Objective:To analyze the clinical features, risk factors and prognosis of IPA combined with lung infection, aiming to further improve clinicians' understanding and diagnosis and treatment of it.Methods:Patients with IPA admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to October 2021 were retrospectively enrolled, and their clinical data was collected from the electronic medical record, including demographic information, clinical characteristics, biochemical indicators, auxiliary examination, microbial data and prognostic indicators. Patients were divided into two groups of IPA with pulmonary infection and IPA alone, and the clinical features, risk factors and prognosis of IPA patients with pulmonary infection were compared and analyzed in comparison with IPA patients alone.Results:A total of 156 IPA patients were finally recruited, with an average age of (67.12±12.89) years old and a main male proportion of 69.20%. Among them, there were 86 cases (55.13%) with IPA with pulmonary infection and 70 cases (44.87%) with IPA alone. Half of the IPA patients with pulmonary infection were mixed with one pathogen. The main pathogen of mixed infection was bacteria (82.72%), whereas acinetobacter baumannii accounted for the most common pathogen(25.93%, 42/162). Multivariate logistic regression analysis found that mechanical ventilation ( OR 4.89, 95% CI 2.23-10.70) and prior neutropenia ( OR 6.41, 95% CI 1.33-30.93) were independent risk factors for the occurrence of IPA with pulmonary infection. Compared with IPA alone, IPA patients with pulmonary infection were more likely to develop septic shock(69.80% vs. 32.90%, P <0.05), and have longer lengthes of hospital stay [16.00(8.00,36.50) vs.13.50 (7.00,20.50)] and ICU stay[11.50(6.00,31.25) vs.8.50(1.75,11.00)], and mechanical ventilation days [12.00(6.75, 25.25) vs.8.00(2.00,10.00)], as well as a higher 28-day mortality (55.80% vs.35.70%) and in-hospital mortality (64.00% vs. 35.70%). Conclusions:IPA patients with pulmonary infection accounts for more than half of IPA patients. The main respiratory etiology of IPA with pulmonary infection is acinetobacter baumannii. The independent risk factors of IPA patients with pulmonary infection are mechanical ventilation and neutropenia. The prognosis of IPA patients with pulmonary infection is worse than patients with IPA alone, which is worthy for the attention of physicians.

Blood stasis is an important pathological factor throughout the whole course of radiation-induced pulmonary fibrosis， which could evolve from new into long stagnation， and the methods of dispelling stasis to promote regeneration should throughout the whole disease progress. It is believed that the basis of the radiation-induced pulmonary fibrosis is heat toxin dispersing qi and yin， and deficiency of healthy qi promoting blood stasis. The process of the disease showed latent fire burning pulmonary collaterals， and the binding of phlegm and stasis. The key factors of the disease were the damage of ying-wei （营卫） qi in channels and collaterals， as well as the blood stasis evolving into dried blood. It is suggested that during radiotherapy， we should pay more attention to relieve heat， moisten dryness， supplement qi and yin， nourish and harmonize blood， and remove blood stasis， so as to prevent disease before it arises. If there is radiation pneumonia， we could focus on dissolving phlegm， removing blood stasis， clearing latent fire， and unblocking the collaterals and veins， in order to "control the development of existing disease". If it develops into radiation-induced pulmonary fibrosis， we could relive the center and supplement deficiency， tonify original qi， dispel stasis to promote regeneration， and clear dried blood， for the purpose of slowing the progression of disease. These ideas might provide reference for clinical treatment.

Objective To explore the effect of controlled low central venous pressure(CLCVP)on venous congestion and postoperative acute kidney injury(AKI)in cardiac surgery under cardiopulmonary bypass(CPB).Methods A total of 137 patients scheduled for elective cardiac surgery under general anes-thesia with CPB were selected,including 73 males and 64 females,aged 18 to 70 years,with a BMI of 20 to 28 kg/m2,and ASA physical status Ⅱ or Ⅲ.The patients were randomly assigned into two groups:the controlled low central venous pressure group(group CL,n=68)and the control group(group C,n=69).In group CL,CLCVP was applied by pumping nitroglycerin to reduce CVP to below 10 mmHg after 20 minutes of CPB cessation until the end of surgery.If necessary,norepinephrine was applied to maintain MAP≥65 mmHg.Patients in group C received standardized anesthesia management.Urine samples were collected before anesthesia induction and 12 hours postoperatively to detect the concentration of kidney injury molecule-1(KIM-1).Urine samples were also collected before anesthesia induction and 2 hours postopera-tively to detect the concentration of neutrophil gelatinase-associated lipocalin(NGAL).Cumulative time a-bove 10,12,16,and 20 mmHg and time-weighted average CVP were used to assess venous congestion.The occurrence of postoperative AKI,stage 2 or above AKI,renal replacement therapy(CRRT),postoperative low cardiac output syndrome(LCOS),acute kidney injury following cardiac surgery(AKICS)score when arriving in ICU,in-hospital mortality,ICU stay,and postoperative hospital stay were recorded.Results Compared with group C,the cumulative time of CVP above 10,12,16,and 20 mmHg after CPB in group CL was significantly shorter,and the time-weighted average CVP was significantly lower(P＜0.05).AKI occurred in 9 patients(13.2%)in group CL and 15 patients(21.7%)in group C postoperatively,and there was no significant difference between the two groups.One case(1.5%)of stage 2 or above AKI oc-curred in group CL and 2 patients(2.9%)in group C,with one patient in group C requiring CRRT.Com-pared with group C,the concentrations of KIM-1 at 12 hours postoperatively and NGAL at 2 hours postoper-atively were significantly lower in group CL(P＜0.05).There were no statistically significant differences between the two groups in LCOS,AKICS score,in-hospital mortality,ICU stay,and postoperative hospital stay.Conclusion Controlled low central venous pressure in cardiac surgery under cardiopulmonary bypass can reduce venous congestion and decrease the occurrence of postoperative renal injury,thereby exerting a certain renal protective effect.