Abstract: Objective　To evaluate the value of bronchoalveolar lavage fluid Aspergillus-specific fluorescent PCR assay combined with galactomannan (GM) assay in the diagnosis of patients with non-neutropenic invasive pulmonary aspergillosis (IPA). Methods From March 2022 to December 2023, 113 hospitalized patients with clinically suspected IPA were selected from the Zibo First Hospital of Zibo City, Shandong Province. Bronchoalveolar lavage fluid samples from each patient were simultaneously subjected to potassium hydroxide microscopy, fungal culture, GM assay, and Aspergillus-specific fluorescence PCR assay. According to the diagnostic criteria of IPA, patients were divided into clinically diagnosed IPA and non-IPA groups. The values of these four methods for the diagnosis of IPA were compared. Results According to the diagnostic criteria for IPA, 37 out of the 113 suspected patients were clinically diagnosed as IPA. The proportion of diabetic patients was significantly higher in the IPA group compared to the non-IPA group (χ2=7.494, P=0.006); similarly, the proportion of patients using glucocorticoids was significantly higher in the IPA group (χ2=6.981, P=0.008). Patients in the IPA group more frequently showed cavitation within consolidation areas on imaging, which was statistically significant (χ2=15.603, P<0.001). There were significant differences in the sensitivity of the four fungal detection methods in the diagnosis of IPA (χ2=45.803, P<0.001), with Aspergillus-specific PCR assay showing the highest sensitivity at 94.59%. Specificity also varied significantly across the four methods (χ2=31.511, P<0.001), with the highest specificity being seen in potassium hydroxide microscopy and fungal culture at 100.00%. There were significant differences in the clinical coincidence rate of the four methods in the diagnosis of IPA (χ2=11.768, P=0.008), with Aspergillus-specific fluorescence PCR assay having the highest coincidence rate at 90.27%. The AUC of the ROC curve of Aspergillus-specific fluorescent PCR assay combined with the GM assay was 0.976 7, higher than 0.913 8 by Aspergillus-specific fluorescent PCR assay merely. Conclusions The combination of Aspergillus-specific fluorescent PCR assay and GM assay using bronchoalveolar lavage fluid could significantly improve the accuracy of IPA diagnosis in patients without neutropenia.

Objective To investigate the correlations of serum prealbumin and albumin with the shortterm outcome in patients with acute cerebral infarction in different age groups.Methods Patients with acute ischemic stroke admitted to hospital with 48 h were prospectively enrolled in the study.The modified Rankin Scale was used to assess the functional outcomes at 14 d after onset,0-2 was defined as a good outcome.According to the age of the patients,they were divided into either a young and middle-aged group (＜ 60 years) or an elderly group (≥60 years).The demography,baseline clinical data and laboratory findings of the patients were compared in the overall patients and the different age groups between the good outcome group and the poor outcome group.Multivariate logistic regression analysis was used to determine the independent influencing factors of short-term outcomes.Results A total of 622 patients with acute ischemic stroke were enrolled,including 402 (64.6％) males and 220 (35.4％) females;206 (33.1％) were in the young and middle-aged group,and 416 (66.9％) were in the elderly group;310 (49.8％) had good outcomes and 312 (50.2％) had poor outcomes.There were significant differences in the proportions of patients in male,old people,hyperlipidemia,diabetes mellitus,history of previous stroke or transient ischemic attack (TIA),as well as age,body mass index,levels of prealbumin,albumin,triglyceride,high-density lipoprotein cholesterol low-density lipoprotein cholesterol total bilirubin,direct bilirubin,indirect bilirubin,urea nitrogen,and uric acid between the good outcome group and the poor outcome group (all P ＜0.05).Multivariate logistic regression analysis showed that the female (odds ratio [OR] 1.522,95％ confidence interval [CI] 1.023-2.266;P =0.038),diabetes (OR 1.789,95％ CI 1.171-2.735;P =0.007) and higher low-density lipoprotein cholesterol (OR 1.251,95％ CI 1.017-1.539;P =0.034),total bilirubin (OR 1.054,95％ CI 1.029-1.081;P＜0.001),urea nitrogen (OR 1.245,95％ CI 1.100-1.409;P=0.001),and baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 2.854,95％ CI 1.027-3.628;P =0.019) were the independent risk factors for poor outcomes,and higher prealbumin (OR 0.798 95％ CI 0.633-0.979;P =0.034) and albumin (OR 0.741,95％ CI 0.693-0.988;P =0.020) were the independent predictors of good outcomes.In the young and middle-aged patients,there were significant differences in the proportions of patients with small artery occlusion as well as age,triglyceride,and high-density lipoprotein cholesterol levels between the good outcome group and the poor outcome group (all P ＜0.05);multivariate logistic regression analysis showed that diabetes (OR 2.343 95％ CI 1.127-4.871;P=0.023) and higher baseline NIHSS scores (OR 2.041,95％ CI 1.304-4.125;P =0.027) were the independent risk factors for poor outcome,and higher high-density lipoprotein cholesterol (OR 0.742 95％ CI 0.639-0.937;P =0.044)was an independent predictor for good outcome.In the elderly patients,there were significant differences in the proportions of patients in male,previous stroke or TIA,and cardiogenic embolism,as well as prealbumin,low-density lipoprotein cholesterol,total bilirubin,direct bilirubin,indirect bilirubin,and uric acid levels between the good outcome group and the poor outcome group (all P ＜ 0.05);multivariate logistic regression the analysis showed that diabetes (OR 2.797,95％ CI 1.153-4.756;P =0.039),higher baseline NIHSS score (OR 2.586,95％ CI 1.033-3.435;P =0.035) and higher low-density lipoprotein cholesterol (OR 1.304,95％ CI 1.027-1.656;P =0.029) were the independent risk factors for poor outcome,and higher prealbumin was an independent predictor for good outcome (OR 0.795,95％ CI 0.691-0.998;P =0.002).Conclusions Prealbumin and albumin are the independent predictors for short-term good outcome in patients with acute ischemic stroke.The protective effect of serum prealbumin is more obvious in the elderly population (≥60 years).