Immune dysfunction plays a pivotal role in the pathogenesis and progression of severe viral pneumonia.Both hyperactivated immune responses and immunosuppressive states may adversely affect clinical outcomes.Glucocorticoids,widely utilized as immunomodulatory agents,hold significant therapeutic value in managing this condition.Elucidating the intricate mechanisms underlying immune dysregulation in these patients,accurately assessing individualized immune profiles,and optimizing glucocorticoid regimens alongside other immunomodulatory interventions are critical to improving clini-cal success rates.This review synthesized current progress in research on immune disorders and glu-cocorticoid therapy in severe viral pneumonia,providing theoretical foundations for clinical practice to enhance patient prognosis.

Objective:To study the value of shear wave elastography (SWE) combined with contrast-enhanced ultrasound (CEUS) in diagnosing the invasiveness of papillary thyroid microcarcinoma (PTMC), and analyze its risk factors.Methods:This study included 200 patients with pathologically confirmed PTMC who underwent surgery in Fenyang Hospital from January 2019 and June 2021. All were diagnosed with SWE and CEUS before surgery. The value of the two methods in diagnosing the invasiveness of PTMC was explored. The patients′ data were collected to screen the risk factors for the invasiveness of PTMC.Results:It was pathologically confirmed that among the 200 patients with PTMC, there were 112 cases with malignant nodules, 88 cases with benign nodules, 75 cases with cervical lymph node metastasis (including 71 cases with capsular invasion) and 125 cases without lymph node metastasis. CEUS parameters of malignant nodules were significantly higher than those of benign nodules ( P<0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SWE combined with CEUS to diagnose capsular invasion were 94.66%, 85.60%, 89.00%, 79.77% and 96.39%, with high consistency with the pathological results ( Kappa>0.75). Multivariate Logistic regression analysis showed that multiple foci, irregular shape, breakthrough capsule and small calcification were independent risk factors for the invasiveness of PTMC (VIF<3). The ROC curve results showed that the AUC of SWE combined with CEUS to diagnose capsular invasion was 0.772, and the diagnostic sensitivity and specificity were 73.91% and 80.56%. Conclusions:SWE combined with CEUS can significantly improve the diagnostic accuracy for the invasiveness of PTMC.

Objective:To observe the effect of tracheotomy high-flow oxygen therapy (THFO) on the clinical efficacy of non-mechanically ventilated patients undergoing a tracheotomy.Methods:Sixty adult patients with tracheotomy and non-mechanical ventilation who were diagnosed and treated from January 2019 to December 2020 in Fenyang Hospital of Shanxi Province were enrolled. According to the random number table, the patients were divided into Venturi oxygen therapy group and THFO group, 30 cases in each group. The THFO group was given oxygen therapy with THFO; the Venturi group (without mask) was given Venturi connected the MR850 base and the ventilator tube. Observe the changes of two groups at 7 AM within 5 days, including body temperature which was 1 ℃ higher than the baseline, white blood cell count (WBC) which was 2×10 9/L higher than baseline, oxygenation index (PaO 2/FiO 2) < 300 mmHg (1 mmHg = 0.133 kPa), the occurrence of lower respiratory tract infections (based on radiography), and changes in sputum indexing and sputum formation. Results:Compared with the Venturi oxygen therapy group, the body temperature increased > 1 ℃, WBC increased by 2×10 9/L, PaO 2/FiO 2 < 300 mmHg, and the proportion of lower respiratory tract infection in THFO group decreased significantly [body temperature increased > 1 ℃: 10.0% (3/30) vs. 13.3% (4/30), WBC increased by 2×10 9/L: 10.0% (3/30) vs. 30.0% (9/30), PaO 2/FiO 2 < 300 mmHg: 3.3% (1/30) vs. 10.0% (3/30), the proportion of lower respiratory tract infection: 6.7% (2/30) vs. 13.3% (4/30), all P < 0.05]. The proportion of patients with sputum scab formation and sputum viscosity of Ⅰ degree were significantly increased [sputum scab formation: 16.7% (5/30) vs. 6.7% (2/30), sputum viscosity of Ⅰ degree: 30.0% (9/30) vs. 20.0% (6/30), both P < 0.05]. Conclusion:THFO during non-mechanical ventilation of adult patients with tracheotomy can maintain a higher oxygen partial pressure and ideally control the temperature and humidity of the inhaled gas, promote the discharge of sputum with degreeⅠ andⅡ viscosity, thereby reducing the tracheotomy complications such as lower respiratory tract infections.

Objective To investigate the effect of oxygen therapy with Venturi combined with MR850 heating humidifier on patients without mechanical ventilation after tracheotomy. Methods Eighty patients (≥ 18 years old) who had undergone tracheotomy and without mechanical ventilation admitted to Fenyang Hospital of Shanxi Province from June 2016 to December 2017 were enrolled, and they were divided into control group and observation group according to random number table method, with 40 patients in each group. The observation group was given Venturi (removed the mask) combined with MR850 device active warm and humid oxygen therapy; the control group was given one-off ordinary flow device and warm and humid exchanger (artificial nose, HME) passive humid oxygen therapy. Body temperature increased by 1 ℃ above basal body temperature, white blood cell count (WBC) increased 2×109/L than the base value, oxygenation index (PaO2/FiO2) < 300 mmHg (1 mmHg = 0.133 kPa), airway mucosal hemorrhage, pulmonary infection and sputum viscosity were observed in the two groups for 5 days after oxygen therapy. Results Among the 80 patients, there were 46 males and 34 females, with an average age of (67.7±12.2) years. Compared with the control group, the incidence of increased body temperature (5.0% vs. 20.0%), the incidence of increased WBC (7.5% vs. 35.0%), the incidence of low PaO2/FiO2(2.5% vs. 7.5%), the incidence of airway mucosal bleeding (5.0 % vs. 15.0%) and the incidence of pulmonary infection (2.5% vs. 10.0%) were significantly decreased in the observation group (all P < 0.01), and the proportion of sputum viscosity Ⅰ degree of patients was significantly increased (57.5% vs. 12.5%, P < 0.01). Conclusion Venturi combined with MR850 device can effectively control airway temperature and humidity, promote sputum dilution and conducive to drainage, reduce pulmonary infection in adults patients without mechanical ventilation after tracheotomy, thereby reducing postoperative complications of tracheotomy.

Objective To observe the differences in functional capacities generated by different simple breathing balloons extruded by different hand types and methods.Methods The lung functional measurement instrument was used to measure the generated functional capacities of two types of simple breathing balloon extruded by different hand methods: using big-, mid- and small-size hands with 5 fingers generally separately open and maximally extended states or with both small-size hands to extrude balloon; the effective generated gas quantity of the above methods were compared.Results ① Comparison between different balloons: the functional capacity generated by black rubber balloon extruded by any hand type was 68 - 132 mL lower than that generated by light blue silicon balloon. ② The comparison between different hand types: the functional capacities generated by any hand at maximally extended state in extruding balloon was 13 - 70 mL higher than that by hand commonly separate state; extrusion by a small size hand was nearly unable to reach 400 mL, while the functional capacity was 520 - 650 mL when the balloon was extruded by a big size hand, and 435 - 635 mL by a mid-size hand; it was necessary to use both small hands when the black rubber balloon was extruded, when the light blue silicon air bag was extruded, the functional capacity could reach 430 - 440 mL with a small size hand. ③ Difference in extruding methods: the functional capacity generated by either big size hand or mid-size hand with 5 fingers maximally extending state to extrude balloon was significantly higher than that with 5 fingers commonly separate state, the functional capacity generated by both small size hands with fingers maximally separating and extending state to extrude balloon was obviously higher than that generated by 5 fingers generally separating and extending state, the functional capacities generated by light blue silicon balloon were obviously higher than those by black rubber balloon, no matter the 5 fingers of big- or mid-size hand being at generally separating or extending state (mL: 623.00±21.11 vs. 522.00±41.85 by big size hand with common 5 fingers separate state, 649.00±26.01 vs. 575.00±58.55 by big sizehand with maximum 5 fingers extending state; 566.00±37.77 vs. 436.00±21.19 by mid-size hand with common 5 fingers separate state, 637.00±30.02 vs. 505.00±37.49 by mid-size hand with maximum 5 fingers extending state); the light blue silicon balloon extruded by small hand with 5 fingers at generally separate state and at maximally extending state could generate functional capacities (mL)432.00±13.02 and 444.00±37.18 respectively, significantly higher than those using the 2 types of hand state extruding a black rubber balloon (the tidal volume < 400 mL), the functional capacities generated by both small hands extruding a light blue silicon balloon was obviously higher than that by using a black rubber balloon (mL: 557.00±54.98 vs. 489.00±40.12, allP < 0.05).Conclusions Different functional capacities will be generated by different hand sizes, different hand extruding methods and types of simple breathing balloon, clinical application should be based on patients' body weights to decide their tidal volumes, and combined with the rescuers' hand sizes and types of simple breathing balloon to choose a proper extruding method for a certain patient, thus sufficient oxygen can be surely provided in time for him/her and rescue successful rate can be elevated.