Avian influenza H10N3 is a type of avian influenza virus that can occasionally infect humans and cause severe pneumonia and acute respiratory distress syndrome (ARDS). On December 25, 2024, a 23-year-old obese female patient with H10N3 avian influenza complicated with severe ARDS was admitted to the Fourth People's Hospital of Nanning. The patient was transferred to our department due to "fever, cough, and shortness of breath for 13 days". Physical examination revealed moist rales in bilateral lungs. Chest imaging showed large areas of ground-glass opacity and consolidation in both lungs. Based on the patient's medical history, clinical manifestations, and laboratory findings, she was diagnosed with human infection of H10N3 avian influenza, severe pneumonia, and severe ARDS. Supported by mechanical ventilation and extracorporeal membrane oxygenation (ECMO), daily monitoring of airway peak pressure, plateau pressure (Pplat), driving pressure (ΔP), and lung compliance was performed to guide the adjustment of tidal volume (VT) and positive end-expiratory pressure (PEEP) during invasive mechanical ventilation. Medications including anti-avian influenza virus agents, antibacterial drugs, and antifungals were administered. Eventually, the patient's condition improved gradually, and she was successfully weaned from ECMO. No ventilator-induced lung injury (VILI) or multiple organ dysfunction syndrome (MODS) related to ARDS occurred during ECMO support. However, during the final stage of ventilator weaning after the restoration of spontaneous breathing, a right pneumothorax occurred. Closed thoracic drainage was performed, after which the ventilator was successfully discontinued. The patient was successfully transferred out of the intensive care unit (ICU), recovered fully, and was discharged from the hospital. In the invasive mechanical ventilation management of patients infected with H10N3 avian influenza complicated by ARDS, monitoring airway peak pressure, Pplat, ΔP, and assessing pulmonary compliance may facilitate more standardized management of such ARDS patients and help reduce VILI.
Humans ; Female ; Influenza, Human/complications* ; Respiratory Distress Syndrome/complications* ; Respiration, Artificial/methods* ; Obesity/complications* ; Young Adult ; Extracorporeal Membrane Oxygenation ; Influenza A virus

Objective:To discuss the effective of artesunate in the treatment of coronavirus disease 2019 (COVID-19).Methods:Using prospective method, the 43 cases of confirmed COVID-19 patients in Nanning Fourth People's Hospital from January 22nd to February 15th in 2020 were enrolled and divided into routine treatment group ( n = 25) and artesunate treatment group ( n = 18) by odd-even rule after admission. According to the guidelines, the routine treatment group was recommended to receive lopinavir/ritonavir 500 mg + α-aerosolized interferon 500×10 4 U, twice daily; the artesunate treatment group was given artesunate 60 mg, twice daily besides the routine treatment, for 10 days in both groups. During the treatment period, the pharynx swab test of 2019 novel coronavirus (2019-nCoV) nucleic acid was carried out every 2 days, and the routine blood test, liver and kidney functions, blood coagulation function and myocardial enzymes were re-examined. Chest CT was checked every 3 days after the treatment, and re-examined every 5 days after the condition was improved. The routine blood test and biochemical results of two groups were observed, and the efficacy evaluation was performed by monitoring the time for significant improvement of symptoms, negative conversion time of throat swab virus nucleic acid, lung lesion absorption time, adverse drug reactions and the length of hospital stay of the two groups. Results:There were no significant differences between the two groups in terms of gender, age, body weight, routine blood test and biochemical results before treatment. In artesunate treatment group, the time for significant improvement of symptoms (days: 3.33±1.91 vs. 4.84±2.19), negative conversion time of 2019-nCoV nucleic acid (days: 4.72±2.16 vs. 6.68±3.76), lung lesion absorption starting time (days: 5.39±2.36 vs. 7.48±3.78), lung lesion absorption greater than 70% time (days: 14.11±4.16 vs. 17.04±4.42) and the length of hospital stay (days: 16.56±3.71 vs. 18.04±3.97) were significantly shorter than those in routine treatment group, with significant differences (all P < 0.05). The incidence of adverse drug reactions in two groups had no significant difference (72.2% vs. 80.0%, P > 0.05). Conclusion:Artesunate can shorten the treatment time of COVID-19, improve prognosis and eliminate pathogens, with fewer adverse reactions and a good application prospect.

Objective: To observe the plaque surface morphology and neo-vascularization within the plaque using superb microvascular imaging(SMI)and contrast-enhanced ultrasound(CEUS), and to compare the correlation and consistency of the two technologies based on making clinical diagnosis of symptomatic carotid artery plaque as the standard. Methods: A total of 92 patients undergoing carotid ultrasonography in Beijing Tiantan Hospital from August 2016 to October 2017 were recruited, including 61 males and 31 females, aged(63.5 ± 7.7)years(range, 42-80 years.A total of 105 plaques were found.According to whether or not to have plaque-induced ipsilateral ischemic symptoms, patients were divided double-blindly into the symptom group and the non-symptom group.The features of plaque(including surface morphology and neo-vascularization)were recorded.The ultrasonographic findings were chi-squarely tested. Results: There were statistically significant differences in the surface morphology and enhancement degree of CEUS between carotid artery plaque-induced ischemic symptom group and the non-symptom group(χ²=6.865, P=0.032; χ²=22.494, P<0.001). The SMI-detected surface morphology and neo-vascularization had statistically significant differences between the two groups(χ²=10.367, P=0.006; χ²=8.186, P=0.041). The correlations of plaque surface morphology(r=0.856, P<0.001)and diagnostic consistency(r=0.802, P<0.001)between SMI and CEUS were higher.In the symptom group, SMI-showed plaque fissures and small surface pitting were in 33.9%(20/59)of patients, and CEUS-showed plaque fissures and small surface pitting were in 25.4%(15/59)of patients.And SMI had a better detection rate of slight and irregular appearances on plaque surface.Taking the first grade of the plaque surface as the standard, CEUS showed a sensitivity of 42.4% and specificity of 80.4% for detecting symptomatic plaques, and SMI showed a sensitivity of 54.2% and specificity of 76.1%.The two methods had similar specificity, and SMI had a slightly higher sensitivity than did CEUS.CEUS and SMI had a good correlation of plaque neo-vascularization(r=0.802, P<0.001)and a moderate diagnostic consistency(r=0.539, P<0.001). Taking the enhancement level of 2 as the standard, CEUS showed a sensitivity of 75.8% and specificity of 67.4% for detecting the symptomatic plaque, and SMI showed a sensitivity of 58.6% and specificity of 69.5%.The two methods had similar specificity, and CEUS had a higher sensitivity than did SMI. Conclusions SMI and CEUS have a good consistency for detecting plaque surface morphology.SMI and CEUS are more correlated with plaque-induced symptoms than is two-dimensional ultrasound.The SMI has a higher display rate and repeatability than does CEUS for detecting the small fissures and the surface features of plaques.Compared with SMI-detected neo-vascularization, the degree of CEUS enhancement is more correlated with the symptoms.The specificity of CEUS and SMI is similar, and the sensitivity of CEUS is higher than that of SMI.