Due to lack of the practical application guidelines for Interferon-Gamma Release Assays (IGRAs), the testing result of IGRAs may be misinterpreted in clinical practice in China. Therefore, we clarify some important issues related to IGRAs based on the available evidences in this review. The available data reveals that IGRAs can be used to assist the diagnosis of Latent TB Infection (LTBI) and combined with HIV infection; while for the definite diagnosis and therapeutic monitoring of active TB have no value. In addition, IGRAs showed no better performance than TST in low income countries. It should make practical guidelines to TB diagnostic tools and further strengthen the training and guide for the clinicians the low income countries, so as to more scientifically manage TB.

The increasing prevalence of obesity has lead to an increase in the prevalence of sleep disordered breathing in the general population. Obesity is a serious disorder resulting in significant health impairment. Obese adults are at increased risk of morbidity and mortality from acute and chronic medical conditions. Obesity is associated with anatomic alterations that predispose to upper airway obstruction during sleep. Obesity and sleep related breathing disorders occur to a particular subgroup that includes obese patients with hypoventilation correlated with Hypercapnic-OSA (obstructive sleep apnea), Hypercapnic-OSA with OHS (hypoventilation syndrome) and OHS without OSA.

OHS is a disease entity distinct from simple obesity and OSA. OSA is a common disorder. Obesity and particularly central adiposity are potent risk factors for OSA. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system–acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue.

The OHS is characterized by the combination of obesity (BMI>30 kg/m2 ), daytime awake hypercapnia and hypoxemia , in the presence of sleep-disordered breathing without other known causes of hypoventilation, such as severe obstructive or restrictive parenchymal lung disease, kyphoscoliosis, severe hypothyroidism, neuromuscular disease, and congenital central hypoventilation syndrome. It is estimated that 90% of patients with OHS also have OSA. Patients with OSA typically have normal control of breathing and obesity is not a necessary condition; patients with OHS are morbidly obese, have hypoventilation during wakefulness with increased arterial PCO2 and decreased arterial PO2 , as well as nocturnal hypoventilation. The gold standard for the diagnosis is monitored polysomnography during sleep. In stable hypercapnic patients therapeutic choice will depend on two factors: underlying diagnosis (presence or absence of OSA) and severity of hypercapnia.

A 62 year old female patient with mild intermittent asthma was seen in the pulmonary clinic with a history of a productive cough for two years. She had required multiple courses of antibiotics over the past year. She underwent a CT scan of the chest which showed central bronchiectasis and multiple discrete diverticula projecting posteriorly from the membranous trachea measuring up to 2.3 x 1.7 x 1.7 cm.  The diverticula involved nearly the entire course of the trachea (Figure 1). A bronchoscopy was performed which showed tracheal pouches and indentations (Figure 2). There were no prior scans and therefore it is unclear for how long she had the diverticula. Her symptoms improved with antibiotics and she remains relatively well with chest physiotherapy and bronchial hygiene.

A 36 year-old man with previous biliary surgery due to pancreatitis with pseudo cyst formation five years earlier, had one week of right upper-quadrant pain. Although the pain was pleuritic, he had no respiratory symptoms and a normal chest radiograph.

Although very rare, nocardiosis is considered as an important opportunistic infection, especially in immunocompromised patients with long-term corticosteroid use or organ transplantation. Lung and skin involvements are frequent, but primary soft-tissue nocardiosis is very rare. Herein, we described a 48 year-old Chinese man with a primary soft-tissue nocardial abscess caused by multidrug-resistant nocardia asteroides, which was sensitive only to imipenem and resistant to trimethoprim-sulfamethoxazole and other antibiotics like amikacin and vancomycin.An initial treatment with a combination of surgical drainage and imipenem was conducted, but a secondary severe pneumonia was complicated two weeks later. Then, the antimicrobial regimen was shifted to sulbactam sodium/cefoperazone and itraconazole injection for the severe pneumonia. For nocardiosis, drainage was continued and minocycline was administered instead of imipenem for maintenance therapy for 9 months. Eventually, the patient recovered well from the primary soft-tissue nocardial abscess and the secondary severe pneumonia. To our knowledge, this is the first case with a combination of primary softtissue nocardial abscess, multidrug-resistant nocardia asteroides and complication of severe pneumonia.