Yilian Xie

Background: How to increase the diagnosis rate of pulmonary tuberculosis (PTB) has always been a major challenge in medicine. Compared with conventional microbiological tests (CMTs), nanopore targeted sequencing (NTS) is undoubtedly a faster and more effective diagnostic method. This study explores the feasibility of combining chest CT imaging screening with NTS to improve PTB diagnosis. Method: This retrospective observational study was conducted from March 2023 to December 2024, enrolling 380 patients from a single center who underwent bronchoalveolar lavage fluid (BALF) analysis and NTS testing. We compared the diagnostic accuracy of radiologists with varying experience levels to determine the most suitable preliminary screening protocol for PTB. Additionally, we compared NTS results with CMTs (including mycobacterial culture, acid-fast bacilli smear and Xpert MTB/RIF) to evaluate differences in diagnostic performance between NTS and CMTs. Results: We conducted a horizontal comparison of PTB diagnostic accuracy among three radiologists with different levels of experience. The most experienced radiologist had the lowest missed diagnosis rate. When combining cases suspected by all three radiologists (202 cases), the missed diagnosis rate dropped to as low as 9.09% (27.27% [95% CI: 16.77–40.70%] vs. 30.91% [95% CI: 19.73–44.51%] vs. 16.36% [95% CI: 8.38–29.82%] vs. 9.09% [95% CI: 3.80–19.84%], p = 0.019). Furthermore, we analyzed the diagnostic performance of NTS and CMTs in PTB patients and found that NTS had significantly higher sensitivity than Xpert MTB/RIF, mycobacterial culture, and acid-fast bacilli smear (89.09% [95% CI: 78.17–95.02%] vs. 78.18% [95% CI: 65.44–87.12%] vs. 23.64% [95% CI: 13.99–36.99%] vs. 16.36% [95% CI: 8.38–28.82%], p < 0.001). ROC analysis demonstrated that incorporating NTS into the testing of suspected PTB specimens significantly improved diagnostic capability (AUC = 0.990, 95% CI: 0.968–1.000). Conclusion: Radiologists’ experience in PTB imaging diagnosis can reduce missed diagnoses. Additionally, combining NTS with CMTs helps improve early diagnosis in suspected PTB patients. The combined use of NTS and Xpert MTB/RIF yielded the highest diagnostic accuracy (AUC 0.990).

Stress hyperglycemia ratio (SHR), an index reflecting relative hyperglycemia under stress conditions, has been linked to adverse outcomes in various clinical settings. However, its prognostic significance in individuals with nonalcoholic fatty liver disease (NAFLD) remains poorly understood. This study aimed to examine the association between SHR and mortality risk in adults with NAFLD. We analyzed 12,604 adults with NAFLD from the NHANES 1999–2018 database. Multivariable Cox proportional hazards models, restricted cubic spline (RCS) analysis, and Fine–Gray competing risk models were employed to evaluate associations between SHR and all-cause and cardiovascular mortality, During an overall mean follow-up time of 99.26 months, a U-shaped relationship was observed between SHR and all-cause mortality in adults aged 40–59 years and ≥ 60 years. Risk increased at both low and high SHR levels, with identified thresholds at 0.89 for middle-aged and 0.94 for older adults. No significant association was found with cardiovascular mortality. Findings were consistent across subgroups. SHR showed a U-shaped association with all-cause mortality in middle-aged and older adults with NAFLD. Monitoring SHR may help identify high-risk individuals and guide clinical management.

The non-HDL cholesterol to HDL cholesterol ratio (NHHR) is a novel composite lipid index. However, its relationship with mortality, particularly in individuals with non-alcoholic fatty liver disease (NAFLD), remains unclear. The aim of this study was to explore the association between NHHR and both all-cause and cardiovascular mortality in adults with NAFLD in the United States. This study included 12,648 adult participants with NAFLD from the National Health and Nutrition Examination Survey (NHANES) database (1999–2018). Multivariate Cox proportional hazards models and restricted cubic spline (RCS) methods were employed to assess all-cause and cardiovascular mortality. Subgroup analyses were performed to verify the consistency of these associations. Over a median follow-up of 99.27 months, 1,659 participants died from all causes, including 460 from cardiovascular disease. RCS analysis revealed a U-shaped relationship between NHHR and all-cause mortality, no association was found between NHHR and cardiovascular mortality. The inflection points for all-cause mortality were 2.67. Subgroup analysis showed that a stronger association between NHHR and all-cause mortality in those with diabetes(P = 0.048). NHHR is associated with all-cause mortality in NAFLD patients, with distinct non-linear relationships, while it is not associated with cardiovascular mortality. NHHR monitoring may be valuable for assessing mortality risk, particularly in those with diabetes.

Low muscle mass is a critical indicator of frailty and adverse health outcomes. However, the potential link between systemic oxidative stress and low muscle mass remains underexplored. This study aims to investigate the association between the Oxidative Balance Score (OBS) and low muscle mass in U.S. adults. In this cross-sectional study, data from 4096 adults aged 20 to 59 years from National Health and Nutritional Examination Survey (NHANES) 2011 to 2018 were analyzed. Low muscle mass, the primary outcome, was evaluated utilizing the Foundation for the National Institutes of Health (FNIH) definition. Analysis involved the application of restricted cubic splines and weighted multivariate regression techniques. A nonlinear association was observed between OBS and low muscle mass (p for nonlinearity < 0.0049). Compared to the lowest OBS quartile, individuals in the highest quartile had an adjusted OR of 0.26 (95% CI: 0.14–0.48) for low muscle mass (P for trend < 0.001). Additionally, the adjusted β value for ALM/BMI was 0.067 (95% CI: 0.053–0.082), P for trend < 0.001. Both dietary and lifestyle OBS also showed negative associations with low muscle mass, with fully adjusted ORs of 0.38 (95% CI: 0.19–0.76) and 0.17 (95% CI: 0.05–0.62), respectively (both P for trends < 0.01). Furthermore, in stratified analyses, this relationship was particularly prominent in the 40–59 years age group (P for interaction = 0.048). Higher OBS, indicative of greater antioxidant exposure, was robustly associated with a lower risk of low muscle mass, particularly in 40–59 old adults. These findings underscore the potential role of oxidative balance in preserving muscle health and highlight the need for targeted interventions in this demographic. Further longitudinal studies are warranted to confirm these associations and evaluate potential clinical applications.

Epstein–Barr virus-positive mucocutaneous ulcer (EBVMCU) is a rare condition characterized by skin or mucosal lesions resulting from defective immune surveillance of EBV due to immunosuppression, which can be iatrogenic or age-related. It represents a benign lymphoproliferative disorder that clinically may mimic malignant tumors. However, EBVMCU typically progresses slowly and often resolves spontaneously without specific treatment, emphasizing the critical need for differential diagnosis from malignancies. In this study, we report a case of EBVMCU in an elderly patient demonstrating ulcers on the oral mucosa, buccal area, and maxillary mucosa, with associated bone destruction, which was initially suspected to be an oral malignancy but was confirmed as EBVMCU through biopsy. This case underscores the importance of considering EBVMCU in elderly patients with unexplained persistent mucosal ulcers to exclude malignancies. In addition, attention should be given to unhealthy lifestyle habits such as smoking and drinking, as well as poor oral hygiene, which are potential factors that increase the risk of this disease and contribute to worse prognoses.

Background: Previous studies have demonstrated a significant association between serum vitamin A concentration and non-alcoholic fatty liver disease (NAFLD) development. However, the long-term prognostic implications of serum vitamin A in patients with NAFLD remain underexplored. This study aims to investigate whether there exists a correlation between serum vitamin A concentrations and overall mortality among subjects diagnosed with NAFLD.Methods: To investigate the association between serum vitamin A concentrations and NAFLD outcomes, we conducted prospective cohort studies using data from the 1999–2006 and 2017–2018 National Health and Nutrition Examination Survey (NHANES). We utilized a multivariate Cox regression model to explore the relationship between serum vitamin A levels and all-cause mortality. Survival curves related to serum vitamin A were constructed using the Kaplan–Meier method. Additionally, the restricted cubic splines (RCS) method was applied to examine potential nonlinear relationships between serum vitamin A concentrations and all-cause mortality of NAFLD.Results: Over a median follow-up period of 10.3 years, a total of 1,399 all-cause deaths were recorded. The weighted average concentration of serum vitamin A was 61.48 ± 0.37 μg/dL. After adjusting for potential confounders, a significant U-shaped relationship was identified between serum vitamin A concentrations and the risk of all-cause mortality in NAFLD patients. This relationship was particularly pronounced in men and elderly individuals aged 60 to 85.Conclusion: Our study reveals a significant non-linear relationship between serum vitamin A concentrations and the risk of all-cause mortality in patients with NAFLD. These findings underscore the importance of monitoring and maintaining optimal serum vitamin A levels to potentially improve survival outcomes in NAFLD patients.

Cutaneous mucormycosis is a rare fungal infection marked by skin abscesses, swelling, necrosis, dry ulcers, and eschars. Though less fatal compared to other mucormycosis forms, delayed diagnosis and treatment in immunocompromised patients can cause the infection to spread to vital organs, becoming life-threatening. We report a case of lower extremity cutaneous mucormycosis secondary to acute myeloid leukemia, successfully managed with sustained surgical debridement and short-term oral posaconazole. This case highlights the effectiveness of surgical debridement and the potential for short-course antifungal therapy in managing cutaneous mucormycosis.

The rapid and effective identification of pathogens in patients with pulmonary infections has posed a persistent challenge in medicine, with conventional microbiological tests (CMTs) proving time-consuming and less sensitive, hindering early diagnosis of respiratory infections. While there has been some research on the clinical performance of targeted sequencing technologies, limited focus has been directed toward bronchoalveolar lavage fluid (BALF). This study primarily evaluates the pathogen detection capabilities of nanopore-targeted sequencing (NTS) in BALF, providing a comprehensive analysis. The retrospective study, spanning from January 2022 to November 2023, includes 223 patients exclusively sourced from a single center. We conducted a detailed comparative analysis among NTS, targeted next-generation sequencing (tNGS), and CMTs. Initially, we compared the detection capabilities of NTS and tNGS and found no significant differences in their sensitivity and specificity. Specifically, we observed that the sensitivity of NTS was significantly higher than that of CMTs (74.83% vs 33.11%, P < 0.001). Furthermore, NTS exhibited a higher positivity rate in common pulmonary infections (62.88% vs. 23.48%) and in clinically suspected tuberculosis patients compared to CMTs (87.18% vs. 48.72%). Additionally, NTS showed less susceptibility to antibiotic interference, indicating a more sensitive detection capability, especially in detecting fastidious organisms. It complements GeneXpert in tuberculosis diagnosis and offers excellent advantages in identifying pathogens challenging for CMTs, such as non-tuberculous mycobacteria and viruses. Moreover, NTS significantly shortens the reporting time and is only a quarter of the cost of metagenomic next-generation sequencing. Clearly, NTS can facilitate faster and more cost-effective early diagnosis of respiratory infections. IMPORTANCE: This study holds paramount significance in advancing the field of respiratory infection diagnostics. By assessing the pathogen detection capabilities in bronchoalveolar lavage fluid (BALF) of patients with pulmonary infections, we illuminate the promising potential of nanopore-targeted sequencing (NTS). The findings underscore NTS as a comparable yet distinct alternative to traditional methods like comprehensive conventional microbiological tests (CMTs). Notably, NTS demonstrates a pivotal edge, expanding the spectrum of identified pathogens, particularly excelling in the detection of challenging entities like non-tuberculous mycobacteria and viruses. The study also highlights the complementary role of NTS alongside GeneXpert in the identification of tuberculosis, providing a comprehensive overview of the diagnostic landscape for respiratory infections. This insight carries significant implications for clinicians seeking rapid, cost-effective, and accurate diagnostic tools in the realm of pulmonary infections.

Objective: Muscle mass gradually declines with advancing age, and as an anti-aging protein, klotho may be associated with muscle mass. This study aims to explore the relationship between klotho levels and muscle mass in the middle-aged population.Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011 to 2018, we conducted a cross-sectional analysis on a cohort of individuals aged 40–59. Weighted multivariable analysis was employed to assess the correlation between klotho and low muscle mass, with stratified and Restricted Cubic Spline (RCS) analyses.Results: The cross-sectional investigation revealed a significant negative correlation between klotho levels and the risk of low muscle mass (Model 3: OR = 0.807, 95% CI: 0.712–0.915). A notable interaction between klotho and sex was observed, with a significant interaction effect (P for interaction = 0.01). The risk association was notably higher in females. The risk association was notably higher in females. Additionally, RCS analysis unveiled a significant linear relationship between klotho and low muscle mass (P for nonlinear = 0.9495, P for overall<0.0001).Conclusion: Our observational analysis revealed a noteworthy inverse relationship between klotho and low muscle mass, particularly prominent among female participants. This discovery provides crucial insights for the development of more effective intervention strategies and offers a new direction for enhancing muscle quality in the middle-aged population.

Background: Type 2 diabetes mellitus (T2DM) is a well-known independent risk factor for non-alcoholic fatty liver disease (NAFLD). However, research exploring the association between blood glucose management and the risk of NAFLD status in subjects without diabetes was insufficient. This study aimed to explore the association of glycated hemoglobin (HbA1c) with NAFLD status and the severity of liver steatosis and fibrosis in non-diabetic people. Methods: A cross-sectional analysis was conducted on 2998 non-diabetic American adults using data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 cycle. We used multivariable logistic regression models to evaluate the association between HbA1c and NAFLD status and the severity of liver steatosis and fibrosis. Interaction and stratified analyses were additionally performed. Results: The multivariate regression analyses showed that HbA1c was associated independently with NAFLD status in all the models (model1: OR = 2.834, 95%CI: 2.321, 3.461; model 2: OR = 2.900, 95%CI: 2.312, 3.637 and model 3: OR = 1.664, 95%CI: 1.284, 2.156). We further performed the interaction and stratified analyses and discovered a significant interaction between HbA1c and BMI (P_interaction < 0.05). Finally, a robust link was shown between HbA1c level and the severity of liver steatosis, which was mainly significant in the prediabetes group, while the correlation was not significant in HbA1c level and severity of liver fibrosis after controlling for all the potential confounders. Conclusions: We concluded that HbA1c level was positively correlated to the risk of developing NAFLD in a large non-diabetic American population. Moreover, HbA1c level was associated with the severity of liver steatosis in subjects with prediabetes, suggesting that routine screening for HbA1c among individuals with prediabetes is necessary.