Background: Patients with pulmonary tuberculosis (PTB) have a high risk of concomitant tracheobronchial tuberculosis (TBTB), which commonly causes severe complications such as tracheobronchial stenosis. The prevalence and predictors of TBTB in China remain unclear due to the lack of prospective and large-scale studies. Objectives: To investigate the incidence of TBTB in PTB patients in southern China, and elucidate the predictors of TBTB and related tracheobronchial stenosis. Methods: We prospectively performed bronchoscopy in PTB patients to diagnose TBTB at four medical centres in southern China from September 2015 to August 2016. Clinical and epidemiological data were recorded and analysed to determine predictors of TBTB and related tracheobronchial stenosis. Results: A total of 345 (23.9%) of the 1,442 PTB patients undergoing bronchoscopy were diagnosed with TBTB. Female sex (OR 2.53), age < 50 years (OR 1.88), living in urban (OR 2.19), diabetes (OR 1.84), coughing (OR 2.61), and symptoms ≥4 weeks (OR 1.66) were predictors of PTB concomitant with TBTB. About 59.7% TBTB patients developed tracheobronchial stenosis, of which 23.3% cases presented severe airway narrowing. Female sex (OR 2.27), age < 50 years (OR 2.11), shortness of breath (OR 1.97), and symptoms ≥4 weeks (OR 1.71) were predictors of TBTB-related tracheobronchial stenosis. Conclusions: About 23.9% of PTB patients undergoing bronchoscopy present with TBTB in Guangdong province, southern China. Young and middle-aged females with symptoms persisting for ≥4 weeks (the main predictors of TBTB and related tracheobronchial stenosis) should receive bronchoscopy immediately when diagnosed with PTB.

BackgroundPD-1 checkpoint inhibitors have shown a robust tumor response in the treatment of various cancers. Pembrolizumab is an anti-PD-1 checkpoint antibody approved for the treatment of unresectable or metastatic melanoma in more than 40 countries. Although autoimmune pneumonitis is considered a common immune-related adverse event of PD-1 inhibitors, only limited studies have assessed the development of opportunistic infections such as pulmonary tuberculosis (TB).Case presentationA patient with metastatic melanoma whose pulmonary TB was activated after administration of pembrolizumab for melanoma is reported. Anti-TB drugs were administered, followed by pembrolizumab (2 mg/kg, repeated every 28 days), which successfully cured the TB and achieved complete response for melanoma.ConclusionActivated pulmonary TB was observed during the administration of pembrolizumab. It was safe and effective in the current patient to combine anti-TB drugs and PD-1 inhibitors. More importantly, screening pulmonary TB before administration of PD-1 inhibitors is recommended.

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An empirically based analysis of propagation characteristics in two vegetated suburban areas with different types and fractions of vegetation cover in 5G millimeter-wave bands is presented. A basic distance-dependent path loss model with a Gaussian random variance for shadow fading is utilized in accordance with the maximum-power directional and omnidirectional measurement data, therein exploiting significant path loss exponents in the presence of vegetation. In comparison with the existing ITU-R and 3GPP models, the effect of dense-leaved trees on path loss prediction is similar to that of buildings, whereas these standard models are inapplicable for sparse obstacle-line-of-sight (OLoS) links. Consequently, an azimuth-angle-based path loss characterization is proposed considering the antenna pattern, beam misalignment, and blockage effects. Moreover, several composite and cluster-level small-scale channel parameters, such as the number of clusters, delay spread, and angular spread, are extracted. Analysis of the first-arrival cluster in the OLoS setting reveals that forward scattering through foliage is still dominant and is expected to produce a larger azimuth angular spread of the arrival and compact multipath components in the time domain compared with line-of-sight and reflected clusters. Measurement results improve existing 3GPP channel models for suburban macrocell scenarios in millimeter-wave bands.

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An empirically based analysis of propagation characteristics in two vegetated suburban areas with different types and fractions of vegetation cover in 5G millimeter-wave bands is presented. A basic distance-dependent path loss model with a Gaussian random variance for shadow fading is utilized in accordance with the maximum-power directional and omnidirectional measurement data, therein exploiting significant path loss exponents in the presence of vegetation. In comparison with the existing ITU-R and 3GPP models, the effect of dense-leaved trees on path loss prediction is similar to that of buildings, whereas these standard models are inapplicable for sparse obstacle-lineof-sight (OLoS) links. Consequently, an azimuth-angle-based path loss characterization is proposed considering the antenna pattern, beam misalignment, and blockage effects. Moreover, several composite and cluster-level small-scale channel parameters, such as the number of clusters, delay spread, and angular spread, are extracted. Analysis of the first-arrival cluster in the OLoS setting reveals that forward scattering through foliage is still dominant and is expected to produce a larger azimuth angular spread of the arrival and compact multipath components in the time domain compared with line-of-sight and reflected clusters. Measurement results improve existing 3GPP channel models for suburban macrocell scenarios in millimeter-wave bands.

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