.